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should be cut into to see whether the blood be still in the vessels or effused into the tissues. Blood may even coagulate in a post-mortem cut. The skin may be dis colored by Addison's disease, yellow fever, etc.1

9. Anomalies of all kinds, as cicatrices (from buboes, chancres, wounds), tattooed spots, herniæ, etc.; deficiency of members; ulcers, dirt or fecal matter on the body, abrasions, wounds, etc., even down to the slightest mark of a cord around the neck or other part, or even the trace of a ring having been worn.

10. Abrasions, Wounds, etc.-If blood from them be on the person, it should be so stated. The size, exact posi tion (measured), and nature of the wounds, etc., should be noted, whether incised, lacerated, contused, etc. Their direction and depth must be stated and compared with any instruments found anywhere that might be supposed to be the means of violence. Their internal lesions and connections must be investigated at a later stage of the examination.

11. Take up each region separately, and examine the hair, teeth, mouth, as to its contents of foreign body, fæces, etc.; tongue, as to the presence of acids, alkalies, etc.; nose, its condition, presence of foreign bodies, etc.; eyes, as to anomalies, color of iris, etc.; vagina, rectum, etc., for foreign bodies; generative organs, groins, etc., for evidence of anomalies and disease.

In very young children and fœtuses, other points must be examined, as the fontanelles, diameters of the head, which vary at different months; the eyes for the mem brana capsulo-pupillaris, which disappears at the seventh

1 Under the subject of Internal Examination (p. 318) will be found further remarks on coloration, etc.

2 Casper gives a case in which a body was disinterred in order to see whether a ring had been worn, so that identity might be established.

month; the nails; ossification of various bones; the scrotum, for the presence or absence of the testicles,1 etc.

Internal Examination.

Usually we examine only the thorax, abdomen, and pelvis; the head and spine, if necessary. In medicolegal cases the examination should begin where we suspect the cause of death, and thence extend to other parts. If the subject be an infant and viable, the abdomen is first to be opened, to ascertain the position of the diaphragm.

The operator should not omit a single part, or his testimony may be impugned, either as a medical witness, if he reports the case, or as a legal one, and this omitted part might be assumed as the seat of the cause of death.

Protect the hands, before making the internal examination, with oil and soap. This diminishes the probability of absorption of matter, but has the disadvantage of rendering the holding of instruments more difficult.2

During the fifth or sixth month the testicle descends to the iliac fossa; seventh month enters the inguinal canal; at end of eighth month passes into the scrotum.

2 At the outset of the internal examination, it may be well, for the sake of reference, that the practitioner should be reminded of the

Average Weight of the Various Organs.*

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* Tabulated from Quain and Sharpey's Anatomy, iu Heath's Manual of Minor Surgery, etc.; Phila. 1875, p. 288.

Incisions.-Short quick cuts are not to be made in autopsies, as in ordinary dissections, as they are tedious. and cause too much division of the larger organs; while free incisions, possibly involving the whole of the organ, save time and give increased insight and clearness. The knife-handle should be grasped in the palm, the blade appearing as a direct prolongation of the arm when stretched, the cutting movements being made with the whole arın. The right arm must be free, and the elbow raised quite away from the trunk, so that the flexed forearm may be moved freely, and in any direction. backwards or forwards, making it easy to divide the integuments of the trunk by a single long incision from the chin to the symphysis pubis, or to display the lung from apex to base in two halves. Incisions should not completely separate the portions of an organ, so that we may restore the connection of parts, in case re-examination be necessary.

Order of Examination.-The abdomen must be opened -but not dissected-before the thorax, to ascertain the position of the diaphragm and various organs, abnormal abdominal contents or adhesions, penetrating wounds, foreign bodies, color of exposed parts, etc. Note also how much fat is present in the subcutaneous areolar

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tissue. The position of the diaphragm is important for establishment of the respiration test in the new-born. The thorax must be dissected first, lest by removal of the liver, stomach, etc., and division of the abdominal vessels, a collapsed and emptied condition of the right side. of the heart may result. The stomach may, however, be at once removed in cases of suspected poisoning. If the thorax be opened first, and the anterior attachments of the diaphragm divided, the general and relative position of the abdominal viscera, thus displaced, and their rela tion to injuries of the abdominal walls, cannot be readily determined. Peritonitis might exist; it would be a nice point to determine whether it is due to traumatic causes or a pathological process in one of the abdominal viscera.

Coloration and Condition of Vessels.—It is a fallacy that arterial blood and arterial vessels are distinguishable by their deep-red or bright-red color, and that in a dead body arterial injection can be recognized by the color test. In the veins or plexuses formed by venous radicles, venous blood may absorb oxygen, and venous hyperæmia thus assume the appearance of arterial injection. The coloration, which has really occurred from exposure during the dissection, after opening the abdomen, for example, might be mistaken for inflammation or irritation. The color must be determined at the moment of opening the abdominal cavity, before the oxygen of the atmosphere has had time to affect it.

True capillary injection cannot be recognized by the naked eye; it is red tissue, not red capillaries, that is seen, and what is generally called hyperemia is usually only veins. The venous or arterial character of a vessel cannot be determined by the quality of the blood contained in it, but by its structure, connections, and position; in puzzling cases the course of the vessel must be followed

to a point at which its size becomes a sufficient guide. Note the quantity of blood in a vessel, the kind of vessel, the degree of fulness (as profuse, slight, bloodless, etc.). Manipulation, as of the intestines, etc., diminishes the quantity of contained blood, and of gaseous, fluid, and solid matters.


The reasons for opening-not dissecting the abdomen before examining the thorax, are stated elsewhere (p. 317). To open the thorax and abdomen, a free incision should be made from the chin to the pubes, along the middle of the sternum and down to that bone, through the skin to the umbilicus, passing around the latter. Then by deepening the incision from the lower portion of the sternum, open the peritoneal cavity for an inch or two, introduce the first and second fingers of the left hand, with which to hold up the abdominal wall, passing the knife between them, with its back to the intestines, and cutting through the whole thickness of the muscles at once down to the pubes. Then dissect off the skin and pectoral muscles from the sternum and costal cartilages.

The knife must be carried through the sterno-clavicular articulation on each side, by introducing it downwards and outwards at a point close to the inner end of the clavicle; then divide all the costal cartilages as close to their ribs as practicable, bearing in mind that the cartilage of the first rib is further from the median line. In older persons, the cartilages may be somewhat calcified. Lift up the inferior end of the sternum and divide the attachment of the diaphragm and the cellular tissue, and remove the sternum, with the pleura partially detached, exposing the lungs to view. In this operation, and while making the incision through the first rib and the articulation,

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