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 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 neces sary, 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 fol lowing 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 capsule, 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.

Note whether it is distended, the thickness of the walls, appearance of the mucous membrane, etc. In medicolegal cases, draw off the water, and put it in a clean jar. The bladder may be removed alone, or with the rectum, uterus, and ovaries; in the latter case, by dividing all the structures on the floor of the pelvis close to the levator ani muscle.

If the urethra is to be removed with the bladder, a portion of the pubes may be divided, and by proper incisions, and division of the penis, the latter, the urethra and bladder can be removed together.

The prostate gland and vesiculæ seminales may also be examined.

THE TESTICLE.-To open this organ, make a single incision in a perpendicular direction from its free to its attached border, the parts being then forcibly separated. The spermatic cord and penis may also be examined at this time.

THE UTERUS.-In private practice, this organ is not usually removed-unless absolutely necessary-on ac count of the vagina offering an outlet for the escape of fluids. If it should be removed, the vagina must afterwards be closed up. Note the size, position, consistence, etc., of the organ, and the appearance of the mucous membrane.

The VAGINA, FALLOPIAN TUBES, OVARIES, RECTUM, etc., may also be examined in this connection.

THE DUODENUM, LIVER, GALL BLADDER, ETC.--The order of sequence at this stage should be as follows: first open the duodenum in situ, determine its contents above and below the papilla biliaris, which should be gently squeezed; and by pressure on the gall-bladder determine the presence of obstacles to the flow of bile and the presence of gall-stones. Sit up the ductus com

munis choledochus, examine the vena cava, and remove the liver, taking care not to wound the right supra-renal capsule. Examine the external surface of the liver, make sections of it, and note the appearance of the acini, veins, and ducts. The hepatic may be distinguished from the portal vein by the pad of cellular tissue around the latter, in which run the artery and duct. The ligaments should be divided and the liver should be removed as the last stage but one of the abdominal examination. To remove it at an earlier period would be to wound the large veins and the diaphragm, the small omentum, the vena portæ, gall-duct, etc., besides interfering with the detection of obliterations of the vena portæ, defects in the perviousness of the ductus communis choledochus and of the cystic and hepatic ducts. If the thorax has already been opened, a portion of the diaphragm may be removed with the liver. The vena cava must be divided above and below, but the blood from it may interfere with any further abdominal dissection. Next open the gall-bladder and examine its

contents.

THE STOMACH-This organ may be opened in situ at the same time as the duodenum, by continuing the incision, except in cases of suspected poisoning. The spleen may be readily separated from it.

In a medico legal case requiring removal of the stomach. and its contents, tie the oesophagus and divide it above the ligature, before removing the lungs, etc. Then tie the duodenum and remove the stomach. Cut one of the ligatures and pour the contents carefully into a clean glass jar. Take all possible care by labelling and locking them up to see that no mistake is made as to the right jar and that they cannot be tampered with. They should never be allowed to go out of the physician's possession except personally into the hands of a chemist. Open the

stomach by carrying a pair of scissors along the lesser curvature. Note the thickness of the walls, their condition, and the appearance of the mucous membrane, taking care not to misinterpret the rugæ.

THE PANCREAS AND SEMILUNAR GANGLIA should next be examined. Any change in size, consistence, etc., should be noted; after which the mesentery, with its glands, vessels, etc., should receive the operator's attention.

THE INTESTINES.-These should be examined last, as, even with the greatest care, the operator, the instruments and receptacles, the subject, and the table are liable to be soiled. If there be valid reason for haste, they can be removed without injury to the other parts, except in the case of the duodenum, its removal being impossible without cutting through the excretory ducts of the liver and pancreas which open into it, and even wounding a portion of the pancreas.

If the intestines must be removed, place two ligatures at the commencement of the jejunum and the rectum and divide the bowel between them. Separate the large intestine throughout from its attachments, turn it over to the right side; do the same with the small intestines, and, taking the mesentery in the left hand, isolate them from their connections. Open them on the side that is attached to the mesentery.

In examining the intestines, note the state of the walls, the condition of the mucous membrane, particularly as regards inflammation, ulceration (how deep), perforation, the appearance of Peyer's patches, the mesenteric glands,

etc.

The examination of the retro-peritoneal lymphatic glands, receptaculum chyli, aorta, and vena cava inferior, will complete the abdominal investigation.