Pathological technique

Introduction.-The method of making post-mortem examinations as originally taught by Virchow has been variously modified in its details by his pupils and followers. We have endeavored, while following in general his plan, to select those modifications that have proved simplést and of greatest value. In certain instances we have not hesitated to adopt, or at least to call attention to, useful methods of procedure originating in the Rokitansky school of pathology, as now best exemplified by Chiari.

The problem offered by an autopsy is often solved in part or wholly by the macroscopic post-mortem examination. More frequently, however, the complete and final solution is reached only after careful bacteriological and histological study. The post-mortem examination may, therefore, be looked upon as the beginning of the solution of the problem. Its particular function is to demonstrate in the individual case all congenital or acquired abnormalities, all macroscopic lesions, and to explain all gross mechanical questions. It furnishes the material for bacteriological and histological study. Perfectly to accomplish its purpose a post-mortem examination must be made in a careful, systematic manner.

While a general method of procedure is advisable, it will often be found advantageous, or even necessary, to depart

from it. According to Orth, "the chief requisite of every exact post-mortem examination is this, that no part shall be displaced from its position until its relations to the surrounding parts are established, and that no part shall be taken out by whose removal the further examination of other parts is affected."

The order and method of procedure in making a postmortem examination, including the various incisions, may be said to have been planned for the routine examination of normal or diffusely diseased organs. As soon as a noticeable focal lesion is present the order of procedure and the customary method of removal and of incision must be so altered as best to display the lesion.

Instruments.-The following instruments will be found extremely useful in the autopsy-room, although not all of them are necessary:

The autopsy-table should be large, so as to accommodate on it the instruments and several dishes in addition to the body. It should have a slightly raised edge, and should slope gently toward an opening in the center for the escape of fluids. The table is best made of zinc, and along one edge should have a centimeter scale. The water for use on the table is best supplied by a rubber tube from an overhead pipe reaching to within 60 to 100 cm. of the table.

The scales for weighing the various organs should have a large pan and gram and kilogram weights.

A band-saw will be found very useful for sawing bones for the inspection of the marrow, and for calcified and osseous

tumors.

The best autopsy-knife is a stout, broad-bladed knife with bellied edge and heavy handle. The blade should measure about 12 cm. in length and 3 cm. in width; the handle should be 12 cm. in length. Many operators prefer a somewhat smaller knife than this.

Amputating-knives of different sizes are useful for long, deep cuts into organs and tumors.

A myelotome is a short, thin, narrow knife-blade, 1.4 cm. long and 4 mm. wide, set obliquely on a slender steel stalk

ending in a wooden handle (Fig. 2). It is used only for cutting the cord squarely across in removing the brain.

FIG. 1.-Instruments for use in the autopsy-room: a, saw; b, holder for the head; c, steel hammer with wedge end and blunt hook on the handle; d, costotome; e, bone-cutter; f, hatchet-chisel; g, autopsy-knife.

Cartilage-knives and scalpels of different sizes are used for a variety of purposes.

Scissors, both straight and curved, should be of various

sizes. A medium-sized and a fine pair should each have one probe-pointed blade.

An enterotome is a long, straight pair of scissors, of which

FIG. 2.-Myelotome.

one blade is longer than the other and blunt at the extremity (Fig. 3). A hook at the end is not advisable. The instrument is used in opening the heart and the intestines.

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FIG. 3.-Enterotome.

A saw with movable back and rounded end will be found the most generally useful for opening the skull and the

spinal canal. An ordinary meat-saw is preferred by some, but cannot be used on the vertebræ.

Luer's double rachiotome, or adjustable double saw (Fig. 4), is very useful in removing the cord, and is the safest instrument to put into the hands of beginners.

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