Forceps: several sizes, large and small, mouse-toothed. Costotome: heavy bone-shears for cutting the ribs.

A powerful bone-cutter, with short blades, 5 cm. long, set at an angle of about 45° to the handles, which are 36 cm. in length, is employed for dividing the arches of the cervical vertebræ and for other purposes where ordinary bone-cutters will not do.

A chisel with 2 cm. cutting edge, for exposing the marrow of the long bones, removing portions of the base of the skull, etc.

A hatchet-chisel of steel for starting the calvaria and spinous processes after sawing the skull and the vertebral column. Soft-iron hammer with wooden handle.

Steel hammer with wedge end, and blunt hook on the handle.

Holder for the head while sawing the skull.

Autopsy-needles, long and a little curved.

Probes of flexible metal; also fine glass probes for small blood-vessels or ducts.

Grooved director.

Pans for holding water, organs, etc.

Boards, square or oblong, 30 X 30 or 30 X 50 cm., on which to lay instruments or cut organs.

Sponges.

Catheters.

Strong hemp twine is the best for sewing up the body.

Glass graduates for measuring fluids.

A block of wood with shallow depression for the neck; for use while opening the head.

Vise.

Small cup or dish for removing fluid from cavities.

General Rules.-The room for an autopsy should be well lighted, otherwise the finer changes in the tissues cannot be recognized. Artificial illumination is not good, because the colors of the tissues are entirely changed by the yellowness of the light.

Before beginning an autopsy the necessary instruments

should be arranged on a short board on the autopsy-table in the order in which they are most likely to be used.

The operator stands on the right side of the body. This position he rarely leaves except for some definite purpose; for example, in opening the skull he stands at the head.

Order and cleanliness are the first points to be insisted upon at every autopsy. Clean water should always be at hand for washing the instruments and for keeping the hands free from blood and pus. The cut surface of an organ should not be washed with water except to remove blood; gently scrape the surface with the knife held obliquely.

In cutting, the knife should be drawn, not pressed or shoved into the tissues. According to Virchow, a broad, clean cut into an organ, even if incorrectly made, is much better than several short cuts which leave a ragged surface.

The autopsy-knife should be grasped in the hand as if to cut bread. In using this knife the main movement should be from the shoulder, not from the wrist as in dissecting. It goes without saying that the sharper the knife the better.

In cutting the brain and cord, especially if their consistency is lessened, moisten the knife to prevent the tissue from sticking and tearing.

Before beginning an autopsy it is important to know the main points in the clinical history of the case, as they may greatly lighten the work of investigation by calling attention to those organs that require special examination.

The record of an autopsy should be dictated by the operator as he proceeds with the examination of the case, and should be as nearly as possible an objective description of the appearances found. Only the anatomical diagnosis should express the opinion of the operator. If it is not convenient to dictate the autopsy during its performance, the description of the lesions certainly ought to be made with the organs in sight, and not from memory after the lapse of hours or even days, when many of the details may be forgotten. Later, the results of the bacteriological and histological examinations should be added to the autopsy report, so as to make the case complete.

Rubber gloves are sometimes worn to protect the hands while making a post-mortem examination; but they greatly dull the sense of touch, and cannot be recommended for routine work except while opening the stomach and intestines. Rubber cots for the fingers are often useful.

For cuts on the fingers use celloidin dissolved in equal parts of alcohol and ether, instead of flexible collodion, because the latter will not stick. A cut received during an autopsy should immediately be washed thoroughly, and then sucked so that the blood will flow freely. For protection during the rest of the autopsy use a rubber glove or cover the cut with celloidin.

It is always well to wash the hands after an autopsy with an antiseptic solution, such as corrosive sublimate (1: 2000). For removing odors from the hands turpentine will often be found serviceable, or a saturated solution of permanganate of potassium followed by oxalic acid. Orth highly recommends a dilute solution of formaldehyde for this purpose.

Suggestions to Beginners. In a case of general miliary tuberculosis the older focus from which the organisms have spread must always be found. Look especially for tubercular thrombi in the pulmonary veins as the frequent source of the general infection.

In a case of embolism hunt for the thrombus, bearing in mind, however, that the whole of a thrombus may become free and form an embolus. An arterial embolus may be due to a venous thrombus, in which case it must have passed through an open foramen ovale, except in the case of thrombi of the pulmonary veins.

In acute peritonitis always seek for a source of infection (appendix, female genitals, gastro-intestinal tract, etc.). It cannot always be found.

In hemorrhage from the stomach associated with cirrhosis of the liver look for rupture of dilated esophageal veins. In cases of more or less sudden death, especially if preceded by signs of asphyxia, always examine the pulmonary artery in situ for possible emboli. In cases of instantaneous death examine the coronary arteries.

Private autopsies must often be made under many disadvantages, and, when out of town, not infrequently in a short space of time. It is always important to warn the attending physician not to allow the undertaker to inject the body before the autopsy, because the color and consistency of the organs are so changed by most injecting fluids that it is difficult to recognize the pathological processes. If there is danger of post-mortem changes, have the body packed in ice.

A regular autopsy-bag will be found very convenient for carrying to private autopsies. It is made of black leather lined with rubber, and measures about 40 X 18 X 20 cm. Loose within it is carried a rubber bag 40 X 24 X 20 cm., shaped like a short envelope with a flap (22 cm. long) on one side, for bringing away any organs that demand further examination. The case of instruments should contain one or two autopsy-knives, two scalpels, a pair of forceps, one or two pairs of scissors, an enterotome, a steel hammer with wedgeend and with a blunt hook on the handle, a small chisel, a saw with detachable handle and back, an autopsy-needle, and a probe; free within the bag should be carried a spool of strong twine, a costotome, a long slender knife for use in removing the brain, a hammer with soft iron head, and a sponge. In rare cases additional instruments may be required. A white duck apron for personal use will always be found convenient. It is also well to carry along several blood-serum tubes and a platinum needle for making cultures at the autopsy. When there is a lesion of the nervous system it is advisable to bring a jar of a 4 per cent. solution of formaldehyde and to place the tissue in the fluid at the autopsy, as otherwise it is not easily gotten to the laboratory in good condition.

At the house can always be obtained a slop-pail, a washbowl, a pitcher of water, several newspapers, and an old sheet. The body is usually on an undertaker's frame, but it may be in an ice-box or on the bed. The examination of the chest and abdomen can be made in any of these positions. If, however, the body is in an ice-box, it must be

raised to the level of the top of the box in case it is necessary to open the head.

The clothing on the body can be removed, or, if only a shirt or a night-dress, is best slit down the middle and turned out over the arms. Tear the sheet into four equal pieces. Fold and tuck in one piece on each side of the trunk and neck, allowing the outer portion to fall over the arms. Fold and lay the third piece on the lower extremities, tucking the upper end beneath the clothing below the pubes. The fourth piece can be placed beneath the head if it is to be opened. This procedure leaves the front of the thorax and abdomen free for operation and protects the rest of the body and the clothing. On the thighs place one or two folded newspapers, and on these the necessary instruments. On the legs place the bowl containing only a dampened sponge. If the undertaker has not put a rubber sheet on the floor beneath the body and on the side where the operator is to stand, newspapers should be spread to protect the carpet. Place the slop-pail on the rubber sheet within convenient reach. Having thus made all arrangements, even to the threading of his needle, the operator is ready to begin.

If the cord and brain have to be examined as well as the body, it is best to do the cord first, so as to avoid the leakage that might otherwise occur from the trunk-cavities if they had been opened first. To support the head while opening it, use a stick of wood, a brick, or, in case of necessity, the instrument-box wrapped in a newspaper.

At a private autopsy cleanliness is extremely important. If there is no undertaker or nurse present, the operator himself must see that everything is cleaned and put in order before leaving, that all the blood-stains are removed from the dishes, and that all papers and soiled cloths are burned or rolled up and left in a neat bundle for the undertaker to dispose of. Ground coffee thrown on a shovelful of burning coals will be found an excellent deodorizer for the room after the autopsy.