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tinued as before. The heart may now be removed, taking care to cut all the vessels rather long. The sufficiency of the aortic and pulmonary valves may now be tested by pouring water into these vessels. For this purpose the heart must be suspended by the vessel the valves of which are the subject of the test. It is important that the suspension is made in such a manner as to preserve as far as possible the circular form of the artery. This may be done either by passing a number of sutures through its walls or by grasping its walls with the fingers of both hands in such a manner as to preserve its shape. No lateral traction should be made. The real efficiency of the water test may be called in question, for it may be doubted whether the integrity of the valves may not be better determined by inspection and touch. The ventricles may now be fully opened for the purpose of examining the flaps of the auriculo-ventricular valves, the endocardium, and other structures in the interior of the heart. (Fig. 3.) The incision for the right ventricle (Fig. 2) is made by entering a pair of scissors into the previous incision and carrying it toward the pulmonary artery, avoiding the anterior papillary muscle by passing in front of it. The incision for the left ventricle (Fig. 3) is made in a straight line, prolonged from the aorta, close to the septum. This incision must not cross the pulmonary orifice, as it will if carried too close to the septum, nor must it cut that portion of the mitral valve which is attached to the left border of the aorta by going too far to the left. The incision should pass midway between the pulmonary orifice and the left auricle.

The examination of the heart being completed, the lungs may now be removed. This is done by seizing each lung in turn, lifting it up, and dividing the vessels at the base. The bronchi should now be opened with a pair of scissors, and examined for foreign bodies and morbid appearances, commencing with the primary bronchi and following them up to their subdivisions as far as necessary. The lung tissue itself is to be examined, by means of long incisions made with sweeping strokes of the knife, from apex to base, on the posterior aspect. The cut surfaces may then be inspected, and any fluid contained in the lung tissue or smaller bronchi expressed by passing the edge of the knife at right angles over the surface of the incision. Blood, pus, mucus, or serum may thus be squeezed out and examined. The presence of sanguinolent mucus in the air-tubes is significant.

The abdominal viscera are now to be dissected. In cases of gunshot wound of the abdomen, the intestines should be examined first; but in other cases it is best to leave them to the last, for the sake of cleanliness. Where it is necessary to search the intestinal canal for perforations resulting from gunshot wounds, it is best to do this in a methodical manner. The search may commence with the sigmoid flexure and rectum, thence extending to the three divisions of the colon, the intestines being passed through the fingers until the duodenum is reached. The location of all wounds, their number, and especially their position with regard to the wound in the parietes, are to be noted. In order to search for the bullet, it will be usually necessary to remove the intestines. This may be best accomplished by first ligaturing the gut both at the rectal and gastric ends with a double ligature, and then commencing at the rectum, dividing the mesentery until the whole intestine is freed from its attachments to the posterior abdominal wall. Further search for the missile may now be made, after the abdominal cavity has been thoroughly

cleansed. In cases not involving perforating wounds of the intestine, it is usual to examine the abdominal viscera in the following order: first, the omentum, which may be inspected for miliary tubercle or carcinoma; second, the spleen; third, the kidneys, suprarenal capsules, and ureters; fourth, the sexual apparatus; fifth, the stomach and duodenum; sixth, the liver, gall-bladder, bile-ducts, and portal veins; lastly, the structures in the posterior portion of the abdomen, such as the abdominal aorta, the receptaculum chyli, lymphatics, etc.

As a rule, the spleen possesses no special interest to the medico-legal examiner. It is often ruptured as a result of violence. Its pulp softens very early as a result of putrefaction. The kidneys may be removed by separating the peritoneum from them and dividing the vessels and ureter. The capsule is then to be stripped off; if adherent, this is to be noted. The pelvis may be inspected for calculi. An incision is then to be made in the convex border of the organ, right down to the pelvis, laying the kidney open in two equal parts. The cortical and medullary portions may then be inspected for evidences of disease. This should never be omitted. In cases where narcotic poisoning is suspected, the examination of the renal organs ought to be as exact and complete as possible. In late autopsies the naked-eye appearances are perhaps of more value than the deductions of a microscopic examination, for the conclusions which can reasonably be drawn from microscopic findings after the changes of commencing putrefaction have set in are untrustworthy. It may, however, be quite possible still to appreciate a change in the proportion of the cortical and medullary portions of the kidney, which would indicate the existence of a previous chronic disease. It is not usually necessary to remove the bladder for examination. It is sufficient, after drawing the urine with a catheter, to make an incision into the upper surface of the viscus and examine it in situ. The urine should be preserved for future examination, particularly in cases of poisoning. It is important to examine the bladder walls for injury, especially in cases where fracture of the pelvis exists. To determine whether there is any perforating wound, the viscus may be filled with water or air through the urethra, before opening. It may be necessary to remove the entire bladder for purposes of examination, in which case care should be taken not to wound the bladder wall-something which it is not difficult to do in careless manipulation. It is not often that a further examination of the male genitourinary organs will be required; but if this should become necessary, the penis may be stripped out of the skin, cut off at the glans, and drawn out like a finger from a glove. It may then be removed with the bladder attached. A pair of scissors curved on the flat facilitate the necessary dissection.

The inspection of the female organs of generation within the pelvis is often of great importance, especially in cases of criminal abortion. The ovaries are to be inspected for the corpora lutea of pregnancy, which are to be distinguished from the false corpora lutea of menstruation. The pelvic tissues are to be examined for evidences of old or recent inflammation. The uterus will, of course, receive particular attention in a certain class of cases. Its size should be noted, also the depth of its cavity, the condition of the os and cervix, the thickness of its walls. If any discharge is present, either in the cavity of the uterus or vagina, this will be of importance. The condition of the uterine sinuses and endometrium

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should receive attention, also the Fallopian tubes. The orifice of the tubes will not admit anything larger than a bristle, as a rule, and this can be passed most easily, after the uterus has been laid open so as to expose the cornua. The entrance to the Fallopian tube will be found in the apex each cornu. In cases of abortion where death has occurred within a few days, the uterus must also be examined for signs of injury, as perforations, which would indicate the use of a pointed instrument-not necessarily, however, in the hands of another than the woman herself. The writer knew of two women, one of whom was accustomed to produce an abortion on herself by the aid of a lead-pencil, and the other used an umbrella wire for the same purpose, at last inflicting a fatal injury. The size of the uterus is of some importance in determining the period of pregnancy, where this has existed. The normal unimpregnated uterus measures two and a half inches in length, one and three quarters inches in breadth, and one inch thick. For further measurements as indicative of the period of pregnancy, the reader is referred to the appropriate chapter. In examining the uterus where death has taken place shortly after confinement, the observer ought not to forget that the site of the placenta presents appearances which may be mistaken for inflammation or even gangrene. The presence of pus, the condition of the uterine sinuses, the coexistence of peritonitis, and the presence of septic microorganisms, possibly the streptococcus pyogenes, will make the distinction clear. One or all of these conditions will be found in acute inflammations of the uterus. The ovaries are usually involved in the morbid process, and will be found to be congested, swollen, and, where the disease has been of sufficient duration and acuteness, infiltrations and local abscesses may exist.

The examination of the stomach and duodenum is of special importance in cases of suspected poisoning. As the preservation of the contents is of prime importance, in order that this may be done without even the possibility of contamination, it is recommended that the stomach and duodenum be ligatured separately with double ligatures, and placed in new glass jars with glass tops, previously well washed in distilled water. The jars should then be sealed and at once sent to the analytical chemist. The examiner is to inspect the interior of both stomach and duodenum after the chemist has transferred their contents to suitable and wellwashed vessels. It is better not to make this transfer in a room where chemicals are kept. The stomach may then be opened along its greater curvature, and its interior examined. This is a method which involves some extra trouble; but as the contents of these organs are not removed until they reach the laboratory which is their final destination, there is one less manipulation to call in question, and the risk of possible contamination is consequently lessened. Nor is such a precaution needless. Any one who is conversant with the refinements of modern chemistry and the history of past trials for poisoning will admit that any proceeding is proper which will limit the suspicions which a clever defense, aided by a friendly chemist, is able to cast on any chemical analysis, no matter how skillfully conducted. If the viscera have to be sent to a distance, another consideration must be taken account of, however, which is the cloud which putrefactive changes occurring in transit may cast on the analysis, by the production of ptomaïnes. This will occur particularly where the chemical analysis results in the discovery of some form of

alkaloidal poison, especially morphine. The Buchanan trial may be cited as an instance of the confusion in the expert chemical testimony which the presence of ptomaïnes occasioned. Indeed, in this case it may well be questioned whether the accused was not fairly entitled to the doubt which was raised when Professor Vaughan showed the similarity which existed between the reactions of morphine and indol. Certainly on the testimony alone of the chemists for the prosecution, the State was not entitled to a conviction. Where putrefactive changes are liable to occur in transit, it is better to transfer the contents of the stomach and duodenum to separate vessels. The viscera can then be immediately examined. With regard to the inspection of the mucous membrane of the stomach, it is to be remembered that post-mortem digestion commences at from twenty-four to thirty-six hours after death, causing softening and disintegration of the mucous membrane. This process is most active in the pouch of the greater curvature of the stomach, which may serve to distinguish this form of softening from that caused by disease. Occasionally when death takes place immediately after a full meal, during active digestion, the action of the gastric juice has produced a perforation of the stomach. Ulcers of the stomach occur, as a rule, at the pyloric end near the lesser curvature, although they may be found anywhere. They frequently have an indurated margin.

The examination of the liver is frequently of the utmost importance in medico-legal cases, as, for instance, to determine the existence of the changes which this organ undergoes as a result of certain poisons. So, too, in cases of death by extreme violence the autopsy may reveal extensive lacerations of the substance, even where the external signs of violence were absent. The liver may be removed for examination by first dividing the diaphragm on either side as far as the spinal column, then severing the lateral ligaments, the broad ligaments, after which it may be turned into the thorax, the vessels and coronary ligament divided, and the organ removed. If it seem necessary, the bile-duct must be examined previous to removal. For the purpose of inspecting the parenchyma, sweeping incisions may be made in the substance of the organ with the long knife. After the removal of the liver, it is possible to examine the posterior surface of the abdominal wall. The receptaculum chyli and lymphatic may be inspected with a view of determining, in certain cases, the relation of the time of death to the ingestion of food.

In the foregoing description of the method of conducting an autopsy, nothing has been said of the propriety of weighing the solid viscera. The utility of ascertaining their weight is doubtful, as this may vary within quite wide limits. Any conclusions based on the evidence of the scales ought for this reason to be accepted with caution. For the purpose of comparison, however, the following table is appended:

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