INTERNAL EXAMINATION.
Having completed the examination of the external parts of the body, the next proceeding is to open the body and make an internal examination.
This should be done by following a regular method, so as to examine the relations of parts and not to injure one organ while removing another.
In opening the various organs an incision should be made which will expose the greatest amount of surface at one cut. Never make a number of small and always unsatisfactory incisions in an organ. In opening certain organs like the brain and heart, the incisions are so planned that the parts of the organ may be folded together, and, if necessary, their relations to one another and the whole organ studied. Such organs are opened as one would open a book to examine its pages.
It is important to remember that after death the blood leaves the arteries and left side of the heart, and collects in the veins and the right cavities of the heart. Especially does it collect in the vessels of the most dependent portions of the body and of the various organs, so that local congestions may often disappear after death; and again, they may be found at an autopsy where they were not present during life. Especially is this true of the mucous membranes such as those of the trachea and bronchi, and also of the blood in the sinuses of the dura mater.
In making autopsies it is a cardinal rule that all the cavities of the body should be examined, and not alone the one where one might expect to find a lesion. At medico-legal autopsies, the great cavities—the head, the thorax, and the abdomen—should be examined in their successive order from above downward. The reason for beginning with the head is that the amount of blood in the brain and its membranes may be determined accurately; for, if the heart and great vessels of the neck are opened first, the blood will drain away from the brain and local congestions disappear. In pathological autopsies, the opening of the head first is not so important, and often the vertebral column need not be opened at all, for it is a complicated process and takes time; but in medico-legal cases, especially where a question as to the cause of death may arise, and has not satisfactorily been determined, after all the other cavities are examined the vertebral column should always be opened and the cord removed.