POST-MORTEM EXAMINATION.
Having completed the examination of the surroundings, one next proceeds with the post-mortem examination, which should be conducted according to a well-defined plan, following which the results obtained will always be satisfactory.
If possible the body should be removed to a large, well-ventilated, and especially well-lighted room. No artificial light, if it can possibly be avoided, should be used when performing the autopsy; artificial light is especially bad on account of its yellowness and its power to modify natural color. Many diseased conditions cannot be satisfactorily determined by artificial light. The body should be placed on a high table, and the facility with which the autopsy is made will often depend on having the table high enough to render stooping unnecessary. Never make an autopsy, if it can possibly be avoided, on a body while in a coffin, as the examination is always unsatisfactory. The size and surroundings of the room, and how it is lighted, should be entered in the note-book.
Instruments.—If possible the following instruments should be at hand before proceeding with an examination, although some of them may be dispensed with:
(1) Large section knife; (2) scalpels; (3) enterotome (for opening intestines and stomach); (4) costotome, or large bone forceps (for cutting ribs); (5) scissors, large and small (one blade blunt); (6) saw; (7) chisel; (8) dissecting forceps; (9) probe; (10) blowpipe; (11) curved needles and strong twine; (12) measuring and graduated glass; (13) small scales.
Besides the above instruments, some basins containing water; sponges, bottle of flexible collodion, Lugol’s solution of iodine for the amyloid test, will be needed.
Post-Mortem Wounds.—Various plans have been proposed to protect the operator’s hands from the post-mortem wounds which are often so dangerous, such as wearing rubber gloves, smearing the hands with carbolized vaselin, both of which have their disadvantages: the gloves being too clumsy, and the vaselin rendering it almost impossible to hold the knife steady. Gloves should always be worn, however, where the body has undergone much decomposition, or where the person may have died from any septic disease. A method which I have found satisfactory is to cover all cuts and hangnails with flexible collodion, and then to have a basin of clean water at hand, and from time to time to rinse one’s hands in the water. It is from bathing the hands in the cadaveric fluids and not from cuts that most of the danger comes. If possible an absolutely new board, large enough upon which to examine the organs, should be at hand, for it may be claimed at a trial that the organs and tissues, if placed and examined on surrounding objects, have become contaminated.
Toxicological.—If a chemical analysis of the various organs and tissues is to be made, and it is impossible to have the chemist present, the medical examiner should obtain some new glass jars of suitable size, with close-fitting glass covers. These jars should be rinsed with distilled water, and in them the various organs are to be placed; if possible with no preserving fluid on them. But if it is found impossible to deliver the jars to the chemist at once, alcohol may be poured over the organs in the jars, but it is specially important that a sample of this alcohol should be retained, that a chemist may at a future date test the same for any impurities. After the organs and tissues have been placed in the jars, the mouths should be closed and sealed, and the seal remain in the custody of the examiner until the jars are delivered to the chemist.
Parts to be Preserved for the Chemist.—In cases of suspected poisoning, it is not sufficient that the stomach and intestines alone should be preserved for the chemist as has been indicated, each part by itself; for it should be remembered that the portion of poison remaining in the alimentary tract is but the residue of the dose which had been sufficient to destroy life, and if the processes of elimination have been rapid no trace of the poison will be found in the alimentary canal but can readily be detected in other organs. Again, the poison may not have been introduced by the mouth, in which case none may be found in the digestive tract.
The chemist should receive, besides the stomach and entire intestinal canal, the liver, one or both kidneys, the spleen, a piece of muscle from the leg, the brain, and any urine found in the bladder.
When it is impossible for any reason to obtain the whole of any organ, the part removed should be carefully weighed and its proportion to the rest of the organ noted.
It is also of extreme importance to preserve in sealed and labelled jars those parts of a body which may show the evidence of disease, or on the appearance of which one’s evidence is founded.