10. Pathologic Lesions. Anomalies, defects, erosions, ulcers, evidences of trauma, inflammations, abscesses, tubercles, gummata, neoplasms, parasites, and all forms of pathologic changes, local or general, must be accurately located and described. The changes peculiar to certain diseases and infections must always be borne in mind during the examination of any organ in which such conditions are likely to be found. The relationship of lesions in different parts of the body must be recognized. Localized lesions must be described according to position, size, form, color, consistence, etc. Their nature must be recognized, their relation to other or to pre-existing conditions determined, the stage of the process estimated, and the part played in the causation of death ascertained.
In the examination of the body-cavities and hollow organs, as well as pathologic hollow structures, the first thing to note is the escape of gas or air under pressure. Occasionally it is best to open the organ under water to note the escape of bubbles. The odor of the gas, inflammability, etc., are to be noted. The fluid or solid contents (blood, bile, urine, féces, mucus, pus, exudates and transudates, altered secretions, food-remains, concretions, foreign bodies, parasites, etc.) are described as to their amount, color, consistence, odor, reaction, chemical nature, precipitate, presence of cellular elements, etc. The size of the cavity, monolocular or multilocular, the character of its lining (transparency, translucency, cloudiness or opacity, color, “shine,” moisture, smoothness, roughness, villous or polypoid, consistence, thickening, swelling, elevations, atrophy, incrustations or deposits on the lining, etc.) are to be considered. In the case of cystic tumors (adenocystomata, dermoid cysts, cholesteatomata, etc.) especial attention should be paid to the character of the cyst-contents (mucoid, glairy, colloid, jelly-like, pea-soup-like, pultaceous, mushy, doughy, caseous, pearly, laminated, flaky, powdery, etc.).
CHAPTER IV.
THE EXTERNAL EXAMINATION.
THE BEGINNING OF THE AUTOPSY. The autopsy begins with the examination of the exterior of the body. The cadaver should be completely stripped of clothing and examined as a whole, then as to its separate parts. Time is saved and omissions prevented if a definite order is followed in the external examination, such as follows here.
1. Identification of the Body. In ordinary cases the name of the deceased will be given upon the autopsy-permit, and this will serve as sufficient identification. In large autopsy-services, when several cadavers may be brought in at the same time, each one should be properly tagged so that no mistake is possible. It is necessary in medicolegal cases to make a more formal identification by having the cadaver positively identified by persons having knowledge of the individual during life, or by those who first saw the body, or who took it in charge. In such cases when identification is impossible at the time of autopsy the protocol should give in full details the place, time, and conditions of discovery of the body, with an accurate description of its external characteristics, clothing, articles found on the body, surroundings, etc. Bertillon measurements and finger-markings may be taken; dental work should be carefully described; false teeth and hair, eyeglasses, etc., should be preserved, and the most careful attention should be paid to bodily anomalies or peculiarities, birth-marks, tattoo, etc. Photographs, casts, Roentgengrams, etc., may be taken. Powder-marks, blood-stains, as well as those of semen and other discharges, should be described and, if necessary, preserved. Legal names, as well as aliases, should be recorded and attested in all cases of legal significance. In fact, the only proper way to conduct any autopsy is with the assumption that the results will have legal value; and such an assumption is the best safeguard against important omissions.
2. Sex. This should always be mentioned in the protocol. In the case of pseudohermaphrodism the determination of the real sex may be difficult and may eventually be decided by microscopic studies. Likewise in bodies that have been burned or mutilated the question of sex becomes a matter of anatomic and histologic study. The character of the bones, pelvis, remains of sexual organs, etc., are used as criteria to decide the question. In cases of burning, the uterus in the female and the prostate in the male may often be recognized microscopically when the head and extremities are burned off and only a charred mass of flesh and bone remains.
3. Age. When the true age is not known the apparent age must be estimated by considering the general appearance of the body, development, bones, epiphyses, sutures, blood-vessels, skin, hair, teeth, sexual organs, etc. Roentgengrams of the epiphyses, hands and feet may be made. The presence of an arcus senilis should be noted. Arteriosclerosis of the temporal and radial arteries may be determined by inspection and palpation. The determination of the age of the new-born will be considered in a later chapter.
4. Nationality. When not definitely known this may be estimated by such criteria as color of skin, finger-nails, character of hair, facies (cheek-bones, jaw, forehead, cephalic index, facial angle, eyes, etc.), hands, feet, general build, etc. For ethnologic and anthropologic data the body may be described according to the primitive type it represents (Australioid, negroid, mongoloid, xanthochroic, melanchroic, Iberian, dolichocephalic, etc., according to the different classifications).
5. Status. Unmarried, married, widow, widower, divorced, legal status, citizen of what country, state, county or town, etc.
6. Occupation. As this often throws light upon the pathologic condition present in the body, the trade or occupation should be ascertained and stated in the protocol. When no direct information is available a judgment concerning it may be made on the basis of certain conditions, occupation or industrial diseases found in the body (anthracosis, argyrosis, siderosis, silicosis, chalicosis, lead-poisoning, chronic phosphorus poisoning, nitrobenzol and other forms of poisoning, localized muscle-hypertrophy or atrophy, callus, etc.).