When permission to open the body by means of the usual main-incision cannot be obtained, it is possible to remove the thoracic and abdominal organs through the vagina or rectum. The cadaver is placed on its back, with buttocks near the end of the table, the thighs separated as widely as possible and flexed upon the body. In the male the scrotum is drawn up out of the way. A circular perineal incision is then made, beginning anteriorly at the perineoscrotal junction and extending around the anus. The arm may be introduced through this opening after the removal of the rectum and the abdominal and thoracic organs pulled downward and removed. In the female the uterus and vagina are removed through the vaginal opening; the arm is then introduced and the abdominal and thoracic organs removed.
II. POINTS TO BE NOTED IN THE EXAMINATION OF THE PELVIS.
I. MALE PELVIS. 1. Penis. Size, anomalies, condition, character of prepuce, evidence of circumcision, presence of smegma, character of meatus, discharge, wounds, scars (on and back of corona), evidence of syphilis, neoplasms, etc. Postmortem priapism occurs particularly in leukæmia. It may be caused also by traumatic or infective thrombosis and hæmorrhage, tumor-metastases, inflammatory infiltrations, and in death from hanging. The most important pathologic conditions of the penis are: inflammations (balanitis, posthitis, cavernitis, gonorrhœa, etc.), gangrene, phimosis, paraphimosis, præputial concretions, soft chancre, hard chancre, secondary syphilides, traumatic lesions (fracture, hæmorrhage, urine-infiltrations, etc.), anomalies (hypospadias, epispadias, etc.), tuberculosis (rare), condylomata, elephantiasis, cornu cutaneum, carcinoma, sarcoma (rare; melanotic sarcoma the most common form), secondary carcinoma (primary in prostate), lipoma, angioma and teratoma.
2. Scrotum. The most important pathologic conditions of the scrotum are: œdema, inflammation, gangrene, trauma, burns, elephantiasis, carcinoma, melanotic sarcoma, lipoma, fibroma, myofibroma, lymphangioma and teratoma.
3. Testis and Epididymis. Testis and epididymis weigh 15-30 grms. Note size, form and consistence. Normal color of cut-surface is grayish yellow; becomes brown in atrophy. Note character of tunics (color, lustre, smoothness, consistence, etc.), and contents of sacs (hydrocele, hæmatocele, empyema, etc.). The most important conditions affecting the testes are: inflammation (orchitis, epididymitis, vaginitis, abscess, hæmatogenous inflammations in pyemia, mumps, scarlet fever, typhoid fever, variola, chronic fibroid orchitis in syphilis, gonorrhœal epididymitis), tuberculosis, gonorrhœa, syphilis, actinomycosis, leprosy, leukæmic infiltrations, atrophy, compensatory hypertrophy, cryptorchidism, hydrocele, varicocele, spermatocele, cysts, malignant teratomata (syncytioma, cysts, cystocarcinoma, adenocarcinoma, adenoma, adenosarcoma, cystosarcoma, rhabdomyosarcoma, chondroma, osteoma, myxoma, etc.), carcinoma, sarcoma, lipoma, fibroma, etc., metastatic sarcoma and carcinoma, dermoid cysts, benign teratoma, parasites (echinococcus is rare). Tuberculosis is most common in the epididymis; syphilis more frequently affects the body of the testis. Torsion of the vas deferens may occur; atrophy of the testis may result. Twisting or thrombosis of the spermatic vessels may cause gangrene of the testicle.
4. Rectum. Note contents (amount, color, consistence, odor, etc.), color and character of mucosa (normally grayish red or reddish gray, smooth and translucent, solitary follicles just visible). Normally the rectum should contain formed brownish féces; in catarrh the contents are fluid and not formed, while the mucosa is covered with a thick glassy mucus. In obstruction of the gall-ducts the féces are gray (“clay-color”). In catarrhs and chronic passive congestion the mucosa is red. Decubital ulcers are often green from the imbibition of bile, and are surrounded by hæmorrhages. They are circular or correspond in shape to the fécal mass pressing upon them. Traumatic ulcers, hæmorrhages, diphtheritic inflammation, follicular ulcers, foreign bodies, stricture, fécal impaction, hæmorrhoids, fissures, fistulous tracts, tuberculosis, syphilis, adenomatous polyps and carcinoma are the most common pathologic conditions. The oxyuris vermicularis is the most common animal parasite. Gonorrhœa of the rectum is not uncommon. Stricture is most commonly caused by syphilis.
5. Prostate. Normal size is about that of a walnut or horse-chestnut. Weighs 19-25 grm. Average dimensions are 2.7 cm. long, 4.0 cm. broad, 2.0 cm. thick. Note form, consistence, color of cut-surface (smooth or granular), amount of secretion, corpora amylacea (color brown to black), size of gland-spaces, cysts, abscesses, tubercles, neoplasms. The most common pathologic conditions are: hyperplasia (usually inflammatory, the result of old gonorrhœal infection, less commonly due to chronic pyogenic infection), neoplasms (carcinoma is relatively common, usually developed in a prostate showing chronic inflammatory hyperplasia, adenoma, myoma, fibroma, myofibroma), cysts, acute inflammation (usually gonorrhœal), typhoid prostatitis, abscesses, tuberculosis, syphilis (rare) and atrophy. Thrombosis and the formation of phleboliths are very common in the prostatic veins; they are usually associated with gonorrhœal infection. The inflammatory hyperplasia may involve one or all three lobes of the prostate. In old men showing no evidences of prostatic inflammation the prostate may be atrophic.
6. Seminal Vesicles and Duct. Should be symmetrical. Note size, contents, character of wall, and appearance of lining membrane. They measure 3-5 cm. long, 1-2 cm. broad and 0.7-1.5 cm. thick. Gonorrhœal inflammations and tuberculosis are the most common conditions. In old men the vesicles contain a brownish-yellow mucoid substance. As a result of chronic inflammation the walls of the vesicles are thickened, often hyaline; the lumen is sometimes wholly obliterated. Calcification of the wall is not uncommon. Concretions are found in the vesicles following obstruction. Cystic dilatation may occur. Primary neoplasms (carcinoma and sarcoma) are rare.
7. Urethra. Mucosa should be grayish-red, smooth, shining and transparent. The most common and important pathologic condition is gonorrhœa (acute, chronic, anterior, posterior, erosions, ulcers, abscesses, perforation, stricture, periurethral abscess, cavernitis, etc.). Non-gonorrhœal urethritis is rare (colon- and influenza-bacillus, streptococcus, pneumococcus, etc.). Trauma (crushing, laceration, perforation, urine-infiltration, hæmorrhage, periurethral abscess, phlegmon, gangrene, stricture, urinary fistula, etc.), soft chancre, hard chancre, secondary and tertiary syphilitic lesions (gumma), tuberculosis (lupus), leprosy and neoplasms (rare: adenoma, carcinoma, melanotic and round-cell sarcomata [lymphosarcoma], fibroma, angioma) may occur. The most common anomalies are hypospadias and epispadias.
8. Bladder. Size, degree of distention, amount and character of contents, character and color of mucosa (normally gray-red, smooth and transparent), muscle-coats (hypertrophic, atrophic). The most common pathologic conditions are: anomalies (ectopia, ecstrophia, vesica bipartita, vesica bilocularis, diverticula), congestion, œdema, cystitis (acute and chronic catarrh, cystitis granulosa, cystica, purulent, phlegmonous, diphtheritic, emphysematous, interstitial, peri- and paracystitis, erosions, ulcers, gangrene, malakoplakia), tuberculosis, dilatation, trauma (rupture, perforation, fistula), neoplasms (papillary fibro-epithelioma, carcinoma, adenoma, myxoma, myoma, rhabdomyoma, angioma cavernosum, sarcoma, dermoids, secondary carcinoma [usually from prostate], and sarcoma [melanotic sarcoma]), concretions (urates, uric acid, oxalates, phosphates, carbonates, cystin and xanthin), and parasites (filaria sanguinis, distomum hæmatobium, echinococcus, trichomonas, ascaris and oxyuris).