The most important pathologic conditions of the bones are: atrophy, osteomalacia, rachitis, fractures, dislocations, periostitis, osteomyelitis, ostitis, acromegaly, necrosis, syphilis, tuberculosis, actinomycosis, leprosy, exostosis, hyperostosis, hyperplasia, defects, hypoplasia, dwarfism, giantism, neoplasms (primary sarcoma the most common malignant tumor [periosteal, myelogenous, myeloma, lymphosarcoma, chloroma, leukæmia]; secondary carcinoma [primary in mamma, thyroid, prostate, adrenal] also relatively common; osteoma, lipoma, exostosis cartilaginea, fibrosa and ossificans, fibroma, myxoma, lipoma, angioma, chondroma, etc.), cysts, and parasites (echinococcus, cysticercus).
2. Joints. Capsule (thickness, tension, defects, tears, perforations, adhesions), cavity (contents [normally a few drops of light-yellow, clear fluid, more in knee-joint than in other joints; may be serous, purulent, hæmorrhagic or fibrinous], adhesions, granulation-tissue, rice-bodies, free bodies, joint-mice, obliteration of cavity, osseous, fibrinous or cartilaginous ankylosis, changes in internal articular ligaments), synovial membrane (a delicate pale grayish, smooth membrane; rough from exudate or formation of granulation-tissue; red in hyperæmia or hæmorrhage. Note folds and villi; subserous fat-tissue), articular surfaces (loss or increase of cartilage, separation of cartilage, newly-formed bone, granulation-tissue, deposits of lime-salts or urates, necrosis or purulent infiltration of the cartilage, erosions, eburnations, defects or enlargement of ends of bones; in degeneration and necrosis the bluish-white, transparent cartilage becomes opaque, cloudy and yellowish). The most important pathologic conditions of the joints are: arthritis (acute, chronic, serous, purulent, gangrenous, primary, secondary, gonococcal, pneumococcal, streptococcal, tuberculous, syphilitic, deformans, villosa, prolifera cartilaginea, adhæsiva, ulcerosa, sicca, neuropathic), dislocations, deformities, abnormal position, congenital anomalies, chondritis, spondylitis, gout, necrosis, ankylosis, tuberculosis, syphilis, free bodies, neoplasms (rare: angioma, sarcoma, chondroma, lipoma; secondary more common from an extension of sarcoma of neighboring structures; metastatic tumors rare), and parasites (echinoccocus very rare).
3. Lymphnodes, Peripheral Vessels and Nerves, Sympathetic and Organs of Special Sense. The pathologic conditions of these structures have been given above.
CHAPTER XIII
THE AUTOPSY OF THE NEW-BORN.
I. METHODS OF EXAMINATION.
The Section of the New-Born differs from that of the adult in several particulars, as follows:—
a. Spinal Cord. The spinal canal may be opened with the scissors alone, as the soft, bony structures of the spinal column are easily cut.
b. Skull. The cranium is opened, after the removal of the scalp, in the usual way, by cutting with the scissors into the posterior angle of the anterior fontanel and then introducing the shears into the longitudinal sinus, and cutting the latter posteriorly in the line of the sagittal suture. The sinus is then opened anteriorly. The sutures between the frontal and parietal bones, and between the parietal and occipital bones, are now cut with the shears down to the level of the greatest circumference of the cranium. The cranial bones with the adherent dura are then pressed outward from the brain, and are either held in this position or cut through with the bone-shears so that sufficient room for the removal of the brain is afforded. The anterior falx is then cut and the brain removed as in the adult, using great care because of its very soft consistence. When too soft to be removed the brain may be opened within the skull; or a horizontal section may be made with the large, flat brain knife at the level of greatest circumference. Some prosectors freeze the brain before removal, or remove it while the cadaver is immersed in a strong solution of brine.
c. Section of Thorax, Neck-organs and Abdomen. A small block of wood is placed beneath the lumbar vertebræ, and the main-incision reaching from thyroid cartilage to the pelvic crest is made, the incision passing to the left of the umbilicus, and diverging outward below it so as not to cut the left umbilical artery. The incision is now extended through the abdominal wall into the peritoneal cavity, the right half of the abdominal wall turned up so as to expose the umbilical vein, which is cut loose from the abdominal wall, so that a second diverging incision can be made through the abdominal wall, beginning just above the umbilicus and passing down to the right of the right umbilical artery, without cutting the umbilical vein. There is left between the two diverging cuts a triangular flap of abdominal wall (see Fig. [47]) containing the umbilicus, urachus and umbilical arteries, and connected with the liver by the umbilical vein. The umbilical vessels are then probed and examined by transverse sections; and the triangular flap of abdominal wall turned down over the pubis. After the height of the diaphragm has been noted the thorax is opened by cutting the ribs outside of the costochondral articulations so as to give more room. The thymus gland is then examined and removed. The heart may be opened in the same way as in the adult, extending the cut into the pulmonary artery up to the ductus arteriosus, which is examined by the probe. The ductus arteriosus is easily found by cutting the pulmonary artery in the middle of its anterior wall. In the median line beyond the right and left branches of the pulmonary artery is the opening of the duct, which can be probed into the descending aorta. (See Fig. [48].) The heart may then be removed, and the foramen ovale carefully examined.
