Fig. 47.—Method of opening the abdomen in the new-born, with especial reference to the examination of the umbilical vessels. Note triangular flap, including umbilicus, urachus and umbilical arteries, and attached to umbilical vein. (After Nauwerck.)
Fig. 48.—Section of pulmonary artery and pulmonary ring in the new-born, showing openings of right and left pulmonary arteries and ductus arteriosus (containing probe). (After Nauwerck.)
Fig. 49.—Method of demonstrating the Béclard center of ossification in the lower epiphysis of the femur. (After Nauwerck.)
It is usually better to take out the neck and thoracic organs en masse and examine on the table. This must always be done in cases of suspected thymic death and when the question of the child having been born alive or dead is to be settled. The position of the diaphragm must be taken before the thorax is opened. The upper air passages are then ligated. The thoracic cavity is then opened; the pericardium and heart opened and examined. The larynx and trachea are opened above the ligature, and the whole respiratory tract with the ligature in position is removed from the thorax and placed in a vessel of clean water. The air passages below the ligature are then opened, and the lungs, after their floating power has been tested, are cut beneath the water in order to see if air-bubbles arise from the cut-surface or from the bronchioles. The lungs are examined piece by piece for air-containing portions, noting their floating power, crepitation, occurrence of bubbles, etc. In the case of suspected thymic enlargement the trachea should be explored from above for a stenosis, before the thorax is opened. If evidences of pressure upon the trachea cannot be demonstrated in this way the body of the child can be fixed in formalin and then opened. The thymus and trachea are then examined by means of transverse sections. The stomach should be ligated at both ends and then removed, and opened under water. The presence of air points to extra-uterine “swallowing” movements. This test is worthless if decomposition has set in. When the thoracic organs are taken out en masse the ductus arteriosus can be examined from the aorta. The removal of neck, thoracic and abdominal organs en masse is often of advantage in the examination of the infant cadaver, as the organs can be much more easily examined on the table than in the body. The neck organs are first removed after ligating trachea and œsophagus, and with the thoracic organs are stripped down to the diaphragm and then lifted up out of the body and laid over the left side of the body. The diaphragm is then cut laterally and posteriorly. The rectum is ligated and cut between ligatures. The crura of the diaphragm, the cœliac vessels and root of mesentery are then cut, and the viscera, including the kidneys, are stripped down to the brim of the pelvis, where the peritoneum and blood-vessels are cut.
The ear-test (the demonstration of the opening-up of the Eustachian tube and middle ear by the establishment of respiration) may be shown by the examination of the middle-ear from the cranium. The ear-drum must be examined to see if it is intact.
The Béclard center of ossification in the lower epiphysis of the femur is examined by opening the knee-joint, flexing the leg, and then making parallel transverse cuts perpendicularly to the long axis of the bone, until the greatest diameter of the center of ossification is cut.
The eye-ball may be removed and examined for the pupillary membrane. The eye is cut through a few millimetres back of the cornea, the anterior segment is fixed in dilute chromic acid or alcohol and then examined microscopically; or it can be examined in the fresh state, the membrane being visible even to the naked eye.
Bacteriologic examinations should be made in the usual way, the material being secured by sterile pipette, sterilized knife or platinum loop, smears, etc. In the examination of a very fresh cadaver the possibility of danger from infection with syphilis must always be borne in mind.