...............................Superintendent.
There can be no doubt that the public in general is beginning to appreciate the usefulness of autopsies, as it is much easier to obtain them now than it was ten years ago. The proper display of tact and a reasonable exposition of the object of the examination will practically always meet the objections urged on sentimental grounds. Aside from these the chief objection usually met with is the fear of mutilation of the body. Emphatic assurance may be given in this respect, not only as to the entire absence of any disfigurement resulting from the examination, but also as to the marked improvement in the general appearance and condition of the cadaver as the result of the autopsy.
While it is obviously difficult to give any specific rules as to the method to be pursued in seeking permission for an autopsy, there are certain arguments that can be used to advantage. Natural curiosity, the general good to humanity, the control of diagnostic and therapeutic methods, new knowledge to be gained, the question of inherited or infectious conditions, the strengthening of insurance claims, etc., are some of the lines that may be followed in working for an autopsy. Satisfaction is always expressed when definite light is thrown upon the hereditary or infectious nature of the condition. Religious scruples may often be overcome by an appeal to the pastor or priest.
In a certain number of cases the matter is hopeless from the beginning, but in the majority the autopsy may be secured by the exercise of proper tact and patience. The laity should be educated to ask for the autopsy; and even at the present time laymen often show a greater willingness in this direction than some members of the profession. That physicians and undertakers who discourage or oppose autopsies should be avoided is a principle that should be instilled into the minds of the public at large. Undertakers soon come to recognize the aid given them by the autopsy in the matter of embalming and preserving the body, and the prosecutor should always show his readiness to allow the undertaker to profit by his operations, and to render him such definite help as may be within his power.
As a last resort the offer of a small amount of financial aid in the burial expenses will secure sometimes a permission otherwise refused. In extreme cases the physician may decline to sign the death certificate, or the Coroner may be called in, or the case turned over to the Board of Health. Under suspicious circumstances such procedures are necessary, but threats to resort to these expedients should not be made without good reasons.
With the request for the autopsy should be included the right to take such portions of organs or tissues as is necessary for a microscopic examination and for the complete diagnosis. It is, of course, never necessary and certainly unwise in the majority of cases to make any definite statements as to what or how much shall be taken away or left. No specimens should be taken if this is absolutely forbidden; and, while a half autopsy is better than none, the importance of the microscopic examination should be urged, if necessary, as strongly as the performance of the autopsy. The use of a written permission, such as is given above, obviates the necessity of making a special request for material and avoids the complications that such a request often brings about. Moreover, the legal decision above quoted grants the right to microscopic examination as included in the permit for the autopsy when such an examination is necessary to complete the aims of the autopsy.
5. AUTOPSY INSTRUMENTS. An autopsy can be properly performed with very few instruments; indeed, a knife and a saw, with a needle to close up the body, would suffice for the majority of cases. But there are very great advantages in the use of certain instruments adapted especially to autopsy needs, and these the physician should gradually acquire for his work. It is not advisable to purchase the so-called “postmortem sets” sold by the dealers, but far better to start with two or three of the most necessary instruments and gradually add to these. Surgical instruments as they become discarded can often be made to do good service in the autopsy outfit. In private practice the fewer instruments one can get along with the better, as there is much less trouble in carrying them about and in taking care of them, and it is better to make the performance of the autopsy as inconspicuous as possible. In teaching institutions and in hospitals the number and variety of instruments that can be utilized in autopsy work are limited only by the financial means at disposal, but even under the most favorable conditions in this respect it is better to simplify as much as possible. The list given below will meet all requirements.
Fig. 1—Large Section, or Cartilage Knives
