Medical Jurisprudence, Forensic medicine and Toxicology. Vol. 1

by R. A. Witthaus; Tracy C. Becker

The Kidneys.—Drawing the intestines aside we cut through the peritoneum over the kidneys, and introducing our left hand we grasp the organs with their suprarenal capsules attached. Raising first one kidney and then the other, we easily divide the vessels and the ureters as close to the bladder as possible. The kidneys are often found imbedded in a mass of fat which must first be removed. Their surface is sometimes of a greenish color owing to the beginning of putrefaction. We note the size of the organ, its color and weight. A normal kidney weighs from four and one-half to five ounces. Grasping the kidney firmly in the left hand, we make an incision in its capsule along its convex border, and with a forceps strip off the capsule and note its degree of adherence and the condition of the surface of the organ; whether it is smooth or granular. Prolonging our incision already made through the cortex of the organ, inward toward the pelvis, we divide the organ into two halves and now closely examine the internal structure. The average thickness of the cortex, which should be about one-third of an inch, is noted; as also its degree of congestion, and whether the normal light (tubes) and reddish (vessels and tufts) lines are seen running through it. If these alternate light and dark markings are lost and the organ has not undergone decomposition, the presence of some of the forms of Bright’s disease may be suspected. If the cut surface of the organ presents a waxy appearance, the amyloid test should be applied by first washing the cut surface of the organ and dropping upon it a few drops of Lugol’s solution of iodine, when the amyloid areas will appear as dark mahogany spots on a yellow background.

The pelvis of the kidneys should be examined for calculi and the evidence of inflammatory lesions. The suprarenal capsules readily decompose, but if the autopsy is not made too late hypertrophy, tuberculosis, tumors, and degeneration in them may be recognized.

The Spleen.—This organ will be found in an oblique position at the left side of the stomach. Grasping it firmly in the left hand and drawing it forward, it can easily be detached. Normally in the adult it is about five inches in length by three inches in breadth by one inch in thickness, and weighs about seven ounces. The size, color, and consistency of the organ should be noted, as well as abnormal thickenings of its capsule and the presence of any tubercles or tumors in its substance. The spleen softens very early as the result of decomposition, and this decomposition should not be mistaken for a pathological condition.

The Intestines.—In cases of suspected poisoning the greatest care should be taken in the removal of the intestines and the stomach. Double ligatures should be placed in the following situations so as to preserve the contents of the organs intact: (1) at the end of the duodenum; (2) at the end of the ilium; and (3) at the lower portion of the rectum; and an incision should be made with a pair of scissors between these ligatures. The jejunum and ilium should first be removed together by seizing the gut with the left hand, keeping it on the stretch, and cutting with a pair of scissors through the mesentery close to its intestinal attachment. The cæcum, colon, and rectum should then be removed in a similar manner.

The intestines being placed in large absolutely clean dishes, which have previously been rinsed with distilled water, are opened; great care being taken that none of the intestinal contents are lost. The small intestines should be opened in one dish and the large intestine in another. A portion of the intestines where morbid appearances are most likely to be seen in cases of poisoning are the duodenum, the lower part of the ilium, and the rectum. The comparative intensity of the appearances of irritation should be especially noted. For example, if the stomach appears normal and the intestines are found inflamed the possibility of poison from an irritant may be denied.

The intestines are opened along their detached border by the enterotome. Care should be taken to distinguish the post-mortem discolorations which are usually seen along the intestines from those produced by disease. The former are most marked in the dependent portions. They are apt to occur in patches which can be readily recognized by stretching the wall of the gut. The darkish brown or purple discolorations which are sometimes seen as the result of decomposition are due to the imbibition from the vessels of decomposed hæmoglobin. Much care and experience are necessary to tell the amount of congestion which is within normal limits and to recognize changes of color produced by decomposition.

The pathological lesions ordinarily looked for in the examination of the intestines are ulcers, perforation, hemorrhages, strictures, tumors, and the evidences of various inflammations. To obtain an accurate idea of the various portions of the mucous membrane of the intestines, it is sometimes necessary to remove their contents. When very adherent this should be done by allowing as small a portion of distilled water as possible to flow over their surface. If any abnormalities are noticed along the intestinal tract, an accurate description should be given of their situation and extent; as also the amount of congestion seen in different portions of the intestinal tract.

If possible the different portions of the intestines, as well as the stomach, should be examined immediately after being exposed to view, as under the influence of the air those parts which are pale may become red, and slight redness may become very pronounced. In this way only can we estimate the degree of vascularity of the various parts after death. However, in cases of suspected poisoning, when it is impossible for the chemist to be present at the autopsy, the medical examiner should not open the stomach and intestines, but place them in sealed jars. As soon as possible afterward, the chemist being present, they should then be examined in the manner indicated. What may be lost by waiting, in changes of color which have taken place, will be more than counterbalanced by the data which the chemist will obtain from observing the contents and mucous membrane of the stomach and intestines when they are first exposed. The characteristic odors of certain poisons are so evanescent that they quickly disappear after opening of the stomach and intestines.

After a thorough examination of the intestines, they are to be put with their contents into wide-mouthed vessels, each part by itself, and the basins in which they were opened washed with distilled water and the washings put into the same bottle. As soon as the intestines are transferred to the jars they should be sealed.

The Stomach.—The stomach and duodenum are removed together. They are opened by passing the enterotome into the duodenum and dividing it along its convex border, the incision being continued along the greater curvature of the stomach as far as the œsophageal opening. They should be opened in a large glass dish which has been carefully washed with distilled water. The chemist and medical examiner will carefully note the quantity, odor, color, and reaction of the stomach contents; also whether luminous or not in the dark; the presence or absence of crystalline matter, foreign substances, undigested food or alcohol.