31. In inspecting the organs in the chest, a cursory examination should be first made by turning them over, ascertaining the nature and measuring the quantity of effused fluids, feeling for fractures of the ribs, tumours, or other diseases, and opening the pericardium to obtain a view of the heart. The most convenient course to pursue next is, without moving the heart from its place, to lay open its several cavities, in order to judge of the quantity and state of the blood in both sides of that organ. For this purpose the following incisions should be made: The first, beginning close to the base, is carried along the right border of the heart directly into the right ventricle towards the apex, care being taken not to cut the septum. This lays open the right ventricle. The second incision, opening up the right auricle, begins midway between the entrances of the venæ cavæ, ending just in front of the base. The third, for exposing the left auricle, commences at the left superior pulmonary vein, and ends just in front of the base, close to the coronary vein, care being taken not to wound it. The fourth, displaying the left ventricle, commences behind the base, and ends close to the apex. If the blood is in a fluid state, the quantity contained in the right auricle may be materially affected by the head being examined previously, as the blood may have escaped from the heart by the jugular veins. The whole of the organs in the chest—the lungs, heart, and gullet—together with the parts dissected downwards from the throat, should now be removed in one mass, in order to examine them in detail on a table. But previously two ligatures should be applied on the gullet, just above the cardiac orifice of the stomach, and the division made between them.

32. The organs in the abdomen ought to be turned over, like those of the chest, before any one of them is minutely examined, but before the thorax is opened, for the reasons given in Sect. 22. In the subsequent examination, that organ is to be first proceeded with in which there may appear to be disease.

V. Examination in Cases of
Wounds and Contusions

33. In a post-mortem examination, the most approved mode of examining these injuries is, if they be situated over great cavities, to expose the successive structures in the manner of an ordinary dissection, observing carefully what injuries have been sustained by the parts successively exposed before they are divided. Wounds ought not to be probed, especially if situated over any of the great cavities. The depth of a wound is best ascertained by careful dissection and exposure of the parts involved; but after this is done, the thickness of the tissues penetrated may be measured by the probe.

34. The seat of the wounds must be described by actual measurement from known points, their figure and nature also carefully noted, and their direction ascertained with exactness.

35. Before altering by incisions the external appearances of injuries, which should never, if possible, be done, care must be taken to consider what weapon might have produced them, and if a particular weapon be suspected, it should be compared with them. The wounded parts should be cut out entire, and carefully preserved.

36. Apparent contusions must be examined by making incisions through them; and the inspectors will note whether there is a swelling or puckering of the skin; whether the substance of the true skin be black through a part or the whole of its thickness; whether there be extravasation below the skin or in the deeper textures, and whether the blood be fluid or coagulated, generally or partially; whether the soft parts below be lacerated, or subjacent bones injured; and whether there be blood in contact with the lacerated surfaces. By these means the question may be settled whether the contusions were inflicted before or after death.

37. In the cases of wounds, too, the signs of vital action must be attended to, especially the retraction of the edges, adhesion of blood to their surfaces, or the injection of blood into the cellular tissue around, or the presence of the signs or sequelæ of inflammation. Hypostasis must not be mistaken for vascular injection.

38. When large arteries or veins are found divided, care must be taken to corroborate the presumption thus arising by ascertaining, in the subsequent dissection, whether the great vessels, lungs, liver, and membranous viscera of the abdomen be unusually free of blood.

39. In the course of the dissection of wounds, a careful search must be made for foreign bodies in them. When firearms have occasioned them, the examination should not be ended before discovering the bullet, wadding, or other article, if any, lodged in the body; and whatever is found must be preserved. When the article discharged from firearms, or when any other weapon had passed through and through a part of the body, the two wounds must be carefully distinguished by their respective characters, especially as regards their comparative size, inversion or eversion, smoothness or laceration, of their edges, their roundness or angularity, and the comparative amount of bleeding from each. In gunshot injuries, the presence or absence of marks of gunpowder should be noted.