20 THE METHOD OF MAKING POST-MORTEM EXAMINATIONS. 



tioii of the muscles. In order better to expose the abdomiual cavity, the 

 rectus should be divided transversely beneath the skin just above the 

 pubes, and the abdominal flaps may then be turned freely outward. 



General Inspection of the Abdominal Cavity. We first notice the posi- 

 tion and general condition of the viscera. It is best at this stage of the 

 examination to note the condition of the vermiform appendix, and to 

 look over the peritoneal cavity for serum, inflammatory lesions, evi- 

 dences of perforation, and for the existence of invagination, incarcera- 

 tion, and heruise of the intestines. A small quantity of reddish serum 

 is frequently found in the abdominal cavity, particularly in warm 

 weather, as the result of commencing decomposition. 



It should be remarked here that various striking changes in the 

 character and appearance of the internal organs are produced by putre- 

 faction changes which are often mistakenly regarded as evidences of 

 disease, and much experience is required in judging correctly of their 

 significance. These changes are, in general, softening and discoloration, 

 both of which may occur as the result of disease. It may be said in 

 general that the post-mortem reddening, or hypostases, are most marked 

 in the more dependent parts of the organs. Post-mortem softening usu- 

 ally affects entire organs, not being limited to a part, as is often the case 

 in disease. Gray or greenish-brown post-mortem discolorations are apt 

 to appear in those organs or parts of organs which lie in contact with the 

 intestinal canal. Parts of internal organs such as the liver, which have 

 been the seat of localized congestion during life, may after death assume 

 a dark-greenish color. 



The omentum is usually spread over the surface of the small intes- 

 tines, but it may be rolled up and displaced in a variety of ways, or may 

 be adherent at some point to the small intestines or the abdominal wall. 



The surface of the small intestines should be smooth and shining. 

 They may be greatly distended with gas, and thus so completely cover 

 the other abdominal viscera that it becomes necessary to let out some of 

 the gas by a small puncture. The transverse colon passes across the 

 abdomen through the upper part of the umbilical region. It may be 

 lower than the umbilicus, or higher up against the liver and diaphragm ; 

 it may be distended with gas or contracted. 



The liver is situated in the right hypochondriac and epigastric re- 

 gions, filling the concavity of the diaphragm. Its upper border reaches, 

 in the linea mammillaris, to the fifth intercostal space ; in the liuea axil- 

 laris, to the seventh intercostal space ; close to the vertebral column, to 

 the tenth intercostal space. At the median line the upper border of the 

 liver corresponds to the lower border of the heart. The left lobe extends 

 about three inches to the left of the median line. The lower border of 

 the right lobe usually reaches to the free border of the ribs, while the 

 left lobe is visible for about an inch below the ensiform cartilage. In 

 women the liver is usually lower than in men. 



The position of the liver is affected by changes in the thoracic cav- 

 ity, forcing it downward ; by changes in the abdominal cavity, forcing 



