THE METHOD OF MAKING POST-MORTEM EXAMINATIONS. 21 



it upward ; by constriction of the waist in tight lacing, forcing it either 

 upward or downward ; by changes in the size of the organ itself. The 

 liver may not only be displaced downward, but dislocated so that its 

 convex surface faces the abdominal wall and its posterior edge is turned 

 upward against the diaphragm. 



The stomach is situated in the left hypochondriac and epigastric re- 

 gions, extending also into the right hypochoudrium ; it lies in part 

 against the anterior wall of the abdomen, in part beneath the liver and 

 diaphragm, and above the transverse colon. Its anterior surface, which 

 is directed upward and forward, is in contact above with the diaphragm 

 and the under surface of the liver, and lower down with the abdominal 

 wall opposite to the epigastric region. Its posterior surface is turned 

 downward and backward, and rests on the transverse mesocolou, the 

 pancreas, and the great vessels. To its lesser curvature or upper border 

 are attached the gastro-phrenic ligament and the gastro -hepatic omen- 

 turn. To the greater curvature or lower border is attached the gastro- 

 colic omeutum. Its cardiac orifice communicates with the oesophagus, 

 its pyloric end with the duodenum. 



When the stomach is distended the greater curvature is elevated and 

 carried forward, the anterior surface is turned upward and the posterior 

 surface downward. When distended with food or gas the organ is prom- 

 inent ; when empty it may hardly be visible below the ribs ; when the 

 intestines are dilated it may be entirely covered by them. 



Before opening the thorax the hand should be passed up against the 

 under surface of the diaphragm on either side, to determine its height. 

 According to Quain, the vault of the diaphragm rises, in the dead body, 

 on the right side to the level of the junction of the fifth rib and sternum, 

 on the left side as high as the sixth rib. Both the relative and the 

 absolute height of the diaphragm vary under a variety of pathological 

 conditions. 



If the existence of air or gas in the pleural cavities be suspected, the 

 abdominal cavity should be filled with water and the diaphragm punc- 

 tured below the level of the fluid. If air be present, it will escape in 

 bubbles through the water. 



THE THORAX. 



We now leave the abdominal viscera and proceed to the examination 

 of the thorax. With a costatome or a strong knife the costal cartilages 

 are divided close to the ribs, the clavicles are disarticulated from the 

 sternum, and the latter is removed, care being taken not to wound the 

 large veins. We first examine the position of the heart and lungs. 



The Heart. The upper border of the heart is on a level with the 

 third costal cartilage; the lower border extends from 1.3 cm. below 

 the lower end of the sternum to the fifth left intercostal space. The 

 left boundary of the heart is situated to the left of the junction of the 

 fifth rib with its costal cartilage, and behind or to the left of a vertical 



