THE METHOD OF MAKING POST-MORTEM EXAMINATIONS. 23 



heart is held horizontally by both auricles, so as not to pull the valves 

 open, and water is poured into the aortic and pulmonary arteries, and 

 we observe how well the valves support the column of liquid. To ascer- 

 tain the sufficiency of the mitral and tricuspid valves, the auricles are 

 first laid open so as to expose the upper surfaces of the valves. A large 

 pipe is passed through the aorta or pulmonary artery beyond their 

 valves, and a small stream of water allowed to flow into the ventricles. 

 The auriculo- ventricular valves will be swollen upward, and we can ob- 

 serve their degree of sufficiency. The tricuspid valve is normally some- 

 what insufficient. These water tests, however carefully applied, are not 

 very reliable, since under the most favorable conditions the natural 

 bearings of the valves are not perfectly preserved. 



To ascertain the size of the different valvular openings, we introduce 

 the fingers, held flat with their sides in contact, into each of the orifices, 

 and then measure the width of the fingers at the point where they fill the 

 orifice. In this way we find that, under normal conditions in the adult, 

 the aortic measures about 2.5 cm., the mitral valve about 4.5 cm., the 

 pulmonary about 3.1 cm., the tricuspid about 5 cm. 



In order to examine the interior of the heart, we first make an incision 

 through the anterior wall of the left ventricle, close by and parallel to 

 the septum, and reaching to the apex of the ventricle; through this 

 opening the blade of the enterotorne is passed up into the aorta, the 

 pulmonary artery being drawn aside with the fingers, and the ventricle 

 and aorta are laid open. With a little care the incision may be made to 

 pass through one of the points of junction of the aortic valves. 



The auricles and ventricles may be empty, or may contain fluid blood 

 or the so-called heart dots. These heart clots are of two kinds those 

 which are formed some time before death, and those which are formed 

 during the last hours of life and after death. The clots which are formed 

 some time before death are usually associated with organic disease of the 

 heart, especially with dilatation of the ventricles. They are firm, dry, 

 and of whitish color; they may be infiltrated with the salts of lime. 

 They are free in the cavities of the heart, or entangled in the trabeculse, 

 or firmly adherent to the endocardium. They are usually composed of 

 coagulated fibrin, blood platelets, leucocytes, and red blood cells, and are 

 often lamellated. The clots which are formed during the last hours of 

 life and after death are red, yellow, or white. They may be soft or suc- 

 culent or quite firm. They may be free in the heart cavities, or be 

 adherent to the trabeculae, or extend into the large vessels. They are 

 usually -most constant and of largest size in the right auricle and ven- 

 tricle. Such clots may be formed within two hours after death. Clots 

 of this character are common. If, then, the blood coagulates in the heart 

 within twenty-four hours before death, this coagulum may not be dis- 

 tinguishable from the ordinary post-mortem clots. If it is supposed, 

 therefore, that a person dies from heart clot developed a few hours before 

 death, the proof of this must be derived largely from the clinical symp- 

 toms, and not from the autopsy. 



