30 THE METHOD OF MAKING POST-MORTEM EXAMINATIONS. 



any clinical history indicating disease. We should look for changes in 

 size, color, and hardness ; for pigmentation, hyperplasia of the connec- 

 tive tissue, amyloid degeneration, tubercles, and infarctions. 



Not infrequently one or more spheroidal or flattened so-called acces- 

 sory spleens are found in the vicinity of the spleen ; they vary in size 

 from that of a pea to that of a walnut. 



PRESERVATION. In certain diseases of the pulp, leukemia, leucocythaemia, etc., the 

 tissue should be teased, when fresh, in one-half-per-cent salt solution, or examined by 

 the staining methods described under the lesions of the blood. For general purposes 

 small pieces of the organ are hardened in Orth's fluid, Flemming's osmic-acid mixture, 

 or in alcohol. 



The Intestines. The rectum is divided, the intestine seized with the 

 left hand, and, being kept stretched, is separated from its attachments 

 by repeated incisions through the mesentery close to the gut, until the 

 duodenum is reached, where the intestine is again cut off. The opera- 

 tion is more cleanly if, before dividing the gut, ligatures are placed 

 around it at either end. The entire length of the gut is now laid open 

 with the enterotome along the mesenteric attachment, the mucous mem- 

 brane is cleaned with a stream of water and then examined. 



In cases of suspected poisoning, a ligature should be placed around 

 the rectal end of the gut and two around the duodenal end, and it should 

 then be cut off below the former and between the latter ligatures. The 

 gut is now opened and the contents are emptied into a clean glass jar for 

 delivery to the chemist, care being taken that they be not allowed to 

 touch anything but the inner surface of the jar. After washing the in- 

 testine in pure, fresh water and examining it, it should be placed entire 

 in another clean jar and the jar sealed. 



Cadaveric lividities are very common in the intestines, and are 

 usually most marked in the dependent portions. They are apt to occur 

 in patches, but may be diffuse and very extensive. If the wall of the 

 gut be stretched, they are often seen to be discontinuous, owing to the 

 pressure of the blood from the parts which are squeezed by folds. Small 

 patches of arborescent or diffuse red staining are often seen, formed by 

 the imbibition from the vessels of decomposing haemoglobin. In the 

 more advanced stages of decomposition the mucosa may be softened and 

 loosened. A dark purple or brownish discoloration of the entire intes- 

 tinal wall is frequently seen, either diffuse or in patches. Much experi- 

 ence and careful observation are requisite in forming a correct judgment 

 regarding the significance of changes of color in the intestines. Caution 

 is necessary in distinguishing normal digestive hypersemia from abnor- 

 mal congestion. A very considerable congestion may exist without 

 disease. 



The lesions ordinarily to be looked for are catarrhal, croupous, and 

 ulcerative inflammations, perforations, haemorrhages, strictures, tumors, 

 amyloid degeneration, swelling and ulceratioii of the solitary follicles 

 and Peyer's patches, and pigmentation. For the detection of amyloid 



