THE METHOD OF MAKING POST-MORTEM EXAMINATIONS. 31 



degeneration of the mucosa this structure should be carefully washed 

 and brushed with a solution of iodine (see p. 28). 



PRESERVATION. For the general purposes of microscopic study, portions of the gut 

 should be gently stretched on cork (the mucosa side free) and hardened in Orth's fluid 

 or in Flemming's osmic-acid mixture. 



For obvious reasons the mucous membrane should be handled as little as possible, 

 for, in the majority of cases, decomposition and softening have already set in at the 

 time of the autopsy, and, under the most favorable conditions, the epithelium is very 

 easily rubbed off. 



In cases in which the most perfect preservation of the topographical features, as 

 well as the minute structure of the intestinal mucosa, is desired, even at the expense of 

 an inspection of the fresh tissue, another mode of procedure is to be recommended. 

 Selected segments of the gut are, after removal from the body, allowed to remain un- 

 opened on the table while ligatures are tied around the ends. The isolated segments, 

 or the whole gut, are now to be moderately filled not distended with one of the 

 above fluids by means of a syringe with a needle canula ; or one end of the segment 

 may be tied and the fixative introduced through a funnel at the other, which end is then 

 ligated. The segments to be preserved should now be placed unopened in the fixative 

 solution. After twenty-four hours they may be opened with scissors or a sharp knife, 

 cut into suitable pieces, and kept permanently in eighty-per-cent alcohol. 



The Stomach and Duodenum. We now introduce the enterotome into 

 the duodenum at its transverse portion, and open it on the convex border. 



When the pylorus is reached the incision is carried obliquely over to 

 the greater curvature of the stomach, along which it is extended as far as 

 the cesophageal opening, and the organ examined in situ ; or, if a more 

 careful examination of the stomach is called for, after ascertaining 

 whether or not the bile duct is pervious (see below), the duodenum and 

 stomach may be removed together, and the stomach opened and examined 

 on the table. Alterations in size and form, the presence of tumors, 

 ulcers, etc., may now be sought for. 



If poisoning be suspected, a ligature should have been placed, earlier 

 in the examination (see above), around the lower end of the oesophagus 

 and the duodenum. The stomach and duodenum are now removed to- 

 gether unopened. They are to be opened in a carefully cleansed glass 

 jar, and after an inspection of the mucous membrane and the contents 

 with the naked eye and a hand lens, stomach, duodenum, and contents 

 are to be sealed in the jar for the chemist. 



We now look for the orifice of the bile duct, which will be found 

 about the middle of the descending portion of the duodenum en its con- 

 cave border. Pressure on the gall bladder or on the common duct will 

 usually cause the bile to flow into the intestine if the ducts are pervious. 

 But a sufficient degree of stoppage may exist in the ducts to give rise to 

 marked symptoms of disease, without preventing the flow of bile under 

 these conditions, even with a moderate pressure. A long director is now 

 passed into the gall duct, which is laid completely open ; ulcerations, 

 cicatrices, gall stones, inflammatory lesions, and tumors are looked for. 

 In stricture of the gall duct the mucous membrane above will often be 

 found bile-stained, while below it is colorless. At this point, should 



