32 THE METHOD OF MAKING POST-MORTEM EXAMINATIONS. 



there be any special reason for doing so, the portal vein, which lies close 

 behind the ductus choledochus, should be opened and examined for peri- 

 phlebitis, phlebitis, and thrombosis. The mucous membranes of the 

 duodenum and stomach are now examined. Acute inflammation from 

 caustic poisons, chronic catarrhal inflammations, haemorrhages, ulcers, 

 erosions, swelling of the solitary follicles (lymph nodules), and tumors 

 are lesions most frequently seen. We sometimes find a diffuse congestion 

 of the stomach, similar to that produced by irritant poisons, as a result 

 of doses of crotou oil given just before death. 



PRESERVATION. The same methods should be used as for the intestines (see above). 

 Tumors should be cut into small pieces and hardened in Orth's fluid or five-per-cent 

 formalin. 



.The Liver, To remove the liver, the diaphragm is first divided on 

 one side of the suspensory ligament as far back as the spine ; the suspen- 

 sory ligament is then divided ; then the right and left lobes being in turn 

 raised, the lateral ligaments are severed. Then, the left lobe being seized, 

 the organ is dragged obliquely downward into the abdominal cavity, the 

 remaining attachments being dissected away. The liver is first laid on 

 its superior surface and the gall bladder and its contents are examined. 

 The character of the gall is to be determined, and gall stones, inflam- 

 matory lesions, and tumors are to be sought for. To determine the 

 actual size of the organ, it should be both measured and weighed. Its 

 size varies greatly in different healthy individuals, but in general it may 

 be said that it measures from 25 to 30 cm. transversely, from 15.3 to 18 

 cm. antero-posteriorly, and from 9 to 12 cm. at its thickest part ; its or- 

 dinary weight is between 1,550 and 1,860 grams. In children its weight 

 relative to that of the body is greater than in adults. The liver is 

 increased in size and weight during digestion and by congestion from 

 any cause. 



The convex surface of the right lobe of the liver not infrequently 

 shows several grooves running from front to back, approximately par- 

 allel with the suspensory ligament of the liver. These grooves, which 

 may be found in persons of all ages, are believed by some to be usually 

 congeuital, by others to be the result of pressure of the diaphragm and 

 the abdominal muscles on a relaxed atrophic liver. They seem in any 

 event to be of no practical importance. On the other hand, a transverse 

 groove running at right angles to the axis of the body is a not infrequent 

 result of tight lacing, and is usually associated with local connective- 

 tissue thickening of the capsule and underlying tissue of the liver. In 

 this way the liver may become much distorted and the gall bladder com- 

 promised. 



The capsule of the liver is now examined ; the organ is then laid on its 

 lower surface and several deep incisions are made from above downward. 

 The color and consistence of the liver tissue should be noticed, also the 

 distinctness with which the lobular outlines can be seen ; whether or not 

 the centres of the lobules are congested or their peripheries lighter in 

 color than usual ; the presence of tumors, tubercles, abscess, ecchiuococ- 



