THE METHOD OF MAKING POST-MORTEM EXAMINATIONS. 37 



Bacterial Examination of Post-Mortem Specimens. 



It is often important to make a thorough post-mortem examination 

 by cultures as well as morphologically of the blood and of all the vis- 

 cera. This is important not only in those cases which during life gave 

 clinical evidence of general infection, but also in many forms of disease 

 whose nature is still wholly obscure. 



In the interpretation of the results of all such examinations, however, 

 it should be borne in mind that after death a new distribution of germs 

 may occur, and that from the gastro- intestinal canal and from other sur- 

 faces or cavities of the body micro-organisms may, as decomposition 

 progresses, penetrate the tissues and the viscera. 



A careful consideration of the general conditions under which the 

 body has been kept and its state of decomposition is of especial impor- 

 tance in the interpretation of the significance of the Bacillus coli com- 

 munis, which is always present in such enormous numbers in the intes- 

 tinal canal, and which is not only apt to effect wide distribution in the 

 body after death, but as a result of careless manipulation is likely to be 

 accidentally brought in contact with other viscera after the opening of 

 the gut. The preparation of cover slips for staining and the inakiug of 

 cultures is, as a rule, best done at the autopsy table. 



It is well as each organ is exposed commencing with the heart to 

 sear the surface of the organ to be examined with a broad-bladed knife 

 heated over a flame, and then, making an incision through the seared 

 surface with a sterilized scalpel, to press a sterilized cotton swab (see 

 p. 155) into the opening and absorb the juices which exude, or to pick 

 out a small fragment of the solid tissue from the depths of the opening, 

 or . to secure some of the blood or fluid on a sterilized platinum loop ; 

 and then with the material thus procured make the required cultures 

 and afterward the cover-slip smears for staining. 



If it be necessary to transport the material to the laboratory before 

 making cultures, it is well to reserve the unopened organs, or large por- 

 tions of these in the case of the solid viscera, and to wrap each separately 

 in a cloth saturated with sublimate solution, or to put each in a separate 

 sterile receptacle for transportation. 



It is well to remember that in the last hours of life the safeguards 

 of the body against the entrance and growth of micro-organisms may 

 be ineffective, so that the determination of the significance of bacteria 

 in the tissues a short time after death requires care and experience. ' 



Autopsies in Medico-Legal Cases. 



While every autopsy should be made as carefully and completely 

 as circumstances permit, it should be always borne in mind that in 

 examinations which may have medico-legal bearings it is of the highest 



1 For details of bacterial flora of the human body, see references pp. 5 and 162. 



