40 THE METHOD OF MAKING POST-MORTEM EXAMINATIONS. 



blood, marks of injury, and the existence of putrefaction. It should be remembered 

 that putrefaction is apt to commence earlier in the bodies of young children than in 

 those of adults. 



The umbilical cord may be cut or torn. It usually separates by the fifth day, some- 

 times not until the tenth. If the umbilicus is cicatrized and healed, the child has prob- 

 ably lived for three weeks. A zone of redness around the insertion of the cord may ex- 

 ist previous to birth. Redness and swelling (which may disappear after death) with 

 suppuration can be found only in a child which has lived for several days. The drying 

 and mummification of the cord may take place as well in dead as in living children. 

 It is possible for a child to die by haemorrhage from a cut or torn cord, either before or 

 after it has breathed. The umbilical vessels should be examined, as they may be the 

 seat of umbilical infection. 



The extremities may exhibit fracture of the bones. These may occur during intra- 

 uterine life, from injuries to the woman or from unknown causes; or may be produced 

 by violence in delivery, or by injuries after birth. 



INTERNAL EXAMINATION. The Head, The fontanelles and sutures should first be 

 examined as to their size and for penetrating wounds. An incision should then be made 

 through the scalp across the vertex, and the flaps turned backward and forward as in 

 the adult. With a small knife the edges of the bones should be separated from the 

 membranous sutures and the dura mater, beginning low down in the frontal and going 

 back into the lambdoidal suture on either side. The bones are then drawn outward and 

 cut through around the skull with strong scissors. The brain is removed and examined 

 as in the adult. 1 



Effusions of blood cephalhaematoma may be formed, soon after birth, between 

 the pericranium and bone, or, more rarely, between the dura mater and bone. Clots are 

 also found between the dura mater and skull ; between the dura and pia mater ; more 

 rarely in the substance of the brain, as the result of protracted or instrumental deliveries, 

 or of injuries after birth. 



The cranial bones may be malformed, or exhibit the lesions of rickets or caries, or 

 be indented, fissured, or fractured. These latter lesions may be produced during intra- 

 uterine life by injuries to the mother, by unknown agencies, by difficult deliveries, or 

 by direct violence after birth. 



In cases of chronic internal hydrocephalus in young children, in which the ventri- 

 cles are much dilated and the brain substance is thinned over the vertex, the brain is very 

 apt to be torn in removal, and the amount of dilatation thus becomes difficult of deter- 

 mination. It is> therefore, better in such cases to place a pail of water beneath the head, 

 or even immerse the latter in it, and remove the brain in the water. In this way it floats 

 after removal, supported on all sides. It may now be opened in the water and the ex- 

 tent of the lesion determined at once, and parts saved for microscopical examination. 



If it be desired to preserve the brain for demonstration of the lesion or for a museum 

 specimen, it should be transferred unopened to a large jar containing five-per-cent. forma- 

 lin. A portion of the ventricular fluid should now be removed with a syringe provided 

 with a small canula, and replaced by formalin. This may be done by puncturing the 

 ventricles from below. The fluid in the jar, as well as in the ventricles, should be 

 changed in forty -eight hours. The brain may then be cut transversely across, when 

 the degree of dilatation of the ventricles, etc., will be revealed. The weight of the 

 brain, according to Bischoff, is 380 grains. 



It is normally much softer and pinker than in the adult, the pia more delicate; both 

 may be much congested or anaemic without known cause. The ventricles contain very 

 little serum. Malformations, apoplexies, hydrocephalus, simple and tuberculous inflam- 

 matory lesions, are to be looked for. 



The Spinal Cord. Extravasations of blood between the membranes of the cord 

 may occur from the same causes as those in the brain. Spiua bifida is the most fre- 

 quent malformation. 



The Thorax and Abdomen. These are opened as in the adult. The peritoneal 



1 Or an incision through the bones with a fine saw may be made as in the adult. 



