THE METHOD OF MAKING POST-MORTEM EXAMINATIONS. 41 



canty contains a very little clear serum. A red fluid may be produced by decomposi- 

 tion. The peritoneum is often the seat of intra-uterine inflammation. 



The Diaphragm. In still-born infants its convexity reaches to the fourth or fifth rib. 

 After respiration it reaches a point between the fourth and seventh ribs. Its position 

 is, however, so variable that it is of little diagnostic importance. 



The Thorax. The thymus gland, at this period very large, occupies the upper por- 

 tion of the anterior mediastinum, covering the trachea and large vessels. Its average 

 weight is about 15.5 grams. It is usually about 5 cm. long, 3.8 cm. wide at its lower 

 part, and about .63 to .85 cm. in thickness. It may be hypertrophied and compress 

 the large vessels, or be inflamed and suppurating. 



The heart lies more nearly in the median line than in the adult. It weighs from 

 20 to 24 grams. The ventricular walls are of nearly equal thickness. The pericardium 

 contains very little serum. A considerable quantity of red fluid may accumulate here 

 as a result of decomposition. There may be small extravasations of blood beneath the 

 pericardium in still-born children and in those born alive. Pericarditis with effusion of 

 serum and fibrin, and endocarditis with consequent changes in the valves, may exist 

 before birth. Malformations and malpositions of the heart and large vessels are not 

 infrequent. The time of closure of the foramen ovale and the ductus arteriosus varies 

 very widely in different cases. 



The pleural cavities contain very little serum, but decomposition may lead to the 

 accumulation of a considerable quantity of red fluid. Small extravasations of blood 

 in the subpleural tissue may be found in children who have died before birth and after 

 protracted labors. Inflammation, with exudation of serum, fibrin, and pus, may exist 

 before birth. 



The lungs in a still-born child are small, do not cover the heart, are situated in the 

 upper aud posterior portion of the thorax, are of a dark-red color and of firm, liver-like 

 consistence, and do not crepitate. In a child born alive, and which has respired freely, 

 the lungs rill the thoracic cavity, but do not cover the heart as much as in the adult ; 

 they are of a light-red or pink color, and crepitate on pressure. If respiration has been 

 incompletely performed, we find various intermediate conditions between the foetal and 

 inflated states. 



If any doubt exists as to respiration having taken place, it is customary to employ 

 the hydrostatic test. This is done by placing the lungs, first together, then separately, 

 and afterward cut into small pieces, in water. It is commonly said that if they sink 

 the child has not breathed ; if they float it has. This test is not, however, a certain 

 one. 1 



The lesions of inflammation, and vesicular and subpleural emphysema, may be 

 found in the lungs of new-born children. 



The pharynx should be opened and examined for foreign bodies. 

 ' The larynx and trachea should be examined for the lesions of inflammation and for 

 injuries to the cartilages. 



The thyroid gland weighs about 12 grams. It may be so enlarged as to interfere 

 with respiration. 



The Abdomen. The kidneys are lobulated and proportionately larger than in the 

 adult. Thoma estimates the average weight of both organs together as 23.6 grams. 

 There may be ecchymoses on their surface ; inflammation ; deposits of uric acid and 

 urates in the tubules of the pyramids; cystic dilation of the tubules, sometimes reach- 

 ing an enormous size. There may be absence or retarded development of one kidney. 

 Malformations and malpositions of the kidneys are of frequent occurrence." 



The adrenals are large. They may be dilated into large cysts filled with blood. 



The spleen is large and firm. Its average weight is about 11 grams. It may be 

 abnormally enlarged, and its surface is sometimes covered with fresh inflammatory 

 exudations. 



The Intestines. In the small intestines, inflammation and swelling and pigmenta- 

 tion of the solitary and agminated follicles (lymph nodules) are sometimes found. The 



1 See works on medical jurisprudence. 



