A surgical handbook : for the use of students, practitioners, house-surgeons, and dressers / by Francis M. Caird and Charles W. Cathcart.

Caird, Francis Mitchell, 1853-1926

Date:: 1889

Credit: A surgical handbook : for the use of students, practitioners, house-surgeons, and dressers / by Francis M. Caird and Charles W. Cathcart. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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$CIIAITKR XXVIII. POST MORTEM EXAMINATION. Contents. IVi.-liminarii-s- Special Mxamination: lln; liitad—Neck anfl Thorax- Mcarl anil l^ungs- .Mjdoincn—Spinal (Joril. 'I'llK practitidncr may he called upon lo make a post-mortem examination, either in private or in a mortuary. In jirivate practice it is well lo be provided with a plentiful supply of newspapers, a couple of old sponi,res, mackintosh, collon wadding, twine and one or two jars, in addition to the usual case of instruments. Preliminaries. - It is always advisable to have an assistant to take notes as the examination proceeds. The body should be lifted from the coffin, and laid on a long lal)le. Tiie grave-clothes should be most carefully removed, and laid aside in due order, and the pins with which they were secured retained in ]xjsition for re-insertion. The general apjiearance and state of nutriti(jn, rigor mortis, and liy]X)static congestion should be noted, and the length of the body and its thoracic circumference ascertained. Ivocal peculiarities, such as cEclema, birtii marks, deformities, cicatrices, wounds, and the condition of tiie pupils should l)e described. Newspapers are now to be packed under and around the body. The jjart on which interest chiefly centres should he first examined. Special Examination—The Head.---To relk-ct tlie scalp, the knife shoidd be entered deejily hehind the ear with the back directed towards the bone and the edge towards the skin. It is now firmly pressed against the skull-cap, and carried across the vertex to the opposite ])oint. The two flaps thus formed are to be thrown well down, detachment being effected by means of the handle of the knife, aided by a few touches with the blade. The pericranium and attachments of the temporal muscles are now divided by sweeping the scalpel around the skull, about three-quarters of an inch above the upper angle of the orhit, and iia!f-an-inch above the occipital protuberance behind. The saw is more easily managed if the table be low. It is advisable either to stantl on the left side of the cadaver, and grasp the frontal flap with the left hand, or to stand on the right side, and steady the head with the left hand wrapped in a towel. The saw is now carried, at the marked out level, lightly through the outer table, except at the temporal ridges and occipital bone, where the entire thickness of the skull-cap should be divided, care being taken not lo injure the dura mater or the brain. Tlie chisel may now lie inserted and detachment completed by means of a few smart strokes with a mallet; or by merely rotating the chisel in the saw-cut, the skull-cap may be prised off. [In Medico-legal Cases, and where fracture of the cranium is sus- pected, the saw should divide the entire thickness of the bone every- where, as the chisel is apt to make cracks and fissures. If the skull-cap$