SOME PRACTICAL POST-MORTEM POINTS. 
A PAPER READ BEFORE 
THE PHILADELPHIA COUNTY MEDICAL SOCIETY, 
OCTOBER 25, 1893. 
BY 
HENRY W. CATTELL, A.M., M.D., 
DEMONSTRATOR OF MORBID ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA SOME PRACTICAL POST-MORTEM POINTS. 
By HENRY W. CATTELL, A.M., M.D., 
DEMONSTRATOR OF MORBID ANATOMY IN THE UNIVERSITY OF PENNSYLVANIA. 
[Read October 25, 1893.] 
1. Gbt all the anatomical knowledge you can out of every autopsy 
you make. It is, therefore, usually advisable, especially in the case 
of females, to perform a preliminary laparotomy. Many surgical 
operations can be practised upon the body without disfigurement, 
such as Alexander’s operation, oophorectomy, removal of the ear 
ossicles and vermiform appendix, stretching of the sciatic nerve, sym- 
physeotomy, etc. 
2. Do not forget to dictate the post-mortem notes while the autopsy 
is in progress. 
3. Respect the feelings of the friends in every possible manner, 
and always return everything in a private house to its proper place. 
Be sure to leave no blood-marks behind. 
4. Be sure you have a legal right to make the post-mortem before 
you begin. The nearest relative, or the one who is going to pay the 
expenses of the funeral, should give the consent in writing. 
5. Do not take away more tissue from a post-mortem than you are 
able to thoroughly work up. 
6. Try to encourage a demand among the laity for the performance 
of autopsies. 
7. In making an autopsy have a regular method for its perform- 
ance, which is only to be modified by exceptional circumstances. 
Finish the examination of each organ in as thorough a manner as pos- 
sible before the examination of another organ is commenced. 
8. Label all your specimens at once with the name of the person 
from wdiom the specimen is removed, character of the specimen and 
relations in the body, date, and preservative fluid employed. 
9. If you are so unfortunate as to cut yourself, wash the wound 2 
CATTELI,, 
with running water for four or five minutes, and then dress anti- 
septically. I)o not, out of bravado, go on with the post-mortem, if 
there be anyone else present who can complete it. 
10. If you are not making the autopsy yourself, do not be too for- 
ward in making suggestions to the one who is making it; but always 
be ready to do anything that you are asked to do in connection with 
the autopsy. 
11. Let your medical friends enjoy the autopsy and specimens 
with you. 
12. Get all the posts you can ; never refuse to make an autopsy for 
another, when you possibly can. 
13. Tact will get you many autopsies; curiosity of relatives and 
friends can often be worked upon to get permission for an autopsy. 
14. As the object of the autopsy is usually to find out the cause of 
death, either for legal or scientific purposes, the post-mortem should, 
therefore, be conducted in as thorough and accurate a manner as 
possible. 
15. In legal cases be sure to protect yourself in every possible way. 
The jars (which should never have been used) containing the speci- 
mens should be sealed in the presence of a witness. In important 
cases here in Philadelphia, the Coroner has both of his physicians 
present at the autopsy, so that the testimony is stronger; and in case 
of absence of one of the physicians the other can go on the witness 
stand and the case not be postponed. 
16. If you value your peace of mind do not put yourself forward 
as an expert witness in medico-legal matters. Knowledge which you 
already have should be freely given to the court in criminal cases, but 
the court cannot compel you to obtain expert knowledge without your 
consent. 
17. In Germany the legal evidence of a post-mortem held by gas- 
light has been judged by the court, except under certain peculiar 
circumstances, to be void. 
18. If two persons are lifting the body the lightest weight is at the 
feet. 
19. Chloroform, when placed on a towel and the head enveloped 
in the towel, will quickly dispose of pediculi capitis. 
20. Many signs of inflammation, especially of the mucous mem- 
brane, disappear after death. Remember that red flannel often colors 
the skin red. 
21. Make the undertaker your friend. Do not recommend an 
undertaker who disapproves of post-mortems. SOME PRACTICAL POST-MORTEM POINTS. 
3 
22. It is a good knife that will keep its edge in more than one post- 
mortem. 
23. Do not jump at conclusions too quickly. Tentative diagnoses 
alone should be made until the post-mortem is complete. 
24. Always weigh the important organs, and have some method by 
which you can tell the right from the left organ in case of the double 
ones. One nick in the left-sided organs and two in the right will 
readily distinguish them. 
25. Wash your hands frequently during the performance of an 
autopsy so as not to allow the blood to dry on the skin. 
26. In opening a cystic kidney be careful that the liquid does not 
injure the eyes or soil the linen, as when the kidney is opened the 
liquid in the cyst is under pressure and may squirt several feet. 
27. A duct can often be easily followed by making a nick in it, and 
then introducing a piece of broom stick or a grooved director in the 
direction you desire to dissect. This is especially useful in the ureters 
and the ductus choledochus communis. 
28. In writing the account of an autopsy describe what you see; 
do not use names of diseased conditions. These should be put in 
under the head of pathological diagnoses. 
29. Urine, or aromatic spirit of ammonia will best take off the 
odor from your hands. This odor is usually gotten from opening the 
intestines. 
30. Ammonia (also the aromatic spirit) will remove iodine stains; 
a weak solution of the hypobromite solution will remove carbo-fuchsin 
and other aniline stains from the hands. 
31. Any organ which you desire to save should be placed in a safe 
place so that it will not be returned to the body and sewed up. 
32. The dissecting-room is a poor place in which to study pathology, 
on account of the chloride of zinc forming with albumin an insoluble 
albuminate of zinc. 
33. Nervous tissue for microscopic study should not be placed in 
zinc chloride or in alcohol. 
34., Remember that a post-mortem, with the exception of the brain 
and cord, can be made with a penknife. 
35. Remember that the thoracic and abdominal organs can be 
removed by the rectum or the vagina. 
36. Before removing the calvarium have a basin so placed that it 
will receive the blood and cerebro-spinal fluid. 
37. Drawings, photographs, casts, cultures of micro-organisms, and 4 
SOME PRACTICAL POST-MORTEM POINTS. 
microscopic slides are valuable additions to a well-written account of 
an autopsy. 
38. A lesion in one part of the body will often suggest a careful 
search for a lesion in another part of the body. 
39. Do not mistake the normal for the abnormal. 
40. Squeezing the gall-bladder after the duodenum has been laid 
open, will often cause bile to pass out, and the papilla, the ending of 
the common bile-duct, can thus be demonstrated. 
41. Remember that frozen sections of fresh tissue can be cut and 
mounted in a half-hour to an hour. 
42. Three hours is none too long in which to make a complete 
autopsy. 
43. Be careful that the first rib does not scratch your hands when 
removing the tissues in that region. Therefore cover over the cut 
ends of the clavicle and ribs with the skin flaps. 
44. Blood makes a good glue for affixing labels, and the blood of a 
person dying from hydrocyanic-acid poisoning makes a most excellent 
red ink which will keep for years without the addition of any preser- 
vative fluid. 
45. Remember that after the brain has been removed the fundus 
of the eyes can be excised by a circular incision posteriorly, without 
disfigurement. The cavity should then be stuffed with dark-colored 
wool or cloth. 
46. In private cases your skill as a pathologist will be frequently 
judged of by the neatness with which you sew up the body. 
47. If you discover suspicious lesions always stop the post-mortem 
and report the case at once to the Coroner. 
48. Remember that in warm weather the intestines are especially 
liable to undergo rapid decomposition when exposed to the air. 
49. Remember that a railway train or cart may pass over the body 
and there be no abrasion in the skin more than a brush burn. 
50. Remember that the color of organs is frequently changed when 
exposed to the air by the oxidation of the haemoglobin. Also that 
the sulphide of iron frequently discolors organs after death, due to the 
sulphuretted hydrogen during decomposition precipitating the iron of 
the haemoglobin. 
51. The clavicle can be grasped and moved and the claviculo- 
sternal articulation thus readily discovered. 
52. In removing the spinal cord the following method may be used 
without disfigurement to the skin of the back part of the neck. Make 
a circular incision from the middle of the trapezius muscle of the one DISCUSSION. 
5 
side to the middle of the same muscle of the other side, using as the 
centre of the circle the external occipital protuberance. This will 
take you in the median line to about the second dorsal vertebra ; then 
dissect away the skin with the muscles attached, and elevate this flap 
with a tenaculum and draw the shoulders backward. A sufficient 
amount of space will be then given to remove the cord in the usual 
manner. 
53. If the rectus muscle on each side be cut near its origin, in the 
direction of Poupart’s ligament, the abdominal cavity will be much 
more thoroughly exposed to view than in the ordinary manner. First, 
however, examine with the finger for hernia. 
54. And lastly, be honest. Everyone diagnoses lesions during life 
which are not found at the post-mortem. Even after a most careful 
post-mortem it is often impossible to tell from what the patient died. 
DISCUSSION. 
Dr. G. Betton Massey : This paper shows that the art of one who makes 
post-mortems is something of a specialty, a matter which I have often thought 
was true, and hence, not being a specialist in that direction, I have allowed 
some opportunities for scientific study to escape me. That we should use the 
services of the specialist in cases requiring autopsy I am convinced, but the 
question arises as to how we can arrange to thus serve science in these cases. 
Who is to pay to have the work done properly ? There are few physicians 
who would be willing to go into their own pockets to pay for the services of a 
specialist in this final act in the drama of life. It occurs to me that such 
work might-be done by this Society if it had sufficient capital. The mem- 
bers might have some arrangement by which they could call upon an official 
postmortem-maker of the Society for his co-operation, either free or at a small 
expense, in accordance with the case. Such a service would be of far more 
importance than that of the mere microscopist, which many societies have. 
I doubt if work with the microscope alone is attended with such possibilities 
as lie in the hands of the all-around pathologist.