selves, are then to be divided; the pituitary body to be dislodged from the hollow in the centre of the sphenoid bone; and an incision is to be made through the fourth nerve, and the tentorium cerebelli close to its attachment to the temporal bone. We then successively perceive, and must divide, the two roots of the fifth nerve, the sixth, the seventh with its facial and auditory portions, the three divisions of the eighththe glosso-pharyngeal, pneumogastric, and spinal accessory,— and the ninth nerve. Lastly, we cut across the vertebral arteries as they wind round the upper portion of the spinal cord, and then, as low as possible, divide the cord itself, with the roots of the spinal nerves attached on each side. The brain may now be readily taken from the skull, and carefully examined, by slicing it in thin layers in the horizontal direction, from above downwards. The vascularity of the gray and white portions, the quantity of fluid in the ventricles, and the condition of the cerebral arteries must be noticed. To judge of its consistence, a fine stream of water should be poured from a height on the different parts, as they are successively exposed.

The Spinal Cord is to be exposed by sawing through the arches of the vertebræ on each side, close to the articular processes, after the skin and muscles have been divided down to the bones. In some parts-as in the hollow of the lumbar region-difficulty will be experienced in using the saw; a chisel and hammer will then be found useful. When the spinal canal is opened, the strong tube of the dura mater prolonged from that lining the skull will be exposed; this is to be slit up, and the cord, examined in situ, at the same time observing the quantity of fluid in the spinal canal, and the condition of the spinal veins. Subsequently divide the anterior and posterior roots of the thirty-one spinal nerves, and remove the cord for a closer inspection.

The Thoracic and Abdominal Cavities.-For the purpose of examining the morbid appearances presented by the thoracic and abdominal viscera, we open the cavities containing them at the same time, by making a straight incision from the thyroid cartilage of the larynx down to the symphysis pubis. Dividing the integuments, muscles, and peritoneum, we open the abdomen, the contents of which may be more readily exposed by making, in addition, a transverse subcutaneous incision on each side, through the fascia, muscles, and peritoneum; then dissecting back the skin and muscles covering the front of the thorax, we expose the cartilages connecting the ribs with the sternum. The cartilages are then to be

cut through at their junction with the ribs, except those of the first ribs; and the sternum may now be raised like the lid of a box, a good substitute for a hinge being made by cutting the articulation of the first joint of the sternum on the inside.'

In inspecting the trachea and bronchi, they should be opened along their anterior surface. To show the valves of the heart, the right ventricle must be opened by a V-shaped flap, made by an incision immediately to the right of the septum, meeting at the apex another, carried along the right edge of the heart. Before laying open the pulmonary artery, the finger should be introduced, so as to guide the incision between the valves. The left ventricle should be opened by an incision in the direction of the aorta, beginning at the apex, a little to the left of the septum, having previously dissected the pulmonary artery off from the aorta, and taking care to use the same precaution against injuring the valves as in opening the pulmonary artery.

The Urinary and Generative Organs may be readily removed from the body for examination through the pelvis, and if the integuments in the perineum be left uninjured, and the several outlets stitched up, any portion presenting diseased appearances may be taken away without disfiguring the body, and without any of the contents of the abdomen protruding. With regard to the remaining viscera, no special directions seem necessary as to the mode of preparing them for inspection.

SECTION 8. MODE OF TAKING NOTES OF A POST-MORTEM EXAMINATION.

As it is of course requisite that the details of the morbid appearance should be strictly accurate, the notes should be taken at the time of making the autopsy. The following arrangement may be adopted :

General Observations.-Name; age; day and hour of death; day and hour of examination; temperature to which the body has been exposed; degree in which external sexual characters are marked, mammæ, mons veneris, &c.; state of nutrition; eruptions; peculiarities of formation, or deformities; œdema of face, limbs, or trunk; marks of violence, contusions, wounds; degree of rigor mortis; and the presence or absence of any marks of putrefaction.

Examination of Head, Face, Mouth, and Fauces:Bones of the head; fractures and their seat; adhesions of

calvarium to dura mater; characters of dura mater, arachnoid, and pia mater; Pacchionian glands; quantity and character of the sub-arachnoid fluid. Weight of brain; weight of cerebrum, pons Varolii, medulla oblongata, and cerebellum. Convolutions of the brain, their appearance and consistence. White and gray substance of hemispheres; consistencewhether natural, increased, diminished, soft, creamy, diffluent; color of cut surface; number and size of red points. Extravasation of blood; situation; quantity. Unnatural cavities in cerebral substance; situation; contents; linings; state of surrounding brain substance. Tubercular, calcareous, or malignant deposits. Lateral ventricles; contentscolor and quantity of fluid; condition of choroid plexus. Third ventricle; contents. Optic thalami and corpora striata. Pons Varolii. Medulla oblongata. Cerebellum; form; firmness; color; appearances on section. Face; lips; cavity of mouth, contents-food or foreign substances; teeth, whether recently fractured; tongue-size, form papillæ, if stained or corroded. Fauces; tonsils; pharynx, contents of, nature of; œsophagus, dilated or constricted; epiglottis, rima glottidis.

Examination of Thorax.-Trachea; bronchial tubes. Pleura; nature and quantity of fluids effused into pleura. sacs; adhesions. Lungs; external characters; degree of collapse; puckering at any part; cicatrices; emphysema; deposits of tubercle, of cancer; hydrostatic test, whether the lungs sink or float, result with various portions; substance of lungs, consistence, exudation of serum on section; crepitation; abscess; gangrene; pulmonary apoplexy; tubercles, their seat and condition; cavities, their seat, size, form, contents, and if communicating with bronchial tubes; cysts; deposits of cancer. Pericardium; adhesions; effusions; white spots, their size, shape, and situation. Heart; weight; size; quantity of blood contained in various cavities, and its condition, frothy, liquid, or coagulated; thickness of walls; size of cavities, right auricle and ventricle, left auricle and ventricle; condition of musculi pectinati, columnæ carneæ, chorda tendineæ; condition of foramen ovale; auriculo-ventricular openings tricuspid valve, bicuspid or mitral valve; aperture of pulmonary artery, semilunar valves, and corpora Arantii; aortic orifice, valves, and corpora Arantii. Coronary arteries, their condition. Microscopical examination of muscular

fibres of heart.

Examination of Abdomen.-Peritoneum; condition; contents; parts through which hernia have passed. Liver; external characters, form, measurement, weight, color, condi

tion of capsule; substance, cut surface, color, degree of fat, deposits of tubercle, of cancer; cysts; gangrene; microscopical examination. Gall-bladder; size; shape; contents; calculi; ductus communis choledochus. Spleen; position; size; weight; capsule; substance. Pancreas; position; weight; substance; color; duct. Kidneys; external cha racters; capsule; surface after removal, if lobulated, granulated; cut surface; cortical substance; pyramidal portion; pelvis of kidney; ureters; microscopical examination. Urinary bladder; contents; walls. Stomach; position; size; form; contents; condition of mucous membrane; ruga; cardiac orifice; pyloric orifice; walls of; cicatrices; ulcers; perforations; wounds. Abnormal condition of intestines generally; cicatrices; ulcers; wounds; perforations. Duodenum; Brunner's glands; ductus communis. Jejunum and ileum; valvulæ conniventes; villi; Peyer's patches; glandulæ solitariæ. Cæcum; appendix vermiformis; ileo-cæcal valve; ileo-colic valve. Colon; glandulæ solitariæ. Rectum; hemorrhoids; prolapsus.

Examination of Male Organs of Generation.-Inguinal canal; vasa deferentia; spermatic cord; tunica vaginalis; testes; penis; prostate gland.

Examination of Female Organs of Generation.— Labia; nymphæ; clitoris; urethra; hymen; vagina; uterus -lips, size of cavity, thickness of walls; Fallopian tubes; ovaries; pelvic tumors.

Examination of Spinal Cord; vertebral canal; theca vertebralis; size and consistence of cord, cervical and lumbar enlargements, gray and white substance; roots of nerves; cauda equina.

SECTION 9. THE CLINICAL EXAMINATION OF THE

INSANE.

The clinical examination of a man supposed to be insane differs very materially from that adopted in the diagnosis of corporeal diseases. To inquire of a lunatic of what he complains or where he suffers pain-or how long he has been ill?-is in the majority of cases useless; since he will only reply that he has no pain, that he is quite well, and that he wishes to know by what authority you venture to question him. Neither does the appearance of the tongue, the nature of the pulse, nor the character of the secretions afford us any valuable indications; but we are obliged to rely upon the informa

tion gained from a close examination of the physiognomy actions, conversation, powers of memory, &c. The state of the general health is, however, by no means to be neglected, since, as is well known, the body affects but too closely the state of the mental faculties :-want of vitality and of nervous tone, deficient healthy action of the skin and internal organs, and torpidity of the primæ viæ, are, moreover, exceedingly common in the insane.

The difficulties experienced in the diagnosis of insanity will, of course, depend upon the degree in which the mental faculties are lost. The complete maniac lives in a waking dream; he raves without the power to control himself, without the power of appreciating the necessity for doing so; he is completely the victim, not in the least the master, of the strongest impressions uppermost in his fancy. The partially insane person, on the other hand, will restrain himself, though probably with a great effort, on occasions when he thinks such restraint advisable, as before strangers, &c. The majority of insane people-especially chronic cases are able by a greater or less degree of exertion to restrain their insane impulses on occasions, and they do so. Consequently, we must draw our conclusions not merely from the evidence derived from the nature of the countenance, or of the actions, or of the conversation, but from our entire-and, if necessary, frequent and unsuspected-examination of the patient.'

Investigation of the Physiognomy.-To appreciate correctly the inferences to be drawn from this examination, the eye must be practised by long-continued observation not only of the insane, but of the varieties of expression which indicate the growth, normal state, and decline of mental vigor. We should be familiar with the cheerful open countenance of the man in the enjoyment of mental and bodily health and ease, with the vacant stare of the thoughtless, the melancholy visage of the disappointed, the dreamy look of the absent man, and with the wildness of expression of the maniac; we shall then be able justly to estimate the evidence written upon the forehead, the expressive language spoken by the eyes-the mirror of the mind, and the inward restlessness betokened by the constant play of the muscles around the mouth. The more closely these appearances have been observed, the more readily will the peculiar manifestations of insanity be recognized.

Investigation of the Actions.-From examining the

'See Remarks on Insanity, by Dr. Henry Monro.