CHAPTER XXIV.
TREATMENT OF POSTED CASES.
=Cranial Evisceration.=—By this term is meant the complete removal of the brain. To do so the scalp is cut from ear to ear, the front part is pulled forward over the nose and the back part over the occipital bone. A skull clamp is placed in position and with a saw take away the calvarium. When the calvarium or skull cap has been removed the brain is in full view and can be easily removed by cutting the arteries at the circle of Willis and the ligaments at the base of the skull.
=Thoracic Autopsy.=—By this term is meant the complete removal of all the organs of the thoracic or chest cavity. To do so the skin is cut on either side from the sterno-clavicular junction to a point where the ninth rib joins to its costal cartilage. The ribs are cut on either side at the costochondral articulation, which will permit the entire front chest wall to be taken away. The heart and lungs are now in full view and can be easily removed.
=Abdominal Post.=—By this term is meant the complete removal of all the organs of the abdominal cavity. To do so the skin and muscles are cut on either side from a point where the ninth rib joins its costal cartilage vertically downward to about an inch above Poupart's ligament and from there to the top of the pubic bone. When the anterior abdominal wall has been removed all the organs will be in full view and can easily be removed.
=Posted Cases.=—By this term is meant those cases on which an autopsy has been held and all the internal organs of the body have been removed. Here all the internal circulation has been destroyed.
_Treatment._—Place the body on the cooling board and undo all the stitches made by the physician in sewing up the body after the post-mortem. Remove all the organs, that have been previously removed by the physician, and place same in a bucket or other container. Clean out thoroughly all the blood from the cranial, thoracic and abdominal cavities. Now try to tie off the arteries in the cranial cavity which will be the vertebrals or the basilar and the common carotids. If these have been cut too short to be tied, then mix up some plaster of paris and cover them securely so that there will be no leakage. While the plaster of paris is setting raise the common iliac artery, which you will find at the back of the abdomen just over the ilio-psoas muscle, represented by a line drawn from the body of the fourth dorsal vertebra to the center of Poupart's ligament. Inject the right and left common iliac arteries downward which will take care of the lower extremities. Here the only artery you need to tie off is the deep epigastric artery which is a branch of the external iliac just a short distance above Poupart's ligament and which takes a course upward over the abdominal muscles finally to anastomose with the deep mammary artery.
By the time you have injected the lower extremities, the plaster of paris will be set. Work from the inside of the thoracic cavity, and tie off the innominate, left common carotid and the left subclavian arteries, and when this has been accomplished inject each one separately. Here the only leakage you will have will be through the mammary or intercostal arteries which you will tie off as the leakage occurs.
Now turn the body over and hypodermic the back, then turn body over again. Fill the cranial cavity with sawdust, place the skull cap in position and sew up the scalp. Wash all the organs and place them back in the cavities in their proper positions or as nearly so as possible and as you do so fill in with hardening compound. Sew up the abdomen and wash the body with a disinfecting solution and apply outward cosmetics.