THE RESTORATION OF THE BODY.
When the autopsy is finished the body-cavities are cleansed and then
thoroughly dried. No blood, stomach- or intestinal-contents should be
left in the cadaver. All bleeding or dripping parts should be tightly
secured; the anus and vulva should be tightly stitched, and the penis
ligated. If necessary, the organs are then cleansed and returned to
the body, as nearly as possible to their normal positions, although
the brain, because of the difficulty of getting it back into the
skull-cap, is usually put into the thoracic cavity. When several
autopsies are done at the same time, care should be taken not to mix
the organs. The undertaker should always be aided in his work; and,
if he so desires, an embalming powder or fluid may now be sprinkled
or poured into the cavities.
The skull-cap must be securely fastened in its normal position, so
that no slipping can occur. If the body is not to be shipped any
distance the posterior interlocking joint will usually hold it firmly
in place if the scalp is drawn tightly together and closely stitched.
When the body is to be moved some distance, the skull-cap must be
more firmly fastened. This can be accomplished by drilling holes at
the sides of the saw-cut and fastening the skull-cap to the cranium
by means of copper wire, which must be tightly twisted and pressed
flat against the bone. When this is done in the temporal region the
wire is completely concealed by the temporal muscles when these are
drawn up with the scalp, or if these have been cut away pads of
cotton can be put in their place. The cranial fossæ and the skull-cap
may be filled with plaster-of-Paris; while this is still soft a piece
of wood may be pushed through into the foramen magnum and allowed to
project high enough above the saw-cut to hold the skull-cap on, when
it, filled with plaster, is put in position. With the setting of the
plaster the skull-cap is firmly held. A little ingenuity will suffice
to improvise various other methods of securing the skull-cap, by the
use of bandages, metal pins, etc. After the employment of Harke’s
method the halves of the skull must be brought together and securely
fastened at the base or in the occipital region. After resection of
the temporal bone for the examination of the auditory apparatus the
defect must be filled in with cotton or other substance, and the
lower jaw and external ear restored to their normal positions. After
examination of the orbit and the removal of the posterior half of
the eye-ball a wad of red- or black-stained cotton should be used to
fill out the eye so that it will have the same degree of fullness
that the other eye has. When the eye is enucleated a glass-eye may
be substituted and the lids fastened together by fine stitches made
on the conjunctival side. If it is desired to save the skull-cap an
artificial skull-cap may be molded from a square piece of pulp-board
of the thickness of 0.5 cm. in the case of the adult, somewhat
thinner for children. The pasteboard is soaked in warm water for
about fifteen minutes, and is then molded over the skull-cap. It is
then cut parallel with the edges of the saw-cuts so that the edge of
the board will extend about 1 to 1.5 centimetres over the edges of
the skull-cap to overlap the bones below the saw-cut. The cranial
cavity is then filled with plaster or cotton. The pasteboard is
removed from the skull-cap before it becomes too dry for its lower
edge to be adapted easily to the lower border of the saw-cut. Ridges
or folds are trimmed off with the knife and the surface made smooth.
It is then adjusted and firmly fastened in position by passing
several turns of strong twine around the lower border over-lapping
the cranial bones. The temporal muscles and the scalp-flaps are then
drawn up and tightly stitched. A close base-ball stitch should be
used to fasten the scalp-flaps, and a black thread should be used. If
the scalp has been stretched so that it is loose and baggy, a portion
of it may be cut out, so that when sewed together the flaps will fit
tightly. The hair must be freed from all bone-dust and blood-clots,
washed if necessary, then dried, and arranged in its former position
in such a manner as to hide the sutures.
The place of any bone that has been removed may be filled by a piece
of wood cut to the required proportions, and securely fastened
by wire or bolts, or plaster-of-Paris may be poured about it and
allowed to set. After removal of the spinal column or of portions
of it, there may be substituted a block of wood or an iron pipe of
suitable size, which may either be securely fastened above and below
by means of wire or bolts, or it may be held in place by imbedding
it in plaster-of-Paris. These expedients are not necessary after
the removal of the cord alone, but only when entire sections of the
spinal column are removed. When the cord is removed posteriorly the
skin-incision is tightly closed with a base-ball stitch, and then
covered with a strip of surgeon’s plaster or collodion to prevent
leakage of blood and serum after the body is turned over.
The thoracic and abdominal cavities are filled with dry bran,
saw-dust or finely-cut excelsior to fill out the normal contour, a
piece of old cloth or paper is laid over the whole, and the sternum
replaced. It is usually not necessary to fasten the latter, but if
desired the costal cartilages may be stitched together, or wired
when the needle cannot be pushed through the cartilage. When the
tongue and neck-organs have been removed, the lower jaw must be held
in position by fine stitches in the mucous membrane of the lips to
prevent the jaw from dropping and leaving the mouth open. The contour
of the neck may be restored by a pad of cotton.
The main-incision is then closed by a continuous base-ball stitch,
using a stout linen pack-thread and a rather large, slightly curved
needle. The first stitch begins in the middle-line about 1 cm. above
the beginning of the main-incision, the needle being introduced from
below through the incision, and the thread secured at its end by a
knot. The stitches are then made about 5-7 mm. apart, the needle
each time being pushed through the skin from the inside, so that it
comes through the skin about 5 mm. on either side of the incision,
alternately to the left and right. The thread is kept tightly pulled,
and as perfect coaptation as possible is secured. At the end of the
incision the thread is secured by a knot before it is cut. Collodion
or surgeon’s plaster may then be used to cover the entire incision.
All other skin-incisions are sewed up in the same manner. When
the testes and the body of the penis have been removed, it may be
necessary under certain conditions to restore the form of these parts
before the main-incision is closed. Cotton wads may be used for this
purpose.
When all incisions are finally closed the cadaver is carefully washed
and all blood-stains and discolorations removed. When formalin has
been used as an injection-fluid blood spilled upon the skin may
produce a brownish stain that is removed with difficulty. Corn-meal
or hand-sapolio may be used to remove such stains. After the cadaver
has been thoroughly washed, it is dried, and can then be turned over
to the undertaker.