violent struggles. We must look for weapons and traces of blood; for bottles or anything that may have contained poison. We should next observe whether the body is clothed, or is wholly or partially naked, the clothes injured or stained, the limbs rigid or relaxed, the hands clenched. What is the expression of the face. Whether the eyes are staring or closed; the pupils large, small or unequal. Whether the mouth is open or the teeth clenched, and whether there is froth about the mouth or any peculiar smell. Is the face livid as after death from apoplexy, suffocation, etc., or is it pinched and anxious, the result of severe abdominal symptoms as produced by corrosive poisons? What are the condition of the gums? Has the tongue been bitten?

We should next remove all clothing from the body and note carefully all scars and other means of identification; as, for example, whether the body is fat or thin; whether it is distended with dropsy or gas, etc. If any wounds are found we should ascertain their direction and depth; and should indicate the point at which the missile or weapon would emerge, if the wound had been extended sufficiently far in the same direction. We should likewise note carefully the organs and parts affected by such wounds; also, all circumstances tending to throw any light upon the time as well as the mode of death, such as temperature, rigidity, putrefaction, etc.

If we are not fully satisfied after this inspection, we should next proceed to examine the head and internal viscera in somewhat the following order. Beginning with the head, we first make an incision across from ear to ear down to the bone, reflect the scalp, and look for fractures or injuries to the outer table of the skull. Then we divide the skull all round about half an inch above the meatus auditorius externus; remove the upper portion of the calvarium and note the condition of the dura mater. We then remove this membrane and examine the arachnoid and pia mater. This done, we lift the brain from the skull and note the condition of its base and the sinuses. We next proceed with a keen sharp knife to make sections of the brain and examine congestion, extravasa. tion, clots, lymph, pus, hydatids, aneurisms, tumors, etc.

The examination of the spinal cord is next in order. This is done by cutting through the lamina of the vertebræ on each side of the spinous process. We make sections of the cord and carefully note its appearance and condition.

This completed, we now turn the body over for the examination of the chest and abdomen; which we commence by making a long incision from above the top of the sternum down to the pubes, cutting through and reflecting the muscles and integuments as low as the ensiform cartilage. We next cut through the sterno-clavicular ligaments and the cartilages of the ribs, and reflect the sternum. We now investigate the condition of the lungs. Are they collapsed or do they fill the chest? Do they adhere? Is there any fluid in the pleural cavities, or in the pericardium? Are the cavities of the heart full or empty? We also note the color of the lungs and of the blood in the heart; also, the condition of all large vessels and the air-passages. We open the larynx and trachea and look for foreign bodies, false membranes and marks of corrosion. We open the bronchi in the same way, and make sections of the lungs. This completes the examination of the thorax and its viscera.

We now proceed to the abdomen, noting its contents, the character and condition of its viscera and the peritoneum. We now look for strangulation of the intestines, intus-susceptuns and internal hernia. If we find blood, we look for laceration, of the liver, spleen, kidneys, and rupture of vessels. We also make a careful examination of all the pelvic organs. Having done this we place a ligature around the œsophagal end of the stomach, and two around the duodenal end; after which we proceed to remove the stomach, cutting between the two ligatures last tied.

We then carefully examine the contents of the stomach and duodenum, and also the appearance of the internal walls of these organs. If it is a case of suspected poisoning, their contents should be placed separately in clean, wide-mouthed jars, carefully sealed, labelled and preserved for analysis, if this is deemed necessary, by a practical chemist.

Just here, permit me to remark that every physician should

be able to recognize and determine the condition produced by syphilis, tubercles, typhoid fever, dysentery, tabes mesenterica, etc. Especially is it important in these examinations that he shall distinguish accurately between the rounded and thickened edges of a chronic ulcer, and the thin and frayed appearance of perforations made by corrosive fluids and irritant poisons. It is equally as important for the medical man to be thoroughly acquainted with the post-mortem appearance of healthy organs, so as to enable him to make an intelligent statement of the character and extent of disease found to exist in any of them.

The foregoing is but a briefly-sketched outline of a postmortem examination, which should be made more or less in detail, as the case and occasion may demand.

Having completed the examination and testified to the result of his conclusions before a Coroner's jury, and being in possession of accurate and complete notes of all important facts discovered by him, the medical man is now prepared to appear as a competent and intelligent witness in a court of justice, to give testimony as to the guilt or innocence of the individual arraigned for the crime of murder. The weight of his evidence will depend largely, with an intelligent jury, upon his reputation as a physician, his social and moral standing in the community, and upon the manner and reasonableness of his testimony. That the physician's statements should be made with great care and precision, needs no other proof than the fact that upon his testimony solely may depend the conclusion as to whether death was the result of "natural causes," or of poisoning, or of physical violence. If caused by disease, it will devolve upon him to satisfy the court and jury of its character, and why death was the result. If poison has been the cause of death, he will be expected to establish that fact as well as the particular kind of poison used, and why it destroyed life; and also whether it is necessarily a fatal agent. If death has been produced by physical violence, it will be proper for him to explain whether the wounds received were penetrating, punctured, lacerated or contused. He should state in detail the organs affected.

Where more than one wound has been inflicted, it will be necessary to show whether any one was sufficient, or if all were necessary, to produce death, and whether it were possible for recovery from the injuries under proper medical and surgical treatment. Upon his evidence may also depend a knowledge of the fact as to whether the case is one of suicide or of murder; whether wounds were inflicted in self-defense; whether they were inflicted by a second party, and whether the homicidal act or attempt was the result of previous premeditation and deliberate forethought.

Whatever may be the character of the case on which the medical man is called to testify, this fact is patent, that he should be sufficiently versed in all the details of legal medicine to enable him to meet the reasonable expectations of intelligent people, and acquit himself in a manner creditable to his profession.

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(C) OBSTETRICS AND GYNECOLOGY.

REPORT ON GYNECOLOGY.

By A. L. CLARK, M.D.

To report in minutiæ upon the subject of gynæcology, would require a time and space so great as to be tedious, and too great to be profitably spent by this Convention. I have, therefore, thought it better to simply call attention briefly to a few leading ideas, not by any means claiming completeness in the list, upon which, should the Convention desire, more extended discussion may ensue.

In the multitude of objects presented for such a report, the writer will naturally seize upon and note such points as are or have been perhaps fortuitously of especial interest to him, neglecting other equally valuable and to some, possibly more interesting points.

Whether uterine displacements, especially the different varieties and degrees of flexion, are causes or consequences of hypertrophy and chronic inflammation, is, as heretofore, an unsettled point in pathology, each side finding its able advocates. The experience of the writer would indicate that treatment should not always be based upon either hypothesis. For, if we contend that flexions are caused by hypertrophy from whatever cause, we must logically direct curative treatment to the cause, paying but little attention to the effect. In many cases complicated by pelvic cellulitis little, if anything, can practicably be done for the relief of the flexion until the inflammatory symptoms are removed. Upon the other hand, causes are not infrequent in which flexion exists with little or no tenderness of the uterus or surrounding viscera, and, in such cases, what can be more rational than by straightening the organ to restore a normal calibre of its blood-vessels and thus aid Nature in reducing the hypertrophy? It may be added that experience proves the wisdom of such a course.