In the examination of the abdomen the _color and appearance of the
peritoneum_, _position of abdominal organs_ and _height of diaphragm_
should be noted. Before respiration is established the diaphragm is
at the fourth rib; after respiration is begun it is about one rib
lower on both sides, usually a little lower on the left side than on
the right. The condition of the _umbilicus_ and _umbilical_ vessels
is of great importance (umbilical hæmorrhage, infection, insertion
of cord, line of demarcation, etc.). Note contents, size of lumen,
thickness and character of walls, appearance and moistness of intima.
In umbilical infection the process spreads through the sheaths of the
umbilical arteries rather than of the vein. The infected arteries
contain yellowish-brown purulent thrombi; and the tissues about them
show œdema, hæmorrhages, purulent infiltration or small abscesses.
The perpendicular position of the stomach, the relatively large size
of appendix to that of kidney and spleen, the lobulation of the
kidneys, and the relatively large size of liver and adrenals must be
borne in mind and not be regarded as pathologic. Examine _adrenals_
especially for occurrence of hæemorrhage, infarction and thrombosis.
Look for accessory adrenals (“adrenals of Marchand”) in broad
ligament and along the spermatic cords. Thrombi in the renal and
spermatic vessels are not rare in the new-born. Note occurrence and
degree of _uric-acid infarction of the kidneys_ (formerly supposed
to indicate that child was born alive). Meconium is present in the
large intestine of the child born at term; when prematurely born it
is found only in the small intestine. It is greenish in color and
contains cholesterin, crystals of calcium sulphate, bile-pigment,
desquamated epithelium and granular detritus.
In the examination of the thorax especial attention should be paid to
the _thymus_, noting its size, color, consistence and evidences of
pressure upon underlying structures, particularly upon the trachea.
In death from suffocation small petechiæ are often found in the
thymus and in the serous membranes. The _lungs_ rise up over the
edges of the pericardium and thymus when respiration has occurred,
and their color is a light rose. Areas of atelectasis are bluish. The
unexpanded lungs are brownish-red, firm in consistence and distinctly
lobulated. Air-containing lung floats in water and crepitates, and
gives off bubbles when cut beneath the water. Attempts at artificial
respiration may draw some air into the lungs. Gas-bubbles may be
produced by decomposition. In _white pneumonia_ the lung is pale,
grayish-white and airless. The _larynx_, _trachea_ and _bronchi_ are
to be examined for presence of mucus, amniotic fluid, meconium,
foreign substances, etc. The ligated stomach should also be tested as
to its floating power, and should be opened under water to determine
the presence of air or gas.
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