James J. Putnam M.D.
Albert M. Barrett, M.D.
Elmer E. Southard M.D.
Routine Methods of the Danvers State Hospital Laboratory:
The performance of an autopsy is dependent upon the consent of the relatives or nearest friend, except in case the body is unclaimed at the end of three days following death, when no consent is necessary. Because of this law, many cases of great interest and importance are not autopsied. It has often been urged, and with justice, that there should be an autopsy on the body of any person who has been supported at State expense, if such is desired by the institution physicians. This would solve also the vexing problem of the interval between death and autopsy.
During the past year consent for autopsy has been obtained in about 58 per cent. of the deaths.
All bodies are removed from the ward to an ammonia process refrigerator as soon after death as may be possible.
The fixing fluids used at the autopsy are three in number. In Zenker's fluid are put pieces from each of the body organs, and from three levels of the cord. In 10 per cent. formalin we put pieces from all of the body organs and the remainder of the cord. When the brain is sectioned at the time of autopsy, pieces from certain different areas are fixed in 95 per cent. alcohol, Zenker's fluid and formalin. The remainder of the brain, or the entire brain when sections are not made at the time of the autopsy, is fixed in 10 per cent. formalin containing 0.6 per cent. of sodium chloride. When the brain is preserved entire, a thread is passed through the carotid arteries, and another through the pia mater of each hemisphere just behind the corpus callosum. These threads are long enough to bring up across the top of the brain jar after it is covered, and there tied. The brain is thus suspended in a practically isotonic fluid, base up, and is fixed without any pressure distortion.
If the brain is fixed in toto, it is allowed to harden for at least six months and preferably a year. It is then gone over again and the original description checked up and amplified, if necessary. If it presents lesions of certain types, it is then photographed. If there were time, it would be desirable to photograph all brains from certain classes of cases, for more intensive group study. At present there is only time for cases with certain rather definite lesions.
In photography we use a Cooper-Hewitt mercury vapor arc lamp, which frees us from having to consider outside light conditions. All of the photography is done with a vertical camera, using a 13¾-inch anastigmat lens and 5 by 7-inch plates. For a black background velvet is best. We find that Stanley plates give quite as good results and are much cheaper than other makes. For photographing sections, however, I prefer the Cramer Iso Medium, as these give greater contrast to the bleached out gray matter. For printing, Azo paper is entirely satisfactory and cheap.
After being photographed (or when cut up at autopsy) small blocks are taken from the first frontal, precentral, postcentral, first temporal, calcarine and hippocampal convolutions of each hemisphere, from the cerebellum, pons and medulla and in some cases basal ganglia. These blocks are strung on a white thread along with a slip identifying each, are embedded in paraffin, and sections stained in cresyl-violet.
The remainder of the brain is now jacketed with cheesecloth, labeled, and stored along with others in straight-sided stone crocks of 6-gallon capacity, which will easily hold 8 or 10 brains. Special care must be taken of the labels, since they are immersed in formalin solution. We use only the best quality of paper and India ink. To the wrappers, if desired, may be tied a long thread with a tag on the end. This tag is allowed to hang over the edge of the jar under the cover, and thus is never in danger of fading from the action of the solution. Furthermore, this offers a convenient way of finding any desired brain in the crock. Care must be taken to tie these securely to the wrapper.