The_Invention_of_Surgery

around, handle the organs with our hands, and use our powers of
observation to guess what hastened death.
A more advanced technique would be to cut out the organs as they lay in
the thoracic and abdominal cavities. With the Rokitansky method, groups
of organs are removed at once, and inspected on a side table. Virchow’s
technique is to remove the organs one by one in situ, cutting into them and
preparing tissue samples for microscopic analysis, a dramatic leap
forward compared to manual manipulation alone.
Today, we will use a technique that, indelicately stated, reminds me of
how I learned to “gut a deer” while hunting with my father and brothers
on our family’s ranchland in Wyoming. The Letulle technique involves
exposing all the organs and intestines from throat to anus, and dissecting
them cleanly away en masse. While cutting away the soft tissue
connections from the cavity walls, the pathologist lifts out the heart and
lungs, all the intestines, and all the abdominal organs while still
maintaining all the connections to each other; what remains are hollowed
out, empty cavities. On the dissection table, all the organs are much more
easily evaluated, with easy inspection of every aspect of every organ, since
they are no longer tethered down to the body walls. This method is favored
by my mentors, and no doubt arose from someone who was from a hunting
family.
After removing the mass of organs and tissues, Dr. Anderson and I
struggle to transport the slippery jumble of tissues onto the dissection
table. Here, we slowly start to cut into the organs, looking for gross
abnormalities. Small tissue samples are collected, and we plop the masses
into small plastic containers with labels, filled with formalin, and screw
on the orange lids.
The head is approached last. The hair on top of the corpse is divided,
and after making a long incision along the top of the skull, the skin is
easily peeled down on either side, exposing the skull. A specialized saw is
used to cut the bone all the way around the top of the skull, and after
chiseling away the final soft tissue connections, the membrane around the
skull is encountered—smooth, thick, and opalescent. This is the dura mater
(Latin: tough mother), and after cutting through it, the brain is
encountered. Severing the nerve connections and the spinal cord at the
bottom of the brain, the gelatinous mass is lifted out by Dr. Anderson, and
he (unbelievably) hands me an entire human brain.