public expense, shall deliver same to member of State or county medical
society, etc., for anatomical study, unless claimed by relatives, or
they consent to such disposal, or deceased requested to be buried, or
was a stranger or traveller (S. & B. Am. Stat., sec. 1,437).
THE POWERS AND DUTIES
OF
CORONERS AND MEDICAL EXAMINERS.
BY
AUGUST BECKER,
_Of the Buffalo (N. Y.) Bar_.
THE POWERS AND DUTIES
OF
CORONERS AND MEDICAL EXAMINERS.
BY
AUGUST BECKER,
_Of the Buffalo (N. Y.) Bar_.
POWERS AND DUTIES OF CORONERS AND MEDICAL EXAMINERS.
I. THE CORONER AND HIS COURT.
_Coroner an Ancient Officer._—The office of coroner is one of the
most important and ancient known to the common law. A coroner, or
_coronator_, was so called because he had principally to do with
the pleas of the crown, or suit wherein the king was immediately
concerned.[507] The office is first mentioned in a charter granted in
the year 925 by King Athelstan, to the authorities of Beverley. The
office as at present constituted was not clearly established until
after the Norman conquest.
Under this head come the lord chief justice and puisne justices of the
King’s Bench, who are supreme and sovereign coroners respectively.[508]
The duties of the office of coroner involve questions of the greatest
interest to society, to government, and to the rights and privileges
of the individual citizen. The office has lost much of the honor and
respect which formerly appertained to it. Its character and importance
have been much diminished in latter times, making striking contrast
with the high estimation it was held in by our ancestors in days when
none but the gentry and knights of the shire were deemed eligible.
In fact so great was the dignity of this office in ancient times, that
it was never presumed that coroners would condescend to be paid for
their services.[509] They were chosen by all the freeholders of the
county court for life or good behavior, and were liable to be removed
for cause by the writ _de coronatore exonerando_. There were three
kinds of coroners at common law: _Virtute officii_; _virtute cartæ sive
commissionis_; and _virtute electionis_.[510] The office of coroner
was brought to America by the colonists along with the institutions of
the common law, and may be said to exist in the several States with all
the common-law incidents, except so far as they may have been modified
by statute. The present defined powers of coroners in Great Britain and
the United States, unless modified by British statutes and American
acts, are derived from the English Stat. de Officio Coronatoris, 4
Edward I., s. 2. Coroners _virtute officii_ and _virtute cartæ sive
commissionis_ are unknown to our institutions. Here the office of
coroner may be classed under the head of coroners _virtute electionis_.
Generally speaking the coroner is a county officer.
CORONER’S DUTIES BOTH JUDICIAL AND MINISTERIAL.
By the common law his powers and duties are both judicial and
ministerial. In his ministerial capacity he is merely a substitute for
the sheriff, as when the sheriff is a party.[511] His powers and duties
thereunder it is not the present purpose to state and define. His
judicial authority relates to inquiries into cases of sudden death, by
a jury of inquest, _super visum corporis_, or, as it is more commonly
defined, an inquisition, with the assistance of a jury, over the body
of any person who may have come to a sudden or violent death, or who
may have died in prison.[512] It is not necessary that the death should
be both violent and sudden, and that both these circumstances must
concur to give the coroner jurisdiction. It is sufficient to give the
coroner jurisdiction if the death occurs from any violence done to
a person by another, although such violence may not have terminated
the life of a party suddenly, and it is still the duty of the coroner
to hold an inquest.[513] Indeed the presumption is that he has acted
in good faith and on sufficient cause.[514] And so when several
persons have been suddenly killed by the same violent cause, under
circumstances proper to be inquired of by a coroner’s inquest, it is
proper and necessary for the coroner, acting in good faith, to hold a
separate inquest over each body.[515] A coroner’s inquest is a judicial
investigation. The coroner cannot delegate his authority to any one.
Neither can he appoint a deputy under the common law. He must act in
person as any other judicial officer; and it may safely be said that a
coroner has no power to appoint a deputy coroner, except where special
provision is made therefor by statute.[516] In England, a coroner’s
court is a court of record, and it has accordingly been held that
trespass cannot be maintained for turning a person out of a room where
the coroner is about to take an inquisition.[517] But in this country,
it may safely be said that a coroner’s court is not one of record,
but of inferior jurisdiction.[518] The performance of the functions
of a coroner are judicial in their character; so judicial that he is
protected under the principles which protect judicial officers from
responsibility in a civil action brought by a private person. His
proceedings amount to entries concerning matters of public interest,
made under the sanction of an official oath, and in compliance or
presumed compliance of the law.[519]
_Of his Authority to Hold an Inquest._—His authority to hold an
inquest is not confined to the body of a person who may have died
within his territorial jurisdiction, but extends to all bodies
brought within his jurisdiction, no matter where death may have taken
place.[520] So in any case where, after burial, an inquest becomes
necessary to determine the manner of the death of a person who, dying
in one, is buried in another county, the coroner of the latter county
is the proper officer to hold the inquest.[521] A coroner cannot hold
a second inquest while the first is existing. As we have seen, in
holding an inquest the coroner performs a judicial duty, and he is
_functus officio_ as soon as the verdict has been returned. He can hold
no second inquest in the same case unless the first has been quashed
by a court of competent jurisdiction, and a new inquiry ordered. He
cannot set aside or quash his own inquest. If he were allowed to hold
two inquests, not only might the greatest inconvenience arise from the
inconsistent findings of the respective juries, but such a practice
would be liable to great abuse, and as the object of the proceeding is
merely preliminary, the main purpose being to ascertain whether it is
probable that a crime has been committed, and to examine the facts and
circumstances and preserve the evidence, all the ends of this inquiry
are answered by one inquisition, _super visum corporis_. We believe no
reported case is to be found in this country where a second inquisition
has been held, the first remaining undischarged, nor is any such
practice known to or recognized by our laws.[522]
THE INQUEST MUST BE HELD UPON VIEW OF THE BODY.
The coroner can in no case hold an inquest except upon view of the
body. This is jurisdictional and cannot be waived by any one. He is
not bound to hold an inquest before burial of the body takes place.
When it has been buried, and he believes an inquest necessary, he
is vested with authority to have the body disinterred and hold his
inquest, and if necessary direct a post-mortem examination to be
made, but after having done so, he must cause it to be reburied.[523]
Deep interests are involved in the proper discharge of the duties of
coroners; the character, liberty, and perhaps the life of a citizen
accused of crime on the one hand, and on the other the aiding of public
justice in establishing the guilt and securing the punishment of the
actual criminal. Many of the questions which fall within the scope
of a coroner’s inquisition are of an intricate and most perplexing
character, a correct solution of which can only be arrived at by minds
the best instructed and habituated to their investigation. In many
cases some of these questions can be satisfactorily settled by the
evidence of persons having cognizance more or less direct of the facts;
in others, however, they can only be solved by the facts deduced from
pathological anatomy, and other circumstances connected with the dead
body, the cause of the extinction of life in which is the subject of
the inquest.
_In Massachusetts Office of Coroner Abolished._—Indeed, in
Massachusetts the office of coroner was abolished in 1877, and the
governor was invested with power, and it is his duty, to appoint, by
and with the advice and consent of the council, able and discreet men,
learned in the science of medicine, to be medical examiners, whose
duties are to make examinations as provided in the statute upon the
view of the dead bodies of such persons only as are supposed to have
come to their death by violence.[524]
_Coroner may Employ Professional Skill._—A thorough examination aided
by professional skill is in general absolutely necessary to the proper
administration of justice. It would no doubt be strange if a coroner
had no authority to pledge the responsibility of the county for the
compensation of all auxiliary services which are necessary to the
proper execution of his office, and which he can by no other means
command; for instance, when his duty requires him to disinter a body,
he cannot be expected to do it with his own hands, or by hands paid
for with his means. Indeed it has been said that, in this enlightened
age, a coroner who would consign to the grave the body over which he
had held an inquest, without availing himself of the lights which the
medical science has placed within his reach, would in most cases fall
short of what his official duty requires.[525] It is the generally
accepted view of the law now that it is the duty of a coroner holding
an inquest _super visum corporis_ to avail himself of professional
skill and aid, and his contract will bind the county to the payment of
a reasonable compensation for making a post-mortem examination.[526]
POST-MORTEM EXAMINATION.
Whether such examination should take place before the coroner has
empanelled a jury seems to be an open question. We would venture the
opinion that it should not, inasmuch as the jury ought to see and
view the body in the same condition, as near as may be, as it was
when found, and not after it has been mutilated, as it must need be
by a post-mortem examination. It is, however, settled that the post
mortem should not be in the presence of the jury, and that they are to
be instructed by the testimony of the physicians who are designated
by the coroner to make the examination.[527] The coroner’s right to
dissect the dead body of a human being does not extend to all cases.
Such a power could be wielded with the most injurious effects upon a
community. His power to dissect is confined to those cases where he is
authorized by law to hold an inquest upon the body. But a post-mortem
examination, conducted by surgeons employed by a coroner holding an
inquest, is not a part of the inquest in such a sense as that every
citizen has a right freely to attend it. At common law it was essential
to the validity of a coroner’s inquisition that the jury should view
the body. And so is our law. But it was never required that the body
should be dissected in any case. It is discretionary with the coroner
to cause a dissection to be made, and to select the surgeons. He has
also a discretion to determine whether any person, and what persons,
may be present besides the surgeons. Not even the jurors have a
right to witness the examination. They are to be informed of what it
discloses by the testimony of the surgeons. Indeed, no person has a
right to be present at the post-mortem examination upon the ground that
he is suspected of having caused the death. He loses no legal right by
being excluded. He has no right to dissect the body. If the coroner’s
jury pronounce him guilty, the inquest, like the indictment of a grand
jury, simply makes him liable to arrest.[528]
MASSACHUSETTS STATUTORY PROVISIONS.
The statute law of Massachusetts has already been referred to. It
has abolished the office of coroner and in its place put medical
examiners, so called, who are presumed to be learned in the science
of medicine. Their powers, however, are not co-extensive with those
of coroners. A medical examiner cannot hold an inquest. He cannot
hold an autopsy without being thereto authorized in writing by the
district attorney, mayor, or selectmen of the district, city, or town
where a dead body lies. He can only upon receiving notice that there
has been found, or is lying within the county, the dead body of a
person who is supposed to have come to his death by violence, repair
to the place where such body lies, view and take charge of the same.
If he deems a further examination necessary and is authorized so to
do, he must make an autopsy in the presence of two or more discreet
persons, whose attendance he may compel by subpœna if necessary, and
he must then carefully reduce or cause to be reduced to writing every
fact and circumstance tending to show the condition of the body and
the cause and manner of death, together with the names and addresses
of the witnesses. If he deems it necessary, he may employ a chemist
to aid in the examination of the body or of substances supposed to
have caused or contributed to the death,[529] the record of which
he must subscribe.[530] Such an autopsy does not, however, upon
the trial of an accused render other competent evidence, as to the
condition and appearance of the dead body at the time of the autopsy,
inadmissible.[531] The autopsy may be followed by an inquest held, not
by the examiner, but by a justice of the district, police, or municipal
court for the district or city in which the body lies, or a trial
justice. One of these functionaries must hold an inquest upon being
notified by a medical examiner that in his opinion a death was caused
by violence, and after hearing the testimony draw up and sign a report
and issue process for apprehension of a person charged by the report
with the commission of an offence, if he is not in custody.[532]
Even though a medical examiner reports that a death was not caused
by violence, and the district attorney or the attorney-general is
of a contrary opinion, either one may, notwithstanding such report,
direct an inquest to be held in accordance with the provisions of the
statute.[533]
NEW YORK’S STATUTORY PROVISIONS.
In New York the powers and duties of coroners are defined by statute.
Coroners in the city of New York are governed by a special act relating
to that city exclusively. For the State at large it is provided
that whenever a coroner is informed that a person has been killed
or dangerously wounded by another, or has suddenly died under such
circumstances as to afford a reasonable ground to suspect that his
death has been occasioned by the act of another by criminal means, or
has committed suicide, he must go to the place where the person is, and
forthwith inquire into the cause of the death or wounding, and summon
not less than nine nor more than fifteen persons, qualified by law to
serve as jurors, if such death or wounding be of a criminal nature, to
appear before him forthwith at a specified place, to inquire into the
cause of death or wound, and if it appears from the evidence taken or
during the inquisition, that any person or persons are chargeable with
the killing or wounding, or that there is probable cause to believe
that any person or persons are chargeable therewith, and if they are
not in custody the coroner must forthwith issue a warrant for the
arrest of the person or persons charged with such killing or wounding,
who must be arraigned before the coroner for examination, and the
coroner has power to commit the person or persons so arrested to await
the result of the inquisition. A coroner is disqualified from acting
as such in any case where the person killed or dangerously wounded is
a co-employee with the coroner of any person or persons, association
or corporation, or where it appears that the killing or wounding
has been occasioned, directly or indirectly, by the employer of the
coroner.[534] It is further provided that whenever a convict shall
die in any State prison, it shall be the duty of the inspector having
charge of the prison and of the warden, physician, and chaplain of the
prison, if they or either of them shall have reason to believe that
the death of the convict arose from any other than ordinary sickness,
to call upon the coroner having jurisdiction to hold an inquest upon
the body of such deceased convict.[535] The New York Criminal Code
further provides that when six or more of the jurors appear, they must
be sworn by the coroner to inquire who the person was, and when, where,
and by what means he came to his death or was wounded as the case may
be, and into the circumstances attending the death or wounding, and
to render a true verdict thereon according to the evidence offered to
them or arising from the inspection of the body.[536] The coroner may
issue subpœnas for and summon and examine as witnesses every person
who in his opinion, or that of any of the jury, has any knowledge of
the facts; and he must summon as a witness a surgeon or physician,
who must, in the presence of the jury, inspect the body, and give a
professional opinion as to the cause of the death or wounding.[537] The
jury, after inspecting the body and hearing the testimony, must render
their verdict, and certify it by an inquisition in writing, signed by
them, and setting forth who the person killed or wounded is, and when,
where, and by what means he came to his death or was wounded, and if
he were killed or wounded, or his death were occasioned by the act of
another by criminal means, who is guilty thereof, in so far as by such
inquisition they have been able to ascertain.[538] The testimony of the
witnesses examined before the coroner’s jury must be reduced to writing
by the coroner, or under his direction, and must be forthwith filed by
him, with the inquisition, in the office of the clerk of the court of
sessions of the county, or of a city court having power to inquire into
the offence by the intervention of a grand jury.[539]
If, however, the defendant be arrested before the inquisition can be
filed, the coroner must deliver it with the testimony to the magistrate
before whom the defendant is brought.[540] If the jury find that
the person was killed or wounded by another under circumstances not
excusable or justifiable by law, or that his death was occasioned by
the act of another by criminal means, and the party committing the act
be ascertained by the inquisition and is not in custody, the coroner
must issue a warrant signed by him with his name of office, for the
arrest of the person charged.[541] The coroner has power to compel
the attendance of a witness and testify, and he may punish a witness
for disobedience, as upon a subpœna issued by a magistrate.[542] The
coroner’s warrant may be served in any county; and the officer serving
it must proceed thereon, in all respects, as upon a warrant of arrest
on an information, except that when served in another county it need
not be indorsed by a magistrate of that county.[543] When the defendant
is brought before the coroner, he must proceed to examine the charge
contained in the inquisition or information, and hold the defendant to
answer, or discharge him therefrom, in all respects as upon a warrant
of arrest on an information.[544]
II. THE JURY AND INQUEST.
_Jurors Must be Sworn by Coroner._—The jurors summoned by a coroner to
attend an inquest must be from the county or jurisdiction wherein the
coroner is empowered to act. He cannot proceed with the inquest until
he has summoned and sworn the jury. The jurors are not challengeable,
and therefore they should be carefully selected and sworn by the
coroner himself. His duties are judicial and he can only take an
inquest _super visum corporis_, and an inquest in which the jury is not
sworn by himself is absolutely void and of no effect.[545]
_They Must Investigate and Determine the Facts._—After being sworn
by the coroner they must investigate and determine and are the sole
arbiters of the facts; the coroner’s duty being to instruct them in
the law. They must go, view, and examine the body together, and not
separately. It is essential to the validity of the inquest that the
jury should view the body.[546]
_Coroner may Compel Attendance of Witnesses._—When the coroner sits
to hold an inquest, he sits as a judicial officer, armed with all the
ordinary powers possessed by judicial officers. He may compel the
attendance of jurors whose qualifications are usually such as are
required of jurors in a court of record. It is his duty to present
before the jury all the material testimony within his power, touching
the death as to the manner whereof the jury are to certify, and that
which makes for as well as against the party accused. It is his duty
to summon before his inquest every person whom he has any reason to
believe possesses any knowledge relative to the death which he is
investigating. He is to summon such persons to attend before him for
examination. He has full authority to compel obedience to his subpœnas.
He has this power by the common law.[547] If a post-mortem examination
is made, the examining surgeons should testify before the jury as to
the matters disclosed by the examination.[548] The witnesses produced
must be sworn by the coroner, and their testimony reduced to writing by
him or under his direction.
RIGHTS OF ACCUSED PARTY.
The coroner is not required to take the testimony of the witnesses who
are examined before the jury in the presence of the party accused.
The accused has not the right to be represented by counsel, or to
cross-examine the witnesses.[549] He is not permitted to produce
witnesses before the coroner to show himself innocent of the crime. The
coroner is not required to examine any witnesses to establish the guilt
of such party when brought before him by virtue of process issued after
the finding of the inquisition.[550]
_Deliberation by Jury and Return of an Inquisition._—After the
evidence has been taken, and the jury instructed in the law by the
coroner, the jury should retire to deliberate upon their verdict.
During such deliberation and until they have arrived at their verdict
the coroner should not be present in the room where the jury is
deliberating. After they have agreed on their verdict it should be
reduced to writing, and the coroner is bound to accept it as final in
his court. The inquisition should then be signed by the coroner and
jury.[551] If the inquest is signed by the coroner and duly certified
by him, the jurors having signed by making their cross marks, and the
whole being certified by the coroner, his certificate of the signatures
of the jurors is sufficient and the inquisition is properly made.[552]
If several jurors on the inquest have the same christian and surname,
it is not necessary in the caption of the inquisition to distinguish
them by abode or otherwise.[553] The law requiring the coroner to make
a return of the testimony with the inquisition cannot be satisfied
short of some official certificate indicating that the witnesses named
were sworn before him, to the matter insisted on as evidence against a
prisoner. At least if there be no formal authentication, there should
be proof _aliunde_ that the memorandum presents the testimony of the
witness truly.[554]
III. THE EFFECT OF THE EVIDENCE AND VERDICT.
Under the common law formerly, a coroner’s inquisition was equivalent
to an indictment by a grand jury upon which the accused might be
tried. But in this country no person can be tried upon a coroner’s
inquisition, yet the inquisition of a coroner’s jury finding a person
guilty of murder has about the same force against him, until the
grand jury passes upon his case, that an indictment found by them has
thereafter, prior to his trial.
_Coroner has Power to Issue Process of Apprehension._—If a person is
charged with the crime in the inquisition, the coroner has power and
he issues his process for the apprehension of the accused when not in
custody solely upon the inquisition. The inquisition, though taken in
the absence of the prisoner, and upon the testimony of witnesses he
could not cross-examine, settles the question of his guilt until the
grand jury passes upon the case. It justifies the commitment of the
prisoner to jail, in the same manner that the testimony of witnesses
does taken before a justice of the peace. The coroner can only examine
the prisoner in the same manner as upon a warrant of arrest or on
information, and is not authorized to examine witnesses either against
the prisoner or for him, when he is apprehended by virtue of process
issued subsequent to the finding of the inquisition by the jury, or in
custody of the coroner without process at the time the same is found.
_Privilege of Prisoner upon Arrest._—The prisoner has the privilege
of telling his own story before the coroner, which is to be returned
with the inquisition, and that is all. He cannot be discharged on it,
however plausible it may be; and he has not the privilege of proving it
true before the coroner. He should, therefore, not be discharged, and
he cannot have the case investigated again before it is passed upon by
the grand jury.[555]
_Under the provisions of the New York Criminal Code_ the defendant
against whom an inquisition has been found by a coroner’s jury is
entitled to a hearing before a magistrate, whether he has been arrested
before the inquisition has been filed or is arrested after such filing.
Under the provisions of sec. 779, in the case of a defendant who has
been arrested before the inquisition can be filed, the prisoner is
entitled to be examined before the magistrate, before whom he may be
brought, as provided in sec. 781, and in the case of a prisoner who has
not been arrested until after the inquisition was filed, under secs.
781 and 783 the defendant is entitled to be heard before a magistrate
in all respects as upon a warrant of arrest on an information. The
magistrate must proceed to examine the charge contained in the
inquisition, and hold the defendant to answer or discharge him
therefrom.[556] The information is the allegation made to a magistrate
that a person has been guilty of some designated crime.[557]
WHEN EVIDENCE TAKEN BEFORE CORONER OF A PARTY CHARGED WITH CRIME
ADMISSIBLE IN EVIDENCE UPON HIS TRIAL SUBSEQUENTLY.
There is nothing which distinguishes between the proceedings of a
coroner’s inquest and any other official proceedings taken and
returned in the discharge of official duty as to their admissibility in
evidence. A witness, therefore, may be contradicted by the production
of a deposition thus given by him before a coroner.[558] But the line
is sharply drawn in what cases the testimony of a witness examined
before a coroner’s inquest can be used on his subsequent trial, and in
what cases it cannot. When a coroner’s inquest is held before it has
been ascertained that a crime has been committed, or before any person
has been arrested charged with the crime, and a witness is called and
sworn before the coroner’s jury, the testimony of that witness, should
he afterward be charged with the crime, may be used against him on his
trial, and the mere fact that at the time of his examination he was
aware that a crime was suspected, and that he was suspected of being
the criminal, will not prevent his being regarded as a mere witness,
whose testimony may be afterward given in evidence against himself.
If he desires to protect himself he must claim his privilege. But
if, at the time of his examination, it appears that a crime has been
committed, and that he is in custody as the supposed criminal, he
is not regarded merely as a witness, but as a party accused, called
before a tribunal vested with power to investigate preliminarily the
question of his guilt, and he is to be treated in the same manner as
if brought before a committing magistrate, and an examination not
taken in conformity with the statute cannot be used against him on his
trial for the offence.[559] So the doctrine as to silence being taken
as an implied admission of the truth of allegations spoken or uttered
in the presence of a person, does not apply to silence at a judicial
proceeding or hearing, and since the proceedings at a coroner’s inquest
are of a judicial character, what there transpired must be considered
as a part of the proceedings.[560] The leading cases which have been
before the New York Court of Appeals upon this important question,
and from which that court has finally deduced that rule, may be here
referred to.
_Hendrickson Case._—In the first case the wife of the defendant
died suddenly in the morning, and in the evening of the same day a
coroner’s inquest was held. The defendant was called and sworn as a
witness upon the inquest. At that time it did not appear that any
crime had been committed, or that the defendant had been charged with
any crime, or even suspected, except so far as the nature of some of
the questions asked of him might indicate such a suspicion. On his
subsequent trial on an indictment for the murder of his wife, the
statements made by him at the coroner’s inquest were held admissible,
on the ground that he was not examined as a party charged with the
crime, that it had not appeared even that a crime had been committed,
and that he had simply testified as a witness on the inquiry as to the
cause of the death.[561]
_McMahon Case._—Following this came the _McMahon Case_, in which
it appeared that the defendant was arrested by a constable, without
warrant, on a charge of having murdered his wife. The constable took
him before the coroner, who was holding an inquest on the body, by
whom he was sworn and examined as a witness. It was held that the
evidence thus given was not admissible on the prisoner’s trial for the
murder, and his conviction was reversed upon that ground.[562]
_Teachout Case._—The doctrine of this case was more clearly defined
and somewhat limited in a later case, the _Teachout Case_. In that
case the defendant appeared at the coroner’s inquest in pursuance of
a sub-pœna to testify, and voluntarily attended; he was not under
arrest, but was informed by some one that it was charged that his wife
had been poisoned and that he would be arrested for the crime. Before
he was sworn he was informed by the coroner that there were rumors
that his wife came to her death by foul means and that some of those
rumors implicated him, and that he was not obliged to testify unless
he chose. He said he had no objection to telling all he knew. The
Court in delivering its opinion preludes it by a reference to these
facts as showing that the statements made were voluntary in every
legal sense, and held that a mere consciousness of being suspected
of a crime did not so disqualify him that his testimony, in other
respects freely and voluntarily given before the coroner, could not
be used against him on his trial on a charge subsequently made of
such crime. On that ground it held the evidence properly admitted,
at the same time referring with approval to the _McMahon Case_,
and distinctly limiting the rule of exclusion to cases within its
bounds.[563]
_Mondon Case._—Then followed the _Mondon Case_, where on the
finding of the body of the deceased, the defendant was arrested
without warrant as the suspected murderer. While he was thus in
custody the coroner empanelled a jury and held an inquest, and the
defendant was called as a witness before the inquest and was examined
by the district attorney and by the coroner. The prisoner was an
ignorant Italian laborer unfamiliar with the English language. He
was unattended by counsel, and it did not appear that he was in any
manner informed of his rights, or that he was not bound to answer
questions tending to criminate him He was twice examined; on the first
occasion the examination was taken by questions put either by the
district attorney or by the coroner, and the result written down by
the coroner, who then read the evidence over to him, line by line, and
asked him if he understood it and if it was the truth, and he said it
was, and the coroner then reswore him to the deposition. The coroner,
after taking the defendant’s testimony on the first day, came to the
conclusion that the defendant did not understand English well enough
to be examined, and that it ought to be taken through an interpreter,
which was done, in order that they might get it a little better and
a little fuller. It was held that the defendant’s testimony was not
admissible upon his trial on the indictment.[564] It will be seen that
this latter case follows in direct line with the rule announced in the
_McMahon Case_ and clearly distinguishes another case, the _McGloin
Case_, upon the authority of which the trial court held the testimony
of the prisoner in the _Mondon Case_ admissible.
_McGloin Case._—The case of _McGloin_ was not that of the examination
of a prisoner on oath before a magistrate before whom he was taken
involuntarily, while in custody, and interrogated by the magistrate,
who to all appearance had power to require him to answer, but while
under arrest the prisoner said to the inspector of police who had him
in charge that he would make a statement. The inspector then said
that he would send for a coroner to take it. The coroner was then
sent for and came to police headquarters and took down in writing the
confession dictated by the prisoner, the coroner asking no questions
and not acting in any official capacity, but as a mere amanuensis to
take down the confession and prove the contents. It was held that the
confession of the prisoner was admissible in evidence upon his trial
for murder.[565]
_Rule in Pennsylvania._—The rule in Pennsylvania is substantially that
when the testimony given by the prisoner under oath before a coroner’s
inquest, previous to him being charged or suspected of the murder of
the individual upon whose body the inquest was sitting, may afterward
be given in evidence against him, on his trial for the murder of such
person.[566]
_Rule in Nebraska._—The statements of a prisoner to be competent
evidence must have been voluntarily made. In cases of declaration
made on an examination before a coroner’s inquest by a person under
arrest or charged with the crime and also under oath, they are not
admissible. But when the person, although he be subsequently charged
with the offence, appears voluntarily, and gives testimony, before any
accusation has been made against him, his statements are admissible in
evidence against him on the trial of an indictment for the crime.[567]
MEDICO-LEGAL AUTOPSIES.
BY
H. P. LOOMIS, A.M., M.D.,
_Professor of Pathology in the University of the City of New York;
Visiting Physician and Curator to Bellevue Hospital, New York;
Pathologist to the Board of Health, New York City; President New York
Pathological Society, etc., etc._
AUTOPSIES.
A MEDICAL examiner before proceeding with an autopsy, especially if
called before the body has been removed from the place where it was
found, should carefully note certain facts. These should be entered
by himself or an assistant with great care, in a note-book, as this
book can be introduced as evidence in any trial. A satisfactory way
is to dictate to the assistant as the examination proceeds, and at
the conclusion the assistant reads the notes taken, and the examiner
verifies them.
SURROUNDING OBJECTS—POSITION OF THE BODY.
These should be first noted. The character of the soil; the condition
of the ground, and whether it shows footprints; if so, their direction;
the evidence of any struggle; the presence of any weapon; and finally,
the exact position in which the body lies, especially the position of
the hands and feet. This is important, for the body may be found in a
position which the deceased could not have assumed on the supposition
of the wound or injury having been accidental or homicidal. If possible
a photograph should be taken of the body in the exact position in
which it is found. If it is absolutely necessary to remove the body,
it should be done with great care, keeping the body in as horizontal a
position as possible.
The character of the surrounding soil should be noted. This is of
special importance when the body to be examined has been exhumed: for
the question of preservation of the body and the ability to recognize
pathological changes may be brought up at a trial. This was an
important point raised in the Buchanan case (New York, 1893).
If a body be found in the water, examine the character of the water and
the temperature, and if found near the shore, the character of shore
and bottom.
=Blood.=—The situation of blood-stains, and their number and extent,
on clothing or surrounding objects should be noted. This will often
show whether a struggle has taken place after receiving the fatal
wound, and is also of medico-legal importance if made at the time the
body is found, for it may be so situated as to show that the body has
been interfered with after death.
Again, spots of blood found upon articles of clothing or upon
surrounding objects should be noted as to their form and direction, for
they may serve to furnish an indication of the position of the person
with respect to them when the wound was inflicted. For example, if the
spot was oval, the presumption is that the person was placed obliquely
with respect to the stain while the hemorrhage was occurring. The force
with which the blood was thrown out will in some measure be indicated
by the obliquity or length of the spot. The amount of blood will also
often indicate whether the person has died suddenly, the exact spot
where death occurred, whether a struggle took place, and will also
preclude the possibility of a person moving after receiving the fatal
injury. When we examine a body, especially when found in a room, care
must be taken not to be misled by the accidental diffusion of blood by
persons going in and out, or touching the body (see BLOOD-STAINS, Vol.
II.)
=Clothing.=—The examination of the clothing should be thorough. A
description of each article should be noted, and the order in which it
is removed; for often it is important to prove that the garments were
worn by or belonged to the deceased. If any blood is on the clothing,
note whether the blood is in large patches, or whether it is sprinkled
over the garment: the amount of the blood and what garments are stained
by it. Note and examine whether the blood has flowed down the front
of the clothing, whether it has soaked the inner garments, or again,
whether it has collected along the back; for these appearances will
sometimes demonstrate whether a wound was inflicted while the person
was sitting, standing, or lying down. For example, if the throat is
cut while the person is lying down, the blood will be found on each
side of the neck along the back and not down the front of the body.
Few suicides cut their throats in a recumbent position, and this
distribution of the blood may serve to distinguish a suicidal from a
homicidal wound.
The condition of the clothing may also serve to show whether there
has been any struggle, and the presence of dry spots or mud on it may
sometimes serve to connect an accused person with an act of murder.
This is well illustrated in the case of Reg. _v._ Snipe, reported in
Beck’s “Medical Jurisprudence,” where evidence was adduced to show
that some spots of mud on the boots and clothing of the prisoner, when
examined microscopically, contained infusoria, shells, and some rare
aquatic vegetables. The mud of the ditch close to where the body was
found, as also the mud on the clothing of the dead body, presented
the same microscopical appearances. The medical expert who gave this
evidence swore that in his opinion the mud spots on the body and on
the prisoner’s boots were derived from the same ditch, for the mud
of all the other ditches in the locality was found, on microscopical
examination, to be different. The well-known case which occurred in
New York a few years ago, known as the “Shakespeare case,” furnishes
an example of the importance of carefully examining all stains on the
clothing found on bodies.
If there are several stabs or cuts on the body involving the dress, it
should be noted whether they are blood-stained, and if so, whether the
stain is on the inside or outside of the garments, for sometimes in
simulated personal injury a stain of blood may be inadvertently applied
to the outside of the dress, as in wiping a weapon.
=Weapons.=—If a weapon is found, the character of the weapon and its
exact position should be noted. This is frequently of importance in
telling whether a person has died from an accidental or self-inflicted
wound. In a case where death occurs immediately or within a few
minutes, the weapon is found near the body, or often so tightly grasped
in the hand that it can be with difficulty removed. If the weapon
is found near the body it should be noted on which side and at what
distance, and it must be questioned whether it could have fallen on
the spot or been thrown there by the deceased. It is compatible with
suicide that the weapon should be found at some distance from the body.
An instance has been recorded where an individual was discovered in
bed with his throat cut, and the bloody razor was found closed and in
the pocket of the deceased. If a weapon cannot be discovered, or is
concealed, it is strong presumptive evidence of homicide; especially
when the wound is such as to produce speedy death.
Note whether the weapon is sharp or blunt, straight or curved. If a
knife, the handle and inner portion should be examined, for the blade
may have been washed.
If the wound has involved any large vessels, it is improbable that the
weapon can have been thrown any distance from the body, and when it is,
there are always fair grounds to expect interference with the original
position of the body. One circumstance which always strongly points to
suicide is the finding of the weapon firmly grasped in the hand of the
cadaver. The hand of a dead person cannot be made to grasp or retain
a weapon as does the hand which has grasped it at the last moments of
life. The amount of blood on the weapon should be noted, but it must be
remembered that a knife may have produced a fatal stab wound and still
no blood be found on it. This is explained by the fact that in a rapid
plunge the vessels were compressed, and only after the drawing of the
knife and relieving of the pressure blood began to flow, or possibly
the blood may have been wiped off the knife by the elasticity of the
skin.
When a person has died of a gunshot wound, especially at close range,
it is important to look for any wadding or paper found in the wound, as
in a number of instances the finding of such has led to the detection
of the criminal. For example, handwriting has been found on the paper,
or it has formed part of a printed page the rest of which has been
found in possession of the accused. When a gun is discharged near the
body, a portion of the wadding is almost always found in the irregular
wound produced.
POST-MORTEM EXAMINATION.
Having completed the examination of the surroundings, one next proceeds
with the post-mortem examination, which should be conducted according
to a well-defined plan, following which the results obtained will
always be satisfactory.
If possible the body should be removed to a large, well-ventilated, and
especially well-lighted room. No artificial light, if it can possibly
be avoided, should be used when performing the autopsy; artificial
light is especially bad on account of its yellowness and its power to
modify natural color. Many diseased conditions cannot be satisfactorily
determined by artificial light. The body should be placed on a high
table, and the facility with which the autopsy is made will often
depend on having the table high enough to render stooping unnecessary.
Never make an autopsy, if it can possibly be avoided, on a body while
in a coffin, as the examination is always unsatisfactory. The size and
surroundings of the room, and how it is lighted, should be entered in
the note-book.
=Instruments.=—If possible the following instruments should be at hand
before proceeding with an examination, although some of them may be
dispensed with:
(1) Large section knife; (2) scalpels; (3) enterotome (for opening
intestines and stomach); (4) costotome, or large bone forceps (for
cutting ribs); (5) scissors, large and small (one blade blunt); (6)
saw; (7) chisel; (8) dissecting forceps; (9) probe; (10) blowpipe; (11)
curved needles and strong twine; (12) measuring and graduated glass;
(13) small scales.
Besides the above instruments, some basins containing water; sponges,
bottle of flexible collodion, Lugol’s solution of iodine for the
amyloid test, will be needed.
=Post-Mortem Wounds.=—Various plans have been proposed to protect
the operator’s hands from the post-mortem wounds which are often so
dangerous, such as wearing rubber gloves, smearing the hands with
carbolized vaselin, both of which have their disadvantages: the gloves
being too clumsy, and the vaselin rendering it almost impossible to
hold the knife steady. Gloves should always be worn, however, where the
body has undergone much decomposition, or where the person may have
died from any septic disease. A method which I have found satisfactory
is to cover all cuts and hangnails with flexible collodion, and then
to have a basin of clean water at hand, and from time to time to rinse
one’s hands in the water. It is from bathing the hands in the cadaveric
fluids and not from cuts that most of the danger comes. If possible an
absolutely new board, large enough upon which to examine the organs,
should be at hand, for it may be claimed at a trial that the organs and
tissues, if placed and examined on surrounding objects, have become
contaminated.
=Toxicological.=—If a chemical analysis of the various organs and
tissues is to be made, and it is impossible to have the chemist
present, the medical examiner should obtain some new glass jars of
suitable size, with close-fitting glass covers. These jars should
be rinsed with distilled water, and in them the various organs are
to be placed; if possible with no preserving fluid on them. But if
it is found impossible to deliver the jars to the chemist at once,
alcohol may be poured over the organs in the jars, but it is specially
important that a sample of this alcohol should be retained, that a
chemist may at a future date test the same for any impurities. After
the organs and tissues have been placed in the jars, the mouths should
be closed and sealed, and the seal remain in the custody of the
examiner until the jars are delivered to the chemist.
=Parts to be Preserved for the Chemist.=—In cases of suspected
poisoning, it is not sufficient that the stomach and intestines alone
should be preserved for the chemist as has been indicated, each part
by itself; for it should be remembered that the portion of poison
remaining in the alimentary tract is but the residue of the dose
which had been sufficient to destroy life, and if the processes of
elimination have been rapid no trace of the poison will be found in the
alimentary canal but can readily be detected in other organs. Again,
the poison may not have been introduced by the mouth, in which case
none may be found in the digestive tract.
The chemist should receive, besides the stomach and entire intestinal
canal, the liver, one or both kidneys, the spleen, a piece of muscle
from the leg, the brain, and any urine found in the bladder.
When it is impossible for any reason to obtain the whole of any organ,
the part removed should be carefully weighed and its proportion to the
rest of the organ noted.
It is also of extreme importance to preserve in sealed and labelled
jars those parts of a body which may show the evidence of disease, or
on the appearance of which one’s evidence is founded.
ORDER OF AUTOPSY.
In making the autopsy, the operator should stand on the right side of
the body and make the incision by grasping the knife firmly in the
hand, and cutting with the whole of the blade and not with the point.
The knife should be swept along from the shoulder rather than from the
wrist, thus making a long, smooth, deep cut; never a jagged one.
The method of examining the human body after death will vary somewhat
according to the objects in view. These objects may be threefold: (1)
To ascertain whether a person has died from violence or poison; (2) to
establish the cause of death, especially if it has been sudden; and (3)
to ascertain the lesion of a disease, or to confirm a diagnosis.
The only difference between a medico-legal and pathological autopsy
is that in the former case everything which might subserve the ends
of justice should be carefully noted, and the changes found most
accurately described; especially any abnormalities found on the
external examination of the body. A photograph should be taken of the
body.
The head should be opened and the brain examined first, and not last,
as is often done in the ordinary autopsy.
Careful notes should be taken during each step of the examination, to
be reread, verified, and signed at the completion of the autopsy.
It must be remembered that most of the lesions of disease which are
found, indicate the disease rather than the cause of death; that often
the lesion found will seem hardly extensive enough to cause death, and
that from accidents and injuries apparently trivial, death may result.
It must often be acknowledged that no sufficient cause of death can be
found, but the more accurate and careful the examinations (especially
when a microscopical examination of the organs is made) the fewer will
be the number of such cases. If no apparent lesion is found, it must
not be forgotten that many poisons destroy life and leave no trace that
the pathologist can discover.
Care should always be exercised not to mistake the ordinary post-mortem
appearance which we find at autopsies for the lesions of disease.
The examination of the human body, whether it be made from a
medico-legal or pathological standpoint, is divided into two main
divisions:
(1) The external examination, and
(2) The internal examination.
EXTERNAL EXAMINATION.
Its minuteness will depend on the character of the case, as when the
person is unknown, or when suspected to have died from unnatural
causes. In such cases the external examination is very important.
The following are the steps to be followed:
(1) Give a =general description= of the body; apparent age, height, and
weight of the individual; color of the hair and eyes; condition of the
teeth; and the evidence of any personal peculiarities or abnormalities.
(2) Note the =color of the skin= and observe whether there are any
spots of CADAVERIC LIVIDITY, and if present where situated.
(3) =Contusions.=—Note whether there are any contusions, and, if
present, their character, situation, length, breadth, and depth should
be described, and whether they are accompanied by inflammation or by
the evidences of gangrene.
It is often important to determine whether a contusion has been
inflicted before or after death. This is to be done by cutting into
the ecchymoses and if the extravasated blood or the coloring matter
of the blood is found free in the tissues, one can be almost certain
that it is an ante-mortem injury. In post-mortem discolorations the
blood is found in the congested vessels. The situation of ante-mortem
contusions will not generally correspond to the discolorations produced
by decomposition; the latter being confined to the most dependent
parts. It should be remembered that the contusions produced by blows
on a body dead only a few hours cannot be distinguished from those
which were received during life; and also that putrefactive changes
make it well-nigh impossible to distinguish between ante-mortem and
post-mortem injuries. It should also be borne in mind that blows or
falls sufficient to fracture bones or rupture organs may leave no mark
on the skin (see WOUNDS, Vol. I., pp. 467, 474, _et seq._).
(4) =Wounds.=—The situation, depth, extent, and direction of any
wound should be recorded, as also the condition of its edges; the
changes in the surrounding tissues, and whether inflicted by a cutting,
pointed, or rounded instrument; or by a bullet. In the latter case the
course and direction of the ball should be ascertained by dissection
rather than by the use of the probe, and the character of foreign
bodies, if any are found in the wound, should be noted. What nerves
or blood-vessels, particularly arteries, have been injured, should be
ascertained. It is often important to determine whether a wound was
made before or after death. The following may serve as a differential
point: In all wounds made after death there is slight bleeding,
non-contraction of the edges, and absence of blood in the tissues. This
is the opposite of ante-mortem wounds. Again, wounds inflicted within
two hours after death cannot be differentiated from those made during
life (see GUNSHOT WOUNDS, Vol. I., p. 610 _et seq._; WOUNDS, Vol. I.,
p. 476 _et seq._).
(5) =Fractures.=—If there are any evidences of fractures, the
situation of the bones involved should be noted, and whether they
are accompanied by contusions of the soft parts. Fractures which are
inflicted during life are always accompanied by much more extravasation
of blood, more injury to the soft parts, and more evidences of reaction
than those occurring after death. It is a well-known fact that it is
much more difficult to produce a fracture in a dead than a living body
(see WOUNDS, Vol. II., p. 482 _et seq._).
(6) =The temperature= of the body should be taken.
(7) =The rigidity and flexibility= of the extremities should be
ascertained.
(8) =The state of the eyes= should be noticed, and the relative size of
the pupils.
(9) Attention should be paid to the condition of the cavities of the
mouth and nose. The neck should be specially examined for marks of
external injury, or signs of ecchymosis or compression.
(10) =Genitals.=—The external genitals should be very carefully
examined for evidence of injury, the presence of syphilitic lesions,
and in the female the condition of the vagina should be particularly
ascertained.
(11) =Œdema of the Feet.=—If there is evidence of œdema in any part of
the body, especially about the ankles, its situation and extent should
be noted.
(12) =Ulcers and Abscesses.=—The situation and extent of any ulcer
found on the body should be recorded, as also the presence and
situation of any abscess.
(13) =Burns.=—The extent of a burn, as also the state of the parts
involved, should be noted. For example, whether they are inflamed or
show blisters, etc. (see HEAT AND COLD, Vol. I., p. 647 _et seq._).
(14) =Hands.=—In medico-legal cases the hands of a dead person should
always be examined for the presence of cuts, excoriations, or foreign
substances found upon them; especially should the dorsal extremities
be examined. This examination will often indicate that there has been
a mortal struggle before death. The impression of a hand or of some
of the fingers is often found on the skin of a dead body. The exact
situation where found should be noted. This may be of importance, as
when it occurs where it would have been impossible or improbable for
the deceased to have caused it.
For appearances in death from lightning or electricity, see Vol. I., p.
701 _et seq._, and in death from hanging, strangulation, and garroting,
see Vol. I., pp. 713, 746, 781, _et seq._
INTERNAL EXAMINATION.
Having completed the examination of the external parts of the body, the
next proceeding is to open the body and make an internal examination.
This should be done by following a regular method, so as to examine the
relations of parts and not to injure one organ while removing another.
In opening the various organs an incision should be made which will
expose the greatest amount of surface at one cut. Never make a number
of small and always unsatisfactory incisions in an organ. In opening
certain organs like the brain and heart, the incisions are so planned
that the parts of the organ may be folded together, and, if necessary,
their relations to one another and the whole organ studied. Such organs
are opened as one would open a book to examine its pages.
It is important to remember that after death the blood leaves the
arteries and left side of the heart, and collects in the veins and the
right cavities of the heart. Especially does it collect in the vessels
of the most dependent portions of the body and of the various organs,
so that local congestions may often disappear after death; and again,
they may be found at an autopsy where they were not present during
life. Especially is this true of the mucous membranes such as those of
the trachea and bronchi, and also of the blood in the sinuses of the
dura mater.
In making autopsies it is a cardinal rule that _all_ the cavities
of the body should be examined, and not alone the one where one
might expect to find a lesion. At medico-legal autopsies, the great
cavities—the head, the thorax, and the abdomen—should be examined in
their successive order from above downward. The reason for beginning
with the head is that the amount of blood in the brain and its
membranes may be determined accurately; for, if the heart and great
vessels of the neck are opened first, the blood will drain away from
the brain and local congestions disappear. In pathological autopsies,
the opening of the head first is not so important, and often the
vertebral column need not be opened at all, for it is a complicated
process and takes time; but in medico-legal cases, especially where a
question as to the cause of death may arise, and has not satisfactorily
been determined, after all the other cavities are examined the
vertebral column should always be opened and the cord removed.
THE HEAD.
Make an incision across the vertex of the skull from ear to ear.
Dissect the anterior flap forward until within about three inches of
the bridge of the nose, and the posterior flap backward to the external
occipital protuberance. Examine the internal surface of the scalp for
ecchymosis and evidences of injury. A circular incision is then made
with a saw through the cranium as far backward and forward as the
flaps have been reflected. An incision through the temporal muscle is
necessary so that the teeth of the saw may not become clogged by the
muscle fibres. When the cranium has been sawed through, a stout hook is
inserted under its upper edge and it is removed with a quick jerk. If
the dura mater is very adherent to the calvaria, it may be necessary
to remove it with the bone, by cutting through it at the level of the
cranial incision. Examine the calvaria as also the other bones of the
skull after the brain has been removed and the dura stripped off, for
evidence of fracture.
Note the symmetry, thickness, and density of the cranial bone, and
remember that depressions along the sagittal suture are for the
Pacchionian bodies, and are not pathological.
=Dura Mater.=—The dura mater may be slightly adherent to the bone
of the cranium. This is especially seen in old people and does
not indicate disease. The Pacchionian bodies are seen along the
longitudinal sinus. Examine the internal surface of the dura mater
for the presence of clots, tumors, or inflammatory lesions. Open the
longitudinal sinus and examine for thrombi. Remove the dura mater by
an incision following the cranial incision, the falx cerebri between
the anterior lobes being drawn back and divided. Note whether the dura
mater is adherent to the pia mater, and the condition of its internal
surface.
=Pia Mater.=—The brain, covered by the pia mater, is now exposed.
Note the degree of congestion of the membrane, its adherence, and the
existence of pus, blood, or serum on its surface or in its meshes.
Remember that a considerable amount of serum may be present within
normal limits, especially in cachectic subjects, without indicating
disease, but when the serum is so extensive as to raise the pia mater
and to depress the convolutions, we have a pathological amount which
may be a simple dropsy due to some general cause, or the result of a
chronic meningitis. Enough serous effusion in the pia mater to produce
a condition which has been called by some writers “serous apoplexy,” I
believe never occurs as a primary condition.
Loss of transparency and thickening of the pia mater, especially along
the longitudinal fissure, is often seen in old people and does not
indicate disease.
=Brain.=—Remove the brain by raising the anterior lobes with the
fingers of the left hand and cutting through the nerves, vessels,
and the tentorium as they appear. The medulla is cut as low down as
possible, and the brain as it rolls out is caught in the left hand.
After being placed on a clean board or in a large clean dish, it
is minutely examined. The average weight of an adult male brain is
forty-nine and one-half ounces; of the female, forty-four ounces. Its
proportional weight to that of the rest of the body is as 1 to 45.
Lay the brain first upon its convex surface and examine the arteries
at the base for atheroma, thrombi, emboli, and aneurisms. Examine the
pia mater of the base, especially for the evidences of hemorrhage,
tumors, tubercles, and inflammatory lesions. Next turn the brain over
on its base, and proceed to open its various cavities and examine its
internal structure. Separate the two halves of the cerebrum, until the
corpus callosum is exposed. Make an incision downward and outward at
the junction of the corpus callosum with the cerebrum, and the roof of
the lateral ventricles will be cut through and their cavities exposed.
Prolong the incision forward and backward so as to expose the cornua.
The size and contents of the ventricles should be noted, as also the
condition of the ependyma. The floor of the lateral ventricles being
the most frequent spot of hemorrhage, if one is found its extent and
the parts involved by it should be noted; especially its relation to
the internal capsule.
Transverse incisions (about one-sixteenth of an inch apart) are made
through the ganglia seen on the floor of the lateral ventricles. Thus
any lesions in the substance of the ganglia will be disclosed. Three or
four longitudinal incisions are now made outward into the hemispheres
nearly to the pia mater. These will divide the hemispheres into long,
prism-shaped pieces held together by the pia mater and a little of the
cortex, thus enabling the brain afterward to be folded together, and
the relations of lesions to the brain as a whole studied. The third
ventricle is now examined by cutting through the fornix and corpus
callosum at the foramen of Monroe. Next, the fourth ventricle is opened
by a longitudinal incision through the lower portion of the vermiform
process; its contents, the condition of its vessels and ependyma
noted. Then the floor of the fourth ventricle is divided by transverse
incisions one-sixteenth of an inch apart, and careful examination made
for the presence of minute hemorrhages: for here is a place in the
body where almost a microscopical lesion (hemorrhage) may cause sudden
death. Each hemisphere of the cerebellum is now opened by a number
of incisions starting from the fourth ventricle and passing outward
into its substance. The presence of any tumors or hemorrhage in the
cerebellum will now be recognized.
In opening the brain, when clots, areas of softening, tumors, etc.,
are discovered, their exact location in relation to surrounding
parts should be noted and the blood-vessels examined for areas of
degeneration or aneurism. This examination can be facilitated by
allowing a stream of water to flow over the affected part. This will
wash out the affected area and allow the vessels to appear.
=Eye.=—In rare cases it may be necessary to remove the eye. This can
be done by breaking through the roof of the orbit with a saw or chisel
and dissecting away the muscles so as to expose the optic nerve and the
posterior portion of the organ.
THORAX AND ABDOMEN.
The body being placed on its back, and the operator standing on the
right side, an incision is made through the skin, fascia, and muscles
from the top of the sternum to the pubic bone, passing to the left
of the umbilicus and dividing everything down to the sternum and
the subperitoneal tissue. A small incision is now made through the
peritoneum below the ensiform cartilage. Into this opening two fingers
of the left hand are inserted, and by spreading the fingers and
holding the knife horizontally the peritoneum can be divided to the
pubes without injuring the intestines. The skin and muscles are now
dissected from the chest as far back as the false ribs. This dissection
may be facilitated by keeping the skin and muscles on the stretch and
cutting with the flat part of the knife. In order to better expose the
abdominal cavity, the recti muscles are divided beneath the skin at
their insertion in the pubic bone. Examine the cut surface of the chest
and abdominal muscles, and note their color, amount, and consistency.
Observe whether the chest muscles show the evidence of any parasitic
disease such as trichinosis. The mammary glands are now examined from
behind and opened if necessary.
=Superficial Examination of Abdominal Cavity.=—This should be done
before opening the chest cavity, because the position of organs
may become modified, and blood and other fluids are liable to find
their way from one cavity into another; and again, the blood in the
presenting portion of the abdominal organs will change its color after
exposure to the air.
NOTE THE FOLLOWING POINTS: (_a_) The _relative position_ and _general
condition_ of the abdominal organs.
(_b_) The _color_ and _amount of blood_ in the presenting parts.
(_c_) Whether there are any _signs_ of _inflammation_ or the evidence
of foreign bodies or tumors.
(_d_) Examine the _vermiform appendix_.
(_e_) _The amount of fluid in the abdominal cavity._ Normally a small
quantity of reddish serum will be found, particularly in warm weather,
at the most dependent portion of the abdominal cavity. If the quantity
is small it can only be ascertained by raising the intestines from the
pelvis. When the fluid is considerable, the exact amount should be
ascertained and its character noted.
(_f_) _Perforation_, _invagination_, and _hernia_ of the intestines
should be looked for.
(_g_) Determine the _height of the diaphragm_. Normally, on the right
side, it is at the junction of the fifth rib with the sternum, and on
the left it reaches as high as the sixth. A variety of pathological
conditions change its position. For instance, it may be raised when
the contents of the abdomen are greatly increased in volume, and in
new-born children who have never breathed. It may be depressed by
enlargement of the lungs, disease of the heart, or fluid in the pleural
or pericardial cavities. The presence of air or gas in the pleural
cavity can be determined either by filling the abdomen with water and
puncturing the diaphragm beneath the fluid so that the air will bubble
up, or a puncture may be made through the thorax between the ribs, and
the flame of a match will be deflected by the escaping air.
THORAX.
The thorax is opened by cutting the sterno-costal cartilages as close
to the end of the ribs as possible, the cut being made downward,
outward, and backward, and the knife held obliquely so as not to injure
the underlying parts. Quite often the cartilages will be found ossified
and it will be necessary to divide them by a costotome. Next, separate
the clavicles by a semi-lunar incision at their attachment to the
sternum.
Raise the sternum with the left hand and separate it from the
underlying parts. If there is any adherence of the sternum a slight
twist will be sufficient to remove it.
=Superficial Examination of Thorax.=—Observe the position, color,
and degree of distention of the _lungs_. It should be remembered that
healthy lungs, as soon as the chest is opened, owing to their inherent
elasticity, will collapse, and when this normal collapse is not seen
it is generally due to a loss of elasticity as occurs in emphysema,
to inflammatory diseases binding the lung to the chest wall, or to
the alveoli being filled with solid or fluid substances or pent-up
air. Most complete distention is seen when death is due to drowning or
suffocation.
The area of the _heart_ uncovered will vary according to the degree of
collapse of the lungs and to the abnormal size of the heart. Normally
the cardiac area exposed is quadrangular in shape, and about three and
a half inches in its longest diameter. Examine the _pleural cavities_
for the presence of adhesions, foreign bodies, or fluid. If fluid is
found it should be removed, measured, and its character noted. It
is to be remembered that in warm weather, or when putrefaction has
commenced, a moderate amount of reddish serum is found in the pleural
cavities which has no pathological significance. Lastly, examine the
_mediastinum_ as to the condition of the _thymus gland_ and _great
vessels_ outside the pericardium.
=Pericardium.=—Open the pericardium by an oblique incision along
the anterior wall, and prolong this incision downward and outward
toward the diaphragm and upward to its reflection from the great
vessels. Normally, about a drachm of clear serum, sometimes, however,
blood-stained from decomposition, will be found in the pericardial sac.
The amount is best ascertained by raising the heart. Note next the
contents of the pericardium and whether there is any serous, fibrous,
or purulent exudation. If an abnormal amount of fluid is present,
remove, measure, and note its character. Observe whether there are any
adhesions between the two surfaces of the pericardium. White patches
are often seen on the visceral surface of the pericardium, especially
over the ventricles. These have no pathological significance and are
due to slight thickenings of the pericardium.
=The Heart.=—Having passed the hand over the arch of the aorta and
noticed whether there is any evidence of aneurism or dilatation, we
grasp the heart firmly by the apex, raising and drawing it forward.
We remove it by cutting through the vessels at its base. Test the
sufficiency of the aortic and pulmonary valves by allowing a stream of
water to flow into these vessels, the heart being held in a horizontal
position and care being taken not to pull the valves open.
To apply the water test to the mitral and tricuspid valves, the
auricles are first opened so as to expose the upper surface of these
valves, and by allowing a stream of water to flow through the aortic
and pulmonary valves into the cavities of the ventricles, the degree of
sufficiency of these valves can readily be ascertained.
Another rough test is what is known as the “finger test.” The mitral
valve will normally allow two fingers, held flat and in contact,
to pass through its opening. The tricuspid in the same way allows,
normally, three fingers to pass; or if a more accurate test of the
degree of insufficiency is desired, the valvular orifices should be
measured. Normally, the aortic orifice is one inch across; the mitral,
one and eight-tenths inches; pulmonary, one and two-tenths inches; and
the tricuspid about two inches.
We open first the cavity of the right ventricle by making an incision
over its anterior border close to the septum. Prolonging the incision
downward to the apex and upward through the pulmonary artery, the
cavity of the ventricle will be fully exposed. The left ventricle is
similarly opened by an incision through its anterior wall which is
prolonged upward through the aortic valve. The cavities of the auricle
and ventricle, especially those of the right side, will often contain
blood-clots. These clots are _usually_ post-mortem clots formed during
the last hours of life or after death. It may sometimes be necessary to
distinguish these post-mortem clots from what are known as ante-mortem
clots. The latter are usually of firm consistency, dry, of a whitish
color, and closely entangled in the trabeculæ, while the former are
succulent, moist, of a reddish-yellow color, and are easily detached
from the walls of the heart cavities. Ante-mortem clots are rarely
seen, and the medical examiner should be careful not to attribute the
cause of death to the post-mortem clots which are so often seen. After
the heart is opened we can with more care and greater accuracy examine
the condition of the valves and recognize the extent of valvular
lesions.
The condition of the endocardium should now be examined and any
abnormality noted. Often it will be seen stained a deep red color.
This is not due to disease, but is caused by the absorption of the
coloring matter of the blood which has been set free by decomposition.
The size of the heart cavity and the thickness of the heart walls
should be noted, as also their consistency and color. It should be
remembered that the heart walls may appear unusually flabby as the
result of decomposition, or apparently thickened when death occurs in
extreme systole. The interior of the heart can be further examined by
passing the enterotome into each auricle, carrying the incision through
the mitral and tricuspid valves to join at the apex with the previous
incision, which has been prolonged through the ventricles to the apex.
Thus the auriculo-ventricular valves are completely exposed.
Having removed the blood from the heart it is next weighed. The average
normal weight of the human heart is about twelve ounces in the male,
and a little less in the female: its size roughly corresponding to the
closed hand of the individual. Normally, the thickness of the walls of
the left ventricle about its middle is five-eighths to two-thirds of an
inch, and of the right ventricle one-eighth to one-quarter of an inch.
Note the condition of the aorta above the heart, whether it is dilated,
atheromatous, or shows calcareous deposits. Examine the coronary
arteries by opening them with a blunt-pointed scissors. Disease of
these vessels with thrombosis is one of the causes of sudden death
which is often overlooked.
=The Lungs.=—The lungs are removed by lifting them from the pleural
cavity and cutting through the vessels and bronchi at their base. If
a lung is very adherent it is sometimes better to remove the organ
with the costal pleura attached so as not to tear the lung substance.
Examine the external surface of the lung as to its shape, color, and
consistency. Next open the large bronchi with a blunt-pointed scissors,
and prolong the incision into the pulmonary substance along the minute
bronchi. Observe the contents of the bronchial tubes, the appearance of
the mucous membrane, and their relative thickness. Remember that it is
very difficult to tell the condition in which the mucous membrane was
during life on account of the early post-mortem changes which affect
it, and also because the contents of the stomach may have been forced
after death up the œsophagus and down the bronchi, giving the tubes a
peculiar reddish and gangrenous appearance.
Having examined the bronchi, the lung is turned over and its base
grasped firmly in the left hand. An incision is made from apex to base,
which will expose at a single cut the greatest extent of pulmonary
surface. Note the color of the lung substance, and whether the alveoli
contain blood, serum, or inflammatory products. Blood and serum can
easily be forced from the lungs by pressure between the fingers, while
inflammatory exudations cannot. Examine carefully for the presence of
miliary tubercles.
If a question should arise whether a portion of a lung is consolidated,
this part can be removed, placed in water, and if the air cells are
consolidated the portion will sink; if there is only congestion it will
float. By squeezing the lung between the fingers an inflammation of the
smaller bronchi (bronchitis) can be recognized by the purulent fluid
which will exude at different points. It should be remembered that in
normal condition the lower lobes and posterior aspect of the lungs will
apparently be very much congested as a result of gravity.
=Neck, Larynx, and Œsophagus.=—Throw the head well backward, and
place a block beneath the neck. Make an incision from the chin to
the upper part of the sternum. Dissect the soft parts away on each
side from the larynx and thyroid body, then cut along the internal
surface of the lower jaw from the symphisis to its angle. Through this
incision introduce the fingers into the mouth, and grasp and draw
down the tongue. By dividing the posterior wall of the pharynx and
pulling downward these parts, the trachea and œsophagus can readily be
removed together, a ligature having been first placed around the lower
portion of the œsophagus. Open now the pharynx and œsophagus along
their posterior border. Examine the mucous membrane carefully for the
evidences of inflammation, caustic poison, tumors, foreign bodies,
or strictures. With an enterotome open the larynx and trachea along
their posterior wall. Observe if there is any evidence of œdema of
the glottis, and note the condition of the mucous membrane. Remember
that redness of the larynx is very commonly the result of post-mortem
changes and is also seen in bodies which have been kept cold. Dissect
off and examine the thyroid gland.
ABDOMEN.
Having completed the examination of the organs of the thorax, we next
proceed to examine those contained in the abdominal cavity. We first
raise and,dissect off the omentum, noting if it is abnormally adherent.
The first organs to be removed are:
=The Kidneys.=—Drawing the intestines aside we cut through the
peritoneum over the kidneys, and introducing our left hand we grasp
the organs with their suprarenal capsules attached. Raising first one
kidney and then the other, we easily divide the vessels and the ureters
as close to the bladder as possible. The kidneys are often found
imbedded in a mass of fat which must first be removed. Their surface is
sometimes of a greenish color owing to the beginning of putrefaction.
We note the size of the organ, its color and weight. A normal kidney
weighs from four and one-half to five ounces. Grasping the kidney
firmly in the left hand, we make an incision in its capsule along its
convex border, and with a forceps strip off the capsule and note its
degree of adherence and the condition of the surface of the organ;
whether it is smooth or granular. Prolonging our incision already
made through the cortex of the organ, inward toward the pelvis, we
divide the organ into two halves and now closely examine the internal
structure. The average thickness of the cortex, which should be about
one-third of an inch, is noted; as also its degree of congestion, and
whether the normal light (tubes) and reddish (vessels and tufts) lines
are seen running through it. If these alternate light and dark markings
are lost and the organ has not undergone decomposition, the presence
of some of the forms of Bright’s disease may be suspected. If the cut
surface of the organ presents a waxy appearance, the amyloid test
should be applied by first washing the cut surface of the organ and
dropping upon it a few drops of Lugol’s solution of iodine, when the
amyloid areas will appear as dark mahogany spots on a yellow background.
The pelvis of the kidneys should be examined for calculi and the
evidence of inflammatory lesions. The suprarenal capsules readily
decompose, but if the autopsy is not made too late hypertrophy,
tuberculosis, tumors, and degeneration in them may be recognized.
=The Spleen.=—This organ will be found in an oblique position at the
left side of the stomach. Grasping it firmly in the left hand and
drawing it forward, it can easily be detached. Normally in the adult
it is about five inches in length by three inches in breadth by one
inch in thickness, and weighs about seven ounces. The size, color,
and consistency of the organ should be noted, as well as abnormal
thickenings of its capsule and the presence of any tubercles or tumors
in its substance. The spleen softens very early as the result of
decomposition, and this decomposition should not be mistaken for a
pathological condition.
=The Intestines.=—In cases of suspected poisoning the greatest care
should be taken in the removal of the intestines and the stomach.
Double ligatures should be placed in the following situations so as
to preserve the contents of the organs intact: (1) at the end of the
duodenum; (2) at the end of the ilium; and (3) at the lower portion
of the rectum; and an incision should be made with a pair of scissors
between these ligatures. The jejunum and ilium should first be removed
together by seizing the gut with the left hand, keeping it on the
stretch, and cutting with a pair of scissors through the mesentery
close to its intestinal attachment. The cæcum, colon, and rectum should
then be removed in a similar manner.
The intestines being placed in large absolutely clean dishes, which
have previously been rinsed with distilled water, are opened; great
care being taken that none of the intestinal contents are lost. The
small intestines should be opened in one dish and the large intestine
in another. A portion of the intestines where morbid appearances are
most likely to be seen in cases of poisoning are the duodenum, the
lower part of the ilium, and the rectum. The comparative intensity of
the appearances of irritation should be especially noted. For example,
if the stomach appears normal and the intestines are found inflamed the
possibility of poison from an irritant may be denied.
The intestines are opened along their detached border by the
enterotome. Care should be taken to distinguish the post-mortem
discolorations which are usually seen along the intestines from those
produced by disease. The former are most marked in the dependent
portions. They are apt to occur in patches which can be readily
recognized by stretching the wall of the gut. The darkish brown or
purple discolorations which are sometimes seen as the result of
decomposition are due to the imbibition from the vessels of decomposed
hæmoglobin. Much care and experience are necessary to tell the amount
of congestion which is within normal limits and to recognize changes of
color produced by decomposition.
The pathological lesions ordinarily looked for in the examination
of the intestines are ulcers, perforation, hemorrhages, strictures,
tumors, and the evidences of various inflammations. To obtain an
accurate idea of the various portions of the mucous membrane of the
intestines, it is sometimes necessary to remove their contents. When
very adherent this should be done by allowing as small a portion
of distilled water as possible to flow over their surface. If any
abnormalities are noticed along the intestinal tract, an accurate
description should be given of their situation and extent; as also the
amount of congestion seen in different portions of the intestinal tract.
If possible the different portions of the intestines, as well as the
stomach, should be examined immediately after being exposed to view,
as under the influence of the air those parts which are pale may
become red, and slight redness may become very pronounced. In this way
only can we estimate the degree of vascularity of the various parts
after death. However, in cases of suspected poisoning, _when it is
impossible for the chemist to be present at the autopsy, the medical
examiner should not open the stomach and intestines_, but place them
in sealed jars. As soon as possible afterward, the chemist being
present, they should then be examined in the manner indicated. What
may be lost by waiting, in changes of color which have taken place,
will be more than counterbalanced by the data which the chemist will
obtain from observing the contents and mucous membrane of the stomach
and intestines when they are first exposed. The characteristic odors
of certain poisons are so evanescent that they quickly disappear after
opening of the stomach and intestines.
After a thorough examination of the intestines, they are to be put with
their contents into wide-mouthed vessels, each part by itself, and
the basins in which they were opened washed with distilled water and
the washings put into the same bottle. As soon as the intestines are
transferred to the jars they should be sealed.
=The Stomach.=—The stomach and duodenum are removed together. They
are opened by passing the enterotome into the duodenum and dividing
it along its convex border, the incision being continued along the
greater curvature of the stomach as far as the œsophageal opening. They
should be opened in a large glass dish which has been carefully washed
with distilled water. The chemist and medical examiner will carefully
note the quantity, odor, color, and reaction of the stomach contents;
also whether luminous or not in the dark; the presence or absence of
crystalline matter, foreign substances, undigested food or alcohol.
Portions of the contents should be placed in a small glass bottle and
sealed, so that at a future time they may be examined microscopically.
Only in this way can an absolute knowledge of the character of the
stomach contents be obtained. In certain medico-legal cases the ability
to decide the character of the stomach contents is of the utmost
importance. The mucous membranes of the stomach and duodenum must be
next carefully examined for evidences of hemorrhages, erosions, tumors,
and of acute or chronic inflammations. The appearance of the rugæ and
their interspaces, principally in the region of the greater curvature,
should be noted; because here traces of poison and its effects are
most frequently seen. If the stomach is inflamed, the seat of the
inflammation should be exactly specified, as also that of any unusual
coloration.
The condition of the blood-vessels are also noted. Vascularity or
redness of the stomach after death should not be confounded with the
effects of poison or the marks of disease. It may occur in every
variety of degree or character and still be within normal limits.
Vascularities which we might call normal are seen in the posterior part
of the greater end and in the lesser curvature, and may cover spaces
of various extent. Rigot and Trosseau have proven by experiment that
various kinds of pseudo-morbid redness may be formed which cannot be
distinguished from the varieties caused by inflammation; that these
appearances are produced after death and often not until five or eight
hours afterward, and that they may be made to shift their place and
appear where the organ was previously healthy, merely by altering the
position of the stomach. Ulcers, or perforations of the stomach as the
results of disease, as also the digestion of the stomach after death,
have been mistaken for the effects of _irritant poisons_.
When perforation of the stomach is the result of caustic poisons, the
edges of the opening are very irregular, and are of the same thickness
as the rest of the organ. The parts not perforated are more or less
inflamed, and traces of the action of the caustic are found in the
mouth, pharynx, and œsophagus. This is the opposite condition to that
seen in spontaneous perforation.
In considering perforation of the stomach the following points given by
Taylor are well to remember:
(1) A person may have died from perforation of the stomach and not from
poisoning.
(2) A person laboring under disease may be the subject of poison.
(3) A person laboring under disease may have received blows or
injuries on the abdomen, and it will be necessary to state whether the
perforation did or did not result from the violence.
(4) The perforation of the stomach from post-mortem changes may be
mistaken for perforations from poison.
_Corrosives_, if they do not produce perforation of stomach, will
generally cause intense inflammation accompanied by softening of the
inner coat, sometimes ending in gangrene. The inflammation varies as to
its extent and intensity, sometimes affecting principally the mouth and
œsophagus, but generally the changes are more pronounced in the stomach
and duodenum, while in rare cases the inflammatory process may extend
through the whole alimentary canal. The mucous membranes are sometimes
bright red with longitudinal or transverse patches of a blackish color,
formed by extravasated blood between the coats. _Carbolic acid_ often
produces in the stomach and œsophagus white patches—when these patches
are carefully examined, an ulcerated surface beneath them is generally
seen.
_Narcotic Poisons._—It is a common but mistaken idea that these
poisons produce some mark or characteristic effect upon the stomach
walls; that they induce a rapid tendency to putrefaction; that the
blood is in a fluid state; that hemorrhages are seen in various
parts; that the stomach and intestines show sloughing without any
inflammation. Some of these conditions may and probably do occur, but
they are far from being invariable in their appearance. Experiments
made by Orfila on animals with narcotic poisons prove the above
statement. In conclusion, I would emphasize the fact that the _narcotic
poisons produce no characteristic changes in the stomach that can be
detected_.
=The Liver.=—The liver should be removed from the body and no attempt
made to examine the organ _in situ_. After raising first one lobe and
then the other, the diaphragm should be cut on either side and the
suspensory and lateral ligaments divided, then the organ can easily
be removed. The weight of the organ is ascertained, as also the
measurements of its size recorded. The normal weight is from fifty to
sixty ounces. The organ is normally about twelve inches in length by
seven inches in depth by three and one-half inches in thickness.
The gall bladder is first examined to determine the character and
amount of the bile and the presence or absence of gall stones,
inflammatory lesions, and tumors.
At autopsies the surface of the liver, especially along the free
border, is generally seen to be of a greenish or dark-brown color.
This discoloration is due to the action of the gases developed
by decomposition on the coloring matter of the blood, and has no
pathological significance. The character of the surface of the liver
is now noted, whether smooth or rough. The organ is opened by deep
incisions in various directions, and the color, consistency, and blood
supply of the liver tissue carefully recorded. The presence of new
connective tissue, amyloid degeneration, abscesses, or tumors should
not be overlooked. It should be remembered that, of all the poisons,
phosphorus alone leaves characteristic appearances in the liver.
=The Pancreas.=—The pancreas is now easily removed, and its size and
weight recorded. Normally it should weigh three ounces and measure
eight inches in length by one and one-half inches in breadth by one
inch in thickness. The organ should be opened by a longitudinal cut and
examined for evidences of acute or chronic inflammation, fat-necrosis,
tumors, calculi, and amyloid degeneration.
=Genito-Urinary Organs.=—It is very important in medico-legal cases
that all the urine should be preserved and obtained uncontaminated;
therefore before the bladder is opened a catheter should be introduced
and the urine drawn off into a clean bottle which has previously been
rinsed with distilled water. If more convenient the bladder itself can
be punctured at its upper portion, a pipette introduced, and the urine
drawn off in this manner.
The genito-urinary organs are removed together. This is done in the
following manner. The body of the penis is pushed backward within the
skin and cut off just behind the glans penis; the remaining portion of
the rectum is raised. This with the prostate gland, bladder, and penis
attached is removed by carrying the knife around the pelvis close to
the bone and separating the pubic attachments. The organs are then laid
on a clean board and the urethra is opened on a grooved director passed
into the bladder, and the incision prolonged so that the internal
surface of the bladder itself will be completely exposed. Examine the
_urethra_ for strictures, inflammatory lesions, and ulcers. Examine
the _bladder_ for congestion, hemorrhages, inflammation, and ulcers
of its mucous surface, and note the thickness of its walls. Open the
_rectum_ and examine for ulcers, strictures, tumors, and the evidence
of hemorrhage. The _prostate_ gland is opened by a number of incisions
into its substance. Examine for hypertrophies, tumors, and inflammatory
lesions. Force the _testicles_ through the inguinal canal, and cut
them off. Weigh, open, and examine them for evidence of inflammation,
tuberculosis, and tumors.
=Female Organs.=—Before removing these organs, any abnormalities such
as adhesions, malpositions, and tumors should be noted. Dissect the
organs away from the pelvic bones by carrying the point of the knife
around the pelvis close to the bone. Cut through the vagina at its
lower third, and the rectum just above the anus. The organs can now
readily be removed. Examine the _vulva_ for ulcers, hypertrophies, and
tumors. Open and examine the _bladder_. Open the _vagina_ along its
anterior border and carefully examine its mucous surface for evidences
of inflammation.
THE UTERUS.—Before opening the uterus, its size and shape should be
recorded. The average normal weight of the organ is about one and
one-quarter ounces; its length three inches, breadth two inches, and
thickness one inch. Open the organ along its anterior surface by a
blunt-pointed scissors passed through the cervix, and the incision
carried as far as the fundus. Note the thickness of its walls and any
abnormalities of its mucous membrane. During menstruation, the mucous
membrane of the body is thickened, softened, and covered with blood
and detritus. Retention cysts are found in the mucous membrane of the
cervix and are not generally of pathological significance.
Remove, measure, and weigh the _ovaries_. Their normal weight is about
one drachm each; their size, one and one-half, by three-quarters, by
one-half inch. Open the organs by a single incision and examine for
the evidences of acute and chronic inflammations, tumors, and cysts.
The _corpora lutea_ in various stages can be easily recognized in the
substance of the organ. Open the _Fallopian tubes_ and examine their
contents and the condition of their membranes (see DISPUTED PREGNANCY
AND DELIVERY, Vol. II.).
THE SPINAL CORD.
To remove the cord, the body should be placed on its face with a block
beneath the thorax. An incision is made through the skin and muscles
along the entire length of the vertebral column and the soft parts
dissected away so as to expose the transverse process of the vertebræ.
The lamina are divided with a saw through the articulate process (a
double-bladed saw specially adapted for this work can be obtained).
After the lamina have been completely severed, these together with the
spinous process can now be readily torn away with a stout hook and the
cord exposed. A long chisel with a wooden mallet will often greatly
facilitate this work. Great care should be exercised not to injure
the cord. The roots of the spinal nerves are now severed, and the
cord removed within its membrane. It should be remembered that serous
fluid within the membranes of the cord, as also intense congestion,
especially along its posterior aspect, is often seen as the result of
post-mortem change. The cord is laid on a clean board and the dura
mater opened with a blunt-pointed scissors along its anterior aspect,
and an examination made for the presence of hemorrhage, inflammatory
lesions, and tumors. Softening of the cord can generally be detected by
the finger passed along it. This, however, is not a perfectly accurate
test, especially if the body has been dead some time. The cord is
now cut by transverse incisions about half an inch apart throughout
its entire length, and the cut surface examined for the evidences of
disease such as hemorrhages, softening, and inflammatory lesions.
After the cord has been removed, examine the vertebral column for the
evidences of fractures and displacements.
LATE AUTOPSIES.
Late autopsies are those performed after partial or complete
destruction of the soft parts of the body, through the natural
processes of decomposition, or the examination of bones exhumed long
after interment. The term may be employed also to mean the inspection
of an embalmed body, dead for some time.
The object of late autopsies is to determine identity, or to establish
the guilt or innocence of suspected persons. An examination of the
skeleton even many years after death may give important information as
to the manner in which the deceased came to his end. This cannot better
be illustrated than by the citation of one or two cases.
In the celebrated case of “Eugene Aram,” the bones of his victim were
discovered thirteen years after the crime had been committed. A man who
afterward proved to be Aram’s accomplice was arrested on suspicion. He
confessed the crime, and the opinion formed by the medical witnesses
was confirmed by his statements. The skull presented evidence of
fracture and indentation of a temporal bone. Aram argued the case in
his own behalf, but the testimony was too strong against him: he was
convicted and executed.
Taylor records the case of a man, Guerin, who was convicted of the
murder of his brother from evidence obtained from an examination of the
skeleton three years after interment. Here, again, blows upon the head
were the cause of death, and the fractures were plainly perceptible
upon the exhumed skull.
An autopsy upon a body before the soft parts have been entirely
destroyed, or upon an embalmed body, should be conducted in much
the same manner as ordinary autopsies. In these cases the method of
burial should be noted. If it be a case of murder, and the body has
been hurriedly put into the ground, it is not likely that the custom
of Christian nations has been observed—that of laying the body full
length, with the head to the west.
In the case of partially destroyed bodies, the remaining soft parts
will give little evidence of the mode of death unless the violence has
been very extensive, and even then it may be impossible to determine
whether a wound was inflicted prior to or after death. Recourse must
be had to the skeleton, and the only evidence it can furnish is of
fractures, unless, as happened in one case, a rope be found about the
cervical vertebræ.
When the skeleton only is found, Taylor lays stress upon the following
points:
(1) Whether the bones belong to a human being or one of the lower
animals.
(2) If a human being, whether male or female.
(3) The length of time they have probably remained in the ground.
(4) The probable age of the individual to whom they belonged. If the
maxillary bones be found, much information may be obtained from an
examination of the teeth.
(5) The probable stature of the individual during life.
(6) The race to which he belonged. The conformation of the skull and
thickness of the bones will give important information on this point.
(7) It should be determined whether solitary bones belong to the right
or left side, and whether they form parts of one or more than one
skeleton.
(8) Whether they have been fractured, and if so, whether it occurred
during life, or by accident at the time of the exhumation. If it
occurred during life, whether it be recent or of long standing.
(9) The presence or absence of personal deformities, of supernumerary
fingers or toes, of curvature of the spine, of ankylosis of one or more
joints.
(10) Whether they have been calcined, as murderers sometimes try to
make away with the bodies of their victims by burning. Especially is
this the case in infanticides (see IDENTITY, Vol. I., p. 408 _et seq._;
TIME OF DEATH, Vol. I., p. 452 _et seq._).
AUTOPSIES OF FRAGMENTS.
These cases are usually cases of murder in the perpetration of which
the criminal has mutilated the body with a view to destroying all
traces of identity.
The importance which attaches to autopsies of fragments rests upon
the fact that parts of a body may be found widely separated, and that
one portion may be found before the others. In such cases it will be
necessary to determine if they belong to one and the same body. The
examination is conducted chiefly with a view to establishing this.
The examiner must note the manner in which the fragment has been
separated; whether it is clean cut, as by one who understood something
of anatomy, or, whether it has been separated roughly and by one
ignorant of the body structure. The determination of this point will
be one link in the chain of evidence which may lead to the detection
of the criminal, or the acquittal of one accused. An anatomist or
a butcher would be likely to cut through at a joint, and to do it
neatly. The exact point at which the severance has taken place should
be noted. The place of finding, the circumstances under which found,
the condition and general appearance of the fragment should all be
carefully recorded. The color of the skin will indicate with some
accuracy the race to which the individual belonged. The probable
sex may be determined by the presence or absence of hair, and the
general conformation. This, however, will not apply in the case of
children. The probable age may be fixed upon from the size and degree
of development of the fragment. The cut surface should be carefully
described, and if possible a drawing should be made of it.
There are special considerations which apply to certain parts of the
body.
=The Head.=—The exact point of severance should be recorded. The
number of vertebræ which remain attached to the head should be counted,
and if the section pass through a vertebra, its number and the amount
of it missing should be stated. The sex will be apparent in all
instances; the race may be determined both by the color of the skin
and by the shape of the head; the age may be approximated, though care
must be had in expressing an opinion, for the manner of living is well
known to affect the appearance of age. Evidence of violence prior
to death should be noted, and the presence or absence of fractures
ascertained; also observe the color of the hair and whether it be thin
or abundant; the presence or absence of beard or mustache, and if
present the color; and the color of the eyes.
=The Arm.=—The following points should be determined: the color of the
skin as indication of race; the probable sex from its shape and general
conformation; the probable age from its size and degree of development;
marks of any kind, such as tattooing; and deformities, such as signs of
old or recent fracture, or dislocation; and supernumerary fingers.
=The Leg.=—The examination of the leg should be conducted in much the
same manner as that of the arm.
=The Trunk.=—An examination of the trunk will reveal the race, sex,
and probable age, and may give evidence as regards the manner in which
the deceased came to his or her death. Any marks or deformities should
be recorded, and in all cases the viscera should be examined.
MEDICO-LEGAL REPORTS.[568]
After making a medico-legal autopsy, it will be necessary for the
medical examiner to draw up a report of his findings, and the
conclusions based thereon. The report should be clear and concise, and
the language such as a coroner’s jury can understand. Technical terms
should be avoided, and when their employment is necessary they should
be explained in the margin or in parentheses.
The report should be drawn up in somewhat the following manner:
1. When and under what circumstances the body was first seen; stating
hour of day, day of week and month.
2. When deceased was last seen living, or known to be alive.
3. Any circumstances that would lead to a suspicion of suicide or
murder.
4. Time after death at which the examination was made, if it can be
ascertained.
5. The external appearance of the body: whether the surface is livid or
pallid.
6. State of countenance.
7. Any marks of violence on the person, disarrangement of the dress,
blood-stains, etc.
8. Presence or absence of warmth in the legs, abdomen, arms, armpits,
or mouth.
9. Presence or absence of rigor mortis.
To give any value to this point it is necessary for the witness to
observe the nature of the substance upon which the body is lying;
whether the body be clothed or naked, young or old, fat or emaciated.
These conditions materially influence the rapidity of cooling and the
onset of rigor mortis.
10. Upon first opening the body the color of the muscles should be
noted. Carbon monoxide poisoning causes them to be of a cherry-red
color.
11. The condition of the blood and its color.
12. The state of the abdominal viscera, describing each one in
the order in which it is removed (see p. 370). If the stomach and
intestines are inflamed the seat of the inflammation should be exactly
specified; also all evidences of softening, ulceration, effusion of
blood, corrosion, or perforation. The presence of hardened fæces in the
rectum will bear evidence that no purging occurred immediately before
death.
13. The state of the heart and lungs. (For special consideration of the
lungs in cases of suspected infanticide, see Vol. II.; and of persons
drowned, see Vol. I., p. 805 _et seq._).
14. The state of the brain and spinal cord.
After a thorough consideration of the results of the examination,
conclusions must be drawn from this examination; never from the
statements of others. The conclusions commonly relate to whether
death was due to natural or unnatural causes; if to unnatural causes,
what are the facts which lead the examiner to this opinion. As the
conclusions are intended to form a summary of the whole report, they
must be brief and tersely stated.
PERSONAL IDENTITY,
INCLUDING
THE METHODS USED FOR ITS DETERMINATION IN THE
DEAD AND LIVING.
BY
IRVING C. ROSSE, A.M., M.D., F.R.G.S. (ENG.),
_Professor of Nervous Diseases, Georgetown University; Membre du
Congrès International d’Anthropologie Criminelle, etc._
PERSONAL IDENTITY.
GENERAL CONSIDERATIONS.
Identity is the determination of the individuality of a person. In
jurisprudence the term is applied to the recognition of a person who is
the object of a judicial action. The establishment of the individuality
of a person is known as _absolute_ identity; while the relations of a
person with some particular act is known as _relative_ identity.
The great number and variety of facts concerned in the investigation
of questions of identity are of considerable gravity and importance in
their juridical bearing, and at the same time they are among the most
interesting and most useful of the applications of modern medicine to
the purposes of the law.[569]
Among the varied researches of legal medicine looking to an
interpretation of facts, no other question occurs in which the solution
depends more upon morphological and anatomical knowledge, and none is
more dependent upon purely objective, visible, tangible facts.
Personal identity often constitutes the entire subject-matter of
dispute in a civil case. Upon it may depend the question of absence or
of marriage, of kinship or of filiation involving the possession of
an estate, in which case the court often requires the most subtle of
scientific evidence to assist in its decision. Many anthropological
and medical facts, now appropriated by criminology and penal science,
are useful in proving not only the present but in attesting future
identity, thereby preventing in great measure the dissimulation of
prisoners, deserters, false claimants to life insurance, fraudulent
pensioners, and the like.
Such matters are of daily occurrence. The special agents of the U. S.
Pension Office detect and cause the punishment of many fraudulent
claimants. Stratagems and conspiracies to defraud life-insurance
companies go much further than mere substitution. Instead of a
“fraudulent” a positive death may come up for investigation, and in
order to defraud an insurance company of a large amount, a body may
even be procured by homicide to consummate the deception, as was done
in the Goss-Udderzook tragedy near Baltimore in 1872.
A celebrated case now before the Supreme Court of the United States and
involving the question of personal identity is that of the Mutual Life
Insurance Company of New York, the New York Life Insurance Company, and
the Connecticut Mutual Life Insurance Company of Hartford, Connecticut
(Consolidated), plaintiffs in error, vs. Sallie E. Hillmon.
It is pre-eminently in criminal trials that the personal identity of
the victim often constitutes an essential connecting link. Before it
can move, the law requires, at the outset, proof of the individuality
of both the author of a crime and of the victim. I shall, therefore,
not touch upon such elusive individuals as Charlie Ross and Jack
the Ripper, but limit my remarks to a synthetical exposition of the
best-known facts regarding identification of the dead body and the
interpretation of its organic remains.
The identity of a living person, or even our own identity, is often a
difficult point to establish. It may also require medical evidence,
oftentimes of a most involved character, to establish the fact of
death. Hence the medico-legal process of connecting a dead body, or
the remains or traces of the same, with a human being once known to
have lived and moved on earth, is beset with difficulties that may give
rise to still greater antagonisms of evidence. The question of personal
identity is one of the hardest that could possibly come before a court.
Celebrated cases and judicial errors have given it great notoriety.
There are consequently few questions in forensic medicine that require
more attention and sagacity, and none upon which the medical legist
should pronounce with more reserve and circumspection. Medical men are
absolutely the _only_ persons qualified to assist in resolving the
really delicate question of personal identity; yet the physician and
the lawyer pursue the same line of logic and of inquiry. As the former
must have a subject to dissect or to operate upon, so must the lawyer
in pursuing a criminal investigation first prove a visible material
substance known in legal phraseology as the _corpus delicti_, which he
must connect with some personality, with some human being once known
to have lived. In this important process the physician’s testimony
being the indispensable guide of the court’s inference, he should limit
himself to purely anatomical and material knowledge. The medical expert
has absolutely nothing to do with guilt or innocence, as that is a
question for the jury. He should, above all things, be absolutely free
from prejudice, suspicion, or undue suggestion, and should remember
that in thus sinking his personality his sole function as a skilled
witness in cases of identity is to furnish testimony which, when taken
in connection with other evidence in the case, may establish such a
_corpus delicti_ as would justify the inference of a crime.
A nice point may arise as to dispensing with the proof from the body
itself, when the substantial general fact of a homicide is proved
_aliunde_, as in the case of a criminal causing the disappearance
of his victim’s body by means of its decomposition in lime or other
chemical menstrua, or by submerging it in an unfathomable spot in the
sea. Under circumstances such as the following: a person is seen to
enter a building and is not seen to leave it, although all means of
egress therefrom are watched; another person is seen to ignite the
building, which thereupon burns down, and the charred remains of a
human body are found in the ruins; the proof of identity from the body
itself might be dispensed with in view of the substantial general fact
of a homicide having been committed. In a delicate case where the man
of art hesitates and finds no _corpus delicti_, the investigation of
imprints and stains may give a clew of great value to the expert. Yet
it is only upon absolute evidence, and in the strongest possible case,
that the fundamental principle of the _corpus delicti_ is disregarded.
In the case of Ruloff, the child’s body was not produced and no trace
of it could be alleged to have been found; nevertheless the prisoner
was found guilty of murder. This case was speedily overruled (18 N. Y.,
179), on the ground that a dangerous precedent had been pronounced.
So indispensable is the showing of the _corpus delicti_ in cases
of recognition that lawyers have come to regard even the judicial
confession of an accused as often the flimsiest and most unsatisfactory
kind of evidence. Numerous cases of demonstrated fallibility of
confessions are cited in the books, where the statement was utterly
lacking in anything except motive or hallucination. In the Proceedings
of the New York Medico-Legal Society, December 6th, 1876, Mr. James
Appleton Morgan mentions the case of a German servant-girl who
assured her mistress, whose little boy, a child of seven, had just
died and been buried, that she (the servant) had poisoned the boy.
The servant swore to her crime and was taken into custody, and it was
only when no poison was discovered upon exhuming the child’s body and
examining its stomach that against her own protest she was acquitted
of the possibility of the crime. Another case of the kind that has
had medico-legal notoriety was tried a few years ago before a court
in Brittany. The accused declared that he had killed his servant and
thrown the body in a pond. His guilt seemed certain, when the alleged
victim put in an appearance, thus reducing the evidence to the strange
hallucination that had prompted the confession.
But the most wonderful of these is the celebrated case of Boorn, in
which medico-legal evidence took no part. In view of the seeming
hopelessness of his case, the accused confessed to murder in
expectation of mercy from the court, but was finally acquitted on the
alleged victim walking into court and confronting the man who had sworn
to having killed him.
Although wisdom and experience point to the necessity of showing
something corporal and material in cases involving questions of life
and death, yet very small traces or minute remains of a human body may,
in certain circumstances, constitute a _corpus delicti_ that may lead
to trial if not to conviction. In 1868 the Lambert case, for murder on
the high seas, was tried before Judge Benedict in the United States
Court, the only _corpus delicti_ alleged being a large pool of blood
and brains found on the forecastle of a ship at sea, out of sight of
land or other vessel. Circumstances, acts, and words pointed strongly
to the murder of one of the crew, who was believed to have been brained
with an axe and thrown overboard. Notwithstanding the fact that
animosity was known to exist between the accused and the missing man,
it further appeared that the accused, in a state of great excitement,
had followed the missing man forward and returned alone with a hatchet
in his hand, yet the jury in this instance were not satisfied as to
the establishment of a _corpus delicti_ beyond a reasonable doubt and
accordingly failed to convict.
Two classical cases, that of Gardelle and of Dr. Webster, mentioned
in many of the books, stand forth as instances of conviction where
fragments of the human body were recognized after attempts to destroy
them by intense heat. The conviction of Dr. Webster rested almost
entirely upon medico-legal evidence; but it is probable that upon the
same circumstantial evidence the increased industry of counsel would
have so rung the changes in regard to its uncertain and unsafe nature,
and would have so used the knowledge gained from advanced discoveries
in the regions of the probabilities of science, as to have secured the
acquittal of the prisoner had the trial taken place at the present time.
A similar affair of great medico-legal interest is the Goss-Udderzook
tragedy, already referred to, an account of which is given by Drs.
Lewis and Bombaugh among the “Remarkable Stratagems and Conspiracies
for Defrauding Life Insurance Companies,” New York and London, 1878.
IDENTITY OF BURNT REMAINS.
The medical jurist will no doubt find cremation a formidable barrier in
elucidating the question of identity, although the entire destruction
of a dead body is a matter of extreme difficulty.
In the case of calcination chemical analysis of the ash would detect
the phosphate of lime, but this would throw no light upon the
subject, since the ash of human bones and that of the lower animals
is identical. If the burnt bone is entire, the state of the epiphyses
may enlighten the question of the determination of age. The following
two cases, in which fragments or portions of bone had been submitted
to the action of fire, show how medical training and some knowledge of
comparative anatomy may contribute to the establishment of guilt or may
attest innocence.
In the case of The Queen _vs._ John Henry Wilson, for murder, the
accused burnt his step-father in a lime-kiln for over a week, and on
strewing ashes from the kiln fine fragments of bone picked up were
afterward identified as human. At the trial identity rested on the fact
of finding two buttons and a buckle, which were recognized as part of
the deceased’s wearing apparel when last seen.
In the second case, that of a young woman supposed to be in the family
way who should not have been, it was thought that she had been confined
and made away with the infant. Under this supposition the premises
where she lived were searched by the chief constable, who found in
the stove some bones and fragments of bones that had been burnt. On
examination by a qualified medical man, the fragments turned out to be
not human bones, but those of some other animal, presumably those of a
pig and of a chicken, which the family, who lived in a tenement-house
without a back yard, had put in the stove to get rid of the refuse.[570]
IDENTIFICATION OF HUMAN BONES.
In deciding whether certain bones are human or not, the medical jurist
should exercise great caution in venturing an opinion as to the precise
animal of which he may believe they formed a part. There is no great
difficulty in detecting the smallest fragments of bone by means of
the microscope, but we cannot say with safety whether the fragments
belonged to a mouse, a man, or an elephant. A real difficulty occurs in
recognizing the nature and origin of the bony remains when only a small
fragment or a single bone is submitted for report. If a sufficient
portion of the skeleton be submitted it can be easily recognized as
human, as in the imbedded remains of the troglodyte found in the
limestone deposit of Luray Cave, Virginia, and only in the exceptional
case of the bones of one of the manlike apes could a difficulty of
distinction arise. The characteristic signs that distinguish a gorilla
skeleton, for instance, are the smaller thumb; notable length of tibia
and of radius, although this relative length of extremities has been
remarked in negroes; small facial angle, 30° to 40° in the monkey, 70°
to 80° in man; very inferior cranial capacity, the maximum in a gorilla
being 550 cubic centimetres, while the minimum in the human species is
from 970 with a maximum of 1,500 to 1,900 centimetres; a low index of
the foramen magnum; convexity of the squamo-parietal suture, and larger
and more salient canines and incisors. The volume of the endocranium
in the female gorilla, like that of the human species, is smaller
than that of the male; this difference being almost 80 c.c. for the
anthropoid female.
In studying the osseous system it should be remembered that certain
modifying elements, as artificial compression, pathological
deformities, posthumous distortions, and hygrometric conditions, may
affect particularly the skull, and if due allowance be not made for
these the study may lead to glaring absurdities. Not longer ago than
1725 there was found in a quarry at Œningen the skull of a fossil
batrachian compressed into rude resemblance to the human cranium, which
was announced to the world as Scheuchzer’s “_Homo diluvii testis et
theoscopos_,” and as the remains of one of the sinful antediluvians who
perished in the Noachic deluge.
ARE THE BONES OLD OR RECENT?
An important point may arise in questions of identification of bones as
to the oldness: whether they are old or recent. The first indication
is furnished by the presence or by the absence of the soft parts.
The existence of the periosteum and of the spinal marrow is the most
persistent proof of a recent state; but these alone with the soft parts
are usually destroyed in two or three years. In ordinary circumstances
a body becomes skeletonized in about ten years, although in exceptional
cases the cadaver may resist decomposition after many years.[571]
This summer in transferring an old cemetery in Georgetown, D. C., the
remains of the grandmother of one of the writer’s patients were found
in such a state of preservation as to be easily recognized after fifty
years of burial. More recently, in unearthing the remains of an old
graveyard in East Washington, a striking peculiarity was noticed in the
fact that many bodies of young people buried in recent years when taken
up consisted of a few blackened bones and shreds of grave-clothes.
while the remains of many older people buried long before the Civil War
were found in an excellent state of preservation. One of these was a
Mr. Fullin, who died from the effects of a sunstroke forty years ago
and was buried in a metallic case. An old lady who attended his funeral
was present when his remains were unearthed and said they looked as
natural as when he was laid away in 1852. The features were well
preserved and even the white linen of the shroud was unsoiled.
Alterations in the texture of the bone, such as that caused by
dryness and by diminution in the proportion of organic matter, may be
ascertained by histological examination, and one of the characters of
age may be furnished by taking into consideration the specific weight.
Placing the skull at an average density of 1,649, that of an infant
would be 1,515, an adult 1,726, and that of old age 1,636.
Ascertaining the proportion of organic and inorganic matter, the
phosphates and carbonates, by chemical means may furnish an additional
help in the interpretation of the remains.
With all these diagnostic methods it may still be impossible to
establish identity either absolute or relative, even where a whole
skeleton is in question. The evidence may, however, be of great
juridical use to the accused, as in the case of Van Solen, tried for
the murder of Dr. Henry Harcourt, where the collective facts pointed to
the identification of a body dead two years. The jury, however, after a
second trial, were instructed to acquit unless they were certain that
the remains were Harcourt’s. They acquitted, as no _one_ decided and
apparent feature was known to have existed by which the remains could
be identified beyond a doubt.[572]
IDENTITY IN CASE OF ENTIRE SKELETON OR IN CASE OF ISOLATED BONES.
Where an entire human skeleton has been discovered, the objects of
inquiry here, as in the case of fragments or remains, are to establish
the identity of the victim and that of the author of the act, and to
collect all available information relative to the nature of the death
and to the diverse circumstances attending the commission of the deed.
In gathering evidence from the examination of the skeleton or of
isolated bones, with a view to find out the probable cause of death
of the person of whom they form a part, a great variety of questions
will arise for consideration, such as those relating to race, stature,
age, sex, and trade or occupation; the exterior signs furnished by
dentition; the traces of congenital peculiarity or of injury, and the
signs of disease either hereditary or acquired.
DETERMINATION OF RACE.