THE CHANGES IN THE BODY AFTER DEATH.
=Cooling of the Body.=—The internal temperature of the healthy living
being is about 37 degrees centigrade. But it may be increased several
degrees in consequence of disease. After death the chemical changes
upon which the maintenance of this temperature depends rapidly
diminishes, and the body gradually cools to the temperature of the
surrounding atmosphere. This usually occurs in from about fifteen
to twenty hours, but the time required depends upon a variety of
conditions. Immediately after death there is, in nearly all cases, a
slight elevation of internal temperature, owing to the fact that the
metabolic changes in the tissues still continue for a time, while the
blood ceases to be cooled by passing through the lungs and peripheral
capillaries. After death from certain diseases yellow fever, cholera,
rheumatic fever, and tetanus, a considerable elevation of internal
temperature has been repeatedly observed.
The time occupied by the cooling of the body may be prolonged after
sudden death from accidents, acute diseases, apoplexy, and asphyxia.
A number of cases is reported in which the body retained its heat for
several days without known cause.
After death from wasting chronic diseases, and in some cases after
severe hemorrhage, the cooling of the body is very rapid, the internal
temperature being reduced to that of the surrounding air within four or
five hours.
Fat bodies cool less quickly than lean ones, the bodies of well
nourished adults less quickly than those of children or old persons.
The temperature of the surrounding atmosphere, the degree of protection
of the body from currents of air, of course, modify the progress of
cooling; and the internal organs naturally retain their heat longer
than the surface of the body. The rate at which cooling occurs is
most rapid as a rule, during the hours immediately following death,
notwithstanding the postmortem rise which may ensue.
=Cadaveric Lividity.=—This means the black and blue discoloration from
the effects of the congestion or contusion of the blood.
After life becomes extinct, and before the blood coagulates, it
changes its position chiefly in two ways: First, it is driven by their
contraction out of the arteries and into the veins; second, it settles
in the veins and the capillaries of the more dependent parts of the
body, inducing, usually within a few hours after death, a mottling of
the surface with irregular livid patches. These patches may coalesce,
forming a uniform dusky red color over the back of the trunk, head
and extremities, and sometimes over the ears, face and neck. The same
effect is noticed on the anterior aspect of the body if it has lain
on the face. At points of pressure, from the folds in the clothing,
and from the weight of the body on the bed or the cooling board, the
red color is absent or less marked. This to the undertaker and the
embalmer is known as postmortem discoloration. These changes occur
before putrefaction sets in. This cadaveric lividity should not be
mistaken for the antemortem ecchymoses from which it may usually be
distinguished by its position and extent by the fact that the surface
of the skin is not elevated, and by the fact that on incision no blood
is found free in the interstices of the tissues. Not infrequently
the subcutaneous tissue in the neighborhood of these postmortem
discolorations become infiltrated with a reddish serum. Very soon after
death, particularly in warm weather, the tissues immediately around the
subcutaneous veins of the neck and the thorax and in other situations,
may become stained a bluish red color from the decomposition and escape
from the vessels of the coloring matter of the blood. This to the
undertaker and the embalmer is known as postmortem discoloration.
=Putrefactive Changes.=—As soon as the body dies, it becomes as any
other inanimate object, subject to putrefaction and decay.
The tissues of the body undergo various changes as to consistency of
the solids, semi-solids, fluids, and as to color.
Putrefactive changes are caused by the presence of putrefactive germs
normally present in the tissues or gaining access to them, which in
their effort to satisfy their own nutrition, break down those complex
molecules of which the tissues are composed into simpler compounds.
Putrefaction then is organic decomposition or decay the result
of putrefactive bacteria. Putrefaction may also be defined as the
separating of the constituent elements of the body due to the presence
and growth of bacteria.
Although septic changes may take place before the death of a body, yet
the term putrefaction is not applied until after the death of a body,
and denotes those changes in color, consistence, and smell so clearly
perceptible.
Usually in from one to three days, depending upon circumstances, a
greenish discoloration of the skin occurs at first upon the middle
of the abdomen, over which it gradually spreads, assuming a deeper
hue, and often changing to greenish purple or brown. Greenish patches
may now appear on the different parts of the body, earliest upon
those overlying the internal cavities; this discoloration is probably
produced by the action on the haemoglobin of gases developed by
decomposition.
The eyeballs now become placid and if the eyelids are not closed the
conjunctiva and cornea become brown and dry. The pressure of gases
developed by decomposition in the internal cavities not infrequently
forces a greater or less quantity of frothy, reddish fluid or mucous
from the mouth and nostrils, distends the abdomen, and, if excessive,
may lead to changes in the position of the blood in the vessels and
even a moderate amount of displacement of the internal organs.
After five or six days, under ordinary circumstances, the entire
surface is discolored to a green or a brown. After this the epidermis
becomes loosened through the formation of gases and separating of
fluids beneath, and the tissues become flaccid.
The abdomen and the thorax may be greatly distended, and the features
distorted and scarcely recognizable from swelling, and the hair and
nails loosened.
On the interior of the body, those soft and less compact tissues,
or those tissues in which there is a great amount of fluid, are the
first to decompose. This may be noticed by examining the walls of the
trachea, esophagus and the intestines and noting the change in color.
Decomposition of the soft and liquid portions of the body take place
almost immediately after the death of the body, and then follow in
rapid succession the decomposition of the semi-solids and finally the
solids. Beyond this stage of putrefaction, the consecutive changes can
scarcely be followed with accuracy.
The putrefactive changes can not be said to begin at the same place in
all bodies, as the conditions under which death occurred will regulate
that. The rapidity with which these changes follow one another depends
upon a variety of conditions such as temperature, moisture, access of
air and the diseases which have preceded or caused death.
Various temperature relations will effect greatly the more or less
rapid decomposition of the body. Bodies dying in mid-summer are
decomposed much more quickly than those dying in mid-winter.
Moisture added to the temperature relation will hasten the rapidity
of the decomposition as can be noticed in those localities with a high
temperature but moist climate that the decomposition takes place very
quickly. In those climates with high temperature, but dry or absence
of moisture, the tendency is to dry up the tissues, and instead of
putrefaction we have mummification as the result. This last statement
then serves to explain the reason for the high state of preservation in
the forms of mummification as exists in those countries like Egypt with
their extremely hot and dry climates.
Exposure added to the temperature and the moisture relations adds
greatly to the rapidity of the decomposition. A moist climate with a
hot temperature and free exposure favors rapid decomposition. We notice
that putrefaction progresses much more rapidly in the air than in the
water and in the earth its progress is slower than in the water. The
more exposed a body is then, to the elements, especially the air, the
more rapid will be the decomposition.
An elevated temperature and the presence of air and moisture hasten the
advent and progress of putrefactive changes.
Bodies dying in high fever and edematous subjects are much more quickly
decomposed than those dying with the ordinary wasting away disease.
The bodies of infants usually decompose more rapidly than those of
adults, fat bodies more rapidly than lean ones.
The infectious diseases, intemperance, and the puerperal condition
promote rapid decomposition as also does death from suffocation.
Poisoning from arsenic, alcohol, antimony, sulphuric acid, strychnine
and chloroform may retard the progress of decay.
It is impossible, then, to say how long a body will keep without the
use of preservatives, as it depends partly upon temperature, partly
upon moisture, partly upon the amount of exposure and partly upon the
conditions existing in the body before death.
We can easily understand the reason for all this if we understand the
bacteriology relating to the subject.
In the first place, bacteria require for their best and most rapid
growth the proper temperature, moisture and media relations. By this
we mean that the temperature should be moderately warm, ranging from
about forty to one hundred degrees Fahrenheit, the optimum being
about the body temperature 98.6 degrees Fahrenheit or 37 degrees on
the centigrade scale. With this optimum temperature, the element of
moisture should always be present, as we find that nothing in nature
will germinate without the necessary moisture. Then the bacteria must
have the proper media, meaning that they must have the right substance
on which to grow. Inasmuch as the cause of putrefaction is the host
of putrefactive bacteria which abound trying to satisfy their own
nutrition, and since these bacteria require a moderately warm and
moist media on which to grow, it is only natural that putrefaction and
decomposition should occur much more rapidly in warm moist climates
than in dry cold climates.
In regard to exposure we learn that certain putrefactive bacteria are
aerobic in character, i. e., that they need a great quantity of oxygen
for their growth, and for this reason a body in water or buried in
the earth does not decompose as rapidly as one exposed to the air.
But although they do not decompose as rapidly yet we find that they do
decompose in time. This is due to the fact that there is another class
of bacteria, called anaerobic, i. e., which do not need oxygen for
their growth. In the case of the body in water these anaerobic bacteria
exist and develope slowly in the alimentary tract, and eliminate gases
sufficient to bring the body to the surface, where the aerobic bacteria
enter, and putrefaction progresses much more rapidly.
The starting point of decomposition is usually at the seat of the
disease the subject had before death, but it soon spreads to all the
various tissues of the body.
Putrefaction is always accompanied by a great amount of odor, which
is caused by the generation of gases the result of bacterial action.
The obnoxious gases, offensive to the smell are sulphureted hydrogen,
nitrogen, carbonic acid and ammonia.
The material actually present when the body is actually decomposed has
been determined as being water, nitrogen, methane, carbon dioxide, etc.
_Treatment by the Embalmer._—Putrefaction always means that there
is present a great amount of putrefactive bacteria and if you are to
arrest this condition you must resort to the most thorough embalming.
By placing some preservative fluid in the arteries and having a
thorough circulation all the tissues of the body can be reached
and hence the complete destruction of those bacteria causing the
putrefaction.
If all the tissues are properly bathed with embalming fluid there need
be no further danger of putrefaction; but what seems sometimes at first
a thorough circulation, proves afterward to be only a partial one. If
after several days the body still shows signs of decomposition it is
best to reinject or if the decomposition only occurs in spots a simple
hypodermic injection will prove adequate.
=Skin Slip.=—To properly understand the causes of skin slip a thorough
knowledge of the structure of the skin is necessary. It would be best
then to turn to the chapter on the tissues of the body and study the
minute structure of the skin.
Skin slip is caused by a putrefactive softening of the epidermis.
There is a watery infiltration from the minute capillaries and the
surrounding tissues between the dermis and the epidermis, causing the
latter to loosen and if touched to slip and tear away from the dermis
or true skin.
Many embalmers have been led to believe that the slipping of the skin
is due to the use of certain fluids used in injecting the arterial
system. This error should be corrected, as it is most generally the
absence of the fluid from the part which results in the slipping of the
skin.
Diseases of the heart, liver, kidney and dropsical conditions
predispose to the early skin slip. The immense amount of water
occurring in the minute capillaries of the skin prohibits the embalming
fluid from reaching the tissues.
Skin slip then is due to putrefactive changes occurring in the skin,
and if it should occur after embalming, it is positive proof that the
part or parts have not received a sufficient quantity of a preservative
fluid.
_Treatment by the Embalmer._—In the average case you will never see
skin slip, because you will be called comparatively soon after death
has occurred and the body will be embalmed and buried before this later
form of putrefaction will manifest itself. But in some few cases you
will have to keep the body for a greater length of time, say to await
the arrival of some friend living abroad, or it may be a coroner's
case. In cases like this the body being kept for a period of weeks,
will if it is not perfectly embalmed show signs of skin slip. As has
been stated above, cases that die from diseases causing dropsical
infiltration in the subcutaneous tissues should also be handled
carefully. If you are aware before hand that you are to keep the body
for a great length of time or that you have a dropsical subject, a
little formaldehyde should be added to the fluid that is injected,
about two or three ounces to each quart of fluid. Zinc compounds might
be added, but formaldehyde is better because of its great affinity for
water.
If skin slip occurs after the body is embalmed it is best to place a
layer of cotton over the part where the skin slip occurs and saturate
the cotton with equal parts of alcohol, formaldehyde and glycerine.
In drowned cases where all the skin is slipping it is best to envelope
the whole body with a layer of cotton saturated with formaldehyde.
=Rigor Mortis.=—Rigor mortis is the stiffening condition which occurs
on the body after death.
When the muscle substance dies it becomes rigid, or goes into a
condition of rigor; it passes from a fluid to a solid state. The rigor
that appears in the muscles after somatic death is designated usually
as rigor mortis, since its occurrence explains the death stiffening
in the cadaver. It is characterized by several features: the muscles
become rigid, they shorten, they develope an acid reaction, and they
lose their irritability to stimuli.
After the death of an individual the muscles enter into rigor mortis
at different times. Usually there is a certain sequence, the order
given being the jaws, neck, trunk, upper limbs, lower limbs, the rigor,
therefore, taking a downward course. The actual time of the appearance
of the rigidity varies greatly, however; it may come on within a few
minutes or a number of hours may elapse before it can be detected.
Death after great muscular exertion, as in the case of hunted animals,
or soldiers killed in battle, is usually followed quickly by muscle
rigor. Death after wasting diseases is also followed by an early rigor,
which in this case is of a more feeble character and shorter duration.
Certain drugs such as veratrum, hydrocyanic acid, caffeine and
chloroform, will hasten the development of rigor.
People who die in full habit, meaning that there has been no muscular
exertion or wasting processes before death, usually have the rigor
developing more slowly and of a longer duration.
After a certain interval, which also varies greatly, from one to six
days, the rigidity passes off, the muscles become soft and flexible;
this phenomenon is known as the release of the rigor.
The usual explanation that is given of rigor is that it is due to a
coagulation of the fluid substance, the muscle plasma, of which the
fibers are constituted. During life the fluids exist in a liquid or
viscous condition; after death they coagulate into a solid form.
Rigor mortis is not a sign of death, as there is rigidity of the
muscles following apparent death, as in cases of asphyxia and trance.
If the body is rigid, in a case in which there is a doubt that death
is present the rigidity may be broken up. If it is a case of trance or
that of the contraction of the muscles following drowning, it is likely
to return, especially in case of trance; but if death is actually
present it will not return.
The chemical changes occurring, the result of rigor mortis can be
briefly stated:
(a) There is a coagulation of the proteid material of the muscle plasma.
(b) There is an increased acidity, which is doubtless due to the
production of lactic acid.
(c) There is a production of carbon dioxide.
(d) There is a consumption of glycogen.
_Treatment by the Embalmer._—Many times when called to embalm a subject
you will find the body in a state of rigor. In cases of this kind the
rigor mortis should be broken up. This can be done by taking each of
the joints and gradually bend them a little at a time until they become
perfectly lax. Once a joint is bent the stiffening disappears and the
embalmer can proceed.
=Fermentation and the Production of Gas.=—A molecule is the smallest
portion of a compound which can exist by itself.
An atom is one of the ultimate particles composing a molecule. A
complex molecule is one in which two or more elements have been
combined. Example: water molecules are formed by two atoms of hydrogen
and one atom of oxygen.
A ferment is a substance causing fermentation in other matter with
which it comes in contact. There are two kinds of ferment expressed by
the names organized and unorganized.
Unorganized ferments are chemical substances having the power to
produce or assist in the production of fermentation.
Organized ferments are bacteria having the power to produce
fermentation.
Fermentation means the process through which complex molecules are
decomposed and their ingredients disassociated by the action of
ferments. As an example of fermentation, we can take proteid food
substances, the molecules of which are always of complex form, and
by subjecting them to the action of organized ferments (bacteria),
decompose them, and separate each gas ingredient, obtaining therefrom a
variety of gases from what was formerly a substance of perfect chemical
union. Fermentation is present in most of the natural processes
whereby chemical changes are produced in animal and vegetable matter.
Fermentation is taking place all the time in all the climes excepting
possibly the frigid zones. The organized ferments (bacteria) are
subject to the same temperature limits that govern the reproduction and
the growth of all bacteria.
Fermentation is divided into spirituous fermentation, digestive
fermentation, metabolic fermentation, and putrefactive fermentation.
=Spirituous Fermentation.=—Spirituous fermentation is that process
of fermentation by which forms of yeast cells, by their growth and
reproduction in such complex substances as grapes, fruit, apple
juice, grains, etc., extract alcohol from these substances and by this
process produce wine, cider, spirits, etc. Many times in the dead body,
spirituous fermentation occurs. Spirituous fermentation is caused by a
vegetable parasite called yeast.
=Digestive Fermentation.=—Digestive fermentation is that process by
which digestion and nutrition in the living body is assisted through
the action of ferments called enzymes, acting on the food substance.
This process is mainly one where each food particle is split up by a
particular ferment or enzyme. After death this process may continue for
a certain length of time and result in the formation of gas. Digestive
fermentation is mostly chemical.
Enzymes are unorganized ferments and are cast off the living body
within the living body.
=Metabolic Fermentation.=—Metabolic fermentation is that process by
which enzymes in the tissues of the living body destroy the dead cells,
and reduce them to the following gases: nitrogen (N), carbon-dioxide
(CO₂), ammonia (NH₃), uric acid, and other materials. In the living
body these gases and other products are eliminated from the tissues,
by the sudoriferous glands and ducts through perspiration, by the
lungs with the expired air, by the intestines with the feces and by
the kidneys with the urine. In the dead body the enzymes become active
agents in tissue gas production, unless they are kept in restraint by
being brought in contact with germicidal embalming fluids.
=Putrefactive Fermentation.=—Putrefactive fermentation is the process
by which undigested food substances (principally proteids), under the
influence of ferment bacteria, yield gases. This change rarely takes
place in the small intestines of the living body as the germs are held
in restraint by lactic acid and acetic acid bacteria in those parts.
There is little restraint to their activity in the large intestines,
however, and the intestinal gases along with putrefactive changes in
fecal material are a natural consequence.
Intestinal fermentation is hastened in the dead body by the presence of
much undigested food and the absence of any restraining organisms. The
gases produced in the intestines of either the living or dead body by
the action of putrefactive ferment bacteria are: carbon-dioxide (CO₂),
hydrogen (H), nitrogen (N) hydrogen sulphide (H₂S), methane (CH₄).
The continued fermentation in the stomach and the intestines causes a
coffee colored material of a frothy character to purge from the mouth.
When the hollow needle or trocar is used to reach the scene of ferment
activity, the gases mentioned are released from the effected organs.
As these gases are extremely odorous, they should be passed through
a pledget of cotton saturated with formaldehyde, before being allowed
to pass into the open air. Germicidal fluids when directed against the
bacteria in an intelligent manner should destroy them and prevent their
becoming active again.
Putrefactive fermentation is divided as follows: abdominal
fermentation, gastric fermentation, and intestinal fermentation.
=Abdominal Fermentation.=—Abdominal fermentation is putrefactive
fermentation as it effects the tissues and necrotic substances of the
abdominal cavity itself (excepting the digestive organs), caused by
the action of zymogenic bacteria. Perforations of the intestines or
appendix, inflammation of the mesentery or peritoneum, may allow putrid
material to escape into the cavity proper, where bacterial action will
produce noxious gases. You will recognize a condition of this kind
by the following illustration: As soon as the point of the trocar
has penetrated the peritoneum and the rod has been withdrawn, there
will be an escape of gas. This escape is due to the internal pressure
being greater than the atmosphere pressure. This explains the swollen
condition of the abdominal wall and its subsequent relaxation as the
gas is allowed to escape.
Certain diseases predispose to abdominal fermentation as inflammatory
diseases which effect the peritoneal covering of the organs, and cause
a swollen abdominal wall after death.
_Treatment._—In the treatment of these cases it is always advisable
that the operator be familiar with the location of the disease, so
that direct trocar application can be made to the affected part. The
location of the affected part is not always the same, as it varies
with the location of the particular tissue or organ affected. In
appendicitis, where death has occurred without surgical attempts to
remove the appendix, the operator should spray the right inguinal space
with enough fluid to neutralize the cause of the gas. Where the cause
of death has been typhoid, the umbilical, hypogastric and epigastric
spaces should be sprayed. Where the cause of death is puerperal fever,
the right and left inguinal and hypogastric spaces should be sprayed.
The gas itself, will be eliminated from the cavity of the body by
simply inserting the trocar and allowing the gas to escape until the
internal pressure approximates that of the atmospheric pressure. This
though does not prevent the reformation of gas, as the origin of the
gas is the living and growing fermentative and putrefactive bacteria.
To prevent a recurrence the bacteria must be killed, and this is done
by spraying a germicidal fluid around the affected part. Abdominal
fermentation and gas is much easier to treat than gastric or intestinal
fermentation.
=Gastric Fermentation.=—This is recognized by a frothy coffee colored
purge from the mouth or nose caused by pressure in the stomach, due
to putrefactive bacteria, and their action on proteid food substances
which are present in the stomach. Where the cause of death has been
principally from inflammatory processes, or where the deceased has died
shortly after eating a full meal, this condition must be looked forward
to. The swollen condition directly over the stomach is another visible
sign of value in diagnosing the condition.
_Treatment._—When the body is placed in your care, the embalmer should
make a careful and thoughtful survey of the condition of the body and
the cause of death. Any inflammatory disease of the abdominal tissues
or a full meal eaten shortly before death will almost always predispose
to the formation of gas. The treatment would be to take proper care of
the stomach contents.
(a) Insert the trocar at a point two inches to the left of the median
line, half the distance from the ensiform cartilage and the umbilicus.
Direct the trocar downward and diagonally to the left to a depth of
three to four inches. Remove the trocar rod and allow the gas to escape
into a fluid bottle, containing a small amount of fluid, so that the
gas may be deodorized. Before removing the trocar, inject not less
than one pint of normal fluid into the stomach, so that the fermentable
materials and the bacteria may be destroyed.
(b) Make an incision in the median line of the body, three inches long,
from the tip of the ensiform cartilage downward toward the umbilicus,
and proceed as directed for the direct incision described on page 257.
The treatment for gastric fermentation demands the specific treatment
as directed above. No short treatments can be depended upon for certain
results. Cotton placed in the mouth only delays the time for the
purging to begin from the mouth. Gastric fermentation can be prevented
in all cases by the use of the specific treatments as described in (a)
and (b).
If in your practice, you receive a body from a shipping undertaker,
which unfortunately was not treated in the correct manner, and which is
purging from the mouth, arrange to puncture the stomach in the manner
described in treatment (a). This can be done without disturbing the
position of the body in the casket, by opening the clothes above the
stomach. After puncturing the stomach and allowing the gas to escape,
inject not less than one pint of fluid therein, cleanse the mouth with
absorbent cotton by the use of the lock forceps and a recurrence of the
purge will not be possible.
If in your practice you have overlooked the possibility of gastric
fermentation, and find, either by advice from the family or from your
own observation, that purging is going on, use either the treatment (a)
or (b), neutralize the fermentable material, cleanse the mouth and no
recurrence will be possible.
=Intestinal Fermentation.=—Here we have the fermenting gases in the
intestines and the colons. The pressure of the gases will bear upon the
stomach and there may or may not be purging from the mouth depending
upon the fact of presence or non presence of material in the stomach.
The abdomen though will be greatly distended, and when palpated will
give a drummy note.
_Treatment._—(a) Insert the trocar through the umbilicus, and direct
the point downward into the right inguinal region so as to relieve the
gases from the caecum, then inject a small quantity of fluid; then
direct the point of the trocar upward into the left inguinal region
so as to relieve gases from the sigmoid flexure, and inject a small
quantity of fluid; then direct the point of the trocar upward into
the right hypogastric region so as to relieve gases from the hepatic
flexure, and inject a small quantity of fluid; then direct the point
of the trocar upward into the left hypogastric region so as to remove
gases from the splenic flexure, and inject a small quantity of fluid;
and if at this time it is thought that the stomach contains gas,
relieve it, and inject therein a small quantity of fluid; now place
some fluid directly into the abdomen around the small intestine and
with this treatment you are assured that your intestinal fermentation
is taken care of.
(b) Intestinal fermentation may also be treated by the direct incision,
as described on page 257.