committing both suicide and murder.
Arsenic produces two classes of phenomena, one is purely irritant, by
virtue of which it induces inflammation in the alimentary canal and
elsewhere; and the other consists in a disorder of parts of organs
remote from the seat of its application. It is absorbed by the blood,
which in most cases of acute poisoning, is found in a remarkable state
of fluidity, and can be detected in the liver, the spleen, and in the
urine. It acts with nearly the same energy, whatever be the organ or
tissue to which it is applied.
From two to three grains have proved fatal, but an instance is recorded
of recovery after a dose of sixty grains. Death may ensue in half an
hour, or may be delayed for nearly three weeks; the usual time is
perhaps from twelve to forty-eight hours. There are some cases in which
little or no morbid appearances are to be seen.
Usually, however, traces of irritation will be discoverable. In the
mouth and throat they are often wanting. The inner surface of the
stomach may be red and inflamed, or blackish from the extravasation of
blood, or softened, or in some cases thickened, with the rugæ raised and
corrugated. Ulceration of the coats of the stomach is but rarely met
with, unless the patient have survived nearly two days. The mucous
secretion is generally increased in quantity, sometimes thin, and
viscid, as in its natural state, but sometimes solid, as if coagulated.
In the latter case, it forms either a uniformly attached pedicle, or
loose shreds floating among the contents.
A very common appearance, is the presence of a sanguinolent fluid, or
even actual blood in the cavity of the stomach.
The poison itself may also be found within the stomach. The intestines
may be congested and inflamed throughout their whole length, but most
frequently only in the duodenum and rectum.
Within the chest, redness of the pleura, redness and congestion of the
lungs, have been noticed.
In general, arsenic retards the process of putrefaction after death.
The forms in which arsenic is most frequently used for the purpose of
poisoning, are arsenious acid, and the arsenite of copper, Scheele’s
green.
=Corrosive Sublimate.= The appearances observed in the bodies of persons
killed by this poison, are very similar to those excited by the irritant
poisons already noticed.
The mouth and throat are more frequently affected than by arsenic. The
tongue is often shrivelled, and the papillæ at its root greatly
enlarged. The mucous membrane is swollen and whitened. The same
appearances are generally noticed in the œsophagus. The coats of the
stomach and intestines, more particularly the colon and rectum, have
been found congested and inflamed, and sometimes destroyed, either by a
chemical decomposition of the tissues, or by ulceration.
The bladder is often excessively contracted; the kidneys usually much
congested and inflamed. Inflammation of the peritoneum, and effusion
into its sac are frequent results of poisoning with corrosive sublimate.
=Hydrocyanic Acid.= The poisons whose energy depends upon the presence
of this acid, surpass almost all others in rapidity of action, and the
minuteness of the quantity in which they operate.
The lesions produced are uncertain. The spine and neck are stiff, the
abdomen retracted, the skin usually livid.
The body, generally the blood, serous cavities, stomach and the various
tissues usually exhale, for some time after death, the characteristic
odor of the acid. Turgescence of the venous system, and emptiness of the
arterial system, are commonly remarked throughout the body. The stomach
and intestines are congested and red. The liver and lungs are gorged
with blood.
=Strychnia—Nux vomica.= In poisoning with this substance, the rigidity
of the body which exists during life, is frequently retained for hours
after death. There is congestion of the membranes of the brain and
spinal cord.
The stomach is frequently quite natural in appearance, as also the
intestines, although occasionally signs of irritation are noticed in
both.
=Alcohol.= In death from alcohol, the body is slow to putrify, and the
internal organs exhale no cadaveric odor, but rather that of recent
flesh, or in some cases a faint odor of brandy. The appearances
constantly found are, hyperæmia of the brain, sometimes cerebral
hæmorrhage; hyperæmia of the large abdominal veins, or hyperæmia of the
lungs and heart, and always visible fluidity and dark color of the
blood.
=Carbonic Oxide.= This is the poisonous ingredient of illuminating gas,
and is generated by burning charcoal. It is usually in one of these
forms that it is the cause of death.
The most characteristic appearance after death, is the bright cherry-red
color of the heart. There is, also, hyperæmia of the lungs and of the
right side of the heart.
=Opium.= In cases of death from this substance, lividity of the skin is
usually present.
Turgescence of the vessels of the brain, and watery effusion into the
ventricles are generally met with.
The lungs are sometimes found gorged with blood. The stomach is
occasionally red, but decided inflammation is rare. The blood is always
fluid, and the body is apt to pass rapidly into putrefaction.
2. Death from Suffocation.
By suffocation is meant that condition in which the system is prevented
from receiving the necessary amount of oxygen through the lungs. The
term is generally restricted to a condition arising from the obstruction
of the air passages, either internally, or from without, or from the
breathing of irrespirable gases. (The latter form being attended also by
blood-poisoning, which we have already noticed.)
The appearances noticed are the following:
The face may be more or less bluish-red, swollen, with protruding eyes,
or differing in no respect from that observed after other kinds of
death. Froth is often observed coming out of the mouth.
There is a universal and unusual fluidity and dark color of the blood.
Hyperæmia of the right side of the heart, while the left is either
entirely empty or contains only a few drachms of blood, hyperæmia of the
lungs and congestion of the pulmonary artery, are seldom wanting.
In the case of new-born children, Caspar has noticed capillary
ecchymoses, resembling petechiæ, beneath the pulmonary pleura, upon the
aorta, or the surface of the heart, and even upon the diaphragm, which
gives the parts a spotted appearance.
The mucous membrane of the larynx and trachea are more or less injected,
of a cinnabar-red, either in patches or uniformly over the whole
surface. A deposit of soot upon the tracheal membrane, points to
suffocation in smoke. There is usually present in the trachea a greater
or less amount of fluid, consisting of a mixture of air, mucus, and
blood, in the form of frothy vesicles, or colorless, or bloody foam. The
more gradual the suffocation has been, the greater the quantity of this
fluid. It may exist also in the bronchial tubes, and can be forced out
by careful pressure on the lungs. Foreign bodies of every kind may be
found in the trachea.
We find also as secondary results of the foregoing, hyperæmia of the
abdominal and cranial organs.
3. Death from Hanging, Throttling and Strangling.
In these cases, death may result from simple cerebral congestion
(apoplexy), from simple congestion of the thoracic organs (cardiac or
pulmonary apoplexy), from a combination of the two (apoplexy and
asphyxia), or, as is very frequently the case, from neuro-paralysis
(nervous apoplexy).
The internal appearances will therefore vary, or, as in the last case,
no lesions can be detected.
The face may in some cases be livid, with protruding eyes and tongue;
but in many cases the countenance is like that of any other corpse.
Turgescence of the male and even of the female genitals has been noticed
in some cases.
The mark of the cord about the neck may be wanting, and is nearly always
more or less interrupted, and presents many varieties of appearance. It
maybe of a dirty, yellowish-brown color, cutting hard and leathery; or
of a bright blue or dirty-reddish color, soft to cut; or it may have
little or no color, and also soft to cut. Patches of excoriation are
also sometimes visible, if the cord have been hard and rough. A similar
mark of the cord may be produced after death.
In cases of throttling, the marks of fingers may often be recognized, as
round or semi-circular, or perfectly irregular patches, of a dirty,
brownish-yellow color, hard to cut, and not ecchymosed. Rarely they are
of a dirty-bluish color and ecchymosed.
4. Death from Drowning.
Physiologically considered, death from drowning is to be regarded as
identical with death from asphyxia or strangling, and hence the results
of the dissection, do not differ from those just mentioned. Those
drowned may die from cerebral hyperæmia, the rarest form; from pulmonary
hyperæmia; from both combined; or from neuro-paralysis. Death from
hyperæmia of the thoracic organs, and death from paralysis, are of
almost equal frequency in cases of drowning. The countenance is pale, in
most cases not swollen, the eyes shut, and when asphyxia has been the
cause of death, there is commonly froth over the mouth. If the body has
been in the water for two or three days in summer, or eight to ten in
winter, the face is rather reddish, or bluish-red—the commencement of
putrefaction, which in bodies in water, begins in the head and extends
from above downwards, and not in the abdominal coverings.
An almost constant appearance is the cutis anserina, a phenomenon
entirely independent of the temperature of the water in which the person
has been drowned.
The hands and feet have a livid, grayish-blue color, and the skin is
corrugated in longitudinal folds, provided the body has not been taken
out of the water within about eight hours after death. Sand, gravel,
mud, etc., are often found under the finger-nails.
Contraction of the penis and scrotum in men who have fallen into the
water alive, is an almost constant appearance.
The lungs are greatly increased in volume, completely fill and distend
the cavity of the chest, and are not firm and crepitating like healthy
lungs, but feel like sponge. The trachea and large bronchial tubes are
frequently filled with frothy mucus. The spasmodic closure of the
glottis, will prevent the entrance of water into the lungs while life
continues, but after death it may enter in small quantities.
In the stomach is often found some of the fluid in which the drowning
has taken place.
CHAPTER V.
MEDICO-LEGAL QUESTIONS.
1. Method of Conducting a Medico-Legal Autopsy.
In making medico-legal examinations of human bodies, the greatest care
must be taken not to omit the examination and recording of any of the
appearances presented; since a point trifling in itself, may, in the
course of the subsequent legal process, prove of great importance.
It may sometimes be necessary for the physician to examine the exact
spot and the locality in which the body has been found, to ascertain the
position in which it was discovered, etc., and also to inspect the
clothing.
In cases of suspected poisoning, the utmost precautions are to be used
in making the autopsy. All the viscera are to be carefully examined, and
the stomach and intestines, with their contents, are to be removed in
the manner already described. They are then to be opened, examined in
separate vessels, either entirely new, or thoroughly cleansed
immediately before being made use of. After a careful examination, they
are to be placed in perfectly clean or new glass jars, without the
addition of any foreign substance; the jars are then to be securely
corked and labelled, and handed over to the chemist for analysis. Should
the jars have to remain any time in the hands of the physician, they are
to be kept under lock and key, in some place to which none but himself
has access. Portions of other organs, especially of the liver, spleen,
kidneys and brain, should also be preserved with the same care for
future analysis.
The results of the examination are to be taken down on the spot, by an
assistant, in ink, and after having been read through by the physician
at the close of the examination, are to be signed by him.
All these precautions will be found of great value, in saving from
innumerable petty annoyances, at the hands of the “learned members of
the bar,” if the case should be brought before court.
In the _external_ inspection of the body, we should notice:
1. _The Sex._ Even after the external parts of generation have been
completely destroyed, the sex may still be ascertained by a reference to
the growth of hair around these parts. A circumscribed arc of hair on
the _mons veneris_, is distinctive of the female, while its
prolongation, however slight, from this point towards the umbilicus,
marks the male.
2. _The Age._ In the case of known bodies this is not of any importance,
in unknown bodies it is, however, necessary. The physician can only
conjecture from appearances, which, even in the living body, are very
deceptive, and he will do well, therefore, to allow tolerably wide
limits to this conjecture.
3. _The Size._ The length of the body must be ascertained by actual
measurement in a straight line, from the crown of the head to the sole
of the heel.
4. _The General Condition of the Body._ Lean or fat, etc.
5. _Color and Condition of the Hair._
6. _Color of the Eyes_, if still recognizable.
7. _Number and Condition of the Teeth._ In the case of unknown bodies,
an accurate description is always advisable, with a view to future
identification.
8. _Special Marks or Deformities._ Scars, tattoo-marks, excess or
defects of limbs, marks of disease, as ulcers, etc., should all be
accurately noted.
9. _Injuries or Wounds_, which appear to have been the cause of death,
should be carefully described. In the case of wounds, their position and
direction with reference to the neighboring fixed points of the body,
and their exact length and breadth, must be recorded.
10. _Of the Body itself_, the parts deserving of particular examination
are the natural openings of the ears, nose, mouth, anus and female
genitals; the neck and the hands.
In the _internal_ examination or dissection, the three great
cavities—the head, thorax and abdomen—should all be opened. In some
cases, it may be important to open also the spinal canal.
The first thing to be observed on opening each of these cavities, is the
position of the organs they contain; next, whether there be any fluid
effusions present; and lastly, the external and internal appearance of
each separate organ. In every case, that cavity should be opened first,
in which there is the greatest probability of finding the cause of
death. In the case of new-born children, however, the abdomen must be
first opened in order that the natural position of the diaphragm may be
observed undisturbed.
In examining the base of the skull for injuries, we must not omit to
remove the periosteum, which might otherwise conceal small fissures.
In examining the thoracic organs, if it be particularly desired to
observe the amount of blood contained in them, and we do not wish to
apply ligatures, we examine the heart first, leaving it in its natural
horizontal position, and opening it by a lateral longitudinal incision
on both sides. This gives us a distinct idea of the actual amount of
blood in all the cardiac cavities. The lungs are next cut into, and last
of all the large blood-vessels. This procedure is to be followed, _e.
g._, in cases of suffocation, where it is of particular importance to
determine the amount of blood in these organs, and where the blood is
peculiarly fluid.
In determining the amount of blood in the venous trunks, it will be
sufficient to examine the _vena cava ascendens_.
In penetrating wounds, the wound is of course to be examined as far as
possible before disturbing any of the organs.
The result of the external and internal examinations, thus thoroughly
conducted, are to be noted down at the time, and are not to be trusted
to memory. It is of the utmost importance that this rule be observed.
In presenting a written or verbal report before court, the physician
should be careful to furnish merely a description of the post-mortem
appearances, and not to give an opinion as to their probable or possible
cause or causes, unless called upon to do so. He should also avoid
prolixity and, as much as possible, the use of technical terms,
unintelligible to nonprofessionals.
His answers to direct questions should be concise and decided if
possible, but where this is not possible, he should not hesitate to
state that the dissection has not afforded him any facts which could
enable him to give a positive answer.
2. Questions relating to New-Born Children.
The body of a dead infant is found, and the physician may be called upon
to answer the following questions, one or all:—Was the child mature? Was
it born alive? If so, what was the cause of its death?
_Was the child mature?_ Among the various signs of fœtal maturity, such
as the firm, tense skin, of the usual pale corpse-color, the hair upon
the head, the weight and length of the body, the diameters of the head,
shoulders and hips, the horny nails reaching to the tips of the fingers,
the absence of the pupillary membrane, etc., the most infallible, is the
presence of the centre of ossification of the inferior femoral
epiphysis. “The easiest way to find this, is to make a horizontal
incision through the skin and superficial tissues over the knee-joint
down to the cartilages. The patella is then to be removed, and the end
of the femur made to protrude through the incision. Thin horizontal
sections are then to be removed from the cartilaginous epiphysis, at
first more boldly, but so soon as a colored point is observed in the
last section, then very carefully, layer by layer, till the greatest
diameter of the osseous nucleus is attained. This appears to the naked
eye as a more or less circular bright blood-red spot in the midst of the
milk white cartilage, in which vascular convolutions can be distinctly
recognized.” When there is no visible trace of this centre of
ossification, the fœtus can be no more than from thirty-six to
thirty-seven weeks old.
In still-born children, the commencement of this nucleus indicates a
fœtal age of thirty-seven to thirty-eight weeks; when it possesses a
diameter of from three-quarters to three lines, it shows the fœtus must
have attained a uterine age of forty weeks. When the osseous nucleus
measures more than three lines, we may conclude that the child has lived
after birth.
Isolated exceptions are occasionally met with, when, however,
concomitant appearances, such as, in the one case, defective
ossification of the skull, or in the other, peculiarly advanced
development, will guard us against mistakes.
_Was the child born alive?_ or, _Did it live during and after its
birth?_ and, _If so, how long?_
These questions are intimately connected, and in order to be able to
answer them, we must in our examination note the following points:
_The position of the diaphragm_, is a good diagnostic sign. The
diaphragm will necessarily be higher where there has been no
respiration, natural or artificial, than where the child has actually
breathed. “Its position is most easily ascertained by making a
longitudinal incision through the skin and superficial cellular tissue,
from the chin to the pubis, in the mesial line, dissecting these from
the thorax on both sides, next carefully opening the abdominal cavity,
introducing the finger of one hand into it, and pressing it up to the
highest point of the concavity of the diaphragm, and then with one
finger of the other hand reckoning off the intercostal spaces from above
downwards till both fingers correspond. The rule is, that the highest
point of the concavity of the diaphragm in children born dead, is
between the fourth and fifth ribs, and in those born alive, between the
fifth and sixth.” Where respiration has been but transitory, the
diaphragm will remain very nearly in its fœtal position.
_The lungs_, from lying quite posteriorly in the fœtus, come to fill the
cavity of the chest, the more perfectly respiration has been
established. In the fœtus, the left lung is never found even partially
covering the heart. Where respiration has been but transitory and
imperfect, the volume of the lungs will not be much increased.
The presence of dark bluish-red, insular patches in the lungs, no matter
what may be their ground color, proves that respiration has taken place.
The crepitant spongy consistence of the lungs of a live-born child, is
readily distinguished from the compact, resistent liver-like lungs of
one still-born.
The hydrostatic test for the presence of air in the lungs, is of all,
the surest for deciding whether respiration has taken place. The vessel
used should be at least one foot in depth, eight or ten inches in
diameter, and filled with pure cold water. The buoyancy of the lungs
depends upon the greater or less completeness with which the pulmonary
tissue is permeated by the air. Only one lung may float, generally the
right one, or only single lobes, or only a few pieces into which the
lung has been and must be divided, in order accurately to apply the
test. Artificially inflated fœtal lungs, may be distinguished from those
lungs which have respired, by the presence, in the case of the latter,
of the bluish-red mottling above referred to, and the escape of bloody
froth when the substance of the lungs is cut into, and slight pressure
applied.
The general appearance of putrescence in the lungs, will serve to
distinguish the buoyancy arising from the gaseous products of
putrefaction, from that due to respiration.
Careful attention to the foregoing points, will enable us to answer with
certainty whether the child was born alive.
_How long did the child live after its birth?_ The question can be
approximately answered with reference to the first few days, by
attention to the following points:
If there are no traces of blood, or of that peculiar unctious substance,
the _vernix caseosa_, on the body, sufficient time must have elapsed
since its birth, to have afforded leisure and opportunity for cleansing
it.
The contraction of the umbilical arteries in living children, does not
occur sooner than after eight or ten hours. The mummification of the
cord commences after two, three, or even four days, and the putrefaction
only after a much longer time. Mummification of the cord takes place as
well after death as before, but not in water, nor in the liquor amnii.
If the umbilicus has already cicatrized, the child must be at least five
days old.
The stomach immediately after birth, contains a small quantity of quite
white, transparent, seldom somewhat bloody, inodorous mucus, very tough,
or a trifling quantity of the colorless liquor amnii. If milk be found,
it shows that some time must have elapsed since the birth.
In the large intestines meconium is still to be found, two, three, or
even four days after birth.
The age of a child, evidently older than five or six days, can only be
determined by general appearances.
_What was the cause of death?_ We will here refer only to those injuries
and kinds of death as can only occur in new-born children, and to those
_post-mortem_ appearances which might lead to error in regard to them.
During labor, death to the child may result from cerebral hyperæmia, or
from injuries to the cranium, which are then unattended by traces of
violence on the body, and are frequently due to imperfect ossification
of the bones, detected by holding the bones up to the light after
removal of the periosteum.
Prolapse and pressure of the cord, and coiling of the cord around the
neck, may produce all the appearances of death by suffocation.
The mark of the cord runs uninterruptedly round the neck, is broad,
circularly depressed, grooved, never excoriated, and everywhere quite
soft. A mummified, parchmentlike, unecchymosed depression, with or
without excoriations, points to intentional strangulation.
Subsequent to birth, the child may have been killed by falling on its
head on the floor, if the birth has been very rapid. The probable
results of such a fall, would be rupture of the cord; premature
separation of the placenta, with its consequences; concussion of the
brain and hyperæmia, or actual hæmorrhage within the skull; and fracture
of the skull bones. The fractures are almost exclusively confined to the
parietal bones, one or both, chiefly in the region of the vertex.
Comminuted fracture of several bones of the skull, speak against an
accidental death by a fall. The absence of any signs of violent usage on
other parts of the body, or about the head, with simple fracture of the
skull, speaks for an accidental death.
The child may also have been suffocated by the mother in violent
attempts at self-delivery. The visible signs of this will consist merely
of scratches and nail-marks upon the face or neck. Very severe injuries
are never produced in this way.
We must be careful not to mistake the common blood-coagulum usually
found under the aponeurosis on the child’s head for the result of
violence; nor the folds of the skin, in fat children particularly in
winter, produced by the movements of the head, and which remain strongly
marked in the solidified fat, for the mark left by the cord in a case of
actual strangulation.
3. Supposed Period of Death.
The answer to the question as to the probable time of death, is often of
the utmost importance. To be able to determine this, we must have regard
to the various appearances following death, previous to putrefaction,
and to the chronological succession of the phenomena of external and
internal putrescence.
=A.= _Signs of Death previous to Putrefaction._
Respiration and circulation have entirely ceased.
The eyes have lost their lustre.
There is no vital reaction to stimulants.
The body grows ashy-white. A particularly florid complexion may retain
its color for some days after death.
Neither the red or livid edges of ulcers, nor red, black or blue
tattoo-marks disappear after death.
An icteric hue existing at death never becomes white, and ecchymoses
retain in every case, the hue they had at the time of death.
Most bodies become quite cold in from eight to twelve hours. Fat bodies
and those of persons killed by lightning, or by suffocation, retain the
heat longer than others; in water, bodies cool rapidly.
A general relaxation of the muscular system occurs immediately after
death.
A body presenting only the above signs, has been dead from eight to
twelve hours at the longest.
In from twelve to eighteen hours the eye-balls become soft and
inelastic, and feel flaccid.
The muscles on those parts of the body on which it lies, become
flattened by the weight of the body.
In from eight to twelve hours after death, hypostases resulting from the
gravitation of the blood in the capillaries, begin to form on all the
depending parts of the body.
The most important are the external hypostases—for they are liable to be
confounded with ecchymoses, and consequently with traces of violence
committed previous to death. An incision into the discolored spot should
always be made, when, if it be an hypostasis—a post-mortem stain—there
will be no escape of effused fluid or coagulated blood, as there will be
if it be an ecchymosis, the result of violence previous to death.
The color of these post-mortem stains varies from a livid or coppery-red
to a reddish blue. They are extremely irregular in form, and are never
elevated above the surrounding skin. They are formed after every kind of
death.
Internal hypostases occur in the brain, in the sinuses and veins of the
pia mater of the posterior hemispheres, even after death from
hæmorrhage. They must not be confounded with cerebral hyperæmia.
In the lungs, hypostases are of constant occurrence, and are carefully
to be distinguished from the signs of ante-mortem pulmonary congestion
and pneumonia.
In the intestines and kidneys, hypostases are also noticed.
In the heart we find no hypostasis, but clots, or “cardiac polypi,”
which are the coagulated fibrine of the blood, formed in most cases
after death. Their presence proves that coagulation of the blood may
take place after death.
The last sign of the earliest stage of death is the _rigor mortis_. It
passes from above downwards, beginning on the back of the neck and lower
jaw, passing on into the facial muscles, the front of the neck, the
chest, the upper extremities, and last of all, the lower extremities. It
begins variously after eight, ten, or twenty hours, and may last from
one to nine days. In the mature new-born infant it is feeble and very
transitory. A low temperature, and the existence of alcoholization,
favor the long duration of cadaveric rigidity. A frozen body is stiff as
a board from head to foot, whereas in rigor mortis the extremities,
particularly at the elbows and knees, preserves a certain amount of
mobility. A body in which only the signs thus far mentioned are present,
may be presumed to have been dead from two to three days at the longest.
=B.= _The Process of Putrefaction._ The progress of putrefaction is
modified by the following conditions:
By age. The bodies of new-born children putrefy more rapidly than
others; those of very aged persons much more slowly.
By the condition of the body. Fat, flabby and lymphatic corpses putrefy
more quickly than lean ones, for an abundance of fluid is very favorable
to decomposition.
By the kind of death. The process is rapid after death from exhausting
diseases, from injuries attended with much mutilation, from suffocation,
from narcotic poisons. It is slower after sudden death in healthy
persons, after death from poisoning with phosphorus, sulphuric acid and
alcohol.
By the access of atmospheric air. Whatever prevents this, retards
decomposition. Thus, bodies buried in the earth, or lying in water, or
clothed, putrefy less rapidly than those exposed to the direct influence
of the air.
By the quantity of moisture, which in addition to its own, can and does
reach the body from without. The more moisture, the more rapid the
process.
By the temperature of the air, or of the water in which the body is
lying. “At a tolerably similar average of temperature, the degree of
putrefaction present in a body after lying in the open air, for one week
(or month), corresponds to that found in a body after lying in the water
for two weeks (or months), or after lying in the earth in the usual
manner for eight weeks (or months.”) (Caspar.)
In bodies lying in the air, external putrefaction begins with a greenish
coloration of the abdominal coverings, in from twenty-four to
seventy-two hours after death, according to the modifying conditions
just noticed. (In bodies lying in water, the process of putrefaction
begins in the face, head as far as the ears, and the upper part of the
neck, with a livid, bluish tinge, rapidly becoming a brick-red, and
proceeds downwards in the same relative manner as about to be
described.) Within the same period, the eye-ball becomes soft, yielding
to the pressure of the finger.
After three to five days from the period of death, the discoloration has
spread over the whole abdomen and external genitals, and spots make
their appearance on other parts.
In from eight to ten days the discoloration has spread over the whole
body, and the peculiar odor is developed. The abdomen is distended with
gas; the cornea has fallen in and become concave. The nails are still
firm.
In fourteen to twenty days after death, the whole body is of a
bright-green, mixed with red and brown. The epidermis is raised here and
there in blisters, and in other parts patches of it are quite stripped
off. Maggots cover the body. From the continued development of gas, the
whole body is bloated, and has a gigantic appearance. The nails are
detached at their roots and lie loose, and are easily separable. The
hair is loose and easily pulled out.
Since this stage may continue many weeks or even months, we cannot
distinguish a body in this state after one month, from one in the same
condition after from three to five months.
After from four to six months, or sooner in the case of bodies that have
lain in warm and moist media, the cavities of the body are opened by the
continued development of gas; the skull has separated from the neck, and
the brain has run out; the orbital cavities are empty; all the soft
parts have commenced to break down into a soft pulp, or are partly
already broken down and dissolved, leaving entire bones exposed. The
bones of the extremities are often separated by the destruction of the
fasciæ and ligaments. No trace of a physiognomy is discernible. The
doubtful sex of the deceased can only be determined from the external
peculiarities of form, or the hair about the pubis, or by the presence
of a uterus, which withstands decomposition longer than any other soft
organ of the body.
_Internally_, the process of putrefaction begins in the trachea and
larynx. The brain in children up to the end of the first year, is next
attacked. Next the stomach, intestines and spleen, and then the omentum
and mesentery. The liver is usually compact and firm, even some weeks
after death. Putrefaction commences on its convex surface. The brain of
the adult follows next in the succession of putrefying organs. Several
months usually elapse before putrefaction of the heart has advanced very
far. In the lungs decomposition begins about the same time as in the
heart, sometimes earlier. The kidneys, urinary bladder, œsophagus,
pancreas, diaphragm and larger arterial trunks then succumb, and last of
all the uterus.
4. The Probable Cause of Death.
Although in general, a careful examination of a body found dead, will
readily reveal the true cause of death, yet instances frequently occur
where attempts at concealing it, or peculiar circumstances in connection
with the death, may render the task more difficult.
We confine ourselves here to a brief notice of some of the more
important points to be kept in view, in rightly estimating the relative
value of post-mortem appearances, and in guarding against possible
mistakes.
Rough handling, falls and blows, occurring a short time after death, may
produce excoriations and pseudo-ecchymoses, which cannot by sight be
distinguished from such as are the result of violence inflicted during
life.
_Wounds_ inflicted during life are distinguished from those inflicted
after death, by the entire absence in the case of the latter, of any
signs of vital reaction, as inflammation, hæmorrhage, suppuration,
swelling or cicatrization of the edges of the wound, etc. But in the
case of very sudden death from wounding of an important organ, these
traces of vital reaction may also be wholly wanting. Again, injuries are
often produced on dead bodies, by the instruments used to recover them
from the places in which they have been discovered.
_Contused wounds_ seldom represent the exact dimensions of the weapon
employed.
Blunt weapons may merely contuse and disfigure, or lacerate, or fracture
bones, or produce rupture of internal organs. Healthy organs never
rupture spontaneously, and can only be ruptured by external violence.
The inspection of the position, direction, depth, breadth, and number of
wounds, compared with the weapon with which they have been inflicted,
often furnish the means of approximately judging of the position of the
perpetrator when he committed the deed, and even his object and bodily
strength.
In judging whether _fractures_ have been produced before or after death,
we must remember that it is very difficult to fracture the bones of a
dead body. Hence, for example, considerable injuries of the cranial
bones, particularly of the base of the skull, have most probably been
produced during life. A fracture of the ribs in the dead body is never
splintered.
In deciding whether a case is one of _suicide_ or _homicide_, besides
the previous state of mind of the deceased, the posture and position of
the body, hands, etc., the appearance of the clothing, and the character
of the wounds or injuries, are the points to be particularly noted, as
well as the absence or presence of evidences of robbery.
_Gunshot wounds_ produced upon dead bodies, are never as deep as similar
ones would be in a living body; the track of the bullet can be
distinctly traced; and the edges of the wound show no appearance of
vital reaction. Hence they can readily be distinguished from such as
have been produced during life.
_Burning_ of a dead body does not in general produce vesication; by
exceedingly intense heat it may, however, be produced. The bullæ,
however, last but a few minutes, never contain serum, but only watery
vapor, and never exhibit any trace of the bounding line of redness, nor
any trace of color on their basis. They are, therefore, easily
distinguished from burns inflicted during life.
In distinguishing between spontaneous apoplexy and _cerebral hæmorrhage_
the result of injuries, it will be sufficient to note that, in the
former case, but a very small amount of blood is effused, so that the
discovery of very extensive and considerable extravasation of blood
within the cranial cavity, can be regarded as a proof of the application
of external violence.
In the case of a dead body found _hanging_, it is in most instances to
be regarded as a case of suicide, unless the examination of the body
should show external marks of violence, or internal signs of death from
another cause.
_Where a body has been found in the water_, the question may arise
whether it was alive or dead when it entered the water. The
investigation of the body will reveal the cause of death. The surest
sign that the body was alive when it was thrown or fell into the water,
is the presence in the stomach of some of the fluid in which it was
lying, if this fluid be such as is never voluntarily drank. Whether the
drowning was a case of suicide or homicide, it is sometimes impossible
to determine. All the various circumstances of time and place, and
concomitant appearances, must be minutely investigated, in order to hope
to arrive at a probable conclusion.
In the case of _supposed poisoning_, where the fact of the
administration of poison has been proved, and the person has died with
symptoms attributable to poisoning, and the post-mortem appearances
reveal no other cause of death—then the death is to be regarded as the
actual results of the poison, whether its existence in the body can be
proved by chemical analysis or not. Only such poisons are used by
suicides as a general thing, as are known to be _certain_ poisons, and
such as have a very disagreeable taste are, from this fact, hardly ever
used for the purpose of murder, except in the case of very small
children, or persons rendered insensible by any means. (Caspar.)
CHAPTER VI.
ON EMBALMING THE DEAD.
From the earliest times, the attention of mankind has been given to the
preservation of the bodies of the dead. With the ancient Egyptians, the
art was carried to its highest degree of perfection. The motive which
led these people to devote so much care to this object, is still
conjectural; yet it would seem to have originated, in part at least, as
a sanitary measure, for preserving the purity and healthfulness of the
atmosphere.
While so little is known of the method by which they produced such
wonderful results, as to have placed the process among what have been
termed the “Lost Arts,” yet, from a careful examination of a large
number of mummies, it would appear that the operation consisted:
_First._ In the removal of the abdominal and thoracic viscera, through
an opening in the left side beneath the ribs; and of the brain through
the nostrils, by breaking through the crebriform plate of the ethmoid
bone; or through the mouth, by boring through the basilar process of the
occipital bone.
_Second._ Subjecting the body for a long time to the action of an
alkali, (natron,) after having filled the cavities with various gums and
spices, etc., and thus removing the fatty portions.
_Third._ A rapid desiccation, after further additions of balsams,
resins, etc.
_Fourth._ Enveloping the whole body in numerous bandages saturated with
gum or bitumen.
Modern nations, have long practiced evisceration, in connection with the
use of various substances for preserving bodies. In the middle ages, the
art of embalming consisted in mixing aromatic substances with salt, and
filling the bodies with the same. Henry I. of England, is said to have
been thus embalmed in 1135. Long and deep incisions were made in various
parts of the body, these filled with the composition, and then carefully
sewed up, the body afterwards enveloped in a beef’s skin, and enclosed
in a coffin.
Louis C. Bils, a nobleman of Holland, and Ruysch, a Dutch physician, in
the latter part of the seventeenth and beginning of the eighteenth
centuries, acquired great celebrity from their success in embalming
bodies. Both died, however, without imparting their secrets to others.
The discovery of the preservative properties of corrosive sublimate in
1762, was soon followed by its employment by Chaussier, Beclard and
Larrey, in the preserving of bodies. Dr. Franchina of Naples, employed
arsenic also, with considerable success; but from the danger to
dissectors, where these poisons had been employed, their use after the
discovery of the preservative properties of chloride of zinc, was quite
discontinued.
The latter substance, with carbolic acid, constitutes the best
antiseptis known at the present time, and these are more generally
employed than any other for preserving dead bodies.
The objects of the process of embalming at the present day, are
threefold: 1st. It permits the delay of burial where this is desirable
from the absence of friends; or of the ready transportation of the
bodies of those who may have died a long distance from home, and that
free from decay and post-mortem change. 2d. As a sanitary measure in
large towns and cities, where many bodies are placed in family vaults,
instead of being buried in the ground. 3d. For the preservation of
bodies for the purpose of anatomical study.
For either of these objects, it is desirable that the process be simple,
easy, quick and inexpensive.
Frequently in the large cities, and occasionally in the country, the
physician will be called upon to perform this operation, but without
some information upon the subject, he will be unable to comply with the
request.
The operation at the present time, consists simply in filling the
vascular system with a preserving fluid, by injecting the same into some
one or more of the arteries; the substance employed being either
carbolic acid or chloride of zinc in solution; the latter, from
possessing greater preserving power without the disagreeable odor of the
carbolic acid, being much more frequently employed.
_Preparation of the Zinc._ In the large cities, the chloride of zinc may
be obtained of the manufacturing chemists ready made; but in the
country, the physician may manufacture the solution himself, by the
following process:
Place in an open stone jar, ten pounds of muriatic acid, and add to the
same, old scrap sheet zinc, _ad libitum_. It should be frequently
stirred, and allowed to stand in the open air for from twelve to
twenty-four hours, or until the acid has so acted upon the zinc as to
have become thoroughly neutralized, forming thus a saturated solution of
the chloride of zinc.
The quantity required of this solution to preserve a body, will depend
upon the state of the weather, in connection with the size of the body,
cause of death, etc.; more being required in hot weather, or in a large
body, or in such diseases as are followed by a tendency to rapid
putrefaction. In all cases, however, the rule should be to _throw in as
much as the vessels will hold_, varying the strength according to the
weather, character of the body, etc. With young, thin subjects, and cool
weather, the chloride may be diluted one-half with water; but in warmer
weather, and with a large body full of fluids, a proportion of
two-thirds zinc, or even stronger may be required. It will be well to
commence by throwing in a weaker solution, which, by not constringing
the small vessels, will pass more readily into the extremities, and
follow by a stronger for filling the large vessels of the trunk.
Dr. Vivodtsef of St. Petersburg, employs a mixture of carbolic acid and
alcohol. Taking alcohol of about ninety degrees, he adds one-fifth its
weight of carbolic acid; there being required of this mixture, a
quantity equal to about one-half the weight of the body to be injected.
It may be thrown into the vessels in the same manner as the solution of
the chloride of zinc. The high price of alcohol in this country, would
constitute an objection to the use of this substance, even if it afford
advantages over the zinc, which it probably does not.
_Instruments Required._ For the satisfactory performance of this
operation, there will be required the _anatomical syringe_. This
instrument consists of a brass cylinder and piston, of a capacity of
twelve to sixteen ounces, with a movable stop-cock, and series of
graduated pipes for arteries of different size. Each pipe has a small
rim or shoulder at the point to be introduced into the vessel, above
which the ligature is applied, which thus holds the pipe more securely
in its position.
The absence of the anatomical syringe should not, however, deter the
physician from attempting this operation, as, by a little preparation,
the common gum-elastic family syringe, of the Mattson or a similar
pattern, may be made to answer the purpose. The point of the small or
child’s rectum pipe may be reduced with a file, and a shoulder prepared,
about one-fourth of an inch from the end, for securely holding it when
tied in the vessel.
An apparatus of a complicated character, and working by atmospheric
pressure, has been devised for this purpose; but while it possesses very
few advantages over the syringe described, it is expensive and not
easily managed.
_The Operation._ In the dissecting-room, it is usual to open the chest
and inject through the arch of the aorta; but in other cases, one of the
common carotids, and better the right, may be selected. Extend the head,
placing thus the muscles upon the stretch, and along the inner border of
the right sterno-cleido-mastoid muscle, make an incision two inches in
length, through which may be exposed the upper portion of the common
carotid artery. After detaching the vessel from the surrounding
structures, it should be raised upon the handle of a scalpel and two
ligatures passed around, one of which is to be tightly tied, high up,
upon the vessel. Below this, a longitudinal slit, one-half inch in
length, should be made in the vessel, for receiving the pipe of the
syringe, which, when in position, should be securely tied with the
second ligature, just above the rim. The stop-cock joint may now be
fitted to the pipe.
To permit of the escape of as much of the blood as possible, an opening
may be made into the jugular vein, ligatures being passed beneath the
vessel—one above and one below the opening—that it may be closed at the
proper time.
The antiseptic fluid having been prepared in a convenient vessel, the
syringe, after having been carefully examined and found in good working
order, should be slowly filled, adjusted to the stop-cock joint, the
cock opened, and the syringe slowly discharged. Shutting off the cock,
to prevent escape of the fluid, the syringe may now be detached,
refilled and again discharged, the process being repeated until the
vessels are filled with the fluid, which may be known from the
resistance offered to its introduction. After a few syringefuls have
been thrown into the vessels, the blood will be seen flowing more or
less freely from the jugular, and which will gradually change to the
clear antiseptic fluid; then the vessel may be tied, to prevent any
further loss.
To facilitate the flow of the fluid into the vessels of the extremities,
free flexion and extension of all the limbs should be made; and after
some minutes, another effort made to force in more of the fluid. A
successful filling of all the vessels may be known by the distension of
the superficial veins of the chest and arms, accompanied with an escape
of a dark fluid from the nostrils and, perhaps, mouth, from an oozing of
the fluid through the capillary vessels of the mucous membranes of the
head.
If the extemporized gum syringe be used, its pipe should be tied in the
vessel as in the other case, the opposite end of the tube placed in the
vessel of fluid, and the same thrown in by pressure of the ball. The
operation being completed, a ligature should be tightly placed around
the artery below the pipe, the latter removed and the incision sewed up.
_Changes Resulting from the Operation._ As the vessels become filled
during the operation, the abdomen will gradually swell, the chest become
more round and full, the face and eyelids become puffy, while the
superficial veins will appear full and dark from the contained blood. In
a few hours the skin assumes a pale, ashen hue, with a parchmentlike
feel, which will be a sure indication of the success of the operation.
In a few days the puffed appearance of the face will have disappeared,
when no further change will be noticed, until after several weeks the
ears, with the tip of the nose, and ends of the fingers, begin to
shrivel and dry up.
CHAPTER VII.
PRESERVATION OF SPECIMENS OF MORBID ANATOMY.
Many valuable and interesting pathological specimens are continually
being lost, from a want of knowledge, or a careless neglect on the part
of the physician. That the fullest benefit may result from a post-mortem
examination, any rare or interesting specimen should be carefully
preserved. Should the physician feel no interest in forming a cabinet of
morbid anatomy for himself, he should then deposit the specimen in the
anatomical museum of some medical school, where it may be permanently
preserved, and the profession thus benefited.
All specimens of _soft tissues_ designed for preservation, should first
be soaked in water which is changed daily, until all blood is removed.
If the weather be warm, it will be necessary to add to the water each
time, either a small proportion of alcohol, or some antiseptic, as
carbolic acid, chloride of zinc, corrosive sublimate, or common salt.
After all blood is removed, the specimen may be put into alcohol of a
strength proportionate to the size of the specimen, and then allowed to
remain until thoroughly “cured.” Small specimens are dried up, shrunken
and nearly spoiled in many cases, by the use of too strong alcohol,
while on the other hand, large ones, by diluting the alcohol with the
large amount of water contained, would be likely to spoil in a weak
preparation. Large specimens, particularly in warm weather, should have
deep incisions made at a few points, for the better penetration of the
preserving fluid.
Before being permanently put up, the specimen should be carefully
trimmed, and everything interfering with the best display of the
essential point removed.
While either of the antiseptics mentioned above will answer for “curing”
a specimen, for permanent suspension, there is no substitute for
alcohol. Other fluids may preserve, but they will also become turbid,
throw down a precipitate, and in cold weather are liable to freeze,
while from their high specific gravity, many light specimens will float
on or near the surface. If the specimen has been thoroughly “cured”
before suspension, very dilute alcohol will answer for that purpose:
equal parts of pure water and alcohol of ninety-five degrees, in all
except the larger specimens, being abundantly strong. Delicate, light
specimens will sometimes float in such a dilution, in which case it
should be made stronger.
The best form of anatomical jar is made with ground glass stoppers, with
a hook on the under side of the latter for suspending the specimen.
Although expensive, these jars, by effectually securing the alcohol from
evaporation, as well as from the greater facility with which the spirits
may be changed, which will sometimes be required, will give better
satisfaction than any other.
Where the common jar without a stopper is used, great care will be
required in closing up, to prevent loss by evaporation. There should
first be prepared a circular plate of thick sheet lead, to rest on the
top of the neck of the jar. The specimen having been suspended by a
string, carried through by a large needle, and at two different points,
is to be fastened to the disk of lead by means of two holes, punched by
an awl, about half an inch apart, near the centre. The portion of string
above the lead, with the holes also, should now be carefully covered
with sealing-wax, otherwise, by capillary attraction, the alcohol will
keep the bladder covering continually wet, and finally rot it out. Over
the lead is now to be stretched a piece of moistened bladder, and wound
with twine around the neck of the jar. When dry, this is to be covered
with a coat of black varnish; this again when dry, being followed by a
second layer of bladder and varnish.
Wet preparations should be kept where they may have a free exposure to
sunlight. If placed in a dark closet, they become damaged in texture,
and acquire a dark and unpleasant color; this is particularly the case
with the ligamentous and nervous tissues.
Dr. Brunetti of Padua, who has invented a new process for preserving
certain kinds of specimen, and who received a gold medal some years ago
at the Paris Exposition, gives the following particulars of his method:
“The process comprises four several operations, viz.: 1, the washing of
the piece to be preserved; 2, the _degraissage_, or eating away of the
fatty matter; 3, the tanning, and 4, the desiccation.
“1. To wash the piece M. Brunetti passes a current of pure water through
the blood-vessels and the various excretory canals, and then he washes
the water out by a current of alcohol.
“2. For destroying the fat he follows the alcohol with ether, which he
pushes, of course, through the same blood-vessels and excretory ducts;
this part of the operation lasts some hours. The ether penetrates the
interstices of the flesh and dissolves all the fat. The piece, at this
point of the process, may be preserved any length of time desired,
plunging it in ether, before proceeding to the final operations.
“3. For the tanning process M. Brunetti dissolves tannin in boiling
distilled water, and then, after washing the ether out of the vessels
with distilled water, he throws this solution in.
“4. For the drying process Dr. Brunetti places the pieces in a vase with
a double bottom filled with boiling water, and he fills the places of
the preceding liquids with warm, dry air. By the aid of a reservoir, in
which air is compressed to about two atmospheres, and which communicates
by a stop-cock and a system of tubes, first to a vase containing
chloride of calcium, then with another heated, then with the vessels and
excretory ducts of the anatomical piece in course of preparation, he
establishes a gaseous current which expels in a very little time all the
fluids. The operation is now finished.
“The piece remains supple, light, preserves its size, its normal
relations, its solid elements, for there are no longer any fluids in it.
It may be handled without fear, and will last indefinitely.”
For the preservation and hardening of tissues for microscopic
examination—as sections of tumors, glands, membranes, spinal cord or
brain, etc.—Müller’s fluid may be employed, which is prepared as
follows: bichromate of potassa, 75 grains; sulphate of soda, 35 grains;
dissolved in six ounces of water. The specimen should be suspended in
this fluid until sufficiently hardened to permit of a satisfactory
examination.
Preparation of Bones.
Pathological specimens of bones, may be prepared either by boiling or
maceration. The method by boiling should be employed, however, only
where the texture of the specimen is firm and solid, as in cases of
united fracture, etc.; and in these cases, care will be required to
avoid injuring the specimen by too long exposure to the process.
Maceration, however, is the better method for all cases, and the only
one to be employed in cases where the bone is softened by caries or
necroses.
The specimen having been roughly stripped of the soft tissues, is to be
thrown into a vessel of water, the latter being changed every day, as
long as it becomes colored by the blood. It is now to be left until the
putrefactive process has so softened the tissues that they may be easily
removed, when, after being thoroughly washed in soda water, it may be
dried and mounted. If the weather be cold, it will be absolutely
important that the macerating be conducted in a warm room, else the
process will be so slow as to convert the tissues into a form of
adipocere, quite arresting the putrefactive process, and greatly
damaging the specimen in its beauty and value.
In this connection, it may be observed that bones from a subject that
has been injected with chloride of zinc, can never be successfully
macerated, the zinc having a sort of tanning effect upon the tissues,
which enables them to resist the putrefactive process. Boiling is the
only method by which such specimens can be cleansed.
Where a bone has been properly macerated and dried, and especially if
from a young subject, it will be found white and quite free from grease;
but when taken from old subjects, or when prepared by boiling, it may be
required to be subjected to a bleaching process for removing the grease
and improving the color. By exposure to the sun, with frequent washing
in chlorine and soda water, the appearance of the specimen may be
greatly improved, or what is still better, by covering the specimen for
a few days in sulphuric ether, which will effectually dissolve out all
the grease, and then washing and exposing to the sun for a few days, it
will be left beautifully white and clean.
For permanent preservation, the specimen should finally be mounted on a
block or board, in such a manner as best to expose its interesting
points.
INDEX.
PAGE
Abdomen, method of opening, 127
Abdominal dropsy, 135
Alcohol, poisoning by, 299
Anatomical syringe, 323
Anus, diseases of, 157
fistula of, 157
hæmorrhoids, 159
ulcer in, 157
Aorta. (See _Arteries_.)
Apoplexy, cerebral, 41
pulmonary, 115
Arachnoid, examination of, 38
Arsenic, poisoning by, 297
Arthritis, chronic rheumatic, 271
scrofulous, 271
Arteries, aneurism of, 99
calcification of, 99
examination of, 98
fatty degeneration of, 99
inflammation of, 98
ossification of, 99
rupture of, 102
Arteries, cerebral.
atheromatous degeneration of, 60
calcification of, 60
obstruction of, 59
position of clot in obstruction of, 59
Atresia ani, 149
urethræ, 212
Autopsy, medico-legal, method of conducting, 304
Biliary calculi, 188
effects of, 190
position of, 189
Bladder, gall-. (See _Gall-bladder_.)
Bladder, urinary.
contraction of, 210
catarrh of, 210
cancer of, 211
dilatation of, 209
examination of, 208
hypertrophy of, 209
inflammation of, 210
malformations of, 208
parasites in, 212
removal of, 131
tubercles in, 211
tumors in, 211
Bones, abscess of, 259
cancer of, 266
caries of, 260
examination of, 259
inflammation of, 259
morbid growths in, 263
necrosis of, 260
rickets in, 261
suppuration of, 259
tumors in, 263
tubercles in, 265
Brain, appearance of, in health, 48
abscess of, 50
atrophy of, 53
blood cysts in, 59
calcareous deposits in, 56
examination of, 29
hardening of, 51
hypertrophy of, 52
hydatids in, 57
inflammation of, 47
membranes of, 36
removal of, 29
softening of, 48
tumors of, 54
Bright’s disease, 197
cirrhotic or contracting form, 201
inflammatory form, 197
waxy or amyloid form, 200
Bronchial tubes, dilatation of, 125
examination of, 106, 122
inflammation of, 123
narrowing of, 124
obliteration of, 124
Bronchitis, 123
Buccal cavity, examination of, 65
Burning, ante-mortem distinguished from post-mortem, 318
Cancer, of bones, 266
black, 291
colloid, 292
encephaloid, 291
epithelial, 293
of gall-bladder, 188
Cancer, of heart, 84
hard, 290
of intestines, 158
of kidneys, 204
of liver, 177
of lungs, 120
of mammæ, 256, 257
of mediastinum, 126
medullary, 291
melanotic, 291
of ovaries, 250
of œsophagus, 73
of penis, 217
of prostate gland, 228
of pancreas, 161
of peritoneum, 136
of spleen, 165
of suprarenal capsules, 208
of scrotum, 219
of stomach, 146
of scirrhus, 290
of testicles, 224
of tongue, 68
of ureters, 206
of urinary bladder, 211
of urethra, 214
of uterus, 240
of vagina, 234
Calculi, urinary, 214
Calvarium, removal of, 28
Carbonic oxide, poisoning by, 299
Carditis, 76
Cerebral arteries, 59
Cerebritis, 48
Cerebro spinal meningitis, 61
Chest, examination of, 65
Children, new-born, medico-legal question relating to, 307
Chloride of zinc, preservative properties of, 321
Colon, removal of, 128
Corrosive sublimate, poisoning by, 298
preservative properties of, 321
Cystitis, 210
Death, signs of, previous to putrefaction, 312
probable cause of, 317
Diphtheria, false membranes in, 71
Disinfectants for instruments, 24
Dropsy of abdomen, 135
of brain, 40
of chest, 103
of heart, 74
of ovaries, 248
of testes, 222
Drowning, death from, 302, 309
Duodenum, removal of, 129
Dura mater, inflammation of, 36, 61
fibrinous clots in, 37
thickening of, 37
tubercular deposits in, 38
tumors in, 38
Ear, examination of, 31
removal of, 29
Embalming, method of, by ancients, 320
objects of, 321
instruments required, 323
the operation, 324
changes resulting from, 325
Embolism of cerebral arteries, 59
Endocarditis, 77
Enteritis, 149
Epididymitis, 221
Epispadias, 212, 215
Exostoses, 263
Eyes, removal of, 32
Fallopian tubes, anomalies of, 251
inflammation of, 251
morbid growths in, 251
Fistula in ani, 157
Fractures, ante-mortem distinguished from post-mortem, 318
Ganglions, 270
Gall-bladder and ducts, 187
cancer of, 188
dilatation of, 188
gall-stones in, 189
inflammation of, 187
tumors in, 188
tubercles in, 188
Gastritis, 141
catarrhal, 141
croupous, 141
phlegmonous, 141
Gums, examination of, 65
Gunshot wounds, ante-mortem distinguished from post-mortem, 318
Hanging, death from, 301, 319
Hæmatocele, 223
Hæmoptysis, 114
Hæmorrhage, pulmonary, 114
uterine, 237
Hæmorrhoids, 157
Head, caries of bones of, 35
examination of, 27
removal of membranes of brain, 28
removal of calvarium, 28
removal of brain, 29
thickening of bones of, 35
thinning of bones of, 35
Heart, atrophy of, 82
abscess of, 86
aneurism of, 86
cancers in, 84
displacements of, 87
dilatation of, 80
ectopia cordis, 88
examination of, 66, 75
fatty degeneration of, 82
fatty growth of, 82
hydatids in, 86
hypertrophy of, 79
inflammation of, 76
melanosis of, 84
malformations of, 86
morbid condition of, 75
normal size of, 80
ossification of arteries of, 85
rupture of walls of, 87
stenosis of, 79
tumors in, 84
transposition of, 88
valves of, 77
Heart clots, causes of, 91
color of, 89
consistency of, 89
time of formation of, 90
position of, 89
Hepatitis, 168
Hernia, 154
Hydrarthrosis, 268
Hydrothorax, 104
Hydrocele, 222
congenital, 222
diffused, 223
encysted, 222
simple, 222
Hypospadias, 212, 215
Hydrocyanic acid, poisoning by, 298
Instruments, 21
disinfectants for, 24
Intestines, cancer of, 158
contraction of, 153
dilatation of, 153
displacement of, 154
examination of, 149
inflammation of, 150
incarceration of, 155
malformations of, 149
obstructions of, 155, 156
parasites in, 159
rupture of, 157
tubercles in, 158
tumors in, 158
ulceration of, 152
wounds of, 157
Intussusception, 156
Joints, bursæ of, morbid conditions of, 269
cartilage of, morbid conditions of, 270
inflammation of synovial membrane, 268
malformations of, 268
rheumatic inflammation of, 271
scrofulous inflammation of, 271
Kidneys, anomalies of, 194
abscesses of, 196
Bright’s disease of, 197
congestion of, 194
cancer of, 204
cysts in, 204
dislocation of, 203
examination of, 193
fatty degeneration of, 202
hæmorrhage of, 195
inflammation of, 195
inflammation of capsule of, 197
parasites in, 205
removal of, 129
size and weight of, 193
tubercles in, 203
Larynx, abscesses of, 71
examination of, 64, 65, 69
false membranes in, 71
inflammation of, 69
necrosis of cartilages of, 70
œdema of, 70
tumors of, 71
ulceration of, 70
Liver, abscess of, 169, 171
atrophy of, 174
blood-vessels of, 182
congestion of, 166
cancer of, 177
degenerations of, 171
examination of, 130, 165
effusion hæmorrhagic of, 167
fatty, 172
hypertrophy of, 177
inflammation of, 168
parasites in, 183, 186
removal of, 130
size of, 165
tubercles in, 181
tumors in, 182
Lungs, appearance in health, 107
appearance, post-mortem, 118, 120
abscess of, 111
apoplexy of, 115
congestion of, 107
cancer of, 120
examination of, 67, 106
emphysema of, 116
gangrene of, 112
hepatization of, 108
hæmorrhage of, 114
hydatids in, 122
inflammation of, 107, 109
melanosis of, 121
suppuration of, 110
tubercles in, 117
tubercular cavities in, 119
tumors in, 122
Mammæ, anomalies of, 252
atrophy of, 252
abscesses of, 253
cancer of, 256, 257
examination of, 252
inflammation of, 253
tumors in, 254
ulcers in, 254
Medico-legal questions, 304
external inspection of body, 305
internal examination, 306
Mediastinum, abscess of, 126
cancerous growths in, 126
inflammation of, 126
tumors of, 126
Medulla, spinalis, 62
oblongata, effusions in, 43
of bone, disease of, 267
Membranes of the brain.
appearance of, in meningitis, 39
examination of, 36
morbid changes of, in insanity, 40
removal, of 28
serous effusion into, 40
sanguineous effusion into, 41
Membranes, spinal, tuberculous deposits in, 61
tumors in, 61
Meningitis, 39
cerebro-spinal, 61
tubercular, 38
Metritis, 237, 242
Metrophlebitis, 243
Morbus Brightii, 197
Mouth, catarrhal or croupous inflammation of, 72
examination of, 64
Myelitis, 62
Müller’s fluid, 329
Neck, examination of, 64
Nephritis, 195
Nitric acid, poisoning by, 295
Nux vomica, poisoning by, 299
Œsophagus, cancer of, 73
dilatation of, 73
examination of, 72
inflammation of, 72
stricture of, 72
tumors in, 73
ulceration of, 72
Opium, poisoning by, 300
Orchitis, 221
Osseous growths, 263
Osteomalacia, 262
Osteophytes, 263
Ovaries, abscesses in, 247
cysts in, 248
dropsy of, 248
examination of, 247
inflammation of, 247
malignant disease of, 250
tumors, tubercles, etc., of, 251
Oxalic acid, poisoning by, 295
Palate, examination of, 65
Pacchionian bodies, 39
atrophy of, 161
Pancreas, anomalies of, 160
cancer of, 161
dilatation of ducts, 161
examination of, 160
fatty degeneration of, 161
hypertrophy of, 161
inflammation of, 161
removal of, 129
Parasites in bladder, 212
in brain, 57
in heart, 86
in intestines, 159
in kidneys, 205
in liver, 183, 186
in lungs, 122
in spinal cord, 63
Pelvic viscera, removal of, 130
Penis, anomalies of, 215
atrophy of, 215
balanitis of, 216
chancres on, 216
cancer of, 217
examination of, 215
fracture of, 216
hypertrophy of, 215
herpes of, 216
paraphymosis of, 216
psoriasis of prepuce, 216
tumors of, 218
warts on, 217
Pericardium, adhesions in, 74
blood in, 74
examination of, 73
inflammation of, 73
morbid growths in, 75
Peritoneum, blood in result of violence, 135
congestion of, 133
cancer of, 136
dropsical accumulation in, 135
exudation, fibrinous, on, 134
examination of, 133
gangrene of, 135
inflammation of, 133
suppuration of, 135
tubercular deposits in, 136
tumors of, 136
Peritonitis, 133
puerperal, 243
Perihepatitis, 167
Peripractitis, 151
Perityphlitis, 151
Pharynx, examination of, 65, 72
inflammation of, 72
tumors in, 73
ulceration of, 72
Phosphorus, poisoning by, 296
Pia mater, examination of, 38
inflammation of, in spotted fever, 61
Pleura, adhesions in, 103
examination of, 103
effusions into, 103
inflammation of, 103
Pleurisy, 103
Pneumonia, catarrhal, 109
croupous, 110
double, 109
lobular, 110
single, 109
Pneumothorax, 105
Poisoning, death from, 294
Post-mortem examinations, 24
preliminary preparations for, 24
in medico-legal cases, 304
Pregnancy, abdominal, 244
extra-uterine, 244
tubal, 245
utero-tubal, 245
Preparation of bones, 329
by boiling, 329
by maceration, 329
bleaching of, 330
Preservation of specimens of morbid anatomy, 326
process of Dr. Brunetti, 328
Prolapsus of rectum, 157
Prostate gland, anomalies of, 227
atrophy of, 228
cancer of, 228
cysts in, 228
concretions in, 229
examination of, 226
hypertrophy of, 227
tubercles in, 228
tumors in, 228
anomalies of, 230
Pudenda, examination of, 230
elephantiasis of, 232
hypertrophy of, 230
inflammation of, 231
tubercles in, 232
tumors in, 232
warty excrescences on, 231
Putrefaction, process of, 314
Pyelitis, 196
Pyelonephritis, 196
Questions relating to new-born children, 307
was the child mature?, 307
was it born alive?, 308
how long did it live?, 310
what was the cause of death?, 311
Rachitis, 261
Rectum, prolapsus of, 157
removal of, 128
Sclerosis of spinal cord, 62
Scrotum, cancer of, 219
examination of, 218
elephantiasis of, 218
hypertrophy of, 218
inflammation of, 219
Seminal vesicles, anomalies of, 226
examination of, 226
inflammation of, 226
tubercles in, 227
Signs of death, 312
Skull, caries of bones of, 35
examination of, 34
fracture of, 34
thinning of bones of, 35
thickening of bones of, 35
Spinal cord, atrophy of, 63
examination of, 60
inflammation of membranes of, 60
morbid growths in, 63
parasites in, 63
preservation of specimens of, 33
removal of, 33
softening of, 62
Spinal column, disease of, 272
Spinal canal, serous effusions in, 61
Spina bifida, 61
Spleen, anomalies of, 162
atrophy of, 162
cysts in, 165
cancer of, 165
displacements of, 163
degeneration of, 164
examination of, 162
hypertrophy of, 162
inflammation of, 163
removal of, 129
rupture of, 163
size of, normal and abnormal, 162
thickening of capsules of, 164
tubercles in, 164
Spotted fever, inflammation of pia mater in, 61
Stomach, atrophy of, 145
Beaumont’s experiments on, 140
cirrhosis of, 144
cancer of, 146
cancer in, results of, 148
dilatation of, 145
examination of, 137
erosions, hæmorrhagic, of, 143
inflammation of, 140
post-mortem changes in, 137
poisons in, and their effects, 142
softening of, 143
tumors in, 148
ulcers in, 142
Strangling, death from, 301
Strychnia, poisoning by, 299
Suffocation, death from, 300
Sulphuric acid, poisoning by, 294
Suprarenal capsules, 207
cancer of, 208
cysts in, 208
hæmorrhage of, 208
inflammation of, 207
tubercles in, 208
Testicles, atrophy of, 220
anomalies of, 219
cancer of, 224
cystic disease of, 225
dropsy of, 222
examination of, 219
hæmatocele of, 223
hypertrophy of, 220
inflammation of, 221
tubercles in, 225
tumors in, 226
varicocele of, 223
Teeth, examination of, 65
Throttling, death from, 301
Thrombi in sinuses of dura mater, 37
Tongue, cancer of, 68
examination of, 68
hypertrophy of, 69
ranula of, 68
syphilitic ulcers of, 68
tubercles of, 68
tumors of, 68
Tonsils, catarrhal or croupous inflammation of, 72
examination of, 65
Tubercular disease of lungs, 117
tubercular cavities in, 119
meningitis, 38
Tumors, adenoid, 285
benign, 274
in brain, 54
in bones, 263
in bladder, 211
classification of, 274
cystic, 274
cartilaginous, 280
carcinomatous, 288
in dura mater, 38
fatty, 279
fibrous, 279
in Fallopian tubes, 251
in gall-bladder and ducts, 188
hydatid, 277
in heart, 84
in intestines, 158
lipomatous, 279
lymphatic, 285
in larynx, 71
in lungs, 122
in liver, 182
myxomatous, 278
myomatous, 284
malignant, 286
in mediastinum, 126
in mammæ, 254
neuromatous, 284
osseous, 281
in œsophagus, 73
in ovaries, 251
papillary, 282
polypoid, 283
in pharynx, 73
in pericardium, 75
in peritoneum, 136
in pudenda, 232
in prostate gland, 228
in penis, 218
sarcomatous, 286
in spinal cord, 63
in stomach, 148
in tongue, 68
in testicles, 226
in uterus, 238
in vagina, 234
vascular, 284
Ureters, cancer of, 206
cysts in, 207
defects of, 205
dilatation of, 206
inflammation of, 206
tubercles in, 207
Urethra, contraction of, 213
cancer of, 214
dilatation of, 213
inflammation of, 212
malformations of, 212
rupture of, 213
stricture of, 213
tubercles in, 214
warty growths in, 213
Uterus, anomalies of, 235
atrophy of, 236
cysts in, 240
cancer in, 240
examination of, 235
excrescences, cauliflower, etc., 241
hæmatometra, 236
hypertrophy of, 236
hydrometra, 236
hæmorrhages of, 237
inflammation of, 237, 242, 243
malpositions of, 236
removal of, 132
rupture of, 241
tubercles in, 240
tumors in, 230
ulcerations of, 238
Vagina, anomalies of, 232
dilatation of, 232
examination of, 230
gangrene of, 234
inflammation of, 233
laxity of, 232
laceration of, 232
rigidity of, 232
rupture of, 233
stricture of, 232
tumors of, 234
Valves of heart, aneurism of, 79
atrophy of, 78
calcification of, 78
contraction of, 79
thickening of, 77
Volvulus, 156
Vulva. (See _Pudenda_).
White swelling, 271
Wounds, death from, 317
contused, appearance of, 317
post-mortem distinguished from ante-mortem, 317
Zinc, preparation of, for embalming, 322
quantity of, required, 322
ERRATA.
On page 21, last line, for “culvarium,” read calvarium.
„ 25, fifteenth line, for “collodian,” read collodion.
„ 79, last line, for “that organ,” read those organs.
„ 93, thirteenth line, for “affords,” read afford.
-----
Footnote 1:
Toynbee on the Ear.
Footnote 2:
See No. 509, College Museum.
Footnote 3:
Id, 473.
Footnote 4:
See No. 490, College Museum.
Footnote 5:
“Morbid Anatomy of the Brain, in Mania, &c.,” by Andrew Marshall, M.
D.
Footnote 6:
See No. 1386, Case T, College Museum.
Footnote 7:
See No. 1295, Case R, College Museum.
Footnote 8:
See No. 1385, College Museum.
Footnote 9:
See No. 1387, College Museum.
Footnote 10:
Paget’s Pathology, p. 586.
Footnote 11:
Medico-Chirurgical Trans. xvii. p. 507.
Footnote 12:
See Hahnemannian Monthly for May, 1871.
Footnote 13:
In one case, the clot presented a marked resemblance to the abdominal
fat of the goose, both in color and consistency.
Footnote 14:
Meigs’ Treatise on Obstetrics, p. 308.
Footnote 15:
No. 1470, College Museum.
Footnote 16:
No. 1344, College Museum.
Footnote 17:
No. 1385, College Museum.
Footnote 18:
See article on Spontaneous Cure of Aneurism, with cases in New York
Transactions of Homœpathic Medical Society for 1868, page 170.
Footnote 19:
See case of recovery reported by Dr. R. Koch, in American Jour. of
Hom. Mat. Med., Vol. IV., p. 123.
Footnote 20:
See Nos. 1309 and 1351, College Museum.
Footnote 21:
See No. 1506, College Museum.
Footnote 22:
Jones and Sieveking’s Pathological Anatomy.
Footnote 23:
Cirrhosis, as applied to this condition of the liver, has reference to
the yellow color, due to the presence of large quantities of yellow
pigment contained in the secreting cells; hence the application of the
term to diseases of the lungs, kidneys, etc., which resemble cirrhosis
of the liver, not in color, but in density of the tissues, is
obviously inappropriate.
Footnote 24:
See No. 1495, College Museum.
Footnote 25:
See No. 1496½, College Museum.
Footnote 26:
See report of case of “Ossification of Veins,” by James Kitchen, M.
D., in American Journal of Homœopathic Materia Medica for December,
1871, page 143.
Footnote 27:
See No. 1500, College Museum.
Footnote 28:
Specimen No. 1329, College Museum.
Footnote 29:
See No. 1336½, College Museum.
Footnote 30:
See No. 1259, College Museum.
Footnote 31:
Bright’s Disease, by T. Grainger Stewart.
Footnote 32:
See No. 1507, College Museum.
Footnote 33:
Specimen No. 1260, College Museum.
Footnote 34:
See No. 1261, College Museum.
Footnote 35:
See No. 359, College Museum.
Footnote 36:
See No. 329, College Museum.
Footnote 37:
See No. 331, College Museum.
Footnote 38:
See Nos. 335 and 360, College Museum.
Footnote 39:
See Nos. 325 and 326, College Museum.
Footnote 40:
See No. 1476, College Museum.
Footnote 41:
See Nos. 1340 and 1341, College Museum.
------------------------------------------------------------------------
TRANSCRIBER’S NOTES
Page Changed from Changed to
237 defect in the excretion of the defect in the excretion of the
menses, or form a morbidly menses, or from a morbidly
300 oxygen though the lungs. The oxygen through the lungs. The
term is generally restricted term is generally restricted
● Typos fixed; non-standard spelling and dialect retained.
● Enclosed italics font in _underscores_.