POST-MORTEM EXAMINATIONS AND EXHUMATIONS
The following are some of the Instructions issued to Medical Inspectors
by the Crown Office in Scotland, slightly modified:
I. Part of General Directions
13. When any portions of the body, or any substances found in or near
it, are to be preserved for further examination, they ought never
to be put out of the custody of the inspectors, or of a special law
officer. They must be locked up in the absence of the person who keeps
them. When they are to be transmitted to a distance, they should be
labelled, and the labels signed by the inspectors; and after being
properly secured and sealed, they should be delivered by the inspectors
themselves, or the special law officer whose duty it is to see them
delivered into the hands of the parties for whom they are intended.
II. Necessary Implements
14. Besides the ordinary instruments used in common dissections, the
inspector should be provided with a foot-rule for measuring distances,
and a glass measure graduated to drachms, for measuring the quantities
of fluids, two or three stoneware jars of medium size, or when these
cannot be had, a few clean bladders, for carrying away any parts of the
body which it may be necessary to preserve for future examination, and
in cases of possible poisoning, three or four bottles of eight, twelve,
and sixteen ounces, with glass stoppers or clean corks, for preserving
fluids to be analysed. The common square green glass pickle bottles are
very suitable, and can generally be obtained. No bottle or jar should
be used until it has been thoroughly washed under the supervision of
one of the inspectors. In cases of infanticide a balance, having a flat
scale-pan with a foot-rule painted on it, is of great use; on it the
infant may be stretched, weighed, and measured at one operation. Paper,
pens, ink, and sealing-wax should also be provided.
15. All distances, lengths, surfaces, and the like, whose extent may
require to be described, ought to be accurately measured; and the
same rule ought to be followed in ascertaining the volume of fluids.
When large quantities of fluids are to be measured, any convenient
vessel may be used, whose capacity is previously ascertained by the
inspectors. Conjectural estimates and comparisons, however common, even
in medico-legal inspections, are quite inadmissible.
III. External Aspect, and Examination of the Body
16. The importance of the external examination, and the particulars to
be chiefly attended to in performing it, will vary in different cases
with the probable cause of death. It comprehends an examination--(1)
Of the position of the body when found, as well as of all external
injuries or marks presented by it. (2) Of the vicinity of the body,
with a view to discover the objects on which it rested, or from or
upon which it may have fallen, marks of a struggle, signs of the
presence of a second party about the time of death or after it, weapons
or other objects the property or not the property of the deceased, the
remains of poisons, marks of vomiting; and where marks of blood are of
importance, and doubts may arise as to their really being blood, the
articles presenting them must be preserved for further examination. (3)
Of the dress, its nature and condition, stains on it of mud, sand, and
the like, of blood, of vomit, of acids, or other corrosive substances,
marks of injuries, such as rents or incisions; where injuries have been
inflicted on the body, care should be taken to compare the relative
position of those on the body and those on the clothes; and where
stains, apparently from poison, are seen, the stained parts are to
be preserved for analysis. (4) Ligatures, their material and kind,
as throwing light on the trade of the person who applied them; the
possibility, or impossibility, of the deceased having applied them
himself; their sufficiency for accomplishing their apparent purpose, &c.
17. The inspectors will commence the examination of the body itself by
surveying the external surface and openings. Before cleaning it they
will examine it on all sides, not neglecting the back, as is often
done, and look for marks of mud, blood, ligatures, injuries, stains
from acids, and the like; foreign bodies, or injuries within the
natural openings of the body, viz. the mouth, nostrils, ears, anus,
vagina, and urethra. If there are impressions of finger marks, they
will consider which hand produced them. If there be any doubt about
stains being blood, the skin presenting them must be preserved for
analysis. If there be acid stains, or other probable remains of poison,
or any foreign matter, the nature of which may require to be determined
by analysis, these must also be preserved. The ordinary places for the
impressions of ligatures are the neck, the wrists, the ankles, and the
waist. The degree of warmth of the trunk and extremities, the presence
or absence of cadaveric rigidity, and whether it exists equally in the
upper or the lower extremities, should be noted in this stage of the
proceedings; in other cases the progress of putrefaction, as indicated
by the odour of the body, the looseness of the cuticle, the colour of
the skin, and formation of dark vesicles on it, the evolution of air in
the cellular tissue, the alteration of the features, the softness of
the muscles, the shrivelling of the eyes, the looseness of the hair and
nails.
18. In this part of the examination it will sometimes be necessary to
observe the particulars by which the body may be identified. These are
numerous. But the most important are the stature, the age and sex,
the degree of plumpness, the size and form of the nose and mouth, the
colour of the eyes and hair, the state of the teeth, warts, nævi,
deformities, scars of old abscesses, ulcers, and wounds, and, if a
woman, marks of her having had one or more children.
19. The body is next to be washed, if necessary, and the hair of the
head shaved, or at least closely cut; and a thorough examination of
the whole integuments is to be made. At this stage the inspectors will
look particularly for the appearance of lividity, noting its chief
seat and its relation to the posture in which the body was found--for
impressions on the skin of objects on which it had rested--for marks of
injuries, more especially contusions, taking care to ascertain their
real nature by making incisions through the skin--for marks of disease,
such as eruptions, ulcers, and the like--for marks of burning--for
marks of concealed punctures in the nostrils, mouth, external openings
of the ears, the eyes, the nape of the neck, the arm-pits, the anus,
the vagina, and beneath the mammæ or scrotum; in infants, also in the
fontanelles and the whole course of the spine. At this stage, wounds
and other injuries should be carefully examined according to the
directions given in Division V. (_infra_). Where the injury may have
caused loss of blood, the presence or absence of pallor of the skin,
lining membrane of the mouth, and the gums ought to be noted.
IV. Dissection, or Internal Examination of the Body
20. In commencing the dissection of the body, it must be laid down as
an invariable rule that all the great cavities should be examined, and
also every important organ in each, however distinctly the cause of
death may seem to be indicated in one of them. It is right to examine
the cavity of the spine, and at all events its upper portion, in any
case where an unequivocal cause of death has not been discovered
elsewhere.
21. In examining the organs situated in the several cavities of the
body the inspectors must be guided in a great measure by their ordinary
anatomical and pathological knowledge.
22. The inspectors should begin with that cavity over which there is
a wound or other mark of injury. Or, if there be an injury on the
extremities, the dissection ought to commence there. In the absence
of any such guide, that cavity should be taken first where the
circumstances of death, so far as they are ascertained, may lead the
inspectors to expect unusual appearances. In other cases, the abdomen
should be first opened but not dissected, and a general survey made of
the parts exposed, without disturbing them materially, the position
of the diaphragm being determined by examining it with the hand; then
the thorax is immediately to be examined, unless there is good reason
for doing otherwise. The reasons for this method of procedure are as
follow: If the abdominal organs are removed, and the veins cut, the
blood in the heart may drain away through the venæ cavæ, and error
result. If, on the other hand, the thorax be first opened, the relation
of the abdominal organs to each other cannot be clearly made, owing to
the relaxation of the diaphragm, due to the severing of its thoracic
connections. Again, if the thorax be first opened, the position of the
diaphragm cannot be determined. The inspectors may begin with the head,
which may be examined thoroughly in the first instance, afterwards the
chest and belly, as above described; the spine being reserved till the
conclusion. Wherever unusual appearances are discovered in the first
cursory survey, the anatomical examination ought in general to be begun
there.
23. In examining the several regions of the body it is to be observed
that wherever a wound, or other obvious injury of the external parts,
lies in the way of the ordinary incisions, that part must be avoided,
so as to leave the external injury unaltered.
24. The most approved mode of opening the head in medico-legal cases
is, after dividing the integuments from ear to ear, and reflecting
the scalp over the forehead and occiput, to make the usual circular
incision through the skull, about an inch above the orbits in front,
and over the occipital protuberance behind, using the saw lightly
and carefully after the outer table of the skull has been divided,
so as to avoid injuring the membranes of the brain; and to raise the
skull-cap from before backwards, taking care to detach the dura mater
from the skull with the handle of the scalpel or a spatula where it
adheres firmly. The chisel and mallet should never be used where there
is any chance of finding a fracture of the skull; for how could it be
distinguished from a fracture made with the mallet? Should the dura
mater be firmly adherent to the skull-cap, the better practice is to
divide it carefully, so as to remove both at the same time. Tearing the
membrane and crushing the brain substance are thus avoided. In infants
and young children this mode of procedure is most necessary, as in them
the dura mater is, as a rule, adherent.
25. The ordinary mode of examining the membranes of the brain, and the
brain itself, answers well in medico-legal dissections. Effusions of
fluid within the skull should always be measured. After the brain is
removed, the dura mater ought to be stripped from the base of the skull
to facilitate the search for fractures there, which will, of course,
indicate external violence. After the removal of the brain, the upper
part of the spinal canal should be examined through the foramen magnum
before any part of its course be laid open; and search should be
particularly made for dislocation or other injury in the region of
the atlas and dentata. In cases of fatal fractures of the head, the
strength of the bones should be attended to. In cases of extravasation
within the head, the state of the coats of the cerebral arteries should
be examined.
26. The best mode of opening the spine is, after having finished the
examination of the brain, to cut through the integuments from the
occiput to the coccyx--to lay the vertebræ thoroughly bare on each
side by cutting away the muscles--to make an incision with the saw
on each side of the skull, from the postero-inferior angle of the
parietal bones into the lateral edge of the occipital hole--to remove
the triangular portion of the occipital bone thus detached, and then
to cut the rings of the vertebræ on each side with the bone-nippers or
spine-knife, beginning with the atlas. In these cases preference should
be given to the saw, by which the operation is not only more easily
accomplished, but there is no risk of confounding previous fracture
with that made in dissecting. Where there is reason to think that the
bones are injured, the laying open of the canal should stop at the
distance of two or three vertebræ from the injury, and the injured
bones, with two or three adjacent vertebræ on each side, should be
removed entire before the examination is extended farther down the
spine.
27. The organs of the throat may be examined, either by dividing the
lower jaw-bone at the chin, cutting the soft parts close to the inner
surface of each half of the bone backwards, and then turning the two
segments outwards; or by freely reflecting the skin of the throat,
separating the soft parts from the inside of the lower jaw, the knife
being carried parallel with and close to the bone, drawing the tongue
out below the chin, and then continuing the dissection backwards.
28. The best mode of examining the organs situated in the throat is,
after detaching the soft parts from the lower jaw, as advised in Sect.
27, to dissect the soft palate from the bone, and proceeding backwards,
to detach the whole soft parts from the base of the skull and vertebræ
down to the sternum, leaving them connected with the organs in the
chest. Besides the ordinary points to be attended to in this part of
the examination, the presence of venereal or other ulcerations is a
matter requiring attention in some cases.
29. It is necessary to examine the pharynx and gullet, the larynx,
trachea, and its greater ramifications, the lungs, the heart, and the
great vessels with particular care, because here are most frequently
found the causes of sudden natural death. In examining the heart each
auricle and each ventricle ought to be laid open by an independent
incision of its parietes; and this should not intersect any of the
valvular openings or the septum cordis.
30. For laying open the chest and abdomen, the most convenient method
is to make an incision down the fore part of the neck, chest, and
abdomen to the pubes; then cutting from the peritoneum upwards, to
dissect back the integuments and muscles of the chest, and examine the
abdomen, as in Sect. 22; next, divide the cartilages of the ribs, and,
cutting upwards, close under them, to raise the cartilages along with
the sternum. In separating the sternum from the clavicles, care must be
taken not to wound the subjacent vessels; and this may be avoided by
the dissector moving each shoulder so as to show the exact position of
the sterno-clavicular joints, and then dividing both joints cautiously.
In dividing the cartilages of the ribs, the saw is sometimes necessary.
The cartilages should be cut as far from the sternum as possible, to
give free space for the subsequent examination.
31. In inspecting the organs in the chest, a cursory examination
should be first made by turning them over, ascertaining the nature and
measuring the quantity of effused fluids, feeling for fractures of
the ribs, tumours, or other diseases, and opening the pericardium to
obtain a view of the heart. The most convenient course to pursue next
is, without moving the heart from its place, to lay open its several
cavities, in order to judge of the quantity and state of the blood in
both sides of that organ. For this purpose the following incisions
should be made: The _first_, beginning close to the base, is carried
along the right border of the heart directly into the right ventricle
towards the apex, care being taken not to cut the septum. This lays
open the right ventricle. The _second_ incision, opening up the right
auricle, begins midway between the entrances of the venæ cavæ, ending
just in front of the base. The _third_, for exposing the left auricle,
commences at the left superior pulmonary vein, and ends just in front
of the base, close to the coronary vein, care being taken not to wound
it. The _fourth_, displaying the left ventricle, commences behind the
base, and ends close to the apex. If the blood is in a fluid state,
the quantity contained in the right auricle may be materially affected
by the head being examined previously, as the blood may have escaped
from the heart by the jugular veins. The whole of the organs in the
chest--the lungs, heart, and gullet--together with the parts dissected
downwards from the throat, should now be removed in one mass, in order
to examine them in detail on a table. But previously two ligatures
should be applied on the gullet, just above the cardiac orifice of the
stomach, and the division made between them.
32. The organs in the abdomen ought to be turned over, like those of
the chest, before any one of them is minutely examined, but before the
thorax is opened, for the reasons given in Sect. 22. In the subsequent
examination, that organ is to be first proceeded with in which there
may appear to be disease.
V. Examination in Cases of Wounds and Contusions
33. In a _post-mortem_ examination, the most approved mode of examining
these injuries is, if they be situated over great cavities, to expose
the successive structures in the manner of an ordinary dissection,
observing carefully what injuries have been sustained by the parts
successively exposed before they are divided. Wounds ought not to be
probed, especially if situated over any of the great cavities. The
depth of a wound is best ascertained by careful dissection and exposure
of the parts involved; but after this is done, the thickness of the
tissues penetrated may be measured by the probe.
34. The seat of the wounds must be described by actual measurement from
known points, their figure and nature also carefully noted, and their
direction ascertained with exactness.
35. Before altering by incisions the external appearances of injuries,
which should never, if possible, be done, care must be taken to
consider what weapon might have produced them, and if a particular
weapon be suspected, it should be compared with them. The wounded parts
should be cut out entire, and carefully preserved.
36. Apparent contusions must be examined by making incisions through
them; and the inspectors will note whether there is a swelling or
puckering of the skin; whether the substance of the true skin be
black through a part or the whole of its thickness; whether there be
extravasation below the skin or in the deeper textures, and whether the
blood be fluid or coagulated, generally or partially; whether the soft
parts below be lacerated, or subjacent bones injured; and whether there
be blood in contact with the lacerated surfaces. By these means the
question may be settled whether the contusions were inflicted before or
after death.
37. In the cases of wounds, too, the signs of vital action must be
attended to, especially the retraction of the edges, adhesion of blood
to their surfaces, or the injection of blood into the cellular tissue
around, or the presence of the signs or sequelæ of inflammation.
Hypostasis must not be mistaken for vascular injection.
38. When large arteries or veins are found divided, care must be taken
to corroborate the presumption thus arising by ascertaining, in the
subsequent dissection, whether the great vessels, lungs, liver, and
membranous viscera of the abdomen be unusually free of blood.
39. In the course of the dissection of wounds, a careful search must
be made for foreign bodies in them. When firearms have occasioned
them, the examination should not be ended before discovering the
bullet, wadding, or other article, if any, lodged in the body; and
whatever is found must be preserved. When the article discharged from
firearms, or when any other weapon had passed through and through a
part of the body, the two wounds must be carefully distinguished by
their respective characters, especially as regards their comparative
size, inversion or eversion, smoothness or laceration, of their edges,
their roundness or angularity, and the comparative amount of bleeding
from each. In gunshot injuries, the presence or absence of marks of
gunpowder should be noted.
40. When wounds are situated over any of the great cavities, they ought
not to be particularly examined until the cavity is laid open; and in
laying open the cavity, the external incisions should be kept clear of
the wounds.
41. When the discoloured state of a portion of the skin is such as to
render it doubtful whether it is due to injury or to changes after
death, an incision should be made to ascertain whether there is blood
effused into the textures, constituting true ecchymosis, or merely
gorging of the vessels of the skin, or discoloration from infiltration
of the colouring matter of the blood, which takes place in depending
parts of a dead body. The term suggillation should be avoided, as it
has been used in opposite senses by Continental and British authors.
The respective expressions, “discoloration from extravasated blood,”
and “lividity after death,” are preferable.
VI. Examination in Cases of Poisoning
42. In examining a body in a case of suspected poisoning, the
inspectors should begin with the alimentary canal, first tying two
ligatures round the gullet, above the cardiac orifice of the stomach,
two round its pyloric end, and a third at the sigmoid flexure of the
colon, then removing the stomach and entire intestines; next dissecting
out the parts in the mouth, throat, neck, and chest in one mass; and,
finally, dissecting the gullet, with the parts about the throat, from
the other organs of the chest. The several portions of the alimentary
canal may then be examined in succession.
43. Previous to commencing the dissection in cases of supposed
poisoning, the inspectors should make such inquiries as may enable them
to form an opinion as to the class of poison to which the death may be
traceable, and thus to guide them as to the conclusions to be come to
from the presence, or it may be the complete absence, of any marked
appearance explaining the cause of death.
44. The medical inspectors may afford most important aid to the law
officers in investigating the history of cases of supposed poisoning.
For this purpose minute inquiry should be made into the symptoms during
life their nature, their precise date, especially in relation to meals
or the taking of any suspicious article, their progressive development,
and the treatment pursued. It is impossible to be too cautious in
collecting such information, and, in particular, great care must be
taken to fix the precise date of the first invasion of the symptoms,
and the hours of the previous meals. The same care is required in
tracing the early history of the case, where the inspector happens
to visit the individual before death; and if suspicions should not
arise till his attendance has been going on for some time, he ought,
subsequently to such suspicions, to review and correct the information
gathered at first, especially as to dates. All facts thus obtained
should be immediately committed to writing.
45. Besides inspecting the body and ascertaining the history of the
case, the inspectors may afford valuable assistance to the law officers
in searching for suspicious articles in the house of the deceased.
These are--suspected articles of food, drink, or medicine; the vessels
in which they have been prepared or afterwards contained; the family
stores of the articles with which suspected food, &c., appears to have
been made. All such articles must be secured, according to the rules
in Sect. 13, for preserving their identity. In this examination the
body-clothes, bed-clothes, floor, and hearth should not be neglected,
as they may present traces of vomited matter, acids spurted out or
spilled, and the like.
46. When a medical man is called to a case during life, where poisoning
is suspected, he ought as soon as possible to follow the instructions
laid down for securing articles in which poison may have been
administered.
47. In the same circumstances, it is his duty to observe the conduct of
any suspected individual, were it for no other reason than to prevent
the remains of poisoned articles from being put out of the way, and to
protect his patient against further attempts.
48. The whole organs of the abdomen must be surveyed, and particularly
the stomach and whole tract of the intestines, the liver, spleen, and
kidneys, the bladder; and in the female, the uterus and its appendages.
The intestines should in general be split up throughout their whole
length; and it should be remembered that the most frequent seat of
natural disease of their mucous membrane is in the neighbourhood
of the ileo-cæcal valve, and that, next to the stomach, the parts
most generally presenting appearances in cases of poisoning are the
duodenum, upper part of jejunum, lower part of ileum, and rectum.
49. In cases where the possibility of poisoning must be kept in view,
and where matters may require to be procured for chemical analysis, it
is essential to be sure that all instruments, vessels, and bladders
used are scrupulously clean.
50. When any unusual odour is perceived, either in the blood in the
course of making the dissection, or in the stomach when opened, it
ought to be carefully observed, and if possible identified by all the
medical men present. In this way alcohol, opium, prussic acid, oil of
bitter almonds, and other odorous poisons may be recognised. The smell
of the contents of the stomach ought always to be noted whenever it is
opened, as the smell often alters rapidly.
51. The stomach and intestines should be taken out entire, and their
contents emptied into separate bottles. If the stomach or part of
the intestines present any remarkable appearance, examination may
be reserved, if convenient, till a future opportunity; but in every
circumstance it must be preserved and carried away, as it may itself
be an important article for analysis. The throat and gullet may
be examined at once, and preserved with their contents, which, if
abundant, may be kept apart in a bottle. In addition to the alimentary
canal and its various contents, portions of the solid organs of the
body ought to be secured for analysis. The most important are the
liver, spleen, and kidneys. A part of the liver, at least a fourth
part, should be secured in every case of supposed poisoning; and in
cases where the fatal illness has been of long duration, and therefore
only traces of the poison may remain in the body, the whole of the
liver, the spleen, and both kidneys should be secured. A portion of the
blood, especially when the odour of any volatile poison is perceived,
should be at once put into a bottle, closed by a good cork or stopper.
52. No person ought to undertake an analysis in a case of suspected
poisoning unless he be either familiar with chemical researches, or
have previously analysed with success a mixture of organic substances,
containing a small proportion of the poison suspected.
53. All persons undertaking an analysis should bear in mind that the
opinion of some other person practised in toxicological researches may
be required; and they should therefore take care, when practicable, to
use only a portion of the several articles preserved for analysis. The
identity of the subjects for analysis must be secured by the rules in
Sect. 13.
VII. Examination in Cases of Suffocation
54. In cases of suspected drowning, the inspectors will observe
particularly whether grass, mud, or other objects be clutched by the
hands, or contained under the nails; whether the tongue be protruded or
not between the teeth; state of the penis; whether any fluid, froth,
or foreign substances be contained in the mouth, nostrils, trachea,
or bronchial ramifications; whether the stomach contains much water;
whether the blood in the great vessels be fluid. Careful pressure
should be made upon the lungs; any fluid contained in them in thus
forced into the bronchial tubes and trachea, and its nature observed.
When water with particles of vegetable matter or mud is found within
the body, these must be compared with what may exist in the water in
which the body was discovered, and should be preserved for further
scientific investigation, if requisite. Marks of injuries must be
compared diligently with objects both in the water and on the banks
near it, and especial attention given to the question--whether any
observed injuries had been sustained by the body before or after death.
55. In cases of suspected death by hanging, strangling, or smothering,
it is important to attend particularly to the state of the face
as to lividity, compared with the rest of the body; the state of
the conjunctiva of the eyes as to vascularity; of the tongue as to
position; of the throat, chin, and lips as to marks of the nails,
scratches, ruffling of the scarf-skin, or small contusions; the
state of the blood as to colour and fluidity; the state of the
heart as regards the amount of blood in its several cavities; the
state of the trunk and branches of the vena cava in the abdomen as
regards distension with blood; and the state of the lungs as regards
congestion, rupture of any of the air cells, and small ecchymoses under
the pleura, or the pericardium. The mark of a cord or other ligature
round the neck must be attentively examined; and here it requires to
be mentioned that the mark is often not distinct till seven or eight
hours after death, and that it is seldom a dark livid mark, as is very
commonly supposed, but a pale greenish-brown streak, presenting no
ecchymosis, but the thinnest possible line of bright redness at each
edge, where it is conterminous with the sound skin. Nevertheless,
effusions of blood and lacerations should be also looked for under and
around the mark, in the skin, cellular tissue, muscles, cartilages, and
lining membrane of the larynx and trachea. Accessory injuries on other
parts of the body, more especially on the chest, back, and arms, must
also be looked for, as likewise the appearance of blood having flowed
from the nostrils or ears, and the discharge of fæces, urine or semen.
In cases where death may be due to the emanations from burning fuel or
other poisonous vapours, a small phial should be filled with the fresh
blood, and securely corked for further investigation, if requisite.
VIII. Examination in Cases of Burning
56. In supposed death by burning, the skin at the edge of the burns
should be carefully examined for redness, or the appearance of vesicles
containing fluids.
IX. Examination in Cases of Criminal Abortion
57. In suspected criminal abortion, when the woman survives, the chief
points for inquiry are: The proofs of recent delivery, the ascertaining
of facts tending to show that she has been subjected to manœuvres with
instruments, and the occurrence of symptoms traceable to the action of
any of the drugs reputed as capable of causing abortion.
When the woman has died, the points requiring special attention at the
dissection are: The state of the womb, as regards its size and the
condition of its lining membrane, in reference to the probable period
of delivery; the condition of the intestinal canal, in reference to the
action of irritant drugs; of the mucous membrane of the bladder, in
reference to the action of cantharides; close inspection of the womb
and vagina, in reference to mechanical injuries, especially punctured
wounds; and any appearances that the death may have been caused by
inflammation in the organs of the pelvis, or by bleeding from the wound.
X. Examination in Cases of Infanticide
58. In cases of suspected infanticide, certain specialities must be
borne in mind. The cavity of the head should be laid open with a pair
of scissors. In opening the abdomen, the navel should be avoided, so
that the state of the vessels of the navel-string may be examined
correctly. This is done by carrying two incisions from the ensiform
cartilage to each of the anterior superior spines of the ilia, and by
deflecting downwards the triangular flap thus formed.
59. The inquiry in cases of infanticide should be conducted with
reference to the five following distinct questions: (1) The probable
degree of maturity of the child? (2) How long it has been dead? (3)
Whether it died before, during, or after delivery, and how long after?
(4) Whether death arose from natural causes, neglect, or violence? and
(5) Whether a suspected female be the mother of the child?
60. The points to be attended to for ascertaining the probable degree
of maturity of the child are: The general appearance and development,
the state of the skin, its secretions, and its appendages; the hair and
nails; the presence or absence of the pupillary membrane; the length
and weight of the whole body; whether the navel corresponds or not with
the middle of the length of the body; the situation of the meconium in
the intestines; the size of the testicles in the case of males, and in
either sex the size of the point of ossification in the lower epiphysis
of the thigh-bone. This is easily observed by making an incision
across the front of the knee into the joint, pushing the end of the
thigh-bone through the cut, slicing off the cartilaginous texture
carefully until a coloured point is observed in the section, and then,
by successive very fine slices, ascertaining the greatest diameter of
the bony nucleus. This does not exist previous to the thirty-sixth week
of gestation, and in a mature child is about one-fourth of an inch in
diameter. Has the infant been washed? Absence or presence of vernix
caseosa. Nature and character of the wrappings, if any, found on the
child.
61. The points of chief importance in reference to the period which
has elapsed after death are those specified in the last clause of
Sect. 17--it being borne in mind that the bodies of infants are often
concealed in ash-pits and dunghills, and that in these circumstances
putrefaction is very rapid.
[Illustration: Plate.--Section through the epiphysis of the lower end
of the femur showing ossification centre, in a full-term fœtus.]
62. The circumstances which indicate whether the child died before,
during, or after parturition, and how long after it, are the signs
of its having undergone putrefaction within the womb; the marks on
the crown, feet, buttocks, shoulders, &c., indicating presumptively
the kind of labour, and whether it was likely to have proved fatal to
the child; the state of the lungs, heart, and great vessels, showing
whether or not it had breathed; the nature of the contents of the
stomach and of the intestines; the presence of foreign matters in the
windpipe; the state of the umbilical cord, or of the navel itself, if
the cord be detached.
63. In order to examine properly the state of the lungs, heart, and
great vessels, with a view to determine whether or not the child had
breathed, the inspection should be made in the following order: Attend,
first, to the situation of the lungs; how far they rise along the sides
of the heart; to their colour and texture; whether they crepitate or
not. Then secure a ligature round the great vessels at the root of the
neck, and another round the vena cava above the diaphragm. Cut both
sets of vessels beyond the ligatures, and remove the heart and lungs
in one mass, which must be weighed and put into water, to ascertain
whether the lungs, with the heart attached, sink or swim. In the next
place, put a ligature round the pulmonary vessels, close to the lungs,
and cut away the heart by an incision between it and the ligature.
Lastly, ascertain the weight of the lungs; whether they sink or swim
in water; whether blood issues freely or sparingly when they are cut
into; whether any fragments swim in the instances where the entire
lungs sink; and in every instance of buoyancy whether fragments of them
continue to swim after being well squeezed in a cloth.
64. The general question to be considered in relation to the cause
of death is, whether the appearances are such as to be traceable to
the act of parturition, or whether they indicate some form of violent
death. The directions given in Divisions V., VI., and VII. apply to
infants as well as adults; but the following points are specially to be
noticed in cases of supposed infanticide:
In relation to wounds and contusions, the possibility of
minute punctured wounds of the brain or other vital
organs; in reference to injuries of the head, the
effusion of blood under the scalp, not in the situation
where it could have been produced during labour, or
fracture of the bones not producible by compression
of the head during labour, and not connected with
defective ossification of the skull; in reference to
the allegation that the head was injured by the child
suddenly dropping from the mother, when not recumbent,
the presence of sand or other foreign matters on the
contused scalp, and the existence of more than one
injury of the head; in relation to suffocation, the
external and internal signs of this form of death--marks
of compression of the mouth, and nose, and throat, and
the presence of foreign matters in the mouth and throat,
air-passages, gullet, or stomach, especially if the
body be found in contact with similar substances; in
reference to bleeding from the navel-string, a bloodless
state of the body, without any wound to account for
it; in reference to poisons, most commonly narcotics,
the absence of any of the above appearances, with an
otherwise healthy state of the body; in reference to
starvation and exposure, emaciation of the body, absence
of food from the stomach, and an empty, contracted
condition of the intestines; in reference to the
possibility of the child having been suddenly expelled,
and having fallen on the floor or into privies, &c., the
state of the navel-string is to be noted--whether long
or short, whether remaining attached to the child and
connected with the after-birth, indicating rapid labour,
or, if divided, whether it had been cut or torn across.
Nature of the ligature used, if any.
65. The circumstances noticed in Sects. 60, 61, 62, 63, 64, compared
with the signs of recent delivery in the female, will lead to the
decision of the question whether the suspected female be the mother of
the child. These circumstances may be shortly recapitulated as being
the signs of the degree of maturity of the child--the signs on the body
of the kind of labour, the signs which indicate the date of its death,
and the interval which elapsed both between its birth and death, and
between its death and the inspection.
EXHUMATIONS
It becomes necessary sometimes to exhume the bodies of persons who have
been buried. The cases which generally call for this always unpleasant
proceeding are those where a suspicion of poisoning or violence has
arisen some little time after the burial of the supposed victim. Or
the necessity may arise to show that the body buried is that of a
person whose death it is absolutely necessary to prove. In the case of
Livingstone, though this can scarcely be called a case of exhumation,
yet an examination some months after death of the arm of the corpse
alleged to be that of Livingstone, proved the existence of a badly
united fracture which the deceased was known to have had.
In conducting the exhumation, it is necessary that the medical experts
should be present to see the body removed from the coffin, and also
any person or persons who may be in a position to speak as to the
identity of the corpse--as, for instance, those who dressed it and
prepared it for burial. The person who made the coffin may also be of
assistance to speak as to its identity. As soon as the medical men are
armed with the proper authority, no time should be lost in order to
get the body as fresh as possible, and at once prove or disprove the
accusation of the crime, which, in the case of innocent persons, cannot
be too quickly removed. The best time to take up the body, if in the
summer, is early in the morning; and, in all cases, the examination,
if possible, should be made during daylight. Everything necessary for
making a medical inspection should be taken, and also a table on which
to place the body. Rubber gloves should be worn. A pail containing a
solution of some disinfectant, for the inspectors to wash their hands
after the exhumation is finished, should be close at hand. And it is as
well to expose the body for a short time to the air before beginning
the inspection. There is seldom any risk to health in removing a single
body, yet certain precautions are necessary; thus it is as well to
stand on the windward side of the corpse. Vaults should not be entered
as soon as they are opened, but time allowed for their ventilation.
Carefully note the amount of preservation of the coffin, and, if
broken, if any of the surrounding earth is in contact with the body.
This precaution is necessary in cases of suspected mineral poisoning
(as in arsenic, &c.), and it is as well also to save one or two pounds
of the earth immediately above the coffin for analysis. The body may
then be examined externally, any hair left on head or face preserved
for identification; and then an inspection of all the cavities made,
the contents of the stomach and bowels being placed in dry earthenware
jars or glass bottles, corked and capped with thin indiarubber skin,
and so tied and sealed that the string must be cut or the seals broken
in order to open them. The ends of the string should be sealed in the
presence of the authorities. In the examination, the instructions
previously given should be carefully followed. All injured or diseased
parts should be removed and preserved whenever this is practicable.
Soft parts not intended for analysis may be preserved in a concentrated
solution of salt.
=Beyond what Period is it useless to Exhume a Corpse=?--There is no
scientific limit, for even the bones may show that violence has been
used, or may point to the identity of a corpse, as in the case of
Livingstone just mentioned. Pregnancy may be detected. The medical
inspectors must proceed with the inspection unless they can positively
say that the progress of decay is such as to render the examination
nugatory in relation to its special objects. Casper mentions the case
of a man whose body was three times exhumed for different purposes. In
Scotland the law imposes a limit of twenty years, but in England the
law is silent on the point; in France a limit of ten years from the
date of the supposed crime; and in Germany, the limit is thirty years,
if the offence is that punishable with death, the time varying from
three to thirty years with the nature of the crime.