POST MORTEM EXAMINATIONS.
drop-cap
Beforecommencing the work of embalming, and even while laying out a corpse, it is always necessary to make an inspection of the surface of the body. The minuteness of this inspection will depend upon the character of the case, and, in a great measure, dictate the course of treatment to be followed so as to insure success. It also behooves the operator, for his own safety, to look for evidences of skin diseases, ulcers, abscesses, etc.; the glands, penis and prepuce are to be carefully examined for syphilitic cicatrices.
It is customary to find certain changes in the external appearance of the body, which are due to the cessation of vitality in the tissues and the commencement of decomposition. I speak now of bodies which have not yet been buried, and which have been kept in the ordinary way, partly covered by a shroud, and lying on the back, in a loosely covered coffin.
If the bodies have been left in their ordinary clothes, the appearances are just the same. In such bodies, one of the first noticeable changes is the paleness of the skin and its mottling with irregular livid patches.After a short time the blood settles in the vessels of the more dependent portions of the body, and the skin which covers the back of the trunk and extremities becomes of a livid red color.
In many cases, if we cut through the skin, we find the tissues beneath congested and infiltrated with bloody scum; in bodies which have been kept for a number of days in cold weather, this red color is also seen on the anterior portions of the body, especially on the face and neck. In hot weather, the red color is very soon altered by decomposition; if the epidermis has been detached at any point, the skin beneath this is dry, hard and red. In warm weather, we may find, for a few hours after death, broad, bluish lines, corresponding to the cutaneous veins, ramifying in the skin of the neck and thorax. These lines are formed by the escape of the coloring matter of the blood from the vessels.
Within a few hours after death, even in cold weather, there is usually some escape of bloody froth and mucous from the mouth and nose. If the eyelids are not closed, the conjunctira and cornea soon become dry, brown and hard, the eyeballs also become flaccid. After a considerable time the skin of the abdomen becomes green; still later, decomposition fairly sets in. The entire body is of a dark green color; the tissues are infiltrated with serum, the abdomen is distended with gas, then the color changes from a green to a reddish brown; the epidermis is detached; the skin is covered with maggots; the entire body isswollen from the formation of gases; the face can hardly be recognized; the nails drop off, and the scalp becomes detached.
When a body is in this condition it can hardly be determined whether a month or five months have elapsed since death occurred. After this all the soft parts change into a formless, pustulent mass. The cavities are open, the viscera are indistinguishable, and the bones are left bare.
The rapidity with which these changes take place, varies under the influence of a great number of conditions. The bodies of infants usually decompose more rapidly than those of adults; fat bodies putrefy quicker than lean ones; the bodies of persons who die suddenly from violence, decompose less rapidly than the average, unless the body be considerably mangled. Exhausting diseases, fevers, and the puerperal condition, are followed by rapid decomposition, as is also death from suffocating gases. Poisoning by alcohol, by arsenic, and by sulphuric acid, may preserve the bodies for an unusual length of time. Atmospheric air, moisture, and warmth, quicken decomposition. At the same temperature, a body which has been for one week in the air, one which has been two weeks in the water, and one which has been eight weeks buried in the usual way, will all exhibit the same degree of decomposition.
It is proper to notice whether or not the body is in the condition of post mortem rigidity. More attention has, perhaps, been given to this post mortem condition than it well deserved. According to Kühne, the rigor mortis is produced by a change in the muscular fibres; the fibres first lose their contractibility, then there is coagulation of the myosine and loss of elasticity. When this acidity has reached its height, muscle becomes softer, and the rigor mortis gradually disappears; finally, the acid condition is succeeded by an alkaline fermentation, and decomposition ensues.
The rigor mortis generally begins in the muscles of the lower jaw and back of the neck; it then extends to those of the face, neck, thorax, arms, and finally, the legs; it usually disappears in the same order; it generally begins in from eight to twenty hours after death, but often much sooner. The bodies of persons killed on the field of battle, and of those who have been drowned, sometimes seem to be overtaken by the rigor mortis at the very instant of death; the bodies retain the same position, and the face the same expression, which they had in the last moments of life. The rigor mortis may continue for from one to ten days, generally, but not always; death from narcotic poisons is followed by a short and feeble rigidity. While death by lightning is followed by rapid and intense rigidity, in young children, it is feeble and of short duration. The degree and duration of rigormortis after death from violence, from different diseases, etc., is stated so variedly and contradictorily by different observers, that no definite rules can be given concerning it.
The temperature of the normal living body is 98° to 99° F. In illness, the temperature may be increased several degrees. After death, the body generally cools to the same point as the surrounding air; this is said to take place in from fifteen to twenty hours.
Taylor, from the examination of one hundred bodies, states that the average heat of the skin of the abdomen, at a period of two to three hours after death, is 77°; at four to six hours, 74°; at six to eight hours, 70°; at twelve hours, 69°. The internal viscera retain their heat longer than the surface of the body.
It is said, that, after sudden death from accidents, apoplexy, acute disease and asphyxia, the body retains its heat for an unusually long period. It is both asserted and denied, that after death from hemorrhage the body cools rapidly; the body of an adult cools more slowly than that of a child or an old person; that of a fat person more slowly than that of a lean one.
In some cases there is an exceptional retention and even an increase of heat in the dead body. Dr. John Davy reports, that in case of death from rheumatism, after the viscera had been exposed for several minutes, the temperature of the left ventricle of the heart was 113°, and that of the liver 112°. In a second case, six hours after death, the temperature of the heart was108°. It is stated that after death from yellow fever and cholera, the temperature increases for several hours after death. There are also recorded a number of instances in which the body retained its heat for several days, without known cause.
It will be seen from what has been said, that if we are called upon to pronounce upon the length of time that has elapsed since death, in a given case, this is only to be done approximately, and it is probably necessary to take into consideration the cause and manner of death, the condition of the individual, the state of the atmosphere, the manner in which the body has been kept after death; and even after making these allowances, we can only say that a person has probably been dead for such and such a time.
This chapter may prove tedious to some, but it is, however, an undeniable fact, that the preceding information (compiled from the Morbid Anatomy of F. Delafield, M. D.), is of the utmost importance to the professional undertaker. The external examination of the body, before handling, is a matter not to be neglected. Should any syphilitic sores or foul ulcers be present, the utmost caution must be used in handling the body, as the pus, which is a most virulent poison, might find its way into the system through some abrasion of the skin. The effects of this poison are such, that, should it not prove fatal, it will leave in the system traces that can never be completely eradicated. This chapter also contains information of such character as will be found needful to fully understand the subsequent chapters.