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notifies the coroner in cases of death from chronic disease, in which he has not been in attendance within a period of twenty-four hours of death, that the family of the deceased will be needlessly annoyed. It will be said that, on notification of death, the coroner will hold an inquest involving the bringing of his jury to the house of the deceased, making a post-mortem examination, outraging the feelings of the family, etc. As a matter of fact, however, there is no necessity that the family should be annoyed in the slightest degree. The coroner, being notified, will either authorize the attending physician to sign the certificate, or send his physician to the house to simply inspect the body, and possibly to ascertain if the family and friends of the deceased are entirely satisfied as to the cause of death.
On the other hand, let us suppose that the attending physician does not notify the coroner in a case of death from chronic disease where he has not been in attendance within a period of twenty-four hours, and that the attention of the coroner is called to the fact that the life of the deceased was heavily insured, or that the insurance company objects to the payment of the premiums on that ground. Under such circumstances the coroner is obliged to have the body exhumed, a post-mortem examination made, the attending physician and members of the family of deceased perhaps subpoenaed to appear at his office, the inquest only proving that the true cause of death was such as was first assigned in the death-certificate. All such trouble and annoyance can be avoided in such cases by simply notifying the coroner. However, therefore, the law bearing on such cases may be interpreted, why should the attending physician assume any responsibility, and risk future
trouble when there is an official regularly appointed for the investigation of such cases?
It is sometimes also held by physicians that the law cannot compel the attending physician to notify the coroner in a case of death from violence, if death be delayed several months or years. Such an opinion, however, is a misinterpretation of the law, and would not be sustained, since it is distinctly stated in the act, without qualification, that the coroner shall hold an inquest "on the body of any deceased person who shall have died a violent death." Indeed, even if the attending physician were fully satisfied that the cause of death could not be even remotely traced to some act of violence or injury suffered by the deceased years before death, it would be advisable for him to notify the coroner to relieve himself of any responsibility, in the view of a suit for damages possibly being instituted.
Whatever views physicians may hold as to the propriety of the law regulating the conduct of the coroner, it is well for them to realize the authority enjoyed by that official, at least in this Commonwealth, before entering into any conflict with him. The office is an exceedingly old one, having been in existence hundreds of years, antedating that of any of the judges of our courts. He can subpoena any one to his office at any hour of any day, and commit for contempt. The coroner has an enormous amount of authority, if he chooses to exercise it, and if he abuses it can give those with whom he comes in official contact endless trouble and annoyance. Indeed, so true is this that the office has been abolished in many places. Such being the case, so long as the office exists, the author would recommend to physicians to notify the coroner in all doubtful cases involving his jurisdiction, thereby saving themselves much annoyance, trouble, and loss of time.
Signs of Death-Cessation of Circulation and Respiration-Loss of Sensibility of the Eyes to Light-Ashy Pallor-Loss of Heat-Rigor Mortis-Cadaveric Spasm-Suggillation- Putrefaction-Conversion of Bodies into Adipocere-Length of Time Elapsing since Death— Remote and Proximate Cause of Death-Symptoms and Post-mortem Appearance of Death from Disease of Brain, Heart, and Lungs.
IT is frequently stated that persons have been buried alive, or we hear of individuals having been aroused with great difficulty from a state of trance or catalepsy, premature burial being thereby fortunately prevented. If the slightest doubt prevails as to whether a person is dead, a physician should certainly not give a death-certificate, still less contemplate opening the body. While there is no doubt that all accounts of persons being buried alive are very much exaggerated, nevertheless, as these statements may not be entirely without foundation, it is most important that the physician should be familiar with the signs of death. There are a number of signs by which a living body can be distinguished from a dead body. The continuous cessation of the circulation and respiration may be regarded unequivocally as indicating death.' It is impossible to conceive of a human being living for any length of time-an hour, for example-unless the heart beats or the lungs expand and contract. Not unfrequently, however, it is very difficult to determine positively whether the heart is beating or not, or to state positively that respiration has entirely ceased.
Cessation of Circulation and Respiration.-It is well
1 Tidy, Charles Meymott: Legal Medicine, London, 1882, part i. pp. 32, 36.
known that certain animals, like the marmot, are in the habit, during the winter months, of hibernating. This condition is one of deep and prolonged sleep. The beats of the heart are reduced to three or four to the minute; the respirations are so infrequent, and follow each other at such long intervals, that the most experienced and careful observer will often find it difficult to convince himself that the blood is really circulating, and that the animal is breathing. Nevertheless, such is the case, for, toward the spring, the creature begins to show evidence of returning vitality. The heart increases in the strength and number of its beats, the respiration increases in its frequency and force, and with the spring once well set in the normal activity of the animal is re-established.
A similar condition is presented, to a certain extent, in the case of human beings in a state of trance or catalepsy, and in the case of those who have been suffering from prolonged disease of a low typhoid state. Under such circumstances, the heart often beats so slowly and infrequently, the respiratory movements of the chest are so slight, that the most careful and closest inspection is required to determine whether the patient is alive. In such cases, however, if a ligature be bound around one of the fingers, the part between the ligature and the end of the finger, if the blood is still circulating, will become a deep red or purple in color, through the congestion due to the arrest of the circulation at that point. But no such change will be observed if life is extinct. Further, if respiration has not entirely ceased, by placing a mirror in front of the mouth the watery vapor exhaled can usually be detected through its condensing as a slight cloud upon the glass. The presence of such a cloud, however faint, is a proof that the person is still living.
Loss of sensibility of the eyes to light is a characteristic sign of death. When a lighted candle is brought near to the eye, the pupil contracts, and as it is removed from the eye the pupil dilates. This change in the size of the pupil may be regarded as a characteristic of vitality; for, though the phenomena may occur within a few hours after death, the muscular fibres of the iris, sooner or later, like all muscular fibres, lose their power of contractility. Atropia, also, on account of its effect in dilating the pupil, may be used as determining whether life is extinct.
The ashy pallor of the body may be regarded as a sign of death, though not a characteristic one, since it is not present in death from all diseases, as in a person dying, for instance, from jaundice or from yellow fever.
Loss of Heat.-One of the most remarkable of vital phenomena is the power man possesses of maintaining the temperature of his body at about 98.6° F. whatever be the character of the surroundings, whether the region be tropical or arctic, whether the season be winter or summer. After death, however, the body begins to lose heat, and at first very quickly. During the first three hours after death the body may lose perhaps as much as four degrees per hour. The temperature then progressively falls at the rate of a degree and a half an hour until, within between fifteen and twenty-four hours after death, it is that of the surrounding atmosphere.'
Loss of heat is a characteristic sign of death, but there are certain conditions which influence the rate at which
1 Taylor and Wilks: Guy's Hospital Reports, third series, vol. ix., October, 1863, p. 180; Niderkorn: Rigidité cadaverique chez l'Homme, Paris, 1872; Burman: Edinburgh Medical Journal, vol. xxv., 1880, p. 993; Goodhart: British Medical Journal, 1874, p. 303; Guy's Hospital Reports, 1870, p. 365.