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burst open, discharging their contents. The brain runs out; the soft parts have either become pulpy or have disappeared. The softened flesh falls away from the bones, the skeleton thereby becoming exposed. The sexes finally become undistinguishable, except in the case of the uterus being recognized, the last of the internal organs to putrefy.
As a general rule, the order in which the internal organs putrefy is quite a regular one. Inferences from their condition as to the time elapsing since death are far more trustworthy, therefore, than those based upon an examination of the body externally. The first part of the body to putrefy internally is the mucous membrane of the larynx and trachea, which becomes in color a dirty red, at the same time that the abdomen becomes greenish externally, as just described. The next organ to decompose is the brain of young infants. Then follow the stomach and intestines. In this connection it should be mentioned that the ordinary post-mortem redness of the mucous membrane of the stomach often resembles so closely that due to poisoning, that the superficial examiner might be readily deceived, and attribute such a condition to poison having been taken. The spleen, omentum, and mesentery, and liver, if healthy at time of death, may resist putrefaction for several weeks. The brain in the adult, though a soft structure, does not usually putrefy before the fourth or fifth week. The next organs to putrefy are usually the heart and lungs. Then follow the kidneys, œsophagus, pancreas, diaphragm, and arteries. The last organ to decompose is the uterus. In certain cases the uterus has been recognized even seven months after death. This fact is an important one, as we shall see hereafter in considering such questions as the possibility of a pregnancy having existed, of a fœticide having been committed, etc.
Conversion into Adipocere.-Under certain circumstances, a dead body, instead of undergoing putrefaction in the ordinary manner, is converted into the substance known as 'adipocere," so called on account of its general resemblance to a combination of fat and wax.' Adipocere, being chemically either ammonium or calcium stearate or oleate, is probably produced through the combination of a fatty acid of the fat with the ammonium resulting from the decomposition of the nitrogeneous tissues, the ammonium being often replaced afterwards by calcium. The formation of adipocere being therefore a saponification, the presence of water, as might be expected, is essential to its production. Dead bodies are, therefore, converted into adipocere only in graves containing water, or in wet or at least very moist soil. Inasmuch as dead bodies lying in water for any length of time may be converted into adipocere, it becomes a matter of importance to determine the length of time required for such conversion, since it will enable the medical examiner to state, in a general way at least, how long the body has been lying in the water when it was found. As the result of observations and experiments it may be said that, on the average, the body of a new-born child will be changed into adipocere after remaining in water between five and six weeks. An adult body requires, for complete conversion into adipocere, one year if immersed in water, and three years or more if buried in wet earth."
Length of Time Elapsing since Death.--Having described in a general way the signs of death, there still
1 Fourcroy: Annales de Chimie, tome v., 1790, p. 154; tome vii. p. 17; Chevreul: ibid., tome xcv. p. 5; Orfila et Lesueur: Traité des Exhumations juridiques, tome i., Paris, 1831, p. 351; Schauenstein in Maschka, vol. iii. S. 445.
2 Devergie: Médecine légale, tome i., Paris, p. 97.
remains for consideration the question as to the medical examiner being enabled from such signs alone to determine positively the length of time which has elapsed since death. That it is highly important that the medical examiner should be able to give such testimony has been well shown in cases of murder, such as those in which the defendant proved an alibi, but in which it was also proved by the medical testimony that the wounds causing the death were not inflicted during the period that the defendant claimed he was absent. It must be remembered, however, notwithstanding the verdict of guilty in the cases just referred to, that any estimate as to the length of time elapsing since death based upon post-mortem examination alone can only be approximative. In a general way, therefore, it can only be stated in the case of the body being unburied and exposed to the atmosphere, that if the body is only slightly cold and the jaws beginning to stiffen, the eyes glazed and the eyeballs sunken, death has occurred within a period of from fifteen minutes to four hours. If, however, the entire body be cold and rigid, the abdomen has turned green and the odor of putrefaction is perceptible, the body is cold and pliant, and there is cadaveric lividity, the rigor mortis having passed away, death has taken place within from one to three days in summer and from three to six days in winter. If greenish-brown stains and dark red lines are found extending more or less over a greenish-yellow body, together with relaxation of the sphincter ani muscle, then death has occurred within a period of from eight to ten days in summer, ten to twenty days in winter. If the entire body is green, the chest and abdomen enormously distended, if open blisters are found over the skin, and maggots in the muscles, the nails falling out, the color of the eyes unrecognizable, then
death has occurred within a period of from two to three weeks in summer, of from four to six weeks in winter. If the contents of the chest and abdomen have been discharged, some of the bones bare, the eyes enormously swollen, death has taken place within a period of from four to six months. Whatever be the remote cause of death in any particular instance, whether it be due to disease, injury, wounds, or fractures, it may be referred approximately, at least, to an arrest of the action of the brain, heart, or lungs. In order to be able to determine the cause of death, the medical examiner should be familiar with the symptoms of death as due to the three causes just mentioned, together with the post-mortem appearance accompanying them.
Symptoms and Post-mortem Appearances of Death from Diseases of the Brain, Heart, and Lungs.-The symptoms of death beginning at the brain, or coma, are stupor, insensibility to external impressions, loss of consciousness, slow, stertorous, irregular breathing; the respiration and circulation ceasing as the medulla becomes affected. The post-mortem appearances presented in the case of death beginning at the brain are effusion of blood into the cavities, due to apoplexy, rupture of the bloodvessels from fracture of the skull, embolism, abscess, congestion, and compression. Death beginning at the heart or syncope may be due to a deficiency in the quantity of the blood or anæmia; or in the quality or asthenia. Death from anæmia may be caused by rupture of an aneurism, or from a uterine hemorrhage, or from a division of a large vessel like the carotid artery. The symptoms of such conditions are paleness, lividity of lips, dimness of vision, vertigo, slow, fluttering, weak pulse, ringing in the ears, hallucination, with more or less delirium and nausea and
loss of brain power. On post-mortem examination the heart is usually found contracted and empty, especially if the latter is examined shortly after death.
Death due to the asthenic condition occurs in fatty degeneration of the heart, in exhaustive diseases of any kind, starvation, and in poisoning from prussic acid. The symptoms in such cases are cold hands and feet, lividity of lips, nose, and extremities, great muscular weakness, feeble pulse, senses and intelligence retained usually till the last. After death the heart is found contracted, or its cavities are dilated and flabby, and contain blood.
Death beginning at the lungs, or asphyxia, is caused by mechanical obstacles, such as foreign bodies in the airpassages. Respiration may be arrested by spasm of the glottis, due to nervous excitement, or by paralysis of the respiratory muscles. The symptoms of a person dying from asphyxia are lividity of the face, great dyspnoea, vertigo, loss of consciousness, and convulsions. In death from asphyxia the venous system and the right side of the heart and lungs are found filled with dark blood. The left side of the heart and the arterial system, if rigor mortis has set in, are, however, usually found empty.
Whatever may be the remote cause of death, the immediate cause is then to be looked for in the brain, heart, or lungs. A characteristic set of symptoms precedes death accompanied by characteristic post-mortem appearances in most cases.
The medical examiner should be able, therefore, to usually determine at the least the approximate cause of death. It sometimes happens, however, that notwithstanding that the symptoms are known, and that a most careful post-mortem examination has been made, the cause of death cannot be positively determined. Under such circumstances it may be supposed that there has been a