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sudden stoppage of the heart through reflex nervous inhibition, as occurs in persons who have drunk cold water when in an overheated condition, or as the result of some violent emotion. In such cases no post-mortem lesion of any kind may be found. It can only be said then that death may be supposed to have been due to some nervous influence. It is not worth while, however, for the medical examiner to guess or speculate about the cause of death. The most prudent course to pursue, in reply to any questions, is to admit that the cause of death cannot be stated.
Manner of making Post-mortem Examinations in Medico-legal CasesIdentification of the Dead-Coroner's Inquest-Conduct of the Medical Witness in Court.
Autopsies.-In cases of sudden death, or death from violence, or death under suspicious circumstances, the coroner views the body, and if not satisfied as to the cause of death, directs his physician to make a post-mortem examination, the extent and thoroughness of which will depend entirely upon his discretion. It is essential that the results of the examination should be recorded at once in a book kept for that purpose, the examiner not waiting until he reaches his home, trusting to his memory for the facts. Neither should the record of the post-mortem examination made in one book at the time be transferred later to another book, since the objection may be made that the two records are not the same. It is needless to add that the coroner's physician should have his name and address distinctly written in his note-book, so that in case it is lost, it may be advertised for, or the opportunity afforded for its return to its owner without delay.
Before recording the results of the post-mortem examination, the place, the year, the day of the month, and the hour of the day should be noted by the examiner. The deceased must then be identified from their own personal knowledge, and not from hearsay, by two witnesses who knew the individual upon whom the post-mortem is to be made.' The height of the deceased should then be
1 The medico-legal questions as to the importance of the corpus delicti of proving that a death took place are well considered in Wharton and Stillé: Medical Jurisprudence, 3 vols., fourth edition, Philadelphia, 1884, vol. iii. p. 613.
determined, the examiner being always provided for this purpose with a tape-measure. This may become an important part of the testimony in certain cases, like that of murder, since it may be claimed that the deceased being a taller man, and presumably heavier and stronger than the defendant, the murder was committed in selfdefence. The body of the deceased should, therefore, be weighed. In a properly-equipped morgue means are provided for this purpose. In their absence the weight of the body can at least be approximately estimated, and an idea can be obtained as to whether the deceased was strong, well-built, muscular, or weak, sickly, emaciated. The temperature of the body and surrounding atmosphere should be noted; that of the morgue would usually be constant; but if the post-mortem examination be made elsewhere in a bar-room, in a yard, or in a field-the temperature would be variable, according to circumstances, season of the year, etc. If the medical examiner be called upon to make an examination of a dead body in the place where it was first found, it is very important that all the surroundings should be most carefully and critically observed. If the dead body be found in a room, for example, its condition should be noted as to the position of the tables, chairs, china-whether the room was in order or confusion, the latter being probably the state in the case of there having been a struggle. The floor, walls, doors, windows, and furniture should be carefully examined for blood-stains or stains of any kind, foot-marks. The condition of the clothing of the deceased should be noted as to whether it was cut or torn, etc. Indeed, no fact of any kind that could directly or indirectly aid in determining the cause of death, or lead to the arrest and conviction of
the murderer, if murder has been committed, should fail to be recognized and recorded by the medical examiner.
A thorough examination having been made of the body externally, and the situation, extent, and nature of the external injuries having been noted, if any such be present, the body should next be examined internally. In making the internal examination it is best to begin with the head, except in cases of asphyxia, as in such cases if the head is opened first the blood is apt to run out of the right side of the heart. The scalp having been divided, and the two parts everted, the skull, after it has carefully been examined, should then be sawed through in such a manner that the calvaria can securely be replaced. The dura mater, having been inspected, should then be divided and the condition of the arachnoid and pia mater be observed. The brain before removal should be examined as to congestion of its vessels, laceration of its substance, extravasation of blood, etc. After removal of the brain the base of
1 Orth, Dr. Johannes: Compend of Diagnosis in Pathological Anatomy, with directions for making Post-mortem Examinations, translated by F. E. Shattuck, M. D., and G. K. Sabine, M. D., New York, 1878; Virchow, Professor Rudolph: Post-mortem Examinations with especial reference to Medico-legal Practice, translated by J. P. Smith, M. D., Philadelphia, 1880; Casper: op. cit., vol. i. p. 87.
2 The word calvarium, often used synonymously with calvaria, does not appear, so far as known to the writer, to have been made use of by Latin authors. The neuter plural calvaria was used, however-for example, by Ennius in his description of certain marine animals: “Polypus Corcyræ, Calvaria purgina acarnæ, Purpura, Muriculi, Murex, dulces quoque echini" (Enniaria Poesis Reliquiæ, Lipseæ, 1854, p. 167). The acarnæ mentioned by Ennius are probably the fish referred to under that name by Aristotle and Pliny-the Pagellus acharne of Cuvier. Apuleius also uses the word calvaria, not, apparently, in the same sense in which that word is used by Ennius as parts of the Acarne, but as if the calvaria were distinct animals, the latter being referred to as Marina calvaria" (L. Apuleii, Opera Omnia, Lipsex, 1842, pp. 520, 531).
the skull should be carefully examined for fractures. The condition of the brain should be noted as to its consistence, color, the existence of tumors, abscesses. The spinal column should next be opened through its whole extent, and the cord removed, and its condition noted. The thorax and abdomen should then be opened by making an incision extending from the root of the neck to the pubes, dividing the cartilages of the ribs, and the sterno-clavicular ligaments, and reflecting the sternum. The heart and lungs, larynx and trachea should be at once examined in situ, and after removal, parts of the organ being preserved. The stomach having been ligated at both the cardiac and pyloric orifices, each orifice being secured by two ligatures, should then be removed by cutting between the two ligatures at each orifice, and placed in a clean glass jar. The intestines should be removed and preserved in a similar manner, though separately from the stomach. The condition of the liver, spleen, pancreas, kidneys, and uro-genital apparatus should be noted and portions of the organs preserved for microscopic examination if necessary.
1 Woodman and Tidy: A Handy-Book of Forensic Medicine, etc., p. 11.