CHAPTER IV.

POST-MORTEM APPEARANCES IN DEATH FROM UNNATURAL CAUSES.

1. Death from Poisoning.

In speaking of the lesions produced by poisoning, we will confine our attention to the more common poisonous substances which are given, or taken, either intentionally or by accident, and which may result in death.

=Sulphuric Acid.= Death from poisoning with this acid, commonly results in from twelve hours to three days, but sometimes life is prolonged for a week or a fortnight, or for months, and sometimes death may take place in an hour.

The morbid appearances met with will vary according to the quantity of the acid taken, and the manner of its administration. The appearances are in general as follows:

On the lips, fingers, or other parts of the skin, spots and streaks of a brownish, or yellowish-brown color are met with, where the acid has disorganized the cuticle.

The mucous membrane of the tongue and fauces is white; the pharynx is only in the rarest cases carbonized like the stomach, is generally hard to cut, as if tanned, and of a gray color; the vascular injections of its mucous membrane may be recognized.

The rima glottidis is sometimes contracted, the epiglottis swelled, and the commencement of the larynx inflamed. The œsophageal membrane is often completely detached, or comes off in shreds; and the passage shows traces of the corroding effects of the poison.

The outer surface of the abdominal viscera is commonly either very vascular or livid.

The stomach, if not perforated, is commonly distended with gases, and contains a quantity of yellowish-brown or black matter, and is sometimes lined with a thick paste, composed of disorganized tissue, blood and mucus. The pylorus is contracted. If the acid has been taken diluted, the mucous membrane is merely excessively injected, with blackness of the vessels, and usually a softening of the rugæ, or actual removal of the villous coat.

If the stomach be perforated, the holes are commonly roundish, with thin, colored and disintegrated margins, and surrounded by vascularity and black extravasations. The inner coat of the duodenum often presents appearances closely resembling those noticed in the stomach. Sometimes, especially in cases which are rapidly fatal, it is not at all affected, probably owing to the spasmodic contraction of the pyloric orifice.

The urinary bladder is commonly empty.

The blood is thickened, and of an acid reaction.

=Nitric Acid.= The appearances observed in cases of poisoning by this acid, are similar to those noticed under sulphuric acid. A difference of tint in the color produced by nitric acid on the skin, lips and mucous lining of the mouth and œsophagus, being the only distinguishing mark. Whereas in the case of sulphuric acid the color is brownish, in the case of nitric acid, it is most frequently yellow.

=Oxalic Acid.= This is a poison of great energy, and so more frequently used for committing suicide than for purposes of murder. It has often been taken by accident for Epsom salt, (sulphate of magnesia,) which it greatly resembles in general appearance.

It is the most rapid and unerring of all the common poisons, and produces death generally within an hour, although a large dose may prove fatal in two or three minutes, and a smaller one may be survived for as long as twenty-three days.

The mucous membrane of the throat and œsophagus look as if scalded, and can easily be scraped off. The stomach contains a thick fluid, commonly dark, like coffee-grounds. The inner coat of the stomach is pulpy, in some points black, in others red.

The mucous membrane of the intestines is usually similarly, but less violently affected. In some cases, the stomach and intestines have been found healthy.

=Phosphorus.= This substance has frequently, in the form of heads of lucifer matches, been the cause of death; more frequently taken by accident, or with the intention of committing suicide, than with the design of destroying the lives of others.

The symptoms of phosphorus poisoning vary during life, and after death the morbid appearances are not constant, depending much upon the length of time that has elapsed before death.

In cases which have proved rapidly fatal, the main appearances are those of irritation, somewhat similar to those already described, and due to the direct action of the poison. In more protracted cases there is generally jaundice, the blood is found in a state of complete fluidity, non-coagulable, and with very few corpuscles, while ecchymoses and sanguineous effusions appear everywhere.

Sometimes the stomach is distended with gas, which stinks of garlic. The mucous membrane is partly ash-colored, partly of a dark, purplish-red, and exhibits gangrenous ulcers which penetrate deeply into the muscular coat. In recent cases, the whole contents of the stomach shine in the dark, especially when gently warmed.

The liver is greatly altered, an acute fatty degeneration is found to have taken place in its secreting structure. The acini are sometimes found filled with fat, even to bursting; but more commonly they are wholly destroyed, and oil and fat globules fill their place.

The secreting structures of the kidneys are also found in a state of fatty degeneration, and the ducts are sometimes filled with exudation matter. The heart and the muscles generally also show signs of the same fatty degeneration.

=Arsenic.= This is the poison most frequently chosen for the purpose of committing both suicide and murder.

Arsenic produces two classes of phenomena, one is purely irritant, by virtue of which it induces inflammation in the alimentary canal and elsewhere; and the other consists in a disorder of parts of organs remote from the seat of its application. It is absorbed by the blood, which in most cases of acute poisoning, is found in a remarkable state of fluidity, and can be detected in the liver, the spleen, and in the urine. It acts with nearly the same energy, whatever be the organ or tissue to which it is applied.

From two to three grains have proved fatal, but an instance is recorded of recovery after a dose of sixty grains. Death may ensue in half an hour, or may be delayed for nearly three weeks; the usual time is perhaps from twelve to forty-eight hours. There are some cases in which little or no morbid appearances are to be seen.

Usually, however, traces of irritation will be discoverable. In the mouth and throat they are often wanting. The inner surface of the stomach may be red and inflamed, or blackish from the extravasation of blood, or softened, or in some cases thickened, with the rugæ raised and corrugated. Ulceration of the coats of the stomach is but rarely met with, unless the patient have survived nearly two days. The mucous secretion is generally increased in quantity, sometimes thin, and viscid, as in its natural state, but sometimes solid, as if coagulated. In the latter case, it forms either a uniformly attached pedicle, or loose shreds floating among the contents.

A very common appearance, is the presence of a sanguinolent fluid, or even actual blood in the cavity of the stomach.

The poison itself may also be found within the stomach. The intestines may be congested and inflamed throughout their whole length, but most frequently only in the duodenum and rectum.

Within the chest, redness of the pleura, redness and congestion of the lungs, have been noticed.

In general, arsenic retards the process of putrefaction after death.

The forms in which arsenic is most frequently used for the purpose of poisoning, are arsenious acid, and the arsenite of copper, Scheele’s green.

=Corrosive Sublimate.= The appearances observed in the bodies of persons killed by this poison, are very similar to those excited by the irritant poisons already noticed.

The mouth and throat are more frequently affected than by arsenic. The tongue is often shrivelled, and the papillæ at its root greatly enlarged. The mucous membrane is swollen and whitened. The same appearances are generally noticed in the œsophagus. The coats of the stomach and intestines, more particularly the colon and rectum, have been found congested and inflamed, and sometimes destroyed, either by a chemical decomposition of the tissues, or by ulceration.

The bladder is often excessively contracted; the kidneys usually much congested and inflamed. Inflammation of the peritoneum, and effusion into its sac are frequent results of poisoning with corrosive sublimate.

=Hydrocyanic Acid.= The poisons whose energy depends upon the presence of this acid, surpass almost all others in rapidity of action, and the minuteness of the quantity in which they operate.

The lesions produced are uncertain. The spine and neck are stiff, the abdomen retracted, the skin usually livid.

The body, generally the blood, serous cavities, stomach and the various tissues usually exhale, for some time after death, the characteristic odor of the acid. Turgescence of the venous system, and emptiness of the arterial system, are commonly remarked throughout the body. The stomach and intestines are congested and red. The liver and lungs are gorged with blood.

=Strychnia—Nux vomica.= In poisoning with this substance, the rigidity of the body which exists during life, is frequently retained for hours after death. There is congestion of the membranes of the brain and spinal cord.

The stomach is frequently quite natural in appearance, as also the intestines, although occasionally signs of irritation are noticed in both.

=Alcohol.= In death from alcohol, the body is slow to putrify, and the internal organs exhale no cadaveric odor, but rather that of recent flesh, or in some cases a faint odor of brandy. The appearances constantly found are, hyperæmia of the brain, sometimes cerebral hæmorrhage; hyperæmia of the large abdominal veins, or hyperæmia of the lungs and heart, and always visible fluidity and dark color of the blood.

=Carbonic Oxide.= This is the poisonous ingredient of illuminating gas, and is generated by burning charcoal. It is usually in one of these forms that it is the cause of death.

The most characteristic appearance after death, is the bright cherry-red color of the heart. There is, also, hyperæmia of the lungs and of the right side of the heart.

=Opium.= In cases of death from this substance, lividity of the skin is usually present.

Turgescence of the vessels of the brain, and watery effusion into the ventricles are generally met with.

The lungs are sometimes found gorged with blood. The stomach is occasionally red, but decided inflammation is rare. The blood is always fluid, and the body is apt to pass rapidly into putrefaction.

2. Death from Suffocation.

By suffocation is meant that condition in which the system is prevented from receiving the necessary amount of oxygen through the lungs. The term is generally restricted to a condition arising from the obstruction of the air passages, either internally, or from without, or from the breathing of irrespirable gases. (The latter form being attended also by blood-poisoning, which we have already noticed.)

The appearances noticed are the following:

The face may be more or less bluish-red, swollen, with protruding eyes, or differing in no respect from that observed after other kinds of death. Froth is often observed coming out of the mouth.

There is a universal and unusual fluidity and dark color of the blood. Hyperæmia of the right side of the heart, while the left is either entirely empty or contains only a few drachms of blood, hyperæmia of the lungs and congestion of the pulmonary artery, are seldom wanting.

In the case of new-born children, Caspar has noticed capillary ecchymoses, resembling petechiæ, beneath the pulmonary pleura, upon the aorta, or the surface of the heart, and even upon the diaphragm, which gives the parts a spotted appearance.

The mucous membrane of the larynx and trachea are more or less injected, of a cinnabar-red, either in patches or uniformly over the whole surface. A deposit of soot upon the tracheal membrane, points to suffocation in smoke. There is usually present in the trachea a greater or less amount of fluid, consisting of a mixture of air, mucus, and blood, in the form of frothy vesicles, or colorless, or bloody foam. The more gradual the suffocation has been, the greater the quantity of this fluid. It may exist also in the bronchial tubes, and can be forced out by careful pressure on the lungs. Foreign bodies of every kind may be found in the trachea.

We find also as secondary results of the foregoing, hyperæmia of the abdominal and cranial organs.

3. Death from Hanging, Throttling and Strangling.

In these cases, death may result from simple cerebral congestion (apoplexy), from simple congestion of the thoracic organs (cardiac or pulmonary apoplexy), from a combination of the two (apoplexy and asphyxia), or, as is very frequently the case, from neuro-paralysis (nervous apoplexy).

The internal appearances will therefore vary, or, as in the last case, no lesions can be detected.

The face may in some cases be livid, with protruding eyes and tongue; but in many cases the countenance is like that of any other corpse.

Turgescence of the male and even of the female genitals has been noticed in some cases.

The mark of the cord about the neck may be wanting, and is nearly always more or less interrupted, and presents many varieties of appearance. It maybe of a dirty, yellowish-brown color, cutting hard and leathery; or of a bright blue or dirty-reddish color, soft to cut; or it may have little or no color, and also soft to cut. Patches of excoriation are also sometimes visible, if the cord have been hard and rough. A similar mark of the cord may be produced after death.

In cases of throttling, the marks of fingers may often be recognized, as round or semi-circular, or perfectly irregular patches, of a dirty, brownish-yellow color, hard to cut, and not ecchymosed. Rarely they are of a dirty-bluish color and ecchymosed.

4. Death from Drowning.

Physiologically considered, death from drowning is to be regarded as identical with death from asphyxia or strangling, and hence the results of the dissection, do not differ from those just mentioned. Those drowned may die from cerebral hyperæmia, the rarest form; from pulmonary hyperæmia; from both combined; or from neuro-paralysis. Death from hyperæmia of the thoracic organs, and death from paralysis, are of almost equal frequency in cases of drowning. The countenance is pale, in most cases not swollen, the eyes shut, and when asphyxia has been the cause of death, there is commonly froth over the mouth. If the body has been in the water for two or three days in summer, or eight to ten in winter, the face is rather reddish, or bluish-red—the commencement of putrefaction, which in bodies in water, begins in the head and extends from above downwards, and not in the abdominal coverings.

An almost constant appearance is the cutis anserina, a phenomenon entirely independent of the temperature of the water in which the person has been drowned.

The hands and feet have a livid, grayish-blue color, and the skin is corrugated in longitudinal folds, provided the body has not been taken out of the water within about eight hours after death. Sand, gravel, mud, etc., are often found under the finger-nails.

Contraction of the penis and scrotum in men who have fallen into the water alive, is an almost constant appearance.

The lungs are greatly increased in volume, completely fill and distend the cavity of the chest, and are not firm and crepitating like healthy lungs, but feel like sponge. The trachea and large bronchial tubes are frequently filled with frothy mucus. The spasmodic closure of the glottis, will prevent the entrance of water into the lungs while life continues, but after death it may enter in small quantities.

In the stomach is often found some of the fluid in which the drowning has taken place.