post-mortem appearances

231 Pages·2012·4.84 MB·English

POST-MORTEM APPEARANCES
NLVS/IVRI
Illl'l
Iml IIII II IIIIII 11\11\
06058
PRINTBD IN GREAT BRITAIN BY MORRISON AND GIBE LTD., IIDINBURGH
PREFACE
DR. JOAN Ross's book is designed to fill a, ga,p, which ha,s
long been obvious, in text· books of Pa,thology. In III
concise form, it describes the chief ana-tomicM cha,nge$
found in the commoner diseases, information which
hitherto has only been obta-inable by long practical
experience, or by extensive reading. The general practi··
tioner, who may be called upon to make an occasional
autopsy, will find it a use.ful guide as to what he should.
look for. And the student who habitually consults it in
the post·mortem room will be able to tell, with the leasj,
lI~hl~ h(l.ublce., 'IIhcetheJ: the '<2£e. befNce. hi.m ('.(l.n{(l.nn~
to type, or hoW' it is abnormal. The author has had can·
siderable experience in post-mortem work, and, since she
writes with a first:hand knowledge of the material, sho
has been able to select for emphasis the important changes
and ignore trivial or adventitious ones. My experience
as a teacher makes me sure that practitioners and studentfil
will find the book of value.
E. H. KETTLE.
v
CONTENTS
SECTION PAGE
GENERAL REMARKS
I. DEATH FROM CAUSES OTHER THAN DISEASE 17
II. GENERAL METABOLIC DISEASES 47
III. GENERAL INFECTIONS 54
IV. DISEASES OF THE DIGESTIVE SYSTEM 100
V. DISEASES OF THE KIDNEYS US
VI. DISEASES OF THE RESpmATORY SYSTEM. 127
VII. DISEASES OF THE DUCTLESS GLANDS 146
VIII. DISEASES OF THE ,BLOOD AND BLOOD-FORMING
ORGANS 153
IX. DISEASES OF THE CARDIO-VASCULAR SYSTEM 162
X. DISEASES OF THE NERVOUS SYSTEM 183
APPENDIX
I. ANATOMICAL NORMALS (AVERAGES) 199
II. LENGTH AND WEIGHT OF F<ETUS • 203
III. APPROXIMATE WEIGHT OF ORGANS OF NEWBORN
CHILD 204
IV. DATES OF OSSIFICATION OF PRINCIPAL BONES 204
V. AGES OF ERUPTION OF TEETH 206
INDEX. 207
POST-MORTEM APPEARANCES
GENERAL REMARKS
BEFORE dealing with any particular disease, it is con
venient to consider the subject of death in general, and to
point out certain broad principles which may be of help
in predicting what we should expect to find occurring
under various circumstances.
In the first place, it must be recognised that death from
any contributory cause will always fall under one of three
headings-namely, asphyxia, syncope, or coma. In other
words, life depends on the integrity of function of three
systems of the body-the respiratory, the circulatory, and
the nervous. Death will therefore occur primarily from
failure of one of the three. Thus, if the blood is, for any
reason, insufficiently oxygenated in the lungs, the vaso
motor centres are irritated, the heart's action is hindered,
and death takes place from asphyxia, no matter whetlier
the fault lies in the parenchyma of the lungs, in the sur
rounding air, or elsewhere. Again, if the heart from any
cause is unable to pump the blood effectively through the
lungs and brain, the cardiac and respiratory centres in
the medulla will ultimately suffer, and death will take
place from syncope. If, on the other hand, a hromorrhage
or some other cause throws the medulla directly out of
action, the heart and lungs together cease to function
through lack of nerve impulses, and death may be said
2 POST-MORTEM APPEARANCES
to take place in coma. This last group is, however,
somewhat unnecessary, since the final cause of death is
always the cessation of the heart or of the respiratioJ?.
POST-MORTEM APPEARANCES
In Death from Asphyxia
External Appearances.-There is no characteristic
appearance, but in a number of cases the face and neck
may be cyanosed. Small extravasations of blood beneath
the conjunctiva and on the lower lids may sometimes be
seen.
Internal Appearances. - Circulatory System. -The
blood is fluid and very dark in colour owing to its being
chemic-ally almost completely reduced. There is great
venous engorgement, most marked in the venal caVal,
the veins of the neck, and the pulmonary artery. The
right side of the heart is found dilated and full of blood,
while the left is usually contracted and almost empty.
As in some other conditions, ecchymoses on the surface
of the heart may be found.
Respiratory System.-The lungs are congested, and
there is often evidence of pulmonary disease. The
mucous membrane of the trachea and epiglottis is usually
injected. Subpleural ecchymoses are common.
Other Syslems.-The stomach, liver, and kidneys often
appear hyperallJlic. Occasionally, a curious bluish dis
coloration, with a sharply defined lower border, is seen
in the pharynx.
In Death from Syncope
External Appearances.-The surface of the body is
pallid, and in this respect presents no unusual features.
GENERAL REMARKS 3
Internal Appearances.-Girculatory System.-The stato
of the heart has received most attention in descriptions
of this condition. Thc heart is usually found con
tracted and empty, hut occasionally, when death was
w
supposed to have been due paralysis of the heart, both
sides have been found to contain blood. The condition
of thc heart probably depends on the time which has
elapsed before the post-mortem was performed, since it
has been shown that death never takes place with the
heart in systole. The contraction of one or both chambers,
which is so often found, is in reality due to a condition of
rigor mortis in the cardiac muscles, which comes on after
death and subsequently passes off again.
There may be an appearance of anrnmia of the internal
organs, or signs of severe hrnlliorrhage, internal or external,
may be found.
In Death In Coma
Here the appearances vary. In some cases a gross
brain lesion, hrnmorrhage or thrombosis, may be found
sufficient to account for death. In other cases, such as
the action of various toxins, very little may be seen
beyond possible hyperrnmia of the brain and meninges.
The other findings resemble those in death from asphyxia,
but are not constant.
Signs of Death
It may not be amiss to deal here briefly with the so
called" Signs of death," since all or some of them will be
present in every case. They are as follows:
Cessation of Respiration and Circulation. - The
normal translucent red appearance, seen in a living person,
POST-MORTEM APPEARANCES
on examining the web of the fingers in front of a light,
gives place at death to a general opacity. No swelling
is produced at the end of a finger by tying a ligature
tightly round it. A mirror, held before the mouth, is
not dimmed if death has taken place.
Condition of the Eyes.-The pupils dilate at the time
of death and SUbsequently contract (from one to forty
eight hours after). After ten or twelve hours the eyeballs
begin to look sunken and to soften. The cornea becomes
hazy and can be dented easily by the finger nail.
Post-Mortem Cooling.-From fifteen to twenty hours
is the usual time taken for the temperature of a body to
fall to that of the surrounding atmosphere. This time, of
course, can be greatly modified by circumstances, such as
the amount of body fat present and the nature of the
medium in which the body lies. Again, in some cases of
death from small-pox, cholcra, ycllow fever, acute rheu
matism, and certain injuries to the central nervous
system, a post-mortem rise of temperature has been
observed.
Post-Mortem Stains (syn., Cadaveric Hypostases,
Cadaveric Ecchymoses, Post-Mortem Lividities, Sugilla
tions).-These begin to appear on the most dependent
parts of the body (in the ease of a body lying on its back,
the buttocks, the lumbar region, the posterior parts of
the arms and legs, the shoulders, and the lobes of the
ears) from four to twelve hours after death. The staining
is most marked in asphyxia and in certain acute infectivO')
conditions.
Rigor Mortis. -Ordinarily the muscles begin to show
signs of stiffening in from four to ten hours after death.
Rigor mortis begins in the muscles of the jaw and reaches
the limbs last. It usually laSts from twenty-four to
forty-eight hours. The sooner it appears, the sooner it
GENERAL REMARKS 5
will disappear. Cadaveric spasm (instantaneous rigor)
may occur in exceptional circumstances, such as sudden
death in battle or in death by drowning.
Putrefaction.-This has been stated to be the only
certain sign that death has taken place. The first sign
-a greenish discoloration of the abdominal wall-usually
appears on the second or third day. External conditions
of temperature and moisture may modify the course of
putrefaction considerably. Discoloration of the abdomen
appears very early in cases of suppurative peritonitis.
NOTES ON METHOD OF PERFORMING A
POST-MORTEM EXAMINATION
It is now proposed to describe briefly the main points
of a post. mortem examination. The procedures here
mentioned can always be modified as dictated by the
circumstances of any particular casc, and it will be found
that, in practice, where a reliable clinical history is obtain
able, this affords a valuable assistance in most cases by
indicating the special points to which attention should be
directed. It must be clearly understood, however, that
even though the history may point to an involvement of
one system only, in all cases a thorough examination of
the whole body must be carried out, since it is only thus
that it is possible to reach an honest pronouncement as
to the cause of death.
Tools and Apparatus required for the performance of
a post. mortem :-
Short knife with broad blade (post-mortem knifc).
Cartilage knife.
Long knife with 7·inch blade (brain knife).
Long scissors with blunt ends and one blade longer
than the other (intestinal scissors).
Surgical scissors, blunt and sharp pointed.
Scalpel and dissecting forceps.
Grooved director and probe.
Bone forceps and rugine.
Small butcher's saw.
Chisel and mallet.
Scales and weights.
Measuring cylinders.
Tape measure.
Metal catheter.
Bottles with wide mouths and glass stoppers.
Bacteriological requisites for taking smears and
cultures.
Fixing solution, for preserving specimens.
Needles, thread, sponges, and tow.
Gloves, overall, notebook, and pencil.
External Examination of the Body
The body should be examined in daylight and attention
directed to the following points:
Apparent age, sex, height, general nutrition.
Presence of discoloration or pigmentation, <:edema,
or subcutaneous emphysema.
Presence of any external wound or other sign of
violence (together with powder marks or
burns).
Presence of any deformity.
Presence of hernia.
Condition of eyes, nos(', mouth, ears, urinary
meatus, anus, ul1\bilicus, vagina, and hymen.
Presence of any or all of the "signs of 'death"
(p.3).