EXTERNAL EXAMINATION.
Its minuteness will depend on the character of the case, as when the person is unknown, or when suspected to have died from unnatural causes. In such cases the external examination is very important.
The following are the steps to be followed:
(1) Give a general description of the body; apparent age, height, and weight of the individual; color of the hair and eyes; condition of the teeth; and the evidence of any personal peculiarities or abnormalities.
(2) Note the color of the skin and observe whether there are any spots of CADAVERIC LIVIDITY, and if present where situated.
(3) Contusions.—Note whether there are any contusions, and, if present, their character, situation, length, breadth, and depth should be described, and whether they are accompanied by inflammation or by the evidences of gangrene.
It is often important to determine whether a contusion has been inflicted before or after death. This is to be done by cutting into the ecchymoses and if the extravasated blood or the coloring matter of the blood is found free in the tissues, one can be almost certain that it is an ante-mortem injury. In post-mortem discolorations the blood is found in the congested vessels. The situation of ante-mortem contusions will not generally correspond to the discolorations produced by decomposition; the latter being confined to the most dependent parts. It should be remembered that the contusions produced by blows on a body dead only a few hours cannot be distinguished from those which were received during life; and also that putrefactive changes make it well-nigh impossible to distinguish between ante-mortem and post-mortem injuries. It should also be borne in mind that blows or falls sufficient to fracture bones or rupture organs may leave no mark on the skin (see Wounds, Vol. I., pp. 467, 474, et seq.).
(4) Wounds.—The situation, depth, extent, and direction of any wound should be recorded, as also the condition of its edges; the changes in the surrounding tissues, and whether inflicted by a cutting, pointed, or rounded instrument; or by a bullet. In the latter case the course and direction of the ball should be ascertained by dissection rather than by the use of the probe, and the character of foreign bodies, if any are found in the wound, should be noted. What nerves or blood-vessels, particularly arteries, have been injured, should be ascertained. It is often important to determine whether a wound was made before or after death. The following may serve as a differential point: In all wounds made after death there is slight bleeding, non-contraction of the edges, and absence of blood in the tissues. This is the opposite of ante-mortem wounds. Again, wounds inflicted within two hours after death cannot be differentiated from those made during life (see Gunshot Wounds, Vol. I., p. 610 et seq.; Wounds, Vol. I., p. 476 et seq.).
(5) Fractures.—If there are any evidences of fractures, the situation of the bones involved should be noted, and whether they are accompanied by contusions of the soft parts. Fractures which are inflicted during life are always accompanied by much more extravasation of blood, more injury to the soft parts, and more evidences of reaction than those occurring after death. It is a well-known fact that it is much more difficult to produce a fracture in a dead than a living body (see Wounds, Vol. II., p. 482 et seq.).
(6) The temperature of the body should be taken.
(7) The rigidity and flexibility of the extremities should be ascertained.
(8) The state of the eyes should be noticed, and the relative size of the pupils.
(9) Attention should be paid to the condition of the cavities of the mouth and nose. The neck should be specially examined for marks of external injury, or signs of ecchymosis or compression.
(10) Genitals.—The external genitals should be very carefully examined for evidence of injury, the presence of syphilitic lesions, and in the female the condition of the vagina should be particularly ascertained.
(11) Œdema of the Feet.—If there is evidence of œdema in any part of the body, especially about the ankles, its situation and extent should be noted.
(12) Ulcers and Abscesses.—The situation and extent of any ulcer found on the body should be recorded, as also the presence and situation of any abscess.
(13) Burns.—The extent of a burn, as also the state of the parts involved, should be noted. For example, whether they are inflamed or show blisters, etc. (see Heat and Cold, Vol. I., p. 647 et seq.).
(14) Hands.—In medico-legal cases the hands of a dead person should always be examined for the presence of cuts, excoriations, or foreign substances found upon them; especially should the dorsal extremities be examined. This examination will often indicate that there has been a mortal struggle before death. The impression of a hand or of some of the fingers is often found on the skin of a dead body. The exact situation where found should be noted. This may be of importance, as when it occurs where it would have been impossible or improbable for the deceased to have caused it.
For appearances in death from lightning or electricity, see Vol. I., p. 701 et seq., and in death from hanging, strangulation, and garroting, see Vol. I., pp. 713, 746, 781, et seq.