7, 8. Time of Death and Time of Autopsy. The day and hour of death and the time of autopsy should be noted. When the time of death is not known with certainty it can only approximately be estimated by the condition of the body with respect to such postmortem changes as rigor mortis, algor mortis, hypostasis, diffusion-spots, decomposition, etc. From no one of these signs of death can an absolute statement be made as to the time of death; so great a variation may occur with any one or with all of these so-called positive signs of death that only very relative estimates can be given. Between the actual time of death and the appearance of positive signs of this event there exists a variable period in which death announces its appearance by negative signs only; the cessation of the vital functions, respiration, circulation and nervous excitability. These functions may, however, be reduced to so low a degree of strength that their existence cannot be made out by the usual methods, and a condition of apparent death or “suspended animation” may be present. Such a condition is most frequently seen in cases of cholera, hysteria, catalepsy, hypnosis, excessive fatigue, prolonged exposure to cold or to high temperatures, concussion, severe hemorrhage, action of certain poisons, electrical currents and lightning stroke, strangulation, asphyxia, suffocation, drowning, etc. The condition of apparent death may last hours or even days, but as a rule it is one of very short duration. Granting the existence of such a possibility of apparent death before absolute signs of death appear, it follows that in all autopsies made very soon after death has occurred, the prosector must bear such a possibility in mind, and satisfy himself beyond all doubt of the actual occurrence of death before beginning the autopsy.
Tests for the Determination of the Occurrence of Death. Loss of reflexes or response to stimuli are early signs. Mirror, flame or feather held before the mouth and nose, or vessel containing fluid placed on epigastrium show absence of respiration. Opening of artery, temporal or radial; if death has occurred vessel will be empty. Tests with blood-pressure apparatus are negative in dead body. Electrical tests and Roentgengrams of heart and lungs show no movement in these organs. Subcutaneous injection of ammonia; no congestion or vesicle formed in the dead body. Subcutaneous injection of fluorescin (Icard’s test): in the living body a greenish color soon appears in skin, mucous membranes and conjunctivæ; but not in the dead body. Heat applied to the skin causes no reddening in the dead body, and, if a vesicle forms, the fluid contained in it has no albumin and the underlying skin is dry and glazed and not red. The application of caustics produces no eschar in the dead body. A steel needle inserted into the living tissues becomes quickly tarnished; in the dead body oxidation will not take place after many hours. Glazing of the eyes (if these are open) takes place very quickly after death; the eye-ball collapses ordinarily, but may remain prominent in death from hanging, suffocation, apoplexy, etc. The eye loses its elasticity; the pupils can be made oval by compressing the globe (Ripault’s test). The patch of dark discoloration on the part of the sclerotics exposed to evaporation is known as Larcher’s sign. The hands held against a strong light lose the pink tinge between the fingers, and the soles and palms become yellow. A tight ligature about a finger or limb causes no reddening (Magnus’s test). Relaxation of the sphincters occurs soon after death. It should be borne in mind in this connection that the discharge of gas and féces is not uncommon after death, that a fetus may be expelled by the increase of intra-abdominal pressure due to rigor mortis and gas-formation, that a discharge of semen or prostatic fluid almost always occurs in the adult male, that electric contractility may last several hours after death, that muscles may twitch during this period, and that atropine will dilate the pupils for some time postmortem.
9. Build. The body should be measured by stretching in a straight line a metal tape-measure from the vertex to the centre of the external arch of the instep, the foot being held at a right angle to the surface of the table. Giantism or dwarfism, partial or complete, asymmetrical development, etc., should be noted and the type determined (rachitic, cretinoid, congenital and acquired deformities of bones may cause dwarfism; giantism may be congenital or due to disease of the hypophysis as in acromegaly). In all cases of abnormal development of the skeleton the possibility of diseased conditions of the hypophysis, thyroid, thymus, adrenals and sexual glands must be borne in mind. In a general way the build of the body may be described as large, heavy, strong, medium, small, delicate, etc. Racial, sex and age differences should be noted. Roentgen-ray examination may here also be made use of in the determination of stages of skeletal development. Approximate estimates of the general build may be made when only part of the body is preserved. Such rules as nineteen times the length of the middle finger equals the approximate height, four times the length of the femur equals the height, the distance from the tip of the olecranon to the tip of the middle finger is five-nineteenths of the height, etc., are obviously very uncertain.
10. General Nutrition. The body should be weighed. Nutrition good, medium, poor, emaciated, etc. Condition of skin, muscles, panniculus, etc. Differentiate loss in fat from loss in muscle. Distinguish physiologic fat from pathologic (lipomatosis, etc.).
11. Head. The size and shape of the head should be noted, and any peculiarity or pathologic condition described (microcephalic, macrocephalic, dolichocephalic, brachycephalic, etc.).
12. Facies. Aside from individual and racial characteristics the face of the cadaver may show varying expressions (Hippocratic facies, hepatic facies, expression of peace, pain, horror, distortion, etc.). Note all anomalies and pathologic conditions (leontiasis ossea, leonine expression of leprosy, hare-lip, etc.).
13. Eyes. Closed or open, shape, size, color, deep-set, changes due to death, condition and size of pupils, arcus senilis, color of conjunctivæ and sclerotics, eye-lids. The pupils are usually dilated at death, but after a short time they contract, usually unequally, and remain so for several days. Note particularly all anomalies and pathologic conditions (corneal scars, coloboma, cataract, strabismus, etc.).
14. Neck. Short and thick, long and narrow, thin or fat, smooth or wrinkled, scars, enlargements, marks of rope, fingers, string, evidences of strangulation, hemorrhages, abrasions, etc., other forms of trauma, cysts, enlarged glands, condition of thyroid, etc.
15. Thorax. Shape, length, breadth and depth, angle of Louis, epigastric angle, symmetry of sides, prominence or depressions, pigeon-breast, shoemaker’s or funnel breast, rachitic rosary, character of ribs and interspaces, mammæ, degree of hairiness, eroding tumors or aneurisms, etc.
16. Abdomen. Depressed, scaphoid or elevated, distended, tympanitic, presence of fluctuation, symmetry, results of palpation (neoplasms), character of abdominal wall (tightly stretched or lax, wrinkled), presence of linea fusca or lineæ albicantes (pregnancy, ascites, tumor). The existence of enteroptosis or gastroptosis can often be told by inspection of the abdomen.