Infanticide. The points to be considered in determining the age and viability of the child are given in Chapter XIII. The most important causes of death in the new-born are also given in the same chapter.
Electric Shock. Burns of skin, “lightning figures,” signs of asphyxia, laceration of internal organs.
Burns and Scalds. Extent of burn more important than depth of the burn; death usually ensues if one-third of the surface is burned. Burns show scorching, singeing or marks of the hot object; scalds usually show some action of the hot fluid on the skin or mucous membranes. Demonstration of carbon-monoxide in blood of internal organs proves the inhalation of carbon monoxide. When exposed to intense heat the soft parts of the body show marked shrinking.
Heat or Cold. No characteristic lesions in death from these causes. Diagnosis must be made by exclusion and history of case.
Starvation. Marked disappearance of fat and atrophy of all organs, stomach and small intestines empty, marked emaciation, blood anæmic, concentrated when subject was deprived of water.
Violence. Wounds must be minutely described as to character, degree of laceration, contusion, extravasation, damage to tissues, direction of force, character of instrument, means and method of infliction, path of projectile or stab-wound, etc. Postmortem changes and injuries must be differentiated, as must be also antemortem and postmortem lesions, primary and secondary effects of the injury, effects of injury and pre-existing diseases. Intracranial hæmorrhages must be carefully differentiated with respect to causation by violence or disease. Effects of contrecoup must be borne in mind. The presence of other marks of trauma, the exclusion of disease, the location of the clot, the age of the clot, the age of the patient, etc., are some of the factors to be considered. In young people without alcoholic history or syphilis intracerebral hæmorrhages without signs of violence are rare. When associated with fractured skull they are usually regarded as due to the trauma.
CHAPTER XV.
THE RESTORATION OF THE BODY.
When the autopsy is finished the body-cavities are cleansed and then thoroughly dried. No blood, stomach- or intestinal-contents should be left in the cadaver. All bleeding or dripping parts should be tightly secured; the anus and vulva should be tightly stitched, and the penis ligated. If necessary, the organs are then cleansed and returned to the body, as nearly as possible to their normal positions, although the brain, because of the difficulty of getting it back into the skull-cap, is usually put into the thoracic cavity. When several autopsies are done at the same time, care should be taken not to mix the organs. The undertaker should always be aided in his work; and, if he so desires, an embalming powder or fluid may now be sprinkled or poured into the cavities.
The skull-cap must be securely fastened in its normal position, so that no slipping can occur. If the body is not to be shipped any distance the posterior interlocking joint will usually hold it firmly in place if the scalp is drawn tightly together and closely stitched. When the body is to be moved some distance, the skull-cap must be more firmly fastened. This can be accomplished by drilling holes at the sides of the saw-cut and fastening the skull-cap to the cranium by means of copper wire, which must be tightly twisted and pressed flat against the bone. When this is done in the temporal region the wire is completely concealed by the temporal muscles when these are drawn up with the scalp, or if these have been cut away pads of cotton can be put in their place. The cranial fossæ and the skull-cap may be filled with plaster-of-Paris; while this is still soft a piece of wood may be pushed through into the foramen magnum and allowed to project high enough above the saw-cut to hold the skull-cap on, when it, filled with plaster, is put in position. With the setting of the plaster the skull-cap is firmly held. A little ingenuity will suffice to improvise various other methods of securing the skull-cap, by the use of bandages, metal pins, etc. After the employment of Harke’s method the halves of the skull must be brought together and securely fastened at the base or in the occipital region. After resection of the temporal bone for the examination of the auditory apparatus the defect must be filled in with cotton or other substance, and the lower jaw and external ear restored to their normal positions. After examination of the orbit and the removal of the posterior half of the eye-ball a wad of red- or black-stained cotton should be used to fill out the eye so that it will have the same degree of fullness that the other eye has. When the eye is enucleated a glass-eye may be substituted and the lids fastened together by fine stitches made on the conjunctival side. If it is desired to save the skull-cap an artificial skull-cap may be molded from a square piece of pulp-board of the thickness of 0.5 cm. in the case of the adult, somewhat thinner for children. The pasteboard is soaked in warm water for about fifteen minutes, and is then molded over the skull-cap. It is then cut parallel with the edges of the saw-cuts so that the edge of the board will extend about 1 to 1.5 centimetres over the edges of the skull-cap to overlap the bones below the saw-cut. The cranial cavity is then filled with plaster or cotton. The pasteboard is removed from the skull-cap before it becomes too dry for its lower edge to be adapted easily to the lower border of the saw-cut. Ridges or folds are trimmed off with the knife and the surface made smooth. It is then adjusted and firmly fastened in position by passing several turns of strong twine around the lower border over-lapping the cranial bones. The temporal muscles and the scalp-flaps are then drawn up and tightly stitched. A close base-ball stitch should be used to fasten the scalp-flaps, and a black thread should be used. If the scalp has been stretched so that it is loose and baggy, a portion of it may be cut out, so that when sewed together the flaps will fit tightly. The hair must be freed from all bone-dust and blood-clots, washed if necessary, then dried, and arranged in its former position in such a manner as to hide the sutures.
The place of any bone that has been removed may be filled by a piece of wood cut to the required proportions, and securely fastened by wire or bolts, or plaster-of-Paris may be poured about it and allowed to set. After removal of the spinal column or of portions of it, there may be substituted a block of wood or an iron pipe of suitable size, which may either be securely fastened above and below by means of wire or bolts, or it may be held in place by imbedding it in plaster-of-Paris. These expedients are not necessary after the removal of the cord alone, but only when entire sections of the spinal column are removed. When the cord is removed posteriorly the skin-incision is tightly closed with a base-ball stitch, and then covered with a strip of surgeon’s plaster or collodion to prevent leakage of blood and serum after the body is turned over.