If the deceased be found in an apartment, whether it be in a house of ill-fame?—Although the act of sudden death in a brothel very naturally excites the suspicion that some act of violence may have been committed, yet this feeling should not be carried too far; we must remember that the individual has been thus exposed, in an increased degree, to the occurrence of several of those natural accidents by which life is so suddenly extinguished; apoplexy, hæmopthysis, and syncope have assailed those who might have been predisposed to such diseases, at the moment of sexual indulgence. In persons advanced in life the trunks of the internal, carotid, and basilary arteries are frequently diseased, and are therefore very liable to rupture whenever the blood is accumulated in any unusual quantity, or the circulation is preternaturally accelerated.
3. Circumstances to be learnt by the Interrogation of competent witnesses.
It is merely necessary to enumerate the facts which it is our duty to elicit by such an inquiry, in order to shew their importance and relations; we shall therefore conclude this part of our subject without any farther comments, and proceed to furnish such directions as may enable the medical witness to complete his investigation by the anatomical examination of the body, without which, our preceding researches can never be received as satisfactory and conclusive. “Inspectio ejusmodi cadaveris adeo necessaria est, ut omissa ea, nihil certi de reo statui possit.”[[21]]
4. Circumstances to be learnt by Anatomical Dissection.
After the observations which we have already offered upon the subject of wounds, it can be scarcely necessary to urge the necessity of a speedy examination of the more superficial lesions, which are likely to be effaced, or changed in character by the progress of decomposition; “putredo mutat formam cadaveris et lesionem.” The deeper wounds may at the same time be inspected, but the greatest care should be taken that they are not extended during the dissection, for unless they be preserved, as far as it is possible, in their natural condition, we shall not be able to establish a satisfactory connection between the external injury, and the internal lesions with which it may be complicated. Having complied with these injunctions, we are to proceed to lay open the cavities. The order in which these operations are to be performed is not of much moment; but let it be generally understood that the discovery of what may appear sufficient to account for death in one cavity, ought never to prevent our proceeding to the investigation of the rest.
Dissection of the brain and its membranes.—The body having been placed on its breast, and the chin raised and supported by a block of wood, the anatomist must proceed by making an incision over the top of the head, from the root of one ear to that of the other; and then by dissecting off the integuments, so as to invert one flap over the face, and the other over the occiput, he will be able to discover whether the scalp has sustained any injury, as indicated by the presence of abscesses, sinuses, contusions, and extravasations; he will, at the same time, ascertain whether any fissure or fracture exist, or any morbid change has occurred in the bone, such as sponginess, exostosis, caries, or exfoliation. In performing this part of his duty, we trust he will not mistake, as Hippocrates[[22]] confesses he once did, a fracture for a suture, and vice versa. It is not always easy, however, to determine whether a fracture discovered in the cranium, was produced during life. If it should have occurred immediately before the death of the person, there will be found coagulated blood upon the bone and in the fissures; if the individual has survived for some time, there will be marks of inflammation, and perhaps the formation of pus in contact with the skull; but if a fracture has been occasioned in making the dissection, an accident which may occur in the most careful hands, the blood in the fracture will not be coagulated, nor will there be any effusion around the portions. The skull-cap may be now removed; for which purpose the cranium is to be sawed in a circular direction, about a finger’s breadth above the superciliary ridges, and lateral sinuses; the operation must be conducted with great care, or we shall be in danger of wounding the dura mater; the bone must be then divided by a few slight strokes with the chissel and mallet. We shall always find a strong adhesion between the inside of the cranium, and the dura mater; partly, in consequence of the small blood-vessels with which these surfaces are connected, and partly, from the close application of the fibrous structure of the membrane to the bone, and which will vary with the age of the subject, and the form of the skull; the handle of the scalpel carefully introduced will afford the best instrument for overcoming this resistance, and will not be liable to lacerate the dura mater, or to injure the brain. In effecting the separation, the meningeal vessels frequently deluge the whole surface with blood, a circumstance that deserves attention, in as much as their plenitude marks the congestive state of the brain; it shews also that the blood is in a liquid condition, a fact to which some importance has been attached, as it is supposed to occur more particularly in cases of suffocation. The inner surface of the skull may be inspected with the view of ascertaining whether it be carious. The dura mater, thus brought into view, may exhibit marks of inflammation; or coagulated blood or pus may be discovered on its surface, especially in cases where external violence has been inflicted; and it is particularly worthy of notice that such an extravasation, or injury, is not necessarily under the fracture, or part of the cranium upon which the violence that produced it, had been received; on the contrary it often happens that disorganization occurs in the hemisphere opposite to that upon which the blow was struck; a phenomenon to which the term “contre coup” has been aptly applied.[[23]] The dura mater may now be removed and thrown back, by dividing it all round the margin of the skull, and separating its attachment to the crista galli with a pair of scissars; before we part, however, with this membrane, we should observe whether any osseous deposits,[[24]] or other morbid alterations are visible in its texture; for such changes are not uncommon in the dura mater, especially in the falx: the tunica arachnoidea thus brought into view may present various morbid appearances; it may be opaque, or water may be found effused under it.[[25]]. The pia mater often exhibits its veins turgid with blood, which indicates that some impediment had existed to the return of the circulation from the head to the heart. It is very important to distinguish between this appearance and that which is the result of the inflammation of the membrane; in this latter case, it should be remembered, that the small arterial branches are the vessels gorged with blood;[[26]] and which are so multiplied as to form, by their numerous anastomoses, a beautiful network. In true inflammation also the membrane will be found thickened. There is still another source of fallacy with which the anatomist may have to contend in his examination of this organ, a state of vascular congestion, arising after death, from the effect of gravitation. In attending however to the position of the head, and to the circumstances above mentioned, it will not be difficult to establish a just diagnosis upon these occasions. Before cutting into the brain, we should observe whether the convolutions are furrowed as usual, for when much fluid is contained in the ventricles, as in hydrocephalus, the sulci are more or less obliterated. Such a change, therefore, will offer a precaution to the anatomist, to proceed slowly in his dissection, so that the accumulated fluid may not escape. Where a person has been suddenly killed, while in a state of health, the ventricles will, on examination, appear merely lubricated with a fluid; but in cases where the patient has died after protracted disease, more or less serum will be found in these cavities. In our examination of the substance of the brain, we ought to notice its consistence and tenacity, for in many recorded cases, a part of the medullary mass has been found so morbidly soft as to have assumed nearly the consistence of custard; and it has been said to have occurred in cases of fatuity; it seems, however, more correct to consider it as the effects of inflammation: the phenomenon must be carefully distinguished from that natural deliquescence which the whole of the brain undergoes after death, when in an incipient stage of putrefaction. In some instances, the texture of the brain has been found tougher than is natural, and even to have been dry and friable. (See our observations upon the brain in cases of mania, vol. i, p. 327.) Scrophulous and encysted tumours, hydatids, abscesses, and extravasated blood, may also occur, and its cavities may be distended with fluid. The state of the larger blood-vessels should be attentively inspected, for in persons advanced in life there appears to be a strong disposition to disease in the internal carotid and basilary arteries. The great importance of minutely inspecting every part of the brain cannot be too frequently, or too forcibly urged, in cases of forensic inquiry. The instances already recorded (page [16]) are sufficient to sanction this assertion; and to these, we may add the following illustration which is to be found in the article Cas Rares of the Dictionnaire des Sciences Medicales, by M. Fournier, who was called upon for his opinion in a case of alleged murder at Brussels.[[27]] The deceased had quarrelled with another man, some blows had been interchanged, and he had died a fortnight afterwards, emaciated and completely exhausted. Two of the lowest order of practitioners in France, officiers de Santé, as they are called, inspected the body, and pronounced that death had taken place in consequence of the blows. M. Fournier discovered an extensive suppuration in the brain, with a very carious state of the inner surface of the cranium, and learnt that the deceased had been afflicted with head-aches for twenty years. He therefore declared it to be his opinion, that the man had died of a disease of long standing. In this opinion we concur, but it is not equally clear that the crisis was not accelerated by the violence which he had sustained.[[28]]
We ought not to quit the examination of the head, until we have examined the base of the cranium, in order to determine whether any fracture exists in that part; a curious case is related by Mr. Charles Bell,[[29]] of a person who died suddenly some weeks after having received an injury of the head, when it appeared, on dissection, that the base of the skull had been fractured, and that the foramen magnum having been thus roughened, a sudden turn of the head had forced a spiculum of bone into the spinal marrow. The brain has also received fatal injuries from the introduction of pointed instruments through the orbits; Macklin, the comedian, was tried for killing a brother actor by the thrust of his cane. Thomas Dangerfield, one of the celebrated and perjured witnesses on the Popish plot, in the reign of Charles II, was killed by Mr. Robert Francis, by the blow of a cane, the end of which penetrated the orbit.[[30]] The author also well remembers the case of an old woman, who, in a fit of intoxication, fell to the ground upon the stem of the tobacco-pipe with which she was smoking, when it penetrated the orbit, and occasioned immediate death; the cause of her dissolution was never suspected until after dissection, as no external wound was visible. In some cases it may be considered expedient to extend our anatomical researches into the spinal column, which may be effected by sawing off the transverse processes. The cervical vertebræ should always be examined where dislocation of the neck can be suspected; for in such cases death may be produced without leaving any external vestige of the injury. This has frequently occurred to coachmen and others, who have been crushed while driving under low archways, by which the nerves, necessary for the support of the vital organs have been compressed or lacerated, and death has in consequence ensued. If the cervical vertebræ should be dislocated, a general paralysis will follow, and life can no longer be maintained. M. Petit relates the case of a boy suspended by the head, who striving to disengage himself dropped down dead; and Dr. Monro saw a case where four of the cervical vertebræ were dislocated by a fall, which ended fatally in a few hours.
Dissection of the contents of the thorax.—An incision must be made through the integuments, in a straight line from the os hyoides to the navel; we are then to open into the cavity of the abdomen, for the sake of affording the anatomist free space for his dissections in the chest; and this is to be effected by incisions from the navel to each spine of the ilium, so that we shall have thus described by our dissection a figure resembling the letter Y inverted, thus
In cases where a violent effort has preceded death, violet-coloured spots containing venous blood may be perceived on the surface of the lungs, and which are true ecchymoses, occasioned by the rupture of some small vessels. Such phenomena must be carefully distinguished from the livid, black spots, which have been observed in cases of narcotic poisoning, and which are characterised by a more dense, and less crepitating texture. In this stage of the dissection, we may conveniently extend our examination into the trachea, and bronchiæ, and observe whether these tubes contain frothy mucus as in drowning; coagulated blood, as in pulmonary hemorrhage; pus, as in the event of the rupture of a vomica or impostume; or ropy and tenacious mucus or lymph, as in croup, tracheal inflammation, and bronchitis; or chyme, as may occur in cases of intoxication, and diseases of the brain, where vomiting has taken place during a state of insensibility.[[31]] We shall at the same time be enabled to ascertain whether any mechanical obstruction, from the presence of foreign bodies, exists in the pulmonary passages, and which might have occasioned death to the patient, as related under our history of suffocation, vol. ii, p. 57.