40. When wounds are situated over any of the great cavities, they ought not to be particularly examined until the cavity is laid open; and in laying open the cavity, the external incisions should be kept clear of the wounds.
41. When the discoloured state of a portion of the skin is such as to render it doubtful whether it is due to injury or to changes after death, an incision should be made to ascertain whether there is blood effused into the textures, constituting true ecchymosis, or merely gorging of the vessels of the skin, or discoloration from infiltration of the colouring matter of the blood, which takes place in depending parts of a dead body. The term suggillation should be avoided, as it has been used in opposite senses by Continental and British authors. The respective expressions, “discoloration from extravasated blood,” and “lividity after death,” are preferable.
VI. Examination in Cases
of Poisoning
42. In examining a body in a case of suspected poisoning, the inspectors should begin with the alimentary canal, first tying two ligatures round the gullet, above the cardiac orifice of the stomach, two round its pyloric end, and a third at the sigmoid flexure of the colon, then removing the stomach and entire intestines; next dissecting out the parts in the mouth, throat, neck, and chest in one mass; and, finally, dissecting the gullet, with the parts about the throat, from the other organs of the chest. The several portions of the alimentary canal may then be examined in succession.
43. Previous to commencing the dissection in cases of supposed poisoning, the inspectors should make such inquiries as may enable them to form an opinion as to the class of poison to which the death may be traceable, and thus to guide them as to the conclusions to be come to from the presence, or it may be the complete absence, of any marked appearance explaining the cause of death.
44. The medical inspectors may afford most important aid to the law officers in investigating the history of cases of supposed poisoning. For this purpose minute inquiry should be made into the symptoms during life their nature, their precise date, especially in relation to meals or the taking of any suspicious article, their progressive development, and the treatment pursued. It is impossible to be too cautious in collecting such information, and, in particular, great care must be taken to fix the precise date of the first invasion of the symptoms, and the hours of the previous meals. The same care is required in tracing the early history of the case, where the inspector happens to visit the individual before death; and if suspicions should not arise till his attendance has been going on for some time, he ought, subsequently to such suspicions, to review and correct the information gathered at first, especially as to dates. All facts thus obtained should be immediately committed to writing.
45. Besides inspecting the body and ascertaining the history of the case, the inspectors may afford valuable assistance to the law officers in searching for suspicious articles in the house of the deceased. These are—suspected articles of food, drink, or medicine; the vessels in which they have been prepared or afterwards contained; the family stores of the articles with which suspected food, &c., appears to have been made. All such articles must be secured, according to the [rules in Sect. 13], for preserving their identity. In this examination the body-clothes, bed-clothes, floor, and hearth should not be neglected, as they may present traces of vomited matter, acids spurted out or spilled, and the like.
46. When a medical man is called to a case during life, where poisoning is suspected, he ought as soon as possible to follow the instructions laid down for securing articles in which poison may have been administered.
47. In the same circumstances, it is his duty to observe the conduct of any suspected individual, were it for no other reason than to prevent the remains of poisoned articles from being put out of the way, and to protect his patient against further attempts.
48. The whole organs of the abdomen must be surveyed, and particularly the stomach and whole tract of the intestines, the liver, spleen, and kidneys, the bladder; and in the female, the uterus and its appendages. The intestines should in general be split up throughout their whole length; and it should be remembered that the most frequent seat of natural disease of their mucous membrane is in the neighbourhood of the ileo-cæcal valve, and that, next to the stomach, the parts most generally presenting appearances in cases of poisoning are the duodenum, upper part of jejunum, lower part of ileum, and rectum.