Pallium

“ The method then [477] of breaking them over again is not at all to be admitted, as it may occasion the utmost danger; but if the callus be newly formed, we must have recourse to the allusions of a relaxing nature, and to cataplasms, such as those from fat olives and pigeon’s dung, and the other medicines for dissolving callus; and we also dispel it by friction with the hand, and bending it every way. But if it be of a stony hardness, we make an incision of the skin with a scalpel, and separate the union of the bones with chisels, and then cure the fracture as formerly said. ”

“ When such softening is the result of postmortem autolysis or digestion, as is so often the case in the stomach (postmortem perforations) , thymus, pancreas, adrenals, brain, etc., the term postmortem softening is more frequently used in this country. Soft tumors are described as medullary, encephaloid, etc. In all judgments as to consistence the normal differences between the organs must be considered, as well as the length of time between death and the autopsy, the cause and manner of death, undertaker’s manipulations, temperature, moisture, rigor mortis, putrefaction, etc. ”

“ There may be complete paralysis of one side or of both sides of the body. Not only may the pressure of a blood-clot, an abscess, a foreign body (such as a bullet) or a depressed piece of the skull- wall give rise to coma, but so may a syphilitic, a malignant or an innocent tumour, and in cases in which the administration of iodide of potassium fails to afford relief, the operation of trephining may perhaps be resorted to, as giving the only chance of recovery. ”

“ In death caused by hanging or strangling there may be fracture of the hyoid bone, thyroid cartilage or tracheal rings, marks upon the skin, hæmorrhage, laceration of the intima of the arteries, fracture or dislocation of the cervical vertebræ and injury to the cord. In death from drowning the bronchi, lungs and stomach may contain fluid, there is watery fluid in the pleural cavities, maceration of skin, greater water-content in blood of right heart than of left, with consequent raising of freezing point. ”

“ In fourteen out of the thirty-five cases, in which an examination of the dead body took place, all the chief organs were found to be healthy, if we except the local congestions of blood connected with the mode of dying, and a flabby state of the heart in a few of the cases, which probably depended on its being full of blood at the time of death, or its not being in a state of post-mortem rigidity, at the time it was examined. ”

“ I carefully examined the spinal cord. The body was then in such a condition as to enable me to make a satisfactory examination of it; and if prior to death there had been any disease of a normal character on the spinal cord and marrow, I should have had no difficulty in detecting it. There was no disease. I discovered certain granules upon it. It is difficult to account for their origin, but they are frequently found in persons of advanced age. I never knew them to occasion sudden death. I agree entirely with the evidence which has been given by Dr. Harland. ”

“ The characteristic appearance in a necropsy of plague is that of engorgement and hæmorrhage, nearly every organ of the body participating more or less. There is also parenchymatous degeneration in most of the organs. ”

“ When I touched the glands in the groin, they felt like walnuts under the skin, and it is, as I said, the presence of this obvious symptom which gives the plague its characteristic name of “bubonic,” from the Greek word for groin. After incision, the patient’s temperature often goes down rapidly, but, in any case, the pain from the glands is usually very great; indeed, I think it is the chief cause of such pain as the plague gives.
Next to heart failure, the commonest cause of death is lung complication after the crisis of fever is passed. ”

“ The heart has invariably been filled with blood on the right side, and very often on the left side also. The liver has been congested, the kidneys and spleen generally healthy. The vessels of the stomach on the outer surface have been congested, and on the mucous or inner surface highly vascular. The vessels of the membranes of the spinal cord have been congested, and sometimes red points have been displayed on cutting it through.
From a post-mortem examination you may generally judge of the cause of death. I have in a great many cases experimented for the discovery of strychnia. ”

“ The organs may be inspected and opened in the body without removing them; but when weights and measures are desired they should be removed and sectioned on the table. When the spinal cord is removed posteriorly it should be done at the beginning of the autopsy, for the sake of convenience and cleanliness. If the thorax and abdomen are examined first there is a loss of solidity and resistance, making the posterior opening of the spinal canal more difficult. The head may be opened while the cadaver is face downward and the brain removed with cord attached. ”

“ Only rarely are evidences of arterial congestion seen in the cadaver. It is also necessary to observe the occurrence, location and extent of hypostasis and to differentiate antemortem and postmortem (lungs, brain, intestines, etc.) . The association with œdema and inflammation, particularly in the lungs (hypostatic pneumonia) speaks for antemortem hypostasis. A red color in parts possessing no blood-vessels (heart-valves, endocardium, intima of aorta, cartilage, etc.) ”

“ CHAPTER I. The complaint as to the scarcity of bodies for dissection is as old as the history of anatomy itself. Great respect for the body of the dead has characterised mankind in nearly all ages; post mortem dissection was looked upon as a great indignity by the relatives of the deceased, and every precaution was taken to prevent its occurrence.
It would be beyond the scope of the present work to attempt a history of anatomical teaching; as will be pointed out later on, the resurrection-men did not come into existence until the early part of the eighteenth century. ”

“ For example, a patient may be recovering from an operation such as the removal of an epithelioma of the mouth, pharynx or larynx and the associated lymph glands in the neck, and be able to be up and going about his room, when, suddenly, without warning and without obvious cause, a rush of blood occurs from the mouth or the incompletely healed wound in the neck, causing death within a few minutes. ”

“ The dead cortex and cambium stick to the wood beneath and contract as they dry. The living [241] cambium and cortex around them then begin to push in callus towards the centre of the necrotic area; but since this callus is formed under the pressure of the cortical tissues it does not form a thick lip or margin to the healing wound, as it does in a Canker, but insinuates itself with thinned-off edges between the wood and the dead tissue, or at most traps a little of the latter in the final closing up of the wound. ”

“ When these Wounds penetrate into the Substance of the Brain, or Marrow of the Back-Bone, or into the Heart, Pericardium, great Vessels, and other noble Parts, Death always inevitably follows, and often happens at the very Instant. ”

“ Panaritium or Paronychia, is a Tumour which generally ariseth in the Extremity of the Fingers, at the Root of the Nails: It is red, and accompany'd with very great Pain, even so exquisite, that the whole Arm is sensible thereof, insomuch that a Fever sometimes ensues, and a Gangrene; the Humour being contain'd between the Bone and the Periosteum, or that little Membrane with which it is immediately invested. ”

“ New growths which originate in the skeleton are spoken of as _primary tumours_; those which invade the bones, either by metastasis from other parts of the body or by spread from adjacent tissues, as _secondary_. A tumour of bone may grow from the cellular elements of the periosteum, the marrow, or the epiphysial cartilage. ”

“ It is probable that many of the cancer cells which are carried away in the blood or lymph stream undergo necrosis and fail to give rise to secondary growths. Secondary growths present a faithful reproduction of the structure of the primary tumour. Apart from the lymph glands, the chief seats of secondary growths are the liver, lungs, serous membranes, and bone marrow. ”

“ In more advanced cases, thin patches of lymph, or more extensive strata of it, cover the arachnoid and the inner surface of the dura mater; a puriform fluid is found effused between these membranes, and sometimes blood and matter are deposited in some part of the cerebral substance; bloody serum is effused into the cavities, and at the base of the brain. The above symptoms and appearances sometimes follow injuries not at first thought severe, but are most frequently the result of such as are attended with læsion of the bone, or of the internal parts. ”

“ By which (he saith) it is manifest, that solid bodies sufficiently great, have penetrated the Stomach, the Bowels, the Womb, the Caul, the lower Belly, the skin upon the inside of the Ribs, the Bladder, Membranes (he saith) impatient of so great a wound. That is to say, that Knives have been transmitted through these Membranes without wound, which is equivalent to the penetration of dimensions made in nature without the help of the Devil. And that an human body may be drawn through a small hole, through which a Cat might only pass, but not through a Wall. ”

“ Folds of flesh accumulated around the wrists, at the ankles, behind the knees, on the thighs, at the groins, on the lower abdomen.
Several times also I watched him while he slept. I looked at him for a long time, thinking and re-thinking of the means, made absent-minded by the inner vision of the little corpse in swaddling-clothes stretched in the coffin, amidst the wreaths of white chrysanthemums, between four lighted candles. He slept very peacefully; he lay on his back, his fist closed over his thumb. At times his moist lips made a movement as of sucking. ”

“ If required to make a post-mortem examination, every cavity and important organ of the body must be carefully and minutely examined, the seat of injury being inspected first.
V.—MODES OF SUDDEN DEATH
There are three modes in which death may occur: (1) Syncope; (2) asphyxia; (3) coma.
1. Syncope is death beginning at the heart—in other words, failure of circulation. It may arise from— (1) Anæmia, or deficiency of blood due to hæmorrhage, such as occurs in injuries, or from bleeding from the lungs, stomach, uterus, or other internal organs. ”

“ We operate upon them as upon scrofulous tumours, by incision, dissection, sutures, and the rest of the treatment, only avoiding to wound the membrane, lest its fluid contents be poured out and obstruct the operation, and lest a part of it should be left behind, which often occasions a renewal of the complaint at the wrists, ankles, and the moveable parts about joints, as a scrofulous tumour does in like manner, if the whole or a part of it be left behind. If any such thing be left it will be better not to sew up the wound, but to consume the remainder with septic applications. ”

“ In external necrosis, or death of the outer lamella, reparation is chiefly made by the subjacent parts; and this species of necrosis occurs most frequently in the flat bones. In necrosis involving a greater thickness of the bone, the new matter is also furnished by the subjacent parts, which, however, are materially assisted in the process by the living bone, which forms the margins of the void caused by the absorbent process for the detachment of the dead portion. ”

“ Partridge in the statement, that a flushed appearance of the countenance, and an emptiness of the heart, have been found in cases of sudden death, where no injury has been inflicted. In the course of my practice, I never found the heart empty after death. I do not think that any blow on the top of the head would present the appearances which were found on the back of the neck. Any violence applied to the back of the neck itself, however, whether considerable or not, might produce it. ”

“ The soft cellular tumours are composed mainly of spindle or round cells; they grow from the marrow of the spongy ends or from the periosteum of the long bones, the diploë of the skull, the pelvis, vertebræ, and jaws. As they grow they may cause little alteration in the contour of the bone, but they eat away its framework and replace it, so that the continuity of the bone is maintained only by tumour tissue, and pathological fracture is a frequent result. ”

“ The Panaritium is an Abcess which ariseth at the end of the Fingers; some of these Tumours are only superficial, and others penetrate even under the Periosteum; nevertheless after whatsoever manner the Panaritium may happen, it ought to be open'd on the side of the Finger, that the Tendons may not be hurt. If the Abcess be extended under the Periosteum, the opening must be made on the side, and the Lancet thrust forward to the Bone: Afterward the Pus or corrupt Matter is to be discharg'd, which wou'd cause the Tendons to putrifie, if it shou'd remain too long upon 'em. ”

“ Moreover, in both Diseases, when eminently malignant, Blood is sometimes voided by the Mouth, by Urine, or the like [94] . And we may farther add, that in both Death is usually caused by Mortifications in the Viscera. This has constantly been found in the Plague by the Physicians in France: and I am convinced, from Accounts I have by me, of the Dissection of a great many, who had died of the Small-Pox, that it is the same in that Distemper. ”

“ Sacks, filled with sand, are laid upon his feet and chest, which are so heavy that the poor boy can scarcely breathe beneath their weight. With one incision, with a common razor, the organs of generation of the unfortunate being are removed; hæmorrhage is arrested with melted butter, and the bark of a tree, beaten into fibre, is then laid as dressing on the wound, while a piece of lead, of the size of a quill, is inserted into the urethra, to keep that necessary passage open. ”