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tory murmur, and of the sounds of the heart, the softening of globular structures, hypostatic hyperæmia, and other postmortem changes, are among the most reliable signs that indicate that we are "in the presence of the dead."
Among the tests that may be, and in any doubtful case should be, employed, is the one resorted to in the case of the clergyman's daughter--opening an artery. If blood flows in jets and is of a bright color, life remains; if, however, it be patulous and empty, the life, of that region at least, has departed. About six hours after death cadaveric rigidity hardens the muscles and stiffens the joints, and after a variable period passes away. These conditions are subject to many variations as to time and degree. Taylor says (Jurisprudence): “I believe it may be safely said that there has not been a single instance of resuscitation after rigidity has once begun in a body." The complete and permanent dilatation of the pupil -if not caused by the action of atropine or other mydriatics, or following brain or spinal injuries—is strong presumptive evidences of death. Relying upon this sign alone, Dr. Jessop, of King's College, London, restored a child that was pulseless, without respiration, and with fallen jaw. He says, in connection with the case: "If a fully-dilated pupil be found in connection with the cessation of respiration and circulation, we may safely conclude that life is extinct." To any one who has closely watched the final actions of the dying, the sudden, sometimes almost lightning-like dilatation of the pupil appears the most pronounced change that occurs.
A mirror, or any other metallic substance with a smooth surface, and of low temperature, will condense the vapor of the breath if air continues to be expired.
A bright needle, or other instrument of steel, inserted into the body during life, soon becomes more or less tarnished by oxidation. If, however, life is extinct, the needle will retain its polish and brightness, even after a considerable interval. Pricking a part abounding in capillaries, as the lip or the tongue, is followed by the escape of at least a drop of blood if the circulation is still carried on. After death, however, no such flow will take place.
A ligature around the finger tight enough to compress the veins and not the arteries, which are deeper, will cause congestion, discoloration, and swelling in the living, but not in the dead. A bright, concentrated light sent through the normal hand of a living person, similar to the way in which light is used in the diagnosis of hydrocele, will develop a more or less pronounced pink hue, but in the hand of the dead, a pallid, dusky, grayish white. Dr. Larcher, of Paris, pointed out recently what he believed to be the most certain and earliest reliable sign of death. It consists in the presence of a blackish, at first not perceptible, spot on the sclerotic, which grows darker and darker. It is first seen on the outside of the pupil; then shows itself nearer and nearer the inner corner, draws closer to the centre of the organ, and at last unites and forms an elliptical segment on the lower convexity of the eye. This is said to signify the change from rigor mortis to putrefaction. "It is the sign of death, the herald of corruption."
The effect of electricity applied distinguishes a living from a dead body, to this extent, that the muscles respond in inverse ratio to the length of time intervening after death. No response to a strong current is strong presumptive evidence of death. In 1880, the case of a convict in Hungary who was resuscitated by the electro-galvanic current after he had been pronounced dead and cut down from the gallows, was officially reported. The superficial application of heat to the skin causes a blister to form alike in the living and the dead; but in the dead it is filled with air, in the living with serum, and is circled with a broad band of redness. As a rule the temperature of the dead body gradually falls from that peculiar to the disease which caused death, to the normal, and finally to that of the atmosphere. This, however, is not to be relied upon as a test, since there are exceptions. In malignant cholera, in cerebro-spinal meningitis and small-pox, an increase of temperature has been noticed some time after death, and a case is reported on excellent authority, wherein at the autopsy after the viscera had been exposed fully ten minutes, the thermometer placed under the left ventricle, indicated 113 degrees.
M. Bouchut in a prize essay wrote: "The absence of the sounds of the heart, listened for during more than one or two minutes, is an immediate and certain sign of death.”
A marked exception to this rule is related in Taylor's Jurisprudence, of a Col. Townsend, who possessed the astonishing power of a seeming voluntary death; i. e., he could suspend the action of the heart and lungs for half an hour. In the eye also important signs of death are to be found. The film over the eyeball, the dullness of the cornea and the collapse of the globe are usually signs of death, though they may precede it in Asiatic cholera, or be delayed some time after it in apoplexy, or some cases of poisoning. In the fundus of the eye, characteristic changes are to be seen with the ophthalmoscope, such as intense whiteness of the discs, and disappearances of the retinal arteries.
Some one of the tests enumerated may not, singly and separately, be conclusive proof; each one, however, is strengthened by the presence of any other, and when taken together they are sufficient to live by and die by, and when intelligently applied will prevent all premature burials. Physicians should decline to certify that all sudden deaths are due to heart disease or apoplexy, unless so proven by a necropsy or other conclusive evidence. They should positively refuse to allow a body to be placed on ice until the existence of death is determined beyond a doubt. No doubt the vital spark has been frozen out many an unfortunate one. They should decline to give an opinion as to actual or apparent death, unless allowed to apply as many of these tests as they may deem proper. The public should be taught the foolishness of refusing post-mortem examinations, and should be made to understand that in so refusing they criminally gratify their own. selfishness, and deprive the victim, if any life remains, of a means of resuscitation, for more than once the first cut of the scalpel has restored to consciousness a supposed corpse.
A RARE DISORDER, WITH AN ILLUSTRATIVE CASE.
By C. E. MILES, M. D., Boston Highlands, Mass.
What I have to say concerning convulsive tremor is necessarily limited, as its literature is meagre, and I have seen but one instance of the affection. Indeed, the most I can hope to do is to call the attention of others to the malady so that they may be better prepared to meet it if they have not already observed it, and to study with them its pathology, phenomena and treatment.
Dr. W. A. Hammond, in his Diseases of the Nervous System, sixth edition, p. 696, is the principal authority I have been able to consult on the subject. He says: "In the year 1822, Dr. Pritchard, under the name of Convulsive Tremor, gave an account of two cases, presenting somewhat similar features to the one before us," referring to the case he-Dr. Hammond — was then considering. He also mentions one or two others who have written very briefly on the subject.
May 18, 1882, I visited G. P., æt. 46, a German by birth; single; a short, spare man, and below the average intellect. He had "fits" in his infancy, and did not talk until his tenth year. He had worked in a rubber factory for nearly twentyfive years, except during an illness from abscess of the rectum, many years since, from the effect of which he had never fully recovered. The day before I saw him he had left his work on account of a severe headache and dizziness. He had some difficulty in walking home, a distance of half a mile, had eaten but little after his return, and slept poorly during the night.
I found him in bed, his right arm jactitating violently, and the tendons of the hands tremulous; the head was drawn to the right side and forward. At times the respiration was difficult, occasioned by paroxysmal spasms of the diaphragm. These attacks continued from five to ten minutes, and then there would be a few minutes of intermission, to be followed by another paroxysm. During these attacks he could neither speak or swallow, but was apparently conscious all the time,
and so affirmed when the paroxysms had ceased. The pulse was about 80 per minute, and the temperature seldom arose to 100° F.
These paroxysms continued to recur at intervals of from one to thirty hours for six days, when they ceased. On June 2, after the lapse of nine days, they set up again, and manifested themselves very much as in the first attack, for five days. They then recurred only once in two or three days, till June 29th, when six days elapsed before he had another paroxysm. Since that time there has been no return of the malady. Each paroxysm was followed by a profuse perspiration, great prostration and loss of appetite.
The only variation in the phenomena of the attacks was that in some of them both arms were alike convulsed, and in a few instances both legs as well as the arms were similarly affected, the tremor of the tendons of the feet at these times being as manifest as in the hands. The head was always drawn to the right, and in some of the last paroxysms there was marked opisthotonos. Headache and dizziness preceded, accompanied, and followed the attacks. The face was always deeply flushed during the paroxysms, and in two or three instances, when they continued for two or three hours with but a few minutes of intermission, the eyes became somewhat congested.
Hearty meals, mental excitement and constipation evidently tended to excite the paroxysms.
On examining my patient I was at a loss for a diagnosis. The phenomena were unique to me, except as it was obvious enough that I had to do with a disordered nervous system. It could not be epilepsy, for there was no loss of consciousness. Was it chorea? Certainly not; for the disease manifested itself in paroxysms, and the movements were rapid and tremulous, and were followed by perfect quiet. Nor could it be hysteria, for the spasms were clonic, and there was not anything in the clinical history of the case that pointed directly to the peculiar phenomena. The paroxysmal character of the attacks also differentiated it from the structural diseases of the cerebral and spinal tissues. My thoughts then reverted.