Postmortem Anomalies.--Among the older writers startling movements of a corpse have given rise to much discussion, and possibly often led to suspicion of premature burial. Bartholinus describes motion in a cadaver. Barlow says that movements were noticed after death in the victims of Asiatic cholera. The bodies were cold and expressions were death-like, but there were movements simulating natural life. The most common was flexion of the right leg, which would also be drawn up toward the body and resting on the left leg. In some cases the hand was moved, and in one or two instances a substance was grasped as if by reflex action. Some observers have stated that reflex movements of the face were quite noticeable. These movements continued sometimes for upward of an hour, occurring mostly in muscular subjects who died very suddenly, and in whom the muscular irritability or nervous stimulus or both had not become exhausted at the moment of dissolution. Richardson doubts the existence of postmortem movements of respiration.

Snow is accredited with having seen a girl in Soho who, dying of scarlet fever, turned dark at the moment of death, but in a few hours presented such a life-line appearance and color as to almost denote the return of life. The center of the cheeks became colored in a natural fashion, and the rest of the body resumed the natural flesh color. The parents refused to believe that death had ensued. Richardson remarks that he had seen two similar cases, and states that he believes the change is due to oxidation of the blood surcharged with carbon dioxid.

The moist tissues suffuse carbonized blood, and there occurs an osmotic interchange between the carbon dioxid and the oxygen of the air resulting in an oxygenation of the blood, and modification of the color from dark venous to arterial red.

A peculiar postmortem anomaly is erection of the p.e.n.i.s. The Ephemerides and Morgagni discuss postmortem erection, and Guyon mentions that on one occasion he saw 14 negroes hanged, and states that at the moment of suspension erection of the p.e.n.i.s occurred in each; in nine of these blacks traces of this erectile state were perceived an hour after death.

Cadaveric perspiration has been observed and described by several authors, and Paullini has stated that he has seen tears flow from the eyes of a corpse.

The r.e.t.a.r.dation of putrefaction of the body after death sometimes presents interesting changes. Petrifaction or mummification of the body are quite well known, and not being in the province of this work, will be referred to collateral books on this subject; but sometimes an unaccountable preservation takes place. In a tomb recently opened at Canterbury Cathedral, a for the purpose of discovering what Archbishop's body it contained, the corpse was of an extremely offensive and sickening odor, unmistakably that of putrefaction. The body was that of Hubert Walter, who died in 1204 A.D., and the decomposition had been r.e.t.a.r.ded, and was actually still in progress, several hundred years after burial.

r.e.t.a.r.dation of the putrefactive process has been noticed in bodies some years under water. Konig of Hermannstadt mentions a man who, forty years previous to the time of report, had fallen under the waters of Echoschacht, and who was found in a complete state of preservation.

Postmortem Growth of Hair and Nails.--The hair and beard may grow after death, and even change color. Bartholinus recalls a case of a man who had short, black hair and beard at the time of interment, but who, some time after death, was found to possess long and yellowish hair.

Aristotle discusses postmortem growth of the hair, and Garma.n.u.s cites an instance in which the beard and hair were cut several times from the cadaver. We occasionally see evidences of this in the dissecting-rooms.

Caldwell mentions a body buried four years, the hair from which protruded at the points where the joints of the coffin had given away.

The hair of the head measured 18 inches, that of the beard eight inches, and that on the breast from four to six inches. Rosse of Washington mentions an instance in which after burial the hair turned from dark brown to red, and also cites a case in a Washington cemetery of a girl, twelve or thirteen years old, who when exhumed was found to have a new growth of hair all over her body. The Ephemerides contains an account of hair suddenly turning gray after death.

Nails sometimes grow several inches after death, and there is on record the account of an idiot who had an idiosyncrasy for long nails, and after death the nails were found to have grown to such an extent that they curled up under the palms and soles.

The untoward effects of the emotions on the vital functions are quite well exemplified in medical literature. There is an abundance of cases reported in which joy, fear, pride, and grief have produced a fatal issue. In history we have the old story of the Lacedemonian woman who for some time had believed her son was dead, and who from the sudden joy occasioned by seeing him alive, herself fell lifeless. There is a similar instance in Roman history. Aristotle, Pliny, Livy, Cicero, and others cite instances of death from sudden or excessive joy. Fouquet died of excessive joy on being released from prison. A niece of the celebrated Leibnitz immediately fell dead on seeing a casket of gold left to her by her deceased uncle.

Galen mentions death from joy, and in comment upon it he says that the emotion of joy is much more dangerous than that of anger. In discussing this subject, Haller says that the blood is probably sent with such violence to the brain as to cause apoplexy. There is one case on record in which after a death from sudden joy the pericardium was found full of blood. The Ephemerides, Marcellus Donatus, Martini, and Struthius all mention death from joy.

Death from violent laughter has been recorded, but in this instance it is very probable that death was not due to the emotion itself, but to the extreme convulsion and exertion used in the laughter. The Ephemerides mentions a death from laughter, and also describes the death of a pregnant woman from violent mirth. Roy, Swinger, and Camerarius have recorded instances of death from laughter. Strange as it may seem, Saint-Foix says that the Moravian brothers, a sect of Anabaptists having great horror of bloodshed, executed their condemned brethren by tickling them to death.

Powerfully depressing emotions, which are called by Kant "asthenic,"

such as great and sudden sorrow, grief, or fright, have a p.r.o.nounced effect on the vital functions, at times even causing death. Throughout literature and history we have examples of this anomaly. In Shakespeare's "Pericles," Thaisa, the daughter to Simonides and wife of Pericles, frightened when pregnant by a threatened shipwreck, dies in premature childbirth.

In Scott's "Guy Mannering," Mrs. Bertram, on suddenly learning of the death of her little boy, is thrown into premature labor, followed by death. Various theories are advanced in explanation of this anomaly. A very plausible one is, that the cardiac palsy is caused by energetic and persistent excitement of the inhibitory cardiac nerves. Strand is accredited with saying that agony of the mind produces rupture of the heart. It is quite common to hear the expression, "Died of a broken heart;" and, strange to say, in some cases postmortem examination has proved the actual truth of the saying. Bartholinus, Fabricius Hilda.n.u.s, Pliny, Rhodius, Schenck, Marcellus Donatus, Riedlin, and Garengeot speak of death from fright and fear, and the Ephemerides describes a death the direct cause of which was intense shame. Deleau, a celebrated doctor of Paris, while embracing his favorite daughter, who was in the last throes of consumption, was so overcome by intense grief that he fell over her corpse and died, and both were buried together.

The fear of child-birth has been frequently cited as a cause of death McClintock quotes a case from Travers of a young lady, happily married; who entertained a fear of death in child-birth; although she had been safely delivered, she suddenly and without apparent cause died in six hours. Every region of the body was examined with minutest care by an eminent physician, but no signs indicative of the cause of death were found. Mordret cites a similar instance of death from fear of labor.

Morgagni mentions a woman who died from the disappointment of bearing a girl baby when she was extremely desirous of a boy.

The following case, quoted from Lauder Brunton, shows the extent of shock which may be produced by fear: Many years ago a janitor of a college had rendered himself obnoxious to the students, and they determined to punish him. Accordingly they prepared a block and an axe, which they conveyed to a lonely place, and having appropriately dressed themselves, some of them prepared to act as judges, and sent others of their company to bring him before them. He first affected to treat the whole affair as a joke, but was solemnly a.s.sured by the students that they meant it in real earnest. He was told to prepare for immediate death. The trembling janitor looked all around in the vain hope of seeing some indication that nothing was really meant, but stern looks met him everywhere. He was blindfolded, and made to kneel before the block. The executioner's axe was raised, but, instead of the sharp edge, a wet towel was brought sharply down on the back of the neck. The bandage was now removed from the culprit's eyes, but to the horror and astonishment of the students they found that he was dead. Such a case may be due to heart-failure from fear or excitement.

It is not uncommon that death ensues from the shock alone following blows that cause no visible injury, but administered to vital parts.

This is particularly true of blows about the external genital region, or epigastrium, where the solar plexus is an active factor in inhibition. Ivanhoff of Bulgaria in 1886 speaks of a man of forty-five who was dealt a blow on the t.e.s.t.i.c.l.e in a violent street fight, and staggering, he fell insensible. Despite vigorous medical efforts he never regained consciousness and died in forty-five minutes. Postmortem examination revealed everything normal, and death must have been caused by syncope following violent pain. Watkins cites an instance occurring in South Africa. A native shearing sheep for a farmer provoked his master's ire by calling him by some nickname. While the man was in a squatting posture the farmer struck him in the epigastrium. He followed this up by a kick in the side and a blow on the head, neither of which, however, was as severe as the first blow. The man fell unconscious and died. At the autopsy there were no signs indicative of death, which must have been due to the shock following the blow on the epigastrium.

As ill.u.s.trative of the sensitiveness of the epigastric region, Vincent relates the following case: "A man received a blow by a stick upon the epigastrium. He had an anxious expression and suffered from oppression.

Irregular heart-action and shivering were symptoms that gradually disappeared during the day. In the evening his appet.i.te returned and he felt well; during the night he died without a struggle, and at the autopsy there was absolutely nothing abnormal to be found." Blows upon the neck often produce sudden collapse. Prize-fighters are well aware of the effects of a blow on the jugular vein. Maschka, quoted by Warren, reports the case of a boy of twelve, who was struck on the anterior portion of the larynx by a stone. He fell lifeless to the ground, and at autopsy no local lesion was found nor any lesion elsewhere. The sudden death may be attributed in this case partly to shock and partly to cerebral anemia.

Soldiers have been seen to drop lifeless on the battle-field without apparent injury or organic derangement; in the olden times this death was attributed to fear and fright, and later was supposed to be caused by what is called "the wind of a cannon-ball." Tolifree has written an article on this cause of sudden death and others have discussed it. By some it is maintained that the momentum acquired by a cannon-ball generates enough force in the neighboring air to prostrate a person in the immediate vicinity of its path of flight.

CHAPTER X.

SURGICAL ANOMALIES OF THE HEAD AND NECK.

Injuries of such a delicate organ as the eye, in which the slightest accident can produce such disastrous consequences, naturally elicit the interest of all. Examples of exophthalmos, or protrusion of the eye from the orbit from bizarre causes, are of particular interest. Among the older writers we find Ficker and the Ephemerides giving instances of exophthalmos from vomiting. Fabricius Hilda.n.u.s mentions a similar instance. Salmuth, Verduc, and others mention extrusion of the eyeball from the socket, due to excessive coughing. Ab Heers and Sennert mention instances in which after replacement the sight was uninjured.

Tyler relates the case of a man who, after arising in the morning, blew his nose violently, and to his horror his left eye extruded from the orbit. With the a.s.sistance of his wife it was immediately replaced and a bandage placed over it. When Tyler saw him the upper lid was slightly swollen and discolored, but there was no hemorrhage.

Hutchinson describes extrusion of the eyeball from the orbit caused by a thrust with a stick. There was paraphymotic strangulation of the globe, entirely preventing replacement and necessitating excision.

Reyssie speaks of a patient who, during a fire, was struck in the right eye by a stream of water from a hose, violently thrusting the eye backward. Contracting under the double influence of shock and cold, the surrounding tissues forced the eyeball from the orbit, and an hour later Reyssie saw the patient with the eye hanging by the optic nerve and muscles. Its reduction was easy, and after some minor treatment vision was perfectly restored in the injured organ. Thirty months after the accident the patient had perfect vision, and the eye had never in the slightest way discommoded him.

Bodkin mentions the case of a woman of sixty who fell on the key in a door and completely avulsed her eye. In von Graefe's Archiv there is a record of a man of seventy-five who suffered complete avulsion of the eye by a cart-wheel pa.s.sing over his head. Verhaeghe records complete avulsion of the eye caused by a man falling against the ring of a sharp-worn key. Hamill describes the case of a young girl whose conjunctiva was pierced by one of the rests of an ordinary gas-bracket.

Being hooked at one of its extremities the iron became entangled in either the inferior oblique or external rectus muscles, and completely avulsed the eyeball upon the cheek. The real damage could not be estimated, as the patient never returned after the muscle was clipped off close to its conjunctival insertion. Calhoun mentions an instance of a little Esquimaux dog whose head was seized between the jaws of a large Newfoundland with such force as to press the left eyeball from the socket. The ball rested on the cheek, held by the taut optic nerve; the cornea was opaque. The ball was carefully and gently replaced, and sight soon returned to the eye.

In former days there was an old-fashioned manner of fighting called "gouging." In this brutal contest the combatant was successful who could, with his thumb, press his opponent's eyeball out. Strange to say, little serious or permanently bad results followed such inhuman treatment of the eye. Von Langenbeck of Berlin mentions an instance of fracture of the superior maxilla, in which the eyeball was so much displaced as to lodge in the antrum of Highmore. Von Becker of Heidelberg reports the history of a case in which a blow from the horn of a cow dislocated the eye so far back in the orbit as to present the appearance of enucleation. The conjunctiva hid the organ from view, but when it was pulled aside the eyeball was exposed, and in its remote position still possessed the power of vision. In some cases in which exophthalmos has been seemingly spontaneous, extreme laxity of the lids may serve as an explanation. There is an instance on record in which a Polish dew appeared in a Continental hospital, saying that while turning in bed, without any apparent cause, his eyeball was completely extruded. There have been people who prided themselves on their ability to produce partial exophthalmos.

Rupture of the Eyeball.--Jessop mentions the case of a child of eight who suffered a blow on the eye from a fall against a bedpost, followed by compound rupture of the organ. The wound in the sclerotic was three or four lines in length, and the rent in the conjunctiva was so large that it required three sutures. The chief interest in this case was the rapid and complete recovery of vision.

Adler reports a case of fracture of the superior maxillary in which the dislocated bone-fragment of the lower orbital border, through pressure on the inferior maxillary and counter pressure on the skull, caused rupture of the conjunctiva of the left eye.

Serious Sequelae of Orbital Injuries.--In some instances injuries primarily to the orbit either by extension or implication of the cerebral contents provoke the most serious issues. Pointed instruments thrust into the orbital cavity may by this route reach the brain. There is a record of death caused by a wound of a cavernous sinus through the orbit by the stem of a tobacco-pipe. Bower saw a woman at the Gloucester Infirmary who had been stabbed in the eye by the end of an umbrella. There was profuse hemorrhage from the nostrils and left eye, but no signs indicative of its origin. Death shortly ensued, and at the necropsy a fracture through the roof of the orbit was revealed, the umbrella point having completely severed the optic nerve and divided the ophthalmic artery. The internal carotid artery was wounded in one-half of its circ.u.mference at its bend, just before it pa.s.ses up between the anterior clinoid process and the optic nerve. The cavernous sinus was also opened. In this rare injury, although there was a considerable quant.i.ty of clotted blood at the base of the brain, there was no wound to the eyeball nor to the brain itself.

Pepper records a case in which a knife was thrust through the spheroidal fissure, wounding a large meningeal vein, causing death from intracranial hemorrhage. Nelaton describes an instance in which the point of an umbrella wounded the cavernous sinus and internal carotid artery of the opposite side, causing the formation of an arteriovenous aneurysm which ultimately burst, and death ensued. Polaillon saw a boy of eighteen who was found in a state of coma. It was stated that an umbrella stick had been thrust up through the roof of the orbit and had been withdrawn with much difficulty. The anterior lobe of the brain was evidently much wounded; an incision was made in the forehead and a portion of the frontal bone chiseled away entrance being thus effected, the aura was incised, and some blood and cerebrospinal fluid escaped.

Five splinters were removed and a portion of the damaged brain-substance, and a small artery was tied with catgut. The debris of the eyeball was enucleated and a drain was placed in the frontal wound, coming out through the orbit. The patient soon regained consciousness and experienced no bad symptoms afterward. The drains were gradually withdrawn, the process of healing advanced rapidly, and recovery soon ensued.

Annandale mentions an instance in which a knitting-needle penetrated the brain through the orbit. Hewett speaks of perforation of the roof of the orbit and injury to the brain by a lead-pencil.

Gunshot Injuries of the Orbit.--Barkan recites the case in which a leaden ball 32/100 inch in diameter was thrown from a sling into the left orbital cavity, penetrating between the eyeball and osseous wall of the orbit without rupturing the tunics of the eye or breaking the bony wall of the cavity. It remained lodged two weeks without causing any pain or symptoms, and subsequently worked itself forward, contained in a perfect conjunctival sac, in which it was freely movable.

Buchanan recites the case of a private in the army who was shot at a distance of three feet away, the ball entering the inner canthus of the right eye and lodging under the skin of the opposite side. The eye was not lost, and opacity of the lower part of the cornea alone resulted.

Cold water and purging const.i.tuted the treatment.

It is said a that an old soldier of one of Napoleon's armies had a musket-ball removed from his left orbit after twenty-four years'

lodgment. He was struck in the orbit by a musket-ball, but as at the same time a companion fell dead at his side he inferred that the bullet rebounded from his...o...b..t and killed his comrade. For twenty-four years he had suffered from cephalalgia and pains and partial exophthalmos of the left eye. After removal of the ball the eye partially atrophied.

Warren reports a case of a man of thirty-five whose eyeball was destroyed by the explosion of a gun, the breech-pin flying off and penetrating the head. The orbit was crushed; fourteen months afterward the man complained of soreness on the hard palate, and the whole breech-pin, with screw attached, was extracted. The removal of the pin was followed by fissure of the hard palate, which, however, was relieved by operation. The following is an extract of a report by Wenyon of Fatshan, South China:--

"Tang Shan, Chinese farmer, thirty-one years of age, was injured in the face by the bursting of a shot-gun. After being for upward of two months under the treatment of native pract.i.tioners, he came to me on December 4, 1891. I observed a cicatrix on the right side of his nose, and above this a sinus, still unhealed, the orifice of which involved the inner canthus of the right eye, and extended downward and inward for about a centimeter. The sight of the right eye was entirely lost, and the anterior surface of the globe was so uniformly red that the cornea could hardly be distinguished from the surrounding conjunctiva.

There was no perceptible enlargement or protrusion of the eyeball, and it did not appear to have sustained any mechanical injury or loss of tissue. The ophthalmia and kerat.i.tis were possibly caused by the irritating substances applied to the wound by the Chinese doctors. The sinus on the side of the nose gave exit to a continuous discharge of slightly putrid pus, and the patient complained of continuous headache and occasional dizziness, which interfered with his work. The pain was referred to the right frontal and temporal regions, and the skin on this part of the head had a slight blush, but there was no superficial tenderness. The patient had been told by his native doctors, and he believed it himself, that there was no foreign body in the wound; but on probing it I easily recognized the lower edge of a hard metallic substance at a depth of about one inch posteriorly from the orifice of the sinus. Being unable to obtain any reliable information as to the probable size or shape of the object, I cautiously made several attempts to remove it through a slightly enlarged opening, but without success. I therefore continued the incision along the side of the nose to the nostril, thus laying open the right nasal cavity; then, seizing the foreign body with a pair of strong forceps, I with difficulty removed the complete breech-pin of a Chinese gun. Its size and shape are accurately represented by the accompanying drawing. The breech-pin measures a little over three inches in length, and weighs 21 ounces, or 75.6 grams. It had evidently lain at the back of the orbit, inclined upward and slightly backward from its point of entrance, at an angle of about 45 degrees. On its removal the headache was at once relieved and did not return. In ten days the wound was perfectly healed and the patient went back to his work. A somewhat similar case, but which terminated fatally, is recorded in the American Journal of the Medical Sciences of July, 1882."

The extent of permanent injury done by foreign bodies in the orbit is variable. In some instances the most extensive wound is followed by the happiest result, while in others vision is entirely destroyed by a minor injury.

Carter reports a case in which a hat-peg 3 3/10 inches long and about 1/4 inch in diameter (upon one end of which was a k.n.o.b nearly 1/2 inch in diameter) was impacted in the orbit for from ten to twenty days, and during this time the patient was not aware of the fact. Recovery followed its extraction, the vision and movements of the eye being unimpaired.

According to the Philosophical Transactions a laborer thrust a long lath with great violence into the inner canthus of the left eye of his fellow workman, Edward Roberts. The lath broke off short, leaving a piece two inches long, 1/2 inch wide, and 1/4 inch thick, in situ.

Roberts rode about a mile to the surgery of Mr. Justinian Morse, who extracted it with much difficulty; recovery followed, together with restoration of the sight and muscular action. The lath was supposed to have pa.s.sed behind the eyeball. Collette speaks of an instance in which 186 pieces of gla.s.s were extracted from the left orbit, the whole ma.s.s weighing 186 Belgian grains. They were blown in by a gust of wind that broke a pane of gla.s.s; after extraction no affection of the brain or eye occurred. Watson speaks of a case in which a chip of steel 3/8 inch long was imbedded in cellular tissue of the orbit for four days, and was removed without injury to the eye. Wordsworth reports a case in which a foreign body was deeply imbedded in the orbit for six weeks, and was removed with subsequent recovery. Chisholm has seen a case in which for five weeks a fly was imbedded in the culdesac between the lower lid and the eyeball.

Foreign bodies are sometimes contained in the eyeball for many years.

There is an instance on record in which a wooden splinter, five mm.

long and two mm. broad, remained in the eye forty-seven years. It was extracted, with the lens in which it was lodged, to relieve pain and other distressing symptoms. Snell reports a case in which a piece of steel was imbedded and encapsulated in the ciliary process twenty-nine years without producing sympathetic irritation of its fellow, but causing such pain as to warrant enucleation of this eye. Gunning speaks of a piece of thorn 5/8 inch long, imbedded in the left eyeball of an old man for six years, causing total loss of vision; he adds that, after its removal, some improvement was noticed.

Williams mentions a stone-cutter whose left eye was put out by a piece of stone. Shortly after this his right eye was wounded by a knife, causing traumatic cataract, which was extracted by Sir William Wilde, giving the man good sight for twelve years, after which iritis attacked the right eye and produced a false membrane over the pupil so that the man could not work. It was in this condition that he consulted Williams, fourteen years after the loss of the left eye. The eye was atrophied, and on examination a piece of stone was seen projecting from it directly between the lids. The visible portion was 1/4 inch long, and the end in the shrunken eye was evidently longer than the end protruding. The sclera was incised, and, after fourteen years' duration in the eye, the stone was removed.

Taylor reports the removal of a piece of bone which had remained quiescent in the eye for fourteen years; after the removal of the eye the bone was found adherent to the inner tunics. It resembled the lens in size and shape. Williams mentions continual tolerance of foreign bodies in the eyeball for fifteen and twenty-two years; and Chisholm reports the lodgment of a fragment of metal in the iris for twenty-three years. Liebreich extracted a piece of steel from the interior of the eye where it had been lodged twenty-two years. Barkar speaks of a piece of steel which penetrated through the cornea and lens, and which, five months later, was successfully removed by the extraction of the cataractous lens. Critchett gives an instance of a foreign body being loose in the anterior chamber for sixteen years.