PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. 16 page

brown parchment-color. About the level of the larynx, the epidermis was

distinctly abraded, indicating where the rope had been. The conjunctiva

was insensible and there was no contractile response of the pupil to

the light of a candle. The reflexes of the soles of the feet were

tested, but were quite in abeyance. There was no respiratory movement

and only slight cardiac pulsation. After vigorous measures the woman

ultimately recovered. Recovery is quite rare when the asphyxiation has

gone so far, the patients generally succumbing shortly after being cut

down or on the following day. Chevers mentions a most curious case, in

which cerebral congestion from the asphyxiation of strangling was

accidentally relieved by an additional cut across the throat. The

patient was a man who was set upon by a band of Thugs in India, who,

pursuant to their usual custom, strangled him and his fellow-traveler.

Not being satisfied that he was quite dead, one of the band returned

and made several gashes across his throat. This latter action

effectually relieved the congestion caused by the strangulation and

undoubtedly saved his life, while his unmutilated companion was found

dead. After the wounds in his throat had healed this victim of the

Thugs gave such a good description of the murderous band that their

apprehension and execution soon followed.

Premature Burial.--In some instances simulation of death has been so

exact that it has led to premature interment. There are many such cases

on record, and it is a popular superstition of the laity that all the

gruesome tales are true of persons buried alive and returning to life,

only to find themselves hopelessly lost in a narrow coffin many feet

below the surface of the earth. Among the lower classes the dread of

being buried before life is extinct is quite generally felt, and for

generations the medical profession have been denounced for their

inability to discover an infallible sign of death. Most of the

instances on record, and particularly those from lay journals, are

vivid exaggerations, drawn from possibly such a trivial sign as a

corpse found with the fist tightly clenched or the face distorted,

which are the inspiration of the horrible details of the dying

struggles of the person in the coffin. In the works of Fontenelle there

are 46 cases recorded of the premature interment of the living, in

which apparent has been mistaken for real death. None of these cases,

however, are sufficiently authentic to be reliable. Moreover, in all

modern methods of burial, even if life were not extinct, there could be

no possibility of consciousness or of struggling. Absolute

asphyxiation would soon follow the closing of the coffin lid.

We must admit, however, that the mistake has been made, particularly in

instances of catalepsy or trance, and during epidemics of malignant

fevers or plagues, in which there is an absolute necessity of hasty

burial for the prevention of contagion. In a few instances on the

battle-field sudden syncope, or apparent death, has possibly led to

premature interment; but in the present day this is surely a very rare

occurrence. There is also a danger of mistake from cases of

asphyxiation, drowning, and similar sudden suspensions of the vital

functions.

It is said that in the eighty-fourth Olympiad, Empedocles restored to

life a woman who was about to be buried, and that this circumstance

induced the Greeks, for the future protection of the supposed dead, to

establish laws which enacted that no person should be interred until

the sixth or seventh day. But even this extension of time did not give

satisfaction, and we read that when Hephestion, at whose funeral

obsequies Alexander the Great was present, was to be buried his funeral

was delayed until the tenth day. There is also a legend that when

Acilius Aviola fell a victim to disease he was burned alive, and

although he cried out, it was too late to save him, as the fire had

become so widespread before life returned.

While returning to his country house Asclepiades, a physician

denominated the "God of Physic," and said to have been a descendant of

aesculapius, saw during the time of Pompey the Great a crowd of

mourners about to start a fire on a funeral pile. It is said that by

his superior knowledge he perceived indications of life in the corpse

and ordered the pile destroyed, subsequently restoring the supposed

deceased to life. These examples and several others of a similar nature

induced the Romans to delay their funeral rites, and laws were enacted

to prevent haste in burning, as well as in interment. It was not until

the eighth day that the final rites were performed, the days

immediately subsequent to death having their own special ceremonies.

The Turks were also fearful of premature interment and subjected the

defunct to every test; among others, one was to examine the

contractility of the sphincter and, which shows their keen observation

of a well-known modern medical fact.

According to the Memoirs of Amelot de la Houssaye, Cardinal Espinola,

Prime Minister to Philip II, put his hand to the embalmer's knife with

which he was about to be opened; It is said that Vesalius, sometimes

called the "Father of Anatomy," having been sent for to perform an

autopsy on a woman subject to hysteric convulsions, and who was

supposed to be dead, on making the first incision perceived by her

motion and cries that she was still alive. This circumstance, becoming

known, rendered him so odious that he had to leave the community in

which he practiced, and it is believed that he never entirely recovered

from the shock it gave him. The Abbe Prevost, so well known by his

works and the singularities of his life, was seized by apoplexy in the

Forest of Chantilly on October 23, 1763. His body was carried to the

nearest village, and the officers of justice proceeded to open it, when

a cry he sent forth frightened all the assistants and convinced the

surgeon in charge that the Abbe was not dead; but it was too late to

save him, as he had already received a mortal wound.

Massien speaks of a woman living in Cologne in 1571 who was interred

living, but was not awakened from her lethargy until a grave-digger

opened her grave to steal a valuable ring which she wore. This instance

has been cited in nearly every language. There is another more recent

instance, coming from Poitiers, of the wife of a goldsmith named

Mernache who was buried with all her jewels. During the night a beggar

attempted to steal her jewelry, and made such exertion in extracting

one ring that the woman recovered and was saved. After this

resurrection she is said to have had several children. This case is

also often quoted. Zacchias mentions an instance which, from all

appearances, is authentic. It was that of a young man, pest-stricken

and thought to be dead, who was placed with the other dead for burial.

He exhibited signs of life, and was taken back to the pest-hospital.

Two days later he entered a lethargic condition simulating death, and

was again on his way to the sepulcher, when he once more recovered.

It is said that when the body of William, Earl of Pembroke, who died

April 10, 1630, was opened to be embalmed, the hand raised when the

first incision was made. There is a story of an occurrence which

happened on a return voyage from India. The wife of one of the

passengers, an officer in the army, to all appearances died. They were

about to resort to sea-burial, when, through the interposition of the

husband, who was anxious to take her home, the ship-carpenters started

to construct a coffin suitable for a long voyage, a process which took

several days, during which time she lay in her berth, swathed in robes

and ready for interment. When the coffin was at last ready the husband

went to take his last farewell, and removed the wedding-ring, which was

quite tightly on her finger. In the effort to do this she was aroused,

recovered, and arrived in England perfectly well.

It is said that when a daughter of Henry Laurens, the first President

of the American Congress, died of small-pox, she was laid out as dead,

and the windows of the room were opened for ventilation. While left

alone in this manner she recovered. This circumstance so impressed her

illustrious father that he left explicit directions that in case of his

death he should be burned. The same journal also contains the case of a

maid-servant who recovered thrice on her way to the grave, and who,

when really dead, was kept a preposterous length of time before burial.

The literature on this subject is very exhaustive, volumes having been

written on the uncertainty of the signs of death, with hundreds of

examples cited illustrative of the danger of premature interment. The

foregoing instances have been given as indicative of the general style

of narration; for further information the reader is referred to the

plethora of material on this subject.

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 penis. 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 penis 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 retardation 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 retarded, and was actually still in progress,

several hundred years after burial.

Retardation 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 Garmanus 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 pronounced

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 Hildanus,

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 assured 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 testicle 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 illustrative 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 appetite 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 Hildanus 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 assistance 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 passing 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

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