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due, on the one hand, to degeneration of numerous portions of the algB-
formation, and, on the other, to various precipitates. These are par-
ticularly the ferri oxidum bydratum, from the iron sewer-pipes ; bot,
in addition, various kinds of filth which readily become deposited open
a cadaver immersed in running water. These, when the body is re-
moved from the water and the algse-formation collapses, give to the
entire covering more and more the appearance of ordinary mire.

Upon the extent of the development of this formation of alge — dur-
ing the first week at least — an opinion may be based as to how long the
cadaver has been in the water. Particularly is one justified in the con-
clusion that the body has been in the water but a few (at the most six
or seven) days, when as yet no development of algsB is found. The
development takes place somewhat slower during the winter than dar>
ing summer, but occurs in water of 8° C. and even lower temperature.



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PLATE 80.
Alterations of the Blood due to Irritant Poisons.

As is well known, the irritant poisons are divided into two groups
according to the manner in which they disturb the organic tissues at
their point of application ; that is, upon whether they produce but slight
cauterization or a deeper eschar. In the first group are those which
give rise to eschar-formation through coagulation of the albuminous
bodies ; in the second, those which cause, as a result of their application,
solution, swelling, and softening of the tissues.

The first group comprises the mineral acids, carbolic acid, oxalic
acid, and the metallic irritant poisons, especially mercuric bichlorid ;
the second, caustic potash and caustic soda — potassium and sodium
hyd^te. We obtain, as a primary result of the application of the sub-
stances of the first-mentioned category to a mucous membrane or to an
organ, a grayish-white, cloudy, dried alteration of the affected surface;
in contradistinction to this, the application of a solution of potassium or
sodium hydrate results in a clearing up of the affected tissues, which
assume a swollen appearance. As a consequence of the solution of the
blood which occurs at the same time, through imbibition, they later
become darker in color.

Nor does the primary picture produced by the coagulating irritant
poisons always persist. Subsequently it not uncommonly changes, the
change being especially dependent upon the manner in which the blood
of the affected part and its immediate vicinity becomes altered as a
further effect of the irritant.

In this respect the coagulating irritant poisons vary. Sulphuric acid,
hydrochloric acid, and oxalic acid not only coagulate the blood, but
after a short time change the hemoglobin in part into hematin. As a
consequence, there subsequently ensue-s a brownish -black or black im-
bibition of the region the seat of the eschar- format ion. On the other
hand, carbolic acid and mercuric bichlorid produce only a coagulation
of the bloq^, but no solution of the hemoglobin. There occurs, there-
fore, no hemorrhagic imbibition of the eschar, and the latter, even after
prolonged application of the irritant, presents its original white or
grayish-white appearance.

In Plate 30 we see these processes depicted as they occur in a test-
tube. In a we see blood after the addition of moderately concentrated
sulphuric acid. We see in the lower third of the test-tube the blackish
coagulum, and above this the acid, brownish-black solution of hematin.
The same appearances, but in a darker shade, are seen in 6, which shows
the effect of the addition of hydrochloric acid to blood.

In c we find a complete solution of the entire blood produced by a
solution of sodium hydrate. The fibrin was not only early dissolved,
but the hemoglobin was also changed to hematin in alkaline solution.

On the other hand, in d and e (carbolic acid and mercuric bichlorid)
we see the blood only coagulated, and above this a deep layer of almost
colorless fluid, which evidently contains none of the coloring-matter of
the blood. We observe, in addition, that the color of the blood-coagnla
differs from the color of the coagula or of the solutions of the blood pro-
duced by the addition of sulphuric or hydrochloric acid; that is, they
are not black or brownish-black, but after the addition of carbolic acid
the coagulum is of a bright brick-red color, whereas aft«r the addition



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of mercuric bichlorid it ig of a grayish-violet color. In case of poisoning
with these irritants these colors glimmer through the white epithelial
eschar, and thus independently of other peculiarities assist in the diag-
nosis or differential diagnosis of the variety of poisoning.



PLATE 31.
Poisoning by Caustic Soda.

M. C, aged 21 years, with suicidal intent, swallowed a large quantity
of a so-called solution of sodium hydrate (about 40 per cent, sodium
hydrate). He became immediately ill with symptoms of violent gastro-
enteritis; he vomited blackish masses, and revealed on examination a
"swollen mouth." A neighboring physician, being summoned, ad*
ministered vinegar as an antidote, and ordered the removal of the
patient to a neighboring hospital. Here, despite copious vomiting and
lavage of the stomachy he died at the end of two days.

The body revealed marked congestion and swelling of the entire
mucous membrane of the mouth. The epithelium was in part separated
from the underlying structures; in part it was still attached in the
form of soft, white, turbid shreds. The epithelium was absent from the
mucous membrane of the entire esophagus. The mucous membrane
itself was softened throughout, swollen, markedly congested, and of a
brown color, increasing in intensity below.

The stomach contains coffee-colored, turbid fluid. The epithelium is
aljsent from the entire mucous membrane, The mucous membrane
itself is soft throughout, markedly swollen, and arranged in coarse folds,
of a brownish -black color. This discoloration is especially marked at
the crests of the rugte, at which situations fading ecchymoses and small
superficial ai*eas of loss of substance are also to be noticed. On section
the mucous membrane is of a brownish -black color, dependent upon
imbibition of hematin in solution. This color diminishes in intensity
in the depths of the mucous membrane, but here and there extends to
the submucosa. In addition, the mucous membrane is injected and
shows in places hemorrhagic infiltration. The submucous oelinlar
tissue is edematous. The blood in the vessels is coagulated, but the
coagula are soft.

The mucous membrane of the duodenum is relaxed, and sliowa siignc
imbibition of bile, but no other changes.



PLATE 32.

Poisoning witli Concentrated Sodium Hydrate Colored wfth
Ultramarine-blue.

The preparation is from a man, aged 50 years, who was brought to
the hospital during the night with the history that he had purposely
— ">oed himself with a solution of caustic soda colored with ultm-
-^blue, which he had for sale in his shop.



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Tab 31.



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Externally no blue discoloration was to be noticed ; but there were
larked congestion and swelling of the lips, with partial desquamation
r the swollen epithelium. On the other hand, tbe epithelium of the
ase of the tongue was of a blue color, cloudy, and could be readily
emoved. The mucous membrane of the mouth and pharynx was con-
gested and swollen. On account of edema of the glottis tracheotomy
^as performed, but the patient died the next morning.

The necropsy revealed, in addition to the changes in the month and
pharynx already mentioned, a marked edema of the glottis and of the
lungs. In addition, there was an intense blue discoloration of the
epithelium throughout the length of the esophagus. The epithelium
was also much swollen and cloudy, and arranged in coarse folds; the
mucous membrane beneath was congested and swollen. The stomach
was moderately contracted and tilled with a blackish, turbid, alkaline
material, which was soapy and slippery to the touch, and in which
there were demonstrable soft ragged particles (shreds of desquamated
epithelium) which were of a blue color and appeared as though coagu-
lated. The mucous membrane is throughout wanting in epithelium ; it
is markedly swollen, arranged in coarse rugae, and colored almost uni-
formly black. The< swelling and the blackish discoloration atfect the
entire thickness of the hcmorrhagically infiltrated mucous membrane,
and also reach into the hypereraic and edematous submucous cellular
tissue. The larger vessels of this latter, as also the coronary vessels of
the stomach, contain soft blood-coagula.

In the region of the pylorus, and from here for a distance of about
50 cm. into the jejunum, the mucous membrane is somewhat altered ;
it is flabby, as though edematous, and throughout of a bright blue color,
which color diminishes in intensity toward the lower part.

To avoid accidents, the coloring with ultramarine-blue of solntioiis
of caustic soda, commonly for sale in thQ shops, is extensively and with
reason recommended and employed. The color to which this gives rise
in the viscera can. in a given case, be made use of in the diagnosis of a
case of poisoning by caustic soda, or in differentiating this from similar
poisonings, such, for instance, as poisoning with sulphuric or hydrochlo-
ric acid. If one add ultramarine-blne to such acids, the color becomes
dissipated, with the liberation of sulphur and sulphurt^tted hydrogen.
The blue color in such poisonings would therefore not be present.



PLATE 33.
Suicidal Poisoning witli Concentrated Sulpliuric Acid.

A. M., aged 33 years, a day-laborer, was found groaning and vomiting
in a city park. He could speak with difficulty, and atwerted that a short
time previously, because of a satiety of life, he had drunk a poisonous
fluid.

In the hospital he vomited a blackish material, which was markedly
arid in reaction and in which free sulphuric acid was demonstrable.
He sank rapidly, and died an hour after his admission.

The body revealed extensive, brown, leather-like, dried areas on and
about the lips. On both sides these extended from the angles of the
mouth to the lower jaw, and on the right side also to the middle of the
neck. The oral epithelium was grayish- white, dry, and extensively sep-



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arated in shreds; the macous membrane beneath was counted and
swollen, the superficial vessels injected and black. The raucous mem-
brane of the entire esophagus showed similar alterations, and was at the
same time arranged in rigid folds, and appeared superficially as though
cooked.

On opening the peritoneal cavity there was found therein a brownish, .
turbid fluid, which was very acid in reaction and which contained
crumbling flocculi and vestiges of food. Both layers of the peritoneum
were of a dirty gray color, cloudy, and stiff, — as though cooked. The
vessels were iujected and black, and from them could be expressed
black, friable blood-cylinders. These changes extended over all the
abdominal viscera, affecting some superficially, others more deeply. In
particular, the greater part of the intestines appeared as though cooked,
cloudy, rigid, and completely filled with black cylinders of blood. The
mesentery showed similar changes.

The stomach is contracted; appears externally as though cooked.
The coronary vessels are black and distended ; from them blackish dried
blood may be expressed. At the fundus of the stomach there is a per-
foration— patulous for two fingers — with thinned, ragged edges. Through
this the brownish acid masses found in the abdominal cavity escaped
from the stomach, and engendered the above described lesions.

The mucous membrane of the stomach is wanting in epithelium
throughout; it has been converted into a black, hemorrhagica! ly infil-
trated eschar. In many places it is entirely absent, so that the swollen
connective tissue, discolored brown by imbibition and pervaded by a
network of black vessels, here and there even exposes the peritoneum.
The latter is particularly the case at the fundus of the stomach in the
neighborhood of the perforation, toward which the walls of the stomach
become very much thinned and the ragged margins of which are finally
formed by the perforated peritoneum.

The perforation of the stomach must have occurred soon after the
ingestion of the acid, which fact explains the rapid course of the case,
especially the rapid collapse of the patient. At all events, it occurred
during life, as otherwise the tense iiyection of the vessels of the mesen-
tery with rigid, coagulated masses of blood is inexplicable.

In view of the large quantity and the concentration of the sulphuric
acid employed, as indicated by the anatomical lesions, there can be no
doubt as to the case being one of suicide ; and this fact is made clear
by the attendant circumstances of the case.



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Tab. 34



Lith.Ar«rv. K Rf lohhoild , Mundien

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PLATE 34.
Poisoning witli Dilute Sulphuric Acid.

A servant, aged 20 years, after an unpleasantness with her mistress,
drank about 50 ((rams of dilute (about 20 per cent.) sulphuric acid. Having
vomited violently at home and complained of intense pain in the organs
of deglutition and in the abdomen, she was immediately taken to a hos-
pital. On admission, examination revealed whitish-gray eseharosis of
the entire surface of the mouth, and of the skin below the angles of the
mouth ; in addition, pain and tenderness in the region of the stomach,
vomiting of blackish masses — acid in reaction, and manifestations of col-
lapse. Despite the employment of antidotes the girl died the following
day, twenty-four hours after she had taken the poison.

The necropsy revealed whitish-gray eseharosis throughout the mouth ;
partial desquamation of the epithelium of the oral mucous membrane ;
inflammatory congestion and swelling of the mucous membrane itself;
yellowish-brown, dried, leather-like streaks coursing from the angles of
the mouth ; coffee-colored contents of the stomach ; and, in addition,
the appearances depicted in the accompanying illustration.

The mucous membrane of the esophagus is swollen and arranged in
very rigid longitudinal folds. The epithelium is grayish-white, cloudy,
thickened, appears as though cooked, and shows at the crests of the
folds fine transverse tears.

On the inner aspect of the wall of the stomach one can distinguish
two areas, one of which is colored brownish-black to black, the other
l>eing dirty pale violet in color, with here and there scattered blackish
points. The first, affecting more particularly the left half of the stom-
ach, t'sjH'clally the posterior and lower wall, radiates along the coarse
rugte of the stomach toward the right half. These are the portions of
the stomach which the sulphuric acid first met, and with which it
remained longest in contact. Here in varying degree, through coagula-
tion, the mucous membrane has become the seat of eschar-formation,
and shows extensive hemorrhagic infiltration and imbibition. The
hemoglobin of the blood, both that within and that without the ves-
sels, has been convert^'d into hematin in acid solution, and has given
rise to the brownish-black to black discoloration of the eschar. This
eschar-formation affects especially the crests of the rugs. The blood in
the small vessels of the affected mucous membrane is almost completely
coagulated, and through the withdrawal of its watery constituents has
been converted into friable blood-cylinders. The cellular tissue beneath
the eschar is swollen and edematous, and shows here and there hemor-
rhagic infiltration.

The mucous membrane between the rugte the seat of eseharosis, as
also the mucous membrane of the entire right side of the stomach with
the exception of certain small brownish -black areas, is, with the sub-
mucous cellular tissue, markedly swollen, turgid, and projects above the
eschars.

The mucous membrane of the duodenum is likewise swollen, mark-
edly injected, and reveals slight grayish-white cloudiness of the epi-
thelium.



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PLATE 35.
Hydrochloric-acid Poisoning.

F. P., a servant, aged 46 years, was brought to the hospital, January
23d, with contusions of both ears and a fracture of the inferior maxilla.
He asserted that he had received these injuries eight days previously by
falling from a wagon. He was markedly dyspueic, and died at the end
of three days, with tetanic convulsions.

The necropny revealed healing contused wounds of both auricles
and a diagonal fracture of the inferior maxilla. This was situate
between the middle incisor teeth and showed some suppuration in the
neighborhood. In addition there was extensive escharosis of the mucous
membrane of all the organs of deglutition, the stomach, and the upper
part of the small intestine. These lesions had evidently been produced
by the ingestion of hydrochloric acid, as the filtrate of the contents of
the stomach produced no precipitation of barium chlorid, but gave rise
to a marked precipitate when added to a solution of nitrate of silver.

The epithelium of the oral cavity and of the esophagus is in great
part desquamated, but here and there still attached as grayish-white
shreds. The raucous membrane is congested, swollen, slate-eolored,
cloudy, and pervaded by a network of blood-vessels ipjected with coffee-
colored blood.

In the stomach there was coffee-colored fluid, markedly acid in
reaction, and containing particles of food. The mucous membrane of
the entire fundus, as also that along the greater curvature as far as the
pylorus, is desquamated. The submucosa is black, flabby, ragged, and
its vessels filled with thickened blood. The muscularis and the perito-
neum beneath in many places are as though cooked. The remainder of
the mucous membrane is pale, cloudy, and edematous.

Of especial interest are the inner aspect of the duodenum and the
adjoining portion of the jejunum. Here one notices a rather coarse
black network, and between the meshes of this, roughened mucous mem-
brane which appears as though cooked. The network corresponds with
the crests of the folds of mucous membrane— the valvnlse conniventes —
the seat of the most marked escharosis. The mucous membrane is
absent from certain areas, so that the submucosa is exposed. This shows
hemorrhagic infiltration and discoloration due to imbibition of bematin
in solution. The grayish-yellow areas within this network correspond
with the depressions between the valvule conniventes— that is, with
the less affected portions of the wall of the bowel. To these portions
the mucous membrane with its glands, though the seat of eschar-forma-
tion and coagulation, is still attached.

The organs a(\joining the stomach appeared superficially as though
cooked, and the blood in the portal vein, as also that in the aorta, was



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Tab. 35.



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Tab. 36.



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coagulated to a friable dried mass. From the latter finding, as also
from the distribution of the escharosis, which could have been produced
only by a large quantity of the poison, the conclusion was warranted
that the poison had been taken shortly before death, probably in the
hospital, and evidently with suicidal intent. This supposition is in
accord with the statemcuts of the hospital attendants, that the patient
had not vomited, and that having been to the closet during the evening,
he was found dead in bed the following morning.

No additional information could be ascertained concerning the frac-
ture of the inferior maxilla nor the injuries to the external ears, Their
condition agreed with the assertion of the deceased that they occurred
eight days prior to his admission to the hospital, but whether he was
the victim of another or whether he produced them himself— possibly
with suicidal intent— is incapable of elucidation.



PLATE 36.



Fio. a. — A portion of the duodenum from the case of hydrochloric-
acid poisoning illustrated in Plate 35— somewhat enlarged. It illus-
trates, on the one hand, the grayish-white escharosis of the mucous
membrane and its glands, and, on the other, the black, i^jected> stained
(with hematin) submucosa, corresponding with the crests of the val-
vule conniventes. This has been exposed by the destruction of the
mucous membrane, and presents itself as a black network.

Fig. b. — Difi'usion of the irritant poison through the wall of the
stomach to the adjoining organs. A case of carbolic-acid poisoning, in
which the poison difi'used itself through the fundus of the stomach to
the inner surface of the spleen.

The fundus of the stomach appeared throughout its entire thickness
as though cooked ; it was rigid, and of a pale reddish color. Similar
changes are also noticeable on the inner surface of the spleen and for a
distance of i cm. into the substance of the organ. The«e can have arisen
only through difiVision of the poison through the wall of the fundus of
the stomach.



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PLATE 37.
Poisoning with Concentrated Nitric Acid.

P. B., a servant, aged 36 years, on November 2l8t, at A. M., swal-
lowed a ** large quantity " of nitric acid. At 11 A. M. she was brought
to the hospital vomiting, and died the same day at 4 P. M. The
motive prompting the deed is said to have been a very painful affection
of the head, but particulars could not be ascertained.

The body revealed a remarkable yellow discoloration of the skin
about the mouth, with streaks of similar discoloration radiating toward
the lower jaw. In addition, the epithelium of the oral mucous mcm>
braue was in great part yellowish in color, cloudy, thickened, and could
be readly removed. The mucous membrane was pale yellow in color,
and appeared as though cooked.

The epithelium of the esophagus is of a uniform bright yellow color
throughout; it is arranged in rigid longitudinal folds, is thickened,
cloudy, friable, and readily detachable. The mucous membrane beneath
appears as though cooked ; it has a pale yellowish tinge, and is pervaded
with black iiyected vessels.

The stomach is markedly contracted, and contains yellowish, friable,
crumbling material with which are mixed numerous, small, blackish,
crumbling blood-coagula. The entire mucous membrane of the stomach
has been converted into a bright yellow, dried, fissured eschar. Its sur-
face is irregular; in many situations it is desquamated or becominf^
detached. The submucosa which is thus exposed is ragged, in part it is
yellow in color, in part blackish through imbibition. It presents numer-
ous friable, cylindrical blood -coagu la, some of which are contained
within the vessels, some project from the vessels, while others are free.
The deeper layers of the wall of the stomach arc thickened, appear a«
though cooked, but are without especial yellow discoloration. The
coronary vessels of the stomach are distended with firm blood-coagula.
In the neighborhood of, and along the entire course of the greater cur-
vature of the stomach, beneath the peritoneum, there are numerous,
bean-sized extravasations of blood.

The duodenum is also rigid — as though cooked. Its mucous mem-
brane has also been converted into a bright yellow eschar; it is thick-
ened, and arranged in coarse folds, at the crests of which the mucoos
membrane is wanting, thus exposing the ragged, hemorrhagically infil-
trated submucosa.

The organs adjoining the stomach appear superficially aA though
cooked, and are of a pale yellowish color.

This yellowish discoloration is a special characteristic of eschar-for-
mation dependent upon the application of nitric acid. According to tho
generally accepted view, it is due to the formation of xanthoproteln, and
is especially noticeable on epidermal and epithelial stnictures. It is
produced, however, only by the concentrated acid, the application of
the dilute acid being followed by its development to a slight extent
only or not at all. There may, therefore, occur instances of nitrioHieid
poisoning without any yellowish discoloration.


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Online LibraryEduard Hofmann (Ritter von)Atlas of legal medicine → online text (page 11 of 18)