33. =Putrefaction.= The first signs of putrefaction are seen in the
transformation of the hypostatic areas into _diffusion spots_ and
_stripes_ following the course of the larger veins. The color is at
first a dirty red or brownish-red, but soon becomes gray or green
as a result of the action of hydrogen sulphide diffusing from the
intestines. Diffusion spots cannot be made pale by pressure, nor do
they bleed when cut. The greenish coloration begins first over the
abdomen and lower intercostal spaces, and this gradually spreads over
the body, showing first in the hypostatic areas and along the veins.
The abdomen then becomes distended; gas may form in the subcutaneous
tissues so that the skin becomes swollen, crackles on pressure and
gives off gas-bubbles when cut. The epidermis becomes loosened in
spots, forming blebs containing a dirty-brown exudate, while the
tissues become soft and are easily torn. The odor of putrefaction
is evident. Decomposition sets in more quickly in infants, in fat
and plethoric individuals, and after death from snake-bite, active
syphilis, plague, sepsis, heat-stroke, suffocation, acute infectious
fevers, icterus, gangrene, diabetes, etc.; it is delayed by
hydrocyanic acid and other poisons. When putrefactive bacteria are
present in the body, decomposition may begin immediately after death.
34. =Orifices of the Body.= The _mouth_, _nose_, _ears_, _anus_,
_urethra_ and _vagina_ are to be examined with special regard to
their condition and contents (open, closed, gaping, torn, bleeding,
discharge of pus, blood, mucus, féces, stomach contents, semen,
urine, foreign substances, parasites, ear-wax, etc.). In cases of
suspected rape an especial examination of the orifice of the vagina
or anus is indicated.
35. =Percussion and Palpation.= The external examination may be
closed by the percussion of the heart, lung, spleen, liver and
stomach boundaries, and by the palpation of the abdomen. The fine
opportunity for control of technique, judgment as to sound, size,
consistence, shape, etc., should not be lost. Rigor mortis of the
abdominal muscles can be removed by kneading the muscles or by the
application of hot cloths.
CHAPTER V.
THE EXAMINATION OF THE SPINAL CORD.
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