SIGNS AND TESTS OF DEATH. 
BY 
JUSTIN HEROLD, A. M.f M. D. 
NEW YORK. 
Formerly Coroner’s Physician of the City and County of New 
York; Late House Physician and Surgeon of Saint Vincent’s 
Hospital, New York City; Member of the New York 
County Medical Association, New York County Medi- 
cal Society, New York Medico-Legal Society, 
New York Society of Medical Jurisprudence, 
New York Academy of Medicine, Herman 
Medical Society -of the_City of New 
York; Author of y 
Legal.Medicine.’* v- - - ‘ - 
! J r >;<“! •: «• i'i .vii. 
• ! 
New Orleans 
Medical and Surgical Journal. 
1899. SIGNS AND TESTS OF DEATH. 
JUSTIN HEROLD, A. M., M. D., New Yohk. 
Formerly Coroner’s Physician of the City and County of New York; Late House 
Physician and Surgeon of Saint Vincent’s Hospital, New York City; Member 
of the New York County Medical Association, New York County Medical So- 
ciety, New York Medico-Legal Society,New York Society of Medical Juris- 
prudence, New York Academy of Medicine, German Medical Society of the 
Cityof New York; Author of “Herold’s Legal Medicine.” 
• ‘ How ivunderfill is Death— 
Death, and his brother Sleep!"—Shelley, Queen Mab, I. 
“To be buried alive is. beyond question, the most terrific of 
these extremes which has ever fallen to the lot of mere mortality. 
That it has frequently, very frequently, so fallen, will scarcely 
be denied by those who think. The boundaries which divide 
Life from Death are at best shadowy and vague. Who shall 
say where the one ends, and where the other begins? We know 
that there are diseases in which occur total cessations of all the 
apparent functions of vitality, and yet in which these cessations 
are merely suspensions, properly so called. They are only tem- 
porary pauses in the incomprehensible mechanism. A certain 
period elapses, and some unseen mysterious principle again sets 
in motion the magic pinions and the wizard wheels. The silver 
cord was not forever loosed, nor the golden bowl irreparably 
broken. But where, meanwhile, was the soul!”* Real death 
never misses fire, although the steed upon which this grim 
messenger travels this globe is pictured as a swift and pale 
horse, still he has a sure aim. 
Death is the cessation of all the phenomena of the human 
body which we call vital; the cessation of all acts, whether in 
animal or plant life. It means to be deprived of life, to be 
opposed to life and to living; it means to be reduced to that 
state of a being in which the organs of motion and of life are 
4 Poe, The Raven. 2 
irrevocably lost to a possibility of their resuscitation; their 
capabilities and functions are lost. The definite cessation of all 
acts constitutes death ; the ensemble of these acts in an organ- 
ized being constitutes life. Where there is a total and perma- 
nent cessation of all animal and vegetable functions, vital in 
their importance, that cessation certainly and surely means 
death. The organs not only cease to act, but also lose the 
susceptibility of renewed action, by whatever means that may be 
employed. This cessation of function is the end of all physio- 
logic action, yet really the beginning of another life (what 
becomes of the mind or thinking principle, in man or animal, 
after death, is a matter of philosophic conjecture or religious 
faith, and can not be treated of here), a life characterized by 
tissue changes and appearances at different stages. It is a sec- 
ond life of metamorphoses and an existence of parasites, entirely 
different from the first life, but from a scientific standpoint 
equally as interesting. Death is not an inevitable transition to 
every living creature; the protoplasm of which we are consti- 
tuted passes into the state of dead and putrid matter in a very 
interesting manner—in a manner as deep and difficult of solu- 
tion as the necessarily insoluble Why. 
Unicellular organisms divide, and from this mere division of 
self take unto themselves a distinct immortality of their own, 
the individual elements dying; propagation is then confined to 
certain elements, the unicellular immortality is lost as soon as 
the elements have advanced in differentiation. 
The term of existence that nature has fixed for man is seldom 
reached, death'by violence or disease is the rule; that from age 
or the gradual wearing out of the human mechanism, the excep- 
tion. Natural decay of the organism, as in old age, or from the 
derangements or lesions of the vital organs caused by disease or 
injury are the causes of death in the human subject. The pro- 
cesses actually cease to repair the inertia of all that was capable 
of motion under life’s regime and which is extracted by this so- 
called natural decay. Cessation of life is death, it is the failure; 
the living organized body ceases to perform its functions, in whole 
or in part—it is dead. When the first life ends, and the second 
begins, is a question that has not yet been definitely settled; 
during this transition stage subjects have been supposed to be 
alive, and live subjects have been treated as dead. We hear 3 
now and then of persons having been buried alive who were 
really and practically dead. 
Somatic Death.—The death of the body as a whole is termed 
somatic death; this also is the popular idea of the word death. 
It is the absolute cessation of the functions of the brain, the 
circulatory and respiratory organs. The time of it occurrence 
can generally be reckoned by the entire and continuous stop- 
page of the circulation and of the respiration. General 
death is of two kinds—death of the body as a whole, which is 
somatic, and death of the tissues, which is molecular. 
Molecular Death.—Local death is going on at all times 
and in all parts of the living body, in which individual 
cells and elements are being cast off and as fast as they are so 
cast off they are replaced by new cells ; this is one process that 
is essential to life. When death takes place the body as a 
whole dies first; there is an entire disappearance of the vital 
actions of the ultimate structural parts of the body. But the 
death of tissue itself does not occur until after a considerable 
interval, for it should not be forgotten that life in the ordinary 
signification of the term continues for some time after death, not 
only in the muscles, but also in other tissues, as well as in the 
vibratile cells of the epithelium and in the movements of the 
cells and germs; this may continue for one or two days. This 
is called molecular life and manifests itself after somatic death ; 
were we to know' when it occurs, we would then know the exact 
time of death; by this I mean to say the exact time of the 
cessation of molecular life, for certainly complete mole- 
cular death is the true and scientific death of the human 
body, for molecular death may be partial as well as complete. 
Molecular death may attack a part, a tissue, or an entire organ, 
without causing a general stoppage of the circulation. The part 
of the body thus affected becomes obedient to the operation of the 
ordinary chemic and physiologic agencies which govern the inor- 
ganic molecule. An incessant disintegration of tissue may occur 
without interfering with the general stoppage of the circulation ; 
the active processes of life being manifest throughout; this is 
pure molecular death in part. That part of the organism in 
which it takes place may or may not throw the whole mechanism 
of the human body out of gear; the part may be too weak, and 
thus partial molecular death proceeds; its existence may be 4 
proven by caloricity and muscular irritability, by the post-mor- 
tem growth of the nails, of the hair, and occasionally by evi- 
dences of nutrition and secretion. Complete molecular death, 
is caused by a progressive action and a progressive suspension 
of vital activity, not only in one, but in all parts of the organism, 
thus we are all at sea as to the period of its occurrence. While 
efforts at resuscitation in somatic death are frequently rewarded 
with favorable results, such efforts in complete molecular death 
are without avail, and the precise moment of its occurrence is 
likewise an as yet unsolvable feature. 
Signs of Death.—This subject is one of such immensity, of 
such depth, and burdened with so many and difficult features, 
that any effort on the part of any scientist must be fraught 
with the greatest labor, to be torn with the shafts of criticism, 
to be rent asunder by the blows of the ever-present aunt, 
uncle, or descendant of some one claimed to have been buried 
alive. The scientific world is divided on the reliability of cer- 
tain or even all of the tests. Death has its phenomena, it has 
its signs, its reality must be determined by these, a few of 
them can not be denied, still cases will be reported for centuries 
to come, where the corpse retains all the features of the living 
body. Ttie public are to a certain extent familiar with the signs 
of death, especially the ever-present undertaker; it thus becomes 
a matter of the greatest concern for the physician and also the 
lawyer to familiarize themselves with these phenomena and 
signs of death, with that I mean the precise and unalterable 
signs of death. For certainly no physician is justified in certi- 
fying that a person is dead unless several of the unalterable 
signs of death be present, and also well marked; life is not 
always extinct because one or two signs of death are evident, 
still I say that it is the rarest thing in the world, not except- 
ing anything, for the physician to be placed in any doubt as 
regards the actual presence of death. Although the question of 
whether death is real or apparent is ofttimes one of great diffi- 
culty to the ordinary layman who in these days is allowed to 
settle this point, still very few cases of suspended animation are 
on record as being buried alive. There has been, however, 
among the people of all countries, for all time, a dread of being 
buried alive. It has become a nightmare to some, haunting 
them until cutting of the radial has been incorporated as one of 5 
the provisions of their will, to be carried out after death, in 
order to prevent live burial. This is an unreasonable fear which 
haunts men, women and children. The physician can and 
should tell the families of the departed that he has discovered 
unmistakable signs of death, and thus assure them that life is 
extinct. This fear has been augmented by sensational reports 
of bodies being dug up where it was discovered that the position 
of the body differed from that which it had when lowered into 
the earth. This causes the friends and family to believe that 
life had not been extinct at the time of sepulture. The danger 
of live burial is reduced to the minimum, as I believe that any 
physician can determine the existence of death, and in all cases 
reported of live burial, 1 am quite certain that had a physician 
seen the body he would have detected whether there were any 
doubtful signs or not, for there are certain signs of death which 
are known to the medical man which are, in my opinion, past 
all argument to the contrary. These signs are also known to 
laymen, and are conclusive; thus the danger of live burial is 
reduced to the smallest possible chance—in fact, I do not believe 
that it occurs. An error of judgment is possible, but the watch- 
fulness of family, physician and friends in these days precludes 
any such possibility. For certainly the signs of death are 
as definite and as positive in a few hours after death as 
they are in a few days; still we must not set aside this matter 
so lightly until we get more positive signs of the reality 
of, and the explicit presence of death. Fhysiologic dis- 
cernment must be brought into play, in the determining of the 
reality of death. The action of vital organs is frequently sus- 
pended, producing every appearance of death; by proper manipu- 
lation they may be restored to activity. The most common test 
which is to ascertain whether breathing has stopped or not is in- 
voked by all classes of persons, in all walks of life; breathing 
has been known to stop for hours in cases of suspended anima- 
tion, and so on through all the signs of death. It has been 
claimed from the times of the Grecian and Roman philosophers 
that there was no certain sign of death or of the cessation of life. 
It is almost a physical impossibility to provide for the making 
of all the tests known to science, on any single corpse, still no 
one test in itself is sufficient; they are to be taken collectively. 
The great need of the day is the possession of some simple test, 6 
an infallible test, one that can be applied by the physician at 
the bedside, at once, and before the certificate of death is filled 
out. The test I have in mind is one which applies to the circula- 
tory system, and in my opinion it is infallible; yet, although 
recommended and used for many years, its infallibility has been 
questioned, although no cause therefor has been given. I will 
refer to this test as one which can be applied immediately. It is 
positive, it is reliable and, in my opinion, can never fail. I 
claim this as a simple and sure test of the departure of life from 
the human or any other body. 
To determine by tests whether the bodies were those of dead 
persons or of persons apparently dead, I undertook to apply the 
foremost and best tests known to science on the bodies of 71)00 
persons, males and females, young, old, and of all conditions of 
life and nationalities. These observations comprised the time 
between March, 1882, and December, 1898, almost 17 years. 
The modes of death in these cases were by disease, old age, 
homicide, accident, suicide, and still-births. It was not always 
easy to determine from the histories of the cases when death 
had ensued, but to my own knowledge death had existed all the 
way from one second to eight months. I saw the bodies in all 
the stages that follow dissolution, in cold weather and in the 
heat of summer, in private residences, in the morgue, on the 
highways, in fact in all conditions and under all circumstances. 
The phenomena of vital existence give way to the phenomena 
that accompany death, rapidly in some cases, slowly in others. 
We are all familiar with the scientific fact that decomposition 
may take place before death—namely,in gangrene of the lungs or 
of the extremities. We know as well that bodies may lose their 
heat before as well as after dissolution. We know that jnotion 
and sensibility may disappear before the respiration and heart 
beat cease. We know that bodies become rigid in some 
instances before death, and still these phenomena are those of 
death although they do occur ini life* Valuable incentives have 
been offered for the discovery of some sigu of death, certain in 
application and unfailing in its conclusions. In my observa- 
tions which will follow’ in the succeeding pages, I believe that 
among all the signs of death two are infallible, the tests there- 
for being equally so. One test is so simple that it can be 
applied immediately after the cessation of respiration and the 7 
heart sounds; the other sign appears after the disappearance of 
rigor mortis. The tests I employed were some of them very 
old, others were of more recent date. Usually all the combined 
signs of death are considered as a criterion; I am certain that 
if one of the tests mentioned is used there will be no necessity 
for the use of any of the others, as I believe that this one sign 
is reliable and never failing. The signs of death are in the 
majority of cases as certain and as definite as anything could 
be. The philosophers claimed that there was no certain sign of 
death or cessation of life. It has also been claimed that persons 
have been buried alive; I venture to say that now no medical stu- 
dent could be tripped up on a case of apparent death ; as for per- 
sons being buried alive, if any such have occurred, they must have 
been in instances w'here no physician had been called to verify 
the fact of the cessation of life, consequently the blunders have 
been popular ones. The signs of death are certainly unmistak- 
able, under the eye of the vigilant student or the practical physi- 
cian. I will now consider the signs of death and the tests there- 
for, as I found the former, and as opportunity afforded me to 
apply the latter. The following order was observed, in noting 
the principal signs and tests of death. 
1. -Cessation of Respiration— 
a) Mirror test. 
b) Feather test. 
e) Water or mercury test. 
d) Stethescopic test. 
e) Rhythmic traction of the tongue. 
2. Cessation of Circulation— 
а) Stethoscopic test. 
б) Ligature test. 
c) Scarification and cupping. 
d) Opening of an artery. 
e) Needle test (Cloquet’s). 
/ ) Fluorescine test. 
g) Injection of ammonia (Monte Verde’s test). 
h) Diaphanous test (Carriere’s). 
i) Roentgen ray. 
3. Changes in the Eye— 
a) Test by bright light. 8 
b) Test by mydriatics. 
c) Test by ophthalmoscope. 
d) Test by ophthalmatonometer. 
4. Loss of Animal Heat— 
Temperature test. 
5. Loss of Sensation and of Motion— 
a) Electric test. 
b) Heat test. 
c) Caustic test. 
6. Muscular Flaccidity and Contractility. 
7. Cadaveric Ecchymoses, Lividity or Hypostases. 
8. Cadaveric Rigidity, Cadaveric Spasm, Rigor Mortis. 
9. Putrefaction. 
I. Cessation of Respiration.—In my observations on the 
seventy-nine hundred dead, this sign was present in all without 
exception. Thus 100 per cent, of the bodies presented absence 
of respiration, and in no case was I enabled to produce a respir- 
atory effort. Thus, absence of respiration can generally be 
regarded as sufficient to determine the reality of death, although 
this rule does not hold good as a sign of death in all cases; it 
has been demonstrated by good authority that a child may live 
and yet show absolutely no signs of life, so far as its breathing 
apparatus is concerned ; thus it becomes a very difficult matter to 
decide whether a child was born dead or whether it died after 
birth. The fact that on autopsy evidences are found of the 
lungs having been inflated, is not positive proof that the child 
was born alive, for it has been proven that children breathe 
imperfectly before birth. These remarks apply to still-births. 
Immediately after birth, children may live for hours and even 
days, without an apparent effort at breathing. In such cases, 
partial or bronchial respiration takes place. There are cases 
recorded, although they are very rare, of children living twenty- 
four hours with complete absence of air from the lungs. Resus- 
citation did not follow any of the efforts made in my series of 
cases, although persons have been resuscitated, when apparently 
breathless; in so-called still-births, breathing has been produced 
in numberless instances, still in 160 cases that I have experi- 
mented upon, in not one instance was I able to produce natural 9 
respiration. I made attempts in these eases lasting as a rule five 
minutes; if no respiratory movement could then be produced, 1 
marked the case as certainly beyond hope. I consider that the 
continuous cessation of respiration may be regarded unequivo- 
cally as indicating death; at times it may be difficult to deter- 
mine positively whether respiration has ceased. The respira- 
tions may be infrequent or they may be shallow. Any longer 
suspension of respiration than five minutes must in my opinion 
prove fatal, for the very simple reason that respiration is an 
act of vitality. It is claimed that some persons can hold 
their breathing apparatus in abeyance for minutes at 
a time, but did you ever hear that any one attempted suicide in 
this manner, and if it was attempted did any one ever succeed? 
Respiration is one of the most essential of vital acts, conse- 
quently its permanent suspension is a most positive sign of 
death. Usually, respiration ceases some seconds, in some cases 
some minutes before the heart’s action, still the stoppage of 
respiration is not in all cases to be considered as a sign of the 
disappearance of life; from this we must conclude that the 
moment of death can not be reckoned as being identical with 
the cessation of respiration. When all the usual signs of 
breathing are absent life may still be present. Some of the con- 
ditions associated with stoppage of respiration are matters of 
common observation, even with the most ignorant. It is neces- 
sary in all cases, not only to ascertain whether breathing is 
extinct, but also to determine whether the lungs have actually 
lost their power of being revived. Suspension of the function 
of respiration can be restored, when occurring as a result of 
certain conditions, but when absolute stoppage of this vital 
act occurs, no power on earth can restore that function. The 
tests applied, in my series of 7900 cases, were as follows: 
(a) Mirror Test.—An ordinary pocket mirror was suspended 
over the mouth and nose, this was done in all of the 7900 cases 
in order to collect any traces of moisture which might escape 
through the act of breathing, but not through any other pro- 
cesses. The mirror in every case was cold; the mouth of 
the corpse was forced opened when possible. The mirror must 
be held either close to the lips, or anywhere from one to six 
inches therefrom; in the majority of cases it was held at a dis- 
tance of one-half inch, for a length of time anywhere from 10 
half a minute to one hour. This test has been used from time 
immemorial, and is simple, but unreliable in the highest degree. 
Moisture condenses and dulls the mirror’s face, the presence of 
moisture may prove life, but its absence does not prove death. 
In 39 cases of the 7900, this mirror test was disproved, in that 
the face of the glass became covered with moisture, and was 
soiled; this moisture and soiling was produced by the evacua- 
tion of gases. In none of the cases was moisture found on the 
mirror, where it could in anywise be attributed to breathing, 
although in 781 cases it was held or placed over the mouth and 
nose for the space of one hour. Although in cases where 
decomposition had already taken place, it was useless to try this 
test, still it was used, the object being to get the condensation 
of vapor from the gases of decomposition. 
(6) Feather Test.—Suspending a feather before the mouth and 
nose of a corpse, or placing a piece of cotton-wool, on the lips 
to detect currents of air and the absence of movement in these 
two processes is considered an indication of the stoppage of 
breathing; in 420 cases in which I used this test, movements 
were detected in 180, but these movements were imparted by 
surrounding currents of air. This test is as untrustworthy as the 
mirror test, and no positive conclusions should be drawn from 
the use of either of them. 
(c) Water or Mercury Test.—The standing of a glass of water, 
or quicksilver on the chest of the dead person. 1 used this pro- 
cedure in 378 cases. It proved as unreliable as the two former, 
in that contractions of the diaphragm and probably of other 
muscles of the body produced a disturbance of the surface of the 
liquid used, in 17 cases. In one case of death caused by cancer 
of the omentum, an actual movement of hiccough occurred, 
without the audible sound; this continued for some time after 
the respiration and circulation had ceased. In this case the water 
almost overflowed from the movement imparted to it by this 
post-mortem phenomenon. A shallow vessel may be used instead 
of a glass, but in any event this test is unreliable. 
(d) Stethescopic Test.—Auscultation with the stethescope was 
performed in 140(> cases, but in no case was a respiratory sound 
heard. 
(e) Rhythmic Traction of the Tongue.—1 practised l)r. Laborde’s 
system of rhythmic traction of the tongue in all eases dead 11 
less than two hours. As far as I could ascertain I got no re- 
sponse in any ease. It was continued in some instances for 
twenty minutes, in one case for two hours, especially in cases of 
still-birth, which numbered 160, but in none of these did I get 
the least encouragement. 
Movements of respiration are sometimes difficult to observe; 
they may be going on and still not increase in depth or in fre- 
quency by any process that may be used ; all tests may be used 
and still no reponse be had. Certain animals during the time 
of hibernation breathe so infrequently and so superficially that 
the most acute observer may be nonplussed. Respiration may 
cease for a short time and be consistent with life; entire stop- 
page does not preclude life, entire and continuous stoppage of 
respiration does. 
2. Cessation of Circulation.—The suspension of the cardiac- 
function has been noticed by many observers in cataleptic, leth- 
argic, syncopic and trance conditions. I have never met with 
any of these cases but that I could discern an audible heart 
sound. Like respiration, if cessation of the heart were absolute 
dissolution would follow inevitably, for certainly life can not 
continue without circulation. Like the respiratory movements, 
the movements of the heart may be very slow and infrequent. 
Continuous cessation of the cardiac function precludes all possi- 
bility of a return to life; it may be regarded unequivocally as 
indicating death, still it is very difficult at times to ascertain 
with certainty whether the heart is beating or not. 
How can we conceive of a human being living for twenty, forty 
or sixty minutes without breathing, without circulation ? The beat 
of the heart may be reduced like the number of respirations— 
that is, to a minimum, as it occurs in head injuries, or in certain 
neuropathic conditions—but a continuous stoppage of the circu- 
lation means death. The absence of the pulse at the wrist does 
not denote absence of circulation, for the heart may still be 
beating and resuscitation may be possible; even with the finger 
on the radial no impulse is felt. But when the heart ceases to 
beat death ensues. The heart may beat but four, six or eight 
times a minute, as it does in the hibernating animals; this is 
also possible in human beings but if the cessation of the heart’s 
action be entire and continuous, then it can be taken as a cer- 
tain sign that life is extinct. Vitality may be reduced to the lowest 12 
ebb, but the sounds of the heart can always be distinguished. 
Absence of pulse may occur in many diseases and conditions, 
but the mere absence of the impulse of the heart at the wrist does 
not denote in all cases a cessation of the action of the heart, 
either temporary or continuous; the heart may cease its beating 
for a time, and then after a brief interval recommence its action. 
Such cases have been reported in which the heart recommenced 
its action after intervals of rest of twelve and fifteen minutes. 
Heart pulsations have been produced, so that they became jner- 
ceptible fifteen to thirty minutes after an apparent still-birth, but 
in no case have I ever seen such a result. Where the vital ener- 
gies are reduced to a minimum, not only do the heart beats be- 
come reduced in number, but their characters are lost. Thus in 
cases of profound sleep, or in cases of so-called trance, in the 
human subject, the action of the heart is slowed, and its im- 
pulse at the wrist, or as heard over the cardiac area in the 
chest, may become so feeble as to escape the notice of the medi- 
cal examiner. Hut if auscultation be practised carefully and 
long, at intervals, of a few minutes at a time, the heart’s action 
can be detected. These conditions of profound and long sleep, 
may be accompanied by a rigidity simulating cadaveric rigidity, 
especially when it occurs in women and young girls. This is a 
pure counterfeit of death. In these cases also, the use of the 
stethoscope will detect the heart’s action, infrequent and feeble 
as that action may be. 
Sleep may be so profound as to last days and nights, becoming 
deeper and deeper. The skin in these cases may take on the 
appearance of death. The limbs may become rigid, the secretions 
may cease to be manufactured, that they may become suppressed, 
but the feeble impulse of the heart is always present and can be 
detected by the practised ear, together with the assistance of the 
stethoscope. 
In cataleptic conditions, where there is a coldness of the sur- 
face, a pallor of the skin, an almost imperceptible pulse at the 
wrist, with rigidity of the limbs, with the eyes dulled, and 
unchangeable to light, with respirations infrequent and almost 
imperceptible, in fact a puzzle to the most scientific—in these 
even auscultation will detect the heart’s sound. In fact, through- 
out all these cases that have been reported, the action of the 
heart has been detected by careful and painstaking stethescopy. 13 
When cessation of the action of the heart is permanent for an 
unreasonable length of time, life is certainly and unequivocally 
-extinct; continuous stoppage of the action of the heart can not 
and never will be overcome, by any means known to us or to 
future generations. It is therefore in my opinion a criterion of 
certain death. 1 will agree that the simple placing of the finger 
on the radial is not sufficient, to ascertain death, still in how 
many cases is a further test for death made! The pulse may be 
imperceptible for two, five, and sometimes one hundred and 
twenty minutes, if we are to believe in the cases that have been 
so reported; the action of the heart may be perceptible during 
these periods of time, by auscultation, then stopping, then 
appearing again, finally resuming its normal action, or disap- 
pearing entirely, consequently the pulse is not as reliable as 
auscultation of the heart itself. A low form of circulation of 
the blood may persist for three hours or longer, after respiration 
has ceased. In these cases, circulation can not be taken as a 
sign of life, all efforts at resuscitation being of no avail. It is 
claimed that the heart can beat without being heard by the most 
expert ear. I do not coincide with this view, as will be explained 
in the tests made to determine the existence of circulation as 
performed by me in 1406 cases of dead bodies, the balance of 
the 7900 being so certainly dead as to make it appear foolish to 
auscultate for the heart's action. 1 claim that if continuous 
auscultation is performed in doubtful cases for the space of 
thirty minutes, even for fifteen minutes, or at intervals of a few 
minutes at a time, no error can be committed. The force of the 
contractions of the heart may be lessened, the frequency of its 
action may be reduced, still the expert can detect the presence 
of life by means of the stethoscope. This is the main point to 
be decided, this question whether or not the heart continues to 
contract, for it is admitted that the pulse may be entirely absent 
and still cardiac contractions be present, feeble in the extreme, 
scarcely recognizable, infrequent, a scientific puzzle in fact, but 
the sthethoscope proves the bulwark, the mainstay of science 
as applied to medicine. In all these reported cataleptic and 
trance conditions, in which the friends of the family, and even 
the physician, note an entire absence of voluntary movement 
and an to all apparent condition of death, in all these 
•cases, although the impulse of the heart at the wrist 14 
may not be perceptible to the touch; the ear to the chest may 
not detect the characters of the first or second sounds of the 
heart, yet the careful auscultator, with the improved instrument, 
can settle the point whether the heart is at a standstill or not. 
The characteristic conditions attendant upon instances of cata- 
lepsy and trance overshadow to such an extent the signs of 
real death that error is the extreme exception. When the 
heart actually ceases to act for twenty minutes, in my opinion, 
real death is certain; for the heart is the last organ to die. Ces- 
sation of breathing is more apparent to the medical attendant 
than cessation of the circulation, the former taking place some 
minutes before the latter; in cases of asphyxia, where the 
blood being fluid and capable of flowing, means are resorted to 
to give oxygen to the blood, the circulation and breathing may 
be restored. In death from disease, however, the blood takes 
on a more coagulable form, and in these cases no efforts known 
to science can restore the circulation, much less the contractions 
of the heart. The entire and continuous stoppage of the con- 
tractions of the heart are certainly signs of sure death; while 
the heart may act in an independent manner for some minutes 
after the cessation of respiration, it can not be called into action 
after its entire stoppage. The heart will beat after its removal 
from the body, it will contract after being cut into fragments and 
laid on a plate, but it does so from an inherent life of its own. 
Vitality can not be restored to the heart, after its entire and 
continuous cessation, by any means known to the scientific or 
other worlds. Out of 1406 cases in which I attempted to 
restore the circulation, of the 7000 experimented upon, in not one 
case did I get a response to the general or to the local circula- 
tion, with all the tests that I used. 
(«) Stethoscopic Test.—It were vain and almost foolish for the 
physician to apply the stethoscope to the detection of the heart 
sounds in a ease where rigor mortis had set in, or in the first 
stages of putrefaction, immediately after rigidity had dis- 
appeared. I used the stethoscope in but 1406 cases out of the 
7900 examined. In these I was informed that death was recent. 
The region of the heart was examined carefully throughout its 
entire area, and in no case was any semblance of the heart sound 
discovered; the surrounding auditory conditions were as perfect 
as I could well make them by excluding all outside noisy 15 
influences. In the majority of these cases the entire i*egion of 
the chest was examined, to ascertain if there perhaps might he 
a sound from a displaced heart—displaced upward, downward, 
to the right or backward. In some of these cases auseultatiou 
was practised for hours, at intervals of time ranging from five 
to thirty minutes. Many of these tests with the stethoscope 
were undertaken on the bodies of the drowned, in which cases 
it has been reported that the heart may beat thirty and even 
sixty minutes after respiration has ceased. In all my observa- 
tions such an occurrence never showed itself, though in quite a 
few of the bodies the stoppage of respiration, through immersion 
or submersion, had occurred but a few minutes before my 
stethoscope was applied. Neither did I And that any of the cases 
were in a condition of trance, syncope or catalepsy. In cases of 
asphyxia, from other causes than drowning, where the blood 
is supposed to be very fluid after death, of which I have seen 
quite a number, and where it is taught that the blood is 
in such a condition that it will flow easily, I was never- 
able to detect a sound over the cardiac area, even after- 
all recognized efforts had been made to resuscitate. It 
has been recommended that the heart should be examined for 
thirty minutes, without taking the stethescope from the cardiac 
area. I have tried this manner of listening and finally could hear 
heart beats, but they were the beats of my own heart. I could 
also hear any number of indescribable sounds that could by no 
manner of reasoning be ascribed to the action of any heart. 
The experimenter must have a well trained auditory sense, he 
must be accustomed to auscultate every day, as it were, in 
order to detect the feeblest sound in the chest. One may hear 
absolutely nothing, another auscultator will claim that he hears 
sounds, still they can not be ascribed to the action of the heart. 
Faint movements of a weak heart may escape the auditory senses 
of some; in fact, the right side of the heart may contract for 
some time after the left side has ceased its action, but to the 
expert auscultator even this becomes apparent. The discovery 
of heart sounds in doubtful cases requires some degree of 
technic skill, which can only be attained by the constant and 
careful use of the stethoscope; not for an instant only, but for 
minutes, say five to fifteen, then resting, and re-examining. 
This is advisable in all doubtful cases. If after careful 16 
stethoscopy, cessation of the heart’s action is absolutely estab- 
lished, then it is useless to go any further, it is then almost 
absolutely certain that death has ensued. I doubt that the care- 
ful medical man can make any error in this conclusion. Fur- 
thermore, there can be no doubt that this test of stethoscopy is 
one of the best tests to distinguish between real and apparent 
death. Taking into consideration the fact that the sounds of 
the heart may continue in a very slow and weak manner, the 
microphone, or the phonendoscope may be applied in addition 
to the stethoscope. In all my experience it seemed to answer 
the purpose, and I hold it to be a reliable and certain test. 
(6) Ligature Test.—From childhood’s tricks, we know that 
when a string is coiled about the finger, that the part beyond 
the string becomes blackened. This test has been awarded a 
prize, but has not earned its reputation since. This method 
results with the living body in producing a stoppage of the circu- 
lation ; in the dead body no change in the color of the skin is 
observed. This is perfectly natural and reasonable. If the finger 
or the lobe of the ear be bound tightly, with a ligature, that part 
of the finger or ear beyond the point of constriction will, if the 
person be alive, become of a bright red color; this color 
increases in depth until it finally assumes a uniformly bluish 
red tint, and on looking further a narrow white line may be seen 
where the ligature constricts; but if a ligature is applied to the 
finger or lobe of the ear of a dead body, no such changes are 
noted. This has been considered a certain test of death as 
regards the circulation; it indicates in all oases whether circula- 
tion persists or is entirely absent. This test is especially valu- 
able in cases where the heart beats slowly and feebly, for cer- 
tainly if there be any circulation in the ends of the fingers or 
lobe of the ears, the ligature will produce a congestion at the 
point constricted. If life be extinct no change will be noted. 
This has been counted an almost infiallible test by some author- 
ities in ascertaining whether there be a continued circulation 
present. When in a decided hurry to use this test, a piece of 
worsted will answer, applied around the base of one of the 
fingers, or lobe of an ear, and left in place for about fifteen 
minutes, or even half an hour. If there be a continued How of 
blood, the finger will swell beyond the ligature, and become 
dark in color, and on cutting the ligature, the tightened skin 17 
will be found colorless. A ligature of any material may be tied 
about the arm at almost any point; if circulation be continuous, 
the veins will swell below point of ligation. This test can be 
used by lay persons to determine whether circulation is contin- 
uous or not; it maybe applied to Angers, toes, arms, legs or 
ears. If circulation is present, no matter how feeble, the part 
ligatured, iu the course of a longer or shorter period of time, 
assumes a livid tint from the effects of strangulation and the 
damming back of the contents of the venous vessels, while a 
ring of anemic whiteness will form at the point of constriction, 
due to the pressure of the ligature on the superAcial blood 
vessels. I used this ligature test in 987 of my cases, and in no 
instance was any change noted; in 182 cases I used this test on 
one or the other ears; in 776 cases I used it on the Angers, and 
in the balance of the cases I applied it to the arms or legs. I 
hold this test to be reliable (in so far) as it will indicate any cir- 
culation in the parts ligatured. 
(c) Scarification and Cupping.—This test is that in which 
scariAcation and cupping are employed, in order to ascertain 
if the blood Aows. If used immediately after the subject 
has ceased respiring, and before any effort is made to ascertain 
whether circulation is going on or not, the chances are that 
blood will Aow, simply through and by the mechanical features 
of the test; in fact without using the cupping glass, or the scar- 
iAcator, we know that blood will Aow from wounds on dead 
bodies hours and sometimes days after death, especially if the 
bodies are placed in warm rooms, or during the process of 
putrefaction. Such phenomena can and do take place. Flow- 
ing of blood may take place as long as eight days after dissolu- 
tion. This is an important fact to know and can be attested by 
any one who has performed sections on corpses, in which the 
Arst incision through the thorax brings blood, in some cases 
Aowing in large quantities. If such a phenomenon takes place 
then, why not from cupping and scariAcation! The Auidity of 
the blood, the Aaccidity of the veins, the position of the dead 
body, all these tend to force the blood to the surface and out in- 
to the external world. These points are very important in this 
connection, and certainly ought to do away with this test as one 
regarded of sufficient importance or interest to be connected 
with the circulation of the blood. Capillaries may burst in dead 18 
bodies and take on the same aspects as hemorrhages of the same 
size in living bodies. I have noted this in eighty-nine of my 
cases. In seventy-one of them I found hemorrhagic spots of 
varying sizes, situated on the most dependant portions of the 
bodies of persons found dead on stairways, hanging out of bed, 
or in dependant positions in streets, etc. Dependancy of posi- 
tion was not a bar in some of the cases, especially in those with 
impoverished blood vessels, to the occurrences of hemorrhages 
on abdomen, when found lying on back, or on back when 
found lying on abdomen. In some cases the hemor- 
rhages are so extensive as to show a free tiow of blood 
when incisions were made into the skin. Blood no doubt 
retains its vital functions for a considerable time after death. 
When a vein is opened blood may or may not tiow. Mechanical 
pressure, in the abdominal cavity, exerted on the diaphragm, 
and on the great vessels, heart and lungs, will drive whatever 
blood there is in the veins to the periphery. This blood escapes 
but does not coagulate; it is fluid venous blood. If scarifica- 
tion and cupping are performed on the body, yet wrarm from its 
life recently extinct, it ought not to coagulate, but in some 
cases it does. This is to be distinguished from the coagulation 
of blood from the living body. Leeches may draw blood from 
a dead body; I have seen it in one case twenty-four hours after 
death. This test is applied to determine whether blood will 
flow after death. It is an absolutely worthless test, and should 
never be relied on to the exclusion of other tests. I refer to 
cupping, leeching and scarification as distinguished from letting 
blood from an artery. The opening of veins in dead bodies 
may show that the blood is fluid or coagulable, also an obsolete 
test, and happily so. 
(d) Opening of an Artery.—In the series of tests made on the 
7900 bodies of the dead, I cut down on the radial or temporal 
arteries in 1572 instances. As is well known, blood from 
any ordinary cut or wound in the living subject will coagulate 
on exposure to air, whereas the blood from the dead subject is 
w’atery and limpid, and does not coagulate. Feeble muscular 
contractions of the heart will cause the blood to flow' to the ra- 
dials and temporals, even when there may be no pulse percepti- 
ble, and I hold that the opening of the radial or temporal arter- 
ies will demonstrate infallibly, and without doubt, the exist- 19 
ence of the least life in the human body. The arteries of a dead 
person are likened to empty india-rubber tubes; if there be any 
circulation at all, no matter how slight it may be, blood will be 
found in the arteries, pumped there by the heart muscle. No 
cataleptic or trance subject, no person in profound sleep, nor 
with suspended animation, could exist for more than one hour 
with an artery exposed and open, so that the blood could flow 
from it. This is a certain and infallible test, and in my opinion 
should be practised on the bodies of all dead persons. The lirst 
incision would prove life or death, during the process of em- 
balming. The very operation of forcing the embalming fluid 
into the body precludes any danger of forciug it into the ar- 
teries of a living person, for blood certainly would flow from 
the arteries as soon as they would be opened, and here the oper- 
ation of embalming would cease. The arteries of the dead are 
empty and nothing flows from them when they are opened; the 
embaliner takes this as a sign to proceed and he does so. The 
arteries are pale or yellowish, and completely empty after death; 
during life, the arteries pulsate, and they have the color of the 
tissues surrounding them. In cases where the arteries have be- 
come rigid from any diseased process this latter condition does 
not obtain. If the heart be beating, section of any artery, pref- 
erably the radial or temporal, would be followed by a spurt or 
flow of blood. I hold this to be the most reliable test of the 
condition known as death. No better test can be employed; as 
an immediate and satisfactory test the cutting of an artery is 
supreme. Especially is this the ease after auscultation of heart 
and lungs reveal nothing. 
(<?) Cloquet's Needle Test.—This test is the one in which 
needles are employed by being thrust into the muscles. A clean, 
bright needle is used for this purpose, the theory being that if 
the needle is stuck into the muscles of a living body, it will 
rapidly oxidize, rust or tarnish, but if the needle is thrust into 
the muscles of the dead body, it will neither become oxidized, 
rusty or tarnished. This applies also to the fact that if the 
needle is left in the tissues of the living body but an instant, it 
will be affected the same as if it were left there for hours, 
whereas if it be left in the tissues of the dead body for hours, no 
effect will be noted—on the contrary when removed, the needle 
will look as bright as when thrust in. In making this test it has 20 
been noted that much depends on the extent of the cooling of the 
dead body. I used this test in 202 of the 7900 cases, and in twelve 
instances the needle became oxidized on its removal, showing 
conclusively that the test is worthless. I preferred the biceps 
muscle in my tests, and in all the cases plunged a bright, 
steel needle deeply therein. 
(f) Fluoresein Test.—A hypodermic injection of fiuorescin, un- 
der the skin, will, if a person be alive, be distributed over the 
body, but if it is used on the dead body, only the space about 
the spot where injection is used will become colored. Fluor- 
escin is a substance used for purposes of dyeing, and is a very 
powerful coloring matter; a milligramme is sufficient for the 
test. This test is an almost unnecessary one when other tests 
are considered, in determining the existence of the circulation ; it 
was used by me in seventy-two cases, and in all there was a spot 
of color around the hole made by needle. 
(</) Monte Verde's Test—Injection of Ammonia.—If during life 
a solution of ammonia is injected under the skin, a mark or con- 
gestion of a port wine color is set up in the surrounding tissues, 
no such color appearing when the same solution is used in the 
same manner in the tissues of the dead body. This test in my 
experience has not always resulted in a positive manner. In 
197 cases I injected a solution of ammonia into the tissues of 
dead bodies, some rigid and partly decomposed among them. 
In those dead but a very short time, as regards circulation and 
respiration, the port wine mark was as evident as if they were 
alive. In twenty-seven of my cases I noted the port wine con- 
gestion mark, although the radial had previously been divided. 
But it was noted that the longer life had been extinct, the 
less apparent became the so-called port wine mark; in this man- 
ner data could be collected from which one could formulate the 
time which had elapsed since life ceased. In some of the cases it 
was a dark brown, in others a dirty brown color, depending 
entirely on the length of time since dissolution began. If am- 
monia be injected in the tissues of the living body, the discolor- 
ation produced is of a distinct port wine hue—this is claimed as 
indicative of life: whereas the dirty brown stain is said to indi- 
cate the beginning of decomposition in the tissues. The absence 
of the red blotch under the skin after the subcutaneous use of 
a solution of ammonia may be taken as a sign of death, pro- 21 
viding the test is made some hours after death. This test I can 
not look upon as reliable unless rigidity or decomposition were 
present, in which cases no such test is needed. Before these 
changes occur, we have already had recourse to the opening of 
the radial or temporal arteries, which to my mind is the most 
reliable and unfailing of all tests, and can be used immediately 
after respiration and cardiac action have ceased. 
(/j) Carriere's or Diaphanous Test.—When the hand of a living 
person is held before a strong light, with the four fingers and 
thumb in contact with each other, or even separated from each 
other, but extended, a certain transparency, familiar to all, is 
apparent; but in death this translucency is absent. This is the 
popular opinion. The presence or absence of this phenomenon 
is supposed to relate to the presence or absence of circulation. 
Transmitted light after death would give the part a marble-like 
and opaque appearance; before death it has a certain trans- 
parency and rosy hue. This so-called diaphanous test is sup- 
posed to be a criterion of death, but to me it is unreliable and 
faulty. I applied this test in 478 of my cases, not only with 
powerful sun light, but also with powerful reflectors, which 
gave an excellent and penetrating light, and in fourteen of the 
cases the rosy hue or tinge was apparent between the fingers as 
distinct as if it had been my own hand. The diaphanous test is 
not a trustworthy one by any manner of means. When apply- 
ing this test, the light must not be held more than five inches 
from the fingers. A lighted candle, gas, lamp or electric jet 
may be used. Furthermore, the test must be used on semi- 
transparent parts of the body, such as the ears, fingers or toes, 
and if light is not as powerful as it should be, a magnesia lamp 
may be substituted. At times you will find this so-called red 
line of life in the dead body as distinct as in the living person. 
(?) Rontgen Ray.—No matter what information the radio- 
graph may give us as to the signs or tests for death, that in- 
formation can be no more certain than the cutting of the radial, 
or the beginning of decomposition. Tests have been made with 
the radiograph to test the reality of death. A Rontgen ray 
photograph is made of the chest of the dead person, so as to 
include the heart in the picture. An opaque object with oscil- 
lating edges (like the pulsating, living heart), if interposed 
between an X-ray tube and a photographic plate, will leave on 22 
the latter a shadow print with light-toned margins. Hence, in 
a radiograph of a living heart the contour is light and indis- 
tinct, and merges gradually into the dark main mass of shadow. 
In a dead body, on the other hand, the edge of solid thoracic 
organs, as the heart and diaphragm, is sharp and lacks the dirn 
borderland that marks pulsating movement. I have not as yet 
used this test, and think it superfluous, for a pulsating and 
oscillating heart may be detected by other and simpler means. 
3. Changes in the Eye.—With the cessation of the circula- 
tion and consequent abolition of all arterial pressure and ten- 
sion, the eyeball becomes less tense, in fact loses its tension, 
becomes softened and flattened, and also wrinkled. These phys- 
ical qualities take place from the absorption of the aqueous 
humor. There is a perceptible loss of tone in the globe, also 
absence of elastic resistance. During life the eyeball is elastic 
and resists pressure, but after death it collapses, sinks in its 
socket, and becomes flaccid and buttery, as it were—in fact, so 
much so as to retain dents and marks of any pressure to which 
it may have been subjected. This condition of the eyeball comes 
on in most cases twelve to fourteen hours after death, some- 
times sooner. Still there may be loss of tonicity during life. 
Thus, in old age, the globe may sink into its socket. Various 
diseases of the eye, or of the general system, may produce the 
same result, especially when there is great exhaustion. When 
the heart ceases to beat, circulation ceases in the globe of the 
orbit, emptying the blood vessels, causing the loss of tension 
spoken of. This is counted as a certain sign of death and as a 
proof that the heart is not beating. 
In 128 cases of the 7900, I observed that the eyeball became 
larger and harder; especially was this the case in instances of 
death by drowming where the eyeball absorbs water. Further- 
more, the eyeball may become preternaturally prominent after 
death, having the appearance of the globe being pressed forward ; 
this is in some eases due to the development of gases within and 
behind the globe. The cornea becomes opaque and milky in 
consequence of this; the lustre of the eyes disappears; there is 
no sensibility to the cornea; touching the cornea is a common 
mode of testing its sensibility; this is always found after death, 
but it is also found during a certain stage of epilepsy, also in 
certain injuries of the skull and contents. The loss of lustre 23 
in the eye, just spoken of, sets in speedily after, and depends on 
the formation of a thin film of mucus over the surface of the 
eye; after a time the cornea itself becomes perceptibly milky 
and opaque. Thus it is easy to perceive that the eye may lose 
its lustre during life, as we are all acquainted with a condition 
called opacity of the cornea; and on the other hand, the eye 
may not lose its lustre for a long time after death, especially as 
seen after death from apoplexy, also after death from poisoning 
by oxide of carbon and the compounds of cyanogen. The col- 
lapsed and wriukled cornea, covered by tenacious and glairy 
mucus, also covering the conjunctiva and producing a loss of 
translucency, I have seen frequently as an accompaniment of 
very recent or impending death. The conjunctive present 
changes soon after death, the eyelids lose their elasticity and 
tone, gray, cloudy discolorations rapidly changing to black are 
observed upon the conjunctive and are soon followed by similar 
changes upon the internal surfaces of the same tissues; these 
changes are due to films of mucus, or to processes of putrefac- 
tion. The cornea is insensible to touch, or other influences, 
attesting, in the opinion of some, the reality of death. 
This loss of sensibility of the eye to light is charac- 
teristic as a sign of death, and still it may happen 
under other conditions. Soon after death the conjunctiva} 
exhibit externally gray, cloudy discolorations; as mentioned 
before, these rapidly become black. They are due either to the 
formation of films of mucus or to cadaveric imbibition dependent 
on the changes incident to putrefaction. These stains spoken of 
are on the exterior, and are closely succeeded by stains on the 
interior of a similar nature, and, as some celebrated scientist 
has said, “the two spots extend and approach each other, 
forming the segment of an ellipse.” I examined the eyes for 
signs of death in 7607 of the 7900 cases, and in 92 of them 
the characteristic signs mentioned were absent—I found neither 
the opacity of the cornea nor the loss of tension. Thus in 92 
cases, loss of lustre, softening of the bulb of the eye, and the 
appearance of black spots on the white part of the eye were 
absent. In the majority of cases the iris dilates and remains 
so; being a muscle and one of the smallest in the human body, 
it loses its reflex movements, and, like any other muscle, becomes 
flaccid; consequently the pupil which is formed by the circular 24 
iris reacts to light or other influences no longer—it dilates at 
the moment of death, to the extent of 5 or 6 millimetres. The 
pupil neither contracts nor expands to light, but certain poisons 
and affections of the brain affect the pupil in a similar manner. 
The pupil may dilate so widely as to present the appearance of 
no pupil, or absence of pupil. The black spot on the sclerotic, 
outer corner of the eye, is another phenomenon of death, and 
has been noticed by me in 89 cases only. It is at first very small, 
but gradually grows larger, moving down toward the lower 
border of the cornea, or the angle of the eye, where it remains, 
finally attaching itself to the cornea, with the convexity down- 
ward ; after becoming fixed it grows larger, and in this way 
may be an indication of the time since death ensued. 
(а) Test by Bright Light.—This is accomplished by placing a 
bright light on one side of the eye, so that the focus of light 
may be concentrated on the pupil. This is done to ascertain 
the contractility of the pupil. The light may be moved in dif- 
ferent directions, up, down, or from side to side, shading the 
eye at times, and concentrating the light rapidly on the pupil. 
I tested 871 of the 7900 cases in this manner and in no case did 
I get reaction of any kind; of course, it is a scientific fact that 
no reaction takes place in some diseases. According to some 
authors, reaction to light, or rather non-action, proves nothing, 
unless we take it in with the bulk of the other phenomena of 
death. Commonly it is considered sufficient to hold a lighted 
match before the eye, which will cause the pupil to contract as 
much as any other light. The change in the size of the pupil 
from dilatation to contraction is regarded as characteristic of 
vitality; but very soon before death, the iris, muscular in 
structure, and with the properties of other muscles, loses its 
power of contractility. 
(б) Test by Mydriatics.—Atropin, eserin and a few other power- 
ful alkaloids, have peculiar physiologic effects on the pupil of the 
eye of the living person. This action ceases with the cessation 
of life; the pupil of the eye then loses its responsiveness to my- 
driatics. I tested for the reality of death, in forty very recent 
cases, in fact in those cases where I happened to be at the death- 
bed, and in no case did I get any response with atropin. Thus 
can the reality of death be tested by drugs dropped into the eye, 
for the purpose of getting a contraction or a dilatation of the 25 
pupil; these drugs are supposed to have no effect on the muscle 
of the iris after death, but, since starting this paper, I have seen 
the pupil in a dead person dilated appreciably by atropin. I 
therefore count this test as worthless, and have come to the con- 
clusion that if these mydriatics are used shortly after death, we 
may in rare instances get a response. 
Thus I have seen that dilatation of the pupil does occur after 
death, which is explainable by the fact that the iris becomes 
flaccid as soon as and sometimes before death occurs. It has 
been held that the circular shape of the pupil, during life, is un- 
influenced by pressure brought to bear on the globe. After 
cessation of life, if pressure is exerted on the globe, it may 
affect permanently the normal roundness of the pupil. This also 
is a theory that does not hold, as in seven instances in life I have 
seen the pupillary roundness changed by pressure, by synchro- 
nous compression, brought to bear in two opposite directions ; in 
these cases, this test was applied by accident in attempting to 
close the eyelids. Thus, during life, a certain flaccidity of the 
iris may exist for a few hours before death, but it is not so evi- 
dent as that which exists after death has taken place. Is it this 
flaccidity of the iris, then, which causes the dilatation of the pupil 
as soon as life ceases ! This is a constant occurrence, and is a 
post-mortem dilatation; with it as a phenomenon of death, it is 
impossible to say what the condition of the pupil was at the time 
of death. 
(c) Ophthalmoscopic Test.—This is a procedure that has been 
neglected to a great extent as a test of real death. As yet 
observations derived from the use of the ophthalmoscope are 
very meagre, and consequently its use can not be relied on as a 
certain test of real or apparent death, but the literature on the 
subject shows, thus far, that its revelations are very promising. 
In using the ophthalmoscope the cornea must be very clear, 
which is a very rare occurrence, as we have seen. The ophthal- 
• inoscope applied will shew the normally yellowish red of the 
fundus changed to a yellowish white at death. This is evidently 
due to the absence of circulation ; the red spots in the optic disk 
are replaced by white spots due to the same cause. After death, 
the arteries and veins of the fundus oculi are completely emptied ; 
not only does the optic disk show this, but the surrounding 
tissues also. The fundus of the eye presents a beaded condition 26 
of the veins, due to the presence in them of air bubbles. This 
is then called pneumatosis of the veins, and is due to the nor- 
mally imprisoned gases in the venous blood, which become dis- 
engaged at death ; this causes the column of blood in the veins 
to be broken and to take on this bead-like appearance. This 
condition occurs in the retinal veins, and constitutes, according 
to some authorities, a certain and immediate sign of real death. 
This sign, it is claimed, can be readily seen with the ophthalmo- 
scope. 
The objection I have to it is that it can not be used in all cases 
on accouut of the milky appearance of the cornea. Thus, it is 
claimed, that we can read death, in the human eye, simply by 
applying the ophthalmoscope, and observing the condition of the 
veins and arteries, with a certainty of distinguishing real from 
apparent death. It is claimed that the blood vessels and veins 
of the retina are least nourished of any vessels in the human 
body, and that for that reason feeble circulation ought immedi- 
ately to be noticed, where it exists, when an examination is made 
with the ophthalmoscope. No doubt the eye does take on an 
entirely different aspect after death, and an unmistakable one. 
Within a short time the color of the blood in the arteries and 
veins entirely disappears. No doubt it may occur just before, or 
at death, but we are handicapped in using the ophthalmoscope 
where there is a hazy cornea. Consequently this test is appli- 
cable in a certain number of cases only. We all know that the 
veins and arteries of the retina have distinct differences in color, 
the veins containing a dark, almost black blood, the arteries, a 
bright almost crimson. Under the ophthalmoscope these two 
shades may be distinguished in life, but the opaque film of death 
precludes the possibility of discerning that the shade distinction 
has entirely disappeared. Even in cases where it is possible to 
use the ophthalmoscope after death, it will be seen that the blood 
iu both arteries and veins has been transformed into a pinkish 
color of a uniform shade. This test has recently been advo- 
cated, and in forty-seven of the cases in which I applied it, in all 
of them the uniform color was apparent. It is certainly a simple 
and reliable test, and may be recommended in any case of sus- 
pended animation, trance, catalepsy, or other condition approach- 
ing death, where the eye can be approached with the light of the 
ophthalmoscope. 27 
(d) OpJithalmatonometer Test.—This test has not been used by 
me in my series of cases, but I deem it of sufficient importance 
to recount the method of its application. The instrument is the 
invention of M. Nicati. By the aid of this instrument he has 
discovered that the tension of the globe of the eye, which he 
says is normally from eighteen to twenty-one grammes, may 
oscillate in the physiologic state, between fourteen and twenty- 
five grammes (T. — 0.4 to 1). This tension diminishes with the 
cessation of the heart beat to twelve grammes, and the lowering 
of tension, interrupted by rebounds never exceeding twelve 
grammes, is afterward progressive, until after the lapse of half 
an hour it has sunk to from one to three grammes ; in two hours it 
is nil. The enucleated eye replaced in the orbit presents the 
same phenomena. 
4. Loss op Animal Heat.—The loss of animal heat is a sign 
of great importance in determining real from apparent death. 
At the moment of death there may be a rise of temperature of 
from 3% to 7 deg. F. ; especially is this the case in death from 
infectious diseases, when the temperature is taken by the rectum. 
This rise simply proves that chemical activity continues after 
death has occurred; as a sequel to this rise there is a lowering 
of the temperature. The average internal temperature of the 
body is from 98 to 100 deg. F. This may be increased in con- 
sequence of disease to several degrees higher. One of the most 
remarkable phenomena of life is the power that man possesses 
of maintaining temperature at 98.0 at an average, no matter 
what the character of his surroundings may be, whether he be 
in the tropics or in the arctic regions. This body heat is derived 
from the potential energy admitted into the body with the food, 
and also with the oxygen in the respired air. The blood, during 
and after digestion, becomes surcharged with carbon, oxygen 
and hydrogen. Part of this goes for tissue repair, and part of the 
gases combine with the sulphates to generate heat by chemical 
means, and some of the body heat is generated bv slow combus- 
tion. Temperature of the body is also generated by the brain, 
muscles and glands. When the vital processes which generate 
temperature in the living body cease, as they do after death, there 
is then a gradual and progressive decline in the body temperature, 
until it arrives at a degree equivalent to that of the surrounding 
air. This post-mortem loss of heat seldom falls to a degree less 28 
than that of the surrounding media, unless the temperature 
rapidly increases in the atmosphere. The body after death 
ceases to produce or generate heat. It is then nothing but an 
inert mass, but according to some authorities parts with its heat 
less rapidly than other media. For instance, a body covered with 
a thick coating of fat, or covered with clothing, will cool less 
rapidly than another. Certainly if a person dies in bed, cov- 
ered with bed clothing and perhaps heat in the room, his body 
will retain and preserve its heat for a longer or shorter 
period; there will be less cooling of the body in this 
case than if the person had died in a cool room and with body 
uncovered. For instance, a person dies at a hospital, his body 
is at once removed to the dead house, his external and internal 
temperatures rapidly decrease. Chemical changes rapidly dimin- 
ish after death, still there may be a slight rise in temperature in 
the interior of the body, due to the continuance of metabolic 
changes in the tissues; at the same time respiration has ceased, 
consequently the blood can not be cooled, because it can not be 
sent through the lungs and capillaries of the periphery. Between 
rise of temperature in the dead body and cooling of the dead 
body there is complete opposition; the temperature of the 
periphery is the slower in cooling, thus the temperature externally 
varies, and must not be mistaken for the superficial coldness of 
collapse, which implies the cessation of the peripheral circulation 
only. The coldness of the cadaver, apparent to the touch, is no 
criterion of the cessation of life, for the simple reason that there 
is still a certain amount of internal heat that has to be parted 
with, and the body which is cold to the touch before death may 
after death show a rise in temperature, due to radiation of the 
internal heat. Circumstances favor radiation and the conduction 
of heat in the bodies of the dead the same as they favor radia- 
tion and the conduction of heat in inorganic bodies. Cooling of 
a dead body is slow if the cause of death has been a disease of 
long duration, as consumption of the lungs, but if death be due 
to hemorrhage, then cooling of the body will be a rapid process; 
but if death be due to an infectious disease there will be an ini- 
tial rise of temperature as soon as death occurs. Is this due to 
a rapid rigor mortis, or is it due to a continuance of thermo- 
chemical or other processes in the body! Consequently cooling 
of the body is not a sign of death to be classified as positive; it 29 
is the progressive cooling of the body which stamps death as 
certain. Many conditions may impede the peripheral circulation, 
drunkenness being one of them ; if death takes place during this 
condition, the spasm in the blood vessels which hindered circula- 
tion relaxes, and the temperature as a result of this rises. Cooling 
of the body is most perceptible in the axilla, but is equalized in 
some hours all over the body. After death from certain diseases,, 
as rheumatic fever, tetanus, asphyxia, apoplexy, typhoid and 
scarlet fevers, the body may retain its heat for a long while, and 
even show a rise of temperature. I have repeatedly observed this,, 
as have other observers. Thus the time occupied in cooling the 
body may be prolonged after sudden death, and also by the 
above mentioned causes of death, the body may retain heat for a 
number of days after death, without any explainable cause; thus 
the time elapsing since death can not always be reckoned by the 
temperature. Cooling of the body may be very rapid after 
death from chronic wasting diseases, hemorrhage and fevers, 
the external temperature being reduced to that of the surround- 
ing air within four or five hours. The body of a well-nourished 
person will cool less quickly than the body of a child, or old 
person. The phenomenon of cooling is modified to a certain 
extent by the temperature of the surrounding air, protection of 
the body from currents of air, and the ability of the internal 
organs in retaining their heat longer than the surface of the 
body. Thin and emaciated bodies cool more rapidly than others, 
fat being a non-conductor; a body that is exposed to the air will 
lose its heat more quickly than when it is enclosed, and a body 
unclothed will lose heat more quickly than if it were clothed. If 
the room of death be a large and airy one heat will be given off 
from the dead body more rapidly than if the room be a small, 
close and confined one. A body taken from the water loses its 
heat more rapidly than if it had been exposed to the air. In fact, 
bodies cool more rapidly in the water than in the air, and more 
rapidly in the air than indoors, more rapidly when exposed to a 
draught than in a tranquil atmosphere, more rapidly in a large 
apartment than in a small one. A large body requires more 
time to cool than a small one. It is claimed that if a body is 
exposed in a cold room and the temperature of that 
body falls to that of the surrounding air, that is 
to about 20 degrees centigrade, then death is certain. 30 
As far as my experiments are concerned, temperature has 
proven nothing, for I have known bodies of living persons to be 
as cold as ice, and not be near death. The heat of the interior 
of the body may be retained much longer than the heat of the 
external surface, the internal organs frequently being 10 to 20 
degrees above that of the surface. A continuance of molecular 
life, after the cessation of somatic death, is the cause undoubt- 
edly of heat after death. The rate at which cooling occurs 
is most rapid, as a rule, immediately after death; this is also 
the case where a post-mortem rise has occurred. The time usually 
occupied in cooling is from fifteen to twenty hours, subject to 
modifications which were attendant upon the death. The body 
may be quite cold in about twelve hours; after the preliminary 
rise the temperature gradually falls on an average at about the 
rate of one degree Fahrenheit an hour. During the first three 
hours after death, the body loses as much as 3M degrees per 
hour—many times, less; it then gradually falls until in about 
fifteen to twenty hours it is that of the surrounding air. 
Certain conditions before mentioned will influence this cooling 
of the body, so that the average time within which the body 
cools varies. To sum up, it is varied by the condition of the 
body at the time of death, the manner of the death, and the cir- 
cumstances under which the body had been placed. The aver- 
age rate of cooling for the first three hours, according to an 
eminent author, being about 3 >6 degrees Fahrenheit, which would 
make 10ia degrees in three hours, then in the next six hours 
the rate would be 3 degrees per hour, from then on 1 degree 
per hour; in some cases cooling is complete in five hours, 
in others nqt so for twenty-four hours. In the experience of 
all, it can be asserted that cooling of the extremities exists for 
many hours before death. Return of color to the cheeks has 
been frequently observed in bodies of those who, for the pur- 
pose of preservation, have been frozen by ice, and on the day of 
interment they are removed from the receptacle for freezing and 
placed into the casket for burial, a flush of color ensues not 
unlike the natural hue of a healthy person; this does not last 
very long, but passes into the dusky hue of decomposition. In 
these cases there has been a rise of temperature above that of 
the previously surrounding media immediately on taking the 
body from the freezing mixture. 31 
(a) Temperature Test. — With the thermometer we can 
only approximately pronounce upon the time that has 
elapsed since death. In order to do so even approx- 
imately we must take into account all the conditions 
which modify the rate of cooling of the body, and then 
we can only state the probable time. We know that cause of 
death has something to do with the cooling of the body; still, 
knowing this, we could not infer what actually caused death by 
the state of the thermometer when applied to the body. Cooling 
of the body is a less certain sign of death than some others, 
because the phenomenon of cooling is varied by so many condi- 
tions. In making observations the use of the thermometer for 
ascertaining post-mortem temperature is indicated; the sense of 
touch is not sufficiently delicate for noting actual coldness, it 
will detect apparent coldness only. The temperature of the ex- 
terior of the body should be noted as well as the temperature of 
the interior of the same. In taking the temperature of the ex- 
terior of the body, the axilla may be employed, although the 
tension of the gas which forms in the abdomen, after death, 
drives the blood toward the periphery; thus this part of the 
body gets a little warmer, but in about 30 hours an equi- 
librium is established between the temperature of the rectum 
and that of the axilla. In taking the internal temperature the 
mouth or rectum may be used to place the thermometer in posi- 
tion. If the temperature of the dead person is taken in the mouth, 
you will find it lower than the temperature of the surrounding 
media. Here also, the conditions must be taken into consideration 
which tend to reduce temperature in the dead body. It 
has been contended that as the temperature of the 
skin is always increased during muscular contraction 
in the living person, by electric stimuli, this absence 
of increased temperature in muscles would be a sign 
of death. The thermometer is to be placed upon the skin 
before and after muscular contraction, and the difference noted. 
Temperature in a muscle may indicate death, still the heart may 
beat. Temperature taken in the mouth indicating 62 deg. F. is 
as certain of death as any sign can be, but is not as applica- 
ble as other tests. In from five to eight hours the temperature 
of the deeper tissues falls to about 80 deg. F,, while a few 
hours after this it may be found to be higher. As regards 32 
temperature, I will say that a continuous and progressive cool- 
ing is a more certain sign of death than death certified from an 
absolute temperature. 
The following were the temperature observations made by me 
in my series of cases. Of course all cases were not subjected to 
the temperature test for various reasons: 
External Temperature. 
These observations were made simply by placing the bulb of the ther- 
mometer on the skin of the abdomen, and holding it there. 
2 to 3 hours 
after death. 
4 to 6 hours 
after death. 
3 to 8 hours 
after death. 
12 hours or 
more after 
death. 
N umber of observa- 
tions 
812 
70ft 
812 
559 
Maximum temperature 
of the body 
95 deg. F. 
88 deg. F. 
81 deg. F. 
78 deg. F. 
Minimum temperature 
of the body 
59 deg. F. 
59 deg. F. 
68 deg. F. 
57 deg. F. 
Average temperature 
77 deg. F. 
72.5 deg. F. 
89.5 deg. F. 
87.5 deg. F. 
5. Loss of Sensation and of Motion.—The absence of the 
power of motion, and of sensation, are unimportant signs of 
death in my estimation. The same conditions obtain in all cases 
of suspended animation, asphyxia, trance, syncope, apoplexy, 
catalepsy, and in some diseases and injuries of the skull and its 
contents. At death, or immediately thereafter, there is a general 
relaxation of the muscular system, the muscles of the lower jaw, 
relax, allowing a dropping of that bone. The joints become 
flexible, the tone of the muscles disappears, but their contrac- 
tile power remains; moreover, muscles that are contracted by 
living forces at the time of death, as in cases of poisoning by 
strychnia, do not necessarily become relaxed in death. Per- 
sistency of muscular contractility after death, and the disappear- 
ance thereof follow a fixed order, the first parts to present this 
change being the neck and trunk; next the lower extremities 
and lastly the upper, while its departing follows the same order. 
The duration of this phenomenon is shortened by its exposure 
to warmth and moisture, also to ammoniacal, carbonic, and 
sulphuretted hydrogen gases; it is unaffected by carburetted 33 
hydrogen, sulphurous acid, and hydrogen gases, nor is it di- 
minished in cases of asphyxia. The continuance of this prop- 
erty of muscular fibre is considerably modified by the nature of 
the disease of which the person examined died. In cases of 
persons who had died of peritonitis, it disappeared in three 
hours, in tuberculosis and malignant diseases in from three to 
six hours, in death from mortal lesions of the heart, or profuse 
hemorrhages in about nine hours; these observations correspond 
to those of other authors. In apoplexy with paralytic symp- 
toms, in about twelve hours, and in adynamic fevers and pneu- 
monia, in about twelve to fifteen hours. Softening or want of 
elasticity of the tissues of the body which comes on soon after- 
death, is the first of the changes resulting from the destruction 
of their physical properties. The parts of the body on 
which it rests will become flattened, and the skin will present 
the marks of any peculiar figure upon which it may have 
been lying, and the skin and muscles will not resume 
their original condition upon the removal of the pressure 
which, either by the weight of the body itself, or from 
external sources, has been applied to the parts which 
show this loss of elasticity. This flattening of the dependent 
parts has been considered a valuable sign or indication of the 
reality of death. It is true that this insensible condition of the 
muscles may exist in life and not lead to death, but the insen- 
sibility and loss of power in the muscles that occurs after death 
is a characteristic sign of death, and occurs in the muscles of 
the lower jaw, eyelids, limbs and joints, the two latter becom- 
ing flabby, soft and flexible. The muscles become hard and 
contracted as the body cools, stiffening the joints and present- 
ing an unyielding corpse; the muscles may become flaccid and 
contractile, rigid and incapable of contraction, or relaxed and 
incapable of further contractibility. Insensibility coming on at 
death is complete, while that which follows hysteria, or certain 
general anesthetic conditions, present the same conditions. 
Loss of motion and falling of the lower jaw- have been consid- 
ered as certain signs of death, but the latter is not a constant 
sign. At death the muscles become immobile, but the sphinc- 
ters relax ; contractility of the muscles lasts for some time, then 
disappears; insensibility and inability to move often precede 
death, and as we have seen occur with disease, do not necessa- 34 
rily produce death. The condition of the muscles of the face 
at times depicts the mode of death. I have observed this in 
many instances; it is virtually reading death in the face. The 
expression of the muscles of the face at the time of death 
becomes a fixed one—reposeful when killed by the knife, pain- 
ful when killed by the bullet. After the action of the heart 
has ceased, usually in about three hours, the entire muscular 
system loses its excitability. Though the body be dead as a 
whole, certain parts may continue to retain an independent 
vitality after this so-called somatic death. This is seen espe- 
cially in the muscles, which may retaiu their electric contrac- 
tility from two to three hours after death. 
(a) Electrical Test.—The existence of electrical contractility in 
the muscles of a body supposed to be dead indicates life, or death 
within a period of two to three hours. The muscles will respond 
for a certain time to electric or other stimuli for some time after 
death. The absence of muscular irritability upon application of 
an electric stimulus of galvanic strengh has been laid down as 
a certain criterion of death. The nature of the disease, which 
caused the death of the subject experimented upon, exerts con- 
siderable influence. To get the irritabliity of the muscle you 
must use the galvanic current, though the existence of muscular 
irritability may be demonstrated by simply pricking or other- 
wise irritating a nerve of motion leading to the part. This prop- 
erty is usually lost in from eight to twenty hours. I experi- 
mented in this manner on the bodies of 402 persons and in 107 
irritability asserted itself within an hour, in sixty-seven it 
showed its presence at the end of the second hour, and in four 
at the end of the third hour, the balance presented no muscular 
irritability. The electric current affords almost a certain method 
of ascertaining whether life be extinct or not, by its success or 
failure in producing muscular contractions. The shocks must 
be used at different tensions and intermittinglv. Unless it is 
used skilfully it will fail. The Faradic battery may also be 
used, by attaching it to an electric needle, the needle being 
stuck into the muscle to be experimented upon. The most ele- 
mentary machines may suffice for the purpose; if the same 
determines on the arm of a living being a slight contraction, and 
no contraction whatever on the muscles of the face of the dead 
person, one might affirm that the person is dead, whereas the 35 
muscles of the face are the first to lose their contractility, con- 
sequently care must be observed in giving an opinion, as to the 
certainty of death, in these particular cases; if the slightest 
trace of contractility be observed the same apparatus should be 
without delay employed to electrify the heart, and if death is 
only apparent, one might thus, in restoring the action of the 
heart and the respiration, restore the subject from apparent 
death to real life. Cadaveric rigidity being liable to occur 
before death it is prudent to wait for the first sign of putrefaction 
before declaring that rigidity and consequent muscular irri- 
tability has been absent. 
(6) Heat Test.—Various means may be employed in applying 
heat to the skin. Melted sealing wax may be used, for in- 
stance, by dropping it upon the skin. A candle flame may be 
used until a vesicle forms on the skin. I used the sealing wax 
in forty-two cases without any response as regards sensibility or 
motion. A needle may be inserted for a quarter of an hour, 
and for a quarter of an inch, through the skin into the muscle, 
heating the part protruding with a spirit lamp. If a blister is 
produced by the application of these tests, and it is opened and 
contains a serum rich in albumin whilst the cutis vera, after the 
cuticle has been removed, presents a reddened appearance, more 
especially if after a short interval a deeply injected red line 
forms around the blister, absolute evidence is afforded of the 
vitality of the part to which the heat was applied, and exceed- 
ingly strong confirmatory evidence of the life of the person. If 
a blister formed by the application of flame to the body contains 
air, ora little non-albuminous serum merely, the cutis vera after 
the removal of the cuticle appearing dry and glazed, moreespeci 
ally if, after an interval, no red line becomes visible around the 
blister, the evidence is absolute that the part so treated was dead, 
whilst the presumption is strong that the person himself was 
dead. In a dead body a burn may cause a blister, but it will 
not form an areola. Let a drop of melted sealing wax fall on a 
limb that has just been amputated, and you will succeed in pro- 
ducing a blister. The test of burning is therefore a doubtful 
one. Heated fiat irons may be applied to the heels of dead per- 
sons of whose death it is desired to obtain assurance. Another 
sign is to apply the flame of a candle at the distance of half an 
inch from the extremities of the fingers or toes; if death is real 36 
the epidermis of that part of the finder exposed to the flame dries 
up and separates from the cutis. It forms an air blister, which 
bursts suddenly with a disengagement of gas which is some- 
times strong enough to blow the candle out. This is not a con- 
clusive or certain sign of death. 
I have applied this test in 17 cases but have had no positive 
result one way or the other. A flame held close to the skin will 
form a blister; if this blister contains serum the person is still 
alive, but if it contains air only, theperson is dead. I have seen 
a blister containing serum produced after death, in applying 
alcohol cups for the purpose of ascertaining whether blood 
would How after death or not. consequently I hold this as an un- 
reliable test. A burn on the body of a living person usually 
produces a blister which is surrounded by a reddish areola, and 
which contains an albuminous liquid. When this blister is 
opened, a network of small dilated blood vessels is seen. 
Although this is the usual result, it is not a constant condition in 
life ; for instance, the albumin may be absent from the serum. If 
the same individual died at the moment he was burnt, blisters are 
produced, but as a rule they contain no serum and there is no con- 
gestion. Heat may also be applied to the skin, by means of a 
piece of iron or steel, heated red hot for at least the space of a 
ten seconds. If no blisters have formed, tilled with Hind, then 
death is supposed to be a certainty. I used this test in 72 cases 
and in six of them where death had positively taken place 
within three hours, I succeeded in forming blisters. 
(c) Caustic Test.—If caustic be applied to the skin of those 
really dead, either no eschar is produced or the skin turns yel- 
low and transparent, but if the caustic be applied to the skin of 
living person, the eschar produced is of a black or reddish 
brown color. I applied strong caustic to the bodies of 85 dead 
persons, and in two of them produced eschars similar to the 
eschar produced in the living body. 
6. Muscular Flaccidity and Coxtra< tility.—We have now 
a case of a certainly dead body to deal with. What are the first 
changes that take place, in a general way! The muscles have 
taken on a condition of flaccidity, their tone has disappeared, 
they are in a state of inaction as far as voluntary movement is 
concerned, the masseter and other muscles allow the jaw to drop, 
the muscles that form the eyelids are so flaccid as to give the eye 37 
the appearance of being: half closed, the muscles of the limbs 
have so far lost their tone that the joints become flexible-, and 
the limbs flabby and soft. To determine whether the muscles 
are contractile or not was discussed under the heading; of loss of 
sensation and motion. This period of muscular flabbiness and 
softness precedes the occurrence of rigor mortis and must not be 
confounded with the softness of the tissues preceding putrefac- 
tion. Flattening of the soft parts of the body takes place, the 
parts become very pliable, and may remain in this condition 
from three to twenty-four hours. Of my 7900 cases observed, I 
found muscular flaccidity in 1018. This stage of muscular ftac- 
cidity produces a more than usually placid expression, with 
marked pallor; at times a drawn, contracted, painful expression, 
with reddened countenance, may be remarked. The peculiar 
sharpness of the chin, and of the nose, the paleness of the lips,the 
sunken eyes, the temples hollowed out, the cheek bones promi- 
nent, the forehead dry, the brow wrinkled, the skin livid, these 
are the principal and chief features found immediately after 
death, and are almost characteristic, consequently called by some 
authorities “ Facies HippocraticaIdentification of a body may 
be so difficult, from these changes produced immediately after 
death, that parents, brothers and sisters are not able to identify 
their own, and, on the other hand, these changes may be entirely 
absent after death, or they may be well marked during life. 
The pale ashy color that in some cases covers the entire body is 
not a sign of death, for the reason that those dying of yellow 
fever and other diseases may show the same color. Death-like 
color frequently occurs in syncope, collapse and chills and fever ; 
reddish color remains for some time after death in those who 
had in life a ruddy complexion. Jaundiced skin never becomes, 
white after death. Ecchymotic spots always retain the color 
they had at death, as I might as well say here that the so-called 
“ Facies Hyppocralica ” is an unsafe sign to go by, it is some- 
times decidedly absent in sudden death. Pallor of skin is due 
to absence of circulation, still in all cases of death there is 
absence of circulation and not always pallor of the surface. 
Ulcers and burns may show reddened and livid rings around 
their edges, after death; tattoo marks, the spots of purpura 
hemorrhagica, bruises and ecchymotic spots also remain. 
7. Cadaveric Ecchymoses, Lividity or Hypostases.—Of 
this change I noted 7802 instances in the observations which 38 
covered the 7900 cases. Consequently it was noted in nearly all of 
my cases, either post-mortem ecchymosis, lividity, or hypostasis, 
singly or combined. This change, which is in almost all cases 
apparent to the eye, occurs within a few hours after death, and 
is characterized by the livid and ashen gray tinge, covering the 
most dependant parts of the body. This is due to the still fluid 
blood settling in the most dependant tissues, or a virtual stag- 
nation. This phenomenon is also called suggilation. This 
settling of the blood gives rise to patches which mav be sepa- 
rated from each other, but which later run into one. These dis- 
colorations are sometimes mistaken for bruises, which can easily 
be settled by the division of the tissues. Hypostatic congestion 
is nothing more than cadaveric lividity, when this term is ap- 
plied to the lungs or other internal organs. This settling or 
gravitation of the blood takes place during the cooling of the 
body, and continues sometimes for about twelve hours, during 
which time, if the position of the body be changed and the 
blood is still fluid, they may be made to disappear and re-ap- 
pear. They will then appear in whatever part of the body is the 
most dependant. This post-mortem staining is taken as a positive 
and conclusive sign of death, and occurs in death from what- 
ever cause, without exception. It is claimed that when cooling of 
the body stops, as a result of death, that then the cadaveric pro- 
cess ceases; it probably ceases to form hypostatic, ecchymotic, 
and livid spots, but the discolored parts of the body become of 
a deeper hue; this is ascribed to the blood pigment. No doubt 
the coloring matter of the blood exudes from the vessels into 
the surrounding tissues This pigmentary discoloration can not 
be made to disappear, as the discolorations due to cadaveric 
hypostases can, they are, therefore, a reliable sign of the fact 
that death has taken place at least twelve hours before. The 
bodies upon which I did not notice these post-mortem changes 
were the bodies of those burnt or too far advanced in decompo- 
sition. They are present even in cases of death from hemor- 
rhage, but as a rule not well marked; still in a case of post-mor- 
tem hemorrhage seen by me within five minutes after death, I 
saw the most marked cadaveric congestion in all my experi- 
ence. These ecchymotic, livid and hypostatic spots occur 
usually when death is so certain that we need not examine 
for them. These cadaveric stainings are not the result of 39 
decomposition, they occur long before that process, especially 
in the stage of muscular flaccidity and contractility, while 
the body is still warm, and in the process of cooling; 
as soon as the body has cooled sufficiently, this process ceases. 
These spots may be of variable sizes, owing to the amount of 
blood in the vessels, also to the size of the vessels; if at the 
time of death circulation is very active, then you may expect 
to find post-mortem staining of a very decided character. Inter- 
nal hypostasis takes place at the same time as the staining ap- 
pears on the surface of, or rather the dependant parts of the 
body. It is held that in dead bodies, not only may ecchymoses 
become more extensive owing to hypostatic congestion, but cap- 
illaries may even burst, and thus produce hemorrhages which 
differ in nothing from those petechial hemorrhages which occur 
during life. This is the deduction of the late Professor von 
Hofmann, of Vienna; he suspended bodies, which were dead 
twrenty-four to forty-eight hours ; in these it was possible to pro- 
duce extreme degrees of hypostatic congestion, but no ecchymo- 
sis; but if bodies were suspended a short time after death, 
taking the bodies of newly born infants for this purpose, small 
punetiform or streaky hemorrhages were produced in the con- 
jr.nctiva of the eyeball in from a few to twenty-four hours after 
suspension, which could not be distinguished from ordinary 
ecchymoses which had been produced during life. I recently 
suspended the bodies of three newly born infants, within 
thirty minutes after death, and noted particularly that they had 
no hemorrhages on the conjunctiva of the eyeball before suspen- 
sion,but after being suspended foreighteen hours, ! noted thesame 
conditions as were noted by von Hofmann. It is also possible 
to -watch the gradual enlargement of these hemorrhages; in 
some instances small petechias were produced, even in the cortex 
of the hemispheres of the brain, over the convexity, which 
looked like those produced by commotion or capillary embolism. 
Von Hofmann further says that before suspension there was 
not the slightest evidence of conjunctival hemorrhage in his 
eases. 
This theory of suspension as a cause of hemorrhage into the 
conjunctiva? is applicable to cases of persons found dead and 
hanging out of the bed. In such cases, where the upper part of 
the body was found hanging over the side of the bed, Von Hof- 40 
maun has detected numerous petechia1 in the skin over the chest 
and abdomen, the shoulders, arms, neck and face of bodies of 
people who have been found dead, lying in bed with the upper 
part of the body hanging out over the edge of the bed; this 1 
have noted in four cases recently. He says, further, that it is 
not necessary that the bodies should be found in a dependant 
position ; even those who are stretched out horizontally on their 
backs show sometimes, especially when their blood remains 
liquid for a time, a number of petechia on the back and the sides 
of the chest and abdomen. The fact that these are more often 
found in old people justifies the supposition that the greater 
vulnerability of the walls of the capillaries in old people predis- 
poses their bodies to ecchymoses of this kind. Occasionally these 
ecchymoses are found in the bodies of persons who died of prus- 
sic acid poisoning and in children who have been suffering from 
rickets or acute and chronic gastro-enterits. It is quite possible 
that the origin of these post-mortem petechia is to be sought in 
minute capillary hemorrhages which occur in the agonal stage 
and become visible only after death, owing to hypostatic oozing 
of blood from minute rents in the capillary walls. If this be 
true, then the differential diagnosis between post-mortem and 
ante-mortem ecchymosis will be difficult as long as these hemor- 
rhages are so very small. He writes further that in intra-vitam 
hemorrhage the blood ought to be coagulated, but that we now 
know that the blood retains its coagulability for some hours 
after death, and if, as is often the case, a post-mortem hemor- 
rhage takes place between muscle fibres, it may be impossible to 
remove it thence with water. But when one finds on cutting 
into an ecchymosis that the blood clot or the blood flows out by 
itself, or on gentle pressure, then it is clear beyond doubt that 
the ecchymosis has occurred after death. During life ecchymo- 
ses are much more frequently observed in children than in 
adults. The same seems to hold good also as regards post-mor- 
tem ecchymoses in internal organs; whereas cutaneous ecchy- 
moses are more frequent in adults than in children. 
It can not be doubted that occasionally ecchymoses are formed 
in the lungs, the heart and the thymus, according to the same 
author, in consequence of the pressure of the blood, which, 
following the law of gravitation after death, is collected in the 
dependant parts of the body; but it must also be remembered 41 
that in many instances minute lesions may have occurred in the 
walls of capillaries during the agonal stage, which after death 
become larger, and therefore visible to the naked eye. Nothing 
could be more injudicious than to diagnosticate death from suf- 
focation because a few ecchymoses have occurred under the 
pleura or the pericardium of children who have been found 
dead in bed. Such ecchymoses are of diagnostic value only when 
they appear in parts where there is not, and never has been, 
any hypostatic congestion, when there are signs of hyperemia 
and congestion which have existed during life, and when infec- 
tious and septic diseases, diseases of the blood and indications 
of poisoning can be absolutely excluded. The important deduc- 
tions of Von Hofmann widen the field of research, in cases of 
suffocation, where heretofore ecchymoses found under the 
pleura and pericardium have been assigned as positive diagnostic 
post-mortem evidences of death by suffocation. The blood in a 
dead body coagulates in the same manner as does the blood that 
flows from a wound in the living; consequently the position of a 
dead body may be denoted by the clot found in the interior there- 
of, the lower portion of the clot being of a deeper color than the 
surface of the same. The blood is obedient to the laws of 
gravitation, and congests the superficial capillaries ; as decompo- 
sition comes on the gases evolved therefrom give the eechymotic 
spots a deeper color. These eechymotic spots are usually 
situated in the congested capillaries, in dependant parts of the 
body that are not subjected to pressure; they are irregular in 
shape, dark colored, and never elevated above the skin; they 
appear in patches, gradually running into each other; upon 
incision no effused or coagulated blood escapes, excepting what 
may escape from the points of the divided veins; when putre- 
faction sets in these spots are not characteristic any longer and 
may hardly be distinguished from the bruise on a living body. 
8. Cadaveric Rigidity, Cadaveric Spasm, Rigor Mortis.— 
Muscular rigidity was considered for centuries as a certain sign 
of death. It is a condition which endures longer in summer 
than in winter; thus of 3602 dead bodies seen by me in a condi- 
tion of rigor mortis, 2289 I saw in the heat of summer, and in 
these rigor mortis lasted from 36 to 48 hours. Rigor mortis is 
the concluding indication of the positiveness of death. It pre- 
cedes in almost every case the phenomena of putrefaction, and 42 
comes on generally in from five minutes to four hours after 
death, though sometimes its appearance is postponed until much 
later. It does not invade the muscles of the whole body all at 
one time, it does so gradually. It is a characteristic stiffness 
occurring in the muscular system after death. In many eases it. 
has passed away before the body has been seen; its time of 
appearance and its duration differ in every case, it becomes gen- 
eral, that is I have noted so in my experience, it is lasting and 
generally well marked. There is nothing that can be mistaken 
for it; the bodies of the dead are usually kept long enough for 
this condition to appear; this and putrefaction are almost abso- 
lutely certain signs of death, although one must wait too long 
for them to appear. Of course certain forms of rigidity that 
may occur during life may be mistaken for rigor mortis, as for 
instance tetanus, rigidity from apoplexy, catalepsy, syncope, 
asphyxia and hysteria. But in rigor mortis there is no warmth 
of the body as there is in these diseases; furthermore in rigor 
mortis there is a gradual stiffening of the muscles, whereas in 
these diseases the spa.»m of the muscles is a general one. In the 
rigor mortis of death, the stiffness usually commences in the 
muscles of the neck and lower jaw and then gradually affects 
the other parts of the body. Another distinction between stiff- 
ness of disease and that of rigor mortis is that if a joint be 
forcibly bent in a condition of rigor mortis, it will never return 
to its former condition. There is a spasm of the muscles, which 
is usually observed in certain cases of sudden death, as after 
the more violent forms of death, in battles or from apoplexy, or 
injuries of the cerebro-spinal axis; this is called cadaveric spasm 
and may occur after death from any cause, it is simply prelim- 
inary to rigor mortis proper. It may at times be indistinguish- 
able from rigor mortis, or it may escape the notice of the 
observer. It is simply a failure of the limbs to relax at the 
time of death, no interval being observable between the contin- 
uance or departure of the vital tension of the muscles and their 
fixture by rigidity. 
Commencing at the latest instant of life, the rigidity coutin- 
therefore know that fiaccidity of the muscles is not a bar to the 
supervention of rigor mortis, in fact there may be no stage of 
muscular fiaccidity; the stiffness of the muscles proceeds after 
death in regular order all over the body; the muscles of one part 43 
of the body may be in rigid contraction, whereas the muscles of 
other parts may still be supple and pliable. Rigidity passes off in 
the same order as it began, and when once gone, never returns. 
The body now becomes'as pliable as it was prior to this change, 
and is then attacked by the processes of decomposition. The 
order of the occurrence of post-mortem rigidity has been ob- 
served differently by many observers, so that a regular order 
can not be enunciated. In the majority of my cases the change 
took place in the muscles of the face first. This is about the 
only place on which the majority of the authors will agree, 
and even the laity know well the characteristic changes in the 
eyelids and jaw. In my series of cases, rigidity, soon after at- 
tacking the face, invaded the muscles of the lower extremities, the 
muscles of the trunk and upper extremities, in my observations 
stiffening last. The period of post-mortem rigidity, as regards 
its duration is variable, certainly enduring longer in winter than 
in summer. In my series of cases I have seen it last in one case 
two weeks, in another for three weeks. It was a common occur- 
rence to find rigidity in the cases of still-born children and even, 
in children who had breathed a few times, to occur very rapidly. 
Of the number of drowned included in my observations, 95 per 
cent, showed marked and lasting rigor mortis; this is due to 
the fact that the water is always a few degrees colder than the 
air, and also that it is a better conductor of heat, in this manner 
the process of decomposition is retarded, but this rule does not hold 
good in all cases, for it has been shown that decomposition may, 
and does occur even in a warm bath, in hot countries, and when 
the temperature of the dead body is above the normal. The ap- 
pearance of rigor mortis and its duration are due in great part 
to the development of the muscle and its nutrition, the nutrition 
being altered by the amount of suffering or fatigue the person 
was subjected to before death. In all the cases where paralysis 
had existed before death, the paralyzed limbs were also attacked 
with the rigor mortis, which is such a constant sign of death that 
some authors claim that it is never absent in any case. In 
some diseases where the temperature is very high, and death re- 
ues uninterruptedly till the muscular tissues have begun to 
alter under the effects of putrefaction. Rigor mortis occurs 
sometimes a little before the disappearance of muscular soften- 
ing, but usually it denotes the end of muscular fiaccidity. The 44 
body is now as rigid as a bar of iron and all efforts avail noth- 
ing to bring it into a state of contraction. Whatever position 
the limbs were in, when rigor mortis begins, that position they 
retain, and it takes considerable force to move the limbs. This 
condition exists until putrefaction begins, but the length of 
time of its duration is variable; it affects all the muscles extern- 
ally and internally; when rigor mortis is once on the wane, and 
disappears entirely, it never returns. When it does disappear 
it is followed by the first processes of putrefaction, although 
decomposition may occur in some organs while the body is yet 
rigid. In cases where severe and prolonged convulsive move- 
ments from whatever cause precede death, rigidity sets in early. 
Not only does it occur early, but it disappears very rapidly, in 
those who die from exhausting affections, of whatever nature. 
It may last for days, while it usually exists about thirty hours. 
The duration of rigor mortis is modified by temperature, by the 
physical condition of the person before death and by the mode of 
death. In this connection I may state that the age of the sub- 
ject has an influence on its duration. Of the 7900 dead bodies 
of human beings observed by me, 3602 were in the stage 
of cadaveric rigidity, at the time of inspection. In those which 
were inspected, in cool or cold weather the cadaveric stiffness 
of the limbs was most marked and continued longer 
than in those bodies exposed to heat of any high degree, as was 
also the case in the bodies of subjects who had died suddenly 
or quite so, while in apparent good health. In cases of death 
from suicide, homicide, or accident, the duration of this condi- 
tion of cadaveric rigidity was also of greater length than in the 
instances of persons dying of the every-day affections. Of course 
these observations refer particularly to the bodies of those of 
tender age, whether infantile or senile. There is no doubt of 
the fact that the volume of the muscle which becomes rigid, and 
they certainly do all become so, is diminished in its calibre. 
They are no longer in a condition of irritability, or elasticity; 
their mobile condition, under the influence of the experimenter’s 
fingers, is displaced by a condition akin to an immobile body of 
whatever nature. They become firm in their consistency ; their 
flaccid condition is a phenomenon of the past. How often is it 
seen that a body is found dead in bed, in a position very like 
the position taken on retiring to sleep; the supposed live person 45 
is not disturbed. On further investigation, it is found that the 
person is really dead, and the life-like position is due to the fact 
that the muscles retain the exact position they assumed immedi- 
ately before death, or occupied at the time rigidity came on. 
Cadaveric rigidity is a condition that is common to all the mus- 
cles, voluntary or involuntary. It is a phenomenon which is 
dependent on the state of the muscle itself, since it is found in 
these structures no matter what the condition of the surrounding 
tissues is. While the influence of a cool temperature delays the 
appearance of rigor mortis it also retards its disappearance. In 
17 cases I have seen rigor mortis complete within two hours; in 
140 cases it was complete in three and a half hours; in 162 cases 
it was complete in five hours; in 206 cases it was complete in 
five and a half hours ; in 292 cases it was complete in six hours; 
in 1798 cases it was complete in seven and a half hours, and in 
the balance of the cases it showed itself as complete in from 
eight to fifteen hours, that is in 986 cases. 
As before stated, rigor mortis may not appear for many hours. 
This is regulated by the suddenness of the death, or by the pre- 
viously weakened condition of the body. A firmly contracted 
heart may be mistaken for a hypertrophy of that organ; where- 
as it is but an indication of the well-known fact that voluntary 
muscles stiffen later than the involuntary; the heart being an 
involuntary muscle, becomes hard and contracted as a result of 
the processes of post-mortem rigidity almost as soon as death 
occurs. But there are other muscles which take on this early 
rigidity, for instance the muscles which compose the eyelid, 
which in some cases are rigid before death occurs. Changes in 
the muscles of the face are very frequent before death, and 
when these changes do occur, it is usually the case that post- 
mortem rigidity fixes this change, as it were, and renders identifi- 
cation of the face of the body almost impossible. Warmth does 
not, in all cases, retard rigidity. The body is certainly not cold 
in all its parts before death, still rigidity will and does set in, 
even before the heart has ceased to beat. 1 have seen rigidity set 
in almost within five minutes of death, before and after. We 
suits therefrom during the height of the fever, rigor mortis 
makes its appearance very early and lasts a long time. I have 
noticed this in two cases of septicemia recently. But it has 
always been evident that it is not so much the disease which in- 46 
fluences the early occurrence and duration of rigor mortis, as 
it is the powerful and healthy condition of the muscles. The ex- 
planation thus far given by authors for the occurrence of rigor 
mortis, have not been wholly accepted by the students of 
medico-legal-science, still the plausible theory is the one which 
claims coagulation of a proteid in the muscle plasma, form- 
ing a substance called myosin, as the direct cause of this 
peculiar condition of the muscles. Stimulation of the muscu- 
lar system, by whatever means, may be accomplished be- 
fore the occurrence of rigor mortis, but once this condition 
sets in, there is then no such thing as contracting a muscle by 
electric or other stimuli. In every case that I have met with, 
numbering 3602, this condition of rigor mortis was a sure and 
positive forerunner of the interesting processes of decomposi- 
tion. To come back for a moment to the cause or causes of post- 
mortem rigidity, allow me to say that physiologists make the state- 
ment that the acids of the body which can no longer be removed 
from the body after death has occurred, coagulate the myosin, 
which is in the muscles; in this change the muscles become 
opaque instead of transparent; putrefaction develops ammonia, 
this ammonia, or product of decomposition, dissolves the myosin 
of the muscles, and thus the muscles return to a softened con- 
dition. I have noted in many cases that if the muscles were 
subjected to a great degree of irritability during life just pre- 
ceding or at the time of death, that then the stiffness of the 
muscles comes on late and lasts a long period of time. In these 
■cases certainly putrefaction shows itself late, consequently it 
becomes a very slow process. Rigor mortis is an incontroverti- 
ble sign of death, but occurs so late as to become like putrefac- 
tion, we might say, but a stamp to the preceding signs of death. 
Putrefaction is the trade-mark of real death, and, with rigor 
mortis, is a constant occurrence. It is claimed that rigor mortis 
does not. occur in still-born children. I have seen it very re- 
cently in the bodies of still-born children. Rigidity may exist 
in the uterus, and pass away before the fetus is expelled. To 
fix the time when death occurred by calculation, with rigor 
mortis as a factor, is impossible; all that can be adduced is that 
death had recently taken place. To sum up, in individuals ex- 
hausted by disease, rigor mortis appears early and does not last 
very long, but iu those dying while in apparent good health it 47 
shows late and is of longer duration. Rigor mortis is undoubt- 
edly the first change ushering in putrefaction, the chemic 
change going on in the muscles during or just preceding rigor 
mortis being the first step in this process. Rigor mortis is an 
almost constant sign of death. 
9. Putrefaction.—Putrefaction is a process full of inge- 
nious changes and phenomena. Chemic phenomena taking place 
just before, during the moment of, and after death, result in 
changes in organs of the dead body, whether those organs have 
been in a condition of pathologic alteration or not. It distri- 
butes its products through channels, numberless to conceive, to 
all parts of the body, setting up in one a condition akin to an 
ante-mortem pathologic feature ; in another it removes, or adds 
to the appearance of disease. 
Putrefaction affects the body in numberless ways, but chiefly 
through the intestinal or alimentary canal. Swarms of organ- 
isms penetrate the tissues through this tract, multiply in them, 
liquefy them, destroy them, thus producing such alterations, 
such varied changes, that at times it is very difficult to differen- 
tiate the ante-mortem from the post-mortem condition. These 
phenomena vary, according to the condition of the alimentary 
tract, whether it contained food or not. Soon after death there 
is a reddish froth discerned escaping from the mouth and nose. 
This is preceded or accompanied by changes in the eyes, and 
other superficial parts of the body, as previously treated of in 
other parts of this essay. Then faint greenish or bluish-green 
spots appear on the abdomen or over the groin—they may be 
brown or black—thus the color of these phenomena of decompo- 
sition vary. In some cases I noted the first discoloration to be 
on the side or sides of the nose. The odor of death, so-called, is 
not a constant sign of putrefaction ; it may occur before death, 
in other cases it is absent. The discolorations noted usually 
occur in from one to five days, but more often than otherwise 
on the third day. They are accompanied by greenish patches on 
other parts of the body, and in the case of those on the abdomen 
are caused by the evolvement of gases produced by the decom- 
position of the internal organs. The liquids forced through 
the mouth and nostrils are also a result of this rapid decomposi- 
tion of the internal organs, which press on the walls of the 
stomach and intestines, becoming themselves displaced, and 48 
displacing their neighboring organs in like manner. In 
several days the entire surface of the body becomes dis- 
colored, the products of decomposition—namely, the gases 
and liquefied products, forcing and distending the abdominal 
surfaces in all directions and in this manner separating the 
epidermis, so that it can be almost rubbed off the surface. The 
features become swollen as do all other parts of the body, the 
hair falls out, the finger and toenails separate from their attach- 
ments, and following this there is a disintegration of all the tis- 
sues of the body. The presence of air, the existence of moisture 
in that air, and the high temperature of the surrounding media 
hasten the successive changes incident to decomposition. Age, 
disease and the presence of fat in the body also hasten the pro- 
cess. Disease, bad habits, death from some poisonous gases also 
favor its rapid onset, while other poisons, drowning and quick 
burial retard its advent. Changes may be noted in the body 
showing it has begun in a few hours after death ; to follow the 
changes in the different organs is an impossible procedure, 
suffice it to say that the very first sign of putrefaction is a suffi- 
cient and certain test of death ; while all other phenomena may 
be counterfeited, that of decomposition can not. It is a certain 
but a variable process, as is evidenced by the fact that the rays 
of the sun may effect more and rapid changes than two weeks’ 
burial in the earth. The brain and eye decompose rapidly, because 
they contain a large amount of moisture; the hair, bones and 
nails not so, because they contain little or no moisture. The 
muscles become pulpy, and form an almost fluid mass of putre- 
factive tissue. In 268 cases of putrefied bodies observed by me 
I found that the trachea becomes affected first, the uterus in the 
majority of instances decomposing last. Putrefaction as it 
affects the tissues of the body is a spontaneous change; this 
change is a common one and attacks the tissues successively, 
resolving them into new and similar products. A s an almost 
absolute rule it begins as rigor mortis ceases, although they may 
occur together. In order for putrefaction to be taken as 
a sign of death it must be advanced and at the same time 
must be general in its appearance, Gangrene of the lungs, 
gangrene from local injuries and and gangrene of the skin around 
ulcers must not be confounded with the decomposition following 
rigor mortis. The gases developed from these forms of decoinpo- 49 
sition differ in their constituent parts from the gases formed as 
a result of death of the body as a whole. Coincident with the 
formation of putrefactive gases, there is a softening and discol- 
oration of all the organs of the body, although the process of 
decomposition may attack different organs in an entirely altered 
degree. The structure of the organ, the quantity of blood con- 
tained in the organ, and the ease with which it can be reached by 
air, all have an influence, while discoloration of an organ after 
death may, and does, occur in parts, softening of that organ 
attacks it in entirety. Putrefaction changes the entire mass of 
animal or organic matter, of which the body is composed, into 
a mass of inorganic matter. Whilst this change, or transition, 
is going on gases are necessarily given off; these produce the 
changes in the color of the surface of the body and also of the 
internal organs. By the action of these gases on the fluid blood, 
which has by this time been forced to the surface, whatever 
may be the mode of the destruction of the body in these pro- 
cesses of putrefaction, it is a certainty that fermentation of the 
tissues is a prominent factor, producing gases, which in some 
manner return the body to the mineral kingdom, from which, 
if we are to set our faith in revelation, we exist, through the 
hands of an all-wise Creator, who formed man from a product 
of the mineral kingdom, clay Putrefaction is the surest, per- 
haps the only infallible sign of death, absolute and undeniable. 
The signs are innumerable; they may vary—some of them are 
found in the living body, some have failed of substantiation, but 
putrefaction never failed and never will. It is conclusive, it is 
reliable. To avoid the necessity of waiting for this process to 
take place, it would prevent all possibility if the radial or tem- 
poral arteries were opened with the ever-present scalpel, and 
left open for an hour. Decomposition does not manifest itself 
early enough to be made a necessary legal test, in case the 
authorities should select it as the one to be made, to secure the 
permit of burial. For certainly, if it were made the legal test, 
we would be obliged to wait until the tissues of the body began 
to undergo dissolution and there appeared a discharge from 
the mouth, nose and eyes. 
Leaving out of consideration the cutting of the radial, or tem- 
poral artery, there does not seem to be any determinative principle 
of the question of real or apparent death, excepting the fact of 50 
putrefaction. The old-time vulgar method of approaching a 
lighted candle or a well-polished mirror to the nose of the per- 
son supposed to be dead is still greatly relied on as a good 
means of judging after the pulse has ceased to be perceptible 
and the heaving motion of the chest has stopped. The complete 
immobility of the body, the absence of respiration, the disap- 
pearance of cardiac pulsation, the fixedness and sinking of the 
eyes, the dilatation of the pupils, are not and never will be in 
themselves conclusive evidence of death ; but signs of decompo- 
sition following cadaveric rigidity can only be considered as 
conclusive proof of the cessation of life. The point of my 
paper will be reached, if I have proved that the results of the 
several tests mentioned throughout the paper are satisfactory as 
following and corroborating each other; but in nowise would I 
claim that they are adequate. Science has certainly supplied us 
with signs of death, sufficient in number, when taken together, 
to brand him who does not know enough about them to guard 
against the possibility of burial alive as ignorant and culpable. 
My conclusions, then, are that as a certain sign of death, we hare 
putrefaction, which in itself mag be taken as a test; but the most 
certain test to be applied, without possibility of error, I hold to l>e 
the prompt and immediate opening of the radial or temporal artery. A MANUAL 
OF 
LEGAL MEDICINE 
FOR THE USE OF 
PRACTITIONERS AND STUDENTS OF 
JTED1CINE AND LAW. 
BY 
JU5TIN HEROLD, A. M., M. D., 
Formerly Coroner's Physician of New York City and County; Late House 
Physician and Surgeon of St. Vincent’s Hospital, New York City; 
Member of the New York County Medical Association, County 
Medical Society, Medico-Legal Society, Society of Medical 
Jurisprudence, New York Academy of Medicine, and 
German Medical Society of the City of New York. 
Large Octavo, 678 Pages. Illustrated. Cloth, $4.00 Net. 
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