A Case of Rapid Ante-mortem and Post-mortem Decomposition

The patient, thirty-nine years of age, was admitted into Birmingham Asylum in February, 1898. He was a porter, married, in fairly robust condition, and was a typical example, both mentally and physically, of general paralysis of the insane of somewhat short duration. He was stated to have been steady, of temperate habits, and had been in the army. For twelve years he served in India. No history of fevers or other illness. The disease progressed without any special features until January 14th of this year, when he was noticed to be worse; his breathing was a little rapid, and in consequence he was sent to the infirmary ward and was examined thoroughly by the assistant medical officer, who found nothing specially interesting, but ordered him to be put to bed and kept warm. This was about 3 o'clock in the afternoon. At 7 o'clock the same evening I was asked to see the patient (he had been examined at 5 o'clock by the nurse). I found the left leg from thigh to toe was double the size of the other leg, and nearly the whole surface of the leg was perfectly black, and there were numerous large bullæ the size of one's fist in different places along the leg. There was no special line of demarcation. At first sight it looked like an extreme case of local purpura, but after a careful examination I came to the conclusion that putrefaction had actually set in, and that the man was dying, and death took place an hour after I saw him. The most extraordinary part of this case occurred afterwards. I am accustomed to go and see a body before giving my certificate to the coroner. I saw this man between 10 and 11 on Sunday morning, he having died at 8 p.m. on Saturday. The body was double the former size; it was more like the body of a negro, the whole surface being in a black condition, and the bullæ had increased on the other parts of the body. The scrotum was distended to the size of a man's head, and the penis swelled and distorted. The case was the more extraordinary as the highest temperature recorded locally at the time was 52·8°, and the lowest 34°. I personally saw the coroner, and together we went through numerous works on jurisprudence, but we could find nothing to give us any idea as to the cause of this condition, and he very kindly and in scientific interests ordered an inquest. He sent Dr. Simon, Professor of Medical Jurisprudence in Mason College, to make the post-mortem examination. The results were practically nil, the whole body internally and externally being putrefied. The cause of death was very naturally put down to general paralysis, but as to any cause for this extremely rapid putrefaction we could arrive at no conclusion. The case is one of very great interest. I believe that the first idea that the nurse had in the infirmary was that this man must have been injured. Now there was the usual considerable difference between the appearance of an injury and this condition, which looked like purpura; but besides this the difficulty that occurred to my mind was as to the fixing of the time of death. Here was a body presenting the appearances which are usually recognised as those of three or four weeks' duration, and these had happened certainly within sixteen hours. From the point of view of jurisprudence it occurred to me that a murder might be committed, that the body might present these appearances, and that it would be a most serious matter for a medical man to give an opinion as to the time of death. We know that in hot countries this condition does occur, but we were in the middle of winter, and the condition arose from, so far as we could judge, no special cause whatever. There was some atheroma of the arteries, but otherwise we could distinguish nothing of importance at the post-mortem. It is to be regretted that no bacteriological examination was made.