■ ^: win j£*zs'fl,* , i •, ■: ■, . • . • . ■*&/£&/'ji'Jsf-; ,•-:»:- ;..••;• '•' ■ ■ ;': •; i&W&'ZiktiV'-i' ■;'■•'.■'.■ fif ■•'!*'.''! •,■:•''•.''''.. ' . , ife'''^;,--;-?:':/';'-- ■■.■■'•■'■::;; ^/j/^^\^,-o .■■•■;.•:;■.•■■■•;■■■■■■ ^••^•''■^'■r.'V; •"•:-: ' .•• .- ;■ .te?.'!:-;.':.-.'.'.'' ■■■ •-',-■; • ■: ?*-v* W 600 H217s 1894 28410660R NLM D511bD5b NLM051160562 *T4TRib Plate I Internal surface of the Stomach of a child of nine years who was poisoned by Arsenic, (" Rough on Rats"). Contents o.f S.tomach—foar-cauic£g^f fl,iiH .^ntainjnx Yeljow Salahiile^.IS.ee page_?&a. 1 -— ■ / A SYSJEM OF LEGAL MEDICINE BY ALLAN McLANE ^MILTON, M. D. CONSULTING PHYSICIAN TO THE INSANE ASYLUV3 OF NEW-YORK CITY, ETC., ETC. AND LAWRENCE GODKIN, ESQ, OF THE NEW-YORK BAR WITH THE COLLABORATION OF PROF. JAMES F. BABCOCK, LEWIS BALCH, M. D., JUDGE S. E. BALDWIN, LOUIS E. BINSSE, ESQ., C. F. BISHOP, ESQ., A. T. BRISTOW, M. D., B. F. CARDOZO, ESQ., C. G. CHADDOCK, M. D., A. F. CURRIER, M. Dv C. L. DANA, M. D., GEO. RYERSON FOWLER, M. D.,W.T.G1BB, M. D., W. S. HAINES, M. D., F. A. HARRIS, M.D., W. B. HORNBLOWER, ESQ., CHAS. JEWETT, M. D., P. C. KNAPP, M. D., R. C. McMURTRlE, ESQ., C. K. MILLS, M. D., J. E. PARSONS, ESQ., C. E. PELLEW, E. M., JUDGE C. E. PRATT, W. A. PURRINGTON, ESQ., B. SACHS, M. D,, F. R. STURGIS, M. D., BRANDRETH SYMONDS, M. D., V. C. VAUGHAN, M. D. ILLUSTRATED 9 VOLUME I NEW-YORK E. B. TREAT, 5 COOPER UNION 1894 w GOO H2|7s IS34- v. / Copyright, by E. B. Treat, New York. 1894. All rights reserved. 6 \ PEEFACE. In presenting these volumes the Editor realizes the serious- ness of the work that has engaged his attention for a number of months, and trusts that the production of an encyclopaedic book of reference of convenient arrangement, containing special arti- cles written by authorities in their respective branches, will commend itself to the many thinking physicians and lawyers into whose hands it may fall. It has been his aim to make it in every sense an original embodiment of the most advanced knowledge of the subject, free from the redundancies which are apt to fill the pages of many technical works of this character. To those who expect a collection of statistics and references it will doubtless prove a disappointment, but there is no diffi- culty in obtaining such material elsewhere. An experience of almost a quarter of a century has con- vinced the Editor that both medical and legal practitioners, in the preparation of their cases, need just such information as they will here find in a concise and easily accessible form, and it is hoped that the lawyer and the doctor who go into court will, without much effort, obtain the needed aid. The legal contributors who have so kindly helped the Editor have been requested to prepare special articles upon subjects which most frequently arise in court, and are usually neglected in treatises upon medical jurisprudence, or, at best, are but superficially noticed. It is hoped that the reader will enjoy the Editor's satisfac- tion in the presentation of much experimental work and new 8 PREFACE. material which is inseparable from advanced forensic medicine. It would be unfair to single out examples of such research, but the painstaking and thorough experiments in regard to the effect of gunshot wounds, the inquiries relative to the impor- tance of blood-stains, and the novel and significant investiga- tions in regard to ptomaine poisoning in the first volume, may be cited as examples of the general industry and progressive methods of the contributors generally; and the new material relative to railway neuroses, aphasia, and medical and surgical malpractice, in the second volume, is an earnest of what the writers upon these subjects and the others have done. The thanks of the Editor are due to Dr. Hebbert, lately asso- ciated with Mr. Bond, the Coroner of London, England, who has, in conjunction with Dr. F. A. Harris, presented for the first time in a book of medical jurisprudence the records of the Whitechapel murder cases, and the deductions therefrom, which must in future play a great part in the determination of the identity of the dead body. It has been the aim of the Editor and his associates to be as impartial as possible in their treatment of the different subjects, and it is expected that this work will further the rights of the people and the prisoner as well, and be in every way a safe and useful guide. Allan McLane Hamilton. New York, May, 1894. LIST OF CONTRIBUTOKS. VOLUME I. JAMES F. BABCOCK, formerly Professor of Chemistry in the Mas- sachusetts College of Pharmacy, and in the Boston University, and State Assayer of Massachusetts. LEWIS BALCH, Ph.D., M.D., Professor of Medical Jurisprudence, Albany Medical College; Consulting Surgeon to St. Peter's Hos- pital ; Surgeon to the Child's Hospital; Secretary of the New York State Board of Health; Health Officer of Albany. CORTLANDT FIELD BISHOP, Esq., of the New York Bar. A. T. BRISTOW, A.B., M.D., Demonstrator of Anatomy to the Long Island College Hospital Medical School; Surgeon to the Long Island College Hospital, Brooklyn, N. Y".; etc., etc. BENJAMIN N. CARDOZO, Esq., of the New York Bar. W. TRAVIS GIBB, M.D., Examining Physician to the New York Society for the Prevention of Cruelty to Children; Instructor in Gynaecology, Medical Department, New York University; Assistant in Gynaecol- ogy, New York Polyclinic. WALTER S. HAINES, A.M., M.D., Professor of Chemistry and Toxi- cology in Rush Medical College, Chicago; Toxicologist to the Presby- terian Hospital, Chicago ; Consulting Chemist to the Health Depart- ment of the City of Chicago; Fellow of the Chemical Society, Lon- don ; etc., etc. 9 10 LIST OF CONTRIBUTORS. ALLAN McLANE HAMILTON, M.D., Consulting Plivsician to the In- sane Asylums of New York City; Consulting Neurologist to the Hos- pital for Ruptured and Crippled, and to the Hospital for Nervous Diseases; author of a " Treatise upon Medical Jurisprudence, espe- cially with reference to Injuries and Diseases of the Nervous System," u Types of Insanity," " Nervous Diseases, Their Description and Treat- ment," articles upon Epilepsy in Wood's Handbook and Pepper's " System of Medicine." FRANCIS A. HARRIS, M.D., formerly Instructor of Medical Jurispru- dence in the Harvard Medical School; Medical Examiner of Suffolk Co., Mass. R. C. McMURTRlE, Esq., of the Philadelphia Bar. C. E. PELLEW, Ph.D., Demonstrator in Physics and Chemistry at the College of Physicians and Surgeons, Medical Department of Columbia College; Fellow of the New York Academy of Sciences; author of " Laboratory Schemes in Medical Chemistry " and a " Practical Man- ual of Medical and Physiological Chemistry." WILLIAM A. PURRINGTON, Esq., of New York, formerly Counsel of the New York County Medical Society. BRANDRETH SYMONDS, A.M., M.D., is the Senior Examining Phy- sician of the Mutual Life Insurance Co. for New York City. VICTOR C. VAUGHAN, A.M., Ph.D., M.D., Dean of the Medical Fac- ulty, and Professor of Hygiene and Physiological Chemistry in Mich- igan University; member of the Michigan State Board of Health; member of the American Association of Physicians; member of the German Chemical Society; honorary member of the French Society of Hygiene; etc., etc. CONTENTS OF VOLUME I. PAGE Preface.................................................... 7 Introduction............................................... 17 LAWRENCE GODKIN, Esq. Hedico-Legal Inspections and Post-Mortem Examinations .... 25 ALGERNON T. BRISTOW, A.B., M.D. Death in its Medico-Legal Aspects.......................... 57 francis a. harris, m.d. Blood and Other Stains—Hair............................. 139 Prof. JAMES F. BABCOCK. Identity of the Living............•......................... 191 allan mclane hamilton, m.d. Identity and Survivorship.................................. 213 BENJAMIN N. CARDOZO, Esq. Homicide and Wounds...................................... 243 LEWIS BALCH, M.D., Ph.D. Poisoning by Inorganic Substances.......................... 321 CHARLES E. PELLEW, Ph.D. Poisoning by Alkaloids and Organic Substances............. 415 walter s. haines, a.m., m.d. 'The Toxicologic Importance of Ptomaines and other Putre- factive Products........................................ 475 VICTOR C VAUGHAN, Ph.D., M.D. 11 12 CONTENTS OF VOLUME I. PAGE / The Medical Jurisprudence of Life Insurance.............. 493- BRANDRETH SYMONDS, A.M., M.D. c Accident Insurance......................................... 583 CORTLANDT FIELD BISHOP, Esq. v The Obligation of the Insured and the Insurer............ 591 R. C McMURTRlE, Esq. / Of Certain Legal Relations of Physicians and Surgeons to their Patients and One Another........................ 595 WILLIAM A. PURRINGTON, Esq. / Indecent Assault upon Children........................... 649> w. travis gibb, m.d. LIST OF ILLUSTRATIONS. VOLUME I. PLATES. PAGE I. Internal Surface of Stomach of a Child poisoned by Arsenic.. Frontispiece II. Dissection of the Heart................................. 45 III. Death by Burning, showing Vesicles and Contortions of Limbs.............................................. 133 IV. Arborescent Marking produced by Lightning-Stroke....... 135 V. Absorption Spectra of Blood............................ 145 VI. Human Blood-Corpuscles............................... 153 VII. Effects of Vitriol...................................... 285 VIII. Color Reactions of Alkaloids............................ 415 WOOD-CUTS AND HALF-TONE ENGRAVINGS. Fig. 1. Method of Saw-Cutting for Removal of Calvarium........ 38 Fig. 2. Line of External Incision of Heart......,................ 45 Fig. 3. Exposure of Interior of Heart.......................... 45 Fig. 4. Skull of European.................................... 62 Fig. 5. Skull of Australian................................... 62 Fig. 6. Pelvis of Man........................................ 63 Fig. 7. Pelvis of Woman....................................•> 64 Fig. 8. Inferior Maxilla of New-born, showing Union of Rudimen- tary Processes...................................... 65 13 14 - LIST OF ILLUSTRATIONS. PAGE Fig. 9. The Microspectroscope............................... 143 Fig. 10. Zeiss's Microspectroscope............................. 143 Fig. 11. Cells for the Microspectroscope........................ 144 Fig. 12. Haemoglobin Crystals................................ 148 Fig. 13. Blood-Corpuscles from the Mammalia and the Ovipara ... 151 Fig. 14. Blood Drops and Spatters............................ 155 Fig. 15. Hsemin Crystals..................................... 163 Fig. 16. Blood-clot and Various Spores........................ 170 Fig. 17. Microscopical Appearance of Materials found Associated with Blood........................................ 171 Fig. 18. Eye-piece Micrometer................................ 172 Fig. 19. Diagram representing the Comparative Sizes of the Red Blood-Corpuscles of Various Animals................ 175 Fig. 20. Epithelium from the Vagina.......................... 180 Fig. 21. Microscopical Appearance of Spermatozoa.............. 185 Figs. 22-35. Microscopical Appearance of Hairs from Various Sources, and Vegetable and other Fibers............. 188 Figs. 36, 37. Illustrating Change through the Effect of Disease___ 194 Fig. 38. Growth of Hair, with reference to Race Type............ 197 Fig. 39. Schematic Figure showing the Different Thumb Tip Types of Galton and the Disposition of the Papillary Lines ... 205 Fig. 40. Impression of the Right Thumb—Schematic. (Testut.)... 205 Fig. 41. Causse's Method for Identifying Footprints............. 206 Figs. 42-50. Noses Classified according to Bridge and Base. (Ber- tillon.) ........................................... 209 Figs. 51-59. Classification of Foreheads. (Bertillon.)............ 210 Fig. 60. Some Classifications of the Form of the Ear. (Bertillon.) 211 Figs. 61-64. Powder Tattoo-Marks made by Revolver at Various Distances.....................................255, 256 Fig. 65. Mrs. Billings's Skull. Point of Entrance of Ball........ 265 Fig. 66. Mrs. Billings's Skull. Hole made by Piece of Bone, being driven outward backward........................... 2C5 Fig. 67. Inside View of Mrs. Billings's Skull, showing left petrous portion gone, and on the right side the place where the ball lodged........................................ 265 Figs. 68, 69. Experiment on Skull—Sixth Shot.................. 266 Fig. 70. Inside View of Skull—Sixth Shot...................... 266 LIST OF ILLUSTRATIONS. 15 PAGE Fig. 71. Blood-clot from Right Middle Meningeal Artery, effused between Bone and Dura-Mater. (Mechanicsville Case.).. 268 Fig. 72. Front View of Heart and Lungs....................... 307 Fig. 73. The Liver.......................................... 309 Fig. 74. The Stomach and Small Intestines..................... 313 Fig. 75. Ordinary Reduction-Tube, with Charcoal Splinter........ 373 Fig. 76. Special Reduction-Tube, when Flux is used, drawn out after Mixture is inserted................................. 373 Fig. 77. Marsh's Apparatus .................................. 375 Fig. 78. Ignition-Tube, for Berzelius-Marsh Test................ 376 Fig. 79. Arsenic Deposits in the Berzelius-Marsh Test........... 377 Fig. 80. Crystals of Morphine from Stomach. Magnified 18 diam- eters ............................................. 445 Fig. 81. Crystals of Strychnine Chromate. Magnified 80 diameters. 455 Fig. 82. Crystals of Strychnine from Stomach. Magnified 12 diam- eters ............................................. 456 Fig. 83. Strychnine from Stomach. Magnified 40 diameters......457 INTRODUCTION Medical jurisprudence, or legal medicine, may be defined as the science which applies the principles and practice of the different branches of medicine to the elucidation, in judicial proceedings, and subject to legal rules and forms, of questions relating to the cause or time of death, conception and birth, or the cause or effect upon the legal status of indi- viduals of mental or physical disease or injuries. The questions which are included in this definition have been divided into five classes, the first of which includes inquiries arising out of the relations of sex, as impotence and sterility, pregnancy, legitimacy, and rape ; the second, injuries inflicted on the living organism, as infanticide, wounds, poison, injuries, and death from violence; the third, questions arising out of disqualifying diseases, as the different forms of mental alienation ; the fourth, those arising out of deceptive practices, as feigned diseases; fifth, questions of a miscellaneous nature, as age, identity, pre- sumption of seniority, and life assurance. Of course the means or instrumentalities by which the principles and practice of medicine are applied to the elucidation of questions of law are the utterances of persons skilled in medicine, to wit, of physicians, surgeons, and chemists. These utterances, whether oral or written, are made use of in courts of justice, subject to certain rules which have been adopted as best calculated to correct or assist the infirmities of the human character, mind, and memory. In a general way the evidence given by medical and chemical experts has been classed as "opinion" evidence—that is to say, as evidence which consists in the expert giving the conclusions which he, as a sci- entific man, draws from certain facts which have been, or are supposed to have been, proved. But owing to the progress of the science of medi- cine, and as the result of the modern scientific methods of investigation with accurate results, medicine and chemistry have become more worthy to be classed as exact sciences, and much of the testimony of physicians which formerly might rightly have been classed as pure matter of opinion is now as much a statement of matter of fact as a statement of the law of gravity, or the fact that the earth moves around the sun. And while it is to a large extent still true—as was laid down in a case in New York which established the proposition that the law does not recognize any particular class or school of practitioners as qualified experts to the exclusion of other classes or schools—that medicine is not an exact science in which truths have become established and fixed, but that, on the contrary, it has been characterized in a greater degree by fluctuation of opinion as to its principles and the mode of practice than perhaps any 17 18 INTRODUCTION. ♦ other pursuit, and has been distinguished by the constant promulgation and explosion of theories, and that the popular axiom that doctors differ is as true now as it ever was, still, on the other hand, there has been, ever since the discovery of the circulation of the blood, a steady progression in medicine toward the establishment of an increasing collection of fundamental and precise scientific facts, which are almost as reliable, as premises, as any of the facts in nature of which courts have for many years taken judicial notice without proof. This is especially true of that division of medicine which is known as pathology as distinguished from therapeutics, and in which the modern scientific school of medicine has made such wonderful discoveries, by means of methods of demon- stration and proof which have raised the results out of the domain of controversy. Nor is the complaint which Bacon made in the seventeenth century— that the science of medicine had departed from the true path trod by Hippocrates, who used to set down a narrative of the special cases of his patients, and how they proceeded, and how they were judged by recovery or death—any longer applicable; for to-day a large part of the science of medicine consists, like the profession of the law, in studying and reporting new cases and decisions for the direction of future judgments. It is his learning and experience, drawn from the "myriad of single instances," which qualify the medical expert and gives his opinion, in the specific instance in issue, gravity and weight. In the actual practice of medicine it is still true, as of old, that the physician is judged to a great degree by the recovery or not of his patient, either of which results may be due to a hundred causes other than the skill or ability or incom- petence of the physician; but in forensic medicine the expert is judged by the knowledge and learning evinced in his testimony, and not by the result of the trial. And in these days of criticism and belittling of expert testimony on the grounds that it consists of bought opinion, it is well to bear in mind the remark of that prince of practical philosophers, Dr. Johnson, who, when Sir James Johnston said that he paid no atten- tion to arguments of counsel at the bar of the House of Commons be- cause they were paid for speaking, replied: " Nay, sir, argument is argu- ment. You cannot help paying regard to their arguments if they are good." And so in the case of expert testimony, if the opinion or argu- ment of the expert appears sound and weighty, and to be based on sound premises, it is no answer to the impression it may make upon the minds of the hearers that the expert was paid for testifying. Although the principles of medical science were applied to the deter- mination of certain legal questions by the Greeks and Romans, there is nowhere any authoritative mention of such a procedure in actual trials. There is some doubt whether in Roman criminal trials the accused was himself allowed to call any witnesses in his own behalf except as to his general character. Mr. Trollope, in his Life of Cim-o, says that he was not. There does not seem to be any allusion either in the Digest or the Theodosian Code to insanity, or any form of mental alienation as a defense to prosecution for crime ; but we know that the subject was fullv recognized under the system of Roman jurisprudence, and that insane persons were regarded as having no intelligent will, and as therefore being incapable of having rights or responsibilities, and that their per- sons and property were placed, after due investigation bv magistrates INTRODUCTION. 19 under the custody of curators. It is very probable that in such proceed- ings expert testimony was rehed upon to some extent at least. In Rome, under both the republic and empire, and elsewhere in Em-ope during the middle ages, human suffering produced by physical tortm-e was rehed upon in criminal procedure to extort confessions or other evidence which might be used against the prisoner, and during all these dark ages of the criminal law we hear but little of medicine as an adjunct to, or a miti- gator of, its enforcement. Torture played a prominent part in Roman criminal procedure, particularly in the preliminary investigation after the arrest of the accused. Slaves were tortured when their masters were suspected of offenses, and the accused himself might be tortured repeat- edly when the evidence against him was particularly strong. It is worthy of note here that the Roman law was especially severe upon the crime of poisoning, and extended its provisions to every one, "qui venemum necandi hominis causa fecerit, vel rendiderit" and that the crime of rape was spe- cially provided for, and was not included under the "Lex Julia deAdul- teriis," which apparently was intended to cover every other sort and description of sexual crime. But the crime of murder or attempted mur- der 1 >y poison has always been regarded with special abhorrence in ancient systems of law. By the Statute 22 Hen. VIII. it was provided that will- ful poisoners should be boiled to death; and in the trial of Richard Wat- son for poisoning in 1615 Lord Coke declared that " of all felonies murder is the most horrible ; of all murders, poisoning the most detestable ; and of all poisoning, the lingering poisoning." (State Trials, vol. ii., p. 91.) The idea of preliminary torture of the accused with a view to extract- ing from him a confession, or evidence that can be used against him, is preserved, although of course in a very much modified and milder form, in the French system of criminal procedure. In France the juge (Vinstruc- tion, who in some respects corresponds to our committing magistrate, may put the prisoner in solitary confinement for an indefinite time, and during the time question him in secret as often as he desires. This secret interrogation may be carried on without giving the accused any information as to the nature of the evidence against him, and every art of verbal torture—in addition to the solitary confinement—calculated to extort from him a confession may be used against the unfortunate prisoner. . . The system of trial by ordeal which existed, particularly m England, in the middle ages, and even up to the sixteenth ceutury, may have suf- ficient interest to the student of legal medicine to deserve a passing mention In England, under this system, if an accused person could not get a sufficient number of satisfactory " compurgators;' or persons who would swear to their belief in his innocence, he was put to the ordeal. This ordeal might be of various descriptions. It sometimes consisted in compelling the accused to handle red-hot irons, or plunge parts of his body into boiling water, and if the skin showed any mark of burn or scalding, he was guilty. Another form of the ordeal was to throw the accused into water, and if he sank he was innocent, and if he floated he was guilty These ordeals, whatever might be their nature, were simply tests of human endurance of such a kind that only a reversal of some law of nature could enable the victim to successfully support them. The real beginning of the science of forensic medicine is generally ascribed to the publication in 1553, by the Emperor Charles V. of Ger- 20 INTRODUCTION. many, of the Constituo Criminalis Carolina, or Carohne Code, in wliich it was directed that the opinion of medical men should be taken in cases where death was alleged to have occurred by violence, and suspicion existed of a criminal agency. But It was not until the seventeenth century that we began to have authentic recorded instances of the em- ployment of forensic medicine in England, and in some of the English state trials of that time we find cases in which medical men were called upon to testify in criminal trials; but in a large class of inquiries which are to-day the subject of medical examination and testimony, medical men were not consulted. For instance, we know that in applications for postponement of the sentence of death on account of pregnancy, in prosecutions for rape, and in applications for a decree of nullity on the ground of incapacity to consummate the marriage contract, it was the practice to impanel a jury of matrons to examine and report to the court. In the trial for murder of Jane Norkott, in 1628, there is a curious in- stance of the disinterment of a body for a second inquest thirty days after the first inquest had been held. At the first inquest the coroner's jury rendered a verdict of suicide. It was shown upon the trial that when the body of Jane Norkott was disinterred for the second inquest, one of the persons accused of her murder touched the dead body, " whereupon the brow of the dead, which before was of a livid and carrion color, be- gan to have a dew or gentle sweat arise on it, which increased by degrees till the sweat ran down in drops on the face, the brow turned to a lively and fresh color, and the deceased opened one of her eyes and shut it again; and this opening the eye was done three several times; she like- wise thrust out the ring or marriage finger three times and pulled it in again, and the finger dropped blood on the grave." (14 State Trials, 1342.) In 1665 occurred the trial of the Suffolk witches, Rose Cullender and Amy Duny, on a charge of bewitching children, in which we find one of the most enlightened and distinguished physicians of the time, Sir Thomas Browne, author of the Beligio Medici, testifying to his belief in witchcraft, and it was largely upon his testimony that the unfortunate women were convicted and hung. As an illustration of the value of the best medical testimony in England in that day, it is worth while to quote Dr. Browne's testimony in court, delivered after an examination of the two accused women and the aunt of the children alleged to have been bewitched. It seemed that Rose Cullender and Amy Duny had quarreled with the parents of the children; that the children subse- quently had fits and threw up crooked pins and a twopenny nail with a broad head, and that thereupon a bee brought the nail and forced it into the child's mouth; and the two children declared that the prisoners were tormenting them, and that they saw their apparitions. There was other evidence, but the foregoing was the most weighty. After hearing the evidence and making his examination, Dr. Browne, having been called on for his opinion, stated to the court that " he was clearly of opinion that the persons were bewitched, and said that in Denmark there had been lately a great discovery of witches, who used the very same way of afflicting persons by conveying pins into them, and crooked as these pins were, with needles and nails. And his opinion was that the devil in such cases did work upon the bodies of men and women upon a natural foun- dation (that is) to stir up and excite such humours superabounding in INTROD UCTION. 21 their bodies to a great extent, whereby he did in an extraordinary man- ner afflict them with such distempers as their bodies were most subject to, as particularly appeared in these children; for he conceived that these swooning fits were natural, and nothing else but that thev call the mother, but only heightened to a great excess by the subtlety of the devil cooperating with the mahce of those we term witches, at whose instance he doth these villainies." In his Beligio Medici (part i., sec. 30) Dr. Browne emphaticahv affirms his belief in witches, and describes those who do not believe in'them as " a sort not of Infidels, but Atheists." In charging the jury in the case just alluded to, Chief-Justice Hale said " that there were such creatures as witches he had no doubt at ah." In the early part of the eighteenth century we have what is probablv the first recorded instance of a criminal trial in which the result de- pended largely upon the conflicting evidence of medical experts. The case was that of Spencer Cowper, an Englishman of high position, who was accused of the murder of a Quakeress, Sarah Stout by name. Miss Stout's body was found one morning in a mill stream. There was evi- dence to show that the last person who had been with her on the night before was Cowper. He was tried for her murder, and a considerable number of physicians were called by the prosecution and defense to establish or controvert, among others, this proposition: that " it is con- trary to nature that any persons that drown themselves should float upon the water; we have sufficient evidence that it is a thing that never was; if persons come alive into the water, then they sink; if dead, then they swim." Witnesses were also called to prove the proposition that water must be found in the stomach of a person who died of drowning, and that its absence was inconsistent with death so caused. The case was prosecuted and defended with great energy and vigor, and resulted in Cowper's acquittal. Baron Hatsell, who presided at the trial, made some remarks upon medical testimony in the course of his charge to the jury. which have a decided resemblance to some of the reflections which are made to-day by judges charging the jury upon the merits of the same kind of evidence. Baron HatseU said: " You have heard also what the doctors and surgeons said on the one side and the other concerning the swimming and sinking of dead bodies in the water; but I can find no certainty in it, and I leave it to your consideration. The doctors and surgeons have talked a great deal to this purpose, and of the water going into the lungs or the thorax; but unless you have more skill in anatomy than I, you will not be much edified by it." (13 State Trials, 1188.) In another criminal trial somewhat later we find a very curious result of the denial to the prisoner of the assistance of counsel in trials for felony. At the trial of Lord Ferrars, the prisoner set up the defense of insanity, and was obliged himself to examine the witnesses whom he called to support this plea. In the nineteenth century the development of the science of forensic medicine has been rapid and important, and a quantity of literature has appeared upon the subject. Some of the best known names of contrib- utors to the science are those of Orfila and Tardieu in France, Casper in Germany, Christison, Taylor, Guy, and Ogston in England, and Beck, Reese, Wharton and Stille, and Wormley in the United States. The increasing complexity of modern life resulting as it has in a marked in- 22 INTRODUCTION crease in the quantity and variety of litigation, the rapid strides in the direction of accurate knowledge and means of scientific investigation which have been made in medicine, surgery, and chemistry, and the tendency to a relaxation of the strictness of the old common-law rules of evidence, have all contributed to activity in the domain of forensic medi- cine and to the enlargement of the field of its application. Recurring to the definition of medical jurisprudence which has been given, it is obvious in the first place that a wide field of science may be covered by the terms "principles and practice of medicine." Anat- omy, physiology, medicine, surgery, chemistry, and physics, all come to a greater or less extent within the province of the science of medicine, and they are all constantly caUed upon to contribute to the elucidation of legal questions affecting life, liberty, and property. It may be said that the progress which has been made in the application of the sciences of toxicology and pathology in courts of law has greatly increased the dif- ficulty of successfully concealing the crime of death by poisoning. Nor is the category of the kind of judicial proceedings in which the assistance of the trained medical witness is invoked less varied than the nature of the subjects covered by the science of medical jurisprudence. The determination of the capacity of testators to make wills, of contract- ing parties to contract, and in the marriage relation to consummate the contract, the decision of property rights depending upon questions of legitimacy, survivorship, age, and identity, mental capacity to take and hold property, are all familiar instances on the civil side of the law of the daily application of the science of medical jurisprudence to assist courts and juries in arriving at just conclusions in regard to property rights; while in the criminal branch of the law, the increasing frequency with which mental alienation is interposed as a defense to prosecution for crimes of violence, the necessity of the ascertainment of the causes, and probable means or instrument, of death or injury, and the duration and effect of such injuries, and questions arising out of what is known as hypnotism, which has already more than once been interposed in France as a defense to criminal prosecutions—aU furnish a class of cases in which the testimony of the medical expert is indispensable. It is to be noted, however, that the statute law of many of the States has interposed a wise and salutary check upon possible forms of abuse of the confiden- tial relation which must of necessity exist between physician and patient, by prohibiting the disclosure by a physician of communications made by, or information received from, the patient while in attendance upon him in a professional capacity. This topic will be fully treated in a subsequent article. It is an instance of a class of cases in which expert testimony is limited or excluded on the same well-founded grounds of public policy which has caused the enactment of laws prohibiting the disclosure of confidential communications made by chents to their attor- neys, and persons to their spiritual advisers. Under the systems of legal procedure which obtain in England and the United States, the contesting parties to the proceeding select their own experts and pay them. That this system has in some cases led to abuse, and that it has, particularly in the last few years, had a tendency to throw discredit upon aU medical expert testimony, cannot be doubted. The spectacle which is now constantly witnessed in our courts, of equally qualified experts called on different sides of a case flatly contradict- INTRODUCTION. 23 mg each other, must of necessity cast doubt either upon the reliability oi medical opinion, or else upon the standing of medicine as an exact science. But as the real object of all judicial proceedings is the ascer- tainment of truth and the doing of justice, the important question is wnetner our system conduces to these ends to a greater or less extent than the system m vogue elsewhere. As regards this question there is much room fen- discussion and difference of opinion. But that there is a growing restiveness on the part of judges, juries, and experts themselves under the faults and defects of our system, and a casting about for some better solution of the problem, is undoubted. A very brief statement of how it is managed in France and Germany, where the English and American system of common law procedure does not exist, may be not without interest. In France the court may order an investigation and report (expertise) by experts whenever it deems it advisable. If the parties cannot agree upon the experts the court appoints them. They are at least three in number, and are generally, though not necessarily, selected from a list of specialists termed experts assermentes. The order directing the inves- tigation contains a statement of its precise object, and appoints a referee, or juge commissaire. Barristers, or avocats, are not allowed to appear before the experts, but the parties are represented before them by solic- itors (avoiu's), and sometimes by persons specially skilled in the matter of the investigation. The report must be signed by all three of the ex- perts ; and if there be a dissent, the dissenting opinion and the reasons for it are set forth in the body of the report. The judges, however, are not at all bound by the report if it is opposed to their convictions. (-Si leur conviction sy oppose." Code de Procedure Civile, titre quatorzieme.) In Germany since 1870, under the Code of Civil Procedure for the Ger- man Empire, after the issues are framed upon which expert testimony is sought, the parties may agree upon the experts, and the court appoints those agreed upon, but it may confine the parties to a given number of experts. Sometimes the court submits to the parties the names of a number of experts, and allows each side to object to a certain number of them, and then appoints those remaining. There exists in Germany a class of officially appointed experts on certain subjects, and in trials wliich concern these subjects such experts have the preference in appoint- ment, unless there exists some special reason why they should not be appointed. In Prussia, for instance, it is said to have been the custom to appoint as experts a physician and surgeon for every county. In addition there was a medical college in each province to which an appeal lay if the experts disagreed or the parties desired it. In addition to this there was an appellate medical commission for the whole kingdom. (Rogers, Expert Testimony, § 41.) But in Germany, as in France, the court is not constrained to follow the expert opinions, and if it is not satisfied with them it may order a new expert opinion from the same or from other experts. The plans for reform in the American system of calling expert wit- nesses have generally been in the direction of establishing a class of official experts; and the trouble with most of the plans is that they con- travene one or all of the three fundamental ideas of our system of crim- inal trial, to wit, that the judge alone is to be the judge of the law, that the jury alone are to pass on the facts, and that the accused shall be 24 INTRODUCTION allowed to produce any relevant and competent evidence in his own behalf. The plan suggested by Sir James Fitzjames Stephen at the end of the first volume of his History of the Criminal Law of England, would seem to meet the situation, although it is one which requires a very high standard of medical honor and knowledge. It seems that under this plan, which has been for some time in operation at Leeds in England, medical men refuse to testify unless before doing so they can meet in conference with the expert witnesses to be called on the other side of the case, and have an interchange of views. And it is stated that the result is that at Leeds medical witnesses are hardly ever cross-examined at all, and it is by no means uncommon to have them caUed on one side only. If such a system could be adopted by the profession in America it would be of immense service in raising the standard of expert testimony, and increasing the reliance placed upon it by the courts and juries. The adoption by the medical profession of some such plan as this, is, in the opinion of the writer of this brief and inadequate introduction to the great science which is treated in the following pages, the proper solution of the difficulty. And not its least merit lies in the fact that it may thus be brought about by the members of the profession taking the matter into their own hands, and dealing with it upon the lofty and dis- interested plane upon which the medical profession should be moving on to the great future which, as an instrumentality for the attainment of righteousness and justice, as well as the retarder of death and the alle- viator of human suffering, is surely before it. Lawrence Godkin. MEDICO-LEGAL INSPECTIONS AND POST-MOETEM EXAMINATIONS. BY A. T. BRISTOW, A.B., M.D. A post-mortem examination as ordinarily undertaken is made for the purpose of determining the cause of death where this is the result of disease, to observe the resulting pathological changes, their nature, and extent, together with the organs implicated. The inquiry concerns the physician himself. The friends of the deceased are disposed to accept the results of the examination without question, and with the signing of the death certificate the function and responsibility of the examiner cease. In the case of a medico-legal in- spection the responsibility of the examiner is much increased. On his report and testimony may depend the issue of a civil damage suit, or, more important still, the arrest of a freeman, his prolonged imprisonment' indictment, and trial. The liberty of the citizen and the vindication of the law alike demand that the examiner should proceed with the utmost circumspection, to the end that the guilty may not escape njr the inno- cent suffer. It is to be remembered that when prosecution follows as a result of the inspection the examiner must expect that his methods will be subjected to the minutest scrutiny, and bear the test of hostile criti- cism from the acutest minds the defense can summon. Loose and inac- curate methods, hasty observations, deductions rashly drawn, may bring confusion on the medical witness and involve in ruin a righteous prosecu- tion. On the other hand, it is to be observed that although the prose- cuting officer may demand a victim, justice calls for the criminal. Not seldom it may be the duty of the medical witness to stand between the unfortunate and an ambitious or too zealous prosecutor, carried away by the ardor of battle, the hope of future gain or preferment. In such a case too often the prosecution is degraded into an intellectual contest between the counsel for the defendant and the prosecuting officer, becom- ing a sort of prize-fight, in which the stake fought for is a conviction, a victory for the prosecution which may lead to professional distinction, possibly political preferment. When such motives prevail, it is not strange if the medical witness, especially when retained by the prosecu- tion, enters upon his investigations with a biased mind. Such an attitude is not conducive to that judicial spirit which the task of a medical exam- iner requires. It may be objected that it is the function of the examiner simply to determine certain facts and report accordingly, it being for the 25 26 A SYSTEM OF LEGAL MEDICINE. jury to judge of their significance. It may be observed, in reply, that there are many instances where the jury must be guided solely by the inferences of expert witnesses, amended and clarified by proper cross- examination and comparison. It is this very lack of the judicial spirit which has brought the opinions of the expert witness into well-deserved discredit. He is too apt to regard the case from the point of view of the side that employs him, and so looks rather for what he hopes or wishes to find than at the facts as they really are. That medical witnesses should be'entirely free from bias is expecting too much, perhaps, under the present system; but it is certainly then- duty, as honest and true men, as far as in them lies to divest themselves of every feeling wliich is likely to give their minds a slant. The medical witness should therefore be on his guard, and with his natural desire to serve those who have employed him yet keep his judgment unclouded. It is quite possible to be mistaken with regard to even natural appear- ances. The writer has seen the petechias of the early stage of decompo- sition mistaken for the marks left by contusions. It is unnecessary to point out the possible consequences of such an error. Because of similar blunders, payments on policies of life insurance have been refused, and criminal prosecutions instituted involving the innocent in ruinous ex- pense, perhaps even jeopardizing human life. Post-mortem examinations made for forensic purposes may be classi- fied as follows: 1. Before burial: (a) examination made soon after death, before de- composition has set in; (b) when decomposition is far advanced. 2. After burial: (a) before the soft parts have lost their identity; (&) at a more remote period, when the bones only are left, the soft parts having either disappeared altogether or been merged in an undistinguishable mass. In all medico-legal examinations the examiner should be accompanied by at least one other physician not only as an assistant, but also as a witness. It shah be his duty to write out an accurate and fuU account of the proceedings of the examiner at his dictation, with the findings, to- gether with a description of the methods employed. The journal should be kept in ink, and signed and sworn to by both the examiner and his assistant, also by any other physician who may be present. It is impor- tant that every organ should be examined, not excluding the spinal cord and the ribs, especially the first and second. A full and complete exam- ination should be the rule in every case, to which there should be no exception. Ogston relates a case in which, owing to the fact that the examination of the spinal cord was omitted, the prosecution failed to convict. The case was as follows: Two men having quarreled, one of them in the struggle which foUowed strangled his opponent by twisting his neckcloth violently. In the subsequent trial the defense claimed that the deceased lost his life from spinal hemorrhage, and the cord not having been examined, the prosecution was unable to disprove the claim of the defense, and lost. It is important to examine the ribs, not neglect- ing the first and second. In an autopsy held by Dr. Van Cott at the Brooklyn City Hospital on the body of a man who died from injuries received from falling into the hold of a ship, the writer saw a quantity of blood in the left pleural cavity, which had come from a wound in the left subclavian vein, made evidently by a sharp spicule of bone from a. MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 27 fractured first rib. So too the lamina? and bodies of the vertebrae should be examined. The inspection cannot be too minute or precise. It is always a very great advantage for the medical examiner to be able to make the inspection and autopsy at the place of death, and if possible, before the body has been interfered with or moved from the spot where it lay when discovered. There are many facts connected with the position of the corpse, its distance from a bed, door, or stairway, which might be of the utmost importance as bearing on the cause of death, yet which would almost certainly escape the lay witness. Such details' as these would be estimated at their true value by the medical examiner and noted accordingly. It will be seen that the role of examiner is thus extended beyond the mere making of an autopsy. It is certainly high time that the important data which may be obtained from a proper examination of the premises should no longer be left to the bungling of ignorant persons. At pres- ent, the court has to depend on the testimony of policemen and excited neighbors for what is in many eases vital evidence, and then falls back on the much-abused hypothetical question, which the medical examiner is required to answer categorically. It is certain that some change should be brought about in the nature of the judicial proceedings at present in vogue on the discovery of a homicide or supposed suicide, and known as a " coroner's inquest." The reform ought to commence at the very beginning, starting from the moment when the corpse is discovered. On the arrival of the officer, he should first satisfy himself that life is extinct. A physician will usually have been summoned, so that he will not have to depend on his own judgment to determine this important point. This done, he should close the room and permit no one to enter. In cases of suspension, the body should always be cut down at once; nor is this so unnecessary a direction as may at first sight appear. Instances have not been wanting where an absurd fear of interfering with the coroner has prevented this, although life was not entirely extinct. A life may thus have been sacrificed which might have been saved. Under all other circumstances it is better that the body be not in any respect disturbed, nor should any article of furniture, wearing-apparel, household utensils, or weapons be moved from the position where first discovered. If evi- dences of a struggle are apparent in other apartments, not only should the room be closed where the body was discovered, but also the whole house, and left in charge of an officer, the inmates being either confined to their rooms or allowed to remove to other quarters. At all events, they should not be permitted to roam about the premises unhindered, at full liberty to commit any indiscretion, or, if necessary, make prepara- tions to conceal evidences of crime. The coroner's office having been notified, a duly authorized medical examiner should at once go to the house, and with his assistant, and possibly a representative of the law- officer, make the necessary medico-legal inspection of the body and its environment. After the autopsy, and on the written permission of the examiner, the body may be properly cared for, but under no circum- stances should the use of any embalming fluid be permitted. Such fur- ther arrangements may then be made as cleanhness and necessity may require. The inmates may be allowed such liberty in the house as may seem advisable to the law-officer. They shall, if they desire, be aUowed the privilege of accompanying the medical inspector in his search, either 28 -J SYSTEM OF LEGAL MEDICINE. in person or by representative, but shall not be allowed to remove articles of wearing-apparel or other articles until written permission has been obtained from the medical inspector. Such a proceeding as this may seem unnecessarily harsh, yet it will not only prevent guilty inmates from removing evidences of their crime, but will also protect the inno- cent by deterring them from the commission of actions which might render them liable to suspicion. Had such regulations been carried out in the Borden house after the discovery of the bodies, is it likely that Lizzie Borden would have been put on trial for her life ? She certainly would not have been permitted to destroy clothing as she did, innocently enough, perhaps. Yet this error of judgment was one of the strongest inducements to the State to hold her for trial. It certainly was one of the strongest points against her. Such ill-considered acts are to be expected from persons laboring under great excitement, as must be the case where relatives or even strangers have been found struck down by the hand of violence. Pru- dence is not to be expected under such circumstances, and the innocent may not only do things unwittingly which may destroy evidence, but also be the means of entangling them in the meshes of the law. It may be said of such a procedure that it would be impracticable in rural districts and in lonely situations; but there is no hamlet without its village constable and justice of the peace. The latter, in the absence of the regularly appointed examiner, might delegate the office to the village practitioner, whose observations would be far more likely to be of service to the court than those of the constable or the casual neighbor. Other processes of law are carried out in remote districts, and there is no reason why so important a function as a medico-legal inspection should not be likewise conducted in an orderly and precise manner. In most States the law makes no provision for such a procedure. In one State, however (Massachusetts), the medical examiner is a regular official appointed by the State, and this is a step in the right direction. It is to be hoped, however, that a more enlightened practice may ultimately prevail, and that the prosecuting officer will not have to depend on the testimony of ignorant persons and laymen for the preparation of what is often the most important part of the case. It is rare at present for the medical examiner to have an opportunity to inspect the body and its surroundings before both have undergone interference and change. If, however, he has been so fortunate as to have forestalled this, on his arrival at the place of death he should first note accurately the position of the body, whether on face, side, or back. The position of the hmbs should also be observed, especially that of the arms and hands. If there is a weapon in either hand, the position of the fingers with regard to the handle of the weapon should be carefully noted, as, for instance, whether tightly clinched upon or only loosely surrounding it. The nails of the corpse should be carefully inspected for shreds of skin, which in a struggle may have been scratched from the assailant. If found, they should be carefully preserved for future examination. So, too, the hands, when clinched, should be opened and examined for tufts of hair or fragments of clothing. These inspections should be completed before the removal of the body from its orio-inal position. A rough diagram of the room, which any intelligent man could make, will be of material assistance. On this may be plotted the MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 29 position of the body, together with that of every article of furniture in the room, and any weapon or weapons which may be discovered. Nor is it necessary to be a surveyor to do this with sufficient accuracy for the purpose. A tape-measure used with ordinary intelligence will give the required measurements, and these can be recorded on a rude diagram. Such a sketch shows at a glance the position of the body with regard to every article of furniture in the room, together with the distances. If a weapon is found in the room, its distance from the corpse can be indi- cated in like manner. If any blood-stains are found on the floor, whether in the room or without, then* distance from the corpse should be noted, and if on the wall, their height. It is also of importance to notice the character of the stains, as, for instance, whether produced by the spouting of an artery or smeared on the wall or floor by hands or feet. With re- gard to the furniture in the room, the position of each piece should be noted, and whether disposed in an orderly manner or overturned. The bed should be examined with reference to the condition of the bedclothes, whether stained, in disorder, or undisturbed. The minutest detail is worth mentioning, for until the entire case is made up it is impossible to be sure that any fact is trivial and of no importance. It is, besides, ex- tremely difficult to supply a link which may be essential to the evidence after all traces of the act of violence have been effaced from the spot. With reference to the importance of noting the position of the body, as regards the different articles of furniture in the room, the following case may be cited from Christison. The deceased died from poisoning by hydrocyanic acid. The question arose whether it was self-admin- istered or not. The body was found in bed, covered in an orderly man- ner with the bedclothes, while the vial which had contained the acid, together with a tumbler from which it had been drained, was in a dis- tant part of the room. The whole case turned on the following point, as to whether a person, taking the poison with suicidal intent, could afterward set the tumbler and vial deliberately where found, then go over to the bed and draw the bedclothes up, before being overtaken by death. Here it was evidently of the utmost importance that the distance between the body and the vial and tumbler should be accurately known. So, too, in rapidly fatal wounds accompanied by violent hemorrhage, a knife or other cutting instrument may be found at a distance from the corpse, possibly in another room or part of the house. Irrespective of the nature and direction of the wounds, it may be asked whether it was possible for the deceased to traverse the distance between the spot where the weapon was discovered and that where the body lay, before death ensued. If the medical witnesses answer no, it is evident that the death was not self-inflicted. When the body has been discovered in the open air, similar, though less precise, observations are still possible. Accidents of weather may, of course, obscure or entirely obliterate much that would prove useful in the way of evidence ; still, the vicinity should be carefully examined, especially for traces of a struggle. If found, the distance should be measured from the spot where the body lay to the farthest point where traces of a struggle are visible. If the body be that of a woman, the condition of the underclothes should be examined, and par- ticular search made for seminal stains. Rape followed by murder is more apt to be perpetrated in secluded localities than near or in a dwelling, and therefore the evidence of such a crime should be looked for with 30 A SYSTEM OF LEGAL MEDICINE. care. Often after an unsuccessful attempt at rape murder may be com- mitted, either as a result of the violence used or with the object of con- cealment. The foregoing remarks apply to the preliminary examination of the premises in which the body was discovered. Reasons have been given why it is best for the medical examiner to make this a part of his duty. Afterward he will proceed to the actual inspection of the body itself. The external inspection should always include an examination of the clothes. Bullet-holes in clothing should be inspected to determine the condition of the edges of the rents, for if these are burned, it is evident that the shot was fired at very close range. The cuts made by a knife or other sharp instrument should be counted and described. They may be afterward compared with the body wounds. Where the cuts in the clothes exceed those in the body, this fact is in itself a presumption against suicide, as self-inflicted wounds are not likely to miss their mark. The special examination of the clothing for seminal stains will be referred to and described in the article on Blood and Other Stains. The actual examination of the body consists of two stages, the external examination and the internal. Let it not be supposed that the autopsy proper, the dissection of the body, and the inspection of the viscera form the most important or only important part of a medico-legal examina- tion. It is often of the greatest importance to determine the identity of the corpse, and this is frequently a most difficult task. Nothing would seem to be easier than for a wife, brother, or sister to recognize the body of a deceased husband or near relative; yet there is hardly a body found, where the necessity arises for identification, which is not claimed by several different people. Nor are these false recognitions caused alto- gether by putrefactive changes, for the most extraordinary mistakes of recognition have been made before putrefaction has had time to occur. No doubt such errors are due in part to the changed appearance of the body after death; but there is also, in the natural desire of friends to recover the body of a near relative missing and supposed to be dead, an incentive to exaggerate the importance of slight points of resemblance, and to overlook points of marked dissimilarity. In no other way can we account for the mistakes of this sort which are being constantly made. The recognition of the corpse must depend, however, mainly on the ex- ternal examination, together with such corroborative evidence as may be afforded by the clothing and other property found on the body. In this connection, it may be both useful and interesting to give several recent instances of mistaken identity which 4iave come to the writer's notice. On September 3, 1893, there appeared the following account in the New York Herald of the case of Marcus A. Quinn: " He was entered as dead in the books of the morgue, and at the Bureau of Vital Statistics. A body was buried as his in consecrated ground in Calvary Cemetery, and yet on Tuesday (August 29th) he was found alive in the hospital of the almshouse. Quinn was employed as messenger and teacher in the office of the warden of the almshouse on Blackwell's Island. His wife, however, hved in the city, and Quinn was in the habit of visiting her every five or six days. He came to the city on leave of absence August 5th. Having been long away from his friends, he re- ceived a warm welcome, and it is said drank too freely, and afterward wandered about aimlessly. His wife, hearing of his vagaries through a MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 31 relative, became alarmed as time passed and he did not caU upon her. She finally sent to Blackwell's Island, and learned that he was not there, but had been away for a number of days, and there was no clew to his whereabouts. She then went to police-headquarters on August 18th, and saw the following report, filed August 11th: < The body of a man was found off Pier 9, East River; about fifty years old, five feet nine inches tall, weighing about one hundred and fifty pounds; gray hair and mus- tache, and beard about a week's growth; gray eyes; mixed black-and- brown ribbed vest, blue-and-brown striped trousers, white shirt, leather belt about the waist, black Prince Albert coat; in the water about five hours.' To Mrs. Quinn this description seemed to tally with that of her missing husband in every particular. She arrived at the morgue the following morning armed with a tintype. The body had been buried in Hart's Island, but the photograph taken before burial left no room for doubt in the mind of the wife. The pictures were compared and carefully scrutinized by the authorities at the morgue, and the policeman stationed there said, ' You could not tell one from the other.' Mrs. Quinn wanted to make sure. She went to Hart's Island on Monday, where the body was disinterred for her, and not only she, but her eldest son Matthew and a friend, positively identified the body as that of her husband. In a sealed coffin the body was taken back to the morgue, while the supposed widow went to the office of the Prudential Insurance Company, from whence an agent was sent to adjust the claim. To him the evidence seemed so complete that Quinn was dead that the claim, $165, was paid in full. The funeral followed, which the widow and her three sons attended, together with a friend. Even the clothing on the dead man was burned, so positive was the identification. Shortly after the funeral her eldest son, who was employed on the island steamer, walked in and told her that he had seen her husband in the hospital, and that she had buried the wrong man. It appeared that in his adventures about the city the man had contracted pneumonia, and had finally brought up in the hospital on August 29th." With regard to the insurance money, it may be added that the woman paid it back at once, receiving a receipt in full from the company. Indeed, the small amount of the money, and the fact that the bulk of it must have been spent on the funeral, preclude the idea of a fraudulent identification. Here was a case where a body was positively identified by five persons, including the wife, as that of her husband. Not only were the city officials satisfied of the validity of the recognition, but the insurance company also. The photographs were compared by certainly ten persons, and declared to be those of the same individual. Yet all were mistaken. Another case equally singular happened about the same time. It occurred in connection with the Halliday murder in this State. The bodies of two women found in the Halliday barn were first identified as those of Halli- day's daughter and granddaughter, although not without some difference of opinion on the part of the relatives, as the two sons of Halliday denied that the bodies were those of their sister and niece, while other relatives were just as positive that they were. Within twenty-four hours the bodies were identified again as those of a certain Margaret M'Quillan and her daughter, by a second set of relatives equally positive. All this happened before decomposition had become sufficiently far advanced to account for the errors. 32 A SYSTEM OF LEGAL MEDICINE. Cases like these, where the nearest relatives of an individual have been mistaken in the identity of a corpse, should sufficiently emphasize the care which it is requisite for the medical examiner to exercise in that part of the external examination which is intended to establish or confirm the question of the identity of the corpse. To this end, after noting the ap- pearance of the body with regard to blood-stains, extraneous dirt, etc., it should be carefully washed. This is necessary not only to facilitate the inspection for the purpose of establishing identity, but also to pre- vent the drawing of erroneous conclusions from superficial appearances. Strange as it may seem, the stains produced by ingrained dirt have been mistaken for the marks of commencing decomposition, also for contu- sions. The external examination should commence with the head, and be completed in an orderly manner. The special external details neces- sary for establishing identity are treated of in another article. If the identity of the body is beyond dispute, many of the details of the exter- nal examination, as far as this relates to identification, may in the discre- tion of the examiner be omitted, always bearing in mind, however, the fact that certain questions may be settled at this time which, arising later, when decomposition has advanced, cannot be answered. It is better in a doubtful case to be over-particular than to regret an omission when it is too late to remedy it. The body should now be examined for contusions, recent fractures, and external wounds. The region of the scalp should be particularly observed, for extensive ecchymoses are frequently found in this locality, especially on the lateral and posterior surface of the head, and not neces- sarily associated with fracture of the skull. Sometimes they cannot be seen until the scalp has been retracted, previous to the removal of the calvarium. If this is done at this juncture for the purpose of determin- ing the existence of a suspected ecchymosis, the brain should be left in situ. In general, it is better to defer the removal of the calvarium until the examiner is ready to proceed with the inspection of the brain. The region of the neck should always be examined for finger-marks and the lividities produced by throttling. Other evidences of violence about the neck, such as the circular or oblique marks left by a cord, are to be noted and described; if multiple, this fact should be particularly men- tioned. Some writers regard this as proof that death was homicidal and not self-inflicted. When wounds of the neck are present, their direction should be carefully observed, also their extent and number. Suicidal wounds made by a right-handed person run from left to right, while homicidal wounds take the opposite direction. The so-caUed tentative wounds of the suicide are to be noted. As the court must depend upon the medical examiner for a de- scription of the wounds, their nature, direction, etc., the matter is here briefly mentioned. In making the external examination of wounds, the most important question with regard to determining the manner of their infliction is that of direction. In describing a wound this is the first and most important detail. With a view of determining the character of the weapon, the peculiarities of the wound are next to be described, whether incised, lacerated, or contused. With regard to wounds with clean-cut edges, the examiner is cautioned against hastily calling them incised, particularly when on the scalp, where a blow from a bludgeon may produce a wound having all the characteristics of that inflicted by a cutting instrument. In penetrating wounds extreme care MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 33 should be exercised in the use of the probe, lest the examiner be accused of producing, for instance, a puncture of the intestine, or some other such injury. It is to be kept in mind that the lawyers for the defense will look not for a probable but for any possible circumstance, no mat- ter how remote, wliich may exculpate their client or throw doubt on his conviction. It is better, therefore, to use the probe simply to determine the direction of a wound, and leave the question of extent to a subsequent dissection to decide. Of course the dimensions of all external wounds require mention. In mentioning their situation the measurements should always be taken from fixed bony points. The question whether a wound has been inflicted before or after death is more fully treated in another article. It is sufficient to suggest here that the edges of wounds be examined for retraction, ecchymosis, swelling, and the depths for clotted blood. These circum- stances all point to a wound inflicted during life. If pus be found, or other evidences of inflammation, this should be mentioned, as it is evident that the person must have survived the infliction of the wound some time. The examiner should not be content with a superficial de- scription of a wound. He should state exactly what vessels have been divided, what large nerves and other important structures. Foreign bodies should always be looked for, and if found, their location stated. The hands, especially 011 their palmar surfaces, should be examined for cuts. In cases of homicide there are almost always marks of injury in this situation, particularly if the assault has been committed with a cutting instrument. The external examination of the body may be completed by an inspection of the natural orifices. The mouth'and pharynx should be examined for the evidences of the action of corrosive poisons, such as the mineral acids or oxalic acid. In cases where death has resulted from strangulation the mouth and nostrils are often filled with a bloody froth, the tongue and hps swollen. These appearances are to be noted. Some- times, also, evidences of disease may be seen in this locality, as, for in- stance, the sears of syphilitic ulcers, or possibly the mucous patches of active disease. So, too, the scarred tongue of epilepsy may be made to tell its story. The pharynx should be inspected for foreign bodies, and such portions of the upper air-passage as are accessible to external ex- amination. The more complete inspection of the larynx and trachea must be deferred until the internal examination of the body. The ex- ternal auditory meatus on each side is to be inspected for traces of hem- orrhage ; so with the nasal passages. The information which is to be gained from an examination of the male genitalia is not usually of much importance, other than as bearing on the subject of identity. In the case of a female, the examination of the vagina and external genitalia is of great importance. The lacerations and injuries which are inflicted on these parts in criminal assaults are often very great, and cannot easily be overlooked. In the case of women who have borne children, or who have been accustomed to sexual inter- course, an assault may have been perpetrated without the infliction of any injury on the genitalia. In such a case the vaginal mucus may be withdrawn on a piece of surgeon's gauze and preserved in a test-tube for subsequent examination by the microscope. In this way the crime of rape may be detected, which otherwise might have escaped notice from the uninjured condition of the pudenda. It is often of importance to be able to determine the length of time 34 A SYSTEM OF LEGAL MEDICINE. which has elapsed since death. To facilitate such an estimate, we may divide the period after death into three divisions: first, that period dur- ing which the body is cooling, but prior to the inception of rigidity; second, the period of rigidity; third, when rigidity has disappeared and putrefaction has commenced. It is not possible to draw any distinct boundaries between these different epochs, because there are many cir- cumstances which modify both the time of their inception and their duration. These will be treated of in another chapter. With regard to temperature, it may be stated that if a body has an external temperature of 80° F. or over, death has occurred, probably, within four hours. In deaths from certain diseases, such as cholera, hydrophobia, tetanus, in strychnine poisoning, the temperature rises after death. The latter case is the only one likely to be a cause of error to the medical jurist. For the purpose of taking the temperature of the dead body, any surface- thermometer may be used, such, as Seguin's or that of Immisch. The instrument is placed on the abdomen, and a reading is taken after it has been in position at least fifteen minutes. The rigidity wliich occurs after death, the so-called rigor mortis, does not as a rule come on until from two to three hours after death, and in previously healthy persons dying suddenly, not for some hours later. In such a case as the last mentioned, which is that most likely to come under the notice of the medical jurist, if rigor mortis be well marked death has almost certainly occurred at least six hours previously, and possibly twelve hours may have elapsed since death occurred. In the temperate zone putrefactive changes do not appear, unless under exceptional circumstances, until the end of the second day after decease. In death from septic disease putrefaction commences much earlier, but these cases are not of that class in which it is necessary to estimate the period which has elapsed since death. Such a necessity arises usually where the person deceased has previously been in perfect health, and has perished by violence. This consideration will enable the medical examiner to make reasonable and fairly positive as- sertions with regard to the inferences to be drawn from the appearance of putrefactive changes in such cases, unless the post-mortem examina- tion reveals pathological conditions which compel him to make reserva- tions. Thus it can be said that if a body show the characteristic dis- coloration of the abdomen together with lividity of the dependent parts, death has occurred at least forty-eight hours previously, if the season be summer; while in the winter from seventy-two to one hundred and twenty hours will elapse before the appearance of the characteristic dis- colorations. As all such questions as these are likely to come up in a medico-legal inquiry, it has been thought best to refer to them in con- nection with the external examination of the body. They will be found in another chapter, where they are treated at length. In the inspection of the bodj^ for injuries such as contusions, etc., there is one precaution to be observed: the petechias of decomposition should not be mistaken for the extravasations of contusions. A curious instance in which this error was committed lately came to the writer's notice. A young man of dissipated habits in a fit of despondency com- mitted suicide by taking laudanmn. The ambulance surgeon who was called to the case found him dead on arrival, and after examining the body returned to the hospital. The friends of the young man lived in a distant city, and after the coroner's inquest the body was sent to them. MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 35 Some days thereafter an indignant communication came to the hospital, in which it was charged that the young man had been the victim of foul play, owing to the fact that the body was " covered with bruises when received." As a matter of fact, there was no truth in the suspicions of the relatives. It appears that they were quite ignorant of the vicious habits of the deceased, and had mistaken the petechia? of decomposition for contusions. There were, however, a number of witnesses to the cir- cumstances of the young man's death, and the mistake resulted in no harm. It is easy to see, however, how very serious might be the results of such a blunder. To make the distinction between the ecchymoses re- sulting from violence and the lividities of decomposition is not difficult. In the first place, the ecchymosis is a true hemorrhage, which the lividity is not; therefore an incision into the former will either be followed by the escape of the effused blood, or, what is more common, a subcutaneous clot will be found. Post-mortem lividities are displaced by pressure of the fingers; ecchymoses are not. That an actual hemorrhage ever occurs after incision must be quite exceptional, and can only happen when for some reason the blood retains its fluidity long after death. In the post-mortem lividity, the incision is not followed by the escape of blood, nor is there any clot present. The position of the spots is significant. When of post- mortem origin, they are found on the most dependent portions of the body, such as the calves of the legs, the posterior parts of the arms. The sides of the chest posteriorly are almost always the seat of these post- mortem discolorations, which, as they extend downward, coalesce until the back presents the appearance of a uniform suggillation. The time at which the discoloration appears is of some importance, post-mortem spots not appearing until an interval of some hours after death. No exact time can be fixed, however, for their appearance, as this varies according to climate, season, cause of death, as well as for other reasons at present unknown. Of course, if the injury which caused the discoloration oc- curred some time before death, swelling may be found in the vicinity, and the ecchymotic spot wiU be elevated above the surrounding surface —something which never happens in a post-mortem spot. So also the color of the ecchymosis may be characteristic, if time sufficient shall have elapsed before death for the familiar changes to occur. No such changes take place in the petechia? of decomposition. When decomposition is far advanced, the difficulty of distinguishing between the ecchymosis and the spots of decomposition increases greatly. It is impossible to say at what period it becomes impossible to make the distinction. This is a matter which must be left to the discretion of the examiner. It is very doubtful whether such a, distinction should be attempted after the skin is far advanced in decomposition. # Internal Examination.—The technique of an autopsy is very differ- ent from that of a dissection. The broad and vigorous sweep of the knife with which the incisions are made to expose the viscera is very different from the cuts of the dissecting-scalpel. As Virchow remarks in his work on post-mortem examinations, fine work may occasionally be re- quired for pathological anatomy, vet it is not the rule. It may be further stated that in the majority of medico-legal inspections it is still more ex- ceptional for the necessity for fine dissections to occur. The ordinary dissecting-case is therefore not well adapted for the purposes of an autopsy. The incisions in the soft parts are of two kinds: first, that 36 A SYSTEM OF LEGAL MEDICINE. which exposes the cavities of the body, for which purpose a rather broad but short and stout knife is used, fitted into a thick and broad handle ; second, incisions into the viscera themselves. For the purpose of avoid- ing a number of short cuts, which should never be made, a knife should be used as long as an ordinary amputating-knife, but with broader blade, for making sections of the brain and the larger viscera at one sweep. The object in making these sections of the viscera in this manner is to expose a broad and even surface for examination without tearing the tissues, and this can only be done with a long and rather broad knife. For finer dissections an ordinary scalpel may be used. The blade of the first knife should be about three and a half inches long by one inch in breadth, with a handle four inches in length. The long-section knife should have a length of eight and a half inches, a breadth of one and a quarter inches. Other instruments wliich are of use in the autopsy are a saw, a hammer with hooked handle for removing the calvarium, a saw slightly curved for exposing the spinal cord, a costotome for dividing the ribs when ossified, and an enterotome for slitting the intestines or trachea. A few probes of different lengths, the chain and hooks of the dissecting-room, and a blow-pipe complete the necessary appliances of the post-mortem table. A brass gauge marked in millimeters is some- times used for the purpose of making such measurements as the thick- ness of the ventricular walls, etc. A pair of small scissors having one blade pointed, the other probe-pointed, is often of use in laying open a small duct like the common bile-duct, but the necessity for such an ex- amination seldom occurs to the medical jurist. Where the weight of the viscera is likely to be of importance, a pair of scales is a necessity. For the purpose of estimating the amount of fluid found in a large cavity, such as the chest, a large sponge is useful with which to remove the fluid, which is afterward expressed into a vessel of suitable size and measured in a graduate provided for the purpose. Usually no autopsy ought to be performed earlier than twelve hours after death, except in cases where death has resulted from violence, and the German regulations do not permit an autopsy until twenty-four hours after. Even in cases of death by violence it is questionable whether an earlier examination is advisable, for it is possible to make the external examination as early as necessary, deferring the autopsy proper to the usual time after death. The Bishop case will no doubt occur to the reader as an instance where neglect of this precaution was the cause of great annoyance to the examiners, who were even indicted for their precipitation in hastening the autopsy. Yet it was because of their fear that post-mortem changes would obscure the peculiar condition which they sought in the nervous system, that they hurried the autopsy, with most unpleasant results to themselves. However desirable an early ex- amination may be, considerations of humanity and obvious expediency will induce the examiner to defer the dissection until the lapse of at least twelve hours and possibly a full day after death. It is essential that an autopsy should not be held by artificial light. Differences in color, par- ticularly such as denote the existence of pathological changes in the nervous system, are not easily appreciated except by dayhght. Frozen bodies should be thawed out in a warm room, but the thawing process ought never to be hastened by artificial means. In corpses other than those of new-born infants, the order in which MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 37 the examination should be made is as follows: first, the brain and cranial cavity; second, the vertebral column and spinal cord; third, the thorax; and lastly, the abdomen. The skull is to be exposed by an incision through the scalp made from ear to ear, over the vertex. The two flaps are then reflected anteriorly and posteriorly sufficiently to give room to saw through the calvarium. Any ecchymoses not before visible are now to be noted, and the surface of the cranial vault examined for fractures. If found, they should be traced throughout their whole extent, especially when, as is often the case, they extend into the base. In this situation they can be more conveniently followed after the calvarium has been re- moved. For this purpose usually it is directed that the saw-cut be made in a perfectly circular manner around the skull. There is one disadvan- tage connected with this method, which is, that when the calvarium is replaced, as the cut surfaces are horizontal, it is easy for them to glide apart. Thus an unsightly ridge or depression may be left over the fore- head, marking the edge of the sawn bone, after the soft parts have been drawn together and the body prepared for burial. As it is desirable to conceal all traces of the autopsy subsequently, when possible, a modifica- tion of the usual method of applying the saw is here suggested. Instead of the circular cut around the cranium, two saw-cuts are made, one on each side of the skull, commencing anteriorly in the median line just above the superciliary ridge, running backward and terminating one inch above the external auditory meatus. Commencing a little below the "lambda," two other similarly oblique cuts are made, which join the first at their termination. The calvarium may now be removed. The dura should be cut through if adherent. The calvarium should never be violently torn off, for fear of injuring the brain. It will be seen that when replaced the obliquity of the saw-cuts prevents the calvarium from sliding in either direction. An ingenious method of still further secur- ing the calvarium when replaced is practiced at the Methodist Episcopal Hospital of Brooklyn. . In each of the anterior cuts, a little in front of their termination, a second saw-cut two inches long is made, parallel to the zygoma. Into these short cuts a two-inch roller is passed directly through the skull from side to side. The calvarium js then replaced and the ends of the roUer bought together over the vertex and pinned. This renders it impossible for the calvarium to be subsequently moved. The tem- poral fascia should also be sutured before the scalp is replaced. (Fig. 1.) After the removal of the calvarium its interior is to be examined with regard to the condition of the internal table, extensive shattering of wliich may exist without corresponding injuries of the external table. The dura mater is then to be inspected and its condition noted. Extra-dural clots are to be turned out into a graduate and measured—which is more exact than to make the usual loose statements, "a quantity of clotted blood," " a large clot." The meningeal arteries are to be carefully exam- ined, especially where extra-dural clot exists, as they are frequently the seat of the hemorrhage. The longitudinal sinus may then be slit up and examined, after which the dura is to be divided and the arachnoid and pia inspected. Particular attention is to be given to the membranes with reference to the existence of such conditions as lepto- or pachy- meningitis. The explanation of many an act of violence may often be found in just such pathological changes. The vascularity of the mem- branes is also to be noted. After this the brain is to be removed, the 38 A SYSTEM OF LEGAL MEDICINE. section of the cord being made by a long knife, as low down as possible, to secure the whole of the medulla for examination with the brain. The base of the skull is now accessible for examination after removal of the dura which hnes it. The sinuses of the base can also be inspected. Fig. 1. The brain should then be weighed. The circle of Willis is then to be examined for miliary aneurism, emboli, etc., and also the middle cerebrals, so frequently the seat of disease. In cases of suspected poison- ing by narcotics, particular attention is to be given to the state of the membranes, the sinuses, and the intra-cerebral circulation. In poisoning by opium the veins are said by some to show a slightly deeper color than the arteries. This seems doubtful in view of the imperfect aeration of the blood which occurs in these cases. At any rate, this disappears after exposure to the air, as both veins and arteries soon take up oxygen and become of uniform color. In estimating the amount of congestion present in the vessels of the central nervous system, it is never to be forgotten that the injection of an embalming fluid, particularly where a vein has not been opened and the vascular system washed out previous to the injection of the preservative fluid, is perfectly competent to pro- duce an appearance which it is difficult to distinguish from the extreme congestion of narcotic poisoning or other pathological congestions. There will be found the same arborescence, the same punctate appearance MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 39 of the white matter on section, the same turgescence of the choroid plex- uses. The coloration of arteries and veins will be uniform, however. In the Harris case the defense, singularly enough, overlooked this obvious point, for the body of Mrs. Harris had been embalmed previous to burial. In this connection it is also of some importance to remember that under- takers use for this purpose a small force-pump, and that as the fluid is forced through the vessels it takes up the coloring matter of the blood and produces the appearance above referred to. The writer has verified this statement many times in the dissecting-room. The more dependent portions of the brain are also apt to have a congested appearance even when no injection has been made, simply from the gravitation of fluids. The fact that the congested appearance is restricted to the more depend- ent parts will prevent this condition from being mistaken for true con- gestion. The dissection of the brain is next in order. To make proper sections here, it is imperative that the knife used should be as keen as possible. The cut through the hemisphere should be made with a quick drawing motion with the minimum of pressure, otherwise the soft nervous tissue will certainly be torn as the knife drags and tears its way through. It has been recommended by Virchow that the incisions should commence from within and terminate at the pia mater, which is not, however, divided, but serves as a binding to keep the various sections together in proper serial order. In this manner the relations of the divided struct- ures are preserved, and it is possible to reexamine them in their natural order, if desirable. With regard to the thickness and number of the sections necessary, it may be observed that in cases where it is likely that the condition of the brain will form an important part of the case, it is easy to make too few sections, impossible to make too many. In sections half an inch thick many a spot of softening or small hemor- rhage may lurk concealed. This is particularly true of the " pons " and medulla, where very small lesions may be the cause of very formidable symptoms. It is in this particular part of the brain, therefore, that the sections should be most numerous, perhaps even microscopic. It is recommended that the first sections be made from within the great lon- gitudinal fissure outward serially until the level of the corpus callosum is reached. At this point the lateral ventricles are to be opened by two incisions a quarter of an inch on either side of the raphe. The cavity of the ventricle once found, the rest of the ventricle may be exposed by cutting through the roof with the probe-pointed scissors, following the floor with the probe blade. The presence or absence of serum in the ventricular cavity is to be noted, and its quantity, if present. For the purpose of measuring the contained fluid, it may be withdrawn from the cavity of the ventricle by the aid of a small syringe, and measured in a graduate. Some writers recommend that the ventricles be opened first before any other incisions are made in the brain, lest the manipulations necessary for the other incisions should so lacerate the substance of the brain as"to permit the escape of fluid. It is difficult to see how a satis- factory dissection of the ventricles is possible without removing so much of the cerebral lobes as to bring the cut surface on a level with the corpus callosum which forms the ventricular roof. It is evident, however, that the utmost care is needed to prevent the occurrence of lacerations in handling so soft a tissue as that of the brain. The most important parts 40 A SYSTEM OF LEGAL MEDICINE. to be examined in the ventricles are the choroid plexuses. After ascer- taining then- condition, the pillars of the fornix are to be divided and reflected, when the velum interpositum will come into view, with the veins of Galen. The state of the vessels in this tissue is to be_ noted, after which the velum is to be reflected, and the cavity of the third ventricle may be then inspected, together with the corpora quadrigemina, the geniculate bodies, and the iter. With regard to the further dissection of the brain, which involves the making both of macroscopic and microscopic sections, it has already been stated that the examiner, in a certain class of cases, is more likely to make too few than too many. Indeed, the only limit wliich can be placed on the number of the sections to be made in cases like that of Harris or Buchanan is that which time imposes. In ordinary in- stances, sections of the convolutions made at intervals of half a centi- meter will usually be sufficiently close, although it is quite possible, as before stated, for smaU foci of softening to lie concealed in sections of this thickness. Much must be left to the judgment of the examiner in each individual case with regard to the thickness and number of the sections. Virchow's remark in this connection is significant: " The less you find, the greater ought to be the number of the sections." Microscopic sections will rarely, if ever, be required in any number save in the regions of the medulla and pons. Where these are required, the examiner may remove the parts mentioned and preserve them in alcohol for the subsequent microscopical examination. In the examination of the internal capsule, particular attention should be given to that portion supplied by Charcot's artery of hemorrhage, the lenticulo-striate artery. This is a branch of the middle cerebral, which, passing through a separate hole in the anterior perforated space, runs upward between the lenticular nucleus and the external capsule, then perforates the internal capsule, terminating in the caudate nucleus. In the dissection of the basal ganglia the incisions should be made radially in an antero-posterior direction, converging toward the peduncle. The floor of the fourth ventricle should be inspected for the petechial hemorrhages, which are of quite frequent occurrence in this vicinity. In cases where fracture of the skull has occurred they are not uncommon, and are probably the result of concussion. The writer has also seen them in cases of death from opium poisoning, and from gunshot wound of frontal lobe. In one case they were in the pneumogastric nucleus, on each side. It has been shown that they also are found in this vicinity in criminals who have been put to death by electricity. The examination of the spinal cord is next in order. There is no part of the autopsy which should be conducted with more care. It has been conclusively shown by Van Giesen that injuries may be inflicted on the cord by rough handling during its removal, which may simulate softening, displacement of both gray and white matter, etc. For a com- plete account of the various injuries which may be inflicted on the cord in process of removal, the reader is referred to the original paper, which appeared in the New York MediceilJournal, June, 1892, " A Study of the Artefacts of the Nervous System." The conclusions which the writer draws which are to be noted in describing the technicpie of the removal of the cord from its bony canal, are as follows: The use of mallet and chisel is inadmissible for the purpose of cutting through the lamina? of MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 41 the vertebra?, because it is easy by this method to force in upon the dura and cord fragments of bone, which will surely produce a bruise. The blows of the mallet are of themselves quite sufficient to produce effects which may be mistaken for pathological changes. The use of heavy bone shears is equally to be deprecated, as the introduction of the inferior blade into the vertebral canal is almost certain to result in a contusion of the cord. The double-bladed saw is objectionable because it is liable to jam in the saw:cut, and the violence which is necessary to release the blades may thrust them into the vertebral canal and injure the cord. The chisels of Brunetti, used in removing the cord through the abdominal incision by chopping through the pedicles, while expeditious, are, accord- ing to Van Giesen, as objectionable as the use of the chisel in the ordi- nary manner. Of all the different methods employed for the purpose, Van Giesen considers that the use of the chisel is most likely to result in the production of artefacts. He recommends the use of a single saw " slightly curved or gently rounded at the point." With this saw the vertebral archway is to be completely severed on both sides of the spinous processes, due care being exercised not to drive the saw into the vertebral canal so as to injure the cord. Prior to the use of the saw, the soft parts will have been retracted, and the vertebra?, especiaUy those in the cervical region, carefully inspected for fracture. After finishing with the saw, the spines are to be gently tested with the hand, and if any are found immovable the saw is to be reapplied until the arches have been com- pletely severed. On no account is the hook or chisel to be used to release a partly divided arch, as this is sure to result in bruising the cord. The bone shears are also to be avoided. With regard to Dr. Van Giesen's criticisms on the use of the tAvo-bladed saw, it may be observed that this instrument is at present used by the best pathologists in Europe, and that the single saw may be made to lock in the saw cut, just as the double blade. The older instrument furnishes the readiest means of exposing the spinal canal, and if used carefully ought not to result in the production of artefacts. After the removal of the posterior vertebral archway, the cord is to be taken out of the vertebral canal in its dural sheath, any epidural hemorrhage being noted. While dividing the attachments of the dura, the spinal nerves, etc., care is to be taken not to handle the cord itself. It is safest to remove the cord from its canal bv taking hold of the dura with forceps and lifting it out in this way, taking care neither to stretch nor twist it. As the examination of the cord will usually be made by the aid of microscopic sections, it must be taken to a distance for this purpose, and in order to avoid injury should be carefully placed on a bed of soft cotton and covered with alco- hol. It mav be divided into a convenient number of sections for this purpose. Van Giesen relates a case where a cord was taken across the city resting on a bed of pounded ice. The cord settled down in the ice in transit, and bruises occurred. In this case the cord was already very vulnerable because of an acute myelitis. Where the cord has been trans- ported in its dural sheath, the examination of the subdural space for hemorrhages, clots, etc., must be left for the microscopist, or the examiner may himself be present when the dura is opened, in order to inspect its interior. The practical point for the medical examiner to bear in mind with regard to the spinal cord is the ease with which artificial injuries, inflicted either in process of removal or transportation, may be mistaken 42 A SYSTEM OF LEGAL MEDICINE. for injuries incurred before death. The importance of this fact to the medical jurist cannot be overrated. The incision for exposing the cavities of the thorax and abdomen, as usually made, commences at the episternal notch and terminates at the symphysis. It should be firm, deep, and pass to the left of the umbilicus to avoid the round ligament of the liver. In extending the incision through the peritoneum, the recti muscles may be severed at their pubic attachments. This will be found convenient, especially if rigor mortis is well developed and the muscles large. As in medico-legal autopsies it frequently becomes necessary to examine the trachea, pharynx, and oesoph- agus, it is better to commence the incision at the chin and complete it 1 as usual. This is the present German method. It exposes the region of the neck, and renders it possible to remove the larynx, trachea, and oesophagus. The two former structures will always require examination in cases bearing marks of violence in the neck, as from strangulation or suspension. Sometimes, in cases where the body has been found face downward in a shallow pool of water, an examination of the pharynx and trachea will show, by the presence of water, sand, or weeds, that efforts at respiration had taken place after immersion of the mouth; and such evidence would tend to tin' conclusion that the deceased met death by drowning, or at least that when he fell into the pool he was alive. Where there is reason to expect fracture of the trachea or larynx, it has been advised that the structures should be opened from behind, and examined after removal. In those instances where corrosive poisons have been taken, the examination of the oesophagus will show the action of the drug. If the examination of the trachea and larynx reveal reddening and oedema, it should not be forgotten that these structures are almost the first to undergo putrefaction, of which the reddening and oedema may be but signs. In the somewhat rare cases where a foreign body has lodged in the oesophagus, and, as in a case seen some years ago by the writer, caused ulceration into the aorta and sudden death from rapid hemorrhage, an examination of the oesophagus will be necessary in order to show the cause of death; also in death from corrosive poisons. In order to expose the thorax, it is, of course, necessary to reflect the soft parts to a point beyond the cartilages of the ribs. This may be most conveniently done with the short, broad, knife. In the abdominal region, the primary incision may extend quite down to the peritoneum; but as such a tour de force can only be accomplished after much practice, it is better to make several incisions through the abdominal wall, than by one ill-judged slash of the knife to wound the intestines. When the perito- neum is reached, it may be opened by passing two fingers into a narrow opening made for the purpose, and then slitting it up between the fingers as a guide. The abdomen is to be opened and inspected first, but the contained viscera must not be dissected or removed until after the exam- ination of the thorax, because the division of the large vessels of the abdominal viscera wrould certainly drain the blood from the cavities of the heart, and render it impossible to state with precision their condition with regard to contained blood. So too, if, on the other hand, the thorax be opened first, it will be impossible to determine the position of the diaphragm—a point of some importance in autopsies on the bodies of new- born infants. The inspection of the abdomen should therefore be made with a view to determining the position of the diaphragm with regard to MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 43 the ribs, the color of the contained parts, and, where this can be ascertained without dissection, the presence and position of any foreign body. With regard to the latter consideration, it may be observed that the search for a missile in the abdominal cavity is always a matter of difficulty, as witness the autopsy in the Garfield case, where the bullet was not found in the abdomen at all, although most careful search was made for it, but was afterward discovered in the vessel which had been made the receptacle of the removed viscera. It will therefore be necessary in these cases to defer the search for the foreign body until the dissection of the abdomen. The presence of fecal matter from wounds of the intestine, of clotted blood or of serum, may be ascertained at this point. Blood-clots should be transferred to a graduated vessel and thus measured, so that an exact statement of the amount of clot may be made in the report in place of the usual inaccurate wording, "a large amount of clot," etc. The quantity of blood-clots or other fluids in the cavities of the body may also be determined by weight. Serum may best be measured by sopping it up with a large moist sponge and expressing it into a suitable vessel, until the cavity is dry. The color of the abdominal contents ought to be ascertained soon after opening the cavity, as, owing to absorption of oxygen, they quickly change from a dusky red to a deep red, w^hich may and often is mistaken for the signs of an inflammation. It may be fur- ther remarked that bright red arterial blood is never found in the dead body. (Virchow.) The more dependent parts of the abdominal viscera always assume a deeper red than those which are uppermost, and this fact will assist the examiner in determining whether the color is due to inflammation or not. If confined to the dependent parts, it is certainly the result of the gravitation of the blood; whereas if uniform, particularly if the peritoneum have lost its gloss, it is probably due to irritation or inflammation. Old adhesions, thickenings of peritoneum, and other signs of past inflammation are to be noted. The preliminary inspection of the abdominal cavity having been com- pleted, the thorax may now be opened. One precaution is to be observed in this connection. After the costal cartilages have been divided close to the ribs, in disarticulating the sternum from the clavicle particular care is to be taken not to wound the great veins beneath, as is often done. Where this happens, it is impossible to determine whether the blood which is certain to be found in the chest is the result of the wounding of the veins, or, if there is a wound of the chest, to determine what propor- tion of the effused blood is due to the previous injury and what to the divided veins. If the crescentic shape of the sterno-clavicular articula- tion be borne in mind, the separation of the articular surfaces will be facilitated if the examiner direct the knife in such a manner as to follow the curve. The cartilage of the first rib is frequently ossified, and it is here that the greatest care must be exercised, else the knife or costotome wiU wound the vessels beneath. In the first place, it is to be remembered that the cartilage of the first rib extends about half an inch further out- ward than that of the second, consequently the incision must be made with this in mind, else the knife will come in contact with the manubrium. If the knife is placed under the rib and the cut is made in a forward direction, the vessels wiU be avoided. After dividing the sternal attach- ments of the diaphragm, the entire sternum may be removed or reflected and the pleural cavities examined. Any fluid, as serum or blood, is care- 44 A SYSTEM OF LEGAL MEDICINE. fully to be removed with the sponge and expressed into a vessel, and measured or weighed. The presence of adhesions is to be noted, and other evidences of recent or chronic disease which appear on the surface of the lungs. The mediastinum is also to be inspected. The pericardium is then to be opened carefully so as to prevent the escape of any fluid therein contained, which is to be measured as before directed. Both its visceral and parietal surfaces are to be inspected for pathological changes. With regard to the external appearance of the heart, an important point is the condition of the coronary arteries. After the removal of the heart, their caliber should be tested,'after which they should be slit and their interior examined for atheroma, etc. Many a case of sudden death may be explained by an inspection of the coronary arteries, one of which may be found to be almost or quite occluded by a thrombus, which has rapidly formed about an atheromatous plate stripped up by the blood current. If the heart be now removed from the thorax, much of the blood in the auricles may escape, and an exact estimate of the blood in the heart rendered impossible. It may be objected that such exactitude is unnec- essary. In a medico-legal inquiry it is impossible to be too exact, as the result of many a trial has shown, to the mortification of the too confident medical witness. The auricles and ventricles are therefore to be opened in the manner about to be described, and their contents examined both with regard to color, quantity, and general appearance. Ante-mortem clots will be evidenced by their extreme pallor and toughness, also the fact that their centers are disintegrated. Pale yellow and succulent clots are of no significance, as they may be formed in the last moments of life, whatever the cause of death. (Delafield.) The heart should be opened in such a manner as to expose the cavities and valves without injuring the latter. The dissection of the heart consists of two stages. The first stage includes the opening of the auricles and ventricles, the heart being in situ, and the subsequent estimation of the clots and the measurement of the auriculo-ventricular openings. The second stage consists in the re- moval of the heart and the examination of its valves and interior. The right auricle should be opened first. The incision should commence be- tween the two vena? cava? and end in front of the base. (Fig. 2.) The clot should then be turned out into the pericardium, from whence it may be removed for estimation by weight or measure. If measured, an ordinary glass graduate may be used. The approximated index or middle fingers of the left hand may then be introduced through the tricuspid valve into the right ventricle, the walls of which must be gently separated. If the auriculo-ventricular opening permits the introduction of these fingers, especially if the fingers be thick, the lumen of the valve may be consid- ered normal. In the case of slender fingers, it is possible to introduce between the index and middle fingers of the left hand the index finger of the right. After the size of the opening has been ascertained the incision into the right ventricle should be made. This should commence close to the base, pass into the ventricle, and end just short of the apex. The septum must be avoided. In the case of each cavity, the clot is to lie turned out as before directed and measured. The incision for the left auricle commences at the left pulmonary vein and ends in front of the base, avoiding the coronary veins. The incision into the left ventricle begins behind the base and is carried down toward the apex, which it must not quite reach. The measurement of the valves and clot is con- PLATE II. Fig. 2. LINE OF EXTERNAL INCISION OF HEART. (VIRCHOW.) Fig. 3. EXPOSURE OF INTERIOR OF HEART. (VIRCHOW.) MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 47 tinned as before. The heart may now be removed, taking care to cut all the vessels rather long. The sufficiency of the aortic and pulmonary , valves may now be tested by pouring water into these vessels. For this purpose the heart must be suspended by the vessel the valves of which are the subject of the test. It is important that the suspension is made in such a manner as to preserve as far as possible the circular form of the artery. This may be done either by passing a number of sutures through its walls or by grasping its walls with the fingers of both hands in such a manner as to preserve its shape. No lateral traction should be made. The real efficiency of the water test may be called in question, for it may be doubted whether the integrity of the valves may not be better determined by inspection and touch. The ventricles may now be fully opened for the purpose of examining the flaps of the auriculo-ventricular valves, the endocardium, and other structures in the interior of the heart. (Fig. 3.) The incision for the right ventricle (Fig. 2) is made by entering a pair of scissors into the previous incision and carrying it toward the pulmonary artery, avoiding the anterior papillary muscle by passing in front of it. The incision for the left ventricle (Fig. 3) is made in a straight line, prolonged from the aorta, close to the septum. This incision must not cross the pulmonary orifice, as it will if carried too close to the sep- tum, nor must it cut that portion of the mitral valve which is attached to the left border of the aorta by going too far to the left. The incision should pass midway between the pulmonary orifice and the left auricle. The examination of the heart being completed, the lungs may now be removed. This is done by seizing each lung in turn, lifting it up, and dividing the vessels at the base. The bronchi should now be opened with a pair of scissors, and examined for foreign bodies and morbid ap- pearances, commencing with the primary bronchi and following them up to then- subdivisions as far as necessary. The lung tissue itself is to be examined, by means of long incisions made with sweeping strokes of the knife, from apex to base, on the posterior aspect. The cut surfaces may then be inspected, and any fluid contained in the lung tissue or smaller bronchi expressed by passing the edge of the knife at right angles over the surface of the incision. Blood, pus, mucus, or serum may thus be squeezed out and examined. The presence of sanguinolent mucus in the air-tubes is significant. The abdominal viscera are now to be dissected. In cases of gunshot wound of the abdomen, the intestines should be examined first; but in other cases it is best to leave them to the last, for the sake of cleanhness. Where it is necessary to search the intestinal canal for perforations re- sulting from gunshot wounds, it is best to do this in a methodical mauner. The search may commence with the sigmoid flexure and rectum, thence extending to the three divisions of the colon, the intestines being passed through the fingers until the duodenum is reached. The location of all wounds, their number, and especially their position with regard to the wound in the parietes, are to be noted. In order to search for the bullet, it will be usually necessary to remove the intestines. This may be best accomphshed by first ligaturing the gut both at the rectal and gastric ends with a double ligature, and then commencing at the rectum, dividing the mesentery until the whole intestine is freed from its attach- ments to the posterior abdominal waU. Further search for the mis- sile may now be made, after the abdominal cavity has been thoroughly 48 A SYSTEM OF LEGAL MEDICINE. cleansed. In cases not involving perforating wounds of the intestine, it is usual to examine the abdominal viscera in the following order: first, the omentum, which may be inspected for miliary tubercle or carcinoma; second, the spleen; third, the kidneys, suprarenal capsules, and ureters; fourth, the sexual apparatus; fifth," the stomach and duodenum; sixth, the liver, gall-bladder, bile-ducts, and portal veins; lastly, the structures in the posterior portion of the abdomen, such as the abdominal aorta, the receptaculum chyli, lymphatics, etc. As a rule, the spleen possesses no special interest to the medico-legal examiner. It is often ruptured as a result of violence. Its pulp softens very early as a result of putrefaction. The kidneys may be removed by separating the peritoneum from them and dividing the vessels and ureter. The capsule is then to be stripped off; if adherent, this is to be noted. The pelvis may be inspected for calculi. An incision is then to be made in the convex border of the organ, right down to the pelvis, laying the kidney open in two equal parts. The cortical and medullary portions may then be inspected for evidences of disease. This should never be omitted. In cases where narcotic poisoning is suspected, the examina- tion of the renal organs ought to be as exact and complete as possible. In late autopsies the naked-eye appearances are perhaps of more value than the deductions of a microscopic examination, for the conclusions which can reasonably be drawn from microscopic findings after the changes of com- mencing putrefaction have set in are untrustworthy. It may, however, be quite possible still to appreciate a change in the proportion of the cortical and medullary portions of the kidney, which would indicate the existence of a previous chronic disease. It is not usually necessary to remove the bladder for examination. It is sufficient, after drawing the urine with a catheter, to make an incision into the upper surface of the viscus and examine it in situ. The urine should be preserved for future examination, particularly in cases of poisoning. It is important to examine the bladder walls for injury, especially in cases where fracture of the pelvis exists. To determine whether there is any perforating wound, the viscus may be filled with water or air through the urethra, before open- ing. It may be necessary to remove the entire bladder for purposes of examination, in which case care should be taken not to wound the blad- der wall—something which it is not difficult to do in careless manipula- tion. It is not often that a further examination of the male genito- urinary organs will be required; but if this should become necessary, the penis may be stripped out of the skin, cut off at the glans, and drawn out like a finger from a glove. It may then be removed with the bladder attached. A pah of scissors curved on the flat facilitate the necessary dissection. The inspection of the female organs of generation within the pelvis is often of great importance, especially in cases of criminal abortion. The ovaries are to be inspected for the corpora lutea of pregnancy, which are to be distinguished from the false corpora lutea of menstruation. The pelvic tissues are to be examined for evidences of old or recent inflam- mation. The uterus will, of course, receive particular attention in a cer- tain class of cases. Its size should be noted, also the depth of its cavity, the condition of the os and cervix, the thickness of its walls. If any dis- charge is present, either in the cavity of the uterus or vagina, this will be of importance. The condition of the uterine sinuses and endometrium MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 49 should receive attention, also the FaUopian tubes. The orifice of the tubes will not admit anything larger than a bristle, as a rule, and this can be passed most easily, after the uterus has been laid open so as to expose the cornua. The entrance to the Fallopian tube will be found in the apex of each cornu. In cases of abortion where death has occurred within a few days, the uterus must also be examined for signs of injur}', as perforations, wliich would indicate the use of a pointed instrument—not necessarily, however, in the hands of another than the woman herself. The writer knew of two women, one of whom was accustomed to produce an abor- tion on herself by the aid of a lead-pencil, and the other used an um- brella wire for the same purpose, at last inflicting a fatal injury. The size of the uterus is of some importance in determining the period of pregnancy, where this has existed. The normal unhnpregnated uterus measures two and a half inches in length, one and three quarters inches in breadth, and one inch thick. For further measurements as indicative of the period of pregnancy, the reader is referred to the appropriate chapter. In examining the uterus where death has taken place shortly after confinement, the observer ought not to forget that the site of the placenta presents appearances which may be mistaken for inflammation or even gangrene. The presence of pus, the condition of the uterine sinuses, the coexistence of peritonitis, and the presence of septic micro- organisms, possibly the streptococcus pyogenes, will make the distinction clear. One or all of these conditions will be found in acute inflamma- tions of the uterus. The ovaries are usually involved in the morbid pro- cess, and will be found to be congested, swollen, and, where the disease has been of sufficient duration and acuteness, infiltrations and local ab- scesses may exist. The examination of the stomach and duodenum is of special importance in cases of suspected poisoning. As the preservation of the contents is of prime importance, in order that this may be done without even the possibility of contamination, it is recommended that the stomach and duodenum be ligatured separately with double ligatures, and placed in new glass jars with glass tops, previously well washed in distilled water. The jars should then be sealed and at once sent to the analytical chemist. The examiner is to inspect the interior of both stomach and duodenum after the chemist has transferred their contents to suitable and well- washed vessels. It is better not to make this transfer iu a room where chemicals are kept. The stomach may then be opened along its greater curvature, and its interior examined. This is a method which involves some extra trouble; but as the contents of these organs are not removed until they reach the laboratory which is their final destination^ there is one less manipulation to call in question, and the risk of possible con- tamination is consequently lessened. Nor is such a precaution needless. Any one who is conversant with the refinements of modern chemistry and the history of past trials for poisoning will admit that any proceed- ing is proper which will limit the suspicions which a clever defense, aided by a friendly chemist, is able to cast on any chemical analysis, no matter how skillfully conducted. If the viscera have to be sent to a distance, another consideration must be taken account of, however, which is the cloud which putrefactive changes occurring in transit may cast on the analysis, bv the production of ptomaines. This will occur particularly where the "chemical analysis results in the discovery of some form of 50 A SYSTEM OF LEGAL MEDICINE. alkaloidal poison, especially morphine. The Buchanan trial may be cited as an instance of the confusion in the expert chemical testimony which the presence of ptomaines occasioned. Indeed, in this case it may well be questioned whether the accused was not fairly entitled to the doubt which was raised when Professor Vaughan showed the similarity which existed between the reactions of morphine and indol. Certainly on the testimony alone of the chemists for the prosecution, the State was not entitled to a conviction. Where putrefactive changes are liable to occur in transit, it is better to transfer the contents of the stomach and duodenum to separate vessels. The viscera can then be immediately ex- amined. With regard to the inspection of the mucous membrane of the stomach, it is to be remembered that post-mortem digestion commences at from twenty-four to thirty-six hours after death, causing softening and disintegration of the mucous membrane. This process is most active in the pouch of the greater curvature of the stomach, which may serve to distinguish this form of softening from that caused by disease. Occa- sionally when death takes place immediately after a full meal, during active digestion, the action of the gastric juice has produced a perfora- tion of the stomach. Ulcers of the stomach occur, as a rule, at the pyloric end near the lesser curvature, although they may be found any- where. They frequently have an indurated margin. The examination of the liver is frequently of the utmost importance in medico-legal cases, as, for instance, to determine the existence of the changes which this organ undergoes as a result of certain poisons. So, too, in cases of death by extreme violence the autopsy may reveal exten- sive lacerations of the substance, even where the external signs of violence were absent. The liver may be removed for examination by first divid- ing the diaphragm on either side as far as the spinal column, then sever- ing the lateral ligaments, the broad hgaments, after which it may be turned into the thorax, the vessels and coronary ligament divided, and the organ removed. If it seem necessary, the bile-duct must be exam- ined previous to removal. For the purpose of inspecting the parenchyma, sweeping incisions may be made in the substance of the organ with the long knife. After the removal of the liver, it is possible to examine the posterior surface of the abdominal wall. The receptaculum chyli and lymphatic may be inspected with a view of determining, in certain cases, the relation of the time of death to the ingestion of food. In the foregoing description of the method of conducting an autopsy, nothing has been said of the propriety of weighing the solid viscera. The utility of ascertaining their weight is doubtful, as this may vary within quite wide limits. Any conclusions based on the evidence of the scales ought for this reason to be accepted with caution. For the purpose of comparison, however, the following table is appended: Weight of brain .. '' lungs .. '' heart .. '' liver . .. " spleen . " kidneys " uterus . Male. 46-53 oz. 1-37 of body-weight 10 oz. 60 oz. 7 oz. (average) ii-6 oz. Female. 41-47 oz. 1-43 of body-weight. 8oz. 50 oz. 4-5i oz. 8-10 drs. MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 51 Examination of the Body of a Child.—The maturity of the child should first be determined. For this purpose its length and weight should be taken, also the length and condition of the hair on the scalp, the condition and length of the nails, the condition of the eyes with regard to the presence or absence of the membrana pupillaris; finally, the lower epiphysis of the femur is to be inspected with reference to the center of ossification. For this purpose a curved incision is to be made over the lower end of the femur, the patella removed, and the end of the bone protruded through the incision, when thin cross-sections may be made until the greatest diameter of the center is ascertained, which should be measured in millimeters. For the necessary measurements the reader is referred to the article on infanticide. The head must be examined for injuries, but the caput succedaneum formed during labor should not be mistaken for an ante-natal ecchymosis. The fontanelles should be inspected with care. There is a case on record where a mid- wife was convicted for the destruction of several children, which she accomplished by piercing the fontanelle before birth with a long pin. It is important to examine the neck for the marks of strangulation, but the ecchymosis left by an encircling umbilical cord which has strangled the child must not be mistaken for that wliich is the result of criminal strangulation. When this has been accomplished by the use of a soft ligature, it will be exceedingly difficult to make the distinction; but if a cord has been used, abrasions and excoriations of the skin will be found, and the mark wTill be narrower than that produced by the umbilical cord. The mouth, nose, and pharynx should be inspected for foreign bodies. As it may be sometimes necessary to establish the identity of the corpse, the existence of any peculiarities or malformations should be noticed, also the condition of the skin, more especially as to the presence or ab- sence of the vernix caseosa, for if this be absent, we may infer that the child has been washed, although not necessarily born alive. The condi- tion of the cord should be noted, whether succulent or mummified, also the state of the umbilicus with reference to the healing process. Evi- dences of an inflammatory process in this locality show that the child has lived some time after birth. Fractures of the long bones cannot of themselves be considered evidence of criminal violence, as they not in- frequently occur as the result of accident in ordinary labors. If the body of the child be found wrapped in a covering of any kind, this should be carefully preserved, as its subsequent inspection may furnish a valuable clue to the identity of the child. Perhaps the most important point connected with the technique of the internal examination of the body is the rule which requires that the abdomen should be opened be- fore the thorax. This is for the purpose of ascertaining the position of the diaphragm with reference to the occurrence of respiration, in which case the convexity of the diaphragm is said to be found at from the fourth to the seventh rib, but if respiration has not taken place it reaches only to the fourth or fifth. Evidently if the position of the diaphragm were the only evidence available in deciding so important a point, in those cases where the diaphragm is found at the fourth or fifth rib, as far as this point is concerned, the child may or may not have breathed, and can only lie of value where the diaphragm is found occupying the lowest of the positions possible. In any event, this can be only of value as corroborative evidence. 52 A SYSTEM OF LEGAL MEDICINE. The technical part of the autopsy is conducted precisely as in the adult. The scalp is reflected in the same manner, when the ealvariuni may be removed with a pah* of stout scissors. It is not uncommon in cases of difficult or instrumental labor to And extravasations of blood, not only on the surface of the dura, but also in the subdural space, and even in the substance of the brain itself, although some writers consider that effusions in the substance of the brain are sure signs of extreme violence. These may exist either as simple ecchymoses or as genuine clots. On this account the medical examiner should be extremely cau- tious in making the deduction that such appearances are the result of criminal violence. It may be remarked, however, that the more difficult a labor the more difficult will concealment have been; and if instru- mental interference has been necessary and concealment practiced, the probable collusion of a practitioner must be inferred. The brain presents no peculiarity worthy of mention. It is some- what softer than in the adult, and a little pinker. The thorax is opened as before directed, in the adult. The principal point of difference to be noted here between the infant and adult is the presence of the thymus gland, which in the infant covers the lower part of the trachea and the great vessels. It is about two inches in length, about one inch in breadth, and a quarter of an inch in thickness. It is a light fawn color, and ex- tends upward as far as the thyroid body and downward as far as the cartilages of the fourth rib, The thyroid and thymus glands are con- nected by two flattened bands of fibrous tissue, which are prolongations of the capsule of the thymus. The weight of this structure at birth is about half an ounce. Immediately on opening the chest, the position of the lungs in the pleural cavities is to be noted, and also their relation to the pericardium. When the child has not breathed they lie shrunken in the posterior part of the chest, whereas when the child has fully respired they fill up the chest and cover the pericardium. They are then, more- over, of a light pink color. It must not be forgotten that if the observa- tion regarding color be deferred until the lungs have been exposed some time, they may acquire a light color from imbibition of oxygen. Pre- vious to the removal of the thoracic viscera, a ligature is to be placed on the trachea and great vessels. After removal the lungs must be weighed separate from the heart in order to obtain the data for the static test, which depends on the fact that the lungs are heavier after respiration has been estabhshed than before. As the weight of the lungs must vary with the weight of the child, the data which are often given for purposes of comparison cannot be considered very reliable. Petechial spots are often seen on the surface of the pleura in cases of death from suffoca- tion, but as they may occur in death from other causes, they must be noted with due allowance. As usually directed, the ductus arteriosus, the ductus venosus, and the foramen ovale are to be inspected with reference to patency or closure. They may not be completely closed until a week after birth. The amount of blood contained in the cavities of the heart is to be measured or weighed. The same appearances are to be expected in the internal viscera in death from apncea occurring in infants as in adults. The abdomen, previously opened for the determination of the posi- tion of the diaphragm, may now be dissected. The stomach and intes- tines are to be examined with reference to the presence of air, food, and MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 53 blood. It has been shown by Breslau that there is no air in the stomach or intestines of new-born children. The stomach and small intestines, if there is suspicion of poisoning, should be removed in the same manner as in the adult. In any case, the contents, if any, should be tested for the presence of starch, and examined microscopically for the oil-globules of milk. Blood may sometimes be found in the stomach. Its presence has not the same significance as that of milk or starch. The liver in the infant is of large size in proportion to the body. It is said to diminish in size after the establishment of respiration, but this fact is of httle sig- nificance. Large extravasations of blood are sometimes found under the capsule of the liver, without known cause. (Delafield.) The spleen may be abnormal in size. The kidneys are lobulated. The bladder may be full or empty. It is rare that the spinal cord needs examination. If, however, the examiner deems this necessary, the same precautions are to be observed against the production of artefacts as in the case of an adult. The natural and great mobility of the head on the spinal column in the infant should not be forgotten. In conducting the examination of bodies advanced in putrefaction, we are compelled to modify, not so much our methods, as the conclu- sions which we are enabled to draw from the autopsy. The identifica- tion of the body in these cases is always important and often difficult. After the features have become undistinguishable the question of sex can always be determined, even when a further identification is impos- sible. Long after the external parts of generation have become undis- tinguishable the sex may be determined from the presence of hah- on the face or the length of "the hair of the scalp. The circle of hair which surrounds the pubes is characteristic of the female, while its prolonga- tion upward in the median line is equally distinctive of the male. In the bodies of children too young for these peculiarities to be available, even although the soft parts have become an undistinguishable mass, the uterus may stiU be recognized. In the adult it is possible thus to determine the' existence or non-existence of pregnancy months after burial. The uterus is not only last in the order of putrefaction, but is still distinguishable long after all the other soft parts have become an undistinguishable mass. Casper gives numerous instances of this fact. In one case, that of a young servant-girl drowned in a privy and discov- ered nine months subsequent, although all the other soft parts had either been changed into adipocere or were but black and greasy masses, from out this mass of putridity Casper was able to separate the uterus, which was of a bright red color, firm, hard to feel and cut, its form perfectly rec- ognizable, its size that of a virgin uterus, its cavity empty. As it had been charged that the girl was pregnant by her master at the time of her death, Casper was thus enabled to prove that this accusation was unfounded, in spite of the fact that the body had lain in a privy for nine months. Such a case as this ought to teach us that there is no stage of decom- position in which we may not expect to gain useful information from an autopsy. Frequently the question of sex is the only fact relating to identity that the examination will settle. Here, however, it is sometimes possible to gain additional information from such peculiarities as old or recent fractures, and peculiarities of the teeth. In case a recent fracture is discovered there is a question which may arise, not necessarily con- nected with that of identity, as to whether the fracture was the result 54 A SYSTEM OF LEGAL MEDICINE. of violence inflicted before or after death, also its relation, if any, to the death of the person injured. If the fracture be of the skull, an exami- nation of its interior may reveal the presence of extra vasated blood or of an inflammatory process, as evidenced by the presence of pus, in which case the answer will not be difficult; but if the progress of decay is too far advanced to admit of this, it will be extremely hazardous to attempt to give a definite reply. If callus be found, it is quite certain that the fracture preceded death at least a week, or, according to the amount and condition of the callus, even longer. Fractures of the base of the skull are not likely to be produced after death, and if extensive fractures of the vault are present, it is most unlikely that they have been produced other than by violence before death. Circumstances may cause us to modify such a declaration as this—as, for instance, where a body is found in the ruins of a fire with the skull crushed and other bones fract- ured. Here the character of the fracture in the skull will determine whether it was the result of injuries inflicted beforehand, as the sharp incised fracture produced by a cutting instrument, as an ax, can readily be distinguished from the crushed condition resulting from the impact of a mass of debris. The findings which it is possible to make from the soft parts of a body much decomposed, particularly as to the existence of disease, will largely depend on the degree of disorganization of the organs which the inquiry concerns. Every anatomist is familiar with the rapidity with which the tissue of the brain undergoes putrefactive changes. Therefore, while it may still be possible to harden and make sections of the brain quite late, yet it wTould be dangerous to draw any conclusions, with regard to patho- logical processes, based on a microscopic examination of such sections. If it is possible to produce artefacts in the comparatively firm texture of the cord simply by rough handling, how much easier may this happen as the result of the softening produced in a texture so little refractory as that of the brain. After putrefaction has advanced to any extent in the external tissues, we are only justified in making such findings as are based on the grosser lesions—as, for instance, the presence of decom- posed blood-clot or the existence of pus. The same remarks apply to the microscopic examination of other structures, as the kidneys and liver, in proportion to their power of resisting putrefactive processes. He is certainly a bold, if not a reckless, pathologist who is willing to make statements based on a microscopical examination of these organs many days after death, unmindful of the cloudy swelling and other progressive changes which so quickly occur in their epithelium. It is quite possible, however, to determine such microscopic changes as an altered relation in the cortical and medullary portions of the kidney, the contracted liver of cirrhosis, or an undue predominance of connective tissue. These facts are, of course, evidence of chronic disease rather than the acute processes so often sought for. Acute changes in the digestive tract, owing to the fact that the stomach and intestines decay relatively early, cannot be discovered with certainty long after death, as the stomach commences to putrefy in about six days thereafter; and the changes in coloration are thenceforward so various, its condition in other respects so changeable, that it is difficult to give a precise opinion with regard to its possible condition in life. With regard to the detection of metallic poisons, it may be stated MEDICO-LEGAL INSPECTIONS—POST-MORTEM EXAMINATIONS. 55 that no degree of decomposition is incompatible with their discovery by appropriate analysis; therefore the stomach and intestines should be re- moved as carefully as possible, taking the same precautions as directed heretofore. It is usual in such cases, whether the body has been buried or lam exposed, to remove a portion of the adjacent soil in order to ex- clude by analysis the presence of a metallic poison therein. This precau- tion should not be neglected. The foregoing remarks apply equally to autopsies performed on bodies advanced in putrefaction, whether before burial or after exhumation. Such autopsies are not attended with un- usual risk to the examiner. Post-mortems in fresh subjects are attended with far more risk. Indeed, the only serious consequences which the writer ever saw occurred in recent cases. In an experience of over five years 111 the dissecting-room of the Long Island College, no cases of poisoned wounds ever came under the author's observation, although he saw many cut fingers and one or two bad lacerated wounds made with the saw in process of removing the calvarium. Late autopsies should always be made in a room through which a draught of air is blowing, and such precautions taken as will readily occur to the reader. Exhu- mations should be made with care, rather, however, with reference to the dead than to the living. When bodies are buried in the cheap pine coffins of the poorhouse, the thin sheU soon decays, and cannot be used to raise the body from the grave. In this instance, a sheet of stout can- vas with rope handles on either side may be slipped under the frail coffin, which may then be removed from the grave without accident. It occasionally happens that the medical examiner is required to make medico-legal inspection so long after death that the bones alone are left. When it becomes necessary to disinter the remnants of the body in such, a case, it is best to take the following precautions, in order that ah the bones may be recovered: a space much exceeding that of the grave is to be dug over, and the earth in the vicinity of the remains carefully sifted through a moderately fine sieve. In this way the small bones of the carpus and tarsus may all be recovered, and such frag- ments as the separated bones of the infantile skull. There is one case on record where the identification of the body depended, on the-fact that the fifth metacarpal bone of the right hand possessed two articular facets, the deceased having had a supernumerary finger to which the second facet corresponded. (Reese.) It would have been impossible in this case to have identified the exhumed bones had it not been for the discovery of so small a bone as the fifth metacarpal. The main facts to be determined by the inspection of bones are : first, the identity of the remains; second, whether they throw any light on the cause of death. It is evident that the question of identity must depend on the determination of sex, age, and stature. It is easier to speak pre- cisely with regard to the first two points than the last. In mature bones, it will never be difficult to distinguish the peculiarities of the two sexes, where the pelvic bones are entire. In the male, the obturator foramen is oval rather than triangular, as in the female. With regard to the pelvis as a whole, it is to be noted that the bones are more massive and the mus- cular impressions more prominent in the male than in the female. The subpubic arch is narrow and angular in the male, much wider and more arched in the female, the respective angles being seventy-five and a hun- dred degrees. The actual size of the pelvis varies in different individ- 56 A SYSTEM OF LEGAL MEDICINE. uals; in the male, however, the antero-posterior diameter is the greatest, whereas in the female the bilateral is the largest. The bones in general of the female are more slender proportionately than those of the male, and if the age of the remains can be fixed, even though the pelvic bones are missing, by comparing the proportion of the bones with their estimated age it may be possible to form a fairly positive opinion as to the sex of the remains. No positive opinion, however, ever ought to be given which is not based on an inspection of the pelvic bones. When the teeth are present, up to the age of twenty-one the age of the skeleton may be determined by them alone. If no teeth be found, the age of the bones must be determined by the degree of ossification of the various bones, and by the union of the epiphyses to the shaft of the long bones. This is of no avail after the age of twenty-four, at which time the upper epiphysis of the tibia unites to the shaft of the bone, being the latest of all the epiphyses to unite with its shaft. From the twenty-fourth year until middle life it is not possible to form any exact idea of the age, as ossification is complete. If the metasternum is found joined to the mes- osternum by bone, it may be concluded that the individual had reached middle life. It is quite exceptional for the presternum and mesosternum to be united by bone, but when this is found it is probable that the indi- vidual had attained the age of sixty. The same applies to the bony union of coccyx and sacrum. The process of absorption which takes place in the alveolus of the lower jaw, and the approach of the mental foramen to the lower border of the bone, are also signs of old age. After the age of twenty-four it is only possible, therefore, to say that the individual was middle-aged, or that he had reached the age of sixty, or that he was an aged man. Not infrequently the teeth are found detached from the jaw-bone. The following brief description of their points of difference may serve to then distinguish them. The central upper incisors are very much larger than the laterals; the lower central incisors much narrower than the upper set. The root of the first bicuspid is either single or marked by a single longitudinal depression, while the root of the second is double. The lower bicuspids are smaller than the upper, and have single roots. The upper molars have four cusps and three roots; the first of the lower molars has five cusps and two roots, which are sometimes completely divided by a groove so as to make four; sometimes only one root is so divided in this way. The second lower molar has but four cusps or a faintly developed fifth cusp. Its roots have a tendency to coalesce. The roots of the upper wisdom tooth coalesce and form a cone. The lower wisdom tooth has two roots, which may become confluent. (Morris.) When no teeth are found, but only a few of the larger bones, we must rely on. the degree of ossification of the bones and the condition of the epiphyses. DEATH IN ITS MEDICO-LEGAL ASPECTS. BY FRANCIS A. HAEEIS, M.D. In the preparation of an article which shall treat of the subject of death in its relation to forensic inquiry, with the consideration of the phenomena attending and following upon certain forms of violent death, it must be obvious that little that is absolutely novel can be offered to the student of legal medicine who has availed himself of the careful and scientific exploitation of the subject by such eminent writers as Devergie, Tardieu, Casper, Taylor, and Ogston, who from their great opportunities for observation, and from the fact that most of them occupied positions under governments which at a very early period recognized the impor- tance of this branch of medical investigation, and which provided a cer- tain fixed and logical method of inquiry, have been enabled to present most accurate data in the matter of medico-legal examinations; and the writer acknowledges at the outset that he has availed himself, in the preparation of this article, of the results of their labors as found in their published works. He will only endeavor to present such facts as haVe already been found to obtain, and, if possible, to emphasize them by such illustrative cases as have come under his personal observation in the course of the past sixteen years, while acting under the provisions of the so-called medical-examiner law of Massachusetts. Governmental Regulation.—Other countries, notably France and Germany, have for a long time had statutes which provided for the action of medical experts in criminal cases, or in those which were supposed to be such, and have even laid down with the greatest care and minuteness not only the legal steps to be pursued, but definite instructions as to the method of performing an autopsy and recording the results of the same. The United States has not thus far advanced. Inmost States the old-fashioned, illogical, and practically worthless system of investigation, derived from the English custom, the coroner's inquest, still is the pri- mary court of inquiry, and the solutions of questions of great moment to the State and the individual are still left to men who have neither the legal nor the medical training requisite to determine either the cause of the death in a given case or decide the responsibility, if there should be any. The Massachusetts law still leaves much to be desired both in the matter of accurate phrasing and the complete instruction as to details of a medico-legal examination. It is, however, a great step in advance of anything which has obtained before, and has worked very well in prac- tice. The essential points of the law are that in the first place it f ollows 57 58 A SYSTEM OF LEGAL MEDICINE. a logical order, and when there is to be an investigation into the manner of any suspicious death it puts the primary part of the inquiry—namely, Was this death one that resulted from violence, or did it result from natural causes ?—into the hands of trained medical men, who under cer- tain conditions and under certain proper restrictions make the autopsy; and it puts the second part of the inquiry—if there should be demon- strated the fact that the death was due to violence rather than to natural causes—into the hands of a judge of a court of first instance, who reports his finding to the superior court, and so everything is in train for prose- cution. At the outset there was naturally doubt in the minds of the medical men acting under its provisions as to what really was meant by a dead body. They were required to act if they received notice that a dead body was lying within their district; but the courts had never de- cided what a dead body was. Was it a foetus in the very early stages of development ? Was it a child that was at viable term, say at the period from one hundred and eighty to two hundred and ten days, or must it be a child at term to be considered a body within the meaning of the law ? Accepted Period of Life.—Medically, a foetus at the fourth or fifth month, although incapable of independent life, is a human being; but up to 1893 there had been no decision as to its status in law, that is, by the Massachusetts courts. The laws of foreign countries had made the distinction that a child must be wholly born alive before it could be the subject of an assault, and had even gone further, and decided that a child who was born alive and had lived not only for hours, but even days, but who on account of some congenital deformity, such as atresia of the rectum or the oesophagus, was incapable of sustaining independent life, is not a human being within the meaning of the law, whether civil or criminal. On the other hand, a child who had been born alive at a time when it was capable of sustaining a life independent of the mother, even if it was born prematurely, would be a subject of criminal assault like any other human being. During the present year, in the course of a trial for infanticide it was found that there had been no decision on this point in the State of Massachusetts, and for the first time the law was made, following the English law, that it must be proved that the child had been wholly born alive and capable of maintaining a separate exist- ence before a charge of infanticide could be sustained. Whether this law has been established by the courts of other States or not, the writer has no knowledge; but it is probable that if it is to be established it will be on the same lines. Such legal requirement, of course, increases the difficulty of securing the conviction of persons charged with killing a new-born child; but that is a matter wliich more nearly concerns the bar and the judiciary than the medical jurist. The medical jurist may be required to examine the bod}T of a foetus at any term when the question of pregnancy is involved; but in general, he has to consider that only as a dead body wliich has arrived at least at a period of development where it is capable of sustaining independent life—that is, from the one hundred and eightieth to the two hundred and tenth day, and later. The Determination of Death.—At the above-named period and later, a dead body, as far as the purposes of forensic inquiry are concerned, is a dead human being, and an investigation into the cause of its death DEATH IN ITS MEDICO-LEGAL ASPECTS. 59 may be necessary to assist the criminal courts; and, furthermore, an examination of a dead body may be necessary to establish certain civil rights, such as succession, by determining the period at wliich death has occurred. This brings us naturally to the consideration of the signs of death, and the changes produced in the economy by the cessation of the vital functions. Identity of the Dead Body—Before proceeding directly to that sub- ject, however, it occurs to me that a few words on the question of estab- lishing the identity of an unknown body may not be out of place, as such an inquiry would naturally precede the autopsy itself. I am indebted to Dr. C. A. Hebbert for very great assistance in the preparation of the portion of this article relating to this question of identity. His experi- ence with Mr. Bond, of London, renders his work of great value, and several cases cited by hhn in the Westminster Hospital reports are exceedingly interesting. The determination of the identity of human remains is one of the most important and often most difficult problems submitted to the med- ical jurist. It is especially interesting to the student of forensic medi- cine in the United States, as the nation is composed of people from all parts of the world. Not only are met members of all the European races, but also the negroid, Australoid, and Mongoloid races, each presenting different and distinct characteristics. The examination will also include the subordinate or mixed people, such as the mulatto, a mixture of the European with the negro, the mestizos, a mixture of the European and the American indigenes, and the zambos, a mixture of the American in- digenes wdth the negroes, and in these sub-races the physical characters and proportions are necessarily modified. These sub-races are particu- larized, inasmuch as they are all prolific and not sterile, as is the marriage of the European with the Australoid. Let us first consider the cases where the whole body or the whole skeleton has been found, and secondly where the body has been muti- lated, dismembered, or partially destroyed, so that only a portion or por- tions have been discovered, and see how far, from such data as we have, we can identify the individual. Such study will involve observation of the following points: 1. Race. 2. Sex. 3. Age. 4. Stature (including measurement of body and limbs). 5. Features (hair, nails, etc.). 6. Scars, moles, depressions on fingers by rings, or on legs by garters. 7. Deformities. 8. Occupation, as shown by stains on body or fingers, or tanning by exposure to the sun, callosities' (bursa?, corns, etc.), the effects of pressure of dress on various parts of the body, the presence of foreign substances on the body (hair, straw, flour, etc.). In addition to the above there is to be remembered the great value of photography, not alone in the case of the features, but also where several portions of a corpse are found at different intervals, and the question arises whether they belong to the same individual. In such a case, in addition to detailed measurements, photographs of the twro arms 60 A SYSTEM OF LEGAL MEDICINE. or of the two feet would be of material assistance in determining the question of identity. i. Race.—Where the corpse is entire and but partially decomposed, no great difficulty will be met, as the characters of the four great families are distinct; but it will be useful to bear in mind a brief summary of these features. (a) The Australoid type, such as the coolies in southern India and the native Australians : skin chocolate-colored, hair black and wavy, the skull narrow or dolichocephalic, the brow ridges prominent, with a projecting or prognathous jaw, and thick lips: the nasal index platyrhine. (b) The negroid type: the skin dark brown to black, the hair black, crisp, or woolly, the skull dolichocephalic, the brow ridges not prominent, the jaw prognathous, with fleshy, protuberant lips, the nose and nasal bones flat, the index being platyrhine. (c) The Mongolian type, which includes the Chinese, the Japanese, and the American indigenes : skin from yellowish brown to a mahogany tint, the skull broad or brachycephalic, the hair black and straight, the brow ridges not prominent, the jaw not projecting except in the Esquimaux, the nose mesorhine, small and flat in the Japanese and Chinese, with oblique eyes, and the cheek-bones high. In some of the American Indians the nose is prominent; but as we are dealing with such peoples as are commonly met with, it is not necessary to do more than specify the typical features of the main group. (d) The whites, divided by Huxley into the Xanthochroi, or fair whites, with pale skin, fair, wavy, or curly hair, light-colored eyes, mesocephalic skull, jaw orthognathous, and nose leptorhine; and the Melanochroi, or dark whites, the complexion darkening to a sallow or swarthy hue, the hair dark, and the eyes brown or black, the skull mesocephalic, with orthognathous jaw and leptorhine nose. The comparison of the foregoing characteristics will at once decide the question of the membership of a definite race; but as in the sub- races the skull and facial points are modified by the mingling of types so that other and probably external circumstances will be required for a proper decision, these will be considered hereafter, chiefly under the discussion of features. (Vide Identity of the Living.) No mention is made of the stature or size of races, as it is well known that the height of individual members of each race varies, the Melanochroi, for instance, though being smaller than the Xanthochroi as a rule, having among them large and powerful individuals, and in the negroid group the Bosjesman is much smaller than the average negro. The value of the various indices, cephalic, facial, and nasal, is as follows. The cephalic index is the comparison of the length of the skull to its breadth, the length being taken as 100. The length of the skull is taken from the ophryon to the occipital point, the breadth the greatest interparietal measurement. If the index is above 80 the skull is brachycephalic, as in the Mongoloid races; if from 75 to SO, mesocephalic, as in the whites; if below 75, dolichocephalic, as in the negroid and the Australoid races. For example, if the length is seven inches and the breadth five inches, the index is 71.4, or dolichocephalic. If the length is seven inches and the breadth six inches, the index is 85.7, or brachycephalic. The gnathic index is reckoned by comparing the basi-alveolar length with the basi-nasal length, the basi-alveolar length being taken from the DEATH IN ITS MEDICO-LEGAL ASPECTS. 61 basion to the alveolar point, the basi-nasal from the basion to the nasion, the basi-nasal being taken at 100. Below 98 the jaw is orthognathous; from 98 to 103, mesognathous; above 103, prognathous, as in the negroid or Australoid groups. The nasal index is the comparison of the height of the aperture with the width, the height being from the nasion to the sub-nasal point, the width being the greatest transverse diameter of the anterior aperture, the height being taken as 100. If below 48, leptorhine; from 48 to 53, mesorhine; above 53, platyrhine, as in the negroid. These indices are here exploited to furnish aid to such as may be obliged to examine a case where the head or skuU alone is presented for investigation, and where the first step toward determining identity is the fixing the race, though such minute descriptions and measurements are rarely necessary. Still, the medical jurist should observe everything when he is examining a dead body, and this apphes to the part as well as the whole, and in any medico-legal inquiry it is not always possible at the outset to say what may be of the most vital importance in the case before its conclusion. The method of arriving at the above-mentioned indices may be made more plain, possibly, by the example of an equation such as the follow- ing: Dolichocephalic, 7:5:: 100 : x; x = 71.4. Brachycephalic, 7:6:: 100 : x; x = 85.7. Figs. 4 and 5 are intended to illustrate the above-mentioned measure- ments. 2. Sex—The distinction of sex where a whole unmutilated corpse is presented for inspection is too obvious to require comment. On the other hand, if the body is mutilated and decomposed, great care is re- quired on the part of the expert, and still further difficulties are presented when it is the skeleton alone with which he has to deal. Indeed, there may be cases where the whole body has been so mutilated that it is by the preparation of the skeleton alone that an idea of the sex may be formed. Just such a case might have occurred in one of the so-called Whitechapel murders in London, in the years 1887-89. Here nine women were murdered and mutilated by an unknown assassin. In the particular illustrative instance, the woman was murdered in a bedroom. The body was naked when found. The eyebrows, eyelids, ears, nose, lips, and chin had been cut off, and the face gashed by numer- ous knife-cuts. The breasts had been cut off, and the whole abdominal parietes, together with the external organs of generation, had been re- moved. The skin and much of the muscular tissue, not, however, ex- posing the bone, had been slashed away from the anterior aspect of the thighs as far as the knees. The abdominal viscera and pelvic viscera, including bladder, vagina, and uterus with appendages, had been torn from their cavities, and in fact there was no sign of sex except the long hair upon the head, and, as is well known, that alone is not a posi- 62 A SYSTEM OF LEGAL MEDICINE. Fig. 5. Skull of Australian. Op, ophryon; 0, occipital point; Ob, obelion; Bg, bregma; B, basion; N. nasion: A, alve- olar point; S, subnasal spine; Pt, pterion; As, asterion; I, inion, or external occipital protu- berance; L, lambda. DEATH IN ITS MEDICO-LEGAL ASPECTS. 63 • tive sign, inasmuch as in some nations the hair is worn long by men. The fact that the whole bladder had been removed did away with the help that might have been afforded by the presence of the prostate gland. In this case, to be sure, all the organs except the heart were found scattered about the room, and showed the sex without doubt. But if all the organs and parts had been taken away or the body exposed to the effects of decomposition, a careful preparation of the skeleton would have been imperative to decide that the body was that of a woman. It might further be stated that in this case, in consequence of the hacking of the features, the presence or absence of a beard could not be stated, and if the hair had been designedly cut off there would have been absolutely no sign by wliich sex could have been determined. The hair on the pubes had been removed in this case, and the difference in the growth of the pubic hair tapering up toward the umbilicus in the male, and simply surrounding the organs of generation in the female, could not be availed of as an indication of sex. Of course, if there be only decomposition or destruction of the exter- nal organs of generation, the internal examination would decide the point of sex by demonstrating the presence of either a uterus or a prostate gland, both of wliich organs resist decomposition longer than most if not any other parts. In general, it may be said that the female is smaller, lighter, and has a less developed muscular system than the male; but here we are again met with the objection that a healthy, hard-working woman would have stronger limbs and more powerful frame than a sickly student or clerk. Therefore, in the case of the examination being limited to a single limb, as an arm or a leg, it is in a measure guesswork, though with care the guess may be pretty accurate. A case in point will be cited in extenso hereafter, where an arm, large and muscular and lengthy, was decided to be that of a woman, and the opinion was at a later date found to have been correct. The skeleton of the male is generally larger, stronger, and has more prominent processes and im- pressions for muscular at- tachment on the bones of the limbs than the female skele- ton. The sternum is less convex, and the xiphisternal articulation is opposite the curve of the fifth rib, while in the female the sternum is more convex and shorter, and the xiphisternal articulation is opposite the curve of the fourth rib. It is in the pelvis, however, that we find the main distinguishing points. The male pelvis is composed of more massive bones, with ^ig 6 pelVjS 0f ^i;ul. rough, well-marked pro- cesses ; the cavity of the true pelvis is deeper, narrower, and has smaUer apertures. The 'cm-ve of the sacrum is more evenly distributed, and not 64 A SYSTEM OF LEGAL MEDICINE. so abruptly marked in the lower part as in the female. The subpubic arch is more pointed, the obturator foramen oval, the tuberosities of the ischia nearer together, and the diameters of the true pelvis narrower than in the female, as will be shown in a subsequent table. The female skeleton has a shallower false pelvis, with more widely spreading ala? ilii. The bones of the true pelvis are lighter, with much less marked impressions. The cavity is shallower, and the sacrum is flatter in the upper two thirds, and then curves somewhat abruptly below. The apertures are wider, the subpubic angle has a lower and rounder arch, and the obturator foramina are triangular, the rami of the pubes and ischium are more everted, and the diameters are much longer. The following table gives the respective measurements as found in the male and female: Male. Female. In. In. Distance between widest part of iliac crests ............. 10-11 10-J-ll Distance between antero-superior spines of ilia........... 9^-10 10-10^ Distance between front of symphysis pubis and sacral spines (external conjugate) ............................... 6-J-7 6-J-7-J Pelvis of Woman. True Pelvis Diameters. Brim. In. Transverse.................... 4£ Oblique....................... 4£ Antero-posterior, or conjugate.. 4 Male. Cavity. In. 41 4| Outlet. In. 3i 4 3i Female. Brim. Cavity. Outlet. In. In. In. 5* 5 4* 5 5i 5i In addition to the measurements of the pelvis it is also well to notice that the angle of the neck of the femur with its shaft more nearly ap- proaches a right angle in the female than in the male; but this difference is only of importance where the limbs of the same or of different bodies can be compared, and is not a valuable sign where only one leg is dis- covered. The above indications should ordinarily be sufficient to guide the examiner to a proper decision in the matter of sex where this is in dispute, or the object of inquiry. 3. Age.—Though the features of the living are fairly well marked on external examination in each of the ages of man, from the infant to the "lean and slippered pantaloon," yet after death the effacing work of decay so rapidly alters the special characters that we require more deci- sive and scientific points to ascertain the probable age of the deceased. DEATH IN ITS MEDICO-LEGAL ASPECTS. 65 Take the face as an iUustration. The general suggestions of age from the wrinkles about the corners of the eyes, the so-called crow's-feet, and the deepening of the lines at the wings of the nose and corners of the mouth, the drooping of the angles of the jaw with the gradual approxi- mation of the lips caused by the absorption of the alveolar borders of the maxilla, are all absent or modified in the first appearances after death; nor would the smooth, rounded look of the young give more than an indication of age, though an estimate with some degree of accuracy could be made by a trained observer. Therefore it is clear that more than a mere inspection of the external appearances is necessary. Take the case of a newly born infant, for instance, though this belongs more properly to a chapter on infanticide. We know that the length should be, for a child at term, eighteen to twenty inches, and the weight from six to eight pounds avoirdupois. The finger-nails project beyond the ends of the fingers, and the toe-nails reach nearly to the ends of the toes. The um- bilicus is at most three quarters of an inch below the center of the length of the body. In the male the testicles are in the scrotum, and if the child has lived a short time the anus will probably be smeared with me- conium. The most reliable sign of age at this period is the presence of a small ossific center in the lower epiphysis of the femur. It is the first and as a rule the only epiphysial center to appear before birth, though the upper epiphysis of the tibia can be occasionally noticed at full term. The femoral epiphysis usually appears shortly before birth. The size of this center is about one eighth of an inch in diameter. As the appearances of the epiphyses and their union with the bodies of the bones are the most impor- tant proofs of age from birth to the age of twenty-five, the different dates of their appearance must be borne in mind. To generalize these points is a matter of some difficulty; but it may be stated that there are times in the development of the body when growth appears to be more energetic. For instance, in the first three years there is ossific deposit in the epiphyses of the humerus, femur, ulna, tibia, and fibula—that is, the extremities are practically mapped out in bone; and it is also in this period that the fontanelles of the skull close and the cranial bones unite. Aii-ain, about puberty we have another period of activity, the vertebra? attaining their full size and shape, and in the pelvis additional centers appear in the sacrum and ossa innominata, so that during this time the trunk is solidifying. The third period of importance is that from twenty to twenty-five, the latter being the fuU attainment of adult age, and at this time in the majority of cases all the epiphyses have become joined to the bodies of the bones* though the complete ossification of the vertebra? may be delayed for a year or more. After the age 'of twenty-five until the changes of advanced life, which will be hereafter alluded to, occur, it is difficult to satisfactorily determine the age from the points of ossification alone; but it should be remembered Fig. 8. Inferior Maxilla of New-born, showing Union of Rudimentary Pro- cesses. 66 A SYSTEM OF LEGAL MEDICINE. that the sexual powers are in full activity, and in the female the breasts, the uterus, and ovaries vill aid in determining the age. If there are signs of present or recent menstruation, the presence of corpora lutea either of menstruation or pregnancy, or the secretion of milk in the breasts, we shoidd have an indication that the woman was probably under forty or forty-five. On the other hand, the presence of spermatozoa in the vesicula? seminales or the testicles would not afford much assistance, as men have been known to have been capable of procreation at an ad- vanced period of life. The eruption of the milk and permanent teeth affords a very trustworthy sign of the age of the young, and a case oc- curring in London is worth citing on that point. During the repair of a house, a few remains were found buried under the hearthstone, and these on examination proved to be those of a human lower jaw, with the small though well-marked mental process (no other animal has a chin), part of the upper jaw and shaft of a small femur, with some few light brown long human hairs. As the second molar teeth had erupted, and there was an indication of a cavity in the upper jaw where the first molar of permanent teeth had begun to develop, the age was determined as be- tween three and four years. The hair indicated the complexion, and the length thereof the sex. On inquiry it was learned that a long time ago a httle girl of three and a half years had disappeared. The mother of this child was confronted, and confessed that the girl had died of natural causes, and had been buried in this spot by the parents to escape the ex- pense of an ordinary sepulture. As age advances, structural changes occur in the cartilages of the larynx and ribs, so that they become ossified; but these changes may occur at any period after thirty, and indeed, are so modified by disease, such as that of the heart or kidney, that they are only a general indica- tion. In old age, or in those who have lost their teeth, the alveolar borders of the jaws are gradually absorbed, giving the angle of the jaw an appearance of obtuseness which is more apparent than real. The angle of the neck of the femur with its shaft is obtuse in man, rectangu- lar in woman, and with increasing age the angle becomes more rectan- gular—may even sink below the level of the trochanter. From the foregoing it will be seen that our best guide to the ascer- tainment of age is the examination of the skeleton; but that even that is not wholly accurate, but only approximate, and that all other appear- ances possible must be considered in arriving at a correct solution of the problem. The following resume, chiefly from Quain, will be of service in deter- mining identity as far as light is thrown on the matter by the study of the matter of ossification. The value of this test of age will be found principally in the examination of the long bones and the pelvis; and while in works on forensic medicine it is customary to give very elaborate tallies of all the times of appearance of centers and junction of epiphyses with the bodies, in practice it is better to consider these special parts in the three periods before mentioned. In the first year the nucleus for the head of the femur appears. In the second year nuclei for the head of the humerus, lower extrem- ities of the tibia and fibula, carpal end of radius. In the third year the nuclei for the great tuberosity of the humerus, upper end of the fibula, capitellum of the humerus. DEATH IN ITS MEDICO-LEGAL ASPECTS. 67 In the fourth year the nuclei for the great trochanter of femur, and carpal end of ulna. In the fifth year the nucleus for the lesser tuberosity of humerus, which, uniting with the greater tuberosity and head, forms a distinct epiphysis. In the same year appear the nuclei for the internal condyle of humerus and the head of the radius. Thus in the first five years we have the most of the important epiph- yses of the long bones; the lower end of the femur and the upper end of the tibia, as before mentioned, being in evidence at or soon after birth. In the age period eleven to fourteen are to be found the nuclei of the troclilea and external condyle of the humerus, a small epiphysis of the olecranon and the lesser trochanter, and at the period of puberty the three portions of the innominate bone are united in one by the ossifica- tion of the Y-shaped epiphysis in the acetabulum. It must be remembered that the blending of the epiphyses of the long bones takes place in an order the reverse of their appearance, with the single exception of the upper end of the fibula. From sixteen to eighteen, union between the bones and the lower epiphysis of the humerus and the upper epiphyses of the radius and ulna occurs. From the eighteenth to nineteenth year occurs the union of the head of the femur and the lower end of the tibia. In the twentieth year union occurs in the head of humerus, lower end of radius and ulna, and lower end of femur. In the twenty-first year this process occurs in the upper end of tibia, and of the epiphyses of the metacarpal and metatarsal bones. In the twenty-fourth year the process occurs in the upper end of the fibula, and in the twenty-fifth in the sternal end of the clavicle, the acromial process of the scapula and crest of the ilium unite with their respective bones, the ossification of the vertebra? is completed, and at this, the period of adult life, the whole skeleton becomes ossified. The eruption of the teeth is in the following order: Milk Teeth. Central incisors......................Sixth month. Lateral incisors......................Sixth to ninth month. First molars.........................Eighth to twelfth month. Canine..............................Eighteenth month. Second molars.......................Twenty-fourth month. Permanent Teeth. First molars.........................Sixth year. Central incisors......................Seventh year. Lateral incisors......................Eighth year. First premolars ......................Ninth year. Second premolars..................... Tenth year. Canines..............................Eleventh to twelfth year. Second molars.......................Twelfth to thirteenth year. Third molars.........................Eighteenth to twenty-fifth year. Of course, it must be borne in mind that the time of the eruption of the teeth varies, and especially in weakly, scrofulous, and rachitic chil- dren, where dentition is both irregular and delayed; but here only the 68 A SYSTEM OF LEGAL MEDICINE. normal growth and development is taken as the standard both in regard to the teeth and the ossification of the skeleton. At the end of the article on identity some illustrative cases will 1 >e cited, in which the determination of age was an interesting feature, and in one the exact age was decided by the fact that the acromial end of the scapula was not united, while the upper epiphysis of the fibula had evi- dently only recently joined the shaft. 4. Stature.—The estimation of stature is our next consideration. There are many inaccuracies and differences in each of the various modes of estimation usually adopted. If the whole skeleton be found, by plac- ing the bones in position and adding one and a half inches for the soft parts, we shall get a fairly accurate notion of the stature, allowance being made for any shrinking of the bones or partial destruction of their ends. Next we will take the method of calculating the height by measuring the long bones, and according to Orfila's tables, as quoted below, the re- sult differs to the extent of several inches. Roughly speaking, however, it may be said that the length of the femur equals one quarter of the whole length of the body. In analyzing Orfila's tables we have separated the observations on the upper and lower extremities. Orfila's Tables. Upper Extremity. Stature. Ft. In. L. Ft. In. L. First Table. Maximum. Minimum. Difference. Humerus, 6 observations ..110 613 599 36 Ulna, 7 observations ..... 10 8 6 1 3 550 83 Second Table. Humerus, 19 observations. 126 581 546 37 Ulna, 14 observations..... 10 8 5 10 10 5 5 8 5 2 Lower Extremity. First Table. Ft. In. L. Maximum. Minimum. Difference. Femur, 7 observations... 161 6 0 0 5 70 50 Tibia, 7 " ...130 5 10 6 550 56 Second Table. Femur, 12 observations ...159 5 98 546 52 Tibia, 11 " ...125 598 546 52 The great discrepancy in the calculation will be seen from these tables; but to make such tables valuable, the age of the bodies examined, the entire absence of disease, such as bowing of the bones or curvature of the spine, ought to have been noticed, and the same difficulty constantly occurs in deciding the stature of the whole body. Observations made by Dr. Hebbert, of London, in very many cases— upward of one hundred—in the post-mortem room on the full length of the femur, show that this bone equals in length one quarter of the full length of the body, the variation in general being about one inch. The next method of estimation is by measuring the length, by taking the upper border of the symphysis pubis as the center of the body after DEATH IN ITS MEDICO-LEGAL ASPECTS. 69 the twenty-fifth year. M. Sue first suggested this mode, but Orfila at- tempted to show that there was an average difference of two and one third inches, and that usually the lower half was the shorter, especially in women. As the top of the head of the femur is on the same line as the top of the symphysis pubis, it follows that the total length of the lower extremity is equal to one half the total length of the body. M. Sue's tables take an average from numerous observations: Body. Trunk. Lower Extr. Upper Extr. 5 ft. 8 in. 21. 2 ft. 10 in. 11. 2 ft. 10 in. 11. 2 ft. 8 in. 0 1. According to Orfila, in women six out of seven have the greatest length from vertex to pubes. In men (fifteen observations), vertex to pubes, 2 ft. 9 in.; lower ex- tremities, 2 ft. 7 in. The commonest mode, however, and the one which has hitherto been most rehed on, when only the arms or upper parts are found, is the figure car re des ancients; that is, when the body is lying flat with legs extended, and the arms lying at right angles to the trunk, a square can be described around the body. Now this, although fairly correct in the living subject, is faulty in three ways when applied to a single hmb. We are told to double the length of the arm, and add twelve inches, five for each clavicle and two for the sternum. Now, the first error is that when the arm is at right angles to the trunk the head of the humerus is from a half to three quarters of an inch to the inner side of the acromial end of the clavicle. Secondly, the sternal ends of the clavicles projecting more forward than the outer ends, an obtuse-angled triangle is formed with the apex forward, and we ought to take the measure along a transverse vertical plane of the trunk, that is, the base of the triangle instead of the sides; this difference is from half an inch to one inch, as verified by several measurements of skeletons. Thirdly, in females the outer end of the clavicle is directed a little, though very slightly, downward, as shown by their more sloping shoulders, so that to calculate from the exact length of the clavicle would again give two sides of a triangle instead of the base. This mode of estimating height is furthermore misleading in females, on account of their relatively shorter legs, so that it cannot be safely trusted. Other methods are derived from the ancient Egyptian canon, viz., that the length of the middle finger, as measured down from the root of the thumb-nail at right angles to the axis of the middle finger when the hand is laid flat on a table, equals one nineteenth of the height, and that the forearm, from the tip of the olecranon to the end of the mid-finger, equals five nineteenths of the height. In order to be accurate in these measurements, several observations should be made, forasmuch as, if only a finger be measured, an inaccu- racy of one sixteenth of an inch will give a false result. In a case to be afterward given in detail, it will be seen that the two measurements agreed to one fortieth of an inch. A number of observations were made in London by each of these last methods, both in the living and the dead, and the conclusion derived is that they are both fairly reliable, and especially the calculation of the measurement of the forearm, which has been for centuries a standard of measure under the name of cubit. According to the old Egyptian canon, 70 A SYSTEM OF LEGAL MEDICINE. the human body can be divided by transverse hues into nineteen parts, of which five parts represent the length of the forearm and hand, and one part the exact length of the middle finger. This measurement must be made not from the prominence of the knuckle, wliich is the head of the metacarpal bone, but from the upper end of the proximal phalanx, which is exactly on a line with the base of the thumb-nail in a well-pro- portioned man. In the latter part of this section are indicated the methods of meas- uring the body. The points of measurement of the height and breadth, and the various indices of the skull, have been described under the head- ing of race. The circumference of the skull is taken in a plane from the ophryon in front to the occipital point behind. If the limbs be still attached to the trunk, in measuring the two arms. it is usual to measure from the tip of the acromion to the external condyle of the humerus, and thence to the styloid process of the radius, all these being in one straight hue; and from the last point the length of the hand is to be measured. The legs are measured from the top of the great trochanter externally to the heel, and internally from the symphysis pubis to the heel. If separated from the trunk, of course the greatest length is selected. In measuring the circumference of the limbs, it is best to take the greatest measurement, and then take measurements at different points expressed in inches from a flexure of the limb or other fixed points. The umbilicus is always below the center of the hne from the xiphisternal articulation to the pubes, and about a half-inch to one inch above the highest point of the iliac crest. The circumference of the trunk should be taken transversely at the nipple hne—that is, opposite the fourth rib and just below the costal arch. 5. Features.—The general character of the capital features in the great races have already been indicated; but in addition the exact linea- ments of the individual should be described, such as the size and color of the eyes, the shape of the nose, the cm-ve of the lips, and the shape of the ear, mentioning whether it projects or not from the head, the pres- ence or absence of the lobule, the character of the helix, and the presence of the Darwinian tubercle, a small projection just at the curve of the helix. The teeth should be carefully examined to note those absent, or to remark the presence of artificial teeth. Apropos of this examination of the teeth, it may be remembered that in a case in London known as the Great Coram Street murder, an apple with a single bite taken was found by the woman's bedside. A cast of this was taken, but it proved to correspond to the woman's own mouth. This is an instance of the importance of never missing any detail, though in this case it did not lead to the discovery of the murderer. Apart from the general description of the indices of the head and face, any peculiarity of the skull, such as undue prominence of the frontal or parietal eminences, or of the supraorbital ridges, or the deep depression often found in front of the lambdoid suture, and which an ignorant per- son might take for an old depressed fracture, should be noticed. The chin and lower jaw, wliich are very significant features, should be ex- amined. The color and character of the hair, both in head and face, are the next points to be noticed. The difference between human and animal hairs will be discussed later. Care must be taken to discriminate between DEATH IN ITS MEDICO-LEGAL ASPECTS. 71 general or partial baldness, whether due to personal peculiarity or to ad- vancing life, and the alopecia of constitutional disease, such as svphilis or that due to fungi, e.g., alopecia decalvans. After the description of the features of the face and head, the body should be noticed in detail. In the female, the breast, the pelvis, whether large or small, the externai organs of generation, including the orifice of the vagina, must be exam- ined, and any peculiarity or malformation noted. On the lower part and sides of the abdomen may possibly be seen the linea> alba?, which have been caused by overstretching of the abdominal walls, and usually, though not necessarily, associated with pregnancy. In the male, after examining for any defect of the genitalia, the result of circumcision should be looked for, though, as said elsewhere, this is a practice not now confined to Jews amd Mohammedans. In both sexes the inguinal glands should be examined. In describing the arms first note the general appearance, the greater muscularity of the male, the deltoid, triceps, and biceps being specially prominent, the flatter forearm, and wider, thicker wrist of the man, while the woman's arm is rounder and softer, the wrist more slender, and her fingers more tapering. Note also the nails, their shape and appearance, as to their having been pared or bitten or neglected. In the living the question may arise, as in the great Tichborne case, as to how far the features may be modified by age and by change of life and habits, the claimant being a very coarse, corpulent man with bloated features, and the heir who originally disap- peared being a slim youth with delicate face and timid manner. Another feature in this remarkable trial was the peculiarity of the genital organs, an unusual condition being present in the claimant, and known to be a peculiarity of the missing heir. In this trial it was stated that the direc- tion of the curve of the two eyes was markedly different, and also the shape of the nose.and the condition of the ear, the claimant having ears with large pendulous lobes, and the real heir small ears without lobes. 6. Scars, etc.—A scar or cicatrix is the term applied to the result- ing appearance in the skin after the loss of its substance, together with the deeper tissues. It is due to the formation of firm, fibrous tissue and its subsequent contraction, as in the repair of a wound. The wound may be superficial and only affect the epidermis, and may entirely disappear; or it may be deep, and destroy the true skin and deeper tissues. The scar which f ollows in the latter case will be well marked, and generaUy resem- bles in shape the wound which was inflicted, or it may become smaller and narrower. AU scars run through two distinct stages, that of inflammatory red- ness and that of brown discoloration; and when the destruction is con- siderable or the inflammation high a third condition may be seen, namely, bleaching. The first stage lasts during the period of healing, two, three, or four weeks; the brown or coppery stage from a few months to a year; the white is permanent. In examining a scar carefully measure it, note its color and the con- dition of the surrounding tissues, observe whether it is on a level with or sunk below the surface, and its mobility in relation to surrounding tis- sues. It may be mentioned that a considerable bleached area of the skin, such as occurs sometimes in negro races, resembles a superficial scar; but if the surface is carefully examined for lanugo or the fine downy hairs 72 A SYSTEM OF LEGAL MEDICINE. found on most parts of the body, then- presence will decide the question. as there are no hairs in scar tissue. With regard to scars produced by such means as setons, cupping, venesection, vaccination, pitting from smallpox, an operation on a boil or carbuncle, etc., the position, shape, size, and appearance would readily indicate the causation, and these are generally known even to the laity. The brown discoloration foUowing herpes is a fair illustration, as no other scars would so closely follow the distribution of a nerve. With regard to scars caused by wounds of any kind, each case must be taken on its merits; but as much depends on exact description in prov- ing the identity of a person, such description should be most accurate. Many cases are on record, and can be easily studied. The identity of a mutilated woman in a well-known English case was decided by an oblique scar on the wrist caused by a cut from a bottle. In the Wainwright case, where the mistress, Harriet Lane, was shot by her paramour and the body buried in quicklime, the identity was established a year later by the presence of a scar on the anterior aspect of the shin. The scar was caused by a burn. A preparation of this scar is still in the Black Museum at Scotland Yard. Tattoo marks would form a very decided indication of the identity of a person, if the design was previously known to friends. Their presence or absence may be of the greatest importance, as in the Tichborne case. (Vide Identity of the Living.) It is a very usual habit for a man, especiaUy a sailor, to have his own initials tattooed. An American sailor would be more likely to have a flag with the stars and stripes than the tricolor of France. Moles, birth-marks, na?vi of all kinds should be described as to locality, shape, color, etc., as such marks are usually known to intimate friends and relatives, and may prove of great value in identification. It is not necessary to do more than mention these en passant. In addition to true cicatrices there are two appearances which resem- ble shghtly superficial scars, for instance : If a finger-ring be worn for any length of time, there is a well-marked depressed line made by the ring. This is paler than the surrounding skin, as it is unexposed to the air, and unless made by a wedding-ring has generally some irregularity in outline according to the design of the ring, e.g., a signet-ring. The mark made by a wedding-ring in European countries is a slender, even-defined circular mark around the left fore- finger. A signet-ring is usually worn on the fifth finger. Another mark is that made by the garter on the legs of a woman. This may be above or below the knee, and is best seen below. It is more customary to find this mark among the lower classes, and is usually below the knee, I beheve because, the richer classes wear suspenders or garters above the knee. This may be a means toward establishing identity. 7. Deformities.—It would seem a simple matter to identify a corpse by a deformity, such as a curved spine or the various forms of tahpes, and this is no doubt the case; but in smaller deformities, such as the loss of a finger or contraction of a joint, confusion often arises. A case in point happened in London in 1889, where the body of a man was found drowned, and was identified by the relatives on account of a curiously contracted ring-finger, and while the inquest was being held the real man appeared, shoving precisely the same physical condition. One point is, however, clear, and it is that any deformity found in the dead body, DEATH IN ITS MEDICO-LEGAL ASPECTS. 73 whether of head, spine, or limbs, is real, but it is by no means uncommon for deformities to be feigned by " old soldiers "; but this is beyond our inquiry. Among malformations to be described may be mentioned shortening of limbs, spinal curvature, talipes, imperfect conformation of the genitals, anchylosis and contraction of joints, polydactylism, whether of hands or feet, or the absence of one or more members. " 8. Occupation, etc.—In the examination of a corpse some aid toward identity may be obtained by carefully observing if there are any marks on the body or limbs wliich are the results of the occupation followed during life. These would be found, in most instances on the bodies of manual laborers, or those exposed to wind and weather, such as sailors, soldiers, engineers, etc., rather than on the studious or wealthy classes, who are protected from such influences. The delicacy of the skin, espe- cially the softness of the palms of the hands, the care taken of the nails, the trimming of the hair in either sex, would sufficiently indicate that the body is that of a person in a good position in life. With regard to outdoor workers, the face of a sailor or a soldier is gen- erally well tanned by the sun, in the case of sailors the tan reaching down the neck to the chest, where it is seen as a triangular patch with the apex downward. In the case of the soldier the tan is over the face and neck only, while the forehead is often obhquely marked by the wearing of the cap on one side, and the chin-strap may protect a part of the cheeks and chin from the sun, and so its position is kno wn by a paler color. It may here be noticed that among the colored races in India, in some instances, one arm and shoulder and part of the breast is exposed, while the other is covered, the two being separated by a well-marked oblique hne of a lighter shade. The palms of the hands of laborers and outdoor workers are hard- ened, and generally there are hardenings at the base of the fingers over the heads of the metacarpal bones from grasping weapons or tools of various kinds. (See Identity of the Living.) Other callosities may be produced by certain occupations where constant pressure is made upon a part. In India these callosities are found on the feet—sometimes on the outside of the foot, sometimes on the dorsum, according to the sect; while sometimes there is a distinct mark on the forehead of a Moham- medan, from striking the head on the ground as he bows toward Mecca. Stains on the fingers again may be of help. These are found in those working in chemical factories or laboratories, or in dye-works, and are produced by acids or dyes of various kinds; nitric acid, for instance, leaving a yellow, while sulphuric acid leaves a blackish, stain, and nitrate of silver leaves also a black stain. Other occupations may be discovered by the presence of skin affections, such as the washerwoman's eczema on the back of the hand, and the so-called baker's itch, also on the hand. In regard to muscles, it may just be mentioned that blacksmiths, engi- neers, and prize-fighters have the upper part of the body developed more strongly than the lower. The well-formed calf of the ballet-dancers is auother well-known instance of muscle hypertrophy from occupation. With regard to the effect of pressure by dress, the marks of tight lacing are well seen, the waist being much narrowed and the organs dis- placed, the liver and stomach sometimes being close to the pelvis. Corns on the toes and bunions are often the result of a short tight shoe with pointed ends, and more often remarked in women's feet. The hands of the well-to-do are generally soft and white from wearing gloves. 74 A SYSTEM OF LEGAL MEDICINE. All these points should aid in giving an idea of the occupation of an un- known person, no single point being sufficient in itself. The presence of foreign substance, such as hay, straw, grains of wheat, flour, animal hairs, or human hairs differing from those of the deceased, may be an important help toward finding out both the occupa- tion and identity of the deceased. For instance, a coachman would more hkely have horse's hairs on his person or dress, and a baker would more likely have flour. In one case a murder of a girl preceded by rape was traced to a miller, in consequence of some grains of wheat being found on the girl's person and underclothing. Hairs are appendages of the skin, and are modified epithelium. Each hair consists of a bulb—which is the dilatation of the hair fixed in a de- pression in the skin called the hair-follicle—a shaft or stem, and a point. The stem is generally cylindrical, or more or less flattened, the section of a hair in the straight-haired races being circular, in the woolly-haired smaller and oval. The stem is covered by finely imbricated scales, the edges of which give rise to a series of fine, waved, transverse lines, and these are the hues which are so characteristic in different animals. Internal to this is a fibrous substance consisting of fusiform fibers with more or fewer pigment-granules and diffused coloring matter. Internal again is the medulla or pith, though it is not present in all hairs. This is formed of cubical cells with air-bubbles among them; the presence of the air-bubbles gives a dark appearance on transmitted light, but a white appearance to reflected light. The bulbous extremity which fits in the depression of the true skin called the hair-follicle is lighter and softer than the stem. The point of the stem tapers, and is free from a medulla. Human hairs have a diameter of 1-170 inch to about 1-3000, the female hairs being larger and from 1-2500 to 1-3000 inch less in diam- eter, except on the pubes, where the male hairs have a smaller diameter. Human hairs may be distinguished from animal hairs by the fine, wavy, transverse lines of the cortex, which are more marked in man than in any other mammal. The size of the hair of the deer and horse is greater than that of man, and there is in these animals a greater develop- ment of the meduUa at the expense of the cortex. In man and monkey the pigment is confined to the cortex, while in the rodent it is found in the medulla. Diameters. Hair from young girl's arm..................1-1666 Hair from head (female) ....................1-34 Hair from pubes (female) ...................1-166 Hair from beard............................1-166 Hair from head (male)......................1-333 Hair from pubes (male).....................1-233 Deer.......................................1-250 Horse......................................1-340 Fox .......................................1-600 Dog.......................................1-1100 Rabbit.....................................1-1125 The value of photography has already been commented on, and its use is becoming of daily increasing importance. Careful photographs are taken of every unknown body examined by the medical examiners in Boston, and they prove of the greatest value. DEATH IN ITS MEDICO-LEGAL ASPECTS. 75 We have now discussed in somewhat the form of an essay the vari- ous points of importance in the identification of the dead, and have given several rules for guidance of the students in this inquiry. We add a tabular statement of the points to be observed, and conclude by giving in detail four cases, illustrative of many of these points. TABULAR STATEMENT OP DETAILS TO BE NOTED IN THE EXAMINATION OF BODIES, OR OF PARTS OP BODIES, OR OP BONES IN THE QUESTION OP IDENTITY. 1. The surroundings and conditions of parts found. 2. Height. 3. Weight. 4. Probable age, considering teeth, maxillse, skull, fontanelles, centers of ossifica- tion, and condition of ephiphyses. 5. Sex; genital system and breasts; general shape, hair, pelvis bones. 6. Deformities. 7. Marks on skin, including scars, tattoo marks, signs of previous disease, such as scrofula, syphilis, smallpox, skin diseases, ngevi, moles, warts. 8. Injuries, wounds, fractures, dislocations. After this examine in detail the various parts and organs of the- body. 1. Head and features. 2. Neck. 3. Chest. 4. Pelvis. 5. Extremities. Mutilated Remains. 1. Accuracy of the fitting of the various parts. 2. Nature of mutilations, whether the soft parts were cut with blunt or sharp knife, or done with or without skill; whether the bones have been chopped or sawn by coarse or fine saw. 3. Whether they have been burned, boiled, acted on by chemicals, or buried in earth or macerated in water. The following cases, which came under the observation of Dr. Heb- bert in London, are cited in extcnso for the purpose of iUustrating many of the points alluded to in the preceding part of this article. Case I. In July, 1887, Mr. Bond was requested by the treasury to examine some remains found in various parts of London, and I had the oppor- tunity of helping at the autopsy. AU the portions were found either in the Thames or in the Regent's Canal, and consisted of eight separate parts. In the inquiry we had to determine the following points : whether they were human and belonged to the same body, the race, age, sex, height, complexion, and condition of life, and, if possible, the cause of death, and the skill or ignorance of the operator. The parts were: (a) the lower part of the thorax and the upper part of the abdomen, from the fifth dorsal vertebra to the third lumbar ver- tebra ; (b) the pelvis below the third lumbar vertebra; (c) the right thigh, including pateUa; (d) the left thigh; (e) both legs and feet, the left hav- ing patella attached; (/) the arms from the shoulders to the fingers. They were obviously human, and on applying the various joint and bone sur- faces together we found that they fitted. The skin-cuts apparently cor- responded, but had been too much altered by decomposition to warrant 76 A SYSTEM OF LEGAL MEDICINE. a certain opinion. The limbs were muscular, and the remains generally had a fair amount of subcutaneous fat. The various parts were then described in the report. First, the thorax had been cut above, through the body of the fifth dorsal vertebra, and below, through the body of the third lumbar vertebra, the bones. having flat but somewhat rough surfaces, and through the skin and other tissues by a series of more or less clean-cut incisions, so that the fourth left rib and the fifth right rib had been left, and the sternum below the articulations of these ribs. The diaphragm was intact, but the lungs, heart, and other thoracic viscera were absent. Below the diaphragm were the liver, stomach, both kidneys, and spleen; the remaining viscera of the abdomen were included in the pelvis below the third lumbar ver- tebra. The lower piece of the trunk was the abdomen from the third lumbar vertebra and the pelvis. Xo part of the small intestine from the duode- num was found, nor the large intestine, except the sigmoid flexure and. rectum in the lower fragment. In the pelvis were the uterus, vagina, ovaries and appendages, and the bladder. The acetabula were empty, the thighs being separated from the pelvis by incisions passing around the flexure of the joint. The external organs of generation were those of a female. The uterus measured three and one eighth inches, the body one and one half inches, and the cervix one and five eighth inches. The os internum was well marked, and the arbor vita? very distinct. The os externum was smaU, and would barely admit the point of a sound. The ovaries were small, and one showed a corpus luteum of menstruation. The ruga? of the vagina were prominent. On the pubes were some black hairs. An incision had evidently been made from the ensiform cartilage to the pubes. There was no trace of ecchymosis in the skin of the in- cisions separating the limbs or those dividing the trunk. The skin of the two pieces of the trunk was partly decomposed and sodden, but was evidently fair in color. The arms had been taken off at the shoulder by incisions passing obhquely downward and outward from the tip of the shoulder around the axilla, so as to leave most skin on the upper and outer aspect of the arm. The heads of the humeri had been cleanly disarticulated. The skin of the arms was peeling off, and that of the palms thick, white, and sodden; the two terminal phalanges of the fingers, with the exception of the thumb and the left ring-finger, had rotted off. The length of the left. arm and hand was twenty-five and three-eighth inches. There was no' circular depressed mark on the left ring-finger. The thighs had been cut off at the hip-joint by cuts around the flex- ure of the joint, and the heads of the femora disarticulated. The right thigh had the patella attached, but was separated from the leg at the knee-joint. The left thigh, which was found at a later date, showed not only more signs of decomposition, but the head of the femur was riddled with the smaU circular holes of a water worm. The femur measured sixteen and one eighth inches from the head to the lower level of internal condyle. The legs, including the feet, had been cut off by circular cuts from the center of the knee-joints, the left leg having the patella attached. The legs were well shaped and muscular, and the foot small and without deformity. There were circular, slightly depressed marks, about half an DEATH IN ITS MEDICO-LEGAL ASPECTS. 11 inch deep, just below the knees. Each leg with the foot measured six- teen inches ; right and left tibia?, thirteen inches; right and left fibula?, thirteen inches. The skin of the thighs and legs was decomposing, the cuticle in places being raised in buha? and peeling off. The cuticle of the feet had disappeared with the nails, and the terminal phalanges had fallen off. The following inferences were then drawn from the foregoing facts: 1. The sex was easily told, as the external organs of generation, as weU as the uterus and ovaries, were present. 2. The age.—The union of the epiphyses proved the age was over twenty-five. 3. The complexion was dark, as shown by the pubic hair, while the fair skin proved Caucasian origin. 4. Height.—The length of the arm being 25| in., by doubling this and adding 12 in. for clavicles and sternum we should have a result of 5 ft. 2f in. The length of the lower extremity was 32£ in. x'2 = 64J, i.e., 5 ft. 4^ in. By measuring the ring-finger the length was 3£ in. x 19 = 5 ft. 1^ in., so we had to average the three measurements, and calcu- late her as about 5 ft. 3 in. in stature. 5. Condition of Life.—The skin of the hands and feet was too much decomposed to show whether she had led a life of hard manual work. There was no mark made by a wedding-ring. The uterus was that of a virgin, but the vulva was too decomposed to give indication with regard to old or recent injury. The mark around the leg showed that garters were worn below the knee—a custom, I believe, more common among the lower than the upper classes, who either wear garters above the knee or suspenders. She had recently menstruated. The cuts on the surfaces of the vertebra? were such as would be made by a saw, and the long clean sweeping incisions through the skin showed that a very sharp knife had been used. The disarticulations were neatly and cleanly done, in each case the joint being exactly opened. The ab- sence of ecchymosis showed that all the cuts were made after death. It was obvious, from the direction and manner of the cuts, that no ordinary surgical or dissecting-room operation had been carried out. Although no special knowledge of anatomy was shown, the cuts indicated a practical skill in amputating limbs at joints, and making clean sweep- ing skin cuts. It may be argued that such skill would be gained by a hunter or a butcher, as either of these are in the habit of rapidly and skilfully separating limbs, and of cutting up a trunk into several parts. I do not think that any surgeon or anatomist could have done the work so well, as they are not constantly operating, while a butcher is almost daily cutting up carcasses. Moreover, the limbs wrere separated in almost precisely the way a butcher or hunter would adopt, i.e., making a series of cuts around the flexure of the joint, and then by a strong twist wrench- ing out the head from the joint, and cutting the capsule. The condition of the skin showed that each part had been lying and decomposing in water, and that several months had elapsed since the date of death. The summary was that the remains were those of an adult female of Caucasian origin and dark complexion, from twenty-five to thirty-five years old, and about 5 ft. 3 in. high, that she had not borne a child, and in fact, from the small size of the os uteri, was unlikely to conceive; that 78 A SYSTEM OF LEGAL MEDICINE. the body had been mutilated after death by some person who, though not necessarily a skilled anatomist, yet had some knowledge of joints and the readiest mode of separating limbs, and by inference a butcher or hunter; that decomposition had taken place in water, and some months had elapsed since death. Case II. September 16, 1888. " (a) On this date I examined a right human arm, separated from the trunk at the shoulder by an incision passing obliquely around the upper third of the humerus, so that the lowest point is internal and five inches verticaUy from the head of the humerus, and the highest point external and two and three quarter inches vertically from the head of the humerus. " (b) The head and neck of the humerus are exposed, the capsule of the joint having been cut circularly and the head enucleated. The carti- lage shows two or three small nicks. The amputation has been made by seven separate cuts, cleanly dividing the tissues. " (c) Description.—The arm is large, shapely, and muscular, but has rather the roundness and general contour of a female than the muscu- larity, as shown by the development of the triceps and biceps, of a male limb. The wrist is small, the hands long, with tapering fingers ; the nails are small, flat, and well formed, and have been carefully trimmed. The fingers of the hand are firmly flexed and stiff, and the thumb opposed and flexed. In dissecting the limb it is found that the flexion of the fingers is due to the rigor mortis of the flexores digitorum. " (d) Six in.—The skin of the arm is adherent and white, though there are several patches of brown color and of a hard leathery consistence from decomposition. There is some fine downy hair on the back of the forearm, not thick and strong as in a man. There are no bruises nor cuts nor old scars. The skin of the hand is thick, white, and much cor- rugated, in some places the epidermis being raised from the cutis vera. The nails are firmly adherent. There is no circular depressed mark on the fingers. " (e) Hair.—There are a few hairs in the axilla, of a dark brown color. "(/) Weight—lib. 6 oz. " (g) Measurements.—Length of the whole arm from head of humerus to tip of middle finger, 31£ in.; the measurements along both flexor and extensor aspects corresponding. Length of forearm from tip of olecranon to tip of middle finger, 18 in. Humerus from external condyle to great tuberosity, 12^ in. Humerus from head to internal condyle, 12J in. Ulna from tip of olecranon to styloid process, lOf in. Hand from third metacarpal bone to tip of finger, 7£ in. Third finger from tip to point on first phalanx, which meets a line drawn transversely from root of the thumb-nail, 3f in. Circumference of arm just below the lower end of incision, 13 in. Circumference five inches above internal condyle, 12^ in. Circumference of forearm one inch below tip of olecranon, lOf in. Wrist, 61 in. Hand, 8£ in. " (h) Ligature.—Surrounding the arm six inches above the internal condyle is a piece of string, tightly tied; this string is partly wrapped in paper (newspaper). The mark made by the string is circular, and shows the strands of the ligature. The skin below the string is parchment-like in character, but there is no ecchymosis. DEATH IN ITS MEDICO-LEGAL ASPECTS. 79 " The tissues divided by the amputation show no clotting nor ecchy- mosis. The veins are full of black fluid blood, which has been kept in by the ligature. " (0 Disease.—There is no disease of the joint or limb. " (j) Age.—The epiphyses of the humerus are firmly united to the shaft, and also that of the fourth metacarpal bone. These unions occur from the eighteenth to the twentieth year. " Height.—The height is suggested by three methods: " (a) Twice the length of the arm plus ten inches for the clavicles (or less in the female) and one inch for the episternal notch. This would give 31 x 2 = 62 + 10 = 72, which is probably several inches too much. " (b) The length of the third finger from the tip to a point meeting a line, drawn transversely from the root of the thumb-nail, is iV part of the height. 3f x 19 = 68| = 5 ft. 8f in. " (c) The length of the forearm from the tip of olecranon to tip of third finger equals -fV of the height; this is: 18 x *$■ = 68£ = 5 ft. 8f in. "Inferences. Date of death.—The appearance of the hands woidd suggest maceration in water from three to four weeks, and the absence of ecchymosis proves that the limb was separated after death. " History.—The limb is clearly not separated by the ordinary surgical operation at the shoulder-joint, for the following reasons: " 1st. The incision of an ordinary operation by transfixion has the lowest part outside and the highest inside for the formation of the flap; and if by the double flap methods, the longest piece of skin is taken from the outside of the arm. " 2d. The entire absence of disease, either of joint or limb, such as would warrant aii operation. " 3d. The separation took place after death. " It certainly shows no trace of having been prepared for the dissect- ing-room, as there is no injection in the vessels, nor sign of preservation by antiseptics." The general shape and appearance of the hand and arm suggested at once a female limb, the taper fingers, the small wrist? and the absence of any special peculiarity all favoring this view; the neat appearance of the nails, and the absence of any deformity by occupation, were against a low-class person. The manner in wdiich the limb had been separated was exactly the same as in the first case, and similar arguments as to the occupation of the operator will apply in this case. " Summary.—The limb is apparently that of a female adult above twenty years of age, of Caucasian race, of dark complexion, and about 5 ft. 9 in. in height. " It has not been separated by the ordinaiy surgical operation during life, but has been cut off after death by a person with some knowledge of anatomy. " The ligature was either tied around to prevent the bleeding from the veins, or to fix a newspaper wrapper around the limb. In either case it had the result of preventing the draining out of the blood. " Decomposition had begun after maceration in water." A few days after this a portion of the trunk was found in Whitehall, and was examined by Mr. Bond and myself. It consisted of the whole 80 A SYSTEM OF LEGAL MEDICINE. thorax and the upper part of the abdomen as far as the fourth lumbar vertebra. Description,—The trunk is that of a female, the breasts being present. It comprises the thorax and upper part of the abdomen, the head having been separated at the sixth cervical vertebra, and the pelvis and lower part of the abdomen at the fourth lumbar vertebra. The bones have been cut through the middle of the bodies, showing flat, somewhat rough surfaces. The skin incisions have clean, well-defined edges. There is a fair amount of subcutaneous fat, and the muscles are large and well de- veloped. Measurements.—Length, 17 in. Circumference of thorax at level of nipple line, 35£ in. Circumference of waist, 28£ in. Surface,—The skin is fair, and not much decomposed. The breasts are large and prominent, with small, well-shaped nipples. There are no scars nor wounds, but there are impressions made by the string with which the trunk was tied. These are four in number, two running down obhquely from the shoulder and two crossing the chest, one at the level of the nipples and one across the upper part of the sternum. The divided surfaces are much decomposed, and the parts full of maggots. There are no appearances of linea? alba? on the surface of the abdomen. Cut Surfaces. Arms.—The arms have been amputated at the shoulder- joints by several incisions passing obliquely downward and outward from the tip of the shoulder around the axilla. The glenoid fossa? are bare, and the limbs cleanly disarticulated. Xeck.—The skin of the neck has been divided opposite the cricoid cartilage by two clean lateral cuts, joined in front and behind by several small, jagged incisions; the posterior plate of the cricoid and the body of the sixth cervical vertebra have been sawn through. The tissues of the neck on either side are in an advanced state of decomposition. Organs. Breast.—The mammary glands are large and healthy. On opening the thorax it is noticed that the rib cartilages are unossified. Heart.—The substance of the heart is healthy, the valves normal, and there is no staining of the endocardium of either ventricle. Lungs.—The left lung is free from adhesions, and the substance healthy. The right lung is firmly adherent to the chest wall and dia- phragm by old adhesions; the substance appears healthy. The liver, spleen, and kidneys are normal. Stomach contains about one ounce of partially digested food. Intestines.—The small intestines, with the mesentery, are in situ, and appear healthy. There are a few remains of the transverse ascending and descending parts of the colon, but the lower parts are absent, as well as the pelvic viscera. Hair.—There are a few dark-brown hairs in the axilla. The clavicle measures six inches, and the sternum six inches. The sternal epiphysis of the clavicle is united to the shaft. Comparison with Arm.—The arm discovered in Pimlico and examined on the 16th of September was brought to the mortuary, and found to exactly correspond to the trunk. The skin incisions fit, and the bones, i.e., the humeras and scapula, evidently belong to the same joint. The hair taken off the arm and the hair from the axilla of the trunk are iden- tical. Summary.—The trunk is that of a large, weU-nourished woman, of an DEATH IN ITS MEDICO-LEGAL ASPECTS. 81 age of full sexual activity, as shown by the breasts. It could not be de- cided whether she had been a mother, but the appearance of the breasts would indicate that she had not suckled children. The trunk had been mutilated after death, and the death had probably occurred about two months previously. Decomposition had taken place in the air, as shown by the presence of maggots. A fortnight after this a left leg and foot were found. The skin was incrusted with earth, and partly covered with mold. The cuticle of the sole of the foot and toes, with the nails, had nearly separated. The nails were well shaped and properly trimmed. The skin of the leg was fair, and not much altered by decomposition. The limb had been' separated from the thigh at the knee-joint, the patella being absent. The incision had clean and well-defined edges, and the joint exactly opened. The length of the leg was 17J in.; circumference of calf, 14 in.; ankle, 8£ in.; length of foot, 9£ in. On the outside of the leg was a dark purple mark the size of a shilling, and the tissue beneath contained clotted blood. A small but similar mark was on the inside of the leg. The length and size of the leg and foot pointed to its being part of the same body. The marks were ante-mortem bruises. The date of death was from six weeks to two months previously. The remains showed various kinds of putrefaction: the arm had been in the water, the trunk exposed to the air, and the leg buried. As will be gathered from the description, the arm in the second case had been cut from the trunk in a precisely similar manner to that in the first case; in fact, as soon as I saw the arm I was struck by the close re- semblance of the modes of separation, and the mutilation of the trunk was in every respect identical. Case III. The parts found were: (1) two large flaps of skin, the uterus and placenta; (2) both arms and hands; (3) both thighs; (4) both legs and feet; (5) the trunk divided into three parts. The Trunk.—The first portion of the trunk included the shoulders and the upper part of the back; the head and neck had been taken off oppo- site the sixth cervical vertebra; the skin, muscles, and vessels were divided cleanly by a series of cuts; the cricoid cartilage was cut through, and the bodv of the sixth cervical vertebra divided through the center showing a flat and somewhat rough surface. The edges of the skm and the section of the vessels were sharply defined. This part was separated from the trunk below at the junction of the seventh and eighth dorsal The chest had been opened in front by the mid-hne, the upper part of the sternum cut through, and the contents of the chest had been JmBoth arms had been taken off opposite the shoulder-joints by three or four long, sweeping cuts, the joints neatly disarticulated Decompo- sition had not far advanced; the skin was white and sodden, the epidermis peehng off in places. The second portion of the trunk included both breast! and the upper part of the abdomen as far as the mtervertebral substance between the third and fourth lumbar vertebra?. The uppei s:2 A SYSTEM OF LEGAL MEDICINE. surface of this portion exactly fitted the lower surface of the former part. It had also been opened down the center of the sternum. The ribs from the fourth downward were present; the lower border showred a clearly defined skin margin from the back at the junction of the third and fourth lumbar vertebra1 to a point an inch and a half above the umbilicus on the left side, and a point just below the umbilicus on the right side. The intestines had been removed, but the duodenum and a piece of the stomach remained. There were also present both kidneys, the spleen, pancreas, and liver. The breasts were firm and compact, and enlarged; the areola? well marked, and foUicles distinct. All the organs found were healthy. The liver was much decomposed. The third portion of the trunk consisted of the pelvis from below the third lumbar vertebra. The thighs had been taken off opposite the hip- joints by long, sweeping incisions through the skin, muscles, and tissues down to the joint, the heads of the bones neatly disarticulated. The incisions separating both the arms from the upper piece, and the thighs from the lower piece, were exactly opposite the flexure of the joints. The pelvis contained the lower part of the vagina and the lower part of the rectum, the front part of the bladder including the urethra. The vagina was flaccid, the mucous membrane healthy, and still showing ruga?. There was no rupture of the vaginal walls or fourchette, nor was there any swelling nor congestion of the parts. The flaps of skin and subcutaneous tissues consisted of two long, irregular slips taken from the abdominal walls. The left piece included the umbihcus, the greater part of the mons veneris, the left labium majus, and labium minus. The right piece included the rest of the mons ve- neris, the right labium majus and minus, and part of the skin of the right buttock. These flaps accurately fitted together in the mid-line, and laterally corresponded to the incisions in the two lower pieces of the trunk. The skin was fair, and the mons veneris was covered with light sandy hair. There were no appearances of linea? alba?. The upper part of the vagina wras attached to the uterus, both ovaries and broad ligaments were present, and the posterior wall of the bladder. The uterus had been opened on the left side by a vertical cut, six inches long, through the left wall. The organ was much dilated, the vessels on the inner sur- face large and open, and the mucous membrane swoUen and softened. The uterus measured 10 in. long by 7£ in. wide. The circumference of the os externum was 4 in. The length of the cervix from the os exter- num to the os internum was f in. Inside the uterus were the placenta, cord, and membranes. The cord measured 8 in., and the distal ends showed a clean cut. The vessels contained fluid blood. The placenta was circular, and measured 6£ in. in diameter. The ovaries were irreg- ular and shriveled, the right containing a cyst. The Arms.—The arms had been removed from the trunk at the shoulder-joint; when the upper ends of the arms were placed against the shoulders of the trunk it was found that the joint surfaces corresponded, and that the margins of the skin accurately fitted; the two limbs were identical in appearance and measurements. The skin of the hands was white and much corrugated, and the epidermis peeling off; the nails were still adherent. The nails were short, the edge much below the tip of the finger, with an irregular outhne. There was no thickening of the DEATH IN ITS MEDICO-LEGAL ASPECTS. 83 skin of the palm or fingers. The hair in the armpit was similar in color to that on the pubes. On the upper and outer side of the left arm were four round superficial cicatrices. On the back of the left ring-finger was a small discoloration, a quarter of an inch broad; this, when cut into, showed extravasation of blood in the tissues. On the inner side of the left forearm, about one inch above the wrist, there was an irregular, white, hard cicatrix one inch long and a quarter of an inch wide. There was a small bruise over the internal condyle of the left arm, and another one just below the right internal condyle. Measurements.—Whole length of arm and hand, 26J in.; from the elbow to tip of middle finger, 16£ in. Length of middle finger, 3^ in. Length of hand, 6f in.; breadth of hand, 3£ in. Circumference of wrist, 5| in. Circumference of palm, 7 in. Humerus, great trochanter, and external condyle, lOf in. Head, to internal condyle, 11J in. Ulna, to styloid process, 9^ in. Lower Extremities.—Thighs: On placing the upper ends of the thighs to the hip-joints of the pelvis, the heads of the femora exactly fitted the cotyloid cavities, and the margins of the skin corresponded. The legs had been removed at the knee-joint, the left thigh having the patella attached, and also the semilunar cartilages. The length of the femur from the head to the internal condyle was 17 in.; the circumference at the knee-joint, 13 in.; and the maximum circumference, 19£ in. At the inner side of the upper part of the thigh were some light sandy hairs similar in color to those on the pubes. The skin was fair, not decomposed, and the tissues were fresh. The right thigh exactly resembled both in measure- ments and condition the left. Legs : On placing the lower ends of the thighs against the upper ends of the legs, the joint surfaces and the cuts in the skin were found to fit. The leg and foot measured 16£ in. The tibia was 13£ in. long; fibula, 13 in. long; foot, 9i in. long. The circumference of the left calf equals 13£ in., of the right, 13J in. There was no deformity of the toes, and the feet were well shaped. The whole length of the lower extremities equals 321 in. Epiphyses.—The sternal ends of the clavicle had recently joined, but the line of the union was still evident, the tips of the acromial processes of the scapula? had not joined the spine. The upper ends of the fibula? had firmly united. The following inferences were then drawn from the foregoing facts. Sex.—The sex was female. The uterus was that of a pregnant woman, and the size of the uterus as well as that of the placenta would indicate that the pregnancy had advanced to between six and seven months. The measurement and appearance of the os and the length of the cervix showed that delivery had not taken place, but the foetus had evidently been removed through the incision in the left wall of the womb. The condition of the vagina and the non-rupture of the fourchette confirmed this view. Age.—The complete union of the epiphyses of the fibula? proved her age to be over twenty-four years, while the not complete union of the acromial processes and the sternal ends of the clavicle showed she was under tweiitv-five. The complexion w^as fair, as shown by the hair. Height.—-Twice the length of the whole lower extremities equals 65f in. The length of the forearm, 16g x ^ = 63|£. Length of middle s4 .-I SYSTEM OF LEGAL MEDICINE. finger, 3£ x 19 = 63J in. Twice the length of the arm = 53f + 11 in. for the clavicles and sternum = 64f in. Incisions.—The surfaces of the vertebra? are such as would be made by a fine-toothed saw. The clean edge of the skin incisions showed that a very sharp knife had been used. The joints in each case, with the ex- ception of the left knee, were exactly opened, and the limbs neatly dis- articulated. In the case of the left knee the semilunar cartilages were attached to the ends of the femur. Condition of Life—There was no thickening of any portion of the skin of the hands which would suggest any special occupation. The bruise on the back of the left ring-finger might have been made by the forcible removal of a ring. There was no mark either on the thighs or the legs, as is made by the pressure of a garter. It was clear from the direction and manner*of the cuts that no ordinary surgical or dissecting-room operation had been carried out, but the system of division of the parts gave evidence of design and skill—the design probably being for the purpose of concealment of the crime and easy carriage of the parts; the skill not showing the anatomical knowledge of a surgeon, but rather the aptitude learned by a butcher, horse-knacker, or other person used to deal with dead animals and to readily separate limbs at the joints. All the parts evidently belonged to the same body. The state of de- composition of the various pieces is consistent with the theory that death took place about twenty-four hours before the discovery of the first two portions. Summary.—The summary was that the remains were those of an adult female of fair complexion, with light sandy hair, well formed and well nourished, from twenty-four to twenty-five years old, and about 5 ft. 4 in. in height; that she was pregnant of about six to seven months' duration; that she was undelivered when death took place, and that the fostus had been removed by an incision through the walls of the uterus after death; that the mutilations were carried out after death by some person with a considerable technical knowledge of the speediest mode of cutting up animals; that decomposition had taken place, partly in water and partly in the air; and that death occurred about twenty-four hours before the first discovery. That an injury had been suffered to the left forearm wliich left a permanent cicatrix. The great interest in this case was that the foregoing inferences were verified by the identification of the woman. She was proved to be an unfortunate, named Elizabeth Jackson, who was in her twenty-fifth year, measured 5 ft. 4£ in. in height, and was known to be far gone in pregnancy. The verification of the remains was confirmed by the cicatrix on the left wrist, which was caused by a fall on a broken bottle some years pre- viously. She was last seen two days before the discovery of the remains. With regard to the height, the various calculations do not exactly correspond, but the average of the four would give a little over 64^ in., so that the inference wras very near the exact truth. This case is remarkable from the fact that, beginning with one limb only, the other parts of the body Avere found. The adoption of four different methods was pursued in estimating the height, Each method gave a result within an inch; and then, taking the mean of the four measurements, we arrived at the actual height as described by the per- sons who identified the body. DEATH IN ITS MEDICO-LEGAL ASPECTS. 85 Case IV. This case was that of a trunk found under an archway in White- chapel, and on September 11, 1889, I was present at the post-mortem ex- amination, and made the following report to the pohce. The remains consisted of the trunk and arms of a female body. The head had been cut off at the lower part of the neck, and the thighs had been separated at the hip-joints. The trunk was plump and well formed, with full breasts, fair skin, and dark-brown hair on the pubes and axilla?; the arms well shaped, hands small, and nails well kept. The weight of the trunk could not be taken. The length was 26 in., and circumference of chest at nipple-hue 34 in., and below breasts, 31| in. Rigor mortis had passed off, and decomposition, as shown by green discoloration of the abdomen, just beginning. The cut surfaces at the hips were black and dry, but the surface at the neck moist and red. The skin and muscles of the abdomen had been cut by a vertical incision, running from two inches below the ensiform cartilage downward, and ending on the left side of the external genitals, just opening the vagina, but not opening the peritoneal cavity. There were a number of small round bruises on the forearms and arms, most on the inner surface of the forearms, and varying in size from a shilling to a sixpence. On the left wrist were two cuts, one just grazing the skin, three quarters of an inch long, and the other cutting through the skin, and one inch long. There was no ecchymosis on the edges, and no gaping of the wounds. There are no linea? alba? on the abdomen, and no further scars or injuries. The incisions separating the head were apparently two in number: the first beginning behind, opposite the spinal column, and ending in front on the right side, and carried from left to right; the second begin- ning on right side in front and carried to back, joining the first, but leaving a tongue of skin behind. There was no ecchymosis in the skin. The muscles and tissues down to the spinal column were cut on the same level, the cricoid cartilage being cut about the center. The spinal col- umn was divided at the junction of the fifth and sixth cervical vertebra?, through the intervertebral substance, just a thin shaving of the body of the fifth cervical vertebra being left. The ends of the vessels were very clean cut. There was no retraction of the muscles or other tissues. The thighs had been separated at the hip-joints, the skin cut through by two or three sweeping, circular incisions, beginning apparently just below the hip-bone, and carried downward and inward around the but- tock. The capsules of the hip-joints were opened, and the heads of the bones neatly disarticulated. There was no retraction of the muscles and tissues, and the incisions, both at the hip and neck and in the abdomen, had xery clear-cut edges. The internal viscera were then examined. Heart.—The walls were flaccid, the ventricles empty and dilated; the valves healthy and competent, the muscle pale and fatty. On the peri- cardium was a patch of old inflammation. Weight, 9£ oz. Lungs.—Right upper lobe adherent to pleura by old firm adhesions. Left lung free. Both lungs were apparently healthy, but were beginning to decompose. 86 A SYSTEM OF LEGAL MEDICINE. Spleen large, soft, decomposing; 1\ oz. Liver.—Weight, 50 oz.; decomposing, substance fairly healthy. Kidneys.—Weight, 7 oz. each; slight decomposition, substance fairly healthy. Stomach,—Walls normal, with healthy mucous membrane. About a dram or so of partly digested food, which appeared to be plums; there was no odor of the contents. Intestine.—The large intestine contained faeces. There was no abnor- mality in either large or small gut. Vulva.—The vulva is patent, and there is no hymen. The fourchette is unruptured. The vagina is wide, but still rugose. The mucous mem- brane is healthy. The uterus weighs rather less than 2 oz., and is 3 in. long, of which the body measures 1£ in., the cervix, 1£ in. The cavity of the body is triangular, with a convexity downward at the base. The cervix has well- marked arbor vita?. The os is small, and the lips are not everted. The os just admits a large probe. There is a little whitish thick mucus ooz- ing from the os uteri. The mucous membrane is rather thick, and covered with a reddish mucus. The ovaries are small, cystic, and degenerating. There is a smaU ex- travasation of blood in the left ovary. The measurement of the arms outstretched across the chest equals 64 in. The forearm measured 16£ in., the hand, 6\ in. long and 6f in. in circumference at the palm. On the first joint of the dorsal surface of the right little finger is a small round hardening, not amounting to a corn, and a similar but smaller hardening on the inner side of the back of the first joint of the right ring-finger. The sternal epiphysis of the clavicle had united by bone. The tissues generally were pale and bloodless. Comment.—The remains are those of a large, well-nourished woman. Her height, as calculated by the transverse measurements and forearm, about 5 ft, 3£ in. The length of the forearm was 16\ in., and this mul- tiplied by ±2- equals 62^ in.; the transverse measurement of outstretched arms equals 64 in., so that the mean equals 63£. Her age is above twenty-five, as shown by the union of the epiphyses. The presence of a small extravasation of blood in the ovary showed that she had not reached the menopause, but we could not calculate her age more accurately than to say she was over twenty-five and under forty years old. She had not borne children, as shown by the uterus and absence of linea? alba?, and the breasts did not give the impression of having been used for suckling. She was apparently not a virgin, and the vagina had been distended, though not so patent as after child-bearing. The skin is fair and the hair dark brown. The hands are shapely, and the skin soft, There are no marks indicating any occupation, except that on the right little finger is a small circular hardening, but no corn. This mark is such as might be made by writing. There is no mark as of a ring worn on the left ring-finger. The immediate cause of death was syncope, as shown by the condition of the heart, and the general bloodlessness of the tissues would indicate hemorrhage as the cause of the syncope. DEATH IN ITS MEDICO-LEGAL ASPECTS. 87 There was no organic disease of the viscera examined which would have caused death. The edges of the cuts showed that a very sharp knife had been used; all the cuts had been made after death. All the cuts were made from left to right except those separating the right thigh and right arm, which had been carried from right to left across the flexures of the joints, and so probably done by a right-handed man. The incisions were evidently made with design, and Avere skilfully performed, as by a man who had some knowledge of the position of joints and the readiest means of separating hmbs—such knowledge as a butcher or slaughterer would possess. They do not indicate a special anatomical knowledge of the human body. Signs of Death.—The question of the reality of death as distinguished from apparent death is not often raised in these days. There has been, hoAvever, among the people of all countries a dread of being buried alive —a fear that has been augmented by sensational reports of exhumations where the position of the body differed so much from that presented when committed to the earth as to cause the belief in the minds of the unin- formed that life had not been extinct at time of sepulture. The expla- nation of this change of posture, as will be seen later, is undoubtedly due in most instances to the effects of the gases arising from decomposition, and not to voluntary muscular movements. It is possible that in times of severe epidemics of diseases, such as, for instance, cholera or smallpox, there may have been in the desire for speedy interment an occasional case of burial before life was demonstra- bly extinct, especially in Eastern countries, but such cases are the rare exception. I can recall several cases of persons so imbued Avith the fear of premature burial that they have insisted, as a last request, upon the opening of a vein or artery after death. One case in particular was that of a very intelligent man, a clergyman and an editorial Avriter, avIio was in the greatest state of anxiety upon this subject, and extracted a solemn promise from me that I would not permit the burial to take place till I had opened both veins at the elbow. In consequence of such appre- hension, the medical man may be, and doubtless is occasionally, called upon to decide the question of the reality of death. The apparent ab- sence of some of the more commonly known signs of death have a dis- quieting effect upon the minds of relatives and friends, so that careful consideration of the signs of death, both those presenting themselves immediately at the cessation of hfe and those wliich are observed as the consequence of chemical and putrefactive changes at a later period, is most necessary. It is well recognized that death, whatever may have been the remote cause, begins at one or the other of three points, the brain, the lungs, or the heart, all three being soon involved in the cessation of vital molecular process. It is only necessary to consider, however, for the purpose of deter- mining the reality of death, the question of the arrest of respiration and circulation. To the onlooker the more obvious of these two things is the cessation of the breathing, which is followed in a short time by the cessa- tion of the circulation in consequence of the stopping of the action of the heart. Usually the breathing is arrested some seconds, or even minutes, 88 A SYSTEM OF LEGAL MEDICINE. before the cessation of the heart's action, and in any question of doubt the careful examination of the chest should not fail to give evidence, through the stethoscope, of the complete cessation of respiration. The same test should be applied to the action of the heart, inasmuch as it is Avell known that complete arrest of the respiration need not, and often does not, mean the cessation of life. An example of this is the possibil- ity of the resuscitation of the droAvned after a short period of submersion. In these cases often there is no respiration to be detected, though the physical signs of cardiac movements are to be found. * That respiration can be entirely suspended for any considerable period without the consequent cessation of heart action seems incredible, al- though it has been claimed by some authors that persons who have been submerged in a state of syncope have been resuscitated after as long a period as half an hour, or even an horn*. From a physiological standpoint it might be argued that as long as the blood remains fluid, as it generally does in cases of asphyxia, and thus capable of flowing through the heart, that it Avould be possible, by restoring to the blood the oxygen of which it has been deprived, to furnish to the heart that stimulant Avhich is necessary for its action. It is quite clear, nevertheless, that after rigor mortis is established—and this occurs very soon after submersion, par- tially owing to the rapid cooling of the body—no such thing as restoring the heart's action would be possible. While a person who has been submerged in a state of syncope AArould struggle less, and in consequence of this absence of struggling would in- spire a smaller quantity of Avater, and therefore would be in a somewhat more favorable condition for resuscitation, it is difficult to believe, all tilings considered, that after the cessation of respiration for so long a period as thirty minutes life would not be extinct; and while, as stated, a fcav such cases are reported, it is possible that the face was not AArholly . submerged. At all events, the strongest proof as to the completeness and the duration of submersion should be required before such cases are removed from the domain of the apocryphal. The condition of the blood at the immediate approach of death from disease, and the rapid change which occurs after the cessation of systemic life, namely, its coagulation, would obviously prevent any possible res- toration of the vital processes after the shortest possible period. I would not deny that there are cases Avhere the death appearances have been so striking that eA^en physicians of ordinary skill have been deceived; but I belieA-e had there been a veiy careful examination of the organs of circulation and respiration, there would have been found evidence that those processes Avere not wholly arrested, though proceeding in the faint- est Avay. Two cases which came under my own observation illustrate this posi. tion. Some four years ago I was called to examine the body of a young woman avIio Avas said to have committed suicide by the self-administration of a solution of carbohc acid. On arriving at the room wrhere the body lay, I found it lying on the bed covered only with a sheet; the eyes were closed, there was no perceptible respiration, and I could not disco\*er any pulsation at the wrist, though it must be admitted that I did not make n, very careful examination at the moment, inasmuch as I was informed by the person present that death had occurred more than half an hour pre- vious to my arrival, and I Avas making inquiries as to the circumstances DEATH IN ITS MEDICO-LEGAL ASPECTS. 89 of the case. The body was cool but not cold—a condition not one to attract attention at so early a period after death. After a short conver- sation with the attendant, during wliich I found that the drug had been taken early in the morning, and, owing to the suicide's having taken the entire contents of a two-ounce vial of the solution, the strength of the solution could not be ascertained, and thereby a conclusion formed as to the actual amount of acid taken, I had occasion to repeat a question in an unusually loud tone at a moment when I chanced to be looking at the body. I noticed a shght movement about the eyelids, and on addressing the assumed dead person by her Christian name*, perceived an attempt to raise the lids. Although the physician who was first summoned to the case had some hours before pronounced the woman to be in articulo mortis, and had prognosticated death within a few minutes, I succeeded after a long time in getting animation so far restored that in spite of her objection I administered an antidote, and eventually secured her removal to a hospital, where she recovered without even a sign of gastritis. I am quite sure that had I, in the first place, instead of assuming that death was present, applied my stethoscope to the lungs, I should have found ample evidence that life was not extinct. It is quite probable that the woman might have eventually recovered wdthout medical assistance, as from the subsequent history of the case it is improbable that a large amount of the acid was swallowed; but at all events, she had taken enough to reduce her to a condition where all the more common appear- ances of systemic life Avere obscured. Another case was the following: In the winter months, seven years ago, a young unmarried Avoman was a patient at the lying-in hospital. When in the month of January she Avas discharged, from fear of the re- ception she would meet at home, where her condition had not been known, she strove ineffectually to place the illegitimate child in some one of the public institutions. She then, according to her own statement, reasoning that if the child was found exposed in a public place it would be taken to one of these institutions and its reception there follow as a matter of course, placed the child, with such clothing as wras furnished at the hospital, in a basket, and placed it in an alley near a platform erected for the reception of goods into the rear entrance of a store on a principal street. Her idea as to its being immediately found Avas falla- cious, for the child was deposited in the afternoon of Saturday, at a time Avhen there chanced to be no teams sent to this place. The child re- mained in this alley tiU the afternoon of the following da}7, there having meanAvhile occurred a severe snoAvstorm. It was then discovered by a policeman, avIio, on examination, decided that it was dead, and it was taken to the rooms of a neighboring undertaker, instead of being taken to the morgue, as was the usual custom. After the body had remained at the rooms of this undertaker for many hours I Avas called to examine the body. After talking Avith the undertaker and policeman in another room for a while, the attention of all Avas attracted by an unusual sound proceeding from the rear room. After an interval of two minutes the sound was repeated, and on inves- tigation it was found that the sound Avas the very faint cry of the supposed dead child. There was absolutely no pulse to be found. Respiration occurred at intervals of more than a minute, and auscul- tation shoAved the faint sound of the heart. Prompt and energetic 90 A SYSTEM OF LEGAL MEDICINE. measures, covering more than two hours, finally resulted in the complete resuscitation of the child. The babe was then taken to a public institu- tion, and subsequently placed in the charge of the mother, and lived for a period of months, though it eventually died of natural causes. In this case there can be no doubt that animation was so far suspended and the end of life so near, that had it not been for the chance placing of the child in a warm room instead of the morgue, which then Avas not warmer than the external air, life would have ceased altogether. It is reasonable to suppose that had an examination of the chest been made at the time of the discovery of the child it would have resulted in the failure to dem- onstrate respiratory movements, and even the beat of the heart might have escaped notice. Such cases as the foregoing, however, are of the rarest, and if attention is paid to the other signs of death there should be no occasion for doubt as to its actual presence. There was an additional sign present in the last case mentioned, namely, the coldness of the body, which emphasized the probability of the case being one of real death. This brings us to the consideration of one of the earliest signs of death, namely, change in temperature. Cooling of the Body.—As is Avell known, the normal temperature of the living body is 98.4° F., while in many forms of fever, such as typhoid and scarlet fever, the temperature rises to a very considerable degree, sometimes reaching the mark of 113° F. So, too, in cases of septicaemia the temperature will run up very rapidly at the approach of death, and a further rise has been noticed after death has occurred, even AA'hen the presence of death has been demonstrated by the unmistakable signs of decomposition, which supervenes Avith the greatest rapidity after death from this cause. In ordinary cases of death from disease the loss of the natural temper- ature of the body takes place with a rapidity proportioned to the sur- rounding media. If a body remains in a Avarm room and is covered with clothing, the cooling is somewhat retarded, while if exposed to the air of a cool room, especially if there be a current of air passing through the room, it cools with great rapidity. A body which has remained in water, as after death by drowning, will also cool with great rapidity; on the other hand, the bodies of those avIio haA*e died suddenly from shock, or from apoplexy, or of acute disease, cool Avith less rapidity, and as the temperature of the body approaches that of its surrounding media the cooling process is more slow. The experiments of Goodhart, as quoted by Taylor, showed that on the a Average the rate of cooling for the first three hours was 4° F. per hour; in the next six hours the rate was three degrees per hour; and at a later period, in excess of one degree per hour. The cooling of the body is a less certain sign of death than some others, because it allows of so many variations. As has been already stated, certain forms of disease and accident are foUowed by a comparatiA*ely slow loss of animal heat. Casper has fixed upon the average time of ten to twelve hours for the cooling of the body in ordinary cases, yet in cases of asphyxia, cases of submersion excepted, the cooling is more gradual; cases of asphyxia present great variation, hoAvever, some fatal cases being followed by complete cooling in the same time as in cases of death from natural causes, while in others the heat has been known to be retained for as long as forty-eight hours. In one case of death from septicemia, Avhere the temperature imme- DEATH IN ITS MEDICO-LEGAL ASPECTS. 91 diately before death reached 112° F., I found the viscera perceptibly warm at time of autopsy, something more than twenty-four hours after death. On the other hand, the bodies of persons who have died of chronic dis- eases, and where the death has been slow, cool Avith great rapidity, not more than four or five hours being required to reduce the temperature to that of a body which had died under other circumstances, and Avhich had required nearly a day to cool. The body in such cases manifests a decided lowering of the temperature, especially that of the extremities, for a considerable time before death. The fact is, that under similar circumstances the dead human body cools practically like any other mass of animal matter. The body of a child will cool more rapidly than of an adult, that of a thin person than that of a fat one, and, as before stated, an exposed body than one invested with wrappings. Although the time that a body will take to cool may form an impor- tant element in a capital trial, the opinion of the medical jurist should be given with a large degree of caution, and with a careful review of all the facts of the case as indicated in the essential particulars enumerated above. This caution is emphasized by the cases and experiments reported in the Avorks of writers on this subject, notably those of Tidy and Ogston. The former author cites M. Laborde in demonstration of the fact that in five to eight hours the temperature of the deeper tissues falls to 80.6° to 82.4° F., while Dr. F. Niederkorn shows that in six cases taken in- differently the rectal temperature, taken six to eight hours after death, averged 90.6°, and in nine cases where the temperature was taken twelve to fourteen hours after death the rectal temperature Avas 89.2° F. The same authors quote the observations of Wilks and A. S. Taylor from Gnif s Hospital Reports, which show a decidedly lower average of the temperature at corresponding periods after death, the difference being something more than 11° F. for the first period (six to eight hours), and something more than eight degrees for the latter period (twelve hours or more). It is to be observed that the temperatures.taken by Drs. Wilks and Taylor were taken by simply applying the bulb to the abdomen, while those of Niederkorn (as stated by Tidy), were taken either in the axilla or rectum. The chief value of this sign of death, however, lies rather in the continuous and progressive cooling than in any absolute temperature. A case cited by Ogston corresponds with my observation in septicemic cases. He was called to inspect the body of a seaman who had died sud- denly from (as it proved) a sudden effusion of serum into the pleural -cavities, while suffering from scorbutus. He found the heat of the trunk and limbs little, if any, below the normal temperature, but on the next day putrefaction had so far advanced as to leave no doubt of the reality of death, the heat being greatest in the chest, where the decomposition was farthest advanced. At another time he was called to see the body of a lad who had died suddenly when apparently in good health and spirits. Perceiving that the lad was dead, he left the house, only to be recalled on the afternoon of the same day because of the belief of the mother that the lad was about to come to life again, inasmuch as the bodv did not become cold, there was no rigidity, and the color had re- turned to the cheeks. Dr. Ogston assured her that these phenomena were only those of rapidly approaching decomposition, which was fully developed on the next day. 92 A SYSTEM OF LEGAL MEDICINE. This return of color to the cheeks has been frequently observed in the bodies of those avIio, for the purpose of preservation, have been frozen by the undertaker and on the day of sepulture removed from the freez- ing mixture a feAV hours before the funeral rites. The return of a flush of color closely resembling the natural hue of life ensues and endures for a feAV hours, Avhen it passes Avith great rapidity into the dusky hue of decomposition. That there should be a rise of temperature to something like that of the surrounding atmosphere is of course natural, but it is claimed that it may rise, in consequence of this putrefactive change, even higher than that. From the facts stated above it Ayill be seen that the caution to be observed by the medical expert in giving an opin- ion as to the time Avliich has elapsed since death occurred should be, as before stated, A~ery considerable. Changes in the Eye.—Immediately after death the eye loses its luster in the great majority of cases, and, in addition to this loss of luster, the cornea becomes opaque, milky, and sensibly flattened, the globe having lost its normal tension, and, of course, there is no response to light by the pupil. I have said that this condition of the eye obtains in the ma- jority of cases, but in cases of death by carbonic acid and carbonic oxide,. cyanide of potash and hydrocyanic acid, I have seen this change in the eyeball wholly Avanting, or ATery long delayed. At this very writing I Avas called to view the body of a man who had in a fit of melancholia taken an indefinite quantity of cyanide of pot- ash in a public square and died within twenty minutes. Directly after death, and again two hours later, the eyeballs were prominent, staring, glistening, Avith the pupils Avidely dilated, and eighteen hours after death the same condition Avas present. There is also at the time of death a change in the color of the bodyr Avhich, Avith very few exceptions, such as in the cases of people witliA'ery florid complexions, becomes an ashy white. The exceptions above men- tioned rest on the statement of Casper. I have newer seen exceptions to the rapid pallor in cases of death, except in cases of death from burn- ing and some cases of suffocation. But while certain colors will dis- appear, such as the redness of scarlet fever, on the other hand the yellow of jaundice, the purple of ecchymosis, and the varied colors of tattooing remain. There is also at the time of death, or immediately thereafter, a general relaxation of the muscular system—the lower jaw drops, the joints are flexible, and the eyelids lose their tension; but although the tonicity of the muscles is lost, it is not the case Avith their contractility, inasmuch as they AAill respond for a certain time to electrical and other stimuli, and moreover muscles that are contracted by living force at the time of death, as in the case of poisoning by strychnine, do not necessarily be- come relaxed in death. According to Ogston, the persistence after death of the muscular contractibility in different parts of the body and its disappearance fol- lows a fixed order, the first parts to present this change being the neck and trunk, next the lower extremities, and lastly the upper, Avhile its departure follows the same order. The duration of this phenomenon is shortened by its exposure to warmth and moisture, and to ammoniacal, carbonic, and sulpliureted hydrogen gases; it is unaffected by carbureted hydrogen, hydrogen, and DEATH IN ITS MEDICO-LEGAL ASPECTS. 93 sulphurous acid gases, nor is it diminished in cases of asphyxia. It has been found, however, that the continuance of this property of muscular fiber is considerably modified by the nature of the disease of which the person died. _ Experiments show that it disappeared from the muscles in cases of peritonitis in three hours; in phthisis, schirrus, and cancer, in three to six hours; in death from mortal lesions of the heart or profuse hemorrhage, in about nine hours; in apoplexy with paralysis, in about twelve hours; and in adynamic fevers and pneumonia, in from ten to fifteen hours. (Ogston, Lecture XXV.) So far as the signs of death which have thus far been mentioned (namely, the cessation of respiration and circulation, the loss of the luster of the eye, the pallor of the surface, the relaxation of the muscles, the loss of animal heat, and the loss of muscular contractility) indicate the period of death, it is practically agreed by all Avriters on this subject that a body in which ah these phenomena have occurred has been dead for a period of from ten to twelve hours at the longest, provided there are no other changes to be noticed. Succeeding the changes just mentioned, and preceding the commence- ment of decomposition, are certain other changes originating in the physical alteration in the soft solids. Softening or want of elasticity of the tissues of the body, which comes in evidence soon after death, is the first of the changes result- ing from the destruction of their physical properties. The parts of the body on Avhich it rests Avill be flattened, and the skin will present the marks of any peculiar figure upon which it has been lying, as for instance the grating of a dissecting-table, and the skin and muscles do not resume their original condition upon the removal of the pressure which, either by the Aveight of the body itself or from external sources, has been applied to the parts Avhich show this loss of elasticity. This flattening of the dependent parts has been considered a valuable indication of the reality of death. Rigor Mortis.—At the disappearance, or often a little before the disappearance, of the softening just described, comes another sign, that is, the appearance of an opposite state of the limbs and joints, Avhich is knoAvn as cadaveric rigidity, or rigor mortis. The body becomes rigid, and is incapable of contraction. The muscles acquire a brawny firmness, and it requires considerable force to move the joints from the position which they have assumed. This phenomenon is not an active process, but the limbs become, as it were, fixed in the position which they had when this change occurred. This cadaveric rigidity affects not alone the external muscles, such as those of the jaAv and limbs, but also is to be demonstrated in the internal organs, especially in the left ventricle of the heart. The duration of this state is variable. It usually disappears Avith the approach of putrefaction, but I have seen it present after the abdomen has assumed the greenish color characteristic of that condition. The portions of the body to be consecutively affected by this change follow practically the same order as that mentioned in regard to muscu- lar contractibihty. It is first noticed in the lower jaw, where it is always most pronounced, and where the greatest force is required to overcome its effects, and where it persists the longest, according to my own experi- ence, though I am aware that this observation does not coincide with the observations of some other writers. It next appears in the neck and 94 A SYSTEM OF LEGAL MEDICINE. trunk, then in the lower extremities, and lastly in the upper extremities. When it is once gone it does not return, but gives place to a softening of a kind different from that previously mentioned, which is not only more marked, but proceeds to complete putrescence. The early appearance of cadaveric rigidity is modified to a certain degree by the causes operating immediately before death. Under the action of strychnine and those alkaloids which cause death by convul- sions, the more violent and frequent the convulsions the sooner the rigidity sets in. It seems to be accelerated by whatever exhausts the muscular irritabihty before death. In cases of death from exhaustion or from septica?mia it has been observed that rigidity sets in early and passes away quickly, and is very speedily followed by putrefaction. While the time of its appearance varies considerably in different cases, in some being noticed as early as eight to ten hours after death, and in others being delayed for more* than thirty hours, and while in some cases its coming and going is so speedy as to leave a doubt whether it occurred at all, as in death from lightning, it is fair to state that the mean time of its occurrence is from ten to tAvelve hours. Two cases illustrative of this long duration of post-mortem rigidity are these. A man died suddenly of organic disease of the heart in late September. On the exhumation of the body eight weeks later there was marked rigidity of the loAver extremities—so marked that the body could be carried from one room to another by power applied to shoulders and feet only. The rigidity had, however, Avholly disappeared from the arms, but was present in the lower jaw. The arm of a mutilated body was recovered from a river in which the arm had lain long enough to have the skin of the hand quite macerated, and after its removal was kept without preservatives for a period of at least two days before being examined by the deputy-coroner of the dis- trict. At time of examination the death rigidity was very pronounced in the elboAv-joint. A case like this must be considered as quite excep- tional. It is also to be borne in mind, in regard to the former case, that the loss of rigidity noticed in the arms while it was present elsewhere may have been due to the forcible flexing of the joints in dressing the corpse shortly before burial. The duration of the rigidity is also subject to considerable ATariation. Generally it lasts from twenty-four to thirty-six hours, Avhile it has been knoAvn to last for several days. Cold favors the continuance of this con- dition, as does also previous vigorous constitution, and in cases of death from accident or violence its duration is prolonged. Its duration is less in the young and those in advanced life. It is said, as before mentioned, that in cases of death from lightning the rigidity is but little marked. I have seen but one case of death from lightning, and though the deceased was a child of but five years, the rigidity, though not strongly marked, was still undoubted. Various explanations of this condition of rigidity have been offered by physiologists and writers on legal medicine—such, for instance, as the coagulation of a proteid in the muscle-plasma giving rise to the so-called mvosine—but though its seat is undoubtedly the muscular system, it cannot be said that any of the theories advanced are wholly satisfactory. The importance of bearing in mind the fact that this condition affects internal organs is demonstrated by the mistakes not infrequently made DEATH IN ITS MEDICO-LEGAL ASPECTS. 95, of attributing certain appearances, such as a seeming thickening of the left ventricle, to pathological change during life, when the appearance Avas wholly due to the presence of post-mortem rigidity. Casper states that after death from narcotic poisoning this rigidity either does not occur, or is of so short duration that at the usual time when such bodies are received by the medical jurist for observation no trace of it is found. This does not correspond with my observation. Indeed, within the last sixty days I have had opportunity to examine the bodies of two persons, both cases of suicide by laudanum, where the rigor mortis was quite pronounced at the time of autopsy, more than twenty-four hours after death. I find that my observations in this re- spect are in accord with those of Tidy. When a joint stiff from rigor mortis is forcibly bent, the stiffness does not return, and this may distinguish real death from certain cases of supposed trance, from cases of catalepsy, and from the rigidity of tetanus or poisoning by strychnine, and some other poisons. There are seAreral so-called tests of minor importance which should be mentioned here, although if the signs already mentioned are present there should be no doubt as to the reality of death, inasmuch as the tests themselves are rather tests of the cessation of the circulation than of anything more. The first of these tests is to note Avhether, after making an incision in the body, blood flows, especially if it flows in jets instead of a continuous dribbling. A dead body does not bleed in the ordinary sense of the word. It is said that bright steel needles inserted anywhere in the skin will be found free from rust even after some hours; but as this test depends on the condition of the body as to cooling and moisture, it is not trustworthy. Another test is the attempt to produce vesication by heat or blistering fluids, it being assumed that as the formation of a blister is a vital process, it could not occur after death; yet as a matter of fact it has been found possible to produce a certain kind of blister upon the skins of young persons shortly after death. Another test is the observation of the translucency of the fingers and hands. If the hand of a living person, especially if young and in good health, be held in front of a bright light with the fingers closely approximated, there will be observed a pinkish red, almost translucent appearance, while after death the hands become opaque. Yet in demonstrating this test to a class of students, the subject being a girl in whom the unmistakable signs of death were present, I found that the hand was still translucent, and that the pinkish color at the edge of the approximated fingers was quite demonstrable. This case, however, is very exceptional. Another test is the production of local congestion by obstructing the flow of the current of blood, as, for instance, by tying a string around the finger. The usual phenomena of swelling and purple discoloration will not follow this constriction m the dead bod v. Ogston calls attention to a form of cadaveric rigidity which I believe to occur, though I have never chanced to see an instance. It is what is called cadaveric spasm. It consists in a sort of spasmodic contraction Avhich is assumed by the muscles at the instant of or immediately before death, and which is retained for some hours after death, then passing into true rigor mortis. It has usually been observed in forms of sud- den or violent death, but it has also been known to occur after death by pneumonia and pulmonary apoplexy. Ogston, in addition to mentioning 9G A SYSTEM OF LEGAL MEDICINE. eleven cases AA'hich came under his observation, cites a striking example of this kind of rigidity which occurred at the battle of Balaklava. Cap- tain Nolan, while riding in the advance of the cavalry, had his chest torn open by a shell from the Russian battery. The arm Avhich he was wav- ing in the air at the time remained uplifted, and he retained his seat upon his horse, which wheeled round and retreated; the rider gave a death-shriek, and passed through the ranks in the same attitude before dropping from the saddle. Inasmuch as the hand of a dead person cannot be made to grasp a weapon, it is of importance to bear the possibility of this kind of spasm in mind, as suicide Avould be indicated where the weapon Avas found grasped in the hands of a corpse. On the other hand, the finding of clothing, or fragments thereof, or hairs grasped in the hand after death may form an important part of a trial for murder. It is to be noted in this connection that after death from strychnine, as mentioned before, the rigidity, if forcibly broken down, returns after a time, while in other forms of tetanic spasm it is believed to disappear shortly after death. I have observed this return of rigidity after forcible flexion in the case of a man who had partaken of some cheese which had been plentifully covered with strychnine for the purpose of poisoning rats, and who had died from asphyxia from the spasmodic fixing of the muscles concerned in respiration. But in the case of a middle-aged Avoman avIio had pre- pared a fatal dose for her husband and had by mistake taken it herself, and who died from exhaustion, this phenomenon Avas not to be produced. Indeed, the former case Avas the only one of many cases of strychnine poisoning in which I have noticed a return of rigidity Avhen it was once broken doAvn after death. As an indication of the period at which death has occurred, the pres- ence of rigor mortis, in addition to the signs previously mentioned, and without other signs to be mentioned hereafter, the presumption is, ac- cording to Casper, that the person has been dead within from two to three days at the longest, Soon after death, sometimes within an hour, and generally within twelve hours, there are to be noticed upon the exterior of the body cer- tain changes in color due to the gravitation of the blood in the capillaries. These lividities are usually found upon the under or dependent portions of the body. If the body has chanced to remain upon the face and ab- domen, it is upon those surfaces that the color changes are found. The color varies from a light pinkish tinge to a deep purple, and not infre- quently these purple discolorations are mistaken by the inexperienced, especially by friends and relatives of the deceased, for marks of violence inflicted during life. If the body has rested upon the back, the lividities Avill be found there, except at the points wdiere the pressure caused by the weight of the body has been greatest. Here the skin Avill have its usual pallor. There is an appearance similar to this which I have observed in the cases of the droAvned which have been exposed to extreme cold imme- diately before and after death. I had occasion to examine the bodies of four sailors who were wrecked off a ledge at the entrance to Bos- ton Harbor. The cold and the action of the waves dashing the bodies against the shore had so flattened them they bore a grotesque resem- blance to the cakes in a pastry-cook's shop made and baked in the form DEATH IN ITS MEDICO-LEGAL ASPECTS. 97 of a human being. All these bodies Avere of a rosy pink color over their entire surface. This was probably nothing more than a frost erythema, but it Avas very much more marked than I have observed in the cases of those who Avere frozen in squalid rooms on land. Again, I have noticed the same appearance in the bodies of those who have died of poisoning by illuminating-gas, especially in those who have inspired the mixed form of gas Avhich contains a large proportion of so- called Avater-gas, where the percentage of carbonic oxide is very high. In these cases there Avas not only the bright scarlet color of the blood and muscles and internal organs, but a decided pinkish tint to be seen all over the surface. This color in the cases of those poisoned by this gas is much modified, and in some cases largely wanting, if the patient has received very energetic treatment before death, especially if the person has had a large amount of pure oxygen administered. There need be no necessity for confounding these conditions of color if attention is paid to the location of the change. The post-mortem hypostases are to be found in the dependent parts chiefly, Avhile frost and carbonic oxide affects the color of the whole surface, the superior quite as strongly as the inferior. Hypostases are easily differentiated from ecchymoses, or bruises in- flicted during life, by comparing the results of an incision in the dis- colored parts. No cut in a post-mortem lividity will e\Ter give A'ent to fluid or coagulated blood; there will be at most a feAV reddish points; Avhile an incision into an ecchymosis discloses immediately the true blood effused into the tissues. There is a wide difference of opinion as to the value of these hypos- tases as an indication of the reality of death. Casper puts it tersely: u They are of themselves a sufficient indication of death." Ogston, on the other hand, maintains that, Avhile of importance, they are not much to be trusted as indications of the reality of death, on account of their liability to be confounded with marks produced before death. He claims that the term " hypostases " is incorrect, as they occur not alone on the dependent but on the non-dependent portions of the body as avcII ; nor are they to be termed cadaveric, as they may be observed in certain in- stances upon the living. My OAvn experience leads me to doubt if they are ever found to the extent upon the liAdng Avhich they are upon the dead. They generally are to be seen covering the larger portion of the dependent parts, the exceptions being, as before stated, Avhere certain portions have been subjected to pressure, and ca-cii here they may be noticed after a time if the pressure be removed. Neither have I observed on the non-dependent portions of the body any considerable patches Avhich in character and size could be considered as lividities from settling of the blood. Even Avhere small patches of this sort are to be found on the limbs of the aged, and in typhus and other adynamic diseases, it is a question if they do not indicate a possible putrefactive change locally. BelieAdng as I 'do that this settling of the blood is the immediate pre- cursor if not the initial process of decomposition, it seems to me that the presence of these lividities is a very strong indication of the reality of death. It may be Avell to wait for a' little while to observe the extent of the lividities, for often at the outset of the process they are in irregular patches small in extent; but after a few hours it would seem impos- sible for a careful observer to confound these AArith the result of a vital 98 A SYSTEM OF LEGAL MEDICINE. process, such, for instance, as the effects of flogging,_where there would be presented on incision the appearances characteristic of ecchymoses. These hypostases occur not only externally, but also in the internal organs, especially in the brain, the lungs, the kidneys, the intestines, and the spinal cord. In the brain the condition is noted by an overloading of the posterior portion, marked by a fullness of the veins of the pia mater, and is to be found even in cases of anaunia or hemorrhage. This is to be observed chiefly where the body rests, as is usually the case, upon the back. Ex- periments have shown that where this change does not take place soon after death it is quite doubtful if it can be artificially produced. Care should be used to avoid confounding this condition of the veins of the posterior hemisphere with the pathological condition of cerebral hyper- emia, Avhich is more general in location rather than restricted to the posterior portion. In the lungs these hypostases occur oftenest. They manifest them- selves at a much earlier period than is usually stated; indeed, in the old and feeble there is a process very like it during life, OAving to the extreme feebleness of the circulation; but after death, inasmuch as the lungs generally have a large amount of blood in their vessels, this fluid gravi- tates Avith considerable rapidity. An incision into the posterior portion of these organs, if the body has rested on the back, sIioavs marked over- loading even in a lung otherwise generally ana?mic. This condition is very readily confounded with an ante-mortem congestion, especially as there is often more or less oedema present at the same time. In the intestines the line of demarcation of the portions colored by settling of the blood is quite pronounced, whereas in a case of inflamma- tion the color would not only be brighter and show the ramiform in- jection of the blood-vessels typical of that process, but would also be continuous. The color of an inflammatory process in the kidneys, for instance, would be continuous, while in the simple condition of post- mortem change in the intestines, if the convolutions be pulled forward, the breaks in color which distinguish hypostases from inflammatory process are readily distinguishable. The same remarks which have been made in regard to post-mortem congestion of the posterior hemispheres apply to the hypostases of the spinal cord, and great care should be exercised by the medical expert that he may not confound what is merely a cadaveric change with what he might suppose to be a vital inflammatory process. In this connection it is Avell to mention that while the heart does not present hypostases, certain changes take place in the contents of the caA'ities, namely, the coagulation of the blood and the formation of either red or white clots, the so-called cardiac polypi. These clots are sometimes formed, in a case of slow death, before life is extinct; but usually they are formed after death, during the cooling of the body. Moreover, the ante- mortem clots are more difficult of removal, because they are mixed up with the chorda? tendinea?, etc., while the post-mortem clots are loose, and simply assume the shape of the caAdties. The establishment of the fact of the coagulation of the blood after death has a bearing upon the question of the formation of ecchymoses. It AATas formerly held that the presence of an ecchymosis upon a dead body Avas e\ddence that the vio- lence which caused it must have been inflicted during life; but iioav it is DEATH IN ITS MEDICO-LEGAL ASPECTS. 99 knoAvn that violence inflicted upon a body after hfe is extinct, but before it has cooled, may present the same appearances as it would if the injury were done during life. Although generally the blood remains fluid for a considerable period after death from suffocation and from droAvning and from other forms of asphyxia, I have found it in many cases coagulated even in the right auricle. Putrefaction.—The last change Avhich takes place in the body after death begins Avith the occurrence of putrefaction, Avhere chemical changes take place in the human body as in any other kind of dead animal mat- ter, and where offensive gases are evolved. After a longer or shorter time the whole organic mass is changed to inorganic matter, chiefly water, ammonia, and carbonic acid, and in the transition stage compounds of nitrogen, sulphur, carbon, and hydrogen are evolved. Generally speaking, this change' succeeds upon the disappearance of cadaveric rigidity; but, as said before, I have observed cases where the putrefactive process Avas demonstrated by the discoloration of the loAver portion of the abdomen, while the death rigidity had not wholly passed There is some variation as to the region of the body primarily affected by putrefaction. In cases of drowning, as wiU be seen later Avhen dis- cussing that mode of death, it generally manifests itself first upon the head, neck, and upper portions of the body; in other cases it usually is first noticed as a green or greenish-yellow discoloration of the abdomen, accompanied by great tumidity thereof, and of the scrotum, penis and labia. Subsequently this discoloration is to be observed upon the face and neck, and lastly upon the legs and arms. A somewhat striking instance of the manner in which the loose connective tissues are affected bv this process of decomposition was observed by me in the early part of the present vear. The body of a person who had been in the water, as was afterward proved, several weeks was presented for inspection. On the afternoon of the day when the body was first observed there Avas noted the marked advance of decomposition about the head and neck while the rest of the bodv was quite free from the appearances caused bv putrefaction. The retraction of the penis commonly observed in cases'of drowning was noted. On the folic wing day, as the body Avas uncovered for purpose of autopsy, it was noted that the penis had assumed a position of semi-erection, and was of nearly the same size as it would have shown in erection during life. Of course, here the change was wholly due to the action of the gases of decomposition. Ogston states that the discoloration of putrefaction usually commences af the center of the bellv and extends toward the groins. I doubt if any ocneral rule can be laid down as to this order. My own experience has been just the reverse. The greenish color has manifested itself at the groins first, and thence extended to other regions. As Ogston was a careful observer with large opportunities, I believe that it is safest to as- sume that it may begin anywhere on the abdomen, with no regular order of procedure. „, . . . * x- -n In certain forms of death the evidence of beginning putrefaction will be found in other regions than the abdomen. Take, for instance, cases of death from septicaemia. There I believe it to be the rule that unless there is some special means used to retard putrefaction, decomposition will be first evidenced by the purple color of the superficial veins, which 100 A SYSTEM OF LEGAL MEDICINE. Avill be quite distinctly mapped out on the surface of the arms, neck, and shoulders. Some stress has been laid upon the order of the appearance of these signs of putrefaction as a test for discriminating bodies which have begun to decay in the Avater from those which began to decay in the air or earth. Casper and Devergie hold this opinion, and it accords Avith most of the observations made by me; and when Ave consider Avhat especially favors decomposition, there seems good ground for believing that the bodies of the droAvned should show the marks of putrefaction most strongly, as Avell as earliest, in the upper regions of the body, inas- much as the things that chiefly favor decomposition are moisture and heat; and as Ave shall see Avhen treating of death from droAvning, in that form of death usually the head, chest, and upper part of the body are much overloaded with blood. But I have noted one case which coin- cides Avith Ogston's experience, having met the green discoloration of the body in a ease of death by droAvning before1 it appeared on the chest. I had occasion some ten years ago to examine the body of an elderly man who Avas found in the Avater just Avithin reach of high tide, in Boston Harbor. The man had been missing but a short time, less than thirty hours, before the discovery of the body. The clothing Avas thoroughly Avet, and the usual appearances of a body AA'hich had lain in the Avater, such as corrugation of the skin of the hands, etc., Avere observed. There were many things in the history of the man's recent past Avhich would Avarrant an opinion of death from suicide, and that the method Avas submersion : but there Avas no sign of putrefaction about the head or chest. A mod- erate amount of rigor was present in the lower limbs, and the loAver region of the abdomen from the groins nearly to the umbilicus Avas of a green color. The section of the body, hoAvever, shoAved clearly the presence of water in the lungs and stomach, a moderate congestion of the solid vis- cera, and an overloading of the right side of the heart, and no other cause of death. Undoubtedly the appearances in this case Avere modified by the fact that the man Avas feeble and had simply lain doAvn in shalloAv Avater, and had died from asphyxia without making any struggle. The pressure of the gases evolved in putrefaction is A*ery considerable, and is not only sufficient to account for the escape of the contents of the alimentary canal, but for more pronounced phenomena, such as the bursting of the coffin after inhumation, and for changes of position in the dead, Avhich have been attributed to the terrible struggles of the prematurely interred. I observed during the intensely hot summer of 1SS7 a striking instance in point, The body was that of a very large and fat Avoman, who Avas a laundress. She lived and worked alone in an upper room of a house in the crowded part of the city, where she was exposed to all the intensity of the summer heat in addition to that of her own stove, heated for the purpose of her occupation. Her absence was not noticed till the second day, as she had no family. The ther- mometer had registered for those forty-eight hours from 85° F. to 92° F. When the body Avas found, it Avas swollen to a third more than its natu- ral size. The tongue Avas black and protruding from the mouth, and the large intestine Avas inverted like a glove and protruding for nearlv two feet of its length from the anus, Avhile the Avhole of the exposed parts of the body Avere coA'ered by thousands of larva?. The effect of these same gases is also to be observed in the Aoav of blood from the wounds made on the bodies of the drowned bv the ravages DEATH IN ITS MEDICO-LEGAL ASPECTS. 101 of marine animals. From the effects of these putrid gases upon the face, there may be such a change in the features as to render an identification of the body by the physiognomy a difficult if not an impossible matter. The decomposition of the upper regions of the bodies of the drowned, after removal from the Avater and exposure to the ah-, proceeds with the greatest rapidity. Features which Avere quite distinct at the time of the recovery of the body may become quite unrecognizable after the lapse of twenty-four hours in the summer. There is also a change in the color first observed as a sign of decom- position. The red of the superficial veins Avill change to a brownish black, and the green color of the abdomen and other parts of the body changes to a brown and even to a black. Simultaneously Avith the changes produced externally by putrefaction are changes in the appearances of the A'iscera, The mucosa of the larynx and the bowels present discolorations which might be mistaken for the signs of poison or disease. The mucous membrane of the stomach pre- sents Aarious tints: a reddish broAvn, a livid purple, or, more commonly, if observed a considerable time after death, a slate color. This slate color is particularly noticeable in the brain Avhere the bodies are examined within a week or ten days after death, pro Added no means have been used to retard decomposition. It is by no means easy for the medical jurist ahvays to distinguish between the effects of poison and the effects of decomposition by mere inspection. In both cases there will be redness, and this more or less circumscribed; and an additional element of doubt is presented when the possibility of the action of the digestive fluids themselves is consid- ered. Taylor lays doAvn the rule that the change has taken place during life if it is met in an examination soon after death; yet I have seen many cases Avhere the stomach presented a redness suspiciously like that caused by irritant poison, Avhen death had occurred from natural causes soon after the ingestion of food. When the redness is accompanied by effusion of coagulated blood, mucus, or the effects of ulceration, corrosion, or destruction of the coats of the stomach, we may assume that it Avas the result of a vital process. In such cases, if there be doubt, the Ayell- knoAvn effects of irritant poisons upon other organs, notably the liver and kidneys, should help the solution of the problem, and at all events a properly made chemical analysis of the viscera should absolutely deter- mine the question. A delay in expressing an opinion till the facts are definitely ascertained can do no possible harm, while the opposite course might involve the plivsician in an awkward dilemma at a later period. Another point, which will be of service in the differential diagnosis of irritant poisoning during life, and the reddening of the mucous mem- brane of the stomach after death, is that this redness will be observed in all the other viscera as well. It is especially noticeable in the mem- branes which naturally have no color. The deep staining of the aorta and of the respiratory canals is an instance in point. It is true, however, that Trouseau and Roget succeeded in producing the appearances of true inflammation upon the bodies of the dead, so far as these appearances consisted in the injection of the vessels rather than the general dyeing of the parts. As a consequence of the progress of putrefaction the blood becomes fluid, and the action of the gases may change its position to the extent 102 A SYSTEM OF LEGAL MEDICINE. that it may be forced from the cavities of the heart, AA'here it was in large quantity at the time of death. It is propelled toward the cap- illaries, and gives to the external portions of the bodies, seen some Aveeks after death, a diffuse redness differing from the early post-mortem dis- coloration; and this redness is accompanied by a looseness of the cuticle, which presents a sort of blistered appearance. Moreover, this discolor- ation affects the true skin, and the subcutaneous areolar tissue is bathed in reddish serum, and the back part of the scalp presents an appearance appropriately compared by Ogston to red-currant jelly. In the cases AA'hich I have observed I have found that the suggestions made by Ogston are of much value : namely, that, first, in post-mortem redness the color is limited to the course1 of the A'essels, Avhile in inflam- matory redness the parts around the vessels partake more or less of the coloration ; and second, that in inflammatory redness the color is usually limited to the inflamed membrane, AAhile in the redness from putrefaction the color peiwades the Avhole of the tissues of the part. It is true that aside from olwious changes, such as the presence of clots, tumors, or abscesses, the brain gives on examination very little that is of absolute diagnostic value, especially in the matter of differentiating between inflammatory and putrefactiA'e alteration. There is something in faA'or of the assumption of inflammatory change if the appearances are found at the superior portion of the brain instead of at the base, Avhere, if the body has remained in the usual position, there Avould be likely to be, from ob\dous conditions, the greatest amount of coloration in a location provided Avith the material favoring a more rapid decom- position and color change. If an individual tract of the mucous membrane of the larynx be alone considered, there might be difficulty, as Casper has pointed out, in dis- tinguishing between the effects of a laryngitis and a post-mortem stain- ing, or the effects produced in death by drowning. After all, attention to the collateral appearances and the history of the case should ordinarily be sufficient to determine the question. The fact that the contents of the gall-bladder may transude through the coats of the duodenum and ca'cu of the stomach, and thus present appearances simulating those produced by the swallowing of nitric acid during life, is not of great moment, inasmuch as the great changes necessarily produced in the mouth and oesophagus by swallowing acid would preA'ent any error ill diagnosis. Effusion of fluid into the cavities of the body is a further effect \>f putrefaction. The blood ferments, becomes full of bubbles, and is driven oiiAvard toAvard the capillaries, and ultimately to the place where it meets the least resistance. In the serous cavities wiU be found blood-tinged serum in greater or less quantity. The amount is usually less in the peritoneal cavity than in the pleural. The odor is distinct, and the color bi-OAvnish red. This effusion is seldom met Avith in the earlier period after death, probably never during the first week—except in cases of death from heart disease Avith pulmonary oedema and cases of death from drowning—and usually not till after the lapse of several weeks. Parts that have been affected with gangrene in the living and parts that have been the seat of severe injury putrefy more rapidly than those which have not, and post-mortem putrefaction may easily simulate the appearance of gangrene in the living. In such cases caution should be DEATH IN ITS MEDICO-LEGAL ASPECTS. 103 observed in giving an opinion. Testimony of those who have seen the condition of affairs in the person while alive Avould be conclusiA'e, and if no other part of the limb Avas in a state of putrefaction, the probabilities Avould favor the theory of gangrene during life ; but even then allowance should be made for the more rapid putrefaction of Avounded parts. Any confusion Avhich might arise as to the origin of the fluids found in the caA'ities of putrefied bodies will be avoided if attention be paid to the character of the fluid, its homogeneity, its freedom from pus, lymph, or false membranes, and its color, which is not so dark as that of putrefying blood. It does not seem necessary here to speak of the changes produced in the body after death by purely adventitious means, such as the Avounds made by the striking of the body against hard substances Avhile floating, or the ravages of marine animals, or the gnawing of squirrels or rats, which often leave Avell-defined marks of their attacks upon the bodies of those exposed in fields or eA'en in the dead-houses of cities. The rapidity with which decomposition occurs varies considerably, according to seA'eral factors which may obtain. It is favored by high temperature, by moisture, as exemplified in the eases of the dropsical and the decay of the upper portions of the bodies of the droAvned, by free access of ah*, absence of clothing, preAuous injuries, sudden death, acute diseases, especially those of a septic character, corpulence, and possibly by the cause of death having been poisonous gases or animal poisons. Whether prussic acid favors rapid decomposition, as claimed by some authors, or not, I cauuot say further than that in the few cases AA'hich have come under my personal observation there Avas no perceptible1 in- crease in the rapidity of decomposition Avithin the first three days, as compared with that of cases of death from other causes. On the other hand, decomposition will be retarded by Ioav temperature, or very high -temperature where the body has been thoroughly cooked and charred. Also profuse hemorrhages, wliich dimmish the amount of fluid in the body, tend to retard decomposition. Continued immersion in Avater and burial in a deep grave, by keeping the body at a Ioav tem- perature, also retard putrefaction, though the process of decomposition goes on with the greatest rapidity after the body has been remoA'ed from such surroundings. Burial soon after death, and burial in dry sand or earth and in dry, elevated ground, is said to retard decomposition. This does not correspond with my observations in a few cases of exhumation, neither does the claim that nitrogen gas and the residuum of air in air- tight coffins retard decomposition. Certain poisons, especially arsenic and alcohol, are claimed to render the body less liable to rapid putrefac- tion. I have found that the cases of death from acute and chronic alco- holic poisoning differ in rapidity of decomposition very little from those of death from other causes; if there has been a difference, it is that the bodies seem to decay with rather greater rapidity than the bodies of those where death has resulted from various natural causes, AA'hich seems only reasonable when the changes produced in the body by alcoholic narcosis are considered. I may say, in this connection, that the most rapid and repulsiA-e con- dition of putrefaction which I have seen, a case1 where the body was largely liquefied, was that of a man who had died of arsenic poisoning, where* the1 drug had been administered in pretty large doses for a period of several days, and where the body had been buried in dry, elevated soil in 104 A SYSTEM OF LEGAL MEDICINE. a nominally air-tight casket, and afterward exhumed and transported two days before examination. Of course, leanness—and old age, which favors leanness—(aside from dropsical conditions or corpulence), favors slow putrefaction by the absence of an excess of those fluids which naturally hasten this process. Since writing the above I have had occasion to ex- amine the bodv of a man exhumed after a burial of eight weeks. The cause of death was organic disease of the heart. This body was, in gen- eral, in a very good state of preservation. Chiefest to be noted were the large spots of mold upon the cheeks and chin and forehead, while the orbits were filled with a white fluffy mold presenting quite a contrast to the greenish tinge of the mold elsewhere. There were some vesicles as large as an English walnut upon the flanks, purplish in color and full of serum, but slightly tinged. The brain was quite soft, but preserved its form and permitted of sections with a thin, very sharp knife, and the different structures, as, for instance, the corpora striata, avci-c in condition to be fully examined. The heart, as would be expected of an_ organ which resists decay among the longest, admitted of clear discrimination between the effects'of post-mortem change1 and tie fatty infiltration which had occurred during life. The scalp was mummified, rendering its re- moval rather more difficult than usual; but all the organs were in a bet- ter state of preservation than I have seen, twenty-four hours after death, in many cases of septicaemia, where the body had been kept in a moder- ately cool room. Various forms of so-called embalming are supposed to prevent putre- factive changes. I have never had occasion to witness the condition of a body at any long period after the injection of the cavities or the arteries Avith the \-arious so-called preseiwatives, but in many cases I have noticed that putrefaction proceeded with unusual rapidity after this pro- cess, AA'hile in none have I seen any difference in the putrefactive change . betAveen the embalmed and non-embalmed during the usual period elapsing between death and burial. Of course, much may depend upon the kind of fluid and the skill of the operator; but as far as my own ex- perience goes, this process of embalming tends rather to the obscuring of signs of death from poisoning, and the pecuniary advantage of the undertaker, than to anything else. Any consideration of the subject of putrefaction would be incom- plete AAdthout allusion to a change which occasionally occurs at a long period after death, namely, the saponification of the body, or the forma- tion of adipocere. This change is wholly chemical, and consists in the union of the fatty acids with ammonia. It has been oftenest observed in bodies that have lain a long time in water or in very damp soil, wdiere moisture has continuously acted upon a putrefying corpse. There are some other conditions under which adipocere is formed, but the tAvo men- tioned are the only ones definitely knoAAm. Its formation to any consid- erable extent usually requires a long time, though it may begin to form at a rather early period. Casper cites the case of one child where adipocere Avas observed after the interval of only three weeks, and of another child AA'here it was noted after a period of only thirteen weeks; but usually a period of three to four months in the Avater, or of six months in moist earth, is required before this saponification occurs. It is not necessary that so long a period as many years should elapse before it is formed, as was at one time supposed. DEATH IN ITS MEDICO-LEGAL ASPECTS. 105 Adipocere is a fatty substance, generally of a yellow color, occasion- ally of a pure Avhite. It is unctuous or soapy, brittle, and soft to cut. It melts at different degrees of temperature, some requiring no more than 200° F. As it is due to the checking of the colliquative putrefaction, it occurs more readily in the bodies of fat people than in the lean, and children present the change more readily than do adults. In addition to the value of this condition as an indication of the length of time that has elapsed since death, it is of importance to bear in mind a fact to Avhich Glints has called attention, namely, that adipocere is always greater in A'olume than the total amount of fat preexisting in the body, and therefore in Aveighing the body of a neAv-born child for the purpose of ascertaining the age alloAvance must be made for the difference. This saponification of the body has also been termed mummification, but as true mummification is essentially different from the chemical pro- cess by AA'hich adipocere is formed, the terms should not be used as if in- terchangeable. True mummification consists in the rapid evaporation of the Avatery constituents of the body. This change is favored by A'ery high tempera- tures with great dryness of the atmosphere, and by atmospheric draught. In this dried state the soft parts are retained, and the features, though distorted, are preserved, and present a rusty broAvn color. The internal organs have partly disappeared, or are blended together so as not to be distinguished from one another, and they present an odor more hke cheese than that of a putrefying body. Whether occupation has any effect on the process is not known, in spite of the assertion of the First CIoavii in " Hamlet," that " a tanner Avill last you nine year." It must be admitted that his assertion that " your water is a sore decayer of your Avhoreson dead body" is confirmed by medico-legal observation. At all events, the value of the process of mummification to the medi- cal jurist is, as Casper says, practically confined to the question of the mummification of the umbilical cord in the neAv-born and the mummifi- cation occurring in bodies after arsenic poisoning. Chronological Order.—Though it doubtless is true that the medical jurist should ncA'er refuse to perform an autopsy, irrespective of the time that has elapsed after death, it is well to consider what the relative order of change is. in order that the probability of obtaining any satisfactory data, either as to the cause of death or any other ante-mortem conditions, may be properly estimated. It is well known that certain organs resist dec'av much longer than others; and in a body where there would be no possibility of determining whether the cause of death may have been natural, like typhoid-fever, or a poison, like hydrocyanic acid, it might still be possible to determine the sex by the discovery of a uterus or a prostate gland, or to determine the question of pregnancy in the female. Even in the bodies of those dead for a number of years, though pathological changes are no longer to be perceived, yet the remains may afford proof of the presence of some of the mineral poisons in the debris. Therefore the chronological order of the phenomena of putrefaction in the internal organs deserves especial attention. There is practically little difference among authors as to this order. First to present the changes of putrefaction are the trachea and larynx. Whether due to the access of atmospheric air or to imbibition, it is certain that in from 106 A SYSTEM OF LEGAL MEDICINE. three to five days in summer, and six to eight in winter, the trachea as- sumes in its mucosa a uniform dirty cherry-red or broAvnish-red discolor- ation without vascular injection. This color is to be differentiated from that bright color Avhich obtains in cases of death from asphyxia or from laryngitis. But in these cases both the history of the case and the period after death at which the examination is made will help to determine the question. As putrefaction goes on the mucous membrane becomes olive- green and the cartilages separate from one another, but months elapse before they disappear. Next in order come the brains of neAv-born children and those under one year of age. The contents of the cranium of these children are very soft, the access of air is easy, and they are not affected by those changes in consequence of modes of life wliich sometimes render the brains of adults more durable, as in the case of extensiA'e supplanting of cerebral matter witli connective tissue granulations, and their subsequent contrac- tion, Avhich is so often observed in the brains of chronic alcoholic subjects. The stomach putrefies at a very early period, generally in fiA'e to six days, the traces of the change1 being obseiwed in a dirty red color at the fundus, and this color is at first noted in isolated patches and on the posterior Avail, rapidly appearing afterward on the anterior, and then fading into a dirty gray with patches of black, Avhile later the coats become softened. Next in order of putrefaction are the intestines, and the changes occurring there1 are similar to those AA'hich haA'e been mentioned as happening in the stomach. The change caused by bile-staining has already been mentioned. The intestines eventually burst and discharge their contents, and finally become a pultaceous mass. The spleen is said to resist decay longer than the organs just men- tioned, but it is certain that it softens A'ery quickly, and especially in cases of septicemia. It softens AA'ith the greatest rapidity, and may become almost liquefied in some cases, while in others it assumes a steel- gray color with rather more consistency. If fairly free from fat, the mesentery and omentum resist putrefaction for a period of several weeks, but the process is someAvhat accelerated if they are very fat. In neAv-born children the liA'er begins to putrefy earlier than the liver of an adult, Avhich may be found pretty well preserved several Aveeks after death. I haA'e seen it in a fair state of preservation at a period six Aveeks after death. The convexity sIioavs the greenish change first, AA'hich eA'ent- ually pervades the Avhole organ, and as time passes the organ becomes more and more pultaceous. The gall-bladder remains for a much longer time recognizable. The brain of an adult shoAvs the change of putrefaction first at the base, and a greenish color pervades the whole organ; but the color is not so pronounced as elseAvhere, at all events at the earlier stages. The color is more of an ashy gray, and the brain retains this color eA'en after it has become A'ery soft, eA'en to the point of almost liquefaction. I haA'e never observed, as a result of putrefaction, the reddish pulpy condition Avhich is to be observed at a very early period in the brain of the neAv- born, although that such a condition may be found cannot be doubted, as it has been observed by many writers on the subject. The brains which have been seen by me Avhen they had arrived at a condition of putrefaction haA'e been cases examined, at the farthest, three months DEATH IN ITS MEDICO-LEGAL ASPECTS. 107 after death. These were uniformly gray and soft, some even to lique- faction ; and I admit that it does not seem clear to me AA'here these partic- ular brains were to get the tinge of red at any subsequent period, Avhich Casper says putrefying brains do months after death. The heart and lungs begin to putrefy at pretty nearly the same time. The heart will be found empty of blood and someAvhat shriA'eled, the peri- cardial fluid Avill haA'e evaporated, but still the heart muscle will be clearly recognizable, and, in general, permitting, months after death, and long after the other organs mentioned have passed beyond recognition, a pretty good idea to be formed as to any pathological change. The same is true, in a measure, of the lungs. The structure may be demonstrable, and a differentiation between gray hepatization and putrefactive change may be possible many Aveeks after death. The diaphragm is a muscular structure like the heart, capable of resisting decay for a long time; but the organ which presents the greatest resistance to putrefactive change is the uterus. This will be found intact after the destruction of the external genitals. Casper cites a case of an adult AA'hose body Avas in a very advanced state of putrefaction, and wliich had lain in a privy A'ault, a condition favoring rapid decomposition, for nearly ten months, AA'here the uterus was of a bright red color, firm to feel and cut, its form per- fectly nortnaband recognizable. Though I do not find it mentioned by any AA'riter, and have not had opportunity to make any observation in the matter myself, it is probable that the prostate gland, also, like the heart and uterus, long resists decay, a not unnatural conclusion AA'hen its dense structure is considered. Its examination at a late period after death Avould only have a medico-legal value AA'here it was necessary to determine the sex in a mutilated body. In conclusion, it is worth AA'hile to present a resume of periods at Avhich some idea of the time that has elapsed since death may be gained from external inspection, as stated by Casper. (1) The greenish discoloration of'the abdomen and the softening of the eyeballs indicate that the person has been dead from twenty-four to seA'entv-two hours. (2)' After three to five days the green discoloration has become deeper, and has extended over the entire abdomen, including the genitals; AA'hile similar patches have begun to appear on" other parts, especially the back, loAver extremities, neck, and sides of the chest. (3) In about eight days the greenish patches have coalesced and ■changed to a reddish green, gaseous products have become developed in the abdomen, the cornea has become concave, the sphincter ani has re- laxed, and the ramifications of the subcutaneous veins can be traced on the neck, breast, and limbs. (4) After fourteen or twenty days, blisters have appeared upon the skin, and the development of gases has become general, distending the AA'hole body. (5) Lastly, after this period it is impossible to determine the date ot the decease. . . These data refer to bodies exposed to the atmosphere, and it is as- sumed that the mean temperature between summer and winter was main- tained. Of course, from what has been said, it Avill be understood that these data must be much modified bv a different condition of things; but as a general rule Casper holds that a body, after lying in the open air 108 A SYSTEM OF LEGAL MEDICINE. for a week (or a month) at a tolerably similar average temperature, cor- responds in its degree of putrefaction'to that of a body lying in the water twice as long, or after lying in the earth in the usual manner for a period eight times as long (eight Aveeks or months). DEATH BY SUFFOCATION. Death by suffocation is due to the complete arrest of the respiratory functions, and the consequent interruption of that exchange of the gases of the external air and the blood gases of the lungs which is necessary for the life of the individual, the object of respiration being to supply the oxygen necessary for tissue metabolism, and to remove the carbonic acid formed in the body. Suffocation is produced in two Avays—either mechanically, by dis- turbing or destroying the pulmonary mechanism, or dynamically, by depriving the blood of the influence of oxygen. The first class includes: (a) injury to the chest Avails, or prevention of their movement by crushing by weights, or pressure in crowds, or being buried alive in sand-pits, hay, etc., or by the faUing of walls of buildings; (&) any cause operating on the mouth and nose and throat externally, such as covering the face with bedclothes or plasters, or ex- ternal compression of the throat, or a cause operating on the throat, windpipe, and air-passage internally, such as blocking them up Avith food and plugs of various kinds. Disease itself may furnish another cause of suffocation, such as the complete obstruction of the larynx in diphtheria, oedema of the glottis, or acute laryngitis. The second class, AA'hich operates dynamically, includes the breathing of irrespirable and poisonous gases, though in the case of carbonic oxide and sulpliureted hydrogen poisoning the death is not due to asphyxia, but to the direct interference with the oxygen-carrying function of the blood-corpuscles. It will be proper first to consider the phenomena of asphyxia, which are usually divided into several stages. During the first there is hyperpncea, the respirations being more frequent and labored, the extraordinary muscles of inspiration and ex- piration being used. Next the condition of dyspnoea is rapidly produced. The oxygen of the blood is used up. The venous blood resulting circu- lates in the medulla, and causes violent respirations by stimulating the respiratory center. This stage usually lasts about one minute, and gives place to the second or conA-ulsive stage, in which the inspiratory muscles are less actiAre, but the expiratory muscles are very violently agitated and the whole muscular system becomes convulsed, the convulsions being due to the stimulation of the respiratory center by the Arenous blood. This stage is short, and is succeeded by the third stage, that of exhaus- tion, the respiratory centers being now paralyzed by the venous blood- Consciousness is abolished, the pupils of the eyes are Avidely dilated, the muscles flaccid, reflex acts are suspended, and the only signs of life are a few feeble inspiratory efforts at longer and longer intervals. At last, as the venous blood circulates in the spinal cord the extremities and trunk are extended, there is one last long gasp, and breathing entirely ceases. After this stage the heart becomes paralyzed, partly by over- DEATH IN ITS MEDICO-LEGAL ASPECTS. 109 distention and partly by the action of the venous blood on its walls, the pulse is imperceptible, and the heart stops a few seconds after the cessa- tion of respiration. The whole series of phenomena lasts from three to five minutes, the third stage being the longest. The post-mortem appearances in death from asphyxia are generally Avell marked. The right side of the heart, the pulmonary artery, the vena cava, and the veins of the neck are all engorged Avith*blood. The left side is comparatively empty. The blood is fluid and almost black, nearly all of the ha?moglobin being reduced, Avhile ordinary venous blood contains some oxyhemoglobin. The brain, liver, and Avails of the intes- tines and the kidneys are full of black fluid blood. The mucosa of the larynx and trachea are injected, and the lungs engorged with dark fluid blood. Such are the appearances in death from asphyxia from Avhatever cause. Let us iioav consider the appearances which are generally present in death from suffocation, and are especially characteristic of this form of death. In some cases of death by suffocation the post-mortem appearances may differ, inasmuch as the immediate cause of death may be something other than asphyxia. If the larynx is suddenly constricted or blocked, the death is A'ery sudden, and there is no time for the production of all the phenomena of asphyxia., inasmuch as the suddenness Avith Avhich the larynx and trachea sometimes become impervious causes such a shock as to result in a very speedy death, the neuro-paralysis of Casper. We have, therefore, to consider those cases by AA'hich shock has modified or shortened the mani- festations of death, and the alteration in the post-mortem appearances which are the consequence of this modification. The face may be pale or present a dusky violet tint, the e}-es are congested, Avith, sometimes, protruding eyeballs, the tongue is sometimes clenched between the teeth and protrudes, and is sometimes behind the teeth. The mucosa of the larynx and trachea are hiA'ariably injected. The lungs may or may not be congested, and sometimes, as quoted by Taylor, one lung may be con- gested and the other not. Tardieu says the lungs are of a reddish color, sometimes pale, not distended, and only congested posteriorly. One sig- nificant sign, especially in smothering, observed in the lungs is the pres- ence of small subpleural ecchymoses. They vary in size from a pin's point to a lentil, in number from five or six to a considerable number, and are due to small effusions of blood from ruptured bloodvessels. These ecchymoses are said, hoAvever, to be found in cases of death from asphyxia other than those by suffocation, though admittedly more fre- quent in the latter. (Legroux, Ann. d'Hygiene, 1878, vols. i. and ii.r pp. 174, 335.) They have also been seen in new-born children who have never breathed. HoAvever, Casper explains this point by saying that " should the exchange of gases necessary for the child's life, which takes place in the placenta, be interrupted by a separation of the placenta, or by pressure on the umbilical cord, or by the death of the mother, then the child makes instinctive respiratory movements in order to maintain this exchange, and so these congestions and ecchymoses are found to occur even in the uterus." These ecchymoses are seen in other parts than the A-isceral pleura?, and in one remarkable case of death by smoth- ering, Avhich happened in the writer's experience, the ecchymoses were scattered over the visceral pericardium, over the surface of the hver, and markedly over both kidneys as well as on the lungs. HO A SYSTEM OF LEGAL MEDICINE. Both Tardieu and Ogston noticed such ecchymoses on the surface of the neck, and Ogston has seen them on the thymus gland and pericra- nium. The more rapidly suffocation takes place, the more marked are these ecchymoses, and sometimes in addition to these signs there are rupt- ures of the air-cells and emphysematous patches on the anterior portion of the lungs. There is generally a little bloody, frothy mucus in the air-passages. It is obvious that as the appearances here described are also found in other forms of death we must not lay too much stress on any single one, but consider it as one point only in the determination of the cause of death. The presence of ecchymoses on the surface of the lungs would justify an opinion that death was due to suffocation in the absence of other signs, especially when it is remembered that they are most marked in the more rapid deaths from this cause. We may not find the heart greatly engorged with the black fluid blood of asphyxia, for in cases of sudden death from shock the organ may be flaccid and nearly empty, the action having ceased in diastole. In such cases the other organs would not be markedly hyperaemic. There are some external appearances seen in death from suffocation, though common also in death from convulsions, and these are the car- popedal contractions, the thumbs being strongly opposed and flexed, and the fingers flexed over them, and the toes showing similar contractions, Avith only, henvever, slight opposition of the great toes. After this form of death rigor mortis is said to be slight, or to rapidly pass off. In a terrible catastrophe AA'hich occurred in Sunderland in 1883, about two hundred children lost their lives by suffocation. By the accidental closing of a door, the children, pouring doAvn a staircase and pushed from behind, trampled on those in front, and the bodies were heaped up to a height of several feet, The same appearance Avas seen in each case, namely, a congested, puffy face, purple turgescence of the Aessels of the neck, closed eyelids, protruding eyeballs, pupils Avidely dilated, Avith bloody froth issuing from the nose and mouth, giving the appearance of great suffering and anxiety; yet after twenty-four hours much of this passed off, and the face appeared placid, Avith a slight smile as if in sleep. It is important to insist on the fact that Avhen the larynx itself is suddenly occluded or compressed, death occurs so quickly that the post- mortem appearances described above are not so pronounced. So far Ave haA'e described the post-mortem appearances in those cases where death has resulted from suffocation by mechanical interference with the principal organs of respiration, the lungs; for although the skin is classified as an organ of respiration by physiologists, yet in the annals of medical jurisprudence death by complete obstruction of the pores has never been recorded, There is one case quoted by Foster (Physiology), where an Italian boy was covered wdth gold-leaf to represent an angel, and died a few minutes after the whole body Avas enveloped, with the signs of asphyxia. The case of the children suffocated by crowding in a narrow stair- case, above quoted, is a good illustration of the signs observed after death from mechanical compression of the chest, with perhaps the addi- tional cause of vitiated air. Other instances are frequently seen, AA'here the Avails of a building have fallen, or where people have been buried under a load of hay or DEATH IN ITS MEDICO-LEGAL ASPECTS. m straw. In the famous series of murders by Burke and Hare, the Auctims were suffocated by fastening a plaster tightly over the mouth and nose while in a state of intoxication. The bodies were then sold to surgeons for dissection. Smothering is that form of suffocation which is produced by closing the external apertures of the lungs. This is by no means an infrequent cause of death of infants and young children, sometimes by accident, sometimes by intent. It may be caused by wrapping the head up in shawls or clothing, as occurred in a case at Ayr, Avhere a young woman Avas charged with the murder of a child by closely investing its head in a shaAA'l. She Avas acquitted on the defense that she Avas protecting it from the cold. In large cities many cases come under the notice of the medical jurist in Avhich children have been overlain in bed and suffocated by the breasts or body of the mother or by the bedclothes. In three cases described by Canton, and in most of the cases seen by me, the features were placid, lips congested, eyes slightly prominent, hands clenched, but no ecchymosis of the skin. Internally, the lungs Avere congested, and there were ecchymoses over pericranium, pia mater, pleura?, pericardium, and thymus gland. Homicide by suffocation, except in the cases of young children or those helpless from disease or narcotics, is Arery rare. The case of a nurse-girl named Norman, fifteen years old, quoted by Taylor, is worthy of mention. She was charged with the murder of three children and the attempted murder of a fourth. The three children showed signs of death by suffocation. The fourth, a boy of ten, was aAvakened by feel- ing the girl lying upon him and closing his mouth and nose with her hands, and this Avas probably the means she employed in the other cases, but the children, being younger and weaker, could not resist as did the boy. Accidental suffocation may occur in people helpless from intoxica- tion or debility, and the mouth covered over or the throat externally compressed. I am indebted to Dr. Hebbert for the report of the folloAv- ing cases—one a case Avhich happened in London in 1889, and known as the Poplar mystery. A woman Avas found dead in an alley. The post-mortem signs were those of death from asphyxia. The larynx Avas much congested, and both aryepiglottic folds were ecchymosed. Dr. Hebbert thought that the death was due to compression of the throat and closing the mouth, as there were bruises on both cheeks and scratches on the throat, and the larynx was so markedly ecchymosed; but Mr. Bond, the well-known English expert, thought the compression was caused bv the head falling forward while helplessly drunk, and being compressed bv a tight collar. And though the jury brought in a verdict of murder, it'did not follow that Mr. Bond's opinion was wrong. The cases of death from internal occlusion of the air-passages are probably mostly accidental, and frequently due to the impaction of food in the glottis or larvnx. In these cases death is generally very sudden. A case of this nature which occurred in London is to the point. The body of a young man was found in the Thames, but there was no eAU- dence, on section of the body, of death from asphyxia by drowning. On examining the larynx it was found blocked by a large piece of partly cooked potato, and some smaller pieces were in the trachea. The heart was flaccid and nearly empty, and the lungs uncongested, so it was con- 112 A SYSTEM OF LEGAL MEDICINE. eluded that the man died of that form of asphyxia coming under the head of nerve shock, or neuro-paralysis. Another English case is this (Lancet, 1850, vol. i., p. 313): Two men quarreled and fought, and feh to the ground. Tavo hours later, one of them, rising from the dinner-table, Avas taken suddenly ill and died in a few minutes; the other Avas accused of manslaughter, but the post- mortem revealed the cause of death to be suffocation from a large piece of meat Avedged in the throat, A child was brought into the Westminster Hospital in the second stage of asphyxiation. Tracheotomy Avas immediately performed, but though the tube was inserted no air passed through, and the child died without relief. On examining the body the larynx Avas found to be filled up by the wooden end of a Avhistle to Avhich a thin elastic bag Avas attached. This bag AA'as in the trachea, and prevented the tracheotomy tube from passing down. Death was from acute suffocation. A dangerous practice is common among nurses, Avho giA'e little children bags filled AA'ith sugar to suck, or even thrust them into their mouths. The children are thus gagged and respire only through the nostrils, and if these become obstructed suffocation might easily result. A case is described by Little John AA'hich illustrates homicide by suffoca- tion. He examined the body of a Avoman aa'Iio died suddenly, and found the cork of a quart bottle tightly Avedged in the larynx. The sealed end was uppermost, and the opinion was that it Avas forcibly inserted while the Avoman Avas helplessly drunk, and that murder Avas deliberately con- templated. Her ribs Avere also fractured. The folloAving case illustrates death from vitiated air: Tavo years ago three children, the eldest six years, Avere playing in a house Avhich Avas in process of construction. The workmen had gone aAvay, and, in sport, these children entered a small closet beneath a sink, Avhich had sufficient space to barely contain them. They pulled to the door of the closet, It fastened AA'ith a spring catch AAdiich could only be opened from the out- side. The children Avere missed, and search Avas made for them, but they were not discovered for many hours. When discovered, two of the children Avere dead, and the third, barely aliAre, Avas resuscitated Avith con- siderable difficulty. They Avere exposed to no noxious v^apors, and the only cause appearing Avas the vitiated condition of the air caused by the exhaustion of the oxygen from the air in the closet by their oAvn respi- ration. Five years ago I had occasion to examine the body of a man AA'ho had died with the folloAving history: He was a vigorous laboring-man AA'ho was eating his dinner hastily in a public restaurant, AA'hen he was noticed to suddenly turn exceedingly pale, and, rising from the table1, imme- diately fell to the floor, and expired AA'ithin less than tAvo minutes. The autopsy showed very great cerebral congestion and engorgement of the lungs. There Avas no froth in the air-passages, but an examination of the posterior fauces and larynx showed the presence of a piece of beef- steak measuring two inches by one and a half inches, without the slightest appearance of having been masticated, and AA'hich seiwed as a wedge to thoroughly occlude the air-passages, and to cause death by sudden and great congestion of the brain. A clergyman had come from the country for the purpose of ha\Ting a comparatively trifling surgical operation performed, and Avas adAdsed bv DEATH IN ITS MEDICO-LEGAL ASPECTS. 113 his physician to be etherized. The physician had neglected to caution him about dining before the operation, and as the man was coming fairly AA'ell under the influence of the anaesthetic he had an attack of vomiting, and then expired almost immediately. In this case the autopsy shoAved the presence in the larger bronchi of t\vo pieces of asparagus stalk, and in the smaller bronchi whole peas mixed with some fragments of food; there was also great hypera?mia of the brain and of the lungs, part of which was undoubtedly due to the effect of the ether; the death, however, resulted entirely* from the prevention of the entrance of atmospheric air. In consequence of the burning of a tenement-house in the city of Boston, a number of Italians, male and female, adults and children, per- ished. The post-mortem examination of these bodies shoAved varying appearances. In some there was extensive charring of the exterior of the boclv, accompanied by numerous vesicles which were filled AA'ith serum; distinctly marked burns' inside of the mouth and intense redness of the larynx and trachea, but without any marked degree of cerebral or pul- monary hyperemia. In others the burns Avere few in number and slight in degree,' but the larynx, trachea, and bronchi Avere reddened throughout, and fine particles of black soot were found even as far as the base of the lungs. The lungs were highly engorged, and there was marked conges- tion of the brain. In the first-mentioned cases death was undoubtedly due to the effects of burning. In the other cases death was due to suffocation by the inhalation of smoke, and Avas not influenced in any decree bv the burns on the surface of the body. &The term "dynamical asphyxia" is used by Casper to denote those cases in which death is brought about by the respired air, charged with some noxious gas, acting directly on the lungs. Death may occur by this means in three ways : First, the gas mav cause spasm of the glottis, or by entering the larynx cause inflammation, swelling, and occlusion of the tubes. This mav properly be caUed a mechanical cause, but is best considered under the second heading of dynamical causes of asphyxia, as the action may be twofold. Such gases are the pungent vapors of hydrochloric, nitric, nitrous, sulphurous, or other acids. The post-mortem signs would be those of death from asphyxia, _ t Second the gas may destroy life by acting in the blood, either by displacing Oxygen, such as CO", carbonic oxide, and HCN, hydrocyanic acid, or bv reducing the haemoglobin and robbing the corpuscles of oxy- gen, as in the case of H2S, sulpliureted hydrogen, where sulphur (S) and Avater (H.,0) are formed. . . , Third "the cases in which the air is wanting in, or has been deprived of, the oxygen sufficient for continued life, as, for instance, m vitiated at- mosphere, when the CO,, carbonic acid, is increased in quantity either by over production, or by the oxygen being gradually used up, ten percent. of COo in atmospheric air endangering life. As"the first division consists of gases rarely causing death it will be well to pass on to those which are more frequently met with. These are: ('() carbonic oxide1, as the result of charcoal vapor, or as a constituent of illuminating-gas; H2S, sulpliureted hydrogen, m ^er:&f>^">*> carbonic acid in mines, ill-ventilated rooms, or as a product ocomktm Prussic acid vapor, HCN. kills rapidly by displacing the 0x5 gen of 114 A SYSTEM OF LEGAL MEDICINE. the blood-corpuscles, and then paralyzing the respiratory centers. The blood at first appears bright red and then black. Death is from rapid asphyxiation, the post-mortem signs being similar to those of death when the liquid acid is swallowed. In poisoning with pure CO, carbonic oxide, there is no dyspnoea, the coma not being very marked. There is also temporary but pronounced paralysis of the limbs, followed by spasms. After death the heart and brain are congested with intensely florid blood. In poisoning with the mixed vapors of CO and C02 there is a varying degree of coma, There is dyspnoea, muscular spasms, and gradual paraly- sis and asphyxia. After death the blood-vessels are filled with a bright cherry-colored fluid blood, Avhile the lips, muscles, and viscera have the same color. The brain is soft, the liver, kidneys, and spleen are hypera1- mic. The post-mortem hypostases are bright red. The effects of CO on the body are very insidious, and one of the first results is profound languor and loss of' muscular strength. It is said that after recovery there may be paraplegia or disturbances of the cerebral activity. The external appearances after death are quite unlike those of death from gradual asphyxia by choking, the face being usually pale and placid, the eyes bright and not prominent, the pupils dilated, and the tongue not necessarily protruding. Such cases Avere, and probably still are, common in France, where charcoal-stoves are burned in the sleeping- rooms, but they are also very frequent in American cities and toAvns, AA'here the illuminating-gas contains a high percentage of carbonic oxide. The following cases illustrate the death from Avhat is sometimes called asphyxia, but what is really carbonic oxide poisoning, due to the inhala- tion of illuminating-gas. In the first case the individual Avas a domestic in the employ of a family in the city of Boston, who had retired in her usual health and was found dead in bed in the morning. There Avas not the slightest sign of any struggle, and the room presented a distinct odor of illuminating-gas. The bracket which furnished the supply Avas found to be partially open. It Avas supposed that the girl had turned the gas down so that there Avas but a small flame present, and had left her window partially open, and during the night a high Avind, Avhich had arisen, extinguished the flame Avithout cutting off the supply of gas. The autopsy showed fluid and bright crimson-colored blood throughout the body, and the same color of lungs, liver, and kidneys. The gas Avas of the kind known as Avater-gas, Avhich contains a very high percentage of carbonic oxide; and the fact that the room Avas not entirely closed, but that there Avas a windoAv open, and that the amount of gas Avhich must have escaped was small, sIioavs the speed and certainty Avith Avhich this agent acts, and its deadly nature. A man coming into the city from the country registered at a hotel, and a room Avas assigned to him. He retired about nine o'clock in the evening, and at one o'clock in the morning the night-Avatchman on his rounds noticed a distinct odor of gas, and traced it to the room of this man. A forcible entrance was effected, and the room was found to be filled with gas, tin1 man having either blown the gas out or having turned the stop-cock too far in shutting off the gas. The man himself was uncon- scious, and breathing heavily. Surgical treatment was promptly afforded him, and he Avas removed to the hospital, where he was given large quantities of pure oxygen and exposed to a full current of outdoor air, but within tAventy-four hom-s he died. The autopsy in this case shoAAred DEATH IN ITS MEDICO-LEGAL ASPECTS. 115 in general no crimson color of the blood, AA'hich, however, AA'as fluid. The lungs were dark in color in general, but in the middle of each of the lobes of each lung there were found circumscribed patches, varying in size from that of a dime to that of a half-dollar, of the bright crimson color characteristic of the action of carbonic oxide. Sulpliureted hydrogen, H2S, has a very poAverful action on the body. It is said to be instantly fatal when breathed pure, but the cases which come under the notice of the medical jurist are those in which the gas is diluted, as in the foul air from sewers. The victims are usually night- men. The physiological cause of death is due to the rapid destruction of the blood-corpuscles, first by robbing them of oxygen, and then decom- posing the haemoglobin. The blood becomes dark brown to black in color, and under the microscope sIioavs remarkable and complete destruc- tion of corpuscles. (Casper.) The symptoms before death are said to be giddiness, nausea, loss of strength, and paralysis, then convulsions preceding coma and insensibility, or sometimes tetanus Avith delirium. The skin is cold, pulse feeble, and breathing labored. The post-mortem signs in six cases examined by Casper Avere as fol- io avs : In tAvo the fae:es Avere of a greenish-yeUoAv tint, in the other four they Avere pale, AA'ith amende lips; in each case the brain was firm and anaemic, the cortical substance being of a dirty gray color, and the choroid plexuses pale and livid. The lungs Avere hyperaemic and of the color of black ink, and the blood from the lungs showed the destruction of the corpuscles before mentioned. The heart was collapsed, the right ven- tricle containing only a few drops of blood, and the left side was empty. There Avas no froth in the larynx or trachea, and the mucous membranes were of a dark-brown crimson color. In the cases of four men avIio lost then- lives in the Fleet Street sewer in London cited by Taylor (Lancet, 1861, vol. i., p. 187), the blood AA'as black and fluid throughout the body, but the lungs and heart Avere gorged AArith blood, and there Avas froth in the air-passages. The bodies rapidly decomposed. Probably the difference in the post-mortem appearances in the two series of case's arose from the difference in time of the occur- rence of death, the more protracted death giAdng rise to the greater con- gestion. In the third class of cases, in Avhich the respired ah- is Avanting in or has been deprived of oxygen, the cause of death is due to the inhahng of COo. carbonic acid gas. This kills, not as in the foregoing cases by dis- placing oxygen, but by preventing its being inspired in sufficient quan- tity to maintain life. The result may come about by over-production of the gas, as in fires in houses or in mines, or by the oxygen in the air being exhausted by its inhalation by the persons or animals present, and changed in the body to COL,, the air being in this Avay oA'ercharged to an amount rendering life in peril. Such a catastrophe happened, for in- stance, in the terrible " Black Hole of Calcutta," AAdiere during the Indian Avars several hundred Avomen and children Avere incarcerated in a small prison, and many died of asphyxia; and there is the historic case of a bride hiding in a chest in Kenihvorth Castle, Waiwiekshire, where the lid of the chest became closed, and the girl Avas found dead, Avith her body and limbs distorted by the contractions of preAuous convulsions. The post-mortem "appearances in death from carbonic acid poisoning are those of asphyxia already described. 116 A SYSTEM OF LEGAL MEDICINE. DEATH BY HANGING AND STRANGULATION. Some authors treat these subjects under one heading, AA'hile others, as Tardieu, think they should be considered separately. The cause of death in both cases is similar, and brought about by constriction of the throat by an external ligature sufficiently tight to prevent the ingress of air to the lungs. This interference may be sudden or gradual, but the ultimate result is the same—that is, death by asphyxia. In the so-called judicial hanging it is claimed that death occurs from the dislocation or fracture of the atlas or axis, and consequent pressure by the bone on the spinal cord; and though this may sometimes obtain, these cases only come under the notice of the judicial jurist in his official capacity, as the death is knoAvn to the authorities to be necessarily due to hanging. The cases in AA'hich he is consulted are those in which he has to determine the cause of death, unknown to any one but the victim or the culprit, and to say Avhether it may be due to strangulation com- plete or partial by suspension, or strangulation by forcible constriction of the throat Avithout suspension. In considering the post-mortem appearances of strangulation by sus- pension it is found that the principal differences in the external signs are due to the rapidity or sIoaaucss of the death. In the violent form of judicial or of homicidal hanging there is lividity or SAvelling of the face, lips, and eyelids, the eyes are red and protruding, the tongue is livid and protruding or clenched between the teeth, and there is bloody froth about the nose and mouth. There is a deep-reel ecchymosed impression of the cord around the hyoideal region of the neck, sometimes Avith laceration of the muscle's and ligaments, or great injury to the larynx and trachea; indeed, even the head has in some cases been nearly torn off. The hands are livid, Avith clenched fingers, and there are commonly circumscribed patches of ecchymosis about the upper and Ioavcc extremities. The urine, faeces, or semen are sometimes expelled involuntarily, and there may be some SAvelling and congestion of the genital organs in both sexes. In the cases of suicidal hanging, Avhere death occurs more sIoavIv, the face is generally pale, and the tongue may or may not protrude; the hands are not always clenched. The mark around the neck is a simple depression, acquiring a parchment-like appearance after a time. The internal appearances are those of death from asphyxia, namely, great engorgement of the AA'hole venous system ; the lungs, right side of heart, liver, and especially the kidneys and brain, being very full of dark, venous blood; sometimes, indeed, there is extravasation of blood into the sub- stance of the brain. The mark of the cord on the neck is oblique, being loAver in. front than behind, and may be interrupted in its course. The skin is commonly depressed and broAA'n, hard, or of a parchment-like consistency in the depression, Avith bluish, ecchymosed edges. Naturally, a difference in the AA'idth of the cord AA'ould produce a difference in the appearance of the mark, AA'hich, consequently, may be Avide and superficial or narroAv and deep. The latter may be accompanied AA'ith abrasions of the skin and subcutaneous ecchymoses, and ruptures of the more superficial muscles. e.g., sterno-mastoid muscles. The condition of the deeper seated parts, such as the eleArator and depressor muscles of the hyoicl bone, the arter- ies, nerves, and cartilages in the neighborhood, depends on the amount DEATH IN ITS MEDICO-LEGAL ASPECTS. 117 of force used, and may be limited to ecchymosis or extend to tearing and fracture of these structm-es. In the case of the arteries the internal coat and inner layer of the middle coat are torn, as in the ordinary liga- ture of a surgical operation, while the outer coat may escape. 'These more serious injuries are seen commonly in judicial executions, while in suicidal hanging the signs are those of asphyxia internally, and the external indications of violence slightly marked." One very important consideration for the medical jurist is, whether the hanging occurred before or after death. It has been pointed out by Casper that a uon-ecchymosed mark similar to that noticed in suicidal hanging may be produced two hours after death. Norman Chevers, in his Medical Jurisprudence for India, says that usually the saliva Avill drib- ble from one corner of the mouth after suspension during life on account of the drooping of the body to one side. This could not happen if the body Avas hung after death. Strangulation Avithout suspension is most frequently homicidal. The post-mortem appearances are similar to those by hanging, but the injury to the parts about the neck may be greater. It may be said in regard to the mark of the ligature that it is generally circular, and, as a, rule, at or just beloAV the level of the larynx, while in strangulation with suspension the mark is oblique, and most often aboA'e the larynx. The damage to the windpipe and the vessels and muscles in its neighborhood is generally considerable, as the force is suddenly and strongly applied. The external marks may not show so plainly as in hanging, for in the garroting period, in England the choking was effected by pressure on the throat by the forearm of the assailant, and left little evidence externally; and in the long series of murders by the Thugs in India the strangulation was caused by a soft silk handkerchief twisted rapidly around the throat, and often causing death very suddenly. In most cases of violent death by strangulation the face is livid and swollen, the eyes prominent, with dilated pupils, the tongue swollen, black, and protruding, and the mouth and nostrils covered Avith bloody froth. There may also be numerous spots of ecchymosis about the face and neck. The internal signs are those before described as due to asphyxia. It must, hoAveA'er, be remembered that any sudden application of force to the larynx may cause a rapid death, and this was a frequent occurrence in the choking by the Thugs. In such instances it follows that the post- mortem signs are much modified, and the heart wiU be found empty and the walls flaccid, the lungs not markedly congested, and the abdominal organs apparently normal. The brain is almost always A-ery full of blood, a condition readily explained by the prevention of the return of blood to the heart in consequence of the compression of the jugular veins, and it is this hypeiwmia wliich is the immediate cause of death. A relief of this congestion of the blood-vessels of the brain is the proper treat- ment in cases of strangulation. Chevers quotes a case of an English officer throttled by the Thugs, aa'Iio, to make assurance doubly sure, cut his throat, but the ensuing hemorrhage saved his hfe, by reducing the blood-pressure in the brain. It AvhT be easily undeu-stood that this marked increase of blood in the brain occurs whether the interference of the Aoav of the blood to and from the brain is sudden or gradual, and is a contrast to the condition seen in asphyxia from suffocation or drowning. A laboring-man, for some time despondent because of ill health, suspended himself from a 118 A SYSTEM OF LEGAL MEDICINE. beam in his barn and kicked over the stool upon which he had stood in fastening the rope. He was not discovered for several hours, at Avhich time life was extinct. The external examination showed the ordinary pallor and rigidity of the body, and a grooved furrow around the neck. perfectly Avell marked in front, but slightly so at the back of the neck, and this furrow corresponded in dimensions to the rope which the man had used. The groove was in the region of the hyoid in front. The dissection shoAved minute ecchymoses on the inferior surface of the skin and in the subcutaneous connective tissues. There was no fracture or dislocation of the bones of the neck. The lungs, brain, and other internal organs presented the ordinary signs of death from asphyxia. A prominent business man, after an extended indulgence in stimu- lants, was found in a room in a hotel with life extinct. He had a shawl- strap around his neck. The strap was attached simply to the headboard of his bed, his knees and lower part of legs rested upon the floor. The furrow around the neck was distinctly marked, and corresponded in size Avith the strap. In this case there Avere no ecchymoses beneath the fur- 1-oav, but there was a general engorgement of the lungs and vessels of the brain, and dark, fluid condition of the blood. These signs, considered with the fact that there were no other physical changes, indicated clearly that death had resulted from strangulation. Another case very similar is that of a person who had attached his suspenders to the post of a very low bed, and had fastened them about his neck and lain down upon the floor in such a position as to bring by the Aveight of the body a stricture about the neck, and thus cause death. Almost the entire body was resting upon the floor. The post-mortem appearances were similar to those in the case just cited, and death Avas due also to strangulation. The appearances of death by hanging may occasionally be found in persons AAdio haA^e died from other causes. In the vast majority of cases, hoAvever, persons that are found dead suspended, or partially suspended, may be considered cases of death from suicide, as such means of murder is most unusual. An interesting case illustrating an attempt to conceal a crime by giving the outward appearance of suicide has lately been reported in London. A prominent business man AA'ho was left alone in his office in his factory Avas seen last by the foreman as he left the Avorks at the close of the day's duties. Shortly afterward fire was discovered in the building, and after the flames were extinguished the body of the gentleman Avas found in an upper room suspended near the fireplace and thoroughly charred; but the examining surgeon discoArered by post- mortem examination that it was murder. In this case the body was borne by the murderer through the passage up a staircase, AA'here he deposited his victim on the stairs, then, placing a piece of cord around his neck, set fire to the place, where, if any of the body was left at aU, the rope Avould point to suicide. The fire was kindled at a spot adjoining a chimney, AAdiich had for some time past been regarded as dangerous, being partly constructed of Avood. Strange to say, though the premises themselves Avere entirely gutted, the chimney itself was left intact. Moreover, AA'hile the legs and thighs, also the greater portion of the arms, of the A'ictim Avere burned away, and eA'en the features burned beyond recognition, the neck at the back Avas left to show the mark of the rope and the traces of a brutal assault. The examination Avas made by Mr. Thomas DEATH IN ITS MEDICO-LEGAL ASPECTS. 119 Bond, who reported as follows : " The body was charred by fire, both legs and thighs had been burned off, and both forearms. The "left upper arm was the only part of the body which was uncharred. This Avas extended at right angles to the body, and, of course, stiff. The right upper arm Avas in a sloping position downward. The head and neck were bent down toward the left side. The features were burned away and quite unrecognizable. The hair and scalp were entirely destroyed, and the bones of the skull Avere charred through in places. On the upper and back part of the skull, on the right side, there was extensive fracture of the bones, and just over the right ear the brain substance was protrud- ing. On moving the charred and fractured fragments of bone on top of the head I found a good deal of brain protruding from the dura mater, or fibrous covering of the brain. The brain was not calcined, but fresh and uninjured. I also found directly under the fractured and calcined bone a large quantity of dark-red putty-like substance. It was quite an inch thick, and lay in contact with the bone on the outside and on the fibrous covering of the brain internally. This putty-like substance extended all over the top of the head. I took some away with me, and I have since analyzed it and examined it microscopically. I find that it is blood par- tially dried by heat. On the right side of the head below the ear I saAV traces—in fact more than traces—I saw a quantity of this red substance adhering to the charred remains, but of course quite dry. This I have ascertained to be blood. On the left side there Avas none of this sub- stance : the part was simply black and charred. Around the neck, espe- cially the back part of the neck, there was a deepish groove an inch and a half in width and half an inch deep. It showed the indentation of a rope. The grooA^e was quite low down in the neck near the shoulders, and just in front it was just on a level with the lower part of the larynx. Dr. Becker at this point showed me four strands of charred rope, AA'hich, he informed me, he had removed from the neck. The rope appeared to fit the groove which I saAV around the neck. He told me it lightly encircled the neck and Avas tied in a knot. Then I found three or four little pieces of rope hke that produced lying under the charred remains— under the neck, in fact. The groo\re I have described Avas A'ery distinct behind but not so distinct in front. Underneath AA'here the rope had been the skin was protected from the fire and was not charred, though it was discolored; and on making incisions through the skin into the tissues underneath I found there Avas entire absence of any extravasated blood or of congested blood-vessels. " The remarkable thing Avhich I found was the extensive effusion of blood between the skull-cap and the fibrous covering of the brain. The brain Avas also white and soft, and seemed little affected by fire. I haA'e no doubt that this blood was effused during life, and I have no doubt either but that it was caused by extensive fracture of the skull during life. The injuries I found Avere quite sufficient to cause death, and also to cause death very quickly. Then, again, I am able to say that the death Avas not caused by strangulation. In death from strangulation or hanging there would be extravasation and congestion under and around the mark of the rope. I examined the larynx also. There Avas no injury of the larynx, no extravasation of blood about it, or injury to its external surface. Then the condition of the heart and lungs did not point to strangulation. I have no doubt the man met his death from A'iolent 120 A SYSTEM OF LEGAL MEDICINE. blows inflicted on the head with a heavy instrument, and they were ap- parently caused by a hammer or some other heaA-y instrument." Cases of accidental suspension are also not unknown, as where per- sons have been caught by a Avindow falling upon the neck Avhile the in- dividual was gazing out into the street; and cases of suspension are well known AA'here children have hanged themselves in sport, and where they have failed to let themselves down before consciousness Avas lost, and have expired in conseemence of the suspension. DEATH BY DROAVNING. Death by drowning is perhaps the most common form of death from asphyxia AA'ith which the medical jurist has to deal, inasmuch as it is one of the most common forms of accident occurring to pleasure-seekers, whether in the yachting-season, or at the time of year when skaters venture on thin ice, or AAdien the hardy sailor is lost overboard in the discharge of his duty, or because of attempts to board his ship Avhen he has yielded to the influence of boon companions during his short stay on land; and, moreover, it is one of the easiest and most frequent forms of suicide. We say that death is due to drowning when it has occurred in conse- quence of cutting off the atmospheric air from the mouth and nose by a fluid, irrespective of its density. It may be the water of a lake or the contents of a cesspool, the ooze of the marsh or the fluids of the mother in Avhich a new-born child may be immersed. The quantity of the fluid is immaterial: it may be the whole ocean or it may be the merest pool by the roadside into which an epileptic has fallen during a seizure, and Avhere there is depth of Avater enough to barely occlude the nose and mouth. In any case of death from drowning the real cause of death is the presence of an excess of carbonic acid in the blood, due to the con- tinuation of the process of elimination, while the Aivifying effect of the mingling of the oxygen of the atmospheric air is stopped by the inability of the indi\ddual to respire. In this respect it does not differ from any other form of asphyxia. Death may occur in cases of drowning either by hyperaemia of the brain or of the lungs, or of both combined, or by the sudden paralysis of the whole nerA'ous system. According to Casper, the form of death from cerebral hyperaemia is of the rarest, though undoubtedly most cases of death by drowning are accompanied by some signs of engorgement of the vessels of the brain; but these appearances haA^e been given undue weight by some Avriters, and the presence of an unusually large amount of blood in the vessels at the posterior part of the brain has been attributed to a vital process, Avhereas it is far more likely that it was due simply to post-mortem change, as has already been pointed out. Casper says: "It is, however, certain that even in those rare cases of drowning in Avhich cerebral hyperemia is found to be the only positive cadaveric phenomenon, except one other special appearance, and must therefore be recognized as the cause of death, this hypera?mia is ahvays relatiA'ely inconsiderable, and actual hemorrhage is the rarest of phenom- ena, and is only observed under very peculiar circiunstances." In this connection this author cites a case of a man Avho fell into a swamp Avhile DEATH IN ITS MEDICO-LEGAL ASPECTS. 121 drunk. In this case the autopsy shoAved the presence of the muddy fluid of the marsh in the trachea, but all the other usual signs of death by droAvning Avere absent, The meninges Avere turgid Avith blood, and beneath the dura mater Avas an extravasation an inch in diameter. The other two forms of death in cases of drowning, pulmonary apo- plexy and lieuro-paralysis, are of about equal freepieiicy. Just aa'Iiv death should be caused in different indiA'iduals by one or the other of these physiological changes cannot be certainly determined, but individual tendencies, temperature of the water, fright, A'oluntary or involuntary passiveness while sinking, must have some influence. That there has been much discussion as to Avhether a decision in a doubtful case of death from droAvning could be made is undoubtedly due to the fact that there is no absolutely diagnostic sign Avhich is neA'er wanting; but in my opinion, the difficulties in the Avay of an accurate diagnosis are much overrated, in spite of the undoubted occurrence of cases more or less puzzling, and AAdiere such observers as Devergie and Casper assert that they could "in nine tenths of all the cases declare aa ith a clear conscience Avhether the submersion had been during life or after death," it is not necessary for less experienced men to assume the role of Thomas and demand the utmost proofs before being Avilling to give an opinion. A priori, Avhen a body is found in the Avater it may be assumed that the inchyidual died by droAvning; and though such a death may in rare instances haA'e been the result of murder, and while occa- sionally bodies, especially of children, are thrown after death into the Avater to avoid the expense of sepulture, the total number of ah these cases is the very small minority. An exploitation of the various appearances claimed by various Avriters as characteristic of death from drowning seems unnecessary, inasmuch as most of these haA'e been found to be untrustworthy and of no value as certain signs of death from this cause. I Avill simply mention them in passing. Coldness of the body has been claimed as a sign of death by drown- ing. The fact is that a "dead body, whatever the cause of death, as has been mentioned before, soon assumes the. temperature of the surrounding media, Avhether air or Avater, and bodies submerged in cold Avater Avill cool more quickly than those in the air in summer; but the thermometer has as yet been unable to shoAV any difference between the. bodies of the droAvned and those that have died of other causes after a certain intei-A'al, other things being equal. It seems to me, therefore, that relative tem- perature of a body is of no value as pointing to a death by drowning. Paleness of the body is also mentioned as a characteristic of the drowned. I haAe not only seen the bodies of the drowned present a livid appearance, but also a peculiar rosy hue. I have seen the bodies of sev- eral people lying side by side in the morgue, some of which had died of natural causes, some by railway accident, one by hemorrhage from cut throat, and one from drowning, and it would have been impossible for anv observer to select the body of the drowned man by any difference in color. A statement that there'was no difference in color would not apply to the bodies of those who have been long drowned, when the evidence of commencing putrefaction, either in the water or after exposure to the air, is to be seen. Here there is a dusky redness, characteristic not of the cause of death, but of post-mortem change, and it is only 122 A SYSTEM OF LEGAL MEDICINE. the localization of the color change which furnishes a suggestion of the cause of death. The situation of the tongue, whether it be behind the teeth, or whether it protrude, or is clenched between the teeth, is of no importance as a characteristic of this form of death. Tavo days ago I had occasion to make a post-mortem examination of the body of a child AAdio had been apparently Avell till a few hours before its death, Avhen it Avas suddenly seized Avith diarrhoea and vomiting, and after an illness of hours only had some convulsions and died. The child Avas a negro, and the history suggested an irritant poison; but the autopsy developed the fact that there Avas oedema of both Ioavci- extremities, and acute nephritis Avith cerebral and pulmonary oedema combined with organic disease of the heart, In this case the tongue Avas found tightly clenched betAveen the teeth. This is only one of many instances where I have obseiwed the incarceration of the tongue in cases AAdiere the death did not result from violence of any form. The same lack of value attaches to that appearance of the skin known as goose-flesh, or cutis anserina, I had attached some A'alue to this ap- pearance, owing to the instruction in the text-books; but after a very short time I found that the appearance was to be noted in the bodies of those Avho had died from almost any cause. Indeed, it occurs in the living, as any one Avill knenv that has taken a cold bath, or been obliged to make his toilet in a room in the country where the conA'eiiiences for heating in the Avinter time do not obtain. I have had occasion to point out this appearance of goose-flesh to my students in cases of death from pistol-shot, from cut throat, and even from pneumonia. I do not mean to assert that this phenomenon is wholly due to the effects of cold, as it may be obseiwed in the summer as Avell as in the winter. It is probably largely due to mental or nervous shock, of Avhich sudden exposure to cold may be one cause. The condition of the hands and feet is of importance only so far as the hvid, blue-gray color and the maceration of the epidermis indicate that the body has lain in Avater. Something resembling this appearance may be seen in the hands of washei-Avomen during life, and any body, whatever the cause of death, which has been alloAved to lie in Avater after death Avill present the same change of color and the same maceration. On the other hand, this process requires time, and the body of a person Avho has been remoA^ed from the Avater Avithin a short time after death, say six to eight hours, Avill not present the corrugation and maceration which is claimed as a sign of death by drowning. The absence of sand or graArel from under the finger-nails of the boelv is of no value, as such appearance is not usually present, and is only to be found where the person has clutched the bank or bottom in efforts to save himself, or Avhere the body has been dragged up a bank in the pro- cess of its removal from the Avater. It is too much of a refinement to suggest that a murderer would endeavor to conceal a crime by attempt- ing to imitate this appearance of the nails. Casper attaches considerable importance to the retraction of the penis in cases of actual droAvning. He has found this condition frequently in the bodies of the droAvned, and rarely after death from other causes. He claims that even the distention caused by putrefaction does not preA'ent this longitudinal shortness from being distinctly observed. When, how- DEATH IN ITS MEDICO-LEGAL ASPECTS. 123 ever, the very great variation in the size of the organ in different indi- viduals is considered, a A^ery careful observation combined Avith previous knoAvledge of the anatomy of the person under examination is required. An instance of this organ assuming more than natural proportions after death from drowning in consequence of putrefactive changes has been previously cited. Casper apparently accepts the explanation of this phe- nomenon offered by Brettner. This is as folloAvs : " Bundles of unstriped muscular fiber lying in the upper stratum of the true skin surround the sebaceous glands and force them forward by their contraction, thus making cutis anserina. Precisely similar un- striped muscles are found in the subcutaneous cellular tissue of the penis. They run parallel to the long axis of the member, but very often large bundles run across it. (KoUiker.) It might, therefore, be expected that their contraction would compress the spongy tissues of the penis, which are capable of little resistance, and thus reduce its dimensions in length, breadth, and thickness, and thus produce what might be called a contraction of the penis; and further, that irritants capable of exciting the contraction of ordinary unstriped muscle might also be capable of inducing the contraction of these unstriped muscles of the penis, e.g., cold and fright." It is difficult for me to understand why the same objections to this ingenious explanation which are raised by Casper himself as to the value of cutis anserina as a sign of death by droAvning, and which have been previously mentioned, should not lie against the value of the presence of a contracted penis as a sign of this form of death. So much for the external appearances. On internal examination we occasionally find cerebral hypera?mia. As has already been said, this condition is by no means constant, and therefore nothing can be argued from its absence. If present directly after death, it may disappear Avith putrefaction, and bodies which have lain in water any considerable time, or AA'hich have been exposed to the air after a short immersion, very rapidly take on this change. The position of the epiglottis is of no Aralue, inasmuch as the upright position may exist in cases of death from other causes, or may be pro- duced in the droAvned by manipulation during the course of autopsy. Of much greater importance is the vascular injection of the mucosa of the trachea and the presence of mucous froth in that canal. In every form of death from suffocation, except that of nervous apoplexy, the mucous membrance of the larynx and trachea is found, on examination soon after death, more or less 'injected, varying from isolated patches of a cinnabar-reel color to a uniform coloration of the whole mucous mem- brane. This differs distinctly from the dirty-red or brownish-red color of decomposition, and there is also usually in the trachea a fluid varying in amount from a few frothy bubbles to an amount of foam sufficient to fill the entire canal. This wells out of the nose and mouth in conse- quence of the evolution of gases by putrefaction, and even Avhen absent in the trachea may be forced from the bronchi by gentle pressure. The amount may, and probably does, depend in a degree upon the rapidity or the slowness of the death process. In general, in the bodies of the •drowned this appearance of froth, both externally and in the trachea, is only to be found when the body has been removed from the water within a very short time after death, and it would not be found in cases of 124 A SYSTEM OF LEGAL MEDICINE. droAvning Avhere the death was from apoplexy or from neuro-paralysis Indeed, I have seen cases of pretty sudden death from organic di.M-ase of the heart where the amount of foam in the lungs and trachea, as well as externally at the nostrils, Avas greater than any I have ewer seen in the droAvned, and which in appearance could in no wise be distinguished from the froth of the drowned, inasmuch as in both cases the foam is simply a mixture of air-bubbles with the fluid either involuntarily inspired or present because of pathological process, or a mixture of air with the mucus naturally contained in the air-canals. Casper and Devergie differ in opinion as to Avhether it is necessary for the pro- duction of this froth in the droAvned that the individual should have got his head above Avater after the first plunge. Casper claims to have found tins froth present in the cases of those who have gone at once under the water, and remained there in consequence of coming up under the bottoms of ships or sunken logs, Avhile Devergie main- tains that the inhalation of atmospheric air is necessary for the pro- duction of this froth. I remember the case of a longshoreman who fell from the side of a ship on AA-hich he Avas employed, and in falling struck his head on a boom beside the ship and never rose after immer- sion. The body was immediately recovered, but life Avas extinct. In this case there was no considerable amount of cerebral hyperemia, the trachea and larynx were injected, and there was froth in these canals and in the bronchi. Therefore it must be admitted that in rare instances such a phenomenon may be present Avitbout the inspiration of air after submer- sion, the froth being formed of the inspired Avater mingled Avith the mucus and air that Avas already in the lungs at the time of submersion; yet Avhile I have had occasion to examine the bodies of many persons Avho have died under similar circumstances, I have neA'cr found the froth except in this solitary case. I am inclined to belieA^e that the presence of froth in such cases is exceptional. I certainly am of the opinion that the amount is largely proportionate to the length of the struggle and the amount of combined air and water inspired. It is unfortunate that this sign disappears so quickly in consequence of putrefaction, inasmuch as the opportunities for examination of bodies of persons avIio haA'e fallen into the Avater stunned, or of suicides aa'Iio haA'e weighted their bodies with stones, or, as in one case coming under my observation, Avith chain armor, do not come to the surface or are not recovered till decomposition is well under Avay. If the foam is present, hoAvever, the medical jurist will at least be in a position to say that life existed at the time of its formation, and thus dispose of the question Avhether the body was thrown into the Avater after death. No value is to be attached to the position of the diaphragm. It is found variously arched in recent cases of drowning, and, as is Avell knoAvn, may be forced higher and higher by the gases of decomposition. The increase in the volume of the lungs is a very important sign of death from droAvning, though in consequence of my own observation I am not prepared to go as far as Casper, who declares that " it never fails except in the rarest instances, Avhere putrefaction of the whole body and of every organ is already far advanced." I have made dissections of bodies Avhere the decomposition was only indicated by the commencing putrefaction of the soft parts of the head and a moderate greenish dis- coloration of the surface of the body, and in these cases I have found DEATH IN ITS MEDICOLEGAL ASPECTS. 125 the lungs entirely collapsed, and the pleural cavities containing a very large amount of reddish fluid, the result of post-mortem osmosis. I may add that in several of these cases the history of the misadventure was wholly known, and there was no question as to the real cause of death. This increase in the volume of the lungs, however, generally occurs in cases of death by drowning even where death occurred as "a result of nervous apoplexy, and is caused by the violent attempts to breathe as the head emerges from the water, and also by the inhalation of the fluid in Avhich the drowning occurs, the latter probably playing the chief part in the production of this phenomenon. The lungs no longer have the crepitant feel of normal lungs, but are very like a sponge, and when these organs are incised there is a copious flow of a bloody froth. It is of little moment avIiether Avater can get into the lungs after death, a point which is much in dispute, inasmuch as the formation of froth is essentially a vital process, and cannot occur after life is extinct. This sign of death by droAvning is Avholly incontrovertible when in the lungs is found a fluid of peculiar character, and of the same nature in AA'hich the body has been found, as, for instance, liquid manure, or liquor amnii. I had occasion to make a section of the body of a man, in a case of suspected murder, where the body Avas found in a barn cellar in the manure-pit of a stable accommodating a great number of animals. It Avas sIioavii that the man had come there with a companion for the pur- pose of carting aAvay the manure at a A'ery early hour in the morning. Both the man and his companion were soineAA'hat intoxicated. After daylight an employee of the proprietor of the stable found the cart still there, AA'hile both men had disappeared. Search revealed the presence of one of the men in the half-liquid manure of the pit. His companion, when found, could give no Arery connected account of AAdiat had hap- pened, claiming that he had left the man there Avhen he Avent away for more liquor, and as he did not find him on his return, went home himself in a dazed Avay, leaving the team at the stable. External examination shoAved the absence of all bruises—in fact, there Avas nothing unusual except the extreme filth of the clothing and body from its environment since death. The volume of the lungs Avas Arery much increased, and in the bronchi eA'en of the smaller size there were particles of equine fa^es mingled with urine. It Avas clear that the man had come to his death by drowning in the pit, and the result of the further investigation seemed to make it probable that in the absence of his companion the man had opened the scuttle, and from intoxication fallen into the pit and drowned. OA'erloadiug of the right side of the heart may occur, and generally does in any form of asphyxia, and is not characteristic of the particular form of death by asphyxia Avhich is under consideration. It might be found in any case where the body of a person AA'ho had died by strangu- lation had been throAvn into the AA'ater after death. MoreoA'cr, in the rare cases AA'here death has been due to cerebral hyperemia or to neuro- paralysis, this condition of the1 heart is not to be obseiwed. Congestion of the lungs and hyperemia of the pulmonary artery are also common to various forms of asphyxia whateArer the cause, and consequently are not peculiarly characteristic of death by drowning. The dark color and the fluidity of the blood is always present in cases of death by drowning, but it is also present in any case of death where the access of atmos- pheric air is prevented; and "indeed, it is found in cases of death from 12G A SYSTEM OF LEGAL MEDICINE. narcotic poisoning and from lightning or any other fatal amount of elec- tricity. This has been demonstrated frequently since the introduction of this fluid into general use for power or light.* It should be remarked that this condition of the blood, Avhich is always to be found if the body is examined sufficiently early, disappears entirely when putrefaction is considerably advanced. In regard to the congestion of the sohd viscera of the abdomen, as weU as the overloading of the vena cava and the mesenteric veins, the same remarks AA'hich Avere made about the hyperaunia of the brain and lungs are applicable. These parts Avill be found congested in most cases of drowning, but this only means that the death has resulted from as- phyxia, though not necessarily from drowning. Of course this hyper- emia is not likely to be found in the organs of those who have died in the water from any other cause than drowning. Whether the bladder is full or empty is a matter of no diagnostic value. I have frequently found the bladder very much distended AA'ith urine in cases of drowning, and on the other hand I have also found it entirely empty. In cities Avith a water-front it is not at all uncommon to see cases Avhere the body has been found alongside a wharf, and AA'here the condition of the clothing and the emptiness of the bladder have very strongly suggested that the deceased had gone to the side of the Avharf for the purpose of A-oiding urine, and in so doing, or immediately there- after, had lost his balance from intoxication and fallen into the AA'ater and drowned. The presence of AA'ater in the stomach of the drowned is a fairly con- stant appearance. Its value as a diagnostic symptom is someAvhat in dis- pute. Casper thinks that it is ahvays present in fresh bodies, and that Avhere it is apparently absent the absence is rather dependent on illusion than reality. Ogston claims to have found water present in the stomach in nearly thirty-seven percent, of his cases. In at least fifty percent. of my own cases the presence of AA'ater in the stomach has been ob- served. Ogston further states that in ten of his cases, though there Avas no water in the stomach, it Avas present to a limited extent in the abdominal cavity, never to an amount more than six ounces. This sug- gests to the anatomist the question as to Iioav it arrived in this serous cavity in the process of drowning. However, as it gets into the pleural cavdties by osmosis it is possible that it reaches the abdomen in the same manner. This presence of water in the pleural cavities, which I have observed in a very large proportion of the cases of droAvning Avhich came under my observation, is, in my opinion, a A^ery important sign. It is to be found at a time when putrefaction has at most just begun. It is tinged Avith the coloring matter of the blood, and is generally altogether too much in amount to be accounted for by the serum Avhich AA'ould naturally come from the blood of a congested lung, and, to my mind, indicates the presence in the lung of a considerable amount of AA'ater in- troduced during the death-struggle. The presence of other pathological changes would of course settle any question as to AA'hether this fluid Avas the result of an effusion caused by pleuritic inflammation during life. I haA-e found as much as a quart of this fluid in each pleural cavity, To return to the question of water in the stomach, it has been sIioavh by experiments on animals that Avater enters the stomach during the process of drowning by the act of deglutition as the animal comes to DEATH IN ITS MEDICO-LEGAL ASPECTS. 127 the surface to respire, while when they are kept continually under water till life is extinct, little, if any, water enters this caAdty. It has also been found by experiment that water does not enter the stomach of an animal thrown into the water after death. The power of swallowing is lost after death, and the walls of the oesophagus apply themselves too closely together to permit the passage of water. Nearly aU writers are agreed that water cannot enter the stomach after death, at any rate till putre- faction is far advanced. It must be borne in mind that water may have been swallowed by the deceased just previous to immersion; but such cases are the exception, and if the fluid found in the stomach should be different from the kind of water AA'hich would naturally be drunk—sea- Avater for instance, or a fluid Avhich is never voluntarily drunk, as hquid manure or liquid mud—the proof is positive that death resulted from drowning. The only exception to this is the case of a new-born child. It has been shown that there are movements of deglutition made by the foetus while in the membranes. Consequently if liquor amnii or uterine mucus be found in the stomach of a new-born child, it would not show that the child had been drowned, as these substances have been found in the stomachs of children aa ho have never breathed. Generally speak- ing, hoAvever, when other substances are found, such as human ordure, it is an indication that the child has been drowned. If there should be any doubt, a careful examination of the lungs as to the matter of their having been distended by natural respiration should be made. The following case illustrates a manner of death not at all uncommon, but which has given rise to what seems an unnecessary amount of discus- sion. During the bathing season a few years ago a man Avas wading in the surf at a seaside resort, and Avas not in the water at a greater depth than his hips. A female friend, Avho was sAvimming at some distance farther out from the shore, in a spirit of mischief cried for help, exclaim- ing that she Avas drowning. The man made a A'iolent attempt to reach the woman, but after a few steps fell forward into the water and did not rise. He Avas immediately taken out, but all attempts at resuscitation proved unavailing. The dissection showed a large, very fatty heart, dis- tended Avith blood on both sides, no unusual darkness or fluidity of the blood, and no cerebral or tracheal injection, and entire absence of froth in the air-passages. Xoav, although this death occurred in the water and the body Avas submerged, the case Avas clearly one of death from syncope. Owing to the fright and the sudden exertion, a heart in a pronounced degree of fatty infiltration became incapable of work. This might equally have happened on land. Such cases ought not at all to be considered cases of drowning. During the same season, at another resort, a man who could not SAvim at all Avas Avading in the water, Avhen he suddenly fell and was submerged. He had been in the Avater but the shortest time before this happened, but he had just previous to jumping into the Avater eaten a very large meal and had partaken freely of stimulants. The autopsy in this case showed only very great engorgement of the cerebral A-essels Avithout actual rupture. This case should properly be classed as a death from cerebral congestion and shock rather than as a death from droAyn- ing, although the death did occur in the water, and it is possible that life Avas not AA'holly extinct at the time of submersion. Something more than two years ago I was called to investigate the 128 A SYSTEM OF LEGAL MEDICINE. death of a new-born infant in one of the outlying districts of the city of Boston. The mother was a domestic, and Avas not knoAvn by her em- ployer to be pregnant until after the delivery. She Avas alone at the time of the birth, and claimed that the child had never cried or given any sign of life, and that, belieAdng that it Avas dead, she had put it into a pail containing various fluids, Avater, urine, blood, etc. The umbilical cord had been cut but not tied. The section sliOAA'ed that the child had breathed, as the lungs Avere fully distended, and presented a number of blebs upon their surface (emphysema), and Avere Avholly buoyant in Avater, both in mass Avith the thymus attached, and also in small sections after being subjected to great pressure. The lungs Avere, howeA*er, overloaded with blood, and there Avas cerebral congestion; the bronchial tubes con- tained a little froth, and in the stomach Avas found a reddish-brown fluid with an odor of urine, in which Avere blood-corpuscles. Although this was apparently a case of homicidal drowning, the authorities thought it unlikely that a con Auction of an ignorant Avoman, who Avas alone in her travail, could be obtained. I have made post-mortem examinations in A'ery many cases of new-- born children, Avhich were said by the parents—and no doubt the state- ment was made in perfect good faith—to have been still-born, Avhere the section has shoAvn in the stomach the presence of the uterine fluids mixed with blood, AA'hile the lungs clearly indicated that the. child had breathed, and had afterAvard died from the prevention of access of atmospheric air. These are cases Avhere the mother Avas alone at the time of birth, and the child AA'as expelled rapidly into a pool of the fluids of the mother, wdio may have been in a half SAvoon herself, and AAdiere the child, lying face doAvinvard in this mass of fluid, Avas drowned before anything could be done to remove it from its situation. The neAA'-born child dies in a very short time in such a situation, and the speed Avith AA'hich death ensues prevents the changes AA'hich are seen so markedly in the adult. The question Avhether any given death from droAA'ning Avas the result of accident, suicide, or homicide is one most difficult to determine, and very little aid is given in the majority of cases from the examination of the body alone. External circumstances must be carefully weighed, and an opinion given Avith a great deal of caution, as it is in many cases im- possible for the medical jurist to give an opinion which shall be exact. If the body has not too far advanced in putrefaction he will generally be able to state whether the body Avas alive or dead AA'hen it Avent into" the water. In the latter case suicidal droAA-ning Avould be out of the ques- tion, and the question of the homicide by droAvning of a neAA'-born child would be settled in the negative if the body was found to have been dead AAdien throAvn into the water. This is of importance, inasmuch as many cases come up for investigation every year AA'here the body has thus been disposed of to escape the expense of burial. That the body of an adult should be throAvn into the Avater for such cause is A'ery unusual. Injuries of various kinds maybe found upon the body, and* they maA' have been produced both before and after death in A-'arious Avays. A man may have been wounded and subsequently fallen into the Avater or a suicide may resort to drowning after haAdng failed in other AvaA's. In the summer of 1893 I Avas called to examine the body of a man wliich had just been taken from tide-water at the junction of the river Charles. The body had evidently been in the water but a short time. DEATH IN ITS MEDICO-LEGAL ASPECTS. 129 The post-mortem examination showed all the characteristic signs of death by asphyxia from droAA'uing. Yet in the right side of the head were found two wounds produced by pistol-balls, both bullets having been fired into the head at short range; but as the}' Avere of the smallest cali- ber, and therefore fired Avith a small charge of powder, they had buried themselves in the skull without penetrating it, and had produced no further effect upon the brain than a trifling ecchymosis directly beneath the site of the bullet. In this case it was clear that the man had been shot and then had died from drowning, and would not necessarily have died from the effects of the shooting. Fortunately, some letters left by the deceased, and an investigation of his financial situation, left no doubt that the case Avas one of suicide. A body in running water may be subjected to injuries by being hurled against floating ice, the piers of bridges, or by being mutilated by the propellers or paddle-wheels of steamboats. In such cases great care must be used in the inA'estigation to determine as far as possible whether these Avounds shoAV any signs of vital reaction indicating that they Avere inflicted during hfe. Moreover, the medical expert must be careful not to mistake post-mortem changes from putrefaction, such as the presence of swelling of the scalp, or blood beneath it, for a process occurring before death. Bodies are often much crushed aa hen lying in tide-Avater by the weight of a ship settling upon the body as the tide ebbs. Such'injuries, hoAvever, are so great as to leave little doubt that they Avere not inflicted during life. Collateral circumstances may often throw some light on the question of homicide, or suicide, or accident. Certain people, from the nature of their occupation, are liable to accidents of this sort, such as sailors, long- shoremen, dyers, icemen, and railroad employees' who are required to walk over trestleAvork. Weights of any kind attached to the body sug- gest suicide in the case of the adult, * The case previously cited of a young man who was found with a suit of chain armor attached by a belt to the body is illustrative. No one kneAV that the man was inclined to self-destruction; but the fact that he was an actor, and that this suit was a part of his own Avardrobe, and some subsequently ascertained facts, clearly demonstrated suicide. A'celebrated case occurring in a comity of Massachusetts some tAvo years or more ago is of especial interest in this connection. On or about Christmas eve a voung Avoman disappeared from her home, and some months later her* body was discovered in tide-water near a bridge con- necting the town where she had hved with an adjoining city. It was asserted that on the night of her disappearance, Avhich was very stormy, she Avas seen to get into a buggy with a man who Avas assumed to be her lover and the father of her unborn child. There were some letters which pretended to have been mailed by her after the time of her disappear- ance, which Avere written in a hand resembling that of the accused, and these, together wdth other circumstances, led to the arrest and trial of this man. The autopsv, which was very carefully conducted by Drs. Durell and Swan, was 'witnessed bv myself. The appearances showed nothing of external violence, and only a moderate degree of putrefac- tion There was eiio-orgement of the lungs, and the blood was dark and fluid. Both chest cavities contained a large amount of reddish fluid, and the mucosa of larvnx and trachea were stained a dark red. lliere 130 A SYSTEM OF LEGAL MEDICINE. AA'as about a pint of water in the stomach. There was nothing indicat- ing any other cause of death. In the uterus Avas a foetus of the fifth month. The examination of the body showed nothing to indicate whether the death was one of homicide or suicide except the moral evidence afforded by the pregnancy suggestive of a motive for suicide. The contention of the government was that this Avas also a sufficient motive for murder on the part of the alleged father. . It Avas claimed that because he Avas for a long time deaf to her entreaties to marry her, at last, to rid himself of her importunity, he, under the pretense of taking her aAvay to be married, had driven to this bridge, and there had taken her out of the carriage and throAvn her over. The defense claimed that it would haA'e been impossible for the man to have taken this girl, in the full possession of her senses (and there Avas nothing to indicate she Avas not; indeed, the government claimed that she shrieked AAdien thrown in), and thrown her OArer the high rails of a bridge into the AA'ater AA'ith out using sufficient force to have left marks on her body; and again, that the physical relations of the buggy and the bridge did not admit of his attaining a position where he could haA'e thrown her over either Avith or Avithout great force; that murder by drowning in the case of an adult Avas most unusual; and that the mo- tive was entirely insufficient, inasmuch as under the laws he would have had to submit to the penalty only of supporting the child under the Bastardy Act; that suicide of Avomen pregnant with an iUegitimate child is of very frequent occurrence; and that the throwing the girl into the water Avhere there was the possibility of her floating to the bank of the river, or of her being rescued, was not the probable act of a man avIio was ingenious enough to have planned the scheme as outlined by the government, a man who would not have been so shortsighted as to take such a chance. To show Iioav much the matter was in doubt, it may be stated that there Ave re two trials of the case, in the first of wliich the jury promptly convicted, and on the second, and with the same evidence practically, the jury Avith equal promptness acquitted the prisoner. It must be1 admitted that the entire absence of any marks of violence upon the body in the Avay of scratches or bruises lent a certain sort of moral weight to the claim of the defense. The nature and depth of the fluid should be considered, though great caution should be usee! in forming an opinion of homicide because of the shalloAvness of the water. An epileptic might have a seizure on the edge of a shallow pool of water and die of drowning because of his inability to assist himself. In the summer of 1877 I had occasion to examine the body of a man who Avas found in a A'ery shalloAv ditch of water in a toAvn near Boston. At the time of finding the body there was scarcely water enough to cover the half of the body when lying prone. The physical signs were clearly those of droAvning, and it was ascertained that he had left a resort Avhere he had spent the eArening in drinking, quite late on the previous night, and that his route homeAvard was over a low trestlework crossing the ditch AA'here the body was found, and AA'hich, though often dry, Avas ac- cessible to tide-water, and at about the time that he started for home the tide AA'as high. AU of his valuables, including money and a costly gold Avatch, were found on his person, and the conclusion Avas Avarranted that DEATH IN ITS MEDICO-LEGAL ASPECTS. 131 in a state of intoxication he had fallen from the trestle and drowned, and by the incoming tide the body had been carried a little farther inland. The ansAver to the question, Hoav long has this body been in the Avater? is of importance, but it can rarely be answered AA'ith exactness, as has been shown in the part of this article Avhich treats of putrefaction. DEATH FROM COLD AND HEAT. While cases of death from extreme cold are of comparatively rare occurrence, they are still Avorthy of some passing mention in a Avork of this character. Of course the cases Avill occur only in the winter time, in the northern part of temperate climates, and in those zones Avhich are known as frigid. The rarity of the occurrence of these cases has left the medical jurist Avith insufficient data from Avhich to draw accurate conclusions as to the post-mortem appearances characteristic of death from cold. Out of some four thousand cases of death from violence which have come under my oavii observation, there Avas only one ease Avhich could be in any Avay attributed to the effect of extremely Ioav temperature, and eA^en in this case the history was such as to render rather obscure the ejuestion AA'hether the death was not caused primarily by the narcotic effect of alcohol, the freezing occurring immediately after death. From an observation of some nineteen cases, Dr. Ogston says that the peculiar appearance in the bodies of adults AA'ho are frozen are: first, an arterial hue of the blood generally, except AA'hen AdeAved in masses wdtliin the heart; second, an unusual accumulation of blood on both sides of the heart and in the large A'essels, and both arteries and A-eins above the chest; third, a pallor of the general surface of the body, an ana'inia of the viscera largely supplied with blood; fourth, the irregular and dusky red patches on limited portions on the exterior of the body in parts not dependent, and AA'hich contrast visibly Avith the pallor of the skin and general surface, On the other hand, Casper says: " There is not one appearance AA'hich can, Avith any certainty, justify the assumption of death from cold." He mentions also that in cases where the ears, the points of noses, and the fingers are1 readily broken off. such appearances have been proclaimed as signs of death from freezing. But this condi- tion only proves that these parts of the deceased had possibly been frozen before death. Of course it is not an infrequent occurrence to find, in Avinter time, on post-mortem examination of bodies, in the IioIIoav organs fluids Avhich have been converted into masses of ice. He further says that the overloading of the A'essels of the brain, lungs, and heart, and large venous trunks, any or all of them, is of no real value in the way of demonstrating death from cold, since this condition is found after other kinds of death; so that, really, the diagnosis is only to be made by considering the AAdiole picture in connection Avith the history of the case, and the absence of CAddence of death from any other cause. But Casper calls atenttion to one point of negative evidence, Avhich is this : if a body found frozen is in a state of commencing or advancing putrefaction, it is quite edear that the indiA'idual did not die from cold, but that the body had already begun to putrefy before the freezing, inasmuch as ice itself is a preservative. 132 A SYSTEM OF LEGAL MEDICINE. In regard to the points made by Dr. Ogston, it is said that the arte- rial hue of the blood is to be found after death in other cases, notably in cases of death from carbonic oxide poisoning. As to the unusual accumulation of blood in both sides of the heart, it is well known that this may be found in cases of death from other causes, as, for instance, in some cases of heart disease. Pallor of the general surface of the body is common to all kinds of death; but as to the dusky red patches which are found in parts other than those dependent, it may be said they are of a certain diagnostic value, but, without corroborating circumstances, would not be in themselves sufficient to warrant an absolute opinion that the death Avas caused by cold. It may be said with regard to the persons who most readily succumb to exceedingly low temperature, that they are naturally those people whose vital pmvers are the feeblest—that is, in the very young and the very old, and those who are narcotized from excessive indulgence in alcohol. And it may also be stated that in the case of the habitual drunkard the pathological changes which have taken place in the tis- sues of the heart render the circulation more feeble, and consequently render the individual himself less able to withstand the effects of the cold. The diagnosis of death by freezing must rather depend upon common sense than upon specific changes found on dissection; and although there have been exceptionally rare cases AA'here death from this cause has been attributed to the intentional act of another, in the vast majority of cases such deaths must be looked upon wholly as the result of accident. Death from the other extreme of temperature—excessive heat—is, on the other hand, of fairly common occurrence. And AA'hile the human body is capable of resisting for a brief period a high degree of tempera- ture, a long-continued exposure to a moderately great eleA'ation of tem- perature, or the exposure a short time to excessively high temperature, results in the destruction of life. There are notable instances of people who are able to bear high tem- perature for an extended period—the firemen or stokers in the engine- rooms of the ocean steamers, AA'here the temperature is often from 145° to 150° F. In the Turkish bath the temperature is sometimes from 180° to 200°. In both of these situations deaths ha"«e occurred. The first effect of heat is to stimulate tremendously the action of the heart, fol- loAved by a feeling of giddiness and suffocation and death by coma; or if the person does not die immediately, it may lead to congestion of the lungs AAdth the attendant feAer. Excessive heat, aside from actual burn- ing, kills by producing apoplexy, and the post-mortem examinations in cases of death from sunstroke haA'e shoAvn that the appearances were those of apoplexy. According to Dr. Tidy, when death has occurred from excessive heat rigor mortis comes on quickly, putrefaction sets in very rapidly, and liA'id spots and petechia? are often found on the body. The brain and its membranes are injected, and serum will be found in excess in the ven- tricles. The lungs are especially dark and injected, particularly the cen- tral and posterior parts and the bases. There are often large pulmonary apoplexies. The heart is generally fiUed AA'ith liquid blood, especially on the right side, and the entire venous system is usually congested; and yet these appearances are by no means constant. PLATE III. **** DEATH B\' BURNING, showing vesicles and contortions of limbs. DEATH IN ITS MEDICO-LEGAL ASPECTS. 133 Death in Consequence of Burning.—Under this head I shall not consider the cases where death is from suffocation by smoke or by the spasm of the glottis in consequence of inhalation of flame. The effects of heat upon the body vary in proportion to the severity, from simple reddening to an entire charring of the body and destruction of the deep- seated parts. Death takes place in two different ways: severe and ex- tensive burns may destroy life from the depression of the nervous sys- tem, OAving to the number of superficial nerves that are affected; or the victims may suffer from inflammatory reaction and from suppuration and fever at a later period, and they may die from the effects of the de- struction of the skin (although the burn may be superficial, yet covering a very large area of the body), the chief gland of the body. The question as to the connection of certain pathological changes in the interior of the body with alleged burns, which have not during life attracted special attention, is not likely to give rise to a great deal of trouble. It is in cases where the appearance of the exterior of the dead body is suggestive of burns that the question might be raised as to whether the burns were inflicted in hfe, or whether after death for the purpose of concealment of crime. The researches of Christison and Taylor, which are practically in agreement, show that the appearance which follows immediately upon the apphcation of heat to the1 living hoclj is a flush of redness around the burned part, removable by gentle pressure, disappearing in time, and not permanent after death. Next to this in order, following almost im- mediately after the injury, is a narrow hne of deep redness, separated by a line of deep whiteness passing into a blush, but not capable of being removed by pressure. This line of redness may be seen after the applica- tion of the actual cautery. The next phenomenon is the appearance of bhsters, which may generally, when the agent is a scalding fluid, appear in a very few minutes, as in young children, or may be delayed for hours. Christison considers that a line of redness not removable by pressure, followed by blisters containing serum, is a certain sign that the burn Avas inflicted during life, while blisters containing only air may be produced by heat after death. In bodies dead thirty minutes he failed to produce such an effect by boiling water or cauterizing-irons. Dr. Taylor arriA^ed at the same results and same conclusions, though he Avarns us that the absence of these blisters does not certainly lead to a conclusion that death was not caused by burning. Casper, after repeated experiments, says: "It is quite impossible to confound a burn inflicted during life with one inflicted after death." The vesicles produced after death are of very small size, do not contain serum, and quickly burst. Ogston's criticisms on these conclusions are, that we not only occa- sionally fail to produce vesication by burning during life, but sometimes even any redness at all of the burned part is not perceptible; and, more- OArer, that vesication without redness on a dead body would not be suffi- cient to warrant the conclusion that the burn had occurred during life, as such bhsters may come from other causes, as was illustrated in the article on putrefaction. In regard to the matter of so-called spontaneous combustion, al- though its occurrence has been claimed by as eminent an authority as Orfila, the possibility of such an occurrence is extremely doubtful. 134 A SYSTEM OF LEGAL MEDICINE. DEATH BY ELECTRICITY. Death from lightning is well known to occur during thunderstorms in the summer time, and in tropical climates; but now that electricity is so largely in use for furnishing power and light, accidental deaths from this fluid are more than ever common. In some of the States of the Union this agent is used for the jmrpose of execution of criminals. The post-mortem appearances in these cases are not particularly marked. There is usually, in death from electricity Avhen used for mechanical purposes, a charring and burning of the parts of the skin which have come in contact with the Avii-es conveying the fluid. An internal examination shows little beside a general fluid con- dition of the blood, and death in the majority of cases is due to shock or neuro-paralysis. In a suburban town some years ago I was cognizant of the case of a young man who had just been acquitted on a charge of attempt to kill, and as he Avas retiring for the night and sitting on the edge of the bedr a bolt of lightning from a thunder-cloud struck the house. Directly afterward the young man Avas found dead. The bolt entered his room, making a small hole as if from a bullet, directly above his head, and the only mark upon his person Avas a small purple spot on the top of his head. The apparent resemblance to the tree under Avhich the deceased had been standing at the time of receiving a fatal shock of lightning found on the body is fancied rather than real, and is only due to the rapid coming on of putrefaction and the showing of the superficial veins. A case occurring in the year 1892, which Avas examined by Dr. Sted- man, has the following history: This man Avas an employee in the poAver- house of an electric-light company. He had occasion to leaA-e his post of duty and walk across the room, when his foot slipped. He grasped an adjacent wire to save himself; the Avire Avas heavily charged Avith elec- tricity, and the man expired almost immediately. The autopsy shoAved a remarkable fluidity of the blood, and slight charring of the hand which had grasped the Avire. Otherwise there was an entire absence of any pathological change to account for the death. DEATH BY STARVATION. Cases of death from starvation are comparatively rare in this coun- try, aside from cases of atresia of the oesophagus and cases of so-called "baby farming," where the child is either insufficiently or improperly fed, and death results either from an absence of food or from inability of the child to assimilate the food with which it is pro\dded. In foreign countries, and in rare instances in America, cases have been reported AA'here attempts at prolonged fasting for pecuniary gain have resulted fatally, or Avhere persons have lain in apparent trance, or sleep, for such a long period that death has sometimes resulted. The cases of prolonged fasting where there has been no apparent diminution in the weight of the body are ahvays tainted with suspicion, and the imposture has often been exposed. In cases where death has occurred from starvation the post-mortem PLATE IV. - " ' "■■'-■' - * v.-V'J 1 ► ARBORESCENT MARKING PRODUCED BY LIGHTNING STROKE. (mackay.) DEATH IN ITS MEDICO-LEGAL ASPECTS. 137 examination should shoAV a great diminution in weight, a dryness and shriveled condition of the skin, and the absence of fatty tissue in gen- eral. Especially the entire absence of omental fat. The separation of the skin from the muscles is attended Avith difficulty. The muscles them- selves are much wasted, the stomach and intestines are generally found collapsed, contracted, and empty, and their mucous membrane is thin and almost transparent. According to Dr. Martin, the intestines in some cases are not only contracted, but shrunken in length as well as caliber, and appear like a mere cord, as if the canal were obliterated. The solid viscera are small, shrunken, and ana?mic. The large blood-vessels are comparatively empty. The gall-bladder is generally full and there is a cadaveric exudation of bile; the urinary bladder, on the contrary, is generally empty. As minor signs may be noted the sunken appearance of the face, the fades hippocratica, the open, staring eyes, generally with dilated pupils, the conjunctiva? sometimes red. The mouth, anus, and other outlets are red and inflamed-looking. Such fa?ces as are contained in the intestines are hard like bullets, and of dark color. Dr. Woodman has found the thymus gland unusually large and persistent in infants who have been badly fed. (Tidy, loc. cit.) This author cites a number of illustrative cases, wliich are of interest as showing how long life can be prolonged without food. One is a case of a prisoner at Toulouse, AA'ho voluntarily starved him- self to death. He lingered till the fifty-eighth day; he, however, did drink water and urine, and died after struggling hours in compulsions. The autopsy revealed unusual pallor of the brain, natural lungs, contrac- tion of the oesophagus, but not of the stomach, which contained a httle fluid; reddening and softening and injection of the lower portions of the small intestines, distention of the gall-bladder AA'ith thick, black bile, and attenuation of the muscles. In the case of Sarah Jacob, the " Welsh fasting girl," who died after a total abstinence from food for at least seven days, and AA'ho was be- lieved to have been an. impostor at the outset of her apparent fasting, but who continued the deception for the purpose of making money until death ensued from her being unable as formerly to obtain food surrep- titiously, the post-mortem appearances were not so marked. They Avere these: the body was plump and weU formed, Avith signs of incipient puberty. There was a layer of fat three fourths of an inch in thickness on the average beneath the skin of the chest and abdomen. The brain was healthy and firm, but the membranes were much injected. The thoracic viscera were healthy, but contained little blood. The stomach contained about three teaspoonfuls of dark gelatinous fluid having slight acid reaction. The small intestines were empty, but the colon and rec- tum contained about half a pound of fa?ces in a hard state. The gall- bladder was distended and the urinary bladder was empty, and there was nothing else unusual noted. In the cases of death from baby farming which I have seen, the appearances have corresponded very closely with the general signs as described by Tidy: great emaciation, absence of fatty tissue, fullness of the gall-bladder, and emptiness and contraction of the alimentary canal. The eyes were also sunken, open, and staring, though the condi- tion of the pupils has been \'ariable. BLOOD AND OTHER STAINS. BY JAMES F. BABCOCK. In many trials for homicide, especially in cases where the eAddence is circumstantial, questions arise concerning spots or stains found upon clothing, weapons, furniture, carpets, Avails, or other objects, and the scientific witness is expected to answer whether or not the stains are of blood or some other substance. If blood, are the stains old or com- paratively recent ? What was their origin ? Are they human, or from some domestic animal? Are they stains of venous, arterial, or men- strual blood? Was the blood from a living or a dead body? Male or female f Adult or child ? To some of these questions ansAvers may be given Avhich are perfectly definite and reliable, but as to others it can only be replied that our pres- ent knoAvledge furnishes insufficient data for any certain conclusions. In giving the results on these matters to which science leads us, we shall first briefly state the various physical and chemical properties of blood as it is found in man and animals, and then fully explain the appli- cation of these facts to the practical operations necessary for the solu- tion, so far as possible, of the different questions Ave have stated. CHEMICAL AND PHYSICAL PROPERTIES OF BLOOD. Fresh blood is an opaque and someAvhat viscous fluid slightly heaAuer than Avater. Its specific graAdty, on the average, is in normal blood 1.055, but it is slightly less in women and children. In the higher animals the gravity is substantially the same as in man. The color of blood varies from a bright scarlet to a deep purple, ac- cording as it floAvs from an artery or a vein. In very thin films as obsei-Aed in the microscope, it is transparent and nearly colorless. The variations in color of venous and arterial blood are due to the degree of oxidation of the coloring matter, called hasmoglobin ; hence, venous blood on exposure to the air becomes brighter, and arterial blood in certain diseases dependent upon a reduction in the supply of oxygen (asphyxia, etc.) is dark. On leaving the body the blood becomes gelatinous (coagu- lation), the change taking place in from three to fifteen minutes. Grad- ually, certain portions (coagulum) shrink in volume, and after a period of from twelve to forty hours there is a complete separation into thick red clots and a yellowish watery fluid (serum). The coagulation of the 139 140 A SYSTEM OF LEGAL MEDICINE. blood may be hastened or retarded by a A'ariety of circumstances. Mod- erate warmth accelerates, AA'hile cold retards coagulation. Access of air promotes coagulation, hence blood in thin layers thickens more rapidly than when it exposes a more limited surface1. Coagulation takes place more readily AA'heii the blood flenvs upon rough surfaces; on cloth blood becomes clotted quicker than upon a smooth marble floor or polished furniture. Chemical Composition of Blood.—1000 parts of blood contain, on the average, 795 parts of Avater and 205 parts of solids. The solids consist of albumen, fibrin, coloring matter containing iron, called haunoglobin, cholesterin, and fatty bodies, various salts and extractive matters. The salts contain chlorin, sulphuric, phosphoric, lactic, oleic, stearic, uric, and hippuric acids, combined with potassium, sodium, calcium, and magne- sium. The extractive matters contain small amounts of sugar, leucin, tyrosin, xanthin, creatin, and other substances. When examined by the microscope, blood is seen to consist of a colorless fluid (liquor sangui- nis) in which are suspeneled large numbers of cell-like bodies called blood- corpuscles. One thousand parts of the liquor sanguinis and of the blood-cor- puscles contain: Blood-Corpuscles. Liquor Sanguinis. Water............... 688.00 parts. Water............... 902.90 parts. Solid constituents--- 312.00 " Solid constituents___ 97.10 " 1000.00 parts. 1000.00 parts. The sohd constituents of each of these portions consist of: Haemoglobin......... 298.97 parts. Albumen............. 78.84 parts. Fat.................. 2.31 " Fibrin............... 4.05 " Extractive matters--- 2.60 " Extractive matters___ 3.94 " Mineral salts......... 8.12 " Mineral salts......... S.r>,A " Fat.................. 1.72 " 312.00 parts. 97.10 parts. The blood-corpuscles in their moist condition constitute about fifty percent. (47.2 to 54.2) of the total weight of the blood, and have a spe- cific-gravity of 1.088. The specific gravity of the liquor sanguinis is Of the various bodies entering into the composition of blood, there are only two which are of interest or importance to the medical jurist in his study of blood and blood-stains—hcemoglobin, AA'hich contains the coloring matter, and the blood-corpuscles. The chemical and spectroscopic phenomena produced by hsemoglobin afford positive evidence of the pres- ence of blood, from whatever source it may haA'e been derived; and the microscope, aided by the micrometric measurement of the diameters of the blood-corpuscles, gives all that may be determined eoncernino- the origin of the blood, and Avhether it be human or otherwise. Haemoglobin.—The coloring matter of blood, now generally caUed hmnoglobin, Avas first described by Le Canu under the name of ha?matin. (Xouvelles Etudes Chimiques sur le Sang, Paris, 1852.) Stokes called it cruorin, and showed that it Avas capable of existing in two forms or states BLOOD AND OTHER STAINS. 141 of oxidation. Scarlet cruorin was the name given to the product found in arterial blood, and purple cruorin to that found in venous blood. (Stokes, Proc, Roy. Soc, 1804, p. 355.) Sorby described an intermediate body under the name of brown cruorin. (Sorby, Monthly Micros. Jour., London, vol. vi., p. 9.) Thudicum and Kingzett'adopted the name 1mm- ato-cvystallin. (Jour. Chew. Soc, London, September, 1876.) When blood defibrinated by whipping is mixed with a 3^-percent. solution of common salt, the corpuscles are gradually deposited, and the supernatant liquor may be decanted. On washing the deposit AAdth a fresh portion of the salt solution the corpuscles are obtained free from serum. They consist of a stroma or colorless skeleton containing ha?mo- globin, a little cholesterin, paraglobulin, fatty matters, and mineral salts. If the Avashed corpuscles are shaken with water and ether, the stroma, cholesterin, and fatty matters are taken up by the ether, while the color- ing matter of the blood passes into solution in the Avater. On exposure to a Ioav temperature a deposit of crystals is formed. They consist of haemoglobin. One half its volume of "alcohol may be added to the aque- ous solution to promote crystallization. Ha?moglobin thus obtained con- sists of several proximate principles: an albuminous substance, AA'hich, when separated, is amorphous and colorless, and a crystalline boely, called Immatin, having a formula C32H32FeN406. (Kingzett.) Haemoglobin is perfectly and freely soluble in water and dilute alcohol. By the action of acids or alkalies, or of any reagent capable of coagulating albumen, it is separated into haematin and the albuminous body above mentioned. The same change is produced by long exposure to the air, or by a shorter exposure to air containing considerable moisture or impurities such as are found in the atmosphere of cities. Exposure for a shorter period produces a broAvn substance intermediate between haemoglobin and haem- atin, called met-hamoglobin. Haematin—Ha?matin is insoluble in water and ether, but is very slightly soluble in alcohol. It readily dissolves in ammonia AA'ater and in solutions of sodium and potassium hydrate. It is soluble in dilute acids, and especially in dilute citric acid. It is a A'ery stable body, and when once formed may remain unchanged for years. If ha?matin or dried blood is heated with glacial acetic acid and a small amount of com- mon salt, and the solution eA-aporated, a neAv combination is produced. It is generally considered to be haematin hydrochloride, but Avas named Jmmin by Teiehmann, its discoArerer, and it is by this name that it is generally called. It crystallizes readily from its solution in hot acetic acid. Haemin crystals are insoluble in Avater, alcohol, ether, and dilute acids, but are sparingly soluble in ammonia water, and freely soluble in solution of sodium or potassium hydrate. Recapitulation.—Fresh and unaltered blood yields crystals of luemo- globin. Oxidized blood or dried blood contains 1mm at in. Dried blood or blood treated Avith glacial acetic acid and salt yields Immin. Fresh blood-stains are bright scarlet, and yield their coloring matter very readily to cold water. Hot Avater renders the stain more or less insoluble, on account of the coagulation of the albumen, while soap and AA'ater have a tendency to fix the color, from the conversion, in consequence of the presence of the alkali, of haemoglobin into luematin. 142 A SYSTEM OF LEGAL MEDICINE. Less recent stains are reddish broivn or dark brown in color. They eon- tain met-hcemoglobin. They yield but little of their coloring matter to water, while very old stains yield no coloring. Such stains are soluble in dilute citric acicl, and giA'e up their coloring to ammonia water. Optical Properties of BIood=Coloring Matter.—AVhen a solution of the coloring matter of blood is examined by the spectroscope, certain dark spaces called absorption-bands are observed. These bands in num- ber and position Arary according to the elegree of oxidation of the blood- coloring matter or the presence1 of reagents. The study of the absorption- bands under different conditions has led to the discovery of a method (spectrum analysis) which may be relied upon Avith absolute certainty for the identification of blood and for distinguishing it from all other substances. A brief description of the principles involved in this method and the apparatus employed for the purpose is here given. Spectrum Analysis and the Spectroscope.—When a beam of light is passed through a narrow slit of 1-100 to 1-1000 of an inch in Avidth, and then through a prism and allowed to fall upon a white screen, an elongated colored image is produced containing all the brilliant hues of the rainboAV. If the light be passed through several prisms no additional colors are produced, but the image is lengthened and the colors more widely sep- arated. This image is called the spectrum. If it be observed through a magnifying-lens or a small telescope, it is found to be crossed at right angles by numerous dark lines. These lines Avere first carefully observed by Fraunhofer in 1815, and have since been called Fraunhofer's lines. This observer found that the lines always kept their position, provided the same prism and lenses Avere employed, and he made a map or chart of them. He selected eight of those which appeared wider than the others, and named them by the letters of the alphabet from A to H. These lines have been adopted as standards of comparison for denoting the position of any set of colored rays which may be submitted to exam- ination. Lines A and B are in the red portion of the spectrum; C, in the red, near the orange; D, between the yelloAV aud the orange; E, in the green; F, on the borders of the green and blue ; G, in the dark blue ; and H, at the extreme end of the violet. Kirchoff in 1859 proved that Fraunhofer's lines were due to the presence of certain gases in the solar atmosphere Avhich have the power of absorbing the same rays of light as. those emitted by the heated body producing them. Later it was found that various colored solutions hael a similar property, so that light passed through them produces a spectrum crossed by dark bands (absorption- bands), which vary in position and intensity according to the nature of the substance or its strength of solution. An instrument adapted to the examination and study of the spectrum or its absorption-bands is called a spectroscope. The ordinary form of instrument such as is used in lab- oratories for the analysis of colored flames is not adapted to the exami- nation of the absorption-bands of blood, although it may be used in the absence of one specially designed for this purpose, called the microspec- troscope, and sometimes described as the spectrum-microscope. It consists of a series of prisms so arranged that they may be attached to the micro- scope either above the eye-piece or in the ordinary position of the object- glass. The best forms are proAuded with a scale, which enables the exact position of the bands to be determined, and a supplementary stage, by which the spectrum of one body may be compared with another, the two BLOOD AND OTHER STAINS. 143 spectra being visible side by side at the same time. Sorby in 1866 sug- gested the form of instrument generally used. Its essential features are shoAvn in the accompanying outhne. Two rectangular prisms of flint-glass are separated from each other by a prism of crown-glass, and two other similar prisms are attached one on each end of the combination. These are cemented Avith Canada balsam. This compound prism is mounted in a tube, F, haAdng a cap with an elongated opening at A and a circular stop at B. The tube is constructed so that it may be slipped over the upper lens of the eye-piece. The upper lens, Of, is compound and achromatic, and is mounted so that the focus may be adjusted by suitable rackwork or by turning the milled head, H. At I is a sht capable of being adjusted to a wider or narrower lnn"1 —r-'-1"1 i"i,™,ni i ..»■»■" Fig. 9. The Microspectroscope. Fig. 10. Zeiss's Microspectroscope. opening, and a right-angled prism, C, is fixed half-way over it. By this means light passing through an opening at E is reflected through half of the slit, Avhile light coming through the field-glass from the object passes through the other half. In this Avay may be seen side by side the spec- trum of the hght passing from the object under examination and that produced by the light coming from the stage E, which holds the stand- ard for comparison. The supplementary stage has an adjustable sht by which the two spectra may be made to appear of equal brilliancy. # The solution or object to be examined is placed upon the stage of the miscro- scope and strongly illuminated by the mirror; the standard for compari- son is contained in a sealed tube held by springs on the stage E Fig. 10 represents the spectroscopic eye-piece made by Zeiss. In this 144 A SYSTEM OF LEGAL MEDICINE. instrument the tube containing the prisms may be turned to one side while the object is being adjusted upon the stage It has also a scale, an image of which is projected upon the field of the spectrum It has the disadvantage of being unprovided with the supplementary stage tor the comparison of spectra. Messrs. R. and J. Beck of London construct a microspectroscope which is attached below the eye-piece m the position of the object-glass. This form has been highly recommended as being more simple in its arrangement and more easily manipulated, particularly in cases where two similar spectra are to be compared. . For the examination of liquids, glass cells like those slie»wn in r ig.11 may be employed. The form, A, is made from thick tubing hke that used for barometers. About one-half inch in length is cut off, the ends ground to a square surface, and the tube cemented to an ordinary glass slide with Canada balsam. Tubes of varying lengths are convenient tor giving greater or less depth of liquid according to its intensity of color. Sorby recommends wedge-shaped cells "like B. In these cells the thick- ness of the solution may be about one-fourth inch on one side and one- fortieth on the other. The effect of varying thickness of the solution is then readily observed. The ceUs should have* a thin cover placed over them, and be completely filled with the fluid under examination. The cover readily adheres by capillary at- traction. A reduction of the amount of light transmitted through the slit is equivalent to an increase in thick- ness of the fluid, so that by varying the width of the opening in the stage attached to the eye-piece the spectrum is modified as much as if a change were made in the depth of liquid. Various methods have Deen devised for measuring the exact place of the absorption-bands. This is some- times useful, but it is advisable in the examination of blood-stains to compare the spectrum of the suspected stain with that produced by specimens of known origin, rather than rely upon the position of the bands with reference to the projected scale, since this is hable to varia- tion bv various adjustments of the instrument. Spectroscopic Appearance of Haemoglobin and its Derivatives.— When a concentrated solution of haemoglobin is examined by the spec- troscope, all hght is excluded except the red. On diluting the solution with water, green and blue light passes, while in the yehow and the be- ginning of the green portion of the spectrum a dark space makes its appearance. StiU further dilution effects the resolution of this dark space into tAvo absorption-bands near the lines D and E of the spectrum: the one nearest D is narrower, darker, and better defined than the other. The band at E has more than double the width of the other, and is some- what weaker. These bands, called oxy-hamoglobin bands, were discovered by Hoppe-Seyler in 1862. A proper dilution is one part of defibrinated blood in eighty parts of water viewed through a depth of one-half inch. (PI. V., No. 1. * Absorption-bands of oxy-hcemoglobin.) Fig. 11. Cells for the Microspectroscope. Plate V. B C OXY-HEMOGLOBIN, REDUCED HEMOGLOBIN. ACID H/EMATIN BLOOD AFTER EXPOSURE. BLOOD AFTER LONGER EXPOSURE. REDUCED H/EMATIN. AMMONIATED CARMINE. J.F.B.Del. ABSORPTION SPECTRA. BLOOD AND OTHER STAINS. 147 If to the solution of blood-coloring matter used in the last experi- ment there be added a drop or two of solution of ferrous ammonium sul- phate (double sulphate of iron and ammonia), or a solution of ferrous sulphate mixed Avith a small amount of potassio-sodic tartrate (Ro- chelle salt), and then a very httle ammonia water, the ha?moglobin is altered chemically (deoxidized), and is called reduced haemoglobin. An examination of the spectrum of this new product shows but one broad band in the place of the former two. This band was discovered by Stokes in 1864, and is called the reduction-band of haemoglobin. It is also sometimes referred to as Stokes' band. (PI. V.,Xo.2. Absorption-band of reduced luvmoglobin.) Agitation with air causes the two bands to reap- pear. The spectrum showing two bands is characteristic of arterial or oxidized blood, and the single-handed spectrum is peculiar to venous or deoxidized blood. A solution of ha?matin in a little alcohol to which a small crystal of tartaric acid has been added shows a very broad band in the red (C), another in the green between D and E, and by very careful management of the light a third very faint band in the blue between E and F. If the solution be made strongly alkaline with ammonia the band at C dis- appears. The subsequent neutralization of the ammonia by acid does not restore it. These bands are called the acid and alkaline bands of Immatin. They vary somewhat in number and position, according to the kind and quantity of acid used. (PI. V., Xo. 3. The acid band of haematin.) A solution of the coloring matter of blood obtained from a stain which has been but a short time exposed to the air shows the two bands of haemoglobin, but they are weaker than is the case with fresh blood. There is also a third band in the red, near the line C. (PI. V., Xo. 4. Absorption-bands of solution of blood-coloring having but a short exposure to the air.) With a solution from blood which has been long exposed to the air the band in the red (C) is wider and darker, while the others are much weaker. (PI. V, Xo. 5. Absorption-bands of blood solution after long ex- posure.) The addition of ammonia to such a solution causes the band in the red to disappear, but it causes the bands in the green to become much more distinct. The effect of reducing agents added to a solution of blood obtained from a stain after prolonged exposure is shown in PI. V., No. 6. The tAvo bands are much darker, and perfectly well defined. They closely resemble the bands of ha?moglobin, but are a little farther to the right. In very dilute solutions the band at the right may fail to make its ap- pearance. (Sorby, Monthly Microscopic Journal, London, vol. vi., p. 9.) (Suffolk, Speetntm Analysis Applied to Microscopical Observation, Lon- don, 1873.) (Prever, Die Blutkrystalle, Jena, 1871.) (Thiidicum, Chemical Physiology, New York, 1872.) (Rosenberg, The Use of the Spectroscope, New York, 1876.) Crystalline Bodies obtained from Blood=Coloring Matter.—From fresh blood crystals of haemoglobin (oxy-ha?moglobin) may be obtained which show some differences in crystalline form, according to the source whence they are derived. Blood-crystals were first observed by Funke 148 A SYSTEM OF LEGAL MEDICINE. in 1851. (Zeitschrift fur rat. Med., vol. i., p. 148.) They may be pro- duced from blood by mixing it Avith about one sixteenth its volume of ether and shaking the mixture until the liquid becomes a clear lake color. Sometime's the crystals form in a few minutes, and sometimes seA'eral days are required to develop them. A single drop of blood should be mixed AA'ith a very little ether and covered Avith a thin glass. Crystals are obtained less readily from the blood of the1 ox, pig, pigeon, and frog than from the bloexl of man, mouse, rabbit, and sheep ; they are easily obtained from the blood of the dog, rat, squirrel, and guinea-pig. In the majority of animals the crystals are in the form of prisms belong- ing to the rhombic system; in the guinea-pig they are rhombic-tetrahedra, and in the squirrel they are hexagonal. They have a light-red color when observed Avith a microscope of low poAver, and appear of greater or less intensity of color according to their thickness, A-arying from purplish red to a peach-blossom. The tetrahedral crystals are much more soluble than those AA'hich assume the prismatic form, AA'hile the solubihty of the hexagonal plates is someAvhat greater than that of the prisms, but less than is the case with the tetrahedra. The general Crystals from Man and most of the Carnivora. Crystals from the Squirrel. Crystals from the Mouse. Fig. 12. Haemoglobin Crystals. appearance of these crystals is shown (after Funke) in Fig. 12. (Atlas de Physiolog. Chemie, Leipzig, 1853, Tl. x.) Crystals can be obtained only from fresh blood, or a moist clot not more than a day or two old. They are not characteristic of the blood of any particular genus, since all of the forms have been found in the blood of several different animals. BLOOD AND OTHER STAINS. 149 As already stated, haemoglobin by exposure to air or by the action of reagents is changed into haematin. " Haematin, being insoluble in water, yields crystals only from its solution in acid. Teichmann in 1853 found by treating dried blood with strong acetic acid in presence of common salt that small crystals entirely different from haemoglobin were pro- duced. They have been found to be haematin hydrochloride, and are commonly caUed 1mmin, and sometimes Teichmann's crystals. (Zeitschrift fur rat. Med., Zurich, vol. hi., p. 375.) Most minute traces of blood will yield these crystals, and all authorities agree that they can be produced from no other substance. They assume the form of slender prisms Avith irregular rhombic terminations. They are frequently found in stellate groups and in the form of an X. They vary considerably in size, ac- cording to the strength of the solution, and are identical in composition and crystalline form in all of the different kinds of blood AAdiich have been examined. Haemin crystals are obtaineel by heating a drop of fresh or a smaU particle of dried blood with a trace of salt and glacial acetic acid. The materials are placed in the center of a microscope-shde and heated until by the evaporation of the acid the liquid begins to solidify. In some cases the microscope shoAvs transparent cubical crys- tals mixed with the crystals of haemin. These are scope, the broAA-n matter was found to contain corpuscles similar to those of blood. The stain, hoAvever, failed to give any haemin crystals when this test was apphed, and this caused Erdmann to enter- tain doubts as to the value of the other tests. He repeated the micro- scopical examination with greater care, and then discovered that the bodies supposed to be blood-corpuscles Avere the spores of an alga, prob- ably porphyridium cruentum, a A'egetation so named on account of its resemblance to blood. The disks found in pine, spruce, cedar, and other coniferous Avoods, the excrements of the cimex, spheroidal crystals of ammonium urate, oh- globules, air-bubbles, etc., are mentioned by writers as possible causes of error in suspected stains, but no microscopist of experience can possibly mistake any of them for blood-disks. The only dangerous fallacies are to be found in bacteria and spores. Bacteria are Aery much smaller than blood-corpuscles. The micrococcus known as p>rodigiosus, which in masses appears to the naked ejTe like fresh blood, has not one tenth the diameter of a blood-disk. But there are spores of various fungi and algae which in many instances have the same diameter as blood-corpus- cles. The spores of porphyridium mentioned in Erdmann's case measure from 1-2900 to 1-3700 of an inch in diameter. (Rabenhorst.) Some of the fluids which have been recommended by certain writers for soaking out the corpuscles from blood-clots, particularly sodium sul- phate, sodium phosphate, and glycerin solu- tion, if too much diluted will, in a few days, if kept in a Avarm place, develop spores some of AA'hich closely resemble decolorized blood- corpuscles. Richardson, referring to a preparation recommended by several writers, a saturated solution of sodium sulphate, says : " It must, I think, OAve its popularity chiefly to the fact that it contains large quantities of fungus, the spores of which resemble blood-corpuscles both in size and general appearance, and have, I have no doubt, frequently been mistaken for blood-cells." (Amer. Jour. Med. Sciences, vol. lxviii, p. 109.) Under the action of water, blood-corpus- cles become globular and finaUy transparent and invisible, but spores are not in any way changed in appearance under the same circumstances. Spores are never "disk-shaped, though they often Fig. 16. Blood-clot and Various Spores. (750 diameters.) BLOOD AND OTHER STAINS. 171 appear so. They are frequently oval and often circular; they may have buds upon them, and they are generaUy found in groups of two, three, or more. Close examination will, in many cases, show an interior struct- ure whoUy different from a blood-corpuscle. That they are a dangerous source of faUacy is proved by the instances we have given, and the ob- server should make it a rule to first micro- scopicaUy examine the preparation with which he intends to soak up a suspected stain, and use only fresh or recently made solutions. Materials found Associated with Blood. —IncidentaUy to the microscopic examina- tion of suspected stains in the search for blood-corpuscles, other bodies may be discovered, of Avhich careful note should be made. These may be one or more of the fol- lowing : fibers of silk, IVOOl, Cotton, or linen; Fig. 17. a, Cotton Fiber; b, Air Bubbles; c, Portions of Feather; fragments Of mineral d, Silk; e, Oil Globules. (After Hofmann; 300 diameters.) substances, as sand, earth, bits of metal, etc.; hairs of various kinds, barbules of feathers, vege- table tissues, grass, wood, etc.; particles of bone, muscular fiber, cerebral mat- ter, epithelium, etc. AU such substances should be carefully preserved. They may furnish important evidence as to locality or circumstances. The limits of this article do not permit the discussion of the means of identification of these bodies, and the reader is referred to any good work on the microscope, as the treatises of Carpenter, Frey, Beale, and others. MEASUREMENT OF BLOOD-CORPUSCLES. If blood-corpuscles are found by the microscopic examination, it AviU be necessary to measure them. There are several methods by which this may be accomplished: (1) By the screw micrometer. (2) By photography. (3) By the eye-piece micrometer. The last is the most common as weU as the most convenient method, and is the only one which Ave shall describe. The eye-piece micrometer in its simplest form consists of a circular glass plate ruled with fine hnes (Fig. 17, B), which is cemented upon the diaphragm of the eye- piece between the field-glass and the ocular lens. The best arrangement 172 A SYSTEM OF LEGAL MEDICINE. is that of a thin brass slide holding the ruled glass, which is inserteel through a sht in the side of the eye-piece and has at one end a screw by which the micrometer can be given a slight lateral motion. The object to be measured is observed through the glass micrometer; one side of the object to be measured is brought exactly up to one of the lines, and the number of spaces which the object covers is carefully counted. The value of the spaces of the eye-piece micrometer is merely rela- tive, and dependent upon different objectives and varying aeljustments of the instrument The value of the spaces is determined by a stage micrometer. This consists of a piece of ruled glass with spaces of 1-1000 of an inch. These spaces, when magnified and seen through the eye-piece micrometer, are covered by a certain number of lines in the latter. With a given objective, a 1-1000 space, for example, may be magnified until it covers five lines in the eye-piece; one of the latter spaces, therefore, measures 1-5000 of an inch. In most cases the eye- piece micrometer wdl not cover any certain number of full spaces, but there will be so many spaces and a fractional part of another space. In such cases the draw-tube of the instrument must be extended until the increased amplification makes the space of the stage micrometer equal to a number of full spaces in the eye-piece. For convenience of calculation the number of these should, if possible, be some multiple of five or ten. If, under a high power (2500 diameters), forty spaces in the eye-piece are required to cover one space (1-1000 inch) of the stage micrometer, one space of the former wiU indicate 1-40,000 of an inch. Fig. 18, A, repre- sents a portion of an eye-piece micrometer under a micrometry of 40,000, and the concentric circles the outlines of blood-corpuscles of man, the dog, rabbit, ox, and sheep. The largest corpuscle covers 12£ spaces; its measurement is therefore 12.33-40,000 of an inch. Reducing this fraction to its simplest form, Ave obtain 1-3244. In the same manner we find that the corpuscle of the sheep covers 7| spaces, and there- fore measures 7.75-40,000, which equals 1-5161. We cannot enter further into the minute detahs of micrometry, but must not omit a single most im- portant suggestion. No perfect stage micrometer was ever produced, and the observer must carefuUy com- pare and calculate the true value of each space which forms the basis of his measurements. An otherwise valuable piece of testimony may be completely shattered by a single question on cross-examination: " If you have not verified your micrometer, how do you know that your measure- ments are correct ?" Fig. 18. Eye-piece Micrometer. THE DISTINCTION BETWEEN HUMAN AND OTHER BLOOD. It is only by the microscope that any satisfactory distinction can be made between human and other blood. Various methods have been suggested depending upon other principles, but they have been found to be unreliable or impracticable in their application to dried stains. Bar- ruel's process depends upon the production of an odor characteristic BLOOD AND OTHER STAINS. 173 of the particular animal when fresh blood is mixed with sulphuric acid (Annates de Hygiene, 1829.) Taddei proposed to distinguish human blood from that of animals by the degree of fluidity produced in a com- pound of blood and carbonate of copper when treated with sulphuric acid. (For an account of Taddei's process, caUed haematoUoscopy, and also Ban-uel's method, see Fleming's article on blood-stains in Am. Jour Med. Sciences, vol. xxxv, p. 98,1859.) Neumann claims that blood evap- orated at a temperature of 60° F. gives a resielue exhibiting certain appearances called " blood pictures," which are characteristic of different animals. (Die Erkeunung des Blutes, Leipzig, 1869.) There are two marked points of difference, under microscopic exam- ination, between mammalian and oviparous blood: 1. The circular out- line of the corpuscles of the former, in contradistinction to the oval shape of the latter; 2. The presence of a nucleus in oviparous, and its absence in mammalian, blood. Whether the stain be fresh or dry, re- cent or very old, these differences are apparent and unmistakable. Many instances have occurred in murder trials in which the defendant has claimed that stains on his clothing were produced by the knling of a f oaa-1 or were due to the blood of fishes. In aU such cases, the falsehood, if it be one, is easily proved. The possibility of distinction between the blood of man and the other mammalia has been claimed by several eminent authorities, including Schmidt, Richardson, Formad, Wormley, and Reese, and strenuously denied by others, especially by Woodward and EweU. Nearly aU Avriters on medical jurisprudence express grave doubts as to the value of opin- ions based upon variable fractional differences obtained by comparative measurements of corpuscles derived from dried stains. The blood-corpuscles of most of the mammalia are smaller than those of man, so that when human blood is compared with that of the ox, for example, each being in a fresh state, by examining the specimens side by side upon the same slide (for an account of Richardson's method of preparing such slides, see American Xaturalist, May, 1876) a difference in the diameters of the two is, even to the most careless observer, clear and unmistakable. The diameters of the corpuscles of a large number of animals have been measured and their averages recorded. Suppose now that a speci- men of mammalian blood of unknown origin and in a dried state upon cloth is subjected to microscopic examination: within what limits is the observer warranted in expressing his opinion as to its origin ? In ansAver to this inquiry, we remark that there is no fixed or invari- able average for the diameters of the blood-corpuscles of any animal. It is true that the average does not vary beyond certain limits, but these limits have been shoAvn by the observations of Woodward and EweU upon the corpuscles of man and the dog to be much greater than for- merly supposed. Not only is this true, but the averages given by differ- ent observers, AArhile agreeing closely in some instances, show consider- able differences in others, so that, assuming the principle involved in this method of comparison to be correct, " it entirely depends," as Formad observes, " upon whose figures we accept whether we can or cannot dis- criminate between human blood and the blood of certain other animals." The foUoAving tables giA-e the average measurements of the blood- corpuscles of man, dog, guinea-pig, rabbit, rat, mouse, opossum, wolf, 174 A SYSTEM OF LEGAL MEDICINE. ass, pig, ox, cat, horse, sheep, and goat, according to different observers. The figures represent fractions of the inch, and the measurements are of fresh blood dried upon glass. Man. Woodward (1876)......., Ewell (1890)............ Gulliver (1875)......... Formad (1888)........... Richardson (1876)...... Wormley (1885)........, Masson (1885). ..■....... C. Schmidt.............. Malinin (1875)........... Woodward (1875)........ Kollicker............... H. Schmid (1878)....... Harting................, Robin.................. Taylor......................1 Flint........................1 -3092 -31612 -3200 -3200 -3224 -3254 -3257 -3267 -3300 -3379 -3390 -3412 -3436 -3484 -3500 -3500 Rabbit. Gulliver.....................1-3607 Masson.....................1-3636 Wormley....................1-3653 Formad.....................1-3662 Schmidt.....................1-3968 Rat. Wormley....................1-3652 Gulliver.....................1-3754 Schmidt.....................1-3968 Schmid.....................1-5000 Fig. Schmidt.....................1-4098 Masson.....................1-4098 Gulliver.....................1-4230 Formad.....................1-4250 Wormley...................1-4268 Ox. Formad.....................1-4200 Wormley....................1-4219 Masson.....................1-4237 Schmidt....................1-4254 Gulliver.....................1-4267 Welcker....................1-4545 Schmid.....................1-4695 Sheep. Wormley....................1-4912 Formad.....................1-5000 Welcker....................1-5076 Gulliver.....................1-5300 Schmidt....................1-5649 Schmid.....................1-6060 Dog. Woodward..................1-3246 Gulliver.....................1-3395 Welcker....................1-3485 Wormley....................1-3561 Masson.....................1-3577 Formad.....................1-3580 C. Schmidt..................1-3636 H. Schmid..................1-3846 Guinea-pig. Woodward..................1-3213 Masson.....................1-3300 Formad.....................1-3400 Gulliver.....................1-3538 Opossum. Wormley....................1-3145 Gulliver.....................1-3557 Wolf. Wormley....................1-3422 Formad.....................1-3450 Gulliver.....................1-3600 Ass. Wormley....................1-3620 Gulliver.....................1-4000 Mouse. Wormley....................1-3743 Gulliver.....................1-3814 Schmidt....................1-4000 Cat. Welcker....................1-3922 Wormley....................1-4372 Masson.....................1-4400 Schmidt....................1-4545 Horse. Wormley....................1-4243 Formad.....................1-4310 Schmidt.....................1-4464 Welcker....................1-4545 Gulliver.....................1-4600 Goat. Welcker....................1-5525 Formad.....................1-6100 Wormley....................1-6189 Gulliver.....................1-6366 Schmidt.....................1-6369 The subjoined diagram represents the apparent areas of the corpus- cles of these animals (except the ass and wolf) according to the tables. The outside columns represent respectively the highest and the lowest BLOOD AND OTHER STAINS. 175 Man. Opossum. Guinea-pig. Dog. Rabbit. Rat. average of any observer, while the middle column represents the averages of the averages. It is obvious that the blood of some of the common animals cannot be distinguished from that of man even in a fresh state. Formad (Jour, of Comp. Med., 1SSS, vol. ix., p. 269) attacks the measurements of WoodAvard, and endeaveus to prove that they are erroneous. To this it may be re- plied that if it be possible that so distinguished a microscopist as WooelAvard did make an error, it demonstrates that the conclu- sions drawn from measurements of a less competent observer Avould be of little Aalue as evi- dence in a capital trial. There is no doubt, however, that micrometric measurements are liable to error. In order to ascertain the relative accuracy of such determinations made by different competent observers, EavcU ruled a glass slide Avith fifteen lines, making spaces ap- proximately of 1-250 to 1-125 of an inch, and caused the same to be measured by six Avell-knoAvn microscopists, Avho Ave re instruct- ed to take the mean of at least five measurements of each space. Using stanelard micrometers by the same maker, the result shoAved that the measurements of the same space bv different observers varied from 0 to 1-9090. This is a greater difference than that be- tween the average diameters of the blood-corpuscles of man and any of the common domestic ani- mals except the sheep and goat, according to all observers. On the other hand, Wormley and tAvo others measured ten lines of the 1-1000 divisions of a stage mi- crometer, and it Avas found that theAr agreed in the several read- ings AAdthin 1-200,000 of an inch. The uncertainty of discrimination between human blood and that ot other mammals does not depend upon possible errors of measurement. Mouse. Horse. Sheep. Goat. Fig. 19. Diagram representing the Compara- tive Sizes of the Red Blood-Corpuscles of various Animals. (1450 diameters.) 176 A SYSTEM OF LEGAL MEDICINE. Gulliver, referring to his own extensive measurements of corpuscles, says: "Special circumstances, too, of AA'hich aac have not yet sufficient knowledge, may affect the A-alue of any series of such measurements as are recorded in these tables. When the bird is much excited and the circulation quickened by attempts at its capture in an aviary, the oval figure of its red blood-corpuscles may be more elongated than in the same bird when quietly at rest; . . . and my attention Avas sometimes arrested by like diversions in other vertebrates at different times and seasons, though not in so many observations, and Avith such notes as would be needful for satisfactory conclusions. But the facts are suffi- cient to show that exact and extensiAe investigations are yet necessary on the comparative magnitude of the red corpuscles and their aggregate proportion to the other parts of the blood at different seasons and under different circumstances. For example: Avhether minute diversities in the corpuscles may not be found in man at the tropics and at the frigid zone; in animals at rest and during violent exertion; in hibernating animals during summer and Avinter; in species subject to periodic changes in temperature." (Proc. Zoolog. Soc, London, 1875, p. 477.) Woodward measured 1766 corpuscles in groups of 22 to 140 upon twenty-two photographic negatives taken from the blood of eight per- sons, and found averages * as foUoavs : 1-2915 1-3049 1-3068 1-3165 1-3215 1-2967 1-3058 1-3068 1-3165 1-3236 1-2985 1-3058 1-3125 1-3175 1-2994 1-3068 1-3135 1-3185 1-3021 1-3068 1-3155 1-3205 General average of 1766 corpuscles, 1-3090. (Trans. Am. Med. Asso., 1876, vol. xxvii., p. 303.) In another series of measurements of 651 corpuscles in groups of 50 each Woodward found the averages to be: 1-3289 1-3356 1-3379 1-3425 1-3472 1-3333 1-3367 1-3400 1-3448 1-3344 1-3367 1-3425 1-3460 General average, 1-3379. (Am. Jour. Med. Sciences, 1875, vol. lxix., p. 151.) Ewell obtained the foUowing averages: Man (plumbism), t. 100 ..1-2950 Man (tuberculosis), u 100 ..1-3048 Man (gastritis), it 100 ..1-3067 Man (normal), u 100 ..1-3162 Man (anaemia), u 100 . 1-3311 (North American p» actitioncr, 1890, pp. 9 151.) In the dog Woodward reports the averages obtained from 1571 cor- puscles measured upon thirteen negatives: * In these and the succeeding values the original decimal measurements have been reduced to the form of vulgar fractions, and the order of statement slightly transposed. J BLOOD AND OTHER STAINS. 177 1-2941 1-3226 1-3246 1-3356 1-3379 1-3155 1-3226 1-3279 1-3356 1-3175 1-3226 1-3322 1-3379 General average, 1-3246. (Trans. Am. Med. Asso., 1876, vol. xxvii., p. 303.) EweU, in measuring several series of 100 corpuscles from each of three dogs, obtained the f oUowing results: Puppy (eight days old)........1-2985 1-3039 1-3039 1-3125 Puppy (eight weeks old).......1-3333 1-3378 1-3412 Puppy (seventy-six days old) .. 1-3257 1-3355 1-3610 (North American Practitioner, pp. 97, 151.) We are not aware that any extended series of measurements has been made of the corpuscles of other animals covering different ages, breeds, etc., but it is probable that as wide variations exist in aU cases as have been proved with man and the dog. The averages above given are of fresh blood rapidly dried upon glass under the most favorable conditions for measurement. In dried blood after attempted restoration, the difficulties of exact measurement and of possible variation are much greater. In a moist atmosphere corpuscles on drying sometimes diminish in diameter to a very marked degree. In the Sturtevant murder case, tried at Plymouth, Mass., in 1874, two medi- cal experts of exceUent reputation testified that "in aU probability" cer- tain blood-stains were human, because the corpuscles averaged " between 1-5400 and 1-6000 of an inch in diameter," these figures having also been obtained by the witnesses from measurements of their oavii blood, dried and treated in the same manner as the specimens in evidence. The question may still be asked, Are there not limits in the measure- ments of blood-corpuscles AA'hich, in certain cases, avUI warrant the ex- pression of opinion as to their origin ? Doubtless there are limits, but, in our opinion, these practically exclude all the common animals except the sheep and the goat. There may be instances, under specially favor- able circumstances (as spots upon glazed paper, porcelain, or metalhc buttons, etc.), in which one may make satisfactory measurements of the corpuscles. Not less than 300 corpuscles should be measured to ascer- tain the average (Formad says 500). In such cases, if the corpuscles be too large, it can be said with reasonable certainty that the blood is not that of some given animal. Richardson admits that it is practically impossible to determine the difference in dried stains between human blood and the blood of any animal the average measurement of whose corpuscles is more than 1-4000 of an inch. (Monthly Micros. Jour., London, vol. xiii., p. 215.) The foUowing animals are included under this head, if we accept the highest average of any observer as the one on AA'hich we base our conclusion: Elephant.......1-2745 (Gulliver) Sloth...........1-2865 (Gulliver) Whale.........1-3099 (Gulliver) Opossum.......1-3145 (Wormley) Capybara.......1-3164 (Wormley) Guinea-pig.....1-3213 (AA'oodward) Dog............1-3246 (Woodward) Seal...........1-3281 (Gulliver) Wolf............1-3422 (Wormley) AVoodchuck......1-3484 (Gulliver) Hare............1-3560 (Gulliver) Rabbit..........1-3607 (Gulliver) Ass.............1-3620 (AVormley) Rat.............1-3652 (AVormley) Bear............1-3656 (AVormley) Mouse...........1-3743 (Wormley) 178 A SYSTEM OF LEGAL MEDICINE. Muskrat........1-3282 (Wormley) Mule............1-3760 (Wormley) Beaver.........1-3325 (Gulliver) Bat.............1-3880 (Gulliver) Porcupine......1-3369 (Gulliver) Cat.............1-3922 (Welcker) Monkey........1-3382 (AArormley) Raccoon.........1-3950 (Wormley) Kangaroo.......1-3410 (Wormley) Squirrel.........1-4000 (Gulliver) The foUowing expressions of opinion of well-known authorities are of interest: Gulliver (Proc. Zoolog. Soc, London, 1875, p. 484) says: " The magni- tude of the corpuscles in a single species, not excepting the human, is liable to variations within certain limits; and there commonly appeal- in one field of vision of the same corpuscles differences amounting to at least one third larger and smaller than the average. Hence, as regards the medico-legal question, however truly a careful observer (Dr. Richard- son, Monthly Micros. Jour., 1874) may have distinguished, by comparative measurements of the corpuscles, stains of human blood from those of the sheep and ox, this kind of diagnosis would be ineffectual in some prob- able and more possible cases." Woodward (Am. Jour. Med. Sciences, 1875, p. 151) maintains it to be the duty of the microscopist summoned as a scientific expert to examine a suspected blood-stain to make it clearly understood by both judge and jury " that neither by the microscope nor by other means yet known to science can the expert determine that a given stain is composed of human blood and could not have been derived from any other source. This course is imperatively demanded of him by common honesty, with- out which scientific experts may become more dangerous to society than the very criminals they are called upon to conA'ict." EweU (Medical Jurisprudence, Boston, 1887, p. 243) says: "It Avould be extremely perilous to undertake by mere micrometric measurements alone to distinguish the blood of man from that of another mammal." Tidy (Legal Medicine, vol. i., Philadelphia, 1882) says: "It would, in our judgment, be unAA'ise to hazard an opinion as to the source of a given specimen of blood from the microscopic measurements of the disks, especially considering that, as a rule, where evidence of this kind is needed the measurements have to be made after treating the dried corpuscles with some liquid reagent." Halliburton (Chemical-Physiology, London, 1891) remarks as to cor- puscles in dried stains: "PracticaUy it is not possible to distinguish between them." Stevenson (in Taylor's Manual of Medical Jurisprudence, Philadelphia, 1892, eleventh American edition, p. 277) writes as foUows: " It is gen- eraUy admitted by scientific men that we have at present no certain method of distinguishing human blood from other mammalian blood when it has once dried on an article of clothing or a Aveapon. This is practically the form in which the problem usuaUy comes before the medical jurist. He may be able to state that the shape and size of the corpuscles as seen by the microscope are consistent with the blood being mammalian and probably human, but it is impossible to say with absolute certainty that it is not the blood of an animal, like the ox or pig." Expert testimony in wliich distinctions are attempted between human and other mammalian blood based on differences of 1-10,000 to 1-15,000 of an inch are not generally regarded with favor either by judge or jury. BLOOD AND OTHER STAINS. 179 Such niceties of distinction are looked upon Avith considerable skepticism by jurymen accustomed only to measurements in feet and inches. If the witness is able to say that " stains are of mammalian blood and that the diameters of the corpuscles are consistent with human blood" and if he expressly states that they may be of other blood, he is giving testimony which will doubtless be accorded the weight to which it is entitled, and which cannot be effectively contradicted by the defense. On the other hand, ex- treme opinions given in evidence always lead to contradictions betAveen opposing experts, the result of Avhich is that the jury are confused in- stead of assisted, and generally disregard aU the expert testimony upon that branch of the case. In the trial of Leavitt Alley in Boston in 1873 evidence was tnven by a medical witness caUed by the government that certain blood-stains were not those of a horse, and that the difference in the size of the cor- puscles of this animal and man in dried stains could be " distinguished as easily as pease and corn." The defense, as might be expected, brought other witnesses who disputed the radical opinions which had been given, making the case, for the time being, " a trial of blood-stains " and not of the defendant. The testimony as to blood, while of no direct benefit to the defendant, was a source of weakness to the government. More moderate opinions would, no doubt, have been received with favor and could not have been disputed. The slight importance attached to the opinions of the six expert witnesses who testified may be inferred from the charge of Judge WeUs. His only allusion to the experts was as fol- lows : " Perhaps the jury might not think it worth while to consider the difference between the medical experts, but if they could get any help out of it they would give it such weight as it deserved." In the case of Beg. vs. Nation (quoted by Taylor) it was contended by the prosecution that a certain knife had been used for cutting the throat of a man who had been murdered. The defense claimed that the knife had been used for cutting raw beef. A government expert testified that the knife had been stained by living blood, and that it was not the blood of the ox. Chief-Justice Cockburn, in commenting upon the evidence of experts, said: " In admitting the advantages of science, they are coming to great niceties indeed when they speculate upon things almost beyond perception," and he added that he would advise the jury not to convict upon this scientific speculation alone. Menstrual, Arterial, and Venous Blood.—The question may arise whether certain stains are of menstrual blood. There is no distinguish- ing chemical or microscopical test by which blood of this character and that floAAdng from a wound may be determined. Certain well-known chemical differences exist, but they do not furnish a basis for any reli- able conclusions in dried stains. Menstrual blood uneler the microscope may show epithelial scales from the vagina. Vaginal epithelium resem- bles that from the mucous membrane of the respiratory organs and of the Avhole alimentary canal; hence, blood from a hemorrhage, from the bowels, or from piles might be mistaken for menstrual blood. For the medico-legal comparison of menstrual blood and that of other stains, see Annates de Hygiene, 1858, vol. x., p. 421. No distinction can be made betAveen venous and arterial blood based on chemical or microscopical examination. Age of Stains.—The color of blood-stains (crimson or dark brown) 180 A SYSTEM OF LEGAL MEDICINE. and the spectroscopic examination may, under special circumstances, warrant the conclusion that the blood is comparatively recent or other- wise. Beyond this noth- ing can be determined with certainty. Undue Importance Attached to Small Stains. —An unAvarranted im- portance is often at- tached to small stains upon the clothing of per- sons accused of crime. Taylor mentions the case of a man tried for mur- der upon AA'hose shirt were found minute spots of blood, Avhich Avere re- garded as proofs of guilt, untU it Avas explained that they were probably derived from flea-bites, and that some Avere on one side and some on the other, showing that the shirt had been worn on the tAvo sides. The stains made by crushing the cimex and the mosquito show unchanged cor- puscles of human blood. The clothing worn by the laboring classes may show blood-stains derived from various innocent sources AAdiich an accused person might be entirely unable to explain. On the other hand, nothing can be more erroneous than the very common idea that no per- son can commit a murder in which blood is effused Avithout having his clothing more or less stained. Taylor gives many instances in which he had examined clothing worn by persons subsequently convicted of mur- der, and either no blood was found on any part of the dress, or only small spots whoUy out of proportion to the amount of blood which must haAre flowed from the wounds of the deceased. (Principles and Practice of Medical Jurisprudence.) Fig. 20. Epithelium from the Vagina. (After Ultzmann; 300 diameters.) ILLUSTRATIVE CASES. Case I. Attempted Distinction betaveen the Blood of Man and the Cow. (Abridejed from Casper's "Handbook of Forensic Medicine," vol. i., case lei.J REPORT OF PROFESSORS CASPER AND DUBOIS-REYMOND. A man Avas struck bleeding and senseless upon the highway and afterward robbed. A party was arrested for the crime Avhose boots exactly fitted some footprints in the snow at the place of the robbery, and upon AA'hose trousers was a bloody stain the size of the palm of the BLOOD AND OTHER STAINS. 181 hand. This he explained by saying that during the Christmas just passed he had assisted at the slaughtering of a cow. This statement was found to be correct, and the trousers were sent to Professor Casper with the request that he would determine microscopically whether the blood-stain arose from human or coav's blood. The examination was made jointly by Professors Casper and DuBois-Reymond. Their report in part was as foUows : "Investigations of this nature are rendered more difficult by the blood not being perfectly recent, and also by the question lying between the bloods of such animals as have their blood-corpuscles of similar form. The latter is particularly the case in respect to the blood-corpus- cles of man and those of most of the mammalia, particularly oxen, in so far as both are uniformly circular, and the human blood-corpuscles merely somewhat greater in diameter than those of oxen. At our first microscopic examination, on the 8th of February, we once more com- pletely satisfied ourselves on these points, for recent human and ox blood having been compared together the difference could most distinctly be made out; also, after mixing both kinds of blood together, the smaUer corpus- cles of the ox could be readily distinguished from the larger human ones. We then proceeded to the corpus delicti. Portions cut from the blood-stain on the trousers were soaked in pure neat'sfoot oil and exam- ined, but instantly the utmost variety and uncertainty of opinion began to prevail among the observers present because the form of the blood- corpuscles was indistinctly seen. The blood-stain in question, moreover, at the time of examination might have been six and was at least three weeks old, and could therefore only present to view perfectly shriveled blood-corpuscles, which always give an uncertain result. In order to test the contrary opinion advanced by a recent author (Schmidt), . . . we experimented by dropping upon other parts of the same trousers recent human and recent ox blood, laying the pieces of cloth aside in precisely similar conditions for eight days to dry. On the 15th of Feb- ruary we proceeded to our second microscopic investigation by soaking both these stains in bone oil, and bringing them under the same micro- scope, first examining each stain separately, and afterward mixing the bloods together. The result was that although the dried human blood seemed to have more resemblance to that of the corpus delicti than the dried ox blood had, yet the form and diameter of both kinds of blood were so much altered by the shriveling they had undergone that it was perfectly impossible to give a decided opinion upon the subject. We must therefore give it as our opinion that it is impossible to state with certainty whether the blood-stain on the trousers of the accused is caused by the blood of man or the cow." Case II. Human Blood or the Blood of the Duck. (Abridged from "Annates de Hygiene," 1857, vol. viii.,p. 369.) REPORT OF PROFESSORS ROBIN AND SALMON. The foUowing is an extract from a report by Professors Robin and Salmon upon the examination of stains upon a cotton blouse belonging to one Doiteau, accused of murder. The blouse was taken from the 182 A SYSTEM OF LEGAL MEDICINE. prisoner about eight hours after the commission of the crime Avith Avhich he Avas charged, and appeared to be stained AA'ith blood. The defendant attempted to account 'for the stains by the story that he had killed a duck. One of the questions submitted to the experts Avas in substance the foUowing: "Are the blood-stains those of a duck or from the body of a murdered Avoman of about seventy years of age ?" The ansAver of the experts Avas as foIIoavs : " The dark reddish-brown stains upon the blouse have been produced by blood. . . . We are Avarranted in this conclusion since blood is the only fluid containing the red globules which we have separated from these stains; in blood alone are found these bodies, together with fibrin anel the white globules Avhich we have recognized in the network which it forms. The microscope only can determine this question, for these stains are too small to allow of the detection of albumen: moreover, albumen having all the characteristics of the albumen of blood is found not only in a great number of animal fluids, but also in the colored or uncolored juices of plants, while blood alone contains at the same time the fibrin, the flattened circular red globule's—destitute of a nucleus— and the Avhite spherical globules, shoAA'ing from one to three granules after the action of acetic acid. . . . But the elements of blood Avhich compose these stains are not those from the blood of the duck; they have, on the contrary, aU the constituent elements of human blood; they have neither the oval form, the dimensions, nor the central nucleus which are found in the red globules from either fresh or dried blood derived from ducks or other birds. " The elements of the blood forming the stains upon the blouse are those of human blood, for they contain fibrin and respond to the re- actions of acetic acid, etc.; the white globules are found in these stains, and they have the volume, the form, the granulations, the nuclei, and the chemical reactions belonging to the white globules of human blood. The red globules are found, also; they have the volume, the flattened circular biconcave form, the pale reddish-yeUow color which are seen in the red globules of human blood viewed by transmitted light in the microscope, and, like these, dissolve in water and acetic acid without leaving any traces behind them. " But in the present state of science, it is impossible to determine, by the examination of this blood, either the sex or the age of the individual from whom it flowed." Case III. Possible Human and Sheep's Blood Present at the Same Time in Stains upon Clothing. REPORT OF A JOINT EXAMINATION BY PROFESSORS AVORMLEY, CHASE, HAR- RDIAN, AND BABCOCK MADE DURING THE PROGRESS OF A TRIAL BY ORDER OF THE COURT. In the month of January, 1875, the dead bodv of the wife of a farmer named Emerson, residing in Piermont, N. Hj was found about nine o'clock m the morning with the head entirely blown off. The body was still sitting in a chair near the stove in the kitchen of the house; the right hand held a needle with which the deceased had been sevving,' and BLOOD AND OTHER STAINS. 183 scissors and thread were in her lap. A recently discharged gun, the butt-end farthest from the body, Avas found two "feet behind it. There Avere but two persons about the premises at the time—the husband and a man of about sixty years of age, a visitor named SaAA-yer. The latter Avas arrested for the supposed murder. There had been no trouble of any kind betAve'en the members of the family, and no motive could be assigned for the commission of the deed. The gun, which belonged in the house1, had been loaded by the husband Avith a heavy charge of shot on the night before the tragedy, for the purpose of shooting a strange cat wliich had been proAvling about the premises. Blood in seA'eral small stains AA'as, some days after the homicide, found upon the clothing both of Sawyer and of the husband, but the expert for the goA-ernment declared that the blood upon the clothing of the prisoner Avas " probably human blood, as the corpuscles measured 1-3400 of an inch in average diameter," while that upon the husband's clothing Avas "probably sheep's blood, the corpuscles having an average diameter of 1-5840." Emerson stated that about a week before the affair he had killed a sheep, and this was proA-ed by several witnesses. Circumstances developed which pointed strongly to the1 theory of accident: that the husband AA'ith mittens on his hands and icy boots had hurriedly gone into the house to get the gun for the possible chance of shooting a fox which Avas being pursued by dogs a short distance down the road; that Avith his snow-covered boots he probably slipped upon the wooden floor, and that the gun was acci- dentaUy discharged; and that the husband, fearing the consequences, denied aU knoAvledge of the occurrence. Under these circumstances the counsel for the prisoner demanded a reexamination of the clothing of Emerson. The court granted the request, and appointed four experts, representing both the government and the defendant, to conduct a joint investigation to be made during the progress of the trial. Professors Wormley, Chase, Harriman, and Babcock were selected for this service. The Avriter acted as secretary of this board of experts, and in giving the results of the inquiry testified substantially as follows: " Our examination, in which all agree, shows: " 1. In numerous places, both upon the jacket and overaUs of Emer- son, there are blood-stains. " 2. The stains are of mammalian blood. " 3. The very marked difference in the size of the corpuscles in the different stains indicates two kinds of blood. One kind is hke that Avhich belongs to such animals as man, the dog, monkey, rabbit, guinea- pig, etc., and the other kind is like that found in animals having much smaller corpuscles, as the sheep. " The measurements of the corpuscles of the larger kind were from 1-3300 to 1-4200, and averaged about 1-3500. The corpuscles of the smaller kind averaged 1-6000 of an inch, and varied from 1-5000 to 1-7000." (Figures showing the detaUs of a large number of measurements were here given.) "The micrometer used for the measurements Avas one which had been verified by Professor Wormley. The larger corpuscles were within the1 ranue of the average of human blood, and could not have been from the'blood of the sheep, as they were much too large. The 184 A SYSTEM OF LEGAL MEDICINE. smaller corpuscles were consistent Avith the presence of sheep's blood." The jury disagreed as to then- verdict, but the majority Avere in faA'or of the defendant. Under the circumstane'es, the government being sat- isfied that there Avas no more eA'idence against SaAA'yer than against Emerson, and it being doubtful, eA'en, if there had been a murder, con- sented to the release of the prisoner, upon nominal bail. SEMINAL STAINS. The seminal fluid is a A'iseous and opaline fluid of peculiar odor and shght alkaline reaction. It contains about eighty-five per cent, of Avater and fifteen per cent, of solid constituents. But little is known in regard to the nature of these solids beyeuid the fact that they contain albumin- ous principles, extractive matters, a small amount of fat, and salts. The latter are principally calcium phosphate and sodium in combination as albuminates. There are no characteristic chemical tests by which this secretion may be identified in a dried stain. Examined by the microscetpe under a poAver of three hundred or four hundred diameters, the fluid is seen to contain more or less numerous so- caUed animalcules, or spermatozoa. These structures consist of a flattened pear-shaped portion caUed the head, and a long filament or taU. The latter is thickest at the end nearest the head, and has a terminal portion of extreme fineness. The tail is ten or twelve times the length of the head, and on account of its extreme transparency may be iiiA'isible except in its thicker portion, thus appearing much shorter than its actual length. The addition of a drop of solution of eosin or of iodine in potassium iodide brings out the entire length of the taU Avith distinctness. The head at its broadest part is a little more than one third the diameter of the human blood-corpuscle. According to Lehmann, the head measures from 1-5300 to 1-4500 of an inch in length, and from 1-16,000 to 1-9000 of an inch in breadth; the tail has a length of from 1-600 to 1-450 of an inch, but may be, in some specimens, no more than 1-1000. The seminal fluid contains also epithelial scales, mucus-corpuscles, and spher- ical bodies called seminal granules. Seminal stains on cotton or linen when held near the fire become pale yeUow. According to Orfila, this effect of heat is characteristic, and is different from its action upon all other discharges. If moistened with water and warmed, there is developed the peculiar odor of the seminal fluid. These tests must be regarded only as indications, and in no case should a stain be pronounced as of seminal origin unless the microscope shows the presence of spermatozoa. It is true that under certain condi- tions these bodies may be absent from the secretion, but in such a case there can be no absolute proof that the suspected stain is of spermatic origin. The folloAviug method, proposed by Koblanckin 1853, mav be adopted for the preparation of specimens for microscopical examination : A portion of the stained linen about one-half inch square is moistened Avith a feAV drops of pure Avater contained in a watch-glass. The glass is covered to protect it from dust, and the linen allowed to absorb the water for an hour or more. The stain should be moistened only, not immersed in BLOOD AND OTHER STAINS. 185 the water, and the latter should be in no greater quantity than is /suffi- cient for the purpose. When the stain has been softened it is scraped hghtly with a scalpel, a portion transferred to a microscope-slide, a drop of eosin solution added, and covered with a thin glass. Hamlin (Proc Amer. Soc. Micros., 1883, p. 83) has described a process for the investigation of seminal stains which the Avriter has found to be much more satisfactory in its results than the usual method. If the stain is upon a fabric of cotton, linen, silk, or wool, a smaU piece about one- eighth inch square is cut out and laid upon a slide previously moistened Avith Avater, and allowed to soak for a half-hour or more, renewing the Avater as it evaporates. The cloth is then carefully frayed out into threads by needles, and covered Avith a thin glass for examination. Specimens prepared in this manner sIioav the spermatozoa clinging to the fibers or lying in masses in the meshes of the fabric. By the usual pro- cess of soaking and sea-aping the greater portion of the spermatozoa are destroyed, and in stains of known origin evidence of their presence is only obtainable after long and persistent search, and even then but few specimens are to be found. Hamlin's method sIioavs them at once and without difficulty. The appearance of the spermatozoa under the microscope is highly characteristic, and there can hardly be a mistake in regard to their pres- ence. Fig. 21.—a, trichomonas vaginae (Donnd); b, spermatozoa. No separated parts should be regarded. Spermatic granules may be mistaken for detached heads, and minute filaments from the stained fabric may appear like portions of the taU. Nothing less than the pres- ence of complete spermatozoa should be deemed conclusive evidence that a stain is of seminal origin. In the examination of stains upon the linen of females careless of personal cleanliness and containing vaginal mucus, there mav possibly be observed an animalcule described by Donne (Be- cherches Microscopiques, Paris, 1837) as trichomonas ragina. This organ- 186 A SYSTEM OF LEGAL MEDICINE. ism has four or six short cilia Attached to the head; the head is granular, and three or four times larger than that of the spermatozoon. The latter has no cilia, and both in itsf head and tail is transparent and structure- less. Spermatozoa present in dried stains resist decomposition by atmos- pheric influences, and, if not subjected to abrasion by rough handling, may be detected even after the lapse of several years. BIBLIOGRAPHY. A List of some of the Most Important Publications on the Medical Jurisprudence of Blood-stains. 1848. Schmidt, Carl, " Diagnostik verdachtiger Flecke in Criminalf alien." Milan und Dorpat, 1848. 1852. Freidberg, "Forensische Diagnostik des Blutes." Berlin, 1852. 1857. Robin, "Memoire concernant l'examen a l'aide du microscope de taches de sang," etc. "Annales de Hygiene," 1857, vol. viii., p. 368. 1859. Fleming, C, "Blood-stains." "Amer. Jour. Med. Sciences," 1859, vol. xxxv. 1865. Sorby, "Quarterly Journal of Science." London, 18(55, vol. vi., p. 9. 1869. Richardson, J. C, "Amer. Jour. Med. Sciences," 1869, vol. lviii., p. 50. 1869. Sonnenschcin, "Handbuch der gerichtlichen Chemie." Berlin, 1869. 1869. Briand, J., et Chaude, E., "Manuel Complet de Medecine Legale avec une Traite" de Chimie Legale par J. Bouis." Paris, 1869. 1873. Mialhe (avec Mayct, Lefort, et Cornil), "Instruction pour servir a determiner les elements constituants du sang dans les taches." "Annales de Hygiene," 1873, vol. xl., p. 190. 1874. Richardson, J. C, "Amer. Jour. Med. Sciences," 1874, vol. lxviii., p. 102. 1875. Richardson, J. C, "Monthly Microscopic Journal." London, vol. xiii., p. 213. 1875. Gulliver, G., "Observations on the Sizes and Shapes of Red Blood-Corpuscles of the Blood of Vertebrates." "Proc. Zoological Society," London, 1875, p. 474. 1875. Otto, "Anleitung zur Ausmittelung der Gifte und zur Erkennung de Blut- fleeken." Braunschweig, 1875, p. 162. 1875. Woodward, J. J., " Blood-Corpuscles of Man and the Dog." "Amer. Jour. Med. Sciences," 1875, vol. lxix., p. 151. 1876. Woodward, J. J., "Medical Jurisprudence of Blood-stains." "Trans. Amer. Medical Association," 1876, p. 302. 1877. Woodman, W. B., and Tidy, J. M., "Forensic Medicine and Toxicology." Philadelphia, 1877. 1880. Clement, " Conferences pratiques de Medecine Legale." Paris, 1880. 1880. Fipicr, R. U., "Expert Testimony and the Microscopic Examination of Blood."' "American Law Register," 1880, vol. xxviii. (old style), pp. 529, 593. 1881. Dragendorff, "Der Blutflecken." Maschka's "Handbuch der Gerichtlichen Me- decin." Tubingen, 1881, Bd. I., p. 482. 1881. Hoffman, "Nouveaux Elements de Medecine Legale." Paris, 1881. 1882. Tidy, J. M., "Legal Medicine." Philadelphia, 1882. 1885. Masson, 21., "L'Origin du Sang en Medecine Legale." "Annales de Hygiene," Paris, 1885, series iii., vol. xiii., p. 393. 1885. Wormley, T, "Microchemistry of Poisons." Second edition, Philadelphia, 1885. 1888. Formad, H. F., " Comparative Studies of Mammalian Blood." " Jour, of Comp. Med. and Surgery," 1888, vol. ix., p. 254. 1890. EweU, M. D., "North American Practitioner," 1890, pp. 97 and 173. 1892. Bell, G, "Blood-stains in Medical Jurisprudence." "Medico-Legal Journal," New York, vol. x., p. 129. 1892. Taylor, A. S., "Manual of Medical Jurisprudence." Philadelphia, 1892. HAIRS AND FIBERS. BY JAMES F. BABCOCK. The presence upon weapons or the clothing of a defendant of hairs from animals or of various fibers used in the manufacture of textile fabrics has in numerous cases proved to be of great importance in trials for homicide. In the trial of Rubenstein for the murder of Sarah Alex- ander a fragment of corn-husk and a fiber of wool from the shawl worn by the girl, found attached to a blood-spot upon the boot of the defend- ant, proved to be very important evidence. Taylor gives the case of a woman accused of murdering her child, upon whose clothing were found spots of blood Avith hairs from a victorine worn by the victim. In the Piper case, in Avhich the sexton of a church was tried and convicted of the murder of a child in the belfry, a single hair found, upon the person of the defendant was claimed by the goArernment to be identical Avith that cut from the head of the deceased. Hairs found upon weapons or clothing may be from the head or other parts of the human boely, or from some domestic animal. As in the case above cited, they may be from the fur of a A'ery large number of animals, of which many varieties are used in different forms as articles of apparel. Fibers may be of silk, wool, cotton, linen, or a mixture of these in the various kinds of textile fabrics employed for clothing. The identification of hairs and fibers is, in most cases, conclusive and satisfactory—i.e., it can be asserteel with certainty that a given hair is human or from some animal, and in most cases the animal, or at least, the class to which it belongs, can be determined. The diameters, length, and peculiar markings of hairs Avhen observed in the microscope furnish the means for distinguishing them. Indeed, these are practically the only data by which reliable conclusions can be drawn. Hairs from the human body may be classed in three different varie- ties : 1. Long, soft hairs from the head, from one to three or more inches in length; 2. Short, thicker, and more rigid hairs from one fourth to one half inch in length, as in the eyelashes; 3. Short and A'ery fine hairs from one twelfth to one sixth of an inch in length, as the down or woolly hairs from the face, back, or extremities. In the microscopic examina- tion of hairs tAvo structures are Adsible : a median, more or less dark, and somewhat irregularly granular portion, the medulla or pith; and an outer fibrous-looking portion, colored according to the color of the hair, the cortex or cortical portion. Under certain conditions of focussing, hairs from the head show a very light portion in the center, giving the appear- 187 188 32 33 34 33 Microscopical Appearance of Hairs from ATarious Sources, and Aregetable and other Fibers. Figs. 22 to 33.-22, horse (back); 23, mouse; 24. cat; 25, chinchilla; 2t>. large hair from seal; 27, hair from head of female, age. eighteen: 28, hair from head of man after treatment with caustic soda; 29, fine hair from back of hand; 30. from head of child; 31, cross-sections of hairs from the head; 32, silk; 33, cotton; 34, flax; 35, wool. [j. f. Babcock—DeL] HAIRS AND FIBERS. 189 ance of a tube; but this is merely the effect of refraction, and disappears when the hair is examined after a preliminary soaking in a weak solution of caustic soda. The diameters and lengths of hairs Arary greatly, according to their position or the age or sex of the individual. Hairs from the head are usually longer, softer, and finer in females than they are in males. Hairs from children are softer and finer than those from adults. The long hairs from the head average about 1-350 of an inch in diameter in man and 1-450 in Avoman. The downy hairs from the body (lanugo) vary from 1-1000 to 1-3000 of an inch in diameter. Hairs from the eye- brows, the pubes, and the mustache are about 1-200 of an inch; on the back of the hand in man they vary from 1-250 to 1-500 of an inch. These figures are subject to considerable variations in different indi- viduals, but may be taken as shoAving the comparative diameters of the hairs from different positions. Variations to a somewhat similar extent occur among animals. Most mammals have two or more A'arieties of hairs, one long, stout, and straight, and overlying others which are much finer and shorter. The peculiar markings and other appearances of these hairs may vary greatly eA-en in the same animal, according to its situation, or whether they are of one or another of the A'arieties aboA'e mentioned. Figures showing the appearance of various animal hairs under the microscope may be found in the Micrographic Dictionary of Griffith and Henfrey (plate 29), and other drawings in the Proceedings of the American Society of Microscopists, 1884, p. 59, and in Woodman and Tidy's Forensic Medicine, p. 498. Hairs for microscopic examination should be soaked in oil of turpen- tine and mounted in Canada balsam. The accompanying plate, together Avith the draAvings to wliich we have referred, may be useful in determin- ing the character of any particular specimen; but in all cases the latter should be compared Avith hairs of known origin before arriving at a definite opinion. Silk fibers are cylindrical in form, and exhibit a strong refraction of the light passing through them; they are almost entirely devoid of mark- ings of any kind or other peculiar structural appearances. Wool has ir- regular fibers, and the transverse markings are very large and noticeable. Cotton has a spiral and twisted structure. Flax has fibers wliich are tapering toward the point, and they show joints at unequal distances. A solution of eosin or of any of the aniline colors produces a strong dye upon silk or wool, but upon cotton only a feeble and easily washed out stain. Xo reliance can be placed upon conclusions drawn from the appear- ances presented by a single hair as to the identity of the individual to whom it belonged. This has been attempted in many criminal trials, with results almost invariably damaging to the side which has attempted it. All that can be fairly stated in such cases is that hairs from some particular head have a resemblance. The reader may consult with profit a paper by William J. Lewis, en- titled " Hair Microscopically Examined and Medico-LegaUy Considered," in Proceedings of the American Society of Microscopists, 1884, p. 59. Also articles by Lassaigne, Robin, and Orfila in Annates de Hygiene, 1857, 2d series, vol. viii., p. 226; 1858, 2d series, vol. x., p. 434; 1835,1st series, vol. xiii., p. 466. IDENTITY OF THE LIVING. BY ALLAN McLANE HAMILTON, M.D. Trials where instances of mistaken identity have been the issue are so numerous and curious as to form many of the causes celebres of all times, and have reflected perhaps more upon the value of human testi- mony than any other influence. Plentiful cases upon record prove either how poor is the observation of the ordinary indiA'idual, or how common are certain appearances which have been looked upon as more or less striking peculiarities. Many interesting questions have arisen in con- nection with identification, not a few of which haAre formed the basis of legal proceedings, and the literature of medicine is fuU of dramatic in- stances of mistaken personality. While under some circumstances per- sons Avho have had ample opportunity for observation make the gravest errors in identification, on the other hand it is sometimes the case that a momentary glance in the shortest possible association has sufficed for a perfect identification.* It often happens with our OAvn authorities that persons who have been robbed wiU readily pick out the guilty person from a score of others in whe>se' company he may be placed; but possibly this facility is owing to the manner and anxiety of the culprit to escape detection as much as anything else. The matter of systematic identification is largely a question of prac- tice and skill, but in some measure1 depends upon the faculty of intuition, which, however, does not belong to many. It is certain that the power of unconscious observation is possessed by some individuals to a marked degree; and while these persons never forget a face, they are quite un- able to explain their quickness or the means which enables them to reach a conclusion. An expert detective sergeant Avith twenty years' experi- ence, AA'ho is known as having one of the best memories and the sharpest Avits of the New York police force, tells me that he rarely looks at other * Considerable space is devoted in some works of this kind to the momentary rec- ognition that often takes place where the only illumination is the flash of a pistol or the gleam of lightning. In many instances these examples are grossly exaggerated. Cauvet conducted a series of experiments, the conclusions of which are the following: (1) That the person firing a pistol may be recognized if the observer is placed very near him—sav five paces—and at the side of the line of fire ; (2) that he may be rec- ognized when the discharge has been in a close place of small dimensions, and the observer is in a stooping posture or squatting; (3) that the chance of distinguishing the person firing is affected by the quality of the powder employed, the best English powder enabling the observer, Avhen near or by the side of the person firing, both to see and identify him. 191 192 A SYSTEM OF LEGAL MEDICINE. features than the eves, and usually by their expression and color he remembers his man* It is a well-known fact, hoAvever, that those whose occupations should make them familiar with particular persons are sin- gularly untrained in the matter of identification, such being the case with fiortrait-painters, a great many of Avhom are unable to retain an impression of a sitter five minutes after his departure, or to be able to paint the portrait in his absence. UNRELIABILITY OF EVIDENCE. The most astonishing examples of confident identification are found in books and the daily press, which often relate instances of individuals who were perfectly sure of the identity of another, but whose positive declarations were 'afterward proved to be valueless by the appearance of the real person. Such a condition of affairs occurred in the Tichborne case (see Identity and Survivorship), where Arthur Orton was recognized and whose cause was championed not only by the mother of the real heir, but by the old friends and servants of Sir Roger Tichborne. It seems almost incredible, but women have lived upon the closest intimacy Avith men who have turned up long after the disappearance of their lawful spouses, firmly believing them to be their long-lost husbands. " In one of the early criminal records of New York City we find the history of one Joseph Parker who was tried for bigamy in the year 1804 in the court of Oyer and Terminer, the indictment charging that on the 8th of May, though he was lawfully married to one Susan Fearon, AA'ho was still living, he had unlawfully, on the 25th of December, under the name of Thomas Hoag, contracted a second marriage with one Catherine Secor. The first marriage and the present existence of the first wife being admitted, three Avitnesses then testified that the defendant then in court before them Avas the Thomas Hoag who had come to Rockland County, thirty miles distant from New York City, in September, 1800, had lived there working as a laborer, had married Catherine Secor on Christmas Day, 1800, and in the folioAving March had disappeared. One of these witnesses was the Avoman who claimed to be his wife; another, the judge who married them; and another was a man who had worked with him constantly for five months. They were positive the defendant was Thomas Hoag, and recognized him not only by his features, but by vari- ous marks and scars on his person, and by a certain impediment in his speech. On the strength of this testimony, which must have seemed conclusive, the prosecution rested, and the defense called six witnesses AAdio swore just as positively as the others that the defendant was Joseph Parker, that he was by occupation a rigger, and that he also served on the city watch. And they swore with equal positiveness that on Christ- mas Day, 1800, and before and after that date, he Avas in New York City foUowing his usual occupation, and by no possibihty could he have been at that time in Rockland County. With this testimony the defense rested, but the prosecution seems to have had other eA'idence in reserve. Seven additional Avitnesses were noAV caUed for the prosecution, each of whom in the most positive manner identified the defendant as Thomas Hoag, who had married Catherine Secor on Christmas Day, 1800. They swore to various marks on his face and neck, which the defendant plainly IDENTITY OF THE LIVING. 193 had, but particularly a deep scar on the ball of his foot, occasioned by treading on a drawing-knife. " The prosecution closing their case, the defense called two more wit- nesses, one of whom was the mother of his wife, who had knoAvn him for sixteen years, and SAVore positively that he had not been out of New York more than a week during that time; and the other SAvore to work- ing with him on the particular Christmas Day in question. It was then agreed by the counsel that the defendant should show the soles of his feet to the jury, that they might ascertain whether the peculiar scar upon one of them, wliich had been sworn to by several of the Avitnesses for the prosecution, Avas visible. Upon exhibiting his feet no mark or scar could be seen upon either of them. " The captain of the Avatch was then called, and after swearing posi- tively that the defendant Avas Joseph Parker, whom he had known for many years, he produced his books, in which he kept a register of the Avatchmen and their times of sei-A'ice, and showed that from October, 1800, till March, 1801, defendant Avas on duty as a Avatchman in the city. The jury, Avithout retiring, found a verdict of not guilty." When it is borne in mind that the witnesses on both sides of this most astonishing case AA'ere persons of responsibility, and of such stand- ing as to preclude all thought of perjury, it must be admitted that it presents one of the strangest examples of disputed identity ever knoAvn. The similarity of two individuals some time ago induced a lawyer in the city of New York to resort to a ruse for the purpose of clearing his client, AA'ho had been accused of a serious crime. While the latter was seated out of range of A'ision of the AA'itness in the box, Avho was A'ery decieled in his opinion of his own powers of observation and his certainty of the appearance of the assailant, the double of the man under trial Avas told to arise, when he was positively identified by the confident Avitness. His mistake, of course, led to the discharge of the prisoner. ACCIDENTAL OR A'OLUXTARY ALTERATIONS IN APPEARANCE. In investigating the history and condition of the person whose iden- tity is suspected, it is of the utmost importance that the examiner should give Aveight to two kinds of influences that may effect an alteration, viz.: 1. Those in wliich the changes are due to age, disease, and natural or accidental alteration; 2. Those1 in Avhich the alterations are Avillfuhy produced. To the former belong the organic and facial expression changes due to insanity, to trophic changes in which pigment bleaching or deposit takes place, to the loss of teeth or hair, or through cutaneous disease with pitting1 or other lesions. To this class belong the existence of acci- dentally produced cicatrices, the loss of limbs, deformities, etc., and the appearance's due to manual or other labor. In the second class we find changes voluntarily wrought which are sometimes willfully brought about for a purpose, or occasionally exist as evidences of former vanity. In this group we are presenteel Avith cases where Ave are required to determine whether the hair has been dyed, whether abrasions, wounds, or burns have been made for a purpose, and whether tattoo or other marks have been removed, or, on the other hand, executed 194 A SYSTEM OF LEGAL MEDICINE. with the intention of counterfeiting the marks upon the body of some per- son AA'ho has disappeared or died, for the purpose of perpetrating a fraud. The determination of the indications of age is sometimes an issue, especially where a claimant presents himself; and we may divide the im- portant periods of life into adolescence, AAdiich begins at the age of puberty and lasts until twenty-five, adult life, which is prolonged until the sixtieth year, and old age, Avhich may be said to begin at sixty and last until eighty- five, Avhen decrepitude commences. It is only exceptionally that we are called upon to determine the age of children, but such may be necessary in cases of rape, the question of consent, or possibly where the applicability of the kiws of the Society for the Prevention of Cruelty to Children is questioned; but there is usually little difficulty in closely approximating the period of infantile life. The exact determination of the age of the adult is extremely difficult AA'here it is necessary to be precise, and the same may be said to be the case with old age. Of course, in the latter the association of evidences of bodily decay must be more or less consistent and harmonious, for in men in their prime, so far as time is concerned, Ave often find indications of premature decay. We1 must take into account the nature and form of the inferior maxilla, the condition of the teeth, rigidity of articulation, possible existence of friable bones, coldness of the extremities, weakness of the genital apparatus, troubles of excretion and circulation, as well as that mental weakness which is manifested by loss of memory, and ulti- mately by childishness. In addition to these, the presence of the a reus senilis, weakness of vision, and alteration in gait and carriage may be recognized. Change through the Effect of Disease—As every one is aware, a notable facial change takes place as the result of many general diseases, so that sometimes what amounts to an almost complete loss of identity Fig. 36. Fig. :?7. occurs. Those especially who are in the habit of examining the insane cannot fail to be impressed with AA'hat I mean. As au illustration, two IDENTITY OF THE LIVING. 195 pictures may be presented of a young married woman who was indicted for infanticide in a town in the northern part of New York (Figs. 36 and 37). But one year elapsed from the time the first picture was taken until commission of the crime, and it was during her incarceration in prison before the trial that the second photograph was made. Her insanity had not been recognized by her townspeople, and in fact, it was of a low order. So rapid a change in appearance can hardly be conceived, and I am sure under certain circumstances Avould lead to a mistake in identity. Certain atrophic affections of the nervous system, which are attended by loss of hair, discoloration of the skin, and various other metamorphoses, can produce a startling transformation. The Teeth.—The coloration of the teeth may have something to do with the determination of personal identity, and Tardieu has referred to the existence of erosion, separation, and other changes due to the habitual use of the pipe in smokers. It is the custom with most dentists to keep accurate records of the nature of the work done by them, and, when pos- sible, such data should be consulted to ascertain the history of the person whose place has been usurped by the impostor. Changes in the Hair.—It is often a difficult matter to determine the identity by the color and condition of the hair. Criminals and others, for the purpose of disguise, haA'e by means of dyes wrought a change in appearance which has been more or less effectual. Perhaps, after all, a knoAvledge of the configuration of the head and the natural growth of hair among people of different temperaments may guide the examiner as much as anything else; and, of course, the relation of head coloration to that of other regions Avill enable him to expose a fraud, for it is rare that any systematic and harmonious dyeing is resorted to. It is often necessary to bring the microscope to our aid, when it will be found that the imbibition of the dye does not extend throughout the hair-trunk, but there is a spot which presents normal and uniform color. This aid will also disclose the adherence of fatty particles which have followed the use of various pigments. Vibert has pointed out the fact that hair dyed with black presents under the microscope a coloration apparently eA'eryAA'here uniform, which is never the case with that which has preserved its natural color. If the dyeing is imperfect there Avill be brusque changes in color and none of the gradations that belong to a normal condition. Blond tints, Avhich are nearly ahvays obtained by the use of peroxide of hydro- gen, result in a discoloration of the pigment AAdthout destruction. In nearly every case AA'here seA'eral days have elapsed betAveen the last appli- cation of the dye and the time of examination there Avill be ordinarily no difficulty in detecting the change in groAvth. Briand and Chaude have Avritten extensively upon this subject, and have given certain instructions for the examination of the hair of sus- pected persons. When lampblack combined AA'ith some fatty substance has been apphed, it Avill be necessary to Avash the hair in ether, which Avill rapidly remove the fatty substance, leaving the carbon in suspen- sion in the liquid. Sometimes a mixture1 of litharge, chalk, and lime Avater is used, and the effeed is produced after two or three hours. When the head is Avell Avashed Avith warm water and a smaU quantity of acid is added, the presence of these substances may be determineel by the effer- vescence, and the subsequent addition of sulpho-hydric acid and oxide of ammonia indicates the existence of lead. SIoav dyeing produces a much 196 A SYSTEM OF LEGAL MEDICINE. more obstinate and less easily removable tint, and in such cases it is avcU to get some of the hair and treat it thoroughly with the above reagents. The salts of bismuth and sulphur are often used when it is desired to obtain a more rapid coloration, and ordinarily with the latter agent the hair is Avashed in ammoniateel water, and aftenvard, while damp, satu- rated with nietallic salt, and then put in contact with water containing hydrosulphuric acid or sulphur. Decoloration after dyeing with nitrate of silver can usually be effected Avith cyanide of potash and pyrogallic acid, and sometimes'a Aveak solution of hydrochloric acid Avill change the color of hair thus dyed from black to a more or less violet hue. Briand and Chaude believe* that the best means for recognizing the nature of a salt Avhich has been used to color the hair is to burn a part of the hair and to treat the ashes by nitric acid evaporated to extreme concentration, and then aftei-Avard to apply the ordinary tests for silver or lead. Orfila (Traite de Med. Leg., T. i., p. 122'et. seq.) has statedthat locks of black hair when plunged into chlorine Avater pass from a light chestnut color to deep blond, clear blond, and finally be'come entirely bleached. After a long immersion in chlorine AA'ater the hair preserves for a long time the odor of chlorine, and becomes brittle. Red and brown tints are obtained by means of saffron and the permanganate of potash. We should not lose sight of the fact that at times it is necessary to determine the individual type so far as hair, features, etc., are concerned, and while, of course, such identification is not in itself a matter of cer- tainty, anthropological aid may be unexpectedly suggestive. The abun- dance of hair in relation to race type is, according to many observers, Arery variable. The plate1 from Testut (Traite' cVAnatomic Humaine, T. hi, Fas. 1, Paris, 1S92) (Fig. 38), taken in consideration Avith the researches of Hil- gendorf, Withof, anel others, may prove of service in determining the race characteristics in appropriate cases. The former counted in a square centimeter 272 hairs in a German, 252-286 in a Japanese, 214 being the average among the Ainos (the hairy tribe of northern Japan). Withof has found that the hairs are more numerous in blond subjects than among those of darker skin and coloring. He has counted 147 black hairs, 162 brown, and 1S2 blond in a quarter-inch. The classification of hair, as agreed upon by Isidore Geoffrey, Saint- Hilaire, Huxley, and Haeckel, is as follows: Primitive man. Woolly hair. f In tufts. J Hottentots. ( Papuans. .. Straight hair. Fleecy. r stiff. .. Curly. ( African Blacks. \ Kaffirs. Australians. Hypoboreans. ■{ Americans. Malays. Mongolians. i Dravidians. \ Nubians. ( Mediterraneans. The finger-nails may be the seat of changes due to the particular work of the person, or to preAdous disease. Esbach (Modifications de la IDENTITY OF THE LIVING. Phalangette dans la sueur, etc., Paris, 1870) has carefuhy examined a great many finger-nails, and announces it as a fact that it is possible by the breadth, thickness, and shape of the nail not only to distinguish tuber- Fig. 38. —1 (Straight), American Indian; 2 (wavy), French child; 3 (frizzly), Australian; 4 (fleecy), Tasmanian; 5 (bushy), New Caledonian; 6 (kinky), Zambesi. (Testut.) culosis, but he finds that typhoid feA'er, chloro-anaemia, and gestation effect and leave a marked variation in the thickness of the nail. He gives several tables which s1k)av the influence of the different callings upon the thickness of the nail, and finds that those occupations in which the hands are used .to a very great extent, and where there is habitual sweating, the nail substance is increased. GENERAL STIGMATA OF OCCUPATION. It is possible sometimes to fix AA'ith certainty the occupation followed by the suspected person by various marks, such as softening or destruc- tion of skin, deep fissures, destruction of nads, and the formation of cysts, tumors, or callosities; changes in the trunk; coloration of the 198 A SYSTEM OF LEGAL MEDICINE. skin, or corrosive action exerted upon the same by substances used in manufacture. It is requisite to bring to our aid the help of chemistry, and to carefully examine the traces of organic or inorganic discoloration, the parings of'the nails, or the dirt that may accumulate beneath them, the stains upon clothing, and to carefully note the deformity of the fin- gers or body, the expansion of the finger-tips, the retraction of the flexor tendons, to recognize the duration or age of such appearances; and we should naturally examine the hands first. The Hands.—Le Grand du Saulle (Traite de Medecine Legale, second edition, p. 101-5 et seq.) says that in four fifths of the workmen he ex- amined the hands showed" the only trace of the kind of Avork done. Tardieu has by the condition of the hands recognized the folloAving: laundresses, bleachers, copper-workers, coal-miners, coachmen, hair- dressers, tanners, cutters, hair-Avorkers, nail-makers, porters, gilders, cabinet-makers, clerks, florists, engravers upon metals, Avatchmakers, locksmiths, miUiners, mother-of-pearl workers, shoemakers, glass-pol- ishers, button-makers, rag-pickers, tortoise-shell polishers, bookbinders, grinders, saddle-makers, stone'-masons, drummers, dyers, Aveiod-turners, metal-spinners, vermicelli-makers, and glass-blowers. He divides the alterations of the hand into those occupying the palmar portion, the fingers separately or together, the two hands or one only. The right hand is that in which the appearance is most often marked, and when both are changed, that of the right is different from the left; and it is nearly always found that the fold of the flexion in the palm has the greatest degree of epidermis thickening. When the entire hand is the seat of alteration, according to Du Saulle, we find that this is the result of the contact with some substance which produces a general altera- tion, as is the case with washei'Avomen, tanners, dyers, locksmiths, and saddle-makers. Changes in the feet are much more rare than elseAvhere, but such changes are found among porters, tailors, and turners. Shoemakers, lace-makers, clock-makers, and shell-polishers all present a change in the form, length, thickness, and wear of the nails, which signs are very characteristic. RECOGNITION OF CHANGES INCIDENT TO SPECIAL OCCUPATIONS. These professional stigmata are by no means absolute evidences of the occupation followed by the suspected individual, for there is a decided difference not only in the shape of tools used, but in the method of work of different mechanics; deductions, however, may be drawn AA'hich are more or less helpful, and, with other confirmatory data, will be of great service to the person making the inquiry. Jewelers are apt to present a retraction of the last phalanx of the left thumb, and it has been held that cataract is more frequent as a result of the fine work AA'hich so many of them are in the habit of doing; nev- ertheless Desmarres, pere, out of nine hundred and fifty-tAvo patients affected Avith cataract found but two jeAvelers. Sometimes cramp is found of the flexors AA'hich is analogous to that of AA'riters and others. ~\Yasherwomen do not ahvays Avork in the same position, but when folioAAdng a habit they present different deformities of the upper extrem- ities, callosities due to the exercise of pressure, and sometimes a con- IDENTITY OF THE LIVING. 199 dition of the skin of the hand with swollen fingers, Avhich is highly characteristic. Metal-workers and burnishers present sometimes in the right hand a general callosity and blackness, the creases of flexion remaining un- affected and unstained. The last phalanx of the little finger is often held in extreme flexion, the skin of the left hand wliich covers the back and the radial side of the index finger and is found over the head of the second metacarpal bone is very hard and callous, showing the same ap- pearance at the extremity of the palmar face of the thumb. Coachmen and drivers nearly ahvays present a distinct spot of callous1 between the thumb and the index finger, and betAveen the second and third and third and fourth fingers of the two hands. The first siter however, is most common. Shoemakers. On their left hands where the thumb and index finger hold the thread the soft parts are broadened, and the fold which separates the second from the third phalanx of the index finger is cut by the thread, presenting a deep crevasse, the borders of which are hard and callous. On the thumb of the right hand the fleshy substance is expanded in spat- ulous form, which is quite broad and characteristic, and is like the analo- gous deformation met AA'ith among glass-workers. A still more characteristic sign, and one which is more striking, con- sists in the depression of the nail of the left thumb, which is considerably thickened, hard, and at its free border is dentated, brittle, crenated, and sometimes deeply indented by sharp cuts from the aAvl. This aspect of the left thumb among Avorking shoemakers is consistent, and really characteristic. There is a certain depression of chest, so that the sternum presents a distinct concavity which is very sharply circumscribed, and not accompanieel by any general deformity of the thorax as a whole. The hair-bulbs of the skin of the thighs are obliterated, the skin is often rough, and in other Avays shoAvs eA'ielences of pressure made by the lap- board. Curriers and tanners present in both hands a great breadth of fingers, particularly at their base, and A'ery hard and prominent folds, which correspond exactly Avith the line of flexion of the metacarpo-phalangeal articulatieuis. The hands of curriers sometimes present a deep broAvn discoloration, the result of a species of tanning which is distinct; if the spots are touched Avith a solution of prussiate of potash and iron, they instantly turn a darker color, and eventually become black. Dressmakers and seamstresses present a familiar appearance wliich is unmistakable, consisting of a hardening of the index finger of the left hand, which is pierced by numerous needle-points; the skin is rough, thick, and blackened. It is true that these traces appear in many pro- fessions. Workers in copper. The calloused skin of these workmen may be easily removed with the aid of a bistoury. The sections of epidermis of these people are thickened, and the nails of copper-workers are consider- ably thickened at the edges. If the detached skin and clippings of nails be put into boiling nitric acid and the solution subsequently treated by ammonia, it takes a beautiful blue color. The result is not always con- A'incing. It is then best to burn the debris of the skin in a platinum crucible and treat the residue with nitric acid and ammonia. This result 200 A SYSTEM OF LEGAL MEDICINE. Avas obtained even in a workman who for forty days had not worked, having been confined in a hospital. There are exceptions, hoAvever, but the process is generally a reliable one. Boatmen and seafaring men, and others whose occupation causes them to come in contaet, Avith AA'ater a great part of the time, present a certain softening of the skin AA'hich varies in extent, In this connection Parent elu Chatelet (Annales d'Hyyieue et Med. Legale, T. iii., p. 245) has described an affection AA'hich is designated under the name of " grenouille," and consists of an extreme1 softening of the skin, Avith actual disintegration of parts AA'hich are in constant contact with AA'ater. He has found both the superior and inferior extremities, but more1 often the latter, to be the seat of softening, so that there are vast tracks and crevasses of the depth of several lines between the great toes and the others. It is not rare to observe the same fissures in the palms of the hands, sometimes associated Avith redness and extreme sensibility. (lilders. Signs AA'hich indie-ate the effects of work are detected in young workmen at the end of five or six months, at the anterior and internal part of the left forearm, Avhere a considerable callous commences at the Ioavci- edge of the flexure Avhich marks the separation of the fore- arm and the hypothenar eminence, with an elevation on the anterior part of the forearm to the height of five centimeters, and of considerable breadth. There are other marks which have been very positively con- nected with this trade by Du Saulle, and consist of various caUosities which are produced by burnishing-tools. Clerks and those aa;1io write extensively present a dermal hardening at the cubital edge of the little finger of the right hand, corresponding to the last phalangeal articulation, which is in the form of a corn, and is pro- duced by the constant rubbing and pressure of the finger upon the paper. Sometimes there exists, besides, a hardened fold at the extremity of the middle finger at its radial side at the point where it comes in contact with the pen. Workers in artificial flowers present a characteristic stigmata between the thumb and index finger of the left hand. The formation of bursas in various situations may throw some hght upon the occupation or mode of life of the person whose identity it is desirable to establish. Housemaids and others who kneel a great deal present local prominences which, in the case of the former, have been recognized, as a distinct surgical condition. These same appearances are not uncommon among nuns, priests, and religious devotees of aU kinds. SKIN LESIONS AND THEIR RESULTS. Evidences of Cutaneous or Venereal Disease.—The skin presents appearances which, when taken alone, do not ahvays afford a certain means of identification, but are occasionally extremely suggestive and important. No weight, except that which belongs to a fact that mav be used in con- firmation, can be attached to the existence of pitting or skin lesions Avhich are permanent. It can be well understood hoAV the mark of a venereal sore will influence the features of a case. Many of the lesions of tertiary syphilis last for a long time, if they are not permanent, and especially is IDENTITY OF THE LIVING. 201 this the case where bony changes have occurred. The induration of the primary sore is not ahvays of long standing, and the excavation or cica- trix left by a " soft chancre " may become obliterated in a comparatively short space of time. Ogston refers to a cicatrix left by a chancroid Avhich disappeared in an unusually short period. In the case of rape re- ferred to by this writer, e\ idence was brought forward by the defense to show that, in the female, soft chancres could not have existed after the period of intercourse, as no mark of their previous presence was visible about the genitals of the prisoner six weeks afterward. His testimony at the prosecution was that he and another physician had seen them at the time alleged. He Avas later the more confirmed in this opinion, from the fact that in a subsequent case in private practice, where several such chancres were met Avith and treated by him, ah trace of them was found to haAre disappeared six Avee'ks subsequently. Cicatrices.—The duration of scars has been questioned upon many occasions, and the theory naturally suggests itself whether a scar ever entirely disappears. Ogston is of the opinion that as a rule "all scars resulting from Avounds and cutaneous diseases Avhich involve any loss of substance are indelible, the only exception that can be made being in regard to trifling punctured Avounds where but little violence has been done to the skin and where there has been no loss of substance." Before going further, it is well to say that the determination of identification by means of a scar is very often quite unreliable, unless the cicatrix be of a pronounced and prominent character. In a large number of collected cases I haA'e been impressed with the positivenoss of testimony as to certain body-marks, and in many instances it has been found that innocent persons have presented the scars that have seu-ved to fix the identification in the minds of obstinate witnesses. The follow- ing is a case in point: John aI. Poyn, a Cincinnati detective, had sworn out a warrant for the arrest of W. A. Hedden, of Tacoma, charging him Avith having de- fraudeel life insurance companies out of over $14,000. He Avas arrested and bailed, and his examination Avas deferred tAvo weeks, in order that additional evidence might be1 secured in Buffalo, Avhere the alleged frauds had been committed. As he could not give bonds he AA'as kept in jail for over a month, Avhen he AA'as rehased. He had been taken for B. A. Crandall, avIio in 1886 lived in Buffalo and had an insurance on his life for $14,000. He Avent West, and in that year it was reported that he had committed suicide. The evidence of such suicide was so strong that the companies paid the dead man's relatives in full. In 1887 Crandall had been seen at Los Angeles, and the fact reported to the insurance companies. They immediately offered a combined reward of $2000 for the arrest of Crandall, and detectives Avere placed on his track. Detee'tive Poyn heard that Crandall Avas at Tacoma, went there and saAV Hedden, Avhose resemblance to Crandall was great. He got acquainted AA'ith him, they Avent into partnership, and established a land-locating agency. Hedden's height, coleir of his eyes, beard, his size and Aveight exactly coincides! Avith Crandall's. On the latter's right foot Avas a scar OA-er four inches in length, the residt of a Avound accidentally inflicted upon himself Avith an ax when a young man. In order to find out whether Hedden had this scar, Poyn proposed that they should rent a room to- gether, to Avhich Hedden agreed. The first night when the latter un- 202 A SYSTEM OF LEGAL MEDICINE. dressed the detective watched his room-mate, and discovered the scar; the folloAving day a Avarrant was secured by Poyn, and Hedden Avas arrested; and now more positive evidence1 Avas needed from Buffalo, and the telegraph wires were kept busy. Hodden's photograph Avas taken and sent to Buffalo, and word came back that it Avas the picture of Crandall. Hedden asserted his innocence vehemently and repeatedly, and said that he oAAiied a farm at Lake View, near Rochester, upon AA'hich his family Avere living; and two or three Tacoma people of prominence became interested and elid ah they could to help him. It subsequently transpired that persons who kneAV Crandall saw the prisoner, and AA'hile admitting that the resemblance Avas striking, said that the prisoner Avas not Crandall. After a long and bitter fight Hedden finally got his liberty. It is a fact that must be patent to all that careful examination of a large number of scalps Avill reveal the presence of traces of long-forgot- ten injuries which have escaped ordinary observation, and these may be discovered for the first time by persons anxious to find something. The Age of Cicatrices.—French Avriters have tried to fix with more or less certainty the date of formation of a cicatrix, but there is no absolute way of determining the exact time of the wound itself. Much, however, depends upon its situation, and character of the instrument used, and, after all, AA'e can only be geiverned by the general rule of Casper, that "a AA'hite cicatrix indicates that the wound is not recent." Occasionally it is possible to determine the existence of the marks of a former solu- tion of continuity by vigorous rubbing, which brings the blood to the surface. A cicatrix is not always the consequence of a wound, for those left by a Aery sharp instrument may heal quickly without any trace, espe- cially if antiseptic precautions have been taken; on the other hand, if no cicatrix remains to mark the alleged locality of a burn or stab of any magnitude, it is most probable that none has been made. Tattooing.—Atery often the identity of a suspected person may be determined by initials or inscriptions Avhich have reference to some other person, or to his calhng or preA'ious life. According to Lombroso, the greater number of tattooed criminals are among the recedivists and instinctive criminals, " especially those Avho have committed crimes against the person." Ellis (The Criminal, Lon- don, 1892, p. 104) says that " the fewest are found among SAvindlers and forgers, the most intelligent class of criminals." In making an examination it will be found that among women of easy virtue, pa^drasts, and tribades the designs are nearly always obscene, but it cannot be denied that tattooing among women is as a rule very rare. Alborghetti found that 40 of 100 children at the reformatory at Turin were tattooed, AA'hich was not the case with the children among the ordi- nary population. Greaves (referred to by Ellis) examined oy>o tattooed persons in Derby Prison; 41 were tattooed, the subjects being chiefly soldiers, sailors, and miners. The Question of Indelibility.—Considerable controversy has taken place regarding the indelibility of tattoo marks. Tardieu, Avhose in- vestigations were very thorough and far-reaching, believed that it was possible to entirely get rid of extensive tattoo marks, and found that it IDENTITY OF THE LIVING. 203 was the custom for criminals in French prisons to resort to blisters, acids, and other escharotics, with more or less success. It Avould appear from his investigations that deposits of India ink are much more in- delible than vermilion, or other pigments, but even they Avould occa- sionally disappear without any systematic attempt at removal. A French criminal referred to by Tardieu effectuaUy removed within six days very extensive marks from his body by means of an application of a paste of acetic acid and lard, and afterward they were rubbed with potash and finally with dilute hydrochloric acid. Tardieu, who experimented, found that if the paste were left on for a day there would be some detachment of the cuticle, and that if the potash were used the second day, and the parts rubbed five or six times, such application Avould be followed on the third day by the formation of a crust which finally fell off, leaving a partial obliteration. Successive crusts, which were undoubtedly due to a more or less deep destruction, were removed, and at last it was found that the parts beneath Avere without any remaining pigment. Taylor, on the other hand, is of the opinion that deep tattoo marks cannot be effaced, in which conclusion he is opposed by the Avriter to whom reference has just been made, as well as by Casper and Hutin. Casper found that out of 37 persons examined the marks had become effaced in 6 ; Hutin, of 509 examined, disappeared in 47; Tardieu, of 76 examined, effaced in 3—over nine percent, of the whole. In the famous Tichborne trial, evidence was given that both Roger Charles Tichborne, the. heir, and the man called Arthur Orton ha el been tattooed. Now Tichborne's tattoo Avas R. C. T., and Arthur Orton's was A. O. On the arm of the claimant there were no tattoo marks at all, but there were tAvo round depressed scars on the left wrist about the size of a shilhng, and suggestive of the tattoo marks as A. O. These scars had evidently been produced by escharotics. Of course excision of tattooed wounds is an easy possibility, HANDAA'RITING. Identification by means of handwriting is largely a matter of com- parison and natural proof, and I will only refer to it briefly. Attention, however, must be called to the peculiarities of style, the formation of habits, and the variation of chirography under different circumstances. When once the automatic habit of writing is acquired, there is usually very little difficulty in determining by comparison the correspondence of one given example with another; but when through disease the vohtional impulse is interrupted, a very decided change occurs, which may to a certain extent confuse the examiner. Mere tremblings need not be con- sidered, but through mental disease or certain organic nervous affections a very material change in style and letter formation is a familiar feature ; among the sane, sustained efforts at deception are almost impossible, and different parts of the same letter, as avcU as an inspection of letters Avrit- ten at different times, will reveal peculiarities which are the result of acquired habit, It will be necessary to determine sometimes whether a person has written Avith his right or left hand, and it must not be for- gotten that it is possible, as we know in the cases of writer's cramp, for 204 ^ SYSTEM OF LEGAL MEDICINE. persons to educate themselves to write with the unaffected extremity, the result being often a legible and clear production with more or less change of style. FINGER AND FOOT IMPRESSIONS. For the establishment of the identity of a criminal a careful exami- nation should always be made of the papers handled, windoAv-panes, and china and glass ornaments, or, in fact, any other object aa Inch may re- ceive an impress from his more or less greasy fingers, at the place of commission of the crime. By oblique hght there AviU sometime-s be no difficulty in finding upon the'polished window-pane; a faint though per- fect imprint, AA'hich can aftenvard be strengthened and made the subject of a permanent record. For this purpose the method contrived by For- geot (publications of the Laboratoire dAnthropologie Criminelle, of Lyons), AA'hich consists in the application of common ink or some aqueous pig- ment which will adhere to the parts that are not greasy, may be tried; or the glass may be subjected to the vapor of hydrofluoric acid. Forgeot has shoAA'n that even pieces of paper which have been touched by slightly greasy hands will bear the imprint of the fingers, and the most delicate markings may be brought out after treatment with ordinary ink, and these used as a negative AA'ith good results. In exceptional cases the finger-marks may be made to giA-e lithographic impressions. Gallon (Finger Prints, London, 1S92) refers to the comparison of these markings Avith those AA'hich are obtained by making the suspected person press his thumb and fingers upon transfer-paper, the impression being subsequently transferred to stone, thus correcting the impression, Avhich should be rewersed if direct contact were made. The value of finger impressions as a proof of identity is certainly one that has not been over-exaggerated. Gallon says: " So far as the propor- tions of the patterns go, they are not absolutely fixed, even in the adult, inasmuch as they change Avith the shape of the finger. If the finger is plumped out or emaciated, or variously deformed by usage, gout, or age, the proportions of the pattern Avill A-ary also. Tavo prints of the same finger, one taken before and the other after an interval of many years, cannot be expected to be as closely alike as two prints similarly made from the same woodcut. They are far from satisfying the shrewd test of the stereoscope, AA'hich shows if there has been an alteration even of a letter in tAvo otherwise duplicate pages of print. The measurements vary at different periods, even in the adult, just as much if not more than his height, span, and the length of his several limbs. On the other hand, the numerous bifurcations, origins, islands, and inclosures in the ridges that compose the pattern are proved to be almost beyond change. A com- parison is made betAveen the pattern on a finger and one on a piece of lace; the latter may be stretched or shrunk as a whole, but the threads of which it is made retain then respective peculiarities. The evidence on Avhich these conclusions are founded is considerable, and almost AA'holly derived from the collections made by Sir W. Herschel, who most kindly placed them at my disposal. They refer to one or more fingers, and in a feAV instances to the whole hand, of fifteen persons. The intervals be- IDENTITY OF THE LIVING. 205 fore and after which the prints were taken amount in some cases to thirty years. Some of them reach from babyhood to boyhood, some Fig. 39.—Schematic figure showing the different thumb-tip types of Galton and the dispo- sition of the papillary lines. The capitals, C and T, respectively indicate the curved lines (C) and the transverse lines CI); the small letters, e and i, correspond to the external and internal sides of the last phalanx. 1, First type (primary type); 2, second tvpe (Cei, Tei); 3. third type ■(Ce, TO; 4, fourth type (C£, Te); 5, fifth type (Cf, Ti); 6, sixth type ((Vi, 27); 7. seventh type (Ci, Tei); 8, eighth type (Ce, Te); 9, ninth type (Ce, Tei); 10, tenth type (CYi, Te). (Te.-tut.) from childhood to youth, some from youth to advanced middle age, one from middle life to incipient old age. These four stages nearly include the whole of the ordinary life of man. I have compared altogether some 700 points of reference in these couplets of impressions, and only found a single instance of discordance, in AA'hich a ridge that was cleft in a child became united in later years. Photographic enlargements are given in illustration, which include between them a total of 157 pairs of points of reference, ah bearing dis- tinctive numerals to facilitate comparison and to prove their unchangeableness. Reference is made to another illustrated publication of mine1, Avhich raises the total number of points compared to 389, all of Avhich were successful, with the single excep- tion above mentioned. The fact of an almost com- plete persistence in the peculiarities of the ridges from birth to death may iioav be considered as de- termined. They existed bef < >re birth, and they per- sist after death, until effaced by decomposition." A definite and constant series of patterns is found. (Se'e Fig. 39.) These consist of ridges and depressions, and the last phalanx of the thumb con- tains in its space between the parallel ridges "a compact little system of its own, variously curved and AA'horled, being a fictitious resemblance to an eddy between Iavo currents." (See Fig. 40.) Galton gives example's to sIioav Iioav the outlining is performed, and some of the patterns which are characteristic. He says: " Outhnes fall Fig. 40.—Impression of the right thumb—schem- atic. (lYstut.) 1, Curved lines; 2, transverse lines; 3, intermediate lines: C, the highest of the curved lines; T, the lowest of the curved lines: e i, external and in- ternal sides of the thumb. 206 A SYSTEM OF LEGAL MEDICINE. for the most part into nine distinct genera, confined by the relative direc- tion of the divergent ridges that inclose them." He divides his classifi- cation with reference to the existence of arches, loops, and AA'horls. *' In the arches there is no pattern, strictly speaking, for there is no inter- space ; the need of it being avoided by a successive and regular broad- ening out of the ridges as they cross the bulb of the finger. In loops the interspace is filled with a system of ridges that bends back upon itself, in AAdiich no ridge turns through a complete circle. Whorls contain all cases in Avhich at least one ridge turns through a complete circle, and they in- clude certain double patterns Avhich have a aadun-led appearance." I append one of his plates, which has been reproduced by Testut, which may serve as a guide for examination. THE SIGNIFICANCE OF FOOTPRINTS. Sometimes footprints are the only traces left by a murderer, and will alone lead to the identity of the assassin. Much attention has been paid, especially by Ogston, to the impressions that are often found in the soil near the place where the deed has been committed. Putting out of the question certain scars and other peculiarities that may be subsequently compared with the foot of the suspected person, and devoting more atten- tion to the footmark itself, we may assume that, according to Mascar and Fig. 41. tnost others, the print in the ground is smaller than the foot which made it. This is in variance with the popular idea that the impression in the ground is equal if not larger than the foot that made it, and Causse holds to this view that the impression is usually larger. It has been shown that the action of the individual can be somewhat determined— that is to say, Avhether he Avas standing, walking, or running—from the depth and extent of the marks. IDENTITY OF THE LIVING. 207 Fig. 41 represents the method adopted by Causse (Annales d'Hygiene Publiquc et de Medecine Legale, 2d series, vol. i., 1854) for the purpose of identifying the footprints of incriminated persons. The line A B is draAvn betAveen the internal part of the curve of the heel and the prominent point at the metatarso-phalangeal articulation. This line is divided br- others equidistant at right angles from the first, leaving a number of dh-i- sions which serve as guides for measurement and for tracing the internal border of the footprints. It will be se'en by Fig. 41 the variations that may take place under different circumstances, and this may be con- sidered in every Avay to be a safe and certain guide, unless the bottom of the foot is so smeared with blood as to prevent the recognition of its contour. It is often of the utmost importane'c that a mold should be taken of the footprints, and when one is found that is the most satisfactory, the method of Hougilon may be resorted to. This consists in heating the impressed ground to 220° F., or more, AA'hich may be done by holding oven- it a shallow pan containing burning charcoal, or more quickly and simply by the use of a painter's benzine lamp, and then dusting the heated impression with ground paraffine. When the soil is coed the paraffine may be removed for a mold of plaster of Paris, or electro-metal- lurgical reproduction. RIGHT- AND LEFT-HANDEDNESS. A consideration to be regarded is the question of right- or left-hand- edness; the movements of the suspected individual should therefore be closely Avatched. The degree and situation of a possible asymmetry should be determined, and his boot-heels inspected—in fact, it is ahvays wise to closely examine the clothing of a prisoner with reference to its condition, fit, and neAvness. A trap into which the prisoner unwarily falls may be arranged by asking him suddenly to hold up his right or left hand, and he will usually not consider the result. A case is referred to in wliich Sir Astley Cooper Avas called as a witness where the prisoner Avas pressed to admit that he Avas left-handed, but denied the accusation. "When called upon, hoAvever, to plead to the indictment, he uncon- sciously held up his left hand." GENERAL SUGGESTIONS AS TO EXAMINATIONS. The conduct of the examination of a suspected person should be thorough and painstaking. The memory of past occurrences should be investigated and the consistency of answers noted. His body should be carefully gone over, and, if possible, an outline figure should be presided upon Avhich the location of body-marks are noted, Avith measurements and explanatory text. Not only is every external part to be inspected, but evidences of mutilation or disease alteration should be looked for, and the presence of artificial pigments, poAvder grains, tattooing, the scars of venereal and other sores recognized. The teeth must be sep- arately looked at, and their appearance, condition, and the fact recorded whether and Iioav they are filled. 208 A SYSTEM OF LEGAL MEDICINE. If possible, a photograph is to be secured, and it is best to haA'e two, one of the full face and the other of the profile. The photographer should carefully avoid any sources of distortion; lighting the face uni- formly, and avoiding the forward projection of the upper or lower half. If there be any bodily peculiarities, or extensive tattooing, a photographic representation should be made. As a rule, old photographs, carelessly taken, are not of much use, and are often unreliable for positive identifi- cation. I have seen three pictures of one Ncav York criminal taken at different times, but all during a criminal career of adult life, Avhich are utterly dissimilar. At the Prefecture in Paris, although photographs accompany the identification cards, very little value is placed upon their help except as an auxiliary aid. In these days of progress, criminal registry is becoming so general that some notice should be made of the admirable Avork of Bertillon. M. Alphonse Bertillon has invented an admirable system, which has been adopted by the French Government and has found its way to this country, being in vogue in Boston and Chicago, and may serve to fix the identity of criminals coming from these places, although it is not prac- ticed as systematically as in France. In ten years he has made measure- ments of no less than 100,000 criminals, preserving the results and classi- fying them so that it is possible to accurately hit upon the required description of any suspected person, and I haA'e myself seen habitual criminals or recedivists positively identified at the Prefecture after a few minutes' search. It is BertiLlon's method to tabulate the measurements, together with a description of certain physical appearances, and a front and profile photograph, which are recorded upon a card which is filed aAvay Avith others within easy reach. There are four chief measurements: (1) the head length ; (2) the head breadth ; (3) the middle-finger length ; and (4) the foot length—the meas- urements of these parts being found to be more constant than others. These four are still further subdivided into "small," "medium," and " large," so that there are in all eighty-one principal headings which may include the case of the particular prisoner. There are still further sub- divisions of these primary headings, the same triplex classification being carried out. The height of the trunk is made the basis of one division, while the ear measurements are recorded so that its length and breadth are taken, the height, the span, and cubit forming others. The color of the eye is determined, and is classified under seven headings, and finally the records are grouped and subdivided, and upon each body-marks and special appearances are detailed. Bertillon's classification of appearances presented by the ear includes the variations presented in Fig. 60. He also refers to the configuration of the nose and the characteristics of the forehead, and these arc portraved in Figs. 42-59. According to this investigator the ear undergoes very little change. Contorted and swollen ears often indicate the existence of previous insanity. It can be seen that numerous classifications are possible, and it is comparatively easy to nearly approximate the exact description of any particular person. The possibilities of this admirable system are unlimited, and doubtless when insurance companies subject their applicants to some general form IDENTITY OF THE LIVING. 209 Mk ^n& **'-. WR-^ "*"' jps-1" •■^^ k^ Fig. 43. Concave-elevated. Fig. 43. Concave-horizontal. Fig. 44. Concave-descending. Fig. 45. Rectilinear-elevated. Fig. 46. Rectilinear-horizontal. Fig. 47. Rectilinear-descending. :..<: ■•"..,. ;i ijfj^. ^EL* js^^ BUJJi1' *"--s^< \ vVV Fig. 48. Convex-elevated. Fig. 49. Convex-horizontal. Fig. 50. Convex-descending. Noses Classified according to Bridge and Base. (Bertillon.) By permission of S. S. McCIure Co, 210 SYSTEM OF LEGAL MEDICINE. Fig. 51. Receding forehead. Fig. 53. Intermediary inclination. Fig. 53. Vertical inclination. Fig. 54. Height of forehead: Small. Fig. 55. Medium. Fig. 56. Great. Fig. 57i Breadth of forehead Small. Fig. 58. Medium. Fig. 59. Large. Classification of Foreheads. (Bertillon.) By permission of S. S. McCIure Co, IDENTITY OF THE LIVING. 211 of measurement at the time of taking policies, there will be no likelihood of conspiracies for the purpose of illegally obtaining premiums. Drs. Smart and Greenleaf, of the Medical Department of the United ■States Army, have adopted a system which has its advantages, although it is less reliable than the Bertillon system. •.<■, \ K_y \......s> Open. Medium. Adherent. Outer Border of the Ear. \ \\r\; Rectilinear. Medium. Indented. Profile of Antitragus. />r-.\ />"?-\ /-;-rA />"n:\ &T<\ ,<-?\ ' .': 'h l <> i^lf ■' y/f I {in sy-.....:> v::-° '••••:.......J. \VS? vH? \S?^ •N \ ft Vs V- \ S. ' \>, K* "M Square. Medium. Gulf-like. Exterior Contour of Lobe. Complete. Medium. Separate. Adherence of Lobe to Cheek. Fig. 60.—Some Classifications of the Form of the Ear. (Bertillon.) According to Smart and Greenleaf, desertions from the United States army are believed to greatly exceed deserters who are apt to repeat their offense. It is believed to be possible to detect such " repeaters" if the body-marks of all recruits are recorded, if all deserters are recorded, and if all recruits are compared with previous deserters. In hke manner men discharged for cause should be excluded from reentry. The originators of this plan do not beheve in the value of Bertillon's method before courts-martial, because of possible inaccuracies and allowable errors, but only as a confirmatory proof AA'hen folloAving coincident indelible marks, Avhen height, age, and hair fairly correspond. In other words, Bertillon's collateral evielence is practically primary eAddence. Smart and Greenleaf use for each man an outline-figure card, giving anterior and posterior surfaces, divided by dotted hnes into regions, which are filed alphabet- ically ;it the Surgeon-General's office at Washington. As a man goes out for cause, or deserts, his card is filed separately, and the cards of recruits are compared with the last file. "To make this comparison, a register in two volumes is opened, one for hght-eyed and one for dark-eyed men. Each is subdivided into a fair number of pages, according to height of entrance, and each page is ruled in columns for body regions. Tattooed and non-tattooed men of similar height and eyes are entered on opposite pages. Recruits without tattoos are not compared with deserters Avith tattoos; but recruits with tattoos are compared with both classes. On the register, S., T., B., M., etc., are used as abbreviations for scar, tattoo, birth-mark, mole, etc. One inch each side of recorded height allowed for variation or defective meas- urement. When probabihty of identity appears, the original card is used for comparison." IDENTITY AND SUBVIVOKSHIP. BY BENJAMIN N. CAEDOZO. . It would seem, to the world of to-day, a strange, if not incredible, notion that there Avas a stage in the growth of law Avhen personal iden- tity Avas a problem of very limited concern. Yet it Avas so. That prob- lem has not always existed to tax the energies of litigants and to per- plex the minds of courts. Only with the gradual development of law has it emerged as a legal concept of permanent and paramount impor- tance. It is a concept that had but little place in the most primitive stages of legal growth, for the identity of the individual was absorbed in the identity of the tribe. Vengeance, to be sure, Avas not unknown; vengeance, prompt and sharp and merciless, Avas exercised then as now; yet it was ven- geance not merely on the perpetrator of the deed, but on his kinsmen, his family, his clan. There Avas no thought of this as a punishment vicarious in its nature. It did not present itself to those ages in such a light. The individual had no hfe apart from his clan; he had no legal status except beneath its sheltering care; and a sense of solidarity, un- known to future times, made each the agent of the other and each the guardian of all.* It is a slow and in many Avays a curious history that marks the rise of this concept of personal identity from its crude beginnings to the commanding position which it holds to-day. There seems, indeed, to haA'e been a sort of intermediate stage where the identity of the offend- ing person was confused Avith the identity of the instrument through which the offense Avas perpetrated. It must be borne in mind through- out that the unit of society in primitive times is not the individual, but the family or clan.t Community of property, or rather perhaps the absence of any definite notion of property at all, tended still further to subtract from the individual's importance as the bearer of rights or the subject of duties. And so it is that private wrongs Avere wont to en- gender as their consequences, not merely private vengeance upon the offender, but vengeance upon his clan. The personality of the individual was merged in the personality of his tribe. The search after the identity of the offender was forgotten in the pursuit of the clan from which his station in the community Avas derived. And so we find that the first dim awakening of a sense that the individual offender should bear the * H. S. Maine, Ancient Law, p. 122. t Ibid., pp. 121, 178. 213 214 A SYSTEM OF LEGAL MEDICINE. burden of his own guilt was due to the desire of the clan to avert from itself, and to cast upon its guilty member, the consequences of his crime.* By yielding up the offender to the vengeance of his accuser, or perhaps by sacrificing him to the anger of the gods, the family purged itself of blame. It Avas felt that the wrong of the offender Avas the Avrong of the clan. It Avas felt that the accuser might fairly exact reparation of the clan. It AA'as felt that the divine indignation would justly be A'isited on the clan; and the first trace of a weakeneel sense of tribal solidarity, the first trace of a groAAdng notion of individual responsibility, the first trace of a distinct recognition of personal identity as a permanent legal concept, may be found in the effort to absolve the tribe, to cleanse the community, from the crime and the taint of its guilty member. And yet eAren here the effort was not so much to insure the punishment of the real offender as to insure the punishment of somebody. It was not so much an effort to fasten the crime upon the guilty wrong-doer as to save and purify the elan from the threatened vengeance of men or of the gods. It was an effort to preserve intact that corporate personality in which the identity of the individual was deemed to have been merged. The controlling necessity Avas that the tribe should be purified; and the divine power might Avell be trusted to single out for destruction no other but the true offender. The traces of this notion may be seen in the ordeal, which once formed a part of the judicial system of every people, whether of the East or West, and wliich in its essence " was a passive appeal to the power of nature as the voice of God." t In England, even in the twelfth century, an accusation by the body of the country, preferred on common fame or general suspicion, was " practically equivalent to a conviction, subject to the chance of the favorable termination of the ordeal by water." If the ordeal failed, the accused person lost his foot and his hand. If it chanced to succeed, he was nevertheless banished. Accusation Avas thus equivalent to banishment at least, and the survival of the ordeal only mitigated the punishment of the suspected criminal.! That old notion of the potency of certain tests to indicate the divine judgment as to the identity of an offender lived on, indeed, for genera- tions to come, and under the most divergent forms of haw. Some of us may recall the account that is given by Mr. Lowell of the trials for witchcraft among our ancestors of two centuries ago.§ It Avas suggested that no witch could repeat the Lord's Prayer, and the court directed that the test be made, but informed the jury that they were not in the least measure to regard it, "because it was not legal evidence." The davs of the old ordeal had not been yet forgotten. The assumption that the minds of the jurors, abstracting from the case every item of irrelevant proof, would be swayed solely by the directions of the court, strikes us to-day as grimly grotesque in its hypocrisy; yet perhaps it is not neces- sary that Ave should turn to the records of a bygone age to meet with parallel instances of the blindness of the law. It AA-as a step in advance of the old trial bv combat when the law re- quired proof, though of an arbitrary and iUogical kind, as to the identify * Liglitwood, The Nature of Post tire Law, p. 163. t George Neilson, Trial by'Combat, p. 1. t 1 Stephen, Hist. Crim. Law of England, 252; Assize of Northampton, A.D. 1176, Stubbs' Charters, 145-150; Hurtado vs. California, 110 U. S. 516, 530. § J. E. Lowell, Among My Books, vol. i., p. 104. IDENTITY AND SURVIVORSHIP. 215 of the person accused of crime. For a long time it indulged in certain presumptions of guilt wliich it treated as conclusive, and which no evi- dence Avould be permitted to rebut. A man, for example, Avho Avas found standing e)ver a dead body Avith a bloody knife in his hand Avas deemed estopped from denying the charge of murder. The inmates of a house in which a man had been found murdered in the night, if they had raised no hue and cry, and could show no wounels or other marks of violence sustained in defending the dead man from his assassin, were conclusively presumed to have caused his death.* But eA'en these presumptions, crude as they are. marked a certain adA-ance in the groAvth of legal thought. The circumstances from which guilt was inferred had a certain probative force—not that conclusive force AA'hich Avas ascribed to them, but still a certain force as tending toward the conclusion of a defendant's guilt. They Avere steps in the direction of requiring proof of the identity of the offender, even though the proof was weak, and the inference of guilt that Avas drawn from it unauthorized. The necessity that punish- ment should be visited on the real offender—the necessity, too, that some- thing more than chance should determine who the offender Avas—that ne- cessity had at last made itself manifest to the consciousness of the race. It should be noted, indeed, that Avhen the clan had been, as it were, resolved into its elements, and individual identity had become a familiar concept of the hvw, the concept Avas apphed Avith a simplicity, a rigor, and a hteralness Avhich are unknown to later days. Back of the mere instru- ment by Avhich a wrong is done, developed systems of laAv look to the intelligent agent by AA'hom the instrument is directed. Primitive laAAr, however, knoAvs no such distinction, t It recognizes a guilt in slaves, in animals, even in lifeless things. It yields up to the accuser the tree Avhich has fallen on him, the sAvorel AA'hich has wounded him, the beast Avhich has trampled on him. They are his, to satisfy his vengeance upon them; they are given up to destruction ; it is the noxa deditio.% And so Ave may say, I think, that the problem of identity in early law is a problem of physical rather than personal identity. It is a search after the hand that did the Avrong; it is not a search for the mind that willed it. In all this, early law is but true to its vindictive origin. " All the huv in the Avorld has,'' in the words of Ihering,§ "been obtained by strife ;" and the passion of revenge, satisfying itself even upon inanimate things, has been the final source and sanction of the peace and the order of the world. But the truth which I desire to enforce is that the problem of personal identity as it presents itself to-day is a problem which has an historic past and which has met with different answers at different stages in the growth of law. The gradual recognition of the truth that the law must regard the intelligent agent rather than the passive instrument and the gradual demolition of arbitrary presumptions have been the work of centuries of legal progress. If it* be possible to-day to treat questions of identity by the methods, for the most part, of a rational logic, it must not be forgotten that the problem was once a very different problem, and the mode of its solution a very different mode. * Forsyth, Trial by Jury, p. 167. Braeton, lib. iii., e. 18. t O. \V. Holmes, Jr., The Common Law, p. 10. i Ibid., p. 19. § Diering, The Struggle for Law, p. 1; and see O. W. Holmes, Jr., Tlie Common. Law, p. 2. 216 A SYSTEM OF LEGAL MEDICINE. Adequately to present the possible phases in which the question of identity may arise before a court, and the possible means by Avhich that question can be solved, would be to catalogue aU the conceivable instances in which the presence or absence of a giA'en fact may be deemed to e'on- firm or to weaken the hypothesis of the identity of two given individuals. Far as we have gone of recent years in basing our laAv of evidence upon the canons of inductive logic, a survey of the decisions on this topic must leave one impressed Avith the belief that problems of evidence may, indeed, be problems of logie', but they must ahvays be something more as Avell. "The life of the haw,"* it has been truly said, "has not been logic; it has been experience;" and experience in last analysis is the final test of the validity of proof. We cannot diA'orce the rules of laAv from the life, the emotions, and the history of men. We cannot explain the causal relation which Ave feel to exist between tAvo phenomena except by reference to the expedience1 of the race that the two have in practice been found combined. We cannot give an intelligible explanation of the com- pelling force exercised b}' a given circumstance upon our minds except by our knowledge that in the ordinary course of events, in the ordinary hfe of the race, in the ordinary experience of mankind, a given circum- stance is wont to accompany another, and so in the language of the laAv is deemed to prove it. The content of ah rules of evidence is given by experience; and logic can never do more than to classify, and perhaps to limit or restrain them. We shall feel this, I think, if we attempt to give any strictly logical explanation of the decisions which illustrate this problem of personal identity. We shah feel that the content of the rule of evidence is so dependent on experience that it resists our efforts to formulate it as a rule of orderly, coherent thought. And the question is further compli- cated by the fact that personal identity is itself a symbolic term; that identity is known to us only by its external manifestations, and vet is felt to be something separate and distinct from those manifestations by which it is revealed. To any one but to a man's own self, his identity may be said to be a complex notion in which his physical and mental traits, and his past his- tory and experiences in so far as they are known, may be deemed to be the predominant elements. It is manifest, therefore, that as identity can be known to us only as a man's qualities or experiences are known to us, proof of any element that goes to make up our notion of identity Avill, in this connection, be material and relevant. If the identity of a person, either -with some one known to us in time past or with the per- petrator of a given deed, be a fact in issue, it will accordingly be per- missible to proA'e: (a) Any fact that shows the coincidence (or the contrary) of the gen- eral appearance of the one with that of the other. (b) Any fact that shows the coincidence (or the contrary) of the physi- cal peculiarities of the one with those of the other. (c) Any fact that shows the coincidence (or the contrary) of the mental peculiarities of the one Avith those of the other. (ti) Any fact that shows the coincidence (or the contrary) of the his- tory or experiences of the one with those of the other. * O. W. Holmes, Jr., The Common Law, p. 1. IDENTITY AND SURVIVORSHIP. 217 (e) Any fact that in the ordinary course of events renders it probable that the person before the court is the person by whom an act in issue has been perpetrated; and all facts that would in common experience precede or that would in common experience follow the act in issue, such as motive, preparation, or the possession of the fruits of crime, are, Avithin the meaning of this principle, to be deemed to be relevant. The foregoing analysis Avill suffice in itself to show the complexity of the problem; but the question is further complicated by the fact that those external quahties by Avhich identity is known are not really of the essence of ielentity; that the epaalities may change in their entirety, and the identity may still subsist. If, for example, we know the present traits and the past history of A, and the present traits and the past his- tory of B, and if complete agreement exists, the process is mainly one of comparison, though the Avarrant for the conclusion of identity results from the general experience of the race that complete coincidence of traits and of history is never found, as between different persons, to exist.' On the other hand, if Ave simply know the present traits of A and the past traits of B, and if disagreement, partial or complete, exists, the main question Avill be the hkehhood that such e-hanges should have occurred were the persons in reality the same; and any fact that in the ordinary course of events would tend to cause or to prevent such changes will thus become releA^ant. A case Avhich excellently serves to illustrate the difficulties of such inquiries and the application to them of the teach- ings of medical science is quoted by Dr. Beck * from the commentaries of Zacchias: "A noble Bolognese, name Casali, left his country at an early day and engaged in military pursuits. He was supposed to have lost his life in battle, but after an absence of thirty years returned and claimed his property, which his heirs had already appropriated to them- selves. Although there Avere some marks which appeared to identify him, yet the change in appearance Avas so great that none who remem- bered him were willing to allow that this Avas the individual. He was arrested and imprisoned. The judges Avere in great doubt, and consulted Zacchias whether the human countenance could be so changed as to render it impossible to recognize the person. This distinguished physi- cian, in his consultation, assigns several causes which might produce such an alteration: as age, change of air, ailments, manner of life, and the diseases to Avhich we are liable. Casali had departed in the bloom of youth; he had entered on the hardships of a military life, and if the narrative of the individual in question is to be credited, he had languished in prison." AU these causes, it Avas conceived, might produce a great change in the countenance, and render recognition difficult, if not im- ■possible. It is because traits of body or of mind are those with wliich in the main Ave associate a man's identity, and because medical science can bear the most important witness to the possibility of the effacement of traits, Avhether bodilv or mental, that questions of identity have found a place in treatises on medical jurisprudence. It is very manifest, however, that their connection Avith medicine is rather the result of the accidents of given cases than of any inherent union between the two, or of any neces- sary dependence of the one upon the other. * Beck's Medical Jurisprudence, vol. i., p. 659. 218 A SYSTEM OF LEGAL MEDICINE. The cases in which questions of personal identity have been debated or illustrated may be ranged in accordance Avith the classification that has been already suggested. We shall have, therefore, to e-onsidcr in the first place the cases Avhere a man's identity has been proved by the testi- mony of persons acquainted AAith his general appearance. (a) General Appearance—We have seen that in early times identity was proved by certain irrefutable presumptions, and that the develop- ment of law has been marked by the gradual disappearance of artificial rules of evidence and the demand for rational proof. It was one of the presumptions of the scholastic jurists that a mother's recognition of her child proved the child's identity beyond the possibility of debate.* How unreal was the assumption on which even this rule was based, how falli- ble is even that evidence of identity which to many minds might well appear the most cogent and direct, the history of reported decisions must serve conclusively to show. There are certain cases of disputed identity which are the common stock of all the writers on medical juris- prudence, but which are at once so striking and so typical that, in any discussion of the topic, they cannot Avell be omitted from review. One of the earliest and most notable of these cases is a case which came before the parliament of Toulouse in 1560—the case of Martin Guerre and Arnaud du Tilh.t After Guerre had been absent from his home for a period of eight years, one Arnaud du Tilh claimed to be the missing man. Guerre's entire family, his wife, his four sisters, his uncle, and his brothers in-law, aU positively and without hesitation acknowl- edged the identity of the impostor Avith Guerre himself. For three years Arnaud hved with Guerre's wife, who bore him two children in the in- terval; but circumstances at last arose which awakened suspicions as to his identity, and he was brought to trial upon the charge of having falsely personated the absent Guerre. The accused man, though sub- jected to a most searching examination, showed a complete acquaintance with the history and experiences of the man Avhose name and position he had assumed. The place of Guerre's birth, the precise date of his mar- riage, the circumstances of his departure from his home, and numberless little incidents which had characterized his life—all these Avere stated with a minuteness that seemed to establish beyond dispute the defend- ant's innocence of the crime. Of the witnesses that testified upon the trial—some hundred and fifty in all—between thirty and forty deposed that "the defendant was really Martin Guerre; that they had known and conversed with him from his infancy; that they were perfectly acquainted with his person, air, tone of voice; and that they moreover were convinced of the truth of what they asserted by certain scars and secret marks which it was impossible for time to efface. " On the other hand, a great number of witnesses deposed positively that he was one Arnaud du Tilh, of Sagias, and was commonly called Pansette, and that they were perfectly acquainted with his person, air, and voice. The rest of the witnesses, to the number of sixty or upward, declared that there was so strong a resemblance between the two per- sons that it was impossible for them to declare whether the accused was Martin Guerre or Arnaud du Tilh." Nearly all the witnesses, however, * AVharton on Evidence, vol. i., p. 17. t Earn on Facts (3d Am. ed.), p. 400. IDENTITY AND SURVIVORSHIP. 219 agived that Martin Guen-e had two scars on his face, that his left eye Avas bloodshot, the nail of his first finger Avas groAvn in, that he had three Avarts on his right hand, and another on his little finger; and all these marks Avere found on the accused. From a judgment of con Auction before the criminal judge of Rieux, an appeal Avas carried to the parliament of Toulouse; and that tribunal aa as so perplexed by the conflicting testimony adduced before it that the rcA'ersal of the judgment of the loAver court seemed highly probable. It Avas only the sudden appearance of Guerre himself upon the scene, and the direct comparison of the two men by their rehuwes and by the court, that dispelled the doubts of the judges, and led to Arnaud's conviction of the crime Avith Avhich he had been charged. In this remarkable case nearly eA'ery element by Avhich the identity of a pea-son can be established Avas proved by clear and cogent anel unhesi- tating proof. Many of its features are so extraordinary as to suggest at least a doubt Avith reference to the sincerity of the' impostor's Avitnesses. That a man should fraudulently personate another in an action in the courts, that he should so closely resemble the missing man as to cause the relatives of the latter to testify in the claimant's behalf, that he should even in some Avay have so acepiainted himself AA'ith the hfe and history of the abse-nt man as to AA'itlistand a searching examination directed to these points,—all this in itself is maivelous enough. But that for three years, in all the relations of daily life, in all the manifolel inci- dents by which character and temperament are revealed, Avith all else that goes to make up our notion of identity—that in all these details the impostor should have satisfied the doubts of those Avho had been closest to the missing man, is a fact that must tend to inspire renewed convic- tions of the fallibility of every form of proof. It is related that the members of the parliament were someAvhat incred- ulous as to the possibility of practicing a deception upon the AA'ife of the missing man for so long a period of time; and many of them Avere dis- posed to believe that the lady had Avearied of her single life, and Avere inclined to adjudge her a party to the scheme; but her character, it is said, in point of modesty and prudence, and the fact that many of the closest relatives of Guerre1 had beeai similarly misled, caused the parlia- ment to resolve their doubts in her favor and to acquit her of the charge of any intentional Avrong. Guerre himself, according to the report, was. less charitable in his judgment, and maintained that a wife could not thus be imposed upon, " unless she had secretly cherished an inclination to be deceived.'' A case of much more recent date, which excited popular interest and discussion to a marked degree, anel which seems to sum up within itself most that can be said upon the problem of identity in its relations te) legal medicine, is the famous case of the claimant to the1 Tichborne estate. Almost all those circumstances from which identity may be in- ferred—almost all those elements of wliich our notion of identity is com- pounded—Avere there testified to by those witnesses, of all the world, whose testimony on such a topic might most implicitly be behaved. The mother of the absent man, the family solicitor, seventeen sen-ants of the Tichborne household, and a host of other Avitnesses—aU swore that the claimant was the real Sir Roger. The charge of Chief-Justice Cockburn presents with rare ability the difficulties that attend the solution of prob- 220 A SYSTEM OF LEGAL MEDICINE. lems of this kind, and demonstrates that even the most direct testimony is subject to the gravest possibilities of mistake1. He is speaking of the meeting of Lady Tichborne with the alleged heir to the estate, and of the mother's acknowledgment of the claimant as in reality her child. "Were there not several things," he asks, "which ought to have made Lady Tichborne hesitate in accepting the defendant as her son, even if the defendant in his appearance had presented the outward and external appearance of the son whom she had lost ? Were there not circumstances Avhich ought to have made her hesitate, and certainly not decide, before she had an opportunity of asking, in the Avords of the Patriarch, ' Art thou my A'ery son?'" That maternal instinct, which, it was urged, outweighed a score of opposing Avitnesses, outweighed the Avcighticst arguments of labored proof, is not, as Lord Cockburn clearly saAV, an instinct at all. "It is not," he says, "an impulse of nature stronger than human judgment or human reason; something Avhich carries you irresistibly on to some particular person." It is the product of long and close association, of Avatehing by day and by night, and for year after year; " it arises from being familiarized by daily habit AA'ith eA'ei-ything that appertains to personal identity—features, form, gestures, everything which constitutes the sum total of identity." " We must not alloAV ourselves," said the court, " to be carried away by declamatory commonplace about a mother's instinct, but must look to see hoAv far Ave can trust to the1 mother's judgment. We should listen AA'ith all due respect to the opinion of the mother; Ave should take it as a circumstance calculated to Aveigli strongly in the scale; but if our con- Adction, haA'ing taken into account the large range and A'ariety of facts Avhich Ave knoAv and AA'hich the mother did not knoAV, is that she must be AAi-ong, no appeal that is made to your feelings, or addressed to you in the name of the departed mother, ought to influence your judgments. Take it as a most important circumstance in the case, but not as conclu- sive as the learned counsel would make it. If it Avere so, what need of all this long and protracted inquiry ?" And yet, in spite of certain points of diversity, which are noted in the charge of the court, the claimant, so far as physical traits Avere concerned, Avent far toAvard satisfying the1 most exacting tests. Both in general appearance and in certain physical peculiarities, the resemblance, though not complete, Avas at least sufficiently marked to forbid the hasty rejec- tion of the claim. The collapse of the plaintiff's case and his subsequent conA'iction for perjury, as Ave1 shaU later have occasion to note, illustrate the place Avhich mental traits occupy in our notion of identity—a place AA'hich, if less prominent, is perhaps more constant and determining than that which is occupied by any traits of the physical organism alone. But the Tichborne case is only a single instance of a type of AA'hich numberless examples may be found. Cases involving similar errors, though on a less imposing scale, are scattered through ah the journals and reports* There is the Avell known case of The People a's. Hoag] — a prosecution for bigamy—AA'here twelve AAdtnesses testified to the identity * Some curious cases may be found cited in the opinion of Mason. J., in Ruloffvs. Tlie People, 3 Parker's Crim. Eep. 401, 446. See also an article in the Albany Law Journal of September 28, 1S72, p. 230. t Earn on Facts (3d Am. ed.), p. 412. IDENTITY AND SURVIVORSHIP. 221 of the defendant, apparently from long and intimate personal acquaint- ance. His innocence was established by the equally positive testimony of six witnesses, and more particularly by evidence as to the absence of a distinctive scar. There is the equally well-known case of Luther Ha use* where a young man personated the part of a son who had been lost in childhood, and took up his abode for a long period of time as an acknowledged member of the household. Nor is there any lack of in- stances where, after the conviction and execution of supposed criminals, upon the most direct and unfaltering evidence of their identity, the ap- pearance of the real offender has demonstrated anew the infirmity of every form of proof. The poor vagabond avIio in 1727 was put to death at York,t protesting vainly that his identity had been mistaken, AA'hile Avituess after Avitness with confident emphasis denounced him as Geddely, the thief, found, in the fullness of time, a tardy Adndication—long after his prosecutors had hurried him out of the world. There is a grim pathos in the narrative of the trial of Shaw, avIio was executed for murder in 1721. Years afterward, Avhen the poor fellow's body had been resting quietly in his dishonored grave, the truth of the case came out. And so in token of his innocence they fastened a flag upon the graA'e ; they set the flag flying in the Avinel; and that Avas the Avay that they undid the wrong.i. Yet it is easy to exaggerate the number anel even te) exaggerate the importance of cases of this kind. The sacrifice is one that every system of remedial justice must invoh'e; and it will not do, fastening our gaze upon the instances of error, to forget the manifold instances where the right has been attained. Conspicuous cases of doubt or of injustice haAre so fixed the popular attention as possibly to engender a behef in the un- certainty of inquiries as to identity, which almost outruns the distrust that the difficulties of the problem might reasonably inspire. Impressions of general resemblance have, hoAvevea*, so often proved themselves at fault that courts have been eager to discover some surer token by which identity might be revealed. They have found in evidence of special traits or peculiarities of feature or of form a test by AA'hich the vagueness of general impressions might safely be corrected. (b) Physical Peculiarities.—Physical peculiarities have been a most common, and in many respects a most satisfactory, means for the solu- tion of problems of identity; yet even here, as Ave have already seen, the possibility of error exists. In Guerre's case, as has been shown, the correspondence of certain physical peculiarities of the missing man with those of the impostor was most striking and complete. In the Tichborne case, too, " the claimant gave proof of a fish-hook wound on the eye; of a mark of bleeding on the ankle; and of a peculiar scar on the head, AA-hich a hair-dresser swore had been seen upon the head of the real Sir Roger." Yet due alloAvance being made for these and other conspicuous instances of error, the existence of any distinctive physical trait, when coupled with a general impression of resemblance, not only affords, to say the least, the strongest corroborative proof, but frequently furnishes the only data from which a witness may be enabled to recall the personal appearance of a man who has been hastily observed. (1) Physical Marks.—Congenital marks, marks of tattooing, and the * Earn on Facts (3d Am. ed.), p. 432. t Rtdolfvs. The People, 3 Parker, 401. i Earn' on Facts (3d Am. ed.), p. 453. 222 -1 SYSTEM OF LEGAL MEDICINE. scars left by wounds and by disease have been repeateelly employed in cases of disputed identity as instruments of proof. In the case of Salome Milieu-,* Avho was held as a slave in Louisiana, and who brought suit for her liberty in the courts of that State1, the existence of tAvo small nan matemi upon the inside of each thigh was the medium by which her identity was established and her liberty secured. In the Hoag e-ase\t as Ave have seen, the innocence of the accused defendant was demonstrated l:»v the absence of a scar AA'hich a cut with a scythe was known to have left upon the foot of the1 man for whom the defendant was mistaken; vet it is to be1 noted that in the existence of a scar upon the forehead the physical peculiarities of the two were proved to coincide, The Hause caset is a still more curious instance of the frequent correspondence of marks of violence upon different men; for the impostor exhibited numerous scars which agreed in the most striking manner with the scars of the missing son. From the French tribunals comes the1 record of the case of a man named Lesurgues avIio Avas eoimcted and executed upon a charge of murder in 1794; and not only did the real murderer, who Avas subsequently discovered, resemble Lesurgues in general form and feature, but on the forehead and the hand of both a similar seal* was to be found.§ Artificial marks have been equally common as a medium of proof. The Tichborne trial for perjury again supplies a pointed illustration. It was sIioavu by a number of Avitnesses that Sir Roger had upon the inside of his left forearm certain tattoo marks of a blue color, representing a cross, a heart, and an anchor. Lord BelleAv, a school-fellow of Sir Roger, tes- tified that he had seen the symbols on Roger's arm, and that he himself had imprinted there in addition the letters R. C. T. The defendant not only could show no similar marks upon his person, but he denied that he had ever been tattooed at all. The proof of the existence of these emblems upon the real Tichborne heir at the time when he was lost at sea in April, 1851, was so abundant and convincing as to contribute doubtless in no slight degree to the ultimate detection of the fraud. "Unless we are prepared to admit," says Dr. Taylor,|| "that a man can be tattooed and have no knoAvledge of the fact, and having been thus unconsciously tattooed, that all the marks had disappeared before he saAV them, it is impossible that this claimant could have been the Roger Charles Tichborne, the heir to the estates." In an early case in this State,1] the identity of a man aa'Iio was found murdered Avas established in the main by the presence upon the leg of the initial letter of his name; and the courts of some State's have even gone so far as to permit the forcible inspection of distinctive marks for the purpose of identifying a suspected criminal. In a case, for example, that came before the courts of Nevada,** where a witness had testifieel that the defendant had certain tattoo marks on his person, the defendant Avas compelled by the court to exhibit these marks to the inspection of the * Beck's Medical Jurisprudence, vol. i., p. 661. t Earn on Facts (3d Am. ed.), p. 412. % Ibid., p. 432. § Taylor's Medical Jurisprudence, p. 347; Earn on Facts (3d Am. ed.), p. 420. || Taylor's Medical Jurisprudence, p. 361. *?, People vs. Wilson, 3 Parker's Crim. Eep. 199. ** People vs. Ah Chuey, 14 Xev. 89; s. c. 33 Am. E, 530. IDENTITY AND SURVIVORSHIP. 223 jury. Not a little diversity of opinion* however, has existed AA'ith refer- ence to the propriety of such procedure, and the Aveight of authority would seem to sustain the vdew that to compel the prisoner to exhibit the marks upon his body is to compel him to give evidence against himself, and is therefore a A'iolation of his constitutional immunity. A distinction has, hoAvever, been drawn between those cases, on the one hand, AA'here the prisoner has been required te> expose to vieAV marks not commonly visible, and those cases, on the other hand, AA'here he has sought to cem- ceal his form or features by the use of a mask or a A'eil or some other disguised The constitutional immunity extends te) cases of the one class, but it is doubtful Avhether the immunity is broad enough to cover cases of the other. Probably of all marks upon the body, marks of tattooing, by reason of their frequent presence, have most often played a part in judicial in- quiries as to personal identity; and the common introduction of such evidence has raised extended discussion as to AA'hether these symbols may ne>t, in the course of years, spontaneously disappear. The conclusion arrived at by Dr. Taylor J after a careful resume of the recorded cases— a conclusion which seems in harmony with the prevailing current of authority—is "that tattoo marks once properly made in the cutis are practically indehble; but that when the operation is imperfectly per- formed, the marks may, in the course of many years, become lighter and disappear. . . . The only methods by AA'hich such marks admit of removal are by excision of the cutis or the application of actual cautery or es- charotics to destroy the skin. In such cases, cicatrices remain, which under a proper examination may lead to detection." A curious instance, Avhich will serve as an illustration of the questions that arise in this connection, is cited by Dr. Taylor § from the records of the courts of France. "A man named Aubert Avas charged with having committed a robbery in 1S4:}. His defense was that he Avas at that date confined in a certain prison under the assumed name of Solignon. On searching the prison register it Avas found that a man named Solignon was there confined at the date assigned, and the description of the pris- oner shewed that he was tattooed on both arms—on the left there were two hearts, a dog, and other emblems; on the right, a man, a woman, a dog, and two hearts. On examining the prisoner Aubert no marks of tattooing Avere seen upon his arms, although he affirmed that he had been tattooed by a friend in 1840 and again in 1846 with a blue vegetable ink, but that he had some months ago removed the marks by a chemical pre>eess. He also described the marks; those on the right arm repre- sented the bust of a woman and the letters J. S., and on the left arm a tomb, Avith foliage, etc. In 1S46 a hunting scene had been added, but this was the faintest of ah. By close examination of the skin with a lens * See 22 Alb. Law Jour. 144; People vs. McCou, 45 How. Pr. 216; State vs. Gar- rett, 71 N. C. 85; s. c. 17 Am. E. 1; Black-well vs. State. 67 Ga. 76; s. c. 44 Am. E. 717; Stokes vs. State, 5 Baxt. 619; s. 0. 30 Am. E. 595; Boyd vs. United States, 116 U. S. 616; cf. Counselman vs. Hitchcock, 142 U. S. 547. Contra, Walker vs. State, 7 Tex. Ct. of App. 245; s. c. 32 Am. E. 595; and see State vs. Graham, 74 N. C. 646. t So it has been held permissible to summon a defendant to the bar for the pur- pose of identification. People vs. Mount, 1 Wheeler's Crim. Cases, 411. % Taylor's Medical Jurisprudence, p. 355. See also Wharton and Stille's Medical Jurisprudence, vol. ii., p. 261. § Taylor's Medical Jurisprudence, p. 356. 224 A SYSTEM OF LEGAL MEDICINE. in a strong light, M. Tardieu was able to detect faint white marks like cicatrices, representing the outhne of a tomb with two hearts, and the marks indicative of two letters were also detected on the skin of the other arm by the same means. By these observations, the1 non-identity of the accused Aubert with the former prisoner Solignon was clearly proved. Both were tattooed, but the tattoo designs Avere quite different, and under less skillful hands than those of M. Tardieu, Aubert might have escaped the punishment Avhich he merited." A similar inquiry has been raised, and analogous cases have1 arisen, with reference to the possible effacement of cicatrices or scars; but the physicians are apparently agreed * that " all scars resulting from wounds anel from cutaneous diseases which involve any loss of substance are1 in- delible ; the only exception that can be made being in regard to trifling punctured wounds, where but little violence has been done to the skin." (2) Teeth.—Some very striking instances of the recognition of per- sons by peculiarities of teeth are reported in the1 books. The trial of Professor Webster for the murder of Dr. Parkman—one of the classics of the criminal laAv—is perhaps the most notable illustration of the em- ployment of this form of proof.! The body had been consumed in a furnace; but the artificial teeth, being composed of an infusible material, remained substantially intact. It was shown by the dentist, Dr. Keep, that a peculiar set of teeth had been constructed by him for the murdered man; and the production of the trial-plate and the mold of the jaw, and the correspondence of the teeth found in the furnace with the peculiar formation of the plate and mold, pointed Avith almost convincing force to the identity of the victim. So, in a case which came before the courts of NeAv York, the body of a man Avas found six months after a supposed murder, and the inquiry turned upon the question of the man's identity. A dentist avIio testified that he had extracted some teeth for the person believed to have been murdered, proved also that on the teeth remaining there were certain peculiar marks. Evidence was offered that the same teeth Avere absent from the jaw of the body that had been found; and similar marks in the other teeth were sIioavu to exist.! (3) Hair.—The same case affords an illustration of the possibility of identifying a body by peculiarities in the color of the hair or beard. It has been held, however, that an expert witness who has made a study of human hair, on being shown hair from the head of the Adctim of a mur- der and hah* found AA'ith blood on it upon a wheelbarrow belonging to the accused, may not be permitted to give his opinion, founded only on the ordinary appearance of the hair, that the two were from the same head.§ That is a conclusion to be drawn only by the jury from the points of resemblance or diversity AAdiich the evidence may disclose. (4) Size and Stature.—In Lindsay's case, the measurement of the body was one of the tests adopted for the purpose of identifying the A'ictim; and in the case of The People ys.Wilson, the correspondence of the height of the body which had been washed ashore with that of the man believed to have been murdered, coupled with the fact of an unusual length of * Wharton and Stille's Medical Jurisprudence, vol. ii., § 301; Taylor's Medical Juris- prudence, p. 34S. t Com. vs. Webster, 5 Cush. 295. X Lindsay vs. Tlie People, 63 N. Y. 143; and see State vs. Vincent, 24 Iowa, 570. § Knoll vs. The State, 55 Wis. 249; s. c. 42 Am. E. 704. IDENTITY AND SURVIVORSHIP. 225 face, facilitated the solution of the problem of identity. So in the trial of Arnaud 1 »cfore the parliament of Toulouse, a shoemaker testified " that tfuerre's foot reached to the twelfth size, AA'hereas the foot of the accused reached no further than the ninth.'' It is remarked by Mr. Burrill in his treatise on circumstantial evi- dence* that size is the circumstance "AA'hich ordinarily makes the first impression on the sense of vision when directed toward a particular per- son; and Avhere it exists in excess or the reArerse, as where the person is unusually large or unusually small, much beloAv or much aboA'e the com- mon height, it ahvays arrests the attention and impresses the memory. The impression it makes is an instantaneous one, and may be received under circumstances admitting any exercise of the faculty perceiving it. Hence, it may be observed under circumstances of imperfect light or hurried motion, AA'hich Avould not admit of the observation of minuter pe'culiarities. If there be light enough to see an individual Avith any dis- tinctness at all, the outline of his person, which suffices to gh'e an idea of his size or stature, must be Adsible. It is, moreoArer, a circumstance AAdiich cannot, ordinarily, be disguised by artificial means, like other per- sonal peculiarities." t (5) Voice.—Singularities of A'oice haA'e sometimes served as an impor- tant aid in judicial inquiries touching the identity of men. In lloag's case, a peculiar shrill tone and the presence of a slight lisp avciv among the marks of correspondence of Avhich evieleuice Avas given. In Harri- son's case.t Avhich is cited by Wharton and Stille in their book on medical jurisprudence, " a Avitness testified that on the night when the deceased was found strangled in a hackney-coach in the street, she saw a coach stop at a place named, and heard a person in the coach teU the coach- man to go to a certain house, and when he did not go fast enough she heard the passenger SAvear at him for going so s1oaa\ Aftei-Avard she saAV the coachman return Avith the deceased, av1k> entered the coach. The Avit- ness upon hearing the A'oice of the prisoner declared that it Avas the same she heard SAvear at the coachman on the night in question, and in this way led to an entire ielentifiedition."§ The principle that evidence of voice is a legitimate means for the solution of questions of identity finds, I suppose, a logical, if somewhat startling, extension in the rule announced by a decision in Ncav York that the identity of a dog may be shown by the peculiarity of its bark.|| (G) l>ress.—In connection Avith the subject of the identification of persons by means of bodily pe'culiarities, mention may appropriately be made of cases Avhere a man's dress or other articles connected AA'ith his person have furnished a decisive cleAV to his identity. Cases of this character, as might reasonably be expected, are extremely numerous. In Hoaav's case.'] for example, a faAvn-skin Avaistcoat Avas particularly noticed as an article of the prisoner's dress; and -'the absence of an * Burrill, Circumstantial Erideucc, p. 63S. t For other illustrations of identification by means of stature, see BarboVs Case, 18 State Trials, 1267; Rex vs. Brook, 31 id. 1137; State vs. Avery, Burrill, Circ. Ev., p. 621. So a man's carriage—for example, a habit of stooping or of carrying the head on one side—may serve to identify him. Regina vs. Brush, Burrill, Circ. Ev., p. 638. X 12 State Trials, S50. S60. 6 See also Com. vs. Scott, 123 Mass. 222. | Wilbur vs. Hubbard, 35 Barb. 303. 1 Wills, Circumstantial Evidence, p. 234; Burrill, Circumstantial Evidence, p. 639. 226 A SYSTEM OF LEGAL MEDICINE. article of apparel usually worn out-of-doors, such as a hat, constitutes an observable circumstance by which a person may be identified.''* It has frequently happened that in cases of death by violence, where the body of the victim was no longer recognizable, the discovery of his clothing, hat, or papers has been the sole agene-y through which the question of his identity could be solved.t In a recent case in this State1, the body of the victim, supposed to be one Bernard, was in a decomposed and mutilated condition. A satchel near the body containing an almanac on which the name "Bernard" Avas written, keys on the body which fitted the lock of the satchel, shoes and other articles of clothing recognized as belonging to the murdered man, were the only tokens by which identity could be revealed.| Not only the dress of the victim, but the peculiar nature of any other object in his possession, may thus become important. Cases, for exam- ple, may be cited Avhere evielenee as to the color of a man's horse has opened the door to the solution of problems of this kind.§ Akin to these cases in principle are eases where articles belonging to the prisoner have been found near the scene of the murder ;|| or where article's known to have belonged to a person believed to have been mur- dered are found in the possession of the prisoner himself.^f Peculiarities of dress, like peculiarities of stature, are wont to arrest the attention of the observer and to stamp themselves sharply upon the memory. They enter largely into our notion of a man's general appear- ance ; and more often perhaps than any strictly physical qualities have they played a part in the solution of questions of this character. (c) Mental Traits.—It has frequently happened, hoAveA'er, that with the most striking similarity e>f bodily form and features, the mental at- tributes of two men haAre been proved to be so radically divergent as to exedude the hypothesis of their identity. Evidence as to the mental poAvers and attainments of pea-sons atIiosc identity is at issue has been frequently receive1*!, and often Avith the most telling force. Thus, in Guerre's ca.se, Arnaud's ignorance of fencing—an art in which Guerre Avas proved to have been expert—Avas noted as repelling the inference of the identity of the claimant Avith the absent, man. In Hause's case, a circumstance that had led to the aeknovAdedgment of the defendant as the missing son Avas his familiarity with certain local tales AAdiich the son Avas knoAvn to haAre learned. But the most conspicuous instance of the potency of evidence of this kind may be found in the Tichborne case, to which reference has been so often made. The claim- ant, as Ave have seen, had been acknoAAdedged by Sir Roger's mother as her son ; a host of AA'itnesses had corroborated the mother in declaring that he Avas the true heir to the estate; and yet in the face of all this proof, in the face of the most striking similarities of feature and of form, * Burrill, Circumstantial Evidence, 640. See also Barbofs Case, 18 State Trials, 1229; AVills, Circumstantial Evidence, 96; Com. vs. Rear don, 4 Gray, 420. t Taylor vs. State, 35 Tex. 97; State vs. Williams, 7 Jones, 446; Regina vs. Hopkins, 8 C.& P. 591; People vs. Beckwith, 10$ N. Y. 67, 73. X People vs. Palmer, 109 N. Y. 110. % Williams vs. State, 24 Tex. App. 17. || People \'s. Hamilton, 137 N. Y. 531; State vs. Rainsbure/er, 74 la. 196; Caldwell vs. State, 14 S. W. Eep. 122; Burrill, Circumstantial Evidence,'p. 642. H Taylor vs. State, 35 Tex. 97; State vs. Wagner, 61 Me. 17$; Burrill, Circumstantial Evidence, p. 642. IDENTITY AND SURVIVORSHIP. 227 the disparity in the intellectual acquirements of the two men stamped the claim as a scheme of perjury and fraud. The claimant's " ignorance of the mother-tongue of the real Sir Roger; his ignorance of the toAAii in Avhich the first sixteen years of the life of Sir Roger had been passed; his ignorance of the rudiments of knowledge AA'hich Sir Roger Avas shoAvn to have possessed;" his Avant of those instinctive tendencies of mind which a man of Sir Roger's birth and breeding could never, it was felt, have lost—all this combined to overthrow the formidable fabric of proof that had been reared in his behalf. It could not lie that in twelve years a man Avho Avas still, by concession, a keen, an intelligent, an able man, could have lost every distinctive trait of mind that had marked him off from others in the past. And yet the case raises an interesting doubt. Is it in fact true that the things of the mind are to such a degree more constant and immut- able than those of the body? Hundreds of years ago, as Ave have seen, Zacchias did not hesitate to ansAver to his inquirers that toil and hard- ship, exposure and suffering, the thousand incidents of a busy and active life, might change the form of the man of mature years beyond recog- nition by the friends of the youth. Can the same answer be made of the things of the mind ? Do they survive and defy all the conflicts and storms, all the errors and Aveaknesses, of a tumultuous or a dissolute life? We cannot ansAver with assurance that they do; and yet AAre feel that, more perhaps than any trait of feature or of form, the possessions of the mind are indeed a possession to us forever. The mind, of course, may be blotted out; its powers maybe atrophied or dulled; but while geneu-al intelligence apparently survives unimpaired, we can hardly con- ceive but that some vestiges of its past attainments, a scrap or tatter of its bygone poAvers, Avould outlive the Avreck and ruin of the past. Some faint and feeble echo, some olusiA'e, mocking memory of what Avas once its OAA'n, would haunt it Avith a sense of latent force, and stir it sometimes Avith resurgent powers. There have been cases, doubtless, where for long days and nights, as George Eliot has said of her own Baldassarre, "memory has been little more than the consciousness of something gone "; there have been cases where by some passing emotion the vibra- tions of that memory have been stirred, and the old scenes, the old KnoAViedge, the old associations haA'e struggled forth, and waked the mmd at last. But these Avere cases of mental decay or of mental stupor which affected the mind in its entirety. They do not make it the easier to believe^ that, along Avith present ability and mental force, complete loss of past acquirements should coexist. We can conceive, in short, of the destruction of the mind; Ave can conceiA'e of the impairment of its fac- ulties ; but Ave can hardly conceiA'e that with the mind still existent, with general intelligence still survhdng, AA'ith no trace of idiocy or senility at hand, the mind should be substantially a different mind from that which once it was. We can conceive of it as annihilated, Ave can conceive of it as impaireel; but with difficulty can aac conceive of it as transformed. Yet the inference of the identity of the Tiediborne claimant with the missing heir to the estate Avas not only overborne by the diversity of their mental traits ; it Avas overborne by the very theory and basis of the claim. Why Sir Roger Tichborne should have led this wandering life, why he should have left his home to act as a horse-breaker, a stock-driver, and idtimately a butcher, Avhy he should have abandoned the splendors 228 A SYSTEM OF LEGAL MEDICINE. of his former life for the hardships and privations which apparently he courted, Avhat intelligible motive could have existed for such a course', there Avas little effort to suggest. One feels that, on the claimant's e>AA'n theory of the case, the temperament, the tastes, the 2>assions of the two men Avere inherently at variance. It Avas not only that the man aa'Iio had returned had lost the traits of mind of the boy AA'ho had gone forth; it AA'as, that the hfe AA'hich, of his oavii volition, he had led, did violence1 to every impulse and desire that the true Sir Roger Avould naturally haA'e felt. (d) History and Experiences.—And just as the disparity of mental traits is a corrective of the errors to Avhich bodily resemblance1 may give rise, so too, by proof of the agreement or the diversity of the history of men, of the incidents of their careers, of the course anel tendency of their liA'es, the conclusion of identity may be defeated or sustained. A case came before the courts of this State but a few years ago,* where a woman, claiming to lie the child of a testator, instituted proceedings to contest the validity of his Avill. It Avas sIioavh by the discrepancy betAveen the liA'es and records of the testator and of the contestant's father, that the hypothesis of their identity could not for a moment be sustained. It AA'as proved that the father of the contestant Avas an illiterate man AA'ho had been a farm-laborer, a policeman, anel a convict, and avIio signed his name AA'ith a mark. It Avas proA-ed that the testator had been a tutor in prominent families, a professor of anatomy, and a physician. The infer- ence of identity that might have been drawn from the correspondence of then* names, the similarity of their stature, and the agreement of their places of residence Avas held to be utterly repelled by this evidence of the diversity both of their mental attainments and of the incidents of their careers. Yet here, as in so many other phases of the problem, experience tells us, I think, that though evidence of diversity may justify us in refusing to draAv the inference of identity, evidence of agreement is a far less trustworthy and certain guide. The most striking coincidences may occur, and the conclusion of identity be still unwarranted. The knoAA'l- edge that Arnaud exhibited as to the details of the life of Guerre Avent far to baffle the court, and to induce a belief in the good faith of the imposter. The avenues by AA'hich kn numerous, the chance of tracing such knoAvledge to its root is so remote, that Ave should hesitate1 long before assigning decisive force to an apparent correspondence betAveen the histories of men. (e) Incriminating Circumstances.—If, however, the question at issue be not simply the question of the identity of a given person AA'ith one who Avas knoAvn to us in the past, but rather of his identity Avith the un- knoAATi perpetrator of some giA'en deed, the possible sources for the solu- tion of the problem are multiplied a hundred-fold. We are in the broad field of what is commonly denominated as circumstantial proof; and its forms are at once as various as the possible combinations of cause and of effect, and as complex as the lives and the passions of mankind. To catalogue them is impossible ; to reduce them to any consistent principle is vain. They have no other test of their validity than the experience of the race that the conjunction of two circumstances may be of such a * Re Darling, 6 N. Y. Supp. 191. IDENTITY AND SURVIVORSHIP. 229 nature or so often repeated as to suggest a causal relation existing be- tAveen the two. I can frame no more definite statement of the principle AAdiich sanctions evidence of this kind than that AA'hich I adopted at the outset of the discussion: any fact that would in the ordinary course of eA'ents have precedeel or have folloAved the perpetration of the act in issue by a given man, will be evidence from AA'hich the agency of the act may legitimately be inferred. It may be objected that this statement does not leave us much wiser than Avhen we started; that it does not afford us a test by which the ordinary course of events may be accurately gauged and measured. And this, I think, is entirely true; but the difficulty, as I have already tried to show, is inherent in the very nature of the inquiry. Reduce our problem to rules or to principles as we will, that which we cannot force within the rule, the informing and animating life of which the rule is but the empty shell—that life is the common experience of the race; and by the test of this experience all our problems must in the end be solved. That wliich in common experience Avould precede, that which in common experience Avould accompany, that which in common experience would follow, the perpetration of a crime by a given man, is proof confirmatory of the hypothesis of his guilt, aud on this account it is admissible as evidence* It is in pursuance of this principle, and in the main to aid in determin- ing the identity of an offender, that proof of motive has been admitted to so prominent a part in the history of criminal trials. A very recent case t contains a clear recognition of the rationale of evidence of this kind. " The prosecution," says Judge Earl, " is never bound to prove the motive for the commission of a crime. Motive furnishes corroboration in a case depending upon circumstantial evidence. But where there is no dispute about the killing, and the other ingredients of the crime are established, motive is unimportant, and a conviction may be proper although no motive for the crime can be sIioaaui or discerned. It is one of the facts tending to the identification of the criminal, or characterizing the criminal act, but is never as matter of law essential." In brief, the existence of motive is, as our experience tells us, a common antecedent condition to the commission of a crime; and the fact that an accused man had a perceptible incentive for the commission of an offense is a circumstance tending to confirm the hypothesis of his identity with the perpetrator of the deed. And just as a fact that Avould naturally precede a crime may be evi- dence of the identity of its perpetrator, so also facts that Avould naturally have followed it are similarly relevant. Indeed, as Bentham has pointed out,t "the probative force of posterior events in regard to prior ones is naturally much stronger than that of prior events Avith regard to poste- rior ones. In all human affairs, execution is better evidence of design than design of execution," because human designs are so often frustrated. * Stephen, Digest of Law of Evidence, Appendix, note 1; Bentham, Rationale of Judicial Evidence, bk. v., chap. xiv. t reoplc vs. Johnson, 139 N. Y. 358, 362. See also in this connection Jewctt vs. Banning, 21 N. Y. 27; Com. vs. Robinson, 146 Mass. 571; People vs. 1-7*7;, 125 X. Y. 136; People vs. Trczza, 125 N. Y. 740. X Bentham, Rationale of Judicial Evidence, bk. v., chap, xiv.; 2 Best on Evidence, § 354. 230 A SYSTEM OF LEGAL MEDICINE. The possession, for example, of the fruits of theft, at a period not too iv- mote from the date of its commission, is a circumstance that would nat- urally have folloAved the offense, and so their possession is often cogent evidence of the identity of the accused. The presence of the prisoner at the scene of the crime, the purchase by him of weapons with AA'hich the crime might be committed, the flight of the accused, or his demeanor upon the stand—ah these are relevant as circumstances more or less significant of the identity of the perpetrator of the wrong. And these circumstances need not, of course, be proved by direct eA'idence; they may be proved indirectly as well. The presence of a prisoner at the scene of a murder has repeatedly been evidenced by correspondence be- tAveen the size of his boots and of footprints discoA-ered upon the ground* And all these elements of proof,motiAe, preparation, subsequent incrim- inating acts or words—inconclusive frequently alone—may be so com- bined as collectively to fix the identity of the criminal to the exclusion of every other reasonable hypothesis.t The propriety, henvever, of leaving to circumstantial proof the identi- fication of a murdered body has not passed entirely unchallenged. It Avas a rule of the common law that the corpus delicti in cases of murder had two components, death as a result, and the criminal agency of an- other as the means • and it was only where there Avas direct proof of one element that the other could be established by circumstantial evidence.! That rule, hoAvever, was satisfied when the death of some one was directly proved; the identity of the victim might be indirectly sIioavii. A case§ came before the courts of New York not many years ago, in which it Avas claimed that the proA'isions of the Penal Code || had changed the rule of the common law, and required direct evidence, not of the fact of death alone, but of the two facts of death and of identity. The body of the Adetim had become so decomposed that personal recognition Avas impos- sible; and to sustain the prisoner's claim Avould have been to grant him complete immunity from punishment for his crime. But the court con- strued the provisions of the statute in the light of the history of the rule, and held that the law had not " placed a premium upon the brutal courage which can mangle and burn the lifeless body." A wide range, it will be found, has been given by the decisions to the instrumentalities by which identity may be shown. " The complex nature of the problem has led the courts to avail themselves of every agency by which a sound conclusion might conceivably be reached. They have permitted, with substantial unanimity, the introduction of properly au- thenticated photographs fl as evidence'of general appearance or of special physical traits; and important aid has often thus been lent to the deter- * See, for example, Clanrcrius vs. Com., 81 Ya. 787; Sutton vs. Com., 7 S. E. 323; Caldwell vs. State, 14 S. AV. 122; People vs. McCurdi/. 68 Cal. 576; People vs. Myers 70 Cal. 582; State vs. Read, 89 Mo. 168; People vs. McCallam, 3 X. Y. Crim. Eep.' 189. t See, for example, People vs. Johnson, 140 N. Y. 350. X Ruloffvs. The People, 18 X. Y. 179. § People vs. Palmer, 109 N. Y. 110. || Section 181 of the Penal Code prohibits a conviction "unless the death of the person alleged to have been killed, and the fact of the killing by the defendant as alleged, are each established as independent facts, the former by direct proof and the latter beyond a reasonable doubt." H Marion vs. The State, 20 Xeb. 233; s. c. 29 N. W. 211; People vs. Cowley, 83 X Y 464; People vs. Buddensieck, 103 X. Y. 487; People vs. Fish, 125 X. Y. 136. * IDENTITY AND SURVIVORSHIP. 231 minafion of the issues in dispute. Images of a rude kind have served, indeed, since early times as a means for identifying bodies; and Charles I. of England Avas recognized,* it is said, by his resemblance to the head upon coins of the realm AA'hich had been issued in his reign. Nice problems of evidence in connection with questions of identity have frequently arisen in the course of bastardy proceedings, and there has been some diversity of opinion t as to Avhether, in passing upon the identity of the parent, where the child and its putative father are present in the court, the jury may take into account the resemblance of the one to the other. The mere opinion of a witness, hoAvever, as to the existence of such a resemblance, has, it would seem, been generally excluded,! and the courts haAre required that the resemblance should be shown by the comparison of the two persons in open court before the eyes of the jurors.§ No very definite statement can lie found, and none in the nature of things could avcU be given, as to the degree or cogency of proof that is required before the inference of identity will be drawn. The mere fact that a witness hesitates in the identification of a criminal,|| or that his eAddence is in some respects conflicting,^] has been held insufficient cause for the withdrawal from the jury of the issue of identity; but, on the other hand, if it plainly appear that the testimony of the complainant is little more than a conjecture or suspicion, the courts have not hesitated to declare that a conviction is unwarranted.** The tendency of a study of the cases of disputed identity is to break doAvn the supposed distinction betAveen direct and circumstantial proof, and to lead to the conviction that, at least in cases of this character, the latter form is perhaps the safer of the two. From the standpoint of psychology, the distinction is of doubtful validity at best. So little of our knoAAledge is directly given us by our senses, so little of it but is the product of association anel comparison working upon the raw material which the senses supply, so much that seems to us immediate and direct is, in reality, mediate and indirect, that from a philosophical standpoint almost all emdence is the eA'idence of a fact, not directly, but indirectly perceived. I find a notable judicial recognition of this truth in Judge Gray's opinion in the recent case of The People against Harris.tt "All evidence," he says, "is in a strict sense more or less circumstantial; whether consisting in facts AA'hich permit the inference of guilt, or whether given by eye-witnesses of the occurrence; for the testimony of eye-wit- nesses is, of course, based upon circumstances more or less distinctly and directly observed." Such a notion as this of the inherent parity of seemingly divergent forms of proof Avas impossible for the jurists of an earlier day. That * Mason, J., in Ruloff vs. Tlie People, 3 Parker's Crim. Eep. 401. t See, for example, 50 N. J. Law, 490; 67 N. C. 89; contra, 81 Me. 348. X Young vs. Makepeace, 103 Mass. 50. \ On the rule that identity of name is prima facie evidence of identity of person, see Stcbbins vs. Duncan, 108 U. S. 32; Spottcn vs. Keeler, 22 Abb. X. C. 105, note. But this presumption is not of universal application. Hoyt vs. Newbold, 45 N. J. Law, 219 ; s. c. 46 Am. E. 757. || People vs. Foley, 27 AV. Dig. 217. fl" People vs. Ilracco, 69 Hun, 206. ** People vs. Smith, 7 X. Y. Crim. Eep. 425. tt People vs. Harris, 136 N. Y. 423. 232 A SYSTEM OF LEGAL MEDICINE. it should have found, as I beheve it has, a conscious lodgment in the law at all, is proof of the reaction upon legal science of the other depart- ments of man's knoAA'ledge and advancement. The truth is, as tvery student of psychology knoAA^s, that very little of AA'hat AA'e seem to see is actually given us by sight alone. It has been pointed out, I beheve by 31r. Mill, that the act of mind which is indicated by the words "I see my brother " is not merely a perception, but an inference. The cases Avhich legal medicine has collected sIioav that it is not only an inference, but an inference in certain instances of the most uncertain and dubious kind. When the Tichborne claimant, in the words of the lord-chief-justice, "stood as it Avere lietAvenui tAvo persons, between Arthur Orton on the1 one hand and Roger Tichborne on the other, and Avhile he declared that he Avas Roger Tichborne, a host of Avitnesses declared that he Avas Arthur Orton," the truth that almost all cA'idence is acoiudusion, that the differ- ence between the proof Ave call circumstantial and the proof Ave call direct is one not so much of kind as of degree,—that truth received an object illustration AA'hich we might hardly expect to meet AA'ith in the musty rec- ords of the hnv. We commonly permit a Avitness to testify directly: " This is the man that I have seen before." We think of this testimony not as an inference or a conclusion; we think of it as a statement of a fact. The psychology which tells us we are in error, Ave brush asiele as speculative anel unprac- tical in its vieAA's; and doubtless for the ordinary purposes of life we are entirely in the right. None the less, however, is a conclusion really drawn; a conclusion AA'hose data are the acts, the impressions, the mem- ories of a lifetime; a conclusion whose premises are so manifold and so complex that they are lost and scattered and merged before the inference has, almost unconsciously, been reached. And the huv is quite consist- ent Avith itself, quite consistent AA'ith elementary rules of proof, AA'hen it permits the Avitness, omitting the process Avhic'h generated the behef, to testify to the resultant fact. That infraction of the cardinal rule that testimony as to opinions may not in general be received, is one that finds manifold illustrations in the books. The laAv recognizes the fact that there are certain unconscious inferences AA'here1 the average mind can only testify to the inference itself; that there are certain complex processes AA'here the individual links in the chain of thought, if presented one by one, Avould lose their meaning and their force; that there are certain opinions which, as the courts have put it, are."but abbreviations of the facts." * But every now and then a case arises AAdiich puts the problem in its true light; and the knowledge that seemed to us immedi- ate is seen to be the result of a long process of reasoning—an elaborate train of thought.! We are surprised and awakened at times inte> a con- sciousness that there is a practical side to this analysis of the phenomena of the mind—that as a working hypothesis Ave may'treat it as superfluous, but that it discloses a deep truth which may not permanently be ignored. * Sloan vs. R. R., 45 X. Y. 125; People vs. Wright, 136 N. Y. 625; Knoll vs. State, 55 Wis. 249; Udderzook vs. Com.. 76 Pa. St. 340; State vs. Dickson, 78 Mo. 43S; People vs. Rolfe, 61 Cal. 540 ; DeWitt vs. Early, 17 N. Y. 340. t So, too, the identity of physical objects, it may be noted, is generallv to be de- termined by the tests of the popular understanding; yet " even lawvers are occasion- ally called upon to consider more minutely in what the identitv of a thing consists." Holland's Elements of Jurisprudence, p. 8S; and see Silsbury vs.'McCoon, 3 X. Y. 379. IDENTITY AND SURVIVORSHIP. 233 There is a case illustrative of this which is reported in the early deci- sions of the criminal courts of New York.* A dead body AA'ith marks of violence upon it had been Avashed ashore. It Avas alleged that the body was the body of Captain Palmer, but personal, immediate recognition had long become impossible. " The height of the deceased was shoAA'n, an unusual length e»f face, and a AAddening of the end of the little finger to Avhich in a general Avay the bod)' corresponded. But a more important fact Avas that the captain had imprinted his name upon his arm and leg; and on the same portions of the body found the skin had been cut away, except that on the leg the letter P remained visible. A brother-in-laAv of the deceased, aa-Iio had seen the body, Avae asked the direct question AAdiose body it AA'as; but the court would not permit an ansAver, saying that the question Avas not the ordinary one of personal identity, since the body had been submerged for five months, but Avas one of an inference from resemblances, Avhich the jury and not the Avitnesses must draAv." In ah this, as I have already said, the law is thoroughly consistent. Systems of law must deal Avith the acts of the mind as the common ap- prehension eleals AA'ith them. The subtleties of psychological analysis cannot be permitted to disturb the current of forensic proof. Whether or not the so-called philosophy of common sense be a sound system of metaphysics, it is the only metaphysics on Avhich a body of laAv can be built. The rudest and the most developed systems alike are constrained to adopt as their final or at least prevailing tests the hasty and superficial notions of the popular intelligence. PrimitiA'e law ncA'eu- attempts in the slightest degree to penetrate back of the common understanding of things and into their essential nature. It sees only the outAvard forms of trans- actions ; it is blind to their inherent substance. The spoken Avord is bind- ing, though it AA-as spoken under the coercion of fraud or of mistake.! We of to-day have shaken ourselves free from that primitive subordina- tion to the external s1k>avs of things; we have striven to some extent to substitute the ideal for the popular conceptions; but the tendeuiey has its limits that are Avell defined; they are defined both by the inherent purpose of law itself and by the possibilities of human proof. The law is concerned Avith "objective conformity to a rule"; and if, as it Avould seem to be, the history of legal progress has been the history of a de- velopment from form to substance, from that AA'hich is accidental to that which is essential, from a sort of legal anthropomorphism to a sort of legal spiritualism, it is still true that the law was made for a Avork-a-day world; that it must often rest satisfied Avith external standards, and govern itself by rules which it knoAvs are but provisionally true. I think, therefore, that in its solution of problems of identity, and in its answer to the questions of eAddence involved, the common laAv has sIioavii a vigorous and healthy spirit. It seems to me to have pursued the just mean between the dangerous extremes of metaphysical refine- ment upon the one hand and superficial formalism upon the other. And that healthy and vigorous spirit which the law has manifested here, it has preserved in its treatment of other and analogous questions that often remain to be solved after the preliminary question of identity has been settled. The bodies of persons aa-Iio have perished in a common calamity are * People vs. Wilson, 3 Parker's Crim. Eep. 199; and see statement of Finch, J., in People vs. Palmer, 109 X. Y. 110. t Maine, Ancient Law, pp. 303, 304. 234 A SYSTEM OF LEGAL MEDICINE. found; the resources of science are taxed in the effort to deterniine their identity ; and that question being answered, the inquiry will still remain, Which of the two persons was the first to die; which of them was the SUl-ATVOl* ? Survivorship.—It is the tendency of all systems of law as they de- velop to narrow the field of presumptions. Like the fictions which with early law supply the place of legislation, presumptions find their Avidest field in the infancy of legal systems. The1 refusal of our law to adopt a formal or artificial doctrine as to the survivorship of those Avho have died in a common calamity is quite in harmony with the course and history of the development of its rules of proof. Yet it is a someAvhat noteworthy fact that almost every system of law has solved problems of this character by certain fixed and formal tests. We are referred to the Mahometan law of India, and are told that where relatives perished together it Avas presumed that the same moment marked the death of all* We turn to the Roman hrw,t and Ave find that it, too, had its fixed and a priori rules. Where husband and wife Avere lost, the former Avas adjudged the survivor. Where father and son had died together, the son, if below the age of puberty, was deemed the first to have succumbed; if above that age, he was deemed to have been the survivor. In the same spirit, the Code Napoleon \ de- clares that if those AAdio perished together were under fifteen years, the oldest should be presumed the1 survivor; if they were ah above sixty years, the youngest should be presumed the survivor; if some were under fifteen, and others above sixty, the former should be adjudged the surviv- ors ; if those AA'ho had perished together had completed the age of fifteen years, and Avere under sixty, the male should lie presumed the survivor, AA'here ages Avere eepial, or the difference did not exceed a year; if they Avere of the same sex, that presumption should be admitted which Avould open the succession in the order of nature; thus, the younger should be considered to have survived the older. The same rules, it is saiel, Avere in force1 in the territory of Orleans at the time of its cession to the United State's, and haA'e since been incorporated into the code of Louisiana.§ The principles of the Roman law regulated for many centuries the practice and speculations of European jurists, and statutory enactments of more recent date have served in some instances to perpetuate these or similar presumptions. It is not unnatural, therefore, that Avhen the question first presented itself to an English court, the common law, awed, it may be, by the imperious authority of Roman jurisprudence, should haA'e faltered for an appropriate1 lvply. The question arose in 1766, after the loss by shipAA'reck of General StaiiAvix and his daughter. On the one hand the nephew of General Stanwix, on the other hand the maternal uncle of the daughter, laid claim to the personal estate. It Avas urged that the general, a soldier and a man of courage, might reasonably be supposed to have struggled long and earnestly against the fury of the Avaves. It AA'as urged on the other hand that the general Avas old and feeble, and that the chance of survival was rather with the daughter, who * Greenleaf, Evidence, vol. i., § 29; Cowman vs. Rode/ers, 73 Md. 403. t Dig. Lib. 34, tit, 5; Greenleaf, Evidence, vol. i., * 29. X Code Civil, U 720-722; Coye vs. Leach, 8 Met, 371; Greenleaf, Evidence, vol. i., § 29; Beck's Medical Jurisprudence, vol. i., p. 626. § Civil Code of Louisiana, arts. 930-933; Greenleaf, Evidence, vol. i., § 29. IDENTITY AND SURVIVORSHIP. 235 retained her youth and health. The learned court was so impressed Avith the force of the arguments upon botli sides that it confessed its inability to arrive at any conclusion, and the case is authority for nothing, except for the complexity of the problem* Yet the courts seem at an early day to have felt that the question, if it was te> be solved at all, should be soh'ed by evidence, and not by a priori rules. Even in the familiar case which is cited by Blackstone,t where a father and se>n Avere hanged at the same time, and the son, being obsea-ved to struggle longest, was decreed to be the survivor, the law, if it dreAV its inference from someAvhat inconclusive eA'idence, Avas still faith- fid to its requirement of proof. And though no very satisfactory dis- cussion of the true principle's applicable to cases of death by a common disaster can be found in the early English reports, still the trend of judicial dicta and decision J Avas entirely in the direction of the rule that has since become firmly established both in that country and in our oAvn. In the United States the question first presented itself in connection Avith the loss of the steamer "Pulaski," in June, 1838. Among the A'ic- tims of that disaster were a man named Ball, his Avife, and his adopted daughter. By the terms of his will Ball bequeathed to his wife, in the eA'cnt that she surviA'ed him, certain portions of his estate; and her rep- resentatives brought suit in the courts of South Carolina, and sought to establish her rights as the survivor of her husband. The opinion of the chancellor § treats the question as one that should be determined not by presumptions, but by proof. He discusses in much detail the circum- stances of the loss of the ship as narrated by survivors of the calamity; he notes the fact that Mrs. Ball Avas the last to be seen alive; he notes the fact that her husband may possibly have escaped the explosion Avhich shattered the boat, but that she, as the testimony showed, had certainly escaped it; he notes the fact that her husband failed to respond in an- SAver to her cries, AA'hich were heard above the din of the disaster; and grouping these and other edrcumstanccs together, he reaches the con- clusion that the husband Avas the first to die. " The right on the part of Mrs. Ball," says the chancellor, "is deiivative, and the burden is on the plaintiffs to proA'e that she Avas the surviAror; but although bounel to prove it, it does not folloAv that they are to prove it to demonstration; Ave must take the best evidence the case affords." UnAvilling to rest on the fact that Mrs. Ball Avas the last person seen, he prefers " to put the case upon the ground of probability arising from the evidence upon a belief en- gendered by a combination of circumstances, and upon the superiority of positive proof OArer conjecture or eA'eai probability." Subsequent decisions || haA'e perhaps cast a doubt upon the sufficiency of the evideuice from Avhich the conclusion of survivorship Avas drawn by the chancellor; but the theory and basis of the judgment, it would seem, haA-e neA'er been impugned. A few years later, in 1844, the courts of Massachusetts were asked in * The King vs. Dr. Hay, 1 AV. Bl. 640. t Bl. Comm. X Wrie/ht vs. Sarmuda, 2 Phill. 266; Sclwyn's Case, 3 Hagg. Eccl. E. 748; Mason vs. Mason, 1 Meriv. 308. § Pell vs. Ball, 1 Cheve's Ch. Cases. || Russell vs.Hallett, 23 Kan. 276; In re Ridgway, 4 Eedf. 226; Wing vs. Angrave, 8 H. of L. Cases, 183. 236 A SYSTEM OF LEGAL MEDICINE. a case resulting from the same calamity to apply the presumption that a daughter of thirty-three had survived her father, a man of seventy years. The court declared* that no legal presumption of survivorship existed, and that in the absence of eAddence as to the time and manner of the death of the Adctims the law could frame no judgment as to the relative duration of then- lives. The rules of the civil law, it was said, "are clearly arbitrary rules, as in the nature of things a week or a day less than the respective ages named would not usually, in any degree, affect the ability of the party to sustain and prolong life in case of exposure by shipAvreck. Such rules, being thus arbitrary in then- character, to some extent, would seem to require a legislative act for cases of this character and description. But without such legislation Ave do not feel authorized to adopt any fixed period of age as decisive of the craestion of survivorship of those Avho perish in a common disaster, and where no facts or circumstances are knoAvn that would aid in deciding the point of survivorship. To a certain extent we might well go, in applying the principle as to disparity of age. Thus it would be proper and reasonable to hold that one in middle age and in the full vigor of life would ordi- narily survive a mere infant, or child of very tender years ; and the same would be alike true as to such person and the man avcU stricken in years." These were the pioneer cases upon this troublesome topic of the law. If their discussion of the question Avas somewhat fragmentary and faltering, they displayed at least a sound intuition as to the appropriate legal rule. Subsequent decisions, however, have considered the subject with a Avealth of argument that has Avithdrawn the topic from the realm of the debatable problems of the laAv. In 1854, in the case of Underwood vs. WingJ the courts of England were confronted again AA'ith the necessity of declaring .the true doctrine that Avas applicable to such a case. " The question of survivorship," they declared, "is the subject of eAudence to be produced before the tribunal wliich is to decide upon it, and Avhich is to determine it as it determines any other fact. If there be satisfactory evidence to sIioav that the one survived the other, the tribunal ought so to decide; and if there be no evidence, the case is the same as a great Arariety of other cases, more fre- quent formerly than at present, where no evidence exists, and conse- quently no judgment can be formed. We have no doubt that the scien- tific gentlemen aa4io Avere examined were perfectly sincere in their opinions, but it is obvious that their opinions Avere given having reference to the case of two persons quietly submerged in water and remaining there until drowned, or to the ease of two persons, one being a SAAdmmer and the other not, and both thrown suddenly into the AA'ater unincumbered, and acting on certain instinct. The present case is that of two persons clasped together, two boys clinging to one of them, and standing pretty high out of the Avater on the ship's side, swept off together by an OArer- AAdielming Avave into a raging sea, and one or other, or both of them, may have been stunned by the violence of the bloAv from a AvaA'e. or they may haAre struck against a timber of the ship, and may have, in fact, been dead before he or she reached the AA'ater at ah. How is it possible, under such circumstances, for any tribunal, sitting judiciahv, to say which of * Coi/e vs. Leach, 8 Mete. 37; s. c. 41 Am. Dec. 518. t Underwood vs. Wing, 4 DeG., McX., & G. 633; s. c. 31 Eng. Law & Eq. 293. IDENTITY AND SURVIVORSHIP. 237 these two individuals died first ? We may guess, or imagine, or fancy, but the law of England requires evidence." The opinion of Lord-Chancellor Cranworth, in the same case, is sub- stantially to the same effect. " I give the medical gentlemen," he says, " most entire credit for speaking scientifically, and, as we believe, quite accurately. I do not think that they themselves even are very confident. Indeed, it is idle when you are calculating and reasoning d priori in this way, as to AA'hich of two persons may have breathed a few seconds the longest at the bottom of the sea; for that is aU it comes to. To think that one can take that as establishing the fact seems to me to be quite misunderstanding the nature of human testimony. The medical men may be quite right in the observations they have made of persons dying of asphyxia; that there is a small interval, of perhaps hah a minute, after sensation has ceased, in which life stiU continues; and I think they say that that is, as far as their observation goes, uniform in all states of health and in ah state's of strength. I dare say that may be very learned and probably accurate, as far as science enables us to form such an opinion; but happily the instances of such events cannot have been sufficiently numerous to have enabled anybody to have formed at all an accurate1 anel certain conclusion on such a difficult subject; and I confess that I rose from the perusal of their evidence utterly unconvinced that those gentlemen can tell us AA'hich of them died first if they had both been taken and quietly submerged to the bottom of the sea. But when you add to that that they are all A'iolently thrown by one blast from the side of the ship, and may have fallen against some spars (from what we know, that may haA'e been so); and then in the whirlpool and confusion of the moment to pretend that you can come to any conclusion on which you can act, that these medical gentlemen are right in supposing the Avife did die a tew seconds before the husband, seems to me to be confusing and confounding the province of human testimony." The doctrine of Underwood vs. Wing received new confirmation, and its limits at the same time were metre sharply defined, by a decision of the House of Lords, AA'hich was rendered in 1860.* " When tAvo persons," said Lord Chelmsford, " are swept away by a calamity like that which happened in this case, it is possible that there may be evidence to prove distinctly which was the survivor; as where one of them has been seen struggling Avith the waves after the other has sunk, and never again appeared above the surface, or as in this very case, where there can be no doubt that there is eAddence to establish satisfac- torily that Catherine, the eldest daughter, survived her parents for some short time, though she afterward perished in the same shipwreck. But Avhere two persons are at one and the same instant washed into the sea and disappear together, and are never seen any more, it is not possible for any tribunal, called upon judiciaUy to determine the question of survivorship, to form any judgment upon the subject which can be founded upon anything but mere conjecture derived from the age, sex, constitution, or strength of body or mind of each individual; and as our law has not established any rules of presumption for these rare and extra- ordinary occasions, the uncertainty in Avhich they are involved leaves no greater weight on one side or the other to incline the balance of evidence either way." * Wing vs. Angravc, 8 H. of L. Cases, 213. 23S A SYSTEM OF LEGAL MEDICINE. The adjudications of the Enghsh courts upon this topic have met Avith general approval in the courts of the United States; and the decisions in the two countries are in substantial conformity. In New York, in Florida, in Kansas, in Maryland, in Colorado, and in Maine * the courts have declared that there is no presumption of survivorship, and that the rights of representatives must be established through the ordinary agen- cies of proof. In California, however, the question has been set at rest by statutory enactment; and where two persons perish in the same calamity, such as a wreck, a battle, or a conflagration, and there is no evidence1 from AA'hich it can be sIioavu or inferred which of them Avas the first te> die, if both are over fifteen and under sixty, and the sexes differ- ent, it Avill be presumed that the male survived.t In a case Avhere a husband and his Avife Avere murdered at their home at the same time and the house set on fire, the rule laid down by the statute Avas applied, and the husband Avas adjudged the survivor.} There Avere dicta in some of the earlier decisions § which intimate that in these cases of death by a common calamity, the law would presume that all the victims perished at the same time; but later decisions have united in declaring that the presumption of death at the same moment is quite as arbitrary and illogical as the presumption of death according to some fixed and definite principle of succession. " That two human beings," it has been said by Lord CraiiAvorth,|| "should cease to breathe at the same moment of time is hardly Avithin the range of imagination. I suppose that time, like space, is infinitely divisible; and if Ave are to speculate on such a subject, one could hardly suppose that the one did not breathe a millionth part of a second longer than the other. There- fore, to adjudicate on a principle1 that they did actually cease to breathe at the same moment, would, I think, be proceeding on false data. The real ground to proceed on is that it cannot be proved which died first; they both probably died within a few seconds of each other, but which die'el first it is impossible to say. That being so, what is the result? Why, here is a wiU made in Avhich in one state of circumstances, namely, that the Avife died in the husband's litetime, the property is given away. It is not proveel that that state of circumstances existed, and in no other state of circumstances is it given away. Then it is not given away at all. Therefore, it is to be taken as upon an intestacy, and must be dis- tributed among the next of kin." \\ The question whether ah the victims of the disaster will be presumed to have died together, or Avhether the law will refuse to draw any pre- sumption Avhatever, is, after all, a question more of form than of sub- stance. The true principle doubtless is that no presumption at ah will be entertained;- but "the practical consequence," as has been remarked * Newell vs. Nicholls, 75 N. Y. 78; Smith vs. Crobm, 7 Fla. 149; Russell vs. Ilallett, 23 Kan. 276 ; Cowman vs. Rodgers, 73 Md. 403; Kansas sed to the same peril under like circumstances, it is not, as a question of prollability, Arery unlikely to happen. At most the difference can only be a few brief seconds. The scene passes at once beyond the vision of human penetration, and it is as unbecoming as it is idle for judicial tribunals to speculate or guess whether during the momentary life-struggle one or the other may not have ceased to gasp first, especially when the transmission of title to property depends upon it; and hence, in the absence of other evidence, the fact is assumed to be unascertain- able, and property rights are disposed of as if death occurred at the same time. This is done, not because the fact is proved, or that there is any presumption to that effect, but because there is no evidence and no pre- sumption to the contrary." But questions of survivorship do not only arise as a consequence of the death of several persons in some common disaster; they arise also AA'here persons have left their homes, and have remained absent from thedr relatives and friends for an extended period of time. It is a pre- sumption of the law, based upon the known stability of certain human conditions, that a person once proved to have been born is still alive |—a presumption which, in general, is only defeated by the lapse of time so great that continuance of life would, in our experience, be palpably impossible.§ But Avhere a man has departed from his home, and for seven years no tidings haA^e been received from him by those who would naturally have heard from him Avere he alive, it is a doctrine of the laAA-, sanctioned by a long series of decisions, that his death must be presumed.|| The period of seven years Avas adopted by the courts in analogy to an early English statute,^ which exempts from the penalties of bigamy " any per- son AA'hose husband or wife shall be continually remaining beyond the seas by the space of seven years together, or Avhose husband or wife shall absent himself or herself, the one from the other, by the space of seven years together, in any parts Avithin the king's dominions, the1 one of them not knowing the other to be living within that time." Mere absence is not sufficient to satisfy the requirements of the rule ;** those who would * Best on Presumptions, § 144. t Newell vs. Nicholls, 75 N. Y. 78. X Greenleaf, Evidence, vol. i., § 41; Stephen, Digest of Law of Evidence, art. 99; Eagle's Case, 3 Abb. Pr. 218; O'Gara vs. Eisenlohr, 38 X. Y. 296. § 92 Am. Dec. 704, note; Spritp/ vs. Moalc, 28 Md. 497. || Eagle's Case, 3 Abb. Pr. 218; MeCartcr vs. Camec, 1 Barb. Ch. 455; Davie vs. Bri

r in such position that the dead man could not have made1 it upon himself. He knoAvs that the in- jury talked of Avas a Avound, anel that is sufficient for him. Contused Wounds and Ecchymosis.—Wounds made by some blunt instrument may leaA'e such traces as to leael not only to a clear statement as to Avhat kind the instrument Avas, but also to the perpetrator, as the evidence given by the marks inflicted is sIioavii to be possible only by the use of a particular Aveapon knoAvn to be owned and in the possession of the prisoner at the time the assault Avas committed. To detail these signs Avould be an easy task, but it becomes a far different one when such distinctive marks are Avanting. A bloAv from a cane, bludgeon, lead pipe, or other such substance having a smooth surface Avith rounded edges, gives no clue as to the particular Aveargon, and the same kind of injury may often be made by falls. It is then only possible for the medical Avit- ness to state that such a Avound could have been produced by the weapon shoAvn, if the latter is of the character given above. Wounds of this kind generally give the sign of a bruise, viz., the dis- coloration of the skin called ecchymosis. When this ecchymosis follows immediately upon the reception of the bloAA', the color is red or blue, being of deeper tone in its center; and it may not be anything more, for, death resulting from the blow, time is not given for the changes noticed AAdiere the ecchymosis passes through certain stages in the hving body, going from blue to almost black, then purple, violet, green, yellow, and fading from the last-named color to the natural condition. This is due to the effusion of blood into the skin and cellular tissue from the rupture of capillaries or small vessels; and as the blood ceases to flow and clots, is foUoAved by serum, and that in turn by inflammation, we have the change in color as nature gathers her forces te) get rid of this abnormal condition. It is to be remembered that the ecchymosis does not ahvavs appear in the spot Avounded. It does do so if it appears at once, that "is, in a few minutes after the blow is struck; but the bruise does not ahvays show at once, and then the effusion is governed by the resistance given to it and the guidance it receives as to its course by the arrangement of the tissue into wliich the blood is effused. Thus, Avhen the force of the blow is transmitted to the deeper parts, or when it causes a fracture, the ecchy- mosis generally appears late, twenty-four to thirty-six hours after the infliction of the injury, and it is also generally at a distance from the seat of the true wound. This may be misleading unless the fact is kept in mind, for one may say when he saw the body there was no bruise upon it, and another may be equally positive the signs of severe bruising were present, for even after death the discoloration from the effused blood will make itself apparent, the laAvs of gravity and least resistance allow- ing of the blood forcibly driven from the small blood-vessels at the time of the violence to come to the surface and give the eAddence of ecchymosis. HOMICIDE AND WOUNDS. 245 Again, we may have blows where no ecchymosis follows. Contusions of the abdomen, oAving to the want of sohd support under the tissues, rarely shoAv bruising. These injuries are sometimes so seA'ere that rupture of the internal organs, liver, spleen, and kidneys, takes place, and yet no appearance of injury is visible externahy. Fahs may give similar results, and e-ases are reported where vehicles have run over persons, death folloAving in short order, and no injuries Avhich would draw the attention of the uninitiated appearing on the surface of the body. And the condition a body is in at the time a contdsion is received has to be taken into account, for AA'hat on the person of a trained athlete would leave no trace, would on that of a Aveak or diseased person cause a bruise of much greater magnitude than would be expected from the force exer- cised. When death results suddenly from a blow or a fall and no signs of the violence are given externahy, it is imperative an autopsy be held, the diagnosis of apoplexy or heart failure being more apt to be erroneous than that death is due to the rupture of an internal organ in consequence of the A'iolence sustained. Contusions from " sand-bags," a favorite weapon with the criminal class, give no external marks. The sand, being loose in the bag, spreads in it at the moment of contaed, and while the' force of the blow is not lessened, the yielding nature of the Aveapon allows of adaptation to the part struck, and does not even stir the cuticle. But the contusion is none the less apparent on dissection, for it partakes of the same character as those of the abdomen, Avhere the effect of the blow is felt in the deeper parts, and ecchymosis may follow in time. Generally these wounds are made to the head or neck; and if not immediately fatal from shock to the nei-A'e centers, are dangerous from subsequent inflammation and from the effusion of blood, Avhich causes pressure on brain or spinal cord. Has a Given Contused Wound been made on the Living or Dead Body?—It is readily understood that where some swelling of the part strue'k is present or changes of color at the edges of the bruise have taken place, the contusion was necessarily inflicted during life, for, from what has already been said, after the blood is driven into the1 skin and its cellular tissues by the force of the blow, the extension of the bruise is due to the effusion of serum from the clotted blood, and this gives the lighter marginal color. Consequently, if such a condition be found on the dead body, the inference is positive that the injury Avas received dur- ing life. But the case is different AAdien there is only the initial evidence of a Moav. Here the dark reel to blue color is from the blood direct, and as the Woav en- other causes may be fatal immediately, nature does not go on te> giA'e the changes observed in bruises during hfe, Avhen the absorbents are active. Anel here comes in the question of time of infliction. If the blow causing the ecchymosis at the same instant causes death, the appear- ance of the bruise is practically the same as if death had been delayed for a feAV minutes or even half an horn-. Authorities ah agree that it is more than doubtful if positive evidence can be given on this point. The experiments of Sir R. Christison shoAved that even up to two hours after death the appearances made by a blow upon the dead body Avere appar- ently equal, and not to be positively told from a bruise of like character in life. The force of the IiIoav, hoAvever, on the dead Avas found to require considerable augmentation to produce a similar appearance to a light blow on the living; but as other evidences would not be present to show 24G A SYSTEM OF LEGAL MEDICINE. how much force had been used, this point does not help in the decision. The ecchymosis produced by a bloAv should not be confounded with the discoloration of the skin Avhich folloAvs death, generally called suggilla- tion, but better described by Dr. Taylor as cadaveric lividity. Here the appearances may lead an untrained observer into error, but one having experience AA'ith cadavers will not be in doubt, for the general extent to which this cadaveric hvidity is found precludes the conclusion that it could be from violence. While, then, the medical Avitness must use caution in stating that a given bruise*is the result of a wound received during life, unless, as has been before said, the changes in it are such as could not haA^e taken place after death, if chance is given for dissection the1 fact that the effusion of blood is in the skin—though it must be borne in mind that this effusion into the skin de>es not always take place even in the living —as well as in the cellular tissue, would incline to the opinion that the injury Avas received before death or just at the time of death. In the1 drowned, or in bodies wliich have begun to putrefy, the pass- ing of an opinion upon marks AA'hich appear to be contused wounds be- comes even a more doubtful matter. Where the body has been for some time immersed in water and putrefaction has begun, it is found to be swollen, of a greenish-blue sort of color, the cuticle comes off in handling, the superficial veins are enlarged, and sIioav dark, being easily recognized; and a contused Avound, or in fact any other kind of a Avound, has under- gone such changes as to make it impossible on the part of the medical expert to say Avhether such Avound had been received during hfe or not. One can, from careful examination of the AA'hole body, form a conclusion, but this conclusion can be only a supposition, and' cannot be a positive one. The evidence given must therefore be that of Avhat is apparently, from all considerations, the greatest probability, but cannot be positive, or even approaching positiveness. A condition exists Avhich has been termed pseudo-ecchymosis, result- ing in slight abrasions of the cuticle, and giving a yellowish or brown appearance after time has sufficiently elapsed to allow of the abrased surfaces becoming dry. These are to be taken into account in the ex- amination of a body; but as they may be made by the body striking against any hard substance as it fahs, either before or after death, alone they cannot be held to be of great significance. The noting of them may, however, have an important bearing in determining Avhether a struggle has taken place, for the cuticle peels quite easily under pressure, and the position and direction of these erosions may indicate some other cause than a fall. Any one who has been familiar with dissecting-rooms will readily recall many instances where these broAvnish patches, hard and dry, were seen on cadavers. It is as easy to produce them davs after death as it is before death, and the difference between the two cannot be determined. The epidermis, if rubbed off from any cause, gives such a condition as the result, It may be said if the excoriation is a shade deeper than the cuticle, enough to cause slight abrasion of the true skin and draw blood, the result is a scab, as it is ordinarily called, and this would only be present during life. If a similar abrasion was made after- death, the part would be a darker broAvn and probably harder than where only the epidermis had been removed, and in this way it mitrht fairly be distinguished as to time of infliction. The scab would not,' however, be the result if the abrasion was made at the time of death. It would re- HOMICIDE AND WOUNDS. 247 quire from one to two hours for formation, and so if such an excoriation Avas due to violence, Avhen death Avas the immediate result, the appearance would be the same as if made after hfe was extinct. Where fractures result from blows, the skin not being broken, the ecchymosis not only is not always immediate, but may make its appear- ance at some distance from the seat of the injury. Generally it Avould be expected that a bloAv stremg enough to cause fracture would also cause a bruise at the place struck, and this is true if the wound be made Avith some Aveapon such as a club, billy, or other hard substance. But if it is made Avith a softer substance, as a sand-bag, the result may be identical Avith the conditions noticed in fractures by indirect violence. Unless there be semie such external evidence to show the wound Avas made dur- ing life, the presence of the break does not allow of positive statement as to the time it took place, for a fracture made in the dead body at or shortly after death, before animal heat has departed, gives the same ap- pearance as one made just before death, the muscles surrounding the bone being similarly torn, anel blood effused in the laceration in the same manner as it is during life. If the fracture is made some hours after death, AAdien the body temperature is notably lowered, then Ave do not haA'e as marked a condition as in the other cases, for here the blood effused is not so much as when animal heat is still present, unless a A'ein is torn, and the ruptured muscles do not give the appearance of sudden tearing. It is hardly necessary to call attention to the different discolorations of the skin produced in eruptive diseases, sue'h as the dark purplish spots of typhus fewer, scurvy, etc. Any of these petechias should be reaelily recognized by the physician as not the products of violence, and the his- tory of the case Avill aid in the diagnosis. The appearance after death of purpuric spots is A'ery similar to that of a bruise produced at the time of death, but their size and general e'onnection, combined Avith the fact that similar spots are to be found in the mucous membrane of the throat and alimentary canal, AviU prevent the examiner from confounding them with ecchymose's resulting from Adolence. In old people it is common to find dark spots or patches on the extremities, sometimes enveloping the whole of the limb, AA'hich are due to imperfect capillary circulation, and which might be mistaken after death for bruises. The seat of these, however, they being almost invariably on the lower part of the leg, and their character, Avill show their true nature, It is but necessary to call attention to these different simulations of ecchymosis to put the medical examiner on his guard. Wounds by Cutting Instruments—In describing all wounds, of whatever nature, AA'here the person to whom the description is giver is not of the medical profession, it is best to use ordinary plain language, avoiding all technicalities. This saves the trouble of explaining what is meant, and allows those hearing the statement to understand its import, they not being required to do any hard thinking over unaccustomed Avord sounds, and so lose the thread of the tale and the sense of AA'hat folloAvs the scientific phrase. And in describing the position of wounds on the body, the medical Avitness should endeavor to use the simplest of language and the shortest of descriptions compatible with clearness. To too minutely describe every abrasion, bruise, scratch, cut, fracture1, or anv other mark of violence that may be found on the body, is to burden the mind of the jury with much that may far better be condensed into 248 A SYSTEM OF LEGAL MEDICINE. coUective statements, which not only prove less tedious but also much clearer to the listeners. By this is not meant that careful note should not be taken of eA'ery mark and its location defined, as Avell as its pre (li- able cause and probable time of reception, but that Avhere many similar injuries—small bruises, for instance—are found ewer the body, it may be stateel in one sentence, one having been fully described, as "so many similar bruises, on the body, arm, leg," or AvhereA'er the situation may be. Cut or incised wounds are those made by an instrument possessing an edge AA'hich aatJI diA'ide the integument as it is drawn across or pushed into it, as in stabs made AA'ith knives. The instrument may be a piece of glass, tin, or sheet-iron, and the wound resulting be a cut, although, as a general rule, in homicidal wounding axes, hatchets, SAvords, knives, and such like Aveapons are used. All these haA'e cutting edges, and make Avounds A'ery similar in appearance. When an ax or hatchet is used, AA'hile the edge cuts, at the same time the Aveapon delivers a blenv, and to the cut may be added the breaking of bone, or, if the weapon be dull, the appearance of a lacerated or torn Avound rather than one incised. As in e'ontused AA'ounds, so in cut ones: if the Avound has been made during life and sufficient time given for reparative process to begin, the telling of Avhenit Avas inflicted, or a fairly approximate period, is not so difficult a matter. If the signs of the inflammatory healing process are present, or if adhesion of part of the wound has taken place, the surrounding tissues a little sAvollen, or if pus lie found, Ave knenv the wound was made during life. But the Avemnd may be a mortal one, and the victim pass instantly from life te) death. Here, then, is a condition with other phe- nomena, and one requiring careful examination to give a definite state- ment upon. The Avound being a cut, if made upon the living body as a general rule it presents the characteristics of gaping, the skin being a little everted, showing the deeper tissues, while blood is freely poured forth, especially if an artery has been wounded, and clots of blood are found lying in the cut. The skin is highly elastic, and when severed while alive, draws away from the hne of incision; and if the cut is transverse to muscular fiber, more gaping is noticed, on account of the contraction of the divided muscles, than when the AA-ound is in the line of the muscle. In a transverse cut is found not only more gaping, but more bleeding takes place than when the cut is longitudinal. The blood, being fresh, will coagulate where it falls, and if an artery has been involved with a chance to discharge its blood in spurts, traces of this sort of bleeding will be seen on the clothes or on the body, and may also be found on Avails, floor, furniture, or other articles within reach of the spurting vessel! This was well shown in a case of a gentleman who lived in Albany, N. Y. Having had an operation performed for cataract, the day he was told his sight would be tried having arrived, he anticipated the visit of the doctor, and while the family were at church got out of bed, made his wav to a shaving-stand in the room, and took off the bandages. Not finding his sight as much improved as he expected, he took a razor from the drawer of the stand and cut his throat, severing the left carotid. The stand, its glass, and the wall above and on either side were spattered with blood, spots reaching as high as six or seven feet. The man himself was about five feet ten, and was also bloody to a great deirree. The blood-marks from an incised wound, therefore, may be an im- portant factor, aiding the decision of whether the wound was before or HOMICIDE *AND WOUNDS. 249 after death where the wound is a cut. If, hoAvever, the wound is a stab, and but the size of the blade making it, no vessel being severed in its course, the appearance of the wound may be such as to make the exam- iner hesitate as to its time of infliction. Casper relates a case where a man stabbed his Avife in the breast, causing instant death by the seA-er- ance of the aorta, and yet the wound through the chest Avails showed no sign of bleeding, and Avas to all appearances identical with a wound made upon the cadaver. The autopsy aauU do much to clear up any doubt in wounds of this character. If no other condition can be found to wliich death could possibly be ascribed, and a mortal Avound is dis- covered, the logical inference can only be that it Avas made before death and was the cause of death. For if the wound had been made after death, unless the cause be shock, some evidence of other destroying means Avould be seen, and then the study of not only the AA'ound itself, but the deductions to be draAvn from the internal evidences, would be the guides to a conclusion as to AA-hether death Avas prior to the wounding or not. As, for instance, AA'here a throat has been cut to simulate suicide and hide the crime of murder by suffocation. Here we have a wound which may giA'e all the signs of haAung been made during life with the exception of one, viz., the bleeding, and the autopsy Avould find the char- acteristic evidences of death from suffocation. The wound would bleed freely, but the absence of arterial action, the very fluidity of the blood, combined with the other post-mortem appearances of death from inter- ference with respiration, Avould lead the examiner to the conclusion of homicide, and that the cut Avas made after death. A wound made immediately after death Avill present the same appear- ances as a wound made before, but the hemorrhage will be different, and, unless some large A'ein has been cut, not so copious. We may even find coagula in the wound and the gaping and evecteel edges if infliction has been done before the elastiedty of the skin is lost; but the bleeding is venous and follows the laws of gra\dty, does not spread so widely as when the heart still acted, even if it gave but one or two beats; and this fact of itself calls for most careful search. While it is possible, as in the case quoted from Casper, that a mortal Avound may present only the appearance of one made on the dead, if the AA'ound has been made on the body after death has been established for half an hour or more and the death could be attributed to another cause, such as a bloAv upon the head, the question of the wound having been made on the hving would properly be decided in the negative, the majority of eAddence pointing to another cause for death, and ah the appearances of the cut being those of wounds on the cadaA'er. StiU doubt might lie raised, for the wound to the head might be such as could be received by the body fahing; and as the fall would be simultaneous with the wound and Avith the death, the question of which injury took hfe Avould be one of difficulty. I con- sider great stress should be laid upon the hemorrhage from the wound, for the heart is the last part of man to die, and while its action may be feeble by reason of the nature of the injury, if the cut was made before death took place more bleeding could properly be expected, and, as said before, of an arterial character. In 1 s.39, at Lyon's Falls, N. Y., a Mrs. PrisciUa Budge Avas found dead in bed, cold, and AA'ith her throat cut. Her husband, the Rev. Mr. Budge, Avas arrested for murder, but the ver- dict of acquittal was rendered by direction of the judge, as clever cross- 250 A SYSTEM OF LEGAL MEDICINE. examination of counsel had confused one of the people's medical experts, and if the statements he made were correct, conviction could only be had on probabilities. The evidence, however, of the body and its sur- roundings, as reported by Dr. SAvinburne, showed a transverse cut of the throat, behvw the thyroid and severing the cricoid cartilage, going so deep on the left side as to cut the transverse process of the fifth cer- vical vertebra, the periosteum and substance of the vertebra also cut, and then the soft parts of the right side of the neck. The cut Avas evidently from right to left, from the manner of its beginning and ending, and the bedclothes, which Avere undisturbed, as well as the nightdress of the woman, were free from blood. Blood had flowed from both sides of the wound down the neck and soaked the mattress. There was no spatter- ing of blood anywhere, and the defense was suicide AvhUe in bed, the Aveapon being a' razor found lying near the right hand. The autopsy, Avhich was not held until four"months after death, but which, owing to the winter Aveather, hard frost, and character of soil in Avhich the body AA'as burie'd, AA-as still a valuable autopsy, gave the signs of death from suffocation. The appearances of the Avound as the Avoman lay in bed Avere in every Avay the same as if it had been made during life. The only difference was that the blood floAved by gravity, and Avas not throAvn for- cibly by the per saltern action of the heart. Had the medical man who first saw the case been familiar Avith the rudiments of medical jurisprudence or been a close observer, the fact that there Avas an absence of blood over the bed, Avails, floor, face, hands, or anyAAdiere else that a live artery could throAv it, he Avould not have been so ready to consider the case one of suicide, but would haA-e made proper examination of the body for other cause of death. Comparing this case with the one of throat-cutting pre- viously quoted, the immediate difference is ne>teel: the body living and but one carotid severed, the Avails, shaAdng-stand, floor, everything around covered with blood; the body dead, heavy oozing of blood, floAA'ing in the line of gravity, no spattering of spots anyAvhere about. Lacerated Wounds.—These may be caused by other than sharp in- struments, or even by them, for the injury is where the wound is torn and ne>t clean cut. A marked feature is, they are generally attended with but little hemorrhage, the vessels being severed by tearing, the ragged edges entangle the blood so it rapidly clots, and preA'ents further bleeding. A hmb may be torn completely off and not so much hemor- rhage foUow as Avoidd from a severe cut. StiU, death from bleeding as the result of a lacerated Avound can and does take place. The chief danger, liOAveA'er, is from the extent of the injury and the shock to the nervous system. The appearance of a lacerated wound made during hfe, unless it is of some days' standing, is not to be distinguished from one made immediately or shortly after death. Coagula are found in the AAround in both eases, for, as shown above, the blood does not lose its poAver of coagulation untU the body has lost its heat. Consequently, if the wound is made near to the time of death the blood effused AviU be found more or less clotted in it. And the arteries being torn, Ave do not have the free spurting seen when they are cleanly cut. The evidence to be relied upon as to the wound haA'ing been made upon the living is chiefly the history of the case to be obtained from those AA'ho first saw the body. Naturally, if Avitnesses of the wounding can be found the question is easy of solution; but where none such are obtainable the de- HOMICIDE AND WOUNDS. 251 eision has to be very guarded, nothing being positive about the wound itself. An injury of this nature may present some of the characteristics of one incised, for a bloAv deliA-ered on a part under which lies a ridge of bone, AA'hile not causing the cut by the Aveapon, may by the force cause a division of the skin and subsequent parts by the poAver Avith Avhich they are driven upon the bony ridge or protuberance. And thus made, the cut may appear more like an incised Avound. A similar result may be obtained where the bone under the tissue strue-k is smooth, for if" the tissue is not thick the force of the bloAv may cause a wound sufficiently clean cut in character to ahoAv of an artery divided in it to spurt blood to quite a distance. In the case of O'Shea, tried for the murder of his Avife in Washington County, N. Y., in 1881, evidence AA'as presented of a fight between the two, and lacerated and contused Avounds were found on the AA'oman in different positions. The three principal one's AA'ere: first, over the right eye, severing the anterior branch of the temporal artery; serond, on the back of the head beloAv the occipital protuberance; and third, on the left lower jaw, probably cutting the facial artery Avhere it crosses the body of the bone. The Avoman Avas found dead in her bed in a small room, and blood in spots Avas noted on the Avails, windows, and ceiling, as avcU as on the bed and floor. It Avas claimed by the people that the'se1 blood-spots Avere from the cut over the eye, and it was shoAvn the distance they had to be throAvn Avas from three to five feet. From the body, as it lay on the bed, to the ceding Avas about four feet, and it Avas claimed that the temporal artery could throw the blood up to the ceiling from the bed. The woman's hair Avas done up in a knot behind her head, the ends of AA'hich, hoAvcwer, hung loose, and Avere Avet Avith blood. It Avas claimed by the defense that the spots were more liable to come from blood being throAvn from these ends of hair in the fight Avhich took place, as the artery could not, in all probability, have sufficient force to raise a jet of blood four feet. It Avas a drunken braAvl, anel the jury brought in a A'erdict of murder in the second degree. In this case the wounds Avere all lacerated anel contused, and yet hemorrhage to a con- siderable amount took place. I am more inclined to the belief that the spots of blood on ceiling and walls. especiaUy if they reached their desti- nation from a distance of four to five feet, Avere more probably caused by the1 flirting of the hair in the struggle, than directly from the artery, especially as a fenv Aveeks after the trial I saw a case where a young man. had been cut in exactly the same spot on the right forehead by a brick thrown Avith force, Avhich caused a clean, lacerated wound, ahowing the anterior branch of the temporal to give characteristic arterial hemorrhage. In this case the man Avas standing, for the blow did not knock him down or render him insensible, and the extreme distance to which the artery threAv the blood Avas three and a quarter feet, and AA-hen I saAV the case the vessel Avas still bleeding, though not with such force. From the foregoing it Avill be seen that as much care must be exer- cised by the medical examiner in passing judgment upon a lacerated wound "as upon one incised, supposing the former to have been made during life. In the case cited small wounds have been given as examples. If, hoAvover, large arteries are cut by the blow of the bludgeon or other blunt Aveapon and the wound be fairly sharp in outline, the1 bleeding may be more that of an incised wound than a torn one, and caution is neces- 252 A SYSTEM OF LEGAL MEDICINE. sary, for the wound may be the direct cause of death; and yet if it is considered to be an incised one, it is not sufficient to be fatal, the concus- sion from the blow making the wound being the1 death producer, the wound being but an additional injury and not one which would be con- sidered dangerous to hfe. Gunshot Wounds.—This class of injuries are generally produced by missiles, chiefly lead, fired from some sort of pistol or gun, the propelling force being powder. And this is in fact what one mainly meets in legal practice; but it is still to be remembered that the same character of wound may be made by any projectile, no matter of what it is composed, and no matter what the propeUing force. As, for example, a small stone or pebble, resembling a bullet in size, thrown by a blast or any sufficient force, will give what is technicaUy known as a gunshot Avound, and it is such a wound, only not one caused by the use of fire-arms. Where the injury is by a bulled, fired from a gun or rifle Ave have certain characteristics Avhich are ceimmon to this class of wounds. The effect of a ball striking the soft tissues of the human body is, first, that of contusion, and the degree of this contusion is in proportion to the velocity of the bullet. Ordinarily, when traveling at the usual velocity, a bullet does not at first sight appear to have bruised the tissues, but the force is so great, the speed is so swift, the contusion reaches the point of disintegration of the tissue struck, and Ave see but the open wound of entrance and the corresponding one of exit. The track is open in all its course, for the contusion Avas so strong the tissue in the course of the baU was rapidly and instantaneously reduced to a pulp. Shreds of it may he in the course of the1 wound, but what remains is dead tissue, all life having been done aAvay AAdth by the terrible force of the bloAv. There is added to a gunshot injury, AA'hich of itself may not be dangerous either from the part shot or the amount of blood lost, the factor of sloughing and the healing by second intention, and a slight wound may under these considerations become a dangerous one. The contusion is so complete and the time of the bruising force1 so short that the surrounding parts are not hiA'olved, and ecchymosis is rarely seen. It is different, hoAvever, if the ball is a spent one or one traveling at a very Ioav rate of Arelocity. Here the skin may not be broken and the contusion constitutes aU the wounding, although that contusion may have deep effects, and bruise in- ternal organs in a Avay to cause death. The signs externally Avould be the ones already described in other like Avounds made by any blunt, hard instrument, anel the size and appearance of the bruise would be in accord Avith the missile making it. When a bullet has entered or traverses a body, supposing it does not touch bone, its track may be followed on dissection and shown as a blood-stained line, as weh as the openings in the various tissues pene- trated. If the recipient has survived the Avound a few days, tAvo or three, while the track is then not an open one, it is nevertheless as easily fol- lowed, for slight inflammation having by this time started in the course of the ball, the sharp red line is plainly seen against the other tissues. If bone be struck, something more happens, for the buUet, being of soft lead, is more or less " upset," as the saying is, and if it penetrates the bone it loses some of its lead by attrition. The fracture thus caused is generally radiating in character. The baU may disintegrate bone in the same way it does the soft parts, especiaUy when the bone struck is of HOMICIDE AND WOUNDS. 253 hard and brittle constituency. And when this is the case, the ball loses even more of its lead than Avhen merely piercing a bone or lodging in one. In these days the majority of fire-arms throwing buUets are rifled, and the ammunition used is caUed "fixed," from the fact that baU and cartridge form one package, the cartridge-sheU being of metal and the baU being set firmly in it direct upon the powder, Avails being no longer interpe>seel between the two. These facts alter somewhat our dealings with this class of wounds. Formerly, when smooth-bore muskets and pistols Avere in common use, with round balls, as such weapons gave but a low velocity and comparatively smaU penetrating power, a buUet Avas often deflected by encountering bone or even by tendons, when these were struck at an acute angle, and the buUet changed its course in the body. I do not mean to say bullets from rifled weapons are never de- flected, but their higher rate of speed, their greater power of penetration, the form of the ball being long and pointed, the rotary motion imparted by the rifling of the barrel, tend rather to send the buUet in a straight hne to its destination, boring its way through bone or all obstacles, than to let it be turned one way or another by tissues lying in its course. And this should be remembered, for it may have an important bearing in the opinion expressed on a given wound as to its danger. In the early eighties a man was shot at Fonda, N. Y., in the neck, left side Three days afterward he was paralyzed on the right side, and died in about a week. The surgeon in attendance supposed from the paralysis being on the right side that the bullet had turned on the trans- verse process or on the bodies of the cervical vertebra?, probed further for the ball, and his probe passed easily its entire length up toward the head. At the autopsy, however, he found no wound or clot or other injury to the brain, and then began dissecting the neck, foUowing the Avound of entrance. In a straight line from where the bullet entered it passed to lodge betAveen the fifth and sixth vertebra?, cutting the left vertebral artery completely in two. The cause of the paralysis was then apparent. The Aveapon used was a smaU revolver, but with rifled barrel and conoielal baU. Wounds made by shot-guns, unless they are loaded Avith buckshot or baU, depend upon the distance from which the shot was fired for their appearance. If fired at close range, before the charge of shot has had time to separate a tearing wound of large size is made. The edges are not as clean as when a rifle-ball has entered, for the charge is not a com- pact one. If fired from a greater distance, then we find shot in a larger area, some deeper than others in penetration, and the shot go in singly or hi groups, depending on how carefuUy they were put into the car- tridge. If not fatal outright and if not entering a cavity, the wounds are dangerous only from the inflammation that may follow. Gunshot wounds may be fatal without any external mark, for the weapons may be discharged into the mouth, or the bullet may enter by the vulva or" anus. During the War of the Rebellion, a general officer of the Federal forces, riding in a fog up to a picket, discovered it to be the enemy. He wheeled his horse1, and leaning down on him as far as possible, drove in the spurs. The picket fired a volley. The general's horse carried him into our lines, but the general was dead. A bullet had entered the anus, leaving no mark of its entrance, and ended its course in the thorax. 254 A SYSTEM OF LEGAL MEDICINE. Marks of Discharge upon Clothing or Skin.—To burn aU the poAV- der used as an ordinary charge, a gun Avould have to haA'e a barred about fourteen feet long. The " flash " of fire-arms so eloquently written about is from particles or grains of burning poAvder not fully consumed. The smoke is from that part of the poAvder completely burned. It is clear, then, that the burning grains Avill cause fire-marks on clothes e>r skin if the discharge is near enough to the body. The distance the muzzle of the piece has to be from the body depends upon the kind of arm used, its caliber and charge. AU vary, and experiments made with the aUeged Aveapons are the only guides Avhich can be truly relied on. In general, it may be said the muzzle must be almost touching for burns of clothing or skin to be present, but here again we find some cloths take fire more readUy than others. The skin is more uniform in this particular, and burning of it, or the numerous inrplantations of powder-marks, shows the weapon to have been held Avithin a short distance. In 188:] a man named Heigham shot another to death in Watertown, Jefferson County. Self-defense Avas claimed, and the distance the weapon Avas from the body Avhen the shot was fired became an important ques- tion in the case. As part of the evidence to decide this question was hoAvfar powder Avould be implanted in the skin, the subject was referred to Dr. James D. Spencer, of Watertown, one of the medical experts for the people. The doctor consulted me, and together we made certain experiments to see Iioav far the Aveapon, described in the notes as an "English buU-dog pistol, self-cocking, .32 inch caliber, 9 grains of pow- der, 88 grains of lead, made by Smith & Weston," would carry unburned powder and plant it in human cuticle. On the 8th of December, 1883, in the dissecting-room of the Albany Medical College, we fired at a piece of skin which had been taken from a fairly fresh subject, and Avhich is described as having been " nine inches square, with cadaveric rigidity." Shots were also fired at cloth. The notes say: Skin. sTo. of Shot. Distance. Direction. Result. 1 2 3 6 feet. 8 " 10 " Direct. a a Powder too numerous to count. 25 to 30 grains. Flashed. 8 to 12 " " Scalp with Coarse Hair. 1 2 3 4 5 2 feet. 2 " 3 " 3 " 3 " Direct. a u it n Hair singed. n a a a n n a tt Flashed. 3 6 4, twice 7 5, " 8 6, thrice 10 0 " 10 On Cloth of Coat. 4 feet. Direct. Lubricant on cloth around bullet-hole. Two Cloths over Cotton Shirt, Undershirt, and Skin. 5 feet. Direct. Lubricant around bullet-hole. 4 " " " n tt Original cloth over skin torn; bullet-hole; no lubricant. Same as No. 7. 10 HOMICIDE AND WOUNDS. 255 o -.* :; r* r,,,' -.• •• • • »«•« • • * Oi-i--; ■* «,i -I"1 '■''"WKf,.!* * * e . « • '■: v.'v.'.--?.-'.---..■.•:.• • . » * * #• * *' ' ', ' * • ♦ Fig. 61.—13 Centimeters. - » ♦ * « » • . »■• * , V • • . ♦ * t » 4 ' , , ' Q./17 , ;/ % • * Fig. 62.—20 Centimeters. Powder tattoo-marks made by revolver at various distances. (Tourdes.) 256 A SYSTEM OF LEGAL MEDICINE. • _ « » * .. *' < . » • * . • . * * / v ' * . ' ' * « • • « ' * 0 W # * Fig. 63.— 30 Centimeters. Fig. 64.-95 Centimeters. Powder tattoo-marks made by revolver at various distances. (Tourdes.) HOMICIDE AND WOUNDS. 257 On December 25th further experiments were made in the same place on human skin. i. of Shot. Distance. Direction. Powder-marks and lubricant. Flashed. 1 7 feet. Direct. 2."> to 30 powder. Yes. 0 6 u n 25 to 30 " it 3 5 it a 15 to 20 " it 4 5 it it 15 to 20 " it 5 4 a n Too ' numerous to count. tt 6 3 it n it tt tl n 7 3 a Oblique. a ti it a 8 4 tt it a it it n Experiments were then made as to powder-marks on cloth in frames Avith canton-flannel behind at the armory of the Tenth Battahon, N. G. S. N. Y. Result. Lubricant on cloth and frame. Lubricant on cloth and frame, and powder-marks. a a tt n ti a a it it it Lubricant on cloth and frame. Lubricant on cloth and frame, and powder-marks. No. of Shot. Distance. Direction. 1 6 feet. Oblique. 2 5 " n 3 4 " it 5 2 " u 6 1 foot. n 7 6 feet. Direct. 8 5 " n 9 4 " u 10 3 " n 11 2 " it 12 1 foot. a From one to five feet, some scorching. Further experiments to determine radius of powder-marks. Avas fired at so stretched as to aUow of a smooth surface. Paper No. of Shot. 1 2 3 4 5 Distance. 6 feet. 5 " 4 " 2 " 1 foot. Direction. Direct. Radius. 2 feet. . 2 " 18 inches. Most in 12 inches. Result. Powder too numerous to count. it it a Paper scorched. .. it Paper scorched; fire. Powder was driyen through paper in all experiments. WhUe these experiments are Aaluable, it must be remembered they are the results of only one kind of fire-arm. Another pistol of the same caliber but with a longer barred woulel show differently, or if the caliber Ave re smaUer, A'ariations would be1 found. They give, however, some idea of AA'hat may lie expected of fire-arms in general. Gunshot wounds on the deael body give the same appearance as in the liA'ing. The only difference may be bleeding, for on the cadaver, unless the bullet cut a A-ein, no bleeding follows the shot. The size of the Avound on the dead does not differ frenn ones made in life. The en- trances and exits bear about the same relation to each other, and in all other respects, to give an opinion only on the evidence of the orifices, Avithout taking every circumstance obtainable into consideration, would be to give but negative testimony. The track of the Avound internaUy in the dead body, unless, as said before, the bullet had traversed a vein, 258 A SYSTEM OF LEGAL MEDICINE. would not give the same color from blood-staining as Ave find in like1 wounds before death. While practice and care may make the distinction, it is not one that can be considered as positive proof, although it may aid in the conclusion AA'hen e-oupled with other revelations of the autopsy. Self=inflicted Gunshot Wounds.—To state that a given Avound could not be made upon a body by the person himself is to put one side1 the knoAvn peculiarities of suicides. The most improbable means as AveU as the most unexpected methods are practiced at times by those bent on sedf-de'struction. One fact is generally present, and that is. Avhere deter- mination to die is the cause of inflicting a wound, what is supposed tei he a vital spot is always chosen, into AAdiich the shot is discharged. And the pistol or gun is more apt to be held near than to be fired from a dis- tance. The results of near fire would then be1 present, and, aelded to other circumstances, show the wound to have been self-inflicted. Wounds may be giAren with fire-arms Avhich, Avhile fatal, are entirely accidental. One often sees accounts of such accidents to sportsmen, avIio in carelessly handling their guns receiAe dangerous or fatal injuries, or who, in some careh'ss Avay, shoot a companion. In wounds of this kind, while the wound itself may haA'e all the appearance of being homicidal and not accidental, surrounding circumstances haA'e much Aveight. A man found dead from a gunshot Avound in the back, murder would not be thought of if he was out shooting, and his gun was found hanging in a hedge or close by a fence which gaA'e evidences of haA'ing been passed by the man himself. Wounds of this character may not be so close as to give burning or bruising, but attendant proof aa ill show how they came to be inflicted. Danger and Severity of Wounds.—If one considers that any injury done to a human body, from chances of inflammation or absorption of some septic matter, or on account of a speculative condition of the wounded that he may have disease of the kidneys, stomach, or Avhat not, prove in time a dangerous injury, all assailants, no matter AA'hat the result of their assault, should be confined until such time as all remote danger from whatever cause is entirely removed. The law, however, does not so hold, and medical men should be able to place some fair limit to the danger zone, as they must be able to state Avhy a given injury is dangerous to hfe. Wounds which involve cavities like the chest or abdomen, cut large vessels, cause great laceration or crushing of soft tissues, create com- pound fractures of the larger bones, contuse or fracture the skull or spinal column so the nei-A-e tissues are directly injured—in short, any wound that does such grave harm that the danger to life is imminent, is one upon AA'hich the prisoner Avould be held until the issue as to hfe or death is decided. It is well known that even slight wounds, cuts, or lac- erations may be attacked by erysipelas and the patient die, but the " may- be's" are not to be taken into consideration, unless the chance of their developing is almost immediate ; the "is" is what must decide the ques- tion. A kick or severe blow to the abdomen would have to be judged by the condition of the patient just after the receipt of the injury, and the physician would properly state that such an injury, judging from the collapsed state of the patient, Avas one he could not give a positiA'e statement upon as to its danger, but must wait two or three davs to de- termine if internal lesion of serious character had not been done. Here. HOMICIDE AND WOUNDS. 259 then, reasonable time is taken, and taken because of the alarming condi- tion of the patient shortly after his receiving the injury. In the case of a man suffering concussion of the brain and insensible, the surgeon gives his opinion at once that the wound is dangerous to life. In the case of the bloAv to the abdomen, the patient not insensible, but evidently badly hurt, he takes a reasonable time and states his reasons therefor. A wound may not be immediately dangerous to life and yet be a seri- ous Avounding, one which may become dangerous in a few hours, or may not assume any such change. Here the committing magistrate is to be guided by the requirements of the laAv, the doctor merel}' stating the Avound is a serious one, but if nothing out of the ordinary occurs, it is not necessarily dangerous to life. The medical opinion must not only be founded upon the nature of the injury, but also upon the condition and history of the patient, for Avhat would only be a severe wound in one person Avould be a dangerous one in another, and the surgeon's knowledge of his profession enables him to differentiate between the two. It may be a difficult and trying position for the medical man, and one where, whichever way he decides, he may be severely criticised; but, " for this AA'e are doctors." Evidence of Wounds, Weapons, and other Articles___After the examination of a body dead under circumstances which caU for legal in- vestigation, the medical examiner has to make deductions from aU the different appearances of the case as to the questions, Was the death from homicide, suicide, or accident? To do this, everything about the body and the Avounds must be carefully noted, and the weight due each in the general summation carefully balanced. The question wiU be asked, Was there a weapon used, and if so, AA'hat kind of a Aveapon f This is to be answered from the evielenees of the wound itself, the cloth- ing, and the autopsy. Where death is from an incised wound the ehar- ae'ter of the cut indicates the knife. In the case of Mrs. Budge, already cited, the defense claimed her throat Avas cut by the razor found on the beel near to her right hand. The Avomid Avas undoubtedly an inciseel one, and it is described as being " on the right siele, three and one half inches beloAV the lobe of the ear; on the left side, about three and one quarter inches beloAV lobe of ear; four and one half inches below center of chin on medium curved line, severing the cricoid cartilage, oesophagus, arteries, A'edns, pneumo-gastric nerves, and all the muscles of the anterior part of the neck. Circumference of neck above, or at the Avound, twelve inches; curved length of cut, fiA'e and one half inedies. Depth of cut in a direct line, two inches back to the vertebra', cutting through the periosteum anel into the osseous matter of the fifth vertebra, and also shaving off a lateral portion of the transverse process e)f this vertebra. Skin on the right side cut down one half to three quarters of an inch loAver than tissue. Tissue on left side cut deeper than skin about one half to three ■quarters of an inch, and extending elown into the muscles external to the vertebra^, so that the skin at the termination of the cut on the left side appeared as if stretched and rounded instead of being sharp, or an- gular. Trachea and tissues retracted, so that wound gaped about two inches." It Avas claimed by defense the death Avas suicidal, but the evi- dence of the wound puts this assertion in doubt. It is to be noticed on the right side the skin is cut further than the muscles, the incision tails off in the skin. To do this the knife must have been drawn gradually 260 A SYSTEM OF LEGAL MEDICINE. from the cut. On the right side, however, the skin is not cut. as far as are the muscles underneath it by half an incdi. From what has been said before, the first e\ddence of this wound Avould be that it started on the right side and finished on the led't, for the known elasticity of the skin gives this evidence. It is divided first at the beginning of the in- cision before the knife sinks into deeper tissue, as is ahvays the case unless the knife be plungvel in at right angles to the surface as deep as it is intended the incision should be made, and then drawn on. At the left end of the incision Ave have the1 skin divided less than the deeper tissues. It yields before the force of the knife, and resumes its position after the force is withdrawn. The wound teUs more. It goes doAvn to the backbone, strikes and shaves off a portion of the transverse process of one of the vertebrae, then sinks a little into its body; and when released from this hard, re- sisting substance, suddenly sinks deeper on the left side than it did on the right in the softer tissues, cutting them beyond where the skin is divided. The evidence of the wound,-clean cut and evidently made- Avith one stroke, points to strong muscular effort and a strong-bladed knife as Avell. Could a cut of this nature be made from left to right, be made by a not over-powerful woman as she lay in bed, and with a razor f The evidence of the razor should be noted. It was but little bloody, and not nicked. Could the highly tempered blade of a razor cut through a trans- verse process and into a vertebral body and not be nicked or broken on its edge ? And finaUy, could such a wound be made by a razor in the manner this wound AA'as, the cut to start on the left side ? Would the woman have the strength to finish such a cut as is descidbed on the right side, after cutting so deeply on the left? Would there be sufficient muscular power left to cut a transverse process after severing the carotid, jugular, and pneumo-gastric nerve on the left side ? AU the evidences of the wound and the allegeel Aveapon point to another conclusion. The razor could not have made such a Avound and remain intact in cutting-edge. It AA'ould have been almost impossible to begin the cut with a razor in the manner this cut is described as found on the left side of the neck. And strength could not have remained long enough after the left Avound to have made the right. The cut clearly started from right to left, was done by great force, anel with some knife strong enough to stand such usage. The evidence presented by the Avound negatives, therefore, the theory of suicide. On August. 5,1873, the body of John D. Weston was found dead on a farm near Albany, X. Y. Weston Avas an old soldier, who had lost his left arm. Emil Lowenstein, who had been a friend and who Avas seen in company Avith him, Avas arrested as the one who had committed the crime. The body not being found until two days after death, and having during that time been exposed to the weather, AA-as pretty Avell decomposed. The autopsy was held on the Sth, and the following wounds were discovered : an incised wound of throat, about five inches long, just above the thyroid cartilage and extending tAvo inches to the left and three to the right of the median line, dividing no large vessels. No mention is made as to the edge of this wound, or whether it presented any evidence of haA'ing been made from left to right or vice versa; the coroner described it as " fly-blown " AA'hen he Avas called to see the body where it lay in the Avood. Along the left side of the face another cut, AA'hich merely penetrated the HOMICIDE AND WOUNDS. 261 skin, and corresponded to the line of the jaw. A trifle to the left of the median line and an inch above the eyebrow, almost in the center of the forehead, was an oblong opening or Avounel AA'hich penetrated the skull, and was apparently made by two bullets. FoUowing this, tAvo baUs were found in the substance of the brain far back, having nearly gone through the brain. The wound of entrance Avas a little more than half an inch in one direction and a little less than half an inch in the other. Another gunshot wound was found, about two inches to the left and someAA'hat above the hne of the first mentioned. The buUet in this Avound did not penetrate the cavity, but Avas found flattened against the bone. At the termination of the left eyebrow, internally, a bah had entered and pene- trated about a quarter Avay through the skull waU. Behind and at loAver eelge of left ear another bullet wound, which led dowiiAA'ard into the muscles of the neck. In this case the baU was not found. About two inches behind right ear Avas another wound, evidently also from the same pistol, and here the ball Avas found in contact with the skull and more flatteneel than the one before mentioned. On left side of chest and slightly to the left and aboAre the nipple a small Avound, like a bullet Avound. The ball for this was not found. Its course was traced, how7- ever, for about twelve inches doAvnward anel toward the back. A little lower doAA'n and more toAvarel the center of the body, in the fourth intercostal space, there Avas found another gunshot Avound of entrance. FoUoAving this, the ball Avas found to have passeel through the heart and lower lobe of the right lung, anel Avas recovered in the right pleural cavity. The man had lost his left arm, it having been amputated near to the shoulder. In the back of the right hanel another bullet wounel was seen, entering opposite the metacarpal bone of the midelle finger, which Avas broken, anel passing forAvard to the base of the thumb, where it Avas lodged. The track of a bullet was found leading to the right upper jaAv from bedoAv and to the left. It Avas supposed this ball had entereel the left siele of the neck anel passeel upward, but neither Avound of entrance nor ball Avere found. From the amount of blood in the chest cavities the wound in the breast was considereel to have been made during life. No poAvder-marks or burning of tissue were present about any of the gun- shot injuries. In this case the evidence of the wounds is perfectly conclusive that they were not self-inflicted. While it is true, as will be referred to fur- ther on, that Avemnds of the heart are not necessarUy immediately fatal, it is not compatible Avith any theory, even supposing the deceased had first cut his throat, and then, not finding that wound sufficient, shot him- self, he could have inflicted all the Avounds found before muscular poAver had deserted him. The Avound through the heart AA'as not described minutely as to what part of that organ Avas traversed by the bullet; but it was so cut that blood in large quantities was poured out, sufficient to convince the gentlemen making the autopsy the wounding had taken place during life. The evidence of this particular wound Avas that it Avas fired from above down, and from left to right, for it entered between the fourth and fifth ribs, passed through the breast and lower lobe of the right lung, being recovered in the right pleural cavity. This is a wound a person could make upon himself, and there need be no evidences of the weapon being held so close to the body as to give powder-marks on the skin or edge of the Avound; for a man could so hold a pistol of smaU 262 A SYSTEM OF LEGAL MEDICINE. size—and later in the trial evidence Avas adduced to prove the weapon was of this sort—as to send a bah in this general direction. The proba- bilities are, hoAvever, against such a theory, for it would be not only more natural, but easier, to hold the weapon more at right angles to the chest than te> use the strained position such a shot Avould require, the right hand being used. The shot Avhich entered the heart might not have proved instantly fatal, and one or more of the other Avounds ceiuld have been made. But suicides generally strike for vital points, and it is not compatible Avith knoAvn laws of injuries to nerve tissue that tAvo shots could be fired, by the person taking his life, into the brain, as Avere found in this case, going in from the forehead. One such buUet Avould in all human probability produce instant insensibility, and tlie hand would not have been able to give the second shot. Other positive evi- dences of homicide were present. It has already been said the deceased had only his right arm, and a bullet Avound and the ball Avere found in the back of the right hand. This would of itself be positive evidence of murder, for it Avould be impossible that this shot could haA-e been self-inflicted. The body Avas too far advanced in decomposition to decide AA'hich wounds were made before or after death, and on account of this the evidences to be deduced from the incised Avound of the neck are nil. A razor found near the body, from its blood-stained condition, was eAddently the cutting instrument. No pistol Avas found, but one was recovered from the prisoner which could have fii-eel the bullets taken from the body. The prisoner was convicted anel executed. In the summer of 1879 one Briggs, a farmer living at the lower border of Albany County, Avas arrested for the killing of a man named Woods, employed by him as general utility man about the farm. Briggs, having hacl his suspicions aroused concerning the relations of his wife and Woods, determined to investigate, and stating he Avould be aAvay on business for a feAV days, left his farm. He did go a Avar, but returned secretly in the night, and entereel the general liA'ing-room by means of a window. Off of this room, opposite to the AvindoAv by which he climbed in, were two small bedrooms, one of Avhich was oceaipied by Mrs. Briggs. The door of this room Avas open, and Avas also the nearer to the door leading into the front haU. The Aveather being Avarm, this haU was only closed at the house front by a sash-door fastened by an ordinary cast-iron bolt, one inch Avide by one eighth of an inch thick. Woods' room Avas upstairs. Briggs advanced to about the center of the hving-room, from where he could commanel a view of the bed in his wife's room. Some slight noise made by him caused a movement by an occupant of the bed, and Briggs, his suspicions now converted into certainties, raised his pistol and fired. Woods sprang from the bed and the room, turning into the front hall. Briggs fired another shot, and then, changing his position by advancing so as to command the haU, fired again. Woods had by this time reached the sash-door, and not Avaiting to draw the bolt, he threw himself against the door, breaking the bolt squarely in tAvo, and continued his flight down the slight hill on which the house stood to the nearest cottage, about one quarter of a mile away, AA'here he feU at the door groaning. His faU and groans aroused the inmates, AA'ho got up, opened the door, and were considerably surprised to find a man without a stitch of clothing on him lying on their doorstep. Woods was carried into the cottage and put to bed. On the third day he died. HOMICIDE AND WOUNDS. 263 The autopsy disclosed the gunshot wounds. One through the fleshy part of the inside of the right arm, another grazing the right side, about on a level with the Avound in the arm. Both of these were clearly made from behind foi-Avard, and neither was a dangerous wound. A third wound of entrance, oval in shape, Avas found in the left chest, in the third intercostal space, penetrating the cavity. On opening the chest the right cavity Avas found full of blood, right lung compressed to its smallest extent, left lung normal. The track of the ball was clearly marked by a red line, anel led to the pericardial sac, into and out of the right auricle, across the loAver edge of the right pleural cavity at its in- ternal angle, through the diaphragm into the liver, AA'hich it traversed, anel Avas found lying in the fat anel areolar tissue near the gall-bladder. Brain and all other organs Avere healthy, and no cause of death except the pistol wound Avas found. The eA'idences here presented by the wounds alone were most im- portant. The prisoner claimed he had shot Woods as he Avas in the act of rising from the body of Mrs. Briggs, and as Wooels ran down the hall he had fireel at him twice. The Avounds in the right arm and side were probably these last two shots, they showing clearly the bullets had passed from behind forward. The fatal wound could only haAre been receh^ed in two ways, either as claimed by the prisoner, he standing and Woods nearly horizontal, or from aboA'e, the wounded man being erect. Of this there Avas no evidence, there being no doubt that Briggs entered the room from the windoAV, and that he fired from about its center. The ball noAvhere touched bone, was not upset, showed the marks of the " lands and grooves " in the rifling of the barrel, had made a straight hne in the boety, anel gone as far as it had the power. It AA'as of .36-inch caliber, the pistol being a large one. I advised the district attorney that the evidence of the fatal Avound substantiated the statement of the pris- oner. Briggs Avas convicted of manslaughter. Another point is brought to notice by this case. The bullet cut through the heart, and yet, after receiving what would generaUy be stated as a Avound which Avouid be immediately fatal or at least would incapac- itate the recipient from any strong muscular effort, the man jumped from the bed, ran doAvn the hall, broke an iron bolt one inch wide by an eighth thick, ran about a quarter of a mile before falling exhausted, and then lived three days Avith every pulsation of the heart pouring blood out of it. There are plenty of cases on record where instant death did not follow a gunshot wound of the heart, but I do not know of one where after being wounded by such a large bullet the injured person did so much. It leads one to be careful in pronouncing a decided opinion on such a AA-ound as to its being instantly fatal. It certainly is one which in many would be so; but all considerations must be taken into account, as well as the extent and character of the wounding, before definite ex cathedra statements are made. Another death from gunshot injury Avas that of Mrs. Jesse BiUings, who, Avhile sitting seAving opposite a window, was killed by a bullet fired from outside of the house, and which entered her head but did not go out of it. Her husband was arrested for the murder and twice tried, the jurv disagreeing in the first and acquitting in the second. The time was the evening of the 5th of June, 1878. She was sitting with her left side toward the window and about three feet from it, the lamp on the table 264 A SYSTEM OF LEGAL MEDICINE. was burning, and the window-shade Avas up. As soon as the shot Avas fired she fell to the floor dead. The autopsy showed that the baU had entered the left side of the head, about half an inch above the opening e)f the ear, had plowed its Avay across the base of the skull to the opposite1 side, where it caused a triangular fracture of the mastoid pertion of the right tem- poral bone, forcing this through the skin so the fragment protruded. The ball stayed in the skull at the base of this triangular fragment, and partly buried in the posterior surface of the right petrous portion. The autopsy Avas carried no further than the head, but as certain questions concerning the size of the bullet and its action upon the skuU came up in the first trial, the beaty Avas raised and head removed that more careful examina- tion could be made of it. The case was evidently one of murder, and many questions relating to the kdling and in connection Avith the weapon which the people claimed was the one used were relegated to the medical witnesses. It Avas claimed by the defense that the ball would haA'e gone through the heael if it had been fired from the rifle or carbine the people put in evidence. It was thought some little retarding of the bullet might have been caused by its first going through the Avindow-pane, and an- other point raised by the defense was that the Aveapon could not carry unexploded powder a greater distance than one foot, and at this distance the moving body of gases of the discharge would bloAv the AvindoAv-glass from its frame: hence this point. Another apparently strange fact was that the hole in the glass through which the bullet had passed was enough smaUer than the caliber of the gun (.41 inch) as to prevent an unfired ball going through without breaking off the edge of orifice. AU these questions were acted upon by the medical men engaged on both sides, for the answers had to do with the Avound found in the head of Mrs. Billings. The evidence of the wound itself was that a weapon of forceful fire and large caliber had made the injury. The ball, at least so much of it as Avas found in the head, Aveighed but 165 gr., while an unfired baU of the cartridge used in the carbine weighed 220 gr., and the recovered bullet Avas very much upset. From the wound and the ball found it was evident that pistol or rifle had been used, for a smooth bore was out of the question, lines shoAving the impress of the lands and grooves of the barrel being found upon the bullet. The district attorney Avished two questions definitely answered, and these Avere, What effect would the ball have upon the bone ? and, What the bone upon the baU ? To decide these it Avas considered necessary, supposing the carbine to be the weapon, to knoAv AAdiat force a ball fired from it would have, for the ball did not go out of the head. The piece was therefore tested at the United States Arsenal at Springfield, Mass., permission to do so haA'ing been obtained from the Avar department. It preyed to be a weapon of low velocity, the mean being 998.8 ft. per second. This brought the energy of the ball down to 521.1 foot-pounds, or about half what it would have been had the velocity been up to that of an ordinary rifle, as stated by the defendant's experts to be—about 1300 to 1400 ft. per second. The force of the buUet was not so very much more than a ball fired from an army revolver. And the force being found so much less than was ex- pected, the stopping of the bullet in the head was not such a mystery, especially when the thickness of the skuU was taken into account (and 'it was abnormally thick and dense), and also the course of the ball. Tests were also made at the arsenal to determine whether the bullet, passing HOMICIDE AND WOUNDS. 265 through glass, lost any of its velocity. It was found that no appreciable effect Avas made by the glass. The ball struck almost its fuU diameter on the base of the left petrous portion, and crumbled this part of the tem- poral bone so but little1 of it could be recognized. The ball, having plowed its way through this bone, passed over to the right petrous portion, into Fig. 65. Fig. 66. Mrs. Billings' skull. Point of entrance Mrs. Billings' skull. Hole made by piece of of ball. bone being driven outwards backwards. which it crushed a little, and expended its force in breaking the triangular piece of bone from the mastoid portion, and forcing this outAvard through the skin and tissues. The effect the baU had upon the bone Avas to fract- ure the skuU in different directions; but the most noticeable effect was the almost complete disintegration of the left petrous portion. This might be described as being ground up. The bullet seemed to have the effect on it that is produced on the contused tissue Avhen the wound is in the soft parts, and this complete destruction may partly be accounted for by the someAvhat brittle character of the petrous portion, it con- taining hardly any canceUous bone. It yielded, therefore, more readily to a suel- den and forceful contusion or concussion, and went all to pieces. Upon the rest of the skull the action of the bullet Avas AA'hat Avould be expected and is usually seen: hnes of fracture radiating from the point of contact and folloAving the general laws of physics. The action of the bone upon the bah was to use up part of its lead. The first impact with the bone did the upsetting, but its having to plow through such fine, sharp particles as the fracture reduced the petrous petition to, caused more loss of substance than AA'ould appear reasonable if it could not be shoAATi by other experiments to be probable. We may assume the ball to have been of 220 gr. Aveight before firing. It Avas 165 gr. Avhen found in the head. To see" what effect might be had upon a bullet following as nearly as possible the track of this one, I made six experiments of shoot- 266 A SYSTEM OF LEGAL MEDICINE. ing at cadavers, and then examining the heads afterward, care being taken to recover eA'ery particle of lead possible. In the last of the series Fig. 68. Fig. 69. Sixth shot. Experiments on skulls. the bullet foUowed more nearly the track of the Billings baU. The sub- ject was badly decayed, and the skuU old and A^ery thin. But the baU struck the base of the left petrous portion fairly, and had but strength enough to fall out of the head, on the right side, upon the table, anel then roU to the floor. I give the record of this experiment, as made at the time. Sixth shot, no glass, distance ten feet from subject: Weight of ball................ 220 gr. Weight of ball recovered......159.291 gr. Weight of lead found.........000.000 " Total weight of lead recovered 159.291 gr. Loss not found............... 60.709 '' The other five bullets lost any AA'here from 3.975 gr. to 50.557 gr., and by loss I mean total loss, the lead not being found even in smaU particles. But in none of the first five experiments did the buUet folloAv the line of the Billings baU, and nowhere do Ave find an equal amount of weight lost until the experiment quoted where the pe- trous portion was traversed by the bullet. These experiments then proved that the ball taken from Mrs. Billings' head could have weighed 220 gr. before being fired, and proved further that for such a bullet to lose as much as Avas the case in the BiUings baU, it would have to travel through considerable bone, which would cause enough attrition to reduce its weight. But these two questions out of the Avay, and the third one of the gun being of comparatively low force, Iioav could the bullet be for a weapon of .44-inch caliber when the hole through the window-pane would not admit of such a baU passing through it ? This Avas ansAvered by a num- HOMICIDE AND WOUNDS. 267 ber of experiments, firing at glass set in sashes, both glass and sash being similar in size and Aveight to the window through which the fatal bullet had gone. The notes show for these tests the foUowing: " BaUard carbine, old style, .44-inch caliber, long cartridge, 220 gr. lead, 28 gr. pow- der. Experiments made May 8th and 10th, 1880, in the Tenth Regiment Armory, Albany, X. Y. Shots fired through glass set in sashes: glass, 28 x 13£ in., double thick, American make." The distance from muzzle to glass was generally ten feet, but other distances were tried, from seventy feet doAAui to two. At the last distance the glass was blown out of the frame. As a summary the notes state: Balls unable to pass................. 1 Balls barely passed.................. 3 Balls passed........................18 Cartridges passed....................21 Glasses blown out................... 2 Total...........................45 From these tests, in forty-five shots one hole in the glass would not permit an unfired ball to go through Avithout further fracture. The force with AA'hich a bullet strikes a pane of glass acts precisely as it does on the tissue Avhen it enters or wounds the soft parts of the body. It dis- integrates by the concussion the part struck. So in the glass the action is so rapid that the part struck is punched out before it has time to call on the surrounding parts for help. And the glass yields a trifle to the force, resuming its natural position after the momentum has passed on. Again, the temperature of the air and its humidity haA'e something to do with the glass yielding. Another piece of evidence then in the case under discussion was shown to prove that the carbine could have been the weapon. It was claimed by the defense that the gun coidd not carry uncon- sumed powder farther than one or one and a half feet. It should, how- ever, be borne in mind that in fixed ammunition the bullet is driven into the cartridge directly upon the powder, and generaUy the heel of the baU is greased before being put into the shell. As long as that grease holds on to the ball, just so long may a grain or two of poAvder cling to it and be carried groat distances. As the firing experiments at glass had proA'ed that AA'ithin the distance of tAvo feet the gases Avould shatter the glass, it. would haA'e been impossible for the carbine to have been the weapon, if it could only carry unburned powder oue foot, and powder or marks of powder were found in the Avindow-sash. To determine this question more experiments were maele. Seve'ii boards, of about fourteen inches by ten inches, were fired at Avith the carbine, the distances from the muzzle being from ten feet to two feet. The boards AArere produced in court, and tests then made of what Avas supposed to be powder implanted in them. The suspected grains Avere picked out and put on a piece of glass. A platinum Avire-point, heated by a gah'ano-cautery battery, was brought in contact with the grain on the glass. From eight feet down to tAvo distinct flash and smoke avci-c elicited, showing the grains to be powder. At ten feet no flash could be gotten, but the marks Avere con- sidered to be those of powder. The experiments Avere, hoAvcve'i-, proof that the carbine could have been the weapon, for at eight feet the window- 268 A SYSTEM OF LEGAL MEDICINE. pane would not have been dIoaaui out by the discharge, and the gun could implant unburned poAvder into boards that far from its muzzle. The evidence of the Avound, therefore, Avas in support of the proper claim that the carbine sIioavu by the testimony to belong to the prisoner, and AA'hich had been hidden in an old AveU on his farm, could have been and probably Avas the Aveapon Avith AAdiich the crime Avas committed. But as said'before, Avhen speaking of the nearness of the muzzle to the gunshot AA-ound found, the fact that it might have been the AA'eapon Avas only conclusively sIioaaui by the A'arious experiments made Avith it. In 1881, in Herkinier bounty, a boy named Klock, of sixteen years of age, shot and killed a man in a barn. The ball entered the chest cavity and caused death by hemorrhage, the pulmonary vein being cut. He Avas tried for the crime of murder, and set up self-defense as the reason of the killing, claiming the man Avas about to attack him, Avhen he dreAv his pistol, stretched his arm to f uU length, so that the muzzle almost touched his assailant's body, and puUed the trigger. The truth of this story was at first doubted, and the district attorney Avished to know hoAv near the muzzle of the pistol had to be in order to scorch the clothes. The pistol Avas a smaU one of .22-inch caliber. Tests AA'ere made, part of the man's coat and AA'aistcoat being used, anel some cotton cloth similar to the shirt worn by him. It Avas found that the cloth would not singe beyemd a distance of two to three inches, but at this distance the cotton would be set on fire. As the Avaistcoat Avas singed, it shoAved that the boy's story of the nearness of the weapon was true, and other eA'idence in the way of elirect proof of the attack by the deceased being produced, the lad was convicted of manslaughter and sentenced for four years. In this case, if tests had been made on other clothes, it might haAre led to the giving of improper testimony, for the Avaistcoat was woolen fabric, and it did not take Are so readily as the cotton. To rely on the cotton alone would have been im- proper. In 1880, on Christmas day, I was summoned to Mechaii- icsviUe, Saratoga County, to hold an autopsy on the body of a man supposed to have been murdered. External ex- amination shoAved a badly contused wound over the right temple. Xo fracture coidd be detected. On autopsy a fracture Avas found opposite the contusion, Avhich. had al- lowed the inner table of the skull to cut the middle menin- geal artery, and a large clot of blood was effused between the bone and membranes, causing such severe pressure that the brain did not resume its natural form after the clot was Fig. 71.— Mechanicsville Case. Blood-clot from right middle meningeal artery effused between bone and dura mater. HOMICIDE AND WOUNDS. 269 removed. Xo other mark of violence or other cause of death was found by a fidl examination. All the organs AA-ere healthy. The wound had evidently been made by one bloAv, and with a rounded sort of weapon. A pien-e of pine board, five eighths of an inch thick, abemt ten feet long, and four and a half inches Avide, was supposed to be the Aveapon which had been used. It appeared rather doubtful if one bloAv from such a weapon could do such an injury, anel the absence of laceration did not seem likely Avith the sharp edges of the board. Still, for Avant of a better, it might have been the weapon. Examination of the room AA'here the murder Avas e-ommitted shoAveel a Ioav ceiling of not over seven to eight feet. There Avas evidence to show that the two men had been quar- reling and were standing up when the bloAv Avas struck. If this evidence was true, force enough could not have been given AA'ith the board pro- duced to have resulted in such an injury. Searching brought to light a piece of log, cut so that twei limbs, short, led from the trunk, and which had been used as a boot-jack. This was a hickory or ash log, still had the bark on, and Avas heaAy. One arm of the boot-jack made a coiiacii- ient handle, and Avith such a weapon it did not need height of ceiling to get full arm-swing so as to deliA'er a blow that Avould produce the condi- tion found at the autopsy. I Avas inclined to look on it as the more prob- able weapon, but the case never came to trial, the assaUant being arrested in Pennsylvania anel cennmitting suicide in his cell. The eA'idence pre- sented by the Avound Avas such as to call for more examination of the scene of the murder than had been made, for AA'hde it was homicide from the fact that the quarrel had been heard taking place and the suspected man had fled, the nature of the injury was not compatible Avith the weapon that was at first supposoel to have been the one used. In May, 1885, a Avoman was found dead in the yard of the house where she lived, in the village of Fort Eehvard, lying on lieu- face, and with marks of violence on head and other parts of her boely, with eAd- dence of a struggle, from the torn clothing. The autopsy disclosed sev- eral severe contusions and some laceration on left side and back of head. Also contusions on arms, and some on trunk. The dress Avas torn in front. On opening the body, lungs Avere found to be congested. Heart was fairly healthy, right ventricle empty, left also, but fluid blood ran from right auricle into the right ventricle. The stomach gave appear- ances of free indulgence in alcoholic liquors. The spleen, liver, kidneys, and pancreas were all congested, the blood being dark and fluid. A smaU ecchymosis was found on some of the small intestines. Brain was congested. Clots were found under the larger contusions in the head, but not fractures. It was stated by the district attorney that the evi- dence he had shoAved a drunken fight between the woman and her hus- band, both being intoxicated, that she Avas struck AA'ith a revolver butt in the hands of the man, and that she was last seen alive walking toward the outhouse in the yard, near AA'hich she was found in the morning. Some sand in the nostrils and mouth led to further question. It appeared that she had fallen, as she staggered when walking, and when found her face lav in a sand-heap which was near the outhouse. It rained a little in the night, and the sand was wet as well as her clothing. The husband Avas under arrest, The autopsy AA'as thirteen hours after death, and rigor mortis Avas avcU marked. While the evidences of the different wounds showed a severe beat- 270 A SYSTEM OF LEGAL MEDICINE. ing, none of them could be considered mortal or dangerous to life. EAren the main contusion OArer the right temple, Avhich Avhen receiveel knocked her down, was not necessarily a fatal injury. The appearances of the internal organ, hoAvtwer, and the position the body Avas found in, face eloAviiAvarel in the sand, showed death Avas from asphyxiation, and not from the injuries. The coroner's jury so found, anel the man was re- leased. (hi March 4, 1879, Mr. W. J. Hadley, a prominent laAvyer in Albany, X. Y., Avas stabbed twice by a man named Jediu Hughes. The trial Avas helel at the Oyer and Terminer in March, 1880, and resulted in a verdict of murder in the seconel degree. The assault was maele in Mr. Hadley's office in the morning, and from there he was removeel to his home, where he died from the effects of the Avounding late in April. The wounds were di'scribed as incised wounds, one penetrating between the bones of the left forearm a little beloAV its center, going completely through, and another in the right side over the short ribs, about tAvo and a half inches te> the right of the median line, its direction being doAviiAvard and back- Avai-d for about an inch and a half. The Avound penetrated about four inches. It had not entered the abdominal cavity. Blood Avas freely scattered about the office and on the clothing. The patient Avas sixty-five years of age. The blow making the stab on the right side Avas so severe as to separate the cartUage of the seventh rib from the bone, but no displacement took place at first. The prisoner was a one-armed man, and, as is usual in such cases, the one arm having to do the Avork of tAvo, it was much stronger than had he had the normal number of limbs. The force of the blow, therefore, was greater and without any apparent increase of muscular action to those who saw it struck. The patient Avas of highly nervous temperament and compara- tively little muscular strength. He was a weU man, hoAvever, not haAdng any organic disease; but the fact of his having been struck down in the Avay he AA'as, by a cUent Avho was demanding money of him, Avas a nervous shock, from Avhich he at no time recovered. He rallied from the physi- cal shock the night of the assault. Pyaemic abscesses formed on forearm and side, and the autopsy disclosed a circumscribed peritonitis around the liver, the necrosed end of the cartUage having cut through the parietes, and by pressure brought on an ulceration of the liver and the attendant inflammation. Death was caused by exhaustion due to this blood-poisoning from the suppurating wounds. The evidence of the wounds themselves was that they were made by some sharp instrument, were stab-Avounds, and were made with force. The evidence from the autopsy was clear that death had resulted as a sequence of the wounding, for aU the organs were found in good condi- tion. The peculiar effect of the patient's mental condition is to be noted in the case. Had such wounds been inflicted on a strong, ordinary man, the chances are they would not have proved fatal and troublesome. Sepsis might certainly foUow, as in this case, for the knife-blade could carry septic material Avith it when making the wounds, and in Mr. Had- ley's case very likely did. But even then, if the wounds had been upon one whose mental shock, if such a term may be used, had not been so great, they Avere not wounds that would be considered more than dan- ger nis. Here, however, the patient never rallied his general mental tone. And nothing could arouse him. He objected to the taking of food, and HOMICIDE AND WOUNDS. 271 in every way was passive. That this was the condition was of course no palliation to the crime. The intent to do injury was shown by the as- sault, and that the assault proved more severe than was intended by the prisoner was no mitigation of it. In 1878, in Albany, X. Y., a man named MaUon shot his wife, killing her instantly. The Aveapon used was an old-style Springfield rifle, one Mallon had carried in the war, and it was loaded with buckshot and slugs. The shooting Avas in a narrow hall of the home they lived in, and the waUs and ceiling were marked with blood and tissue, wliich the near discharge of the gun had blown over them. A door behind Mrs. Mallon Avas pierced in several places by the missiles that went by her. Mallon was indicted for murder, but a miscarriage of justice brought in a verdict of manslaughter in the third degree. I did not see the wounds, and therefore in that particular can only speak from hearsay, for the records of the autopsy Avere destroyed by a fire wliich burned the city haU. The majority of the wounds Avere in the chest on the right side, some, however, penetrating the abdomen, and the right arm and forearm also suffered severely. WliUe, on account of the loss of the records, the fuU evidence to be drawn from the wounds cannot be commented on, the evidence as to the position of the woman when shot was clearly shown by the manner in Avhich blood and tissue were thrown on the surrounding walls. The defense claimed, and, by the verdict of the jury, apparently established, that the gun was accident- aUy discharged, and the wounding was from the front of the hall and not the back. But if this was the fact, then it was hard to explain Avhy all the blood-stains on the wall were evidently and absolutely in the opposite direction. As wiU be referred to later on, the manner in wliich blood strikes a wall is indicative of the directing force. And in the same manner, if tissue is by a tearing discharge thrown on a wall or any other surface, the mark it makes is a slight guide to the direction it came from. It is a positive rule in the giving of evidence that the medical witness exhaust every means to assure himself that but one statement can be made about any giAren condition he has to pass upon. It has already been said, as a caution to medical witnesses, that it is the better part when giving testimony not to be too minute, but to—having the fullest of notes and examinations—condense many things into one general state- ment. The part I played in this trial emphasizes this advice, and is here given for that object. A piece of ceiling-plaster, Avithout paper on it, but having in its center a dark, dried, and blackish-appearing lump, was brought me from the district attorney with the request that I would tell him what the black stuff was. The officer's directions were to say noth- ing further. Sections being made, the microscope disclosed the fact that this dried mass was human, voluntary muscle. But as a man was on trial for his life, and the specimen was shriveled beyond any possible recognition, except by microscopic examination, I made further tests, tak- ing at the market specimens of beef, mutton, and pork, and from the disseicting-room voluntary and involuntary muscular fibers from old and fresh sul g'ects. The result of all examination Avas the positive conclusion that the specimen could be nothing else than a piece of voluntary muscle from a human being. Reporting the results of the examinations to the district attorney, he asked that I state them to the jury in " plain Eng- lish." This Avas done. After the verdict was rendered—and if the evi- 272 A SYSTEM OF LEGAL MEDICINE. dence of this piece of tissue and of other blood-stains was correct, the woman could not have been AA'here the defense claimed she Avas—the; prosecuting officer asked one of the jurymen how he came to render such a verelict; did he not believe the evidence of the doctor ? The reply Avas made: " Wall, if that 'ere feUow had a-knowed what he Avas about he Avouldn't haAre taken so durned much trouble! " It Avas a lesson to me that the ordinary juryman does not appreciate the reason Avhy eA'ery test is made, but only looks at the general result. Where the assault is with a cutting Aveapon, and vessels are severed so that spurting follows, there is chance blood Avill be found upon the clothes of the assailant. That blood is not found, hoAvever, may be no proof that the prisoner is not guilty of the crime, for the cutting may be so done that no blood AviU get upon his clothes or person. A notable instance of this is related by Dr. Taylor in the murder of Lord Kussedl, Avhere his throat was cut by his valet, who wore no clothing Avhen com- mitting the murder. Or the throat, or wound, AA'hatever it may be, may be cut or made from behind, and in that way the evidence of blood upon the clothes of the assassin may be Avanting. In the murder of Catherine Dunsback by LatrimouiUe, in Albany County, in 1878, the murder was by throat-cutting. It was expected the clothing of the prisoner would sIioav marks of blood, as the cutting was done partly in front of the Avoman, but no blood-stains were anywhere traceable. The murderer Avore his hat at the time of the assault. The hat, coat, waistcoat, and trousers Avere aU carefully examined, but no blood found anywhere. It transpired later in the case that the prisoner had worn at the time of the crime a long gray ulster. What became of it no one knows, for it AA'as not in his possession at the time of his arrest, and no trace of it could be discovered. This would lead to the logical assumption that this ulster had blood on it, and the prisoner had destroyed it to remove the evidence it might give. On other testimony presented, a verdict of guilty was rendered, and the man executed. Evidence to be drawn from Blood=stains. (Also consult Blood and Other Stains.)—A medical examiner should not only see and note all marks upon a body he is called upon to inspect, but he should, AA'here possible, investigate the place and its surroundings where the suspected crime had been committed. And the clothing worn by the prisoner at the time of the assault, and any other clothes he may have, should be carefuUy looked over for the evidence of stains from blood. Blood, when thrown from a vessel, if it strikes a waU or furniture at an acute angle, gives such a mark that strong inference may be drawn as to the direction it came from. Being globular in form while in flight, its first marking is a round splash indicative of the size of the globule; and this round splash tads off into a point given by the force carrying the elon- gated globule as far on the surface it impinges against as circumstances AviU permit. Specific gravity plays its part in the formation of the char- acteristic mark. The stains point downward, according to the point of the parabola they have reached at the time of their contact with the Avail or furniture. This gives an idea as to the distance they may have come; from, the size of the spurting artery being known. The taU of the splash is generally the darkest, gravity having carried the major portion of the blood there, and consequently the rounded or upper part of the mark is hghter in color than the pointed portion or final ending. HOMICIDE AND WOUNDS. 273 The manner in Avhich blood flows from a wound should also be noticed. As a general rule the greatest amount of blood will be seen near to the Avounds themselves, especiaUy if the patient has lain quiet after the Avounding. It shoulel be remembered, hoAvever, that persons dying from hemorrhage become very restless, move about, or try to do so, unless the wound is such that motion is prevented by the rapidity Avith AA'hich life is lost. Consequently the largest spot of blood may be at a distance from the body, and lie only indicative of where the wound- ing first took place. In Xovember, 1870, a man cut his throat in a hotel in Burlington, Vt. The fact Avas discoArered about nine o'clock in the morning. Happening to be in the house and hearing the alarm, I went up to the room and noted the foUowing: The man, still alive, lay on the floor about four feet from the AvindoAv of the room and about eight feet from the eloor. BetAveen him and the door there Avas a pool of blood about the size of an ordinary saucer. Another clot Avas under his neck, not so large as the first. Tavo more, one longer than the first named, Avere betAveen the body and the AvindoAv. By the windoAV Avas a rocking- chair, and in front of it a tin pail, about in the position one would place it if it Avere set betAveen the legs of one sitting in the chair. Blood Avas in the pail, aU over it, and on the1 carpet. Here, evidently, the greatest amount of blood Avas lost, and here the suicide had cut his throat, intend- ing to bleed quietly into the pail; but nature AAras not to be denied, and he moveel about, bleeding a while here and there until he feU exhausted. AU hemorrhage had ceaseel Avhen he Avas found. In the slop-pail was found the razor Avith which the Avound Avas inflicted. These points hav- ing been rapielly noted, the man Avas put on the bed anel the Avound ex- amined. The cut AA'as not deep, did not involve either carotid, Avas be- tween the cricoid and thyroid cartilage's, and the only A'essel that could be found severed Avas the oricoid-thyroid artery. How such an amount of blood could have come from this small A'essel seemeel a mystery, but there Avas no other Avound, and no other place from which the blootl could have come. Death resulted in the eArening, the man not rallying from the shock and loss of blood. Blood Avas on his right hand and some on the left. The clothes were bloody in different places, noticeably in front, anel it Avas concluded that the other blood-stains were probably gotten Avhen he feU anel tried to get up, falling and rolling over, until he lay quiet in the position he Avas found in. The evidence of the blood-stains in the Budge case, before quoted, Avere very marked. From \he large Avound, cutting all the great vessels of the neck, blood only flowed doAAm by gravity on both sides of the neck into the feather-bed underneath. A feAV sprinkles of blood were on the right sleeve of the night-dress, a little blood on the right hand, a few spots on the sheet, and bloody marks on the pillow next the one on which the Avomans head lay. In all only about one quart of blood had been lost, It was found that great effort was made to stop the flowing of the blood, the doctor stuffing the wound with cotton, and even then persistent oe>zing was noticed. And this aft en* the body had been dead for twenty- four hours. With no more blood on surrounding objects from such a wound as this, the proof is pe>sitive that the heart had stopped its action when the cut AA-as made. Where execution is by decapitation, the records show that a tremendous spurt of blood follows the falling head; it springs from the body like a jet from a hose-pipe; and after that the 274 A SYSTEM OF LEGAL MEDICINE. bleeding stops. The want of more blood on the front of the body, on the hands, the night-dress, the bedclothes, the Avails, the floor, every- where, in short, that the action of the heart could throAv it, negatives the claim of the defense in this trial that the Avound Avas suicidal. I AA-as called one day from my carriage to see a woman avIio had cut her throat. She did it in an outhouse, and used an ordinary table-knife, which she sharpened by whetting on the back steps of the house, these steps being of stone. When I saAV the body it Avas in a heap on the floor. Blood Avas eA'eryAA'here—walls, seat, floor, dress, right arm and hand. The cut had severed the left carotid. Tavo cuts were made.- the first, superficial, going but barely deeper than the skin and crossing on the left cornu of the hyoid bone; the second, loAver, cutting part AA-ay into the trachea. This last took the vessel in its course, and was carried no further. The manner in Avhich the blood Aoavs from the wound may be indic- ative of the position of the assailed at the time of the Avounding. If the blood is doAvn the front of the body from a cut in the throat or a stab of the chest, the probabUities point to the erect position ; AAdiile if it is toAvard the sides of the neck en- runs to the arm-pits, the assumption Avoulel be that the Avemnds Avere inflicted AA'hen the body Avas recumbent. In the case cited of the man AAdio Avas hit AA'ith a brick, and the temporal artery of the right side cut, the bleeding after the first spurting of the vessel was over the face and chest, it running down upon the shirt. In October, 1893, a gentleman Avas injured by his horse falling at a fence AA'hile foUoAving hounds. One of the injuries received Avas a cut underneath the chin. The cut was caused by the chin being suddenly and A'iolently driven upon his coUar, AA'hich happened to be stiffly starched. Although rendered insensible by the fall, he was instantly picked up by compan- iems, and regained consciousness as soon as he Avas on his feet; the blood from the wound had, before hemorrhage ceased, coA'ereel his shirt-front, was liberaUy sprinkled on coat, Avaistcoat, and breeches. From the blood-stains on the clothing alone, the evidence would be properly drawn that the person bleeding Avas in the erect position, for the wound could not possibly have sent the blood AA'here it Avas found had the man re- mained on his back. The stains made by blood upon clothing can sometimes be made out, or rather surmised, long after they have been received. To teU AA'hen they have been made is an impossibility if the marks haA'e become per- fectly dry. A year or more after having in an operation got some blood on a pair of trousers, the stain remained, although it had been carefully Avashed. It AA'as a peculiar broAvnish color, but Avhether made by blood or not, one not conversant AA'ith it in the first instance could not state positively. It had a suspicious look, as if it might have been from blood, but that is aU that could be said. On linen or cotton, the stuff not being colored, a fresh blood-stain gives a red color, wdiich soon, hoAvever, changes to brown; and after such change, and perfect ehyness is present, the time when it Avas made cannot be placed, for but little further change takes place. The dry blood-stain is hard, giving the cloth the feeling of being starched or gummed in that particular spot; anel if freshly dry, there is a glaze OA^er the spot, If no attempt has been made at Avashing, anel the stained part be rubbed together, a brownish poAvder is produced, AA'hich, placed under the microscope, moistened Avith water or glycerine, HOMICIDE AND WOUNDS. 275 wdll shoAV blood-corpuscles. That the stain then is blood may be confi- dently stated, but that it is human blood is another affah*. While it is perfectly well knoAvn that the human blood-corpuscle has a certain aA'er- age measurement, and differs from aU other animals to a slight degree in that measurement, it is equally weU known that when the blood on cloth- ing or anything else has had time to become perfectly dry, a shrinking of the corpuscles takes place, and although when treated with water or glycerine they resume some of their natural shape, still it is a mooted question whether an expert can swear positively a given blood-stain Avas produced by blood from a human being, and from no other animal. The medical Avitness can say it is blood and blood alone which made the stain- ing, but that is as far as it is considered safe to go. Other evidence should be brought to sIioav that there was no other source from which the stains could come than the Avounds proving mortal to the corpus de- licti, and as the medical Avitness says confidently the spots AA-ere made by blooel, the corroborative evidence proves the blood to be human, and from the wounds found. In adelition to this examination chemical tests should be used, and no means left untried to prove conclusively that blood alone was the agent making the discolorations. Blood upon Weapons.—The evidence that a knife AA'hich is clean of blade has been lately used in the cutting of tissue AA'here blood would get upon it, is not difficult to deduce from the stains on the blade, even if but very little blood had marked the steel. If, hoAvever, the knife be old and tlie blade rusty, the task of deciding as to the marks found hav- ing been produced by blood or some chemical action upon the metal be- comes one of delicacy, and requires more examination than mere visual in- spection. The rusting caused by the juice of lemons is at first sight apt to be taken for blood, and so close is the resemblance that chemical tests have to be resorted to to decide the question. Stains upon the blade of the Aveapon are not ahvays the only spots that may be found, and every particle of the Aveapon should be carefully searched and tested before stating no blood is on it. Where a fixed handle is present, if it is made by two pieces of AA-ood, bone, or other substances being riveted to an ex- tension of the blade, the rivets should be drawn, and every particle of dust or foreign substance found be examined in all the ways known for testing for blood. The same where the knife is a clasp-knife. Blood may have been plentifully spread over the blade, and the knife carefully Avashed by the criminal, and still blood be found in the cracks under the handle pieces in the hinges, and prove an important link in the chain of evidence. Fire-arms are not so apt to be marked by blood. They may be used, however, in clubbing, AA'here the noise of the discharge would be liable to bring about discovery. The same condition may then be found as is noticed Avhere blunt weapons are used, and the blows struck cause more or less bleeding. When the weapon is wood, the blood makes its mark readily, and can be studied in the same Avay as blood upon cutting instruments. If the bark is still on the club used, then blooel Avill be found clotted in the interstices of the bark, and may be more readily detected. The weapon may be a stone, and blood be found upon it. In the trial of Sam Stoenbergh, a negro, for the murder of one Palmer, at Fonda, X. Y., the murder was proved to have been committed by Steenbergh pounding Palmer on the head AA'ith a stoue, even after the body Avas upon the ground. The skull was crushed and the scalp broken. 276 A SYSTEM OF LEGAL MEDICINE. A stone having blood upon it Avas found by the body and was the Aveapon used, the Avouuds being of such a uatm-e as could be made by a stone of like character. It AA'as, of course, but one part of the evidence, but it filled out the perfect line of the people's case. The verdict of guilty was rendered, and the negro hung. When hair is found clinging to a Aveapon it may become a factor. The microscope Avill determine AA'hat kind of hair it is, and it may also, according to Casper, decide whether it has been cut, or broken by a bloAv. Wool and cotton fibers found adhering to a blood-stained Aveapon may have1 the appearance of hair, but the magnifying-glass proves the charac- ter and shoAvs Avherein they differ from human or animal hair. Taylor caUs attention to an interesting case Avhere rabbit-fur and shellac Avere found oil a rake, Avhich had evidently got on the rake by the burning of a hat in AAdiich this fur entered as one of the constituents. It is con- sidered, then, that the clinging of hair to a Aveapon may aid in proving it the one used in the assault; but before the meelical Avitness can state1 pos- itively the hair is that of the deceased, he must make comparisons Avith otheT hairs taken from the victim, to see if the two correspond; for the hairs of different persons vary in size, the characteristics of the markings alone being the same. Bullets, Shot, and other Substances in Wounds.—Where the homicide has been by gunshot injury, portions of the dress or sometimes. of the wadding of the gun may be found in the wound. Nowadays it is rather rare to find muzzle-loading guns in which paper or other sub- stances may be used for wads. The breech-loader haA'ing almost uni- versaUy taken the place of the muzzle-loading fire-arm, the Avads for the cartridges are of so little cost that one rarely finds anything else than the niaedhne-made ones used, anel consequently if one of these be found in a wound, it merely confirms the evidence of the Avound itself as to the character of the gun. It may be found entire, or enough so to give the caliber of the weapon; but direct evidence as to the Avad having been part of some paper or letter belonging to the suspected assassin is in these days rare to find. The shot taken from the wound may have some bearing, if other- cartridges are found to belong to the prisoner loaded Avith the same kind and size of shot, but while all shot that can be found in the wound should be kept, the chances that they can be proved to have belonged to the prisoner is remote. The Billings trial showed the importance of ree-OA'er- ing by patient search all the lead possible from a gunshot wound AA'here bone has been traversed by the ball. The ball recovered is also of A'alue. If it can be measured, either by calculating the lands and grooves found upon it or by some portion which still maintains its periphery undis- turbed, it may be stated as positively of a kind able to be fired from the weapon suspected, or that it could not be; and this fact alone may free a person accused of crime. In a braAvl in Troy some few years ago,. shortly after the second trial of Jesse Billings, a man was shot. More than one shot was fired, anel by different persons. One arrested for doing the wounding Avas freed, by the medical witnesses who had held the autopsy proving absolutely that the ball recovered from the dead man could not have been fired from the pistol known to have been in the possession of the prisoner at the time of the brawl, and wliich Avas taken from him on his arrest. Had the doctors not saved and produced the HOMICIDE AND WOUNDS. 211 baU, the man would probably have stood a fair chance of being convicted of homicide ; for the testimony presented pointed strongly to him as the one giving the fatal shot. In'the case of Woods shot by Briggs, the ball AA-as recovered entire. It was not upset, as it had encountered nothing but soft parts, and it Avas the same caliber and the lands and grooves Avere of the same number and size as those in the pistol used by Briggs. This was further proof of the story of the prisoner, he relating he shot We>ods with a certain Aveapon. Dirt, grass, hay, and similar substances may be found in Avounds, and should all be carefully preserved, as they may aid in tracing a crime to the person guilty of it. Position of Weapon, Clothes, or Body.—Where death is homicidal, suicidal, or accidental, the position of the weapon to the body has a bear- ing on the decision of the examiner in determining to Avhich category the death belongs. If a weapon is found near to a body it may argue strongly for suicide; but suicides haA'e been knoAvn to endeaAror to simu- late homicide, and throAv the Aveapon some distance to lend color to this view, and in the same Avay criminals have placed Aveapons by their vic- tims in orcter to cover the crime. The manner in Avhich the wound is made, and the Avay the Aveapon is found with reference to the body, taken together, are strong points on AA'hich to reason. In the Budge case the razor AA'ith Avhich the Avemian Avas claimed to have cut her throat was founel lying under the right arm anel Avas partly closed. The arm itself Avas bent across the chest. There Avas hardly any blood upon the razor. Taking into consideration the character of the Avound in this woman's. neck, it is more than questionable if she could have, after its infliction, moveel her arm to where it Avas seen, having first half shut the razor and put it on the bedclothes beside her. To do this is to assume that death Avas not instantaneous from such a terrible wound, and that consciousness and poAver of movement existed after both carotids, both jugulars, both pneumogastrics, trachea, anel oesophagus had been completely severed. When a knife or razor is found shut after a mortal AA'ound, it is a suspi- cious circumstance, for one having determined on suicide and inflicted a fatal injury does not care much Avhat becomes of the Aveapon. Again, where the wound is instantly fatal and made under the pressure of ex- citement most suicieles experience Avhen taking their lives, the weapon is very apt to be founel graspeel firmly in the hand. This, of itself, Avould be almost certain proof of suicide, for cadaveric spasm will not take place except at the moment of death, and a murderer does not stay by his prey anel holel the AA'eapon in the dead man's hand until it is fastened there by the rigor mortis. In the case of the woman avIio cut her throat in an outhouse, before qtmted, the knife Avas found in a large clot of blood, and under the body. It had evidently fallen from the hand, and she shortly folioAveel it to the floor. The position the clothes of the deceased or the bed-coverings are found in should be noticed. In the Budge case the night-dress aams open in front, the sheets and coverings neatly folded doAvn upon the bed, and everything about the bed arranged as if the person were merely asleep. It Avould appear impossible to have this condition prevail if the wound had been self-inflicted; the mere moving of the arm up and exerting the strength necessary to do the cutting would in all probability disturb the ueatly smoothed sheet lying folded over the chest. 278 A SYSTEM OF LEGAL MEDICINE. In 1879 a man named Thompson kept a smaU photograph shop in West Troy, X. Y. The place consisted of one room downstairs about fifteen by twelve, and upstates a dark room was made of a closet in the back, and a sort of workshop alongside, taking off about five feet, while the remainder was used as the operating-room. A narrow staircase ran up by the left-hand waU as you entered from the street, only wide enough for one person to go up at a time. This stairway, in the second story, opened directly into the room where the cameras stood. The place Avas entered by a rather narrow door, wliich opened on the level of the sidewalk. This door was glazed in its upper part; a curtain or shade, with the man's name and occupation printed on it, covered this upper half. A window to the right of the door as one entered, also shaded. Standing at this door, to the right, high up in the wall, was a half window opening on to an alley. It had no fastening. Underneath it was an old sofa. A stove nearly in the middle of the room, a table, some chairs, and various photographs on the waUs, Avith the carpet, com- pleted the furnishing. The stairs were uncarpeted. The hand-rail was narrow and round, ending in a round-topped newel-post. The distance from the bottom step to front Avail Avas about three feet. On the side Avail of the staircase three or four large-sized photographs were hung in gilt frames. Thompson lived by himself in this place, sleeping on a sofa in the room he used as his gallery. He took his nu'als out, and at the time of his death had no one Avorking for him. His habits Avere not good. One Sunday he Avas missed at his boarding-place. He had been there the evening before, but had gone to his shop about nine in the evening. It being winter, made it dark at that hour. Xot being seen either Sunday morning or noon, inquiries Avere made. He had been seen going into the place the eA-ening before, but no one saw him come out. Some Avent and looked at the shop, but the curtains were down, and nothing could be seen. As excitement grew more peeping at the windoAvs Avas tried, and one person said he could see through a tear in the door-curtain a man's legs lying on the floor. This being confirmeel by others, the door was forced. Thompson's dead body, evidently dead for some hours, lay on its back at the foot of the stairs. Mening the body, after carefully noting its position, the condition of clothes, and surroundings, a lacerated and contused Avound, forming two sides of an acute angle, each side being about an inch long, was found on the left side of the head near the parietal eminence. This wound Avas made from its apex downward. The head when first seen touched the base-board. The feet interfered a little with the opening of the door. To his right side, standing on edge, Avas one of the photographs in oval frames Avhich hung on the stair AvaU. Its glass AA'as not broken, and its string, a heavy red cord, Avas also in- tact. The nail from which it had hung Avas bent dowmvard, folloAving nearly the angle of the stairs. An ordinary kerosene lamp Avas on the floor at his left and near the newel-pe>st, The chimney Avas found on the stairway, lying unbroken upon the fourth step. There Avere no marks of blood anywhere, except on the floor Avhere the Avound of the scalp rested. The clothing was neat, the legs straight out alongside each other, and the trousers were pulled down over tlie boots! Was this a case of murder or accidental death ? Suicide Avas out of the question. The man was sober when last seen, so it was presumed he HOMICIDE AND WOUNDS. 279 Avas so when he died. The autopsy showed the wound on the head cor- responeled to a depresseel triangular fracture of the same shape and dimensions, and death Avas due to the blow and compression. No other cause for death Avas any AA'here apparent. Rumor had it that Thompson had been on bael terms Avith the man who last worked for him, and that this man had threatened A'cngeance. The coroner's jury could not find sufficient evidence on Avhich a warrant could be issued, and so gave the verdict of death from compression due to a fracture received in some manner unknoAvn. Minute inspection of the photographer's shop failed to show any signs of a struggle. On the Avail of the stairway, underneath where the picture had been torn off, Avere some marks, Avhich examination proved to be made by boot-blacking. They Avere made from above down, trending in the same plane as the stairs. A hammer, the hammer head square with cut-off corners, Avas found upstairs. This could have made the Avound, but there Avas no blood or hair on it, and if it had been used it was put back on the bench in the smaU workroom. There Avas no mark on the ncAved-post, stairs, stair-rail, base-board, or floor AA'hich Avould indicate that the heael had been Avounded by striking against them. And the body lay out straight on its back, one hand across the chest, the other by its side, the clothes not disarranged, and the trousers pulled doAA'ii on the boots. If this was a fall, and consequently accidental death, how the body could faU from about half-Avay up the stairs, as it must have to make the boot- marks on the Avail or to pull doAvn the picture, strike the newel-post on the left side of the head—for that was the most likely object about which could possibly make such a wound—and then turn over and as- sume the position this body Avas in, is hardly possible to imagine. The more probable theory of homicide is easier of explanation. The man, going upstairs, sees an enemy above, coming toward him. He has no Aveapon, and seizes the first thing he can lay hand to, the picture, turns Avith it in his hand to reach the floor beloAV, and receives the blow; falls head foremost, feet striking the Avail. The assailant follows, and to clear his oavii Avay throAvs the legs over. This turns the body on its back, and to make it appear as if accidental, he straightens the legs by pulling on the trousers. Escape Avas easy out of the half window into the aUey, and from there to the street. This could be conjectured to be somewhat the manner of the death ; but so much would have to be mere conjecture that an almost equally plausible theory could be as weU constructed on the question of accidental death. The case is one of interest, and wiU always remain one of doubt. It shows, however, how every point must be taken into account, and Iioav the logical bearing of one upon the other must be carefully studied before a medical witness can pronounce whether death was from "homicide, suicide, or due to accident. When More than One Wound is Present.—The medical witness may be caUed on to sav, where several Avounds have been found on a body, which was the first inflicted. Lawyers, apparently, seem to believe that a doctor should be able to state with positiA'e and unqualified speci- fication any question that may enter their heads to ask about an injury, a disease, or the permanent effects of either. Unfortunately for this, man is not machine-made, and what wih in one person cause death im- mediately will in another allow of more or less action before loss of either mental or muscular activity. Therefore it is that a medical Avitness 280 A SYSTEM OF LEGAL MEDICINE. oftentimes appears at great disadvantage. He must, however, expect the question, and prepare himself, as well as may be possible, to answer. When several wounds are present, if a case of homicide, or no evidence1 of strimule is attendant, the mortal Avound was probably the one first inflicted- for if the others are Such as would not be mortal or incapaci- tate the assailed from an effort for life, it is a fair assumption that some defense would have been made and evidence of this be found. If the wounds are made by twe> or more attacking at the same time, no definite ansAveu- can be given as to wliich would be the first, or, if more than one be mortal, which caused the death. The examiner studies each Avound on its merits, and by the character of the injury arrives at a probable conclusion of the ones made before and those made after death. Further than this he cannot go, unless other evidence than that of the Avounds themselves can be presented Avhich will decide the question. Where1 wounds are incompatible Avith one cause for all, the examiner can state Avith positivene'ss the ones produced by one kind of injury and those produced by another. This may be most important eA'idence, for the death may be due to a fall, and the cause of the fah a blow which shoAved laceration or other symptoms, and the two injuries so placed that both could not be produced by the fall or by the blow. Suicides often make more than one Avound, or may make an incised wound and then use a pistol, or jump into Avater or from a height. They may do all these, and both cut and gunshot Avould have been mortal if a little patience to see the effect of their Avork had been exercised. The finding of a body AA'ith its throat cut and Avith a pistol-shot in the brain would be apt to raise the cry of murder, but calm study of the matter Avould prove both injuries compatible AA'ith self-destruction, although both were mental. The case of Weston is one Avhere three mortal wounds were present, if not a fourth. Two buUets in the brain, which had tra- A'ersed it from before backward, one through the heart, and the throat extensively cut, gives a case where the question of which wound was made first is not possible of answer. The surgeon thought, from the amount of blood effused in the chest, that the heart wound Avas made while the man Avas living; but it may have instantly preceded the buUet in the brain and before pulsation had ceased, and then the amount of blood would have been equal to that found. The amount of blood found on the clothing and on bushes and grass around where the body lay Avas not enough to say the throat Avas cut during life ; but as betAveen the tAvo mortal wounds in head and heart, it would be impossible to do more than to give an opinion of priority baseel on conjecture. Criminals sometimes make wounds upon themselves as evidence of attack, and that their action Avas, therefore, in self-defense. The manner in which the wounds are stated to have been received, AA'hen compared with the reading of the cut itself, do not ahvays agree, and suspicion is created as to the truthfulness of the prisoner's statement. The marks of the cutting through the clothing avUI have important bearing in de- ciding Iioav such Avounds have been received, for feAV care to boldly cut direct through all that may interpose between knife and skin, but rather prefer to see AA'hat and how deep they are cutting and then make the necessary incisions in the clothes afterward. As feAV know, there are points of difference in the beginning or ending of a cut, or that to an ex- perienced eye every wound teUs a story; the cutting on the person may HOMICIDE AND WOUNDS. 281 be made in one direction, and the required rents in the clothes in the opposite. In June, 1874, I examined a man named Bruin in the Wash- ington County jail at Sandy HiU, by direction of the district attorney. Bruin was an old man over fifty years of age, but of an extremely bad temper. He was under arrest for attacking with a pitchfork a man who worked for him and inflicting a stab-wound in the face, seriously wound- ing one eye. The prisoner claimed it was done in self-defense, saving the man had attacked him with a large-bladed jack-knife and cut him in the abdomen. Examination showed a freshly healed Avound, it appear- ing from the cicatrix as if two incisions had been made close to each other, of one half-inch in length, running perpendicularly and situated six inches above the antero-superior spinous process of the ilium, and five inches from the umbilicus, its upper end being at lower border of the cartilage of the ribs. The cicatrix showed the Avound to have been made from a cut directed upward, and that it did not penetrate, merely entering through the true skin. Examination of the shirt, waistcoat, and trousers which the prisoner had on, and which he said he had worn when assaulted, discovered rents or cuts in each; but in the shirt there was a tear five to six inches long; in the waistcoat a rent, also several inches long, about on a line with the wound, but extending both above and beloAV it; while the cut in the trousers Avas so made that AA'hen they were drawn up upon the body as far as the make of the garment Ave mid aUow, the upper edge of the rent did not come opposite the wound. The shirt appeared more torn than cut; the waistcoat was cut from without in and from below up, as if held out from the body and the knife passed through, and then sawed up and down as far as thought necessary; Avhile the cut in the trousers was made by thrusting the knife from within and cutting down. The linings of these two garments told the direction of the cut, AvhUe the fibers of the cloth showed in which direction the knife had gone through them. As the prisoner claimed all cuts in his clothing as weU as that on his abdomen had been made when he was struck by his man's knife, there was no hesitancy in reporting to the district attorney that the injury was self-inflicted. In a recent trial in Albany for murder, a strong point for the defense was made of the fact that the prisoner had shot himself immediately after the murder, and had intended to kill himself. The case Avas wife- murder. A young man named Shattuck shot his wife and then fired the pistol at himself, making a dangerous wound in the right temple; but the weapon was so held the baU plowed the muscles, merely grazing the bone. On the ground of insanity a verdict of murder in the second de- gree was renelered, and the prisoner escaped the electric chair. From aU the evidence of the crime, it was fairly considered his shooting himself was accidental, although the appearance of the scar was avcU used by the defense. Had the case happened differently, this wound Avould have been excellent evidence of injury by another, for the pistol Avas not near enough for the discharge to cause burning by the flash. Suicide.—To say that all who take their own lives are laboring under a temporary aberration of mind is, in many cases, to rely merely on the fact of self-destruction for eA'idence of mental unsoundness. That mania is undoubtedly a frequent cause of suicide nobody would deny, and with that class of cases Ave have httle to do, insanity being treated of elsewhere. 282 A SYSTEM OF LEGAL MEDICINE. It may be said that where insanity plays a part the methods used are at times so peculiar as to lead not only to positive proof of self-slaughter, but to the presence of mental disease. A rational being avIio decides on suicide does it generaUy in the easiest and quickest way he can. A plunge in the water, and all is over. Determination to succeed is often manifested. A case occurred of a patient who had been in my wards when I seiwed in the Brooklyn City Hospital in 1870. The man had been operated on for partial removal of the lower jaw. Unfortunately, the surgeon attempted to save the rami, the elisease being only in the anterior portion of the body of the bone ; but the pterygoid muscles drew the rami iiiAvard, causing the remaining parts of the body to press upon the tongue. This being unbearable, a second operation was decided upon, but the patient thought he had had enough. Obtaining leaA'e of absence, he did not return, and the reason for this was explained when his body was found in Gowanus Bay, near the city, when the tide went out, AA'ith the pockets of his coat filled with stones. This man was not crazy. He simply determined to die, and took precautions to prevent any effort on his part floating his body after he once threw himself into the water. And then his method insured his body being found, for he was securely anchored in the mud. As has been seen from the foregoing, homicide may be made to appear like suicide to hide crime. It is rare that suicides so plan then- exit as to show a desire to have then- death appear to be murder. An interest- ing case of this character is reported by Dr. J. B. Lewis in his book of " Stratagems and Conspiracies to Defraud Life Insurance Companies." Captain Colvocoresses, a retired officer of the United States Navy, was found in a dying condition in a by-street in Bridgeport, Conn., at a late hour of the night of June 3, 1872. The captain, although possessed of smaU means, obtained insurance upon his life for $195,000. He was ostensibly on his way to New York from his home in Litchfield when his death took place in Bridgeport. He had been to the boat, secured a room, left in it his traA-eling-bag, but as the boat did not leave until ekeven o'clock at night he left it to go to a hotel and get some supper. When going off the boat he was seen to carry a small black bag and his cane. This latter was a bamboo sword-cane. After getting something to eat at a restaurant, he idled away his time untU half-past ten, when he left a drug-store, where he had made some small purchases of paper and emrelopes, and being directed how to find the boat, he apparently started to reach it. Just as the boat Avas putting out the report of a pistol was heard, and a policeman, of whom the captain had earlier in the evening asked some questions, hearing the shot, ran to the place from where the sound seemingly came. Lying on the sielewabk, and in a dying condition, Avas Captain Colvocoresses. A large gunshot Avound was in the left breast, his left hand pressed against it, and he Avas on his back. The discharge had set fire to his shirt, and the light from it guided the policeman. In a diagonal direction across the street, in the gutter, Avas an old-fashioned percussion-lock horse-pistol. This weapon had evi- dently just been discharged. The sword-cane was about two yards from the captain's feet, and toward the gutter. The cane was broken, and the blade in it bent. From examination it had the appearance of haA'ing been broken by being struck or snapped over a fence. The buUet had gone completely through the body. HOMICIDE AND WOUNDS. 283 First one thing and then another was brought to light. A pill-box, having percussion-caps AA'hich fitteet the pistol, Avas discovered. A bey, seeing a bit of rag sticking out from under a gutter plank, carelessly pulleel it out, anel Avith it an old poAvder-horn. Tiring of his plaything, he threw it where it Avas afterward found. The black bag carried off the boat by the captain Avas founel on another wharf, partly hidden uneler a railroael-tie. One end Avas slit open, and nothing Avas in it but a blank check-book and some Ioav grains of powder, AA'hich, on comparison Avith the grains in the poAvder-horn, Avere sIioavii to be similar. Peculiar in- dentations AA'ere noticed in the bag, and trying the pistol, these were seen to cen-respond to the point where the hammer would rest if the pistol was put into the bag. The captain's coat anel Avaisteoat Avere unbuttoned anel lay open Avhen he Avas found on the sidewalk. It Avas proved that he habitually Avore his coat buttoned up, and AA'hile it Avas supposed that the openeel clothing Avas a sign of A'iolence on the part of footpads, the but- tons Avere not torn off either garment. The evidence of the Avound was that of close fire. The discharge must have been fairly near, or the shirt AA'ould not have been set in a blaze. Anel the carefully cut satchel, the peculiar Aveapon—one'AAdiich Avas traceel as having been oAvneel by the deceased—the peculiar manner in Avhich the sworel-cane Avas broken, the evident care Avith which the percussion-caps and poAvder-horn had been hidden, the repeated questions by the captain in the early evening of the way te> the boat, although he AA'as avcU acquainted with the1 toAvn, the motive for death, that his family Avould be left in affluent circumstances, the peculiar maimer of his bid- ding good-by to the faniUy when leaving home that morning—all brought the positive conclusion that this Avas a e-ase1 of suicide and not of homicide. Dr. LeAvis, in his report/says the pistel being founel thirty feet aAvay AA-as accounted for by the recoil of the Aveapon, the pistol springing back from the chest after it Avas fired. I am inclined to differ from this view, and would rather think it an act of volition. All the evidence points to so carefully e'euiceived a plan that some arrangement must have been thought of by Avhich the Aveapon Avould be found a distance from the body. Therefore, I do not think it incompatible AA'ith the wounding that the captain could throAv the Aveapon. The recoil may have helped in this, the arm giving the sudden jerk predetermined on, and both forces com- bined carrying the pistol thirty feet. The case of Woods shows coordi- nate muscular ability after a terrible wound, and in this case but much less was attempted. "And the captain was not deael when found, although life lasted but a feAV minutes after. (Also see article Life Insurance.) A young man some five years ago attempted his life by shooting. The weapon, a pistol, fortunately for him, Avas faulty in action, and while the shot aa^s weU aimed and intended, it did no material harm. The wound Avas in the right temple, just in front of the hair line. When I saAV the patient, about an hour after the shooting, he was lying on his bed, his head done up in a wet cloth, and he thought himself wounded unto death. As this was AA'hat he wanted when he fired the shot, he was perfectly resigned, and did not wish anything done to interfere with an edifying end. But being persuaded to allow an examination of the Avound, as soon as he Avas assured it Avas but a trifle and there Avas abso- lutely no danger, his tune edianged, and he was as anxious to live as a few "minutes before he had been to die. The wound was a ragged, lacer- 284 A SYSTEM OF LEGAL MEDICINE. ated one, and but for the powder-marks, not such as Avould at first sight appear to have been maele by a pistol ball. But part of the bah was there in plain sight in the Avound, and lying flattened against the bone. Taking this out, it Avas seen to be only half a ball, so the pisted Avas pro- duced and the cause of his escape from death Avas easily explained. The cylinder elid not reA'olve properly, so but half of the edianiber Avas pre- sented to the barrel AA'hen the trigger Avas pulled. The ball cut itself in two, one part going out of the muzzle AA'ith just sufficient force to cut the skin, the other half squeezing sideways betAA'cen cylinder and barrel, and being found on the floor. When the suicide is by cutting, blood is generally found on the hand using the knife; and if cadaveric spasm keeps the Aveapon in the hand, the blood is on the back and between the fingers. It is hardly Avithin the range of the possible that a person can cut his throat, severing the carotid, and not have blood over hand and arm. To find otherwise AA'ould be to raise stremg suspicions of homicide. If the death is by stab- bing, then no blood would lie expected other than what might Aoav from the Avound on the surrounding parts. The hands, hoAvever, would prob- ably be free from stains, and if the suicide threAv aAvay the weapon the appearances of homicide would lie very real. Other facts Avould haA'e to be relied on to decide the question, for the evidence of the wound would only sIioav that it could have been produced by the dead as easily as by another. It often happens that a person trying to commit suicide fails by rea- son of pointing the weapon improperly. A yeiung man, Avhose "course of true love " elid not run as smoothly as he thought it should, and con- sidering life was no longer worth living, fired a shot at his head from a small pistol, which he hoped Avould end his troubles. The intention Avas evidently to fire a bullet into the right ear. Instead, the ball Avas fired a little to the front and just underneath the zygoma, and as the direction, given by the manner the pistol Avas held, was upward and forward, the ball passed into the zygomatic fossa, entered and crossed the right orbit, lodging against the nose at the inner canthus. It did not enter the brain cavity, and although a painful Avound, Avas not elangerous. The result was to cure the young man of the desire for self-destruction, and to allow him for the future to observe matters with a "single eye," for the sight of the right was destroyed by the buUet. I remoA'eel the ball without difficulty, and the case made a good recoA-ery. The determination betAveen suicide and accidental wounding is at times difficult, and, it may be said, sometimes impossible; for so many accidental deaths occur when persons are examining or cleaning fire-arms that it is beyond mortal poAver to say whether the death Avas by mishap or design. The medical witness can only state the evidences presented by the wounds and weapon, and must use caution in giving positive opinions as tei how the death came about. Such peculiar accidents do take plae'e that the range of possibilities for them is infinite, and at times the most improbable happens. Taylor relates a case of where a man's gun went off accidentally, the recoil throwing the gun backAvard, and as it fell the second barred was fired, the1 charge entering its OAvner's thigh. This case is sufficiently unique to call attention and emphasize the care that must be exercised in the examination of Avounds and the expression of opinion as to how they Avere caused. Plate VII. EFFECTS OF VITRIOL. HOMICIDE AND WOUNDS. 2S7 Burns and Scalds.—WhUe it is not common to consider injuries arising from the application of external heat to the body as wounds, under the definition of wounds before given, and for the purposes of a clearness of description before a jury, the lesions caused by burns and scalds will be considered in the same light as incised, contused, gunshot, or other injuries—viz., as wounds. Burns are considered as those wounds made by fire, heated metals, sohds ov fluids; and scalds, as the result of hot fluid, hke water, tea, etc., and steam. Boiling oil makes a bum as does boiling sugar, while they may also give scalding, if but a small amount of the liquid be thrown upon the body, not sufficient in quantity to cause a true burn. The danger from either kind of wounding is due to the extent of sur- face involved or the severity as to the destruction of tissue. A scald or burn which covers a large extent of surface, even though it involve the cuticle alone, is very dangerous to life, for the shock is so severe that the patient may not rally, and death be due to it. In such a case as this pain is excruciating, and aids the shock by its exhausting effect. It is weU to remember that such an injury has, especiaUy in children, a stupe- fying action, and the patient usuaUy dies in a comatose condition. The administration of narcotics may become a question of investigation, as the death may be attributed to their improper use. While pain is a symptom where the burns are slight, it decreases in amount as the severity or depth of the burn and destruction of tissue increases. Where the skin is killed by the action of whatever causes the burn, there is no sen- sation in it itself, and it rapidly sloughs. It at first contracts, and then, if the patient lives, inflammation begins, and the dead skin separates. The seat of the injury has also a marked influence on its risk, burns of the abdomen being more dangerous than those of the thigh, the Avound- ing being equal, and burns of the hands more dangerous than those of the feet. Death may be due to shock alone, uncombined Avith the effects of the burning, in which case no internal evidence Avould be found on post-mortem examination; or it may be due to secondary inflammations, as pneumonia, pleurisy, or of the intestines. Perforating ulcers of stom- ach and intestines also result from Avounds of this character, and the prognosis is not to be lightly given Avhen a .fair amount of injury has been done, as death may take place when everything is apparently pro- ceeding toward recovery. The patient may sink under the exhaustion caused by the pain and shock, the collapse coming on suddenly. Where death is immediate from a general burning, it may be long before any great pain is suffered, for the shock may kill, or suffocation from smoke take place. In the latter case, the body being recovered in such state that an autopsy can be held, the usual appearances of death from asphyx- iation will be present, while it is common to find where death has been from the shock of the intense heat or of the burns, the heart empty, the blood of a red color, and the organs generally congested. As burning may be resorted to as a cover for crime, the medical ex- aminer has to be prepared to state whether the Avounds found were made before or after death. It is agreed by aU the authorities on this subject that certain marks are fairly indicative of burns before death; but the question is on the same plane as other injuries, for the burns made at the1 time of eleath or immediately after present the same appearance, so that a decision can only be positive x a relative sense. Where certain 288 A SYSTEM OF LEGAL MEDICINE. signs are present, such as the slough beginning to separate, there is no hesitation in saying the wound Avas made during life, for nature had to have time to form pus and commence the operation of throwing off the dead tissue. And the same may be said of lighter burns or scalds; for if Ave find evidence of the blister, which undoubtedly Avas caused, haAung been broken or cut aAvay, and some pus-corpuscles lying on the healing surface, aac knoAv that life had gone on for twenty-four or more hours at the very least. The question, for the medical Avitness, is not of easy solution like the above. It is Avhether death took place1 either at the time the burn Avas inflicted or after it, and if after, Iioav long a time probably elapsed between the two. Blisters.—Blisters or vesiedes are made by the application of heat to the surface of the skin, usually by boiling Avater, direct flame barely touching, or steam-jets; for Avhere the injury is produced by heated metal or molten metals, or longer continued applications e)f flame, the skin is more deeply involved, and an eschar results. The vesiede in the cuticle at first turns Avhite from the heat, and then rises from the surface. It is seen te> contain serum, anel the surface of the skin under it is intensely red. If pricked anel the1 serum alloAved to escape, it will Avrinkle down upon the inflamed skin and remain there, if not rudedy disturbed, ae-ting as a dressing until the healing process has formed a new cuticle, AA'hen it comes away in dry scales; or it may again fill from more exudation. If torn off, the skin shoAvs red ca'cii after death, in this eliffering from the removal e>f the cuticle by abrasion, the skin in this latter case drying a yedlow or brenvn. The capillary congestion accounts for the red color, and this may and does become a red-brown color some time after death, but sufficiently different even then to be distinguished from the plaques resulting from abrasions. Experiments made by Sir R. Christison, Dr. Taylor, and others, sIioav that vesications can be made on the dead body, but unless on dropsical subjects, air instead of serum is found in the blister. Blootly serum wiU be present if the blister is made directly after death, that is, within a few minutes. As Avith contusions, so with blis- ters : more heat is required to cause one in the dead than in the living, as more forceful blenvs Avere found to be required to produce an ecchy- mosis in the dead AA'hich resembled one made in the lhdng body. The serum effused into a living blister coagulates when heated or on the ad- dition of nitric acid ; but that in a vesication produced on the dead, even if life has but departed Avithin a few minutes, is more Avatery, and is merely rendered opaline by the use of the above-named agents. Boiling \vater poured on the dead wiU not produce a blister. It shriv- els the cuticle, but does not produce effusion of serum. Some fifteen years ago I AA'as caUed to perform an autopsy on the body of a boy AA'ho had died at the Elmira Reformatory. The statement received from the prison Avas that he had committed suicide by hanging in his cell; that he Avas discovered lief ore1 life was extinct, cut down, and every effort made at resuscitation, but in vain. At various points on the body, especially the prominent joints, such as elboAvs, knees, and other exposed portions, were reddish brown spots, varying in size and extent. Careful examina- tion shoAved these had been made" by heat. There were no blisters, how- ever, but the color of the spots Avas such as to lead to the conclusion that they Avere slight scalds made while life was present. Further inquiry from those conversant with what Avas done at the reformatory when the boy HOMICIDE AND WOUNDS. 289 Avas found hanging, disclosed the fact that one method used for resusci- tation had been emersion in a hot bath. In the excitement attendant upon the matter, the water had been made too hot, being boihng, or nearly so, anel as the boy was plunged in, this being discovered, he was immediately taken out, The points slightly vesicated were in contact with the metal lining of the tub, Avhich had become very hot from the water. As the autopsy disclosed evidences of strangulation and death from that cause, the explanation of the scalded spots was probably cor- rect. Vesication does not always immediately foUow the injury. It may appear in a few minutes, and it may not appear for hours; therefore, a patient may die from the shock or exhaustion before blisters appear, and after death they may come on and contain serum, the capillary conges- tion having taken place during life. The appearance of the skin under such a vesicle avUI be a guide as to the period the burn Avas received. More serious burns, those when an eschar is produced from red-hot solids, molten metals, or flames, show more marks than vesication. The part burneel—that is, the skin—turns white. Around the spot is a sharp red line, and generahy redness of the skin beyond that again, AA'hich graduaUy fades into the normal color. This inflammatory blush, if pressed on, disappears under the pressure, returning again as soon as the pressure is removed. The deeper red hne, resembling the hne of demar- cation around a slough, will not yield to pressure, and remains present after death. The attending blush, however, fades entirely when death takes place. While this red hne is a mark of a burn during life—for there are no satisfactory experiments recorded that shoAV it can be pro- duced on the dead, it being caused by deep injection of the true skin— its absence is not proof that the burn was made after death, for it is not always present in such wounds produced in the living. Its pres- ence, then, is fairly rehable proof that the burn was made while vitality existed. Bodies may be so destroyed by fire as to preclude any autopsy, or any judgment being pronounced as to the cause of death. All appearances in one so cremated are to be observed, especially those relating to sex. If the body has been rescued before more than partial destruction has taken place, the autopsy may reveal much or little, for if death is frem shock, with the exception of the conditions before noted nothing will be seen. If, however, death has been produced by other means, and the fire has been caused to hide the crime, the examination of the remains will in all probability reveal the facts. Burns which are severe in character mav cause fissures in the skin, which have the appearance of incised Avoiinds. The reason for the fissure is the destruction of the elasticity of the skin and its being desiccated by the heat. While the skin gives way, the cellular and fatty tissue below, being intimately connected Avith it, may also part, so that the apparent cut may show the muscular tissue. Examination of the tissue, however, will demonstrate the elifference from Avounding by the knife, for the edges are more uneven, the fissure may extend in one direction and then go off at a tangent, and the condition of the deeper tissue will also aid in the decision. Corrosive Liquids.—A medical witness maybe asked to state Avhether a given Aveumding was bv the apphcation of heat or some corrosive fluid. WhUe both are caUed burns, the latter are not properly so. UsuaUy, the color of the wound is a guide to the cause, those made by sidphuric acid 290 A SYSTEM OF LEGAL MEDICINE. being brown, AA'hile nitric and muriatic acid give yeUow stains. As these injuries are generally made Avith malicious intent on the part of another, the most common seat is the face and hands. There is no blistering, anel the eschar is colored, and Avithout either the red line or red blush. The skin touched is killed and sloughs aAvay, healing taking place by granu- lation. Generally these Avounds are not dangerous to life, but the at- tendant inflammation may become so. It is not found that ulceration of the intestines folloAvs these injuries as it does burns from hot sub- stances, and consequently, AA'hile disfigurement folioavs them, they are not so serious in prognosis. Fractures and Dislocations.—With these classes of injury all sur- geons are familiar, but aU those avIio have to do Avith legal eases in AA'hich such injuries come are not equally well informed Avith the medical man. And both edasses are met with from criminal violence, either as the direct result of the violence, or as an indirect one, for the force AA'hich causes a fracture may exert itsedf in different Avays. A fracture is the break of a bone, and divided into classes, according to its character or its cause. A simple break is AA'here the bone is at some point of its course divided into two fragments, and it may be caused by a blow or pressure exerted op- posite the place of the break, or it may be from the force being trans- mitted to this particular bone and expending its energy there in break- ing it. In the first case, it would be called a direct fracture, in the second, an indirect. As an example, the arm-bone may be broken, at any point between the shoulder and the elbow, by a blow from a club: this would be a direct fracture. A man might fall and land on his feet, sustaining a fracture of the neck of the thigh-bone : this Avould be an indirect fract- ure. If the bone is broken in more than two pieces, it is called a com- minuted fracture, and this does not mean, as the name "comminuted" would seem to imply, that the bone is crushed into smaU pieces, but that it is divided into three or more fragments, broken in more than one place. The break may be said to be compound when the soft parts lead- ing to the seat of fracture are lacerated or cut, and the wound leads from the outer air to the break. This laceration may be either done from Avithout in, by the force making the fracture, or from Avithin out, the force driving one or more of the fragments through the skin. If the laceration or cutting of the soft parts does not reach to the break itself, or a dislocation of one end of the broken bone from its joint-socket is present with the fracture, then the injury is called complicated, by the adelitional wounding or by the dislocation. And this complicating of a fracture may be done in more ways, for one end of a fragment may wound a nerve or blood-vessel, thus adding to the primary injury the complications of the secondary ones. A faU on the knee may produce another kind of fracture, comminuted, it is true, but taking its name more from its peculiar radiating line of cleavage; for the faU being re- ceiA-ed on the knee-pan, that bone may be broken in star-shaped form, and give us what is called a stellated fracture. This mav also be found elsewhere, for a fracture from the blow of a hammer or other like Aveapon, or from a bullet, may cause a steUated fracture of the skuU. The force which causes the break may drive one part of the bone broken into another and hold it fast. This, whUe an indirect fracture, is known by the name of an impacted one. And lastly, fracture may be in the line of the bone's axis, longitudinal sphts, either clipping loose a project- HOMICIDE AND WOUNDS. 291 ing part of the bone, or splintering the shaft itself. These are generaUy the result of gunshot injuries, and when so are also called compound, as the Avound of the bone opens by means of the Avound of the soft parts to the outer air. Fractures take place iu some persons much more readUy than in others. In an old person the hemes are more earthy and break easier than in the adult, and the force being equal, the young breaks easier than the adult, because in the latter the bones are at their strongest period. In the chUd or young person the bone may bend, partially breaking on the periphery of the arc, giving what is called by writers "the green-stick fracture." And in the ye mug the epiphyses do not unite to the diaphyses untU certain ages have been passed, all the epiph- yses not becoming bone until about the twenty-fifth year; consequently, there may lie a separation of one of these ununited epiphyses, Avhich to all intents anel purposes is a fracture or break. Certain diseases or con- ditions of the system, resulting from elisease or medication, predispose to fracture : mollifies ossium, cancer, syphilis, rickets, gout, scurvy, mer- curializatioii, and any disease dependant upon cachexia1. These facts are to be borne in mind, for the wounding may be increased in severity by their presence, and yet the responsibility of the assailant be not, and the assault not be aggravated. Fractures may be spontaneous, anel caused by the action of the mus- cles attached to the bones so breaking. Commonly, those bones pecul- iarly exposed to the Adolence of sudelenly contracted muscles are the ones broken in this Avay, but the long bones, such as the bones of the arm and thigh, have been fractured in this manner. If the patient suffers from fragUe bones, breaks may take place by turning over in bed. Breaks thus made are the simplest kind of fracture, the bone merely parting, anel not causing laceration of the soft parts. Where the fracture is from any violence or force, either directly or indirectly exerted, the fragments lacerate the soft parts surrounding the break according to the degree of force experienced. This wounding is a guide to the de- cision of the time it took place, for if much bleeding foUow the tearing the probabUities are that the break was during life. The muscles may be torn as much after death as before it by the fragments, but unless a vein be cut across, less hemorrhage will take place in the dead than in the living. A fracture made at the moment of eleath, or immediately after it, could not be told from one made at a corresponding time before eleath; but if the body has been dead a short while, say from ten minutes to half an hour, the appearances around the broken ends of the bone will sIioav life to have been extinct Avhen the wounding took place. If the fracture be of some hours' or days' standing before death takes place, then the examiner can give a positiA'e opinion, for, as in Avounds of the soft parts by other instruments, Nature is getting ready to repair the injury she has received, and the signs of this work are apparent. As to the Cause of Fracture.—The medical witness may be asked Iioav a certain fracture was produced, Avhether by a blow or by a fall. The defense usually edaims that the attack of their client did not cause the break, but it was the result of a faU. The first thing is, was a weapon used f If so, what kind ? Of course the answer is easy if the wounding Avas bv means of powder and shot, for then Ave have the wound of en- trance' to reply to the question of time of occurrence. If extensive con- 292 A SYSTEM OF LEGAL MEDICINE. fused or lacerated wounds, and it may be incised ones, are present, a\ ith the fracture directly in the track of the force making the wounding. Ave have but to find the weapon, club, stone, pistol-butt, gun, hatchet or ax, and the Avhole story is ready for recital. Leaving aside Aveapons Avhich divide the skin, Ave cemsider ones making contused wounds. Here the extent of the contusion on the soft part is not only indicative of the AA'eapon, but also of the amount of force used. Taking the bruise of the muscles into consideration, the extent and elepth of this bruising Avould sIioav that a faU could ne>t have produced the wounding, for undoubtedly as the break Avas caused at the same time as the1 contusions, it bedng a fracture from direct violence and in line of the external injury, the im- possibility of a man falling so as te) cause just so much violence in one spot, without corresponding injuries AA'hich Avould be naturally and necessarily received by the same1 fall and at the same1 time, the breaking by direct violence, and that from a Aveapon, would be clearly shown! This presupposes careful examination of the place where1 the assault is stated to have taken place, as Avell as of the wounded limb itself. If the1 wounded man is suffering from fragile bone's or from any cause1 AA'hich renders the resistance to force less strong than normal in the bones breaking, it is no aggravation of the1 assault, for the force used Avas prob- ably such as Avould in no Avay break a heme in an ordinary man; and as no intent to do such sewere injury is sIioavii, the responsibility for the break Avould lay with the assailed. " If he did not have a condition which rendered his bones brittle, he would not have had them broken, for the force used was not sufficient, to break a like bone normal in its condition. Fractures of ribs may be made by blows on the sides, by compres- sion, as by a person jumping on another. The fracture, like those in the long bones, is either at the point where the force impinges, in which ease depression of the fragments may follow and the lung be wounded, or by the transmittal of the force around the rib until it extends itself at the angle. In this case the fracture is outward, and no danger of wound- ing the pleura need be feared. When the injury is by compression, more than one rib may be found broken, and at different points. Unless the' pressure is sharp and sudden, the angles of the ribs suffer the most. Quick, direct pressure, so strong that the natural spring of the rib is overcome, will be apt to make a break at the point of application. In 1882 a man Avas tried for the supposed murder of a boy who worked for him. The case was tried in Schoharie, X. Y., and the people presented the following: That on a Sunday afternoon the farmer, finding his sheep had strayed from the paddock, the bars of which had been left down told this boy to go and bring them back. The house stood bv the roael- side Across the road Avas a pasture leaeling down an incline to some brush and smaU woods, in which ran a little stream, and also contained more or less SAvamp. The sheep having gone in that direction, the last seen of the boy was his entering the woods. He never returned, and some inquiry was made, but the conclusion reached was that he had run away, for the short cut to the village1 lav through these woods and across the fields beyond. The boy was abont thirteen years old, lame in the left leg, that limb being shorter than the right, of light hair, dressed in brown overall trousers, a shirt, and an old jacket. It was late in Septem- ber, and frost was felt at night, The foUowing spring a man, following the by-path to the village, was HOMICIDE AND WOUNDS. 293 someAvhat startled to see a smaU human skull grinning at him from be- tAveen two bars AA'hich on a line-fence crosseel the brook. Remembering the disappearance of the boy the autumn before, he gave the alarm, and • search revealeel the folk wing: Further up the stream, AA'hich from the melting siioavs had quite a volume, on one bank was found some scalp with hair adherent, anel part of the skin of the back of the neck. This was shriveled and dry, showing the appearance of having been alternately Avet and dried until it had been left where it was found by the waters going doAvn. In different places were found bones, and as excitement grew and different persons engageel in the search, many bones were founel scat tercel oveu- quite a territory, and belonging to different animals. The Avhede of the boy's skeleton Avas not founel, but enough AA'as to make out height and age, and that the left femur Avas shorter than the right. Nearly all the left ribs Avere recovered, and semie of the opposite side. The loAver jaw Avas not found, nor Avere any bones of the hand, while only a feAV vertebrae and foot-bones Avere among the remains. The long bones all gave eAddence of having been cheAveel by some animal, and the ends of both ulnae, the head of one radius, and both ends of one fibula Avere thus eaten off. The medical witnesses for the people and elefcnse agreed as to what were human bones, the age and size of the skeleton, but differed as to the two main facts—one, the probable cause of death, the other whether the body had been buried. On this latter question turned the guilt or innocence of the prisoner, for if the boy had been placed in a grave, murder had been done. The expert for the people thought death was due to a blow over the left chest, which could have been made by a hoe or some such instrument, and marked three ribs of that side, the third, fourth, and fifth, as being the ones struck, and showing this by a slight line of fracture, not complete, but still apparent, which Avent across each. The doctor also thought the body had been buried, and dug from its shalloAv grave by foxes or dogs. I could not agree Avith this theory, and chiefly because if these lines of fractures on these three ribs Avere made by a IdoAV from a hoe, hoAV came similar line's on all the other ribs found, ribs belonging to both sides of the body? Nor did I agree AA'ith the theory of burial, for evidence of great unanimity on the part of the dogs and foxes which dug up the body must have been present to scatter the bones in the Avay they Avere found, and to cheAV only certain ones. The ribs had much more the appearance of having been frozen in ice, for Avhen carefully scanned the lines of fracture wore such as Ayould be made bv some general pressure in a straight line, the body on its back. The jury took the same view, for they rendered a verdict of acquittal Avithin ten minutes after retiring. Fractures of the bones of the skull differ from those of the long bones in that there is generally more than one line of break. And commonly these fractures are from direct violence, either by falls, blows, or bullets. It has already been seen what effect a ball has upon the head and upon hone itself. When the break is by a blow, unless a soft weapon or a large one has been used—large in the sense that its striking-surface does not? hit one line of scalp—the fracture is not usually compound. The soft parts may be contused to a considerable extent, the bone broken beneath them, and still the skin be not lacerated. The line of fracture in such case may be single, following the course the force of the blow 294 A SYSTEM OF LEGAL MEDICINE. Avould take around the skull, or it may be multiple, one hne going around, the other passing inward through the base. Whether such an injury is from a fall or bloAv Avill be knoAvn by the presence of the con- tusion, and the seat of this will lead to the statement to AA'hich class of cause the wound is to be attributed. If the contusion is either in front or behind, it is as easily made by a fall as by a bloAv, but on the side1 the probability is in faA'or of a bloAv, it being more difficult to receive such injuries on the side of the head from a fall, the shoulder being apt to in- terfere. Still it is by no means impossible, and therefore the medical Avitness must be guided in his opinion by attendant evidences, such as the character of the contusion, the place Avhere the alleged fall is said to have taken place, what object the head could haA'e struck, and any other circumstance that bears upon the case. Fractures of the base may happen from a fall on the feet, the force being transmitted upAvard so rapidly that the base is broken by contact Avith the condyles. In such an accident it will not be difficult to sIioav no homicidal assault Avas made upon the head. Fractures of the head made by hammers, hatchets, and other like weapons are characterized by the article producing the Avound. A sharp-pointed tool, like a pick or the pointed end of a fireman's ax, will make a depressed fracture, often- times driving before it a piece of bone, Avith hardly any lines of fracture in the rest of the skuU. The size of the hole and shape, for it is nearly if not quite sepiare, is a guide to the manner of its production. The cut made by a hatchet or ax is likewise indicative, for while extensiA-e lines of fracture may lie present, the cleavage made by the cutting part is dis- tinct, and shows the kind of instrument used. Dislocations.—Dislocations of the long bones are rarely fatal. They show less disturbance of the soft parts at the point of luxation than that made by the ends of broken bone, for the smooth articular surface is not disarranged, and the bone tears its way through the capsular ligament and then usuaUy stops. There is not, therefore, as much effusion of blood as in fractures, and the injury is not so severe. If, however, the luxation is of a A-ertebra, then the injury is dangerous and may be in- stantly fatal, according to the amount of pressure exerted upon the spinal cord. These injuries are more common in the cervical region than elsewhere in the column, and if the luxation is sufficient to cause press- ure on the cord, are attended by paralysis, if not death. They are ac- cidental rather than homicidal, for even if caused during an assault, the assaUant is not usually of the class that knoAvs such an injury could be produced by certain bendings, and if he creates it, it is more by accident than design. Position of the Body when Wound was received.—The medical Avitness may be asked to determine the position the body was in Avhen the wounds found Avere received. In many cases it can be readily under- stood the wound would give no positive eAddence of how the assailed stood or AA'hat position he assumed AA'hen struck. . A contused or lacerated wound of the head could be made on the person standing, sitting, or lying down. Again, the wound could only be given Avith the body in some position Avhich would allow of the fuU force of the blow being delivered Avhere its effect is found. Stab and gunshot Avounds are more apt to give evidence of the body's position than other injuries, for here the direction of the wound gives some clue to the position of both assailed HOMICIDE AND WOUNDS. 295 and assaUant. In the case of Woods, the eAudence of the course of the ball showed he received the wound in two ways, either semi-inclined, as claimed, or erect, the shot coming from aboA'e. It Avas impossible for the buUet to have been fireel at right angles to the body, for it could not have taken the course it did, as nothing hit by the baU deflected it, the line being perfectly straight from the Avound of entrance to the spot where the ball Avas found. In 1892, in Greene County, a negro named Bedell Avas shot and kUled by a man named Hess. It Avas in a country hotel bar-room. Bedell, avIio Avas a powerful man, engaged in a fight Avith another and knocked his opponent down, rendering him insensible. He Avas then going to attack Hess, who was behind the bar, Avhen two others seized him, one on either side, and a struggle ensued. Bedell broke aAvay from his Avould-be captors, and at the instant he freed him- self Hess fired. BedeU stopped, turned and walked to a bUliard-table, about twelve feet aAvay, leaned against it, then walked to a chair about twenty-five feet from the table, into which he sat. While sitting there the man whom he had just knocked doAvn recovered his senses, and made an assault upon the negro, striking him over the head Avith a pistol-butt. Men interfered to prevent further fighting, when Bedell got up, walked forward about eight feet, and struck his assaUant a strong blow in the face. Then he Avent to the chair and lay down on the floor, exhaustion coming on. The whole affray only took five minutes. Bedell went into a state of coUapse. I am indebted to Dr. A. Beach, of Coxsackie, for the description of the Avounding. Dr. Beach states that the ball, which weighed ninety grains, entered by an oblique Avound a little to the left of the median line, passing over the cartilages of the sixth and seventh ribs, then through the left lobe of the liver into the stomach, and out again nearer the pyloris, through the transverse colon, six times through the smaU intestines, and lodged in the right psoas muscle near to the prom- ontory of the sacrum. Here, as in the ease of Woods, from the line of the bullet the man could not have been in the erect posture. Xor was he lying down. The track made shows he was bending forward, prob- ably the last effort he made in breaking away from the two holding him, anel in this position the bullet struck. If one tries the position it will be seen that the ball could wound just the viscera that were found injured, the bending of the body bringing them in such relations that the bullet would make a straight course from its entrance to its resting-place. In the case of the man kUled at Mechanicsville in 1882, the wound could have been received either standing, sitting, or lying down, for it was a blow on the temple, and nothing gave evidence from the Avound in what position the body was Avhen it was inflicted. Other facts that could be adduced had to'be shown to prove the body was standing when it was sfrnok Did the Person move after being Wounded ?—It may be of impor- tance to knoAV how much a Avounded man, one " wounded unto death," can move or accomphsh after he has received the injury. The medical Avitness mav be asked the question if, in his opinion, it was possible for any voluntary movements to take place after the receipt of a given Avound; and the question is not ahvays one where a positive yes or no can be given for ansAver. Men differ in this regard as much as they do in others, some falling to the ground from a comparatively slight wound, others fighting until nature is exhausted by hemorrhage or other cause. 296 A SYSTEM OF LEGAL MEDICINE. Some wounds are, of course, instantly disabling, no matter by whom received. A rifle-ball going through the head would, by the force of the concussion alone, Avithout taking into account the injury to the brain, render the patient insensible. A heavy blow on the head or neck from a sand-bag or other weapon would cause insensibility, or instantaneous death could foUoAV stab-wounds of chest or abdomen, as well as gunshot injuries. But the cases cited have been sufficient to sIioav that mortal, and what would ordinarily be considered paralyzing, wounds may be suffered and stUl violent exertion follow. Woods, with blood pouring out of the wounded right auricle, broke an iron bolt and ran nearly a quarter of a mile before falling. Bedell walked about and began again to fight, although the wound he had received cut the mesenteric arteries, and blood and the contents of the intestines were being discharged into the peritoneal cavity. Here are two wounds, both mortal, and yet both borne Avithout any apparent effect for some few minutes, and the recip- ients doing that which a medical Avitness, not knoAving the evidence, Avould have felt justified in saying Avould have been a physical impossibility for either to perform. When serving as dresser in the Montreal General Hospital in 1867, a fire breaking out, a panic started among the patients. When the fire was over, a Avoman aaIio had a fracture of both bones of one leg, and who had been dressed in the old fracture box, was found in the main hall two flights of stairs doAvn from the Avard. How she got there she could not explain, but no one helped her, and in her fright she walked and ran. As soon as aU excitement was over she Avas perfectly helpless, and coulel not move. Instances innumerable might be cited Avhere men have fought for their lives after receiving Avounds wliich were mortal; but it is only cumulative eA'idence, and enough has been said to shoAv the need of cau- tion on the part of the medical witness in stating that the deceased could not have moA'ed after the receipt of his wound. It is but another illustra- tion of Iioav eA'ery circumstance bearing upon the death must be carefully sought for, and consielereel by the medical examiner before he passes an opinion. And even Avounds involving the brain are not ahvays preventive of motion. The celebrated case, quoteel in physiologies, of a man AA'ho had a blasting-iron three feet long bloAvn through the anterior portion of his head, and AA'ho got up anel Avalked to a cart, rode from the quarry to his home, walked upstairs and elid not become insensible untU he Avas in bed, is known to all. Had this man been found dead AA'ith such a wound, it would have been said he never moved from the spot AAdiere he received the injury, for such a AA'ound Avould render him insensible, if it Avas not immediately fatal. A hasty expression of opinion as to the poAver of one seriously Avounded to move, might cause an innocent person to be accused of the crime of murder. Wounds affecting Special Parts of the Body.—The character and eAddences of wounds in general haA'e been iioav studied. It remains to see how injuries affect different parts of the body, and to look somcAvhat more closely into the question of Iioav dangerous wounds in regions may be, and what influence they exert in causing death. Of the Head.—Incised Avounds of the scalp are not usually dangerous. If properly treated they heal readily, and the patient suffers but little inconvenience. A contused and lacerated AA'ound of the scalp is a differ- HOMICIDE AND WOUNDS. 297 ent affair. These are dangerous, for the liabUity to inflammation and erysipelas is great, A patient Avho walked into the Brooklyn City Hos- pital during my service as resident surgeon died from inflammation of the meninges of the brain, resulting from suppuration of a large, lacer- ated Avound of the scalp. The man had fallen about twenty feet out of a cherry-tree, tearing the scalp on the left side of his head so it hung doAA'n over the ear. The wound Avas carefully cleansed AA'ith disinfect- ants, the parts brought together by suture pins, the patient sitting on a chair and talking all the time his head was being dressed. Inflammation Avith suppuration folloAved, the periosteum was denuded, matters went on from bad to Accuse1, until death ended the case. Here, apparently, Avas a simple Avound, and one not likely to cause any danger to life, but it Avas a lacerated and contused one, and despite all that Avas done for the patient, a fatal issue followed. Another danger from a contused Avound of the head is the amount of injury done to the brain, and this cannot be at first definitely decided, for a slight injury wiU be folloAved by inflammation of the brain or its membrane and cause death, AA'hile one much more severe, eA'en AA'here a depressed fracture is present, may be fully recovered from, and no bad result be noticed as a sequel. A physician cannot prognosticate from the appearance of the Avound, and therefore must call time to his aid be- fore giving the dictum that the patient is out of danger. It is perfectly proper for a medical man, after the usual time for brain symptoms to appear has passed, and the Avound is free from erysipelatous inflamma- tion or undue suppuration, to pronounce the man out of danger, espe- cially if pulse and temperature are normal. But the effects of the con- tusion may not yet be dissipated. The injury to the brain may go on to the formation of an abscess with no symptom until a sudden explosion, and the patient rapidly dies from the abscess, due to the original Avound- ing. That the physician has pronounced the patient out of danger from the assault, anel in a fenv days the man suddenly dies from brain lesion due to the blow, is no reflection on the skiU of the doctor, as all symptoms of regaining health were present, and none of special brain injury. A severe bloAv to the head gives concussion. The degree of this is according to the force of the IiIoav and the individual struck, but it may ordinarily be considered that a A'iolent IiIoav is followed by some amount of concussion, effusion of blood, or both. The Woav may be so severe that the recipient falls anel dies at once from concussion alone. The autopsy Avould show no cause of eleath, and there might be nothing more than a small contused wound of the scalp to indicate that violence has been done. Concussion comes on immediately, and may Arary in inten- sity from a slight dazing to insensibility, folloAA^ed by vomiting, or a state of coma lasting for some days, until death takes place. If the con- cussion does not of itself prove fatal, it may be followeel by brain lesions in the same Avay as contusions. Like the others, the secondary injuries are but sequels of the primary one, and responsibility for the original wound is also responsibility for the effects. The condition of concussion may be mistaken for intoxication, and the medical witness may have to decide betAveen the two. This is not ahvays easy to do, especially if a history of the case cannot be obtained. The fact that there is a smell of alcohol about the breath is no proof, for a person may have taken spirits and received a concussion afterward. Where concussion is slight, the 298 ^ SYSTEM OF LEGAL MEDICINE. patient mav walk as if intoxicated, talk unintelligibly, act in an aimless manner, aiid be totally unconscious of what he is doing, simulating drunkenness so closely that an ordinary observer would unhesitatingly pronounce him intoxicated; anel yet all is due to the effect of the blow. If a man dies while in an extreme state of intoxication, the brain does not shoAv more than it does after severe concussion, no rupture of vessels having taken place. Contusions may be found on the head in both cases, alcohol may be found in the stomach in both, the brain is equally congested, and so are the other post-mortem appearances similar. The medical examiner can only, the body living, await further developments in the case; the body dead, gather aU evidence possible from circum- stances. It is necessary to treat all such cases Avith the utmost caution, anel to carefully note all facts that may develop. Cases are constantly reported AA'here' persons have been arrested for being drunk and dis- orderly, put in a cell, and found dead next morning, the autopsy showing fracture of the skiUl with effusion of blood as the cause of death, and proving the prisoner not to have been drunk at all. Extravasation of Blood from a Blow.—A bloAv on the head may cause extravasation or effusion of blood, which, from its pressure, be- comes the cause of death. As said elseAvhere, contusions of the head may result equally from IiIoavs or falls, and as the contusion precedes the concussion, the latter and its effects may be ascribed to a fall as Avell as to a Moav. Supposing a blow is struck AA'hich knocks the person receiv- ing it doAvn. This bloAv, AvhUe severe, may not be strong enough to give more than a slight contusion. But in the falling the head receives a violent concussion, and the man dies. WhUe the concussion is not directly from the IjIoav, it is a result of the Woav, for the fall would not have taken place if it had not been struck, and the concussion, therefore, would not have been suffered. To the medical AA'itness it makes no difference whether the concussion results from a blow or a fall; he has but to de- scribe the condition he finds, and state to the best of his knoAvledge how the lesions causing death were received. When the effusion is due to the injury it is most commonly from rupture of a meningeal artery. This may be ruptured by the force of the blow even Avithout fracture of the skull, anel Avhere a clot from a meningeal artery is found, causing pressure on the brain or its base, it is more apt to haA'e A'iolence for its cause than disease, therefore atten- tion is called to other matters in the case, and a hasty opinion that death was due to an apoplexy preAented. The blow causing the effusion may make so little contusion as to escape notice; or if on division of the scalp some ecchymosis is apparent, it might be assumed that this Avas due to a fall and followed the effusion, instead of preceding and causing it. Spontaneous rupture of these arteries from disease is rare, and this fact being known, the medical examiner, finding such a cause of death, has his suspicions aroused, and should make inquiries to show AA'hat led to the artery breaking. The blood, when the effusion is from one of the meningeals, is between the inner table and the dura mater. If the effu- sion is large, death may be rapid; but the brain avUI stand a great deal of pressure at all other points than the base, AA'here the medulla may be impinged upon, and the effusion may be not sufficient in amount or it may be spread OA'er the whole side of a brain, and in this Avay not give the amount of compression necessary to cause trouble; or, in fact, it HOMICIDE AND WOUNDS. 299 may not make its presence known at aU. In the MechanicsviUe case the clot found was from the right meningeal artery, and was as large as the hand. It showed not only its origin and cause, but also that it was a fresh clot, death supervening before any changes could occur in it. A person receiving a severe injury to the head may recover its first effects and be apparently on the high-road to his original health, when he suddenly becomes worse, goes into a state of coma, and dies. The autopsy may show clots more or less extensive in the cavity of the ven- tricles, or over the brain surface and dipping into the sulci. The condi- tion here arises from the contusion, some vessels being ruptured, and the blooel slowly escaping. The clot will show that it is not of late origin by being partially organized and of different colors, and its time of begin- ning can be drawn to or near to the time the contusion Avas receiveel. Is the Effusion found from Violence or Disease ?—Hemorrhage may take place from violence in almost any part of the brain, for the blow may rupture the brain or it may cause effusion into its substance into the ventricles or about the base. And similar bleedings may have dis- ease for the cause. If a man dies after a fight or fall, and an intracranial hemorrhage* be found, the medical witness may be called on to state which cause, the bloAv or disease, gave the effusion of blood. Much may depend on his answer, for a person innocent of crime may be placed in a serious position because he Avas engaged in the braAvl and his opponent died after it was over. In 1880 tAvo policemen in Albany Avere summoned to arrest a man who was creating a breach of the peace. The fellow was drunk, or had been, and was ugly, as the stupefying effects of the liquor Avere passing off. His age was a little over thirty years. He re- fused to be quiet when the officers appeared, and they started to take him to the station-house, about three quarters of a mile distant. The man fought, and the patience of the officers becoming exhausted, one of them used his club, hitting his prisoner over the right temple. He Avas only hit once or twice, the skin Avas not cut, and no fracture Avas caused. The prisoner continued his struggles aU the Avay to the station-house, but was not struck again. After his name Avas put upon the blotter, he fought the officers to the cells, anel until he Avas pushed in one and the door locked. Then he continued to SAvear and abuse them as long as they Avere in hearing. The arrest Avas late in the afternoon. The watchman saAV and spoke to the prisoner in the evening, getting curses for a reply. He saw him again before midnight, Avhen he stated that the man was asleep and snoring. In the morning the prisoner Avas dead. An autopsy was held by the coroner's physician, and he stated that he found the contusion Avith a clot under the muscle; no fracture of the skull, no break of the skin. On opening the skull nothing Avas found external to the brain, but on section a clot, eA'idently from the branch of the right anterior cerebral, Avas buried in the right lobe. The rest of the autopsy did not show A'ery much, according to the doctor's report, and he gave as a cause of death the hemorrhage in the brain. When asked AA'hat caused the hemorrhage, he stated that, in his opinion, it Avas the blows the deceased had received. This led to the arrest of the tAvo officers, and the presentment of this case to the grand jury. The defense had the body exhumed, and further examination made. The statements of the coroner's physician Avere substantiated as far as the contusion and there being no fracture of the skull, but from that on I differed in the opinion 300 , A SYSTEM OF LEGAL MEDICINE. that the man was healthy. Both kidneys and liver Avere fatty. Speci- mens of the aorta, vertebral, basilar, and cerebral arteries Avere taken and put under the microscope. All proved the presence of fatty degenera- tion. The condition of the contused part Avas carefully examined. As consielerable decomposition had taken place, it being the summer, the evidence from the contusion Avas not so conclusiA'e as it Avas on the first examination, so questions Avere asked the doctor AA'ho held the first autopsy, concerning this and other points. Upon the statements made by him anel upon the microscopical appearances, I gave the opinion the rupture Avas due to disease, anel Avas not causenl by the bloAv. If this case is scanned, the reasons leading to this decision AviU be apparent. While' apoplexy is not usual in persons under forty, intemper- ance and A'iolent habits predispose to it, and consequently in such sub- jects the age has less to do with the effusion than the intemperate habits. The microscopical examination shoAved the arteries of the brain in an enfeebleel state, by reason of fatty degeneration. This Avas undoubtedly due to the intemperance of the man; an el'as neither the examination I made nor the statements of the coroners physician as to the evidence of the contusion showed it had been a sewere one, one that would do injury to an ordinary man, the fair inference AAras that the rupture Avas not due to the bloAAT, but to the congestion caused by his intoxication and bad temper and his struggles Avith the officers, a congestion too prolonged and too much increased by the constant struggling to be borne Avith im- punity by the weakened vessels. The grand jury elid not indict, and the policemen Avere released. Here, it appears to me, aU the evidence1 points to rupture from disease. The bloAv Avas comparatively slight, the vessels Avere diseased, the man Avas a drunkard, Avas violent anel excited, the cere- bral vessels Avere highly congested from the time of his arrest until put in a ceU, and the point of the rupture Avas in the brain substance. Had a rupture in that situation been the result of a contusion, the contusion ought to have been a more violent one than Avas shown to have been re- ceived. In deciding on these eases as to what produced the effusion, whether the violence or the disease, it must be taken into account whether the injury clone is one that Avould cause a wound sufficient to harm one in ordinary health and Avho did not suffer from the effects of alcoholism. While the general rule may be foUowed that where the injury done would not give danger to a healthy man, the rupture is from disease, it should be borne in mind that ruptures sometimes follow quite slight cemtusions, and that cases are on record to substantiate this condition. It again comes back to the same story. Adz., that the medical examiner must take into consideration all circumstances attendant upon the case before giv- ing his opinion. Wounds to the Spine.—Concussions of the spinal cord caused by blows or falls are more likely to be cases where a medical witness's ser- vices are needed in civil suits, and not such injuries as are subjects of criminal charges. It is, hoAvever, a legitimate condition for study, as in- juries may be received to the cord which are either fatal or permanent, and be the result of criminal assault, Many cases of sudden death from injury, in Avhich no appearances post-mortem are found to account for the death, might be found due to some injury to the spinal cord if it Avas taken out and examined. We have found that the brain may suffer secondarily from a bloAv upon HOMICIDE AND WOUNDS. 301 the head, inflammation, softening, abscess, and death resulting. The spinal cord is of itself a nerve center, and in construction is analogous to the brain. What, therefore, wiU cause injury in one avUI in the other, and Ave may have varying degrees of injury from contusions to the spine or indirect falls or dIoavs, Avhich wiU cause concussion and temporary disablement to folloAv, to traumatic meningitis or traumatic myelitis anel death.. The lesser of these injuries are often made subjects of suits for damages, anel many times the plaintiff is partiaUy paralyzed in one or both limbs Avith interference with the functions of the bladder and boAvels, recovering Avith Avonderful rapidity Avhen a favorable verdict has been obtained. But all are not frauds, and genuine injury is suffered from a concussion of the spinal cord. In 1879, a man AA'ho was a brakeman on a freight-train feU from the top of his car by the break- ing of a brake-head. He was picked up insensible, and Avhen conscious- ness returned he Avas found paralyzed in the lower limbs. The catheter had to lie used, and bloody urine Avas voided for some days. He re- covered the control of the bladder, the pain he had suffered disappeared, sensation and temperature were somewhat impaired in the lower hmbs, but elsewhere were normal, and he got so he could walk on crutches. He sued for the injury and recoA'ered, his injuries being considered per- manent by the medical AAdtnesses. His suit came to trial three or four years after the accident, and it Avas then I first saw the man. He had been treated in Albany, XeAv York, and Hartford, being in hospital in all these places, but his legs only recovered enough power to swing back and forth, and, aided by the crutches, carry him along at a rapid walk. He could not raise the feet high enough to step upstairs, nor could he stand without his crutches. I saAV the man daily, for two years or more, at his post of gate-keeper on the XeAv Capitol. He Avas fat and healthy, in every Avay perfectly avcU, excepting the Avant of poAver in the lower limbs. Losing his posi- tion in 1881, I lost sight of him, and did not see him again until 1891, AA'hen he came to my office on some errand, and told me he was going out shooting. His condition Avas the same as in '7G or '78, when I first examined him. He still had to use his crutches, for his legs would not hold him up Avithout them; otherwise he was perfectly weU, and with their aid he could Avalk far and fast. There Avas no symptom of fracture or dislocation of the A'ertebnu, and whether any existed of course could not be told. The case was undoubtedly a concussion of the cord with probably some hemorrhage in or about it, and the recovery was only partial. From this to severer injuries inflicted Avith Aveapons or by faUs, Avhere more direct violence is done to the spinal column itself, is but a step, and the wounding to the cord may be so severe as to cause mortal injury, either Avithin a few days or later, inflammation supervening, and complete paralysis interfering with respiration, bringing on death. The injuries may be by criminal violence or be accidental. The fact that they may occur is to be borne in mind, for the death may be an obscure one, no appearances to account for it being found on the post-mortem examination until the vertebral canal is explored, when the condition of the cord or its membrane "will shoAV why life ceased. Where dislocation of a vertebra takes place the pressure on the cord may be so severe as to cause death at once, or it may only cause paralysis, 302 A SYSTEM OF LEGAL MEDICINE. which, under treatment, may improA'e for a time and then suddenly grow AA'orse, the patient sinking into coma, and death shortly fbUowing. This may be from inflammatory products causing increase of pressure, or from the^formation of pus. This same condition may follow injuries from fract- ure of the arches or bodies of the vertebra1, cwen if after the fracture the fragments spring back into place, for the pressure AA'ould be so severe at the time of the primary displacement that the contusion sustained by the meninges or the cord Avoulel lead to effusion of blood from rupture of the vessels of the meninges, hemorrhage Avithin the substance of the cord, or subsequent inflammation of either. The cause of the fracture may either be direct or indirect—1)1oavs, fahs, crushes, or gunshot injuries all giving this result. In ls(>7 a case Avas brought into the Montreal General Hos- pital, in AA'hich I then served as dresser. The man Avas driving a load of hay under an arch, and Avas kneeling on the load. His head Avas bent. but not enough, and in some Avay not known he Avas caught by the arch ; the horses kept on, and he Avas found insensible on the top of the load Avhen the passage Avas finished. Being brought to the hospital, the diag- nosis of an impacted fracture of some of the dorsal A'ertebra? Avas made. The man suffered some slight paralysis, from AA'hich he recoA'ered, but when he Avas well and ready for discharge he had lost oaci- an inch in height, I do not pretend to account for Iioav the cord escaped severe injury, but merely state the case to illustrate the fact that severe fractures may take1 place in the back and recoA'cry follow. Fractures of the spine or seA'ere injuries to the cord are more com- mon from gunshot Avounds than from other classes of injuries. Here, the bones not being broken, Ave may also have the elirect cause of a fatal concussion, for the buUet may render such a IiIoav to the A'ertebra1 into Avhich it drives, or to the intervertebral substance, if it lodges between two of the bones, as to cause hemorrhage Avithin the cord. In the case of the man shot in the nock at Fonda, else AA'here described, the ball im- pinged upon an intervertebral disk and the man died of paralysis of the right side. What caused this, AA'hether a clot or a piece of the left lacer- ated A'ertebral artery Avent up to the brain Avith the last Aoav of blood in that vessel and, lodging in some of the vessels of the right hemisphere, caused the paralysis, or Avhether, AA'hat I think more probable, the con- cussion gave hemorrhage in the cord substance, the autopsy Avas not carried sufficiently far to decide. It Avas certain, hoAvever, no fracture had been produced, and yet the buUet undoubtedly caused the paralysis and eleath. Death may not ahvays folloAv immediately upon fracture or penetra- tion of the1 spinal canal by a bullet, although, Avhere the cord is injured by the missile, movement of the part of the injured man below the point of Avounding is generally impossible. The case of President Garth Id is one in point, and I quote its description from Ashurst's International Encyclopedia of Surgery •. "The aperture by AAdiich it [the ball] entered involved the1 intervertebral cartilage next above [the first lumbar A'erte- bra], and AA'as situated just beloAV and anterior to the intervertebral fora- men, from AA'hich its upper margin was about one fourth of an inch dis- tant. Passing obliquely to the left and forward to the upper part of the body of the first lumbar vertebra, the bullet emerged by an aperture, the center of AA'hich Avas about half an inch to the left of the meehan line, and which also involved the inter\rertebral cartUage next aboA'e. The HOMICIDE AND WOUNDS. 303 cancellated tissue of the body of the first was much comminuted, and the fragments were very much displaced. Several deep fissures extended from the track of the bullet upward into the lower part of the body of the twelfth dorsal vertebra. Others extended downward through the first lumbar vertebra into the intervertebral cartUage between it and the second lumbar vertebra. Both this cartilage and the next above were partly destroyed by ulceration. A number of minute fragments from the fractured lumbar vertebra? were driven into the adjacent soft spots. On sawing through the vertebrae from behind, a little to the right of the median line, it Avas found that the spinal cord was not involved by the track of the missile. The spinal cord and other contents of the spinal canal presented no abnormal appearance. The fractured spongy tissue of the vertebra* was suppurating. The missile was lodged behind the pancreas. Secondary hemorrhage from the splenic artery had super- vened, causing death seventy-eight days after the infliction of the wound." And Avhen the bullet cuts the cord death is not immediate, but may be deferred for some weeks. Immediately all power of motion is lost if the cord is divided below the point of injury, and the injury, causing paralysis, proves fatal from varying causes. The digestion may be so impaired that death is due to this, or asphyxia from interference with the muscles of respiration; or exhaustion from bed-sores and loss of functions may be the immediate cause of death. The bullet, where it has cut through the body of a vertebra, will be more or less upset, It may still be measured, for part will probably retain the circumference, anel so alloAv of determination whether it could have been fired from the Aveapon with which the assault is aUeged to have been committed; and the same remarks as AA'ere made when speaking of the Billings case, con- cerning the care with which the bullet should be examined, are equally applicable AA'here a wounel of the spinal column is made by a baU. Facial Wounds.—UsuaUy wounds of the face give deformity, and this may become a question the medical expert has to pass upon; for if an assault is claimed and the wound healed, the question of whether such a wound as is said to have been received would leaA'e the mark in evidence will be asked of the physician. And the results of apparently trivial wounds are matters to be carefuhy consielered. The injury re- ceived over the orbit may be but a smaU lacerated and contused Avound, but the supraorbital nerve may be in Avowed in the bruising, and traumatic neuralgia develop, converting a simple wound into one of serious nature. The eye itself is protected by being placed in a deep socket, which is surrounded by a strong ring of bone, and when a bloAv is struck upon the eye the ball is pressed by the muscles of the lids as far back into the orbit as possible, nature taking this mode of protecting the organ from injury. A penetrating Avound of the orbit, hoAArever, may be a fatal one, for while the external bone forming the cavity is strong and thick, the plates lining it are thin and easily pierced. The roof of the orbit, the orbital plate of the frontal bone, is so thin as to be translucent, and any instrument which can penetrate the soft parts can also force this plate. In this Avay injury to the membranes of the brain, or to the brain sub- stance, may be received, and Avhile not ahvays proving fatal at once, is liable to give from inflammation not only cause for alarm, butbe the cause of death. And even if the orbital plate be not pierced, the inflam- mation and suppuration of the tissues around the eyeball may foUow 304 A SYSTEM OF LEGAL MEDICINE. into the brain along the course of the optic nerve. All wounds, there- fore, involving the orbit are serious ones, and if the wound is deep, dan- gerous. Wounds of the nose, if it is fractured and the arch is broken, result in deformity. When the fracture does not destroy the integrity of the arch, there may be no deformity, and no opinion could be given as to the IiIoav or character of the injury. In the case referred to of the gentleman injured when riding to hounds, the nose Avas broken by the hat being forcibly driven doAvn upon it. Crepitus could distinctly be felt after the injury, but as the septum Avas not crushed no deformity resulted. Pen- etrating Avounds of the nasal cavities may lead to serious results, for the upper passage leading to the ethmoidal and sphenoidal cells may partici- pate in the inflammation and suppuration, and as the ethmoid is of paper-like bone, the spread to the cranial meninges is not difficult. The instrument making the wound may go into the brain and wound it pri- marily, causing either sufficient hemorrhage to give compression, or sup- purative inflammation. Incised or lacerated Avounds involving other portions of the face, aside from the deformity they leave, are not more dangerous than wounds in other parts of the body, and they may vary in extent as far as the size of the face aa'UI permit, One involving the cheek and cutting across Steno's duct, AA'hile not more dangerous, is more serious, the difficulty in prevent- ing a fistula resulting complicating the wound. Gunshot Avounds in the face, if not fatal by penetration into the brain, are usually followed by great deformity, especially if the baU has torn through bone. They are dangerous wounds, if of any extent, but not necessarily fatal, although other results than the deformity are to be ex- pected. The concussion may be so severe as to impair the brain, and the patient never recover the former condition of that organ. Or by reason of loss of bone, mastication be interfered with, bringing Avith it disar- rangement of the digestion and its attendant evils. The sight of one eye may be lost and the other injured; the special senses may be affected, the sense of smell being killed, and hearing in one or both ears destroyed by injury to the Eustachian tubes or obliteration of the external meatus by cicatricial tissue. The speech may be changed by loss of bone or wounds of the tongue, so as to make intelligible conversation almost an impossibility; the lower jaw may be anchylosed on one or both sides, in- terfering with mastication; deglutition may also suffer from the loss by suppuration following these Avounds; and these facts must all be taken into account in giA'ing an opinion as to the severity of an injury of this nature and the permanency of the effects. Wounds of the Neck.—Commonly these are incised, and more fre- quently suicidal than homicidal. In suicidal wounds the cut is generaUy slanting, from left to right and from above down. They are not invari- ably fatal, for persons cutting their throats are apt to carry the knife too high, and thus strike the hyoiel bone instead of severing the "jugular," the point aimed for. Unless the suicide is determined, a missed fatal cut may not be followed up, the pain of the first effort deterring from a second, and bringing the actor to a sense of what he is doing, and at the same time to a desire for life. The difference between wounds self- inflicted and those for the purpose of homicide has been already dwelt upon. The murderer cuts to kill, and is more apt to use greater force HOMICIDE AND WOUNDS. 305 than he who seeks his OAvn life, and the wound wiU give evidence of this fact. Then also the cut is as often from right to left as vice versd, and proof being aelduced to show the deceased was right-handed, would give suspicion of murder rather than suicide. Stab-wonnds depend, of course, upon Avhat the Aveapon divides as it is driven in. If the bloAv misses its mark by the assaUed turning or from whatever cause, a slight Avound may result, the knife only passing through muscular tissue Avithout severing any vessels, trachea or oesophagus. These wounds are almost ahvays homicidal, and from their position, on right or left side, struck probably from behind or in front. The eA'idence of the Avound will lead the medical examiner to the conclusion of the as- sailant's position. They are dangerous Avounds, and if dividing the large vesseds, almost immediately fatal. When the weapon is driven with sufficient force and by chance takes the proper direction, the spinal cord may be severed, the blade passing betAvc'en two vertebrae. In such case the assailed drops at once, for if not instantly killed, he is instantly par- alyzed below the section. When the wound is from a bullet it is generally fatal, especially if the shot is from the front, as in this position there is more chance of its cut- ting vital parts. If, hoAvever, the baU passes only through the muscle, say, for example, the sterno-cleido-mastoid. the wound is not a dangerous one; but if it approaches nearer the median line, the danger increases the closer to the center it comes. If the patient survive the shot, per- manent injury may result, for where it is in the loAver part of the neck some of the cervical plexus of nerves may be cut through, and more or less paralysis of the upper extremity of that side follow; for, as stated before, a bullet kills the tissues it plows through, disintegrating them by the force with which it is driven, and a nerve severed by a ball does not heal again as one divided by a knife. By injury to the Avindpipe or gul- let deglutition and respiration may be permanently impaired, and these probable results must be taken into account in deciding upon the danger of the wound and the extent of the injury. Wounds of the Chest.—Superficial wounds of this region require but little if any attention, for unless the wound penetrates the cavity the danger is small. Hence, contusions are, however, more serious, for from them fracture of the ribs or sternum may take place, or rupture of inter- nal organs. When speaking of fractures, the break of a rib from direct Aiolence was stated to occur opposite the point of the contusion, and here the danger is that the fragments are apt to be driven in by the force used, perforating the pleura, if not the lung itself. In such a ease em- physema may follow, or inflammation of the tissue injured. On Christ- mas, 1S71, there was brought into the surgical wards of the Brooklyn Citv Hospital, of AA'hich I then had charge, a young man avIio Avas found by the police insensible and injured. Examination showed a long list of Avounds, and among others fractures of two ribs of the left side. The general injuries comprised lacerated Avound over left eye, punctured wound behind left ear and on left cheek, fracture of left clavicle, scapula, and ribs, dislocation of right clavicle from the acromion, dislocation of the cartilages of left ribs from sternum, frozen hands and frozen feet. The evidence1 of the injuries showed the man, while lying on his right side, had probably been jumped upon, for all the direction of force Avas from left to right." The fractured ribs had punctured the lungs and em- 306 A SYSTEM OF LEGAL MEDICINE. physema began, but did not spread further than over the left breast, and a httle on left side of the neck, for traumatic pneumonia developing, the in- flammation shut up the puncture through Avhich air was escaping. De- spite these serious injuries anel the opeuations on hands and feet that had to be performed to remove the frozen fingers and toes, the man made a good recovery. The heart as avcU as the lungs may be injured by a broken rib, and Avhen so, a fatal result is to be expected. When the Avound is to the lungs, the first element of dangvr is from bleeding. The force of the 1)1oav, AA'hile it may not fracture a rib, may rupture a lung, and death from hemorrhage folloAv. And such an injury may also be clue to a fall or to a crush, Avhere great Aveight may pass over the body, such as a carriagc-Avheel. If the Avound is from a Aveapon, a knife, for instance, the injury to the lung may be comparatively slight, and yet eleath ensue; for these Avounds bleed more than their extent ap- pears to Avarrant, and Iioav much blood is being lost cannot be determined, the blood running into the pleural cavity rather than out of the external Avound. If the stab divides one of the larger vessels, then the patient generally sinks rapidly; for, as shown in the autopsy on the body of Woods, the blood may fih the entire side of the chest cavity, compressing the lung to its smaUest circumference. If air can escape from the wound, the diagnosis of the deeper wounding involving the lung is made by bub- bles being mixed Avith the blood; the blood is frothy. While Avounds to the parietes are generally of little danger, gunshot injuries may leaA'e such conditions as cause a positive crippling of the patient, especiaUy where the missile tears more substance than a simple bullet Avould. The sequeke may be a contracted condition of the chest Avails, impairment of respiratory movements, pleuritic inflammations with adhesive exudations, and cough and pain follow, to shorten the days of the sufferer. If the baU or shot penetrate the chest cavity, the fatality is much greater, and generally the person shot surA'ives but a short time after receiving the wound. The Surgical History of the War of the Rebellion gives, hoAvever, instances in which wounds of this character were recovered from, Avhere ordinarily it would be considered the inju- ries Avere fatal. Private Charles P. Betts was struck by a three-ounce grape-shot at the battle of Fredericksburg. The sternum was commi- nuted at the bend of the third rib, and the costal pleura torn through. The arch of the aorta and its pulsations could be plainly seen through the Avound. The man recovered, but in 1872 reported the wound was not perfectly healed, the left lung weak, and that he suffered somewhat from dyspnoea, In 1864 Private Steele was wounded by a round ball which entered upper part of sternum and lodged under left scapula. He recovered, but Avith permanent interference Avith motion of the arm and Avith hemor- rhage of the lungs. This condition AA-as reported in 1869. A remarkable case Avas that of Lieutenant-Colonel Lewis, who Avas Avoundeel at Port Hudson in 1863, by an iron grape-shot weighing half a pound and being an inch and a half in diameter. The shot entered just above the right clavicle, fractured that bone, passed downward through apex of lung, passed out of chest about third dorsal vertebra, breaking the ribs, and lodged under the skin on the left side of the spine near the fifth dorsal vertebra, from whence it Avas removed. This man recovered, but the wound was not healed for a year, and several pieces HOMICIDE AND WOUNDS. 307 of bone had to be removed. Air could be blown out of both wounds of entrance and exit until they closed. In 1865 he was reported by the pension examiner as having his right arm very weak, some cough at times, and a gooel deal of tenderness on right side of chest. These cases could be multiplied many times, but they are sufficient to caU the medical examiner's attention to the fact that Avhile such AA'ounds are highly dangerous, they are not necessarily fatal, and it further again emphasizes the fact that care must be exercised before pronouncing in- juries necessarily ones from Avhich death must result. Wounds of the Heart.—BIoavs or seAere contusions may rupture the heart the same as rupture may occur in the lungs. The death is caused by two factors: one, the bleeding; and the second and more potent, the hydrostatic pressure of the blood, preventing the movements of the heart, for the rupture does not involve the cardiac sac, and it being inelastic, the blooel exerts so much pressure the heart cannot Avork. Pressure from ve- hicles or weights on the chest may cause rupture, and it may also come from natural causes or disease. Severe pressure is there- fore to be carefully looked after, for while no appar- ent injury is to be seen ex- ternally, we may haA'e a le- sion AAdiich avUI cause death as a result of the sustained force. Like every other class of wounds, exceptions are found, and these serve but to enforce the meaning of the proverb, " What's one man's meat is another man's poison." I remember a case which AA'as brought into the yard of the old Xew York Hospital in 1869, AA'hen it was on BroadAvay. I was serving as a substitute on the surgical division, and happening to be alone, Avas called to see a patient just brought in by the police. Going down to the yard, I found a man lying in a push-cart, insen- sible, very pale, anel evidently suffering from shock. Asking the acci- dent, the'officer stated that the man had been pushing his cart along Broadwav when he was knocked down by an omnibus and run over. The mark of the Avheel was plainly to be'seen on the patient's clothes, and the track extended from the right hip to the left shoulder, passing directly over the heart. Xo fracture could be found. I went to report the case to the superintendent and get the order for his admission. Fig. 72.—1, Right ventricle; 2, left ventricle; 3, right auricle; 4, left auricle: 5, pulmonary artery; 6, right pulmonary artery; 7, left pulmonary artery; 8, liga- ments of'the ductus arteriosus; 9, arch of aorta; 10, superior vena cava; 11, arteria innominata; 12, right subclavian vein; 13, right common carotid artery and vein; 14. left vena innominata; 15, left carotid vein and artery; 16, left subclavian vein and artery; 17, trachea and windpipe; 18, right bronchus; 19, left bronchus; 20, pulmonarv veins; 21, superior lobe of the right lung; 22, middle lobe; 23, inferior lobe: 24, superior lobe of the left lung; 25, inferior lobe. (After Taylor.) 308 A SYSTEM OF LEGAL MEDICINE. When I left, the man was stiU insensible. When I returned, after an absence of about six to ten minutes, I heard a shout of laughter in the yard, and there Avas the man on his feet and using language more forcible than polite, at being detained until "some fool doctor" would let him go, and he not hurt. He Avent, pushing his cart before him, nor did he thank the policeman who had pulled him out from his dangerous position, or the " fool doctor " AAdio tried to make a patient of him. When the AA'ouneling is by stabbing, it is usuaUy instantly fatal. The shock and the hemorrhage both bring about the result. But the stab may be by a small-pointed instrument, or the point of the knife may wounel the muscular tissue of the heart without penetrating the cavities. In such case death may be deferred for some days, and be due to inflam- mation caused by the wound. A small puncture may bleed but little, and only as the contraction of the heart allows the muscular fibers to come into the position in Avhich they Avere at the moment the stab Avas received. This bleeding may continue for some time and death folloAV. Gunshot wounds of the heart are almost ahvays instantly fatal. It is not the iiiA'ariable rule, for, as shoAvn by the Woods case, the injured man may use violent muscular action even when a bullet of large size has gone through the heart, and live three days. The Avound in this case was through the right auricle. If the A'entricles, one or both, are pene- trated, it would be more probable to cause death sooner than where an auricle was injured; but the fact is established by more than one case that a bullet may wound the heart and the person hve for some time, varying from hours to days. Wounds of the Diaphragm.—When these are from gunshot or stabs, the organs lying either above or below are more or less involved, and death is due to the injuries beyond the diaphragm, its Avound being com- paratively unimportant. When, however, the wounding is a rupture of the muscle caused by contusions or falls, the condition is altered. Here the danger is from the complications that are apt to take place, for the torn muscle itself bleeds but little, and with as perfect rest as can be given would heal readily. The danger comes from what is known as phrenic hernia, as the passage through the opening made by the rupture of some portion of the abdominal contents is termed, and as the Avound heals strangulation may supervene and be the cause of the death, even though over a year has elapsed since the receipt of the injury which caused the rupture. The history of the case would have to be carefully gone into by the medical examiner before he could give an opinion that the hernia was due to the injury under investigation. Wounds to Abdominal Walls.—Blows struck on the abdomen do not usually show ecchymosis. While the yielding character of the ab- dominal walls aUoAvs of their escaping a good deal from the effects of a blow, the injury, nevertheless, may be most serious, for this very yielding aUoAvs the force of the blow to'be expended on the deeper'tissues or the contents of the abdominal cavity. The blow may lie folloAved by peritonitis or by rupture of liver, spleen, stomach, or intestines; or it may be instantly fatal by shock, the concussion being to the solar plexus. In this case no trace post-mortem Avould be found, and the IiIoav even coiUd be a light one. Professor T. G. Thomas, of XeAv York, used to relate a case where, in coming out of the theater, some young men Avere indulging in rather boisterous play, and one bending'another quickly HOMICIDE AND WOUNDS. 309 over his arm, tapped him a sharp blow Avith the disengaged hand on the stretched abdomen. The bloAv alighted over the solar plexus, and, to the horror of him striking, his friend Avas immediately killed. In a fight, a blow may be seen struck and the recipient faU dead. If the medical ex- aminer finds nothing on holding the autopsy to cause the sudden death, he can testify that a shock to the solar plexus will cause death, and the post-mortem examination give no eAddence to support or disprove the statement. The absolute absence, however, of any other reason or injury to other organs will add Aveight to his testimony, evidence of the blow being present. Wounds to the Liver.—The hver, by its position and structure, is peculiarly liable to suffer rupture from violence done to the abdomen. Or, like ah the other or- gans, it may be injured by a faU. The contusion causing the rupture may not give external evidence of its infliction, and the patient after receiving the blow is able to Avalk and may com- plain of only pain and weak- ness. This condition is, how- ever, only found when the rupture does not involve the large vessels, for if the vena cava is also torn, death is al- most immediate. The rupt- ure of the liver itself does not bleed rapidly, death fol- io Aving the injury in from one to two elays, or it may be earher. Cases are reported where the patient has lived longer, but the general rule is that death takes place Avithin about forty-eight hours. The liver may be involved in other wounds, such as a stab either from above or below. If death is from the wound to the liver, and its large blood-vessels are not involved in the cutting, it foUows much the same •course as in rupture. In the case of Mr. Haelley, the stab did not involve the liver, but the sharp end of the cartilage of the rib, becoming depressed and eroded by the action of the suppuration, caused the lesion of the hver, and the in- flammation was only prevented from infecting the peritoneal cavity by the adhesions Avhich had formed between the hver and parietes. It has been seen in two cases quoted that gunshot wounds of the liver apparently had but smaU effect upon the wounded, and in neither case was the evidence post-mortem that death was due to the hepatic injuries. In both cases the wound was by pistol-ball, and in the case of Hess the man did not live long enough for any inflammation to start in the liver as the result of the bullet's passage. In the case of Woods, while he lived three elavs after the shooting, the hepatic wound showed merely the red hne of the ball's track, and union Avas taking place. There was no evi- dence of bleeding having followed the bullet. Naturally, if a lacerating gunshot wound, such as would be made by a shotgun, was inflicted m Fig. 73.—The liver: 1, right lobe; 2, left lobe; 3, lobus caudatus; 4, lobus Spigelii; 5, lobus caudatus; 6, longitudinal fissure; 7, pons hepatis; 8, fissure of the duct: 9, inferior vena cava; 10, gall-bladder; 11, transverse fissure. (After Taylor.) 310 A SYSTEM OF LEGAL MEDICINE. the hver, it would be fatal, and probably immediately so; but here the shock would be much greater than from a single baU, and this might have to do with the death before the Avounding of the liver Avould have time to exert much influence. Again, such a AA'ound AA'ould cause much greater hemorrhage than a pistol-bullet, and death might be due to this. The spleen may be considered in the same way the liver has been, as affected by the same class of injuries, and causing death in the same manner. Both glands are so near alike in general character as regards injuries, that the description of wounds to one is equally applicable to Avounds of the other. Wounds to Kidneys.—Concussion may rupture these organs either to such an extent as to cause a fatal result, or slighter injuries ensue, from Avhich recovery take s place. In 18M9 a horse-car driver was vio- lently throAvn from Ids car by collision AA'ith a railroad engine. He was dazed by the fall, but after coming to his senses got on to another horse- car, went to his doctor's, walking a block after leaving the car, then AA-ent back in the same Avay to near the place where the accident occurred, and again leaA'ing the car, Avalked to his home, about three blocks distant, and AA^ent to bed. He Avas assisted by two men Avhen Avalking. That night and for three days afterward he passed bloody urine. After that time the blood gradually disappeared until it was entirely gone, about a Aveek or ten days after the injury. There was undoubted rupture of a kidney in this case, for there was no injury to the bladder, no wounding which would cause bleeding, and in no other Avay could the blood in the urine be accounted for. And yet eAren Avith this ruptured kidney the man walked some distance. Cases are reported where persons suffering from ruptures which eventually caused death Avalked after the receipt of the injury, and gaA'e at first no symptoms of such serious Avounding. Wounds of the Stomach and Intestines.—These organs may be ruptured from external violence in the same way as the foregoing, although ruptures from disease, from ulcers which have existed some time, are more common. The injury is one generally quickly fatal, and is characterized by shock and pain. The contents of the viscera escape into the peritoneal cavity, but usually there is little hemorrhage unless the rupture has involved a vessel. When the rupture is from disease, the microscope would aid in determining the fact, as it would show on some part of the rent the presence of the ulcer. And unless the body was found dead, or under such circumstances as to cause doubt of the manner of the eleath, the history of the case would answer the question of criminal interference. Stab-Avounds have the same effect as ruptured ones, with the added injury of the entering wound through the parietes. Death in such cases may be due to the shock and escape of the contents, or to these combined with bleeding. Even though a serious rupture may be present in the stomach, the patient may Avalk some distance and fatal coUapse not ensue for some hours. This is also true of ruptures of the intestines. I am indebted to Dr. W. G. MacDonald, of Albany, for the following case : In 1893 a man of thirty-six years of age, strong and weU, Aveighing about one hundred and forty pounds, a junk-dealer by occupation, engaged one Sunday morning in a wrestling bout Avith a friend AA'ho Avas a heavier man than himself, one weighing about two hundred pounds. They used what is caUed the "back hold," that is, each put his arms around the HOMICIDE AND WOUNDS. 311 other, the hands being clasped behind the adversary's back, and then each endeavored to throAv the other by sudden side wrenches. WhUe struggling and tugging the hghter of the two said, " Let go, I am hurt." He complained of pain in his right side, and sat down for a little Avhile on a bench in his shop, where the wrestling took place. The pain did not lessen for some few minutes. Then, feeling a little easier, he started for his home, walking four blocks to the electric cars, in AA'hich he rode about half a mile, and then Avalked a block and a half to his home. The doctor was sent for, but did not see the patient untU six o'clock in the evening, some three or four hours after the wrestling. When the physi- cian arrived the man was sitting up. His piUse was fifty-four per min- ute, but no rise in temperature. Considering he had to deal with mus- cular strain, the doctor ordered morphine and hot-packs. BetAveen two and three o'clock Monday morning the patient vomited, but no alarm was felt by the family until near seven o'clock, when symptoms of col- lapse appeared. The doctor Avas summoned, and in company with Dr. MacDonald, who had been called for consultation, he reached the house at nine, to fine! the patient was dead. The autops}- showed no external lesion of any kind. All the organs were healthy, and no signs of disease were found. On opening the abdomen, extravasation of faeces stained Avith blood was found in the peritoneal cavity. Xo clots were seen. The whole peritoneum was congested, and freshly effused lymph Avas present. The intestines were matted together. The effusion was like that of hemorrhagic peritonitis. Fifteen inches above the ileo-caecal Aratee, in the wall of the ileum, was a rupture five eighths of an inch long by three eighths wide, the long diameter being transArerse to the gut, About one and a half inches below the rupture, nearer the caput coli, was an ecchymosis in the intestinal wall the size of a tAventy-five cent piece. This ecchymotic effusion was in the muscular layer, and section showed it to be a fresh bruise. The intestines Avere very fuU of fasces. Careful examination of the rupture showed no sign of inflammatory process around the edge of the rupture, and noAvhere in the intestinal track was there any point where an ulcer was beginning or had been. The position of the rupture, the history of the case, and the fact that solitary ulcers of the small intestines do not occur, shows this case to have been a rupture from exertion, and, it may be, aided by strong press- ure from the outside, for in the position the arms of the two men were in while Avrestling, the forearm of his adversary Avould compress the abdom- inal parietes just about opposite the position of this rupture. And this outside pressure Avould not be light, but at the same time it Avould not be like the force of a blow, as it AArould be a sepieeze or hug. Taking into consideration the full condition of the intestines, the pressure exerted from AA'ithin by the diaphragm and from Avithout by the arm of his ad- versary, the rupture was clearly due to the straining, and took place at the moment he called out, " Led me go, I am hurt." And notwithstanding the pain and the shock to the peritoneum of intestinal contents being poured out into it, the man Avalkecl five and a half blocks, rode in a street-car haU' a mile, sat up for an hour or more before the doctor saAV him, and gave no symptom of being mortally hurt untU tAvo hours before his death. On July 10,1878, Avith suicidal intent, T. B., a prisoner in the Albany County Penitentiary, inflicted AA^ounels upon himself Avith a knife he had 312 A SYSTEM OF LEGAL MEDICINE. made out of the steel of a woman's gaiter, the blade being three eighths of an inch wide, two long, thick, pointed, and well ground. The case was reported by Dr. Samuel B. Ward, of Albany, who saw the patient with the penitentiary physician, Dr. H. R. Haskins. The man Avas serv- ing a thirty years' sentence for counterfeiting, and at the time he at- tempted self-destruction Avas undoubtedly suffering from mental aliena- tion. He did the cutting at night in his ceU, and was not found until the morning. The doctor was sent for, and found the man exsanguinated, Avith no pulse at the left Avrist and very little at the right. B. had made an attempt to seArer the right carotid, had cut his abdomen and the left brachial about an inch above the elbow. The doctor found a wound one and a quarter inches long over the left brachial, but the artery Avas not in sight; a wound in the abdominal parietes Avhich extended for seven inches, beginning a little to the left of the umbilicus and ending at the ensiform cartilage, through which protruded the stomach, large and smaU intestines, with omentum, gashed in several places, and fecal matter Avas on the skin, the viscera having been further cut after protrusion. The intestines were cold and dry, somewhat adherent, and had fuzz from the blanket which lay over the man sticking to them. Being apparently moribund, the parts were merely wiped dry with the handkerchief, and after an hour returned to the abdominal cavity, immediate efforts at re- duction being prevented by severe hiccough and pain. The wound was closed by eight stitches, not through the peritoneum, and broad bands of adhesive plaster were passed around the trunk. The wounds in the neck and arm, bleeding having ceased, were brought together with plaster only. The man Avas kept under the influence of morphine, and after forty-eight hours Avas removed from his cell to the prison hospital. For four days he did not raise his head or move hand or foot. At the end of that time the stitches Avere remoA'ed, the wounds having nearly healed by first intention, about an inch of the abdominal wound being still open at top, but healed at the bottom. The pulse was always below a hun- dred, and the temperature never notably increased. Morphine was dis- continued on the eleventh day, and the bowels moved voluntarily on the fourteenth day after the wounding. Dr. Ward states that by the 27th of the month a firm cylindrical mass could be felt where the left brachial was wounded, Avith pulsation in the artery two inches above and also at the left radial, as coUateral circulation had been established. The pris- oner was returned to duty Xovember 1st. About a year after this attempt B. made another, this time by cutting his throat. Dr. A. Yander Yeer, of Albany, saw him, in consultation with the prison physician, Dr. W. H. Murray, and reported that the cutting had been done Avith very much the same sort of knife as was used in the first instance. This time, however, two knives were used, one in each hand, and the cutting done both ways. The trachea Avas completely severed, the oesophagus cut into, and severe hemorrhage Avas present from both superior thyroids, which the doctor ligated. The wound in the oesophagus was closed AA'ith fine silk stitches, that of the trachea Avith silver AAdre, the external Avound carefully adapted, and good drainage secured. B. again recovered, and recovered not only from his Avounds, but also his mental balance. He was pardoned by President Cleveland in 1887, and at that time was in excellent health, his former Avounds giving him no trouble AA'hatever. HOMICIDE AND WOUNDS. 313 This case is truly remarkable, and shows what a human being can stand without loss of life. It is, however, more than probable that it is one of those cases AA'here " the exception proves the rule," for the injuries inflicted in either case Avould ninety-nine times out of a hundred be fatal. Still, it is just such cases that are most useful to the medical jurist, for he has to give opinions upon not only how wounds cause death, but whether they are the only and absolute cause; and cases like the above impress caution and the greatest of care in the post-mortem examination to see that nothing escapes notice which could in any Avay, even the slightest,, have an effect upon the vital forces. The injuries done the intestines were done after they had come out of the body. Xo mention is made of their extent, or Avhether any attempt was made to close their Avounds. The man was so nearly dead and the wounding was so extensive that at the time he Avas seen the doctor considered there Avas no possible chance of his liv- ing, and it was only a question of time Avhen he would die. Precautions were not taken, therefore, as to cleansing the intestines : these were merely Aviped dry and returned to the cavity. To compare this with the case of Dr. MacDonald's is to call attention to the great distance which lies between the cause of death in one man and the vital- ity and power of resistance to injuries in another. Gunshot wounds of the intestines are usuaUy fatal. Where the wounding in- volves the abdominal waUs alone without puncture, if there is but little laceration no marked trouble may be expected; but if much loss of substance follow the in- jury, hernia may be a sequence, the cica- trix not being strong enough to control the viscera. From penetrating wounds the danger is hemorrhage, with escape of the intestinal contents, as in the case of BedeU, shot by Hess. If the large blood- vessels are cut by the ball, death would be rapid, and the bullet may lodge in the spinal column in such Avay as to cause in- jury to the cord and paralysis of all below the'point of its contact. Balls have lodged in the abdominal cavity and the patient recovered Avithout any bad effects. When the buUet passes in and out, traversing the large intestine, a false anus may result. Lieutenant Boric, of the navy, was severely wounded at the at- tack on Fort Fisher during the War of the Rebellion. The ball traversed the left side of the abdomen, cutting the descending colon. For three months and over he passed the faeces through the wound. Eventually recovering, he returned to duty. In December, 1867,1 was returning Fig. 74.—a, Stomach; b, oesophagus;. c, cardiac end of stomach; d, pyloric end of stomach; e, pylorus; /, duode- num; g, jejunum; li, ileum; i, vermi- form appendix; k, csecum; t, m, n, as- cending, transverse, and descending colon; o, rectum. (After Taylor.) 314 A SYSTEM OF LEGAL MEDICINE. from Rio de Janeiro, and on the same ship Lieutenant Borie took passage, going home on sick leave. He had been attached to the South Atlantic squadron, but coiUd not stand the effects of the hot Aveather, it seemingly affecting his old Avound, causing paroxysms of pain Avhich rendered him unfit for duty. His state-room being next to mine, I had full chance to observe his condition, and noticed Iioav he suffered AA'heneA'er the heat in- creased. As soon as we ran into cooler latitudes his condition improved. He stated that this had happened eA-er since his recoA'ery, and Avhile he felt no inconvenience from his wound Avhen in cold climates, as soon as he Avas exposed to constant and high temperatures the pains came on, rendering him Aveak and absolutely unable to stand or AvaUc. Shot Avounds of the smaUer intestines are much more dangerous than those of the large, and the injury to the colon is less dangerous AAdiere it is to the descending than to the transverse or ascending portions. In the Medical and Surgical History of the War of the Rebellion but five cases of bullet wounds to the small intestines are reported as having recovered, and these are given Avith caution as to the fact that the intes- tines had really been implicated in the Avounding. The medical examiner can, therefore, in making his statement as to the danger to life of a pen- etrating gunshot wound of the abdominal cavity, gauge someAvhat the amount of danger by the probable course of the ball, and by knowing also the character of the Aveapon Avhich fired the bulled. Wounds of the Bladder.—This viscus may be injured in the same way as others, by blows, falls, incised or gunshot Avounds. When the rupture is due to a bloAv, kick, or other contusion, it is usually fatal from peritonitis folloAving the escape of the urine. These ruptures, from whatever cause, are most dangerous Avounds, and the prognosis is neces- sarily unfavorable. If the extravasation does not pass into the peritoneal caA'ity, the chance of recovery is greater than in the contrary case, for the abscess consecraent upon the presence of the urine in the tissues may be relieAred by surgical interference. Should the diagnosis of rupture be made and of effusion of urine into the peritoneum, early laparotomy might increase the chance of recovery and certainly Avould he justified, for that the rupture would close spontaneously or that peritonitis would not be excited by the escaping urine are matters too conjectural to rely on, and surgical aid should be rendered, even though it carry with it an element of danger from the operation. While this is Avhat the surgeon is called on to do, it may materially affect the case in court should the rupture be due to criminal A'iolence, for the defense Avould justly emestion AA-hether the death of the patient Avas not due to the operation and inflam- mation foUoAving it, rather than to the rupture whose production Avas charged to the prisoner. The surgeon, of course, cannot hesitate, his duty being to save life if possible; and the operation gteing a chance greater to the patient than the almost positive condition which Avould folloAv the rupture, he should give the patient the benefit of that chance. Rupture takes place when the bladder is more or less distended and AA'hen it is the result of blows no mark of injury or ecchymosis may be apparent. This is for the same reason as was noted A\diere other viscera suffer rupture from contusion, the yielding parietes aUoAA'ing the force to pass on inward. Bullet Avounds are not as dangerous as incised or rupt- ured ones, and a fatal issue may not follow them bv peritonitis until the wounds in the AA'aUs of the bladder slough. Out of one hundred and HOMICIDE AND WOUNDS. 315 eighty-three cases reported during the Civil War, eighty-seven cases of recovery took place, and no cases of rupture from blows or Adolence were reported at aU. WhUe the pain caused by all wounds of the bladder is severe, and in case of rupture Avith extraArasation of urine the person ex- periences a sinking feeling, movements are not incompatible AA'ith the injury, and the wounded man may Avalk after its receipt. This fact pre- vents the defense from claiming absolute inability of motion on the part of the assaUed as a proof that the rupture did not follow the assault. Wounds of the Genitals.—In homicidal wounding by men, the gen- itals are not often if ever attacked, for the object of the assaUant is easier gained by assaulting other parts. Accidental Avounding from bullets, or even criminal wounding Avhere the aim of the offender is poor, may take place. Kicks or bloAvs, also, are reported as affecting these parts, but the generality of cases are in women. A severe bloAv on the A-iitea may cause laceration so sharply defined as to appear like an incised wound, and the danger is from hemorrhage, the parts being so A'ery vascular. Unless in the insane, incised Avounds of the genitals are indicative of homicidal intent, for accidental cutting is most rare, and the fact of a clean cut being found in the labia would be sufficient to arouse suspicion of an assault. Contusions or cuts made after death Avould be knoAvn by the fact of bleeding not having folloAved their infliction, for the autopsy would shoAv the effect of profuse hemorrhage of other organs, and this condition woiUd not be present if the laceration was made after death. A year or two since, in New Hampshire, a man named Almy killed a girl by putting the muzzle of a pistol into the vagina and firing a shot. He was seen to commit the deed, and the post-mortem examination con- firmed the statement of the Avitnesses. He Avas convicted and executed. Here Avas a Avounding of the genitals, but death was not due to it, for the ball penetrated further and caused immediate death by Avounding the more vital organs. Wounds may take place in this region by faUs, but they are compar- atively rare. The most frequent form of wound the medical jurist would meet Avith would be contusions and lacerations from kicks, and the evi- dence presented by the injury would decide against the probability of a faU being the author of it. The uterus may also be Avounded, and the injury prove fatal. The wounds produced by those performing criminal abortions have been fully treated in another portion of this Avork, and wiU, therefore, not be referred to further. Blows and kicks or faUs on the gravid uterus may cause rupture, and the escape of the foetus into the abdominal cavity. Death here Avould probably be due to the shock and hemorrhage, the autopsy revealing the condition. External marks may be absent, as is general in aU this character of injuries, but the uterine walls may show ecchymosis in the same way the intestine did in the case reported by Dr. MacDonald. The Relation of the Medical Witness in Matters other than Wounds.—It is contended by some that the medical man employed in a legal case should in no way take into consideration the bearing of any facts other than those purely pertaining to medical questions. # I cannot agree to this view, for it is considered much would be lost which Avould be of great value to the proper administration of justice, if itwas en- forced. The doctor is more than a mere witness, for while he is caUed 316 A SYSTEM OF LEGAL MEDICINE. as an expert on those subjects upon which he is supposed to have special knowledge, knowledge not possessed by laymen, and in this is an expert, experience shows he is more, for he is virtually the medical counsel. And it is no improper procedure for him to act in that capacity, for AA'hile he takes no part in the actual trial, in the examining and cross-questioning of the Avitnesses, and further has nothing to do with saying Avhat course shaU be followed iu the management of the case, he must, in the very nature of things, counsel the laAAyers how certain facts are the leading ones in the medical phase of the case, and Avhy they are so. Before being able to act in this Avay, one in Avhich there is not only no impropriety but also in which his absolute impartiality as an expert is not called in question, he must prepare himself to give an opinion which, to his mind, covers every medical feature, and to do this he must, or at least should, understand aU the circumstances connected Avith the crime, that the bear- ing they have on the relations of the autopsy and the evidence of the wounds may be fully and justly weighed. I have made it a rule to always investigate, personaUy, if it is possi- ble, the place where the crime was committed. In the Mechanicsville case this led to finding another Aveapon than the one supposed, for the height of the ceUing prevented sufficient power being given to the piece of board claimed as the weapon, the assailed standing at the time of the attack. In the Woods case examination of the house resulted in finding a buUet in a Avindow-siU, which further confirmed the evidence of the wounds, and proved the prisoner's statement to have been true. WhUe it is not necessary before holding the autopsy to examine the res gestce, after full and careful study of the body every item known to the attorney is of importance, and becomes more or less an aid to the forming of a true and just opinion of how the death was caused. The reason of the death is found in the post-mortem, generally speaking, or no cause may be revealed, in Avhich case it is all the more important for the medical Avitness to hear aU the circumstances known. In making a diagnosis of a case in private practice, the doctor asks many questions which appear to those hearing not only unnecessary but at times even impertinent. The family history is gone into as far back as it can be traced. The condition of collateral branches is asked about. The history of the patient himself is sought from the time he was in petticoats until the present, and then is added to the knowledge thus gained of hereditary influences or habits of life, the physical examination of the patient and the further inspection of the excreta. I believe it is just as obligatory upon the medical witness to study the legal case he is called to act in as carefuUy and fuUy before he gives his opinion as it is for him to do the same in the pursuit of his private business. The theory of the defense in the Hess case was self-defense. And the eridence of the autopsy as detailed by Dr. Beach would not be in- consistent AAdth the theory if the statements further made were exact, auz., that the shot was fired as J3edell broke from the men who Avere try- ing to hold him; for the line of the buUet as it traveled from the wound of entrance to the psoas muscle was such as would be made, and could probably only be made, the relative positions of both the assaUant and assailed being taken into consideration, Avith the body bent forAvard. This is a fact for the medical witness to call attention to, for his special knowledge of the relation of the parts wounded in the normal position HOMICIDE AND WOUNDS. 317 when the body is erect, and the changes assumed by them when other forces, such as the pressure of the diaphragm and of the abdominal mus- cles, are exerted, Avould sIioav to him clearly the position in AA'hich the man Avas when he was wounded, and thus the district attorney could be thoroughly informed of the entire bearing the evidence of the autopsy would have upon the case. Without the aid of the knowledge of the struggle, the medical examiner could only say the wound undoubtedly was received when the body was stooping, and he might or might not add, in A'iolent muscular action. The medical Avitness must of course be prepared to adduce the method of the crime from the evidence of the body alone, but while this could be the case and be done with reasonable certainty, doubt may be cleared and conjecture changed into fact if more understanding be had of the cir- cumstances surrounding the crime. Woods had two other wounds besides the one which entered the chest and proved fatal. Both of these AA^ounds were gunshot, both were from behind forward, but whether they were made by one shot or two was at the time of the autopsy undecided. The doctor engaged by the defense was present at the post-mortem examina- tion. Together we discussed the evidence of these two wounds, and de- cided that they could have been made by one ball or by separate shots, for the right arm by being drawn backward, the forearm being flexed, could be brought into a position Avhich would allow of a probe being passed through the wound in the arm and then to the grazing one in the side. Examination of the house showed, hoAveA^er, this buUet in the Avindow-siU. If there Avere only two shots fired, this coidd not have been the buUet which made these slight wounds, for in no way could a man be placed for the baU to act on both arm and side and have it fired from the part of the room AA'hich Briggs stood in. If, hoAvever, it had made the wound in the arm, then it could be, for if the arm AA'as Avounded independently of the side, this shot could easily have made that particular Avound. The direc- tion of the buUet as given by its position in the windoAA'-sill was proof of its having been fired from Avhere Briggs claimed he stood. And while the two lesser Avounds could have been made by one ball, if it so happened that the arm Avas placed in a certain position, it was not a position the arm would naturally assume in one running, while if the ball found in the Avindow diel this Avounding, the arm would be in precisely the extended position natural in one suddenly startled and Avho was fleeing for his life. Careful inquiry ascertained the fact that three shots had been fired. The autopsy, AAuthout endeavoring to place the limb in any particular position, gave the eA'ielence that three shots had taken effect. Had the fact of three discharges not been known, the medical witnesses might have differed on how the wounds of arm and side Avere made, and the medical testimony been Aveakened by just so much in the minds of the jury. In the Mallon case, examination of the place where the murder was committed showed by the evidence of the blood-stains in what position the body was when the shot was fired. While the jury did not convict, and despite all evidence turned the body around and placed it in such a position that the blood-stains would have had to go in the contrary direction to the force causing them, this was a deliberate act on its part and had nothing to do AA'ith the medical evidence. But Avithout inspection and a knoAvledge of other circumstances in the possession of the district attorney, confusion on points of medical testimony would again have 318 A SYSTEM OF LEGAL MEDICINE. arisen, and, judging from the A'alue the jury attached to the medical CA'i- dence, might haA-e succeeded in freeing the prisoner altogether instead of giving Mm the light penalty of manslaughter in the third degree. In the case of Thompson,'examination of the premises did not clear up the mystery of the death. If anything, it seemed rather to lead to the suspicion of homicide than to accidental death, for the absence of any point Avhere such a Avound and fracture as Avere found could be made by Thompson falling backAvard down the stairAvay gaA'C color to the more probable cause of human agency; but sufficient circumstantial proof of an incontestable character could not be found to aUoAV the physicians to state that the death Avas by murder. For the medical Avitness to know all the facts, as far as may be possi- ble, is not to bias his conclusions, but rather to help his arriving at just ones, and in this adding to the value of his testimony as avcU as to the value of his opinion on the medical bearings of the case. By neglect of this part of the Avork his testimony may not be thoroughly understood by court, counsel, or jury, and it adds another subject for counsel to try and make plain what should require no such effort. t The attention of the medical examiner to every point presented by the autopsy should be constantly borne in mind. Murders are not com- mitted as a general rule in the presence of witnesses, and many devices are sought by homicides to cover their crime and make it appear the death was suicidal or accidental. The case of Mrs. Budge illustrates this point in a strong manner. Had the doctor who was caUed first known anything of medical jurisprudence, the chances are a miscarriage of jus- tice would have been prevented. But the case shows he took no pains to even hold an autopsy. The throat was cut, a razor was found: plainly suicide. As to the evidence of the wound, the condition of the organs of the body, the question of disease or poison being present, the appearance of blood-stains, the appearance of the razor-blade, the position of the body—in short, any of the points a medical examiner should haAre con- stantly before him when summoned to such a case, he never stopped to look or reason about one of them. To stuff the throat with cotton to tiy and stop the bleeding, which, despite these efforts, continued, to sew up the wound and never ask AA'hy a corpse should bleed hours after death, was aU he seemed capable of doing. In the case of the man lolled at Fonda Avith a pistol-baU in the neck, the doctor failed to hold a complete autopsy, being satisfied with finding a cause of death. And this neglect on his part was turned to the advantage of the prisoner by his counsel, for death could have come from other causes, the wound not necessarily being a mortal one, and by the doctor's remissness no proof could be shown by the people that it did not. The autopsy on a body, where the cause of death is the subject of legal inquiry, is not a proper one unless every organ has been examined, every mark noted, eA'ery wound carefully inquired into, every morbid condition found inspected to see if death could have been produced by it; and the report made of the autopsy should show the cause of the death, and the only cause that it could come from. And where death is from a shock which Avould leave no positive signs on the dead body, the completeness and carefulness of the post- mortem examination would go a long Avay to shoAA'ing that such cause alone could be held responsible for the death, and the proof of how that shock Avas brought about Avould be for the jury to consider. If no other HOMICIDE AND WOUNDS. 319 thought actuates the doctor to thoroughly perform this most important work, the fact that a man's life or liberty may be at stake should impress him Avith the responsibUity he is assuming when he gives his opinion on the examination of the corpus dehcti, on which opinion all may depend. The eAddence of wounds is most subtle, and care is needed that no point escapes the observer. At the best, the medical witness's testimony may be but the most probable and not the certainty; but the inspection he has made wiQ enable him to decide upon the most probable, and not a number of possibihties. The autopsy is the most important part of the examiner's work, for from its reading his conclusion is first formed, to be strengthened by the attendant circumstances. The evidence of a wound, if clear and positive, is the strongest circumstantial evidence, for it points to the manner in which it was inflicted, it declares for the weapon, it shows the agency of another's hand, it proves the death was due to it, and teUs its story in the most powerful manner an inanimate object can. Without careful study and a knowledge of the effects of wounds, a medical witness would misread the evidence, and be more than apt to give an opinion which further examination would show to be based on erroneous conclusions. INOKGANIC POISONS. By C. E. PELLEW, E.M. INTRODUCTION. Definition of a Poison.—Before entering upon the main subject, it is proper to state what must be understood by the term " poison." As a rule this name is given to different substances AA'hich, when taken into the healthy human body in quantities not unusuaUy large, produce, as a general result, injurious or even fatal effects. These effects are, as a rule, due to the chemical, not the mechanical, action of the substance, although it is not uncommon to include in the list broken glass, which in some parts of the world is not infrequently used as a slow, subtle, irritant poison. It must be remembered, however, that almost aU medicines AAdien taken in excess wUl give poisonous symptoms, and, in like manner, many, if not most, of the commonest poisons are in general use, in small quan- tities, as medicines. Accordingly, the classification of any drug as a poison depends, after. aU, upon whether it has so far caused a sufficient number of dangerous or fatal results. Again, a true poison wiU be active against the normal healthy body. In Ararious diseases, perfectly harmless articles of diet may prove dis- tinctly injurious and set up characteristic symptoms; Avhile every now and then perfectly healthy people are met with who are affected by doses of common drugs, and by simple kinds of food. Thus the eA'il effects of sugar in diabetes, and of alcohol in genito-urinary diseases, are well known even to the laity; while cases of idiosyncrasy have been frequently described, where a saucer of oatmeal or a single strawberry have produced poisonous symptoms. The effects of a poison wUl vary very much according to the size and condition of the dose, the state of the system, the method of administra- tion, and many other conditions. As a rule, though not quite invaria- bly, it wUl produce injury no matter how it is introduced into the body, whether by the stomach, lungs, skin, mucous membranes, wounds, or any other way. OccasionaUy, however, a drug is met Avith, like curari, for instance, which is comparatively harmless when taken in the stomach, though exceedingly powerful when directly introduced into the blood. The effects of the various poisons differ greatly among one another. Many of the mineral poisons here dealt AAdth have a distinctly irritating, if not corrosive, effect upon the tissues with wliich they are brought in contact. As good examples of these we may mention the fixed alkalies and the mineral acids. 321 322 ^ SYSTEM OF LEGAL MEDICINE. In most cases, however, besides the local effects of the poison, there are other specific effects produced in various parts of the system by the poison, after it has been absorbed into the circulation. These may be' inflammatory changes in various organs, the hver, kidneys, heart, etc., as from phosphorus; or in the stomach and intestines, as, for instance1, in ordinary cases of arsenic poisoning; or a distinct paralysis, partial or complete, of the great centers in the medulla, as in poisoning by bro- mides, by large and soluble doses of arsenic, by ammonia and nitric acid vapor, and the like; or a slower and gradual paralysis of the peripheral nerves, as in chronic lead and arsenic cases; or some direct change pro- duced in the blood, as by potassic chlorate and carbonic oxide. Besides these there may be marked disturbances of the brain and spinal cord, principally produced by the alkaloids and kindred principles. To properly classify the mineral poisons according to their effects would be a difficult and complicated task. Hence, in the following pages they are taken up, one after the other, in a rough and simple classifica- tion, somewhat according to their physical and chemical properties. The first section will treat of the alkalies; then will come the acids, the hal- ogens and haloid salts, and phosphorus. Next I shaU discuss the metal- lic poisons, beginning Avith antimony, arsenic, lead, mercury, and cop- per. And I shaU close my treatise with a few words on the metals of less importance. I. THE ALKALIES AND THEIR SALTS. The term " alkali" is apphed to a substance possessing certain prop- erties. It avUI dissolve in water, wUl neutralize acids, avUI turn red htmus-paper blue, avUI saponify soaps, wUl have a " soapy" taste, and, when strong, wUl corrode many organic substances, including the skin and many of the tissues. These properties are possessed by the hydrates, carbonates, and phos- phates of the common alkahne metals, sodium, potassium, and ammo- nium, and also of the rarer metals lithium, caesium, and rubidium. They are possessed by the hydrates of the alkaline-earthy metals, calcium, mag- nesium, barium, and strontium, but only to a shght extent. The most powerful of these compounds are the caustic or hydrated alkalies, i.e., the hydrates of sodium, potassium, and ammonium. The carbonated alkalies, i.e., the carbonates of these same metals, whUe less active than the former, can stiU, especiaUy when impure, act as powerful corrosives when taken internally. The bicarbonates, however, of soda and potash are so mUd that their solutions can be apphed in large quan- tities, as antidotes to acids, not only upon the skin, but also internally, and upon delicate surfaces such as the face and eyes. Soda and Potash. These compounds, which are practicaUy simUar in their reactions and effects, are met Avith, as a rule, in the form of sodium and potassium carbonates mixed with some of the caustic alkali. They are in common use, both in the arts and in the household, for the manufacture of soap, and the preparation of other sodium and potas- INORGANIC POISONS. 323 shun compounds. And yet cases of poisoning by their means are ex- tremely rare, and usuaUy are the result of accident. Symptoms.—When the solutions are concentrated the victim feels at once an acrid, burning taste, which is usuaUy enough to make him try and spit the liquid out, and to wash out his mouth as weU as he can. If the solution is actuaUy SAvaUowed, there is a burning sensation in the throat, reaching doAvn to the stomach. This is usuaUy foUowed by in- tense pain, and by vomiting, first of mucus and then of blood. The lips, tongue, anel pharynx become swoUen, raw, and inflamed; the voice becomes husky, and there is much difficulty in swaUoAving. This is generaUy accompanied by symptoms of severe shock. The skin becomes cold and clammy, the pulse feeble, and the patient becomes extremely weak and exhausted, sinking often into a comatose state. Death may result from this in the course of a few hours, but the patient often recoA'ers from this only to suffer from stricture of the oesophagus and consequent inability to swaUow food, or from ulcerations of the stomach, or stricture of the duodenum, AA'hich prevent the food from being digested. In either of these cases the patient may hnger on for weeks, months, or even years, only to die a miserable death from starvation. An example of this is given by Dr. Hadden (Trans. London Pathol. Soc., 1890, vol. xli., p. 86), where a stoker on board ship swallowed, for suicidal purposes, several ounces of caustic potash. When seen a few days after, his mouth and pharynx were much swoUen and charred, and the patient was suffering greatly. At the end of a week a cast of the oesophagus was found protruding from his mouth, and when carefully removed it proved to consist of the mucous and submucous coats of the whole oesophagus and the larynx, carrying with it some of the circular muscular fibers. The patient lingered for some time, but constriction began to take place, and more and more difficulty was experienced in swaUoAving, untU the poor felloAv finally died at the end of three months. Post=mortem Appearance.—When death has occurred in a few days, the mouth, oesophagus, and stomach wUl all show extensive signs of corrosion. The mucous membranes wUl be much abraded and bloody, and the exposed surfaces raw, and often colored yellow or brown. When the patient has died from the secondary effects of the poison, the mouth and upper part of the throat may have healed, but signs of ulceration or of thickening and constriction wUl be noticed in the oesoph- agus and stomach, or in the smaU intestine. Fatal Dose.—The smaUest fatal dose on record is given by Taylor in the case of a young lady, who died seven weeks after taking one and a half ounces of the common potash solution of the shops, containing some thirty or thirty-five grains of caustic alkah. In other cases death has been reported from half an ounce or so of the dry poison. Time of Death.—Taylor mentions a case of a boy dying in three hom-s after drinking the poison, and other cases are on record where death occurred, from shock, Avithin twenty-four hours. The patient, however, may hnger for a long time, two or three cases being known Avhere death occurred after two years, and one case, quoted by Wormley from Sir C. Bell, where the patient died after twenty years. Treatment.—Where the poison has been swallowed for some minutes antidotes aauU have but little effect. The alkah should be neutrahzed as 324 A SYSTEM OF LEGAL MEDICINE. far as possible Avith dUuted Adnegar, or Aveak organic acids, or by lemon, hme, or orange juice. Some gooel can also be done by giving milk, barley-Avater, solutions of albumen or gum, and the like, and also by giving ohve-oU in some quantities, to soothe the inflamed surfaces, anel also, perhaps, to saponify any free alkali remaining. It is dangerous to use the stomach-pump AA'here the oesophagus is likely to be so corroded, for fear of perforation. Chemical Analysis.—The presence of alkalies can be best told by the soapy taste and the reaction Avith litmus or other test-paper. The carbonated alkalies can be distinguished from the caustic by effervescing Avith acids, and from the bicarbonates by at once giving a white precipi- tate Avith magnesic siUphate. To distinguish potash from soda Ave can use four different tests: (a) A moderately strong solution of potash or its salts is precipitated by a solution of platinic chloride, forming yeUow octahedral crystals of potassic platinic chloride. A precisely similar compound is produced by solutions of ammonia, so, if the latter be present, it must be removed by boding AAuth calcic hydrate, or by evaporating to dryness and ignit- ing at a duU red heat, before making the test. (b) If a rather strong solution of potash or its salts is added to a strong solution of tartaric acid, or, better, of acid sodic tartrate formed by adding a little soda to the acid, it wUl form a white crystalline pre- cipitate of cream of tartar. This is soluble in free mineral acids, and also in the free alkalies. (c) When alkah solutions are carefuhy neutrahzed with dUute nitric acid and then allowed to crystallize on glass slides, the potassium nitrate wUl form long, slender, fluted prisms. The sodium nitrate, hoAvever, crystallizes in rhombic plates. (d) When a drop of alkali solution upon a platinum AAdre is heated in a Bunsen flame the yeUow flame of sodium wiU ahvays be present. If, hoAvever, Ave place in front of the flame a piece of cobalt blue glass, it is possible, if potash is present, to distinguish its characteristic violet flame. It is more accurate, however, to make this test before a spectroscope, and to recognize the potassium by its tAvo lines, one red and the other blue. Ammonia. The alkaline salts of ammonium differ from those of potassium and sodium by being volatUe and temporary. Caustic ammonia, or ammo- nium hydrate, is simply a solution of the ammonia gas (XHa) in water, and on heating or evaporation the gas disappears, and Avith it the alkaline properties. Ammonium carbonate is a solid which dissolves freely in Avater, but this too is volatUe in the air, Avhen dry, at ordinary tempera- tures, and is readUy driven from its solution by heat. Accordingly, in poisoning by ammonia the patient, if he suiwives a short time, is more apt to recover and escape permanent injury than in the case of soda and potash. But, on the other hand, the gas itself is poisonous, and hable to cause death suddenly, when inhaled, not only from its caustic effect upon the air-passages and lungs, but also from it's action on the central nervous system, causing, AA'hen concentrated, a paralysis of circulation and respiration. INORGANIC POISONS. 325 Caustic Effects.—Cases are not infrequent where persons, usuaUy whUe intoxicated, have swaUoAved smaU or large doses of aqua ammonia, and suffered from the usual symptoms of caustic alkah. Thus (France Med., 1879, p. 65) a case is reported Avhere a few drops of ammonia Avere taken by mistake, and almost immediately spit out. There resulted purely local lesions in the mouth and throat, which became, in a day or Iavo, very deep and very painful, but healed up in eight or ten days. In another case (Boston Med. and Surg. Jour., 1891, vol. exxv., p. 677), a man, aged forty-six, swallowed a gulp of household ammonia. He spit it out at once, and took dUuted vinegar and then milk. In two hours' time his lips, gum, tongue, and tonsils Avere swoUen, raw, and much in- flamed. His voice was husky, his respiration slow, but he had no vom- iting. He was treated Avith cold compresses around the neck, and oU, milk, etc., internaUy. The second night he developed symptoms of Bright's disease, i.e., albumen, casts, blood, and pus-cehs in the urine, which was very scanty, and some headache and dehrium. But when treated Avith digitalis his kidneys recovered, and the local lesions healed and the man was AveU in eight or ten days. In another case (Lancet, 1890, part n., p. 1214), a man Avho had taken a mixture of ammonia, turpentine, and oU, whUe drunk, suffered so badly from dyspnoea in an hour and a half after taking the poison that the sur- geon, to saA'e his hfe, performed tracheotomy. In spite of rather graAre kidney and lung trouble the man slowly recovered, and was quite weU in less than a fortnight. Severer cases, ending in death, and shoAving symptoms very similar to those of rapid soda or potash poisoning, can be found occasionally in the books or in the journals. Thus, Dr. Garvin (Boston Med. and Surg. Jour., 1880, vol. cni., p. 166) gives an interesting case of a man, when tipsy, who took some four tablespoonfuls of aqua ammonia, remarking at the time that it smelt pretty strong. Some of this dose reached the stomach, for he vomited at once, and complained of burning, not only in his mouth, but down his throat and in his stomach. He died in four days and a quarter. A similar case is given in the Canada Med. and Surg. Jour., vol. x., p. 449. Taylor gives several instances of this sort. Among others he quotes from Dr. Barclay a case of a girl who died, three months after taking some ammonium carbonate, from contraction of the •oesophagus and irritation of the stomach. Cerebral Effects of Ammonia.—Besides, however, acting solely as a caustic, cases are met with Avhere death occurs very rapidly, and long before the inflammation could have produced fatal results. This occurs sometimes when taken in solution. Thus two or three cases are quoted by Taylor where death occurred within a few minutes after drinking some ammonic hydrate. But usuaUy these cases result from smelling and inhaling the gas. Thus a case is mentioned by Routier (France Med., 1879, p. 65) where a doctor, in an epileptic fit, Avas given strong ammonia to inhale, and im- mediately feU in a syncope and died. A a eiy interesting report is given by Dr. Fairbrother (St. Louis Med. and Surg'Jour., 1887, vol. Iii., p. 272), AA'here three men lost their lives and a fourth was permanently injured by an accident Avhen setting up an ammonia ice-machine. They were exposed to the gas for some three minutes. One AA'hen dragged out was comatose and unconscious, and 326 A SYSTEM OF LEGAL MEDICINE. died in fifteen minutes. Another was suffering as though from chloro- form in the stage of excitement—i.e., he Avas unconscious, in Avild delir- ium, and could not stand. He was not improved by the injection of hah a grain of morphine sulphate, and died suddenly in Iavo hours. The third Avas entirely conscious and Avalked home. He could sAvalloAv readily and talk easUy, but complained of occasional difficult breathing, and after five hours'' time, in a sudden attack of dyspnoea, he gave tAvo or three gasps and died. The1 last suffered from bronchial irritation for some months. His leg was broken by the faU and had to be amputated, and he became partially paralyzed on one side. Analysis.—Ammonia and its compounds can be readily recognized by their being volatile, and by their giAdng off ammonia gas Avhen heated, either by themselves or Avith' calcium hydrate (lime-water). The ammo- nia gas not only has its characteristic odor, but wiU also turn blue a wet piece of red litmus-paper exposed to it, and avUI give white fumes in the presence of a rod dipped in hydrochloric acid. II. THE MINERAL ACIDS. Sulphuric, Hydrochloric, and Kitric Acids. Also Chromic and Boracic Acids. These compounds in many respects are the reverse of the alkalies,. just mentioned. They have a sour taste, turn blue litmus-paper red and most vegetable dyestuffs either red or yeUow, neutralize alkalies, and dissolve most metals, liberating hydrogen or some other gas. Upon or- ganic matter and upon the tissues of the body the strong mineral acids act even more violently than the alkalies, corroding rapidly and fiercely any part of the body with which they come in contact. Sulphuric Acid—Oil of Vitriol—H2SOi. This substance was known to the alchemists, and has been an article of commerce since the middle ages, under the common name of oU of vitriol. When concentrated it is a heaAy, oily hquid, usuaUy with a yeUoAAdsh or brown color, and no smeU. It combines Arery readUy Avith water, dissolving in it Avith the formation of considerable heat, and ex- tracting it from the air and from organic compounds. It is intensely corrosiA'e, charring organic compounds and destroying their substance. It is, of course, less active the more it is diluted. Sulphuric acid, in common Avith the other mineral acids, is not often used for murder, the taste betraying the attempt to the Auctim, and the symptoms of death from it being characteristic. Cases, however, haA'e been occasionaUy reported where it has been purposely administered to chUdren, and also to intoxicated adults, Avith fatal results. It is not uncommonly used for suicide, especiaUy among the loAver classes on the Continent. For instance, in Berlin it is the commonest of aU poisons, in some recent years aA^eraging forty percent, and over of aU the poisoning cases taken in the general hospitals, Avhile phosphorus came second, Avith some twenty percent., and oxalic acid next, Avith some eight percent. In that city the cases seem most common among the INORGANIC POISONS. 327 servant-girls, who on comparatively slight cause become inclined to sui- cide, and take the first and readiest means to attain their end. In other parts of Germany these cases are less common, and in France and Eng- land they average only six or eight percent, of the casualties from poison. Some seventy-five percent, of aU the cases are of women, who, as yet. do not seem to have found out that, of aU the poisons knoAvn, this is the most painful in its effects. Cases of accidental poisoning are also occasionaUy met with, fre- quently in chUdren; while the strong acid is not infrequently used for throAving upon the face and hands of riArals or enemies. This pleasant practice is also largely confined to the gentler sex, and often results in terrible and permanent disfigurement, and sometimes in A^ery serious in- jury to the health. Symptoms.—These are, in general, the same as those of the strong alkalies. There is great pain in the mouth, throat, oesophagus, and stomach, if the acid penetrates as far. The interior of the mouth, if it can be seen, is greatly inflamed, swoUen, and covered with a AA'hite lining. The tongue, in bael cases, is terribly swoUen, often projecting out of the mouth, and is gray in color, while the salivation is profuse. After a short length of time come the evidences of coUapse, sunken eyes, paUid face, cold and clammy skin, impaired circulation, and labored breathing. There is great thirst, which cannot weU be satisfied, and choking, retching, and Aromiting, often of much blood. GeneraUy the patients are roUing around in agony on the bed, but at other times, eA^en quite rapidly, they faU into a semi-unconscious state, and lie in a state of stupor. Death, under these circumstances, may occur in a few hours, or, more often, in one or two days, either from coUapse or from perforation of the stomach. It may also occur, sometimes veiy rapicUy indeed, from the effect upon the air-passages, eA^en when no acid has been actuaUy swaUowed. In other cases, Avhen the patients recover from the immedi- ate effects of the poison they often die in the course of some weeks or months from the secondary effects of the poison, such as strictures of the oesophagus or stomach, or from perforation of the oesophagus. Ac- cording to Litten (Berlin Klin. Woehensch., 1881, p. 616), in the Berlin hospitals some thirty-nine percent, die while in the hospitals, and some thirty percent, more from the after-effects. Treatment.—If taken at once the acid may be more or less neutral- ized with bicarbonate of soda, or magnesia, taken in good quantities Avith large amounts of water. If these cannot be obtained, plaster from the waUs of rooms may be of some service. The stomach-pump must not be used, for fear of perforation ; but after the acid has been neutral- ized, and before, if possible, swaUoAving has become too difficult, albumen, mUk, and mucilaginous fluids of aU sorts should be taken into the stomach, and the mouth and throat covered with vaseUne and the like. The coUapse and other symptoms must be treated as they come. An interesting case, where life was saved by a httle forethought, is reported in the Glasgow Med. Jour. (1879, vol. xii., p. 390). A child, thirteen months old^ while playing, swaUowed a few drops of concentrated sul- phuric acid, and feU on the floor in great distress. A local doctor was caUed in, and gave emetics, causing the chUd to vomit some dark-colored 328 A SYSTEM OF LEGAL MEDICINE. hquid. Later a prominent physician was summoned, and found the ehUd suffering greatly from acute laryngitis, with breathing much affected He sent the baby around at once to the hospital, AAdth a note to his house-surgeon there to be ready to perform tracheotomy if necessary. Soon afterward the ehUd got worse, but AA-as relieved at once by trache- otomy, and recovered completely in five weeks' time. The acid never reached the oesophagus, for the child swaUoAved food aU right the next day. Post-mortem Examination.—This mainly shows the evidences of acute inflammation and corrosion upon aU portions of the body touched by the acid. When the action is rapid and the acid strong, the contents of the stomach, any effused blood, and even the waUs of the oesophagus and stomach, avUI generaUy show marks e>f charring, this acid having the peculiar property of browning or blackening most kinds of organic matter. The skin also, where any acid has faUen on it, wUl be much corroded, and sometimes blackened. Tests.—In like manner it is generaUy possible to trace this poison, in fresh cases, by noticing the black and burned appearance of any spots upon the clothes, hnen, or other material touched by the acid or by the first vomited matter. The regular test for sulphuric acid is by means of a solution of barium chloride, acidified with hydrochloric acid, which gives a white, insoluble precipitate of barium sulphate. To extract the free sulphuric acid from the tissues, it is best to soak them thoroughly, finely divided, in a httle Avater, and to evaporate this extract to dryness. It is taken up with a mixture of alcohol and ether in equal proportions, which dissolves free sulphuric acid and also free phosphoric acid, if present, but not their salts, nor free hydrochloric or butyric acids. This hquid can then be tested by barium chloride. From experiments made by Gamier (Ann. d' Hyg., 1884, vol. xi., p. 227, and 1887, vol. xvii., p. 148) it would appear that free sulphuric acid is rarely found in the tissues, but that it liberates free phosphoric acid in- stead. And hence, that the presence of the latter, proved by obtain- ing a yeUow precipitate on adding ammonium molybdate to the alcohol and ether extract, is a satisfactory indication of the action of the more powerful acid. External Application of the Acid.—It is weU known that the con- centrated acid, oU of Adtriol, acts Avith great violence upon the skin and flesh, and not infrequently most serious injuries result from the acid being thrown, either from malice or hj accident, upon the face and skin. In ah those cases great suffering and permanent disfigurement can hardly be avoided excepting by prompt treatment by the Adctim or bystanders. It so happens that sulphuric acid does not act instantaneously; so, if directly the acid strikes the skin the injured parts are washed with a good stream of AA'ater, and then any residual acid neutralized AAuth sodic bicarbonate, no harm wUl be done. If water is not at once obtainable, the acid may be largely removed by wiping it off thoroughly Avith hand- kerchiefs and cloths, and then, even if the rest is not Avashed off for some few minutes, the results wUl not be serious. These points should lie par- ticularly impressed on students in chemical laboratories. A few years ago a School of Mines student, by carelessness, exploded a flask of hot, concentrated sidphuric acid, getting the liquid all over his face and hands, and some even into his eyes. The man himself rushed toward the sink; INORGANIC POISONS. 329 his friends ran to help him, and whUe some turned on the water and Avashed the acid off, two others carried over the sodic bicarbonate bottle and deluged his face and his eyes Avith it, pulling the eyelids open for the purpose. The man was out of coUege for three or four weeks, but then returned with perfect eyesight, and with hardly a perceptible scar on his face. A somewhat simUar accident with cold acid occurred in another weU- known laboratory a few years ago, and was the basis of a lawsuit. The student was frightfully burned on one side of his face, losing part of his nose and the sight of one eye, and it was claimed that no treatment was given in the laboratory, but that the lad was taken first to one doc- tor some blocks away, and then to another, the latter finahy applying some oU. Hydrochloric Acid—Muriatic Acid—HCl. True hydrochloric acid is an acid, irritating gas, extremely soluble in water. The acid of commerce is a colorless or yellowish hquid, with a specific gravity of 1.15 to 1.20, and contains some thirty-five or forty percent, of the gas dissolved in water. It has a strong, irritating smell and acid taste, and produces white fumes when exposed to vapors of ammonia. It is but rarely taken as a poison, and then almost invariably from accident or for suicide. Its symptoms are very much like those of sul- phuric acid, or of the caustic alkalies described before, i.e., intense in- flammation of mouth, oesophagus, and stomach, foUowed by coUapse, and, if these primary symptoms are not fatal, by secondary symptoms of stricture of oesophagus or duodenum. As in the other cases, the time of death is very variable. Most of the acute cases reported have died in one or two days, although Wormley quotes a case of death in fifteen hours, and an interesting case, dying in seventeen hours, is given in the Lancet (1884, part i., p. 65). In the lat- ter case death resulted from coUapse, and, on autopsy, there were found perforations of oesophagus, stomach, and duodenum. The mucous sur- face of the mouth was white. Bbyth (Poisons: Their Effects and Detec- tion) quotes a case of death in two hours. Some interesting cases of death from secondary symptoms have been recorded of late years (Lancet, 1890, part i., p. 797; New Zealand Med. Jour., vol. ii., 1889, p. 241; and others). In the first of these the patient drank by mistake an ounce or two of strong acid. He had severe in- flammation of the stomach, which healed up satisfactorily in twenty or twenty-five days, and in ten days more he was dismissed as weU. But two months after this cure he returned to the hospital to be treated for intestinal trouble. His stomach was opened, in the hopes of dilating the stricture of the pylorus or duodenum, which seemed to be present; but the mucous membrane of the pylorus was so thickened, and adhered so closely to that of the stomach, and there were so many cicatrices in the latter, that the surgeon could not find the pylorus at aU, and the patient died in a few days. It was found afterward that the pylorus was completely closed. In the New Zealand case death occurred after four months from strict- ure of the duodenum just below the pylorus. 330 A SYSTEM OF LEGAL MEDICINE. The fatal dose, as Avith sulphuric acid, depends more upon its strength, and upon Avhether it has actuaUy reached the stomach, than upon its quantity. Cases of death have been reported from one or two teaspoon- fuls of concentrated acid. Distinction from Other Acids.—Hydrochloric acid, in distinction to sulphuric and nitric acid, does not leave any particular stain or scar upon the surface of the skin, although, AA'hen concentrated and alloAved to stand, it AviU set up inflammation. It does not char organic substances, like sulphuric acid, nor does it turn woolen goods or hair or epidermis AreUow, as does nitric acid. It is more A'olatile than the other acids, and after a day or two cannot be detected in dry stains. The test for hydrochloric acid, as weU as for common salt and other metallic chlorides, is the formation of argentic chloride, a white curdy precipitate soluble in ammonic hydrate, by the addition of a solution of argentic nitrate acidified with nitric acid. In making this test upon any extracts of tissues or of the contents of a stomach, it is important to remember that aU the tissues contain sodium chloride, and that the gas- tric juice, during digestion, contains about 0.2 percent, of free hydro- chloric acid. It has been proposed, to see if the hydrochloric acid in an extract is free or combined, to divide it into two parts, to add a little excess of sodic carbonate to the one, and to evaporate both to dryness. Any uncombined acid wUl thus be driven off, and if, on testing with acid argentic nitrate, the one with sodic carbonate shows more chlorides than the other, the excess must have been due to free acid. Nitric Acid—Aqua Fortis—HN03. This substance, as found in commerce, is a colorless or yeUow corro- sive liquid, with a specific gra\dty of about 1.40. It acts on organic sub- stances more rapidly, and quite as \dolently, as sidphuric acid, but by oxidizing them, whereas sulphuric acid deprives them of water and chars them. It has been used for poisoning for some four hundred years, and yet but few cases are reported. When cases do occur they are very simUar to those from other corrosive poisons, although occasionally accompanied Avith less pam. It can, however, be at once distinguished from the other acids by producing yeUow, and finaUy brown, stains upon any tis- sues, or indeed, any substances of animal origin, with which it comes in contact. Death from this poison may result very rapidly, especiaUy Avith chU- dren. Thus Taylor mentions a case where a child, intentionaUy poisoned, died in a few minutes, and another case, of an adult, in an hour and three quarters. UsuaUy death takes place within tAventy-four hours, al- though occasionaUy it is delayed for some weeks or months, untU the usual secondary symptoms are developed. The fatal close of this poison is probably smaUer than of the other mineral acids, and is generaUy given as about one quarter of an ounce, an amount AA'hich has been knoAvn to kUl in two or three instances. Treatment is usuaUy unsuccessful, but is conducted on the same prin- ciples as in the case of sulphuric acid. INORGANIC POISONS. 331 Poisoning by Nitric Acid Fumes—When large surfaces of the acid are exposed to the air, the resulting fumes, partly of the acid itself and partly of some of the lower oxides of nitrogen, are extremely poisonous. Three or four instances of fatal accidents from this cause are reported in the journals, and quoted by the standard authorities. In almost every case they happened to chemists or druggists, and their assistants, AA'ho were endeavoring to clean up the debris after breaking a jar or carboy of nitric acid. The symptoms generaUy come on after some httle time, and then de- velop more or less rapidly into acute inflammation of the air-passages, which may prove fatal. An interesting case of this class of poisoning is given by Dr. Temple {Boston Med. and Surg. Jour., 1884, vol. ex., p. 496), where, out of four persons who tried to get a broken carboy of acid out of a store, one died and the rest were more or less affected. One of these was a gentleman who was exposed to the fumes but a few minutes, and was taken doAvn with a moderately severe attack of pneumonia in a few days. Another, a healthy assistant, felt suffocated, and found that he was relieved by going into the open air to breathe. This lasted, off and on, for thirty-five minutes. In about three hours he felt a constriction at the chest, and pain on inspiration; he had a cough, and his face was pale, almost of a lemon color. His pain and cough increased during the night, and next day he was worse. The third day he had a slight cough and some pain on inspiration, and felt very weak. There were a few moist rales over the chest. After that he got better, and was quite weU by the end of the week. The third was exposed in the same manner as the one just mentioned, but escaped with a severe cold for two weeks. The last was the proprietor of the shop, a healthy man of about fifty- four years, who had a longer exposure to the fumes. Four hours later he complained of " not feehng right," and took a car to his brother's house. In an hour and a half more he felt worse, with a cough, and pain on deep inspiration, and caUed a doctor. His pulse was rapid and weak, his respiration fast and shaUow. The doctor prescribed ten grains of ammonium carbonate, which reheved him, and he went home feehng weak, and with a dragging step. During the night he coughed incessantly, bringing up frothy, straAV- yeUow mucus. In the morning he felt easier, and took some milk, and in the afternoon he was free from pain, excepting a tightness around the chest. But later his pulse became Arery feeble, and in his chest were many coarse rales, and before night he died, about thirty hours after the accident. At the autopsy his lungs were cedematous, AAdth slight injec- tion of the bronchi, and more of the mucous membranes of the trachea and larynx. His heart and liver were injected, and there were smaU ecchymoses in the right auricle of the heart. Chromic Acid—Chromic Anhydride—Cr03. This compound, which crystaUizes in deliquescent crimson prisms, and is extremely soluble in both Avater and alcohol, is frequently used in medicine as a cautery. It gives but little pain, and destroys rapidly and 332 A SYSTEM OF LEGAL MEDICINE. deeply, and hence is often employed as a substitute for electro-cautery in remoAdng vegetations, extirpating tonsUs, and the like. Most of the text-books on materia meelica and therapeutics recom- mend it highly, and give no mention of any dangers from its free use1; but of late years a few cases have been reporteel AAdiich make it Avorth whUe to speak of it here. For instance, Dr. Fowler (Brit. Med. Jour., 1889, part i., p. 1113) was cauterizing the tonsUs of an emotional Avoman, forty-five years old, with the acid. The patient, in spite of instructions, sAvallowed her saliva aa ith a drop or two of acid in it, and noticed a slight burning in her throat. In half an hour she had violent pain in the epigastrium, with severe and agonizing vomiting of a green ropy fluid, and feU into a state of collapse. Purging came on in about an hour. She Avas treated with stimulants, hot-Avater bottles, and the like, and recovered in about three hours, hav- ing after reccwery an abundant flow of urine. A similar case is reported by Tisne, in the Jour, de Med., Paris, 1887. The acid can also act violently when used externaUy. Thus, Dr. White (Univ. Med. Mag., PhUa., 1889, vol. ii., p. 54) gives a very interesting and straightforward account of the death of a patient of his in twenty- seven hours, after remoAung some vegetation from her genital organs by a strong solution of chromic acid. The patient, after recoA^ering from the ether, complained of pain in the vulva, and died in a state of col- lapse. The liver and kidneys, on autopsy, were found congested, and on analysis contained chromium. In other words, not only is chromic acid a powerful corrosive, but it probably has some direct action on the central nervous system when taken into the blood. It is worth noticing that potassic dichromate, K2Cr207, an orange-red salt in common use in the arts, also has very decided toxic properties, partly local, but principahy affecting the nervous system, and that a few cases of poisoning have been reported from its use. Boracic Acid—Boric Acid—H3B03. Boracic acid occurs in commerce as white or colorless crystals, easUy soluble in hot, and moderately in cold, water. It has a slight acid taste and reaction, but is non-irritant, has no odor, and is much used as a mild antiseptic, not, it is beheved, actuaUy killing the germs, but preventing their further growth. Some few cases have of late years been reported which tend to show that when absorbed by the body in moderately large epiantities it may act as a vigorous poison. Thus in the Med. News (1882, vol. xl., p. 571) are quoted two cases where death occurred from washing, with five-per- cent, solutions, in one case a large abscess and in the other a pleural cav- ity. And cases of poisoning, with recovery, are given in the N. W. Lancet (1888, p. 22), and by Dr. Welch (Med. Record, 1888, vol. xxxiv., p. 533) and Dr. Lemoine (Gazette Med., Paris, 1890, p. 205). The latter, who gives four cases of poisoning by surgical dressings of the acid, explains them by the fact that the patients aU had kidney trouble, which allowed the drug to accumulate. The symptoms were much the same in most of the cases. There was INORGANIC POISONS. 333 a general rash, beginning near the place of application, resulting often in exfoliation. There Avas loss of appetite, nausea, and vomiting; there was often more or less trouble Avith the inteUeet, great depression, mel- ancholia, insomnia, hallucinations, and even delirium; and in the worst cases there Avas coUapse. III. THE HALOGENS AND THEIR SALTS. Under the aboA'e name Ave include four elements, chlorine, bromine, iodine, and fluorine, AA'hose sodium and potassium compounds closely re- semble sea salt, sodium chloride. These substances all combine with one atom of hydrogen to form acids, and their compounds Avith oxygen and with various metals resemble each other greatly. They differ from other elements in having colored vapors, AAdiich, b}r the way, are all intensely irritating to the lungs. Chlorine—CI, This substance, a he&vy, greenish-yeUow, corrosive gas, is manufact- ured in large quantities for bleaching and antiseptic purposes. It is very corrosive, and, in any quantity, Avill set up acute inflammation of the air-passages. Inhaled in large amounts it produces narcotism, and even death, by paralysis of the nerve-centers; but although in eArery cpiaUta- ttee laboratory some student or another ahvays gets a violent spell of coughing, from smeUing too eagerly at the gas as it is evolved, cases of serious poisoning are rare. In fact, one of the few cases on record has just occurred (February, 1894) in Ithaca, AA'here, in a foolish attempt of some college boys to break up a rival class supper by injecting chlorine gas into the room, one person in feeble health was kiUed, and several others severely affected. Its salts are not poisonous, unless in enormous doses, Avith the following exception : Potassic Chlorate.—This salt occurs in the form of colorless flat crystals, AA'ith a bitter, salty taste, readily soluble in water. It is largely manufactured for oxidizing purposes, for use in explosives, and for pro- ducing oxygen. Externally it is a poAverful irritant upon mucous membranes and ulcerated surfaces, anel is used largely for gargling and Avashing the mouth in sore throat, salivation, small ulcers, and the like, and also for treating other inflamed surfaces. Internally it is a decided poison, and though often swaUowed rather freely in the above disorders, is, in large doses, always to be considered dangerous. The symptoms are usually those of an irritant, i.e., nausea, vomit- ing, pain in stomach and abdomen, dyspnoea, diarrhoea, and the like, AA'ith, when severe, more or less collapse. But besides this it has a characteristic action upon the blood, breaking down the red blood-ceUs, and changing the haemoglobin into brownish methaemoglobin. This results in changes, inflammation, and sweUing of the liver and spleen, anel in A'ery marked trouble Avith the kidneys. These become highly congested, producing small amounts of brownish, thick urine, full of albumen, and of brownish-red casts containing broken-down blood- cells. FoUoAving this frequently come nervous symptoms, headache, 334 A SYSTEM OF LEGAL MEDICINE. delirium, and coma, and the patients die of coUapse, sometimes in a few hours, but generally after a day or two. It has been claimed that this action of the salt AA'as due to its oxidiz- ing poAver upon the blood; but careful experiments by Hirne anel others have shoAvn that from ninety to ninety-eight percent, of a dose of potas- sic chlorate can be recovered, unchanged, from the urine in the course of a few hours. There is much difference of opinion as to the amount of this salt that can be taken with safety. Various experimenters have taken one ounce at a time Avithout any special effects, although one of these, Dr. Foun- tain, after taking one and one eighth ounces, died in seven days from nephritis. The smallest fatal dose recorded is forty-six grains, AA'hich killed a ehUd of three years. Dr. Jacobi, aa'Iio studied carefully the toxicology of potassic chlorate, considers that the maximum amount, in divided doses, for twenty-four hours, should be, for infants under three, from twenty to tAventy-five grains, and for children older than that, up to about thirty grains, Avhile for adults it may amount to a hundred or a hundred and twenty-five grains. Bromine—Br. Bromine is a dark red liquid, Avith a A'ery disagreeable pungent smell, and emitting, at ordinary temperatures, acrid, irritating, broAvnish-red fumes. It is slightly soluble in Avater, but more so in alcohol and ether, and is used to some extent, in medicine, as a poAverful and rapid caus- tic, and occasionally as a vigorous antiseptic. When taken internally it Avould act as a poAverful caustic, and indeed one case is reported Avhere an ounce of bromine1, taken into the stomach, produced death, with symptoms of active corrosion folloAved by collapse, in seven and a half hours. Potassium Bromide, KBr.—All the metalhc bromides are more or less poisonous, but from experiments by Fere (Compt. Rend. Biol., 1891, vol. in., p. 771) it Avould appear that potassium bromide, the salt most used in medicine, is five times more poisonous than strontium, and fif- teen times more so than sodium, bromide, both of which may be substi- tuted for it. Potassium bromide acts distinctly as a nerve depressor, and is largely used to quiet and soothe the nerves in cases of excessive excitement. Thus, for instance, it is of value in the convulsions of children, sexual excitement, the vomiting of pregnancy, epilepsy, tetanus, strychnine poi- soning, and the like; and in these conditions it is given in large doses, even half an ounce at a time, Avithout serious symptoms. When, hoAvever, it has been pushed too far, or taken for too great a length of time, it produces marked effects upon the nervous system. The patients suffer from cerebral Aveakness; they are stupid, difficult to rouse, lose their memory ; they stagger and become dizzy on slight exer- tion, sometimes becoming partially paralyzed, and are much depressed. The boely temperature is, as a rule, much loAvered. They also generaUy suffer from a severe rash, some oedema and swelling of the skin, eyelids, and occasionally mucous membranes, and they have a fetid breath. Occa- sionaUy, too, there are symptoms of local irritation. These cases usually recover AA'hen treated Avith stimulants, and AArhen given plenty of water so INORGANIC POISONS. 335 as to wash the salt from the system, but occasionaUy they result in death from exhaustion, heart-failure, and collapse. The time of death, and also the fatal dose, varies greatly. In one case (Dr. Hamer, Columbus Med. Jour., 1884, vol. in., p. 259) a woman was given eighty-five grains of the salt every four hours. After four days another doctor found her almost comatose, muttering to herself, with a temperature of 951;°, weak rapid pulse, very anaemic, passing httle, albu- minous urine, and Avith pain in head and over ovaries. The medicine, she said, burned her mouth and throat AvheneArer she took it. In spite of treatment she died in eight and a half days from the first dose. In another case (Brit. Med. Jour., 1882, part i., p. 616), a doctor caUed to treat a ehUd recovering from convulsions prescribed five grains of potassium bromide every four hours. After the first dose the child seemed much better, but, a few minutes after, drank doAvn most of the medicine, some eighty grains in all. In ten minutes the ehUd became pale, Avith blue hps, and lay down to rest; and Avithin five minutes more it died quietly. In general the symptoms of "bromism" come on graduaUy, Avith ordinary-sized doses, and can be recognized in time to prevent serious injury. Iodine—I. This occurs in soft, bluish-black, crystalline scales, having a metaUic luster and an irritating smeU and taste. It volatilizes slightly at ordi- nary temperatures, and at about 220° F. it melts and changes into a vio- let Arapor. It is almost insoluble in water, but dissolves freely in a solu- tion of potassic iodide, and also in alcohol, and ether. Its solutions turn starch blue. Externally it acts as a powerful irritant, and if very strong, as a caus- tic. It is largely used in medicine for producing local counter-irritation, and for this purpose is painted on the skin, in the form of a tincture. If the latter is strong, and is applied repeatedly, it avUI produce blisters and very elecided inflammation. When swaUowed, it acts as a poAverful irritant, and when in moder- ate-sized doses, ten and tAventy grains, has been known to produce death, Avith the usual symptoms of a corrosive poison. It also has certain specific effects Avhen absorbed into the system, either from injection into a cyst or cavity, or by being painted on an ulcerated surface. Under these circumstances it produces more or less gastric irritation, shown by vomiting, purging, and the hke; also some nervous symptoms, neuralgia, disturbed intellect, dizziness, and so on; and finaUy, by its elimination, produces considerable inflammation of the kidneys, and often an eruption on the skin. An interesting case of acute iodine poisoning is given by Dr. Culpeper (Therap. 6ns., 1888, vol. iv., p. 225). A colored woman painted both legs of her eleven-year-old boy Avith a solution of iodine strong enough to take off aU the skin from above his knees to below his ankles. This was done at night, and aU night and next day the little feUow complained of much local pain. At night he had a headache, with pain in stomach, boAvels, and bladder, and in the back over the kidneys, and passed no mane. The second day he Avas worse, Avith diarrhoea and vomiting, and the 336 A SYSTEM OF LEGAL MEDICINE. third day these symptoms increased. On the fourth day he Avas suffer- ing from vomiting, purging, and hiccoughing, and iodine Avas found in both faeces and vomited matter. He Avas a cry dizzy and had fainting- fits, Avhile no urine Avas passeel at aU, and after five and a half days he died quietly, after passing almost pure blood. His temperature ehd not rise1 above 1)8.8°, although there Avas much raw surface; there Avas total suppression of urine from the beginning; his inteUect Avas clear, although lie Avas very giddy on taking the least exertion, and he had constant symptoms of gastric irritation. Potassium Iodide, KI.—This salt is given in very large doses, espe- ciaUy in the latter stages of syphUis, and is usually borne quite well. It must, hoAvever, be used carefully, or it avUI gtee some of the symptoms of iodine poisoning, beginning, usually, with a rash, and continuing with cerebral symptoms, and sometimes Avith lowering of temperature. These effects, as a rule, are not dangerous, and are easUy cured after stoppage of the drug. IV. PHOSPHORUS. This substance was discoA'ered by Brandt, in 1669, in the residues from urine, while searching for the phUosopher's stone. It was named from its power of shining in the dark, and for a hundred and fifty years Avas regarded almost solely as a curiosity. In the early part of this century it Avas introduced for the manufacture of matches, and after- Avards as a vermin kiUer, and since then has been manufactured in large quantities. Phosphorus neA'er occurs in nature excepting when combined with oxygen or some other element. Its compounds, however, especially the (ortho)phosphates of calcium, magnesium, sodium, and potassium, are found, Avidely distributed, in the form of rocks and minerals, in aU soils, in almost aU natural terrestrial waters, and in the tissues and fluids of plants and animals. In the latter it chiefly occurs in the bones and the brain tissue. It is prepared from the ashes of bones, which are principally com- posed of calcium phosphate, by separating the calcium with sulphuric acid, and distilling the resulting acid with charcoal. Properties.—It is a light yeUow, translucent, horn-like solid, which can be easily cut, and which appears in commerce usually as small sticks covered with a Avhitish coat. It has no taste, but a peculiar garlic smeU. It ignites in the air at 100° F., but when in an inert atmosphere like carbon dioxide, or under AA'ater, it melts at 109° F. It is practically insoluble in Avater, but dissolves freely in carbon disulphide, and to a less extent in oils, concentrated acetic; acid, and ether. By suitable treatment it can be changed into two if not three other varieties of phosphorus. One only of these is important, the red phosphorus, which is a red powder, insoluble in the above media, far less combustible than the common form, and non-poisonous. In com- merce, however, it almost always contains a small percentage of the yellow or ordinary phosphorus. Physiological Properties.—In smaU quantities, this element acts as a stimiUant to the nutrition of the tissues, and especiaUy of the nerve- centers. It is, therefore, much used in exhaustion, or even disease, of INORGANIC POISONS. 337 the spinal or brain-centers, in neuralgia, anaphrodisia, incipient myelitis, and the like. It also stimulates the formation of bone tissue, and is often employed, Avith iron, in cases of osteomalacia, rickets, and similar diseases. In experiments on animals the spongy tissue becomes denser, and the hard tissues thicken, in some cases till the canal is almost fiUed up. Poisonous Properties—These haA'e been recognized eA'er since phos- phorus AA'as manufactured for commercial purposes. In this country and England cases of poisoning by it have been mostly confined to ac- cidents or murders ; but on the Continent, anel especially in France, it is much used for suicide, and, some years, heads the AA'hole list of poisons. It has the advantage of being cheap and easUy obtained, but it produces great suffering and, usuaUy, a slow, lingering death. Symptoms—Rapid Cases.—In some cases, perhaps ten or fifteen percent., a fatal dose of phosphorus wiU act promptly and produce death Avithin tAventy-four hours or so. Under these circumstances the first symptoms are usuaUy retching and vomiting, Avith sharp pains in the epigastrium, and an odor of phosphorus both in the breath and vomited material. These symptoms often improve instead of groAving worse, but the patient sinks into a state of coUapse, and dies in coma, or in convulsions. Death may occur, under these circumstances, in but a few hours after taking the poison. Von Maschka (Wien. Med. Woehensch., 1884, pp. 608, 648) reports in detail two cases of his oavii, of a girl twenty- seven years old and a man sixty-one years old, each of whom died in eight hours; and quotes cases of death in eight, seven, and four hours respectively. The last case, which is quoted from Kessler, was of a child seven weeks old, aa'Iio had sucked the heads from six or seven matches. Symptoms—Ordinary Cases.—In the great majority of cases the first symptoms do not appear for some hours or even days after the poison is taken, and then are not very severe. They consist of a feehng of weakness and general iU-health, with some nausea, and, perhaps, vomiting, and some epigastric pain. The vomited matter and the breath usually smeU of phosphorus, and occasionaUy are luminous in the dark. These symptoms, especiaUy under treatment, get no worse, and in- deed often improve, for one or two days or even longer. There may be slight fever, thirst, loss of appetite, and the like, but nothing to cause much alarm. Then come symptoms of jaundice, usuaUy beginning with yellow coloring of the cc'mjunctiA^ae and the presence of bile in the urine. The skin becomes velloAv, the stools are liver-colored, and finaUy almost white —"chalk anel Avater," as they are frequently described—the liver be- comes considerably enlarged,'and is painful on pressure. The kidneys also are affected, as is shown by the urine being scanty, fuU of albumen, often containing casts and blood, and, sometimes, glu- cose. Bile1 acids and bile pigments are present in it, and not infrequently leucine and tyrosine; while under the microscope can be seen small fat- globules, partly free in the hquid, partly in epithehal cells. The patient by this time is dangerously Ul; nervous symptoms, such as delirium, frequently of an erotic character, or a heavy comatose sleep, set in. The temperature may fall very decidedly, but not infre- quently rises, sometimes very high; and the patients finally die of col- lapse, sometimes in coma, sometimes in convulsions. 33S -^ SYSTEM OF LEGAL MEDICINE. Occasionally, AA'ith these signs of liver disease, come some peculiar symptoms of the blood. The blood becomes dark, not easily coagu- lated, if at aU, Avith feAver red and more AA'hite blood-cells, and gives rise to bleedings from different parts of the body. Women frequently Aoav freely, as at menstrual periods (they invariably abort or have a mis- carriage when in pregnancy), and there may occur obstinate bleedings from the gums, nose, kidneys, or bowels. In the'se cases the disease may last for a long time, anel the patients finally die of anaunia. Post=mortem Changes.—In the ordinary cases there aa ill be found an extreme fatty degeneration of the liver and kidneys, and also gener- ally of the heart, lungs, and, in fact, almost aU the tissues of the body. The hver, in the early stages, is much enlarged, but aftei-Avard dimin- ishes in size, and may be much atrophied. It ahvays, hoAvever, has more or less of a yelloAvish look Avhen cut, and contains little or no blood. Pieces of it will sometimes burn freely when touched with a lighted match. Under the microscope the ceUs appear much broken doAvn and full of fatty globules. The kidneys present simUar appearances. The cortex peels off easUy, and on section the tissue has a vcIIoav color and a greasy feeling. The lungs and heart also show signs, generaUy, of fatty degeneration; the1 blood is dark colored, and forms numerous ecchymoses in the en- docardium, the mediastinum, and, in fact, aU over the body. It used to be stated that phosphorus produced inflammation, and often idceration, of the stomach and intestines. It really produces, rather, a gastro-adenitis—i.e., the mucous membrane becomes much thickened, white, and opaque, from a great enlargement of the glands and a fatty degeneration of the epithehum. This also is the case Avith the intestines. Phosphorus Poisoning vs. Acute Yellow Atrophy of the Liver.— When jaundice has once set in it is almost impossible, by clinical means, to distinguish between these two forms, if the liver, in the phosphorus cases, has had time to contract. In the earher stages it enlarges a good deal, and does not, as a rule, get small until the jaundice has lasted two or three days. It is claimed that in acute yellow atrophy there is far more leucine and tyrosine in the urine than in phosphorus poisoning; and also that the intestines contain gray-white, knotty faecal matter, whUe in the phos- phorus cases the excreta are usuaUy fluid. These differences, however, are slight, and it is better to trust for distinction upon tests for phosphorus, either in the early vomited matter, or in the intestines and tissues after death. Time of Death.—These cases usuaUy die in from three to seven days, though they sometimes linger ten days or a fortnight. Out of 129 cases of aU kinds looked up by Dr. Blyth, 17 died within twenty-four hours, 30 within two days, 103 Avithin seven days, 22 more before ten days, and 4 lived for more than ten days, 1 dying at the end of eight months. Treatment and Antidotes—When once the phosphorus has been absorbed in the circulation in sufficient amounts to produce the liver lesions, treatment is of but little Aralue. The poison must be ejected as far as possible, before it is absorbed, by A-omiting and purging, and then AA'hat remains must be, if possible, rendered inert. It is not absorbed INORGANIC POISONS. 339 very cruickly, for free phosphorus has been found in the faeces for two or three days after it was taken. There are two antidotes to phosphorus, of more or less value, cupric sulphate and oU of turpentine. The copper salt forms a black phosphide of copper, AA'hich is harmless and can be removed, it is said, by the kid- neys. So it is good practice, Avhen a patient is brought in, to give him an emetic of three grains of cupric sulphate in some water, and to repeat it at frecment intervals. The use of oil of turpentine Avas introduced by Andant, who in 1868, it is said, met a case of a man who, to commit suicide, took a lot of phosphorus paste, and then, to hasten his end, took a good drink of tur- pentine. To the great astonishment of both physician and patient the symptoms Avere slight, and recovery was rapid. At any rate1, some kinds of oil of turpentine, probably turpentines that haAre been exposed to the air for a long time, have undoubtedly the property of making an inert, gelatinous mass with the poison, and also, very possibly, help to oxidize it and thus make it harmless. One exper- imenter, Persoime, poisoned fifteen dogs with phosphorus, "and gave turpentine to ten, aU of Avhom survived, while the other five died with the characteristic symptoms. It should be given in doses of from thirty to forty minims (2 to 2^ gr.) every half-hour or so, for two or three days. Dangerous and Fatal Doses.—The medicinal doses of phosphorus vary from one thirtieth to one tAvelfth or even one quarter of a grain. In an interesting paper Mr. Thompson (Practitioner, 1872, part ii., p. 13), gteing his experiences in neuralgia, advises starting with one eighteenth of a grain every three hours, and increasing to one tAvelfth of a grain and higher. He teUs of one case where a person took one quarter of a grain four times a day, for three days, without injury. On the other hand, on page 103 of the same volume, Dr. Anstie teUs how a man taking one thirtieth of a grain three times a day for six or seven days (under three epiarters of a grain in all) developed distinct symptoms of poisoning. The subject, in this case, was highly neurotic. Death has been more than once reported from quantities of phos- phorus varying from one to t\vo grains. Sir R. Christison gives two fatal cases, one from one and a half grains and the other from about two grains, and Galtier, a case Avhere a Avoman died from taking about one grain in the course of four days. A case was reported by Lobel of Jena Avhere a lunatic Avas kiUed by a dose1 of one eighth of a grain. It is fair, accordingly, to state that from one to two grains would constitute, as a rule, a dangerous if not fatal dose. It is not necessary for the poison to be taken internaUy. A curious case is reported by Dr. HU1 (Lancet, 1890, part L, p. 398), where a ser- vant-girl, Avishing to ghre an interesting " dark seance" to her fellow- servants, rubbed some phosphorus paste on her face and hands. The resulting iUumination was satisfactory enough, but the poor girl died, Avith characteristic symptoms, on the eighth day. Poisoning by Phosphorus Vapor—Necrosis of the Jaw.—Soon after phosphorus was manufactured on a large scale, it was noticed that work- men exposed to its fumes Avere subject, to a peculiar disease of the jaw- bone. In 1845 twenty-two cases Avere reported in Austria, and two years later Von BUva and Geist discussed fully the etiology of sixty- 340 A SYSTEM OF LEGAL MEDICINE. eight cases in Germany. Of late years, thanks someAvhat to improved ventilation, enforced cleanhness, washing the mouths with alum and alkaline solutions, and rejection of workmen AA'ith unsound teeth, and, more than all these, to the use of red phosphorus, the disease has almost disappeared. The first symptoms Avere usually those of a seA'ere toothache, gener- aUy in the lower jaAAr. This Avould become avoi-sc, and the aching teeth would be pulled out, thereby relieving the pain. But the wound in the gum would not heal; offensive matter Avould ooze out, and the sockets of the teeth Avould become bare and exposed. OccasionaUy this bare piece of bone Avould slough off, Avith two or three neighboring teeth, and the Avound would heal up all right. But generally the disease would spread sIoaaIv or fast; more of the jaAV Avould become involved, the teeth falling out and the bone being laid bare. The gums would become swoUen anel infiltrated, offensive pus Avould exude, and often, if not treated, in the course of some months or years, the patient would die of debility, septic pneumonia, or the like; or else get weU, though horribly deformed by the loss of large masses of the jaAv. The disease, it Avould appear, is a purulent inflammation of the mar- row of the bone (osteomyelitis), and spreads from the interior toAvard the periosteum. The poisonous fumes are usually supposed to enter the system through a decayed tooth, but this does not seem invariably to be the case. The treatment usuaUy adopted is an immediate removal from the exposure, folloAved by a pretty free use of the knife. The dead bone is removed wherever possible, and the Avound opened up, and thoroughly cleansed by irrigating constantly AA'ith antiseptic Avashes. If carefully done it is possible to remove the decayed bone, leaving the periosteum intact, in which case neAv bone will frequently form and preserve both the strength and the shape of the original jaAv. A case of this sort, AA'here a whole Ioavci- jaw Avas remoA'ed from a girl by Dr. Wood, at BeUeA'iie, in 1857, is commented on most favorably, as a specimen of American surgery, in the Lancet (1877, part i., p. 813). The patient recovered from the operation, and died of some brain disease three years after the operation, and the jaw was found to be completely re-formed. It Avas pre- served as a curiosity, and, twenty years afterward, Avas exhibited at a Medi- cal Congress at Berlin, much to the interest of the European physicians. Tests for Phosphorus.—The vomited material, as well as tlie faeces, urine, and even the breath, will generally, in the early stages of poison- ing, have a peculiar garlic smell, and shine in the (lark. Besides this there are two methods, one discovered by Mitscherlich and the other by Dusart, for obtaining good evidence of the presence of minute traces of phosphorus or phosphorous acid. Mitscherlich''s Test,—If a mixture containing phosphorus is acidu- lated with sulphuric acid and carefully distilled on a sand-bath, and the A'apors condensed in a glass condensing-tube in a dark room, any phos- phorus present aauII be volatilized, and, in condensing, light up the tube. If present in any quantity, its amount can be determined by oxidizing it Avith nitric acid, and then precipitating it with amnionic molybdate, or ammonio-magnesic sulphate, and weighing. But. in this case, care must be taken that nothing from the flask is allowed to spatter over into the condenser. INORGANIC POISONS. 341 This luminosity can be observed for quite a time, half an hour or more, with one fortieth or one fiftieth of a grain of phosphorus, mixed with several ounces of hquid. It is interfered with by the vapors of alcohol and ether, which would be quickly volatUized, and of oil of turpentine; also by calomel, corrosive sublimate, and large quantities of iodine. It is not affected, however, by the presence of organic matter. Phosphoreted Hydrogen Test.—This gas is formed by the action of nascent hydrogen on free phosphorus or on its lower oxides, and burns with a characteristic green flame. Hence, if a suspected solution is placed in an evolution-flask containing zinc and dUute sulphuric acid, from which the hydrogen, passing through a drying-tube containing caustic potash or lime, is led to an ignition-tube and is there burned, the color of the flame, if phosphorus be present, will change from a faint blue to a brilliant green. This flame can be further tested by the spectroscope. The end of the tube should be kept cool in this experiment. This test will show the presence of phosphorus in as small amounts as the Mitscherlich test, and is not interfered with by anything that is hkely to be present. V. ANTIMONY. History.—This element was known to the ancients both in its metaUic state and in its salts. The metal, known as stibium, was used to some extent by both Greeks and Romans, while the black sulphide, now called stibnite, which is the commonest form in which antimony occurs in nature, has been used from time immemorial up to the present day, in the East, on account of the fine black powder obtained from it. This is mentioned not only in comparatively recent tales, like the Arabian Nights, Avhere the women always paint and touch up their eyebrows and eye- lashes with " kohl," but is even aUuded to in the Bible, when Jezebel, be- fore putting her head out of the castle window to greet the victorious rebel, Jehu, "painted her face," or, as the other translation gives it, "put her eyes into painting." The name antimony was given1 to it in the middle ages by BasU Val- entine, a German monk, who, early in the fifteenth century, described its medicinal poAvers in a book Currus Triumphalis Antimonii. The story goes that AA'hile studying the properties of some of the metals he threw the refuse from some of his experiments into a pig-pen, and was interested to see that, although the pigs were violently purged, they grew fat and strong under the treatment. He accordingly put some in the food at the convent, but, whether from his carelessness or the poor con- stitution of the good brothers, he killed nearly all of them. Hence the nickname antimony—" bad for the monks." Paracelsus was one of the first to parade its virtues, and he brought it into Avide notice, but, at the same time, into much disrepute among the regular practitioners, so that in 1556 the Faculty of Physic at Paris condemned it as a poison, and the Parliament prohibited its use under heavy penalties. As late as 1609 they expelled a doctor from their faculty for using the drug, and Guy Patin, a famous professor in Paris, published a Martyrotogy of Antimony giving great lists of the victims from it. Its use, however, graduaUy spread, tartar emetic was discovered 342 A SYSTEM OF LEGAL MEDICINE. in 1631, and a feAV years later it Avas restored to the pharmacopoeia, and its use made general. Later it Avas used as a panacea; it Avas claimed to be an emetic, pur- gattee, diuretic, stimulant, sedative, anti-scorbutic, and a cure for acute mania. Cups Avere made of antimony glass, an impure oxide, AA'hiedi gave purging properties to liquids drunk from it. It is still used in medicine, in the form of tartar emetic, to a moderate extent, but the ex- cessive claims for it haA'e disappeared. Its salts are active poisons, although not generaUy used as such, and cases of poisoning by it are not very common, excepting when taken acci- dentally. Taylor, in 1857. coUected thirty-seven cases, of AAdiich sixteen Avere fatal, and in the course of that year investigated three or four cases of murder. Since then it has been of less importance*, although every uoav and then it has been the basis of some famous trials—the Pritchard case and the Bravo or Balham case in England, and the great Wharton case in this country, some details of which last will be given later. Preparation and Properties.—The metal is usually prepared by roasting and reducing the sulphide, stibnite. It is a grayish white, brittle solid, with metallic luster, and Avithout taste or smell. It crys- tallizes readily, and is volatile. It does not oxidize in the air at ordinary temperatures, but when heated it burns to the oxide, Sb._,Oy. It dissolves in hot concentrated sulphuric, hydrochloric, anel nitric acids, but not in alkalies or solutions of hypochlorites. It is probably not poisonous, unless, possibly, when inhaled as gas, AA'hen it may easily become oxidized, and then produce characteristic symptoms. Its two important compounds are tartar emetic, and antimonious chloride or butter of antimony. Tartar Emetic, KSbOdH^Oo. This compound, formed by boUing antimonious oxide with cream of tartar, is sold as a white, crystaUine powder, with a nauseous, styptic, me- tallic taste. It is readUy soluble in hot, and less so in cold, water; strong alcohol faUs to dissolve it, but proof spirits and wine dissolve it according to the amount of water which they contain. It crystaUizes from its solu- tions in the form of colorless, transparent crystals of the rhombic form. Its aqueous solutions decompose readily, on standing, by the action of molds and algae, Avhich form a stringy deposit in the liquid. It is also decomposed by acids, alkalies, plumbic acetate and subacetate, and by astringent solutions containing tannic acid, Avhich forms a more or less insoluble compound with the metal. Physiological Effects—These have been studied on animals as weU as on man. Externally.—When antimonial solutions are rubbed on the skin some local irritation is produced, but the effects are shght. When antimonial ointments have been used in some quantities, the local irritation may get so severe as to form true pustular eruptions which look a good deal like smallpox, accompanied by the specific effects of vomiting and purging, and a lowering of the arterial tension. Similar resiUts have been produced on animals by inhaling antimo- niureted hydrogen. INORGANIC POISONS. 343 Internally.—Minute quantities produce, usuaUy, but a shght nausea and discomfort. As the dose increases these symptoms get worse, until Avith one third or one half of a grain, as a rule, the patients begin to vomit. With stiU larger doses the vomiting becomes more and more severe, AAdth retching, much discomfort, increased perspiration, diminished pulse, muscular weakness, and even faintness. Poisonous Effects.—When the danger hmit is reached the vomiting will usuaUy be violent anel incessant, bringing up mucus, often stained Avith bile, and finally even with blood. This seems to be caused, to some extent, by the local, irritant action of the drug, but, for the most part, by the action of the absorbed antimony upon the vomiting center in the medulla. It has been observed in animals when a rubber bag was substituted for the stomach, and is also generally present when antimony is given externally. The intestines are also affected, and there is violent and severe purg- ing, the stools becoming more and more Avatery, and often having the " rice-water " appearance noticed in cholera. Later they may be bloody. There is generaUy pain and purging in the oesophagus and stomach, and a great deal of thirst. The resemblance to cholera is often strengthened by cramps in the extremities. The urine is often increased at the outset, but, a little later, is gener- aUy scanty, sometimes containing blood, and may be completely sup- pressed. The nervous system is often affected, with more or less loss of sensa- tion, and occasionally with convulsions. The patients almost always are greatly depressed, and feel wretchedly weak and miserable. The circulation is affected very early, the arterial tension being lowered by the action of the drug not only on the heart-centers them- selves, but also on the peripheral vasomotor system. Finally, when the severe symptoms haAre lasted for some time, there are distinct signs of collapse. The face becomes pale and haggard, the eyes sunk, the skin cold and clammy, the extremities cold, the pulse weak, the respiration slow. Death may occur from exhaustion, in a stupor, or in convulsions or even delirium. Other Symptoms.—Occasionally, the vomiting and purging is slight or even absent, and the victims suffer from intense prostration, almost from the start, and die from failure of respiration and circulation, owing to the action of the drug on the centers in the meduUa. Chronic Cases.—In other cases the drug is administered in smaU doses repeated at successive intervals. The same amount of poison is more apt to kiU in this way than when given in one large dose, because in the latter case it is often rejected at once by the violent vomiting. These chronic cases are characterized by nausea and persistent, though not very violent, vomiting, Avith purging or, occasionally, constipation, and with very marked depression. The food cannot be digested, the cir- culation graduaUy fails, and the patients get weaker and weaker, and finaUy die of exhaustion. The Pritchard Case.—Instances of both acute and chronic antimony poisoning occurred in the above case (Edin. Med. Jour., 1865, vol. ii., p. 163, and Archives. Gen,, 1865, part ii., p. 267), where a doctor, in good practice in Glasgow, was convicted of murdering both wife and mother-in-law. 344 A SYSTEM OF LEGAL MEDICINE. His Avife was taken down, in the autumn, AAdth nausea, A'omiting, and general iU-health, and after a week or two went to Edinburgh to Adsit her parents, and improved rapidly. On her return she again began to suffer from retching, vomiting, cramps, pain in the stomach and intes- tines, and great prostration, and finally died some ten weeks after she came back. While she was ill, her mother, Mrs. Taylor, came on to nurse her, and was attacked with similar symptoms a dajr or tAvo after her arrival. She then recovered; but one evening, a fortnight later, after taking some supper, she became violently Ul, vomited, and then fainted, feU into a comatose state soon afterAvard, and died of collapse in six or eight hours. Chemical examination of the remains shoAved the presence of anti- mony in the organs, blood, and urine of both Adctims, anel tartar emetic was also found in food and medicines used by them both. It was believed that Mrs. Pritchard's case was a characteristic one of chronic poisoning, but that Mrs. Taylor died from acute antimony poisoning complicated by the presence of a little mercury, and possibly of some opium. Post-mortem Appearances.—These usually indicate more or less in- flammation of the stomach, and also of the intestines. They are not, as a rule, Aery marked, and in a feAV cases luwe been entirely absent, as, for instance, in the body of Mrs. Taylor, just mentioned. The blood is un- usuaUy fluid, and the viscera are freepiently much engorged; the lungs, especially, are apt to show signs of emphysema, effusion into the pleura, and the like. Indeed, it may be said that there are no particular lesions distinctly characteristic of antimony poisoning, anel death from the latter has not infrequently taken place with but slight changes in the body. Prognosis.—Antimony poisoning differs very distinctly from arsenic poisoning, AA'hich, in some respects, it resembles by responding more or less Avell to treatment. In the first place, the poison is largely eliminated from the system by the incessant vomiting and purging, and what re- mains unabsorbed can be neutralized by giving solutions of tannin, or of green tea or other vegetable astringents, and also of albumen, all of which form comparatively insoluble compounds with the antimony. The depression and prostration, which form such a marked feature of the Ill- ness, must be counteracted by stimulants and Avarmth. Thus cases are reported of recovery from doses of one hundred and seventy grains (Med. Rec.,.1883, vol. xxiv., p. 401), and of half an ounce (Am. Jour. Med. Sei., 1853, vol. xxv., p. 131) and even more, of tartar emetic, after it had been largely absorbed anel had produced character- istic symptoms. Dangerous and Fatal Doses.—It is very hard to determine with this poison at what size of dose to fix the danger hmit. Cases are on record where very A'iolent symptoms have been produced Avith minute quantities. Thus Dr. Richardson (Lancet, 1856, part i., p. 400) prescribed for a patient, who had Avarned him that he was easily affected by antimony, fifteen minims of antimony Avine (two grains of tartar emetic to the ounce), causing thereby incessant nausea for many hours, with abdominal pain and griping, faintness, general exhaustion, and such prostration that the victim could not leave his room for three or four days. Other cases are reported AA'here really serious results came from half'a grain or so of the poison. INORGANIC POISONS. 345 Death has been caused in a ehUd recovering from measles by three fourths of a grain in one hour, and in a medical student, Avith all the usual symptoms of acute poisoning, by two grains. Other fatal cases have been reported, in children from doses of ten and fifteen grains, and in adults from twenty grains and over. According to Taylor, doses of from ten to twenty grains are distinctly dangerous for adults, if taken at one time, and less than that if taken in divided doses. On the other hand, undoubted tolerance exists in many persons, both in health and disease, for very much larger doses. Thus in the old- fashion ed treatment of pneumonia, abandoned now for some years, and also in pleurisy and fevers, it Avas thought good practice to give twenty, forty, sixty grains, and even more, in twenty-four hours, in doses of from two to five grains each. In most cases these did not cause emesis, purg- ing, or other severe symptoms, and in some cases, at least, they seemed to be of benefit to the patient. It was customary, in these cases, to try to establish a tolerance in the first day or two, after Avhich the heroic treatment could continue without much danger. If, however, after the second day emesis and purging continued, it was very dangerous to push the drug any further. As it was, a good many patients probably died from the treatment, even if cured of the disease. Time of Death.—As before mentioned, Taylor reports a case of a ehUd dying from tartar emetic in three quarters of an hour. In healthy adults death has occurred from this poison in seven hours, and two or three deaths have been reported in ten hours. As a rule, however, the patients live for twenty-four hours at least, and generaUy die in the course of some days after the fatal dose. Elimination of the Poison.—The poison absorbed into the system is eliminated with considerable rapidity by the kidneys, and also in the mUk, and through the mucous membranes of the stomach. To proA'e the latter, Dr. Brinton (Lancet, 1853, part ii., p. 599) injected ten grains of tartar emetic into the femoral artery of a dog, who at once feU in col- lapse, and in fifteen minutes antimony was found in the contents of the stomach. The poison is also ehminated by the liver, and in chronic cases it is common to find inflammation of both liver and kidneys. But, more than other poisons, tartar emetic is largely expeUed from the body by vomiting and purging, so that it is impossible to tell how much of a given dose ever enters the circulation at aU. It is this prop- erty Avhich causes such uncertainty about the size of a fatal dose. For all these reasons, in a chemical examination it is very rare to find any large amount of antimony in the body, and to insist, as laAvyers are fond of doing, that unless a full poisonous dose is isolated from the tissues the victim did not die of antimony poisoning, is absurd. In- deed, Avhile criminals have been convicted of antimony poisoning, and plenty of bodies undoubtedly poisoned hy antimony have been analyzed, it is doubtful if such quantities of absorbed antimony have ever been separated from a dead body. To illustrate this, it may be mentioned that in the Pritchard case, above mentioned, antimony Avas found in aU the tissues and organs of the bodies of both women, but in smaU quantities, the liver, intestines, 346 A SYSTEM OF LEGAL MEDICINE. kidneys, and stomach of Mrs. Taylor containing about one anel a half grains, and the same organs of Mrs. Pritchard, about four and a half grains. In the Ann Palmer case, in 1865, the internal organs contained about four grains, and in the Hardman case, from one half to three fourths of a grain. Tests for Antimony.—(a) Sulpliureted Hydrogen.—If this gas is passed through a Avarm solution of tartar emetic or other antimony salt, acidified Avith hydrochloric acid, there avUI be formed an orange-red pre- cipitate of antimonious sulphide, Sb2S:s. The precipitate readily dis- soh'es in concentrated hydrochloric acid and in caustic alkalies, but not in amnionic hydrate. This hydrochloric acid solution, when cold, if added to several times its bulk of water avUI form a white precipitate, wliich dissoh-es readily in tartaric acid. This test is very deUcate, being perceptible with 1-10,000 of a grain of antimonious oxide in five grains of solution; but when made in com- plex solutions containing organic matter and other compounds, the color of the precipitate is often obscured by the color of the solution, and the precipitate itself may be masked by the precipitation of sulphur. (b) Iteinsch's Test.—When a bright strip of metallic copper is boUed with a solution of antimony acidified Avith hydrochloric acid, the coppeT will become coated Avith a violet or gray coating of metallic antimony. This may easily be mistaken for the simUar deposits made by arsenic, bismuth, mercury, and other metals. The deposits of antimony, arsenic, and mercury will produce subli- mates, when the Avashed and dried slips of copper are heated in a smaU reduction-tube. The antimony subhmate wiU be near the slip, and amor- phous or granular, Avith very few if any crystals; whUe the arsenic avUI sublime half an inch or so from the copper and consist almost AAdioUy of octahedral crystals. The mercury sublimate is composed of smaU globules. But, better than this, if the coated copper is boiled with a dilute solu- tion of caustic potash, the antimony aa'UI dissolve, especially if the copper is hfted out and exposed to the ah- every now and then. ' This solution, when acidified Avith hydrochloric acid and concentrated, wiU give an orange-red precipitate with sulpliureted hydrogen. (c) Zinc Test.—If a drop of an antimonial solution, acidified with hydrochloric acid, is placed in a platinum dish, and a small piece of zinc is placed in it, there aauII form on the platinum a black or brownish stain of metallic antimony. This can be identified by moistening it Avith nitric acid, evaporating it to dryness, and touching the spot with am- monium sulphide, AAdiich will form orange-red antimonious sulphide. (d) Marsh's Test.—This test, when made exactly as described in the next section under the tests for arsenic, will give similar reactions for antimony. In case it is thought best to test the gas by making stains on porcelain, or by depositing the metal in the tube, by the Berzelius Marsh test, the antimony can be distinguished from arsenic by not dis- solving in a hot, strong solution of bleaching powder. They'both dis- solve in yelloAv ammonic sulphide solution, but antimonv leaves, on evap- oration, orange-red stains of antimonious sulphide, insoluble in ammonia, and soluble in concentrated hydrochloric acid, while the deposit of yel- Ioav arsenious sulphide, formed in the same Avay dissolves in ammonia, but not in hydrochloric acid. INORGANIC POISONS. 347 A better and more satisfactory m'ethod of distinguishing the two metals is by passing the gas into a solution of argentic nitrate. The antimony wUl be deposited as black argentic antimonide, Ag3Sb, AvliUe any arsenic present avUI dissolve in the hquid. To prove the presence of antimony in the deposit, the latter is filtered off (the filtrate being reseuwed so as to examine it later for arsenic) and boiled AAdth dilute hydrochloric acid, which will dissolve the antimony and not act on the silver. The latter is then filtered off, and the solution tested AA'ith sul- pliureted hydrogen. This test is extremely delicate, and avUI give a good deposit (Wormley) with 1-20,000 grain of antimonious oxide, or 1-8000 grain of tartar emetic. Separation from Organic Material.—When examining material like food, medicines, vomited matter, the contents of the stomach and intes- tines, and the like, it is possible to extract antimony by acidulating Avith a httle hydrochloric acid, and then heating with tartaric acid, straining, and filtering. The solution is then treated with sulpliureted hydrogen and allowed to stand for some hours, and the precipitate filtered off. This precipitate, which wUl contain all the antimony as sulphide, along with sulphur and the sulphieles of other metals, should be boUed in strong hydrochloric aedd, until the sulphur fumes have disappeared, and then filtered, if necessary. This solution can be tested by the zinc and Reinsch's tests, and also by the addition of a large quantity of water, in which case the resulting Avhite precipitate should be soluble in tartaric acid, and react Avith sulpliureted hydrogen. Or it may be placed in a Marsh's apparatus and passed into argentic nitrate. In examining the tissues for absorbed antimony the organic matter should be destroyed as thoroughly as possible by boihng with hydro- chloric acid and potassic chlorate, and the antimony separated from the solution, as before, by sulphureted hydrogen. When the exact quantity of antimony is to be determined, the pre- cipitate thus obtained should be purified by evaporation in an evaporat- ing-dish Avith some strong nitric acid, and then, after moistening the residue with a strong solution of potash, by reeYaporation and fusion. The antimony is then dissolA'ed out AA'ith boUing tartaric acid, and re- precipitated by sulphureted hydrogen, after adding a httle hydrochloric acid. This precipitate, carefully Avashed, can be collected on a weighed filter, Avashed, dried, and weighed. The Wharton Case.—The AAdiole question of the tests for antimony was worked over most carefully in connection with this famous case. In 1872 Mrs. Wharton, a member of a Avell-knoAvn and prominent Mary- land famUy, was tried for the murder of General Ketchum. The latter had been taken violently ill AA'hile visiting at her house, and died, under rather suspicious circumstances, a feAV days later; AvliUe, at the same time, another friend of the famUy had suddenly fallen ill and nearly died, after taking some refreshments in the same house. In both cases there were various money transactions which might have acted as an in- ducement for a crime, and also, in both cases, suspicious-looking sedi- ments were found in liquids given the invalids by Mrs. Wharton. The symptoms of General Ketchum, and the post-mortem condition of the body, Avere consistent with, though not especially characteristic of, antimony poisoning, so the case turned entirely upon the chemical CAddence. 348 A SYSTEM OF LEGAL MEDICINE. The latter indicated the presence of tartar emetic in considerable quantities in both the liquids mentioned and in the stomach of General Ketchum. But unfortunately, in every case, the original solutions and the resulting precipitates were thrown away, so that, when the tests were disputed, it was impossible to confirm them. The principal chemical Avitness for the prosecution testified that both the sediment in a glass of milk punch, and the contents of the stomach, gave a brownish-red pre- cipitate with sulpliureted hydrogen, after acidifying with hydrochloric acid; that this dissolved in boihng hydrochloric acid; that this solution, Avhen diluted with large amounts of AA'ater, gave a white precipitate, which dissolved in tartaric acid, and gave an orange-reel precipitate1 when the tartaric acid solution was again treated with sulphureted hydrogen. The above tests are a pretty certain indication of the presence of antimony, but they were not confirmed by any others, except by a very unsatisfactory Marsh's test made by another chemist. Nor Avere any of the precipitates saved or shoAvn in court, although the amount of tartar emetic in the stomach was estimated roughly at twenty grains. Besides this, no attempt was made to remove any, far less aU, of the organic mat- ter, before making the tests. This carelessness ruined the case, for several experts were brought in to testify that the metal itself, under those circumstances, should have been produced. They even Avent to the extreme of making up a solu- tion of gelsemium extract, chloral, beef tea, white of egg, and milk, which they claimed was a fair reproduction of the contents of General Ketelium's* stomach after death, and, by using nearly though not quite the same steps, produced results which to the jury seemed to agree more or less closely Avith those produced by antimony. In short, they fought so hard that the jury disbelieved the chemical evidence on the other side, and accordingly acquitted the prisoner. Whether tlie testimony of some of the experts did not overstep the hmits of scientific and impartial evidence is an open question; but there is absolutely no doubt that, in any case of this sort, a chemist is unpar- donably careless unless he saves with the utmost care everything sub- mitted to him, and preserves, and brings into court, if at all possible, every particle of poison that he can isolate. (See the Wharton trial, pub- lished by Bait. Gazette, 1872; also Reese, Am. Jour. Med. Sciences, April, 1872; Williams, Med. and Surg. Reporter, 1872; Aiken, Richmond and Louisville Med. Jour., 1873, vol. xv., p. 7; and others.) Butter of Antimony—Antimony Chloride—SbCl3. This compound, which at ordinary temperatures is a yellow semi-solid mass, not unlike butter, is used to some extent in pharmacy, dissolved in hydrochloric acid, and is occasionaUy met with in cases of poisoning. Its first symptoms are those of an active irritant or sometimes cor- rosive poison, foUowed by extreme exhaustion and signs of collapse in the course of a A'ery few hours. If this stage can be passed there is a fair chance of recovery, the few deaths recorded taking place Avithin twenty-four hours. (See Taylor, Treatise on Poisons.) For treatment it is AArell to give magnesia and other mUd alkalies in milk, albumen solutions, and the like. Also to give infusions of tannic, and to treat the symptoms of collapse Avith stimulants. INORGANIC POISONS. 349 A simple test for this substance in solution is the addition of a large amount of water, when a white precipitate of oxychloride wUl be formed. Antimoniureted Hydrogen. According to Richardson (Lancet, 1856, part i., p. 508), this gas, in- haled into the lungs of animals, will cause death from collapse, with the characteristic symptoms of vomiting and purging. No cases have been recorded where it has been injurious to man. VI. ARSENIC. History.—The poisonous properties of this element, which is by far the best knoAvn and most important of aU the mineral poisons, have been recognized from the earliest ages of chemistry. The name is first mentioned by Dioscorides Pedanius, a physician of Cilicia, avIio pubhshed a celebrated book on materia medica, about the beginning of the second century a.d. He speaks of arsenikon, or auri pigmentum, as a yeUow or golden mineral, coming from Mysia or from Pontus, with poisonous and astringent properties, " making sores, burning violently, eating away the hair." Later, in his book on poisons, "fhpi Ay]Xy]ty]p[wu apfj.ax(uu," he states how the same mineral taken internally " gives violent pains in the stomach and intestine's, corroding them fiercely. Hence they must take something, as soon as possible, to mitigate the burning and to pro- duce smooth and easy vomiting." He mentions as antidotes the juice of the maUoAv, decoction of linseed, milk, and other soothing beverages. The aboAre eA'idently refers to the ycdlow sulphide, As2S3, orpiment, a not uncommon mineral, which can be easily purified, as Dioscorides mentioned, by gvntle calcination. It Avas probably not long after this that the white arsenic, arsenicum sublimatuni, was discovered, for it is mentioned by Geber in the ninth century, and in the early middle ages we find it already an article of commerce, weU known for its poisonous properties. One of the earhest arsenic cases on record is carefuUy recordeel in the French archives under the date of 1384. A Avandering minstrel, caUed AVondreton, was arrested in Paris for trying to poison King Charles VI. of France, his brother the Duke of Valois, and the Dukes of Berri, Burgundy, and Bourbon. During the trial, under the stimu- lus of torture, he confessed that he had received detailed instructions for the crime from Charles the Bad, King of Navarre. He was told that there Avas a white powdeu-, arsenicum sublimatum, to be found at the apothecary shops in Pampeluna, Bordeaux, Bayonne, and aU the large towns through which he would travel. ''If a man eats from it a piece as large as a pea he wUl never live. Take it and put it into their soups, Avine, or meat, wherever it can be done in safety." It is pleasant to learn that this early attempt proved abortive, and that the troubadour AA'as duly executed. From that time on, arsenic seems to have been a favorite agent for secret poisoning. In a celebrated English case in 1618 Sir Thomas Overbury, secretary to King James I., died of slow poisoning in the ToAver. at the hands of Lord Rochester and his Avife, the infamous Lady 350 A SYSTEM OF LEGAL MEDICINE. Essex. Upon the trial it appeared that arsenic and cantharides had first been employed, but as the victim proved unusuaUy resistant, aqua. fortis, mercury, poAvdered diamonds, lunar caustic, and " a great spider" had also been administered, and he Avas finally kUled by a strong dost1 of corrosive subhmate. The most AA'holesale poisoning, hoAvever, AA'hich the world ever saw took place in Europe from the middle of the seventeenth to the begin- ning of the eighteenth century, AA'hen three Avomen, Tophania in Naples, Spera in home, and the beautiful Marquise de BrinviUiers in Paris, dis- tinguished themselves above their fehoAvs by the skUlful use of sIoav poi- sons. The stories told of this time seem really incredible. It is stated that the strength of the drugs Avas so proportioned as to kih the victim in a Aveek, a month, or a year, Avith perfect surety, and Avithout any re- markable symptoms. The most celebrated of the three, La Tophania, is believed to have kiUed over six hundred persons, and used to send her drops, the aepia tophana, all OArer Italy to her clients, among the fashion- able Avomen of the day. In some cases, it is said, Avhen the aauvcs who wished to rid themselves of their husbands were too poor to buy the medicine, she used to send them vials of it gratis. A letter to Hoffman, in 1718, from GaveUi, physician to the Emperor (diaries VI., states that the drops Avere composed of crystaUized arsenic dissolved in Avater dis- tilled Avith the herb Linaria cymbularia. In those days, and, indeed, avcU up to the early part of this century, it was impossible to distinguish arsenic, with any certainty, in the bodies of patients, or even in the drugs themselves. But after Orfila, Reinsedi, Marsh, and others had made their famous researches on the subject, it graduaUy became understood that of aU poisons arsenic Avas the one most easily and surely recognized by chemical tests. And yet, eA'en up to the present day, oAving to its wide distribution, its cheapness, its lack of taste, the similarity of its symptoms with those of ordinary eiiseases, and the widespread knoAvledge of its powers and properties, arsenic is stiU used, and used probably, far more generally than is supposed, for criminal poisoning, as weU as for suicides. We may eA'en boast, in our oavii country, of having furnished individ- uals, in the last few years, Avho would not be unfit companions for the worthies mentioned above. Mrs. Sherman, for instance, in New Haven, disposed of three husbands, and some seven or eight children, stepchU- dren and others, without suspicion, and Avas only caught, by accident, on the death of husband number four. WhUe Mrs. Robinson, at Som- erviUe, Mass., from February, 1885, to August, 1886, poisoned no less than six members of her immediate family, besides at least tAvo or three more on previous occasions, and she Avas only suspected on the last case. This seems to throw rather a slur upon the state of medical science in these two localities; but it is not a A'ery easy matter to distinguish the symptoms of arsenic poisoning. And while the Sherman woman carefuUy selected rather old and inferior physicians to attend her A'ic- tims, Mrs. Robinson adopted a far more bold and ingenious plan. She waited untU her relatives were sick of some AveU-defined disease, and had them treated by the best physicians in Massachusetts; and after these had made a satisfactory diagnosis, she Avould kiU them off rapidly, AA'ith arsenic, before the time of the next visit. The first woman was caught by the accidental summoning of a bright young doctor, AA'ho at INORGANIC POISONS. 351 once recognized the case; whUe the physician who attended Mrs. Rob- inson's last son thought it strange that a blow in the back of the neck should have such unusual sequelae, and ordered an autopsy. Modern Statistics.—At present, however, the cases of arsenic poison- ing are not as abundant as might be imagined. In the famous May- brick trial, Dr. Tidy, for the defense, claimed, AAdthout much contradic- tion in court, that the symptoms of arsenic poisoning were so varied because there Avere so very many cases of it knoAvn and studied. Dr. Stevenson, who appeared for the crown, looked the matter up after the trial, anel found that, as a matter of fact, this was not the case. In the five volumes of the reports of the Registrar-General of England, from 1883 to 1887 inclusive, he coUected the fohowing statistics. (Guy's Hos- pital Reports, 1889, p. 307.) DEATHS FROM POISONING (1883 TO 1SS7 INCLUSIVE) IN ENGLAND AND WALES. Opium.........................646 Phosphorus and matches.........71 Lead..........................437 Alcohol.........................66 Carbolic acid...................332 Chloral.........................52 Prussic acid....................132 Arsenic........................51 Oxalic acid.....................120 Sulphuric acid...................49 Strychnine.....................106 Ammonic hydrate...............45 Vermin-killer .................. 59 Nitric acid......................29 Hydrochloric acid.............. 90 Mercury and its salts............26 Potassic cyanide................ 74 A\'erage cases of arsenic per year, 10.2. In this country, where the sale of arsenic is not attended Avith nearly so many precautions, and where Paris green and " Rough on Rats " are articles of such common use, cases of arsenic poisoning, especiaUy for suicidal purposes, are more frequent. In the Forty-sixth Annual Registration Report of Massachusetts, published by the secretary of the commonwealth (1888, p. 412), there is found a list shelving the deaths from arsenic in Massachusetts from 1877 to 1887 inclusive: DEATHS PROM ARSENICAL POISONING. Years. Homicidal. Suicidal. 1877, six months................. .. 2 187S.............................. 2 1879.............................. 6 1SS0............................ 2 3 1881............................... 3 1S82.............................. 2 1883.............................. 3 1884.............................. 16 1885.................V............ 12 1SS6............................ 6* 14 1887............................ 1 35 9 9S 7 114 In a New York City Board of Health report for 1892 are pubhshed some interesting statistics, which teU much the same story. The cases of homicide are not given, but the accidental deaths for idental. Total 2 1 3 6 2 7 3 0 1 4 16 1 13 2 22 36 * Eobinson cases, recorded in year when investigation was made. 332 A SYSTEM OF LEGAL MEDICINE. twenty-one years and the cases of suicide for the year 1891 are reported in much detaU. Accidental Deaths in New York City from 1870 to 1891 inclusive. Illuminating-gas (of which 266 Oxalic acid......................14 were from 1SS0 to 1891inclusive).279 Ether...........................11 Opium, morphine, etc...........179 Potash.......................... 8 Lead...........................113 Aconite......................... S Carbolic acid................... 5S Potassic chlorate................. 7 Arsenic and its compounds...... 42 Muriatic acid.................... 6 Chloroform..................... 34 Nitric acid....................... 6 Chloral......................... 26 Phosphorus...................... 6 Mercury........................ 19 Minor poisons Coal gas.........................14 Total number of deaths...................................977 In this table arsenic stands far higher in the list than it does in England, AvliUe the next table, that of suicides, shows the same astonish- ing state of things as in Boston. Suicides in New York City for the Year 1891. Gunshot.......................104 Carbolic acid.....................9 Hanging....................... 50 Drowning........................9 ( Paris green___20 i Prussic acid and potassic cyanide Arsenic \ Rough on rats.. 12 > • • 35 (each, 3).......................6 ( White arsenic .. 3 ) Chloroform.......................3 Cuts and stabs.................. 24 Strangulation.....................3 Falls and leaps................. 22 Aconite (?), ammonia, belladonna, Illuminating-gas................ 19 corrosive sublimate, ether, muri- Morphine and opium (each, 5) ... 10 atic acid (each, 1)..............6 Total number of suicides.................................300 It is difficult, on comparing these figures Avith the English statistics,. not to beheve that there are far too few restrictions upon the sale of arsenic in this country. Surely the number of suicides alone from arsenic in one city hke Xcav York, or one State like Massachusetts, ought not to be three or four times as many as aU the cases in England and Wales. Indeed, some stringent legislation on the subject was passed in Massachusetts the year of the above report. Occurrence in Nature.—Arsenic is found to some extent in a free state, as a black metallic solid. It is more frequently, however, extracted from some of many minerals, in which it occurs combined with metals such as iron, copper, cobalt, and nickel, or with sulphur. The most im- portant ore of arsenic is the arsenical iron pyrite, or mispickel, FeAsS, but the arsenides of iron and of cobalt are also sprite common. The lat- ter, indeed, is often powdered and sold in bulk, as a fly poison, under the name of " cobalt." The two sulphides of arsenic, orpiment, As2S3, and realgar, As2 So, are not uncommon minerals, and we also occasionaUy find in nature smaU quantities of arseuious acid, As203, and of arseniates. Besides this, arsenic in smaU quantities is distributed very widely. As a common impurity of iron pyrites it occurs in many soils, generally in an insoluble state, and, being also found in sulphur, it is present in almost aU samples of oU of vitriol, and of the many compounds—hydro- INORGANIC POISONS. 353 chloric acid, bleaching powder, sulphates, carbonates, and hydrates of soda and potash, and the like—prepared by its use. From the sulphuric acid it also finds its way into the various superphosphates and other artificial manures, and hence into plants; so that arsenic has been dis- covered in turnips, cabbages, potatoes, and other common vegetables, as Avell as in straAA', Avood, and charcoal. From its association Avith pyrite it is not at aU uncommon to find arsenic in coal, in quantities running as high as fifteen or tAventy grains to the pound. This arsenic is of course volatUized on burning, and again appears in the smoke and soot. Arsenic is also a common impurity in many metals and metaUie salts. It is difficult to get zinc perfectly free from aU traces of it, and it is fre- quently found, sometimes in comparatively large quantities, associated with antimony and bismuth, as, for instance, in common drugs hke tartar emetic and bismuth subnitrate. Of course, in ah these cases it never occurs as crystallized white arsenic. It is present in smaU quantities in sea-water, and is frequently found, sometimes to a medicinal extent, in mineral Avaters. Thus it has been traced in practicaUy all the iron or chalybeate springs, both of this country and abroad, and has been found in the celebrated Avaters of Vichy, Ems, Wiesbaden, Pyrmont, Ripoldsau, Carlsbad, and others. Among the most famous arsenical springs are those of Bourboule, in France, and of Roncegno, in the Southern Tyrol, in AA'hich last Avater Gliiser and Kalmanu (Berichte, vol. xxi., 1888, pp. 1637, 2879) found nearly nine and a half grains of arsenic acid (equivalent to over seven grains of AAdiite arsenic) to the gaUon. In this country some interesting arsenical springs have been found in the YeUoAvstone Park, the AA'ater from the Hygeia Spring, for instance, AA'hich is much used for bathing, containing about one fifth of a grain of Avhite arsenic to the gaUon (A. Hague, 1885). Arsenic in Graveyards.—The arsenic naturally present in the soU is almost ahvays combined AA'ith iron, in such an insoluble form that hot concentrated aciels are necessary to separate it. In seA'eral instances, bodies h&ve been buried for months in an arsenical soil, eA'en in Avet Aveather, and no trace of arsenic has penetrated the corpse. (See Son- neuscliein, Gerichtl. Chemie, 1881, p. 139.) These cases occurred, how- ever, when the system of arsenical embalming, iioav so common in the United States, Avas either prohibited or unknown. And at present the graA'eyards are so fiUed with soluble salts of arsenic, from this cause, that post-mortem absorption in this way must be considered as epiite possible, if not indeed probable, in many eases. It Avas claimed at one time, by as good an authority as Orfila, that arsenic AA'as a normal con- stituent of the body. This, liOAA-eArer, has been completely disproved. Occurrence in the Arts.—Besides the cases above mentioned of sul- phuric acid and its compounds, AA'here arsenic is accidentally present in substances largely used for manufacturing purposes, there are many special Avays in which arsenic, more or less disguised, is AAddely distrib- uted anel freely used. Tn Medicine.—Arsenic is usually prescribed by regular practitioners in the form of FoAvler's solution, a one-percent, solution of AA-hite arsenic in potassium bicarbonate. OccasionaUy the arsenates of soda and potash are used for the same purposes (Brett's and Pierson's solutions). But, 351 A SYSTEM OF LEGAL MEDICINE. leaving aside the numerous quack medicines, Avhich A'ary from the "complexion Avafers," containing infinitesimal traces of arsenic, to the blisters of almost pure arsenious acid AAdiich have been used, with often- times such fatal results, by the "cancer doctors," Ave also find in the catalogues of nearly aU the manufacturing chemists many varieties of arsenic-containing piUs, under the most A^aried names. The amount of arsenic in these piUs varies, as a rule, from one twentieth to one thirtieth of a grain, and it is generaUy combined Avith either iron, strychnine, or epiinine, so as to act, as far as possible, as a general tonic, a nerve tonic, or as an antidote to malaria. As a Household Poison.—The amount of arsenic compounds sold and used for this purpose is enormous. "Rough on Rats" is the most com- mon, and consists practically of pure arsenious acid. It is very com- monly used, especiaUy in cities, for committing suicide; whUe occasion- aUy murders, and frequently accidents, are reported from its use. Paris green, or aceto-arsenite of copper, known to chemists as SchAveinfurth green, is in frequent use not only on potato and tomato vines, but also on fruit trees and different kinds of plants and vegetables, to rid them of noxious insects. Its bright color is the best safeguard against accidental poisoning, which is largely confined to cattle and stock feeeling upon the poisoned plants. It is, however, constantly used for suicide. London purple, a waste product from the anUine factories, contain- ing some forty percent, of Avhite arsenic, is also largely employed instead of Paris green. As a fly poison, metaUic arsenic sUghtly oxidized, powdered " cobalt," and papers steeped in solutions of arsenic or of alkaline arsenites, are widely sold. These have served as a source of poison in many cases. Arsenic soaps, consisting of white arsenic, alkali, and soft-soap boiled down together, are in common use on sheep farms to rid the animals of lice and similar vermin. They have frequently caused death by acci- dent ; in one case a whole family of five or six persons was destroyeel by using drinking-water carried in a pail in which this soap had been kept. FinaUy, solutions of arsenic are occasionaUy used, more, however, in Europe than in this country, to eradicate weeds. Indeed, only a couple of years ago, in a little Scotch village near Edinburgh, over a hundred people were seriously poisoned with sugar bought from the local grocer, which, as was afterward proved, had been in the same cargo Avith some leaky cans of "weed killer." (Lancet, 1891, part i., p. 900.) In Paints, Wall-paper, Fabrics, etc—Arsenic is the source of many briUiant colors, as, for instance, the Paris or Schweinfurth and Scheele's greens, and also certain briUiant purple colors. These contain large quantities, often thirty percent, or forty percent, of arsenic, and, being distinctly poisonous, should be used with great care. Accidents are liable to occur from chUdren licking these colors from the covers of books, kindergarten toys, Christmas cards, and the like. Occasionally also there may occur cases Avhere dresses, curtains, and other fabrics, or eA^en AvaU-papers, unglazed and thickly coated with such pigments, may prove injurious. These colors, hoAvever, are nowadays rarely, if at all, used in places where they might prove dangerous, and their use in wall- papers has disappeared almost entirely. In the manufacture, however, of many of the aniline dyes arsenic INORGANIC POISONS. 355 acid is frequently used for oxidation, and although almost entirely re- moved in subseepient operations, generaUy leaves traces of arsenical compounds behind. The arsenic thus left is in extremely smaU quanti- ties, and as a rule can haA'e no injurious effects; and yet such is the common prejudice against the very Avord arsenic that the merest trace of it is enough, in the common opinion, to cause a suspicion of poison- ous properties. A curious case of this sort came under the writer's notice in 1889 (Swain vs. Schieffelin). Nearly a hundred people in Brooklyn, one night, after inehUgiug in ice-cream made by one confectioner, were taken AA'ith symptoms of acute irritant poisoning. Most of the cases were diagnosed as due to arsenic, and Avere treated as such, but some doctors withheld their diagnosis, largely on account of the rapid and complete recovery of all the cases. An inspector of the Board of Health, prowling around the ice-cream factory, came across a smaU bottle of a red solution, used for coloring the straAvberry ice-cream, tested it for arsenic with Marsh's test, reported it full of arsenic, and held it responsible for aU the symptoms. Whereupon the ice-cream manufacturer brought suit for $10,000 dam- ages against the firm supplying the coloring matter, for selling him poisonous goods. The resulting laAVSiiit shoAveel great carelessness in the manufacture of the ice-cream, and it AA'as proA^ed that the cream in question had been made up from some left over from a preA'ious occa- sion, which had been melted up and refrozen. The symptoms, also, Avere evidently those corresponding to ptomaine (tyrotoxicon) poisoning, and not to arsenic. But although the arsenic in the coloring matter AA'as so minute in quantity that the AA'hole bottle could have been drunk with impunity, and the dye Avas so powerful that only one and a half or two ounces (half a Avine-glass fuU), containing from one thirtieth to one fiftieth of a grain of Avhite arsenic, were used for twenty-six quarts of the cream, the intelligent jury brought a verdict against the chemical firm, and the verdict Avas sustained by a higher court. (a) Metallic Arsenic. This substance is occasionaUy found native in sufficient quantities and purity to be used as such, but is generaUy prepared by reducing the arsenious oxide Avith coal or charcoal. When pure it is steel-gray in color, AA'ith a metallic luster. It is very brittle. In moist air it sloAvly oxidizes, and becomes duU and dark gray in color. When heated it volatilizes, Avithout melting, with a character- istic garlic odor. At a red heat it burns with a bluish flame, emitting Avhite fumes of arsenic acid. It is not soluble in hydrochloric acid, but dissolves in sulphuric and nitric acids, the latter oxidizing it to arsenic acid. If this last solution is evaporated to dryness and then moistened Avith a strong solution of argentic nitrate, it will turn a brick-red color, OAving to the formation of argentic arsenate. It can be readily recognized by this test, and also by the fact that it is easily soluble in a hot, strong solution of bleaching powder. A better test, however, is to put it into a narrow reducing-tube, and to heat it until it sublimes. The sublimate, which is of a steel-blue color, or Avhen very faint is brown, can be chased, on careful heating, up 356 A SYSTEM OF LEGAL MEDICINE. and doAvn the tube, and, especially if a little air is admitted, can be easily turned into a white deposit of arsenious oxide, AA'ith its characteristic octahedral crystals. Poisonous Effects.—Metallic arsenic, as such, is supposed to have no marked effects on the system, but it is readily oxidized to arsenious oxide, in which case, of course, it has the properties of that substance. In the few cases of poisoning reported, it has been used either pure or as cobalt, a native arsenide of cobalt, poAvdered to serve as a fly poison, and its effects have been in ever}' respect similar to these of ar- senious oxide. (b) Arsenious Oxide—As203. White Arsenic, Arsenious Acid ("Rough on Rats"). As before mentioned, this substance has been known as a poison for many hundred years, and is indeed almost universally meant by the term arsenic. It occurs in small quantities in nature, but is manufactured for the market in enormous cuiantities, by roasting and subliming arsenical ores, such as mispiekel or arsenical iron pyrites, FeAsS. The fumes are condensed in a series of brick chambers, upon the AA'aUs and floor of which the arsenic collects, in large or small crystals. In some places the arsenic is caught in iron hoods placed over the roasting-furnaces. These get hot enough to melt some of the arsenic, AA'hiedi fuses into a thick, glassy cake, with loose layers of Avhite crystals upon it. This last layer is chipped off of the cake by hand. Properties, Physical and Chemical.—Arsenic is usually sold as a white, heaAry powder, but occasionally as the hard solid masses of molten arsenic described aboA'e. The latter are colorless and almost transparent when fresh, but on exposure to the air soon become opaque and AA'hite, looking like porcelain, oAving probably to a partial crystallization. The powder may be formed from grinding these lumps, but generally comes from grinding the crystals, which are octahedral and vary greatly in size. Many, indeed, are quite small enough to pass the finest grindstones un- crushed, varying in size from 1-250 to 1-5000 of an inch in diameter. Hence under the microscope it is often possible to identify a specimen of arsenic by carefully studying (a) the percentage of crystals, (6) their size and diameter, and (c) their surface, striations, brilliancy, etc. This Avas attempted, Avith very considerable success, by Prof. E. S. Dana, of NeAv Haven, in the famous Mary Stannard, or Hay den, trial, AA'here he tried to show, first, that the arsenic found in the girl's stomach Avas identical Avith that bought by Mr. Ilayden a few days before; and second, that the package of arsenic claimed to have been bought by the defend- ant a few days before in the neighboring toAvn, had, in fact, come from a different locality. The microscopic appearance is altered to some extent by soaking in water and other fluids, but often not enough to spoU this examination. Arsenic is quite heavy, one teaspoonful Aveighing about one hundred and fifty grains, and a tablespoonful about three hundred and fifty grains, or about three fourths of an ounce. (Taylor.) It is, howeA^er, perfectly possible to suspend quite large quantities in thick lieiuids, like cocoa, gruel, and the like, so that its presence is not suspected. INORGANIC POISONS. 357 SmaU doses of arsenic have no taste, but when in large doses its taste has been variously described as slightly acid, metalhc, sharp, sweetish, salty, and so on. This can be entirely concealed by the taste of food or drink. Arsenic is sparingly soluble in water, and eA^en less so in organic liquids, like tea, milk, beer, etc. According to Taylor, cold AA'ater, aUoAved to stand on arsenic for many hours, dissolves from one half to three quarters of a grain to the ounce. If the Avater is boiled on it for an hour and then allowed to cool, it retains some tAvelve grains to the ounce. The amorphous or A'itreous arsenic dissolves some three times more readUy in cold Avater, and in boiling Avater dissolves to the extent of fifteen or sixteen grains (Seidel in Maschha, Gerichtl. Medecin). Its solution is slightly acid in reaction, and deposits octahedral crystals on cooling or evaporation. Arsenic is easily soluble in both acids and alkalies, the latter forming salts of meta- arsenious acid, HAs02, or occasionaUy of the normal acid, H3As03. Arsenic in alkali solution tends to oxidize into the arsenic oxide, As205, and hence is somewhat used as a reducing agent. It sublimes at a low red heat in the form of a AA'hite cloud, and if charcoal is present, Avith a garlic odor. It deposits readUy in octahedral crystals. Properties, Physiological.—In small quantities arsenic acts as a distinct tonic. It increases the appetite and the nutrition of the body. Its effects are most marked upon the stomach and intestines, but it also seems to directly benefit the blood, and to stimulate the nervous system. It is, indeed, largely used as a medicine in a Avide range of diseases. Next to quinine it is the most valuable drug for the treatment of mala- ria. It is largely used for dyspepsia, for a A^ariety of skin diseases, and especially in the treatment of certain nervous diseases, hke chorea, for example. In these eases it is given, as a rule, in the form of Fowler's solution, in doses ranging from five e>r six drops up to sixty drops a day. The latter dose, twenty drops three times a day, is about as high as it is safe to go, and AA'hen kept up for a long time may produce trouble. In- deed, when given medicinally, in f 11U doses, for some time, arsenic often seems to accumulate in the body, and, Avhen once the more marked symptoms begin to show themselves, the injurious effects often distinctly increase, for days and weeks after the drug has been discontinued. The first injurious symptoms noticed Avith these full medicinal doses are usually connected AA'ith the digestion, and consist of nausea, vomiting, pain, and diarrhoea; and also AA'ith the skin, itching, eczema, conjunctivitis, and the like. These symptoms can easily develop into those of chronic poisoning, mentioned below. Poisonous Symptoms.—When arsenic has been administered in doses large enough to endanger life the symptoms that may present themselves are very numerous. It is acknoAvledged by all the best authorities that arsenic* symptoms present more anomalies than those of any other poi- son, and to insist, as is often done in a defense, notably in the case of Mrs. Maybrick, that arsenic is not the cause of death because one or two common' symptoms are absent, is wholly unjustifiable. The effects of arsenic vary with the size of the dose, Avith. its form, whether dry or in solution, Avith the emptiness and condition of the stomach, with the gen- 358 A SYSTEM OF LEGAL MEDICINE. eral health and idiosyncrasy of the patients, with the treatment given to them, and many other conditions. It must be remembered that arsenic is not only an irritant like sul- phuric acid or caustic alkali, but has certain specific effects as AveU. Thus, in the ordinary forms of arsenic poisoning, Ave have symptoms of irrita- tion and inflammation of the gastro-mtestinal tract, vomiting, nausea, tenesmus, pain in the stomach and abdomen, and the like. In other cases the arsenic seems to pass directly into the blood and thus into the cerebrum, and overwhelms the whole nervous system. The stomach symptoms may be entirely absent, and the patient fall into a heavy narcotic sleep, and die in a state of coma. While the poison is being eliminated, a process wliich begins very soon after it is taken, it generaUy causes fatty degeneration in the liver, heart, and kidneys, the symptoms from Avhich are often very prominent. And with these we often find an irritation of the conjunctiva, and also of the skin, AA'ith pains in the legs and loAver extremities. Finally, if the arsenic is in the system for some length of time, a week or more, Ave are apt to have a series of chronic nervous symptoms,. due to a gradually progressing, multiple, peripheral neuritis, which may finally terminate in complete paralysis. Accordingly we can roughly subdivide the cases of arsenical poison- ing into four heads: 1. Acute; 2. Sub-acute; 3. Cerebral or narcotic; 4. Chronic. i. Acute Cases.—As a rule, where large doses of arsenic have been taken the main action of the poison is upon the digestive tract. The first symptoms noticed are of weakness and faintness, generaUy in half an hour or an hour after the dose. Then comes vomiting, Adolent and inces- sant, a very constant symptom, beginning generaUy within two or three hours after the dose and continuing almost always until death. The vomited matter is partly a Avatery secretion, and partly a thick glairy mucus, often containing bUe and sometimes streaked with blood. Accompanying this is dryness of mouth and throat, great thirst, and pain in the stomach. This last is usuaUy strongly marked, and is a sensa- tion of burning. Next comes diarrhoea, a less constant symptom, which is absent, or comes very late, in many well-marked cases. It is usually accompanied Avitha good deal of tenesmus. The discharges are gener- aUy yelloAvish, and very loose, often of the rice-water type, and occasion- aUy blood}-. The urine is usually scanty, of a dark red color, and is sometimes entirely suppressed. After these symptoms have lasted a greater or less time there are signs of collapse. The pulse gets quick and feeble, the face white and sunken, the eyes deep, the lips blue, the skin cold and clammy, often covered Avith a cold sweat, and the patient dies sometimes in convulsions and sometimes in coma. These cases usually die rapidly, in six to twelve hours as a rule, cer- tainly in less than tAventy-four hours, and the cause of death seems to be the shock from the intense inflammation of the stomach and intestines. Some of the cases are a good deal Uke cases of cholera. 2. Sub=acute.—If the dose of arsenic is smaUer, or the excess of the poison is eliminated quickly by A-omiting, antidotes, and the hke, the above symptoms may be less strongly marked, may come on more slowly,, and continue longer. INORGANIC POISONS. 359 In these cases the A'omiting is the most consistent and constant symp- tom, and the stomach and abdomen are usuaUy distended and very ten- der. All of the above-mentioned symptoms of inflammation of the digest- ive tract are or may be present, but in addition we have the signs of inflammation of the liver and kidneys. Arsenic is ehminated by these organs in a very short time, that is, tAvo to four hours after its ingestion, and if in large quantities, almost invariably sets up acute inflammatory changes, Avith fatty infiltration. This change in the kidneys is indicated by scanty, high-colored urine, containing albumen, casts, and occasion- aUy blood. The skin, AA'hich is hot and dry in long-continued cases, often gets covered with a rash; the tongue is cracked and dry; the lips and gums are often inflamed and bleed easUy; the patients are more or less jaun- diced, and the eyes become yeUow, with congested conjunctiva*. The patients often complain of pains in the legs and thighs. Death, which occurs in two or three days or even later, is, as before, generally from collapse, and is preceded by prostration and then coma, or by delirium. Appearance of First Symptoms.—The first signs of poisoning, such as faintness and nausea, usually appear pretty rapidly, i.e., Avithin an hour after taking the poison. Cases are on record where the symptoms came on in the act of eating poisoned food. On the other hand, even when large doses haA-e been taken Avell-marked symptoms have been delayed for many hours. This seems due, in some cases, to the arsenic being mixed AA'ith food and hence not being easily absorbed, and in some cases to the action of sleep, or the use of morphine or of alcohol. In most of these cases the later symptoms belonged to the narcotic type. In one case (Med. Gaz., 1851, vol. vii., p. 722) a strong, healthy man, while drinking, took half an ounce of arsenic in a glass of beer, wash- ing the poison cIoavii with some AA'ater. He A'omited once in an hour or so, and then lay down and slept tih the next morning, when, about nine hours after taking the poison, the characteristic symptoms of A'omiting, thirst, pain in the abdomen, etc., appeared. His brother, who slept in the same bed, considered his sickness was caused by his drink, and did not learn of the arsenic until noon. The man died in about three days. In another case (Hartshorn, Phila, Med. Exam., 1855, vol. xi., p. 707), where the symptoms were delayed for sixteen hours, a girl took a dose of poAvdereel arsenic at 9 p.m. and another at 9 a.m. the next morning. About eleven o'clock she had hysteria, but no evidences of an irritant poison, and they gave her water, the first she had taken for thirty-six hours. At 1 p.m. there appeared violent pain and vomiting. In still another case (Lond. Med. Times, 1819, vol. xix., p. 26), no marked symptoms occurred for twenty-three hours; but there were sus- picions that the patient was under the influence of morphine at the time. Time of Death.—-This varies greatly, but, as a rule, takes place in less than twenty-four hours when large doses have been taken. Out of twentv-nine recent cases in Massachusetts, quoted by Dr. Abbot (Boston Med. and Su>-g. Jour., 1889, vol. cxx., p. 480), the longest lasted six days and the shortest six hours, Avhile the average time was sixteen hours." The average of the rest, leaving out the six-day case, was about eleven hours. The shortest time on record is given by Dr. Taylor as twenty mm- 360 A SYSTEM OF LEGAL MEDICINE. utes, and in another case (Von Tschudi, Wien. Med. Wochensch., 1851, p. 455) a peasant is stated to haA'e taken a smaU lump of arsenic, mixed with water, and died in half an hour. These rapid cases, as, for instance, the one quoted beloAV, AA'here death occurred in an hour, are usuaUy of the cerebral or narcotic type; but Taylor gives an interesting case (Guy's Hospital Reports, 1851, p. 183), Avhere a Avoman took a teaspoonful of poAv- dered arsenic, AAdth a little water, on an empty stomach; had A'omited thoroughly and Avas suffering great pain when the doctor saAV her in an hour and a half; and, in spite of treatment, died of coUapse in tAvo hours and a half. Death may be delayed for quite a time after the administration of the poison. Cases of eleath in six and seven days are not at all uncom- mon, and patients have been known to linger for weeks or even months, and still die from the effect of the arsenic, either upon the digestion or, secondarily, upon the liver and kidneys. A famous case, often quoted, is that of Dr. Alexander (Med. Times and Gaz., 1857, p. 389), a prominent Irish clergyman, who was given some arroAvroot in Avhich the grocer had carelessly mixed arsenic. In spite of prompt treatment he died in sixteen days, and on the trial of the grocer for manslaughter it was proved that his death was due directly to the poison, although not a trace of poison could be found in the body. Illustrative Cases.—Dr. Taylor quotes an interesting example of sub- acute arsenical poisoning in the case of some three hundred and forty chUdren in an industrial school near London, who Avere given mUk ■dUuted Avith Avater from a boUer containing a solution of arsenic. The amount of arsenic taken by each child was about a grain, and the symp- toms, shivering, pain in the stomach, and, in most cases, vomiting, de- veloped Avithin an hour. In about three hours after the meal they had more or less severe pain in the forehead and Avatery running of the nose. Seven had a croupy sort of cough, three vomited blood, and one passed blood by the bowels. Some had distinct gastritis; but as the cause of sickness Avas speedUy recognized, and treatment Avas applied at once, all recovered, and only six were being treated at the end of a week. The treatment consisted of giving gum-water with albumen, and of keeping up vomiting by emetics and greasy water for twelve'hours, finishing Avith doses of castor-oU. A famous example of one of these cases was that of the Due de Choi- seul Praslin, who, when arrested after brutaUy and clumsily murdering his wife, poisoned himself with a large dose of arsenic. The story goes that the clever and ingenious French detectives, before taking him to prison, searched him and his clothes thoroughly from head to foot. They finally made him change his coat and put on a dressing-goavii, in the pocket of AA'hich there happened to be, unknown to them, a package of arsenic, which he had bought some time previously, probably for his wife's benefit. He took this, and in a few hours began to vomit auo- lently. He had no diarrhoea, except an involuntary movement on the second day, had no conjunctivitis, no cramps, no pain in his abdomen until the fourth day, probably oAving to his having been given some morphine early in the attack. His doctors, the best in Paris, were much bothered, diagnosed it for the first two days as cholera, and then as laudanum poisoning, and INORGANIC POISONS. 361 finally found out the true cause by analyzing the ejecta. He died of collapse on the sixth day. An interesting series of cases of this class is reported by Dr. Steven- son (Guy's Hospital Reports, 1875, vol. xx., p. 145), where eight persons in one family Avere poisoned by drinking water kept in a paU which had been used for an arsenical sheep-wash. Five of these died, in six, seA'en, twelve, thirteen, and thirteen days respectively from the time of the fatal dose. Of the eight patients, all had persistent and violent vomit- ing ; only four (three of whom died) had diarrhoea, seven had conjunc- tivitis, and five had a rash or eruption on the skin. 3. Cerebral or Narcotic.—In these cases the signs of gastric or in- testinal irritation are almost entirely absent. The principal symptoms are great feebleness, with a weak pulse and cold skin, dizziness and pal- lor, and cold extremities. The patients generaUy sink into a heavy nar- cotic sleep, from Avhich they cannot be roused, and die in a state of coma. Sometimes they may remain conscious, although sinking, untU near the end, and die in a state of collapse, occasionally with convulsions. These cases are not Arery commonly met Avith, and usuaUy are due to the rapid absorption of the poison, which has either been taken in solution, or, if dry, in large quantities on an empty stomach. The time of death in these cases is usually quite short. These patients rarely survive twenty-four hours, and have been known to die very rapidly indeed. Heath in One Hour.—One of the most rapid cases ever reported is given by Dr. Finley (Lancet, 1883, part ii., p. 943). A healthy man, aged fifty-one, had drunk by mistake, upon an empty stomach, a solution con- taining about twenty-six grains of arsenic. He was taken almost at once with faintness and collapse, Avith some epigastric pains. He was brought to the hospital in about half an hour, and had not yet vomited. His symptoms were cold skin, a free, clammy sweat, feeble, slow pulse, shallow respiration, pupils moderately dilated. He was still con- scious, and complained of headache, constriction across the chest, and pain in the epigastrium. Emetics did not work; they washed out the stomach, but Avithout effect. He was put to bed, given brandy, hot- water bottles, warm blankets, and the rest; but in spite of everything he sank rapidly, became pulseless, and died in one hour from the time he took the poison. Post-mortem examination showed intense congestion of the mucous- membrane of the stomach, with some congestion of the trachea and larynx. The intestines, spleen, and heart were normal, except for an ecchymosis on the endocardium of the left ventricle. The liver and kidneys were congested, and arsenic was found in the contents of the stomach, the tissues, and in the liquid remaining in the bottom of the bottle. In another case (Edin. Med, Jour., 1843, vol. lix., p. 350) a girl, aged twenty, took some two ounces of dry arsenic on an empty stomach, and although she vomited soon, died in two hours and a half from collapse. These cases do not always terminate rapidly. For instance, Dr. WU- lard (Man/land Med, Jour., 1885, vol. xii., p. 333) gives an instance of a healthy girl, twenty-three years old, who took a teaspoonful of " Rough on Rats," dissolved in tea, just after midnight. Soon afterward she vom- ited and fainted, and she was found next morning unconscious, with 362 A SYSTEM OF LEGAL MEDICINE. symptoms of extreme paUor and weak, rapid pulse. Vomiting Avas in- duced by zinc sulphate, aud at two o'clock in the afternoon she recov- ered consciousness. She complained of a dryness of the throat but no pain, and AA'as Aveak and sleepy. Her stupor increased, and she died comatose at about three o'clock, fifteen hours after the fatal dose. On post-mortem examination her stomach Avas founel to be much inflamed. 4. Chronic Cases.—The previous symptoms all hael reference (a) to the local irritation of the digestive tract, (b) to the later lesions of the hver and kidney, and (c) to an overAAdielming effect on the central nerv- ous system. WTe now come to a class of cases where the symptoms are chiefly due to lesions of the nerve fibers themselves, resulting frequently in almost complete paralysis. These effects of arsenic have been knoAvn for a long time. Peter Abano, for instance, in the thirteenth century, states in his treatise I)e VenenisEorumque Remediis that "whoever gets realgar in his drink suf- fers thirst and heat and drought, and is either cured, or dies, or remains paralyzed and contracted." He further quotes a case of such paralysis. Ambroise Pare and other Avriters of the sixteenth century fully eon- firmed his statement. And yet in recent times these symptoms have been largely overlooked, and have only been brought into prominence in the last ten years. These symptoms occur in two different sets of cases: that is, in patients Avho are recovering from the effects of an acute or sub-acute attack, or else in cases AA'here the poison has been administered for some time in comparatively smaU doses. These latter are not uncommonly met with in practice, from the ex- cessive use of arsenic as a medicine. This rarely happens AA'ith careful treatment. The head of one of the New York nerve clinics told me that out of several hundred patients avIio had been treated, in his clinical practice, with fuU doses of Fowler's solution, two cases only had suffered from the effects of arsenic. These two, hoAvever, had by some careless- ness of his assistants become almost completely paralyzed. Dr. Dana (Brain, 1887, A'ol. ix., p. 456) tells of a man aged forty-eight who had been suffering AA'ith chronic gastralgia for tAventy-eight years, and finaUy Avas treated, at Bellevue, Avith FoAvler's solution in graduaUy increasing doses. After two months the dose reached thirty drops of Fowler's solution three times a day, or nine tenths of a grain of arsenic per diem. This lasted for nearly a month, when nervous symptoms came on, and resulted in complete paralysis. Another similar case is given by Roucher and Brouardel (Ann. d'Hyg., 1874, vol. xiii., p. 406), AA'hen simUar disturbances resulted from a much mUder course of arsenic. A girl, twenty-two years old, suffering with persistent eczema, Avas given Fowler's solution for the first fortnight at the rate of thirty drops (three tenths of a grain of arsenic) per day, and for tAvo Aveeks more at the rate of forty drops (four tenths of a grain of arsenic) per day. She began the fifth week with twenty drops three times per day, but after one day went back to forty drops, and then in a day or two stopped the treatment. Nervous symptoms came on almost at once, resulting in marked paralysis at the end of five or six weeks. But besides these and other isolated cases, there have been of late INORGANIC POISONS. 363 years tAvo weU-defined epidemics of chronic arsenic poisoning, which haA^e been thoroughly studied by the best French physicians, and from which the symptoms of this disease have been clearly defined. In one case some four hundred and thirty-five people, in the vUlage of Hyeres, Avere poisoned by Avine containing from about one sixth to two and a half grains of arsenic to the quart. The sickness Avas at first thought to be " mucus fever," then grippe, and, when five or six old peo- ple had died from it, and almost every family in the neighborhood Avas suffering from it, the iUness Avas at last traced to the Avine from a neigh- boring vineyard. There was naturally great excitement; the proprietor was accused of having intentionally poisoned his wine, and was thrown into prison. But it appeared, on investigation, that the trouble was aU due to an accident, a barrel of white arsenic haAdng been mixed in with the plaster, which was apphed in small quantities to the grapes before pressing. The other case, AA'hich although it involved fewer people was stiU more curious, is reported in full in the Annales dfHygiene (1889, vol. xxn., p. 36) and elsewhere. In July, 1888, a civU suit was commenced in Havre against the owner of a small apartment-house, with a pharmacy on the ground floor, on account of the unsanitary condition of the premises. In accordance Avith the excellent French custom, a commis- sion of four of the best doctors in France, Messrs. Brouardel, Delaunay, Huchon, and Pouchet, came doAvn from Paris to investigate. They ex- amined thoroughly the drainage, plumbing, soU, wall-papers, etc., studied carefuUy the symptoms of the invalids, and after a complete investiga- tion, aided largely by the results of the Hyeres epidemic, decided that the iUness came from small doses of arsenic. This started the authorities on a new track, and it Avas soon found that a young clerk, Pastre Beaussier, employed in the drug-store, had, from pique, fear of dismissal, and other reasons, amuseel himself by poi- soning first his employer and then his feUoAA'-clerks and sei-Aants. He had reached, at the time this Avas found out, in the space of barely two years, the respectable tale of fifteen A'ictims, three of whom died, and the rest of whom were more or less completely paralyzed. The symptoms of the Havre and the Hyeres cases Avere the same, and may serve as a model for all cases of chronic arsenic poisoning. (a) Trouble with the Digestion,—The patients would first notice a feeling of sickness and nausea, AAdiich increased, almost ahvays, to actual vomiting. This vomiting Avas quite characteristic; it was not painful, nor did it leaA'e pain or a burning feeling in the stomach; it Avas quite frequent, running up often to sca'cii or eight times a day; the vomited matter was fuU of mucus and bile. Occasionally, however, it occurred only two or three times during the iUness. Sometimes the patients became quite feverish, Avith some typhoid symptoms. Intestinal troubles were less marked, and lasted, as a rule, but a short time. (b) Symptoms in Larynx and Bronchi, Sinn Symptoms.—After some little time the patients developed decided symptoms of a catarrhal in- flammation of the larynx and bronchi. They suffered from coughing, spitting of mucus and occasionally of blood, loss of voice, with sibilant and sonorous rales in the bronchi. Indeed, at Hyeres, the doctors at this stage diagnosed the iUness as grippe, and prescribed accordingly. 364 A SYSTEM OF LEGAL MEDICINE. Accompanying this was intense coryza, with inflammation and running of the nose, often spreading to the eyes and producing more or less marked conjunctivitis. With, or before, these catarrhal symptoms there developed a cutane- ous eruption, beginning AA'ith redness and sweUing of the eyelids, the scrotum, anel then of different parts of the body. This was often fol- lowed with exfoliations and by loss of the nails. The eruptions varied greatly, being vesicular, pustular, sometimes rubeohc, or like urticaria. The surface of the skin Avas more or less pigmented, frequently becom- ing a dirty brown color, especially on the neck, the rump, and the ex- tremities, and also in the armpits, under the knees, and around the anus. In autopsies arsenic Avas found in the skin, nails, and hair, and it is claimed that these symptoms may have been caused by the elimina- tion of the poison in that Avay. (c) Disturbances of Sensation.—Next to these symptoms there came more or less marked trouble AA'ith the nervous system. This began with headaches, severe and persistent, over the whole head, and an unpleasant numbness in the legs and feet. One of the fellow-clerks of Pastre Beaussier testified that he used to keep hitting the soles of his feet, be- hind the counter, Avith a spatula, to try to keep up the circulation. This numbness Avas often accompanied AA'ith painful cramps. Then came extreme pain, sometimes shooting, more often grinding, situated chiefly in the calves and thighs. The patients complained of dogs biting the calves and the soles of their feet. There was an in- creased sensibility of the skin; a ehUd complained of butterflies running up and doAvn his back. In almost all of the cases the pressure of the bedclothes became unendurable. There was some loss of general sensation in hands and feet. It was hard to feel the ground or to hold small objects. In almost ah cases there Avas an anaphrodisia. (d) Disturbances of Motion.—In every case the disturbances of sensa- tion preceded those of motion, and in light cases the latter were hardly perceptible. In the severe cases, however, they graduaUy increased to almost complete paralysis. They began Avith some muscular weakness, first noticed in the legs. The patients Avere easily fatigued; found it hard to mount the stairs; threAv the legs out in front Avhen they walked. Then they lost the power of walking; they had to drag themselves along. When they stood up they had to grasp some support, or keep changing their feet aU the time. The feet became flabby and hung when at rest. SimUar symptoms Avere noticed in hands and arms, the " wrist-drop " usuaUy appearing after the " foot-drop." The tendinous reflexes were constantly, and the cutaneous reflexes generaUy, absent. The plantar reflex was feeble, but still existed in many cases. The cre- master and abdominal reflexes Avere normal. If treated at the onset of the paralysis, the patients usuaUy, though slowly, recovered. But if the poisoning stiU continued, the paralysis became more and more complete, and the patients died usuaUy of dyspnoea and syncope, from heart faUure, though without any decided lesions. Death sometimes resulted from fatty degeneration of the hver and kidney, caused by the elimination of the poison. INORGANIC POISONS. 365 Chronic Symptoms after Large Doses.—Very similar disturbances of the sensory and motor nerves are frequently met Avith in patients avIio have recovered from the acute or sub-acute symptoms of large doses. It is supposeel, in these cases, that the arsenic, sloAA'ly working out of the system, permeates it and affects it in the same Avay as when given for a long time. Scolosuboff, for instance, in an important paper (Compt. Rend. Biol., 1875, part ii., pp. 309, 313), gives tAvo cases. One of these, who was a porter, who, for a syphilitic eruption, rubbed into his scrotum, arm, and nose an alcoholic solution of arsenic, and also an arsenic pomatum. He soon had A'omiting and gave up this treatment; but in two weeks entered the hospital suffering from numbness and tingling in his hands and feet, and great muscular feebleness. In spite of careful treatment his symptoms got Averse for ten or twelve months, after AAdiich he began to improve. His second case, AAdiich is more characteristic, was of a woman forty- eight years old, avIio took a dose of arsenic instead of chalk, and began to A'omitin one hour, keeping up the A'omiting constantly for forty-eight hours. In four or iiA'e days she noticed a feeling of cold and numbness at the ends of her fingers and toes. Then the cold reached her forearms and legs, anel she had great feebleness in her hands and feet. In ten days she could not walk without assistance, and in fifteen days she took to bed permanently, almost completely paralyzed. Dr. Miles (Phila. Med. News, 1883, a-oI. xiii., p. 257) quotes a similar case of a lawyer, twenty-four years old, Avho AA'ith six other people, of whom two died, ate some pie accidentally poisoned with arsenic. He vomited soon after eating, and after some hours A'omited incessantly all night long. This subsided in three days, leaving him much prostrated. His boAvels diel not move. In four or five days he had marked fever, and in six days he noticed aching and numbness about his knees anel then his feet. In nine days he noticed numbness in his fingers and hands, as far as the wrist, AA'ith loss of poAver in his forearms; while his legs, at this time, from the knees down, Avere almost completely para- lyzed. His face Avas puffed and sAvollen. In four weeks he had severe pain from the knees down, and a little later in his hands and fingers. The symptoms got Averse for two or three months, and then graduaUy improveel under treatment. A typical case of this sort Avas seen by the Avriter recently (Novem- ber, 1893), in the person of a German clerk, thirty-nine years old, of good history and preAdous health, who in November, 1892, took five cents' Avorth (a big tablespoonful) of Paris green. In three quarters of an hour he vomited and felt severe pain in the abdomen, and, after being Avithout treatment for three days, went to the Presbyterian Hos- pital. Tavo Aveeks later he lost sensation, more or less completely, in the legs and forearms, and soon aftei-Avard began to lose power in the legs and hands. The sensation returned in about six weeks more, but the loss of poAver became Avorse up to some three months and a half from the time of taking the poison, after AAdiich he very slowly im- proved. He never lost poAver completely, though quite unable to walk or to use his hands or forearms. In April he had a macular eruption aU over his body, which was cured by sulphur ointment. In April he was removed to BeUeAuie, AA'here under careful treatment he sIoavIv improved, the hands recovering quicker than the feet. In ;>(J(J A SYSTEM OF LEGAL MEDICINE. about eleven months he began to recover the use of his legs, and in November, after one year's illness, he Avas just able to move around on crutches, after being assisted out of his chair. Lesions Peculiar to these Symptoms.—It has been claimed by Seguin (Jour. Nervous and Mental Diseases, 1882, A'ol. ix., p. 665) and others that these peculiar nervous symptoms are due to an affeefion e>f the spinal cord, of the nature of a diffused myelitis. It is, hoAveA'er, gener- aUy agreed at present, by the best authorities (see Rouchet, Ann. d'Hyg., 1874, vol. xiii., p. 406 ; Starr, Med. News, 1887, vol. 1., p. 173 ; and others), that the symptoms are caused by a general peripheral neuritis, an actual degeneration of the nerve fibers themselves, progressing from the ex- tremities toAvard the cord. These lesions are very simUar to those produced by lead poisoning and by chronic alcoholism, and it is often quite hard to distinguish be- tAveen them. The lead paralysis can usuaUy be diagnosed, first, by beginning, as a rule, in the hands and arms before the feet and legs, the " Avrist-drop," for instance, occurring before the feet are affected at all; and secondly, by the almost constant presence of the "lead line," the bluish-black line along the gums. It is usually stated that the alcoholic paralysis must be recognized by the history. In this connection it is Avell to remember that the nerve lesions are caused not so much by the excessive, as by the chronic, use of alcohol. For instance, a friend of mine told me of a patient of his, a Avoman of good family and position, brought in by her sisters for treat- ment of partial paralysis. Her symptoms were due to the modest dose of two milk-punches a day, taken for five or six weeks at a time, at a physician's aetvice, because she had become Avorn out by attendance at a sick-bed. It is also worth remembering that alcohol produces these symptoms more commonly in Avomen than in men. Another point in the diagnosis is the fact that in arsenic paralysis the mind is usuaUy unimpaired, AA'hile in alcoholic and sometimes in lead paralysis there are marked mental delusions. The pecuhar delusion con- sidered characteristic of alcohol is the " time and place aphasia." The patients cannot judge hoAv long they haA'e been talking, hoAv long they have been in the office; cannot tell what room they are in, will agree AA'hen told that they are in a strange city, and the like, although in other respects they may be perfectly sound in mind. A rather striking case, shoAvdng how good physicians may be misled in dealing Avith such cases, occurred in Boston some feAV years ago {Bos- ton Med. and Surg. Jour., 1887, vol. cxau., p. 423), and Avas discussed at a meeting of Massachusetts doctors. It appeared that a young fellow, worth some1 $4,000,000, aa'Iio Avas lead- ing a rather fast career in Boston, Avas looked up at last by his family. They found him extremely Ul at the Beacon Street house of a friend, in some of whose projects he had hiA'ested large sums e>f money. lie Avas being attended by his friend, his friend's Avife, and by an apothecary, but not by a physician. A good doctor Avas summoned, and found him almost completely paralyzed from head to foot. He had but fenv move- ments left, and had lost almost all sense of touch in his extremities, and besides this he had symptoms, severe A'omiting and the like, of consid- erable gastric inflammation. INORGANIC POISONS. 3G7 His vomit and urine Avere analyzed for arsenic Avith positive results (one quarter and one third of a grain of arsenic in the vomited material, one twelfth of a grain in the urine), so he Avas removed to another house, and, under careful treatment, sIoavIv recovered. It appeared that he had been on a regular spree before he Avas taken iU, and, in fact, had been living for some time at a house of bad repute, and had now and then been taken to Beacon Street for dinner, and back again, in a carriage. He related how, when at dinner at his friend's house, he had taken certain articles of food which ahvays made him Ul. The doctor who related this closed his story by stating that the facts had been laid before the district attorney, and that a prosecution might result. Whereupon a distinguished doctor in the meeting informed his friends that he took a livery interest in this tale, because, a feAV months before, a very pleasant, gentlemanly-looking man had caUed him in to see a friend lying sick at his house. The patient AA'as, as described, lying crippled Avith paralysis, and,had symptoms of vomiting; but his friend kindly gave a fuU history of his previous career, and carefuhy explained that his condition might be due to alcohol, syphilis, diarrhoea, or malaria. The doctor did not state exactly what diagnosis he did make, but con- fessed that the idea of arsenic never entered his head. Prognosis and Treatment.—As before stated, these patients, if treated properly and in time, usually recover, although Avhen the paral- ysis has once fairly set in the treatment is long and tedious. It consists, as a rule, of nerve tonics like strychnine, of doses of salicylate of soda, of massage to try to keep up the tone of the muscles, and of wholesome and stimulating food. Morphine may have to be applied to relieve the pain. Poisoning by External Application.—As may be noticed in one of the cases lately mentioned, the characteristic symptoms of arsenic poi- soning maybe produced by the application of dissolved, and also of dry, arsenic upon the skin, and upon any of the mucous surfaces. Cases of criminal poisoning have been described AA'here arsenic Avas apphed to the rectum and to the vagina. In these cases the poison Avas rapidly absorbed, and produced symptoms of gastric irritation as avcU as of local. The1 absorption is more rapid if applied upon a raAv or inflamed surface, but cases are numerous Avhere death has resulted from the application of arsenical ointment, or even of dry arsenic, upon the scalp, or upon the healthy and unbroken skin. A well-known example of this occurred in England in 1878, when seventeen children died from dusting the skin and private parts AA'ith a A'iolet-powder, containing some thirty-five or forty percent, of dry arsenic instead of gypsum. Scweral cases of severe illness, and indeed of death, haA'e been reported, time and time again, from the efforts of quack doc- tors to burn out cancerous and other ulcers AA'ith Avhite arsenic, orpi- ment, and other arsenical compounds, or from the careless use of arsen- ical soaps and Avashes. In aU these cases a local inflammation is invariably first observed, but this is rapidly foUoAved by the ordinal'}' arsenical symptoms, the arsenic, AA'hen once absorbed, showing the characteristic stomach and in- testinal lesions, as avcU as the later effects upon the iicta-ohs system. Dangerous and Fatal Doses of Arsenic.—The above-mentioned chronic symptoms of arsenic poisoning lawe sometimes occurred after 368 A SYSTEM OF LEGAL MEDICINE. the taking of but smaU doses of arsenic, if kept up for a long time. Thus Dr. Putnam (Boston Med. and Surg. Jour., A'ol. cxviii., p. 646; vol. cxix., p. 1) describes a case of slight neuritis from doses of four or five drops of FoAvler's solution (one twenty-fifth to one twentieth of a grain of arsenic), AA'hen taken three times a day for a month, and states that six or seven drops a day have, after long continuance, proved poisonous. Generally it is possible, especially in chorea, to run up the doses of FoAvler's'solution to thirty or forty and even to sixty drops (six tenths of a grain of arsenic) per day without inconvenience. It must be remem- bered, hoAvever, that the poison, in spite of Taylor and others, is to some extent cumulative, and that the symptoms, once started, are liable to in- crease in sewerity for some time after the stoppage of the drug. Generally a dose of from one third to one half a grain, taken in a soluble1 form, avUI produce symptoms of A'omiting and other gastric trouble; and from three to four grains of AA'hite arsenic are usually enough to produce death. The smallest, fatal dose on record (Provincial Med. and Surg. Jour., 1848, p. 347) AA'as in the case of a Avoman avIio took, possibly for abortion, about one half of an ounce of Foaa'Ict's solution (tAvo anel one sixth grains of arsenic) in varying doses between Saturday and Wednesday. She Avas ill on Friday vvifli fever, but without vomit- ing, purging, or pain in the stomach; she had freejuent fainting-fits on Saturday; and on Sunday, after improvement, elied in a fainting-fit. Her stomach and small intestines were inflamed. Arsenic Eating.—Directly contrary to all the statements in the last paragraph are the facts, fully proAen, that in certain parts of the Avorld, notably in LoAver Austria and in Styria, and also in the Punjab in India, people exist avIio haA'e trained themselves to eat AA'ith impunity, at more or less regular intervals, arsenic in considerable quantities. These curious facts Avere first brought into notice by Von Tschudi (Wien, Med. Wochensch., 1851, p. 453) apropos of a poisoning case in Vienna, where a girl, accused of poisoning a young Austrian officer, Avas acquitted on statements by three witnesses that the latter was an arsenic eater. In this paper Von Tschudi stated that arsenic AA'as com- monly eaten by the peasantry to improA'e their personal appearance, to benefit their " Avind" in climbing mountains, and for aphrodisiac pur- poses ; that they began, usually, Avith doses of one half a grain or so once a week, anel that this was increased up to some four grains or more at a time. He1 also mentioned that grooms and hostlers in Vienna were accustomed to giA-e arsenic to their horses to improA'e their coats. These statements, especially when repeated and embeUished by Professor John- ston in his Chemistry of Common Life, were violently attacked by Chris- tison anel others, who stated in the most positive manner, both in their writings and on the witness-stand, that they Avere entirely contrary to the universal experience of physicians and physiologists all over the Avorld. NeA'ertheless they were proved to be correct, notably by Dr. McLagan (Edin. Med. Monthly, 1864, vol. x., p. 204), in AAdiose presence two peasants swallowed pieces of arsenic weighing five and six grains respectively. The urine passed by these men, on analysis, contained arsenic. These facts haA'e been set up by the defense in almost every impor- tant arsenic case of late years, to explain the presence of small quanti- ties of arsenic in the body of the victim. A notable example of this INORGANIC POISONS. 369 took place in the famous Maybrick trial in Liverpool, 1889. On this occasion, besides several corroborating circumstances, such as a well- proven inducement for the crime, the agreement of the symptoms and post-mortem appearance of the body Avith those of arsenic poison, and the consensus of all the physicians in attendance on Mr. Maybrick, some two days before his death, that he Avas being poisoned, there were three points of vital importance to the defense which had to be explained in order to save the defendant. These Avere : first, the presence of arsenic, although in small quantities, in the liver and intestines of Mr. Maybrick; secondly, the presence of arsenic in large quantities, and in numerous forms, either in Mrs. May- brick's room, or in articles belonging to her, or to which she had free access; thirdly, the fact that after suspicions had been aroused and food proven free from arsenic had been provided for the patient, a nurse saw Mrs. Maybrick enter her husband's room, secretly take a bottle of beef extract from the room, and bring it back and replace it in the room, in a few minutes, full of arsenic. The defense claimed, first, that Mr. Maybrick Avas an arsenic eater. This was based on some rather slight evidence. There Avas a colored valet, who said that eight or nine years before, in Norfolk, Va., his mas- ter used to send him out for arsenic, fifty cents' Avorth at a time, and stir it into his beef-tea in smaU quantities AA'ith a spoon. There Avas also some evidence to show that he Avas a hypochondriac, and used to dose himself Avith all kinds of drugs, but there Avas no direct proof of arsenic eating in late years. SeconeUy, they claimed that Mrs. Maybrick used the various solutions of arsenic, the extracts of arsenical fly-papers, anel the packages of rat poison, Avhite arsenic, and the rest, AA'hich Avere in her possession, as cos- metics. In fact, she stated that she had made the fly-paper extracts to remove an eruption from her face, before a baU. This Avas aU quite un- supported by other evidence of any sort. And thirdly, Mrs. Maybrick stated on the stand that, remembering a Avhite poAvder AA'hich. her hus- band was in the habit of using, she had, at his request, put a teaspoonful of it into the beef extract. These explanations, it might be remarked, Avere of more effect upon the outside public than on the jury. The Avriter has been able to find out only one authenticated case of arsenic eating that has been proven in court in this country or in Eng- land. Dr. Charles H. Porter, of Albany, in an interesting pamphlet pub- lished, in 1862, about A^arious arsenic cases in AA'hich he Avas interested, states that in the trial of Sarah Harrington, at Delhi, Delaware County, N. Y., in March, 1861, for the murder of her husband, Avitnesses showed clearly that the Adctim, a hostler, had for years used arsenic as a medi- cine for horses, anel had it constantly in his possession. Others swore that he frequently took it himself, and four different persons testified to seeing him take some on different occasions some years before his death. The man died after a seventeen-days iUness, and some fh'e and a half grains of arsenic Avere found in his boely, some on his tongue, and some in tlie; contents of his stomach, whUe he had been sick in bed for some time before the symptoms of arsenic poisoning appeared. Any general habit of arsenic eating for the complexion, health, or any other purpose, is, it is believed, unknoAvn at present in this city, Ncav York, or in the eastern part of the United States. It is denied by the 370 A SYSTEM OF LEGAL MEDICINE. leading physicians, especially by those working in nerA'ous diseases, Avho certainly ought to know if it exists, and by the leading druggists, both AA'holesale and retail. An examination at several of the leading Ncav York hospitals has brought to light only one case, of late years, that of an actress avIio claimed to haA'e ruined her health by arsenic pills, but avIio AA-as suffering from a cocaine, anel an alcohol, habit at the same time. OccasionaUy, however, a true case of arsenic eating is met Avith. A Avell-knoAAUi physician stated to me positively, a little time ago, that he knew one Avoman, of the demi-monde, aa'Iio AA'as accustomed to take small doses of FoAvler's solution for her complexion, AAdiich Avas unusually pink and Avhite, and that he believed the same Avas true of one or two others. The commonly advertised " arsenic wafers," and similar compounds for the complexion, do not, as a rule, contain more than infinitesimal traces of arsenic. Treatment and Antidotes.—In treating a case of arsenic poisoning, the first thing to do is to remove as much as possible of the poison from the body, and next to make insoluble Avhat remains. After this has been done the physician must try to counteract the symptoms as best he can. It is accordingly good practice to induce thorough vomiting as soon as possible, by tickling the throat, by warm water, mustard and water, and the like, or, better, by drugs like zinc sulphate, cupric sulphate, or tartar emetic. The last drug in full doses, five or six grains, is probably best, as it acts on the bowels as avcU as the stomach, and thus helps to remove the poison from the intestines also. Doses of castor-oil are also valuable. These should be followed by an antidote, and then the stomach should be washed out thoroughly with a stomach-pump. The best-known antidote for arsenic is the freshly precipitated ferric hydrate, Avhich forms insoluble compounds with solutions of arsenious acid. This should be prepared on the spot, by mixing ferric chloride or ferric sulphate Avith an excess of amnionic hydrate, or, better, of sodic bicarbonate, and straining the precipitate through a handkerchief or piece of loose rag. Perhaps the best antidote is Avhere ferric sulphate is mixed Avith an excess of magnesia, and the whole is taken together; for besides the value of the ferric hydrate, the magnesium sulphate thus formed has a good effect upon the boAvels. This iron precipitate is perfectly harmless and should be given in large quantities, a spoonful or so at a time, mixed Avith a gooel deal of warm water. Numerous instances are on record where, sometimes by natural means, vomiting and the like, and at other times by prompt treat- ment, patients haA'e survived even A'ery large doses, two ounces and more, of arsenic. Recovery, however, eA'en from light doses, is slow, and often leaA'es troublesome chronic symptoms. It must, moreover, be remembered that the crystals of white arsenic, and, still more, particles of Paris green, have a Avay of sticking fast to the mucous membrane of the stomach, and becoming embedded in, or covered by, a thick, slimy mucus, AA'hich aa'UI not be dislodged. Under these circumstances neither antidotes, emetics, nor stomach-pumps aa'UI have the slightest effect. Every hospital physician can give instances AA'here the ferric hydrate has been given by the basinful, and the stom- ach washed out tUl long after the Avashing showed no sign of suspended matter, and yet a post-mortem examination would show the stomach perfectly green with the poison. INORGANIC POISONS. 371 Postmortem Appearance of the Body.—As a rule, after arsenic poisoning the body remains in a better state of preservation than is ordinary. The preservation is generally proportional to the amount of arsenic found in the body. This is not invariably the case, for Dr. Tidy reports that the bodies of two chUdren who died, as above mentioned, from arsenical violet-powder, decomposed unusuaUy fast. On examining the body critically there is noticed, as a rule, nothing abnormal about the brain, lungs, spleen, or bladder. The blood is gen- erally dark and fluid, but there are usually evidences of tAvo distinct classes of lesions: first, an inflammation of the gastro-intestinal tract, and secondly, a fatty degeneration of the liver, heart, and kidneys. The Stomach,—This generally sIioavs marked traces of an inflammation of the mucus coat, even AA'hen the poison has been administered exter- nally. Sometimes the whole interior of the stomach is covered light red or broAA'n. In other cases there is more or less sub-mucous ecchymosis, Avith groups or streaks of reddish dots. GeneraUy there are inflamed and injected patches, principally toward the pylorus. These signs of in- flammation appear quite rapidly after the poison is taken, and have been found Avell marked in cases of two, three, four, and five hours' duration. OccasionaUy, especiaUy AA'here death has been of the narcotic or cerebral variety, the marks of inflammation may be very slight, but they are al- most invariably present to a greater or less extent Often particles of solid poison can be found adhering to the walls of the stomach in thick, pasty, Avhitish-gray (or green, with Paris green) spots or patches, surrounded by a ring of brightly injected membrane. On scraping off the spots the mucus coat below is seen much inflamed, and occasionally corroded. In spite of the vomiting the stomach usu- ally contains some thin, odorless liquid, colored broAvn or sometimes red, often Avith white masses of mucus and other solid matter floating in it. The Intestines.—The smaU intestines generally present, though in a less marked degree, the same signs of inflammation as the stomach—that is, patches of red, sometimes large, sometimes small, occasionally con- tinuous for quite a distance. The contents are fluid, ofteu bloody, and sometimes contain the poison in lumps or sediments. The large intestine is not inflamed excepting when the patient has survived for some days. It is generaUy contracted and empty, and cov- ered Avith AA'hite stringy mucus. The Tongue, Pharynx, and (Esophagus.—These occasionaUy sIioav signs of more or less acute inflammation, especiaUy where the poison has been repeateelly administered, or AA'here the arsenic has been taken in a dry form, or has adhered more or less to the throat itself. The oesophagus, in such cases, shows patches and streaks of dull or even bright red, and sometimes has been founel corroded. We noAV come to an entirely different class of lesions, Avhich has been comparatiA'ely overlooked by most of the authors and experts; that is, the evidences of fatty degeneration in the heart, liver, and kidneys. These do not appear quite as soon as the gastro-intestinal lesions, but after some hours are, Avhen carefuhy looked for, almost as regular and as characteristic. The Heart.—This organ is in normal condition if death occurs rapidly: hut if life has been prolonged for some hours the Avails are usuaUy less firm, look pale and yeUowish, and under the microscope show signs of 372 A SYSTEM OF LEGAL MEDICINE. fatty degeneration. This appearance has been observed as soon as six hours after taking the poison, and has been absent in a case of ten hours, although it can almost ahvays be found, AA'hen carefully looked for, in cases that have lasted as long as that. Another common appearance in arsenic poisoning is ecchymosis on the muscular tissue under the endocardium. This may be founel all over the interior of the heart, but is generally to be seen on the left ven- tricle, on the posterior Avail or the intra-ventricular septum. In some cases the ecchymosis coArered half the surface of the left ventricle. (Lancet, 1862, vol. i, p. 325.) The Liver.—The symptoms of fatty degeneration are more marked in this organ than in any other. The arsenic is stored up in it very quickly after centering the blood, and in its efforts to excrete the poison it rapidly becomes diseased,, probably undergoing an acute, parenchymatous in- flammation, resulting in changes in its tissue. The organ, Avhen eleath occurs after a feAV hours' time, is usually enlarged, more firm than usual, looking, on section, vcIIoav, either in streaks or all over, and presents a characteristic appearance under the microscope. The Kidneys.—These also rapidly become inflamed from the excretion of the poison, and undergo changes in the tissue, beginning AA'ith the parenchyma. They are usually found somewhat enlarged, pale and soft, and on section sIioav a thickened cortex and a yelloAvish-gray color, first on the surface, and later in spots and streaks, Avhen the fatty degenera- tion has affected the tubules. It should be remembered that death, in sub-acute cases, results from the inflammation of the liver and kidneys almost as often as from the inflammation of the stomach itself. Accordingly, in cases of suspected poisoning these organs should be carefully examined, and any symptoms of fatty degeneration should be accounted for by previous history or by analysis. TESTS FOR ARSENIC. i. Solid Arsenic.—Arsenic, when in a sohd state, can be easUy recog- nized by seA'eral simple tests. It is only slightly soluble in Avater, and when stirred, or eA'en boiled in it, floats like a AA'hite film on the surface, or forms little dry masses on the top or at the bottom of the liquid. With the addition of a little alkah it is readily dissolved, AAdthout changing color, and it is soluble in both hydrochloric acid and nitric acid when heated. More characteristic, hoAvever, is its behavior Avhen it is sublimed, or when it is Arolatilized after reduction. (a) Sublimation Test.—When white arsenic, arsenious oxide, is heated, it sublimes readih', without melting, in the form of a AA'hite cloud, and condenses in the form of octahedral crystals. This can be elone before the blow-pipe, upon a piece of charcoal, in which case the arsenic is first reduced to a metallic form, AA'hich, as it oxidizes, emits the characteristic garlic odor. When small quantities, hoAvcwer, are to be tested, it is best done in a small reduction-tube, one sixteenth of an inch or so in diameter anel some three inches long. This tube is cleaned and elided, anel the substance, in the form of a dry powder, is placed in the closed end and heated till it INORGANIC POISONS. 373 sublimes, and deposits on the glass as a white cloud. This can be distin- guished from similar white rings made by calomel, corrosive subhmate, ammonium salts, oxahc acid, and other compounds, first by the shape and character of the crystals, and second by its dissolving in hot nitric acid and responding to some or all of the tests mentioned later. A simple test is to evaporate the solution gently to dryness, and to touch it with a drop of strong argentic nitrate, when it aviU form a brick-red deposit of silver arsenate. (b) Reduction Test.—Another and perhaps surer test is to heat the pow- der in a little reduction-tube with a closed end drawn to a point (Figs. 75 and 76), either mixed with some carbonaceous flux, hke potassic ferro- cyanide, or else with a little sliver of charcoal above it in the tube. If Fig. 75.—Ordinary Reduction-Tube, with Charcoal Splinter. the charcoal is heated tUl it glows, any white arsenic in the powder wUl, on heating, be reduced to metallic arsenic, which wUl give a garlic odor, and deposit, further up the tube, in a black or brownish ring. This ring may be distinguished from similarly colored ones formed by mercury and cadmium salts: first, by not being globular in appear- ance under the microscope; second, by dissolving in a hot, strong solu- Fig. 76.—Special Reduction-Tube, when flux is used, drawn out after mixture is inserted. tion of bleaching powder and in hot nitric acid (the solution in the latter wUl respond, as above, to argentic nitrate); and third, by forming Avldte octahedral crystals when gently heated after the end of the tube has been nipped off. The test is very delicate, responding (Wormley) to 1-10,000 of a grain of arsenic. 2. Tests for Arsenic in Pure Solutions.—OccasionaUy, after a com- pound supposed to be arsenic has been isolated by other means, it is de- sirable to test it by every possible means, so as to thoroughly identify it. For this purpose the following tests are sometimes useful: (a) Ammonia-Argentic Nitrate Test.—This reagent—freshly formed by carefully adding a weak solution of amnionic hydrate to a strong solu- tion of argentic nitrate until the broAvn precipitate first produced is al- most entirely redissolved—when added to an aqueous solution of arseni- ous oxide aa'UI produce a light yeUow precipitate of argentic arsenite, Ag3AsO,. This precipitate readUy dissolves in amnionic hydrate and in nitric, citric, and acetic acids to colorless solutions; it is insoluble in sodic and potassic hydrates. Hydrochloric acid changes it to AA'hite argentic chlo- ride. Tlie test is interfered with by the presence of hydrochloric acid or its salts, and also by organic matter. 374 A SYSTEM OF LEGAL MEDICINE. (b) The Ammonio-Cupric Sulphate Test.—This reagent is formed by add- ing ammonia to a solution of copper sulphate tiU the bluish-Avhite cupric hydrate first produced is ahnost all redissolved. The clear liquid is filtered off and used. An excess of ammonia avUI spoil this test, as avcU as the former one, by dissohdng the precipitate. When this solution is added to a solution of arsenious oxide it pro- duces a light green preedpitate of cupric arsenite or Scheele's green, CuHAs03, soluble in acids and ammonia, but not in potassic or sodic hydrates. The reagent must be used Avith discretion, or its blue color wiU hide the reaction. If the arsenic is in small amounts the mixture must be aUoAved to stand for some time, Avhen the precipitate avUI settle out. This test is also interfered Avith by the presence of organic matter, and is about as delicate as the preceding one, responding to about 1-10,000 of a grain of arsenic. 3. Tests used for Arsenic in Complex Solutions.—(a) Precij/itation as Sulphide.—Sulphureted hydrogen gas, when passed for some hours through a warm solution of arsenious acid, acidified with hydrochloric acid, avUI precipitate the arsenic as a bright yeUow, amorphous precipi- tate of arsenious sulphide, AsL,S3. This precipitate dissolves readily to colorless solutions in the caustic and carbonated alkalies, and in the sul- phides of the alkaline metals. It is insoluble in cold, and dissolves but slightly in boiling, concentrated hydrochloric acid. It is oxidized by hot nitric acid, and dissolves, forming arsenic acid. The test is delicate, re- acting (Wormley) with 1-5000 of a grain of As203, dissolved in ten grains of acidified AA'ater. Similar yeUow precipitates are formed by the sulphur itself, and also by the sulphides of cadmium, tin, antimony, and selenium. Hence the precipitate must be filtered off, dissolved on the filter in a feAV drops of ammonia, and this solution evaporated to dryness, and tested for arse- nic by some of the previous tests, or by Reinsch's test, described below. This test may also be used for quantitative Avork. The sulphide, formed with great care, and purified as much as possible, is, as before,. dissolved from a filter AA'ith a httle ammonia, into a weigheel watch-glass, and on careful eA-aporation its weight is determined. It cannot be too urgently insisted on that any and all forms of the poison, isolated in this or other tests, should be most carefully preserved, and presented in court for inspection and, if necessary, subsequent testing. It has been satisfactorily proven that the sulphureted hydrogen, if AveU Avashed, cannot introduce arsenic, even when made from impure materials, into the suspected solution. (6) Reinsch's Test.—If an arsenical solution, acidified with one sixth or one eighth of its bulk of pure hydrochloric acid, is boUed for half an hour or so Avith a bright strip of pure copper foil, any arsenic present wiU be deposited on the latter as a dark metallic coating. The latter can be, anel must be, in eA-ery case distinguished from simUar coatings formed by antimony, mercury, silver, bismuth, and other metals, by form- ing octahedral crystals of arsenious acid AA'hen heated in a small reduc- ing-tube. The sublimate thus formed may also be dissolved out of the tube, and tested as before. The limit of this test, Avith ordinary reduction-tubes, is about 1-10,000 of a grain, but Wormley, by very fine tubes and minute strips of foIL, INORGANIC POISONS. 375 obtained the crystals from 1-50,000 of a grain. The test is inter- fered with by the presence of nitric acid, potassic chlorate, manganese dioxide, and any other substances which would cause the copper to dis- solve. Reinsch's test has been much abused of late years, but, as claimed by Taylor, Wormley, and other excellent authorities, it has many advan- tages, being simple, easily made, very dehcate, and requiring only two pure chemicals. It must be considered, on the whole, as the best test to be used, during life, for examining suspected food, drugs, vomited matter, urine, or faeces, in the case of suspected poisoning, provided the physician or chemist who makes the test is careful to prove the test by forming and recognizing the octahedral crystals. (c) Marsh's Test—This famous test, proposed by Mr. Marsh in 1836, depends on the fact that when hydrogen is set free in an arsenical solu- tion it hberates the arsenic as a gas, arseniureted hydrogen, Avhich can be separately examined. In making this test an apparatus like that shoAA'ii in Fig. 77 is usually employed. In the flask is placed some pure granulated zinc, previously coated with a little platinum by dipping into a solution of platinic chloride, and this is covered with dUuted, pure sulphuric acid, through Fig. 77.—Marsh's Apparatus. the funnel tube. Hydrogen gas is at once formed, and passing through a drying-tube filled with calcium chloride, and then through an ignition- tube with an upturned end, is, after the air has aU been expeUed, ignited and burns with a pale blue flame. The utmost precaution must be taken, in this experiment, to have the chemicals perfectly free from arsenic, and under no circumstances should the test be made Avithout running a blank experiment, upon the chemicals alone, using the same time and the same tests as when the suspected solution is being examined. It has been proposed, by Bloxam and others, to evolve hydrogen by decomposing Avater in a U-tube with electricity. (Quart. Jour. Chem. Soc, vol. xin., p. 14; also Doremus and Witthaus, N. Y. Phys. and Pharm,, 1879, aoI. xii., p. 71.) Unfortunately, a little arsenic is always lost by combining with the platinum electrode. After the apparatus has been properly tested, and the hydrogen has been ignited, the arsenical solution is admitted through the funnel-tube. 376 A SYSTEM OF LEGAL MEDICINE. The arseniureted hydrogen is evolved almost immediately, and the color of the ignited gas"^ changes to bluish AA'hite, with some white fumes of arsenious oxide. This gas can be tested for arsenic in three different Avays: 1. By Forming Metallic Mirrors from a Burning Jet.—If a piece of cold porcelain is placed close doAvn OA'er the flame, any arsenic present wiU be depositeel as a black, or brown, stain or ring. By changing the place directly a good spot is made or the porcelain gets hot, a Avliole series of stains can be made from minute amounts, 1-5000 of a grain or so of the poison. Wormley states that the amount of arsenic in a good stain may not be over 1-80,000 of a grain. These1 stains can be distinguished from exactly similar deposits made by antimony by their solubility in bleaching-poAvder and hypochlorite solutions and in hot nitric acid; by the argentic nitrate test; and by dis- solving, though with difficulty, in yeUow ammonium sulphide solution, and leaving, on evaporation, a film of yellow arsenious sulphide, which dissolves easily in ammonia, but is insoluble in hydrochloric acid. The antimony sulphide, formed in this last way, is orange-red, and, whUe dis- solving readily in concentrated hydrochloric acid, is insoluble in am- monia. 2. By Depositing Metallic Arsenic when Heated.—In this test, proposed by Berzelius, an ignition-tube of hard glass is used, drawn out, as in Fig. 78, into two, or even three, very narroAV constrictions. By strongly heating the tube, protected by and supported on wire gauze, if neces- Fig. 78.—Ignition-Tube, for Berzelius-Marsh Test. (Dragendorff.) sary, in front of these places, the metallic arsenic wUl be deposited on the narrowed parts of the tube. If more than one flame is used almost all, if not aU, the metal should be deposited by the first one, and the others are used as a safeguard, and as a proof that no poison is escaping. The deposit can be distinguished from that produced by antimony by the test aboATe mentioned. It is claimed that a simUar deposit can be formed from the presence of much organic matter in the solution. When properly made the test is exceedingly delicate, giAdng a characteristic deposit (Wormley) Avith 1-50,000 of a grain dissolved in one hundred grains of liquid. It can be used as a quantitative test by cutting off the little piece of tubing which contains the mirror, and after weighing it carefully, dis- solving out the arsenic and weighing it again. The loss of weight avUI be due to the metaUie arsenic. AA'hile the solution of the latter can be subjected to further tests. (For full description see Chittenden and Donaldson, Am, Cliem, Jour., vol. ii., p. 235.) When the quantities of metal thus deposited are too smaU to be weighed they can be more or less roughly determined by comparison with similar deposits made under similar circumstances, by known INORGANIC POISONS. 377 amounts of the poison. (See Fig. 79). The results from this are only partiaUy successful. _ 3. By Decomposing Silver Nitrate Solution.—-If the gas, instead of being ignited, is passed, by a bent tube, into a weak solution of argentic nitrate, it wiU dissolve, forming arsenious acid, H3As03, and decompos- Mirror from 1 mg Arsenious Acid. Mirror from 0.1 mg Arsenious Acid. Mirror from 0.05 mg Arsenious Acid. The Glass Tube without Arsenic. Fig. 79.—Arsenic Deposits in the Berzelius-Marsh Test. (Robert.) ing the silver salt into nitric acid and metaUie sUver. The latter can be filtered off, and any excess of sUver nitrate removed by hydrochloric acid, after which the arsenic in solution can be tested for and isolated as before. Both sulphureted and phosphoreted hydrogen give simUar black de- posits, and so, under similar circumstances, does antimony. The latter, hoAvcA-er, is itself precipitated as argentic antimonide, Ag3Sb, and hence, on filtering and washing, can be completely separated from the arsenic,. Avhich remains as in the filtrate. Examination of Drugs, Food, Vomited Material, etc., for Arsenic. —It is always extremely important to see if any arsenic is present in a solid state. Hence the suspected material should be thorouglUy stirred and mixed, with the addition of Avater, if necessary, and then aUowed to settle in a conical glass or taU beaker. From this the hquid and the lighter material can be decanted, but any heavy sediment should be carefuUy examined, under the microscope, if necessary, for undissolved arsenic. If found it should be separated as completely as possible, and with a minimum of agitation and solution, for special testing. The rest of the material should be filtered, and the solid matter should be boiled thoroughly with hydrochloric acid untU thoroughly disinte- grated, and then mixed with the filtrate. The mixture is concentrated, if necessary, and its bulk carefully measured, after AA'hich portions of it are tested for arsenic by Reinsch's or Marsh's test. If arsenic is present it may be determined quantitatively as described. Separation of Arsenic from the Tissues.—The above method will do \Tery AveU for qualitative tests. It is, however, universaUy agreed, by all the best authorities, that Avhen smaU amounts of arsenic are to be quantitatively determined in the presence of large quantities of organic 378 A SYSTEM OF LEGAL MEDICINE. matter, the latter must be completel}' remoA'ed in one Avay or another, or the results are bound to be untrustworthy. Unfortunately, this is no easy task, for both arsenic itself and especially arsenious chloride are volatile, the latter at quite Ioav temperatures, and unless care is taken the arsenic will disappear Avith the organic matter. Dr. Taylor proposed and used a simple method of obtaining the arsenic as chloride, in a comparatively pure conditiou, by distilling the dried tissues Avith pure hydrochloric acid, on a sand-bath, and condensing the fumes in. a receiver containing Avater. The chief trouble Avith this process is the fact that arsenious sulphide is not decomposed by it, and hence there may be a loss of arsenic. The most approved methods, noAvadays, of preparing the tissues for examination depend upon oxidizing the organic matter either Avith hydrochlen-ic acid and potassic chlorate (Fresenius and Babo) or by the use of sulphuric and nitric acid. In the first, Avhich is most commonly used, the tissues, finely cut, are boUed in hydrochloric acid, Avith the con- stant additions of chlorate, until they dissolve to a clear yellow solution. This is strained, Avashed, concentrated, and treated AA'ith sulpliureted hydrogen ; and the arsenic in the precipitate, after more err less elaborate treatment to remoA'e other metals and organic matter, is determined as sulphide or metaUie arsenic. FuU details of this and the nitric acid method have been carefully de- scribed by Wormley (Microchemistry of Poisons), Doremus and Witthaus (N. Y. Phys. and Pharm., A'ol. xii., p. 71), Chittenden and Donaldson (Am. Client, Jour., vol. ii., p. 235), and others. Distribution of Arsenic in the Body.—In all cases of poisoning it is A'ery important to separate that contained in the contents of the stomach and intestines, Avhether solid or in solution, from that absorbed in the tissues themselves. The latter represents more or less of the poison AA'hich has actually produced death, AA'hile the former is simply that left over and Avhich has hael no part in killing the individual. Unfortunately, so much has been said about the characteristic effects of arsenic on the digestive tract that it is common, in cases of suspected arsenic and other poisoning, for the coroner and his staff to submit to the expert for analysis the stomach by itself, or, as a great favor, accom- panied with some of the intestines. Such practice is distinctly bad. It has been recognized for fifty years that most of the absorbed poison avUI be found in the liver, and after that, in the kidneys, spleen, and heart. These organs will contain the poison after it has almost, if not entirely, disappeared from the contents and even from the tissues of the stomach and the intestines. Of late years much work has been done upon the absorption of ar- senic in the tissues. Some stir was made by M. Scolosoff (Compt. Rend. Biol., 1875, part ii., p. 304), who made various experiments upon dogs, poisoning them AAdth sodium arsenite, and in seneral eases found three or four times as much arsenic, comparativcdy, in the brain and spinal cord as in the hver, and some thirty-five or forty times as much as in the muscles. These experiments raised a storm of contradiction from all OA'er the Avorld, and since then abundant eAddence has sIioavii that the liver is. in almost eA-ery case, the great seat of the absorbed poison. It is. however, believed by Chittenden and others that in cases of poisoning by a sohu INORGANIC POISONS. 379 ble and diffusible salt of arsenic the poison will be found in quantities in the brain. It was, indeed, argued on these lines in the AveU-known case of Jennie Cramer, where some of the not excessive amount of arsenic present was found in the brain, that the poison must have been adminis- tered in such a form. This was of importance in the trial, for it helped the hypothesis of the State that, in spite of the absence of the least sign of gastric inflammation, death Avas caused by arsenic and not bv drown- ing, the arsenic, taken in a soluble form, acting rapidly, Avith cerebral or narcotic symptoms. Many interesting analyses, those of Jennie Cramer's boely among the number, have been published of late years, showing the presence of arse- nic in the muscles, and in many cases in the bones of the body, as well as in the organs. This Avas done Avith the utmost care by Johnson and Chittenden (Am. Chem. Jour., vol. ii., Xo. 5) in the case of a Mrs. Riddle, where 2.38 grains of AA'hite arsenic had been previously found in the in- ternal organs. Tlie defense claimed that this AA'as not necessarily a fatal dose, and accordingly further analyses Avere made of tissue from the arm, thigh, feet, and hand, of a thigh bone, and of a transverse section of _ the boely itself—in all, over twenty-one pounds of material. From this analysis it was calculated that the AA'hole of the body not preA'iously analyzed contained 2.85 grains, making the respectable total of over five grains. This precaution, it aa'UI be remembered, was not taken in the May- brick trial, where the stomach, intestines, liver, bile, spleen, and kidneys Avere the only portions submitted to analysis, and AA'here the only Aveigh- able amount of arsenic, excepting a minute quantity in the intestines, Avas found in the liver, AA'hich contained about one third of a grain. Hence the defense Avas able to claim that death had not been caused by arsenic, because a fatal dose of arsenic Avas not extracted from the tissues. This argument is a thoroughly misleading one, and, as wUl be sIioavii, has absolutely no basis in fact. Arsenic is not a normal constituent of the body, anel Avhen once absorbed is rapidly eliminated in many different Avays. And more than one case is on record AA'here death has undoubt- edly been due to arsenic, add yet not a trace of the poison has remained in the principal organs of the body, if not in the AA'hole boely. In chronic arsenic poisoning, or in cases AA'here death has been delayed for seA'eral days, or even Aveeks, the examination of the boely outside the principal organs is still more important. In the HaA're cases, already discussed, arsenic was discoA'ered in the skin, nails, and hair of the A'ic- tims. Careful experiments by Dr. Pouchet (Ann. d'Hyg.. 1889, A'ol. xxn., pp. 356, 486) tend to sIioav that, AA'hen administered sIoavIv, arsenic may be detected not only in those parts, but also and more noticeably in the spongy tissue of the bones, especially in the A'ertebra?, scapula, and bones of the cranium, for Aveeks after it has disappeared from the hver and vis- cera, and eA'en from the other tissues of the body. Amounts of Arsenic Found in the Body.—The quantity of arsenic that may be present in the contents of the stomach and intestines is A'ery large. Dr. Pearson, in the Cross trial in Ireland, in 1887, testified that oa'ci- tAAro ounces had been so found, and reports of one ounce and over are not uncommon. The amount, hoAA'eA'er, actually present at any one time in the tissues 380 A SYSTEM OF LEGAL MEDICINE. themselves is far smaller, and in perfectly AveU authenticated cases of arsenic poisoning they haA*e diminished to the A'anishiiig-point. As just stated, the liA-er is the main source of the poison, and yet in the hver it is hard to find it in any great quantit}'. Tlie average amount seems to be from one third to tAvo thirds of a grain. Wormley, an excel- lent authority, states that " the absolute quantity thus found, even under the most favorable circumstances, rarely exceeds a grain in Aveight." In some cases, indeed, the presence of larger quantities, as, for instance, in the Cross ease, where 1.28 grains Avere found, has been made a ground for disputing the analysis. In that same trial the learned judge Avas so impressed Avith the defense's view of the case that he solemnly charged the jury that the liver Avas like a sponge, and that from one to tAvo grains of arsenic was its total capacity. His honor, hoAveA'er, Avas evidently napping on this occasion, for larger amounts haA'e been not infrequently reported. Hayes, for instance (Am. Chem., Dee., 1875), found 3.86 grains of arsenic in the liver of a lady who elied in forty hours after drinking some poisoned tea prepared by a crazy servant. WhUe the largest amount of arsenic yet found was reported by Dr. Barker (Am. Chem., 1872, vol. ii., p. 441), in the Lydia Sherman case, where he isolated from the liver of Horatio Sherman, her fourth and last husband, arsenic equivalent to nearly five grains for the whole liver; and obtained over sen-en grains from the liver of Dennis Hurlbert, a previous husband. These results seemed so remarkable, and such a slur had been recently cast upon expert testimony by the fiasco in the famous Wharton case, that Professor Barker Avas particularly careful to isolate the poison, to bring the poison itself into court, and to preserve it, in various forms, for future reference. As a general rule the amount of arsenic found in any of the other organs—the kidneys, spleen, stomach, intestines, heart, bladder, and brain —is not as much as that found in the liver, nor does the total amount often exceed five grains. To illustrate the amounts that have been found in different portions of the body, we give here two famous analyses, made by Johnson and Chittenden, and by Chittenden alone, published in the Am. Chem. Jour. (vol. ii., Xo. 5, and vol. v., No. 1): MRS. RIDDLE (A CASE OF CHRONIC ARSENIC POISONING). Internal Organs. Arsenic Found. Stomach and spleen...............................0.825 grain. Kidneys..........................................0.103 " Liver............................................0.738 " One lung and heart...............................0.235 " • Intestines and uterus..............................0.388 " One lung and liquid from thorax....................0.091 " Urinary bladder, etc.................Distinct trace Brain...........................Unweighable trace Total.........................................2.380 grains. Other Tisanes. Total Weight. Total Arsenic. Arm............................. 2 1b. 61 oz. 0.111 gr. Leg..............................12" 4|" 0.408 " Muscular and bony tissue, including transA-erse section of body....... 6 " 7f " 0.577 " Total 211b. 3 oz. 1.096 grs. INORGANIC POISONS. 381 The body, exclusive of the internal organs, weighed 880 ounces; hence it was calculated that the whole amount of arsenious acid to be found in it was 2.846 grains, which, added to the 2.380 grains found in the internal organs, amounted to 5.226 grains for the whole body. JENNIE CRAMER (CLAIMED TO BE A CASE OF NARCOTIC POISONING FROM A SMALL DOSE OF DISSOLVED ARSENIC). Internal Organs. Amount of As.,03 Found. Stomach and oesophagus................... 0.158 grain. Liver (i)................................. 0.109 " Intestines................................ 0.314 " Kidneys ................................. 0.029 " Heart (i)............................... 0.028 " Lungs and spleen (}) ..................... 0.1146 " Brain (£) ................................ 0.0255 " Trachea, larynx, and tongue............... 0.081 " Diaphragm............................... 0.010 " Total arsenic found................... 0.8691 grait. Liver (|)................................. 0.109 grain. Heart (f) ................................ 0.084 " Lungs and spleen (£) ..................... 0.0573 '' Brain (|)................................. 0.050 " Rest of arsenic calculated............. 0.3003 grain. Total arsenic in internal organs....................1.1694 grains. Muscular and Bony Tissue. Total Weight. Arsenic. Left arm............................ 2 lb. Hi oz. 0.094 grain. Right leg, except thigh-bone..;.......10 " 4 " 0.118 " Thigh-bone.......................... 74 " Transverse section«of boely........... 8 •' 15| " 0.186 " Muscle from heart................... 1" 2± " 0.098 " Muscle from back.................... 1 " 6 " 0.356 " Total...........................24 lb. 14^ oz. 0.852 grain. The entire body, excdush'e of the internal organs, Aveighed fifty-seA^en pounds. Hence, on calculation, the amount of arsenic in the body was 1.9498 grains, which, added to that found in the internal organs, gave a total of 3.1192 grains. The body of Mrs. RideUe had been buried for a year and a half, whUe that of Jennie Cramer was analyzed but a few days after death. Amount of Arsenic Necessary to Prove Poisoning.—As before men- tioned, it is A'ery common for the defense to insist that, in a case of sup- poseel arsenic poisoning, unless full fatal doses of arsenic are found ab- sorbed in the system, the prosecution has failed to prove the cause of death. To be sure1, in aucav of the almost universal presence of traces of arsenic and the extraordinary delicacy of the tests, it is generally con- sidered improper to coiiAdct of poisoning on the evidence of mere traces, unless overwhelmingly corroborated by other evidence. Orfila himself at one time asserted the presence of minute epiantities of arsenic in the normal human body; and yet, but a few years after- AA'arel, in the dramatic case of Madame Lafarge, after two separate seds of chemists had failed to find any arsenic in the body of her husband, 382 A SYSTEM OF LEGAL MEDICINE. Orfila obtained her coiiA'iction by finding, with Marsh's test, mere un- weighable stains, amounting all told, as he estimated, to not over 1-100 of a grain. This amount is to be considered beloAV the limit, espe'cially when, as came out in a subsequent trial, the zinc used by Orfila in his Marsh's apparatus on that occasion had not itself been tested for arsenic. Another case, AAdiere A'ery small amounts of arsenic formed the most conclusive evidence against the prisoner, Avas that of Margaret AYishart, coiiA'icted on an analysis, by Sir E, Christison, showing one fortieth of a grain in the linings of the stomach. When, hoAvever, the arsenic extracted is in Aveighable quantities, and in such a form that it can be isolated and sIioavii to the jury, and AA'hen the eare sIioavii by the analyst and his previous reputation make it rea- sonably certain that the arsenic in question came from the cadaA'er, it is perfectly proper to insist that quite minute quantities of the poison fur- nish A'ery strong eAddence of the cause of death. Indeed, the best experts are agreed that in perfectly well-defined cases of arsenic poisoning it is not only not uncommon to find but small amounts of the poison, but it may easily happen that no arsenic at aU may remain in the system. The case of Dr. Alexander, previously men- tioned, is one often quoted. He lived sixteen clays after a fatal dose of white arsenic. There AA'as no cpiestion whatsoever as to the cause of death, and yet Dr. Geoghegan, professor of medical jurisprudence in the Eoyal Medical CoUege in Dublin, and an expert of great experience and ability, found no trace of arsenic in the contents of the stomach nor in the A'iscera. Elimination of Arsenic.—When arsenic is taken into the system through the stomach, but a short time elapses before nature endeaA'ors, by constant anel thorough vomiting, and subsequently by purging, to expel the poison before too much has entered, the circulation. That this is frequently successful is well knoAvn from the numerous instances of persons AA'ho haA'e taken large doses and recovered Avithout special treat- ment. The poison that is absorbed enters the portal circulation, and is stopped by the liA'er, AA'hich retains as much of the arsenic as possible. The poison begins to be stored up in the liver probably in a few min- utes, if not seconds, after it is absorbed, and gradually increases in quan- tity for some fifteen or tAventy hours. But from the time it enters the system until it is entirely removed or death intervenes, active agencies are at Avork to eliminate it from the body. The most important of these is the kidneys, which begin their work almost at once. Dr. McLagan, when experimenting on arsenic eating in Styria, found arsenic in the urine three quarters of an hour after taking the drug; while in a case fully reported by Prof. E. S. ATood (Boston Med. and Surg. Jour., 1888, vol. xix., p. 435), it AA'as present in the urine Avithin five minutes after it had been taken. Besides this, the arsenic is excreted through the bUe, the skin, and probably, after some little time, at least, through the large intestine. So it is perfectly eAddent that if the patient does not die for some time the amount of arsenic present in the system must be diminishing eA^ery day and every hour, anel sooner or later AA'iU disappear entirely. Opinions differ as to the length of time required for such disappear- ance. AU the older authorities. Orfila, Christison, Herapath, Geoghegan, Taylor, and others, agree that from fifteen to twenty days would suffice INORGANIC POISONS. 383 to remove aU traces from the body. These writers, however, rarely ex- amined more than the main viscera, and it is probable that a e-areful examination of the muscles, and especially of the bones, skin, nails, and hair of the A'ietim might have shown at least traces of the poison for much longer periods. In experiments on animals Ludwig found arsenic, in some quantities, in the liver of a dog after forty days, and it is prob- able that traces of arsenic Avould still be founel in the body, if carefully looked for, for two or three months at least after the poison had been taken. Indeed, if Ave are to beheve the wonderful stories published by some of the Massachusetts doctors, exposure to infinitesimal traces of arsenic is hable to leave evidences of that poison in the urine not only for months, but for years, after removal from the contagion. (See Putnam, Boston Med, and Surg. Jour., vol. cxix., p. 3, and others.) Detection of Arsenic after Long Periods.—It has been often noticed, AAdien bodies containing arsenic have been exhumed after some months or years, that the tissues are unusuaUy avcU preserved, seemingly in pro- portion to the amount of poison which they contained, and also that the stomach and intestines are e>ften lined Avith a bright yellow deposit. An excellent example of this is sIioaati in the frontispiece illustration (Plate I.) of this volume. This deposit has been usually considered to be the yellow arsenious sulphide, formed by sulphureted hydrogen coming from the decomposi- tion of the tissues. In some cases, at any rate, this compound contains no arsenic at all, but consists of organic compounds probably derived from bile. The subject is thoroughly discussed by Drs. Brown and Davies (Lancet, 1884, part i., p. 421) in the case of persons poisoned at Liverpool by fly-paper solution; and also by Stevenson (Brit. Med. Jour., 1884, parti., p.G00),av1io insists that the yelloAv deposit is sometimes, Avith- out question, arsenious sulphide, and proAres it from his own experience. Whether it is due to the formation of this sulphide or of some other stable compound, it is quite certain that after a body has once been buried no great loss of arsenic occurs either by A'olatilizing or leaching. Accordingly mere lapse of time is no bar to the detection and isolation of arsenic. Cases are on record, both in this country and Europe, where crimes have thus been traced, and the murderers convicted, after ten, fifteen, and even twenty years. Under these circumstances, ever}' precaution must be taken to satisfy the jury that the poison could not have come from the earth, coffin, or coffin-lining, clothes, ornaments, or other post-mortem sources. This, in former years, presented no such great difficulty, but at present, in this country,^ the universal habit of embalming renders it almost impossible, unless "strong suspicions have been aroused before death, to convict of poisoning not years and months, but days and even hours, after a person has died. Post=mortem Imbibition of Arsenic.—The possibility of the inten- tional injection of arsenic after death, so as to throw suspicion on sus- pected persons, Avas suggested by Orfila in 1813, and has been referred to since by most of the1 authorities. Only two cases, however, so far as I can learn, have vet reached medical literature. In the case of Mrs. Bleazby (Kidd, Dublin Quar. Jour., 1850, vol. x., p. 73), the defense claimed, from post-mortem appearances and other 384 A SYSTEM OF LEGAL MEDICINE. reasons, that the arsenic found in stomach, kidneys, and liver had been introduced into the stomach after death. In this case the chemist for tlie crown swore that under such circumstances it could not possibly have reached the hver or kidneys, for "absorption ceases directly after death." A second case (Eeese, Trans. Coll. Physicians, Phila., 1877, vol. iii., p. 23) is of an old man who married his housekeeper, and before death left her all his property. There was constant squabbling over the avUI, and finally, three or four years afterward, the Avidow, avIio had married again, Avas accused of poisoning her first husband. The body Avas ex- humed and arsenic found in the stomach and intestines, though not in the form of sulphides; but the case was dropped, owing to the strong suspicions that some of the relatives had tampered with the body. Since, however, arsenical solutions have been used for embalming purposes, there is no doubt at aU but that more than once they have been used to conceal crime. This possibility was first pointed out in an excellent letter of Dr. Hay to the Medical Times (1876, vol. vi., p. 57G)r after, at the request of an undertaker, he had analyzed a much used and highly recommended embalming fluid, and found it a strong solution of sodium arsenate. This possibility Avas soon proved to be a fact, for not long afterward A'aughan (Jour. Amer. Med. Ass'n, 1883, vol. 1., p. 115) published a case where a husband injected, with the aid of his brother and an undertaker, some arsenic into the mouth and rectum of his dead wife, to " preserve her body till he could get a handsome casket from a neighboring city." The body after one hundred and fh'e days was exhumed, and arsenic Avas found in the stomach and liver, although not in the brain or calves of the legs. But it was impossible to tell whether it had come from the injection or not. A more striking case was reported (Boston Med. and Surg. Jour., 1890, vol. cxxii., p. 544) by one of the Massachusetts medical examiners, Avho Avas evidently much chagrined by the facts he mentioned. A young married Avoman died A'ery suddenly, two hours after luncheon, Avith symptoms of violent irritant poison. The medical examiner was sent for, and although he was out of town at the time, he reached the house at about eight o'clock that night, Avithin seven hours after the woman had dieel. But already an undertaker had been called in, and the body had been embalmed with an arsenical solution, and so, although there Avas ever}- ground for suspicion and the body was full of arsenic, the case had to be dropped. The most remarkable case of all, however, which has once or twice been referred to, although not in detail, in some of the journals, was laid before some prominent legal, chemical, and medical experts, of whom Professor Chandler was one, some nine years ago. As I write, aU the documents of the case are before me. From these it appears that the Avife of a country clergyman, after a year or two of married life, died, in a country village in this State, under somewhat suspicious circumstances. Some of the relatives started an investigation. The husband, an attractive, intelligent-looking old gentle- man over sixty years old, had come to New York soon after the funeral, and Avas, at the time, preaching regularly every Sunday afternoon in one of the most prominent Fifth Avenue churches. It AA'as soon found that he had had at least six wives. Detectives, ac- INORGANIC POISONS. 335 cordingly, started to study up the deaths of wives numbers five and four, as AveU as of the last one, Avhile tAvo other detectives, one of them liA'ing at the same boarding-house as the reverend gentleman, made daily re- ports as to his life and occupation. He appeared, indeed, to have sbme- Avhat recovered from the recent bereavement, for, besides his clerical work, the reports showed that he was devoting himself assiduously to one of the fair residents at the boarding-house. But suddenly, prob'ably because he heard of the investigations going on in the country, he packed up and started for Europe. He was heard of the next year, with wife number seven, in charge of a parish in Ncav Mexico. The investigations, which are most interesting reading, sIioav that he generally selected for his better halves old maids, AA'ith some property of their oavii, living in country villages. Soon after marriage he would move to another country parish, and, almost as soon as he had settled there, he would spread reports of his wife's ill-health and poor constitu- tion. The wife Avould soon be taken sick, and, treated by the local country doctor, Avould alternately get better and avoi-sc, until she died. Before death she would have made a avUI leaving her devoted husband aU her property, and immediately after a hasty and superficial autopsy, at which he himself was generally present, the body Avould be thoroughly embalmed Avith arsenic. His grief would be so great that he Avould be obliged to give up his parish and lea.Ae1 for other parts, AA'here he Avould console himself aneAV. As can easily be seen, there was no possibility of proA'ing anything in such a case, although suspicious circumstances Avithout number Avere brought to light. The experts unanimously advised the abandonment of the case, anel the worthy clergyman, if his former good health has not deserted him, by this time has probably reached wife number eight or eA'en number nine. Possibility of Distinguishing Anti=mortem from Post=mortem Arsenic.—This question has been discussed by most of the writers on poisons, and numerous experiments have been made on it in connection with the different cases already mentioned. Orfila, Dr. Kidd, and Pro- fessors Ei'ose and Yaughan (toe. cit.) aU have published experiments on the subject, and, as a rule, agreed that AA'hile, Avith sufficient length of time, arsenical and other metalhc solutions Avould travel far and Avide through the body, it Avas very improbable, to say the least, that Avithin any moderate length of time such compounds could enter the brain. The Avhole question, however, was finaUy settled, once for all, by some experiments made by Professor AVitthaus, and described in an ex- cellent paper in the first A'olume of the Researches of the Loomis Labor- atory, 1890. Professor AVitthaus Avas engaged by the State to examine the body of a certain Mrs. Ford, supposed to have been poisoned by arsenic. The corpse, which had been dead fourteen days, had been em- balmed by injecting into the stomach through the nostril a solution of sodium arsenate, some four pounds to the gallon. The undertaker stated, by the Avay, that, excepting in A'ery cold weather, it Avas his in- variable habit to do this embalming as soon as possible after death. Upon analysis arsenic Avas readily found, not only in the viscera, but also in the brain. But on making exactly paraUel experiments upon cadavers by injecting similar solutions and similar amounts in the same manner, or even more carefully, it was found that witliin fourteen days 386 A SYSTEM OF LEGAL MEDICINE. arsenic had penetrated from the stomach into every part of the body, in- cluding the muscles of the feet and legs, the hands, the arms, and, finally, every portion of the brain. The case accordingly was dropped. At the present moment it would seem that, if once the undertaker is aUoAved to enter the house, there is no chance of conviction, in arsenic poisoning. This means that arsenic, instead of being the most dangerous, is now, practicaUy, the safest agent for committing murder. And also, that unless the attending physician is clever enough to properly diagnose the case during life, and is courageous enough to risk his own profes- sional career by calling in the authorities and insisting on an autopsy at once, there is practically no hope of coimction. (c) Arsenic Acid and Arsenates—H3AsOi. Arsenic acid is formed by the oxidation of arsenious oxide with nitric acid or aqua regia. The arsenic oxide thus formed has a formula of As._,Or>, but it absorbs water very readUy, even from the air, thus forming the true acid, HyAs04. The latter is a thick, syrupy, colorless liquid, with a sour, metallic taste. It is quite caustic, and has poisonous properties similar in every respect to those of arsenious oxide. It has been largely manufactured for use as an oxidizing agent, but has been superseded of late, in the aniline and kindred industries, by other and non-poisonous compounds. The tests for this substance are like those for arsenious oxide. It reacts promptly Avith Marsh's test, the nascent hydrogen reducing it rapidly to the loAver oxide, and then to arseniureted hydrogen. It re- sponds to Eeinsch's test, but not as weU as white arsenic. Sulphureted hydrogen, however, precipitates it very slowly, if at all, from dilute solu- tions, unless it has been first reduced to arsenious oxide. Characteristic tests for it are with argentic nitrate, which gives a brick-red precipitate, and with ammonio-magnesic sulphate (formed by adding amnionic hydrate to magnesic sulphate tUl the white precipitate is redissolved), Avhich gives a white, crystaUine deposit of ammonio- magnesic arsenate. Cases of poisoning are extremely rare, and when they do happen present about the same characteristics as those from white arsenic. One case of a child who ate some "pest poison," consisting of arsen- ate of soda, AA'as published by Prof. B. SiUiman, in an interesting paper read before the Xenv York Medico-Legal Society, October 3, 1883. The child died in about nine hours, Avithout symptoms of any gastric or in- testinal irritation, but with such strong evidences of narcotic poisoning that the poison Avas first thought to be an alkaloid of the belladonna type. (d) Arseniureted Hydrogen—Arsine—AsH3. This gas, as already mentioned, is produced by the action of nascent hydrogen upon solutions of arsenic. It is formed in laboratories in making Marsh's test, and also occasionaUy is produced in the arts AA'hen metals contaminated with arsenic are treated Avith acid. It is a colorless, inflammable gas, Avith a garlic odor. It burns to water and arsenious oxide, deposits metallic arsenic Avhen heated, anel INORGANIC POISONS. 387 precipitates metalhc silver AA'hen passeel into argentic nitrate, the arsenic elissolving in the nitric acid set free. It has marked poisonous qualities, not only producing the usual effects of arsenic, but also having a specific action on the blood and kidneys. The blood becomes dark and inky, Avhile the kidneys become much congested, and the flow of urine, AA'hich is dark and full of blood, is much diminished and even stopped. The victims also suffer usuaUy from jaundice. The gas, hoAArever, is not nearly as poisonous as is supposed, for it is evolved in considerable quantities by the students in almost every quali- tative laboratory in the world, and yet it is extremely rare to hear of any accidents from it. Its discoverer, Gehlen, Avas poisoned by it from try- ing to trace a leak in his apparatus by smelling at the joints, and three or four similar instances are reported in the books and journals, but that is aU. Cases haA'e occasionally been reported AA'here accidents have happened from it in the arts. In one case (Coester, Deutsch. Med.Wochcnsch,, 1884, ]). 119), a workman in an anUine factory inhaled some hyelrogen contain- ing some of this gas. He suffered at first from nausea, giddiness, and general discomfort. Then he had jaundice, and passed practically no urine after the first day, AA'hen it Avas bloody, dying, in spite of treatment, on the tenth day. Similar symptoms were reported in a very interesting case (Dr. Frost, Vierteljahrsh. fiir Gerichtl, Med., 1873, vol. xviii., part ii., p. 6), fully quoted by Sonnenschein, Blyth, and others, where twelve Avorkmen, three of Avhom died, Avere seu-iously affected by fumes from treating zinc with hydrochloric acid. The early symptoms Avere folloAved by jaundice, bloody urine, and narcotic sleep, Avhile in the fatal cases the urine was suppressed, and death occurred in a state of coma. In all these cases arsenic Avas found in all parts of the body. (e) Sulphides of Arsenic—Realgar, As.>S2, Orpiment, As2S3. These two compounds, the red sulphide containing seventy percent. of the metal, and the already mentioned vcUoav or arsenious sulphide, containing sixty-one percent., occur in small quantities in nature, and are manufactured for use in the arts. Their toxic effects, tests, etc., are practically the same as those of Avhite arsenic. (/) Soluble Salts of Arsenic. These usually consist of the arsenites and the arsenates of the alka- line metals. An example of these is the officinal Fowler's solution, which contains arsenic to the amount of one percent., dissolved in a solution of potassic carbonate. The poisonous effects of these salts are much the same as those of white arsenic, excepting that, being soluble and easily diffused, they usu- aUy act more rapidly, penetrate the brain and nerve tissue sooner and in greater abundance, and produce symptoms rather of the narcotic or cere- bral type. 388 A SYSTEM OF LEGAL MEDICINE. (g) Paris Green—Sehweinfurth Green. This compound, an aceto-arsenite of copper, containing some 58.4 percent, of arsenious oxide, has of late years come into common use as a poison for potato-bugs and similar insects, and, especiaUy in country districts, has been frequently used as a means of suicide. Accidents from its use are occasionally met AA'ith, but are rare. Internally its symptoms are the same as those produced by white arsenic, excepting that it is stiU more difficult to wash it out of the stom- ach. ExternaUy it occasionally produces rashes and similar surface dis- turbances upon workmen engaged in its manufacture, and upon farm hands Avho use it carelessly, especially if their fingers or arms are at all sore. But it is rare that these results have any serious consequences. (h) Arsenic in Wall-paper and Other Fabrics. For a great many years there has been a feeling, expressed not only by the laity but also by many physicians and toxicologists of exceUent standing, that there was more or less real danger in the free use of arsenical pigments, like Paris or Scheele's greens, for instance, in the manufacture of wall-paper, and also of A-arious articles of household use —dresses, carpets, book covers, Avater-c.olor paints, toys, and the like. With regard to some of the latter the feeling was undoubtedly cor- rect. To color chUdren's toys, or pigments, or confectionery, or, in many cases, book covers, with Paris green, is simply to invite accidents. With regard to dress materials, carpets, and the like, there is more cause for doubt, although a light tarletan, full of Paris green which can be shaken off as a fine dust by the mere exercise of dancing, may be not unjustly considered as needlessly dangerous. For some reason, hoAArever, the cry was concentrated against AvaU- papers, which, even AA'hen made fluffy and velvety, as Avas the custom, and full of loosely adhering arsenical pigment, are, owing to their station- ary position, far less liable to give rise to accidents than the articles just mentioned. Indeed, it is more than doubtful AA'hether a single case of fatal, or even dangerous, arsenical poisoning has ever been caused by wall-paper, although minor accidents may occasionally haA'e occurred. For instance (Lancet, 1879, part i., p. 686), two children are reported to haA-e been seized one morning AA'ith vomiting, cramps, and diarrhoea, after amusing themseh'es with repainting the walls of their room. They used their fingers as paint-brushes, and Avould lick them to get them Avet, and then rub off green paint from one part of the wall to put it on another. At any rate, in obedience to the wishes of the consumers, manufact- urers have practically ceased to use arsenical pigments in any quantity, not only on toys and the like, but also on Avail-papers. The latter are, as a rule, thin and lightly painted, and the pigment is firmly fastened on with size and generally glaze, and iioav, instead of finding from fifty to several hundred grains of arsenic to the square yard, it is quite rare1 to find a paper Avith more than one or two. The presence of the latter, too, is almost ahvays accidental, and results from the impossibUity of getting paper, sizing, paints, and so on, absolutely pure from arsenic. INORGANIC POISONS. 389 Nevertheless the same old cry against arsenical waU-paper, which now has absolutely no basis, stUl goes on, and has risen in the fine old State of Massachusetts, during the last ten years, to an actual craze, an " arse- nic fad," as some outsiders haA'e dared to caU it. The excitement culminated in two different attempts to pass legisla- tion forbidding, under heavy penalties, the presence in AvaU-paper, and, to a less extent, in other fabrics, of more than a minute fraction of a grain to the square yard. The evidence, which is given in great detaU by Professor Wood {Report Mass. Mate Board of Health, 1885) and by Pro- fessor Lyon, Professor Hill, and many of their friends and coUeagues, in the Arsenical Wall-paper Hearing, House Bill Xo. 417, 1886, and in the Hearing before the Committee of Public Health, Senate BUI No. 215, 1891, is exceedingly interesting and entertaining, and deseiwes a brief reAdew. The susceptibility of the Adctims Avas extraordinary. Professor Lyon (Senate Hearing, p. 121) stated that a member of his famUy Avas seriously affected (sleeplessness, repeated colds, tenderness in throat, skin and nerv- ous symptoms) by the mere presence in the room of a lounge containing, aU told, in its coverings and Unings, about 1.8 grains of arsenic. Pro- fessor Wood, too, gives a case (No. 31) of obstinate eczema of the hands, from using playing-cards containing on their backs one eighth of a grain of arsenic apiece. And in another case (Senate, p. 14), fever was caused by the mere presence in the room of a red-and-yeUow comforter, which, on analysis, shoAved a little arsenic. The climax, perhaps, Avas reached in the much-quoted case of a child (Senate, p. 19) whose father, a physician, stated that severe symptoms of Bright's disease had been produced (a) from a plush seat in an arm-chair; (b) from a slightly arsenical border in a room; (c) from some arsenical paints frescoed on a ceiling; and finaUy, by the presence of some green glazed paper boxes in a closet of a neighboring room. In this, as in the preA'ious cases, arsenic was found in the urine. The symptoms, too, are interesting, for they include those of practi- cally every slight affection anel almost any graAre disease that flesh is heir to, and vary from a cold in the head to almost complete paralysis; the latter, by the way (Professor AYooel, case 19), occurring Avithin two hours after exposure to the poison. In one famous case, that of ex-Mayor Cobb, of Boston, the long, tedious illness and final death AA-ere confidently ascribed to arsenical wall-paper. On autopsy it appeared that the victim had been suffering aU along from a cancer of the stomach. Nor did " age stale or custom Avither their infinite variety," for papers Avhich had been on Avails twenty-five years and more, and Avere in good condition at the end of that time, Avere still quoted as the cause of disease. The most extraordinary claim of all, hoAvever. Avas that paper, covered over by a non-arsenical one, could still produce disease. Thus (Senate, p. 108), irritation of the air-passages, tonsillitis, and other diseases AA-ere caused by an arsenical paper completely covered by one free from any trace of the poison. A still more striking case is told yearly to his stu- dents by a well-known professor of chemistry, as an illustration of this subtle and deadly wall-paper poisoning. Some persons were taken sick, and the wall-paper Avas examined, but founel free from arsenic. This was scraped off and the underneath one examined, but also found non- arsenical. Not content with this, a third paper AA'as uncoA'ered, and, to 390 A SYSTEM OF LEGAL MEDICINE. the good professor's huge dehght, traces of arsenic were found in some fioAvers with which it Avas decorated. This paper, number three, is iioav triumphantly exhibited to his classes as an example of a physician's abU- ity and a chemist's perseA-erance ! It avUI be seen at once that these results coiUd not have been sup- poseel, by the greatest enthusiast, to have been the work of ordinary Paris green, mechanically dislodged from the waUs. So a theory Avas propounded, based on papers by Fleck (Zeitsch. f Biol, vol. viii., p. 444) and Hamburg (Pharm. Jour, and Trans., August 1, 1874), that, by tlie action of microbes, arseniureted hydrogen Avas constantly being evolved from arsenical pigments and dye-stuffs. Sad to say, Prof. C. F. Chandler, called on from NeAV York to testify on the subject, demolished this AA'hole story in very short order. He explained how, AA'hen president of the Xew York Board of Health, he had, years before, thoroughly investigated the whole subject and found there Avas nothing to it. Deaths and Ulness from wall-paper poisoning did not exist in either Xcav York or Philadelphia, and the best physicians and health authorities in both cities agreed in calling it a humbug. He then, after pointing out the general absurdity of the claims, attacked their eAddence on two lines: first, that their tests for arsenic Avere un- trustworthy ; aud second, that arseniureted hydrogen or other poisonous gases were not set free from arsenical pigments, as stated. It so happened that the Boston chemists had determined the presence of arsenic by the simple formation of a dark or black deposit with the Berzelius-Marsh test, and when occasionally they took the trouble to further test this deposit to see if it Avas arsenic or not, they simply broke the tube and smelled of it, to see if it had a garlic odor. This careless method of testing made all their results entirely unreliable. About the exhalation theory Professor Chandler not only quoted Hoffman, Henry Watts, Professor Galloway, and others in favor of his vieAvs, but described some experiments of his own, never before pub- lished, AA'hich Avere made in 1880 while studying the matter for the Board of Health. The claim had been made that in the decomposition of the starch paste enough hyelrogen Avas produced to form arseniureted hydrogen. Tavo of his assistants, under his direction, mixed Paris green AA'ith fresh paste, and AA'ith paste in an active state of decomposition, and they also spread Paris green and paste thickly on a sheet of paper. But although they passed air for hours and hours over these surfaces and mixtures, not a trace of arsenic could be found to have volatilized. It is interesting to know that this testimony of Professor Chandler, seconded once by that of Professor Henry Morton of Stevens Institute, Hoboken, Avas enough to nip the proposed legislation in the bud on both occasions. This subject has been discussed someAvhat at length, partly because the discussions, in which both sides of the question Avere very fully covered, are not readily accessible to the public; but also because some of the results published of late years in the Massachusetts journals about the presence of arsenic in urine from cases of wall-paper poisoning, will undoubtedly be quoted to the discomfiture of experts unless they can also have access to some of the reasons why those results are to be considered unreliable. INORGANIC POISONS. 391 VH. LEAD, PB. Metallic lead has been known and used by man from the early histor- ical ages, and to this day we can see, notably in England, not only the traces of the ancient mines, but also the old pigs and weights of lead, stamped with the mark of the old smelting-works, and the remains of the original lead pipes used by the Eomans to conduct water to their baths. It occurs in nature principally as the siUphide, galena, and can be readUy extracted by smelting with coal and, sometimes, iron. Properties.—It is a soft, lustrous, heavy metal, with a bluish-white color, melting at about 315° C. It dissolves readily in dilute nitric acid, and with difficulty in hot concentrated sulphuric acid. It is, however, insoluble in cold sulphuric acid, and practically so in hydrochloric acid. In pure water it is not dissolved; but if the Avater is or has been exposed to the air the lead oxidizes, and then becomes converted into a hydrated carbonate, a white compound, a little of which dissolves in the water, whUe the rest forms scales anel incrustations, Avhich settle to the bottom, or may, in fine particles, be carried along with the liquid. This action of Avater is supposed to be assisted by the presence of nitrates and also, to some extent, of chlorides, while even small quantities of sulphates and phosphates, or of carbonates, protect lead from corrosion by forming insoluble coatings upon its surface. As a Poison.—Metallic lead dissolves but slowly in the fluids of the body, and hence has been known to remain in the body for years, as, for instance, in the case of bullet wounds, without causing serious incon- venience. If, however, it enters the circiUation, as has been known to happen in those very cases after doses of potassium iodide, it wUl, even in small quantities, give rise to characteristic symptoms of poisoning. Cases of acute lead poisoning may occur from taking considerable quantities of the soluble salts, plumbic acetate, or, more rarely, plumbic nitrate. These cases, hoAveA'er, are very rare, and form but a minute fraction of the whole. By far the greater bulk of the victims of lead poisoning have absorbed the metal, purely by accident, in minute quan- tities, day by day, for considerable periods. The number of these cases is extraordinary; for, as will be seen on reference to the tables on pages 351 and 352, deaths from lead poisoning rank, at least in this country and England, next to those from opium and its compounds, forming some twenty percent, of the whole number; AA'hile these figures re})resent but a smaU part of the cases more or less permanently injured by its action. How Introduced into the System.—Chronic lead poisoning is most common among those constantly at Avork with the metal or its com- pounds, as, for instance, plumbers, painters, type founders and setters, shot-makers, anel the like. In lead Avorks and paint factories it is so frequent that special precautions have to be taken to protect the Avork- men: the A'eiitilation is looked after, white lead and other powders are ground in water, AA'hile stringent rules have to be made and enforced, insisting on great personal cleanliness, and the eating of all food outside the gates of the factory. In many cases, as I haA'e myself seen, sul- phuric acid lemonade is furnished freedy as a prophylactic drink, and employees who complain of any trouble from constipation are given doses of Glauber's or Epsom salts. 392 A SYSTEM OF LEGAL MEDICINE. Food.—Innumerable cases of lead poisoning haA'e also been caused by the presence of the metal in ordinary foods, drugs, and drinks. Many people have been poisoned by the presence of lead compounds in flour and bread, in one case (Stourbridge) from accidentally mixing leael acetate Avith the flour, but in most of the other cases by the careless use of white lead in repairing the grindstones. Foods cooked in lead-glazed pots, beer and cider draAvn through lead pipes, Avine SAveetened Avith litharge or lead acetate, or kept in bottles carelessly cleaned Avith shot, sAveet- nieats and the hke packed in tin-foil, fruits and A'egetables canned AA'ith the use of leael solder, have all contributed their share of A'ictims. Hair-dyes.—Another A'ery important source of poisoning is the use of cosmetics, hair-restorers, and hair-dyes made of leael salts. The latter aim to reproduce the original broAvn or black color of the hair by im- pregnating it Avith lead sulphide, anel hence usually consist of Iavo solu- tions, one of lead acetate, to be weU rubbed into the hair, and the other of alkahne sulphide, to be applied later. In a report on dangerous cosmetics made to the Xcav York Board of Health in 1870, Professor Chandler gave analyses of most of the face and hair preparations sold at the time in the city, and showed that they almost invariably container! large amounts of lead; while a similar state of affairs Avas shoAvn a few years later by Dr. Benjamin (New Remedies, November, 1878). Water.—The most common source of lead poisoning, to the com- munity at large, lies in the use of drinking-Avater conveyed through lead pipes or kept in lead-lined tanks. The amount of lead necessary to make a water poisonous need not lie large. Thus in the Avell-knoAvn case of the Orleans family, Avho, after their expulsion from France in 1848, settled at Claremont in England, the use for five or six months of water containing about eight tenths of a grain of lead to the (United States) gaUon, produced distinct symptoms of chronic poisoning. As already noticed, the purer the AA'ater, and the more free it is from sul- phates, phosphates, and carbonates, the more liable it is to attack the lead. These evil effects Avere well known to Yitruvius (B.C. 50), Galen (a.d. 130), and other of the earliest authorities, and the use of lead pipe for conducting drinking-water was forbidden, in early days, under severe penalties. But it is so cheap and so convenient for this purpose that its use has never been superseded. Lead tanks are ahvays dangerous, and should invariably be replaced by copper, zinc, or, better, block-tin. If lead pipes are used the precaution should ahvays be taken of letting the water run freely before draAving any to drink. Many cases are on record, in this city as well as elsewhere, of lead poisoning from using drinking-water that has stood overnight in the pipes. Effects of Lead on the System—(a) Acute Poisoning.—This occurs but rarely, and then usually from taking plumbic acetate, sugar of lead, in considerable quantities. This compound is a AA'hite crystalline sub- stance, Avith a sAveet metallic taste, anel readily soluble in Avater. Unlike most poisons, it is less dangerous in one large dose than AA'hen the same quantity is taken diAdded into many smaller" doses. Nor can it be con- sidered as a A-ery active poison, for it is given medicinally as an astrin- gent, and to stop bleeding from the bowels, in doses of from two to five grains, and in quantities running up to fifteen and twenty, or even thirty and forty grains a da}', Avithout injury. Indeed, the fatal dose of it is INORGANIC POISONS. 393 not known, for recovery has taken place in very few days, and with simple treatment, after taking in solution an ounce and more of the compound. Symptoms.—In the few fatal eases of plumbic acetate poisoning that have been reported, the patient, as a rule, notices at once a metaUie taste, and burning and sense of dryness in the throat and mouth. This is foUowed by vomiting and retching, with pain in the stomach and abdomen, sometimes relieved by pressure. Sometimes there is severe purging, with passage of blood, but usuaUy there is obstinate constipa- tion, and any material passed is dry and colored black, probably from the presence of lead sulphide. The urine is diminished, the breath is foul, and the tongue coated. There is a quick, weak pulse and great prostration. Time of Death.—If the dose proves fatal the patients usuaUy die in three or four days from prostration. After the first few days they are apt to suffer from the A'arious nervous symptoms of chronic lead poison- ing, and after sui-A'iA'ing the acute attack they may remain in wretched health for a long time. Treatment.—The proper antidotes to lead salts of aU kinds are the two saline emetics, Glauber's salts and Epsom salts, the sulphates of sodium and of magnesium. These not only counteract the constipating effects of lead and help to remove it from the body, but also convert any of its salts as yet unabsorbed into the insoluble plumbic sulphate. The stomach should be weU washed out, and the vomiting and prostration controUed as far as possible by opium, and by stimulants. After lead has once been absorbed into the system, as, for instance, in chronic cases, it is possible to remove it by doses of potassium iodide. These, however, should be administered with care, or else, by suddenly throwing large amounts of lead into the circulation, the chronic symp- toms may be changed into acute. Post-mortem Appearances.—It is usual to find after death eAdelences of more or less severe inflammation of the stomach or intestines. The liA-er and kidneys are also affected if death has been delayed for some days. (b) Chronic Lead Poisoning.—This is far more common than any other kind, and indeed presents such a variety of symptoms that prob- ably many cases of it are entirely overlooked. There is much difference among individuals Avith regard to their susceptibUity to smaU doses of lead. As a rule it attacks the weaker ones first, and especially if they are predisposed to gout. On the other hand, as, for instance, in the case of the Orleans family mentioned above, young chUdren are sometimes not affected. The poison is usually absorbed through the stomach, but it can pen- etrate through the skin or the lungs without much difficulty, under the proper exposure. The length of time necessary to produce the poison- ing A'aries, of course, Avith the amount of lead that reaches the system. Thus the characteristic symptoms may appear in a few weeks or even davs, or they may not be noticed until exposure has lasted for years. InuVed, lead is considered to be a poison AA'hich slowly accumulates in the body until the poisonous limit is reached, or until the body, becom- ing Avcakened from one cause or another, gives Avay to influences AAdiich it formerly resisted AA'ith success. 394 A SYSTEM OF LEGAL MEDICINE. Occasionally there seems to be some local action of the lead. Thus plumbers and painters are usually first paralyzed in the hands, right or left as the case may be, with Avhich they Avork the most. This, however, precedes the lesion on the other side by only a feAV days at the most, anel it is generaUy beheA'ed that the poison is first absorbed into the general circulation, and then selects the particular organs or parts for attack. Symptoms.—(a) General Nutrition.—As ;i rule, before developing any characteristic lesions the patient feels generally run cIoavh and AA'retediecl. His appetite faUs, his digestion and nutrition are poor, and he feels feedih1, and becomes more or less emaciated. This is generally accom- panied with anaemia, more or less scA'ere, in AA'hich, it is claimed, the red blood-ceUs diminish in quantity and increase in size at the same time. The Uver is often affected, and the kidney is very commonly diseased, undergoing a parenchymatous inflammation, and dually becoming hard and granular, with diminished excretion of urea. Indeed, many of the later nervous symptoms haA'e been referred, by many good authorities, largely to uraunia caused by the kidney lesions. Abortions are extremely common in the ease1 of pregnant Avomen, and the children of chronic lead patients, as a rule, die at childbirth or a few years afterward. Blue Line on Gums.—Quite early in the course a peculiar bluish-black line can be observed on the gums, usuaUy AA'here they join the teeth. This is formed by the deposition of plumbic sulphide, and has been ' noticed in tweuty-four hours after taking, medicinally, twenty grains of plumbic acetate, and for four years after exposure to lead had ceased. It can be traced first on the projections of the gum betAveen the teeth, and in some cases, especially where the teeth haA'e been A'ery carefuhy attendc'd to, it may appear there only. In a feAV instances it has not been obseiwed at all, and it has once or twice been observed in mercury and silver poisoning; but, as a rule, it is the characteristic and distinctive mark produced by lead. Intestinal Pains, " Colica J'ictorum."—Soon after this the patient suf- fers from obstinate constipation, accompanied by acute paroxysms of pain in the abdomen. This pain is probably produced by the action of lead on the sympathetic gangha of the intestines, and not by any in- flammation of the intestinal waUs. It can often be relieved by pressure, and is situated mostly around the umbilicus. (b) Nervous Symptoms.—Besides the affections of the nervous system sIioavii by the coUc and by pains in A'arious joints and muscles of the body, there are some characteristic nerve lesions due to a progressive peripheral neuritis. This sometimes produces an atrophy of the muscle along Avith a loss of poAver, but as a rule the parts affected are first partially or wholly paralyzed, and do not Avaste for some little time. This paralysis does not often attack a whole group of muscles, but picks out one or two here and there. The muscles most affected are the extensors of the fingers and Avrists, causing thereby a characteristic hanging of the Avrist knoAvn as the " Avrist drop." The corresponding leg muscles are occasionaUy affected, but almost ahvays after the upper extremities, AA'hile the paralysis may spread to the upper arm and even attack muscles of the trunk. If the * muscles are only paralyzed and not much atrophied, it is possible to make a complete cure by the aid of electricity and similar nerve stimu- lants, although relapses are common from even very slight exposures. INORGANIC POISONS. 395 But when atrophy and paralysis occur together, recovery is A'ery slow, if indeed possible at aU. Along AAdth this paralysis there may occur more or less tremor, some- times fine, like that of old age, and often very marked, hke that of paral- ysis agitans, only of AA'ider range and increased after motion or exertion. Sometimes this tremor affects the lips and tongue, and is much hke that of mercury. (e) Cerebral Symptoms.—Again, the poison may affect the brain, caus- ing at first light symptoms of giddiness, headache, insomnia, disturbed sight and hearing, and the like, AAdiich may develop into delirium or into stupor, with coma and sometimes conA'ulsions, especiaUy before death. Sometimes the cerebral symptoms may result in attacks resembling those of epUepsy. The disturbances of sight are quite common, and seem to depend upon an optical neuritis produced by the lead, as AveU as upon retinitis that may result from the kidney disturbances. The eyesight may be affected after only a few days' exposure. Beside these there may be mental disturbances, melanchoha, for in- stance, and hallucinations and delusions, generally mUd, but sometimes acute. Occasionally there is mental failure, AA'hile, especially in France, there have been described cases of plumbic hysteria AA'hich counterfeited many of the most severe forms of nervous lead symptoms. Cause of Death.—Death, as a rule, results from the general anaemia and malnutrition produced by the poison, and especiaUy from its action upon the kidneys. Sometimes, hoAvever, the patients die in an acute cerebral attack, and occasionally from a paralysis of respiration or circu- lation. The treatment is the same as that already described under acute poisoning. Location of the Poison in the Tissues.—The amount of lead found in the body after death is generally extremely small. It has been found chiefly in the liver and kidneys, though small quantities haA'e been traced in the brain, stomach, spleen, anel lungs, in man, and in the bones and muscles also, in a dog. Excretion of Lead.—The poison absorbed into the system is undoubt- edly excreted chiefly by the kidneys, although the actual amount of lead present in the urine is usuaUy very small. Excretion is helped by the in- gestion of potassium iodide, wliich tends to dissoh'e the lead. It is prob- ably also excreted by the bile, and perhaps by the skin and intestines. The ehmination is, as a rule, extremely sIoav. Tests for Lead.—(a) Sulphureted Hydrogen.—This gas Avhen passed through an alkaline, neutral, or moderately acid solution of lead will give a black (or, when the amount of metal is extremely minute, a brown) pre- cipitate of plumbic sulphide. This precipitate can be reduced to metaUie lead by heating on charcoal AA'ith the bloAv-pipe. It is soluble in dilute nitric acid and also in hot concentrated hydrochloric acid, which changes it into lead chloride. If other metals are present the mixed sulphides can be separated from each other by dissolving the arsenious sulphide Avith ammonia, and the antimonious sulphide Avith sodium sulphide. If the residue is treated Avith hot, strong hydrochloric acid, the lead AviU be dissolved and the copper or mercury compound remain behind. The lead chloride thus obtained, if in any abundance, wiU precipitate, on cool- ing and dUuting Avith AA'ater, in the form of Avhite crystals. 396 A SYSTEM OF LEGAL MEDICINE. The test is extremely delicate, and, according to AYorniley, AviU give a distinct broAvnish tinge to ten grains of solution containing, in all, 1-25,000 of a grain of plumbic oxide. (b) Sulphuric Acid.—A solution of leael is readUy precipitated by dilute sulphuric acid, or by a soluble sulphate, in the form of AA'hite, needle- shaped crystals of plumbic sulphate. This precipitate is soluble in a large amount of alkali, and also in hot concentrated hydrochloric acid. (c) Potassium Iodide.—This reagent gives a vcIIoav precipitate1 of plumbic iodide, soluble in caustic potash and in strong hydrochloric acid; it also dissolves in boiling Avater, and AviU be deposited from this solution in the form of yellow hexagonal plates, quite similar to crystals of iodoform. (d) Potassic Bichromate.—This avUI precipitate the lead as yellow plum- bic chromate, soluble in potash and in strong hydrochloric acid. Separation of Lead from the Tissues.—If lead alone is being looked for, it is generaUy best to extract it from the organic material by re- peated treatment with concentrated nitric acid. As a rule, however, the tissues are oxidized, as in the case of the other metals, with hydrochloric acid and potassic chlorate, and the mixed sulphides are precipitated from the acid solution by sulphureted gas. The lead sulphide can be extracted by hydrochloric acid and reprecipitated by sodic sulphate in the form of plumbic sulphate, Avhich can be separated and weighed. To proAre this to be lead it is possible to dissolve the sulphate in an alkaline carbonate and reprecipitate it by sulphureted hydrogen. It is important to remember that lead, in minute quantities, has fre- quently been found in the body when there has been no suspicion of either acute or chronic lead poisoning; so that, unless the quantity found is comparatively large, or some at least of the characteristic symp- toms have been present, it is not right to lay too much stress upon the analysis alone. vm. mercury, Hg. Mercury is occasionaUy found free in nature, but is generally extracted by reducing and subliming the red sulphide, cinnabar. It is, at ordinary temperatures, a bright, metallic, heavy hquid, freezing at —39.9° C, and boihng at about 350° C. It is volatUe at all temperatures, to a greater or less extent. It dissolves readUy in hot concentrated sulphuric acid, and in cold nitric acid. Physiological Effects.—Metallic mercury, when taken in single large closes, is, as a rule, quite harmless. Cases are on record where as much as two pounds have been administered, either at once or in the course of one or two days, and no toxic symptoms have resulted. On the other hand, in one or tAvo cases where iarge doses were taken, enough of the metal has been absorbed to produce slight but distinct marks of poi- soning. AYhen administered in minute doses for a considerable length of time the mercury becomes absorbed into the system, and then produces its characteristic effects. This is equaUy the case AA'hen given by the stom- ach or through the skin, or AAdien inhaled as a A-apor. AYhen the doses are very minute mercury seems to act as a tonic to the blood, and thus to the general system. In somewhat larger quanti- INORGANIC POISONS. 397 ties it acts as a mild purgative by stimulating the flow of bile from the liA'er, and is much used, along with calomel, for this purpose. Besides this it has a weU-knoAvn specific effect in the early stages of syphUis, counteracting both the specific lesions and also the general depressing effect, anaemia, Aveakness, and the like, of the disease. Poisonous Effects.—(a) Mouth Symptoms.—The first signs that the drug has been pushed to its limit as a medicine consist of a slight red- ness about the gums, a smell to the breath, and a shght gray deposit at the base of one or more teeth. The teeth feel long, and are tender AA'hen tapped or struck, and there is a slight excess of saliva. If the mercury is pushed still furtluu' true poisonous symptoms set in. The gums and tongue are SAvollen and sore, and bleed very freely. The teeth get loose, the saliva is enormously increased in quantity and be- comes thick and ropy, and the breath is excessively offensive. The sali- vary glands become inflamed, and the soft parts of the jaw may even become ulcerated, and bleed more or less constantly. In some cases there is a necrosis of the jaw itself; and in ah cases the general discom- fort, sleeplessness, loss of blood, and bad condition of the tissues produce great Aveakness and emaciation, anel sometimes may even cause death. (b) General Symptoms.—These large doses of mercury ahvays impair the general health and nutrition of the body. The patient becomes anaemic, loses appetite, becomes emaciated and Aveak, and often develops ulcers, bed-sores, and the like upon various parts of the body. This has been called mercurial cachexia. The kidneys, also, are apt to become in- flamed, although not as seA'erely as in acute poisoning. (c) Nervous Symptoms.—Very important effects are produced upon the nervous system, especially when the mercury has been absorbed slowly through the lungs. Cases of this are A'ery common in persons Avorking in mercury mines, in the manufacture of barometers and thermometers, in plating looking-glass, in furriers and hatters Avorking in fur preserved by mercurial solutions, and others. These nervous symptoms sometimes occur Avithout salivation, and occasionally af ter all exposure to the poison has ceased. The most common and characteristic symptom is the mercurial tremor, wliich usually conies on sIoavIv and graduaUy, although occasion- ally it may appear all at once, as after a fit of rage. It at first affects the face anel tongue, though but slightly. Then it attacks the arms, espe- cially the forearms, and finally the legs. At first it is only occasional, coming on most markedly after exertion, or when exciteel for any cause. The patient is not quite sure of his hands. They move by jerks, and not sIoavIv and steadily. When he tries to drink he spUls the Avater and is apt to miss his mouth, whUe after he has once taken hold of anything it is hard to let it go. Then his legs fail to seiwe him well; it is hard to walk Avithout assist- ance, and his limbs tremble and move Avithout his control. His tongue is tremulous and his speech is jerk}-, hard to articulate and hard to understand. AVhen once excited the tremor is hard to stop, and finally may continue all the time, only lessening, though not stopping entirely, during sleep. The muscles become Aveak, although not losing their poAver of reacting AA'ith electricity. These motor disturbances may in- crease to partial paralysis. Along Avith this, or sometimes before it, there are some psychical 398 A SYSTEM OF LEGAL MEDICINE. symptoms, i.e., the patients become irritable and sleepless, anel find it liard to fix their attention on anything. They may even develop symp- toms of mental disorder; sometimes they have hallucinations, or even outbreaks, as in mUd forms of mania; other cases become extremely stupid, almost idiotic. The sensation, also, is almost ahvays more or less disturbed. Some- times there is a tickling feeling on the limbs, even marked neuralgia, At other times there is more or less amesthesia, sometimes over half the boeb', but generally in patches. The eyes are very commonly affected, and there1 is occasionally more or less deafness, and eA'en aphasia. Sometimes the disturbances are confined to some part of the body, one arm, or a foot, for instance, spe- ciaUy exposed to the metal. This, however, is rare. Cases of Chronic Mercurial Poisoning.—A remarkable and often quoted instance of this chronic poisoning on a large scale is that of the British man-of-war, the Triumph, which, off Cadiz in 1810, stowed in her hold one hundred and thirty tons of quicksilver saved from a wreck. The packages broke, and, as the Aveather Avas hot, the ship was permeated Avith the vapor of mercury. In three Aveeks over two hundred men were ill Avith salivation, ulceration of the mouth, diarrhoea, and partial paral- ysis. Tavo men died of gangrene of the jaw and mouth, and three others of consumption, although they had not previously been suffering from that disease ; Avhile others lost teeth and pieces of the jaAv, or suffered from more or less chronic nervous symptoms. Almost all the stock on the A'essel died, cats, mice, a dog, and eA'en a canary bird. An interesting ae-count is given by Dr. Adder (Med. News, 1891, vol. lix., p. 186) of five cases of chronic poisoning among Avorkmen in a hat factory. One of these, a man of forty-five years, had Avorked for nine years in the factory anel had been sick-for oa'ct a year. He first noticed the usual signs of saliA'ation, AA'hich, hoAveA'er, die! not become A'ery scwere. Then his hands became tremulous and unsteady, so that he could not read his newspaper. His eyes, too, began to trouble him; black spots Avould dance before him, and they Avould keep tAvitching. His gait Avas next affected; he Avas unsteady on his feet and staggered as though in- toxicated. Then his appetite failed; he lost his sexual poAver; he became emaciated, losing twenty-five pounds or so in six months, and he had occasional vertigo. There was a blue line on his gums. Another of these patients Avas a boy of fourteen years, who had been in the shop one year and had not been affected until about four months before. He then began to lose his memory and to suffer from headaches ; his breath was affected, and he had symptoms of salivation. In about a month's time he found it hard to Avalk; his feet felt heaA'y, like lumps of leael. He then found it hard to pick up things from the ground, Avas slow to drop a pencil AA'hen he held it, and so on. AVhen he came under treatment there Avas a marked tremor, and much ataxia, especially in his arms and shoulders. In another case (Dr. Thiroloix, Gaz. des Hop., 1891, vol. lxiv., p. 417) simUar symptoms Avere produced, in an attendant in a shooting-gallery, by the fumes of the fulminate of mercury used in the cartridges. They are beheA'ed, also, to have been caused (Dr. Buckley, Jour. N. Y. Med. Assn., 1884, a^oI. i., p. 127) by the use of rubber teeth-plates colored Avith cinnabar. INORGANIC POISONS. 399 Nerve Lesions—Some authors claim that the above nervous symp- toms are due to the action of mercury upon the brain and cord. On the other hand, LetuUe (Archie, de Physiol, 1887, pp. 301, 437) has observed degenerations of the sheaths of the peripheral nerves, although he claims that the axis cylinders remain intact. This Avould correspond with the action of other poisons, alcohol, arsenic, and lead, and would show that the effects are due to a progressive peripheral neuritis. Mercurial Hysteria.—It is only proper to say, in this connection, that prominent neurologists of the Paris school claim that in many cases the nervous symptoms of chronic mercury, and also of lead, poisoning, are exaggerations of previously existing hysteria, and that, haAdng pro- duced no true nerve lesions, they may be cured by suggestion. They give instances not only of tremor, but also of mercurial hemiplegia, hemianaesthesia, amblyopia, and even of apoplexy, which, they state, are of an hysterical character, and, while not producing death, are often very hard to cure by ordinary treatment. They carefully distinguish these from other cases of severe nervous disease, which rapidly leads to paral- ysis and death, and which results from exposure, as in the mercury mines, to large amounts of mercury vapor. ' A curious case of this sort is given, in great detail, by Dr. LetuUe (France Med., 1888, part ii., pp. 1578, 1589), of a workman who was ex- posed to mercury fumes for ten years, and at last came doAvn AA'ith mod- erated}' severe palsy in his arms. He returned to his work partiaUy cured, after a six-weeks treatment at the hospital with the ordinary remedies, and kept on for five years more without much trouble. Finally, while at Avork, he was seized Avith Adolent tremors of all four extremities, fell cloAA'n, found that he could not raise himself, and was carried out and driven to the hospital. He presented very marked features of mercurial palsy, violent tremors in both arms and legs, anaesthesia in part of his arm, teeth blackened and striated (a symptom noted by many French authors), left eye someAA'hat affected. He was unable to walk Avithout the greatest effort, and after such exertion his AA'hole body was set trembling. But he was cured of all his nervous symptoms in four days, on the application by Dr. LetuUe, with a certain amount of formality, of a tight rubber bandage round one arm, followed on the next day and the day after by the placing of a magnet upon his shoulder, and again on his thigh. Besides the above reference, the reader is directed to another paper by Dr. LetuUe (Soc. Med. cles Hop., 1887, vol. iv., p. 370), where numerous examples are given and references are made to papers by Charcot, Jean, and others, on the same subject. Treatment.—In other countries chronic mercury poisoning is treated by less striking methods. In the first place, the patient must be pre- A'ented from absorbing more of the poison. The mouth symptoms, sali- vation and the like, are controlled by washes of potassic chlorate, and by small doses of the same salt taken internally. The nervous symptoms are, as a rule, much improved anel in many cases cured by galvanic elec- tricity, whUe the mercury in the system is removed by small doses, from two to three grains, of potassium iodide. This salt, in some obscure way, seems to dissolve out the mercury and eliminate it through the kidneys; but, if done too rapidly, it may, by throwing large quantities of poison into the blood, aggravate the symptoms. 400 A SYSTEM OF LEGAL MEDICINE. Elimination of Mercury.—This is done principaUy by the kidneys, and also largely through the large intestine1 and the saliva. Mercury has been found, hoAvever, in the sAveat, milk, bUe, and, in fact, all the secre- tions of the body. It has been found in the urine half an hour after a hypodermic injection, and two hours after a dose of mercuric chloride, taken through the mouth. Experiments on animals tend to sIioav that Avhen a single dose of a mercury salt has been administered, it will be eliminated from the body in a feAV days. AVlien, hoAvever, a patient has been absorbing mercury for some time, it may remain in the system for months if not for years. Calomel—Mercurous Chloride—Hg2 Cl2• This is formed by subliming mercurous sulphate Avith common salt. It occurs in commerce as a heavy Avhite poAvder, insoluble in cold water. It is largely used in medicine, generally in small but occasionally in huge doses, as a purgative and liver tonic, and also as a diuretic. As a rule it is too insoluble to produce any seA'ere effects, and doses of an ounce and more act no more poAverfully than those of a few grains. Occasionally, hoAveAer, whether from some idiosyncrasy in the patient, some impurity in the medicine, or some change in its composition set up inside the body, quite small amounts of calomel, five or six grains, in some cases, have produced marked salivation and even death. Corrosive Sublimate—Mercuric Chloride—Bichloride of Mercury—HejCl This is the most poAverful and most important of the corrosive salts of mercury, among which are included other mercuric compounds, the nitrate, sulphate, and the like, and also "turpeth-mineral" and "white precipitate." These compounds, when taken in small doses for some time, avUI set up the constitutional effects of mercury described above. But Avhen administered in any quantity, they haA'e an irritant and even cor- rosive action both upon the mucous membranes Avith AA'hich they come in contact, and also upon the organs through which they are excreted. Corrosive sublimate occurs in commerce as a AA-hite crystalline solid or poAvder, with a peculiar metaUic taste, and soluble in sixteen parts of cold, and three parts of boiling, water. It can readUy be distinguished from other salts, by forming a brilliant scarlet precipitate with potassium iodide; and eA'en minute quantities can be identified by heating them in a smaU reduction-tube and moistening the white sublimate with a little iodide. Symptoms, when taken Internally.—When swaUowed in any quan- tity the patient notices at once the characteristic taste, and a sense of con- striction about the throat. The throat and mouth become A'ery sore and painful, and the mucous membranes look white and shriveled. This is soon folloAved by pain in the stomach, and then by nausea and violent A'omiting. the vomited matter being frequently stained Avith blood. There is seA'ere purging, often of bloody material, and the abdomen becomes painful to the touch. Sometimes there is profuse hemorrhage from the boAvels, or, occasionaUy, from the stomach. Along with these symptoms come those of marked coUapse. a feeble,, INORGANIC POISONS. 401 rapid pulse, cold SAveat, difficult breathing, faintness, stupor, and the like. There are often cramps in tlie extremities, thirst is intense, and the urine is scanty or even suppressed. Time of Death—Death may come on very rapidly from suffocation, owing to corrosion of the trachea and oedema of the glottis. As a rule, it results from collapse, in a state of coma, or preceded sometimes by convulsions, in the course of from one to three days. After this time the symptoms are more like those of dysentery, i.e., frequent bloody stools containing often shreds of bloody mucus, and accompanied with much straining. The kidneys are much affected, while the case is apt to be complicated with salivation, and even by the nervous symptoms due to mercury. The shortest period of death in the case of an adult is given by Tay- lor as half an hour. He also quotes another case of death in three and'a half hours. Protracted cases of six, eight, and ten days, or even of some Aveedis, are not rare. Fatal Dose.—Not a few cases have been reported AA'here adults have died from doses varying from fh-e to ten grains, and Taylor states that, under favorable circumstances, death might result from doses of from three to five grains. On the other hand, with proper treatment, patients have recovered from much larger doses. For instance1, Dr. Lodge (Brit. Med. Jour., 1888, part ii., p. 720) tells of a man who ran into his office ten minutes after drinking a solution of one hundred grains of bichloride. He had already drunk a pint of milk, and the doctor, after washing out his stomach with warm water and an emetic, and giving c'gg albumen, had him put to bed in hot blankets. He suffered from a slight coUapse, and next day from dysenteric symptoms, but Avas all well in a fortnight. Treatment.—Mercury forms insoluble compounds with albuminous bodies, and hence the best antidotes are milk and Avhite of eggs. The stomach, of course, must be avcU washed out, and the symptoms, as they occur, treated Avith soothing drinks, morphine, and stimulants. It not infrequently happens that the symptoms improve for a Avhile only to re- turn with greater violence. Post=mortem Appearances.—These show evidences of inflammation of the digestive tract, although not ahvays of the same part. Usually signs of softening, congestion, and even corrosion of the mucous mem- branes are found in the mouth, throat, and stomach, and in the few cases AA'here these are found nearly normal, the intestines, and especially the large intestine, are much iiiA'olved. After a few days the kidneys become large1 and much congested, and the bladder is usually contracted and almost or quite empty. The liver is not affected as much as by some other poisons. Other Irritant Mercurial Compounds.—Similar effects have been produced by somewhat larger doses of other salts of mercury, as, for in- stance, mercuric nitrate, white precipitate, and turpeth-inineral. Mercuric nitrate has poisonous qualities, Avhether taken internally or externally, but httle inferior to those of corrosive sublimate. It has, in- deed, been used as a means of attempted poisoning. The Avhite precipitate, mercury-ammonium chloride, XdU.HgCl, is largely used as an ointment, and as such is a mild and easy form of ad- ministering mercury. InternaUy, hoAvever, it acts as an irritant, as, for 402 A SYSTEM OF LEGAL MEDICINE. instance, in a case (Brit. Med. Jour., 1885, part n., p. 15) where a drunken man, drinking forty grains of it in water, Avas taken A'ioleiitly ill in half an hour, with great pain, vomiting blood freely, anel passing bloody stools, and, in spite of treatment, died of collapse in fh-e hours. A case of re- covery from tAventy grains, Avliere the early symptoms of an irritant poi- son were complicated in two-elays time by acute mercurial symptoms, is given by Dr. Sandberg (Brit. Med. Jour., 1889, part i., p. 709). Turpeth-mineral, a basic sulphate of mercury, HgSO,2HgO, has also been the cause of many accidents, especially when given to croupy chil- dren as an emetic. Cases have been reported (Med. and Surg. R patient, without the deep corrosions of sulphuric acid. If the silver is in solution it is easy to precipitate and weigh it as chloride, by the addition of hydrochloric acid or common salt. In the tissues, hoAvever, it usually exists as a chloride, and for that reason it is necessary, after destroying the organic matter with nitric acid and potassic chlorate, to extract with a solution of potassium cyan- ide and a little ammonia. This dissolves the silver, Avhich can then 1 »e precipitated as chloride by an excess of hydrochloric acid. Tins chloride can be easily reduced to metallic silver 'by heating on charcoal with a blow-pipe, or by touching it with a piece of metaUic zinc. INORGANIC POISONS. 413 XII. IRON—FE. Although solutions of iron are constantly employed in medicine in considerable quantities, and are considered harmless, it is worth remem- bering that two of its salts, ferric chloride and ferrous sulphate, may, on occasions, act as seA'ere poisons, and haA^e eA'en been used for murder. Ferric Chloride, FeXlB.—This compound is a broAvn delicjuescent substance extremely soluble in Avater, anel only met with dissolved in AA'ater or alcohol. Careful experiments have been made with it upon animals, in connection with a famous trial in Martinique (Berenger- Ferraud and Porte, Ann. d'Hyg., 1879, pp. 312, 508), from AA'hich it would seem that, given AA'ith the food, it is practically harmless, but upon an empty stomach, and especially AA'hen dissolved in alcohol, it is an active poison. The symptoms noticed Avere those of gastric anel intestinal in- fiammation, Avith suppression of urine, sometimes paralysis, and death generaUy in coiiA'ulsions. Effects upon Man.—The tincture of ferric chloride has occasionally been taken in large amounts by accident, and produced serious conse- epiences. But in the case mentioned aboA'e it was used for murder, and actually killed four people. The A'ictims Avere aU French Creoles living in Martiniepic, and successively devoted to a fair Creole Avidow; Avhile, in three of the cases, the symptoms of poisoning occurred shortly after drinking a glass of punch given them by the aaucIoav's son. The poison was,in each of these three case's, taken on an empty stomach,and produced violent pains in the abdomen, with either diarrhoea or constipation, Avith tenesmus, and Avith suppression of the urine. One of the patients died in about thirteen hours, and the other tAvo in about sixty-five hours, while the fourth one, AA'hose eleath Avas not as thoroughly traced as the rest, survived nearly four days. Post=mortem Appearances.—The most noticeable appearance after death, in both animals and these men, Avas the blackish coating left on the mucous membrane of the mouth, throat, and stomach. The liver and kidneys Avere SAVoUen and congested, and the brain and meninges were hyperamic, and engorged AA'ith blood. Fatal Dose.—The dose given in these cases could not be ascertained, but from other cases it is knoAvn that an ounce or so of the tincture, containing one and a third percent, of the dry salt, Avill produce, under proper conditions, quite serious symptoms on the stomach and kidneys. It is excreted through the urine, and probably also through the intestines, for the fan-es are usually stained black. Ferrous Sulphate—Green Vitriol—FeS04.—This salt occurs in commerce in the form of large, green, transparent crystals, with an as- tringent taste, and readily soluble in Avater. It is frequently used, in common Avith ferric chloride, as an abortive, and has occasionally been taken in dangerous or even fatal amounts by accident, and also, in rare cases, for suicide. An interesting example of this last is reported by Dr. Lucy M. Hall (N. Y. Med. Jour., 1883. aoI. xxxviii., p. 401), AA'here a woman prisoner cheAved anel sAvalloAved, on an empty stomach, about two ounces of the crystals. She soon became partially blind and deaf, she Avas dizzy, and her legs Avere partly paralyzed, so that she walked Avith diffi- culty. In four days she Avas brought to the infirmary suffering from 414 A SYSTEM OF LEGAL MEDICINE. diarrhoea and severe pain in the abdomen, especially over the sigmoid flexure. Her stools Avere Avatery, greenish in color, and without any facal odor, her tongue Avas furred, her piUse Avas AA'eak and irregular, her temperature low. The intestinal trouble increased for two or three weeks, and developed, in some tAventy-five days, into an exceedingly severe inflammation of the stomach as AveU as of the intestines. This nearly caused the death of the patient, but Avas finally subdued by injecting fifty-percent, solutions of plumbic acetate, containing some morphine, in four- and five-ounce doses, and keeping them in the intestines, by pressure, for two hours at a time. Under this somcAvhat heroic treatment the inflammation Avas finally controlled, and after two months the patient graduaUy began to improAC. In this case, as will be noticed, there Avas no particular effect upon the kidneys, and after the first feAV days the lesions Avere confined to the digestiAe tract. Tests for Iron.—It must be remembcn-ed that iron is a normal constit- uent of the blood and the red muscles of the body, forming an essential part of the haemoglobin. Accordingly it is extremely difficult to distin- guish, on chemical analysis, betAveen the natural and the foreign iron. According to Orfila—and his example has been folloAveel by chemists since—the foreign metal can be dissolved by steeping the finely cut tis- sues, as well as the contents of the stomach and intestines, in cold acetic acid, wliich, it is claimed, has little or no effect on the iron in the hauno- globin. The iron in the filtrate can be separated by ammonic sulphide, in the form of black, ferrous sulphide, and after dissohing in hydro- chloric and nitric acids, may be reprecipitated by ammonia as broAA'n feu-- ric hydrate. The solution may also be tested Avith potassic ferrocyanide, Avhich will form a blue precipitate, or, after nearly neutralizing, by add- ing ammonic sulphocyanide, which AviU turn the solution a deep red. It Avould probably be easier and more satisf'aedory to obtain a good test for iron in the faces, or especially, after death, from the black depos- its on the mucous membranes of the stomach and intestines, than from the tissues themseh-es. Any stains upon the bedclothes or garments of the patient should also be carefuhy examined for iron. VIII. H BHK&T JSc3§ BarSZmmB $»JgB H MHKt^Wv ----------- No. 1. Atropine with Vitali's Test. No. 2. Morphine with Nitric Acid. No. 3. Morphine with Ferric Chloride. No. 4. Morphine with Sulpho-Molybdic Acid. No. 5. Strychnine with Sulphuric Acid and Potassium Bichromate. No. 6. Veratrine with Sulphuric Acid PAIimoBr0,^.00^. COLOR REACTIONS OF ALKALOIDS. ALKALOIDAL AND OTHER ORGANIC POISONS. BY WALTER S. HAINES, A.M., M.D. 1. Alkaloidal Poisons. The term alkaloid is used Avith somewhat varying significance by dif- ferent authorities; but as commonly employed it refers to the bases or alkali-like bodies found in many plants, to which the latter as a rule owe their physiological effects. They are often spoken of as plant bases. The total number knoAvn is large, and embraces some of our most valuable remedial agents, and not a few of our most active poisons. There are many properties common to aU, or to nearly aU, of the different mem- bers of the class, and these may advantageously be considered together before taking up the indiAudual substances. Composition.—All alkaloids contain carbon, hydrogen, and nitrogen, and all but a few contain oxygen also. The major portion of them, therefore, do not differ from one another in the elements of which they are composed, but only in the relative proportion of these elements. The chemical formulas of a few of the most important toxic alkaloids are as f oUows: Aconitine..................................C33H43N012 Atropine...................................C, 7H23N03 Cocaine....................................C17H2iN04 Colchicine..................................C,;H,9N05 Coniine....................................CSH, 7N Gelsemine........,..........................Cj2H14N02 Morphine...................................C17H19N03 Nicotine....................................C10H14N.2 Strychnine.................................C2 T H,, 2N202 Veratrine...................................C37H, 3NOl, Physical and Chemical Properties.—Alkaloids containing oxygen are fixed solids, whUe those containing no oxygen are volatile hquids. They are generaUy crystaUine, devoid of color, and are usuaUy possessed of a bitter or pungent taste. The volatUe alkaloids have a pronounced odor, but those that are fixed are odorless ; they are generally of alkaline reaction to litmus, and combine with acids, neutralizing them and pro- ducing salts. The free alkaloids are, as a rule, either insoluble or difficultly soluble in Avater, but they generally dissolve Avith readiness in alcohol, ether, chloroform, and benzine, and in many other organic hquids. Their salts, on the other hand, are usuaUy readUy soluble in water, especiaUy when 415 416 A SYSTEM OF LEGAL MEDICINE. slightly acidulated, and also in alcohol, but ordinarily the}' do not dis- solve in ether, chloroform, or benzine. These differences in the solubilily of the free alkaloids and their salts are taken advantage of, as avc shall see later, in the extraction of alkaloids from complex organic mixtures. Like the majority of organic substances, most of the alkaloids are unstable bodies, undergoing complete or partial decomposition uneler a great variety of conditions. All of them Avhen heated considerably aboA'e the boiling-point of AA'ater, and sometimes at a much loAver tempera- ture, are prone to undergo change; as a rule, strong acids and alkalies and active oxidizing agents decompose them; and the}' all appear under suitable conditions to be acted on by micro-organisms, Avhich eventuaUy cause their complete decomposition. For these reasons it is highly nec- essary in extracting alkaloids not to subject the materials under examina- tion to too high a degree of heat, nor, as a rule, to bring them in contact Avith strong acids, alkalies, oxidizing agents, or other powerful chemicals. Failure to observe these precautions can easily lead to negative results, even though an alkaloid be present in the suspected substance. For the same reason, after death by poisoning by an alkaloid the lat- ter sooner or later disappears from the body by decomposition. This is probably brought about chiefly through the agency of micro-organisms, Avhich swarm in the decomposing body. It is A'ery important, therefore, to examine for alkaloidal poisons as soon after eleath as possible; the longer the examination is put off, the smaller the chance of detecting the poison. Most alkaloids Avheu in solution are rendered insoluble and precipi- tated by a number of chemical compounds, which are known, conse- ([uently, as general precipitants or reagents for alkaloids. The most important of these are tannic acid, picric acid (Wormley's reagent), phos- phomolybdic acid (Sonnenschein's reagent), iodine dissoh'ed in a solu- tion of potassium iodide (Wagner's reagent), and potassio-mercuric iodide (Mayer's reagent). The last two are usually the most A^aluable, and both are of great service as general tests for the presence of an alkaloid. If neither of these reagents produces a precipitate in a sus- pected solution, Ave generally say Avith great certainty that no alkaloid is present; if, however, they do occasion a precipitate, the presence of an alkaloid may be suspected, although not positively demonstrated, as sev- eral other substances are precipitated in a similar manner. These tests, therefore, have chiefly a negative value, but this is frequently of great importance. Wagner's reagent may conAreniently be prepared by dis- solving one part of iodine and two parts of potassium iodide in ninety- seven parts of AA'ater, and Mayer's reagent for cpialitatiA'e purposes may be simUarly made by dissohdng one part of mercuric iodide and t\vo parts of potassium iodide in niuety-seA^en parts of Avater. The precipi- tates given by Wagner's reagent are reddish or reddish broAvn, Avhile those produced by Mayer's reagent are generally yeUowish AA'hite. Many of the alkaloids when subjected under appropriate conditions to certain chemical agents produce characteristic colors, and advantage is extensively taken of this fact in the recognition of a large number of the alkaloids. Such reactions are known as color tests. For example, if strychnine is treated AA'ith strong sulphuric acid, anel a crystal of potas- sium bichromate, or other oxidizing agent, is drawn through the mixture, a very brilliant play of colors ensues, beginning Avith blue and ending ALKALOIDAL AND OTHER ORGANIC POISONS. 417 with red. SimUarly morphine, colchicine, atropine, and many other alkaloids develop more or less characteristic colors AA'hen treated with different chemical reagents, especiaUy those of an oxidizing character. As before stated, extensiA^e advantage is taken of these color reactions in testing for the presence of alkaloids, and they are of the greatest util- ity in toxicological investigations. When properly conducted they are entirely reliable, and may be depended upon Avith great certainty; but if not performed Avith skill, or if the observer is decidedly color-blind, they may be worse than useless, and may lead to most unreliable results, iii connection with the several alkaloids, hereafter to be considered sepa- rately, the color tests for each wiU be described, and the precautions to be observed in obtaining them dwelt upon. Symptoms Produced in Case of Poisoning—The alkaloids as a ride produce their poisonous effects rapidly; sometimes the symptoms begin immediately after their administration, and they are rarely delayed for any considerable length of time. After the toxic symptoms begin to show themselves they generaUy progress rapidly, with increasing Ado- lence, and unless relief is obtained death promptly ensues. There are many marked exceptions to this rule, especially in connection with mor- phine, whose effects are often sIoav in manifesting themselves, and some- times persist many hours before leveling to a fatal termination. Rapid- ity of action is somewhat characteristic of the alkaloids, and in a general Avay distinguishes them from most of the mineral poisons, AAdiich usually are slower in producing their effects. The poisonous alkaloids as a rule exert their chief influence upon the nervous centers, and the symptoms, therefore1, in the main, are1 those referable to the nervous system. Per- verted actiou of the heart and of the respiratory organs, disorders of vision, perverted sensation, convulsions, paralyses, and coma are among the most common symptoms shoAvn. With a few exceptions, chiefly in connection Avith colchicine and veratrine, violent vomiting and purging are not usually seen, and in this respect alkaloidal poisoning differs from the toxic effects of most of the mineral poisons, which as a rule occasion pronounced emesis and diarrhoea. As the effects of the poisonous alka- loids are chiefly directed to the nervous system, the diseases with AAdiich they are likely to be confounded are naturally those in Avhich the nerve- centers are involved, such as tetanus, epilepsy, apoplexy, hysteria, etc. Treatment.—Since the alkaloids generally act rapidly, prompt treat- ment must be resorted to if faA^orable results are to be secured. As in all other cases of poisoning, the stomach should be evacuated, either by emetics, or by the stomach-pump or stomach-tube, and the organ thor- oughlv Avashed out Avith tepid water. In the absence of means of evacu- ating the stomach promptly, or even in connection AA'ith such means, sub- stances should be gh'en AA'hich avUI render the alkaloid less soluble, and consequently retard its absorption. The most Araluable of these are tan- nic acid, and ioeline dissolved in potassium iodide (the official compound solution of iodine of the pharmacopoeia). Finely pulverized charcoal has also been highly recommended, and it undoubtedly may sometimes be useful by meehanicaUy uniting Avith the poison anel sloAving its ab- sorption. It has at least the merit of being harmless. After remoA'ing from the stomach Avhatever portion of the poison is still there, the treat- ment should be addressed to the constitutional symptoms; and as these are commonly produced through perverted action of the nervous system, 418 A SYSTEM OF LEGAL MEDICINE. the remedies employed are usually those that exert an influence upon the nerve-centers, such as chloroform, chloral, ammonia, caffeine, alcohol, nitroglycerine, atropine, electricity, etc., according to the poison taken and the indications presented. Post=mortem Appearances.—These are rarely, or perhaps never, en- tirely characteristic, although they are sometimes of considerable utility in enabhng us to form an opinion as to the cause of death, AA'hen taken in connection with the symptoms, the results of chemiical analysis, etc. As the alkaloids generaUy produce their effects chiefly upon the nerve- centers, it might be supposed that characteristic post-mortem appearances would be found in the brain and spinal cord; this, howcA-er, is not often the case, for death usuaUy ensues before definitely marked structural changes visible to the unaided eye, or even discoA'erable by the microscope, can be produced. As a rule it is the absence of marked post-mortem appearances, rather than their presence, that points to death by toxic alkaloids. Detection—The discovery of inorganic poisons in the stomach or other part of the body is, with few exceptions, generally one of mathe- matical certainty, owing to their unalterable character, their ease of puri- fication, and their definiteness of reaction. Such, howeA'er, is not the case with the alkaloids, as a rule. They are aU more or less unstable, and their complete purification, especially when present in but small amount, is frequently difficult, and their recognition therefore by estab- lished tests is ahvays laborious, and sometimes impossible; only by the use of skiU and care at every step can positive results be gained. It should be stated, however, that one of the alkaloids, strychnine, in unal- terability and definiteness of reaction approaches somewhat the inor- ganic poisons. Many methods have been devised for the extraction of alkaloids from complex mixtures, such as articles of food, parts of the body, etc., but they are aU based upon the method first suggested in 1851 by the eminent chemist, Stas, of Brussels. They all depend upon the fact that the salts of the alkaloids are soluble in water, but are decom- posed in aqueous solution upon the addition of an alkaline substance Avhich abstracts their acid and liberates the alkaloid; the latter is then precipitated, but may be removed by shaking with an immiscible solvent, such as ether, chloroform, benzine, or some other simUar fluid, which ex- tracts them from the Avatery mixture and retains them in solution. By evaporation of the liquid the alkaloid is left behind in a condition for further purification, and ultimately for testing. The various methods suggested for the extraction of alkaloids differ chiefly in minor details, and especially in the use of different immiscible solvents. In Stas's original method ether is used, in that of Rogers and Girdwood chloroform is employed, AA'hUe in the method of Uslar and Erdmann amyl alcohol is the solvent recommended. In all cases, however, practically the same general method is pursued, which in its greatest simplicity is as foUoavs : The substance to be tested is finely comminuted and made into a thin paste Avith water, and an acid added in sufficient amount to impart de- cided acidity to the mixture. Acetic or tartaric acid is the one generally to be chosen when operating on the contents of a stomach, articles of food or vomited matter, but AA'hen examining tissues, such as the hver, kidneys, or brain, dUute sulphuric acid is sometimes preferable. The ALKALOIDAL AND OTHER ORGANIC POISONS. 419 acidulated mixture is gently heated on the water-bath one or two hours, Avith frequent stirring, and the occasional addition of a httle water to re- place what is lost by evaporation. By this treatment any alkaloid that may be present is converted into a soluble salt and passes into solu- tion. The mixture is next strained through several thicknesses of fine cloth, and the insoluble material thoroughly washed with hot, acidulated Avater. The turbid fluid thus obtained is evaporated at a very gentle heat on the water-bath to a comparatively smaU bulk, and four or five volumes of strong alcohol are sIoaa'Iv stirred in. By this means a large number of foreign bodies, especially albuminoids and proteids, are coagu- lated and rendered insoluble, Avhile the alkaloidal salt remains in solu- ti< )ii in the alcohol. The mixture is now poured upon a paper filter, and the residue is thoroughly Avashed with hot alcohol. The combined alco- holic filtrates are evaporated at a very gentle heat on the water-bath to the consistency of a thin syrup, and AA'hen eedd the extract is dissolved in four or five times its bulk of water slightly acidulated Avith sulphuric acid, and carefuUy filtered from any insoluble material that may have separated. The acid filtrate, Avhich contains in solution in a small bulk aU of the alkaloids originaUy present in the material tested, is now treated Avith about half its volume of ether and thoroughly shaken; upon standing a short time the ether rises to the top anel is remoA'ed by a pipette, and the process may be repeated a second and even a third time, if deemed necessary. By this procedure considerable coloring mat- ter and much other foreign material are removed, AvhUe the alkaloidal salts, as a rule, remain behind in the aqueous fluid. The ether, hoAvever, may extract, Avholly or in part, certain substances (including a few alka- loids), such as picric acid, salicylic acid, digitaline, caffeine, colchicine, and delphine, which are sometimes of importance in toxicological exam- inations ; the ether, therefore, should be aUowed to eA^aporate in a large Avatch-glass, and the residue tested for the above bodies if their presence is suspected. To the aqueous fluid an alkali is uoav added in very slight excess, such as ammonium hydrate, potassium hydrate, or sodium carbonate, the first being generaUy preferable, although sometimes one of the others is more useful. By this treatment the alkaloidal salt is decom- posed, and the alkaloid set at liberty and precipitated. A double volume of chloroform, or, in case the presence of morphine is suspected, amylic alcohol is added, and the whole is vigorously shaken in a stout stoppered tube, flask, or separator}' bulb. The mixture is set aside, AA'hen the chloroform settles to the bottom of the vessel and carries AA'ith it in solu- tion the greater portion of any alkaloid that may have been present. By means of a pipette the aqueous fluid is draAvn off, and again shaken Avith a double volume of chloroform, so as to insure the complete extrac- tion of the alkaloid. The united portions of chloroform are evapo- rated in a large Avatch-glass at a gentle temperature, and the character of the residue critically observed. It occasionaUy happens that the alkaloid is left in a state of considerable purity, in which case the residue may be examined by various tests at once. UsuaUy, howeA^er, it contains too much foreign material to permit the direct application of spe- cific tests, and it must be purified by solution in dUute acid, filtration, neutralization, and reextraction with chloroform as before described. The residue from the evaporation of this chloroform is sometimes pure 420 A SYSTEM OF LEGAL MEDICINE. enough for the application of the A'arious characteristic tests for the in- dividual alkaloids, but more often still additional purification is neces- sary. One of the best general methods of accomplishing this is to Avash the residue on the Avatch-glass Avith a feAV drops of ice-cold Avater, repeat- ing the operation, if necessary, tAvo or three times. By this means con- siderable foreign matter is removed, AA'hile the alkaloid is left largely undissolved. It may iioav be once more dissolved in dilute acid, filtered, neutralized, and extracted with chloroform. Upon eA'aporating the lat- ter, the alkaloid is generally obtained sufficiently pure for testing. This process of purification necessarily entails the loss of more or less of the poison; but it should be borne in mind that a small amount of a pure1 alkaloid is far more readily and much more certainly recognized than a large quantity that is impure. The latter, indeed, may often fail to respond to any of the characteristic tests of the alkaloid present. Upon shaking chloroform with the alkalinized fluid containing the suspected alkaloid, as directed above, it quite frequently happens that the agitation causes the chloroform to emulsionize. In this event its separation from the aqueous fluid is exceedingly sIoav and unsatisfac- tory. To remedy this, Allen has suggested substituting a mixture of equal A'olumes of chloroform and ether. This is an excellent solvent for most of the alkaloids, although not quite equal to chloroform alone; but as it does not emulsionize nearly as readily as the latter, it is often greatly to be preferred. Many modifications of the aboA'e general method are necessary in special cases, and in connection Avith each alkaloid such departures as may be desirable wUl be noted. Professor Dragendorff has suggested an exceedingly elaborate method for the extraction of alkaloids from unknown mixtures. Various solv- ents are used in his process, and an effort is made to separate, to a greater or less degree, any alkaloids that may be present into a number of groups, to aid in their subseepient recognition. While the method is of great value in plant analysis, and is sometimes of marked utility in testing parts of the boely (especially AA'hen there is no clue to the poison used, or a number of drugs have been administered), as a rule it is un- necessarily cumbersome, and frequently, in my experience, gives less sat- isfactory results than the shorter and more direct methods. It is scarcely necessary to add that Avdiatever process for extracting the poison is selected, the most constant attention and painstaking care are necessary at every step. None but absolutely pure, tested chemicals should be employed, eA'ery utensil should be scrupulously clean, and all operations should be performed in a room from Avhich poisons are ex- cluded, and to AAdiich the analyst alone has access. The total number of alkaloids known is large, but many of them are not toxic, and need not, therefore, be considered. Of the poisonous alka- loids, moreover, a considerable number are so rare and so seldom em- ployed that they do not merit individual attention except in special trea- tises. For our purpose it will be sufficient to consider only the most important of the toxic alkaloids, as folloAvs: Aconitine, atropine, brucine, cocaine, colchicine, coniine, gelsemine, hvoscine, hyoscyamine. jeiwine, morphine, nicotine, strychnine, and vera- trine. Some of these are rarely used in a pure state, either as medicines ALKALOIDAL AND OTHER ORGANIC POISONS. 421 or poisons, but the plants in which they occur may be extensively em- ployed, and as their efficiency is due chiefly or entirely to the presence of the alkaloid, the latter has an importance AA'hich it otherwise Avould not possess. ACONITE AND ACONITINE. Aconitine (synonyms, aconitin, aconitina and aconitia) is the active principle of Aconitum Napellus, commonly known as monk's-hood or wolf's- bane. The alkaloid is found in all parts of the plant, but it occurs in the root in the largest proportion; the amount, however, found in the latter is exceedingly variable, ranging from less than 0.1 to 0.6 percent. In addition to aconitine, the Aconitum Napellus frequently contains smaUer quantities of other aUcaloids, AA'hich, hoAveA'er, are unimportant. Other varieties of the aconite plant, such as the Aconitum ferox and Aconitum Fischeri, owe their activity to alkaloids similar to aconitine, and differ- ing practicaUy so little from it as not to demand separate consideration. Properties.—Aconitine when pure is a colorless, crystalline solid; odorless, but possessed of an acrid taste, which is foUowed by a charac- teristic tingling and numbness of the tongue and lips. As found in the shops it is exceedingly variable in appearance and strength; much of it is amorphous, and some of it has but slight activity, containing probably but little of the pure alkaloid. Pereira states that he took a grain of a French preparation without perceiving the slightest effect either locally in the mouth, or generally; and Wormley examined three German speci- mens, one of which contained only a trace of the alkaloid, and the other two none. In my OAvn experience I have never found commercial ae^ni- tine AvhoUy destitute of actiA'ity, but the difference in the strength of dif- erent samples is very great, some specimens being fully six or eight times as poAverful as others. Like most of the alkaloids, aconitine is sparingly soluble in water, but it dissolves readily in chloroform; in ether it dissolves very much less freely. It has decided basic poAvers, neutralizing acids to form salts, most of which are readily soluble in AA'ater and in alcohol. Symptoms.—Poisoning by the alkaloid aconitine is a comparatively rare occurrence, but cases of poisoning by aconite or some of its prepara- tions, such as the tincture, are not infreepient. In the latter case, how- ever, it is the aconitine that produces the toxic effects quite as much as if the alkaloid had been taken in its pure state. The symptoms produced by poisonous doses of aconite are in many Avays peculiar, and are sometimes so characteristic that a diagnosis may be 'made from them alone. Immediately or soon after swallowing the ■drug there is a sense of numbness and a peculiar tingling of the lips, tongue, and throat; this is folloAved by a burning pain in the stomach, accompanied by nausea, and frequently by vomiting. Purging is also sometimes present. The tingling and numbness, at first confined to the mouth and throat, extend to other parts of the body, swaUowing becomes difficult or impossible, and there is a partial or entire loss of voice; the vision becomes impaired, the body is bathed in cold perspiration, the heart's action becomes feeble^ and irregular, the face pale and shrunken; there is great prostration AA'ith entire loss of strength, and the extremi- ties are cold and clammy. Sometimes there are delirium and convulsions, 422 A SYSTEM OF LEGAL MEDICINE. and death finally takes place by syncojie. Variations from the above symptoms are not infrequently seen, but in practically aU cases the tin- gling and numbness about the mouth and throat are observed, and these especially characterize this form of poisoning. External application of preparations of aconite haA'e sometimes occa- sioned alarming symptoms and even death. Period when Fatal.—Aconite AA'hen taken in sufficiently large doses usuaUy produces death rapidly. One case is recorded in which it occurred within eight minutes, and many have been reported in Avhich a fatal ter- mination ensued Avithin an hour. On the other hand, however, death may be delayed seA'eral hours, or eA'en a number of days. Professor Mallet has reported a case in Avhich death occurred at the end of four days. Fatal Quantity.—As the aconitine of commerce frequently A'aries greatly in strength, it is not surprising that great differences have been noted in the doses necessary to produce death. Pure aconitine is prob- ably the nie>st actively poisonous substance AA'ith which Ave are acquainted; one sixteenth of a grain has occasioned death, and probably hah of this quantity might prove fatal. Pereira records a case in which one fiftieth of a grain nearly occasioned the death of an elderly lad}'; and if admin- istered hvpodermicaUy the alkaloid is even more powerfully poisonous than when taken by the mouth. As the preparations of the aconite plant vary exceedingly in alka- loidal strength, it is impossible to state Avith any degree of accuracy their minimum fatal doses; twenty-five drops, hoAvever, of the tincture, and four grains of the extract, have proven fatal, although Avithout doubt smaUer quantities than these, if prepared from very active specimens of aconite root, might occasion fatal results. On the other hand, recoveries have occurred from comparatively large doses both of the alkaloid and of aconite. Some of these undoubtedly may have been due to the effi- ciency of the treatment pursued, AvliUe others may be accounted for by the inertness or shght activity of the preparation taken. Treatment.—The stomach should be evacuated as soon as possible,. either by the stomach-pump or by emetics, and tannic acid, or vegetable infusions containing it, and solution of iodine in potassium iodide may be administered Avith the hope of reducing the solubility of the aconitine, and therefore retarding its absorption. Heart stimulants should be freely employed, and of these ammonia, alcohol, nux vomica, and digitalis are the most useful; the latter has been highly recommended, especially when given hypodermicaUy. In aU cases the patient should be kept'warm, artificial heat, if necessary, being applied to the extremities. Postmortem Appearances—As is the case with most of the poison- ous alkaloids, aconitine does not produce any decidedly characteristic post-mortem appearances. The stomach and intestines are generally more or less reddened, there is congestion of the lungs and Hver, and an injected condition of the blood-vessels of the brain and its surround- ing membranes. The right side of the heart usuaUy contains more or less blood, and throughout the body the blood is generaUy dark in color, and abnormaUy fluid. Tests.—Solutions of aconitine respond to the general reactions for alkaloids, being precipitated by tannic acid, picric acid, etc.; the precipi- tates thus formed, however, do not in any Avay distinguish it from other ALKALOIDAL AND OTHER ORGANIC POISONS. 423 alkaloids, nor does it produce any characteristic color reactions. In fact, there is no reliable chemical test for aconitine. The physiological effects, hoAvever, of the alkaloid are very marked and quite characteristic. If an exceedingly minute portion of it in solution is placed upon the lips or tongue a peculiar tingling and numbness of the part is observed, Avhich may continue for a number of hours. As small an amount as 1-1 COO of a grain is capable of producing a AveU marked effect. When adminis- tered to the lower animals very small quantities produce fatal results; the 1-3000 of a grain of pure aconitine injected hypodermically Avill kill a mouse Avithin half an hour. These physiological effects are the tests chiefly to be depended upon in testing for the presence of the alkaloid. Detection of the Poison.—In the Contents of the Stomach,—The mate- rial should first be carefully examined for the presence of any pieces of leaAres, root, or bark, since the poisoning may have been produced by parts of the plant itself; in case such portions are discovered, they should be thoroughly cleansed and examined under a microscope, and also chewed betAveen the front teeth to observe whether a tingling sensa- tion is imparted to the tongue and lips. Whether parts of the plant are found or not, the contents of the stomach, finely comminuted if neces- sary, are treated Avith a small amount of acetic aciel, A'ery gently heated, and the general process described on page 418 then followed. The first chloro- form extract should be dissolved in a few drops of water slightly acidu- lated Avith acetic aciel, and a single drop placed on the end of the tongue, aUoAved to remain there for one minute, and then discharged. If no tingling or numbness is observed at the end of fifteen or twenty min- utes, it is generally useless to proceed further; but if these physiological effects are manifested, a smaU amount of the same solution may be given hypoelermicaUy to a mouse, or some other smaU animal, and the effects observed. If aconitine is present, death wiU usuaUy occur Avithin an hour. Should these physiological tests show the probable presence of aconitine, Avhat is left of the solution of the first chloroform extract should be filtered, the filtrate rendered alkaline, and again extracted Avith chloroform; the residue obtained upon eA^aporation of the latter should then be dissolved in A'ery dilute acid, and the generic tests for alkaloids applied to secure in a general Avay confirmatory evidence of the presence^ of the poison. In the Tissues.—The liver and kidneys are the organs in whose tissues aconitine is most likely to be found. To detect its presence, the organ should be finely subdivided, mixed Avith AA'ater to a thin paste, and mod- erately acidulated with acetic or tartaric acid. The process may then be conducted as directed above in connection with the contents of the stomach. Ovving to its exceedingly toxic nature, the smallness of the dose re- quired to produce death, and the somewhat uncertain character of our present tests for its recognition, aconitine possesses rather more interest in legal medicines than most other poisons. It is one of the few sub- stances which in the present state of toxicology might be criminally ad- ministered and leave no positive evidence of the crime; if a small but fatal dose of the poison Avere to be given, especiaUy if it Avere adminis- tered hypodermically, the chances of its detection in the body after death Avould not be great. 424 A SYSTEM OF LEGAL MEDICINE. BELLADONNA AND ATROPINE. Atropine (synonyms, atropin and atropia) is the chief active principle of Atropa Belladonna, or deaeUy nightshade. It exists in aU parts of the plant, but more especiaUy in the root, AA'here it is found in quantities ranging from 0.3 to 0.5 percent. Properties.—Atropine is a colorless, crystalline sedid, devoid of odor, and possessed of a bitter, acrid taste. It is sparingly soluble in Avater, but dissolves fairly readily in ether and A'ery readily in chloroform; it has quite strongly alkaline properties, and completely neutralizes acids producing salts, most of Avhich are soluble in Avater. Symptoms.—Since atropine is the active principle of beUadonna, the poisonous effects of the two are practically identical, the only noteworthy difference being, as Avould be expected, that' the atropine as a rule acts more rapidly than the crude elrug. A toxic dose of either occasions symptoms Avhich vary someAA'hat, but are in the main as foUows: There is great dryness of the mouth and throat, extreme redness of the tongue, difficulty in SAvalloAving, Avide dilatation of the pupils Avith impaired vision, and well-marked delirium; the latter is someAA'hat characteristic, being generally of a pleasing nature, although sometimes it assumes a maniacal form. Nausea is often, and vomiting occasionally, present. As the case progresses speech becomes difficult or impossible, there is great thirst, numbness of the extremities, partial or complete paralysis of the limbs, and frequently entire loss of sight. The pulse becomes feeble and rapid, and often intermitting; a deep red eruption sometimes appears on the skin; profound coma sets in, and death occurs, occasionaUy preceded by convulsions. Atropine and belladonna exercise their poisonous effects hoAvever in- troduced into the system, and man}' cases are reported of toxic symp- toms from their local application to the skin and to ulcers, and eA'en Avhen used about the eye or the ear. At least one case is reported of death from the external use of the alkaloid. Period when Fatal.—The effects both of atropine and belladonna usually begin Avithin an hour, sometimes shoAAdng themseh-es a feAV minutes after they are taken. Occasionally, hoAvever, no disturbance is shown for a considerable period, one case being recorded in AA'hich the first symptoms Avere delayed for five hours. After the effects begin to mani- fest themselves the progress of the case is usually slow, death rarely oc- curring before the end of a number of hours. In one case, however, it ensued in two hours, and in another in three and three quarter hours; and a surprising case is reported of death in five minutes after the hypo- dermic injection of a small amount of the alkaloid. On the other hand, the person may linger fifteen or twenty hours, and death may occur even as late as the second or third day. Fatal Quantity.—Probably the smaUest fatal dose of atropine re- corded is one thirtieth of a grain given hypodermically; one tAvelfth of a grain by the stomach has also produced fatal effects; and a clyster of belladonna root, containing by calculation a sixth of a grain of the alka- loid, has occasioned death. On the other hand, recovery has taken place from cpiite large doses, both of the alkaloid and of the drug. Drs. Loomis and Wescott report cases in AA'hich complete recoA'ery occurred after tak- ALKALOIDAL AND OTHER ORGANIC POISONS. 425 ing a grain of the alkaloid, and in other cases recovery has foUowed even larger doses, Dr. Eliot recording entire recovery after the ingestion of four grains of the sulphate. It is an interesting fact that although atro- pine is an exceedingly active substance physiologically, and sometimes, as indicated above, produces death iu small dose, yet as a rule recovery takes place even from large doses, and often, moreoA-er, without antidotal treatment; of thirty-two cases of poisoning by the alkaloid, coUected by Dr. Eliot, only tAvo proved fatal. Treatment.—If seen early, the stomach should be thoroughly evacu- ated by the use of emetics or the stomach-pump, and at the same time chemical antidotes may be employed. Of the latter probably the best are tannic acid, solution of iodine, and finely pulverized charcoal. Morphine should be administered, preferably hypodermicaUy, in doses of from a quarter of a grain to a grain, and repeated from time to time if necessary to control the delirium. Pilocarpine by the mouth or sub- cutaneously has also been highly recommended. As the poison is elimi- nated largely by the urine, stimulating diuretics, like sweet spirit of niter,. are sometimes useful, and the patient should be catheterized, if necessary, to avoid the danger of reabsorption of the poison from the bladder. Post=mortem Appearances.—These are not usuaUy characteristic, and occasionaUy no post-mortem effects are observable. The most com- mon appearances are dilated pupils, redness of the tongue, and injection of the mucous membrane of the stomach and smaU intestines. The blood-vessels of the brain are usually congested, and there is often en- gorgement of the lungs. The heart is frequently empty, and the blood is generaUy liquid and of a dark color. Tests.—Atropine responds to aU of the general tests for alkaloids, giving precipitate's AA'ith solution of iodine, picric aciel, tannic acid, etc., but there is nothing in its behavior with these reagents which especially characterizes it, or distinguishes it from other alkaloids. We have, Iioav- ever, three tests AA'hich are characteristic, especially AA'hen taken in con- junction with one another; these are the physiological test, Vitali's test, and Wormley's test. (a) Physiological Test.—Atropine Avhen introduced into the eye of man, or into that of one of the lower animals, occasions marked dilatation of the pupil; this is produced by A'ery minute cpiantities, and lasts for a considerable length of time, often persisting several days. The eye of the cat is particularly well adapted for this test, although that of man may be used Avithout danger if proper precautions be observed, such as not using too large an amount, and taking pains to have the material employed and the instruments used for introducing it entirely aseptic. This test is exceedingly delicate, and can detect even a smaUer amount than the 1-100,000 of a grain. Hyoscyamine and hyoscine, wliich _ arc, as we shall see further on, isomers of atropine, and AAdiich constitute with it a group of alkaloids knoAvn as the mydriatics, produce the same effect; hyoscyamine, in fact, is somewhat more energetic in dilating the pupil than atropine, and hyoscine is more poAverful than either. A feAV other substances also cause dilatation of the pupil, the most conspicuous of AAdiich are cocaine, and, to a less degree, digitalis and con due; all of these, hoAvever, are far less energetic than atropine, and their effects are much more evanescent. Selmi and other investigators have found that certain ptomaines pos- 42G A SYSTEM OF LEGAL MEDICINE. sess mydriatic poAA-er closely resembling that of atropine, but the latter may be distinguished from them by other tests, especially by the one next to be considered. (b) Vitali's Test.—If atropine is treated with a feAV drops of strong nitric acid, evaporated to dryness at a gentle heat, anel the residue, Avhich is colorless or slightly yelloAv, touched AA'ith a drop of alcoholic solution of potassium hydrate, ii purple color is developed, rapidly changing to violet, then to'dark red, and finally disappearing. (See No. 1, Colored Plate.) This beautiful and highly characteristic test responds to an ex- ceedingly minute quantity of the alkaloid, considerably less than. 1-50,000 of a grain giving a decided reaction. Tlie two isomers of atropine, hyoscyaniine and hyoscine, produce the same reaction, but no other alkaloid gives an effect Avhich could be mis- taken by a competent observer for that of atropine. It has been claimed that veratrine gives a someAA'hat similar reaction, but I have been unable to verify the statemeut. SeA'cu-al specimens of the alkaloid of the best make1, AA'hen examined by Vitali's test, have given only a brownish color. Brouardel and Ogier have been unable to obtain an atropine reaction by this test from any ptomaine which they haA'e separated from the human body. It is a test, therefore, of great A'alue. In the presence of much foreign material it sometimes fails to respond, and it is important, therefore, before applying it to the suspected substance, especially if the latter is an extract from a stomach or other organ, that it be purified as far as possible. (c) Wormley s Test—If a strong solution of bromine in hydrobromic acid is added to a solution of atropine, a yeUow precipitate is produced, which is amorphous at first but on standing becomes crystalline. This test, discovered and introduced by Professor Wormley, is epiite dedicate, the 1-10,000 of a grain yielding good results. The test is also charac- teristic, for AA'hile most if not aU of the other alkaloiels give AA'ith the test yelloAv precipitates, they aU remain amorphous Avith a feAV exceptions. Hyoscyamine and hyoscine give crystalline precipitates Avhich cannot be distinguished from atropine, and meconine, one of the constituents of opium, also produces a crystaUine precipitate, Avhich, hoAvever, is distin- guished under the microscope by its different crystalline form; meco- nine, moreover, is easily differentiated from atropine by not responding to either the physiological or Vitali's test. Detection of the Poison.—In the Contents of the Stomach.—The ma- terial should be carefully inspected for pieces of leaA'es, root, or berries, which are often found in case the poisoning has been produced by eat- ing parts of the plant. If such portions are discovered they should be thoroughly Avashed and examined under a lens to determine their exact character. Whether portions of the plant are found or not, the con- tents of the stomach should be finely comminuted, if necessary, acid- ulated with a smaU amount of acetic acid, gently heated on the water-bath for an hour or tAvo, and the general process described on page 118 then foUoAA-ed. The first chloroform extract is rarely pure enough for the various tests, and it should be dissoh'ed in a small amount of acidulates! water and filtered; the filtrate should be made feebly alkaline and again extracted AA'ith chloroform. The residue obtained upon evap- oration of the chloroform may now be subjected to the three tests above mentioned, beginning with the physiological test, AA'hich is best performed ALKALOIDAL AND OTHER ORGANIC POISONS. 427 as foUoAvs: a small portion of the extract is dissolved in a little water feebly acidulated with acetic acid, the mixture carefuhy filtered, gently boiled, and when cold one or two drops of the fluid taken up bv means of a small sterilized pipette, and placed in the eye. The pupil should be carefully watched every few minutes and compared with the untreated eye, and if at the end of an hour no effect is shown, especially if nega- tive results are obtained upon repeating the test, the absence of atropine may be definitely stated. If, hoAvever, clilatation is produced, the period of its duration should be carefully noted, anel other portions of the chlo- roform extract should be tested by Vitali's and Wormley's tests. If the two latter also give positive results, the presence of atropine, or one of its isomers, is clearly established. In the Tissues.—The organs to be tested, such as the liver, kidney, or brain, should be finely comminuted, mixed with sufficient water to make a thin paste, and acidulated with acetic or tartaric acid. The mix- ture is gently heated on a Avater-bath for an hour or two, and the subse- quent process conducted as described above in connection AA'ith the con- tents of the stomach. HYOSCYAMUS AND STRAMONIUM; HYOSCYAMINE AND HYOSCINE. The two alkaloids hyoscyamine and hyoscine are the active principles of Hyoscyamus Niger, or henbane. Hyoscyamine is also found in small but variable quantities, associated Avith atropine, in belladonna, and it is the chief active principle of stramonium (Datura Stramonium), in which it is accompanied by a little atropine. Hyoscyamine and hyoscine are isomers of atropine, having exactly the same atomic composition as the latter; they are, moreoA^er, very simi- lar in their chemical properties and physiological effects. For convenience' sake the three are often spoken of coUective]y as the " mydriatic alkaloids," by reason of their effect on the pupil, AA'hich is more marked than that produced by any other substances. On account of their close resemblance all three of the alkaloids, and the various plants from which they are produced, have essentially the same toxic effects; hyoscine, hoAvever, produces upon the system a more hypnotic influence, and has less tendency to occasion delirium than atropine or hyoscyamine. What has been said, therefore, concerning atro- pine and belladonna may be largely repeated in regard to hyoscyamus, stramonium, hyoscyamine, and hyoscine, the symptoms, treatment, etc., being practically identical. The alkaloids hyoscyamine and hyoscine re- spond to the same tests as atropine. They are to be extracted from the organs of the body in the same Avay as has been described in connection with atropine, and the same method of identifying them should be used. Although the three alkaloids may be distinguished and separated from one another by a difference in the solubility of certain of their salts when there is a fair amount of material to operate upon, in toxicological exam- inations the quantity of alkaloid extracted is almost invariably so smaU that a positive determination as to Avhich of the three it is, generally is impossible. We are usuaUy, therefore, obliged to admit that the alka- loid extracted may be any one of the three. This is sometimes a matter of considerable medico-legal importance, for an indictment aUeging specifically the administration of one only of 42S A SYSTEM OF LEGAL MEDICINE. these bodies could not generaUy be sustained if the chemical analysis alone Avere depended on. The presence of one of the mydriatic alkaloids might be clearly established, but it would generaUy be impossible to state absolutely which of the three it AA'as. COCAINE. Cocaine is the active principle of Erytliroxylon Coca, a shrub groAving in various parts of South America, It exists chiefly in the leaA'es of the plant, combined AA'ith cocatannic acid and associated probably Avith one or two other alkaloidal substances, which, however, are of no great im- portance. The quantity of cocaine present in the fresh leaves ranges from 0.3 to 1.0 percent., the average being about 0.75 percent,; but upon being kept some time the alkaloid graduaUy disappears by decom- position, and the drug becomes inert. Properties.—Cocaine when pure is a colorless, crystaUine solid, spar- ingly soluble in AA'ater, but dissolving readily in ether, chloroform, and alcohol. The free alkaloid has only a slightly bitter taste, but its salts are decidedly bitter. It is of strongly alkaline reaction, uniting AA'ith acids, completely neutralizing them, and forming salts. Of these the one produced by its union with hydrochloric acid, and known, therefore, as the hydrochloride, hydrochlorate, or muriate of cocaine1, is the one most commonly employed in medicine. Symptoms.—In most of the reported cases of poisoning by cocaine the alkaloid has not been administered by the mouth, but has either been given hypodermically or applied locally to a mucous membrane, as that of the eye, the nose, or the urethra. However introduced into the system, if in sufficiently large dose it occasions rapid and severe disturb- ances. The symptoms frequently A'ary greatly in different case's, being modified probably by the quantity absorbed, the susceptibility of the in- dividual, and the concurrent action of known or latent disease. The first effect shown is generally great nervous excitement, often attended with a sense of fullness and oppression in the head, and sometimes associated with nausea and vomiting. At first there is usually an increased fre- quency of the pulse and respiration, but this is generaUy succeeded by a marked diminution of both, especially observable in the breathing, which becomes slow and labored. The pupils are usuaUy dilated, the extrem- ities become cold, and the difficulty of respiration produces deficient oxy- genation of the blood, which is shown by a cyanotic condition of the face. The pidse grows feeble, sometimes being imperceptible, the breathing becomes more and more labored, violent convulsions appear, succeeded by coma, and death generally foUows from apnoea, although occasionally from cardiac failure. Many cases occur in which the symptoms differ from these in several respects; in some there is delirium, in others un- consciousness is present almost from the beginning, while in others the only prominent symptom is an intense sense of asphyxia. Period when Fatal.—Cocaine generally acts with great rapidity, especially AA'hen given hypodermically or when applied to mucous sur- faces. One case is recorded in wliich death occurred in twenty minutes, another in four minutes, and stiU another in forty seconds. OccasionaUy case's are someAvhat more protracted, but generaUy if the patient survives half an hour recovery follows. ALKALOIDAL AND OTHER ORGANIC POISONS. 429 Fatal Quantity—It is impossible to state definitely, in the present condition of our knoAA'ledge, the smallest fatal dose of cocaine, but it probably is not far from half a grain. Somewhat less than the latter quantity, given hypodermically, has produced death in at least one case, and one twentieth of a grain given hypodermicaUy to a girl of twelve years has occasioned dangerous symptoms. EA'en as small an amount as the one hundredth of a grain in solution applied to the eye of a child fourteen years old has occasioned decided symptoms of poisoning. On the other hand, recovery has folloAved the ad ministration of large doses of the alkaloid, such as twenty-two grains taken by the mouth, and ten grains given hypodermically. Treatment.—If the poison has been taken by mouth, the stomach should be evacuated promptly by the use of an emetic or the stomach- pump, and at the same1 time tannic acid, iodine, or charcoal may be ad- ministered as possible chemical antidotes. In the great majority of cases of poisoning by cocaine, however, the alkaloid is given hypodermically, or has been absorbed from some mucous surface, anel in these instances evacuation of the stomach is naturally unnecessary. The constitutional symptoms should be combated by the use of stimulants such as alcohol and ammonia, given by the mouth or by hypodermic injection. Inha- lations of amyl nitrite and hypodermic injections of nitro-glycerine are often signally useful; and inhalations of pure oxygen are very valuable in relieving threatened asphyxia. In case breathing ceases, artificial res- piration should be resorted to, and electricity may be tried, AA'ith some chance of favorable results. Post=mortem Appearances.—No characteristic post-mortem appear- ances folloAV cocaine poisoning. The blood is generally dark and fluid, and there is likely to be congestion of the lungs and other internal organs, but it is scarcely necessary to say that these are not peculiar to eleath from this cause. Tests.—Cocaine responds to all the general tests for alkaloids, giving precipitates Avith tannic acid, picric acid, solution of iodine, etc., but these are not distinctive, nor unfortunately do we possess at the present time any one characteristic test for the alkaloid. The folioAving reactions, how- ever, taken conjointly, wiU usually serve to identify it: (a) Permanganate Test—If to a fairly strong solution of a salt of coca- ine a feAV drops of a solution of potassium permanganate are added, beautiful violet-colored crystals of cocaine permanganate are formed and precipitated. (b) Ferric Chloride Test.—If cocaine in solution is boiled for a few minutes Avith dilute sulphuric acid, it is decomposed Avith the formation of benzoic acid. If the liquid is iioav neutralized by the careful addition of potassium hydrate and a fenv drops of ferric chloride solution then added, a pale brownish yellow precipitate of ferric benzoate is produced. (c) Odor Test—If cocaine is treated with fuming nitric acid, evaporated to dryness, and the residue treated Avith an alcoholic solution of caustic potash, a strong odor like that of peppermint is evolved. (d) Phi/siolot/ical Tests.—If a solution of cocaine is introduced into the eve of man or one of the Ioavci- animals, it causes marked dilatation of the pupil, much resembling the effect produced by atropine and the other mydriatic alkaloids. The mydriasis, lioAA'CA'er, folloAA'ing the application of cocaine differs from that' occasioned by atropine in requiring for its 430 A SYSTEM OF LEGAL MEDICINE. production a very much larger dose, and in being comparatively evanes- cent, disappearing completely in a fe\v hours' time. Another and more characteristic physiological effect of cocaine is the local anaesthesia succeeding its application to the tongue, lips, or other mucous surfaces. The action is transient, the effect disappearing usually in from ten minutes to hah' an hour. Detection of the Poison.—If the poison is sought for in one of the tissues of the body, such as the liver or kidnews, the part should be finely comminuted, mixed AA'ith AA'ater to a thin paste, and acidulated AA'ith acetic or tartaric acid. If A'omited matter or the contents of a stomach are to be tested, the material should be made fluid Avith AA'ater, and acidulated as above. The mixture in either case is digested on the Avater-bath at a gentle heat for an hour or two, strained, and tlie general process for the extraction anel purification of alkaloids described on page 4ls then pur- sued, chloroform being by preference the immiscible soh'ent employed. A part of the purified residue should be dissolved in a very little dilute acetic acid, and a drop applied to the lip or tongue, and the local effect observed; another drop should be placed in the eye of a cat, and the pupil watched for several hours. If the portion applied to the lips pro- duces decided numbness, anel the solution introduced into the eye of the cat occasions a some -what fugitiA'e dilatation of the pupil, Ave haA'e reason- able proof of tlie presence of cocaine.. The remainder of the purified residue should then be tested by the several other reactions for the alka- loid, and if they aU give characteristic responses, the presence of cocaine is estabhshed. COLCHICOI AND COLCHICINE. Colchicine (synonyms, colchicin, colchichia, and colchicina) is the act- ive principle of Colehicum autumnule, or meadoAV-saffron. The alkaloid exists in aU parts of the plant in quantity ranging from 1.0 to 1.5 per- cent. Properties of the Alkaloid.—Colchicine Avhen pure is a Avliite solid, Avhich is usually amorphous, but which may be obtained in a crystaUine form. It dissolves readUy in Avater and also in ether, alcohol, and chloro- form. It is neutral or very faintly alkaline in its reaction to test-paper, and it has but a feeble affinity for acids. Its taste is bitter and pungent, Symptoms.—Colchicine is an active poison, as are also the A'arious parts of the colehicum plant, to AA'hich it imparts its toxicity. Cases of poisoning by the pure alkaloid are very rare, but the plant and its pharmaceutical preparations have not infrequently caused death. The most characteristic effects produced by both the plant and the alkaloid are those in connection Avith the gastro-intestinal tract, the poi- son producing symptoms someAA'hat similar to those of the mineral irri- tants, such as arsenic and antimony. There is seA'ere burning pain in the stomach and bowels, violent nausea and A-omiting, profuse1 purging, intense thirst, extreme prostration, feeble anel rapid pulse, cold extrem- ities, and great exhaustion. The nervous system is rarely or never in- volved ; convulsions do not occur, the intellect remains clear, and con- sciousness may last up to the end. Period when Fatal.—Although the toxic symptoms presented by large doses of colehicum are A'ery seA'ere, the drug does not generally ALKALOIDAL AND OTHER ORGANIC POISONS. 431 lead to a fatal termination rapidly. In one case death occurred in seven hours, but usuaUy a much longer period intervenes. Of five fatal cases of poisoning by Avine of colehicum reported from the convict hospital at Toulon, France, two died at the end of nineteen hours, a third after twenty hours, a fourth in twenty-two hours, and the last twenty-nine hours after taking the fatal dose. StUl longer periods are reported in other cases, two being recorded in which death occurred on the four- teenth day. Fatal Quantity.—Colchicine is a very active poison, and one third of a grain may be regarded as a probably minimum fatal dose. Casper records a case of death from wine of colehicum which contained some- what less than half a grain of the alkaloid, Wood states that death has been occasioned by two and a half drams of the wine, and Taylor men- tions a case in which three and a half drams proved fatal. On the other hand, recovery has occurred after the ingestion of large doses, such as an ounce of the wine of colehicum and three fourths of a grain of the pure alkaloid. Treatment.—In poisoning either by colehicum or its alkaloid, the stomach should be thoroughly evacuated and Avashed out as soon as pos- sible. This may be accomplished if, as usually is the case, the patient is already vomiting, by the copious administration of tepid water to pro- mote emesis; but if A'omiting has not occurred an emetic should be given, or the stomach-pump used; tannic acid may be administered at the same time Avith a hope of diminishing the solubility of the poison, and therefore of retarding its absorption. After complete eAracuation of the stomach, an opiate should be administered to allay the pain and check the vomit- ing, and ammonia, alcohol, and other stimulants may be freely used to counteract the depressing influence of the poison. Post=mortem Appearances.—These are by no means characteristic, nor are the same appearances found in all cases. The stomach and boAvels sometimes show intense congestion, but on the other hand these organs occasionally present an almost normal appearance; the lungs, the membranes of the brain, and the kidneys, however, are nearly always congested, and the blood is generaUy thick and dark colored. Tests.—(a) Nitric Acid Test.—Colchicine when treated with nitric acid gives a bright violet color, AAdiich after a time changes to brown and finally to vcIIoav. If the alkaloid is first treated with sulphuric acid, and to the solution thus produced, after standing some time, a drop of nitric acid is added, the reaction aboA^e described is said to be produced more sharply and more characteristicaUy. Xo other alkaloid treated with nitric acid gives the same reaction as colchicine. (b) Mandelin's Test.—Colchicine gives Avith a sulphuric acid solution of ammonium vanadate (one part of the vanadate to two hundred of the acid) an intense green color, which rapidly changes to a violet broAvn. No other alkaloid that has been submitted to this reagent gives the same reaction. Arbutin, aloin, and chrysophanic acid, however, behave very much like colchicine, but they are clearly distinguished from the latter by not producing with nitric acid a violet color. (c) Zeisel's Test—If the alkaloid is dissolved in hydrochloric acid and ferric chloride added, upon boiling the liquid becomes green. If the fluid is now agitated Avith chloroform the latter takes up a part or aU of the coloring matter, and sinks to the bottom. • 432 -f SYSTEM OF LEGAL MEDICINE. (d) Physiological Test.—Colchicine if given to one of the Ioavci- animals produces marked symptoms, characterized by vomiting, purging, great prostration, and, if the dose is sufficiently large, death. The experiments of Vulpian show that about one tAventieth of a grain is necessary to produce marked purging in a rather large dog, and that one third of a grain is required to kill a medium-sized dog Avith certainty, although hah' that cpiantity occasions intense symptoms, anel may prove fatal. Detection of the Poison.—The material to be operated on should be finely subdivided, mixed AA'ith AA'ater to a thin consistence, mildly acidu- lated with acetic acid, and heated on the water-bath; the mixture should be strained, evaporated to a syrupy consistence, and seA'eral A'olumes of alcohol added; after filtration the nitrate should be gently heated to ex- pel the alcohol, mildly alkalinized with ammonia, and shaken AA'ith twice its bulk of chloroform or ether. Upon evaporating the latter at a gen- tle heat, the colchicine is left in an impure form as an amorphous, colored residue. It may be purified by redissohdng in a dilute acid, fil- tering, alkalinizing, and extracting as before with an immiscible solvent. The residue now obtained upon evaporation may be examined by the sev- eral tests before described. During decomposition of animal tissues substances are not infre- quently produced which behave strikingly like colchicine with all of the general tests, excepting perhaps Zeised's test. In a well-knoAvn case of suspected poisoning from colehicum occurring in Paris a few years since, Brouardel and seA^eral other eminent scientists, who were called upon as experts, found during their investigations that ptomaines might be ex- tracted from decomposing cadaArers, which produced reactions with nitric acid and with Mandelin's test strikingly like those occasioned by traces of colchicine; and other investigators have obtained similar results on many occasions. Nothing, therefore, short of the extraction from the suspected body of a ponderable quantity of material giAdng all of the chemical reactions anel physiological effects of the pure alkaloid, should be accepted as proof of the presence of the poison. Resistance to Putrefaction.—The experiments of Ogier, director of the Laboratory of Toxicology at Paris, show that colchicine resists putre- factive processes to a considerable degree. Three dogs were poisoned by the alkaloid and buried for five and a half months; at the end of that time the remains were examined, and indisputable evidence of the pres- ence of the poison was obtained in each case. CONIUM AND CONHNE. Coniine (synonyms, coniin, conine, eonia, conicine, and conicina) is the alkaloid AAdiich imparts activity to Conium maeulatum, the umbeUifer- ous herb commonly known as hemlock. It is found in all parts of the plant combined with an organic acid, but it is most abundant in the fruit, Avhere it exists in a proportion of betAreen 0.5 and 2.0 percent. The pure alkaloid is an exceedingly energetic poison, almost approach- ing hydrocyanic acid in its actiAdty. But few cases of death, hoAveAer, have occurred from the alkaloid, but poisoning by the plant and its vari- ous pharmaceutical preparations have not been infrequent. The herb ALKALOIDAL AND OTHER ORGANIC POISONS. 433 has occasionally been mistaken for parsley or other edible vegetables, and the great majority of deaths from coniine have occurred through this misapprehension. Properties of the Alkaloid.—Pure coniine is a colorless, oily fluid, lighter than water, and possessed of an unpleasant odor resembhng that of the urine of mice. It boils at 163.5° C, and is slowly volatile at ordi- nary temperatures. Unlike most of the alkaloids, it is fairly soluble in AA'ater, requiring about one hundred parts to dissolve it; and it is very easily soluble in ether and chloroform. It has marked alkalinity, read- Uy uniting with acids forming salts. In contact with air it changes chemically, becoming dark-colored, and eventually being converted into a brown resin. Symptoms.—As coniine is the active principle of conium, the effects produced by the two are identical, except that the alkaloid acts some- Avhat more rapidly and energetically than the crude drug. They both exercise a profound influence on the motor nerves, completely paralyz- ing them. This effect is first manifested in the extremities, but eventu- ally the organs of respiration are affected, and death ensues from apnoea, the heart continuing to beat after the breathing has ceased. The symp- toms usually observed are great muscular Aveakness, beginning in the arms and legs, inability to walk, profound lassitude, dUatation of the pupils, huskiness or loss of A'oice, embarrassment of breathing, and finally death from paralysis of the muscles of respiration. The intel- lect generaUy remains clear until, through deficient respiratory action, the blood becomes overcharged AA'ith carbon dioxide, when we may have unconsciousness accompanied by convulsions and delirium. Period when Fatal.—Both coniine and conium act with rapidity, the symptoms setting in soon* after the poison is swallowed, and generally ending fatally in from one to three hours. Fatal Quantity.—One fifth of a grain of the alkaloid has produced serious effects, and a drop has occasioned alarming symptoms. This may be regarded as a probably minimum fatal dose. Treatment.—The stomach should be thoroughly evacuated as soon as possible, and iodine, tannic acid, or charcoal administered with the hope of retarding the absorption of the poison. Stimulants should be employed, such as alcohol and ammonia, and, on theoretical grounds, strychnine has been suggested as a valuable antidotal agent. Electricity may be serviceable, and copious inhalations of pure oxygen are unques- tionably useful. Post=mortem Appearances.—Coiiiine does not produce any charac- teristic post-mortem appearances. Those seen are such as are commonly found after death by apnoea. The lungs are congested, the brain more or less so, and the blood is dark and fluid. Tests.—Coniine is characterized by the following reactions: (a) Odor.—The mousey odor of coniine is peculiar and exceedingly marked; one part of the alkaloid in 50,000 of Avater, according to Wormley, is recognizable by the sense of smell. (b) IL/drochloric Acid Test—If a watch-glass containing asmaU quan- tity of the alkaloid is covered with another glass on the under surface of "which is a little hydrochloric acid, copious white fumes are produced by the union of the vapor of the two substances, and the coniine soon becomes a mass of Avhite crystalline needles. 434 -f SYSTEM OF LEGAL MEDICINE. (c) Butyric Acid Test.—If coniine is treated with a mixture of potas- sium bichromate and dUute sulphuric aciel, and gently heated, butyric aciel is formed, and may be recognized by its characteristic odor. (d) Alloxan Test—If coniine is added to a solution of aUoxan an in- tense purple-red color is produced and white needle-shaped crystals sep- arate, AA'hich dissolve in solution of potassium hydrate Avith the produc- tion of a purple color and the development of a mousey odor. Detection of the Poison.—The suspected material, whether the con- tents of the stomach or one of the organs, such as the liver or kidneys, should be finely subdivided, made into a thin paste with AA'ater, mildly acidulated with acetic acid, and gently heated on the water-bath; the mixture is then strained, the liquid evaporated to a small bulk, treated Avith four or five times its A'olume of strong alcohol, and filtered from the separated insoluble material. The1 filtrate is carefully heated to ex- pel the alcohol, the residual liquid mixed Avith a little AA'ater, again fil- tered, the filtrate rendered alkaline by potassium hydrate, and vigorously shaken AA'ith twice its volume of ether. The latter, after separation from the aepieous fluid, is removed, placed in a large AA'atch-glass, and put in a cool place. Upon evaporation of the ether any coniine that may have been present will be left behind as oily drops, AA'hich are usually more1 or less colored by the presence of adhering impurities. To purify before testing, the residue should be elissedved in dilute acetic acid, filtered, alkalinized, shaken with ether as before, and the ether again aUoAved to evaporate spontaneously from a large watch-glass. If an oUy liquid is iioav obtained AA'hich exhales a strong mouse1}' odor, it may be submitted to the other tests for the alkaloid. If all of them give unequivocal, char- acteristic reactions for coniine, the presence of the poison is established, but nothing short of the most absolutely perfect response to all the tests should be accepted as proof of the alkaloid. Numerous animal tissues and fluids, especiaUy if somewhat decomposed, yield not infrequently, upon examination as above, compounds of an oily character, possessed of a mousey odor, fuming Avith hydrochloric acid, and otherwise comport- ing themselves somewhat like coniine. A number of cases are recorded in AAdiich the poisonous alkaloid Avas at first supposed to have been dis- coA'ered, but a mistake Avas afterward proved to have been made. The analyst should under no circumstances regard the presence of coniine as established unless ah of his tests agree in every respect Avith those to be obtained from the pure alkaloid. There seems to be some evidence that conune, or at least a substance that possesses most if not all of its properties, is at times actuaUy pro- duced in animal tissue by decomposition. In view of this fact, death from coniine poisoning should never be affirmed from the result of chemical analysis alone, unless the latter has been made immediately after death, and before decomposition, therefore, has set in. GELSEMIUM, GELSEMINE, AND GELSEMIC ACID. Gelsemium, the rhizome and roots of Gelsemium sempervirens, or yedloAV jasmine, oavcs its actiA'ity to the presence of a powerful alkaloid, gvlse- mine (synonyms, gelsemin and gelsemia). This Avas first obtained in the pure state and criticaUy examined by Professor Wormley in 1870, aa'Iio ALKALOIDAL AND OTHER ORGANIC POISONS. 435 also discovered in the drug a peculiar acid, to which he gaA'e the name of gelsemic aciel or gelseminic acid. For most of our knowledge con- cerning both of these substances Ave are indebted to the careful investi- gations of this eminent scientist. Professor Wormley founel, as a mean of several tests, that the root contains about 0.25 percent, of gelsemine and 0.5 percent, of gelsemic aciel. Properties.—(a) Gelsemine,—In the pure state gelsemine is a color- less, odorless solid, having an intensely bitter taste, and crystallizing with difficult}'. It is a strong base, uniting Avith acids readily, forming salts. It is freely soluble in chloroform and ether, but requires 644 parts of Avater for its solution. The alkaloid is exceedingly poisonous, one eighth of a grain killing a cat in one anel a half hours, and one sixth of a grain may be regareled as a fatal dose for man. (b) Gelsemic Acid.—This is a colorless, odorless solid, nearly tasteless anel highly crystalline; it has but feeble acid powers; it requires nearly 3000 parts of water to dissolve it, but it is readily soluble in ether, chlo- roform, and alcohol. Gelsemic acid does not seem to have any well-defined physiological effects upon the higher animals, although it is A'ery poisonous to frogs. Symptoms.—Cases of poisoning by the pure alkaloid are not known, but the various pharmaceutical preparations of the root haA'e often pro- duced fatal effects; and several deaths are recorded from the eclectic preparation " gelsemin," AAdiich is probably the true alkaloid mixed with considerable foreign matter. The symptoms observed in poisoning by gelsemium usuaUy begin Avith a sense of bewilderment and unsteadiness, the vision becomes double, and frequently all external objects assume a yellow hue; there is difficulty in opening the eyes, the upper lids dropping almost, or quite, beyond control; the face becomes congested, the lips blue, the pupils dilated and frequently insensible to light; speech is labored, the lower jaAv falls, and the mouth sometimes remains wide open; the pulse is small and feeble, and respiration is difficult. The mind is not usually affected until near the end, when convulsions may occur and coma set in. Death is produced by apnoea. Period when Fatal.—Death from gelsemium poisoning usuaUy oc- curs early, one case being recorded of a fatal issue within an hour, and several others within two or three hours; but on the other hand, death has been postponed until the seventh or eighth hour. UsuaUy if the patient survives four or five hours recoArery is highly probable. Fatal Quantity.—We do not knoAv surely the minimum fatal dose of gelsemium, but the smallest recorded amount that has produced death in an adult is a dram of the fluid extract. This quantity represents, according to Professor Wormley, about one sixth of a grain of pure gel- semine. Children are naturally much more susceptible, and one case is reported of death from a quantity of the tincture equivalent to twelve minims of the fluid extract. Treatment.—The stomach should be evacuated as promptly as pos- sible, and general stimulants freely administered. Electricity has been highly recommended, and inhalations of pure oxygen Avould undoubtedly be useful in the latter stages when symptoms of asphyxia begin to show themselves. 430 A SYSTEM OF LEGAL MEDICINE. Post=mortem Appearances.—In the few cases in AA'hich post-mortem examinations haA'e been made after poisoning by gelsemium, absolutely no characteristic appearances were observed. As would be naturally supposed, since death occurs from apnoea, the blooel Avas found dark and fluid. Tests.—i. Gelsemic Acid.—(a) Fluorescence.—If gelsemic acid is treated with a solution of a caustic alkali, like ammonium or potassium hydrate, it assumes a yeUoAV color, and quickly dissolves, producing a highly fluorescent liquid. The fluorescence is very marked even with small quantities of the acid, one grain in 100,000 giving a distinct reac- tion. Several other vegetable substances are also highly fluorescent, so that this test is reliable only Avhen taken in conjunction Avith others. (b) Nitric Acid Test.—If gelsemic acid is treated with nitric acid, it dissolves to a vcIIoav or reddish solution; on treating this Avith an excess of ammonia the color turns to a eleep red. (c) Sul2)huric Acid and Ammonia Test.—Sulphuric acid slowly dissolves gelsemic acid to a clear solution; if a drop of ammonia Avater is allowed to floAv into this, the gelsemic acid immediately separates in the form of crystalline needles. " These tests, taken together, distinguish gelsemic acid from other sub- stances AAdth AA'hich it might be confounded. 2. Gelsemin.—The alkaloid gives precipitates Avith most of the gen- eral alkaloidal reagents, but is characterized especially by the folloAving tests: (a) Oxidation Test,—Gelsemine when pure dissolves in sulphuric acid with little or no change of color; but if the solution is treated AAdth an oxidizing agent, such as potassium bichromate, manganese dioxide, or cerosoceric oxide, a beautiful reddish purple color manifests itself. (b) Nitric Acid Test.—Pure gelsemine dissolves in nitric acid to a colorless solution, AA'hich on spontaneous evaporation leaA'es a permanent bluish green stain. If this greenish residue is treated Avith a small quan- tity of sulphuric aciel and an oxidizing agent, the reddish purple color described in the first test is developed, so that the same quantity of the alkaloid may be used for both of these reactions. Both tests (a) and (b) are highly delicate, anel are quite characteristic, especially AA'hen they are used coiijunctiA'cly in the manner spoken of above. Detection of the Poison.—In the Contents of the Stomach,—The finely comminuted substance shoiUd lie acidulated AA'ith acetic acid, diluted Avith water if necessary, digested on the water-bath for an hour or two, and then strained. The strained licpiid should be evaporated to a smaU bulk, treated with several A^olumes of strong alcohol, filtered, and the filtrate heated gently until the alcohol has been expelled. The fluid is iioav ex- amined separately for gedsemic acid and gelsemine. (a) Gelsemic Acid.—The acid liquid is shaken with twice its volume of ether, wliich takes up any gelsemic acid that may be present. The ether is carefully separated from the aqueous fluid, alloAved to eA'aporate spontaneously, and the residue examined for the acid by the tests given above. [b) Gelsemine.—The acid liquid, after treatment by ether for remoA'al of gelsemic acid, should be rendered alkaline and shaken AA'ith chloroform. Upon evaporation of the latter, any gelseniine that may be present aa'UI ALKALOIDAL AND OTHER ORGANIC POISONS. 437 be found in the residue, and its presence may be detected by the tests aheady described. Should the first chloroform residue be too impure for direct testing, it may be purified by solution in dilute acid, filtering, alkaliaizing, and reextraeting with chloroform. The residue from the evaporation of the latter wiU usuaUy be sufficiently pure for the various tests. In the Tissues.—The parts should be finely comminuted, mixed with dilute acidulated alcohol, heated gently on the water-bath, strained, the fluid evaporated to a small bulk, and the subsequent examination con- ducted exactly as in connection AA'ith the contents of the stomach. Both gelsemic acid and gelsemine resist decomposition at least fairly weU. Professor Wormley reports a case in AAdiich he was able four and a half months after death to extract both the acid and the alkaloid from the body of a woman who died from the effects of three teaspoonf uls of the fluid extract of gelsemium. TOBACCO AND NICOTINE. Nicotine (synonyms, nicotin, nicotia, and nicotina) is the aeth-e prin- ciple of Nicoka.ua Tabacum, or common tobacco. It exists in aU parts of the plant combined Avith an organic acid, the amount varying greatly in different specimens, and ranging from two to eight percent., the average being about five percent, Nicotine when pure is one of the most violent poisons with which we are acquainted, fully equaling, if not surpassing, hydrocyanic acid in its toxic powers; only a few cases of death, however, are recorded from the alkaloid itself, but tobacco in its various forms has often proved fatal. Properties of the Alkaloid.—Nicotine AA'hen pure is a colorless liquid, slightly heavier than Avater, and possessed of a very penetrating odor, like that of tobacco, and of a burning, pungent taste. It boils at 250° C, and slowly volatilizes at ordinary temperatures. It is readily soluble in water, and dissolves Avith ease in alcohol, ether, and chloroform. It is highly alkaline, neutralizing acids completely and producing neutral salts.' When exposed to the air and light it sIoavIv becomes colored, and finally is .conA'erted into a broAvn resinous substance. Symptoms.—Tobacco oavgs its effects entirely to nicotine, and the symptoms produced, therefore, by the plant are identical AA'ith those occa- sioned by the alkaloid, differing only in rapidity of action. Soon after taking a toxic dose of either the plant or the alkaloid, there is experi- enced a violent sense of giddiness, accompanied by great prostration, trembling of the limbs, seA'ere nausea and vomiting, and frequently copi- ous purging; the heart's action is disturbed, the pulse becoming rapid and feeble, and the respiration is difficult; the pupils are usually widely dilated, although sometimes contracted; the face becomes blanched, the lips blue, the extremities cold, and the respiratory act becomes more and more embarrassed; the intellect is clouded, convulsions often occur, fol- lowed by coma, and death takes place by apnoea, the heart continuing to beat after breathing has ceased. The external application of tobacco to ulcers, and even to the sound skin, has not infrequently been folloAved by violent symptoms, and some- times by death. Infusion of tobacco, used as an enema for medical pur- poses, lias occasionaUy produced severe symptoms of poisoning, and in 438 A SYSTEM OF LEGAL MEDICINE. a number of cases has proved fatal. The smoking of tobacco occasions decided symptoms of poisoning with persons not accustomed to it, and in not a feAV instances it has produced death. It is surprising, in a icav of the great prevalence of tobacco-smoking, that a greater numlicr of fatal cases have not been recorded. The reason for this probably lies in the fact that during the combustion of the tobacco a large part of the nicotine is destroyed, only about one seventh of that originally present passing unchanged into the smoke. Its place is.taken in the products of combustion by less poisonous pyridine bases. Period when Fatal.—Pure nicotine acts AA'ith great rapidity, one case being recorded in AA'hich death occurred three minutes after its admin- istration ; and in the AveU-known case in Avhich the Count de Bocarmem- poisoned his brother-in-laAv, Gustave Fougnies, by this agent, the victim died in five minutes. A tobacco enema has prove fatal in one case in fifteen minutes, in another in eighteen minutes, and in a third in thirty- five minutes. On the other hand, a fatal termination has been delayed for several hours, and in one case at least, untU the second day. Fatal Quantity.—The pure alkaloid is an exceedingly violent poi- son ; its smaUest fatal dose, however, is not definitely known, although it is probably only a fraction of a grain. The plant is also actively poi- sonous to those not accustomed to its use, an injection of only thirty grains haAung proved rapidly fatal in one case, while somewhat larger doses have killed in a feAV other instances. Treatment.—The stomach should be at once eA^acuated, and iodine and pulverized charcoal may be administered with the hope of retarding « the absorption of the alkaledd; general stimulants should be given, elec- tricity applied to promote the respiratory efforts, and inhalations of pure oxygen administered to increase the oxygenation of the blood. " Post=mortem Appearances.—The body after death from tobacco does not present any characteristic signs. The stomach is sometimes found exceedingly reddened, the membranes of the brain congested, the lungs engorged, the liver and kidneys congested, and the blood dark and fluid. None of these appearances, however, excepting the condition of the blooel, are constant. Tests.-—Nicotine responds to most of the reagents for .the alkaloids,. such as giving precipitates with iodine, picric acid, etc. It is distin- guished. hoAvever, from all of the other ordinary alkaloids, except coni- ine, by being an oUy liquid, and not a crystaUine solid, as vegetable bases generally are. It is further characterized by its peculiar odor and by the following tests: (a) Hydrochloric Acid Test.—If a watch-glass containing a little nico- tine has inverted over it another glass moistened with a drop of hydro- chloric acid, AA'hite fumes are rapidly formed, and an amorphous sohd is deposited on the watch-glass. This reaction distinguishes it from coni- ine, wliich under similar treatment produces a crystalline deposit. (b) Mercuric Chloride Test—If a solution of corrosive sublimate is added to a solution of nicotine, a white precipitate is produced, AA'hich. at first is amorphous, but Avhich soon becomes crystaUine. Most of the al- kaloids, coniine included, produce Avith mercuric chloride a white precipi- tate, but they are easily distinguished from that occasioned by nicotine by remaining amorphous. Strychnine alone of all the other alkaloids gives a crystaUine precipitate, but this may be easily distinguished from ALKALOIDAL AND OTHER ORGANIC POISONS. 439 the crystals produced with nicotine by the fact that the strychnine crys- tals are insoluble in acetic acid, AvhUe those obtained with nicotine read- ily dissolve in that agent. Moreover, the crystalhne forms of the two are different. (c) Iodine Test (Roussin's Reaction).—If to a solution of nicotine in ether an ethereal solution of iodine is added, long ruby-red crystals are deposited, appearing Avithin a few minutes if the nicotine solution con- tains one percent, of the alkaloid, but requiring several horns to form if the solution is quite dilute. (d) Physiological Test.—If even a very small quantity of nicotine is placed in the bill of a small bird, the animal falls dead in a few seconds. Larger animals are affected similarly by proportionately greater doses; a drop put on. the tongue of a cat proves fatal in one or tAvo minutes. Smallness of fatal dose and great rapidity of action characterize nicotine, although coniine is almost equally toxic. Detection of the Poison.—The method described under confine should be folloAved in extracting nicotine. The residue obtained, if it has the physical properties of the alkaloid, should be submitted to the tests for nicotine just described, beginning with the physiological test. The same precautions should be observed in applying the tests, anel in drawing con- clusions from them, as haA'e been laid down in connection with coniine, since substances are occasionally extracted from putrefying bodies that bear many strong resemblances to nicotine, and which can be distin- guished from the latter only by the most painstaking comparative tests. Moreover, in examining a body for nicotine it should always be remem- bered that a large majority of men and a considerable number of women use tobacco habitually, and the detection in a corpse of a small epiantity of the alkaloid would not necessarily be significant of death from this poison. Resistance to Putrefaction.—The alkaloid resists decomposition to a marked degree, and it may be detected, therefore, in a body even after the lapse of a considerable period of time. One experimenter was able to find the poison in two dogs that had been buried in the earth for seven years, and it has repeatedly been found in animals buried for shorter periods. OPIUM AND MORPHINE. Opium, the inspissated juice of the poppy (Papaver somniferum), is an exceedingly complex substance containing a large number of constitu- ents, such as alkaloids, gum, resin, oil, coloring matter, etc. Of these by aU odds the most important are the alkaloids, to which opium owes entirely its remedial value and poAverful toxic effects. The number of alkaloids in opium is large, about twenty having been already isolated, and it is quite likely that others, wliich have not yet been determined, may be present in small quantities. Of the alkaloids, decidedly the most important is morphine, Avhich is present in someAA'hat varying propor- tions in different specimens, ranging from six to fifteen percent. The United States Pharmacopoeia demands the presence of not less than nine percent, in opium in its normal moist state, and from thirteen to fifteen percent, in dried pulverized opium. The most important other alkaloids in opium are narcotine, codeine, 440 A SYSTEM OF LEGAL MEDICINE. narceine, thebaine, and papaA-erine, and they constitute conjointly gen- eraUy from four to ten percent, by Aveight of the opium. Codeine and narceine are narcotics hke morphine, but thebaine is a poAverful tetaniz- ing agent. The alkaloids in opium are present united chiefly AA'ith meconic acid as meconates. This acid is found in no other substance than opium, and is therefore entirely characteristic of it—a fact of considerable im- portance not infrequently in toxicological investigations. Although the physiological effects of opium are not precisely like those of morphine, yet the two are so nearly identical that they may be considered together. Morphine is commonly regarded as having from four to six times the activity of opium. Pharmaceutical Preparations.—Opium is the active constituent of a considerable number of pharmaceutical preparations, of AA'hich the most important are the folloAving, their strength in opium also being given: Tincture of opium, or laudanum.....................10.0 percent. Vinegar of opium, or black drop.....................10.0 " Camphorated tincture of opium, or paregoric......... 0.4 " DoArer's powder....................................10.0 " What is known as Magendie's solution contains sixteen grains of sul- phate of morphine to the fluid ounce. Properties of Morphine.—Morphine is a white, odorless, crystaUine alkaloid of marked basic poAvcrs, neutralizing acids completely forming stable salts. It is A'ery sparingly soluble in cold water, requiring upAvard of four thousand parts to effect its solution at ordinary temperature; it is also but slightly soluble in ether and chloroform, but dissolves Avith a fair degree of ease in ordinal-}' alcohol and in amylic alcohol, especiaUy if they are heated. Symptoms.—As already stated, the effects produced by opium anel morphine are essentially the same ; the latter, hoAvever, owing to its con- centrated form and greater solubihty in the fluids of the stomach, usually acts more rapidly than the former. The effects of both are those of en- ergetic narcotic poisons. The person is generally first taken AA'ith a sense of dizziness and con- fusion, rapidly foUoAved by great drowsiness and an irresistible inclination to sleep. There is often intense itching of the nose, and this symptom is frequently of great value in the diagnosis of opium poisoning. The breathing is sIoav and labored, becoming less and less frequent as the case progresses, the respirations sometimes not exceeding tAvo or three a minute; the pulse is at first full and slow, but toward the end it becomes rapid, feeble, and irregular. The stupor increases, complete insensibility setting in. The pupils are generally strongly contracted, although some- times in the later stages they become Avideiy dilated. The skin is cold and damp, the lips bluish, and the AA'hole muscular system is relaxed. As the case progresses the breathing becomes more difficult, and finally ceasing, death ensues, although sometimes the end comes unexpectedly through sudden heart failure. Convulsions are occasionally seen Avheii opium is given, especially in children, this effect being probably due chiefly to the tetanizing effect of its thebaine. The external application of opium or morphine to ulcers, abraded surfaces of the skin, and eA'en to the sound skin, has not infrequently ALKALOIDAL AND OTHER ORGANIC POISONS. 441 been followed by dangerous symptoms of poisoning, and even by death. Administered by the rectum or hypodermicaUy, fatal resiUts have also not infrequently been produced. Diagnosis of Opium Poisoning.—There are numerous diseases or conditions Avhich are liable to be confounded with opium poisoning, the most important being apoplexy, uraemic coma, acute alcoholism, and poi- soning by chloral or other narcotics. With a fuU knoAA'ledge of the his- tory of the case and of the post-mortem appearances, we sometimes may make an accurate diagnosis, but from the symptoms alone it is probably impossible in any case to be absolutely certain. When, therefore, the history is someAvhat obscure and the post-mortem appearances are more or less negative, Ave are obliged to depend almost exclusively on the re- sults of chemical analysis to make an accurate diagnosis; and since, as Ave shall see later, the detection of opium or morphine in a body is at- tended with many difficulties, no conclusion can justifiably be reached unless the evidence from the chemical investigation is absolutely clear and unequivocal. Period when Fatal.—Both opium and morphine generaUy begin to show their effects soon after their administration; sometimes the symp- toms appear within a few minutes, and they are usuaUy not delayed be- yond an hour. OccasionaUy, hoAvever, they are much retarded in mani- festing themselves, in one case no Avell-markeel symptoms being obseiwed until the eighteenth hour. After the poisonous effects haA^e commenced to shoAv themselves the case usuaUy progresses somewhat slowly, the time of death being generally from six to twelve hours after the admin- istration of the poison. Death, hoAveA'er, has occurred within forty-five minutes, and, on the other hand, it has been delayed until the end of fifty-six hours. Fatal Quantity.—The average minimum fatal dose of opium for the healthy adult may be placed at about four or five grains, and that of morphine at about one grain. If, hoAvewer, the person is feeble, death may be produced by a smaller dose, and children as a rule have a marked intoleration both of opium and morphine, a single drop of laudanum haA'ing produced fatal effects with very young children in several cases. Morphine if given hypodermicaUy is much more toxic than Avhen taken by the mouth, and a number of cases of death are recorded after the hypodermic administration of from one sixth to one half of a grain. Recovery, hoAvever, has not infrequently followed very large doses, such as one to two ounces of opium and two drams of morphine. As is well known, the intensity of the effects of opium and morphine is greatly modified by a number of conditions, such as idiosyncrasy, dis- ease, pain, and habituation to their use. Treatment.—The stomach should be thoroughly eA'acuated as soon as possible. For this purpose the stomach-pump or tube is, as a rule, to be preferred to emetics, as the latter are often unreliable and sometimes entirely useless in this, as in most other forms of narcotic poisoning. Preceding the use of the stomach-pump or tube, tannic acid, solution of iodine, or pulverized charcoal may be administered with the hope of retarding the absorption of the drug, but these should never be depended upon to the exclusion of the eA'acuation of the stomach. After getting rid of the contents of the stomach, atropine should be administered in smaU doses, repeated occasionally, until marked dUata- 412 A SYSTEM OF LEGAL MEDICINE. tion of the pupil is secured, but its administration should not be pressed beyond this point, A strong decoction of coffee by the mouth or by injection into the rectum is undoubtedly of service as a heart stimulant, and caffeine may be used hypodermically for the same purpose. The patient shoiUd not be permitted to sleep, but should lie kept awake at all hazards by flagellations, constant Avalkiug, and continuous conversation. Cold AA'ater may be dashed over the head and chest for the same purpose, and electricity is often found useful as a stimulant to the respiratory and circulator}' centers. If the breathing cease, artificial respiration must be resorted to, and inhalations of pure oxygen are sometimes of service. Post=mortem Appearances.—Those Avhich are most commonly seen are congestion of the cerebral A-essels, effusions in and about the brain, congestion of the lungs, and unusual fluidity and darkness of the blood. These appearances, however, are by no means constant, nor when present do they necessarily indicate death from opium. Tests.—The two most important and characteristic substances in opium are its chief alkaloid, morphine, and its peculiar acid, meconic. Both substances are distinguished by well-marked reactions. 1. Morphine.—Many tests have been proposed, and nearly aU of them are sometimes useful; but the four that are chiefly important are the nitric acid, ferric chloride, sulpho-molybdic acid, and iodic acid tests. (a) Nitric Acid.—If morphine is treated AA'ith nitric aciel it assumes a reddish yeUoAV, or sometimes a brownish vcIIoav color, AA'hich upon stand- ing fades to a light yeUow. (See PI VIII., No. 2.) The reaction is moderately delicate and fairly characteristic. Brucine gh'es with nitric acid a reel color, but upon the addition of stannous chloride it is changed to purple, AA'hUe that from morphine is unaffected, or nearly so. Quite a number of other organic substances, chiefly those of a gummy and resin- ous character, also produce a reddish color AA'ith nitric acid; but these sub- stances are not crystaUine, anel therefore differ materially from morphine. In applying the nitric acid test to a suspected substance extracted from a stomach or other part of a body, it is highly important, in order that any just conclusion may be drawn, that the material be crystaUine and free from extraneous matter. I have repeatedly seen extracts from various organs of the body give AA'ith nitric acid a reaction Avhich could not be distinguished from that produced by morphine, although not a trace of the latter AAras present; but in none of these cases was the residue crystaUine. (b) Ferric Chloride.—Morphine when treated AA'ith a neutral solution of ferric chloride or ferric sulphate produces a deep blue, sIoavIv chang- ing to a dark greenish blue color, which is destroved bv free acids, by alkalies, and by heating. (See. PI VIII., No. 3.) The 1-10,000 of a grain gives a fairly marked reaction. Carbolic acid, salicylic acid, gaUic acid, and some forms of tannic acid, also strike AA'ith ferric chloride a bluish color; but all of these are soluble in water or ether, by AA'hich they should be removed in the course of analysis from the suspected material, before the ferric chloride is applied. By taking this precaution the test becomes a valuable one. The blue color produced by ferric chloride and morphine is destroyed by nitric acid, and a reddish yehoAV mixture is produced, due to the action of the acid on the morphine; by operating in this Avay two tests for the alkaloid may be obtained from the same material. ALKALOIDAL AND OTHER ORGANIC POISONS. 443 No ptomaine has been found giving a morphine reaction with ferric chloride, according to the observations of Brouardel and Ogier. (c) Sulpho-molybdic Acid.—Sulpho-molybdic acid produces a beautiful and fairly characteristic play of colors AA'ith morphine—a fact to AA'hich attention Avas first directed by Froehde, and the test consequently bears his name. The reagent may be conveniently prepared by dissolving a milligram of molybdic aciel in a cubic centimeter of concentrated sul- phuric acid by the aid of gentle heat. When morphine is treated with this solution, a play of colors is produced, beginning with purple, chang- ing to violet, passing through seA'eral other shades, and finally ending in a dark blue. (See PI. VIII, No. 4.) The reaction is A'ery delicate, and if properly employed is characteristic; a feAV glucosides and papaA'erine give a similar reaction, but as these should be separated from morphine by the process eif extraction and purification, they need not be further considered. The test is likely to be interfered Avith, or eA'en Avholly pre- A'ented, by the presence of foreign matter such as is prone to accompany morphine Avhen extracted from complex organic mixtures. Before apply- ing the test, therefore, the1 substance under examination should be care- fully purified as directed further on. (d) Iodic Acid.—A solution of iodic acid if treated with morphine is deoxidized, its iodine is set at liberty, and imparts to the hquid a brown- ish color. If standi is present it is colored blue by the formation of iodide of starch; or if the liquid is shaken AA'ith chloroform, the latter by dissolving the ioeline assumes a purplish color. This reaction, howeA'er, is produced by man}' other substances, and it is of A'alue chiefly as a negative test, for Avhich purpose it is often A'ery useful. 2. Meconic Acid.—Meconic acid is, AA'hen pure, a AA'hite crystaUine solid, someAA'hat sparingly soluble in cold Avater,but readily dissolving in alcohol. It is characterized for toxicological purposes chiefly by two reactions. (a) Ferric chloride strikes Avith meconic acid and its salts a deep red color, which is not discharged by corrosive sublimate, nor by even a con- siderable excess of a free mineral acid. Sulphocyanates, such as are found in saliva, and which may there- fore be present in the stomach, also strike Avith ferric chloride a deep red color, but the color thus produced is readily discharged by corrosive sublimate, AAdiich clearly distinguishes it from the reaction of meconic acid. So, too, strong acetic acid and most of its salts give with ferric chloride a red color; this, hoAvever, is destroyed by the free mineral acids much more easily than that produced by meconic acid. (6) When treated AA'ith a solution of lead acetate a ycdlowish AA'hite precipitate of lead meconate is throAvn doAvn : this is insoluble even in a large excess of acetic acid, and upon being treated AAdth ferric chloride it strikes a deep red color. These reactions combined are highly char- acteristic of meconic aedel. Numerous other acids, such as sulphuric, phosphoric, sulphocyanic, tannic, citric, etc., either in the free state or combined as salts, when treated with lead acetate giA'e white or yeUoAvish white precipitates; but the latter all differ from the precipitate produced with meconic acid, either in being soluble in excess of acetic acid, or in faUing to give a red color Avith ferric chloride. Detection of the Poison.—In the Contents of the Stomach,—If opium or one of its pharmaceutical preparations is beheA'ed to haA'e been taken, 444 A SYSTEM OF LEGAL MEDICINE. Ave examine for both meconic acid and morphine ; but if suspicion points to the use of the pure alkaloid, Ave naturally test for morphine alone. As meconic acid is found in opium only, the detection in the stomach of this substance is as pe>sitive evidence of the administration of opium as the discovery of morphine; and since its reactions are1 sometimes somc- Avhat more delicate than those for the alkaloid, Ave should not omit search- ing for it. If, in an unknown case, both meconic aciel and morphine are discov- ered, we knoAv that opium or one of its preparations must have been ad- ministered ; but if morphine alone is found, the alkaloid must have been used. The contents of the stomach should first be criticaUy examined for the presence of bits of undissolved opium, and the odor should be care- fully observed, as the presence of opium and its different preparations often betrays itself by its peculiar smell. The material should then be finely comminuted, moderately acidulated with acetic acid, and digested on the water-bath for half an* hour or an hour. The mixture is filtered, the filtrate evaporated to a small bulk, three or four volumes of strong alcohol sloAvly stirred in, and the separated insoluble material removed by careful filtration. The filtrate should be evaporated to expel the alco- hol, and the syrupy residue dissolved in water acidulated with acetic acid. After filtration a slight excess of lead acetate is added, by which a pre- cipitate1 is produced containing any meconic acid that may be present in the form of insoluble lead meconate. The mixture is throAvn on a filter and the precipitate thoroughly washed Avith water. We now have Iavo portions to examine—the material on the filter for meconic acid, and the nitrate for morphine. 1. Contents of the Filter for Meconic Acid.—While stUl moist the pre- cipitate is removed, diffused through water, and a stream of hydrogen sulphide passeel through the mixture to saturation; the lead salts will be coiiA'erted by this process into black insoluble sulphide, AA'hile an}' me- conic acid present aa'UI go into solution. The mixture is filtered and the filtrate ewaporated to a smaU bulk; a part of the liquid is treated AA'ith ferric chloride and the remainder with lead acetate, and if from both we get the characteristic reactions already described, the presence of meconic acid is demonstrated. 2. The Filtrate for Morphine.—Hydrogen sulphide gas is passed through the fluid to saturation to remove the excess of lead acetate by convert- ing the lead into the insoluble sulphide. The mixture is set aside in a Avarm place for a number of hours until the sulphide has subsided, and the fluid is then separated from it by filtration. The filtrate is evapo- rated at a gentle heat until all odor of hydrogen sulphide has disappeared; it is then placed in a stout test-tube, a slight excess of ammonia added, and a double volume of hot amylic alcoho? immediately poured in and violently shaken. Upon standing, the ainyl alcohol, AA'hich now contains the greater portion of any morphine that may have been present, rises to the top, and may be removed by means of a pipette. The aqueous fluid should be again shaken vdth amylic alcohol, wliich after separation may be added to the first portion; the combined amylic alcohols are iioav eA'-aporated at a gentle heat on the Avater-bath in a large watch-glass, and the residue is to be carefully examined uneler a low power of the micro- scope. If much morphine is present, crystals AviU often be seen in greater ALKALOIDAL AND OTHER ORGANIC POISONS. 445 or less abundance; but Avhether crystals are found or not, the residue should be very carefully purified and thoroughly freed from extraneous matter. The presence of impurities is ahvays liable to lead to confus- ing results when operating for any alkaloid,"and this is particularly true Avhen testing for morphine. To effect this purification the residue may be dissolved in a little dilute acetic aciel, the mixture filtered, the filtrate alkalinized, and shaken at once with a double volume of hot amylic alco- hol as before elescribed. Upon evaporating the alcohol in a watch-glass, if morphine is present in more than small traces it wiU now usuaUy ap- pear, partially at least in crystaUine form. OccasionaUy the product is sufficiently pure to subject it directly to the various tests for morphine, but in the great majority of cases it is necessary to remove still further any extraneous matter that may be present by washing the material once or twice with a feAV drops of ice-cold water and afterward AAdth a little absolute ether. The residue from these operations should then be submitted to the four tests for morphine previously de- scribed. If the material ex- amined is crystaUine, and each one of the four tests mentioned gives unequivocal results, the presence of mor- phine is demonstrated. It is of the utmost impor- tance in examining for mor- phine that the residue to be tested should lie thoroughly purified and freed to the great- est extent possible from aU foreign material. None of the tests for the alkaloid are absolutory conclusiA'e AA'hen acting upon unknown com- plex mixtures. Professor Yaughan has clearly shown that under certain conditions normal constituents of the gastro-intestinal tract may giA'e reactions strikingly similar to those pro- duced by morphine AA'hen 110$ thoroughly purified, and I haA'e myself on tAvo or three occasions extracted from the stomachs of persons avIio died from other poisons, compounds which behaved remarkably hke morphine, and Avhich could be distinguished from the latter only after the most rigid purification. I should be unAvUling to accept the presence of morphine as haAung been demonstrated unless the alkaloid had been isolated in a pure or practically pure crystaUine form, and had given with aU four tests before described unequiArocal reactions. If,in a suspected case, morphine alone is beheved to have been giAen, the aboAre process may be matoriaUy shortened by omitting that part Avhich relates to the determination of meconic acid; the precipitation by lead acetate, and the subsequent filtration and treatment of the filtrate Avith hydrogen sulphide, may be dispensed with, and the liquid may be operated on at once for the extraction of morphine as above. -Crystals of Morphine from Stomach, crys- tallized from amyl alcohol. Magnified 18 diameters. (Drawn with the camera lucida by Dr. E. R. Le Count.) 446 A SYSTEM OF LEGAL MEDICINE. In the Tissues.—As a rule meconic acid and morphine are not detected in the tissues of the body even after considerable doses haA'e been taken, but in case the examination is to be made Ave may proceed as I'oUoavs : A part or the AA'hole of the organ, such, as the hver, kidney, or brain, is to be very finely subdivided, mixed with Avater to a thin paste, and heated gently for tAvo or three hours after haA'ing been rather strongly acidu- lated Avith tartaric or some other equally active aciel. The mixture is then strained and gently eA-aporateel to a moderate bulk, AA'hen three or four times its volume of strong alcohol should be sIoavIv stirred in, and the liquid filtered from the insoluble precipitate produced; the filtrate is concentrated on the Avator-bath until all alcohol has been expedled and a syrupy residue is obtained; this is extracted Avith Avater, filtered, anel the filtrate treated Avith ammonia and hot amylic alcohol as before described. The alcohol is evaporated on a Avatch-glass, anel the residue may be puri- fied and testod as given above in connection AA'ith the examination of the contents of the stomach. Failure to Detect.—Opium and morphine both resist decomposition in a marked degree, so that there is a possibility of detecting their pres- ence eA'en a considerable time after death. Allen obtained satisfactory proof of the presence of meconic acid in the stomachs of two children exhumed five months after death, and Taylor has detected both meconic acid and morphine in mixtures AA'hich had undergone decomposition for a period of fourteen months. On the other hand, hoAvever, there is not infrequent faUure to detect any trace of the poison eAren Avhen the examination is promptly made. Of all the ordinarily used poisons, none is more likely to escape discovery than opium anel morphine. Why this is Ave do not fully know, but several causes probably conspire to produce this result: (1) Death does not usuaUy occur until the end of a number of hours, and a chance is afforded for the complete absorption of the poi- son from the stomach, and its entire or partial elimination from the rest of the body; (2) our tests for meconic acid and morphine AA'hen in com- plex or organic mixtures are not extremely delicate; and (3) it appears quite likely that under some conditions opium and morphine undergo chemical change in the body even before death takes place. Surgeon-Major Ross reports that there Avere forty-five fatal cases of opium poisoning in the Bengal Presidency in LSOJ), and that an analysis Avas made in each case, yet in only two was opium detected in the stomachs. This is an extreme case, and may be accounted for, partiaUy at least, by the fact that the means for detecting opium tAventA'-five years ago were not nearly as delicate as those used to-day. StiU, a considerable number of cases in late years have been recorded'of known eleath from opium in Avhich the poison was not afterward discovered in the stomach. I have myself had at least one such experience, having failed to find the slight- est trace of morphine in the stomach of a Avoman who was known to have taken not less than ten or fifteen grains of the drug for suicidal purpose. She lived for about eighteen hours after swallowing the poi- son; the stomach was removed soon after death anel AA-as promptly ex- amined, but not the faintest reaction for morphine was obtained after repeated and most careful tests. Note.—As opium and morphine are extensively used as remedial agents, and are not infrequently taken for the relief of pain Avithout the advice of a physician, and, moreover, as these substances are present in ALKALOIDAL AND OTHER ORGANIC POISONS. A,Yi a considerable number of patent medicines which are in common use, the detection of morphine or meconic acid in a body after death would by no means necessarily indicate that poisoning had occurred. NUX VOMICA AND STRYCHNINE. Nux vomica, the seed of Strychnos Nux-vomica, owes its poisonous properties chiefly to the presence of strychnine (synonyms, strychnin and strychnia). It contains, however, another alkaloid, brucine, which is analogous in its physiological properties to strychnine, but is so much feebler that it adels comparatively little to the toxic poAvers of the drug. ►Strychnine exists in mix vomica, combined with lactic and igasuric acids, in the proportion of from 0.5 percent, to iqnvard of 1.5 percent. Strych- nine is also found in the seeds of Strychnos Ignatii, and in three or four other species of strychnos. Chemical Properties of Strychnine.—Strychnine appears in com- merce either as a white powder made up of minute crystals, or in the form of larger crystals, which are sometimes octahedral and sometimes prismatic. It is very sparingly soluble in water, requiring 8333 parts of that fluid to dissolve it when cold, but it is someAvhat more soluble in hot water. It dissolves in a little more than 200 parts of alcohol at ordinary tem- perature, and in about 400 parts of Avhiskey and other simUar spirituous liquors; it requires 1400 parts of pure ether to effect its solution, but it dissolves readily in 8 or 10 parts of chloroform; it also dissolves readUy in a mixture of equal volumes of ether and chloroform. The alkaloid is of alkaline reaction, and when brought in contact with acids neutralizes them, producing salts most of which are quite readUy soluble in Avater and alcohol. The salt most commonly used in medicine is the sulphate, AA'hich occurs in commerce in the form of colorless or white prismatic crystals, soluble in 50 parts of water and about 100 parts of alcohol. An interesting and important point in connection with the properties of strychnine is its resistance to the destructive effects of sulphuric acid even when heated on the water-bath. Most organic compounds when treated Avith sidphuric acid, especiaUy Avhen they are heated Avith it, are chemically changed and lose their identity; the difference in the behavior of strychnine in this respect affords a A'aluable means of separating it from other substances, and of completely purifying it during the process of extraction from the stomach or other organs of the body. Strychnine is intensely bitter, this property being so strongly marked that one part of it gives a decided taste to 70,000 parts of water; its bit- terness, moreover, is very persistent, clinging tenaciously to the tongue and fauces, and being removed Avith difficulty. It is an important fact, however, that some persons are unable to recognize the bitterness of strychnine, and I have personally met four illustrations of this. They were all men in good health, and they kneAv that beer, quassia, and many other substances are bitter, but they could not recognize the bitterness of strychnine; they described it as having a rough or slightly musty taste. All of the men in question used tobacco, and one of them drank liepior somewhat to excess; one also had some nasal catarrh, but not to 448 A SYSTEM OF LEGAL MEDICINE. such a degree as to interfere materiaUy Avith the appreciation of ordinary odors and tastes. The fact that strychnine is not necessarily bitter to all people1 is occa- sionaUy of medico-legal importance in such cases as the following: A person" after partaking of food is suddenly seized with violent convul- sions and soon dies. In spite of the fact that strychnine is found in the body by analysis, yet as the person made no complaint that the food eaten was bitter, although abundant opportunity Avas afforded for doing so, doubt is entertained as to the cause of death, and, in case of legal inepiiry, this circumstance is made a strong point by the1 defense. It is quite possible, hoAvever, in such cases that the deceased, like the persons mentioned above, Avas either AvhoUy or largely incapable of recognizing the bitterness of strychnine. The taste of strychnine, moreover, may be considerably masked, anel its bittorness large'dy concealed, by the presence of certain other sub- stances, such as tannic acid, licorice, and chocolate. In a case of poison- ing AA'hich came under my observation not long since, it A\'as claimed by the defense at the time of trial that strychnine could not have beem ad- ministered, as the deceased had complained of bitterness but slightly after eating some confectionery AA'hich the prosecution alleged contained the poison. Since the candy, hoAvever, was composed largely of chocolate, the absence of intense bitterness Avas easily explained. Symptoms.—Both nux vomica and strychnine produce essentially the same effects, the only difference observable being that the latter,, as would naturaUy be expected, acts somewhat more rapidly than the former. The symptoms occasionally begin to show themselves immediately after the swaUowing of the poison, but more often they are delayed for ten or fifteen minutes; they do not usuaUy appear earlier than five min- utes, nor are they often delayed later than an hour, although they have been known to be postponed until the end of the third hour. This great difference in time of the first symptoms is due chiefly to the form in wliich it is administered and to the condition of the stomach. If taken in solution it acts more rapidly than in the form of a powder, and in pills it is still slower in its action; if taken on an empty stomach it is absorbed more quickly and produces its effects eariier than when the stomach is full of food. The first symptom manifested is usually a sense of discomfort, ac- companied by a feeling of tightness about the chest and throat, and a twitching of the muscles of the hands and feet. These, however, usually last but a short time, and are followed suddenly by a Adolent tetanic convulsion: sometimes the entire muscular system seems to be affected almost simultaneously, but generally the rigidity appears first in the extremities, rapidly extending to the trunk, and finally to the face and jaws. The legs are extended, the feet arched, and the head is thrown violently backAvard, so that the body often rests only upon the heels and occiput, producing a condition known as opisthotonos; the arms are sometimes widely extended and sometimes drawn tightly across the chest; the muscles of respiration become so rigid that breathing is diffi- cult and often seems to cease, and the pulse is weak and irregular, occa- sionally becoming imperceptible. The countenance is livid, the eyes staring, the pupUs widely dilated; foam often appears at the mouth, anel ALKALOIDAL AND OTHER ORGANIC POISONS. 449 the countenance generaUy assumes a ghastly, grinning expression. The convulsion lasts from half a minute to several minutes, when the mus- cular rigidity nearly or entirely disappears. There is generally uoav a condition of great relaxation: cold perspiration breaks out over the whole body, the pupUs contract, a sense of Aveariness is expressed, and the patient not infrequently sinks into a profound sleep. This period of intermission continues from a few minutes to half an hour, when another paroxysm shoAvs itself. It sometimes comes on unexpectedly, but often is preceded by a feAV moments of intense anxiety on the part of the patient, who piteously pleads for reUef. All the senses are unnaturally excited, and the convulsion is often brought on by a loud noise, the slamming of a door, a sudden current of air, or eA'en a gentle touch. The second paroxysm is usually a counterpart of the first, but is more seA-ere; the breathing is more difficult, the strength more exhausted, and the suffering more acute. After two or more paroxysms, unless relief is afforded, the patient dies, either in the height of a convulsion from asphyxia, or at the close of one from exhaustion. The mind is usually not affected, the inteUect generaUy remaining clear until the end, and there is a thorough appreciation of the gravity of the situation and the imminence of death. Vomiting is occasionally but not often seen. However given, strychnine produces essentially the same effects, and numerous cases are recorded of violent symptoms from its hypodermic ust!; it is usuaUy more active when thus administered than Avhen taken by the mouth, one sixteenth of a grain having occasioned alarming symptoms. When associated with other drugs, as would naturally be expected, the effects of strychnine may be materially masked; opium, morphine, chloral, and other narcotics great!}' retard its action and modify its symptoms. Diagnosis of Strychnine Poisoning.—The manifestations produced by a poisonous dose of strychnine are so characteristic that usually there is but little difficulty in making an accurate diagnosis from the symptoms alone. On various medico-legal occasions, however, it has been claimed that several diseases might be mistaken for strychnine poisoning, among others being epilepsy, uraemic and puerpural convulsions, chorea, the various forms of tetanus, and even syphilis. But all of these, with the exception possibly of tetanus, differ so essentiaUy in their manifestations from strychnine poisoning, that they could not possibly be confoundeel by a competent obsei-A'er. The different forms of tetanus do in some respects resemble strychnine poisoning, yet there are such weU-marked differences betAveen them that after careful examination they should never be mistaken for each other. In both, it is true, there are violent tonic spasms AA'hich are strikingly simUar, but in almost aU other respects the1}' are unlike. In tetanus Ave almost ahvays have a history of an injury, and the dis- ease usually comes on graduaUy and progresses sIoavIv to a fatal termina- tion, a number of days generally elapsing between the onset of the dis- ease and death, Avhile in strychnine poisoning there is no antecedent injury, and the manifestations appear suddenly, almost Avdthout Avarning, and progress rapidly to a fatal termination; in tetanus the muscles first affected are generally those of the back of the neck, and those of the jaAv are early invaded, producing persistent lockjaw, whUe in strychnine 450 A SYSTEM OF LEGAL MEDICINE. poisoning either the muscles of the extremities are first affected, and those of the neck and jaw last attacked, or the entire muscular system is thrown into a spasm almost, or quite, simultaneously; in tetanus there is usuaUy considerable persistence of the muscular rigidity even betAveen the severe spasms, and opisthotonos, or some other perverted_position of the bod}', is generally permanent, AvliUe in strychnine poisoning there is almost ahvays complete relaxation between the spasms, and the opisthot- onos, Avhich may have been very marked during the attack, entirely passes aAvay; in tetanus the temperature is generally someAA'hat elevated beyond the normal, while in strychnine poisoning it is not usually affected. There are, it is true, occasionally marked exceptions to the above differences, one case being recorded in Avhich tetanus proved fatal in twelve hours after the first tAvitchings, another within an hour and a half after the first convulsion, and a third in fifteen minutes after the injury producing the disease; on the other hand, a case of strychnine poisoning is recorded in AA'hich death occurred after a lapse of eighteen hours, and seA'cral cases arc knoAvn in which repeated smaU doses of the poison have been administered in such a Avay as to extend the symptoms over a period of several days. So also in tetanus, cases are occasionally seen in AA'hich little or no increase of temperature is found, whUe in poi- soning by stryedinine the temperature is sometimes elevated. In spite, hoAvever, of these irregularities both in strychnine poisoning and in tetanus, a competent observer avUI rarely have difficulty in distinguish- ing the two, the difference in the order in which the muscles are attacked and the marked dissimilarity in the condition of the patient betAveen the spasms generaUy sufficing to establish the exact character of the derangement. Period when Fatal.—One or two cases are recorded in which death is said to have occurred almost immediately after the ingestion of the poison, and tivo or three are on record in which the fatal termination came in ten minutes. In most cases strychnine acts rapidly, and death almost ahvays occurs Avithin two hours; if the person lives beyond this time his chance of recovery is good. Some cases, hoAvcwer, are much prolonged; at least four are recorded in which death Avas delayed for six hours, and Tardieu and Roussin have reported a protracted case in AA'hich death did not occur until the eighteenth hour. In a case of strych- nine poisoning Avhich I Avas called on to investigate tAvo years since, death occurred in eleA'en hours after the administration of the poison; morphine and chloroform, hoAveA'er, had been abundantly administered, and this probably accounted for the long delay. Fatal Quantity.—A quarter of a grain is recorded as having occa- sioned death, and good authorities beheve that even one sixth of a grain should be regarded as a possibly fatal dose. Dr. Warner, who took by mistake not over half a grain of the siUphate of strychnine, died from its effects in eighteen minutes. But numerous cases are reported of recovery from large doses, such as fifteen, twenty, and even forty grains; in almost all of these, howeA'er, there was early vomiting, or the stomach Avas promptly eA'acuated by emetics or by the stomach-pump, aud energetic general treatment Avas employed. Treatment.—The stomach should lie at once evacuated by the use of emetics or the stomach-pump; oAving, however, to the violent spasms ALKALOIDAL AND OTHER ORGANIC POISONS. q.yi AA'hich early set in, it is often difficult or impossible to use the stomach- pump until by the plentiful administration of chloroform the tetanic condition is relieved, Avhen the tube may be inserted AA'ith ease. Tannic acid, solution of iodine, or finely pulverized charcoal may be adminis- tered as supplements to the use of emetics or the pump'; they render the strychnine less soluble and retard its action. Chloroform should be freely given by inhalation during the paroxysms, and chloral may be ad- ministered with great advantage in the intervals, either by the niouth or hypodermically. During the convulsions, when there seems impending death by asphyxia, pure oxygen may be played over the mouth and nose, and it sometimes affords marked relief. The patient should be kept as quiet as possible; all strangers should be excluded from the room, direct draughts of air should be shut off, and loud noises, such as those produced by the slamming of doors, stamping of feet, etc., should be prevented. For the same reason, as little medicine as possible should be given internally, as the mere raising of the head, or the touching of the lips AA'ith a spoon may cause a convulsion. Ex- periments on animals have repeatedly shoAvn that absolute quiet is a very important factor in securing recoA'ery from poisonous doses of strych- nine ; and clinical experience abundantly demonstrates that the same is true with man. Post=mortem Appearances.—The stomach is usuaUy normal, but is sometimes found in a state of intense congestion ; the liver, kidneys, and lungs are frequently engorged with blood; the heart is occasionally full and distended, but rather more often is empty and flaccid. The brain anel spinal cord and their surrounding membranes are occasionaUy normal in appearance, but usually are congested, and sometimes present effusions of serum or blood. The muscles immediately after death are1 usually relaxed, but rapidly take on extreme rigielity, which is generally very marked; neither arms nor legs can be bent except Avith great diffi- culty, and the body often lies in a condition of opisthotonos. The rigid- ity occasionaUy disappears Avithin a few hours, but sometimes lasts for Aveeks, and even months. In a case of death from strychnine which I examined some time ago, I found the body five months after death in- tensely rigiel, though decomposition had progressed to a marked degree. None of the above post-mortem appearances are entirely character- istic of death by strychnine, although the congestion of the brain and spinal cord, the effusions of blooel and serum about them, and the well- marked rigor mortis are rarely produced coUectively by any other cause. Tests.—Strychnine responds to all the general reactions for alkaloids, giving precipitates AA'ith tannic acid, picric acid, iodine, etc., but these are not particularly distinctive. Fortunately, hoAvever, we possess sev- eral tests that are highly characteristic, of AA'hich four are particularly A'alliable, namely: the taste, the color test, the chromate test, and the physiological test. (a) The Taste.—As has already been stated, strychnine is intensely bitter, and it has this property in a higher degree than any other known substance. In examining a suspected residue, therefore, Ave expect to find more or less bitterness if the alkaloid is present. Many other substances, hoAvcA-er, as is Avell known, are also bitter, such as quinine, salicine. and morphine, but none of these approaches strychnine in the intensity of its bitterness. 452 A SYSTEM OF LEGAL MEDICINE. (b) The Color Test—If strychnine is treated AA'ith strong sulphuric acid it dissolves, if pure, Avithout the production of color; but if an oxi- dizing agent is iioav added a highly characteristic display of colors mani- fests itself in the following order :* first, a deep blue, almost immediately passing to purple, then hlac, rapidly changing to red, Avhich sIoavIv fades aAvay, leaving a mixture AA'hich is nearly colorless. (See PI. VIII, Xo. ',.) A considerable number of oxidizing agents have1 been proposed for producing this reaction, the most important of AA'hich are potassium bichromate, manganese dioxide, lead peroxide, potassium permanganate!, and cerosoceric oxide. Any one of these AA'hen properly employed gives good results, but personaUy I prefer either the bichromate or the ceroso- ceric oxide. In my hands the first of these yields almost uniformly good results, but the cerosoceric oxide has the advantage of occasioning a some- AA'hat sloAver change1 of colors, and producing a cherry red at the end, which is very persistent and quite characteristic. Whichever oxidizing agent is used, the best Avay to proceed in making the test is to treat the suspected substance Avith a single drop of strong sulphuric acid, Avhen no color should be produced, or at most only a slight darkening from the presence of a trace of impurity; a small particle of the oxidizing material is then cautiously draAvn into the mixture, and very gently anel sIoavIv moved about; if strychnine is present the colors above spoken of AviU manifest themselves in the order named—blue, purple, violet, and red; the blue, hoAvever, is sometimes so evanescent as to be almost impercep- tible. Dr. Letheby has suggested passing an electrical current through the mixture for the purpose of deA'eloping the color, the nascent oxygen evolved by the electrolysis of the acid acting as the oxidizing agent. My oavii experience AA'ith this test, hoAveA'er, has not been A'ery satisfactory, and I should place it below ah the others both in delicacy and con- A-enience. The color test for strychnine Avhen properly applied is exceedingly delicate, being capable of detecting a Arery minute quantity of the alka- loid ; it has been stated, and quite correctly, that the smaUest particle of strychnine that can be seen by the unaided eye will give this reaction unmistakably. Not only is the test exceedingly delicate, but Avhen accu- rately made it is entirely reliable. It is true that some other substances, among them being anUine, curarine, quebrachine, cod-lh'er oil, papaverine, and veratrine, AA'hen treated Avith sulphuric acid and an oxidizing agent, produce a play of colors more or less resembling those occasioned by strychnine ; but, Avith the exception of quebrachine, all of them are either colored by siUphuric acid alone, or the colors developed by adding the oxidizing agent do not haAre the same sequence as those produced by strychnine. Thus, curarine, cod-liver oil, papaA'erine, and A'eratrine are colored by sulphuric acid alone, and therefore may be distinguished from strychnine by this fact, AA'hUe aniline, although not colored by the acid separately, when treated AA'ith both the aciel and oxidizing agent gives colors almost opposite in order to those produced by strychnine, begin- ning Avith yeUoAV, passing to blue, and finally becoming black. Quebrachine (one of the alkaloids of quebracho bark) alone, of all the substances with AA'hich Ave are acquainted, might easily be mistaken for strychnine upon applying the color test. It dissolves in sulphuric acid AA'ith little or no change, and upon adding an oxidizing agent practically the same colors are developed as Avith strychnine, and in the same order. ALKALOIDAL AND OTHER ORGANIC POISONS. 455 By a careful comparison of the two substances when tested side by side, a slight difference can be seen in the intensity and duration of the colors; but if the strychnine is somewhat impure, as is likely to be the case upon extracting it from a part of the body, the two reactions are practically indistinguishable. Quebrachine, however, is destroyed by heating it on the Avater-bath with strong sulphuric acid, AA'hile strychnine is not, and by this process Ave may separate the two absolutely. Aspidospermiue (another alkaloid of quebracho bark) as it appears in the market some- times contains so much quebrachine as to give it a Avell-marked strych- nine-like reaction. In a few rare cases ptomaines have been found Avhich gave a color reaction somcAvhat similar to that of strychnine; but as they differed from strychnine in other properties, and as, Avithout doubt, they would be destroyed by heating Avith sulphuric acid, there would be no possi- bility of confounding the tAvo if proper skill Avere employed in making the tests. The color reaction for strychnine is more or less interfered Avith by the presence of a number of other substances, such as morphine, brucine, and nitrates; of these the most important is morphine, AA'hich has the poAver in a marked degree of preventing the color reaction if present in moderate amount. I lnrve known of at least one case in which the pres- ence of strychnine in the organs of a body was entirely OArerlooked on account of its association AA'ith a considerable quantity of morphine, and the use of inadequate means of separating the two in the analytical pro- cess employed. When the tAvo alkaloids are present in a mixture they may be separated by a number of means, but heating Avith strong sul- phuric acid is generally the best; it remoAres the morphine and enables the strychnine to be recog- nized readily. Practically, the most common substance interfering with the color test in toxicological examinations are certain indefinite organic ■compounds derived from the organs examined, which are almost sure to be extracted to a greater or less degree AA'ith the strychnine. The presence of even a moderate amount of this material sometimes Avholly prcA'cnts the recogni- tion of the alkaloid by this test. By careful purification, hoAA'ever, it may be removed, when the color reaction comes out distinctly. (c) Chromate Test.—If an aqueous solution of a salt of strychnine is treated AA'ith a solution of potassium bichromate, a yeUoAv precipitate of strychnine chro- mate is produced, unless the solutions are too dilute. The precipitate, if examined under a microscope, is found to consist of a mixture of octahe- Fig. 81.—Crystals of strychnine chromate. Magni- fied 90 diameters. (Drawn with the camera lueida hy Dr. E. R. Le Count.) 450 A SYSTEM OF LEGAL MEDICINE. dral and dendroidal crystals, which are A'ery characteristic. If the crystals are alloAA'eel to settle, the supernatant fluid drained off, and the1 precipitate well dried, upon touching them AA'ith a drop of strong sulphuric acid a fine play of colors is at once produced, exactly the same as those de- scribed under the color test. This double reaction for strychnine is prob- ably the best we possess for the alkaloid, as it combines the characteristic play of colors of the oxidation test AA'ith the peculiar crystals of the chromate of strychnine. No other knoAvn substance produces the same effects. (d) Physiological Test.—If strychnine is administered to a frog the animal is soon thrown into convulsions, and if the dose is sufficiently large, death ensues. Advantage may be taken of this fact in testing an unknoAvn substance for the presence of the alkaloid. The material should be dissolved in a little dilute acid and given to a small frog, either by hypodermic injection or by blowing it into the animal's stomach through a small tube. The frog should then be covered with a bell- jar and carefully watched; if strychnine is present, in the course of a few minutes the animal becomes vigorously tetanized; its head and trunk become rigid, and its hind legs are violently extended. The paroxysms at first haAre remis- sions, during which the ani- mal assumes its normal pos- ture, but by blowing across it, by striking the table, or by otherwise slightly disturbing the animal, it is again thrown into a violent convulsion, and if these are kept up sufficiently long death follows. This test, if applied to a A^ery small animal, is fairly delicate, the 1-10,000 of a grain usually being recognizable by it. It is also quite characteristic, for AA'hUe some other substances occasion con- A-ulsions in frogs, they differ materiaUy from those produced by strych- nine in lacking the intense tetanic character of the latter. The test, therefore, is a good one, and should be applied Avhen it is practicable, but I do not agree with some authors avIio insist that Avithout it the pres- ence of strychnine has not been definitely established; it is absolutely certain that in competent hands the chemical tests for strychnine are more delicate than and fully as reliable as the physiological test. Detection of the Poison.—In the Contents of the Stomach,—The ma- terial should be finely comminuted if necessary, mixed with enough water to make it thoroughly fluid, strongly acidulated with acetic acid, and digested on the water-bath for about an hour, replacing from time to time the liquid that may evaporate Avith a little water. The hot mix- ture should be strained, the liquid evaporated on the water-bath to about Fig. 82.—Crystals of strychnine from stomach, crystallized from chloroform. Magnified 12 diame- ters. (Drawn with the camera lucida by Dr. E. R. Le Count.) ALKALOIDAL AND OTHER ORGANIC POISONS. 457 a quarter of its original bulk, and while still hot five or six times its volume of strong alcohol sloAA'ly stirred in. This causes the separation of a considerable amount of insoluble material, which should be removed by filtration. The filtrate is evaporated to a syrupy consistence on the water-bath, and when cold is taken up with a small amount of AA'ater slightly acidulated Avith acetic acid; the mixture is filtered into a strong flask, test-tube, or separatory bulb, a very slight excess of potassium hydrate added, an equal bulk of chloroform at once poured in, and the mixture vigorously shaken. When the chloroform has settled out the aqueous fluid is removed and again shaken Avith another volume of chloroform; the two chloroform solutions thus obtained are united and allowed to evaporate at a gentle heat in a porcelain dish. The residue, which contains practically all of the strychnine present in the stomach, is usually too much contaminated with extraneous substances for direct testing for the alkaloid, and least partially accomplished by stirring it up with dilute acetic acid, filtering, render- ing alkaline, and shaking with chloroform as before. Upon eAraporating the chloroform the strychnine will occasion- aUy be eleposited in a crystal- line and nearly pure condi- tion, but more often there is stUl enough impurity present to interfere somewhat with the unequivocal recognition of the poison, and as a rule it is much safer, before apply- ing tests, to purify the resi- due still further. For this purpose it is treated with two or three drops of strong sulphuric acid, and heated on the water-bath for an hour or tAvo. During this process the strychnine is but slightly changed, Avhile most or all of the accompanying impurities are carbonized or are otherwise chemically altered and lose their identity. The mixture is diluted Avith Avater, filtered, alkalinized, shaken out AA'ith chloroform, and the latter aUoAved to evaporate in a Avatch-glass. The residue is iioav almost ahvays sufficiently pure to be tested for the presence of the alka- loid. It shoulel first be1 examined under a low poAver of the microscope for the presence of crystals, Avhich avUI usuaUy be found in case the amount of strychnine is more than a trace. The residue may then be dissolved in a little dilute acetic acid: one drop of this is put upon the tongue, anel the taste carefully observed; another is evaporated on a small porcelain plate, and the residue treated with sulphuric acid and an oxidizing agent for the color reaction; to a third drop a solution of potassium bichromate is added, and any precipitate obtained is carefully examined under the microscope, and subsequently dried and treated with should be further purified; this may be at Fig. 83. —Strychnine from stomach, crystallized from chloroform, showing different crystalline forms from those in Fig. 82, p. 456. Magnified 40 diameters. (Drawn with the camera lucida by Dr. E. R. Le Count.) 458 A SYSTEM OF LEGAL MEDICINE. sulphuric acid as before described; and finaUy a few drops are adminis- tered to a small frog, and the effects critically observed. If the results of all these tests agree Avith those obtained from strychnine, the presence of the poison is established. It is very desirable in testing an unknown residue for strychnine, or for any other poison, to have a small amount of the substance for AA'hich we are examining at hand, and to apply the same tests side by side to the suspected and to the known material. If Ave obtain identical reactions AAdth all our tests, the evidence of the presence of the poison is conclusive, but not otherwise. Upon shaking the alkaline fluid with chloroform as directed above, it not infrequently happens that an emulsion is formed, from AA'hich the chloroform separates very sIoavIv and imperfectly; to obviate this a mix- ture of equal parts of chloroform and ether may advantageously be used, as has already been spoken of on page 420. The use of strong sulphuric acid for purifying strychnine, as described above, is strongly recommended ; it removes very efficiently a large num- ber of other substances, some of which may seriously interfere Avith the tests for the alkaloid, anel it very materially adds, therefore, to the cer- tainty of detecting the poison. The sulphuric acid used, hoAvever, must be entirely free from nitrous compounds, since the latter when heated with strychnine destroy it. In the Tissues.—If the person lives sufficiently long after a fairly large dose of strychnine, the alkaloid may generaUy be found in nearly aU parts of the body; the organs, however, in which it is usually most eas- ily detected are the liver and the kidneys, and it may often be discoA^ered in the spleen, heart, brain, and blood. To separate it from these, the tis- sue is to be very fined}' subdiA'ided and digested for an hour at a gentle heat AA'ith dilute alcohol strongly acidulated with acetic or tartaric acid. The mixture is then filtered, the residue repeatedly Avashed with acidu- lated alcohol, and the mixed filtrates evaporated almost to dryness. The residue is taken up with a little water, filtered, alkalinized, and shaken with chloroform. The chloroform is evaporated, and the residue puri- fied and tested as directed above in connection AA'ith the contents of the stomach. Quantitative Determination.—It sometimes is of great importance to determine the amount of strychnine present in the contents of the stomach or in the tissues, for as mix vomica anel strychnine are exten- sively used in medicines, the finding of a mere trace or even a remedial dose of the alkaloid in the body would not necessarily point to poison as the cause of death. Whenever, therefore, strychnine, or any preparation containing it, is knoAvn to have been taken for medicinal purposes before death, a most rigorous quantitative determination of the poison should be made. For this purpose the method described aboA'e may be fohoAved as far as aUowing the chloroform, after the carbonizing process, to evap- orate in a watch-glass. The residue thus obtained, although it may be sufficiently pure for qualitative tests, is not fit for Aveighing, as it still is liable to contain more or less impurity. It should be Avashed, therefore, Avith a feAV drops of ice-cold Avater, dried, again carbonized with strong sulphuric acid, and again extracted AA'ith chloroform as before. The lat- ter should be aUoAved to evaporate in. a tared Avatch-glass, and the residue obtained should once more be Avashed Avith one or tAvo eh-ops of ice-cold ALKALOIDAL AND OTHER ORGANIC POISONS. 459 water, carefully dried on the water-bath, and when cold, weighed. This process is someAvhat long, and in carrying it out some strychnine is always lost, but it yields, when properly executed, a very pure product, which may be weighed with great assurance as being the alkaloid nearly, if not quite, free from impurities. In several eases of strychnine poisoning the accused at the time of trial has presented the defense that the strychnine found in the body came from homeopathic preparations of mix vomica wliich the deceased had 1 teen using. Such a plea, however, is rarely or never valid in case a ponderable amount of pure strychnine was found in the remains, for the quantity of the alkaloid in the ordinarily used homeopathic preparations is very minute; I have found that a grain of the third decimal trituration of mix A'omica, as obtained from a reliable homeopathic pharmacy, when mixed with the contents of a stomach afforded absolutely no definite qualitative test for the presence of strychnine, and consequently was very far from giving a quantitative result. Detection after Long Periods.—Strychnine resists decomposition to a very marked degree, and it may be detected, therefore, in a body even a considerable period after death. Professor Wood reports finding the poison a year after death, and I also on one occasion extracted it in pon- derable quantity from a body that had been buried nearly tweh'e months. AUen states that he detected strychnine in a stomach AAdiich had been kept untreated in a jar for six years ; Richter was able to extract it from putrid tissues exposed for elcA'en years; and Woodman and Tidy report finding it in a dog's stomach after it had been sealed up in a bottle for thirteen years. Experiments on animals seem to indicate, howeA^er, that the alkaloid slowly disappears when the body is buried underground, so that the amount that can be extracted progressively diminishes, and finally the poison can be no longer recognized. Failure to Detect.—It has occasionally happened that no strychnine has been found in the body after death even when it was known to have been taken. Probably the larger number of these failures to detect have been due to imperfect methods of extraction, or to incompetent manipu- lation ; still, a feAV cases are on record in which expert investigators have been unable to find the poison though it was known to have been used. Such a case is reported by Dr. Reese, and Professor Sonnenschein reports another ease in Avhich he could not discover the poison in either the tis- sues or the blood, although he detected it in the stomach. A few months since I Avas called on to examine the stomachs of two children who died suddenly with all the symptoms of strychnine poisoning; no other cause of death was found or could be suspected, yet most careful examinations failed to show the presence of the slightest trace of the poison in either organ. Upon adding a tenth of a grain of the alkaloid to a reserved portion of the stomachs it Avas easily detected, showing that the method used AA-as reliable, and that no interfering substance was present. In both of these cases the amount of strychnine taken Avas probably the minimum fatal dose, and as the stomachs Avere not presented for analysis until more than a month after death, it is barely possible that the poison may have undergone decomposition. Elimination.—Strychnine is ehminated from the body chiefly by the kidneys, and its presence in the urine may usually readily be demon- strated even when fairly smaU doses have been taken. The examination 4G0 ^ SYSTEM OF LEGAL MEDICINE. of the urine for strychnine is sometimes of great importance in cases of suspected poisoning, as a means of verifying the presence of the poison in the system. The eUmination by the kidneys is rapid, no strychnine being found in the urine generally after the second day. The poison, therefore, seems to be eliminated from the bod}' Avithin forty-eight hours. BRUCINE. Brucine (synonyms, brucin and brucia) is found in various strychnos plants associated with strychnine. Both alkaloids have similar physical and chemical properties, and produce almost identical physiological effects. Brucine1, hoAvever, is much feebler in its toxic poAvers than strychnine, being estimated as having only from one scA'enth to one thirty-eighth of the latters activity. The cause of this Avide difference of opinion as to its powers is probably due to the fact that some of the experimenters have operated with specimens of the alkaloid that Avere more or less impure; stiU, it is safe to say that brucine does not have more than one fifteenth the activity of strychnine. In its physiological action it is iden- tical with the latter in the character of its effects, differing only in in- tensity. All that has been said, therefore, concerning the symptoms of strychnine poisoning may be repeated in regard to brucine, provided a sufficient dose of the latter is taken. The same treatment should be pur- sued, and the same post-mortem appearances are observed. The poison may be extracted from the contents of the stomach and from the tissues in a manner similar to that described under strychnine; but the tests by which Ave identify it are different. Like strychnine, brucine is intensely bitter, and AA'hen administered to a frog it also occasions tetanic convul- sions, but the quantity necessary to produce this effect is much larger than with strychnine. Unlike strychnine, however, when treated Avith sulphuric acid and an oxidizing agent brucine does not produce the char- acteristic play of ('olors occasioned by the former, and in this Avay the two alkaloids may be easily distinguished. The best and most characteristic test for brucine is the combined use of nitric acid and stannous chloride. If the alkaloid is treated Avith nitric acid a blood-red color is produced, which is very intense, ewen though the amount of brucine present be smaU; upon gently warming the color fades to orange and yelloAv, and after cooling, if a solution of stannous chloride is added a fine purple color is developed. This reaction distin- guishes it not only from strychnine, but from all other alkaloids. Nitric acid, it is true, strikes a red color with morphine and Avith seweral other substances, but Avith none of these is there a change to purple upon the subsequent addition of the tin salt. A'ERATRUM, A'ERATRIXE, AND JERVINE. The various Areratrums are characterized by the presence of a number of alkaloids, most important of AA'hich are veratrine and jerA'ine. The chief A'eratrums in medicine and toxicology are Veratrum album, or AA'hite helleliore, and Veratrum viride, or American hellebore, in both of AA'hich A'cratrine and jervine are found associated Avith three or four other alka- loids. ALKALOIDAL AND OTHER ORGANIC POISONS. 461 Both the white and the green veratrums and their two chief alkaloids have simUar toxic powers, and aU may be considered together. Properties of the Alkaloids—Both veratrine and jervine when pure are colorless, odorless solids, which may be obtained in a crA'stalline form with ease m the case of jervine, and with difficulty in the case of vera- trine. They have an exceedingly acrid, bitter taste", and veratrine is ex- cessively irritating when applied locally to the skin'; if inhaled into the nostrils, even in very minute quantities, it produces violent sneezing. Both are very sparingly soluble in water, but both dissolve Avith readi- ness m chloroform; veratrine dissolves in ether Avithout difficulty, while jervine is but slightly soluble in it. Both alkaloids possess well-marked basic properties, uniting with acids and producing salts. Symptoms.—After the ingestion of a poisonous dose of either vera- trum album or veratrum viride, or their alkaloids, the effects generaUy shown are severe burning and pain in the stomach and bowels, in- tense nausea, violent A'omiting, painful purging, great prostration, cold extremities, small and feeble pulse, vertigo, bUndness, and sometimes convulsions and coma. These symptoms are by no means invariable; in some cases the effects upon the braiu predominate, while in others the cerebrum appears to be but little involved. Intense nausea, A-omiting, and purging are generaUy present, yet occasionaUy they are nearly or quite absent. Period when Fatal.—Just as Avith colehicum, the active principle of which was formerly confounded with veratrine, the two veratrums gen- eraUy lead to a fatal result only after a lapse of considerable time. A case is reported in which death occurred from veratrum album in three hours, and another in six hours from veratrum viride, but as a rule a fatal termination is not reached short of a considerably longer period than these, and one case is on record in which death did not occur until four weeks after taking the fatal dose. Fatal Dose—TAventy grains of veratrum album in the form of a pow- der, and half a dram of the tincture of veratrum Adride, have proved fatal; but on the other hand, A'ery large doses have been recovered from. Dr. H. C. Wood states that he has several times known a teaspoonful of the fluid extract of veratrum viride to be taken without producing death, and recovery has occurred after the ingestion of a tumblerful of the tinct- ure of the same drug. Dr. Blake, of St, George's Hospital, reports the recovery of a patient after SAvalloAA'ing a liniment supposed to contain three grains of veratrine. Treatment.—Vomiting, if present, should be encouraged by the copi- ous administration of tepid Avater; if emesis does not occur spontane- ously, an emetic should be given or the stomach-pump used. The patient should be kept flat upon his back, the head loAver than the feet, and after the stomach has been thoroughly evacuated an opiate should be given to control the pain and quiet the vomiting. The prostration should be com- bated by stimulants such as external heat, alcohol, and ammonia, and in- halations of amyl nitrite have been recommended. Post=mortem Appearances.—The gastro-intestinal tract is usually found in a state of congestion, although this is sometimes entirely want- ing, and the lungs, liver, and other viscera are usually engorged AA'ith blood; the post-mortem appearances, hoAveA^er, as in most other cases of poisoning AA'ith alkaloids, are neither constant nor characteristic. 462 A SYSTEM OF LEGAL MEDICINE. Tests.—Both veratrine and jervine respond to the general tests for alkaloids, giving precipitates Avith tannic acid, ioeline, etc. The special reactions which characterize them are as foUoAvs: i. Veratrine.—(a) Sulphuric Acid Test—If veratrine is treated Avith strong siUphuric acid it dissolves to a yellow solution, which upon stand- ing change's to a brilliant red, the latter color persisting unchanged for many hours. (See PI. VIII, No. y the chemist who under- takes to do toxicological Avork is the purity of his reagents. Especially is this true in the employment of alkaloidal solvents. The writer has found a number of samples of German ether, AA'hich Avas imported on account of its supposed purity, to yield on spontaneous evaporation a residue AAdiich gaA'e several of the alkaloidal reactions, and a fe\v drops of Avhich, injected under the skin of a frog, caused paralysis and death within a few hours. In the use of ether I Avould advise that 500 c.c. of this reagent be aUowed to evaporate spontaneously, and the residue, if there be one, be examined both chemically and physiologically. The basic substance Avhich is found in some samples of sulphuric ether is pyridine. Commercial alcohol almost invariably contains small quanti- ties of an aU^aloidal substance the odor of AA'hich is similar to that of nicotine and pyridine. Solutions of this substance are precipitated by gold chloride, phospho-wolframic acid, phospho-molybdic acid, potassium iodide, and Meyer's reagent, but not by platinum chloride or tannic acid. It does not reduce, or reduces feebly, ferric chloride. From one sample of alcohol Guareschi and Mosso obtained a base AA'hich, in addition to the above reactions, did give a precipitate AA'ith platinum chloride. Alco- hol may be freed from these substances by distillation over tartaric acid. Chloroform sometimes leaves a marked residue on evaporation. When this is the case, the chloroform shoiUd be Avashed first AA'ith distiUed AA'ater, then with distilled water rendered alkaline AA'ith potassium car- bonate, then dried over calcium chloride, and distiUed. Petroleum ether and benzole sometimes contain a base which has an odor similar to that of trimethylamine or pyridine, and which gives a precipitate AAdth plati- num chloride, crystallizing in octahedra. Of ah the solvents used in the extraction of A'egetable alkaloids, amylic alcohol is the one most likely to lead the chemist into serious error.' This fact is due to two causes • in the first place, the amylic alcohol itself is very likely to contain impuri- PTOMAINES AND OTHER PUTREFACTIVE PRODUCTS. 477 ties—in one sample Haitinger found as much as .5 percent, of pyridine; the second som-ce of danger in amylic alcohol hes in the fact that it is a ready solvent for many of the putrefactive alkaloids. For this reason the amyhc alcohol residue is probably less suitable than any other for the application of color tests in the final identification of poisons. Amylic alcohol, when found to be impure, may be rectified in the same manner as recommended above for ethylic alcohol. I avUI uoav give a brief account of those substances which have been found to resemble in their reactions the vegetable alkaloids. CONIINE. At present it is very difficult, probably impossible, for the chemist to state Avith absolute certainty that he has detected true coniine in the dead body. Before he can do this even Avith a reasonable degree of certainty, the symptoms and the post-mortem appearances must conform with those induced by the vegetable alkaloid, the analysis must be made before decomposition sets in, and the amount of the base found must be sufficient for physiological experiments to be made AAdth it. Brouardell and Boutmy found in the body of a Avoman who had died after suffering from choleraic symptoms caused by eating of a stuffed goose, a base wliich gave the odor of coniine and the same reactions Avith gold chloride, iodine in potassium iodide, etc., as coniine. The same base was found in the remainder of the goose. This substance did not give the red coloration with the vapor of hydrochloric acid, and it did not form butyric acid on oxidation, and although it Avas poisonous it did not induce in frogs the symptoms of coniine poisoning. Selmi repeatedly found coniine-like substances in decomposing animal tissue. By distdling an alcoholic extract from a cadaver, acidifying the distillate with hydrochloric acid, evaporating, treating the residue with barium hydrate and ether, and alloAving the ether to evaporate spontaneously, he obtained a residue of Arolatile bases, the greater part of AAdiich consisted of trimethylamine. After remoA'ing this base, the residue had the odor of the urine of the mouse. Later, Selmi obtained an unmistakable co- niine odor from a chloroform extract of the viscera of a person who had been buried six months, and in another case ten months after burial. The chloroform residue Avas alkaline in reaction, and AA'hen dissolved in a feAV drops of AA'ater and aUoAved to evaporate on a glass plate it gaA^e off such a penetrating odor that the chemist Avas compeUed to withdraw from close proximity to the substance. The odor imparted to the hands in testing the substance AA'ith the general alkaloidal reagents remained for half an hour. This volatile base seemed to be formed by the spontaneous decomposition of other ptomaines. An aqueous solution of a ptomaine obtained by Selmi by extraction with ether according to the Stas-Otto method from the undecomposed parts of a cadaver had no marked odor, but after having been kept for a long time in a sealed tube, it not only gaAre off a markeel coniine odor, but the A^apor turned red litmus-paper blue. Selmi also obtained a ptomaine from putrid egg albumen. After converting this base into a sulphate, and aUowing it to stand, it formed in tAvo layers, one of which Avas a golden vcIIoav liquid; and this, on being treated Avith barium hydrate, gave off ammonia, and later the odor 478 A SYSTEM OF LEGAL MEDICINE. of coniine. Finding that butyric and acetic acids Avere formed by the oxidation of this base, Selmi concluded that he had real conime or methvlconiine, and that it was formed by the oxidation of certain fixed ptomaines, or by the action of amido bases on volatUe fatty acids. For these reasons Selmi believed in the bacterial origin of confine or closely allied bases, also in the existence of a " cadaveric coniine." In a criminal trial in east Prussia, Sonnenschein found a substance AAdiich he believed to be the alkaloid of the water-hemlock, but Otto, Husemann, and others believed it to be a cadaveric coniine. Otto says that the symptoms reported in the case Avere not those of either confine or cicuta. * This base was obtained six Aveeks after the exhuming of the body, which had been buried for three months. It had the odor of coniine, the taste of tobacco, and gave with potassium bichromate and sulphuric acid the odor of butyric acid, and behaved with reagents like coniine. The most celebrated trial in Avhich a putrefactive coniine has figured was the Brandes-Krebs investigation, which took place in Braunschweig in 1874. Two chemists obtained from the undecomposed parts of the body, in addition to arsenic, an alkaloid Avhich they pronounced coniine. This substance Avas referred to Otto for further examination. He re- ported that it was neither coniine nor nicotine, nor any vegetable alka- loid AA-ith which he was acquainted. He converted the substance into an oxalate, dissolved it in alcohol, evaporated the alcohol, dissedved the resi- due in water, rendered the solution alkaline with potash, and extracted the base with petroleum ether. On evaporation of the petroleum ether the alkaloid appeared as a bright yellow oil, AA'hich had a strong, unpleas- ant odor, quite different, hoAvever, from that of coniine. It was strongly alkaline, and had an intensely bitter taste. At ordinary temperature it AA'as volatile. From its aqueous solutions it Avas precipitated by the chlorides of platinum, mercury, and gold. In these reactions it resem- bled nicotine, from AA'hich. hoAveArer, it differed in the double refracting and crystalline character of its hydrochloride. With an ethereal solu- tion of iodine this substance did not give the Roussin test for nicotine, but instead of the long, ruby-red crystals there appeared small dark- green needle-shaped crystals. The substance was found to be highly poisonous. Seven centigrams injected subcutaneously into a large frog- produced instantaneous eleath, and forty-four mUhgrams given to a pigeon caused a similar result. On account of its poisonous properties the jury of medical experts decided that the substance was a A'egetable alkaloid. The reason for this decision certainly must now be regarded as AA'holly inadequate. We knoAv that some of the most highly poisonous substances are found among putrefactive products. In examining the stomach and intestines in a case1 of suspected poi- soning, Liebermann found in the ether extract from alkaline solution a brownish, resinous mass, which dissedved in Avater to a turbid solution, the cloudiness increasing on heating. The aqueous, strongly alkaline solution of this substance gave the folloAving reactions : First, AA'ith tannic acid, a AA'hite precipitate. Second, AA'ith potassium iodide, a yelloAv broAvn, turning to dark-brown precipitate. Third, AA'ith chlorine Avater, a marked Avh.ite cloudiness. Fourth, with phospho-molybdic acid, a yeUoAV precipitate. PTOMAINES AND OTHER PUTREFACTIVE PRODUCTS. 479 Fifth, AA'ith potassio-mercuric iodide, a AAdiite precipitate. Sixth, AA'ith mercuric chloride, a white cloudiness. Seventh, Avith concentrated sidphuric acid after standing, a reddish violet coloration. Eighth, with concentrated nitric acid after evaporation, a yeUoAvish spot, This substance might have been easily confounded with coniine, but the odor differed from that of the vegetable alkaloid. Moreover, the putrefactive substance did not distil when heated on the oil-bath to 200° C, while coniine distUs at 133° C. Lastly, the putrefactive sub- stance may be distinguished from coniine by the non-poisonous proper- ties of the former. NK'OTINE. Schwanert, in examining the decomposing intestines, liver, and spleen of a child wliich had died suddenly, perceived a peculiar odor, and ob- tained in the ether extract from alkaline solution smaU quantities of a base wliich Avas distinguished from nicotine only by its greater volatUity and its peculiar odor. Supposing that this substance Avas produced by decomposition, and in order to ascertain the truth of this supposition, he took the organs of a cadaver that had lain for sixteen days at a temper- ature of d0° C, and Avas AveU decomposed, treated this AA'ith tartaric acid and alcohol, extracted first the acid solution Avith ether, and then the alkaline solution with the same reagent. The last-mentioned extract gave on evaporation the same substance which he had found in the organs of the child. The residue was a yellowish oU, having an odor sonicAAdiat similar to propylamine, and Avas alkaline in reaction, and bitter, but not repulsive, to the taste. With hydrochloric acid it formed AA'hite needle's, which Avere freely soluble in Avater and soluble with diffi- culty in alcohol. These crystals dissolved in sulphuric acid, forming a solution Avhich Avas at first colorless, but gradually became dirty broAvn- ish yelloAv and grayish brown on the application of heat. On being- warmed Avith sodium molybdate, a splendid blue color becoming grad- ually green Avas produced. Potassium bichromate and sulphuric acid gave a reddish broAvn passing into a grass-green color. Nitric acid gaA'e a yelloAv, and tartaric acid solution of the crystals produced on the addi- tion of platinum chloride a dirty yellow precipitate of small, six-sided stars. Gold chloride gave a pale-yellow amorphous precipitate; mercuric chloride yielded Avhite crystals; potassio-mercuric iodide a dirty white precipitate ; and potassio-cadmic iodide yielded no result. Tannic acid produced only a turbidity; sodium phospho-molybdate gave a yelloAv flocculent precipitate, which became blue on the addition of ammonia. Wolckenhaar obtained from the decomposing intestines of a Avoman avIio had been dead six Aveeks, by extraction Avith ether from an alkaline solution, a base AAdiich bore a close resemblance to nicotine. This sub- stance, at first yelloAv, on being exposed to the air gradually became broAvuish. It had a strongly alkaline reaction, and gave off a marked nicotine odor. It Avas soluble in all proportions in Avater, and the solu- tions, AA'hich did not become cloudy on the application of heat, had no bitter taste, but Avere slightly pungent. The peculiar odor did not dis- appear on saturating the base Avith oxahc acid. The hydrochloride Avas broAvnish, had a strong odor, and became moist on exposure to the air. 480 A SYSTEM OF LEGAL MEDICINE. Under the microscope it showed no crystals, differing in this respect from nicotine hydrochloride. It differed from nicotine also in its reac- tions with potassio-bismuthic iodide, gold chloride, iodine solution, mer- curic chloride, and platinum chloride. It also failed to give the Roussin test for nicotine. Moreover, it could not be identified with trimethylam- ine, sparteine, mercurialine, lobeline, or other fluid and volatile bases. STRYCHNINE. In a criminal prosecution at Verona, Ciotta obtained from the body, wliich had onlv slightly decomposed, an alkaloid Avhich gave a crystalline precipitate with iodine in hydriodic aciel, a red coloration Avith hydriodic acid, and a color test similar to that of strychnine with sulphuric acid and'potassium bichromate, and Avith other oxidizing agents. This sub- stance Avas strondv poisonous, but did not produce the tetanic convul- sions Avhich are characteristic of strychnine. Ciotta pronounced this substance as probably identical AA'ith strychnine. Portions of the body were subsequently submitted to Selmi for his opinion. This investigator found the substance giving the above-mentioned color reactions to be amorphous, and that it had only the presumption of a bitter taste, while one part of strychnine in forty thousand parts of water is intensely bitter. Selmi also held that many ptomaines give reactions simUar to strychnine Avith iodine in hydriodic aedd, anel Avith hydriodic acid alone. He also held that the physiological properties of this substance were such that it could not be strychnine. It could hardly have1 been aspidospermine, Avhich reacts AA'ith sulphuric acid and potassium bichromate similarly to strychnine, because quebracho bark, in AA'hich this alkaloid is found, Avas not at that time used as a medicine, or knoAA'ii in Italy. There prevails in Lombard}' and in adjacent countries^ chronic dis- ease known as pellagra, In 1SS1 Lombard}' alone furnished fifty-six thousand cases of this disease. The symptoms may be grouped into three classes: first, those affecting the skin; second, those manifesting themselves in disturbances of the digestive organs; and third, symptoms referable to the central nervous system. The skin first becomes painful, then red and swoUen. Soon there is loss of appetite and repugnance to food. Then a severe and exhaustive diarrhoea sets in. Later, delirium and spinal disturbances manifest themselves. Muscular Aveakness and paraplegia are common among the victims. Post-mortem examination sIioavs numerous small ulcers in the skin and in the intestines, also marked histological changes in certain portions of the spinal cord. According to Paltauf and Heider, this disease is due to infection of the corn-meal, eaten by these people, AA'ith the bacillus maidis Cuboni anel the bacillus mesentericus fuscus. These germs produce certain ptomaines. which are soluble in alcohol, and AA'hich cause the disease pellagra. Some of these ptomaines give reactions similar to those of strychnine, and agree with this vegetable alkaloid also in their physiological effects. producing tetanic spasms in animals. As early as 1S71 Lombroso shoAved that the extract from moldy corn-meal produced tetanic convulsions in animals. In 1S7G Brugnatelli and Zenoni olitained with the Stas-Otto method from this moldy meal an alkaloidal substance which was AA'hite. non-cry stalhne, unstable, and insoluble in Avater, but readUy soluble in PTOMAINES AND OTHER PUTREFACTIVE PRODUCTS. 481 alcohol and ether. With sulphuric acid and bichromate of potassium it yields a color reaction very similar to that of strychnine. Lombroso has named the poisonous substance found in this moldy meal peUagrocine, but this is really a mixture of ptomaines, some of which produce narcosis and paralysis, and others produce the symptoms of nicotine poisoning instead of the spasms caused by strychnine. ATROPINE. Ptomatropines are frequently met AAdth among the products of putre- faction. They haA^e marked mydriatic properties. To this class belongs a substance observed by Ziilzer and Sonnenschein. It was removed from alkaUne solutions by ether, and formed microscopic crystals, an aqueous solution of which when applied to the conjunctiva produced a mydriatic effect, and when administered internaUy increased the action of the heart and arrested the movements of the intestines. Moreover, with certain alkaloidal reagents, such as platinum chloride, it resembled atropine, but when heated AA'ith sulphuric acid and oxidizing agents it did not give off the odor of blossoms, Reuss's test. However, Selmi founel ptomatropines which, Avith sulphuric acid and oxidizing agents, did give the blossom odor as distinctly as the Aregetable atropine. Some of these putrefactive bases also develetped this odor spontaneously after .standing for two or three days, and this does not happen with atropine. The odor is also produced with the ptomatropines by nitric and sulphuric acids both in the cold and on the application of heat, AA'hile these acids in the cold do not produce the odor AA'ith atropine. Ptomatropines have been found in decomposing fish, corn-beef, putrid game, and poisonous sausage. We do not knenv as yet whether this is an individual or a class of substances. The symptoms are markedly like those of atropine. The fauces become dry, tlie gums red and swoUen, the secretion of saUA'a and of SAveat is arrested, the muscles of deglutition are partiaUy paralyzed, there is marked mydriasis, paralysis of accommo- dation, ptosis, and strabismus. In some instances convulsions appear. The heart-beat is in the beginning increased, then markedly weakened. The tongue is coated and the boAvels become constipated, there is marked thirst, diplopia, and general weakness. The voice may be wholly lost. Death, AAdiich frequently results, is caused, according to Anrep, by paraly- sis of the heart, Section shows A'enous hyperemia of the brain, the kid- neys, and the lungs, swelling of the pharynx, oesophagus, and mucous membrane of the stomach, AA'ith minute hemorrhagic points, cloudy swell- ing of the solitary follicles and Fevers patches, and a yellowish-broAAUi colored degeneration of the muscle of the heart. There is some question as to whether or not any of the ptomatropines will give Vitali's reaction. According to Giotto and Spica, certain ptoma- tropines do give this reaction. Ptomatropines are probably excreted with the urine in some diseases. A'ERATRINE. Brouardell and Boutmy obtained from a corpse Avhich had lain in water for eighteen months, and a large portion of Avhich had changed into adipocere, a ptomaine resembling veratrine. It Avas removed from 4SJ A SYSTEM OF LEGAL MEDICINE. alkaline solutions by ether. On being heated Avith sulphuric acid it became violet. With a mixture of sulphuric acid anel barium peroxide it became in the cold brick-red, and, on being heated, violet. With boil- ing hydrochloric aciel it took on a cherry-red coloration. HoAvever, it differed from veratrine inasmuch as it reduced ferric salts instantly, and Avhen injected into frogs suboutaneouslv it did not induce in them the spasmodic muscular contractions characteristic of vera trine1. Beehamp obtained Avith the Stas-Otto method from the products of the pancreatic digestion of fibrin an alkaloidal body which gave1 Avith sulphuric acid a. beautiful carmine1 red similar to that given Avith A'cra- trine. By digesting this substance AA'ith gastric juice and again extract- ing, he olitained a body which behaved AA'ith sulphuric acid similarl}' to curarine. DELPHESflNE. In 1870 General Gibbone, an Italian of prominence, died suddenly at Rome. His servant was accused of havdng poisoned him. Tavo chemists of some reputation reported the presence of delphinine in the A'iscera. It seemed somewhat improbable that the servant should know anything of so rare a substance, or that he should haA'e been able to obtain it. However, two or more A'arieties of staphisagria grow in southern Italy, and it was possible that the servant had used some preparation made by himself from the plant. Selmi Avas called upon to make a further study of this supposed alkaloid. He found that it was remoAred from alkaline solutions by ether. When heated with phosphoric acid it became red, and when brought into contact with sulphuric aedd, reddish brown. In these tests the substance did resemble delphinine, but AA'ith sulphuric acid and bromine Avater, also Avith Frohde's reagent, the colorations characteristic of the vegetable product failed to appear. Moreover, Selmi showed that delphinine gave the foUowing reactions, to which the suspected substance did not respond: First, delphinine dissoh'ed in ether, and, treated Avith a freshly pre- pared ethereal solution of platinum chloride, gives a white flocculent precipitate, AA'hich is insoluble in an equal volume of absolute alcohol. Second, delphinine gives precipitates with auro-sodium hyposulphite, and AA'ith a sulphuric acid solution of cupro-sodium hyposulphite, the latter precipitate being soluble in an excess of the reagent. Finally, Ciaccia and VeUa showed that whUe delphinine arrests the heart of the frog in diastole, the suspected substance arrested it in systole. DIGITALINE. Rorsch and Fassbender, in a case of suspected poisoning, obtained Avith the Stas-Otto method a substance which could be extraeded from acid as well as from alkaline solutions by ether, and Avhich gave aU the general alkaloidal reactions. They Avere unable to crystallize either ex- tract by taking it up with alcohol and evaporating. The colorless aque- ous solution was not at all bitter. The precipitate formed Avith phospho- molybdie acid dissolved on the application of heat, giving a green solu- tion, AA'hich became blue on the addition of ammonia They believed that PTOMAINES AND OTHER PUTREFACTIVE PRODUCTS. 483 this substance was derived from the hver, because fresh ox hver treated in the same manner gave them a substance Avhich could be extracted with ether from acid as weh as from alkaline solutions. Gunning found the same substance in liver sausage from Avhich poisoning had occurred. Rcirsch and Fassbender state that while in some of its reactions this sub- stance resembled digitaline, it could be distinguished from this A^egetable glucoside by the failure of the ptomaine to give the characteristic bitter taste1. TrottarreUi obtained a similar substance from the brain of a man in whose abdominal A'iscera he coiUd find no poison. The sulphate of this base gave on eA-aporation an aromatic-smelling and astringent-tast- ing residue. It became purple with sulphuric acid alone, and dark red Avith hydrochloric and sulphuric acids. On frogs this ptomaine showed no toxic effect. COLCHICINE. Baumert found in a suspected case of poisoning, twenty-two months after death, a substance which gave many of the reactions for colchicine. It was extracted from acid solutions Avith ether, to which it imparted a yellow color. On evaporation of the ether a yeUow, amorphous sub- stance remained, and this dissolveel in warm Avater with yellow coloration. It could be extracted from acid solutions also by chloroform, benzol, and amylic alcohol, but not by petroleum ether. It was removed with much more difficulty from alkaline solutions. All the extracts were yellow, and left on evaporation a feebly alka- line, bitter, sharp-tasting, amorphous yellow residue, which dissoh'ed in water and dilute acids incompletely, forming a resin. When this resin Avas dissolveel in dilute sodium hydrate, and the solution rendered acid by sul- phuric acid, the same reactions were obtained as Avith the original extract, With phospho-molybdic acid,phospho-tungstic acid, potassio-bismuthic iodide, potassio-mercuric iodide, iodine in potassium iodide, tannic acid, and gold chloride, this substance gave the same reactions which were obtained by parallel experiments with genuine colchicine; thus, the tan- nic acid precipitates were both soluble in alcohol, and the precipitates Avith phospho-molybdic acid in both cases became blue on the addition of ammonium hydrate. Concentrated sulphuric and dilute nitric and hydrochloric acids dis- solved the supposed colchicine with acUoav coloration. Strong nitric acid (1,4 sp. gr.) colored the substance dirty red, scarcely to be called a violet. When the substance was purified as much as possible, this color became a beautiful carmine red. The addition of water changed the reel into vcIIoaa', and caustic soda produced a dark, dirty orange. In general, in the above-mentioned reactions the putrefactive product agreed with the real colchicine, but the former gaAre precipitates with picric acid and platinum chloride, whUe the latter gave no precipitates with these reagents. In 188G Zeisel proposed the following test for colchicine: When a hydrochloric acid solution of this substance is boiled Avith ferric chloride, it becomes green, sometimes dark green and cloudy. Now, if the fluid be agitated with cdiloroform, the chloroform avUI sink, taking up the coloring matter, and appearing broAvuish, granite red, or dark, and the supernatant fluid clears up Avithout becoming AvhoUy colorless. 484 A SYSTEM OF LEGAL MEDICINE. Baumert applied this test to both colchicine and the putrefactive product. To from two to free cubic centimeters of the suspected solu- tion in a test-tube, he added from five to ten drops of strong hydrochloric acid and from four to six drops of a ten-percent, solution of ferric chlo- ride, then heated the mixture directly over a small flame until it Avas evaporated to half its volume or less. In the presence of one milligram of colchicine the originally bright-yellow solution became gradually olive-green, and, on further concentration, dark green and cloudy. Then, on shaking the fluid with chloroform, admitting as much air as possible, the chloroform subsided, taking a ruby-red color if as much as t\vo mil- ligrams of colchicine Avere present, and a bright vcIIoav with only one milligram, and the supernatant fluid became of a beautiful olive-green. When ether, petroleum ether, benzol, carbon disulphide, or amyhc alcohol AA-as substituted for the chloroform, the coloration did not appear. From this Baumert infers that the red coloring matter is either wholly soluble in chloroform, or that it is not formed until the chloroform is added. Baumert founel this test of great value in deciding whether or not the substance which he found was colchicine. The putrefactive product did not respond to the test. Some of this substance was sent to Brieger, who decided that it was not a base, but a peptone-hke substance. It was also found to be inert physiologically. Before these investigations were made by Baumert, Liebermann had found the same or a similar colchicine-like substance in a cadaver. His description differed from that of Baumert only in regard to the taste of the substance, Liebermann having failed to observe any marked taste in the body which he found, while, as has been stated, Baumert reported a distinctly bitter taste. A colchicine-like substance has been found in beer, anel it has been suggested that it was this Avhich the above-mentioned toxicologists found in the bodies which they examined; but Liebermann states that the man Avhose body he examined had been a total abstainer from beer. MORPHINE. In the Sonzogna trial at Cremona, Italy, the expert chemists con- founded a putrefactive product with morphine. Selmi, AA'ho Avas ap- pointed by the government to investigate the case, demonstrated that the chemists, avIio had reported the presence of morphine, were in error. This substance Avas not removed from either alkahne or acid solutions with ether, but could be extracted with amylic alcohol. It reduced iodic acid, but in its other reactions, as weU as in its physiological properties, it bore no resemblance to morphine. In frogs it arrested the heart in systole, AA'hich is said never to happen in poisoning Avith morphine. It failed to give both the ferric chloride and the Pellagri tests. In the same body there Avas found a substance Avhich Avas extracted from alkahne solutions with ether, and which gave Avith hydrochloric acid and a few drops of sulphuric acid, on the application of heat, a red- dish residue similar to that obtained by these reagents AA'ith codeine, but in its other reactions it did not resemble this alkaloid. In the examination of a stomach and part of a liver, sent from Lin- PTOMAINES AND OTHER PUTREFACTIVE PRODUCTS. 485 coin, Neb., the writer, following the method of Dragendorff, obtained in the amylic alcohol extract from alkaline solution a residue AA'hich gave with more or less distinctness aU of the principal color-tests for mor- phine; but failing to obtain crystals Avhich could be identified with those of this alkaloid, the absence of morphine was reported. Aftenvard it Avas quite clearly demonstrated that death in this case had been caused by a bloAv upon the back of the head Avith a heavy piece of iron. The above-mentioned facts induced the Avriter to undertake some experimental studies upon this point, In tins Avork the author has been greatly aided by one of his students, E. M. Houghton. The results which we have obtained are sufficient to convince us that the identifica- tion of morphine in the liver and other organs in cases of suspected poisoning is beset with difficulties not provided for by the methods now generally employed. Since the substances which vitiate the morphine tests are of bacterial origin, and since bacterial products A'ary with the conditions under which the germs producing them grow, it is essential that the putre- factive changes AAdiich the tissue undergoes before the tests are begun should occur under the conditions, as nearly as possible, Avhich exist in the cackwer. Neglect of this point has undoubtedly been the chief factor in securing the confidence of toxicologists generally in the methods of Dragendorff and Stas-Otto. Many most skillful chemists have carried companion portions of decomposed tissue, one portion AA'ith and the other Avithout morphine, through the processes of extraction recommended by Dragendorff, and have obtained satisfactory results, finding that the proper residue responds to the color tests in the one in- stance and fails to do so in the other. Tissues have been thus tested in apparently every stage of putrefaction, and yet the results haA'e been satisfactory and confirmatory of the methods now generally employed. There is one point, Iioavca'ci-, AA'hich has been constantly overlooked. The putrefaction to which the tissues in these experiments are subjected has been aerobic, Avhile that occurring in the dead body is anaerobic; conse- quently the putrefactive products are not the same in the two cases. This leads us to state that in all experimental studies of the Aralue of the tests for morphine in decomposing tissue, the decomposition must be aUoAved to proceed in the absence of oxygen. This is the first point. The second is probably of eepial importance, and this concerns the kind of tissue employed. The upper portion of the small intestine (and the adjacent tissue aftei- death) has a bacterial flora peculiar to itself. These tissues are the ones quite uniA'ersally examined in medico-legal cases, and consist of the small intestine itself, the stomach, the liver, the pancreas, the spleen, anel, in some instances, the kidneys. Of course the bacteria present in the small intestines during life may after death extend to all the abdominal and thoracic viscera. Since the liver is so generally examined, avc decided to ascertain the effects, if any, of the putrefactive products formed in this organ, decomposing under anaerobic conditions, on the tests for morphine carried out according to the scheme of Drag- endorff. Recognizing the fact that arsenic is so frequently employed in the form of an embalming fluid, it Avas thought best to add this to the liver. The experiment is detailed in the folloAving statement: FiA-e kilograms of ox liver chopped finely and mixed AA'ith two grams of arsenic dissolved in caustic potash, was placed in a large bottle. The 48G A SYSTEM OF LEGAL MEDICINE. bottle was closed Avith a cork and sealed AA'ith paraffine. A glass tube bent at a right angle was inserted in the center of the cork, while the other end of the tube Avas connected by means of a short piece of rubber tubing Avith a Drechsel wash-bottle. The other arm of the wash-bottle was connected Avith a receiver filled with Avater. The rubber connecting the large bottle with the wash-bottle was supplied with a clamp. During the first fifteen or twenty days this clamp Avas left open, and a large amount of gas passed through the wash-bottle and collected in the receiver. After the above-mentioned time, AA'hich varies according to temperature, the passage of gas ceases and the water rises in the receiver, absorbing the collected gas. When this occurred the bottle containing the tissue and the Avash-bottle Avere disconnected, and the clamp on the rubber tubing Avas closed. By this time the chopped liver has become sufficiently fluid to absorb the gas as fast as it is formed, and unless the bottles are disconnected the water in the wash-bottle may be draAvn back into the large bottle. The fermentation was alloAved to continue for thirty days, counting from the beginning. Then the contents of the bottle, decidedly acid in reaction, and giving off a not disagreeable ethereal odor, were poured into a large dish. A considerable portion of the tissue had become fluid by this time. One kilogram of this decomposed tissue Avas placed in each of three evaporating-dishes, and these Avere marked A, B, and C. To B, 130 milligrams of morphine sulphate was added, and to C the same amount of morphine, together with .5 gram each of indol, skatol, and phenol. No addition Avas made to A. These portions Avere carried through the manipulations recommended by Dragendorff (" Die gerichtlich-chemische Ermittelung von Giften," clritte Auflage, 1888). To each 100 c.c. of the fluid 5 c.c. of dilute (1: 5) sulphuric acid was added. Then 500 c.c. of distilled Avater Avas added to each dish, and these Avere kept at from 40° to 50° C. for eight hours. Next, each portion Avas filtered through a falten-filter (No. 572 of Schleicher & Schull). The fluid passeel through quickly, and formed a clear, broAvuish filtrate. The filtrates Avere evaporated at 50° C. to 600 c.c, and four volumes of absolute alcohol avci-c added to each por- tion. These mixtures Avere alloAved to stand for twelve hours, and in each a brown resinous precipitate1 formed. After filtration the alcohol AA'as removed by distillation. A fatty-like residue formed in each flask on the remoA'al of the alcohol, and this Avas removed by filtration. The acid solutions Avere then thoroughly shaken, each Avith four volumes of petroleum ether. The ethereal layers, Avhen draAvn off and evaporated in portions, left A'ery slight residues. The residues from A and B gave no reactions on the application of the color tests for morphine mentioned below. The residue from C shoAved minute traces of indol AA'ith nitric acid alone, and AAdth sulphuric acid containing nitric. The acid solutions Avere next shaken Avith benzol. The benzol resi- dues gave no response to the morphine tests. Chloroform Avas then employed as a solvent. The resielue in this case gave none of the reactions. The acid solutions were iioav rendered alkaline AA'ith ammonium hydrate, and shaken successively Avith petroleum ether, benzol, and PTOMAINES AND OTHER PUTREFACTIVE PRODUCTS. 487 chloroform. None of the residues from these solvents responded to the morphine tests. The alkaline solutions, haA'ing been subjected to the above-mentioned processes of purification, avci-c shaken, each Avith five volumes of amyhc alcohol. The shaking was frequently repeated during the afternoon, and then the mixtures were placed in separators and alloAved to stand for eighteen hours. The amylic alcohol extracts evaporated on the water-bath gave the following reactions: Reagent. ABC Nitric acid.............................All gave a lemon-brown color. Sulphuric acid..........................None showed any change. .Sulphuric with nitric acid...............All gave a lemon yellow, slowly changing to pink. Ferric chloride.........................All gave a dirty green. Ioelic acid..............................All promptly reduced the iodic acid. Frohde's reagent........................All gaA'e a blue color, Avithout any violet. Sulphuric aciel and cane-sugar...........All became brownish red, changing to a wine-red. Portions of the amylic alcohol extract allowed to evaporate spontane- ously showed the same reactions as those given aboAre. The remaining portions of the amylic alcohol solutions were now shaken Avdth distilled AA'ater acidified Avith sulphuric acid. After separa- tion, portions of the amylic alcohol Avere evaporated and subjected to the above-mentioned tests, Avith negative results in each case. This shows that amylic alcohol does not dissolve from acid solutions the sub- stance or substances interfering with the morphine tests. The acid aqueous solutions of A, B, and C Avere again rendered alka- line with ammonium hydrate, and shaken Avith amylic alcohol. The residues from these amylic alcohol extracts Avere evaporated and sub- jected to the fohowing tests: Reagent. ABC Nitric acid.............................All became lemon yellow. Sulphuric acid..........................No change in any. Sulphuric acid with nitric acid...........All became lemon yellow. Ferric chloride .........................All became bluish green. Iodic acid..............................All promptly reduced iodic acid. Frohde's rengent........................All became blue, with a faint and evanes- cent purple in B and C. Pellagri's test ..........................All responded promptly. The above-mentioned experiment, AA'hich has been repeated with no Arariation in results, convinces us that the tests for morphine by follow- ing the scheme of Dragendorff are altogether untrustAvorthy. Naturally the question arises, What is the nature of the substance or substances which give these color reactions? Quite as naturally the ansAver that these substances consist of indol and its derivatives suggests itself. The probabilities in favor of this ansAver may be briefly stated as foUoAvs: (1) Germs AA'hich produce indol and its derivatives are native and, so far as avc knoAV, constant representatives of the bacterial flora of the upper portion of the small intestines. There are man}' indol-forming germs, anel Avhile some of these may be present in any tissue, they are certainly present, in health and in disease, during life and after death, in the small intestines. 488 A SYSTEM OF LEGAL MEDICINE. (2) Indol and its derivatives are products of anaerobic putrefaction. and tliis accounts for the fact that the reactions Avhich avc obtained are not familiar to those toxicologists AA'ho haA'e experimented Avith tissue aUoAved to putrefy in the presence of oxygen. The apparatus AA'hich Ave used in our experimental Avork is practicall}' the same as that employed by E. and H. SalkoAvski ("Zeitschrift f. physiologische Chemie," B. s, S. 462) in the preparation of indol. MoreoA'cr, in the preparation of indol the same peculiarity in the evolution of gas is observed as in our Avork. It AA'as on account of our belief that indol and its derivatives had been in some instances mistaken for morphine that we were led to add these substances to C in our experiment. We have obtained seA'eral samples of indol and skatol, and have compared the reactions obtained AAuth these on the application of the color tests for morphine. The samples of indol may be briefly described as folioavs : No. 1.—Prepared by myself from decomposing pancreas. It is a brown, granular substance, and is probably not chemicaUy pure. This fact, hoAvewer, does not unfit this sample for experiments on the point uneler consideration, because any impurities which it may contain origi- nated in the decomposing tissue, and may be present in the same sub- stance obtained from like tissue. No. 2.—Obtained from Merck. The order was simply for "indol," Avithout any specifications Avhether it should be synthetic or putrefactive. It is broAvuish red in color. No. 3.—Obtained from Schuchardt and ordered as synthetic indol, which it undoubtedly is. This sample is white and in flakes. No. 4.—Obtained from Kahlbaum. Putrefactive indol was ordered, but the label is simply " indol." This sample consists of white flakes. These samples were submitted to the following tests: Reagent. Xo. l. Xo. 2. Xo. 3. No. h. ^JSt™™ Nitric acid.....Bluish black Reddish brown. Reddish brown. Reddish brown. Brownish red, with violet passing into border. lemon yellow. Sulphuric acid.. Yellowish green. Brown. Greenish yellow. Brownish red. Faint yellow. Sulphuric with nitric acid. . . . Same as with nitric acid alone. Brownish red. Ferric chloride.. Xo change at first, but all become greenish blue. Blue. Iodic acid.....Xo reduction. Reduced. Frohde's reagent Reddish, then Reddish, then Reddish, then Reddish, then Purple, then blue. dark blue. greenish blue. greenish blue. greenish blue. Tavo samples of skatol (No. 1 from Schuchardt and No. 2 from Kahl- baum) Avere compared with morphine Avith the folloAving results: Reagent. No. 1. No. 2. Morphine Sulphate. Nitric acid..............All become lemon yellow. Sulphuric acid...........All become very faintly yellow. Sulphuric with nitric acid. . . All become more of a red than with nitric acid alone. Ferric chloride...........Xo change. No change. Blue. Frohde's reagent..........Green to blue. Green to blue. Purple to blue. Iodic acid..............All promptly reduce the acid. While it Avould be comparatively easy to distinguish pure morphine from either indol or skatol, it must be admitted, from the results of the experiments already detaUed, that the separation of morphine from tis- sue, decomposing in the absence of oxygen, and its identification, are,. PTOMAINES AND OTHER PUTREFACTIVE PRODUCTS. 489 by the methods now generally employed, so uncertain that the conscien- tious chemist aa'UI seek for methods free from these sources of error be- fore he gives positive testimony of the presence of this alkaloid. I have spoken of indol and its derivatives as being present in the decomposing tissue, anel it should be stated that the number of knoAvn indol derivatives is by no means small, and how many others there may be which remain unknown, no one can tell. Many of these substances give brilliant color reactions. Indol was first obtained by Bayer by the reduction of indigo. Later, Kiilme and Nencki independently obtained indol with skatol by the putrefaction of albuminous substances. There has been some difference of opinion as to the identity of the indol obtained by putrefaction and that Avhich results from the reduction of indigo. According to Baumann neither indol nor skatol originates directly from the proteids, but both arise from the decomposition of a substance soluble in ether containing alee died. Skatol is methyl indol. Indoxyl is an easily decomposable substance, AA'hich gives some strik- ing color reactions, among Avhich may be mentioned the production of indigo-blue with ferric chloride in the presence of free hydrochloric acid. Skatol-carbonic acid is another product of putrefaction, E. and H. Sal- kowski having obtained 1.3 grams from 2 kilograms of moist fibrin after twenty-six days' putrefaction. Among the knoAvn color reactions of this substance, Hoppe-Seyler mentions the following: (1) If a dilute solution of this acid (1-1000) be treated with a few drops of pure hydrochloric acid of 1.2 specific gravity, and then with a feAV drops of potassium nitrate solution (2 percent.), a cherry-red colora- tion is produced, and later a red precipitate falls. (2) If such a solution be mixed with an eepial volume of hydrochloric acid, and then a few drops of chloride of lime solution (£ percent.) be added, a purple-reel color is produced. (3) Treated Avith a feAV drops of hydrochloric acid, then with two or three drops of a very dilute solution of ferric chloride, and heated, the mixture becomes intensely A'iolet before boding. Skatol-carbonic aciel is nonvolatile. Skatol-acetic acid has been obtained by Nencki by the anaerobic putrefaction of serum-albumin. The aqueous solutions of this substance give AA'ith ferric chloride a white cloudiness, which on Avarming becomes brick-red, and in more concentrated solution fire-red. Both indh-ubin and indigo-blue may be formed by the oxidation of indol. KnoAviug now that indol and its derivatives are formed in anaerobic putrefaction, and that in Dragendorff's scheme for the separation and identification of vegetable alkaloids these substances appear in the resi- dues which are tested for morphine, and knowing the great number and variety of color reactions given by these substances, it may be asked how much reliance can be placed on the color tests for morphine ? Besides the indol bodies, certain other substances are formed in the anaerobic putrefaction of proteid substances. Among these are certain aromatic products of the putrefaction of tyrosine. The folloAving may be mentioned: (1) Hydroparacumaric acid (para-oxyphenyl-propionic acid). This substance gives Avith ferric chloride a distinct, but evanescent, blue col- oration. 490 A SYSTEM OF LEGAL MEDICINE. (2) Para-oxyphenyl-acetic acid. This substance gives with ferric chloride a pale grayish-violet, Avhich soon changes to a dirty given color. Among other products of the anaerobic putrefaction of proteids phe- nol anel parakresol may be mentioned. Phenol gives with ferric chloride a violet color. Parakresol gives Avith ferric chloride a blue coloration. With the aboA-e-mentioned substances in a decomposing liver, and knoAving that some of them at least are present in the amylic alcohol residue, following the process of Dragendorff, hoAv much reliance, may again be asked, can be placed on the color reactions of morphine ? The conscientious chemist Avho swears that he avUI tell the truth, the whole truth, and nothing but the truth, ma}' answer this question. POISONS FORMED IN DECOMPOSING TISSUE IN THE PRESENCE OF ARSENIC. It has already been shoAvn that the presence of arsenic does not in- terrupt the anaerobic putrefaction by which those substances interfering with the reactions for morphine are formed. Besides this, it is known that certain highly poisonous substances may be obtained from the bodies of persons who have been embalmed Avith arsenic. From one arsenical body Avhich had been buried for fourteen days, Selmi obtained, by ex- tracting with ether the fluid rendered alkaline Avith baryta, a substance which formed in needles and which gave crystalhne salts with acids. With siUphuric acid it gave a red color; with iodic acid and sulphuric acid it liberated free iodine, and gave a violet coloration; Avith nitric acid it gave a beautiful vcIIoav, which deepened on the addition of caustic potash. This cadaver Avas apparently Avell preserved, and the crystalline substance obtained from it was found to be highly poisonous. From a second arsenical body Selmi obtained by the same process a larger quan- tity of a most A'irulent poison. From the stomach of a hog which had been preserved in a solution of arsenious acid, the same1 investigator separated an arsenical organic base. This substance produced symptoms like those of stryedmia. Also from the same stomach he obtained a substance Avhich produced in frogs torpor and paralysis. These researches throAv some light upon a most interesting and curi- ous point hi the history of toxicology. It is Avell knoAvn that during a certain period of Italian history poisons were freely used. One of these was sold under the name of aqua toff ana, while another Avas knoAvn as acquetta di Perugia. Probably many other simUar solutions were sold to those AAdio desired to rid themselves of friends or foes. There seems to have been some diversity in the method of preparation used by those engaged in supplying these poisons. Duclaux states that one of these solutions Avas prepared by eA'iscerating a pig, powdering the abdominal caAdty Avith arsenic, suspending the animal, and catching the drippings from the decomposing tissue. Robert states that another preparation was obtained by preserving the sahva of animals poisoned Avith arsenic, and alloAving this fluid to undergo putrefactive changes. It will be seen that by either of these methods powerful arsenical ptomaines may haA'e been obtained. It Avill also be evident that these solutions may have OAved their poAA'erful action to the presence of toxicogenic germs, or, in other words, death may have been due to inoculation rather than to intoxication. PTOMAINES AND OTHER PUTREFACTIVE PRODUCTS. 491 As has been stated in giA'ing the experimental results obtained in the tests for morphine, anaerobic germs producing considerable quantities of gas were found in the liver. Another interesting point, which needs further study, Avas observed. Some of the putrefactive fluid resulting from the decomposition of the chopped hver contained a considerable amount of arsenic. This fluid Avas placed in a bottle and kept in the laboratory for six months. During this time the bottle Avas frequently opened. Whenever this was done a large1 amount of gas escaped AA'ith almost cxplosiAe rapidity. After the above-mentioned time it was de- cided to estimate the amount of arsenic in the fluid. Upon attempting to do this, it Ava.s unexpectedly found that the fluid contained not the slightest trace of arsenic. In other Avords, the arsenic had been given off from the fluid in the form of a gas. It AA-as supposeel at first that this AA'as a nenv discovery; but upon looking the matter up it was found. that Hiinefeld, in the early part of the1 present century, found that tis- sues impregnated AA'ith arsenic gave e>ff during putrefaction a garlic odor, and that later arsenic disappeared wholly from such tissue. This is an interesting fact, and one which needs further study. POISONS FORMED DURrNG PUTREFACTION. Mefhylguauidine.—This base, AAdiich has been found by Brieger and Bocklisch in decomposing flesh, is highly poisonous. The symptoms are marked by dyspnoea, muscular tremor, and general clonic convulsions. Tavo tenths of a gram administered to a guinea-pig produced the fol- lowing symptoms: the respiration at once became rapid, anel in a feAV minutes there Avere abundant eA'acnations of the bladder and boAvels; the pupils rapidly dilated to the maximum, and then ceased to react; the animal became motionless, though not paralyzed; dyspnoea set in, and the animal died in convulsions twenty minutes after the administra- tion of the poison. Post-mortem examination showed the heart to be arrested in diastole, the intestines fiUed with fluid, the bladder contracted, the cortex of the kidney hyperaemic, but the papillae of the kidneys Avere surprisingly pale. Tetanine, tetanotoxine, spasmotoxine, and tetanus toxalbumins have been founel in cultures of the tetanus baciUus. These substances produce vio- lent clonic and tonic convulsions. Patoammiue.—Selmi obtained this substance from the mine of patients suffering from progressive paralysis, also of those AA'ith interstitial pneu- monia. The substance produces convulsions, and probably consists of a mixture of liases. Isoamylamine has been found in yeast AA'hich has undergone putre- factive changes. It is a colorless, strongly alkaline Uquid, possessing a marked but not disagreeable odor. It is a highly energetic poison, pro- ducing rigor, convulsions, and death. Four miUigrams caused the death of a greenfinch in three minutes. Fthylendiamin has been found in a cancerous stomach. It produces uninterrupted convulsions. Ethylidendiamin.—This substance was obtained from putrid fish by Brieger. and Avas found to induce dyspnoea, and dilatation of the pupils. Trimethylendiamin.—This substance is present in cultures of the com- ma bacUlus. It produces coimilsions. 492 A SYSTEM OF LEGAL MEDICINE. In the urine of men with epUepsy Ferre found a substance AA'hich produces convulsions similar to those of strA'chnia. From like urine Griffiths has isolated a base. With the germs obtained from the bodies of Avomen dead with puer- peral eclampsia. G-erdes has obtained a highly poisonous substance which produces coiiA'ulsions. Tyrotoxicon.—This substance, first obtained by the writer in poison- ous cheese, and subsequently in poisonous ice-cream, milk, anel certain niUk products, is a highly active poison. Small doses cause in kittens retching, A'omiting, and purging. SimUar doses in man produce like symptoms, together Avith marked constriction of the fauces. Fatal eloses in man cause dilatation of the pupUs, rapid breathing, hurried pulse, and depression of temperature. Mytilotoxine.—This substance, found in poisonous mussels, produces paralysis, resembhng curare in its action. Fugin, found in the roe, liver, stomach, and intestines of certain fish, has a curare-like action. Ptomo-muscarines are frequently found in decomposing matter. Neurine, found in decomposing tissue after five or six days, also has an action simUar to that of curare. According to Lustgarten, there is found in the dead skin resulting from severe burns a substance which produces symptoms similar to those of muscarine. AdamkieAA'icz has obtained a substance Avhich he believes to be the acthre agent in the production of cancer, and to AA'hich he has given the name of eancroin. He also proposes that this agent be usee! in the treat- ment of cancer, following the theory employed by Koch in the treatment of consumption. The substance is probably identical Avith neurine. Susotoxine, a base isolated by Noaw from cultures of the hog cholera bacUlus, first retards, then increases, and finally again retards, respiration. Convulsive tremors occur at frequent intervals. A hundred milligrams produced death in a young rat, Avhen given subcutaneously, in an hour and a half. Cholin, found frequently in decomposing tissue, produces muscarine- like symptoms. It must be given, hoAvever, in large doses in order to produce poisonous effects. Brieger found that the fatal dose for a rab- bit weighing one kUogram is about half a gram. Mydatoxine Avas first obtained by Brieger from putrid human viscera. It produces paroxsymal convulsions, diarrhoea, and dyspnoea. Gadinine, which may be present in human faeces, is mUdly poisonous, requiring from one half to one gram to kUl a guinea-pig. Typhotoxine is produced by the Eberth germ of typhoid fever. Its action has been studied only on mice and guinea-pigs. It produces at first slight salivation AA'ith increased respiration. The animals lose con- trol over the muscles of the trunk and extremities, and faU down help- less upon their sides. The pupils become strongly dilated and cease to react to light. Death follows in from one to tAvo days. Mydaleine is present in putrefying cadaA-eric organs, such as the liver and spleen. It has the peculiar property, when injected subcutaneously, of causing a marked rise in temperature, sometimes as much as two degrees. THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. BY BRANDEETH SYMONDS, A.M.. M.D. History—The growth of life insurance during the past hundred years is one of the most striking features of the period. The amounts invested have become enormous; the amounts which the companies have con- tracted to pay to their policy-holders are stupendous. On the 1st of January, 1893, there were sixty life insurance companies organized under the laAvs of the different States. The total assets of these companies amounted to over $919,000,000. The insurance which thev had in force reached the gigantic total of over $4,897,000,000. This is greater than the debt of any country in the world. The mind cannot grasp the mag- nitude of the operations involved in the handling of this colossal trust- fund. For in nearly all the companies which are mutual, or AA'hich share their profits largely with the policy-holders, these assets can be regarded only as a fund, set aside by the policy-holders, intrusted to the care of the companies, returnable to the policy-holders at the end of a given time, or to their heirs in the event of their prior death. It is therefore A'ery much to the interest of the policy-holders that the companies be AveU managed in all respects. That they have been so in the past is well shown by the rapid progress life insurance has made in the last thirty years. During that time the life insurance companies reporting to the department of the State of NeAv York have increased then- assets from $37,000,000 to $903,000,000; the amount of insurance in force has in- creased from $183,000,000 to $4,199,000,000. While the United States has been the seat of the greatest expansion of life insurance, other coun- tries have to some extent shared in its growth. In fact, the whole civil- ized world has participated; but this is especiaUy true of Great Britain and her colonies. The Anglo-Saxon race can claim the credit both of originating life in- surance and of carrying it to its present magnificent proportions. We are told by Francis (Annals and Anecdotes of Life Insurance) that mutual insurance associations were known in Great Britain soon after the Con- quest. "The necessity of proA'iding for casualties by mutual assistance —in other words, insurance on its broadest and most rational basis—Avas practiced in the Saxon guild, the origin of AA'hich Avas very simple. Every freeman of fourteen being bound to find sureties to keep the peace, cer- tain neighbors, composed of ten families, became bound for one another, either to produce any one of the number who should offend against the Norman law, or to make pecuniary satisfaction for the offense. To do 493 494 A SYSTEM OF LEGAL MEDICINE. this they raised a fund by mutual payments, AA'hich they placed in one common stock. This Avas pure mutual assurance." Further on he gives extracts from the by-huvs of these ancient friendly societies. Thus: "4. If any one take away the life of a member, his reparatory fine1 shaU not exceed eight pounds; but if he obstinately refuse to make rep- aration, then shall he be prosecuted by and at the expense of the Avhole society; and if any individual undertake the prosecution, then each of the rest shall bear an equal share of the expense. If, however, a member AA'ho is poor kill any one, and compensation must be made, then, if the deceased Avas Avorth twelve hundred shUlings, each member shall con- tribute half a mark; but if the deceased Avas a hind, each member shall contribute two one; if a Welchman, only one.'7 " 7. If a member, being at a distance from home, shall die or fall sick, his fellow-members shaU send to fetch him, either alive or dead, to what- ever place he may have A\dshed, or be liable to the stated penalty; but if a member shall die at home, every member aa'Iio shall not go to fetch his corpse, and every member who shall absent himself from his obsequies, shall forfeit a sextarius of honey.'-' Among the rules of St. Catherine's Guild he gives the following: "If a member suffer from fire, AA'ater, robbery, or other calamity, the guild is to lend him a sum of money without interest. If sick, or infirm through old age, he is to be supported by his guild according to his con- dition. If a member falls into bail courses, he is first to be admonished, and if found to be incorrigible he is to be expelled. Those who die poor, and cannot afford themselves burial, are to be buried at the charge of the guild.'' These Avere very humble beginnings, and it Avas long before there were any further developments. Other varieties of insurance, especially marine, greAV slowly into favor. It AA'as aU done by individual under- writers ; the rates were high and the term Avas short. There was insur- ance effected at that time for ransoming sailors and pUgrims in case of capture by Turks, but there Avere no data upon which to make scientific hfe calculations. The census Avas faulty, and the mortality register did not contain the ages of the dead. In 1G93 Halle}' published the first table which showed the probabilities of living, at every age. This Avas founded on the death-registers of Breslau in Silesia, as that Avas the only place Avhere the ages of the dead Avere recorded. Even this was not used for many years. A few years prior to this, Graunt made some Arery shrewd guesses as to the expectation of life, which Avere founded on the London bills of mortality. As these bills did not giA'e the ages of the dead, we can attach no scientific value to the results. The causes of death stateel in these bills of mortality are Arery quaint, and indicative of the state of medicine at that time. Who Avould recognize croup as "the rising of the lights" 1 The resemblance of hydrocephalus to "horseshoe head'' is a little closer Avhen it is remembered Iioav this disease separates the bones of the head and makes the coronal suture look a little like a horseshoe. Long before this, in the beginning of the third century, LTpianus con- structed a table of the expectation of life for the calculation of annuities under the Fahudian law of inheritance. We do not know upon AA'hat these tables were founded, for the census, Avhich was taken by the Romans every fiA'e years, did not in itself furnish sufficient data. The number of births THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 495 and deaths and the ages at death must be known also, and Ave are rea- sonably sure that the Komans made no record of these. The tallies of tdpianus compare favorably with sonic of the earlier English tables, but Avith improved methods of calculation and a greater extent of data the more recent tables show a much greater averag-e longevity. On the other hand, it is cpiite possible that human life has lengthened its clays since those times. Many students in this subject have come to this conclusion. ToAvard the end of the eighteenth century Dr. Price constructed three mortality tallies, the Northampton, the Chester, and the Swedish National tables. Of these three the Northampton is by far the least accurate, oAving to a curious cause Avhich was not appreciated by Dr. Price. In the toAvn of Northampton there avc re a large number of Baptists AA'ho did not belieA-e in infant baptism. In that Avay the ratio of births to the christenings Avas reduced to such an extent that the population of the toAvn AA'as thought to be stationary, Avhereas in reality it Avas constantly increasing. Hence the table made the average lifetime in the town to be six years less than avc can reasonably suppose it Avas then, anel thirteen less than it is iioav. Unfortunately, this table Avas the one which many insurance companies adopted, probably for the very reason that it AA'as more favorable to them and discriminated against the policy-holder. Of late years it has been entirely dropped by insurance companies, AA'ho now depend chiefly upon tables constructed from the combined mortahty ex- perience of seA'eral companies. The most elaborate AA'ork in this line is the English Life Tables con- structed by Dr. Farr. These are three in number. The first is founded on the census of 1841 and the death records for that year. The second is based on the same census, but includes the eleath records for three pre- ceding and three subseepient years. The English Life Table No. III. in- cludes also the census of 1S,11 and the death recorels for seventeen years. From the same data Dr. Farr has constructed a table of Healthy Lives, using for this purpose only those' districts in Avhich the mortality Avas seventeen or less per millc per annum. To giA'e some idea of the enor- mous labor iiiAolved in these computations, it is stated that the ages of OArer fifty million living persons and of over six million deaths enter into the calculations. The first life insurance policy of AA'hich Ave have legal record is dated June IS, 1 r>S3. It was on the life of William Gibbons, for twelve months from that date. It Avas underwritten by a number of individuals at the enormous rate of eight pounds percent. The insured died on May 29, l.")S4, anel payment Avas resisted on the ground that the twelve months referred to Avere lunar months of tAventy-eight days. This was promptly overruled in the courts. Prior to this there Avas insurance for ransoming sea-captains and pilgrims, and very probably on ordinary lives. Annui- ties certainly avc re granted to inelividuals before this, but the rates Avere enormous. The highest expectation of life at this time AA'as held to be scA'en years, and it Avas considered to be the same for all ages. The profits of the insurer under these circumstances Avere A'ery great, anel amounted to the grossest usury. In 1699 the earliest project for mutual life insurance Avas devised. It Avas called "The Society of Assurance for WidoAvs anel Orphans." In manv respects it resembled quite closely some of the modern assessment associations. There AA'as an entrance fee of five shillings, anel an assess- 496 A SYSTEM OF LEGAL MEDICINE. ment of five shillings more on the death of each member. This AA'ould have gh'en five hundred pounds AA'hen the full membership of tAvo thou- sand Avas obtained. The applicant had to furnish a certificate of his age, and also had to make affidavit that he knew of no illness AA'hich afflicted him, and that he Avas in a good state of health. He had to appear in person before the trustee's, and might be rejected by them. As there AA'as no medical examination, death Avithin six months after issuing the policy did not avail. There were clauses providing for the forfeiture of the policy in case of death by the hands of justice. MUitary, naval, and seafaring risks Avere excluded, and in case of members dying in violation of any of these provisos, the policy was forfeited. Forfeiture also oc- curred in case the subscriber did not pay his assessment within seven days after notice. This scheme Avas certainly very ingenious, and ought to"have given satisfaction; but, like most of these plans, the death-rate probably increased in a feAV years, the assessments rolled up and became too numerous. It lived but a few years, and, so far as avc knoAV, died a natural death about 1711. In 170G a charter AA'as granted to the "Amicable Society for a Per- petual Assurance Office." This is the first life insurance confpany of which AA'e haA'e any A'ery definite information, and Avhich sustained the strain of early years. It Avas a purely mutual company ; the rates Avere A-ery high, and Avere the same for all ages between tAvelve and forty-five. They did not accept risks outside those ages. The annual income after deducting expenses Avas divided yearly among the representatives of those AAdio had died during the past year. This Avas of course a most in- equable arrangement. In some years the mortality AA'as light, and the individual return Avas proportionally large; but the next year it might be just the reverse. This Avas modified in later years, but not A'ery suc- cessfully. The inherent faults of the scheme Avere too great, and the old Amicable finally succumbed in lSfid, after an existence of one hundred and sixty years. It was then absorbed by the Norwiedi Union LU'e. It is sometimes said that the Hanel-in-Hand and the Sun offices Avere founded before the Amicable. This is true, but the1}' both started out as fire in- surance companies, and did no life business until many years after the Amicable had been established. It may be amusing to note some of the other features of this period. It Avas a time AA'hen gambling Avas rife in aU classes of society, and the South Sea Bubble Avas sweUing. There Avas a company for suppressing thieA'es and robbers and for insuring aU persons and goods from the same; a company for insuring against losses they shall sustain by ser- vants, thefts, etc.; an insurance company for horses dying natural deaths, stolen, or disabled; for assurance of female chastity; insurance from house-breakers; insurance from highwaymen; insurance from lying; in- surance from death from drinking geneva; rum insurance. The forego- ing is a A'ery imperfect list of these schemes, AA'hich amounted to nothing in the end. heal life insurance had to go through a feeble infancy and an overfed childhood before it reached its present Adgorous youth. In 1720 two proprietary companies were started, the Royal Exchange and the London Assurance. These first confined their attentions ex- clusiA'ely to fire and marine insurance, but in 1721 their charters were amended so as to permit them to Avrite risks on lives. They did a smaU business, at heavy rates, and nearly aU of it was for short terms of a THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 497 year or less. Few people could afford the luxury longer, AA'hen it cost £5 5s. per year for £100 of insurance. ' Some years later Thomas Simp- son showed that on the basis of Halley's Breslau table it was possible to construct a table of life expectation for every age, and soon after James I )< >dson actually did this. These results attracted much attention. Finally a number of gentlemen formed themselves into a purely mutual hfe insur- ance company. Avhich stiU survives in England under'its original title of "The Equitable Society for the Assurance of Life and Sui-A'ivorship.'' They endeavored to obtain a charter from Parliament, but this was frus- trated through the objections of the Royal Exchange and the London Assurance. The Royal Exchange stated with ingenuous simplicity that it was a very poor business and that the expenses ate up all the profits. But as the new company required no capital, being purely mutual, they over- came this by drawing up a deed of settlement, Avhich Avas finally enrolled in 1705, three years after the first policy had been issued. At first the outcome was very doubtful, and Francis says that, in order to give an appearance of strength and age to the delicate infant, they caUed the twenty-fifth policy the two hundred and seventy-fifth. The premiums were at first fifty percent, to one hundred percent, higher than those charged at present; but by the end of the century they had been very much reduced. The "Old Eejuitable" is still alive and flourishing, although in a very conservative Avay. To it we must boAV as being the first real representative of modern life insurance. WhUe life insurance was fostered and encouraged in England by law anel custom, the reverse Avas the case on the Continent. In the end of the seventeenth and the beginning of the eighteenth century, ordinances forbidding the insurance of lives of persons were issued in the Nether- lands, in Genoa, Amsterdam, and Rotterdam, and in 1681 Louis-XIV. issued a similar one in France. The result has been that life insurance rather languished throughout the rest of Europe until Avithin late years. But now it has become a fixed institution there, and a great Arolume of life insurance is written in most of Europe, a considerable part of wliich is done by American companies. It is necessary to say a word about the tontine plan, Avhich has been revived in a A'ery modified form. This oavcs its name to Lorenzo Tonti, who lived during the seventeenth century. His original plan was as follows.- A certain number of persons clubbed together a specified sum (without reference to age or sex), and at the expiration of each year the interest of this fund was divided among the subscribers avIio Avere hving, and so on from year to year, until the last survivor received the whole of the interest. After the death of the last survivor the principal reverted to the founders of the scheme, i.e., the State, for their oavii use. This termination sufficed to kUl the original plan, and it was soon altered so that the entire original sum Avas received by the last surviving member. Even on this basis it was too great a speculation, and ncA'er had much pop- ular support. The results that Avere olitained in some of these tontines Avere almost fabulous. One Avas started in 1689, the subscription being 300 livres. The last survivor of this, in 1726, was a Avidow of ninety- six years of age, and she received an income from it of 73,500 livres. At the present time all purely tontine methods in life insurance haA'e been dropped. There are, hoAvever, methods by which the insured allows all his profits from early lapses, compound interest, etc., to accumulate 498 A SYSTEM OF LEGAL MEDICINE. for a number of years, usually ten, fifteen, or tAventy, and then receives the Avhole of it in one dividend. This is more befitting than the usual yearly diAddend in many respects, for it tends to equalize the inequalities which affect that system by reason of a heavy mortality one year and a light one the next. The so-caUed semi-tontine system is the one adoptod by a large proportion of insurers iu this country. LEGAL. Before entering upon the discussion of the medico-legal features of this question, it is necessary to elaborate a little some of the purely legal points. This must be done A'ery briefly, anel only things of importance can be touched upon. Any extended discussion Avould be quite unbe- coming on the part of the Avriter. A contract of insurance has been defined as "an agreement by AA'hich one party, for a consideration (which is usually paid in money, either in one sum or at different times during the continuance of the risk), prom- ises to make a certain payment of money upon the destruction or injury of something in which the other party has an interest." (Commonwealth vs. 'Wetherbce, 105 Mass. 149, 160.) This definition has been aelopted in many cases of life insurance, and can be considered as generally accepted. Courts have erred at times in regarding this contract as governed by different rules from ordinary contracts, but it is iioav usually held that the same principles apply to it as to other agreements invohdng pecuniary obligations. There is this difference, however, that in the case of any ambiguity in the contract of insurance, the construction most unfavorable to the insurer will be adopted. This is right, for it happens that the in- surer is the one that makes up the printed contract used in nearly all cases. Hence, since it is his language which is used, it should be turned against him if it is at all doubtful in its meaning. There are three parties to these contracts: the insurer, aa'Iio nowadays is practically always a company or association; the insured, Avho is the person applying and examined; and the beneficiary, who is the person to whom, or to whose legal representatives, the amount due at the death of the insured is to be paid. It is of course possible for the insured to be also the beneficiary. Insurance corporations may be divided into three classes, stock, mutual, and mixed. The first has for its basis a capital stock. It ordi- narily issues pohcies at lower premium rates than the others. None of its profits are divided among the policy-holders, but all go to the stock- holders. In mutual companies the insured themselves are the members of the company, anel receive their share of the surplus premiums over anel above those necessary for the payment of losses and expenses. In mixed companies a certain proportion of the profits is paid to the stock- holders and the remainder distributed among the insured. Warranties and Representations.—The applicant is required In- most companies to Avarrant the truth of the statements made by him iii his application for insurance. In the case of a warranty the validity of his policy depends upon the accuracy of his statements!, and any falsity in them will prevent the liability of* the insurer from taking effect. A Avarrant}' forms a part of the contract, and if not strictly complied AA'ith the AA'hole contract is rendered void, even if the mistake is entirely im- material and innocent. Furthermore, it makes no difference what the THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 499 object of the insurer was in asking the question, or even AA'hether he had any object. In some cases the statements of the apphcant are not certified in such a manner as to constitute a warranty. They then become representa- tions, anel are divided into two classes, material and immaterial. The former are those on Avhich the insurer relies in making his contract. |' But in many cases AA'here the language of the contract is regarded as insufficient to create a warranty, it is regarded as sufficient to create an agreement that a statement, of itself immaterial, is to be regarded as material; that is to say, as a material representation. This commonly happens in the case of an answer made to a specific inquiry made by the insurer, the fact of his asking it being regarded as sufficient to sIioav that he regards the answer as a material representation, and the assent of the insureel that it be so regarded is sufficiently shoAvn by his making the ansAver." Material representations must be untrue in some material particular to aAoid the contract. Their materiality does not depend upon their ultimate influence on the risk or their relation to the cause of loss. It depends upon the effect it has on the judgment of the party who as- sumes the risk at the time he assumes it. Even if the loss should occur from circumstances totally unconnected with the fact materially misrep- resented, the policy is A'oid. The insurer, had he knoAvn the true state of affairs, might then have declined the risk or charged a higher premium. Many of these points are so carefully considered in the decision in the case of (1ampbcll vs. Life Insurance Co., 98 Mass. 381, that it is Avorth our while to quote somewhat extensively from it. "A warranty, in in- surance, enters into and forms part of the contract itself. It defines, by way of particular stipulation, description, condition, or otherwise, the precise limits of the obligation which the insurers undertake to assume. No liability can arise except within those1 limits. In order to charge the insurers, therefore, e A'ery one of the terms Avhich define their obligation must be satisfied by the facts which appear in proof. From the very nature of the case, the party seeking his indemnity, or payment under the contract, must bring his claim within the provision of the instrument he1 is undertaking to enforce. The burden of proof is upon the plaintiff to present a case in all respects conforming to the terms under which the risk Avas assumed. It must be not merely a substantial conformity, but exact and literal; not only in material particulars, but in those that are immaterial as AveU. " A representation is, on the other hand, in its nature, no part of the contract of insurance. Its relation to the contract is usuaUy described by the term ' collateral.' It may be proved, although existing only in parol and preceding the Avritten instrument. Unlike other verbal nego- tiations, it is not merged in nor Avaived by the subsequent writing. This principle is peculiar in some respects to insurance, and rests upon other considerations than the rule Avhich admits proof of verbal representations to impeach written contracts on the ground of fraud. Representations to insurers, before or at the time of making a contract, are a presentation of the elements upon AA'hich to estimate the risk proposed to be assumed. They are the basis of the contract; its foundation on the faith of Avhich it is*entered into. If wrongly presented, in any respect material to the risk, the pohcy that may be issued thereupon aauII not take effect, To enforce it would be to apply the insurance to a risk that was never pre- 500 A SYSTEM OF LEGAL MEDICINE. sented. But Avhen the insurer seedvs to defeat a policy on this ground,, his position in court is essentiaUy different from that AA'hich he may hold upon a policy containing a like description of the risk as one of its terms. It is sufficient for the plaintiff to shoAV fulfillment of all the conditions of recovery AA'hich are made such by the contract itself. The burden is then thrown upon the defendant to set forth and prove the collateral matters upon AA'hich he relies. . . . " When statements or engagements on the part of the insured are inserted or referred to in the policy itself, it often becomes difficult to determine to Avhich class they belong. If they appear on the face of the policv, they do not necessarily become Avarranties. Their character AviU depend on the form of expression used, the apparent purpose of the insertion, and sometimes upon the connection or relation to other parts of the instrument. If they are contained in a separate paper, referred to in such a manner as to make it a part of the contract, the same con- siderations of course1 will apply; but if the reference appears to be for a special purpose, and not Avith a A'iew to import the separate1 paper into the policy as a part of the contract, the statements it contains wiU not thereby lie changed from representations into warranties. It is perhaps needless to add that verbal representations can never be converted into Avarranties othci-Avise than by being afterAvarel Avritten into the policy. " In considering the question AA'hether a part of the contract is a Avarranty, it must be borne in mind, as an established maxim, that Avar- ranties are not to be created nor extended by construction. They must arise, if at all, from the fair interpretation and clear intendment of the Avords used by the parties. When, therefore, from the designation of such statements as ' statements' or as ' representations/ or from the form in AAdiich they are expressed, there appears to be no intention to give them the force and effect of Avarranties, they will not be so construed. " The application is, in itself, coUateral merely to the contract of in- surance. Its statements, whether of facts or of agreements, belong to the class of representations. They are to be so construed, unless con- verted into warranties by force of a reference to them in the policy, and a clear purpose, manifested in the papers thus connected, that the Avhole shaU form one entire contract. When the reference to the application is expressed to be for another purpose, or when no purpose is indicated to make it a part of the policy, it will not be so treated." In a later trial in the same case it was held (98 Mass. 402): "It is true that a rep- resentation need not, like a Avarraiity, be strictly and literally complied Avith, but only substantially and in those particulars AA'hich are material to be disclosed to the insurers to enable them to determine AA'hether they will enter into the contract; and that, Avhere the question of the materi- ality of such particulars depends upon circumstances, and not upon the construction of any writing, it is a question of fact to be determined by the jury. But where the representations upon AA'hich the contract of insurance is liased are in writing, their interpretation, like that of other AA-ritten instruments, belongs to the court, and the parties may, by the frame and contents of the papers, either by putting representations as to the quality, history, or relations of the subject insured into the form of ausAvers to specific questions, or by the mode of referring to them in the pohcy, settle for themselves that they shall be deemed material; and AA'hen the}' have done so, the applicant for insurance cannot afterward THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 501 be permitted to show that a fact Avhich the parties have thus declared to be material to be truly stated to the insurers, was in fact immaterial, and thereby escape from the consecpienees of making a false answer to such a question." In the c^ase of Price vs. Life Insurance Co., 17 Minn. 473, some excel- lent definitions are given in very simple and concise language. " So far as the questions presented by the case at bar are concerned, it is suffi- cient to define a Avarranty in insurance to be1 a part of the contract evi- denced by the policy, and a binding agreement that the facts stated are strictly true. A representation in insurance may, for the purpose of this case, be defined to be1 a statement in regard to a material fact made by the applicant for insurance to the insurer Avith reference to a pro- posed contract of insurance. As representations simply, they are not a part of the contract of insurance. And though expressly referred to in the policy, so as to become a part of the written contract, they may not become Avarranties. And even if it be made by the very terms of the policy, as in the case at bar, an express condition of the contract of insurance that if such representations are found to be untrue the policy shall be null and void, they do not necessarily lose their character as rep- resentations and become Avarranties, though the effect of such express condition may be to make them conclusively material. "It is sufficient if representations be substantiaUy true, while a Avarranty must be strictly complied AA'ith. A false Avarranty, therefore, aA'oids a policy, AvhUe a false representation (not fraudulent) does not avoid a policy unless it relates to something which is material in fact, or is made material by the contract of the parties. Warranties, then, are conditions precedent, so that their truth must be pleaded by the assured, upon Avhom, of course, the burden of proving the same rests, Avhereas the falsity of representations is matter of defense to be pleaded by the insurer." In both the preceding cases it is assumed that the burden of proA'ing the truth of a Avarranty rests upon the insured. This is not the opinion usually held, and, as a rule, it may be said that the burden of proof of a breach of Avarrant}' rests upon the insurer. For, considering the number of Avarranties in any application, their positive proof Avould be out of the question on the part of the insured, and AA'ould throAv an overwhelm- ing task upon the beneficiaries of CA'cry policy. In England, AA'here the doctrine of Avarranties apparently originated, it is construed quite as strictly as in this country. In the case of Anderson vs. Fitzgerald, 4 H. L. 484, it AA'as carrieel to the House of Lords and very thoroughly discussed. In this case the policy contained the proviso that "if any circumstance material to this insurance shall not have been truly stated, or shaU have been misrepresented or concealed, or any false statements made to the company in or about the effecting of this insurance," the policy should lie nuU and void. The applicant answered in the negative tlie questions, " Did any of the party's near relatives die of consumption or any other pulmonary complaint!" and " Has the party's life been accepted or refused at any office ?" It Avas proven that his negative ansAvers Avere both false. The House of Lords held that the proviso, above quoted, covered aU statements, Avhcther material or immaterial, Avhether false1 by design or through ignorance. A simUar decision was rendered by the Supreme Court of the United -AY2 A SYSTEM OF LEGAL MEDICINE. States in the case of Jeffries vs. Life Insurance Co., 22 Wall. 47. In the policy it was agreed that " the statements and declarations made in the application, and on the faith of Avhich it is issued, are in aU respects true, anel Avithout the suppression of any fact relating to the health or cir- cumstances of the insured, affecting the interests of the company." The applicant stated that he Avas single, and that he had made no appli- cation to any other company. Both of these statements were proven to be false. It*Avas held as follows: "It is contended, also, that the false answers in the present case Avere not to the injury of the company, that thev presented the applicant's case in a less favorable light to himself than if he had answered truly. Thus to the inquiry, 'Are you married or sinale V when he falsely ansAvered that he Avas single he made himself a less eligible candidate for insurances than if he had truly stated that he was a married man ; that, although he deceived the company anel caused it to enter into a contract that it did not intend to make, it was deceived to its advantage, and made a more favorable bargain than was supposed. "This is bad morality and bad law. None may do eA'il that good may come. No man is justified in the utterance of a falsehood. It is an equal offense in morals, Avhether committed for his own benefit or that of another. . . . " The statements need not come up to the degree of Avarranties. They need not be representations even, if this term conveys the idea of an affirmation having any technical character. ' Statements and declarations' is the expression; what the applicant states and what the applicant de- clares. Nothing can be more simple. If he makes any statement in the application, it must be true. If he makes any declaration in the appli- cation, it must be true. The faithful performance of this agreement is made an express condition to the existence of a liability on the part of the company. " There is no place for the argument that the false statement Avas not material to the risk, or that it Avas a positive advantage to the company to be deceived by it. It is the distinct agreement of the parties that the company shaU not be deceived to its injury or to its benefit. The right of an individual or corporation to make an unwise bargain is as complete as that to make a Avise bargain. The right to make contracts carries Avith it the right to determine what is prudent and Avise, AA'hat is miAvise and imprudent, and upon that point the judgment of the individual is subject to that of no other tribunal. The case in hand affords a good illustration of this principle. The company deems it Avise and prudent that the applicant shaU inform it truly AA'hether he has made any other application to have his Ufe insured. So material does it deem this infor- mation that it stipulates that its liabUity shaU depend upon the truth of the ansAver. The same is true of its inquiry AA'hether the party is mar- ried or single. The company fixes this estimate of its importance. The applicant agrees that it is thus important by accepting the test. It Avould be a Adolation of the legal rights of the company to take from it its acknoAA'ledged poAver thus to make its opinion the standard of Avhat is material, and to leave that point to the determination of the jury." WhUe the language of insurance contracts has been made more and more stringent, the tendency of both judge and jury has been toAvard a very liberal construction of them, Avith all the odds in faA'or of the in- sured. They seize upon the slightest turn or tAvist of phraseology which THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 503 AviU enable them to convert a sentence apparently intended for a war- ranty into a representation. They say, AAdth much*truth, that these con- tracts are drawn up by the insurer and the language used in them is •carefully considered beforehand. If there is the slightest ambiguity any- where, it must be construed to the benefit of the insured, Avho usually signs the application Avithout noticing the printed declarations on it. He knows that he wiU not have to pay anything until he gets the policy, anel when he reads that he is not apt to observe that the application is made a part of it. This liberal tendency of the courts is weU brought out in the following case of Clapp vs. Massachusetts Benefit Association, 146 Mass. 519: " The seven rulings requested by the defendant are based upon the theory that it Avas entitled to a verdict if the ansAvers of Clapp in refer- ence to such matters were in fact untrue, although made honestly and in good faith. Whether it was so entitled or not must depend upon the construction to be given to the acknowledgment or certificate AA'hich Avas subscribed by the deceased as part of the apphcation, and which from its language1 must be held to have controUed and governed the ansAvers to Avhich it referred. " This acknowledgment, as it is termed, is as foUoavs : ' I, EdAvard A. Clapp, of West Manchester, county of Essex, State of Massachusetts, do here!)}' Avarrant each and all of the foregoing particulars and statements to be1 true to the best of my knowledge and belief, and that I have not, in this application for above-named contract, concealed or Avithheld any material circumstance or information concerning the past or present state of my health or habits of life; and I do hereby acknowledge, con- sent, and agree that any untrue or fraudulent statement made above, by me or any one else, or to any medical examiner of said Massachusetts Ben- efit Association, or any concealment of facts by me or any one else, may forfeit and cancel aU rights to any benefit under the above-named contract.' "... Undoubtedly the acknoAvledgment may grammaticaUy be sep- arated into two parts: the first a Avarrant}- that the statements made are true according to the best of the applicant's knoAA'ledge and behef, and the second an agreement that any untrue or fraudulent statement may forfeit the contract. But, if susceptible of such a grammatical construc- tion, it can hardly have been intended that it should haA'e been thus understood. Nor Avould it be a natural construction, and one that Avould suggest itself to an applicant. He Avould not suppose that, AA'hUe he Avas only required to Avarrant that his ansAvers Avere true according to his ' knoAvledge and behef,' his certificate or pohcy was to be forfeited if an ansAver honestly made should prove in fact untrue. The language used in the form of acknoAvledgment does not suggest any idea so much in the nature of a contradiction as this. " These forms are prepared by the insurer Avith great care and great minuteness of detail. They are often signed in comparative haste; and if the association had intended to impose a forfeiture of his certificate upon the applicant because of an untrue statement, AA'hile it had only re- quired him to Avarrant that his statements Avere true to the best of his knowledge and belief, a contract so anomalous should have been clearly expressed. It must be presumed that the defendant prepared its forms of apphcation and certificate with the intention both of protecting itself against fraud and of securing the just rights of the assured under a vahd 504 A SYSTEM OF LEGAL MEDICINE. contract. It is reasonable that its Avorels should be construed against itself, rather than in such a manner that one dealing AAdth it should by any ambiguity be deceived as to his rights. * " The defendant urges that the Avorels ' untrue or fraudulent/ used in the disjunctive, and thus expressing different states of things, sIioav that by the use of the first Avord it Avas intended that the policy should be avoided if any material thing Avas untrue, although stated Avithout fraudulent intent. The connection in which the word is used sIioavs otherwise. In foUoAving the earlier clause, it means a statement Avhich is untrue in opposition to the sens*1 in which it has been promised that it shaU be true. Again, AA'hile in strictness a statement is untrue Avhich is not in precise conformity Avith the facts, yet in a more general sense the AA'ord 'true' is often used as a synonym of honest or sincere, Avithout evasion or fraud. Such is the sense in Avhich it is used in the acknoAvl- edgment. . . . " The case Avas presented by the defendant on the theory that it was entitled to a A'erdict if Clapp's ansAvers Avere sIioavu in any material re- spect to be untrue. This Avas rejected by the presiding judge, avIio held that it must be shown also that such statements were knoAA'ii or believed to be untrue. ... In each request for a ruling, the defendant omitted the edement of Clapp's knoAA'ledge and belief. This Avas the point of conflict between its contention and the position taken by the presiding judge, aa'Iio throughout his instructions insisted that not only must the ansAvers of Clapp be proA'ed untrue, but that they were so according to his knowledge anel belief." The Supreme Court of Massachusetts held that the judge Avas right in giving these instructions, and overruled aU the exceptions of the defendant. These extracts are, I think, sufficient to sIioav the distinctions be- tAveen warranties, material representations, and immaterial representa- tions. At the same time it must be repeated that the more recent deci- sions sIioav, if not a favoritism, certainly a decided sympathy Avith the insured. Furthermore, even if the court holds that any given arrange- ment of words makes the statements of the applicant Avarranties, it is stiU Avithin the proAdnce of the court to define what is warranted in most cases. Here a great deal of latitude is alloAved. Thus the ques- tion, "Have you ahvays been temperate V has been held to refer to the habitual use of alcoholics, and hence an occasional intemperance was regarded as no falsification. One judge has even gone so far as to say that an attack of dehrium tremens was not incompatible with an affirma- tive ansAver to this question. Incomplete and Omitted Answers.—If there is no specific inquiry by the insurer as to any fact, the omission of the applicant to state it does not necessarily invalidate the policy, unless the omission Avas inten- tional, and the fact material in itself. This is right, for the insurers regularly ask aU the questions AA'hich they think avUI have a bearing on the risk except those for Avhich they rely upon their oavii independent means of information. When an ansAver to any cpiestion appears to be complete, although in reality it is incomplete, the omission wiU avoid the contract, if it is that of a material statement. Thus in the case of Cazenove vs. Life Insurance Co., 3 BigeloAv's Life and Ace, Cases 202, 213, it AA-as held that " an ansAver may in one sense be said to be true, namely, if as much as it does state is not untrue, but it may nevertheless be sub- THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 505 stantiaUy an untrue statement. I think that this answer is untrue; just as Avhen a man is asked how old he is, and he savs he is thirty, and as he is that, and something more than that, it may lie-* said in a sense that the answer is true. However, in a case of this sort I think it is trifling to sav that it is a true answer, if something more is to be added to make it true.*" If, hoAvever, the question appears on its face to be ansAA'ered imper- fectly or not at all, and there are no further steps taken bv the insurer to make the applicant complete the answer, this partial or entire omis- sion does not avoid the contract. Here, too, the courts are very liberal m construing any ambiguity to the detriment of the insurer. Thus in the case of Life Insurance Co. vs. Baddin, 120 U. S. 183, the Supreme Court of the United States held as foUows: "The twenty-eighth printed ques- tion in the application consists of four successive*inquiries, as foUows: 'Has any application been made to this or to any other company for assurance on the life of the party? If so, Avith what result? What amounts are now assured on the life of the part}-, and in what compa- nies ? If already assured in this company, state the number of the pohcy.' The only ansAver written opposite this question is < $10,000, Equitable Life Assurance Society.' " The question being printed in very small type, the answer is written in a single line midAvay of the opposite space, evidently in order to pre- vent^ the ends of the letters from extending above or below that space; and its position Avith regard to that space, and to the several interroga- tories in the question, does not appear to us to have any bearing upon the question and effect of the ansAver. " But the four interrogatories, grouped together in one question, and all relating to the subject of other insurance, Avould naturally be under- stood as all tending to one object—the ascertaining of the amount of such insurance. The ansAver, in its form, is responsive not to the first and second interrogatories, but to the third interrogatory only, and fully and truly ansAvers that interrogatory by stating the existing amount of prior insurance and in Avhat company, and thus renders the fourth inter- rogatory irrelevant. If the insurers, after being thus truly and fully in- formed of the amount and place1 of the prior insurance, considered it material to know AA'hether any unsuccessful applications had been made for additional insurance, they should either have repeated the first two interrogatories, or have put further questions. The legal effect of issu- ing a policy upon the ansAver as it stood AA'as to Avaive their right of re- quiring further ansAvers as to the particulars mentioned in the twenty- eighth epiestion, to determine that it Avas immaterial for the purposes of their contract AA'hether any unsuccessful applications had been made, and to estop them to set up the omission to disclose such applications as a ground for avoiding the policy. The insurers, having thus conclusively elected to treat that omission as immaterial, coiUd not afterward make it material by proving that it Avas intentional." This reasoning is certainly drawn out to a A'ery fine point, and the decision seems hardly fair to the company. In the case of Mutual Aid Society vs. White, 100 Pa. St. 12, the ruling on a very similar condition of affairs Avas practicall}' the reverse of this. There was one question arranged like this: " (a) Arc you married ? .......... " (b) GiA'e name of consort. Widdower." .506 A SYSTEM OF LEGAL MEDICINE. It was proven that he had a wife living at the time of the application, from whom he Avas separated. The appeUate court ruled that there Avas no ambiguity about the reply, as it Avas evidently responsiA'e to both epicstions, and bad speUing is so common as not to count against the ansAver. It constituted a material misrepresentation, anel therefore the judgment of the Ioavct court Avas reversed. Superfluous Answers.—The insured is not bound by immaterial statements made by himself AA'hich are not responsive to any epiestion put by the insurer, even though his statements are held to be Avarranties. In the case of Buell vs. Life Insurance Co., 5 BigeloAv's Life and Ace. Cases 473, the question Avas asked: " Has father, mother, brother, or sister of the party died, or been afflicted Avith consumption, or any disease of the lungs, or insanity ? If so, state full particulars of each case." The ansAver AA'as: "No. Father died from exposure in AA'ater; age1, fifty-eight." ItAvas proven and admitted that the father had died before the age of thirty; but the court held that " the falsity complained of in the answer consists only in reference to the age at which the father died. This certainly Avas not inquired of in the epiestion, unless Ave are to find it in that part of it which reads, ' If so, state full particulars in each case.' ... I think the question fairly means, not whether the father, etc., had died from any dis- ease, or from any cause, but whether he had died of, or been afflicted with, consumption, or any disease of the lungs, or insanity. This being the fail- import of the question, ' No' was a complete ansAver to it, and the remain- der of the ansAver Avas uncalled for and not responsive to the question. But suppose that be so; defendant claims that it is nevertheless an an- swer of some sort, and therefore an important part of the contract. The reply to that is that the declaration AAdiich relates to the answers to the questions to be made by the plaintiff, and Avhich it was agreed should be made part of the contract, must be construed to, anel does mean such an- swers as are responsive to the questions, and such as may be called for by the defendant, and that it does not cover such answers as may be volun- teered and irrelevant, and that amount to mere representations. . . . The part of the ansAver in question in this case, in reference to the age of the father at death, being a mere representation, does not constitute a defense, unless it appears to have been material as AveU as false." Beneficiary.—In the beginning of the last century it was the custom in England to effect insurance upon lives in which neither the insurer nor the insured had any interest. These pohcies were properly nothing but wagers. The amounts bet were very large, and the subjects often were very absurd. Thus as late as 1777 there Avere very large gambling assurances as to whether the so-called Chevalier d'Eon Avas a man or a Avoman. This extraordinary man had been sent to St. Petersburg, on some confidential diplomatic mission, disguised as a woman. He retained the dress for some time after he returned to France. When he went to England he assumed that of a man, but it Avas there decided in an action before Lord Mansfield (Da Costa vs. Jones, Coaaui. 729) that he was a woman. Soon after this he returned to France, but under the orders of the Court of Saint-Germain he Avas compeUed to wear female garb. He did this until he died in 1810, when it was thoroughly established by post-mortem investigation that he was a man. The practice of wager policies grew to such serious proportions that finally it Avas forbidden by an act of Parliament. (14 George III., c. 48.) THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 507 This enacted that " no insurance shaU be made on the life of any person, or any event Avhatsoever, where the person on aa'Iiosc account such pohcy shall be made shaU have no interest; or by gaming or wagering; and that e\-ery such insurance shah be null and void. " It shall not be laAvful to make any policy on the life of any person, or any other event, without inserting in the pohcy the name of the per- son interested therein, or for whose use or whose account such policy is so made. " Where the insured has an interest in such life or event, no greater sum shall be received than the amount of the interest of the insured in such life or event." This has been foUowed by similar statutes in this and other States. The doctrine that the beneficial-}' must have an insurable interest in the hfe of the person assured is rather an anomaly. It has been held that the lack of an insurable interest Avas contrary to public policy; but it is more than likely that this idea arose from the statutes bearing upon the subject. However, it must be considered as an estabhshed principle now and accepted until it is overruled. It is difficult to state just AA'hat con- stitutes an insurable interest. Two well-known definitions are as follows: "All which it seems necessary to show, in order to take the case out of the objection of being a Avager policy, is, that the insured has some in- terest in the hfe of the cestui que rie; that his temporal affairs, his just hopes and well-grounded expectations of support, of patronage, and ad- vantage in life wiU be impaired; so that the real purpose is not a wager, but to secure such advantages supposed to depend on the hfe of another. Perhaps it would be difficult to lay down any general rule as to the nature and amount of interest which the assured must have." (Chief- Justice Shaw, in Loomis vs. Eagle Co., 6 Gray (Mass.) 396, 399.) " It is not easy to define Avith precision what will in all cases consti- tute an insurable interest, so as to take the contract out of the class of wager policies. It may be stated generally, however, to be an interest, arising from the relations of the party obtaining the insurance, either as creditor of or surety for the assured, or from ties of blood or marriage to him, as wUl justify a reasonable expectation of advantage or benefit from the continuance of his life. It is not necessary that the expectation of advantage or benefit should ahvays be capable of pecuniary estimation." (Justice Field, in Warnock vs. Danes, 104 U. S. 775.) The distinctions drawn in the cases are sometimes very fine; but generally they tend to follow the above definitions. A wife has an in- surable interest in the life of her husband (Baker vs. Insurance Co., 43 N Y. 283), and the validity of the policy will survive a divorce (Insur- ance Co. vs. Schafer, 94 U.S. 457). A husband has ordinarily an insur- able interest in the life of his wife, and a father in that of his minor son; but not necessarily a son in the life of his father, nor a nephew in the life of his uncle ; but a sister can be the beneficiary of her brother. (Insurance Co. vs. France, 94 U. S. 561.) A creditor has an insurable interest in the life of a debtor. If a policy is taken out in good faith and assigned to a creditor, it has been held that it still remained valid even if the insurable interest of the as- signee ceased to exist. Thus in the case of Olmstead vs. Keyes, 85 N. Y. 593, it Avas held that: " The rule, as gathered from these authorities, is that Avhere one takes out a pohcy upon his oavii life as an honest and 508 A SYSTEM OF LEGAL MEDICINE. bona fide transaction, and the amount insured is made payable to a person having no interest in his life, or where such a policy is assigned to one having no interest in the hfe, the beneficiary in the one case1 and the as- signee in the otheu- may hold and enforce the policy if it Avas valid in its inception, and the policy Avas not procured or the assignment made as a contrivance to circumvent the laAv against betting, gaming, and wager- ing policies." On the other hand, it has been held that a creditor has no interest in the policy beyond the amount of his claim. This Avas the aucav taken in the case" of Cammack vs. Lewis, 15 Wall. 643. The same court on the case of ]Yamock vs. Daeies, 104 U. S. 775, held that: "If there be any sound reason for holding a policy invalid when taken out by a party who has no interest in the life of the assured, it is difficult to see Avhy that reason is not as cogent and operative against a party taking the assign- ment of a policy upon the life of a person in AA'hich he has no interest. The same ground AA'hich invalidates the one should invalidate the other, so far at least as to restrict the right of the assignee to the sums actuaUy advanced by him." In May on insurance, vol. i, p. 199, the opinion is given that: " Upon the Avhole, it is not improbable that, when the point is distinctly taken, it will be held that AA'hen the contract, at its inception, is based upon a substantial interest, and in good faith is entered into for the protection of that interest, it is not objectionable as a Avager contract, and may be enforced though the interest may have ceased at the time of the death. And this the more probable, as while such a rule avUI keep the door shut against mere gambling and speculation, it will tend to encourage what is iioav almost universally regarded as a president contract, securing not only an indemnity in case of loss, but the means of presently increasing capital, anel a not disadvantageous mode of investment." One of the most extraordinary cases in wdiich the epiestion of a beneficiary entered occurred a few years ago. ToAvard the end of 1877 Benjamin Hunter took out $10,000 in one company and large amounts in two others on the life of John Armstrong. A feAV Aveeks later, whUe Armstrong Avas going home one night, he Avas attacked by some one in the streets of Camden, N. J., and received several IiIoavs on the head, from the effects of Avhich he died tAvo days later. No motive could be assigned for the crime until the existence of these policies Avas found out. Then Hunter was suspected, arrested, and finaUy convicted of murder in the first degree, for Avhich he Avas hanged. BetAveen the time of his conviction and execution he assigned the policies over to the AvidoAV of Armstrong. She of course received them subject to aU the equities be- tAveen the original parties. Suit Avas then brought against the insurers. and a verdict Avas giA'en in her favor. On appeal it Avas held (117 U. S. 597,598) that: " The theory of the defense is, that the purpose of Hunter in obtaining the insurance Avas to cheat and defraud the company. In sup- port of that position, evidence that he effected insurance upon the life of Armstrong in other companies at or about the same time, for a like fraudulent purpose, was admissible. A repetition of acts of the same character naturaUy indicates the same purpose in all of them; and if, when considered together, they cannot be reasonably explained without ascribing a particular motive to the perpetrator, such motive will be con- sidered as prompting each act. A creditor has an insurable interest in THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 509 the hfe of his debtor, and may very properly procure an insurance upon it for an amount sufficient to secure his debt; but if he takes out policies in different companies at or near the same time, and thus increases the insurance far beyond any reasonable security for the debt, an inquiry at once arises as to his motive, and it may be considered as governing him in each insurance. . . . The evidence offered that Hunter olitained the insurance in other companies on the life of Armstrong at or near the same1 time was, under these authorities, clearly admissible. It tended to establish the theory of the defendant that the insurance obtained in this case was obtained by Hunter upon the premeditate purpose to cheat and defraud the company. EspeciaUy Avould it have had that effect if fol- lowed by proof of the manner of the death of Armstrong. " But independently of any proof of the motives of Hunter in obtain- ing the policy, and even assuming that they were just and proper, he forfeited aU rights under it when, to secure its immediate payment, he murdered the assured. It Avould be a reproach to the jurisprudence of this country if one could recover insurance money payable on the death of a party whose life he had feloniously taken. As Avell might he recover insurance money upon a buUding that he had wUlfuUy fired." MEDICO-LEGAL. As a preliminary to the discussion of the relations of legal medicine to life insurance, it seems advisable to tedl in a few words the plan AA'hich has been adopted in the subseepient pages. In this Avay the relations of the individual parts to the AA'hole subject, and also their comparative im- portance, can be sIioaa'u. And a certain coherency betAveen the different topics will be established. The opening section is devoted to a A'ery brief reAuew of the duties of the medical examiner, and a short statement of the value of medical selection. In the section foUowing this are discussed the questions as to Avhat constitutes medical attendance and medical attendant. Next is taken up the definition of "sound health." And immediately after this comes the correlated idea as to Avhat constitutes "freedom from disease." This topic is first discussed in its general aspects, and then foUowhig this discussion are a number of diseases, eacdi of AA'hich has been the subject of judicial comment. These are treated individually. Next is taken up a very important subject, named}', the habits of the insured hi regard to alcohol, opium, and other narcotics. This is treated at considerable length, both on the legal and the medical sides. It has seemed advisable to insert it here, immediately after the discussion of health and disease1, on account of its marked influence on both these conditions. The next topic taken up is that of the famUy record and its manifestations of heredity. The remaining topics have less cognate relation to the main subject. But medical questions enter more or less into their discussion, and med- ical selection is someAA'hat affected by the statements in the applications regarding them. So they do not come amiss in this relation. The first of these topics has reference to the occupation, anel then comes the subject of the residence, anel that of the age immediately foUoAvs. The amount of other insurance that an applicant has frequently affects the acceptance of the risk, and of stiU more importance is the question referring to pre- 510 A SYSTEM OF LEGAL MEDICINE. A'ious rejections. These are both discussed shortly. Last, but by no means least, is the very important topic of suicide in its relations to life insurance. ' This is discussed fully and at length. These have seemed to be the only subjects Avhich can be properly included under the title avc have chosen. . The Examiner.—Since Ave hope that many medical examiners tor lite insurance companies avUI honor this article by reading it, it has seemed right to us to preface it by a feAV words concerning their duties and the value of medical selection in eliminating unfit risks. "It is a truism to remark that the whole fabric of life insurance depends upon the fidelity, the learning, and the skill of medical men. When a company is formed, a lawyer may carefuUy draw its charter and its by-laws, anfl formulate the contracts upon which it is willing to enter; the actuary may accu- rately estimate the risks to be encountered, the rate of interest to be ex- pected, and the loading necessary to cover expenses; the executive may organize with skill and economy the Avorking force and the agents in the field ; but unless the medical examiner does his duty in barring out undesirable risks and accepting only those who may reasonably be ex- pected to live out the theoretical expectation of life, the company is pre- destined to loss anel ruin. He1 stands as a sentinel at the gate to prevent the ingress of those vho Avould only destroy the structure, and upon his vigilance and care depend its continued existence. Any lapse from the strict performance of duty, any concealment of facts which the company should knoAV in order to estimate properly the risk to be assumed^ and any approval of doubtful lives from motives of personal friendship or uuAvUlingness to incur local enmities, is to admit a traitor to make a breach in the groAving edifice Avhich may easily result in its total doAvn- fall." (The Chronicle, lSi)3, p. 326.) And it can be said that the medical examiner seldom fails in the1 high trust reposed in his integrity and fidel- ity. He becomes the confidential adviser of the company, and sIioavs toward it the utmost good faith in nearly all cases. Oftentimes he sacrifices lifelong friendships to do the almost thankless task of rejecting an unsuitable applicant. It is seldom an applicant is so unsound as to die Avithin a short time after rejection, for in that case he is usuaUy so palpably sick that he does not dare to apply for insur- ance. Hence the examiner gets the approval of no one for rejecting the ease, for it is buried at the home office along AAdth thousands of others, and the applicant and agent usually have opportunity, for a a ear or_two, to revUe and upbraid the examiner. And Avhen the rejected candidate1 finally dies within a time far short of his expectation, the medical exam- iner rarely gets his credit for it from the officers of the company, for they seldom hear of it. This is his own fault, and he should endeavor to correct it. For the sake of his OAvn reputation he should report the deaths of all his rejected cases to the home office. Furthermore, it Avould prove of great scientific value to the company. But the examiner prob- ably thinks that the damage already done in his immediate circle cannot be rectified, and he does not care to take the extra trouble to notify the company. It is said, sometimes in jest but occasionally in earnest, that a life in- surance company would be better off if the medical examination Avere abolished and applicants taken Avithout examination; that the reduction in expense would more than counterbalance the increased loss from the THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 511 higher mortality. Those avIio advance this view seem to do so on the supposition that the effect of abolishing medical selection would be to bring the death-rate up to the average at large of the population, and they seem to think that it could go no higher; but there is every reason to beheve that it would. Would not "the halt, the maimed, *and the blind" come swarming to the doors of any insurance company Avhich did away with medical examinations? Would not those over whom the family physician had shaken his head eome rushing up to join the throng before it Avas too late* And equally Avould not those who knew they were in good health keep away from such an institution, as one avoids a pest-house ? The net resiUt of two such forces would be that in a short time the company would be composed, not of average risks, but of in- valids, of those who had been rejected by other companies, of those only avIio kneAv they Avere unsound. Hoav long could any company stand such a strain ? The great value of medical selection is AveU shown in the foUowing tallies. _ (Assurance Magazine, vol. xxiii, page 285.) The actual rates of mortality in them were taken from the experience of ten assurance com- panies in Scotland. The computed rates of mortality were based upon the deaths registered in Scotland during the ten years, 1855-64. For the benefit of those to whom the actuarial science is a terra incognita, Ave Avill say that the cases are grouped according to the number of years they have been insured, and not according to their age. The year 0 refers to the first six months of insurance. The importance of selection for the first two or three years is AveU shown in the following table of deaths from aU causes: Actual Rates Computed Rates Actual Deaths to of Mortality. of Mortality. 100 Computed. .004592 .012809 35.85 .007622 .013166 57.90 .009894 .013705 72.19 .011498 .014206 80.94 .013161 .014759 89.17 .013079 .015290 85.54 .014254 .015929 89.49 .014893 .016613 89.65 .015342 .017301 88.68 .016296 .018010 90.49 It has also been said that those avIio can afford to pay for insurance are naturally a better class of risks than the average population, and hence the diminished mortality, after two or three years of insurance, is due to.natural, and not medical, selection. Fortunately, Dovey has pre- pared other tables which enable us to refute this. Some diseases will sIioav A'ery slightly the effects of selection, while there are others in which its theoretical value cannot be questioned. In the first group naturally belong the zymotic diseases. There is nothing in a medical examination Avhich Avould show any capacity for restraining the development of such diseases and preventing a fatal termination. We are not, therefore, surprised to find in the table devoted to this class that the actual mor- tality surpasses the computed mortahty in the first year, and remains ahead of it for the remaining eight years. Dovey makes the suggestion that this is probably due to the fact that a larger proportion of the in- 512 A SYSTEM OF LEGAL MEDICINE. sured come from towns than from the country, and cities are well known to be more troubled Avith this edass of diseases. A similar result is to be noticed in the talde devoted to the diseases of the digestive organs. If applicants Avish to minimize their symptoms, an examiner will naturally reject only those cases in Avhich a disease of this class is so far advanced that it affects the applicant's general health and gives rise to objective manifestations. Forjdiis reason we find that the actual mortality in cases chin0' of some disease of the stomach is beloAV the computed for one and a'half vears only; and after that it practically equals or surpasses it. Let us turn'iioav to the other group of diseases, in which Ave would naturally expect to find much value from the medical selection. Among these diseases the most marked results would be seen in cardiac and tuberculous lesions. In both the examination is usually thorough, heredity plays an important part which is given due weight, and the preAdous history of rheumatism, hemoptysis, etc., helps materially in ex- cluding undesirable risks. In other words, Ave Avould reasonably expect to find the fuU value of medical selection manifested, and AA-e are not disappointed. The accompanying tallies speak so avcU for themselves that further comment on them is unnecessary: TUBERCULAR DISEASES. Years of Actual Rates Computed Rates Actual Deaths to Assurance. of Mortality. of Mortality. 100 Computed. 0 .000374 .003750 9.97 1 .000981 .003672 26.72 0 .001915 .003668 52.21 3 .002109 .003619 58.27 4 .00203] .003569 56.91 5 .00196* .003518 55.94 6 .002351 .003460 67.79 7 .002154 .003408 63.20 8 .001956 .003356 58.28 9 .002010 .003306 60.93 HEART DISEASE. Years of Actual Rates Computed Rates Actual Deaths to Assurance. of Mortality. of Mortality. 100 Computed. 0 .000198 .000917 21.59 1 .000436 .000980 44.49 2 .000657 .001049 62.63 3 .000764 .001121 68.16 4 .000990 .001197 82.72 5 .000738 .001272 58.02 6 .001228 .001358 89.83 7 .001100 .001440 76.38 8 .001422 .001525 93.24 9 .001274 .001612 79.03 These observations of Dov-ey are reinforced 1iat the foUoAving extract from an essay, " On the Effects of Selection," by Mr. Emory McClintock: " Concerning medical selection in general, all known statistics go to show that it exerts a most important influence in favor of the office during the first years of insurance. That part of its influence Avhich is conspicuous in varying the earlier percentages is due to the rejection of diseased THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 513 lives. It must not be forgotten that another, and perhaps equally im- portant, function of meehcal selection is to repel members of short-lived famUies, who are them selves in fair health. The beneficial effect of such action continues for many years. Those who say hastily that medical selection does no good after five years of insurance, and that therefore any one may be taken without examination, provided the office assumes no risk until after five years have expired, take upon themselves a most serious responsibility." The duties of a medical examiner are to a considerable extent clerical. He must record the answers of the applicant with care and fidelity. The omission to answer any epiestion always costs much time and trouble. No matter Iioav unimportant he thinks any question is, he must see that its answer is put doAvn. If the applicant gives the history of any disease or injury, aU the essentials must be carefully inquired into and recorded. If an applicant makes any statements to the medical examiner and he adA'ises and directs the applicant to modify them, in so advising he may act as the agent of the company, and the latter is then estopped from subsequently setting up the falsity of the statements, thus moehfied, as a breach of war- ranty. (Flynn vs. Life Assurance Soc., 78 N.Y. 508.) This, of course, sup- poses that there is no collusion between the apphcant and the examiner. The examiner should alloAV himself but little latitude in judging AA'hat is important or unimportant. This particular case may be the subject of a future trial, and eA'ery detail then necessary. The applicant may have made statements to other companies Avhich conflict AA'ith AA'hat he is iioav telling. He may say iioav that his rheumatism Avas muscular, while before he said it Avas articular. But his cross-examination must be con- ducted Avith tact and adroitness, so carefully and epiietly that it is re- garded by the applicant as a conversation only. For he is noAV on a totally different footing from that on Avhich he is AA'hen he seeks the phy- sician's professional aid. Now he AviU mitigate any sickness and speak of its consecpiences lightly. An attack of petit mat aa'UI become a little vertigo; he forgets that he has to get up two or three times to pass his AA'ater. It is the examiner's business to get the true facts. In order to do this it is of great importance to insist upon the rule that no third person be present at the intervieAv. People will often make confession of some detrimental circumstance to the doctor alone, AA'hen nothing Avould induce them to utter a Avord on the subject to any one else. A Icav Avords must be said about proofs of loss and certificates of death. It AA'ould seem reason aide to assume that the plaintiff in a suit upon a policy to recover from the company would be bound to some ex- tent by the statements made in the proofs of death. Such Avas the vkwv taken in the case of Life Insurance Co. vs. Newton, 22 Wall. 32. " They were intended for the action of the company, and upon their truth the company had a right to red}'. Unless corrected for mistake, the insured Avas bound by them. Good faith and fair dealing required that she should be held to representations deliberately made, until it was shown that they Avere made under a misapprehension of the facts, or in igno- rance of'material matters subsequently ascertained." In the case of Keels vs. Beserve Fund Association, 29 Fed. Rep. 198, this misinformation Avas pleaded, and in consequence the beneficiary Avas aUowed to prove that the death had occurred from accident, although the proofs of death made it to be the result of suicide. 514 A SYSTEM OF LEGAL MEDICINE. In the case of Goldschmidt et at, vs. Life Insurance Co., 102 X. Y. 4S6, to the proofs of death were added copies of the verdict of the coroner's jury and of the evidence presented to it, as Avas required by the company. The verdict of the coroner's jury was that the insured came to his death by suicide by means of potassium cyanide. The claimant, in the proof of death, said: " We do not admit that there Avas any such inquest, ver- dict, or eAddence, and we deny that the purported finding of such aUeged jury was true or Avell founded, and we deny the fact alleged to have been found by such jury, and we deny the truthfulness of the alleged eAddence on Avhich said verdict is said to be based." The court held that the ver- dict of the coroner's jury was of A'alue in drawing attention to a possible mode of death, but that it was in no sense binding upon the plaintiff; in fact, it did not even throw the burden of proof upon them, bid that it AA'as necessary for the company to prove that the insured died by suicide. Similarly the company is not bound by proofs of death Avhich it re- ceives, eA'en though it does not question them at the time. Thus in the case of Crotty vs.Life Insurance Co., 144 U. S. 621, it Avas said: "Nor is the fact that the proofs were received by the insurance company Avithout question an admission on its part of the truth of aU the matters stated therein. The purpose of proofs of death in life insurance and proofs of loss in fire insurance cases is to put the company in possession of the facts concerning the death or loss, as claimed by the beneficiary or in- sured, upon which it is to base its determination as to making or refus- ing payment; and Avhen it receives such proof without question, it is an admission on its part that they are in form sufficient, but not that all the facts stated therein are true. The policy in this case caUed for proofs of death; and the company by its answer admitted that satisfactory proofs had been furnished. The fact that in the blank it had prepared and sent to be filled out it asked many questions Avhich Avere answered by the claimant, and the proofs thus made Avere received without objection, did not preArent the company from challenging in court the truth of any fact stated therein, essential to the plaintiff's right of recovery, and did not amount to an admission on its part respecting such fact." Medical Attendance.—There are tAvo questions of considerable im- portance iu life insurance, which must be treated together on account of their close relationship to each other. These are: What constitutes a family physician ? and, What is included in the term medical attendance ? The decisions haA^e varied much, and frequently on small technical points, so that it AviU be necessary to study each case separately. In the case of Price vs. Life Insurance Co., 17 Minn. 473, the definition of famUy physician was discussed at length. The twenty-fifth question in the application was, " Name and residence of the family physician of the party, or of one whom the party has usuaUy employed or con- sulted?" The answer was, "Have none." The majority of the court held as folioavs : " The phrase family physician is in common use, and has not, so far as we are aware, any technical signification. As used in this instance, and for the purpose of the testimony appearing in this case, the chief-justice and myself are of the opinion that it may be sufficiently defined as signifying the physician who usuaUy attends and is consulted by the members of a family in the capacity of a physician. We employ the word ' usuaUy,' both because we do not deem it necessary to constitute a person a famUy physician (as the phrase is used in this instance j that THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 515 he should invariably attend and be consulted by the members of a family in the capacity of a physician, and because Ave do not deem it necessary that he should attend and be consulted as such physician by each and aU members of a family. For instance, the testimony in this case shows that at the time AA'hen the apphcation for insurance was made the family of Richard Price consisted of himself, his wife, and tliree or four chil- dren. We think that a person who usually attended and was consulted by the Avife and chUdren of Richard Price as a physician would be the family physician of Richard Price in the meaning of the above, twenty- fifth interrogatory, although he did not usuaUy attend on and was not usually consulted as a physician by Richard Price himself." McMillen, J., did not agree with this part of the opinion, and said, AA'ith a great deal of propriety, that a man might have one physician for his family and another for himself; and that, according to the opinion above given, he Avould be obliged to Avithhold the name of his personal physician. This Avould certainly be contrary to the intent of the ques- tion. In concluding he says (p. 497): "I think the phrase, as used in this instance, means the physician who usuaUy attends and is consulted by all or most of the members of the family of the person whose life is assured, and that the person thus assured, if he has medical attendance, must be one of the members attended by such physician." This defini- tion seems a more reasonable one than that Avhich prevailed. In the case of Cushman vs. Life Insurance Co., 70 N. Y. 72. the insured stated in his application that Dr. P. AA'as his "usual medical attendant," but in the proofs of death Dr. O. stated that he had been " attendant phy- sician " upon Cushman for the preceding five years, coAering the period of the former declaration. It Avas held that this did not falsify the state- ment in the application, for " a party may have several l attending physi- cians' and one 'usual medical attendant.'" Furthermore, Cushman Avas not responsible for the statements made by Dr. O. If the company accepts any ambiguous or incomplete answer concern- ing medical attendance, and on the strength of it issues a policy, it must abide the cousequences. It cannot then plead that this ambiguity or incompleteness estops the insured from recovering. Thus in the case of Higgins A's. Life Insurance Co., 74 N. Y. 6, the question in the apphcation was, " Name and residence of the famUy physician of the party, or of one whom the party has usually employed or consulted?" The answer Avas, " Refer to Dr. A. T. HUls, Corning, X. Y." It Avas proven that the in- sured had occasionally consulted another physician, but for no serious ailment, and to no greater extent than he had Dr. MiUs. It was held that the ansAver aboA'e giA'en did not affirm a fact, and so did not consti- tute a Avarranty. It Avas further held that the ansAver was indefinite and not responsive; that the company, haA'ing issued a policy on the strength of it, shoAved that they were satisfied with it. This is a fair vieAv, and one that avUI commend itself to every loArer of accuracy. The defense was a pure quibble, and had very properly no standing in court on this point. As regards what is comprised under the term medical attendance, the decisions are varying and conflicting. It would seem as if the term ought to include aU medical advice sought for by a person from a physi- cian. AAdiether that adAdce consisted in the administration or prescribing of medicines, the use of instruments or other apphcations, or simply the 516 .1 SYSTEM OF LEGAL MEDICINE. regulation of the diet or other hygienic measures. Many a real disease is improved by the simple regulation of the diet Avithout the use of a single drug. Notice how frequently sugar disappears from the urine after the elimination of starches and sugars from the dietary, and without otlu'i- treatment. It is not at all uncommon, in some forms of Blight's disease, for albumen to disappear when the individual is put on a restricted diet, such as milk, with the addition of some simple mineral Avater which cannot be properly caUed a drug. On this point Ave are in accord with a number of decisions. In the case of Cobb vs. Bin eft Association, 153 Mass. 176, the epiestion in the application was, " Have you personally con- sulted a physician, been prescribed for, or professionally treated, Avithin the past ten years ?" The answer was, " No." The Avording of the dec- laration and proposal Avas such that the court held that all the statements of the insured were representations, made material by express agreement that they were " full, complete, and accurate." This being decided, the court then held with reference to the question above stated as follows: " The plaintiff further contended that the question referred to in the ap- plication should lie construed as referring to a specific disease, and that if the insured had consulted or been prescribed for by a physician for a pain that did not amount to a disease, his answer to this epiestion would not prevent the plaintiff from recovering. The presiding judge declined to instruct the jury in accordance Avith this contention, and instructed them that if the insured, being as he supposed in need of a physician, Avent to one-for the purpose of consulting him as to what was the mat- ter AAdth him, and had an intervieAV, answering such inquiries as the physician deemed pertinent, receiving aid, advice, or assistance from him, that the insured consulted a physician Avithin the meaning of the inter- rogatory ; and further, that if they found that he Avent to a physician for the purpose of procuring aid and assistance from the physician as such, and the physician prescribed a remedy, or treated him profession- ally, either by giving him a prescription or by administering hypodermic injections of'morphine (of Avhich there was some evidence), then he Avas professionally treated Avithin the meaning of the interrogatory, or pro- fessionally prescribed for. This ruling seems to us correct. . . . Even if the insured had only visited a physician from time to time for temporary disturbances proceeding from accidental causes, the defendant had a right to knoAV this, in order that it might make such further inves- tigation as it deemed necessary. By ansAvering the question in the nega- tive1, the applicant induced the defendant to refrain from doing this." A A'ery similar conclusion Avas reached in the case of Life Insurance Co. vs. McTague, 49 N. J. L. 587. In an application for the restoration of a lapsed policy, the applicant averred that he had not " consulted or been prescribed for by a physician " since the policy was issued. It was held that these averments Avere Avarranties, and it was proven that he had con- sulted a physician, who had prescribed for a " cold." The Appellate Court in delivering its opinion (p. 592) says : "The Common Pleas, in their opinion before us, declare that this fact did not show the representation to have been false, because it did not appear what sort of a prescription the doctor gave, whether one com- pounded by a druggist or made up of some common remedy. But it is obvious that this circumstance cannot be of the least importance in de- termining the truth or the falsity of the representation in epiestion. That THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 51J representation did not aver a condition of health, or that it was requisite or proper to consult a physician. It averred that he had not consulted a physician or been prescribed for by a physician. The fact found con- tradicted this averment, whether the consultation and prescription related to a real disease or an apprehension of disease. Indeed, so material does such a representation seem to be to the contract proposed by the applica- tion, that, in my judgment, if made falsely and knowingly it would avoid the contract. But the materiality of the representation in this case is not in question, for, as Ave have seen, its truth is Avarranted. Its falsity appears from the fact found." Another point seems correctly viewed in the case of Cushman vs. Life Insurance Co., 70 N. Y. 72 : "To constitute a medical attendance, it is not requisite that a physician should attend a patient at his home; an attend- ance1 at his oaa'ii office is sufficient." On the other hand, avc have some decisions of an entirely different tenor, so liberal in their scope as to make one aghast at the elasticity of a language which avUI permit such strains. In the case of Brown vs. Life Insurance Co., 65 Mich. 306, the policy Avas issued in 1883. In the apph- cation Avas the question, "Name of the physician who last attended hfe proposed, and Avhen ?" The ansAver was, " 1 )r. H., nine or ten years ago." At the trial Dr. G. testified that he had seen her professionally at her house five times in tAvo months in 1880 ; Dr. S. had attended her professionally several times in one month in 1881; and Dr. V. N. had seen her fourteen times at his office in the time between October, 1882, and May, .1883. Against all this testimony the court held as foUoAvs: "As these questions and ansAA-ers ought to be construed liberally in favor of the assured, I am of the opinion that the mere calling into a doctor's office for some medicine to relieve a temporary indisposition, not serious in its nature, could not be considered an attendance by a physician Avithin the meaning of this question, nor would the calling at the home for the same purpose be so regarded. The jury should have been instructed that the attendance of the physician must have been an attendance upon the assured for some disease or ailment of importance, anel not for an indisposition of a day or so, trivial in its nature, and such as aU persons are liable to who are yet considered to be in sound health generally." In the case of Life Insurance Co. vs. Sehnltz, 73 111. 586, the insured gaA'e a liegatiA'e ansAver to the question, - Has the party employed or con- sulted, individually, any physician ? Please ansAver this yes or no. When yes, please giA'e name or names and residence." This would seem to be about as direct and unequivocal a question as could be put. It Avas entirely free from the uncertainty inhering in the terms family physician or usual medical attendant. It Avould seem to refer distinctly to the employment of any physician for any cause by the insured Avithin a time limited only by his capacity for remembering. It Avas proven that the insured, about one year prior to his examination, had a large axillary abscess, AA'hich confined him to his bed for about a Aveek, and that he was attended several times by a physician for this condition. Under these circumstances it Avould seem to any reasonable mind that the ansAver to the above question Avas a direct falsification. Of course the jury gaA'e the usual A'erdict, and on appeal it was held: " By the particular form of the question, the mind is naturally directed to a time recent, and AveU might be to the subject-matter in connection 518 A SYSTEM OF LEGAL MEDICINE. AA'ith which the question is asked, namely, the apphcation for a life insur- ance, and fitness as a subject of insurance, and the question not unnatu- rally might be understood as an inquiry Avhether the party had employed or consulted a physician with reference to having his life insured. The auxiliary < have,' as here used, serves to denote a tense, grammatically, which expresses an action past, and often that which is just past and completed. To aUow the interrogatory, as put, to have reference to any accomplished event wholly disconnected with the apphcation, and which may have taken place in any previous period of time then fully completed, Avould be to say that it coA'ered the whole period of the ap- plicant's life. To give any such effect to the interrogatory Avould be to make it extremely misleading to the applicant. We are1 of the opinion the question was*not sufficiently definite and specific as regards time, to warrant the finding of a breach of Avarrant}' upon this point, from the fact of the insured having employed a physician six months or a year and a half before, in the way as testified." This case is particularly flagrant, as there was considerable medical testimony to sIioav that the applicant died of pyaemia, which certainly might have had some connec- tion with this abscess. This would seem to belong to that rare class of cases in which judicial liberty has become license. In the case of Dillebar vs. Life Insurance Co., 69 N. Y. 256, a ruling was made Avhich Avas directly opposed to the doctrines Ave have stated in the section on partial anel incomplete ansAvers. In the application the foUowing questions and answers are given : "Q. Has the party had, during the past ten years, any sickness or disease ? If so, state particulars, and the name of the physician or phy- sicians who prescribed or who were consulted. UA. Nine years ago had an attack of typhoid fever. "Q. Have you employed or consulted any physician for yourself or your family ? If so, give name or names and residence. aA. Dr. Paine, Putnam, Conn., nine years ago; he is now dead." It was proven that one year prior to examination the applicant had had an hemoptysis for which he was attended by a physician; and an- other physician testified that he treated insured and his Avife only a feAV weeks before the application for insurance. In spite of this the Court of Appeals stated that: " It was not said that he had no other physician, and if a fuller and more precise ansAver Avas desired the defendant should haA^e exacted it. It Avas fuU and complete so far as it Avent. If a question is not answered there is no warranty that there is nothing to answer. And so in the case of a partial answer, the Avarranty cannot be extended beyond the answer. Fraud may be predicated upon the suppression of truth, but breach of warranty must be based upon the affirmation of something not true. Here there Avas no warranty that the ansAver stated the names of aU the physicians whom he hael employed or consulted at any time. It is true that in the agreement annexed to the application it is said that the ansAvers are Avarranted to be full. But AA'hat was intended by these Avoids, and what had the assured a right to suppose was intended by them? Was it intended that the insured should lose the benefit of his policy, after parting AAdth his money, if he omitted innocently or inadvertently to give the name of every physician who at any time had been employed for himself or for his famUy in an}' illness, hoAvever temporary or trifl- ing ? The circumstances under AA'hich the words Avere useel forbid such THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 519 a construction. The assured had answered many questions caUing for minute information on many subjects, and for the substantial truth of his ansAvers he Avas responsible. The other thing to be provided against Avas the suppression of the truth, and hence in the agreement there is a Avarranty that the ansAvers are full, and that no material circumstance has been 'concealed or withheld.' Taking all the language used, the meaning was that the answers were true, and that they Avere full, in the sense that the assured had not intentionaUy concealed or Avithheld any material fact or circumstance. The assured could not have understood from aU the language used that if he ansAvered honestly all the questions put to him, he was to lose the benefit of his policy in case he omitted some fact requisite to make any one of the numerous ansAvers fuU, be- cause his attention Avas not particularly caUed to it, or because it had es- caped his attention or memory, or because he did not deem it material to a fuU answer. Warranties in policies of insurance are strictly construed. They avUI not be extended to include anything not necessarily implied in their terms." This is not a ruling which wUl stand Avith time. Good faith on the part of the insured necessitated a more complete ansAver than Avas given. The facts concealed Avere material, and had they been disclosed, it is safe to assume that the company Avould never have taken the risk. Only by •concealing these facts Avas the applicant enabled to obtain the insurance. The negligence Avhich avUI omit to mention an hemoptysis occurring within a year is too culpable to be excused. The precedent here established is very bad, and at variance AAdth other decisions on simUar points. Sound Health.—What constitutes sound or good health from a life insurance point of aucav ? This phrase certainly does not mean absolute perfection of physical health, for on that construction hardly any one Avoidd be insurable. The actuarial calculations, on Avhich are based the premiums of the company, are supposed to have for their foundation persons of average good health, but they do not require more than that. At the same time the boundary line betAA'een sound and unsound health is A'ery Ul-defined and unsubstantial, they merge into one another so in- sensibly. Some of the old decisions on this point are more amusing than valu- able iioav. Sir James Ross took out a policy of insurance for one year from October, 1759, and he then warranted that he was in good health. He died before the end of the year, and payment Avas resisted on the ground of a breach of this Avarranty. It AA'as proven that he had received a wound in his loins, in the year 1747, AAdiich gave rise to incontinence of urine and faeces. It was sIioavii that this had no connection AA'ith the disease of AA'hich he died. There Avas some medical testimony to the effect that the incontinence Avas not a disorder AA'hich tended to shorten life. Lord Mansfield said: " The question of fraud cannot exist in this case. When a man makes insurance upon a life generaUy, Avithout any repre- sentation of the life insured, the insurer takes all the risk, unless there Avas some fraud in the person insuring, either by his suppressing some circumstance AA'hich he kneAv, or by alleging Avhat Avas false. But if the pers< >n insuring kneAv no more than the insurer, the latter takes the risk. When an insurance is upon a representation, every material circumstance should be mentioned, such as age, way of life, etc. But where there is a Avarranty, then nothing need be told,* but it must in general be proved, 5:20 A SYSTEM OF LEGAL MEDICINE. if htigated, that the hfe AA'as in fact a good one, and so it may be, though he have a particular infirmity. The only question is, Avhether he Avas in a reasonably good state of health, and such a life as ought to be insured on common terms." Needless to say, the jury promptly found for the plaintiff. In another case, about the same time or a, little later, the same judge remarked, in reference to a Avarra.nty of good health, that " such a Avar- ranty can never mean that a man has not the seeds of a disorder. We are aU born AA'ith the seeds of mortality." To this there can certainly be no objection ; but Avhen the learned judge goes on to say that this Avar- ranty is not broken in the case of a man AA'ho Avas subject to the gout, one is startled. It is A'ery likely, hoAvever, that his personal medical igno- rance compared favorably Avitli that of the times. Both of these cases Avould be thrown out of court at the present time. After aU, the question is, provided the man is not in absolutely per- fect physical health, AA'hich condition from our oavii experience is the height of rarity, Is there a fair possibility that the aUment from Avhich he is suffering will tend to shorten life in the degree in Avhich he has it f This Avay of putting the question seems simple enough until it comes to a particular application. In the case of Watson vs. Mainwaring, 4 Taun- ton's Rep. 763, the term "good health" AA'as construed A'ery liberally. The insured concealed from the company the fact that he had had con- siderable dyspepsia. It Avas certified that this disease was the ultimate cause of eleath, although it avus much disputed AA'hether it was organic at the time of the application. The fact that he died from the dyspepsia Avould seem reasonably conclusive that it Avas organic. In spite of this it Avas held that " all disorders have more or less tendency to shorten life, eA'en the most trifling; as, for instance, corns may end in a mortification ; but that is not the meaning of the clause. If dyspepsia Avere a disor- der that tended to shorten life, within this exception the lives of half the members of the profession of law Avould be uninsurable." By these generalities the judge completely ignored the fact that the insured had died from the same disease which he was proven to have had at the time he made apphcation. In more recent times the term has been construed very variably. On the one hand it has been held not to mean perfect physical health. Thus in the case of Morrison vs. Life Insurance Co., 59 Wis. 162, it AA'as said: " It would lie most unreasonable to interpret the term l in sound health,' as useel in contracts for life insurance, to mean that the insured is abso- lutely free from aU bodUy infirmities or from all tendencies to disease. If that Avere its meaning, we apprehend that but few persons of middle age coiUd truthfully say they were in sound health." Of very similar purport was the charge to the jury in the case of Gaucher vs. Life Insur- ance Assn., 20 Fed. Rep. 596 : " The term ' good health,' as here used, does not import a perfect physical condition. It Avould not be reasonable to interpret it as meaning absolute exemption from all bodUy infirmities, or from aU tendencies to disease." Some very good dicta are laid down in the case of Peacock vs. Life Insurance Co., 20 N. Y. 293, 296. "The epithet 'good' is comparative. It does not require absolute perfection. When, therefore, one is described as being in good health, that does not necessarily nor ordinarily mean that he is absolutely free from aU and every iU AA'hich ' flesh is heir to/" THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 521 If the phrase should be so interpreted as to require entire exemption from physical ills, the number to whom it Avould be strictly apphcable Avould be very inconsiderable. In applying terms someAAdiat indefinite, reference should be had to the business to AA'hich they relate. This rule is very necessary when construing a language which, like ours, is defect- ive in precision. The most important question on apphcations for life in, surance is, Avhether the proponent is exempt from any dangerous disease- one which frequently terminates fatally. It is not usuaUy deemed an objec- tion that one has some slight physical disturbance, of AA'hich in all human probability he will soon be relieved, although it might possibly lead to a fatal disease. A slight difficulty, such as the sting of a bee, the puncture of a thorn, a boU, or a common cold, has sometimes induced complaints which have shortened human life; but this result is so infrequent and improbable that the mere possibility is disregarded in the business of life insurance." If any fault could be found with these exceUent obser- vations, it might be in the use of the word "frequently," AA'hich we have italicized. This objection, hoAvever, is practicaUy obviated by the rest of the quotation. An opinion Avhich was more open to criticism Avas rendered in the case of Brown vs. Life Insurance Co., 65 Mich. 306, 314. "The 'sound health' evidently meant in the application is a state of health free from any disease or ailment that affects the general soundness and healthfull- ness of the system seriously, not a mere temporary indisposition which does not tend to weaken or undermine the constitution of the assured. The instruction that the disease must be ' of serious nature' is objected to, and it may seem at first blush to be too strong a term to use; but it is difficult to see how a person can be in unsound health or unsound condition of boely or mind Avithout the disease that causes such condi- tion is a serious one. If the affliction is of a permanent character, it must certainly be a serious one; and if it is merely temporary, and to pass away Avithout serious results, it cannot,weU be said to render a per- son unsound in his general health. The Avord 'serious' is not generally useel to signify a dangerous condition, but rather to define a grave, im- portant, or Aveighty trouble." Against this we can say that there are numerous afflictions AA'hich are permanent but not serious, such as nasal catarrh, for example. Furthermore, lobar pneumonia is usually tempo- rary, the mortality being only about fifteen percent., and recovery being generally complete. But no one Avould say that this Avas not a serious disease, or that, Avhile it lasted, the individual was in sound health. Now let us suppose that the insured, at the time of making application, had some disease of which he Avas entirely ignorant, and which was not inquired about in the application; and let us also suppose that he Avar- ranted that he Avas in good health. Such a case Avas presented in Hutch- ison vs. Life Assurance Society, 3 Bigelow's Life and Ace. Ins. Rep. 444. The case was submitted to the Court of Session in Scotland with a note ' from the lord ordinary, in Avhich he said: " The defenders allege that there has been a breach of the warranty thus undertaken by the insured. And without going into the details, it avUI be found that their plea upon the Avarranty results in this: if it shall be proved that, at the date of opening the policy, Mrs. Armstrong Avas not health}', or free from dis- ease, but Avas affected by a particular disease (not being one of those1 par- ticularly mentioned, and in regard to which a special query was put and 522 A SYSTEM OF LEGAL MEDICINE. answer given), this amounts in law to a breach of Avarranty, although, to aU appearance, and so far as her knowledge went, she Avas at the time in perfect and robust health, and had no disease Avhatever; and although there may have been no negligence or want of attention to render her actual ignorance inexcusable, the disease alleged to have existeel never having exhibited itself, and being, AvhUe present in the frame, entirely undiscernible to all ordinary or even the most skiUfiU observation. . . . " Noav, holding that in construing the Avarranty the intention of the parties must be found out by a reference to the subject-matter, it is diffi- cult to see Iioav the declaration of the party insured, that 'I am iioav' (that is, at the date of the policy) 'in good health and do ordinarily enjoy good health,' can be held to import a Avai-ranty or undertaking by the policy that he is free not only from any disease which has positively affected his health, but from any latent disease tending to shorten life, although it has never sensibly affected his health; and that the decla- ration must be true in the latter sense in order to support the policy. Such a declaration, it is thought, in its natural and obA'ious meaning, imports an ansAver to an inquiry capable of being ansAvered by the party at whom it is made; and, therefore, has reference to the apparent and known condition, present or past, of the individual as respects his act- ual enjoyment of good or bad health, or to his positive experience in re- gard to health, and not to the possible existence of some disease, AA'hich, hoArever injurious in its character, has had no perceptible influence upon the health, or no influence which can impeach the truth of the declaration —applying it to the feelings and experience of the party—that he is in good health and ordinarily enjoys good health. To extend the warranty undertaken by such a declaration so as to make it embrace the latter case would be an excessive stretch of its meaning, if indeed it wUl, by any Adolence, admit of that meaning being put upon it." Further on in the same case Lord FuUerton makes these exceUent remarks : " Xi the term ' good health' means the perfect, conscious enjoy- ment of all one's faculties and functions, and the conscious freedom from any ailment affecting them, or any symptom of ailment, the epiestion may be asked and answered; but if the term is construed as meaning an ab- solute freedom from all defect or derangement, imperceptible as AveU as perceptible, the declaration is one which cannot be made, and Avhich it would, therefore, be absurd to ask. And AA'hen the defenders represent it as a Avarranty, nothing is gained in the inquiry, because the question occurs, 'What is it which was Avarranted? Good health;' and that just leads to the same inquiry, in AA'hat sense the term Avas employed; for, it will be observed, there is here no express Avarranty by Avhich a party may, and often does, take the risk of events or circumstances on AA'hich he possesses no present information. Here the AA'arranty is at best only im- plied from the term of a declaration, asked by one part}' and given by the other, and Avhich is made part of the contract; and* as the term i's used in mere declaration, its sense must be determined by that wliich it evidently bears in the passage containing it. The provision, that the declaration shall form the basis of the contract, may be held to render the declaration equivalent to a Avarranty; but still the point, Avhat is declared, and consequently, what is Avarranted, depends on the construction of the declaration, and in choosing between the two senses of the disputed term, according to one of which a party may declare, while, according THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 523, to the other, it would be absurd to ask and impossible to give a declara- tion, the former sense must, according to every rule of construction, be adopted." The court finally issued an interlocutor, in Avhich thev said that the declaration " I am now in good health, and do ordinarily *enjov good health " imports " a warranty only to the effect that the declarant AA'as and had been, according to her own knoAvledge and reasonable belief, free from any disease or from any symptom of disease material to the risk, and that they do not import a warranty against any latent and imperceptible disease, that coiUd oiUy be discovered by post-mortem examination, or from symptoms disclosing themselves at an after period of time." This decision was certainly very liberal to the insured, but it was completely transcended in the case of Life Association vs. Foster, 4 Bige- Ioav's Life and Ace. Rep. 520, and the doctrine expressed above Avas carried to an unreasonable length. In this case it appears that the in- sured had at the time of making apphcation, and for some months prior, a SAvelling in the groin, the existence of Avhich she kneAv. This Avas a hernia, which became strangulated and caused death Avithin six months of the time of taking out the policy. She was asked in the apphcation if she had rupture, and gave a negative answer, as she did not know the nature of the swelling in the groin. The following declaration was also made by her: "I undertake that, in the event of my having rupture, either now or at any other future time, I avUI constantly wear a properly adjusted truss." She did not comply with this declaration for the same reason, that of ignorance. The court held that there was no negligence on the part of the insured in not having mentioned the existence of the swelhng in the groin, since persons Avdthout medical knowledge could not be expected to knoAV that it Avas material, and that, as the answers Avei-e not absolute Avarranties, the pohcy Avas not avoided. It seems to us that the doctrine of irresponsibility from ignorance Avas carried to an extreme in this case, as the question about hernia Avas specifically asked and attention Avas again drawn to the subject by the declaration. The opinion given in these two Scotch decisions is radicaUy different from the decisions rendered in Enghsh cases. Thus in the case of Duekett vs. Williams, 3 Bigelow's Life and Ace. Ins. Rep. 8, it Avas decided that absolute truth must prevail. "A statement is not the less untrue because the party making it is not apprised of its untruth." But it must be noted, hoAvever, that the declarations in this case were made by third parties, and not by the insured. It might weU be held that in such a case, Avhere one states as a matter of fact that Avhich is not within his oavii knowledge, with a vieAv to induce another to enter into a contract, he does so at his own peril. Otherwise he should qualify his statements as being to the best of his knenvledge. The possibility of evaeling the issue is well shown in the case of Fowkes vs. Loan Assn., 3 Best and S. 917. Here the proposal and decla- ration contained the proviso that if " any fraudulent concealment or de- signedly untrue statement be contained therein," the policy should be null and A'oid. Although the statements of the insured were Avarranted, it Avas held that an untrue statement about good health did not avoid the policy unless it Avas designedly untrue. Freedom from Disease.—This is another phase of the question just discussed. The insured states that he is free from some disease, specif- 524 A SYSTEM OF LEGAL MEDICINE. ically mentioned, or from any serious iUness. Of course the question arises, What constitutes a serious iUness ? Very good limitations Avere given in the case of Goueher vs. Life Insurance Assn., 20 Fed. Rep. 596, Avhere it Avas said that " clearly the term ' severe' or ' serious' illness does not mean slight temporary physical disturbances or aUments, speedily and entirely recoA'ered from, not materially interfering with the pursuit of one's avocation, producing no permanent effect on the constitution, and not rendering the insurance risk more than usually hazardous." The cases under this head can be divided into three groups. In one the contract is construed liberally in favor of the insured, he being usually held more or less irresponsible on account of ignorance. In the second group the statements are held to be warranties and the contract is interpreted A'ery rigidly. In a third set there is evidence that the in- sured knew of the existence of the defects or diseases, and, so knowing, misrepresented them. We aa'UI discuss each group separately. 1. One of the earliest cases decided in this group was that of Life Insurance Co. vs. Francisco, 17 WaU. 672, 680. "The principal defense set up at the trial was that in the application for insurance false aiisAvers had been given to the questions propounded by the defendants. These questions were, in substance, whether the person whose life was proposed for insurance had had certain diseases, or, during the next preceding seven years, any disease, and the answers given were that he had not. It was in reference to this that the court instructed the jury that it was for them to determine from the evidence whether the person whose life was insured had had, during the time mentioned in the questions propounded on making the application, any affliction that could properly be called a sickness or disease, Avithin the meaning of the term as used, and said: ' For example, a man might have a slight cold in the head, or a slight headache, that in no way seriously affected his health or interfered Avith his usual avocations, and might be forgotten in a week or month, which might be of so trifling a character as not to constitute a sickness or a disease within the meaning of the term as used, and which the party would not be required to mention in answering the questions. But again, he might have a cold or a headache of so serious a character as to be1 a sick- ness or disease AA'ithin the meaning of those terms as used, Avhich it Avould be his duty to mention, and a failure to mention AA'hich would make his answer false.' " There is no just ground of complaint in this instruction, either con- sidered abstractly or in its application to the evidence in the case. It was, in effect, saying that substantial truth in the answer Avas Avhat Avas required." The argument advanced in the preceding opinion has many points in its favor. But a little extension of the same idea borders on the unrea- sonable. The same court, in the later case of Moulor vs. Life Insurance Co., Ill U. S. 335, 343, went to much greater length in this question. The declarations made by the insured were to the effect that statements " untrue in any respect" Avould avoid the policy. There was considerable proof that some of the diseases mentioned in the application had existed, although possibly unknown to the insured. By some adroit word-jug- gling the statements denying the existence of these diseases were con- verted into representations only, and it was then held as follows : " Look- ing into the application upon the faith of which the pohcy was issued and THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 525 accepted, avc find much justifying the conclusion that the company did not require the insured to do more, when applying for insurance, than observe the utmost good faith, and deal fairly and honestly Avith it, in re- spect of aU material facts about which inquiry is made, and as to AA'hich he has or should be presumed to have knowledge or information. The applicant was required to ansAver yes or no as to Avhether he had been afflicted with certain diseases. In'respect of some of those diseases, par- ticularly consumption and diseases of the lungs, heart, and other internal organs, common experience informs us that an individual may have them, in active form, Avithout at the time being conscious of the fact, and be- yond the power of any one, however learned or skillful, to discover. Did the company expect, AA'hen reepiiring categorical answers as to the exist- ence of diseases of that character, the applicant should ansAver Avith abso- lute certainty about matters of Avhich certainty could not possibly be predicated ? Did it intend to put upon him the* responsibihty of know- ing that Avhich, perhaps, no one, hoAvever thoroughly trained in the study of human diseases, could possibly ascertain ? . . . "The entire argument in behalf of the company proceeds upon a too literal interpretation of those clauses in the policy and apphcation which declare the contract null and void if the answers of the insured to the epiestions propounded to him were, in any respect, untrue. What was meant by ' true' and ' untrue' ansAvers ? In one sense that only is true Avhich is conformable to the actual state of things. In that sense, a statement is untrue Avhich tloes not express things exactly as they are. But in another and a broader sense the word ' true' is often used as a synonym of honest, sincere, not fraudulent." Hence it was held that aU that was required of the applicant was the utmost good faith in ansAvering the questions. This seems rather stretch- ing the meaning of " true," especially in view of the declaration made by the insured that statements "untrue in any respect" should avoid the policy. In the case of Horn vs. Life Insurance Co., 64 Barb. 81, this uoav familiar doctrine of irresponsibility from ignorance Avas carried to a still further point. " The applicant may not know enough of the human sys- tem to be aAvare of the existence of some affection of a vital organ. The victim of Bright's disease, or of an affection of the heart, liver, or lungs, may lie, and often is, in the enjoyment of such a condition of health and strength as to lead him to the belief that his Adtal organs are all sound. It Avould be monstrous to hold, in such a case, that the applicant Avar- ranted himself to be sound as to those organs by an ansAver to the effect that he Avas never sick, or had no disease of those organs. The company retains their OAvn medical advisers for the purpose of making a careful and scientific examination of all applicants for life insurance ; and the}' are far better able to detect incipient disease than the subject, in most cases. I think these statements are not understood or intended by the parties as Avarranties. I think the judge at the trial properly held that the inquiry AA'as one of honest and fair dealing on the part of the appli- cant, and that the statements concerning the condition of his health AA-ere not Avarranties. . . . " The assured must state all that he knows bearing upon the condi- tion of his health; and any untrue statement or concealment in this re- spect ought, justly, to render the policy void. In all respects, where it 526 A SYSTEM OF LEGAL MEDICINE. appears, or it can be proven, that the applicant had any knowledge of the facts caUed for by the interrogatories, it matters very little whether the ansAver be held a AA'arranty or not, inasmuch as an untrue statement will be a misrepresentation or fraud Avhich will equaUy render the pohcy void." This is not an inequitable doctrine if strictly applied. Under it the AA'hole burden of proving a man sound would be throAvn upon the medical ex- aminer ; but it is AveU knoAvn that in the early stages of the diseases men- tioned above, especially consumption and Blight's disease, the diagnosis can hardly be made Avithout material assistance from the patient by in- forming the physician of every little symptom that he has. It is absurd to expect that an applicant for insurance avUI render such aid. On the contrary, he undergoes a species of self-deception and glosses over all that he can, even though he knoAvs that he is not as strong as he has been. He does not do this exactly AA'Ulfully or consciously, but still he does it. The result is that, unless these principles are very strictly ap- plied, the company has to bear aU the burden of the concealment of Ids condition. This often does not seem fan, nor Avhat is reasonably to be expected by the insurer. For if it can be proved by collateral cA'idence that the insured had a certain disease prior to the time of examination, it seems reasonable to assume that, if he had fully and accurately told the examiner aU his symptoms, the examiner Avould have been able to make the correct diagnosis by means of them and the physical signs which his examination woulel elucidate. We have seen in many of the preceding cases that a strong endeavor was made to take the declarations and statements of the applicant out of the category of warranties through some wording of the clauses of the contract. This is notably the case in some of the American decisions, and in the Scotch cases brutal force was exerted to make the statements representations. This principle Avas very properly applied, however, in the case of Benevolent Soeiety vs. Winthrop, 85 IU. 537. The declaration contained the words "no misrepresentation or suppression of knoAvn facts." The court held that the contract should be construed in just this manner, and that the concealment must be a wUlful one in order to avoid the policy. SimUarly in the case of Clapp vs. Benefit Assn., 146 Mass. 519, the ap- phcant certified his statements " to the best of my knoAvledge and belief." It was held that this element of the applicant's knowledge must be con- sidered in aU his ansAvers. 2. In this set of cases the statements of the insured have been held to be absolute warranties. There are no mitigating expressions in the contract and no doctrine of irresponsible ignorance Avhich would tend to excuse the misstatements of the insured. These decisions seem to bear hardly at times upon the insured, and the tendency of the courts at pres- ent is undoubtedly toAvard the other interpretation. One of the stiffest decisions in this set is that given in the case of Powers et at. vs. Life Association, 50 Vt. 630. It was proven that the applicant had had heart disease for seven years prior to the application for a policy, although he very possibly might not have known it. It was held that the ansAvers AA-ere Avarranties, and hence that " the applicant assumed the whole risk of the conseeiuences if his ansAvers turned out untrue. The existence of disease in an apphcant for life insurance is the presence of the very perU that the company insures against. It is like insuring a building aheady THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 527 on fire. The question as to the health of the applicant is a preliminary one, to ascertain if he is an insurable subject. The force of the stipula- tions and conditions above recited is, to create a contract obligation on the part of the applicant that he Avas free from heart disease. He agreed that such peril and risk woidel not be encountered by issuing the policy, and if such peril did exist the contract should not be operative. Proof of the existence of heart disease established a breach of the underlying contract upon which the policy rested. "It is Avholly immaterial whether the applicant knew of the existence of the disease, because1 he agreed absolutely that it did not exist. Nor is it any answer to say that the question is a scientific one, and a layman might easily be deceiA'ed into a false ansAver. Scientific or simple, the applicant took the risk of the ansAver. If he had ansAvered that he had no knoAA'ledge that the disease existed, the finding of the jury might affect the result." Of very similar import was the decision rendered in the case of Day A's. Life Insurance Co., 4 BigeloAv's Life and Ace. Rep. 15, 23. "We are of the opinion that if the statements made by Day in the application, being part of the contract to procure the policy, were untrue in point of fact, the contract became null and void. This results from the form of the contract. It Avas evidently the design to protect the company from the ignorance, as well as the wUlful misrepresentations, of those applying for insurance. If, for instance, Day did not know or suppose that he had consumption, although in point of fact that fatal disease had already seized upon his lungs, his statements would be contrary to fact in an im- portant respect, for no company would insure a life subject to so much risk. It Avould be untrue as matter of fact, and therefore fatal to the contract." In the case of Price vs. Life Insurance Co., 17 Minn. 473, one of the important rulings given by the Appellate Court was as follows: " But if he had any affection amounting to a disease of the kind mentioned, his negative ansAver Avould be a material misrepresentation, no matter how ' trifling' the character of the affection, nor whether it Avas remembered at the time of the application, nor Avhether it would have any influence on the length of his hfe, nor whether it Avould be noticed by the medical examiner." In the case of Baker vs. Life Insurance Co., 64 N. Y. 648, the court affirmed the rule that the policy having been issued upon the condition that, if the statements should be found untrue, the policy should be void, the untruthfulness of such statements avoided the policy, and it was immaterial Avhether they were made in ignorance or fraudulently. The statements in the application were Avarranties, but there was some evi- dence that the applicant knoAvingly misrepresented the facts, or that the ignorance amounted to culpability. This circumstance possibly deter- mined the severity of the opinion. SimUar considerations may have influenced the court in the case of Miles et at. vs. Life Insurance Co., 3 Gray 580. Here it Avas provided that if the statements of the insured, " upon the faith of which this agreement is made, shall be found in any respect untrue, then and in such case the policy shall be null and void."' Testimony was presented that the insured for some time before the application had been troubled with bronchitis and consumption; that his father had elied of consumption, and his brother 52$ A SYSTEM OF LEGAL MEDICINE. had been afflicted with some pulmonary trouble. He had denied all of these facts when making application, although possibly he Avas not aware of their existence. The court held that "the statements and declarations contained in the application for insurance, and referred to in the policy, Avere Avarranties; and if any of them, AA'hether material or immaterial to the risk, Avere untrue, either from design, mistake, or ignorance, the plaint- iffs cannot recover." A simUar epiestion Avas raised in the case of Vose vs. Life Insurance Co., 6 Cush. 42. Here the applicant died of consumption soon after the policy was issued. It Avas proven that he had the disease prior to the elate of examination, although it Avas possible that lie did not knoAV it. The case Avas carried to the AppeUate Court, and it Avas there held that "it is immaterial that the deceased did not suppose himself in a consump- tion ; the fact Avas so, and the statement Avas manifestly contrary to the fact, which \vas a most material and conclusiA'e fact." In the application he stated that he had had some general debility lately, but the court ruled that " the fact of the general debility- of the system, as stated by the insured, Avas not important in the manner in AA'hich it Avas stated; as it might arise from a A-ariety of causes not materially affecting the risk, and Avould not, therefore, by any means, give the insurers the informa- tion Avanted." 3. In the second set of cases it Avas noticed that the scA'erity of sonic of the decisions Avas influenced by the suspicion that the insured knew something of his condition before he applied for insurance. The third set of cases comprise those in which there is good evidence that the mis- representation or concealment concerning health or previous disease Avas of facts knoAvn to the applicant, or that should haA'e been knoAvn to him in all reasonable probability. Under these circumstances the courts are usuaUy A'ery seA'ere in their decisions, anel hold the insured closely to the line of his contract. In many of them high-sounding principles are laid down Avhich do not weU agree Avith those offered in the cases Avhere irre- sponsible ignorance is aclA'anced as a palliative. Thus, compare the opinion given in Moulor vs. Life Insurance Co. (p. 524) AA'ith that given in the case of Life Insurance Co. vs. France et at, 91 U. S. 510. Here it AA'as proved that the insured Avas ruptured in 1X46, in 1854, and in 1870, al- though from 1855 until after the examination in 1865 he1 Avas compara- tively, if not absolutely, free from rupture. He Avas asked directly if he had ever had rupture, and denied it, There Avas no dispute that the in- sured kneAv that he had had a rupture prior to the time of making the application. Consequently the misrepresentation Avas one of facts known to him, even if it happened by accident. The court reA'ieAved the case- of Jeffries vs. Life Insurance Co., 22 Wall. 47, and said: " It is only necessary to reiterate that all the statements contained in the proposal must be true; that the materiality of such statements is removed from the con- sideration of the court or jury by the agreement of the parties that such statements are absolutely true, and that, if untrue in any respect, the policy shaU be A-oid." Cancer.—By this term noAvadays is meant the careinomata, and on a strict construction Ave think it should be limited to that group of neo- plasms. Thus Payne says (General Pathology, p. 239): " The term cancer, AA'hich AA-as formerly used in a clinical or physiological sense to signify tumors haA-ing the properties called malignant, is now a structural or ana- THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 529 tomical term, meaning tumors arising from epithelial tissues, and com- posed of epithelial cells irregularly arranged." Greene (Pathology and Mor- bidAnatomy) and also Satterthwaite (Reference Handbook of the Medical Sciences, vol. i.) use the term in a similar Avay. Some other tumors are fully as malignant as the carcinomata. Only one case could be found in Avhich the question of cancer arose. That is the case of Cheever vs. Life Insurance Co., 5 BigeloAv's Life and Ace. Cases 458. In it only the clinical aspects of the malignancy of the cancer Avere considered, and its histology Avas entirely overlooked. One or two years prior to the date of policy the apphcant had a malignant tumor or cancer on his needs, Avhich Avas made the subject of a medical consultation, at AA'hich it was determined to perform an operation. He changed his mind, however, and went to a quack, avIio healed up the open sore. Three years after the policy was issued the cancer recurred at the original site, and was operated on, but the insured died. The jury gave the usual verdict. On appeal the court held that the state- ments were only material representations, but said: " The point for the determination of the jury really Avas Avhether or not the recurrence of the cancer or tumor Avas the reappearance of the old trouble, or Avhether it was a new and distinct ailment occurring after the insurance Avas effected. If the former, there1 should have been a verdict for the defendant; if the latter, for the plaintiff. The court instructed the jury in effect, that if the party had once supposeel and been told that he had cancer, and in alarm had engageel physicians to treat it as such, and they did so, but that after it healed they aeb-ised him that it Avas not a cancer or a seri- ous aUment, and he beheA'ed them, and in fact it was not AA'hat he and they once thought and feared, lie Avas excused from stating the facts, the same as he Avould have been had he, from eating green fruit or A'egetables during the prevalence of cholera, been attacked with acute cholera mor- bus, and, in his alarm, caUed in scweral physicians to treat him, and aaIio at the time thought his disease Avas cholera, but that all afterward ascer- tained the trivial nature of the complaint. But avc think that the evidence established clearly that the insured had been, prior to his application, afflicted with a malignant fibroid tumor or cancer; that treatment had simply arrested it for a time Avithout removing it from his system; and that it reappeared and caused his death. If Ave are right, he misrepresented the fact, though, as Ave think, innocently, under the belief that his ailment had been trivial, producing more of fright than of danger. But the effect of a misrepresentation of a material and positive fact, upon AA'hich an insurer relies, does not depend upon the good faith or honest belief of the appli- cant making the representation. Such representations must be true; anel if not so, substantially, the liabUity of the insurer will be a A-oided AA'here the truth of such representation is made the basis of the contract of insurance." Under the construction of this decision, any malignant tumor would be included under the term " cancer." While this is incorrect anatomi- cally, it probably represents the idea of the framer of the application, it being rather an old one. Hence the decision, although it might he tech- nically incorrect, is prol (ably in consonance Avith the ideas preA'alent at the time the contract Avas consummated. Consumption.— This is a term which is supposed to refer to seAreral varieties of tuberculosis, especially pulmonary, laryngeal, and intestinal. It does not seem proper to embrace the other varieties of tuberculosis 530 A SYSTEM OF LEGAL MEDICINE. within this designation. There are, however, several synonyms used by the laity which it is necessary to mention. These are hemorrhage of the lungs, abscess of the lungs, disease of the lungs, and chronic pneumonia. These terms are largely used by them in stating the cause of death of other members of the famUy. From the experience of a life insurance office Ave can safely say that they practically ahvays mean consumption. Consumption is a more frequent cause of death than any other disease. xVbout fifteen percent, of aU deaths are to be traceel to this. When adults only are considered, this proportion reaches nearly one third. It is so common and AA'idespread that all insurance companies guard as carefully as they can against admitting cases of it. The effect of this selection is very marked anel important, but not complete. The method of examina- tion as usuaUy practiced by Ufe insurance examiners is not sufficiently thorough to eliminate entirely this risk. It is no easy matter to detect, at times, the signs of incipient phthisis even under the most favorable cir- cumstances and when the attention is drawn to it by the history of the patient. Hoav much more difficult is it when the patient denies or con- ceals all pulmonary symptoms? But this selection of risks has a decided influence on diminishing loss to the insurer from this disease, as can be seen by the folloAving table (Mortuary Statistics of the Mutual Life Insur- ance Company of New York, part ii.): SHOWING THE ANNUAL NUMBER OF DEATHS FROM CONSUMPTION IN NEW YORK CITY AND IN THE MUTUAL LIFE, CALCULATED FOR 10,000 LIVING AT EACH DECENNIAL PERIOD OF LIFE. Age in Decennial Periods. New York City. Mutual Life. 20 to 29 years....................... 70 24 30 to 39 years....................... 71 20 40 to 49 years....................... 66 17 50 to 59 years....................... 84 14 60 to 69 years....................... 110 18 70 and upward...................... 150 30 This table shows also how mistaken is the common impression that consumption is more prevalent between the ages of fifteen and thirty. To quote further from this statistical report: " This prevailing but erro- neous opinion has originated, as suggested by Dr. Walshe, from merely counting the number of cases occurring at each year, or period of life, Avithout taking into consideration the number of individuals hving at cor- responding ages to furnish the observed number of cases. For instance, there are nearly three times as many persons living at the ages of tAventy to thirty years as at fifty to sixty years, and consequently, three times as many cases of consumption at the earlier period as at the later Avould only indicate an equal prevalence of the disease at both periods." Undoubtedly many applicants are insured Avhile the}- are in the first stages of phthisis. They find out that they have some trouble Avhich is steadily debUitating them, but to which they do not care to give a name. Their own doctor is ignorant or deceives them. But they knoAV that they are not capable of doing as much work as formerly, and that their physical health is deteriorating. For this reason they seek to make sure of some future means of sustenance for their famihes, realizing, probably in a vague wav, that they are no longer certain of an apparently indef- inite term of hfe. In this mood thev come to obtain insurance, if they THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 531 can. But like the man whose toothache fled when he reached a dentist's door, their ideas on the subject of Ul health undergo a radical change when it comes to telhng their symptoms to the medical examiner. As a rule they do not intend to deceive, but the little trifles, Avhich make up the early history in many cases of consumption, do not seem to be of sufficient importance to teU the examiner. They have not been told that they have phthisis, and of course they do not know it themselves, so AA'hat is the use of bothering the examiner with these petty details about a little dry cough, some loss of weight, and an occasional pain in the chest? Besides that, he is going to examine their lungs, and it is his business to find out if there is anything wrong there. And the old story is repeated in about six months or a year. The proofs of his death are handed in, the company looks up the case, and unless they find evidence of gross fraud, the death-claim is paid without protest, for the futility of an ap- peal to the jury, in such cases, is too AveU known to the loss department. In the case of Vose vs. Insurance Co., 6 Cush. 42, quoted on p. 528, the evidence was fairly conclusive that the applicant kneAv that he Avas quite sick, even if he did not know that he had consumption, of AA'hich he died soon after the issuing of a policy. The jury gave the usual verdict for the plaintiff, but on appeal it was held as foIIoavs : " It is immaterial that the insured did not suppose himself in a consumption; the fact Avas so, anel the statement was manifestly contrary to the fact, which was a most material anel conclusive fact. The fact of the general debility of the system, stated by the insured, was not important in the manner in wliich it Avas stated, as it might arise from a A'ariety of causes not materially affecting the risk, and would not, therefore, by any means give the in- surers the information wanted. The insured was asked directly whether he Avas at the time affected Avith an}- disease or disorder, and what; to Avhich he ansAvered that he could not say he Avas afflicted with any disease or disorder; but he could have stated the symptoms of consumption, which he had, and Avhich he knew he had, and wliich he had had for five months previous; and which were most certainly material and impor- tant to be known by the insurers. It is believed that omissions or con- cealments less important than this, and Avithout any intentional fraud, haA'e^ been held to avoid policies upon hfe." It is doubtful, however, if this opinion would be held to apply unless the evidence was reasonably conclusive that the applicant knew he was suffering from some iUness at the time of examination. OtherAvise there would be a doubt as to the commencement of the Ulness. In the case of Glutting vs. Insurance Co., 50 N. J. L. 287, and also in Life Insurance Co. vs. Dempsey, 72 Md. 288, there was apparently conceal- ment of the symptoms and existence of phthisis, and on appeal the ver- dict of the jury Avas reversed. An interesting point was decided in the case of Scoles vs. Life Insiw- ance Co., 42 Cal. 523. The question in the application Avas : " Have you had any serious illness, local disease, or personal injury; and if so, of AA-hat nature, and Iioav long since ?" Answer, " Not any." It Avas proven that he had consumption, Avhich Avas defined as tubercles on the lungs, and also tubercles on the brain. On appeal it Avas held that these would come clearly Avithin the definition of " a local disease." To this there can be no exception, for, although general miliary tuberculosis Avould probably be considered a constitutional disease in the same sense that 532 A SYSTEM OF LEGAL MEDICINE. typhoid fever is, this is quite rare, and certainly other manifestations of tuberculosis are local. Hemoptysis.—This is so striking a symptom, that its preexistence is almost ahvays asked by the companies. Fm-thermore, it is one that can hardly be overlooked by the subject. The question is variously Avorded, the more common Avars being "spitting of blood," "raising of blood," "coughing of blood," for it is reasonable to suppose that but few of the laity Avould understand Avhat hemoptysis meant. As the question is usuaUy put, it covers all source's of the hemorrhage from the lips and nose down to the pulmonary alveoli and the stomach itself, except AA'hen the term "coughing" is used. This way of wording the question is A^ery comprehensive, but is more satis- factory to the companies; for many patients, if there is no further trouble from the hemorrhage within a short time, are apt to persuade themselves that the origin of it Avas something trivial, such as a sore gum or an inflamed pharynx. As a symptom, it indicates in the large majority of cases some tuber- culous affection of the throat or lungs. It may be due to a variety of other causes, but they sink into insignificance as compared Avith this. The table (Mortuary Statistics of the Mutual Life Insurance Company of New York, part ii.) from which the foUowing quotations are taken has considerable value in this connection, for it is founded upon the state- ments of the laity themselves and their beliefs. The records of the cases were then submitted to careful medical scrutiny. All the doubtful ones, especially those in Avhich there was any family history of phthisis, Avere carefuUy eliminated. The conclusions herewith given are only based upon those subjects which, after all these precautions to exclude the possibility of future phthisis, were finaUy accepted. The conclusions were as foUoavs : " The general ratio of the consumption mortality Avas 19.74 percent, while in these cases it is 34.92 percent., or nearly double. ... Of the total 63 cases of hemoptysis, the date of its occurrence is stated in 39; in 13 cases the date of the hemorrhage Avas within seven years, in 22 cases AAdthin ten years. Of those occurring within seven years, 9, or C9 percent., died of consumption; of those occurring Avithin ten years, 13, or 58.18 percent.; Avhile in those cases in Avhich the date of the hemorrhage Avas more than ten years before insurance, only 18.75 percent, died of consumption. ... In less than half the cases the supposed source or cause of the hemorrhage is given, and in the majority of these it Avas re- ported as slight, as coming from the throat and nose, or as the result of an injury or excessive exertion. These explanations are mostly given in the consumptive cases, and our experience shows that statements indi- cating the cause of the hemorrhage are usually iintrustAvorthy, as the patient always, anel the physician sometimes, are apt to delude themselves Avith the most hopefiU views." These statements show how important an influence hemoptysis exerts upon the risk even after seven years. Hence the knowledge of its exist- ence is of prime importance to the correct estimation of the prospect for longerity. Therefore, no matter how insignificant it may have been, it should be carefuUy stated in all cases. This opinion has good legal authority, for in the case of Life Insurance Co. vs. Miller, 39 Ind. 475, it was held that: " Whether the hemorrhage proceeded from one cause or THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 533 another, it was material and necessary that the statement in answer to the epiestion relating to it should have'been true." This AA'as more elaborately considered in the case of Geach vs. Ingalls, 14 M. and W. 95, and the folloAving extracts from the opinions of the three judges avIio sat on the case are given as shoAving slight variations. Pollock, C. B.: "By the expression 'spitting of blood' is, no doubt, meant the disorder so called, Avhether proceeding from the lungs, the stomach, or any other part of the body; stUl, hoAvever, one single act of spitting of blood Avould be sufficient to put the insurers on inquiry as to the cause of it, and ought therefore to be stated." Alderson, B.: " By spitting of blood must, no doubt, be understood a spitting of blood as a symptom of disease tending to shorten hfe; the mere fact is nothing: a man cannot have a tooth puUed out Avithout spitting blooel. But, on the other hand, if* a person has an habitual spitting of blood, although he cannot fix the particular part of his frame from AAdienee it proceeds, still, as this sIioavs a Aveakness of some organ AA'hich contains blood, he ought to communicate the fact to the insurance company, for no one can doubt that it Avould most materially assist them in deciding Avhether they should execute the policy; and good faith ought to be kept AA'ith them. So, if he had had spitting of blood only once, but that once Avas the result of the disease called spitting of blood, he ought to state it, and his not doing so would probably avoid the policy." Rolfe, B.: "I luree no doubt that, if a man had spit blood from his lungs, no matter in hoAv small a quantity, or even had spit blood from an ulcerated sore throat, he would be bound to state it. The fact should be made knoAvn to the office, in order that their medical adviser might make inquiry into its cause." To one point in these opinions Ave must take exception. There is no such disease as " spitting of blooel," unless by this is meant that the blood comes from a diseased organ. It should be distinctly understood that hemoptysis is in aU cases only a symptom, whether of a wound or of a diseased viscus. There may even be hemoptysis Avithout any wound or disease, such as that occurring in A'icarious menstruation, but these latter cases are notoriously short-liA'eel, and the hemoptyses certainly cannot be caUeel a elisease in these eases. In A'iew of these facts the ex- istence of a single hemoptysis should be carefully stated, although by a cpiibble the contrary Avas held in the case of Dreier vs. Life Insurance Co., 24 Feel. Kep. G70. The epiestion in the application AA'as: "Has the party had any of the folioAA'ing complaints ? . . . Spitting or raising of blooel?" AnsAver, "Xo." It AA'as held that: "There is no Avarranty in this case that the insured never had spitting or raising of blood, but only that he had not had the complaint of spitting or raising blood, equiva- lent to a Avarranty that he had not blood-spitting in such form as to be caUed a disease, disorder, or constitutional vice. ... If the question had 1 teen put to the applicant for insurance AA'hether or not he had had any spitting of blood, or had had any symptom of disease, such as spit- ting or raising of blood, it would doubtless have required the disclosure of a single instance of blood-spitting." It cannot be too strongly insisted upon that one single hemoptysis constitutes evidence of disease; for, to repeat, it is only the symptom of a disease, unless it comes from a wound. The disease may be trifling or grave, but that is for the company to judge. 534 A SYSTEM OF LEGAL MEDICINE. Even more liberal is the opinion given in the case of Singleton vs. Life Insurance Co., 27 Am. Rep. 321, 326, as folloAvs: "We think eAddence properly admissible to show in what sense the term ' spitting of blood' Avas used in the application. Without any evidence of the meaning of that term, the court might properly have instructed the1 jury that spitting of blood in consequence of a drawn tooth, or a cut on the gums, was not meant by that term, and yet if Anderson had spit blood from such trivial causes, literally the ansAver to his question Avould have been false. . . . There is something ambiguous in the term < spitting of blood.' Literally the meaning is spitting of blood, Avhether from the teeth, gums, or lungs, but it would be absurd to hold that sense in the application." Against these Ave can set, in pleasing contrast, the decision in the recent case of Bancroft vs. Benefit Association, 12 N. Y. Supp. 718. Here it was proven that the insured, about one year before the issue of the policy, spat a little blood after a fencing-bout; and that this Avas after- Avarcl considered to be due to a slight injury to his larynx from the foU. He denied this fact of the hemoptysis in his application. His statements Avere held to be Avarranties; it was found that " the said Bancroft was afflicted with the complaint of spitting of blood." This was sustained on appeal to the General Term. Fits.—This term unfortunately is one that is used in a good many of the older apphcations. It is so indefinite and vague that it has no stand- ing medicaUy. The present tendency is to construe it as referring to epileptic convulsions alone. Thus the definition in the Century Diction- ary is: " An attack of convulsive disease; a muscular convulsion, often Avith loss of self-control and unconsciousness; spasm; specifically, an epileptic attack." In the old apphcations some importance was attached to it. As the distinction between the different varieties of spasms was not then weU understood, the term probably then included other convulsions than epUeptic. The use of the word in former times is well shoAvn in the case of Chattoek vs. Shaive et at., 3 Bigelow's Life and Ace. Ins. Rep. 10. One Griswolcl Avas insured in 1831 and then stated that he Avas "in a sound and perfect state of health, and has not been afflicted Avith, nor is subject to, gout, A-ertigo, fits, hemorrhage, dropsy, etc." It was proven that he had had two fits, of an epileptic character, in 1827, but testimony was offered to show that they Avere the result of an injury to the head. The judge, in his charge to the jury, said: " The interpretation I put on a clause of this kind is, not that the party never accidentally had a fit, but that he was not, at the time of the insurance being made, a person habitually or constitutionaUy afflicted Avith fits; or a person liable to fits from some peculiarity of temperament, either natural or contracted from some cause or other during life." Dyspepsia.—From a medical point of view, dyspepsia, strictly speak- ing, is of little consequence unless seA'ere. The ordinary form, which every one has after eating too much or too rich food, has but little effect upon the expectation of life. If it becomes a chronic condition, its influence is more marked, not necessarily serious, howeA-er. But in many of these cases the term "dyspepsia" is used to coA'er more decided organic changes, such as chronic gastritis or eA'en gastric cancer. It is, therefore, of some little importance to describe this condition with care THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 535 and accuracy, for it, associated with other conditions, might be sufficient to cause rejection. OAAdng probably to the misuse of the terms, dyspep- tics are less desirable risks, and do not as a class come up to their expec- tation. We think that the opinion expressed in the case of Morrison vs. Insurance Co., 59 Wis. 162, is excellent: "A touch of dyspepsia coining on, Avhich manifests itself only after long intervals, AA'hich yields readily to treatment, and AA'hich is not shown to have been organic and excessive, is not inconsistent Avith a representation that a person is in sound health, as that term is employed in contracts for life insurance ! " If the state- ments Avere Avarranties, it might be held otherwise ; but eA'en in this case it would seem correct to make the exception. A man in this day and generation can hardly remember ever}- little attack of indigestion or dyspepsia, or reasonably be supposed to. In this connection the terms "dyspepsia" and "indigestion" should be considered synonyms, for the distinctions and differences betAveen them are practically nil. Thus WU- son Fox (Reynold's System of Medicine, A'ol. iii.) uses them interchangeably with perfect freedom. The examiner must bear in mind that they are, after all, nothing but symptoms, and must closely question the applicant to see if there is a possibility of any organic lesion being present. Disease of Heart.—Under this head Avould be naturahy included all the lesions of the coverings of the heart, inside and out, as weU as of the muscle substance, and eA^en the functional diseases of the heart would properly be grouped here. It is hardly necessary to state that the term heart-burn is a symptom of a gastric disorder exclusively, and has no relation to the heart except in the situation of the pain. The possibihty of well-marked heart disease being present without the knowledge of the indiAddual is thoroughly established. This is, of course, eA'en more true of the lesser grades of cardiac involvement. Our oavii experience is that many cases are not recognized by the individuals from any symptoms AA'hich the heart gives rise to. Vahudar disease can generaUy be diagnosticated on careful physical examination, although occasionaUy the murmur may be slight or even absent for some time. Other forms of cardiac trouble, such as adherent pericardium, myocar- ditis, etc., hardly admit of diagnosis Avithout careful edaboration of the symptoms beforehand. This is also true of many of the functional forms Avhich appear only at intervals, such as palpitation, angina pectoris, and paroxysmal tachycardia. Unless the individual is seen in an attack of one of these his condition can only be discoA'ered by carefid study of the symptoms as related by himself. If the huhVidual kneAv that he had heart disease at the time of the examination and AviUfuUy concealed the fact, it Avould be fraudulent. If he felt distinct symptoms from it but did not knoAV AA'hence they origi- nated, the suppression of these symptoms would probably be considered a material misrepresentation, conformably to the rule laid down in Vose vs. Insurance Co., 6 dish. 42. But suppose that it had given rise to no symptoms noticeable to the applicant, and he had not been informed of its existence. We could find but one case bearing directly on this point; that is the case of Powers et at, vs. Life Insurance Association, 50 Yt. 630. It appears in this ease that the applicant had been examined several years before for a pension, and at that time the heart disease was discov- ered but not mentioned to him. The life insurance examiner confessedly made a hurried examination, and did not detect the lesion. The appli- 536 A SYSTEM OF LEGAL MEDICINE. cant died soon after, and on the trial these facts Avere brought out. In the AppeUate Court it Avas held to be " Avholly immaterial Avhether the ap- plicant knew of the existence of the disease, because he agreed absolutely that it did not exist. Xor is it any ansAver to say that the question is a scientific one, and a layman might be deceived into a false ansAver. Scientific or simple, the apphcant took the risk of the ansAver." This was construed thus literally because the statements of the applicant Avere considered to be absolute Avarranties. In most cases of this kind the language of the contract Avould be scanned A'ery closely to see if the Avar- ranties coiUd not be converted into representations, or if there Avere not some modifying Avords to break the force of an absolute warranty, in accordance with the established legal custom. Rheumatism.—This is a term in Avhich are included a number of conditions. MedicaUy, it is often used Avith an excess of freedom ; and httle aches and pains in joints and muscles are often spoken of as " rheu- matic" AA'hen they hardly amount to any disease. Included under this designation "rheumatism" are the foUoAving diseases: acute articular rheumatism, subacute articular rheumatism, chronic articular rheuma- tism, gonorrhceal rheumatism, and probably the rheumatism associated Avith certain infectious diseases, such as scarlet fever and puerperal feAer, even though these latter may be due to septic poisoning. It is very d< ml d- ful if the so-caUed muscular rheumatism should be grouped under this head. On this point authorities are much divided. Flint (Practice of Medicine) calls muscular rheumatism "myalgia," and groups it Avith diseases of the nerves. Further he says (p. 807): " The term rheumatism, as applied to these affections, is manifestly inappropriate, and it is de- sirable that the name in this application should become obsolete." On the other hand, Strumpell (Textbook of Medicine) speaks of it in connec- tion Avith the other rheumatisms, but he says (p. 863): " The tAvo diseases [acute articular rheumatism anel muscular rheumatism], therefore, are alike only in certain symptoms and in the fact that they are often, though not ahvays, ascribable to Avet or cold and the like." Part of the importance of rheumatism from a life insurance point of vieAV consists in its tendency to recurrence and its liability to invade the heart. This latter is more especiaUy applicable to the acute and sub- acute articular rheumatism. Concerning the influence of the subacute forms on the heart, most Avriters are agreed. Thus Garrod (Reynold's System of Medicine, vol. i.) says: "As far as my oaaui experience goes, it amounts to this, namely, that although the seiverer forms of the articular disease are A'ery apt to be comphcated Avith cardiac inflammation, yet even in the very slight forms, measured by the febrile and joint symp- toms, serious mischief may arise in the heart; and several such cases have come under my oavu observation." These statements seem a necessary prelude to a discussion of the case of Price vs. Life Insurance Co., 17 Minn. 489. When the case came up for revdeAv by the Supreme Court, Judge Berry spoke with reference to this point as follows: " The thirteenth question anel ansAver in the appli- cation were, 'Has the party ever had any of the following diseases?' (Naming several, and among others rheumatism.) Answer,' Never.' . . . There was eAddence in this case tending to show that the hfe insured had had subacute rheumatism. There was also evidence in this case tend- ing to shoAv that subacute rheumatism is not the disease of rheumatism THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 537 in the ordinary understanding of the term. There was also evidence tending to show that, technically and in medical parlance, subacute rheumatism is the disease of rheumatism. The rheumatism referred to in the question is the disease of rheumatism. Any rheumatic affection not amounting to the disease of rheumatism is not comprehended in its terms, any more than the spitting of blooel occasioned by a wound of the tongue, or the extracting of a tooth, is the disease of spitting of blood mentioned in the same question. The life insured had the right to answer the question upon the basis that its terms Avere used in their ordinary signification. If there Avas any ambiguity in the question, so that its language Avas capable of being construed in an ordinary as AveU as in a technical sense, the defendant can take no advantage from such ambiguity." The principles enunciated in the beginning of this section woidd involve the inclusion of all forms of articular rheumatism under the designation rheumatism, no matter Iioav light the attacks were. But if the inflammation did not involve the joints, it might possibly be construed as not rheumatic. Even on this point it Avould be reason- able to speak of it as rheumatic, as it is certainly considered so by the laity. While these Avould seem to be the fundamental principles, the difficulty arises that many cases described as subacute rheumatism are nothing but neuralgias, or other painful affections not rheumatic. This question Avould be one of fact for a jury to determine on the proper pres- entation of testimony. But in the ordinary as weU as the technical sense of the words, subacute rheumatism must be considered one of the forms of the disease rheumatism. Bright's Disease.—The views held by physicians about the lesions which should be grouped under this term are so diverse that it seems a mistake to use it at aU in life insurance. Any misrepresentation con- cerning it can be so AveU excused that its A'alue as a warranty is but little. It cannot be regarded as synonymous AA-ith nephritis, nor is even the lat- ter term free from objection; for the condition of the kidneys AA'hich Flint (Practice of Medicine) calls parenchymatous degeneration Delafield and Prudder (Handbook of Pathological Anatomy and Histology) call acute parenchymatous nephritis. It is iioav proven that albuminuria is present iu many conditions Avhich are not indicative of inflammation of the kidneys and not due to any exudation further doAvn the urinary tract. This fact of functional albuminuria is weU recognized at present in insurance work. In 1S92 Ave traced the after-history of forty-four cases of albuminuria which had been obseuwed in the years 1875-78. (New York Medical Examiner, August, 1892.) Of these forty-four cases thirty Avere alive and in apparent good health in 1892. The phy- sician of one stated that at intervals he had slight albuminuria—which fact Ave also confirmed—Avithout apparent detriment to his health. The existence of casts eA'en has been held not to be incompatible AA'ith freedom from organic disease of the kidneys. Furthermore, it is true that it is not easy at times to differentiate them from the so-called mu- cous cylindroids, Avhich, in many cases, are certainly not indicative of any nephritis, AA'hateA-er their origin may be. On the other hand, some cases of inflammation of the kidneys give but feAV symptoms in their early stages. In some of these cases an examination of the urine may reveal no abnormal constituents, either chemically or microscopicaUy. Such a case might readily be passed by an examiner and die in a few 538 A SYSTEM OF LEGAL MEDICINE. months from an acute exacerbation of a chronic condition. In fact, this has happened more than once, to our certain knoAvleelge, after careful ohemical and microscopical examinations by skUled physicians. From aU these considerations it Avould seem much better to drop the terms Bright's disease and nephritis, and use in their stead, disease of the kid- neys. This, Ave hold, Avould coA'er also ah forms of albuminuria except those due to the presence of pus or blood from some part of the urinary tract beloAV the kidney. For whether the albuminuria is transient or permanent, it is due to some affection of the kidneys, either functional or organic, which could properly be called a disease. We hold that a man, knoAving that he had albuminuria and denying that he had disease of the kidneys, Avould be misrepresenting, Avithin the Umitations stated aboA-e. In the case of Insurance Co. vs. Yung, 113 Ind. 159, the term Bright's disease Avas discussed. The conflict of medical opinions Avas so great, however, that the court A'ery properly eleclineel to give any ruling on its use or meaning. Tonsilitis.—In the case of McCollum vs. Life Insurance Co., 55 Hun 108, it was held as foUows: " It is argued, hoAvever, by counsel for the appeUant that tonsilitis is not a sickness Avithin the meaning of McCol- lum's ansAver in the application for these policies. It is sIioaati, however, by the testimony of Dr. Eddy, that tonsilitis is an inflammation of the tonsils, caUed by the common term quinsy, and commonly results from a cold, and that a person AA'ho has hael it is much more liable to have his throat affected by colds than he Avould otherwise be; that it is liable to make a man quite ill, and is oftentimes an indication of a scrofulous tend- ency. No effort was made at the trial to proA'c that the deceased Avas not in fact as ill as serious tonsilitis might cause him to be. But the deceased himself, who Avas a medical man, seems to have had no idea that tonsUitis Avas not a disease, for in the question put to him in his apphca- tion to the Buffalo Life and Reserve Association he Avas asked Avhen he was last attended by a physician, not for any mere ailment, but for ' Avhat ■disease ?' His ansAver AA'as, ' Eight years ago; tonsilitis.'" Although the opinion Avas undoubtedly correct on the evidence offered, the medical testimony is open to considerable criticism on the foUoAving points: 1. There are several varieties of tonsilitis, among them simple, follic- ular, diphtheritic, and phlegmonous. 2. The term quinsy is applied only to the last, and in this the major- ity of abscesses are peritonsUar, according to Brannan. (Medical Record, 1893, vol. ii, p. 549.) 3. The other forms of tonsilitis are often very mild and harmless, and might frequently weU be described as " a mere ailment." Disease of the Liver.—Under this term are properly included a num- ber of conditions so AAreU known that it is unnecessary to mention them here. The hver, however, is unjustly accused of many crimes, and it be- comes advisable to consider the limitations of the term. Jaundice should not be included, for it is properly only a symptom of some elisease AA'hich may or may not be of the liven*. It seems to us that the passage of a gall- stone should be regarded as a disease of the liver, although it arises "out- side of the liver, strictly speaking. We think that the term hver in this connection includes its appendages, the gah-bladder and the ducts. THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 539 " Biliousness " is applied by the laity to so many conditions, most of which have no connection with the liver, that its inclusion here does not seem warranted. In fact, it is doubtful where it Avould be placed, for it is neA-er " a serious iUness." We heartily approve of the limitations of the term " disease of the hver," laid cIoavii in the case1 of Cushman vs. Life Insurance Co., 70 N. Y. 76. " In construing contracts Avords must have the sense in which the parties useel them; and to understand them as the parties understood them, the nature of the contract, the objects to be attained, and all the circumstances must be considered. By the questions inserted in the application, the defendant was seeking for information bearing upon the risk Avhich it Avas to take, the probable duration of the life to be insured. It was not seeking information as to merely temporary dis- orders or functional disturbances having no bearing upon general health or continuance of life. Colds are generally accompanied with more or less congestion of the lungs, and yet in such a case there is no disease of the lungs AA'hich an applicant for insurance Avould be bound to state. So most, if not all, persons avUI have at times congestion of the liver, causing slight functional derangement and temporary iUness; and yet in the contemplation of parties entering into contracts of life insurance, and having regard to general health and continuance of life, it may safely be said that in such cases there is no disease of the hver. In con- struing a policy of life insurance it must be generally true that, before any temporary ailment can be caUed a disease, it must be such as to indicate a A'ice in the constitution, or be so serious as to have some bear- ing upon general health and the continuance of life, or such as according to common understanding would be called a disease." A similar ruling Avas giA'en in the case of Life Insurance Co. vs. Trust Co., 112 U. S. 250. It AA'as helel that: "Unless he had an affection of the liver that amounted to a disease—that is, of a character so well de- fined and marked as to materially derange for a time the functions of that organ—the ansAver that he had never had the disease called affection of the liver Avas a 'fair and true' one; for such an answer involved neither fraud, misrepresentation, evasion, nor concealment, and withheld no information as to his physical condition with which the company ought to have been made acquainted." In the case of ircGrath vs. Life Insurance Co., 6 N. Y. State Rep. 376, it AA-as held that jaundice and torpid liA'er were not organic aihnents of the liver; that their existence was not fatal even in view of the warranty that the insured never had disease of the hver. Diseases of the Eye.—Many of the more serious ocular disturb- ances, such as glaucoma, cataract, iritis, etc., would properly come under this designation. But it seems reasonable to consider that errors of refraction do not amount to a disease. This is the view taken in the case of Cotton vs. Life Insurance Co., 41 Fed. Rep. 506, where it Avas held that myopia Avas not included under the term bodUy infirmity. This Avould probably not hold if the question referred to impairment of sight directly, but even in this case there Avould be some doubt, provided that the error was avcU corrected by glasses. The term impairment of sight might AveU be held to refer to some disease of the eye which prevented normal acuteness of vision. In examining applicants we have noticed that, as a rule, they say their sight is good even if they are wearmg 540 A SYSTEM OF LEGAL MEDICINE. glasses at the time. This is so regularly the case that we haA'e concluded that laymen do not consider their A'ision impaired simply by some error of refraction which is corrected. In vieAV of this fact, a judicial inter- pretation of the term impairment of A'ision might be held not to include errors of refraction, unless seA'ere or uncontroUable. In Fitch vs. Life Insurance Co., 2 N. Y. Sup. T. and C. 247, it AA'as proven that the in- sured had had, six years before the issuing of the policy, conjunctivitis, due to some injury to the eye. This Avas considered to prove a breach of warranty, as he had a negative ansAver to the question, " HaA'e you ever had any iUness, local disease, or any injury in any organ?" But on appeal (59 N. Y. 557) it Avas decided that the statements were not Avarranties, and it Avas held: "We think that, according to the construc- tion avc have put upon the contract in question, tlie judge Avould not have been justified in holding that the omission to mention a temporary injury to the ewe by sand being thrown into it, which had produced in- flammation six years before the policy Avas applied for, and AA'hich was then cured, Avas conclusive eA'idence of fraud, or a breach of Avarranty sufficient to avoid the policy. If of any importance, it Avas at most eA'i- dence of fraud, to be submitted to the jury." Headaches.—It is out of the question to •enumerate the different causes of headaches. In themselves they are, of course, only a symptom, and may be due to either functional or organic disturbances. They are not a cause of death directly unless they lead to suicide. As a symptom they haA'e a bearing upon the risk, and a question AA'ith reference to them is usuaUy asked in the application. It is generally worded so as to cover only seA-ere or frequent headaches, or the question is directly asked, "Are you subject to headaches?" Hoav these questions AA'ould be construed it is not possible to state, as we have not been able to find a decision bearing upon this point. EA'en if they are severe and frequent, headaches are not necessarily indicative of any intracranial disease. In many of the worst cases, they are due to some general elycrasia, such as gout, or to some local disease of another organ, such as Bright's disease or some peripheral irritation, such as an uncorrected error of refraction. In view of these facts, Ave must indorse the decision rendered in the case of Higbie vs. Life Insur- ance Co., 53 N. Y. 603. In the application in this case occurred the question, "Are the functions of the brain, the muscular and the nervous system, in a healthy state ?" AnsAver, " Yes." It was proven that the applicant had been subject to seA'ere headaches for several years. But the court very properly held that the question above stated " did not in- clude a temporary or occasional physical disturbance the result of ac- cidental causes; that there Avas no evidence that the recurrence of the periodical headaches had an origin or cause indicating any mental un- soundness or derangement of the head or brain or permanent disease, or that the fact of their existence Avas at all material to the risk." Cold.—This is an utterly unscientific term, used to designate a number of affections supposed to be due to the action of cold. When used as the name of a disease, it would mean an acute catarrhal inflammation of the nose, larynx, trachea, or bronchi. It is rarely serious except at the ex- tremes of life, and in the A'ast majority of cases is not AA'orth mentioning. This vieAV of its importance is borne out in the opinion rendered in the case of Life Insurance vs. McTague, 49 N. J. L. 587. AA'here it Avas held THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 541 that a cold, even if prescribed for by a physician, did not necessarUy sIioav that it had produced either disease or sickness; that it Avas not in- consistent AA'ith the statement that he had not been sick or afflicted Avith any disease. Presumably its existence at the time of an examination is incompatible with a Avarrant}' of sound health at that time, although in vieAV of the principles laid cIoavii in the case of Cushman vs. Life Insur- ance Co., 70 N. Y. 76 (see p. 539), this vieAV might be epiestioned. Habits.—For the purposes of life insurance, this term refers only to the various forms of drug-addiction. Getting up late, eating too much and too fast, wet feet, and such other bad habits, are not considered of importance to knoAV about. Nor does the insurer regard it of any con- sequence to knoAV the amount of tobacco, tea, and coffee consumed by an individual, since the capacity to assimilate these varies so greatly. If they are taken to an excessive degree, they promptly show harmful effects by causing functional disturbances of A'arious kinds; and then the ap- phcant would lie rejected on account of these functional disturbances, and not on account of the abuse of tobacco, tea, or coffee. Consequently Ave mean the use of alcohol, opium, chloral, and other narcotics. Of these by far the most important is alcohol. The question of the thanking habit can be diAided into tAA'o phases, the first with reference to past anel present custom, and the second AA'ith regard to the restriction of future excesses. In order to elicit informa- tion concerning the first, the application contains some questions about the habits, such as, " Do you iioav, or haA'e vein CA'er, used intoxicating licpiors ? " or, " Have you ahvays been sober and temperate ?" or, " Are the party's habits of life temperate or otherwise ?" The second is accomplished by inserting agreements and proA'isos AAdiich restrict future excesses, but AA'ith considerable A'ariations in the details. Their general idea is that, if the insured die in consequence of the use of alcoholics, the policy shall be, AA'holly or in part, avoided. If an applicant proves that he has always been temperate, most companies assume that he Avdll continue so, and therefore do not require any agree- ment Avith regard to future excesses. It has uniformly been held that, if the question refer only to past and present habits, it will in no Avay be construed as referring to future excesses. Hence it might be possible to subdivide this subject into these two categories ; but this is not practicable, and is of no consequence, since the gist of the Avhole matter lies in the definition of the Avords " temper- ate and sober." We AviU first consider AA'hat the legal decisions on this point have been, and then see Iioav they comport with the medical ideas on the same subject. 1. If the questions or proA'isos are so worded as to indicate total ab- stinence Avithout the possibility of any mistake, then they must be liter- ally construed, and nothing but the total abstinence from all alcoholic licpiors avUI suffice. Thus, in the case of Hogin vs. Supreme Council, 76 Cal. 109, the assured agreed to abstain Avholly from alcoholic hquors, the association being composed only of prohibitionists. He broke his pledge, and by so doing aA-oided the policy, Avithout reference to anything else. Of a somewhat similar purport is the decision in the case of Sliader vs. Life Assurance Co., 66 N. Y. 441. although here no epiestion of total ab- stinence enters. In this case the proviso AA'as that: "No claim shall be made uneler this policy AA'here the death or injury may have happened 542 A SYSTEM OF LEGAL MEDICINE. Avhile the insured was, or in consequence of his having been, uneler the influence of intoxicating drink." It was held that proof was not required that the use of intoxicating drinks Avas the moAdng cause of death, but oiUy that he Avas under the influence of stimulants at the time of death. 2. When the AA'ords used in the question are -'temperate and sober," it has been held that this expression in no sense means total abstinence from all intoxicating liquors. Thus, in the case of Brock way vs. Life Insurance Co., 9 Fed. Rep. 249, the questions Avere, "Is the party sober and temperate? Has he always been.so?" The ansAver to each was, " Yes." In the charge it Avas laid doAvn that " the Avorels ' sober and tem- perate ' are to be taken in their ordinary sense. The language does not imply abstinence from intoxicating liquors. The moderate, temperate use of intoxicating liquors is consistent Avith sobriety. But if a man uses liquors to such an extent as to produce frecpient intoxication, he is not sober and temperate within the meaning of this contract of insur- ance." The latter part of this decision may be considered too liberal, as we shall see later, but it is to the first part that Ave now Avish to draw attention. The same idea is AA-ell brought out in the case of Mcacham vs. Insurance Association, 120 N. Y. 238. There the questions were, "Is the apphcant temperate and correct in his habits ? Does applicant agree to remain so ?" The ansAver to each Avas, " Yes." The Court of Appeals held that: " The Avord ' temperate' suggests moderation, not abstinence, and the warranty is to the effect that his habit is to refrain from excessive indulgence in the use of intoxicants, anel not that he abstains from all use." 3. We have seen in the preceding section that temperance does not necessarily mean total abstinence, but from the very necessities of the subject no hard-and-fast definition of temperance can be given. In the case of Van Valkenbergh vs. Life Insurance Co., 70 N. Y. 605, it Avas held that the question, " use any intoxicating liquors or substances ?" did not direct the mind to a single or incidental use, but to a customary or habitual use. This idea is also very weU expressed in the case of Holter- hoff vs. Life Insurance Co., 4 Bigelow's Life and Ace. Rep. 395. Here the questions were, "Is the party sober and temperate? Has he always been so ?" The answer to each was in the affirmatiA'e, and these answers were held to be material representations. Judge Tilden, in his charge to the jury, which was afterward approved by the higher court, said: "The statement itself amounts to an assertion that the insured at the time of the application Avas sober and temperate, and had ahvays been so. As a matter of construction, it is manifest and clear to the court that these Avords, taken, as they are placed, together, refer to the charac- ter, habit, or state of the party, and that they are fairly convertible into the phrase or statement that the party AA'as, and always had been, a sober and temperate person. The question of fact wiU then be, - Was he such ?' In considering this question you will inquire whether or not he continued the use of intoxicating liquors sufficiently long, or repeated libations sufficiently often, to amount to a habit; and if he did, then Avhether such habit, considered in reference to its extent or degree of indulgence, Avas such that he was not temperate and sober." In the case of Life Insurance Co. vs. Davey, 123 U. S. 739, it is Avorth whUe to note the distinction drawn betAveen intemperate and habituaUy intemperate. Here it Avas provided that if the insm-ed should become THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 543 '• so far intemperate as to impair his health or induce delirium tremens, or if his death shall result from injuries received while under the influ- ence of alcoholic liquors," the policy might be avoided. On appeal it Avas held that: " If the substantial cause of the death of the insured was an excessive use of alcoholic stimulants, not taken in good faith for medical purposes or under medical advice, his health Avas impaired by intemper- ance, Avithin the meaning of the Avorels 'so far intemperate as to impair his health,' although he may not have had delirium tremens, and although previously to his last illness he had not indulged in strong drink for such a long period or so frequently as to become habituaUy intemperate." In England, in the case of Southcombe vs. Merriman, 1 C. and Marsh 286, the assured stated that he Avas of temperate, sober habits. It was helel sufficient to avoid liability uneler the policy to prove that he was in- temperate, but not necessarily to such a degree as to impair his health. Unfortunately, this opinion has not always been adopted in America. Thus, in the case of McGinley vs. Life Insurance Co., 8 Daly 390, the ques- tion AA'as, "Are the party's habits of life temperate or otherwise ?" To Avhich the ansAver Avas, "Temperate." It was held that this "rather de- pended upon the individual, for Avhat Avould be temperate in the use of alcoholic drinks in one man would be intemperate in another; that the taking of a moderate amount of liquor in a weak man might be an in- temperate act, when it Avould not be by a man of vigor and strength; that it is not in the use of alcoholic drinks that intemperance exists, but in taking them to such an extent as to impair the constitution and gen- eral health." This eloes not take into account the A'ery unfavorable effect which alcoholics have on the prognosis of all acute diseases or their in- fluence in producing accidents. These are factors of great importance, as Ave shall see later, but they seem to be entirely ignored in this as in many of the other decisions. The great value of an Appellate Court is shown in the case of Miller vs. Life Insurance Co., 34 Iovva 222, and also to what extremes a jury aa'UI go in cases of this kind. It Avas provided that the policy should be forfeited if the insured should die " by reason of intemperance from the use of intoxicating liepiors." It was proven that he Avas a confirmed drunkard. At last, after a spree of several days, he developed delirium tremens. While in this condition he escaped from his keepers and ran about the city in his night-clothes. It Avas proven that the congestion of the lungs and brain, of which he died, Avere due to exposure and that to intemperance, and hence the policy should be avoided. These facts were hardly questioned, but yet the jury promptly returned a verdict for the plaintiff. The case Avas carried to the Appellate Court, the judgment Avas there reversed, and the case Avas sent back for another trial. It Avas a second time taken to the highest court, whose opinion (39 IoAva 304) was as foUoAvs : " Hoav, in A'iew of the evidence and the laAv given by the court, an impartial and unprejudiced jury, indifferent as betAveen the parties, and anxious to ascertain the truth and effectuate the right, could return a general verdict for the plaintiff, and find specially that the congestion of the lungs and brain which caused Miller's death Avas not caused by the intemperate use of intoxicating liquors, passes our comprehension. . . . We intcu-fere AA'ith the verdict of a jury ahvays reluctantly, and never unless it is clearly unsupported by the evidence, or has been otherwise improperly reached. 544 A SYSTEM OF LEGAL MEDICINE. " We deprecate the necessity which impels us a second time to set aside a verdict upon substantially the same testimony. But it Avere much more to be deprecated if the pertinacity of a jury could override law and right and giA'e triumph to injustice and AA'rong." An interesting and, so far as we know, unique question is presented in the case of Jarvis vs. Life Insurance Co., 5 Ins. L. J. 507: Does intem- perance1, leading to insanity, and that to suicide, avoid the policy if there are provisos against both insanity and intemperance as causes of death ? In this case there Avere proA-isos against suicide1 and also against intem- perance. The jury Avere charged as foUoAvs: " If you should find that his intemperance produced the mental condition relied upon to avoid the effect of the self-destruction clause in the policy, then the plaint- iff cannot recover. If the insanity Avas produced by habits prohibited by the policy, then it cannot be set up in avoidance of a breach of another condition. Intemperance aAoids the policy, and if intemperance produced the insanity, this insanity cannot be set up as an excuse for the A'iolation of the proviso against self-destruction." Unfortunately, the1 jury dis- agreed, so the case has not yet been carried to one of the higher courts. 4. We haA-e grouped in this section some opinions against AAdiich Ave can only offer our most earnest protest. They abuse language, medicine, and sense so grossly that it seems impossible for them to prtwaU ulti- mately. We do not doubt that they Avill be recanted, but their influence is very bad AA'hile it lasts. The first degree of liberality is probably represented in the charge of the judge in the case of Fox vs. Life Insurance Co., 4 Bigelow's Life and Ace. Rep. 458 : "Noav, Avhat is the meaning of these Avorels in the fifth question, 'HaA'e you ahvays be'en sober and temperate?' It does not mean total abstinence. We are to give these Avords the common, ordi- nary interpretation. It does not mean total abstinence from drink, and there is no man Avho takes a glass or two Avhen he feels like it Avho would not describe himself, in answer to that question, a sober and temperate man. As to the question of what constitutes sobriety, or to mean a tem- perate man, I suppose there are classes of people in the community who hold different opinions. ... On the other hand, there are a class of peo- ple aa-Iio would drink a great many times a day and become very much under the influence of liquor, who, perhaps, because they never become what is termed ' dead drunk,' Avould say, if they were asked this question, 'I take an occasional glass,' or, 'Yes, I occasionally take too much.' Well, I neeel not say to you that an occasional debauch even Avould not make a man of intemperate habits. I take it that this epiestion means habitual intemperance. Especially it means so when you consider the word ' always.' If the question to be put to a man obtaining a life insur- ance policy is. ' HaA-e you always been sober and temperate ?' and if that means, ' ever drunk in your life,' I am afraid there would lie a great many people Avho would never get their lives insured. There are very feAv who have not some time or other, young or old, been drunk literally "and fully, and are conscious of it, so that they could not give an affirmative answer if such Avere the meaning of it; but it means habitual drunkenness. . . . The risk may be increased by habitual drinking every day of an amount of liquor that perhaps woidd not at all affect his header liis legs." There was the usual verdict for the plaintiff, but it was set aside and a new trial ordered, the outcome of -which was not reported. To this charge avc THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 545 must take great exception, not only medicaUy but logically. Let us strip his propositions of verbiage, and then arrange them in orderly sequence. 1. " I have ahvays been sober and temperate." 2. This statement does not imply total abstinence. 3. An occasional debauch does not make a man intemperate. 4. This statement therefore disaffirms only habitual drunkenness. If we look back now from proposition 4 to proposition 1, we can readily see how untenable his argument is. A very simUar ruling, but by a higher court, was given in the case of Life Insurance Co. vs. Rjj sumption and probably others. It was held: " It is true, the twentieth question is very far-reaching. And the answer to it, being an unqualified negative, Avas a very incautious and dangerous assertion, but it is not for the court to alter the plain contract of the parties." In the case of Insurance Co. vs. Gray et at., 91 111. 159, the insured gave a negative answer to the question, " Have either of your parents, brothers or sisters, ever had any pulmonary, scrofulous, or any mental or constitutional or hereditary disease ?" On appeal it was held: " The evidence that both parents died of pul- monary consumption, of wliich they each suffered for several years before their respective deaths, is all one way. It is proved by relatives, neigh- bors, and physicians, and it is not reasonable to assume that the assured was even ignorant of this fact, for he seems to have been hving with or near his parents during the time they Avere thus afflicted. There is no effort to prove that either of them died of a fever, or Avere even sick of a fever. The disease of wliich they died is generally believed to be heredi- tary, and it is impossible to escape the conviction that the truth here was Avithheld because its communication would either haA'e defeated the ap- plication for the policy or materially increased the premiums for the risk." In the case of Insurance Co. vs. Gridley, 100 U. S. 614, to the question, " Have the person's [whose life is to be insured] parents, uncles, aunts, brothers, or sisters been afflicted Avith consumption, scrofula, insanity, epilepsy, disease of the heart, or any other hereditary disease?" the as- sured ansAvereel, "No hereditary taint of any kind in famUy on either side of house, to my knoAA'ledge." It Avas proven, on behalf of the company, that an uncle of the insured was insane for more than a year, and that he died in an asylum, tAventy years before the application for insurance. And it Avas argued that on this ground a verdict should be rendered for the company. It was not, hoAvever, and on appeal it Avas held: " To make out the defense sought to he established by the insurers, three things were, therefore, necessary to be shoAvn: that the alleged insanity of the uncle had existed; that it was hereditary; and that both of these things Avere known to the appli- cant Avhen he aiisAverecl the question. The first point Avas clearly proA'ed. In relation to the second and third there was no proof whatever. What Avas proAred, Avithout AA'hat was not proved, Avas of no account. The de- fense, therefore, wholly failed." This seems very reasonable, as the de- fense, on its face, is oiUy a quibble. Here there was a proper indication for the use of the term " heredi- tary." In some cases, however, it seems to be confounded AA'ith the term "inherited." The definition of "hereditary," according to Webster, is, " Transmitted, or capable of being transmitted, from a parent to a ehUd; as, hereditary disease." Except for its narrow limitations to hneals only, this definition is exactly what the insurer means. The insurer does not care to know about diseases which are already transmitted to the applicant, for in that case his physical condition is already such as to Avarrant his rejection. But the insurer does wish to know about diseases in the famUy which are capable of being transmitted, and which may break out iu the usual Avay at any time. To say in effect that the disease must be inherited is absurd, for, to make a bull, it cannot be proved that it is an inherited disease until it has been inherited, i.e., developed. This Adew, however, 556 A SYSTEM OF LEGAL MEDICINE. Avas the one apparently taken in the case of Sinclair vs. Life Insurance Co., 9 Ins. L. J. 523. Here the insured gaA'e a negative ansAver to the epies- tion, " Have the parents or brothers or sisters of the party been affected with insanity, or AAdth pulmonary, scrofulous, or any other constitutional disease hereditary in its character?" It Avas proven that the father anel sister had died of consumption. The family physician said he did not knoAV Avhether it AA'as hereditary or not, but that he elid not think that it \vas. It AA'as held that it must be proA'en that it Avas "hereditary in its character," in order to come AA'ithin the question above mentioned. The judge said that "the undoubted object of that question Avas to procure information as to AA'hether insanity, scrofulous and pulmonary diseases had developed in an hereditary form among the relatives of the appli- cant." That is true; but the question did not state that the elisease must be an inherited one. Consumption is an hereditary disease, and in about one half of the cases Ave can get eA'idenee of its diathesis having been in- herited from the progenitors or the collaterals of the individual. The accidental deA'elopment of the other fifty percent, does not preclude con- sumption from being an hereditary disease. The question does not refer to a particular instance, but does ask if the individual eA'er had any hered- itary constitutional disease. Hoav many generations does it take to make an hereditary elisease ? The medical testimony admits of strong criticism on this point, A someAA'hat different criticism must be made in the case of Peasley vs. Life Insurance Co., 15 Hun 227. Here the insured gave a negative ansAver to the question, " Have the party's parents, uncles, aunts, brothers, or sisters been afflicted Avith consumption, scrofula, insanity, epilepsy, diseases of the heart, or other hereditary disease ?" It Avas prewen that the mother of the insured had had three attacks of insanity, in each case apparently due to accidental causes, such as a fever or displacement of the uterus. Although the statements Avere warranties, it Avas held that the last three Avorels of the question qualified all the others, and Avere intended to shoAv that the diseases mentioned must be the product of heredity. This definition Avas right; but does not the development of such a disease indicate a weakness of the system AA'hich is capable of transmis- sion to the offspring, and hence hereditary ? Hereditary does not mean necessarUy inherited. An outbreak of insanity must rarely occur in women solely as the result of a displacement of the uterus unless there is associated AA'ith it a latent capacity for mental alienation. If it elid, there are &av of our women who Avould not be in an asylum at some time of then- lives. Then this inability to resist nervous' strain, being the foundation of the insanity and being* hereditary, would not the insan- ity itself be considered hereetitary ? Occupation.—It is weU knoAA'ii that the rates of mortality vary greatly according to the occupation. Some occupations are so hazardous that no company aa'UI take persons engaged in them. In the case of others less dangerous, the company may issue a policy, but obliges the insured to take the risk of death from any accident'which is incident to the occupation. In still others the company assmnes the AA'hole risk, but charges an extra premium. The following table sIioavs the relative mortality in the more common occupations. It represents the number of deaths occurring in each occupation between the ages of twenty-five THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 557 and sixty-five, as compared Avith a normal standard of one thousand deaths in the general population dmdng these years. (Medical Handbook of Life Assurance, by PoUock and Chisholm, p. 206 et seq.) PROFESSIONAL MEN. Clergyman......................................... 556 Schoolmaster...................................... 719 Barrister.......................................... 842 Artist............................................. 921 Physician..........................................1122 Musician..........................................1314 MERCHANTS. Coal merchant..................................... 758 Bookseller, stationer................................ 825 General shopkeeper................................ 865 Ironmonger........................................ 895 Fishmonger, poulterer.............................. 974 Tobacconist........................................1000 Cheesemonger.....................................1009 Chemist, druggist..................................1015 Greengrocer, fruiterer...........................1025 MANUAL WORKERS. Gardener, nurseryman.............................. 599 Farmer............................................ 631 Agricultural laborer................................ 701 Fisherman......................................... 797 Carpenter, joiner................................... 820 Baker, confectioner................................ 958 Builder, mason, bricklayer ......................... 969 Tailor.............................................1051 Printer............................................1071 Stone, slate-quarrier................................1122 Cutler, scissors-maker..............................1309 File-maker.........................................1667 Earthenware manufacturer..........................1742 OCCUPATIONS PARTICULARLY SUBJECT TO INTEMPERANCE. Butcher...........................................1170 Brewer............................................1361 Cab, omnibus service...............................1482 Inn-keeper, publican...............................1521 Costermonger, street-hawker........................1879 While the courts are quite strict in their construction of the statement of the insured as to his occupation, they wiU accept no quibbling defense on the part of the company, as the foUowing cases show. In the case of Life and Accident Co. vs. Burroughs, 69 Pa. St. 43, the insured stated in his apphcation that he was an earthenware manufacturer. His death was due to peritonitis, caused by an accident whUe working in a hay field. It Avas proven that he was on a visit to his grandfather and Avas A similar ruling Avas given in the case of Stones' Administrators vs. Casualty Co., 34 N. J. L. 371, where it was held that: " A teacher who has a home in the course of erection may visit said house as a spectator, Avith- out doing anything AA'hich is aside from the ordinary hne of his life." 558 A SYSTEM OF LEGAL MEDICINE. Again, in the case of Tucker vs. Life Insurance Co., 50 Hun 50, there AA'as a clause forbidding employment in "mining, blasting, or Avrecking." The insured met Ins eleath by droAvning, Avhile saving the ci-cav of a schooner Avhich had been driven ashore near his farm. The court held that: " He Avas a farmer, and not, by occupation, a Avrecker. As avcU might a farmer who should be smothered in attempting to rescue his neighbors from their burning dwelling be called a fireman, as this man a Avrecker." This Avas indorsed in 121 X. Y. 718. Similarly, in the case of Grattan vs. Life Insurance Co., 80 N. Y. 281, it was held that there Avas no material difference betAveen a soda-Avater maker and a soda-water peddler. On the other hand, AA'here there is any suspicion of fraudulent con- cealment the decisions are very severe against the insured. Thus, in the case of Hartmann vs. Life Insurance Co., 21 Pa. St. 466, it was held: "If the insured, who represented himself to be a farmer, was in fact a slave- taker by occupation, and if the business of slave-taking Avould expose his hfe to greater danger than farming, it is not possible to escape the conclusion that the policy was thereby rendered void, since, if it Avas AviUfuUy made, it Avas a fraud; and though made ignorantly, or by mis- take, it Avas a Avarranty by the express terms of the policy. . . . " The court very properly charged that the occupation of the insured, which his duty required him to disclose, was that business which he Avas engaged in at the time he made his application. If it meant the trade he learned in his youth, and AA'hich he had folloAved years before, it would indeed be immaterial Avhether he tolel the truth or a falsehood, and it Avould have been mere foUy in the insurers to ask him the question." Again, in the case of Aid Society vs. White, 100 Pa. St. 12, the insured stated in his application that he was a laborer, but it was proA'ed that he had done no Avork at aU for seAreral years. The Appellate Court held that it Avas an error to charge : " AYe, therefore, instruct you that the answer 'laborer' in evidence sIioavs that Murray was a laborer in former years, and covers the question in the application." It was also stated that a merely temporary suspension of the aUeged occupation would not con- stitute a breach of Avarranty, but that a suspension extending through a number of years Avould. This AA'as apparently the view taken in the case of Mowry vs. Life In- surance Co., 1 Daly 321. The insured stated in his application that his occupation Avas "manufacturing." It was held that the fact that he Avas keeping a bndiard saloon at the time of the application did not constitute a breach of Avarranty, for he had been for many years engaged in manu- facturing soda-water and expected to resume that business in a few days. This is a very liberal extension, and is susceptible of great abuse. The company itself, hoAvever, Avas partly responsible, since it accepted this ansAver as being a sufficiently definite statement of his business. A more rigid rule was laid down in the case of Fitch vs. Life Insur- ance Co., 2 X. Y. Sup. Rep. T. and C. 247. In the application made in 1870. the apphcant Avas asked to state his vocation, Avhat it AA'as, and what it had been, and his answer AA'as, " Traveling agent." It was proven that he Avas in the army in 1864 anel 1865, and had been a painter before and after that time until 1867. " His ansAvers, too, in respect to his Arocation, and where he had hved since his birth, contained coA'ert falsehoods, which, if not intended to de- THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 559 ceive, were likely to do so. The inquiry as to his vocation Avas what it then Avas and AA'hat it had been. His ansAver, ' Traveling agent,' Avas true as to Avhat it then Avas, but untrue as to what it had been; for the in- quiry as to his past vocation obviously caUed for the statement that he had been a painter and a soldier as AveU as a traveling agent. The answer AA-as false from the clear and manifest faUure to teU the whole truth." This ruling Avas reversed in 59 X. Y. 557, chiefly on the ground that the statements of the insured Avere representations only, and not Avarranties. One of the most common phases of this subject to be decided arises from the applicant's ansAver to the question whether he is engaged in the occupation of selling liquors. The form of question used for eliciting- this information varies so much that no fixed rules can be deduced from the determinations of the courts, Generally it may be said that if the questions as to the licpior-seUing are clearly put by the company, the courts will construe as material and fatal any falsity in the answer. Thus, in the case of Dwight et at. vs. Life Insurance Co., 100 X. Y. 341, the insured gaA'e a negative ansAver to the question, "Is he now or has he been engaged in or connected with the manufacture or sale of any beer, Avine, or any other intoxicating liquors?" It Avas proven that the insured had kept a hotel for three years, and had sold Avines and liquors to his guests, although there was no bar in the hotel. It Avas held that this constituted a breach of Avarranty. On the other hand, the courts will here, as elsewhere, give the insured the benefit of any construction of the contract that may be possible. In the case of McGurk vs. Life Insurance Co., 56 Conn. 528, a correct defini- tion was used Avith teUing effect against the company. The insured stated in his application that he Avas a " grocer." It Avas proven that he sold licpiors freely in his store, but it Avas held that: "Webster defines the meaning of the Avord 'grocer' to be 'A trader who deals in tea, sugar, spiee-s, coffee, liquors, fruit, etc' The Avord, therefore, properly describes McCurk's occupation, and nothing AA'hatever appears in the case tending to sIioav any want of sincerity on his part in his ansAver, much less that by it he committed a fraud on the defendants which made void the con- tract of insurance in its inception. He doubtless believed at the time that the Avord 'grocer' covered his entire occupation." This ruling seemed for a moment incorrect, but the Century Dictionary bears out Webster, and Ave remember that Ave have hardly ever seen a country grocery where liquor Avas not sold. A very fine point Avas decided in the case of Kenyan et at. vs. Aid Asso- ciation, 122 X. Y. 247. The insured Avas asked: "Profession or occupa- tion f State preAdous nature of business. ".4. Importer and wholesale dealer in wines and liquors. " (f Is the person engaged in any way in the retailing of alcoholic liquors ? " A. Xo; keeps no bar and seUs only at wholesale; have government license and town license." These ansAvers of the insured Avere regarded as strict warranties. It AA'as proven that he sold by measure and bottle, in quantities less than five gallons, but not to be drunk on the premises. It Avas held that this AA'as not incompatible with his statement that he was a AA'holesale dealer, in A'ieAv of the elaborate explanation he had made in the next ansAver; that he intended to convey the idea, and did convey it, that he did not 560 A SYSTEM OF LEGAL MEDICINE. seU liquor to be drunk on his premises; and that the company, having accepted his application with this explanation, must stand by it. Residence.—A company will either decline to insure applicants in a locahty which they know to be unhealthy, or else avUI, Avhen insuring, charge a higher premium, sufficient to coA'er the increased risk. In order, therefore, to prevent persons avIio are insured in healthy regions from moAung into unhealthy localities, clauses are inserted in the policy restricting the right of travel and residence. In former times these re- strictions Avere quite complicated, and extended oA'er the AA'hole life of the policy. Of late years they have been much simplified, and usually apply to the first year or two only. These clauses are generally interpreted quite rigidly by the courts, but in one of the earliest cases, Baldwin vs. Insurance and Trust Co., 3 Bosworth 530, a liberal rule Avas laid doAvn. The insured Avas forbidden to visit "those parts of the United States wliich lie south of the southern boundaries of Virginia anel Kentucky." He received a permit "to travel any AA'here in the United States, but must be north of the south boundary of Virginia by July 10, 1854." He was taken sick in Appalachicola, Fla., on June 11th, was too sick to be moA-ed, and died there on July 20th. It Avas held that the contract Avas not void, for the disability to perform the condition Avas the act of God, and oc- curred Avithout any defaidt or neglect on his part. This opinion was overruled in the case of Evans vs. Life Insurance Co., 64 X. Y. 304, on a permit of a simUar character. The insured made no effort to return, it is true, but the court held that " another answer to this claim [that it Avas the act of God] is, that he took the chances of being able to return. He went south for business purposes, knowing that the policy Avould be avoided if he did not return by the 1st of July." A similar decision was rendered in the case of Nightingale et at. vs. Insurance Co., 5 R. I. 38. Here the insured between July 1st and Octo- ber 15th avus not allowed to be in any portion of the United States, out- side of certain named States, more than five days Avithout a permit. He went to Maryland, which was outside the permitted limits, and stayed there ten days, when he died of apoplexy. This disease had no relation to the climate or the country, but the court held that that made no differ- ence, and the policy Avas void according to the terms of the restriction. This case seems particularly severe, as the insured was the Bishop of Rhode Island, who was caUed to Maryland on account of the illness and temporary absence of the Bishop of Maryland, to attend to some of his canonical duties, and also because the fatal disease was in no sense due to the climate or the voyage. The court probably construed the proviso so rigidly because a permit to extend his time beyond five days could easUy have been olitained by the insured. A reminiscence of the days when avc had a frontier is brought out bv the case of Caster vs. Life Insurance Co., 22 N. Y. 427, where the courts held by five judges against three that the term "settled limits of the United States " did not mean the region of the settlements, but referred to the established boundaries of the United States, including in this both States and Territories. This case was decided in 1860. Restrictions as to the routes to be traveled in going from one place to another must be followed very closely. Thus in the case of Hathaway vs. Life and Fire Insurance Co., il Cush. 448, the insured Avas permitted " to make one voyage out and home to California, in a first-rate vessel THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 561 around Cape Horn or by Vera Cruz." He went to California, was taken sick, and returned home by way of Panama. There was no usuaUy trav- eled route then by way of Vera Cruz, and the one chosen was the safest and shortest. But the court held: "It is of no consequence that the route taken home by the assured was, or may have been, as the plaintiff offered to prove, the safest and shortest. The policy excluded him, if he would avail himself of the provisions and of the assurance contained in it, from being governed by what was advisable and expedient. It fixed the terms upon which the promise should be binding, and upon which it should be annuUed. By these terms the parties are bound. There haA'- ing been a breach of the condition, the contract is thereby rendered A'oid." The "glorious days" of Bill TAveed and the stUl brighter days of his downfall are recalled in the case of Douglas et at, vs. Life Insurance Co. 83 X. Y. 492. Tweed took out a policy in 1868 which contained the re- striction that the insured should not, "without the written consent of this company, previously obtained, travel upon the seas except in voyages between coastwise parts of the United States." As is weU remembered, Tweed Avas arrested and sent to jaU, but escaped from custody on September 4, 1875. He Avas not found until September, 1876, when he was recaptured at Vigo, in Spain. Xeedless to say, he had not obtained the consent of the insurance company for this little trip. They very properly and successfully resisted payment on this technical point. Had it been any one but a notorious criminal, who broke the conditions of his pohcy in Adolation of the law, it is more than likely that no ques- tion would have been raised about the settlement of the claim by the company. In the case of Pohalski vs. Life Insurance Co., 36 N. Y. Sup. Ct. 234, there Avere the usual restrictions in the policies issued at that time, for- bidding the insured to pass outside of the United States and Canada. The insured had business in Havana, and obtained the following permit Avithout extra charge: " Permission is hereby given to J. M. Pohalski to proceed to Cuba, and return before April 1,1871. He to take his OAvn risk of death from epidemics." He went to Cuba and died there in Feb- ruary, 1871, of yellow fever. Payment of the pohcy was resisted on the ground that yellow fever belonged to the class of diseases known as epi- demics. It is most hkely that this was the idea that the insurers had when the permit was given. But the referee found that, as the word was ordinarily used, it referred to a condition of a disease, in AAdiich the number of cases of that disease were so great that it might be called gen- eraUy prevalent. He found that yeUow fever Avas endemic in Havana at the time of insured's Ulness there, but not epidemic; in fact, it seemed probable that the cases which occurred there during that time might be called sporadic, so infrequent were they. We think this a very proper verdict under the circumstances. The permit Avas so loosely drawn that on its face it had no other meaning than the one given above. The at- tempt was made to introduce parol evidence that between the parties it had the interpretation which the defendants desired, but this was suc- cessfully resisted. The case was then carried to the Court of Appeals and judgment affirmed (56 X. Y. 640). Age.—The question of age is one of fundamental importance in life insurance, for upon it depends the amount of the premiums to be paid, except in some assessment companies. Furthermore, it is of prime con- 562 A SYSTEM OF LEGAL MEDICINE. sequence in the medical selection of some cases. In many companies it is the rule not to take applicants, one of AA'hose parents has died of con- sumption, before the1}' have reached a fixed age, usually thirty or thirty- five years. In the case of Avomen an extra premium is usually charged during the child-1)earing period, the limit of Avhich many companies fix arbitrarily at a certain age, about forty-eight or fifty. For these and man}' other reasons it is necessary to know the age exactly. Many com- panies, especially in Europe, require certificates of birth before they issue a pohcy. As a man may not knoAV his age, it is sometimes necessary to obtain coUateral evidence. In the case of Sjrfcntsvs. Lefeere, 11 L. T. X. S. 114, it AA'as held that a family Bible Avas not good evidence as to age, unless it Avas also proven that the date's therein were made by some living member of the family, or AArere known to be made by some dead member. As it is a matter of simple fact, the courts have usually been very strict in their decisions upon this point. Thus in the case of Swett vs. Relief Society, 78 Me. 541, the applicant stated his age to lie fifty-nine, Avhen in reality it Avas sixty-four, and was so proA'en. It Avas held that " the age of the applicant Avas a material fact. . . . His representation of the fact Avas a Avarranty of its truth, and if not true, the contract was invalid. This rule is so uniformly held by the courts that no authorities need be cited." A similar conclusion Avas reached in the case of Life Insurance Co. vs. France et al, 91 U. S. 510, and in the case of Ortlieb vs. Insurance Co., 4 Ins. L. J. 311. On the other hand, the company may, by carelessness, inadvertence, or the faulty conduct of agents, lose its right to set up a claim of breach of Avarranty as to age. Thus, in the case of Morrison vs. Life Insurance Co., 59 Wis. 162, the insured had one policy in this company, and then took out another. In this one he put his age at ten years younger than in the correct previous policy. Five years later he took out a third policy, in which he now again stated his age correctly. The company continued to receive assessments on all these policies for two more years, when he died. It AA'as held that his misstatement in the second policy had been Avaived by the company. A similar result Avas reached in the case of Miller vs. Life Insurance Co., 107 X. Y. 292. AA'here it was proven that the insured was seventy- three instead of sixty-four, as Avas stated in the application. It was also proven that the insured was a German who knew but little English ; that AA'hen he Avas asked his age by the agent he said he did not know; that the agent made some computation as to his probable age and inserted this, which Avas apparently largely a guess, into the apphcation. The court held that under the circumstances the company Avas estopped from setting up the falsity of this statement, as it was in reahty the statement of its own agent. Other Insurance.—The question is asked by most companies whether the applicant has been insured in other companies, and for what amounts. This is not a theoretical consideration, or mere inquisitiveness on the part of the company. It is proper for them to know it, for, if a man is taking insurance beyond his means, the knowledge wiU put them on their guard and cause more searching inquiries as to the reasons for the heavy insurance. And in many cases it might weU cause them to refuse the THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 563 risk altogether, on the ground of the financial hazard. Therefore, the epiestion should be answered quite closely and accurately. In the case of McCullum vs. Life Insurance Co., 55 Hun 104, 106, it was even held that benefit and accident associations Avere included under the term in- surance company in the question as to other insurance. The law on this point was very clearly announced in the case of Jeffries vs. Life Insurance Co., 22 Wall. 47 : '"The company deems it Avise and prudent that the applicant shall inform it truly Avhether he has made any other application to have his life insm-ed. So material does it deem this information that it stipulates that its liability shaU depend upon the truth of the ansAver. The same is true of its inquiry whether the party is married or single. The company fixes this estimate of its importance. The apphcant agrees that it is thus important by accepting the test. It would be a violation of the legal rights of the company to take from it its acknoAvledged power, thus to make its opinion the stand- ard of what is material, and to leave that point to the determination of a jury. The jury may say, as the counsel here argues, that it is imma- terial whether the applicant ansAvers truly, if he ansAvers one way, to wit: that he is single or that he has not made an application for insur- ance. Whether a question is material depends on the question itself. The information received may be immaterial, but if under any circum- stances it can produce a reply which will influence the action of the company, the question cannot be deemed immaterial. Insurance com- panies sometimes insist that individuals largely insured upon their lives, avIio are embarrassed in their affairs, resort to self-destruction, being willing to end a Avretched existence if they can thereby bestOAv comfort upon their families. The jury would be likely to repudiate such a theory on the ground that nothing can compensate a man for the loss of his life. The jury may be right and the company may be AATong, but the company has expressly pro Added that their judgment, and not the judgment of the juror, shall govern." But suppose that the applicant does tell part of his insurance but omits some. In that case it would come under the head of partial or in- complete answers (see p. 504), and, if Avarranted, would be construed rigidly against the insured. This point is Avell brought out in the case of Brennan vs. Ins. and Annuity Co., in which, on appeal to a higher court (4 Daly 296), it was held as foUows: " The judge also erred in refusing to direct the jury to find a verdict for the defendants if they believed the insured Avithheld from the defendants the fact that he held two [undis- closed] policies in the Guardian and Equitable Companies, sIioaa'u to haA'e been for $30,000 in addition to the $35,000 [disclosed], but referred to his previous charge, in AA'hich he had stated that, as to the ansAver of the insured to the twenty-fifth question in the application ["What amounts are iioav assured on the life of the party, and in what company ?" the answer being " .Etna, $10,000; Knickerbocker, $15,000; $10,000 addi- tional applied for in ./Etna"], 'if they found that George Schott, the assured, when he made that ansA\rer or declaration AA'as guilty of a false or fraudulent representation, and that such representation was material in the judgment of the insurers, and induced them to take the risk, then you avUI find for the defendants.' " In this there Avas a disregard of the contract of insurance sued on, in AA'hich it was expressly stated that ' if the declarations made by the 564 A SYSTEM OF LEGAL MEDICINE insured, and forming part of this contract, and upon the faith of AA'hich this policy is made, shall be found in any respect untrue, then and in such case the policy shall be nuU and void,' and AA'ithout considea-mg that entire truthfulness'of such declaration was, by the contract, made matter of Avarrantv, or condition precedent to any recovery upon it." This epiestion is construed thus closely by the courts because there is no decent excuse for any misstatement in reference to it. Ignorance cannot be pleaded, and any negligence in reference to it is culpable. Prior Rejection.—This, like the preceding, is a question of so much moment to the company that it regularly asks in the application about the non-acceptance of the risk by any other company, or even if the risk has been accepted at a higher premium than was applied for. Unless directly asked by the company, it is not material for the applicant to make any statement concerning his prior rejection by another, as was decided iii the case of Goodwin vs. Life Insurance Co., 18 L. Can. Jour. 1. But if the question is asked, absolute accuracy should be exercised in answering it, for the courts, regarding this as a matter of simple fact,. have been quite strict in construing the answer. Thus, in the case of McDonald vs. Life Insurance Co., 4 Bigelow's Life and Ace. Rep. 609, the insured denied falsely that there had been a prior rejection by another company. It was held that: "If the statement is not in every respect true in fact—not in the sense if it be fraudulent, or if it be a lie, or in the sense that there is moral culpability—then the policy is to be void." This rule was applied with great severity in Edinejton et al. vs. Life In- surance Co., 11 X. Y. 564. In this case it was provided in the applica- tion, which Avas expressly made part of the policy, that if any of the statements Avere "in any respect false or fraudulent," the pohcy should be void. The insured was asked, " Has any application been made to this or to any other company for assurance on the life of the party ? If so, with what result?" He answered, "Yes, and always successful. Yes, accepted." It was proven that the insured, one Diefendorf, filled up and signed an application to another company. He went Avith the agent, one Windsor, to the examiner's office, and, not finding him inr decided to return later. The agent in the meantime saw the examiner, who told him that the risk Avas a bad one, that the examination would be a farce and an unnecessary expense to the company. The agent then told these facts to the applicant, and destroyed the application. So that the applicant was never examined, and no record was received by the company. Xevertheless, the court held as foUows: "This evddence shows beyond question that an apphcation for insurance in the Xew Jersey Company had been made, and that it had not been successful. Windsor Avas agent of that company to receive such applications. When the application Avas delivered to him it was delivered to the company, and Diefendorf had done all he could do or Avas required to do to place himself in the attitude of an apphcant for insurance. In forwarding the application to the office of the company, Windsor would act, not as his agent, but as agent for the company. The medical examination Avas no part of the application. That was something to be done after the application Avas made. It was an act to be done, not by Diefendorf, or at his expense, but by the medical examiner, as the agent of the com- pany, and at its expense. The doctor knew him and was acquainted with his physical condition, and pronounced him unfit for insurance THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 565 Avithout an examination. That left the case precisely as if an examina- tion had been made and his application had been rejected. It was just such information as this that the questions put to the assured in these apphcations Avere designed to ehcit. The ansAA-ers were clearly untrue, no matter Iioav innocently they may have been made. There was nothing upon this branch of the case for submission to the jury, and the judge should have held that these ansAvers avoided the poUcies." The case Avas brought up again before the same court (100 X. Y. 536), and the decision above given Avas affirmed in stronger language: " The test is not Avhether Windsor or the medical examiner had authority to finaUy reject the application. If they were utterly Avithout authority to dispose of it, and so the company never acted upon it, at least there was an application to the company, Avhich Avas not successful and did not end in an accepted insurance." A rather fine point Avas made in the case of Langdon vs. Life Insur- ance Co., 14 Fed. Rep. 272. Here the question Avas, " Has any application ever been made, either to this or to any other company, upon Avhich a policy Avas not issued ?" This was ansAvered in the negative, but it was proven that on the day prior to his taking out the insurance with the above company he made application to another company, and was ex- amined for it. The examiner considered the risk unsatisfactory, and so stated hi his report to the company. This report Avas not acted on until several days later. In vieAV of these facts it Avas held that: "If the question had been, ' Has any application ever been made, to this or to any other company, upon Avhich a policy has not been issued ?' I should have had little difficulty in deciding that the ansAver Avas false; but I think there is a distinction between the Avorels ' was not' and lhas not been' issued. I think a person of ordinary intelhgence might answer no to the first form of the question, supposing that the company desired to know Avhether an application had been made and rejected. But the ap- plication in this case had not been rejected. The examining surgeon had no authority beyond his certificate as to the physical condition of the party examined. Xotwithstanding this certificate, the company might haA'e issued a policy if it had chosen to do so. It did not, in fact, reject the application until some time after the application in this case had been made to the defendant. The question, as put, was someAvhat ambiguous, and I think it contemplates, AA'hen fairly and reasonably construed, that the company desired to knoAV AAdiether an application had been made and rejected. So long as the matter Avas still pending, it does not seem to me that a negative ansAver to the epiestion was an improper one." Suicide.—In nearly all policies nowadays there is some proviso which tenels to aA'oid the contract in case of the suicide of the policy-holder. Sometimes this restriction extends OA'er the whole life of the policy, but more commonly it is limited to the first year or two. Upon the interpre- tation of these clauses has been expended a great deal of judicial learn- ing and skill. It is usually held that the expressions " suicide," " death by one's own hand," and " taking his own life," are synonymous. Thus, in the case of Eastabrook vs. Life Insurance Co., 54 Me. 224, it is stated as foIIoavs : -'The terms 'suicide' and 'dying by one's OAvn hand' are generally used synonymously. Sometimes one form of expression is used and some- times the other. They have the same meaning. ' Dying by one's oavd 566 A SYSTEM OF LEGAL MEDICINE. hand' is but another form of expression for suicide." Again, in the case of Cooper a's. Life Insurance Co., 102 Mass. 227, the Supreme Court of Massachusetts held: " Upon a careful consideration of the elaborate dis- cussion of the matter in the cases above cited, by the dissenting judges as weU as by those in the majority, Ave think that, as applied to this case, there is no substantial difference of signification betAveen the phrases ' shall die by his OAvn hand,' ' shaU commit suicide,' and ' shaU die by suicide.'" The subject is so large and important that it must be A'ery consider- ably subdivided; but the decisions have been so numerous, and to some extent conflicting, that it is difficult to reduce it to any systematic ar- rangement. 1. If a policy is taken out by one in good faith, and he subsequently commits suicide, there being no proviso against that act, it seems reasonable to suppose that the policy would not be avoided by such act, even though it was done A'oluntarily and Avhile in full possession of his faculties. This is certainly the case if the suicide Avas committed Avhile the insured Avas insane, and has been so decided in Horn vs. Life Insurance Co., 2 Bige- low's Life & Ace. Cases 602. Concerning the other phase of this question, dicta were laid down in Hartmann vs. Life Insurance Co., 21 Pa. St. 466, as follows: "The court was A'ery plainly right in charging that if no such condition had been inserted in the policy, a man Avho commits suicide is guUty of such a fraud upon the insurers of his life that his representatiA'es cannot recover for that reason alone." Against these dicta, AA'hich had no bearing on the ultimate decision in the case, are the rulings in the case of Fitch vs. Life Insurance Co., 59 X. Y. 557. " The policy contained no stipulation that it should be void in case of the death of the insured by suicide. It Avas not taken out for the benefit of Fitch, but of his wife and children. Although they were bound by his representations and any fraud he may have committed Avhile tak- ing out the pohcy, the policy haA'ing been obtained through his agency, yet they were not bound by any acts or declarations done or made by him after the issue of the policy, unless such acts were in violation of some condition of the pohcy." Similarly, in the case of Mills vs. Rebstock, 29 Minn. 381, it was held that "AA'here the constitutions and laAvs of the association contain no provision qualifying the right of recovery in case of suicide, the heirs of a member are entitled to recover the amount stipulated, irrespective of the mode of his death." A slight modification of this state of facts existed in the case of Dar- row vs. Fund Society, 116 X. Y. 537. In the policy Avas a proviso against death in consecpience of a violation of the law, but it Avas held " that sui- cide AA-as no defense unless it came Avithin some condition of the contract of insurance relieving the defendant from liabUity in such a case : that suicide was no crime in this State, although an attempt to commit sui- cide AA'as." Still another idea was presented in the case of Aid Society vs.Wanner, 24 111. App. 357. Here there was a proviso against death as the result of any immoral practice, but it was held "that an act of suicide Avas not an immoral practice Avithin the meaning of the certificate covenanted against by the assured." These rulings are sufficient to sIioav that at THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. ' 567 present a policy would not be forfeited by suicide, if there were no pro- visions in it against that mode of death, unless some other circumstances influenced the decision. 2. If an insurance policy is taken out by one Avith intent to commit suicide, there being no proviso in the pohcy against that form of death, Avould it be avoided by that act ? Francis (Annals and Anecdotes of Life Insurance, p. 310) relates an an- ecdote of a case of this kind in his usual interesting style : " A man went and insured his life, securing the privilege of a free-dying Englishman, and then took the insurers to dine at a tavern to meet several other per- sons. After the dinner he said to the underwriters, ' Gentlemen, it is fit you should be acquainted with the company. These honest men are trades- men, to whom I was in debt, AA-ithout any means of paying but by your assistance, and now I am your humble servant.' He pulled out a pistol anel shot himself." Unfortunately, Francis deals so largely in romance that we cannot vouch for the accuracy of this story, especially since neither the name of the company nor of the insured is given. In the case of Smith vs. Benefit Society, 51 Hun 575, a simUar state of facts received judicial consideration. This case is so remarkable in many respects that it is Avorth Avhile to go into details. In the first six or eight months of 1886, John Tyler procured insurance on his life to the amount of $282,000, diA'ided among thirty-six different companies. In none of the policies Avas there any reference to suicide. He had a family dependent on his efforts to earn a living. These efforts had not proved successful. He Avas in considerable debt, and had no way by AAdiich to meet his obligations. In particular he owed Frederick H. Smith about $10,000, and to meet the obligation he took out a policy for that amount in the National Benefit Society of Xew York. He did not disguise the object for which he was seeking this insurance. He told friends that if he faded to raise money by other means Avithin a reason- able time he would commit suicide, and in that way meet his obligations, and at the same time assure a future income to his family. He also made inquiries as to the easiest method of producing death. His finan- cial affairs greAv no better. The time approached Avhen the second pre- miums on some of his policies Avould fall due. It became necessary for him to act, On Xovember 9, 1886, he gaA'e the proper directions for his burial and said that he assumed responsibUity for his acts. On Xovem- ber 10th he AA'rote to his mother and told her that his policies were aU in companies AA'hich made no condition as to cause of death; that in that Avay his plans Avere so laid that if he could not benefit or help himself he could help those AA'hom he ought to help. On the next day he committed suiciele. The company very properly resisted the payment of the policy, and proved the truth of the foregoing statements. The case was ap- pealed to the General Term, and Judge Barnard gave the opinion of the court (51 Hun 576): " The policy was clearly a fraud upon the defendant Avithout any condition that suicide avoided the policy. The deceased de- signed to get a large aggregate of insurance. He was unable, and did not intend, to continue the payment of the premium until death came naturally, but his purpose Avas to provide for creditors and famUy by causing his oaa'ii death. This Avas a legal fraud in its inception, and a pohcy thus obtained never had any binding force in his hands. . . . The 568 A SYSTEM OF LEGAL MEDICINE. jury were told that if the deceased took out the policy AA'ith the intent to commit suicide, and did, in fact, commit suicide in pursuance of that intent, the action failed if the deceased Avas sane when he took his oaati life, if he did so take it, This covers the Avhole case." The case was finally carried to the Court of Appeals, and the judgment was affirmed (123 N."Y. S5). Judge Finch, in delivering the opinion, said: " Some of this evidence Avas resisted on the ground that death by suicide Avas no defense under the terms of the policy. That is true; but the defense Avas fraud, and suicide the ultimate agency by Avhich the fraud AA-as accomplished. It Avas necessary, therefore, to prove it, and in such a manner as to indicate that it AA-as not an insane or sudden im- pulse, but the culmination and effective Avorking out of a deliberately conceived purpose of fraud."' 3. If there is a proviso in the pohcy against self-destruction, and the insured commits suicide voluntarily and intentionaUy, whUe in the pos- session of his faculties and conscious of the immoralities of the act, there is no difference of opinion. Under such circumstances the policy is avoided, and aU authorities agree as to this. It makes no difference, of course, in these cases Avhether the pohcy was taken out in good faith or with intent to defraud the company by committing suicide. 4. On the other hand", even though there is a proviso against self- destruction, and the mode of death is by the insured's oavii hand, this- does not avoid the policy if the act is purely accidental and uninten- tional. This has been held true in a ease of poisoning by mistake, of accidental shooting, and in every case where the act of self-destruction Avas unintended by the party dying. This opinion is very well stated by Judge Rapallo in the case of Pen fold vs. Universal Life Ins. Co., £5 N. Y. 320, as follows: " The policy contained a condition that, if the person whose life Avas insured should 'die by his OAvn hand or act, vol- untary or otherwise,' the company should not be liable, etc. " The sole defense to this action is the aUeged violation of this condi- tion, and the ground of appeal is that the court gave improper instruc- tions to the jury in two respects : "First, the defendant contends that the evidence shows conclusively that the deceased came to his death by taking an overdose of medicine- which had 1 >een prescribed for him by his physician, and that the court therefore erred in leaving it to the jury as an open question to say whether or not the death arose from that cause; secondly, that the court again erred in instructing the jury that in order to sustain the defense they must find that the deceased took the overdose for the pur- pose of destroying his hfe, voluntarily, knoAvingly, and intentionally, it being conceded that there was no evidence of insanity. The excep- tions to these two portions of the charge raise the only questions to be determined on this appeal. "As to the first point there is not much difficulty. The evddence strongly tended to sIioav that the deceased took an excessive quantit}' of the medicine, and that his death Avas attributable to that cause; but there was no direct evidence of either of these facts. " The conclusions in respect to them depended upon inferences which it was Avithin the proA'ince of the jury to draw. The serious question in the case is that which arises upon the charge that, in the conceded ab- sence of any insanity, the defendant Avas not exempted from any habihty THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 569 unless the deceased took the overdose for the purpose of destroying his oavu life, knoAvingly, voluntarily, and intentionally. " The ordinary clause in life policies, that the insurer shall not be liable in case the person whose life is insured shall die by his oavii hand or act, has been repeatedly the subject of judicial construction, and it is iioav AveU settled that it is not to be construed as comprehending every possible case in which life is taken by the party's act, and that an unin- tentional or accidental taking of one's own life is not Avithin the meaning of the clause. . . . " The question in ah eases of this character is the proper interpretation of a contract, and the point of inquiry is, what obligations the parties must, from the language useel with relation to the subject-matter and the circumstances, be reasonably supposed to have intended to assume. The clause against suicide is clearly intended to protect the insurance company against the fraudulent act of the insured AAdiereby he may, even at the sacrifice of his oavii life, secure a benefit to those whom he may desire to faAror, at the expense of the insurance company. ... At a later day in the history of life insurance, some companies, for the purpose of avoiding the difficulties involved in the inquiry as to the condition of the mind of the person committing self-destruction, stipulated for exemption from liability in aU cases of suicide, Avhether ' sane or insane.' Others adopted the words ' voluntary or involuntary'; others, as in the present case, ' A'oluntary or otherAvise.' " It Avould not be a fair interpretation of this clause, in either of the forms mentioned, to hold it to cover the case of a purely accidental death from poisoning occurring to a sane person, through mistake or ignorance, though his OAvn hand might have been the innocent instrument by AA'hich the deadly potion was conveyeel to his lips. Such an accident cannot be presumed to have entered into the minds of the contracting par- ties, or to have been intended to be stipulated against. The insurance Avas intended to cover the risk of premature death, which might result from any of the casualties to which human life is subject—seh'-destruc- tlon being excepted. A purely accidental act, committed by a sane per- son AA'ith no idea of injuring himself, cannot be regarded as an act of self-destruction Avithin tlie meaning of such a contract. Suicide is the act stipulated against. The words ' voluntary or otherwise' preclude the parties claiming under the policy, if the act Avas one of suicide, from setting up the condition of mind of the party committing it, and con- tending that it AA'as an in A'oluntary act of suicide. But stUl it must be a suicide, and Avho would contend that the taking of poison by mistake, or any other act Avhich a sane person might innocently commit, though it should result in death, wras what is ordinarily understood as self- destruction or suicide ? It is unreasonable to suppose that one effecting an insurance upon his hfe, in stipulating against death by his oaaui hand or act could intend to embrace such a casualty, or that the insur- ance company could fairly expect him so to understand." A simUar ruling Avas given in the case of Life Insurance Co. vs. Ilazelett, 105 Ind. 212. Although the testimony as to the mode of death AA'as a little dubious, it AA'as held that: " Death resulting from accident or from an act Avhich at the time it Avas entered upon or engaged in was not expected, or intended to produce that result, cannot be said to be within the meaning of the policy. ... It is not averred that the assured 570 A SYSTEM OF LEGAL MEDICINE. was insane. From causes o\-er which he had no control a state of mental and physical weakness resulted, and Avhile in that state he took an over- draught of whiskey, Avithout any expectation or intention of elestreying his life. Death Avas therefore the result of an accident, and the pohcy was not avoided." In the case of Edwards vs. Life Insurance Co., 20 Fed. Rep. 661, it Avas held that the accidental taking of poison (prussic acid) Avas not included under the clause "shaU die by suicide, Avhether the act be voluntary or involuntary." The facts in the case Avere someAA'hat obscure, but the jury found that death Avas accidental. 5. If there is a simple proviso against self-destruction, and the in- sureel commits suicide Avhile insane, the determination of the effects of these circumstances has been different in different courts. The de- cisions seem to agree upon one point, that suicide is not in itself any eA'idence of insanity. Thus, in the case of Coffey vs. Life Insurance Co., 4 Bigelow's Life and Ace. Rep. 224, it was held: "No presumption that insanity exists in the case supposed can be deduced from the mere fact that the death of the person was caused by his own physical act; for every legal presumption of a fact of that character must be founded and derived from some other fact or facts, Avith AA'hich it is usuaUy or always found, as the result of general experience and knowledge, to be connected in a ecu-tain relation." And this A'ieAv Avas strongly approved in the later case of Weed vs. Life Insurance Co., 70 X. Y. 561, in which this language was used: " It was also held in the same case, as it has been uniformly held in other cases, that as sanity is the normal condition of man, it is presumed as to each indi- vidual, and that it Avas incumbent upon the plaintiff to overcome this pre- sumption by proof that the self-destruction was not the conscious, volun- tary act of one responsible for his action^; that the insured was, in fact, insane. Insanity cannot be presumed from the mere fact of suicide, as was said by Judge Grover in the case cited, for the reason that experience has shoAvn that self-destruction is often perpetrated by the sane." 6. Regarding the effect wdiich the suicide of the policy-holder,, while insane, has in avoiding the policy, there being a proviso against that mode of death, the decisions can be divided broadly into two classes, and wiU be so discussed: (a) If an individual commits suicide voluntarily, and the act is carried out in an inteUigent and purposeful manner in pursuance of a definite purpose, it is suicide on the part of the insured, even if he is urged thereto by an insane impulse, or if insanity exists to such an extent that the immorality of the act is not appreciated by him. This view is so ably set forth in the case of Dean vs. American Life Ins. Co., 4 AUen (Mass.) 96, by the Supreme Court of Massachusetts, as to serve for a model of reasoning. It proceeds as foUows: " There can be no doubt that the facts agreed bv the parties concern- ing the mode in which the insured destroyed his OAvn life bring this case within the strict letter of the proviso in the policy, by which it was stip- ulated that it should be void and of no effect if the assured should ' die by his own hand.' The single question, therefore, which avc have to deterniine is, whether, on the well-settled principles applicable to the con- struction of contracts, we can. so interpret the language of the policy as to add to the proAdso words of qualification and limitation, by which the THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 5J1 natural import of the terms used by the parties to express their meaning will be so modified and restricted that the case wiU be taken out of the proviso, and the policy wiU be held vahd and binding on the defendants. In other Avords, the inquiry is whether the proviso can be so read that the policy was to be void in case the assured should die by his OAvn hand, he being sane when the suicide was committed. If these or equivalent words cannot be added to the proviso, or if it cannot be held that they are necessarily implied, then it must follow that the language used is to have its legitimate and ordinary signification, by Avhich it is clear that the policy is void. " In considering this question Ave are relieved of one difficulty which has embarrassed the discussion of the same subject in other cases. If the proviso had excepted from the policy death by ' suicide,' it would have been open to the plaintiffs to contend that this word was to have a strict, technical definition, as meaning in a legal sense an act of crimi- nal self-destruction, to which is necessarily attached the moral responsi- bility of taking one's life voluntarily, and in the fuU exercise of sound reason and discretion. But the language of the proviso is not neces- sarily limited by the mere force of its terms. The Avords used are of the most comprehensive character, and are sufficiently broad to include every act of self-destruction, however caused, Avithout regard to the moral condition of the mind of the assured, or his legal responsibility for his acts. " Applying, then, the first and leading rule by wliich the construction of contracts is regulated and governed, we are to inquire what is a rea- sonable interpretation of this clause according to the intent of the parties. It certainly is very difficult to maintain the proposition that, where par- ties reduce their contract to writing, and put their stipulations into clear and unambiguous language, they intended to agree to anything different from that which is plainly expressed by the terms used. It is, however, to be assumed that eA'ery part of a contract is to be construed with ref- erence to the subject-matter to AA'hich it relates, and AA'ith such limitations and qualifications of general Avords and phrases as properly arise and grow out of the nature of the agreement in AA'hich they are found. Giv- ing fuU force and effect to this rule of interpretation, Ave are unable to see that there is anything unreasonable or inconsistent AAuth the general purpose which the parties had in riew in making and accepting the pol- icy, in a clause wliich excepts from the risk assumed thereby the death of the assured by his own hand, irrespective of the condition of his own mind, as affecting his moral and legal responsibUity at the time the act of self-destruction was consummated. Every assurer, in assuming a risk, imposes certain restrictions and conditions upon his liability. Nothing is more common than the insertion, in policies of insurance, of exceptions by Avhich certain kinds or classes of hazards are taken out of the general risk AA'hich the insurer is wiUing to incur. EspeciaUy is this true in re- gard to losses which may arise and groAv out of an act of the party in- sured. Such exceptions are founded on the reasonable assumption that the hazard is increased when the insurance extends to the consequences AA'hich may Aoav from the acts of the person who is to receive a benefit to himself or confer one on others by the happening of a loss Avithin the terms of the pohcy. Where a party procures a policy on his life, pay- able to his Avife and chUdren, he contemplates that, in the event of his 572 A SYSTEM OF LEGAL MEDICINE. death, the sum insured AviU inure directly to their benefit. So far as a desire to provide in that contingency for the Avelfare and comfort of those dependent on him can operate on his mind, he is open to the temptation of a motive to accelerate a claim for a loss under the policy by an act of self-destruction. Against an increase of the risk arising from such a cause, it is one of the objects of the proviso in question to protect the insurers. Although the assured can deriAe no pecuniar}' advantage to himsedf by hastening his oavii death, he may haA'e a motive to take his own life, and thus to create a claim under the policy, in order to confer a benefit on those who, in the event of his death, avUI be entitled to re- ceive the sum insured on his life. Unless, then, Ave can say that such a motive cannot operate on a mind diseased, Ave cannot restrict the words of the proA'iso so as to except from the risk coA'ered by the policy only the case of criminal suicide, AA'here the assured Avas in a condition to be held legaUy and morally responsible for his acts. It certainly Avould be contrary to experience to affirm that an insane person cannot be influ- enced and gOA'erneel in his actions by the ordinary motives AA'hich operate on the human mind. Doubtless there may be eases of dehrium or raA*- ing madness AA'here the body acts only from frenzy or bhnd impulse, as there are cases of idiocy or the decay of mental poAver, in AA'hich it acts only from the promptings of the loAvest animal instincts. But in the great majority of cases AA'here reason has lost its legitimate control, and the poAver of exercising a sound and healthy volition is lost, the mind still retains sufficient poAver to supply motives and exert a direct and essential control over the actions. In such cases, the effect of the dis- ease is often to give undue prominence to surrounding circumstances and events, and by exaggerating their immediate effects on future con- sequences to furnish incitement to acts of violence and folly. A person may be insane, entirely incapable of distinguishing betAveen right and Avrong, and Avithout any just sense of moral responsibUity, and yet re- tain sufficient powers of mind and reason to act with premeditation, to understand and contemplate the nature and consequences of his own con- duct, and to intend the results Avhich his acts are calculated to produce. Insanity does not necessarily operate to deprive its subjects of their hopes and fears, or the other mental emotions which agitate and influ- ence the minds of persons in the fuU possession of their faculties. . . . " It is against risks of this nature—the destruction of life bv the vol- untary and intentional act of the party assured—that the exception in the proviso is intended to protect the insurers. The moral responsibility for the act does not affect the nature of the hazard. The object is to guard against loss arising from a particular mode of death. The causa causans, the motive or influence Avhich guided or controUed the wiU of the party in committing the act, is immaterial, as affecting the risk which the insurers intended to except from the pohcy. This view is entirely consistent with the nature of the contract, It is the ordinary case of ah exception of a risk which would othei-Avise faU AAuthin the general terms of the policy. These comprehended death bv disease, either of the body or the brain, from AA'hatever cause arising. The proviso exempts the in- surers from habihty when life is destroyed bv the act of the party insured although it may be distinctly traced as the result of a diseased mind. It may weU be that insurers would be A\dUing to assume the risk of the re- sults floAA'ing from aU diseases of the body, producing death bv the opera- THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 573 tion of physical causes, and yet deem it expedient to avoid the hazards of mental disorder, in its effects on the aa'UI of the assured. . . . " It was urged by the learned counsel for the plaintiffs very strongly that this vieAV of the construction of the contract was open to the fatal objection that it Avould necessarily lead to the absurd conclusion that death occasioned by inevitable accident or overpowering force, or in a fit of dehrium or frenzy, if the proximate and immediate cause was the hand of the person insured, Avould be excepted from the risk assumed by the defendants. But this objection is sufficiently ansAvered by the obvious suggestion that such an interpretation, although within the lit- eral terms of the proviso, Avould be contrary to a reasonable intent, as derived from the subject-matter of the contract. . . . The question in such cases is not how far can the literal meaning of Avords be extended, but AA'hat is a reasonable limitation and qualification of them, having re- gard to the nature of the contract and the objects intended to be accom- phshed by it. Applying this principle to the present proviso, and assum- ing that the plaintiffs are right in their position that the words used are not to be interpreted literally, it Avould seem reasonable to hold that they were intended to except from the policy all cases of death caused by the voluntary act of the assured, AA'hen his deed of self-destruction was the result of intention, by a person knowing the nature and consequences of the act, although it may have been done under an insane delusion, Avhich rendered the party moraUy and legally irresponsible, incapable of distin- guishing between right and Avrong, and Avhich, by disturbing his reason and judgment, impeUed him to its commission. If the suicide was an act of vohtion, however excited or impelled, it may in a just sense be said that he died by his own hand. But beyond this it would not be reason- able to extend the meaning of the proviso. If the death was caused by accident, by superior and overwhelming force, in the madness of delirium, or uneler any combination of circumstances from Avhich it may be fairly inferred that the act of self-destruction Avas not the result of the wiU or intention of the party adapting means to the end, and contemplating the physical nature and effects of the act, then it may be justly held to be a loss not excepted within the meaning of the proA-iso. . . . Those familiar with the business of insurance, and Avith the result of actions on policies of insurance in courts of laAv, knoAV Iioav difficult it is to establish a case of exemption from liability under an exception in a policy where it de- pends on a question of fact to be decided by the verdict of a jury. If this is true in regard to ordinary claims under pohcies, it is obvious that the difficulty would be greatly enhanced in cases like the present, where it would be sufficient, in order to take a case out of the operation of the proviso, to prove that self-destruction Avas the result of insanity. It Avould not be hazardous to affirm that, in all cases AA'here such an issue was to be determined by a jury betAveen an insurance company and the represeiitatiA'es of the deceased, the act of suicide would be taken as proof of insanity. . , . " The learned counsel for the plaintiffs have insisted Avith great force on an argument draAvn from the context, to show that the proviso Avas intended to embrace only a case of criminal self-destruction by a reason- able and responsible being. But it seems to us that the maxim noscitur a sociis, on wliich they rely, does not aid the construction for AA'hich they contend. The material part of the clause is, that the pohcy shaU be void 574 A SYSTEM OF LEGAL MEDICINE. if the assured 'shall die by his own hand, or in consequence of a duel, or by the hands of justice, or in the knoAA'n violation of any State, national, or provincial law.' Xoav the first and most obvious consideration sug- gested by other parts of this clause is, that in enumerating the causes of death wliich shaU not be deemed to be within the risks covered by the policy, one of them is in terms made to depend on the existence of a criminal intention. It is a 'knoAAui violation of haw' which is to avoid the policy. This tends very strongly to show that where an act produc- ing death may be either innocent or criminal, if it is intended to except only such as involves a guilty intent, it is carefuUy so expressed in the proviso. The inference is very strong that if they designed to confine the exception in question to cases of criminal suicide, it would have1 been so proA'ided in explicit terms. ... It seems to us to be a petitio prineipii to assume that death in consequence of a duel necessarUy implies an act for which the party would lie criminally resjionsible. Why is not this part of the proviso open to the same argument as that which is urged in regard to the clause relating to self-destruction ? A duel may be fought by a party acting under duress, or impelled thereto by an insane delu- sion, which might blind his moral perceptions and render him legally ir- responsible. If so, then the same answer to a defense set up against a claim under the policy would be open, under this clause, as the one now urged in behalf of the plaintiffs; anel the argument founded on the as- sumption that a forfeiture under this part of the proviso necessarily in- ATohres a criminal violation of the law falls to the ground. Therefore the inference that a gnUty intention is communicated from this branch of the proviso to that relating to death by the act of the assured seems to us to be unfounded. The only remaining clause is that AA'hich pro- Addes for the case of death by the hands of justice. This undoubtedly implies that the person insured has been found guUty of a criminal act by a judicial tribunal, according to the established forms of huv. But it is not correct to say that it involves the existence of a criminal intent, because it might be shoAvn that the conviction of the assured was errone- ous, and that he Avas in fact innocent of the crime for which he1 suffered the penalty of death. So far, therefore, as any argument can be justly drawn from the connection in which the words as to self-destruction stand in relation to other parts of the proviso, it leads to the conclusion that it was not solely death occasioned by acts of the assured involving criminal intent or a AviUful violation of the law by a person morally and legally responsible, wliich was intended to be excepted from the risks as- sumed by the insurers; but that, with the exception of death in a known violation of law, the proviso embraces all cases Avhere life is taken in con- sequence of the causes specified, Avithout regard to the question Avhether at the time the assured Avas amenable for his act, either in foro conscientice, or in the tribunals of justice. . . . "To say that insanity exonerates a party from a forfeiture under such a proviso in a policy is to assume that this Avas the intention of the parties Avhen the contract of insurance was entered into. But if such AA'as not the intention, then it follows that the assured gave an intelligent assent to a contract by AA'hich he stipulated that if he took his own life voluntarily, knowing the consequences of his act, he Avould thereby work a forfeiture of his claim under the policy, although he may have acted under the influence of insanity in committing the suicidal act. So that, THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 575 after all, Ave are brought back to the inquiry, What was the intention of the parties to the contract? in order to ascertain the true construction of the proviso. "The result to which we have come, after a careful and deliberate consideration of the question, during which we have felt most sensibly the Arery great difficulties and embarrassments which surround the sub- ject, is that the plaintiffs are not entitled to recover. The facts agreed upon by the parties concerning the mode in which the plaintiffs' intestate took his oaa'ii hfe, leave no room for doubt that self-destruction was in- tended by him, he having sufficient capacity at the time to understand the nature of the act AA'hich he Avas about to commit, and the conse- quences which Avould result from it. Such being the fact, it is Avholly immaterial to the present case that he was impeUed thereto by insanity, which impaired his sense of moral responsibility, and rendered him to a certain extent irresponsible for his actions." This opinion has been quoted at great length, because it seems to us to be the only logical one that can be applied in these cases; and further, the position is stated Avith such clearness, and eA'ery objection is answered so ably, that it seems as if it Avere incontroArertible; but human tender- ness and the fact that corporations have no soul have elsewhere materi- ally modified it, as we shall see later. In 1848 the weU-known English case of Dormay vs. Borradaile, 5 M. & G. 380, was decided. In that case the jury founel that the assured "voluntarily threw himself into the water, knowing at the time that he should thereby destroy his life, and intending thereby to do so; but at the time of committing the act he was not capable of judging between right and Avrong." On appeal it Avas held by three out of four judges that the pohcy was avoided. Erskine, J., said " that the question whether at the time he was capable of understanding the moral nature and quality of his purpose is not relevant to the inquiry further than as it might help to Illustrate the ex- tent of his capacity to understand the physical character of the act itself." This Avas substantially repeated in the case of Cliff vs. Sehwabe, 3 C. B. 437, and may be considered accepted noAV in England; as is indicated in the case of Stormont vs. Waterloo Life and Casualty Ass. Co., 3 BigeloAv's Life & Ace. Cases 196, AA'here the court instructed the jury that "the question is, Did the assured know that he AAas throwing himself out of the window ? If he did, no recovery could be had under the pohcy." In the United States the same principle has been again folloAved in Massachusetts in the case of Cooper vs. Massachusetts Mutual Life Ins. Co., 102 Mass. 227, where it was said: "In the present case there was no offer to prove madness of delirium, or that the act of self-destruction was not the result of the wUl and intention of the party, adapting the means to the end, and contemplating the physical nature and effects of the act. The insanity, therefore, was not such as to take the case out of the proviso." In Xcav York the first case decided Avas against this view. This is the famous case of Breasted vs. Farmers' Loan and Trust Co., 4 Hill (N. Y.) 73 anel 8 X. Y. 299, the history of which is related quite fully on page 577. Even in this case three out of eight judges held a dissenting opinion, Avhich was very ably expressed by Judge Gardiner, who said: " It is by the finding established that the assured cast himself into the 576 A SYSTEM OF LEGAL MEDICINE. river for the purpose of droAvning himself. The act committed by him Avas therefore voluntary, and accompanied by so much intelligence as to enable the agent to contemplate a particular result, and adopt the means requisite to accomplish it. His object Avas self-destruction by droAvning. For this purpose he cast himself into the river, and thereby effected it. If this AA-as not 'dying by his own hand' Avithin the spirit and intent of this clause of the pohcy, it is difficult to attach any legal significance1 to such language. "If, under the same circumstances, the assured had destroyed the property or assaulted the person of a citizen, he AvoiUd have been civilly responsible for aU the damages sustained by the latter. Insanity, unless it suspended the power of volition, Avould be no justification: still less a want of moral perception to distinguish between right and Avrong. "I can perceive no reason why upon the same principle he should not be held responsible for a AviUful breach of contract resulting from self- destruction, where it was premeditated, and accomplished by means usual and appropriate to effect his design." At a later date this vienv prevailed in the case of Van Zaudt vs. Life Insurance Co., 55 X. Y. 169. Here it Avas held that: "In the practical ad- ministration of justice in cases of this description, it seems to us a dan- gerous doctrine to hold that the attention of the jury should be directed' principally to the degree of appreciation winch the deceased had of the moral nature of his act, and that this question, most speculative and difficult of solution, should be made the test by which it should be de- termined whether he had knoAvingly and voluntarily riolated the condi- tion of his insurance. The real question is whether he did the act con- sciously and voluntarily, or whether from disease his mind had ceased to control his actions. Supposing a man to be in the possession of his avUI and of the ordinary mental faculties necessary for his self-preservation, but that his mind has become so morbidly diseased on the subject of sui- cide that he cannot appreciate its moral Avrong, and in this condition of mind he takes his oavii life A-oluntarily and intentionally, perhaps with the very object of securing to his family the benefits of an insurance upon his hfe, it is difficult to say that this is not a eleath by his oavii hand within the meaning of the policy. It has been doubted AA'hether public policy would permit an insurance covering the case of intentional suicide by the assured AA'hUe sane. But hoAvever this may be, no rational doubt can be entertained that a condition exempting the insurers from liability in case of the death of the assured by his OAvn hand, whether sane or insane, would be valid if mutuaUy agreed upon betAveen the insurer and the in- sured. When nothing is said in the policy with respect to insanity, the words ' die by his own hand,' in their literal sense, comprehend all cases of self-destruction. The exceptions AA'hich have been grafted upon these words by judicial decisions must rest upon the ground that the excepted cases could not have been within the meaning of the parties to the policy. The intent on the part Of the insurer in inserting the condition is erident. The policy creates in the assured a pecuniary interest in his own death. To a man laboring under the pressure of poverty and the urgent Avants of a dependent family, or of inabUity to discharge sacred pecuniary obligations or other similar causes, the pohcy offers a tempta- tion to self-destruction. To protect the insurers against the increase of risk arising out of this temptation is the object for wliich the condition THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 577 in eiuestion is inserted. The condition ought, therefore, to be so construed as to exclude only those cases in AA'hich these motives could no" have operated, such as accident or delirium." The vieAvs stated above in this section are those held also by the best- known text-books on life insurance, Biddle, May, and Richards. May says that " to hold ' death by his own hand' identical with criminal sui- cide, and to require freedom from irresistible impulse, is clearly making a neAv contract very different from the plain sense and spirit of the words. It is a question if any impulse that causes action is resistible. The prospect of providing for wife and famUy may in some states of mind be an irresistible motive, yet it is the very one the company wishes to exclude." Holland, France, anel Germany apparently have adopted the same construction of this question. (6 Ins. L. J. 719.) (b) Unfortunately, the sanctity of such motives, as providing support for wife and chUdren, and possibly other considerations, have, in another class of cases, influenced the judicial mind; consequently we find it held that, even if the act of suicide be voluntary, stiU, to bring it within the exception it must be accompanied by an understanding of its normal aspect, an ability to distinguish right from wrong, and also a freedom from the influence of an irresistible impulse. This view was apparently first enunciated in 1818 by the Chief-Justice of Bengal, in the case of Bayley vs. Alexander, Biddle on Insurance, sec. 832. It therefore has AAdiatever merit antiquity may lend to it. The next case was that of Breasted vs. Farmers' Loan and Trust Co., 4 Hill (N. Y.) 73, the dissenting opinion in which Ave have already quoted. In the prevailing opinion it was held that: " Suicide involves the deliberate termination of one's existence while in the possession and enjoyment of his mental faculties. Self-slaughter by an insane man or a lunatic is not an act of suicide within the meaning of the law." This case Avas finally carried to the Court of Appeals, and it was there held (8 N. Y. 299) by five out of eight judges as foUoAvs: "The connection in which they are useel in this policy indicates that the phrase ' death by his own hands' meant an act of criminal self-destruction. . . . The connection in which they stand in this policy favors this construction. The first four exceptions in the policy are of acts innocent in themselves, three of which become inoperatiA'e if the defendants give their consent and have it indorsed on the policy. Then follow the last four exceptions, A'iz., if he shall die by his own hand, or in consequence of a duel, or by the hands of justice, or in known violation of any law, etc. By the acknowledged rule of construction, noseitur a sociis, the first member of the sentence, if there be any doubt as to its meaning, should be con- troUed by the other members, which are entirely unequivocal, and should be construed to mean a felonious kUling of himself. It is a note laid by Lord Bacon that copulatio rerborum indicat acceptionem in eodem sensu ; the couphng of words together shows that they are to be under- stood in the same sense. And when the meaning of any particular word is doubtful or obscure, or when the expression, taken singly, is inoperative, the intention of the parties using it may frequently be ascertained and carried into effect by looking at the adjoining words, or at expressions occurring in other parts of the same instrument, for tpue non raleant singula juncta juvant. Besides, the Avords in this case are those of the insurer, and if susceptible of two meanings, should be 578 A SYSTEM OF LEGAL MEDICINE. taken strongly against him. It was not intended on the part of the defendant that the policy would be avoided by a mere accidental destruction of life by the' party himself. It Avas urged that it would be if the act was done intentionaUy, although under circumstances Avhich would exempt the party from all moral culpability. It was insisted that it must be taken to mean a death by his own act. It seems to me that this is a yielding of the whole question. An insane man, incapable of discerning'between right and Avrong, can form no intention. His acts are noc the result of thought or reason, and no more the subject of punishment than those Avhich are produced by accident. The acts of a madman, Avhich are the offspring of the disease, subject him to no criminal responsibUity. If the insured, while engaged in his trade as a house- joiner, had accidentally faUen through an opening in the chamber of a house he was constructing and lost his life, the argument concedes that the insurer would have been liable. The reason is that the mind did not concur with the act. How can this differ in principle from a death in a fit of insanity, when the party had no mind to concur in or oppose the act? ... " If the insured was compeUed by duress to take his own life, it wiU hardly be contended that the insurers could avoid payment. In what consists the difference betAveen the duress of man and duress of Heaven ? Can a man be said to do an act prejudicial to the insured when he is compelled to do it by irresistible coercion? and can it make any difference AA'hether this coercion came from the hand of man or the Ausitation of Providence ?" This rule, although afterward reversed in the same State in the case of Van Zandt vs. Mutual Benefit Life Insurance Co. (see p. 576), furnished a precedent that has been elsewhere eagerly followed. The question was brought before the Supreme Court of the United States in the case of Mutual Life Insurance Co. vs. Terry, 15 Wall. 580. The dicta in this case are: " The propositions embodied in the charge before us are in some respects different from each other, but in principle they are identi- cal. They rest upon the same basis, the moral and inteUectual capacity of the deceased. In each case the physical act of destruction was that of George Terry. In neither was it truly his act. In the one supposi- tion he did it when his reasoning powers were overthrown, and he had not the power or capacity to exercise them upon the act he was about to do. It Avas in effect as if his intellect and reason were blotted out or had neA'er existed. In the other, if he understood and appreciated the effect of his act, an uncontrollable impulse, caused by insanity, compeUed its commission. He had not the power to refrain from its commission or to resist the impulse. Each of the principles put forth by the judge rests upon the same basis, that the act was not the voluntary, intelligent act of the deceased. . . . " We hold the rule on the question before us to be this: If the assured, being in the possession of his ordinary reasoning faculties, from anger, pride, jealousy, or a desire to escape from the iUs of life intentionaUy takes his own life, the proAuso attaches, and there can be no recovery. If the death is caused by the voluntary act of the assured, he knoAving and intending that his death shall be the result of his act, but when his reasoning faculties are so far impaired that he is not able to understand the moral character, the general nature, consequences, and effect of the THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 579 act he is about to commit, or when he is impeUed thereto bv an insane impulse, Avhich he has not the poAver to resist, such death is' not within the contemplation of the parties to the contract, and the insurer is liable." It will be noticed that this is even more liberal than the preceding case, for it brings in the idea of an irresistible impulse as well as a lack of appreciation of the moral consequences of the act. To the average juryman in such a case the convincing proof of the irresistibility of an impulse would be the fact that it was not resisted. It seems to us' hardly worth the while to separate these decisions of such marked leniency into separate classes. One or both of them has been adopted in the following cases: Life Insurance Co. vs. Groom, 86 Pa. St. 92; Schultz vs. Insurance Co., 40 Ohio St. 217 ; Hathaway vs. Insurance Co., 48 Vt. 335 ; Life Insur- ance Co. vs. Broughton, 109 U. S. 121; Eastabrook vs. Life Insurance Co., 54 Me. 224 ; Blaekstone vs. Standard Co., 74 Mich. 593 : Life Assn. vs. Waller, 57 Ga, 533; Knickerbocker Insurance Co. vs. Peters, 42 Md. 414; Scheffer vs. National Co., 25 Minn. 534. The situation in Xenv York State is rather interesting. In the case of Breasted vs. Farmers' Loan and Trust Co., 4 HiU (X. Y.) 73, the court, as AAre have seen, made a most liberal decision, but this Avas overruled in Van Zandt vs. Life Insurance Co., 55 X. Y. 169. Although in this latter decision the idea that moral irresponsibility excused the act of suicide is distinctly rejected, the doctrine of irresistible impulse is faintly outlined. This grew into large proportions in the case of Newton vs. Life Insurance Co., 76 X. Y. 426, and became the predominant thought in the ruling; thus : " Without referring to the evidence in detail, our conclusion is that although it might have required the jury to find that Ross Avas aAvare when he took the laudanum that it would terminate his life, yet it would also have justified a finding that he acted under the control of an insane impulse caused by disease and derangement of his inteUect, Avhich de- prived him of the capacity of goArerning his own conduct in accordance with reason. An act committee! under such circumstances cannot be re- garded as voluntary or within the proviso of the pohcy." This Adew was affirmed in the case of Meaehttm vs. Benevolent Associa- tion, 120 X. Y. 237, AA'here it was held that: " Unless, therefore, such self- destruction was the result of accident, mistake, or insanity, or Avas invol- untary because he was driven to it by an insane impulse, Avhich disabled him from controlling his own actions, Hay committed suicide Avithin the meaning of the policy and it became void." This AA'as a question of fact for the jury to determine, wliich they did in the usual Avay. At this time we must range XeAv York with the liberals in this matter. It is not worth while, for practical purposes, to separate cases of " moral irresponsibility " from those of " irresistible impulse." The result is the same, for the question, being one of fact, is left to the jury, and they al- Avays find for the plaintiff in these cases. 7. In order to olmate the difficulties mentioned in the previous section, the companies have inserted additional qualifying Avords, com- monly "sane or insane." The folloAving expressions haA'e been con- sidered as synonymous Avith that: "self-destruction, felonious or other- Avise," "Avhile insane," "dying by his oaaui act or intention, Avhether sane or insane." But the meaning must be A'ery clearly expressed, or the courts will disregard the apparent intention of the insurers and rule against them, for, as has been already stated, it is AveU understood that, in case of any 580 A SYSTEM OF LEGAL MEDICINE. doubt, the interpretation of the contract wUl be adverse to the insurers, as they were the ones Avho dreAV it up. Consequently, the foUcnving clauses have not been held to make any additional restriction: " dying by his oavii hand or act, voluntarily or otherwise" (Jacobs vs. Life Insurance Co., 5 BigeloAv's Life & Ace. Cases 42), "under any circumstances die by his own act or hand" (Schultz vs. Insurance Co., 40 Ohio St, 217). These additional quahfying words first quoted have been interpreted in two different Avays : (a) By some it is held that aU acts of self-destruction not accidental Avere included in the proviso. In the case of De Gorgoza vs. Life Insur- ance Co., 05 X. Y. 232, the restricting clause was "die by his own hand, sane or insane," and it was held as follows : " I shall assume that the jury found that when the hand of the assured delivered the fatal shot he Avas whohy bereft of reason. ... If the words mean anything, it is just what they commonly import, and that is, if death ensues from any physical movement of the hand or body of the assured, proceeding from a partial or total eclipse of the mind, the insurer goes free. . . . We are of the opinion that, in the common judgment of mankind, it wiU be consid- ered that when a totaUy insane man blows his brains out with a pistol he wiU be said to have died by his own hand within the meaning of a pohcy such as we have now under consideration." In this case the deci- sion was rendered by three out of five judges. In the case of Riley vs. Insurance Co., 25 Fed. Rep. 315, the restricting clause was " self-destruc- tion, felonious or otherwise," and it was held that, no matter under what circumstances he kiUed himself, no recovery could be had under the pol- icy, but of course that did not mean accidental death. In the case of Scurth vs. Insurance Co., 75 Iowa 346, the clause was "suicide, felonious or otherwise, sane or insane." This was held to cover " all suicidal acts, whether such as are denominated criminal, or such as are the offspring of insanity," and a very simUar aucw was held in the case of Solentine vs. Insurance Co., 24 Fed. Rep. 159. (b) In the other set of cases the additional restrictions are considered apparently to cover the case of intentional suicide, but not if the indi- vidual is unconscious of the physical nature of his act and its results, nor perhaps if he is acting under an irresistible impulse. Thus in Pierce vs. Insurance Co., 34 Wis. 389, the restricting clause was " die by suicide, felonious or otherwise, sane or insane," and it was held: " The condition here relieves the company from liability only where the self-destruction was intentional, or committed by a party who was conscious of the nature of the act he Avas committing, or about to commit, and conscious of its direct and immediate consequences, though the act may have been unac- companied by any criminal or felonious intent or purpose." Similar lan- guage, though not quite as explicit, AA'as used in Bigclow vs. Insurance Co., 93 U. S. 284, anel Streeter vs. Insurance Society, 65 Mich. 199. In the case of De Gorgoza vs. Insurance Co. two judges dissented from the pre- vaUing opinion anel held views similar to the aboA'e. 8. In spite of all restricting words and provisos, there has been found a way to get around the exception in some cases, and that has been by the expedient of caUing the suicide an accident, Generally speaking, that is a epiestion of fact, and as such is presented to the jury for its consid- eration. And there hardly exists a jury AA'hich will hesitate in a choice between suicide and accident as the cause of death of one of their neisrh- THE MEDICAL JURISPRUDENCE OF LIFE INSURANCE. 581 bors. The good old principle, de mortuis nil nisi bonum, wUl aUow but one conclusion. Of course, if the facts are susceptible of two explanations, the natural, legal, and judicial presumption is that a case is one of accident rather than of suicide. Thus, in Mallory vs. Insurance Co., 55 N. Y. 52, it was held that: " Death was caused by such an injury or the suicidal act of the deceased; but the presumption is against the latter. It is contrary to the general conduct of mankind; it shows gross moral turpitude in a sane person." Similarly, in the case of Insurance Co. vs. Delpeuch, 82 Pa. St. 225, it AA-as held that: " The party aUeging suicide must prove it. The mere fact of death in an unknown manner creates no legal presumption of suicide. Upon evenly balanced testimony the law assumes innocence rather than crime. Preponderating evidence is necessary to establish the latter." The folloAving cases show the present method of avoiding this issue. In the case of Keels vs. Fund Association, 29 Fed. Rep. 198, the insured had been suffering for some months from mental aberration due to softening of the brain. One afternoon his body was found in a past- ure, near a fence from AA'hich he had apparently faUen, with a bullet-hole in his head and a pistol in his hand. The restricting proviso avoided the policy in case of " eleath by his OAvn hand, sane or insane, voluntary or involuntary." The jury founel for the plaintiff, on the ground that it was an accident. On appeal it was held: " Accidental or unintentional self-kiUing is not within a condition forfeiting a pohcy for suicide or taking one's oaa'u life, whether such death results from taking poison by mistake, supposing it a Avholesome medicine, or from an act done in frenzy or delirium, as by leaping from a windoAv, tearing off a bandage from an artery, or from an act done under the stress of an oA'erpowering force. ... If it were intended by this policy to include death by acci- dent, it was easy enough to say so." Of course this ruling sounds and reads A^ery nicely, and one might imagine from it that a cruel, grasping corporation was trying to defraud the beneficiary out of her rights on a mere technicality. But it appears that in the proofs of death which the beneficiary submitted to the company she declared, over her own signa- ture, that her husband's death Avas due to suicide, superinduced by de- mentia. Also this Avas the A-erdict of the coroner's jury, which was pre- sumably held Avithin a short time after the death, and therefore while the circumstances Avere fresh and capable of accurate consideration. When one regards these facts there is but httle justice in the decision, hoAvever correct it may have been legaUy. In the case of Phillips vs. Life Insurance Co., 21 Am. Rep. 549, it was held that if the defendant Avas insane when he committed the act of self- destruction, no responsibility could be attached to his act. But it was also held that there AA'as a reasonable doubt as to the proof of his haring committed suicide. The facts were1, that he retired to bed, and about 1 o'clock a.m. a pistol shot was heard. The inmates of the house rushed in and found he was shot in the mouth and a pistol was lying on the floor near by. It AA'as considered possible that an enemy might have shot him or' that he might have done it accidentaUy. The burden of proof, of course, Avas on the insurers. 9. Our oaa'u vieAV can be summed up in a few words. We do not think that the ordinary rules of criminal responsibUity which are apphed to the 582 A SYSTEM OF LEGAL MEDICINE. insane should be considered adequate in these cases. The contraed is a definite one, and it is neA-er assumed that the individua], AA'hen he signed it, was anything but perfectly sane. What other contracts are aA'oided under simUar circumstances ? He assumed this contract knoAvingly and intelligently. It AA'as understood by him that there Avas a proA'iso in it that the policy should be forfeited if he died by his oavii hand. It Avas reasonable for him and for any one else to suppose that this did not in- clude death by accident under any circumstances. The only question left, then, is to construe Avhat the term " accident " means. When an act is done involuntarily and unintentionally, or by an individual avIio is not able to form an idea of the physical sequence of cause and effect Avith reference to this particular act, such an act coulel weU be included under the term "accident." In the language of the Supreme Court of Massachusetts, " If the death be by accident, by superior and oA'ci-Avhelming force, in the madness of delirium, or under any combination of circumstances from Avhich it may be fairly inferred that the act of self-destruction Avas not the result of the avUI or intention of the party adapting means to the ends, and con- templating the physical nature and effects of the act, then it may be justly held to be a loss not excepted within the meaning of the proviso." But it is said that an insane delusion or an irresistible impulse may be so marked as to preponderate over the rest of the inteUect, so that the subject is no longer responsible for his acts. That is true, but if it leave him with sufficient inteUigence to adapt means to ends and to knoAV the result of a contemplated act, such a grade of irresponsibility certainly should not abrogate this contract, made in good faith AA'hile he aa.-is per- fectly sane, and set up in its stead another contract of very different im- port. If the delusion or impulse is so marked that he no longer under- stands the physical nature of the act, then it might be called an accident, and as such would not be included Avithin the proA'iso. ACCIDENT INSURANCE AND BENEFIT ASSOCIATIONS BY COETLANDT F. BISHOP, Ph.D. In a treatise on medical jurisprudence it is necessary to consider but one branch of accident insurance, namely, that relating to the insurance of human beings against casualty. From this point of view accident insurance is reaUy a branch of life insurance, and is therefore to a cer- tain extent governed by the same rules. The ordinary life pohcy grants relief in case of death, however caused, or in the event of the assured's reaching a certain age. Accident insurance, on the other hand, proAddes against loss arising from death or disabUity caused by violent and ex- ternal means rather than by disease, the latter being particularly the province of insurance by beneficial societies. The first question that presents itself is one of definition. What is an accident ? The Supreme Court of Pennsylvania has declared that it is " an event that takes place AAdthout one's foresight or expectation, an event which proceeds from an unknown cause, or is an unusual effect of a known cause and therefore not expected." (North American Life and Accident Company vs. Burroughs, 69 Pennsylvania State, 43.) It wUl be noted that the word is used in its popular sense, the element of the un- foreseen being always present. A contract of accident insurance is not one of indemnity, for a per- son cannot be indemnified for the loss of life or limb as he can for the loss of a house or ship. The aUoAvance for disabhng injuries, though usuaUy so called, is not really an indemnity, for in most pohcies it is limited to a certain fixed sum per week, always less than the wages or income of the assured. In one of the few known cases of accident insurance in the form of an indemnity contract, the Court of the Ex- chequer held that the insurer was bound to indemnify the assured for the costs of medical attendance and expenses to AA'hich he was put by the accident, and not for loss of time or profits. (Theobold vs. Railway Pas- senger's, etc., Company, 10 Exchequer, 45.) The modern form of policy is more convenient in that it does away with the necessity of going into the assureel's private affairs. The applicant for accident insurance is seldom, if ever, required to submit to a medical examination. His application is based on a Avarranty of the truth of certain facts concerning his condition. Among these are physical anel mental soundness, correct and temperate habits, and entire freedom from fits or disorders of the brain. It is frequently stipulated that any medical adviser of the insurer shaU be permitted as often as r>s;j 581 A SYSTEM OF LEGAL MEDICINE. required to examine the person or body of the insured in respect to alleged injury or cause of death. In addition to ansAvering inquiries regarding other insurance, the applicant is obliged to state that he has no special journey or hazardous undertaking in contemplation. The companies are in the habit of diAud- ing occupations into classes, each of AA'hich is insured at a given rate in proportion to the hazard. The policy is not avoided in case of a change of occupation, but the insured agrees that if injured whUe engaged in work classed as more hazardous, he shall be entitled to recover only such an amount as the premium paid by him would purchase at the rates fixed for such increased hazard. (Standard Life and Accident Insurance Company vs. Martin, 33 Northeastern, 105.) As in the case of life poli- cies, the applicant may designate a beneficiary to take in case of death. Some accident companies avUI only insure persons between the ages of eighteen and seventy, and refuse to insure women of any age or men of sixty-five or more against anything but death. Other companies refuse to deal AA'ith cripples, deaf, dumb, or blind persons, or those AA'ho are reckless or Avithout visible means of support. Accident policies resemble marine policies in that they may be for a time or for a particular voyage. Voyage policies may or may not be limited in point of time, but are ahvays made to cover a prescribed jour- ney, and deviation is not permissible. In recent years, examples of acci- dent insurance on a large scale have presented themselves. In consider- ation of a premium the insurer agrees to insure a raUroad company, for example, against claims arising from personal injuries received by its passengers (South Staffordshire Tramways vs. Sickness and Accident Asso- ciation (1891), 1 Queen's Bench, 402), or an employer against claims aris- ing under the Employer's Liability Act. Such insurance is not regarded as opposed to pubhc policy, and in England is sanctioned by statute. (44 and 45 Victoria, cap. xii.) The Avord "accident" is so broad in its meaning that the companies have sought to limit its scope by inserting in their policies numerous exceptions, and it is the construction of general restrictive clauses that makes .up the greater portion of the case laAv of the subject. So much depends upon the particular phraseology employed that it is a difficult matter to formulate any general rules. It may be said generaUy that the burden of bringing the accident within one of the exceptions rests on the insurer. (Badenfield vs. Massachusetts Mutual Accident Association, 154 Massachusetts, 77.) A policy covering accidents caused by " external" means was lately construed by the Court of Appeal in England. The assured stooped to pick up a marble, and in so doing dislocated the car- tUage of his knee. He had never had any weakness in that limb, and the court held that the word " external" was used in contradistinction to an internal cause, such as disease, and that therefore the injured per- son could recover. (Hamlyn vs. The Crown Accidental Insurance Com- pany, Limited (1893), 1 Queen's Bench, 750.) In 1892 a curious case arose in London. The defendants offered one hundred pounds to any one who contracted influenza after taking a cer- tain patent medicine. The plaintiff took the medicine according to direc- tions, but, nevertheless, caught influenza. He sued for the reAvard, and one of the defenses set up was that it Avas a contract of accident insur- ance, and therefore unenforceable because not in the statutory form.. ACCIDENT INSURANCE AND BENEFIT ASSOCIATIONS. 585 But the court overruled the objection. (Carlill vs. Carbolic Smoke Ball Company (1892), 2 Queen's Bench, 484.) An accident policy does not usuaUy cover death resulting from dis- ease, and it therefore frequently becomes of importance to determine what was the cause of the loss complained of. A recent case on this point is Bacon vs. United States Mutual Accident Association (123 New York, 304). The assured died of malignant pustule, which the expert medical witnesses refused to characterize as a disease. They, hoAveA-er, admitted that it was a "pathological condition." The loAver court ruled that the deceased came to his death by accident, but the Court of Appeals, by a divided vote, reversed the decision, and held that malignant pustule was a disease. Sunstroke is not an accident, but a disease. (Sinclair vs. Maritime Passenger's Assurance Company, 3 Ellis & Ellis, 478; Dozier vs. Fidelity and Casualty Company, 46 Federal Reporter, 446.) Though a known consequence of undue exposure to the heat, it could not have been fore. seen, and Avas undoubtedly caused by external means, which is the defini- tion usually given in contracts of accident insurance. The English court, however, Avent upon the ground that a disease produced by known means could not be considered as accidental. The American case Avas decided partly on precedent, but largely on the authority of Xiemeyer and Ober- nier, who classed sunstroke as a disease of the brain, and held that the rays of the sun AA'ere not essential to its occurrence. If, however, the disease is the result of an accident, the insurer is held liable. So a eleath from peritonitis, due to a A'iolent blow on the stomach (North American Life and Accident Company vs. Burroughs, 69 Pennsylvania State, 43), or from hernia brought on by an accidental faU (Fitten vs. Accidental Death Insurance Company, 17 Common Bench, Xew Series, 122; Traveler's Insurance Company vs. Murray, 16 Colorado, 296), is coA'cred by an accident policy. The question is one of proximate cause, and is often of considerable nicety. Thus a death from erysipelas brought about? from a Avound by a cut Avas considered the result of the disease rather than of the wound. (Smith vs. Accident Insurance Compeiny, Law Reports, 5 Exchequer, 302. See also Young vs. Accident Insurance Company of North America, 6 Law Reports, Superior Court, Montreal, 3.) Porter, in his Avork on Insurance (second edition, p. 457), cites two Eng- lish cases on this subject AA'hich are difficult to reconcile. In the one, gangrene from a cut was held to be an accident; and in the other, death by dislodgment of a gall-stone, the result of a faU, Avas held not a death by accident. In a recent Xcav York case, the insured died of blood-poi- soning, folloAAung upon a Avound in his right hand. Some time previ- ously he had injured his other hand, and it was an open question whether or no the pus from the first AA'ound had entered the second and caused the poisoning. The death being charged to the second wound, the court held that it Avas for the jury to determine whether or no death was due to the accident. (Martin vs. Equitable Accident Association, 61 Hun, 467.) Several cases haA^e arisen in Avhich a fit cooperated to produce the death of the assured, and yet his representative Avas aUowed to recoA-cr under a policy in Avhich a fit Avas an excepted cause. In three instances the de- ceased feU into a pool of Avater and was drowned. (Reynolds vs. Accident Insurance Company, 22 Law Times, X. S., 820; Winsjxnr vs. Accident In- surance Company, 6 Queen's Bench Division, 42; Tennant vs. Traveler's 586 A SYSTEM OF LEGAL MEDICINE. Insurance Company, 31 Federal Reporter, 322.) In another case the in- sured was seized with a fit whUe standing on the platform of a raihvay station. He feU on the track as a train Avas approaching, and was kUleel. (Lawrence vs. Accident Insurance Company,! Queens Bench Division, 216.) The ground for these decisions seems logical, for the deaths were not the necessary resiUts of the fits, but Avere caused by an accident, i.e., the Avay in which the deceased fell. It has been intimated that the rupture of a blood-vessel AA'hile using Indian clubs is not an accident unless some un- foreseen and involuntary movement of the body occurred. If the death were caused by inflammation of the lungs consequent upon such rupture, an accident pohcy Avould cover the loss. (McCarthy vs. Traveler's Insur- ance Company, 8 Bissell, 362.) The insurer is generaUy not liable when a supervening disease aggra- vates the original injury and produces death. On the other hand, Avhen the insured died from pneumonia, wliich he contracted Avhile in a Aveak- «ned condition from an injury to his shoulder, it Avas held that as disease and subsequent death could not have occurred but for the accident, the insurer was liable. (Isiff vs. Raihvay Passenger's Assurance Company, 22 Queen's Bench Division, 504.) This distinction, though apparently AveU founded, may be difficult in its practical a](plication. Death from drowning, eA'en AA'hen in bathing, is an accident (Kn icker- bocker Casualty Insurance Comjxiny vs. Jordan, 11 Insurance Law Jour- nal, 475), and so is eleath from asphyxiation, AA'hether by natural (Pickett vs. Pacific Mutual Life Insurance Company, 144 Pennsylvania State, 79) or by illuminating gas. (J}aul vs. Travelers Insurance Company, 112 Xcav York, 472. In this case the Court of Appeals made a distinction between breathing gas involuntarily and inhaling gas, the latter being excepted by a clause in the pohcy.) Death from a pistol-shot fired by another person is an accidental death, even if the shooting is intentional. (Supreme Council, Order of Chosen Friends vs. Garrigus, 104 Indiana, 133.) But as a matter of fact, accidents arising from intentional injuries, whether caused by the insured or by another person, are excepted in the policies of many companies. Other customary exceptions are injuries happening while under or through medical and surgical treatment (except amputations necessitated solely by injuries, and made Avithin a certain period after the accident), and while under the influence of intoxicating liquors or narcotics. In construing exceptions with regard to poison, the courts have been very strict, attributing to the word its popular conception. Accordingly, malignant pustule caused by contact with the flesh of a putrid animal was not poison Avithin such a clause. (Bacon vs. United States Mutual Ac- cident Association, 44 Hun, 599; 123 Ncav York, 304.) But poison taken by mistake for medicine (Cole vs. Accident Insurance Company, 61 Law Times Reports, 227) is Avithin the clause. An accidental overdose of opium, a proper dose having been prescribed, aa'UI prevent recoA'ery under a clause excepting death caused wholly or in part by medical treatment. (Bayless vs. Traveler's Insurance Company, 14 Blatchford, 143.) On the other hand, in case the exception is to operate, if the in- sured " die by his oavu hand or act, A'oluntary or otherwise," it is held that death from an OA'erdose of medicine avUI not avoid the policy, as the clause is eAddently intended to coA'er suicidal self-destruction. (Penfold vs. Universal Life Company, 85 Xew York, 317.) ACCIDENT INSURANCE AND BENEFIT ASSOCIATIONS. 587 Some policies stipulate that the injury shaU not be one of which there is no external or visible sign. The courts are not apt to favor such clauses, perhaps because they are an attempt to construe the laAvs of evidence. Accordingly, a late XeAv York case decided that an injury to the diaphragm and contiguous muscles which was not visible to the eye, but could only be ascertained by applying the hand to the exterior of the body, was not Avithin the proviso. (Gale vs. Mutual Aid and Acci- dent Association, 66 Hun, 600 (1893).) When the deceased AA-as found dead in bed with the gas turned on, the court held the company liable on a simUar policy, though there Avas no visible or external sign on his body. The ground of the decision was that the clause applied only to an accident not causing death. (Paul vs. Traveler's Insurance Company, 112 New York, 472.) Soreness is not a visible sign, and in a case where the body was covered with red spots and there was bloody froth at the mouth, the question was left to the jury. (United States Mutual Accident Association vs. Newman, 84 Virginia, 52.) GeneraUy an accident policy will cover injuries resulting from the neghgence of the assured. Nice questions often arise AA'hen the policy excepts such injuries. Thus, AA'hen the assured, after he had seen two men jump safely five feet from a platform to the ground, foUowed their example, and received a stricture of the duodenum resulting in death, it was held a question for the jury as to whether there Avas an accident. (Association vs. Barry, 131 Uniteel States, 100.) " Voluntary exposure to unnecessary danger " is a common clause ; and " walking or being on a railroad track or bridge" are also often forbidden. But getting on a slowly moving train is not within the first clause (Schneider vs. Provident Life Insurance Company, 24 Wisconsin, 28), and it would seem that cross- ing a railroad track to reaph a railroad station is not necessarUy within the prohibition of that last mentioned. (Duncan vs. Preferred Mutual Accident Association of New York, 59 NeAv York Superior Court Reports, 145.) Injuries resulting from a violation of laAv are also frequent excep- tions. Thus, an accident from slipping upon frozen ground whUe re- turning from hunting on Sunday (Duron vs. Standard Life and Accident Insurance Company, 20 Insurance Law Journal, 1035, Vt.), or whUe en- gaged in a horse-race (Insurance Company vs. Seaver, 19 WaUace, 531), both acts being illegal by statute, discharged the insurers. Some policies only cover accidents whUe traveling by public or pri- vate conveyance. It has been held that such a policy covers an accident caused by walking from a steamboat AvhUe en route to a train, even though the assured could have ridden in a hack. (Northrup vs. Railway Passenger's Assurance Company, 43 New York, 516.) GeneraUy speaking, however, Avalking is not traveling in the manner indicated. (Ripley vs. Insurance Company, 16 Wallace, 336.) The so-called indemnity is usually given in case the assured is " wholly disabled." Usually this would mean disabUity from performing one's usual vocation, and not a total disabUity for any kind of labor. (Hooper vs. Accidental Death Insurance Company, 5 Hurlstone & Norman, 546.) The loss of one's fingers or hand does not ordinarily constitute total disabUity. (Hutchinson vs. The Supreme Tent of the Knights of the Mac- cabees of the World, 68 Hun, 355.) Throughout the United States and England there exist a vast num- ber of beneficial societies engaged in the business of insurance against 5S8 A SYSTEM OF LEGAL MEDICINE. death, accident, or sickness. These associations are really insurance com- panies on a cooperative plan AAuthout shareholders, the insured anel in- surer being members of the same organization, and each member being an insurer of aU his associates. A loss on the part of one member is paid by means of an assessment upon the others, the purpose of such societies being benevolent, and not the earning of a profit. Generally speaking, insurance by these societies is governed by the same rides as the business of the regular stock companies, and in the absence of special provisions the courts hold that it is subject to the same statutory regulations. (See Biddle on Insurance, § 67.) A certificate of member- ship in such an association is AdrtuaUy a pohcy, and the constitution and by-laws are ahvays a part of the contract of insurance. The tendency of the courts is to hmit benevolent societies strictly to the classes of beneficiaries designated in their charters, and any insurance for the benefit of persons not of those classes is void. (Biddle on Insurance, § 60.) Whenever a particular method of nominating and appointing ben- eficiaries has been adopted, it is held to exclude all others, and a person improperly designated cannot take the benefit of the insurance. (Biddle on Insurance, §§ 135, 137.) Insurance by beneficial societies is now generally regulated by special statutes (for the English law, see the elaborate Friendly Societies Act, 38 and 39 Victoria, cap. lx.), and the recently adopted "Insurance LaAv" of the State of XeAv York may be taken as an example of the most advanced thought upon this subject. "Fraternal Beneficiary Societies, Orders, or Associations" is the caption of the seA'enth article of "The Insurance Law." (LaAvs 1892, chapter 690; chapter 38, General Laws.) It is pro- A'ided that nine or more persons may become a corporation for relief by insurance upon the mutual or assessment plan of members or benefi- ciaries in the case of sickness, disability, or death. A certificate must be filed with the superintendent of insurance, and accompanied by the SAvorn statement of at least three subscribers, to the effect that two hun- dred eligible persons haA-e, bona fide, made written application for mem- bership. These tAvo hundred persons must subscribe an aggregate amount of $400,000, and pay in cash one full assessment amounting to at least one percent, of their subscriptions. Foreign corporations can- not do business in the State until they have filed similar papers. When these requirements have been complied with, a hcense is issued by the superintendent of insurance, and the association can be^in business. {Ibid, §§ 230-232 inclusive.) With three exceptions, all beneficiary societies, AA'hether voluntary or incorporated, doing any business authorized by this article, i.e., busi- ness not for profit or for gain, and the members of AA'hich are proposed, elected, and initiated in subordinate lodges, councUs, or similar bodies according to prescribed rites and ceremonies, are declared to be mutual benefit fraternities, and exempt from the other insurance krws of the State. (Ibid., §§ 233, 239.). Each society may adopt a constitution or by-laavs, not inconsistent wdth the statutes of the State. (Ibid., § 234.) A benefit association may make such agreements as it pleases AA'ith its ; members for the payment of benefits, although a member is permitted ■■ to change his beneficiary at any time Avithout the latter's consent. It is, hoAveA'er, forbidden to issue certificates for the payment of a greater sum of money than could be raised by one assessment upon aU the members, ACCIDENT INSURANCE AND BENEFIT ASSOCIATIONS. 589 or for the payment of a gross sum upon the expiration of a fixed period of less than five years. The reason for every assessment, as weU as the precise amount thereof to be used for the payment of other than bene- ficiary claims, must be truthfuUy stated in the notices. Benefit societies are permitted to distribute their revenues in accordance with their con- stitutions so long as no money coUected for the payment of beneficiary claims is otherwise appropriated. AU moneys or other benefits to be paid by these societies are exempt from execution or from seizure by process, either legal or equitable, for the purpose of paying a debt or habihty of any member or beneficiary. (Ibid, §§ 235, 236, 238.) AU benefit associations are required to make detaUed annual reports, and are, in fact, closely under the supervision of the superintendent of insur- ance. Their books and papers are at aU times open to the inspection of State officers, and they are liable to a fine in case they neglect or faU to perform a duty imposed by law. The superintendent is also empowered to revoke the license of any society which conducts its business improp- erly, and the attorney-general is authorized to proceed at once against a delinquent association. (Ibid., §§ 232, 237.) THE OBLIGATION OF THE INSURED AND THE INSURER. BY R. C. McMURTRlE, Esq. With regard to the relations of the medical profession to life insur- ance, they occur in the formation of the contract and in the inquiry into causes of death. 1. As the contract is based on the average duration of human life, the known conditions that tend to shorten it are essential in forming a judgment as to the probability of the particular hfe that is to be insured coming up to the average or faUing short. These facts cannot practicaUy be obtained from any one but the ap- plicant or person whose life is to be insured, i.e., on the termination of whose life a payment is to be made. The facts when thus ascertained are made the subject of examination by medical experts. Accuracy is essential, as it is in all cases AA'here inferences are dependent on facts. But the limitation of accuracy is the capacity of the person examined to give the information. This the insurer takes on himself unless the con- tract interferes. The insured, on the other hand, takes on himself the burden of answering truthfully. Obviously there are likely to occur cases where the answers are per- fectly truthful and yet absolutely untrue. The insured assumes this peril where the contract stipulates for accuracy as a basis of contracting. The person inquired of may have forgotten absolutely or temporarily a most important fact, or he may have been misinformed on a matter which he never could know saving by information, but AA'hich aU of us speak of as if Ave knew; e.g., our age and the ages of ancestors, even relation- ship and parentage, are mere matters of hearsay, and yet are always spoken of as known facts. So they are practically; but it is evident that if they prove to be untrue there has been a misrepresentation in an essential fact which is the agreed basis of the contract. But this depends on the contract. There is, then, another and a distinct class of facts, which are subject, hoAvever, to the same rule. It frequently happens that a fact is not supposed to be material, and is therefore omitted. On the other hand, it is plain that as the insurer is the questioner and proposes to act on the information received, he must so frame his ques. tions that men must be able to comprehend what facts they include. Noav here there must come in the same rule that, strangely enough, 591 ft 592 A SYSTEM OF LEGAL MEDICINE. seems to have surprised the legal profession when enunciated in P< ek vs. Berry, 14 Appeal, 337. EA-en AA'here there is a Avarranty of the truth of the ansAvers, this rule must be applied where the ansAver is literally correct but is liable to the charge of being an evasion. The insurer is entitled to a truthful ansAver; but Avhether the question has been truthfully ansAA'ered must depend on what AA'as understood by the question. It is impossible that the insured can be held to Avarrant the truth of the ansAver if no person but a highly educated expert could have supposed it included an inquiry as to a par- ticular fact. This question is one for the jury—the ansAver being liter- aUy accurate—Did the man beheve what he said, or did he knowingly conceal or suppress with intent to deceive by evasion ? It is not Avhat somebody else thinks he ought to haA-e knoAvn from the information he had. This Avould make the matter turn on a false issue, and substitute the comprehension of a judge or jury for that of the man avIio spoke, which is near to requiring a Avarranty of truth irrespective of the compre- hension of the question. It is obviously the same thing as AA'hat occurred in Peek vs. Derry. The question Avas AA'hether there Avas a fraudulent and deceitful representation. The court below held there was a liability if the representation was founded on information Avhieh ought not to have been believed, or Avas quite insufficient to Avarrant the statement, it being such as no prudent man would have acted on. The court subse- quently disclaimed aU intention to assert Avillful and conscious false- hood. In the House of Lords it Avas ruled, and it is now the settled laAv of England—tUl it shall have been changed by act of Parliament—that while the frivolity of the evidence on which a man is said to have made a representation is a ground for refusing belief to his assertion that he did rely on it, stiU there can be no action for deceit unless there was in- tentional or conscious falsehood. It is difficult to resist the argument that a fraudulent deceit inA-olves moral turpitude, and that to substitute another's judgment as to the sufficiency of the evidence to found beUef omits the essential ingredient of the charge. Whether this avUI be ac- cepted in this country or the old formula AviU be preferred, however in- accurate, is of course an open question. This line of reasoning emphat- ically applies to all cases of inquiries on which it is proposed to contract. If conA-erted into Avarranties, as they are AA-hen recited in the contract or referred to as a basis of contracting, no doubt the fact asserted must be literaUy true; but Avhether the answers are also truthful ansAvers must depend on the intention of the speaker. They may seem to be eA'asive— especially AA'hen the judgment is aided by competent counsel—but it is eA-ident that must depend on the capacity of the speaker to comprehend the purport of the question, not on the capacity of a jury to see a mean- ing Avhen aided by the trained dialectician. Xo better illustration can be giA'en than Huekman vs. Fernie, 3 M. and W. 505, 4 H. and H. 149, AA'here the question Avas, '• Who Avas the usual medical attendant of the life about to be insured?" That person had been attended for many years by a physician for a chronic disorder. Within a short time that physician had retired from practice and another was employed by the family, but AA'ho had seen the life insured only in refer- ence to a matter of no moment. In reply the name of this gentleman Avas given. It is quite plain that to any one who comprehended the object THE OBLIGATION OF THE INSURED AND THE INSURER. 593 of the question this was absolutely false whUe hteraUy true, and so it was held by the court in banc. It may be, though, that all these distinctions are useless, because if there is a question for the jury it wUl always be answered in one Avay. There is no doubt about the fact that justice is very unfairly administered by juries if we mean justice according to law, and there can be no other standard in a court. But to a great extent the courts are themselves to blame for the miscarriage. If they would compel a categorical ansAver by the jury to the crucial question of fact, there woiUd be much less probability of a false verdict. When juries are permitted to render a general verdict hypothetically based on their findings of certain facts, it is much more likely that Avhat has been stated as a condition wUl be overlooked or disregarded; that when they are asked to say, " Did A be- lieve that statement to be true, or did he intend to mislead ?" it may be doubted whether this is not the only mode in which an ordinary jury can be used to advantage. 2. The medical profession is also intimately connected with the in- quiry into the causes of death. They are necessarUy experts in the proper inference to be drawn from facts ascertained after the event as to the condition of things before the death. Do these prove that the ansAvers of the insured were false ? Or wherever medical testimony as such can be pertinent to the issues raised in actions on policies, these necessarily include aU things relating to the causes of death where they are relevant to the issues. These statements seem to be supported by authority: (1) If there is a warranty or a contract that a fact is true and it is made a condition, the materiality is unimportant. A fortiori is the in- tention to deceive. Anderson vs. Fitzgerald, 4 H. L. Cases, 484; Fowkes vs. Manchester, 3 B. and Sm. 917 ; Jones vs. Provincial, 3 C. B. X. S. 65 ; Wheeler vs. Hardesty, 8 Ellis and Bl. 332 ; McDonald vs. Law Union, 9 L. R. Q. B. 328. (2) But where there is a mere representation or where the contractual representation is so qualified as to be evidently a mere representation, as where " believed " is inserted, then materiahty and intentional deceit are Huckman vs. Femie, 3 M. and W. 505; and 1 H. and Hurles, 149. It appears to be implied in Parke's, B., remark in Wainwright vs. Bland, 1 M. and W. 35 ; British Eg. vs. G. W. By., 38 L. J. Chan. 316; Duckertt vs. Williams, 4 Tyr. 242. (3) That an evasion must have been known to be such where the statement is hteraUy true. Maynard vs. Bhode, 1 C. and P. 360, where it is rested on the contract. Geaeh vs. Ingall, 14 M. and W. 93; Perrans vs. The Marine and General Travelers' Insurance Co., 2 E. and E. 317; British vs. G. W. By., 38 Law Jour. Chan. 132, 314; General Prov. in re Damdriel, 18 W. R. 396 ; Fowkes vs. The Manchester, 3 Fost. and Fin. 440; 3 B. and Sm. 916. It seems to be plain that if incorrectness is in itself sufficient to avoid the contract, it is misleading to caU attention to the effect of the contract on making the truth of the statement a basis of the contract, and therefore essential, or, in the language of pleading, a mate- rial averment. (4) Where there is an ambiguity the paper is to be read against tlie company who prepares it. Anderson vs. Fitzgerald, 4 H. L. Cas. 484-507. OF CERTAIN LEGAL RELATIONS OF PHYSICIANS AND SURGEONS TO THEIR PATIENTS AND TO ONE ANOTHER. By WILLIAM A. PURRINGTON, Esq. Of Legislative Restrictions on Medical Practice.—To restrict need- lessly the free use of his powers and talents is a wrong to the individual; it is also an injustice to the community. That every man should have as free scope to earn a livelihood or widen the field of knowledge as is consistent with the common welfare, is a truism. But it has been clev- erly pronounced an easier task to renounce the devil and aU his works than to know them when met with; so that while none avUI dispute the initial proposition, many controversies have arisen, anel many wUl arise, over the need of restrictions. It is no new theory that an ignoramus should not be allowed to practice medicine. Socrates, wishing in his amiable way to ridicule Euthydemus, the handsome, likened that un- fortunate youth to a supposititious quack who shoidd seek appointment as a health officer upon the ground that, although ignorant of medicine, he could soon learn aU about it by practicing upon the Athenians; at which iUustration the gossips burst into laughter,* and, as a consequence, Euthydemus probably found something not entirely displeasing to him in the episode of the hemlock prescription. But the thoughts of aU men do not Aviden with the process of the suns, and the advocates of ignorance as a qualification for medical practice have gone in late years far beyond this merry reductio ad absurdum; for with solemn faces they presented to the New York legislature of 1884 a memorial in favor of repealing the Medical Practice Acts, which declared that such powers as that of healing by " the laying on of hands" " cannot be imparted or increased by, but are more likely to be diminished by, the course of study required by the medical colleges." Herein is the unconscious admission of one advan- tage of medical legislation: for while it would be manifestly undesirable, even if laAvfid, for a statute to ordain that any system of therapeutics should be foUowed exclusively,t since this would stifle experiment and progress, nevertheless it is reasonably certain that by requiring of aU aa-Iio begin to practice medicine a fair acquaintance with the human sys- * Memorabilia, Bk. IV. c. 2. 3-5. t Section 23 of the British Medical Act, 21 & 22 Vict. c. 90, provides that any body entitled to grant qualifications under the act shall forfeit its right if it persist in requiring as a condition of its examination or certificates, that the candidate shall " adopt or refrain from adopting the Practice of any particular Theory of Medicine or Surgery." 595 596 A SYSTEM OF LEGAL MEDICINE. tern and the past and present condition of medical knowledge, the la\v protects the public in some degree against the imposture and ignorance of those who pretend, in good or bad faith, to substitute mysterious " gifts " for skill and learning. The history of medical legislation is a story of reactions. An era of uniA-ersal privUege to practice medicine, subject only to the risk of suits for malpractice, breeds a pest of quackery and an appeal for protection to the law-making poAver. A too rigorous enforcement of the letter of license laAvs begets counter-reaction. In the beginning of the eighteenth century the prosecution, by the College of Physicians, of Apothecary Rose for prescribing a bolus to Seale, the butcher, although successful in the Court of Kings Bench,* faded in the House of Lords,! because it seemed intolerable to the peers that every one, their servants and the poor included, should be compeUed in sickness to call in a physician to prescribe, an apothecary to dispense, and perhaps a surgeon to let blood. This victory made the apothecary a general practitioner in England, and such he is to-day. But a century of quackery drove the apothecaries themselves to procm-e an act! m the earrJ Part of **"** century forbid- ding any one to practice then- art without the license of their company.§ The reaction against the fierce opposition to homeopathy, and a few other "pathies," in New York brought about a modification of the medi- cal law of that State by the act of 1844, making an unlicensed physician a misdemeanant only in case of gross malpractice.|| That act, in turn, has been repealed by subsequent legislation making all unlicensed prac- tice a misdemeanor/] And if there is any lesson to be learned from studying the attempts to regulate medical practice, it is this: that when- eA-er it is generally believed that such a regulation is only enforced either to benefit physicians, by limiting competition or regulating fees, or to suppress schismatic opinion, the law falls into disfavor and is repealed or becomes unenforceable. Theory and Constitutionality of Medical License Laws.—Under the governmental theories obtaining throughout the United States, any statute obviously enacted to favor either physicians as a class in disre- gard of public right, or one class of physicians at the expense of others, would be unconstitutional.** Medical license laws.are defensible solely on the ground that they are a fair exercise of the pohce power to protect the public health. It has been forcibly argued that their scope should be limited to punishing fraudulent pretenses of a nature to deceive persons of ordinary intelligence and care, such as the false assumption of med- ical titles; but should not be extended to forbidding the practice of un- licensed persons. Thus the purpose of the British Medical Act of 1858,+t as stated in its preamble, is " to enable persons requiring medical aid to * 3 Salk. 17; 6 Mod. 44. t 5 Bro. Pari. Cases, 553. t 55 Geo. III. c. 194. This act is not repealed by the Medical Act, c. 90, 21 & 22 Vict. Davies vs. Makuna, 53 L. T. 314; 29 Ch. D. 596. § For an account of this struggle between the physicians and apothecaries see "The Evolution of the Apothecary," Medical Record, Sept. 11, 1886, by the writer. H See history of New York Medical Legislation prior to 1887 in the Medical Record of Oct. 23, 1886, by the writer. 51 Laws of 1874, 1880, 1887, 1892, and 1893, the last statute being now in force. ** State vs. Pennoyer, 65 N. H. 113; 18 Atl. 878; State vs.Hinmcui, 65 N. H. 103; State vs. Fleischer, 41 Minn. 69. ft 21 & 22 Vict. c. 90. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. 597 distinguish qualified from unqualified practitioners." Those who hold that this is as far as the laAv should go argue that fools can only be pro- tected by incarceration, and that it is an ancient privilege to be cheated if you Avish to be* The Apothecaries Act of 1815,t on the other hand, forbade unlicensed persons, under civil penalties for disobedience, to act as apothecaries; and this statute rather than the former has been followed and exceeded in our medical legislation, which, in nearly all the States, makes a crim- inal offense of unlicensed practice. The constitutionality of this prohi- bition has been directly passed upon and affirmed by the highest courts of most of these jurisdictions and by the Supreme Court of the United States; and by their decisions it is settled that such legislation is not a taking of property Avithout due process of laAv,! that the fact of having been engaged in medical practice for years prior to the enactment of a licensing act does not create a vested right to continue in practice con- trary to the new statute,§ and that the exemption of persons in practice prior to the date of the laAv from the examination, etc., required of per- sons thereafter beginning to practice does not create a "privileged class." || Among the A'arious statutory provisions that have been held vahd by the courts are the folloAving: forbidding any one to practice medicine if neither graduated from the Harvard Medical School nor licensed by the Massachusetts Medical Society ;«j confining examinations by a State Board of Examiners to persons holding diplomas ;** making residence in the State for a term of years a condition of the license ;tt permitting all persons actually in practice at the elate of the enactment to continue practicing upon registration and the payment of a fee of three doUars, but requiring of all commencing practice thereafter a diploma, registra- tion, and a fee of ten dollars ;f| forbidding licensed physicians from opening shops for retailing, disbursing, or compounding medicines or poisons except in compliance Avith the pharmacy laAv; §§ exempting from the statute's operation aU persons in practice AA'ithin the State for ten years prior to its enactment ;|||| permitting physicians of another State to visit the enacting State for consultation without the registration required of resident practitionci-s ; Dr. Gerlach got his fee by the aid, although almost in spite of the law ;* for under the general principle that a husband must furnish his Avife Avith necessaries suitable to her condition in life, he is hable for medical services rendered to her unless a special agreement on her part is shoAvn.t even if Avithout fault on her part she be living away from his domi- cile.! But she may contract to pay out of her separate estate; and if she be separated from her husband by hen- own fault, as if she be living in adultery, the latter wiU not be liable unless he authorizes the scrvices.§ "Mesmeric treatment," including " dreams, visions, and revelations," has been held to be a "fancy article" and not necessary!| A father should supply his child Avith necessaries. In England and in some of our States this duty is imposed by la\v as to children of very tender years; and under an English statute to this effect, one of the '-Peculiar People1" was convicted of manslaughter because his child died for lack of medical attendance, which Avas not supplied, in obedience to the tenets of his sect, which held such aid to be contrary to the teachings of St. James V. 14, lo.fl In a simUar ease in New York the child of an Episcopal missionary was taken from the father by a humane society and put under surgical care, because the parent, AA'ith greater faith than Avis- dom, refused to do more for the infant's broken arm than adopt this same apostolic but surgicaUy ineffectual treatment; the bishop of the diocese, it is said, very properly disapproved of the missionary's vieAvs. Although at common law it is considered that the duty of employing a physician for a child is moral only and not legal,** still if the medical services can be said to have been rendered Avith the father's assent or AA'ith his knoAA'ledge and AA'ithout objection, a contract wUl be implied; and such assent may be implied even though the child have left the parental roof ;tt but not if the parent provide for the child and does not assent to the services.!! Inability of the father to pay does not make the child liable.§§ Lord Kenyon Avas of opinion that a master was liable for medical ser- vices rendered to his servant ;|||| but such is not the rule,^!, except where a contract of service involves that obligation, as apprenticeship.*** * Gerlach vs. Turner, 89 Cala. 446; 26 Pac. 870. t In re Shipman's estate, 5 N. Y. Supl. 559; 22 Ab. N. C. 289. Revd. in part on another point: 53 Hun, 511; 23 Ab. N. C. 101; 6 Supl. 276. i Harrison vs. Grady, 13 L. T. N. S. 369 ; Thorpe vs. Shapleigh, 67 Me. 235 ; Webber vs. Spannhake, 2 Redf. 258. § < 'ooper vs. Lloyd, 6 C. B. N. S. 519. As to separate estate, see Moody vs. Osgood, 50 Barb. 628. || Wood vs. O3Kelly, 62 Mass. (8 Cush.) 406. 1T R. vs. Downs, 13 Cox. C. C. Ill, under 31 & 32 Vict. c. 122, s. 37. Prior to the statute there had been an acquittal in a like case : R. vs. Wagstaffe, 10 Cox. C. C 530. ** R. vs. Wagstaffe, supra; Kelly vs. Davis, 49 N. H. 187; Gordon vs. Potter, 17 Vt. 348. tt Porter vs. Powell, 44 N. W. 295; 79 Iowa, 151; Gillcy vs. Gilley, 9 Atl. 623 (Me.); Deane vs. Ann-is, 14 Me. 236; Strain vs. Tyler, 26 Vt. 1; Ncilson vs. Gray, 17 X. Y. Supl. 500 ; Hunt vs. Thompson, 4 111. 179. XX Rogers vs. Turner, 59 Mo. 116. j§ Hoyt vs. Casey, 114 Mass. 397. An infant living Avith a parent or guardian who provides for it, cannot bind its estate for necessaries; but a stepfather is not bound to support his predecessor's children: Atchison vs. Bruff, 50 Barb. 381; cf. 3 Barn. & C. 484. |||| Scarman vs. Castell, 1 Esp. 270. flU Scllen vs. Norman, 4 C. & P. 80. *** Ii. vs. Smith, 8 C. & P. 153. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. 611 Agents.—Neither for services rendered to themselves or others can servants, not authorized to do so, bind principals to pay. Thus, if the superintendent of a corporation send for a physician to attend a man in- jured in its employ, no contract by the corporation to pay for the medical service can be implied from this fact alone; for the relation of employer and employed is not such as of itself to create the obligation* But it is otherwise if the superintendent have authority to employ a doctor in such cases, and does, in fact, employ oue.t Dr. Cooper sued the New York Central and Hudson River Railroad Company to recover fees for attending on and amputating the leg of one Haley, an employee of the defendant. It appeared that the engineer of defendant's train, Scanlon, had thus telegraphed to its station-agent, Martin: "June 6, J. Martin: Have Mr. Cooper at depot on arrival of No. 1; man hurt. J. Scanlon." Martin sent this telegram by a hackman to the physician, who also offered testimony, which was held irrelevant, to prove previous employ- ment by defendant in other cases. The doctor was nonsuited upon the ground that there Avas no proof that the engineer and station-agent had poAver to bind the company to pay for medical serA'ices.! Where, Iioav- eyer, a railroad conductor employ ed a physician under somewhat similar circumstances, and notice of the employment was conveyed by both con- ductor and physician to the company's superintendent and general agent, and the employment was not questioned or repudiated, the contract was held to be ratified, and a cause of action to recover fees made out.§ In England, since the cases cited in Cooper vs. Railroad, the employees' authority has been implied. || Where ratification is needed slight acts will be so construed.^ If physicians are called in consultation with the assent of the patient, obA'iously he is liable to them for their fees; and in an extreme ease the patient was held thus hable to a consultant called in by the * Meisenbach vs. Southern Cooperage Co., 45 Mo. Ap. 232. t McCarthy vs. R. R., 15 Mo. Ap. 385. X Cooper vs. N. Y. C. /, 51 Mo. Ap. 416. X In re Freeman, 46 Hun, 458. § In re O'Neill's Est., 7 X. Y. Supl. 197. || Pandjiris vs. McQueen, 13 N. Y. Supl. 705; not as to particulars affecting the patient: Burley vs. Barnhard, 9 N. Y. St. 587. 51 Stowcll vs. Amer. Coop. Relf. Ass'n, 5 N.Y. Supl. 233. As to when the objection is to be made, see Feeny vs. L. I. R. R. Co., 116 N.Y. 375; cf. Hoyt vs. Hoyt, 112 N.Y. 493. ** Edington vs. Mutual Life Ins. Co., 67 N. Y. 185, revg. 5 Hun, 1; Edington vs. uEtna Life Ins. Co., 77 N. Y. 564, revg. 13 Hun, 543; Grattan vs. Met. Life Ins. Co., so N. Y. 281 ; Renihan vs. Dennin, 103 N.Y. 573 ; Feeny vs. L. I. R. R. Co., 116 N. Y. 375'; in re Darragh's Est., 52 Him. 591; Sloan vs. A. Y. C. R. R., 45 N.Y. 125; and cf. Patten vs. United L. and Ac. Ins. Ass'n, 16 N. Y. Supl. 376 ; revd. 133 N. Y. 450 ; Numrich vs. Sup. Lodt/c K. re, however, if a confidential communication to such a one is not privileged; it certainly should be. t Henry vs. N. Y. L. E. .(• TT. R. R,, 57 Hun, 76; 10 N. Y. Supl. 508. t 57 Hun, at p. 593. In Renihan vs. Dennin, 103 N. Y. 573, it is held that the privilege exists as to a consultant called in by an attending physician. § Heath vs. Bwy. /. Co., 105 Mo. 455; 16 S. AV. 866; Dotton vs. Village of Albion, 57 Mich. 575; 24 N. AV. 786. X McConnetl vs. City of Osage, 80 Iowa, 293 ; 45 N. AV. 550 ; semble if she testified to a statement made to the physician he might contradict her as to that. § Williams vs. Johnson, 13 N. E. 872. || Marx vs. Man. Ry. Co., 56 Hun. 575 (May, 1890). This is consonant with the common law rule that if a client testify against an attorney, the latter may protect himself by testifying to a privileged communication. 51 Treanor vs. Man. Ri/. Co., 16 N.Y. Supl. 536 ; 28 Ab. N. C. 47 ; cf. Frcel vs. Market St. Cable Ry. Co., 31 Pac. 730. ** People vs. Schuyler, 106 N. Y. 298. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. 629 Iioav, even by most subtle reasoning, the Treanor case can be brought into accord AA'ith Record vs. Village of Saratoga Springs* and Hope vs. Pa it road.\ ^ Marx, by testifying that a physician examined him thrice and told him nothing, except to go to another physician for examination, ami Treanor, by testimony as to the injury of her head, are held to have Avaived the privilege so as to permit their physicians to contradict them and show that they had httle or nothing the matter. While Hope and Record each testified in detail as to their respective injuries, and each caUeel one of the attending physicians in corroboration, and yet neither Avas held to have Avaived by this testimony the privilege as to other attending physicians. The question, although substantially the same in all actions to recover damages for negligence, has ahvays seemed clearer when the action groAvs out of alleged medical malpractice; for here the nature of disease or injury and all circiunstances necessary to judge of the skill and Avisdom of defendant's treatment are the main issues, and the plaintiff Avaives the privilege both as to the attending physician and his consultants.! But Avhen it is the question Avhether if a party to an action offers upon one trial medical testimony as to his physical condition this is such a Avah'er of privilege as AviU permit the other party on a neAV trial to offer the same testimony, we again find doubt anel conflicting decisions. The Ncav York Court of Appeals have decided this point upon reasoning that, at least, as the phrase is, " squints both ways." In Crattan's case,§ upon a second trial the defense called a physician who attended the insureel in his last Ulness. The witness had testified on the former trial, but it did not appear by whom he was then caUed. He was asked if he had not then testified in reply to plaintiff's counsel that the insured died of consumption. This Avas held to be improper: first, be- cause AA'hat he testified at the former trial Avas admissible only to refresh his memory or discredit him, and the occasion for doing either did not exist; second, because the court did not agree that the plaintiff's inquiry on the former trial precluded his objection on the latter one. "It Avas an incident in the mode of trial. It AvaiA'eel for that occasion and under then existing circumstances an objection AA'hich might have been relied on. It was in no sense an admission of the party, but proof by a wit- ness. The party was not even then bound by the fact, but might dis- proA'e it." If this language could be understood as a rule that a Avaiver on one trial is not a Avaiver for all time—anel the Michigan Supreme Court has so understood it||—then the case is distinctly overruled by that of McKinneA',11 AA'here it is argued that after the patient had once admitted his confidence to be published, the purpose of the statute, viz., * 46 Hun, 448 ; afd. 120 N. Y. 646; cf. McConnell vs. City of Osage, 80 Iowa, 293. t 40 Hun, 438 ; cf. with this and the Treanor ease, the opinion in Jones vs. Brooklyn B. ty W. E. R. R. Co., 3 N. Y. Supl. 253; afd. 121 N. Y. 683. X Lane vs. Boicourt, 27 N. E. 1111 Ind. § Grattan vs. Metropolitan Life Ins. Co., 92 N. Y. 275. || Breisenmeister vs. Knights of Pythias, 81 Mich. 525. 1[ Me Kinney vs. Grand St. , 884, and 886 of this code apply to the examination of a physician or surgeon as prescribed in this section." The word "diseased" in Section 836 is an inadvertence. The word has been deceased until the passage of c. 295, Laws of 1893, when the mistake was made. By these amendments the power of waiver has been enlarged. What their effect will be the learned Dr. Abbott has essayed to outline (see notes to Abbott's Nor Cases, vol. xxviii. at p. 55. and vol. xxx. at p. 84. also Columbia Lair Times, April, 1892); but who shall blithely assume to prophesy the result of legal hermeneutics when applied by different courts? * Westover vs. AAua Co., 99 N. Y. at p. 60. t De May vs. Roberts, 46 Mich. 160; 41 Am. E. 154. X Blackstone Com. 2, 429; Corven's case, 12 Co. 105; Haynes's case, ib. 113 ; 3 Inst. 202', R. vs. Lynn, 2 T. B, 733. § Williams vs. Williams, L. R. 20 Ch. D. 659. He may under special statutes; § 305 Penal Code of New York so provides. || Am. Law Times, July, 1S71. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. 633 misdemeanor ;* a chdl action Avill also lie for the trespass on the soU, and the circumstances of the act may be shown to enhance damages.! When the body is once buried, it cannot be removed without the consent of the oAvncr of the grave, or permission of the proper ecclesiastical, municipal, or judicial authority.| This topic, which is more curious than practical, is more fully discussed in WUcock's Medical Profession,^ and the treatise of Mr. Rogers.|| Its practical bearing is upon the method of procuring material for the dissecting-room. By an early statute "to preA'ent the odious practice of digging up and removing, for the purpose of dissec- tion, dead bodies interred in cemeteries or burial places," M the New York legislature provided that in the exercise of their discretion the judges of the Supreme Court, oyer and terminer or goal deliA'ery, might make it part of the sentence of one convicted of murder, arson, burglary, or any capital crime, that his body should be delivered to a surgeon for dissec- tion ; anel since this act was passed provision has been made by laAA', in New York and elseAvhere, both to furnish to the hospitals and schools the bodies of convicts and other unclaimed dead for dissecting-material, and also to punish body-stealing, grave-desecration, and unlaAvful dissec- tion.** In a very extraordinary case of late years, a woman, at whose request a coroner had exhumed the remains of one deceased, was con- victed of body-stealing, but the judgment was reversed on appeal.!! And a father who exhumed, his child's body to get its thigh-bone as an exhibit in an action for malpractice was held not to have violated the statute.!! Duty as to Contagious Diseases.—A duty is devolved upon practic- ing physicians in most jurisdictions of reporting to the municipal author- ities the existence of diseases classified as contagious, an omission to perform AAdiich subjects the delinquent to a penalty. Such sanitary regu- lations are different in different States, are subject to constant change by amendment, and must be sought not only in the statute books but in the sanitary codes issued by Boards of Health. The duty to report a case of contagious disease is of course directly in conflict Avith the phy- sician's duty to guard the secrets of the sick-room; but it grows out of the fundamental principle, Salus populi supremo lex. At the same time it may well be questioned how far a statute imposing this duty could be effectually enforced, if, Avith a vie'AV to quarantining them, the classifica- tion of contagious diseases should be enlarged to include, as is now sug- gested, consumption and tuberculous maladies. It is, of course, the physician's duty to use every precaution when attending a contagious disease to avoid becoming himself a medium of * R. vs. Lynn, 2 T. B. 733. t Meagher vs. Driscoll, 99 Mass. 281. X Weld vs. Walker, 130 Mass. 422 ; cf. R. vs. Sharpe, 7 Cox C. C, where defendant was convicted of misdemeanor in removing his mother's body to bury it by his father's; Wynkoopvs. Wynlcoop, 42 Penn. St. 293; Guthrie vs. Weaver, 1 Mo. Ap. 136; contra, Bogert vs. Indianapolis, 13 Ind. 134. § London, 1830. || The Law and Medical Men, by B. Vashon Sogers, Jr., Toronto, 1884. 1[ Laws of 1789, c. 3. ** Penal Code of Ncav York, ^ 305 to 314 inclusive; ch. 123, Laws of 1854 as amended by Laws of 1887; Bev. Statutes, 8th ed., vol. ii, p. 1219 & Part IV. ch. 3; Art IV., §§ 132, 133, vol. iv., p. 2821. (See the statute books of other States.) tt People vs. Fitzgerald, 105 N. Y. 146. In New York the district attorney may uxlmme a body for examination : Penal Code, § 308. \X Rhodes vs. Brandt, 21 Hun, 1. C31 A SYSTEM OF LEGAL MEDICINE. infection; and where a physician, contrary to his promise to one patient, attended another one sick AA'ith smaUpox, and communicated the hitter's disease to the former, it Avas held that he Avas hable for the results of his neghgence, and that they might be shoAvn in reduction of his charges* If it be necessary, a physician may order, under the Maine laAv, proper disinfecting process even to the extent of destroying property; for in- stance, causing the removal of wall-paper of an infected room;! and it AA'as held to be an indictable offense unlaAvfully to inoculate children Avith smallpox,! or while they were sick expose them in the1 public high- Avay.§ Under a Michigan statute requiring physicians to report immedi- ately contagious diseases, it was held a question for the jury Avhether a physician, who had reported cases of diphtheria in children a week or ten days after his diagnosis, had acted Avithin a reasonable time; and it Avas decided that diphtheria, being a virulent and rapid disease, eight days AA_as not a reasonable time, and also that verbal mention to the health officer of the existence of the cases Avas not such a report as the .statute required.11 The question of the liability of a physician to a patient for reporting him as sick of a contagious elisease was considered a few years ago in a XeAv York case that aroused much interest at the time. Dr. Purdy, a physician of excellent professional standing, AAdio had been elected president of the medical society of that county, Avas caUed in by a Miss Brown, a florist, to attend her. The testimony Avas conflicting. The patient at the time of her illness was suffering from a cutaneous affection, and expert testimony differed as to whether it Avas a light attack of smaUpox or only an eczema. HoAveAer that matter be, the physician considered the case one of smaUpox, and called in a health inspector, who agreed Avith that diagnosis and ordered the removal of the patient to the smaUpox hospital, Avhence she was soon after discharged. In an action against Dr. Purdy, Miss Brown recovered a verdict of five thousand doUars; but upon appeal this judgment Avas reversed upon the ground that her remoAral Avas an independent act of the inspector upon his OAvn diagnosis; that Dr. Purdy was only performing his duty in mak- ing his report, whether he Avas mistaken or not, and that the complaint should have been dismissed.^] The principle of the Purely ease is equaUy appUcable in cases of " Commitment of the Insane," although no duty of reporting the condition of an insane patient to the public authorities is prescribed, as in the case of contagious diseases. Whether such a report should not be required in aU cases where the patient's mania is of homicidal tendency is worth serious consideration. The liability of physicians upon whose reports persons are committed as insane has been carefuUy considered.** And it has been held that while the judge who signs the report possesses judicial immunity, the physicians Avho make * Piper vs. Menifee, 12 B. Monroe (Ky.) 465. t Seavy vs. Preble, 64 Me. 120; cf. Raymond vs. Fish, 51 Conn. 80; a case of de- stroying oyster beds in purifying a river. X R. vs. Burnett, 4 M. & S. 272. $ 7?. vs. Vantandillo, 4 M. & S. 73. || People vs. Brady, 90 Mich. 459; 51 N. W. 537. 51 Brown vs. Purely, 54 Super. Ct. (N.Y.) 109; 8 N.Y. St. B. 143, cf. Penned vs. Cum- in ings, 75 Me. 163. If patients are carelessly removed the authorities are liable : Aaron vs. Erodes et al, 64 Tex. 316. ** Ai/ers vs. Russell, 50 Hun, 282; Penned vs. Cummings, 75 Me. 163; Hall vs. Semide, 3F.&F. 337. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. 635' it act as medical experts, not as judicial officers, and are liable, as in other cases of malpractice, for their failure to have and exercise due care, skill, and knowledge. They must make careful examination of the facts in the case. There are feAV graver wrongs than the careless com- mitment of a sane person to a lunatic asylum. And where an eminent alienist directed a commitment upon hearsay alone this was admitted by counsel of both parties to be assault, and a verdict of five hundred pounds AA-as rendered against the physician* A somewhat analogous case of Avrong-doing by the erroneous report of a physician occurred in New York, where a verdict for plaintiff was sustained in an action for deceit growing out of the fact that defendant, the surgeon of the Seventh Regiment of Nenv York, had made a maliciously false report of plaintiff's physical condition, thereby causing the latter to be discharged from the regiment.! Partnership.—The ordinary mercantile partnership is an association of tAAro or more persons to carry on a particular business and share its profits and losses. And Avithin the scope of this business they are liable one for the act of the other. In an early New York case partners in the practice of physic were said to be, within the law merchant-! And in Tennessee the note of one of two physicians in partnership was said to be binding on both if " executed for anything for AA'hich a firm of phy- sicians had use "; e.g., drugs or instruments, cweii though the proceeds were appropriated to his own use by the drawer. " But," continued the court, " money is not an article for which such a firm has use directly, though it may indirectly." And therefore, the drawing of notes not being Avithin the scope of the partnership, the firm is not bound.§ The " good-wiU" of a medical practice may be sold, and it is a valid agree- ment if the seUer contract not to practice in a certain locality.|| Mr. Glenn says that a meehcal man is liable for wrongful acts of his partner in practice,^ and there are two American cases that so hold.** In Hyme vs. IJrwin it appeared that a father and son practiced medicine as part- ners, and both Avere charged with negligence in practice. Plaintiff reoA'erecl a verdict. The court said that in such an association each partner " guarantees that within the scope of the common business rea- sonable care, diligence, and skiU shaU be displayed by the one in charge," or at least the failure of one to exercise such skiU and care is the failure of all. In Whittal-er vs. Collins it appeared that plaintiff had employed the firm of Graff & CoUins to set his leg, which was broken. Graff attended him part of the time skUlfully, so plaintiff considered, but (bUins attended him the rest of the tune, and made a mess of it. So Whit taker, holding Graff blameless, considerately sued Collins, alone; but the defendant ungraciously demurred to the complaint on the ground of defect of parties ; and the court considering the action to be in contract, sustained the demurrer because the innocent Graff was not sued. This * Anderson vs. Burrows, 4 C. & P. 210. t Dedcrick vs. Morris, 14 Week. Dig. 232. X Allen vs. Blanchard, 9 Cow. 631. $ Crosthwaitc vs. Ross, 1 Humph. 23 ; cf. Thompson vs. Howard, 2 Ind. 245. || Hop vs. Holly, 39 Conn. 326; Dwight vs. Hamilton, 113 Mass. 175; War field vs. Booth, 33 Md. 63 ; and see May vs. Thompson, L. B. 20 Ch. D. 705; Christie Administra- trix vs. Clark, 16 Upper Canada C. P. 544. fl Manual of the Laws Affecting Medical Men (London, 1871), at p. 340. ** Ilyrue vs. Erwin, 23 S." C. 226; 55 Am. R. 15 ; Whitteikcr vs. Collins, 34 Minn. 299; 25 N. A\\ 632. C36 A SYSTEM OF LEGAL MEDICINE. shows the danger of partnerships, and recaUs the occasion when Chang, the Siamese tAvin, having been made president of a total abstinence society and chosen to lead its parade, Eng fuddled himself, and the two stoned the procession to the lasting disgrace of Chang, avIio neA'er used stimulants. An unlicensed person may form a partnership with a qualified practi- tioner, and share the profits of the practice, although he cannot himself treat the patients of the firm* And whateA'er the conditions of the relationship may be, its habUities are dependent on its scope and the application to it of the general principles of partnership. Grateful Patients, as is weU knoAvn, often send gifts to their doctors. Sometimes the gift is in lieu of payment of the bUl, but often it is given by Avay of bequest, and is of considerable value. If it be a large part of decedent's estate, the question of undue influence might be raised. It is enough to say on this point that whUe a medical man may make a contract with or be the legatee of his patient, stiU if the donor or tes- tator be a person of weak mind the relation is such as to make1 the court Anew the transaction Avith suspicion. Nor should a physician who has reason to beheve that he may be a legatee sign a avUI as AA'itness, lest being called on to prove the document he lose his legacy. The case's on undue influence are, as Mr. Redfield says, "almost infinite in number and variety," and it is impossible in a limited space to do more than refer to a few in which the relation of physician and patient has played part.! Who Owns the Prescription ? is a question freepiently asked by phy- sicians, but not as yet answered by the courts. In his treatise on medi- cal jurisprudence Ordronaux has devoted some pages to its discussion; but the matter is one of academic rather than of practical interest. The patient pays for advice. He receives a prescription orally or in writing. It is his. He can take it as often as he Avishes at his own risk, or give it to his friends. No one has ever pretended that a lawyer can forbid a client repeating the legal adrice given to him. Perhaps a contract might be made Avith the patient not to " repeat the prescription "; but then if he break the agreement, what is the physician's measure of damages ? If indeed the patient put up the prescription as a patent medicine and advertise it under the physician's name, this might be a libel; J but the gist of that offense would be not selling the prescription, but imputing unprofessional conduct. There is no practical method of preventing a patient from repeatedly swaUoAving a prescription intended for a single occasion, except to give him the actual remedy, after the old fashion, now again coming into vogue, or else to make the dose so disagreeable that to take it will be a pain rather than a pleasure. Criminal Offenses.—It has been seen that the practice of medicine in some jurisdictions is entirely free; in others it is prohibited to the unlicensed under penalties collectable in civil suits; in yet others unlaAv- ful practice is declared to be a misdemeanor. In any criminal proseeu- . tion or suit for penalty against an unheensed practitioner, the plaintiff's * Turner vs. Reynall, 14 C. B. N. S. 328; 8 L. T. 281. t Crisped vs. Dubois, 4 Barb. 393 ; Dent vs. Bennett, 4 Myl. & C. 269 ; Gibson vs. Rus- sell, 2 Y. & Coll. C. C. 104; Popham vs. Brooke, 5 Russ. 8; (ireville vs. Ti/lee, 7 Moo. P. C. 320; Calhoun vs. Jones, 2 Bedf. 34; Peck vs. Belden, 6 Dem. 289; cf.' Newhouse vs. Godwin, 17 Barb. 236, where an attorney was legatee. The English cases are col- lected in Glenn's Manual, p. 312 seq. X Clark vs. Freeman, 11 BeaA'. 112. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. 637 prima facie case is made out as soon as defendant's practice is shown * The burden of proving authority then shifts to defendant.! Nor is this making the accused prove his innocence, as some have fancied. The forbidden act is the practice, and the defense is a license, AA'hich must be established affirmatively like the defenses of autrefois acquit and former jeopardy. Were this not the rule, it would be obviously impos- sil de to convict unlicensed practitioners in jurisdictions where any med- ical diploma is a license; for the prosecution would have to prove a negative as wide as the world. Proof of Diploma.—In order to establish his defense, the defendant must show the qualifications required by the statute ; and if one of them be the possession of a diploma conferred by a foreign corporation, it is not enough to produce the parchment, but under the strict rule he should prove also the charter of the coUege, its existence at the date of the di- ploma, the genuineness of the seal, anel that it was affixed by the proper officer;! but in practice the rigor of the rule is relaxed. It would seem, too, that compliance with the requirements prehminary to conferring the degree should also be shoAvn.§ It scarcely needs a statute to emphasize the inadvdsability of under- taking any duty Avith '• a drappie in our ce " ; but it has seemed good to legislative wisdom in seA'eral States || to declare the performance by an intoxicated physician or surgeon of any act endangering the patient's life, or seriously affecting his health, a misdemeanor, or if death result, manslaughter.^} And under the common laAv Baron Garrow, in Long's ease,** said: "Suppose the person comes drunk, and gives me a tum- blerful of laudanum, and sends me into the other world, is it not man- slaughter?" Bay ley considered, however, that so rash an act would be homicide, whether the prescriber were tipsy or sober;!! but in the Georgia case referred to (supra) it was. held no good plea in defense to Dr, SeAvell's suit against Mr. McKleroy for fees, that plaintiff went to defendant's house in a state of intoxication, and administered four cups of ipecac at a dose, AA'hich caused him to vomit so violently that he Avas * As to what constitutes practice, see ante. t Apothecaries Co. vs. Bentlcy, 1 C. & P. 538 ; People vs. Nycc, 34 Hun, 298 ; People vs. Fulda, 52 Hun, 65 ; People vs. Rontey, 4 N.Y. Supl. 235 ; 117 N.Y. 624 ; Raynor vs. State, 62 Wis. 289; 22 N. W. 430; Wharton on Criminal Evidence, §§ 333-341; Lawson's Pre- sumption of Evidence, p. 20. X Hill vs. Boddie, 2 Stew. & Porter (Ala.), 56; Hunter vs. Blount, 27 Ga. 76; Moises vs. Thornton, 8 T. B. 303 ; but see Finch vs. Gridlcy's Excrs., 25 Wend. 469 ; and Walmis- ley vs. Abbott, 1 C. & P. 309. § Andrews vs. Styrap, 26 L. T. B. 704; Chadwick vs. Bunning, 2 C. & P. 106; and Collins vs. Carnegie, 1 A. & E. 695. || N. Y. Penal Code, $ 357; Bev. Stat, Ohio, § 6813; Gen. Stats. Mich., § 9319; and see statute books of other States. There seems to be no need for such a statutory regulation of the drinking habits of lawyers; whether on account of their capacity or their good habits may be surmised. If Penal Code, $ 200. ** Rex vs. St. John Long, 4 C. & P. 378. tt Rex vs. St. John Long, 4 C. & P. 423. Whether causing the death of a patient by erroneous medical treatment would be manslaughter on the part of the unlicensed physician, although only actionable malpractice on the part of a legally qualified prac- titioner, is more appropriately discussed under Malpractice. It is sufficient here to say that whether a practitioner be licensed or not, if by his gross ignorance or neg- ligence he causes the patient's death, he may be guilty of manslaughter. (See the opinion of Judge OliA'er A\rendell Holmes. Jr., in the recent case (1884) of Pierce vs. Commonwealth, 13S Mass. 165, 52 Am. E. 264.) It is a principle of common law, how- 638 A SYSTEM OF LEGAL MEDICINE. seriously injured, and Avas damaged to the extent of two hundred dollars. For the court held that -'teirt cannot be setoff against contract," and added: "The idea that an overdose of ipecac endangered a man's life two hundred doUars, without stating in the plea AA'herein and Iioav, is hardly plainly and distinctly setting out a defense."* Abortion.—The unlawful attempt to kill a child en ventre de sa mere- has been said to lie only a misdemeanor at common laAv; but if the death of an unborn cddld, or of the mother, result from the attempt, this AviU render the defendant guUty of homicide. The degree of the crime1 is noAV established by statute in nearly eAery chdlized jurisdiction; the ill- founded distinction between the condition of the ehUd before and after quickening being generally maintained. Of course to saA'e the mother's life procuring an abortion is lawful, but the burden of proving the necessity of the operation is upon the defendant.! The full discussion of this topic also is referable to the article on Malpractice. To have carnal knoAvledge of a patient under pretense of medical treatment,! or to unnecessarily make her disrobe under pretext of ex- amination^ have been held to be assaults. In Regino vs. Case, it appeared that defendant, a surgeon, under pretense of treating a girl fourteen years old for suppressed menstruation had had carnal inter- course Avith her, she consenting in the belief that it was good treatment. And Wilde, C.-J., discussing the evidence in the case, said: " The defend- ant, for aught that appears to the contrary, may have adopted the course he took bona fide Avith a aucav to her cure. The court cannot say that it might not have been beneficial in a medical point of vieAV." But in the end the entire court agreed that such a system of practice should be discouraged, and affirmed the conviction. Excise Laws are not to be disregarded by the medical practitioner, who must be Avary in prescribing spiritus frumenti, especiaUy if the patient is a chronic sufferer anel given to repeating the prescription. In Alabama, where a physician may krwfully administer the prohibited liquor in cases of necessity, he cannot prescribe a quart of Avhiskey anel give the patient an order for it upon a drug shop in which he is inter- ested.! | Anel if a country doctor prescribe and furnish Avhiskey at the usual price he is a retailer, and violates Section 3242 of the he vised Statutes of the United States, unless he pay the special tax.«| In Iowa a doctor cannot without a permit put up prescriptions containing intoxi- ever, that if one, while committing a misdemeanor, cause death, he is guilty of man- slaughter; and, as we have pointed out, illegal practice of medicine in England is a prohibited offense punishable only by a civil penalty, and not an indictable mis- demeanor. This was true in the time of Hale, whose opinion (Pleas of tl\e Crown, 429) the American cases have followed. And it is to be noted that those cases have been decided in jurisdictions where the medical law Avas similar to the English. But it was early said that such a killing would be manslaughter in New York, where illegal medical practice is a misdemeanor. (March vs. Davison, 9 Paige, 584.) * McKleroy vs. Setcell, 73 Ga. 657. t People vs. McGonegal, 136 N. Y. 62. t R. vs. Stanton, 1 Car. & Kir. 415; R. vs. Case, 19 L. J. M. C. 174. e^ /.'. vs. Rosinski, 1 Moo. C. C. 19. It was said in R, vs. Case that the evidence in Bosinski's case showed that the removal of the clothing was not an entirely voluntary act of the patient, bnt that defendant used some force ; therefore the conviction of as- sault was maintainable. But the case is always cited to the effect stated in the text. || Brinsonvs. Stale. 8 So. 527. If U. S. vs. Smith, 45 Fed. 115. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. G39 eating liquor.* In Kentucky physicians, aaUio are the only persons allowed to keep and prescribe liquor as a medicine within three miles of XcAA'castle Court-house, A'iolate the laAv if they fail to record the sale in a book, and the statute so proA-iding has been held to be constitutional.! In the same State Dr. Greene being indicted for "prescribing AA'hiskey improperly,'' the court held this to be bad pleading; for prescription o'f Avhiskey is entirely consistent Avith propriety, and facts shoAving bad faith should be aUeged.f In Oregon a physician selhng any of the drugs enumerated in the act relating to poisons must shoAv that he also pre- scribed it anel kept the record required by laAv.§ Medical Societies have been incorporated very generally, for the purpose of increasing knowledge of medical science, fostering personal relations, and regulating professional conduct. New York, which in 1760 enacted her first statute forbidding unlicensed medical practice,|| created in 1806 by a general act of incorporation a system of State and county medical societies^] "for the diffusion of true science, and particularly the knowledge of the healing art." Since that time kindred societies have groAvn up all oa'ct this country of a national, State, and county jurisdiction. In the beginning of the century epiackery of every kind Avas rampant, as Carlyle has forcibly pointed out in his essay of Cagliosfro ; but the medical profession Avas comparatively homogeneous. There were individual pretenders, such as Thompson, whose disciples haA'e been repeatedly indicted for manslaughter by Ul-adA'ised prescrip- tions of his specifics, "ram-cats" and "well-my-gristle,"** and avIio him- self founded what avms called the "botanic system," and Perkins, who established treatment by metallic tractors. But these men had no legal status as physicians belonging to incorporated societies. Reputable prac- titioners avc re not divided among themselves; and it Avas feasible to enact, as was done, that eA'ery practicing physician should upon notice1 join a county society under penalty of forfeiting his license in case of contumacy.!! This law is still in force in New York; but the incorpora- tion of Homoeopathic and Eclectic county societies has made it prac- tically a dead letter; since in order to enforce it cooperation would be needeel among the three societies. Therefore many legal practitioners do not belong, as the laAv contemplates they should do, to any county society. These organizations have, of course, aU the powers specified in their charters and necessary to effect their purpose, preserve their being, and enforce their lawful discipline.!^ And it was early held that such a society could demand an initiation fee,§§ expel a member for gross' ignorance or immorality, ca-cii though he had been tried and acquitted on the charges,|||| and also that it would not be directed by the writ of mandamus to admit to membership one Avhom it would have to expel * State vs. Bcnadouc, 79 Iowa. 90 ; 44 N. AAr. 218. t San-is vs. Commonwealth, s:> Kentucky, 327. I Commonwealth vs. Green, 80 Kentucky, 178. \ State vs. Jones, 18 Or. 256 ; 22 Pac. 840. || Ch. 108, Laws of 1760; Livingston & Smith, p. 188. H Ch. 138, Laws of 1806. ** Lobelia infiata of Linnaeus. tt Bev. St. of N. Y., Part I., ch. xiv., title vii., §§ 1 and 2. tf People ex rel Ilartlctt vs. Med. Soc. of Eric, 32 N. Y. 187. §§ Peojde ex rel Dunned vs. Med. Soc. of N. Y., 3 Wend. 426. |||| Ex parte Smith, 10 Wend. 449. 040 A SYSTEM OF LEGAL MEDICINE. immediately, e.g., a homoeopath Avith an avoAved intent to adhere to his belief in the doctrine of sun ilia, psora, and the high potencies * But Avhere one who had in the past acted contrary to the medical code by advertising, being othei'Avise qualified and ready to abandon his misdoing, AA'as refused admission to such a society, a mandamus was granted commanding his election, although it AA'as conceded that if he should advertise after becoming a member, he AvoiUd be liable to ex- pulsion; the point being that advertising is not of itself immoral, and that the obligation of the code and by-laAvs does not exist until they are subscribed to ;1 but the same society AA'as not permitted to expel a member aa'Iio attended the county poor in viedation of a rule establishing a tariff of charges, for the rule itself Avas considered con- trary to public policy.} Dr. FaAvcett was elected to the Alleghany County Medical Society in 1831, as a physician and surgeon, on produc- ing his diploma from the Royal College of Surgeons of Edinburgh. "This document,"' says the report, "AA'as in Latin, and it appeared that although the credential Avas handed about and inspected by the members of the society, the greater part of them could not translate it. It Avas, hoAvever, translated on the trial, and found to lie only a diploma author- izing the practice of surgery.'' Dr. (diaries, getting Avind of this wicked deception, offered the following resolution: "Whereas, Henry Fawcett, by false pretensions, became a member of the Alleghany County Medi- cal Society: therefore resolved, that Ave reconsider the vote taken at the last meeting in February, 1831, making Henry FaAvcett a member of this society, and that he be no longer considered a member of the Alle- ghany Count}' Society, until he qualifies himself to practice physic, etc., according to the Laws of this State." This sounded so well that not only did the society adopt it, and as they supposed, expel Fawcett, but the Angelica Republican, with a kindly spirit of "newspaper enterprise," also published the proceedings. Whereupon FaAvcett sued (diaries for libel and recovered a verdict of one hundred and fifty dollars, which the Ap- pellate Court sustained, saying that plaintiff's performance in palming off his Latin for more than it Avas worth was no ground for expulsion. " It Avas not breach of his oath, for he had taken none, nor of his official duty, for he Avas not yet a member," Avherefore the court held that FaAvcett, like Sanely's shilling in the box, "being once in Avas ahvays in," and added, for the benefit of the society, and doubtless Avith unconscious humor, that "their proceedings Avere coram non judice." Slander and Libel, therefore, are actions that will lie for wrongfully assailing a physician's professional reputation. It Avould be inadvisable to enumerate here the cases of this nature AA'hich have grown out of the careless speeches concerning medical practitioners, many of them being grotesque to a degree. Nevertheless, as a finger-post of Avarning to the impetuous and irascible, it may be worth Avhile to cite a feAV instances, more or less modern, in which utterances concerning the practitioner of medicine haA'e been held to be slanderous or libelous. Libel and slander are both malicious defamation of character. But the latter is by Avord of mouth; the former, by the more deliberate and enduring expressions * Ex parte Paine, 1 Hill (N. Y.), 665. t People ex rel Bartlettvs. Med. Soc. of Erie, 32 N.Y. 187 ; see opinion of DaA-is, P. J., at General Term, 25 How. 333 ; this case led to the enactment of Laws of 1866, ch. 445. X People ex rel Gray vs. Med. Soc. of Erie, 24 Barb. 570. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. 641 that are apprehended by the eye—printed or written Avords, signs, pict- ures, or effigy* But because rerba dicta pereunt, litem scripta moment, and also because the deliberation of writing and perhaps revising the proof of a defamatory saying or joke shows greater depravity than does the sudden impulse of a speech, words that if spoken would be, in the mild eye of the hue, innocent, become libels if printed or Avritten. Slanderous words must defame a man Avith respect to his occupation in life or character; it is even said that they must impute crime or such ig- nominy as Avoidd exclude him from society; while to constitute libel it is sufficient if he be made ridiculous. Thus Avords charging a physician with gross ignorance and unskilL fulness or neglect in his profession may constitute either slander or libel, according as the}' are spoken or written.! To say of an unlicensed phy- sician that he is a quack is not actionable, as we have already seen.} But it is otherwise if the person defamed have complied with the laAv although he adopt a " system " disapproved by the del amer. And if the imputation of quackery be made maliciously it wUl not be privileged, because it Avas made on the witness-stand. Doctors White and Carroll practiced medicine in Amsterdam, N. Y. White, though a graduate of a regular medical college, adopted and practiced homoeopath}'. Both attended Jay Phillips. Nevertheless Jay died, and his aa'UI being con- tested after the fashion of the time, both physicians were called before the surrogate to testify as. to decedent's mental capacity. Dr. Carroll being asked if any other physician than he attended Mr. Phillips, an- swered, " Not as I knoAV of." He was then asked, " Did not any physi- cian attend him at the time he was at Mrs. Moore's, Avhen yon did not ?" and he replied : " Not as I know of. I understand he had a quack; I Avould not call him a physician. I understood that Dr. White, as he is called, had been there." The jury thought that Dr. White Avas damaged to the extent of one hundred dollars by this aspersion.§ So to say of a physician, " He is no doctor; he bought his diploma for fifty dollars," || is actionable. Where adultery is a crime, it is of course slanderous and libelous falsely to impute the guilt of it to any man or Avoman; but in the absence of statute making that offense criminal, it was held at com- mon laAv that merely to impute it to a physician was not slander, because a man may be a good physician, or rather an able man in his profession, and yet play havoc with the seventh commandment ;|| but if the charge * A learned text-writer (Townshend on Libel and Slander, ch. 1, p. 3, 4th ed.) is of opinion that "effigy" includes "gestures"; but the adjudicated cases do not seem to have determined the point. Gesture appeals to the eye, it is true, and not to the ear, but it is less premeditated and more transitory even than words. It would make a great difference in the case of the Sacristan cited by Ingoldsby, whether his subtle aspersion of character by gesture Avere slander or libel. "An uncle—so 'tis whisper'd now throughout the sacred fane, And a niece—whose father's far away upon the Spanish main. The Sacristan he says no word that indicates his doubt. But he puts his thumb unto his nose, and spreads his fingers out." t Carroll vs. White, 33 Barb. 615 ; Gaurrean vs. Superior Publishing Co., 62 Wis. 403 : Southee vs. Dcum/, 1 Exch. 196 ; Secor vs. Harris, 18 Barb. 425. X Hargan vs.'Purdy, 20 S. W. 432 (Ken. Ct. Ap. 1892); March vs. Davison, 9 Paige, 580; Skirrine/ vs. Ross, 31 Up. Can. C. P. 423. * White vs. Carroll, 42 N. Y. 161. II Bergold vs. Putcha, 2 Th. C. (N. Y.) 532. To impute to a practicing physician general ignorance of medical science and lack of professional skill is actionable, AA'ith- 642 A SYSTEM OF LEGAL MEDICINE. be of adultery with a patient, this iireolves professional character, and for such an imputation a physician of prominence recovereel a verdict of twenty thousand dollars against the Detroit P ecu ing News* The lux/tes- ter Democrat and Chronicle, under the headline1 "A NarroAV Escape Fmni Being Buried Alive," narrated that farmer Hainmell had been found frozen stiff in the liigliAvay, that coroner Purely promptly sat on the body and was investigating the cause of death AA'ith his jury, AA'hen Dr. Lester insisted, despite the laughter aroused by his statement, that the farmer still lived, as indeed proA-ed to be the case. It chanced that the coroner AA'as also a physician, although the Democrat said nothing of the fact, and he brought his action iu libel to recoA'er damage's. Anel let this case1 sIioav how futile it Avould be to try to giA'e to our definition a point like that of Ithuriel's lance, able to detect libel the moment the loathsome thing appears. The trial judge, being of opinion that the Avords Avere not libelous per se, elirectecl a A'erdict for defendant. But A'erdicts by judges or juries are elusive. The General Term AA'ith one accord Avere of opinion that the Avords Avere libelous per se. For they said, with some appearance of argument, "Was it not calculated to bring disgrace or ridicule upon a physician to say of him in substance that he did not know on inspection that a man Avas alive or dead?" So they reA'ersed the judgment below and ordered a new trial. But the Court of Appeals still remained, and thither the parties trudged in quest of justice. That court—also with one accord—reA-ersed the General Term, for, said the1}': "It appears from the complaint anel evidence that the plaintiff Avas by profession a physician and by office a coroner. In the article complained of he is referred to in the latter capacity only, and noAvhero can be found a word or suggestion from which the most astute inquirer could infer that he had any other than that public occupation. As the lan- guage used did not relate to his profession in any way, so as to his office of coroner, it exhibits on his part a prompt and efficient performance of its duties; and it is impossible to see how any person reading it could ascribe to the words a defamatory meaning, or without the innuendoes apply them to the plaintiff in his professional capacity, and there is no eA'idence that such application Avas intended."! As the procedure alloAved no further appeal, and the defendant had won the best two out of the three legal bouts, the coroner got no damages. The audacity of those AAdio do business by advertising presents an- other phase of this subject of libel. Dr. Clark applied to the courts for an injunction to prevent the use of his name by one Freeman, a manu- facturer of "consumption pills," which were put in boxes and labeled Avith Dr. Clark's name. The injunction was refused on the ground that Freeman's act Avas libelous and therefore damages Avere recoArerable at law; and when this is so equity refuses to interfere by injunction.} out proof of special damage. Cruikshank vs. Gordon, 48 Hun, 308 ; afd. 118 N. Y. 178. See Lyndevs. Johnson, 39 Hun, 12 ; Carroll vs. White, 33 Barb. 615; Collins vs. Carnegie, 1 A. & E. 695; Long vs. Chubb, 5 C. & P. 55. * Maclean vs. Scrijips, 52 Mich. 214. t Purdy vs. Rochester Printing Co., 26 Hun, 206; reA-ersed, 96 N. Y. 372. X Clark vs. Freeman, 11 Beav. 112. A droll action for libel was that of Suitings vs. Shakespeare, 46 Mich. 408 ; 11 Amer. 166. Plaintiff wrote a puff of himself which de- fendant, publisher of the Kalamazoo Gazette, misprinted, so that it read that Sullings had remoAred a " patty tuber " from the " hypogastrium " of A. B. Smith. Verdict for defendant. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. 643 But in a very recent case* the court at special term granted an in- junction to Sir MorreU McKenzie restraining the use of his name by a manufacturing company to advertise certain salts of Carlsbad. The case never reached the AppeUate Court. The use of his photo- graph as an advertisement is something that the public man may expect, He may approve of it or he may not. That makes little difference to the advertiser. An eminent English actor, whose face a great pilh maker has used as an advertisement, fled not long ago for rest and privacy to a little country toAvn where he thought he would be un- knoAvn. He met two pretty children in his walks, who smUed in recog- nition as they passed. He turned and said: "My dear, do you know me?" "Oh yes," they said, "you're----'s pills'" And the players dream of fame was reahzed. But AA-hen an abuse becomes intolerable, the courts find a remedy even if they shatter a tradition to do so. The use of a private person's likeness Avithout his permission wiU be en- joined.! The relatives of a decedent have been able to procure an injunction} to prevent the erection of a statue identifying their dead with a movement of a public nature, and there is reason to hope that the right of privacy and. pubhc decency will be more and not less en- forced in the future. DENTISTRY. If Celsus said truly that all parts of medicine were so interwoven as not to be separable, argument is unnecessary to show that dentists belong to the class of medical men. It is common knowledge that the clergy Avere Avell-nigh the only practitioners of physic and surgery prior to a.d. 1163, when the Council of Tours, perceiving that the success achieved by the faithful was but a snare of the arch-enemy to divert pious souls from holy things to things temporal, issued the decree restricting excur- sions from the cloister and the absorbing practice of healing arts by priest or monk. Thereafter surgery fell into the hands of smiths and barbers; in oblivious commemoration Ayfiereof the barber erects his pole to this day. The greater surgical operations soon feU naturally into the better educated and more skiUful hands, and surgeons formed into colleges; but " tooth-pulling," which by some is even yet understood to constitute dentistry, remained until comparatively recently, together Arith cupping and leeching, part of the barber's business. And if it be true that the Avorld takes us at our own estimate of ourselves, it is in no small degree the fault of dentists themselves that they continued so long to occupy a less dignified plane of usefulness than their medical brethren, the physicians and surgeons. Their advertisements by hideous displays of artificial teeth and instruments, their lack of organization, ethical rule's, and esprit du corps, possibly even the similarity of the dental chair to that of the barber, all tended to preserve the old tradition, especially when joined with a steady flow of conversation not far removed in sub- ject and quality from that of the gentlemen of the pole. "Attaejue, calommnie, ridiculise conime le chirurgien on le medeein an temps deMoliere, le dentiste a eu pendant nne bonne partie de le siecle nn sort peu enviable." * McEenzie vs. Soden Mineral Springs Co., 27 Ab. N. C. 402, 18 N. Y. Supl. 240. t Pollard vs. Photographic Co., 40 Ch. D, 345; Marls vs. Taffa, 26 N. Y. Supl. 908. X Schuyler vs. Curtis, 27 Ab. N. C. 387; 24 N. Y. S. 509. 644 ^ SYSTEM OF LEGAL MEDICINE. (Code du Chirurgien-Dentiste, par MM. Roger et Godon, Paris, 1S03.) But all this has been changed. The organization of societies and col- leges, the enactment of registration and license laws, the extraordinary progress of dental art and science, and the high character of their lead- ing exponents, have been such as to elicit admiration, and some enthusi- asts have gone so far as to consider dentistry a separate profession, which it is undesirable to " hitch on to the taU of the medical kite to give it ballast for a higher flight"*—a proposition not to be rashly accepted. However this may be, the practice of dentistry, and the relations of the dentist to his patient so far as the laAv is concerned, are governed by the same rules already laid down in the preceding pages. The question has indeed been raised in the courts as to whether a dentist Avas a trades- man, an artisan, or a professional man. Thus a dentist AA'ho made at her request two sets of teeth for a lady, who died before she could try them in, Avas held in a suit against her executor incapable of recovering their value upon the ground that the action was not for services but for goods sold, and as such not maintainable under Section 17 of the Statute of Frauds.! In a Mississippi case, decided in 1856, the question at issue being whether dental instruments were exempt from levy under execu- tion, as mechanical tools, the court held that they Avere not, because den- tistry is not a trade.} In a simUar case, however, in 1868, Chief-Justice Cooley held that such instruments were exempt from levy under attach- ments. The learned jurist did not hold a dentist to be "a mechanic," as Mr. Rogers suggests,§ nor do his words quoted by that excellent writer fairly bear such an interpretation. His decision went no further than to hold that the vocation is of a duplex nature; that dental operations are for the most part mechanical, " and so far as tools are employed they are purely so ; " but is not this so of the surgeon's saw ? The court said : " Indeed, dentistry was formerly purely mechanical, and instruction in it scarcely went beyond manual dexterity in the use of tools; and a knowl- edge of the human system generally, and of the diseases which might affect the teeth and render an operation important, was by no means considered necessary. Of late, however, as the physiology of the human system has become better understood, and the relations of the various parts and their mutual dependence become more clearly recognized, dentistry has made great progress as a science, and its practitioners claim, with much justice, to be classed among the learned professions." || The most recent expression of judicial opinion that dentistry is a medical specialty is in Flickinger's case,ff wherein the Missouri statute exempting "a medical practitioner" from jury service was held to apply to one lawfully practicing dentistry. The court said: " While dentistry as an independent calling may have had a humble and comparatively recent origin, it has now become a very important branch of medical science. * Dentistry not a Specialty of Medicine, by N. W. Kingsley, D.B.S., Medical Record, November 20, 1886. Is Dentistry a Specialty of Medicine t by the writer, Meelical Rec- ord, December 4, 1886. t Lee vs. Griffin, 30 L. J. Q. B. 252 ; cf. Gilman vs. Andrus, 28 Vt. 241, where a hus- band was held liable to pay for his wife's teeth. X Whitcomb vs. Reid, 31 Miss. 567. § Eogers, The Law and Medical Men, p. 170. || Maxon vs. Perrott, 17 Mich. 332. IT State ex rel. Flickinejer vs. Fisher, 21 S. W. 446, 593. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. 645 [Address of N. S. Davis, M.D., president of the American Meehcal Asso- ciation.] The fact that this branch of the medical profession has grown to such proportions as to have its oavii independent colleges and to con- fer its oavii degrees, anel that it has become necessary that its practice should be regulated by statute, indicate the importance of the exercise of its functions to the public welfare. The fact that it is regulated in a separate article, and as an independent calling from that of an M.D., does not in any manner affect the character of those functions." The Dental Act of 1878* regulates the practice of dentistry in the United Kingdom, and places it, hke medical practice, under the super- vision of the General Council of Medical Education and Registration, whose functions in dental as in medical matters are discretionary and not controllable by mandamus.! In France the practice is regulated by the recent law of November 30, 1892. German}-, Austria, Switzerland, Belgium, Spain, Italy, Norway, Sweden, Finland, Denmark, and Russia, aU prescribe rules of license.} In this country Alabama seems to have been the first State to enact a dental law. At present such laws are in force in Arkansas, Connecti- cut, District of Columbia, Georgia, Indiana, Kentucky, Maine, Massa- chusetts, Michigan, Minnesota, Missouri, Mississippi, Ncav Hampshire, New York, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, Vermont, Virginia, Wisconsin. The Dental Act of 41 & 42 Vict, is very similar to the Medical Act in its provisions, and up to the present year the diplomas of Harvard and Ann Arbor have been recognized as en- titling their holders to registration thereunder. But it was decided by the General Council lately (in 1893) to discriminate no longer as between American diplomas, none of which now entitle their holders to register as dentists. The French laAv has so recently become operative that its results cannot be criticised. The statute confines practice of dentistry to doctors of medicine or surgeon dentists, the diploma of the latter class to be conferred by the gOA'ernment, after a course of study to be promulgated by the higher council of public instruction and examina- tions. Illegal practice is punishable by a fine of from fifty to one hun- dreel francs for the first, and from one hundred to five hundred francs for the second offense. To make a synopsis of the statutes of our States is hardly worth while in this place, for the same reasons that have caused an omission of a like synopsis of the medical laws. In this transition and formative period the statutes are subject to change by every legislature; and the only safe prac- tical guide for one desiring to begin the practice of dentistry in any State is to consult its most recent statute book. A summary of the law made to-day might prove to-morrow a mere Jack-o'-lantern misleading the inquirer. It may be said generally, hoAvever, that the prevalent requirement of license is that the candidate shall appear before a board of dental examiners appointed by the1 State or State Dental Society, and either satisfy them that he holds a diploma from a college in good standing, or submit to their examination. And we have already seen that the courts will not aUow a State Board to delegate its powers to a national association^ * 41 & 42 Vict, c. 33. t Partridge vs. GenH Council Med. Ed. $ Reg.; L. R., 25 Q. B. 90. X Code du Chirurgien-Dcntiste, supra. I Illinois State Board Dental Exrs. vs. People, 123 111. 227. C46 A SYSTEM OF LEGAL MEDICINE. The contract of the dentist is goA'erned by the same rule as to the1 standard of skill and knowledge AA'hich applies to the physician. A elentist must haA'e and exercise the reasonable and ordinary knoAA'ledge, skUl, and care of his profession.* In a Ncav York case it Avas said that a dentist OAved the highest degree of skiU and care to a patient under the1 influence of an amesthetie, and that the fact that the operator instead of extracting the tooth of the unconscious man let it slip down his throat, was sufficient proof of negligence to carry the case to the jury.! In administering chloroform, hoAvever, it AA'as said in a Pennsylvania case that a dentist Avas only bound to look to the natural anel probable effects of the anaesthetic.} It has been seen above that the confidential relations between physi- cian and patient render extraordinary agreements by the latter in the former's faA'or suspicious; and in a grotesque case Avhere a dentist took from a pensioner of GreeiiAA'ich Hospital a bill of exchange for £262 10s. upoii an alleged agreement to keep the old gentleman supplied Avith teeth for the rest of his life, the court held the agreement to be a gross fraud.§ Partnerships, signs, and such matters are, of course, regulated by the ordinary rules of law in such cases provided. And so far as signs and advertising are concerned, there is no call to cite authorities in a book intended for professional men. PHARMACISTS. Reference has been already made to the maimer in which the apothe- cary became in England a general practitioner of medicine, being suc- ceeded in his ancient and narrower function by the pharmacist and chemist. In the practical administration of medical laws, constant com- plaint is heard against " counter-prescribers," so caUed, Avho are the true successors of apothecary Rose, who made the great fight against the CoUege of Physicians and Surgeons. It is chiefly in sparsely settled districts and the poorer quarters of great cities that the druggist as- sumes to act as a physician. The test of whether he A'iolates the laAv in any instance must be determined by the particular facts of each case, for, as Avas said by Mr. Justice HaAvkins in a case already cited, u It is idle to lay'doAvn a golden rule upon the subject,"|| It becomes always a question of fact Avhether under the proven circumstances the druggist merely sold an article, as he is entitled to do, or prescribed it after the manner of a physician. A druggist is responsible for aU injury due to his lack of reasonable ■knowledge, skill, and care. He is bound to knoAV the properties of med- icines and to employ competent assistants, for AA'hose acts in the course of his business he is also hable. In the leading case of Thomas vs. 'Win- chester]] the defendant Avas held hable for injuries resulting from a mis- * Simonds vs. Henri/, 39 Me. 155. t Keily vs. Colton, 1 City Court (N. Y.), 439. X Bogle vs. Winslow, 5 Phila. 136. § Allen vs. Davis, 4 De. G. & S. 133. || Apothecaries Co. vs. Jones (1893). 5 R. 101; 1 Q. B. 89; 67 L. T. 677. U 6 N. Y. 397. LEGAL RELATIONS OF PHYSICIANS AND SURGEONS. 647 take of his assistant in labeling a jar of belladonna as dandehon, which jar was first sold to one Aspinwall, by him to Ford, and by Ford to the plaintiff. In two Kentucky cases* druggists were held liable, the one for selling cantharides on a prescription calling for snake-root and peruvian bark, the other for selhng croton oil instead of Unseed; and in Michigan! a defendant was held liable for his clerk's error in dispensing sulphate of zinc for Epsom salts. But although a drug- gist sells a poisonous drug without labeling it, he is not responsible for its reckless use by one whom he has AA-arned of its properties,} and he is entitled to have the competency of his clerk submitted to a jury, together with the question whether there AA-as actual negligence in the ease.§ Although one who manages a pharmacy is required to have a certifi- cate of competency under the statutes of many of the States, neverthe- less one who is not entitled to such certificate may invest his money in a pharmacy and employ a duly certified agent to carry it on;|| but he cannot take part in the conduct of the pharmacy himself.^j A pharmacist entitled to register, and who has apphed so to do and paiel his fee, has been held not liable under the statute of IUinois if the Board of Pharmacy failed to register him.** The sale of poisons and intoxicants being noAV almost universaUy regulated by law, it behooves both physicians and druggists to know the statutory regulations of their domicUes in this regard. The fact that in- toxicants or poisons are sold under a physician's prescription is no de- fense if the vendor has no license.!! Under the British Pharmacy Act,}} forbidding the sale by unregis- tered persons of certain poisons, but exempting patent medicines, the exemption is held not to embrace all proprietary remedies, but only those covered by letters patent.§§ But a sale of poison under the act is not established by proving the sale of a compound containing an infini- tesimally small quantity of a poison defined by the act.|||| An unregistered assistant, who in his master's absence seUs a poison, is liable to the penalty under this statute.flfl There is a joyous opinion in a Georgia case of interest to physicians, druggists, and laymen ahke, for it holds that whiskey is not a drug. The term drug, said the learned and experienced court, " carries along AAdth it an idea inseparable from it, of something repulsiA'e, nauseous— at AA'hich the gorge heaAres. Whiskey, on the contrary, is inviting, ex- hilarating." And the court also argued Avith profundity that a drug is so hard to sell that merchandise difficult to dispose of is commonly * Elect et al vs. Hollenkemp, 13 B. Mon. 219; Hansford's Admx. vs. Payne $• Co., 11 Bush. 380. t Brown vs. Marshall, 47 Mich. 576. t Wohlfahrt vs. Beckert, 92 N. Y. 490. I Beck with vs. Oatman, 43 Hun, 265; afd. 132 N. Y. 94. || Commonwealth vs. Johnson, 144 Pa. St. 377; 22 Atl. 703. e all the examining physician is able to detect. The exact time and date of the aUeged assault and of the ex- amination should be noted carefuUy in order that the physician may determine whether the condition of the injuries would indicate that they had existed for a longer or a shorter period than that which has elapsed since the assault. The examination of the child's injuries should be made as soon as possible after the aUeged assault, for the eAddences of physical injuries, unless they have been extremely serious, wUl disappear within a very few days. The condition of the genitals as to cleanliness anel disease should be carefuUy noted, for it is frequently found that the irritation and discharge from wliich she is suffering, and which are thought by her friends to be the result of an indecent assault, are merely the natural consequences of filth and neglect, or sometimes to ascarides that find their way from the rectum to the vulva and vagina. The largest majority of the cases of indecent assault upon chUdren occur among the poorest and most depraved classes of people, and if the child has escaped serious physical injury no notice may be taken of the occurrence. In fact, unless the child is very young or the assault has been Avitnessed by a third person, the knowledge of it may not reach the chUd's parents at all. If, however, the child has receiveel a serious injury, she is usuaUy taken to a dispensary or some free medical institution for treatment, where for lack of time too often httle attention is paid to the cause of the condition from which the child is suffering, the physicians' entire efforts being directed to the appropriate treatment. Even if a history of an indecent assault is given, the physician is some- times loath, especially if the injury is shght, to report it to the proper authorities, fearing, if he does so, that he may be brought to court as a witness. In many of these cases a careful examination by the attend- ing physician into the character and cause of the vaginal irritation and discharge from which a child is suffering might reveal cases of rape and indecent assault which otherwise would remain unknown, and when such cases are known it is the duty of any physician to report them to the proper authorities. Many of the vaginal discharges for which chil- dren of this class are brought for treatment are gonorrhoeal in their origin, and due to^an indecent assaidt or attempted rape, but which are considered by their physicians, for lack of proper inquiry, to be cases of simple vulvitis or vaginitis due to filth or some constitutional disease. INDECENT ASSAULT UPON CHILDREN. 657 As far as practicable the medical examination of the clnld should be made without giving her or her friends warning, for in cases of false accusation the friends, or the chUd herself, desiring to have the charge substantiated by the corroborating testimony of the examining physician, might easUy so irritate the genitals as to make it appear as if the assault had reaUy taken place. Any refusal on the part of the friends to aUow an examination of the chUd's genitals by a properly authorized disinter- ested physician would form a strong point in circumstantial evidence against the accusation. 'Vtri 7—V k \ j? v W 600 H217s 1894 28410660R NLM D511bD5b 5 NATIONAL LIBRARY OF MEDICINE