W 600 H561m llTfo 28410900R .-..** k y m. — IUT10N11. LlWA«T Of «DICI« OUVN 3NI3I03W JO AWVS8M IVNOUVN 3NIDI0 3'-/ dO A3VH8 < Y OF MEDiCr.r national LIBRARY T' ...,f.lCINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY O ivaan ivnouvn 3Noia3w jo Asvaan ivnouvn 3noi03w do Aavaan ivnouvn 3noi03w do Aavaai V aei < a. ?Y OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY Ol \ * I J? IV88I1 IVNOUVN 3NOI03W dO A»vaaiT IVNOUVN 3NOIQ3W dO Aava8ll IVNOUVN 3NOI03W JO Aava9l ?Y OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY O ivaan ivnouvn 3nidiq3w do Aavaan ivnouvn 3ni3iq3w jo Aavaan ivnouvn snidiqsw do Aava Y OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY Y OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBFARY OF MEDICINE NATIONAL LIBRARY C %/f^4 A MANUAL OF LEGAL MEDICINE FOR THE USE OF PRACTITIONERS AND STUDENTS OF MEDICINE AND LAW BY JUSTIN HfROLD, A.M., M.D. FORMERLY CORONER'S PHYSICIAN OF NEW YORK CITY AND COUNTY; LATE HOUSE PHYSICIAN AND SURGEON of ST. Vincent's hospital, new york city; member of the new yokk county medical ASSOCIATION, COUNTY MEDICAL SOCIETY, MEDICO-LEGAL SOCIETY, SOCIETY OF MEDICAL JURISPRUDENCE, NEW YORK ACADEMY OF MEDICINE, AND GERMAN MEDICAL SOCIETY OF THE CITY OF NEW YORK LIBRARY SURGEOti GENERALS OFFICE PHILADELPHIA J. B. LIPPINCOTT COMPANY London : 6 Henrietta Street, Covent Garden 1898 600 16 ?S Copyright, 1897, BY Justin Herold. PREFACE The preparation of the following pages was undertaken at various times, during such brief intervals of leisure as the writer could spare from his pro- fessional duties. In offering the work to the legal and medical professions and to coroners, he fully realizes the fact that the field is already occupied by many excellent works on medical jurisprudence ; but he long since became convinced, from his experience as a coroner's physician, of the need of a work of a somewhat different character, for the special use of those whose duties are such that they have neither the time nor the inclination to devote to the consultation of the more pretentious works now to be had. The object of a great majority of medico-legal students, even of those who pursue a collegiate course, is not so much to familiarize themselves with minute details of facts or theoretical discussions as to understand the great principles of the science and the leading facts which serve for its founda- tion. To facilitate the accomplishment of this purpose is the object of the present work. In preparing it the writer makes no pretensions to originality, nor does he profess to be giving information that is in itself entirely new ; but he does claim that he has prepared a book of medium size in which the attempt has been made not only to embrace the contents of the more elab- orate and classic works, but to present them, together with original material hitherto unpublished, condensed into a comparatively small, but not too scant, space. As already intimated, the greater part of the matter has been drawn from the actual practice of the recognized medical jurists of the day, while a not inconsiderable portion of the book's contents reflects the actual practical experience of the writer himself. Recognizing that the work should be true to the science which it portrays, and present in exact proportion all its important features, yet at the same time be as practical as possible, the writer must acknowledge that the acme of this desideratum was reached only after considerable effort. So various and comprehensive are the subjects of legal medicine and toxicology at the present time, that the writer earnestly trusts that the magnitude of the work has in no manner interfered with that proper consideration of the different subjects which a work of this scope should exhibit, for he has endeavored to produce a volume which will fulfil all these requirements. It is a curious fact that in no part of the civilized world is the subject of legal medicine more neglected as a scientific study than in this country ; and iii IV PREFACE it may not be amiss to state right here that the present system of teaching this highly important branch of medicine in the medical colleges of the United States is highly defective ; in reality, there are but a score (if that many) of in>titutions which treat of the subject at all, and even in these the study is by no means compulsory. Hence it is that the ignorance of medical witnesses as regards forensic questions is so wotully palpable. The well-edu- cated physician, even though he be acquainted with all the other branches of medicine, is utterly incapable of solving important questions of medical juris- prudence. He is completely baffled when confronted by such intricate ques- tions as those embracing infanticide, strangulation, suffocation, drowning, or others. And why is it that he displays such gross ignorance, notwithstand- ing the fact that he is well versed in all other branches of medical science ? The plain reason is that none of the conditions of forensic importance are subject to solution by theoretical principles, but are comprehensible only when studied alone as facts. Young graduates in medicine are very often summoned hastily to cases which involve questions of medico-legal interest, when, to their utter dismay, they are confronted with the hopelessness of their position. What is such a person to do ? To give an illustration : suppose a man has just been found dead from submersion in water, and the newly made doctor is called. His duty, as outlined for forensic pur- poses, will be to discern between death before immersion and death from submersion ; whether any injury which may be detected was of ante- or post-mortem origin, etc. It is also his duty to ascertain whether the indi- vidual was strangled and then thrown into the water ; whether he was drowned ; whether articulo mortis was apparent when he fell into the water ; or whether the person was in his usual good health at the time. There is no time for the hasty looking up of books, and, as foul play is suspected and a coroner's jury summoned to consider the results of the post-mortem examination, we can well imagine the awful responsibility which rests upon the physician ; for it is possible that persons may be apprehended or sub- jected to trial for homicide on his testimony. Such an experience is liable to confront any physician, and may actually be presented within a very short space of time subsequent to his graduation. Hence the importance of improving and elevating the position of legal medicine in the medical institutions of this country. It is time that the attention of both the professions of medi- cine and law should be at least directed to this, the greatest deficiency in our medical education. Graduates of medicine should not be cast adrift by their alma maters without appreciating their responsibility to the State, and it becomes the bounden duty of every institution of medical learning to at least equip their students with a knowledge of the more important of forensic questions. In the present volume everything that is practical and useful has been inserted, and all idle and superfluous questions which are still sub judice are dispensed with. Simplification has been the motto of the writer, so that any person possessing ordinary intelligence may benefit thereby. PREFACE v This book is divided into two parts. The first relates to Toxicology. The body of the work commences with a short dissertation treating of prin- ciples, or, in other words, furnishing the reader with the medical and legal definitions of a poison, together with the administration, effects, absorption, elimination, and antagonism of these deleterious substances. The second chapter of the first part, entitled Evidences of Poisoning, includes remarks relative to poisoning in the living, evidences from the symptoms, dis- eases simulating poisoning, and the general treatment of these cases. The Evidences in the Dead Subject are then discussed, together with questions of forensic importance relative thereto. Chapters III. and IV. embrace the rules and duties to be observed in poison cases, and the classification of these substances. The remaining chapters of Part I. are devoted to a dis- cussion of the various drugs, with the exception of Chapter XVL, which comprises those poisons formed during the process of decomposition,— ptomaines and other putrefactive products. Embalming in its medico-legal aspect is also included here. The more important poisons (morphine and opium, nux vomica and strychnine, belladonna and atropine, arsenic, hydro- cyanic acid, phosphorus, etc.) have received special attention. The science of toxicology is rapidly progressive, and, in order to keep fully up with its advancement, new matter has been introduced, and such changes and modifications made as the progress of the science seemed to re- quire. New cases have also been added (vide Appendix), notably those of Carlyle W. Harris, Dr. Meyer, Holmes, and Dr. Robert W. Buchanan. These add to our knowledge the various phases of the respective poisons with which the cases are associated. The second part of this work relates to Forensic Medicine proper. Within its limits will be found every subject of importance relative to this branch of medicine, with the exception of insanity and its allied branches. Under Chapter XVII. the Powers and Duties of Coroners are defined. This part also includes The Criminal Court, Evidence, Ordinary and Expert Witnesses, and Dying Declarations. Other chapters include the Phenomena and Signs of Death ; Presumption of Death and of Survivorship ; Hairs and Fibres ; Burns and Scalds ; Death by Heat and Cold ; Death by Starvation ; Railway Injuries ; Feigned Diseases, etc.; Pregnancy; Criminal Abortion and Infanticide; Legitimacy, Inheritance; Impotence, Sterility ; Rape; Life Insurance; Medical Malpractice ; and the Medical Examination of the Living. Under Medico-Legal Autopsies (Chapter XX.), special reference has been made to the technique of post-mortem examination. Since the medical ex- aminer should work unencumbered by the minute consideration of the various appearances of pathological changes, which but decrease the value of the various practical details, only general and comprehensive statements have been made. In Chapter XXII. (Personal Identity) will be found a synopsis of the Bertillon System of Identifying Criminals. This system of identification, which is in use in various parts of Europe and this country, was adopted by the Police Department of New York City, March 6, 1896, VI PREFACE to replace the former antiquated methods. This system of measurements and descriptions, together with the photographs of criminals, may be said to furnish an almost perfect test of identification. Commissioner Andrews, in his report to the Board of Police Commissioners of New York City, says that '' the system is not a means of detecting crime and criminals in the first instance, but a means of identification, and a complete, accurate, and indis- putable record of the criminal classes. There are now in the department three thousand photographs of criminals. While of service, these are mani- festly inadequate and primitive. In the central office of the prefecture of police in Paris there is now the fullest and most detailed record by the Ber- tillon system of more than one hundred and fifty thousand of the chief criminals of Europe. The things which commend the system most are the reliability of the standard of measurements and the ease of index. The Chinese use the imprint of the thumb, which, while interesting and reliable, is impossible of index. The success of the system depends upon three facts, which Bertillon considered of great importance, and which many years of experience have rendered indisputable : "First. The almost absolute fixity of the human skeleton, beginning at and after the twentieth year of age. '' Second. The extreme diversity of dimensions which the human skeleton pre- sents when one subject is compared with another. " Third. The facility and relative precision with which certain dimensions of the skeleton are capable of being measured." The measurements adopted were as follows : " First. Three body measurements, consisting of height standing, stretched-out arms, and height sitting. " Second. Four head measurements, consisting of length of head, width of head, length of right ear, and width of the same organ. " Third. Four limb measurements, consisting of length of foot, length of left middle finger, length of left little finger, and length of left cubit." '' All these measurements can be taken in a few minutes by an ordinary operator." (The reader is referred to page 199 for a more detailed descrip- tion of this system.) Under Chapter XXIV. the consideration of Blood-Stains is taken up. In this connection might be mentioned the incorporation of the opinions of the latest authorities regarding the medico-legal importance of the red blood- globules in homicide cases. This is one of the largest chapters in the book and embraces such important subjects as the Form and Direction of Blood- Spatters, the Effects of Reagents, the Preliminary Examination of Suspected Stains, etc. The largest portion of the work is devoted to the medico-legal consid- eration of Wounds. This subject is treated of as Wounds in General Wounds Regionally Considered, and Gunshot Wounds, the whole being PREFACE VU dilated upon in three chapters,—/.*?., Chapters XXV., XXVI., and XXVII. respectively. Violent Death from Different Forms of Apncea is discussed in Chapters XXIX., XXX., and XXXI., the subjects, treated in the same order, being Suffocation, Strangulation and Hanging, Drowning, together with the Medico-Legal Aspects of Electricity, including the mode of judicial execution in New York State (Electrocution) and the Effects of Lightning. At the end of the book will be found an Appendix, which gives various important cases, etc. The writer has now to return his most grateful thanks to Civil Justice George F. Roesch, of the Fourth District Court of this city, for his exceed- ingly interesting chapter on Pharmaceutical Jurisprudence. He also has en- deavored, to the best of his ability and recollection, to acknowledge, in the course of the work, the sources from which he has culled information. The extracts from other writers have been introduced in their original language, except in those instances where it was deemed necessary to make some slight changes to incorporate the quotation the better with the passage with which it comes in connection. Among the works from which the writer has extracted freely, and to which acknowledgments are due, are the elab- orate and standard ones of Witthaus, Hamilton, Tidy, Reese, Taylor, Whar- ton and Stills, and others (vide Bibliography of Authorities, Appendix). The writer has endeavored to adhere to a systematic arrangement through- out the work. This has been done as far as was practicable, but in certain instances it has been departed from ; especially was this the case where it became obligatory on his part to introduce new facts that had arisen after the parts of the book to which they belonged had been finished. The table of contents and the index have been prepared with extreme care, so that the detached pieces of information referred to above will be readily found when looked up. Should any errors of commission or omission be discovered by readers, the writer asks their indulgence, as the work has been prepared in the midst of a busy professional career. Justin Herold. New York City, September, 1897. CONTENTS PART I. TOXICOLOGY. CHAPTER I. Medical and Legal Definitions of a Poison—Administration of Poison—Effects of Poisons—Absorption—Elimination—Modification of the Action of Poisons- Antagonism of Poisons.........................u CHAPTER II. Evidences of Poisoning—Remarks relative to Poisoning in the Living Subject- Evidences from Symptoms—Diseases simulating Poisoning—General Treat- ment of Poisoning—Evidences of Poisoning in the Dead Subject—Remarks— Post-Mortem Evidences—Evidences from Chemical Analysis—Experiments on Living Animals—Post-Mortem Imbibition—Circumstantial Evidence— Medico-Legal Queries..........................15 CHAPTER III. Rules to be observed in Poison Cases—With respect to the Living Person- Inspection of the Body—Exhumation of Bodies—Disposal of the Viscera— Identity of Vomited Matters, etc.—The Use of Notes—Medico-Legal Reports 29 CHAPTER IV. Classification of Poisons—Irritant and Neurotic Poisons—Diseases which simu- late the Action of these Poisons—Table of Classification......... 32 CHAPTER V. Sulphuric Acid—General Remarks—Symptoms—Treatment—Post-Mortem Ex- amination—Toxicological Examination—Detection of Stains on Clothing— Tests—Quantitative Analysis. Nitric 'Acid—Remarks—Symptoms—Treat- ment—Post-Mortem Appearances—Toxicological Examination—Detection of Stains on the Clothing. Hydrochloric Acid—Symptoms—Treatment — Post-Mortem Appearances—Toxicological Examination—Detection of Stains on the Clothing, etc.—Tests—Quantitative Analysis. Mixed Acids—Sul- phate of Indigo, etc. Common Effects of the Mineral Acids—Symptoms— Treatment—Post-Mortem Appearances. Potassa, Soda, Ammonia, etc. - . 36 ix X CONTENTS CHAPTER VI. PACK Phosphorus—General Remarks—Symptoms—Treatment—Post-Mortem Appear- ances— Toxicological Examination—Tests—Diagnosis—Chronic Poisoning- Table. Iodine—Symptoms—Treatment—Post-Mortem Appearances, etc.— Iodide of Potassium. Bromine, Chlorine, etc. Arsenic—General Re- marks—Symptoms in Acute Cases—In Subacute Cases—Cerebral or Narcotic Effects—In Chronic Cases—External Application of Arsenic—Dangerous and Fatal Quantities—Elimination of Arsenic—Treatment—Post-Mortem Appearances—Toxicological Examination—Separation of the Poison from the Tissues—Reinsch's and Marsh's Tests—Potassium Arsenite—Arsenic Acid—Scheele's Green—Paris Green—Sulphides—Arsine......... 49 CHAPTER VII. Antimony —Tartar Emetic — Symptoms — Treatment — Post-Mortem Appear- ances—Elimination of the Poison—Toxicological Examination—Tests—An- timony Chloride. Mercury—Corrosive Sublimate, etc. Lead—Acute and Chronic Poisoning, etc.—Sugar of Lead—Lead Chromate, etc. Copper- Acute and Chronic Poisoning, etc. Zinc—Bismuth—Tin—Iron—Silver- Chromium ............................... 66 CHAPTER VIII. Oxalic Acid—Binoxalate of Potassium—Tartaric Acid—Acetic Acid—Carbolic Acid—Croton Oil—Elaterium — Castor-Oil Beans — Colchicum—Savine— Hellebores—Veratrine—Yellow Jasmine—Mushrooms.......... 80 CHAPTER IX. Animal Irritants — Cantharides, etc. Poisonous Foods — Sausage Poison — Cheese Poison—Poisonous Fish—Putrid Meat—Poisoned Meat. Trichina Spiralis—Symptoms—Treatment—Microscopic Examination........ 89 CHAPTER X. Opium and Morphine—Remarks—Alkaloids—Preparations—Symptoms—Treat- ment—Fatal Dose and Period—Diagnosis—Post-Mortem Appearances- Tests—Toxicological Examination—Detection of the Poison in the Tissues- Action of the Poison on Frogs—Failure to detect the Poison. Alcohol- Official Preparations—Remarks—Acute and Chronic Symptoms—Treat- ment—Diagnosis, etc........................... 92 CHAPTER XI. Anaesthetics—Ether—Chloroform—Hydrate of Chloral—Nitrous Oxide—Meth- ylene Bichloride—Ethyl Bromide.....................102 CHAPTER XII. Nux Vomica and Strychnine — Preparations — Symptoms — Treatment—Fatal Dose — Fatal Period — Post-Mortem Appearances — Diagnosis — Chemical Tests—Detection of the Poison in the Stomach—Detection in the Tissues_ Quantitative Determination—Physiological Test—Discovery of the Poison after Long Periods—Failure to detect the Poison—Elimination of Strych- nine. Brucine.............................IQg CONTENTS xi CHAPTER XIII. PAGE Belladonna and Atropine—Symptoms—Treatment—Fatal Dose and Period— Post-Mortem Appearances — Tests — Toxicological Examination — Physio- logical Test. Stramonium — Hyoscyamus — Solanum — Erythroxylon and Cocaine................................113 CHAPTER XIV. Tobacco and Nicotine—Hemlock—Cowbane—CBnanthe Crocata. Aconite and Aconitine—Remarks—Symptoms—Treatment—Fatal Dose and Period— Post-Mortem Appearances—Tests—Toxicological Examination—Medicinal Preparations. Calabar Bean......................119 CHAPTER XV. Hydrocyanic or Prussic Acid—Sources—Symptoms—Treatment—Quantity re- quired to destroy Life—Fatal Period—Post-Mortem Lesions—Chemical Analysis—Toxicological Examination—Quantitative Determination — Cya- nide of Potassium. Oil of Bitter Almonds—Cherry-Laurel Water—Nitro- Benzole. Digitalis — Remarks — Symptoms — Treatment — Fatal Quantity and Period—Post - Mortem Lesions—Chemical Analysis—Physiological Test —Toxicological Examination—Medicinal Preparations. Cocculus Indicus— Picrotoxin—Cytisus Laburnum—Taxus Baccata, etc............126 CHAPTER XVI. Ptomaines and other Putrefactive Products—Poisons formed during the Pro- cess of Putrefaction—Tyrotoxicon—Typhotoxine—Mydaleine—Neurine— Susotoxine — Choline — Methylguanidine — Isoamylamine — Patoammine — Trimethylenediamine—Ethylidenediamine, etc. Embalming from a Medico- Legal Stand-point—Tables, etc......................133 PART II. FORENSIC MEDICINE. CHAPTER XVII. Forensic Medicine—Definition—Powers and Duties of Coroners—The Coroner's Court and the Inquisition—The Criminal Court—Evidence—Ordinary and Expert Witnesses—Dying Declarations..................145 CHAPTER XVIII. Phenomena and Signs of Death—Definition of Death—Molecular and Somatic Death—The Causes of Death—Characteristic Post-Mortem Evidences of the Varieties of Death. The Signs of Death—Cessation of Circulation and Respiration—Changes in the Eyes—Insensibility and Loss of Power to move..................................J52 xii CONTENTS CHAPTER XIX. PAGE Signs of Death {Continued)—Pallor of the Body—Loss of Animal Heat—Rigor Mortis (Cadaveric Rigidity)—Cadaveric Lividity (Suggillation)—Putre- faction—Saponification (Adipocere)—Mummification, etc.—Tables—Points of Difference between Vital and Post-Mortem Ecchymoses—Data upon which an Opinion is formed as to the Length of Time which has elapsed since Death...............................J57 CHAPTER XX. Medico-Legal Autopsies—General Considerations—Surrounding Objects—Po- sition of the Body—Examination of the Body before the Clothing has been removed—External Examination of the Body—Internal Examination of the Body—Post-Mortem Dissection Wounds, etc................ 171 CHAPTER XXI. Presumption of Death and of Survivorship—General Remarks—Cases in which this Question may be raised—Presumption of Survivorship—Cases involving Presumption of Survivorship—French Law of Survivorship—Probabilities afforded by the Age—Presumption afforded by the Sex—Presumption afforded by the Cause of Death.....................187 CHAPTER XXII. Personal Identity—Definition and Prefatory Remarks. The Identity of the Living—Remarks—Value of Professional Stigmata—Hairs and Fibres—The Determination of the Age—Changes wrought through the Effect of Disease —Handwriting, etc.—The Limits of Sight and of Hearing—Bertillon's System of identifying Criminals—The Identification Record—Finger and Foot Impressions—Methods of taking Casts, etc. The Identification of the Dead—Of the Body recently Dead but Entire—Race—Tattoo Marks—Cica- trices, etc.—In Cases where Mutilated Remains or a Portion only of a Body have been recovered—Remarks—Cases, etc.— The Identity of Burnt Remains — The Identity of Human Bones, etc.—Tables—Tabular Statement of De- tails to be noted in the Examination of Persons, of Bodies or Parts of Bodies, or of Bodies in the Question of Identity.............191 CHAPTER XXIII. Hairs and Fibres—Remarks—Cotton—Wool—Linen, etc.—The Hairs of Ani- mals—Diameters of Hairs—Average Diameters of Medulla and Shaft of Hairs—Effects of Reagents—Classification of Hairs—Questions......221 CHAPTER XXIV. Examination of Blood-Stains—Remarks—Human Blood—Its Physical and Chemical Properties—Blood-Corpuscles—Coagulation of the Blood—Haemo- globin—Hsematin, etc.—Drying of Blood—Form and Direction of Blood- Spatters—Effects of Reagents upon Blood—Preliminary Examination of Suspected Stains—Stains that are Liable to be mistaken for Blood—Methods of identifying Blood : (1) Chemical Tests ; (2) The Microscopic Examination • (3) The Spectroscopic Examination—Tables, etc........... 22q CONTENTS xin CHAPTER XXV. PAGE The Medico-Legal Consideration of Wounds—Definitions of a Wound—Se- verity of Wounds—Classification of Wounds—Concussion—Fractures—Dislo- cations—Examination of Wounds and Injuries—Of Clothing or Dress, etc.— Evidence to be drawn from Blood-Stains—Position of the Weapon, Clothes, or Body—Distinction between Wounds inflicted before or after Death- Cause of Death from Wounds—Homicidal, Suicidal, or Accidental Wounds —Presence of More than One Wound..................263 CHAPTER XXVI. Wounds Regionally considered—Wounds of the Head—Of the Face—Of the Neck—Of the Spine and Cord—Of the Thorax and Contents—Wounds and Ruptures of the Diaphragm—Wounds of the Abdominal Walls and Viscera —Wounds of the Genitals—Wounds of the Extremities..........306 CHAPTER XXVII. Gunshot Wounds—Danger of these Wounds—Was the Wound inflicted before or after Death ?—Evidence from the Situation of the Wound—Evidence from the Weapon and Projectile—Deflection of the Ball—Wounds from Shot, Wadding, and Powder—Was the Weapon fired Near or at a Distance?— Complicating Conditions.........................326 CHAPTER XXVIII. Burns and Scalds—The Danger of Bums and Scalds—Presence of More than One Burn—Burns before and after Death—Causes of Death from Burns— Post-Mortem Appearances—Period of the Occurrence of Death—Wounds upon the Burned............................338 CHAPTER XXIX. Violent Death from Various Forms of Apncea—Suffocation—Causes—Symp- toms—Treatment—Post-Mortem Signs—Evidence of Death by Suffocation- Accidental, Homicidal, and Suicidal Suffocation—Asphyxia from Charcoal Vapors—Asphyxia from Illuminating and Natural Gases—Asphyxia from Privies and Cesspools..........................345 CHAPTER XXX. Strangulation—Modes of Strangulation—Symptoms—Treatment—Post-Mortem Signs—Proof of Death by Strangulation—Accidental, Suicidal, and Homi- cidal Strangulation. Hanging—Cause of Death—Symptoms—Treatment —Post-Mortem Appearances—Internal Signs—Proof of Death—Accidental, Suicidal, and Homicidal Hanging—Outline for the Inspection and Examina- tion of a Subject in a Case of Hanging or Strangulation..........356 Drowning—Mode of Death—Symptoms of Death by Drowning—Treatment of the apparently Drowned—External and Internal Signs of Drowning—Time of Submersion—Accidental, Homicidal, and Suicidal Drowning—Medico- Legal Considerations..........................379 XIV CONTENTS CHAPTER XXXI. The Medico-Legal Aspect of Electricity—Remarks—Resistance of the Human Body to Electric Currents—Symptoms produced by Powerful Discharges of Electricity—Methods for Resuscitation from Electric Shock—Death from Electricity—Post-Mortem Appearances—Electrocution—Conclusions Rela- tive to Electricity and the Death Penalty—Executions, etc., in the State of New York...............................39° Lightning— Effects of the Current of Electricity—Cause of Death—Symptoms- Injuries due to Lightning—Post-Mortem Signs—Medico-Legal Relations of Death from Lightning..........................4X3 CHAPTER XXXII. Death by Heat and Cold—Animal Heat and the Extremes of Temperature- Effects of Extreme Heat on the Body—Sunstroke, etc.—Post-Mortem Ap- pearances— Effects of Cold—Symptoms—Treatment—Post-Mortem Signs . 419 Death by Starvation—Remarks—Symptoms of Acute and Chronic Starvation- Period at which Death occurs—Post-Mortem Signs—Accidental, Homicidal, and Suicidal Starvation—Medico-Legal Relations.............426 CHAPTER XXXIII. Pregnancy—Medico-Legal Relations—The Signs of Pregnancy—Precocious Preg- nancy — Late Pregnancy — Unconscious Pregnancy — Post-Mortem Preg- nancy .........................430 CHAPTER XXXIV. Criminal Abortion—General Remarks—Spontaneous or Natural Abortion—Arti- ficial (Therapeutic or Criminal) Abortion — Means employed to procure Abortion—Diagnosis—Age of the Foetus—At what Stage of Pregnancy has the Abortion occurred ?—Sequelae—Duties of the Legal Physician in Cases of Criminal Abortion—Signs afforded by the Mother—Examination of Sub- stances expelled from the Uterus—Examination of Instruments, Drugs, etc. in Possession of the Suspected Individual—Medico-Legal Bearings.....439 CHAPTER XXXV. Infanticide—General Considerations—Definition— Questions relating to the In- fant—Was the Child born Alive ?—If the Child was born Alive, how long did it survive ?—Proofs that the Child has breathed—Viability—Was the Death due to Natural Causes or to Violence ?—Was the Violence Accidental or Crim- inal ?—Mode of conducting the Post-Mortem Examination, and the Evidence to be obtained therefrom—Questions relating to the Mother in a Case of Infanticide—The Signs of Delivery—The Signs furnished by the Early Ex- amination of the Woman—Examination of the Milk—Concealed Deliverv— Concealment of Birth—Feigned Delivery........... „ CONTENTS xv CHAPTER XXXVI. PAGE Rape—Legal Considerations—Rape on Females after Puberty—Rape on Chil- dren and Infants—Rape by Boys—Rape on the Dead—Rape under the Influ- ence of Narcotics, etc.—Rape on Idiots—Conditions which show that Coitus has occurred—Microscopic Evidence—False Accusations—Actual and Ap- parent Age—Simulation of Virginity—Accidents following Rape—Can a Woman be violated against her Will ?—Can a Woman be violated during Natural Sleep ?—Rape by Fraud—The Employment of Hypnotism in forcing Sexual Congress—Examination of the Accused and his Victim—Evidence of Rape after Death—Record of Examining Physician............499 CHAPTER XXXVII. Impotence; Sterility—Causes of Impotence and Sterility—Procreative Power in the Male—Procreative Power in the Female—Legal Relations.......522 CHAPTER XXXVIII. Medical Examination of the Living—Medical Malpractice. Railway Injuries— Injuries of the Back—Nervous Shock—Traumatic Hysteria, etc.—Treatment —Malingering—Medico-Legal Aspects..................527 CHAPTER XXXIX. Feigned Diseases—General Rules for Diagnosis—Simulated Diseases and other Affections—Factitious and Fictitious Wounds, etc.............552 CHAPTER XL. Legitimacy; Inheritance—Medico-Legal Relations—Ordinary and Protracted Gestation—Premature Delivery—Early Viability of the Child, etc.—Tenancy by Courtesy—Laws Relative to Legitimacy—Paternity—Affiliation.....568 CHAPTER XLI. Life Insurance—Definition of the Term Life Insurance—Conditions of the Policy —Expectation of Life—Concealment of Facts—Intemperance in Relation to Life Insurance—Relation of Suicide to Life Insurance—The Medical Exami- nation—Tables......................581 CHAPTER XLII. PHARMACEUTICAL JURISPRUDENCE. BY JUDGE GEORGE F. ROESCH. Definition—Foundation of the Office—History of the Laws—Constitutionality of Laws regulating the Practice of Pharmacy—The Revocation of a License- Liability of the Pharmacist—Registration—Civil Liability of Pharmacists- Prescriptions, etc......................593 APPENDIX. Illustrative Cases—Table showing the Total Number of Still-Births and Deaths which occurred in New York City during the Ninety-one Years ending December 31, 1894, and the Number of Births and Marriages reported since the Year 1847—Differential Diagnosis and Treatment of Coma.....611 Index PART 1 TOXICOLOGY 9 A MANUAL OF LEGAL MEDICINE CHAPTER I. INTRODUCTION. Definitions of a Poison—Administration of Poison—Effects of Poisons—Absorption —Elimination—Modification of the Action of Poisons—Antagonism of Poisons. Toxicology is that branch of the science of medicine which treats of the nature, properties, and effects of poisons. Its object is the prevention or cure of all forms of poisoning. Forensic toxicology refers to the detection of criminal poisoning. A poison is a substance which, when applied to the body externally, or introduced into the system either by the mouth, rectum, vagina, skin, lungs, etc., without acting mechanically, but by its own inherent qualities, is capa- ble of altering or destroying some or all of the functions necessary to life. The intent with which such a substance is given enters into the legal con- ception of a poison. The law never regards the manner in which a sub- stance acts, and it is of little consequence, so far as the responsibility of the accused person is concerned, whether its action on the body be of a me- chanical or of a chemical nature, so long as the substance administered is capable of causing disease or death. Broken or crushed glass, needles, pins, and like bodies are not poisons in the medical signification of the term, yet, when taken inwardly, may be destructive to life. Any substance which causes disease or death, given with homicidal intent, may be regarded as a legal definition of a poison. Administration of Poison.—Poisons may be introduced into the body in various ways and in various forms. They may be given by the mouth or by the rectum, by the vagina or by the respiratory organs, or subcutane- ously, etc. The gastro-intestinal tract is the most usual avenue of access into the body; but the rectum, vagina, skin, lungs, etc., are also readily accessible as channels of entrance ; and even the ears and nose have been n 12 A MANUAL OF LEGAL MEDICINE utilized for the criminal administration of poison. It is usual for poisons to act more rapidly when given by the mouth than by the rectum or vagina ; still more so when introduced into the system by hypodermatic injection ; and most powerfully when thrown directly into the blood. The inhalation of poisonous vapors or gases through the respiratory tract affects the system with remarkable rapidity, because of the activity of absorption being superior to that of most other mucous membranes. Poisons may be administered in the form of solids, solutions, or gases and vapors, alone or in combination with various matters. The legal significance of a poisonous or non-poisonous material is not affected by the mere size of the dose of a poison, and no distinction exists between the two ; thus, half an ounce of oxalic acid may prove as fatal as half a grain of strychnine. Effects of Poisons.—The effects of poisons are usually considered as local and remote. The local effects are the direct impressions produced on the tissues of the body with which the deleterious material comes in contact. These effects are mainly of three kinds,—viz., (i) Corrosion, or chemical decomposition, as is observed in the effects of the strong alkalies and mineral acids on the mucous coats of the stomach and intestines ; (2) Irritation, the extremes of which are simple inflammation or redness and ulceration or gangrene. Irritation or inflammation frequently follows the use of corrosive sublimate ; (3) A local specific effect, which is manifested by certain poison- ous substances, on the sentient terminals of various nerves, as is experienced on the local application of aconite, prussic acid, etc. The remote effects of a poison are those results which are produced on organs situated at some distance from the part to which the substance has been applied ; for example, opium, after having been taken into the stomach, exerts its peculiar narcotic effects on the brain. Frequently a poison may act both locally and remotely, as cantharides, for instance, which affect the part to which they are applied, in producing blisters ; their remote effects influencing the kidneys and bladder, causing strangury and occasionally bloody urine. Most poisons, however, no matter in what way they are introduced into the body, are rapidly absorbed and disseminated through the blood, exerting their influence on those organs which are peculiarly sensitive to their action. In this manner the poison soon reaches some one of the great centres of life,—the brain and spinal cord, the heart, and the lungs,—and there spends its effects. Thus, opium exerts its narcotic effect on the brain ; digitalin or prussic acid acts on the heart, causing asthenia ; strychnine produces tetanic convulsions by attacking the spinal cord; and so on with other poisons which have an elective affinity for various organs. Absorption of Poisons.—A poison to produce its peculiar effects on the system must pass into the blood,—that is, it must be absorbed into the general circulation. The degree of absorption depends, to a certain extent upon the diffusible nature of the poison itself, for it is a well-known fact TOXICOLOGY t3 that some agents are more readily taken up by the system than others. Another point of interest is that some textures possess the power of absorp- tion through them more than others ; serous membranes, for example, permit of absorption more quickly than mucous membranes. On account of the impermeable nature of the skin, absorption is sluggish through the unbroken cuticle. Poisons taken into the empty stomach manifest themselves by their specific effects in a short space of time, and act much more rapidly than when that viscus is loaded with food. Some poisons are rapidly taken into the general circulation, while others are slow in showing their effects. The proofs of absorption are shown by the detection of the substance in the blood, secretions, or various viscera of the body. The discovery of a poison in the stomach by the toxicologist would not be absolute proof as to the cause of death in an individual supposed to have been poisoned, because cases are recorded where the deleterious agent has been introduced after life has departed. Hence, the duty of the examiner is to ascertain the existence of the poison, in the absorbed state, in various other viscera. The rapidity with which absorption takes place will depend on the solu- bility of the substance employed, the relative fulness of the blood-vessels, and the nature of the surface to which the poison is applied. Bleeding or purging through depletion of the vascular system will favor absorption. Elimination of Poisons.—The elimination of a poison takes place through the agency of the various excretions, such as the bile, urine, saliva, pancreatic fluid, and perspiration. Elimination is not an immediate result of the passage of a poison through the different organs, for a portion of the substance is deposited for a variable period of time in the organs and tissues. This deposition usually occurs in the following order as to quantity : the liver, spleen, kidneys, heart, lungs, brain, pancreas, muscles, and bones. Gaseous poisons are eliminated at once by the lungs without deposition. Some poisons are eliminated or deposited more rapidly than others, which goes to show that the time required for either of these processes will depend entirely upon the poison itself and the state of the patient's system at the moment of its ingestion. For example, some poisons make their ap- pearance in the urine within a few minutes after being taken into the body. Arsenic may be found in the liver a few hours after its administration. The salts of lithium pass through the entire circulatory system after the lapse of some minutes, and may be found in the perspiration. With various other poisons a greater length of time is required for their elimination ; antimony, for instance, being found four months after its ingestion. The proportion of poison circulating in the capillaries at any one time to that found in the stomach is exceedingly small, but it is sufficiently large to create the impression that its influence is of a noxious nature. It is, in fact, due to this small portion of poison that the deleterious effects continue so long as the circulation of the blood goes on in the capillary vessels. The poison which becomes stored in the stomach or in other organs, for the time being, is really innocuous, and remains so until again taken into the circulation. j4 A MANUAL OF LEGAL MEDICINE Modification of the Action of Poisons.—The most important of the modifying agencies connected with the poison itself is the quantity or dose. As a general rule, the larger the quantity the quicker the effect. For example, there are many drugs which are exceedingly poisonous in large doses, while in small amounts they prove useful as valuable remedies ; such substances are arsenic, opium, digitalis, prussic acid, etc. Then, again, the mode of administration is of consequence. Dilute diuretics, for instance, act more powerfully than when concentrated, while saline purgatives have better effect when given in the latter condition. The chemical constitution of a poisonous substance is an important modifying agent. The more soluble a compound is, the more speedily are its effects pro- duced. Inert substances are those which are insoluble in water, yet certain conditions of the digestive organs must be considered when discussing them. Thus, orpiment is insoluble in water, but when administered internally may show signs of poisoning. The poisonous material, to be absolutely inert, must be insoluble not only in the suspending fluid, but also in the digestive fluids, else it might find its way into the system, thereby causing fatal results. Some persons are more susceptible to the influence of poisonous sub- stances than others. A tolerance to certain poisons is a bodily condition influenced, to a certain extent, by habit. When a substance is habitually taken into the system, the latter becomes accustomed to its effects, and larger quantities are necessary to reproduce them. This is well seen in the arsenic-eaters of Styria and other mountainous countries, where enormous quantities of arsenic are annually consumed, and in a less degree in the practice of opium-eating and smoking as observed throughout the civilized world. Men generally bear larger doses of poison than women ; and, as a rule, the larger and more robust the individual, the less easily is the influence of the drug shown. Some persons are very susceptible to the effects of certain plants, while others may even handle them with perfect impunity. Some are easily influenced by minute doses of arsenic ; others cannot take quinine, opium, belladonna, etc. ; and in others very dilute solutions of otherwise harmless preparations may cause the most alarming symptoms. ( Vide p. 55, foot-note.) Mental and bodily conditions play an important part in the modification of the action of poisons. Sedatives produce no effect in certain convulsive disorders, though they may produce serious results when administered to otherwise healthy individuals. Again, there are certain animal and vegeta- ble substances, such as the venom of reptiles, and curari, most virulent when introduced into the blood, which may be swallowed with perfect impunity. The active ingredients of various articles of food are sometimes virulent poisons. During the process of digestion larger amounts of poisons are borne than can be taken when abstaining from food. TOXICOLOGY I5 Disease modifies the action of poisons. Enormous doses of opium can be taken in certain affections like cerebro-spinal fever and peritonitis. The tolerance of alcohol is manifest in typhoid fever, etc. Persons suffering from such diseases as inflammation of the brain and apoplexy are very sus- ceptible to opium, as also are nephritics. It is important to remember that absorption is slow in certain conditions of the alimentary canal, as in some of the stages of cholera and yellow fever, during a congestive chill of the gastro-enteric variety, etc. Absorption may not take place at all during profound narcosis. A state of the system particularly proof against the effects of powerful poisons is not easily found. Cases of acquired idiosyncrasy are very rare, for the peculiarity appears to be a congenital condition. Antagonism of Poisons.—The researches of Ringer, Frazer, and others have demonstrated the fact that there exists an antagonism between certain poisons. The experiments of these observers prove a physiological and a toxic antagonism. Ringer observes that toxic doses of the calcium salts produce complete ventricular contraction in the frog's heart, the animal succumbing to the influence of the drug, with the heart in systole. On the other hand, relaxation of the ventricle and death in systole follow poisonous doses of the potassium salts. The physiological effects of these salts can be neutralized, however, by a careful regulation of the dose, whereby the healthy action of the heart is restored. Certain other poisons, such as veratrine, morphine, aconite, and conium, are more or less neutralized by the following antagonists, respectively: potash salts, atropia, digitalis, strychnine, etc. On the same principle many other poisons are found to possess a similar antagonism. CHAPTER II. EVIDENCES OF POISONING. Remarks relative to Poisoning in the Living Subject—Evidences from the Symptoms —Diseases simulating Poisoning—General Treatment of Poisoning—Evidences of Poisoning in the Dead Subject—Remarks—Evidences from Post-Mortem Ap- pearances—Chemical Analysis—Experiments on Living Animals—Post-Mortem Imbibition—Circumstantial Evidence—Medico-Legal Queries. The chief characteristics of poisoning are afforded by the symptoms, which usually make their appearance shortly after the ingestion of food, drink, or medicine. Sudden illness occurring in a healthy individual after swallowing any substance strongly suggests a suspicion of poisoning, which is much strengthened if several persons are affected in the same way, after i6 A MANUAL OF LEGAL MEDICINE having partaken of the same food or drink. It is extremely difficult to determine, from the symptoms alone, whether a person is suffering from poisoning or not, for there are various other circumstances which must be taken into consideration before arriving at any positive diagnosis. A correct knowledge of the symptoms, however, furnishes the chief evi- dence of poisoning in the living, and it becomes of paramount importance for the physician to be familiar with them as they arise, and be able to differentiate between the signs of poisoning and those following the course of natural diseases. There are many affections the symptoms of which bear close resemblance to those caused by the ingestion of poisons. Thus, cholera, cholera morbus, ulcer of the stomach, peritonitis, etc., present similar signs to various forms of poisoning. The symptoms of apoplexy, epilepsy, tetanus, convulsions, etc., are very much like those occasioned by the narcotic and neurotic poisons. Rupture of the intestines, of the biliary ducts, uterus, or Fallopian tubes, aneurism, etc., have been confounded with cases of poisoning. If each poison presented its own characteristic symptoms, there would be no better evidence of the existence of poisoning ; but, as such is not the case, it becomes obligatory on the part of the toxicologist to use other methods, such as making a chemical analysis, etc., of the various parts of the body, ere arriving at any definite results. Evidences from the Symptoms.—The effects of most poisons are very rapidly produced, and, as mentioned above, their chief characteristic is their sudden appearance in a perfectly healthy person, soon after taking food, medicine, or drink. On the other hand, it is well to remember that there are many exceptions to these rules. Thus, very small quantities, given at intervals, may delay the appearance of the symptoms, which usually come on gradually, as in cases of slow poisoning. These may be easily mistaken for those arising from disease. Again, the individual poisoned may have an over- loaded stomach, or be suffering from disease for which medicine may have been administered, thus aggravating or delaying existing symptoms. The fact must not be overlooked that the symptoms of poisoning may remit for a time. And, lastly, the symptoms are, as a usual thing, uniform in their nature throughout their course, and more or less rapid toward a fatal termination. The symptoms of poisoning are usually ushered in with violent pain, vomiting, purging, and convulsions ; or there may be delirium, or great drowsiness, as is observed in opium narcosis. The chief characteristic of the corrosives is their destructive action on the tissues with which they come in contact. There is always intense thirst, with a burning pain in the throat and stomach, nausea, and vomiting of matters which contain shreds of mucus, darkened blood, and portions of mucous membrane. Dysphagia and dyspnoea are also prominent. After considera- ble suffering the patient becomes exhausted, the face anxious and imploring, the pulse being small and frequent and the skin cold and clammy. The symptoms indicate the corrosive action of the poison. TOXICOLOGY 17 (Among the different classes of corrosives are the mineral acids, the caustic alkalies, their carbonates, and corrosive sublimate. Carbolic acid, strong solutions of oxalic acid, etc., belong to the organic class of cor- rosives.) The irritant poisons cause burning and constriction in the oesophagus and throat, pain in the stomach and intestines, nausea, vomiting, thirst, purging, bloody stools, dysuria, and an irregular and feeble pulse. (Irritants maybe of two kinds,—viz., local irritation, such as is produced by the principal vegetable irritants, the less active metallic poisons, and irri- tant gases, and specific remote effects, such as are the result of poisoning by arsenic, antimony, lead, copper, cantharides, etc.) Poisons which act on the brain are divided into three classes,—viz., the opium group, producing sleep ; the belladonna group, producing illusions and delirium ; and the alcohol group, producing exhilaration, followed by sleep or delirium. The symptoms arising from the first, or opium group, are giddiness, headache, tinnitus aurium, dimness of vision, contraction of the pupils, con- fusion of the intellect, and drowsiness, merging into insensibility. Breathing is stertorous, and the skin is cold and clammy. The second, or belladonna group, causes dilatation of the pupil, spectral illusions, thirst, dryness of the throat and mouth, and delirium. There may be paralysis and tetanoid convulsions. The third, or alcohol group, exhibits the loss of power of co-ordination and of muscular movement, excitement of the cerebral functions and of the circulatory apparatus, diplopia, profound sleep, and deep coma. Delirium tremens is characteristic of the chronic form of alcoholism. Of the poisons acting on the spinal cord (strychnine, brucine, etc.), the leading symptom is the tetanic spasm, which lasts from one to five minutes, with intervals of perfect relaxation. Other poisons than strychnine, etc., may produce tetanic convulsions, and it is well to recollect this, although the diagnosis is usually not very obscure nor difficult, as the tetanus in this instance will be generally complicated with other symptoms, whereas in strychnine-poisoning the one great and prominent sign is the tetanic spasm. Poisons affecting the heart, among which are oxalic acid and the oxalates, digitalis, aconite, prussic acid, and tobacco, cause death by sudden shock, syncope, or collapse. Those acting on the lungs, such as carbonic acid gas, etc., produce asphyxiation. Poisoning is frequently feigned, and at other times imputed. A poison- ous draught is sometimes substituted for a harmless medicine. Diseases simulating Poisoning.—The differential diagnosis between strychnine-poisoning tetanus and that arising idiopathically is as follows : In the tetanus of the former the development of the symptoms is accomplished in a few minutes ; the trismus may be absent, or it is imperfect. The opis- thotonos is very violent, and appears early in the convulsion. The spasms are clonic and intermittent, and deglutition is peculiar, but perfect. In the 18 A MANUAL OF LEGAL MEDICINE tetanus of idiopathic origin the supervention of the symptoms is gradual, though being at first rather obscure. The earliest and most prominent symptom is the condition known as lockjaw (trismus), which is almost per- fect in its form. The trismus is followed by stiffness of the trunk and extremities ; the fades tetanica is much more marked than in strychnine- poisoning. The spasms are tonic and very persistent. Intermissions rarely occur. Deglutition is very difficult and tedious, on account of the locked condition of the jaws, and, when the mouth is spasmodically closed, impos- sible. Epilepsy and hysteria likewise produce convulsions similar to those just mentioned; but the general history of the case, together with the nature of the spasms, with the rapid alternations of relaxation and contraction, and the rarity of fatality, will assist materially in reaching a correct diagnosis. Coma and insensibility are prominent symptoms of many of the diseases of the nervous centres which greatly simulate those occasioned by narcotic poisoning. The greatest difficulty which confronts the toxicologist consists in differ- entiating between the symptoms of poisoning and those of disease. The diseases which closely simulate poisoning by the corrosives and irritants are acute gastritis (rarely occurs idiopathically), Asiatic cholera, cholera morbus, gastro-enteritis and all acute inflammations of the alimentary canal, perito- nitis, ulceration of the stomach, ileus, and hernia. The diseases which re- semble neurotic poisoning are epilepsy, apoplexy, inflammation of the brain, and various affections of the heart. Asiatic cholera produces symptoms which resemble the action of tartar emetic, such as the cramps, nausea and vomiting, rice-water evacuations, extreme weakness, etc. Blood is seldom found in the vomit of cholera, while it is of common occurrence in irritant poisoning. Purging is an early symptom in this disease, being somewhat slow in making its appearance in poisoning. Pain and constriction are rare. Cholera morbus bears a close relation to arsenical poisoning and other irritants. Reese' mentions two cases, which came under his notice, where arsenical poisoning was mistaken for cholera morbus by the physician in attendance. Gastro-enteritis, peritonitis, ulceration of the stomach, ileus, and hernia strongly resemble, in their symptoms, those of the irritant poisons. In apoplexy, symptoms are presented which bear close resemblance to those of opium-poisoning. It is necessary for the observer to note the gen- eral premonitory symptoms, and also to recollect that apoplexy usually attacks the aged. The apoplectic sleep is frequently most profound, and it is often impossible to arouse the patient. Epilepsy may be confounded with the symptoms of prussic acid. The arrival at a correct diagnosis will be guided by considering carefully the history, the chronic nature, and the peculiarity of the epileptic paroxysms. 1 Medical Jurisprudence and Toxicology. Third edition, Philadelphi; TOXICOLOGY 19 Similar symptoms to those caused by narcotic, etc., poisoning take place in hydrocephalus, fever, uraemic poisoning, and injuries or blows on the head. General Treatment of Poisoning.—The first indication is to eliminate the deleterious substance from the system, and meanwhile, if possible, pre- vent its absorption. Some poisons act as their own antidotes by producing an emetic effect,— that is, they evacuate the contents of the stomach. When such is the case, the use of warm water will materially aid in removing any small particles, tenacious mucus, etc., which might adhere to the walls of that organ. If free vomiting does not occur, then recourse must be had to the stomach- pump or tube, because the use of this instrument is not attended with the exhaustion that is liable to succeed repeated vomiting produced by the free administration of emetics. This method, however, is not always admissible or convenient, and the use of emetics is necessary. A good rule to follow is to never wait for a remedy, if an imperfect one is at hand, for that is best which is readiest. Of the many emetics, the sulphate of zinc, in twenty-grain doses, is the best. Sulphate of copper, in six- or eight-grain doses, has been effectual in certain instances where other emetics have failed, as in the poisoning of nar- cotics ; its action, however, is of an irritant nature, and may increase instead of diminish the poisonous effect. Other methods of producing an evacuation of the stomach contents are by giving copious draughts of lukewarm water, tickling the fauces with a feather, or allowing the patient to drink warm water impregnated by one or two teaspoonfuls of ground mustard. A handful of common salt in a pint of lukewarm water is also efficacious. The hypodermatic injection of one- tenth of a grain of hydrochlorate of apomorphine may be administered when the sufferer is unable to swallow ; its use, however, is rather depressing. When discussing the antagonism of poisons, reference was made to the character of the antagonism existing between certain poisons. This was found to be twofold,—viz., physiological and toxic. Therefore, when con- sidering the treatment, the action of the antidote may be regarded as physio- logical and chemical. Our object must be to neutralize the effects of poisons on the general system by administering remedies of an opposite character. Thus, for example, morphine antagonizes atropia, and atropia neutralizes strychnine ; or, digitalis counteracts the poisonous effects of aconite, and so on. If all these fail, the next process is to stop the action of the poison. This is accomplished by giving some antidote which will combine with the poison in the stomach, forming a substance which is insoluble or inert. Ferri oxidum hydratum cum magnesia, for instance, is the reputed antidote for the arsenical preparations. In treating poisoning by the vegetable compounds it is well to make the patient drink a pint of water containing ten to twenty grains of tannin, or an infusion of green tea ; for the tannic acid unites with the poisonous alka- 20 A MANUAL OF LEGAL MEDICINE loids, and also with tartar emetic, forming compounds which are insoluble in water. For corrosive sublimate and other mercurial salts and the salts of copper, albumen is the remedy. For the nitrate of silver, common salt in solution is appropriately given. For the mineral acids, the administration of chalk or magnesia, soap, and the alkaline carbonates is advised, or whiting from the wall, etc., when other remedies are not available. Alkalies must be avoided in oxalic-acid-poisoning, since they form poisonous compounds, and the antidote to be given is magnesia and chalk. Ammonia, potash, and soda are treated with vinegar or the diluted vege- table acids. When the poison taken is known, the chemical antidote is frequently in- dicated with precision. For example, when carbolic acid and sugar of lead are the poisons, they are rendered inert by administering a soluble sulphate, as Epsom or Glauber's salt, the carbolic acid being transformed into a harm- less sulpho-carbolate, and the sugar of lead into an insoluble powder. Animal charcoal has been advocated as an antidote to poisons, although its action is somewhat mechanical; it has the power of absorbing alkaloids, which may render it useful. The third indication should be devoted to the relief of the suffering ex- perienced by the patient and obviating the tendency to death. If absorption of the poison has taken place, direct antidotes will be of little avail. The relief of suffering is called for principally by poisons of a purely irritant class. Cool, bland, and protective liquids relieve the burning pain experienced in the stomach and intestines or the eroded condition of the mucous mem- brane. Relief is hastened by the application of mustard to the pit of the stomach ; but opium is our chief anodyne, particularly applicable in aggra- vated cases. Attend to the shock, etc. Our object must be to alleviate the symptoms as they present themselves. Evidences of Poisoning in the Dead Subject.—In seeking for evidences of poison in the dead body the legal physician must endeavor to ascertain all the particulars which have already been incidentally touched upon,—viz., the symptoms, etc., as indicative of poisoning in the living sub- ject. Besides, the circumstances of the attack must be considered. The evidence furnished by the time at which death takes place after the first occurrence of symptoms, like that derived from the symptoms, can never be absolutely conclusive, although the more common poisons produce their fatal effects within certain periods of time. Attention to this point may be the means of denying a charge of poisoning, or, in other instances, enable the observer to form an opinion as to the kind of poison adminis- tered. The legal physician may be called upon in court to specify the usual time within which poisons prove fatal. Poisons differ from each other in this respect, and the same substance will differ in its action when the form or quantity is subjected to a change. Prussic acid, when given in large doses TOXICOLOGY 21 may cause death in less than two minutes, but in ordinary cases of poisoning by this substance life may be destroyed in from ten to twenty minutes. Should a patient survive half an hour, the chances of recovery would be favorable. Oxalic acid may prove fatal, when taken in doses ranging from half an ounce to an ounce, within an hour, although cases are on record where death resulted within ten minutes. The rapidity with which fatality occurs will depend, to a certain extent, on whether the poison was perfectly dissolved or not. Death has been prolonged to the fifth day in such poison cases. The smallest amount of oxalic acid necessary to kill is one drachm. Poisonous doses of the strong mineral acids mark their fatality in from nineteen to twenty-four hours. The shortest period of time at which death takes place in nitric-acid-poisoning is one hour and three-quarters. Fatal results have followed half an ounce of hydrochloric acid in two hours. Phos- phorus causes death usually from the third to the seventh day. Arsenic operates fatally in from eighteen hours to three or four days. In some instances, however, it has caused death within twenty minutes. Opium sometimes proves disastrous in three-quarters of an hour. The average time may be stated at seven to twelve hours, and if the patient survive the latter time, the chances of recovery are good. These statements are merely average results, and it is of importance to recollect that the fatal period may be lengthened or shortened, according to all those circumstances which have been alluded to when discussing the actions of poisons. Attempts have been made to negative a charge of poisoning on the ground that death may have been too rapid or too slow to justify the sus- picion. Careful observation of numerous cases proves that fatal results may rapidly follow the action of various poisons. Unfounded suspicion of poisoning frequently arises where the death of a person has been sudden. Unjust imputations are thereby often cast upon innocent people. The fact must not be forgotten that there are many dis- eases which commence suddenly and rapidly progress toward a fatal termi- nation. For example, apoplexy or diseases of the heart frequently end fatally instantly, or within an hour or so. Of the poisons, prussic acid, for instance, acts fatally with remarkable rapidity, while poisoning by opium is commonly protracted for several hours before death takes place. The additional evidences to be derived from the death of an individual may be considered as follows : Evidences from Post-Mortem Appearances.1—Although one of the chief methods of determining whether a person has died from the effects of poison, the evidences furnished by the post-mortem examination, like those derived from the symptoms, can never be but strongly suggestive, because numerous diseases present very similar pathologic conditions. 1 Vide Medico-Legal Autopsies. 22 A MANUAL OF LEGAL MEDICINE The. external inspection of the body may be of material assistance in clearing up a case of supposed poisoning. For example, stains of the min- eral acids may be noticed about the mouth, cheeks, tongue, and fauces, as well as on the clothes of the person. Occasionally the odor of certain poisons is noticed on the body, being much strengthened on opening the corpse. Still, there are no external appearances upon which safe reliance can be placed, as the effects of the acids just mentioned might have been occasioned after death. Among the post-mortem signs usually presented in poisoning may be noted redness, ulceration, softening of the mucous membrane of the stomach and intestines, and perforation. The irritants act mostly upon the stomach and intestines, setting up irri- tation, inflammation, and corrosion, and occasionally ulceration, perforation, and gangrene. The coats of the stomach or other viscera may be thickened or thinned and softened. On the other hand, the narcotic poisons present no well-marked post-mortem appearances. The narcotico-irritants may affect the brain or the alimentary canal, or both. Occasionally, both the irritants and narcotics produce fatal results, without presenting any very decided changes in the body, and the proofs of the existence of the poison must be searched for elsewhere, or by other methods. Redness.—This is one of the most common post-mortem signs arising from the administration of the irritant poisons. It is also a resultant of many diseases. Irritant poisons produce redness of the mucous membrane of the stomach and small intestines, which is also attendant in many instances of violent death, such as hanging, strangling, suffocation, and drowning. The congestion is at first of a deep crimson hue, which rapidly assumes a brighter color when exposed to the atmosphere. The whole mucous membrane of the stomach or intestines may be of this color, or it may be confined to patches, dots, or striae, irregularly spread over the various sur- faces. Its usual site is at the larger extremity of the stomach, although it is sometimes noticed at the smaller end. On the other hand, the congestion may be confined to the folds and prominences of the mucous membrane. In the healthy state the mucous membrane of the stomach is pale or white, or of a light-pink color. During the progress of digestion it becomes somewhat reddened, which condition has been noted even after death. Transudation of blood from the liver or spleen has produced a deep livid color in the stomach. A somewhat similar change has been noted in the intestines, as a resultant of post-mortem gravitation of blood. These differ- ences, however, are not likely to be mistaken for the action of irritant poisons. As a similar redness may be occasioned by disease, it will be necessary to be familiar with the nature of the symptoms preceding death, or have some chemical demonstration of the presence of the irritant poison in the body. Redness of the mucous membrane of the stomach may be caused by acute gastritis, gastro-enteritis, etc. TOXICOLOGY 23 Putrefaction alters the redness of the mucous membrane of the stomach when circumstances are favorable to this process. This renders it difficult to discern the cause of the discoloration. No definite rule can be advanced regarding the length of time during which the redness of the stomach will be recognizable, nor as to the changes produced by the process of putrefac- tion. Taylor refers to two cases of arsenical poisoning where the appear- ances of inflammation were apparent in the stomach and duodenum twenty- eight days after burial ; and in another instance of poisoning by the same substance nineteen months after interment. As evidence of poisoning, redness can be relied upon as a safe sign only when the origin of the discoloration is known, else it would be unsafe to trust to this appearance alone, unless the poison were detected. Ulceration.—This pathologic change is sometimes the result of irritant poisoning. The mucous membrane of the stomach is usually found to be in a state of disintegration,—that is, the membrane is removed in small circular patches. In the ulceration caused by poison the resultant redness is diffused ; the reverse is usually the case when due to disease. Ulceration from the effects of various maladies is of more frequent occurrence than that arising from the action of poisons. In determining the cause of ulceration due to the irritants, the history of the case previous to death will be of great assistance. The difference between ulceration and corrosion is this : ulceration is a vital process,—that is, the substance of the part is removed by the absorb- ents as a result of inflammation. Corrosion is a chemical action, the im- mediate contact of the poison being necessary for the destruction of the parts, which are decomposed and enter into combination with the cor- rosive matter itself. Ulceration is slow in establishing itself, while the cor- rosive action of a poison is often of instant occurrence. Softening.—Softening of the coats of the stomach may be the result of poison or of disease. Corrosives are the most frequent cause of this con- dition, and it is important to note that their action will be observed also in the mouth, fauces, and oesophagus, while in softening from the effects of disease alone, the change will be confined to the stomach, most frequently at its cardiac extremity. Cases are on record where the appearance of the stomach was of a hardened instead of a softened nature. Softening of the stomach is by no means characteristic of poisoning. Innumerable instances go to show the truth of this assertion. If produced by the action of the irritant poisons, it is usually accompanied by other decided marks of their action, the absence of which would negative all suspicion of poisoning. Perforation.—As with softening and other pathologic changes observed in poisoning, perforation may be the result of disease as well as of poison. Perforation may be the result of corrosion or ulceration. Where the strong mineral acids have been taken, the perforation will be large and 24 A MANUAL OF LEGAL MEDICINE ragged, the margins being soft and friable. After perforation the poison is readily detected in the abdominal cavity. Perforation from ulceration due to the irritants is of rare occurrence, and is usually observed where arsenic and other irritant poisons have been taken. In the perforation caused by poisoning, the pain experienced by the patient previous to death is rather of an insidious nature, coming on gradu- ally ; it increases slowly. In disease its appearance is suddenly noticed soon after partaking of a meal. The vomiting due to irritant poisoning is ex- cessive and the purging almost constant. In disease it is frequently absent, or, if present, it is slight, the vomit consisting of the material swallowed. In the latter case the aperture is small, of an oval or rounded form, and the edges smooth, while in poison cases it is large and ragged. Death takes place most frequently in from eighteen to thirty-six hours, when the aperture is the result of disease. The average period of death in arsenical poisoning and other irritants is the same ; but arsenic does not cause perforation of the stomach within twenty-four hours. Therefore, in differentiating between perforation produced by poisoning and that caused by disease, it is necessary to be familiar with the history of the case, the presence or absence of poison in the stomach, together with the other char- acteristic marks of both poison and disease. In perforation from disease the symptoms and death are referable to peritonitis. Occasionally the coats of the stomach are rendered soft by spontaneous changes. This change usually occurs at the cardiac extremity. Such ex- travasation is very likely due to post-mortem changes, the stomach under- going a process of solution. The solvent action of the gastric juice is a sup- posed cause of this condition. The diaphragm, liver, spleen, and other viscera are sometimes found to have softened spontaneously. This spontaneous or gelatinized form of post-mortem perforation is most commonly situated at that portion of the stomach which lies to the left of the cardia. In form it is irregular ; its size is large, and the margins of the perforation ragged and pulpy. The mucous membrane is not inflamed, though an occasional slight redness, with black striae near the softened parts (coats), is frequently observed. This form of perforation may be mistaken for that caused by the action of corrosives ; but the symptoms during life, the detection of the poison after death, and the evidences of changes pro- duced in the mouth, fauces, and oesophagus will be sufficient to enable the pathologist to reach a correct result. Evidences from Chemical Analysis.—The chemical detection of a poison is, in many instances, a very difficult matter, and the physician must be well skilled in the minutiae of the various processes adopted. In making a chemical analysis in case of poisoning, it is important that the physician acquaint himself as to the nature of the symptoms, as well as of the post-mortem changes, as such knowledge may be of material assist- ance in determining the nature of the ingested poison. Evidences derived from chemical analysis are generally regarded as the TOXICOLOGY 25 most positive, although satisfactory proof of death by poisoning is afforded, in some instances, without this method. If the symptoms, post-mortem changes, effects of the poison on animals, etc., are perfect, then this par- ticular line of proof is unnecessary. There are certain poisons which have no chemical test, especially those of the animal and vegetable kingdoms. The evidence of poison in the stomach does not necessarily prove that death resulted as a consequence ; and, were the usual symptoms, lesions, moral proofs, etc., absent, might justify the suspicion that the poison gained entrance into the body after death. ( Vide Embalming.) The discovery of the absorbed poison in the liver, spleen, kidney, etc., is far stronger evidence of the existence of poisoning than its mere presence in the stomach, since, in the latter instance, it might possibly have been introduced after death ; and the fact must not be overlooked that it is quite possible for a liquid poison, after its introduction into the stomach or rectum of a corpse, to pass through the coats of the viscus, when the conditions, are most favor- able to osmosis, and thus come in contact with adjacent organs, penetrate them, and leave evidence of its presence. The injection of arsenic or cor- rosive sublimate into the blood-vessels, as is done in the process of embalm- ing, may occasion similar results. These are important facts to keep in mind, for the reason that suspicion of poisoning might be aroused, even months after interment; and when the body is disinterred and opened, marked signs will be shown to exist in the different organs which might be mistaken for absorbed poison.1 In every case of chemical analysis the utmost care and accuracy on the part of the toxicologist is essential for the facilitation of the process. The purity of his reagents must be carefully ascertained, else the suspected sub- stance may fail to respond to any one of the tests applied. The first step to pursue in the examination of suspected matters is to note the general appearance, the odor, and the color. The odor may be useful in indicating the presence of various poisons, such as alcohol, prussic acid, opium, etc. The color may suggest the salts of copper, parts of insects, such as cantharides, or certain preparations of arsenic with various coloring- matters. The general appearance and condition of the various organs may assist the examiner in determining the method by which the poison was in- troduced into the system, the kind of food or drink used to conceal it, and so on. These organs should be carefully examined, and the facts accurately noted and preserved for future reference in the course of the analysis. The failure to find poison in those instances where all the other evidence substantiates the fact that poison had been taken, may be due to one or more of the following reasons : (i) The poison may have been vomited before death, or eliminated through the faeces and urine. (2) Elimination may occasion loss of the poison, this being particularly the case where the 1 Vide p. 12. 26 A MANUAL OF LEGAL MEDICINE dose is small and death protracted. (3) The poison may be of such a nature as to be undiscoverable by chemical tests. (4) The poison may be unrecognizable on account of its having been decomposed in the blood or tissues before or after death. This is more particularly the case with the organic substances. The mineral poisons are not decomposed after death, although their chemical constitution may be subject to change. (5) The alkaloids of putrefaction (ptomaines), in the case of the vegetable poisons, which they strongly resemble, may render detection of the real noxious substance impossible. ( Vide Ptomaines.) The toxicological examination of the contents of the stomach and intestines, or other viscera, should be conducted with great care. Only one portion of the suspected material should be examined at a given time, reserving the other portion for future experiments. To the naked eye alone should not be intrusted the entire search in the examination of the suspected matters of the stomach, etc., but it should be aided by the use of a magnifying glass of some power. In this,way characteristic crystalline forms, etc., may be discerned. Suspected poisons ought to respond to all the chemical tests ; therefore, the object of the toxicologist is to secure the materials which he has to ex- amine in as pure a condition as possible, else there might be doubt as to the results of the various tests employed. The bulk of the liquid to be examined is reduced by evaporation, since a minute amount of poison present might not be responsive to the usual tests. At times the material may be separated by simple filtration ; or, in order to separate colloid substances from crystalloids, the process known as dialysis is employed. In the case of volatile bodies, such as phosphorus, prussic acid, chloral hydrate, alcohol, chloroform, etc., distillation is employed to secure them in as pure a state as possible. But in the case of the poisonous alkaloids other methods must be employed. For the destruction of organic matter in the search for an inorganic poison, such as arsenic, the process suggested by Fresenius is most fre- quently adopted. Its essentials are as follows : The substance to be tested is finely comminuted, and boiled with about one-eighth of its bulk of pure hydrochloric acid, crystals of potassium chlorate being added from time to time until the solids are reduced to a straw-colored fluid. A hydrogen sodium sulphite is then added to this fluid until a distinct odor of sulphurous acid is given off. Sulphuretted hydrogen is then passed through the fluid for some hours, precipitating most metallic poisons in the form of sulphide. The precipitate is then collected and reserved for further test. In the separation of the poisonous alkaloids from complex mixtures the use of the various methods for testing introduced by Stas, Roger and Gird- wood, and Uslar and Erdmann, which are practically the same is recom- mended. In Stas's method ether is used as the solvent; in Roger and Gird wood's chloroform is employed ; while in the Uslar and Erdmann method alcohol is used. Stas's Process for separating Alkaloids.—A solution of the contents of TOXICOLOGY 27 the stomach, or of the solid organs reduced to fine shreds, is made by digest- ing them with water or acidulated alcohol, and then subjecting the whole to filtration. Ether is next added to the filtrate, in order to remove the oily matters. The ether is then removed, and the aqueous solution neutralized by the addition of soda or potash. Finally, the alkaloid is separated by ether, when it will probably be left behind in a condition fit for further testing. With the exception of crystalline morphine, the pure alkaloids are soluble in ether, while the salts of the alkaloids are insoluble, although they are soluble in water and alcohol. There are many modifications of the Stas process. For example, the substance to be tested is acidulated with hydrochloric acid and heated over a water-bath for an hour or more. The mixture is then filtered, continuing the process until a pure product is the result, which is neutralized by the addition of hydrogen sodium carbonate. The freed alkaloid is then taken up by shaking it with ether or chloroform, put in a well-corked tall test-tube, and set aside. The ether or chloroform is separated by means of a pipette and allowed to evaporate, when the alkaloid remains for further purification or testing.1 Other methods employed by the skilled toxicologist in detecting even minute traces of poison exist. Combinations are formed with other elements, revealing the poison in the form of solids, liquids, or gases. Others are arrayed in varied colors, in crystalline shapes, or volatilized in flame, and viewed by the achromatic or apochromatic lenses of the microscope, or their incandescent vapors through the prisms of the spectroscope. For example, the existence of metals is indicated by brilliantly tinted and sharply defined lines as they are presented in front of the narrow slit of the spectroscope, even infinitesimal traces being accurately noted. The microscope is a delicate and essential adjuvant in many toxicological examinations. By its use the expert is enabled to recognize characteristic crystalline forms and to present them to the court and jurors. Not only is this possible, but by the aid of chemical reactions applied to various specimens the examiner is enabled to determine, by the changes they effect, the identity of the poison sought. The great advances made in electricity have contributed the mysterious power of this fluid in toxicological analyses, as is exemplified in the pro- duction of ozone for the purple-color reaction for strychnine, or in evolving hydrogen from distilled water for the " Marsh test." (Doremus.) Evidences from Experiments on Living Animals.—In those cases where the poison cannot be identified by any of the previously mentioned methods, the introduction of the suspected substance into the body of a living animal is a resource marked with decided accuracy. For example, in a recent instance of supposed morphine-poisoning the analysis lasted for three months, at the end of which time a little of the substance abstracted from 1 Vide, also, the various alkaloidal poisons. 28 A MANUAL OF LEGAL MEDICINE the exhumed stomach was introduced into a frog, with the result that it ex- hibited all the symptoms of morphine-poisoning as shown by a second frog, which was subjected to an inoculation at the same time with pure morphine obtained in commerce. It is well to remember in connection with these experiments that the secretions of the alimentary tract may become poisonous through disease, and in this manner affect the animal inoculated. On the other hand, certain animals may eat poisonous plants, which, when swal- lowed by man, may be fatal in their action ; poison may be thus introduced into the human system by eating an animal that had previously fed upon such plants. Post-Mortem Imbibition.—The possibility of the post-mortem absorp- tion of poison into the viscera of the human subject leads to the necessity of determining whether the poisonous substance was introduced into the system previous to or after death. The experiments carried on by Orfila proved the possibility of post-mortem imbibition. Dr. G. B. Miller injected strychnine into the stomach of a dead rabbit, with the result that it penetrated by imbi- bition into the liver, spinal cord, and bladder. Sutton, of Philadelphia, and Vaughan, of Michigan, performed various experiments in this line, showing that when a solution of arsenic was injected into the stomach of a dead animal, it could, after a reasonable lapse of time, be detected in the brain, spinal cord, and cranial bones. ( Vide Embalming.) Orfila observes that after imbibition the poison is more likely to be found on the exterior parts of an organ, while in genuine poisoning the poison is deposited in the interior of the organ. This is an important point to re- member, since the detection of real poisoning by chemical analysis is one of the strongest proofs as evidence. ( Vide p. 25.) Circumstantial Evidence.—Among the various circumstances often of service in establishing the fact of an administration of poison is the be- havior of suspected persons. Any suspicious acting on the part of those surrounding the patient should be noted. Ascertain, if possible, whether the accused person had a motive in administering poison, whether he pur- chased or possessed poison, whether he was in the habit of giving the poisoned individual his meals, and whether he prevented the deceased from obtaining medical aid. Did the accused assume the exclusive duty of disposing of vomited matters ? of administering medicine ? Did the accused express an opinion as to the likelihood of a speedy death ? Did he object to an autopsy, and was the burial of the poisoned person premature ? Was the conduct of the accused suspicious after the death of the deceased ? Did he venture a false history of the illness ? There is no person so well fitted to make note of these points as the physician, and the application of his scientific knowledge to the detection of crime might be the means of bringing a murderer to the bar of justice. In the recent trials of the wife-poisoners, Carlyle Harris and Dr. Robert W. Buchanan, many of the above series of evidences were so many links welded to a chain of proof that conviction and execution were rapid results. TOXICOLOGY 29 Medico-Legal Questions.—There are certain questions of a medico- legal nature in all criminal cases of poisoning that the analyst must be pre- pared to meet when the case is presented for trial. Some of these questions are : (1) Could the illness or death of a person be due to poison ; and, if so, what is the nature of the poison ? It is rarely possible for the toxicol- ogist to exhibit the poison that caused death, as the corpus delicti. He can, however, demonstrate the chemical tests. The mineral poisons must be ex- hibited, together with their chemical reactions. (2) Would such a poison, administered in sufficient quantity, cause death ? At what period was the poison administered ? This latter query leads to the consideration of the symptoms,—viz., the time of their first appearance and their duration. ( Vide Evidences from the Symptoms, p. 16.) (3) Is it possible for such a poison to disappear entirely from the body without leaving any trace? Complete elimination may take place, provided the person has survived long enough. ( Vide Elimination of Poisons, p. 13.) Might the poison detected in the system be ascribed to any other source than that due to criminal poisoning ? Poison found in large quantities and in the absorbed state in the organs would furnish a negative reply to this question ; although the fact must not be lost sight of that minute quantities of a poison might be present in the body as the result of medicinal or accidental administration. Further, post-mortem imbibition is possible. ( Vide Post-Mortem Imbibi- tion and Embalming.) (4) Can poisoning be feigned? The answer must be affirmative. ( Vide Feigned Diseases.) CHAPTER III. DUTIES OF THE PRACTITIONER IN CASES OF POISONING. Rules to be followed in Poison Cases—With Respect to the Living Person—Inspec- tion of the Body—The Exhumation of Bodies—Disposal of the Viscera—Iden- tity of Vomited Matters, etc., from the Deceased Body—The Use of Notes— Medico-Legal Reports. When a practitioner is called to a case of supposed poisoning, his first duty, of course, must be to prolong or preserve life. But if he reaches the patient too late to dispense his services, a second duty devolves upon him in those cases where a suspicion of criminal poisoning has been aroused. This second requirement on the part of the physician is to see that justice is done. The neglect of this duty, or carelessness in its performance, might stop instead of setting in motion the wheels of justice. In addition to the ordinary rules framed for the guidance of physicians in dealing with poison cases, the following points are appended for his careful attention : 3° A MANUAL OF LEGAL MEDICINE I. Symptoms.—Ascertain the exact period at which the symptoms were first observed to occur after the ingestion of food or medicine. Inquire as to the time of their occurrence, the order of their progression, and the nature of the symptoms from the beginning of the sickness onward. Ascertain whether there was any remission or intermission in their course ; whether they became more and more severe in their character until death ; or whether their violence was emphasized after a particular meal, or after the administration of any particular article of food or medicine. Note the odor, color, and acid or alkaline reaction of vomited matter, if any ; also the quantity, and if possible base these observations upon the matters first ejected. Observe whether the patient was in the recumbent position or not when the vomiting occurred ; if in the erect or sitting posture, parts of the patient's clothing will very likely be stained with the ejected matters. II. Articles of Food and Medicine.—Ascertain the exact time, if possi- ble, at which any substance was last taken by the patient ; also its nature, together with that of all the various articles of food used at a meal. Inquire whether the food was taken by more than one person ; and, if so, whether the others suffered poisonous effects. III. Death of the Patient.—When fatal results follow the ingestion of poison, the physician must make note of the following : the time of death, and the attitude and position of the body. Pay particular attention to the condition of the clothing of the deceased ; also to surrounding objects, etc. Inspection of the Body.1—Carefully examine the external appearances of the body to ascertain the state of the countenance, condition of the gen- eral surface of the body (livid or pallid ?), the presence or absence of rigor mortis, and the warmth and condition of the room in which the person died. If the person was found dead, then attempt to ascertain when the de- ceased was last seen alive ; also note any circumstances which might lead to a suspicion of homicide or suicide. The Exhumation of Bodies.—In connection with criminal poisoning, any suspicious conduct or misbehavior on the part of suspected persons would warrant the disinterment of a corpse for the purpose of satisfying the authorities as to the suspicion of poisoning being entertained or not. This was the means of causing the arrest of Dr. Buchanan, the recently electro- cuted wife-poisoner. Inspection of a body is often made long after interment. The expectation of detecting certain of the mineral poisons in the organs is much strength- ened so long as the coffin is found in good condition. However, in some cases decomposition has advanced to such a stage as to preclude the possi- bility of securing pathologic evidence. When such is the case inspection is usually limited to the abdominal viscera. The stomach and duodenum, with 1 For the details respecting the mode of performing an inspection of the body, the reader is referred to the chapter on Autopsies. TOXICOLOGY 3t ligatures applied to each, together with the liver and spleen, should be re- moved for separate analysis. ( Vide Medico-Legal Autopsies.) When the coffin is not entire, and when decomposition is so far advanced as to permit mixture of the earth with the viscera, it has been suggested that portions of both earth and coffin be submitted to analysis. The advisability of this procedure is questionable. After a careful analysis of the viscera is made, and no evidence of poison is apparent in any one organ, it is unlikely that it will be discovered in any other part of the body. When the body of a deceased person is exhumed, it is important that its identification be absolute, else all other evidences that might be elicited would fall fiat, and be of no material benefit. Disposal of the Viscera.—With the view to preserving various por- tions of the body for subsequent examination, extraordinary care must be exercised in their removal, else serious errors in the analyses might occur. In cases of suspected poisoning, the alimentary canal is the most impor- tant organ to preserve. It is usually removed in separate portions. ( Vide Medico-Legal Autopsies.) Portions of the liver, if not the entire organ, should be preserved for the toxicologist. Frequently it becomes necessary to examine the brain, spinal cord, thoracic viscera, spleen, kidneys, etc., and, in women, the uterus and vagina. When such is the case, portions or the entire organ should be set aside for analysis. When all precautions have been taken to secure the organ or organs in as pure a condition as possible, the part or parts are transferred to jars, which are then sealed, numbered, labelled, and initialled, to facilitate identification, as well as to avoid subsequent confusion. It is almost unnecessary to add that no preservative or other fluid is to be employed. The Identity of Vomited Matters, etc.—In a case recited by Taylor the evidence of the presence of poison in the contents of a stomach was thrown out in a court of law on account of the negligence on the part of the physician who performed the autopsy in placing the stomach contents in a jar secured from a person known to have dealt in poisons. Satisfactory proof of the cleanliness of the vessel was found wanting, and the benefit of the doubt was properly given to the suspected person. Another important point to recollect is that the identity of a substance, such as vomited matter or other liquids, must be preserved, else such evi- dence will be rejected. The Use of Notes.—It is very important that all the observations made by a physician in poison cases be committed as speedily as possible to writing. These notes should embody everything pertaining to symptoms, post-mortem appearances, and the results of the chemical analysis. In courts of law the use of notes is admissible only to assist recollection, not to convey information ; if used for the latter purpose, the evidence is inadmissible. 32 A MANUAL OF LEGAL MEDICINE Medico-Legal Reports.—One of the duties of the medical jurist is to draw up a report of the symptoms, the post-mortem appearances, and the results of the chemical analysis. Facts should be stated in plain language ; and if it becomes necessary to introduce technical terms, their meaning should be parenthetically expressed, so as to make them easily intelligible to non-professional persons. Medico-legal reports should only state facts, not opinions and inferences. The conclusions of the examiner should be reserved for the latter part of the report. CHAPTER IV. CLASSIFICATION OF POISONS. There is nothing more difficult in toxicology, as in every other branch of natural science, than to exhibit with exactitude a satisfactory classification of poisons, insomuch that the definite limits to their action are boundless. Some writers upon the subject of toxicology have grouped poisons ac- cording to their source ; thus, a sort of natural-history system is the result, and is expressed by the two classes of inorganic and organic poisons, or by those of mineral, vegetable, and animal poisons. Another classification, based on the effects of poisons upon the healthy animal system, is appropriately mentioned as the general arrangement of nearly all toxicologists. The arrangement of the poisons to be treated of in this book is founded upon the latter classification, a grouping simply according to the physiological action of the poisons. Under such circumstances a scheme somewhat similar to the following, however imperfect it may be, will be of great assistance to the toxicologist when the action and influence of a poison upon the system are sought. All poisons are classed as irritants (simple and specific) and neurotics (cerebral, spinal, and cerebro-spinal). I. IRRITANT POISONS.—The group of irritants comprehends all poisons which by contact produce an irritation or inflammation of the alimentary canal. The symptoms are burning pain in the oesophagus and stomach ; nausea and vomiting, with altered blood in the matters ejected. The thirst is intense, and there usually exist pain in the abdomen and cramps in the stomach and other parts of the body. There is straining and blood in the stools. Depression of the vital powers is great, and in fatal cases death follows from exhaustion. The post-mortem signs are more or less inflammation of the mucous mem- brane of the alimentary tract. Occasionally there may be ulceration, per- TOXICOLOGY 33 foration, and gangrene. When these poisons are administered in a diluted state they may be incapable of destroying the tissues directly, but their in- direct action, occasioned by inflammatory changes, may do so. Poisons acting in this manner are classified as simple irritants, though they possess the power of destroying life by virtue of their secondary effects. Specific irritants are not only capable of causing inflammations of a local character, with their secondary effects, but are also possessed of remote specific properties. Arsenic, for example, is such a poison. Irritant poisons are further separated according to their source, and are grouped as mineral, vegetable, and animal poisons, the former (mineral) being subdivided into non-metallic and metallic. Certain of the irritants are properly classified as corrosives. These irri- tant poisons destroy the bodily textures by contact, occasioning fatal results as a consequence of their chemical action. Diluted corrosives are simple irritants. II. NEUROTIC POISONS.—These poisons include those substances whose effects are specific, and are referable to the great nervous centres, the brain and spinal cord. They are subdivided into cerebral (narcotics and anaesthetics), spinal (sometimes called tetanies), and cerebrospinal, which act upon the brain and spinal cord (deliriants, depressants, asthenics). Such a diverse group must be somewhat imperfect, and its analysis, of course, difficult, as the boundary line between the various classes and orders of poisons cannot be marked out with any degree of accuracy. The neurotic poisons are derived from the vegetable kingdom, and ex- hibit substances like strychnine, atropine, opium, chloral, Calabar bean, prussic acid, tobacco, aconite, etc. The symptoms occasioned by the poisons which act on the nervous system are giddiness, headache, drowsiness, stupor, delirium, coma, convulsions, paralysis, etc. Diseases which resemble the Action of Irritant Poisons.—The diseases which simulate the action of these poisons are severe diarrhoea, malignant cholera, colic, gastritis, enteritis, obstruction of the bowels, rup- ture of the stomach or of the intestines, etc. Diseases which resemble the Action of the Neurotics.1—Various symptoms of certain affections are strikingly similar to those occasioned by the neurotic poisons. Thus, delirium with spectral illusions or convulsions results from the poisonous administration of belladonna. Sometimes, as in strychnine-poisoning, there is tetanus. Coma follows opium or carbolic-acid- poisoning, and syncope digitalis. It is well to remember that diseases of the brain and spinal cord, likely to be mistaken for the effects of narcotic poisons, are rather of an insidious nature in their progress, and might occasion suspicious symptoms. Atten- 1 Vide Diseases simulating Poisons. 3 34 A MANUAL OF LEGAL MEDICINE tion to the history, etc., will usually enable the physician to reach a correct diagnosis. The following tabular arrangement exhibits the subdivisions and their poisons, classified according to the Irritant and Neurotic divisions. Table of Classification. Class I.—Irritants. Order Irritants proper. Order 2. Specific Irritants. Sulphuric acid. Nitric acid. Hydrochloric acid. Potassa. Soda. Ammonia. Nitrate of potash. Chlorate of potash. Bitartrate of potash. Alum. Sulphate of potash. Chlorinated soda and potash. Salts of barium. Mineral. Non-metallic. Metallic. Phosphorus. Iodine. Bromine. Chlorine. Arsenic. Antimony. Mercury. Lead. Copper. Zinc. Bismuth. Tin. Iron. Chromium. Oxalic acid. Tartaric acid. Acetic acid. Carbolic acid. Croton oil. Vegetable, -j Elaterium. Castor-oil beans. Savine. Hellebores. Yellow jasmine. L Poisonous mushrooms. Animal. Cantharides. Poisonous animal food. Poisonous fish. Decayed meat, etc. TOXICOLOGY 35 Table of Classification—Continued. Class II.—Neurotics. Order i. Cerebral. Narcotics. . Anaesthetics. _ , f Nux vomica. Order 2. I c. , . c.. . ,, , . . i Strychnine. Spinal {tetanies). Rr • ' Deliriants. Order j. Cerebrospinal. Depressants. Asthenics. Opium. Morphine. Alcohol. Ether. Chloroform. Chloral hydrate. Belladonna. Atropine. Stramonium. Hyoscyamus. Solanum. Tobacco. Nicotine. Lobelia. Lobeline. Hemlock. Coniine. Aconite. Aconitine. Calabar bean. Prussic acid. Cyanide of potassium. Oil of bitter almonds. Cherry-laurel water. Nitro-benzole. Digitalis. Digitalin. Cocculus indicus. Picrotoxin. Cytisine. 36 A MANUAL OF LEGAL MEDICINE CHAPTER V. CLASS I.—IRRITANT POISONS. POISONING BY THE MINERAL ACIDS. SULPHURIC ACID. General Remarks—Symptoms—Treatment—Post-Mortem Examination—Toxicologi- cal Examination—Detection of Stains on Clothing—Tests. SULPHURIC ACID—oil of vitriol—is used in the arts and manufactures for a great variety of purposes, and is one of the most useful acids known. In its concentrated state it is an oily-looking liquid, of a light-brownish color, intensely sour, and has a decided acid reaction. Its specific gravity is 1.845. Sulphuric acid is often the cause of death in infants and young children. Not infrequently men, while under the influence of liquor, are poisoned by it; and its employment as a disfiguring agent, by being thrown over the person, is well known. When the latter is the case the parts of the body stained by the acid are at first of a white color, but afterwards assume a dark-brown or blackish hue. Homicidal deaths are more frequently the result of this acid than of any of the others, and its dangerous qualities are proportionate to its degree of concentration rather than to the quantity administered. The smallest fatal dose of the concentrated acid for an adult is one drachm (recovery has taken place after two ounces); for an infant, one-half drachm. The shortest period at which death takes place is one hour and three- quarters ; its fatal effects are very rapid where the rima glottidis is attacked, as suffocation supervenes. The average time at which fatal results occur is from sixteen to twenty-four hours. It is believed by some authorities that sulphuric acid is absorbed into the circulation and eliminated by the secretions, though it has not been dis- covered in the urine during life. This acid has the power of preventing putrefaction for a long period. (Casper.) Symptoms.—When the acid is taken in its concentrated form, the symp- toms appear almost immediately. There is violent pain in the mouth, throat, oesophagus, and stomach. The pain is frequently so severe that the body is bent. These signs are followed by vomiting, the latter being accompanied by the discharge of shreds of tough mucus, altered in color, and of a coffee- ground-like matter, containing blood and portions of the lining membrane TOXICOLOGY 37 of the stomach. The mouth is excoriated and the surface of the tongue white ; after a time this color changes to gray or brown. Salivation is pro- fuse, and the cavity of the mouth is filled with a thick, viscid mucus, which is composed of saliva and the membrane of the oral cavity. After a short space of time great prostration ensues, the eyes are sunken, the face is pallid, the skin cold and clammy; the circulation is impaired, and the breathing is extremely difficult, owing to the swelling and excoriation of the fauces and larynx. There is generally great thirst, which cannot well be satisfied. Obstinate constipation may exist. The patient appears to be in the greatest agony, and convulsive movements are frequently observed. At other times the patient passes into a semi-conscious condition and stupor. Death takes place either from collapse or from perforation of the stomach. On the other hand, it may occur very rapidly from asphyxiation. Patients frequently recover from the immediate effects of the poison, but they finally succumb to the secondary results, and die from strictures of the oesophagus or stomach, or from perforation of the oesophagus. Treatment.—Avoid the use of the stomach-pump or tube, for fear of perforation. If the patient can swallow, give diluents and neutralizing agents (powdered chalk, whiting, or pounded plaster, magnesia, etc.) freely. Barley-water, linseed tea, oatmeal gruel, diluted starch, etc., are all useful. Treat the collapse and other symptoms as they are presented. Trache- otomy has been resorted to for the relief of the excessive dyspnoea. Post-Mortem Appearances.—The larynx, trachea, and lungs are softened and blackened. The oesophagus is gray or blackish in color, softened, and the mucous membrane separated, coming off in shreds. The stomach is softened or perforated ; it may contain a blackish, pulpy fluid, due to altered blood. The contents of the blood-vessels are hard and black. If perforation exists, the edges of the opening will be dark and ragged, and the adjoining viscera blackened and softened. If life has been pro- longed, inflammation of the intestines, peritoneum, etc., may be present. The skin of the face or surrounding parts, where any acid has fallen, will be corroded and blackened. Toxicological Examination.—All thick and viscid organic matters should be boiled in distilled water, filtered, and then subjected to the nitrate or chloride of barium test, when a dense white precipitate of the sulphate of barium is formed. This is insoluble in acids and alkalies. Occasionally the solution contains a soluble sulphate, together with an acid, such as citric, acetic, etc. When such is the case the method of differ- entiating between this and a solution containing free sulphuric acid is as follows : Acidulate a given volume of the solution with nitric acid, and pre- cipitate with the above-mentioned test. The next process is to evaporate an equal volume of the original solution to dryness (which frees the sulphuric acid), and dissolve the residue in distilled water ; filter, and precipitate. The 33 A MANUAL OF LEGAL MEDICINE dried precipitate is then weighed and compared with the other, when, if the result is equal, there was no free sulphuric acid present. But if the weight of the former precipitate is greater than that of the latter, then the excess of weight will show the amount of free sulphuric acid in the first or original solution. In some instances the chemical analysis alone is not sufficient to detect the poison, and other signs must be looked for in the symptoms, etc. This is generally the case where the acid has been neutralized by the administra- tion of alkaline antidotes, the vomit and stomach containing only sulphates. Detection of Stains on the Clothing.—Sulphuric acid stains on dark cloth are red or brownish red in color, their moisture being retained for a considerable time. A bright reddish or yellowish stain follows the applica- tion of the acid to other colored materials. Holes burnt into cloth by heated bodies contain no adherent moisture, as is the case when sulphuric acid spends its effects. Moisture, therefore, is the distinguishing mark between the effects of heat as produced by a heated body and that of the acid. The charred hole in the former case is always dry, while in the latter the moisture is adherent. To detect the acid on clothing, the parts affected should be cut out and boiled in distilled water, and then tested with any soluble barium salt. Tests.—(i) Sulphuric acid is known by its oily appearance, its weight, its action on organic matters (which it chars), its energetic action when mixed with water, and the freeing of sulphurous acid fumes when heated with metallic copper, mercury, wood, or charcoal. (2) The diluted acid' is recognized by the action of any of the soluble barium salts upon it, which throw down a white precipitate, which is in- soluble in nitric acid. (It is well to recollect that neutral sulphates give similar results, when treated with nitrate of barium, as the free acid.) To distinguish between them, a drop of the suspected solution is evaporated to dryness, when, if it consisted of free acid, no residue is found ; but if a sul- phate be present, a saline residue will be left. Again, where the solution consists of both the free acid and some soluble sulphate, the application of the following test will clear up the matter : Warm the liquid to be tested, and add finely powdered carbonate of barium, when a precipitate of free sulphuric acid will be formed, showing that the newly formed sulphate of barium represents the free acid present. (3) To the diluted acid a small portion of veratrine is added, and care- fully evaporated to dryness, when a crimson-purple color is formed. This test produces no effect upon a sulphate. Quantitative Analysis.—This is estimated as a sulphate, as follows : Care- fully wash in hot water, with a trifle of hydrochloric acid added, the precipi- 1 A white precipitate with the barium salts is also produced by other acids, such as oxalic, phosphoric, carbonic, etc.; but they are readily dissolved by nitric or hydro- chloric acid, while the sulphate remains unaffected by them. TOXICOLOGY 39 tated sulphate of barium ; then filter, dry, and weigh ; ioo parts of the sul- phate are equal to 42.02 parts of monohydrated sulphuric acid. NITRIC ACID. (Aqua Fortis.) This powerful substance is of a yellow or orange color, with a specific gravity of 1.35 to 1.45. Its color is due to peroxide of nitrogen, with which it is mixed. Nitric acid is occasionally administered or taken in poisonous doses, but cases of death from its employment are rare. Two drachms is the smallest recorded quantity required to produce fatal results, and one hour and three-quarters (average within twenty-four hours) the shortest period at which death has taken place. Less than two drachms of this substance will prove disastrous if the trachea be involved. Symptoms.—When the acid is in its concentrated state, the symptoms do not differ materially from those caused by sulphuric acid, with the excep- tion of the pain, which is less severe, and the color, which is at first white, then yellow or orange, and finally brownish red. The vomited matters are yellow or brown. The fumes of nitric acid are extremely poisonous, the symptoms there- from manifesting themselves within a short period ; they develop into acute inflammation of the air-passages. The chemical action of the poison is likely to produce gaseous eructations. The abdomen is usually swollen and exquisitely tender; in some cases the pain is confined to the fauces. The enamel of the teeth is liable to destruc- tion. The pulse is small, frequent, and irregular, and the act of deglutition ex- tremely difficult, and may give rise to severe vomiting. There is obstinate constipation, etc. Treatment.—Avoid the use of the stomach-pump or tube. Subsequent treatment in all respects similar to that recommended for sulphuric acid. Post-Mortem Appearances.—The most characteristic appearances after death are the discoloration of the lips, tongue, and inside of the oral cavity. The mucous membrane of the digestive tract is eroded and softened. The stomach is softened, though rarely perforated. It may be altered as regards color in the following way : By the action of the acid on the mucous membrane, producing a yellowish hue; on the blood, a blackish; and on the bile, a green or brownish color. Toxicological Examination.—The contents of the stomach, etc., should be tested with litmus paper, as the antidotes administered, being of an alkaline nature, may have neutralized the acid. Any viscidity of the liquid must be counteracted by the addition of a sufficient quantity of distilled water, and boiled for fifteen minutes. This is 4o A MANUAL OF LEGAL MEDICINE then filtered,1 and, if acid, first tested by subjecting part of it to the influence of copper filings. A solution of weak carbonate of potassium is added for neutralization purposes, and crystallized by evaporation. The crystals should be washed with alcohol to remove impurities, and tested by the methods described in the next paragraph. When the matters examined are not acid, they having been neutralized by alkalies (carbonate of lime or magnesia), the process to follow is to boil the insoluble nitrates of these earths with potassium carbonate or liquor potassae, and filter, crystallize, and test as before. Examine the urine for nitric acid. This is done by distillation with sul- phuric acid and neutralization with carbonate of potassium. To examine the tissues, proceed as follows : Secure four test-tubes, and put from twenty to thirty drops of a mixture composed of equal parts of sul- phuric acid and water into each tube. Now add a little brucine to the first tube, when no change will be noticed ; but if a small piece of the tissue to be examined is added, and nitric acid be present, the mixture will assume a blood-red color. To the second test-tube a trace of sulphate of indigo is added, with the same result as that shown by test-tube number one, until a piece of the tissue is placed in the mixture, when, if nitric acid be present, the color will at once disappear. A few copper filings and a piece of tissue are added to the third test-tube and boiled, when, if nitric acid be present, the ruddy-brown fumes evolved will strike a blue color with white paper moistened with a solution of iodide of potassium and starch. To the last test-tube a solution of the sulphate of iron is added : if nitric acid be present, when the tissue is placed in the tube, the mixture will assume an olive-brown color. (Woodman and Tidy.) Detection of Stains on the Clothing.—To examine a piece of cloth or other fabric, it is only necessary to soak it in warm distilled water. If the solution is acid, it should be neutralized with the carbonate of potassium and the resulting crystals treated by the methods above mentioned. The stains are of a yellowish color, distinguishable from those of iodine and bile by the intensity of the acid when a weak solution of potassa is applied. Tests.—(i) The concentrated acid is recognized by its yellowish stains, forming picric or carbazotic acid ; by its evolving ruddy-brown fumes when exposed to the atmosphere, or with copper, mercury, or silver; by its giving off white fumes with the vapor of ammonia ; by its bleaching power with a solution of indigo ; by its leaving no residue when subjected to heat in a watch-glass ; by its negative action on gold-leaf. (2) The diluted acid is detected by its acid reaction ; by the negative action of nitrate of barium or nitrate of silver, proving the absence of sul- phuric and hydrochloric acids ; by its power of turning morphine or brucine 1 A slow operation ; dialysis may be resorted to. TOXICOLOGY 41 red ; by its power in dissolving gold-leaf in the presence of hydrochloric acid. Quantitative Analysis.—The free nitric acid in solution is discerned by saturating it with recently ignited carbonate of sodium. Every fifty-three grains of the carbonate will neutralize fifty-four grains of anhydrous acid. HYDROCHLORIC ACID. (Muriatic Acid. Spirit of Salt.) This acid has a light-yellow color, due to chlorine, and a specific gravity of about 1.15. It fumes when exposed to the atmosphere, and is but seldom taken or administered as a poison. The commercial acid is frequently con- taminated with nitric acid, arsenic, and antimony. Symptoms.—The symptoms are similar to those occasioned by the other mineral acids. The mucous membrane of the mouth and tongue is gray or white in color. The formation of a false membrane is sometimes observed. Death has resulted from half an ounce of the acid, manifesting itself within eighteen hours. The shortest period at which fatal results follow the ingestion of the poison is two hours. Treatment.—The same as that recommended for the other mineral acids. Post-Mortem Appearances.—The mucous membrane of the oesoph- agus is found detached, and the interior of the stomach presents blackened or charred ridges, which somewhat assimilate the appearances of sulphuric acid. Occasionally the glottis and larynx present an injected and corroded appearance. Toxicological Examination.—The contents of the stomach, viscera, etc., are placed in a glass retort, with a sufficient quantity of pure water, and distilled. This latter process (distillation) is carried out on account of the volatility of the acid. The distillation is carried on nearly to dryness. The characteristic test with nitrate of silver is then applied. Objections to this process are raised, on the ground that hydrochloric acid and alkaline chlorides are natural constituents of the fluids of the ali- mentary canal. Therefore, if the symptoms and post-mortem appearances are negative, proof of poisoning, on the chemical analysis alone, would not be conclusive, and the detection of the acid after death of no value. To rectify this the following method is employed : To determine whether hydrochloric acid is present in the free state, or as a chloride, the solid par- ticles of the mixture to be examined should be divided into small particles, and distilled water added. The whole is then boiled for thirty minutes, cooled, and filtered. The liquid is next measured into equal parts, one of which is precipitated with nitrate of silver, after the addition of a trifle of nitric acid. The precipitate is then washed, dried, and weighed. The second portion of the liquid is evaporated to dryness in a water- 42 A MANUAL OF LEGAL MEDICINE bath, thus freeing all of the free acid ; the residue is dissolved in pure water, and precipitated, as in the former instance, with nitrate of silver. Filter, dry, and weigh as before. The weight of the first precipitate (chloride of silver) equals all the free and combined hydrochloric acid present; that of the second precipitate furnishes only the combined acid. The difference indicated by the two weights will give the amount of free acid present in the original solution. (Reese.) Detection of Stains on the Clothing, etc.—Dark cloth is at first stained a bright-red color ; after some days have elapsed, this color assumes a reddish brown. Hydrochloric acid is frequently employed to remove ink- marks in forgery cases. The examination of stains is conducted after the method already mentioned. Tests.—The concentrated acid is known from other acids by the following tests: (i) By its evolving white fumes with the vapor of ammonia ; by its yellow color ; by its giving off chlorine when heated with peroxide of man- ganese ; by its power of dissolving gold-leaf in the presence of nitric acid ; by its negative action on mercury and copper. (2) The diluted acid is distinguished by the silver nitrate solution test, which gives a white, curdy precipitate of chloride of silver. This precipitate darkens on exposure to light, is insoluble in boiling nitric acid, but soluble in ammonia. Quantitative Analysis.—The acid is estimated as chloride of silver. One hundred grains of the chloride of silver are equal to about eighty grains of hydrochloric acid of specific gravity 1.15. MIXED ACIDS. The mixed acids are used for commercial purposes,—the nitro-muriatic (aqua regia) to dissolve gold, and the nitro-sulphuric (aqua reginae) to dis- solve silver. They are sometimes used as poisons. Sulphate of indigo, a solution of indigo in common sulphuric acid, has also proved fatal in some instances. The symptoms and post-mortem signs are the same as those described under sulphuric acid. The membrane of the mouth has a blue or blue-black color. This color is observed also in the vomit, in the faeces (afterwards green), and occasionally in the urine. Treat- ment same as previously described. COMMON EFFECTS OF THE MINERAL ACIDS. Symptoms.—The symptoms of the three acids (sulphuric, nitric, and hydrochloric) possess certain general characters. There is burning pain in the mouth and oesophagus, which is intensified in the stomach. These symptoms begin at once. Following these signs are retching and vomiting, the latter being a dark-colored liquid, composed of shreds of mucus, together with parts of the mucous membrane of the oesophagus and stomach. When the poisonous agent has been administered in a spoon, or by other like means, the oral cavity is uninjured ; but when such is not the case, the TOXICOLOGY 43 lips, inside the mouth, are shrivelled and corroded. The characteristic stains of the acid used are apparent. Thirst is intense, swallowing difficult or impossible, and the respiratory powers impeded. Constipation exists, and the urine is scanty or entirely suppressed. Great prostration ensues, and the pulse becomes rapid and feeble. The skin is cold and clammy, the countenance expressive of great agony, and death soon follows. The intellect usually is clear to the last. Fatal results may follow these acids without their having entered the stomach. They have been introduced into the rectum, vagina, ear, etc., with fatal results. Recovery from the primary effects of any of these poisons is usually fol- lowed, at the end of one or two years, by the secondary results (stricture of the oesophagus, etc.) and death. Treatment.—The stomach-pump should not be employed. Administer at once carbonate of magnesia, calcined magnesia, or bicarbonate of soda, in milk or a mucilaginous fluid. Or, in case these remedies are not at hand, chalk, whiting, soap and water, etc. Tracheotomy is sometimes resorted to. Bathe external parts with soap and water, and subsequently treat like ordi- nary burns. Post-Mortem Appearances.—Stains about the mouth, fingers, etc., of the acid employed. The appearance of the body may be healthy. The oral cavity is usually white and corroded at first, this turning to a dark- brown and shrivelled condition. Swelling of the epiglottis and glottis is present, and the oesophagus has appearances similar to those of the mouth. The stomach is generally found to be in a contracted state, its outer surface being very vascular, corroded, and occasionally perforated. Some- times it is distended with gas, and contains a thick, dark-brown fluid. The inner surface may present a charred appearance, and the mucous membrane between the rugae be of a scarlet hue. Similar appearances are presented by the duodenum and small intestines, although to a less degree. The peritoneum may be intensely inflamed, as a result of the escape of the stomach contents (perforation) into the abdominal cavity. POISONING BY THE ALKALIES AND THEIR SALTS. POTASSA—SODA—AMMONIA. Common Effects—Symptoms—Treatment—Post-Mortem Appearances—Toxicologi- cal Examination—Tests. Common Effects.—The effects of the three alkalies are very similar, and somewhat resemble those produced by the mineral acids. They cause disorganization and complete destruction of the tissues with which they come in contact. 44 A MANUAL OF LEGAL MEDICINE These substances occasionally prove fatal as the result of accident; they are rarely employed for homicidal poisoning. Potassium hydrate—caustic potash—-is a white, crystalline mass which deliquesces readily, absorbing water and carbonic acid ; its action is strongly alkaline, and it is readily soluble in alcohol and water. It is cast in moulds, and is usually found in the market in the form of thin sticks. Sodium hydrate— caustic soda—is a white, crystalline substance, usu- ally found in the market in cylindrical sticks. It attracts moisture, and on exposure changes to sodium carbonate. These caustics occur under the names potash, pcarlash, and soda ash, or soap lees. Ammonia,—hartshorn,—when pure, is a gas, colorless, of a pungent odor, and specific gravity of 0.59. The aqua ammonia of commerce is a cencentrated solution of the gas in water. The vapor of ammonia is poison- ous, and may prove fatal by causing inflammation of the larynx and trachea, or even of the lungs. Symptoms.—When administered in the concentrated condition, soda and potash have an acrid taste and excoriate the buccal cavity. The burn- ing pain in the throat may extend to the stomach. This is followed by vomit- ing, first, of mucus, then of blood ; there is difficulty in swallowing ; and the lips, tongue, and pharynx become swollen, inflamed, and raw. Severe shock usually follows these symptoms ; the skin is cold and clammy, and the pulse feeble and rapid. The patient soon becomes weak and exhausted, and may pass into a comatose condition. Death may follow in a few hours, although the time is variable, the fatal result depending upon the degree of concentration rather than upon the quantity. If the patient recovers from the primary effects of the poison, stricture of the oesophagus and consequent inability to swallow food and drink follow ; or ulcerations of the stomach or stricture of the duodenum may result. Any of these affections prevent the proper digestion of the food, and the patient finally dies from starvation. Ammonia produces similar symptoms to the above, although it is more irritating, producing a sensation of choking, intense heat, and burning in the throat, oesophagus, and stomach. Besides the caustic effects of am- monia, there may be cerebral symptoms, producing rapid death. A char- acteristic feature of ammonia-poisoning is the frequency with which the air- passages are affected. An enema of the strong solution of ammonia has caused fatal results. Ammonium carbonate (smelling salts) is an active poison, concentrated solutions of it causing severe pain, vomiting (sometimes of blood), and occasionally obstinate constipation. Treatment.—The alkali should be neutralized, as far as possible, by administering vinegar and water, or weak organic acids, or by oranges, lemons, etc. Oils, which form soaps with these alkalies, may be of benefit. Good can also be accomplished by giving barley-water, milk, solutions of TOXICOLOGY 45 albumen or gum, etc. The use of the stomach-pump should be avoided, as it is extremely dangerous where the oesophagus is likely to be cor- roded, for fear of perforation. Opium should be administered if the pain is severe. The treatment of ammonia-poisoning is similar to the above. The effects of the inhalation of the vapor are best controlled by smelling acetic acid or dilute hydrochloric acid. Post-Mortem Appearances.—In recent cases the mucous membrane of the mouth, throat, oesophagus, and stomach will be found softened, de- tached, and chocolate-colored, or even black. When the patient has suc- cumbed to the secondary effects of the poison, signs of ulceration will be noticed in the oesophagus and stomach or intestines with more or less con- striction. The stronger ammonia produces post-mortem lesions similar to those of soda and potash. The mucous membrane of the mouth and throat is corroded and covered with false membrane. The stomach may be perforated in some instances, its lining membrane being congested and blackened. Toxicological Examination.—Characteristics of caustic potash and soda are the soapy feel and frothy appearance. It is usually sufficient to evaporate the suspected liquid to dryness ; then heat thoroughly in order to char the organic matters. Digest the ash in distilled water and filter. The alkali will be found in solution as the carbonate. If it is necessary to separate the caustic alkali from the carbonate that may be present, the liquid is evaporated to dryness and the residue treated with absolute alcohol. This will dissolve out the free alkali, but not the carbonate, as it is insoluble. After filtering and evaporating, the process of incineration is performed. The tests to follow will then be apropos. Ammonia.—If the organic matter is in a state of decomposition, it will be difficult to recover ammonia, on account of its volatility. Ammonia is itself generated by decomposing animal matter. If ammonia or its carbonate is present, the liquid has an alkaline odor and reaction. One-fourth of the mixture should be distilled over, and the vapors conducted through a bent tube into a cold receiver, into which a quantity of water has been placed. Other salts of ammonia are to be looked for if ammonia is not evolved by the methods just described. This is accomplished by treating the residue in the retort with strong alcohol, then filtering and heating with caustic potash. Distil as before, and test. Tests.—Potash : (i) The potash compounds give a violet color to the smokeless flame of gas or spirit. (2) The spectrum of this flame shows two bright lines,—viz., one in the red, one in the violet. (3) Tartaric acid throws down a white precipitate of acid tartrate of potassium (cream of tartar) on standing or stirring. The addition of a little alcohol increases the delicacy of this test. (4) Perchloride of platinum produces a yellow granular precipitate of 46 A MANUAL OF LEGAL MEDICINE potassio-platino-chloride. This chemical has no effect upon soda, but it will precipitate ammonia. Soda: (i) With the exception of the antimoniate, all the sodium com- pounds are soluble, and give an intense yellow color to the smokeless flame of gas or spirit. (2) A bright line in the yellow band of the spectrum is observed. (3) Antimoniate of potash gives a white precipitate of antimoniate of sodium, but the liquid must be freed of all bases excepting the alkalies. Ammonia: (1) Ammonia and its compounds are recognized by their volatility and by their power of setting free ammonia gas when subjected to heat, either by themselves or with calcium hydrate (lime-water). (2) The gas has a characteristic odor, and will turn blue a wet piece of red litmus-paper which has been exposed to its vapor. It will also give white fumes in the presence of hydrochloric acid. (3) An alkaline reaction is characteristic of the ammonium compounds. (4) A strong solution of ammonia in excess, when added to a copper salt, develops a deep sapphire color. A white precipitate is formed with corrosive sublimate. A yellow precipitate is formed of ammonio-platino- chloride with perchloride of iron. Quantitative Analysis.—Potash is determined as a double chloride with platinum. ( Vide Test.) After the precipitate is washed with alcohol, dried, and weighed, it will be found that every 100 parts of the double chloride represent 22.5 parts of caustic potash, or 28.25 parts of anhydrous carbonate. The determination of ammonia is the same as that of potash. Every 100 parts of the double chloride represent 7.62 parts of pure ammonia. POISONING BY THE ALKALINE AND EARTHY SALTS. NITRATE OF POTASSIUM. (Nitre. Saltpetre.) General Remarks—Symptoms—Treatment—Post-Mortem Appearances—Toxicologi- cal Examination—Tests. Potassium nitrate is the result of the decay of nitrogenous substances in the presence of carbonate of potassium. It crystallizes in six-sided rhombic prisms, fuses at 3380 C, and at higher heat evolves oxygen. It is principally employed in the manufacture of gunpowder, but is also used in medicine. When acted upon by sulphuric acid it gives off nitrous fumes, and when administered in large doses is extremely poisonous. Symptoms.—There is burning pain in the throat and epigastrium, and in the concentrated state it acts as a powerful irritant to the alimentary mucous membrane. There is also vomiting (haematemesis) ; bloody stools ; cold, clammy skin ; frequent pulse ; muscular weakness ; syncope and col- lapse, sometimes preceded by convulsions or paralysis ; suppression of the urine; and death. TOXICOLOGY 47 Sometimes the impression of the poison upon the nervous system, after large doses, is more decided than the local effects. An ounce to an ounce and a half, in a concentrated state, may be re- garded as a fatal dose, although an ounce has proved fatal in three hours. Treatment.—The treatment consists in evacuating the contents of the stomach, and giving opiates, demulcents, and stimulants to relieve pain and depression. External applications of fomentations, etc., are of service. There is no chemical antidote. Post-Mortem Appearances.—Marks of violent inflammation are found after death in the stomach and intestinal canal. The lining membrane may be detached in places. Perforation may follow the use of the poison. Some- times the contents of the stomach are tinged with blood. Toxicological Examination.—The toxicological examination is the same as that for nitric acid, which see. Nitre has been discovered in the urine, liver, spleen, and kidneys. It is chiefly eliminated by the urine, in- creasing the amount. CHLORATE OF POTASSIUM. This salt is derived from chloric acid, in which the hydrogen is replaced by potassium. It possesses a saline, cooling taste, is astringent, and is em- ployed to make oxygen. It is used in medicine, and in doses of from half an ounce to an ounce and upward has proved fatal to adults. Potassium chlorate explodes violently when heated or rubbed up with oxidizable sub- stances. It increases the excretion of urine, but does not affect its chemical reaction. Symptoms.—It acts as a powerful irritant to the alimentary canal and nervous system. Death is usually preceded by salivation, great dyspnoea, cyanosis, delirium, coma, tonic and clonic spasms, and occasionally ecchy- moses. The skin is generally jaundiced. Poisonous doses of this substance interfere with the oxygenation of the blood-corpuscles and produce methae- moglobin. Acute tubal nephritis supervenes, and the excretion of urine is increased, although its chemical reaction remains unchanged. Treatment.—Similar to that pursued when dealing with the other salts. Post-Mortem Appearances.—The blood is usually found to be of a brownish color, thickened, with a tendency to agglutination of the blood- globules. BITARTRATE OF POTASSIUM. (Cream of Tartar. Argol.) This salt is very much used in medicine, and has caused death in at least one instance. Concentrated doses (two ounces) produce poisonous symp- toms similar to those produced by nitrate of potassium. Paralysis of the lower extremities may occur. Death generally takes place within forty- eight hours. 4s A MANUAL OF LEGAL MEDICINE SULPHATE OF ALUMINUM AND POTASSIUM. (Alum.) Alum is a powerful irritant in large quantities, causing vomiting and purging. It has caused death in one case at least. In small doses it is a powerful astringent. SULPHATE OF POTASSIUM. The action of this salt is that of an irritant when administered in large quantities. Death has been caused by ten drachms. Sulphate of potassium crystallizes in rhombic prisms. Its taste is bitter and saline, and it was formerly employed in making Dover's powder. Arsenic may be an impurity of this salt. Ordinary purgative salts may cause great irritation and prove fatal. Overdoses of Epsom salt, and even -common salt, have caused death. (Christison and Taylor.) CHLORINATED POTASSA AND SODA. (Bleaching Salts.) These salts have occasionally caused death. In a case reported by Tar- dieu, a child was poisoned after taking divided doses of this substance, and died in a few weeks. The identity of the poison was established by the dis- covery of an abnormal amount of chloride of sodium in the kidneys and urine. This was supplemented by the further discovery of a formation of chloride of lead on the mouth-piece of the bottle, which was composed of lead and contained the poison. Characteristic stains of a reddish-white color were apparent on the child's cap. SALTS OF BARIUM. With the exception of the insoluble sulphate, all of the barium salts are active poisons. Their symptoms are very similar to those produced by nitrate of potassium. There are decided nervous symptoms and palpitation of the heart. The post-mortem signs are of an inflammatory nature, such as congestion of the mucous membrane of the stomach and intestines, inflammation of the brain and air-passages. The heart contains dark blood. The antidotes are the soluble sulphates (sulphate of soda or of magne- sium). Evacuate the contents of the stomach by emetics and mucilaginous drinks. Subsequently use antiphlogistic medicines. Mode of Extraction from the Stomach.—After filtering the contents of the stomach, the residue is boiled with sodium carbonate, filtered, and the result flushed with distilled water acidulated with hydrochloric acid. The filtrate may be tested for baryta, the oxide of barium, as follows : Add diluted sulphuric acid to the filtered liquid, boil the mixture, and filter again. TOXICOLOGY 49 Destroy the organic matter on the filter-paper by burning, and boil the residue with water acidulated with sulphuric acid. Filter again and weigh. Every ioo grains indicate 65.66 of barium oxide, thus denoting the amount of soluble barium salt. Tests.— Chloride of barium crystallizes in plates, which are soluble in water. With sulphuric acid, or with an alkaline sulphate, it throws down a white insoluble precipitate. The powdered salt, burnt on platinum wire in a smokeless flame, gives to this flame a greenish-yellow hue. With nitrate of silver the chloride precipitates a white silver chloride. Carbonate of barium, which is an insoluble white powder, is completely dissolved with effervescence of carbonic anhydride upon the addition of diluted hydrochloric acid. When evaporated, it presents crystals of barium chloride. CHAPTER VI. ORDER II—SPECIFIC IRRITANTS. PHOSPHORUS. General Remarks—Symptoms—Treatment—Post-Mortem Appearances—Toxicologi- cal Examination—Tests—Diagnosis. Phosphorus is a wax-like, colorless, or slightly yellow, semi-transparent solid, which is luminous in the dark. Some of the physical properties of this substance are its softness and toughness at ordinary temperatures, its insolubility in water, and its solubility in ether, alcohol, and carbon disulphide, from the latter of which it crystallizes in rhombic dodecahedra. It occurs in two allotropic states ; the one is yellow and the other dark red. The latter modification is called amorphous.1 The dark-red variety is insoluble 1 The following table exhibits the di the Red variety: Common Phosphorus. Poisonous. Evolves a strong odor. Luminous. Melts at 440 C. Transparent. Soluble in various liquids. Crystalline. Soft and waxy. Flexible. Oxidizes in the air. Unites readily with other elements. Nitric acid acts on it with great energy. nee between Common Phosphorus and Red Phosphorus. Not poisonous. Almost odorless. Not luminous. Does not melt. Opaque. Nearly insoluble. Amorphous. Hard and tough. Brittle. Unalterable in the air. Is rarely acted on by other elements. No effect. {From Percy's Prize Essay.) 5° A MANUAL OF LEGAL MEDICINE in carbon disulphide, is not luminous, nor is it poisonous ; it is prepared by heating the yellow phosphorus in an atmosphere of carbonic acid gas to 3oo°C. One of the technical uses of phosphorus is in the manufacture of matches. It is also employed as an ingredient of rat-poison. In its free state it acts as a powerful irritant poison. It is much more frequently used for poisoning in Germany and France than in England and the United States. The way in which it is usually employed is in the form of phosphorus paste (rat-poison), or the ends of matches. Fatal results have occurred from children sucking the ends of matches, and in one instance a child died from the effects of chewing two matches. Correspondingly small amounts have proved disastrous to adults. The quantity required to destroy life varies : one-fiftieth of a grain has caused the death of a child. Lobel, of Jena, reports the case of a lunatic who died from the effects of about one- tenth of a grain. One and five-tenths of a grain killed a man, and one- eighth of a grain a woman, within twelve hours. A case is recorded in which a child recovered after having swallowed one drachm of rat-poison, and another of a child who recovered after having sucked three hundred matches. The period at which death takes place is also subject to variation. In one case it occurred in half an hour, one in thirteen hours, one in twenty-four hours, and others at periods varying from two to twelve days. The most common time is from the third to the seventh day. The local action of phosphorus causes severe burns and sloughs, and not infrequently systemic intoxication. It ignites when handled carelessly. Symptoms of Acute Poisoning.—Phosphorus acts insidiously, some- times producing fatal results soon after its administration. Usually toxic effects are produced in from one to three hours after its ingestion. Violent epigastric pains occur, followed by nausea. The vomited matters smell of the poison, and are luminous in the dark. If the phosphorus passes into the intestines, violent purging takes place. The pulse is at first strong, then feeble and rapid. Thirst is intense, and restlessness and anxiety correspondingly great. Convulsions usually precede the delirium, or coma, and death. The urine is diminished in quantity, and contains albumen and blood. Jaundice may supervene after a few days, if the patient survives. In that case the urine will contain biliary pigment. The pupils are usually dilated, the temperature low, and the abdomen dis- tended. Symptoms of Chronic Poisoning.—In chronic poisoning by phos- phorus the patient experiences great fatigue, severe griping pains in the abdomen, diarrhoea, intermittent toothache, and more or less swelling of the cervical glands. The teeth become carious, the gums swollen, and pus may issue from the latter. The gums retire more and more each day from the teeth, and eventually the maxillae are found to be in a state of necrosis. TOXICOLOGY 5I There are gastric disturbance, nervous irritability, falling of the hair, eruptions upon the skin, and tubercular deposits. A black condition of the blood may exist, and the urine is loaded with phosphates. Treatment (Acute Poisoning).—Sulphate of copper in five-grain doses should be administered at once as an emetic. It may act as an antidote by forming a less soluble phosphide. Magnesia (hydrated) or its carbo- nate should be given freely in mucilaginous fluids as a purgative. Small doses (one-twelfth of a grain every fifteen minutes) of sulphate of copper should be continued as an antidote or emetic. A better plan, however, is the administration of oil of turpentine. It must be given early, and the French, or old, common, crude oil is to be employed. This forms with phosphorus an almost insoluble mass, neutralizing the effects of the poison. The introduction of oxygenated water into the stomach through a tube and the inhalation of free oxygen have been highly recommended by Dr. Percy.1 For the general depression, opium is admissible to counteract its effects. Transfusion should be resorted to if the blood is much damaged. The use of oils (except oil of turpentine) or fatty matters must be avoided, since they dissolve the phosphorus and thus assist its absorption. It is very important for those who are employed in phosphorus manu- factories to observe certain precautionary measures ; these are change of clothing every day after work, and extreme cleanliness, the face and hands always being washed in some slightly alkaline fluid. The mouth should always be rinsed with a weak solution of sodium carbonate. Alkaline drinks are advisable. Turpentine vapors diffused thoroughly through the rooms occupied by workmen in phosphorus factories are recommended. Post-Mortem Appearances.—These are very peculiar, and vary ac- cording to the form of the poison taken. When the poison is administered in the pure state, or dissolved in oil, the lesions are usually situated in the oesophagus and alimentary canal. In rapidly fatal cases there are the ordi- nary signs of irritant poisoning, more or less distinctly marked. At a later period there may be a peculiar jaundiced (icteric) hue of the skin, and ecchymosis beneath the pleura, peritoneum, and pericardium. This may likewise exist in the lungs, kidneys, bladder, uterus, muscles, and subcu- taneous tissue. This peculiarity is perhaps due to the speedy disintegration of the blood-globules. Bloody fluid may be found in the visceral cavities. The most constant change found in the stomach is a granular degeneration of the cells which fill the gastric follicles, occasioning a change in appearance of the mucous membrane, which is white, gray, or yellow in color, and thick and opaque. Occasionally perforation exists, but the usual lesions are small circumscribed spots of inflammation, erosion, or gangrene. The small intes- tine is either in its normal condition or congested. Acute fatty degeneration of various viscera, such as the liver, kidneys, and heart, and of the walls of the arterioles and capillaries, is usually found. 1 Prize Essay, 1872. 52 A MANUAL OF LEGAL MEDICINE Toxicological Examination.—The garlicky odor and the luminosity occasioned by the whitish fumes in the dark of the stomach contents are char- acteristic of phosphorus, and should be carefully sought for. If the mixture is ammoniacal from putrefaction, the display of luminosity is lost. This is prevented by neutralizing the ammonia with sulphuric acid. Particles of phosphorus may be obtained as a sediment by washing the contents of the stomach with water. These are placed in a tube, plunged into hot water, and melted into a mass. If this is spread out on a metallic plate and heat applied, the particles will ignite and burn brilliantly. Phosphorus may be separated from organic matters by the action of carbon disulphide. This reagent is a ready solvent of the poison. The best method of extraction, however, is that of Mitscherlich, a process em- ployed where the substance is either in solution or in too minute a quantity for the other tests. Mitscherlich s Method.—The principle of this test is based upon the dis- tillation of the substance or mixture suspected to contain phosphorus from water acidulated with sulphuric acid, when, upon coming in contact with the cool surface of the condenser, it displays a distinct luminosity. The dis- tilled poison, with the aqueous vapor collected in the receiver, imparts the characteristic odor. This is an exceedingly delicate and accurate test; but alcohol, oil of turpentine, ether, and other essential oils interfere with its success. Dr. Reese states that one-sixtieth of a grain of phosphorus pro- duces a luminosity for half an hour in the condensing tube. The poison thus collected by this test may be further oxidized (with nitric acid) and estimated as phosphoric acid. Tests.—(i) It is recognizable by its smell and taste. (2) By the action of nitric acid upon it, it is converted into phosphoric acid. (3) By boiling the material supposed to contain it in acidulated water, and allowing the vapors to come into contact with a paper containing nitrate of silver, which is changed to a dark color by the formation of silver phosphide. (4) In its free state it is easily detected by its white, waxy appearance. Diagnosis.—This will depend upon the odor exhaled by the patient, the luminosity of the breath and vomited matters, together with the other symptoms and post-mortem lesions referred to before. Chronic cases might be mistaken for yellow atrophy of the liver. IODINE. Iodine is a crystalline, elementary body of metallic lustre. It has a specific gravity of 4.95, fuses at 1130 C. to a liquid, and, boiling at 1750 C, gives off dark-violet vapors. Iodine is readily soluble in alcohol and sparingly so in water. Its chemical properties are similar to bromine and chlorine, but weaker. In nature iodine occurs in sea-water and mineral springs ; also in sea- weed. Medicinally it is used as tincture, compound tincture, and ointment TOXICOLOGY 53 Symptoms.—Acute Form.—Iodine produces a local irritant effect and a remote influence. In large quantities it occasions heat and pain in the throat and abdomen, with vomiting and purging, the latter possessing the odor characteristic of the poison. The vomited matters sometimes contain blood, but as a general thing are yellowish in hue, except when mixed with farinaceous articles, when their color is blue. Giddiness and faintness, with headache and convulsive movements, are not infrequent. In the chronic form there are nausea, vomiting, purging, irritability of the alimentary canal, indigestion, palpitation of the heart, enlargement of the liver, and cramps, together with increase of all the secretions (salivation), general atrophy of the body, and a tendency to absorption of certain glands, —the testes in the male and the mammae in the female. Iodine may appear in the milk, sweat, blood, urine, and saliva after the administration of medicinal doses. It appears in the urine in forty minutes, and may not disappear for several days (four or five) ; it is present as hydri- odic acid. The amount necessary to kill is variable. Twenty grains have proved fatal; whereas, recovery has taken place after the ingestion of one drachm and a half. Death usually occurs within thirty hours after taking the poison. Treatment.—Induce vomiting by the administration of emetics. Give freely of amylaceous fluids (boiled starch, gruel, etc.). For the chronic form (iodism), administer a chlorate of potassium gargle, and have the patient discontinue the poison. Post-Mortem Appearances.—The liver is found enlarged and con- gested. The brain may be in a state of congestion. Ulcers have been observed in the stomach. The other lesions are those of an irritant poison. Toxicological Examination.—The stomach contents should be fil- tered, and, if found to be too dark-colored, should be shaken with its own bulk of ether. The ethereal solution should be decanted and tested for the poison. If the filtrate is clear and colorless, add a starch solution, when, if iodine is present, a blue color appears. Disulphide of carbon dissolves iodine from organic mixtures, forming a pink solution. The watery liquid should be removed and the disulphide solution evaporated to dryness, when the poison will be left. Tests.—(i) Iodine may be readily detected by the blue color which it imparts to starch. (2) By its solid form, volatility, color, and odor. (3) Iodide of potassium gives a blue color to starch. Iodide of Potassium.—This substance crystallizes in cubes, has a specific gravity of 2.9, and dissolves in 0.7 part of water. It is used in medicine in quantities up to sixty grains. Sometimes it occasions alarming symptoms, such as abdominal pains (griping), headache, thirst, frequent pulse, an erup- tion upon the skin, salivation, with inflammation of the eyes and nostrils. It is frequently found adulterated with the carbonate. 54 A MANUAL OF LEGAL MEDICINE BROMINE. This is an elementary liquid, of a dark, reddish-brown color, with a dis- agreeable odor, excessively pungent to the eyes and respiratory organs. Its specific gravity is 3.18 at o° C, and it crystallizes at 7.30 C. At 630 C. it boils, evolving yellowish-brown vapors. It is soluble in alcohol, ether, chloroform, and carbon disulphide. One part of it at 150 C. dissolves in 39 parts of water. Bromine occurs in nature in saline springs and sea-water. The corrosive action of this poison is very great. When administered internally, it becomes converted into hydrobromic acid. Bromine has rarely been employed as a poison. In a case which proved fatal in seven hours, bromine was taken on an empty stomach to the amount of one ounce. The symptoms that followed were difficulty of respiration, intense abdominal pain, great anxiety, rapid pulse, and trembling of the hands. A catarrhal inflammation of the eyes and lungs may follow the irri- tating nature of the vapor. Post-Mortem Appearances.—The interior of the stomach has been found coated with a thick black layer, and the mucous membrane intensely congested. Externally it may be injected. The viscera in the vicinity of this viscus may be of a deep-yellow color. The odor of bromine is usually detected in the stomach contents. The peritoneal coats of the stomach and duodenum are generally injected. Bromine should be separated from organic matters by means of disulphide of carbon, or by ether. Chlorine or strong acids decompose the bromides. Bromine gives a deep-yellow color to starch. CHLORINE. Chlorine is a yellowish-green elementary gas of a powerfully irritating nature. Its specific gravity is 2.46, and it is freely soluble in water. The action of this gas upon the tissues is that of a corrosive, causing extreme laryngeal irritation, and even oedema and consequent asphyxia. It occa- sionally produces black eschars on the tongue and pharynx, and possibly perforation of the oesophagus and stomach. It is easily recognized by its powerful bleaching properties, its smell, and its color. ARSENIC. Arsenic is by far the most important of all the poisons, and it is exten- sively used, both as a homicidal and suicidal agent. It is found in nature in the form of a metal, and exists as an impurity in several metallic substances, such as iron, copper, cobalt, nickel, and, with sulphur, as native orpiment and realgar. The metal itself is a steel-gray, crystalline, elementary solid, of metallic lustre, with a specific gravity of 5.7. It volatilizes at 1800 C. without fusing, occasioning yellowish-brown fumes of garlicky odor, by which it is readily recognized. The metal is not often used as a poison, but TOXICOLOGY 55 is frequently sold as fly-powder. In the latter state it becomes poisonous by oxidation to arsenous acid. The technical use of this substance is in the manufacture of fireworks, shot, fly-powder (cobalt—fly-stone), enamel, glass (may be detected in glass, etc.), composition candles, etc. It is also employed extensively for the de- struction of vermin, under the name of " Rough on Rats," and as various alloys in speculum metal, white copper, etc. ; also by farmers for washing sheep, and to improve the coats of their horses ; by ship-builders, to protect their timber from worms ; and by the peasants in certain parts of Styria and Hungary, who are said to eat from two to five grains of arsenic daily,—the men doing so to increase their physical powers of endurance, and the women that they may improve their complexions.' Arsenic, from a medico-legal aspect, as a rule, signifies arsenous acid, or white oxide of arsenic. ARSENOUS ACID, As203.— White Arsenic; "Rough on Rats."— This substance occurs in commerce as a white, heavy powder, or in masses. It is almost without taste, although occasionally slightly sourish, but not acrid. It is only slightly soluble in water (i to 2 parts in 1000) ; more readily so in boiling water (60 to 80 parts dissolve in 1000). Arsenous acid volatilizes at 218° C. in the form of a white vapor, which is odorless. On cool surfaces this vapor is deposited as an amorphous powder or in octahe- dral crystals. Although this poison is quite heavy (3i = grs. 150), it is pos- sible to suspend large quantities in thick fluids, like soups, milk, gruel, coffee, etc., without possibility of its presence being suspected. Symptoms in Acute Cases.—Weakness and faintness are generally the first symptoms manifested. These make their appearance in half an hour or an hour after the administration of the poison, and are attended 1 Relative to the immunity experienced by certain persons addicted to the use of powerful poisons, the following hypothesis is certainly unique and worthy of repro- duction : "When any toxic agent is taken into the system, there is developed in the body an antidote,—a counter-poison. If the dose of the drug taken be increased slowly, pari passu with the power of the system to elaborate a corresponding dose of the antidote, the toxic effect is prevented. If the taking of the poison becomes habit- ual, the production of the counter-poison becomes also habitual. If, then, the taking of the poison be suddenly stopped, the elaboration of the antidote does not necessarily cease at the same time, because its production has become a habit. Hence, what we term the withdrawal symptoms, following the disuse of a drug habit, are really symp- toms of poisoning by the systemic poison, which, no longer needed to antidote the drug taken, exerts its toxic action upon the body producing it. If this hypothesis be correct, we will see, when the habitual drug is withheld, the symptoms due to the leucomaine ; and the treatment of this stage will consist in endeavoring to prevent the formation of this organic alkaloid, and in antidoting its effects. Certainly the most direct antidote will be the drug habitually taken, and hence the gradual withdrawal is better, so far as relieving pain is concerned, than the sudden stoppage. But our experience has been that it is better to substitute for the habit-drug some other an- tagonist of the toxic leucomaine."—From monograph, "Auto-toxaemia in Drug Habits," by Professor William F. Waugh, A.M., M.D., Chicago, 1895. 56 A MANUAL OF LEGAL MEDICINE by a feeling of heat and constriction of the throat. Then comes vomiting, which is violent and incessant, and a very constant symptom. The mat- ters thrown up are occasionally streaked with blood ; they may be mixed with bile, or consist of a thick, glairy mucus. This latter symptom com- mences within two or three days after the dose, and may continue until death. Dryness of the mouth and throat, together with great thirst, and pain in the stomach follow. Accompanying these is diarrhoea, which, however, is often absent or very late in making its appearance. With this last is usually associated tenesmus. The discharge is yellowish, of the rice-water type, sometimes bloody, and very loose. The urine may be entirely suppressed, or, as is generally the case, scanty and of a dark-red color. After a greater or less period signs of collapse appear. The pulse becomes rapid and feeble, the lips blue, the eyes sunken, the face white and cadaverous, the skin cold and clammy and covered with cold perspiration, the sufferer finally dying in convulsions or coma. In these cases death occurs in from six to twelve hours, shock, from in- flammation of the alimentary canal, being the cause. Two and a half grains may be said to be a fatal dose, although a less amount has caused death. These symptoms are liable to great variety. Pain and vomiting may be wanting ; there may be coma ; frequently there is tetanus ; and there are often nervous twitchings, etc. As a usual thing the symptoms are continu- ous, although there may be remissions and intermissions. The symptoms are frequently mistaken for those of cholera and cholera morbus. Symptoms in Subacute Cases.—The above train of symptoms are less strongly marked ; may make their appearance more slowly, or continue longer if the quantity of arsenic administered is smaller, or if the excess of poison is eliminated rapidly by antidotes, vomiting, etc. All of the symptoms manifested in the acute cases, particularly those due to inflammation of the digestive tract, are present. But in these cases the most constant symptoms are the vomiting and the distended and tender condition of the abdomen. In addition, signs of inflammation of the liver and kidneys are present. This latter state is occasioned by the ingestion of large doses of the poison, although arsenic is eliminated by these organs in from two to four hours. As a result of the acute inflammatory changes in the kidney, the urine is scanty, albuminous, high-colored, and contains casts and frequently blood. The skin is hot and dry, and occasionally covered with an eruption. There are inflammation of the lips and gums, which bleed readily ; dry and cracked tongue ; eyes yellowish in color, due to more or less jaundice. There may be present cramps and pains in the legs and thighs. Death generally follows collapse in two or three days, or later, and is preceded by prostration, coma, or delirium. TOXICOLOGY 57 Cerebral or Narcotic Effects.—The symptoms in these cases are pallor, dizziness, a weak pulse, great feebleness, cold skin and extremities, and the patient soon passes into a heavy narcotic sleep and dies in coma. A marked feature in the cerebral or narcotic effects is the entire absence of signs of gastric or intestinal irritation. Sometimes consciousness remains until the last, and the sufferer passes into a state of collapse, with or without convulsions, from which he never emerges. The period at which death takes place in these cases is usually quite short, and patients rarely survive twenty four hours. This class of cases is of rather rare occurrence, being due to the quick absorption of the poison. The rapid succession of the symptoms depends on whether the arsenic was given in solution, or, if dry, in large doses on an empty stomach. Symptoms in Chronic Cases.1—These symptoms are due to lesions of the nerve-fibres rather than to local irritation of the alimentary canal, to lesions of the liver and kidneys, or to the effects on the nervous system. Such cases result from the administration of the poison for some time in small but frequently repeated doses. Another set of symptoms is occasioned in those patients who are convalescing from the effects of an acute or sub- acute attack. Exposure to the vapors of arsenical products, or the inhalation of arsenical dust, is a frequent cause of this form of poisoning. The usual symptoms are watery and inflamed eyes, great gastric distress, vomiting, diarrhoea, headache and giddiness, arsenical eczema, a jaundiced condition of the skin, great emaciation, local paralysis, falling of the hair, salivation, and even mania. The symptoms are often misleading or obscure. In some cases dis- turbances of the sensory and motor nerves are observed, especially in patients recovering from the effects of the ingestion of large quantities of the poison. These disturbances may be a result of the slow elimination of the arsenic from the body, affecting it in the same way as when given for a considerable time. To illustrate : Pellew3 mentions the case of a German clerk, thirty-nine years of age, of good history and previous health, who swallowed half an ounce of Paris green. After three-quarters of an hour had passed he vomited and complained of severe pain in the abdomen. The patient was without treatment for three days, but finally entered a hospital. In two weeks the following symptoms were observed : loss of sensation, more or less complete, in the forearms and legs ; loss of power soon followed, the legs and hands being affected. This latter symptom continued prominent up to some three months and a half from the time of the ingestion of the poison. Sensation returned in about six weeks. The patient never lost power com- 1 The writer appeared as an expert in the recent and familiar " Dr. Meyer Chronic Arsenical and Antimonial Poisoning Case." ( Vide Appendix.) 3 Hamilton's System of Legal Medicine, vol. i. 58 A MANUAL OF LEGAL MEDICINE pletely, although unable to walk or to use his hands or forearms. Eight months after he had taken the arsenic a macular eruption appeared all over his body, which was cured by sulphur ointment. The patient was then re- moved to another hospital, where, under the most careful treatment, he slowly improved, the hands recovering quicker than the feet. In about eleven months the use of the legs returned, and, after exactly one year's sickness, he was just able to get around on crutches, after being assisted out of his chair. The lesions peculiar to these cases are probably due to a peripheral neuritis, a degeneration of the nerve-fibres, which progresses from the ex- tremities towards the cord. Similar lesions to' those just mentioned are produced by lead-poisoning and chronic alcoholism, making it somewhat difficult to distinguish between them. External Application of Arse?iic.—The application of arsenic in solution, or dry, upon the skin or mucous membrane has been followed by poisoning. Cases are on record in which the substance has been introduced into the rectum and vagina, resulting in rapid absorption and symptoms of gastric irri- tation, as well as that of local origin. The rapidity of absorption depends more or less on whether the poison was applied to a raw or inflamed surface, or the application made upon the healthy and unbroken skin. Death, how- ever, has followed the use of arsenical ointment, and even dry arsenic, upon the healthy skin and scalp. The symptoms of this form of poisoning soon follow the local inflamma- tion, and comprise the ordinary arsenical signs. Dangerous and Fatal Quantities.—Symptoms of gastric trouble follow the administration of from one-third to one-half a grain of the poison in solution. Three to four grains of white arsenic are usually fatal. The smallest quan- tity on record * that killed was one-half ounce of Fowler's solution (two and a half grains of arsenic). This amount was taken by a woman, presumably for abortion, in varying doses for five days. A week afterwards she had fever, but no vomiting, purging, or pain in the stomach ; on the eighth day fainting-spells were observed ; and on the following day a fainting-fit, from which she never rallied. Her stomach and intestines were afterwards found to be inflamed. Chronic symptoms have followed the use of small doses of arsenic, if continued for a long time. Cases are on record in which slight neuritis was occasioned by the administration of from four to five drops (one-twenty-fifth to one-twentieth of a grain of arsenic) of Fowler's solution, three times a day for one month. Six to seven drops a day have proved fatal." One minim of Fowler's solution has caused gastro-enteric symptoms. To convict a person of poisoning by arsenic on the evidence of mere traces, without other convincing corroborative signs, is generally considered 1 Provincial Medical and Surgical Journal, 1848. 2 Morris, Materia Medica and Therapeutics, Philadelphia. TOXICOLOGY 59 a wrong act. However, when the poison extracted is subject to weight and isolation, so that it may be shown to the court and jurors, and the reputa- tion of the analyst and his work are unquestionable, and proof exists that the arsenic came from the dead body, this form of evidence is very strong. It is well to recollect that even in well-marked cases of arsenical poison- ing it is not uncommon for the analyst to be unable to find even minute traces of the poison. In the well-known case of Dr. Alexander, in which death was occasioned by white arsenic, and resulted sixteen days after its ingestion, although there was no question as to the cause of death, Dr. Geoghegan, the analyst, was unable to find even traces of arsenic either in the stomach contents or in the viscera. Elimination of Arsenic.—It is generally stated that arsenic is not cumu- lative in the system ; but that it is so to a certain extent cannot be denied, for symptoms of poisoning by this substance, once manifested, are liable to increase in severity for some time after the discontinuance of the drug. The poison, after absorption, enters the portal circulation, much of it being taken up by the liver. This takes place in a few minutes or seconds, the quantity increasing for fifteen or twenty hours. Elimination from the system takes place through the urine, the bile, the skin, and probably through the large intestine. Thus the poison is gradually diminished, day by day, until it finally disappears entirely from the body. The length of time required for this process varies ; some authorities (Herapath, Taylor, Orfila, Geoghegan, and others) state that it takes place in from fifteen to twenty days. Others (Boston Medical and Surgical fiour- nal, vol. cxix. p. c.) note the existence of infinitesimal traces of arsenic in the urine months and even years after its ingestion. This latter observation is to be taken cum grano sails. Treatment of Arsenic-Poisoning.—Should the patient be seen soon after the poison has been taken, the stomach-pump may be used, but not at any later period. Emetics of sulphate of zinc or mustard may be employed, or hot milk and water given. After this the free use of ferri oxidum hy- dratum cum magnesia, provided by the " Pharmacopoeia," to be followed by a dose of castor oil. Suffering is relieved by opium, and inflammation allayed by mucilaginous drinks and cataplasms. Threatening collapse should be averted by stimulants, hot-water bottles, flannels, etc. Post-Mortem Appearances.—The brain, lungs, spleen, and bladder may be in a perfectly normal state. The usual characteristic lesions found in arsenical poisoning are inflammation of the gastro-intestinal tract and fatty degeneration of the heart, liver, and kidneys. The Stomach.—This viscus maybe empty or it may contain blood mixed with mucus. It may show traces of an inflammation of the mucous mem- brane in the interior of the organ, even in cases in which the poison was ad- ministered externally. The mucous coat may be corrugated and the organ contracted, or the entire interior may be of a light-red or brownish color, or there may be streaks of deep congestion. Thickening of the congested 5Q A MANUAL OF LEGAL MEDICINE patches is sometimes noticed; these patches maybe covered with false mem- brane mixed with particles of the poison. Frequently there is an extravasa- tion of blood into the mucosa and submucosa. Small petechiae may be found upon the mucous membrane. Evidences of acute gastritis are usually present, even when the poisonous substance was absorbed by the skin or otherwise. Often particles of solid arsenic adhere to the walls of the organ in thick, pasty, whitish-gray, or green (Paris green) patches. These spots are gen- erally surrounded by brightly injected membrane. The Intestines.—Inflammation is observed here similar to that of the stomach, although to a less degree. The whole of the intestines may be congested and inflamed. The large intestine is usually normal, unless the sufferer has lived for some days after the ingestion of the poison. Peyer's patches, the solitary lymph-nodules, and the mesenteric nodes are in some cases swollen. The Heart.—When the death of the patient has been sudden, the post- mortem appearances of this organ are usually normal. Otherwise, evidences of fatty degeneration exist. The walls of the heart are pale and yellowish and less firm than in the normal state. The muscular tissue under the endo- cardium is ecchymotic. This ecchymosis may be observed also in the interior of the organ, but its usual site is on the left ventricle, on the posterior wall, or on the intra-ventricular septum. The Liver.—This organ generally presents no special appearances ; al- though, on the other hand, in some instances the symptoms of fatty degen- eration are more decided than in any other organ. This is probably occa- sioned by the effects of the poison left behind, notwithstanding its efforts toward the rapid excretion of the drug. The organ may be enlarged, a con- dition usually following sudden death. The Kidneys.—The excretion of the poison occasions a rapid inflamma- tion, which soon causes the tissues, especially the parenchyma, to change. The kidneys are enlarged, soft, and pale. A thickened cortex and a yellow- ish-gray color, either in streaks or all over, are revealed by the microscope upon section of the organ. It must not be forgotten that fatal results in subacute cases are occasioned just as much by inflammation of the kidneys and liver as by the toxic effects produced in the stomach. The Tongue, Pharynx, and (Esophagus.—These structures may be more or less inflamed, particularly if the poison has been administered in the dry form. The oesophagus may be found streaked in patches of a dull or even bright red. It has been found corroded. Toxicological Examination.—Observe if any arsenic in the solid state is present in the stomach and in the vomited matters. The suspected ma- terial should be diluted with water, placed in a conical glass, and allowed to settle. The liquid and lighter material are then decanted, and any heavy sediment examined carefully under the microscope for undissolved arsenic. The rest of the material should be filtered. The solid matter is then TOXICOLOGY 6l boiled with hydrochloric acid until disintegrated, and mixed with the filtrate. The mixture is then strained and concentrated, if necessary, by evaporation, and a portion subjected to Reins ch's test. If the poison is present, it may be estimated quantitatively. The Stomach and Contents.—The stomach should be cut up into small fragments with perfectly clean scissors, and, together with its contents, placed in a clean porcelain dish. For the purpose of disintegrating the solid portions of the drug, distilled water and hydrochloric acid, known to be free from arsenic, are added to the mixture, and the whole boiled for an hour or so. The mixture is then allowed to cool. It should be placed in a strainer (muslin), and the solid matters flushed with warm water and squeezed. The filtrate is concentrated by evaporation and filtered through paper. A portion of the liquid may now be subjected to the above-mentioned test, and if no arsenic is found, another portion may be tested with sul- phuretted hydrogen. If there is still no result, it is safe to conclude that these negative results are conclusive evidence of the absence of arsenic. If arsenic is detected, then a given portion of the liquid should be com- pletely exhausted by Reinsch's process, and the remainder subjected to sulphuretted hydrogen, for the purpose of throwing down all the poison (arsenic). This precipitate will be of a dirty-yellowish color, and be com- posed of organic matter and reduced sulphur. To prove the character of this suspected sulphide, the precipitate should be thoroughly flushed on a filter. It should then be digested with pure aqua ammonias to dissolve out the sulphide of arsenic and organic matter, and then filtered and evaporated to dryness. If the results are satisfactory, and much arsenic be present, it will have a yellow color. If, however, the residue demonstrates the exist- ence of but a minute amount of the poison, it must be subjected to a still further process,—one of purification. The dried residue, which is of a brown- ish hue, is placed in a porcelain capsule, to which a trifling amount of concen- trated nitric acid is added. It is then evaporated to dryness, the acid being added until the mixture assumes a yellowish color. A few drops of caustic soda with a little pure nitrate and carbonate of sodium, are added and well stirred, and cautiously evaporated to dryness over a water-bath. With in- creased heat the mass becomes colorless, showing that the organic matter is entirely dissipated. The residue consists of sodium arsenate, with nitrate and nitrite of sodium. This mass is now dissolved in warm water, filtered, acidu- lated with sulphuric acid, and evaporated until dense white fumes appear. This reduces the mixture to arsenate and sulphate of sodium. Marsh's apparatus may be used in testing a portion of this solution, the remaining portion being subjected to the sulphuretted hydrogen test for quantitative analysis, the arsenic acid being first reduced to arsenous acid. Separation of Arsenic from the Tissues.—In all cases of poisoning, the substance detected in the stomach and intestines should be separated from that absorbed in the tissues. This is important, because the poison found in the stomach took no part in the actual killing of the patient, it being merely 62 A MANUAL OF LEGAL MEDICINE that which was left over. The real effects are occasioned by the absorbed poison, or that found in the liver, kidneys, spleen, and heart ; for it is in these organs that the drug is found, even long after its elimination from the tissues of the stomach and intestines. Its discovery in any of these organs would be proof positive that the poisonous material was administered during the life of the individual. ( Vide Post-Mortem Imbibition.) Arsenic has been found to exist in the brain, and many analyses have demonstrated its presence, after death, in the bones and muscles. Johnson and Crittenden1 detected 2.38 grains of arsenous acid in the organs of the body of a Mrs. Riddle. During the trial the counsel for the defence claimed that this amount was not necessarily fatal. Further analyses were carried on, tissue being taken from the arm, thigh, hands and feet, off a thigh-bone, and from a transverse section of the body itself,—in all, some twenty pounds of material. From this examination 2.85 grains were ab- stracted, showing a grand total of over five grains. Dr. Pouchet, by careful experimentation, has demonstrated the existence of arsenic not only in the skin, nails, and hair of poisoned persons, but like- wise in the spongy tissues of the bones weeks after its elimination from the liver, other viscera, and tissues of the body. The various methods advocated for the preparation of the tissues for analysis depend upon the destruction of the organic matters. The Fresenius method is generally employed for the separation of the inorganic substance from organic matter, which is oxidized with hydrochloric acid and potassium chlorate. Tests.—(I.) Solid Arsenic.—1. Arsenic is but slightly soluble in water, and when boiled or stirred in it, appears as a white film on the surface, or at the bottom of the liquid in the form of little dry masses. It is readily dissolved upon the addition of a little alkali, without changing color. When heated, it is soluble in both nitric and hydrochloric acids. 2. The par- ticles to be tested are placed in a small reduction-tube and heated, when arsenic will be sublimed as octahedral crystals in the cooler portion of the tube. The reduction of arsenous acid is accomplished by covering the par- ticles with a mixture (flux) of dry sodium carbonate and potassium cyanide; or with charcoal an arsenical mirror will form in the cooler portion of the tube. This latter is proved by heating the mirror, with access of air, when it will sublime in the cooler portion of the tube as a white ring, which, when examined by the lens or microscope by reflected light, will be found to be composed of the triangular facets of the octahedral crystals of arsenous acid (sublimation test). 3. The reduction test is as follows : the mixture of arsenous acid and charcoal (or potassium ferrocyanide) is placed in a small reduction-tube, which must be perfectly clean and dry, drawn to a point at its closed end, and the charcoal heated till it glows, when any white arsenic in the powder will, on heating, be reduced to metallic arsenic. This reduced 1 Amer. Chem. Journ, vol. ii. No. v. TOXICOLOGY 63 metallic arsenic will evolve a garlicky odor, and deposit farther up the tube in a black or brownish ring. The "white-cloud" deposit in the sublimation test may be distinguished from similar white rings occasioned by oxalic acid, corrosive sublimate, am- monium salts, calomel, etc., by its shape, or by dissolving it in hot nitric acid and applying the subjoined tests. Gently evaporate the solution to dryness, and touch the residue with strong argentic nitrate, when a brick- red deposit of silver arsenate is formed. The '' black or brownish ring'' in the reduction test is simulated by simi- larly colored rings formed by the cadmium salts and mercury. The differ- ences are these : it is not globular under the microscope ; it is readily dis- solved in hot nitric acid1 and in a hot strong solution of bleaching powder; and it will form white octahedral crystals when heated after the closed end of the tube is broken off. (II.) Arsenic in Pure Solutions.—As it is important, in testing for arse- nic, to confirm in as many ways as possible the various processes, so as thoroughly to identify the poison, the following tests are added, to be pre- pared only when their use is desired, (i) The ammonio-cupric sulphate test is made by carefully adding aqua ammoniae to a dilute solution of cupric sul- phate, until the bluish-white cupric hydrate is barely redissolved. The clear liquid is filtered off and used. This test is spoiled by an excess of ammonia, which will dissolve the precipitate. When this reagent is added to a solution of arsenous acid, a light-green arsenite of copper (Scheele's green) is pre- cipitated. This precipitate is soluble in ammonia and acids, but not in potassium or sodium hydrates. If the arsenic is in minute quantities, the mixture must be allowed to stand for some time, when the characteristic blue color will be deposited. (2) The ammonio-silver nitrate test is made by adding aqua ammoniae to a strong solution of nitrate of silver, until the brown pre- cipitate (oxide) is almost entirely redissolved. When added to an aqueous solution of arsenous acid, alight-yellow precipitate of argentic arsenite occurs (King's yellow). This is freely soluble in ammonia, and in citric, acetic, and nitric acids, the solutions being colorless. It is insoluble in potassium and sodium hydrates, but hydrochloric acid changes it to white argentic chloride. This test responds to one-ten-thousandth of a grain of arsenic. Both of these tests are inadmissible in the presence of organic matter, and the first one is interfered with by the presence of hydrochloric acid. (III.) Arsenic in Complex Solutions.—Sulphuretted Hydrogen Test.— The suspected solution is warmed, acidulated with a few drops of hydro- chloric acid, and treated with sulphuretted hydrogen by allowing it to pass for some hours through the solution. If arsenic is present, a lemon-yellow precipitate of arsenous sulphide will result. This precipitate is insoluble in cold hydrochloric acid. It is oxidized by hot nitric acid, dissolving and forming arsenic acid. It dissolves readily in the caustic and carbonated alka- ' This solution will respond to the argentic nitrate test, as above. 5. A MANUAL OF LEGAL MEDICINE lies and in the sulphides of the alkaline earths. According to Wormley, this test reacts with one-five-thousandth of a grain of arsenous acid dissolved in ten grains of water that has been acidulated. This precipitate can be further tested by filtering, drying by reducing it with flux, and producing the arsenical mirror and the characteristic white ring of octahedral crystals. Reinsch's Test.—This test consists in reducing arsenical compounds with metallic copper. For that purpose the suspected liquid is acidulated with about one-sixth of its bulk of pure hydrochloric acid. The mixture is then brought to the boiling-point, when a piece of copper gauze is introduced and the boiling continued. If arsenic is present, the copper will be coated with elementary arsenic, and will finally assume a dark steel-gray or black color. This is used as the trial test, and may be practised in organic fluids. The sensitiveness of this test shows one-ten-thousandth of a grain ; but Wormley, by the use of very fine tubes and minute strips of foil, obtained the crystals from one-fifty-thousandth of a grain. Any substance which will cause the copper to dissolve will interfere with the success of the test. Such substances are nitric acid, potassium chlorate, manganese dioxide, etc. Besides the delicacy of the Reinsch test, it can be made quantitatively by gradually inserting into the boiling acid mixture previously weighed particles of copper until they are no longer coated. The increase of weight gives the amount of arsenic in the quantity of liquid employed. Antimony, mercury, etc., may also deposit on the copper in this test, but they give respectively amorphous or metallic globular sublimates. Marsh's Test.—This process depends upon generating hydrogen from pure zinc with pure sulphuric acid from a suitable apparatus. The purity of the apparatus and materials should be tested by allowing the hydrogen to burn for some time, when a piece of cold porcelain is introduced into the flame. If no stain is thus produced, introduce the suspected solution through the funnel-tube, when, if arsenic is present, arseniuretted hydrogen is evolved immediately, and the color of the hydrogen flame becomes a bluish white, with some white fumes of arsenous oxide. This gas is then tested as before, —that is, by placing a cold porcelain surface close over the flame, when the arsenic present will be deposited as a black or brown stain. Accord- ing to Wormley, the amount of arsenic in a good stain may not be over one- eighty-thousandth of a grain. The advantages of this test are that other compounds are readily de- tected, such as arsenites, arsenic acid, arsenates, and arsenous acid. One great disadvantage, however, is that it cannot be used in the presence of or- ganic matter, and another that it shows antimony as well as arsenic. The stains of arsenic and antimony are differentiated as follows : the arsenic stain is immediately soluble in sodium hydrochlorite, while the antimony is not; the process of dissolving arsenic stains in ammonium sulphite is slow, antimony dissolving instantly ; nitric acid dissolves the arsenic stainj and TOXICOLOGY 65 when evaporated produces a brick-red stain with nitrate of silver, while an- timony does not; the mirror in the tube, if it is arsenic, is located beyond the flame ; if antimony, it is nearer and on either side of the flame. The sensitiveness of Marsh's test shows one-fifty-thousandth of a grain. Other important preparations of arsenic, from a medico-legal point of view, are the following : potassium arsenite, arsenic acid, cupric arsenite, cupric aceto-arsenite, the sulphides, etc. Potassium Arsenite.—Fowler's Solution.—This preparation, which contains four grains of arsenous acid to the ounce, is prepared by boiling arsenous acid with carbonate of potassium and tincture of lavender. It is much used in medicine. Arsenic Acid.—This powerful poison is prepared by the oxidation of arsenous oxide with nitric acid. The arsenic oxide absorbs water even from the atmosphere, thus forming the true acid (H3As04). The tests for this substance are similar to those for arsenous acid. With sulphuretted hydrogen it gives a yellow precipitate ; with nitrate of silver it yields a brownish-red precipitate. Cupric Arsenite.—Scheele's Green.—A bright-green powder precipi- tated by treating copper solutions with potassium or sodium arsenite. Scheele's green contains one part of arsenous acid to two of oxide of copper. It yields crystals of arsenous acid by sublimation in a reduction- tube, and is soluble in ammonia and in nitric acid. Cupric Aceto-Arsenite.—Schweinfurt, Brunswick Green, Paris: Green, Vienna or Emerald Green.—This compound, which is an insol- uble green crystalline powder, representing a mixture of acetate and arse- nite of copper, is extremely poisonous. Paris green is used extensively for destroying potato-bugs, etc. It has been frequently employed as a means of suicide, and has also been administered with homicidal intent. The symp- toms occasioned by its ingestion are in every way similar to those by arsenous acid, but it is more difficult to wash it out of the stomach. This poison is rarely employed nowadays as a pigment for wall-paper, although it is often used to color candy, toys, etc. Paper or other articles to be tested should be dipped in a weak solu- tion of ammonia, when they will be bleached and the solution changed to a blue color. Add to the latter a crystal of nitrate of silver, and a film of yellow (silver arsenite) is formed around it. If a drop of aqua ammoniae is applied to paper containing this pigment, it turns blue at once. The inhalation of the fine powder that becomes detached from wall- papers frequently gives rise to symptoms of chronic arsenical poisoning. Sulphides.—Of the native sulphides, the red contains seventy per cent. of the metal, and the yellow or arsenous sulphide seventy-one per cent. Orpiment is sometimes administered as a poison. Both compounds are soluble in ammonia ; their toxic effects are the same as those of arsenous acid. 5 66 A MANUAL OF LEGAL MEDICINE Arseniuretted Hydrogen.—Arsine.—This gas is produced by the action of nascent hydrogen upon solutions of arsenic. It is occasionally produced in the arts, but is chiefly formed in the preparation of Marsh's test. It is a colorless, inflammable gas, having the characteristic garlicky odor. When heated, it burns to water and arsenous oxide, depositing metallic arse- nic, and throwing down metallic silver when transmitted through nitrate of silver, the arsenic dissolving in the nitric acid set free. This gas produces marked poisonous effects, having a specific action on the blood and kidneys. In other respects its action is similar to that of ar- senous acid.1 CHAPTER VII. ANTIMONY. Preparation and Properties—Tartar Emetic : Symptoms—Treatment—Post-Mortem Appearances—Elimination of the Poison—Toxicological Examination—Tests- Other Preparations. Antimony is an elementary, crystalline, bluish-white solid, of metallic lustre, with a specific gravity of 6.7. It fuses at 4300 C., and is without taste or smell. The metallic character is exhibited to a greater degree than in arsenic, and it volatilizes at a bright-red heat, burning in the atmosphere to antimony trioxide. It exists in nature as black sulphide (black antimony, or crude antimony), and is employed in the arts as an alloy, mostly in type- metal. The only preparations of medico-legal importance are tartar emetic and antimonious chloride. Antimoniuretted hydrogen has produced fatal results in animals. TARTAR EMETIC. (K(SbO)C4H4Oe.) This compound is also known as tartarized antimony, tartrate of anti- mony and potassium, and stibiated tartar, and is formed by boiling antimo- nious oxide with cream of tartar. It is the most common of the antimonial compounds used in medicine, and is sold as a white, crystalline powder, which is readily soluble in water with acid reaction, and in proof spirits and wine according to the quantity of water they contain. From its solutions it crystallizes in the rhombic form. When heated to redness, tartar emetic chars, from the decomposition of the organic acid, and is reduced to a mix- ture of carbon and metallic antimony. The taste is nauseous, styptic, and metallic. Symptoms.—In acute poisoning by this substance there is a harsh, 1 Vide also Embalming, for possibility of distinguishing ante-mortem from post- mortem arsenic, etc. TOXICOLOGY 67 metallic taste in the mouth after swallowing, soon followed by nausea, vio- lent vomiting, pain in the epigastrium, intense thirst as with arsenic, cardiac depression, and profuse purging of a watery character. Sometimes blood, mucus, and bile are perceived in the discharges from both the stomach and bowels. The pulse is rapid and feeble, and there is extreme prostration, with a tendency to syncope. There are generally constriction in the throat and pain in the oesophagus. Cramps of the extremities may give rise to difficulty in diagnosing between this condition and cholera. Death may occur from exhaustion, in a stupor, in convulsions, or even in delirium. In exceptional cases the vomiting and purging are slight, or even absent, the symptoms being those of intense prostration, with cold, clammy skin and feeble respiration and circulation, the death of the patient being due to the action of the poison on the centres in the medulla. In chronic poisoning from the use of tartar emetic, the symptoms are distressing nausea, with occasional vomiting, diarrhoea, emaciation, loss of appetite, feeble heart-action, difficult respiration, slimy tongue, and increase of the secretions, such as the perspiration and urine. The countenance is pale and anxious. The patient finally dies from exhaustion. The external application of the poison to the skin causes a deep pustula- tion. Tartar emetic is easily absorbed, and particularly from abraded sur- faces. The symptoms are the same as if the poison were swallowed. After death it has been discovered in the stomach, liver, and other organs. Minute quantities of the poison have caused alarming symptoms. Half a grain has occasioned serious results, and death has been caused in a child by three-fourths of a grain in one hour. The effects of the poison depend a good deal on the idiosyncrasy of the individual. Two or three grains have killed, while in other cases an ounce of the poison failed to destroy life. Probably ten to twenty grains (Taylor) would be dangerous for adults if administered at once, and less, than that if taken in divided doses. Treatment.—Wash out the stomach immediately, and give tannic acid as a chemical antidote, and stimulants and opium to overcome the resulting depression. Strong coffee is of service, given after the removal of the poison from the stomach. Post-Mortem Appearances.—These usually indicate more or less inflammation of the mucous membrane of the stomach and intestines, some- times extending to the oesophagus and throat. The stomach and intestines are generally coated with mucus, and evidences of inflammation of these organs may be absent. The blood is unusually thin. The viscera may be engorged with blood. There may be effusions into the pleura, and the lungs are apt to show signs of emphysema. In cases in which death has followed small and repeated doses of the poison, careful examination of the caecum and large intestines should be made. The brain is usually congested. Elimination of the Poison.—Tartar emetic is largely evacuated by vomiting and purging, more so than is the case with other poisons. The poison absorbed into the system is eliminated by the mucous membranes, 68 A MANUAL OF LEGAL MEDICINE especially of the stomach ; by the liver, kidneys, and skin. In chronic cases it is of common occurrence to find inflammation of both liver and kidneys. Toxicological Examination.—When examining food, medicines, vom- ited matter, the contents of the stomach and intestines, etc., it is possible to obtain antimony by acidulating the material with tartaric acid. Gently heat, with sufficient water, over a water-bath for half an hour ; then strain and filter, and treat the solution with sulphuretted hydrogen ; allow it to stand for some hours, when the precipitate should be filtered off. This pre- cipitate contains the antimony as sulphide, along with sulphur and the sul- phides of other metals. It is next boiled in strong sulphuric acid until the sulphur fumes disappear, and filtered if necessary. This solution may now be tested by the zinc or Reinsch's test. If the amount of poison found in the stomach exceeds the ordinary medicinal dose, there is a strong presumption of poisoning ; but if the quantity is small, it is difficult to tell whether it has been administered with criminal intent or not. It is rare for the analyst to find large amounts of the poison in the body, as it is largely expelled during vomiting and purging. Marsh's test should be employed if the above method fails. ( Vide Ar- senic.) In examining the tissues for absorbed antimony, the Fresenius method should be employed in order to destroy the organic matter. Anti- mony is then separated, as above mentioned, by sulphuretted hydrogen. Tartar emetic may be detected in concentrated urine, as in other liquids, by either the Reinsch or Marsh test; also by dipping pure tin-foil in the acidulated solution, when a coating of antimony, if present, will form. Antimony may be determined quantitatively by weighing the antimony sulphide detected by the sulphuretted hydrogen test, when ioo parts will be found to equal 194.4 °f antimony. The antimony sulphide may also be dissolved in hydrochloric acid and then recovered as antimony by the Reinsch test, the increased weight of the copper slips giving the amount of poison present. Tests.—The compounds of antimony are tested as follows : (1) When brought in contact with a drop of ammonium sulphide or a solution of sul- phuretted hydrogen, an orange-red color is the result. (2) The chloride of antimony, when put in water, produces a white precipitate. (3) Antimo- niuretted hydrogen burns and deposits two rings on cold white porcelain held in the flame. These rings are soluble in sulphide of ammonium, but not in a solution of chlorinated lime. (4) Infusion of cinchona and any solution of tannin causes a dirty-brown precipitate with the salts of anti- mony. Antimony Chloride.—Butter of Antimo?iy.—This compound is used in the liquor antimonii chloridi as an escharotic. It is a yellow semi-solid mass, not unlike butter, at ordinary temperatures. It is occasionally met with in cases of poisoning. Its symptoms are those of an irritant and some- times corrosive poison. In treating such cases, administer magnesia in milk, etc. Infusions of tannin are to be employed. Give stimulants for the collapse. TOXICOLOGY 69 MERCURY. Mercury is at ordinary temperatures a bright metallic liquid, with a specific gravity of 13.6. It freezes at —39-9° C. and boils at 3600 C, and forms alloys with most metals. It is generally extracted from its free state by the processes of reduction and subliming the red sulphide, cinnabar. In its metallic state mercury may be said to be non-poisonous, large quantities having been taken without disadvantage. Corrosive sublimate is the most important of the compounds, although all of the preparations pos- sess poisonous properties to a greater or less degree. CORROSIVE SUBLIMATE.—Mercuric Chloride, Corrosive Chloride of Mercury.—This compound occurs in heavy rectangular octahedra, crystal- lizing from water in fine rhombic prisms. It has a powerful styptic, metallic, nauseous taste, and is soluble in 15 parts of water at ordinary temperatures ; its specific gravity is 5.4, it fuses at 2880 C, and boils at 3000 C. Alcohol dissolves about thirty per cent, at ordinary temperatures ; ether, thirty-five per cent. Symptoms.—These usually come on at once after the ingestion of the drug. It acts as a corrosive, and causes great pain in the throat, bloody stools, slow pulse, bloody and mucous vomit, great thirst, suppression of the urine, and collapse. The pulse soon becomes quick, feeble, and irregular, and salivation is apt to appear on the second or third day, although it may be absent. The external application of the poison may give rise to similar symptoms and post-mortem lesions as when taken internally. The minimum fatal dose is about three grains, but recovery has taken place after eighty grains. It may prove fatal in from half an hour to two weeks. In chronic cases there are loss of appetite, metallic taste in the mouth, soreness of the gums, fetid breath, increase of the salivary secretion, pain in the stomach and abdomen, diarrhoea, rapid pulse, hot skin, etc. There are emaciation and general weakness, and at the margin of the gums a bluish line, as in lead-poisoning. Treatment.—Administer at once white of eggs or wheat flour mixed with milk. Encourage vomiting by emetics, and for the troublesome saliva- tion gargles of potassium chlorate and alum should be employed. The subsequent treatment must depend upon the symptoms. Post-Mortem Appearances.—These are confined chiefly to the di- gestive canal. The mucous membrane of the mouth, fauces, and oesopha- gus is softened and of a whitish or bluish-gray color. The stomach is often softened, particularly at the cardiac extremity. These appearances may also be shown by the intestines, especially the caecum. There may be inflamma- tion of the kidneys and bladder. The congestion of the former is especially marked about the Malpighian bodies, the epithelial cells being deformed, granular, and partially destroyed. The bladder is contracted and empty. 7Q A MANUAL OF LEGAL MEDICINE Dr. Byasson' states that corrosive sublimate takes two hours to reach the urine, four hours to reach the saliva, and that it is eliminated from the system twenty-four hours after its ingestion. Toxicological Examination.—Solid particles of the poison may be found in the stomach; these should be collected and identified. The method to pursue in preparing the stomach and its contents, etc., has already been described. After the mixture has been acidulated with hydrochloric acid and gently warmed it is filtered, and the filtrate subjected to the sul- phuretted hydrogen and Reinsch tests. This process indicates the pres- ence of mercury, but not of the corrosive sublimate. To detect this salt the stomach contents should be concentrated by evaporation. This is shaken with a large bulk of ether, which readily dissolves the poison ; the ether is then decanted and distilled at a gentle heat. The residue is tested for the salt. The saliva may be tested for mercury by acidulating about two drachms of it with hydrochloric acid and placing in it a piece of bright copper, watch- ing if it becomes coated with silver. When the copper is subjected to heat in a reduction-tube, metallic mercury is obtained. The urine may be examined by taking fourteen ounces of the fluid and concentrating it by evaporation to one ounce. To this is added hydro- chloric acid, when the whole mixture is filtered. The filtrate is then boiled, together with a piece of bright copper, and placed in the reduction-tube. Tests.—Mercury Compounds.—(i) The application of heat sublimes and decomposes the mercurial salts. (2) Metallic mercury is obtained by char- coal and sodium carbonate (reduction test). (3) Metallic mercury coats copper strips when the latter are placed in an acidulated solution. (4) The metal (black) is thrown down by stannous chloride in excess. (5) Gold or copper moistened with a mercury solution and touched with a pointed piece of steel is coated with a silvery stain. Mercurial Salts.—(1) A black precipitate ("black wash") is caused by liquor calcis and the alkalies. (2) An olive-green precipitate is produced by the iodide of potassium. (3) A bright-red precipitate is thrown down by potassium chromate. (4) Sulphuretted hydrogen gives a black precipitate. Mercuric Salts.—(1) Liquor calcis and all of the alkalies, with the ex- ception of ammonia, produce a yellowish precipitate ("yellow wash"). (2) Liquor ammoniae, with corrosive sublimate, yields a white precipitate. (3) The scarlet iodide of mercury is given by the iodide of potassium. (4) Sulphuretted hydrogen in excess produces a black precipitate, which turns to red when sublimed. Other preparations of mercury have been used as poisons. Among these may be mentioned calomel (subchloride of mercury), hydrargyrum ammoniatum (white precipitate), peroxide of mercury (red precipitate), the oxysulphate (turpeth mineral), etc. 1 Woodman and Tidy, Medical Jurisprudence. TOXICOLOGY 71 LEAD. Lead in its metallic state is not considered poisonous, but when con- verted into carbonate or other poisonous compounds (acetate, subacetate, etc.) it becomes so. The metal itself is a bluish-white, heavy substance, soft and ductile, of a bright lustre when freshly cut, and with a specific gravity of 11.37. It fuses at 3250 C, and forms alloys with other metallic substances. The principal source of lead is galena, a native lead sulphide, from which it is separated by roasting. Cases of acute poisoning by lead are rare, but may occur from taking considerable quantities of the soluble salts. Chronic or slow poisoning is occasioned by absorption of the metal in small amounts, day by day, for considerable periods. This form of poisoning is of frequent occurrence among those employed as plumbers, painters, type-founders, miners, etc. Other sources of poisoning are found in drinking-water or beer con- ducted through new leaden pipes, cosmetics, hair-dyes containing lead, etc. Pure water does not act on the metal, but by the alternate action of air and water it becomes coated with lead hydrate, which is but sparingly soluble in water. In this manner new lead pipes may occasion contami- nation and cause poisoning. If the water contains carbonic acid gas and salts, the metal becomes coated with insoluble carbonate and sulphate, and old pipes, therefore, give greater immunity from contamination. An excess of carbonic acid, however, may cause the carbonate to become slightly soluble. Lead-contamination may result from the presence of nitrates and nitrites in water conducted through lead pipes. Symptoms of Acute Poisoning.—Dryness of the throat, a metallic taste, and thirst are soon experienced after swallowing the poison. The pain experienced is colicky and intermittent, and is chiefly referred to the umbili- cus, pressure on which affords decided relief. Rigidity of the abdominal muscles is generally present. The pulse is slow and weak. The face assumes an anxious expression, and there is extreme prostration. Constipation is a constant symptom, occasioned, no doubt, by paralysis of the muscular coat of the intestines. The urine is usually scanty and very red in color. As the case progresses the patient is seized with severe cramps, paralysis of the lower limbs, and often spasms of a tetanic nature and convulsions. The skin is bathed in cold perspiration. The mind is generally clear to the last. Vomiting is not a constant symptom. The time of death in fatal cases is usually three or four days after prostra- tion. Symptoms of Chronic Poisoning. — Chronic lead-poisoning may be brought about in three ways : (1) Where the poison has been taken inwardly, as in drinking-water. (2) Where it has been applied to the skin externally, as in the use of hair-dyes. (3) Where it has been taken -2 A MANUAL OF LEGAL MEDICINE into the system through the lungs by inhalation, as with artists, painters, etc. The time required for the exhibition of the symptoms varies with the amount of lead that reaches the system. Thus, the symptoms may appear in a few weeks, or even days, or they may not be observed until the exposure has lasted for years. Lead is a poison that accumulates very slowly in the body until the poisonous limit is reached. Sometimes a local manifestation of the effects of the poison is apparent, such as the paralysis experienced by plumbers, etc. The patient at first feels run down and wretched. There are indigestion, obstinate constipation, loss of appetite, intensely fetid breath, excessive thirst, and a constant metallic taste in the mouth. The expression of the countenance is dull and anxious. There may be fever, but its presence is unusual. The pulse is normal. Intestinal colic is of frequent occurrence, and the navel is retracted. Should there be a movement of the bowels, it is accompanied by great pain, and the stools are of a black color, due to the formation of lead sulphide. The urine is generally scanty and micturition painful. In the female vaginismus is often observed. The blue line on the gums, usually near the margin of the teeth, occurs early in lead-poisoning, and is rarely absent. It is due to the action of sul- phuretted hydrogen, derived from the fluids of the mouth, upon the lead circulating through the capillary blood-vessels. Lead-paralysis occurs in the larger number of cases, and may even arise from a single attack of chronic poisoning. It has occurred in the absence of any attack whatever. The limbs most frequently attacked with paralysis are the upper, especially the extensor muscles. The loss of power and wasting of the arm are first seen in the extensor muscles of the forearm (drop- wrist). The corresponding leg muscles may also be affected, but always after the attack on the upper extremities. Death usually occurs from general anaemia and malnutrition, the kidneys being especially affected. Excretion of Lead.—But extremely small quantities of lead are present after death. The poison has been found in the liver and kidneys, also in the urine. Excretion is favored by the administration of potassium iodide, which probably dissolves the lead. It may be eliminated also by the bile, skin, and intestines. The process of excretion is very slow. Treatment.—In acute poisoning by lead the stomach contents should be evacuated and dilute sulphuric acid or Glauber's or Epsom salt given, together with the sulphates of sodium and magnesium. In the chronic form the source should be located and removed. For example, in the case of painters the utmost cleanliness should be observed, and diluted sulphuric acid administered as a drink. Purgatives should also be given to overcome the constipation, and the soluble sulphates, with baths of potassium sulphide, as antidotes. Aid the elimination of the poison by large quantities of diluents and iodide of potassium. Atropine is of ser- vice in lead-colic, and electricity and strychnine in lead-palsies. TOXICOLOGY 73 Post-Mortem Appearances.—These are not very distinct. There may be an inflammation of the intestinal tract, also contraction. The stomach may present a whitened appearance. In chronic cases the large intestines may appear contracted, and the specially affected muscles flabby and whitish. Toxicological Examination.—The organic substances should be con- centrated to dryness and incinerated. Dissolve the residue in nitric acid, and evaporate the solution to dryness over a water-bath ; dissolve in water, and apply the sulphuretted hydrogen test. If the sulphide is sufficient, it is then reduced by the blow-pipe to a malleable particle of lead ; or it may be dissolved in nitric acid, the acid evaporated, and the residue dissolved in water, to be tested with potassium iodide, when the lead iodide, after heat- ing, will be observed under the microscope as six-sided plates. The exami- nation of the urine, which should never be neglected, is performed as just described. Lead may be detected in sweetmeats, etc., colored with this metal, by slightly moistening them with water and putting them on a plate in the centre of which a small capsule filled with a drachm of sulphide of ammonium is placed. The whole is then covered with a tumbler, when, if lead be present, the evolved sulphuretted hydrogen will blacken the sweetmeats. Tests.—(i) Lead compounds give from acid solutions a black precipi- tate with sulphuretted hydrogen. (2) The same precipitate with ammo- nium sulphydrate, insoluble in excess. (3) A white precipitate is produced with sulphuric acid or any soluble sulphates. (4) With potassium iodide a yellow precipitate ; also with potassium chromate. Acetate of Lead.—Sugar of Lead.—This substance is used in medicine as a sedative and astringent. It is an ingredient of different hair-dyes, and may prove poisonous if its use is persistently continued. Sugar of lead crystallizes in large, colorless prisms, and is of sweetish taste, acetous odor, acid reaction, and efflorescent on exposure. With water containing carbonic acid it causes turbid solutions, on account of the pre- cipitation of lead carbonate. Lead Chromate.— Chrome Yellow.—This salt is employed as a pigment. It is also used to color yellow confections and buns. Lead chromate is formed when potassium chromate is added to a lead solution. It is a bright- yellow, amorphous powder, insoluble in the weaker acids, but readily soluble in potassium hydrate. Lead is estimated quantitatively as a sulphide ; 100 parts of pure dried sulphide represent 93.31 parts of the oxide, or 158.37 parts of crystals of the acetate. COPPER. Copper is not a poison in the metallic state, and poisoning by its salts is comparatively rare. This substance occurs as a reddish-brown metal. It is soft and ductile, and has a specific gravity of 8.9. In a dry atmosphere the metal remains unaltered, but with moisture it becomes coated with the green carbonate of copper. It oxidizes, on heating, to black cupric oxide. The ~. A MANUAL OF LEGAL MEDICINE strong acids dissolve it to form salts, but dilute hydrochloric or sulphuric acid has no effect. It forms alloys with metals. Sulphate of copper (blue vitriol) is the result of the action of strong sulphuric acid upon copper. It is a blue, crystalline, efflorescent salt. When subjected to heat, it gives off its water of crystallization, and appears as a white powder. Sulphate of copper is principally used as an emetic in poisoning by phosphorus. This substance, in doses of half an ounce, acts as a powerful irritant. A child of sixteen months sucked some pieces of blue- stone, and died in four hours. Verdigris (an impure subacetate of copper) is manufactured for paint. It is frequently formed in small quantities by allowing greasy substances to stand in copper saucepans. Half-ounce doses have acted fatally. Symptoms.—Copper compounds produce the following symptoms: vomiting having a metallic taste ; its color resembles that of bilious vomit, being greenish. There are usually purging, tenesmus, colicky pains, sup- pression of urine, and jaundice. In large doses the effects are of an irritant nature. Occasionally there are haematuria, gastro-intestinal inflammation, convulsions, paralysis, delirium, coma, and death. Chronic poisoning is not very uncommon. The premonitory symptoms are languor, loss of appetite, constant thirst, giddiness, and a metallic taste. There may be muscular weakness, constant nausea, and the passages of loose stools of a dark color. Severe colic and local paralysis are rare. The color of the hair is sometimes changed to a greenish tint, and a green line may surround the gums. Treatment.—Warm water should be administered, and, if necessary, the stomach-pump or tube used. The free administration of albumen and milk, mixed with sugar, is indicated. In chronic cases the cause must be sought for and removed. Post-Mortem Appearances.—The surface of the body may present a yellowish tinge. Evidences of inflammation are found in the stomach and intestines. The mucous membrane may be ulcerated and bluish-green in color. Sometimes particles of the poison are found adhering to the coats of the intestines. The lungs, in some cases, are congested ; in others ulcerations of the rectum exist; and in most instances the mucous membrane of the stomach and small intestines will be found thickened and inflamed, the stomach being softened, ulcerated, or even gangrenous. Toxicological Examination.—Copper may be found in both a soluble and an insoluble state. Organic fluids in which the poison is present show a bluish-green color. The contents of the stomach or other organic matter should be destroyed with nitric acid and potassium chlorate. Repeated evaporations are to be carried on, as also extracting with nitric acid. Then evaporate any excess of acid, and dissolve the residue in hot water contain- ing a drop or two of acid. This solution is then tested. Tests.—For the Soluble Salts: (i) Potassium ferrocyanide gives a mahogany-colored precipitate. (2) Ammonia produces a blue color, and TOXICOLOGY 75 metallic iron, on which metallic copper will be deposited from a solution. (3) Sulphuretted hydrogen produces with copper solutions a black precipitate. The quantitative analysis of copper is determined as the black oxide ; 100 parts equal 314.21 parts of crystallized sulphate. ZINC. Zinc in the metallic state is inert. It may be acted upon, if taken in- ternally, by the gastric juices and be converted into a salt, which might occasion poisonous symptoms. These effects are likely produced by the sulphate and chloride. Zinc is a bluish-white metal, having a specific gravity of 7 to 7.2. It fuses at 412° C, and distils at about 10000 C, and is solu- ble in dilute acids, potassium or sodium hydrate on boiling, when it gives up hydrogen as with acids. The zinc of commerce (spelter) may be contaminated with arsenic or other impurities. Sulphate of zinc (white vitriol) occurs in rhombic crystals, and forms in- soluble compounds with milk and albumen. As an emetic, in doses of twenty to thirty grains, it is rapid and non-depressing. In appearance it resembles Epsom salt and oxalic acid. It is a very mild irritant. Half an ounce to an ounce may be considered a poisonous dose. The chloride of zinc1 is a white, deliquescent, fusible substance. In strong solution it is known as Burnett's disinfecting fluid ; and in a fifty per cent, solution it is called liquor zinci chloridi. Zinc chloride is a very painful caustic. Diluted it is employed as a soft injection for the preserva- tion of dead subjects. Fatal results have followed poisonous doses of this substance in four hours. (Taylor.) However, instances are on record where the case became chronic, lasting for years. Burnett's fluid has been taken by mistake for pale ale, magnesia, etc. Symptoms.—The effects of the zinc salts are very similar to those pro- duced by copper, though less powerful. There are a metallic taste in the mouth, vomiting of matters mixed with blood, pain in the oesophagus and abdomen, purging, feeble pulse, etc. The countenance is anxious, the body cold, and signs of collapse may supervene. As a usual thing the faculties remain clear. The action of the chloride is that of a corrosive upon the mucous mem- branes. Froth may issue from the mouth, and there may result aphonia and blindness. The nervous system may be considerably affected. Death generally occurs as a result of the secondary effects, such as stricture of the oesophagus or pylorus, or by the chemical action of the poison on the mucous membrane of the stomach. Treatment is similar to that proposed for copper-poisoning. Give 1 This substance is frequently used in solution in hydrochloric acid instead of borax as a soldering fluid, and when carelessly employed may cause poisoning. 76 A MANUAL OF LEGAL MEDICINE albuminous drinks, and follow with tannin. Opium may be administered for pain. Post-Mortem Appearances.—The lesions that are apt to follow the ingestion of the sulphate are of an inflammatory nature. The intestinal tract is inflamed, and the brain and lungs are usually congested. The chloride causes corrosion. Fatty degeneration of various internal organs may exist. Toxicological Examination.—The fact must not be forgotten that zinc is used as an emetic, and, if discovered in the stomach contents, should not prevent the analyst from looking for other poisons. Boil the contents of the stomach with acetic acid. This dissolves any zinc oxides which are liable to be present in combination with animal matters. After this process the liquid should be filtered. Sulphide of ammonium is passed through the filtrate, causing a precipitate, which is sulphide of zinc. This should be collected and dried. Nitric acid is then added, the mixture being diluted with sufficient water. This is then neutralized with carbonate of ammonium and the appropriate tests applied. Tests.—(i) In neutral solutions sulphuretted hydrogen produces a white precipitate. (2) Ferrocyanide of potassium gives a white precipitate. (3) Sodium carbonate, charcoal, and the blow-pipe give yellow precipitates, which change to white on cooling. The white crust, when heated with cobalt nitrate in the outer flame of the blow-pipe, produces a green color. BISMUTH. This substance is a reddish-white metal, with a specific gravity of 9.9. It is crystalline, and fuses at 2670 C, and distils at white heat. Metallic bismuth is inert, and the less soluble salts are not actively poisonous when pure, as their power of absorption is difficultly accomplished. Subnitrate of Bismuth.—Pearl White, Magistery of Bismuth—-This substance is largely employed in medicine ; it is also used as a cosmetic. Medicinally it is administered in doses of from five to thirty grains. Large quantities are apt to produce toxic effects, the symptoms occasioned thereby being those of a violent irritant. These results may be due to the adultera- tion of the bismuth with arsenic. Subnitrate of bismuth exists as a white powder, soluble in nitric acid, but insoluble in water. When a solution of bismuth and nitric acid is thrown in water, a white precipitate is formed, which blackens by ammonium sulphide, and is not soluble in tartaric acid. The symptoms occasioned by toxic doses of this substance are those of an irritant, but, as stated above, they may be the result of contamination with carbonate of lead or arsenic. Tests.-A black precipitate is given with sulphuretted hydrogen. Metallic bismuth may be reduced from its compounds before the blow-pipe as a brittle bead. It is stated that urine will show the presence of the sub- nitrate when a piece of paper saturated with a solution of potassium sulpho- TOXICOLOGY 77 cyanide is placed in the solution and dried. A yellow spot appears at the point of contact. TIN. Tin is a silvery-white substance, of crystalline structure, soft and ductile, with the power of fusing at 2280 C. The specific gravity of this metal is 7.3, and it distils at a white heat. Tin does not oxidize on exposure. The only preparations from a medico-legal point of view are the chlorides. Symptoms and Treatment.—The salts of this metal act as irritants. The treatment consists in the administration of emetics and large quantities of milk and white of egg. A solution of the carbonate of ammonia is also serviceable. Mode of Extraction.—Boil the organic fluids and tissues in water acidulated with hydrochloric acid, and filter. The filtrate should then be tested. Tests.—The protochloride is thrown down by sulphuretted hydrogen, the precipitate being of a dark chocolate color. The gold chloride produces a beautiful purple precipitate, the purple of Cassius. A piece of zinc throws down metallic tin in an arborescent form. Sulphuretted hydrogen precipi- tates bichloride of tin, the color being yellow. It is insoluble in ammonia, and is thus distinguished from arsenic. It is known from the sulphide of cal- cium by being insoluble in hydrochloric acid. IRON. The only important salts of iron, medico-legally, are the ferrous sulphate and the ferric chloride. The former salt, also known as copperas, or green vitriol, is a crystalline substance ; it is somewhat efflorescent, and loses its water of crystallization on heating, when it becomes a white powder. This product is then termed ferri sulphas exsiccatus, or dried sulphate of iron. Large doses of the sulphate are highly irritant, and have caused fatal results in several instances. Its action is very similar to that of the sulphate of copper. The chloride is used in medicine in the form of tincture. Large quanti- ties of it act as a violent corrosive poison. Ferric chloride is a brown deli- quescent substance, very soluble in water, and has been administered with homicidal intent. Symptoms.—The salts of iron have been used with the intent to pro- cure abortion, particularly the chloride. The symptoms are those of an irritant poison. There are the usual pain in the stomach, violent purging and vomiting. The vomit is generally of a blackish hue. The treatment consists in the use of the stomach-pump or tube, or emet- ics. Give diluents with alkaline carbonates. The post-mortem appearances are those of an irritant poison. Black fluid may be found in the stomach and bowels. Mode of Extraction.—Digest the organic matters thoroughly with „c A MANUAL OF LEGAL MEDICINE /^ acidulated water,' filter, and evaporate to dryness. Incinerate the residue, and dissolve the ash in diluted sulphuric acid. Treat the solution with the appropriate tests. Tests.—The fact must not be overlooked that iron is a constituent of the blood, forming an essential part of the haemoglobin. This makes it diffi- cult to distinguish between the natural and the foreign iron in the body. The ferrous salts are of a light-green color, and in solution produce: (i) With alkalies, a white precipitate, which soon turns greenish brown. {2) With ferrocyanide of potassium, a white precipitate, changing from light blue to dark blue. (3) With ferrocyanide of potassium, a dark-blue precipi- tate. (4) A black precipitate with sulphide of ammonium. No precipitate is occasioned with sulphuretted hydrogen, sulphocyanide of potassium, or tincture of galls. The ferric salts are of a reddish-brown color, and in solution give: (1) A Prussian blue with ferrocyanide of potassium. (2) With ferrocyanide of potassium, no particular precipitate, but the color is usually of a greenish tint. (3) With alkalies, a foxy-red precipitate. (4) With sulphuretted hy- drogen, a precipitate of sulphur (white), and the ferric salts are transformed into the ferrous. A blood-red precipitate results with the sulphocyanide of potassium. (5) With the tincture of galls, a bluish-black precipitate is formed. When examining the body of a person poisoned by iron it is well to observe whether there are any stains upon the garments or bedclothes. If so, they should be carefully examined for iron. The iron might be tested for in the faeces. SILVER.2 The nitrate of silver is the only salt that needs reference to. This sub- stance is soluble in equal parts of water. It crystallizes in colorless right rhombic plates, and turns black when contaminated with organic matters. It fuses, and can be cast in moulds or sticks (lunar caustic). When taken internally, nitrate of silver acts principally as a corrosive poison. The administration of the compounds of silver for some time occa- sion a blue, indelible discoloration of the skin. Three or four fatal cases are on record of poisoning by this substance. The symptoms are occasioned by the irritant action of the poison, also by its effects upon the central nervous system. There may be convulsions, vertigo, coma, paralysis, and marked disturbances of the respiratory function. Death may result from asphyxia. Chronic poisoning may occur when small doses of this salt are taken in- ternally for some time. The treatment consists in the administration of common salt, or chloride 1 Acetic acid should be used. 2 The preparations of gold and platinum, with other metals of an allied nature, are irritant and corrosive, but rarely the occasion of poisoning. TOXICOLOGY 79 of ammonium. Vomiting should be encouraged, and albumen or white of egg given. The symptoms are to be treated as they occur. The post-mortem appearances in cases of slow poisoning show a bluish tint of the body. A blue line is sometimes observed in rapid cases around the gums. The intestines and stomach present either an intensely red color (inflammation), or they are white from the action of the salt, or black from the decomposition of animal matters. Mode of Extraction.—The contents of the stomach should be boiled with bicarbonate of potassium, and filtered. The residue should then be boiled with nitro-hydrochloric acid, and again filtered. The filtrates should be mixed together and evaporated to dryness. This process chars the or- ganic matters. Redissolve the residue in diluted nitric acid, and saturate with ammonia. Filtration should again be performed. The silver should then be thrown down with hydrochloric acid, in a solution acidulated with nitric acid. Tests.—The use of this salt can be recognized by the white and after- wards black stains that appear upon the mouth, gums, skin, and clothing of the person, (i) Hydrochloric acid or soluble chlorides give a white, curdy precipitate, soluble in liquor ammoniae. (2) Alkalies produce a brown pre- cipitate, soluble in an excess of liquor ammoniae. (3) Sulphuretted hydro- gen gives a black precipitate, soluble in sulphide of ammonium. (4) The metal is thrown down white, with iron, mercury, and copper. (5) A yellow precipitate is given by tribasic phosphate of sodium. (6) Chromate or bi- chromate of potassium gives a brown precipitate. CHROMIUM. The most important of the chromium salts is the bichromate of potassium, which is largely employed for dyeing purposes. It has caused death in more than one instance. The chromate of potassium may also cause poisonous symptoms. In large quantities these salts are violent irritants ; sometimes they act as corrosives to the mucous membrane of the alimentary canal. The chromates also act as local irritants, producing in those who work with them chronic ulcers and ozaena. Symptoms.—In cases of acute poisoning these salts act as powerful irritants. Among the early symptoms is violent and constant purging, the stools being of a peculiar gray color, and the vomited matters yellowish. There may be very severe cramps in the legs, also extreme depression. The pupils are generally dilated, and the urine may be suppressed. Swell- ing and pain of the periosteum are usually present. The action of the sub- stance is usually marked upon the mucous membranes. Two drachms have caused death in four hours. Treatment.—The treatment calls for the use of emetics and magnesia, or chalk and milk. In chronic cases paint or sponge the throat with nitrate of silver. Post-Mortem Appearances.—The lesions are those of an irritant 8o A MANUAL OF LEGAL MEDICINE poison. The stomach is inflamed and destroyed, or it is marked with patches of a dark-red discoloration. The blood is thin and black. Mode of Extraction.—The stomach and contents should be digested with hydrochloric acid, then boiled and filtered, and the filtrate tested. The solution in the stomach is usually of a red color ; this may be a guide to its presence. Tests.—(i) For the chromous salts sulphide of ammonium produces a black precipitate, while for the chromic salts it gives a grayish-green pre- cipitate. (2) Liquor ammoniae for the chromous salts gives a blue precipi- tate, turning green ; for the chromic salts liquor ammoniae produces a grayish- green precipitate. (3) For the chromic salts silver gives a crimson precipitate. CHAPTER VIII. VEGETABLE IRRITANTS. OXALIC ACID. Sources in Nature—Symptoms—Treatment—Fatal Dose and Period—Post-Mortem Appearances—Tests—Toxicological Examination. Oxalic acid (acid of sugar) is one of the most important of poisons. It exists in various plants, principally the sorrel. It may be artificially pre- pared by the action of nitric acid on cellulose or sugar. The principal com- pound of oxalic acid is potassium oxalate (potassium binoxalate). From its cheapness, oxalic acid is frequently made use of in cases of suicide, but it is rarely employed as a homicidal agent, since it would be readily detected by its excessively sour taste. It has been the cause of acci- dental death, from its being taken instead of Epsom salt (sulphate of mag- nesium), which it much resembles. In strong solutions, or in substance, oxalic acid acts as a corrosive, and by absorption from dilute solutions as a neurotic poison. Symptoms.—The symptoms depend to a certain extent on the size of the dose and the degree of concentration. If half an ounce to an ounce of the poison be taken, there is experienced at once a hot, acid, burning taste in the mouth. This is rapidly followed by tightness and pain in the throat, extending to the stomach, accompanied by pallor, clammy perspiration, pros- tration, abdominal pain, and vomiting. If the poison is in a diluted state, the latter symptom may be protracted for a quarter of an hour or so. In some instances the vomiting has been incessant until death ; in others there is little or no vomiting. Numbness and tingling of the legs have been noticed in some cases, which would go to show that this acid has a remote effect upon the nervous system. Spasmodic twitchings of the facial muscles TOXICOLOGY 81 have also been observed. These latter phenomena sometimes follow in cases of recovery from oxalic-acid-poisoning. Treatment.—Magnesia, plaster from the walls, chalk, or carbonate of calcium should be given. The latter substance forms, with oxalic acid, ox- alate of calcium, which is an inert substance. Vomiting should be encour- aged by sulphate of zinc in doses of twenty grains, or by the hypodermatic injection of apomorphine. The use of the stomach-pump is to be avoided. Alkalies and their carbonates are also contraindicated, since the resulting compounds are poisonous. Fatal Dose and Period.—The smallest quantity required to destroy life is one drachm. Half an ounce to an ounce may be regarded as a fatal dose. The period at which death takes place is variable. A case is reported by Ogilvie where fatal results followed the ingestion of the poison in three minutes. Death has occurred in ten minutes, but the great majority of cases prove fatal within an hour after swallowing of the substance. In other instances death has been protracted to the fifth day. The period of death does not depend upon the amount and concentration of the poison. Post-Mortem Appearances.—The stomach, as a rule, contains a dark- brown, acid, mucous fluid ; it is usually contracted, and its mucous mem- brane pale, soft, and easily detached. Occasionally it is red and congested, blackened or gangrenous, or peeled off in patches. The small intestines may be inflamed. In some cases the pleura and peritoneum are inflamed and the lungs congested. The mucous membrane of the mouth, pharynx, and oesophagus is white and shrivelled, and readily peels off. The oesophagus may also be in a state of contraction. Sometimes there are no well-marked lesions at all after death. Tests.—The crystals of oxalic acid are four-sided prisms, colorless, and without odor. They are permanent in the air and are very acid. The acidity distinguishes them from the crystals of the sulphate of zinc and the sulphate of magnesia. When heated, the crystals melt and are dissipated without being charred, leaving no residue. This is a means of distinguishing oxalic acid from other crystals that are similar. Their solubility is reached in from eight to twelve parts of cold water. In solution this acid is recog- nized by the following tests : (i) Nitrate of silver produces a white precipitate of oxalate of silver, which is soluble in nitric acid, and, when dried and heated on platinum-foil, deto- nates and evolves a white vapor. (2) Sulphate of calcium causes a white precipitate of oxalate of calcium, which is soluble in nitric or hydrochloric acid, but not in the vegetable acids. This substance will also throw down solutions of barium, lead, and strontium, but the sulphates of these bases are insoluble in nitric acid. (3) Cupric sulphate gives a faint bluish-white precipitate of cupric oxalate, which is almost insoluble in nitric acid. Toxicological Examination.—The liquid contents of the stomach should be filtered at once if acid. If this condition does not prevail, they 6 82 A MANUAL OF LEGAL MEDICINE should be digested with water before filtration. If the liquid contents are highly colored, they should be boiled some time with animal charcoal, being afterwards subjected to filtration. They are then evaporated to concentra- tion, and acidulated with acetic acid and acetate of lead added. This pre- cipitates oxalate of lead, which may be diffused through water. Sulphuretted hydrogen is then passed into it, when the lead will be thrown down as the black sulphide, the oxalic acid being liberated. The urine should always be examined for an increase of the octahedral crystals of oxalate of lime. This is done by collecting the fluid in a conical glass and examining the sediment under the microscope. It should not be forgotten that these crystals may be detected in the urine of persons who have eaten food containing oxalic acid, such as sorrel and rhubarb. Oxalic acid stains on cloth, etc., are discovered by boiling the material in water and applying the usual tests. This acid is sometimes employed in cases of forgery for the purpose of removing ink. Traces of iron in the latter may be detected by the applica- tion of the ferrocyanide of potassium, which will turn it blue. The quantitative estimation of oxalic acid is determined as oxalate of lead ; every 100 parts of the dried oxalate equal 42.5 parts of the crystallized acid. BINOXALATE OF POTASSIUM.—Salt of Sorrel; Essential Salt of Lemons.—The poisonous properties of this salt are due to the oxalic acid it contains. It is found in the leaves of the wood-sorrel, and is used for re- moving ink-stains, etc. Its effects are almost similar to those occasioned by the acid itself; and it has been taken by mistake, on account of its similarity to Epsom salt. The common rhubarb plant contains considerable quantities of oxalate of lime. TARTARIC ACID. In large concentrated doses, tartaric acid acts as a powerful irritant, and may produce serious symptoms and fatal results. In a case reported by Tanner, a man swallowed an ounce of tartaric acid by mistake for a dose of an aperient salt. He suffered intense pain in the throat and stomach. Magnesia and soda were administered at once, but without relief, and the sufferer died at the end of nine days. The post-mortem appearances showed intense inflammation of the stomach and intestines. ACETIC ACID. Concentrated acetic acid is highly corrosive. Orfila mentions an instance of death rapidly following poisoning by this substance. Convulsions just preceded the fatal issue. The post-mortem examination revealed coagulated blood in the submucous areolar tissue of the stomach, which was interspersed with elevations of a black color, produced by this coagulation. The tongue and oesophagus were of a dirty-brown color. The mucous membrane of the TOXICOLOGY 83 stomach was neither corroded nor softened, but the mucous membrane near the pylorus was almost of a blackish hue. CARBOLIC ACID. (Phenic Acid. Phenol.) Carbolic acid, when anhydrous, is a colorless solid, with a character- istic smell. If five per cent, of water is added to it a liquid results. It turns red without deterioration if exposed to the light. Carbolic acid is a coal-tar product, whence the name coal-tar creosote. It is employed in sur- gery as an antiseptic, as it is a protoplasmic poison. Locally it causes a white eschar to appear on the skin, which produces a numbness. It coagu- lates mucous membranes, and at times is absorbed from wounds, thereby occasioning systemic effects. The toxic action is neurotic, and it is this effect which most frequently causes fatal results. When taken internally, un- diluted, its effects are very energetic. It is rarely used as a homicidal agent, although it is frequently employed for suicidal purposes. Symptoms.—When the acid is taken undiluted it acts as an irritant to the gastro-intestinal tract. It causes immediate vertigo and intoxication. These are accompanied by an intense burning pain in the mouth, throat, and stomach. There is vomiting of a frothy mucus. The pupils are in- variably in a state of contraction, the conjunctiva being insensible to touch. The pulse is intermittent and rapid, and the skin is cold and clammy. The characteristic odor of the poison is detected in the breath and vomit. Complete suppression of the urine may supervene, or it is smoky and dark-colored. There may be intense coma and convulsions. The patient frequently dies from syncope, or, if prolonged, from apncea. The external application of the acid has produced many of the above- mentioned symptoms. Fatal results have followed its use as an injection. Treatment.—Death is usually very rapid, so that little time is left for treatment. The best antidotes are castor oil, olive oil, saccharated lime, and magnesia. Emetics are of little use, on account of the anaesthesia of the mucous membrane of the stomach. To counteract collapse the injection of stimulants may be tried. Fatal Dose and Period.—Death takes place usually in from thirty minutes to four hours after the administration of the poison. The shortest time in which fatal results have taken place was ten minutes, and the longest sixty hours. Dangerous symptoms have followed six or seven drops or grains of the poison ; but the usual deaths have been caused by one or two ounces. This quantity, however, is much greater than is required to prove fatal. Post-Mortem Appearances.—The mouth, throat, oesophagus, and stomach are whitened and sodden. The mucous membrane of the same is readily removable. Reddening (inflammation) is noticed between the folds of the stomach. The brain is occasionally in a state of congestion, fluid g4 A MANUAL OF LEGAL MEDICINE being present in the ventricles. The stomach may be thickened and con- tracted. It is often intensely congested, and the mucous membrane de- tached or destroyed. The lungs are usually filled with blood, and the left ventricle of the heart is contracted, while the right is flaccid. The smell of the acid is readily perceived in the stomach and occasionally in the intestines or other viscera. The blood is fluid and dark-colored. The bladder is usually in an empty state. Tests.—The odor of the acid is the most characteristic test, (i) When it is acted on by nitric acid, yellow crystals of picric acid are formed. (2) A whitish-yellow precipitate is formed in a weak solution of carbolic acid by bromine water. (3) It precipitates albumen and collodion. (4) A violet color is developed when neutral perchloride of iron is added to the acid. (5) Solution of ammonia and of chlorinated soda produce a deep-purple coloration. (6) Millon's reagent (mercurous nitrate and nitric acid) gives with it a red color when warmed. This latter test detects 1 in 200,000. Toxicological Examination.—The odor of the acid will be perceived in the body after death. Unless it can be detected, tests are likely of no avail. For the recovery of the acid the organic matters should be distilled along with dilute sulphuric acid. The urine should also be examined. CROTON OIL. (Croton Tiglium.) Croton oil is a fixed oil obtained from the seeds of Croton tiglium (nat. ord. EiiphorbiacecB), a tree of India, the active principle of which has not been isolated. This oil has proved fatal as a powerful irritant to the gastro- intestinal mucous tract, occasioning vomiting and purging, followed by col- lapse, resembling severe cases of cholera. Croton oil presents a light-yellow color, and has an unpleasant odor. Its taste is burning and acrid. The seeds of the plant are of a dull, dirty appearance. At Mount Holly, New Jersey, a woman was found guilty of attempting to poison her son for the express purpose of obtaining his life insurance.' The defendant claimed that she had purchased and used the oil for the cure of her corns. When croton oil is applied to the skin, it acts as an intense irritant, pro- ducing a papular eruption which soon becomes pustular. Internally it is a rapid and powerful hydragogue cathartic, causing griping pains, and occa- sionally depressing the circulation. In toxic doses it causes great depression, and frequently ends fatally. Analysis.—The oil should be separated from the stomach contents by ether. The solution should then be allowed to evaporate spontaneously, when the resulting oil is tested with nitric acid and heat. 1 The Vandergrift case. In this case the croton oil was administered in successive doses, which were small, so as to cause gastro-enteric symptoms. TOXICOLOGY 85 ELATERIUM. This substance is obtained from the juice of Ecbalium officinarum (wild or squirting cucumber). It is employed in medicine as a drastic hydra- gogue purgative, also proving diuretic, and in large doses often causing fatal results. Its action, or effects, is very similar to croton oil. Violent effects have been produced by one grain of this substance. It is unaffected by nitric acid, but sulphuric acid gives it a reddish-brown color. The active principle of elaterium is elaterin, a neutral substance, to which the poison owes its activity. CASTOR-OIL BEANS. These are obtained from the Ricinus communis. From them are ob- tained, by pressure, the castor oil of commerce. The action of the seeds upon the stomach and intestines is that of an irritant poison, the active prin- ciple being due to the oil. Three seeds proved fatal to an adult male in forty-six hours, and twenty seeds destroyed life in a lady in five days. The symptoms presented in these cases were similar to those occasioned by cholera. COLCHICUM. Colchicum is the corm and seed of Colchicum autumnale, or meadow saffron (nat. ord. LiliacecB). It is a native of Europe, and contains a powerful alkaloid principle, colchicine, which is converted into colchicein by the action of the mineral acids. This alkaloid resembles veratrine in some of its properties ; it is found principally in the bulb of the plant, but exists also in the seeds. In medicine, colchicum is used as an alterative, diuretic, and cholagogue. Symptoms.—Large doses of colchicum cause burning pain in the throat, oesophagus, and stomach. These are supplemented by great thirst, sore- ness, vomiting and purging, cramps, dilated pupils, cold, collapsed skin, suppression of the urine, and rapid exhaustion. Delirium and convulsions may take place. Treatment.—The treatment calls for the employment of emetics and cathartics. As a partial antidote, tannic acid should be given, as well as de- mulcents, to protect the surfaces of the stomach. Opium and stimulants are indicated to counteract the resulting depression. Fatal Dose and Period.—Death usually follows the administration of the drug within twenty-four hours, although it has occurred in seven hours, and again has been protracted for several days. Less than half a grain of the alkaloid is fatal. Half an ounce of the seeds have caused death, while, on the other hand, half an ounce or less of the wine of the root and forty-eight grains of the dried bulb proved fatal. A party of nine persons, who had partaken of what they supposed was ordinary wine, but which was colchicum wine, were seized in a few hours with nausea, vomiting, purging, excruciating pains, cramps, g6 A MANUAL OF LEGAL MEDICINE and prostration. Five out of the number died within thirty-six hours. (Occurred in Montreal, 1873.) Post-Mortem Appearances.—There is generally inflammation of the stomach and intestines. The pia mater may be congested, and the lungs are usually inflamed. In some instances the post-mortem appearances are Analysis.—Colchicine is soluble in water, and has a feeble alkaline reaction and a bitter, acid taste. It occurs in white crystals. With nitric acid it produces a violet color, which afterwards changes to blue and brown. Sulphuric acid produces no effect, and this fact distinguishes it from veratrine. It is recovered from organic matters by a modification of Stas's process. SAVINE. Savine is the tops of Juniperus sabina (nat. ord. Conifercz), an ever- green shrub of Southern Europe. It contains a volatile yellow oil which may be procured by distillation. It is employed in medicine in the forms of powder and oil, both of which are powerfully irritant. When applied locally, savine acts as an irritant, and when administered in toxic doses it produces great depression, unconsciousness, convulsions, and hemorrhages from the uterus and kidneys. There are usually suppression of the urine, and, in the pregnant female, abortion. Savine is seldom used as poison, but it is fre- quently employed as an abortifacient. Death is often delayed for several days, or the patient may die in fifteen or sixteen hours after the ingestion of the poison. Post-Mortem Appearances.—These are usually congestion of the capillary and venous systems. The heart is full of blood, especially on the right side. The color of the blood is black. There seems to be a general plethora of the vessels of the intestinal system. Toxicological Examination.—When powdered savine has been taken, the color of the stomach contents will probably be of a greenish tint, and the coniferous structure of the herb will become apparent under the microscope. The organic matter in the stomach should be distilled. The distillation should then be agitated with ether, in which it is soluble, and evaporated. The poison is recognized by its odor. HELLEBORES. Black Hellebore.—Helleborus Niger.—This substance is a powerful irritant to the stomach and intestines. It has caused fatal results when given in overdoses, producing vomiting (which is violent), purging, cold sweats, abdominal pain, collapse, and convulsions. This poison was formerly named melampodium. White Hellebore.— Veratrum Album.—Violent sneezing is caused by the powder. When taken internally the following symptoms are manifested : a burning heat and constriction of the throat, great anxiety, abdominal pain, nausea, vomiting and purging, and great prostration. The pulse is feeble, TOXICOLOGY g7 the pupils dilated, trembling in the limbs is apparent, the body is bathed in cold sweats, and the patient soon passes into insensibility and death. Death may occur in from three to six hours. The active principle of this substance is veratrine. Green Hellebore.— Veratrum Viride; American Hellebore; Indian Poke.—This plant contains two alkaloids, veratroidine and jervine, to which its effects are due. Other alkaloids are rubijervine and pseudojervine. Poisoning rarely occurs, as an overdose produces emesis. Dangerous symptoms do frequently arise, and the ingestion of a toxic dose has proved fatal in several instances. The tincture is a very powerful cardiac depressant, diminishing the frequency and force of the contraction of the heart. Treat- ment consists in the administration of alcoholic and other cardiac stimulants. VERATRINE. This alkaloid is obtained from the seeds of Asagraea officinalis (nat. ord. Liliacecz), a Mexican plant. It also exists, as above mentioned, in V. album and V. viride. Large doses of this alkaloid produce vomiting and purging, muscular weakness, with a cold and clammy skin. The pulse is weak, irregular, and rapid, and there are muscular tremors. At first veratrine appears to stimu- late the excito-motor cardiac ganglia and muscle, temporarily increasing the pulse, but this soon changes to depression and paralysis of both. The vaso- motor centres are first stimulated, then depressed. Finally the respiratory centre is paralyzed, and the result is death. Veratrine is eliminated chiefly by the skin and kidneys, increasing their secretions. The one-sixteenth of a grain has caused dangerous symptoms in the human subject. Treatment.—The stomach-pump or emetics and powdered charcoal should be used. The use of tannin and stimulants is indicated. Opium combined with purgatives is beneficial. Tests.—(i) When veratrine is applied to the nostrils it induces violent and uncontrollable sneezing. It possesses no smell. (2) It is turned yellow, and then crimson, by sulphuric acid. The red color appears at once when the acid is gently heated. (3) It is changed to a light red by the action of nitric acid. (4) When warmed in concentrated hydrochloric acid a dark-red color is the result. This resembles a strong solution of potassium perman- ganate (Trapp's test). Toxicological Examination.—Veratrine should be separated from or- ganic mixtures by a modification of Stas's process. The chloroform extract is then tested by sulphuric acid. YELLOW JASMINE. Yellow jasmine (Gelsemium sempervirens) is used in medicine in the form of the rhizome and rootlets of the yellow or Carolina jasmine (nat. ord. 88 A MANUAL OF LEGAL MEDICINE Loganiacea:), a climbing plant of the Southern States. It owes its effects to an alkaloid, gelsemine, combined with gelseminic acid. Symptoms.—Toxic doses cause extreme muscular weakness, partial blindness, dilated pupil, often internal strabismus, incoordination, ptosis, feeble pulse, and occasionally spasms of the throat. The jaw drops, articu- lation is impaired, and general sensibility much impaired or diminished. The respiratory function is slowed, the temperature declines, and a profuse sweat covers the body. Death takes place from respiratory failure. The mind is generally clear to the last. The poison appears to depress the heart directly. Mydriasis with paralysis of accommodation and ptosis are caused by the paralyses of the end organs of the motor oculi nerve. This action must also affect the sixth nerve, as the external rectus muscle is somewhat enfeebled. Treatment.—The stomach should be speedily evacuated, and followed by stimulants, both internal and external. Morphine hypodermatically is recommended ; also electricity. Fatal Dose and Period.—The fluid extract is four times stronger than the tincture, both of which preparations are official. A child of three years was killed by twelve minims of the fluid extract. Thirty-five drops of the tincture have produced fatal results in an hour and a half. Death has occurred in an hour or more. Tests.—(i) When pure, sulphuric acid dissolves gelsemine without any change of color ; as commonly found, however, its color is changed to a brownish hue, and, if warmed, to a purple. (2) A fragment of bichromate of potassium stirred in the acid solution produces a red color, which soon changes to blue. This reaction is distinguished from that of strychnine by the action of nitric acid, which gives to gelsemine a bluish-green color when evaporated. It does not affect strychnine. Toxicological Examination.—Gelsemine and gelseminic acid may be extracted from organic mixtures by the process recommended for the alka- loids. The filtered solution should then be shaken with ether to remove the gelseminic acid. The residue is rendered alkaline and extracted by ether and chloroform to procure the gelsemine. POISONOUS MUSHROOMS. Symptoms.—The usual symptoms are those of narcotic irritants, such as violent vomiting, purging, abdominal pain, anxiety, thirst, etc. These may appear within an hour. Death usually takes place in a day after the poisonous fungus has been given. Treatment.—Administer an emetic, such as sulphate of zinc, or use the stomach-pump. Castor oil should also be given. Post-Mortem Appearances.—The stomach and intestines are usually found to be inflamed or even gangrenous. Carefully search the stomach for the gills and spores of the suspected mushroom. The fungus should be identified. TOXICOLOGY 89 CHAPTER IX. ANIMAL IRRITANTS. CANTHARIDES. (Spanish Flies.) Cantharis vesicatoria is an insect found in different parts of Europe, but especially in Spain. It is used extensively in medicine, both externally and internally. When dried, cantharides contain a volatile oil and a neutral crystalline principle, cantharidin, which is the vesicating principle. Can- tharidin also exists in cantharis vittata, or the potato fly, which is frequently substituted for the Spanish fly. When applied to any surface, cantharidis acts as an intense irritant, and, in contact with the skin, produces an inflammation which often results in a serous effusion under the cuticle. If the application be long continued, gangrene may result and constitutional effects be manifested. The one-hun- dredth of a grain of the active principle may raise a blister on the lips. Symptoms.—It acts as an irritant to the gastro-intestinal tract, causing vomiting and purging, burning heat in the stomach, pain in the loins, and great thirst. The vomit may be mixed with bloody mucus and shreds of membrane. There is constriction and difficulty of swallowing and dryness of the fauces. Then there is an incessant desire to urinate, which is attended with severe pain and the voiding of but a few drops of bloody urine. This is accompanied with tenesmus. Priapism occurs in males, and heat and swelling of the labia in females. Sometimes there is faintness, with giddi- ness and delirium, the patient soon passing into convulsions and death. The stools frequently contain shiny golden or green particles, which are remnants of the wings of the insect. If the tinctura cantharidis has been taken, the symptoms develop very rapidly. One ounce of the tincture and twenty-four grains of the powder have caused death. The fatal period is usually stated at from twenty-four to thirty-six hours. Treatment.—There is no known antidote. Emetics and thick warm liquids should be given. The administration of cathartics (castor oil), opium, and stimulants is advisable. Post-Mortem Appearances.—Intense inflammation of the mucous membrane of the stomach and intestines. The mouth, oesophagus, and throat, together with the ureters, kidneys, and bladder, are also inflamed. Congestion of the brain has been noticed in some instances. If the powder has been taken, the shiny green particles can be distinguished in the stomach and bowels. Tests.—An extract of the suspected materials should be made, and OO A MANUAL OF LEGAL MEDICINE treated by digesting with ether or chloroform until exhausted. This dis- solves out the active principle, cantharidin. The ethereal solution is then evaporated until almost dry, when the few drops that are left should be ap- plied on lint to the lips or the forearm, and covered with isinglass plaster or gold-beaters' skin, when the resulting vesication is the test of the presence of the cantharidis. POISONOUS FOODS. Certain animal foods are frequently found to produce poisonous symp- toms, either owing to idiosyncrasy (for only a single person out of several may be affected) or depending upon the action of some noxious agent in the organic matter of the food itself, either introduced for homicidal pur- poses or of bacterial origin.1 Such cases occasion symptoms of a violent nature, and are of some importance to the medical jurist on account of their poisonous effects. Sausage Poison.—The poisonous effects of sausage-meat are supposed by some to depend on a peculiar fatty acid (batrolinic acid), which is capable of developing in cured and dried sausage. A more recent theory, however, is that the presence in the meat of an entozoon named trichina spiralis is the cause of the so-called sausage-poison. ( Vide Trichina Spiralis.) In other cases there is generated in uncured sausage-meat a ptomaine developed by the action of bacterial growths, and this may be the cause of the untoward symptoms of the poison. The symptoms thus occasioned might give rise to unfounded charges of criminal poisoning, or be attributed to poisoning by one of the mineral irri- tants. The examination of the suspected food, or of a piece of a muscle of a living or dead subject, both microscopically and chemically, will generally demonstrate the true source of the trouble. Cheese Poison.—This common article of food frequently gives rise to symptoms of poisoning very similar to those occasioned by the ordinary irritants. The cause of the peculiar effects shown after the ingestion of such food is unknown. By some it was ascribed to a putrefied state of the curd. Again, it has been supposed that the poison is derived from an improper fermentation-of the milk. Professor Vaughan, of Michigan, claims that it is due to a ptomaine to which he has given the name tyrotoxicon. This recent discovery appears to be the true source of the disorder. Poisonous Fish.—It is a well-known fact that certain individuals, through idiosyncrasy, are poisoned after eating various kinds of fish. Severe symptoms arising from an irritation of the gastro- intestinal tract, somewhat resembling cholera morbus, are developed. This poisonous action, how- ever, cannot be referred in all cases to idiosyncrasy. Of all the varieties of shell-fish, mussels, which are extensively employed in various parts of Europe as food, occasionally produce very alarming symptoms. The poisonous action of this shell-fish seems to be due to a specific ptomaine, mytilotoxine, 1 Vide Ptomaines. TOXICOLOGY QI discovered by Brieger. The action of this substance somewhat resembles that caused by curarine. The symptoms in some cases are those of a simple irritant, such as nausea, vomiting, purging, cramps, etc. In other instances the nervous symptoms are well marked, while the gastro-enteric disturbances are slight. Of these nervous symptoms, delirium, insensibility, loss of muscular power, coma, dyspnoea, and convulsions are conspicuous. Again, an eruption similar to urticaria, together with asthma, frequently appear. Pickled salmon and herrings have produced poisonous symptoms. Putrid Meat.—The symptoms occasioned by decayed meat are both of a gastro-enteric and typhoid character, or septicaemia. ( Vide Dissecting Wounds.) Partial decay also renders meat unfit for food. The nature of the poison is probably due to one or more poisonous ptomaines. Much of the meat sold to the poor of this city is unwholesome, being in a state of decay, and totally unfit for human food. Poisoned Meat.—Persons are often poisoned by having partaken of the flesh of various animals or birds which have fed upon such deleterious substances as datura stramonium, the leaves of kalmia, or grain which has been steeped in a solution of arsenic previous to planting. Cows and goats frequently feed upon the first-mentioned plant, and cause poisoning in those who drink their milk. Kalmia, or laurel, leaves and buds are common food for the pheasant. TRICHINA SPIRALIS. The seat of this microscopic entozoon is in the muscular tissue of the body. It exceeds in minuteness of form and in numbers every other para- site. The minute worm exists coiled up within an oval cyst, appearing to the naked eye as a tiny white speck. When found in the muscles, it is generally in those that are superficial, the affected muscles being of a pale reddish-gray color, and the trichinae, which exist in all stages of develop- ment, being scattered about within the muscular-fibre sheaths. Trichinae have been found in the substance of the heart itself. The source of the parasite is from raw or imperfectly cooked pork or sausages. After the introduction of the ova into the stomach, trichinae de- velop at once, the embryos passing into the intestines, from which they progress to the muscular tissue of the body. The parasite is perfectly harm- less while enveloped in its capsule. Symptoms.—These are manifested by great depression, lassitude, loss of appetite, and sleeplessness. Fever follows, with muscular pains of great severity, and sometimes oedema of the face and eyelids, swelling of the joints, followed occasionally by severe contractions of the flexor muscles of the extremities. Diarrhoea is often an early symptom. Again, typhoid dis- turbances supervene, and the patient dies in an unconscious state. In fatal cases, trichinosis produces its effects within a month after the ingestion of the parasite. 92 A MANUAL OF LEGAL MEDICINE Treatment.—There is no known remedy for trichinae. Santonin may be tried. Avoid raw or imperfectly cooked pork. Microscopic Examination.—The form of the trichina spiralis is ex- pressed in the name. It is found within the sarcolemma of the muscular fibres. It possesses an alimentary canal. When removed from its cyst, this parasite measures about one-thirtieth of an inch in length, and about one- seven-hundredth of an inch in diameter. CHAPTER X. CLASS II.—NEUROTIC POISONS. ORDER I.—CEREBRAL NEUROTICS. (i) NARCOTICS. OPIUM AND MORPHINE. Remarks—Symptoms—Treatment—Fatal Dose and Period—Diagnosis—Post-Mortem Appearances—Tests—Toxicological Examination—Failure to detect the Poison. Opium is the concrete milky exudation of the unripe capsules of the Papaver somniferum, or white poppy (nat. ord. Pap aver ace a), a native of Persia, but cultivated throughout the world. It is a very complex sub- stance, being composed of various constituents, such as alkaloids, resin, gum, coloring matter, oil, etc. Its principal properties are due to morphine (CI7HI9N03), an alkaloid which crystallizes in truncated prisms, of an alka- line reaction, combining with acids to form salts. The chief salts of this alkaloid are the acetate, the sulphate, and the hydrochlorate, which are soluble in water and alcohol, but insoluble in acetic ether. Morphine itself is insoluble in ether and chloroform, very little in water, more so in alcohol, and also in acetic ether. It is also soluble in the saliva and gastric juices. Therefore, if at any time of the ingestion of the drug the individual's saliva and gastric juice do not happen to be flowing freely, he may take without apparent harm a much larger quantity than would be necessary to kill him if these juices were being freely secreted. Other opium alkaloids are codeine, narceine, narcotine, thebeine, papa- verine, pseudomorphine, laudamine, hydrocotarnine, cryptopine, porphyrox- ine, meconine, etc., united with meconic acid as meconates in the natural state. Meconic acid is characteristic of opium alone. The proportion of opium and morphine in different specimens ranges from six to fifteen per cent. Dried pulverized opium should contain from thirteen to fifteen per cent., while in its normal moist condition not less than nine per cent, is required by the United States Pharmacopoeia. Of the TOXICOLOGY 93 other alkaloids, they form together from four to ten per cent, by weight of the opium. The various preparations of opium and morphine with their strength are as follows : Opii pulvis {powdered opium) contains not less than twelve nor more than sixteen per cent, of morphine. Opium denarcotisatum (denarcotized opium) contains fourteen per cent, of morphine. Pilulas opii {opiumpills) contain each one grain of powdered opium. Trochisci glycyrrhizae et opii (troches of glycyrrhiza and opium; Mslar's cough lozenges) contain each one-twentieth of a grain of the extract of opium. Pulvis ipecacuanhas et opii {powder of ipecac and opium; Dover'spowder) contains opium and ipecac, of each one grain, with sugar of milk. Tinctura opii {tincture of opium; laudanum) contains ten per cent, of opium. Acetum opii {vinegar of opium ; black drop) contains ten per cent, of opium. Tinctura opii camphorata {camphorated tincture of opium; paregoric) con- tains four-tenths per cent, of opium. Magendie's solution contains sixteen grains of sulphate of morphine to the fluidounce. In addition to these preparations, there are numerous patent medicines rich in opium or morphine which have proved fatal. Such are Mrs. Winslow's Soothing Syrup (containing about as much as one grain of morphine to the ounce), Godfrey's Cordial (containing about one grain of opium in two ounces), and Dalby's Carminative (containing one grain in six). The action of the alkaloid morphine differs from opium in that it is less of a diaphoretic, less constipating, and about four to six times as active in other respects. The effects of both these drugs are so nearly alike—those of energetic poisons—that they will be considered together in this work. In the years 1876 to 1880 over forty per cent, of all the cases of poison- ing in England were due to opium. (Blyth.) Of these, three hundred and ninety-three were males and two hundred and fifty females, and out of the total number there were but two cases of homicide; the rest—twenty-two and four-tenths per cent, of the female cases and thirty-six and five-tenths per cent, of the male—were due to self-destruction. Out of nine hundred and seventy-seven accidental deaths in New York City from 1870 to 1891, inclusive, one hundred and seventy-nine were poisoning by opium or its alkaloid. Symptoms.—The symptoms of opium and morphine, as already stated, are essentially the same ; the latter drug, however, acts more rapidly and tends to produce convulsions more frequently than does opium. This is especially the case with infants. The first appearance of the symptoms will depend on the size of the dose, the condition of the stomach at the time of administration, and the form of the poison. The symptoms usually show themselves after a large dose in about twenty or thirty minutes. They begin with giddiness and confusion, soon followed by great drowsiness and an irre- 94 A MANUAL OF LEGAL MEDICINE sistible inclination to sleep. The breathing is slow and stertorous, the res- pirations frequently not exceeding two or three a minute. The pulse may be unaffected or at first slow and full, but toward the end it becomes rapid, feeble, or irregular, and often scarcely appreciable to the touch. The pupils are minutely contracted (pin-hole), and it is well to recollect that other alka- loids, such as eserine, aconitine, and strychnine, produce the same effect, but the general symptoms occasioned by them are different. Often an intense itching of the nose is present, being a symptom of great value in the diagnosis of opium-poisoning. In some cases the skin is cold and livid ; in others it is bathed in a profuse perspiration. The mus- cular system is generally in a relaxed condition. Vomiting sometimes occurs. In the later stages of the poisoning it is with the greatest difficulty that the patient can be aroused, and at last he passes into complete coma, with pallor and a ghastly countenance. Death may occur through sudden heart- failure, and it is often preceded by convulsions, especially in children or infants. The external application of opium and morphine, especially to an abraded surface, and even to the sound skin, has proved dangerous, and even fatal. Death has followed the administration of the drug by the rectum or hypo- dermatically. Treatment.—The first object is to remove the poison from the stomach as speedily as possible by means of the stomach-pump or tube, or by an emetic, as mustard-water, or sulphate of zinc. If no emesis is induced by these in a short time, they must be abandoned. It is important to wash out the stomach with strong tea. The absorption of the poison may be retarded to a certain extent by the administration of tannic acid, solution of iodine, or pulverized charcoal. Use faradism and artificial respiration, flagellation with wet towels, to keep up respiration by reflex irritation, best applied to the region of the trigeminus. Keep the patient moving about and awake. The administration of strong coffee enemata with brandy is indicated. Atropine is good as a respiratory stimulant. It may be given hypoder- matically in one-sixtieth of a grain doses, repeated in half the amount at the end of fifteen to thirty minutes if required, the guide to its administration being regulated by the respiration. Strychnine, cocaine or caffeine, and potassium permanganate are also recommended. Fatal Dose and Period.—It is well known that some individuals are always more susceptible to the influence of the drug than others ; also that beginners can only stand a small quantity at first, but when they become accustomed to it they can take, without serious results, doses which at first would have surely proved fatal. Even the confirmed habitue", who imagines himself " proof" against anything but the largest quantities, may some day end his existence by a dose smaller even than he has frequently taken before. This peculiarity is probably due to the fact that at the time of the ingestion of the poison the stomach glands were actively secreting juices of a more TOXICOLOGY 95 acid nature than usual. By this means the drug is assimilated into the blood much more rapidly and thoroughly than usual, and the result is disastrous. Children and young infants are very susceptible to the effects of opium and morphine. Two or three drops of laudanum have caused death in very young infants. The narcotic effects may be transmitted to the child through the milk of a mother who has taken the drug. The tenth and twelfth part of a grain of opium have respectively proved fatal to infants two and five days old. There is a case recorded where about the twelfth of a grain (one drop of laudanum) resulted in death in an infant seven days old. The child was in a comatose condition up to the time of death, some eighteen hours. On the other hand, children sometimes recover from very large doses of the drug.' The average minimum fatal dose of opium for an adult is about four or five grains, but persons have survived much larger quantities. The system may soon acquire a tolerance for the poison by habit, and enormous quanti- ties can be taken without apparent effect. Thus, De Quincey accustomed himself to the daily use of nine ounces of laudanum, an equivalent to three hundred and sixty grains of solid opium. The habitual employment of this drug, however, is extremely injurious to the human system, especially in the form of opium-smoking. The average period at which death takes place from opium-poisoning may be stated at from seven to twelve hours. The shortest recorded period is three-quarters of an hour, while, on the other hand, death has been pro- tracted for twenty-four or forty-eight hours. The chances of recovery are good if the patient survives twelve hours. One grain of morphine has proved fatal, and, hypodermatically, one-sixth to one-half of a grain. Again, enormous quantities have been taken with- out serious results ; thus, two drachms of morphine were taken by a person without causing death. The symptoms of morphine-poisoning come on in from fifteen to thirty minutes to an hour or three-quarters. Death may take place within forty- five minutes, but usually not before eight to ten hours. Diagnosis.—In diagnosing the effects of poisoning by opium from those due to apoplexy, epilepsy, etc., it is to be remembered that in apoplexy, involving the pons Varolii, the pupils are also contracted as in opium-poi- soning. Other important diseases or conditions to be kept in mind are acute alcoholism, uraemic coma, and poisoning by chloral and other nar- cotics. It is extremely difficult, if not impossible, to diagnose opium-poison- ing from the symptoms alone ; and even with the post-mortem evidences the exact nature of the case is fraught with difficulties. Unless the evidence from the toxicological examination is clear and unequivocal, particularly if 1 The writer saw a case of accidental poisoning by morphine in a new-born child. One-quarter of a grain was the quantity administered, and the infant lived several hours. {Farace case.) 96 A MANUAL OF LEGAL MEDICINE the history of the case is obscure and the postmortem appearances nega- tive, no definite conclusion can justifiably be reached. Post-Mortem Appearances.—These are not very characteristic. There is usually a turgid state of the vessels of the brain, with an effusion of serum into the ventricles and at the base. The lungs and other vascular organs may be in a state of congestion. There may be heart-clots in both sides of the heart, and thrombosis of the pulmonary artery. These changes, when present, are not characteristic of death from this poison. Tests.—Opium itself has no direct chemical test. But, as every watery solution contains the meconate of morphine, well-marked reactions are used to distinguish the alkaloid of opium, morphine, and its peculiar acid, meconic. I. Morphine.—The important tests for this alkaloid are the nitric acid, ferric chloride, sulphomolybdic acid, and iodic acid. (i) Nitric Acid Test.—With morphine and its salts concentrated nitric acid produces a rich orange-red, slowly fading to yellow, or sometimes a brownish-yellow color, which upon standing strikes a light yellow. Nitric acid also produces a reddish color with other organic substances, but these are not crystalline. It strikes a deep-red color with brucine, which upon the addition of stannous chloride is changed to a bright purple ; no such change is produced in the case of morphine. (2) Ferric Chloride Test.—This chemical, also the sulphate, strikes with morphine or its salts a deep-blue color, which slowly changes to a dark greenish blue, which is destroyed by free acids, by alkalies, and by heating. With ferric chloride, salicylic acid, carbolic acid, gallic acid, and various forms of tannin produce a bluish color. These substances are all soluble in water or ether. It is important, therefore, to remove them from the sus- pected matter before making use of the ferric chloride test. Nitric acid destroys the blue color produced by ferric chloride, forming a reddish-yellow mixture. This is occasioned by the action of the acid on the alkaloid. Ptomaines do not produce any morphine reaction with this test. (3) Sulphomolybdic Acid Test.—This reagent is prepared by dissolving five or six grains of molybdate of sodium or ammonium in two drachms of strong sulphuric acid. If morphine is treated with this acid, it strikes a beautiful violet color, changing to green, and finally to a sapphire-blue. A similar reaction is produced by a few glucosides and papaverine. The foreign matter that usually exists in complex organic mixtures may interfere with the success of the test; therefore the material to be examined should be thoroughly purified before applying the test. The sulphomolybdic acid test is also known as Froehde's test. (4) Iodic Acid Test.—Iodic acid is reduced by morphine, rendering the color of the solution brownish, from the free iodine. If starch is present, a blue color is formed by the formation of iodide of starch. If the liquid is treated with chloroform, the latter dissolves the iodine and assumes a purple color. Other substances produce this reaction, however, but the value of the reaction is principally as a negative test. TOXICOLOGY 97 Other tests for morphine are employed, and are sometimes useful, but the four reactions just mentioned are the important ones used to distinguish morphine. Among the different tests for this alkaloid are the following : iodine in iodide of potassium, terchloride of gold, and bromine in hydro- bromic acid. II. Meconic Acid.—Pure meconic acid occurs in the form of colorless crystals, and is somewhat sparingly soluble in cold water, but more so in alcohol. This acid is found in no other substance than opium ; therefore its discovery affords positive proof of the existence of that drug. (i) Ferric Chloride Test.—Meconic acid gives with ferric chloride a deep- red color ; this is also true of the salts of this acid. This red color is extin- guished by stannous chloride, but not by corrosive sublimate, nor by any free mineral acid in excess. A similar color is produced by the sulphocyanates, such as found in the saliva, and consequently in the stomach ; but the color of the meconate is not discharged by chloride of gold or corrosive sublimate, while that of the sulphocyanates is. A red color is also produced by strong acetic acid and most of its salts, but the free mineral acids destroy it more readily than that occasioned by meconic acid. (2) Lead Acetate Test.—When meconic acid is treated with a solution of acetate of lead, meconate of lead is thrown down as a yellowish-white pre- cipitate. This precipitate is insoluble in acetic acid. If the ferric chloride test is applied, a deep-red color results. Lead acetate produces a white or yellowish-white precipitate with sul- phuric acid, sulphocyanic acid, tannic acid, citric acid, etc., either free or combined as salts. These latter generally fail to produce the red color that ferric chloride gives with meconic acid, or they are soluble in excess of acetic acid. Toxicological Examination.—The presence of opium in the contents of the stomach, the vomit, or the tissues may be considered certain if the chemical analysis shows the existence of either meconic acid or the principal alkaloid, morphine. Therefore, when opium is suspected to have been ad- ministered, the duty of the toxicologist is to examine for both meconic acid and morphine. If, however, the latter drug is believed to have been taken, the tests are for morphine alone. The contents of the stomach should be examined for particles of undis- solved opium. The odor of opium or its preparations may be detected in the stomach or vomited matters. If the matters found in the stomach be solid, they should be finely comminuted, digested over a water-bath, acidulated with acetic acid, and filtered. The filtrate is then evaporated, and three volumes of strong alcohol added, and well mixed. Filtration is again resorted to, in order to separate the insoluble material, and the filtrate evaporated ; this expels the alcohol. The residue should then be dissolved in acidulated water and strained. To the fluid which has passed through, a slight excess of acetate of lead is added until all precipitation ceases. The precipitate produced containing any meconic acid that may be in the solution 7 9g A MANUAL OF LEGAL MEDICINE is in the form of the insoluble lead meconate. After standing, it is thrown on a filter and the precipitate flushed with pure water. The morphine re- mains in the solution as an acetate. Therefore there are two portions to be subjected to analysis,—viz., the substance on the filter for meconic acid, and the filtrate for morphine. I. To separate the meconic acid, the material on the filter is diffused through pure water, and sulphuretted hydrogen gas passed for a time ; this throws down the black insoluble sulphide of lead, the meconic acid remaining in solution. The mixture is then filtered to concentration, and a trial test made with a portion of this liquid. This is accomplished by treating it with ferric chloride. The remaining part of the fluid is subjected to the lead acetate test. If the characteristic reactions follow, then meconic acid is present, and if in sufficient amount will crystallize on evaporation of the liquid. II. In the search for the morphine, the filtered fluid, containing the mor- phine in the form of acetate, together with the excess of lead acetate, is to be treated with sulphuretted hydrogen, which is passed through the fluid to saturation, in order to remove the excess of lead acetate by converting the lead into the insoluble sulphide. The mixture should stand in a warm place for several hours, in order that the sulphide may settle, when it may be sep- arated by filtration. The latter is evaporated by gentle heat and placed in a test-tube. To this is added a slight excess of ammonia, a double volume of hot amylic alcohol poured in, and the whole violently shaken. After a little while the amylic alcohol will rise to the top of the tube, and may be removed by means of a pipette. The aqueous fluid should be shaken again with the alcohol, when separation will occur. This may be added to the first portion, and the combined amylic alcohol evaporated at a gentle heat. The residue is then carefully examined for morphine under the microscope. All impurities and extraneous matter should be freed from the residue before applying the characteristic tests for the alkaloid. This is accomplished by dissolving the residue in a little dilute acetic acid and filtering the mixture. The remaining liquid should be alkalized by pure potassium carbonate, and shaken up with a double volume of hot amylic alcohol. This takes up the impurities, leaving the morphine unaffected. The material is then subjected to one of the tests before described.1 Detection in the Tissues.—As a rule, the detection of morphine in the 'Organs and tissues is a very difficult if not an impossible task. On the other hand, cases are recorded where it has been detected months after death. 'Dr. Walter S. Haines (Hamilton's System of Legal Medicine) says, "None of the tests for the alkaloid (morphine) are absolutely conclusive when acting upon unknown complex mixtures. Professor Vaughan has clearly shown that under certain conditions normal constituents of the gastro-intestinal tract may give reactions strikingly similar to those produced by morphine when not thoroughly purified. ... I should be unwilling to accept the presence of morphine as having been demonstrated, unless the alkaloid had been isolated in a pure or practically pure crystalline form, and had given with all the tests unequivocal reactions." TOXICOLOGY 99 Subdivisions of the organ to be examined, such as the liver, brain, etc., are made. These are treated with water until a thin paste results, when they are subjected to a gentle heat for three hours after having been strongly acidulated. The mixture is then strained, and the fluid which has passed through evaporated to a small bulk. Three or four times its volume of strong alcohol is added, being stirred in. The liquid is then filtered from the resultant insoluble precipitate, and concentrated on the water-bath until complete expulsion of the alcohol has taken place. The remaining sirupy residue should then be extracted with water and filtered. The filtrate is treated with ammonia and hot amylic alcohol, the alcohol evaporated on a watch-glass and tested. Action of the Poison on Frogs.—Opium or morphine produces a peculiar action on these animals. When the drug is injected, the frog jumps about restlessly, and soon passes into a condition strikingly similar to that occasioned by strychnine when that substance has been employed in experi- mentation. Tetanic convulsions are readily produced upon the slightest movement on the part of the animal, or by the application of external irri- tants. This condition is by no means constant. Paralysis of the reflex movements and cessation of respiration follow the tetanic stage, the action of the heart being unimpaired. Failure to detect the Poison.—It frequently happens, notwithstanding the careful details followed in ascertaining the presence of opium or its alka- loid in complex mixtures, that the minutest trace of the poison is undiscov- erable. This result may be due to one of several causes. The poison may undergo some decomposition in the body even before death, thus interfering with the chemical analysis ; or life has been prolonged for a number of hours, thus affording an opportunity for its complete absorption from the stomach, rendering it impossible to discover it in any one of the tissues. Again, the presence of ptomaines might entirely obscure the poisonous sub- stance.1 In the famous Dr. Buchanan poisoning case, where the accused was finally convicted of murder in the first degree and electrocuted, the medical experts for the defence claimed that the victim died a natural death, and that the substances found in the body forty-five days after life departed, and which responded to several well-known tests for morphine, were really products of decomposition. W. S. Haines reports a case where he failed to find the minutest trace of morphine in the stomach of a woman who lived about eighteen hours after swallowing not less than ten or fifteen grains of the drug. The exami- nation was conducted soon after death, but the most careful tests failed to produce the faintest reaction. It is important to remember, in instances of supposed poisoning, that opium and morphine are used as remedial agents ; hence the mere detection 1 Vide Ptomaines. IOO A MANUAL OF LEGAL MEDICINE of morphine or meconic acid in a dead body would by no means demonstrate the existence of poisoning. ALCOHOL. Alcohol (ethyl hydrate) results from the fermentation of sub>tances containing grape-sugar. It is a light, colorless liquid of burning taste and characteristic smell, uniting in all proportions with water. It is an inflam- mable liquid. The alcohol of the United States Pharmacopoeia has a specific gravity of 0.820, containing ninety-four per cent, of absolute alcohol by volume. When first distilled, alcohol contains fusel oil (amylic alcohol), glycerin, and succinic acid. Alcoholics are used medicinally as diffusible stimulants, particularly for the action on the heart. Spirituous liquors in large quanti- ties frequently cause death. The administration of this liquid for suicidal or homicidal purposes is rare. The most common cause of fatal cases is ob- served in those instances where large doses of spirits are ingested, either as a foolish wager, as a silly bravado, or where a person, already in an intoxi- cated state, is drugged by his companions in a spirit of fun. The official preparations, together with their strength in alcohol, are subjoined : Alcohol {alcohol) contains ninety-four per cent, by volume of absolute alcohol. Alcohol dilutum {diluted alcohol) contains fifty per cent, of alcohol; specific gravity 0.920. Spiritus frumenti (whiskey) is obtained by distillation from grain, and is at least two years of age; it contains from fifty to fifty-eight per cent, by volume of alcohol; its specific gravity is from 0.917 to 0.930. Spiritus vini gallici {brandy) must be at least four years old. It is obtained from distilling fermented grapes, and contains from forty-six to fifty-five per cent, by volume of alcohol; its specific gravity is from 0.925 to 0.941. Brandy contains tannic acid, and is therefore better to use in bowel com- plaints than whiskey. Yinum rubrum {red wine) is obtained by fermenting the juice of colored grapes in the presence of their skins. It contains from ten to twelve per cent, of absolute alcohol, and is somewhat astringent. Vinum album {white wine) is made by fermenting the juice of the grape, and contains from ten to twelve per cent, by weight of absolute alcohol. Vinum album fortior {stronger while wine) contains from twenty to twenty- five per cent, by weight of absolute alcohol. Many other preparations are employed as beverages, such as gin (forty to fifty per cent, alcohol), weiss beer (one per cent, alcohol), cider (about six per cent, alcohol), and rum (about forty to fifty per cent, alcohol). The sweet wines contain undecomposed sugar, while the dry wines have their sugar converted into alcohol. Alcohol acts as an acute poison by the nerve-action being paralyzed until the progressive influence reaches the medulla oblongata, when coma follows. In cases of chronic poisoning the connective tissue is thickened by its in- fluence, thus setting up catarrhal conditions of the mucous membranes and TOXICOLOGY IOI atrophy of the various glands and organs. The blood-vessels are in a brittle condition ; there are tremor and dulness, terminating in paraplegia. Whiskey owes its injurious effects to the presence of fusel oil (amylic alcohol, potato spirit). This oil has an agreeable smell when in small quan- tities, but it is suffocating when strong, and produces intoxication, with its sequelae, with great rapidity. Symptoms.—Acute.—These usually come on rapidly. Large quantities cause disordered digestion, intoxication with muscular incoordination and weakness, and hallucinations. The temperature is lowered, and the patient soon passes into the stage of complete stupor and coma. Collapse soon sets in, unless there is vomiting. The pupils are usually, but not invariably, di- lated. The patient's features have a ghastly expression, or they may appear bloated. The lips are livid, the conjunctivae red, and the odor of alcohol may be detected in the breath. There may appear a bloody froth on the lips ; involuntary evacuations may take place ; the respiration may be ster- torous, increasing in difficulty until, finally, the sufferer dies. This may occur in half an hour, or even sooner, after the ingestion of the fatal bev^ erage. In some cases a remission of the symptoms has taken place, the patient even performing one or more rational acts, etc., apparently recov- ering from the effects, when suddenly he becomes insensible, and expires during convulsions. Treatment.—Evacuate the contents of the stomach, and administer strychnine or ammonia. The hot and cold douche, a free supply of fresh air, and galvanism may be tried if there be asphyxia. The administration of coffee as a drink is recommended. Diagnosis.—Acute alcoholism may be confounded with concussion of the brain and opium-poisoning. In the former affection there may be bruises or injuries of the head, bleeding from the nose and ears, etc. In drunken- ness the odor of alcohol is apparent at once, being sufficient to disclose the nature of the case. The dilated condition of the pupils in alcoholism is not a constant sign, since it is not invariably present. Another important point to remember is that the patient may generally be roused for a short period. Post-Mortem Appearances.—The body, as a general thing, is re- markably well preserved. The stomach presents marks of deep conges- tion, and the odor of alcohol is readily perceived. There is more or less congestion of the brain, cerebral vessels, and membranes. The lungs are in a state of congestion, and the blood is fluid. Rigor mortis is rather persistent. Tests.—The odor of alcohol is a valuable sign. Anstie's test consists in adding to the suspected liquid a little potassium bichromate and some sul- phuric acid, when, on warming the mixture, an emerald-green color will be produced if alcohol is present. This test depends upon the formation of chromic acid, which by the oxidation of the alcohol is reduced to the emerald- green chromium oxide. Other tests are the taste of the alcohol, which is hot and pungent; its power of burning with a pale-blue flame, leaving no 102 A MANUAL OF LEGAL MEDICINE carbonaceous residue, but producing carbonic acid and water. Alcohol dis- solves camphor. Toxicological Examination.—In some cases the recovery of the alcohol from the stomach can be accomplished by distillation. If the con- tents of the stomach are acid, they should be neutralized with potassium or sodium carbonate. The mixture is then mixed with calcium chloride and again subjected to the process of distillation. This latter distillate is shaken with dry potassium carbonate. After standing a short time, the stratum of alcohol which appears at the top of the fluid is drawn off for testing pur- poses. If alcohol has not been detected in the contents of the stomach, it should be looked for in the liver and brain. CHAPTER XI. (2) ANAESTHETICS. ETHER. This substance, when pure, is a limpid, colorless, mobile liquid, of a peculiar ethereal odor, and hot, pungent taste. It is highly volatile and in- flammable, and, when mixed with air, explosive. Ether has a specific gravity of 0.723, while it boils at 34.50 C. It is sparingly soluble in water. Symptoms.—Its effects, after the administration of large doses, are very similar to those of alcohol. When inhaled it causes slow and stertorous breathing, the surface of the body becomes cold, the face pale, and the lips livid. The period of delirious excitement is soon followed by coma and other symptoms of narcotism. Sensation is entirely abolished. There may be nausea and vomiting. Treatment.—The stomach-pump should be employed when the liquid has been taken, and followed by emetics ; otherwise the treatment consists in exposing the patient to the fresh air, the application of cold affusions, artificial respiration, the galvanic current, etc. Post-Mortem Appearances.—Ether is a powerful local irritant, and the stomach may be found in an inflamed condition. Congestion of the brain and lungs is usually present. The cavities of the heart are filled with dark liquid blood. The odor of the anaesthetic is perceptible if the autopsy is performed immediately after death. Tests.—Ether is discernible by its odor and taste and by its volatility. It burns with a smoky flame, depositing carbon, and it strikes a green color, evolving aldehyde when bichromate of potassium and diluted sulphuric acid are added. The method for its extraction from the stomach is the same as that described for alcohol. TOXICOLOGY 103 CHLOROFORM. Chloroform is a colorless, volatile, heavy liquid, evolving a dense vapor. It has an agreeable smell and a pungent taste. Its specific gravity is 1.497, and it is non-inflammable. Chloroform is almost insoluble in water, in which it sinks. At a red heat its vapor is decomposed into chlorine and hy- drochloric acid ; its solvent powers are great. Two varieties are found in the market, the chloroformum venale and the chloroformum purificatum, the latter being used for anaesthesia. Chloroform, like ether and other anaesthetics, when introduced into the system by inhalation, may cause death. Symptoms.—Locally, chloroform acts as a rubefacient, as a vesicant if confined, and as an anaesthetic to a slight extent. When taken internally it causes inflammation of the stomach. The symptoms produced by its inhalation may be divided into three sets, of varying intensity. These are : First, stimulation is not so well marked as in the case of ether inhalation. The patient experiences a certain degree of relief from pain, and the various senses are little affected. In the second stage the struggles of the patient are, as a rule, not violent, though in some cases the attempt to struggle is made. The pulse is strengthened and quick- ened ; but during the third stage, or period of anaesthesia, when muscular relaxation and the abolition of sensation and consciousness take place, it is somewhat diminished in frequency, being more or less weak. The breathing is stertorous, and the reflexes are entirely abolished. The patient usually dies from cardiac paralysis. When chloroform is taken internally in large amounts it acts as an irri- tant, causing gastro-enteritis, producing anaesthesia after its absorption. Elimination takes place through the lungs and kidneys. One drachm of chloroform has caused fatal results in a boy aged four years, who died in about three hours after its ingestion. Half an ounce and upward has caused death. Treatment.—When dangerous symptoms occur, the inhalations should be stopped and the patient inverted. Atropine hypodermatically is recom- mended ; also artificial respiration and faradization. Ammonia and whiskey are indicated if heart-failure ensues. If it has been given internally, the case is to be treated as one of irritant or narcotic poisoning. Post-Mortem Appearances.—In some cases the appearances of death by asphyxia are apparent. The odor of the anaesthetic is often perceptible. Putrefaction of the body is retarded to a certain extent, and rigor mortis is persistent. In death from inhalation there are no characteristic lesions. The lungs and bronchial tubes may be congested, and likewise the vessels of the brain. The condition of the blood is dark and fluid, and the heart is frequently flabby and collapsed. The writer has seen cases where death re- sulted from cardiac paralysis from the inhalation of chloroform preparatory to operations, and where no cardiac disease was present. 104 A MANUAL OF LEGAL MEDICINE Tests.—Characteristic tests are the odor and the taste. Chloroform burns with a green flame. When the chloroformum purificatum is shaken with equal volumes of sulphuric acid, a slightly yellow color is produced. It dissolves camphor, caoutchouc, and gutta-percha, and is a powerful solvent of many organic substances, such as the alkaloids, etc. Toxicological Examination.—The suspected substances are divided, and, together with distilled water, should be put into a large flask, through the neck of which is passed a hard glass tube, bent at right angles. The flask is slowly heated on a water-bath, while the horizontal portion of the tube passes over the flame of a Bunsen burner. The heat decomposes the chloroform, as it passes along the tube, into chlorine, hydrochloric acid, and carbon. If a piece of moistened litmus-paper is placed over the mouth of the tube, it is reddened and bleached. Starch-paper dipped in iodide of potassium is changed to blue, the iodine being liberated and forming the blue iodide of starch. The carbon may be known by its black deposition. The white chloride of silver is thrown down if the extremity of the tube is placed in a solution of nitrate of silver. It is important to remember, in connection with this subject, that during profound sleep a person may be anaesthetized without being awakened. If the sleep be slight or partial, the result is negative. ( Vide Holmes case.) HYDRATE OF CHLORAL. Chloral with water forms chloral hydrate. It is a white, crystalline solid, boiling at 980 C. and fusing at 570 C. Chloral hydrate has a disagree- able, pungent taste and an ethereal odor. It is obtained by passing chlorine through absolute alcohol. In water it is tolerably soluble, and with the alkaline hydrates it forms alkaline formates and chloroform. It is non- inflammable. Symptoms.—In large doses, chloral hydrate acts on the brain as an hypnotic, producing a powerful depressant action on the ganglia at the base of the brain and on the spinal cord. The sleep may pass into coma. Res- piration is slowed, and, by the depressing action of the drug on the heart, cardiac failure ensues. The temperature falls, and sensibility and reflex action are depressed. Its irritant action on the mucous membrane may occasion nausea and vomiting. In some cases delirium may supervene and take the place of the sleep which it generally causes. Toxic doses produce profound narcosis, slow and weak pulse, diminished frequency of respiration, great muscular relaxation, great reduction of the temperature of the body, and a decided contraction of the pupils. The surface of the body is usually livid. Death may be due to heart-failure, occasioned by paralysis of its motor ganglia, or by paralysis of the respira- tory function. Chloral hydrate appears to be a cumulative poison ; so care must be exercised in its administration. Frequency in repetition of the medicine is to be discountenanced. TOXICOLOGY IQ5 The action of this drug is supposed by some to be due to its decomposi- tion in the blood, whereby an alkaline formate and chloroform are produced. The smallest recorded fatal dose is thirty grains, while, on the other hand, enormous quantities (more than one ounce) have been swallowed with impunity. Treatment.—The temperature of the body should be kept up by artificial heat. Small and repeated doses of atropine are indicated to maintain the action of the heart. Respiration is to be maintained by atropine or mor- phine, or by artificial means. Picrotoxin has been used as an antidote. Post-Mortem Appearances.—The odor of the drug may be noticed after death. The lesions of chloral-hydrate-poisoning are not characteristic. Hyperaemia of the brain may be observed in some cases. Extraction from the Stomach.—The solid, suspected materials should be divided and diluted with distilled water. They are then treated with potash to render them alkaline, heated in a flask, and tested for as previously described under the head of Chloroform. NITROUS OXIDE. This is a colorless, almost odorless, gas, produced by the action of heat on ammonium nitrate. It is frequently employed as an anaesthetic in minor surgical operations, as the extraction of teeth, etc. The anaesthesia pro- duced is very likely due to a diminution of the relative amount of oxygen in the blood. When death results, it is usually due to asphyxia. METHYLENE BICHLORIDE. ETHYL BROMIDE. The first of these anaesthetics is a colorless, neutral liquid, with an odor similar to that of chloroform. Its vapor is highly inflammable, and when inhaled produces unconsciousness and freedom from pain. These effects soon disappear when the inhalation is discontinued. Fatal results are due to paralysis of the heart. Ethyl bromide is a colorless, neutral liquid, with a sweetish, disagreeable taste and ethereal odor. When inhaled it acts on the heart similarly to chlo- roform, being equally as dangerous. It is anaesthetic in its effects, but is seldom used as such. io6 A MANUAL OF LEGAL MEDICINE CHAPTER XII. ORDER II.—SPINAL NEUROTICS. NUX VOMICA AND STRYCHNINE. Nux Vomica—Strychnine—Symptoms—Treatment—Fatal Dose—Fatal Period—Post- Mortem Appearances—Diagnosis—Chemical Tests—Detection of the Poison in the Stomach—Detection in the Tissues—Quantitative Determination—Physio- logical Test—Discovery of the Poison after Long Periods—Failure to detect the Poison—Elimination—Brucine. Nux vomica is the seeds of Strychnos nux vomica, or poison nut (nat. ord. LoganiacecE), a tree growing in India. The seeds contain two active principles, strychnine and brucine, combined with lactic and igasuric acids. These latter exist in the proportion of from five-tenths per cent, to upward of one and five-tenths per cent. Some authorities claim a third alkaloid, igasurine. Nux vomica is the most important poison of the neurotics. The preparations employed medicinally in the treatment of disease are as follows : Abstractum nucis vomicae {abstract of nux vomica). Dose, gr. ss to ii. Extractum nucis vomicae {extract of nux vomica). Dose, gr. \ to i. Extractum nucis vomicae fluidum {fluid extract of nux vomica). Dose, rnji to v. Tinctura nucis vomicae {tincture of nux vomica). Dose, v\} to xx. Strychnina {strychnine). Strychninae sulphas {sulphate of strychnine). Dose, internally, gr. ^ to fa\ hypodermatically, gr. -fa, cautiously increased. Strychnine is frequently employed as a homicidal or suicidal agent. It appears in commerce as a white powder, or in the form of larger crystals, which are usually octahedra and four-sided prisms. It is odorless and very sparingly soluble in water (8333 parts of cold water are required). Abso- lute alcohol dissolves one part in about two hundred at ordinary tempera- tures, whiskey one part in about four hundred, and so with other similar liquids. Fourteen hundred parts of ether are necessary to dissolve one part of strychnine, chloroform one part in eight, and commercial ether one in about one thousand parts. Equal volumes of ether and chloroform dissolve it readily. It is insoluble in the fixed alkalies and sparingly so in ammonia. Strychnine is also found in other species of strychnos and in the seeds of Strychnos ignatii. The taste of this alkaloid is intensely bitter, and may be recognizable when so dilute as 1 in 100,000. The principal salt of strychnine is strychnine sulphate (StH2SO ), which dissolves in ten parts of water and sixty parts of alcohol. An important TOXICOLOGY IOy point in connection with the properties of this alkaloid is that it does not char or color with sulphuric acid, as do most other organic compounds. Symptoms.—As the symptoms of nux vomica and strychnine are essentially the same, they will be considered together. Strychnine acts more rapidly than the former, but that is the only difference between the two. The form in which the drug is given regulates to a certain extent the period of commencement. The first effect of the poison is a sudden shud- dering, restlessness, and great uneasiness, with a sense of impending danger. This is quickly succeeded by tetanic convulsions of all the voluntary mus- cles, accompanied with muscular pains, which pervade the whole body. The legs are stretched out stiffly, the feet are in an arched condition, and the arms drawn tightly round the chest. The head is bent back rigidly, and the body rests upon the head and heels, opisthotonos. The face presents a ghastly grin, the risus sardonicus, and soon becomes livid from the em- barrassed respiration. The muscles of respiration are rigidly contracted, producing a sensation of suffocation ; these muscles and the diaphragm remain fixed. The pupils are contracted, but dilate again with the relaxation of the spasm. The jaws are not always set during a paroxysm, and hence the patient may be able to speak. The pulse is usually very rapid and feeble. The mind is clear, even during the most intense suffering ; gasping for breath, the patient seeks in vain for relief. The paroxysm generally lasts from a quarter of a minute to a minute, though in some instances it may last from half a minute to several. After a time the muscles relax and an interval of quiet occurs ; the patient is ex- hausted and bathed in perspiration ; the pupils may be in a state of contraction or dilatation. After a short period of rest, varying from a few minutes to half an hour, the convulsions return, succeeding one another with remarka- ble rapidity. In fatal cases the spasms increase in frequency and violence, and the patient may die of asphyxia from fixation of the respiratory muscles, or death may follow paralysis or collapse during one of the intervals. The mind is usually clear to the last, though it may become clouded just before death, as a result of the deficient aeration of the blood. The symptoms of poisoning may be masked somewhat when the drug is associated with other substances, such as opium, chloral, and other narcotics. Treatment.—Prompt and free emesis is to be carried out; but if emetics fail, the stomach-pump should be passed through a perforated gag, to prevent the patient from biting it during a convulsion. Through this strong infusions of tea or oak bark or solutions of tannin should be injected, and the stomach thoroughly washed out. Before resorting to this method, the usual antidotes, such as chloral, chloroform, and the bromides, may be administered. If the sufferer cannot take them on account of the spasms, he should be put under the partial influence of an anaesthetic, such as chloro- form, when they can be given. The chloral may be given by the rectum, thirty to sixty grains, as necessary. While the latter drug is a good anti- dote for strychnine-poisoning, the converse does not hold good. Paralde- 108 A MANUAL OF LEGAL MEDICINE hyde and urethane have been recommended as antagonistic to this poison. The latter drug is administered in doses of from four to six grains. Atropine has proved efficacious where chloroform failed, and where the spasms were severe. Nitrite of amyl is another efficient remedy. Fatal Dose.—One-sixth of a grain has caused death ; also one-quarter of a grain. In the celebrated case of Dr. Warner, one-half of a grain, taken by mistake, occasioned death in eighteen minutes. A fatal dose for an adult may vary from half a grain to a grain. On the other hand, recovery has occurred after large doses, even after the ingestion of fifteen to forty grains. One-sixteenth of a grain proved fatal to a child of two years. Reese mentions the case of a man who suffered intense spasms after taking about one-twentieth of a grain. Infants at the breast may show poisonous symp- toms occasioned by the mother's milk, though the latter remains unaffected. This is probably due to the more irritable nature of the spinal cord of chil- dren. One-sixteenth of a grain hypodermatically has produced alarming symptoms. Fatal Period.—As a rule, death or recovery is always speedy, and the hope for recovery may be entertained if the patient lives over five or six hours. In Dr. Warner's case, before referred to, death occurred in eighteen minutes, and instances are recorded where the poison caused fatal results in five minutes. Again, life has been prolonged for several hours. Reese mentions a case where a woman died six hours after taking six grains of the alkaloid. In this instance, however, morphine had been previously given. Death has followed a dose of nux vomica in fifteen minutes after swallowing. (Christison.) Post-Mortem Appearances.—These are not characteristic, nor are they always similar. There may be congestion of the brain and spinal cord, with considerable effusion of blood. The stomach is usually normal, but occasionally it is found to be in a state of intense congestion ; also the lungs. The heart is sometimes full and distended, but more frequently these signs are absent. The body is usually relaxed at the time of death, but it rapidly takes on extreme rigidity, which is generally very marked and lasting. As mentioned above, the appearances after death are not entirely char- acteristic ; but other affections rarely produce collectively the congestion of the brain and cord, the effusion of blood and serum, and the rigor mortis. Diagnosis.—The effects of strychnine-poisoning are usually so char- acteristic that there is no great difficulty in forming a clear diagnosis from the symptoms alone. The only affection that can be confounded with it is tetanus, and possibly some forms of epilepsy. As a general thing, there is a great difference between the tetanus occasioned by a wound, or from disease, and that produced by strychnine. Diseases that have been advanced, on various medico-legal occasions, as bearing a resemblance to strychnine-poisoning are chorea, puerperal and uraemic convulsions, epilepsy, and syphilis. TOXICOLOGY Iog The symptoms occasioned by tetanus differ from those of strychnine- poisoning in the following respects : There is usually a history of some ex- citing cause, such as an injury, etc. The symptoms come on gradually, and reach their maximum development only at the end of several hours, pro- gressing slowly toward a fatal termination. As a general thing, several days elapse between the commencement of the trouble and death. The muscles that are first attacked are generally those of the back of the neck, and those of the jaw are early affected. The rigidity is more or less permanent, there being no intervals of relaxation, as in the case of strychnine-poisoning. The temperature is generally above the normal. In strychnine-poisoning there is no history of an injury, and the symp- toms appear suddenly, without warning, and progress rapidly to a fatal ter- mination. The muscles of the extremities are affected before any of the other voluntary muscles, those of the neck and jaw being affected last. The entire muscular system may be thrown into a convulsion almost simultane- ously. During the intervals between the spasms there is mostly complete relaxation, and the opisthotonos passes away. The body-heat is usually normal. There are some exceptions to these differences, but, as a rule, the diagnosis between the two affections is clear. As regards epilepsy, the mode of invasion, the unconsciousness, the clonic spasms, etc., are entirely at variance with the characteristic signs of strych- nine-poisoning. So, too, the profound stupor which ends the epileptic attack is markedly contrasted with the perfect consciousness and complete relaxation that succeed the strychnine convulsion. Tests.—Strychnine may be recognized by its intensely bitter taste, and can be readily detected i in 50,000, and 1 in 10,000 is distinctly bitter. The taste is even more delicate than the color test. It is well to remember, how- ever, that salicin, quinine, morphine, and other substances are also bitter, though none possesses the intensity of the bitterness of strychnine. Taste, therefore, is a highly characteristic test for this alkaloid. Haines' mentions four instances where persons were unable to appreciate the bitterness of strychnine. They described the taste as rough and slightly musty. Again, the bitterness may be covered by such substances as tannic acid, licorice, and chocolate. More or less bitterness is to be expected in examining a suspected residue if strychnine be present. If it is not bitter, it is not strychnine, but, though bitter, it may be something else. The Color Test.—If strychnine is dissolved in sulphuric acid, no change occurs ; but if an oxidizing agent, such as manganese dioxide, lead peroxide, potassium bichromate, etc., be added, it gives rise to a play of colors from deep blue to purple, violet, rapidly changing to crimson or red, and orange- yellow. Other substances, when treated with sulphuric acid and an oxidizing agent, occasion a play of colors similar to those mentioned. Such sub- stances are quebrachine, aniline, cod-liver oil, papaverine, curarine, and 1 Hamilton's System of Legal Medicine. no A MANUAL OF LEGAL MEDICINE veratrine. The colors produced by these agents are sometimes due to the sulphuric acid alone, or they do not present the same sequence as those occasioned by strychnine. Quebrachine is the only alkaloid substance which might be mistaken for strychnine when the color test is applied, as it pro- duces the same colors in the same order as does strychnine. It is possible, however, to discern a slight difference in the intensity and duration of the play of colors. Again, quebrachine is dissipated by heating it on a water- bath, while the alkaloid of nux vomica remains unaffected. Aspidospermine may also give a strychnine-like reaction, as it contains quebrachine. The medico-legal importance of the color test does not consist merely in the production of the blue color, for this might be occasioned by the appli- cation of potassium permanganate to other organic bodies in the absence of strychnine ; but its chief value lies in the regular succession of colors. The one-millionth of a grain of strychnine can be detected by this test if the drug be perfectly pure. There are other substances, such as brucine, morphine, and the nitrates, which might considerably modify this test by their presence. Accordingly, they must be separated, else the true value of the reaction is lost. The most important of these modifying substances is morphine ; and it can be readily isolated by heating the mixture with strong sulphuric acid, when the strychnine will be easily recognized. The color test may be further interfered with by the presence of certain indefinite organic substances extracted from the organs to be examined. Therefore, the material should be carefully purified ; which done, the re- action becomes perfect. Ptomaines may produce a strychnine reaction, but their other properties are so entirely different from strychnine that the two should not be confounded ; besides, they are destroyed by heating with sul- phuric acid. The Chromate Test.—If a solution of strychnine is treated with potassium bichromate, a bright-yellow precipitate of strychnine chromate is produced. It soon becomes crystalline, and under the microscope appears as octahedral plates. If dried and touched with a drop of strong sulphuric acid, a play of colors is formed which is similar to that occasioned by the color test. This is a very true test. The Galvanic Test.—Dr. Letheby suggested the use of galvanism in the production of the play of colors (color test), the principle being the same, with the exception that the nascent oxygen is evolved by means of the bat- tery. A drop of a solution of strychnine (i part in 15,000 or 20,000 parts of water) is placed in a small cup-shaped depression on the platinum-foil, and allowed to evaporate, when the spot is moistened with strong sulphuric acid. The foil is then connected with the positive pole of one cell of Grove's battery ; the acid is touched with a platinum terminal from the negative pole, with the result that the violet color will flash out, and remain after the nega- tive pole is removed. The Chlorine Test.—U a slow stream of chlorine gas is diffused through TOXICOLOGY in a dilute solution of strychnine, each bubble of the gas will be enveloped in a white film, and a white, amorphous deposit, soluble in ammonia, takes place. According to Tardieu, no other alkaloid produces the same effects. The Carbazotic Test.—Strychnine is thrown down in solution by carba- zotic or picric acid, an abundance of yellowish crystals being the result. The reaction is best viewed under the microscope ; and, for this purpose, the strychnine solution is placed on a glass slide, to which a drop of the carbazotic acid solution is added. Detection of the Poison in the Stomach.—The stomach and its con- tents should be finely comminuted, and a sufficient quantity of pure, acidulated water added in order to make the mixture distinctly fluid. The mixture is digested on a water-bath for about an hour, and then strained while still hot. After the liquid has been evaporated to about one-quarter its former volume, strong alcohol is slowly stirred in to separate the insoluble material, which should be removed by filtration. The filtrate is then evaporated to a thick sirup, and, after cooling, is taken up with a small amount of water acidulated with acetic acid. The mixture is again filtered into a test-tube and liquor potassae added, also an equal bulk of chloroform, when the whole is shaken. When the chloroform has settled, the aqueous fluid is removed, and the same process repeated with another volume of chloroform. The two chloro- form solutions are united, and concentrated by evaporation, when the residue will be found to contain any strychnine that may be present, mixed with organic matter. This residue should next be freed from the impurities by thoroughly mixing it with diluted acetic acid. It is then filtered, rendering it alkaline, and agitated with chloroform for some minutes. If this is evapo- rated, the alkaloid will be deposited in an almost pure crystalline condition. For still further purification, which is absolutely necessary in medico-legal cases, two or three drops of strong sulphuric acid should be added to the residue, and subjected to the heat of the water-bath for several hours, when the impurities will be carbonized or chemically altered. The mixture is then diluted with a small quantity of water, filtered, alkalized, and briskly shaken with chloroform. The chloroform is allowed to separate by evapo- ration on a watch-crystal, the residue being left in a pure condition. The various tests are now in order. After dissolving the residue in acetic acid, the taste test may be applied, or a drop of this solution evaporated and sub- mitted to the color test, or another drop treated with the chromate test, and subsequently examined by the microscope. Again, some of the sus- pected liquid may be injected subcutaneously into a small, delicate frog, and the effects noted. ( Vide Physiological Test.) Detection in the Tissues.—Strychnine, after absorption, is deposited in the various organs like mineral poisons. Its absorption may occur with considerable rapidity, and the detection of the poison be accomplished soon after death. Strychnine is usually found in the liver and kidneys, but it has been discovered in the blood, spleen, brain, and heart,—in fact, in almost all parts of the body. It is best to examine the body immediately after death. 112 A MANUAL OF LEGAL MEDICINE The tissues should be finely subdivided and digested in alcohol acidulated with sulphuric acid. When cool, the mixture is subjected to filtration and concentration, the residue being flushed with alcohol previously acidulated. Evaporation is then resorted to, and the residue treated, as above described, with chloroform. The latter is evaporated, the residue purified, and the tests applied as before. Quantitative Determination.—The qualitative process, as described previously, is carried on to the point where the chloroform (after the impuri- ties are carbonized or otherwise altered) is evaporated on a watch-crystal. Further purification is accomplished by treating the residue with a few drops of cold water, when it is dried and subjected to the action of strong sulphuric acid, and again dissolved out with chloroform, the latter being evaporated, and the process just described repeated in order to insure the perfect purity of the alkaloid, which is necessary for the weighing. The residue, when cool, is then weighed. Physiological Test.—Dr. Marshall Hall was the first one to employ this test, and it consequently bears his name. If a small frog be immersed in a solution of strychnine, or a subcutaneous injection of the fluid be made, strong tetanic convulsions will follow and reappear every time the animal is subjected to irritation. If the dose administered be a large one, death ensues. The one-ten-thousandth of a grain may be recognized by this test. Discovery of the Poison after Long Periods.—Strychnine may be discovered in a body some time after death, and it probably owes this prop- erty to its power of resisting decomposition. Cases are recorded where the poison has been detected even after the lapse of years, and Richter extracted it from putrid tissues eleven years after death. Most authorities agree, however, that the alkaloid slowly disappears after the interment of the body underground, until, finally, it cannot be recognized. Failure to detect the Poison.—Failure to discover strychnine after death, even where the conditions are favorable, may be due to the smallness of the dose, imperfect methods of extraction, incompetent manipulation of the analysis, or to the interference of some ptomaine, especially where de- composition is far advanced. Elimination.—The kidneys are the chief channels for the elimination of strychnine, and its presence in the urine is readily detected, though it usually disappears after the second day. It is generally understood that the poison is eliminated from the entire system within forty-eight hours. BRUCINE. This substance is generally found associated with strychnine, but its poisonous action is feebler, possessing from one-seventh to one-thirty-eighth of its powers. Brucine is soluble in chloroform and alcohol, being more so in the latter fluid and water than is strychnine. If taken in sufficient quantity, the symp- toms are identical with those caused by the latter substance, and the treatment TOXICOLOGY "3 is the same. Like strychnine, brucine is intensely bitter. It turns to a blood-red color in the presence of nitric acid, and is dissolved by concen- trated sulphuric acid, a faint rose coloration resulting. Brucine occurs in powder form, or in colorless prismatic crystals, and does not respond to the color test of strychnine. Tests.—Nitric acid produces a blood-red color, which on heating changes to yellow, rapidly dissolving the alkaloid. If, after cooling, a solu- tion of stannous chloride is added, a beautiful purple color is formed. This test distinguishes brucine from all other alkaloids. Nitric acid strikes a somewhat similar red color with morphine, etc., but it is not changed by stannous chloride. Nascent oxygen generated in the color test for strychnine has no action on this poison ; but if it is treated with bichromate of potassium, and then sulphuric acid, a play of colors is produced in the following order : orange, green, and, lastly, yellow, being dependent upon the reduction of the chromium salts. If methyl iodide is added to a strong alcoholic solution of the alkaloid, crystals in the form of circular rosettes appear. This test acts negatively with strychnine. The physiological test is applicable to brucine. The toxicological exami- nation is similar to that described under strychnine ; and, in testing, the nitric acid should be first tried and then the stannous chloride. CHAPTER XIII. ORDER III.—CEREBRO-SPINAL NEUROTICS. (1) DELIRIANTS. BELLADONNA AND ATROPINE. Belladonna is the berries, leaves, and root of Atropa belladonna, or deadly nightshade (nat. ord. Solanacea), a plant of Europe, but cultivated in the United States of America. Its properties depend upon an alkaloid termed atropine, which exists in all parts of the plant, especially the root, as a malate. It is found to exist in the root in quantities ranging from three- tenths to five-tenths per cent. The parts of the plant mentioned are all vio- lently poisonous, children being often poisoned by eating the berries. Atropine.—This alkaloid exists as a bitter, colorless, crystalline solid, without any odor, and is possessed of an acid taste. It is somewhat soluble in water, and readily so in chloroform and ether. Its properties are strongly alkaline, so much so that it neutralizes acids and produces salts, most all of which are soluble in water. Its principal salt is atropinae sulphas, the 8 II4 A MANUAL OF LEGAL MEDICINE medicinal dose of which ranges from one-hundred-and-twentieth to one- sixtieth of a grain. Symptoms.—Atropine, as a rule, acts quicker than belladonna ; other- wise the symptoms are identical. The symptoms generally begin in from one and a half to two hours after the ingestion of the drug, but may be pro- tracted for four or five hours. Sometimes they occur within twenty minutes. There are a sense of heat and dryness in the mouth and throat, dysphagia, nausea, and vomiting, together with giddiness, drowsiness, and intense thirst. There are extreme dilatation of the pupil, loss of vision, and the saliva may be suppressed. The vision may be indistinct or double. The action of the heart is increased, the pulse being abnormally rapid and strong. The face is flushed, and the eyes unusually brilliant and prominent. There may be some congestion of the conjunctivae. An early sign is loss of speech, with con- stant movement of the tongue and lips, as if attempting to speak. Irri- tation of the genito-urinary apparatus frequently occurs, and strangury, suppression of the urine, and haematuria follow. Often a scarlet erup- tion of the skin is noticed, and the limbs of the patient may appear numb. Profound coma sets in, and death occurs, frequently preceded by con- vulsions. Treatment.—If the case is seen early, the stomach should be thoroughly emptied by the stomach-pump or tube, or stimulant emetics, castor-oil, and animal charcoal administered. Chemical antidotes should also be given, such as tannic acid, a solution of iodine, or morphine. The latter may be administered hypodermatically, in doses of from a quarter of a grain to a grain, and repeated if required, to control the delirium. Diuretics, like sweet spirit of nitre, are often useful, as the poison is largely eliminated by the urine. Pilocarpine has been recommended as a useful remedy, given either by the mouth or subcutaneously. To prevent reabsorption of the poison, the patient should be catheterized. Fatal Dose and Period.—Fatal results have followed the eating of a few ripe berries ; and a clyster of the root, containing one-sixth of a grain of atropine, has caused death. The smallest quantity recorded that has oc- casioned fatal results was one-thirtieth of a grain of the alkaloid. This was administered subcutaneously. One-twelfth of a grain, given by the mouth, likewise proved fatal. On the other hand, large doses have been recovered from. Dr. Elliot mentions but two deaths out of thirty-two cases. In some cases death takes place within a couple of hours ; one case is reported where the fatal results occurred in five minutes after the hypoder- matic injection of a small dose of atropine. Death usually takes place, how- ever, within fifteen or sixteen hours after the poison has been taken. Post-Mortem Appearances.—These are usually not very character- istic. The main points are the congestion of the cerebral vessels and lungs, together with the dilated and brilliant condition of the eyes. There may be redness of the tongue and injection of the mucous membrane of the stomach and small intestines. If the berries have been ingested, the mucous mem- TOXICOLOGY II5 brane of the former organ may assume a purplish hue. Occasionally no post-mortem effects are noticed. Tests.—(i) Physiological Test.—This test consists in introducing a portion of the ultimate extract into the eye of the rabbit, or of man, when marked dilatation of the pupil occurs. The minutest amount of atropine will produce this effect, and the test is very delicate, the one-hundred- thousandth of a grain being detected. Other substances produce a similar effect, and hyoscyamine and hyoscine are more powerful even than the belladonna alkaloid. Other drugs, like digitalis, cocaine, and coniine, also produce dilatation of the pupil, though to a less degree. Other investigators, notably Selmi, have demonstrated the mydriatic power of certain ptomaines. (2) Vitali's Test.—A small portion of atropine is treated with fuming nitric acid, evaporated to dryness on the water-bath, and when the mixture is cold it is touched with a drop of potassa dissolved in absolute alcohol, when a violet color is instantly produced, rapidly changing to dark red, and then vanishing. Less than one-fifty-thousandth of a grain of the alkaloid gives a decided reaction. Hyoscyamine and hyoscine give the same reaction. Before applying Vitali's test to the suspected material, the latter should be thoroughly puri- fied. (3) Wormley's Test.—If a solution of hydrobromic acid, saturated with free bromine, is added to an atropine solution, a yellow precipitate, which rapidly becomes crystalline, is produced. This precipitate is insoluble in the mineral acids, acetic acid, and the caustic alkalies. This is a character- istic test for atropine, the one-ten-thousandth of a grain producing excellent results. With hyoscyamine and hyoscine it produces similar results. A crystalline precipitate is also formed with this test, though the difference be- tween it and atropine can be observed under the microscope ; moreover, meconin does not respond to either the physiological or Vitali's test. (4) If atropine is heated in a test-tube with a few drops of sulphuric acid and a fragment of potassium bichromate, it gives rise to a green color and an odor of attar of roses or orange-blossoms. (5) Iodine in iodide of potassium produces a reddish-brown precipitate, which is insoluble in potash or in acetic acid. This reaction is not character- istic, though a very minute portion of the alkaloid produces it. Toxicological Examination.—The contents of the stomach should be carefully examined for berries, seeds, or remains of the leaves or root, as their discovery affords strong evidence as to the cause of death. Pieces of these substances may also be found in the vomit and stools. The stomach and contents should be finely comminuted and acidified with acetic acid and warm alcohol and filtered. The latter is then treated with subacetate of lead and sulphuretted hydrogen, thus throwing down the sulphide of lead. The clear filtrate is evaporated to dryness, acidified, and saturated with an excess of a solution of potassa. Alcohol is added and the extract tested. n6 A MANUAL OF LEGAL MEDICINE STRAMONIUM. Stramonium is a very common plant, found in Europe and the United States ; other varieties occur in India. It is the leaves and seeds of Datura stramonium (famestown zvced or gypsum, thorn apple) (nat. ord. Solatia- ceo), and contains an active principle called daturine, which is isomeric with the alkaloid of belladonna, producing the same effects. The seeds and fruit are very poisonous, but all parts of the plant are noxious. Symptoms.—The symptoms are similar to those occasioned by bel- ladonna-poisoning. There are dryness of the throat, dysphagia, dilated and insensible pupil, delirium, headache, vertigo, nausea and vomiting, tinnitus aurium, spectral illusions, etc., succeeded by stupor and coma. Occasionally convulsions and paralysis and the scarlatinal kind of rash are observed. Poisonous symptoms have originated from the external applica- tion of the bruised leaves. In India the Datura is frequently employed for the purpose of drugging persons. The post-mortem appearances are very similar to those resulting from belladonna. The treatment is the same as for the latter drug. The method of extracting daturine from the stomach and contents is the same as that described for belladonna and atropine. HYOSCYAMUS. Hyoscyamus niger, or henbane, is a native of Europe, but is found in America (nat. ord. Solanacea). All parts of this plant are poisonous, but the seeds are more active than either the root or leaves. It owes its powers to two alkaloids, hyoscyamine and hyoscine, both of which are isomers of atropine and daturine. Their effects are very similar to those produced by atropine and the latter alkaloid. Hyoscyamine does not dilate the pupil as rapidly as atropine. Hyoscine produces flushing of the face, dryness of the mouth and throat, sleep, retarded respiration, and in large quantities a slow and full pulse. It also causes a rise of the temperature of the body, muscu- lar weakness and incoordination, diaphoresis, and has a less tendency to produce delirium than atropine or hyoscyamine. There are no characteristic lesions after death, and the treatment is the same as that of belladonna-poisoning. SOLANUM. Of this genus there are three species which are decidedly poisonous — viz., Solanum dulcamara (bittersweet, woody nightshade) ; Solanum nigrum (garden nightshade) ; and Solanum tuberosum (common potato). The active principle of these plants is solanine. Solanum dulcamara is largely cultivated in gardens on account of its beautiful purple flowers and red berries. It is, however, a native of Great Britain. The berries are often eaten by children with poisonous results. Solanum nigrum possesses white flowers and black berries, the latter TOXICOLOGY II7 being also frequently swallowed by children. The poisonous effects of the berries are more powerful than any of the other plants. Solanum Tuberosum.—The berries of this plant have caused death, the symptoms being similar to those of belladonna and other mydriatics. The young shoots of the plant are also poisonous in some instances. The general symptoms of solanine are like those occasioned by the myd- riatics, though less powerful. Solanine exists in the form of acicular crystals, almost insoluble in water. It is soluble in alcohol, amylic alcohol, less so in ether, and insoluble in chloroform. Nitric acid dissolves it, the result being at first a colorless so- lution, which finally changes to a rose-red tint. Cold sulphuric acid produces an orange-yellow, and, after dissolving, it turns brown. To separate this alkaloid from organic mixtures, a modification of the Stas process is employed. Alcohol and sulphuric acid are used as solvents, and warm alcohol to separate the final extract. ERYTHROXYLON AND COCAINE. Erythroxylon is obtained from the leaves of Erythroxylon coca (nat. ord. Erythroxylacece), a shrub indigenous to Peru. It contains an alkaloid called cocaine combined with cocatannic acid. The amount of the alkaloid found to exist in the fresh leaves varies from three-tenths to one per cent., the average being about three-fourths per cent. The physiological effects of erythroxylon and its alkaloid are similar. Symptoms.—The symptoms are modified, to a certain extent, by the quantity of cocaine absorbed. There are usually great nervous excitement, oppression and fulness in the head, sometimes attended with nausea and vomiting. At first the respiration and pulse may be increased in frequency, but later on the former may be lessened considerably; the pulse also may be diminished in frequency. The breathing may then be slow and labored, and the face cyanotic, on account of the deficient oxygenation of the blood ; the pupils are dilated, and the extremities become cold. In fatal cases the breathing is labored, the pulse feeble, often imperceptible, and convulsions supervene, followed by coma and death ; the latter usually occurs from apncea, or heart-failure. These symptoms are subject to variation. Occa- sionally there is delirium, or unconsciousness even from the commencement of the trouble, while in other instances the only prominent sign is the as- phyxia. Treatment.—Evacuate the stomach if the poison has been taken by that route ; also use emetics, iodine, tannic acid, or animal charcoal. If given by subcutaneous injection, which is usually the case, administer stimulants (alcohol and ammonia). Nitrite of amyl has been successfully employed. The hypodermatic injection of nitro-glycerin may be tried. Inhalations of oxygen are of service in relieving threatened asphyxia. Sometimes elec- tricity or artificial respiration is necessary. Fatal Dose and Period.—One-half of a grain of cocaine has proved u8 A MANUAL OF LEGAL MEDICINE fatal when taken internally ; and one-twentieth of a grain, hypodermatically, caused violent and dangerous symptoms in a girl of twelve years. Poisonous symptoms have been produced by the application of one-hundredth of a grain to the eye of a child fourteen years of age. Recovery has followed the ingestion of twenty-two grains, and ten grains administered subcutaneously. When applied to mucous membranes or administered subcutaneously, cocaine acts with rapidity. Death has occurred in forty seconds, and in another case in four minutes. Recovery is almost a certainty should the patient survive half an hour. Post-Mortem Appearances.—These are not very characteristic. There may be congestion of the lungs and other organs, and the blood may be dark and fluid. Tests.—(i) If a few drops of potassium permanganate are added to a solution of cocaine or any of its salts, violet-colored crystals of cocaine per- manganate are thrown down. (2) If a solution of cocaine is boiled with dilute sulphuric acid for a few minutes, decomposition results with the formation of benzoic acid. If potassium hydrate is now added to the liquid, and also a few drops of a solution of ferric chloride, ferric benzoate is thrown down as a pale, brownish- yellow precipitate. (3) A peppermint odor is given off if fuming nitric acid is added to cocaine, evaporated to dryness, and the residue treated with an alcoholic solution of caustic potash. (4) Cocaine is a colorless, crystalline solid, which dissolves in ether and chloroform. It is sparingly soluble in water. The salts are very bitter, but the free alkaloid has only a slightly bitter taste. Cocaine unites with acids and forms salts. The most frequently used salt in medicine is the muriate or hydrochlorate, produced by the union of cocaine with hydrochloric acid. (5) Marked dilatation of the pupil follows the introduction of the alkaloid into the eye of man or one of the inferior animals. This action differs from that occasioned by atropine in disappearing in a comparatively brief period of time,—a few hours at the most,—and also in requiring for its production a larger quantity of the drug. Toxicological Examination.—The tissue to be examined should be finely comminuted. Water is then added until a thick paste results, when the mixture is acidified with acetic acid. The contents of the stomach or the vomit should be made fluid by the addition of water, and also acidified, as in the above case. The mixture is next digested for an hour or so, and strained, when the process for the extraction of alkaloids, already described, is followed. After this has been done, a portion of the residue is dissolved in a little dilute acetic acid and touched to the lip or tongue, and the effect noted. The second portion is applied to the eye of a cat or rabbit, and the effects upon the pupil watched for some hours. A third portion should be tested by the several reactions already mentioned. If all these results are negative, no cocaine is present. TOXICOLOGY H9 CHAPTER XIV. (1) DEPRESSANTS. TOBACCO AND NICOTINE. General Remarks — Nicotine — Symptoms — Treatment—Fatal Dose and Period — Post-Mortem Appearances—Resistance of the Alkaloid to Putrefaction—Tests— Toxicological Examination—Tobacco-Smoking. Tobacco is the dried leaves of Nicotiana tabacum (nat. ord. Solanacece), a plant which owes its peculiar properties to nicotine, an alkaloid which somewhat resembles coniine. Tobacco also contains nicotianin and an empy- reumatic oil. Nicotine exists in all parts of the plant, the amount varying in the various specimens, and ranging from two to eight per cent. Nicotine, when pure, is a colorless oily liquid, of characteristic smell, somewhat heavier than water, and boiling at 2500 C. It is soluble in water, alcohol, ether, and chloroform. It has a strong alkaline reaction, neutralizes acids, and produces neutral salts. Nicotine slowly volatilizes at ordinary temperatures, becoming colored, and finally changed into a brown resinous substance. It is very poisonous, and is more rapid in its effects than even prussic acid. Symptoms.—The symptoms produced by tobacco are the same as those of nicotine, and hence the two drugs will be considered together. Toxic doses produce a violent sense of giddiness, together with nausea and vomit- ing, great prostration, trembling of the limbs, and often violent purging. The pulse is rapid and feeble, and the respiration difficult. There is great heat in the stomach, the skin is cold and clammy, and in some cases convul- sions of a tetanic character occur. The pupils are usually dilated, though the reverse often happens; the face becomes blanched, the lips blue, and the extremities cold. The respiratory function becomes more and more embar- rassed ; there is a sense of impending danger ; coma, preceded by convul- sions, occurs, and the patient dies in apncea. The heart continues to act after cessation of respiration. The external application of tobacco, either to ulcers, etc., or to the sound skin, often produces violent symptoms, and even death. Fatal effects have followed the administration of the infusion of tobacco when used as an enema. A case is recorded where a man suffering from an eruptive disease died in three hours after the application of a decoction to the skin. Treatment.—This consists in the administration of emetics, to be fol- lowed with iodine and pulverized charcoal, to prevent the absorption of the poison. The stomach should be well washed with a strong infusion of tannin, and stimulants given. Electricity is sometimes applied to promote 120 A MANUAL OF LEGAL MEDICINE the respiratory efforts. The oxygenation of the blood may be increased by inhalations of pure oxygen. Fatal Dose and Period.—The fraction of a grain of the alkaloid may prove fatal. The application of the leaves has occasioned death. Recovery has followed large quantities. The rapidity of the effects of tobacco and its alkaloid depends upon the size of the dose and the mode of administration. Nicotine acts with re- markable rapidity, death having occurred in one case within three minutes of the administration of the poison. In the case of Count de Bocarme\ who poisoned his brother-in-law, Gustave Fourgnies, and who was afterwards executed, the latter died in five minutes after the poison (nicotine) had been given. In other cases the fatal period has been delayed for several hours, and even until the second day. Post-Mortem Appearances.—There are no characteristic signs left by nicotine-poisoning. About the only changes that will be found are congestion of the brain, liver, and lungs. The heart is empty, and a diffused redness may be seen over the mucous surfaces of the stomach and bowels. The blood is dark and fluid. This latter sign is about the only constant one. Resistance to Putrefaction.—Nicotine may be detected in the body after a considerable length of time. In animals it has been found to exist even after the lapse of several years. Tests.—The alkaloid responds to most all of the reagents for alkaloids, producing precipitates with picric acid, iodine, etc. (i) Nicotine is distinguished from the ordinary alkaloids, with the excep- tion of coniine, by its oily consistence and non-crystalline state ; further, its odor is characteristic. (2) If an ethereal solution of iodine is added to a solution of nicotine in ether, long ruby-red crystals are thrown down and deposited. These appear at once if the nicotine solution contains one per cent, of the alkaloid ; other- wise, a few hours will be necessary for their complete formation. (3) Corrosive Sublimate Test.—This substance produces a white crystal- line precipitate with a solution of nicotine. It is at first amorphous. The other alkaloids, coniine included, which cause precipitates by the same re- agent are distinguished from that occasioned by nicotine by remaining amor- phous. Strychnine gives a crystalline precipitate, but its crystals are insoluble in acetic acid, while those of nicotine are not. (4) Hydrochloric Acid Test.—U a watch-glass be moistened with a drop of hydrochloric acid, and placed over a second glass containing a little nico- tine, an amorphous solid is deposited, while white fumes are rapidly evolved. Nicotine may be thus distinguished from coniine. Nicotine may be tested physiologically by noting the effect produced on placing a small quantity of nicotine—a drop or so—upon the tongue of a cat or dog. Death usually follows in from one to two minutes. Toxicological Examination.—The stomach contents, or one of the other organs, such as the liver, kidney, etc., should be finely comminuted TOXICOLOGY 121 or subdivided, and water added in sufficient quantity to make a thin paste. The mixture should then be acidified by the addition of acetic acid and heated on a water-bath, when it is strained, the liquid evaporated to a small bulk, and four times its bulk of alcohol added. The insoluble mate- rial is next separated by filtration, and the latter heated to get rid of the alcohol. The next process consists in adding a little water to the residual liquid, again filtering it, and alkalizing the filtrate with potassium hydrate. The whole is then shaken with twice its volume of ether, and the latter, when properly separated, allowed to evaporate on watch-crystals, when nicotine, if present, will be observed in the form of oily streaks or drops, which should be dissolved in a little water and submitted to the tests already described. The odor of nicotine is very characteristic. TOBACCO-SMOKING.—The excessive smoking of tobacco has resulted in fatal symptoms, and where the smoke has been diffused through water and swallowed, it has caused death. Dyspepsia and extreme nervous symptoms frequently follow the use of tobacco, and, where smoking has been carried to excess, paralysis of the portio dura. Persons not accustomed to the use of this plant are easily affected, and decided symptoms of poisoning may occur, and frequently fatal results follow. Some authorities regard the active poisonous agent in tobacco-smoke as a product of the decomposition of the alkaloid (nicotine) ; others assert that the harmful effects are due to carbonic oxide, a poisonous constituent of the smoke ; others doubt the existence of nicotine in the smoke at all; and still others claim that they are occasioned by the presence of the vapor of cyanide and sulphide of ammonium. Cigarette smoking is decidedly more injurious to the system than either pipe or cigar smoking, probably on account of the inhalation of the poison into the lungs, the blood being thereby rendered noxious by the carbonic oxide. LOBELIA. (Indian Tobacco.) Lobelia is a native of the United States, and is derived from the Lobelia inflata (nat. ord. Lobeliacecz). The seeds and leaves are the parts employed, and owe their activity to the fixed alkaloid, lobeline. Lobelia also contains an acid, lobelic, fixed and volatile oils, etc. This alkaloid exists as a yel- lowish liquid with an aromatic odor, being lighter than water. It pos- sesses most of the properties of nicotine, and is precipitated from its solu- tions by tannic acid. It is soluble in water, alcohol, and ether, and has an alkaline reaction, forming soluble salts with acids. In large doses it produces nausea, violent vomiting, with great de- pression, feeble pulse, muscular relaxation, and sometimes purging. In lethal doses there are collapse, coma, frequently preceded by convulsions, and death from paralysis of the centre of respiration. The treatment con- sists in the administration of emetics, tannic acid, morphine, ammonia, alcohol, and counter-irritation to the surface. 122 A MANUAL OF LEGAL MEDICINE Lobeline does not produce on animals the emetic effect of the plant. The detection of the seeds or parts of the leaves would aid materially in the diagnosis. HEMLOCK. (Conium.) The Conium maculatum (spotted hemlock) is a native of both the United States and Great Britain. It belongs to the nat. ord. Umbelliferce, and owes its activity to coniine, an alkaloid found in all parts of the plant, com- bined with an organic acid. It exists in the fruit in the proportion of five- tenths to two per cent. It also contains conhydrine and methyl-coniine. The seeds, leaves, and root are all poisonous, the fresh leaves being often mistaken for parsley, which it somewhat resembles. Its action is variable. Symptoms.—In poisonous doses it intensifies the effects resulting from the administration of medicinal quantities. The alkaloid acts more ener- getically than the crude drug. There is dryness and constriction of the throat, headache, drowsiness, difficulty in keeping the eyelids raised, and disordered vision from paralysis of accommodation. There is a peculiar tingling sensation along the muscles, and gradually complete paralysis of the extremities ensues. This extends to the respiratory muscles, and the patient dies from apncea. Occasionally delirium, coma, and convulsions exist. Treatment.—Prompt emesis and active stimulation. Subsequently, artificial respiration should be resorted to if necessary. Fatal Dose and Period.—Serious results have followed the administra- tion of one-fifth of a grain of coniine, and a drop has proved equally disastrous. The action of both the crude drug and the alkaloid is rapid, and fatal results may follow the ingestion of the poison within an hour or two. Post-Mortem Appearances.—These are negative. There may be congestion of the lungs or of the brain. The blood is usually dark and fluid. Tests.—(i) The odor is very penetrating, and may be detected in the proportion of i part to 50,000 parts of water. (2) If a mixture of bichromate of potassium and dilute sulphuric acid is added to coniine and heated, butyric acid is formed and readily detected by its odor. (3) Copious white fumes are generated by the union of hydrochloric acid and the alkaloid. This is accomplished by placing a trifle of hydro- chloric acid in a watch-crystal and putting it over a similar glass containing a small quantity of coniine. (4) If a solution of alloxan is added to coniine, a purple color results, with the separation of white, needle-shaped crystals. These latter dissolve in a solution of potassium hydrate and produce a purple color and a mousy odor. Toxicological Examination.—Search should be made for particles of the leaves or seeds of the plant in both the stomach and intestines. The leaves are often taken for those of parsley. They should be rubbed in a mortar with potassa to develop the characteristic mousy odor. Then distil, TOXICOLOGY I2. and examine the latter before resorting to the process for the detection of the poison. This has already been described under tobacco and nicotine. The residue should be purified before resorting to the regular tests. This may be done by dissolving it in dilute acetic acid, filtering, rendering it alkaline, and agitating it with ether. The latter should be allowed to evaporate spontaneously. If the result is an oily liquid with the mousy odor, it may be tested with the regular reagents already mentioned. A ptomaine has been discovered that possesses most if not all of the properties of coniine. WATER HEMLOCK. (Cowbane.) The root of the water hemlock (Cicuta virosa) has been frequently the cause of poisonous symptoms, and even death. It has been mistaken for parsley. The symptoms occasioned by this poison are dilatation of the pupils, tetanoid convulsions, vomiting, diarrhoea, insensibility, and coma. The post-mortem examination generally reveals corrosion and perforation of the stomach. The Phellandrium aquaticum (fine-leaved water hemlock) may also be mistaken for parsley. CENANTHE CROCATA. (Hemlock Water-Dropwort.) This is a very poisonous plant. It somewhat resembles common celery, but its root is more like the parsnip. Fatal results have followed the swal- lowing of a small piece of the root, the symptoms being acute pain, tetanic spasms, with the signs of intestinal irritation. Like all the other species of hemlock, this plant belongs to the order Umbelliferce. The sEthusa cyna- pium (Fool's parsley), or Lesser hemlock, is also a poisonous substance, having been mistaken for parsley, and its roots for young turnips. Its symptoms are heat in the mouth, nausea and vomiting, headache, trismus, dilatation of the pupils, and stupor. ACONITE AND ACONITINE. Aconite is the tuberous root of Aconitum napellus (nat. ord. Ranuncu- lacece), and is indigenous in Europe, but is cultivated in this country. It is commonly known as monkshood or wolfsbane, or blue-rocket. Aconitine is the principal alkaloid, although others have been discovered,—viz., aconine, pseudaconitine, pseudaconine, and picraconitine. These latter are unimportant. The root of the plant is the most poisonous part, its shape being very similar to that of the carrot, although it has been frequently mistaken for that of the horseradish. It differs from the latter, however, in its appearance and general properties. The root has been administered with criminal intent in more than one instance, its powder being mixed with pepper or other substances and sprinkled over food. Aconitine, the active alkaloidal principle of Aconitum napellus, is found in all parts of the plant, but it occurs principally in the root, the amount ranging from one-tenth to six-tenths per cent. In the pure state aconitine is I24 A MANUAL OF LEGAL MEDICINE probably the most deadly poison known. It occurs as a colorless, odorless, crystalline substance, with an acrid taste. Much of the aconitine as found in commerce is exceedingly variable in strength and appearance, sometimes being totally inert. It is slightly soluble in water, quite so in alcohol and chloroform, but is insoluble in ether. It has the power of neutralizing acids to form salts, most of which are soluble in water and alcohol. Symptoms.—When applied locally, aconite, or its alkaloid, produces a numbness of the sensory nerves, and causes a tingling sensation. Death has followed such applications. After poisonous doses have been taken, the symptoms are sometimes so characteristic that the diagnosis can be made from them alone. Immediately or soon after swallowing there is a sensation of numbness and tingling in the lips, tongue, and extremities, followed by a feeling of weakness. Dryness of the throat is an early symptom, and is soon followed by nausea and vomiting, with pain and tenderness of the epigastrium. Sen- sibility soon becomes diminished or entirely abolished ; there is ringing in the ears and deafness, with dimness and, occasionally, loss ot sight. The muscular prostration is occasionally so intense that the patient is unable to walk. The pulse is slow and feeble, and respiration extremely difficult. The countenance is anxious, and a cold perspiration covers the body. The pupils are generally dilated, and the mind remains clear to the last. Death usually occurs suddenly, either from shock, asphyxia, or syncope. Delirium is rare. The above symptoms are subject to variation. Purging is some- times present. Treatment.—The contents of the stomach should be evacuated early, and the stomach washed out by the stomach-pump. The solubility of the poison may be arrested, to a certain extent, by the administration of a solu- tion of iodine in iodide of potassium. The patient should be kept perfectly quiet, with his head in a low position. Administer heart stimulants, such as ammonia, ether, or alcohol, and give digitalis hypodermatically. Artificial heat may be necessary to keep the patient warm. Fatal Dose.—On account of the variable strength of the various prepa- rations, the fatal quantity is uncertain. One-sixteenth of a grain of the alkaloid has occasioned fatal results ; one-half of this quantity might cause death in some instances. The one-fiftieth of a grain nearly caused death in an elderly lady. (Pereira.) The alkaloid is much more poisonous when ad- ministered subcutaneously. Four grains of the extract and twenty-five drops of the tincture have produced death. Fatal results might also follow even smaller quantities, provided very active preparations are employed. Recoveries have followed comparatively large quantities of both aconitine and aconite. Severe symp- toms have even resulted from the inhalation of the dust of aconite during the process of reducing the root. Fatal Period.—Death usually is very rapid after large doses have been taken. The symptoms appear in a few minutes, or may be protracted to TOXICOLOGY I2. one or two hours. Fatal results follow, as a rule, within three or four hours. In one instance death occurred in eight minutes, and in others within an hour. On the other hand, it may be deferred for twenty-four hours, and one case is reported where the patient lingered for four days. (Mallet.) Post-Mortem Appearances.—The results of autopsies are by no means of a characteristic nature. There may be general venous congestion, with more or less congestion of the lungs and liver. The brain and its mem- branes are frequently found in an injected state, and the stomach and intestines reddened. The right side of the heart contains more or less dark and fluid blood. Tests.—There is no reliable test for aconitine. The best test is the physiological action of the poison on the tongue, which is very marked and quite characteristic. Minute portions of the alkaloid in solution produce a tingling or numbness when applied to the tongue. This sensation may con- tinue for some hours. The effect may be produced by the one-sixteen- hundredth of a grain. One-hundredth part of a grain, dissolved in spirit and rubbed into the skin, may produce the same effects. A mouse may be killed by the subcutaneous injection of the one-three*thousandth of a grain of aconitine. The poison responds to most of the tests employed for the alkaloids, and is precipitated by picric acid, tannic acid, etc. Toxicological Examination.—Careful search should be made for parts of the plant, since the poisoning may be due to any one of these parts. The process already described under nicotine should be employed here for the detection of the poison. The residue thus obtained should be dissolved in a few drops of water, and slightly acidulated with acetic acid. It is then sub- mitted to the physiological test. Medicinal Preparations.—The following is a list of the various prep- arations and their doses : Abstractum aconiti {abstract of aconite). Dose, gr. ss to i. Extractum aconiti {extract of aconite). Dose, gr. % to ss. Extractum aconiti fluidum {fluid extract of aconite). Dose, rn^ss to ii. Tinctura aconiti {tincture of aconite). Dose, rnj to v. Aconitine, not official; it should not be employed internally, on account of its poisonous properties. Dose, gr. ?%■$ to 5^. It is sometimes used as a liniment (gr. ii to f^i). PHYSOSTIGMA. (Calabar Bean.) Physostigma is the seed of Physostigma venenosum (nat. ord. Legu- minosce), a plant existing on the western coast of Africa. It owes its activity to an alkaloid called eserine, or physostigmine, which is found in the coty- ledons. Another alkaloid, calabarine, has been isolated, but it is probably a derivative alkaloid of eserine. When the active principle of the plant is treated with nitric acid or per- 126 A MANUAL OF LEGAL MEDICINE chloride of iron, an orange and a brown color are respectively produced. The alkaloid is found as a crystalline, colorless, bitter solid, which is some- what soluble in water, and readily so in alcohol, benzol, ether, and chloro- form. Symptoms.—These are opposite to those occasioned by strychnine, as the action of physostigmine is that of a spinal depressant. It causes giddi- ness, great muscular weakness, a slow and often irregular pulse, nausea, and occasionally vomiting. There is generally free purgation, and the pupils are usually in a state of contraction. Muscular twitchings and the abolition of the reflex action, slow respiration, myosis, and motor paralysis precede death, which occurs from respiratory failure. The mind is generally clear throughout the course of the symptoms. Treatment.—Administer emetics and cathartics. The use of the catheter is advised, to prevent the further absorption of the poison. As a physio- logical antagonist, atropine should be subcutaneously employed. Fatal Quantity.—Death followed the swallowing of six of the beans by a boy of six years. Post-Mortem Appearances.—These are negative. Tests.—The most important test is the physiological. A drop or two of the suspected liquid is dropped into the eye of a rabbit or other small animal, when in the course of a few minutes (ten or fifteen) contraction of the pupil will be observed. This effect is of diagnostic importance in noting the difference of the poison from coniine, atropine, hyoscyamine, or daturine. According to Dragendorff, less than one-thousandth of a grain of the alkaloid will produce a red color with bromine in bromide of potassium. The poison may be separated from the tissues by a modification of Stas's process, the ultimate solvent used being benzene instead of ether. (Dragen- dorff.) CHAPTER XV. (3) ASTHENICS. HYDROCYANIC OR PRUSSIC ACID. Sources—Symptoms—Treatment—Quantity required to destroy Life—Fatal Period- Post-Mortem Lesions—Chemical Analysis—Toxicological Examination—Quanti- tative Determination—Cyanide of Potassium. Hydrocyanic acid is one of the most formidable poisons with which we have to deal. It exists in bitter almonds, wild cherry, peach kernels, apricot kernels, the pips of apples, and the flowers and leaves of cherry laurel, peaches, etc. In this concentrated state it is a limpid, colorless, extremely volatile liquid, having an odor resembling that of oil of bitter almonds. It is a compound of cyanogen and hydrogen (HCy), and is one TOXICOLOGY I27 of the deadliest of poisons. The diluted acid is formed by the action of water and sulphuric acid on potassium ferrocyanide, or of hydrochloric acid on chloride of silver ; it is a colorless, volatile fluid, and contains about two per cent, of the concentrated acid. It possesses great medico-legal inter- est, as it is so frequently the cause of death. Scheele's acid is of the aver- age strength of five per cent.; but it often happens that both of the acids are totally inert, probably on account of exposure to light, which decom- poses them. The French acid has a strength of ten per cent. Symptoms.—When applied locally, the concentrated acid transudes the cuticle and paralyzes the end organs of the sensitive nerves beneath. The inhalation of the vapor, or the ingestion of large quantities of the poison, may produce instant death. If the poisonous dose has not been large enough to arrest the circulation instantly, giddiness and loss of muscular power occur, and the patient staggers and falls to the ground. Dyspnoea and depression of the heart take place, followed by dilatation of the pupils, the eyes being glassy and protruded ; the extremities are cold, and some- times the bladder and rectum are evacuated involuntarily. The convulsions which take place are of cerebral origin. A point of importance to remem- ber is that unconsciousness is not always immediately produced, nor is the utterance of a cry or shriek characteristic of poisoning by this agent. Toward the end respiration is convulsively performed, and asphyxia soon sets in, being due to paralysis of the respiratory centre. The face is usually pallid or livid, and the jaws may be spasmodically closed, as in tetanus. Often there is frothing at the mouth, which is sometimes bloody. The odor of the poison can be detected in the breath. The patient occasionally passes away during a severe convulsion, or death is preceded by coma, with stertorous breathing. The latter symptom might lead the observer to mistake the trouble for apoplexy. Treatment.—The effects of the poison are usually so rapid that there is scarcely any time left for treatment. However, the stomach contents should be evacuated as soon as possible and cold water dashed over the face and chest. This should be succeeded by the free inhalation of ammonia, given by the mouth or by intravenous injection. Stimulants should be given both externally and internally. Atropine hypodermatically, as a respira- tory stimulant, is advised. A mixture of the ferrous and ferric sulphates may be tried as an antidote, to be followed by a solution of carbonate of potassium. This combination produces in the stomach the inert Prussian blue. Quantity required to destroy Life.—The smallest recorded quantity is nine-tenths of a grain of the anhydrous acid, which is equal to about forty-five minims of the official acid. On the other hand, recovery has taken place after the administration of one drachm of Scheele's acid, which is equivalent to two and four-tenths grains of anhydrous acid. The inhala- tion of the vapor has caused death, as before stated. Fatal Period.—Death may occur instantaneously, but the period is 128 A MANUAL OF LEGAL MEDICINE modified by various circumstances. Ten or fifteen minutes generally elapse before death in the majority of cases. In one case an hour elapsed before the fatal termination. Instances are recorded of persons, after swallowing fatal doses of the poison, doing certain acts, such as replacing the cork in the bottle, fixing the bedclothes, or even walking into another room, etc. To show the rapidity with which consciousness is lost, Hufeland mentions a case where a full-grown and healthy person, about to be arrested as a thief, swallowed an ounce of the poison, staggered a few steps, and fell to the ground, being dead within five minutes. Post-Mortem Lesions.—The post-mortem appearances are inconstant and not characteristic. The stomach may be normal or congested. The most frequent sign after death by this poison is a general venous congestion. In some cases the odor of hydrocyanic acid may be noticed in the stomach or other parts of the body, or it may be absent in the former organ and present in other parts. The liver, kidneys, lungs, and spleen are often gorged with blood, and the arterial system is empty. The brain may show turgescence of the vessels, and there may be an effu- sion into the ventricles. The bile has been found to be of a deep-blue color in some instances, and the blood black, fluid, or coagulated, the odor of the poison being readily recognized. Chemical Analysis.—(i) The addition of a solution of nitrate of sil- ver to a solution of hydrocyanic acid produces a white precipitate which is entirely soluble in boiling concentrated nitric acid. It is further distinguished from the white chloride by its form, prisms or needles (the chloride is amor- phous) ; by its being sparingly soluble in ammonia (the chloride is very soluble) ; by the permanence of its color when exposed to light (the chloride becoming dark-colored), etc. The cyanide of silver may be further known by the giving off of cyanogen gas and by its purplish flame if it be well heated and dried. (2) If a little liquor potassae is added to the suspected liquid, and then a mixture of ferrous and ferric sulphates, a dirty greenish-blue precipitate is produced, which becomes clear Prussian blue on the addition of a few drops of pure hydrochloric acid, should hydrocyanic acid be present. (3) If a solution of hydrocyanic acid is treated with ammonium sulphide, and gently heated, a white sulphocyanide of ammonium is produced; if this is then touched with a drop of persulphate or perchloride of iron, a blood-red sulphocyanide of iron is formed. This test is characteristic in the absence of meconic acid. (Lie big's test.) It is best adapted for discov- ering the poison in a state of vapor. A drop of ammonium sulphide in a watch-crystal is inverted over a vessel containing the suspected liquid, which may be gently warmed by immersion in warm water, or by the hand, when the vapor will rise. This is permitted to evaporate until it has nearly dried, after which it is touched with a drop of the iron salt, which will immediately give rise to the characteristic blood-red color. (4) The suspected liquid, rendered slightly alkaline by liquor potassae, TOXICOLOGY is treated with a dilute solution of cupric sulphate, when a greenish-white precipitate is formed, which changes to white on the addition of a few drops of hydrochloric acid. This reaction may be used also for the acid in the vapor state, as follows : If a drop of the cupric sulphate solution is placed on a watch-crystal, and alkalized, the addition of a drop of the suspected fluid will produce the characteristic color if the poison be present. Toxicological Examination.—The attempt should be made to detect the odor of hydrocyanic acid in the stomach. The latter, together with its contents, and other viscera, should be distilled at a comparatively low tem- perature, and, if the material is alkaline, diluted sulphuric or some other acid should be addedx previously. The rising vapors are then collected in a cool receiver, and, if the amount be small, caustic potash or nitrate of silver may be placed in the retort, thus fixing the acid by the production of potassium or cyanide of silver. Or, the method described above may be followed as far as the acidifying process, when any of the vapor tests may be applied to the rising acid. Quantitative Determination.—Nitrate of silver throws down free hydrocyanic acid, and for the determination of the weight the resulting cyanide is washed, dried, and weighed, when every ioo parts will be found to represent 20.15 parts of the anhydrous acid. Cyanide of Potassium.—This salt of prussic acid is employed by photographers, electrotypers, etc., and has frequently been the cause of poisoning. It occurs in commerce as a white, deliquescent salt, or in crys- talline masses, very soluble in water, less so in alcohol, and evolving the characteristic prussic acid odor. Its reaction is alkaline. Its action is simi- lar to prussic acid ; three to five grains will kill as rapidly as the acid just mentioned. Chemical Analysis.—With acids it is decomposed with the giving off of prussic acid. Nitrate of silver produces the white cyanide of silver with potassium cyanide. Tartaric acid precipitates the potash, as also does bichloride of platinum. Iron and copper (vide prussic acid tests) may be applied to detect this substance, but the alkalizing agent must be left out. Prussic acid may be obtained from organic mixtures by neutralizing with dilute sulphuric acid and distilling. The symptoms, treatment, and post-mortem appearances are similar to those of prussic acid. Cyanide of mercury also causes poisonous symptoms, but these are allied to those of corrosive-sublimate-poisoning. ' In medico-legal cases of suspected poisoning by hydrocyanic acid, where the most careful accuracy in the analysis is demanded, the employment of any acid in the distilling process is discountenanced, since it may be impossible to discover whether the poison was actually present in the free state in the stomach, or "formed" by the analyst out of the potassium sulphocyanide existing in the saliva. 9 13° A MANUAL OF LEGAL MEDICINE OIL OF BITTER ALMONDS. This substance has a pungent, prussic acid smell, and a light-yellow color. It is somewhat heavier than water, but is slightly soluble in it, but more so in alcohol and ether. The essence of bitter almonds is a solution of this oil in alcohol, and is a poisonous fluid. The oil exists in the bitter almond as a result of the reaction of water upon amygdalin and emulsin, constituents of the nut, and is obtained therefrom by distillation. Its poi- sonous effects are due to prussic acid. The symptoms, treatment, and post-mortem lesions are like those of hydrocyanic acid. Twenty drops may be stated as a fatal quantity. CHERRY-LAUREL WATER. This is obtained by distilling the leaves of the Prunus lauro-cerasus (cherry laurel). It contains an essential oil like that of the oil of bitter almonds, and owes its poisonous effects to hydrocyanic acid. Cherry-laurel water has occasioned death in more than one instance. Poisonous effects have likewise followed the ingestion of the kernels of the cherry, peach, and apricot. The symptoms are similar to those occa- sioned by a small dose of hydrocyanic acid. NITRO-BENZOLE. (Essence of Mirbane.) Nitro-benzole results from the action of nitrous acid upon benzole. It is employed in confections and perfumery as a substitute for the bitter- almond oil, and is a powerful narcotic, the effects of which are similar to those of prussic acid. It occurs as a pale-yellow liquid, with the odor of bitter almonds. Its vapor is exceedingly powerful. It is known from the bitter-almond oil by the action of strong sulphuric acid upon it. A few drops of bitter-almond oil and of nitro-benzole are poured upon a saucer, and a drop of sulphuric acid added, when the almond oil acquires a crimson hue with a yellowish border, while the other fluid is unaffected. Nitro-benzole, when mixed with organic substances, may be separated by adding sulphuric acid and distilling. DIGITALIS AND DIGITALIN. Digitalis is a native of Europe, but is cultivated in this country. It is the leaves of Digitalis purpurea, or purple foxglove (nat. ord. Scrophulari- necB), and is obtained from the second year's growth. The seeds, leaves, and roots are poisonous, the leaves being used in medicine. The active principles of the plant are due to several glucosides, called digitalin, digi- toxin, and digitalein. Digitonin, another glucoside, resembles saponin in its effects. Symptoms.—In toxic doses, digitalis produces symptoms referable to the heart and the gastro-intestinal tract. The poisonous effects are nausea, vomiting, and purging. There are severe abdominal pains, vertigo, heat in TOXICOLOGY I3I the head, and dimness or loss of sight. The pupils are dilated and insensible, and the pulse slow, irregular, and weak. Prostration and a tendency to syn- cope come on, the eyes being prominent and fixed. Occasionally there is suppression of the urine. Death is usually preceded by delirium, stupor, and convulsions. Sometimes the symptoms of the gastro-intestinal tract are more prominent than those of the heart, and vice versa. The heart is gen- erally arrested in systole. Treatment.—Emetics and cathartics should be administered, to remove the poison from the system. As a chemical antidote, tannic acid is advised, and as physiological antagonists, ammonium carbonate, alcohol, opium, or saponin. Fatal Quantity and Period.—As digitalis is a cumulative poison, the effects may not appear until a number of doses have been taken. It is ex- tremely difficult to state the fatal dose. Eight or ten grains of the powdered leaves have occasioned dangerous and even fatal symptoms. Half a fluid- ounce of the tincture and as much as a drachm of the powder have been taken without producing untoward symptoms. Post-Mortem Appearances.—These are not very characteristic. Con- gestion of the brain and its membranes and inflammation of the mucous membrane of the stomach are sometimes seen, but often these are absent. Chemical Analysis.—Digitalin and digitoxin are the most important of the active principles of the crude drug. They appear in the form of color- less crystals of neutral reaction. They have an intensely bitter taste, and are very sparingly soluble in water, benzene, and ether ; they, however, dissolve readily in alcohol and chloroform. (i) Lafon'sTest.—If a few drops of a mixture of equal parts of sulphuric acid and alcohol are heated with digitalin, a light yellowish-brown color is produced. If a drop of dilute solution of ferric chloride is added, the color is changed to blue or greenish blue. (2) Grandeau's Test.—If digitalin is dissolved in concentrated sulphuric acid, it yields a green color, which on the addition of bromine-water changes to a reddish violet, and on dilution with water to an emerald-green. Neither of these tests is characteristic, and we are obliged to depend on the physiological effects of the drug. (3) Physiological Test.—If some of the ultimate extract of the suspected material is injected hypodermatically into a frog or other small animal, there is soon noticed a gradual irregularity and slowness of the heart-beats, with final stoppage in the state of strong systole of the ventricle. The pure digi- talin should be injected under the skin of a second frog, and the two experi- ments compared. Toxicological Examination.—Careful search should be made for par- ticles of the leaves in the vomited matters and in the stomach and intestines. If the tincture has been taken, the odor may be detected, and the membrane of the stomach may show a greenish color. The suspected material should be mixed with alcohol and acidified with 132 A MANUAL OF LEGAL MEDICINE acetic acid. It is then digested on a water-bath and filtered, and the latter evaporated to dispel the alcohol. The aqueous fluid is mixed with petroleum ether and shaken, to dissolve out the impurities, such as foreign bodies, etc. The ether is then separated, and the remaining liquid shaken with chloro- form. This is allowed to evaporate spontaneously, when the toxic principles of the drug will be left behind. Part of the residue should be injected subcutaneously into a dog or cat, and the effects noted. Another portion may be administered to a frog, and its exposed heart watched. Pure digitalin is then administered to another frog for comparison. If these tests are positive, a portion of the chloroform ex- tract may be subjected to the regular tests. Medicinal Preparations.— Abstractum digitalis {abstract of digitalis. Dose, gr. ss. Extractum digitalis {extract of digitalis). Dose, gr. '+, gradually increased. Extractum digitalis fluidum {fluid extract of digitalis). Dose, Tt\j. Tinctura digitalis {tincture of digitalis). Dose, n\,v to x, gradually increased. Infusum digitalis {infusion of digitalis). Dose, f^ss to iv. COCCULUS INDICUS. (Levant Nut.) Cocculus indicus is the berry of the Menispermum cocculus, or Ana- mirta cocculus, imported from the East Indies. It is used for destroying vermin, and also to give malt liquors their characteristic bitter taste. Coc- culus indicus owes its poisonous properties to the presence of picrotoxin, a neutral principle. The action of both the crude drug and its active agent is that of a gastro-intestinal irritant. Cocculus indicus belongs to the nat. ord. Menispermacece. Picrotoxin is a crystalline, colorless substance which is somewhat solu- ble in water, and constitutes about one per cent, of the seeds of the plant. It is very soluble in alcohol, ether, chloroform, and amylic alcohol. Cold sulphuric acid has no effect on it, but the hot acid gives it an orange-yellow color. Nitric and hydrochloric acids have no effect on it. When it is boiled with sulphate of copper and potassa it acts like grape-sugar. Picro- toxin is not an alkaloid, but is said to belong to the glucosides. Symptoms.—These appear to be, in some cases, nausea, vomiting, and severe abdominal pain. There is loss of voluntary power, but conscious- ness remains for some time. In some cases there are convulsions and a scarlatinal eruption. The convulsions bear a resemblance to those occa- sioned by strychnine. Treatment.—Evacuate the stomach thoroughly. For the convulsions, if present, give chloral or chloroform. Toxicological Examination.—The liquid or suspected material should be exhausted with alcohol and evaporated to a small bulk. The residue ;= then extracted with chloroform, which, upon evaporating, will deposit the TOXICOLOGY 133 crystals of picrotoxin. These may be recognized by the brick-red color that they produce when mixed with an excess of potassium nitrate, the mixture being moistened with a little sulphuric acid and a strong solution of sodium hydrate; or the suspected material may be administered to animals and the physiological effects noted. CYTISUS LABURNUM. The seeds of this plant are frequently eaten by children with poisonous effects. It contains an active principle, cytisine. The symptoms are irrita- tion of the alimentary canal, dilatation of the pupils, rigidity of the extremi- ties, and convulsions. Cytisus laburnum is a very common shrub of Great Britain. The parts of the plant generally used are the bark and seeds. TAXUS BACCATA. (The Yew.) Symptoms of irritant narcotic poisoning are occasioned by the leaves and berries of this plant. It is sometimes used as an abortifacient on account of its action on the bowels, thus indirectly stimulating the uterus to con- traction. The poisonous properties of this plant are due to an alkaloidal principle, taxine, which has the power of destroying life by paralyzing the respiratory centre. The symptoms produced are usually accompanied by insensibility and convulsions. Other vegetable poisons of little importance are Ligustrum vulgare (the privet), Ilex Aquifolium (holly), and Viburnum Opulus (Guelder rose). CHAPTER XVI. PTOMAINES AND OTHER PUTREFACTIVE PRODUCTS. General Remarks—Substances whose Reactions are Similar to those of the Vegetable Alkaloids—Poisons formed during the Process of Putrefaction—Embalming from a Medico-Legal Stand-Point. Ptomaines are the basic products derived during the process of decay of animal and vegetable substances ; in other words, they are the products of putrefaction. Like the vegetable alkaloids, they may be either volatile or not. Some of the ptomaines contain oxygen, and all possess nitrogen as a chemical constituent. The former correspond to the volatile vegetable alka- loids coniine and nicotine, and the latter to the fixed alkaloids. Putrefaction is due to the presence of bacteria, which, by dividing pre- existing complex compounds of the body, generate ptomaines. The forma- tion of the various kinds of these products will depend upon the nature of the material acted on, together with the conditions under which the process T34 A MANUAL OF LEGAL MEDICINE of putrefaction advances. The putrefactive changes produced in the absence of air, and their products, are phenomena chiefly of interest to the legal physician, as it is now generally understood that experiments made upon tissues permitted to decompose in the presence of an unlimited supply of air are negative in their results,—are worthless. The presence of bacteria in certain parts of the alimentary canal, as well as in other cavities of the human body, is a fact now generally accepted. After death they are said to multiply with wonderful rapidity, extending their growth until the entire body is encompassed within their influence. Ptomaines are found more or less in every organ with which the toxicol- ogist has to deal, and it is of importance that he be familiar with the nature of these substances, as it might readily happen that one of these ptomaines might be encountered when searching for one of the alkaloids in a decom- posed body in a case of alleged poisoning. Certain albuminoid bodies and peptones occasionally produce substances which are analogous to the cadaveric alkaloids, differing from them only in that their generation is independent of putrefaction. Certain organic acids, also, have been identified, which may confuse the toxicologist when making his tests for vegetable alkaloids. The number of known ptomaines has multiplied considerably with the march of medical science, and the toxicologist is now confronted with an array of substances which, if he be ignorant of their nature, might interfere with the ends of justice. Among the known ptomaines may be mentioned the following: tyro- toxicon, mydatoxine, neurine, neuridine, cadaverine, muscarine, mydaleine, saprine, putrescine, sepsine, collidine, hydrocollidine, typhotoxine, methyl- guanidine, mydine, mydatoxine, tetanine, tetanotoxine, spasmotoxine, tet- anus toxalbumins, trimethylenediamine, ethylidenediamine, isoamylamine, ethylendiamine, fugin, ptomo-muscarines, etc. They are by no means all poisonous, but for those of a toxic nature certain affixes have been proposed. For example, the affix "toxine" is used to denote the poisonous character of such a substance, as typhotoxine, mydotoxine, etc. In making an analysis in a case of poisoning, it is of the greatest impor- tance that the reagents to be employed are of the purest kind. So-called chemically pure reagents frequently contain impurities, which often interfere with their ultimate success during experimentation. This is particularly the case when alkaloidal solvents are used. Vaughan,1 of Michigan, observes that several samples of German ether with which he experimented yielded alkaloidal reactions, and he further states that commercial alcohol contains an alkaloidal substance possessing an odor similar to that of nicotine and pyridine. Haitinger found five-tenths per cent, of the latter substance in amylic alcohol. 1 Hamilton's System of Legal Medicine. TOXICOLOGY I35 Ptomaines have been found to exist in yeast which has undergone putre- factive changes, in poisonous sausages, ice-cream, cheese, decayed meat and fish, sea-mussels, etc. Those found in various kinds of food are possessed of great toxic powers and are extremely poisonous to man. The actions of ptomaines as found in decomposing viscera are subject to great variation. Thus, the ptomaine mydatoxine produces paroxysmal convulsions, diarrhoea, and dyspnoea. That of mydaleine causes a marked rise of temperature, etc. ; and so on with other such products. Poisonous bases (compounds of ptomaines and arsenic,—arsines) have been extracted from persons who have been fatally poisoned by arsenic, one of which was volatile, while the other acted similarly to the alkaloid strychnine. What is chiefly of importance to the medico-legal expert is the fact that these putrefactive products might occasion serious doubt in a case of sus- pected poisoning by the vegetable alkaloids. After the most careful analysis in such an instance, mistakes are liable to occur, such as reporting the exist- ence of a poison when it is not present, whereby an innocent person could be made to suffer unjustly. There are various substances which bear a striking resemblance in their reaction to the vegetable alkaloids, and these are necessarily of great impor- tance to the toxicologist. The alkaloids which are thus apparently duplicated in their various actions are atropine, coniine, morphine, nicotine, strychnine, digitalin, colchicine, delphinine, and veratrine. Atropine.—Zulzer and Sonnenschein mention a putrefactive substance possessing decided mydriatic properties, and the power, when given inter- nally, of increasing the cardiac action, and preventing, more or less, the peristaltic movements of the intestines. Ptomatropines, as these products are scientifically named, have been found in corned beef, poisonous sausage, decomposing fish, and putrid game. The symptoms produced by them are very much like those occasioned by atropine. There are dryness of the fauces, great thirst, red and swollen gums, with partial paralysis of the muscles of deglutition ; other symptoms are marked dilatation of the pupils, paralysis of accommodation, drooping of the eyelids, and strabismus. The tongue is coated and the bowels con- stipated. The action of the heart is at first increased, and then weakened. There are occasionally double vision and aphonia. General weakness is of common occurrence, and convulsions may appear. Death results from cardiac paralysis. The post-mortem lesions are swelling of the pharynx, oesophagus, and mucous membrane of the stomach. There may be venous hyperasmia of the brain, lungs, and kidneys. Degeneration of the heart-muscle, together with injection of the intestines and swelling of the solitary and Peyer's patches, may exist. It is generally believed that these substances are excreted with the urine in various diseases. Coniine.—Substances having an oily, alkaline, and volatile property, 136 A MANUAL OF LEGAL MEDICINE and which bear a close resemblance to coniine in their reactions, have been discovered by various experimenters. They are very bitter to the taste and highly poisonous. Selmi obtained a ptomaine from decomposing animal tissue which was coniine-like in many respects. He later succeeded in obtaining substances from a chloroform extract of the viscera of bodies buried six and ten months which yielded the mousy odor of coniine. Morphine.—In the Buchanan trial for wife-poisoning, the chemists for the defence claimed that the morphine reactions submitted before the jury by the experts of the State could be duplicated with ptomaines formed in the decomposing human body. They further asserted that the chemicals used in the tests for the alkaloid must have extracted many substances similar in re- action to morphine. To further substantiate their views, experiments were carried on in open court, before judge and jury. Two bottles were pre- sented, one containing a decomposing human pancreas and the other one- tenth of a grain of morphine in solution. These substances were submitted to the ferric chloride test, and the characteristic blue color produced. This is the decided morphine reaction. Subsequently the nitric acid and sulpho- molybdic acid tests were applied, and with like results. The fact seemed apparent that the pure morphine had not produced such distinctive reac- tions as the putrefactive product generated in the human body; never- theless the suspected individual was found guilty of murder in the first degree. The above case recalls to the writer's mind another instance of similar behavior, in which all the reactions quoted in the case just referred to were found. Professor Vaughan received from the authorities at Lincoln, Ne- braska, in 1890, a stomach and part of a liver, with instructions to look for morphine. He followed the method of Dragendorff, and obtained from the amylic alcohol extract from alkaline solution a residue which produced most of the color tests for morphine, but failed to produce morphine crystals; hence his report was "no morphine." It was subsequently learned that the cause of death was a blow upon the back of the head. The citation of these two cases will be sufficient to demonstrate the im- portance of exercising the greatest care when examining tissues for mor- phine, for it has been proved over and over again that none of the morphine tests are conclusive evidence of the existence of poisoning when acting upon unknown complex mixtures. The presence of impurities is always liable to lead the analyst astray, and the presence of morphine should never be ac- cepted as certain unless the pure morphine crystals are produced and the several tests verified. The residue to be subjected to chemical analysis should be thoroughly cleansed and freed from all foreign material. Professor Vaughan1 states that "the identification of morphine in the liver and other organs in cases of suspected poisoning is beset with difficul- 1 Hamilton's System of Legal Medicine. TOXICOLOGY I37 ties 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 vary with the conditions under which the germs producing them grow, it is essential that the putrefactive changes which the tissue un- dergoes before the tests are begun should occur under the conditions as nearly as possible which exist in the cadaver. . . . The upper portion of the small intestine (and the adjacent tissue after death) has a bacterial flora pe- culiar to itself. These tissues are the ones quite universally examined in medico-legal cases, and consist of the small intestine itself, the stomach, the liver, the pancreas, the spleen, and, 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." Nicotine.—Wolckenhaar succeeded in obtaining from the decaying in- testines of a woman, dead six weeks, a nicotine-like substance of yellowish color, marked nicotine odor, and strongly alkaline reaction, but differing in some of its chemical reactions. Schwanert noticed a peculiar odor in examining the decomposing liver, spleen, and intestines of a child, and pro- cured in the ether extract from alkaline solution a small amount of a nico- tine-like material which differed from that alkaloid only in its smell and greater volatility. Strychnine.—A substance which is somewhat similar to strychnine in its reactions has been detected in a decomposing body. This ptomaine was highly poisonous, and produced a crystalline precipitate with iodized hy- driodic acid, a red coloration with hydriodic acid, and the usual color test with sulphuric acid and potassium bichromate. This substance was slightly bitter, while strychnine is intensely so, even in the proportion of i part to 40,000 parts of water. Paltauf and Heider state that the chronic disease known as pellagra, which prevails in Lombardy and other near-by countries, is produced by the infection of the corn-meal used as food by the inhabitants of these coun- tries with the bacillus maidis Cuboni and the bacillus mesentericus fuscus. Certain ptomaines are generated by these bacilli which are soluble in alco- hol and possess the power of exciting the disease. Their reactions and physiological effects are somewhat similar to those of strychnine. In 1871, Lombroso discovered an alkaloidal substance (pellagrocine x) in mouldy corn-meal which was insoluble in water, non-crystalline, unstable, and of a whitish color, but soluble in ether and alcohol. Its color reaction with sulphuric acid and potassium bichromate was very much like that occasioned by the alkaloid strychnine. Digitalin.—Digitalin-like substances have been found in liver sausage, and Gunning states that they could be differentiated from digitalin by the absence of the characteristic bitter taste. A similar substance has been 1 Pellagrocine is composed of several ptomaines, some of which occasion nico- tine-like symptoms, and others produce narcosis and paralysis. I38 A MANUAL OF LEGAL MEDICINE discovered in the brain of a man, by Trottarrelli, the residue of its sulphate producing an aromatic odor and astringent taste. When treated with sul- phuric acid alone, and with the latter and hydrochloric acid, it struck a purple and dark-red color respectively. Colchicine.—Brouardel and others have stated that ptomaines might be found in decomposing human bodies, which, when extracted, form reactions with nitric acid, and with a sulphuric acid solution of ammonium vanadate (200 parts of the acid and 1 of the vanadate), similar to those produced by traces of colchicum. Baumert discovered a substance in a supposed case of poisoning which occasioned most of the colchicine reactions, and a similar substance has been detected in beer. Veratrine.—A veratrine-like ptomaine has been extracted from a body which had been in water for a period of eighteen months. This substance produced the veratrine reaction when subjected to heat with sulphuric acid. However, it differed from the vegetable alkaloid in reducing ferric salts im- mediately, and in its negative results when injected into frogs. Curarine.—A ptomaine has been found in the putrefied human brain which produced paralysis of the terminals of the motor nerves in a similar manner to curarine. Bechamp obtained an alkaloidal body from the products of the pancreatic digestion which produced a carmine-red color, when treated with sulphuric acid, similar to that occasioned by veratrine. By subjecting this substance to digestion with gastric juice and extracting it, a substance was obtained which acted with sulphuric acid like curarine. POISONS FORMED DURING THE PROCESS OF PUTREFACTION. Tyrotoxicon.—This ptomaine was discovered by Professor Vaughan, in 1884, in milk and cheese, and later in ice-cream and certain milk products. This powerful poison forms crystals with potassium hydrate, and when treated with a mixture of carbolic and sulphuric acids, produces a green color. As found in whey, the coloration may vary from yellow to orange- red. Small doses of tyrotoxicon in man cause retching, vomiting, and purging; and toxic quantities, hurried breathing, dilatation of the pupils, rapid pulse, and depression of temperature. Typhotoxine.—This substance is produced by the Eberth bacillus of typhoid fever. It causes in mice and guinea-pigs increased respiration and slight salivation. Muscular incoordination and weakness follow, the animals being unable to stand. The pupils are strongly dilated, and fail to react to light. Fatal results follow in a day or two after the administration of the poison. Mydaleine.—This substance, which is found in putrefying cadaveric organs, as the liver and spleen, causes the temperature to rise when it has been administered subcutaneously. Neurine.—Neurine is found in decomposing animal tissue, and has an action somewhat like curare. TOXICOLOGY U39 The substance discovered by Adamkiewicz is supposed to be the active agent in producing cancer. It was named cancroin by the discoverer, and is probably similar to neurine. This observer advocates the employment of cancroin in the treatment of cancer, after the Koch theory of consump- tion. Susotoxine.—Novy extracted and isolated this base from cultures of the hog cholera bacillus. Its action seems to be confined to the centre of respi- ration. It slows this function, then increases it, and finally again retards it. Convulsive tremors may occur. One hundred milligrammes, hypoder- matically injected, caused the death of a young rat within an hour and a half. Choline.—This substance is often found in decomposing tissue. It causes muscarine-like symptoms, but its effects are not produced unless large doses are exhibited. Methylguanidine.—This base is extremely poisonous. It was discov- ered by Brieger and Bocklisch in decaying flesh. The main effects of the substance are muscular tremors, dyspnoea, and general clonic spasms. Isoamylamine.—This interesting ptomaine has been discovered in yeast which has undergone putrefactive changes. It causes convulsions, rigors, and even death, being extremely poisonous. Isoamylamine is a colorless, strongly alkaline liquid, with a marked but inoffensive odor. Patoammine.—The urine of persons suffering from progressive paralysis is said to generate this poisonous substance. It occasions spasms. Pato- ammine is also found in the urine of those with interstitial pneumonia. Trimethylenediamine.—This substance has been found in the cultures of the comma bacillus, and it produces convulsions. Ferre obtained from the urine of persons suffering from epilepsy a base which occasioned spasms similar to those of strychnine. Griffeth also isolated such a substance, and Gerdes secured highly poisonous germs from the cadavers of women with puerperal eclampsia, which occasioned spasms. Ethylidenediamine.—Brieger obtained such a substance from decaying fish. Its poisonous effects are severe. It causes dyspnoea and dilatation of the pupils. Other poisonous ptomaines found during the process of putrefaction are ethyl- endiamine (found in cancerous stomachs), tetanine, tetanotoxine, and spasmotoxine (from tetanus bacillus cultures). All of these substances produce convulsions and are poisonous. Mydatoxine, obtained from decomposing human viscera, causes convul- sions, dyspnoea, and looseness of the bowels. Many processes have been advocated for obtaining these bodies, but the following method is usually resorted to : The decomposed material should be treated with acetic acid and alcohol for some days. It is then filtered several times, and the alcoholic extract reduced on a water-bath. The aqueous extract is concentrated to a sirupy consistence. This may now be used for experimentation on the lower animals. By treating this acid solution with chloroform, ether, or amylic alcohol, after it has been alkalized, the various ptomaines have been isolated. 140 A MANUAL OF LEGAL MEDICINE EMBALMING FROM A MEDICO-LEGAL STAND-POINT. The almost universal custom of using embalming or preservative fluids after death, for the purpose of preventing decomposition, by introducing antiseptic substances into the various spaces, blood-vessels, and organs of the internal parts, is a practice which calls for specific and strict statutory instructions. If the body to be examined be embalmed, the greatest care must be exercised in the inspection of the various parts, as it frequently happens, in poison cases, that the changes produced by the embalming fluid are of such a nature as to preclude the possibility of determining the actual signs of death. The various structures with which the fluid comes in contact are so altered and changed, both in color and consistence, as to render the exami- nation utterly worthless. It is a well-known fact that arsenic and corrosive sublimate (but particu- larly the former) enter into the composition of most embalming fluids, and are indiscriminately used, so much so that they are frequently employed as a certain method of concealing crime. This possibility was first pointed out by Dr. Hay in 1876. These preparations are commonly used by undertakers and others for the preparation of bodies for burial. The methods for performing the opera- tion of embalming are various. Some undertakers place the entire body in a solution of arsenic, or simply cover it with cloths saturated with such a solution. Some inject the fluid into the mouth and rectum ; others make numerous punctures through the abdominal walls with a trocar, and thus fill the cavity with the fluid ; and still others inject the arsenic into an artery, or into all of the cavities of the body. In addition to the changes occasioned by the contact of the embalming fluid with the tissues, the numerous punctures made, when the trocar is employed, may open abscess and other cavities, permitting collections and accumulations of various kinds, to the great annoyance of the toxicologist. The following recipe is very often employed for preservative purposes : R White arsenic...................60 ounces, Salts of tartar...................32 ounces, Carbolic acid (common black)........... 2 pints, Glycerin...................... y2 gallon, Water...................... ^ gallon. M. These are allowed to simmer gently over a fire until the whole is in solution. A less quantity of water can be used if it is desired to preserve the body for some months. This fluid keeps for any length of time. The possibility of the post-mortem diffusion of arsenic through the body has been proved by several investigators. The following experiments by Professor Vaughan, of Michigan University, demonstrate this fact beyond a doubt. About fifty grains (3.24 grammes) of arsenous oxide, suspended in cold water, were injected into the mouth and rectum of a dead musk-rat, TOXICOLOGY 141 which was then buried in the ground for a period of twenty-five days, after which it was disinterred and the various organs subjected to analysis, with the following results : Name of Part examined. Amount of Arsenic, calculated AS AS^Oj, FOUND. Kidneys .......... Liver............ Lungs ........... Stomach and contents .... Large intestine....... Small intestine....... Heart........... Brain............ Total As,0, recovered .00095 .01082 .19252 .00686 •40339 •I9I57 .02507 .03960 gramme. gramme. gramme. gramme. gramme. gramme. gramme. gramme. .78078 gramme. As portions of the poison may find their way down into the lungs through the trachea, this may account for the larger proportion of arsenic found in the lungs than in the stomach in the above instance. As the liver likewise contained more arsenic than the stomach, it is presumed that the poison passed thereto from the lungs. The second experiment was performed on a cadaver. The person had been dead two or three days when the arsenic was introduced. The mouth and rectum were used, as in the first experiment, as channels of entrance for the arsenic, of which an unweighed quantity suspended in cold water was injected. After the body had lain away in a dry place (cellar) for twenty- five days, the kidneys, liver, heart, stomach, spleen, etc., were removed, weighed, and analyzed, with the results exhibited in the following table : Name of Part. Weight of Part. Weight of AS2O3. Per Cent. Right kidney...... Left kidney....... Liver.......... Lower lobe of right lung . Heart.......... Transverse section of colon Rectum......... Spleen......... Stomach........ Brain.......... 104 grammes. 90 grammes. 865 grammes. 99 grammes. 370 grammes. 85 grammes. 22 grammes. 48 grammes. 300 grammes. 1028 grammes. A distinct mirror. .00703 .08316 •04333 .02199 .02659 1.65000 .00455 2.11200 .00363 .00782 .00961 .04376 .00594 .03128 7.50000 .00947 .70405 .00030 These experiments prove that the post-mortem imbibition of arsenic, and its diffusion through the cadaver, are quite as thoroughly performed as they would have been had the body had life and had the poison caused death. They further demonstrate that the discovery of the poison in the various organs after death is no proof of its administration during the life of the person.1 ' Journal of the American Medical Association, vol. i. p. 115. I42 A MANUAL OF LEGAL MEDICINE It is an utter impossibility to distinguish ante-mortem from post-mortem arsenic. Dr. Pellew x says, "At the present moment it would seem that, if once the undertaker is allowed to enter the house, there is no chance of con- viction in arsenic-poisoning. This means that arsenic, instead of being the most dangerous, is now, practically, the safest agent for committing murder. And also that, unless the attending physician is clever enough to risk his own professional career by calling in the authorities and insisting on an autopsy at once, there is practically no hope of conviction." Again, unjust sentences may be passed upon innocent persons accused of committing murder by arsenical poisoning so long as the practice of using arsenic in embalming fluids continues. Laws should be enacted making it unlawful for any one to introduce into or upon any corpse, for the preserva- tion of the same, any so-called embalming fluid or material which will in any manner interfere with the chemical tests which may subsequently be made use of by toxicologists in medico-legal investigations. ' Hamilton's System of Legal Medicine. PART II FORENSIC MEDICINE CHAPTER XVII. INTRODUCTION. Definition—Powers and Duties of Coroners—The Coroner's Court and the Inquisition —The Criminal Court—Evidence—Ordinary and Expert Witnesses—Dying Decla- rations. Forensic medicine may be defined to be the science which treats of the application of medical knowledge to the purposes of the law, such as the elucidation of doubtful questions in courts of justice. The connection between medicine and law bore traces of recognition at a very early period ; but it was not until the fourteenth century, when anatomy was first studied in the human subject, that forensic medicine attained the dignity of a science. During the latter part of the sixteenth century and the earlier part of the seventeenth marked progress was made in this science, particularly in Germany and Great Britain. At the present time its impor- tance as a science is indicated by the fact of its almost universal recognition, particularly so in various parts of Europe, but more tardily in the United States. Forensic medicine proper embraces all those questions which require for a proper understanding an appeal to the various branches of medical science. It includes questions affecting the civil rights of individuals and of injuries to the person, and enables courts of law to reach a proper conclusion on any contested question affecting life or property. Powers and Duties of Coroners.—The office of coroner is a very ancient one, and of very great antiquity in England. Coroner, or coronator, refers to an officer whose original functions were for the most part as con- servator of the peace, and in other respects he had to do with the pleas of the crown. Coke called the chief-justice of the king's bench the principal coroner of the kingdom, and as such he was entitled to perform all the duties of the office. During the reign of Edward I. it was enacted by statute that none but lawful and discreet knights should be chosen for the office. It, however, soon fell into disrepute, and, according to Blackstone, "got into low and indigent hands." More recently, however, men of great respectability have held the office. There were three kinds of coroner at common law,—viz., virtute officii, which included the chief-justice of the king's bench ; virtute cartes sive commissionis, or those so called because they existed by charter, commission, or privilege ; and virtute electionis, or those approved of by election or appointment. In this country the office of coroner may be classed under this heading. The colonists introduced the system into America which, at the present 10 145 146 A MANUAL OF LEGAL MEDICINE time, exists in the several States with all the common-law provisos, unless the same have been modified by special statute, such, for example, as exists in the State of New York, and particularly in the city bearing the same name, where the statutory provisions alone regulate the powers and duties of these officers. The powers of coroners in the United States, as at present defined, emanate from the English Stat, de Officio Coronatoris, 4 Edward I., s. 2. The duties of a coroner are both ministerial and judicial,—ministerial, as to become, ex-ojficio, sheriff when the office of the latter has been vacated; or to act as a substitute for the sheriff, as when the latter officer is a party himself. The duties, rights, and powers of the sheriff will devolve upon the coroner when he assumes these responsibilities. The judicial authority of the coroner relates to inquiries into the unknown or unexplained causes of sudden or violent death, by a jury of inquest, super visum corporis. He can compel the attendance of witnesses, and at the inquest he is fortified with all of the ordinary power of a judicial officer. The common law gives him authority to compel obedience to his subpoenas. The authority to hold inquests extends beyond the territorial jurisdiction of the coroner. For ex- ample, an individual dies in one county and is buried in another, and if, on account of the suspicious nature of the death, an inquest becomes neces- sary, the coroner of the latter county is the proper officer to conduct the proceedings. Besides these duties, the coroner is also invested with the fur- ther power to inquire of other felonies, of treasure-trove, and of wrecks. In the United States the coroner is elected for a term of several years, but in England he is appointed for life, subject to removal for cause by the writ de coronatore exonerando. The common law does not permit of the appoint- ment of a deputy coroner, though most States in the Union have estab- lished statutory provisions whereby the coroner has the power to make such appointments. Coroners are excused from serving in offices which might interfere with their duties of coroner, and are further privileged from serving on juries, and from arrest when employed in their official duties. On the other hand, they are liable to punishment for wilful neglect of duty and for wilful misconduct in the execution of their office ; in fact, they may be in- dicted. At any rate, they make themselves liable to a criminal information for any misconduct in taking an inquisition. The Coroner's Court and the Inquisition.—This is a court of record, of which the coroner is the presiding judge. He enjoys all the privileges which are accorded judicial officers, and he is further protected from any responsibility in a civil action that might be brought by a private person. Whenever a coroner receives notice that any person has been slain, has suddenly died, been dangerously wounded, or found dead under such cir- cumstances as to require an inquisition, he is legally bound to proceed to the place where the body has been found, and to forthwith summon a jury, to the number required by the statute law of his State, to appear before him at such place as he shall appoint. Those selected by the coroner as jurors FORENSIC MEDICINE I47 are bound to appear, and should be probi et legates hominis. Their selection should be carefully made. Jurors are not liable to challenge, as is the case in criminal courts. Their duties are to investigate and determine the facts of the case. They must view and examine the body of the deceased to- gether, and not separately ; and they must establish, if possible, the identity of the dead person. After the jury has viewed the dead body, they retire to some convenient locality for the purpose of hearing the testimony of wit- nesses and the post-mortem report of the physician or surgeon delegated by the coroner for the inspection of the deceased. After the recital of the testi- mony, the jury consult together, and after reaching a conclusion, which is usually in accordance with the report of the coroner's physician, they deliver to the coroner, in writing, their inquisition. "An inquisition, properly speaking, is the written statement of the verdict of the jury, returned for the purpose of particular inquiry, as distinguished from an indictment. Where it contains the subject-matter of accusation, it is equivalent to the finding of a grand jury, and the parties may be tried and convicted upon it. The cap- tion is a necessary and essential part, and should be drawn up with precision, and contain the name of the county. The time and place when and where holden must appear with certainty ; also, that it was taken before a court of competent jurisdiction. The name of the deceased must be set out, if known; also, where the body lies ; also, that it was taken by the oaths of the within-named jurors, and it must expressly appear that the jurors are from the county or jurisdiction, and that they present the inquisition upon oaths. The verdict must be stated with legal precision and certainty, and the charge must be direct and positive. The attestation is an essential part of the inquisition." ' One inquisition may be sufficient in cases where several persons were ; killed by the same cause, as, for example, where wholesale death results from a sudden explosion, etc. On the other hand, the coroner may hold an inquest on each separate body, he being the sole judge of the necessity of such pro- ceeding. If upon the inquest any one is found guilty of a crime, the coroner has the power to issue a warrant for the arrest of the suspected person, and if ' captured he is to be committed to prison by the coroner, and the inquisition with the evidence forwarded to the proper authorities. Massachusetts's Statutory Provision.—The office of coroner was abolished in Massachusetts about eighteen years ago, having been supplanted by a system which provides an officer for medical examination, and requires him by the terms of the law to be "an able and discreet man, learned in the science of medicine." The law invests the governor with the power to make these appointments, with the advice and consent of the council. t Under this system the medical and judicial functions are separate and dis- ) tinctly defined. The medical officer is authorized to take charge of all au- 1 American and English Encyclopaedia of Law, vol. iv. I4S A MANUAL OF LEGAL MEDICINE topsies and medical questions in inquiries, and if, on examining a dead body, and after personal inquiry into the cause and manner of death, he deems further examination necessary, he shall, on the written authorization of the district attorney or other competent judicial authority, proceed in a careful way to make an autopsy in the presence of at least two discreet persons. He is further required to then and there reduce to writing every circumstance and fact tending to show the condition of the body and the cause and manner of death, together with the names and addresses of the witnesses, and for- ward them at once to the district attorney or the nearest trial justice. An inquest is then held by the latter to determine, if possible, who is responsible for the death in question. The inquest may be conducted privately or not, just as the justice sees fit, and he may keep witnesses apart; he has the same powers conferred on him as in other cases. The standing of the medical examiner at the inquest is on a plane with that of other witnesses, his authority having ended with the post-mortem examination and the deliv- ery of the body to the undertaker for burial. New York's Statutory Provision.—As stated heretofore, the powers and duties of coroners are regulated by statute. For the State at large it is pro- vided that four coroners be elected in each county, each for a period of three years. They are not required to furnish bonds, except when acting as sheriffs, when they may be required to do so. The duties of these officers in this State are to inquire into all cases of sudden or violent death. They are authorized to arrest those who disturb religious meetings ; to take charge of wrecks and wrecked property, and to take measures for the preservation thereof and for its delivery to the proper owners. They also have the power to investigate the origin of fires, by an inspection and inquest with a jury, with proceedings in most respects like the inquests in cases of sudden death, with authority to arrest in case there is found to have been arson committed or an attempt at arson. In case of the absence or inability of the coroner to act, in the city of New York any alderman or special justice may act instead, exercising the same duties and powers as the coroner. The coroner usually has the power to appoint one or more physicians as assistants, or deputies, known as coro- ner's physicians. These officers have the power to make all the medico-legal investigations. According to the New York Criminal Code, "a coroner is disqualified from acting as such in any case where the person killed or dangerously wounded is a co-employee with the coroner of any person or persons, asso- ciation or corporation, or where it appears that the killing or wounding has been occasioned, directly or indirectly, by the employer of the coroner. . . . The defendant against whom an inquisition has been found by a coroner's jury is entitled to a hearing before a magistrate, whether he has been arrested before the inquisition has been filed, or is arrested after such filing " • The Criminal Court.-After the inquisition held by the coroner's jury in a criminal case where the suspected person has been committed for trial, FORENSIC MEDICINE I4g a preliminary examination is held by the grand jury, who either find a true bill or ignore the case altogether. In the latter event the whole matter is dropped and the prisoner discharged from custody. If, however, a true bill has been found, the case comes up before the judge and petit jury for trial as to the guilt or innocence of the suspected individual. To this trial the medical witness is likely to be summoned to appear by a subpoena, which is an imperative order that cannot be slighted. Here it is that his professional knowledge, experience, and acquirements will be thoroughly ventilated in the cross-examination, requiring all his thought and acumen to offset the otherwise certain annoyance and confusion that invariably follow such in- quisitions. Therefore, the following advice by the late Dr. Taylor, if fol- lowed, will place the physician-witness upon such a plane that he need have no hesitancy or fear in testifying. " First, he should be thoroughly prepared on all points of the subject on which he is to give evidence ; and, secondly, his demeanor should be that of an educated gentleman and suited to the serious occasion on which he appears." Evidence (Medical).—Following the opening of a case in court, the dis- trict attorney or one of his representatives proceeds to examine the different witnesses according to the rules of evidence. This is called the exami- nation-in-chief, because the witness recites the actual evidence in support of the side on which he has been subpoenaed. Leading questions that sug- gest their answers are not allowed, though certain allowances are permissi- ble in cases where witnesses have an object in concealing important evidence which is essential in establishing the guilt of an accused party. Such per- sons are called "hostile witnesses." In connection with this part of the subject there are certain questions which frequently arise that require notice here, (i) As to written notes: These are only admissible in court that the witness may refresh his memory, and not to supply its place. They are not admissible if they were made after the occurrence to which they relate, and they must be original and not copies. According to Tidy, '' the actual notes taken at the time of, or, at most, immediately after, the occurrence to which they relate—uncorrected, unexplained, uninterpolated—are the notes to be used, and no other." (2) Expert witnesses frequently feel inclined to quote authorities in the witness-box. This, as a general rule, is inadmissible evidence, because the scientific witness is merely called upon to express his own opinion, and not to corroborate it by reading similar opinions from stand- ard medical works. But in England and in some of the United States coun- sel are permitted to lay before the court readings from recognized scientific books as a part of their argument. These works may be read in evidence to contradict a witness who has testified concerning statements alleged by him to be contained in the book.1 This permission is not allowable in all States, but is left to the discretion of the court. (3) As to medical secrets: In some instances the court may compel a medical man to divulge secrets ; 1 American and English Encyclopaedia of Law, vol. xv. I50 A MANUAL OF LEGAL MEDICINE but in England no special privilege is granted medical men with regard to professional secrets. In the State of New York " no person duly author- ized to practise physic or surgery shall be allowed or compelled to disclose information which he may have acquired in attending any patient in his pro- fessional character, and which information was necessary to enable him to prescribe for such patient as a physician, or to do any act for him as a surgeon." The cross-examination is conducted by the counsel for the prisoner. Its special aim is to break down the testimony of the witness, leading questions being the method of attack. Great latitude is allowed to counsel in the cross-examination of a hostile witness, his duty being to expose omissions and inconsistencies in the previous testimony of the witness. In re-examination, which sometimes follows the cross-examination, the object of the counsel for witness's side is to clear up matters that may have been rendered obscure by the opposing counsel's examination. Counsel cannot bring up any new matter except by special consent of the court, the rule being that he must confine himself to the subjects about which the wit- ness was cross-examined. In some instances the presiding judge may ask the witness certain questions bearing upon the case. Ordinary and Expert Witnesses.—The difference between an ordinary and an expert witness is this : the former testifies only to facts which have come within his personal knowledge, while the expert or skilled witness gives an opinion on the facts observed by himself or proved in evidence by others. " The medical expert, when placed on the witness-stand, is called upon not only to state medical facts, but also to express an opinion on the special facts of the case under examination. He may be examined as to conclusions of science drawn from particular experiments ; he may be questioned as to the health of a particular person whom he attended ; he may be asked his opinion as to the probable cause of the death of a person ; he may testify as to the presence of poison in the stomach, and generally give an opinion on medical facts as observed by himself, or on facts observed by other persons and given in evidence." * Among the rights of an expert is his compensatio?i. Every medical man is bound to obey the subpoena which compels his attendance in court, but that he is bound to act as an expert witness without other compensation than the ordinary witness fee has not been definitely settled. Reese uses the follow- ing language concerning this matter : " As regards the obligation of a wit- ness to obey subpoenas when he is to be questioned only as to his opinion, we think that in this country the mandate of the court is obligatory ; the wit- ness's duty is to obey it, and then, if not previously, endeavor to arrange about his compensation before giving his evidence.'' This whole matter of expert testimony has been placed before the general public as being of little value, because when employed on both sides of any 1 Encyclopaedia of Law, vol. xv. FORENSIC MEDICINE j-j case it is conflicting and anything but convincing. So, too, has the atten- tion of the ablest minds of both lawyers and physicians been turned toward the abuse of this method of testimony. The only true and proper system would be for the State to appoint one or more experts at an adequate salary, to be known as State officers, for, as Dr. Reidz states, "it is exceedingly unjust that any physician, whether willing or not, may, at any moment the law sees fit to specify, be required to go on the witness-stand in the character of a medico-legal expert. In that place, unless he be well posted in forensic medicine and possess the coolness and self-reliance required to repel the onslaught of the lawyers, his reputation for knowledge and skill may receive in twenty minutes injuries that cannot be repaired in a lifetime." Dying Declarations.—To be admissible, death-bed confessions or dec- larations must be made when the party is at the point of death,—that is, when every hope of recovery is gone. These declarations are admissible as evidence as soon as death has taken place. " In consideration of the fact that the mental and physical conditions of the person at the point of death are usually such as to render the reliability of his statement extremely doubtful, no matter how conscientious he may be, there is no time when justice more imperatively demands the presence and aid of an intelligent, experienced physician than when the law is endeavoring to fasten the crime of homicide upon a prisoner through the identification and dving declaration of the victim of deadly assault or of foul play. As in many instances the fate of the prisoner rests mainly upon such evidence, no means should be left untried which will assist in determining its credibility. The nature of many agents used to destroy life, and of injuries which result fatally, can be alleged as sufficient reason why, when it is necessary to bring the accused into the presence of the injured person to be identified, the State should, if possible, have a physician present, whose duty should be to make a careful examination of the declarant's mental, visual, and other con- ditions ; for, at the time that the declarant may be trying to identify the prisoner, his intellect and vision may be so disturbed by cerebral anaemia resulting from the loss of blood as to lead to the gravest mistakes. Also, because the insidious intellectual changes which are sometimes the sequence of cranial injury may convert the best friends into the bitterest foes, and yet be undetected by inexperienced persons, though they would be suspected by the physician from the nature of the injury. Another fact likely to be unknown to a large majority of the laity is that, in anaemia resulting from loss of blood, the upright or semi-recumbent position may render the declarant less capable of making a trustworthy statement; whereas, the horizontal position, by encouraging the flow of blood to the brain, would increase mental activity, and thus tend to promote the ends of justice. The effects of the kind and quantity of stimulants given so freely at such times should also be noticed, as these not only vary greatly in different persons, ' Journal of the American Medical Association, vol. x. No. xxiii. I52 A MANUAL OF LEGAL MEDICINE but vary greatly at the different periods at which they are administered to the same person. Where a woman is dying of septicaemia consequent upon criminal abortion, there may be slight delirium, or such form as occurs at intervals, which might slightly confuse the memory and distort the imagina- tion, yet not be discovered by persons unfamiliar with the concomitant symptoms and pathological conditions present.'' ' CHAPTER XVIII. PHENOMENA AND SIGNS OF DEATH. Definition of Death—Molecular and Somatic Death—The Causes of Death—Charac- teristic Post-Mortem Evidences of the Varieties of Death—The Signs of Death: Cessation of Circulation and Respiration—Changes in the Eyes—Insensibility and Loss of Power to move. . When the vital phenomena of living organized bodies cease to present themselves, we have death, or a cessation of life. The term of existence that nature has fixed is seldom reached ; death by violence or disease is the rule ; that from old age, the gradual wearing out of the human mechanism, the exception. By molecular death, which may be either partial or complete, is to be understood the death of a part, organ, or tissue,—the incessant disintegration of tissue which occurs without the general stoppage of the circulation, the active processes of life being manifest. Complete molecular death, which is the true scientific death of the body, is progressive until the vital activity of every part of the organism is destroyed. Somatic death is the death of the body as a whole,—that is, the entire cessation of all the vital functions of the organism. The time when it takes place can be generally recognizable by the stoppage of the circulation and respiration. This is not the case when complete molecular death occurs. Some degree of molecular life may continue after somatic death, as is manifested by post-mortem caloricity and muscular irritability, by the post-mortem action of the heart, by epidermic fecundity, such as a growth of the nails and hair, and occasionally by evi- dences of nutrition and secretion. Somatic death is the universally popular idea of dissolution. When death is sudden, the immediate or actual cause is referable to one or other of the three great centres of life,—the heart, the lungs, and the brain. These three centres, being the fundamental basis upon which animal existence is erected, were metaphorically called by the ancients the '' tripod of life." The functions of this tripod are so intimately related that when one ceases to work the actions of the others are speedily inhibited, as each 'Journal of the American Medical Association, E. M. Reid, M.D. FORENSIC MEDICINE „, of these organs is absolutely essential to life. The following tabular view of the modes of sudden death is after Bichat's classification,—viz., (i) death beginning at the brain, coma; (2) death beginning at the heart, syncope; and (3) death beginning at the lungs, asphyxia, or apncea. Tabular View of the Modes of Death. COMA. {Death beginning at the Brain.) Causes.—Cerebral compression ; apoplexy ; fractures of the cranial bones ; injury of the skull; hydrocephalus ; blows on the head causing cerebral disturbance ; the action of poisons, such as the narcotics (opium, etc.), or the minerals (arsenic, etc.) ; various discharges and hemorrhages ; certain diseases of the liver and kid- ney (uraemic poisoning, etc.), etc. Symptoms.—More or less profound stupor ; insensibility to external impressions ; loss of consciousness ; slow, stertorous, and irregular breathing ; power of voluntary control over respiration is lost, the latter becoming more and more feeble as the medulla begins to be affected; the blood is no longer aerated ; the pulmonary circulation is stopped ; the pulsations of the heart are arrested, and the lungs cease to move ; the pupils are sluggish, and often dilated. Post-Mortem Appearances.—Congestion of the membranes and substance of the brain and lungs, more or less blood being found in the cavities of the heart, especially in the right, though they are not so engorged as after death from asphyxia. (It is well to recollect that the appearances in the thorax after death in coma may be very slightly different from those occasioned by death in asphyxia.) a SYNCOPE. {Death begifining at the Heart.) Causes.—The arrest of the heart's action may be due to two distinct causes : (1) Ancz- mia, or a deficiency in the normal quantity of blood, which may be occasioned by a sudden loss of blood, as in rupture of an aneurism, or by hemorrhages from the uterus and lungs, and from injuries to the heart or larger blood-vessels. Extensive suppurations, etc., which indirectly drain the blood, are also etiological factors. (2) Asthenia, or a deficiency in the heart's power, on account of paralysis of its muscular walls. This may be brought about by various cardiac diseases (fatty degeneration, etc.), starvation, exhausting diseases (phthisis, cancer, diabetes, dysentery, cholera, etc.), certain poisons (digitalis, prussic acid, etc.), certain in- juries (blows on the epigastrium, concussions of the spine, etc.), and severe brain-lesions. Symptoms.—(1) Ancemia.—A mortal paleness or duskiness of the face ; lividity of the lips ; cold perspiration ; dimness of vision ; tinnitus aurium ; vertigo ; fluttering and weak pulse ; dilated pupils ; gradual insensibility. Other symptoms that may occur are nausea or vomiting; jactitations ; irregular breathing; transient de- lirium ; photophobia; convulsions before death. There is frequently hiccough. The nervous symptoms are due to the deficient supply of blood to the brain. Sometimes the nervous system is primarily affected in consequence of this want of blood. (2) Asthenia.—Lividity of the fingers, lips, nose, and ears, on account of the arrest of the circulation in the extremities. The general surface, also the hands and feet, become cold ; there is extreme muscular weakness ; the pulse is weak and frequent; the senses and the intellect are unimpaired to the last. This condition is also seen in the collapse of Asiatic cholera. 154 A MANUAL OF LEGAL MEDICINE Post-Mortem Appearances—{\) Anccmia.—Xw death from ancemia the heart is found to be in an empty and contracted state, the organ being arrested on account of de- ficient blood-supply. If life has been somewhat lengthened, a heart-clot may be detected. The tissues and various organs are usually of a pale color. (2) Asthe- nia.—In. asthenia the blood is found in the large arteries and veins, and, on account of this stoppage of the fluid in its course, the cavity of the heart is more or less dilated or flabby, though it may contain some blood. There is no en- gorgement of the brain or lungs. APNCEA. {Death beginning at the Lungs.) Causes. — Respiration may be arrested (1) by any mechanical obstruction to the ingress of air into the lungs, as tetanic spasm of the respiratory muscles (strychnine- poisoning, tetanus) ; pressure of the thorax ; exhaustion of the muscles from de- bility or cold ; foreign bodies in the air-passages ; paralysis of the pneumogastric or phrenic nerves; submersion ; suffocation, hanging, strangulation ; absence of air, as in very high altitudes ; certain irritant gases (sulphuretted hydrogen gas, chlorine, etc.). (2) By diseases, such as those of the lungs (bronchitis, pneumonia, etc.) ; spasm of the glottis ; oedema of the glottis ; embolism of the pulmonary artery; pharyngeal abscess ; and the accumulation in the pleural cavities of serum, blood, or pus. Symptoms.—Sense of suffocation, with an intense struggle to breathe ; lividity of the face; loss of consciousness ; vertigo; relaxation of the sphincter muscles; and general convulsions. Post-Morton Appearances.—-These are engorgement of the pulmonary artery, the right cavities of the heart, and the venae cavae ; the viscera are commonly en- gorged, while the left side of the heart, the aorta, and the pulmonary veins are found comparatively empty. In some instances, however, the cavities of the right side of the heart are empty. The lungs may be engorged with dark blood. In order to be able to determine, at the least, the approximate cause of death, the medical examiner should be familiar with the foregoing varieties of somatic death, and keep in mind the post-mortem appearances attend- ant on each variety. The immediate cause of death is to be looked for in the brain, heart, or lungs, no matter what the remote cause may be- Occasionally, however, it happens that the cause of death cannot be de- termined, such as when a sudden stoppage of the heart through reflex nervous inhibition occurs, as is seen in those suffering from violent emotion, etc. Post-mortem lesions are rarely found to exist in such cases. In other cases the causes are many. Thus, the nervous system will feel the effects of injuries to the heart or lungs, and, vice versa, the circulatory system will be affected if the proper nerve-energy is found wanting, or the heart-action will fail to respond properly if the respiratory system is in an abnormal state. This combination of causes may make it extremely difficult or impossible for the examiner to state which cause was foremost in contributing to the fatal result. This interdependence existing between the nervous, circulatory, and respiratory systems is not always uniform in degree ; death beginning at the lungs or at the heart is of more rapid occurrence than when it begins at the brain. The latter is the centre of the organism, while the other two are FORENSIC MEDICINE the chief means of maintaining the organic functions. When disease or violence arrests the action of the brain and causes a cessation of the func- tions of sensation, thought, and action, the organic functions of respiration and circulation may still continue, as in apoplexy, where the patient falls senseless and motionless, while the heart and lungs continue to operate. A matter of great medico-legal importance is that which comprises the phenomena and signs of death. That the reality of death can be determined by certain signs cannot be denied, although exceptional cases crop up where the corpse retains all of the natural appearances usually observed previous to final dissolution. It becomes, therefore, a matter of great importance for the medical examiner to be familiar with all the signs which are the precise indications of death. Other questions of medico-legal import that arise at every inquest over a corpse are the cause of death, and, secondly, the time that has elapsed since life has been extinct. The horror of being buried alive naturally suggests the great importance of being familiar with the signs of death. Professor Nussbaum, of Munich, gives full scope to his credulity, and states, without hesitation, that during the war between France and Germany many soldiers were buried alive. These persons, he claims, were merely suffering from an extreme lethargy occasioned by excessive hemorrhage, exhaustion, hunger, etc. However this might be, there are but few well-authenticated cases of premature burial. True it is that sounds have been heard, disarrangement of the coverings of the dead noticed, bodies frequently found turned in their caskets, etc., but as these effects are due entirely to other causes, they are readily explained. The gases generated in the body by its corruption simulate in their action upon a corpse many of the movements of vitality. The bodies of persons who have been submerged in the water for a long time have been known to be heaved up and even thrown upon the ground from the effects of the gaseous products of decomposition. The sounds that have occasionally been heard, the change in position of the body, and so on, are undoubtedly due to the gases already referred to. The signs of death, to be of value in determining the absence of life, must be considered collectively, and not singly. THE SIGNS OF DEATH. I. Cessation of Respiration and Absence of Audible Heart- Beats.—The suspension of these functions has been observed in cases of apparent death, as in catalepsy or lethargy, syncope, trance, etc. This arrest of the functions of respiration and circulation is not absolute ; for were it so, death would rapidly follow. It is well known that certain of the lower animals—the marmot, for example—pass into a state of hibernation during the winter season, being to all outward appearances dead. According to the experiments of M. Bouchut, the beats of the heart in the marmot were reduced from a range of eighty to ninety per minute during its state of 156 A MANUAL OF LEGAL MEDICINE activity to eight or nine in the state of hibernation. Cases are recorded in which human beings could suspend the action of the heart, so that no move- ment, such as pulsation, could be noticed. Colonel Townsend, as reported by Cheyne, had the power of retarding the action of his heart, so much so that no heart-action was discernible. He was apparently dead, and remained in that state for half an hour. Braid mentions instances where Indian fakirs were able to pass into a state of trance by holding their breath, during which time the absence of audible heart-sounds was noticed. Loomis» says that these phenomena have been observed in the new-born child. These instances, however, are of rare occurrence, and contrary to all physiological experience, for life cannot continue long without the circulation of the blood and the exercise of the function of respiration. Nevertheless, it is well to remember that the heart often beats so slowly and infrequently, and the movements of respiration are so slight, that the greatest care must be taken to determine whether the person is really alive. Duval mentions an interesting case where the heart of a criminal pulsated fifteen minutes after decapitation, the left auricle continuing to beat more or less for an hour. To be positively certain of death, the examiner must convince himself not only of the entire cessation but of the continuous cessation of the action of the heart and the arrest of the function of respiration. Tests.—(i) The region of the heart should be carefully examined with the stethoscope, recollecting that the position and sounds of the heart might be abnormal. (2) A good test is to apply a ligature to a finger, limb of the body, etc., and note the change, if any is produced ; if the person be alive, the part beyond the constriction will become a deep-red or purple color, on account of the arrest of the circulation at that point. (3) If a scarificator and a cupping-glass be applied to a dead body, no blood flows, although cases are recorded where blood has escaped as many as eight days after death from certain wounds inflicted during life. (Levasseur.) (4) If a clean, bright needle be thrust into a muscle, such as the biceps, and left there, it will rust and tarnish (oxidize) rapidly if life be present. After death there is no such change. (Cloquet's needle test.) (5) The opening of a vein, to note whether coagulation has occurred or not. (6) As moisture is a constant constituent of the breath, the application of a looking-glass over the mouth and nose renders perceptible the slightest trace of moisture as it condenses upon the glass. (7) The suspension of a feather or other light body near the mouth or nose may be regarded as a sign of death when it remains unmoved. II. Changes in the Eyes.—The following changes occur in the eyes after death : (1) The loss of sensibility of the eyes to light, there being absolutely no contraction nor expansion of the pupils. Certain poisons, however, act upon the eyes in a similar manner, as is also the case in some of the affec- 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicoloev vol i.. 1894 & FORENSIC MEDICINE I57 tions of the brain. (2) The loss of sensibility of the cornea to touch is always found to exist after death, although it occurs in certain injuries of the brain, etc. (3) The loss of transparency of the cornea, and the loss of tonicity and of the elastic resistance of the eyeball occur speedily after dissolution, although these conditions may exist before death. Cases are recorded where the former condition was observed several hours before death in cholera. On the other hand, the cornea may not lose its trans- parency for a considerable length of time after fatal consequences, as has been noted after death from apoplexy, poisoning by the oxides of carbon, etc. (4) The conjunctivae present changes soon after death, and the eye- lids lose their tonicity and elasticity. Gray, cloudy discolorations, rapidly changing to black (due to films of mucus, or to putrefactive changes), are observed upon the conjunctivae, and, according to M. Larcher, are soon followed by similar changes upon their internal surfaces. III. Insensibility and Loss of Power to move.—This condition may occur without resulting in death, as is well seen in asphyxia, apoplexy, catalepsy, syncope, etc. CHAPTER XIX. signs of death—Continued. Pallor of the Body—Loss of Animal Heat—Rigor Mortis (Cadaveric Rigidity)— Cadaveric Lividity (Suggillation)—Putrefaction—Saponification (Adipocere)— Mummification—Subsequent Remarks. IV. Pallor of the Body.—After death a peculiar ashy pallor usually spreads over the entire body. This is not a characteristic sign of death, however, since there are some exceptions, as in death from yellow fever, etc., and also in persons who have a ruddy complexion, where the lips and cheeks retain their natural high color for some time after dissolution. The red or livid rings around ulcers and burns, the spots of purpura hemor- rhagica, tattoo marks, and ecchymoses and bruises do not disappear. More- over, a death-like pallor frequently occurs in cases of fainting, the cold stage of ague, and occasionally in collapse. V. Loss of Animal Heat.—During life the healthy animal body has the power of maintaining its own temperature of about 36.7°C. (980 F.), notwithstanding the character of the surrounding medium. This source of heat is derived in the potential energy admitted into the body with food, and with the oxygen during the process of respiration ; but the direct sources are contained in the blood during digestion, when it becomes sat- urated with more carbon, oxygen, and hydrogen than are needful for tissue repair ; these gases by their combination with the sulphates generate heat by chemical means, the rest of the body heat being slowly developed by a 158 A MANUAL OF LEGAL MEDICINE slower combustion. Heat is also generated by the brain, muscles, and glands. When these vital processes cease, as they do after death, there is a gradual and progressive lowering of the temperature of the body, until it attains that of the atmosphere surrounding it. For the period of three hours after dissolution the loss of body heat per hour may be stated at about three and a half degrees, after which it gradually fells at the rate of a degree and a half each hour. This loss continues on the average for fifteen to twenty- four hours, when the temperature of the atmosphere is reached. The med- ico-legal importance of this cooling process after death is that the loss of heat is progressive, thus aiding in the determination of the time that a body has been dead. The post-mortem loss of heat never falls below that of the atmosphere un- less the temperature of the latter becomes suddenly increased. When making observations on post-mortem temperature, the use of the thermometer is in- dicated, as the sense of touch is not sufficiently delicate for noting the actual coldness of the body. The external and internal temperature of the body should be recorded, the former being taken in the axilla and the latter in the mouth or rectum. If the temperature taken in the oral cavity is lower than that of the surrounding medium, it is a good sign of death, but the fact must not be lost sight of that there are certain conditions which in- fluence the rate at which the body turns cold. Thus, the time of cooling may be modified by the condition of the body at the moment of death, by the manner of death, and by various other circumstances, as where the corpse has been freely exposed to the air, etc., thus hastening the cooling process, or, in the case of certain diseases, retarding it. Thin and emaciated bodies lose heat more rapidly than fat bodies ; the bodies of old persons and children become cold quicker than those of per- sons of middle age ; while those who are killed by suffocation or electricity (lightning) lose their heat less rapidly. Other circumstances that prolong the cooling of the body after death are : (i) the body being clothed ; (2) if kept in a small and close room ; and (3) its being covered, or kept on non- conducting material. Causes of rapid cooling are: (1) its exposure to a good conducting sur- face ; (2) death from immersion in water ; and (3) its exposure to currents of cold air, etc. The heat of the interior of the body is retained much longer than that of the external surface, the viscera frequently being twenty degrees or more above that of the surface. In some instances the temperature of the dead body rises instead of falls ; this is observable in the bodies of persons who have succumbed to the effects of yellow fever, rheumatism, chorea, cholera, small-pox, tetanus, etc., where the temperature has reached 400 C. (1040 F.), and even 44.40 C. (112° F.), as recorded by Davy in the pericardium. This singular phenomenon may be occasioned by the continuation of molecular life after the cessation of somatic. FORENSIC MEDICINE I£. The following table of the time occupied for post-mortem cooling is taken from Tidy's "Legal Medicine," vol. i., the observations being those of Drs. Taylor and Wilks. (The external temperatures were taken by the application of the thermometer to the skin of the abdomen.) Period after Death. Two to Three Hours. Four to Six Hours. Six to Eight Hours. Twelve Hours or more. Number of Observations .... 76 49 29 35 Fahr. Cent. Fahr. Cent. Fahr. Cent. Fahr. Cent. Maximum temperature of body Minimum temperature of body 94 60 77 34-4 15-5 25 86 62 74 30 16.6 23-3 80 60 70 26.6 15-5 21.1 79 56 69 26.I *3-3 20.5 Niderkorn's observations on external temperatures, taken in the axilla, are shown in the following table, being the average results of one hundred and thirty-five observations." Temperature of Body after Death. Two to Four Hours. Four to Six Hours. Six to Eight Hours. Eight to Twelve Hours or more. Fahr. Cent. Fahr. Cent. Fahr. Cent. Fahr. Cent. I09.4 89.6 96.9 43 32 36.1 98.2 80.6 90.2 36.8 27 32-3 95-3 70-5 81.7 35-2 21.6 27.6 100.4 62.6 77-9 37-8 17 25-5 In the subjoined table of Goodhart1 the rapidity of the post-mortem cooling during the first few hours after dissolution, compared with that which takes place at later periods, is recorded. Time after Death. Three Hours. Loss per Hour. Degrees Fahr. Six Hours. Loss per Hour. Degrees Fahr. Loss per Hour. Body nearly Cold. Degrees Fahr. In the robust......... 4-7 3-5 3 3 1.12 I.26 The observations of Taylor and Wilks on internal temperatures after death show 24.450 C. (760 F.) seventeen and eighteen hours after death, and 29.450 C. (850 F.) ten hours after death. VI. Rigor Mortis.—Rigor mortis or cadaveric rigidity is the stiffening of the muscles throughout the body after death, which generally takes place within six hours after that event. It lasts for from sixteen to twenty-four hours, or until putrefaction sets in. Rigor mortis is probably occasioned ' Tidy's Legal Medicine, vol. i. i6o A MANUAL OF LEGAL MEDICINE by the coagulation of the myosin in the muscles, an albuminous principle of muscular tissue. After the stiffness of the muscles and joints passes off the corpse regains its original pliancy, which is probably due to the dissolving of the myosin when putrefaction occurs. An important fact of medico-legal interest is that during the stage of rigor mortis the muscles retain the position they assumed at the time when the stiffening began ; in other words, a flexed limb remains in that state until it is overcome by external force, as in bending a leg. If a limb is bent after being flexed, it never regains its rigidity unless the rigor mortis is incomplete. The order in which rigor mortis occurs is a very definite one. It occurs first in the muscles of the eye ; next in the muscles of the lower jaw and neck ; then the chest and upper extremities ; and, finally, the muscles of the abdomen and lower extremities. The rigidity generally disappears in the same sequence. Rigor mortis is the rule in death from any cause, and its supervention and duration depend upon the previous degree of exhaustion. Thus, in death from phthisis or other exhausting diseases, it manifests itself early (in a case of death from typhoid fever, recorded by Brown-Sequard, it set in three minutes after the patient ceased to breathe) ; whereas, in those dying suddenly from accidental causes while in perfect health, it is protracted for some hours, sometimes for as long a time as twelve hours, or even more. An important fact to recollect is that heat shortens and cold prolongs the rigor mortis. As already observed, the duration of cadaveric rigidity is extremely variable, averaging from sixteen to twenty-four hours ; although in some cases, such as death by lightning or electrocution, it occurs within a few hours, while in other cases it has lasted for seven and fourteen days. (Loomis.) Rigor mortis should not be confounded with cadaveric spasm, which is closely connected with it. The latter occurs in persons who have died sudden or violent deaths, such as by suicide, etc. Reese, in his " Medical Jurispru- dence," etc., says that "the best illustrations of this peculiar condition are afforded in those cases of determined suicides who have taken their lives by shooting themselves with a pistol. Very commonly, in such cases, the lethal weapon is found so tightly grasped in the dead man's hand as to require considerable force to remove it. The same thing is witnessed in the bodies of drowned persons,—fragments of wood, grass and weeds, or other objects which had been convulsively seized in the water before death, being found tightly grasped in the hands ; and where two persons have perished to- gether by drowning, it is not uncommon to find them, after death, con- vulsively clasped in each other's arms. To a similar reason, doubtless, is to be ascribed the singular and striking posture which bodies of soldiers on a field of battle, killed in conflict, are noticed to have assumed in the act of dying." VII. Cadaveric Lividity.—Cadaveric lividity, cadaveric ecchvmosis, or hypostasis, is the result of the gravitation of the blood in the capillaries, FORENSIC MEDICINE 161 which occasions those livid or violet-colored patches or discolorations which are observed upon the body within a few hours after death. It is presented in diffused patches of very great extent on the back part of the trunk, head, ex- tremities, face, ears, and neck, but is not fully developed until the body has cooled, when it is arrested. These patches are at first isolated, and often mottled in interspaces, but they soon become coalesced. Upon section of the skin being made, the color is found to be confined to the upper layer of the true skin, or in the interspace of cuticle and cutis. The color deepens immediately before putrefaction sets in, the change being probablv due to an infiltration of pigment, derived from the blood, into the dependent portions of the body. Internal lividities occur at the same time that the external discolorations are taking place, and, like them, they settle in the most dependent parts of the several viscera,—a fact of forensic importance in determining whether the congestion be due to some disease, or to the lividity occurring after death. Internal hypostasis is most marked in the veins of the pia mater and the posterior hemisphere of the cerebrum, the posterior part of the spinal cord, the posterior part of the lungs, and the most dependent portions of the in- testines, stomach, and kidneys. Cadaveric hypostasis of the brain may be mistaken for congestive apo- plexy ; this condition in the spinal cord for pre-existing meningitis, or for the sequelae of injuries to the back inflicted during life ; in the lungs it may be confounded with pulmonary apoplexy or the first stage of lobar pneu- monia ; and in the intestines it may be mistaken for the effects of inflamma- tion. The position of these lividities should aid the medical jurist in avoiding possible error in this connection. The following tablel shows the chief points of difference between a vital ecchymosis and a post-mortem ecchymosis : Vital Ecchymosis (Bruise). Post-Mortem Ecchymosis. Anatomical Seat. Anatomical Seat. Effusion of blood into the true skin Congested capillaries in the rete mu- and subcutaneous tissue. cosum and vascular tissue above the true skin. Situation. Situation. At the seat of the injury, the deeper Such dependent portions of the body tissues being generally discolored. as are not subjected to pressure. The superficial layers of the true skin are principally involved. Appearance. Appearance. The mark of the instrument that in- The post-mortem lividity is irregular flicted the injury is often perceived on the in shape, the edges, however, being well bruise. The color of the latter is not gen- defined. The color is dark throughout, erally uniform. The injured part is fre- and there is no elevation above the sur- quently elevated above the adjacent skin, rounding skin. 1 After Tidy. n l62 A MANUAL OF LEGAL MEDICINE Vital Ecchymosis (Bruise) — Continued. Extent. Generally limited in area to the parts injured. Results of Incision. Either a flow of effused blood, or else a coagulum will be observed. Changes by Age. Change of color occurs after eighteen or twenty hours (sometimes two or three days), the dark purple bruise becoming highly tinted at the margins, being of a more or less violet color. The color then passes to green and yellow, the centre always remaining the darkest part. The spots enlarge during these changes, which are completed in from a few days to sev- eral weeks. Oxidation of the effused blood is the cause of the various shades. Ecchymosed marks are sometimes found upon the skin in the living sub- ject, being found on the bodies of those dying from scurvy, typhus fever, and other adynamic diseases ; or they may be located on the legs and feet in very old persons. They are probably occasioned by a sort of stasis of the capillary circulation, the venous capillaries offering a sort of barrier to the progress of the blood. This condition has been termed asthenic hyperemia. These lividities may also be found on persons killed by hanging, suffocation, apoplexy, or carbonic-acid-poisoning. Under certain states of the system these spots develop spontaneously, often covering the body in the form of petechia; or, when extensive, they may constitute the principal pathognomonic character of the eruption known as purpura. '' A peculiar appearance of cadaveric lividity is observed in bodies which have been wrapped in a sheet and allowed to cool, or that have cooled in their clothing. It occurs in the form of bands or stripes over the whole sur- face, and often gives an appearance as of a person flogged. The explanation of this appearance is that the congestion of the vessels takes place in the interstices of the folds, while the parts compressed remain whole. The un- broken condition of the cuticle, together with the other characteristics just mentioned, are sufficient to distinguish these ecchymoses from those pro- duced by violence." (Loomis.) Cadaveric lividity makes its appearance, according to Caspar, in from twelve to fifteen hours after dissolution. If death be due to hemorrhage or anaemia, it is very slightly if at all apparent. Post-Mortem Ecchymosis—Continued. Extent. Very extensive. Results of Incision. There is no escape of e (Fused or co- agulated blood, although there may be apparent a few bloody specks or points, arising from the division of small veins of the skin. Changes by Age. Are not effected by time, the color re- maining constant until putrefaction occurs. There are no zones of color round the margin, as are noticed in vital ecchy- moses. FORENSIC MEDICINE l6- VIII. Putrefaction.—In from a few hours to three days1 after the death of a person, a greenish-blue discoloration appears upon the middle of the abdomen, and then gradually extends over the rest of the body. After a short space of time the color deepens, and gradually becomes purplish or brown, being due to the action of the gases of decomposition upon the coloring matter of the blood, the haemoglobin. Simultaneously with this change is developed the peculiar odor of decomposition. The chest, the inter- costal spaces, the face, the neck, the legs, and finally the arms are similarly discolored, this discoloration being especially marked along the venous trunks of the latter. The eyeballs become soft and yielding, and, if ex- posed to the open air, the conjunctivae and corneae become brown in color and dry. In the course of a few days—five or six—the discoloration extends over the entire body, at first in spots, which gradually coalesce. Streaks of a dirty-red color are now observed throughout the surface ; they follow the course of the blood-vessels. In ten or fifteen days, according to the weather, loosening of the epidermis, together with the formation of blebs, occur. The tissues become flaccid, and the thorax and abdomen greatly distended from the great formation of gas. This gaseous formation causes the eyeballs to protrude, and the features are so much swollen and distorted as to be unrecognizable. In two or three weeks the epidermic blebs open, the in- crease of gas continues, and the body thereby becomes enormously swollen. A frothy, reddish fluid is forced from the mouth and nostrils, due to gaseous formation in the cavities of the head and face. The cavities of the body may burst and discharge their contents. The muscles become pulpy, the whole body finally being changed into a soft mass. The nails and hair are loosened, and at this stage of decomposition it is difficult, if not impossible, to distin- guish the sexes, except a uterus, which is the last organ to yield to putre- factive influence, is discovered. These changes are subject to considerable variation, but the above de- scription furnishes the average changes as seen in a body exposed to the air at a moderate temperature. Loomis2 has "seen bodies buried two months " that have shown fewer of the changes produced by putrefaction than others dead but a week." The order in which the internal organs undergo putrefaction is shown, chronologically, in the following table : Internal Signs of Putrefaction. / The Mucous Membrane of the Larynx and Trachea. This membrane assumes a dirty red coloration at the same time that the greenish spot appears upon the abdomen. It should not be mistaken for congestion. Follow- 1 This is the usual order observed in bodies which are exposed to the atmosphere. In winter the time of commencing putrefaction is from three to six days. 5 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology, vol. i. 164 A MANUAL OF LEGAL MEDICINE ing this stage of redness, the lining membrane becomes olive-green in color, and the tracheal rings soon fall apart, the organ finally disappearing altogether. II. The Brain of Young Infants. This is the next organ to decompose, the process being a change of the delicate organ into a rosy, soft mass, which exudes from the smaller openings. III. The Stomach. This organ putrefies generally in from five to six days, the change showing itself in a dirty red color at the fundus, together with the formation of dirty red streaks on the posterior wall, which soon after appear on the anterior, and then pass into a dirty gray, with patches of black. These streaks may be mistaken for the inflamma- tion due to irritant poisoning. Next in order of putrefaction are the various coats of the organ, the traces of the change being observed in the dark-red streaks (veins) running through the grayish patches, and the pultaceous condition of the organ. IV. The Intestines. Next in order of putrefaction are the intestines, which become greatly distended with gas, burst, and discharge their contents. They finally become a pultaceous mass. Their discoloration and other changes occurring are much the same as in the case of the stomach. V. The Spleen. The next organ to putrefy is the spleen. It first changes to a dark-red color, then to a greenish blue, finally becoming soft and pulpy, a state that is assumed with great rapidity, especially in cases of septicaemia. If the organ was in a healthy state at the time of death, its resistance to putrefaction may last for from two to three weeks. VI. The Omentum and Mesentery. These organs, if not diseased, may resist putrefaction for several weeks. The process, however, is accelerated if they contain much fat. VII. The Liver. The liver of a new-born putrefies earlier than that of an adult person, which may resist putrefaction for several weeks. It first assumes a greenish color, which soon changes to black. This color generally appears at the convexity of the organ, and finally pervades the entire structure. The organ eventually softens, shrivels, and disappears. The gall-bladder is recognizable for a much longer time than is the liver. In cases of fatal arsenical poisoning, the liver resists the process of decomposition for a considerable time, no doubt on account of the affinity of that organ for arsenic. VIII. The Brain of Adults. Putrefaction generally manifests itself in the brain of adults at the end of the fourth or fifth week, and sometimes later. It shows itself first at the base, which softens and assumes a bluish-green color; it then progresses upward and inward. Harris * states that the "color is more of an ashy gray, and the brain retains this color even after it has become very soft, even to the point of almost liquefaction." Brains that have been injured in any way (depressed bone, gunshot wound, etc.) are affected earlier. ' Hamilton's System of Legal Medicine, vol. i. FORENSIC MEDICINE l6_ IX. The Heart. The heart is the next organ to become involved. The softening commences in the columnae carnese, with a progression outward toward the walls of the organ, which subsequently changes into an unrecognizable mass. The heart is one of the tough- est organs in the body. X. The Lungs. Healthy and uninjured lungs at the time of death resist decomposition for several weeks, and it is a curious fact that, although these organs are very soft, they should resist this process so long. The first indications of putrefaction are the little bead-like bladders of air in the sulci on the inferior surface of the lobes. The structure proper of the lung turns at first green, then black, finally softening and disappearing. A differ- entiation between gray hepatization and putrefactive change may be possible many weeks after death. (Harris.) XI. The Kidneys. Next in order are the kidneys, which assume a reddish-brown color and soften, after which they become greenish black ; they then disappear. XII. The Urinary Bladder and (Esophagus. These organs follow the decomposition of the kidneys. XIII. The Diaphragm and the Arteries. The diaphragm being a muscular structure similar to the heart, is capable of re- sisting putrefaction for a long time. The tissues of the arteries likewise resist this process. XIV. The Uterus. The uterus is the toughest organ in the body, and presents the greatest resistance to putrefactive change, a fact of forensic importance in considering the possibility of pregnancy, foeticide, etc. The identity of the uterus has been ascertained at the end of seven months ; and Caspar refers to an instance of its recognition after it had lain in a privy vault nearly ten months ; the organ was of a bright-red color, having also retained its normal shape. CIRCUMSTANCES WHICH PROMOTE OR RETARD PUTREFACTION. Circumstances promoting Putrefac- Circumstances retarding Putrefac- tion, tion. i. Temperature.—The most favor- i. Temperature.—Putrefaction is corn- able temperature for putrefaction is that pletely arrested below o° C. (320 F.), and between 2i.i°and 37.70 C. (700 and ioo° above 1000 C. (2120 F.). This is due to F.). Putrefaction may commence as low the intensifying of cohesion and the evap- as io° C. (500 F.), but it is wholly arrested oration of moisture respectively. A re- at o° C. (320 F.), below which the body markable example of the preservative freezes, and, upon thawing out, putrefies power of cold is cited by Erman, who with remarkable rapidity. Putrefactive states that the body of Prince Mentchi- changes are arrested at ioo° C. (2120 F.), kof, that had been buried in the frozen the body desiccating on account of loss soil of Siberia, on being exhumed, after of its fluids. ninety-two years' burial, was found in a state of almost perfect preservation. The rapidity of putrefaction grows less and less as the temperature advances above 37.8° C. (ioo° F.). It is also re- tarded in bodies buried in hot sand, mum- mification being the result. 166 A MANUAL OF LEGAL MEDICINE Circumstances promoting Putrefac- tion— Continued. 2. Moisture.—This state promotes pu- trefaction by favoring solution ; that is, the various organs undergo putrefaction in proportion to the amount of fluids they contain. For instance, the brain and eye contrast widely with the bones and hair or teeth. 3. Air.—Air promotes decomposition by carrying to the body the lower forms of organic life (micro-organisms), which have the power to bring about the change. Absence of air renders decomposition slow, as is seen in bodies which are her- metically sealed in metallic caskets. Moist air favors the process by lessening evapo- ration. Still air promotes the change. Bodies putrefy more quickly in air than in water or after interment. 4. Condition of the Body.—Corpulent bodies putrefy more rapidly than lean ones, on account of the preponderance of fluids ; dropsical conditions favor putre- factive changes. 5. Age and Sex.—According to Cas- par, the bodies of new-born children and of women dying in childbed decompose more rapidly than others, especially the aged. Orfila states that females change more quickly than males. 6.—Certain Poisons.—Caspar states that putrefaction is rapid after death by morphine, prussic acid, and narcotic poi- sons generally. The same is true when death follows certain animal and gaseous poisons, such as sulphuretted hydrogen and carbonic acid gases. 7. Manner of Burial—Burial in low, damp, swampy soil favors the rapid ad- vancement of decomposition; so, likewise, when the grave is shallow, so that the con- stant variations of the temperature reach the body. This process is also favored Circumstances retarding Putrefac- tion— Continued. 2. Moisture.—The process of decom- position is retarded by an absence of moisture, on account of the absence of air. Dryness of the atmosphere acts as a preservative, as is seen in the dry air of the desert, where bodies have been pre- served for a long time. 3. Air.—The prevention of the access of air to a dead body, such as by its en- closure in a close casket, by close-fitting clothing, or by complete immersion in water, retards the process of putrefaction. 4. Condition of the Body.—Leanness retards putrefaction by the absence of those fluids which hasten this process. 5. Age and Sex.— Adults and old persons decompose more slowly than children. Males change less rapidly than females. 6. Certain Poisons.—Poisons which actually cause death, such as arsenic, an- timony, zinc chloride, chloroform, strych- nine, phosphorus, etc., may be said to retard the process of putrefaction. The action of sulphuric acid, and perhaps other mineral acids, is probably to neutralize the ammonia during its formation rather than to retard putrefaction. Alcohol and arsenic are antiseptics. Lime acts both as a deodorizer and antiseptic, and may pre- vent putrefaction, if applied freely to a dead body, by preventing the access of air. Various other antiseptics have a similar influence. 7. Manner of Burial—-The burial of a body a short time after death retards the effects of putrefaction, as also does inter- ment on high ground and in a dry and ab- sorbent soil (sand or gravel); burial in ground over six feet in depth ; burial in FORENSIC MEDICINE l6_ Circumstances promoting Putrefac- Circumstances retarding Putrefac- tion— Continued. tion—Continued. by a porous soil, interring a body without clothes and a well-secured casket; injec- clothes or coffin, and by insects finding tion of the body through the arteries with their way to the body (as where it has arsenic, zinc chloride, etc. been exposed to the air before burial for a long time) and depositing their ova in or upon it. Order of the Various Parts of the Body affected by Putrefaction in Water.1 When bodies have been submerged in water, the putrefactive changes are less rapid than when they have been subjected to atmospheric or other changes. Sometimes the changes are not shown for a period of twelve days, when the order of parts affected is as follows : ears and temples, face, neck, shoulders, chest, abdomen, and legs. This order is almost the inverse of the putrefactive changes produced in bodies exposed to the air, and, according to Tidy, occurs equally whether the body be submerged alive or dead. Ogston states that the discolorations observed in submerged bodies commence on the abdomen. The effect of the gases developed within dead bodies, after being in the water for some time, is to cause them to float on the surface. After remain- ing buoyant for a short time, the body sinks, on account of the escape of gases, and rises a second time when a new supply of gas has been formed. These gases are equally developed in water as in air. The decomposition of a body in water varies, the rapidity depending on the temperature, 17.8° C. (640 F.) to 200 C. (68° F.) being the most favorable. Putrefaction is also favored by shallow and stagnant water. The change is retarded if the body is covered with mud, or if it be submerged in a cess- pool. These conditions are said to favor the formation of adipocere. The position in which a body floats is such that either the abdomen or the back is above the surface of the water, while the head and the extremi- ties are below the water surface. In the case of females, according to Tidy, the abdomen is always uppermost. After the removal of a body from the water in which it has been sub- merged, its exposure to the air promotes rapid decomposition, and at the end of twenty-four hours the condition of the face is such that its recognition is almost impossible. Forensically, the estimation of the time which has passed since death, in bodies found in the water, is of importance. The following changes of the body at different periods of time, as estimated by Devergie, are abridged from Tidy's work on Legal Medicine : First Four or Five Days.—Little change ; cadaveric rigidity may persist to the fourth day, particularly if the water be cold. 1 Vide Death from Drowning. 168 A MANUAL OF LEGAL MEDICINE Fourth or Fifth Day.— Skin of the ball of the thumb and little finger, and the lateral surfaces of the fingers, begin to whiten. This whitening extends (on the sixth or eighth day) to the palms of the hands and the soles of the feet. The skin of the face will appear softened, being of a more faded white than the rest of the body. Fifteenth Day.—Face somewhat swollen and red ; a greenish spot begins to form on the neck and skin of the mid-sternum. The hands and feet are white and wrinkled. The subcutaneous tissue of the thorax is of a reddish color. The upper part of the cortical substance of the brain is of a greenish tint. At One Month.—Face is of a reddish-brown color, the lips and eyelids swollen and of a greenish tint. The neck is slightly green, and a brown spot with a greenish areola is observed over the upper and middle part of the sternum. The skin is wrinkled, but the nails and hair are still intact. The scrotum and penis are distended by gas, so that the latter organ is sometimes in an erect position. The lungs become very emphysematous, and overlap the heart. About the Sixth or Seventh Week.—The cuticle at the wrists begins to separate. The neck and thorax become very green in color. At Two Months.—A slime, which penetrates the clothes, covers the body. The face is tremendously swollen and brown, the lips separated, and the teeth exposed. The cuticle on the arms, forearms, thighs and legs, and the middle of the abdomen is in its natural state, being an inverse order of putrefaction in the air. The skin (with the nails attached) of the hands and feet now begins to peel off, and the hair falls out, or can be easily de- tached. The veins are almost empty of blood, being filled with gas ; and the right ventricle of the heart will be of a jet-black color, provided the right cavities were filled with blood at the moment of dissolution. At Two and One-half Months.—Adipocere will be formed on the chin, cheeks, breasts, armpits, and internal aspects of the thigh. The green color of the skin extends to the arms, forearms, and legs. Gases greatly distend the abdomen. The muscles are not changed in color. At Three and One-half Months.—At this period in the stage of putrefac- tion, identification or the determination of age is difficult or impossible, on account of the almost complete destruction of the scalp, eyelids, and nose. The color of the skin on the breast is greenish-brown, and the centre of the ab- domen of an opaline appearance, studded with small ulcerations. Other parts of the body present larger erosions. The hands and feet are bare of skin. The lungs are incapable of filling the thorax, a space between them and the costal pleura being the result; this space contains a reddish serum. At Four and One-half Months.—The skull is bare, owing to the com- plete destruction of the face and scalp. The brain shows traces of adipocere on its anterior parts. The remnants of the face, neck, and internal aspects of the thighs are entirely converted into adipocere. Indications of calcareous incrustation are noticeable on the prominent parts. FORENSIC MEDICINE l6g After Prolonged Submersion.—The skin becomes blue, green, and black, and as putrefaction advances, softening and discoloration of the muscles occur, certain parts being converted into adipocere. In course of time all of the soft parts of the body remaining disappear from the skeleton, which finally separates. Tidy mentions a case where a body was found drowned in a cesspool, and of its complete reduction to a skeleton in the short space of eight or nine months. This result was due to the surroundings, which prevented the conversion of the body into adipocere. IX. Saponification, or Adipocere.—This change in the dead body is a modification of the process of putrefaction, due to the conversion of the body into a new substance, which was styled adipocere, from its marked re- semblance to both fat (adeps) and wax (cera). This substance is of a cheese-like consistence, with an unctuous feel, and a yellow or yellowish- brown color. It is composed chiefly of a mixture of the fatty acids. By the analysis of Chevreul, it was shown to be a true ammoniacal soap (compound of stearic acid and oleic acid),—that is, a combination of fatty acids with ammonia. When it is formed in water saturated with lime, a calcareous base may be substituted for the ammoniacal, a result occasioned by the ex- posure of a body either to river-water or to a grave impregnated with water containing calcium carbonate or sulphate. Two things are necessary for saponification,—viz., animal fat and nitrog- enous matter ; when kept separate, neither will saponify. Therefore skin minus its fat will not be converted into adipocere. Saponification begins in bodies where there is an extensive distribution of fat, such as in the following parts : the female breast, the cheeks, around the kidneys, the omentum, etc. Among the circumstances which are favorable to the change are : (i) bodies of children and young persons, where the fat is abundant and super- ficial ; (2) bodies of corpulent grown persons; (3) exposure of bodies to the soil of water-closets ; (4) burial in an overcrowded cemetery, in humid soil, especially where the bodies are placed one upon the other, the lowest being first affected ; (5) immersion of bodies in water, especially in running water. A completely saponified body may remain in this state for many years, even as long as seventeen years after burial, when the various organs may be still identified. (Loomis.) The time required for the production of adipocere is of forensic impor- tance. Devergie places the time at one year when the body is submerged in water, and three years for bodie's buried in the earth. These periods, under ordinary conditions, must elapse before complete conversion will be accomplished. In some cases the body changes at an earlier period ; Loomis mentions instances where the bodies of new-born children were completely saponified in six weeks. Under specially favorable conditions, adipocere is not formed under three to four months' submersion in water, and six months' burial in earth. (Caspar.) This process affects the muscles first, but finally reaches all the organs I7o A MANUAL OF LEGAL MEDICINE of the body, which are changed into one shapeless mass, whose former ap- pearance is no longer recognizable. Guntz states that the adipocere thus formed has more bulk than all the fat which originally belonged to the body. This fact is important to recollect in regard to the weight of the dead bodies of infants. (Wharton and Stille\) X. Mummification.—By mummification we understand the complete drying (desiccation) up of the body ; it is another change which modifies the putrefactive process, and is the result of burial in a dry, hot soil, or the exposure of the body to a continuously cold and dry atmosphere. ( Vide Putrefaction.) DATA UPON WHICH AN OPINION IS FORMED AS TO THE LENGTH OF TIME WHICH HAS ELAPSED SINCE DEATH. This question assumes great importance in cases of murder in connection with the attempt on the part of the defendant to prove an alibi, and, in the absence of direct evidence, is to be determined by attending to the signs of death occurring before and after putrefaction. The following inferences are approximative ; they cannot be positive, and, further, they are founded on the supposition that the body under examina- tion has been exposed to the influence of the surrounding atmosphere, and has not been buried. i. Data from the Signs of Death before Putrefaction has set in.—If the body is only slightly cold and the jaws show signs of rigidity, the eyeballs sunken, and the eyes glazed, death has taken place within a period of from a quarter of an hour to four hours. If, however, the entire body be perfectly cold and rigid throughout, death has occurred in from twelve or fifteen hours to three or four days. If there be cadaveric lividity (suggillation), it has probably been dead from one to four days. 2. Data after Putrefaction.—If the abdomen has turned green and the body is cold and pliant, the rigor mortis having passed off, death has probably occurred in from one to three days in summer, and from three to six or eight days in winter, the peculiar odor of putrefaction being per- ceptible. If the greenish-yellow discoloration of the abdomen extends over the en- tire surface, and greenish-brown stains and dark-red lines are found, more or less, on various parts, together with relaxation of the sphincter ani muscle, then death has occurred in from eight to ten days in summer, and from ten to twenty days in winter. * If the body is of a greenish color all over, the chest and abdomen greatly distended ; if blebs are found on the skin and maggots in the muscles, the nails and hair loose or falling out, the color of the iris unrecognizable, the features almost obliterated, then death has taken place within a period of from two to three weeks in summer, or from four to five weeks in winter. If the chest and abdomen burst, and the sutures of the skull give way from the gaseous products developed within the head ; if some of the bones FORENSIC MEDICINE I7I are bare and the eyes enormously swollen ; if the viscera appear pulpy, or have perhaps disappeared, death has occurred within a period of from two to four months. In giving an opinion on this question, the legal physician must consider, besides the condition of the various organs of the body, the mode of death, the quantity of clothing worn by deceased, the season of the year, the heat and moisture to which the body has been subjected, etc. Another question arises here,—viz., Of two persons found dead, which expired first? This sometimes becomes a question of great importance, often presenting itself to the legal physician. It was well brought out in the celebrated '' Lizzie Borden case,'' by establishing the fact that Mrs. Borden was dead two hours before her husband, proved by an analysis of the food in the stomachs. CHAPTER XX. MEDICO-LEGAL AUTOPSIES. General Considerations—Surrounding Objects and Position of the Body—Examina- tion of the Body before the Clothing has been removed—External Examina- tion of the Body—Internal Examination of the Body—Post-Mortem Dissection Wounds—Medico-Legal Reports—Table. The object of the medical examiner in performing an autopsy may be to determine whether an individual has died from the effects of violence or poisoning, to assign the cause for a sudden death, or to observe and study the various pathological changes and lesions occasioned by disease. In any case, accuracy of observation and completeness of detail are necessary. In the case of a medico-legal investigation, the physician who undertakes it assumes a very serious responsibility, and he will save himself an enormous amount of trouble, time, and vexation if he will prepare himself well to meet the various contingencies that may present themselves. His duty should be performed with strict impartiality, entirely free from bias, and unshackled by fear or favor ; and, finally, he should be an able anatomist and pathologist. In all cases where disputes are likely to arise, it is advisable that the autopsy should be conducted by or in the presence of two medical exami- ners, and the suspected individual should be represented by an expert or friend of his own selection. An examination of a body after death, as ordinarily undertaken for the purpose of ascertaining the cause of death, where this is due to the effects of disease, concerns the physician himself, the relatives or friends of the deceased accepting the results of his inquiry without question or hesitation ; therefore, with the signing of the death-certificate the duties of the medical examiner are at an end. Not so, however, if the case be one of forensic i72 A MANUAL OF LEGAL MEDICINE interest, because upon the report of the examination and the subsequent testimony will depend the issue of a civil damage suit, or the arrest and trial of a person suspected of criminality, such as homicide, etc. Therefore, in order that the course of justice may progress untrammelled, the legal phy- sician should be eager in his efforts to assist the court in the discovery of truth; for it should not be overlooked that loose and inaccurate methods upon his part may be the cause of jeopardizing the liberty of a citizen on the one hand, or the vindication of the law on the other. An autopsy should always, if possible, be conducted by unobstructed daylight, since artificial light might interfere with correct color interpretation, such as stains of nitric or of picric acid, and other spots. If the exami- nation is to be made in a private house, the available room should be large and well ventilated. The body may be placed upon a high kitchen table, or left lying upon the stretcher furnished by the undertaker. An autopsy should never be performed while the body is in a casket, on account of the unsatis- factory results. The utmost cleanliness must be observed, and suitable cloths should be in readiness to protect the floor around the body ; also, provision must be made for the presence of wash-basins with hot and cold water, soap, cloths, aprons, disinfectants, etc. In the case of a frozen body, it must be allowed to thaw thoroughly before attempting the autopsy. This should be done by placing the body in a warm room until the parts are sufficiently thawed, and not by immersion in warm water or other warm substances. If the body to be examined be embalmed,x great care must be taken in observing the appearances of the various tissues, etc., because the embalm- ing preparation used is capable of modifying the color and consistence of the parts with which it comes in contact. A post-mortem examination is best performed with the following instru- ments at hand, although some of them are not absolutely required : (i) large section knife, with deeply-bellied blade, well-rounded point, and a large and heavy handle; (2) scalpels; (3) brain knife, for incising the solid organs; (4) curved, probe-pointed bistoury, for cutting through the dura mater, etc.; (5) Valentine's razor-like double knife, for making thin sections ; (6) costo- tome, or large bone-forceps, for cutting ribs ; (7) scissors, large and small, for incising vessels and canals of various kinds, also an ordinary sized pair with one blunt and one sharp blade ; (8) enterotome, useful for opening the intestines, heart, etc. ; (9) dissecting forceps, two or more pairs of different sizes; (10) probes, large and small; (n) grooved director; (12) chisels; (13) blow-pipe with stop-cock ; (14) saws ; (15) measuring and graduated glasses ; (16) post-mortem needles and strong twine ; (17) mallet, heavy wooden or rawhide ; (18) scales ; (19) metal and flexible catheters, litmus- paper, vessels, sponges, bottle of flexible collodion, Lugol's solution of iodine for the amyloid test, plates, and magnifying lens. 1 Vide Embalming in its Medico-Legal Aspects. FORENSIC MEDICINE I73 Besides the above instruments, a microscope and adjuncts are necessary for carrying on a satisfactory and complete examination. Of course, an autopsy can be performed with a few of the above-mentioned instruments, such as knives, scissors, forceps, and a saw ; but, in order to make an exami- nation as thorough as possible,—a desideratum in medico-legal cases,—all the necessary appliances should be within reach. For the reproduction of wounds, so as to fix their location on the body, and for other purposes, a photographer's camera is an exceedingly valuable accessory. Tubes with sterilized media (for inoculation), an alcohol lamp, injecting syringes and solutions, and bottles and jars should not be forgotten. In cases where microscopic or chemical examinations become necessary, the parts required should be placed in new glass jars with close-fitting glass covers, with or without alcohol,1 and sealed, numbered, labelled, and ini- tialled, so as to facilitate subsequent identification. In cases of suspected poisoning, the medical examiner should preserve for the chemist the stomach, entire intestinal canal, the liver, both kidneys, the spleen, a portion of muscle from the leg, the brain, and any urine remaining in the bladder. In case the whole of any organ cannot be obtained, the part removed should be weighed and its proportion to the rest of the organ ascertained. When possible, it will be best to make the autopsy within twenty-four hours after the death of the person, although, according to some authorities, the sooner it is performed after dissolution the better for the finer results. On the other hand, putrefaction or long burial should not be allowed to detract from the thoroughness of medico-legal investigations, nor afford justi- fication for declining the examination. Much useful information may be obtained from such examination, such as abnormalities, injuries to bones, foreign bodies in various parts, such as bullets, etc. Notes of the autopsy should, of course, be made. Surrounding Objects and the Position of the Body.—The sur- roundings should be first noted, such as locality, or the place where the body was found, as where the body of an infant is discovered in a privy vault, etc. Sometimes the body may be found in a position which could not have been assumed by the dead person ; or, again, it may have been dragged over the ground by the assailant to a distant place, or the victim may have followed his murderer after having been dealt the fatal blow, and thus perished at a distance from where the assault originally began. The presence of footmarks and their direction, together with the character and condition of the soil, should be noted. These latter signs, together with the presence of any weapon, may show evidence of struggling. In winter the condition of the snow will materially aid one in arriving at definite conclu- sions which would otherwise be difficult of presentment. 1 Where the different organs can be delivered to the chemist at once, preserving fluids should not be used ; but if employed, a sample should be retained, that the chemist may test the same for any impurities. IJ4 A MANUAL OF LEGAL MEDICINE If the dead person is found in a room, then the exact position in which the body lies, especially the position of the hands and feet, is important. Its relation to articles of furniture, to weapons, to cups, glasses, and bottles from which poison may have been taken, and to blood-stains on the floor, walls, etc., should be carefully ascertained and noted. The importance of examining into such details was forcibly illustrated in the li Webster case," New York. If possible, a photograph of the body should be taken in the exact position in which it was discovered ; this also may be of importance as a possible means of future identification. When a body to be examined has been removed from its grave, the character of the surrounding soil should be ascertained, for the question of preservation of the body may arise in court during the process of a trial. Again, if a body be found in a pool or stream of water, the temperature and character of the latter should be noted. Finally, a diagram or sketch of the position in which the body was discovered, especially its position in relation to surrounding objects, should be made. Examination before the Clothes are removed.—The medical ex- aminer should note the exact position of the body when found, particularly in cases where death was occasioned by wounds. The examination of the clothes should be very thorough, noting whether they are torn or cut or stabbed, ascertaining the exact position of all cuts and their correspondence with injuries or wounds upon the body ; also whether any piece or frag- ment of cloth subsequently found tallies with the garment of the suspected person or that of the deceased. Observe whether the clothes are stained with blood, acids, etc. (All articles of clothing should be preserved for evidence.) The condition of the hands should be noted,—that is, whether they con- tain in their grasp hair, clothing, etc., or whether they are blackened or burned with powder, stained with blood, or otherwise injured. The attitude and position of the limbs, the condition of the hands, etc., may assist the examiner in discovering whether or not a struggle occurred before death. (Vide Wounds.) External Examination of the Body.—All clothing, including the stockings, is to be removed, and the body placed upon a high table in the supine position. The inspector of the body takes particular notice of the following points : i. The signs of death, decomposition, and external pathological or trau- matic changes. Any circumstances which tend to throw light upon the time at which death occurred should be carefully noted. 2. The stature, the sex, the probable age, and the weight of the indi- vidual should be ascertained. 3. The temperature of the body should be taken. 4. The rigidity ox flexibility of the extremities should be noted. 5. The color of the skin; note whether there are any marks or scars, or any spots of cadaveric lividity, and, if so, ascertain their situation. FORENSIC MEDICINE T~- 6. Abnormalities ox peculiarities, such as club-foot, spinal disease, excess or deficiency of limbs, etc. 7. The color of the hair and eyes. Also note whether the pupils are large, small, or unequal; whether the cornea is transparent and tense or opaque and loose. 8. The color and expression of the face ; also ascertain the condition of the cavities of the mouth and nose. 9. Contusions —If present, ascertain their situation, character, breadth, length, and depth. ( Vide Vital Ecchymosis vs. Post-Mortem Ecchymosis.) Contusions produced by blows after death cannot be distinguished from those occasioned during life. 10. J Founds.—Note their depth, extent, and direction ; also the con- dition of the margins of the wound, changes in adjacent tissue, and whether caused by a knife, bullet, or other weapon. If necessary, the wound may be enlarged without interfering with its original character. Injuries without any solution of continuity should induce the medical examiner to look for internal trouble. In the case of bullet-wounds, the course and direction of the ball should be noted ; also the presence or absence of foreign bodies in the wound. To distinguish between ante-mortem and post-mortem wounds, observe the following points : slight hemorrhage, non-contraction of the edges, and absence of blood in the tissues are characteristic of post-mortem wounds. There is no differential point between wounds made within two hours after death and those inflicted during life. ( Vide Wounds.) Sometimes a weapon is found near an injured body, and the questions arise whether the injuries could have been inflicted by the weapon in evi- dence, and whether they could have been done by the deceased person. Again, if a body is found wounded, without the discovery of a weapon, the questions arise, What kind of weapon was employed to cause the injuries ? In what manner was it used? etc. These points will be considered farther on. ( Vide Wounds.) 11. Fractures.—These, when present, require consideration as to their situation, bones involved, and contusion of the soft parts, if any. Fractures occasioned during the life of a person are always followed by a greater ex- travasation of blood, more injury to the soft parts, etc., than those produced after death. Post-mortem fractures are much more difficult to produce than those inflicted during life. 12. The presence or absence of foreign bodies in the mouth, nostrils, anus, or vagina. 13. Condition of the Genitals.—These should be examined for injuries, syphilitic lesions, etc. In the female, note the same, arid ascertain the pres- ence or absence of virginity. 14. Qidema of the Feet.—Ascertain, if present, its situation and ex- tent. 15. Burns.—Make note of the parts involved, whether they are inflamed, blistered, etc. ( Vide Burns.) I76 A MANUAL OF LEGAL MEDICINE 16. Appearances due to electricity, lightning, hanging, etc. ( Vide those subjects.) Internal Examination of the Body.—The following order should be observed in the examination of the interior parts of the body : i. The Head.—The scalp should be carefully examined for wounds and scars, and the condition of the hair observed ; the color of the lips and nose should be noted ; also the condition of the teeth, situation of the tongue, etc. In some cases the mouth will be found firmly closed, on account of the rigor mortis, necessitating the use of a chisel to open it. After the above examination, the scalp should be separated by an incision down to the bone and across the head from ear to ear ; the flaps are then everted in both directions, showing the skull. Now look for ecchymoses and inflammatory changes on the internal surface of the scalp and the peri- cranium ; also for fractures or injuries to the outer table of the skull, avoid- ing the error of mistaking them for irregular sutures. Notice any abnormal shape of the skull or unusual thinness of the bone. With a saw, a circular incision is made through the cranium, about half an inch above the external auditory canal, and the top or skull-cap removed. The incision is carried in front to a point about three and one-half inches above the bridge of the nose, and behind through the external occipital pro- tuberance. Remove the calvaria, and examine the external surface of the dura mater, noting its color, the condition of its vessels, the presence of Pacchionian bodies, any morbid changes, etc. If this membrane is very adherent to the calvaria, so that the latter cannot be torn from it without cerebral injury, it may be removed with the bone by cutting through it at the level of the cranial incision. After opening the longitudinal sinus, examine it for thrombi. The dura mater is then removed by a careful incision around, following the cranial incision, and the condition of the arachnoid and pia mater noted. In old persons the latter membrane is often thick and white, being especially marked along the longitudinal fissure and large vessels. Ascertain the degree of congestion, the existence of serum, pus, or blood under, within, or above it. After examining the upper part of the brain as to congestions of its vessels, laceration, or extravasation of blood upon its surface, remembering that this latter condition is frequently observed on the side opposite to the external injury, it is carefully removed by raising the anterior lobes with the fingers of the left hand, and incising the nerves, vessels, and tentorium as they are presented. The medulla oblongata is divided across as low down as possible, and the brain removed. The base of the skull should be examined for fractures. Next, the brain is laid upon its convex surface and the arteries at the base examined for atheroma, thrombi, emboli, and aneu- risms. Look for evidences of extravasations of blood, tumors, and inflam- matory lesions. The brain is then turned over on its base, and an incision carried downward and outward at the junction of the corpus callosum with the cerebrum, after separation of the two lateral hemispheres, when the roof FORENSIC MEDICINE T_- of the lateral ventricles will be cut through and their cavities exposed. The incision thus made is prolonged forward and backward, so as to expose the cornua. The size, shape, and contents of the ventricles should be observed, and the appearance and thickness of the ependyma. Hemorrhage should be sought for on the floor of the lateral ventricles, and, if present, its size and the parts involved by it noted. This done, the brain should be sliced horizontally (one-sixteenth of an inch apart) through the ganglia, exposing any lesions that might be in its substance. Further incisions are carried outward into the hemispheres nearly to the pia mater, with the result of forming long prism-shaped pieces joined by the pia mater and a trifle of the cortex, and allowing the subsequent folding together of the brain, so that the relations of lesions to the organ as a whole may be investigated. Next, the fornix and corpus callosum at the foramen of Monroe are incised and the third ventricle examined. An incision through the lower portion of the vermiform process opens the fourth ventricle, which should be examined as to its contents and the condition of its vessels and ependyma. The floor of this ventricle is divided by making transverse in- cisions (one-sixteenth of an inch apart), and examination is made for minute hemorrhages. The hemispheres of the cerebellum are next opened by in- cisions made from the fourth ventricle and passing outward into its substance, disclosing the presence of any tumors or hemorrhage in the cerebellum. Sometimes the removal of the eye is called for. When such is the case, its removal is accomplished by breaking through the roof of the orbit with a chisel and removing the muscles, thus exposing the optic nerve and the posterior part of the organ. 2. The Spinal Column.—To examine the cord and its membranes the body should be placed on its face with a block beneath the thorax. An incision is made through the skin, subcutaneous tissue, muscles, and the fascia connected with the spinous processes, extending from the occipital protuberance along the spines down upon the sacrum. After the soft parts are dissected away from the laminae out to the articular processes, the ver- tebral arches are fully exposed. The laminae are then sawed through close within the articular processes, so as to open the spinal cavity at its outer margins (Luer's rhachiotome, a double-bladed saw specially adapted for this work, should be used, although a single-bladed instrument accomplishes the same with more time). The laminae and spinous processes are now removed by means of a stout hook, and the cord is brought to view. Great care in the use of the saw must be exercised, so as not to injure the cord. Next, the roots of the spinal nerves are divided and the cord is removed, together with its membrane. It is laid on a clean board or table and the dura mater laid open with blunt-pointed scissors on the anterior and pos- terior surfaces over its entire length, and an examination made for inflam- matory lesions, tumors, etc. Softening or sclerosis of the cord can generally be discovered by passing the finger gently along it. The cord is now divided by transverse incisions (half an inch apart) through its entire length, allow- 12 178 A MANUAL OF LEGAL MEDICINE ing the segments attached to the pia mater to remain, and the incised sur- faces are carefully examined for hemorrhages, softening, scleroses, inflamma- tory lesions, and pigmentations. After the removal of the cord the vertebral column should be examined for fractures and dislocations. 3. The Neck.—Note if there be any marks of violence by the fingers, such as would result from garroting, or by a cord round the neck (strangling or hanging) ; also carefully inspect the neck for ecchymoses, and observe whether the great vessels are full or empty and the nerves in their natural state. Examine the cavity of the nose and mouth, likewise the ears for the presence of blood and other fluids or foreign bodies. The neck should also be examined for glandular enlargements, etc., and the condition of the larynx, trachea, pharynx, and oesophagus noted. 4. The Thorax and Abdomen.—The body is replaced on its back, and a single incision, from the top of the sternum to the pubes, is made, dividing the skin, fascia, and muscles, and passing to the left of the umbili- cus to avoid the round ligament of the liver. A short cut is then made through the peritoneum below the xiphoid appendix, and two fingers of the left hand are inserted and separated, the parietes being raised so that the peri- toneum can be divided to the pubes without damaging the intestines. The skin and muscles are next dissected from the chest on both sides as far back as the false ribs. In order to turn the abdominal walls to the side, the recti muscles are severed subcutaneously near their insertion in the pubes. The cut surface of the chest and abdominal muscles should be examined as to their color, amount of subcutaneous fat, and consistency ; also note whether the former muscles show any evidence of trichinosis or other parasitic disease. The fulness of the mammary glands, together with the presence or absence of milk, should be ascertained in women. These glands should be opened if necessary. A superficial examination of the abdominal cavity should be made now, in order to avoid any possible change in the position of the organs or mixture of fluids that might follow the previous opening of the thoracic cavity. In cases of forensic importance, when the cause of death is believed to exist within the abdominal cavity, it is a rule to examine the organs contained therein first, with, of course, such modifications as the special indications of the case require. Inspection of the abdominal cavity includes the relative position and general condition of the various organs, the condition and color of the peritoneal surfaces, abnormal adhesions, and the amount of blood in the presenting parts. Examine carefully for various forms of hernia and other intestinal malpositions. Note the condition of the vermiform appendix, the amount of fluid in the cavity of the abdomen, and whether there are any signs of inflammation, or evidence of tumors or other foreign bodies. The determination of the height of the diaphragm is of importance, since there are a variety of pathological conditions which change its position. The omentum should be raised and laid over the lower thoracic wall, in FORENSIC MEDICINE I7 order that the small intestine can be more readily inspected ; for this purpose it should be raised out of the pelvis, after which any abnormal contents in the peritoneal cavity will be brought to view ; and, if fluid, its quantity, color, consistence, and nature should be ascertained. In women an examination of the pelvis shows the size and shape of the uterus and the condition of the broad ligaments and the ovaries. The ileo-caecal region seems to be the most frequent site of old adhesions in women, where they are generally joined with the vermiform appendix, about the gall-bladder and around the spleen. 5. The Thorax.—The cartilages of the ribs with the sterno-clavicular ligaments are divided, the incision being downward, outward, and back- ward, the knife (costotome) being held in an oblique position so as not to damage the parts beneath. By a semilunar incision the clavicles are sepa- rated at their attachments to the sternum. The latter bone is now raised with the left hand and reflected. Notice the condition of the lungs, also their position, color, whether adherent, collapsed, or emphysematous. If fluid is seen in the pleural cavity, notice the amount and nature. Complete distention of the lung is observed when death is occasioned by drowning or suffocation. Open the pericardium, and note the presence and amount of fluid, if any. The lungs are removed by passing the hand under them, noticing any adhesions, and lifting them from the pleural cavity and severing the vessels and bronchi at their base. The external surface of the organ should be examined as to shape, color, and consistence. Then open the large bronchi with scissors (blunt-pointed) and extend the incision into the pulmonary substance along the minute bronchi. The condition of the bronchial tubes and pulmonary artery should be noted and the presence of foreign matters in the air-passages (in case of drowning) ascertained. Any blood which has escaped into the thorax should be removed with a sponge, so as to note the color of the parts. The next process is to turn the lung over, grasp its base in the left hand, and make an incision extending from the base to the apex. This will expose the pulmonary surface, which should be examined as to color, and whether the alveoli contain serum, blood, or in- flammatory products ; these latter cannot be forced from the lungs by press- ure, while the serum and blood can. The presence or absence of miliary tubercles should be ascertained. (The hydrostatic examination of the lungs will be considered farther on.) It is best to examine the heart in situ before removal. Note its size and the fulness of the coronary vessels ; also whether there is any evidence of aneurism or dilatation. The organ is then firmly grasped at the apex and removed by severing the vessels at its base. Note its weight, condition of the tissues (sometimes microscopically), thickness of the walls of the ven- tricles, capacity and size of the valves, and condition of the organ gen- erally. The right ventricle of the heart is opened by making an incision over its i8o A MANUAL OF LEGAL MEDICINE anterior margin near the septum. By extending the incision to the apex and upward through the pulmonarv artery, the cavity of the ventricle will be disclosed. Normally, the tricuspid valves will admit the presence of three or four fingers ; in this manner the size may be estimated. The cavi- ties on the left side are similarly opened by making an incision through the anterior wall of the left ventricle and prolonging it upward through the aortic valve. They often contain blood-clots, usually of post-mortem origin, which are readily distinguished from those formed previous to death by their suc- culent, moist condition and reddish-yellow color ; they are easily detached from the walls of the cavities. Ante-mortem clots are of a whitish color, usually dry, and of a firmer consistence ; they are rarely observed after death. The next procedure is to note the condition of the endocardium, which is often stained a deep red, due to the absorption of the coloring- matter of the blood set free by decomposition. Ascertain the size of the cavity and the thickness of the walls of the organ, which may appear un- usually flabby on account of decomposition. The auriculo-ventricular valves are completely exposed by introducing the enterotome into each auricle and extending the incision through the mitral and tricuspid valves to meet the former incision, which has been prolonged through the ventricles, at the apex. The blood should be removed and weighed. The aorta may show signs of dilatation, atheromatous changes, or calcareous deposits. 6. The Larynx and CEsophagus.—An incision should be made from the chin to the upper part of the' sternum. Dissect the soft parts away on either side of the larynx and thyroid gland ; cut along the inner surface of the inferior maxilla from its symphysis to the angle, and through this opening introduce the fingers into the mouth and pull down the tongue. The trachea and oesophagus can be removed together by severing the pos- terior wall of the pharynx (a ligature should first be applied to the oesopha- gus at its lower portion). The pharynx and oesophagus should now be opened along their posterior margin, and evidences of inflammation, tumors, caustic poison, foreign bodies, and strictures looked for. Next open the larynx and trachea along their posterior wall with an enterotome; note whether there is any sign of oedema of the glottis, and also the condition of the mucous membrane. The thyroid gland should be removed and exam- ined. 7. The Abdomen.—Returning to the abdominal cavity, the next pro- cedure is to cut away the omentum. The examination of the intestines, except in gunshot wounds of the abdomen, is best left to the last for the sake of cleanliness. The abdominal viscera, therefore, will be inspected in the following order : the omentum, the spleen, the kidneys, the sexual apparatus, the stomach and duodenum, the liver, gall-bladder, bile-ducts, and portal veins, and, lastly, the abdominal aorta, the receptaculum chyli, lymphatics, etc. The omentum may afford an opportunity for the study of miliary tuber- FORENSIC MEDICINE 181 cles, disseminated carcinosis, or inflammatory changes. For this purpose a small piece should be cut from a portion that contains little or no fat. The spleen is situated obliquely at the left side of the stomach, and pos- sesses little or no forensic interest. It is readily detached and removed from the body. Note its size, color, and consistency, which may vary considera- bly ; also whether there are any abnormal thickenings of its capsule or tubercles or tumors in its substance. Decomposition softens it. Sometimes it is ruptured as a result of violence. The kidneys are removed from the abdominal cavity by separating the peritoneum from them and dividing the vessels and ureters as close to the bladder as possible. These organs may be softened as a result of putrefac- tion, or their surface may have a greenish color owing to the post-mortem action of putrefactive gases on the haemoglobin of the blood. The color, size, and weight of the organ should be ascertained. The next step is to divide the kidney into two parts ; this is done by firmly grasping the organ in the left hand, and making an incision in its capsule along its convex border, when the membrane is stripped off and examined as to its degree of adherence. Note whether the surface of the organ is smooth or granu- lar, pale, congested, or mottled. The organ is then completely divided into halves by prolonging the incision already made through its cortex, inward toward the pelvis. The internal structure should now be examined. Note the thickness of the cortex, which should average one-third of an inch ; also its degree of congestion, and whether the normal light and reddish striations are observed running through it. If these alternating light and dark striations are absent and the organ has not felt the influence of de- composition, various forms of Bright's disease may be suspected. If waxy degeneration be present, the cut surface of the organ should be washed with water and brushed with a few drops of Lugol's solution of iodine (iodine, 5 parts ; potassium iodide, 10 parts ; water, 85 parts), when the amyloid areas will appear as mahogany-colored dots and lines on a yellow background. The pelvis of the kidneys should be examined for inflammatory lesions and evidences of calculi. Occasionally a whitish fluid, produced by post- mortem desquamation of the epithelium, is seen in the pelvis ; it may be mistaken for pus. The suprarenal capsules are of a triangular shape, being situated at the upper and inner border of the kidneys. They readily decompose ; but if this process is not too far advanced, hypertrophy, tuberculosis, tumors, and cheesy degeneration are to be looked for. Where narcotic poisoning is suspected, the examination of the renal organs should be exact and thorough. The bladder may be examined in situ. After drawing off the urine, it should be set aside for future examination, especially in poisoning cases. Careful examination of the walls of the viscus should be made, particularly in cases where fracture of the pelvis exists. Perforating wounds are deter- 182 A MANUAL OF LEGAL MEDICINE mined by filling the organ, before opening it, with water or air through the urethra. In case it becomes necessary to remove the entire organ, care should be taken not to injure it in any way. The further examination of the male genito-urinary system is hardly required ; but if it is desired to remove the penis, it may be stripped out of the skin and severed at the glans, being removed with the bladder attached. Note the condition of the urethra, whether there are evidences of strictures, diverticulae, inflammatory lesions, etc. The Female Organs of Generation.—The inspection of these organs becomes of great importance in connection with criminal operations. The external generative apparatus should be carefully examined for lacerations, haematoma, inflammation, and neoplasms. In medico-legal cases of sus- pected abortion or rape, punctures may be found in the external genitals, occasioned by the bungling use of instruments, as well as the ordinary lacera- tions due to childbirth. In rape cases there are lacerations, swelling, dis- coloration, and often purulent inflammation, especially in the case of children. The condition of the vagina should be ascertained; note its color, presence or absence of rugae, condition of the hymen, etc. This canal may be thor- oughly inspected by incising it on the left side up to the cervix uteri and separating it from the anterior surface of the uterus. The uterus should be measured externally in its longest, broadest, and thickest diameters. The position of the organ should be noted, and it must not be overlooked that retracting perimetritic adhesions may sometimes affect the position and shape of the organ. Observe, before incising, the appearances of the external os, whether it is changed by childbirth, etc. Open the organ by an incision from the fundus to the cervix ; also make two shorter incisions from the upper end of and at right angles with the previous cut, outward toward the uterine openings of the Fallopian tubes. Next measure the thickness of the walls, and at the same time note the relative size of the cervix compared to the body of the organ. Another important point is to examine the uterine vessels and the thickness of their walls. These observations may show whether any previous pregnancy has taken place or not. Ascertain the condition of the mucous membrane and muscular tissue of the uterus, whether it is normal, congested, covered with mucus, dark-colored (after abortion), etc. ; also whether there are any remains of decidua, etc. The cervix may be hypertrophied, ulcerated, etc., conditions which must be carefully ascertained and noted. The ovaries axe to be examined as to size, condition of the surfaces, and shape. After bisection of the ovaries by a longitudinal incision, the color, state of the Graafian vesicles, the corpora fibrosa and lutea, possible abscesses and cysts, etc., should be ascertained ; also any diseased conditions that may be present. The condition of the Fallopian tubes should receive attention, and the possibility of tubal preg- nancy should be borne in mind. The Stomach and Duodenum.—The examination of these organs be- FORENSIC MEDICINE l83 comes of great importance in cases of suspected poisoning. The position and the fulness, together with the color and smell of the stomach and duo- denum, should be carefully noted. These two organs are removed together. The enterotome is introduced into the duodenum at its transverse portion, dividing it along its convex border ; when the pylorus is reached, the incision is continued over to the greater curvature of the stomach as far as the oesophageal opening. Previous to the operation just described (in cases of poisoning), a double ligature should be placed around the lower end of the oesophagus above its junction with the stomach, the duodenum being tied in the same way in two places. The two organs are then removed together unopened, placed in a clean wide jar, and emptied by raising the cardiac end of the stomach. The stomach contents should be examined as to quantity, color, odor, and reaction, and the presence or not of undigested food, alco- hol, or crystalline matter ascertained. It is customary to place portions of the contents in glass bottles for preservation and subsequent microscopi- cal examination. The mucous membranes of the stomach and duodenum should now be examined for evidences of erosions, hemorrhages, tumors, and acute or chronic inflammations. Note the appearance of the rugae • and interspaces, and also the condition of the blood-vessels. Post-mortem redness of the stomach should not be mistaken for the effects of poison or the marks of disease, nor ulcers or perforations due to disease for the results of irritant poisons. Perforations of the stomach from the effects of caustics are readily distinguished from those of spontaneous origin by noting the irregular edges of the opening, which are of the same thickness as the rest of the organ, and the more or less inflamed condition of the parts not affected. The liver frequently undergoes changes as a result of certain poisons. It should be removed from the abdominal cavity for examination. The diaphragm should be cut on each side, together with the suspensory and lateral ligaments, the right and left lobes having previously been raised. Ascertain the weight, measurements, and size of the organ. The gall-bladder is then examined as to the presence or absence of gall-stones, inflammatory lesions, and tumors ; also note the amount and character of the bile. The peculiar discoloration of the surface of the organ is due to the gases generated by decomposition. Note the character of the surface, whether it is smooth or rough. To open the liver, deep incisions in various directions are made. The color and consistency of these cut surfaces should be noted ; also the blood-supply of the liver-tissue, and evidences of amyloid degeneration, tumors, or abscesses. Phosphorus is the only poison that leaves characteristic appearances in this organ. The pancreas is readily removed. Its size and weight should be noted. Make a longitudinal incision into the organ, and examine for evidences of acute or chronic inflammation, tumors, calculi, amyloid degeneration, and fat-necrosis. Post-mortem staining of this organ produces a dark-red color. KS4 A MANUAL OF LEGAL MEDICINE The posterior wall of the abdominal cavity should be examined after removal of the organ. The receptaculum chyli and lymphatics may be examined in certain cases, to determine/ if possible, the relation of the time of death to the ingestion of food. ( Vide table at end of chapter.) Post-Mortem Dissection Wounds.—These are contracted in the examination of dead bodies, and occur in the form of punctures, abrasions, or slight incisions. Not infrequently a pre-existing scratch or abrasion is the channel through which inoculation is effected. The poison is probably generated shortly before death, or soon after, its development being due to a vitiated state of the blood, and its virulence to inoculation from the bodies of those who have died from such affections as puerperal fever, erysipelas, carbuncle, phlebitis, pyaemia, carcinoma of the liver, etc. When the poison is communicated by persons dead of strangu- lated hernia, it is peculiarly dangerous. When the virus is once formed, it becomes independent of its source. Gross mentions an instance which came under his notice, in the person of a young cutler, who, in sharpening some dissecting instruments which had not been in use for some months, slightly pricked one of his fingers, with the result that the hand and arm soon became very painful and swollen, showing a characteristic red line extending up as high as the axilla, the glands of which were speedily involved ; a month's time was required ere the imme- diate effects of the injury passed off. Some persons seem to be peculiarly susceptible to the effects of this poison; disordered health, general debility, mental anxiety, etc., may pre- dispose to the development of the trouble. After a very brief period of latency, well-marked symptoms become mani- fest. The patient complains first of a smarting, stinging, and burning sensa- tion about the part inoculated, which is usually covered with a whitish vesicle, filled with serum, over an indurated reddish base. The part is extremely sensitive to the touch. In the course of twenty-four hours the vesicle rup- tures, showing a small ulcer, with a thin and sanious discharge and foul base. At about this time the pain is distressing, burning, and pulsatile; there is loss of sleep, and the affected part is hot, tense, heavy, and numb. The sore begins to enlarge, and the swelling increases in size ; the course of the absorbent vessels of the arm is outlined by a red line extending from the point of inoculation to the axilla. Soon the whole limb becomes enormously swollen, pits on pressure, and exhibits an erysipelatous appearance. Ac- companying these changes is an increase of pain, and, in very severe cases, inflammatory extension to the summit of the shoulder or to the correspond- ing side of the body. In some cases the symptoms are just the reverse of the above. There may be an extension of the inflammation up the neck and down the side of the body, the involvement of the arm being only slightly apparent; or, as sometimes happens, the limb is entirely free from the trouble. FORENSIC MEDICINE l8- In the great majority of cases the symptoms are local, being confined to the parts adjacent to the original injury. Under such circumstances the patient usually complains of feeling unwell,—headache, want of appetite, some chilliness and aching of the limbs, etc. There is no apparent disturbance of the general health. The latter takes place only when the poison has gained full admission into the general system, when the symptoms are apparent in from twelve to twenty-four hours. The prognosis depends, in some degree, upon the course of the symp- toms. When the trouble is strictly local, ultimate recovery is, as a rule, certain, although the part immediately affected may become useless. In the severe cases fatal results may show themselves within thirty or more hours, the nervous system being apparently under the complete influence of the poison, there being very little evidence of local disease. In other cases marked with severity the patient may survive five or six days, and then succumb to the violence of the resulting inflammation. In still other cases, weeks or months may elapse before the patient finally succumbs to the constitutional irritation occasioned by abscesses formed in the limb or near to the affected area. The prognosis is therefore uncertain. The treatment is both preventive and curative. All abrasions, cuts, etc., upon the exposed skin should be either cauterized or securely covered with some impermeable material before beginning a post-mortem examination. As soon as a wound of this kind has been received, the affected part should be thoroughly washed, and instantaneous interruption of the venous and lymphatic circulation effected by any constricting band. The skin about the wound should be disinfected with strong antiseptic solutions, and the injured part enlarged, if necessary, by making an incision with a sterilized instrument. Bleeding should be encouraged, also the flow of lymph. A strong solution of carbolic acid (ninety-five per cent.) should be applied to all parts of the wound, and the constricting band removed and succeeded by a wet antiseptic dressing. A post-mortem wound should never be closed with collodion or caoutchouc solution. Previous to the application of the cauterizing fluid the wound should be thoroughly sucked. If an infective inflammation appears, freely incise the wound and curette the indurated tissue. For the pain, apply chloral (gr. xx. to water § i) locally. The extension of the lymphangitis may be controlled, in some cases, by applying a circular blister about the arm. The constitutional effects of these wounds (fever, pain, loss of sleep, etc.) should be treated with febri- fuges, anodynes, etc.1 Medico-Legal Reports.—In drawing up a report of the post-mortem appearances of a body, and the conclusions based thereon, the examiner should be exceedingly careful to avoid the use of technical terms, or, when their employment is necessary, should embody their significance in paren- thesis. In a word, the report should be an accurately recorded statement ' Vide Infanticide for Examination of New-Born Children. 186 A MANUAL OF LEGAL MEDICINE of the observations at the time they were made, framed in language such as any coroner's jury can understand. Table. (After Tidy.) Organ. Brain . . . Spinal cord Thymus (at birth) Thyroid body Lungs { r left Heart Orifices of the heart Mitral..... Tricuspid . . . Aortic..... Pulmonary . . Stomach Liver Spleen Weight. 49^ ozs Female. 44 OZS. I OZ. to 1^4 OZS. Pancreas ....... ""MS?*.:::: Suprarenal capsules (each)........ Ureters........ Prostate gland..... Testicles (together) . . Uterus (unimpregnated) Ovaries (together) . . . Bladder....... ^oz. r oz. to 2 ozs. (largest in females 24 ozs. \ __ 17 ozs. \ _ 21 ozs. / 45' 15 ozs. J 2. Measurements, Con- tents, ETC. 15 to 18 in. long. g}4 ozs. 8^ ozs. This organ bears a direct pro- portion to the weight of the body generally. \x/z ozs. Slightly under AYz ozs. 50 to 60 ozs. 45 to 55 ozs. 5 ozs. to 7 ozs. (May vary even in health from 4 to 10 ozs.) 2% ozs. to 2,% ozs. 4*4 ozs. I 3% ozs. 5}4 ozs. | 5 ozs. 1 to 2 drachms. 6 drachms. % oz. to n ozs. 7 to 13 drachms. 120 to 200 gr. About the size of the closed fist (5 in. x 3 k in. x 2)4 in.). Cir- cumference 9.2 in. at widest part. 4 in. circumference. 4}4 in. circumference. 2,Y(> in. circumference. 3Y in. circumference. Length 10 to 12 in.; di- ameter at widest part, when moderately full, 4 to 5 in. 12 in. x 4 in. x 2 in. Length 14 to 16 in. 3 in. x 2 in. x 1 in. Size subject to variation. Probably greater in fe- males. FORENSIC MEDICINE I87 CHAPTER XXI. PRESUMPTION OF DEATH AND OF SURVIVORSHIP. Presumption of Death—Cases involving this Question—Presumption of Survivorship- Cases involving Presumption of Survivorship—The French Law as contained in the Code Napoleon—Probabilities afforded by Age, Sex, etc. The question of presumption of death may arise in such cases where an individual leaves his home and is not heard of for many continuous years, and in some instances never again. The usual limit of time by statute is seven years ; but where a person is known to have been alive during that period, the supposition is that he is still alive until his death is known to have occurred, or until the presumption of death is legally established. Hence this question must depend on general evidence, being a presumption of fact to be ascertained by a jury. Absence of an individual alone does not raise a presumption of his death ; but such absence, in connection with surrounding circumstances, such as the failure by his family and friends to learn of his whereabouts, his character, and his business relations, together with the fact that he was last seen near the place where a murder is supposed to have been committed, and the belief in his family and circle of friends that he is dead, creates a strong presumption of death. The law, however, is satisfied with a less certainty, although a preponderance of proof is re- quired to establish the fact. On the other hand, evidence to overcome the presumption of death—i.e., that the party supposed to be dead was in a financial condition which might have induced him to abscond, or that he was a speculator, or visionary in his business—is all proper evidence to be con- sidered by the jury in ascertaining and establishing the fact. (Sensendefer vs. Pacific, etc., Ins. Co., 19 Fed. Rep., 68.) The question of the presumption of death may be raised in cases where heirship and property are concerned. The law will, in that event, presume the death of a person after the lapse of the necessary period of time estab- lished by statute, and direct the administrator or executor of such person to settle the estate. In life insurance cases, where the insured party has been absent from his usual place of residence for a number of years, and where his lawful heirs demand the payment of his policy, the presumption of death is frequently a point at issue.1 In the case of married persons, a person cannot be convicted of bigamy if he or she can prove that his or her husband or wife has not been heard of for 1 In cases where property was inherited, and in some cases of life insurance, courts have not considered it necessary to wait the lapse of the entire seven years before effecting a settlement; in some instances the lapse of two years was deemed sufficient. iSS A MANUAL OF LEGAL MEDICINE a period of seven years by those who would naturally have heard of him or her had the party in question been alive. In other cases of a special character, such as where the person concerned and presumed to be dead was afflicted with some affection or disease when last heard from, the courts have decided the presumption of death to be earlier or later than the allotted seven years, but the probable issue would involve the hearing of medical testimony as to the probabilities of life. Presumption of Survivorship.—At one time it was said that where several persons have perished in the same catastrophe, the presumption was in favor of the survival of the stronger person ; and again, many cases are to be found seeming to support the position that simultaneous death is to be presumed. But it must now be taken as the law that there is no artificial presumption in cases of this nature, either that any one in particular survived or that all died at the same time; and it will merely be considered, in the ab- sence of evidence to the contrary, that one of them survived, leaving it to be discovered from the evidence who was the individual survivor. The question is one of fact, depending wholly on evidence, the real or supposed superior strength (as from age or sex) of any of the persons perishing by a common calamity being left merely to carry its natural weight,—i.e., as a circumstance proper to be taken into consideration by a judicial tribunal, but which, standing alone, is insufficient to shift the burden of proof. The onus pro- bandi is on the person who claims derivatively through a survivorship of one out of several to prove the fact affirmatively ; and if the evidence does not establish the survivorship of any one, the law will treat it as a matter inca- pable of being determined. ("American and English Encyclopaedia of Law.") The decisions rendered by the courts of New York, Florida, Maryland, Maine, Colorado, and Kansas upon the presumption of survivorship are neg- ative, every case in which the question is involved being adjudicated according to its individual merits, or through the ordinary agencies of proof. In Cali- fornia, however, when two persons lose their lives in the same calamity, and it is not shown who perished first, and there are no particular circumstances from which it can be inferred, survivorship is presumed from the probabilities resulting from the strength, age, and sex, according to certain rules, one of which is, if both be over fifteen and under sixty, and the sexes be different, the male is presumed to have survived. ("California Code of Civil Pro- cedure," par. 1963, subd. 40.) Cases involving Presumption of Survivorship.—Among questions upon this topic dependent upon a legal decision are such as, '' When the parties dying are a father and a son, if the son survive but a moment, his wife shall have dower, for the lands descended the instant the father died." Again, "In the case of a testator and legatee, if the latter dies first, the legacy lapses ; but if he survives the testator for ever so short a time, his executors can claim." So again, " The husband of a woman possessed of freehold property (not specially settled) has a life interest in her estate, pro- FORENSIC MEDICINE l8g vided she has issue by him, born during the life of the mother, and which survives her even for a moment of time (tenancy by courtesy).'" The old Roman law upon this subject enacted that when persons of different ages perished, and there was no evidence presented to show which survived, those under puberty were presumed to have died first; but if one person was above the age of puberty, and both perished together, it was presumed that the former survived the latter. In the case of husband and wife, the husband was presumed the survivor. (Beck.) French Law of Survivorship.—This, according to Fod£re" and Beck, is as follows : i. If several persons, naturally heirs of each other, perish by the same event, without the possibility of knowing which died first, the presumption as to survivorship shall be determined by the circumstances of the case, and, in default thereof, by strength of age and sex. 2. If those who perished together were under fifteen years, the oldest shall be presumed the survivor. 3. If they were all over sixty years of age, then the youngest shall be presumed the survivor. 4. If some were under fifteen and others over sixty, the former shall be presumed the survivors. 5. If those who perished together were over the age of fifteen, but under sixty, the males shall be presumed the survivors where the ages are equal or the difference does not exceed one year. 6. If they were of the same age, that presumption shall be admitted which opens the succession in the order of nature. Of course, the younger shall be considered to have survived the elder. By Section 4 in the above French Code there is no distinction made be- tween an infant one year old and a man of sixty-one years of age, yet it may fairly be supposed that the man of sixty-one years had a better chance of life than the infant, nevertheless the advantage is given to the latter. (Tidy.) The following points are of such importance (notwithstanding the fact that our laws relative to questions of presumption of survivorship are not decisive) that they are presented for the consideration of the court and those who have to discharge the duties of a jury : I. Probabilities afforded by the Age.—(1) In the case of a father and of a child, the English civil law decides the former to be the survivor if the latter be under the age of puberty. (2) There is no probability of survivorship afforded between the ages of fifteen and sixty. (3) Between a middle-aged man and one under fifteen and over sixty years, the probabilities are in favor of the middle-aged man. (4) In the case of one under fifteen and one over sixty years, the latter is supposed to die first. (5) In the case of two under fifteen perishing, the oldest is considered the one who lives longest. iqo A MANUAL OF LEGAL MEDICINE (6) Between a mother and infant, both dying in childbed, without assist- ance, the presumption of survivorship is in favor of the former,' because the child might be still-born, and also because, if large, its life might be endan- gered by delay, and it would be more exposed to danger without assistance. (Reese.) II. Presumption afforded by the Sex.—In the case of a man and a woman perishing by the same casualty, the presumption of survivorship is in favor of the former when it is a question of physical strength and courage, although the question of health might have to be considered. When, how- ever, the passive endurance of the party is considered, the presumption of death would be in favor of the woman. III. Presumption afforded by the Cause of Death.—(i) In cases of drowning or shipwreck, the age, sex, strength, opportunity, and position must be considered. For example, as regards the sex, etc., a man, being stronger, and more likely able to swim than a woman, and in case of ship- wreck being more apt to be on deck, and therefore in the best available position for relief or escape, has the better chances of escape, hence the best probabilities for survival. But, on the other hand, a woman's breasts and her clothes might buoy her up and support her in the water when her strength was fast waning. If the question of survivorship occurs in the case of two or more persons, equally exposed, the presence of bodily injuries or other weakening causes, together with their respective swimming capabilities, would have to be carefully noted. Again, the physician would have to con- sider whether the bodily injuries were inflicted when the person first fell into the water, or not; and further, Were the injuries the outcome of violent efforts to save the person's life? (2) In death from asphyxia (apncea), cold, heat, lightning, or starva- tion, the presumption of survivorship will be considered later on. (Vide Asphyxia, Cold, Heat, etc.) If the question be on the survivorship in the case of several persons being poisoned, the medical jurist should consider the following,—viz., (1) the quantity of the deleterious substance ingested, and (2) the strength of the persons poisoned. It is, however, in such cases (as remarked by Tidy) that some definite law determining survivorship is required. 1 Tidy quotes the following cases from Zacchias, vol. i. pp. 440, 441 : " First, of a mother and infant being shipwrecked; and the other of a mother and infant being killed by lightning, where the parents in both instances were deemed the survivors." FORENSIC MEDICINE 191 CHAPTER XXII. PERSONAL IDENTITY. The Identity of the Living—The Identification of the Dead: (I.) Of the Body re- cently Dead but Entire—(II.) In Cases where Mutilated Remains or a Portion only of a Body have been recovered—(III.) In Cases where a Body has been burnt —In Cases where the Skeleton remains, etc.—Tabular Statement. By identity is meant the determination of the separate or distinct ex- istence of a person, drawn from a series of facts, some of them obscured, perhaps, by trick or fraud, and all of them more or less varied by circum- stances. When the recognition of a person is the object of a judicial action, the forensic application of the term is to be considered. Medico-legally, the consideration of personal identity is one of great importance, embracing, as it does, questions which affect cases of both a civil and a criminal character ; in fact, it may constitute the most important evidence of any presented. Cases of mistaken identity have frequently arisen, and medical literature fairly teems with instances which go to show that innocent persons have often been made to suffer because they had the misfortune to resemble others. The subject of personal identity will be considered under (1) The Iden- tity of the Living and (2) The Identification of the Dead. THE IDENTITY OF THE LIVING. The identity of the living may usually be established by the direct evi- dence of those who have had such acquaintance with the person in question that they have a perfect recollection of his personal appearance. This kind of evidence is, however, often very defective, for the reason that instances do occur where the most confident identification of persons has afterwards proved to be of no value whatever. In the celebrated Tichborne1 and Guerre cases illustrations are afforded of the extreme difficulty of deciding this question. In the former instance eighty-five witnesses swore that the claim- ant was Sir Roger Tichborne, even the latter's mother and family solicitor being among the number. The claimant's case, however, was lost on the cross-examination. The uncertainty of identification is also well shown in the Martin Guerre case, which was tried in the year 1560, before the Parlia- ment of Toulouse. This personage had been away from his home for a period of about eight years, when an individual named Du Tilh appeared and represented himself as the long-absent man. So strong was the resem- blance that his statement was universally accepted by all of Guerre's family, 1 In this case a man named Arthur Orton, with various aliases, undertook to personate Sir Roger, heir to a large estate. 192 A MANUAL OF LEGAL MEDICINE including his wife, sisters, and two brothers-in-law, among whom he had lived unsuspected for three years, having two children by Guerre's wife. Some circumstances, however, occurred to cause suspicion in regard to his true character, and he was arrested on a charge of fraud. Upon his exam- ination he gave perfectly satisfactory answers to the most minute inquiries in relation to Guerre's former life. Some one hundred and fifty persons were examined during the proceedings, of whom between thirty and forty testified from a life-long acquaintance that the prisoner was Martin Guerre, while about the same number swore positively that he was Armand Du Tilh, whom they well knew ; and over sixty, who knew them both, declared that they were unable to say which the prisoner was. Finally, however, the real Martin Guerre appeared upon the scene, when immediately he was recog- nized by the four sisters who had previously testified that Du Tilh was their real brother ; they now admitted their error and acknowledged the dis- tinction. There being now no doubt of the guilt of the prisoner, he was condemned to death and executed. (Wharton and StilleVs " Medical Juris- prudence," vol. ii. p. 1092.) From these two most astonishing examples the fact is demonstrated that appearances are not conclusive evidences of personal identity, simply be- cause they convey different impressions to different observers. This goes to show that a large proportion of people are untrained in minute obser- vation. A second means of establishing identification, especially in a criminal, is by (a) size, (b) dress, (c) voice, and (d) by the presence of peculiar mark (moles, scars, cicatrices, deformities, fractures, and tattoo marks).1 (a) Size.—This relates to the appearance of the person,—that is, whether he be very tall or very short, very corpulent or very slim, or whether he be lame or otherwise deformed. (b) Dress.—This means is sometimes very accurate in establishing the identity of an individual, as where a portion of the prisoner's clothing is found retained in the grasp of his victim, or discovered in the vicinity where the crime was perpetrated. (c) Voice.—The identification of an individual may be aided by certain peculiarities of the voice ; thus, a deep or shrill, lisping or stammering tone always makes an impression hardly forgotten by those who hear it. (d) Peculiar Marks.—These may be either natural or acquired, and may form strong evidence in proof or disproof of identity. Moles are occasion- ally transmitted through several generations. Mother's marks are very- common. '' Many curious cases of doubtful or disputed identity might be cited to illustrate the singular fortuitous resemblance between individuals, not only in their general personal appearance, but also in accidental marks. Other cases might also be related in which long absence and various circum- 1 Scars, cicatrices, deformities, fractures, and tattoo marks will be considered under The Identification of the Dead. FORENSIC MEDICINE z stances have so changed a person that his nearest relatives have not been able to recognize him. Usually in cases of disputed identity, whether of the dead or living, a scar, a deformity, or some congenital or indelible mark, as na'vus maternus, ox mother's mark, a mole, a tattooing, etc., has proved the only means of recognition." Value of Professional Stigmata.—Under this head may be mentioned the appearance of various marks upon the body of the suspected person, thus indicating the occupation of the person. For example, washerwomen present a peculiar condition of the skin of the hands, swollen fingers, and callosities occasioned by the exercise of pressure ; the surgical condition known as housemaid's knee results from kneeling a great deal. Cataract is supposed to be more common among jewellers, as a result of the fineness of their work. It is pretended that retraction of the last phalanx of the left thumb is of frequent occurrence among this class of workers. A character- istic sign of the occupation of drivers and coachmen is the distinct spot of callus situated between the thumb and index finger, and between the second and third and third and fourth fingers, of both hands. Among dress-makers, etc., the skin of the index finger of the left hand will be found to be rough, thick, and blackened, being dotted with numerous points, the result of needle punctures. This condition, however, appears in many occu- pations. Among violinists there exists a hardness of the skin of the tips of the fingers of the left hand. A deep-brown discoloration is sometimes dis- cernible upon the hands of curriers, being due to their peculiar work of tanning. These spots turn to an almost black color if touched with a solu- tion of prussiate of potash and iron. Besides these instances, others might be mentioned, but the observer may gain considerable information as to the occupation of an individual by noting carefully the appearance of the hands. Thus, Hamilton x quotes Le Grand du Salle as saying '' that in four-fifths of the workmen he examined the hands showed the only trace of the kind of work done." Tardieu has by the condition of the hands recognized the following: laundresses, bleachers, copper-workers, coal-miners, coachmen, hair-dressers, tanners, cutters, hair-workers, nail-makers, porters, gilders, cabinet-makers, clerks, florists, engravers upon metals, watch-makers, lock- smiths, milliners, mother-of-pearl workers, shoemakers, glass polishers, button-makers, rag-pickers, tortoise-shell polishers, bookbinders, grinders, saddle-makers, stone-masons, drummers, dyers, wood-turners, metal-spin- ners, 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 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 Salle, we find that 1 System of Legal Medicine. 13 194 A MANUAL OF LEGAL MEDICINE this is the result of contact with some substance which produces a gen- eral alteration, as is the case with washerwomen, tanners, dyers, locksmiths, and saddle-makers. Changes in the feet are much more rare than elsewhere, but such changes are found among porters, tailors, and turners. Shoe- makers, 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. (Identity of the Living, Hamilton's "System of Legal Medi- cine.") Hairs and Fibres.—(This will be discussed in detail in a separate chapter.) The Determination of the Age.—The determination of the age of an individual during life is a matter of some difficulty, especially so in the case of adults. In children it may be necessary to fix the age, more or less pre- cisely, "where the applicability of the laws of the Society for the Prevention of Cruelty to Children," or the question of consent, is at issue. The age of children is determined by noting the appearance of the teeth, the general development of the body, and the height and weight. The fact must not be overlooked that puberty may be somewhat retarded in cases of congenital or hereditary syphilis. The successive appearance of the teeth, both of the first and second den- tition, is shown in the following tables : Milk Teeth. Age. Teeth. 5 to 7 months.................Central incisors. 6 to 9 months.................Lateral incisors. 8 to 12 months.................First molars. 15 to 18 months.................Canine. 18 to 24 months.................Second molars. Permanent Teeth. Age. Incisors. Cus-pids. Bicuspids. Molars. Years. Central. Lateral. An-terior. Pos-terior. An-terior. Second. Pos-terior. 7 8 9 IO ii 12-12^ 12^-14 18-25 4 4 4 4 4 4 4 4 4 4 4 4 l L L \ \ \ 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 t 1 \ \ t \ Of course, it must be remembered that the time of the appearance of the teeth varies considerably in different children, and this is especially so in those of weakly, scrofulous, and rachitic constitutions. Again there are others who have no teeth for several years, and still others who are born with the incisors above the gums. The determination of the age of an adult is of extreme difficulty, on FORENSIC MEDICINE I95 account of the many changes, such as bodily decay, etc., which are con- stantly occurring in those who have been subjected to the usual routine of hard work, mental anxiety, and so on. Thus, the man of thirty or thirty- five may be made to look like a person of fifty, while the absence of any of these changes may cause the individual to appear much younger than he really is. Old age is by no means denoted by gray or white hair, and vice versa. Premature decay is often associated with those who have been the subjects of constant dissipation. Therefore, in determining the approximate age of a grown person, attention must be directed to the following points : (i) the nature and form of the lower jaw (inferior maxilla) ; (2) the con- dition of the teeth ; (3) the rigidity of articulation ; (4) the existence of friable bones ; (5) the coldness of the extremities ; (6) weakness of the genito- urinary apparatus ; (7) troubles of excretion and circulation ; (8) mental weakness ; (9) presence of arcus senilis ; (10) weakness of vision ; (11) altera- tion in locomotion, etc. Tidy1 says, "After thirty-five, besides the crafty crowsfeet (of which the laureate speaks) about the eyes, other lines make their appearance in the face, more especially around the mouth. The features become more set. The eyelashes, eyebrows, and hairs of the face generally grow coarser and longer. Hair, particularly in the male sex, grows pro- fusely in the nostrils and ears and about the nipples. The thumbs become more pointed, and the great toe turns in a curved direction toward the middle line of the foot. The skin loses its suppleness, and becomes either drier or more greasy. The body may either fall away (sinking into little room) or grow stout. The abdomen often becomes pendulous, while in females the mammae either waste or enlarge considerably. The arteries may become tortuous and cord-like, or of even bony hardness. An arcus senilis may be apparent in the eye. The figure begins to stoop as the intervertebral substance is absorbed or shrivels ; the muscular power lessens, and the ver- tebrae become more bevelled. The teeth decay, the nose and chin approxi- mate, and old age creeps on in the lean and slippered pantaloon." Changes wrought through the Effect of Disease.—Facial changes are often, as is well known, occasioned by various general diseases. These changes may be so great that the identity of a person is completely lost. Among the affections that often produce startling results are certain atrophic conditions of the nervous system ; therefore, the medical examiner must be on his guard when dealing with such cases. Handwriting and Variety of Inks.—Handwriting as a means of identification may be of use in detecting the condition of the mind in certain individuals. The style and letter-formation of persons suffering from mental or other organic nervous affections are often greatly changed ; in the in- sane, especially in the first stage of dementia, the handwriting is sometimes very characteristic. Rosse2 mentions an instance, in the case of a former ' Legal Medicine, vol. i. 2 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 196 A MANUAL OF LEGAL MEDICINE patient of his, an aphasic, who, being unable to express himself phonetically, used a book and pencil, with the result that his writing showed a degree of agraphia sufficient to establish his identity beyond question. A fact of im- portance, not to be overlooked when considering the handwriting of persons, is to determine whether the writing in question has been written with the right or the left hand. Some persons afflicted with writers' cramp are often enabled to operate with the unaffected extremity, a result brought about by constant training in this particular line. In cases of suspected forgery or erasure, the chemist is frequently called upon on account of his special knowledge covering such cases. Kvidences of identity are often furnished in cases of forgery by noting the similarity that frequently is found to exist between the variety of ink employed in a certain document and that discovered in the possession of a suspected person. When the chemist is furnished with a document on which an erasure is suspected, he should note the following points before experimenting in any way with the paper : (i) the character of the paper, whether it is glazed on the surface only or all through ; also whether it is hand or machine made; (2) the texture and water-marks ; and (3) the character of the substance used to cover the erased spot; whether it presents a gummy or other con- sistence, etc. The suspected paper should be subjected to a powerful lens in order to ascertain its transparency or translucency or any other peculiarities. The use of the microscope facilitates the demonstration of the water-marks and texture of the paper. Again, the comparative absorptive power of the sus- pected paper at the point of erasure and elsewhere may be determined by wetting it and placing it on a glass plate. In case the paper is unusually thick, paraffin, turpentine, etc., may be employed instead of water. Where animal gelatins, etc., have been used to cover the spot erased, certain re- agents may be of service in detecting their nature ; thus, when the suspected part is treated with a weak solution of iodine and starch, if animal gelatin is present, a blue color results. If gum were used, it would dissolve in water and be precipitated on the addition of alcohol. Resinoid bodies are dissolved by alcohol and reprecipitated by the addition of water. Remnants of the iron of the original ink employed, where an erasure has been at- tempted, may be detected by applying to the spot a solution of galls. The blue color of the iron inks will be revealed upon the application of a solu- tion of the ferrocyanide of potassium. In cases where an acid has been em- ployed to remove ink, litmus will be of use in affording detection. Solutions of ammonia are of service as a means of discovering the remains of any of the iron inks that have been bleached by acids. The color of the writing of most inks1 will be destroyed upon the application of chlorine or solutions of the hypochlorites. (Tidy, " Legal Medicine," vol. i.) Sympathetic inks are those preparations which, when used for writing, • Except those containing carbonaceous matter. FORENSIC MEDICINE IQ- leave no visible, or at least only colorless, marks upon the paper. These may be revealed or brought out in colors by exposure to moisture or to heat, or by the application of other substances. When used separately, the materials of the ferro-gallic inks may be used as sympathetic ink, the writing being done with the sulphate of iron solution and washed over with that of the galls. A dilute solution of the chloride of copper used for writing is invisible until the paper is heated, when the writing is seen, the color being a beautiful yellow, which disappears when the heat is withdrawn. Similar properties are possessed by the salts of cobalt, such as the acetate, nitrate, and sulphate, the writing appearing in a bluish tint. They are rendered green upon the addition of a salt of nickel. ( Vide Table.) Black Inks.—These contain gallate or tannate of iron, suspended by gum. To prevent mouldiness, a few drops of creosote, carbolic acid, or other substances (antiseptics) are added. Copying inks, such as are used to give an impression of the writing made by them to another sheet of paper, are the ferro-gallic inks, with a larger proportion of gum than they usually contain, and a portion besides of sugar. Other inks are the so-called alizarin (contains a little free acid), and those made from the extract of logwood mixed with chromate of potassium. Solutions of oxalic acid, chlorine, and hydrochloric acid will remove any of the inks referred to. The possibility of removal is prevented if Indian-ink is added. The indelible inks are made by mixing a decoction of galls with vanadate of ammonium, or by dissolving wheat gluten in vinegar, after steeping it in water from twenty-four to thirty-six hours, and rubbing up the resulting fluid with Indian-ink or lamp-black. This ink cannot be removed by chlorine, although the black color is dissipated. The silver inks are readily dissolved by the cyanide of potassium. Blue Inks.—The following formulae are given by Tidy : Prussian blue, 30 parts ; oxalic acid, 4 parts ; water, 1000 parts ; or, Prussian blue, 12.5 parts ; oxalic acid, 25 parts ; water, 1000 parts. Red Inks.—These inks may be made by boiling two ounces of Brazil wood, half an ounce of alum, and half an ounce of crystals of tartar in six- teen ounces of distilled water, until it is reduced one-half; after straining, half an ounce of gum-arabic is dissolved, and a tincture added, made by digesting in one and one-half ounces of alcohol (sp. gr. 0.839) one and one- half drachms of cochineal. Another variety is made according to the fol- lowing formula : Brazil wood, two ounces ; chloride of tin, one-half drachm ; gum-arabic, one drachm ; water, thirty-two ounces ; this to be boiled down to sixteen ounces. A third variety is made by boiling together to one-half, two gallons of good vinegar, two pounds of Brazil wood, and one and one- half pounds of Roch or Rupel alum. Other Inks.— Various different-colored inks are prepared by different formulae, such as the yellow and green inks, etc. These latter contain a de- coction of saffron and a solution of indigo carmine mixed with picric acid, respectively. igS A MANUAL OF LEGAL MEDICINE Printing-ink is a preparation verv different from the inks used for other purposes. It is a mixture of boiled linseed oil, yellow soap, drying ingredi- ents, and lamp-black. Sometimes ultramarine, vermilion, and lead chromate, respectively, are employed for blue, red, and yellow printing-inks instead of lamp-black. Lithographers use an ink for tracing designs on paper, which are to be transferred to stone ; and also an ink for taking impressions from engraved plates, which are to be transferred to stone. They are generally composed of shellac, soap, white wax, etc. There is little use for their description in this place. Tidy's Table of Sympathetic Inks. Ink. Developer. Color. Solution of galls. Dilute solution of an Dark brown or black. iron salt. Dilute solution of ferrocya- As above. Rich blue. nide of potassium. Chloride of cobalt. Heat. Blue. Color evanescent, but can be restored by heating. Mixt. (1 chlorides of cobalt and Heat. Green. Color evanescent.but nickel. again appears with heat. Dilute solutions of gold and Exposure to light and Brownish black or purplish. silver salts. heat. Watts's Table showing the Composition of Various Inks. Ingredients per iooo Parts. a b c d e / g h i 62 87 43 135 J 3i 16 47 100 23 k 50 20 20 20 10 / U4 21 16 21 16 m Galls..... Green vitriol . Logwood . . • Vinegar .... Sugar ..... 33 75 25 42 73 73 6o 55 55 225 24 24 187 22 19 133 3i 3i 125 19 8 66 32 9 125 50 11 n-5 33 The Limits of Sight and of Hearing.—The limits of healthy sight, unassisted by instruments, on a clear day and on level ground, are as fol- lows : at a height of five feet the range of distance is 2.96 miles, at a height of twenty feet it is 5.91 miles, at a height of fifty feet it is 9.35 miles, at one hundred feet it is 13.2 miles, at five hundred feet it is 29.5 miles, atone thousand feet it is 41.8 miles, and at a height of five thousand feet it is 94 miles. Therefore, a man of ordinary height may be seen at a distance of from two to three miles, though recognition may not occur. Three essential requisites are necessary for the recognition of objects at the distances above stated ; these are (1) normal vision, by which is meant that the sight of both eyes is perfect ; the eyes must also be perfect in their power of dis- cerning color ; (2) sufficient light; and (3) sufficient size of object. The recognition of a person at a nearer or greater distance depends FORENSIC MEDICINE x upon his stature, gait, color of hair, complexion, color of eyes, and peculi- arities of appearance. According to Tidy, well-known persons cannot be recognized by moonlight farther off than sixteen or seventeen yards ; in broad daylight at one hundred and nine yards; and by starlight the best- known persons cannot be distinguished at a distance greater than ten to thir- teen feet. In some instances a fiash of lightning may be sufficient to effect recognition. The light from a pistol shot may enable one to recognize the person using the weapon. From the many experiments carried on by Desgranges, of Lyons, the following conclusions were reached : '' that on a very dark night, and away from any source of light, the person who fired the gun might be identified within a moderate distance. If the flash were very strong, the smoke very dense, and the distance great, the person firing the piece could not be identified." De Gueret averages the results on the acuteness of vision as follows : at fifty years it is diminished one-fifth, at sixty years it is diminished one- fourth, at seventy years one-third, and at eighty years one-half; so that a person of thirty or forty years of age could identify an object at one hun- dred feet distance ; at sixty years he could not distinguish it at a distance greater than seventy-five feet, and at eighty years he could not recognize the same object farther off than fifty feet. The distance at which the report of a pistol or gun may be audible de- pends to a great extent upon the condition of the atmosphere,—moisture, direction of the wind, etc. The velocity of sound in the air averages eleven hundred and thirty-five feet per second, which is at the rate of about thirteen miles to the minute. The limits of hearing are fixed by Savart as between eight complete vi- brations per second and twenty-four thousand ; by Helmholtz as between sixteen and thirty-eight thousand, or eleven octaves. The practical limit, however, as stated by Tidy, is between forty and four thousand vibrations per second, or a range of about seven octaves. Bertillon's System of identifying Criminals.—The anthropometri- cal system, invented by M. Alphonse Bertillon, and adopted by the French government, is also in vogue in New York, Chicago, Boston, in various cities of Michigan, Ohio, Wisconsin, and of other States, and in the prison at Joliet, Illinois. The method of identification is based upon close attention to facial peculiarities that are not affected by time. Bertillon discovered that the dimensions Of the head, the color of the eyes, and the shape of the ears or nose never changed, and although expressions may vary, the meas- urements never do. Thus by an ingenious method of tabulation he intro- duced a system which has baffled the efforts of old criminals to deny their identity when recaptured. Under this plan mistakes in identification are practically impossible. Of the five hundred thousand individuals who have been subjected to measurement by this system, no two have been found to be exactly alike. The following identification card is a fac-simile of that adopted by the 200 A MANUAL OF LEGAL MEDICINE French government, and is used for keeping records in the various prisons of the country. Upon one side of the card are headings for name, birth- place, occupation, pedigree of the individual, and a description of any marks or wounds. On the reverse side of the card, in addition to the profile and full-face photograph of the person, accurate measurements of his height, length and width of the head, length of the left middle and little finger, of the foot, the forearm, the ear, the stretch of the arms, description of the eyes, circumference of the bust, etc., are recorded. ( Vide Table below.) The Identification Record.' Height......................... Stoop of shoulders- Spread of arms........ Trunk........................... Color of left iris Inner circle Outer circle •■ Peculiarities ' Root (cavity)- Bridge base Nose Height. I Projection. | Breadth. I Peculiarities Aged..................................... Born...................................... At............................................ Canton................................... Department.......................... Rim................. Lobe............... Fold................ . Peculiarities Right ear■ Beard Hair- Left foot..................... Left middle finger Left little finger........ Forehead Inclination..... Height........... Breadth.......... Peculiarities i Color of skin. Full-blooded or pale........ Corpulence............................. Apparent age......................... Other characteristic feat- Photograph. Profile. Photograph. Full face. No..................................I .............................................................................................................................■- ....................................... | Surname and given names..........................................................................- Aliases....................................... Born................................... , at................................................. Son of......................................... Profession................................. Last residence.......................... Papers of identity.................... Relations................................... Military service....................... Number of previous convictions.................... Cause and place of previous detention....... ...................................................................... Cause of present detention, detailed specification of crime.................................................................................................................................................„.....- I..... IV Peculiar Marks and Scars. - II................................................... III. V................................................... vi. 1 Vide Preface. FORENSIC MEDICINE Rosse1 says that "the measurements, which can be made by any person of average intelligence in three or four minutes, are extremely simple. The right ear is always measured, for the reason that this organ is always repro- duced in the traditional photograph which represents the right face. Other special measurements are taken on the left side. ... It is contended that by these measurements alone the identity of an individual whose face is not even known may be established in another country, by telegraph. The ap- plication of the system has proved of great service in the apprehension of deserters from the United States army (when the authorities have been able to find the card), while it is claimed to have caused the disappearance of numerous dissimulators of identity in the prisons of Paris. ... To avoid a possible source of error, mensuration of the organs and the ascertainment of their form may be resorted to in the case of a cadaver that is much de- cayed, or in one that has been purposely mutilated or burned by the assassin in order to prevent recognition. A sufficient number of cases may be cited in which the measurement of a limb or a bone of a deceased person known to have been lame or deformed during life has resulted in the establishment of identity or the reverse."2 Finger and Foot Impressions.—The value of imprints made by the finger- or thumb-tips, as a means of establishing the identity of an individual, was first pointed out by M. Francis Galton. His attention was first drawn to this subject in 1888, when preparing a lecture on personal identification for the Royal Institution, which had for its principal object an account of the then new anthropometric system. He studied the various striations of the human fingers, and was able to corroborate the value attributed to them as a means of personal identification. The markings of a finger of Sir William Herschell made in i860, 1874, 1885, and 1888, respectively, are figured, and show a striking similarity. The difference in age of the digit marks testifies to the wearing of the epidermis. So far as the proportions of the patterns go, they are not absolutely fixed, inasmuch as they change with the shape of the finger. According as 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. ' The Bertillon system, as adopted by the Police Department of New York City, is somewhat of an improvement over that used in foreign countries. For example, much greater accuracy is secured in the measurement of the height of the person under arrest. By the old method the height of the individual was secured by having him measured standing. By this method any clever person could alter it by simply flexing his muscles, whereby the difference in measurement might be so much as half an inch. Under the new order of procedure the measurement is secured by having the criminal laid flat upon his back, with his head and heels in contact with metallic plates so arranged that when the contact is perfect a signal is given by the play of electric bells. In this way the record is infallibly accurate. Besides this modification, other measurements are taken, as those of the head, the bones of which are subject to less alteration than those of other parts of the body. In addition, imprints of the feet are made on charcoal paper, and greater attention is paid to the measurements of the ears and of the occipital angles. 202 A MANUAL OF LEGAL MEDICINE the finger is plumped out or emaciated, or variously deformed by usage, gout, or age, the proportions of the patterns will vary also. Two prints of the same finger, one taken before, another after, an interval of many years, cannot be expected to be as closely alike as two prints made from the same wood-cut. At different periods of time the measurements vary, even in an adult person, just as much as his height, span, and the length of his several limbs. On the other hand, the numerous bifurcations, origins, islands, and enclosures in the ridges that compose the pattern are proved to be almost beyond change. To demonstrate the difference existing between propor- tions and patterns, a comparison is made between 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 their respective peculiarities and inter- relations. The evidence on which these conclusions are founded is mainly derived from the collections made by Sir William Herschel. They refer to one or more fingers, and in a few instances to the whole hand, of fifteen dif- ferent persons. The intervals before and after which the prints were taken amounted in some cases to thirty years. Some of them reach from baby- hood to boyhood, some from childhood to youth, some from youth to ad- vanced middle age, and one from middle life to incipient old age. These four stages nearly include the whole of the ordinary life of man. Altogether Galton has compared some seven hundred points of reference in these couplets of impressions, and found only a single instance of discordance, in which a ridge that was cleft in a child became united in later years. ("Finger Prints," London, 1892.) Further illustrations are afforded in Galton's book, of photographic enlargements which include between them a total of one hundred and fifty-seven pairs of points of reference, all bear- ing distinctive numerals to facilitate comparison and to demonstrate their unchangeableness. Reference is also made to another publication of the author, which raises the aggregate number of points, photographically com- pared, to three hundred and eighty-nine, all of which experiments were suc- cessful, with the single exception mentioned above. This observer, therefore, holds that the fact of an almost complete persistence in the peculiarities in the patterns formed by the ridges, from birth to death, may now be considered as determined. They existed before birth, and they persist after death, until effaced by decomposition. A fixed and constant series of patterns is found. M. Galton shows how systems of parallel ridges sweep in strong curves over the palmar surface of the hand, and how, whenever the boundaries of two systems diverge, the interspace is occupied by a compact little system of its own, variously curved or whorled, having a resemblance to an eddy between two currents. An interspace of this kind is found in the interspace of each finger. The ridges run in parallel lines across the finger up to its last joint, beyond which the insertion of the finger-nail causes a compression of the ridges on either side; their intermediate courses are in consequence so much broadened out that they commonly separate, and form two systems with an interspace between. FORENSIC MEDICINE • 2 A classification of the principal varieties of patterns is into arches, loops, and whorls. In the arches there is no pattern, for there is no interspace ; in the loops the interspace is occupied with a system of ridges that bends back upon itself, and in which no one ridge turns through a complete circle. Whorls comprise all cases in which at least one ridge turns through a com- plete circle, and they include certain double patterns which have a whorled appearance. A third method of classification is determined by the origin of the ridges which supply the interspace from the thumb side or the little-finger side. ("Finger Prints," Galton, London, 1892.) Hamilton' says, '' For the establishment of the identity of a criminal a careful examination should be made of the papers handled, window-panes, and china and glass ornaments, or, in fact, any other object which may re- ceive an impress from his more or less greasy fingers at the place of com- mission of the crime. By oblique light there will sometimes be no difficulty in finding upon the polished window-pane a faint though perfect imprint, which can afterwards be strengthened and made the subject of a permanent record. For this purpose the method contrived by Forgeot (publications of the Laboratoire d'Anthropologic Criminelle, of Lyons), which consists in the application of common ink or some aqueous pigment which will adhere to the parts that are not greasy, may be tried ; or the glass may be subjected to the yapor of hydrofluoric acid. Forgeot has shown that even pieces of paper which have been touched by slightly greasy hands will bear the im- print of the fingers, and the most delicate markings may be brought out after treatment with ordinary ink, and these used as a negative with good results. In exceptional cases the finger-marks may be made to give litho- graphic impressions.'' In the trial of Gurney, of the American Express Company, at New Orleans, the identity of the prisoner was established by the expert, through a faint impression of his thumb left in the wax of a broken seal and com- pared with a subsequent impression of the thumb. Photographs of the thumb impressions on the seal were made and enlarged. The thumb impression which had been made by Gurney was also enlarged ; they were identical. Nevertheless, the prisoner was acquitted. The value of footprints as a means for the identification of criminals is fully recognized, and may alone lead to the identity of such individuals. Mascar, of Belgium, and Causse, of France, differ as to the value of such impressions ; the former holding that the impression of the foot in the ground is smaller than the foot that made it, while Causse, on the contrary, insists that the impression is usually larger. The following remarks are abridged from Tidy's "Legal Medicine." The impress of a foot in sand, etc., is usually smaller than the foot producing it. This is due to the particles of sand at the margins of the impress, which partially fill up the space previously occupied by the foot. In the case of 1 System of Legal Medicine. 204 A MANUAL OF LEGAL MEDICINE clay, or other like material, the impress is larger than the foot, for in the act of walking the foot is lifted from the groundin an opposite direction to that in which it was placed upon it. Again, the impress will depend on the shape of the boot, shoe, slipper, or even the naked foot itself. Further, the size of the impress will depend on the rapidity of progression. Thus, the impress of a naked or shoed foot, produced by a person running, is smaller than that of the same person walking. In the case of a person standing, the impress will be larger. Therefore, from the depth and extent of the marks thus made it may be possible to determine whether the person was standing, walking, or running. In walking, the mark of the whole foot is more or less discernible, as in standing ; while in running, or in ascending a hill, the mark of the heel will be less distinct, although the mark of the ball of the foot may be very evident. Peculiarities of gait may affect the character, shape, and size of the im- pression made by the foot. Thus, in a case mentioned by Tidy, the person had a peculiarity in moving the heel as soon as the foot reached the ground. Even otherwise trifling peculiarities are of importance in comparing foot- prints, as they may constitute valued evidence. The impress of a naked foot covered with blood may lead to important discoveries. The following tabular arrangement, by Tidy, furnishes the rules to be followed and the questions to be considered in the examination of footprints, etc. (i) Note any special peculiarities in the conformation of the foot; for example, bunions, etc. (2) Note any special peculiarities in the boots supposed to have been worn when the impressions were made,—e.g., unusual pieces of iron, nails, and any parts of the soles or heels worn away, indicating peculiarities of tread, etc. (3) Question.—Do the impressions appear to correspond with the boots said to have been worn ? (Be careful not to be misled by comparing a right- handed boot with a left-handed impress, or vice versa. Specially compare all peculiarities.) (4) Note (a) the material on which the impressions occur,— e.g., sand, clay, etc.; (b) the exact shape of the impressions. Is the heel well formed or not ? Endeavor from this to draw some conclusion as to whether the person was standing, walking, or running. Note any signs in the footprints indi- cating peculiarities of gait, (c) The level of the ground on which the im- pressions occur. (5) If there be any marks of blood on the ground, do they correspond or not with marks found on the soles of the boots ? (6) Take, if possible, casts' of the impressions for "evidence. Preserve the blood-stains, or take impressions of them on paper. ■ In taking a mould of a footprint, the method of Hougilon (which is applicable to all kinds of unpnnts except those in snow) may be resorted to. This consists in FORENSIC MEDICINE 2Qe. (7) Note all the surroundings of the footprints, such as stains, weapons, etc., and their position in relation to the footprints. The question as to the length of time since the footprints were made will depend upon various circumstances, such as the weather, temperature, etc. "Circumstances sometimes direct expert attention to vestiges of other animals. The tracks of a dog or of a horse may become the object of a medico-legal inquest. The books record a case in which it was necessary to ascertain whether a bite had been made by a large or a small dog. This question was settled by producing the dogs and comparing their teeth with the scars. Persons familiar with border life know the importance of trails and the minute observation that is brought to bear on them by the expe- rienced frontiersman. In following cattle thieves and murderers, while with the Fourth United States Cavalry on the Rio Grande frontier, I have known the peculiarity of a horse's footprint in the prairie to tell a tale of great sig- nificance. Observation in this respect may extend to such trivial objects as the tracks of wheels, as those of a wagon, a wheelbarrow, or a bicycle, or to the singular imprints left by crutches or a walking-stick. The imprint left in the ground by a cane usually occurs in the remarkable order of every two and a half or every four and a half steps. Investigation of such circum- stances may result in material facts that may be of great assistance in estab- lishing the relation of one or several persons with some particular act." (Rosse, in Witthaus's " Medical Jurisprudence, Forensic Medicine, and Toxi- cology.") THE IDENTIFICATION OF THE DEAD. I. Of the Body recently Dead but Entire. In cases where a body has been dead a short time only, identification may be established by the same general methods as have already been re- ferred to in the identity of the living. Other points to be considered are as follows : Race.—Where the body is but recently dead and but partially decom- posed, no great difficulty will be experienced in determining the race of an individual. The following brief summary of the four great families is taken from Harris's article, "Death in its Medico-Legal Aspects," in Hamilton's "System of Legal Medicine." " (1) The Australoid type, such as the coolies in Southern India and the native Australians : skin chocolate-colored, hair black and wavy, the skull applying heat (to 2200 F. or more) to the impressed ground by holding over it a ben- zine lamp, and then dusting the heated impression with ground paraffin. When cool, the latter may be removed for a mould of plaster of Paris, etc. For the reproduction of imprints left upon snow, common salt is sprinkled over the impress, followed by melted gelatin. The salt lowers the temperature of the snow about fifteen degrees, thereby allowing the mould to form solidly. The gelatin negative is removed and used to make on white plaster an exact representation of the imprint. 206 A MANUAL OF LEGAL MEDICINE narrow or dolichocephalic, the brow ridges prominent, with a projecting or prognathous jaw and thick lips ; the nasal index platyrrhine. " (2) 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 mesorrhine, small and fiat in the Japanese and Chinese, with oblique eyes, and the cheek-bones high. In some of the American Indians the nose is prom- inent, 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. " (3) 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 platyrrhine. "(4) The Whites, divided by Huxley into the Xanthochroi, or fair whites, with pale skin, fair, wavy, or curly hair, light colored eyes, meso- cephalic skull, jaw orthognathous, and nose leptorrhine ; and the Melano- chroi, 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 leptorrhine nose." (Vide The Skeleton, at end of chapter.) Note should also be made of the shape of the nose, the color and size of the eyes, the curve of the lips, the shape of the ear, etc. The length and general appearance of the nails should also be carefully recorded. (The color and character of the hair, etc., will be discussed in a separate chapter.) Tattoo Marks.—The identity of a suspected person may often be deter- mined by such marks or inscriptions. Tattoo marks may sometimes be acci- dental,—that is, where various coloring materials find their way into a wound. In gunshot wounds, when the weapon has been held near the person, minute and scattered dots of powder may be found in the skin. Again, it frequently happens in coal-mine explosions that minute particles of the dust, etc., are forcibly driven into the skin. Tattoo marks are found mostly among criminals of the recedivist and instinctive type ; also among women of easy virtue, paederasts, and tribases. The designs are nearly always of an obscene nature ; thus, it may be possible to determine the calling or previous life of a person by suggestive initials or inscriptions. The indelibility of tattoo marks is such that they may be recognized in the dead body, even when the latter is in a state of decomposition. Tardieu states that extensive tattoo marks may be got rid of; while Taylor, on the other hand, is of the opinion that they cannot be effaced. "Caspar found that, out of thirty-seven persons examined, the marks had become effaced in six ; Hutin, of five hundred and nine examined, disappeared in forty-seven ; Tardieu, of seventy-six examined, effaced in three-over nine per cent, of the whole. In the famous Tichborne trial, evidence was given FORENSIC MEDICINE that both Roger Charles Tichborne, the heir, and the man called Arthur Orton had been tattooed. Now, Tichborne's tattoo was 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 two round, depressed scars on the left wrist about the size of a shilling, and suggestive of the tattoo marks as A. O. These scars had evidently been produced by escharotics. Of course, ex- cision of tattooed wounds is an easy possibility." (Hamilton.) It is well to recollect, in connection with these marks, that otherwise in- visible tattooing may be rendered apparent by briskly rubbing the suspected skin. Cicatrices, etc.—The identity of an individual may sometimes be de- termined by an examination of a cicatrix or scar. (This subject will be more fully discussed when the subject of Wounds is considered.) Other points to be remembered in this connection are the depressions made upon fingers by rings, or upon legs by garters, as they may resemble slightly superficial scars. The value of photographing the remains of a dead person cannot be ques- tioned, not alone in the case of the whole body, but also where portions of a corpse are found at different intervals, since the question may arise whether they belong to the same individual or not. II. In Cases where Mutilated Remains or a Portion only of a Body have been recovered. The difficulty of identification is very much increased in those cases where the body of a person has been subjected to mutilation after death, or where severed portions of the same body have been removed to a dis- tance or even destroyed. Murderers often dispose of the mutilated remains of a dead body with a view to escape detection. In the brutal murder of his mistress, Caesar, the New York negro, who was recently convicted and sentenced to death, muti- lated the remains in a horrible manner, and then removed the severed por- tions to a distant part of the city, for the evident purpose of avoiding the suspicion that was soon cast upon him. In addition to the foregoing remarks (see also the Identity of the Skel- eton) on the identity of the entire body recently dead, the following case, which came under the observation of Dr. Hebbert, of London, is quoted from Dr. Harris's contribution to Hamilton's " System of Legal Medicine," vol. i. (" Death in its Medico-Legal Aspects"), and will serve to illustrate many of the important points which the medical examiner must note,—to wit: "In July, 1887, Mr. Bond was requested by the treasury to examine some remains found in various portions of London, and I had the opportu- nity of helping at the autopsy. All 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, 208 A MANUAL OF LEGAL MEDICINE 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 pan of the abdomen, from the fifth dorsal vertebra to the third lumbar vertebra; (b) the pelvis below the third lumbar vertebra ; (c) the right thigh, including patella ; (d) the left thigh ; (e) both legs and feet, the left having patella attached ; (/) the arms from the shoulders to the fingers. They were ob- viously human, and on applying the various joint and bone surfaces together we found that they fitted. The skin-cuts apparently corresponded, but had been too much altered by decomposition to warrant a certain opinion. The limbs were muscular, and the remains generally had a fair amount of subcu- taneous 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 vertebra. " The lower piece of the trunk was the abdomen from the third lumbar vertebra and the pelvis. No part of the small intestine from the duodenum 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 ap- pendages, 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-eighths inches. The os internum was well marked and the arbor vitae very distinct. The os externum was small and would barely admit the point of a sound. The ovaries were small, and one showed a corpus luteum of menstruation. The rugae of the vagina were prominent. On the pubes were some black hairs. An incision had evi- dently been made from the ensiform cartilage to the pubes. There was no trace of ecchymosis in the skin of the incisions 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 obliquely 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 FORENSIC MEDICINE 2Qg 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-eighths 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 flexure 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 small cir- cular holes of a water-worm. The femur measured sixteen and one-eighth inches from the head to the lower level of the internal condyle. "The legs, including the feet, had been cut off by circular cuts from the centre of the knee-joints, the left leg having the patella attached. The legs were well-shaped and muscular, and the foot small and without de- formity. There were circular, slightly depressed marks, about half an inch deep, just below the knee. Each leg with the foot measured sixteen inches, right and left tibiae thirteen inches, right and left fibulae thirteen inches. The skin of the legs and thighs was decomposing, the cuticle in places being raised in bullae 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 : " i. The sex was easily told, as the external organs of generation, as well 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 twenty-five and three-eighths inches, by doubling this and adding twelve inches for clavicles and sternum, we should have a result of five feet two and three-quarters inches. The length of the lower extremity was thirty-two and one-eighth inches, multi- plied by two would equal sixty-four and one-quarter inches,—i.e., five feet four and one-quarter inches. By measuring the ring-finger the length was three and one-quarter inches ; this multiplied by nineteen would give us five feet one and one-quarter inches ; so we had to average the three measure- ments and calculate her as about five feet three inches 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 surface of the vertebra were such as would be made by '4 210 A MANUAL OF LEGAL MEDICINE 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 absence 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 sweeping skin- cuts. It may be argued that such skill may 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 con- stantly operating, while a butcher is almost daily cutting up carcasses. Moreover, the limbs were 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, wrenching 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 five feet three inches high ; that she had not borne a child, and, in fact, from the small size of the os uteri, was unlikely to conceive; that 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." ( Vide Tabular Statement at end of chapter.) III. The Identity of Burnt Remains. One of the most difficult problems submitted to the medical examiner is the determination of the identity of burnt human remains. Nevertheless, if the burnt bone be entire, the state of the epiphyses may clear up the ■question of the determination of age. In the case of calcination, the pres- ence of lime phosphate in the ash would constitute no evidence of the bone being that of a human being, since the bone-ash of other animals is identical. The following case, in which the body of a man was almost incinerated, shows how the recognition of even minute portions of bone may lead to the identification of a person. A fireman employed in the engine-room of a coal-pit was missing. Blood being discovered on the door of the furnace, together with burnt portions of dress proved to belong to the dead man, suspicion arose that he had been foully dealt with and his body submitted to the action of the fire in the furnace. A physician examined the ashes of the furnace and FORENSIC MEDICINE 211 found portions of the occipital bone and the base of a human skull, together with the fangs of an incisor and molar tooth. Continuing the search, he discovered portions of the arches of the dorsal vertebrae, a part of the lumbar vertebrae, a portion of a head, body, and humerus, and part of the head and joint of the femur. These bones had been subjected to a high temperature, which had destroyed their internal structure, but the external form was well preserved. A chemical and microscopical examination of some of the clinkers showed that there was blood upon them having the character of human blood. There was no doubt that these were the re- mains of the missing man. He was last seen alive at eight o'clock in the evening, and at four o' clock the next morning nothing remained of him but the few bones referred to above. (Taylor.) THE IDENTIFICATION OF HUMAN BONES. In cases where the question of identity relates to isolated bones or to the entire skeleton, the highest anatomical skill may be requisite before a satis- factory answer can be given. The following points will suggest themselves in the course of the examination : (i) Whether the bones submitted for in- spection belong to a human being or one of the lower animals. (2) If they belong to a human being, whether male or female. (3) The length of time they have probably remained in the ground. (4) The probable stature of the person during life. (5) The probable age of the person to whom they be- longed. (6) The race to which he or she belonged. (7) It should be deter- mined whether solitary bones belong to the right or to the left side, and whether they form parts of one or more than one skeleton. (8) Whether they have been fractured, and, if so, whether it occurred during life, or by accident at the time of the exhumation. If it occurred during the life of the person, whether it be recent or of long standing. (9) The presence or ab- sence of deformities, of supernumerary fingers or toes, of curvature of the spine, of ankylosis of one or more joints. (10) Whether they have been calcined. (Taylor.) Age in the Dead.—In determining the age, the progress of ossification in the different bones, and in young persons the development of the teeth, are the best guides. Of course, it must be remembered that in the identifi- cation of detached bones, or of the entire skeleton, the determination of the age is only approximative. In a case mentioned by Tourdes, the age of a deceased person was guessed as between sixty and sixty-five, whereas the person was eighty-five. Therefore the exact age is difficult to state with any degree of certainty. The following resume", chiefly from Semple, shows the extent to which osseous union has progressed : The separate bones of the skull are generally united within a year or so after birth ; but occasionally the two halves of the frontal bone remain separate throughout the natural period of life. The cranial bones become thinner in old age, as the diploe is more or less ab- sorbed. The sutures at this time of life become ossified, and, if very indis- 212 A MANUAL OF LEGAL MEDICINE tinct, the age may be approximated at from fifty to sixty years. At about the age of puberty the parietal sutures disappear, although they may remain separate during life. The arch and body of the vertebra, together with the body and odontoid process of the axis, unite about the third year, while ossification does not begin in the epiphyses of the spinous and transverse processes until about the age of puberty. They join the vertebral at the age of twenty-five years, or sometimes later. Separation of the several vertebrae of the sacrum continues until eighteen years of age, at which period they commence to unite from below upward, the process not being completed until the age of twenty-five or even later. At a later period the coccyx becomes united to the sacrum. The epiphyses and shafts of the ribs are not united until the age of twenty-five. In the sternum the five segments of the bone are not united until the age of puberty, when it takes place in the lower segments. The body and manubrium of this bone are not joined until old age, but the upper segments unite from the twenty-fifth to the thirtieth year of age, or later. Union takes place in the various os- sific centres of the scapula from the twenty-second to the twenty-fifth year. The sternal epiphysis of the clavicle appears from the eighteenth to the twentieth year, although its junction to the shaft of the bone is not apparent until the age of twenty-five. The head and tuberosity of the humerus be- come united at the age of five years, and are joined to the shaft at twenty years. From the sixteenth to the eighteenth year the condyles unite with the shaft. The superior epiphysis of the radial bone joins the shaft at from the seventeenth to the eighteenth year, while the lower epiphysis unites with the shaft at twenty years of age. The osseous union of the ulna is similar to that of the latter bone. Of the metacarpal and phalangeal bones, the epiphyses join with their shafts at about the twentieth year. The three portions of the os innominata unite about the seventh or eighth year, although they can still be separated. At about the twenty-fifth year the os innominatum is completely ossified. The head and shaft of the femur join at about the eighteenth or nineteenth year, the lower epiphysis and the shaft continuing separate until the twentieth year. Before puberty the neck of this bone has an oblique direction, forming a slight curve from the axis of the shaft. In the adult male and female there is a difference in this direction; in the former it forms an obtuse angle with the shaft of the bone, while in the latter it approaches more nearly to a right angle. It has a horizontal direction in very old and greatly debilitated subjects. The lower epiphyses and shaft of the tibia unite at the eighteenth or nineteenth year, while the upper epiphysis joins with the shaft in the twenty-first or twenty-second year. The same parts of the fibula unite at a somewhat later period. Of the meta- tarsal bones, the epiphyses and shafts unite at a period of from the eighteenth to the twentieth year, and those of the phalanges somewhat later. In advanced life the cartilages of the larynx and ribs become ossified to a certain extent,—that is, their structure assumes more the appearance of osseous than of cartilaginous tissue. By some observers this ossification, FORENSIC MEDICINE particularly of the ribs, is regarded as a sign of disease rather than of age. (Humphry.) Other points worthy of note in connection with old age are the approxi- mation of the osseous laminae of the flat bones as a result of the absorption of the osseous plates of the cancelli. In consequence, further, such bones (ilium, scapula, etc.) are rendered lighter and more brittle. They assume a yellowish color, and their aspect and touch are greasy, through the more or less infiltration of free fat. In the vertebral column the bodies of the several vertebras are bevelled off in front, and the column bends forward. Shrivel- ling in the intervertebral disks also takes place during this period of life. In the lower jaw, however, age produces the greatest structural changes. At a very early period of intra-uterine life and in early infancy the ramus and body of the inferior maxilla form an exceedingly obtuse angle ; in middle life a right angle is almost formed ; while in advanced age, after the disap- pearance of the teeth and absorption of the alveolar border, a reverse order to the infantile type occurs, a prominent ridge replacing the sockets for the teeth as they originally existed. ( Vide Identity of the Living.) Sex.—In the matter of sex there should be no great difficulty, as this can usually be determined from the skeleton, if complete. In cases where single bones and the entire skeleton are submitted for examination, it is well to remember that up to the age of puberty there is little or no difference discernible in the general characteristics of the sexes, although there are many exceptions, of course, in which the males have the advantage both in height and weight. The bones of the male are generally larger and stronger than those of the female ; but the thorax of the latter is deeper and the costal cartilages longer. In short, the corresponding bones of the two sexes differ in size, weight, and the prominence of their ridges and protuberances. There is also a certain difference in the bones of the head. Thiem-Cottbus * ad- vances the following craniological criterion of sex : " The os tympanicum forms part of the posterior wall of the glenoid cavity of the inferior maxil- lary bone, and also closes in front and below the bony meatus of the ear. It arises perpendicularly from the petrous portion of the temporal bone pos- teriorly, and turns backward, in women at about half the height of the mas- toid process, but in man at a less height. In the male the bone develops a sharp edge, which divides to form the sheath of the styloid process ; but in woman this sharpened edge does not exist, the bone is rounded into a tuber- cular form, and the fossa is shallower and flatter. Thus, in the male, this fossa-tympanico-stylo-mastoidea is small and the posterior wall of the glenoid cavity extends so deep that it is not possible for the condyloid process to slip over it. In the female it is so much more spacious that this feature alone will serve to distinguish the skulls of one sex from the other." It is in the pelvis, however, that the main characteristic distinctions are 1 Archiv fur Klinische Chirurgie, Band xxxvii. 2I4 A MANUAL OF LEGAL MEDICINE observed. The male pelvis is deeper and narrower than that of the female. Its bones are thicker and its muscular impressions well marked. In the female the ossa ilii are more expanded and flatter, and therefore more capa- cious at the superior portion. The sacrum is more concave, being broader and turned farther backward, while the pubes is shallow and wider. The greatest diameter in the male is the antero-posterior ; whereas, in the female, the bilateral is the greater. The foramen ovale is egg-shaped in the male; in the female it is triangular. The acetabula are farther apart in the female. All of these appearances, it must be remembered, are not exhibited until the age of puberty is reached. The following table, after Tidy, shows the measurements of the male and female pelvis. Measurements. Between the antero-superior spinous processes of the ilia ...................... Between the middle points of the cristae of the ilia The transverse The oblique .... The antero-posterior The transverse . . The oblique .... The antero-posterior The transverse . . The antero-posterior diameter of the abdominal strait of the true pelvis. diameter of the cavity of the true pelvis. J diameter of the perineal 1 strait of the true pelvis. Ma LE. c ►J 7 8 8 3 4 6 4 5 4 o 4 o 5 o 5 o 3 o 3 3 Female. I I to 10 to II o to 5 to to to to to to to Race.—The principal differences of race are most manifest in the skull, the chief characteristics of which are indicated in the following classes : i. The Prognathous Skull of the Negro.—The chief peculiarity in this form of skull is the characteristic extension or projection of the jaws. The so-called facial angle of Camper is about seventy degrees. The situation of the foramen magnum is generally far back, and the shape of the nasal opening is an equilateral triangle. 2. The Pyramidal Skull of the Esquimaux ; also of the Inhabitants of North and Central Asia.—This skull is pyramidal in shape, due to the form of the malar bones. In reference to this point, Rosse' says that " the books usually speak of the Esquimaux skull as pyramidal, which, in point of fact, is not true. Inspection and examination of a large collection of Esquimaux crania has changed and greatly modified some of the previous notions of the conventional Esquimaux skull. From more than one hundred, collected in the vicinity of Behring Strait, I find that the skulls present very considerable variations among themselves, some being brachycephalic, others dolicho- cephalic. In many the facial angle is eighty degrees, and in one instance eighty four degrees, which exceeds that observed by me in many German skulls. Nor is the prominence of the zygomatic arches such a constant 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. FORENSIC MEDICINE 2I- difference in the configuration as to justify one in speaking of the skull as pyramidal. On the contrary, in many specimens lines drawn from the most projecting part of the zygomatic arch and touching the sides of the frontal bone, instead of forming a triangle on being elongated, might, like the asymptotes of a parabola, be extended to infinity and never meet. The index of the foramen magnum in these skulls is about the same as that of European crania. The internal capacity shows marked difference, the cubic contents of the endocranium averaging that of the French or German." 3. The Oval Skull of the Indo-European or Caucasian.—The facial angle of the skull of a European varies from eighty to ninety degrees. Great caution must be exercised in drawing conclusions from the shape of the skull alone. In addition to the characters of the skull, other parts of the skeleton must be examined if possible. Thus, in the negro, the feet are very broad and flat, the backward prolongation of the os calcis being very great. "In studying the osseous system it should be remembered that certain modifying elements, as artificial compression, pathological deformities, posthumous dis- tortions, and hygrometric conditions, may affect particularly the skull, and if due allowance be not made for these the study may lead to glaring absurdi- ties." (Rosse.) The following table by Ward shows the relative capacity of the skull in different races : Rack. Weight of Skull without Lower Jaw, oz. av. Weight of Millet Seeds the Skull will hold, oz. av. French < l Chinese I Scythian-j * 26.00 20.60 34-50 27.00 40.25 32.00 42.50 3I-50 37-25 39-25 34.00 35-75 The subjoined tables, by Dr. Humphry, give the measurements of human skeletons of different races, etc., the first table in inches, and the second reduced to a scale of 100 : H X •J 2 X 65 62 54 57 [x. 0 h Z ft, p h« ' l-J Qu Q * a" u z 1/3 0 X h 0 z w J 0 w V z w a. w S j ^3 2* u 2 at HI O X D 5 < Q Z < X w < h 0 0 (x. Pelvis. Race, etc. 1-0 v . ■£ ^* oii fc.3 < 8.1 go H European (av-i erage of 25)/ Negro (aver-i age of 25) . / Bosjesman (av-erage of 3) . Idiot (in Berlin Museum) . Symphysis pubis 1 in. below symphysis Symphysis Symphysis 22.2 19-3 17.0 19-5 20.5 19.8 19.6 T3-5 12.7 12.1 IO.8 12.0 9.2 9-4 8-3 8.8 7-3 7-7 6.0 7.0 17.88 17.00 15.00 16.00 14.4 14.4 12.9 12-5 IO.60 II.II 7-50 8.50 5-2 4.6 4.4 5-o 4.3 4.1 3-5 3-8 2l6 A MANUAL OF LEGAL MEDICINE Race, etc. European . . . Negro .... Bosjesman . . Idiot..... 0'Byrne, 8 feet 2 inches . . . Irish giant, 8 feet 6 inches . Sicilian female at io, 20 inches Bebe (or N. Per- ry) at 23, 3 feet S a j p u d u z u 100.00 34.15 3x-54 100.00 31.13 31.94 100.00 31.48 36-29 100.00 34.21 23.68 100.00 30.61 23.98 100.00 100.00 100.00 33-04 33-83 31.00 70.00 19-54 I9-52 20.00 21.05 17-35 16.86 i7-5o 22.23 I4-I5 15.16 15-37 13-43 13.26 13-23 13.00 13.60 Pelvis, U.23 1 27.51 | 22.15 16.03 8.00 6.61 12.42 27.40 23.23 17.90 7.42 6.61 II.II 12.28 10.41 IO.IO II.00 27.78 28.07 24.69 24.70 25.00 26.39 23.S9 13.78 8.15 6.4S 21.92 - 14.96 8.94 6.66 21.43 , 12.75 20.90 n-57 17.50 14.00 19-45 6.94 6.33 8.33 4 45 7.00 7-5° 8.63 6.67 Stature.—If the whole skeleton is laid out, the original height may be determined by allowing one and a half to two inches for the soft parts. Reese,1 quoting M. de St. Lucca, says, "There is a general proportion between the different bones of the body and the stature, and that an approxi- mate estimate of the stature may be had by measuring the length of the first phalanx of the middle finger, thus : this phalanx is equal in length to one- fourth that of the whole hand, including the carpus ; and the carpal and metacarpal bones together represent one-half of the hand. The arm may be divided into five parts, of which two are included in the humerus, two in the forearm, and one in the hand. The total length of the hand is, therefore, one-fifth of the arm. Double the length of the arm (or the two arms stretched out horizontally), added to the length of the two clavicles, to- gether with the transverse diameter of the sternum, is equivalent to the whole length of the body." Ordinarily, the top of the symphysis pubis is the centre of the body in the average woman, while in man the centre is below the symphysis. Ac- cording to Quetelet, the length of the foot equals that of the head, and a little more than one-ninth of the body in man. Dwight assumes that the total height of the intervertebral cartilages is twenty-five and six-tenths per cent, of the entire length of the spinal column. In Orfila's tables, given below, the stature is calculated from the length of bones, the measurements being given in inches and fractions of an inch. Length of Bone (Inches). Stature. Maximum. Minimum. Difference. Humerus 1 Ulna Femur > Tibia 19 observations) .... 14 observations) .... 12 observations) .... 11 observations) .... 14.50 10.66 17-75 14.21 68.IO 70.80 69.66 69.66 64.50 65.66 64.50 64.50 3.60 5-i4 5-16 5-i6 1 Medical Jurisprudence and Toxicology. FORENSIC MEDICINE Length of Bone (Inches). Stature. Maximum. Minimum. Difference. Humerus (6 observations) .... Ulna (7 observations) .... Femur (7 observations) .... Tibia (7 observations) .... 13.00 10.66 18.10 15.00 73-25 73-25 72.00 70.50 69-75 65.00 67.OO 65.OO 3-50 8.25 5-00 5.50 The question, How long have bones been buried? may arise in medico- legal inquiries, but the reply at most can only be approximative. Much will depend upon the condition of the soil in which they have been buried. Thus, in a dry soil they will resist decomposition for a period of from thirty to forty years ; and if preserved in crypts, etc., they may not be affected for hundreds of years. Taylor states that the bones of William Rufus were discovered in a stone coffin at Winchester, almost perfect, after a burial of seven hundred and eighty years. During the process of decay bones become lighter in weight as a result of the loss of animal matter ; the external color assumes a darker hue, and the ends, becoming gradually brittle, crumble away and, together with the shaft of the bone, are reduced to ashes (dust). It is stated that so perfect were the bones of Abelard and Heloise, after the lapse of five hundred years, that the female skeleton could easily be distinguished from that of the male. To determine whether exhumed bones are old or recent, every little detail should be noted with great accuracy. Thus, the discovery of the periosteum and spinal marrow would be proof of a recent state, etc. It requires a lapse of about ten years for a cadaver to skeletonize, although the resistance to decomposition may last for a long time. "The trade or occupation leaves but few marks on the bones that are useful in the matter of identification. ... As a rule, the relatively larger scapula; point to the fact of a day-laborer ; necrosis of the lower jaw suggests a worker in phosphorus ; worn and discolored teeth, a user of tobacco ; and aurification of the teeth might suggest the previous social condition. Gold crowns and fillings and dental prosthesis generally are among the most common and, at the same time, among the most useful signs of identification. By this means the bones of persons killed by Indians on the Western plains have been recognized years afterwards. The traveller Powell, massacred in Abyssinia, was recognized in this way. From the presence of artificial teeth and the mechanical appliances for fixing them, dentists may recognize their own work beyond a doubt. One of the most common-hackneyed of these cases is that of Professor Webster. Later cases, in which this kind of proof established convincing and conclusive identification, are those of Dr. Cronin, assassinated in Chicago in 1889, and of the bomb-thrower, Norcross. . . . In every important case a cast of the mouth should be taken, in order to set at rest any question that may subsequently arise as to the condition of the 218 A MANUAL OF LEGAL MEDICINE jaw, the absence of teeth, their irregularity, or other dental peculiarities." (Rosse.) Other means of identification are afforded by congenital peculiarities, deformities, fractures, and other injuries. Hereditary or acquired disease of the bones, such as rickets, spinal disease, caries, necrosis, ankylosis, etc., may also furnish sufficient evidence to reconstitute individuality. It is well to remember, however, that post-mortem lesions made at the autopsy of a body are not impossible. Again, the effects of violence apparent in exhumed bones may be the result of the spade of the grave-digger. Tabular Statement of Details to be noted in the Examination of Persons, of Bodies or Parts of Bodies, or of Bones in the Question of Identitv. {After Tidy.) I. General Observations. /. The Surroundings of the Body. Noie.-(i) Clothes. (2) Jewelry. (3) All articles found on the body or in the coffin. (4) Hairs grasped in the hands or free about the body. 2. The Probable Business or Trade at which the Person worked. Note.-(i) Condition of the hands, whether horny or soft. (2) Any special injuries to nails. (3) Any special stains, as silver and dye stains, etc. j. The Height of the Person. 4. The Weight of the Person. 5. The Probable Age of the Person. Note.— The Sex. Note.— Deformities. Note.— 1) The amount and color of the hair. 2) The teeth. 3) The maxillae ; condition of the alveolar processes. 4) The condition of the fontanelles. 5) The centres of ossification. 6) The condition of the epiphyses. 7) The size of the bones. 1) The genital system. 2) The condition of the breasts. 3) The general conformation. 4) The length of the hair and its nature generally. 5) The pelvic bones. 6) The markings on the bones. 1) Shortening of legs from hip-disease, etc. 2) Spinal disease. 3) Talipes. 4> Large wens, etc. FORENSIC MEDICINE 2 8. Marks, etc., on the Skin. Note.—{ i) Marks on the skin may include tattoo marks, scars, signs of former disease, etc. (2) Distinguish between those arising : (a) From disease, such as scrofulous ulcers, small-pox, dis- eased teeth, syphilis, etc. (b) From operations (major operations; also bleeding and cupping, leech-bites, etc.). (c) From tattooing or flogging. (d) From natural causes (discoloration, naevi, moles, warts etc.). (e) From violence. (f) From such stains as blood, etc. 9. Injuries. Note.—(i) Fractures. (2) Dislocations. (3) Wounds. Consider : (a) their probable origin; (b) position ; and (c) extent. Then examine in detail the various parts and organs of the body, as follows : 10. The Head. Note.—(1) Complexion; fair, dark, sallow. (2) Shape of head, etc., and features ; European, Mongolian, etc. (3) Forehead ; low, high, prominent. (4) Eyes; large, small, sunken, prominent. (5) Nose; short or long, flat and broad, broad or well-formed nos- trils, etc. (6) Ears; lobules well formed, or continuous with the cheeks; pierced or not. (7) Mouth ; large or small; note scars on the roof; condition of alve- olar processes. (8) Lips ; large or small. Cicatrices. (9) Teeth: Number. Regularity. State of decay. Any special parts where they are more than usually worn. Whether there are false teeth, or indications exist of their having been worn. (10) Chin; full, round, double, pointed, or receding. (11) Hair ; amount, color, and length on head, lip, or chin. Test, if necessary, to ascertain whether the color be natural; whether it has been recently cut. //. The Neck. Note.—Its characters ; short or long ; thick or thin; cicatrices. n. The Chest. Note.—(1) Formation; well formed or pigeon-shaped. (2) Shoulders ; high or sloping. (3) Sternum; flat, sunken, etc. 220 A MANUAL OF LEGAL MEDICINE 13. The Pelvis. Note.—(1) The genitals ; normal or otherwise. (2) In females the question of pregnancy. (3) In the case of a skeleton, decide whether the pelvis be that of a male or a female. 14. The Extremities. ]Vote.—(i) The arms. Size and length generally. Observe whetlier the fingers are short or long, and whether they are of proper proportional length. Any peculiarities of the nails. Note whether the hands are roughened or not by hard work, and whether marked or not by stains. (2) The legs ; whether uniform or not in length. Ankylosis of the joints. Whether bowed or not. Whether in-kneed. The ankles and feet. II. Mutilated Remains. In addition to what has already been stated, note the following : /. Degree of Accuracy of the Fitting of the Various Parts, as follows : (1) Bones. (2) Muscles. (3) Blood-vessels. 2. Nature of the Mutilations : (1) Whether the soft parts were divided with a blunt or a sharp knife, with or without skill. (2) Whether the bones have been chopped or sawed with a coarse or fine saw. (3) The after-treatment to which the parts have been subjected: whether they have been acted upon by lime or other chemi- cals. Burning : If the bones be entire, examine as usual; but if an ash only be found, examine this for phosphate of lime. Boiling, etc. III. The Skeleton or Individual Bones. In addition to the points already indicated, note : (1) The extent to which the soft parts have disappeared. (2) The extent to which separation of the bones has taken place. (3) The color of the bones; their state of preservation; whether human or not. (4) The sex. (5) Whether the bones belong to the same body or not. (6) Examine the pelvis and surrounding parts for the remains of foetal bones. (7) Whether any evidence of disease of the bones exists, such as spinal disease, rickets, syphilis, etc. (8) The existence of injuries. (Blood-stains, seminal spots, etc., will be treated of later; also the In- fantile Skeleton.) FORENSIC MEDICINE 221 CHAPTER XXIII. HAIRS AND FIBRES. Their Structure—Effects of Reagents on Hair—Medico-Legal Questions connected with this Subject—The Hairs of Different Animals—Tables. Hairs are epidermic appendages ; in reality, modified skin formations. Each hair consists of an assemblage of epidermic cells at the bottom of a bulbous-shaped follicle in the substance of the skin, which is supplied with nourishment by blood-vessels distributed to its walls. It is composed of a root, from which the hair is developed, and a stem or shaft continuous with it. The root is that portion above the bulb and within the follicle. Under the microscope two structures are visible,—the cortex, cortical, or outer por- tion, which is fibrous in structure and dotted or striated in appearance, and the median (inner) portion, the pith or medulla, which consists of granular nucleated cells containing air. These latter are from y^g^ to ^wo mcn in diameter, and are angular or rounded in form, being arranged linearly. The air contained in the cells referred to causes them to appear black by transmitted light and white by reflected light. The tubular appearance of hair under the microscope is due to the effect of refraction, and disap- pears when the hair is soaked in a caustic soda solution previous to the microscopic examination. Human hair may be divided into three varie- ties,—(i) long, soft hairs from the head (one to three or more inches in length); (2) short, rigid, and thicker hairs (one-fourth to one-half an inch in length), such as are found in the eyelashes ; and (3) short and very fine hairs from the face, back, and extremities (one-twelfth to one-sixth of an inch in length). A cuticular coat of flat epithelial cells surrounds each hair. The well-marked characteristics of the latter, as observed in different animals, depend, to a certain extent, on the arrangement of this cuticular investment. The diameters and lengths of hairs from different parts of the human body, as well as from different persons (male and female), vary greatly. Thus, the hairs from the head are usually finer, longer, etc., in the female than in the male, and in children they are softer and finer than those ob- tained from grown persons. According to Pincus, the length of the hair from the head is from twenty-two to thirty-one inches, and the rate of growth during the first two years from one-twelfth to one-fifth of an inch ; the diameter averages about -^ inch in man, and ¥i7 inch in woman. The following comparative diameters of the hairs from different positions 222 A MANUAL OF LEGAL MEDICINE are subject to variation: The lanugo from the body measure from ^ to 80i00 inch in diameter; the hairs from the moustache, eyebrows, and pubes about yfo- inch ; from the back of the hand, from ^ to ^ inch ; from the cheek-whisker, ^ inch ; from the eyelid, ^ inch ; from the nostrils, T^ inch ; from the genitals, 7T¥ inch ; from the scrotum, ^ inch ; and from °the axilla, ^ inch. The average diameters of hairs from the neck, temple, and forehead are ^x, ^ and imr inch respectively. N„ medico-legal importance, however, can be attached to these measurements, since hairs from the same locality are subject to too great variations, so far as the identification of their locality is concerned ; nor can any relationship be drawn between the appearances presented by a single hair and the identity of the person to whom it belonged. ( Vide Table.) The question, Is a certain substance presented for examination hair, or is it some fibre, etc., not hair ? is of forensic importance ; therefore the micro- scopical and chemical peculiarities of various fibres, etc., likely to be con- founded with hair will be outlined, as follows : (i) Cotton.— This is the hairs from the epidermis of certain seeds. The cotton fibre is in the form of a flattened band of a twisted or spiral structure, due to the collapse of the cells when dried. It is not colored by Millon's test liquid.1 (2) Wool.—This fibre is irregular, wavy, and of unequal thickness, being found in certain of the Ruminantia. It is a variety of hair. The transverse markings on the fibre are very large. (3) Linen.—This consists of round fibres, with jointed transverse mark- ings at unequal distances, tapering to a point. It is the liber fibres obtained from the stems of the flax plant. They show a very oblique and close striation when boiled with nitric acid. Linen is not colored by the above- mentioned test. (4) Silk.—This is obtained from a substance secreted by the glandular organs of the silk-worm. The fibres are cylindrical in form, and almost free from any markings. They refract light very powerfully. Upon microscopic examination they exhibit solid and somewhat flattened fibres, the boundaries of which are well marked. Millon's test colors silk. (5) Hemp.—This is the liber fibres of the Cannabis sativa. Its fibres re- semble those of flax (linen), but are coarser. Boiled with nitric acid, they swell and become brittle, but exhibit no spiral streaks. (6) fute and Bast.—The former is from an East Indian plant (Corchorus capsularis), while the latter is the liber of the lime-tree. They both show a vegetable structure, their fibres being of a long and glossy nature, with blunt ends. Their walls are not as thick as those of flax fibres, and when boiled with nitric acid no spiral streaks are exhibited. (7) Coir.—The fibres of this material are found in the form of bundles, 1 A strongly acid solution of the mercuric and mercurous nitrates. It turns silk red. FORENSIC MEDICINE 22- blunt ends being characteristic of each fibre. No markings are exhibited, and when boiled with nitric acid no spiral streaks are noticeable. The Hairs of Animals.—These are, as a rule, thicker, shorter, and coarser than those of the human being. The hairs of all animals possess the essential parts of cortex and medulla, however much they may differ in general appearance. In some animals, particularly the smaller rodents, the cortical tubular portion is crossed by transverse partial or complete par- titions, while in others the essential structure does not differ from the finest wool. The greater part of the diameter of the shaft of animal hairs may be occupied by the medulla, so much so that the cortical portion can hardly be detected. This is an important point of difference, since the resultant jointed appearance of the cuticle, in some cases, marks the differences existing between such hairs and the fine downy ones of man and of the foetus. Further, the medullary substance of the hair of man may be absent, or, if present, it represents but a small proportion of the total diameter of the shaft; while, as has been mentioned above, the medulla is almost always constant in the hairs of animals. In cows, horses, the deer, etc., microscopic examination generally reveals the true nature of the hair ; but in some animals—the sky-terrier and spaniel, for example—the distinctions are not so marked, since the hairs bear a close resemblance to those of man. In the reindeer and the musk-ox the entire hair-substance seems to be made up of delicate polygonal cells. In distinguishing the hairs of man from those of an animal the following points are to be remembered : the size, shape, and microscopical appear- ances, the locality of the pigment, the relative proportion of medulla and cortex, and the arrangement of the medullary cells. (Tidy.) The hairs of man have a much finer appearance than those of any other animal; besides, the transverse lines of the cortex are more marked. The size of the hair of the horse and the deer is greater than that of man, with a relatively greater de- velopment of the medulla. The locality of the pigment, both in man and in the monkey, is confined to the cortex, while in the rodent it is found in the medulla. The medullary air-cells in the hair of man are smaller and more crowded than in the quadrumana. The following diameters of hairs from different parts of the body are expressed in fractions of an inch : DIAMETERS. Down from a suckling..................stst to ^ Hair from a young girl's arm...............sifs Hair from the head of a female..............*i? Hair from the pubes of a female..............tss Hair from the head of a man...............ttj Hair from the pubes of a male..............sks Hair from the beard...................\\s Hair from the eyelashes of a male.............sis Hair from the arm of a man...............roVff to ^fa Hair from the hand of a man...............sfo 224 A MANUAL OF LEGAL MEDICINE DIAMETERS—Continued. Hair from the moustache.................jrb to T}T Hair from the ears....................*!* Hair from the eyebrows...................?fo Hair from the nostrils...................j$j Hair of deer.......................jfa Hair of horse......................jju Hair of fox.......................shv Hair of dog.......................ttVs Hair of rabbit......................n'ij Hair of goat.......................sta Pig's bristle.......................ib The following table by Oesterlen furnishes the average diameters of the medulla and shaft in different kinds of hair (the originals have been reduced to fractions of an inch). Average Diameters of the Medulla and Shaft in Different Kinds of Hair. Location of Hairs. Men. Top of head........... Crown of head.......... Temple............. Forehead ............ Eyelashes............ Eyebrows............ Moustache............ Axilla.............. Pubes .............. Women. Top of head........... Crown of head.......... Temple............. Forehead ............ Eyelashes............ Eyebrows............ Axilla.............. Pubes.............. Old Man. Top of head........... Crown of head.......... Temple............. Forehead ............ Boy (aged fifteen years), Top of head........... Nape of neck.......... Crown of head.......... Eyebrows............ Medulla. TSTI T?¥ ZTT TIT5 TIT? 7TT7 TTT? TSVV ITT7 rsVff Shaft. ¥b lb 37? sir sb lb lb sb SSI jb lb ¥77 1 5T¥ *b 1 25T lb ¥b 577 rhs sb ITS *b ¥TI ¥7"5 FORENSIC MEDICINE 225 Average Diameters of the Medulla and Shaft in Different Kinds of H ai r— Continued. Location of Hairs. Boy (aged one and one-half years). Forehead .............. Boy (aged six months). Crown............... Animals. Dog, belly.............. Dog, back.............. White poodle............ White horse, back.......... White horse, belly.......... Black horse, back.......... Black horse, belly.......... Goat................ Cow, belly.............. Cow, back.............. Cat, belly.............. Cat, back.............. Hare, back............. Hare, belly............. Mole, fine.............. Mole, coarse............. Effects of Reagents on Hair.—Nitrate of silver blackens hair, form- ing a sulphuret. This substance and sulphur form the bases of most of the hair-dyes in use. Acids cause the hair to appear rough ; and while alkalies possess similar effects, they have the power of restoring the color of hair bleached by acids. Another effect of the alkalies is their power of dissolving hair. Alcohol adds transparency, while chlorine water or the gas causes the hair to decay with more or less disintegration. A greenish tint of the hair is frequently a result observed in indigo-workers and ebony-turners. Tidy noticed, quite often, a bluish-green tint of the hair of copper-smelters. Peroxide of hydrogen is commonly used to dye the hair a golden tint. Light or red hair may be darkened by the employment of the common hair-dyes, which are principally composed of the salts of silver, lead, and, more rarely, bismuth. In hair thus colored the metal may be discovered readily by treating it with nitric acid, and testing the solution by the appropriate processes. To effect this, the hair is first washed in an alkali, to remove the greasy matters. It is then soaked in chlorine water, its tint being thereby lightened, but the hair is rendered brittle. Medico-Legal Questions.—These are : (1) Ls the hair human or not; if so, from what part of the body ? Upon microscopic examination this question may be answered, since the differences in the cells and linear mark- ings of the cortical portions of the hairs are made apparent. The following 15 Medulla. ¥¥S 1 ■?b ¥2^1 Shaft. 3TJ TSTS 226 A MANUAL OF LEGAL MEDICINE outline gives the chief characteristics of hairs from various parts of the body. The second part of the question under consideration should be replied to with extreme caution. Location of Hairs. General Characteristics. Hairs from the nose and ears .... Hairs from the beard and moustache Hairs from the back of hand .... Firm at the point; bulb stout and knob-like. On section they are smooth, angular, or oval. Roots spindle-shaped and short colored. Roots stout, the structure of the hairs being coarser than those of the eyelashes. Triangular on transverse section ; shaving and cutting modify the shape. The shafts do not taper ; points are conical but not sharp ; perspiration modifies the shape and lightens color of hair. Modified by friction and soap, which also tend to fray them. Roots club-shaped. Oval and flattened ; may also be rough ; in the male the roots are generally knotty, and in the female they are broader. Long in old persons. (2) If the hair is human, does it correspond with that of the murderer or that of the victim ? This question involves the size, color, and character of the hairs in such comparisons. TidyT says, '' The observations, to be valuable, should be numerous. Correspondence, the result of a single observation, should not be deemed sufficient to prove identity, any more than non-corre- spondence in a single observation should lead us to assert non-identity. In giving evidence it will be safer to say that two hairs are similar than that they are identical." (3) Is the hair that of a male or of a female person ? The hair of males is shorter, and from ^J^ to -^^ inch greater in diameter than that of females. The roots are from -^ to -5-^7 mcn wider, and they are not so easily affected by alkalies. ( Vide Tables.) (4) If a hair be not human, from what animal has it been derived? In cases of bestiality this question may arise ; also where hairs are found em- bedded in blood-stains, or discovered on a weapon supposed to have caused death. ( Vide Tables, etc.) (5) Has the hair in question been lately cut or shaved; or, if free, has it been pulled out forcibly, or did it fall out spontaneously ? To ascertain whether the hairs were cut off, attention should be directed to the appearance of the fragment toward the root; also whether the root is absent. Cut hair never 1 Legal Medicine. FORENSIC MEDICINE 227 regains its tapering condition, being more or less rounded. If the ends are smoothly cut, it is probable that a sharp instrument was employed ; but if they appear jagged, the hairs were either cut with a dull instrument or broken off. Hairs forcibly pulled out appear crushed and frayed, the sheath being torn away with the bulb, although it is extremely difficult to decide whether such hairs were pulled out or fell out spontaneously. The hair fre- quently falls out after certain diseases, such as febrile affections, especially typhoid fever, or erythematous affections of the scalp. Irritating applications to the head often occasion a loss of hair, and the present fashion of wearing tightly fitting and unyielding hats no doubt contributes largely toward the premature fall of hair. In such cases the bulbs of the hair are often dis- eased, although Tidy states that "the appearance of hairs lost after fevers and other acute diseases closely resembles, as regards the conditions of their bulbs and hair-sheaths, those torn out violently." (6) Has the color of the hair been naturally or artificially changed? The hair of old persons naturally turns gray, but this change may be hastened by disease or shock, as from sudden fright or grief. The hair of children grows darker as they advance in life. The hair may also be dyed so as to obscure identification. Occasionally a man from thirty to forty-five years of age appears grayer than one ten or more years older. The following case illus- trates how the hair may be discolored so as to interfere with identification : "A man named Benoit was arrested on suspicion of murder. Some wit- nesses testified that they had seen him in Paris at two in the afternoon, with black hair, while others declared that they saw him at Versailles with fair hair at five or six of the evening of the same day. The question being pro- posed whether it was possible to change the color of the hair from dark to light, Orfila deposed that it was. He made numerous experiments to show this, from which it resulted, that by washing the hair with solutions of chlo- rine, black hair could be changed to various lighter shades, according to the strength of the solution and the length of time that it remained applied. This mode of discoloration can, however, readily be detected by the peculiar smell of the chlorine, and by there being something unnatural in the color resulting from its application. He found also that the most effectual way to darken hair naturally light was by the employment of a compound of litharge, chalk, and fresh lime in nearly equal parts. After the hair, which has been wetted with a solution of these materials, has become dry, the chalk and oxide of lead remaining attached to the hair are removed by weak acetic acid and cleaned with the yolk of an egg. The hair is thus effectually dyed black, without any injury to its texture. The fraud can, however, easily be detected by steeping some of the hair in dilute nitric acid, which dissolves the ingredients with effervescence, and, on testing the solution with hydrosulphuric acid, the black sulphide of lead will be obtained." ' ( Vide Effects of Reagents on Hair.) 1 Wharton and Still's Medical Jurisprudence. 228 A MANUAL OF LEGAL MEDICINE In all artificially colored hair the fraud can be detected by observing the new growth, which will usually present a different color. (7) May the hair grow after death ? Hairs will not only endure during a long life, but will also grow after death. Cases in proof of this fact have been reported by Good, Pariset, Bichat, Villerm£, Caldwell, and others. That it is not incompatible with the known laws of physiology is shown by the continuance of the life of individual cells after the organs of the body cease to do their work (somatic life). Dr. Caldwell, of Iowa, reports a re- markable case of post-mortem growth of hair. This observer was present in 1862 at the exhumation of a body which had been buried for four years. The coffin had given at the joints, and he discovered that the hair protruded through the openings. He had proof to show that the dead person was shaved before interment; nevertheless, the hair of the head measured eighteen inches, the whiskers eight inches, and the hair of the breast over four inches.1 The following table exhibits the classification of hair : Woolly hair . . . \ Straight hair . . . Fleecy. African blacks. Kaffirs. In Tufts. Hottentots. Papuans. Stiff. Australians. Hypoboreans. Americans. Malays. Mongolians. Curly. Dravidians. Nubians. Mediterraneans. "The comparison of hair with hair, or of fibre with fibre, as to form, color, length, breadth, etc., yields at all times more valuable evidence, and furnishes data for more exact conclusions, than mere detailed information respecting the microscopical characteristics of an individual hair or fibre. Hence the actual comparison of the hair in question with hair actually re- moved from the person to whom it is suspected to belong should, in all medico-legal cases, be aimed at." (Tidy.) Hairs should always be washed in warm water, thoroughly dried, then steeped in turpentine, and finally mounted in Canada balsam. In all cases of examining hairs, with the ex- ception of those suspected of containing spermatozoa, this process is to be followed. 1 It may not be out of place here to state that post-mortem growth of the nails has been proved by careful observations. FORENSIC MEDICINE 229 CHAPTER XXIV. EXAMINATION OF BLOOD-STAINS. General Remarks—Human Blood—Blood-Corpuscles—Coagulation—Haemoglobin— Haematin—Drying of Blood—Form and Direction of Blood-Spatters—Effects of Reagents—Preliminary Examination of Suspected Stains—Stains that are Liable to be mistaken for Blood—Methods of identifying Blood-Stains: (1) Chemical Tests (Haemin and Guaiacum Tests); (2) Microscopic Test (Red Corpuscles; Table of Red Corpuscles ; Use of High Microscopic Powers ; Effects of Age on the Size of Corpuscles ; Influence of Disease ; Quantity of Blood in the Body; Methods of Procedure in the Examination; Measurement of Red Corpuscles; Tables). Various medico-legal questions concerning the nature of stains re- sembling those of blood found on clothing, bedding, pieces of furniture, weapons, etc., are often presented to the legal physician for solution, as their identification often constitutes an important link in the chain of evi- dence in a trial for murder. Persons suspected of homicide frequently assert that the suspicious stains discovered on their clothing or implements are occasioned by the presence of the blood of some lower animal. Therefore, the examination and determination whether such stains are the result of human blood or not are of the greatest importance. The main medico-legal questions connected with the identification of such stains are : (1) Are the stains blood? (2) If the stains are blood, are they old or recent ? (3) What was their origin ? (4) Are they human blood- stains or those from some lower animal ? (5) If from an animal, is it possi- ble to state from which animal ? (6) Are the stains of venous, arterial, or menstrual blood ? (7) Was the blood derived from a living or a dead subject ? (8) Was the blood from a male or a female, an adult or a child ? Human Blood.—Human blood, as it exists in the human body, is a red, viscid, and homogeneous alkaline fluid of saltish taste and faint odor, with a specific gravity of 1055, tne extreme limits being from 1045 to 1075. It consists of an innumerable quantity of minute solid bodies, the blood- corpuscles, and also some still more minute particles, the so-called plaques of Bizzozero, the function of which is unknown. These bodies float in a liquid known as the plasma or liquor sanguinis. The function of the blood is to distribute the nutritious materials to the different parts of the body and to collect those substances which have re- sulted from the changes constantly occurring in the tissues and carry them to those organs whose function is to expel them from the system. The blood keeps up a constant intercourse between the tissues of the body and the air, thus furnishing them with oxygen. 230 A MANUAL OF LEGAL MEDICINE A thousand parts of blood contain about 795 parts of water and 205 parts of solids. The latter consist of albumen, fibrin, and coloring matter containing iron, fatty bodies, cholesterin, salts, and extractive matters. The salts are made up of chlorine, lactic, sulphuric, phosphoric, oleic, uric, stearic, and hippuric acids, combined with sodium, potassium, calcium, and magnesium. The extractive matters contain minute quantities of leucin, sugar, tyrosin, creatin, xanthin, etc. According to the following table, 1000 parts of the liquor sanguinis and of the blood-corpuscles contain : Liquor Sanguinis. Water..........902.90 parts. Solid ingredients..... 97.10 parts. 1000.00 parts. Blood-Corpuscles. Water..........688.00 parts. Solid ingredients.....312.00 parts. 1000.00 parts. The following list comprises the solid ingredients of each of the above portions : Albumen.........78.84 parts. Fibrin.......... 4-°5 parts. Extractive matters..... 3.94 parts. Mineral salts....... 8.55 parts. Fat............ 1.72 parts. 97.10 parts. Haemoglobin . . . Fat....... Extractive matters Mineral salts . . . 298.97 parts. 2.31 parts. 2.60 parts. 8.12 parts. 312.00 parts. Blood-Corpuscles.—These are of two kinds, the red and the white. In their moist condition they constitute from forty-seven and two-tenths to fifty-four and two-tenths per cent, of the total weight of blood, and have a specific gravity of 1105. The red blood-corpuscles form about one-half of the bulk of the blood (513.04 parts per 1000) and give to the blood its red color. When spread out in a thin layer on a glass slide under the micro- scope they appear yellowish, the red hue being due to the refraction of light when in large numbers. The number of red globules in the blood is enormous ; one drop contains between four and five million, and they pre- sent an aggregate surface of about three thousand square yards, while the surface they represent for the absorption of oxygen in the lungs in one second is estimated at about eighty square yards. One grain of human blood contains about three hundred and twenty-five million red corpus- cles ; and, according to Wormley, a single corpuscle weighs approximately 600000000 grain. ( Vide the microscopic examination of these bodies.) The white blood-corpuscles are small protoplasmic cells, somewhat similar to the round cells found in most parts of the body, and occur in large quantities in the lymph. They are also termed lymphoid cells or leucocytes. They possess a finely granular structure and nuclei, and are lighter and larger than the red globules. These corpuscles contain no cell-wall. They possess an amoeboid movement under certain circumstances, being thus FORENSIC MEDICINE 231 enabled to migrate and pass through the walls of blood-vessels, etc. Their general character and appearance are the same in all kinds of blood. In diameter they measure about g-roir inch. Coagulation.—When blood is drawn from the blood-vessels, its fibrinous substances consolidate into a soft clot resembling a gelatinous mass the meshes of which entangle the blood-corpuscles as if in a spider's web. Coag- ulation is due to the union of fibrinogen and paraglobulin (fibrinoplastin) and a ferment necessarily present known as the fibrin ferment. Some hours after the clot is formed it becomes smaller and of firmer consistence on ac- count of the displacement of the greater part of the serum. This contrac- tion and expulsion of serum lasts for from twenty-four to thirty-six hours. When the surface of the coagulated mass is concave it is said to be cupped; and when it is covered with a grayish-yellow layer of almost pure fibrin, as it occasionally is, the buffy coat is produced. The buffy coat results in those cases where the blood-corpuscles subside a little before becoming fixed in the consolidating mass. The time required for the beginning of coagulation in man is from three to four minutes ; it is complete in seven or eight minutes. In animals it varies somewhat under different circumstances. According to Nasse, the blood of the horse and the ox begins to clot in from five to thirteen minutes ; in the dog in from one to three minutes ; in the sheep, pig, and rabbit in from one-half to one and one-half minutes ; and in fowls in one and one-half minutes. The clotting of blood is slow and the clot small in cold-blooded animals, while in birds the reverse is the rule. The tabular statement given below gives the various conditions which hasten, delay, or even prevent coagulation : Circumstances favoring Coagu- lation. 1. Contact with foreign matter. 2. Exposure to the air. 3. Collection in shallow dishes. 4. Agitation with twigs, etc. 5. Moderate temperature, 37.7° C. to 48.8° C. (1000 F. to 1200 F.). 6. Dilution with less than twice its bulk of water. 7- Stasis of blood in the vessels or injury to the lining membrane. Circumstances retarding Coagu- lation. 1. Contact with the lining membrane of blood-vessels. 2. Cold at freezing point. 3. Contact with oily or greasy substances. 4. The addition of small amounts of al- kalies. 5. The addition of concentrated solutions of neutral salts of alkalies, princi- pally magnesium sulphate. 6. The addition of egg albumen, sirup, glycerin, and much water. Coagulation is prevented by heating the blood immediately to 560 C. (132.80 F.). The subjoined tables show (1) the composition of the living blood, (2) the changes after coagulation, and (3) the changes produced in the blood by stirring it with a stick or twig as it flows from the blood-vessels. 232 A MANUAL OF LEGAL MEDICINE ' Liquor sanguinis . . . I. Blood in Living Body . . I Water. Salts. Albumen. . Elements of fibrin. . Blood-corpuscles. T . . . f Serum . . . ' Liquor sanguinis . . -i I Fibrin II. Liquid Blood III. Liquid Blood Blood-corpuscles ' Liquor sanguinis Blood-corpuscles Clot J Coagulated blood. ' Elements of fibrin }- Fibrin Albumen . . Salts .... I Water .... • Defibrinated blood. Haemoglobin.—This is the coloring-matter of the red blood-corpuscles, which acts as the carrier of oxygen to the various tissues of the body. It is found in the corpuscles of all the vertebrates, with the exception of the amphioxus and leptocephalus, and also in some of the crustaceans, mollusks, insects, and worms. In the invertebrates it exists in solution in the serum of the blood. It forms different crystallizable compounds with oxygen, carbonic oxide, and nitric oxide. Two compounds, oxyhaemoglobin and methaemoglobin, result from its union with oxygen. Both of these substances possess the same crystalline form, but the color of the oxyhaemoglobin solu- tion is different from that of the methaemoglobin solution, the former being red, while the latter is brown. These compounds are sometimes found in the urine in diseases like haemoglobinuria, etc., and also after the ingestion of large doses of potassium chlorate. With carbonic oxide and nitric oxide, haemoglobin produces carbon monoxide haemoglobin and nitric oxide haemoglobin respectively. The for- mer compound has some forensic interest. The crystals of haemoglobin are composed of hydrogen, oxygen, carbon, nitrogen, sulphur, and iron, and are soluble in water and in very dilute alka- line solutions. Ferrocyanide of potassium, acetic acid, chlorine, or nitrate of mercury precipitates the haemoglobin from these solutions. When haemoglobin is treated with dilute acids, alkalies, or heated to the boiling-point of water, or only to 700 C. (1580 F.), it is decomposed into globin and a ferruginous pigment called haematin. Haematin.—This, as stated above, is a result of the decomposition of haemoglobin. It is a brown pigment, and is soluble in alkaline hydrates and in alcoholic sulphuric acid, but insoluble in water, ether, and alcohol. When an alkaline solution is treated with sulphide of ammonium, the re- ducing effect of the latter produces haemochromogen, another pigment, also called reduced haematin. When subjected to oxidation, it is reconverted to haematin. When relieved of its iron by certain reagents, haematin is decom- FORENSIC MEDICINE 23 posed into another product called haematoporphyrin, a substance of forensic importance in certain cases. This product is also obtained by heating haematin to a sufficiently high temperature. Professor WoodJ says, "These decomposition products are of value from a medico-legal point of view, since it sometimes happens that blood-stains are accidentally or intentionally subjected to the action of certain influences which decompose both the haemoglobin and the haematin, so that the ordinary chemical tests will not suffice to detect the blood in the stains ; it may also happen that the cor- puscles also have been destroyed by the action of moisture or some other condition. Hence it is possible that the recognition of a blood-stain may depend entirely on the identification of one of these decomposition products by means of the spectroscope. The recent studies of Liman, Kratter, and Hammerl have shown some of the conditions which will prevent the detection of blood in blood-stains by the application of the ordinary tests, and render necessary the examination of the stains for these other decomposition products,—haemochromogen and haematoporphyrin. The action of high temperatures is especially apt to thus decompose the blood pigment.'' Hcematoidin occurs only when blood coagulates without the circulation, or becomes decomposed, as in old extravasations into the tissues. Its for- mula (C3oH34N406) makes it homologous with bilirubin, although they have different spectroscopic effects. Drying of Blood.—The desiccation of a spot or pool of blood is in- fluenced by certain conditions ; thus, the degree of temperature and the moisture of the atmosphere have much to do with this process. Again, the character of the surface upon which the blood strikes is of importance. An absorbent surface, such as cloth, etc., will favor the drying process much more speedily than a non-absorbent surface (glass, painted wood, steel, etc.). Large quantities of blood dry less rapidly than small quantities. This subject is of importance, forensically, as affording evidence as to the period of time at which a homicide has been committed. Form and Direction of Blood-Spatters.—Spots of blood, if thrown out from a living blood-vessel, very speedily coagulate, and hence may serve to indicate the direction from which the blood came, or the position of the individual with respect to them when the wound was inflicted. Thus, when a blood-stain is elongated, or of an oval shape, it is very likely that the position of the person was in an oblique direction with respect to the stain during the bleeding. The direction of blood-spatters is indi- cated by the smaller extremity, which is farthest from the point of origin, for, as a usual thing, the force with which the blood is propelled from the artery is sufficient to drive it to the farthest end of the stain. "This peculiar shape of the stains will, when it exists, show the direction from which the blood issued, even if it has impinged upon a perpendicular surface and has a direction from below upward. If this perpendicular surface happen to be ' Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 234 A MANUAL OF LEGAL MEDICINE rough, like an overcoat made of rough cloth, the coagulation of the blood will usually take place so rapidly that the bulk of the fluid cannot gravitate to the lower part of the stain, and the upper and narrower part of the stain will contain the larger portion of blood. On a smooth surface, however, the coagulation is usually sufficiently rapid to prevent the gravitation of the larger portion of the blood to the lower part of the stain." (Wood.) If blood be dropped from a height of a couple of feet, the resulting spots will be larger than those dropped only a few inches, and, moreover, they will be indented along their circumference, while those in the second instance will have a perfectly regular outline. (Babcock.) Effects of Reagents upon the Blood.—(i) Ammonia and the Alka- lies.—If a small quantity of ammonia be added to blood, the color will either remain unchanged, or, if changed, it will be a trifle brighter and clearer. If a strong solution be employed, the color of the blood is changed to a brownish tint. Diluted ammonia water will dissolve old stains upon cloth, especially if gentle heat be applied. Caustic potash or soda, in solution, causes stains of blood upon linen to assume a dirty-greenish hue. (2) Heat.—When heat is applied to blood it coagulates. On continuing the heat a flocculent reddish-brown precipitate forms, which consists of albumen combined with haemoglobin. It is soluble in ammonia water. (3) Water.—On the addition of water to blood a bright-red solution is formed, due to the coloring-matter. The haemoglobin, by continued ex- posure, grows less soluble on account of the formation of methaemoglobin, and, when finally transformed into haematin, the haemoglobin is quite in- soluble in water. The solubility of a blood-stain will therefore depend upon its age ; thus, old stains are much less soluble in cold water than recent ones, while very old ones may be wholly insoluble. (4) Bleaching Agents.—Such substances as chlorine water and solu- tions of sulphurous acid and sodium hypochlorite effect no change in the haemoglobin of the blood unless they are concentrated or heated with the blood. (5) Acids.— The albumen of blood is coagulated and precipitated with the coloring-matter by acids of all kinds. Strong nitric acid produces a dirty-brown color with blood. The coloring-matter of dried blood is soluble in nearly all of the acids. (6) Tincture of Galls.—A red precipitate is produced by tincture of galls or by an alcoholic solution of gallic acid. The precipitate contains the albumen and coloring-matter of the blood. (7) Alcohol, Ether, Chloroform, and Petroleum Benzine.—Dried blood is insoluble in any one of these agents. (8) Guaiacum.—On adding fresh tincture of guaiacum to blood, either in a pure state or mixed with water, there is formed a reddish-white precipitate of the guaiacum resin. If now a few drops of peroxide of hydrogen be added to this, a beautiful sapphire-blue color is developed. This test may be applied to particles of dried blood or stains upon linen, etc., when the same FORENSIC MEDICINE 2 reaction will be given. The rich color results from the oxidation of the resin of guaiacum. Preliminary Examination of Suspected Stains.1—Before employ- ing the methods of identifying blood-stains, memoranda of the following details should be put in writing for future reference : " (i) Date and time of day when the specimens were received. "(2) From whom the specimens were received, together with all par- ticulars as to condition of the packages, seals (if used), place where the specimens were received, etc. " (3) A detailed list indicating every article submitted for examination. " (4) The number, size, shape, and exact position of the suspected stains. "(5) If the stains are upon clothing or other fabric, note the side on which they occur. Examine particularly all the pockets, linings, buttons, and seams. These portions often contain minute clots which escape casual observation. "(6) If there appear to be drops, spatters, or smudges upon any of the objects, note the direction of the spatters and the appearance of the drops. " (7) When not in use, keep the specimens under lock and key. "(8) As the examination proceeds, each spot tested should be marked. In the case of clothing, this may be done by securely pinning a small piece of white linen to the side of each spot or place from which it is taken, and marking it in ink with a designating letter or figure. Chips cut from the floor or furniture, and other small specimens, should be kept in separate small vials, properly labelled. Spots upon weapons may be sufficiently indi- cated by descriptive notes. * "(9) If possible, use only a portion of each stain for the examination. In the case of minute spots, the whole may be required for the necessary tests, or further examination in consequence of facts developed during the trial, and possibly the defendant's counsel may desire a portion for the in- spection of his own experts. In the latter case deliver nothing except upon a written order of the prosecuting officers.'' Stains that are Liable to be mistaken for Blood.—The following stains have been mistaken for blood : (1) Grease- and Tar-Stains.—A magnifying glass will be of service in distinguishing grease- from blood-stains. They may also be detected by placing a piece of white filter-paper over the stain and pressing a hot iron upon it, when more or less of the grease or tar will disappear by absorption. Both of these substances are soluble in petroleum naphtha, ether, and oil of turpentine ; they are, however, quite insoluble in water. (2) Pitch-Stains.—Such stains may be detected by their color and odor. Pitch is soluble in turpentine and alcohol, neither of which solvents have any effect on blood-stains. * Babcock, Hamilton's System of Legal Medicine. 236 A MANUAL OF LEGAL MEDICINE (3) Red Paint.—This is insoluble in cold water, but it is softened and can be removed on soaking in oil of turpentine, naphtha, or in a strong solution of alkali. After a small portion of red paint has been treated with any of the above-mentioned reagents, a deposit of the mineral pigment will be found, which may be tested for iron. So the stain from iron-moulds is readily identified on account of its solubility in hydrochloric acid. It may also be examined for iron. (4) Red Fruit-fuices.—None of these stains coagulate when subjected to heat; their color is changed upon the addition of ammonia. (5) Cochineal, Kino, Logwood, Madder, etc.—These are not coagulated (when in solution) by heat, and all of them are changed in color by ammonia. Most of them are changed to a crimson or a deep-red color. Madder be- comes yellow when treated with acids, and upon the addition of iron salts is changed to brown. Chlorine water, unless very concentrated, bleaches these colors. (6) Brazil- Wood, Red Sanders, Anatto, etc.—Red-colored solutions are derived from these substances. Ammonia turns the red color of Brazil- wood crimson. The color of anatto is soluble in water, to which it yields an orange-yellow color ; the addition of ammonia does not change this color, but, if anything, intensifies it. Sulphuric or nitric acid turns it dark blue. Red sanders and cam-wood yield their colors to ether and alcohol; they are, however, insoluble in cold water. Acids change the color of anatto to a red or pink. (7) Iron-Rust and Corrosions upon Metals by Vinegar, Lemon- or Orange-fuice, etc.—Some of the various forms of iron-rust resemble dried blood. Their character may be determined by placing a detached portion in a porcelain capsule which contains hydrochloric acid, and applying heat. If the stain be from iron-rust, the particles are dissolved with the forma- tion of a yellow solution. When a drop of this is tested by a solution of ferrocyanide of potassium, a blue color is produced. This color may be changed to a reddish-brown precipitate by alkalies. If another drop be treated with sulphocyanide of potassium, a deep-reddish tint follows. These tests are equally applicable to iron-rust stains upon linen, etc. In a case reported by Orfila a man was arrested on suspicion of murder, and on whose person was found a knife apparently smeared with blood. Upon sub- mitting the stains to chemical examination, they were found to be due to citric acid. The man had previously used the knife for cutting a lemon, and had forgotten to wipe it after using. The contact of lemon and other like juices with steel produces a citrate of iron, which is of a light-yellow color and soluble in water. The reaction is of an acid nature. The color is not affected by ammonia or boiling. Methods of identifying Blood-Stains.—Three series of means may be employed for the detection of blood in a stain or spot,—the chemical test, the physical or microscopic, and the spectroscopic examination. The chemical tests of importance are (1) the haemin test and (2) the guaiacum test FORENSIC MEDICINE ,,, It must be observed that the chemical tests do not distinguish human blood from that of the lower animals, nor arterial from venous blood. They do, however, serve to distinguish blood from other substances. I. Chemical Tests. (i) The Haemin Test (Teichmann's).—This consists in the forma- tion of microscopic prisms or plates of haemin or haematin hydrochloride (Teichmann's crystals). The method of procedure, as described by Bab- cock, is as follows : "A drop of blood-solution is taken up by the end of a glass rod and spread upon a microscope slide, so as to give it an extended surface. The slide may be set aside in a place free from dust and allowed to evaporate spontaneously, or it may be heated very carefully in the flame of a spirit-lamp, the slide being moved to and fro, so that the liquid will not be raised to a temperature of more than twenty or thirty degrees above the natural heat of the body. The warmth may be ascertained from time to time by applying the slide to the back of the hand. The temperature must not be allowed to reach 1400 F. (6o° C), the point at which albumen coagulates. Should the coagulation take place, the test is likely to fail. Some writers recommend the addition of a particle of common salt to the solution during the evaporation. This is unnecessary in the case of fresh blood, because it contains a sufficient amount of this substance as a natural con- stituent ; but with old or dried blood it is absolutely necessary. The amount required is very small. The best plan is to prepare a solution by weighing out two grains of pure sodium chloride and dissolving in eight fluidounces of distilled water. A drop of this solution is quite sufficient for the test, and is placed upon the centre of the film of evaporated blood. The drop is spread over the film so as to cover all parts of it, and dried off with the same precautions as at first. A drop of glacial acetic acid is next added to the film, the latter covered with a thin glass and the slide heated, this time to a sufficient degree to produce a slight ebullition. There is no longer any danger of the coagulation of the albumen. If the boiling be too rapid, the cover may be violently projected from the slide by the force of the vapor. If the blood to be tested is in a dried state, so that a small particle may be detached, a minute portion is placed in the centre of the slide and warmed with a drop of acetic acid. The acid is evaporated and the residue treated with the salt solution and afterwards with a fresh portion of acid, as previ- ously described. In the case of fresh blood a single heating with the acetic acid is sufficient, but with very old blood it is frequently necessary to add the acetic acid a second time and heat it anew. When the acid has wholly evaporated, the slide is examined in the microscope under a power of three hundred or four hundred diameters. The operation is easy, but it requires a certain degree of skill in manipulation. The attempt to obtain Teich- mann's crystals will often fail in unskilful hands. The principal causes of failure are the coagulation of the albumen and an excess of salt. Coagula- tion retards the solvent action of the acetic acid, and during the prolonged 238 A MANUAL OF LEGAL MEDICINE ebullition required under such circumstances the salt may be entirely de- composed, and the evolved hydrochloric acid necessary for the formation of the crystals is expelled before it can enter into combination. The acid em- ployed must be in its highest state of concentration, the so-called glacial acid. Acid of lower strength fails to decompose the salt. If too much salt be employed the experiment fails, and the slide shows only a mass of crystals of sodium chloride. Distilled water must be used. Ordinary water leaves a residue of organic matter and mineral salts,—in some cases very considerable in amount,—which interfere with the development of the crystals, or may produce a crystalline deposit by itself." (Hamilton's " Sys- tem of Legal Medicine.") (2) The Guaiacum Test.—On adding freshly prepared tincture of guaiacum J to an aqueous extract from the suspected stain, precipitation of the resin takes place, with the formation of a milk-white opacity in the liquid. Upon the addition of a small quantity of peroxide of hydrogen, a rich sapphire-blue color replaces the milky appearance if blood-pigment be pres- ent in the stain. In the case of very old spots, the tincture may be applied directly to the stain, the latter having previously been moistened with a drop of water. The peroxide is added immediately after the tincture. If the material stained be of such color as to obscure the reaction, such as where the spot is upon a dark surface, a small piece of tissue- or filtering-paper should be pressed upon it, when the characteristic color will be absorbed by the paper. In this manner several impressions may be taken from a single stain. Substances like saliva, bile, and red wine will produce a blue color in the presence of the tincture of guaiacum and peroxide of hydrogen ; neither of the two former substances has a red color, while the red wine requires some time to produce the same result, which, in the case of blood, is of immediate occurrence. The substances which produce a blue color with the tincture of guaiacum alone are milk, gluten, unboiled flour-paste ; the fresh juice of potato, onion, carrot, dandelion, horseradish, chiccory, sorrel, cherries, cur- rants, mushrooms, etc. ; also all oxidizing agents,—hypochlorites, chlorine solution, mercuric chloride, gold chloride, nitrous ether, iron peroxide, man- ganese dioxide, platinum black, permanganates, and ferric chloride. The guaiacum reaction is also produced by pus, sweat-stains, nasal mucus, etc. II. Microscopic Test. The microscopic or physical examination not only proves the existence of blood, but also enables the examiner to differentiate between the blood of man and that of some of the lower animals. Human blood-corpuscles are readily distinguished from those of birds and reptiles by their shape, but 1 Dissolve two or three pea-sized pieces of the resin in a fluidounce of alcohoL The color of the solution should not be deeper than pale sherry wine. FORENSIC MEDICINE 2 they resemble those of many of the warm-blooded animals in shape, though not in size. The average diameter of the blood-corpuscle of the human blood is -j^Vir inch. This is the average of Professor Formad. According to other authori- ties it is placed at ^Vo" (Wormley), -j^Vr (French Medico-Legal Society), jfcj (Masson), and ^Vo" (Gulliver). ( Vide Tables of Corpuscles.) The corpuscle in human blood and in all mammalia, with the exception of the camel tribe, is a round, flattened, biconcave, transparent disk, without a nucleus. In camels, birds, fishes, and reptiles it is oval, larger in size, and nucleated. These differences are unmistakable, no matter whether the blood-spot be recent, old, fresh, or dry. The largest corpuscles are found in the Amphiuma, a species of reptilia. Professor Formad1 says that "only the following animals have corpuscles larger than man,—i.e., larger than ^Vtf incn>—viz-> tne elephant, great ant-eater, walrus, sloth, platypus, whale, capybara, and (according to Wormley) opossum. Animals the cor- puscles of which are slightly below man in size—i.e., having corpuscles from t^m t0 ^hrts inch average diameter—are the seal, beaver, musk-rat, porcu- pine, monkey, kangaroo, wolf, and guinea-pig. None of these are domestic animals. All other animals, including all domestic animals, have blood- corpuscles of a mean diameter less than -^-^ inch, and, in fact, those ani- mals which, as a rule, are blamed for blood-stains found on the clothing and apparel of criminals (ox, pig, horse, sheep, and goat) 2 have corpuscles with an average diameter less than TJwr{ inch." His conclusions, based upon the above facts, are : "(i) The blood-corpuscles of birds, fishes, and rep- tiles, being oval and nucleated, can never be mistaken for human blood. (2) Fresh human blood cannot be mistaken, under the microscope, for the blood of any animal the corpuscles of which have a mean diameter of less than jfaji or even -g^Vo" inch. (3) a. If the average diameter of blood-corpuscles in fresh blood is less than ^nnr, then it cannot possibly be human blood, b. If the diameter is more than 3 5X0 0, then it may be human blood, c. If the blood-corpuscles, after exhaustive measurement, give a mean diameter of 1 Comparative Studies of Mammalian Blood, Journal of Comparative Medicine and Surgery, July, 1888. 2 The method of the late Dr. Richardson, of Philadelphia, for determining the dif- ference between human blood-corpuscles and those of the various domestic animals is described as follows in the American Journal of Microscopy, June, 1881: "Place near the upper right-hand corner of a microscope slide a small drop of fresh human blood, and then with a narrow strip of glass or metal spread a thin streak of it diago- nally across a glass, toward the lower left-hand corner. Next, let fall a drop of pig's blood, for example, upon the upper left-hand corner of the glass and spread a similar narrow strip so as to cross the first one at a very acute angle, forming a figure resem- bling an elongated capital X. On each side of the meeting-point of the two lines will be found (should the experiment succeed) areas when the two kinds of blood-cor- puscles are in the same field of the microscope, and so placed as to afford excellent opportunities for direct comparison of their magnitudes." 240 A MANUAL OF LEGAL MEDICINE more than -^^, then it is human blood (provided it is not the blood of one of the wild beasts referred to)." The following table shows the average size (fractions of an inch) of the red corpuscles, according to different observers : Mammals. Man. Gulliver.............tAs Formad.............tststj Wormley.............stst! Richardson............72V4 Ewell.............."stVi Masson.............SS57 C. Schmidt............72*57 Flint...............-jTffTf Taylor..............tsW Malinin .............T57m Kollicker ............tsW Robin..............ifji Woodward (1875)........s-sts ■ nfa? • ST5* • TS?* - ■JTffTT Woodward (1876) ..... Harting.......... French Medico-Legal Society Dragendorff........ Dog. Gulliver.............tsVs Formad.............jtsis Wormley.............-stVt Richardson............ts*? Masson.............s-sn C. Schmidt............s^s H. Schmid............jris Woodward............ssVs French Medico-Legal Society . . . ^Vs Dragendorff...........y£tts Welcker.............-j?Vs Pat. Gulliver.............irW Wormley.............tss^ C. Schmidt............jrs-g H. Schmid............sinns Ass. Gulliver.............rsW Wormley.............t&tj Ox. Gulliver.............t?V7 Formad.............^Vs Wormley............?2T? Richardson............xi%' Masson.............jj'jt C. Schmidt............j^ H. Schmid............fit- French Medico-Legal Society . . . ^,, Dragendorff...........T1'^ Welcker.............rin Pig. Gulliver.............nta Formad.............12S5 Wormley.............xhj Richardson............ifo Masson ..."..........jirn C. Schmidt............j^Vi French Medico-Legal Society . . . T^n Dragendorff...........jsVi Cat. Gulliver.............ttVi Wormley.............?.iV: Masson.............nVi C. Schmidt............riu French Medico-Legal Society . . . 73V7 Dragendorff...........tsVs Welcker.............?in Bat. Gulliver.............jtYt Wormley.............rsta Elk. Gulliver.............-%h\ Wormley.............rfn Wolf. Gulliver.............rhs Formad.............-j^jj Wormley.............^Ai Rabbit. Gulliver.............j^i Formad.............jfci Wormley.............rfci Masson.............jjn C. Schmidt............rfot French Medico-Legal Society . . . r£n Dragendorff...........rfai FORENSIC MEDICINE 241 Mammals— Continued. Goat. Gulliver.............W*s Formad.............^rW Wormley.............txts C. Schmidt............ssV? Welcker.............si?* Horse. Gulliver.............W?ny Formad.............tsts Wormley.............?irg C. Schmidt............j*V* French Medico-Legal Society . . . ^is* Welcker.............??\? Gulliver Wormley. Mouse. S7TT Elephant. Gulliver.............s7Vs Wormley.............?7Vs Mule. Wormley.............-j7\7 Gulliver Camel. f Long diameter t Short diameter 3T2 Wormley / Long diameter t Short diameter Hippopotamus. Gulliver.............jfa Wormley.............j?1^ Sheep. Gulliver.............^Vs Formad.............^ Wormley.............^ Richardson............^^ C. Schmidt............si?? H. Schmid............^fa, French Medico-Legal Society . . . sijs Dragendorff...........^ Welcker.............T7TW Gulliver Porcupine. Gulliver Wormley. Opossum. Lion. Gulliver Wormley Gulliver . Wormley , Richardson. Monkey. Leopard. Gulliver . Wormley.............^ Ibex. Wormley, Llama. Gulliver / Long diameter t Short diameter Wormley {L°ng diameter t Short diameter Rhinoceros. Gulliver Wormley 1~SSJ T75T Whale. Gulliver.............TTfos Richardson............si^s Ground Squirrel. Wormley.............?sW Woodchuck. Gulliver.............^t Capybara. Gulliver.............7TW Wormley.............stV* Raccoon. Gulliver.............si*? Wormley...........• . «V* Hyena. Gulliver.............srs? Wormley........... Kangaroo. Gulliver Wormley TSJ1 J?T? 16 242 A MANUAL OF LEGAL MEDICINE Mammals— Continued. Guinea-Pig. Gulliver.............ttVi Wormley.............tin Formad.............TTinr Masson.............ttW Woodward............sirs Musk-Deer. Gulliver............ttji? Ocelot. Gulliver Wormley 3T5T Beaver. Gulliver.............ttW Duck-billed Platypus. Gulliver.............Tota Tapir. Gulliver.............tbtsts Wormley.............rrr* Red Squirrel. Gulliver.............tttW Wormley.............TtVs Buffalo. Gulliver.............firs Wormley.............ttst Musk-Rat. Gulliver.............ysVff Wormley.............tzV? Black Bear. Gulliver.............tsVj Wormley.............rirs Seal. Gulliver Gulliver Birds. Chicken. j Long diameter I Short diameter w , f Long diameter I Short diameter Duck. Gulliver J Long diameter t Short diameter 1xr , f Long diameter Wormley < „, 6 ,. t Short diameter 2142 1__ JTTE 1 2036 T¥TT xi** Turkey. - ... ( Long diameter Gulliver \ _, ° ,. t Short diameter w . f Long diameter I Short diameter Dove. ~ ... f Long diameter Gulliver •{ _. ° ,. I Short diameter Quail. Gulliver J Long diameter t Short diameter ~ „. J Long diameter Gulliver 4, & ,. t Short diameter Pigeon. Gulliver { Long diameter t Short diameter Wormley { Long diameter I Short diameter Goose. Gulliver { Long diameter t Short diameter Sparrow. ~ „• f Long diameter Gulliver < 6 ,. t Short diameter Fishes. Perch. Gulliver { Long diameter t Short diameter loTX irn rr\r» loirs 23fT 1 31T0 Im xirt jiii tfji rsVi an JTJ5 7TT5 1 J3J5 Gulliver Lamprey. f Circular...... t Diameter of nucleus Pike. Gulliver / Long diameter t Short diameter Trout. Gulliver ( Long diameter t Short diameter Eel. Gulliver J Long diameter t Short diameter jin irirff rrn • irVr FORENSIC MEDICINE Batrachians. Frog. _ ... ( Long diameter . t Short diameter . . v . f Long diameter . I Short diameter . Gulliver Toad. (Long diameter I Short diameter Proteus. Gulliver j Long diameter . . •■ Short diameter . . Amphiuma tridactylum. Gulliver { Long diameter . . <■ Short diameter . . Wormley { Long diameter . . t Short diameter . . Triton. Gulliver J Long diameter t Short diameter XXTSS TJT2T xijs ttVt XTST5 1 727 Reptiles. Land Tortoise. Gulliver { Long diameter <• Short diameter Wormley { LonS diameter t Short diameter Viper. Gulliver / Long diameter •- Short diameter 243 T2T2 Z2TS xisn ?iiu> X17J Gulliver Lizard. (Long diameter I Short diameter Green Turtle. Gulliver { Long diameter . t Short diameter . Boa- Constrictor. Gulliver j Long diameter . t Short diameter . Wormley / Long diameter . t Short diameter . Xttlf ttVs ii*~s The average measurements above given apply to fresh blood which has been allowed to dry upon glass. In dried blood on clothing, etc., where it becomes necessary to restore the corpuscles, the difficulties of exact meas- urement are considerably greater. The differences in the measurements of different observers may be attributed (i) to the micrometer, since it is impossible to make absolutely accurate measurements by means of this appliance (no true stage micrometer was ever invented), and (2) to the great variation in size of the blood-corpuscles, not only in the same animal, but also in the same person. These differences may depend on the age, on disease, or on various other causes. Babcock * quotes Gulliver as saying, " Special circumstances, too, of which we have not yet sufficient knowledge, may affect the value 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 corpus- cles may be more elongated than in the same bird when quietly at rest; • • . and my attention was sometimes arrested by like diversions in other vertebrates at different times and seasons, though not in so many observa- tions, and with such notes as would be needful for satisfactory conclusions. But the facts are sufficient to show that exact and extensive investigations are yet necessary on the comparative magnitude of the red corpuscles and 1 Hamilton's System of Legal Medicine. 244 A MANUAL OF LEGAL MEDICINE their aggregate proportion to the other parts of the blood at different seasons and under different circumstances. For example, whether 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 winter, in species subject to periodic changes in temperature." The Use of High Microscopic Powers.—The late Dr. Richardson was the first to demonstrate the possibility of high microscopic powers in the diagnosis of blood-stains. By his method—that of using one-twenty-fifth and one-fiftieth of an inch immersion objectives with a micrometer eye piece magnifying over three thousand diameters—the human red corpuscle is made to appear about one and one-eighth inches in diameter, while those of the goat and sheep appear about five-eighths of an inch in diameter and that of the ox seven-eighths of an inch. Formad obtained a still greater enlargement of the corpuscles through rephotographing normal blood-cor- puscles to an amplification of ten thousand diameters, as exhibited by the following photographic measurements : human blood-corpuscles (3 2*0 0 inch) will appear three and one-eighth inches in diameter ; guinea-pig CnVir), three inches ; dog (-5^7), two and four-fifths inches ; ox (±£(,<>), two and one-third inches; sheep (-ginnr), two inches; and goat (-g-fVir)* one anQ< three-fifths inches. Through microphotographs taken with a Zeiss photographic stand and the Zeiss two-millimetre apochromatic oil-immersion objective,' Professor E. S. Wood obtained amplifications of five thousand and two thousand five hundred diameters, respectively, of the corpuscles of man, the dog, ox, and sheep. The difference in size of these corpuscles is shown as fol- lows : magnified five thousand diameters, the human corpuscle (ygVir mcn) measures one and nine-sixteenths inches in diameter ; the dog (-3-^nr), one and three-sevenths inches ; the ox (^inr)* one and one-fifth inches. Rela- tively, these measurements are one-half as large as those of Formad's men- tioned above. Effects of Age on the Size of Blood-Corpuscles.—Dr. Reese states that the blood-corpuscles in very young animals are larger than in adults of the same species,—that is, their average size is greater,—and there is a wider range between the extremes. Of three hundred corpuscles ex- amined from the blood of puppies two days old, the mean measurement gave 3ifW incn. tne largest ^^ and the smallest 7^-5-. In puppies eleven weeks old the mean diameter of two hundred measurements was -j^y inch, the largest being ^^ and the smallest T^. The average size of one hundred 1 " The amplification was first determined by photographing a standard t^ inch on the object micrometer, so that the lines of the y^W-inch space were ex- actly two and one-half inches apart in the one case and five inches apart in the other. The apparatus being perfectly fixed and immovable, the blood-corpuscles on the slide were photographed under precisely the same conditions as the stage mi- crometer." (Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology.) FORENSIC MEDICINE „ „ 245 blood-corpuscles from the blood of an infant thirty-six hours old was * » inch, the largest 3^ and the smallest -rfS9. Of one hundred measurements of the corpuscles in a healthy adult, the average size was i2\s inch, the largest ^^ and the smallest ^fa. ("Medical Jurisprudence and Toxi- cology.") Ewell obtained the following results : In puppies eight days old the average measurement of several series of one hundred corpuscles gave ^U, nro> wj¥' and Tits incn m diameter, respectively ; in a puppy eight weeks old, examined in the same manner, the diameters were ^w, ^Ut and 3^., respectively ; and in a puppy seventy-six days old the averages were -^j, infV*. and Sinr mch> respectively. (North American Practitioner.) Influence of Disease on the Corpuscles.—The number, size, shape, and color of the red blood-corpuscles may be altered by certain diseases. In pernicious anaemia this is remarkably so, the diminution in the number of the corpuscles varying from the normal standard (viz., five million per cubic millimetre) down to six hundred thousand per cubic millimetre. The diameter of the red corpuscle is diminished in such affections as diphtheria, high fever, and septicaemia, while in some of the anaemias the opposite pre- vails. According to Wood, the red corpuscles may be nucleated in some cases of leukaemia. Manassein observes that the red corpuscle may be diminished by septic fever and enlarged by extreme cold and the narcotism of alco- holism,1 morphine, and hydrocyanic acid. The following averages of Dr. Ewell are taken from Hamilton's " System of Legal Medicine," p. 176 : Man (plumbism), average of 100 corpuscles Man (tuberculosis), average of 100 corpuscles Man (gastritis), average of 100 corpuscles Man (anaemia), average of 100 corpuscles Similar alterations were found by the same observer in blood-corpuscles of the blood of persons afflicted with such diseases as purpura haemorrhagica and syphilis. Quantity of Blood in the Body.—The quantity of blood in man has been estimated to be equal to one-thirteenth of the body-weight. In the dog it is equal to one-eleventh or one-twelfth of the body-weight. In the rabbit it is estimated as from one-twelfth to one-thirteenth, and in the cat from one-tenth to one-twelfth. Methods of Procedure in the Microscopic Examination of Blood- Stains.—In order to examine fresh blood-corpuscles a very small drop of blood should be placed upon a clean microscopic slide and covered with a thin glass, the edges of which should be sealed with paraffin, oil, or mounting 1 Formad, who examined the blood in a great many cases of fatal alcoholism, found no increase in the diameter of the red corpuscle. Manassein experimented upon animals. TffTS TiTST rrn 246 A MANUAL OF LEGAL MEDICINE varnish, to prevent evaporation. Such a specimen will show the corpuscles lying flat, so that they can easily be measured. The late Professor Richard- son's method is to detach a minute particle from the suspected blood-clot with the point of a cataract-needle, allowing it to fall upon a perfectly clean glass slide. The fragment is then covered with a thin covering-glass, pressed down firmly in order to crush the particle to powder. The specimen is next transferred to the microscope-stage. Pure water should be introduced at the edge of the covering-glass, and allowed to flow very slowly toward the fragment of blood. When this is reached a movement is noticed, after which an aggregation of compressed corpuscles, very faint and colorless, but very distinct, is brought to view. The corpuscles are rendered more per- ceptible by introducing at the edge of the covering-glass a minute portion of iodine or red aniline solution. In preparing dried blood for microscopic purposes a different method of procedure is encountered. Most of the stains submitted to the medical expert for microscopic examination are in the dried state, and, further, the conditions under which they are produced are generally unknown. In order to free the corpuscles from the material or surrounding masses to which they cling, so that they may be examined under the microscope, some menstruum' must be employed to separate them. The method followed by Formad in examining dried blood is first to ex- pose it to a gentle moist heat from one to ten days, according to the age of the stain. '' A small granule of the suspected blood or a fibre from the blood-stained fabric is placed on a glass slide, on a drop of a thirty- to thirty- five-per-cent. solution of caustic potash, and covered with a glass slide. If the blood-stain was recent the disintegration of the clot commences at once, ' The principal menstrua are the following : Roussin's Liquid.—Glycerin, three parts ; sulphuric acid, one part; and sufficient water to give the liquid a specific gravity of 1028. Richardson'1 s Liquid.—Sodium chloride, three parts ; water, four hundred parts. Virchow's Liquid.—Potassium hydrate, thirty-three to thirty-five parts; water, one hundred parts. Viberfs Liquid.—Corrosive sublimate, one part; sodium chloride, four parts; water, two hundred parts. Welcker's Liquid.—Pure concentrated glycerin, one part; water, seven parts ; the solution to be diluted to a specific gravity of 1028, the density of the blood-serum. Malassez and Polain's Liquid.—Equal parts of a solution of gum-arabic, sulphate of sodium, and sodium chloride, each solution having a specific gravity of 1020. Pro- fessor Wood frequently uses a solution of the acetate of potassium of a specific gravity of 1030. Midler's Liquid.—Potassium bichromate, two parts; sulphate of sodium, one part; and water, one hundred parts. Wormley employs distilled water in quantities not to exceed that originally present in the dried blood-mass examined. He also recommends a solution of glycerin (sp. gr. 1030), as it does not evaporate as readily as water alone. To the above solution a little caustic potash is added when treating an old stain. FORENSIC MEDICINE 247 and the isolated corpuscles separate and swim swiftly through the liquid if the stage of the microscope is slightly inclined.'' x In case the dried blood has been treated with water or any liquid of less density than the serum of the blood (sp. gr. 1028), the red corpuscles grad- ually swell up and undergo a change of form and size. The circular disk of mammalian blood finally assumes a spherical form, with a diminution of its diameter. If the action of the water is prolonged, the corpuscle loses its haemoglobin, and consequently its color. The outline, at the same time, be- comes very faint. According to Formad, corpuscles which have undergone these changes may still be recognized under the microscope, since the ratio of diminution in the red corpuscles is uniform in all animals, and may be relied upon in the diagnosis of any blood thus affected. Therefore there is a normal standard average for the normal biconcave red corpuscle of each animal, and another for the swollen spherical corpuscle. The following measurements, by Formad, of corpuscles artificially swollen by the absorption of water show a reduction of about one-third of their normal diameter in all of the experiments made. Average Diameter of Spherical Corpuscles. Average Diameter of Normal Corpuscles. Normal Diameter reduced One-Third. Guinea-Pig . . . Wolf...... Dog....... Rabbit..... Ox....... rios inch. linns inch. rim inch. T^rff mch. T^ inch. ^ios inch. ttVt mch. jtVtt mch. ska inch. s^ inch. FfW inch. Tifta mch. ■sis? inch. Tikis mch. siuis inch. sk^ inch. rk7 inch. lis-s inch. Ttjro inch. ttts mch. nr** inch. sks mch. b _, ON >- « Number of Individ- uals EXAMINED. vO X X X 71 71 71 71 71 7s b b b b b b b b b *j b c § y C a a 3 a 3 a 3 w •^ ■^ V i> 5* 5> 5*" f - 11 ^ •fl ■*1 T] 1 10 n Number of Preparations made. K CI 0 11 C O O 0 0 a S3 a v a N to to to to to to in in >< p.. p. a C a a w v >< >< X X V X X l/l in 3- O 0 Caj c o 2 3 c -■ C- Q. t: Percentage ok Meas- urable Corpuscles in Each Preparation. 8 8 2 8 ' Total Number of Corpuscles measured. Sh s- : =- r I- * r t s-13- 3- s- Average Diameter in Inch. s- s- a- > a- Normal Diameter of Fresh Blood-Corpuscle. — . V HNIDIG3K TVOH'I AO 'IY.iXYK V Z$2 Wormley's Table of Measurements of Old Blood-Stains.' (The original table has been slightly modified.) Animal. Human . Human . Human . Human . Elephant Dog . . Rabbit . Ox . . . Ox . . . Ox . . . Buffalo . Goat . . Ibex . . Age of Stain. 2 months. iYz months. 3 months. 19 months. 13 months. 4 months. 18 months. 16 months. 32 months. 4^ years. 18 months. 17 months. 18 months. Stain, unknown. Stain. Stain. Clot. Clot. Trace of stain, unknown. Clot. Stain. Stain, unknown. Clot. Clot. Stain. Clot. Average in Inch. sirs TTS* T5T5 TSTS Fresh Blood in Inch. 325S STS15 J-kli ■ST5T5 2T3T *~5*~S t£x? t£xv TTXS 3rVr sii* Vide below. Vide below. Vide below. O 72 M w o w D Vide below. Q W 1 The deposit in the case of the human blood two months old (vide supra) was in the form of a thin stain on muslin ; its nature, other than that it was mammalian blood, was unknown at the time of its examination. Two series of thirty disks each were measured ; they were readily found. Those of two and a half months, fifty disks, ranging from ^rW to 3A3 inch, were measured. The single blood-stain of the dog was barely visible to the naked eye. Its nature was unknown. The disks of the ox blood (four and one-half years old) were rather readily obtained. 254 A MANUAL OF LEGAL MEDICINE of figures. It can be used with accuracy by those who have had no previous experience in work of this kind, and by those who have not and cannot ob- tain the expensive screw micrometer eye-piece. " The method and apparatus are simple, and the calculation of the size of the object is easy. To get the diameter of a corpuscle in any direction, one has only to reverse the paper bearing the reading scale. This scale can be either in millimetres or in inches, according to the stage micrometer in use " With it, one does not have to designate whether his measurement was taken from the outside of the dark border of the corpuscle. A faint light is used, a flat image is thrown in every case, and the corpuscle is drawn with- out shadowy borders. The method employed in this case is certainly one to be commended in these examinations." III. Spectroscopic Test.' This means of investigating blood-stains depends upon the fact that solu- tions of haemoglobin and of its various decomposition products, when placed between the source of light and the prism of the spectroscope, absorb cer- tain portions of the spectrum, producing in the latter certain dark bands (absorption-bands), which are characteristic of the presence of even minute quantities of blood. If blood be deoxidized, a single band of haemoglobin will replace the two dark bands of the oxyhaemoglobin. This absorption- band is broad and visible in the green of the spectrum ; the blue end is also darkened. Methaemoglobin, which results from the putrefaction of oxyhaemoglobin, produces a spectrum with the blue end darkened, the two bands of oxidized haemoglobin quite faint, with a third absorption-band seen in the red. Deoxidized haematin shows a dark and sharply defined band in the blue end and two well-defined lines in the green, with the disappearance of the band in the red. Sorby2 describes the spectroscopic examination as follows : " In apply- ing the spectrum test to the detection of blood-stains, the method of exam- ination must to some extent depend on the amount of material at command. If there be not too little, a small portion of the stained fabric should be soaked in a few drops of water in a watch-glass, the liquid squeezed out, allowed to stand a short time in the glass, so as to deposit any insoluble matter, and then poured out into one of the small, deep cells used in ex- amining the spectrum. These cells should be made from barometer-tubing having the internal diameter of one-eighth or one-tenth of an inch, and should be one-half or three-quarters of an inch long, one end being fastened to a piece of plate-glass, like an ordinary cell for mounting objects in liquids. If the stain has been recently made, the spectrum of fresh blood 1 For a fuller description of the details of spectroscopic examination, the reader is referred to the larger works. 2 Guy's Hospital Reports, 1869^70, p. 274. FORENSIC MEDICINE 255 would then be seen, the spectrum of oxidized haemoglobin, which has two well-defined absorption-bands in green. If, however, the blood has been exposed for some time to the action of the air, these bands would be fainter, and another would be seen in the red, the spectrum of methaemoglobin. The relative distinctness of this shows the amount of change, and is some indication of the age of the stain ; but in forming any such conclusions it is necessary to know the circumstances of the case, since the sulphurous acid met with in towns or in rooms where gas is burned produces more change in a day than pure air does in a week. If, however, little or no change has occurred in a town, it would be good evidence of the stain having been recently made. In order to make the detection of blood still more certain, it is well to observe the effects of reagents and examine other spectra. A piece of citric acid about one-fifteenth of an inch in diameter should, there- fore, be dissolved in the liquid in the cell, when it will be seen that the ab- sorption-bands of the fresh blood gradually disappear, and are not restored by the subsequent addition of excess of ammonia. This is a most important fact, since it shows that the acid produces permanent change, which is not the case in nearly all other red coloring-matters. To remove all doubt about the presence of blood, a very small piece of sulphate of protiodide of iron, not above one-hundredth of an inch in diameter, should be added to the cell, care being taken to insure the presence of excess of ammo- nia, and to avoid, as much as possible, oxidation by the exposure to air. It is well, therefore, not to stir up the liquid, but, having previously rather more than filled the cell, to cover it with a small piece of glass, and, after removing excess of liquid by blotting-paper, to fasten down the glass by putting around it a little gold-size. If enough citric acid and not too much sulphate of iron have been added, the protoxide of iron may be made to dissolve by turning the cell upside and downside over and over again, or by keeping it for a time upside down if the oxide has adhered to the bottom. By this means the haematin is slowly deoxidized and the well- marked absorption-band of deoxidized haematin gradually makes its ap- pearance in the green, with a second fainter band nearer the blue end. If the solution be at all turbid the cell should be horizontal for a time, so that the insoluble matter may be deposited on the side. The production of such a remarkable and characteristic spectrum by the addition of sulphate of iron, as far as I am aware, only occurs in the case of blood, and there- fore affords very conclusive evidence of the presence of that substance. With proper care these various results may be seen to perfection with about one-hundredth of a grain of blood, but I need scarcely say that before any one attempts to apply the test in any important case he should try the experiments with a little undoubted blood, so that he may be made familiar with the various spectra and quite certain that he understands all the requisite manipulations. In all cases the spectra of a suspected stain should be compared side by side with those of blood, in order to see that there is a perfect agreement; and, of course, in all of these experiments the 256 A MANUAL OF LEGAL MEDICINE solution must be diluted to such an extent as to show the spectra in a proper manner." In answer to the question, Do other substances produce similar spectra to those of blood ? Sorby states that nothing gives a spectrum like that produced by oxyhaemoglobin, although various other bodies strike absorp- tion-bands somewhat resembling the former, but are readily differentiated by their appearance under the action of reagents. Are the stains of venous, arterial, or menstrual blood f According to Chapman,1 venous blood can be distinguished from arterial by means of the spectroscope. Dr. Babcock, however, says, "No distinction can be made between venous and arterial blood based on chemical or microscop- ical examination." Arc the stains of menstrual blood ? To the question whether or not blood is menstrual, Dr. Tidy says, '' We urge the necessity for great caution in attempting to distinguish menstrual from ordinary blood. It has been stated (i) that menstrual blood contains no fibrin ;a (2) that it is acid, owing to it-, admixture with vaginal mucus, and (3) it is invariably associated with the pavement epithelium derived from the vaginal walls. This last peculiarity is the only one of any practical importance, and in admitting its truth we doubt if in the present state of science we should be justified in venturing a positive opinion as to a stain being or not being menstrual from this circumstance alone." (Legal Medicine.) In hemorrhage from the intestines or from piles the blood might be mistaken for menstrual, since there is a resemblance between the vaginal epithelium and that from the entire alimentary canal. There is also a simi- larity between the vaginal epithelium and that from the mucous membrane of the respiratory organs. (Babcock.) Was the blood derived from a living or a dead subject? In trusting to the coagulation of the blood as evidence of its being derived from a living vessel or from a body recently dead, it is better, according to Tidy, "to admit the impossibility of answering this question positively, although, should coagulated fibrin be found on the stained portion, it may be stated that there is a clear presumption that the blood was derived either from a living person or from one recently dead." ( Vide Coagulation of the Blood.) In certain diseases, as scurvy and typhus, the blood does not readily coagulate ; and it must also be remembered that coagulation may be retarded in the healthy body after death. Taylor says, "Blood which has escaped ' Medical Jurisprudence and Toxicology, Philadelphia. 2 According to Wood, " coagula may form after the menstrual blood has left the vagina when the flow is abundant, and coagulated blood has been found within the vagina and the uterus during menstruation. In dried stains of menstrual blood, coagula of fibrin may be found with the corpuscles and vaginal cells. Menstrual blood frequently contains a smaller proportion of fibrin than blood coming directly from the blood-vessels, since it may be diluted by the fluids from the uterus and vagina." FORENSIC MEDICINE 257 from a recently dead body, although it would not be found diffused as if by spirting, might, in so far as coagulation is concerned, assume the appearance of having been effused from a living body.'' Was the blood from a male, female, adult, or child? Piper describes a case in which he was called in as an expert, where the blood of two persons (male and female) was distinguished from each other: "A man had been killed by a bullet through the head, shot from a pistol in the hands of his wife. The charge was that of wilful murder, resting upon the alleged state- ment that he was shot while lying asleep in bed. The woman had two razor- cuts in her throat, and was also wounded by a pistol in her side. She stated that her husband had attempted to murder her, and in this attempt had in- flicted these wounds, and that in the scuffle she had snatched the pistol from his hand and had shot him through the head, as above stated. His body was found lying at the farther side of the room from the bed, where, as she said, he fell upon being shot. In the charge it was also alleged that her wounds were self-inflicted. The question presented to me for solution in the first place was as to which of the two parties the blood on the sheet belonged. If to the wife, then she was innocent of the crime charged ; if to the husband, then she was guilty. Preliminary to the examination of the blood-spots themselves, I took the blood from the arm of the accused and constructed tables for the measurement of the corpuscles as described in my drawings. Next, search was made in the blood from the spots on the sheets, and the corpuscles found were arranged in similar tables. The last step in this part of the process was to make a similar examination of the blood on the carpet where the head of the dead man lay when he was found, and also of the blood-spots on the sheets on which the post-mortem was made. A number of corpuscles was found here also, which were arranged in the tables as above. Upon measuring the first and second tables, those from the arm and those from the sheet from the bed, the corpuscles were found to average very close to each other, while between these and those in the other tables, which of course came from the man, there was quite a measurable difference, the first measuring -g-^ro" inch, the other 3ox8g inch. "The conclusion arrived at from the results of the measurement was confirmed by the substances found in the blood on the sheet where the woman's head lay as she testified, and which, therefore, must have come from the wounds in her throat." (19 American Law Register, 608 N. S.) It is a practical impossibility to found an answer to these queries with any degree of certainty, and it is better to at once confess our inability to do so. (Vide Effects of Age on the Size of Blood-Corpuscles.) CONCLUSIONS. Professor E. S. Wood says, '' From my own experience in the exami- nation of numerous specimens of dried blood in medico-legal cases and in dried blood of known origin, I am satisfied that if the blood is dried properly a sufficient number of red corpuscles of normal size and shape can be ob- 17 258 A MANUAL OF LEGAL MEDICINE tained to give as satisfactory an average as in the case of fresh blood, and that whenever a satisfactory average can be obtained, as from the measure- ment of several hundred corpuscles of normal size, we are warranted in forming an opinion within certain limits as to the nature of the animal from which the blood in the dried state originated. If the red corpuscles are seen to be nucleated, we may decide at once that the blood did not originate from a mammal, but from one of the oviparous animals. If the corpuscles are biconcave disks having an average diameter of between -jyVir and ^ta inch, we may say at once that it is not the blood of any animal whose corpuscles measure less on the average than 4^0 inch. This includes all the ordinary domestic animals except the dog, unless possibly the rabbit and the guinea-pig be classed among the domestic animals. The corpus- cles of the ox, horse, pig, cat, sheep, and goat, being all less than ^fa inch in diameter, can, under favorable conditions, be distinguished from those of man in dried stains. In addition to this, we may state that these measurements (-jyVo" to mi inch) are consistent with this blood being of human origin. " If corpuscles of normal shape are found, and the measurement of these corpuscles shows them to average not less than 4^ inch, we may state as positively that they are not human blood-corpuscles, but are consistent with the blood of those mammals whose corpuscles approximate in size those of the given stain. " By far the majority of recent investigators within the last twenty years are fairly well agreed upon this : that it is possible, in the case of dried stains, to discriminate between human blood and that of most of the domestic animals ; but there are some who think that the range of variation in the size of the corpuscles in the same individual is too great to permit of a positive opinion." (Witthaus's "Medical Jurisprudence, Forensic Medicine, and Toxicology.'') Formad sums up the argument for the positive detection of human blood as follows : " It is plain, however, that the great majority, if not all, of the recent observers in the domain (certainly all who have worked with improved instruments and have employed lenses of high amplification and proper methods of micrometry) are in favor of judicious discrimination between human blood and that of animals. " In France a committee appointed by the Soci6te* de M6decine L6gale, composed of Messieurs Mayet, Mialhe, Cornil, and Lefort, decided that the expert measuring the corpuscles has the right to affirm whether or not they are human. "Other French medico-legal examiners, such as Lacour and Masson, who made most extensive researches upon blood-stains, have testified as follows : ' One can certify that corpuscles found in the blood under ex- amination are in all points identical with those of man or of the guinea-pig, if they measure more than y^y millimetre.' "The Russian medico-legal experts often testify directly that certain FORENSIC MEDICINE 25g blood is human or not human. Professor Rudnew, of St. Petersburg, told me himself that he has testified in the affirmative in regard to human blood in blood-stains. Dr. Malinan, of Tifiis, Russia, a prominent expert on blood in criminal cases, makes the following statement: ' If we find corpuscles in blood-stains the diameter of which is .0077 millimetre or more, then we can conclude that it is in all probability human blood,' and he testified in court to that effect." ("Comparative Studies on Mammalian Blood," 1888.) Wormley says, '' This difficulty of individualization arises from the fact, as we have already seen, that the average diameters of the corpuscles of different mammals are, in many instances at least, practically the same, and these averages, for the most part, pass by imperceptible gradations through- out the entire class. Thus, virtually of the same size as the corpuscles of a man are at least those of the guinea-pig, musk-rat, seal, beaver, opossum, and capybara, while those of certain other animals are but slightly larger and might be reduced in size to those of man. Hence, then, the micro- scope may enable us to determine with great certainty that blood is not that of a certain animal, and is consistent with the blood of man ; but in no instance does it, in itself, enable us to say that the blood is really human, or indicate from what particular species of animal it was derived." (" Micro- Chemistry of Poisons," 1885.) In the Cronin case at Chicago, Professor Talman testified as to the results of his examinations of blood taken from the Carlson cottage and from the trunk, and of hair taken from the same place and Dr. Cronin's head. The following questions were then asked the witness : Q. "In view of the examination which you have described, what do you, as a man of science, say as to the kind of blood which you dis- covered ?'' A. "I should say that it was human blood, partly because the average of all those measurements brings it above the generally established average of human blood, which is about 3^5-7 or -g^Vi mcn '< an0^> secondly, because the kind of hair found adds very strongly to that supposition." After discussing how to prepare blood for microscopic examination, etc., the cross-examination was continued at great length. The following are some of the questions submitted to the doctor : Q. "I will ask if you can cite any recognized authority which enables you to state that you can determine, by the measurement of the corpuscles, whether or not that blood is human ?" A. " I do not think there is any recognized authority." Q. "Do you mean to say you can testify as to whether it is the blood of a guinea-pig or human being by dry corpuscles alone ?" A. "I think they would come very close together." Q. "Do you think by the microscope it would be possible to determine the difference between the dry blood of a guinea-pig and a human being ?'' A. '' Not if they were under -^jtv mcn '> xt depends upon the size. If it 26o A MANUAL OF LEGAL MEDICINE was -gifi-Q inch, I should be justified in saying it was indicative of the blood of a guinea-pig.'' Q. '' Can you tell anything about the size of the corpuscles ?'' A. "Yes." Q. " Is it not a fact that the size of the two are so near that you cannot determine ?'' A. "If you take -^Vfr as a Dasis vou can-'' Q. " Do you cite any scientists who tell us that you can tell the differ- ence ?" A. " I do not think of any." Q. '' Can you tell us of any scientist who says he can tell the difference between the blood of a guinea-pig and a human being, or any scientist who informs us that you can tell the difference between the blood of a rabbit or the opossum and that of a human being ?'' A. '' Not, as I said before, where they agree in size and come up to ^7." Q. "Do you not know as a fact that they did?'' A. "Yes, I know it in the average." ("American and English Ency- clopaedia of Law," vol. xv.) Stevenson says, " It is generally 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 weapon. This is practically the form in which the problem usually 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 abso- lute certainty that it is not the blood of an animal like the ox or pig." (Taylor's " Manual of Medical Jurisprudence," eleventh edition.) '' Expert testimony in which distinctions are attempted between human and other mammalian blood, based on differences of -nrfons' to y^^nr inch, are not generally regarded with favor, either by judge or jury. Such niceties of distinction are looked upon with considerable scepticism 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 defence. On the other hand, extreme opinions given in evidence always lead. to contradictions between opposing experts, the result of which is that the jury are confused instead of assisted, and generally disregard all the expert testimony upon that branch of the case." ' According to Dr. Tidy, " It would, in our judgment, be unwise to hazard an opinion as to the source of a given specimen of blood from the micro- 1 Babcock, in Hamilton's System of Legal Medicine. FORENSIC MEDICINE 261 scopic 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." 1 Dr. Reyburn speaks as follows: " 1. Blood-stains can be certainly and absolutely differentiated from stains produced by other colored fluids by the presence or absence of the red corpuscles. 2. The blood-corpuscles of birds, fishes, and reptiles, being oval and nucleated, can never be mistaken for those of human blood. 3. If the average diameter of the blood-corpuscle in any specimen of blood (containing at least one hundred, or, better, five hundred corpuscles) is less than ^-^ inch, it cannot possibly be human blood. 4. If the blood-corpuscles have an average diameter of from -^^ to winr incn> then it is human blood (excluding the blood of the beaver, guinea-pig, kangaroo, monkey, musk-rat, porcupine, seal, or wolf). None of these are domestic animals, and stains produced by their blood can scarcely ever be met with under such circumstances as to be confounded with the stains of human blood. 5. Blood-corpuscles of the dog, ^i^ ; rabbit, -g-gV? '> ox, itVtt ) pig. T2inr > horse, ^^ ; sheep, -g^ ; goat, -g^, can, by the use of high magnifying power and the careful counting of one hundred to five hundred corpuscles, be differentiated from human blood-corpuscles, both in recently shed blood and dry blood-stains.'' 2 Professor Ewell states the opposing view to most of the above quoted conclusions, as follows : '' According to the present state of our knowledge, it appears to be settled that the blood-corpuscles, even in the fresh state, of man, dog, rabbit, guinea-pig, musk-rat, monkey, elephant, lion, whale, seal, otter, kangaroo, capybara, wombat, and porpoise cannot be distinguished from each other by micrometric measurement. With respect to the cor- puscles of other animals presenting a greater difference than exists between the corpuscles of the above-mentioned animals and those of man, it seems to the writer, in the light of the investigations above recorded, that it would be extremely perilous to undertake, by mere micrometric measurements alone, to distinguish the blood of man from that of another animal. It is possible that further investigation and more extended knowledge of the re- lation between these different corpuscles and of the sources of error in micro- metric measurements may enable a careful observer to distinguish human blood-corpuscles from those of some other mammals, but at present it seems somewhat presumptuous.''3 In a paper read before the Medico-Legal Society in 1892, Dr. Ewell gives the following conclusions : '' There are such large discrepancies between the averages obtained from the measurement of the fresh blood-corpuscles of animals of the same species, and between measurements of the same objects by different observers, as to throw doubt upon published results. 1 Legal Medicine, vol. i. 1882. 3 Medico-Legal Journal, September, 1892. 3 Medical Jurisprudence, 1887. 262 A MANUAL OF LEGAL MEDICINE '' There is no advantage in using very high powers in such observations. " Drying of blood-corpuscles in a clot multiplies the difficulty of identifi- cation. It has never been proven that dried corpuscles can be restored to their normal proportions. '' The mean size of the red corpuscles of very young animals is larger, and their size varies between wider limits, than in adults. '' Many diseases alter the size of red corpuscles ; especially is this so in microcythaemia. '' Fasting diminishes both the size and number of the red blood-cor- puscles. So, also, in the case of various drugs. " In view of the foregoing, it is impossible in the present state of science to say of a given specimen of blood, fresh or dry, more than that it is the blood of a mammal." ' As to the value of the haemin test, all authorities agree and accept its reliability. '' Clement says that ' the crystals of haemin are a certain indication of the presence of blood.' " Wormley asserts that ' their production is characteristic of blood, there being no other substance known from which they may be produced.' " A committee appointed by the French Medico-Legal Society, composed of Mayet, Mialhe, Cornil, and Lefort, decided that '' these crystals are so perfectly characteristic of blood that, should they be found, one may posi- tively assert the presence of blood.'' Professor Reese, in speaking of the value of the spectroscopic test, says, '' We must admit that the spectroscope, in the hands of a skilled oper- ator, affords the most certain and delicate test known for the presence of blood. It cannot, however, discriminate between human blood and that of any of the lower animals. In this respect, therefore, it is inferior to the microscope as a test.''2 Mr. Sorby concludes his description of the spectroscopic test (vide p. 254) as follows : "In conclusion, I must say that in examining some thou- sands of spectra I have been led more and more firmly to believe that with anything like reasonable care there is no difficulty in obtaining satisfactory proof of the presence or absence of blood. I do not at present see any probability of deciding by the spectra from what kind of animal it came ; but of course the mere fact of its presence or absence may be of great impor- tance in connection with other evidence." He further states that he has been able to obtain haematin by the micro-spectroscope in a stain forty-four years old. 1 Medico-Legal Journal, September, 1892. a Medical Jurisprudence, 1891. FORENSIC MEDICINE 263 CHAPTER XXV. THE MEDICO-LEGAL CONSIDERATION OF WOUNDS. Definitions of a Wound—Severity of Wounds—Classification of Wounds—Concussion —Fractures—Dislocations—Examination of Wounds and Injuries—Of Clothing or Dress, etc.—Evidence to be drawn from Blood-Stains—Position of the Weapon, Clothes, or Body—Distinction between wounds inflicted before or after Death- Cause of Death from Wounds—Homicidal, Suicidal, or Accidental Wounds- Presence of More than One Wound—Cicatrization of Wounds. Definitions.—Surgically, a wound may be defined to be a solution in the continuity of the tissues produced by sudden force or developed sponta- neously. Medico-legally, the idea of the term is much broader and more comprehensive, since it embraces any injury occasioned by mechanical or chemical means. Balch considers a wound "as an injury produced by vio- lence whereby solution of continuity in hard or soft parts is occasioned, or where loss of substance from death of the part due to the violence follows its infliction." ' Fod6r6 defines a wound as '' every lesion of the human body by a vio- lent cause of which the results are, singly or combined, concussion, contu- sion, puncture, incision, tear, burn, twist, fracture, luxation, etc., whether the cause is directed against the body or the body against the cause.'' Severity of Wounds.—In reference to persons charged with intent to injure or murder, the medical witness may be asked to give his opinion as to the danger of a given wound, in order to justify the question whether a prisoner may be admitted to bail or not. Hence upon the professional knowledge of the witness will depend the answer to the question whether a wound was or was not dangerous to life. The physician should, however, be extremely cautious in his reply when his opinion is sought upon this point. Wounds may be considered as mortal and non-mortal, or as fatal, severe, and slight. A mortal wound is one which is destructive to life in a compara- tively short period of time. The fact must not be overlooked that compara- tively slight wounds may result fatally on account of some infection. The mortal character of a wound depends upon its position and locality in relation to vital parts, the character of the weapon employed, the amount of hemor- rhage, the constitution of the person, etc. A wound of the heart, or of a great blood-vessel, or of one of the viscera, or a compound fracture of the skull, etc., may be pronounced as mortal in character. A severe wound is one in which the danger to life is not imminent. Such a wound is capable of producing "grievous bodily harm," or, according to 1 Hamilton's System of Legal Medicine. 264 A MANUAL OF LEGAL MEDICINE Pollock, is " any wound requiring treatment." A slight wound, according to French practice, "is one which does not incapacitate one from work for more than twenty days," or it maybe classified with severe wounds, "ac- cording as it is completely curable or not completely curable." The intent of a person in inflicting a wound can only occasionally be inferred from the nature or situation of the injury. A medical opinion may be sought by the court upon this point, although the intent with which an injury was inflicted must be made out by evidence of a non-medical kind; hence it is a question for a jury to decide. Taylor mentions the case of a man who was "indicted for feloniously wounding a girl, with intent to do grievous bodily harm. He kicked her in the lower part of the abdomen; the surgeon described the injury as of the most serious character, and said that at one time he considered the life of the prosecutrix in danger. She was still suffering, and would probably feel the effects of the injury for the rest of her life. The judge, in summing up the case, told the jury that the material question for them to consider was the intent of the prisoner. It was not because serious injury was the result of the prisoner's act that they were therefore to infer his intention was to do that injury ; and they were to judge from all the circumstances whether, at the time he kicked the prosecutrix, he intended to do her grievous bodily harm, as was imputed to him by the indictment, or whether he was merely guilty of a common assault. He was found guilty of a common assault.'' Classification of Wounds.—The classes of wounds to be presented for consideration in the following pages are (1) incised, (2) punctured, (3) contused, and (4) lacerated. (Gunshot wounds will be discussed in a sub- sequent chapter.) (1) Incised Wounds.—A wound is called incised when it is produced by a cutting instrument. Such a wound is characterized by the evenness and regularity of the incision, although in some instances the edges may be rough, dentated, or lacerated, as where a rough and irregular weapon is em- ployed. Incised wounds bleed freely and gape widely. The hemorrhage depends upon the size, number, and character of the blood-vessels involved, although it may be influenced by personal peculiarities on the part of the injured indi- vidual, such as hemorrhagic diathesis, etc. The fact must not be overlooked that such injuries may be very rapidly fatal, especially where the incision involves large and important vessels ; even superficial wounds of this class may occasion dangerous or fatal hemorrhage. Bryant states that "the amount of gaping in a wound varies with the tissue divided. Skin, which is the most elastic tissue in the body, retracts when divided far more than other tissues, and transverse wounds of skin gape more than those which are longitudinal. Arteries, when wounded transversely or obliquely, gape much, and when completely divided across retract far into the tissues. Divided veins retract less than arteries. Muscles, when their fibres are cut across, shorten rapidly by contraction, and thus aid the gaping of a wound. FORENSIC MEDICINE 26 Fibrous tissues and nerves, when divided, retract but little. All wounds, however, which are made in parts in a state of tension, gape much, and tissues which are on the stretch when divided retract far more than they would do if they were relaxed. Thus, an incision made into the full breast of a suckling woman will probably, by gaping, appear as wide as it is long ; while one made into the same organ in a flaccid state would gape but little. Some tissues, on the other hand, never gape on division ; this is best seen in wounds of the palm of the hand and of the sole of the foot." Coagula and clots of blood are found between the lips of incised wounds, and in a recent wound the cellular tissue is completely filled with blood. According to Ogston,1 incised wounds are divided into three parts,—the commencement, centre, and end. The commencement has but a single point of incision, while the end of the wound may present two or more serrations. Tentative incisions are frequently located at or near the commencement. If there are angular flaps on the edges of a wound, the direction in which their free angles point may show whether the incision was made from right to left, or the reverse, since they always point to the commencement of the wound. Healing by primary adhesion or first intention is usually the rule in these wounds. However, when the conditions for repair are not favorable, the adhesion is by second intention, or the union of the divided surfaces by organized lymph or granulation tissue. The diagnosis as to the character of a wound can often be made in cases where the healing was by first inten- tion and the cicatrix linear. The relation of an incised wound with its supposed cause may often be ascertained by an inspection of the injured part. Thus, when an axe, hatchet, sword, etc.,2 has been used, a certain amount of contusion may be noticed about the wound, and to this may be added crushing of the soft parts to a certain extent, and the impression of the cutting part of the weapon on the bone, or fracture. If the wound has been the result of glass, china, or crockery-ware, its edges will be found to be rough and lacerated or irregular and uneven, although in some cases they resemble the perfect incised wound. Scissor-wounds may assume the appearances of those produced by a sharp-cutting instrument, although, as a rule, they are more of the nature of punctured wounds. As regards the particular form of the instrument that may have pro- duced the injury, it is not always possible to ascertain this desideratum, although some light may be thrown upon it by the form and direction of the wound. Thus, Vibert3 mentions a case of a wound in the neck which 1 Lectures on Medical Jurisprudence. ' In a homicide case, tried some thirteen years ago, the writer showed that the wounds found upon the head of the prisoner were occasioned by a closed, double- bladed pocket-knife, belonging to the deceased. This weapon fitted exactly into the wounds upon the prisoner's head. The prisoner was, however, acquitted, proving self-defence, having shot and killed his opponent. (Alvin facobi case.) 3 Precis de MeU Leg., 1890. 266 A MANUAL OF. LEGAL MEDICINE corresponded in form and direction to a pruning-knife. As the incision swept along, its depth was considerably increased toward the extremity of the wound, where it changed its direction, the form corresponding with the aforesaid instrument. " In general a 'tail' or long angle in the skin at one end of an incised wound indicates the end of the wound last inflicted, and some light may thus be thrown upon the inflicter of the wound." (Woolsey.) (2) Punctured Wounds.—These occupy a place intermediate between incised and lacerated wounds ; but, according to Bryant, when produced with sharp-cutting instruments, they may be classed as deep incised wounds. Punctured wounds are caused by pointed instruments, and they are sometimes named after the instrument of infliction. Depth is their greatest measurement, although it is not necessarily great. These wounds are more dangerous than incised wounds, especially where they are deep and involve important structures, as the hemorrhage is generally internal. Other dangers are the carrying in of septic substances, the retention of dis- charge, etc. When a wound is produced by a clean and sharp instrument in a healthy subject, the chances of recovery are greater than where the reverse prevails. "When tense fasciae are punctured,—such as are found in the palm of the hand, sole of the foot, and scalp,—or when deep muscles, bound down by fasciae, as in the thigh, are involved, and secondary inflam- mation ensues, the case is often very serious. Punctured wounds of cavities are worse than those of the soft parts covering bones, in the same way that all other wounds of those parts are graver, as well as from the fact that in punctured wounds there is more uncertainty as to the nature of the parts wounded, and that, with this uncertainty, there are, of course, less clear indications for treatment.'' (Bryant.) The characters of wounds may often be of assistance in determining the kind of weapon used ; in fact, the medical witness may be able to indicate the precise weapon or cause. This is especially the case in stab-wounds. Where the weapon has penetrated perpendicular to the surface of the part involved, the form of the wound may closely approximate that of the instru- ment, and show whether it be double-edged or not.' But where the pene- tration has been in an oblique direction, this correspondence will not be manifest; especially is this the case where the tissues have been stretched. In some regions of the body, where the skin is loose or wrinkled, a stab- wound may suggest the idea of more than one distinct wound. 1 And yet, as remarked by Woolsey, "a weapon with a broad back and only one cutting edge may produce a wound resembling that of an instrument with two cutting edges, the second angle tearing as in the former class. Here on close examination we can sometimes distinguish the difference between the two angles and judge cor- rectly of the shape of the weapon. In fact, wounds made by common pocket-knives are regularly slit-like and not wedge-shaped, as the wound is caused only by the cutting edge of the knife." FORENSIC MEDICINE 26- The dimensions of wounds produced by stabs may be the same as the blade making them. Another important medico-legal significance in these wounds is that they may be broader and shorter than the weapon, due to the elastic state of the skin, which retracts the edges of the wound. Again, upon the withdrawal of the weapon from the wound, the opening of the latter will be found considerably enlarged on account of the lateral motion exerted during the operation. If the wound is oblique in direction, then it measures longer than the weapon. Woolsey remarks that the exit of such wounds is smaller than the point of entrance. Punctured wounds produced by conical or cylindrical instruments differ from stab-wounds in many particulars. For example, the edges and angles of these wounds are torn and irregular in comparison to stab-wounds pro- duced by a knife, which are smooth and even ; furthermore, a comparison of the depth with the size of the opening is a distinguishing point. The re- traction of the edges of the wound is slight, while in stab-wounds it may be considerable. Wounds made by files, foils, etc., or those caused by instruments with ridges or edges, may present the shape of the weapon, although in some instances they simulate those produced by conical or cylindrical instru- ments, being more or less elliptical, with two unequal angles. Irregular perforating instruments cause wounds similar to those which result from the violence of the application of a hard body (contused wounds). (3) Contusions and Contused Wounds.—A contusion is a subcuta- neous injury produced by a fall, or by squeezing or crushing the tissues. There is an effusion of blood, together with discoloration of the affected part. Occasionally vesicles and blebs form, and the injury may assume a gangrenous appearance. The effused blood may form a fluctuating swelling (haematoma), or it may coagulate and form a thrombus. The discoloration of contusions is characteristic, although it is of the utmost importance to recollect that an ecchymosis may be found wanting, even after a severe blow ; in fact, the injury may have been sufficient to cause fatal results. On the other hand, a very slight contusion, occasioning little or no inconvenience, may produce extensive ecchymosis in the young, the aged, in females, or in those suffering from such affections as purpura, scurvy, haemophilia, etc. Contusions in persons encumbered with a large quantity of subcutaneous fat are usually followed by extensive ecchymoses. Another fact not to be lost sight of in medico-legal investigations is that this condition cannot be pro- duced by blows upon the dead body, although an ecchymosis produced during life may not be discernible until some hours after death. ( Vide Ante-Mortem and Post-Mortem Ecchymoses.) The shape of a contusing instrument or body is occasionally seen upon the bruised part, especially when the latter is of recent origin. If, however, the contusing body is very large, only a part of its area will be apparent. (Vide Injuries to the Head, etc.) A contused wound differs from a contusion in that there is a break in 268 A MANUAL OF LEGAL MEDICINE the surface of the skin ; in other words, a solution of continuity. Occasion- ally this form of injury may present the appearance of an incision, as when the scalp is opened by a hammer or club. In wounds of this description the tissues are broken by some irregularity on the surface of the bruising body, or by the violence of its application. They are characterized by slight hem- orrhage, moderate gaping, dull pain, ecchymosis, and shock. Contused wounds have thickened or ragged borders, which are apt to be swollen. It may be impossible to distinguish them when they have begun to granulate. As in the case of contusions, they may reproduce the shape of the contusing body ; even the bone may show the impression of the instrument causing the injury. Plaques parchemine"es is the term employed by the French when referring to the hard, dry, brownish-yellow condition of the skin after death. ( Vide Contusions of the Head.) (4) Lacerated Wounds.—These resemble contused wounds to a certain extent, but are followed by less discoloration and by less hemorrhage than is the case in incised wounds. They do not afford the same facility for indi- cating the weapon used as incised or punctured wounds, but the appearance of the wound often affords indication of the inflicting agency. Lacerated wounds are generally caused by machinery accidents, accidental tears, etc.; the prognosis is somewhat variable, for there may arise dangerous compli- cations. Sometimes there are slow and extensive cicatrization, impairment of function, etc., all of which have an important bearing upon this point. These wounds are more often the occasion of civil proceedings than those of a criminal nature. Concussion.—( Vide Wounds of the Head.) Fractures.—A fracture is the sudden solution in the continuity of the tissue of a bone. It is called simple when the bone is 'broken at one point only, and is not accompanied by a wound leading down to the injury; complete when the break involves the entire thickness of the bone ; compound when accompanied by a wound which penetrates from the surface to the plane of the fracture ; single when there is but one line of fracture, making in the long bones two fragments ; multiple when there are two or more breaks, the lines of fracture not communicating if these fractures are of the same bone; comminuted when the bone is broken into more than two fragments, the lines of fracture communicating ; impacted when one piece is driven into the other and wedged in that position ; co?nplicated when it is accompanied with other serious injuries in the same region, as laceration of nerves or vessels, etc.; and incomplete when the bone is bent, but not entirely frac- tured. Fractures about joints are classed as intracapsular and extracapsular. Further, in young persons epiphyseal separation may take place, especially in the humerus. The symptoms of fracture, briefly, are as follows : (1) deformity or dis- placement ; (2) abnormal mobility ; (3) crepitus ; (4) loss of function ; (5) pain and tenderness ; (6) swelling and ecchymosis. Incomplete and im- pacted fractures do not present any abnormal mobility ; and crepitus is FORENSIC MEDICINE 26 absent under the same circumstances, and also where the fragments overlap or are widely separated, etc. The predisposing causes of fracture include those conditions under which the bone becomes subject to disease or injury, such as age, sex, rickets locomotor ataxia, etc. The exciting causes are external violence and mus- cular action. Spontaneous fractures may occur where the bones are free from disease, and even where a moderate degree of muscular action is apparent. Taylor mentions a case of fracture of the humerus which was oc- casioned by throwing a cricket-ball. In such cases there are no marks of external violence. The complications which may arise are oedema and swelling, often followed by blebs ; ulceration and sloughing of the soft parts ; muscular spasm ; gangrene ; and, rarely, venous thrombosis, embolism, etc. The pathology of fracture is as follows. There is at first free hemorrhage from the blood-vessels of the injured bone, medulla, and surrounding soft tissues. This is soon accompanied by inflammation with exudation, absorp- tion of coagula, and deposit of plastic lymph about the neighborhood of the parts injured. The process is completed by what is called organization, the plastic lymph being converted first into cartilage and secondly into bone. The union of fractured bones is more rapid and perfect in the young than in the old, and in the upper than in the lower extremity. Union between the fractured ends of a bone does not usually commence until about ten days after the infliction of the injury, and three to six weeks are necessaryT for the complete ossification of the callus, the time depending on the size of the bone and the accuracy of the coaptation. In some cases the union of the broken bones is delayed, while in others the continuity of the bone is not restored after twelve or more weeks. The causes of delayed union and non-union are constitutional, such as certain conditions depressing to health and nutrition, undue mobility of fragments, separation of fragments by mus- cular action, etc., and interference with the supply of blood. Was the fracture produced by an accidental fall or a blow ? This ques- tion is sometimes put to the medical witness. It is a common defence on these occasions to claim that the break was the result of an accidental fall. Therefore, in examining a fracture, the first thing to determine, if possible, is, Was or was not a weapon used ? The state of the parts may sometimes be of service in establishing the relation of the injury with its supposed cause : thus, if in connection with the fracture there are contused, lacerated, or even incised wounds in the same track as the force which caused them, the dis- covery of the weapon would clear up the matter at once. Or, again, if the parts about a fracture are contused, the extent of the bruising would not only indicate the weapon used, but likewise the amount of force exerted. Balch2 says, "Taking the bruise of the muscles into consideration, the extent and depth of this bruising would show that a fall could not have pro- 1 According to some authorities, four to eight weeks are required. 3 Hamilton's System of Legal Medicine. 270 A MANUAL OF LEGAL MEDICINE duced the wounding ; for, undoubtedly, as the break was caused at the same time as the contusions, it being a fracture from direct violence and in line of the external injury, the impossibility of a man falling so as to cause just so much violence in one spot, without corresponding injuries which would be naturally and necessarily received by the same fall and at the same time, the breaking by direct violence and that from a weapon would be clearly shown. This presupposes careful examination of the place where the assault is stated to have taken place, as well as of the wounded limb itself. If the wounded man is suffering from fragile bones or from any cause which renders the resistance to force less strong than normal in the bones breaking, it is no aggravation of the assault, for the force used was probably such as would in no way break a bone in an ordinary man ; and as no intent to such severe injury is shown, the responsibility of the break would lie 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." Was the fracture produced before or after death ? The answering of this question is by no means easy. The characters of fractures produced just before death and those produced shortly after death are very similar, • with the possible exception that in the latter case the blood effused would be less. Where a bone has been broken some ten or twelve hours before death, the effusion of blood into the surrounding parts would be copious; one broken at a still longer period before death would be indicated by the marks of inflammation. Post-mortem fractures are not followed by an effu- sion of blood,—viz., fractures produced several hours after death. How long did the deceased live after the fracture was produced ? Changes do not take place until eighteen to twenty-four hours, when lymph is exuded from the surrounding parts. This is slowly organized into bone-tissue, and soon acquires all the characteristics of that substance. Hence the exami- nation of the injured part is of the utmost importance in deciding this ques- tion. If a person dies during any of these changes, the medical witness may be asked to state the period at which the injury probably occurred, in order to connect the violence with the act of a particular individual. As a rule, the data upon which to base an answer are not trustworthy. All that can be said is as to whether a person injured lived for a long or short period after receiving the injury; to specify the precise time, however, is an impossibility. The union of bones is rapid in young persons, while in the old it is pro- tracted or does not take place at all. According to Villerme, the callus is cartilaginous in structure from between the sixteenth to the twenty-fifth day; it becomes ossified in a period varying from three weeks to three months, and it takes from six to eight months to assume the characteristics of normal bone. (Taylor.) Has a bone ever been broken? The existence of a fracture is often indicated by the slight unevenness or projection at the point of ossific cem- entation. The situation of a fracture has much to do with its recognition; FORENSIC MEDICINE 2?I thus, a fractured humerus, radius, clavicle, etc., being readily accessible or exposed, offers no barrier to make its detection difficult or impossible. In cases where the bone lies deeply in the soft parts, it is hardly possible to ascertain whether or where a fracture has taken place. It is not possible to state when the fracture occurred. These facts are of considerable importance in the identification of the dead, particularly in the case of skeletons. In the latter instance a fracture of a bone may be ascertained by sawing it longi- tudinally and noting whether any unusual thickness, irregularity, etc., of the bony shell exists. In such cases it will be easy to state if it were recent or old at the time of death. Dislocations.—These rarely call for medico-legal investigation. They are seldom dangerous to life, unless of a compound nature, or when between the vertebrae. A dislocation produced during life would be recognized post- mortem by the laceration of the tissues in the region of the joint and by the effusion and coagulation of blood. An old dislocation may often be identi- fied on dissection by the cicatrices in neighboring structures. '' The diag- nosis of a dislocation," says Woolsey, "is easy until it has been reduced, and then it may leave no trace except pain in and limitation of the motion of a joint, besides swelling and ecchymosis. These effects are transient, and after they have disappeared it may be impossible to say whether a dislocation has existed on a living body, unless, as sometimes occurs, especially in the shoulder-joint, there may be a temporary or permanent paralysis of a nerve and muscular atrophy." Examination of Wounds and Injuries.—This includes their situa- tion, shape, extent, length, breadth, and direction, and also the parts in- volved. Other matters of importance in connection with the examination of wounds are the condition of the edges of the wound, whether swollen, ecchymotic, smooth or straight, dentated, irregular, inverted, or everted. Note whether blood-clots are present or not, and whether the surrounding tissues are stained with blood. The characters of a wound made after death may be ascertained with much more freedom than is the case in the living ; and, further, an autopsy may be necessary in order to ascertain certain facts bearing on the case. ( Vide Classification of Wounds ; Ante-Mortem and Post-Mortem Wounds ; Homicidal, Suicidal, or Accidental Wounds, etc.) Examination of Clothing, etc.—This part of the examination should be made with particular care and exactness, as it may indicate the mode in which the wound had been made by the character of the cuts, etc., on the injured clothing. It is well to recollect, however, that contused and lacer- ated wounds and fractures, etc., may be produced without in any manner affecting the clothing, as was observed by the writer in the case of a punc- tured wound of the arm, down to the humerus, occasioned by the throwing of a beer-glass across a bar-room. Marks of blood, dirt, grease, grass, etc., on the clothing may afford valuable evidence in such cases ; so, like- wise, fragments of clothing of either the dead person or the suspected indi- vidual, found in close proximity to the former, and which correspond with 2?2 A MANUAL OF LEGAL MEDICINE the clothing worn at the time, may present valuable indications in the same direction. The following instance, related by Taylor,1 shows the importance of examining the clothing, and comparing it with the injuries which may have terminated fatally. A woman was discovered dead in bed with two indentations in the right parietal bone and a large clot of blood here beneath the skin, together with a fracture of the bone four inches in extent. Three ounces of clotted blood were found between the dura mater and the skull. No other cause of death was discovered. The evidence brought out the facts that on the evening before her death she had been suddenly knocked down by a man accidentally running into her. She fell on the back of her head, was stunned, raised upon her feet, and, after some stimulants were administered to her, recovered sufficiently to walk a distance of a mile and a half to her home and eat her supper. There was a suspicion of murder in this case against a fellow-boarder ; but when the bonnet worn by the woman was produced at the inquest, two indentations were noticed on the back of it corresponding to those on the woman's skull. These indentations, more- over, contained dust and dirt, thereby confirming the statement of witnesses who had seen her fall, and rendering probable what from the history seemed unlikely, that the real cause of the fatal fracture and effusion of blood was the fall. J , . Evidence from Blood-Stains.—( Vide Blood-Stains, Wounds before and after Death, etc.) Position of the Weapon, Clothes, or Body.—The position of the weapon to the body and the position the clothes of the dead person or the coverings of the bed are found in may throw light upon the mode of death, whether homicidal, suicidal, or accidental. (Vide Homicidal, Sui- cidal, or Accidental Wounds.) Distinction between Wounds inflicted before or after Death.— The differences between wounds inflicted before and after death should be carefully studied, for in cases of fatal injuries the defence may assert that the wound or injury was made after death. The following tabular statement shows the characters of wounds made in life and after death : I. Incised Wounds. i. In the Living.—(i) Edges regular, even, and everted, the latter due to their elasticity (the edges may be inverted in some instances,—i.e., as in the scrotum, where a thin layer of muscular fibres is connected directly to the deep surface of the skin). (2) Hemorrhage considerable, and usually arterial in character ; spots of arterial blood which have spurted on a wall or furniture are of a peculiar, comet-like shape. (3) There are coagula or clots of more or less abundance in the wound and around it (in scurvy and in the case of menstrual blood, etc., coagula- 1 Medical Jurisprudence. FORENSIC MEDICINE 2?. tion is retarded or imperfect ; a large quantity of blood in a serous cavity, which, if inflammation exists, is found not to coagulate, or, if it does it is imperfect). (4) The surrounding tissues are more or less infiltrated with blood, and the edges of the wound are deeply stained with the coloring-matter (haemo- globin), which cannot be removed by washing. The muscular and cellular tissues are especially involved. The hemorrhage is an active and not a passive one. (5) After some hours or days evidences of repair or of inflammation are shown, such as partial or complete healing, pus, granulations, suppura- tion, etc. 2. In the Dead.—(1) Edges close and not everted, as the skin loses its vitality within a few hours after death (there may be some retraction of the skin if the wound was inflicted within a few minutes after death ; but if the wound was made ten or twelve hours after death, eversion has ceased to occur). (2) Hemorrhage scanty or absent unless a large vein is opened. The bleeding is usually venous when it occurs. The hemorrhage is a passive one. (3) There are few or no coagula (when the animal heat of the body is lost, coagulation as well as hemorrhage, under normal conditions, ceases). (4) There is little or no staining of the surrounding tissues (where there is staining, the blood is merely imbibed by the tissues, and may be washed off the edges of the wound). (5) There is never any attempt at repair, and there are no signs of inflam- mation, although there may be a drying up of the edges and signs of putre- faction. II. Contused Wounds. 1. In the Living.—(1) There is swelling, and, after a period varying from a few hours to a few days, if the swelling be deep-seated, the skin assumes a violet, greenish, or yellowish color, particularly at the edges.1 (2) There is effusion of blood into the cellular tissue under the skin ; sometimes a few clots. The effused blood is due to the rupture of small blood-vessels. (3) After some days, or even weeks, the swelling subsides and the colors fade. (4) Abscesses may appear, or ulceration, sloughing, or erysipelas take place. 2. In the Dead.—(1) There is little or no swelling, and the above changes of color never appear. (2) Very little effusion of blood takes place, and there are scarcely any clots or coagula. 1 According to Reese, the ecchymosis appears within twelve hours after the con- tusion ; the violet color, within three days ; the green, from the fifth to sixth day ; the yellow, from the eighth to tenth day; and in healthy persons the spot disappears completely in from the twelfth to fourteenth day.—Medical jurisprudence. 18 274 A MANUAL OF LEGAL MEDICINE (3) There are no prismatic changes of color. (4) There are no abscesses, nor any of the changes referred to above. III. Lacerated Wounds. 1. In the Living.—(1) These wounds are not always followed by bleed- ing, although it rarely fails entirely. If the wound is in a vascular part, it may cause fatal symptoms, due to hemorrhage ; on the other hand, an entire limb may possibly be torn off without much bleeding. (2) Clots of blood may be found adhering to the edges of a lacerated wound ; there are always more or less coagula present. (3) There may be signs of vital reaction, such as suppuration, granula- tions, sloughing, etc., if the injured person survives a few days. 2. In the Dead.—There is scarcely any hemorrhage or staining (where large veins have been injured there may be some). There are no evidences of repair or inflammation, etc. IV. Punctured and Penetrating Wounds. 1. In the Living.—There is always more or less hemorrhage, unless the weapon used is blunt. Evidences of vital and reparative reaction, as in- flammation and suppuration, or gangrene, are often exhibited, as in other wounds. 2. In the Dead.—There is little or no hemorrhage or coagulation of the blood, and there are no signs in or around the wound of repair, etc. (A stab-wound of the left ventricle of the heart, after death, is followed by no hemorrhage.)1 Recapitulation.—The distinction between wounds inflicted before death and those made ten or twelve hours after death is not a difficult matter. Wounds inflicted during life or very shortly after death may be recognized <(i) if the hemorrhage has been abundant and arterial; (2) if the blood has infiltrated and stained the tissues ; (3) if the stain on the edges of the wound cannot be washed off; (4) if coagulation of the blood is complete ; (5) if the coagula are firm and are found between the lips of the wound ; (6) if the edges of the wound are gaping ; and (7) if the sides of the wound are re- tracted and uneven. In the case of a contusion, if it was inflicted during life, the following signs will be recognized : (1) a bluish, violet, green, or yellow tumor, with more or less superficial oedema ; (2) fluctuation or hard- ness of tumor, and, in either case, elasticity ; (3) effused blood on incision found in tissue spaces, clotted, the coagulum being firm. Post-mortem wounds are characterized (1) by slight or no hemorrhage; (2) hemorrhage is venous ; (3) edges of wound stained by imbibition of blood ; (4) stains easily washed off; (5) no clots of blood, or, if any, they 1 It must not be overlooked, in using the above tabular statement, that there are exceptions, and the various characters of wounds referred to are not by any means strictly accurate in all individual cases. FORENSIC MEDICINE 2?_ are soft; (6) divided arteries on surface of wound are not plugged ; (7) skin of wound is not everted ; and (8) the sides of the wound are smooth and in apposition. If the surface of a contusion is blue or violet in color ; if there is little or no swelling of the skin ; if the ecchymosed part is neither tense nor elastic ; if the blood, on incision, is fluid, or, if coagulated, only partly so ; and if there is no infiltration of blood into the tissues, but merely an imbibition, the presumption is that the injury was made after death. These conditions, however, are subject to modification, but in most cases they are absolutely accurate. Cause of Death from Wounds.—It is important to remember that in cases of criminally inflicted injuries the cause of death must be certain and definite. Although there is only one real cause, other circumstances may be accessory to producing a fatal result. The only difficulty likely to obscure the real cause is where a person has recovered from the first effects of an injury or wound and subsequently dies, or where death seems to be as much dependent on disease as on an injury. The medical witness, if in doubt as to the real cause of death, should state his doubt at once to the court, as it may seriously affect the testimony if brought out on cross-examination. Wounds may prove directly or indirectly fatal to life. A wound may be directly fatal when the person dies at once or very shortly after its infliction, with no other internal or external cause to account for death. A wound operates as an indirect or secondary cause when the injured person dies from some complication which is the direct consequence of the wound. In this connection may be included those cases wherein the person dies by reason of surgical operations necessary in the treatment of the injury. The direct causes of death in wounds are (1) hemorrhage, (2) severe mechanical injury, and (3) shock. (1) Hemorrhage.—Loss of blood may act by causing fatal syncope, although in some instances the quantity of blood lost is insufficient for this result, and death occurs as a consequence of the disturbed function of the organ or part into which the blood is effused. Thus, in the brain it acts mechanically by causing fatal compression ; and, again, in the trachea it may kill mechanically by asphyxia. In wounds involving the heart and lungs the same results follow,—i.e., death is due to compression of these organs. The quantity of blood necessary to cause fatal syncope is subject to great variation. Thus, less blood is required in the young, in the aged, in those diseased, and in women. Infants may die from hemorrhage resulting from very slight wounds. Taylor says that the bite of a single leech or the lancing of the gums has produced fatal hemorrhage in infants ; also that the healthy and vigorous may die from the loss of small amounts of blood occa- sioned by the depression of their vital powers due to maltreatment or brutal violence. It is important to remember that some persons have a predispo- sition to hemorrhage,—a condition which is often hereditary. In such per- sons, while the loss of blood may not be subject to variation under the 276 A MANUAL OF LEGAL MEDICINE normal conditions, still, a fatal result may follow an effusion of blood from the slightest wound or puncture. Thus, the extraction of a tooth may be attended with fatal hemorrhage, and so on with numerous other similar cases. A sudden loss of blood is of greater danger than the same amount lost slowly. This is well shown in the case of a wounded artery, where the hemorrhage is much more rapidly fatal than that from a vein or other source. To state the absolute quantity of blood necessary to be lost in order that a wound may cause death by hemorrhage is hardly possible. The total amount of blood in the body is estimated to be about one-thirteenth of the body-weight,—i.e., about twelve pounds. Out of this amount one-fourth may be considered to be arterial and three-fourths venous. Watson states that a loss of from five to eight pounds would be sufficient to cause death in an adult; although fatal results have followed a much less amount, since the rapidity with which an effusion occurs, together with the age, sex, and bodily condition of the person, are influences of considerable moment. In a case mentioned by Taylorx a man who was wounded in the chest died within thirty-eight hours from hemorrhage occasioned by the involvement of an intercostal artery. Bleeding from a wound of the smaller branches of the external carotid artery has caused fatal results. So, likewise, injuries or wounds in vascular parts cause frequently death from hemorrhage, even although no blood-vessel of any considerable size be involved. Internal Hemorrhage.—This form of hemorrhage, also called concealed hemorrhage, indicates bleeding into one of the cavities of the body. It may prove fatal. This is especially the case where the hemorrhage is occa- sioned by the rupture of such organs as the heart, lungs, liver, and kidney. Extravasation indicates hemorrhage into the areolar tissue, such as follows severe contusions or contused wounds. Large quantities of blood may in this manner produce fatal results. ( Vide Gunshot Wounds.) Taylor2 cites the following means of determining whether a person has died from hemorrhage. If the wound be situated in a very vascular part, or if a large or moderately large blood-vessel was wounded, and the neighbor- ing vessels, especially the veins, are found to be empty, then death may be referred to hemorrhage ; and if the injured person was found to be free from disease, the case is still more apparent. Further, '' This opinion may, how- ever, be materially modified by the fact of the body not being seen on the spot where the fatal wound was actually inflicted ; by the wound having been sponged, the blood removed by washing, and all traces of hemorrhage destroyed. Under these circumstances the case must in a great measure be made out of presumptive proof; and here a medical witness may have an important duty thrown upon him,—namely, that of examining articles of dress, furniture, or weapons for marks or stains of blood. It must not be supposed that all the blood met with round a wounded dead body was actu- ally effused during life. As soon as the heart's action ceases, the arteries 1 Medical Jurisprudence. 2 Op. cit. FORENSIC MEDICINE 277 pour out no more; but the blood, so long as it remains liquid,—/ e from four to eight or ten hours—and the warmth of the body is retained, continues to drain from the divided veins and smaller vessels. The quantity thus lost however, is not very considerable unless the veins implicated be large." (2) Death from Severe Mechanical Injury to a Vital Organ.—Direct injury to the heart, lungs, brain, etc., such as crushing, maybe accompanied by fatal hemorrhage, although death may be more immediate than the loss of blood would account for, and hence the fatal effect may be ascribed to shock. Occasionally a severe mechanical injury is followed by a large effu- sion of blood, so that death is really the result of hemorrhage. (3) Death from Shock.— Shock is a condition of nervous depression brought on by severe injuries. It is sometimes a direct cause of death. In some cases the marks of local injury are not sufficient to account for the rapidly fatal results, and death is attributed to sudden depression of the nervous system, or shock. Blows upon the pit of the stomach operate fatally by the impression they make upon the cardiac plexus, although there is no visible external or internal lesion to account for the result. Concussion of the brain, unattended by intracranial hemorrhage or laceration of the organ itself, may cause almost immediate death from shock. For example, a man is struck a severe blow upon the head, from which he dies immedi- ately, or he becomes unconscious and succumbs to the effects of the injury within a few hours. The autopsy reveals nothing but a healthy condition of all the organs of the body. Here the cause of death can be attributed only to shock, since, as we have seen, no external or internal sign of a fatal injury exists. Medical evidence in such cases must be given with extreme caution, as the defence may claim that there was no visible wound of a suf- ficiently mortal character to account for death. Fatal results may follow the shock occasioned by a multiplicity of wounds, although not one of them, alone, could be called mortal. "It is a well- ascertained medical fact," says Taylor, "that a multiplicity of injuries, each comparatively slight, are as capable of operating fatally as any single wound whereby some blood-vessel or organ important to life is directly affected. Age, sex, constitution, and the previous state of health or disease may ac- celerate or retard the fatal consequences. ... It must likewise be remem- bered that in cases in which a person has sustained a number of injuries, the loss of a much smaller quantity of blood than in other instances will suffice to destroy life." ' Of two or more wounds, which was mortal? An individual wound may be said to be mortal when it is capable of causing death directly or indirectly, notwithstanding the best medical treatment. It is presumed that no other cause, such as a diseased body, etc., has intervened to hasten a fatal result. No general rule can be laid down for determining the fatal character of wounds, as each case must be decided by its attending circumstances; 1 Medical Jurisprudence. 278 A MANUAL OF LEGAL MEDICINE although it may be possible to state, from the nature of the parts involved, which wound was likely to have proved fatal. In some parts of the Conti- nent two classes of mortal wounds are recognized,—i.e., those which are absolutely and those which are conditionally mortal. In the former class are included those in which the best medical service is at hand, sent for, or rendered without preventing the fatal result. A conditionally mortal wound is one in which the injured person would, in all probability, have survived had medical treatment been available, sent for, or actually rendered. Ac- cording to Taylor, the effect of the injury and the intent with which it was inflicted are observed rather than the anatomical relations, which are, at the most, purely accidental, and never considered in the assailant's favor. Suppose a person receives two injuries at separate times and by dif- ferent assailants, and dies : the question naturally arises, Which of the two injuries proved fatal ? For example, the wound inflicted first was, say, a gunshot wound of the shoulder, from which the person was apparently recovering, when, in another fracas, he received a penetrating stab-wound of the abdomen. After hovering between life and death for a time, he finally succumbs to the effects of the injuries, and dies. If at the autopsy the stab- wound was found to have penetrated a large vessel or one of the viscera, while the injury to the shoulder was apparently of trivial importance, the decision as to which of the two wounds caused death would be comparatively an easy matter. If, on the other hand, the stab-wound was superficial in character and non-penetrating, while the shoulder-wound was found to have suppurated and produced septicaemia, death might readily be ascribed to the latter cause. In case the latter injury was proved to be the real cause of death, the first assailant could be convicted of murder, and likewise, if the stab-wound was found to be instrumental in causing the death of the victim, the second assailant could be held. In some cases death may appear to be due to either or both wounds, in which case both assailants would be equally liable to a charge of man- slaughter. Again, the second wound may be inflicted by the injured person himself with suicidal intent, or it may be of accidental origin. In either case the medical witness would have to ascertain the cause of death. Fur- thermore, the injured person may actually have died from the effects of poison or maltreatment. Taylor mentions a case where a young girl died while her father was chastising her for stealing. It was supposed by all that death was due to the effects of the violence inflicted by her father ; and this was further strengthened from the fact that her arms, shoulders, and back bore evidences of the treatment to which she had been subjected, until an examination of the stomach, which was very much inflamed, revealed the presence of a white powder which proved to be arsenic. It seems that, on the theft being discovered, the girl took the poison for fear of her father's anger. She vomited during the flogging, and died in slight convulsions.' 1 Medical Jurisprudence. FORENSIC MEDICINE 2- In such cases, in order to exonerate the assailant, the supervening disease poison, or subsequent maltreatment must be of such a nature as to account for sudden or rapid death under the symptoms which really occurred before death. (Taylor.) Was the death of the injured person due to natural causes ? Here it may be claimed that, although the person was wounded, his death was due to latent natural causes. Cases are numerous where injured persons die from natural causes, although to laymen death may appear to be a direct result of the injury. This is frequently seen in cases of attempted suicide where the wounds are inflicted while laboring under disease, or some morbid change may occur subsequently and destroy life without relation to the in- jury. Taylor' remarks that where a wound or personal injuries have been inflicted by another, it is of great importance to make a careful examination of the body in order to refer death to the real cause, since a hasty opinion may involve an accused person in a charge of manslaughter. Where the question arises as between death from wounds or latent disease, Taylor2 says '' that numerous causes of death may be lurking within the system at the time that a wound is criminally inflicted, and a close atten- tion to the symptoms and post-mortem appearances can alone assist the prac- titioner in the difficult position in which he may be placed should the accused party be subsequently brought to trial. A man may be severely wounded, and yet death may take place from rupture of the heart, the bursting of an aneurism, from apoplexy, phthisis, or other morbid causes which it is here unnecessary to specify. If death can be clearly traced to any of these dis- eases by an experienced surgeon, the prisoner cannot be charged with man- slaughter ; for the medical witness may give his opinion that death must have taken place about the same time and under the same circumstances, whether the wound had been inflicted or not." According to Woolsey,3 "the crime is still manslaughter and may even be murder if the assailant was actuated by malice, and the abnormal or unhealthy state of the body of the victim was taken advantage of.'' A question likely to arise here is, Was the death of the person hastened by the wound, or was the disease under which he was suffering so aggravated by the injury as to cause a more rapid termination ? To answer this ques- tion, the circumstances of the case must be considered. If the death of a person be maliciously hastened, the offence may be regarded as criminal on the principle that an injury or wound which hastens death causes death. According to Lord Hale, if a person be suffering from a disease which would probably end his life in a short time, and he receives a wound or injury which accelerates his death, such a killing would constitute murder, and the person who inflicted the injury would properly be held responsible. Taylor says, " If the person maltreated be an infant, or a decrepit old man, or one labor- 1 Medical Jurisprudence. 2 Ibid. 3 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 28o A MANUAL OF LEGAL MEDICINE ing under a mortal disease, it is notorious that a comparatively slight degree of violence will destroy life in these cases.'' Another question that may arise is that death was not necessarily the result of the injury, since it might have been avoided by good medical treat- ment. It is well known that there are many kinds of wounds which prove fatal only when improperly treated. The medical witness may be called upon to express his opinion as to how far the treatment in the latter case irritated the effects of the wound. Upon his answer will depend the decision of the jury as to the degree of criminality which attaches to the suspected person. Taylor1 supposes the following case. An ignorant person inter- feres with a clot of blood which arrested the hemorrhage from a vessel, and the injured person dies in consequence of such interference ; or he caused death by unnecessarily examining a penetrating wound of the chest or abdo- men. Here the question arises, Would such mitigating circumstances be in favor of the accused ? Undoubtedly so, since it would be unjust to hold the accused responsible for such meddlesome treatment. Of course the mitiga- tion is only admitted on the supposition that the original nature of the wound was not mortal. Woolsey2 says, '' Medically speaking, we can seldom make the sharp distinction which Lord Hale did legally between a wound becoming mortal from improper treatment and one in which improper treatment causes death irrespective of the wound. In case of a slight wound this distinction might be possible, but not so in case of severe wounds; also, there would probably be no conviction, as far as the medical evidence is con- cerned, if the wound was mortal in consequence of improper treatment only, and not mortal as its usual and probable result." Regarding the comparative skill in treatment of wounds,—a question which might arise. If the death of a person be entirely or partly due to an injury inflicted by another, the responsibility of the latter is not lessened by maltreatment. Taylor3 quotes the following case, reported by Alison, in support of this. "The prisoner was one of a party of smugglers who fired at an officer of excise. The wounded man was carried to the nearest village, where he was attended by the surgeon of the country, who was not deficient in attention; but a great collection of matter formed in the leg, fever ensued, and the patient died at the end of three weeks. In defence it was urged that by skilful treatment the man might have recovered ; but the court held that it was incumbent to prove that death arose ex malo regimine." If the medical treatment was so unskilful as to cause death, it would be a miti- gating circumstance in favor of the original author of the injury ; "but if it arise from the want merely of the higher skill, which can only be commanded in great towns," says Taylor, " he will be responsible, because he has wil- fully exposed the deceased to a risk from which he has practically no means of escaping." 1 Medical Jurisprudence. 2 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 3 Medical Jurisprudence. FORENSIC MEDICINE „Q 2oI Again, it may be claimed by the defence that death was not necessarily the result of the injury, and might have been avoided but for imprudence or neglect on the part of the injured person. It sometimes happens that the wounded person absolutely refuses all medical attention, or, in case he does receive it, acts contrary to the advice of the physician, and in fact does all in his power to offset the plans for his recovery. In such cases, or where the neglect to summon medical assistance causes death, the assailant would still be held responsible for the result of the injury, and could be convicted of manslaughter. Thus, in a case supposed by Taylor,1 a man may receive a lacerated wound of an extremity, inflicted by another, and subsequently die from tetanus or gangrene. Medical advice may have been declined, although proposed by his physician. This would not be allowed as a mitigatory circumstance in favor of the accused, since the injured person is not obliged to summon or submit to medical treatment, and the medical witness could not always be prepared to swear that an operation or other treatment would have prevented death. Sometimes the question arises that death might have been avoided but for some abnormal or unhealthy condition of the body of the injured person. Thus, in some instances, a person suffering from a slight wound may die, owing to its indirect action as a result of the unhealthy state of the victim's body at the time of receiving the injury. Again, certain abnormal anatom- ical conditions, such as a brittle state of the bones, or a thin skull,2 etc., may prevail, so that the most trivial injury may be followed by fatal results. Here the evidence furnished by the medical witness may be such as to diminish the responsibility of the assailant, and hence lessen the punishment. As Taylor3 remarks, "The consequence may be, medically speaking, un- usual or unexpected, and, but for circumstances wholly independent of the act of the accused, would not have been likely to destroy life. In general, in the absence of malice, this appears to be the point to which the law closely looks, in order to make out the responsibility of the accused,—namely, that the fatal secondary cause must be something not unusual or unexpected as a consequence of the particular injury ; and the medico-legal question presents itself under this form : Would the same amount of injury have been likely to cause death in a person of ordinary health or vigor? Men who have suddenly changed their habits of living, and have passed from a full diet to abstemiousness, are unable to bear up against comparatively slight injuries, and often sink from the secondary consequences. So a man, otherwise healthy, laboring under hernia, may receive a blow in the groin, attended with rupture of the intestine, gangrene, and death ; another, with a calculus in the kidney, may be struck in the loins, and die in consequence of the ' Medical Jurisprudence. ' The writer recalls an instance where a child six years of age was killed by a blow on the head from a spoon in the hands of a servant. The result was a compound depressed fracture of the skull. The latter was very thin. 3 Medical Jurisprudence. 282 A MANUAL OF LEGAL MEDICINE calculus perforating the renal vessels and causing fatal hemorrhage, or from subsequent inflammation." In case of death following slight personal injuries, the claim may be that death was not the result of the injury, but was due to other causes. In such cases there is commonly some diseased state of the body to clear up this result. When this disease which occasions doubt is located in a part other than that of the injury, a careful examination will clear up the case ; but if the disease and the injury are found in the same locality, the case becomes much more difficult. With careful attention the ordinary results of such in- juries will become explicable. Taylor1 says, " The violence may have been too slight to account for the diseased appearance, and the disease itself, although situated in the part injured, may be regarded as a most unusual consequence of such an injury." When death takes place from wounds after long periods, it may be claimed that this result was not necessarily due to the injury. From a medical point of view the cause of death is clearly traceable to the wound. Sir Astley Cooper mentions the case of a man who died from the effects of an injury to the head which he received two years previously. In this case death was clearly traceable to the results of the injury,—i.e., the symptoms of cerebral disturbance,—which continued from the time of receiving the wound to the death of the victim. Many cases might be cited to show the length of time which may elapse before death occurs. In English law an accused person cannot be adjudged guilty of murder unless the victim of the assault dies within a year and a day after receiving the injury. In practice this law is of little importance, as most wounds cause death within two or three months after their infliction ; but in principle it is wrong, medically speaking. It is of the utmost importance on the part of the medical witness to make a careful examination of the injured part, as by this means the cause of death may be connected with the injury. Indirect or Secondary Causes of Death from Wounds.—These are numerous and varied. A wound or injury is indirectly or secondarily fatal when a person, having recovered from the immediate effects of such injury, dies from some wound, disease, or accident, or from surgical interference, including the use of anaesthetics. Woolsey2 says, '' There may be much difficulty in establishing the proof of death from a wound by means of secondary causes ; for, first, the secondary cause must be in the natural course of things ; and, secondly, there must be no other accidental circum- stances to occasion the secondary cause." The following may be regarded as the most common of the remote causes of death :3 tetanus, erysipelas, hospital gangrene, septicaemia, pyae- mia, delirium tremens, surgical operations, and anaesthetics. 1 Medical Jurisprudence. * Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 3 The reader is referred to works on surgery for a more detailed description of the remote causes of death. FORENSIC MEDICINE 283 Tetanus * is an infectious bacterial disease which produces a tonic spasm of the voluntary muscles with clonic exacerbations. It generally follows punctured and lacerated wounds, and is always a serious complication. The prognosis is bad in acute cases, but is more favorable if the patient lives until the twelfth day. It rarely manifests itself before the seventh day after the infliction of the wound. The writer has made many autopsies on victims of this disease. He has seen two cases in life. The diagnosis of this affec- tion is easy. Erysipelas is an infectious, spreading inflammation due to the presence of a micro-organism,—Streptococcus erysipelatis. The exciting cause attacks the lymphatics of the skin, and effects an entrance through some wound or abrasion of the skin or mucous membrane. Erysipelas may give to wounds a fatal issue, hence it is always to be looked upon as a serious complication. It is particularly apt to follow injuries to the scalp, and may assume an epi- demic form, especially in crowded places, as hospitals. Facial erysipelas is a common variety. The prognosis of this affection is usually good. Wool- sey2 says, "If a man wounded in an assault is taken to a hospital where erysipelas prevails, the question of responsibility arises, for, medically speak- ing, he is subjected to great and avoidable risks." Hospital gangrene is another result of wounds which often proves fatal. It may assume an epidemic form. It results from the infection of the wound by specific germs through the medium of a foul atmosphere, impure instru- ments, etc. The inflammation produced is of a violent nature, although it does not spread as rapidly as that occasioned by erysipelas. It exercises a fatal action on the parts involved, producing mortification. The cir- cumstances which predispose to attacks of hospital gangrene are over- crowding, deficient ventilation, want of proper nourishment; in fact, any depressing cause. It is, however, rarely seen nowadays except in military hospitals. Septicemia is a general febrile affection occasioned by the absorption of the products of putrefaction. It is most liable to take place in wounds not treated with antiseptic precautions, or in those which, from their various peculiarities, cannot be thoroughly disinfected and protected. Since there are two sources of origin, there are also two forms of this affection,—i.e., (1) a septic intoxication or sapraemia, and (2) a septic affection which comes on more gradually. The former is due to the absorption of ptomaines, and begins acutely. The prognosis is grave. Pyemia is a septic fever, closely allied to septicaemia, which is charac- terized by the formation of metastatic abscesses due to staphylococci and streptococci, pathogenic organisms which enter the circulation. There is scarcely any appreciable difference existing between this and septicaemia, as 1 Vide Tetanus (American Medico-Surgical Bulletin, August 1, 1895), by Justin Herold, A.M., M.D. 3 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 284 A MANUAL OF LEGAL MEDICINE they both depend upon the same cause and are of the same nature. Spon- taneous pyaemia is of rare occurrence, if it occurs at all. The prognosis, like that of septicaemia, is very grave. The failure to employ antiseptic means in the treatment of both septicaemia and this affection may be ad- duced by the defence in lessening the responsibility of the person charged with the fatal assault. Delirium tremens often occurs as a secondary consequence of wounds or surgical operations in the case of those who are habitually under the in- fluence of liquor. The alcoholic forms of traumatic delirium are character- ized by an asthenic delirium, a soft, full, and quick pulse, tremulousness, and absence of fever. The prognosis in cases following surgical operations is rather grave. It may be alleged in such cases that death woutd have been avoidable but for the unhealthy state of the body. Surgical Interference and the Use of Anesthetics.—If the operation, which is a part of the treatment of the wound, is skilfully done, then the accused person may be held for the result. In wounds dangerous to life the necessity and mode of performing the operation must be left to the sur- geon's judgment ; therefore, the question of the propriety of such an inter- ference becomes of great importance. Without this method of treatment the patient will surely die, while, on the other hand, fatal results may follow the shock occasioned by the operation. A serious question is here pre- sented,—i.e., that of the legal responsibility for the death ; for it may be claimed for the defence, in the event of a trial, that the fatal issue was not due to the original wound inflicted by the prisoner, but was the result of the surgical operation. This question becomes paramount if it has been proved that the original wound was not of a serious character, or, if the operation was meddlesome and performed carelessly. ( Vide Medical Malpractice.) The circumstances regarded by the law in death following surgical operations are : (i) the necessity of the operation ; (2) the competence of the operator ; and (3) whether the wound would have been fatal without the operation. (Woolsey.) Taylor says that the responsibility assumed by physicians who are con- nected with cases of criminal wounding is very serious ; for any deviation from common practice will, in the event of death, be eagerly sought by the defence in mitigation of the responsibility of their client for the fatal result. On such occasions every surgical point advocated by the physician in the treatment of the case will be thoroughly sifted by the prisoner's counsel, and in case the injured person dies, the defence of the prisoner will be that the surgical interference was unwarrantable or unskilfully employed. Death may follow the employment of anesthetics in an operation, and here the question at issue would be, Was the administration of the anaesthetic called for, and did it form a proper part of the treatment, and was its administration skilfully carried out? The above-mentioned remarks regard- ing surgical interference will apply here. It may be added, however, that as death may be alleged to be the result of the employment of the anas- FORENSIC MEDICINE 2g thetic, it is best, for self-protection, to employ that anaesthetic which is most universally used in the particular part of the country in question. The practitioner must not overlook the fact that it is criminal on his part to oper- ate contrary to the will of a person, and, further, any misconduct from ignorance or inattention, whereby a patient dies, will be sufficient to con- vict him of manslaughter. Homicidal or Suicidal Wounds.— Was the wound self-inflicted or was it made by another? To reply intelligently to this important medico- legal question, certain points relative to the wound, together with such evidence as may be furnished by the weapon, the signs of struggle, the examination of the clothing and body of the victim, must be carefully con- sidered. The points with regard to the wound are its situation, its nature and extent, and its direction. i. The Situation of the Wound.—Suicidal wounds are usually inflicted upon those parts which are readily accessible to the hand. The great majority of these injuries, if produced by cutting instruments, are located upon the throat and phest. Punctured wounds are usually in the region of the heart. If fire-arms (vide Gunshot Wounds) are used, the site selected for the infliction of the injury is the chest (in the region of the heart), the mouth, the orbit, the forehead, or the temples. As regards the infliction of wounds by the insane, it is well to remember that there is no accounting for the variety in the nature and extent of such injuries. Some wonderful examples of self-destruction in this class of persons are recorded in medical literature ; in a few instances the object was accomplished by blows upon the head with a hatchet, axe, or hammer, or by forcing within the skull such implements as a chisel, awl, or pieces of wire, etc. The mere situation, therefore, is only suggestive of the origin of a wound, since it is possible for a murderer to simulate a suicidal wound for the pur- pose of avoiding detection. When wounds exist in the back, or upon parts not within easy reach of the person himself, the presumption would be that the injuries are of a homicidal nature ; but, as Orfila states, it is not so much the situation as the direction of the wound which furnishes proof against self-destruction. A wound passing directly through the body from behind forward would furnish presumptive evidence of homicide rather than of suicide, for the very reason that a person bent upon self-destruction would rather avoid than adopt such a complicated and uncertain method. Never- theless, as stated above, it must not be overlooked that the most accessible parts of the body are often avoided by the would-be suicide. Suicidal wounds, as a rule, are inflicted upon those parts of the body where they will produce rapid and sure results. Concealed wounds, or those which are located in parts which are not readily accessible, are pre- sumptive of homicide, although, again, self-inflicted wounds are occasionally discovered in the most unusual places, sometimes for the very purpose of attributing them to another in order to raise the suspicion of murder. Such cases, however, are very rarely heard of. 286 A MANUAL OF LEGAL MEDICINE The most common site for the infliction of incised wounds is in the neck, and, as Woolsey observes, "they may sometimes be arrested by the larynx, especially if it be ossified, though the incision often divides the larynx. The situation of the wounds is often between the larynx and the hyoid bone, and then, meeting no bony resistance, they may often divide the great vessels and even nick the vertebrae. But it is rare to be so deep, at least on both sides at once. As a rule, it is deepest on the side on which it is begun, and ends more superficially. As far as the situation of the wound is con- cerned, there is no wound which a suicide can inflict but what may be in- flicted by a murderer. The reverse, however, is not true. We cannot always certainly distinguish between suicidal and homicidal wounds from their situation." * 2. The Nature and Extent of the Wound—As a rule, self-destruction is seldom the result of contused wounds, but usually of incised or penetrating (punctured) ones. But an exception must be made here, as where, for example, a person precipitates himself from a great height; or, as regards lunatics, where suicide is accomplished by butting the head against a hard substance, such as a wall or floor, and subsequently hacking it with an axe or similar instrument. In case the contused wound was self-inflicted, the difficulty in clearing up the case is considerable. Taylor quotes a case re- lated by a medico-legal writer in which a man attempted suicide by butting his head against a hard wall, but, having failed in this attempt, he success- fully accomplished his purpose by striking himself repeatedly on the forehead with a cleaver, thereby inflicting fatal injury to the brain. The crime was witnessed by several by-standers. Had this not been the case, the nature of the injury was such as to be presumptive of murder. Incised wounds of the throat are usually regarded as indicative of suicide ; but it frequently happens that homicidal wounds are inflicted in the same locality for the purposes of concealment. Woolsey says, if such be the case, that homicidal wounds of this nature can frequently be differentiated from similar suicidal wounds, provided the victim was not asleep or drunk, or was otherwise incapable of defending himself, by the form and direction of the wound, by its irregularity, and by other wounds on the hands or body of the victim. Thus, for example, if the nature of the wound in the neck indicated that it had been made by an incision extending from within out- ward, like that made by butchers in slaughtering sheep, it would be pre- sumptive of murder. The regularity of the wound of the throat would rather indicate self-murder than homicide, although, if resistance on the part of the assailed is impossible, the assailant may readily make a regular and clean incision. On the other hand, the irregularity of a self-inflicted wound may be due to nervousness or hesitation on the part of the suicide. The evidence furnished by the number and extent of wounds must also be considered. Multiplicity of wounds, although indicative of homicide, are ' Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. FORENSIC MEDICINE o 207 possible in self-murder. Krugelstein1 relates the case of a woman found hung, who had on her head thirty parallel wounds one-half of an inch in length. They were located on the vertex and forehead, and had penetrated the outer table of the skull. In addition to these, parallel incisions were found in the neighborhood of the heart, which, from their being in a state of suppuration, must have been three or four days old. Maschka2 gives the case of an old woman who stabbed herself in the abdomen with a knife then inflicted severe injuries on the head with an axe, and finally made an effort to open the veins in the elbow. The autopsy showed a large fracture situated on the right side of the os frontis. A man fifty-three years old, says Riembault,3 first cut his scalp with a pocket-knife, then inflicted heavy blows on his head with a hatchet, and as a last effort hung himself. The autopsy revealed a large fracture at the point of apposition of the parietal with the frontal bones, and nine distinct parallel incised wounds of the scalp. Sixteen of this unfortunate man's relatives were insane. Kupfer4 relates the case of a man, forty years old, who drowned himself after having inflicted other injuries. His history was that of overwork, anxiety, and a slight tem- porary mental aberration. The autopsy showed thirteen parallel wounds of the integument above and behind the right ear, some of which penetrated to the bone. There were found over the left ear many wounds, with a large loss of substance ; in all, seventeen incisions were counted posteriorly and fourteen anteriorly. The bone was considerably fissured and splintered. Von Haumeder5 furnishes the case of a hostler suffering from typhoid fever, who was found hung. A hole two inches in length and half an inch in breadth, at the bottom of which the bone was exposed, was found at the centre of the vertex of the skull. Both of his hands were stained with blood, and at a short distance from the corpse lay a hatchet covered with blood, and still farther off, near a pool of blood, was a large hammer. Upon an exam- ination being instituted, it was discovered that at least sixteen blows were directed against the head, seven of which penetrated the skull. There was typhus abdominalis in the ulcerative stage. The opinion of self-destruc- tion was based on the facts that the injuries were of comparative insignifi- cance from the use of such large instruments ; that the wounds were parallel to each other ; that they were all more or less bunched together ; that there was not the least evidence of resistance ; and that typhoid fever was present. That multiple wounds are possible in suicide is evidenced from the cita- tion of the above instances. If several equally grave wounds are found upon the body, it is generally set down as presumptive of homicide, for it is unusual for such wounds to be self-inflicted. The medical witness, however, should not rest satisfied from this fact alone, for most wounds are not fatal instantly. It is obvious that if several wounds exist in a case of self-destruc- tion, one of these usually is fatal in character; but if two or more mortal ' Wiener Medicinische Wochenschrift, No. xv. 3 Ibid. 3 Ibid. 4 ibid. s ibid., No. xviii. 288 A MANUAL OF LEGAL MEDICINE wounds are found in different parts of the body of the deceased, or such as may be found in the region of the throat, where large vessels abound, a neg- ative idea of suicide must prevail. Woolsey states that a multiplicity of wounds in a case of homicide may afford evidence as to their origin from their situation or direction. He quotes Ogston as saying "that, especially in the case of incised wounds of the throat, a suicide may make a number of small or superficial tentative cuts besides the principal one ; but these incisions are all usually parallel. In the case of multiple homicidal incised wounds of the throat, on the other hand, the wounds are not parallel, owing probably to the resistance of the victim in this case and his remaining passive in the former." x As to the extent of the wound, we are to make note of the number and importance of the parts involved. It is commonly imagined, no doubt on account of the fact that most suicidal wounds of the neck are not deep, that an extensive wound of the throat cannot be made to involve all of the important structures in this region, clear down to the vertebrae, if inflicted by a suicide. Notwithstanding the fact that most of these deep incisions are homicidal in nature, instances are recorded where a person determined on self-destruction has made a clean sweep of the throat down to the vertebrae. Marc refers to a case of self-murder where the incision involved all the muscles of the neck, the trachea, the oesophagus, the jugular veins, and both carotids, while there were marks of the weapon even upon the anterior ver- tebral ligament. Such extensive wounds, therefore, are not incompatible with suicide, although, when connected with other signs, they are, as a rule, pre- sumptive of homicide. '' The question may arise in regard to a wound," says Woolsey, '' whether the victim wounded himself by precipitating himself on the weapon. This may be alleged by the defence, but it is difficult to believe if the wound is deep, for the body would naturally repulse the weapon. If the wound is deep, the weapon must at least have been strongly held, which may or may not be consistent with the theory of self-defence. If the direction of the wound is oblique from above downward, or if there is one external wound and two separate tracks internally, from a second use of the weapon on the part of the person holding it, then the above allegation is doubtful, if not impossible. By comparing the relative positions of the de- ceased and accused, as indicated by the witnesses and accused, with the position and direction of the wound, we may often judge whether the allega- tion is possible or probable.''2 3. The Direction of the Wound.—This will often enable the legal physi- cian to differentiate between the suicidal or homicidal nature of a wound. In most incised wounds of the throat, inflicted with suicidal intent, it will be noticed that the direction is almost always from left to right, if the person be right-handed, while in punctured wounds it is most frequently from right to 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 2 Ibid. FORENSIC MEDICINE 2g left, and downward. The reverse prevails if the suicide be left-handed. Nevertheless, the extent and direction of such wounds are subject to so much variation that, without particular attention being devoted to surround- ing circumstances, the possibility of generalizing with respect to them is doubtful. Woolsey says that transverse wounds of the throat without ob- liquity are consistent with suicide, although more frequent in murder, while wounds which have an obliquely transverse direction from above downward and from right to left in a right-handed person are evidence of their having been made by another. An incised wound of the throat, inflicted from be- hind by another person, may bear the same direction as similar suicidal wounds if the victim and assailant are right-handed, or from the left side if they are left-handed. Such wounds may be purposely made by the mur- derer to simulate suicide. The direction of a homicidal incised wound of the neck, inflicted from in front, is usually the reverse of a similar suicidal wound. Homicidal incised wounds in this situation may be prolonged be- yond one or the other extremities of the skin-wound, while in similar self- inflicted wounds the skin is the first and the last part injured, at both angles of the wound, and in such injuries the weapon scarcely reaches the vertebrae, although the faculty which some suicides possess of using both hands with equal facility must not be overlooked.1 In the case of Hanson, which came under the observation of the writer, the man was always believed to be left- handed, although his ante-mortem statement elicited the fact that he fired three shots into the right side of his head. In the case of homicidal wounds the direction may be the same as those which are self-inflicted, but they are produced while the assailant stands be- hind or to one or the other side of the victim. In suicidal stab-wounds of the chest the injured part is most frequently located upon the front or side of the body, while its direction, if the person be right-handed, is obliquely from above downward, and from right to left, while the converse holds true if the suicide be left-handed. If a stab-wound, inflicted with murderous in- tent, is from in front, then its direction, as a rule, is from left to right, and it may be from above downward, or the opposite. All oblique wounds from above downward are common to homicide and suicide, but those wrhich have a direction from below upward are generally presumptive of murder. If a wound is the result of a cutting or puncturing instrument, the proba- bility of suicide cannot be entertained, unless the weapon be placed in one or other of the hands of the deceased and the extremity moved toward the wound to see if the direction of the latter could possibly correspond to it in any position. If the arm moved cannot possibly reach the wounded part, it becomes obvious that it was not self-inflicted. Evidences from Circumstances.—(i) The Position of the Body.—( Vide Medico-Legal Autopsies.) In cases of immediate death from hemorrhage, the body will usually be found in the supine position ; but if the death be ' Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 19 290 A MANUAL OF LEGAL MEDICINE less rapid, it will occupy a prone position. A suspicion of murder could be entertained if the deceased was lying in the former-mentioned position, while the weapon was found at a distance from it, although, as previously stated, suicides sometimes try to simulate homicide by throwing the weapon away from them, as has been known to occur. (2) The Position of the Weapon.—This in relation to the body of the deceased may be of considerable importance as regards the question of homicide or suicide. If it be tightly gripped by the hand of the deceased, the presumption is strongly for suicide ; but if it be found at a little distance from the body, the physician must consider whether it might not have dropped to the place or been thrown there by the dead person, as previously stated. If the body has in any manner been disturbed or moved, the rela- tions existing between it and the weapon will be inadmissible as evidence. Taylor cites a case, which was referred to him, where a woman had died from a homicidally made wound of the throat; a razor, the weapon employed, was discovered under her left shoulder, a somewhat unusual position, but which, it seems, it had assumed owing to the turning over of the body pre- vious to the visit of the physician. The following case, reported by Dr. J. B. Lewis, remarkable alike in the position of the weapon relatively to the body of the deceased and the evident desire of the suicide to simulate homicide, is quoted from Dr. Lewis Balch's contribution (" Homicide and Wounds") to Hamilton's " System of Legal Medicine" : " Captain Colvocoresses, a re- tired officer of the United States Navy, was found in a dying condition in a by-street in Bridgeport, Connecticut, at a late hour of the night of June 3, 1872. The captain, although possessed of small 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 travelling-bag, but as the boat did not leave until eleven 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 until half-past ten, when he left a drug-store, where he had made some small purchases of paper and envelopes, and being directed how to find the boat, he apparently started to reach it. Just as the boat was 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 had seemingly come. Lying on the sidewalk, and in a dying con- dition, was Captain Colvocoresses. A large gunshot wound was in the left breast, his left hand pressed against it, and he was on his back. The dis- charge had set fire to his shirt, and the light from it guided the policeman. In a diagonal direction across the street, in the gutter, was an old-fashioned, percussion-lock horse-pistol. This weapon had evidently just been dis- charged. 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 FORENSIC MEDICINE 2 From examination it had the appearance of having been broken by being struck or snapped over a fence. The bullet had gone completely through the body. First one thing and then another was brought to light. A pill- box, having percussion-caps which fitted the pistol, was discovered. A boy, seeing a bit of rag sticking out from under a gutter-plank, carelessly pulled it out, and with it an old powder-horn. Tiring of his plaything, he threw it where it was afterwards found. The black bag carried off the boat by the captain was found on another wharf, partly hidden under a railroad-tie. One end was slit open, and nothing was in it but a blank check-book and some few grains of powder, which, on comparison with the grains in the powder-horn, were shown to be similar. Peculiar indentations were noticed in the bag, and trying the pistol, these were seen to correspond to the point where the hammer would rest if the pistol was put into the bag. The cap- tain's coat and waistcoat were unbuttoned and lay open when he was found on the sidewalk. It was proved that he habitually wore his coat buttoned up, and while it was supposed that the opened clothing was a sign of vio- lence on the part of footpads, the buttons were not torn off either garment. The evidence of the wound was that of close fire. The discharge must have been fairly near, or the shirt would not have been set in a blaze. And the carefully-cut satchel, the peculiar weapon,—the peculiar manner in which the sword-cane was broken, the evident care with which the percussion-caps and powder-horn had been hidden, the repeated questions by the captain in the early evening of the way to the boat (although he was well acquainted with the town), the motive for death (that his family would be left in affluent cir- cumstances), the peculiar manner of his bidding good-by to the family when leaving home that morning,—all brought the positive conclusion that this was a case of suicide and not of homicide.'' Dr. Balch says that Dr. Lewis, in his report, '' says, the pistol being found thirty feet away was accounted for by the recoil of the weapon, the pistol springing back from the chest after it was 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 conceived a plan that some arrangement must have been thought of by which the weapon would be found a distance from the body. Therefore, I do not think it in- compatible with the wounding that the captain could throw the weapon. The recoil may have helped in this, the arm giving the sudden jerk prede- termined on, and both forces combined carrying the pistol thirty feet." Taylor refers to a case where the deceased was found in bed with a deep wound in the neck, and the weapon—a razor—lying shut by his side ; and Casper mentions the case of a man dead with a gunshot wound in the breast, while the pistol was afterwards found in his pocket. It is scarcely probable that a suicide could have inflicted either of the above wounds, much less perform the acts of volition referred to. Most frequently in case of suicide the weapon is found lying by the side of the deceased, or, as already mentioned, it is tightly grasped in the hand. The latter appears to be due to the muscular spasm which continues after death (cadaveric spasm) 292 A MANUAL OF LEGAL MEDICINE until rigor mortis manifests itself. Casper says that this state cannot be imitated by a murderer or other person who might place the weapon in the hand of the deceased for the purpose of avoiding suspicion, since the power- ful muscular contraction which exists at the moment of death is lost, and the weapon falls from the dead man's hand. These circumstances, while strongly suggestive of suicide, are not infallible marks of distinction between this class of wounds and those of a homicidal nature. The weapon in the hand of the deceased may have been there for use in case of defence ; therefore, it be- comes the duty of the legal physician to ascertain whether there is any degree of correspondence between the wounds on the body and those which might result from the use of the weapon. Another important point for consideration is that the weapon found by the side of the victim's body may have belonged to him and been substi- tuted by the murderer for the one which caused death. Hence it is impor- tant to note whether it can be adapted to the wounds as to length, depth, etc., to be suggestive of suicide. When the attempt at self-destruction has been unsuccessful, a second or even a third attempt may be made to end life. In such cases the suicide may employ another weapon instead of using the same one over again ; therefore, two or more wounds made by the same or different weapons can- not be absolute evidence of homicide. ( Vide Presence of More than One Wound.) (3) Blood, Hair, etc., upon Weapons.—The appearance of blood, hair, etc., on the weapon is a matter of great importance in the consideration of suicidal or homicidal wounds ; although a weapon may be used to inflict a mortal wound, and still be free of blood or other substances. In stab- wounds, the weapon, on being withdrawn from the wound, may be cleansed against the sides of the wound in the integuments and by the clothing. In this manner it may appear perfectly clean except for a thin yellowish film. This fact serves to explain the reason why the stab-wound first inflicted leaves no blood on the exterior of the clothes worn, but only on the inside. Balchx says that '' stains upon the blade of the weapon are not always the only spots that may be found, and every particle of the weapon should be carefully searched and tested before stating that no blood is on it. Where a fixed handle is present, if it is made by two pieces of wood, bone, or other substances, being riveted to an extension 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 blood. The same where the knife is a clasp- knife. Blood may have been plentifully spread over the blade, and the knife carefully washed 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, where the noise of the discharge would 1 Hamilton's System of Legal Medicine. FORENSIC MEDICINE 2g3 be liable to bring about discovery. The same condition may then be found as is noticed where 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 way as blood upon cutting instru- ments. If the bark is still on the club used, then blood will 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.'' If blood is not found on a weapon, hair and the fibres of various sorts of fabrics should be looked for. Such substances, however, when found on a weapon associated with blood, often afford the strongest presumptive evi- dence of murder or violence. This is especially so if they are found to cor- respond with similar fibres taken from articles of clothing worn by the deceased at the time of the murder. When hair is discovered on a weapon, the question naturally arises, Is it the hair of a human being or of an animal ? Here the hair or fibre should be removed for the purposes of microscopic examination. ( Vide Hairs and Fibres.) This will also determine whether it has been cut or broken by a blow. If the hairs are discovered embedded in blood on a weapon that has been used with homicidal intent, the aid of a good magnifying glass will be of material assistance before subjecting them to more thorough treatment. In the recent Cronin case at Chicago, the subject of hairs in connection with blood-stains came before the court. Dr. William T. Belfield testified as to the results of examinations of certain specimens of blood, hair, cotton, etc., furnished him by the authorities in connection with the case. The doctor testified that he received some cotton and subjected the liquid portion of a red substance with which it was found associated to examination. He found that it was blood, as demonstrated by the corpuscles. In reply to the question, What examination did you make of the hair ? the doctor stated that he examined single hairs in each of the two bunches, in reference to their length, diameter, and structure. The results of his examination (six hairs from each of the two bunches) proved that they were all human. RichardsonJ mentions the case of a little girl, nine years of age, who was found lying on the ground in a small plantation, dead, with a wound in the neck. The mother of the child was arrested on suspicion of having caused the death of her child. Her manner and be- havior betrayed her to a certain extent, and she admitted that she had taken the child to the plantation, but that it had wandered away and was lost while hunting for flowers. A large knife was found in the woman's posses- sion, but nothing was found upon it, however, but a few pieces of hair ad- hering to the handle, so small as to be hardly perceptible. To the remark, " Here is a bit of fur or hair on the handle of your knife," the suspected woman replied, "Yes, I dare say there is, and very likely some stains of blood, for as I came home I found a rabbit caught in a snare and cut his throat with the knife." The knife, together with the particles of hair, was 1 Medical Microscopy. 294 A MANUAL OF LEGAL MEDICINE. submitted to a microscopic examination, with the following results: " Xo trace of blood could at first be detected upon the weapon, which appeared to have been washed ; but upon separating the horn handle from the shaft, it was found that a fluid had penetrated into the socket which was found to be blood, certainly not the blood of a rabbit, but bearing a resemblance to that of a human body. The hair was then submitted to examination. This hair was found to be that of a squirrel. Now round the neck of the child at the time of the murder there was a tippet of squirrels' fur. This strong circumstantial evidence was deemed by the jury sufficient to convict the prisoner, and while awaiting execution she confessed her crime." Besides the medico-legal questions already referred to in connection with hair (vide also Hairs and Fibres), the following must be considered by the legal physician,—i.e., Does the hair correspond with that of the murderer or of the victim, and has its color been naturally or artificially changed ? (4) Evidence from Blood-Stains.—In medico-legal cases the physician should not only make a careful external examination of the body of the dead person, and note anything and everything that might throw light upon the cause or mode of death, but he should also, where possible, pay particular attention to the surroundings where the victim was found. With reference to the clothing on the prisoner at the time the crime was perpe- trated, all evidences of stains from blood should be carefully studied. The value of noting carefully the form and direction of blood-spots when thrown from a vessel is well illustrated by TaylorI in his remarks suggested by the Reg. vs. Spicer case. He says, '' At the top of the stair, and at the height of four or five feet above the level, several spots of blood were ob- served upon the brick wall, which was whitewashed. The spots took an oblique direction from above downward ; were of a pale red color at the upper part, but dark red below, terminating in a point consisting of the fibrin and the greater part of the red coloring-matter. Their form2 and regularity proved that they had proceeded from a small artery, and that the wounded individual could not have been very distant from the wall, while their shining lustre rendered it probable that they were of recent origin, and their well-defined termination in a firm coagulum showed that they proceeded from a living blood-vessel. The deceased had died from fracture of the skull and vertebral column, by a fall from the top stair ; one branch of the right temporal artery was found divided, and this wound could not have been produced by the fall. It was, therefore, evident that a murderous assault had been made upon her at the top of the stairs ; this had led to the spirting of the arterial blood on the brick. The height at which the spots existed and their appearance proved that the jet of blood had been from above • Medical Jurisprudence. 3 The form may serve to differentiate between arterial and venous blood, since arterial blood assumes an oval or elongated shape when thrown in a jet from a divided vessel. FORENSIC MEDICINE 2 downward, thereby rendering it probable that the deceased was standing up, or that her head was raised at the time the wound was inflicted. Further as the brick with the spots was on his right side, it is probable that the deceased was face to face with her assailant in the act of ascending the stairs, and that she was killed by being precipitated to the bottom." (Vide Examination of Blood-Stains.) It is important to notice how the blood escapes from a wound; and, although the greatest amount of blood will be observed to be near the wounds or the place where the victim has died, still it is well to remember that the deceased may have moved about considerably, a fact which would account for the blood-stains often discovered on clothes, furniture, or other articles at a distance from the dead person. Balch mentions the following case. " In November, 1870, a man cut his throat in a hotel at Burlington, Vermont. The fact was discovered 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 following : the man, still alive, lay on the floor, about four feet from the window of the room and about eight feet from the door. Between him and the door there was a pool of blood about the size of an ordinary saucer. Another clot was under his neck, not so large as the first. Two more, one longer than the first named, were between the body and the window. By the window was a rocking-chair, and in front of it a tin pail, about in the position one would place it if it were set between the legs of one sitting in the chair. Blood was in the pail, all over it, and on the carpet. Here, evidently, the greatest amount of blood was lost, and here the suicide had cut his throat, intending to bleed quietly into the pail; but nature was not to be denied, and he moved about, bleeding awhile here and there until he fell exhausted. All hemorrhage had ceased when he was found. In the slop-pail was found the razor with which the wound was inflicted. These having been rapidly noted, the man was put on the bed and the wound ex- amined. The cut was not deep, did not involve either carotid, was between the cricoid and thyroid cartilages, and the only vessel that could be found severed was the cricoid-thyroid artery. How such an amount of blood could have come from this small vessel seemed a mystery ; but there was no other wound, and no other place from which the blood could have come. Death resulted in the evening, the man not rallying from the shock and loss of blood. Blood was on his right hand and in front, and it was concluded that the other blood-stains were probably gotten when he fell and tried to get up, falling and rolling over, until he lay quiet in the position he was found in." ' The importance of noting the manner in which the blood exudes from the wound will sometimes show the position of the wounded person at the time of the wounding. If the wound be in the throat or the chest, the appearances indicated by the flow of the blood may serve to demonstrate whether the injury was inflicted when the body was in the erect, sitting, or ' Hamilton's System of Legal Medicine. 296 A MANUAL OF LEGAL MEDICINE recumbent posture. Therefore the course which the blood has taken may serve to differentiate between a suicidal and a homicidal wound. Thus, if the throat or the chest is the part involved, the course of the blood mav be down the front of the body, or it may be found on each side of the neck down to the armpits. If the blood be found in the former locality, the as- sumption would be that the body was in the erect position at the time the injury was inflicted ; the collection of blood along the sides of the neck and close to the armpits, as in the second instance, would indicate the recumbent position at the time the throat was cut. It is important, in this connection, to bear in mind that very few suicides cut their throats while lying down, and also that the discovery of recent wounds on the back of one or both hands in cases of death from throat-wounds is, other things being equal, suggestive of homicide, although, as Taylor remarks, these may be absent if the circumstances were such as to preclude the possibility of defence on the part of the assailed, such as where the assault was of sudden origin, or if the deceased was under the influence of liquor, or had been rendered power- less by the combined efforts of accomplices in the crime. It is proper to examine the clothing of the deceased, and, if possible, that of the person accused of the crime, for blood-stains. If any blood be on the clothing of the dead person, the examiner should make note of the amount, —that is, whether it is merely sprinkled over the garment or exists in large patches. ( Vide Form and Direction of Blood-Spatters.) The importance of examining the dress, etc., of the accused for blood for the purposes of microscopic examination has already been referred to. ( Vide Blood-Stains.) If the deceased has committed suicide by a weapon similar to a knife, it is usual for the hand to have blood upon it, although its presence is by no means always presumptive of self-destruction ; while its absence may nega- tive it, since blood on the hand may result from homicidal wounds. The finger-nails of the suspected person may reveal the presence of blood, etc., underneath when all evidence of its presence elsewhere is wanting. This form of evidence in the " Frenchy" case, before referred to, was very marked. The account of the accused as to the origin of blood on his person or clothing may or may not tally with the facts as shown by them. In the case of Adolph Reich, in which the writer furnished expert evidence, the spots and large patches of blood found upon his person and clothes (his shirt, drawers, and stockings were covered with the fluid) were stated by the prisoner to be the result of a nose-bleed on the part of his wife, whom he was subsequently found guilty of having murdered. His wife was found lying in a pool of blood, at her residence, with an incised wound of the throat which extended from ear to ear, and involved the trachea, carotid artery, oesophagus, etc. Here the account of the prisoner as to the origin of the blood upon his clothes, etc., did not agree with the facts as indicated by the surrounding conditions. Acts of restlessness on the part of the wounded person, such as moving about from one room to another, may be indicated by the discovery of blood FORENSIC MEDICINE 297 on distant objects, a fact which has already been alluded to when considering the case of suicide cited by Balch (vide p. 295) ; but in connection with these acts the writer wishes to emphasize the importance of noting whether there are any communications in blood between these different places. Is it possible for the assailant to escape without being spotted with blood? The person who inflicts the wound may escape without blood-stains in certain cases. Thus, in the case of lacerated and contused wounds hemorrhage is not always an accompaniment of the injury, while in punctured wounds the bleeding is not so extensive as is the case in incised wounds ; moreover, they are less likely to spirt. The copious effusion of blood that follows incised wounds may be avoided by the assailant if he stands behind or to one or the other side of the assailed when he inflicts the wound. The presence of multiple wounds renders it more difficult for the assailant to avoid being contaminated with blood. The absence of blood on the clothing of the murderer is often offered by the defence as sufficient proof of the innocence of the accused. The fact must be remembered, in such cases, that the suspected person may have changed or washed his clothing pre- vious to the examination. Also, as Woolsey states, "that blood-stains may be found on the clothing of many, especially on the coarse clothing of working-people. This may be accounted for by the occupation, flea-bites, accidental circumstances, or it may occur without definite explanation. Such persons may be accused of murder and yet the blood-stains be con- sistent with innocence." ' (5) Foreign Substances in Wounds.—These, such as grass, dirt, hay, portions of dress, parts of the weapon, etc., may assist the examiner in tracing the person guilty of the crime. In the Reich case the writer discov- ered a small piece of wood in the neck-wound which belonged to the handle of the knife that caused the wound. ( Vide Gunshot Wounds.) Signs of a Struggle.—The evidence to be derived from these signs is of great importance. If a knife or similar weapon produced the wounds, the signs of struggle may be shown by cuts on the fingers or on the palm or back of the hands. Such injuries are seldom self-inflicted. In the above- mentioned case (Reich) the injuries found upon the body of the victim showed that the woman fought desperately for her life, having grasped the weapon several times before it was sunk into her throat. The autopsy, which was made by the writer, revealed three cuts on the fingers of the right and two on the fingers of the left hand, all of which reached the bone. Other signs which go far to prove homicide are the contusions or ecchy- moses sometimes seen on the face, neck, chest, forearm, or hand of the victim. These generally indicate the form of the foot, fist, fingers, or finger- nails of the assailant. Again, if marks or scratches be found on the person of the accused, they may be of great assistance in fixing the crime where it belongs. Thus, in the following case, which is quoted by Reese ("Medical 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 298 A MANUAL OF LEGAL MEDICINE Jurisprudence") from Gaillard's Medical fournal, 1888, much important evi- dence was furnished by similar signs. '' A dreadful murder occurred in Paris some years ago, in which the throats of three women were cut after severe struggling, and the bedding and walls of the apartment were copiously be- spattered with blood. A man named Pranzini was arrested for the crime, but the closest examination of his clothes revealed no blood-stains upon them. This, of course, was relied upon as a strong point by the defence. But M. Brouardel recalled the fact that in the adjoining room he had noticed a basin containing much bloody water, indicating the washing of a person stained with blood, and this person could only have been the murderer. Hence Dr. Brouardel conceived the idea that the criminal, in order to avoid the risk of being stained with blood, had first stripped himself of his gar- ments and then committed the murders in a state of nudity, after which he had washed and resumed his clothes, and so hoped to escape detection. Dr. Brouardel asked to examine the prisoner completely stripped, when a long, tearing scratch was found extending down the front of the right thigh. In- terrogated upon this, the criminal declared he had been attacked by a severe itching, to relieve which he had torn himself in scratching. Being invited to repeat the gesture, he did so, upward from the knee toward the body (as was natural) ; but the medical expert showed that the tear had been made by nails, or some sharp body, from above downward. Doubtless the assassin approached his victim with the weapon in his right hand, and with his right side exposed, and so received the scratches on his right thigh. The criminal was condemned and executed." Frequently the impression of a dirty or bloody hand, or some of the fingers, may be found on the clothing or person of the victim, where it would have been impossible for the deceased to have made it, notwithstanding the fact that either one of his hands, or both, were bloody. Such a condition would indicate a struggle with an assailant. If there be marks of violence about the mouth of the dead person, such as may arise from a desire on the part of the assailant to prevent an outcry from the victim, the evidence of such would be presumptive of murder. Furthermore, an examination of the clothing of the victim or assailant often furnishes signs of a struggle. ( Vide Surrounding Objects and the Position of the Body ; Examination of the Body before the Clothes are removed ; External Examination of the Body ; Foot-Prints, etc.) Imputed or Self-inflicted Wounds.—These will be discussed in a subse- quent chapter. ( Vide Feigned Diseases, etc.) Accidental Wounds.— Was the wound the result of accident? The determination of a question of this nature depends for its elucidation on the consideration of those points which serve to distinguish suicidal from homi- cidal wounds. The question is often of great consequence in a trial for homicide, as the defence may claim that the injury was not the result of an assault by the prisoner, but was occasioned by accident. Furthermore, they may allege that the wound was due to suicide. (1) Accidental and Suicidal Wounds.—The nature, situation, and direc- FORENSIC MEDICINE 2 tion of the wound may often serve to distinguish between accidental and suicidal wounds. The former class of wounds are most commonly the result of contusion, while suicidal wounds are not or are rarely so, as in cases of insane or delirious persons. Accidental wounds are most frequently situated on exposed parts, except in cases where the injured person falls from a height, when the wound may be in almost any part of the body. The direction of the wound is of little consequence in wounds of an accidental nature, since it is only of importance in wounds which result from a sharp or penetrating instrument, which are seldom due to accident. Severe punctures and stabs in vital parts, occasioned by accident, have occurred. They are generally the result of falls, as where, in the act of running with a puncturing instrument in the hand, the person slips. (2) Accidental and Homicidal Wounds.—The distinguishing marks be- tween accidental and homicidal wounds are summed up as follows by Wool- sey.1 " (1) The evidence from the nature of the wound is not quite so conclusive as when the question lies between suicide and accident; for con- tusions and contused wounds are far more often homicidal than suicidal, and accidental wounds are almost always of this class. If, however, the wounds are incised or punctured, this fact points almost certainly to homicide. (2) As to situation, a homicidal wound may be situated almost anywhere ; an accidental wound, except in falls from a height, only on an exposed place. (3) The direction of the wound can seldom help us in the case of contused wounds, which practically are the only ones in question, though it may pos- sibly be incompatible with accident. (4) As to the number of wounds : homicidal wounds are more apt to be multiple, either in a small area or scat- tered in such a way that an accident could hardly account for them all. (5) A weapon may give evidence more often here than when suicide is in question, for a weapon may be used to inflict contused wounds which resemble those received in a fall. The evidence furnished by a weapon, or blood, hair, etc., on the weapon, etc., is strongly in favor of murder. (6) The evidence from a struggle is also more important, because it is more often found. A struggle may occur in homicide, and only in homicide, as a rule, so that the signs of a struggle are strong evidence of murder and against the idea of accident. (7) The examination of the clothes and body of the deceased may give valu- able evidence, showing, as it may, signs of a struggle or other marks of an assailant, and indicating murder. (8) Examination of the position and atti- tude of the body, and of the spot where it lay, and the ground around may furnish more or less proof of murder."1 ( Vide Suicidal and Homicidal Wounds.) Presence of More than One Wound.—When two or more wounds are present on a dead body, either of which was fatal, the question may arise, IWiich was first inflicted? It is extremely difficult to furnish a direct answer to this question. If but one of the wounds is mortal and the others 1 Medical Jurisprudence, Forensic Medicine, and Toxicology. 3QO ' A MANUAL OF LEGAL MEDICINE not, there can be no question as to which was inflicted first; but if the wounds have been inflicted simultaneously, as where the victim has been attacked by two or more persons, no certain answer can be furnished, nor can any definite reply be given as to which wound caused death, if more than one be fatal. If other evidence than that of the injuries themselves be presented, then the question may be answerable with some degree of certainty. Could a person inflict upon himself consecutively two wounds, either of which is sufficient to cause death ? In answer to this question, Reese says, '' We think there can be no question about the possibility of the self-infliction of two mortal wounds, provided the first one was not instantaneously fatal. It is well known that a stab or bullet through the heart or a pistol-shot through the brain is not immediately fatal, so that ample time is allowed for the repetition of the fatal act on the part of the suicide. Moreover, it is within the bounds of probability that, after the first fatal shot from a self- cocking pistol, a second discharge from the weapon may have been a mere automatic act,—the victim's finger being at the time on the trigger, and thus producing the discharge unconsciously. It might even happen that this second unconscious and chance shot might produce a fatal wound upon another person, and thus give rise to the question of an intentional or acci- dental homicide." * Speaking of suicide in general, the following remarks, extracted from a recent article2 by the writer, as to the alarming increase, causes, and methods of self-destruction, will be of interest. The rate of suicide in this city has been for some time past abnormally high. The community has been passing through a long period of commercial depression, and many take their lives on account of absolute hunger or in despair of ever knowing prosperity again. The sudden heat of the spring season also destroys the balance of many minds. There was an average of four suicides a day in this city for a week recently. Men, as usual, committed suicide much more frequently than women, and during the period of abnormal suicidal tendencies the proportion among the males has been even larger than usual. Suicides in New York are more numerous among persons between the ages of twenty- five and thirty-five. The average rate of suicide among men as compared to women is three to one. The proportion of men to women among elderly suicides is still greater. The fact must be considered that women are in excess of men. The causes of suicide, in the order of their importance, may be given as follows : domestic troubles, reverses of fortune, sorrow, physical suffering, insanity, and the weather. In New York City in 1880 there were one hun- dred and fifty-two suicides, being 12.59 Per one hundred thousand. In Philadelphia the rate was 8.03 ; in Boston, 11.03 > ln San Francisco, 3365. 1 Medical Jurisprudence. * Suicides in New York, 1894, Justin Herold, A.M., M.D. FORENSIC MEDICINE -OI It will be seen that San Francisco shows an enormously larger percentage than any other city, but New York comes first among the Eastern cities. The health records of this city from October to March last show a total of one hundred and seventy-five cases of suicide, or sixty more than during the preceding six months. The average yearly number of suicides for the past five years was one hundred and twenty-two. The increase of the last six months is therefore very great. Although special causes contributed to this increase, it is probable that the proportionate number of suicides will steadily grow larger with the growth of the population. In September, 1893, there were forty-two suicides, that number being the highest record of recent years. Poisoning is the favorite method of suicide in this city, and Paris green and morphine are most frequently used. After poisoning, the commonest methods in the order of their popularity are shooting with a pistol, hanging, throat-cutting, stabbing, and drowning. Poisoning has always been the favorite method of suicide with women, but it is being generally adopted by the male suicides of this city. This is possibly an indication of a general tendency to feminization in modern society. There are less suicides among the cheerful and religious Irishmen than among any other nationality. The German race, with its predisposition to melancholy and metaphysical speculation, furnishes the largest number of suicides. The temperament of the colored man is a happy one, and sta- tistics show that in this city one colored man commits suicide to every thou- sand white men. The small number of the colored people must, of course, be taken into consideration. Many curious cases of self-destruction have come under our notice. Among recent suicides the youngest was twelve years of age and the oldest ninety-two. In 1891 a man attempted to commit suicide by thrusting a tea- spoon down his throat, but did not succeed. Physicians headed the list of suicides in that year, and have done so for ten previous years. German maidens have not infrequently soaked matches in beer. It takes two boxes of matches with plenty of phosphorus on them to supply suffi- cient poison, and the beer cannot retain a trace of its agreeable flavor. Suicides in this city are frequently the result of alcoholism. Although poison is a favorite method of suicide among women, those who drown themselves or jump from windows are almost exclusively women. Suicide is most common in May and June, the pleasantest months in the year. In unpleasant weather the rate of suicides is at a minimum. The daily number of self-destroyers in France averages twenty. In the United States statisticians show that the average of suicides committed daily far exceeds that number. Some reliable observers say that the increase in this country has been marked ever since the great financial troubles in 1873. In France, from the year 1827, the annual average has risen from 1500 to upward of 6000, the number in 1851 having been 3639, or in the propor- tion of one suicide for every 9833 inhabitants, while in the year 1879 there 302 A MANUAL OF LEGAL MEDICINE were 6496 suicides, or one for every 5681 inhabitants. That this increase of seventy-eight per cent, is not alone peculiar to France we see by glancing at the reports concerning Prussia and other countries. In Prussia, from 1873 to 1877, the increase was fifty-three per cent., and in Bavaria sixty per cent. In Belgium the proportion per million people was from sixty-six in i860 to 1870 to eighty-one in 1875 ; from seventy-four in 1865 to one hundred and forty in 1877, in Austria ; from thirty in 1874 to forty-one in 1877, in Italy ; from twenty three in 1872 to thirty-five in 1876, in Russia ; from two hun- dred and thirty-three in 1874 to two hundred and fifty-seven in 1876, in Denmark ; and in England, from 67.2 in 1866 to 69.2 in 1877. The pro- portion of suicides in the different countries of Europe is eighty per cent. of men to twenty per cent, of women. Morselli, in his work " II Suicido," holds that more women proportionately commit self-murder in the country than in the cities. M. Bertillon states that widowers and bachelors are the victims more frequently than married men. As to the mode of committing the act, the following figures show the proportion per one thousand in four of the principal countries of Europe : Hanging . Drowning Fire-arms. Stabbing . Poisoning Falling . . Suffocating England. Prussia. Belgium. Switzerland. 368 208 608 182 545 228 430 267 46 206 109 54 118 39 70 67 94 30 23 33 94 9 15 11 94 3 4 13 The percentage of the modes of committing suicide in France is as fol- lows*: by hanging, forty-five per cent; by drowning, twenty-nine per cent.; by shooting, eleven per cent.; by suffocation, seven per cent.; and three per cent, by jumping from high altitudes. Suicide by drowning was the most frequent form of self-destruction in France forty years ago, being more fre- quent in the summer than in the winter months. To-day statistical reports confirm the fact that suicide is common at all periods of life, even in childhood. Without doubt the greater number of cases occur between the ages of twenty and thirty years, though the years preceding and immediately succeeding the age of puberty show a slight increase, as do the years immediately preceding the fiftieth. Suicide is com- paratively infrequent up to the age of fifteen, but there can be no doubt that the idea of self-destruction enters the heads of the young. There are cases on record of children who have committed suicide because teachers have been inclined to censure or punish too severely. Children are quickly hurt in their moral sensibilities. They have been known to commit suicide in passion as well as in sorrow. A case is reported of a boy who committed suicide because his mother refused to buy him a squirrel to which he had taken a fancy. Another did so because he was sent supperless to bed for FORENSIC MEDICINE -Q having broken his mother's watch. He felt particularly hurt; while he was always punished for his misdeeds, his sisters were generally overlooked. Another destroyed himself because his bird died, and another because he was twelfth in his class. The number of suicides is greater among educated than among illiterate people. This is a rule to which there is no exception anywhere. Self-mur- ders are more prevalent among Protestants than among Catholics or He- brews ; and Wagner, whose researches in regard to the causes of suicide are most reliable, states that in Prussia, out of a population of one million people, there are 159.9 suicides of Protestants as against forty-nine of Catholics and 45.9 Hebrews; in Bavaria, 135.1 suicides of Protestants as against 49.6 Catholics and 45.9 Hebrews, etc. It may be mentioned that in countries which are purely Catholic suicide is at the rate of fifty-eight to the million ; in countries where the people are both Catholic and Protestant, ninety-six to the million ; and in purely Protestant countries, one hundred and ninety to the million. Trashy novels and all kinds of unwholesome sentimental literature are a very important predisposing cause to suicide in this country. They pro- duce a morbid condition of the mind which unfits people for realities. Facts are the most wholesome food for the mind. The thought of impending illness from hereditary disease is also a common incentive to self-destruction. To check the increase in the rate of suicide in this community the ex- citing motives should be sought out and counteracted, as far as possible, even by a resort to unusual measures, and the duty belongs to the sanitary government of the State. Cicatrization of Wounds.—Questions relative to the time at which the wound was produced, or to the responsibility of the accused person, may often be determined by an examination of the injury or its cicatrix. A simple incised wound of no great extent cicatrizes in from fourteen to twenty days,—that is, the process is complete within that period of time. The rapidity of cicatrization is dependent on the situation of the wound, its extent, nature, and the age and health of the wounded person. Wounds of the lower extremities are slower in healing and cicatrizing than wounds of the upper parts. If the wound be near a joint, where the absolute rest of the parts cannot be insured, cicatrization is retarded. When the wound in- volves several structures, or if the latter be complicated, the process of cicatri- zation is less rapid than in those wounds affecting merely the skin and muscles. In those cases where the injured parts are contused and lacerated, or where loss of substance prevails, healing takes place by granulation, and the process occupies a considerable length of time. Cicatrization of wounds in the old is less rapid than in the young. It is retarded in those who are suffering from disease or who are infirm. The cicatrix of a recent wound, if incised, is generally straight and reg- ular ; if the wound is contused by nature, the attendant scar will be oblique. In appearance it is soft, tender, and redder than the surrounding skin ; but 304 A MANUAL OF LEGAL MEDICINE in the course of a month or two it assumes a harder consistence and becomes less tender and of a brownish-white color. Of course these changes are dependent on the circumstances already alluded to. The cicatrices of incised wounds are not always linear, since, on account of the elasticity of the skin and the convexity of the surrounding tissues, they often appear more or less elliptical. The process of cicatrization is always, to a certain extent, influ- enced by the state of the edges of the wound in the living body, which are greatly separated in the centre of the injury. But when the wound is so situated that it lies in a hollow surface or on a loose skin, such as exists in the axilla or groin, its cicatrix may be linear. Irregular scars are found in those parts where the wound is lacerated or contused, in which case they have a puckered appearance, with an irregular skin surface. Oblique wounds generally produce more or less semilunar cicatrices, while those occasioned by stabs are mostly triangular in shape. Tidy says,' "Given a hard, white, glistening, non-sensitive cicatrix, although it is difficult to give a positive opinion whether the original wound was inflicted six months or six years before, a negative opinion may safely be given that the scar did not result from a wound inflicted two, three, or even four weeks previously. Given a brown cicatrix, we are scarcely in a position to give a very definite opinion. Given a soft, red, tender cicatrix, we may say that the chances are against its being of long standing. The various influencing conditions (such as age, the health of the patient, the probable extent and nature of the wound, etc.) must in such cases be care- fully considered. It will be evident, from what we have said, that it is very difficult to fix the date of a wound merely from the appearance of the scar. But if a description of an alleged injury, of the instrument causing it, and of the date when it was said to have been inflicted be referred to the medical jurist, he should in most cases be able to say if the appearances presented by the cicatrix be consistent or inconsistent with the alleged cause and date." Is a cicatrix always a result of a wound ? A cicatrix is always produced by a wound involving a loss of substance. Very minute scars often follow incisions which are produced by sharp instruments. This is especially so in those cases where the direction of the fibres of subjacent muscles corresponds with the line of incision. These cicatrices are even and linear. It is well to remember, in this connection, that if the skin be white such scars may be entirely overlooked, since they are always more distinct in dark skin. Such slight wounds as punctures by needles, etc., the prick of a lancet, or the bite of a leech, where the surface of the skin only is involved, frequently leave no scar at all. Tidy2 says that the epidermis alone may show the cicatrix, while the cutis remains unaffected. If, therefore, there are no visible signs of a scar upon the body, post mortem, a cautious opinion should be given as to whether no cicatrix existed in life. This is particularly so where the process of putrefaction has already commenced. 1 Legal Medicine. 2 Ibid. FORENSIC MEDICINE 3Q5 If, on examining a limb or other part of the body where at some former time a wound is alleged to have been inflicted, no cicatrix is found, the medical examiner should be justified in assuming that the allegation is not consistent with the facts presented, and that no wound was ever inflicted. Can a cicatrix, when once formed, be removed either by time or by arti- ficial means? In wounds of a slight nature, those which involve merely the epidermis, or in those cases of cuts or punctures of the cutis without loss of substance, the lapse of time may cause their disappearance. They are not, however, invariably obliterated. Taylor states that if any scars were readily obliterated, it would be those which result from sharp cutting instruments,— in other words, those which are regular and even, such as follow incised wounds. From his own observation, however, he has known these cicatrices to remain unchanged for periods varying from twenty to twenty-five years. He further states that the scars of contused and lacerated wounds often indicate the form of the weapon that produced the injuries. It is well to remember that the cicatrix of a stab often simulates that produced by a bullet discharged from a pistol at a distance. Both possess round and irregular edges, and have a puckered appearance, unless the stab was the result of a broad-bladed knife. Ogston states that he has known the scars of syphilitic chancres to disappear within six weeks; but, as Tidy remarks, such cases are very rarely presented. The latter authority states that the intensity of a scar varies con- siderably with the person's state of health. Thus, in the case of an old cica- trix resulting from a boil, which under ordinary circumstances was scarcely discernible, the existence of dyspepsia in the patient caused it to become exceedingly well marked. The obliteration of cicatrices which result from skin-diseases, or those of wounds involving a loss of substance, is scarcely a possibility, although cer- tain inherent changes in the scar itself may cause it to be less distinct. Scars the Result of Disease.—Questions relative to the cause of cicatrices may arise. Thus, it may be stated that a scar was produced by a wound, when, in reality, it resulted from loss of substance through disease. Scrofulous ulcers are followed by cicatrices. They are deeply furrowed and irregular. If recent, they possess a flat appearance and a bluish-red color. Nevertheless, they also appear somewhat raised above the surround- ing skin. The scar of a syphilitic abscess is very deep, as is also that pro- ducedby small-pox. They are, however, situated below the surface of the skin. The cicatrices of different other ulcers cannot be well described unless particular attention is paid to their situation,—i.e., as to whether they involve loose or dense tissue. To decide the nature of the cause which produces the cicatrix, the medical examiner must note the general characters and locality of the scar. For ex- ample, a syphilitic abscess would be suggested by a cicatrix in the inguinal region, while a scar in the neck might suggest a strumous abscess. The bend of the elbow might show the cicatrix produced by venesection, and so on. 20 3o6 A MANUAL OF LEGAL MEDICINE Characters of Cicatrices.—As a result of the contraction of the skin during the healing of a wound, a scar appears smaller than the original wound. This is well shown in the case of stab-wounds. And here it is im- portant for the examiner to observe that it is extremely difficult to form an opinion as to the exact size of the weapon. ( Vide also Gunshot Wounds.) CHAPTER XXVI. WOUNDS REGIONALLY CONSIDERED. Wounds of the Head—Of the Face—Of the Neck—Of the Spine and Cord—Of the Thorax and Contents—Wounds and Ruptures of the Diaphragm—Wounds of the Abdominal Walls and Viscera—Wounds of the Genitals—Wounds of the Ex- tremities. Following the character and evidences of wounds in general, it will be proper now to consider injuries as they affect the various parts of the body, inasmuch as they present individual peculiarities of interest to the medical jurist. The dangerous character of wounds and the influence they exert in causing death must be carefully studied, since they are of great medico-legal importance. Wounds of the Head.—Incised wounds of the scalp rarely occasion dangerous results, unless they are very extensive. With proper manage- ment these wounds heal rapidly, owing to the vascularity of the parts. On account of the non-contractile power of the blood-vessels in this situation, hemorrhage from incised wounds may be rather copious, but it is rare for any serious effects to follow. Erysipelas often complicates these wounds, a fact probably due to the imperfect cleanliness of the parts. This complication serves to mark the difference between these injuries and similar ones located •elsewhere. Another source of danger in scalp-wounds is the development ■of diffuse cellulitis, which may occur as well as the affection referred to above. Scalp-abscess or diffuse cellulitis of the scalp follows the infection ■of the wound, which apparently nurtures germs due to imperfect cleansing ■of the parts from foreign matter, injudicious handling, or from other sources. Notwithstanding the marked or severe constitutional disturbances which may be present, the prognosis is generally good. The erysipelas of slight injuries of the head gives suspicion of a constitutional predisposition. Neither of these secondary effects is to be regarded as an unusual result of a severe injury to the scalp ; but if death follow either one of them, especially if they be the consequence of a slight wound, the constitutionally predisposed con- dition of the injured person may be considered as a mitigatory circumstance. Maltreatment may cause fatal effects to ensue in wounds which otherwise may not be regarded as other than trivial. Here the question may arise as FORENSIC MEDICINE -0? to whether a circumstance of this nature would affect the responsibility of the assailant. ( Vide pp. 275, 280.) The dangerous character of wounds of the head is proportionate as they involve the brain or not; and it is of importance for the medical examiner, when dealing with such injuries, to remember that the external appearances of a wound are often very mislead- ing, since the internal injuries may be obscured. Thus, frequently, the sequelae of the slightest injuries may be followed by death. Contusions and contused wounds of the head generally result from blows or falls. They are almost always produced by another person, or are acci- dental. A contused wound, accompanied by considerable laceration of the parts, is invariably dangerous, in consequence of its susceptibility to inflam- mation and infection. Severe wounds of this description usually complicate the brain. It must not be forgotten that the skull may be fractured without any apparent wound of the scalp, and, further, that death may follow an effusion of blood upon the brain, caused by the infliction of a blow, without any external appearance of either a wound or fracture. One of the results of contusions of this region is the swelling beneath the pericranium due to the extravasation of blood. Such haematomata present, on palpation, a soft, yielding centre, the fluid blood, and a hard, distinctly outlined edge, the fat and coagulum. To differentiate a contusion from a depressed fracture, notice must be taken of the hard margins about the cen- tral depressed area of the contusion and the movable condition of the blood- clot on the surface of the skull, while in fracture the examining finger does not first encounter a ridge, as is the case in contusions, but passes at once from the surface of the skull into a depression. Moreover, the edge of a depressed fracture is more irregular, less evenly circular, and sharper. As has been mentioned in another place (ante, p. 265), contusions and contused wounds may sometimes possess the marks of the weapon, showing that they were produced by another person. The origin of the injury may often be indicated by its situation ; also, the position may show whether it is accidental or was inflicted by another. Thus, an injury to the vertex would not be accidentally inflicted unless the injured person was precipitated from a considerable height. The complications which may follow incised wounds are liable to occur in connection with contusions or contused wounds, and more so on account of the tendency which these injuries have toward the inflammatory process. Punctured wounds, even when slight, may end in death in consequence of inflammation and suppuration. Lacerated wounds of the scalp heal re- markably well, although, if the parts involved by the laceration are extensive, dangerous symptoms may ensue. On the other hand, recovery may take place even where most of the integuments have been torn from the bone. Fracture of the Skull.—This is the result of a sudden concentrated force, as the blow of a hammer, or a fall upon a hard body, such as a stone. Fractures of the head are classified as those of the vault and those of the base. Partial fractures involve the inner or outer table of the skull, 3o8 A MANUAL OF LEGAL MEDICINE while those which are termed complete involve the entire thickness of the skull. To the latter class belong what are called fissured, stellate, commi- nuted, depressed, and punctured fractures. Fractures of either the vault or base may be simple or compound. Fractures are serious in proportion as they affect the brain, although a properly treated fracture furnishes a good prognosis without regard to any lesion of the brain. Simple fractures of the vault of the skull, without dis- placement, can only be inferred from the accompanying symptoms. If there is displacement, it can often be detected by carefully examining the surface. Depression generally exists, and the abrupt margins of the bone may be appreciable to touch on palpation. Signs of compression are usually pres- ent. When the fracture is compound, its margins may be felt by the finger. Hemorrhage is frequently copious, and there may be an escape of cerebro- spinal fluid from the wound. Inspection and palpation through the wound will generally clear up the case. The vault of the skull may also be broken opposite to the point originally struck (contre-coup), although it may happen that an inspection of the parts will detect a fissure extending from the point first injured to the opposite side of the skull. Fractures of the base of the skull present a less favorable prognosis, since they may become rapidly fatal on account of the injury inflicted upon the vital centres, or from the effusion of blood into the parts at the base of the brain. Death may also follow the secondary results, such as inflamma- tion or meningitis, irrespective of proper medical treatment. Fractures are due either to direct or indirect force. The latter may be due to falls upon the buttocks or feet, which force the spine against the condyles of the occipital bones ; or the fracture may be occasioned by what is termed a counter-stroke, as when it results from an injury to the vault, the violence of which is transmitted to the base, which breaks. Falls upon the vault of the cranium force the condyles of the occipital bone against the top of the verte- bral column ; and if the head is in a state of flexion, the sudden force is trans- mitted backward, expending itself upon the posterior cerebral fossa. But if there be extension of the head, the force is carried forward, being exerted on the anterior or middle fossa of the skull. In the conduction and amplification of vibrations the force is very great but also diffused. If transmitted to the frontal region, fracture of the anterior cerebral fossa generally occurs. If the force be applied to the temporo-parietal region, the middle cerebral fossa is broken ; and if the force be transmitted to the occipital region, fracture of the posterior cerebral fossa follows. Fracture of the anterior cerebral fossa is followed by a copious and con- tinuous hemorrhage from the nose. There is also subconjunctival effusion with palpebral ecchymosis, generally involving the lower eyelid, and an escape of cerebro-spinal fluid from the nose. There is also paralysis of the olfactory, optic, or oculo-motor nerves, due to the concussion or compression. It is well to remember in these fractures that the cerebro-spinal fluid and blood may find their way into the pharynx. Fracture of the middle cerebral FORENSIC MEDICINE ,og fossa is detected by the free and continued hemorrhage from the ear, and the flow of cerebro-spinal fluid, which increases in quantity on pressure of the jugular veins. After a few days there may be paralysis of the auditory and facial nerves. Escape of cerebro-spinal fluid and blood into the pharynx by the Eustachian tube follows, if the membrana tympani be intact. In fractures of the posterior cerebral fossa there may be depression or com- minution, copious pharyngeal bleeding, and ecchymosis of the regions at the side of the neck. If the latter be not involved, late discoloration may prove of value as a symptom of fracture of the middle or posterior fossa. Fractures of the head, often by their shape and occasionally by their size, show the shape and more rarely the size of the weapon producing them. Concussion.—By this is meant the condition of nervous shock or jarring of the brain induced by more or less violent blows or falls on the head. It is generally associated with contusion of the nervous masses and with fracture of the skull. The contusion is either circumscribed or diffused, and may cause bleeding en masse, or a diffuse miliary extravasation. The effects of the contusion may be either at the point injured or at the opposite portion of the brain ; it is generally associated with laceration and more or less effusion of blood. Concussion may be present without the brain being lacerated, and fatal results have occurred without any indication of brain-injury. It may sometimes be produced by a violent fall upon the feet, and the base of the skull may be broken by the sudden impact against the top of the vertebral column. When concussion is associated with displace- ment of the fractured parts, as it occasionally is, or with hemorrhage within the cranium, its symptoms are obscured by those of compression. Hence it is of importance to remember that symptoms of an injury to the brain may occur which belong neither to concussion nor compression. The symptoms of concussion vary in intensity from a momentary loss of consciousness, which leaves the patient temporarily confused or giddy, with or without falling, to a prolonged unconsciousness, with a feeble, scarcely perceptible pulse, shallow breathing, pale, cold surface, subnormal tempera- ture, muscular relaxation, and variable pupils, depending on the situation and character of the injury. The occurrence of vomiting in a severe form of concussion is rather a favorable than an unfavorable sign, as the sufferer usually rallies after it. If there be screaming, restlessness, and local spasm, suspicion of laceration may be entertained. After a time the stage of cerebral irritation may ensue, when it is difficult to arouse the patient from his prolonged stupor. Urine and faeces may be passed involuntarily ; the pulse is small and feeble, the breathing easy, and the pupils contracted. The third stage is characterized by inflammation, abscess, and softening; and this may be succeeded, later on, by a tendency to disease of the brain. Shock is always associated with concussion and contusion. In some cases the recipient of a blow upon the head falls and dies in- stantly from concussion, and the autopsy reveals nothing, perhaps, but a 3IO A MANUAL OF LEGAL MEDICINE trifling contused wound of the head, to account for the strange result. The prognosis is always bad where the stupor is prolonged. Concussion may sometimes be mistaken for alcoholic intoxication, and the medical witness may be asked to state the differences that exist between the two. The distinction between the state of concussion and that of alco- holism may occasionally be established by the history of the case. Never- theless, this is not always easy to do, and the decision between the two affections must be based upon other circumstances. The odor of alcohol in the breath is no proof of intoxication, for a person may have received a concussion after having drank liquor ; or, again, the latter may have been administered by a by-stander after the accident as a stimulant to the heart. If, on the other hand, there be no alcoholic odor about the breath, the pre- sumption is in favor of the accident. In slight forms of concussion, where the person walks as one under the influence of an intoxicant, talks unintelli- gibly, wanders about, and performs acts in an aimless manner, the condition may easily be confounded, by a layman, with alcoholism. Under such cir- cumstances it is well to await further developments as to the real nature of the case. In case a person dies in an extreme state of alcoholism, there may be nothing to show whether death be due to the intoxication or to con- cussion. As Balch' says, there may be contusions on the cranium in both instances, liquor may be discovered in the stomach in both, the brain is equally congested, and the other post-mortem signs are alike in both cases. All that the medical examiner can do in such cases is to note the individual circumstances. If there be any doubt as to the real nature of the case, the physician should so state it to the proper authorities. Taylor2 states that '' there is nothing in the state of the brain in a dead body which will enable a practitioner to distinguish whether concussion or intoxication has been the cause of the symptoms." Extravasation or Effusion of Blood from a Blow.—Intracranial extrava- sations of blood may occur in the following parts : (i) between the dura mater and the skull; (2) in the cavity of the arachnoid ; (3) on the brain-surface; (4) in the substance of the brain ; and (5) in the ventricles. When the ex- travasation is due to concussion, the sources of the blood between the dura and skull are the small vessels extending from the dura to the bone, the middle meningeal artery, which is the usual source of copious hemorrhage, and the venous sinuses. These latter are rarely a source of effusion. Effusion of blood between the dura and the skull is manifested by the signs of compression appearing after a period of immunity. Almost immediately after an injury to the head has been inflicted, concussion and shock supervene. There is then a stage of reaction, the patient apparently recovering ; but this condition is soon succeeded by the true signs of compression. There is spasm, with paralysis of the face, arm, or one side of the body, accompanied by a decline of the body-heat. This is succeeded by coma and a widely 1 Hamilton's System of Legal Medicine. * Medical Jurisprudence. FORENSIC MEDICINE dilated state of the pupil of the affected side. If the hemorrhage be in the cavity of the arachnoid, there may or may not be signs of compression, although there is nothing diagnostic. After a time the patient may become irritable, and suffer with headache, or convulsions may appear. Cerebral laceration generally accounts for blood in the pia mater, which is consider- ably diffused. The symptoms here are those of the injury or of apoplexy. When the extravasation of blood is due to violence, it may or may not be associated with fracture, and it may take place without any extracranial lesions. The most fatal extravasations are encountered in those cases asso- ciated with a fracture of the base of the skull. Laceration of the brain and effusion of blood to some extent at the base may coexist while the patient still lives. Taylor refers to the case of a woman who survived for twelve davs severe injuries to the head supposed to have been inflicted by her husband. She remained unconscious during this entire period. Some of the extra- cranial lesions had passed through the usual color-changes, while others had almost disappeared. The blow was probably received upon the vertex. The autopsy revealed a laceration of the brain by counter-stroke and a co- agulated mass of blood in the lacerated portion. This clot extended into the ventricles after having passed over the base of the brain. A person with a serious injury to the head from violence may recover from the first effects, and be apparently regaining his previous health, when he suddenly suffers a relapse, becomes much worse, and dies. Here the effusion of blood takes place slowly, a fact proved by the autopsy, which reveals a partially organized clot of different tints. Sometimes the question as to the cause of the effusion arises, whether it be due to disease or to violence. The importance of this medico-legal ques- tion cannot be slighted, for in case of homicide the defence may claim that the effusion of blood was the probable cause of death. If the extravasation be between the dura mater and the skull, or if it be beneath the dura or associated with a superficial laceration of the brain, the effusion is due to violence. When the hemorrhage is due to traumatism, it is found most frequently under the point injured, although it may be directly opposite to this. This is well illustrated in the above-mentioned case, where the injury was by counter-stroke, and was found at the base of the brain together with the extravasated blood. Effusions of blood due to disease are commonly within the brain-sub- stance, although they sometimes occur without, as a result of great excite- ment, especially if accompanied by alcoholism, or from over-exertion of the muscular powers. These hemorrhages seldom take place before forty years of age, except in alcoholic subjects. On examination, the blood- vessels will be found diseased, and the substance of the brain may be in a state of softening. In cases where there is a history of injury coexisting with disease of the cerebral vessels, or of the brain-substance itself, the difficulty of ascertaining the exact cause of the spontaneous effusion of blood is greatly increased. 3I2 A MANUAL OF LEGAL MEDICINE Woolsey says, '' Where the injury was slight in the case of alcoholics or aged people, the medical witness should be especially careful in stating that a cerebral hemorrhage was due to the injury. Then, too, in the act of falling, from the occurrence of a cerebral hemorrhage due to disease, the head may be injured and show marks of violence. It should be borne in mind that an injury to the head may be inflicted when disease of the brain, vessels, or membranes already exists. In such a case a slight blow might cause exten- sive hemorrhage ; but as that which accelerates causes, death, even though it might sooner or later have occurred in the same manner without injury, is due to the injury inflicted." A fatal effusion of blood in or out of the brain from great excitement in a quarrel is of rare occurrence, unless the blood-vessels be diseased or the person aged or alcoholic. It is seldom seen in the young and healthy. Where doubt exists as to the cause of the effusion, the medical witness should state which was the more probable cause, in his judgment. The de- scription of the following case is taken from Balch's contribution to Ham- ilton's "System of Legal Medicine," p. 299: "In 1880 two policemen in Albany were 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 were passing off. His age was a little over thirty years. He refused 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 the prisoner over the right temple. He was only hit once or twice, the skin was not cut, and no fracture was caused. The prisoner continued his struggles all the way to the station-house, but was not struck again. After his name was put upon the blotter, he fought the officers to the cells, and until he was pushed into one and the door locked. Then he continued to swear and abuse them as long as they were within hear- ing. The arrest was late in the afternoon. The watchman saw and spoke to the prisoner in the evening, getting curses for a reply. He saw him again be- fore midnight, when he stated that the man was asleep and snoring. In the morning the prisoner was dead. An autopsy was held by the coroner's physician, and he stated that he found a contusion with a clot under the muscle; no fracture of the skull, no break of the skin. On opening the skull, nothing was found external to the brain; but on section, a clot, evidently from the branch of the right anterior cerebral, was found buried in the right lobe. The rest of the autopsy did not show very much, according to the doctor's report, and he gave as a cause of death the hemorrhage in the brain. This led to the arrest of the two officers and the presentment of the case to the grand jury. The defence had the body exhumed and further examination made. The statements of the coroner's physician were substantiated as far as the contusion and there being no fracture of the skull, but from that on I differed from the opinion that the man was healthy. Both kidneys and liver were fatty. Specimens of the aorta, vertebral, basilar, and cerebral arteries FORENSIC MEDICINE . were taken and put under the microscope. All proved the presence of fatty degeneration. The condition of the contused part was carefully examined. As considerable decomposition had taken place, it being in the summer the evidence from the contusion was not so conclusive as it was on the first examination, so questions were asked the doctor who had held the first au- topsy concerning this and other points. Upon the statements made by him and upon the microscopical appearances, I gave the opinion that the rupture was due to disease, and was not caused by the blow." The medical examiner, when engaged in the investigation of cases of this description, should always, if possible, ascertain whether the violence itself was not sufficiently great to account for the extravasation of blood without the presence of disease, etc. The question as to the date of an effusion of blood in or upon the brain may arise,—i.e., whether it was produced by a recently inflicted blow or had existed previously. Recent extravasations of blood are of a red color, which, after some days, changes to a brown or chocolate, and finally to an ochre, which may be seen from twelve to twenty- five days after the hemorrhage. The coagula, with age, become of firmer con- sistence, and are somewhat laminated. The expressed lymph may be found around the clots or between the laminae. It is impossible to tell the exact date of an effusion of blood, but the color and consistence may indicate whether it be old or recent.1 The following table, after Agnew, shows the distinctive symptoms of concussion and compression, although it must be remembered that in many cases it is impossible to distinguish between them, since the symptoms of one merge into those of the other, each being in this way completely masked by the other. Concussion. Compression. Patient semi-conscious; special senses blunted, not abolished. Power of movement retained. Respiration quiet and feeble. Pulse feeble, frequent, and intermittent. Nausea and vomiting. Pupils generally contracted. Subnormal temperature. Absolutely unconscious, paralyzed, and with abolition of special senses. Respiration full and noisy. Pulse full, slow, and laboring. Neither nausea nor vomiting. Pupils generally dilated ; often unequal. Temperature about normal. Wounds of the Brain.—These are not always fatal, their results varying according to the part of the organ involved. Occasionally trifling wounds destroy life immediately, while severe injuries in another part of the brain do not. Slight inconvenience only often follows severe wounds to the frontal lobes. 1 The writer has seen many sand-bag and slung-shot injuries to the head, some of which showed abrasions, while others exhibited no external indications of an in- jury. Fractures are usually produced by the fall after the infliction of the blow. 314 A MANUAL OF LEGAL MEDICINE If the first effects of a wound of the brain pass off and the patient lives, there is still the danger of inflammation, which may develop slowly, even as late as ten weeks after the injury was received. It may be very protracted. It is of importance to recollect that wounds of the brain are not necessarily followed by unconsciousness or by paralysis. Many cases are recorded of brain-injury in which, after the infliction of the wound, the person was able to perform many acts. Thus, many will recall the report of the case of the man Gage, through whose head passed a tamping rod three feet seven inches in length, an inch and a quarter in diameter, and weighing thirteen and a quarter pounds. The wound commenced just anterior to the ramus of the inferior maxilla of the left side, assuming an upward and backward direction toward the median line, passing through the left anterior lobe of the cerebrum, and making its exit at the junction of the coronal and sagittal sutures. The rod produced a laceration of the longitudinal sinus, fractured the frontal and parietal bones, broke up a large portion of the brain, and forced the left eyeball from its socket by almost one-half its diameter. The patient lived many months after the injury, and followed the occupation of a stage-driver. He was in the enjoyment of good health, with no impairment whatever of his mental faculties. Watson is quoted by Taylor as citing the case of a quarrel between a man and his son. The latter threw a poker at his father with such force that the head of the weapon became fast in his forehead, and was with difficulty removed. The father requested the by- standers to remove it, and he afterwards walked to the hospital. Death occurred from inflammation of the brain. Woolsey states that the acts in- dicative of volition and locomotion "may be raised in relation to an attempted alibi of the accused, who may have been proved to be in the presence of the victim a moment before death. If after this moment the victim has moved from the spot or performed certain acts before death, the attempted alibi may depend upon the answer to the question as to whether the given acts of the victim were compatible with the fatal character of the wound. An alibi can aid in the acquittal of the accused only when the nature of the injury was such that death would be supposed to be immediate or nearly so. Great care should be taken on the part of the medical witness in answering this question, for, after very grave wounds proving speedily fatal, the victim sometimes can do certain acts requiring more or less prolonged effort, as shown by numerous examples." Wounds of the Face.—These are not usually considered dangerous unless they involve the orbit. Thus, the brain may be injured by a pene- trating weapon, and death result. Otherwise, facial wounds heal by first intention, on account of the great blood-supply of the parts. When these wounds are of any great extent they become important, medico-legally, on account of the possibility of deformity of the parts in- volved ; thus, they may produce great disfigurement, which may result in a civil suit. If the wound be made over the orbit, involvement of the supra- orbital nerve may occasion traumatic neuralgia or amaurosis due to paralysis FORENSIC MEDICINE of the superior eyelid. Injuries to the orbit, such as those made by pene- trating instruments (supra), while not always immediately fatal, may give rise to an inflammation of the orbital contents, which subsequently extends to the brain, and in this way causes death. Therefore all wounds of the orbit are serious, while, if deep, they are absolutely dangerous. Injuries to the nose may fracture the ethmoid bone, and later on involve the brain, producing a fatal meningitis. Deformity may follow a fractured nose and arch, but, if the latter remain intact, deformity may not result. Wounds which penetrate the cavities of the nose may become serious for the inflammation and suppuration that follow may involve the upper passage, extending to the ethmoidal and sphenoidal cells, and thus reach the brain. The wounding of Steno's duct is of a more serious nature than other incised or lacerated facial wounds, from the fact that a fistula may result, thus com- plicating the injury. Among the questions that may be asked the medical witness are, Is it possible for the wound to be followed by deformity ? or, Could the wound heal without being attended by deformity ? or, Is it possible for the deformity, if it exist, to have been caused by other means than the wound ? Wounds of the Neck.—These are usually very dangerous, on account of the large vessels and nerves in this region. They are commonly incised, and most often suicidal. Their danger lies in the sudden and profuse hem- orrhage that attends them. Self-inflicted throat-wounds extend obliquely from left to right, and from above downward. They are most frequently found in the laryngeal region, especially over or through the thyro-hyoid membrane. Wounds superior to the hyoid bone may involve the tongue, the lingual artery, the facial artery, and the hypoglossal nerve. They gape extensively, and often there is an escape of saliva and food. Those passing through the thyro-hyoid membrane open the pharynx and may divide the epiglottis, the superior thyroid artery, the lingual artery, and the superior laryngeal nerves. Those penetrating the cartilages may involve the vocal cords and the recurrent laryngeal nerves. The hemorrhage in this region is usually moderate. Wounds below the cartilages may divide the superior or inferior thyroid arteries, the thyroid and anterior jugular veins, the trachea, and perhaps the oesophagus. The division of the larynx and trachea is not necessarily dangerous, the principal danger being the suffocation due to the backward flow of blood. Section of the oesophagus, on the other hand, is almost always fatal, on account of the division of the great vessels. Aphonia may follow division of the recurrent laryngeal nerves, while death may be the result of the involvement of the sympathetic and pneumogastric nerves. The carotid arteries are rarely injured in suicidal wounds, as the force is ex- pended before they are reached. In homicidal cases the great vessels of the neck are likely to be involved in the wound, as greater force is exerted. Here the incision may be from right to left, or vice versa, and if the fact was known that the victim was right-handed, a case of murder would naturally be suspected. With regard to stab-wounds, " If the blow misses its mark 3l6 A MANUAL OF LEGAL MEDICINE by the assailed turning, or from whatever cause, a slight wound may result," says Balch, "the knife only passing through muscular tissue without sever- ing any vessels, trachea, or oesophagus. These wounds are almost always homicidal, and, from their position on right or left side, struck probably from behind or in front. The evidence of the wound will lead the medical examiner to the conclusion of the assailant's position. They are dangerous wounds, and, if dividing the large blood-vessels, 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 between two vertebrae. In such case the assailed drops at once, for, if not instantly killed, he is instantly paralyzed below the section." l The immediate dangers of penetrating wounds of the neck are arterial or venous hemorrhage, suffocation, and the entrance of air into the veins. The suffocation may be due to the plugging of the air-passages with either the tongue, blood-clot, the epiglottis, or the severed cartilages. The second- ary dangers are oedema of the larynx, emphysema, bronchitis, broncho- pneumonia, cellulitis, cicatricial contraction, and stricture. Insensibility, or even death, may follow severe contusions of the neck. These latter may produce fracture of the larynx, laryngeal hemorrhage, and asphyxia. These injuries are most frequently the result of accident, although they may be inflicted by another. Garroting produces injuries to the larynx or trachea similar to those caused by a contusing blow. Wounds and Injuries of the Spine and Cord.—Wounds of the ver- tebral column, including the cord, are somewhat similar to those of the brain. They may be caused by concussion, compression, or violence. Paralysis commonly follows concussion. Secondary effects, such as inflammation and softening, often succeed blows upon the spinal column, even when unattended by fracture or dislocation. The danger of wounds or injuries to the spinal column is proportionate to the degree in which the cord is involved. Death may take place instantly from wounds above the region of the phrenic nerve, since respiration is immediately arrested, and, no matter where the wound is located, if the cord be involved, the functions of the parts below are sus- pended. Slight injuries have occasioned inflammation of the organ and death. Fractures of the spine are nearly always complicated by dislocation, with the result that there are generally displacement and compression. Their de- gree of fatality depends on the seat of the injury. Death rapidly follows when it is situated high up in the vertebral column. If the seat of com- pression be in the dorso-lumbar region, paraplegia, retention and overflow of urine, and incontinence of faeces occur ; if it be in the dorsal region (second to eleventh dorsal vertebra), we have paralysis of the abdominal muscles and the muscular coat of the intestines. The movements of expiration are greatly embarrassed from the involvement of the serratus posticus inferior, the 1 Hamilton's System of Legal Medicine. FORENSIC MEDICINE 317 quadratus lumborum, the sacro-lumbalis, and the longissimus dorsi muscles. If the cervical region be the seat of the compression,—z>., if it be above the fifth and sixth cervical vertebrae,—then paralysis of the arms takes place, together with an increased embarrassment of the respiratory function due to the involvement of the long thoracic nerves (fifth and sixth). Where the compression is above the third and fourth vertebrae, a fatal result occurs im- mediately or very rapidly from paralysis of the muscles of respiration. Fracture of the atlas or axis is not always instantly fatal, since the space of the canal is sufficiently large to prevent any encroachment upon the cord. The symptoms of these fractures are crepitus, mobility, and deformity. Immediate paralysis, as stated above, takes place in the parts situated below the injury, together with the loss of power to control the bladder and rectum. The temperature of the parts paralyzed is usually increased. Lutaudr states that secondary paralysis may sometimes follow fractures of the spine after healing of the fracture. In connection with fracture-dislocation, it is well to recollect that the patient may survive a considerable length of time after the infliction of the injury. The cause of these injuries is direct or indirect vio- lence, and the parts of the vertebra usually involved in the break are the spinous processes, laminae, and the body. Spontaneous dislocation of the second cervical vertebra, due to fracture of the odontoid process through disease, has caused instant death. Fracture of the spinal column is usually attended by concussion, due to the profound shock of the violence inflicted. Death may speedily follow, and this without any external or internal mark of injury. ( Vide Railway Injuries.) The region of the spinal column is rarely the seat of incised or punctured wounds, and such wounds and injuries as do occur are generally accidental, although they may be homicidal or even suicidal. Pithing, or the punc- turing of the medulla oblongata by means of a small needle-like instrument, is often practised, especially in infanticide. It may be accomplished without leaving scarcely any trace. ( Vide also Gunshot Wounds.) Wounds of the Thorax and Contents.—Non-penetrating wounds of this region are those which do not involve the costal pleura. These wounds are rarely dangerous, but they may become so, especially if carelessly ex- amined, when they may be converted into penetrating wounds. Further- more, they may involve such important structures as the brachial plexus of nerves, the intercostal, internal mammary, acromio-thoracic, long thoracic, or axillary arteries. The prognosis is always favorable in non-penetrating wounds, unless they be aggravated by incidental circumstances. Incised wounds are rarely observed, but those of a contused nature are common. This latter class of injury, together with contusions, is dangerous in propor- tion to the degree of violence employed. They may be homicidal, or at least made by another. Such injuries are usually accompanied by fracture of the 1 Manuel de M^decine legale, 1892. 3i8 A MANUAL OF LEGAL MEDICINE ribs ; of the sternum ; rupture of the thoracic organs, including the dia- phragm ; copious bleeding ; or, secondarily, by inflammation of the thoracic viscera, with or without suppuration. Fractures of the ribs are caused by direct or indirect violence, or by mus- cular action. They are most often the result of blows, falls, or the counter- pressure of opposing forces, such as when the wheel of a wagon runs over the chest of a person. They are considered to be very dangerous, as the bones may be splintered and wound such important organs as the lungs, heart, etc., or inflammation of the pleura or lungs may follow. The ribs most commonly fractured are the fifth to the tenth, as the upper ones have better protection and require the application of more force to affect their substance. The greater elasticity of the lower ribs affords them a certain se- curity. The common seat of the break is just anterior to the angle of the bone. The diagnosis is generally easy. Crepitus and mobility may be elicited by merely pressing the finger along the skin over the line of the rib supposed to be broken. The patient may experience a painful stitch at the site of the injury, and the respiratory movements are to a certain extent restricted thereby. If displacement be present, it occurs internally from direct force, and externally from indirect violence. The prognosis of fracture of the upper ribs is not so good as in those of the lower, because, as heretofore mentioned, a greater degree of force is necessary to cause the break. Fracture of the ster?ium is not attended with danger if it be simple, with- out any displacement of bone. When, however, the concussion produces depression as well as fracture, and the organs behind are involved, it is extremely dangerous, if not fatal. The cause of these fractures is either direct or indirect. The deformity is easily appreciable to the touch. Crepitus and mobility may be detected by causing the patient to take a deep inspira- tion, or by extending the body. This injury is usually a separation of the bone at its cartilaginous junction. Here the crepitus would be smooth. Penetrating wounds of the chest may involve the pleura and lung, the pericardium and heart, or the great vessels. In wounds of the lungs the im- mediate danger is the hemorrhage. These injuries are characterized by shock, difficulty in breathing, cough, pain, abdominal breathing, emphysema, pneumothorax, and haemothorax. The blood escapes through the wound and from the mouth, being coughed up. It is bright red and frothy, the latter sometimes appearing also at the mouth of the wound. The blood may be stained with mucus, and as it escapes through the wound may be accompa- nied by a hissing sound (tromatopncea). Woolsey says that the bleeding from the external wound may be slight, especially if it is oblique and acts as a valve.1 In case the pleura alone is involved by the wound, there will be no expectoration of blood and no bloody froth from the external wound. The hemorrhage from the mouth must not be diagnosed as pulmonary until an inspection of the injured person has excluded stab-wounds of the neck 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. FORENSIC MEDICINE 319 by knitting-needles, narrow-bladed shears, etc. The writer has seen such a case recently. The complications of these wounds, some of which have already been named, are external hemorrhage, haemothorax, emphysema, pneumothorax, pleurisy, pneumonia, and prolapse of the lung. Haemothorax is hemor- rhage into the pleural sac. Its main cause is a wound to the lung or inter- costal artery by a fractured rib. The symptoms are those of internal bleeding, accompanied by a bulging of the intercostal spaces, dyspnoea, flatness on percussion, and absence of respiratory sounds. Inflammatory effusion may follow a few days later. By pneumothorax is meant an injury to the lung and pleura by a fractured rib, etc. Here there are collapse of the organ, increased dyspnoea, amphoric respiration, great percussion resonance, metallic tinkling, and bulging of the intercostal spaces. Emphysema is produced by a wound to the lung and pleura. It may, however, follow injury to the lungs alone. It is characterized by a diffused, colorless, elastic, puffy swelling, crackling on pressure. Hernia of the lung may result from the giving way of a cicatrix, the accompaniment of superficial wounds. There is usually a soft circumscribed tumor, which is resonant on percus- sion, furnishing a loud respiratory murmur, and crepitating on pressure. Concussion of the lung is a condition following traumatism, and character- ized by difficulty in breathing, feeble respiratory murmur, and slight dulness on percussion. The prognosis in wounds of the lungs is always doubtful. Patients often recover from the primary effects of the injury to die from such secondary effects as inflammation, recurring hemorrhage, or a relaxation of the regi- men. The death may also be the result of the patient's own imprudence, and it is well for the physician to make note of such matters, as they may often be regarded by the defence as mitigatory circumstances. Wounds of the heart nearly always end fatally and rapidly, if the cavities of the organ be involved. Gunshot injuries to the heart are not always im- mediately fatal. In the Fitzpatrick-Smith homicide case, which came under the writer's notice, the man Fitzpatrick lived six days after a gunshot wound of the left ventricle. The bullet tore one and a half inches of flesh off the heart, and then lodged in the back, between the ninth and tenth ribs. As with the lungs, blows or severe contusions may cause rupture of the heart. Stab-wounds are usually instantly fatal on account of the shock and the hemorrhage ; but, if the cavities are not involved, death may not take place until several days after the infliction of the wound, and may be due to inflammation. Fatal wounds of the heart may be made by small pointed instruments, like needles. These wounds may show but little hemorrhage. That these punctures are not necessarily fatal, Woolsey1 quotes Senn as saying, "The heart can be punctured with a perfectly aseptic medium-sized aspirator needle without any great immediate or remote danger.'' 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 32Q A MANUAL OF LEGAL MEDICINE The part of the heart most often wounded is the right side, particu- larly the ventricle, no doubt on account of its more exposed position ante- riorly. The rapidity with which death follows these wounds depends to a certain extent upon the situation and extent of the injury. Woolsey cites Lutaud as stating that of twenty-four cases of injury to the right ventricle, two only resulted in death within forty-eight hours, and of twelve cases of injury to the left ventricle, three were not instantly fatal. Wounds of the auricles end fatally and rapidly, especially where the cavity is largely in- volved. They produce fatal results most speedily next to wounds of the right ventricle. In wounds of the heart fatal results are produced by two causes,—hemor- rhage and compression of the organ by the blood in the pericardium, pre- venting the cardiac movements. In these cases death may be sudden or it may be prolonged. This latter fact, says Woolsey, " is of little importance as a rule in surgery, for the patients generally die sooner or later ; but it is of importance in medical jurisprudence, for upon it may hang the solution of questions of murder, suicide, or justifiable homicide. It also accounts for the fact that the injured person can exercise voluntary power after the injury." Thus, in a case he quotes from Watson, "a man ran eighteen yards and died six hours after a stab-wound of the right ventricle." x Rupture of the heart, as stated before, may be the result of a violent blow, or it may follow severe contusions upon the thorax. Intense excite- ment or emotion sometimes causes the same result if the organ be diseased, as in fatty degeneration. In this connection the question may arise as to whether the rupture was occasioned by disease or violence. The counter- pressure of opposing forces, as of a vehicle or heavy weight on the chest, may cause rupture of the organ. Here there may be no external injury apparent ; and, although these cases are almost always immediately fatal, there are some exceptions. Balch2 cites the following interesting case : " I remember a case which was brought into the yard of the old New York Hospital in 1869, when it was on Broadway. I was serving as a substitute on the surgical division, and, happening to be alone, was 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, insensible, very pale, and evidently suffering from shock. Asking the accident, the officer stated that the man had been push- ing his cart along Broadway, when he was knocked down by an omnibus and run over. The mark of the wheel was plainly to be seen on the patient's clothes, and the mark extended from the right hip to the left shoulder, pass- ing directly over the heart. No fracture could be found. I went to report the case to the superintendent and get the order for his admission. When I left, the man was still insensible. When I returned, after an absence of about six to ten minutes, I heard a shout of laughter in the yard, and there 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. * Hamilton's System of Legal Medicine. FORENSIC MEDICINE -2I was 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 went, pushing his cart before him, nor did he thank the policeman who had pulled him out from his dangerous position, or the ' fool doctor' who tried to make a patient of him." Wounds of Arteries and Veins.—Serious and even fatal results may fol- low injuries to the intercostal or internal mammary vessels, or to the vena azygos veins. Wounds of large trunks are almost invariably speedily fatal. These injuries are either penetrating or non-penetrating. In the latter class the outer coat or coats of the vessel are involved, and the artery may subse- quently ulcerate and, yielding to the pressure of the circulation, produce extravasation, or it may cicatrize and then gradually give way, forming a true circumscribed traumatic aneurism. The blood that is effused into large cavities, such as the chest, rarely coagulates, or at least the main portion of it. Woolseyx states that the power of locomotion may be preserved after wounds of the carotid artery, but that the power of struggling is lost. From this fact he says it may be possible to distinguish between homicide and suicide. If wounds to large vessels do not cause death by hemorrhage, then gangrene, etc., usually does. The entrance of air into wounded ves- sels may produce fatal results, although it is possible for large quantities of air to gain entrance to the arterial circulation without terminating in death. Wounds and Ruptures of the Diaphragm.—The diaphragm may be injured by weapons which enter the thoracic or abdominal cavities, by falls or crushes, by disease, and by fracture of the ribs. Injuries to this muscle almost always involve the organs situated either above or below it. Therefore, the prognosis is always dependent on the concomitant injury to the immediate organs. Wounds of the diaphragm are usually either acci- dental or homicidal in nature. Death is due to the injuries of the adjoining viscera, and not to the wound in the diaphragm, as it is usually like those of other muscular parts and readily amenable to treatment. If, however, the diaphragm be ruptured, the complications increase the dangerous char- acter of the injury ; not on account of hemorrhage, for that is slight, but really on account of what is termed phrenic hernia, which may become strangulated and be the cause of death. This result may not be immediate, but may occur a year or even a greater length of time after the receipt of the injury. In this connection it is important for the medical examiner to study carefully the history of the case, so that his opinion may connect the death with the injury under investigation. This form of hernia follows es- pecially lacerated wounds, even after their cicatrization. The medical ex- aminer should recollect that a herniated person may succumb to the fatal influence of some other cause ; or, again, he may acquire a phrenic hernia 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology. 21 322 A MANUAL OF LEGAL MEDICINE as the result of a sudden exertion on his part, or of a blow ; or a sudden exertion may strangulate a pre-existing hernia. Persons suffering from these herniae are more or less incapacitated, but they may still have the power of locomotion. Devergie states that rupture of the diaphragm with hernia exists more often on the left side in the central tendon anterior to the crura and at the point of junction of the left muscular slip. Hernia may also occur on either side of the ensiform cartilage, particularly on the left side. Wounds of the Abdominal Walls and Viscera.—These are either accidental or homicidal in nature, and only suicidal in the case of delirious or insane patients. Contusions of the abdomen are more serious in their effects than those of the chest. They generally result from blows, the kick of a person or of a horse, or the passage of a vehicle over the body. They occur with or with- out rupture of the abdominal viscera. In contusion without the involvement of the viscera there are nausea, vomiting, great prostration, and shock. The rectus muscle may be involved so as to rupture, or haematomata may be formed, followed by abscess. Incised and punctured wounds of the walls of the abdomen may prove fatal by involvement of the epigastric artery. So, likewise, contusions may result fatally from shock to the solar plexus of nerves. The yielding nature of the abdominal parietes to external shocks may cause the force of a blow to be expended on the contained viscera, and thus set up peritonitis or produce rupture of the liver, spleen, stomach, or intestines. Such severe injuries to the organs mentioned may often be inflicted without any extra-abdominal marks of violence to account for the trouble. Blows on the abdomen are not always followed by ecchymoses or even abrasions. Extravasations of blood, on the other hand, are often found, post mortem, in the muscular sheaths without there being any external signs indicative of violence. If, on inspection of the body, the medical witness finds no abrasions or ecchymoses, nor any evidence of violence, he should be extremely cautious in attributing the extravasated blood found between the muscles to violence. Contusions with laceration of the viscera are characterized by pain, great shock, and the persistence of collapse. These are accompanied by the signs and symptoms of internal hemorrhage if the solid viscera or the vascular portion of the peritoneum be involved, or by a rapidly developed perito- nitis in case the hollow organs are ruptured. (The signs indicative of the rupture of any of the viscera will be given later on ; vide Individual Viscera.) The cause of death here is usually due to internal hemorrhage, to shock, or, as is usually the case, to septic peritonitis. In determining what organs are involved in the injury, the medical examiner should, in all cases, consider the part of the body which received the greatest force of the violence. Taylor mentions the case of a pugilist who, during an encounter with another, was hit on the abdomen, with the result that he was instantly killed. The autopsy showed no external or internal injury, and the physician who made FORENSIC MEDICINE it pronounced the cause of death to be sudden shock, which no doubt was true. On trial, the judge, in his charge to the jury, left it to them to decide whether the fatal result was due to the blow or not. If they could not form an opinion as to the real cause of death, or if they should imagine it to be the result of excitement, independent of the blow, the accused should be acquitted, a verdict of which was returned. Here, although the blow was seen to be struck, and was a sufficient cause of the fatal issue under the cir- cumstances, the jury doubted that the blow on the abdomen was the real cause of death because there were no visible marks, externally or internally, to account for the death. Any medical knowledge on the part of the jury would have dissipated this apparent difficulty. Penetrating wounds of the abdomen involve the peritoneal cavity. There may be simple penetration without visceral injury or protrusion ; or penetra- tion with visceral injury, but no protrusion ; or penetration with visceral protrusion, but no injury ; or penetration with both protrusion and injury. Sometimes wounds of the abdominal organs are cured spontaneously, but. in the majority of instances they result in death if not subjected to surgical treatment. Penetrating wounds without visceral injury may result fatally if they become infected. On the other hand, they heal rapidly and without danger unless they are extensive. The examination of such wounds with the finger or probe should not be indulged in too freely unless a laparotomy is to be performed, as a non-penetrating wound may be converted into a penetrating one, or the viscera may become infected. The liver, from its structure and position, is subject to rupture from the infliction of violence to the abdomen ; or it may be wounded by a fall, or even by sudden muscular action if the organ be diseased. Death is usually due to hemorrhage, to shock, or to peritonitis. These injuries are danger- ous according to their extent and depth. Rupture of the liver is charac- terized by pain in the right hypochondrium, increased hepatic dulness, the signs of internal hemorrhage, the blood collecting in the right iliac region or in the pelvis ; and subsequently there is vomiting of a bilious nature, clay- colored stools, and sugar in the urine. These injuries may be produced without being attended by any external marks of violence, and the liver may be ruptured from violence applied to the chest. The hemorrhage from in- juries to this organ is slow unless the vena cava, portal vein, or a large branch of either of these be involved. Although these wounds or ruptures are not instantly fatal, they may become so under other circumstances. Sometimes the wounded person can move about, etc., a fact which has been advanced by the defence to show that the injury was due to other than the particular violence in question. If the gall-bladder be involved, fatal results are apt to follow in conse- quence of the effusion of bile. This is usually the cause of death here, and not hemorrhage. This organ is especially liable to rupture if gall-stones be present. The spleen may be ruptured as a result of disease or of violence. That 324 A MANUAL OF LEGAL MEDICINE which has been said concerning the liver is equally applicable here, as the same class of injuries affect the spleen, and death is caused in the same way. These injuries are characterized by pain in the left side and increased splenic dulness on percussion. It is important to remember that an enlarged and softened spleen is easily ruptured, even by slight muscular exertion. Death is generally due to hemorrhage, although it may follow shock. Peritonitis rarely follows these injuries. The internal bleeding accumulates in the lower left side of the abdomen or in the pelvis ; the blood is rarely in a state of co- agulation. The healthy normal spleen cannot be ruptured except by direct violence. The kidneys may be ruptured by concussion so as to cause death. If slighter injuries follow, the recovery of the wounded person may be expected. Wounds of this organ are of rare occurrence on account of its deep situation in the abdominal cavity. The danger to be looked for in these injuries arises from the extravasation of urine, and the consequent inflammation. There are lumbar pain and tenderness, a frequent desire to micturate, and haematuria. In very severe cases there may be the signs of bleeding and of shock. Death may result rapidly from hemorrhage, collapse, or more slowly from perito- nitis, abscess and septic infection, or from uraemia if both organs are dis- eased. Persons suffering from ruptured kidney may be able to move about, etc., as is the case with the liver and spleen, but this power is lost if there be free bleeding. The bladder may be ruptured by a blow or kick, or it may result spon- taneously from over-distention, although in such cases, if the distention be caused by stricture, the urethra is more likely to weaken. The plea of spontaneous rupture of this organ may be advanced by the defence in a case of homicide. Ruptures of the bladder take place most frequently in the upper and posterior part where the viscus is covered by the peritoneum. They are usually of a vertical direction. On account of the extravasation of urine into the peritoneal cavity, peritonitis results; or, if the injury be at the anterior part of the organ, the extravasation occurs into the loose cellular tissue of the pelvis, producing cellulitis with secondary peritonitis or septic poisoning. Rupture of the bladder may occur without any apparent evidence of external injury. Spontaneous rupture may be due to the weakened con- dition of the organ produced by the pressure of a calculus, or by tubercular, syphilitic, carcinomatous, or ulcerous deposits. The usual period of death from these injuries is from three to seven days ; in some cases the victim may die suddenly from the shock, while, again, he may survive for fifteen or more days. The patient may be able to walk after the injury in some cases, and at first show no symptoms of the serious wounding. Punctured wounds of the bladder may be so small as to cause slow ex- travasation of urine ; or the opening may be valvular, and the urine only escape during non-distention of the viscus. The stomach and intestines may be ruptured by crushes, blows, and falls, FORENSIC MEDICINE 325 or by disease. Furthermore, punctured wounds, or occasionally incised wounds, of the abdominal wall may involve them. The injury, if to the stomach, is generally rapidly fatal, and is characterized by radiating pains, vomiting of the stomach-contents, together with blood, the rapid develop'- ment of general meteorism, and tympany over the liver. If the intestines are involved, then we have intense radiating pains, vomiting, at first from the stomach, then bile, and lastly blood. The stools are bloody, and there is tympanites with dulness in the flanks and percussion resonance over the liver. Both ruptures and stab-wounds of these viscera may be multiple. Of the intestines, the ileum is most liable to rupture, the jejunum less so. Hemorrhage, as a rule, is not excessive in these injuries, while in wounds it may be alarming. The greatest danger is the liability of the injured person to septic peritonitis, due to the leakage of the stomach and intestines, or death may occur speedily as a result of shock. Disease may so weaken the walls of both stomach and intestines as to cause spontaneous rupture ; and it is well to recollect, in this connection, that a slight injury may cause rupture, due to the weakened condition of the gut. The attempt of the injured person to walk, etc., may be successful. As with injuries to the organs previously mentioned, the injury to the stomach or bowel may be inflicted without the marks of violence being apparent externally. ( Vide Gunshot Wounds.) Wounds of the Genitals.—These may be incised, punctured, or con- tused. Incised wounds are indicative of homicidal intent, for accidental cuts are rare. These wounds, however, are mostly accidental in origin, although self-inflicted wounds of the genitals are met with most generally among the insane. Wounds of the female genitals may cause death from hemorrhage, and the fact of an incised wound being found in the labia would be strongly presumptive of assault. Contused wounds, such as kicks, or a severe blow on the vulva, may cause death from hemorrhage ; they often resemble incised wounds. Sometimes it is alleged by the defence that contused wounds of the female genitals are inflicted post mortem. The distinction between ante- mortem and post-mortem wounds has already been alluded to (vide p. 272) ; but, in addition, it may be said that in fatal contused wounds of the vulva, death is caused by bleeding or extravasation of blood, conditions which would not be present if the injury was inflicted post mortem. Sometimes the physician will have to determine between accidental, sui- cidal, and homicidal injuries of the genitals. Injuries of these parts, when self-inflicted, comprise castration and partial or entire amputation of the penis. Demarquay mentions the case of a drunken man who excised his genitals and died the next day from hemorrhage. The dangerous character of these wounds is proportionate to the hemorrhage. Wounds of the Extremities.1—The degree of danger in these injuries 1 Vide surgical works. The reader is also referred to Gunshot Wounds in con- nection with the subject of Wounds Regionally Considered. 326 A MANUAL OF LEGAL MEDICINE depends on the vessels involved, the shock, the situation of the injury, and the existing complications, if any. These injuries are more often the cause of civil than of criminal suits. The wounds to be considered here are those of an artery or vein, or both ; those of nerves, muscles, tendons, and the soft parts of the limb. Then the medical examiner must note whether there be wounds of the joints, fractures, dislocations, contusions of the bones, etc. ; also whether the limb be deformed, disabled, or both. CHAPTER XXVII. GUNSHOT WOUNDS. Remarks—Danger of these Wounds—Was the Wound inflicted before or after Death ?—Evidence from the Weapon and Projectile—Deflection of the Ball- Wounds from Shot, Wadding, and Powder—Was the Weapon fired Near or at a Distance ?—Complicating Conditions. Gunshot Wounds,1 whether caused by small or large shot, by bullets, or by small pebbles thrown by any sufficient force, as by a blast, are essen- tially classified as contused lacerations. They differ from other wounds chiefly in the fact that the vitality of the tissue involved is destroyed and instantaneously changed into a disintegrated pulpy mass, which may be found in the course of the wound as dead tissue. When the bullet traverses the body two apertures will be noticed,—the open wound of entrance, which is round and clean, and the corresponding one of exit, which is usually less regular, jagged, and smaller, although at times the reverse is found to be true. The course of the wound is open, and appears on dissection as a blood-stained line ; but if the injured person has survived the wound for two or three days, slight inflammation will have begun, and the sharp red line will still be seen against the other tissues. The contusion of the part struck by the bullet is so complete and the bruising force so short that ecchymosis is rarely observed, and the sur- rounding parts are scarcely ever involved. If, however, the bullet strike the part only when nearly spent, the skin may not suffer any solution of continuity, although the resulting contusion may have such effects as to injure deeper parts. Thus, Conner2 mentions a case where both bones of the leg were extensively shattered from the force of a large piece of shell which did not break the skin ; and Macleod reports an instance where a round shot struck the scale from an officer's shoulder and, glancing off, ' For the effects of gunshot wounds upon the various tissues the reader is referred to the larger works on surgery. 3 Ashhurst's Encyclopaedia of Surgery. FORENSIC MEDICINE 327 grazed his head, causing instant death. The scalp was uninjured, but so completely smashed was the skull that its fragments "rattled within the scalp as if loose in a bag." ( Vide Contusions.) If bone be struck by a bullet, the violent impact will produce disinte- gration, as with the soft parts or fractures, generally radiating in character The contusion may not be dangerous, although at times the part struck is completely devitalized. The common result of these contusions is to light up destructive inflammation. Danger of these Wounds.—On account of their dangerous character, gunshot injuries require the most careful consideration of the medical jurist! They are exceedingly dangerous to life, their gravity varying according to the importance of the part wounded, and also to the size and velocity of the bullet. It is also important to remember that, ceteris paribus, a gunshot wound is less dangerous if lodgement of the ball has not taken place than a penetrating injury with lodgement. Death occurs either from hemorrhage or shock to the nervous system. The former is seldom profuse, except when great vessels are injured. Fre- quently the form of the wound is such as to preclude the possibility of external bleeding, while a fatal internal hemorrhage may be going on. Still, wounds of the great blood-vessels are not necessarily immediately danger- ous to life, since great vessels like the aorta have been injured by shot, and yet life was preserved for weeks. Death from shock often follows these wounds. As in other wounds, it is proportioned to the severity of the injury. The secondary effects are those of inflammation, the degree of which depends upon the health of the injured person, the situation of the wound, the size of the bullet, and the surgical assistance rendered. ( Vide Wounds.) Was the Wound inflicted before or after Death ?—This question may arise in a case of homicide. Although it is not always easy to answer this important query, the medical witness may recall the principal charac- teristics of ante-mortem wounds. ( Vide Wounds.) These are: more or less eversion, more or less hemorrhage, extravasation of blood into the tissues, together with the presence of coagulated blood or clots. Post-mortem wounds show scarcely any extravasation of blood, unless from a superficial vessel, when it would be venous in character and non-coagulable. Moreover, coagula are not to be found in the track of the bullet. Evidence from the Weapon and Projectile. ( Vide Wounds.)— The medical examiner should note the following points in determining facts attending a suspicious case of gunshot injury : (1) the position of the weapon, whether within the hand of the deceased, or whether it had been so placed by another ; (2) the presence or absence of blood upon it; (3) the indications or not of the recent discharge of the weapon ; (4) the number of cartridges or bullets discharged ; (5) the calibre of the weapon ; and (6) the weight and dimensions of the ball discharged. These points of evidence, if obtainable, are of great value. 328 A MANUAL OF LEGAL MEDICINE The determination of the time elapsed between the death of a person and the firing of a shot is hardly possible, although some approximative conclusions may be drawn, as follows. When the weapon is discharged, one of the products of the powder is potassium sulphide mixed with charcoal. Upon its exposure to the atmosphere part of it is converted into potassium sulphate, which forms with water a neutral solution, and produces with the acetate of lead a whitish precipitate. "If," says Semple, " a finger intro- duced into a gun-barrel is blackened, and if the barrel is free from rust or crystals of protosulphate of iron ; if the solution (made by washing out the gun-barrel with distilled water and the washings filtered) is of a yellow color, smelling strongly of sulphuretted hydrogen, or yielding a black precipitate with lead acetate, the weapon has not been discharged more than two hours. If the color of the interior of the barrel is less dark, but contains neither crystals of ferrous sulphate nor rust, but the solution (made as above men- tioned) shows traces of sulphuric acid when tested with chloride of barium, the period that has elapsed is more than two but less than twenty-four hours. If many spots of rust are observable in the interior, and if the solution shows indications of iron when tested by ferrocyanide of potassium, at least twenty- four hours, perhaps six days, have intervened. If the rust is in greater abundance, the solution no longer yielding any iron reaction, at least ten days, and perhaps fifty days, have passed since the discharge of the weapon." ' The medical examiner should note how many cartridges or bullets have been discharged from the weapon, for comparison with the wounds, if there be more than one, on the body, or with the evidences obtained from the place where the shooting occurred. Thus, if he discovers, on examination of the weapon, that four of its chambers are empty, while but two wounds are in the body, evidence of the other missiles may be obtained by an examination of the room or locality. The recovery of the shot from the wound may have some bearing on the case if other missiles of similar shape and size are found on the accused ; or, if it can be measured, it may be found to be of a kind to suit the calibre of the weapon used by the prisoner. " In a brawl in Troy some years ago," says Balch, "shortly after the second trial of Jesse Billings, a man was shot. More than one shot was fired, and by different persons. One arrested for doing the wounding was freed by the medical witnesses who had held the autopsy proving absolutely that the ball recov- ered 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 which was taken from him on his arrest. Had the doctors not saved and produced the ball, 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." 2 If the bullet taken from the body for comparative purposes is found to weigh more than any of the missiles found in the chambers of the weapon supposed to have caused 1 Forensic Medicine. » Hamilton's System of Legal Medicine. FORENSIC MEDICINE 32g the injury, then the weapon in evidence could not have been the cause of the wound. Does a bullet lose weight during its passage through the bore of the weapon and the air before it strikes the body ? The passage of a lead bullet through the bore of a weapon produces sufficient attrition to reduce its weight, although the "leading" is subject to variation according to circum- stances. " Patching" the bullet and lubrication are often resorted to in order to reduce the attrition. A bullet which has been partially fused loses the fused parts either in the bore of the weapon discharging it or in the air, or in both, and its irregularity of form will send it in an irregular line to its destination. In the Billings case, which is quoted in full below, several interesting ques- tions relative to the action of the tissues of the body upon a bullet passing through them, etc., were considered. The following interesting account of this case is taken from Balch's contribution (" Homicide and Wounds") to Hamilton's "System of Legal Medicine." "... Mrs. Jesse Billings, who, while sitting sewing opposite a window, was killed by a bullet fired from out- side of the house, and which entered her head but did not go out of it. Her husband was arrested for the murder and tried twice, the jury 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 was burning, and the window-shade was up. As soon as the shot was fired she fell to the floor dead. The autopsy showed that the ball had entered the left side of the head, about half an inch above the opening of the ear, and ploughed its way across the base of the skull to the opposite side, where it caused a triangular fracture of the mastoid portion of the right temporal bone, forcing this through the skin so the frag- ment 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 por- tion. The autopsy was carried no further than the head, but, as certain questions concerning the size of the bullet and its action upon the skull came up in the first trial, the body was raised and head removed, that more careful examination could be made of it. The case was evidently one of murder, and many questions relating to the killing and in connection with the weapon which the people claimed was the one used were relegated to the medical witnesses. It was claimed by the defence that the ball would have gone through the head 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 window-pane, and another point raised by the defence was that the weapon would not carry unexploded powder a greater distance than one foot, and at this distance the moving body of gases of the discharge would blow the window-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 smaller than the calibre of the gun (.44 inch) as to prevent an unfired ball going through without breaking off the edge of orifice. 33Q A MANUAL OF LEGAL MEDICINE '' All these questions were acted upon by the medical men engaged on both sides, for the answers had to do with the wound found in the head of Mrs. Billings. The evidence of the wound itself was that a weapon of force- ful fire and large calibre had made the injury. The ball—at least so much of it as was found in the head—weighed but one hundred and sixty-five grains, while an unfired ball of the cartridge used in the carbine weighed two hundred and twenty grains, and the recovered bullet was 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 showing the im- press of the lands and grooves of the barrel being found upon the bullet. The district attorney wished two questions definitely answered, and these were, What effect would the ball have upon the bone ? and What the bone upon the ball ? To decide these it was considered necessary, supposing the carbine to be the weapon, to know what 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, Massachusetts, permission to do so having been obtained from the War Department. It proved to be a weapon of low velocity, the mean being 998.8 feet per second. This brought the energy of the ball down to 521.1 foot-pounds, or about half of 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 thirteen hundred to fourteen hundred feet per second. The force of the bullet was not so very much more than a ball fired from an army revolver ; and the force being found so much less than was expected, the stopping of the bullet in the head was not such a mysterv, especially when the thickness of the skull 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 through glass, lost any of its velocity. It was found that no appreciable effect was made by the glass. The ball struck almost its full diameter on the base of the left petrous portion, and crumbled this part of the temporal bone so but little of it could be recognized. The ball, having ploughed its way through this bone, passed over to the right petrous portion, into which it crushed a little, and expended its force in breaking the triangular piece of bone from the mastoid portion, and forcing this outward through the skin and tissue. The effect the ball had upon the bone was to fracture the skull 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 when the wound is in the soft parts, and this complete destruction may partly be accounted for by the somewhat brittle character of the petrous portion, it containing hardly any cancellous bone. It yielded, therefore, more readily to a sudden and forceful contusion or concussion, and went all to pieces. Upon the rest of the skull the action of the bullet was what would be expected and is usually seen,—lines of fracture radiating from the point of contact and following the general laws of physics. FORENSIC MEDICINE . "The action of the bone upon the ball was to use up part of its lead. The first impact with the bone did the upsetting ; but its having to plough through such fine, sharp particles as the fracture reduced the petrous portion to caused more loss of substance than would appear reasonable if it could not be shown by other experiments to be probable. We may assume the ball to have been of two hundred and twenty grains' weight before firing. It was one hundred and sixty-five grains when 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 shooting at cadavers, and then examining the heads afterwards, care being taken to recover every particle of lead possible. In the last series the bullet followed more nearly the track of the Billings ball. The subject was badly decayed, and the skull old and very thin ; but the ball 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, and then roll to the floor. I give the record of this ex- periment, as made at the time. Sixth shot, no glass, distance ten feet from subject: Weight of ball...................220 grains. Weight of ball recovered........159.291 grains. Weight of lead found.........000.000 grains. Total weight of lead recovered.....159.291 grains. Loss not found............60.709 grains. "The other five bullets lost anywhere from 3.975 grains to 50.557 grains, and by loss I mean total loss, the lead not being found even in small particles. But in none of the first five experiments did the bullet follow the line of the Billings ball, and nowhere do we find an equal amount of weight lost until the experiment quoted where the petrous portion was traversed by the bullet. These experiments then proved that the ball taken from Mrs. Billings's head could have weighed two hundred and twenty grains before being fired, and proved, further, that for such a bullet to lose as much as was the case in the Billings ball it would have to travel through considerable bone, which would cause enough attrition to reduce its weight. "But these two questions out of the way, and the third one of the gun being of comparatively low force, how could the bullet be for a weapon of .44-inch calibre when the hole through the window-pane would not admit of such a ball passing through it ? This was answered by a number of ex- periments, firing at glass set in sashes, both glass and sash being similar in size and weight to the window through which the fatal bullet had gone. The notes show for these tests the following : ' Ballard carbine, old style, .44-inch calibre, long cartridge, two hundred and twenty grains lead, twenty- eight grains powder. Experiments made May 8 and 10, 1880, in the Tenth Regiment Armory, Albany, New York. Shots fired through glass set in sashes ; glass twenty-eight by thirteen and one-half inches, double-thick, American make.' The distance from muzzle to glass was generally ten feet, 332 A MANUAL OF LEGAL MEDICINE but other distances were tried, from seventy feet down to two. At the last distance the glass was blown out of the frame. As a summary the notes state : Balls unable to pass Balls barely passed Balls passed . . . Cartridges passed Glasses blown out Total.........................45 '' From these tests, in forty-five shots one hole in the glass would not permit an unfired ball to go through without further fracture. The force with which a bullet strikes a pane of glass acts precisely as it does on the tissue when it enters or wounds the soft parts of the body. It disintegrates 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 sur- rounding part for help, and the glass yields a trifle to the force, resuming its natural position after the momentum has passed on. Again, the tempera- ture of the air and its humidity have 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 defence that the gun could not carry unconsumed powder farther than one or one and a half feet. It should, however, be borne in mind that in fixed ammunition the bullet is driven into the cartridge directly upon the powder, and generally the heel of the ball 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 powder cling to it and be carried great distances. As the firing experiment at glass had proved that within the distance of two feet the gases would shatter the glass, it would have been impossible for the carbine to have been the weapon if it could only carry unburned powder one foot, and powder or marks of powder were found in the window-sash. To determine this question more experiments were made. Seven boards, of about fourteen inches by ten inches, were fired at with the carbine, the dis- tances from the muzzle being from ten feet to two feet. The boards were produced in court, and tests then made of what was supposed to be powder implanted in them. A platinum wire point, heated by a galvano-cautery battery, was brought in contact with the grains on the glass. From eight feet down to two distinct flashes and smoke were elicited, showing the grains to be powder. At ten feet no flash could be gotten, but the marks were considered to be those of powder. The experiments were, however, proof that the carbine could have been the weapon, for at eight feet the window- pane would not have been blown out by the discharge, and the gun could implant unburned powder into boards that far from its muzzle. "The evidence of the wound, therefore, was in support of the proper claim that the carbine shown by the testimony to belong to the prisoner, 3 18 21 FORENSIC MEDICINE -„ and which had been hidden in an old well on his farm, could have been and probably was the weapon with which the crime was committed. But, as said before, when speaking of the nearness of the muzzle to the gunshot wound found, the fact that it might have been the weapon was conclusively shown only by the various experiments made with it." Among other points to be considered in the investigation of gunshot wounds are the following : (i) the number, size, and direction of the wounds ; (2) the presence or not of marks of violence and of blood-stains ; (3) the amount of blood lost, whether clotted or not; (4) the presence or not of stains upon the clothing ; (5) the direction of the effused blood ; (6) the course of the wounds in the body ; the presence or not of foreign substances (splinters of bone, fibres of tendon or aponeurosis) in the course of the missile ; (7) the condition of the lips of the wound, whether there be inver- sion of the wound of entrance and eversion of the corresponding one of exit, or not ; (8) the condition of the weapon, of its barrel; or if a revolver, of its different chambers ; note whether they are clean or not, etc. ; (9) the peculiarities, if any, of the cartridges ; whether the primer is marked by the hammer, and the name of the maker, etc. ; (10) the size and weight of the bullets used ; (n) the weight and number, if shot were employed ; (12) the condition of the sights of the weapon, whether displaced or loosened, etc.; also note the " trigger-pull;" and (13) the places of impact of the various bullets, as upon the wall, etc. The above points, if known, may be of vital importance at times. It is almost needless to remind the medical examiner regarding the value of noting (1) the time at which the wounded person died ; (2) the time of infliction of the injury ; (3) the situation and attitude of the body of the deceased ; (4) the condition of the clothing ; (5) the appearance of the body ; (6) the state of countenance ; (7) the probable age of the deceased, his condition of nour- ishment, etc. ; (8) the nature of the surroundings, such as walls, fences, windows, rooms, etc. ; (9) the presence of cadaveric rigidity ; and (10) whether the position of the body was changed, etc. The obliquity of the wound through the skin may, in some instances, indicate the direction from which the bullet came. One side of the orifice of the wound may show more marked staining and inversion than the other, showing that the impact of the missile was firmer ; so, likewise, the approxi- mate course of the ball through the tissues may be shown by the discovery of splinters of bone, etc., along the track of the ball. (Hall.) The direction of the blood lost may indicate the position of the victim at the time of the wounding. However, it is well to remember that there may be no external evidence of bleeding at all, since the hemorrhage may be entirely internal. In regions where the subcutaneous accumulation of fat is great, the orifice of the wound may appear everted instead of inverted. Regarding the weapon, it is important that the medical examiner makes note of the size, make, number or mark, weight, and length of the barrel, and whether rifled and hammerless or not. He should further observe any A MANUAL OF LEGAL MEDICINE 334 peculiarities of construction, etc., and, regarding bullets, remember that it is possible for the assailant to employ many different varieties in the same weapon. Hall1 says, "The sights of the weapon should be examined with care especially to learn if they have been displaced or loosened. As the sights are detachable, it is perfectly possible that an accidental shooting may have occurred from a change in the position of one of them, as in the foolish attempts to shoot a pipe from one's mouth or an apple from the head. I have known many wild shots made at a target and at game from this cause, although they are more common from changes in the elevation of the rear sight. ... It should be noted that a very slight movement of the sight is needed, in short weapons especially, to produce a considerable deviation in the course of the bullet. ... The trigger-pull, varying from almost nothing in guns with a set trigger to even twenty or thirty pounds in old muskets, should be noted, for it may make a great difference in the accuracy of aim possible with a given weapon. Many shooters pull a hard-shooting rifle to the right, even if using great care. In the case of the pistol, if the trigger- pull is excessive, one may pull it entirely off the mark. ... In some re- volvers the notch serving to hold the hammer at full cock is filed away, so that the weapon will not stay cocked, but is discharged either by raising the hammer and allowing it to fall suddenly with the thumb of the hand holding the stock, or with the fingers of the opposite hand. The trigger is tied back in some cases to attain the same end. In my own practice I have seen the results of two accidental shootings from pulling the trigger in excitement in handling a double-action weapon, which does not require to be cocked, but is discharged by simply pulling the trigger. In one of the cases the revolver was discharged in the pocket of the owner while he was hunting for a man with whom he had quarrelled, and the resulting wound prevented him from pursuing his antagonist farther. It was testified in court that a certain pistol with which a woman had been killed would not remain cocked, after having tried it several times to make certain of its condition. After the case had been given to the jury, in explaining the matter to a friend, I tried it again, and it remained at full cock. Although I tried it many times after- wards, it did not do so again. In this case enough of the notch remained to hold it this particular time, although it could not ordinarily do so. Fortu- nately, the error was of no serious importance in this case ; but if the weapon had been handled when cocked, the slightest jar might have caused its discharge." Regarding the post-mortem examination, especial attention should be directed toward those organs in which occur the most common causes of death. These include the brain, the heart, the great vessels, and the viscera. Furthermore, if there be evidences of an operation having been performed, then it becomes the duty of the medical examiner to ascertain, if possible, whether this method of treatment was absolutely necessary to preserve life, 1 New York Medical Journal, vol. lxii., No. xii. Fig. i. Fig. 2. The above reproductions of a case of suicide by pistol-shot show both the wound of entrance and that of exit. The weapon was held close to the right side of the head the discharge thereof leaving "° evidence of powder marks, stains, singeing: or burning of the hair, nor burned or unburned powder in the ear. The original photographs were cited by the writer in the defence of Foglia. The dotted lines indicate the direction of the bullet. (/>..................years,...................months. Birthplace,............................................................... Time in this country,............................................................ Color and race,................................................. Occupation,................................................... Brought to office by..................................................................... Injury said to have occurred............................................................ 7# Case,................................................................................................................................ Examination: (Date),....................................../#.......... Place,............................. Interval between injury and examination,............................................................................ General condition,.................................................................................................................................. Marks of struggle or violence,....................................................................................................... Ostium vagince admits...................fingers. (Labia; anus; vulvar canal; fourchette; vulvo-vaginal glands; hymen; carunculce mvrtiformes; clitoris ; urethral meatus ; discharge: urethral and vaginal; vagina ; cervix; uterus; stains; skin; breasts.) Presence of venereal disease, Examination of discharge and stains, Diagnosis,............................................................... Certificate submitted (copy of),................. Remarks and subsequent history,............. (Charge. Plea. Verdict.) Case, 'Name, 522 A MANUAL OF LEGAL MEDICINE the medical examiner to determine whether such injuries as might be found were of ante- or post-mortem infliction, and also whether they were sufficient to cause death. If the wounds discovered upon the cadaver were sufficient to cause death, the question arises, Were they the result of the act of rape, or were they produced otherwise ? To ascertain these important facts, an exhaustive, and not a superficial, inspection of the body should be made. The corpse should be examined for bruises, fractures, etc., and the mouth particularly for foreign bodies. The vagina and the pubic hair may show the presence of spermatozoa; but the latter, in the absence of any statement on the female's part, would indicate only that sexual congress had been effected. Edgar and Johnson1 say, "The diffi- culty will be very great in case of external violence to decide whether the marks were due to rape or to some other cause ; in the vast majority of examinations it will be impossible. In the case of a very young girl, who had not reached the age of consent, the presence of injuries about the gen- itals points clearly to rape ; but in a young woman the signs of defloration, no matter how pronounced and how recent, how extensive the inflammations and lacerations, can only be accepted as such, for they do not prove that she did not permit the intercourse. When added to these, however, are other marks of violence and a struggle, coupled, perhaps, with a previous char- acter for chastity in the dead, the evidence is circumstantially in favor of the inference of a rape upon her." CHAPTER XXXVII. IMPOTENCE---STERILITY. General Considerations—Definitions—Causes of Impotence and Sterility—Procreative Power in the Male Subject—Procreative Power in the Female Subject—Legal Relations. Some authors limit impotence to males and sterility to females ; but in this work the writer will arrange the subject as follows : (i) impotence in man, (2) impotence in woman, (3) sterility in man, and (4) sterility in woman. Impotence in the male may be defined to be the incapacity of the per- son for sexual intercourse, although the venereal desires are not extinct. This absence of the procreative power may depend upon a physical or a psychical cause. Of the physical causes, disease and the congenital malfor- mation or defect of the sexual apparatus are the most important, although physiological perversion is sometimes grouped here. Incapacity of the 1 Op. cit., vol. ii. p. 460. FORENSIC MEDICINE 523 male may be due to such diseases as atrophy of the testicle or fungous growths of the organ. The former may result as a consequence of gonor- rhoea! epididymitis, varicocele, and syphilitic orchitis. These causes of atrophy are not amenable to cure, and are, therefore, permanent. Fungous tumors may sometimes be removed by surgical means, thereby removing the physical cause. It is important in these cases for the medical examiner, when questioned as to the relative prospect of a cure following medical treatment, to be able to say whether such be possible or not. Rules are not available for his guidance, so that his professional knowledge will be his only assistance. He should be able to point out the main causes of the affection, as also whether they are remediable or not. Other diseases of the testicle which may not only render the male incapable of performing the sexual act, but also cause sterility, are syphilis, cancer, and tubercu- losis. Wasting of the testicles has followed parotitis, and paraplegia has been referred to by some authors as being a bar to sexual congress. Inju- ries to the head and spinal column have likewise produced impotence, as has also masturbation. Speaking of general diseases, Tidy1 says, "We may note that any cause which decreases bodily vigor probably decreases sexual power. Thus, advanced disease of almost any kind, or the extreme physical weakness resulting from fevers, etc., may induce both impotency and ste- rility. Diabetes is usually accompanied with incompetency. On the other hand, the author knows of cases of advanced heart- and lung-disease (phthisis) in which coitus (followed by the birth of a child resembling the father) took place only a few hours before death." Besides the physical causes, the mental conditio?i of the subject may be such as to render sexual intercourse impossible. Men who are other- wise in perfect physical and mental health, and who can perform the sexual act normally under certain conditions, are perfectly helpless when these conditions to which they are accustomed are removed. Other psy- chical causes of incompetency are mental anxiety, fear, a highly worked-up imagination, or emotional feelings. These causes are, as a rule, only tem- porary. They are remediable by careful advice and assuring counsels. It sometimes happens that a perfectly healthy man will find himself utterly incapable of the act of intercourse at the moment of coitus, although pre- vious to that time the sexual desire was intense and the erection of the penis perfect. Sturgis2 says that '' there is no physical reason for this dread ; the patient is perfectly capable of performing the sexual act; and yet when he is with the woman he is perfectly useless as a bedfellow ; and oftentimes the mere dread of failure, if failure has once occurred on attempt- ing coitus, puts an end to all future attempts. There is often a physical cause for this mental disturbance,—such, for instance, as hyperaesthesia of the deep portions of the urethra, slight and irritable urethral strictures, hemor- 1 Op. cit., vol. iii. p. 13. 2 Hamilton's System of Legal Medicine, vol. ii. p. 501. „. A MANUAL OF LEGAL MEDICINE rhoids, fissures of the anus and rectum, or a subacute inflammation of the neck of the bladder ; and the well-informed surgeon will carefully search in such cases for any physical cause to account for the patient's sexual con- dition, and, if such exists, by removing the physical cause cure the sexual disturbance." Congenital absence of the penis, or, if present, its diminutive or inordi- nately large size, torsion of the organ upon its axis during erection, etc., are purely physical causes of impotence, without the influence of the mind regarding the sexual act. Other etiological factors in impotence are castra- tion of both testicles, malformation of the urethra, as hypospadias and epispadias. Reese says, "The mere absence of the testes from the scrotum does not produce impotence, for such persons (cryptorchids) are capable of begetting children." It is of importance to remember, in connection with this subject, that a male may be impotent without being sterile, and, on the other hand, sterile without being impotent. Procreative Power in the Male.—This usually commences when the male has arrived at the age of puberty. Until this period has been reached the sexual apparatus, particularly the testes, is small and undeveloped. The latter organs grow very little in proportion to the other parts. At puberty the organs of generation should be perfectly developed. The age at which puberty appears is subject to considerable variation, although it is usually from fourteen to seventeen years. Previous to this period the semen con- tains no spermatozoa. ( Vide page 503, foot-note.) Impregnation, to a great extent, depends upon the activity of movement of the spermatozoa, their deficiency in the aged male being, no doubt, a fruitful cause of impotence, while the feeble motion of these small bodies might also reduce the power of impregnation. The procreative power in males is absent until the sperma- tozoa have made their appearance in the semen. If a male person enjoys perfect health, this power of procreating may last for a great many years ; in fact, to a very advanced age. Reese states that spermatozoa have been discovered in the semen at even above the age of eighty. Various kinds of accidents, such as injuries to the head and spine, and diseases (disorders of the brain and spine, malignant fevers, etc.), impair and destroy the procreative power in the male. Sterility in the Male.—When the secretion or elimination of the spermatozoa is interfered with, either congenitally or as the result of acci- dent, sterility results. There are, however, certain diseases which interfere with the normal functions of already existing procreative powers. Thus, the vasa deferehtia may be obstructed by such affections as gonorrhoeal epididymitis, syphilitic epididymitis, tubercular epididymitis, syphilitic and tubercular orchitis, cancerous or sarcomatous orchitis, atrophy from blows, or from an old varicocele, etc. (Sturgis.) Indulgence in sexual pleasures— excessive sexual intercourse and masturbation—may produce a temporary sterility in males, in which case microscopical examination of the seminal FORENSIC MEDICINE 525 fluid will show the existence of certain anomalies, such as a diminished quantity of spermatozoa and an irregularity in form of those present The semen likewise may be thin and viscid-like and without spermatozoa. In these cases careful treatment of the patient will often work wonders ; in fact, may ultimately cure the abnormality. Impotence in Woman.-This may depend upon organic or functional causes. The former include certain malformations of the genital apparatus of the woman. Thus, the most common cause of an organic nature would be absence of the vulva or vagina, etc. Vesico-vaginal and recto-vaginal malformations are also among the principal etiological factors of impotence in woman. Absence of the vulva or vagina would constitute complete impo- tence, and a partially developed vaginal canal incomplete impotence. Hence we see that the perfectness or imperfectness of impotence will depend upon the nature of the organic lesion. Other causes of female impotence are extroversion of the bladder, especially of its anterior wall; an imperforate and tough hymen, although amenable to proper treatment; and certain diseases, as vaginismus, hysteria, etc. Sexual intercourse would not be in- terdicted by absence of the uterus, nor by the presence of a double vagina and uterus. Procreative Power in the Female.—This power manifests itself at puberty or the period at which menstruation is established, and ceases to act upon the stoppage of this periodical flow. The other changes in the female noticeable at puberty are enlargement of the mammae, widening of the pel- vis, the appearance of hair on the pubes, mons veneris, and labia majora, filling out of the body in general, and transformation of the character. This is the period of fitness for reproduction, since evolution and menstrua- tion are established. The causes which influence the first appearance of the menses are climate, race, residence, heredity, and the so-called genital sense.1 In temperate climates menstruation usually manifests itself at from thirteen to fifteen years of age,2 it being earlier in warm and later in cold climates. Females who reside in the city and are not accustomed to out- door life menstruate earlier than do those who live in the country and enjoy healthful exercise and out-door life. The periods normally appear every twenty-eight days, although some females, perfectly healthy, menstruate every three weeks, while others do so only every five weeks. The average duration of each menstrual period is between three and four days, but in this also there are variations,—viz., from two to eight days. Women have conceived who have never menstruated, and in some instances the func- tion is absent throughout life. It is also important to remember that girls have menstruated as early as one, two, or three years of age, and that menstruation has not ceased in some women until the sixtieth, seventieth, 1 The greater or less vigor exhibited in the growth of ovisacs. 2 Cases are on record in which the latest periods were from nineteen to twenty- three years. 526 A MANUAL OF LEGAL MEDICINE and even the eightieth and ninetieth year. Such cases are, however, of ex- tremely rare occurrence. Reese' says that '' the continuance of menstru ation is usually indicative of the power of conception. Its termination nearly always marks the cessation of the woman's ability to bear children. But it is undeniable that women have conceived after the cessation of the catamenia. The latest age for pregnancy cannot be absolutely fixed, although it is comparatively rare after forty-five years, and almost unknown after fifty- five years." Sterility in Woman.—This maybe defined to be "the inability to procreate or a want of aptitude for impregnation." The causes of sterility are numerous, the chief one being absence of the ovaries, either congenital or as the result of surgical interference. Among other causes are extreme flexion or version of the uterus, an acid condition of the vaginal and uterine secretions, imperforate hymen or vagina, ovarian or uterine tumors, con- striction of the os uteri, and functional derangements, such as amenorrhcea, profuse leucorrhoea, debility, dysmenorrhoea, etc. A fact of importance to recollect is that some women are sterile with one man and fruitful with another. ( Vide last paragraph.) Legal Relations.—Divorce may be instituted on the ground of im- potence ; and, furthermore, legal grounds for separation may be afforded in certain cases where hysteria and vaginismus prevail to such an extent as to prove an impediment to the marital obligations of the person so affected. On an application for divorce on the plea of impotence, an examination is essential, which must be voluntary, both upon the part of the man or woman so affected. The court may require this, unless the inspection was made previous to the bringing of the action. Baldwin2 says that '' a certificate by the examining physician is not receivable in lieu of his appearance as a witness. . . . Long and unexplained delay on the part of the petitioner in seeking a divorce will bar the remedy. Ignorance of the existing defect will not excuse the delay, if there was the means of knowledge and a want of reasonable diligence in seeking to obtain it. (Newell vs. Newell, 9 Paige's Chan. Rep. 25 ; B----n vs. B----n, 28 Eng. Law and Eq. Rep. 95.) It is not necessary to prove impotence generally, and as to all women. It is enough to establish its existence so far as the intercourse with the peti- tioner is concerned. A failure to consummate the marriage after three years of cohabitation is presumptive evidence of impotence." 3 1 Medical Jurisprudence. 2 Hamilton's System of Legal Medicine, vol. ii. p. 520. 3 Anonymous, 22 English Law and Equity Reports, 637. FORENSIC MEDICINE 527 CHAPTER XXXVIII. MEDICAL EXAMINATION OF THE LIVING.1 Trial by Inspection-Examination in Cases of Alleged Pregnancy-Examination in Proceedings for Divorce on the Ground of Impotence or Sexual Incapacity-In Cases in Chancery-Inspection of the Child in Filiation Cases-On a Question of Personal Identity-Compulsory Inspection of the Body in Actions for Personal Injuries, etc.—Medical Malpractice— Railway Injuries. TRIAL BY INSPECTION.-This form of trial is frequently resorted to in order to determine collateral questions as they arise in legal proceedings ; in other words, questions of capacity to commit crime in various cases. In ancient procedure the examination was made use of to ascertain the chief issue in an action at law, in which case it was made by the magistrate or magistrates, who gave their judgment without the intervention of a jury. This mode of trial seems to have been in use where the question of non-age was in dispute (3 Bla. Com. 332 ; 9 Co. Rep. 31) ; in questions of personal identity (3 Bla. Com. 332 ; 9 Co. Rep. 30) ; of idiocy (3 Bla. Com. 332 ; 9 Co. Rep. 31); on an appeal of mayhem (3 Bla. Com. 332 ; 2 Roll. Abr. 578) ;2 in actions of trespass for mayhem (3 Bla. Com. 332 ; 1 Sid. 108) ; or for an atrocious battery (3 Bla. Com. 332 ; Hardr. 408). In modern procedure this form of (natural) evidence is called for (1) in cases of alleged pregnancy in capital cases, (2) in divorce proceedings, (3) in cases in chancery, (4) in cases of disputed identity, and (5) in accident cases in actions for personal injuries. Examination in Cases of Alleged Pregnancy.—This is called for in those cases where women are sentenced to death. Such persons frequently feign pregnancy to stay the infliction of capital punishment. In such in- stances, and in those where the woman is really in that condition, it has been the custom in all civilized countries to ascertain by an inspection of the per- son's body whether she be enceinte or not. The early common-law rule of practice exempted a pregnant woman from capital punishment until after her delivery. According to its proviso, a jury of twelve matrons, or discreet females, was summoned to prove or disprove the fact of pregnancy under the writ de ventre inspiciendo. At the present time such a mode of examination would not be tolerated, and it has been condemned by modern medical au- thority, and superseded by a jury composed in whole or in part of physi- 1 Cases requiring examination of the insane are not considered here. ' In this connection it may be added that appeals of mayhem were abolished by statute. (59 Geo. III., ch. 46.) 528 A MANUAL OF LEGAL MEDICINE dans.' In some of the United States, however, there is no such provision, but it is the common practice of the court to appoint medical experts in these cases. Examination in Proceedings for Divorce or Nullity of Marriage. —" In an action for separation on the ground of impotence, the plaintiff may be ordered by the court to submit to an examination. This opinion is sus- tained on the ground that the very nature of the case renders other proof impossible. (Devenbagh vs. Devenbagh, 5 Paige, 554, Court of Chancery, N. Y.) But an order for an examination will not be granted unless the complaint is preferred in good faith." (Briggs vs. Morgan, 3 Phillimore, 325, 328; s. c, 1 Eng. Ecc. 490; 2 Hagg. Con. 324.) Furthermore, ac- cording to Thompson (Law of Trials, 1, 648), " A court will be more reluc- tant to order an inspection of the body of an old person than that of a young person ; and, for equally obvious reasons, it will be more reluctant to grant an inspection of the body of a wife than that of a husband ; though an inspection of the wife is sometimes ordered where she herself is the com- plainant, since the impediment to the consummation of the marriage may exist in her, and since the fact of her virginity may be of itself evidence of his incapacity. (Shafto vs. Shafto, 28 N. J. Eq. 34 ; Brown vs. Brown, 1 Hagg. Ecc. 523; s. c, 3 Eng. Ecc. 229; Anon., Dean & S. 333.) . . . Where, as in some American jurisdictions, divorce cases have been com- mitted to courts of chancery, a reference has been ordered to a master, directing him to conduct such an examination and report the result thereof. (Devenbagh vs. Devenbagh, 5 Paige (N. Y.), 554, 558.) An ex parte ex- amination by the party's own physician will not satisfy the demands of justice, but the defendant will be required to submit to an inspection by one or more respectable gentlemen of the medical profession, to be named for that pur- pose by the complainant with the sanction of the court. (Newell vs. Newell, 9 Paige, 25.) In another case a commissioner was appointed to take proofs, to select disinterested physicians, and through them to make such an ex- amination. (Le Barron vs. Le Barron, 35 Vt. 365, 372.) In the English Ecclesiastical Court the examination was conducted by medical inspectors, generally two physicians and a surgeon, or two surgeons and a physician, nominated by the complainant, with the privilege conceded to the adverse party of naming one or more of them. (Coote Ecc. Prac. 388.) They, of course, take an oath faithfully to perform the duty required of them. (2 1 Arizona Penal Code, \\ 6, 1845, 1846, requires a jury of three medical men. California Penal Code, \ 1221, a jury composed of three physicians. Idaho, Rev. Stats., \\ 8017, 8018, a jury of three physicians. Massachusetts, Public Stat, of 1882, chap. 215, 35, "must appear to the satisfaction of the governor and council," who would no doubt summon physicians. Minnesota Stats, of 1891, \ 6883, "to the satisfaction of the governor," who would probably summon a physician. Mississippi, Code of 1892, § 1450, "six physicians, if to be had," etc. In New York, Code of Civ. Proced., \ 500, sheriff of county where conviction occurs must empanel a jury of six physicians to inquire as to pregnancy. FORENSIC MEDICINE 529 Bishop Mar. & Div. 598 ; Coote Ecc. Prac. 389 ; Browne Div. Prac. (fourth ed.) 622, 623. The form of oath is given in 2 Bishop Mar. & Div. 598.) They certify to the court the result of their examination. (For forms of such certificates, see L. vs. H., 4 Swab. & Tr. 115, etc.) Their certificate merely states the result of their inspection, in conformity with the oath which they have taken, but does not give the reasons for their conclusions. (Pollard vs. Wybourn, 1 Hagg. Ecc. 725, 727.) In this regard it resembles a special verdict. In addition to requiring a written certificate, delivered under the obligation of the oath which they have taken, it is the constant practice of the English ecclesiastical courts to examine them as witnesses touching the result of their inspection." (Deane vs. Aveling, 1 Rob. Ecc. 279 ; W. vs. H., 2 Swab. & Tr. 240; M. vs. H., 3 Swab. & Tr. 517, 520; M. vs. B., 3 Swab. & Tr. 550, 553.) In cases in Chancery, where the question arises whether an heir pre- sumptive, or a person to whom a devise is made or real estate given by will for the remainder of the devisee's natural life, in tail or in fee, is entitled to such, an examination may be ordered before admitting such person to the enjoyment of an estate. (1 Bla. Com. 456 ; Lord Belmore vs. Anderson, 4 Bro. C. C. 90 ; ex parte Aiscough, 2 P. Wms. 591.) Inspection of the Child in Filiation Cases.—Thompson1 says, rela- tively to the trial of an action which involved the question of the legitimacy of a child who was alleged to be of mixed African blood, " It was held proper to allow the child to be exhibited to the jury, since, ' when the question is whether a certain object is black or white, the best evidence of color would be the exhibition of the object to the jury. The eyes of the members of the jury must be presumed to be as good as those of medical men. Why should a jury be confined to hearing what other men think they have seen, and not be allowed to think for themselves ?' (Warwick vs. Warwick, 76 N. C. 179.) In a previous case in the same State it was held no ground of new trial that the mother of the bastard child was put upon the stand having the child in her arms, and that the solicitor called the attention of the jury to the child's features, and afterwards commented upon its appearance in his address to the jury,—the defendant having taken no objection. The court said that it had long been the practice in that State, in bastardy cases, to exhibit the child to the jury. (State vs. Woodruff, 67 N. C. 89.) In a similar case in another jurisdiction it was held not error to allow a bastard child about two years old to be exhibited to the jury for the purpose of enabling them to determine whether there was a. family resemblance between the child and the defendant. (State vs. Smith (la.), 6 N. W. Rep. 153 ; s. c, 22 Alb. L. J. 43 ; s. c, 30 Am. Rep. 387.) But in another case in the same court it was held error to allow a child three months old to be thus exhibited. (State vs. Danforth, 48 la. 43; s. c, 30 Am Rep. 387.) The distinction drawn by the court between these two cases was that where a child has reached a considerable 1 Op. cit., p. 651. 34 53° A MANUAL OF LEGAL MEDICINE maturity family resemblances will appear; whereas all extremely young babies look substantially alike. Examination of Plaintiff in Actions for Personal Injuries.—Has the court power to order an inspection of the plaintiff s or i?iju?-ed person's body for the purpose of determining the extent and nature of the injuries ? The right of the defendant to secure an order for such an examination has been denied by some of the courts.1 On the other hand, other courts, "taking the more enlightened view that the object of a judicial trial is to enable the State to establish and enforce justice between party and party, have held that it is within the power of the trial court, in the exercise of a sound discretion, in proper cases, and upon an application seasonably made, under proper safeguards designed to preserve the rights of both parties, to order such an inspection, and to compel the plaintiff or injured person to submit to it. (White vs. Milwaukee, etc., R. Co., 61 Wis. 536 ; Walsh vs. Sayre, 52 How. Pr. 334; Shepard vs. Mo. P. R. Co., 85 Mo. 620; s. c, 55 Am. Rep. 390, etc.) Another court has held that where the plaintiff in such an action alleges that his injuries are of a permanent nature, the de- fendant is entitled, as a matter of right, to have the opinion of a surgeon, based upon a personal examination, unless there is already an abundance of expert evidence, in which case, in its discretion, it may refuse to order an examination. (Sibley vs. Smith, 48 Ark. 275 ; s. c, 55 Am. Rep. 584.) An- other court has ruled that the trial court may require the plaintiff in such an action to submit to a medical examination, and dismiss his action if he refuses to comply with the order." (Miami, etc., Co. vs. Baily, 37 Ohio St. 104.2) The court has power, under the New York statute, to direct the examina- tion of a person before trial, so as to give the defendant time in which to prepare for trial. It lies within the power of the court whether such inspec- tion shall or shall not be ordered. In the States of Iowa, Ohio, Minnesota, Nebraska, Wisconsin, Kansas, Georgia, and Alabama the practice of the courts has been to issue orders authorizing the ante-tx\a\. examination of the plaintiff. The physical examination of the plaintiff in actions for personal injuries is not performed before the jury, since an indecent exposure would thereby be effected. (Brown vs. Swineford, 44 Wis. 282, 285.) Furthermore, as Thompson3 says, '' While the court, for obvious reasons, will not make an 1 Stuart vs. Haven, 17 Neb. 211, 214; Sioux City, etc., R. Co. vs. Finlayson, 16 Neb. 578, 588 ; Loyd vs. R. Co., 53 Mo. 515 (overruled by Shepard vs. Mo. Pac. R. Co., 85 Mo. 629) ; Parker vs. Enslow, 102 111. 272, 279 (where the point is slurred over with- out discussion) ; Neuman vs. Third Ave. R. Co., 50 N. Y. Super. 412 ; Roberts vs. Og- densburgh, etc., R. Co., 29 Hun. N. Y. 154. In Texas it is ruled that the court will not compel a plaintiff suing for personal injuries to submit his body to examination, unless it is essential to the ends of justice. International, etc., R. Co. vs. Underwood, 64 Tex. 464. 2 Thompson's Law of Trials, vol. i. p. 653. 3 Op. cit. FORENSIC MEDICINE 53I order for such an examination to be had ex parte, or by surgeons selected by one party alone, without an opportunity for surgeons selected by the other party to be present, yet where the party has been examined ex parte with- out an order of the court, there is no rule of evidence which will exclude the testimony of the examining surgeons (Louisville, etc., R. Co. vs. Falvey, 104 Ind. 409, 417), provided their testimony does not come within the rule which excludes confidential communications between patient and physician." The plaintiff may be directed by the court to perform physical acts before the jury, for the purpose of showing the character of the injuries, but the propriety of such an order must rest in the discretion of the trial court. The right of the defendant to such an order might be disallowed, as in the following case. In an action against a railway company for damages, it ap- peared that the plaintiff, while leaving the defendant's cars, fell or was thrown from the platform or steps of the car upon the ground, injuring the sciatic or great nerve of the thigh. The plaintiff, as a witness in her own behalf, testified that this had occasioned great and constant pain, had caused the thigh to shrink, had rendered her lame, and had caused her to "limp" in walking. The counsel for the defendant thereupon requested the court to order her to walk across the court-room in the presence of the jury, which the court declined to do. The reviewing court saw, under the circumstances, no abuse of discretion in refusing to comply with the request. '' Such an act," said the court, " would have furnished the jury little or no aid in deter- mining the extent or character of her injuries. The only fact it could by any possibility have determined was whether or not she was lame, or 'limped,' as she testified, in walking. But there was already ample and uncontradicted evidence of this fact. Her own evidence on the point was fully corroborated by that of three or four other witnesses, her neighbors or members of her family, who had seen her almost daily since the accident." (Hatfield vs. St. Paul, etc., R. Co., Minn., 22 N. W. Rep. 178 ; s. c, 33 Minn. 130.) It may be doubted whether this was a sound conclusion. The fact that there was considerable evidence from the plaintiff herself and her neighbors to prove that she limped does not make it appear why the defendant was not entitled to an exhibition of her manner of walking before the jury, for the purpose, if possible, of showing the contrary, or at least of showing the extent to which she limped. It is true that the experiment might, if fraudulently per- formed by her, confirm her testimony and that of her witnesses on the point; but this would seem to be no reason for refusing the experiment on the appli- cation of the defendant.1 The question as to whether the plaintiff can be proceeded against for re- fusing to undergo an examination, as ordered by the court, may arise. '' In Elfers vs. Wooley, 116 N. Y. 294, the court held that a charge to the jury that it might take into consideration the fact that the plaintiff had refused to permit his person to be examined by a physician, when requested to do so 1 Thompson's Law of Trials, vol. i. p. 656. 532 A MANUAL OF LEGAL MEDICINE by the defendant, as bearing upon the credibility of the plaintiff's statement concerning his injuries, is not error. The court also held that it was not error for the trial court to refuse to charge the jury that the refusal of the plaintiff to submit to such an examination raised a presumption that his in- juries were not as severe as he claimed, putting the decision upon the ground that the charge above quoted was as favorable as the defendant could ask. It appears, however, from inspection of the printed record on the appeal in that case, that no objection was taken to the admission of the evi- dence concerning the plaintiff's refusal to submit to an examination. Hence, the evidence being before the court without objection, it might well be said that it was for the jury to determine what force and effect should be given to it. It seems to the writer of this article that where there is no statute per- mitting the courts to require such an examination, and hence where it is held, as in the Botsford case and the McQuiggan case, cited above,1 that the refusal to submit to such examination is a matter of right, evidence that the plaintiff did so refuse should not be held admissible or permitted to militate against him upon the trial of his case. On the other hand, where there is a statute, as in New York, permitting the court to order an examination by a physician whom it designates, it would certainly seem to be the law that the refusal of the plaintiff to submit to such an examination could be proved against him on the trial, in addition to any remedies the court might have for enforcing its order requiring an examination to be had." 2 MEDICAL MALPRACTICE. Definitions—Care, Skill, and Diligence—Errors in Judgment—No implied Warranty to cure the Patient—Consultation with other Physicians—Gratuitous Services— Contributory Negligence of Patient or Attendant—Liability of Partners in Medi- cine—Action barred by Recovery for Services—Malpractice as a Defence to a Suit for Services—Evidence—Damages—Criminal Liability. Definitions.—Malpractice, from the Latin mala praxis, may be defined to be bad or unskilful practice in a professional person, such as a physician, dentist, midwife, etc., whereby the patient's health is injured or death fol- lows the treatment. Wilful malpractice takes place when the physician or surgeon purposely administers medicines or performs an operation which he knows or expects will end in injury to the patient's health, endanger his life, or cause his death, as in the case of criminal abortion. Malpractice is said to be negligent when there are no criminal or dishonest motives on the part of the medical attend- ant ; but, instead, there is gross negligence or failure to render that attention to the patient which his situation requires. The administration of medicines while in a state of intoxication, or the performance of a surgical operation 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology, vol. ii. P- 257- 2 Ibid., p. 258. FORENSIC MEDICINE 533 while under like conditions, from which the patient might suffer injury, would come under this heading. Ignorant malpractice, on the other hand, consists in the administration of medicines or the performance of operations which do injury, and which an educated physician or surgeon would recognize as unsuitable. Fowler1 says, "The passive malpractice involved in allowing a patient to bleed to death without ascertaining the source of the hemorrhage or taking proper measures to arrest it is quite as reprehensible, cceteris paribus, as the active malpractice involved in causing a dangerous hemorrhage for want of proper care. Errors of omission, however, are of as great importance as those of commission, yet the former are apt to be judged less harshly than the latter. But it would be better, viewing the matter from a purely pro- fessional and scientific stand-point, to reject all artificial distinctions and con- sider only the behavior of the surgeon with relation to the nature of the disease, the condition of the patient, and the particular procedure claimed to be at fault." Care, Skill, and Diligence.—Physicians, surgeons, and dentists, when summoned to treat a case, are supposed to be possessed of the reasonable and ordinary qualifications of their profession ; they do not, however, pose as guarantors to cure. They are, nevertheless, expected to exercise reason- able and ordinary care, skill, and diligence. That is the extent of their lia- bility. What constitutes reasonable and ordinary care, skill, and diligence ? The law requires of physicians, surgeons, and dentists the reasonable and ordinary care, skill, and diligence which is commonly practised by profes- sionals in the same general neighborhood, and in the same general line of practice in like cases. In McCandless vs. McWha, 22 Pa. St. 261, the court said that the degree of skill necessary was that "which ordinarily characterizes the profession ;" but in a preceding portion of the opinion the court said '' that it was such skill as thoroughly educated surgeons ordinarily employ," which would probably indicate that this latter is the test which the court intended to prescribe.2 A patient who had been properly treated for a fractured leg was dis- charged before it had regained its strength without having received in- structions as to its care. The surgeons were held liable for negligence in not furnishing the necessary instructions, the patient having subsequently suffered the loss of his limb because he used it improperly.3 The law does not expect a physician or other professional person en- gaged in the practice of the medical science, who practises in a sparsely settled district, such as a village or small town, to exercise the same care and skill as would be expected of one residing in a large city, where the oppor- tunities of keeping fully alive to the latest methods and appliances are 1 Hamilton's System of Legal Medicine, vol. ii. p. 573. 2 American and English Encyclopaedia of Law, vol. xiv. p. 78. 3 Ibid. 534 A MANUAL OF LEGAL MEDICINE greater. Such persons are only bound to exercise the average degree of skill possessed by the profession in such places generally. A patient who had been improperly treated, as a result of the neglect of the medical attendant to employ the most modern and improved methods of practice, could very properly bring charges of neglect against the attend- ant, who, however honest in his method of treatment, would be liable if his patient suffered injury to his person. Furthermore, the medical attendant would be liable if he discontinued his visits and attention to the patient before giving the latter notice of his intention. The law requires him to "exercise reasonable and ordinary care and skill in determining when his attendance should cease." Errors in Judgment.—Medical practitioners are required to give their patients the benefit of their best judgment, although they do not render themselves liable for a mere error of judgment. If, however, the latter be inconsistent with reasonable care, skill, and diligence, they would be liable. (West vs. Martin, 31 Mo. 375 ; Howard vs. Grover, 28 Me. 97.) No implied Warranty to cure the Patient.—As intimated before, the medical practitioner does not obligate himself to cure a case of disease or injury, unless by contract, in virtue of which, should harm follow such obligation, he would be liable. Reese * says, '' The medical man should always beware of compromising himself by a promise to cure his patient; if, however, he be so unwise as to have made such a contract, he will be held by the law strictly accountable for its performance. In case of failure it will be no defence for him to allege the occurrence of unforeseen con- tingencies ; these he was bound to have knowledge of. Neither may he allege a want of sufficient skill or dexterity ; these he is supposed by the law to possess when he undertook the case." Consultation with others.—It sometimes happens that the physi- cian or surgeon is not competent or feels that he is not able to meet the exigencies of the case. In such an instance it would be his duty to either recommend the employment of another, or, if he feels competent him- self but harbors doubts concerning the case, he should seek consultation with other physicians and surgeons. It is competent in an action for mal- practice for the defendant to show that he engaged another physician or surgeon to assist him in the case. (Jones vs. Angell, 95 Ind. 376.) The refusal to accept the assistance of another medical man would impose no higher duty upon him. (Potter vs. Warner, 91 Pa. St. 362 ; 36 Am. Rep. 668.) Gratuitous Services.—The fact that a medical man renders services gratuitously does not affect his duty to exercise reasonable and ordinary care, skill, and diligence. (McNevens vs. Lowe, 40 111. 209.) Gratuitous treat- ment of a patient by a practitioner does not imply that the latter is privi- leged to treat the former other than in a scientific and careful manner. The 1 Op. cit., p. 653. FORENSIC MEDICINE 535 fact that for eighteen months a physician had abstained from making a claim for compensation for his treatment of a case might, in an action for malpractice, and particularly in a doubtful or balanced case, be urged with great force as in the nature of an admission of neglect or want of skill, as evidence on the part of the medical attendant that he was not entitled to pay for his services, and that they were valueless. It furnishes a collateral issue upon which the defendant is summoned to give explanatory or contra- dictory evidence, and by which the jury may be embarrassed in its delib- erations.1 Contributory Negligence of Patient or Attendant.—A patient or attendant who refuses to co-operate with his physician or surgeon by neg- lecting or refusing to employ the remedies prescribed, or who declines to allow the performance of a necessary surgical operation, cannot recover for malpractice unless the injury is traceable to the medical attendant's ignorance.2 The information, however, which a practitioner furnishes his patient relative to his trouble should be considered by the jury in deter- mining the question whether the patient, in neglecting to follow the physi- cian's advice, was or was not guilty of contributory negligence.3 Experi- mental surgery is not permissible by law without liability to damages should the experiment result in the injury or death of the patient. In some in- stances, however, experimental treatment is not necessarily culpable of itself, since it would be impossible to frame a legal code embodying the rules of the science of medicine. (Fowler.) The refusal to permit a physician or surgeon to experiment to remedy another practitioner's mistake could have no effect in mitigation of damages.4 If the contributing causes of injury or disease arise from the patient's own natural temperament or physical weakness, recovery for malpractice cannot be entertained. (Simonds vs. Henry, 39 Me. 155 ; Haire vs. Reese, 7 Phila., Pa., 138, etc.) Where the injury attributable to the patient's refusal or neglect to follow the directions of his medical attendant can be separated from the fault of the practitioner in his conduct of the case, damages for so much of the injury as is due to the latter's neglect may be recovered by the former.5 The patient cannot, however, claim damages of the medical attendant for the results of his management of the case, if he 1 American and English Encyclopaedia of Law, vol. xiv. p. 81; Baird vs. Gillet, 47 N. Y. 186. 2 " If the patient, by refusing to adopt the remedies or comply with the directions of the physician, frustrates or defeats the endeavors of the physician, or if he aggra- vates the case by his misconduct, he cannot charge to the physician the consequences due distinctly to himself." (Jones vs. Angell, 95 Ind. 376.) 3 American and English Encyclopaedia of Law, vol. xiv. p. 81 ; Geiselman vs. Scott, 25 Ohio St. 86. 4 Ibid., p. 81 ; Chamberlain vs. Morgan, 68 Pa. St. 168, etc. s Ibid., p. 82 ; Hibbard vs. Thompson, 109 Mass. 286; Wilmot vs. Howard, 39 Vt. 447. 536 A MANUAL OF LEGAL MEDICINE gives direction as to how his treatment shall be carried out according to his own judgment.1 In an action for malpractice the burden of proof to show contributory negligence rests upon the defendant. (Gramm vs. Boener, 56 Ind. 497. A contrary rule is adopted in Iowa. Baird vs. Morford, 29 Iowa, 531.) Liability of Partners in Medicine.—Where two or more medical men engage in the practice of their profession as partners, all are liable for malpractice by any member of the copartnership. (Hyrne vs. Erwin, 23 S. Car. 226 ; 55 Am. Rep. 15 ; Whittaker vs. Collins, 34 Minn. 299.) Action barred by Recovery for Services.—A recovery by a medical practitioner for his services will act as a barrier to any future action for mal- practice, with some exceptions. (Bellinger vs. Craigue, 31 Barb. N. Y. 534 ; Blair vs. Bartlett, 75 N.Y. 150 ; Gates vs. Preston, 41 N. Y. 113.) In some of the States, however, it is held that if recovery be by confession or default, it is not a bar. (Ressiquie vs. Byers, 52 Wis. 650 ; 38 Am. Rep. 775 ; Skyes vs. Bonner, 1 Cin. Super. Ct. 464 ; Goble vs. Dillon, 86 Ind. 327 ; 44 Am. Rep. 308 ; Am. and Eng. Enc. of Law, 14, 83.) Evidence in Malpractice Cases.—It is competent, as a rule, to show the general reputation of the defendant for skilfulness and learning. (Leighton vs. Sargent, 27 N. H. 460 ; Am. and Eng. Enc. of Law, 14, 83.) In some States, however, this form of evidence as a defence to an action for malpractice is not allowed. (Ibid., Holtzman vs. Hoy, 19 111., App. 459 ; Carpenter vs. Blake, 66 Barb. N. Y. 448 ; 50 N. Y. 696 ; 10 Hun. N. Y. 358 ; 75 N. Y. 12 ; Williams vs. Poppleton, 3 Or. 139 ; Mertz vs. Detweiler, 8 W. & S. Pa. 376.) The mere failure on the part of the medical practitioner to effect a cure of his patient's ailment raises no pre- sumption of a want of proper care, skill, and diligence. (Tefft vs. Wilcox, 6 Kan. 46 ; Haire vs. Reese, 7 Phila., Pa., 138 ; Ibid., 14, 83.) Hypothetical questions may be put to a witness by the plaintiff if based upon the facts constituting the alleged malpractice. " There is no objection to asking an expert witness what, assuming the testimony to be true without summarizing it in the question, his opinion is as to the treatment." (Ibid., 14, 84 ; Wright vs. Hardy, 22 Wis. 348 ; Gates vs. Fleischer, 67 Wis. 504.) It is not, however, proper to include any supposition not borne out by the evidence. (Reber vs. Herring, 115 Pa. St. 599; Mayo vs. Wright, 63 Mich. 32 ; Ibid., 14, 84.) Where an action has been brought against a sur- geon for malpractice in the treatment of an injured limb, the plaintiff may be permitted to show the injured member to the jury. (Fowler vs. Sergeant, 1 Grant's Cas. Pa. 355 ; Ibid., 14, 84.) In a suit brought several years after the injury, it was held proper to allow the plaintiff to show the injured limb to the jury. (Carstens vs. Hanselman, 61 Mich. 426.) Damages.—In an action to recover damages for malpractice the plaintiff may recover, although the practitioner was summoned and paid by another. 1 Gramm vs. Boener, 56 Ind. 497; Hancke vs. Hooper, 7 Car. & P. (Eng.) 8. FORENSIC MEDICINE 537 (Nugent vs. Boston, etc., R. Co., 80 Me. 62 ; Gladwell vs. Steggall, 5 Bing. N. C. 733 ; 35 E. C. L. 392.) The husband of a woman who has suffered death through unskilfulness in performing a surgical operation may recover damages from the surgeon for causing the death of his wife. (Cross vs. Guthery, 2 Root, Conn. 90 ; 1 Am. Dec. 61.) Under the Indiana acts, 1879, p. 160, a married woman may sue alone for injury caused by malpractice. (Barnett vs. Leonard, 66 Ind. 422 ; Am. and Eng. Enc. of Law, 14, 84.) The measure of pecuniary damages in an action for malpractice would be as follows : (1) loss of time and labor arising from the injury sustained by the malpractice ; (2) the reasonable expenses incurred for surgical, medical, and other attendance in consequence thereof; (3) diminished capacity to work at the trade or business of the injured party in consequence thereof; (4) bodily pain and mental anguish in consequence thereof. Regard is also to be had to the nature of the injury, whether it be temporary or permanent, and also to the situation of the injured party. (Field's Medico- Legal Guide, 225, and Am. and Eng. Enc. of Law, 14, 84.) In an action against a practitioner of medicine for malpractice it is not competent to show declarations of the practitioner indicating ignorance for the purpose of increasing damages. (Am. and Eng. Enc. of Law, 14, 85 ; Grannis vs. Branden, 5 Day, Conn. 260 ; 5 Am. Dec. 143.) "The question as to the amount of damages belongs to the jury. In relation thereto they have a very broad discretion. The general rule has been that a new trial will not be granted in an action of this kind for excessive damages unless they are so clearly excessive as to indicate that the jury acted from prejudice, partiality, or corruption, or were misled as to the measure of damages. That the jury assessed higher damages than the court would have assessed is no reason why the verdict should be set aside." (Ibid., Kelsey vs. Hay, 84 Ind. 189.) An instruction to a jury, in a case where no wilful negligence has been shown, that they may find a verdict for any sum they see fit, up to the amount claimed in the complaint, if they believe that the defendant was wil- fully negligent, is improper. (Ibid., 14, 85 ; Wenger vs. Calder, 78 111. 275.) What are termed compromise verdicts are not looked upon with favor in malpractice cases. Each party has a right to insist that the jury, and each juror, shall render a verdict, if at all, according to the law and the evidence as given on the trial. (Ibid., 14, 85. " It is the duty of each juror carefully and patiently to canvass and consider the evidence, in all its bearings, with an honest and conscientious effort to reconcile any difference that may exist between him and his fellow-jurors as to the truth of the matters put in issue, and with a willingness to adopt the views of his fellow-jurors when he can see that they accord with the law and the evidence. But it would be a gross wrong to one or the other of these parties to carry the spirit of compromise to the extent of yielding to that which you do not believe to be true, and to render a verdict, merely for the sake of compromise, that you do not believe to be in accordance with the truth." Heath vs. Glisan, 3 Or. 64.) 538 A MANUAL OF LEGAL MEDICINE Criminal Liability.—" A physician or surgeon may be held criminally responsible for his malpractice, but only in case of the grossest ignorance or criminal inattention." (State vs. Hardister, 38 Ark. 605 ; Rex vs. Van Butchell, 3 C. & P. 629 ; Rex vs. Williamson, 3 C. & P. 635 ; Rex vs. Long, 4 C. & P. 398.) " If a medical man, through gross ignorance or inattention, cause the death of a patient, he is guilty of manslaughter (Com. vs. Pierce, 138 Mass. 165 ; State vs. Hardister, 38 Ark. 605 ; Tessymond's Case, 1 Lewin, 169 ; Ferguson's Case, 1 Lewin, 181 ; Rex vs. Simpson, Wil- lecock Med. Prof, pt. 2, ccxxvii.; Webb's Case, 2 Lewin, 196, 211 ; Rex vs. Senior, 1 Moody, 346 ; Rex vs. Williamson, 3 C. & P. 635 ; Rex vs. Long, 4 C. & P. 398, 423 ; Rex vs. Spiller, 5 C. & P. 333 ; Queen vs. Spilling, 2 M. & R. 107 ; Reg. vs. Whitehead, 3 C. & K. 202 ; Reg. vs. Crick, 1 F. & F. 519 ; Reg. vs. Crook, 1 F. & F. 519 ; Reg. vs. Markus, 4 F. & F. 356; Reg. vs. Chamberlain, 10 Cox C. C. 486; Reg. vs. McLeod, 12 Cox C. C. 534 ; Reg. vs. Spencer, 10 Cox C. C. 525) ; or if death does not follow, but the patient be injured, he is guilty of a misdemeanor." (Greon- velt's Case, 1 Ld. Raym. 213 ; Rex vs. Long, 4 C. & P. 398.) "Some of the State courts have held that if a physician treats a patient in good faith and to the best of his ability, and death or injury ensues, he is not criminally liable." (State vs. Schultz, 55 Iowa, 628 ; Rice vs. State, 8 Mo. 561 ; Com. vs. Thompson, 6 Mass. 134, dis. in 138 Mass. 165 ; Am. and Eng. Enc. of Law, 14, 85, 86.1) Summary of the Foregoing.—A practitioner of medicine or surgery is guilty of criminal malpractice (1) when serious injury or damage results on account of his gross ignorance or neglect; (2) when he administers medicines or uses any surgical procedure in the attempt to commit a crime prohibited by statute ; (3) when he wilfully or intentionally uses any medical or surgical procedure which is liable to endanger the life or health of his patient; (4) when he wilfully or intentionally neglects to adopt such means as may be required for the safety of his patient; (5) he is civilly liable for any injury that may result which is traceable to his want of knowledge or negligence ; (6) he is expected by the law to exercise an average amount of skill and care in the treatment of his cases, according to the locality in which he lives ; (7) if he exhibits these qualifications, he is not to be held account- able for results, in the absence of an express contract to cure the patient; (8) the fact of his having treated a patient gratuitously does not relieve him of his responsibility to furnish proper treatment, care, and attention to his patient; (9) he is not obliged to accept the treatment of a patient against his will; he cannot, however, withdraw without giving sufficient notice of his desire to do so ; (10) an action for malpractice cannot be brought against him after he has brought suit and obtained judgment for his services ; (11) he is relieved of all responsibility in connection with the treatment of his patient when the latter failed to follow or live up to the advice of the former ; 1 Vide chap. xlii. for the Liability of Druggists, etc. FORENSIC MEDICINE 539 (12) he is civilly responsible when his assistants, through ignorance or care- lessness, injure his patient, but he is not accountable for any wilful crim- inal act upon their part; (13) he is not responsible for errors of judgment or mere mistakes in matters of doubt and uncertainty ; and (14) he is not presumed to engage for extraordinary skill or for extraordinary attention and care. RAILWAY INJURIES.' Remarks—Injuries of the Back—Nervous Shock—Traumatic Hysteria—Malingering— Medico-Legal Aspects. Railway injuries, aside from their surgical interest, assume other de- grees of importance of no less interest to the medical jurist, who may be required to appear in court to testify as to their gravity or reality when pecuniary compensation is asked by the real or alleged injured person. The necessity of being familiar with the more common effects of railway injuries cannot be questioned, since any physician or surgeon may be compelled to act as a witness after having rendered assistance to such an injured individual. At the present time suits for damages are of such frequent occurrence that the medical man must be extremely cautious when called on for an opinion as to the prognosis or gravity of a traumatism resulting under the above circumstances. Experienced surgeons are fully aware of the many attempts made by unscrupulous persons to enlist their services as a means of extorting large sums of money from railway companies for injuries which in reality do not exist. So clever, sometimes, are these persons that their simulation of the injury they pretend to be afflicted with baffles the most experienced and reputable practitioners. Hence the great importance of a correct diagnosis in these cases ; in fact, under such circumstances the question of railway in- juries calls for the highest degree of skill, in order to be able to distinguish accurately between genuine and fraudulent claims for damages. The number of persons in the United States who annually present them- selves as claimants for damages against railway corporations for injuries more or less severe is very large indeed. Out of this number a great pro- portion of the cases are fictitious and fraudulent. It may readily and with- out exaggeration be stated that more or less misrepresentation exists in almost every instance of railway injury. " In the great majority of cases," says Hamilton,2 a "good verdict brings with it a complete cure, and patients who have been brought into court upon a litter, surrounded by tearful and interested friends and attentive physicians, whose cases have been dramati- cally described to the jury, leave the court-room, and a few days or weeks after the swindle engage in their regular pursuits as if nothing had happened. It is to be regretted that in such cases physicians have been found who have 1 Vide the larger works upon the subject for a more detailed description of these injuries. 2 The ^Esculapian, January, 1884, vol. i. 540 A MANUAL OF LEGAL MEDICINE been willing to testify to the existence of serious organic disease of the ner- vous system when no evidence of such was presented except the patient's unreliable and prejudiced statements." Of two hundred and thirty-four cases of suits for damages, cited by Page,1 a great majority were fraudulent or exaggerated. Of twenty-eight reported by Rigler, seven were simulated, and in thirteen the diagnosis in regard to fraud was questionable. The following case, reported by R. M. Hodges, is a characteristic one in so far that it illustrates how a jury was led to believe the plaintiff and award him the damages demanded, notwith- standing the fact that the claim was fraudulent. " In 1872 the Metropolitan Railway, of Boston, Mass., was mulcted by a jury in a sum of ten thousand dollars in the case of a man whose detailed symptoms satisfied them that he was utterly enfeebled in body and wholly unable to earn his own living. At the close of the trial the plaintiff celebrated his victory by becoming uproari- ously drunk, and it required the united strength of three policemen to take him to the station-house." ( Vide also Malingering.) During the year ending June 30, 1894, 1823 employees of railways in the United States suffered death from railway accidents, and 23,422 were injured, as compared with 2727 killed and 31,729 injured in 1893. The number of passengers injured fatally was 324, an increase of 25, and the number hurt was 3304, a decrease of 195. The ratio of casualty to travel- lers was one passenger killed out of 1,912,618 transported, or for each 44,103,228 miles travelled, and one injured out of 204,248 carried, or for each 4,709,771 miles travelled. These numbers serve to indicate the almost wholesale destructive power of railways. The object of this chapter is to furnish the medical jurist with an account of the spinal injuries which are so frequently the result of railway accidents ; hence the subject-matter will embrace none of the many other forms of violence so prevalent in these cases, since they differ in no respect from those which are observed in many other ways. Injuries of the Back.—The frequency of this form of injury is be- yond question. Statistics show that it is a most common result of railway collision, and, as Page states, fully sixty per cent, of those injured in this manner suffer more or less from the effects of the concussion to the back. There seems to be in these cases a marked difference between the injuries to the back occurring to passengers and those affecting employees of the railway upon which both are carried. There is also a difference of results. According to Outten,2 of eighteen thousand eight hundred and eighty-five injuries to those in the employ of the railroad, ten hundred and fourteen in- volved the back. Of this number five hundred and nine showed only par- tial or no external evidence of injury. Twenty-six cases were concussions 1 Injuries of the Spine and Spinal Cord, etc., 1885. 2 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology, vol. ii. P- 574- FORENSIC MEDICINE 541 of the cord, and eighteen concussions of the brain and spine combined. Of eight hundred and forty-four injuries to passengers, one hundred and twenty- seven instances showed slight or no external evidence of injury to the neck. The most frequent cause of these injuries is the jar or jolt, or what the French call embrouillement, the sharp vibration that is transmitted after the complete arrest of motion. In addition to this, sudden and violent strains and wrenches due to great muscular excitation, sudden prehensile movements, and force directly applied to the back are evident etiological causes of injury to this part of the body. Injuries to the back, the result of railway collisions, may be observed in any of the following forms : (1) simple lumbar sprain (traumatic lumbago) ; (2) cervico-dorsal sprain ; (3) sprain of the entire vertebral column ; (4) lumbar sprain, with very acute pain ; (5) sprain of the dorsal and lumbar vertebrae, with hyperaesthesia of the surface ; (6) severe general vertebral sprain, with sensations of numbness and tingling ; (7) severe lumbo-sacral sprain, with probable injury to the cords of the sacral plexus ; (8) lumbo- sacral sprain, with probable injury to or hemorrhage round the pelvic plexuses ; and (9) late myelitis following obscure spinal injury. In simple lumbar sprain, the result of slight collision, if the subject be otherwise of robust constitution, the only probable local manifestation of the effects of the accident would be a simple sprain of the ligaments and muscles about the lumbo-sacral region,—in other words, the patient would be suffer- ing from a traumatic lumbago. In such an instance the passenger was prob- ably suddenly thrown backward and forward in the car, although the sudden arrest of the motion of the train might result in such injury. Again, the muscles and ligaments attached to the spinal column are frequently thrown into a tetanic state by the conscious or unconscious effort of the subject at the moment of the collision, for the purpose of offering resistance to the almost immediate shock to the cord. The effect of this resistance on the part of the traveller is usually the stretching, straining, or even rupturing of these structures. A cervico-dorsal sprain, as the result of railway collision, may be followed by a momentarily acute pain in the cervico-dorsal region of the spine. After the acute character of the pain has passed off, the part involved by the acci- dent may still be the seat of a weary aching for several weeks. This may occur over and on either side of the spinal column. Other indications of injury are absent, and the nausea and vomiting usually experienced at the time of the accident soon pass away. The nature of this form of injury is precisely the same as that mentioned in the case just cited. In sprains of the entire vertebral column the victim may complain of feeling sick at the stomach, although no vomit is present; pain seizes him within a couple of hours, and tenderness will be experienced in the lower part of the back, particularly over the two lower dorsal and two upper lumbar vertebrae. The after-results in cases of this kind are apt to be rather severe. The patient may complain, even a month after the infliction of the 542 A MANUAL OF LEGAL MEDICINE injury, of severe pain throughout the whole spine, together with difficulty when the attempt to move is made. Peripheral pain is not present in these cases, and the pulse and temperature are, as a rule, normal. In any of these three forms of injury to the back, nervous shock may be experienced by the subject. Stiffness, tenderness, and pain are the most prominent symptoms of simple sprain of the back. These signs may exist at any portion of the spinal column, or may involve the whole of it. Added to these signs are others as sequela,—i.e., extreme difficulty in moving the head, limbs, or body, accompanied by severe pain. This latter may be so intense as to cause the patient to be extremely wary in making such movements. Diffi- culty in walking is another sign of diagnostic importance in these cases. The injured person may also experience considerable difficulty in urinating. This is probably due to inability of the lumbar muscles to act as a support and help during the act of micturition. Irritability of the bladder may be an- other trouble, a symptom that may become of great inconvenience to the in- jured person. "When the nervous system has been much upset by the shock of the accident, you may find a condition of 'nervous bladder,' in which the patient has a frequent desire to pass water, with inability at the same time to perform the act perfectly, and consequent slight dribbling at its close." (Page.) Another manifestation of the same muscular incapacity is constipation, which gives rise to the fear of paralysis supervening, which is further in- creased by the peculiar sensations incidental to the incapacity of the muscular and ligamentous attachments already alluded to. These cases of pseudo- paralysis, if not understood, may be the cause of unnecessary alarm. Sprain of the dorsal and lumbar vertebra, with hypercesthesia, is a form of injury which may result from a collision of no great severity. Thus, in a case cited by Page,1 "a young man was slightly shaken in a collision, and in a few days had pains about the vertebral column. He gradually recov- ered from the effects of the shake, but the aching in the back continued, and the spine was therefore more especially examined, not much attention having been paid to it hitherto. The examination revealed a point of tenderness on pressure over one of the dorsal vertebrae, at the point, in fact, where the sprain had probably been most severe. Within a day or two his back be- came so sensitive that he complained of and shrank from the very lightest touch of the finger on almost every part of it, whether over the spinal column or over the muscles at the side. He was so sensitive to touch that he en- deavored to avoid being touched at all, seemed even afraid to have his back looked at, and moved himself away with so much contortion as in itself to afford evidence of the absence of any serious mischief about the vertebral column or its contents. The hyperaesthesia was doubtless perfectly genuine ; but, in addition to the mode of onset, observe the inconsistencies of the hy- 1 Op. cit, p. 17. FORENSIC MEDICINE 543 peraesthesia itself. So great was it that, had it been real and not imaginary, it must have been unbearable for the man either to have rested against his couch or even to have borne the contact of his clothes. This is the hyper- aesthesia so often found superadded to the pain which is a real consequence of the vertebral sprain ; and yet too frequently the inconsistencies thereof are ignored, and the hypersensitiveness is regarded as another and more telling symptom of some inflammatory condition of the membranes of the spioal cord. It has little in common, however, with the hyperaesthesia or the eccentric pains which are a result of irritation of the sensory nerve-roots, whether by thickening of membranes or otherwise ; and it is unlike the zone or girdle of hyperaesthesia which may feel to the patient like a cord or some other abnormal sensation at the periphery. The hyperaesthesia is too wide- spread over one area, and is at the same time too limited to the area which is the chief seat of attention. It is, moreover, unlikely that real irritation of the sensory nerve-roots should give rise to hyperaesthesia upon the back alone. It is rather the natural outcome of that alarm which, both in hospital patients and in those more especially who have been in railway collisions, seems to be inseparable from injuries to the back or spine ; and although undoubtedly a real condition to the patient himself, it is yet unreal, and the product of his disordered imagination alone." Besides the more immediate symptoms or signs (pain, tenderness, stiff- ness, and hyperaesthesia), there are others which deserve attention in these cases of injury to the back. Abnormal sensations of tingling and numbness in some parts of the extremities are not uncommon signs after rather severe railway collisions. In a case mentioned by Page * the patient complained of abnormal sensations in the limbs, which came on synchronously with the pains. This case was precisely similar to the one just quoted, with this ex- ception. The sensations were general, and not confined to any one limb or part of a limb. They are probably due to some effect occasioned by the strain or blow upon the nerve-trunks proceeding from the spinal column to the extremities. "In severe collisions," says Page, " where there is a risk of the body being suddenly bent and strained in many different directions, it is indeed highly probable that every part of the spinal column is subjected to muscular and ligamentous strain, and it is not inconceivable that the nerves which permeate the column at both sides should be involved in the same injury." In a case of severe lumbosacral sprain, with probable injury to the cords of the sacral plexus, the impairment of motion and sensation complained of was very likely the result of some injury to the nerve-trunks. In this case, beyond the bruising, there were no physical signs of injury to the spinal column. In addition to the paresis, injury to the muscular and ligamen- tous structures about the hips and pelvis was apparent. There was not, however, any paralysis of the bladder or bowel. The patient was completely 1 Op. cit., p. 20. 544 A MANUAL OF LEGAL MEDICINE cured at the end of three years. "It is impossible to say with certainty whether that injury was after the nerves had formed the plexuses outside the vertebral column or when they still were individual cords in the cauda equina. If the paresis was due to traumatic lesion of the nerve-trunks within the spinal canal, it is almost inconceivable that the effects could have been confined to the nerves of one limb only, and on this ground it seems more reasonable to conclude that the injury to the nerve-trunks was outside the vertebral column. The length of time, moreover, that elapsed before the recovery of the patient seems further to confirm this opinion, whether the essential lesion was of the nerves themselves or, as is equally probable from the character of the blow, was hemorrhage lying around and pressing upon them." Late myelitis following obscure spinal injury was observed in a case cited by Page.1 The patient, aged twenty-nine, was a thin and delicate man. He was injured in a very serious collision in which several persons were killed. As he was dazed at the time of the accident, he could furnish no accurate account of the occurrence. He was confined to his bed for about three weeks, suffering considerably from pain in his back and legs. He then improved sufficiently to be able to repair to a hydropathic establish- ment in the country, where he remained for two months. His back was a source of great trouble to him, but he was otherwise much improved. At the end of these two months the weakness of the legs observed before be- came a much more definite loss of power, and in a week or so he was unable to walk. Ten months after the collision there was no mistake as to his con- dition. He possessed no power of locomotion, and had almost entirely lost sensation in his legs. There was paralysis of the bladder and bowel, bed- sores, and reflex spasms of the lower extremities, all of which pointed to softening of the cord. His temperature was supra-normal and his pulse frequent. The pain in the back was very much exaggerated, but there was no marked tenderness. After lingering some months without improvement, he died. As there was no post-mortem examination permitted in this case, Page suggests the following as a very probable sequence of events. '' A small localized injury of the membranes, or hemorrhage at the site of the injury to the vertebral column, followed by a meningitis which was at first too limited in extent to give rise to any precise symptoms, but which pro- ceeded and, having implicated the cord, was the cause of the myelitis which had a fatal issue. If this be the explanation, the meningitis must have been exceedingly limited, because traumatic meningitis does not usually follow an unobserved course. Sometimes it is acute, spreads rapidly, gives rise to definite symptoms, and has a fatal result. At other times a less violent in- flammation leads to local thickening and adhesion about the spinal roots, causing peripheral symptoms of impaired innervation ; or similar pathologic changes may involve the cord itself, and setting up degeneration therein, pre- 1 Op. cit., p. 25. FORENSIC MEDICINE 545 sent very definite indications of structural disease. But acute myelitis at so long an interval after injury is most uncommon. Still further doubt, however, surrounds this case ; for at the time when the symptoms of spinal softening were becoming marked the man had epididymitis. It is true that gonorrhoea was altogether denied, and that the epididymitis may have been caused by the frequent use of the cathether ; but it is to be remembered that myelitis of the cord may be the result of thrombosis of the pelvic and vesical veins, a direct consequence of the same urethral inflammation which had produced epididymitis. It seems, therefore, within the range of possibility that the myelitis and the fatal result were not due to the injury at all." Acute traumatic meningitis is rarely present in railway injury, although it is spoken of by some authorities as occurring with seemng frequency. Chronic inflammations of the spinal cord following this class of injuries are not frequently met with.1 Nervous Shock.—Concussion of the spine from general shock denotes a functional disturbance of the nervous equilibrium rather than structural change or damage to any organ of the body. This class of cases is of greater frequency in railway than in other injuries. Shock or collapse, in greater or less degree, is an invariable accompaniment to sudden or severe injury, whether the latter be the result of railway or other accidents. The term " lifelessness" has been applied to the state of shock from severe injury. There is a lowering of the vital powers,—a vaso-motor paralysis, affecting also the heart and especially the abdominal vessels. The collapse may be so profound as to be more dangerous to the well-being of the patient than the injury which was the occasion of it. In such instances death may speedily take place, although such an issue is rather exceptional, especially in uncomplicated cases. In the majority of cases a period of reaction suc- ceeds the collapse of the patient. During this time there is a gradual re- turn to the previous state of health. The duration as well as the activity of the reaction is proportioned to the condition existing during the period of depression or collapse. If the patient's system at the time of the accident be in a debilitated state, due to disease, unusual privations, alcoholic ex- cesses, etc., reaction in the manner just depicted usually fails to ensue, and the patient will pass into that state known as prostration with excitement. Everything depends on proper treatment, which should of course be thor- oughly carried out. The prognosis in shock is always bad if the temperature falls below 35.6° C. (960 F.), or if the reaction is delayed for twenty-four hours. ( Vide Wounds.) Fright may conduce to shock, and in many cases it is responsible for the immediate collapse or insensibility into which the victim is plunged. In railway injuries it plays an important part as being provocative of those 1 The reader is referred to the special treatises upon the subject of railway injuries for notice of the other causes besides trauma which produce functional troubles in these cases. AS 546 A MANUAL OF LEGAL MEDICINE after-effects or symptoms which figure so prominently in the medico-legal considerations of such cases. Jordan' says, '' The principal feature in railway injuries is the combination of the psychical and corporeal elements in the causation of shock in such a manner that the former or psychical element is always present in its most intense and violent form. The incidents of a railway accident contribute to form a combination of the most terrible cir- cumstances which it is possible for the mind to conceive. The vastness of the destructive forces, the magnitude of the results, the imminent danger to the lives of numbers of human beings, and the hopelessness of escape from the danger give rise to emotions which in themselves are quite suffi- cient to produce shock or even death itself. . . . All that the most powerful impression on the nervous system can effect is effected in a railway accident, and this quite irrespectively of the extent or importance of the bodily injury." Fear and profound mental emotion are in a great measure re- sponsible as causes of the symptoms of nervous shock so commonly ob- served after railway collisions. "On the other hand," says Page,2 "we may hear the condition regarded as evidence of serious and irremediable pathologic change in the chief centres of the nervous system ; and, on the other hand, no clear history of pronounced shock or collapse at the time of the injury being forthcoming, the symptoms are deemed unreal, and the bona fides of the patient is called in question. The mistakes are at opposite ends, and I hardly know which is the worse for the patient who, really suffering and ill, lies in the condition in which we find him because his whole nervous system has received a shock, not so much from severe bodily injury, which shows itself in unmistakable signs, as from the impalpable ele- ment of alarm, which has to be measured by the events of the accident itself and by the temperament of the individual who has been affected thereby." The symptoms of shock comprise disturbances of the circulation, disor- ders of secretion, catamenial derangements, derangement of the digestive .and genito-urinary systems, headache, loss of memory, various ocular phe- nomena, nervousness, and sleeplessness, (i) Disturbances of the circulation are commonly observed in cases of general nervous shock. As is well .known, shock is usually ushered in by smallness, feebleness, or slowness of the heart-beat. Sometimes it is scarcely perceptible. In the more serious cases, those based upon a combination of continued terror and emotion, the derangements of the circulatory apparatus are of longer duration. Palpi- tation is complained of, and the frequency of the pulse-beat may be so increased as to register ioo to 150 beats to the minute. These symptoms are, however, brought about by exciting causes other than the mere shock, a point of importance to recollect when examining the patient. Page3 says, '' A perfectly steady pulse throughout the whole examination tells its own 1 Surgical Enquiries, second edition. 2 Op. cit., p. 37. 3 Op. cit., p. 47. FORENSIC MEDICINE 547 tale. Nay, the rate, the character, and the excitability of the pulse form an almost metrical indication of the amount of disturbance of the nervous bal- ance, strength, and tone ; and the pulse is often the only sign there is to guide us to a right estimate of the patient's condition." Besides the changes of the pulse, derangement of the whole vaso-motor system may exist, as evidenced by the alternate sensations of heat and cold, flushing of the face, etc. All of the symptoms characteristic of disturbances of the circu- lation cease upon the patient's restoration to health. (2) Sleeplessness, in these cases, is a sign that shows the loss of tone and equilibrium of the nervous system, and its causes may be other than those arising from the original nervous shock. Headache is the principal symptom of neuras- thenia. In this case it is present as occipital oppression or pain. It may be brought about by various means, such as the exciting causes of palpi- tation, or by derangements of the vaso-motor system, etc. (3) Nervous- ness includes a great variety of complaints and symptoms which, as Page says, "have no more substantial basis than the statements of the patients themselves." (4) Disorders of secretion are of frequent occurrence in cases of general nervous shock. One of the most common disorders of this func- tion is excessive perspiration. Polyuria, menorrhagia, etc., are also evidences of a weakened state of the nerves which control the action of the secre- tory apparatus. (5) Of the various ocular phenomena, valuable evidence of the tone of the nervous system may be afforded by the size of the pupil of the eye. A small pupil, which very readily varies according to the degree of light admitted, is compatible with a healthy tone of the nervous system. On the other hand, a widely dilated and sluggish pupil is in- dicative of exhausted nervous strength. The deeper structures of the eye are rarely affected in spinal injuries due to railway collisions, although in some instances organic changes have been observed. (6) The loss of memory so often complained of by persons suffering from spinal injuries is not so much an inability to recall incidents of past life, etc., as it is a lack of the power of volitional attention, a state of the mind produced by a depressed and weakened condition of the nervous system. (7) Catamenial derangements are not uncommon in cases of nervous shock. Menorrhagia and suppression of the menses may occur in consequence of nervous shock. Suppression of the catamenia may follow immediately the general nervous prostration brought about by an accident, such as a railway collision. This suppression may last for months at a time ; at any rate until the normal tone of the nervous system is restored. (8) The retention of urine is a marked symptom of profound shock. The sexual organs are likewise more or less affected in cases of depression of the nervous tone. Thus, the patient may experience difficulty in accomplishing conjugal relations ; in fact, he may possess neither the will nor the desire. Sexual exhaustion generally lasts as long as the neurasthenia, and is, therefore, to be recognized as evidence of a depressed state of nervous tone in those so afflicted, be it accidental or otherwise in origin. (9) Of the derangements of the digestive 54g A MANUAL OF LEGAL MEDICINE system in these cases, nausea and perhaps vomiting are prominent signs. In early collapse there is also a marked detestation for food evinced by the patient. The bowels are constipated and the tongue heavily coated. This state of affairs is likely to be in a measure the cause of the general wasting of the body so remarkable in all of these subjects. (10) Page1 states as a remarkable fact that railway collisions rarely cause abortion or premature labor, '' strong evidence that the concussion is not as violent as it is often thought to be, for disturbance of the uterine contents is one of the recog- nized causes of induced labor." The prognosis in cases of neurasthenia is, as a rule, good, and with proper treatment complete restoration of the patient's normal health prob- able. But, on the other hand, cases occur where the patient dies from de- pression of the vital powers as a result of the depressed state of the nervous system. The causes which operate to prolong the above-referred-to symptoms are so fully and exhaustively treated in special works upon the subject that their consideration in a work of this description would overreach the bounds of this section ; hence the reader is referred to such special works for their proper consideration. Suffice it to say that the neurasthenical and hysterical disorders of the nervous system are so linked together that their common manifestation in a case is by no means a rarity. Age, sex, the state of the subject's health anterior to the infliction of the injury, the condition at the time of the injury, and that subsequent to it are all factors affecting the symptoms in these cases. Traumatic Hysteria.—Hysteria, like neurasthenia, may be caused by traumatism, such as the injuries a person receives in a railway collision. This mental state is rarely observed after accidents of any other kind, prob- ably on account of the lesser degree of mental shock that accompanies them. One of the main causes of the onset of hysterical phenomena is fright, and this is especially the case with women, who readily succumb to it. Hysteria is, however, occasionally met with among men. Of the pre- disposing causes of this emotional condition, recent illness, sexual excesses, alcoholism, overwork (mental and physical), and the gouty diathesis are most prominent. Symptoms.—The signs of hysteria which are apt to follow a railway col- lision are as follows Great alarm and agitation are the first disturbing in- fluences of the accident. In a few hours, or even days, the emotional symptoms are developed. In the first place occur the convulsive sobbings, cryings, and laughter ; or, again, the patient may become irascible, and even threaten violence to those about him. Everything he attempts, such as the ordinary duties of life, is done in a constrained and unnatural man- ner. He becomes despondent, and his face appears pinched and haggard ; but his digestive organs, as a rule, remain unaffected. Pain may be com- 1 Op. cit., p. 54. FORENSIC MEDICINE 549 plained of, the seat of which will usually correspond with the part of the body affected by the collision. It may be diffused, consisting in great part of what is termed epidermic tenderness. The spine, as a rule, is the part complained of, and although the patient may assert that the pain is very great, examination will generally reveal the non-existence of organic dis- ease such as would account for the excessive agony described by the sufferer. Furthermore, the patient will be able to move about freely and to dress and undress himself without apparent effort, showing the want of consistence between the pain and the freedom of his movements. The exaggerated language by which the sufferer describes his pain is an unconscious state- ment which is not uncommon in such persons. This state usually continues for some time without material improvement, although there may be weekly intermissions. It is, however, dependent upon the condition of the patient's mind, and until that improves will manifest itself. If there be no organic complication, the patient ought to improve rapidly as soon as the anxieties connected with business reversals in consequence of the accident, the forced relinquishment of work, and the prospect of an impending litigation are removed. Erichsenx says, '' Anxiety of mind has much to do with the de- velopment of the symptoms. They arise in the first instance from the agony of fear into which some individuals are thrown on the occurrence of any great catastrophe. It is not given to every one to be able to preserve calmness of mind in the midst of the crash and confusion of a railway col- lision. . . . These anxieties once removed, the mental tone speedily be- comes restored, that power of self-control which has been lost is regained, and the emotional condition and its concomitant phenomena which are con- sequent upon a temporary suspension of the power of will speedily dis- appear." The diagnosis of hysteria accompanying shock is frequently beset with many difficulties, especially when the symptoms of organic injury are ob- scured by those arising from the purely emotional or hysterical state. The mental state of hysterical subjects develops rather speedily after the collision. In this way it differs from the slow mental derangement resulting from chronic irritation of the brain or its membranes. Furthermore, the symptoms of the hysterical state are continuous, not progressive. The pain differs en- tirely from that occasioned by organic disease. It consists of a rather dif- fused epidermic hyperaesthesia rather than a localized tenderness. Again, the functions of the different organs of the body are usually healthily per- formed. The prognosis may be said to be good, although in some cases the converse may hold. (For more detailed information on this subject the reader may turn with profit to the larger special works.) Malingering.—( Vide Feigned Diseases, etc.) Medico-Legal Aspects of Railway Injuries.—This is one of the most difficult subjects with which medical jurisprudence has to deal. Erich- 1 Concussion of the Spine, etc., 1883. 55Q A MANUAL OF LEGAL MEDICINE senx says, '' The importance of an attentive study of these cases does not consist merely in the great frequency of their occurrence, though in this re- spect they stand in an unhappy pre-eminence, greatly exceeding in number all other cases put together in which medicine and law are mutually brought to bear upon, and have to co-operate in, the elucidation of the truth. But the consideration of these cases from a medico-legal point of view is a matter of the greatest importance, by reason of the difficulties with which they are surrounded and the obscurity in which they are enveloped. In this respect their investigation resembles somewhat, and is only equalled by, that of cases of alleged insanity. " In those cases of injury of the nervous system that become the subject of medico-legal inquiry, there is, as in cases of alleged insanity, no material difficulty experienced in the determination of the various questions that may arise in the more severe cases and obvious forms of disease. But it is far otherwise in the slighter and more obscure cases. In these not only may the question be raised as to the actual existence of the alleged symptoms, but, their existence having been admitted, the surgeon must determine the value to be put upon them as evidences of real organic disease or of mere functional disturbance. And in reference to the ultimate fate of the patient, he must state to what extent recovery is likely to take place and when it may be expected. In addition to all the intrinsic difficulties which are necessarily connected with such cases, there is underlying, and greatly dis- turbing their simple professional aspect, the great question of the amount of pecuniary compensation that should be granted for the consequences of the alleged injury. Here we have a disturbing element that, happily, never in- trudes itself into other questions of surgery and into very few of forensic medicine. But it is an element of disturbance, to the effects of which due weight must be given by the medical attendant in so far as it affects the morale of the patient, for it is apt to influence him injuriously in more re- spects than one, by leading him either wilfully or unconsciously to exaggerate his symptoms, just as he is very apt to overestimate his business losses and the pecuniary expenses entailed by the injury. But, remember, if I advise you not to neglect to take this question of pecuniary compensation into your consideration, it is only so far as it affects the patient's symptoms and the estimate he forms of his own condition. In no other way can you as medical men—either as the surgeon to the railway company, or still less, if possible, as the private medical attendant of the patient—have anything what- ever to do with the matter. This is a question that is altogether out of our province. A medical man who considers it in any way except in its influ- ence on the mental—and, through that, on the physical—state of the patient, meddles with what neither concerns him nor his profession, and places him- self in a false and unenviable position. Let me, therefore, urge upon you, when you are engaged in these compensation cases, never under any circum- 1 Op. cit. FORENSIC MEDICINE 55I stances to allow yourselves to be drawn into a discussion as to the amount of money payment to be made to the sufferer, unless the matter is expressly referred to you by the counsel employed by both parties. But even then I would advise you, if possible, to avoid being placed in the undesirable po- sition of arbitrator. You may be sure that neither party will be satisfied with your decision. The fact is that a compensation claim for alleged injury is made up of various elements, of which the personal injury is only one. This, which is alone the surgeon's province, in reality often counts for very little in the case. The losses sustained in business ; the expenses, medi- cal and others, directly incurred by the patient, or to which he is liable to be put as the result of the injury, constitute, as a rule, the heavier and more important items in the claim for compensation ; and these are matters that lie in the province of counsel, attorneys, and accountants, and are al- together foreign to that of the surgeon. Mental sufferings, bodily pain and disability, the diminution of that physical and mental vigor in which the enjoyment of life so largely consists, even complete annihilation of the prospects of a life, weigh lightly in the scales of justice, which are made to kick the beam only by the weight of the actual money loss entailed by the accident.'' The questions with which the medical examiner has to do, in a case of alleged disease or disability due to railway injury, are, (i) Is the condition of the individual real or feigned ? (2) If the person be injured, what is the nature and extent of the injury ? (3) Are the injuries permanent or not ? and (4) If the injuries are not permanent, when will the patient be well again ? The difficulties that surround an investigation are often of the most per- plexing nature, and it is by the most careful and painstaking examination only that the physician will be able to arrive at any conclusive result. In effecting a diagnosis, the physician who examines a patient should pro- ceed in a thoroughly systematic way, else disentanglement of the net-work of knotty problems with which he has to do will be an impossibility, and, instead of eliciting correct replies to his diagnostic questions, he will be more apt to find himself hopelessly floundering about, without support other than his own inaccurate mode of procedure. Dana, of New York, suggests the following outline as proper in cases of this kind : 1. Preliminary facts : name, age, sex, condition, nationality, occupation. 2. Family history. 3. Personal history. 4. History and causes of present disease. 5. Physiognomy of case : general appearance, nutrition, abnormalities, gait, etc. 6. Disorders, if any, outside of nervous sphere. Digestion, heart, lungs ; tem- perature, respiration, pulse, urine. 7. Psychical sphere : mental condition, sleep, etc. 8. Motor sphere: paralysis, tremor, abnormal movements, atrophy, electrical and mechanical reactions of muscle and nerve ; speech. 552 A MANUAL OF LEGAL MEDICINE 9. Sensory sphere.—General sensations: vertigo, pain, paresthesia. Special sensations,—tactile : temperature, pain, muscular (ataxia) ; vision, hear- ing, taste, smell. 10. Reflexes, superficial, deep, organic. 11. Trophic, vaso-motor, and secretory disturbances. CHAPTER XXXIX. FEIGNED DISEASES. Medico-Legal Relations—General Rules for Diagnosis—Simulated Diseases and other Affections—Factitious and Fictitious Wounds—Conditions other than Diseases that are simulated—The Simulation of Disease by Children. Simulated Diseases are frequently the cause of medico-legal inquiry. Thus, soldiers, sailors, and prisoners often feign disease for the purpose of shirking their duties, or to secure a more comfortable mode of life. Such persons will resort to all sorts of pretexts in order to accomplish their pur- pose, and, as Chapman1 says, "will indulge in the most disgusting perform- ances, such as swallowing fasces, urine, blood, or mutilating themselves as occasion may require." Civilians sometimes resort to the same fraud in order to prevent their appearance in court, to avoid jury duty, to escape military service, etc. Disease is frequently simulated by a purely mental effort on the part of the malingerer ; while, on the other hand, mechanical contrivances are some- times called in play to further the purpose. Thus, crutches, trusses, band- ages, spectacles, etc., are included in the armamentarium of the deceiver. ( Vide the special diseases, etc., for mention of other devices used by the malingerer.) It may be mentioned, in connection with the subject of feigned diseases, that the motives which incite an individual to simulate disease are usually fear, gain, laziness, and notoriety. Malingering is not as common at the present time as it was formerly, although it is occasionally resorted to for the purpose of extorting money from private persons, cities, towns, or corporations. "As regards the mode of diagnosis," says Reese,2 " cunning and shrewd- ness must be met by the exercise of these same qualities on the part of the examiner. In nothing are experience and tact of greater assistance to their possessor than in the management of this sort of cases. The examiner should always bear in mind that simulation may be possible, and that this is 1 Medical Jurisprudence and Toxicology, p. 146. 2 Op. cit., p. 469. FORENSIC MEDICINE 553 likely to be practised in a given case if sufficient motive exists ; he should try to discover this motive, using great caution in the attempt. Do not be content with a single examination of the patient, but surprise him with an unexpected visit, made soon after the first one. Observe him closely when he is not aware of your notice ; by this means the deception may often be discovered when he is off his guard. Ascertain whether the patient's ac- count of the rise and progress of his disease is in accordance with the known medical facts connected with the history of the real disorder. It is often useful to mention in the patient's hearing certain false symptoms of the al- leged disease, and afterwards ask him after these symptoms, when, if simu- lating, he will be very apt to enact them just as he heard them. Always suspect one who complains of a multitude of ailments, and which have no actual connection with each other. All local ailments on parts of the body covered with the clothing require to be examined with the parts uncovered ; all dressings and bandages must be removed. Do not be deceived by cica- trices, cupping scars, leech-bites, or blisters. No importance whatever is to be attached to the statements of relatives or friends, since they would natu- rally sympathize with the patient. Anaesthetics (ether and chloroform) may sometimes be employed successfully in suspected cases of contracture of the spine or muscles. A very successful method is to threaten, and even use, some very repulsive medicine or remedy, as powerful revulsives, and espe- cially the actual cautery ; but there are some cases that prove obstinate and unconquerable, even under this severe ordeal." Simulated Diseases.—Abdominal Tumors.—These are rarely simulated at the present time, although some cases have occurred recently. The mode of simulation is by paddings worn in the dress, by causing rigidity of the recti muscles, by pushing the abdomen forward while in the erect position, and by elevating the spine when in the prone position. A case is recorded' where abdominal distention was produced by the malingerer—a young soldier —swallowing air. Chronic constipation might be the means of producing a swelling which would assume the feel of a tumor, especially if the collection of faeces be great. The medical examiner should make a very careful exami- nation of the uncovered abdomen, and cause the muscles to relax by raising and drawing up the pretender's knees. Nauseous and antiflatulent purga- tives might be administered with benefit. Abortion is rarely simulated, although such cases have been observed where black-mail has been the object of the malingerer. The symptoms feigned are usually those of great prostration with irritation of the external genital apparatus. The clothing and body of the subject are usually stained with blood. To detect the imposition the examiner should make a very careful vaginal examination, and also note the appearance of the mammae, especially the condition of the areola. Apoplexy is feigned by the pretender falling down suddenly as if deprived 1 Dictionnaire des Sciences m£dicale. 554 A MANUAL OF LEGAL MEDICINE of consciousness. It is seldom simulated by malingerers. Powerful stimu- lants, sternutatories, the application of the electric battery, hot water, etc., will generally suffice to detect the impostor. The only benefit to be derived from this mode of simulation would be in cases where the object is to escape immediate punishment. Ancemia is commonly feigned by causing the face to appear pale and the general condition of the body weak and trembling. The mode of detec- tion consists in examining the character of the pulse, the action of the heart, and the state of the skin. In some cases the tongue is whitened by means of chalk, the trembling being produced by the use of tobacco, as from an old pipe, etc. Amaurotic blindness is the form generally simulated. It is feigned by the application to the eye of the extract of belladonna or datura stramonium. This form of blindness is characterized by a fixed and dilated pupil. The patient should be carefully watched without his knowing of it. Tanner states that "where belladonna has been used we must wait for some days- even nine or ten—until its effects have ceased, putting supplies of this agent out of reach." Asthma is simulated by assuming difficult breathing, increased on making any exertion. The simulator appears to be affected with cough, expectora- tion, and palpitation of the heart. In these cases the application of the stethoscope will usually suffice to detect the presence or absence of the dis- ease. The patient should also be carefully watched without his knowledge. Calculi in the bladder are simulated, especially by young women, by introducing such articles as cinders, gravel, pieces of bone, etc., into the vagina or urethra and bladder. Parker states that this form of malinger- ing is a manifestation of hysteria gravis.1 The simulation is readily detected by removing and examining (chemical analysis) the various particles or foreign bodies. Cancer has been simulated by gluing to the skin the smooth surface of half of the spleen of an animal. This has the appearance of a malignant and cancerous ulcer. A careful inspection of the parts must be made in order to detect the fraud. Catalepsy has been simulated in some of its imperfect varieties. The individuals who usually feign this affection are hysterical masturbating females, sailors, soldiers, etc. The person, according to Dunglison, appears sud- denly to be motionless, the joints remaining flexible, and external objects making no impression. Opisthotonos, a form of hysteria gravis, has been simulated by the person assuming an arched position for some time. To detect catalepsy (simulated) the medical examiner should propose the use of the actual cautery. John Hunter's mode of detection was to "suspend from the outstretched hand of the impostor a string with a small weight at- 1 Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology, vol. ii. p. 706. FORENSIC MEDICINE 555 tached to it, and, suddenly cutting the string, observed whether the arm was abruptly raised, as it would be by an impostor." Chorea has been simulated by the impostor assuming the absurd con- vulsive movements which are characteristic of that affection. It is a very difficult disease to counterfeit, and is seldom chosen by impostors for that reason. To detect the fraud the person should be watched without his knowledge. Again, by awakening him suddenly from a sound sleep and observing if the movements begin at once, a correct estimate of the case may be made. Convulsions, especially the convulsive movements of the facial muscles, are sometimes feigned. Tanner states that " in the west of Scotland, in 1742, attacks of convulsions—occasioned by religious excitement and enthusiasm —became almost epidemic. Such was also the case in Cornwall in 1813 and 1814. Many of the Jansenists—the Methodists of France—who made pilgrimages to the grave of Deacon Paris during their persecution in 1724, and were there seized with fits, were doubtless impostors ; but it cannot be denied that many credulous zealots actually worked themselves into con- vulsions by the force of their imaginations." * In pretended cases the medical examiner will note that the stiffness of the muscles and the resistance and rapidity of action which manifest them- selves in the real disease are found wanting. The suspected individual should be most carefully watched without his being aware of such surveil- lance. It will be found that the pretender will soon grow tired of the irk- some movements. Cutaneous Eruptions.—Parker2 states that while a student in " Professor Hardy's clinic at the St. Louis Hospital in Paris, I witnessed a severe case of urticaria from indulgence in a quantity of strawberries. Some articles of diet will produce these disturbances in the cuticle, and the knowledge having been acquired by individuals, is used for purposes of fraud." Like simulations may be occasioned by the application of certain drugs to the epidermis. Pustular eruptions are produced by the application to the skin of ointments composed of tartar emetic, croton oil, etc. After a few days have elapsed they greatly resemble the skin-disease known as impetigo. Powdered cantharides have also been employed for purposes of deception. Urticaria has been produced by eating shell-fish, bitter almonds, etc. To detect the fraud the medical examiner must make a careful inspection of the affected parts and also search for particles of the drugs employed in the deception. Consumption has been feigned by coughing and causing emaciation by continued abstinence from food and the use of vinegar. The bloody ex- pectoration can be effected by pricking the gums or fauces. In some in- stances the sputa is mixed with ordinary blood and pus, etc. The imposture can be detected only by making a careful stethoscopic examination. The » Clinical Medicine, 1859. 3 Op. cit., p. 708. 556 A MANUAL OF LEGAL MEDICINE microscope will be of material assistance in discovering foreign blood. This disease is frequently simulated by soldiers or sailors in the hope of securing a discharge. It is also feigned by those recovering from catarrh and bron- chitis. Hcematemesis has been simulated by swallowing blood and then vomiting it up in the presence of others. Microscopic examination of the fluid will usually detect the fraud. Diarrhcea is frequently simulated by soldiers and sailors in hot climates. According to Hutchinson, '' convicts break down in their urinary utensils a healthy evacuation, and intimately mix it with the urine, so as to imitate a diarrhceal stool, or add blood to it, procured by perforating the gums, so as to simulate dysentery." Mucous discharges have been produced by the introduction of suppositories of soap, etc., into the lower bowel. To render the stools black and of an unhealthy appearance the sulphate of iron has been taken. The detection of the fraud requires careful watching on the part of the medical examiner. The patient should be instructed to employ a night-chair, and his proceedings noted, and care must be taken to prevent him from obtaining blood by pricking his gums, etc. The linen also should be inspected. The real odor of dysentery is of course absent. Dysentery.—( Vide Diarrhcea.) Dropsy has actually been simulated by the French conscripts by injecting water into the peritoneum, and thereby produced fictitious ascites. (Tan- ner.) Concealed ligatures have been employed to produce anasarca of the limbs. Hydrocephalus has been produced in young children by the daily injection of air under the scalp. This mode gives rise to considerable distention of the parts, thereby readily simulating the affection referred to. Mode of detection : the abdomen and other parts must be examined with care ; if a ligature has been applied to an extremity a mark will be left. Dyspepsia is frequently resorted to as a form of disease readily simu- lated. Soldiers and sailors most commonly practise this form of fraud. In feigned dyspepsia, absence of the more constant symptoms of the real affec- tion will be noted ; the general health will also be found to be dispropor- tionate to the disease. Tanner' states that '' some people can vomit at will by pressing on the region of the praecordia, and they avail themselves of this faculty when simulating disease of the stomach. They also privately provide themselves with food which they do not vomit." It is extremely difficult to detect the imposition, especially where there is a certain amount of disease with great exaggeration. The person should be carefully watched without his knowledge. Epilepsy.—Of this Parker2 says, " The professional impostors of Eng- land, known as 'tumblers' or ' dummy chuckers,' who simulate epilepsy, have frequently been successful in deceiving medical men. The condition appeals powerfully to the sympathies of on-lookers. The foaming of the mouth after a sudden fall can be produced by soap, but the whole performance 1 Op. cit. 2 Op. cit. FORENSIC MEDICINE 557 of the impostor has usually been obtained by long and patient practice. Searching inquiries should be made from some intelligent witness as to the symptoms of the epileptic seizure.'' To detect the fraud, the use of sternuta- tories might be advocated. The proposal of an operation within the hear- ing of the pretender will usually suffice to bring to light the real conscious- ness of the person. The employment of the actual cautery has also been advocated in these cases. Ear, Diseases of the.—Otorrhoea is artificially produced by the intro- duction of honey, pus, rancid tallow, etc., into the external meatus. Other similar affections of the ear have been occasioned by the introduction within the chamber of the organ of cantharides or other acrid substances. It is sometimes difficult to detect these cases of simulation. The most careful watching and examination are the only means for the exposure of these frauds. Eye, Diseases of the.—These are sometimes simulated for purposes of exciting pity, etc. The introduction of irritants into the eye is a mode of feigning ophthalmia. Reese1 states that "it is, however, detected by the rapidity of its progress, arriving at its height within a few hours after the application of the irritant. In soldiers sometimes only one eye is affected, and almost uniformly the right one,—the one with which he takes aim. A left-handed man would probably inflict the injury on the left eye." ( Vide Amaurotic Blindness.) Fever may be simulated or produced by artificial means. According to Fod6r6, there are individuals who can readily simulate fever, being able to produce an increased rate of pulsation, chattering of the teeth, and deep sighs. The intermittent type of fever is usually selected for purposes of de- ception. The tongue is often covered with soap, chalk, dust, flour, etc., in order to give it an unhealthy appearance. Redness of the epidermis has been produced by the friction of a hard brush. Parker2 states that '' fever symptoms may be excited by strong stimulants, such as wine, brandy, and by the internal use of tobacco, which is generally known to act rapidly upon the heart action. (Guy.) . . . Generally speaking, such factitious fevers are ephemeral." In the latter case one or two days' examination will suffice to detect the fraud. The tongue, etc., should also be examined, and, as Tanner states, '' the general condition of the system will be found incompatible with the truth of the symptoms." Fistula in the anus has been simulated by making an incision close to the border of the anus and placing an acrid tent within it. To detect the simulation an examination of the parts must be made. Hemorrhages.—Hcsmoptysis may be simulated by coughing and color- ing the saliva with blood obtained by pricking the gums or from other sources, or the coloring may be obtained by using such substances as ver- milion, brick-dust, etc. The patient should be examined by means of the » Op. cit., p. 476. 2 Op. cit. 558 A MANUAL OF LEGAL MEDICINE stethoscope in order to detect the simulated signs of the affection. He should also be examined as to symptoms, sputa, etc. Hemorrhoids have been assumed by introducing within the rectum the bladders of fish, etc., inflated and tinged with blood. The discharge of blood from the anus is easily simulated. These artifices will deceive no medical examiner. Hepatitis is quite often feigned by soldiers in India who desire their discharge. Cheyne states, "When men who have not been in warm cli- mates obstinately complain of pain in the right hypochondrium, and when we cannot discover any enlargement or fulness of the liver, when the pulse and breathing are undisturbed, the secretions and excretions natural, and when the alleged pain resists topical bleeding and blistering and mercurial purgatives, the sooner we send them to duty the better." The testimony of the malingerer will not coincide with the general appearance of the countenance, etc., while the absence of any enlargement of the liver is of itself exceedingly suspicious, although disease may be present without this symptom. Hernia has been feigned by inflating the cellular tissue of the scrotum with air. Tanner states that some individuals possess the power of retaining the testes within the groin by the voluntary action of the cremaster muscles, and so occasion hypertrophy of the parts, which has been mistaken for hernia. The fraud is, as a rule, readily detected. Hydrocele.—( Vide Hernia.) Hydrophobia has been simulated. In a case mentioned by MM. Percy and Laurent, the subject came to time when he was threatened with suffoca- tion between two beds. Heart, Diseases of the. —The following is quoted from Parker's article.' '' Simulation of diseases of the heart is less common among impostors, and means for its detection are readily available. The feebleness of the pulse, which has been produced by ligatures around the arm and by the use of internal remedies such as hellebore, is the most prominent symptom manu- factured by the impostor. Dr. McClelland, of Albany, reported a case where a patient deceived the attending physician by placing his finger on the artery under the armpit whenever the pulse on the corresponding side was examined. Reese relates that certain individuals can produce feebleness of the pulse by taking a deep inspiration and suspending the breathing. Dr. Cheyne has reported the case of Colonel Townsend, where there was the voluntary suspension of the heart's action for a limited period. Digi- talis, American hellebore, tobacco, and other drugs are capable of producing palpitation by internal or rectal use. Palpitation may also be excited by strong compression of the abdomen with a bandage ; in this manner hyper- trophy may be induced." Hysteria is sometimes simulated, although the malingerer usually over- 1 Op. cit., p. 711. FORENSIC MEDICINE 559 does the attack. The examination in these cases must be thorough, else the deception, especially in those cases where the hysterical convulsion has been brought about by an effort of the will, will be overlooked. Insanity.— The reader is referred to works on that subject for reference to its simulation. faundice has been simulated by tingeing the skin with an infusion of turmeric, while muriatic acid has been added to the stools for the purpose of giving them the characteristic clay-colored appearance. The color of the urine has been heightened by means of rhubarb, and the temperature of the skin raised by the ingestion of large amounts of spirits. These latter also occasion the disordered condition of the tongue and the rapidity of the pulse. In real jaundice there is general malaise, depression of spirits, sometimes melancholia, together with a yellowish tinge of the skin. This latter is almost inimitable. The application of snuff to the eyes has been resorted to by some, in order to excite inflammation. To detect the fraud, the skin should be washed, in order to remove the coloring matter used by the impostor. The secretions become normal as soon as the supplies of acid, etc., are stopped. The white of the eye cannot be colored by any means known to art. Ophthalmia.—( Vide Diseases of the Eye.) Ozcena is feigned by inserting within the nostrils a piece of sponge satu- rated with offensive juices or oils mixed with decayed cheese. The impo- sition is easily detected. Palpitation.—( Vide Heart-Diseases.) Paralysis is not often employed as a means of imposture. It is always a suspicious circumstance in the healthy adult when the loss of power is con- fined to one limb only. In a case discovered by Cheyne and quoted by Tanner, the former gave his opinion "that the disease was feigned, based upon these considerations,—viz., there existed no other signs of disease ; the countenance indicated health and intelligence ; the function of the brain was undisturbed, and all the senses were entire." Parker quotes a case related by Hutchinson, where the latter "gave one of these impostors, who claimed to have paralysis of the arm, fifty drops of laudanum in his tea. When sound asleep the doctor tickled his right ear with a feather, and was re- warded by seeing the lame right arm rise instantly." To detect the im- posture the most violent means should be resorted to, such as the application of the electric battery, etc. Feigned palsy should be treated in the same manner. Peritonitis is often simulated, especially by hysterical women. Inflam- mation of the peritoneum as feigned is thus described by Tanner :J " Great pain over the abdomen is complained of, the slightest pressure is said to give intense agony, and the patient excites herself until her skin becomes hot and pulse frequent." The mode of detection is to engage the person in conver- 1 Op. cit., p. 136. 56o A MANUAL OF LEGAL MEDICINE sation, "excite her attention, and then make pressure upon the abdomen ; a simulator will feel no pain and utter no complaint. Examine the pulse, expression of countenance." etc. (Tanner.) Phthisis Pulmonalis.—( Vide Consumption.) Polypus nasi is an affection that is sometimes simulated, although such instances are of rare occurrence. The affection is imitated by inserting into the nostril the testicle of a young cock or the kidney of a rabbit, retaining it in place by means of a small sponge secured to it. The fraud may be de- tected by making a careful examination of the nose. Porrigo is simulated by means of nitric acid or other irritants. Careful observation and restraint are the means of detection. Prolapsus ani is rarely simulated. It is imitated by placing in the anus a portion of the intestine of an ox, containing a sponge saturated with a mixture of blood, milk, and the brains of a sheep. The imposture is easily detected. Prolapsus Uteri.—( Vide Prolapsis Ani.) Rheumatism, including gout, lumbago, and sciatica, is quite often the subject of simulation. It is feigned especially by those who wish to shirk work. The wasting of the muscles of the affected limbs in real rheumatism is absent in these cases, as is also the puffiness of the joints. Attention to the constitutional symptoms, and observing their absence in factitious cases, will be the best method of arriving at a correct diagnosis of the case. Parker states that " lumbago, which is frequently practised, is likely to yield to heroic treatment in the shape of minute incisions, or of hypodermatic injections in the region of the complaint." Scrofula—Scurvy.—These conditions are seldom simulated. In some instances, however, ulcers have been made artificially by the use of acids. Feigned scurvy "seldom advances to a further degree than to induce a bleeding state of the gums by artificial means." (Parker.) The patient should be subjected to a rigid examination. The general scrofulous ulcer cannot be simulated. Ulcers.—CEdema of the extremities has been feigned by placing a liga- ture about the part. Ulceration has been occasioned by such irritant sub- stances as cantharides, lime, etc. A piece of spleen has also been glued to the parts for purposes of simulation. These should be examined uncovered. All such ulcers heal readily. ( Vide Diseases of the Ear.) Swelling of the Limbs.—( Vide Ulcers, etc.) Venereal Diseases.—"This class of affections is rarely simulated, ex- cept for purposes of black-mail. Gonorrhoea has been stated to have been simulated by the use of caustics. Artificial irritation of the genitalia to pro- duce eruptions has been attempted by women for purposes of fraud or to excite pity. Soldiers and sailors occasionally make use of the knowledge acquired through personal experience to simulate venereal diseases, in order to obtain discharge from the service, or to escape hazardous service, march- ing, or other duties. We have frequently seen a wagon-load of soldiers ex- FORENSIC MEDICINE 56i cused from marching with the command on account of venereal disease, and very often a considerable per cent, of these cases are simulated, and succeed in escaping detection." * (The above list of diseases, etc., comprises those which are most com- monly feigned. For other simulations the reader is referred to the follow- ing paragraphs.) Factitious and Fictitious Wounds.—Pretended injuries or wounds are inflicted by the malingerer for the purpose of exciting sympathy, or, in the case of soldiers and sailors, to secure their discharge from active service. These latter are adepts, and often display the most wonderful ingenuity in furthering their deceptions. One of the most extraordinary cases of self- mutilation was that of Whittaker, the colored cadet of West Point. Reese states2 that his case affords an illustration of self-inflicted wounds, along with an affected unconsciousness, for the purpose of carrying out a certain scheme. "This youth had repeatedly failed in his studies, and upon the eve of his examination, which would most probably have resulted in his suspension, he made a desperate attempt to excite the sympathy of the community, as well as to gain time for study. One morning he was found in his sleeping-room, apparently unconscious, and tied to his bed with strips of muslin. There were several slight cuts, one on the ear and another across the toe. He continued apparently unconscious of all surroundings for some time, when he opened his eyes in a stupid condition. His story was that he had been surprised several hours before by a band of masked men, who felled him to the floor, and who, after wounding and threatening him, left the room. Numerous circumstances showed that the whole thing was an imposture, and on trial he was found guilty, but his sentence was modified." The writer is familiar with a case which occurred some twelve years ago, where one man was stabbed by another, and the latter, to make it appear as if he had done the injury in self-defence, removed his own coat and fired two bullets through the sleeve, and one close to the forearm, after having rolled up his shirt-sleeve. This latter shot singed the hair and abraded the skin of the arm. (Malloy case.) In the diagnosis of these cases it will be noticed that, as a rule, the injuries are superficial and not of a dangerous character; and, as Reese states, '' the cuts and stabs made in the garments will often be found not to correspond with those made on the body. It sometimes happens that slight and trivial injuries, received in a railway or other collision, are magnified purposely, in order to obtain larger damages in a suit at law. Again, per- sons who have unsuccessfully attempted to commit suicide are apt, from motives of shame or disappointment, to attribute their wounds to another. In such cases the injuries are superficial, made usually by the right hand and in front, while the hands themselves are seldom wounded ; in a real assault the hands are very apt to be cut and maimed." ( Vide Wounds.) 1 Parker, op. cit., p. 718. 2 Op. cit., p. 478. 562 A MANUAL OF LEGAL MEDICINE Conditions other than Diseases that are simulated.—Absti- nence.—This is frequently feigned for the accumulation of gain by exciting the sympathy of on-lookers. Parker says,1 " We often meet with, in private practice, cases where young unmarried people pretend to exhibit profound grief by abstinence from food." The simulation of abstinence is very diffi- cult to detect. The medical examiner and others should inaugurate a system of careful surveillance of the subject. Amputations.—Of these Parker says, " We occasionally find malingerers assuming either loss of an arm or a leg as an excuse for begging. By careful wadding and the use of a canvas jacket an arm is sometimes successfully concealed. It is more difficult to assume amputation of the leg. Factitious amputations are occasionally observed where malingerers have removed a finger or toe with a hatchet or a knife. Such extraordinary instances of self- mutilation are not absolutely uncommon. While resident among many tribes of our North American Indians I have seen instances of self-mutilation where the only gratification could be that of pride. The unsightly wounds and scars of the German student-duellists can be accounted for only by this theory. The self-mutilation of religious devotees extends back to the earliest times." 2 Aphonia is very rarely feigned, notwithstanding the ease with which it can be done. The best means of detecting the fraud is by the use of anaes- thetics ; or, the deceiver may be suddenly awakened from a deep sleep, when he will very likely make an exclamation. Deafness and Dumbness.—These afflictions are, as a rule, assumed by impostors, with grossly exaggerated symptoms, so as readily to bring about the detection of the imposition. They generally lose their hearing suddenly, whereas in the real affection the trouble becomes manifest only by gradual stages. The gestures and expression of countenance of the deaf and dumb are hard to imitate. (Tanner.) Deafness has been produced by the in- sertion of bodies within the ear. To detect the fraud examine the ear. '' Deaf people require you to speak slowly and distinctly ; impostors only demand that you shout when addressing them. Place the patient under the influence of an anaesthetic ; during its exhibition, or as its effects are ;going off, the impostor will in all probability declare himself." (Tanner.) Deformities.—Those most frequently assumed are contractions of the fingers, elbow-, ankle-, and knee-joints. Impostors may also assume short- ness or distortion of a limb, inversion of the feet, curvature of the spine, etc. Tanner mentions the case of a prisoner who shirked his work by keep- ing his right knee in a state of flexion for the entire period of his confine- ment (seven years). At the time of his discharge he impudently remarked, " I will try to put down my leg; it may be of use to me now." His remark was followed by the successful accomplishment of the act, and he walked with a firm step. Serious swellings, etc., have been produced by females 1 Op. cit. 2 Op. cit., p. 705. FORENSIC MEDICINE -g, by the insertion of numerous needles into the parts. Tanner gives the fol- lowing directions for detecting the fraud. "For pretended contractions of the muscles or joints a tourniquet should be affixed above the affected part and tightened to an extent sufficient to render the muscles incapable of act- ing ; the joint will then be found easily movable. In the same way factitious shortening of a limb from any cause may be detected, or the limb may be straightened while the impostor's attention is withdrawn, or while he is under the influence of chloroform." Death.—" Every student of physiology will remember the case of the officer who was able at will to arrest the action of the heart. Some people possess this power, and to excite pity or for other fraudulent reasons will pretend death. Methods recommended for the detection of apoplexy are available in this connection."1 Tanner2 says death is characterized "by the deficiency of the respiratory movements, the cessation of the motions of the heart, and by the complete loss of tone and irritability. In doubtful cases, therefore, hold a fine feather or the flame of a candle before the nose and mouth, auscultate the heart, and try if blood will flow on opening a vein. Irritants, moreover, will not redden the skin in the dead." ( Vide Signs of Death.) Pretended Delivery.—This has been simulated for the purpose of extort- ing money, compelling marriage, or disinheriting parties who have claims to an estate. The external genitalia are usually moistened with borrowed blood, and the child of another substituted as the woman's own. The mode of detection consists in making a proper medical examination of the parts shortly after the alleged delivery. The character of the lochia should be carefully investigated. Dyspnoea.—This is rarely simulated. To detect the simulation the pa- tient should be carefully watched when asleep. Delirium is sometimes feigned, and is most frequently observed in hys- terical subjects. Involuntary Stools.—Of these Parker states, " If an examination is made of the sphincter ani muscle and the contraction is found to be normal, we should suspect malingering in those cases where it is claimed that the pas- sages are involuntary. In children the presence of intestinal worms often excites contractions, inducing emptying of the rectum. These movements have the nature of being involuntary. Such cases require kind and sensible attendance. For the genuine malingerer a diet of solid food should be pro- vided, and, as far as possible, one likely to be constipating. This, with a liberal dosing of opium and the watchful care of an intelligent attendant, will usually unmask the imposition. The passing of solid stools in the bed should be quickly and severely punished.''3 Menstruation is simulated by staining the linen, napkins, etc., with bor- rowed blood. The genitalia are also stained in a similar way. In these 1 Parker, op. cit., p. 708. 2 Op, cit., p. 130. 3 Op. cit. 564 A MANUAL OF LEGAL MEDICINE cases of deception cutting off the supply will suffice to detect the impo- sition. Pain.—Reese states' that "there is probably no symptom so commonly complained of by the malingerer, and none more difficult to determine by the examiner, than pain, because it is purely a subjective symptom. Hence it will try the skill and tact of the physician to the utmost. A close and pa- tient investigation will, however, usually detect the fraud. Bloody Urine.—This deception is accomplished by adding blood to the excretion. ( Vide Jaundice.) Malingering of Railway Injuries.—The following account is taken from Page's " Railway Injuries." " ' Is the condition before us real or feigned?' is a question which we have sometimes to ask ourselves in the routine of practice. A correct answer to it is obviously of great moment to both doctor and patient; and I propose, therefore, to say something on the special kind of malingering which may be met with after the injuries, or after no injuries, received in railway accidents. It may be well, however, in the first place, to name some of the points which have to be borne in mind in the endeavor to come to a right conclusion, that we may decide whether the signs of disease before us be real or assumed, or the complaints we hear be genuine or the outcome of wilful exaggeration ; whether, indeed, to adopt the classification of Ogston, the disease be feigned, factitious, exaggerated, or aggravated. It is a common experience that most feigned disorders have in them some basis of reality, or some revival of the symptoms of a former lesion or injury used again for purposes of deception. Familiarity with the phenomena and history of disease can alone, therefore, enable a man to pronounce with certainty as to the real nature of any particular disorder, and to detect the mistakes into which malingerers so often fall. An apt illustration may be taken from the attitude and position of the joints in real and assumed disease. By his loud complaints a man may wish to suggest the presence of destructive mischief in a joint, but in all probability he will go wrong in the attitude and position which he gives to his limb. Or, without pretending to be afflicted with actual joint-disease, a patient will sometimes affirm that a joint has become stiff, and that it is impossible to move his arm or leg. It is unnecessary to make any mention here of the recognized causes of stiffness and ankylosis of joints ; suffice it that the entire absence of them, both in the history of the case and in the course of the disease, will reveal a flaw in the evidence sufficient to raise suspicion. Suspicion grows into tolerable certainty if you are careful to observe the conduct of the person under examination. 1' A man complained that he could not work because of stiffness in the right elbow and inability to straighten his arm. He said he had fallen on his elbow a month ago, but it was clear from answers to his questions that the injury had not been at all severe. Comparison of the two elbow-joints showed an entire absence of physical signs, and there was no wasting of the 1 Op. cit. FORENSIC MEDICINE 565 limb. Noticing, in examination, that attempts to flex or extend his arm were forcibly resisted, he was told to look in the opposite direction, ques- tions were asked him unconnected with his arm, and there was no difficulty in bringing it at once to natural and full extension. A turn of his head and eyes toward the affected limb was immediately followed by active flexion to the original degree. Complete flexion could also be produced under like circumstances. Examination of both arms simultaneously seemed to confuse him, for he called out with pain when pressure was made on the sound limb. Such inconsistencies as are met with here ought, at any rate, to place us on guard. A man based a large demand for compensation from a railway com- pany on stiffness of his elbow and inability to move his arm, the result of a collision. A verdict incommensurate with his expectations having been re- corded, he threw up his arms and exclaimed, ' My God ! I'm a ruined man.' '' Furthermore, an impostor may adopt devices to produce conditions which, in themselves alarming, are yet seen to be without significance when every feature of the case is examined. A prisoner took to his bed com- plaining of great pain and swelling of the abdomen. Although the belly was enormously distended and tympanitic, there was no other sign of illness about him, and there was an entire absence of any one condition on which tympanites usually depends. After a few days' observation, and after care- fully weighing all the facts of the case, the surgeon came to the conclusion that the man purposely distended himself by swallowing air. Loudly enough for the prisoner to hear him, he accordingly remarked to the warden, 'When I come to-morrow I shall bring an instrument to tap him.' On the morrow the tympanites had disappeared. More common are the cases where patients assure you that they are losing blood in large quantities from the bowel. The causes of hemorrhage from the bowel are well known, although an exact diagnosis may be sometimes difficult because of their very number and variety. The malingerer, however, does not know that profuse hemorrhage —and it is of profuse hemorrhage of which he invariably complains—gives rise to well-defined symptoms due to loss of blood. Who ever saw a patient losing blood, either in alarming quantities or in small amounts spread over a long time, with a florid lip, a tranquil pulse, a cool skin ? Should not the presence of every indication of health warn us that we have to deal with something altogether unusual ? Should we be doing rightly if we paid little or no attention to the general condition of the patient, and endeavored to esti- mate his case by simply hearing the story he told us, without examining the blood which he showed ? By neglect of such simple precautions an errone- ous diagnosis was made of a case where pints of blood, not the man's own, were presented as having been passed per rectum ; and the same thing hap- pened in another case where a man showed, from the same supposed source, prodigious quantities of 'blood and corruption.' Both were cases of impo- sition—subsequently known and proved—after railway accidents ; and yet in both of them the fraud was successful. Surely when conditions such as these occur alone, when there is neither discoverable cause nor the usual inevi- 566 A MANUAL OF LEGAL MEDICINE table result, one ought to be able to say of them at once, ' Impossible, un- true !' "In the same category it is not amiss to refer to dilatation of pupil induced by the use of atropine, a point of some importance, because it has been shown in a previous chapter that a wide, sluggish pupil is a valuable sign of loss of nerve tone. 'The access to atropine or belladonna,' says Mr. Hutchinson, ' on the part of the public is now so easy that we cannot be surprised that we encounter mydriasis as the result of an accidental and perhaps unknown use of this agent or of its use with intention to deceive. It is the first question which will occur to the surgeon on seeing a dilated pupil, " Has atropine been used ?" and he must be on his guard in cases of hasty denial. . . . Not infrequently the ophthalmic surgeon has to encoun- ter cases of intentional deception. These occur usually in young women of emotional tendencies. ... A highly cultivated young lady consulted me for "pemphigus." She had blebs all over the left of her body. But these blebs were, some of them, not round but oblong, in a style which no skin- disease ever assumes, and very obviously the result of the application of a brush. She was liable, I was told, to attacks of dilatation of the pupils and loss of ability to read. These attacks usually lasted a week. This case is only an example of what has frequently come under my notice. Although it is possible to use atropine in such a weak solution that the ciliary muscle is not affected, yet in most of these cases a more complete effect is obtained, and the loss of power to read is produced in addition to mydriasis. If the latter be present alone, and if it persist for long, the suspicion of deception may be put aside.' In all cases where the use of atropine is suspected it is essential to examine the patient frequently, and carefully look for some con- comitant and confirmatory symptom of nerve disturbance. The pupils, moreover, it need hardly be said, must be examined both in light and shade ; and it should be borne in mind that where there is inequality of the two pupils, the dilated pupil need not necessarily be the one affected. The pupil which is the smaller of the two may, for example, be unable to dilate, and be the one really at fault, because of sympathetic paralysis, a condition of things by no means unknown after organic injury to the lower cervical spine. The question might here arise whether eserine had been used, but I am not aware that eserine can induce the other signs of sympathetic paraly- sis,—shrinkage of the globe and contraction of the palpebral fissure. "Let it not, moreover, be forgotten that any kind of old injury, de- formity, or want of perfect symmetry may provide the malingerer with the opportunity for the practice of imposture. Hydroceles, varicoceles, and hernias ; fatty tumors, sloughing gummata, and sebaceous cysts ; distended bursas and ankylosed joints from long-past disease are some of the condi- tions which in my own experience have been attempted to be palmed ofl as the result of railway shock. No man who knows his business can be taken in by such things as these. Great care, however, must be always ex- ercised in the examination and estimation of abnormal conditions which may FORENSIC MEDICINE 567 be presented, that no injustice may be done a man in coming to a hasty conclusion that he is malingering. It is singular, for example, how ignorant some persons seem to be of the existence of deformities or states of body which must have been endured for a long time.'' The Simulation of Disease by Children.—According to Dufesnel,' this is quite common in schools, asylums, etc., for the purpose of escaping some disagreeable duty. He divides these children into three groups : " First, those who feign some simple indisposition with a definite object, and who are otherwise normally constituted ; second, children who pretend to be suffering from more complicated diseases, who present usually an hered- itary history of nervous affections, and who are not well balanced men- tally ; and, third, hysterical malingerers. It is in dealing with the second class of cases that the physician is most likely to be led astray in his diag- nosis and to believe that he has a real malady to contend with. These chil- dren, as before stated, have a neuropathic family history, and they have also been badly brought up, their every whim being yielded to by over-indulgent parents. These precocious malingerers are more often girls than boys, in the proportion of nearly two to one. They are more frequently from eleven to fifteen years of age, though cases are not uncommon in children of more tender years. The author was unable to learn of any recorded instance of simulation in children under four years of age. "In the diagnosis of simulated diseases in children, the author calls attention especially to two points. The physician should be on his guard whenever the little patient's story of his illness is too monotonous. One who is really ill tells a different tale from day to day, his pain and his feelings being modified by passing circumstances. The malingerer, on the other hand, has his story learned by heart, and repeats it always without modifica- tions. Another thing that should excite suspicion in the physician's mind is the long duration of the simulated malady and a want of proportion between the physical signs and the degree of pain or discomfort of which the child complains. The treatment of the little malingerer should consist rather in the treatment of the parents. The physician should not at once announce that the child is shamming, for the only result of such a course will ordinarily be that the child will pass out from under his care. But he should so man- age the case that the deception will become apparent to the attendants. Then, M. Dufesnel thinks, and probably very justly, when the parents are once persuaded that the child is deceiving them, there will not be much time wasted in completing the cure. Parental discipline is the most potent remedy for infantile malingering.''2 1 The Simulated Diseases of Childhood, These de Paris, 1888. 2 Medical Record, New York, July 14, 1888, vol. xxxiv. p. 43, No. 2. 568 A MANUAL OF LEGAL MEDICINE CHAPTER XL. LEGITIMACY---INHERITANCE.1 Medico-Legal Relations—Ordinary and Protracted Gestation—Premature Delivery- Early Viability of the Child—Live Birth in Civil Cases—Tenancy by Courtesy- Laws Relative to Legitimacy—Paternity—Affiliation. Cases involving the questions of legitimacy and inheritance are often surrounded by great difficulties, on account of the uncertainty of the evi- dence advanced by the medical expert alone. They are seldom decided on such testimony, the evidence required to prove that an infant is the offspring of illicit intercourse being of a different character, with which the legal physician is not concerned. The medico-legal questions that do, however, concern him are those of protracted human gestation and of premature de- livery. Their bearing in relation to legitimacy and inheritance will be con- sidered later. The law assumes that every child born in wedlock, or within a certain period subsequent to the demise of the husband in accordance with the natural duration of pregnancy, is legitimate,—in other words, it is presumed to have the mother's husband for its father. The paternity may, however, be disputed upon certain grounds, as (i) where the husband and wife had been separated for a certain time beyond the usually allotted period of preg- nancy ; (2) where there is absolute impotence on the part of the husband during the same period ; (3) where the woman has committed adultery, and the child has been repudiated by the husband ; (4) when the woman was so well advanced in pregnancy at the time of her marriage that her condition must have been plainly evident to her husband, this will be deemed as a recognition of paternity, and also of legitimacy, on his part. It appears that a child born subsequent to the death of its mother, provided she be legally married, is a legitimate one. (Reese.) Ordinary and Protracted Gestation.—What is the natural period of gestation ? The usual period of utero-gestation is about nine calendar or ten lunar months, forty weeks or two hundred and eighty days. Consider- able variation of this period is observed in different women. Wharton and Stille2 say, '' The idea has of late years been put forward and sustained by direct observation that in women whose menstrual function is regular, gesta- tion will terminate at the tenth menstrual period after that upon which con- ception has ensued. Thus, as the ordinary menstrual interval is about twenty-eight days, the ordinary duration of pregnancy would be a few days 1 Vide Impotence, Sterility, etc. 2 Medical Jurisprudence. FORENSIC MEDICINE 569 less than two hundred and eighty days, varying according to the time occu- pied by the monthly flow. On this principle the apparent difference among women in the length of their pregnancies might be explained by reference to the well-known variations in the length of the intermenstrual periods, pro- tracted gestation occurring in those having a menstrual interval naturally of more than twenty-eight days, and apparently premature confinements in those who menstruate at shorter intervals. The successful establishment of such a law would afford striking confirmation of the general truth of a popular belief reposing upon ages of experience. The greater tendency to abortion or premature delivery at the recurrence of the menstrual epochs, and the usual re-establishment of the menstrual function within one month after parturition, in case the woman does not suckle her child, afford a pre- sumption in favor of its correctness. Nevertheless, much additional and careful observation is required before we can be permitted to base a positive opinion in legal cases on such a mode of calculation." The variation re- ferred to may, however, be more apparent than real, as it is frequently very difficult to determine a fixed starting-point,—i.e., the date of conception. The latter is usually calculated from (i) the peculiar sensations experienced by females at conception, although this is altogether ill-defined and scarcely reliable, as conception may take place in the unconscious state ; (2) the cessation of menstruation, which may be regarded as the best method of calculating, although the arrest of the catamenia may be caused by other circumstances, while, on the other hand, it may occur during the entire period of pregnancy ; * (3) the period of quickening ; this sign is also an un- certain one to calculate from, since it is subject to the greatest variation in different persons, and also since it may occur without pregnancy, and vice versa; and (4) a single coitus, which is the most certain starting-point from which to determine the date of conception ; but even here, '' where this can be accurately settled, still there will be found considerable discrepancies which must be attributed to individual peculiarities, and which indicate that there is no absolute law on the subject." (Reese.) In Com. vs. Hoover, 3 Clark (Pa.), 524, the court charged the jury as follows. "The defendant is indicted for fornication and bastardy. The prosecutrix is a competent witness, but her credibility is for the jury. Ac- cording to her account, the child was begotten on March 23, 1845. It was born on January 30, 1846, a male, fine, large, and healthy. The period of gestation was three hundred and thirteen days. It is conceded that the defendant had no intercourse with the mother after the 23d of March, 1845, and that the time of delivery is fixed with equal certainty. A question of science has arisen respecting the possibility of protracted gestation. The ' Other fallacies are : the cessation of the catamenia previous to the time of con- ception ; their arrest by cold at one monthly period, so that conception might occur before the next period, and thus a mistake in the calculation may take in several days, or even a month, etc. 57° A MANUAL OF LEGAL MEDICINE usual period is nine calendar months, or from two hundred and seventy- three to two hundred and seventy-five days. What has been denominated as the extreme of the usual period is two hundred and eighty days, or ten lunar months. But whether any, and, if any, what, longer time may be allowed as possible are the questions which the case presents for decision. Medical writers of celebrity and authority are arranged on both sides of these questions, and the medical witnesses upon the stand are, in like manner, divided in opinion. In construing this evidence, so far as respects the facts narrated by each, it is proper to consider that writers and witnesses are respectively relating only the results of their own knowledge ; and when one states that no case of protracted gestation has fallen under his observa- tion, it is but negative testimony, and cannot justly be relied upon to invali- date the affirmative evidence of others, equally entitled to credit, who can enumerate cases of the kind which they positively affirm to have come within the range of their practice and knowledge. . . . One gentleman, in a long course of practice, may have failed to observe any case of the kind. Another, in a very brief period, may have noticed several, and it is reason- able to believe that when such a diversity of opinion exists, each will be in some measure influenced by his own professional experience, and that this will also, to some extent, affect his belief in the cases reported by others. There are doubtless many of these cases where the struggle for character and property, and the circumstances of the parties whose interests have been involved, have furnished temptations to falsify, and may have influenced the decisions of the tribunals. But, after making all proper allowances for cases of this description, the whole evidence on the question, where fairly con- sidered, appears to show that cases of protracted gestation are not impos- sible, although their existence is very unusual. The heads of wheat in the same field do not all ripen together. The ears of corn on the same stalk do not all come to maturity at the same time. Even the grains of corn on the same ear ripen at different intervals. The fruit on the same tree shows the like deviation ; a portion will ripen and fall, while other portions remain comparatively green upon the parent stalk. The eggs of the fowl, under process of incubation at the same time, are subject to the same variation. In quadrupeds, if the testimony of Mr. Tessler be believed, we have proof of the like irregularity. Whatever may be the causes operating in each case to divert nature from her accustomed course, to accelerate or delay her usual progress, the human species, like the rest of creation, seems occasion- ally under their influences. The developments of puberty, although gener- ally shown at a certain age, are far from regular. Some individuals approach it earlier, others later, in life. "Intellectual maturity is subject to the same irregularities. Some are precocious, others astonishingly tardy in arriving at the usual degree of dis- cretion. The intervals between catamenial visits, although in general regular and fixed, exhibit remarkable deviations. The final departure of the cata- menia, although generally to be expected at a certain age, is as irregular as FORENSIC MEDICINE 5-j their first approach, and as subject to variation as were their periodical re- turns. A certain period of life has usually been assigned for the termination of a mother's perils, but the instances of extensive deviations from this general rule are numerous and well established. The gestation of one child at a time is according to the usual course of nature, but the births of twins, triplets, etc., furnish indubitable proofs of astonishing departure from the usual course. The sensations of the mother produced by the elevation of the foetus from the cavity of the pelvis, called quickening, although usually occurring at a certain period, are known to be subject to the like departure from the usual time. . . . From analogy, and from the statements of dis- tinguished authors and eminent witnesses, after making every allowance for mistakes and the operation of unfavorable influences, we are led to the belief that, although nature delights in adhering to her general usages, she is occasionally retarded in her progress and otherwise coerced, by causes not always apparent, into extensive deviations from her accustomed path. And we are induced to believe that protracted gestation for the period of three hundred and thirteen days, although unusual and improbable, is not impossible. The evidence to establish the existence of such a considerable departure from the usual period should be clear and free from doubt. The witness should possess a character beyond reproach, and her testimony should be consistent and uncontradicted in all material facts. If the jury are satisfied that the evidence for the commonwealth is of this character, the unusually long period of gestation does not require them to disregard it. The law fixes no period as the ultimum tempus pariendi. The usual period has been stated, but longer time may be allowed, according to the opinions of physicians and the circumstances of the case." The jury found the defendant guilty.1 Dr. L. A. Rodenstein, of New York, who reported four cases of pro- longed gestation, says2 "that the number of cases cited upon undoubted authority by every writer on obstetrics, and the cases constantly reported as occurring under the personal observation of general practitioners, go to show that prolonged gestation is not a myth, and especially that it should not be explained away by questioning the virtue of the mother. How long the duration of the period of gestation can extend beyond the normal time is not yet determined, perhaps cannot be determined, but that it. may extend over two months is apparently settled. The same principle is involved, whether the uterus tolerates the presence of the child three days or one hundred and forty-five days3 after the natural time of gestation has expired. He believes that after the uterus has performed its physiological function of gestation for the natural term, it rests from the work of gestation proper. Why does it not, then, exercise the function of expulsion ? That question ' American and English Encyclopaedia of Law, vol. xv. p. 213. 2 New York Medical Journal and Obstetrical Review, May, 1882. 3 Professor Meigs's Report. 572 A MANUAL OF LEGAL MEDICINE he does not attempt to answer, but believes that after gestation has performed its proper and peculiar work the growth of the child is complete, and it thereafter lies dormant in the womb. Otherwise the child would grow to huge size, and its delivery in the natural way would be impossible ; whereas, in the cases cited the size of the child at the expiration of the period of pro- longed gestation was normal." ' The following abstract of the celebrated Gardner Peerage case, before the House of Lords, is taken from Taylor's " Medical Jurisprudence." It affords illustration of many of the disputed points relative to the subject of legiti- macy. "Alan Lagge Gardner, the son of Lord Gardner by his second wife, petitioned to have his name inscribed as a peer of the Parliament roll. The peerage was, however, claimed by another person, Henry Fenton Jades, who alleged that he was the son of Lord Gardner by his first and subsequently divorced wife. It was contended that the latter was illegiti- mate ; and in order to establish this point the evidence adduced was partly medical and partly moral. Lady Gardner, the mother of the alleged ille- gitimate child, parted from her husband on board of his ship, on the 30th of January, 1802. Lord Gardner went to the West Indies, and did not again see his wife until the nth of July following. The child whose legiti- macy was disputed was born on the 8th of December of that year. There- fore, the plain medical question, taking the extreme view, was whether a child born three hundred and eleven days (forty-four weeks and three days) after intercourse (from January to December), or one hundred and fifty days (twenty-one weeks and three days) from July to December, could be con- sidered to be the child of Lord Gardner. If the question were answered in the affirmative, then it followed that this must have been a very premature or a very protracted birth. There was no pretence that this was a prema- ture case, the child having been mature when born. The question, then, was reduced to this, Was this alleged protracted gestation consistent with medi- cal experience ? Many medical witnesses, comprising the principal obstetric practitioners in the kingdom, were examined on this point. Their evidence was very conflicting, but a large majority concurred in the opinion that natural gestation might be protracted to a period which would cover the birth of the alleged illegitimate child. On the moral side of the question, it was clearly proved that Lady Gardner, after the departure of her husband, was living in open adulterous intercourse with a Mr. Jades, and on this ground Lord Gardner obtained a divorce from her after his return. It was con- tended that the counter-claimant was really the son of Lady Gardner by Mr. Jades. The decision of the House was that this claimant was illegitimate, and that the title should descend to the son of the second Lady Gardner." It is important to recollect in connection with this subject that the date of conception is not always synchronous with intercourse or insemination. Bischoff and Valentine have shown that the spermatozoa may retain their 1 Medical News, May 20, 1882. FORENSIC MEDICINE 573 vitality for several days after sexual intercourse before conception takes place. Fecundation cannot result until the spermatozoa come into contact with a matured ovum ; and as the time occupied by the descent of the ovum is subject to variation, conception might be delayed for as long a period as seven days. Taylor' says that this does not satisfactorily explain such ex- treme differences as are alluded to above. "We must, therefore, be pre- pared to admit either that conception in some cases may be delayed for so long a period as from five to seven weeks after intercourse, or that there may be this great difference in the duration of pregnancy. Whatever may be the explanation adopted, it is obvious that, in a medico-legal view, the only conclusion at which we can arrive is that the period of gestation in the human female is not, as it was formerly supposed to be, a fixed and invari- able term." Premature Delivery.—An important question touching upon legiti- macy is whether a fully developed child can be born before the ordinary period of gestation. For example, a husband returns to his wife after being separated from her for some time, say two years. After their reunion, and after a period of seven months or a little more, a fully developed child is born. Is this a legitimate child? This is a question which presents diffi- culties almost as great as does that of protracted gestation. There can be no doubt that children are born at the seventh month of gestation who are capable of living, although they are, as a rule, more delicate than those born at full term. On the other hand, some women always give birth to premature children ; but in these cases some pathologic condition must be the cause of the early emptying of the uterus. It must be admitted that full-term children are subject to considerable variation in length, in weight, and in apparent maturity, so that some births at eight months are appar- ently better developed than some full-term children. Such instances are, of course, the exception and not the rule. '' Hodge and Spiegelberg both taught that strong and vigorous children might be delivered before the completion of the nine months of gestation. It is the belief of the writer that in a given case, where pregnancy has con- tinued to within two or three (or possibly four) weeks of its completion, there may be some doubt whether the child born at that time be a full-term one.or not, on account of the advanced stage of its development." 2 Mont- gomery, of Philadelphia, states that he never observed a child of seven months' gestation present even the remotest appearance of the well-developed child of full term. These children are, as mentioned above, much more deli- cate, and require greater care and attention to preserve them. Reese states3 " that, while in some instances there may be a doubt about an eight months' 1 Op. cit. 2 Edgar, in Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicol- ogy, vol. ii. p. 277. 3 Op. cit. .574 A MANUAL OF LEGAL MEDICINE child, on account of its advanced degree of development, there ought to be no doubt whatever in the case of a six or seven months' child." Viability.—The earliest period at which an infant may be born alive is generally admitted to be eight months, although even a seven months' child may live. Cases are on record where a six months' infant, and even earlier, has survived, but such instances are extremely rare. As a rule, medical au- thorities do not consider an infant viable until it has reached the end of the seventh lunar month of intra-uterine life. An infant born earlier than a little over five months could not be considered viable. (Reese.) Live Birth in Civil Cases.—Reese states that the question of prema- ture birth may present itself under another aspect, of a civil nature,—viz., that of survivorship, where a living child acquires civil rights, such as in- heritance and the transmission of property. In such a case it becomes a matter of vital importance to establish the fact that the child, when born, was actually alive. The laws of this country and of England do not require that the child should be viable,—i.e., capable of continuing to live,—but only that it should be born alive. It matters not whether it be mature or im- mature, so that it was alive. What, then, constitutes a live birth? We reply, anything that will prove that the child was living at the time of its birth. According to the laws of the United States and of England, neither breathing nor crying is essential to establish a live birth ; the pulsation of the child's heart, or of one of its arteries, or the slightest voluntary move- ment, is regarded as sufficient for this purpose. In Scotland crying is re- garded essential, in France respiration, and in Germany crying, attested by unimpeachable witnesses. According to Blackstone, crying, indeed, is the strongest evidence, but it is not the only evidence ; and Coke remarks, " If it be born alive, it is sufficient, though it be not heard to cry, for perad- venture it may be born dumb." " With this clear and definite understanding of what is legally regarded as the proofs of a live birth, we must admit that foetuses have been born alive as early as four months, and, of course, at all periods of a later date. Such a case is reported by Dr. Erbkam, of Berlin, when the fcetus was only six inches long and weighed but eight ounces ; it survived half an hour; it moved its legs and arms, turned its head from side to side, and opened its mouth. Miiller pronounced this fcetus to be not over four months old. Dr. Barrows, of Hartford, reports another case, especially interesting from the fact that the exact period of conception could be fixed ; miscarriage took place at one hundred and forty-four days,—less than five calendar months. The ovum was expelled entire. Before the rupture of the membranes the movements of the child were vigorous. After the rupture it cried out very distinctly ; the cord was tied on ceasing to pulsate, after which it breathed with a gasp for forty minutes ; it repeatedly opened its mouth and thrust out its tongue. It measured ten inches long and weighed fourteen ounces." ' 1 Op. cit., p. 552. FORENSIC MEDICINE 575 Tenancy by Courtesy.—According to Blackstone, this phrase signifies a tenant by the courts of England. It is a mode of inheritance such as fol- lows. If a married woman seized of an estate of inheritance dies, the husband acquires a life-interest in it, provided a living child has been born of the mar- riage during the life of the wife. In such cases the medical examiner may be summoned to determine not only the live birth of the child but also that it was capable of inheritance.1 If there be no living issue of the marriage, the inheritance or estate passes from the husband to the heir-at-law. If the child be born after the death of the mother (Caesarean section), it could not transmit an inheritance. "Lord Coke and most legal authorities quote a case that occurred three centuries ago, which was decided against the hus- band on the ground that the child was extracted by Caesarean operation after the mother was dead. It is possible, now this operation on both living and dead women has become of somewhat frequent occurrence, that this decision might be reversed, more especially seeing that a child thus born is declared to be legitimate, although death had dissolved the marriage before birth. It might prove a curious matter for discussion, altogether apart from this question, whether extraction by Caesarean operation can legally be called birth."2 Laws Relative to Legitimacy.3—How established or proved.—Par- entage may be established at law, and can only, in general, be so established as regards the father by a combination of facts indicating the connection of the parent and the child, between an individual and the family to which he claims to belong. Among the principal of these facts are that his mother was married to the person whom he claims as his father at the time he was born or begotten ; that he has always borne his name and been treated and maintained and educated as his child ; that he has been uniformly received 1 A monster cannot inherit or transmit a property. On this question Tidy {op. cit.) says, "A consideration of the recorded cases and of the specimens in our museums justifies the assertion that none of the so-called human monsters that have lived to adult age can be denied human shape. This, however, can scarcely be so positively stated in the case of certain human births where there has been distinct evidence of life for a brief period only. Still, it would, in our judgment, constitute an almost un- recorded case where the jurist would be justified in saying, without reserve, that a child born alive had not the shape of mankind, implying as the phrase does far more than mere deformity. Hideous as the appearance presented by an encephalic (without brains) monster is, curious as are the so-called human sirens or dolphins (that is, chil- dren where the lower legs are completely united), and inhuman-looking as certain microcephalic (ape-like) and pig-faced children may appear, the medical jurist should, even in such cases, hesitate before he asserts positively that they lack human shape. We repeat that in such births, involving questions of law, it is better for the medical witnesses to describe to the court the exact deformity, and leave the responsibility of deciding whether it be a monster in the true legal sense to others." Reese {op. cit.) says, " It is difficult to say how such a ruling would apply as to the exclusion of such cases as the Siamese twins and others somewhat similar." 2 Tidy's Legal Medicine, vol. iii. p. 152. 3 American and English Encyclopaedia of Law, vol. xiii. p. 226. 576 A MANUAL OF LEGAL MEDICINE as such in society, and that he has been acknowledged as such by the family. These things being shown, his legitimacy is presumed. (J. D. Lawson in 15 Cen. Law Jour., p. 262, citing Weatherford vs. Weatherford, 20 Ala. 548 ; Illinois Loan Co. vs. Bonner, 75 111. 315 ; Barnum vs. Barnum, 42 Eng. 253. Where a man speaks of a child as his daughter, the presumption is that she is legitimate. Gaines vs. Herman, 24 How., U. S. 553 ; Gains vs. New Or- leans, 6 Wall., U. S. 690. If the father is proved to have brought up the party as his legitimate son, this amounts to a daily assertion that the son is legitimate. Taylor on Ev., Text-Book Series, § 549 ; Hargrave vs. Har- grave, 2 C. & Kir. 701.) '' Every child in a civilized community is presumed to be legitimate where the mother was cohabited with and recognized by the father as his wife, and, in the absence of any proof to the contrary, no other evidence of a legal marriage will be necessary to legitimize the offspring. (Strode vs. Magowan, 2 Bush, Ky. 627.) When there has been a marriage, and hus- band and wife have cohabited together, and no impotency is shown, the issue is conclusively shown to be legitimate, though the wife is shown at the same time to have been guilty of infidelity. (Taylor's Ev., Text-Book Series, § 106 ; Hemmenway vs. Towner, 1 Allen, Mass. 209.) This legal presump- tion, that he is the father whom the nuptials show to be so, is the foundation of every man's birth and status. It is a plain and sensible maxim, which is the corner-stone, the very foundation, on which rests the whole fabric of human society ; and if you allow it once to be shaken, there is no saying what consequences may follow. Routledge vs. Carruthers, cited in Nicholas on Adult. Bast. 161. By the ancient common law, if the husband was within the four seas at any time during the pregnancy of the wife, the presumption was conclusive that the issue was legitimate. R. vs. Murray, 1 Salk. 122 ; R. vs. Allerton, 1 Ld. Raym. 122. Where a child is born in lawful wedlock, the husband not being separated from his wife by a sentence of divorce, sexual intercourse is presumed to have taken place between the husband and the wife, until the presumption is encountered by such evidence as proves to the satisfaction of those who are to decide the question that such sexual intercourse did not take place at any time when by such intercourse the husband could, according to the laws of nature, be the father of the child. Banbury Peerage, answer to seventh question, 1 Sim. & Stu. 157 (1811). In the case of King vs. Luffe, 8 East. 207 (1807), Lord Ellenborough laid down the rule that the illegitimacy of a child might be shown where legiti- macy was impossible in five cases. 1. Where the impossibility arose from the husband being under the age of puberty. 2. Where the impossibility arose from the husband laboring under a disability occasioned by natural infirmity, as in Foxcraft's case (Poll. Abr.), an infirm, bedridden man was married in that state twelve weeks before his wife bore a child. The child was adjudged illegitimate. 3. Where the impossibility arose from the length of time elapsed since the death of the husband. 4. Where the impossibility arose from the absence of the husband, as where he was outside the realm at FORENSIC MEDICINE „_ the time the child was begotten. Vide R. vs. Allerton, i Ld. Raym. 395. 5. Where the impossibility was based upon the laws of nature, as where it was attempted to charge a black man as the father of a white child born of a colored woman. Vide Whisterlos's case, cited in Cross vs. Cross, 3 Paige Ch. (N. Y.) 139. Vide Illinois Loan Co. vs. Bonner, 75 111. 315. . . . The ancient policy of the law of England remains unchanged. A child born of a married woman is presumed to be the child of the husband, unless there is evidence which excludes all doubt that the husband could not be the father. But in modern times the rule of evidence has varied. Formerly it was con- sidered that all doubt could not be excluded unless the husband were extra quatuor maria. But as it is observed that all doubt may be excluded from other circumstances, although the husband is within the four seas, the modern practice permits the introduction of every species of legal evidence tending to the same conclusion. But still the evidence must be of the char- acter to exclude all doubt; and when the judges in the Banbury case spoke of satisfactory evidence upon this subject, they must have meant such evi- dence as would be satisfactory, having regard to the special nature of the subject. Head vs. Head, 1 Sim. & Stu. 150 (1823), either before or after marriage. (Cross vs. Cross, 3 Paige Ch., N. Y. 139; 23 Am. Dec. 778.) The presumption of legitimacy may be rebutted, however, by showing that the husband was (r) incompetent; (2) entirely absent, so as to have no in- tercourse or communication of any kind with the mother ; (3) entirely absent at the period during which the child must, in the course of nature, have been begotten ; (4) only present under circumstances affording clear and satisfactory proof that there was no sexual intercourse. (Hargrove vs. Har- grove, 9 Beav. 255.) Access.— Lord Hale, in Horpell vs. Collins, decided that the issue for the jury was as to the fact of access, or, as I understand him to mean, sexual intercourse. For the access in question is of a peculiar nature, not being access in the ordinary acceptation of the word, but access between a husband and wife viewed with reference to the result,—namely, the procreation of children. Lord Eldon, in Banbury case, 1 Sim. & Stu. 159. By access I mean opportunities of having sexual intercourse. Cope vs. Cope, Alderson B., 1 En. & Rob. 275. Access is such access as affords an oppor- tunity of sexual intercourse. Benry vs. Philpot, 2 Myl. & K. 349. . . . The absence of sexual intercourse, where there has been some society inter- course or access, has been called non-generating access. Hargrove vs. Har- grove, 9 Beav. 255 (1846). Access is such access as affords an opportunity of sexual intercourse, and when the fact of such access between a husband and wife within a period capable of raising the legal inference as to the legiti- macy of an after-born child is not disputed, probabilities can have no weight, and the case ought never to be sent to the jury. There is nothing against the evidence of access except evidence of the adulterous intercourse of the wife with H., which does not affect the legal inference ; for if it were proved that she slept every night with her paramour from the period of separation from her husband, I must still declare the children to be legitimate. The interest 37 578 A MANUAL OF LEGAL MEDICINE of the public depends upon a strict adherence to the rule of law. Berry vs. Philpot, 2 Myl. & K. 349 (1834). Vide Morris vs. Davies, 5 CI. & Fin. 243 (1837). . . . Where there is access the presumption of sexual inter- course is very strong, as is illustrated by the case of Plowes vs. Bossy, 31 L. J., Ch. 680 (1862). In this case, B., who was married in 1829, became a lunatic in 1833, and was confined in a lunatic asylum until his death. His wife, who lived twenty-five miles away, occasionally visited her husband, but the keepers of the asylum were under strict orders not to allow them to re- main alone together. He was allowed the freedom of the grounds, and, the porter being sometimes absent, it was possible for a person to enter without being seen. In March, 1835, she visited the asylum and remained alone for some time with her husband. A child was born in December, 1835. There were rumors at the time that Mrs. B. was living in adultery with one D. But the court held that the child was legitimate. Vide contra, Clark vs. Maynard, 1 Madd. & G. 364 (1832). The onus lies on the person alleging that the child of the married woman is illegitimate to prove it. There is no onus on the party whose legitimacy is in question to show opportunities of access or what the circumstances were under which the access took place. Plowes vs. Bossy, 31 L. J., Ch. 680 (1862). . . . The presumption still holds where the parties are living apart by mutual consent (Hemmingway vs. Towner, 1 Allen, Mass. 209 ; Morris vs. Davis, 5 CI. & Fin. 163), but not divorced. (Hemmingway vs. Towner, 1 Allen, Mass. 209.) Neither the evidence of the husband nor wife is admissible to prove access or non- access. (Dennison vs. Page, 29 Pa. St. 420; Patchett vs. Holgate, 15 Jur. 308 ; Parker vs. Way, 15 N. H. 45 ; People vs. Antario, 15 Barb. N. Y. 286 ; Kleinnart vs. Ehlers, 38 Pa. St. 439; State vs. Herman, 13 Ired., N. Car. 502 ; Hemmingway vs. Towner, 1 Allen, Mass. 209. Vide Wright vs. Hicks, 15 Ga. 160 ; Clapp vs. Clapp, 97 Mass. 531 ; Stegall vs. Stegall, 2 Brock., U. S. 256 ; Pendrell vs. Pendrell, 2 Strange, 925 ; Com. vs. Shep- perd, 6 Binn., Pa. 273 ; Cope vs. Cope, 1 En. & Rob. 275 ; Stevens vs. Moss, 2 Cowp. 594. In R. vs. Sourton, 5 A. & E. 180, with a view of proving non-access, the father was asked whether at a particular time he did not live one hundred miles from his wife and cohabit with her sister. Held, that the question could not be put.) Nor are the declarations of the persons whose legitimacy is in question admissible." (Elvi vs. Mader, 1 Rob. 581 ; 38 Am. Dec. 192.) An infant born later than ten calendar months subsequent to its father's demise was not considered legitimate under the Roman law. The legitimacy of a child is allowed by the French law if born one hundred and eighty days after marriage, and three hundred days after the death or non-access of the husband. According to the Prussian law, a child born within three hundred and two days after the husband's death is legitimate, and in Scotland legiti- macy is established if the child is born one hundred and sixty-eight days after marriage, and within ten months after the death of the father. (Reese.) Paternity—Affiliation.—The medico-legal question of paternity pre- FORENSIC MEDICINE 579 sents itself under various circumstances, as in bastardy cases and in cases where a supposititious child claims to be the heir of an estate ; or, again, where the alleged father is obliged to support the child. In such cases the family likeness, although not conclusive in itself, has often been regarded by medical jurists as strong presumptive proof of paternity. This evidence, however, requires further corroboration.1 The resemblance to the alleged parent is determined not only by the features, but the voice, gesture, atti- tude, habits, and personal deformities must also be taken into consideration. In certain cases the likeness of the child to the parent may be evident by color, as, for example, where the mother gives birth to a mulatto, etc., or vice versa. Personal deformities are not necessarily transmitted from the parent to the child. Thus, a deformity in the child might have been occasioned by the woman during her pregnancy being influenced by having seen a person afflicted with a like deformity. Such a case demonstrates how unsafe it would be to make the decision, in a disputed question of paternity, depend solely upon likeness. The question of paternity in the Douglass Peerage Case was shown by Lord Mansfield, in delivering the judgment in the House of Lords, to be an important link in the chain of evidence. He expressed a decided opinion in favor of the resemblance which the claimant bore to his father. In Gil- manton vs. Ham, 38 N. H. 108, "both the child and the putative father were before the jury, who were permitted to draw their own inference as to resemblance." In Iowa a distinction is made as to the admission of a young infant and a child two years old, in favor of the child two years old. State vs. Smith, 54 Iowa, 104 ; 37 Am. Rep. 192. In this case the court said, "A child of the proper age may be exhibited to a jury as evidence of alleged paternity. Precisely what should be deemed the proper age we need not determine. ... A child who is only three months old has that peculiar 1 In Young vs. Makepeace, 103 Mass. 50, the defendant in a bastardy proceeding denied that he was the father of the child, but alleged that one Dean was the father. The complainant then offered evidence to show dissimilarity between Dean and the child. Exceptions to the admission of the evidence were sustained, the court saying, " We think, also, that the testimony to show points of the similarity between the child and Dean should not have been admitted. Even where there is a noticeable resem- blance, there may be equally marked points of dissimilarity. Points of dissimilarity, not implying a difference of race, do not tend to disprove paternity. They are, at most, of much less significance than points of resemblance ; but proof of resemblance was excluded in Eddy vs. Gray, 4 Allen (Mass.), 435. That decision was based some- what upon one in Maine, the reasons for which were considered quite satisfactory. (Keniston vs. Rowe, 16 Me. 38.) In the latter case, however, the evidence excluded was of dissimilarity. Resemblance was held to be properly a matter of consideration by the jury upon this issue in Gilmanton vs. Ham, 38 N. H. 108. But in that case the jury had both the child and the putative father before them, and took the fact from their own observation. ... In People vs. Carney, 29 Hun (N. Y.), 47, evidence of the color of the child's eyes is not admissible to show its paternity." 58o A MANUAL OF LEGAL MEDICINE immaturity of features which characterizes an infant during the time it is called a babe. A child two years old or more has to a large extent put off that peculiar immaturity. In allowing a child of that age to be exhibited, we think the court did not err." In Flannegan vs. Dugan, 14 Allen (Mass.), 197, the court said, "The fact of a resemblance between the child and the putative father was proper for the consideration of the jury. It is a well- known physiological fact that peculiarities of feature and personal traits are often transmitted from parent to child. Taken by itself, proof of such re- semblance would be insufficient to establish the paternity ; but it would be clearly a circumstance to be considered in connection with other facts tending to prove the issue on which the jury are to pass.''' Questions of paternity are sometimes involved in those extending to affiliation. For example, a female having had sexual relations with two men within a few days of each other, and giving birth to a child, one of the men is affiliated rather than the other. The difficulty of settling such a question by medical opinion cannot be denied, although its possible de- termination might be affected by circumstances of parental likeness, color, etc. But, as Reese states,2 "It would seem more just and equitable that each putative father should contribute an equal share toward its support." The same authority says, relative to the question of paternity, '' There is a curious physiological fact that might occasionally be supposed to affect the decision. It is known to breeders of horses and cattle that the influence of the impregnation by one sire may be extended beyond the foal begotten at the time, and affect those begotten subsequently by another sire. This is proved by the later colts or calves bearing the peculiar markings of the first sire. The question, therefore, might be suggested whether this same handing down of parental likeness to the children of a subsequent father might be possible. Without any positive data on which to venture an opinion, it may, nevertheless, be suggested here as a circumstance to be considered in certain cases of affiliation." 1 American and English Encyclopaedia of Law, vol. xv. p. 215. 2 Op. cit. FORENSIC MEDICINE 58l CHAPTER XLI. LIFE INSURANCE. Definition of the Term Life Insurance—Conditions of the Policy—Expectation of Life—Concealment of Facts—Intemperance in Relation to Life Insurance—Rela- tion of Suicide to Life Insurance—The Medical Examination—Tables. Life Insurance may be regarded simply as a contract "in which one party agrees to pay a given sum upon the happening of a particular event, contingent upon the duration of human life, in consideration of the immediate payment of a smaller sum, or certain equivalent periodical payments by an- other. '' (Bunyon.) In other words, it is a contract to pay to certain survivors a certain sum on the demise of the party whose life is insured. It may be called insurance against death.' The premium is the amount payable in a lump sum, or in yearly or half-yearly instalments, on the part of the insured to the insurers. The policy is the writing in which the contract of insurance is embodied. It may contain numerous provisions and conditions which are sometimes the cause of legal disputes. The amount of premium to be paid on the part of the insured to the insurers depends principally upon the age of the applicant, although the sex and occupation of the individual are also taken into consideration. '' The terms of the policy govern its duration, and these are usually definite. To entitle the beneficiary to a recovery the death must have occurred within the life of the policy as thus determined. Recovery could not be had, for instance, by reason of the fact that the insured lay in a dying condition before the expiration of the policy, if, in fact, he survived its expiration. (Howellvs. Knickerbocker Life Ins. Co., 44 N. Y. 268.) In some instances, however, recovery may be had for a death occurring prior to the issuing of the policy. The test is the consummation of the contract, for it is from this time the insurance runs, without regard to the time it is reduced to a formal policy. Thus, where the insured fell sick, after the application and before the policy was issued, of the disease of which he died, he having acted in good faith, it was held that, it appearing that a contract of insurance had been completed orally, the company was liable. (Southern Life Ins. Co. vs. Kempton, 56 Ga. 339. The fact that the insured is stricken with disease and dies soon after effecting insurance does not raise a presumption of fraud. Eclectic Life Ins. Co. vs. Fahrenkrug, 68 111. 484 ; Am. and Eng. Enc. of Law, 13, 630.) But the insured must be living when the contract is made. Otherwise it will be void, though dated prior to the death." (Lefavour vs. Ins. Co., 1 Phila., Pa., 558 ; Ibid., p. 631.) 1 The stipulated amount of money may be paid either to the executors or assigns of the insured person at death, or to the latter at some definite period of his life. 582 A MANUAL OF LEGAL MEDICINE The amount insured for being payable only at death, the companies always insist that satisfactory proof of the death of the insured be made before the heirs can lay claim to the inheritance. In cases of individuals who have disappeared, as where an insured party went to sea and was never heard of again, the law permits the lapse of seven years (presumption of death) before payment of the amount insured for can be pressed. In some instances the insurance company pays the amount before this period, provided there is no reason to suspect fraud. The question of pre- sumption may also be raised in cases where two or more individuals are lost by disaster at sea, etc. Here, if one of the persons happens to be insured for the benefit of the other, the question arises, Which one is pre- sumed to be the survivor ? ( Vide Presumption of Survivorship.) Conditions of the Policy.—The question as to the general health of the applicant, as influencing his expectation of life, is one of the most im- portant conditions of the policy. Here it is that the medical man is brought into relation with the insurance companies. ( Vide paragraphs on the Medi- cal Examination of the Applicant.) "A common warrantee is that the insured is in 'good health.' So used, the words mean nothing more nor less than what they usually and commonly mean, and it is for the jury to say whether or not the party was in good health at the time of the warrantee. (Swick vs. Home Life Ins. Co., 2 Dill. (U. S.) 160 ; s. c, 4 Big. L. and A. Ins. Rep. 176; Swift vs. Massachusetts Mut. Life Ins. Co., 2 N. Y. Supr. Ct., 77 N. Y. 564; Grattan vs. Metropolitan Life Ins. Co., 92 N. Y. 274; s. c, 44 Am. Rep. 372.) They mean freedom from any conscious derange- ment of important organic functions. Goucher vs. Northwestern, etc., As- soc, 20 Fed. Rep. 596. Dyspepsia.—One may have dyspepsia in its milder forms and still truthfully state that his health is sound. Morrison vs. Wis- consin, etc., Ins. Co., 59 Wis. 162. Cancer.—The insured represented that his health was good. He showed the medical examiner a pimple on his tongue, but said it was not serious. The examiner made only a cursory ex- amination, and discovered no indications of disease. Prior to this there had been symptoms of cancer, and the insured had consulted two physicians, and shortly afterwards took medical treatment, underwent an operation, and died. Held, in an action on the policy, that a nonsuit should be directed. Story vs. United L. and A. Ins. Assoc., 4 N. Y. S. Nat. Rep. 373. . . . The company cannot take advantage of fraudulent representations concern- ing the health of the insured, where it is provided that no question as to the validity of an application or certificate of membership shall be raised after two years, or after the death of the member, and death has occurred. Wright vs. Mutual Ben. Life Assoc, 43 Hun (N. Y.), 61. " Where the health of the party is represented to be good, but before the consummation of the contract there is a material change in this respect, such change should be made known to the company. (Whitley vs. Piedmont, etc., Life Ins. Co., 71 N. Car. 480.) Where it is warranted that all material facts concerning the health of the insured have been made known the con- FORENSIC MEDICINE 583 cealment of any will avoid the policy, even though the insured did not know of them himself, even if he had reason to know of them. (The policy was conditioned to be void in case of a concealment of any material fact. At the time the insured was suffering from consumption, but he did not know it, though he had been aware of symptoms sufficient to indicate the nature of the disease, and he stated that he was suffering from general debility. Held, that the policy was void. Vose vs. Eagle Life, etc., Ins. Co. 6 Cush., Mass. 42. Vide also Campbell vs. New Eng. Mut. Life Ins. Co., 98 Mass. 381 ; Britton vs. Mut. Ben. Life Ins. Co., 3 N. Y. Supr. Ct. 220: Harris vs. Equitable Life Assu. Soc, 6 Thomp., etc., N. Y. 108. But where the insured has no good reason to believe facts material which are not revealed, the policy will not be avoided. Life Assoc, of Scotland vs. Foster, 11 Ct. Sess. Cas., 3d Series, 351. Pregnancy.— Whether the pregnancy of a mar- ried woman is a fact material to be stated by the applicant for insurance on her life is a question to be submitted to the jury. Lefavour vs. Insurance Co., 1 Phila., Pa. 558.) "When the insured is asked if he has had particular affections mentioned, and his answers are made warrantees, he must answer fully and truly. Other- wise the policy will be avoided. It does not matter, in such case, that he does not regard the subject of inquiry as material, or that it is not generally considered as having a certain tendency to shorten life. (The policy pro- vided that it should be void if any statement of insured in his application should be untrue. The insured stated therein that he had not had any spitting of blood, consumptive symptoms, cough, or other affection of the lungs. In fact, about four years prior to the issuance of the policy he had spit blood, and had other symptoms of consumption. He died of this dis- ease three years after the issuance of the policy. In a suit thereon the jury were instructed that it was for them to say whether, at the time of such statement, the insured had had such a spitting of blood and such affection of the lungs and inflammatory cough as would have a tendency to shorten his life. Held, that this was error. The fact should have been made known to the office. Geach vs. Ingall, 14 Mees. and W. 95. Vide also to the same effect, Smith vs. ./Etna Life Ins. Co., 49 N. Y. 211 ; Horn vs. Amica- ble Mut. Life Ins. Co., 64 Barb., N. Y. 81 ; Foot vs. yEtna Life Ins. Co., 4 Daly, N. Y. 285 ; Barteau vs. Phoenix Mut. Life Ins. Co., 3 N. Y. Supr. Ct. 576; Baker vs. Home Life Ins. Co., 4 N. Y. Supr. Ct. 355; s. c, 2 Hun (N. Y.), 402 ; Bancroft vs. Home Ben. Ins. Co., 54 N. Y. Supr. Ct. 332 ; Archibald vs. Mut. Life Ins. Co., 38 Wis. 542 ; Connecticut Mut. Life Ins. Co. vs. Union Trust Co., 112 U. S. 250; Dreier vs. Continental Life Ins. Co., 24 Fed. Rep. 670. Nor does it matter that the insured was ignorant of having the disease inquired about. Powers vs. N. E., etc., Life Assoc, 50 Vt. 630; Continental Life Ins. Co. vs. Young, 113 Ind. 159. Otherwise where his answers are only representations. Mouler vs. American Life Ins. Co., in U. S. 335. And see Northwestern Mut. Life Ins. Co. vs. Gridley, 100 U. S. 614 ; Schwarzbact vs. Ohio Val. Prot. Union, 25 W. Va. 584 A MANUAL OF LEGAL MEDICINE 622. But a warrantee that the insured ' has not been afflicted with, nor is subject to, gout, vertigo, fits, etc.,' is not violated by reason of his having had an epileptic fit in consequence of an accident. What such warrantee means is that he was not at the time of the insurance a person habitually or constitutionally afflicted with fits ; a person liable to fits from some peculiarity of temperament, either natural or contracted from some cause or other during life. Chattock vs. Shawe, 1 Moody and R. 498 ; s. c, 3 Big. L. and A. Ins. Rep. 10, etc. The policy contained a provision that the insured should have had no chronic disease at the time of the insurance, June 21, 1850. He was examined at the time of the insurance by the company's physician, and appeared to be in perfect health. He was attended in July by a physi- cian for diarrhcea and fever, but he became convalescent. He died October 23, 1850, of chronic inflammation of the intestines and ulceration. Held, there was not sufficient evidence that the chronic inflammation of the intes- tines and ulceration existed at the time his life was insured. Murphy vs. Mut. Ben. Life, etc., Ins. Co., 6 La. An. 518. An applicant was asked if he had ever had ' open sores.' He replied that he had not. Held, that whether injury received in battle from a bursting shell should have been mentioned was a question for the jury ; that the wound received was not necessarily an ' open sore' within the meaning of that term as used in the application. Home Mut. Life Ins. Co. vs. Gillespie, no Pa. St. 84.) " But where the inquiry is more general, the obligation in this respect may be different. If the insured be asked if he has ever had any sickness, or within a limited period mentioned, he is only bound to state important or serious cases of sickness, such as have a tendency to shorten life. The policy provided that the answers to the application were the basis of in- surance, and that if they were in any respect untrue, the policy should be void. One of the questions was, ' Has the party had any sickness within the past ten years ?' To which the insured replied that he had had pneumonia, but said nothing about a slight attack of chronic pharyngitis some years before. Held, that there was no warrantee, and that the slight disease men- tioned was an immaterial fact, not bound to be disclosed. (Mut. Ben. Life Ins. Co. vs. Wise, 34 Md. 582; s. c, 2 Big. L. and A. Ins. Rep. 46; 3 Big. L. and A. Ins. Rep. 595, etc.) A fall resulting in serious injury to the head is a fact which should be stated. (Snyder vs. Mut. Life Ins. Co., U. S. C. C. E. Dist. Pa., 4 Big. L. and A. Ins. Rep. 424.) He would not be bound, however, to state cases of ordinary headache (Higbee vs. Guardian, etc., Ins. Co., 66 Barb. N. Y. 462), but would be bound to state Bright's disease. (Continental Life Ins. Co. vs. Young, 113 Ind. 159.) '' Whether the sickness with which the insured was afflicted prior to the insurance was material to be stated should be submitted to the jury. (Mor- rison vs. Muspratt, 4 Bing. 60 ; s. c, 2 Big. L. and A. Ins. Rep. 213 ; Man- hattan Life Ins. Co. vs. Francisco, 17 Wall. U. S. 672 ; Fitch vs. American, etc., Life Ins. Co., 59 N. Y. 557 ; Lefavour vs. Ins. Co., 1 Phil., Pa., 558.) " ' Disorder tending to shorten life,' a phrase often used in stipulations FORENSIC MEDICINE 5g5 regarding the health of the insured, means a disorder generally having such tendency. It cannot be said that a disorder is such a one merely because the party afflicted dies of it. (Watson vs. Mainwaring, 4 Taunt. 763.) In this case, Chambre, J., said, 'All disorders have more or less a tendency to shorten life, even the most trifling, as, for instance, corns may end in a mor- tification ; that is not the meaning of the clause. If dyspepsia (which was the disease here in question) were a disorder that tended to shorten life within this exception, the lives of half the members of the profession of the law would be uninsurable.' (Vide also Jones vs. Provincial Ins. Co., 3 C. B., N. S. 64, etc. ; Am. and Eng. Enc. of Law, 13, 632.)" Expectation of Life.—Tidy' says, "Nothing is more uncertain than the duration of a single life, and but few things less uncertain than the average duration of a number of lives. Given there (1) a healthy life, and (2) the absence of any unusual risk, the age of the applicant is practically the only matter for the consideration of the insurance company in granting a policy. Certain well-known tables of the expectation of life at different ages constitute the basis on which the charge to be established is calcu- lated. . . . The expectation of life, by which is implied the number of years that, on an average, a healthy person will live at that age, is capable of reduction to a mathematical formula. Thus, excluding all persons under twenty-five and over seventy-five years of age from our calculations, the formula of Willich, in which x represents the expectation of life, and a the age of the person, nearly represents the facts: * = 2/3 (80 —a)." (See table, p. 586.) Concealment of Facts (vide also Conditions of the Policy, p. 582).— The misrepresentation of the age of the applicant for life insurance will in- validate the policy. (Atty.-Gen. vs. Ray, L. R., 9 Ch. 397 ; Hartford Life, etc., Ins. Co. vs. Gray, 91 111. 159; Linz vs. Massachusetts Ins. Co., 8 Mo. App. 363. But see Continental Life Ins. Co. vs. Goodall, Supr. Ct. Cincinnati, 5 Big. L. and A. Ins. Rep. 422 ; s. c, 3 Am. Law Rec 338.) '' The insured is usually inquired of regarding the place of his residence, and an answer to this inquiry is of the same effect as to any other. But the fact that the insured had been nearly two years in another State than the one where he resided was held not to render his answer untrue. (Mobile Life Ins. Co. vs. Walker, 58 Ala. 290.) The occupation of the insured must be correctly stated when this information is called for. (Dwight vs. Germania Life Ins. Co., 103 N. Y. 341 ; s. c, 57 Am. Rep. 729.) Thus, where the in- sured represented that he was a laborer, when he was not, it was held that the policy was avoided. (United Brethren Mut. Aid Soc. vs. White, 100 Pa. St. 12.) So if it be provided that the insured shall not engage in a specific business, but he does so, it violates the policy. (The policy provided that the insured should not be connected in any capacity with the ale, wine, or liquor business. He kept a grocery-store with a saloon attachment. Held, 1 Op. cit., vol. ii. 586 A MANUAL OF LEGAL MEDICINE Table of the Expectation of Life.1 in !/) m Id W w w a > LO* Ui x y HI > HI > > £u. *'J* J J 3g J 5 " z 5 ° 1-12 > >3 > < Q< > ^s >.< Q < < a! < -J J U < < 22s u 0 i < j 2 < M - X *2S t/l ■*>, W < 7 J £ < < £2 S < a X X Q < X X X Q Years of Years of Years of Years of Years of Years of Years of Years of Life. Life. Life. Life. Life. Life. Life. Life. o 58.43 55-53 57-64 55-56 5o 20.30 2I.6o 20.51 18.29 I 57-43 54-53 56.64 54-56 51 19-63 20.94 19.84 17-73 2 56.43 53-53 55-64 53-56 52 18.97 20.18 19.17 17-13 3 56.31 52-53 55-09 52-56 53 18.29 19.60 18.50 16.52 4 55-31 53-04 54-83 51-56 54 17.60 18.86 17.81 15-93 5 54-31 52.04 53-83 50.56 55 16.93 18.17 17.14 15-45 6 53-76 51.04 53-oS 49-56 56 16.32 17-53 16.53 14.84 7 53-13 50.90 52.67 48-56 57 15-69 16.88 I5-90 14.20 8 52.13 49.90 51.67 47-56 58 I5-07 16.16 15.26 13-74 9 5I-I3 49.18 50.80 46.56 59 14.44 15-56 15.64 13-23 io 50.29 48.18 49.89 45-56 60 13.80 14.85 13-99 12.62 ii 49.69 47-78 49-38 44-56 61 13-23 14.21 13-42 12.19 12 48.69 46.78 48.38 43-56 62 12.66 13-50 12.83 11.60 13 47-88 45-78 47-50 42-56 63 12.09 12.92 12.26 11.09 14 47-Q5 44.78 46.60 41.56 64 n-54 12.38 11.72 10.64 15 46.24 44.27 45-9° 40.56 65 11.01 11.78 11.17 10.26 16 45-34 43.82 45-14 39-56 66 10.49 11.24 10.65 9-85 17 44-34 43-" 44-23 39-°9 67 9.98 10.63 10.12 9-38 18 43-53 42.20 43-39 38.09 68 9.46 10.10 9.61 8.99 19 42-79 41.42 42.64 37-09 69 8.99 9.60 9-13 8.56 20 42.09 40.87 41.98 36.80 7o 8.54 9.12 8.68 8.16 21 41-33 40.17 41.23 36.16 7i 8.02 8.61 8.16 7.67 22 40.62 39-40 40.51 35-73 72 7-52 8.09 7-65 7.18 23 39-87 38.61 39-84 35-15 73 7.12 7-58 7.24 6.77 24 39-i8 37-95 39-15 34-84 74 6.69 7.27 6.83 6.32 25 38-44 37-4o 38.44 34.01 75 6.42 6.99 6.56 6.10 26 37-64 36.80 37-65 33-47 76 6.03 6-57 6.17 5-90 27 36.90 36.21 36-93 32.87 77 5-69 6.29 5-85 5-69 28 36.14 35-69 36.18 32.36 78 5-33 5-92 5-48 5-38 29 35-42 35-07 35-47 31.64 79 5.00 5-86 5.22 5-21 30 34.68 34-55 34-75 31-03 80 4.71 5-56 4-93 4.98 31 33-96 33-9° 34-o4 30.46 81 4.40 5-17 4.61 4.60 32 33-21 33-27 33-30 29.81 82 4.14 4.90 4-36 4-52 33 32.48 32-75 32-59 29.13 83 3-90 4-35 4.04 4.17 34 31-75 32.04 31.86 28.43 84 3-79 3-92 3-84 3-52 35 31-03 31-43 3i.i5 27.76 85 3-5i 3-71 3-58 3.01 36 30.28 30.80 30.41 27.11 86 3-34 3.62 3-44 2.87 37 29-55 30.21 29.69 26.51 87 3-13 3-5i 3.26 2.69 38 28.83 29-55 28.97 25-75 88 2.87 3-40 3-05 2.99 39 28.12 28.88 28.27 25-13 89 2.81 3-14 2-94 2.78 40 27.42 28.24 27-57 24.49 90 2-35 3-33 2.68 4-05 4i 26.69 27-59 26.85 23.82 9i 1.91 3-88 2.46 3-05 42 25.96 26.97 26.14 23-15 92 i-55 3-72 2.25 2.90 43 25-24 26.30 25.42 22.51 93 1.40 3-7i 2-34 3-5o 44 24.50 25.68 24.69 21.80 94 2.21 3-25 2.90 2.50 45 23-79 24.96 23.98 21.11 95 1.21 2.25 1.90 1-5° 46 23.08 24.26 23.27 20.95 96 •50 1-25 1.06 •50 47 22.37 23.68 22.57 20.26 97 1.00 1.00 48 21.68 23.02 21.89 19-57 98 •5o •5o 49 20.98 22.34 21.20 18.92 1 From Tidy's Legal Medicine, vol. ii. p. 2. FORENSIC MEDICINE 587 that the continuance of this business after the issuance and deliverance of the policy violated it. McGurk vs. Metropolitan Life Ins. Co., Conn., 16 Atl. Rep. 263.) It is also provided that if the insured shall change his occupation without the consent of the company the policy shall be void. This means engaging in another employment as a usual business. (Stone vs. United States Casualty Co., 34 N. J. L. 371.) But where it is not pro- vided that a change of occupation shall avoid the policy, such a change will have no effect upon the contract. (Provident Life Ins. Co. vs. Fennell, 49 111. 180.) For the stipulation to have effect, the change must have actually and fully occurred. If death happens while making the change, but before its consummation, though by reason thereof, recovery may be had. (Sum- mers vs. United States Ins., etc., Co., 13 La. An. 504.) A warrantee that the insured is single, when he is married, avoids the policy. (Jeffries vs. Economical Life Ins. Co., 22 Wall., U. S. 47 ; Jeffries vs. Union Mut. Life Ins. Co., 1 McCrary, U. S. 114; United Brethren Mut. Aid Soc. vs. White, 100 Pa. St. 12.) "Where a husband, as the agent of his reputed wife, takes out a policy on his life for her benefit, representing that she is actually his wife, when she is not so, by reason of her having a husband living at the time of their mar- riage, it has been held that the policy is not void, unless they knew at the time of taking out the policy that the lawful husband was living at the time of the second marriage." (Equitable Life, etc., Soc. vs. Patterson, 41 Ga. 338, etc. ; Am. and Eng. Enc of Law, 13, 635.) If a true representation as to the use of intoxicating liquor, opium, etc. (opium and chloral habits), was made at the time the application for in- surance was filed, and the insured subsequently becomes addicted to the intemperate use of liquor, etc., this would be no bar to a recovery of the policy. But if a concealment was made of the fact that the applicant was intemperate at the time of his receiving a policy for life insurance, recovery upon the latter would be questionable. ( Vide also works on Law.) The right to recover on the policy would be forfeited if the insured, who is usually compelled to furnish in his application the name and address of his medical adviser, should state that he had had no medical attendance or prescription. Intemperance in Relation to Life Insurance.—The question whether the habitual use of liquor or various drugs has a tendency to shorten the existence of man is one that might be raised in life insurance cases. To furnish a correct definition of what is implied by the word intemperance is an extremely difficult matter. Chapmanx says, "It is astonishing what a dif- ference of opinion prevails among even intelligent people as to what consti- tutes a temperate person, many an individual who takes several drinks of brandy or whiskey a day considering himself perfectly temperate, and so stating to the medical examiner, utterly unconscious of his health being 1 Op. cit., p. 148. 588 A MANUAL OF LEGAL MEDICINE Dobell's Declaration of the Person to be Assured. Questions to be replied to by the Assurer whose name is hereunto affixed before examination. The Directors wish to impress upon the Assurer the necessity of giving full and correct answers to the following questions : i.—Age next birthday ? - Married or single ? 2.—What is your occupation ? Is it active or sedentary ? How do you bear unusual fatigue?............................................................................... 3.—If now and generally in good health?......................................................... {a) State your height,.............feet.............inches. Weight,............. stones............lbs. {b) Are you increasing or decreasing in weight?............................................................................................................. 4.—Are your habits of life sober and temperate ?- Have they always been so ?................................ 5.—Have you had the small-pox or been vaccinated ? (State which.).................................................................. 6.—Have you ever been bled or cupped, or undergone any surgical operation? If in the affirmative, state particulars....................... 7.—Have you ever suffered from Varicose veins?................................................................................................. Rupture? If so, is a truss constantly worn?......................................... Delirium tremens, apoplexy, fits of any kind, paralysis ?.................... Any head affection ?......................................................................................... Spitting or other discharges of blood? (describe fully).................... Cough? If so, its character and duration.......................................— Any affection of the chest or throat?....................................................... Cancer, scrofula, jaundice, or dropsy?.................................................... Gout, when, and in what part?................................................................... Rheumatic fever, when, and its duration, and was your heart affected by it ?..................................................................................______ Any affection of the stomach or bowels?................................................ Piles or fistula, which ?................................................................................... Any affection of the kidneys or bladder ? (state particulars)............. Have you had any illness not already stated?...................................... FORENSIC MEDICINE 589 N.B.—Much trouble and after-correspondence will be spared by distinct informa- tion as to the causes of death. When there is any doubt about the cause of death (or when it is said to have been connected with childbirth), state dejinitely whether the person was or was not consumptive. 8.—Family History. Father alive, aged-................................................ Health,................_................................. Mother alive, aged-................................................ Health,.................................................... Father died, aged................................................ Cause of death,................................... Mother died, aged-................................................ Cause of death,.................................... ..................................................Brothers alive, ages and health,......................................................... ■.......—......-.............................Sisters alive, ages and health,............................................................. ...................................................Brothers died, ages and causes of death,...................................... ..................................................Sisters died, ages and causes of death,......................................... 9.—Has any member of your family, not mentioned above, suffered from consumption or insanity? If so, give particulars. (This refers especially to uncles, aunts, and first cousins.)................... 10.—Have you ever resided abroad, where, and for what period ?............. If so, was your health affected thereby?............................................... n.—Do you know, have you been informed, or do you suspect that disease or disorder of any kind exists in your constitution ?...... 12.—Are you aware of any circumstances not already stated, connected with your family, or your own constitution, health, or habits, tending to render an Assurance on your life more than usually hazardous?..................................................................................................... 13.—If a Woman,— (a) What is the condition of the uterine functions at present?-...... (b) If married, how long?............................................................................ {c) Have you ever had any children or miscarriages, and have your confinements proved favorable or not ?......................... {d) State whether pregnant or not.......................................................... I hereby declare that the answers to the above questions are to the best of my knowledge and belief in all respects true. As witness my hand this...................day of.................................................18 Signature of the Assurer,............................................................................ Signed in the presence of the Medical Examiner, whose name is hereunto affixed. ...................................................................... Dobell's Report by the Medical Examiner, whose Name is hereunto affixed. On the Life of.......................................................................................................................................Qf i.—Was the declaration already given signed in your presence?............................................. Is the Assurer known to you ? and what opportunities have you had of becom- ing acquainted with his health, habits, and constitution ?......................................... Describe the present appearance.............................................................................................. Is the aspect healthy?................................................................................................................... 2.— What is the actual rate of pulse (standing)?...................................................................... Tf ,, .... ,, , , T , . . If the applicant has ever suffered from Is the pulse normal in rhythm, volume and force, etc. ?............................................... Rheumatism or Rheumatic Fever, please (If the answer is in the negative, give particulars.)................................................... to direct especial attention to the heart. Are the pulsations and sounds of the heart quite normal?............................................ If not, state defects.................................................................................................................... 3.—Are the proportions and development of the chest normal?............................................. T .1 , , , . . , Attention is particularly requested to Is the general character of respiration normal?......................-....................................... th*e* ~..*r*i~ , ««•• • VJ * these questions, as Phthisis is one of the Do the subclavian regions expand normally in respiration?.......................................... principal causes from which Insurance Is the respiratory murmur above and below the clavicles normal?............................. Offices suffer loss. What do you consider to be the condition of the lungs?................................................ {If there is anything abnormal, give particulars.)...................................................... 4-—What is the condition of the tongue?.................................................................................... 5. I lave you any reason to suspect disease of the urinary or generative organs?............. {If you suspect disease of the kidneys, say, is the urine coagulated by heat and nitric acid' ?)................................................................................................................... > c > r o *j r M O > r M O n 5 M re there any traces of {a) paralysis, {3) syphilis, {c) jaundice, {d) gout, {e) rheumatism, (/) scrofula, {g) dropsy, and is there any reason to apprehend (//) an apoplectic seizure?...................................................................................................... 7.—If there is rupture, what is its nature and duration?............................................................ Is it constantly and efficiently supported by a truss?-..................................................... 8.—Have you reason from any source whatever to suspect the proposer is now or has been of irregular or intemperate habits, or addicted to any habits or pursuits likely to shorten life?............................................................................................................... 9.—Is any circumstance known or suspected by you not already stated that might render the life more than usually hazardous ?................................................................ Confidential Opinion. I hereby certify that the answers given by me above are according to the best of my knowledge and belief, and, after a careful consideration of the personal condition and of the personal and family history, lam of opinion that the life should be placed in the 1st Class.—Average Lives. Such as have either no unfavorable circumstances of health or family history, or in which the unfavorable circumstances are so slight as to form no impediment to Assurance at the usual rate.............................. 2d Class.—Lives such as require an addition to the premium to cover increased risk. State how many years should be added to the present age of Assurer to cover the risk............................................................................................................................................ 3d Class.—Lives such as should be declined. Signed, 592 A MANUAL OF LEGAL MEDICINE gradually undermined and of his life being shortened by the daily use of alcohol. It is due to such a difference of opinion as to the effect of alcohol upon the system that the question of intemperance has given rise to so much discussion in cases of life insurance. While it is undoubtedly true that there have been exceptional cases of individuals enjoying good health and living to a good old age who had been in the habit of drinking, and more particu- larly whiskey, all their lives, nevertheless it cannot be denied that, as a gen- eral rule, the habitual use of alcohol in perverting nutrition induces disease of the heart, liver, and kidneys, and so tends to shorten life." Relation of Suicide to Life Insurance.—Suicide committed for the express purpose of liquidating debts or leaving money to the heirs would invalidate the insured's policy. But if the insured person committed the act after the policy was taken out, while laboring under insanity, the heirs would undoubtedly be entitled to the payment of the insurance money. The Medical Examination.—In conducting a medical examination for life insurance, the first essential is the identity of the applicant, for cases are recorded where the attempt has been made to substitute a person perfect in health for the real applicant, who, perhaps, would not be able to pass the medical inspection satisfactorily. Strict inquiry should then be made concerning the applicant's mode of life, habits, etc. Before beginning the physical examination much may be gleaned respecting him by noting his general appearance, expression, man- ner, gait, etc Note particularly whether the eye is bright or dull, the com- plexion healthy or dull, or whether it reflects the signs of dissipation or disease, etc. If the skin be hot, the temperature thereof should be observed; but it is well to remember that many persons become unduly nervous when undergoing a medical inspection. Many examiners, as a preliminary to the regular examination, question the applicant as to his occupation, residence, etc It is also a very good plan to inquire respecting the sanitary conditions of the place wherein he resides. Learn particularly whether he is addicted to alcoholics, or whether he shows signs of opium or chloral habits. Ascertain his family history, hereditary or acquired predispositions, and mental and moral status. The examination should always be conducted in private for obvious reasons, and usually in the examiner's office, although for the sake of con- venience it may sometimes take place at the applicant's residence. It is not necessary here to particularize the various affections of which an applicant might show evidence, as it is presumed that every practitioner of medicine is already familiar with the more common diseases ; hence all that will be stated is the plan of examination. The following systems should be investigated in turn : (i) the nervous system (under this heading is also included the muscular system), (2) the respiratory system, (3) the circulatory system, (4) the digestive system, and (5) the genito-urinary system. The issuance of a life insurance policy should not occur unless the urine of the applicant has been carefully tested and found to be in a healthy condition. It is well to FORENSIC MEDICINE 593 recollect this point, as some persons, who otherwise are first-class risks, possess highly albuminous urine, which, if persistent, should cause the re- jection of the applicant. The same holds true respecting other abnormal deposits. Tidy * says, "As regards the generative organs, sexual incapacity in males is an early symptom of diabetes and of many neuroses. It must be remembered, too, as regards females, that the uterus and ovaries are favorite seats of cancer and of cystic disease respectively. In the male stricture of the urethra should be regarded as an element of danger." Having completed his examination, the physician is required to fill up the blanks, which may be obtained at the home office of the company, so as to make the necessary reports. Some such form as that on pages 590 and 591 may be used. " In view of the essential qualifications of a medical examiner, his respon- sibilities, the necessity of thorough investigation, the demands made on his time by insurance companies, and the delicate attitude he sustains both toward the company and the applicant, his fee in no case should be less than five dollars,—in some instances more,—and should always be paid by the company and from the home office." (McSwain.) CHAPTER XLII. PHARMACEUTICAL JURISPRUDENCE.2 BY JUDGE GEORGE F. ROESCH, Member of the New York Bar. Definition—Foundation of the Office—History of the Laws—Constitutionality of Laws regulating the Practice of Pharmacy—The Revocation of a License—Liability of the Pharmacist—Registration—Civil Liability of Pharmacists—Prescriptions, etc. Pharmaceutical jurisprudence may be defined as that body of written and unwritten laws which affect the transactions of patients and the general public in their dealings with those skilled in the art and practice of preparing and preserving drugs, and of compounding and dispensing medi- cines. No doubt the codes of civilized countries have at all times contained provisions for the regulation of the practice of pharmacy. Shakespeare, the "myriad-minded man," as Coleridge terms him, makes us acquainted in "Romeo and Juliet" with the laws of Mantua. He gives us, too, a vivid picture of an ancient druggist and his shop. Romeo has just been informed 1 Op. cit. 2 Being a synopsis of a lecture delivered October 9, 1895, before the Alumni Asso- ciation of the New York College of Pharmacy. 38 594 A MANUAL OF LEGAL MEDICINE of the death of Juliet. He seeks in self-destruction reunion with his lost beloved. " I do remember an apothecary,— And hereabouts he dwells,—whom late I noted In tattered weeds, with overwhelming brows, Culling of simples ; meagre were his looks, Sharp misery had worn him to the bones ; And in his needy shop a tortoise hung, An alligator stuffed, and other skins Of ill-shaped fishes ; and about his shelves A beggarly account of empty boxes, Green, earthen pots, bladders, and musty seeds, Remnants of packthread, and old cakes of roses, Were thinly scattered to make up a show.'' Romeo calls on the apothecary and asks him for "a dram of poison.'' The latter answers, " Such mortal drugs I have : but Mantua's law is death to any he that utters them." But he gives him the poison, saying, "My poverty, but not my will, consents." The wily apothecary wished to avoid the charge of a criminal intent in breaking the law. The real foundation of the office of apothecary in England was laid in 1543, in an act of Parliament, 34 and 35 Henry VIII., ch. 8. Its preamble speaks severely of the ignorance and cupidity of London surgeons, and then, as a remedy, provides for the toleration and protection of irregular practitioners, who afterwards, as a body, became known as apothecaries. It is interesting, in view of modern prosecutions of druggists for selling remedies without a physician's prescription, to notice that this act distinctly ordains "that it shall be lawful to every person, being the king's subject, having knowledge and experience of the nature of herbs, roots, and waters, or of the operation of the same by speculation or practice, to practise, use, and minister in and to any outward sore, wound, swelling, etc., according to their cunning, experience, and knowledge, and without suit, trouble, or penalty." So that the skill of the apothecary could, without hinderance, be called into service in a quasi-medical capacity by the people of those days. . . . The practice of pharmacy is now regulated in this State by art. xi. of ch. 661 of the laws of 1893, being an act in relation to the public health, and forming ch. 25 of the '' public health law.'' It provides for a State Board of Pharmacy, excepting the counties of New York, Kings, and Erie, of five members, each to hold office for five years from the first Tues- day of September of the year in which such term begins. The New York State Pharmaceutical Association at each annual meeting nominates five resident pharmacists of the State, outside of said counties, from which number the governor fills each vacancy happening after each nom- ination. The members of the board take the usual oath, and meet annually FORENSIC MEDICINE 595 on the first Tuesday of September, at noon, and elect a president, secretary, and treasurer for one year. Other meetings are held at least once in three months. The board makes by-laws and regulations for the examination of applicants for license. There are two grades of licenses granted,—that of pharmacist, which confers the privilege of carrying on the practice of phar- macy, either on his own account as proprietor or for some other person, and that of assistant pharmacist, which permits the holder to retail medicines and poisons, but not to compound physicians' prescriptions in the absence of the licensed pharmacist. The board must examine applicants and grant licenses, keep a record of pharmacists and assistants, investigate complaints of violations of the law, bring such cases and all infractions of the penal code to the notice of the proper prosecuting officer, and render annually to the governor and the State Pharmaceutical Association a full statement of its receipts and disbursements. Any person who has had four years' experience in the practice of pharmacy, previous to January i, 1893, or holds a certificate of registration as a pharmacist by examination from any board of pharmacy legally created under the laws of this State, is entitled to become a pharmacist. Any person who has had two years' experience in the practice of pharmacy is entitled to license as an as- sistant pharmacist, each upon passing the requisite examination. Any person who on May 24, 1884, was entitled to a license, but failed within ninety days to apply to the State Board for a license, might, within ninety days after the passage of that act, on eight days' notice to the secretary of the board, have applied to the Supreme Court for an order directing the board to issue such license, upon proof of good cause for such neglect. No person is entitled to a license as a pharmacist or assistant unless he furnishes proof, by his own affidavit or otherwise, in addition to all the other requirements of the law, that he is a resident of the city, county, or district for which the board to which he applies is created, or, if a non-resident, that he intends to practise therein, and that he has not applied for a license to or been examined by any other board of pharmacy of the State, and has not been refused a license within six months preceding. By that statute a fee of five dollars was to be paid to the State Board for a pharmacist's license, and three dollars for that of an assistant pharmacist. The license must be conspicu- ously posted in the licensee's place of business. No license shall be revoked except for just and sufficient cause, and no one may hereafter practise as a pharmacist unless a license has been granted by the State Board. The statute does not apply to practitioners of medicine who are not the pro- prietors of stores, and does not prevent them from supplying patients. Nor does it apply to wholesale dealers in medicines or poisons, nor to the sale of insect poisons or substances for use in the arts, or to the manufacture or sale of proprietary medicines, or to the sale of the usual domestic remedies by retail dealers in rural districts. These remedies are defined in the act as those, a knowledge of the properties of which and dose has been acquired from common use, and includes only such remedies as may be safely em- 596 A MANUAL OF LEGAL MEDICINE ployed without the advice of a physician. A large number of them are named in the act; but the term does not include poisons requiring knowl- edge and pharmaceutical skill to safely dispense, unless they are sold in original packages, or such as bear the label of a licensed pharmacist. This act itself also furnishes us with a definition of the term '' practice of phar- macy" as meaning the compounding of prescriptions, or of any U. S. Phar- macopceal preparation, or of any drug or poison, to be used as a medicine, or to the retailing of any drug or poison, except as in the act provided for. The law does not prohibit the employment of apprentices for the purpose of being instructed in the practice of pharmacy, but they are not permitted to dispense prescriptions, or sell or furnish medicines or poisons, except in the presence and under the supervision of a licensed pharmacist. The article does not apply to the counties of New York, Kings, and Erie, but a license duly issued by any legal board of pharmacy entitles the holder to a license or certificate of registration from any other board upon complying with the formal requirements of the law. Any person violating any provision of the article forfeits fifty dollars for every such violation to the county, to be sued for and recovered in the name of the county by the State Board. It retains the cost and expenses out of all penalties, and one-half of the penalty goes to the county treasury. The expenses of the State Board are defrayed out of the fees and the moiety of such penalties. In the matter of Ward, 10 Misc. Rep. 424, Judge Herrick, at Albany, held that the act of 1893 was evidently intended to take the place of all statutes thereto passed. Charles W. Ward had failed to apply within the ninety days provided for in the act of 1893, and sought to compel the State Board to license him, notwithstanding that fact. Judge Herrick denied his motion, and held that no period is prescribed within which a person must apply for a license who has had four years' experience in the practice of phar- macy previous to January 1, 1893. But as to those qualified under the act of 1884, who failed to make application within ninety days after the passage of the act of 1893, there is no provision in the statute for obtaining a license except by passing an examination. But we must take into consideration the amendments passed by the Legislature of 1895. By the act which went into effect on June 4, 1895, any person who has had four years' experience in the practice of pharmacy, or holds a certificate of registration as a pharmacist, is entitled to a license as such, and two years of experience will entitle him to be an assistant pharmacist, if otherwise qualified. The fees are made ten dollars for a license as a pharmacist from the State Board, five dollars for a license or certificate of registration after examination by other boards, and three dollars for a license as an assistant. The license from the State Board seems indispensable. I also understand that the last Legislature passed an act, introduced by Senator Donaldson, requiring every licensee of the State Board of Pharmacy who desires to continue the practice of his profession to pay annually within thirty days from November 1 a fee of one dollar, for which he shall receive a renewal, to be displayed with the license. FORENSIC MEDICINE 597 The regulations of the local boards are readily ascertained, and they strive with the State Board to maintain a high degree of excellence as to the requi- sites of admission to practise in pharmacy. Those applicable to this city are found in the Consolidation Act. The constitutionality of laws regulating the practice of pharmacy has been affirmed by the Supreme Court of the United States. Judge Field, in Dent vs. West Virginia, 129 U. S. 114, declared that "due consideration for the protection of society may well induce the State to exclude from prac- tice those who have not such a license, or who are found upon examination not to be duly qualified." (See also State vs. Donaldson, 41 Minn. 74; State vs. Farian, 65 N. H. ; People vs. Moorman, 86 Mich. 433 ; State Board vs. White, 84 Kent, 606.) Of course these laws, like many others which infringe upon personal liberty, may frequently in individual cases, because of their peculiar sur- roundings, work seeming injustice ; but in the exercise of the police power of the State, in protection of the public health, their enactment has re- peatedly been upheld by the courts. In England, in the beginning of the eighteenth century, the College of Physicians prosecuted Apothecary Rose successfully in the Court of King's Bench, for prescribing a bolus for Seale, the butcher. (3 Salk. 16; 6 Mod. 44.) But Apothecary Rose, insistent upon his rights, as apothecaries usually are, won on appeal to the House of Lords (5 Bro. Pari. Cases, 553), because the peers did not believe that every one should be compelled, when sick, to call in "a physician to prescribe, an apothecary to dispense, and a surgeon to let blood." But even their quackery drove the apothecaries to procure the passage of the act of 53 George III., ch. 194, forbidding any one to practise without a license, and their courts, too, have ever since enforced laws similar to our own. The English apothecaries' act of 1815, just mentioned, is the parent of most of the American legislation upon the subject, though our laws exceed that statute in severity in the provisions of our criminal codes. So, too, these laws in our country have been sustained in so far as they forbid others than graduates of certain schools to practise, requiring a certain period of residence in the State, permitting all actually in practice at the time of the passage of a law to continue to practise upon registration, but imposing certain burdens upon others ; forbidding licensed physicians from conducting drug-stores, except in compliance with the pharmacy law, and creating State boards of examiners. (Hewitt vs. Charles, 16 Pick. 353 ; State vs. Vanderslins, 42 Minn. 129 ; 43 N. W. 789 ; State vs. Green, 112 Ind. 462 ; 14 N. E. 352 ; State vs. Hathaway, 21 S. W. 1081 ; State vs. Creditor, 24 Pac. 346 ; Brown vs. People, 11 Col. 109 ; 17 Pac 104.) Again, a license may be revoked for unprofessional conduct, or such other causes as the statute or the board may prescribe. But the holder must have notice and an opportunity to answer the charges against him. (Gage vs. Censors, 63 N. H. 92-94 ; State vs. Med. Ex. Bd., 32 Minn. 324 ; People vs. McCoy, 125 111. 289; 30 111. App. 272; State vs. Schultze, 28 598 A MANUAL OF LEGAL MEDICINE Pac. 643.) So, on the other hand, a mandamus would lie to compel a board to grant a license, if they arbitrarily and without just cause refuse it. (Harding vs. People, 10 Colo. 387 ; Dental Exrs. vs. People, 123 111. 227 ; People vs. Bellevue, 60 Hun, 109 ; State vs. Fleischner, 41 Minn. 69.) An unlicensed practitioner would not be entitled to exemption from jury duty. It is questionable whether he could maintain an action for slander, if a jealous competitor would call him a quack. (Hargan vs. Purdy, 20 S. W. 432 ; Skirving vs. Ross, 31 Upper Can. C. P. 423 ; Collins vs. Carnegie, 1 A. and E. 695.) An unlicensed practitioner could not recover for prescriptions compounded by him and not paid for by his customers. Such cases would fall within the principle of Ferdon vs. Cunningham, 20 How. P. 154 ; Lauger vs. Unter- bury, Misc. 210 ; and Bloom vs. Soberski, 8 Misc. 311, that where a statute prescribes certain regulations, compliance with them is prerequisite to re- covery. There are things which one may not do, although he have a license. If one prescribes under the guise of selling patent medicines or drugs, it would constitute medical, not pharmaceutical, practice. (Alcott vs. Barber, 1 Wend. 426 ; Thompson vs. Staats, 15 Wend. 395 ; Smith vs. Tracey, 2 Hall, 465; Underwood vs. Scott, 43 Kan. 714; 23 Pac. 942; State vs. Doran, 109 N. C. 864.) On the other hand, a man was accus- tomed to gather herbs, was called doctor in his neighborhood, gave reme- dies to a sick friend, and advised him as a neighborly act, without a fee. He was not held to practise, and was acquitted. (Nelso vs. State Ala., 12 So. 421.) The liability of a pharmacist is of a dual nature,—criminal and civil. A criminal proceeding may be prosecuted against him, and a civil action for damages brought at the same time. Nor can he by a settlement of the latter expect to compound the former, for that might in itself amount to a felony. The original liability is that defined in the Penal Code and in the Consolidation Act of the city of New York. It is well to bear in mind that section 29 of the Penal Code makes every one a principal in the commission of a crime, whether he directly commits the act, aids or abets in its commis- sion, is present or absent, or directly or indirectly counsels or procures another to commit it. Section 191 prescribes that a person who provides, supplies, or adminis- ters any medicine, drug, or substance, or uses or employs, or causes to be used or employed, any instrument or other means for improper purposes, unless to preserve the life of woman or child, is guilty of manslaughter in the first degree, punishable by a term of imprisonment not exceeding twenty years. Section 200 provides that a physician or surgeon who, in a state of in- toxication and without a design to effect death, administers a poisonous drug or medicine, is guilty of manslaughter in the second degree, punishable by imprisonment for a term not exceeding fifteen years, or a fine of not more than one thousand dollars, or both. There is no such provision with ref- FORENSIC MEDICINE 599 erence to pharmacists. There would, then, seem to be tacit legislative rec- ognition of pharmaceutical sobriety. Section 217, subdivision 2, ordains that administering any poison or other destructive or noxious thing, so as to endanger life, or causing it to be taken by another, is assault in the first degree. Section 218 provides that administering a drug or medicine, the use of which is dangerous to life or health, with intent to injure, or with intent to assist in or make possible the commission of any crime, when not amounting to assault in the first, is assault in the second degree. Section 297 makes the manufacture, sale, or giving away of an instru- ment, medicine, or drug for unlawful purposes a felony. Sections 318, 319, and 320 make it a misdemeanor to sell, lend, give away, exhibit, or mail any instrument, article, recipe, drug, or medicine for un- lawful purposes, and allows the issuance of a search-warrant in aid of the law. Sections 364 to 368, inclusive, provide severe punishment for counter- feiting trade-marks, and apply equally to the sale, keeping, or offering for sale of goods represented as the product or manufacture of a person not the manufacturer. In this connection I call attention to the discovery by the Carter Medicine Company, a few weeks ago, of a counterfeit of its trade- mark, " Carter's Little Liver Pills." Several arrests were made, and, upon conviction, Justice Jerome, in passing sentence of three months in the peni- tentiary, said, "The whole value of many of these articles lies in the trade- marks. Thousands and hundreds of thousands of dollars are spent annually in placing them before the public If the public cannot rely upon these articles, then a fraud is being practised upon them, and upon the proprietary- rights of those persons who own trade-marks. This is a class of cases upon which this court does not look with any leniency whatever." The court did not intend any sarcasm, but the whole value of many of these articles does lie in the trade-mark, not in the compound itself. Sections 401 and 405 relate to the omission of apothecaries to label drugs, or labelling them wrongly, and compel a druggist to keep a poison-book, in which must be recorded the name and residence of the person receiving the poison, together with its kind and quality, and the name and residence of a witness, unless sold upon the written order or prescription of a physician, whose name must be attached to it. The poison-book must be submitted to the inspection of any person upon reasonable demand during ordinary busi- ness hours, and the refusal to do so is punishable by a fine not exceeding fifty dollars. A poison must be labelled, unless sold upon such order, with the name "poison," and have its name written or printed upon it. No one employed in a drug-store is allowed to prepare a medical pre- scription unless he served an apprenticeship of two years, or is a graduate of a medical college, or college of pharmacy, except under the direct super- vision of some person duly qualified ; nor is it permissible to prepare a medical prescription, except under such supervision. The penalty is a fine not exceeding one hundred dollars, or imprisonment not exceeding six 6oo A MANUAL OF LEGAL MEDICINE months. If death results, the person offending is guilty of a felony, punish- able by a fine of not less than one thousand dollars or more than five thou- sand dollars, or of imprisonment of not less than two years or more than four years, or both fine and imprisonment. Sections 407 and 408 punish the adulteration of drugs and medicines, or selling, offering or exposing for sale, if for any cause unfit to be used, as a misdemeanor. Sections 438 and 438a punish the use of false labels upon any article as a misdemeanor. Sections 580 to 584, inclusive, make the use or possession of false weights and measures or other apparatus a misdemeanor. The Consolidation Act of the city of New York, section 2915, makes it unlawful for any but a graduate or licentiate in pharmacy to open or conduct any pharmacy or store for retailing, dispensing, or compounding medicines or poisons in the city of New York, except as provided in the act; but by the amendment of the laws of 1889, ch. 448, the widow or legal representa- tive of a deceased graduate or licentiate may continue his business, if the actual retailing, dispensing, or compounding of medicines or poisons be only by a graduate or licentiate in pharmacy. The Penal Code, sections 404, 725, and 726, did not repeal this section, and section 405 merely relates to persons employed in a drug-store, and not to the proprietors. (People vs. Routey, 21 N. Y. Rep. 173 ; s. c, 4 N. Y. Suppl. 235 ; 51 Hun, 643.) Under section 2016 no one can be registered but a graduate or licentiate, or a graduate having a diploma from some legally constituted medical college or society. We are furnished with the definition of graduates and licentiates in section 2017, which provides that graduates are those having at least four years' ex- perience in stores where medical prescriptions have been compounded, and having obtained a diploma from any college of pharmacy in the country, or from some authorized institution or examining board. Licentiates are those who have had a like experience, and passed an examination either before the board established on March 28, 1871, or before that created by ch. 817 of the laws of 1872. Foreign pharmacists who present satisfactory credentials or certificates of their competency and qualifications to said board may also be allowed to practise as such. Junior assistants or apprentices are not per- mitted to prepare physicians' prescriptions. In section 2018 the College of Pharmacy is called upon to elect on the first Monday in April of every third year, at a special meeting, five competent pharmacists, of whom three shall be graduates of a medical college and two of a college of pharmacy in this city, to constitute the Board of Pharmacy. Within thirty days after their election they take the oath, and then hold office for three years, and until their successors are duly elected and have qualified. If there be a vacancy, the trustees of the college fill it from two or more nominees elected at a special meeting of the college. The board FORENSIC MEDICINE 601 elects a president and secretary, and must meet at least once every three months, and three members constitute a quorum. The board must transact all business pertaining to the legal regulation of the practice of pharmacy in this city, examine and register pharmacists, and, after satisfactory examina- tion, furnish certificates of competency upon payment of a fee of five dollars. In section 2019 it is made the duty of the secretary to keep a book of registration of the names and places of business of persons affected by the law. All must register and pay a fee not to exceed two dollars for pharma- cists and one dollar for assistants. The moneys received defray the expenses of the board, and any surplus is for the benefit of the college. The salary of the secretary is fixed by the board and paid out of the registration fees. Every registered pharmacist is to be held responsible under section 2020 for the quality of all drugs, chemicals, and medicines he may sell or dispense, except those sold in the original packages, and patent medicines ; and should he knowingly, intentionally, and fraudulently adulterate or cause to be adul- terated such drugs, chemicals, or medical preparations, he is guilty of a mis- demeanor, and liable to a penalty not exceeding one hundred dollars, and in addition his name is stricken from the register. No person is allowed, according to section 2021, to retail any poisons enumerated in the two schedules annexed to it, and which are well known in drug-stores. In section 2022 it is declared that nothing contained in the foregoing section applies to medical practitioners who do not keep open shop for re- tailing medicines and poisons, nor to the business of wholesale dealers ; but the preceding section and its penalties do apply to them. Under section 2023 any one who attempts to procure false registration for himself or another is liable to a penalty not exceeding five hundred dollars. A registered pharmacist who permits a person not registered to compound and dispense prescriptions, or any person not registered who keeps open shop for such purpose, or fraudulently represents himself to be registered, or any registered pharmacist or dealer in medicines who fails to comply with the law in relation to poisons, is deemed guilty of a misde- meanor, and liable to a penalty of fifty dollars. Pursuant to section 2024, the penalties recovered are paid to the trustees of the College of Pharmacy, and expended for the benefit of its library. I did not, however, find any provisions in these sections for procuring their enforcement. This is to be deplored, not alone for the sake of the college and its library, but of the profession itself. It might be well if the recent wholesome investigations into the adulteration of milk were extended to drugs and medicines. It would, furthermore, be extremely advantageous if some such officer of the city government as the corporation attorney were required to institute and conduct prosecutions under these sections. As to the civil liability of pharmacists, the sparseness of litigation con- cerning it is a powerful testimonial to the painstaking care and professional 602 A MANUAL OF LEGAL MEDICINE skill of the druggist of to-day. Almost every vocation in life furnishes far more occasion to the courts for the definition of personal rights and obliga- tions arising out of allegations of negligence than does that of the pharma- cist. The law-books are full of cases touching the alleged incompetency of men of other professions, while the instances in which an apothecary appears as a defendant on account of unskilfulness are comparatively rare. It is true that in more recent years some grave questions have arisen and caused some volume of litigation. But these, in the main, relate, as it were, to the purely mercantile side of the calling as regards proprietary medicines and the like, and not to any difficulties arising out of the compounding of pre- scriptions. The question has been submitted as to who owns the prescrip- tion. Our courts have not yet had opportunity to pass directly upon it, and it remains purely academic Professor Odronaux, in his "Jurisprudence of Medicine," p. 291, indulges in a learned and profound discussion of the sub- ject. He does not claim any exclusive right of property in physician, patient, or pharmacist. He is of the opinion that the first has a proprietary right and the second a fiduciary ownership, but does not fix the status of the last. A pharmacist has no right to communicate to others the nature and ingredients of a prescription, for that would certainly fall within the spirit of the law which holds sacred the communications between professional men and their patrons. Justice Yates, in Mills vs. Taylor, 4 Burr. 2362, said that ideas are free, and every man has a right to keep them, and a right to make public and control their publication. In Abernethy vs. Hutchinson, 3 L. J. ch. 209, a lecture was held to be the private property of its writer, whose publications he could enjoin. In Gee vs. Pritchard, 2 Swan, 402, a letter written to a friend was thus pro- tected. In Morrison vs. Moat, 9 Hare, ch. 241, the publication of a secret in the compounding of a medicine was prevented. In England, in Yovatt vs. Wingard, 1 J. & W. 394, in 1820, an injunction was granted against making any use of or communicating certain recipes for veterinary medi- cines. Wingard, while employed by Yovatt, had access to his prescription- book and copied them. Lord Eldon granted the injunction, upon the ground that there had been a breach of trust and confidence. In these days of intellectual activity in various directions, when the press and modern inventions make private actions public property, the right to privacy has come to be recognized as a personal right, of equal claims to the protection of the law with the time-honored rights to life, limb, and property. The courts will prevent a breach of confidence or trust, and what might be termed an implied contract not to publish the results of mental processes intended solely for the benefit of him who seeks and compensates for their aid. The patient may be said to own the prescription, because he paid for it. The apothecary owns it in so far as he has a right to its retention in self- protection against charges of unskilful compounding or use of improper in- gredients. The prescription itself is functus officio. A physician might print the words '' Not to be repeated'' across the face of the prescription, FORENSIC MEDICINE 603 and thus raise an implied contract not to use it again. The prescription- book is the property of the pharmacist against all the world but physician and patient, and he should in all cases insist upon the retention of the original, and not of a mere copy. I understand that it has been held in Massachusetts that the sale of prescription-books can be restrained, and that they are not subject to sale on execution to satisfy creditors' claims. A prescription cannot be used again if the physician forbid it. In New York, by the laws of 1887, ch. 636, refilling more than once prescriptions of opium or morphine, or preparations of either, in which the dose exceeds one-twentieth of a grain, except upon the verbal or written order of a physician, is made a misdemeanor. If a patient puts up a prescription as a patent medicine and advertises it in the name of a physician, he might be liable to an action for libel. (Clark vs. Freeman, 11 Beav. 112.) If a physician prescribes an overdose of a poisonous drug, and the drug- gist, noticing that fact, calls upon the physician, who directs him, notwith- standing, to dispense it, and the patient sustains bodily injury, or dies in consequence of the drug, both physician and druggist would be liable, though the latter in a lesser degree. The law does not compel a druggist to fill every prescription presented, any more than is a physician compelled to treat every one who comes to him. If, then, a druggist, despite his con- viction as a professional man of its dangerous character, compound such a prescription, he too assumes a share in the risk, and must abide by the consequences. His remedy is to refuse to fill it. It is his duty to be upon his guard against errors, and he compounds them at his peril. In Massachusetts a joint action was sustained against physician and drug- gist, because of an erroneous prescription written by the one and filled by the other. (2 Hilliard on Torts, p. 297, note a.) As Judge F. C. Brew- ster said in Commonwealth vs. Bauer, Philadelphia Oyer and Terminer, April, 1869, "If the exercise of reasonable care would have warned him that he was preparing something which would inevitably kill, it would be criminal for him to go on." But the negligence of the druggist must be established affirmatively. Mere inference will not suffice. The circum- stances of each case must, however, be consulted. No universal rule can be formulated. But negligence has been declared to be the omission to do something which a reasonable man, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or the doing of something which a reasonable and prudent man would not do. A druggist is often called upon to act quasi in the capacity of a physician. He runs the risks of prosecution if he does so. In later days such cases have become fewer, and the frequent prosecutions of the county medical societies have had beneficial results. On the other hand, they have, with the aid of stool-pigeons, often worked grievous wrong. But, as Judge Hawkins says in Apothecaries vs. Jones, 5 R. 101, " It is idle to lay down a golden rule upon the subject." The demarcations of each case must be noted, and the degree of liability becomes a question of fact. 604 A MANUAL OF LEGAL MEDICINE The pharmacist is liable in damages for all injuries inflicted through his ignorance, unskilfulness, or carelessness. He must know, ex professo, the properties of medicines and the proper doses, be fully equipped with the knowledge required by the standards of his profession, and keep abreast with the developments of materia medica in so far as they may come into service in modern pharmacy. The law does not require him to be an expert, but he will be held to warrant the purity of the drugs he employs in filling prescriptions, and that they are of the quality called for by the physician. ( Vide Odronaux's "Jurisprudence of Medicine," p. 259.) He must be con- versant with the language of prescriptions and the means for detecting the quality of drugs. He must not grow rusty in his knowledge, and the discov- eries of the properties of nature's forces, together with the wonderful dis- closures of modern chemistry, must not be "a hidden book" to him. A leading case in our State is that of Thomas vs. Winchester, 6 N. Y. 397. It was decided by the Court of Appeals in July, 1852. A jar had been labelled "One-half pound dandelion, prepared by A. Gilbert, No. 108 John Street, New York. Jar 8 oz." Gilbert was in the employ of Winchester, and the labels were paid for by the latter, and used in his business with his knowledge and assent. The jar was sold to James S. Aspinwall, a druggist in New York, as containing extract of dandelion. As a matter of fact, it con- tained extract of belladonna. He sold it to Dr. Foord, a druggist in Caze- novia, Madison County, N. Y. Mrs. Thomas had been taken ill, and her physician prescribed extract of dandelion. Her husband went to Dr. Foord's drug-store, and was given some of the contents of the jar in ques- tion, in the belief that it contained extract of dandelion. Mrs. Thomas took the medicine according to prescription, and as a result her life was endan- gered. Upon recovering, she brought an action for damages against Win- chester, the original seller. She obtained a verdict and the wholesaler appealed. Chief-Justice Ruggles declared that "the remote vendor of medicine upon which he has carelessly put a wrong label, and which, so labelled, he puts upon the market, is liable for injuries resulting therefrom. This is so, although there be no privity or connection between such vendor and the person injured by its use. Every man is bound under the law to avoid that which endangers another." The court dwells upon the danger to the public because of unskilfulness or carelessness in the profession, and, though there was no contract between the patient and the wholesaler, an implied contract was declared to necessarily exist, because of the danger to the public from mismanagement in the business. So in England a chemist who negligently sold laudanum as paregoric, and caused the death of the person who took it, was declared guilty of manslaughter. (Tessymond's Case, 1 Lewin's Crown Cases, p. 169.) In Kentucky druggists were held liable for selling cantharides for snakeroot and Peruvian bark, and croton oil for linseed oil. (Fleet vs. Hollenkamp, 13 B. Munroe, 219 ; Hanford vs. Payne, 11 Bush, 380.) In Michigan the druggist was held for his clerk's mistake in giving sulphate of zinc for Epsom salts. (Brown vs. Marshall, 47 FORENSIC MEDICINE 605 Mich. 576.) But a druggist is not responsible for the results, though he sells a poisonous drug without labelling it, if in fact he warned the customer of its properties, and the jury must pass upon the competency of the clerk, and whether actual negligence was proved. Mary Wohlfart sued Druggist Charles A. Beckert for damages for negli- gence, because his clerk had given her deceased husband a poison without the usual label. The clerk had warned him that the "black drops" asked for was a strong poison, of which he should take only ten or twelve drops for a dose. He took ten times that amount, relying upon a friend who had told him he had taken half a glass of what he called "black draught," and that it had cured him. It was admitted that the label was not on the vial. The court held that even though it is a misdemeanor to sell a poison without a label, doing so does not render the druggist liable in a civil action, if, before delivering it, he fairly and fully warned him that the substance was poison. (Wohlfart vs. Beckert, 12 Abb. N. C. 478.) In Brown vs. Marshall, 47 Mich. 576, and Beckwith vs. Oatman, 43 Hun, 265, it was held that a failure on the part of the druggist, or his clerk, from whom the medicine was purchased, to exercise due skill and care must be proved. Judge Cooley stated in the Michigan case that a high degree of care may justly be required, but that the courts have not yet gone so far as to dispense with proof of actual negligence as a necessary element in the liability when a mistake has been made. Our Court of Appeals, in Allen vs. State, S. S. Co., 132 N. Y. 95, where a passenger sought to make the com- pany liable for a mistake in the filling of a prescription aboard during the voyage, having been given calomel instead of quinine, though no actual negligence was shown, held that a person is not legally responsible for any unintentional injury from a lawful act when the failure to exercise due care cannot be imputed to him, and the burden of proving such lack of care when the act is lawful is upon the plaintiff. (Losse vs. Buchanan, 51 N. Y. 476, 488; Carpenter vs. Blake, 75 N. Y. 12; Morris vs. Piatt, 32 Conn. 75; Simond vs. Henry, 39 Me. 155.) A man without a license may invest his money in a pharmacy, but cannot himself sell or dispense medicines. (Commonwealth vs. Johnson, 144 Pa. St. 377 ; Commonwealth vs. Johnson, 22 Atl. 703 ; State vs. Morton, 67 Iowa, 641.) In New York a conviction, in January, 1889, for opening and conducting a pharmacy for compounding and retailing medicines without due qualification according to law was sustained by the courts. (People vs. Rontey, 21 N. Y. St. R. 174 ; 4 N. Y. Supp. 235 ; 117 N. Y. 624.) A physician's prescription is in itself no defence if the druggist has no license. (Druggists' Cases, 85 Tenn. 449 ; Liquor Case, 37 Am. R. 284.) In Georgia it has been held that whiskey is not a drug. The court said, "We are old-fashioned and perhaps ignorant of the expansion of many words in modern use, among them the word 'drug.' It carries along with it an idea inseparable from it, of something repulsive, nauseous, at which the gorge heaves. Whiskey, on the contrary, is inviting, exhilarating." 6o6 A MANUAL OF LEGAL MEDICINE It was also urged that goods hard to sell are often called a drug, and, therefore, to call whiskey, proverbially so easy to sell, a drug would be, in the language of the court, "a palpable misnomer." (Gault vs. State, 34 Ga. 533.) One who sells and prepares drugs for medicinal purposes has been held to be a druggist. (Anderson vs. Commonwealth, 9 Bush, 571.) It has been asked whether a proprietor is liable for damages when his clerk commits an error, the clerk being licensed. From the cases already cited, such would seem to be the law. There is force, however, in the sug- gestion that when a board of pharmacy issues a license to an applicant, and sends him forth into the world as a duly qualified druggist, such boards of pharmacy and their licentiates, rather than an employer druggist who relies upon such certificates of qualification, should be held responsible for the con- sequences of the ignorance or unskilfulness of the employee. In State vs. Donaldson, 41 Minn. 74, it was held that the sale of borax by one not a pharmacist was not prohibited. But in Cook vs. People, 125 111. 278, the term " usual remedies" was defined as not including quinine. These peculiarities must be relegated to the language of the statute in question in each case. Gwynn applied to Druggist Duffield to compound a prescription calling for rhubarb. The latter took belladonna instead from a jar, itself properly labelled. Gwynn, standing by, put his finger in it, took a small quantity from it, and asked, was that a proper dose ? The druggist answered affirm- atively. Gwynn took it and suffered. The court held that he was guilty of contributory negligence in himself taking it from the jar, and absolved the druggist. (Gwynn vs. Duffield, 61 Iowa, 64 ; s. c, 47 Am. Rep. 802 ; 66 Iowa, 708 ; 55 Am. Rep. 286.) If a druggist fills a prescription improperly, he cannot raise the defence that the case itself was negligently treated. (Brown vs. Marshall, 47 Mich. 576; s. c, 41 Am. Rep. 728.) A pharmacist had recommended a prescription in good faith which had been given to another. The customer ordered it and the druggist furnished it, charging only for the medicines and their com- pounding. The customer sustained injury and sued the druggist, but the court held that he was not responsible. (Ray vs. Burbank, 61 Georgia, 505 ; s. c, 34 Am. Rep. 103.) The safe course for a druggist when a customer calls for a remedy is to give him what he may say he has been recommended to take, and so asks for, but not to undertake himself to diagnose and prescribe for the case. Where a druggist sells an article in itself harmless, but which in combination with other articles becomes dangerous, and is not informed that it is to be used in such combination, he is not liable for any damage that may result. (Davidson vs. Michels, 11 Allen (Mass.), 514.) A druggist sold a deadly poison as a harmless medicine to a man who bought it to administer to another, who died after taking it. His widow was held to have a right of action against the pharmacist. (Morton vs. Sewell, 106 Mass. 143 ; s. c, 8 Am. Rep. 298.) FORENSIC MEDICINE 607 The statute provided that "it should be unlawful for any person not a registered pharmacist to conduct any pharmacy or drug-store." It was held to be no defence that the sales were made by a clerk who was a registered pharmacist. (State vs. Morton, 67 Iowa, 641.) A policy for fire-insurance covered drugs and medicines, and provided that it should be void '' if the insured shall keep gunpowder, fireworks, salt- petre, etc." It was held that this did not forbid the keeping of saltpetre as a drug, but only keeping it in such quantity and manner as not to increase the risk. (Collins vs. Ins. Co., 281 ; s. c, 28 Am. Rep. 322.) Every pharmacy has some remedy of its own make. Often it is her- alded as a cure for every disease. The domain of proprietary medicines is practically limitless. Humanity, always eager to escape its hereditary ills, greedily clutches at every compound that promises relief. The dealer is exposed to the danger of suits for damages for infringements. A medicine is usually patented by copyrighting the label, using a distinct trade-mark or name. The formula thus is not exposed, yet any infringement can be re- dressed. The mere name of a man is not the subject of a trade-mark. A proprietary medicine must not, however, be put up in such colorable imita- tion of another as to be calculated to mislead an ordinary purchaser. The cases in the books upon the subject are too numerous for citation, but that is the pith of the decisions. . . . The question of the power of the New York Fire Department to collect an annual fee of two dollars for the manufacture, storage, or keeping for sale of certain combustibles was answered in the affirmative in 1884. Gustavus Miller was sued for a penalty for keeping ether on sale without a permit. The Court of Common Pleas, through Chief- Justice Daly, after a review of the authorities, held that the regulation was properly made by the Board of Fire Commissioners in the exercise of the police power for the security and safety of the citizens. (Mayor, etc., vs. Miller, 12 Daly, 496.) I cannot find that the case was ever taken to the court of last resort. APPENDIX 39 609 APPENDIX ILLUSTRATIVE CASES. FAMOUS POISON CASES. In the year 1872, Mary Anne Colton was executed at Durham, England, for having poisoned sixteen children. Dr. Pritchard, of Scotland, was hanged at Glasgow in 1865, after making a confession of having slowly poisoned his wife and mother-in-law by means of antimony. Dr. William Palmer, of Staffordshire, England, poisoned his wife, his brother, and a friend, Mr. Cook, for the purpose of obtaining their life- insurance. Strychnine was the substance employed to effect his purpose ; but the medical experts were unable to discover any trace of the poison in the body of Cook, for whose death alone the criminal was tried. No sus- picion attached to him in the other cases, and it was not generally known that he had been the cause of the death of his wife and brother until he made confession of his crimes on the scaffold. His conviction in the other case was principally on account of his excessive nervousness, together with his peculiar actions during the trial. After the jury had rendered the verdict condemning him to death, he strenuously protested his innocence, and it was not until the very last moment, after he had exhausted all means of escaping death, that he confessed everything. In 1815, Eliza Fenning, a servant, was executed on the charge of having been instrumental in poisoning an entire family with poisoned dumplings. None of her victims died, and the criminal partook of the dumplings herself, suffering, as a result of her act, with exactly the same symptoms as the others. She was, however, convicted of the crime. Many persons believed in her in- nocence, and a great number of petitions were forwarded to the king, request- ing her pardon, but by the advice of the judge who presided at the trial the petition was rejected. " It did not take much to convict a man or woman ac- cused of this crime in the eighteenth century. A famous case in point is that of Captain Donellan, in England, who was hanged on the supposition that he poisoned his brother-in-law, whose heir he was. The principal evidence against him seems to have been that he had a motive for the alleged crime. The brother-in-law, Sir Theodosius Boughton, was in poor health, and Captain Donellan was living with him and occupying adjoining rooms. Sir Theo- 611 6l2 A MANUAL OF LEGAL MEDICINE dosius took, as he supposed, some medicine for which he had sent to the apothecary, and shortly afterwards he died in great pain. Captain Donellan insisted upon rinsing out the bottle, which afterwards retained an odor of bitter almonds. Physicians testified that the liquid might have been laurel- water, a poison having such an odor, and on their evidence Captain Donellan was convicted." Dr. Graves killed his victim at long distance by means of poisoned whiskey, forwarded through the mails. Poisoning by Antimony.—"Mr. Bravo, a weak, vain man, met Mrs. Ricardo, then a wealthy widow, and speedily married her. According to her statement, she told him before marriage that she had been on too inti- mate terms with a Dr. Gully, well known at Malvern. It is certain that Mr. Bravo knew of this connection, and that it rankled in him, nor does he seem to have been sparing in letting his wife know this. At all events, the facts connected with his miserable death are here embodied. Mr. Bravo was a young barrister of about thirty, strong, healthy, and hearty. He had hardly ever suffered from ill health, was a remarkably cheerful man, and of temper- ate habits. On Tuesday, April 18, 1876, after breakfast at his own house at Balham, he drove with his wife into town. On their way, according to her statement, they had an extremely unpleasant conversation. He had a Turkish bath, lunched with a relation of his wife's at St. James Hall, and walked on his way home to Victoria Station with a friend and fellow-barrister, whom he asked out for the following day. He arrived at home about half- past four. Shortly after his return home, Mr. Bravo went out for a ride, in the course of which the cob on which he was riding bolted with him and carried him a long distance. From this he returned tired, ill, and exhausted. When seen at half-past six, Mr. Bravo was sitting, leaning forward on his chair, looking ill, and with his head hanging down. He ordered a hot bath, and in moving to get it he cried out very loud with pain and put his hand to his side. After his bath he did not appear very much better, but seemed to suffer pain all through the time of dinner, though he seemed to avoid attracting the attention of his wife and Mrs. Cox, her companion, who dined with him. The dinner hour was half past seven, but from certain causes it was delayed for a few minutes. The articles composing the food eaten at 'dinner were partaken of more or less in common by all three. As regards drink, this was not the case. Mr. Bravo drank Burgundy only ; Mrs. Bravo and Mrs. Cox only sherry and Marsala. Burgundy was the wine Mr. Bravo usually drank, and this had been decanted by the butler some time before dinner, how long he could not say. The butler noticed nothing unusual in the wine ; and Mr. Bravo, who would only drink wine of a good quality, and who seemed, moreover, a connoisseur in wine, remarked nothing as to its taste and quality, but drank it as usual. The quantity of wine he com- monly took at dinner was about three or four glasses. If he had Burgundy for luncheon, he finished the bottle at dinner; but if not, as on the day in question, the remains of the bottle were put aside in an unlocked cellaret APPENDIX 613 in the dining-room. Whether or not any wine was left after dinner on this day could not be found out; the butler could not remember. At all events, no remainder of the wine then consumed was discovered. This cellaret was opened at least twice subsequently to this and prior to Mr. Bravo's illness, —once by Mrs. Cox and once by the housemaid. "As regards the food itself, Mr. Bravo seems to have eaten fairly well. It was clear, therefore, that the adventure on horseback had not completely destroyed his appetite; but it is also clearly in evidence that he was not him- self, from whatever cause. It was said he had been suffering from toothache and neuralgia, and he had just received a vexatious letter. Here the element of time assumes a greater and greater importance. There was no reason to believe that Mr. Bravo had swallowed any poison up to half-past seven o'clock or twenty minutes to eight. The dinner lasted till past eight; there was some talk, and then the three people who partook of dinner passed into the morning-room, where conversation was continued up to about nine o'clock. Mrs. Bravo and Mrs. Cox went upstairs, leaving Mr. Bravo alone, and Mrs. Cox went to fetch Mrs. Bravo some wine and water from the dining-room. Upstairs Mrs. Bravo undressed and made ready for bed, Mrs. Cox still being with her, and she drank the wine and water brought up. '' The next point of time was exactly fixed. The housemaid was accus- tomed to take up every evening some hot water for washing before the ladies went to bed. On this occasion the bell did not ring, and the house- maid, looking at the clock and finding it half-past nine, of her own accord proceeded to take up the hot water. Mrs. Bravo then asked the girl to fetch her some Marsala, which she proceeded to do, taking the glass which had contained the wine and water for that purpose. On her way back to the dining-room she encountered her master at the foot of the stairs. He looked 'queer,'—that is, 'he looked very strange in the face, but did not appear to be in pain.' He looked twice at the servant, yet did not speak, though that was his custom, but passed on. She thought ' perhaps he was angry.' Mr. Bravo was alone after the departure of his wife and Mrs. Cox, until the time when he passed upstairs before the housemaid. He entered his wife's dressing-room, and the maid Mrs. Bravo's bedroom. In the dressing- room, according to Mrs. Cox's statement, Mr. Bravo spoke to his wife in French, upbraiding her for taking too much wine. This had frequently been the subject of unpleasant remarks before, but Mrs. Bravo did not remember his saying anything on this occasion. This must have brought the time down to twenty minutes or quarter to ten. After this Mr. Bravo left his wife's dressing-room, went to his own bedroom, and closed the door. The maid left Mrs. Bravo's bedroom, and met Mrs. Bravo in the passage, un- dressed, and on her way to bed. The interval between the point of time when Mr. Bravo left his wife's bedroom and entered his own and the next point in the history of the day is not easily measured. This helps. The maid had time to collect and put away Mrs. Bravo's day apparel, to enter Mrs. Bravo's bedroom, where she had a few words of conversation with Mrs. 614 A MANUAL OF LEGAL MEDICINE Cox, who was sitting at the bedside, to leave the room and reach the foot of the stairs leading to Mrs. Cox's own bedroom upstairs, when the door opened, and Mr. Bravo, in his night-shirt, shouted out, ' Florence ! Flor- ence ! hot water !' All this could hardly have been done in less than a quarter of an hour ; but after this, for some time, confusion reigned supreme. The maid ran into Mrs. Bravo's room, calling out that Mr. Bravo was ill. Mrs. Cox, yet dressed, hastily rose and went in to him. She found him standing at the open window, apparently vomiting, and this the maid also saw. Mrs. Cox stated that Mr. Bravo said to her, ' I have taken poison for Dr. Gully ; don't tell Florence' (his wife) ; and to this confession of having taken poison, on the part of Mr. Bravo, Mrs. Cox adhered throughout. After this Mr. Bravo vomited, and some hot water was brought by the maid. After vomiting, Mr. Bravo sank on the floor, became insensible, and re- mained so for some hours. Mrs. Cox tried to raise him, and procured for him some mustard and hot water to make him sick ; but this he could hardly, if at all, swallow. Mustard was also applied to his feet and camphor liniment to his chest. After the mustard and water he again vomited in a hand-basin. The vomited matters ' looked like food, and were red.' These were unfor- tunately thrown down the sink and so disposed of. Meanwhile, coffee had been procured, but Mr. Bravo was unable to swallow. On the first alarm, Mr. Harrison, a practitioner, who had previously seen Mrs. Bravo, was sent for, but he lived at some distance. Mrs. Bravo, who had been roused from sleep by the maid, and who seems to have been greatly excited, insisted on a nearer practitioner being sent for, and in no long time Mr. Moore, a prac- titioner residing not very far off, arrived. Here again we have a point of time fixed. Mr. Moore arrived about half-past ten, and from this time the history assumes a more scientific aspect. As already said, Mr. Bravo became insensible almost immediately after being seen by Mrs. Cox and the maid, but about this insensibility there seems to have been a good deal of miscon- ception. Mrs. Cox rushed at the conclusion that Mr. Bravo had swallowed laudanum, chloroform, or some narcotic, and to this end had given the mus- tard and water to get rid of the poison, and the coffee to obviate its effect. The insensibility was not due to narcotism ; it was the insensibility of utter collapse, of almost complete syncope. Mr. Moore, on his arrival, found the patient sitting or lying on a chair. He was completely unconscious, the heart's action was almost suspended, and he was almost pulseless. His pupils were dilated. Mr. Moore caused him to be laid on his bed, and tried to give him some hot brandy and water, but he could not swallow. In twenty minutes or half an hour Mr. Harrison arrived. He was met by Mrs. Cox, who said she was sure Mr. Bravo had taken chloroform. This was taken in the sense that the chloroform was in a poisonous dose. Both Mr. Harrison and Mr. Moore early came to the conclusion that their patient was in a most dangerous state, and that in all probability he would not recover from the collapse from which he was then suffering. They, however, tried to administer stimulants, first by the mouth ; but that failing, they gave him APPENDIX 615 an enema of brandy and water. Seeing the dangerous nature of the case, other medical aid was suggested, and Mr. Royes Bell, cousin of the deceased, was sent for, with a request to bring some physician with him. He brought Dr. George Johnson, of King's College Hospital, and the two arrived at Balham about half-past two. Meanwhile, the case began to clear up. About two o'clock Mr. Bravo ' began to vomit a bloody fluid ;' the pulse rose, and he passed a bloody fluid in bed. There could no longer be any doubt that the patient was suffering from the effects of irritant poisoning. Mr. Bravo had thus been as nearly as possible four hours without any other symptom of poisoning than profound collapse. "Shortly after the arrival of Dr. George Johnson and Mr. Royes Bell consciousness began to return, and at three o'clock Mr. Bravo was again conscious and able to be questioned. Soon after the arrival of these two gentlemen, Mrs. Cox requested an interview with Mr. Bell, and then told him that Mr. Bravo had said, ' I have taken poison ; don't tell Florence.' Mr. Bell, who seems to have been somewhat angry at this tardy statement on the part of Mrs. Cox, summoned Dr. Johnson, who also heard it; so that when Mr. Bravo returned to consciousness, almost the first question asked of him was, ' What have you taken ?' From first to last—and this is an important feature in the case—the dying man (for he early felt that he was doomed) persisted in declaring in the most solemn manner that he had taken nothing except some laudanum for toothache. Yet he expressed no surprise at being thus taken ill, though he knew quite enough of medicine to appreciate the effects of opium, and to know that they were very different from those under which he was suffering. At an early period Mr. Bravo's bedroom was searched, but nothing was found save the laudanum-bottle, a little chloroform, and camphor liniment, which had been brought from an- other room. There were no remains or indication of any solid poison, no paper or anything else which could have contained it, no traces of a dirty tumbler or drinking-glass,—in short, nothing. It must, however, be remem- bered that great confusion had prevailed; that many things, including vomited matters and dirty glasses, must have been removed ; and that a fire was burning in Mr. Bravo's room. Mr. Bravo himself, on being questioned, mentioned, as poisons in the place, the laudanum, the chloroform, Condy's fluid, and 'rat poison in the stable.' After recovering consciousness, Mr. Bravo did not again lose it to the time of his death. He remained collapsed ; suffered fearful pain ; vomited and purged matters of various descriptions ; was severely convulsed, especially in his upper extremities ; but he remained conscious throughout. On Friday morning, at half-past two, the vomiting and purging ceased, and at half-past five Mr. Bravo died, having thus been fifty-five and a half hours ill. On Saturday, the 22d, Dr. Payne, of St. Thomas's Hospital, made a post-mortem examination of the body. 'There was no appearance of inflammation, congestion, or ulceration. The stomach contained about eight ounces of thick, gruel-like matter, of a yellowish color, containing small solid lumps, and had the odor of alcoholic fermenta- 616 A MANUAL OF LEGAL MEDICINE tion. The oesophagus or gullet was natural, and contained some of the same matter as the stomach. The first portion of the bowels was very soft, being torn in tying it, but subsequent careful examination showed no perfo- ration or ulceration. The surface was pale and yellowish, like that of the stomach. The whole of the small intestine was like this, except the lower part, where there were some red spots. This part of the bowels contained yellow, pasty matter, without any admixture of blood. The large intestine at its commencement was of a deep-red color, and contained clots of blood. Subsequent examination showed, in the portion called the caecum, very small ulcers, from which the bleeding had evidently taken place, but there was no perforation. The remainder of the large intestine was very deeply blood-stained, but without ulceration. The contents were soft, dark-red material, composed of faecal matter mixed with blood. The liver and spleen were natural, as were also the pancreas, kidneys, and other abdominal organs. There was no appearance of hernia or rupture. On opening the head, the skull and the membranes of the brain were found quite natural, and contained no excessive amount either of blood or of watery fluid. The mouth and lips were natural, except that the papillae at the back of the tongue were somewhat more prominent than is usual. There was no other appearance of disease in the body except what has been noted.' Such is the medical history of this extraordinary case; but it would be incomplete without some account of the chemical examination, which was made by Pro- fessor Redwood, of the Pharmaceutical Society. Most extraordinary to re- late, the matters which were vomited at the very beginning of the attack of illness which proved fatal to Mr. Bravo remained undisturbed on the leads of the house from Tuesday night till Thursday, and they were seen both by Dr. Johnson and Sir William Gull. On that day they were directed to be removed, and they were handed over to Professor Redwood. Meanwhile, much rain had fallen, and a great part of the vomit, especially the liquid matters, had been washed away. No doubt in this way a large quantity— probably the larger quantity—of the poison had been lost. Nevertheless, in the vomit a great amount of antimony was discovered. Antimony, too, was discovered in the contents of the great gut after death, in the liver, and in smaller quantities elsewhere. Altogether, the conclusion come to was that something like forty grains, at least, had been swallowed. This esti- mate, nevertheless, must be far under the mark ; for, if we bear in mind the quantity passed in the stools and the quantity of antimony left in the tissues, over and above that detected and estimated, it is clear that an enormous dose had been taken. That being so, the conclusion must be that the poison had been swallowed after half-past eight, when the party adjourned to the morning-room ; probably after nine, when Mrs. Bravo and Mrs. Cox went upstairs, and very likely, indeed, after Mr. Bravo himself had retired to his bedroom. This last notion is by far the most likely. A large dose of anti- mony had been taken; sickness followed in a few minutes. Mr. Bravo, feeling this, shouted for hot water, and so great was the prostrating effect APPENDIX 617 of the antimony that in a few minutes he fell to the ground utterly col- lapsed. During the period of collapse and unconsciousness, which lasted from ten o'clock till three, but little of the poison would be absorbed, and thus all the more would be ejected in the matters vomited just after. The post-mortem condition was most extraordinary. That there was great gastric irritation at one time was evidenced by the vomiting of bloody mat- ters, to which Mr. Harrison and Mr. Moore bore testimony ; but that must have been completely overcome before death. Apparently the irritation and inflammation gradually extended downward, leaving the upper portion of the bowel profoundly damaged, but presenting no signs of active and recent inflammation. The only verdict which ought to have been come to was that Mr. Bravo died from the effects of antimony, for there was no very reliable evidence to show whether the poisoning was suicidal or homicidal. Probability inclined strongly to the former."—"Memoranda of Poisons," Tanner. The Wharton Case.—"The whole 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 well-known and prominent Maryland family, was tried for the murder of General Ketchum. The latter had been taken violently ill while visiting at her house, and died under rather sus- picious circumstances a few days later ; while, at the same time, another friend of the family 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 inducement for a crime, and also, in both cases, suspicious-looking sediments were found in liquids given the invalids by Mrs. Wharton. The symptoms of General Ketchum and the post-mortem condition of the body were consistent with, though not es- pecially characteristic of, antimony-poisoning, so the case turned entirely upon the chemical evidence. '' The latter indicated the presence of tartar emetic in considerable quan- tities in both the liquids mentioned and in the stomach of General Ketchum. But unfortunately in every case the original solutions and the resulting pre- cipitates were thrown away, so that, when the tests were disputed, it was im- possible to confirm them. The principal chemical witness for the prosecution testified that both the sediment in a glass of milk-punch and the contents of the stomach gave a brownish-red precipitate with sulphuretted hydrogen, after acidifying with hydrochloric acid ; that this dissolved in boiling hydro- chloric acid ; that this solution, when diluted with large amounts of water, gave a white precipitate, which dissolved in tartaric acid, and gave an orange-red precipitate when the tartaric acid solution was again treated with sulphuretted hydrogen. The above tests are a pretty certain indication of the presence of antimony, but they were not confirmed by any others, ex- cept by a very unsatisfactory Marsh's test, made by another chemist. Nor were any of the precipitates saved or shown in court, although the amount of tartar emetic in the stomach was estimated roughly at twenty grains. 6i8 A MANUAL OF LEGAL MEDICINE Besides this, no attempt was made to remove any, far less all, of the organic matter 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 went to the extreme of making up a solution of gelsemium extract, chloral, beef-tea, white of egg, and milk, which they claimed was a fair reproduction of the contents of General Ketchum'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 with 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 the testimony of some of the experts did not overstep the limits 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 unpardonably careless unless he saves with the utmost care everything submitted to him, and preserves and brings into court, if at all possible, every particle of poison that he can isolate."—Pellew, in Hamilton's "System of Legal Medicine," vol. i. p. 347. Arsenic-Poisoning.—" One of the most rapid cases of arsenic-poison- ing ever reported is given by Dr. Finley.1 A healthy man, aged fifty-one, had drunk by mistake, upon an empty stomach, a solution containing about twenty-six grains of arsenic He was taken almost at once with faintness and collapse, with 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 and slow pulse, shallow respiration, pupils moderately dilated. He was still conscious, and complained of headache, constriction across the chest, and pain in the epigastrium. Emetics did not work ; they washed out the stomach, but without effect. He was put to bed, given brandy, hot-water bottles, warm blankets, and 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 con- gestion 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."—Pellew, in Hamilton's "System of Legal Medicine," vol. i. p. 361. The fennie Cramer Case.—Some of the medical points in connection with this famous case are as follows. "Jennie Cramer was found dead in the water near the beach, and sufficient arsenic to kill was recovered from her body. Under such circumstances the questions to determine are whether the body was thrown into the water after death by arsenic or whether drowning was the mode of dying. The testimony for the State was with unanimity in favor of the former proposition. Without presuming to decide this point, we may at least attempt to ascertain how far the statements of 1 Lancet, 1883, part ii. p. 943. APPENDIX 619 the witnesses are supported by medico-legal authorities. Dr. Prudden, who conducted the autopsy, said there were none of the usual indications of death by drowning. Frothing at the nose and mouth ; frothy mucus in the air- passages ; goose-skin (cutis anserina) ; sodden hands (washer-woman); clinched hands, sometimes holding firmly grass, sand, or other objects seized in the final struggle ; water in the bronchial tubes and lungs, which may contain sand, mud, or other substances indicating whence derived, and also the same in the gullet and stomach ; the veins of the brain, the great venous trunks, and the right cavities of the heart distended with black blood, while the left cavities are empty, are the conditions present after death by drown- ing. Dr. Prudden disclaimed the opinion that any single sign is conclusive, and rightly held that it is the coincident occurrence of them all which must in any case determine. In this position he is supported by the medico-legal writers. Of these the American Beck and the German Casper have almost created the subject in its modern aspect, and have furnished the facts and opinions upon which succeeding authors have depended. Beck's description of drowning is classic, and affords a clear conception of the mechanism of the lesions. '' The most interesting subject from the scientific point of view is the poisoning by arsenic. Professor Chittenden, who conducted the examina- tion, gave a luminous account of the processes employed, and exhibited the poison to the court and jury. His estimate, based on an examination of different parts, was that three grains and a fraction (3.1192 grains) was the amount present in the body at death. From two to three grains, under cir- cumstances favorable to the operation of the poison, may be assigned as a fatal dose in an adult. Very large doses—from sixty grains to two ounces— have been taken and recovered from ; but such doses were received on a full stomach, and quickly ejected by vomiting. Does arsenic in a toxic dose invariably produce inflammation of the stomach ? Although inserted at any point, it may cause inflammation of the stomach by virtue of a selective action ; this is by no means an invariable result, even when the dose is a large one. There have occurred cases in which, without vomiting and purging or gastro-intestinal inflammation, paralysis, coma, and insensibility have supervened. Much depends on the form in which administered. When arsenous acid, undissolved, enters the stomach, absorption is slow, giving time for the local action of the crystals embedded in the folds of the mucous membrane. As, however, inflammation of the stomach occurs when arsenic is introduced elsewhere, there must be another factor of unknown origin, the presence or absence of which affects the result. Dr. Prudden on this point testified that inflammation of the stomach was not an invariable effect of arsenical poisoning, and quoted statistics in which inflammation was absent in the proportion of thirty-six to one hundred and eighty-five, or in one-fifth of the cases. '' Several important questions arose about the absorption or diffusion of arsenic Professor Chittenden testified that the form in which it entered the 620 A MANUAL OF LEGAL MEDICINE stomach materially affected the result. In solution, as arsenite of potassium. or Fowler's solution, diffusion into the stomach-veins occurs more quickly than when it enters the stomach as solid arsenous acid. When the solution is taken, symptoms of poisoning may appear within a half-hour ; when the solid is taken, a delay incident to the process of dissolving occurs, and hence the distinctly toxic effects may be postponed to an hour. The emetic effect due to a large dose, received on a full stomach, should not be con- founded with the systemic toxical action. No evidence has appeared in regard to the character of the symptoms experienced by Jennie Cramer. Pro- fessor Chittenden assumes that a soluble preparation of arsenic was taken, because there were no crystals of arsenous acid adherent to the mucous membrane of the stomach, and because the poison was so widely diffused, being found in unusually large proportion in the brain, and also found in the muscles of the back. There is much to be said in favor of these statements, but they are not entirely defensible. That crystals of arsenous acid, after the administration of the powder, have been picked off the mucous mem- brane is certainly true. But the difference in the diffusibility and systemic action of arsenic in the solid form and arsenic in solution is one of time. When arsenous acid enters the stomach it obeys the laws of chemical com- bination, and forms an arsenite with sodium or potassium, and diffuses into the blood in this form. After entering into combination with a base and dif- fusing into the blood as arsenite, there can be no difference in the distribu- tion throughout the body of the preformed arsenite and the arsenite made in the stomach. The presence of arsenic in the various organs and tissues, except the bones, is proof of the recent introduction of the poison ; for so quickly is it eliminated that, if the victim live fifteen or sixteen days after receiving the fatal dose, none of the poison can be detected after death. This was Orfila's conclusion long ago, after a course of careful experiments, and it has been confirmed abundantly since by actual cases. As elimination proceeds, arsenic can be detected in the urine. Excretion occurs, to a greater or less extent, also by the liver. In this organ the poison has been found when it could not be detected elsewhere. When arsenic is adminis- tered by the stomach, the liver is the first organ reached after diffusion into the blood has occurred. Poisons are not infrequently delayed in the liver. In this fact we have an explanation, certainly in part, of the extraordinary difference in the action of remedies administered subcutaneously and by the stomach respectively. But the liver, again, filters poisons from the blood and excretes them. Hence it is that poisons are found in the liver in greater proportion than in any other organ or tissue. " In the case of Jennie Cramer, the reasons assigned by Professor Chit- tenden for the belief that the poison had been received not more than twenty- four hours before death were conclusive. There was nearly four times as much arsenic found in the fauces, larynx, and trachea as in the kidneys. The quantity found in the stomach and intestines was more than half of the whole amount contained in the internal organs. It is evident, therefore, that APPENDIX 621 there had not been time to effect the elimination of the arsenic taken ; it had begun, but had not proceeded far when death overtook the victim." —Medical News, May 20, 1882, p. 545. The Dr. Henry C. F. Meyer Case.—Dx. Meyer was found guilty of murder in the second degree, for having poisoned one Ludwig Brandt. The case was tried before Recorder Smyth, in the city of New York, May, 1894. The case, briefly, is as follows. " Ludwig Brandt was poisoned in order to obtain the insurance on his life. Dr. Meyer had been engaged in several insurance swindles, one of which landed him in jail in Chicago. While there, he met Carl Muller, Brandt, Gustav Hinrich, Joseph Baum, and 'Jack' Gardner, alias Adkins. All these readily entered into a plot by which Meyer assured them of a quick and generous fortune. Baum was released before the others. Shortly afterwards he was imprisoned in Cincinnati for forgery. When Dr. Meyer was released from the Cook County jail he hunted up Muller and Brandt and outlined his plot. Brandt was to imper- sonate Baum, have his life insured, and then pretend death. Meyer's pur- pose was to murder Brandt under the name of Baum, and then, if charged with the murder, produce the original Baum alive. Mrs. Meyer was to help them carry out the plot. The conspirators came to New York and hired a flat at No. 320 East Thirteenth Street. Meyer and Muller convinced the unfortunate Brandt that he was to be an equal sharer in the proceeds of the swindle. He was to feign sickness or take drugs enough to produce an illness so realistic as to deceive an experienced doctor, and a corpse should be procured and palmed off on the doctor, and Mrs. Brandt should pass for Mrs. Baum and collect the money. In New York Meyer and Muller found that it was impossible to find a corpse to be surreptitiously substituted for the pretended Baum. They next tried, but failed to get a sick man obliging enough to come and die in their flat. The plotters were about to give up in despair, when Mrs. Meyer, with hysterical tears, declared that the swindle must not be abandoned ; that too much money had been spent on it. Thereupon the silly Brandt, who had an infatuation for Mrs. Meyer, con- sented to make himself ill by taking medicines which would produce a real- istic simulation of dysentery, and of his own will he took heroic doses of salts and croton oil ; but without his knowledge (confiding, however, in Mrs. Meyer and Muller), Dr. Meyer 'salted' Brandt's food first with anti- mony and then with arsenic, and the deluded youth—he was only twenty- six—died in agony, believing almost to his last moment that he was helping along a first-rate scheme which would make him rich. When the investi- gations of the insurance company had revealed these facts the grand jury indicted Dr. and Mrs. Meyer for murder in the first degree. They were captured in Detroit, Michigan, in July, 1893, on the information of Muller, who turned State's evidence." The prosecution's case was this. " There was a conspiracy to cheat the life insurance companies. For this purpose Brandt was insured under the name of Baum, and he became ill and died. The only evidence that Brandt 622 A MANUAL OF LEGAL MEDICINE was made sick by any one comes from the accomplice, Muller, and his only direct testimony was that the dead man took croton oil, and that against the advice of Dr. Meyer. As to the administration of antimony and arsenic, Miiller's testimony was all surmise and guesswork, based on seeing some stuff bearing those names in the doctor's possession, and the man who gave this testimony also by his own testimony admitted himself to be a consummate liar and a criminal of the lowest order, utterly unworthy of belief. The defence expected the evidence of the other to weigh so heavily and accord so finely with Miiller's testimony that it would carry it through. Nobody else con- nected Meyer with the case; and although the expert evidence that antimony and arsenic were found in the body in sufficient quantities to kill was not shaken, yet the expert's qualifications were so badly riddled in parts that the defence was clearly of the opinion that the jury would not place much faith in it.'' The hypothetical question advanced by the prosecution was : '' Assume the following facts. A man, twenty-six years of age, died in this city, March 30, 1892. During the month of August, 1891, he had been carefully ex- amined by three physicians in the city of Chicago for insurance on his life, and after a thorough examination he was found to be in perfect health, and was accepted by four different companies. He was temperate in his habits, both as to eating and drinking, and used tobacco in moderation. When he came to New York, in the latter part of February, 1892, he was in the enjoyment of good health. About March 9, 1892, he took two doses of salts. On the same day he visited a physician, to whom he complained of intermittent diarrhcea with slight pains in the abdomen. The physician prescribed powders containing opium and bismuth, but there is no evidence that the prescription was ever put up or taken. On the nth of that month he took a large dose of croton oil. He complained of pain in his stomach and took to his bed. On the night of the same day he was attended by the same physician, to whom he complained of nausea but no vomiting, excessive thirst, and colicky, griping pains. On examination the doctor found his temperature under the tongue about 1020 F., pulse 100, tongue furred and moist, abdomen rigid. He was visited by the same physician every day thereafter until the day of his death, and on two oc- casions by another physician in company with the first. The symptoms described above continued, and gradually became more accentuated. About the 19th or 20th of March, a white powder, said by the man who gave it to be brechweinstein, or tartar emetic, was frequently seen to be put into his food, and during the last week of his life arsenic, in unknown quantities, was administered to him in the same way. During the last ten days of his life the emaciation of the patient, which had been gradual before, became very marked. He had cold perspirations, his voice became feeble, he com- plained of pains in the calves of his legs, in his back and head, and burning pains in the eyes. His tongue was red and glazed, his pulse was small and weak, and a day or two before his death he had a temperature of 1030 F. APPENDIX 623 As he approached his death he showed extreme emaciation and prostration. The attending physician had at different times prescribed various remedies, which were purchased but not administered. The body was not embalmed, and was buried in a cloth-covered wooden casket, surrounded with an outer box, in Evergreen Cemetery, April 2, 1892. It was disinterred July 6, 1892, and brought to New York City, where an autopsy was performed. The body was very emaciated, but externally in a fair state of preservation. An examination was made of the organs, but no gross lesions sufficient to account for death were found. The spleen was natural in size, and there was no cirrhosis of the liver. A special examination was made of the intes- tines for dysenteric ulcerations and lesions of typhoid fever, but with nega- tive results. The heart was normal in size and in general appearance, and the valves of the heart were normal. The kidneys were normal in size and showed no naked-eye lesions, and their capsules were not adherent. The bladder was empty. The organs were too far decomposed to permit of any microscopic examination. The stomach and its contents, the intestines and their contents, the liver and spleen, together with some fluid from the abdomen and thorax, the kidneys, heart, calf of the right leg, were each separately analyzed. Antimony and arsenic were found in each, though in varying proportions to each other. The chemical analysis, as a whole, disclosed the presence of about six to ten grains of antimony, calculated as tartar emetic, and of three to five grains of arsenic, calculated as arsenous oxide. The greater portion of these was found in the alimentary tract and liver, and only a trace of antimony was found in the kidneys and muscle, very little more in the brain, but a larger portion in the heart." Many expert witnesses for and against the defendant were closely ex- amined by counsel on both sides. The writer testified as an expert for the defence on the questions of acute and chronic arsenical poisoning, acute and chronic antimonial poisoning, croton oil poisoning, identification of the dead body, and decomposition. The Buchanan Case.—" Robert W. Buchanan began life in Halifax, Nova Scotia. He spent several years of his life in a drug-store, where he learned the art of compounding medicines and drugs. From that he easily passed into the study of medicine, prosecuted his studies with success in Nova Scotia, and from there went to Chicago, where he graduated at the College of Physicians and Surgeons. He then returned to Nova Scotia. This was about the year 1883. He stayed there until 1885, when he married his first wife, Miss Annie Brice Patterson, a young woman whose parents were re- spectable and quite prominent people. In 1885 he continued his studies in Edinburgh and took his wife with him. There he remained about a year and returned to America in 1887. He settled in New York City, where he began the practice of medicine, but, like most young practitioners, he met with the greatest difficulty. He was poor. He hadn't been in New York long when he obtained a divorce from his first wife. That was about No- vember 12, 1890. About the same time he became acquainted with Mrs. 624 A MANUAL OF LEGAL MEDICINE Anna B. Sutherland, who lived at No. 371 Halsey Street, Newark. She was fifteen or twenty years older than the defendant, and by economy and hard work in her line of business (she kept a house of ill-fame) had accumu- lated a considerable fortune. The defendant began to pay her successful attention. He boasted to his friends that this old woman had fallen in love with him. Before his marriage to her, November 29, 1890, he induced her to make a will in his behalf. It left him all her property. That will was drawn by a friend of Buchanan in Newark. He took two other friends over to Newark to witness its making. Two days later he married the woman. The couple came to New York and set up housekeeping at No. 267 West Eleventh Street. The house in Newark was rented ; but the same furniture used at No. 371 Halsey Street was used in fitting up the house in New York. The life of the woman whom the defendant married was perfectly upright and beyond reproach during her married life. She was hard-working and in- dustrious, attentive to business, and earnestly anxious for her husband's wel- fare. She died at No. 267 West Eleventh Street, on April 23, 1892, very suddenly. '' The defendant had been married but a short time to this woman when his friends began to hear rumors. To the majority of his friends in New York Dr. Buchanan said that he was not married ; that the woman was his housekeeper. To but one person did he confess his marriage. After a time his friends began to hear of disagreements between him and his ' house- keeper.' He said, early in the middle of the year 1891, to one witness, ' I am getting tired of that old woman ; I wish I had never married her. I wish I had never had anything to do with her at all.' Again, toward the latter part of 1891, he was heard to say, 'That old housekeeper of mine will drive me crazy. I am going to dump her. I am going to get rid of her.' Again, early in 1892, he told other friends that his housekeeper was continually quarrelling with him ; that he was going to get rid of her without trouble ; that she had given him money, but, nevertheless, he intended to break up his house and dispose of her in some way or another. Again, he said to a friend of his, in speaking of his wife, ' Her face is enough to drive a man crazy or to drink. Scandal or not, I am going to get rid of that old chromo.' Mrs. Buchanan had in the mean time planned a return to her old life, when, Buchanan, referring to this, said, ' Damn her, she shall never return to Hal- sey Street and open up her house there again. I'll fix her. She ruined my professional reputation. Imagine a man of my standing married to such a woman as that.' All this was early in April, 1892. '' Very soon after the union the defendant began running around with fresher and younger women. One was called Blanche, one Sadie, one Maggie, and one Hazel. Long before his second wife died, Dr. Buchanan made all his preparations to get rid of her and come into her money, and to do this so adroitly that he never would be found out. To forestall any pos- sible suspicion, Buchanan went to some of his acquaintances and began throwing out hints that the 'old woman' had Bright's disease of the kid- APPENDIX 625 neys. To one he said, 'She can't live long. She is sure to die. She is sick now and can never get better.' Another expression he used was this, ' Go and see her once in a while, and keep her in good humor. She is sure to peg out in less than six months.' In order to prepare the way for certain other results which might follow upon his acts, he stated to one of his friends, ' That old woman threatens to poison herself if I insist upon break- ing up.' Now, what do you suppose he told her? He said, 'I wish to God you would. You know where my poisons are kept. You could not please me better than by taking morphine. It would be the best thing for yourself and for me.' He saw to it that his mother, who had been living with him, was removed to another place. He sent his child by his first wife away. He was putting his house in order so that he might carry out his fell purposes. So one Friday morning, a year ago next month, Dr. Buchanan's wife was taken sick. A doctor was sent for. She was found to be in a highly nervous state, and she kept in that condition until two o'clock, when she was seen by Dr. Mclntyre, who prescribed for her for hysterics. The dose which he prescribed was a small nervine, eight grains of chloral, with eight grains of bromide of sodium, a teaspoonful of which was to be taken every two hours, and he prescribed a two-ounce bottle, so that an ordinary person could have taken the whole bottle without danger. Dr. Mclntyre, a reputable family physician of many years' standing, saw the patient in this excited, hypernervous state at two o' clock. At three o' clock Mrs. Childs, a nurse who had been called in, and Mrs. Brockway, wife of a dentist who was going to take the house from the Buchanans, happened to enter the sick woman's chamber, and they saw Dr. Buchanan giving his wife a dose of something with a spoon. And he attempted to follow it up with another after the first had been swallowed. Dr. Buchanan himself afterwards acknowledged that the medicine he gave his wife was that prescribed by Dr. Mclntyre, who had advised but one teaspoonful of the medicine every two hours. " Mrs. Brockway had sat down by the side of the bed and talked with the sick woman, and just after taking the dose from her husband's hand she reached out for an orange and tore a piece of it with her teeth to counteract a bitter taste in her mouth. The impression made upon the nurse at the time was that the medicine which had been taken by Mrs. Buchanan was bitter, whereas, the medicine prescribed by Dr. Mclntyre at that time was not bitter, but slightly sweet. Immediately after taking that medicine given by the defendant—in about ten or fifteen minutes—the woman sank into a profound sleep. From sleep she went into stupor, and from stupor she went into a profound coma, from which she never awoke. Dr. Watson was called in. He asked Dr. Buchanan the history of the case. Dr. Buchanan said, 'She is suffering from kidney-trouble.' Dr. Watson at once came to the conclusion that the woman was suffering from coma produced by uraemic poisoning, and prescribed for her accordingly. He gave her a hypodermatic injection of digitalis, the antidote. In a few minutes Dr. Mclntyre, the old 40 626 A MANUAL OF LEGAL MEDICINE family physician, came in and made a diagnosis of the case. In order to as- sure themselves of the fact that the woman was suffering from uraemic poison- ing, they drew urine and tested it with nitric acid. They found that the urine did not contain any albumen, and came to the conclusion that she was not suffering from uraemic poisoning. What is the next step ? The doctors came to the conclusion that the woman, from some peculiarity of her con- stitution, was suffering from a coma produced by the chloral Dr. Mclntyre had prescribed. They asked the defendant what he had given her, and, turning to Dr. Mclntyre, he said he had given her ' one dose of your medi- cine.' Dr. Mclntyre thereupon began to treat the patient as though she was suffering from coma produced by chloral; and he treated her thus for two hours by having her rubbed and irritated and using every means to bring her back to consciousness. At nine o'clock the doctors reassembled, having left at seven, and then Buchanan stepped up and said to them, ' Gen- tlemen, I want to disabuse your minds of the idea that this woman is suffering from chloral. Dr. Janeway has been prescribing much larger doses than that for her, and she has become used to it, and cannot be idiosyncratic to its influences.' Now, those doctors wavering, as all doctors must under the circumstances, not knowing with certainty from what the woman was suffering, were led by this defendant in the treatment of the patient. To their minds there were three things from which this woman could be suffer- ing. She might have had from those symptoms either uraemia or coma produced by a narcotic, or she might have had coma produced by a third cause. Just as they were wavering in the balance, just as they were in doubt, what does Buchanan do? He said, ' Gentlemen, this woman's father died of cerebral apoplexy or cerebral hemorrhage.' That is also a disease of the brain, and presents almost similar symptoms to the other two things mentioned. In some cases like this it is impossible for any doctor to tell before an autopsy just what is the matter with the patient, the symptoms are so identical. When he stated that this woman's father died of cerebral apo- plexy it turned the scales, and they came to the conclusion that the woman had cerebral hemorrhage, and prescribed accordingly. We find that the woman was treated first for kidney-disease on the statement of the defend- ant ; second, that when she was treated for narcotism the defendant stepped in and prevented the continuance of the treatment, as we claim, for fear his labor might be lost; and, lastly, he impelled them to find in their diagnosis that she had cerebral hemorrhage by the statement that her father died of cerebral hemorrhage. Her father did not die of cerebral apoplexy. His death was caused by gangrene of the foot. " After the death of Mrs. Buchanan, Dr. Buchanan acted most strangely. No funeral notice was published, except one insignificant notice in an after- noon paper. When asked by his friends why he had kept so reticent over his wife's death, his answer was, ' Why, I left all that to Benedict, the under- taker.' What was Benedict's answer when questioned? 'Buchanan said he would see to all that himself.' When asked why none of Mrs. Buchanan's APPENDIX 627 relatives were present, Buchanan said Mrs. Willard, her sister, was dead, and that her brother was dying in Philadelphia. The facts are that Mrs. Willard is alive, and the brother has not been heard from in years. "Mrs. Buchanan died at three o'clock in the afternoon. What did Buchanan do? He visited the neighboring saloons, after saying he was going to Philadelphia to see his dying brother-in-law, and began to drink. To a friend whom he met he said, ' My God, I can't stay in the house with that dead body. I'm going to a hotel.' He got possession of the woman's jewels and displayed them to acquaintances. The funeral was held on the following Tuesday, April 26. Immediately after the funeral he is found in Newark going from one bad house to another. Between the woman's death and her burial he went to the Presbyterian minister, who preached the ser- mon over her, and told him that his wife was a pious Christian, and that when she was dying he thought that he heard her whisper the name of the Saviour. '' Twenty-one days after he buried his second wife he remarried his first wife in Halifax, Nova Scotia. In the marriage, in answer to the usual questions, he said that he was a bachelor. He comes back to New York and takes her, under the assumed name of Frazer, to the Hotel Hamilton, at One Hundred and Twenty-fifth Street and Eighth Avenue. '' Buchanan, when cognizant of the fact that people were asking curious questions relative to him, denied that he had remarried his first wife, and also said that his dead wife had never been mistress of an immoral house in Newark, nor had she been a morphine eater. These maladroit statements drew more attention to his case. After the newspapers began printing stories about the affair, the doctor went into hiding in Dostch's saloon up town, and disguised himself every day in a different make-up, with green goggles, etc One night, when he suspected that a long story was to be printed the next day in a newspaper, he came down town and waited till it appeared in the early morning. If the story was printed he was to flee at once. Then there was the watching of his wife's grave. The moment the district attorney touched the mound he was to leave town and hide. A telegraph code was even arranged. Buchanan was to push West. If the matter blew over and the body was not dug up, a telegram was to be sent to him under an as- sumed name, to read in this way, 'Will ship goods immediately.' If the grave was turned, the despatch was to run, 'Can't ship goods,' and the doctor was to make haste and get farther out of the way. "After consulting with Herbert W. Knight, his Newark lawyer, Bu- chanan wasn't satisfied. He was then advised to go and see one of the counsel in the Harris case. He went to see Charles E. Davidson, now one of his own lawyers. While going back to Newark, a friend said to him, ' Doctor, you are in no danger. The physicians have certified that she died of cerebral hemorrhage.' 'Ah,' he answered, 'but you know that symp- toms vary and doctors frequently make mistakes.' ' Yes ; but, doctor, you stated that this woman's eyes—the pupils of the eyes—were dilated, which 628 A MANUAL OF LEGAL MEDICINE is inconsistent with the theory that she died of morphine.' 'Don't you know that drugs can be so compounded as to destroy the effects of morphine on the eye?' was his response. 'Don't you know that if you take bella- donna its effect is to dilate the pupil of the eye and make it come back to its normal shape ? I tell you that if they dig that woman up they will find her full of morphine, and morphine lasts in the body a great length of time.' Buchanan had previously told his lawyers that his wife was a morphine eater ; but it is the first time that such an accusation was ever made against her. '' During the trial of the Harris case, Buchanan was greatly interested in it. Dr. Buchanan was a skilled compounder of drugs, a skilled physician. In canvassing the Harris case he said Harris was a----young fool; that if he had known his business he would never have left any trace behind him." —Extract from Assistant District Attorney Osborne's history of the case. Morphine and traces of atropine were found in the woman's body by the State's experts, and light was thrown upon all the facts of the symptoms attending the death of the woman. Furthermore, the defendant's wife was shown to have been poisoned by morphine, which was the cause of her death. The defendant was found guilty of murder in the first degree, and finally electrocuted. The case was tried before Recorder Smyth, New York City. The hypothetical question framed by the prosecution was : '' Suppose that a woman, healthy for her years and healthy the morning of her subse- sequent illness, was attending to her usual household duties, ate a hearty breakfast, as though nothing—no sickness—was impending. Subsequently— a few hours—she was taken ill; was filled with great apprehension of a seri- ous sickness ; complained of a choking sensation, a constriction of the throat that made it difficult for her to breathe. Six hours later she was found in the same state, and at 3.30 p.m., after taking something, she sank into a deep sleep that became a coma, then a profound coma, from which she died ; that in this coma the slowness of respiration, with the quickness of pulse, are out of proportion ; that brisk external slapping aroused her from her coma, so that she opened her eyes ; the examination, which showed no secretion of albuminoids, thus might indicate kidney-disease ; the high tem- perature and flushed skin,—all these indicate narcotic poisoning of them- selves, and the presence of them all together indicate two poisons, narcotic poisoning." The Harris Case.—Carlyle W. Harris, a medical student at the College of Physicians and Surgeons, New York City, had in the summer of 1889 made the acquaintance of Mary Helen Neilson Potts at Ocean Grove, N. J., where her family were living. '' When they moved to the city of New York for the winter the ac- quaintance continued, and on February 8, 1890, obtaining permission from her mother to take her to see the Stock Exchange, he went with her before an alderman, and they were married under the assumed names of Charles APPENDIX 629 Harris and Helen Neilson. He was at the time pursuing his studies as a medical student in that city, and he continued to visit the deceased until her family returned, in May following, to Ocean Grove. He followed them there soon afterwards. Mrs. Potts, the mother of the deceased, testified that there was a falling off in his attentions to the deceased, and a marked change appeared in his manner toward her, which seemed to worry her. A young friend of the deceased, Miss Schofield, coming to visit her in June, upon the occasion of a walk, the defendant informed her, because, as he said, the deceased had insisted upon it, that they were secretly married. Upon Miss Schofield's saying that she would beg the deceased to tell her mother, the defendant became very angry and said she should not do so ; that his pros- pects would be utterly ruined; and that he would rather kill her (the deceased) and himself than have the marriage made public, and expressed the wish that ' she' (the deceased) ' were dead and he were out of it.' Later in the day he went out with the deceased, was absent for several hours, and upon their return to the house she appeared pale and ill, and went directly to her room. Shortly after this, in the latter part of June, she went to Scranton, Pa., and visited an uncle, Dr. Treverton. While there Dr. Treverton dis- covered that she was with child, pnd treated her accordingly, but subse- quently was obliged to remove from her a fcetus of five months' formation, which had been dead for some time. After the operation she recovered her health completely, and returned in the first part of September to Ocean Grove. While she was at Dr. Treverton's, and about the end of July, the defendant came, upon a telegram from the deceased and a letter from Dr. Treverton, and remained a few days. The operation for the removal of the fcetus was made while he was there. Dr. Treverton testified to conversa- tions with the defendant upon the occasion of his visit, in which the defendant said he had performed two operations upon the deceased, and had thought everything was removed. He boasted of his previous intrigues with other women, and in his success in not having had any trouble before. Among other things, he said he had been ' secretly married to at least two other young ladies, and by one had a fine child.' During the same visit he had conversations with the witness Oliver, then visiting the Trevertons, in which he spoke boastingly of his experience with women, and of the facility with which he could gain sensual control of them. He said that in two instances he had overcome their scruples by a secret marriage ceremony, but was ready to stand by them. Upon witness asking him how he could stand by both, he answered, in substance, that there would be no trouble, as the first one was glad to get rid of him ; and he went on to tell the circumstances of their relations, and of the final result that, after a child was born, the woman expressed her disgust with him and wanted to see no more of him. To neither Treverton nor Oliver does it appear that he admitted a contract of marriage with the deceased. While the deceased was at Treverton's her mother joined her, and then learned of the recent marriage and what had happened. In the first week of September the defendant was in the hotel 630 A MANUAL OF LEGAL MEDICINE in Canandaigua, N. Y., under an assumed name, with a young woman named Drew. His conduct toward her was demonstrative in its affection, and her friends there, discovering their illicit relations, compelled him to leave. During his stay witness Latham overheard a conversation between him and the Drew woman, in which he advised her to marry some old gentle- < man with lots of money ; and upon her asking, ' What if she did ?' he is said to have replied, ' Oh, we can put him out of the way ;' and upon her inquiring how, he further said, ' You find the old gentleman, and we will give him a pill, and I can fix him.' After the return of the deceased and her mother from Scranton, they met the defendant in New York City and lunched together. They talked about the secret marriage, of which the mother had been informed at Scranton. He offered to satisfy Mrs. Potts of its legality, and took her to the office of his lawyer, Mr. Davidson. The defendant told her he had burned the original marriage certificate, but sent for and obtained a copy from the records, and, upon Mr. Davidson's sugges- tion, attached it to an affidavit made by him, stating his marriage with the deceased under assumed names before an alderman. During a conversation at the office he asked if Mr. Potts knew of the marriage. Mrs. Potts said it was no time to tell him then, and asked him if he had told his mother. He said, ' No; he would not have his family know of it for half a million dollars.' He suggested to Mrs. Potts that if she was unhappy about the marriage it could easily be broken, and no one would be the wiser. Upon her express- ing herself in indignant refusal of the suggestion and insisting upon a ' minis- terial' marriage, he objected to it at the time, alleging as an excuse that it would connect her name with certain club scandals in which he was involved at Asbury Park. He promised, however, to have the ministerial marriage at any time in the future that Mrs. Potts should say. He expressed his gratification at her not pushing the matter of marriage at that time ; that if she had he would have been obliged to ' leave everything and go West.' "Upon that occasion he suggested putting the deceased at Miss Corn- stock's school, to fit her, as he said, for the society in which they were to move, to which suggestion Mrs. Potts acceded. At his request she promised to write to Dr. Treverton and express her satisfaction with the marriage, and to prevent the doctor from making any trouble for him at the medical college, as he had all he could do, he said, to meet the charge of keeping a disorderly house. Upon leaving the lawyer's office they joined the deceased at the ferry, he crossing with them. The deceased learned of her mother's being satisfied about the marriage, and she seemed to be made very happy in consequence. " In December the deceased was placed at school, and, as a friend of the family, the defendant received permission to visit her. During her visit to her home in the holidays he wrote the deceased, asking that no announce- ment should be made of their engagement at this time. In reply to a letter from Mrs. Potts, in the first week of January, he wrote suggesting that there should be no further question of marriage for two years longer, and APPENDIX 631 that her daughter should take a collegiate course. About January 18 or 19, Mrs. Potts wrote to the defendant, expressing herself strongly upon the hardship of her daughter's position, with a delay of three years as an un- acknowledged wife, and for no apparent reason ; that her daughter's illness at Scranton had been commented upon ; that if he should die it would be humiliating to publish a marriage under the circumstances of its contracting ; that her husband might meet Dr. Treverton and be told of the illness at Scranton and of the doctor's doubts about a marriage. She concluded by asking him to keep his word and to do as he had promised her, and de- manded of him to go upon the anniversary of the-first marriage, February 8, and be married before a minister of the gospel, and give her the certificate to hold, which she would make public at such time as she chose. To this he replied that he would do all she asked of him, if no other means of satisfying her scruples could be found. On Tuesday, January 20, a day after he received Mrs. Potts's letter, the defendant went to the shop of Mclntyre & Sons, druggists, in New York City, and at first ordered some capsules of sandal-wood to be put up. Upon the clerk mentioning that it would take some time, he said he could not wait. He then handed the clerk a prescription, asking if it would take long to prepare, and, upon learning that it would take a few minutes, waited for it. It called for twenty- five grains of quinine and one grain of sulphate of morphine, mixed in six capsules, with the direction to take one before retiring. The prescription was put up by the clerk with minute care, he being aided by another clerk, who checked the amount and weight of the morphine, according to a custom adopted where poisons are put up. The box, properly labelled, containing six capsules, each capsule containing one-sixth of a grain of morphine and four grains and a fraction of quinine, was taken by Harris. He never called for the sandal-wood capsules. The following day, being Wednesday, Janu- ary 21, he was at the school reception and saw the deceased. '' The testimony in the case shows that the defendant stated to both coroner and deputy coroner, when shown and asked about the pill-box taken from the room of the deceased, that it was the one that he had given to her on Wednesday, January 21, and he described the prescription as above, stating that he had given it to her for headaches, and that he had given her only four of the capsules. It was also shown by the testimony of several witnesses from the medical college that in the latter part of December and the first part of January lectures were given upon opium and its effects when used feloniously. The sulphate of morphine, contained in wide-mouthed bottles, had been passed around among the students, of whom the defendant was one, and they were allowed to take it out and to handle it when they chose. "After meeting the deceased at the reception on Wednesday, January 21, the defendant left for Old Point Comfort, Va., and did not return until a week later. While there it appears that the deceased wrote to him that the medicine had not relieved headache, but rather made it worse ; to which he 632 A MANUAL OF LEGAL MEDICINE replied, advising her to continue taking it. On January 31 the deceased, her mother, and the defendant met at the school and walked together. The deceased seemed perfectly well, and very bright and happy. Mother and daughter returned to the school, and when in the bedroom of the deceased she showed her mother the pill-box, with one capsule left in it, and remarked that she had been taking some capsules that Carl (the defendant) had brought her. She complained of their making her feel ill, and of her dislike to take them. She said she was tempted to toss it out of the window, and then to tell Miss Day, the principal, that she had taken it. Her mother advised her to take it, remarking that quinine was apt to make one feel wretched, and that she might have been malarious. Her mother left, and then occurred the scenes of illness and death of that night. The defendant was sent for toward daylight by Dr. Fowler, who, stating that he believed it to be a case of pronounced opium-poisoning, wished to learn what had been contained in the pill-box in her room, and which not only was the only evidence of anything like medicine about the room, but which, according to her room-mates, was the only medicine in the room that day. The defendant told him what had been its contents, and of his having prescribed the cap- sules for headache, insomnia, and the like. Dr. Fowler said one-sixth of a grain could not produce the condition, and advised him to go at once to the druggist and ascertain if the proportions of the drugs had been reversed. He pretended to go immediately, and, when he shortly after returned, stated to Dr. Fowler that the medicines had been prepared exactly according to his prescription. The evidence shows that he did not go to the druggist's that morning, as supposed by Dr. Fowler, nor until eleven o'clock, and after the death, when Dr. Kerr told him to go and try and get the original prescrip- tion, if he could. During the time he was in the room where the deceased lay he surprised the physicians by his composure and general lack of in- terest or affection, except when, upon her death-bed, he exclaimed, ' My God ! what will become of me ?' He spoke to the physicians of being 'somewhat interested in the girl,' and mentioned a possible future engage- ment to her. He asked them repeatedly if they thought he could be held responsible for the death. To them and to the coroner he said that he was merely a friend to the deceased, and pretended hesitation as to her correct given name. 1' On the evening of the Sunday he met Mrs. Potts at the ferry-house and stated to her that her daughter had died of morphine-poisoning, and repre- sented it as 'the druggist's awful mistake.' Mrs. Potts says that when she told him that, as the deceased was the mother of his child, she must be buried under his name, his terror was frightful, and he said it could not be ; that he would do anything, but that the knowledge of the marriage coming at this time would destroy him ; that he would answer just the same if it was Queen Victoria's daughter, ' She cannot be buried under my name,' and he urged as a pretext consideration for the school. '' The coroner met him at the school in the evening. The defendant APPENDIX 633 said he had one of the capsules prescribed for the deceased, and gave it to the coroner, telling him to analyze it and it would be found all right. Sub- sequent chemical analysis of it proved the correctness in preparing the pre- scription. The mother, in order, as she says, to get a permit to take the body as soon as possible out of the house and to New Jersey, represented falsely, as she also admitted, that her daughter had heart-trouble. She left the next day with the body. Some days later the defendant stated to Dr. Hayden, in conversation about the occurrence, and when rebuked for writing prescriptions, that ' These capsules would not hurt any one, and no jury would convict me, because I have two capsules which can be analyzed and be found to contain the correct dose.' "Of the druggist's clerk, witness Powers, at the interview at the store on February 7, when obtaining some medicine, he asked if he had seen the account of the death in the papers, and whether he believed it; and upon the witness expressing his belief that the girl died of heart-disease, said, ' So do I.' They talked about the putting up of the prescription, and the defendant said there was no doubt that it was all right. To Dr. Peabody, whom he went to see with an introductory letter from his medical preceptor, a day or two after the death, to whom he stated the circumstances attending it, he described the prescription and for what given, and alleged as an excuse for keeping out two of the capsules that it was injudicious to put as much as a grain of morphine in a girls' school. Later in February, in a conversation with Dr. White, he said he did not know whether the druggist had made a mistake, or whether there was a brain tumor, which would account for the fact that the morphine in the capsules had been the cause of death. A few days before the coroner's inquest, which was held on February 27, the de- fendant met Mrs. Potts and said that the coroner's inquest would exonerate him, and that he was innocent; and upon her remarking, ' If innocent, how did she die?' he replied that ' It was the druggist's mistake.' She asked how that could be, when he had said the capsules, upon being analyzed, would prove it to be all right, and said the statements conflicted. He ascer- tained from her that neither Mr. Potts nor Dr. Treverton knew of her fears. He then endeavored to obtain from her the affidavit of the marriage, saying that he must have it; that it was more valuable than he dare tell her. She said she would not give it. ' It is not here.' " The body of the deceased was exhumed, and morphine was discovered in the girl's stomach and intestines. The defendant was found guilty of murder in the first degree, and electrocuted. The case was tried before Recorder Smyth, New York City, January, 1892. Digitalin-Poisoning.— The De la Pomerais Case.—This is probably the only instance of homicidal poisoning by digitalin. De la Pomerais, a homoeopathic physician of France, after having had his former mistress's life insured in various companies for his own benefit, fatally poisoned her. He was tried and found guilty of the indictment. Following one of the de- fendant's visits to his victim, she died, after suffering from violent vomiting 634 A MANUAL OF LEGAL MEDICINE and great depression of the action of the heart and debility, within twenty- four hours. Thirteen days after her demise her body was disinterred, the actions of the defendant having been of such a nature as to create suspicion and associate him with the crime. Chemical research having failed to dis- cover any poison, the medical examiners, Tardieu and Roussin, resorted to the physiologic or frog test, employing some of the extract obtained from the stomach and bowels of the woman, and also one procured from the scrapings of the floor on which the dead person had vomited. These tests responded to all the known chemical reactions. Besides the evidence furnished by the tests, an unusually large amount of digitalin was found in the possession of the accused, forming strong circumstantial evidence of his guilt. The prisoner was executed. ( Vide Reese, '' Medical Jurispru- dence," p. 457.) Nicotine-Poisoning.— The Count BocarmZ Case.—Reese describes this celebrated case as follows. Count Bocarm6 was executed in Belgium, 1851, for poisoning his brother-in-law, Gustave Fougnies, with nicotine. '' An unknown quantity was forcibly put into the mouth of the victim, the countess assisting her husband as an accomplice in the murder. Death was believed to have taken place within five minutes. The poison was detected by M. Stas in the tongue, throat, stomach, liver, and spleen of the deceased, and also from stains on the floor near where the act was committed. From the excellent report of the examination of M. Stas we may note the following particulars. The appearance of the tongue indicated the action of some highly acrid agent; it was swollen, blackened, softened, and friable; the epithelium was easily detached. This was also the condition of the mucous lining of the mouth and pharynx ; it was reddened as if cauterized, and easily separated. The lining membrane of the stomach was intensely in- jected, exhibiting large patches, which were livid and black. The vessels were filled with a black coagulum, resembling blood that had been treated with sulphuric acid. The duodenum was also highly injected. There were no ulcerations or perforations of the stomach or bowels. The lungs were engorged with black blood, and exhibited the usual character of asphyxia. The heart was normal, its cavities containing black liquid blood. No odor was observed in the body." (" Medical Jurisprudence.") The Holmes-Pitezel Case.—The crime for which Herman W. Mudgett, alias H. H. Holmes, was executed at Philadelphia, Pa., May 7, 1896, was the murder on Sunday, September 3, 1894, of Benjamin F. Pitezel, a con- federate, at Philadelphia. The history of the crime, briefly, is as follows. "Eugene Smith, a house-carpenter, while passing along Callowhill Street, between Thirteenth and Broad, was attracted by a sign in the house num- bered 1316. The sign consisted of a sheet of muslin stretched across the bulk window, on which was printed, in black and red letters, ' Patents bought and sold. B. F. Perry.' Now, it happened that Smith himself was an in- ventor. He had recently obtained what he claimed to be a valuable patent. He determined to step in and consult Mr. Perry. Walking into the store, APPENDIX 635 he was greeted by a tall, raw-boned, sharp-featured man, who said he was Perry. There was some talk over the purchase of the patent, which was continued at a second visit, but nothing definite was arrived at. On the second visit, however, Smith was employed by Perry to put up a rough counter, required for business purposes, in the first-floor store-room of the house. It was while working at this counter that Smith saw a man enter, give a sign to Perry, and pass upstairs to the second story. Perry followed the stranger, and remained with him for half an hour. In that stranger Smith afterwards recognized H. H. Holmes. The counter was finished, and for some days Smith had no occasion to see Perry again ; but on Sep- tember 3 he called to ascertain whether anything had been done about the patent. He opened the door. The store within was vacant. Smith hal- looed at the top of his voice, but there was no answer. He waited for half an hour, and then left. Early next morning he returned. He found the door shut, but not bolted, just as he had left it. On entering there was the same silence and vacancy. But this time Smith's suspicions were aroused. He made his way upstairs. There was no one in the front room ; but when he turned and entered the back room he met a sight that chilled his blood. Lying prostrate on the floor was a corpse. It was dressed in the clothes that Perry had worn. It was the proportions of Perry ; but the face was disfigured beyond recognition, caused by decomposition and burning. At the side of the body lay the fragments of a large broken bottle, a pipe filled with tobacco, and a burned match. Smith gave the alarm to the police. The body was removed to the city morgue. The coroner's inquest followed, and a verdict of death from congestion of the lungs, caused by inhalation of flame, or of chloroform, or other poisonous drug, was given ; but whether it was murder, suicide, or accident neither the jury nor any one else could determine. Eleven days passed. Then B. F. Perry's body was buried in the Potter's Field. Even before the burial two letters had been received in Philadelphia, one by the coroner, the other by the Fidelity Life Insurance Company. Both came from Jephtha D. Howe, a St. Louis lawyer. He wrote as the representative of Carrie A., wife of Benjamin F. Pitezel. The latter was insured in the Fidelity Company for ten thousand dollars. Howe wrote that B. F. Perry was an alias assumed by B. F. Pitezel, and announced that he was coming on to Philadelphia with a member of the Pitezel family to identify the body and claim the insurance. It was found that the policy on Pitezel's life had been issued on November 9, 1893, at the branch office in Chicago. From Chicago it was ascertained that Pitezel's most intimate acquaintance was one H. H. Holmes, who lived at Wilmette, 111. After some correspondence with Holmes, the latter consented to come on to Phil- adelphia and examine the body. " Holmes and Howe met in the office of the Fidelity Company. They were introduced as strangers and shook hands. But Holmes recognized Alice Pitezel, the fifteen-year-old girl who had accompanied the St. Louis lawyer, and she him. All the performers in this little farce went through 636 A MANUAL OF LEGAL MEDICINE their parts with sufficient skill to impose upon the Philadelphia insurance men. " The marks of identification—a wart on the neck, a cut on the leg, and a bruised nail of the thumb, together with certain peculiarities of the teeth— were then agreed upon. The body was disinterred, and all the marks were found upon it. The officers of the company decided that the identification was complete. A check for the amount of the policy, less the attendant expenses, was handed over to Mr. Howe. Everybody seemed satisfied. The matter was soon forgotten in the multiplicity of duties incident to the business of a great insurance company. But the attention of the officers was recalled to the case by a letter from one Marian C. Hedgepeth, an inmate of the St. Louis City Prison. The writer claimed to be acquainted with both Howe and Holmes. He had introduced them, in fact, and he was to have received five hundred dollars as his share in a conspiracy into which they had entered to defraud the insurance company. And this was the plan as Hedgepeth detailed it. Pitezel had already been insured. Holmes was to make Pitezel fix himself up and appear that he was mortally wounded by an explosion, and then put a corpse in place of Pitezel's body, etc., and then have it identified as that of Pitezel. But, according to Howe, it was almost positive that Holmes deceived Pitezel, and that Pitezel, in following out Holmes's instructions, was killed. The writer naively concluded, ' It is hardly worth while to say that I never got the five hundred dollars that Holmes held out to me to introduce him to Mr. Howe.' "Strange to say, the company was inclined to treat this letter as the fake of a wily criminal. Not so the Philadelphia police. The aid of the Pinkerton detectives was called in. Holmes was traced from place to place, his real name and his identity were discovered, and on November 17, 1894, he was arrested in Boston. . . . After having murdered his victim, Holmes set about to divert suspicion by burning portions of Pitezel's body, but the fire did not destroy his life. While the broken jar and other evidences of the explosion were present, it was clearly shown that they were artificially pro- duced by some person with the intent to mislead. There was no explosion, for, according to the medical examiner, who visited the scene of the tragedy as soon as Pitezel's body was discovered, the pieces of the broken jar were inside the jar itself. The medical examiners explained to the jury the post- mortem appearances of the body, the condition of the heart, and the con- gested state of the lungs, showing conclusively that the death was sudden. They testified that the deceased died from chloroform-poisoning. The condition of the stomach, intestines, and liver indicated that the man had been addicted to the drinking habit, in fact, was a heavy indulger. But the condition of the stomach was from chloroform. The physicians found about two ounces of the poison in the stomach, and the odor was very strong. 1' The plea advanced by the defence—that of suicide—-was refuted by the evidence presented by the prosecution. All the surroundings of the case APPENDIX 637 deny suicide. . . . Numerous other crimes are laid at Holmes's door, and he has been pictured as the worst fiend of modern times." OTHER CASES. Identification of Mutilated Remains.— The Parkman- Webster Case. —"Dr. Parkman was murdered by Dr. Webster in Boston, Mass., about thirty years ago. After the death of his victim, Dr. Webster attempted to destroy all evidences of the deed by cutting up the body into fragments, some of which were burned in a grate, some immersed in chemicals, and others packed away in boxes in distant parts of the building. On the dis- covery of these remains, a week after the murder, the portions of the body were accurately examined by a skilled anatomist. It was proved that they were human remains, belonging to one and the same body, of the male sex, and that they had not been dissected for anatomical purposes, but cut and hacked in different directions, with the object, evidently, of mutilation. On restoring these disjointed parts in situ, and supplying the deficient portions, it was found that the proper measurements agreed closely with those of the missing Dr. Parkman. This* circumstance, together with the discovery of certain marks of identity about the teeth and jaws (the head had been almost completely destroyed by fire), afforded sufficient evidence to enable the jury, on the trial of Dr. Webster, to find a verdict of guilty." (Reese, " Medical Jurisprudence.") Wounds before and after Death.—Casper reports a case where the victim's head was severed from his body, and, as the head was completely drained of blood, the conclusion was reached that the decapitation had been done during the life of the deceased, and that there must then have occurred a profuse hemorrhage to account for the want of blood after death. (Reese.) Cadaveric Rigidity.—"The ice broke while a young man was skating. For a time he supported himself by resting with both elbows on the sound ice surrounding the broken portion, the lower part of his body at this time only being submerged. Eventually the ice on which he rested gave way, and he fell into the water and was drowned. The following day the body was recovered. The arms were found bent, and in the precise position in which he had rested on the ice the previous day. The position of his legs further indicated that he had exerted himself powerfully during the last moments of his life to keep his head above water.'' (Quoted by Tidy, op. cit.) Personal Identity.—"The body of an old man was found on the bank of the Dee, at Drumoak. The left ear and the first finger of the left hand were wanting, the mutilation apparently of long standing. Two young women claimed the body as that of their father, who had been in the habit of leaving home for weeks at a time, and who had lost his left ear and left forefinger. On the return of the daughters and friends of the supposed party from his funeral, the boatman of a ferry which they had to cross asked them for whom they were in mourning, and, on receiving their answer, 638 A MANUAL OF LEGAL MEDICINE laughingly informed them that he had only half an hour before ferried their father over, alive and well, which, on reaching home, they found to be true. Whose the body was which they had interred was not discovered.'' (Quoted by Tidy.) The writer is familiar with many cases of doubtful identification. In the Meyer case he testified that, while coroner's physician, he was summoned to see a body. Death had evidently been caused by cerebral hemorrhage. While there three women called, each with a photograph, and each identified the corpse as that of her husband. The body was in a good state of preser- vation, and had been dead only three-quarters of an hour. In another instance a woman identified a body as that of her husband, and when she returned to her home she found her husband in bed, sound asleep. In another case a body which had been buried three months was identified as that of a person who turned out to be alive and well; and in yet another instance the body of a boy, sixteen years of age, was positively identified by a woman as that of her son, while the father disclaimed it. It was the body of a boy who had been killed in a railway accident, and after the dispute of the parents as to its identity it was removed to the city morgue. The writer has seen a body identified by nineteen people, who all claimed it. The Lane Case (Whitechapel Tragedy).—"In November, 1875, Henry Wainwright was tried and found guilty of the murder of Harriet Lane, a woman with whom he cohabited. Two bullets were found in the brain and a third among the hair, flattened by forcible contact with the skull, proving that she had been shot; but in addition it was also evident that her throat had been cut, one carotid artery having been severed. The crime was dis- covered by a workman, who noticed a mutilated hand protruding from a badly smelling bundle, wrapped in American cloth. The prisoner was re- moving this and another bundle in a cab, and was smoking to hide the odor. A danseuse of his acquaintance was in the cab with him. When a policeman could be found to stop the cab it was discovered that one parcel contained the decomposed trunk of an adult female body. The contents of the second bundle disclosed the head of a female so covered with lime (and chlorinated lime) that it was difficult to guess her age. The arms and legs were also in the parcel. In the Whitechapel premises a new spade, soiled with lime, etc, and a grave under the floor containing disinfectants, were discovered. The poor woman had disappeared nearly twelve months previously (Sep- tember, 1874). She had had two children. The body was identified by some jewelry found on the premises. It was partly mummified and partly converted into adipocere, and had been cut into ten different portions. It was very roughly dismembered, so that a part of the pelvis was connected with the thighs. The medical witnesses supposed her to be about twenty- five years of age and five feet high. There were two distinct fractures of the skull, due to the two bullets. Mr. Larkin, the medical witness first called, said that one of the bullets had entered during life. This he judged from the extravasation of blood underneath the scalp for a considerable dis- APPENDIX 639 tance around the wound. There was also extravasation within the skull, following the direction of the bullet. A scar was noticed on the right leg. ' It was an elongated scar, as big as a shilling, but the puckering or drawn skin was much bigger. It was such a scar as a burn, say from a red-hot poker, would produce.' He also deposed that, owing to the extravasation of blood in or about the parts, the throat must have been cut either just before or immediately after death. The bullets were flattened, but had been conoidal. One weighed sixty-six grains, one seventy-eight, and the third seventy-two grains. The hairs on the shovel were proved by Mr. Bond to correspond with those of the deceased. 'The throat-wounds were either homicidal or had been inflicted suicidally by a left-handed person.' Mr. Larkin gave it as his opinion that the deceased had had children, partly from the linecz albicantes, and partly from the appearance of the uterus." (Quoted by Tidy.) Burns and Scalds.—"A pretty citizeness of London had had six hus- bands, one after the other, the first to please her parents, the rest to please herself. One of her countrymen was brave enough to allow her to make him her seventh husband. For a few months all went merrily. Her fondness, perhaps, made her indiscreet. She told her husband all the faults and follies of his predecessors. She disliked some because they were sots, others because they were unfaithful to her. In short, she had no good words for any of them. The husband, suspecting something, and wishing to test the character of his wife, began to stay out late, and to appear drunk when he returned. She first reproached him, then began to threaten ; but he continued to stop out late, and to feign drunkenness, even more often than before. One night, when she believed him dead drunk and fast asleep, she took a lead button from the sleeve of her dress, melted it in a pipe, and approached the pretended sleeper to pour the melted metal into his ear. The husband, no longer doubting her guilt, seized her, cried for help, and gave her up to justice. She was first imprisoned, and then tried, the dead bodies of her six husbands being exhumed, and all bearing witness against her by the dis- covery of lead in their ears and brains. On this evidence she was condemned to death. Hence the origin of coroners' inquests in England." (Quoted by Tidy.) The Halke Case.—Murder of Widow Halke, aged seventy, by Fritz. '' The woman had been subjected to violence, and the body afterwards burned. The question was, Did the woman die from the violence (of which the pris- oner was undoubtedly guilty) or from the effects of the fire (of which the prisoner might have been innocent) ? Vesications were found on the body, some of which contained serum, others being empty. The post-mortem showed clearly that asphyxia was the cause of death. The question then arose, Was the asphyxia the result of strangulation (which the prisoner denied) or the effect of fire ? A stoppage to respiration might have resulted from an injury to the nose that the victim had sustained, and to the circum- stance that after the prisoner had stunned the woman, he turned her face to 640 A MANUAL OF LEGAL MEDICINE the floor. Although the fire was so severe that the whole of the clothes w-ere consumed and the body carbonized, yet Casper (who reported the case) thought the fire was insufficient, supposing the woman to have been alive, to cause the asphyxia." (Quoted by Tidy.) A female child, aged six years, was scalded with a pot of boiling coffee overturned upon the side of the neck, right axilla, thorax, and right arm. Death in eight days. The post-mortem examination showed brownish patches and granulating sores, pleurisy of the right side, pericardial effusion, body anaemic1 The Druse Case.—" Mrs. Druse, with the compulsory aid of her children, killed her husband with an axe. The body was burned in a wood-stove, with pine shingles. The ashes were thrown into a swamp near by. They were found and carefully sifted. Pieces of bone of various sizes, identified as human, were found, as also a few porcelain buttons, etc. A few hairs found with stains completed the identity. Experiments in this case showed that the body could have been consumed within ten hours. The prisoner was convicted of murder." (Quoted by Stoddard, op. cit.) Heat and Cold.—Sunstroke.—A boy, sixteen years of age, was sud- denly seized with sunstroke while harvesting. Insensibility, convulsions with clinched teeth, conjunctivae congested, and pupils in a state of con- traction. Venesection was performed, with an abatement of the symptoms.3 Tidy quotes the case of a female, aged fifty-five years, who was found on the ice, dead and stiff. Post-mortem : " No signs of injuries, except abra- sions on the knuckles, probably due to her having had a fit and throwing her arms about. Brain appeared half frozen, the cerebral veins and sinuses being only moderately full; lungs normal; trachea pale and empty ; right side of the heart fairly full of blood and the left side distended; blood natural; liver moderately congested ; kidneys and spleen normal; ascending vena cava congested. Opinion : Death the result of cardiac apoplexy, possibly from the effects of cold, but more likely from a convulsive attack while walking over the ice." (Casper.) Infanticide.— Vide the following cases : Beale's, Lancet, July 11, 1846 ; Ruge's, British Medical fournal, April 6, 1878, p. 490 ; Casper's various cases, " Forensic Medicine;" Tardieu's various cases; Stanelli's case, Gazette des Hdpitaux, November 7, 1846, p. 523, etc.3 MISCELLANEOUS MATTERS. The Stomach Test in Murder Trials.—In the Boston Medical and Surgical fournal of February 28, 1895, Dr. Gustav Liebmann contributes a 1 Casper, Forensic Medicine. 2 Medical Times and Gazette, August 27, 1870. 3 For other important cases associated with the various subjects of this work the reader is referred to the larger books on Medical Jurisprudence. APPENDIX 641 short paper on this subject. He stated that the object of this test is to ascer- tain, by the presence or absence of solid contents, or by the intermediary stages of liquefaction of food found in the stomach, how far the process of digestion has advanced, giving thus a clue as to the time at which the death of the victim has taken place, provided the time of the last meal be known. In order to arrive at an exact conclusion, the first and imperative condition would be a uniformly established schedule of time in which the different phases of digestion should be completed. If there be such a physiological law from which there is practically no deviation, we should place full reliance upon the test; but if there be, in healthy people even, numerous exceptions or deviations, the test must of necessity be open to errors. Dr. Liebmann considers that this latter proposition is the true one. The different variations in the duration of the digestive process depend upon the following conditions. 1. The length of time necessary for the transformation of solids into chyme in healthy individuals varies a great deal according to the digestibility of the different foods. 2. The length of time necessary to expel the ingesta from the stomach into the duodenum in the healthy individual varies according to the quantities of food taken. Not only does it take a longer time for larger quantities to be impelled on, but the motor activity of the stomach walls is diminished by the greater distention produced by the larger amount of food present. Thus, pieces of meat are frequently found a day or longer after in- gestion. 3. The shorter or longer stay of food depends on the amount of acidity, which varies in different stomachs, even within the border-line of health. 4. Much variation, even in health, is caused by individuality, by presence or absence of pepsin, hydrochloric acid, psychical factors and emotions (fear, grief, or the opposite, as joy or exaltation). We see there- fore that, owing to the many physical variations, even in the healthy, the forensic value of this test must be considerably impaired. (Times and Register, Philadelphia, June 15, 1895.) Legal Status of the Dead Body.1—Alabama.—Removal of body wantonly for dissection or sale, purchase of a body unlawfully disinterred, violating grave with intent to steal body, etc., or wantonly mutilating body, is punishable by fine or imprisonment (Code, sees. 4023, 4028). Coroner or, in his absence, justice of the peace to hold inquest and direct examina- tion of body by surgeon, etc. (Code, sec. 4801 et seq.). Arizona.—Mutilation, etc., of dead body is a felony (Penal Code, sec. 491). Removal of a part of body unlawfully is punishable (Penal Code, sec. 492). Duty of burying body is, if a married woman, on husband ; if not a married woman, on nearest of kin who is an adult possessed of sufficient means. If deceased has no relatives, on coroner holding inquest or over- seers, etc., of poor (Penal Code, sec. 493). Refusal of one on whom duty of burial is imposed by law is punishable (Penal Code, sec 494). Arrest or 1 Taken from Becker's contribution to Witthaus's Medical Jurisprudence, Forensic Medicine, and Toxicology, vol. i. p. 309. 4* 642 A MANUAL OF LEGAL MEDICINE attachment of a dead body is a misdemeanor (Penal Code, sec. 496 et seq.). Person whose duty it is to bury is entitled to custody, except where coroner holds it until inquest is completed (Penal Code, sec. 495). Arkansas.—Bodies of persons dying in almshouse, prison, house of cor- rection, or jail should be surrendered to a physician for dissection, etc., unless the deceased request to be buried or the body is claimed by relatives, or unless deceased died suddenly and unknown ; and after such use for dissec- tion it shall be decently buried (R. S., sec. 2552). Removal of dead body for the purpose of dissection, or stealing, or from wantonness, or receiving same knowing it to have been unlawfully disinterred, is a misdemeanor (R. S., sees. 1902, 1903). Dead body can be transported out of county in which death occurred on permit of State board of health (R. S., sec 480). Coro- ner to hold inquest and direct autopsy, etc. (R. S., sec. 692). And may order a body to be disinterred for inquisition (R. S., sec. 718). California.—Removal, mutilation, or disinterment of dead body without authority of law is a felony (Penal Code, sec. 290). Removal of part of body for sale, dissection, or maliciously or wantonly, is punishable (Penal Code, sec. 291). Duty of burial: of married woman, on husband ; not a married woman, on nearest of kin who is an adult with sufficient means ; where no relatives, on coroner who held inquest, or overseers, etc., of poor (Penal Code, sec. 292). Refusal to bury t)y person on whom duty rests by law to bury is a misdemeanor, and he is liable for treble the expenses (Penal Code, sec. 293). Custody of body is on him on whom duty to bury is imposed by law, except where coroner detains remains for inquest (Penal Code, sec. 294). Arrest or attachment of dead body for any debt or demand is a misdemeanor (Penal Code, sec. 295). One who disinters or exhumes a body without permit of board of health, health officer, or mayor, or transports such ex- humed remains through streets of town, city, etc., except in a sealed coffin, is guilty of a misdemeanor (Laws, 1878, ch. 673). A sheriff, coroner, or keeper of county poor-house, public hospital, county jail, or State prison, etc., must surrender bodies of those who are to be buried at public expense to any physician or surgeon for dissection, etc, unless deceased during his last sickness requested to be buried, or body is claimed by relatives, etc., or deceased was a stranger or traveller, who died suddenly (Penal Code, sec. 3094). Coroner to bury body when no other person takes charge of same (Penal Code, sec. 4286). Coroner to hold inquest, direct autopsy, and may exhume (Penal Code, sec. 1510). Colorado.—Concealment of death of issue which, if born alive, would be a bastard is punishable (Mill's Stat., sec. 1195). Body of criminal executed for capital offence shall be delivered to a physician or surgeon unless claimed by a relative or friend (Mill's Stat., sec. 1204). Board of health, mayor, etc., or officer, etc., having control of any almshouse, prison, hospital, jail, etc., shall surrender bodies to be buried at public expense to any physician or surgeon for dissection, etc, unless deceased during last illness requested to be buried, or body is claimed by relatives or friends, or deceased was a APPENDIX 643 stranger or traveller who died unknown (Mill's Stat., sees. 1547, 1548). Non-resident poor person to be decently buried (Mill's Stat., sec. 3391). Coroner to hold inquest, etc., or, if none, bury it decently at expense of county (Mill's Stat., sees. 870-882). Removal of body unlawfully for sale, dissection, etc., punishable (Mill's Stat., sec. 1367). Board of health may direct removal of dead bodies from cemetery within a city (Laws, 1893, ch. 113, sec. 54). Connecticut.—No body shall be buried or disinterred or removed beyond limits of any town unless a permit is obtained, and, where deceased died of an infectious disease, body shall be in a hermetically sealed case (Gen. Stat., sees. 106, 108, 113). Custody of remains is in husband or wife or next of kin (Gen. Stat., sec. 536). Coroner to hold inquest, etc. (Gen. Stat., sees. 2005, 2008). And deliver body to friends, or, if none, to town authorities for burial (Gen. Stat., sec. 2015). Mayor, etc., may deliver bodies of those not buried within twenty-four hours after death to medical college for dissec- tion, etc., unless relatives or friends do not consent, or deceased requested to be buried, or was a stranger or traveller (Gen. Stat., sec. 1729). Bodies of convicts dying in State prison, and not having any known relatives, shall be delivered to medical institution of Yale College (Gen. Stat., sec. 1732). Body of one dying in a hospital shall not be examined unless father, etc., consent, or, if none, within forty-eight hours after death (Gen. Stat., sec. 1735). Removal of body from grave unlawfully, or receiving, secreting, or dissecting same, is punishable (Gen. Stat., 1880). Body of executed criminal shall be buried by sheriff (Gen. Stat., sec. 1640). Delaware.—Coroner to hold inquest, etc, or may cause body to be dis- interred (R. L., ch. 33). Removal of body from grave unlawfully a misde- meanor (Laws, ch. 204, 1883). Florida.—Buying, selling, or having in possession for purpose of buying or selling, a dead body is punishable (R. L., sec. 2625). Concealing birth of issue which, if born alive, would be a bastard is punishable (R. L., sec. 2393). Coroner to hold inquest, etc. (R. L., sees. 3011, 3019). Georgia.—Coroner to hold inquest or to disinter same for inquisition (Code, sees. 410, 590, 591, et seq.). Public officers and their assistants, and their deputies of every county, city, town, or other municipality, or of every prison, chain-gang, penitentiary, county morgue, public hospital, having control of dead body to be buried at public expense (not dying of infectious disease), shall deliver same to medical college for dissection, etc., unless claimed by friends or relatives, or such friends or relatives request same to be buried, or unless deceased was a stranger or traveller (Laws, 1887, vol. ii. p. 77). Removal of body from grave, etc., unlawfully for dissection or sale is felony ; or receiving or purchasing it, knowing it to have been so taken, or trafficking in dead bodies, or having them conveyed without the State for sale, etc., is a felony (Laws, 1882, vol. ii. p. 87). Idaho.—Coroner to hold inquest, etc., and may exhume it for that pur- pose (R. L., sec. 8377). Coroner to bury body decently when not claimed 644 A MANUAL OF LEGAL MEDICINE by relatives, etc., and, if necessary, at expense of county (R. L., sec. 2081). Illinois.—Removal of body unlawfully or aiding in such removal is pun- ishable as a felony, one to ten years (S. & C. Am. Stat., vol. i. p. 794). Coroner to hold inquest, etc. (S. & C. Am. Stat., vol. i. p. 606). And to deliver body to friends, or bury decently if no friends claim it, if necessary at county expense (S. & C. Am. Stat., vol. i. p. 606). Body of executed criminals may be delivered to any physician or surgeon for dissection, unless friends object (S. & C. Am. Stat., vol. i. p. 869 ; Crim. Code, sec. 503). In cities and counties, where population exceeds one hundred thousand, super- intendents of penitentiaries, wardens of poor-houses, coroner, city under- taker, having body required to be buried at public expense, may deliver remains to medical college or any physician or surgeon for dissection, unless claimed by relatives (S. & C. Am. Stat., vol. iii. p. 867). Indiana.—Removal of dead body or part of same unlawfully is a felony (R. L., sec. 2165). Concealment of body or part thereof, which has been unlawfully used for dissection, is a felony (R. L., sec. 2167). Receiving or buying a body, knowing it to have been unlawfully disinterred, is a felony (R. L., sec. 2168). Dead body of one dying in a State, city, or county prison or jail, or county asylum or infirmary or public hospital, or dead body of an executed criminal, or dead body of a vagrant, or one killed while committing a felony or escaping from prison or officers, may be delivered to the faculty of a medical college in State for dissection, etc., unless deceased requested to be buried, or body is claimed by next of kin (R. L., sec. 4258 et seq.). Dissecting or possessing body for dissection, except as prescribed by law, is a felony (R. L., sec. 4271). Coroner to hold inquest, etc. (R. L., sees. 5878, 5879). Iowa.— Coroner to hold inquest, etc (McCl. Am. Code, sec. 487). To bury body decently at expense of county, if necessary, or deliver it to rela- tives (McCl. Am. Code, sec. 501). Removal, etc., of dead body unlawfully, or aiding such removal, or knowingly receiving body so removed, etc., is punishable (McCl. Am. Code, sec. 5328). Coroner, undertaker, superinten- dent of public asylum, hospital, poor-house, or penitentiary may deliver body to medical college or physician for dissection, etc., unless relatives, etc., refuse, or deceased desired to be buried (McCl. Am. Code, sec. 5329). Bodies of those executed, or dying in hospitals or prisons under sentence for crime, shall be delivered to medical college or association, or physician or surgeon, for dissection, etc., unless relatives or friends do not consent, or deceased expressed a wish to be buried, and after such use the remains shall be interred (Gen. Stat., sec. 3758). State board of health shall issue permits for transportation of bodies beyond county where death occurred (Gen. Stat., sec. 6030). Kansas.— Coroner to hold inquest, etc. (Gen. Stat., sees. 1780, 15,794). To bury body if not claimed by friends, etc., and at public expense if neces- sary (Gen. Stat., sec. 1792). Removal of a body unlawfully for dissection or APPENDIX 645 wantonly, or receiving body, knowing it to have been so removed, is a mis- demeanor (Gen. Stat., sec. 2372 et seq.). Kentucky.—Coroner to hold inquest, etc. (Gen. Stat, ch. 25, sees. 3, 11). To bury the body or deliver to friends (Gen. Stat., ch. 25, sec. 6). Body of one dying on a steamboat or other craft, if not claimed by friends, shall be buried by master or officer in command on shore, at least four feet deep (Gen. Stat., ch. 29, art. 17, sec. 15). Removal of body unlawfully from grave is punishable (Gen. Stat., ch. 29, art. 17, sec 16). Louisiana.— Coroner shall hold inquest, etc., and bury body when not claimed by friends (Voorh. Rev. L., sees. 653, 660). Maine.— Coroner to hold inquest, etc. (R. L., ch. 139, sec. 1). To bury the body at State or town expense (R. L., ch. 139, sec. 11). Seizure of body on execution punishable (R. L., ch. 124, sec. 28). Removal, etc., of body unlawfully, or receiving it knowingly, or exposing, etc., body, is punishable (R. L., ch. 124, sec. 27). Body may be buried and the expense recovered from the town (R. L., ch. 24, sec. 34). If any resident request or consent that his body be delivered to a physician or surgeon for dissec- tion, it may be so delivered, unless kindred or family connection objects (R. L., ch. 13, sec 1). Body of criminal dying in State prison or jail, or who was executed, may be delivered to medical college or physician, etc., for dis- section, unless deceased or kindred request to be buried (R. L., ch. 13, sec. 2). Body of person dying in the State, which is not claimed by relatives, notice having been given, shall be delivered to medical college, unless ten voters of the town object to such disposition in writing (Laws, 1893, ch- 254)- Maryland.—Coroner to hold inquest, etc. (Md. Code, art. 22, sees. 3, 4). Shall bury the body when necessary at public expense (Md. Code, art. 22, sec. 7). Removal, etc., from graveyard, etc. (except potter's field), of a body is a misdemeanor (Md. Code, art. 27, sees. 133, 134). Massachusetts.—Medical examiners shall hold inquest, etc (Pub. Stat., ch. 26, sees. 10, 11). And shall deliver it to relatives or friends, or if no one claims it, to overseer of poor, etc., for burial (Laws, 1887, ch. 310). Body shall not be buried in city or town, or removed therefrom, without a per- mit (Laws, 1888, ch. 306). Body of one dying of infectious disease shall not be transported without permit, and only in a sealed case (Laws, 1883, ch. 124, sec. 2). Body shall not be cremated without permit and inquest by medical examiner, or within forty-eight hours after death, unless death was occasioned by contagious disease (Laws, 1885, ch. 265, sec. 4). Overseers of poor, mayor and aldermen of city, or superintendent of State almshouse may deliver body of person required to be buried at public expense to any physician or surgeon or medical college, unless deceased requested to be buried, or relative requests burial or claims it, or deceased was a stranger or traveller (Laws, 1891, ch. 185). Body of criminal executed shall be delivered for dissection to a medical college, if requested ; if not, to friends or relatives, or, if none, to any physician or surgeon (Pub. Stat., ch. 202, sec. 8). Re- 646 A MANUAL OF LEGAL MEDICINE moval of body unlawfully from grave is punishable, or buying, selling, or possessing for such purpose is punishable (Pub. Stat., ch. 207, sees. 47, 48). Concealing of birth of child which, if born alive, would be a bastard is pun- ishable (Pub. Stat., ch. 207, sec. 11). Seizing dead body on execution is punishable (Pub. Stat., ch. 207, sec 46). Body of a prisoner shall be buried by sheriff at town expense, if not claimed by relatives or friends (Pub. Stat., ch. 220, sec. 31). Michigan.—Justice of the peace to hold inquest, etc. (How. Am. Stat., vol. ii., sec. 9583 et seq.). And shall bury the body at the State or county expense (How. Am. Stat., vol. iii., sec. 9593). Woman concealing death of issue which, if born alive, would be a bastard is punishable (How. Am. Stat., vol. iii., sec. 9284). Board of health, officers, sheriff, etc, of any prison, etc., poor-house, almshouse, having body required to be buried at public expense, shall, if not claimed by relatives or friends, or if it have died of any infectious disease, deliver it to University of Michigan, etc., for dissection, etc. (How. Am. Stat., vol. iii., sec. 2284). Body shall not be shipped out of State nor used in State for any purpose but anatomical study (How. Am. Stat., vol. iii., sec. 2286). Removal of body unlawfully is pun- ishable (How. Am. Stat., vol. ii., sec. 9297). Minnesota.—Gen. Stat., sees. 6220, 6230, same as N. Y. P. C, sees. 305-315. Concealing birth of child which died before or after birth is a misdemeanor (Gen. Stat., sec. 6210). Coroner to hold inquest, etc. (Gen. Stat., sec. 1011 et seq.). And cause body to be buried at expense of county (Gen. Stat., sec. 1021). Section 6216 same as 303, N. Y. P. C. Body must be buried within four days, and if death was from contagious disease, within twenty-four hours, and in a tightly sealed coffin, which must not be reopened (Gen. Stat., sec. 607). Wardens, superintendents of poor, and other persons having control of bodies shall deliver same to medical college committee for dissection, unless claimed by relatives or friends, or relatives or friends do not consent, or one detained as a witness, or on suspicion of having committed a crime, or deceased requested to be buried (Gen. Stat., sec. 678). Mississippi. —Body of paupers and strangers to be buried (Am. Code, sees. 3145, 3146). Coroner to hold inquest, etc. (Am. Code, sec. 816). Removal of body unlawfully and wantonly for sale, or receiving same, is punishable (Am. Code, sees. 1023, 1024). Missouri.—Coroner to hold inquest, etc. (R. L., sec. 2438 et seq.). And shall bury the body, if not claimed by friends, at public expense (R. L., sec. 2456). And may direct a chemical analysis and microscopical examination of the body (R. L., sec. 2469). Superintendents or wardens of peniten- tiary, houses of correction, insane asylums, poor-houses, and coroners, sheriff, city and county undertakers, having charge of a body required to be buried at public expense, shall deliver the same to medical college for dis- section, unless claimed by friends or relatives, and trafficking in such bodies is a misdemeanor (R. L., sec 6883 et seq.). Concealing birth of child, so APPENDIX 647 that it may not be known whether it was born alive or dead, is a felony (R. L., sec. 3479). Removal of dead body from grave without authority (except that of criminal executed for crime) for purpose of sale, etc., or receiving such body knowingly, is a felony (R. L., sees. 3842, 3845). Montana.— Concealing birth of child which, if born alive, would be a bastard is punishable (Crim. Laws, sec. 41). Coroner to hold inquest, etc. (Gen. Laws, sees. 869, 883). And bury body at public expense, if not claimed by relatives, etc. (Gen. Laws, sec 881). Removal, etc., of body from grave without authority, and for the purpose of sale or dissection, or from wantonness, is a felony (Laws, 1889, p. 114). Nebraska.— Coroner to hold inquest, etc. (Consol. Stat., sec. 3130 et seq.). To bury body, if not claimed by friends (Consol. Stat., sec. 3144). Removal of body from grave without authority for sale, dissection, etc., is punishable (Consol. Stat., sec. 5847). Foeticide is punishable (Consol. Stat., sec. 5582). Bodies of paupers or criminals unclaimed by friends or relatives may be delivered to medical college or physician for dissection, etc., and such body shall not be transported out of State (Consol. Stat., sees. 3299, 3301, 5848). Nevada.—Justice of peace to hold inquest, etc. (Gen. Stat., sec. 2256 et seq.). And cause body to be buried at public expense (Gen. Stat., sec. 2269). Body shall not be buried without certificate of physician or coroner (Gen. Stat., sec. 4872 et seq.). Body shall not be transported out of State without a permit (Gen. Stat., sees. 4870, 4871). Concealing birth of child which, if born alive, would be a bastard is punishable (Gen. Stat., sec 4597)- Non-resident et at. to be buried at public expense (Gen. Stat., sec. 1986). New Hampshire.—Coroner to hold inquest, etc. (Pub. Stat., ch. 262, sec. 1 et seq.). And bury body, if a stranger, at public expense (Pub. Stat., ch. 262, sec. 16). Concealing birth of child which, if born alive, would be a bastard is punishable (Pub. Stat., ch. 278, sec. 14). Body of person dying in a county, city, or town, or State prison or jail, required to be buried at public expense, shall be delivered to any physician or medical college for dissection, etc., unless deceased requested to be buried, or friends claim it or request burial, or deceased was a stranger or traveller who died suddenly (Pub. Stat., ch. 136). Body not to be buried without a permit, or disin- terred (Pub. Stat., ch. 173, sec. 6). Removal of dead body without au- thority, or concealing it, knowing it to have been so dug up, is punishable (Pub. Stat., ch. 266, sec. 7). New fersey.—Coroner to hold inquest, etc. (Rev. Stat., p. 70 et seq.). And bury body, if not claimed by friends (Rev. Stat., p. 170, sec. 5). Con- cealing birth of child which, if born alive, would be a bastard is a misde- meanor (Rev. Stat., p. 241, sec. 83). Body of executed criminal may be delivered to physician, etc., for dissection, unless claimed by relatives (Rev. Stat., p. 239, sec. 69). Removal of a body without authority, for sale, dis- section, etc., is a high misdemeanor (Rev. Stat., p. 249, sec. 122). Ex- 648 A MANUAL OF LEGAL MEDICINE posing body of executed murderer is a misdemeanor (Supp. Rev. Stat., p. 194, sec. 19). Body must not be buried without a permit, nor body brought into the State without permit, nor taken out of State without permit (Laws, 1888, ch. 39, sees. 5-8). New Mexico.—Justice of the peace to hold inquest, etc. (Comp. Laws, sec. 443 et seq.). And bury body (Comp. Laws, sec. 447). Body of one dying of a contagious disease shall not be carried in an open coffin, nor be exposed (Laws, 1889, ch. 79, sec. 8). Body shall not be buried within fifty yards of running stream (Laws, 1891, ch. 83). New York.—Duty of burial, etc. (Penal Code, sec. 305 et seq.). At- tempt at sexual intercourse with dead body is a crime against nature (Penal Code, sec. 303). Transfer of body of one who died of a contagious or in- fectious disease shall be in hermetically sealed casket (Laws, 1893, ch. 661, sec. 23). Bodies of those dying in, or in custody of managers, etc., of, any prison, asylum, morgue, hospital, or in possession of undertakers, shall be delivered to medical college of this State, etc., for purpose of medical study, unless claimed by relatives or friends, or friends or relatives do not assent to such disposal, or deceased requested during last illness to be buried (Laws, 1893, ch. 661, sec. 207). In certain cases bodies of convicts, unless claimed, shall be delivered to certain medical colleges (R. S., pt. 4, ch. 3, sees. 132, 133). District attorney may cause body to be exhumed, examined, etc. (Penal Code, sec. 308). North Carolina.—Coroner to hold inquest, etc. (Code, sec. 657). Con- cealing birth of a child, by burying dead body, is a misdemeanor. Opening grave without authority for purpose of taking body is a felony (Laws, 1885, ch. 90). Coroner may order a chemical analysis of remains (Laws, 1887, ch. 269). Dead body of convict, unclaimed by friends, shall be delivered to medical college, except such dying of contagious disease (Laws, 1891, ch. 129). Body of one dying of contagious disease must not be transported by common carrier until disinfected, nor shall permit for removal be issued until such disinfection (Laws, 1893, °h- 214, sec. 16). North Dakota.—Coroner to hold inquest, etc (Comp. Laws, sec. 664 et seq.). And bury the body, if not claimed by friends, etc (Comp. Laws, sec. 676). Concealing birth of child which, if born alive, would be a bastard, or of child dying within two years after birth, is punishable (Comp. Laws, sec 6947). COMP. LAWS. Section 6549........same as " 6550........ " " 6551........ « " 6552........ " " 6553........ " " 6554........ " " 6559........ " 6660........ " 6663 ........ 305 N. Y. P. 306 307 308(1-3)" 309 310 " 311 312 " 3U APPENDIX 649 Duty of burial of married woman on husband. If not married woman, on nearest of kin who is an adult or has means sufficient. (Comp. Laws, sec 6556). Refusal to bury by one on whom duty is imposed by law a misde- meanor (Comp. Laws, sec. 6557). Custody of body pertains to one whose duty it is to bury (Comp. Laws, sec 6558). When cemetery is by law changed to other place, duty is on relative to move body (Comp. Laws, sec. 6562). Body of executed criminal, and those dying in State penitentiary or county jail under sentence, shall be delivered to medical college or any physician for dissection, unless deceased requested to be buried, or friends ask to have it buried, or deceased was a stranger or traveller (Laws, 1890, ch. 92). Ohio.—Coroner to hold inquest, etc. (R. L., sec. 1221 et seq.). And bury body, etc. (R. L., sec. 1227). Body of pauper or unknown, not an inmate of any penal, charitable, or reformatory institution, and not claimed by relatives or delivered for dissection according to law, shall be buried at public expense (Laws, 1890, p. 283). Corpse shall not be conveyed to or from a city without a permit (R. L., sec. 2119). Bodies of those dying in city hospitals, city or county infirmaries, work-houses, asylums, charitable institutions, penitentiaries, or jails, which are required to be buried at public expense, shall be delivered to medical college or society for study, etc., unless claimed by relative, or deceased was a stranger or traveller (except tramps) (R. L., sec. 3763). Removing body from grave without authority, for dissection, or receiving such body, is punishable (R. L., sec 7034). Body of executed criminal, if not claimed by relatives or friends, may be de- livered for dissection, etc. (R. L., sec. 7343, 1). Oklahoma.—Coroner to hold inquest, etc. (Stat., sec. 1745 et seq.). And bury the body at public expense, if not claimed by relatives (Stat., sec. 1759). Concealing birth of issue which, if born alive, etc., or dying within two years after birth, is punishable (Stat., sec. 2179). P. C. (except subd. 4). ' (except punishment). Custody is to him whose duty it is to bury (Stat., sees., 21, 97). Duty of burial of married woman on husband ; if not married woman, on nearest of kin who is an adult and has sufficient means (Stat., sec. 2195). Refusal to bury by one on whom duty rests is a misdemeanor (Stat., sec. 2196). Oregon.—Coroner to hold inquest, etc. (Crim. Code, sec. 453 et seq.). And bury body, if not claimed by friends (Crim. Code, sec. 462). Un- married woman concealing birth of child, so that it may not be known whether it was born alive or not, is punishable (Crim. Code, sec. 649). Bodies of criminals executed, those dying in hospitals, insane asylums, alms- 2188-2190 . . same as . • • 305-307 N. Y. 2191 . . 308 2192-2193 . ■ • 309-310 2198 . . 311 2199 . . 312 2202 • • 3U 65o A MANUAL OF LEGAL MEDICINE houses, or penitentiaries, may be delivered to medical college or physician for dissection, etc., unless they shall have been interred, or claimed by rela- tives, or relatives or friends do not consent, or deceased expressed a wish to be buried ; and they shall be used for such purpose only, and in this State (Hill's Am. Laws, sec. 3730 et seq.). Removal of body without authority, etc., is punishable (Crim. Code, sec. 656). Pennsylvania.—-Coroner to hold inquest in Philadelphia County only in case of a violent death (Bright's Penn. Dig., 1536, sec. 37). And may in Berks and Lancaster Counties order a post-mortem (Bright's Penn. Dig., 1536, sec. 38). Concealing death of child which, if born alive, would be a bastard is punishable (Bright's Penn. Dig., 431, sec. 158). Removal of body from grave without authority is a misdemeanor (Bright's Penn. Dig., 229, sec. 11). Bodies of those dying in almshouse, hospital, prison, or public institution, or those in morgue, which are required to be buried at public expense, shall be delivered to medical college, physician, etc., to be used for scientific purposes only, unless claimed by relatives, or deceased was a traveller, and trafficking in such bodies is a misdemeanor (Bright's Penn. Dig., 9, sec. 1 et seq.). Rhode Island.—Concealing death of child which, if born alive, would be a bastard, so that it may not be known, etc., is punishable (Pub. Stat., ch. 244, sec. 8). Seizing dead body under execution is punishable (Pub. Stat., ch. 223, sec. 2). Bodies of those dying in jail shall, if not claimed by relatives, be buried at public expense (Pub. Stat., ch. 201, sec. 30). Medical ex- aminer to make autopsy (Pub. Stat., 1884, ch. 420). And bury body of stranger at State expense, if necessary (Pub. Laws, 1884, ch. 420, sec. 24). Coroner to hold inquest if, in opinion of medical examiner, death was caused by act of some one other than deceased (Pub. Laws, 1884, ch. 420, sec. 17). South Carolina.—Coroner to hold inquest, etc. (R. L., sees. 711, 2664, et seq.). And may have body disinterred for inquisition (R. L., sec. 2687). Tennessee.—Coroner to hold inquest, etc. (Code, sec. 6139 et seq.). And may order a chemical analysis of remains, etc. (Code, sec. 6150). Body to be buried, if not claimed by relatives, etc., at public expense, if necessary (Code, sec. 6160). Wilfully or improperly exposing or abandoning a dead body is a misdemeanor (Code, sec 5658). Removing or purchasing dead bodies without authority is a misdemeanor (Code, sees. 5659, 5660). Body of deceased convict to be buried, unless claimed by friends. (Code, sec. 5402). Texas.—Justice of the peace to hold inquest, etc. (Code Crim. P., art. 988 et seq.). And may disinter the body for such inquisition (Code Crim. P., art. 989). Removal, etc., of dead body from grave without authority is punishable (Code, art. 345). Bodies of convicts to be buried (Rev. C. Stat., art. 3561). Vermont.—Justice of the peace to hold inquest, etc. (Rev. Laws, sec. 3934 et seq.). Removal, etc., of dead body without authority is punishable (Rev. Laws, sees. 4194, 4196). Bodies of those dying in poor-house or other- public institution, which are required to be buried at public expense, may be, APPENDIX 651 delivered to any physician for dissection, etc, unless deceased requested to be buried, or friends or relations request burial, or deceased was a stranger or traveller. Such body shall not be removed from State, and shall be used for scientific purposes only (Laws, 1884, ch. 85). Virginia.—Coroner to hold inquest, etc. (Code, sec. 3938 et seq.). And to bury the body at public expense (Code, sec. 3946). Removal, etc., of dead body from grave without authority is punishable (Code, sec. 3794). Bodies of those dying on vessels in State shall be buried by master on shore above high-water-mark (Code, sec. 2002). Bodies of those dying in alms- house, prison, morgue, hospital, jail, or other public institution, which are required to be buried at public expense, and bodies of criminals executed for crime, shall be delivered to medical college, etc., and physician or surgeon for anatomical study, unless (except criminals) relatives or friends claim the body, or deceased was a stranger or traveller, and such bodies shall not be sent out of the State (Code, ch. 80). Washington.—Coroner to hold inquest, etc. (Hill's Am. Stat., vol. i., sec. 245 et seq.) And bury body, if not claimed by friends, at public ex- pense (Hill's Am. Stat., vol. i., sec. 257). Bodies of those dying in poor- house, public hospital, county jail, State prison, etc., which are required to be buried at public expense, shall be delivered to medical college, physician, surgeon, etc., for study, unless deceased requested to be buried, or it is claimed by relatives or friends, or deceased was a stranger or traveller ; and such body shall be used only in the State (Hill's Am. Stat., vol. i., sec. 2428 et seq.). Removal, etc., of body from grave without authority is punishable (Penal Code, sec. 208). West Virginia.—Coxonex to hold inquest, etc. (Code, ch. 154). And bury the body at public expense, or, if a stranger, may forward it to its des- tination and bury it (Code, ch. 154, sec. 8). Removal, etc., of a body from grave is punishable (Code, ch. 149, sec. 13). Wisconsin.—Justice of the peace or coroner to hold inquest, etc (S. & B. Am. Stat., ch. 200). And shall cause the body to be buried at public expense (S. & B. Am. Stat., ch. 200, sec. 4877). Dead body of convict shall, if not claimed by relatives or friends, be buried (S. & B. Am. Stat., sec. 4926). Removal, etc., of body from grave without authority is punish- able (S. & B. Am. Stat., sec 4592). Concealing death of child which, if born alive, would be a bastard is punishable (S. & B. Am. Stat., sec. 4585). A public officer having in his charge a body required to be buried at public expense shall deliver same to member of State or county medical society, etc., for anatomical study, unless claimed by relatives, or they con- sent to such disposal, or deceased requested to be buried, or was a stranger or traveller (S. & B. Am. Stat., sec. 1437). {From "The Medical Register" of New York, New fersey, and Connecticut for 1895-96. Published by G. P. Putnam's Sons, New York.) ON Table showing the Total Number of Still-Births and Deaths (with an Enumeration of some of the most Prominent Causes) which occurred in the City of New York during the Ninety-one Years ending December 31, 1894, and the Number of Births and Marriages reported since the Year 1847. Compiled from the Records of the City Inspector, Metropolitan Board of Health, and Health Department of the City of New York, by John T. Nagle, M.D., Registrar of Records. a w W OS 1/) a H j < OS h O O 0. s H < W Q < H O Number of Deaths from rf 0 CJ B! (1. U °> m m X ^ O D< a III h < (-" (J w< ai g* a. i. 0 8 CH w B. W vi h h "5 z Cm < it < i w x Q Percent-age to thk Total Mortality. 0 h u. 0 0. W a. in X h ~ m < h 0 h m w 0 < 2 u < w ►1 H < d h O 0 B< 0 £ en si ~u .2 'u 01 A a. 5 a 3 0 u U J2 be 3 0 u ie c 'a. 0 0 u.' 0> > Ol in 3 a u 0> > o> h •a "5 •e a >> H 01 > V C "a c/3 6 .0 '0 V a en O C in u 0> > 01 e 01 0 u 01 > 01 h _o 13 Diarrhceal Diseases.3 V > 01 M c '55 a .2 "3 (A "5 c 0 E Oh *3J is a. .3 "S 0 E 3 o> a a. in '£. u c 0 u n 0 z w 1 CO WS h w < u Q _!. IT) B) 01 V > u V 73 c (A 01 < 0 H 0 3*0 c be O J- > ■£>T3 M C 0) ID cd Q 1790 41 47 51 76 64 70 94 93 81 76 93 102 88 118 159 168 189 2,084 2,297 2,174 2,236 1,95° 2,038 2,073 2,431 2,472 2,207 1,884 2,405 2,651 2,409 3,106 3,008 3.326 169 62 48 29 62 66 4 117 21 2 2 94 179 14 19 2 I 64 2 2 2 9 35 15 18 19 20 18 10 74 14 4 4 2 4 9 1 1 1 3 5 5 75 70 100 IOI 94 102 82 136 m 76 78 83 82 60 74 68 97 19 19 72 35 35 50 44 43 82 89 50 95 44 11 123 55 19 20 78 96 108 65 73 65 156 171 121 142 120 100 163 264 165 143 10 19 17 12 12 47 66 130 270 13 23 ' 266 291 228 207 154 186 180 215 150 249 139 154 117 164 319 444 491 499 462 354 464 429 413 569 595 669 562 572 618 678 574 59i 577 625 40 102 127 138 100 106 134 103 225 202 66 202 216 145 178 141 155 790 823 903 845 756 767 664 853 839 781 606 776 831 I, I.so 1 ■' 73 1,293 533,i3i 72,557 76,022 79,653 83,456 87,442 91,618 95,993 95,957 95,920 95,884 95,848 99,952 104,232 108,695 "3,350 118,204 123,266 °27 1804 1805 1806 1807 1808 1809 1810 1811 1812 1813 1814 1815 1816 1S17 1S1S 1819 1820 28.72 30.22 27.29 26.79 22.30 22.24 21.60 25-34 26.10 24-35 19.66 25.12 28.77 22.16 27.40 26.88 20.46 37-91 35-83 41-54 37-79 38-77 37-63 32-03 35-09 33-94 35-39 32-17 32.27 3I-3I 34-50 37-03 39.00 38.88 62.09 64.17 58.46 62.21 61.23 62.37 67.97 64.91 66.06 64.61 67.83 6773 68.69 6550 62.97 61.00 61.12 > V. c > r o **\ r M a > r IS2I ... 174 1822 • •. • 205 I823 ... 223 I824 ... 250 1825 ... 244 1826 ; • . . 302 1827: ... 291 1828 • • • 338 1829 ... 360 1830 • • • 339 1831 ■ • • 372 1832 ... 384 1833 ... 392 1834 ... 492 1835 ... 474 1836 ... 506 1837 ■ • • 550 1838 ... 520 1839 • • • 592 1840 ... 606 1841 ... 584 1842 . . . 701 1843 ... 687 1844 ... 767 1845 ... 862 1846 ■ • 883 IS47 ' "317 12185 944 1848 170 199 1,027 1849 . . . 1,168 1850 1851 . . . 1,286 1852 . . . 1,405 1*53 ' '10,157 133,203 1,575 1854 17,979 5,595 1,615 1855 14,H5 4,199 1,564 1 Premature births are included in this column from 1804 to 1837 inclusive, and also in the year 1842. From 1861 to 1865 there are no statistics of still-births. 2 See typhus fever. 8 Include cholera, cholera infantum, cholera morbus, diarrhcea, dysentery, entero-colitis, and diarrhoeal enteritis and gastro-enteritis. * Includes diseases of the lungs. 6 The United States or State Census of the population, which is taken every ten years ; the population for the balance of the years is estimated. 6 Spotted fever. 7 The first year that deaths were tabulated from bronchitis. 8 The first year that deaths were tabulated from typhoid fever. 9 Including typhoid, see typhus. 3,368 109 3 125 92 128 3,026 1 1 109 34 97 3,221 18 117 2 94 31 89 4,091 394 100 3 139 116 82 4,774 40 53 10 132 69 228 4,671 58 31 24 154 126 137 4,890 149 172 4 171 61 98 4,843 93 28 11 155 157 131 4,734 16 91 188 171 52 57 5,198 176 22 246 178 97 53 5,99i 224 39 258 203 181 54 9,975 89 290 221 179 63 84 5,354 25 38 179 168 105 62 8,590 233 212 418 198 141 ! 106 6,608 351 82 174 173 172 46 7,503 173 443 202 177 r52 117 8,182 170 238 579 151 63 338 7,533 91 79 257 182 219 104 7,36i 69 133 158 141 "3 97 8i6 7,868 234 185 39i 146 73 95 26 8,53i 220 U3 366 120 67 144 38 8,475 181 60 416 120 191 214 10I2 8,006 119 118 223 162 63 68 33 8,188 20 5i 224 276 163 131 -V 10,122 425 136 63 222 89 175 ' ,02I io,435 141 17 114 190 214 9262 210I5 14,844 53 275 142 271 86! 948 io473 14,892 585 77 93 319 213 1 720 10249 22,605 372 125 266 292 112 | 415 1022I 15,826 241 324 3" 356 l80 i 396 10II2 20,738 586 320 627 462 114 977 ,10i56 20,196 5i6 246 613 595 I87 662 10147 21,127 681 134 454 673 1.58 399 |10i7i 26,953 624 362 517 637 34° 390 110189 21,478 107 383 1,052 538 377 439 172 121 50 30 32 120 84 132 91 55 36 69 80 72 53 47 90 130 56 55 73 76 57 "3 39 53 252 143 153 96 147 172 97 50 55 3,513 971 5,071 57 374 33 2,509 19 319 301 339 299 376 413 555 451 349 389 470 4,180 281 1,617 401 499 548 733 752 683 808 796 648 615 908 1,047 1,981 1,044 I,72i 2,420 8,277 1,413 2,079 1,718 2,759 . . . 2,868 1,842 2,479 2,986 6,302 2,542 2,122 715 624 683 736 843 820 829 906 880 974 1,033 1,415 1,251 i,47i 1,437 t,5i4 1,458 1,225 1,318 1,296 1,470 1,339 r,503 1,438 1,659 1,698 1,926 1,869 2,086 1,928 2,374 2,487 2,739 3,032 2,635 157 166 184 216 328 261 257 231 319 228 385 428 406 535 472 551 635 599 496 557 669 581 597 598 753 573 750 738 955 966 1,315 1,084 1,071 1,297 1,242 772 59 78 84 79 89 90 108 139 170 161 132 254 230 283 290 368 1,281 1,071 1,201 1,608 i,55i 1,756 1,980 1,888 i,99i 2,300 2,640 3,333 2,352 3,872 3,140 3,681 3,908 3,806 3,651 3,926 4,111 4,123 3,828 3,847 4,9" 4,982 6,315 6,717 8,905 7,873 10,505 10,427 11,033 13,623 12,125 130,040 138,879 147,413 156,471 6i66,o86 172,978 180,157 187,634 195,421 203,532 215,381 227,920 241,188 255,230 5270,098 278,275 286,719 295,400 304,353 313,578 324,342 335,475 346,991 '358,902 6371,223 396,686 423,896 452,972 484,043 517,246 538,490 560,607 583,632 607,603 632,559 26.15 38.03 61.97 23.12 35-39 64.61 24.09 37-29 62.71 27.00 39-31 60.69 29.62 32-49 67.51 28.68 37-59 62.41 28.52 40.49 59-51 25-81 38.98 61.02 24.22 42.06 57-94 27.13 44-25 55-75 29.47 44.07 55-93 45.00 33-41 66.59 23-59 43-93 56.07 34-90 45.08 54-92 26.27 47-52 52-48 28.99 49.06 50.94 30.08 47.76 5224 26.78 50-52 49.48 25-99 49.60 50.40 27.01 49.90 50.10 28.04 48.19 51.81 27.29 48.65 51-35 24.96 47.81 52.10 24.77 16.98 53-02 > 27.27 48.52 51.48 TJ 28.77 47-74 52.26 TJ 35-02 42-54 57-46 M 32.88 45.10 54-90 Z 46.70 39-39 60.61 0 30.60 49-75 50-25 >< 38.51 50.66 49-34 36.02 5163 48-37 37-65 52.22 47.78 46.86 50-54 49.46 38.65 56-45 43-55 10 Including the following number of deaths certified as nervous fever: 1804, 27 deaths; 1842, 12; 1845, 21; 1846, 15; 1847, 25; 1848, 26; 1849, 34; 1850, 36; 1851, 31; 1852, 51 ; 1853, 34 ; 1854, 33; 1855, 33- 11 Including nervous fever. 12 First year of registration. 13 From July 1 to December 31. 14 In the year 1795, 714 deaths were reported to have occurred from yellow fever. In 1838, 30 premature births; in 1839, 45; 1840, 50; 1841, 38; 1843, 73; 1844, 141; 1845, 103; 1846, 116; 1847, 114; 1848, 134; 1849, 152; 1850, 183; 1851, 220; 1852, 225; 1853, 355 ; 1854, 435; 1855, 374. Were not added to the deaths or still-births. On x X X X x x x x y x x y x x x x x x x x x : x x x x x x X XS ' — O O XS ONVi 4k Oj M — O ^O XS ONOn 4k Oo . _JC0COCOCOCOCOCOCOCO00 \ On ON On ON ON On ONOn On on on O vO 00S ON Date.—Year ending De- cember 31. OJOJOoOJtOWtOMMMMMtOM 4* n O O Xs ONS On On On Oo Oo On O On On ONS O O Oo O'-n-C' 1 S On S CCS ON C ON4k h^ 001 > 4* \o 00 oum Total Births reported. O ONOo vo vo J>> Oo s 00 QC <- 4k S O On ON M S Ov M 4k 4* On O^no Oj M i-1 J-" J-" J-" O VO QOS ^IM^J 00 OOvO 00S 00 ONS On M M 00 M M 4*. Oo Oo Oo OJ SMS OOVi OOO^ Ov"m b On OJ "bob bwb b\vb "n S S "Ov'tO OOvO M '— vO S ON 4*- i-i i-i O On COS O 4* M M vO ONVO S O 4*- COvO M4>vOOoSSvOv04k O 4* h(^ O ON ONOn ONOn S to 0\0 vo vo On S ch 00 ONOn On ON-P* M Oo On M ONOo m O M O Oo Total Marriages re- ported. K) M M M M O vO vO ON ON4* OJi-"i-i-"MMMG On ON O vO On ON ONvO VO ONVO S ON * > GOS 00 M M ON4k0n On vO OJ Oo OnOj 4k on On s Oo oo VO On On VO 00 w 00 00 ON Total Still-Births re- ported.1 n ) 00 Oo OJ Oo Oo Oo M M M M OJ M M M M M . (0 004*. S S ON 00 O H^^VO-f*. •-• 11 4*- vO S O U hUA hAAvJ 10 OOOj m vO S 4»* S ONOn s vo Oo On OJ On ON4k ^l OC/i ONOn M Total Deaths. ONOJ OvO O M m -EkSVO S ONi- —>£-r " < On M 4k On O 4k s vO On Oo Oo ONVO 4* 4»> 4* OOvO ONVO 00 ON 1- OJ vO Small-Pox. vi ONS S S vO 4* 4k M M hc*i 1-1 00 OJ 4* 4* MOn to 4»* w mm t ON ONOJ ON -< — M S 4k S On ON ON m Q ONQVO M OVOOIA ON*' vi 00 ON (0 ONOJ V0V0 4* MOn N^JVO ^ ' GO ON O VO OJ ONOJ On 00 ONS 1 S vO ONVO M OJ Measles. On Oo On ONS QVO ON4k O vO OOOn OOOvO^IVOvO 00 ON OOOn OOVO VO M VO 00 ONOJ M CCS On O 4* ONN CO Scarlatina. vo ■-" vO 004*. ON4* OOS vo Oo >-i 4k vo On O "-"On ON m on ON ~ vo Oo 00 OOS O OOOn OJ |_ _ N- M m HvJOJ ONM MV vl^IOn OOn MOJ ON Q vO S Oo ON >-i 4k M Oo Oo M M 4* Oi vl VO C^ 4^ 4». ~» Q M 4*. vO S O On On M ONOn 4»> Oo O mnj^UOj GO OOvO On W On vOOnvO O m-^ m 0 vo On m ON0000 COS OOOn 4*. >-" O 4* Oo M Oj i Diphtheria. OOvO OOS ONS OvO0n4*»4k0nS0nS ON4*- 4k4*.OoOJOo4>Svo ON4k On ON4k On On ~* ONOn 4k 4k MOJ m M vO S WOiVOUvj ONM 004*. Oo ON4k On O 00 0N\O M S ONOn OOVi 004*. vo COO MVO MS 004*. M On On > OJ OOvO 4* OOOn O vo M GO O O Croup. « On 4* 4*- OJ ON t > On Oo 4k 4*- 4k 4k M On 4* M OJ M — i-tMlOMtOOJOJMM 0"J vo vo M On OOvi Oj 004*- O O OOONONONOOn m on m ON4k MOn ON ■-• On 4k s 4k OOn On OS 00 ONS S to q ONS VO OOOn On m COS On 4k OOOo S On O^U^J O 00 Whooping-Cough. M M >H ON ON H^OlSj^ | . 4*.OnvJOnOnOCo4*.4^^IO 004*. vO ONOn ONOn »-i M M m OJ 00 ONVO M OJ OOOJ O On M OJ \g vq • O Oo m 4*- O ON O 004*. ON ► Typhus Fever. OJ OJ M Oo 4* OJ 4v i. M M VO COS ON4*- 4* vl 4>> S 004»> "-j VO ONOo M M MOJ M MOO M 4=1. 00 Oo Oo On On ON j 4k VI 004k vj vo ONOo M vj k, 4*. m *sj ON OOOn OnOovion4k4kVO M OOvO vj 4^ 00 -> K» 4=- «h vi ONOJ t-< 4k Oo — — On On Typhoid Fever.2 M(0M4kt-IW (HMI-lMMVI to. -h m Oo ONvi 0 vo m w 4k On vo 004=- Oo 4k Oo Oo *-* O OJ 00 M O OOvJ OWl ONGOO M COM M4k M 00- Cerebro-Spinal Fever. 4k ON • 00 OOvI ON Fevers not specified. Cholera. * 4*> On >h ONVO vj*vi 0 M\0\0 M OOOOn MW H MW Yellow Fever. ONVO vj ►-. onvo vo CO m On M Oo OOOn M 10 H (J H M ' M N H N _ . C0"m VO Oo ON "ON . 00 M "OO 0 OOOn -fk vi ON OOOo O M OOOj Under 5 Years. M O vl vo O vo M OOvj OoMvl4kO 0<-ONM 1-1 ONr-fk -vj *vi QN4k . vi oo O OWO M vi vo On vi 4k ON4k On OOOo OWO vo On On Oo Oo vj coOo Mvi to 00 O0\O vi oo M 4k ONVO 000 OviOntnvj to OOVO vi -^ Oo ON4* vj ON O ONOo — 00 m On On vi to Total, all Ages. 03 m MOO ON4=- Relapsing Fever. OnOnOnOnOnOnOn4s*4^4^4i»4^4k4='4k4^4^4i*OoOoOoOoOoOoOJOoOoOoOoOoM N A h W M K) CJ sJ OJ i O h M O h M « O i) A M ^ OJ ON4k "m "b ^."m O G04k Ovv|\QOov0 4k — Q J*> ON4k vo vi Oo Oo vi OOOo ON — On OOVO w OOvj M OOOo 4k m sj 0 vi ONOn O vj to ONOJ ON4k 4k to4»-4»>4^ ON04k4k ONM4kOnOn OOn ONvO ON4k 00 Phthisis Pulmonalis.4 Oo Oo Oo Oo Oo Oo Oo M M v> b\ p* m 4k 4k m OOOn _ O On 4* On Qvi ONMOn 004*. 4*- O VO vivivovovo M m (04*. "' ^___isl OOvl m to Oo i-i M >-* CO _ .0 On OJ OJ O ONOo OOOOo >-« OOn t0VO4>. O ON 00 00 O 4k ON O 004*. 00 ON »h oo Oo vi ONOo Oo \0 ON OOvl ON4k 4k on '. OJ O O COOo X 00 — On On On Oj * O O O VO 00 00 CO ONOn On4>4kOJ4».OJOoOoOJ M < ON ON4k ONOn vJOvOOnM4kOMMOo»-«4k onvO -> CO* ONOOo OOJ Pneumonia. Bronchitis. v M Onvo On m Oo On vi < 4*. On 00 COvi oo On ON4k s O -vj OvO mvOvI ONOO ONOvj Qvi Qvj O QOONM COmOoVOvI O — 4k 4k OJ OJ Oj vi Oo VQ On « 00 ON ON ON X *Onvj b 6n b ■ ?t& ihi-i ih O O OVOVOVOVO GOCO COvJ vjslsjvjvj OOvj vj ON ON S 4*. O vj 4k Oo 00 ONOn 4k vo On O ON tO 4k ONvi vO msIOJvO ON I 4k »-< ON ONOn On OJ ON Owl vO C ■OnvO M <-"VOOjvO Ovj »-« to , M m — »vl vi >o ONvj m O — M M M M OJ ON — COS vo On i*0 M 4k CD 4^- 00 < i Oo Oj covi vo '■ ) i-i On 000 vO ) On On vo ON 00 . vi vo vo OOvl O Oo On 4k 00 M Total Deaths of Chil- dren under 5 Years of Age. Population—estimated OR enumerated. M M M M ON O\0n On C oo o on bobpONbik '-< onon^oj bo ons m bo < Oo O ONOo 0 i-i 4k m oo OOOn wvOviOo O M "-iv( j OO OO OO OJ M Oo Oo OJ OJ Oo OJ M O On On On vO On ONOo O Death-Rate per iooo In- habitants. .4k4k4k4k4k4k4k4k4k4k4k4k4k4k4k4k4kvO0nC M Oo O ONOn On On On ON 00 00 00 OOvO OOvO i 4k On On On On C On On On On On On On M 4*OJOn vi 00 00 Q fvionvj tovb bobvbvbviooonvion O O OOnvb todnOodn to OA '— M MS C- OnvO vO 4*- O M vj OOOn S 4k On CO ON 00 00 ONvO O OOOn Oo ON m to 4k Oo Oo 004*- CO On0nvi0n0n0n0n0n0n0n0n0n0n0n0n0n0n0n4».4k4k0n4k4k4k4k4k4k4k4k4k4k on ons owo &aa^^ h ^rr ? r ? P0*;4 "^ N ^t4 ^° *^ on <^*fc *° M M OOJ to On 00 ONOn M 4k M S vO On COSS Deaths of Chil- dren under 5 Years of Age. Deaths of Persons 5 Years of Age and over. O K s* ^ 2nog HN:i3ia3I\I TVD31 30 ivnxviM V f£g 1888 36,136 14,533 3,239 40,175 81 59i 1,361 i,9i4 639 573 4 364 173 1889 37,525 14,400 3,349 39,679 1 470 1,242 1,686 605 647 397 145 1890 39.250 14,992 3,315 40,103 2 730 408 1,262 521 487 352 136 1891 46,904 15,764 3,414 43,659 2 663 1,220 1,361 609 352 1 3«4 189 1892 49,447 16,001 3,573 44,329 81 864 977 1.436 670 371 45 400 230 1893 5L529 16,144 3,645 44,486 102 393 55i 1,970 538 542 200 38i 409 1894 55,636 17,388 3,575 41,175 154 5«4 541 2,359 5" 272 326 213 3.051 3,489 3,135 3,648 2,997 3,346 3,191 3,587 3,162 3,499 2,898 3,3io 2,708 3,040 5,260 5,179 5,492 5,160 5,033 5,124 4,658 4,288 4,075 4,989 5,818 5,841 6,487 4,725 1,892 1,314 1,987 1,836 1,754 1,577 1,329 17.360 17,152 16,305 18,224 18,684 17,865 17,558 1,521,805 1,566,181 1,611,851 1,658,853 1,707,226 1,757,009 1,808,244 26.40 25-33 24.88 26.32 25-97 25-32 22.77 43-21 43-23 40.66 41.74 42-15 40.16 42.64 56-79 56-77 59-34 58.26 57-85 59-84 57-36 1 Premature births are included in this column from 1804 to 1837 inclusive, and also in the year 1842. From 1861 to 1865 there are no statistics of still-births. 2 See typhus fever. 8 Include cholera, cholera infantum, cholera morbus, diarrhcea, dysentery, entero-colitis, and diarrhoeal enteritis and gastro-enteritis. * Includes diseases of the lungs. 6 Spotted fever. 6 Malignant sore throat. 1 First year that diphtheria was tabulated. 8 For the nine months ending December 31, 1866. 9 First year that cerebro-spinal fever was tabulated. 10 First four months of the year. 11 Still-births from 1862 to 1865 cannot be ascertained. Influenza caused 7 deaths in 1889, 314 in 1890, 854 in 1891, 495 in 1892, 227 in 1893, 188 in 1894. Deaths from typho-malarial fever ought to be included with typhoid fever, and the following deaths from the former ought to be added to the latter,—viz., 1871, 22; 1872, 22; 1873, 29. Note.—There was no law previous to 1851 that required the registration of deaths of persons buried within the city limits. The figures given for these years are in excess of the registered number of deaths, and indicate that a large number of such deaths were either voluntarily reported or that the Registrar received returns of interments from cemeteries located in the city.- It will therefore be seen that the death-rates given for the years previous to 1851 are below the actual rate. On 656 A MANUAL OF LEGAL MEDICINE DIFFERENTIAL DIAGNOSIS By MR. GEO. A. HUNTLEY, UR/EMIC DIABETIC APOPLECTIC ALCOHOLIC OPIUM BELLADONNA COMA. COMA. COMA. COMA. COMA. COMA, 1. History .... Bright's dis-ease. Diabetes. Apoplexy (usually left Alcoholism (usually side). males). 2. Onset..... Delirium or convul-sions. Slow, with somnolency and great oppression. Sudden. Delirium. Gradual. Dryness of mouth and throat. 3. Inspection, etc. (a) Face .... Waxy. Pale. Pale. Flushed and swollen; con-junctiva con-gested ; tongue nega-tive. Pale. Flushed. (*) Body .... General oedema. Emaciation. Surface of body hot; no loss of se-men. Cold sweat. Skin hot and dry. No signs of in-jury. No oozing from nose or (d) Hemorrhage ears. No true Hemiplegia. No paralysis. paralysis. if) Pupils . . . Regular. Irregular. Dilated. Contracted ; Dilated. insensible to light. (g) Respiration . Stertorous. Rapid, shal- Slow and ster- "Steamboat." Very slow Slow and low. torous. and irregu-lar. deep. 4. Temperature. . Usually Normal. Elevated, spe- Low. Often high. cially on par-alyzed side. raised. 5. Pulse..... Full and Rapid and Weak, small, Full and Slow. Greatly in- strong; not weak. slow. strong. creased. rapid. 6. Odor..... Uriniferous Breath Breath and Breath of alco- Opium in about smells urine smell hol. breath. patient. sweet. sweet. 7. Urine. (a) Chemical . . Albumen and casts. Sugar. Alcohol. Opium. (b) Quantity . . Scanty and retained. Large quan-tities pass-ed involun- Abundant, passed invol-untarily. Retained. Retained. 8. Enteric and tarily. Gastric • • • No diar- Retention of Vomiting rhcea. faeces. common. 9. Convulsions • - Repeated convul- None. None. sions. tO. Condition - - - Coma com- Cannot be Stupor intense Aroused with Coma deep- Coma pre- plete. aroused ; from first. . ammonia or ens gradu- ceded by gradually shaking,lasts ally, noise delirium. deepens. for hours, gradually lessens. may rouse, shaking will not. 11. Treatment . • • Pilocarp. hy- Inhalation Head high; Hypo, of apo- Wash stom- Emetics or podermic ; ofO;intra- reduce arte- morphine; ach ; strong wash out croton oil, venous in- rial pressure; empty stom- coffee, Oi, stomach; TTU; vene- jection of venesection; ach ; cold to injected in inject pilo- section if saline solu- ice-bag to head ; heat to rectum; carpine and stimu- plethoric ; tion; if con- head ; heat to extremities; atropinae sulph. sub- chloroform vulsions, extremities ; sustain heart lants inhalation; opium. purge fol- with strych- cutaneous- subcuta- sustain lowed by nine. ly; artificial neously. heart. alteratives. respiration. N.B.—Remember that feigned. Coma APPENDIX 657 AND TREATMENT OF COMA. UNIVERSITY OF VERMONT. ASPHYXIA. CONGESTIVE COMA (Insolation). EPILEPTIC COMA. HYSTERICAL COMA. SYNCOPE Cerebral anamia). COMA RESULT OF INJURY (Meningeal Hem.). CATALEPSY, Exposure to gas or foul air. Tongue and lips livid and blue. Surface dry and hot. Exposure to heat. Gradual. Flushed. No oedema. Epilepsy. Pale or cya-notic ; froth about mouth; tongue bit-ten. Frequent loss of se-men. Hysteria (usually fe-males). Sudden. Flushed and hot. Sudden. Pale. Surface cold and perspir-ing. Injury; may recover and relapse. Signs of head Hysteria. Conscious-ness sudden-ly lost. Expression-less ; death-like. Skin cold, limbs plastic, remain in any position in which placed. injury. Blood or serous dis-charge com-mon. Both sides may be affected. No true paral-ysis. Contracted. Usually quiet. High. Rapid. Contracted (?). Embarrassed (cedema of the lungs). Low. Weak, small, rapid. Normal. High. Not much affected. No odor to breath. Normal; sensitive to light. No stertor. Weak, but not restricted. Slow and ster-torous. Probably high. Frequent. Weak. 20 or 30 below No odor to breath. Not felt at wrist (heart principally affected). normal. Weak. tains large amount of CO2. Passed invol-untarily. Involuntary diarrhceal discharges. With or with-out slight convulsions. Coma yields readily to treatment. Application of cold to entire body; cold enemata ; stimulants. Follows con-vulsions. Cannot be aroused; short dura-tion. Attention to protection of body from cold or heat; wait for conscious-ness. Inconti-nence. No diar-rhoea ; no vomiting. May end in convulsions. Cannot be aroused. Fresh air; in-halation of O; artificial respiration ; if by CO transfusion of blood is indicated. Coma alter-nates with hysterical delirium. Little need be done; application of cold; Sp. ammo-niae arom. Coma short duration. Lower head; stimulants; smelling salts; cold water to face; auto-transfusion, Gradually in-creasing stupor. Operate early; remove blood-clot and ligate artery if necessary. Attack may be repeated without in-termediate symptoms. Arouse with ammonia ; emetics often cut short an attack; between at-tacks tonics and valerian. often misleads the most practical expert. 42 658 A MANUAL OF LEGAL MEDICINE BIBLIOGRAPHY OF AUTHORITIES. Delafield (Francis) and Prudden (T. Mitchell). Hand-Book of Patho- logical Anatomy and Histology. New York, 1892. Field (George W.). Medico-Legal Guide. New York, 1887. Hamilton (Allan McLane). A System of Legal Medicine. Two volumes. New York, 1894. Lee (John G.). Hand-Book for Coroners. Philadelphia, 1881. Merrill (John Houston). American and English Encyclopaedia of Law. Northport (Long Island), N. Y., 1891. Reese (John J.). Medical Jurisprudence. Philadelphia, 1891. Semple (C. E. Armand). Essentials of Legal Medicine and Toxicology. Phil- adelphia, 1890. Tanner (Thomas Hawkes). Memoranda of Poisons. Philadelphia, 1883. Taylor (Alfred S.). Medical Jurisprudence. Philadelphia, 1856. Tidy (Charles Meymott). Legal Medicine. Three volumes. New York, 1884. Wharton and Stille. Medical Jurisprudence. Philadelphia, 1873. Witthaus (Rudolph A:). Medical Jurisprudence, Forensic Medicine, and Toxicology. Four volumes. New York, 1894. Etc., etc. INDEX A. Abdomen, contusions of, 322. examination of, 180. wounds of, 322. Abdominal organs, proofs of live birth from, 480. Abortion, 439. artificial, 439, 442. criminal, 439, 444. diagnosis of, 448. feigned, 553- late, 443. means employed to procure, 444. natural, 440. signs afforded by the mother, 458. Abortives, 446. Absorption of poison, 12. Abstinence from food, 426. simulated, 562. Accelerators of putrefaction, 166. Accidental death by burns, 343. drowning, 388, 389. gunshot wounds, 335. hanging, 375. starvation, 429. strangulation, 364. suffocation, 349, 350. violence in infants, 487. wounds, 298, 299. Accidents, direct, 392. indirect, 392. Accusations, false, 309. Acetate of lead, 73. Acetic acid, 82. Acid, acetic, 82. arsenous, 55. batrolinic, 90. carbolic, 83. carbonic, 353. hydrochloric, 41. hydrocyanic, 126. muriatic, 41. nitric, 39. nitro-muriatic, 42. of sugar, 80. oxalic, 80. phenic, 83. prussic, 126. Scheele's, 127. sulphuric, 36. Acid, sulphurous, 354. tartaric, 82. Acids, mineral, 42. mixed, 42. Aconite, 123. fatal dose, 124. period, 124. poisoning by, 124. post-mortem appearances, 125. tests, 125. toxicological examination, 125. Action of poisons, modification, 14. Adipocere, 169. Administration of poisons, 11. Affiliation, 578. Age, actual and apparent, 514. deduced from the teeth, 194. determination of, 194. of, in the dead, 211. effects of, on the size of the blood- corpuscles, 244. foetal, 449. of skeleton, 209. Air, influence of, on putrefaction, 166. Alcohol, effect of, on blood-stains, 234. poisoning by, 101. post-mortem appearances, 101. tests, 101. toxicological examination, 102. Alcoholic coma, 656. intoxication, 310. Alkalies, 43. poisoning by, 43. Alkaline salts, 46. Alkaloids, Stas's process for separating, 26. Alleged pregnancy, examination in cases of, 527- Alum, 48. Aluminum sulphate, 48. Amaurosis, feigned, 554. Ameer Ben Ali case, 247. Ammonia, 45. effects of, on the blood, 234. poisoning by, 43. Ammonium carbonate, 44. Ampere, 393. Amputations, simulated, 562. Anaemia, 554. cerebral, 657. feigned, 554. 659 66o Anaesthetics, 102, 284. in rape, 507. Analysis, chemical, 24. Anatto stains, 236. Animal food, noxious, 90. hair, 223-226. heat, 157. irritants, 89. Antagonism of poisons, 15. Ante-mortem wounds, 272. Antimony, 66. black, 66. butter of, 68. chloride of, 68. crude, 66. elimination of, 67. poisoning by, 66, 612, 617. post-mortem appearances, 67. tests, 68. toxicological examination, 68. Antiseptic powers of arsenic, 140. Aphonia, simulated, 562. Apnoea, 153, 154, 345. Apoplectic coma, 656. Apoplexy, feigned, 553. Appendix, 609. Aqua fortis, 39. reginae, 42. Argol, 47. Arsenic, 54. elimination of, 59. fatal dose, 58. poisoning by, 55, 618. post-mortem appearances, 59. sulphides, 65. tests, 62. toxicological examination, 60. Arsenous acid, 55. Arsine, 66. Arterial blood, 256. Arteries, wounds of, 321. Artificial abortion, 442. electricity, 391. inflation of the lungs, 475. respiration, 358, 371, 382. Asiatic cholera mistaken for poisoning, 18. Asphyxia, 153, 345, 657. from cesspools, 355. from charcoal vapors, 351. from illuminating gases, 353. from natural gases, 353. from privies, 355. varieties of, 345. Asthenia, 153. Asthenics, 126. Asthma, feigned, 554. Atelectasis of lungs, 473. Atropine, 113, 135. fatal dose, 114. period, 114. poisoning by, 113. post-mortem appearances, 114. tests, 115. toxicological examination, 115. INDEX Attendant, contributory negligence of, 535- Aub, Barbara, case, 509. Authorities, quoting of, in court, 149. Autopsies, medico-legal, 171. B. Baby-farming, 430. Back, injuries of, 540. Ball, apertures made by a, 326. deflection of a, 335. Ballottement in pregnancy, 434. Barium salts, 48. Bast fibres, identification of, 222. Batrolinic acid, 90. Bean, Calabar, poisoning by, 125. Belladonna, 113. coma, 656. poisoning by, 113. Benoit case, 227. Bertillon's identification system, 199. Bichloride of mercury, 69. Bichromate of patassium, 79. Binoxalate of potassium, 82. Birth, concealment of, 496. live, 469, 481. in civil cases, 574. proofs of, 472, 478, 480. still, 471. Bismuth, 76. poisoning by, 76. Bizzozero plaques, 229. Black hellebore, 86. Bladder, calculi in, feigned, 554. wounds of, 324. Blagden, the "fire-king," 420. Bleaching salts, 48. Blindness, feigned, 554. Blood, adult, 257. arterial, 256. coagulation of, 231. -corpuscle, effects of age on size of, 244. -corpuscles, 230, 239, 244, 248, 252. size of, 239. drying of, 233. effects of reagents upon the, 234. effusion of, from a blow, 310. extravasation of, from a blow, 310. from child, 257. from dead subject, 256. from female, 257. from living subject, 256. human and animal, 229. male, 257. menstrual, 256. quantity of, in the body, 245. -spatters, 233. direction of, 233. form of, 233. upon weapons, 292. Blood-stains, arterial, 256. evidence from, 272. INDEX 661 Blood-stains, examination of, 229 245 identifying, 236. measurements of old, 253. menstrual, 256. microscopic test for, 238. suspected, 235. venous, 256. Bloody urine, 564. Blows and falls, injuries from, 269. Blue vitriol, 74. Bocarme- case, 634. Body, embalming of dead, 172. examination of dead, 174, 176. exhumation of dead, 30. frozen dead, 172. identification of dead, 205. inspection of dead, 30. pallor of dead, 157. position of dead, 173, 272, 289. putrefaction of, in water, 167. resistance of, to currents, 393. spontaneous combustion of the human, 343. time required to burn a dead, 345. Boiling oil, burns from, 339. Bones, age of, 209. animal and human, 211. buried, 217. identification of, 211, 217. individual, 220. Borden case, 171. Born alive, definition of, 470. Boys, rape by, 507. Brain, compression of, 313. concussion of, 309, 313. injuries of, 306, 308, 309, 312. wounds of, 313. Bravo case, 612. Brazil-wood stains, 236. Breslau's test, 480. Bromine, 54. Brooklyn bridge crush, 345. jumping from, 389. Brucine, poisoning by, 113. tests, 113. toxicological examination, 113. Bruise, 161. Brunswick green, 65. Buchanan case, 28, 30, 99, 136, 399, 402, 413, 623. Bullet-wounds, 326. Bullets, deflection of, 335. Buoyancy of body, 388. of lungs, 474. Burial, manner of, 166. premature, 155. Burn, presence of more than one, 341- Burning of dead body, time required for, 343. Burns, 338, 639. accidental death by, 343. after death, 341. before death, 341. by electricity, 392, 394. by heat, 339. Burns by hydrochloric acid, 339. by nitric acid, 339. by phosphorus, 339. by sulphuric acid, 339. causes of death from, 342. danger of, 340. death from, 341, 342, 399. homicidal death from, 343. post-mortem appearances in death from, 342. suicidal death by, 343. Burnt body, identification of, 210. wounds upon the, 343. Butter of antimony, 68. C. Cadaveric alkaloids, 133. lividity, 160. rigidity, 159, 637. spasm, 160. Caesar case, 207. Calabar bean, 125. Calculi in bladder, simulation of, 554. Callus of bone, 269. Caloricity, post-mortem, 158. Camera lucida in blood-examinations, 249. Cancer, feigned, 554. Cantharides, 89. Carbolic acid, 83. fatal dose, 83. period, 83. poisoning by, 83. post-mortem appearances, 83. tests, 84. toxicological examination, 84. Carbonic acid, 353. oxide, 353, 354. Cases, illustrative, 611. Castor-oil beans, 85. Catalepsy, 657. feigned, 554. Caustic potash, 44. soda, 44. Cerebro-spinal neurotics, 113. Cesspools, asphyxia from, 355. Chabert, the "fire-king," 420. Chancery, examination in cases of, 529. Changes wrought through the effects of disease, 195. Characters of cicatrices, 306. Charcoal-vapors, asphyxiation by, 351. Cheese, poisoning by, 90. Chemical analysis, evidence from, 24. decomposition, 12. examination, 173. Cherry-laurel water, 130. Chest, examination of, 219. of, in infanticide, 493. penetrating wounds of, 318. Child, blood from, 257. examination of, after death, 498. legitimate, 573. 662 IN Child murder, 468. rape on, 505. simulation of disease by, 567. Chloral hydrate, 104. extraction of, from stomach, 105. poisoning by, 104. post-mortem appearances, 105. Chlorate of potassium, 47. Chloride of antimony, 59. Chlorinated potassa and soda, 48. Chlorine, 54. Chloroform, 103. poisoning by, 103. post-mortem appearances, 103. tests, 104. toxicological examination, 104. Choline, 139. Chorea, feigned, 555. Chromate test, no. Chromium, 79. mode of extraction, 79. poisoning by, 79. post-mortem appearances, 79. tests, 79. Chronic starvation, 429. Cicatrices, 207. characters of, 306. identification from, 207, 303. Cicatrix as a result of disease, 305. as a result of a wound, 304. removal of, by artificial means, 305. of, by time, 305. Cicatrization of wounds, 303. Circulatory apparatus, proofs of live birth from, 478. Circumstantial evidence, 28, 289. Civil cases, live birth in, 574. Classification of burns, 338. of poisons, 32. of wounds, 264. Cloquet's needle-test, 156. Clothing, examination of, 271. position of, 272. Coagulation of blood, 231. circumstances favoring, 231. retarding, 231. Cocaine, 117. fatal dose, 117. period, 117. poisoning by, 117. post-mortem appearances, 118. tests, 118. toxicological examination, 118. Cocculus indicus, 132. Cochineal stains, 236. Coir fibres, identification of, 223. Coitus, conditions showing it to have taken place, 508. Colchicine, 138. Colchicum, 85. Cold, 419, 640. death by, 419. effects of, 422. infanticide by, 490. Cold, post-mortem appearances of death by, 424. Coldness of body in death, 157. Color of hair, 227. Colton poisoning case, 611. Coma, 18, 153. alcoholic, 656. apoplectic, 656. as a result of injury, 657. belladonnae, 656. congestive, 657. diabetic, 656. epileptic, 657. hysterical, 657. opium, 656. uraemic, 656. Combustion, spontaneous, of the human body, 343. . Comminuted fractures, 268. Common phosphorus, 49. Compensation of experts, 150. Complete fractures, 268. Complicated fractures, 268. Complicating conditions of gunshot wounds, 338. Composition of blood, 229. Compound fractures, 268. Compression of brain, 313. of umbilical cord, 486. Concealment of birth, 495. of delivery, 496. of facts, 585. of pregnancy, 430. Conception, date of, 436. Conclusions relative to blood, 257. Concussion, 268, 380. of brain, 309, 313. Conditions, simulated, 562. Congenital malformations, 486. Congestive coma, 657. Coniine, 135. Conium, 122. fatal dose, 122. period, 122. poisoning by, 122. post-mortem appearances, 122. tests, 122. toxicological examination, 122. Consumption, feigned, 555. Contre-coup fracture of skull, 308. Contributory negligence, 535. Contused wounds, 267, 273. of the head, 307. on the dead body, 273. on the living body, 273. Contusions, 267. of the abdomen, 322. of the abdominal viscera, 322. of the head, 307. of the neck, 316. on the dead body, 273. on the living body, 273. Convulsions, feigned, 555. Cooling of body, post-mortem, 157, 158. Copper, 73. INDI Copper, poisoning by, 73. post-mortem appearances, 74. tests, 74. toxicological examination, 74. Cord, mark of, in hanging, 356, 359, 370, . 374- in strangulation, 356, 362, 374. umbilical, 451, 479, 485, 486. Coroner, power and duties of, 145. Coroner's court, 146. inquisition, 146. Corpuscles, human blood-, 230. measurements of, 248, 252. Corrosion distinguished from ulceration, 12. Corrosives, 16. Cotto electrocution case, 413. Cotton fibres, 222. Count Bocarme' case, 634. Coup de soleil, 421. Court, criminal, 148. Courtesy, tenancy by, 189, 575. Cowbane, 123. Cow-hair, identification of, 223. Cramer, Jennie, case, 386, 618. Cranium, fracture of, 307, 487. Cream of tartar, 47. Criminal abortion, 439. lesions in, 453. court, 148. liability, 538. violence in infants, 487. Criminals, identification of, 199. Crocus sativus, 447. Cronin case, 217, 259. Cross-examination, 150. Croton oil, poisoning by, 84. Crying, evidence from, 471. Cupric aceto-arsenite, 65. arsenite, 65. Curarine, 138. Currents, electric, resistance of the body to, 393- faradic, 392. Cutaneous eruptions, feigned, 555. Cuts and stabs, 264, 266. Cyanide of mercury, 129. of potassium, 129. Cytisine, 133. Cytisus laburnum, 133. D. Damages, 536. Date of conception, 436. Datura stramonium, 116. Daturine, 116. Dead, delivery in the, 498. determination of age in the, 211. of race in the, 214. of sex in the, 213. of stature in the, 216. pregnancy in the, 438. rape on the, 507. signs of delivery in the, 498. iX 663 Dead body, blood from the, 256. contused wounds on a, 273. examination of a, 220. identification of the, 205. incised wounds on a, 273. lacerated wounds on a, 274. legal status of the, 641. marks of violence on the, 273, 274, 483- penetrating wounds on a, 274. punctured wounds on a, 274. Deafness, simulated, 562. Death, 563. accidental, by burning, 343. burns before, 341. after, 341. by drowning, 381. by electric shock, 399, 400. by hanging, proof of, 374. by lightning, medico-legal relations of, 418. post-mortem appearances, 417. by strangulation, proof of, 362. by violence in infants, 483. cause of, 155. of, by lightning, 415. of, from burns, 342. of, from wounds, 275. evidence of, by suffocation, 348. examination of the child after, 498. following slight injuries, 282. fractures produced before, 270. produced after, 270. from cold, 419. from debility, 484. from heat, 419. from latent disease, 279. from natural causes, 279. in infants, 483. from starvation, 426, 429. post-mortem signs of, 429. from wounds, 279. after long periods, 282. gunshot wounds before, 327. after, 327. hair growing after, 228. homicidal, by burns, 343. in new-born, 468. indirect or secondary causes of, 282. injuries before, 389. after, 389. length of time elapsed since, 170. modes of, 153. penalty, 396. period of the occurrence of, from burns, 343. phenomena and signs of, 152. presumption of, and survivorship, 187. rape after, 520. signs of, 155. simulated, 563. suicidal, by burns, 343. time elapsed since, 155. varieties of, 153. 664 INDEX Death, wounds inflicted before, 272, 637. after, 272, 637. Decayed meat, poisoning by, 91. Declarations of dying person, 151, 463, 464. Decomposition, chemical, 12. Definition of a poison, n. Deflection of bullet, 335. Defloration, signs of, 502. Deformities, 191, 562, 579. De la Pomerais case, 633. Delfine electrocution, 413. Deliriants, 113. Delirium tremens, 284. feigned, 563. Delivery, concealed, 496. feigned, 498. premature, 573. pretended, 563. signs of, in the dead, 498. of, in the living, 495. unconscious, 497. Depressants, 119. Determination of age, 194. Development of foetus, 449. Diabetic coma, 656. Diaphragm after and before respiration, 472. position of, 472. rupture of, 321. wounds of, 321. Diarrhoea, feigned, 556. Diffusion of poison, 12. Digitalin, 130. poisoning by, 633. Digitalis, 130. fatal dose, 131. period, 131. poisoning by, 130. post-mortem appearances, 131. tests, 131. toxicological examination, 131. Digitoxin, 130. Direct accidents, 392. Direction of blood-spatters, 233. of wounds, 288. Disease, changes wrought through the effects of, 195. cicatrix as a result of, 305. death from latent, 279. feigned, 552. influence of, in poisoning, 14. of, on blood-corpuscles, 245. maternal, 484. of the ear, feigned, 557. of the eye, feigned, 557. of the foetus, 483. of the heart, feigned, 558. simulated, 552. simulating poisoning, 15, 17, 33. simulation of, by children, 567. venereal, 560. Diseased meat, poisoning by, 91. Dislocations, 271. Disposal of viscera, 31. Dissection wounds, 184. Docimasia circulationis, 477. pulmonum, 474. Douches, vaginal, 454. Douglass peerage case, 579. Dragendorff's test, 126. Dress, examination of the, 172, 272. Dropsy, feigned, 556. Drop-wrist in lead-poisoning, 71. Drowning, 379. accidental, 388, 389. death by, 381. external signs of, 385. homicidal, 388, 389. infanticide by, 489. internal signs of, 385. suicidal, 388, 389, 390. Drugs, examination of, 460. Druse case, 640. Drying of blood, 233. Ductus arteriosus, 478. venosus, 478. Dulcamara, effects of, 116. Duodenum, examination of, 182. Duration of pregnancy, 436. Dust, arsenical, 56. Duties of examiner in criminal abortion, 455- in poison cases, 29. Dying declarations, 151, 464. Dysentery, feigned, 556. Dyspepsia, feigned, 556. Dyspnoea, 563. E. Ear, diseases of the, feigned, 557. Earthy salts, 46. Ecbolics, 446. Ecchymosis, 267. post-mortem, 161. vital, 161. Effects of cold, 422. of extreme heat on the body, 420. of poison, 12. Effusion of blood, date of, 313. of blood due to disease, 311. of blood due to violence, 311. of blood from a blow, 310. Elaterium, 85. Electric shock, resuscitation from, 396, 397,.3?8> 399- . , Electricity, artificial, 391. burns from, 392, 394. death by, 399, 400. frictional, 392. mechanical, 391. medico-legal aspect of, 390. static, 392. symptoms of powerful discharges of, 394, 395, 396. Electrocution, 402. Elimination of poisons, 13. Embalming, 140, 172. Embryo, 449. INDEX Emerald green, poisoning by, 65 Emetic, tartar, poisoning by, 66, 613, 617, Emphysema of the lungs, 118 476 Epilepsy, 18, 109. *>>*i- feigned, 556. Epileptic coma, 657. Epileptics, rape on, 508. Epsom salts, 446. Ergot, 446. Ergotin, 446. Errors in judgment, 534. Eruptions, cutaneous, feigned, 555. Erysipelas following wounds, 283. Erythroxylon, 117. Eserine, 125. Essence of mirbane, 130. Essential oil of almonds, 130. Ether, 102. death from, 102. post-mortem appearances, 102. tests, 102. Ethyl bromide, 105. Ethylendiamine, 139. Ethylidenediamine, 139. Evidence, 149. circumstantial, in poison cases, 28. from blood-stains, 272, 294. from chemical analysis, 24. from circumstances, 289. from experiments on living animals, 27. from post-mortem appearances, 21. from projectile, 327. from symptoms, 16. from weapon, 327. in malpractice cases, 464, 536. in poisoning cases, 15. in the dead subject, 20. medical, 149. microscopic, in rape, 509. of death by suffocation, 348. Examination in alleged pregnancy, 527. before the clothes are removed, 174. chemical, 173. external, of the body, 174. in cases of chancery, 529. in chief, 149. in hanging cases, 377. in rape cases, 517. in strangulation cases, 377. internal, of the body, 176. medical, 592. microscopic, 173. of abdomen, 180. of blood-stains, 229. method of, 245. of children after death, 498. of clothing, 271. of dead body, 220. of individual bones, 220. of injuries, 271. of instruments and drugs, 460. of milk, 496. 665 Examination of plaintiff in actions for per- sonal injuries, 530. of skeleton, 220. of substances expelled from uterus, 460. of the living, 527. of wounds, 271. post-mortem, in cases of infanticide, 491. toxicological, 37. Exhumation of the dead body, 30. Expectation of life, 585. Experiments on animals, 27. Expert witness, 150. Experts, medical, 150. Exposure, death from, 490. infanticide by, 490. Extent of wound, 286. Extravasation of blood from blow, 310. Extremities, examination of, 220. wounds of the, 325. Eye, changes in the, 156. feigned diseases of the, 557. Face, wounds of the, 314. Facies tetanica, 18. Factitious wounds, 561. Facts, concealment of, 585. Falls, fractures produced by accidental, 269. False accusations, 509. Family likeness, evidence from, 579. Farace case, 95. Faradic currents, 392. Fast of Stratton, 426. Fasting, continued, 426. Fasting girl, Welsh, 428. Fat in the abdominal wall, 434. Fatality of wounds, 263. Features, evidence from, 578. Fecundation, 568. Fees, medical, claim for, 150. Feigned delivery, 498. diseases, 552. poisoning, 17. Female, blood from, 257. genitals, examination of, 182, 432. wounds of, 325. procreative power in the, 525. rape on, after puberty, 501. Fenning case, 611. Ferric chloride, 77. Fevers, simulated, 557. Fibres, 194, 221. upon weapons, 293. Fibrin ferment, 231. Fibrinogen, 231. Fibrinoplastin, 231. Fictitious wounds, 561. Filiation cases, inspection of child in, 529. Finger and foot impressions, 201. -nails, evidence from, 296. 666 INDEX Fire, injuries caused by, 338. Fire-arms, examination of, 327. Fish, poisonous, 90. Fistula in ano, simulated, 557. Fitzpatrick-Smith case, 319. Flesh, diseased, 90, 91. Fly-powders, 55. Fcetal causes of abortion, 442. heart-sounds, 435. shock, 435. Foeticide, 439. Foetus, age of, 449. character of, 449. circulation in the, 449, 478. development of the, 449. diseases of the, 483. mummification of the, 471. Foglia case, 335. Foods, poisonous, 90. Fool's parsley, 123. Footprints, value of, 201, 203. Ford case, 248. Foreign bodies in wounds, 297. Forensic medicine, 145. toxicology, n. Form of blood-spatters, 233. Fossa navicularis, 501. Fourchette, 501. Fowler's solution, 65. Foxglove, poisoning by, 130. Fracture, how long did deceased live after, 270. of the base of skull, 307. of the ribs, 318. of the skull, 307. of the sternum, 318. of the vault of skull, 307. Fractures, 175, 268. identity from, 192. in the new-born, 487, 491. produced after death, 270. before death, 270. by a blow, 269. by accidental fall, 269. Francois case, 367. Fraud, rape by, 516. French law of survivorship, 189. " Frenchy" case, 247, 296. Frictional electricity, 392. Fright and shock, 545. Frozen body, 172. lungs, 476. Fruit-juice, red stains, 236. Fungi, poisonous, 88. Funic souffle, 435. G. Gage case, 314. Gait peculiarities, identity from, 204. Gall-bladder, rupture of, 323. Gallic acid, effect of, on blood, 234. Galls, effects of, on blood, 234. Galvanic test, no. Gangrene, 283. Garden nightshade, poisoning by, 113. Gardner peerage case, 372. Garrote, 356. Garroting, 316. Gas suffocation, 351. Gaseous poisoning, 351. Gases, asphyxia from illuminating, 353. from natural, 353. from cesspools and privies, 355. putrefactive, 475. Gastro-enteritis, 18. Gelatinized perforation of stomach, 21. Gelsemine, 86. Gelseminic acid, 87. Gelsemium, fatal dose, 88. period, 88. poisoning by, 88. tests, 88. toxicological examination, 88. Genital organs, examination of female, 182, 432. wounds of female, 325, 432. Gestation, legal decisions, 575. normal period of, 568. ordinary, 568. protracted, 568. Globin, 232. Globules, red blood, diameters of, 239. Gonorrhoea, feigned, 560. Gossypium, 448. Gout, feigned, 560. Grand jury, the, 149. Grandeau's test, 131. Gratuitous services, 534. Graves case, 612. Grease-stains mistaken for blood, 235. Green hellebore, 87. Guaiacum, effects of, on blood, 234. test for blood, 238. Guerre case, 191. Gunpowder wounds, 336. Guns, evidence of recent discharge of, 328. Gunshot wounds, 326. accidental, 335. after death, 327. before death, 327. complicating conditions of, 338. danger of, 327. homicidal, 335. suicidal, 335. Gurney case, 203. H. Habit, influence of, in poisoning, 14. Haematemesis, feigned, 556. Haematin, 232. Haematoidin, 233. Haemin test, 237, 262. Haemoglobin, 232. Haemoptysis, 557. Hair, color of, 227. diameters of, 223. effects of reagents on, 225. INDI Hair from female, 226. from male, 226. growing after death, 228. human, 225. location of, 226. upon weapons, 292. Hairs, 194, 221. animal, 223, 226, 292. Halke case, 639. Hamilton electrocution case, 413. Hampton electrocution case, 402, 413. Handwriting, 195. Hanging, accidental, 375. death by, 367. examination in cases of, 377. external appearances in cases of, 378. homicidal, 375, 376. incomplete, 367, 370. infanticide by, 491. internal appearances in cases of, 378. post-mortem appearances in cases of, 37i- proof of death by, 374. suicidal, 375. Hanson case, 289. Harris, Carlyle, case, 28, 44, 413, 628. Hartshorn, poisoning by, 44. Head, contused wounds of the, 307. contusions of the, 307. examination of the, 176, 214. incised wounds of the, 306. lacerated wounds of the, 307. of new-born child, 492. punctured wounds of the, 307. wounds of the, 306. Headache, 547. Healing of wounds, 265. Hearing, limits of, 198. Heart, diseases of the, feigned, 558. examination of the, 179. rupture of the, 320. size of the, 186. weight of the, 186. wounds of the, 319. Heart-beats, absence of, 155. Heat and cold, death by, 419, 640. effects of, on blood, 234. extreme, effects of, on the body, 420. Hegar's sign of pregnancy, 434. Hellebores, poisoning by, 86, 87. Heloise case, 217. Hemlock, poisoning by, 122. water, 123. water dropwort, 123. Hemorrhage from umbilical cord, 485. from wounds, 275. meningeal, 657. Hemorrhages, feigned, 557. Hemorrhoids, feigned, 558. Hemp fibres, identification of, 222. Henbane, poisoning by, 116. Hepatitis, simulated, 558. Hernia, feigned, 558. of the lung, 318. Herschel, case of Sir William, 201. iX 667 Higgins's test, 447. Holly, 133. Holmes-Pitezel case, 634. Homicidal death by burns, 343. drowning, 388, 389. gunshot wounds, 335. hanging, 375, 376. starvation, 429. strangulation, 364, 365. suffocation, 349, 351. wounds, 285, 299. Hood electrocution case, 413. Horehound, 446. Horse-hairs, identification of, 224. How long have bones been buried? 217. Human blood, 229. bones, identification of, 211. hair, 225. Hydatids, uterine, 260. Hydrate of chloral, 105. Hydrocele, feigned, 558. Hydrocephalus, 556. Hydrochloric acid, 41. gas, 355. Hydrocyanic acid, chemical analysis of, 128. fatal dose, 127. period, 127. poisoning by, 126. post-mortem lesions, 128. toxicological examination, 129. Hydrophobia, feigned, 558. Hydrostatic test, 472. Hymen, evidence from, 502. Hyoscyamus, poisoning by, 116. Hypnotism in rape, 516. Hypothetical questions, 536. Hysteria, feigned, 558. traumatic, 548. Hysterical coma, 657. I. Identification of criminals, 199. of hair, 221, 222, 292. record, 200. Identity of blood-stains, 236. of burnt remains, 210. of human bones, 211. of mutilated remains, 637. of the dead, 205, 634, 635. of the living, 191. of vomited matters, 31. personal, 191, 637. Idiosyncrasy in poisoning, 14. Idiots, rape on, 508. Illuminating gases, asphyxia from, 353. Illustrative cases, 611. Imbibition, post-mortem, of poisons, 28. Immaturity of fcetus, 451. Impotence, 522. in man, 522. in woman, 525. Impressions, finger, 201. foot, 201. 668 INDEX Imputed wounds, 298, 561. Incised wounds, 264, 272, 306. in the dead, 273. in the living, 272. of the head, 306. Indian tobacco, 121. Indigo sulphate, 42. Indirect accidents, 392. causes of death from wounds, 282. Infanticide. 468, 489, 495, 640. by drowning, 489. by exposure, 490. by hanging, 491. by injuries, 490. by poisoning, 491. by starvation, 490. by strangulation, 488. by wounds, 490. post-mortem examination in, 491. proofs of live birth in, 472. signs of delivery in, 495. viability of child in cases of, 483. Infants, action of opium on, 93. death by violence in, 483. from natural causes in, 483. rape on, 504, 505. Inflation of lungs, artificial, 475. Inheritance, 568. Injuries after death, 389. before death, 389. coma as a result of, 657. death from mechanical, 277. due to lightning, 417. examination of, 271. of plaintiff in actions for personal, 53Q- in the new-born, 490. malingering of railway, 564. medico-legal aspect of railway, 549. railway, 539. sand-bag, 313. slight, death following, 282. slung-shot, 313. to the back, 540. to the cord, 316. to the nose, 315. to the spine, 316. Inks, 195. Inquests, coroner's, 146. Insensibility, 157. Insolation, 421, 657. Inspection of the body, 21, 30, 173, 218. of the child in filiation cases, 529. trial by, 527. Instruments, examination of, 460. Insurance, life, 581. and intemperance, 587. and suicide, 592. policy, 582. Intemperance and life insurance, 587. Intention, 462. Internal lividities, 161. Intestines, proofs of live birth from, 480. rupture of, 322. wounds of, 322. Intoxication and concussion, 310. Iodine, poisoning by, 52. post-mortem appearances, 53. tests, 53. toxicological examination, 53. Iron, 77. mode of extraction, 76. mould mistaken for blood-stains, 236. poisoning by, 77. post-mortem appearances, 77. rust mistaken for blood-stains, 236. tests, 78. Irritability, muscular, 156. Irritant poisons, 17, 32, 34, 36. disease resembling, 33. Irritants, animal, 89. specific, 49. vegetable, 80. Irritation, 12. Isoamylamine, 139, J. Jacobi case, 265. Jacquemin's test of pregnancy, 433. Jamestown weed, 116. Jaundice, feigned, 559. Johnson electrocution case, 403, 409, 413. Judgment, errors in, 534. Jugigo electrocution case, 400, 413. Jumping from Brooklyn bridge, 389. Juniper, 447. Jurisprudence, pharmaceutical, 593. Jury, coroner's, 146. grand, 149. of matrons, 431. petit, 149. Jute fibres, identification of, 222. K Kemmler electrocution case, 402,404,405, 407, 410, 412, 413. Kidneys, examination of, 181. rupture of, 324. weight of, 186. Kiestein in urine, 434. Kino mistaken for blood-stains, 236. Labia majora, 501. minora, 501. Labor, premature, 573. protracted, 484. Laborde's method of tongue-traction, 384. Laburnum, 133. Lacerated wounds, 268, 274. in the dead, 274. in the living, 274. of the head, 307. Laceration of the abdominal viscera, 322. Lafon's test, 131. Lamont case, 366. INDI Lane case, 638. Larynx, examination of, 180. Late abortion, 443. pregnancy, 438. Latent diseases, death from, 279. Laudanum, 93. 1 Laws regarding abortion, 462. relative to legitimacy, 575. Leach electrocution case, 413. Lead acetate, 73. chromate, 73. excretion of, 72. -poisoning, 71. sugar of, 73. tests, 73. Leading questions, 149. Legal status of the dead body, 641. Legitimacy, 568. laws relative to, 575. Legitimate child, 573. Lemon stains, 236. Length of time elapsed since death, 170. Lesions in criminal abortion, 453. Leucorrhoea, 432, 453, 506. Levant nut, 132. Levy rape case, 516. Liability, criminal, 538. of partners in medicine, 536. License of counsel, 145. Ljebig's test, 128. Life, expectation of, 585. insurance, 581. and intemperance, 587. and suicide, 592. policy, 582. Ligatures, 359, 362, 364, 374. Lightning, 413. cause of death by, 415. injuries due to, 417. medico-legal relations in death by, 418. post-mortem appearances in death by, 417. Lignum vitae, 446. Ligustrum vulgare, 133. Likeness, parental, 578. Lime, oxalate of, 82. Limits of hearing, 198. of sight, 198. Lineae albicantes, 496. Linen fibres, identification of, 222. Liquor sanguinis, 230. Live birth, 469, 481. in civil cases, 574. proofs of, 472. child, survival of, 481. Liver, examination of, 183. length of, 186. rupture of, 323. weight of, 186. wounds of, 323. Lividities, internal, 161. Lividity, cadaveric, 160. Living, contused wounds in the, 273. identity of the, 191. EX 669 Living, incised wounds in the, 272. lacerated wounds in the, 274. medical examination of the, 527. penetrating wounds in the, 274. punctured wounds in the, 274. subject, blood from, 256. Lobelia, 121. . Location of hair, 226. Lock-jaw, death from, 283, 441, 453. Locomotion after severe wounds, 321. Logwood solution mistaken for blood, 236. Loppy electrocution, 413. Lumbago, feigned, 564. Lumbar sprain, simple, 541. Lumbo-sacral sprain, 543. Lunar caustic, 78. Lungs after respiration, 472. artificial inflation of the, 475. before respiration, 472. emphysema of, 476. examination of, in new-born, 472. specific gravity of, 473. weight of the, 186. wounds of the, 318. Luxation of neck, 491. Luxations, 271. M. Maceration of fcetus, 470. Madder mistaken for blood-stains, 236. Magistery of bismuth, 76. Male, blood from, 257. Malformations, congenital, 486. Malingering of railway injuries, 564. Malloy case, 561. Malpractice cases, evidence in, 536. ignorant, 533. medical, 532. surgical, 532. wilful, 532. Mammae, enlargement of, 431, 433, 502. Man, impotence in, 522. procreative power in, 524. sterility in, 524. Marks, blood-, 233, 235. peculiar, 192. tattoo, 206. Marsh's test, 64. Maternal causes of abortion, 441. diseases, 484. Maternity, early, 437. Matrons, jury of, 431. Maturity of new-born, 452. McElvaney electrocution, 413. McGuire electrocution, 413. Means employed to procure abortion, 444. Measurement of old blood-stains, 253. of red blood-corpuscles, 248, 252. Meat, poisoned, 91. putrid, 91. Mechanical electricity, 391. injury, death from, 277. 670 IN Mechanical injury to organs, 277. Meconic acid, 92. Meconine, 92. Meconium, 481. stains of, 481. Medical electricity, 449. evidence, 149. examination, 592. of the living, 527. experts, 150. malpractice, 632. secrets, 149. Medicine, forensic, 145. liability of partners in, 536. Medico-legal aspect of electricity, 390. of railway injuries, 549. autopsies, 171. bearing in abortion cases, 462. consideration of wounds, 263. questions, 225. in poison cases, 29. relations of death by lightning, 418. reports, 185. in poison cases, 32. Meningeal hemorrhage, 657. Meningitis, acute traumatic, 545. Menorrhagia, 453. Menstrual blood, 256. Menstruation, blood of, 256. feigned, 563. suppression of, 431. Mentchiko case, 165. Mentha pulegium, 448. Mercury, 69. chloride, 69. cyanide, 69. poisoning by, 69. post-mortem appearances, 69. tests, 70. toxicological examination, 70. Methods for resuscitation from electric shock, 396. Methylene bichloride, 105. Methylguanidine, 139. Meyer, Dr., case, 57, 621. Microscopic evidence in blood-stains, 238, 244, 245. examination, 173. in rape, 509. test, 238. Middle-ear test, Wreden's, 495. Milk, detection of, in stomach, 481. examination of the, 496. teeth, 194. Mineral acids, 42. common effect of the, 32. poisoning by the, 36. Mirbane, essence of, 130. Miscarriage, 439. Miscellaneous matters, 640. Mixed acids, 42. Molecular death, 152. Monsters, 486, 579. Montgomery, glands of, 433. Morphine, poisoning by, 92, 136, 623, 628. Mortal wounds, 263, 277. Mortality of wounds, 263, 275, 277. table, 652. Miiller's menstruum, 246. Multiple fractures, 268. wounds, 277, 286, 287, 299. Mummification, 170. of the fcetus, 471. Murder trials, stomach test in, 640. Muriatic acid, 41. Muscular irritability after death, 152. Mushrooms, poisoning by, 88. post-mortem appearances, 88. Mussels, poisoning by, 90. Mutilated bodies, identity of, 207, 220. remains, identity of, 637. Mydaleine, 138. Mydatoxine, 139. Mytilotoxine, 90. N. Naevi, identification by, 193. Nails, post-mortem growth of, 228. Narceine, 92. Narcotics, 92. rape under influence of, 507. Narcotine, 92. Natural abortion, 440. causes, death from, 279, 483. gas, 353- asphyxia from, 353. illuminating gas, 354. Nature of wounds, 286. Neck, contusion of the, 316. examination of, 218. marks on, r74. wounds of, 315. Needle test, Cloquet's, 156. Needles and pins, swallowing of, n. Negligence, contributory, 535. Nervous shock, 545. Neurasthenia, 548. Neurine, 138. Neurotic poisons, 33, 35, 92. diseases resembling, 33. Neurotics, cerebral, 92. cerebro-spinal, 113. spinal, 106. New-born, accidental or criminal violence in the, 487. cold in the 490. drowning in the, 489. exposure in the, 490. fractures in the, 487, 491. hanging in the, 491. injuries in the, 490. poisoning in the, 491. post-mortem examination in the, 491, 498. starvation in the, 490. suffocation in the, 487. wounds in the, 490. INDEX 671 cor- of, New York's statutory provisions for oners, 148. Nicotine n9) 134, I37. fatal dose, 120. period, 120. -poisoning, 134. post-mortem appearances, 120. resistance to putrefaction of, 120. tests, 120. toxicological examination, 120. Nitrate of potassium, 46. of silver, 78. Nitre, death from, 46. Nitric acid, 39. effects of, on blood, 234. Nitro-benzole, 130. -muriatic acid, 42. -sulphuric acid, 42. Nitrous acid gas, 355. oxide, 105. Noma pudendi, 506. Norcross case, 217. Nose, injuries to the, 315. Notes of autopsy, 171 use of, in evidence, 31, 149. Noxious substances, legal definition 11. thing, 463. Number of wounds, 286. Nux vomica, 106. Objects, surrounding, 173. Ocular phenomena, 547. Odium case, 389. OZnanthe crocata, 123. Ohm, 393. Oil, burns by boiling, 339. croton, 84. of bitter almonds, 130. of tansy, 447. of vitriol, 36. savine, 86, 446. Omentum, examination of, 180. Operations, death from surgical, 284. Ophthalmia, 557. Opium, 92. coma, 656. fatal dose, 94. period, 94. poisoning by, 93. post-mortem appearances, 96. tests, 96. toxicological examination, 97. Orange-juice stains, 236. Ordinary gestation, 568. witnesses, 150. Orpiment, 54. Oslander's signs of pregnancy, 433. Osmond electrocution, 413. Osmosis of poisons, post-mortem, 28, 133. Ossification a test of age, 211. Otorrhcea, feigned, 557. Ovaries, weight of, 186. Oxalate of lime, 82. Oxalic acid 80. fatal dose, 80. period, 80. poisoning by, 80. post-mortem appearances, 80. tests, 80. toxicological examination, 80. Ozaena, feigned, 559. P. Pain, feigned, 564. Paint stains mistaken for blood, 236. Painters' colic, 71. Palmer case, 611. Palpitation of the heart, feigned, 559. Palsy, feigned, 559. from lead, 71. Pancreas, examination of the, 183. weight of the, 186. Papaverine, 92. Paralysis, feigned, 559. Parental likeness, 578. Paris green, 65. Parsley, fool's, 123. Partial birth, 470. Partners in medicine, liability of, 536. Paternity, 578. Patient, contributory negligence of, 535. Patoammine, 139. Pearlash, 44. Peculiar marks, 192. Pelvis, examination of, 220. female, 214. male, 214. Penal code of New York, 466. Penalty, death, by electricity, 404. Penetrating wounds, 274. in the dead, 274. in the living, 274. of the abdomen, 323. of the chest, 318. Pennyroyal, 448. Perforation of stomach mistaken for poisoning, 23. Peritonitis, 16, 453. feigned, 559. Permanent teeth, 194. Personal deformities, 579. identity, 191, 637. injuries, death from, 282. examination of plaintiff in actions for, 530. Petit jury, 147. Petroleum benzine, effects of, on blood, 234- . , . . Pharmaceutical jurisprudence, 593. Phellandrium aquaticum, 123. Phenic acid, 83. Phenol, 83. Phenomena of death, 152. 672 Phipps case, 337. Phosphorus, 49, 339. burns by, 339. poisoning by, 49. Phthisis pulmonalis, feigned, 560. Physostigma, 125. fatal quantity, 126. poisoning by, 126. post-mortem appearances, 126. tests, 126. Physostigmine, 125. Picrotoxin, 132. Pigmentary deposits, 432. Pilocarpine, 446. Pins and needles swallowed, n. Pitch-stains mistaken for blood-stains, 235. Plaques of Bizzozero, 229. parchemin^es, 268. Plea of pregnancy, 430. Pneumothorax, 318. Poison cases, circumstantial evidence in, 28. duties of the practitioner in, 29. medico-legal questions in, 29. reports in, 32. cheese, 90. definition of a, n. sausage, 90. Poisoned meat, 91. Poisoning by antimony, 612. by arsenic, 618. by chloroform, 634. by digitalis, 633. by nicotine, 634. diseases simulating, 17. evidences of, 15. of, from chemical analysis, 24. of, from experiments on living animals, 27. of, from post-mortem appear- ances, 21. of, from symptoms, 16. of, in the dead subject, 20. in the new-born, 491. infanticide by, 491. Poisonous fish, 90. foods, 90. Poisons, absorption of, 12. administration of, n. antagonism of, 15. classification of, 32. effects of, 12. elimination of, 13. formed during putrefaction, 138. irritant, 19-22, 32-34, 36. modification of the action of, 14. neurotic, 33-35, 92- disease resembling action of, 33. Policy, life insurance, 582. Polypus nasi, feigned, 560. Pomerais case, 633. Porphyroxine, 92. Porrigo, feigned, 560. Position of the clothing, 272. of the dead body, 173, 272, 289. Position of the dead body in water, 167. of the weapon, 272, 290. Post-mortem examinations, 171, 491, 498. imbibition, 58. wounds, 184. Potassa, 44. Potassium arsenite, 65. binoxalate, 82. bitartrate, 47. chlorate, 47. cyanide of, 129. hydrate, 44. nitrate, 46. sulphate, 48. Potato, common, 116. Powder wounds, 336. Powder-marks on clothing, 336. on skin, 336. Powell case, 217. Power, loss of, to move, 157. Powerful electrical discharges, 394. Practitioner, duties of, in poison cases, 29. Pranzini case, 298. Precocious pregnancy, 437. Pregnancy, alleged examination in cases of, 527- concealment of, 430. duration of, 436. feigned, 430. Hegar's sign of, 434. in the dead, 438. Jacquemin's test of, 433. late, 438. medico-legal relations of, 430. Oslander's sign of, 433. signs of, 431. stage of, in abortion, 452. unconscious, 438. Pregnant, 463. Premature burial, 155. delivery, 573. Premium in life insurance, 581. Prenatal circulation, 478. Presence of more than one burn, 341. Presumption of death, 187. Pretended delivery, 563. Pritchard case, 611. Privies, asphyxia from, 355. Procreative power in the female, 525. in the male, 524. Professional stigmata, value of, 193. Projectile, evidence from the, 327. Prolapsus ani, feigned, 560. uteri, 560. Prolonged submersion, 169. Proof of death by hanging, 374. by strangulation, 362. Proofs of live birth, 472. Protracted gestation, 568. labor, 484. Prussic acid, 126. chemical analysis of. 128. fatal dose, 127. period, 127. poisoning, 126. INE INDEX 673 Prussic acid, post-mortem lesions, 128. tests, 129. toxicological examination, 129. Pseudomorphine, 92. Ptomaines, 133. Ptyalism, mercurial, 69. Puberty, rape on females after, 501. Punctured wounds, 266, 274. in the dead, 274. in the living, 274. Putrefaction, 23, 133, 163. circumstances promoting, 165. retarding, 165. of body in water, 167. order of, 163. signs of death before, 170. uterine, 471. Putrefactive gases, 475. products, 133. Putrescent food, 91. Putrid meat, 91. Pyaemia, 283. Quantity of blood in the body, 245. Questions, hypothetical, 536. leading, 149. medico-legal, 29. Quick with child, 464. Quickening a sign of pregnancy, 431. Quicksilver, 69. Race, 205. in the dead, 214. Railway injuries, 539. malingering of, 564. medico-legal aspect of, 549. spine, 539. Rape, 499. anaesthesia in, 507. by boys, 507. evidence of, after death, 520. examination in cases of, 517. false accusations of, 509. legal points in cases of, 517. microscopic evidence in, 509. on children, 505. on epileptics, 508. on females after puberty, 501. on idiots, 508. on infants, 505. on the dead, 507. Reagents, effects of, on blood, 234. on hair, 225. . Receptaculum chyli and lymphatics, ex- amination of, 184. Record of examiner in rape cases, 521. Red blood-corpuscles, 230. measurement of, 248. fruit-juices mistaken for blood, 236. paint mistaken for blood-stains, 236. phosphorus, 49. Red sanders stains, 236. Redness of stomach in poison and dis- ease, 22. Reduction test for arsenic, 63. Re-examination, 150. Regional wounds, 306. Reich case, 296. Reinsch's test, 64. Remains, identification of mutilated, 637. identity of burnt, 210. mutilated, 207, 220. Reports, medico-legal, 32, 185. Resistance of body to electric currents, 393- Respiration, a sign of life, 474. cessation of, 155. Resuscitation from electric shock, 396. Rheumatism, feigned, 560. Ribs, fracture of, 318. Richardson's fluid, 246. Riddle case, 62. Rigidity, cadaveric, 637. Rigor mortis, 159. Rough on rats, 55. Roussin's menstruum, 246. Rue, 448. Rules for poison cases, 29. Rupture of bladder, 324. of diaphragm, 321. of gall-bladder, 323. of heart, 320. of intestines, 324. of kidneys, 324. of liver, 323. of spleen, 323. of stomach, 324. Rust mistaken for blood-stains, 236. Ruta graveolens, 448. Rye, spurred, 446. Saffron, 447. Salivation, 69, 431. Salt of lemons, 82. of sorrel, 82. spirit of, 41. Saltpetre, 46. Salts, alkaline, 46. bleaching, 48. earthy, 46. of barium, 48. Sand-bag injuries, 313. Saponification, 169. Sassafras, 446. Sausage poison, 90. Savine, 86, 447. oil of, 86, 447. poisoning by, 86. post-mortem appearances, 86. toxicological examination, 86. Scalds, 338, 639. danger of, 340. Scalp, wounds of, 306. Scars, 303. 43 674 INDEX Scheele's acid, 127. green, 65. Schweinfurt's green, 65. Sciatica, feigned, 560. Scrofula, feigned, 560. Scrofulous ulcers, 305. Scurvy, feigned, 560. Secondary causes of death from wounds, 282. Secretions, disorders of, 552. Secrets, medical, 149. Self-delivery, 438. -inflicted wounds, 298. -infliction of two wounds, 300. Seminal stains, 503. Sensenderfer case, 187. Septicaemia in abortion, 283, 452. Sequelae of abortion, 452. of sunstroke, 421. Services, action barred by recovery for, 536. gratuitous, 534. Severe wounds, 263. Severity of wounds, 263. Sex, determination of, in skeleton, 213. in the dead, 213. Shea electrocution, 413. Shock, death from, 277, nervous, 545. resuscitation from electric, 396. Shot, wounds made by, 336. Siemens's unit, 393. Sight, limits of, 198. Signs afforded by the mother in abor- tion, 458. external, of drowning, 385. internal, of drowning, 385. of death, 152, 155. of delivery in the dead, 498. in infanticide cases, 495. of pregnancy, 431. of struggle, 297. post-mortem, 401. Silk fibres, identification of, 222. Silver, mode of extraction of, 79. nitrate, 78. poisoning by, 78. post-mortem appearances, 79. tests, 79. Simulation of diseases, 552, 562. by children, 567. by poisoning, 17. Single fractures, 268. Situation of wounds, 285. Skeleton, 220. age of, 211. examination of, 211. identification of, 211. race of, 214. sex of, 213. stature of, 216. Skill and wounds, 280. Skin of the new-born, 470. Skull, 553. contre-coup fracture of, 308. Skull, evidence from, 205. fracture of, 307. of base of, 307. of vault of, 307. Sleep, rape during, 515. Sleeplessness, 552. Slight wounds, 264. Slocum electrocution, 413. Slow poisoning, 62. Slung-shot injuries, 313. Smiler electrocution, 413. Smoking tobacco, 119. Smothering, death by, 346. in infants, 487. Soap lees, 44. Soda ash, 44. and salts, 43. Sodium hydrate, 44. salicylate, 446. Softening of stomach, 23. Solanine, 116. Solanum, 116. Somatic death, 152. life, 228. Sorrel, salt of, 82. Spanish fly, 89. Spasmotoxine, 139. Specific irritants, 49. Spectroscopic test, 254-262, Spectrum analysis, 154. Spelter, 75. Spermatic stains, 503, 504. Spermatozoa, 503, 504. Spicer case, 294. Spinal column, 177. cord, injuries of, 316. length of, 186. weight of, 186. wounds of, 316. Spine, fractures of, 316. injuries of, 316. railway, 549. wounds of, 316. Spirit of salt, 41. Spiritus frumenti, 100. vini gallici, 101. Spleen, examination of, 181. rupture of, 323. weight of, 186. Spontaneous combustion of the human body, 343. fractures, 269. Spotted hemlock, 115. Spurred rye, 446. Squills, 446. Stab wounds, 266. fatality of, 317. Stage of pregnancy in abortion, 452. Stains, anatto, 236. blood-, evidence from, 294. identity of, 236. measurement of old, 253. suspected, 235. examination of, 235. Brazil-wood, 236. INDEX 675 Stains, cochineal, 236. examination of suspected, 38, 40, 235, 503-504. grease, 236. iron-rust, 235. kino, 236. lemon, 236. logwood, 236. madder, 236. mistaken for blood-, 235. of arterial blood, 256. of menstrual blood, 256. of venous blood, 256. on the clothing, 38, 40, 42. orange-juice, 236. pitch, 235. red fruit-juices, 236. paint, 236. sanders, 236. tar, 235. vinegar, 236. Starch, detection of, 481. Starvation, 426, 490. accidental, 429. chronic, 429. death from, 426-429. homicidal, 429. infanticide by, 490. medico-legal relations of, 430. suicidal, 429. Stas's process for separating alkaloids, 26. Static electricity, 392, 474. Stature in the dead, 216. Statutory provisions, Massachusetts, 147. New York, 148. Sterility, 522. female, 526. male, 522. Sternum, fracture of the, 318. Stigmata, value of professional, 193. Still-births, 471, 652. Stomach, examination of, 180. length of, 186. proofs of live birth from, 480. redness of, 12, rupture of, 324. test in murder trials, 640. ulceration of, 12. weight of, 186. wounds of, 324. Stools, involuntary, feigned, 56. Straight hair, 226. Stramonium, extraction of, 116. poisoning by, 116. post-mortem appearances, 116. Strangulation, 356, 488. accidental, 364. by umbilical cord, 488. examination in, 377. external appearances in, 378. homicidal, 364-365. infanticide by, 488. internal appearances of, 378. proof of death by, 362. suicidal, 364. Stratton, fast of, 426, 429. Stroke, lightning, 416. Struggle, signs of a, 297. Strychnine, 106, 137. detection of, in the stomach, in. of, in the tissues, in. discovery of, after long periods, 112. elimination of, 112. failure to detect, 112. fatal dose, 108. period, 108. physical test of, 112. poisoning by, 17, 107. period, 108. post-mortem appearances, 108. quantitative determination of, 112. tests, 109. Subinvolution in abortion, 453. Sublimate, corrosive, 69, 70. Sublimation test for arsenic, 62. Submersion, prolonged, 169. time of, 387. Subnitrate of bismuth, 76. Subpoenas, 145. Succi case, 426. Sudden death, 145, 146. delivery, 495. Suffocation, 349-351. accidental, 349, 350. death by, 346. evidences of death by, 348. homicidal, 349, 351. in infants, 487. in the new-born, 487. post-mortem signs of, 348. suicidal, 349, 351. Sugar of lead, 73. Suggillation, 160. Suicidal death by burning, 343. drowning, 388. gunshot wounds, 335. hanging, 375. relation to life insurance, 592. starvation, 429. strangulation, 364. suffocation, 349, 351. wounds, 285, 298. Suicide, 300. causes of, 300. in children, 302. methods of, 304. Sulphate of aluminum and potassium, 48. of copper, 74. of indigo, 42. of potassium, 48. Sulphides of arsenic, 65. Sulphuretted hydrogen, 354. test, 63. Sulphuric acid, 36. Sulphurous acid, poisoning by, 354. gas, 354- Sunstroke, 421, 640. post-mortem appearances of, 422. Superfcetation, 568. 676 Suprarenal capsules, weight of, 186. Surgery, experimental, 532. Surrounding objects, 173. Survival of live child, 481. Survivorship, 171. presumption of death and, 187. Susotoxine, 139. Swelling of the limbs, feigned, 560. Syncope, 153, 657. T. Turpeth mineral, 70. Typhotoxine, 138. Tyrotoxicon, 90, 138. U. Ulceration and corrosion, 23. feigned, 560. of ileus, 23. of stomach, 23. Ulcers, feigned, 560. scrofulous, 305. Umbilical cord, 479. compression of, 485. cutting of, 485. hemorrhage of, 485. tearing of, 485. Unconscious delivery, 497. pregnancy, 438. Unhealthy condition of injured person, death from, 281. Unit, Siemens's, 393. Uraemic coma, 656. Ureters, length of, 186. Urine, bloody, feigned, 564. kiestein in, 434. Uterus, examination of substances ex- pelled from, 460. length of, 186. putrefaction of, 165, 471. weight of, 186. V. Vagina, dilatation of, in rape of children, 505. discharges from, evidence from, 506, violet color of, 432. Vaginal douches, 454. Vandergrift case, 84. Vapors, asphyxia from charcoal, 351. Vegetable irritant poisons, 80. Veins, wounds of, 321. Venereal diseases, simulated, 560. Venous blood, 256. Veratrine, 87, 138. poisoning by, 87. Veratrum album, 87. viride, 87. Verdigris, 74. Versions, uterine, 453. Vertebral column, sprains of, 540. Vesications, 340. Vibert's liquid, 246. Viburnum opulus, 133. Vienna green, 65. Vinegar stains, 236. Violation, 514. during sleep, 515. Violence, accidental, in infants, 487. ' in the new-born, 487. criminal, in infants, 487. in the new-born, 487. Violent death in infants, 483. Table of classification of poisons, 34. Tabular statement for reference, 461. Tanacetin, 447. Tanacetum vulgare, 447. Tansy, oil of, 447. Tar-stains mistaken for blood, 235. Tartar, cream of, 47. emetic, 66. Tartaric acid, 82. Tattoo-marks, 206. Taxus baccata, 133. Taylor electrocution case, 402. Teeth, a test of age, 194. milk, 194. permanent, 194. Teichman's test, 237. Temperature, bodily, 419. Tenancy by courtesy, 189, 575. Tentative cuts, superficial, 287. Tetanine, 139. Tetanotoxine, 139. Tetanus, 109, 283. Thebeine, 92. Thoracic cavity after respiration, 472. Thorax and contents, 317. examination of, 179. wounds of, 317. Thorn apple, 116. Thymus gland, weight of, at birth, 186. Thyroid body, weight of, 186. Tice electrocution case, 413. Tichborne case, 191, 206. Time of submersion, 387, 389. required to burn a dead body, 345. Tin, poisoning by salts of, 77. Tincture of galls, effects of, on blood, 234. of guaiacum, effects of, on blood, 234. Tobacco, 119. Indian, 121. poisoning by, 120. smoking, 121. Toxicology, 11. Transudation of blood, 22. Traumatic hysteria, 548. meningitis, acute, 550. Trial by inspection, 527. Trichina spiralis, 91. microscopical examination, 92. Trichinosis, 91. Trichomonas vaginae, 504. Trimethylenediamine, 139. Trommer's test, 481. Tumors, feigned, 553. IND1 Virchow's liquid, 246. Virginity, signs of, 501. simulated, 514. Viscera, abdominal, contusion of, 322. laceration of, 322. wounds of the, 322. disposal of the, 31. Vitali's test for atropine, 115. Vitality of child in cases of infanticide, 483, 574- in legitimacy, 575. Vitriol, oil of, 36. throwing, 339. Volition, acts of, after injuries to vital parts, 319. retention of, in poisoning by prussic acid, 127. Volts, 393. Vomited matters, identity of, 31. Vulva, evidence from, 501. wounds of, 325. W. Wormley's atropine test, 115. Wormwood, 446. Wound, cicatrix as a result of a, 304. direction of a, 288. extent of a, 286. mortal, 263. presence of more than one, 299. severe, 263. situation of the, 285. slight, 264. Wounds, 263. abdominal, 322. accidental, 298, 299. after death, 637. long periods, death from, 282. ante-mortem, 272, 637. by wadding, 336. cause of death from, 275. cicatrization of, 303. classification of, 264. contused, 267, 273. in the dead, 273. in the living, 273. of the head, 307. death from, 279. dissection of, 184. examination of, 175, 263, 271, 306. factitious, 561. from gunpowder, 336. from shot, 336. from wadding, 336. fictitious, 561. foreign substances in, 297. genital, 325. gunshot, 326. accidental, 335. after death, 327. before death, 327. complicating conditions of, 338. danger of, 327. homicidal, 335. suicidal, 335. healing of, 265. homicidal, 285, 299. imputed, 298. incised, 264, 272. in the dead, 273. in the living, 272. of the head, 306. indirect or secondary causes of death from, 282. inflicted after death, 272. before death, 272. lacerated, 268. in the dead, 274. in the living, 274. of the head, 307. medico-legal consideration of, 263. mortal, 277. multiple, 277. nature of, 286. number of, 286. of different parts of the body, 306. of the abdominal viscera, 322. walls, 322. Wadding, wounds from, 336. Wainwright-Lane case, 638. Warner case, 108. Warranty to cure, 534. Water, effect of, on blood, 234. -gas, 354. hemlock, 123. putrefaction of body in, 167. Weapon, evidence from the, 327. fired at a distance, 337. near, 337. position of the, 272, 290. Weapons, blood upon, 292. examination of, 292. fibres upon, 293. hair upon, 292. Webster case, 174. -Parkman case, 217, 637. Welcker's liquid, 246. Weldt strangulation case, 366. Welsh fasting girl, 428. Wharton case, 617. Whiskey, 100. White arsenic, 54. blood-corpuscles, 230. oxide of arsenic, 54. vitriol, 75. Whitechapel tragedy, 638. Whittaker case, 561. Wilful malpractice, 532. Wines, 100. Witness, expert, 149, 150. hostile, 149. ordinary, 150. Women, impotence in, 525. sterility in, 526. Wood, Brazil, 236. Woods electrocution case, 413. Woollen fibres, identification of, 222. Woolly hair, 226. 678 INDEX Wounds of the arteries, 321. of the bladder, 324. of the brain, 313. of the chest, 318. of the diaphragm, 321. of the extremities, 325. of the face, 314. of the genitals, 325. of the head, 306. of the heart, 319. of the intestines, 324. of the lungs, 318. of the neck, 315. of the spinal cord, 316. of the spine, 316. of the stomach, 324. of the thorax, 317. of the veins, 321. of the viscera, 322. on new-born children, 490. penetrating, 274. in the dead, 274. in the living, 274. of the abdomen, 323. of the chest, 318. post-mortem, 184, 273, 637. Wounds, punctured, 266, 274. in the dead, 274. in the living, 274. of the head, 307. regionally considered, 306. self-inflicted, 298. severity of, 263. skill in treatment of, 280. stab, 266. suicidal, 285, 298. upon the burned, 343. Wreden's middle-ear test, 495. Written notes, admissibility of, 149. Y. Yellow jessamine, 87. King's, poisoning by, 63. Yew, poisoning by, 133, 447. Z. Zaleski's test, 477. 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