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I I Quality of print varies/ □ Quality indgale de I'impression Includes supplementary material/ Comprend du materiel suppidmentaire Only edition available/ Seule Edition disponible Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partiellement obscurcies par un feuillet d'errata, une pelure, etc., ont 6t6 filmdes d nouveau de fa9on d obtenir la meilleure image possible. □ Additional comments:/ ' Commentaires suppl6mentaires.- This item is filmed at the reduction ratio checked below/ Ce document est filmd au taux de reduction indiqud ci-dessous. 10X 14X 18X 22X 26X SOX J 12X 16X 20X 24X 28X 32X The copy filmed here has been reproduced thanks to the generosity of: Bibliothdque nationaie du Quebec L'exemp^aire filmd fut reproduit grdce d la g6n 1 ,,.^*^«%, 58363 "'*'«»*■». 1^ ••s I » . I ... .• . • . ; • : ••• . . .♦.••:•.: *. . •'. .:•••• •:•.••. ..-..•.: ;•. • •• ., • ••• *. •'•*. •♦' • * : •. : . . • * CONTHNTS, Paoe, iNTnODTTrTtON 3 I. Drowning (22 Cases) 5 , II. Poison 25 Arsenic (3 Cases) 2fi Sulpliate of Copper ; 27 Chloral 28 Chloroform (2 Cvses) 29 Carbon monoxide (3 Cases) 30 III. Injuries 32 Fracture of Skull (14 Cases) 32 Other injuries fron) crushin^^ 39 Rupture of Li ver 39 Dislocation of Neck (3 Cases) 41 Firearms (3 Cases) 42 Surgical Operation 44 Umbilical Hppmorrhage (?) 44 Hanging 4.5 Asphyxia by Food 4.5 Burns (4 Cases) 46 Concussion, Shock, etc. (G Cases) 47 IV. Natural Causks 49 Pneumonia (0 Cases) .51 Phthisis (2 Cases) 54 Pulmonary Embolism .54 Heart Disease (3 Cases) .55 Granular Kidney 5<5 Cerebral Haemorrhage (4 Cases) .57 Cerebral Abscess 59 Still Born (2 Cases) 59 V. Doubtful ok Unknown Cauhks (JO ■ Capillary Thrombosis of Brain 60 Epilepsy (?) (2 Cases) 61 Inanition— Debility (2 Cases) 62 Other Causes (6 Cas^s) , 6^ r.*<^ .y^ My object 1ms been to show the opportunities for sciontiHc medico- Icgal Htudy ad'orded by even a series of one hundred consecutive cases, none of which j)ri'sentod any specially sensational features. Incidentally these cases have served to illustrate the workings of the Quebec Coroner Law, which jjlaces a coroner, who has received a report of a suspicious death, somewhat in the position of the younp; lady who was permitted to swim but not to go near the water. The determination of whether a death is due to violence or not chielly depends upon a knowledge of the cause of death, and this naturally involves a medical examination. But although no coroner is allowed to hold an inquest or summon a jury unless he has lirst made A declaration under oath that in his opinion death has lieen due to criminal violence, he is neither allowed to employ medical aid in deter- mining the cause of death, nor, except under exceptional circumstances, to order an autopsy without first summoning and obtaining the consent of a majority of the jury. It gives me much pleasure to record here my thanks to Coroner McMahon for his many actt of courtesy and consideration, and it may not be out of place to state that, personally, his ideas as to the useful- ness of autopsies and the uselessness of juries as a means of investi- gating violent deaths are quite in accord with my own, and that the proportion of autopsies to inquests has risen from 5 per cent, in 1H!>2 to 15 per cent, in 1893, and to over 25 cent, in 1894. In order to have a satisfactory service, however, autopsies would be necessary in over half the deaths investigated. 1. ONE HUNDRED CASES IN THE CORONER'S COURT OF MONTREAL. 1893. Hy Wyatt Johnston, M.I)., Monlri-nl. The increased interest taken in the proceedings of the Coroner's Court by the medical profession and the public dur- ing the past year, which has led to my being entrusted with the medical examination of bodies upon which inquests are held — as far as was possible under the existing laws and regu- lations, — makes a faithful report of the work done one of the duties of this position. In a preliminary communication pre- pared jointly with Dr. G. Villeneuve,* it was found impossible to do much more than deal with the general statistical aspects of the medical evidence, in order to prevent our paper from being too long, so that the scientific details of the cases could not be considered. It Is perhaps necessary to apologize for including so many ordinary and commonplace cases, but, as no such series has yet been published in Canada, it seemed worth while to give a true picture of the ordinary every-day work of a coroner's physician. Although 100 cases form too small a material to offer much that i£, novel or curious in the way of medicolegal facts, yet it seemed well at the present time to publish a series of observations which would give a general idea of the * Montreal MedicalJourual, Aug., 1893. L'Union M^dicaledu Canada .Aug., 1893, U8ual medical questions coming up for consideration, and the grounds upon which they were decided. In giving evidence, I have made it a rule to confine my statements of opinion as far as possible to what was clearly demonstrated by the facts observed, and in each case to state fully the facts from which these conclusions were drawn ; ir other words, to let the facts speak for themselves. In onm' it became necessary to mo'^e statements based upon prob- abilities, this was frankly admitted, and the possible objec- tions to the view taken fully discussed. The practice of bol- sterintj, up weak and inconclusive facts by strong affirmations of opinion is unworthy of the name of medical testimony. The chief end of the medical evidence was, of course, to establish clearly the cause of death. Many interesting cases of the present series have, unfortunately, not been made clcnr by the medical testimony, owing to autopsies not being pei- mitted. Out of my 100 cases there were 29 autopsies ordered, testimony being given after external examinations only in the remaining 71 cases. As a general rule, it was found that where autopsies were performed the cause of death was demonstrated with absolute certainty in almost every case, and testimony of the most posi- tive kind could be given without reserve. On the other hand, in the case of the external examinations, I can only recall half-;i- dozen instances where I felt justified in making a jjositivo state- ment as to the cause of death, and these few were in connection with public accidents, where, in any case, there would have been no reasonable doubt on this point, even if no medical examination at all had been made, as the circumstances of the accidents and their fatal results were clearly established by eye- witnesses. In two of the more important cases (Nos. 45 and 59) I was fortunate in having the co operation of Dr. G Villeneuve in making the examinations, and obtained valuable uid from his thorough knowledge of medico legal questions and clear reason- ing upon the facts observed by us jointly. It is much easier, as a rule, to recognize the facts brought out by a post mortem ^''' than to decide upon their sit^nificance and the extent to which they are to be allowed to influence an opinion. The system at present in vogue, which necessitates hastily formed conclusions being submitted, without time for reflection, to an impatient jury, is one which is bound to lead, sooner or later, to serious error or miscarriage of justice, and which places the medical witness in a most unenviable position. I have arranged the oases according to the causes of death found, rather than according to the verdicts given, and have considered chiefly the facts brought out by the examination, the conclusions formed from these, and the finding of the jury. In drawing up reports the French form of protocol has been followed. The German system of numbering each paragraph is convenient for reference afterwards, but was found to be too cumbersome. 1 I. — Death by Drowning (22 Cases.) Of the 22 cases, 18 were identified and 4 were those of un- known persons. Three autopsies were ordered, one of which was upon a body not identified. The remaining examinations were external only. In my opinion, autopsies should always be made where the facts of the death are not proved by eye- witnesses, or where there is any reason to suspect the good faith of such witnesses. Two verdicts of suicide and one of man- ' slaughter were rendered, and in 14 the death was stated to be accidental. In the remaining five cases the verdict was simply found drowned or found in the water. In all but two of the ,7, identified persons the circumstances of the death were attested I to by eye-witnesses, making the medical testimony merely I corroborative. In these cases the bodies were usually found close to the scene of the accident, after the lapse of from a few hours to a few days. When a body is found in the water, the following questions always arise : (a) How long has the body been in the water ? (6) Was the death due to drowning ? ((?) Was the death the result of a crime ? % :?*.. 6 A. — Indications of Time in Water. The following signs given by Duvergie and Vibert were prepared from an extensive and accurate knowledge of the appearances of drowned bodies : TiMK. ApPKAKANt'K. WiNTKH. Summer. 5 to 8 hours. 3 to 5 days . . . Rigor mortis ; body feels very cold and elimimy ; epidermis conniieneing to whiten ; (ln;z;er tii)s wrinkled. 4 to 8 days. .. 24 liours Limbs tiaceid; skin of natural colour ; epi- dermis of palms very bleaehed ; i)alms wrinkled; rij:;()r in summer. 8 to 12 days . . 48 hours Flaccidity; l)leachinfi; of backs of hands ; face waxy-lookinjjc. 2 weeks 4 (hiys Face jiufly, reddened in places ; greenish tinge of skin over sternum; e ndermis of )alms and .soles comi)letelv bleaehed an( commencing to form folds. Inter- stitial forn.ation of gases conunenees. {(ircni pufrcjarfloii period.) 1 month 8 to 12 days. Face reddish-brown ; lijjs and eyelids . green : chest greenish ; skin of hands and feet wrinkled, swollen and creased as if by poultices, its consistency chalky. Body floatsowing to production of gases. {Period of bhxtfiug.) 2 months 1 month Face brown and swollen ; epidermis l.trgely peeled oH" from body ; nails still attach- ed ; hiiir of scalj) readily scraped od"; skin begins to get sodden, like wet card- board or i)archment. {Jiroirn putrefav- tio)i period.) 2h months. Epidermis and nails of hands detached ; epidermis of feet detached, nails still adherent ; reddening of subcutaneous ti.ssues; ])artial saponification of cheeks, chin, mamma' and anterior surface oi thighs. (Srtpotiijivation period.) '•ih months Partial detachment of scalp, eyelids and nose; sa))()iulication of neck and groins ; epidermis of h.inds and feet completely detached and nails fallen oft". {Destruc- I'ire pi(fre/(icfio)i period.) 4.\ months . . Complete saponification of face, neck and anterior part of thighs; cutis opales cent; cranium denuded and becoming brittle ; incrustation of lime in the form of small rounded or conical tubercles, size of peas, in skin of thighs. (Incrus- fttfioii period.) ,^~/»' y Duvergie states that the changes in sutnmer appear about 20 to 22 days earlier than in winter, the rate in spring and autumn being intermediate. In these late periods the signs are uiicertain, and the relation between the summer and winter rates of alteration very inconstant. In winter maceration alone occurs ; in summer putrefaction and maceration go on simul- taneously. Immersion, while it lasts, retards putrefaction, but bodies removad from the water putrify with astonishing rapid- ity ; hence t'.ie necessity of their being viewed without delay, in order not to confound the appearances produced while in the water with those which occur subsequently. I have endeavoured, from my own cases, to check these statements as far as possible, and find out by a study of the appearances of bodies where the period of immersion was known, to see what statements might safely be made with regard to bodies found in the neighbourhood of Montreal. The collection of facts on this head was made difficult by the fact that nearly all of the examinations had to be made under unfavourable conditions as regards light, the bodies often being laid out in rooms lighted with candles only. The absence of facilities for dictating full notes also made the task more difficult. The rapid decomposition of bodies after tl-ey had been removed from the water was very striking. Bodies which looked perfectly fresh when first removed became almost unrecognizable in the course of a few hours. It was impossible to prevent tho occur- rence of these changes in the absence of a proper refrigerating chamber. The absence of a suitable morgue made it also im- possible for the progress of decomposition to be followed and noted. As will be seen by reference to the cases, the signs of im- mersion, or, in other words, the evidences of maceration, came on even more rapidly in summer than might be expected from Duvergie's table. After the end of June this was especially marked. In Cases 96 and 07, an immersion of a few hours in Auiiust was found to induce as marked maceration changes than would ensue in as many days in June. 8 In connection with this, it is of interest to record here my observations of the mean monthly temperature of the water about Montreal, made two years ago. As I have found that the water temperature of 21? C. for August was the same in 1893 as in 1890, it may be assumed that these temperatures are fairly constant. The great size of the bodies of water (St. Lawrence and Ottawa rivers) from which they are taken, ren- ders it unlikely that the daily and weekly variations are con- siderable in amount. Canal and reservoir water was found to be 2* to 4® C. higher than river water during the summer. Tempkratuhk in 1890.* Months. i >-> J3 1 ^ § S3 >4 18 • -4-' O > o Water, C 4 10.9 14 65 21 18.3 13 10 4 Air, F"* 15 17 26 42 52 m 66 (52 45 ;« 7 In the examination of the bodies immersed near Montreal, and recorded in tabular form below, the chief deviation from the results given in text 'ooks was the longer duration of rigor mortis, which was still vv M marked after one to two weefes' immersion during the sumoi^ , in spite of the presence of ad- vanced putrefaction in parts of the body. The muscles of the legs appear to resist putrefactive changes for a considerable time. In one case where a body showed marked maceration and decomposition, but where rigor mortis persisted, a bacterio- logical examination showed the absence of bacteria, microscopic- ally, from the rectus femoris muscle and cultures made from that region remained sterile. The early appearance of a greenish tinge over the sternum and pectoral region mentioned by Duvergie was often present. It evidently depends upon the early and rapid decomposition of the head and neck, with penetration of the gases along the planes of the fascia. It appears long before a green tinge of the abdomen is seen. * The teujperature of the air is that recorded by Prof. C. H. McLeod ai the MoQ ill Observatory. 9 The wrinkled and bleached condition of the hands was, on the other hand, produced much more rapidly than one would expect from Duvergi'es tables. I found in a body (Case 97) recovered from the water on a warm August afternoon, after a submersion of loss than an hour, and examined a few hours later, before it had even time to become cold, a quite typical, bleached and wrinkled appearance of the palms and soles, and another body (Case 96) examined earlier on the same day< after being in the water for two hours during the previous night, also presented a typical condition of wrinkling of the epidermis. In neither case was the epidermis specially thick, one being that of a young girl and the other that of a boy of twelve. Whether the water bacteria, or the bacteria of the body are the active agents in bringing about the decomposition of the bodies is a matter which I hope to deal with in a future com- munication. The extremely rapid march of putrefaction in im- mersed bodies appears to depend essentially upon the greater amount of water which the tissues contain, just as a moist gan- grene shows much more marked putrefaction phenomena than a dry, senile gangrene. When, however, a body has been for a very long time immersed in water (several months), its putre- faction upon exposure to air is relatively slow, perhaps because the bacteria which have penetrated the tissues have had time to die out, or non-putrescible substances formed in the tissues. The presence of cutis anserina was noted in 2 cases. It did not appear, as would be expected from the statements found in text books, as an early change, and was found in bodies which had been immersed from three to seven days. It appears to be mere readily produced by cold air than cold water, and was commonly seen in bodies which were placed on ice. Shrinking of the penis and scrotum was often seen, but is not a reliable sign, as the external genitals «oon become puffy and emphysematous when tha bodies are removed from the water. It is said that this appearance may be produced by immersion post mortem. 10 In several instances the skin ovei- the knof i was white ami wrinkled. B — Did Death, rcvdt fiom Druwniufjf The distinction between diownin^ (snhiners'-jn) and the entrance of a dead body into t'l ; water (iniuiorsion), I found to be easy to decide in some cases, and dillicult or impossible in others. It may be well here to mention briefly the si^ns of drownin^^ The sij^ns of immersion given above only show that the body has remained for a certain period. In addition to this, certain appearances indicate that the body entered the water alive. (1) Ilvternnl Signn of Drowning. — The only direct and reliable sign is that of a very abundant, fine, white froth which issues from the mouth and nostrils of drowned for a period of a few hours until two or three days after death. This is not wcM marked until some hours after death and disappears by the time the maceration changes have become advanced, or when putre- faction has fully set in. This foam was found present in 5 of my cases and absent in 17. It is not absolutely characteristic of drowning as I have seen it in two cases of cerebral haemor- rhage, and one of which was spontaneous (case ^^')^ and the other traumatic (case 48), and is of value chiefly in indicating that death has been due to asphyxia. A reddish, frothy fluid, oozing from the mouth and nose of bodies partly decomposed, is no evidence of drowning. The skin of drowned bodies is blanched. Ecchymosis of the skin and conjunctivae, common signs of asphyxia, were not met with in any of my cases of drowning, an observation in accordance with the statements of text-books. Seminal emissions were twice observed. When not emphyse- matous, the penis and scrotum were usually shrunken. The presence of mud, tufts of grass, etc., about the fingers and nails, which is supposed to indicate struggling near a bank, ■was only met with in one case (No. 61). (2) Internal Signs of Drowning. — These are : (a) Respira- tory traH. — The epiglottis is stated to be vertical in bodies ,-^," 11 which have heon drowned, and meiclv partly raised in those immersed after death. The presence of froth or water in tlie air passai^ea, with oedema, or soraetiiries em})hyseinj»tou8 in- flation, eni^orgcment and sub-pleural or deep-seated ecchymo- sis of the kings is highly characteristic. The presence ot" a pint or so of reddish fluid in the pleural cavity was noted, but has no distinct significance. {!>) Foreign bodies, such as mud, etc., in the air passages and eustachian tube. These were not seen in the cases where autopsies were made, and their absence has obviously no negative significance where the body is found in a large, clear body of water like the St. Lawrence river, (t*) Fluid in the stomach. In the three cases examined, the stomach was found practically empty. In one of these the death was sufficiently recent to infer from this that water had not been swallowed in any considerable (juantity. In the other two transudation into the peritoneum may or may not have occurred. It has been recommended* to compare by chemical analysis the fluid found in the stomach, middle ear, air passages, etc., with the water in which drowning is supposed to have occurred, (c?) Water in the middle ear. (e) Foreign substances in the middle ear. The penetration of foreign bodies into the middle ear and bronchi has also been produced artificially by immersing dead bodies in a solution of starch or meal.f This took place in 28 per cent, of the experiments. This is stated by Lacassagne *only to occur after death when there is perforation of the tympanum. None were met with in my cases. The three cases in which autopsies were allowed were all )odie3 which had been a long time in the water and which had addition become putrefied after removal, so that the charac- teristic signs of drowning were absent. It is stated that oedema of the lungs may occur in post- lortem immersion, also that in an ocdematous lung collapse lay occur. Paltauf J was able to show, by means of the f* Bou(?ier. Thesis, Paris, 188t. lluevkovslty. Arch. I'Aiitliropol. Criiiiinci, Sept, ISST. : Ueber Tod durch Ertrinknng, 1888. haemouQometer, that in hodios immersed experimentally^ the blood in the heart had become diluted. * Bougier found that in bodies immersed and afterwards frozen that ico crystals wore found in the lar^^o and mi(Mle- sized bronchi, but not as a rule in the bronchioles. The rii^ht heart may either be engorged with blood or com- pletely empty, according to whether death occurs by asphyxia or syncope. (/) On the whole, the presence of a large amount of watery fluid (over 12 oz.) in the stomach is probably, next to actual froth in the bronchi, the most reliable of signs of drowning, as water does not tend to enter the stomach after death. My own material is too limited to permit me to express an opinion, C. — Was Death the result of a Crime i For the distinction between homicidal, suicidal and accidental drowning the medical testimony, apart from other evidence, can- not, as a rule, be very positive. It is impossible, for example, to tell whether the individual simply fell into the water, or was pushed in. The direct medical evidence bearing upon this point would be the signs of a struggle, bruises, scratches, etc., and for this reason the hands and fingers must be examined with especial care. In two of my cases (Nos. 93 and 94, drowned at the same time and place) such marks of violence were found. These consisted of numerous spots of ecchymosis on the arms and chest. The opinion given was that bruises had occurred before death, and that certain other lesions of the surface, abrasions and parchmentation had been produced after death, probably in the process of fishing out the bodies, but that the legal significance of the bruises could not be definitely stated without further knowledge of the circumstances of the death. It subsequently transpired that one of the victims, who could not swim, seized hold of the other, who struggled in vain to free himself, and when found the limbs of both were locked in a close embrace. ^ U. Bougier. Thesis, Paris. 1884. 18 Anything pointini^ to a ciiiniuu Iiomicido, after which the body might havo heon thrown into ino water, has to be borno in mind. This was not indicated in any of my cases. The absence of any marks of violeiioe or evidence of other modes of death affords, to a certain extent, grounds for sii[)fK)S' ing that death must have been duo to drowning, even when the signs of drowning havo disappeared, but statcmento on this head have to be made with extreme caution, as the posisibility of poisoning must be borne in mind. The question of whether wounds have been made before or after death must also be dealt with in a guarded manner, as on the one hand the blood pigments tend to d ffuso themselves in a remarkable degree in immersed bodies, and on the other hand an actual blood- clot may be washed away, or decolorized, or even dissolved. Definite cc';hymosis of clotted blood about an injury, however, indicates a lesion f r )duced before death. I venture to olfer the present small material for considera- tion, mo»'e from a desire to offer proof of having been "faithful over a few things " than in the hope that the cases quoted are specially interesting to others. The foil )wing are the details of the cases : Case 47. — Blow on Head and Drowniny. — Autopsy.— J. B. C, aged 45, labourer, while working upon a dredge, was struck upon the head by the iron scoop and knocked into the j water. The body was recovered two weeks later, and an [autopsy ordered. Autopsy pLM'foriii'.'il Juiu' :{, IS!)!, 21 hours afUT itiuovjiI t'loiii wjitcr. JClothin;; not torn or disarrunjjced. Head and neuk K''t*Htly swollen, and featuri"-; nearly o'yliti'r.ilcd. (ic'iiitals iMui)liys('niiitons. /fair of nca/p Hid iiL'Jii'ifdclics rrirHIji sn-apiff olf. Skin uf pdliiis an(f soles ic/t if i' Hid wrinkled. Over trunk numerous large blebs beneatli epidermis illed with greenish fluid. On lower limbs similar vesicles containing ^lear fluid. Rigo.- niortis present. Strong odour of putrefaction. A scalp woun 1, with ragged, lacL'rated edges, extends from two Inches above tlie left external angle of the orbit nearly to the vertex. Che pericranium is torn, and the bone exposed. A linear fracture, three inches in lengih, extends u})wards from the ft frontal eminence. On reflecting the scalp, tlij ocjipital region is seen io be infiltrated |lth a bloody, serous fluid extending downwards into the cellular tis- ie of the upper part of the neck., and ciotfcd blood is found free in ■^■^ 14 Hii lissiir. On iTiM(i\ iiip; llic hkull Clip by khwIii^ tlimuKli tliu l)iiii«> uiid Itniiii tn^jclliiT, it is M<'CM timt tin- rnirlmc is ciiicdy ((iiiliiii'd In llu' tiiitci- tal)ic III' I lie I'ntiitnl lioiic, llir inner tiiliif |ii't>scnlinK only u line of I'nictiiro (inc iiicli lonvf. Tlicrc is no fcciiyniosiM iiltoul tlic rnutiii-u ol' till' innri' Initio op Ilir iliiin. Ilniin niucli soflcMi'd, lint tlir sni'fiut' and coiivolnt Ioiim rctiiin snlU I'icnt lonsistrncy In lir slndicd iit llir Hciit ol the injury. Tlicre is no t'videncc of lia'inorrliiiKc or liiceralion. On removal of tlu' dura froin tlie base of tlio skull, Mio boiu' Ih found free from fiaelure. Half a pint of reddlNb lluid in eaeli jikMira. Mroucbi free from foreign bodies. Stoinai-li eontaiiied about 4 o/. of ihick, fjCi'cylHli pulp. No water or foreij^n bodies found in internal ear. (Notbinp; alinormal was found in t be ot lior organs). CinuhislitnH. \. Tlie body shows signs of maeeration corresjiond- ing to a stay of about two weeks in ratlier cold water. The iidernal organs are sultielently well pieserved to rcndei' their exandnation satisfactory. 2. A lacerated and conlnsed scalp wound and fracture of the outer table of the skidl exist. This injury .apjiears to have been pnxluccd bel'nrc death, and been of sulHiieid severity to stun a man, but not to kill him immcdicicly. ;{, The state of the lungs and stomach corresponds \\ ith tiuit of a man unable to struggle in tlie water. In this case the death was the result ot an acc'ulent. A ver- dict of manslaughter was returned, as a foreman was thought to have been guilty of criminal negligence, but the Grand Jury found no bill. The points to be determined at the autopsy were whether death had occurred from drowning or in conse- quence of the blow. The presence of ecchymosis beneath the scalp showed that bleeding into the tissues had taken place after the blow, and this view was afterwards confirmed by the statement of a witness that after the body had sunk a large amount of blood continued to stain the water, which of course would not have been the case if the blow had been instantly fatal. The state of the stomach, however, showed that no water had been swallowed, and that therefore probably no struggle for air had taken place. *This method of removing the brain, followed in the Paris morgue, is extremely siuiple and ciiay. The study of lesimi.s in tlio bruin and membranes are not inter- fered with, and one is perfectly sure that lines of fracture are not artifieially ex- tended. It is possible in this way to successfully remove a brain which is all but diffluent. 16 Cask 4'.). — Unknown Man — C>ntn.sion of Head — Drownhiji — A utopnt/. Itddy rniiiiil ill Lacliiiit' Ciiiiiil nii Jiinr. :i, ISiKI. Aiilu|isy on .liiiic t'l, IHIKt. Weill her \ ciT wiiiiii. Di-coiiiiiusil inn iKlvaiitJMl. I''('ii In »•«•>; iiiircco^iiizalil"'. Skill (if liiiiiil.s 1111(1 IVd wliitr and \vi iiiUlcil. Hair not (irlacln-d. At miU'i- iiiikIi' nt ri^lil I'vclid a lacrrat ion liallan iiicli in li'n;i;lii, iinii'lruliiiK li'dl >>>> inch; imI^^cs rnj^^'i'd. ( 'cllniai' tissue in nci^iilionriioiid iiililt lati'd v\illi riMldisli scriini. IShiks of sknil and lace intai-t, Itrain a |.;ood deal so|'lcn«-d ; no a|i|icaran(-c of lacnioi- rlnijif oi' discHsi'. One pint of rcddisli Unit! in chcIi plcnra. No apprai - lUicc of fojH'iKn liodii's or frolii in iirondii. Stomacli alinosl cniply. ('(tiirfiisi'niis. 1. Tiu! Iiody is llial of a man pinlialils over 10 and uiidci' ">ll yi'ars of ajj,!-. 2. 'i'lic evidence's of inaoeralion jioint to a sveels or leii days in llu' wuter. H. '!'lie lacfalioii al-oiil I lie eyeii'oeral Monfhs — Aufopsj/. l''onnd in SI. Laurence river .Iumc (i, IS!!!!. Antojisy .Iiine 7. IHiCf. [ C'lotliin;j, niiuii toi'ii. Exfefiui! I\.in iiiimit inn. Hei^lil ■") fiel '.'> inciies-. i'lKiy e\leiisi\-ely fniaceraled, hut witliont nincli piitreract ive odonr. Scalp and tiesli of [face all K""^'. witli exception of tetni)i)ral muscles, k'avin;j; liones of lnknll and face hai-e. Flesli of tiMink and linihs softened and lar}j;e ])ieces nissinjj;. The snhcitaneous adipose t issne is I'verywliere changed into J, white, soapy suhslance. Skin and nniscles mostly >ione from liands, jeavinji' tendons and hones exposed. .Nails loosened, hut still attaclu'd to hands and feet. Puhis covi'r.-d with thick, dark hair. Lower jiart ' ah.lomcn much (iisi ended. No si^ns of .' i iury (o ihe hones nor any larks of violence on the body. I lUirnal j'Jjcainunilion. Muscles of dee|), hi'cfy vvi\ colour. Mam- lary glands firm and rounded, are. )la pale, tissue well ], reserved. No Itf Mlf?ns of ftiiy lluld r('M«»ml»llnK milk. In plcurii> nhout ii pint of rcfldlHh tliild. (jivitlcs of liciirl iifHi'ly iMiipty. ViilveH iiorniul. Luiikh (Mfpituiit throughout. F oiichl rrddt-iiod, fn•^^ from foreign bodluH. I'hurynx disiiitt'unitcd and rccliiciMl ton pulpy condition. Splccu nor- mill. Kldui'ys iiormiil, in cortex u few whit hh, gritty polntn, iippurcntly tyroHiu clusti'rs. Mliidflcr empty; mucosii normul, I'i'lvic orKniiH appear normal. A cupus iuteiim of \ inch diameter, with reddish tint In riKhl .. on •June 17. Ott June I: r)7 .Tuiio 1 1. 12 llOIII'H. .\Il)lllt'«Nll llai'lxnii', i')\iiiiiiiii'il liilirH.Hl'it'i rciiiovul. ill S (lilVH III I.aciiiiic CiMial. lOxaMiiiit'il mollis, alt 01 ri'iiiovai, W. It., Nallor. a^«>(l 21. Ki'll (iirHlilii. Nil III. irks di" cNtcnial iiijiiiy. .skin of liaiidH linn and NinonHi. .Skin til' soles ol IVit while anil wrinkleil. A lai'K't>aiiiniint nl' line vvliilc liotli issues rniiii iKtslrils. Wiwdr niuiiis jireseiit. Viscid ilnid in met lira. In I Ills case I lie w rinklin^ ol' c|iidci-iiiis ol' Holes app-aii'il lielorc llial nl I lie liaiids, owiiifj,' lo I lie lad llml I lie li'idv had lain wit h I he wcl liixils and socks on lor 12 Ikmiih het'ore lieiiiK cMliniiied. .Ire. if/ ih af/i. I', (i., a^ed Id. .Seen to fall oil' a wharf w hiie niacin^' a pinnway, on .Iiine (l('(if/i. I'nknowii mail. Body found a( Maisoii- iiouvo. Ki^i'or moil is present. Uodv iniuli docom- i)()so(l. J load and noik sw(»llen and nearly lil.ick ill colour. l"'oaturos olilitorated. N'^oins apjtoar as bluish-jiroon linos over upper ox- troiiiily. Skin of hands and foot while and wriiiklod. I lair comes oil" readily in scrap- iii}:;. Foil lid drotnud. (The time of immorsion was estimated at I one to two weeks.) 1(( days I A. M. Wharf labourer. Last .seen on a in Mont real wharf, and misstdby his friends the follow- ilarbour. ; \]\ix. iUiy. Foinul (/roirncd. Kxaminod . Kifj;or mortis jiresont. Reddish, frothy 12 hrs afto'-| lluid issues from nose, removal. I swollen and discoloured. ' oxtromily show as darl I I'alnis and solos wrinkled. Mead and neck Veins of upper lines in the skin. 2 days j J. R., afj;ed I"). Soon to drown while bath- in Laciiino I in^j;. Canal. Ripir mortis marked. Lividity postor- I'^xamined ' iorly. rndortakor's incisions for injecting Kthrs. after enibalming fluid. Skin cold and elammv. removal. No signs of deconijiosition. Slight wi'ink- 1 ling of skin of jialins, none of solos. Cutis I aiisorin.i absent. Abundant white froth I about nostrils. Su])erlicial abrasions about j backs of hands. Acridcntal drntli. :'. days • in Machine Canal l']xamined (i hrs. after removal. '< I i in St. Law- roiico River, Kxaniined 24 hrs. after rt'iiioval. St. P., aged 12. Seen to fall into water while playing. Putrefaction very far advanced ; body has an internal jmtrid smell. Head and neck swollen and reddened. Chest greenish. Rigor mortis present. Skin of soles and scrotum white and wrinkled.— vlrr. death. rnknown ;nan, 2(» to MO years old. Mud and grass :vbout lingers, Kliiderniis detaching over body. Skin of palms and soles white and wrinkled, llair can be scraped otV scalp. Decomposition advanced. Limbs t\iu-c\d.—Foii7id droioicd. (Lnmersion estimated at one to two weeks.) 1? 19 ExTEBNAL Examinations — Continued. No S-J I)ATi.:. .Inly i">. ^ m SI .Im1v:ii. iK] Auji. m. 04 Aug. V.l TiMK IN W ATI: It. (?) ill Monlrciil A(|llc(lii(M. I'Lxjiiniiicd 21 Ill's. Ufll'l' ri'iii(i\fil. 1 wi'ck ill St. Liiw- ri'iicc IJivcr l^lxiuniiicd 20)ir.s. .-ftc riMiiov il. ^ >iiiV.. ill Moii'lrciil Iliirliouf. Kxaiiiiiicd 12 hrs. after rcruoviii. 2 days in Montreal Harhnor. Kxaniiiied 10 lirs. after I'eiiioxal. llisToiiv Ai'I'i:ai{an( !•: T'nlcnowii ii'an ; iiohistory. Tallooniaik on ri^lit forea.in. Advanced inaeeratioii. liiinhs llaccid. Sealp and Mesh of head and face almost all detached, l-'lesh of hands and feet detached, witli exception of a few ra^K*''! fragments udheriiifi to the hones. Muscles of neck and ? 'uinatiou. Ace. didth. W. S., aged 2"). Di-owiied on same occa- sion as case No. iW. Accidcnftif (Icatlt. M'kl forming on face. Kigor mortis marked. Cutis Mserina of thighs. Skin of palms, solei^ and knees white and wrinkled. Hair lirnily attached. Face swollen and discoloured Abdomen green. Cenitals emphycematous. (Jreenish froth issuing from mouth. Numei(ms marks of parchmentation on trunk, which show in some cases ecchymosis bi'iieath them. On left arm small elevated areas due to ecchy- mosis. 20 I'^XTERNAL Examinations — Continued. Xo. 1)1 Datk. isij;!. Ciuil'd. TlMH IN WaI'KH. •Ml ; All''-. Hi. 07 98 An-i-. 1 Au-. 11 '1 liou Liicl ('ill Exaii S lii-s rciiH IS 111 liiiK' lal. lined lifter )val. Montreiil Qiianies. U lioiirs. Kxaiiiiiied 41ii-s. after remoxal. {>) History— AiM'KARANn; Coiirfiision. 'I'liere is e,vi(leiu'c' of lirnises made before deatli, and also abrasions ajiparently made after deatii. Tlieir sjonili- eaiice eaiinot 1k' determined w itliout more infoni. .ion about tlie cireumstanees of tlie ('ealii and recovery of the body. N'oTi;. It ai)peau'd from the, evidence 1 iiut ')'. W., who was unalile to swim, iiail seized Jiold of W. S., wiio could, and a violent sivup,jri(. took ])lace in coiise(iuence of the latler's ellbrts to save himself. The bodies were found closely locked together. This Kave a clear exiilanatioii of the ecchymosed spots. The otlier abrasions may have been caused at the same tiilie, but more probably were due to the jj,ra])])liii. Skin of palms and soles white and wrinkled. \o cutis an- serina.— .lrc/f/^'///rt/ (lid III. W. W. Missing since July (J (about six weeks). Circumstances of death unknown. Higor mortis present. Intense pucrefac- tion, odour like that of rancid fat. Epider- mis detaching from all parts of body, and has completely separated from the hands and feet. Nails gone from hands and feet. The exposed cutis is smooth, slightly red- dened and oily looking. Veins of surface ajipear as reddish or greenish hues. Hair readi'v scraped od' from scalp. Face and neck swollen and bloated. Tonguf pro- truding between the thickened lips. Eye- lids everted and eyeballs protrude. Scalp feels sodden and at the same time puffy and emphysematous. Reddish tiuid oozing from nose. M KXTEftNAf, KXAMINATIONS — Con///mtv/. UK) 'I'lMi'; IN \Vaii;|{. lIlSTOin AlM'KARANCIv Auir. -2]. '.'• (lays ill Monticiil Ilarl)()ur. Ivxaiiiincil 21ir.s. alter rciiioxal. NoTi:. Ill this ca.^e the ionjith of inun(>r- sioii was est iii;alc(l as iu-iii;;- at icasl 1 wo weeks. N'dt haviiij^r (lata conci'i'iiiii;;' (lie iipiiearaiiee of hitdics iiiniiersed lor sitccilied times at lliis season. I was uiialtle lo slate whether the appearances made it possible that the body had l)een in llie water for the whole six weei(r tl«e lon.n' whiirf on An)j;ust IS, ISiC!, with the inlention of conimittinjjj suicide. The two (•i)nipanions were saved. Kiuor mortis present. l/ii)s thieU. l''ace swollen, diseoloui'ed and bloated. lieddish lluid in month. 'I'estis retracted, scrotum einphysematons. Hair of scalp readily scrajied oil'. Kpidermis of hands and feet white and wrinkled, ixith on dorsal and palmar surh cc, .nid ))artly detached. Skin ove!' knees while and wrinkled, \ails ad- herent. (Iroenish tin;A'e over jiectoral and sternal ref:;ions. Snic'ulr. In the above report I have omitted the description of matters concerning identification of bodies, though, of course, these were recorded in the case of the unknown persons. As a rule the opinions in the casos of external examination were drawn up as follows : 1. The body presents the appearances of having been in the water for 2. The cause of death cannot be stated from external examination. In five of the cases it was stated that the body presented [external appearances found in drowned persons. In several cases it was stated that no external signs of injury were ^present. This statement I have almost ceased to make, as it is jcalculated to mislead the jury into supposing that violence by [blows, etc., has been proved not to have been committed, [whereas it is well known that blows of great force, sufficient, \ov instance, to fracture the skull, can be inflicted without leav- ing any traces upon the surface of the body. 21J In the c'aSG of those bodies where the cause of death remained unex})lainecl, it was a matter of keen regret to me that autopsies were only ordered in 2 out of 7 cases. It is true that the autopsy mi;^ht not have solved this point, owing to the advanced post-mortem changes present, but it might have shown the presence of water or foreign substances in the stomach, air passages, middle ear, etc., on the one hand, or on the other have shown some internal disease or injury. Mj opinion is that the grounds for ordering an antopsy should be simply that the death is obscure, irrespective of whether the difficulties produced by post-mortem changes lessen the chances of a positive result or not. This is the view held in all European countries, and all physicians charged with medico-legal work are officially notified that no degree of decomposition or diain- tegration of the hodg ever justifies a medical man either in refusing to perform an autopsy or in neglecting to recom- mend it. In my own work this view was always carefully stated in a general way to juries, both by Coroner McMahon and myself. As the matter of autopsies is still in an unsettled state in Mont- real and is on its trial, I did not feel justified in directly insist- ing on their being held, on the off chance of finding out the cause of death under unfavourable circumstances, from the feeling that a large number of negative results at the present time might prejudice the whole question of the routine performance of autopsies. I therefore only insisted strongly on an autopsy in my written report in three instances, where I was able to show beforehand that information would certainly be obtained on special points requiring solution. These were case 47, when a fracture of the skull was found ; case 49, where a fracture of the skull was shown to be absent, and case 50, where possibility of pregnancy was negatived. Thus in each case the information looked for was obtained at the autopsy. That in inquests upon the bodies of unknown persons found dead the inquiry should be habitually closed without having used such an obvious means of investigation as is oflFered by an 28 autopsy, is a matter for which the responsibility must be borno by the juries who had it in their power to order autopsies and neglected to do so. An additional case, not in this series, is added because an autopsy happened to be performed (at thi; request of a private individual.) The case presents some interesting features. ('a^ir Ktii, lS!»;i. J. T., uf^ed 2'i, coloured, wjis seen to sink in ;i public bath. \\v was able to swim, 'i'iu' statomciits fil)out the circuiiistaiiccs of the (h'ath were somewhat contradictory, l)nt it is certain tliat the body was removed from the water after an Immers ion of a few miinites only, and fruitless attempts at resuscitation were jmicticed by two skilful i)hysiciaiis. The body when viewed two hours after the accident showed (lae- cidity of the limbs. A white froth was seen ai)out the nostrils. The surface was still warm and quite dry, No signs of maceraticn. Two spots of bruising about the forcdiead. (Jonjunctiva' i)ale. A little fluid like sperm in the urethra. Autopsy 24 hours ]).m. Higor mortis nuirked, Foam still visible in nostrils. A few ounces of reddish (luid in peritoneum and itleui'ic. IMood (luid ; not thick or dark. Lungs bulky, inllated, crepitant throughout, gorgiil with blood, and show a few sub-i)leural ecchymosis and numerous small areas of ha'Uiorrhage in the substance. Out surface yields abundant rusty foam, not watery. Trachea, bronchi and larynx reddened and contain reddisli foam. Pharynx free. Heart enlarged, weighs ;{5t) grannnes ; cavities somewhat dilated. Tricuspid orifice dilated, measures (i inches in cir- cumference; other orilices of usual size. Hi-art nmscles very pale and bloodless, not fatty. A few ecchymosis lieneath ei)icar(lium ; ncme beneath tlie endocardium. Coronary arteries normal. Slight atheroma of aorta and mitral valves. Aorta and iliac arteries present slight but widely distributed atheroma. Inter- vertebral arteries slightly athero- matous. Radial arteries normal. Spleen .lormal. liymphatics and ; mesenteric glands full of white chylous fluid. Stomach contaiiis i2 oz. [of thick, greyish, sour gruel-like pulp, evidently for the most part digested, but including some lumps of meat nearly the size of walnuts. The mucosa thick and grayish, covered with adherent nnicus and with an exti'emely large number of whitish lymph glands as large as split [peas near the pyloris. Intestines full of ordinary looking faeces ; their [vessels full and injection of nuieosa marked. Kidneys large, weigh 2IM) Igrannnes each; shai)e somewhat hog-back. Cap.sules rather thick, [surfaces smooth and dark. Stellate veins full. On section cortex |thick or coarse looking and srpfa Iirrfi)n' wide. Bhulder contains 4 oz. )f ordinary looking urine. iJver normal. Head- In frontal region, m area of coagulated blood extravasated in subcutaneous tissue be- leath pericranium, diameter l.\ inches; bone not injured. Ihain nor- mal; vessels moderately full. Middle ear free from water. Vessels >f mastoid region extremely full of blood. Skull-cup dense, dipki; scanty. Conclusions.— 1, Death has been due to drowning. 24 2. P'riini llic (■omliiiiiii of the licarl fiiiil Uidiicvs i( i^ possililc IIimI tli( •subnu'i-sioii iiiii.v liiive l)L','u tluL- to u n.vii(()1)!iI altiicU, Imt this caiiiKd hi' stated with cortaiut, '. ;{. Tlie sij:;nirK'aiicc of I lie <'oiilnsioii on iho forelicad caiinol he stated; it sccins severe eiiou^ii to liave caused sttimiiii.u:. In this case it was probable from tlie signs of drowning being marked that some accessory cause was present. Whether til. was due to a blow on the head, or to some passing func- tional failure in a heart not perfectly normal, I am unable to decide, though the jury, by admitting heart failure, seem to have considered themselves in aposition to do so. The stomach at the time of death was still in full digestion, but most of the contents seemed to have been disposed of. Sufficient food remained to have masked the presence of a small (juantity of water, say four to five ounces. From the presence of arterio-sclerosis, in the absence of any syphilitic lesions, the possibility of alcohol as a cause of this change had to be considered, but I refrained from making any statement on that point in absence of any conclusive proof, knowing the pre- deliction of juries to bring in what may be termed "alcoholic " verdicts on very slender grounds. I have endeavoured to show in the discussion of the above cases that the collection of facts, such as they furnish, may enable in the future statements as to the length of the period of immersion to be made with more confidence. I think it is also fairly evident that it would be better as a matter of routine to have autopsies performed in cases of death from drowning than not to have them performed. When the object of the in(iuiry is to decide the (juestion of wilful homicide, it is indispensible that the physician making the examination should have a large experience in examining drowned bodies. If in ordinary cases the bodies are merely taken out of the water, viewed and buried, without being made available for scientific study,it is evident thft no one can possibly be expected to acquire the experience necessary to make him an expert whose opinion, in a really difficult criminal case, would be of much value. (2'o be conthiuiO.) 25 II. — Death by Poison (7 Cases.*) Of the series of 100 cases death was assumed to be due to poison in 7, or 7 per cent. Of these deaths 4 were suicidal and 3 accidental. The nature of the poison was Paris green in two cases, Rough on Ruts, chloral, chloroform, copper sulphate and lighting gas each in one case. In the matter of deman'ling an official analysis the medical expert is placed in rather an awkward position, as special per- mission has to be obtained f.-om the de[)artment before this can be done. This necessitates an adjournment of the inquest and a considerable increase in the expense, althou;;h the modest fee of twenty dollars \vh ch is allowed as a minimum for the chemical examination in ordinary cases is too low to permit of any good chemist and analyst profitably iindertaking the work. It is not well understood that, on general principles, the motive for dosirin;^ an analysis is simfjy that the cause of death is not satisfactorily explained either by the autop*y o the other evidence at the inquest. In other words, when an autopsy is performed without decisive results the expert cannoi feel cer- tain that poison has not been the cause. In such caset I have made it a i)ractice to state that it "■ could not be detert lined by the autopsy whether poison had been taken or not, and if the other evidence suggested poisoning an analysis had better be made," thus leaving the matter in the hands of the jury, who should be, of all persons in the world, best qualified to decide the question. It would be better if preliminary qualita- tive analysis (for a small fee) could be maile in all doubtful cases, but under the present jury system this course is imprac- ticable owing to the delay involved f A further disadvantage lies in the fact that at present we have no means in Montreal of freezing the suspected organs so * Roferonco has also been made to a few other cases which came under my notio during ihe s nne peiiod. t I hnve to thank Dr. R. F. Ruttan for having kindly made qualitative analyses fa, me in several ubscure cases. 3 20 as to check the progress of decomposition. Orgnns left at the ordinary room temperature soon develop putrefactive alkaloids, which closely resemble those of the vegetable poisons, wliile at the temperature obtained in an ordinary refrigerator, though the development o; these ptomaines h less abundant, their com- position and reactions resemble still more closely the toxic alkaloids. On the other hand, the more unstable vegetable alkaloids, and especially morphine, rapidly become decomposed and elude chemical analysis. In frozen tissues they remain unchanged for an indefinite period, so that nothing is risked by delaying an analysis except the results as regards volatile sub- stances (prussic acid, chloroform, chloral, etc.) My notes upon the cases of poisoning are as follows : ARSENIC. No. 30.— C. S., male, aged 40. Heavy drinker. Stated to have taken a large quantity of Paris green, with suicidal intent. Removed to hospital two hours later, when emetics and demulcents were given, with the result of inducing vomiting of a large quantity of greenish fluid. Moderate diarrhoea. The patient rallied at first, but afterwards died, six days later, in hospital. It was suspected that the patient had obtained a fresh supply of the poison, and an autopsy was ordered, which revealed a moderately severe reddening and swelling of the mucosa of the stomach and intes- tines. No ulceration. No traces of the poison were visible to the naked eye. Other organs normal. No analysis ordered. Verdict.— Death from suicide by taking Paris green. No. 29.— C. G. S., male, aged 55. Had been acting strangely foi about a year, but was able to attend to liis business. Found about four hours after taking a large quantity of Paris green. A series of doses of sulphate of zinc were given, amounting in all to 160 grains, with mustard and mucilage. This was followed by violent and long- continued vomiting. The patient died from exhaustion. Autopsy.— W&Wfi of stomach intensely reddened and swollen, being nearly J-inch thick through, and oedema and haemorrhage into the sub- mucosa. Surface of mucosa dark brownish-red, and covered with a bi-ownish, shreddy, sloughy coat. Particles of bright green pigment seen lying on surface. The seproved, on chemical examination by Mr. Wolft", to contain both arsenic and copper. Mucosa and submucosa of small bowel intensely reddened and swollen, especially in the duodeum, which shows numerous bright green grains. Scattered particles of this S'ubstance are also seen throughout the whole intestinal tract as far aa the rectum. ST In the brnin, symmetrical cystic wpots of softening, involving both internal capsules and reaching from opposite the head of optic thaiami back as far as pineal glands. ConcluHinna. I. Dcatli has l)een dne to an irritant poison, ^^articles of I'aris green are found in stomacli and intestine-'. 2. The condition of the brain is such as ftould prol)iibly be attended l)y mental weakness. Verdict.— Sairide u'/iilr in»nne. (In my limited experience of arseiiical poisoning, comprising al)out a dozen autopsies, I liave never met with such intense inllammation and huMnorrliage of the stomacli, and am inclined lo attribute it partly to the repeated doses of emetic given.) Case 32.— M. (i., female, aged 50. Died two hours after taking a dose of Rough on Hats. Known to have had the poison in her posses- sion for several weeks, and su|)posed to have taken scmie during that period. Symptoms. - ''^omiting, diurrluea and ccllapse. Treated by emetics and stomach-pump, with dialysed iron. ylit/07J.sy.— Stomach : Mucosa re;ldened, jmnctiform ecchymosis at pylorus, contains (1 oz. of rusty-looking tluid (Iron.) This substance seen in small intestine as far down as tiie valve. J^arge bowel contains soft, whitish-gray mucus. Intestinal contents free from fcetor. Kid- neys show nothing special. Throughout the liver, numerous grayish- yellow, blotchy patches, seen on microscopic examination to be dust. Diffuse and irregr'!>,rly distributed fatty degjneratiou of the cells, not limited in any way to the periphery of the lobules. (In this case the condition of the liver was a])parently due to a former unsuccessful attempt at suicide. The absence of fatty change in the kidneys may mean that this was not done in the form of small, frequently repeated doses. No analysis was authorized, but a private chemical examination showed the presence of arnenious acid both in the stomach and intestines. As Rough on Rats is made by rubl)ing together white arsenic and chari;oal, I thought it possible that some of the wood fibre of the char- coal might be recognized under the microscope in the contents of the intestine, and identified with that of the original powder, some of whicli was obtained. This did not prove to be the case, as tl'e char- coal was found to be entirely in the form of small amorphous black nodules.) SULPHATE OF COPPER. A. G., aged 2S, while despondent, made an attempt to cut his throat, which being unsuccessful, he drank nenrly a quart of saturated copper sulphate solution out of a battery jar in the electric works where he was employed as night watchman. Death \h hours later. Conscious- ness retained till the last. Intense abdominal cramps, with greenish vomiting and diarrhoea. Autopsy, 3i hours p.m. — Intense rigor mortis. Six shallow trans- 28 Verse Incisions In anterior roRion of neck, not penetrating further than the skin, edges lined with seiintj dried l»lood-eIot. Stomvch and intestines externally of a leaden-blue colour, contain a large amount of pale, gravlsh-green, (looculent fluid. The mucosa is dried and Hhrivelled thr uj;h)nt, an I has the app^-arance of having b 'en tarint'd. Tli ' nl'uo^a of stomach is staiiuul of a deej) green, from imbibition of tlio (1 lil CliMuicdly, the contents of the stomach were found to consist of basic sulj-snlnh ite of copper. Heart m\iscle and liver par.'iic'iyma loolc opa pie nnd grayish. Unl'ortunutely these organs were not examined for copper. CHLORAL (?)-DILATATION OF STOMACH.-SARCIN.T;. Case 82.— One case of death after a dose of 25 grains of chloral occur- red in a hard drinker, A. H., aged 30, male, who was sulFering from a mild attack of ddiriuin tremens, and was still under the influenr-e of liquor svhen the dose was given, lie became comatose almost imme- diately, and died in sij^ hours. .4u<07;s//.— Lungs voluminous. Numerous small sub pleural tcchy- moses. On section, large atnuunt of rusty froth on cut surface., with numerous small areas of lue:norriiage. No ctdema. Bronchi filled with reddish froth. Pectoral mus -ies have a markiul odour like alco- hol. No special odour noticed in liv.-r or brain. Heart not fatty. Stomach very large, reaching down to pubis; on opening, it contained nearly two quarts of a frothy, brownish i)aste, having a sweet, alcoholic, yeast-like odour, an I coutainiuj; partly digested food. Under micros- cope, large numbert; of sarcina' found Mucosa not thickened. No stenosis of pylorus. Other organs normal. (In this case I did not feel able to decide whether the alcohol or the chloral, or a coinljination of tlie two, had Irought about the death. The jury in this case probably came very near the mark in stating that tlie deceased •' died from the elFeets of alcohol, having succumbed to an ordinary dose of chloral." It can hardly be looked upon as a safe procedure to give a full dose of chloral to an alcoliolic without first giving him time to eliminate the alcohol from his system. The coincidence of sarcina ventriculi and dilatation of the stomach was very interesting, this condition neve /iug been, to my know- ledge, noted in connection with sudden d. .lU. Possibly the dilatation of the stomach may have acted injuriously by impeding respiration, but there was no proof that such had actually been the case, and reflex interference could hardly be seriously considered in the case of a man whose system was narcotized by alcohol and chloral. I also considered the possibility of the engorgement of the lungs being due to a commencing pneumonia, but this was definitely excluded by the absence of the pneumo-coccus in cover-slip preparations.) DEATH FROM ALCOHOLISM ( ? ) I may mention here another case, No. 81, that of D. M., aged 36, 29 male, a man who wns not an habitual tippler, but who had been drink- ing freely for some dayH, and was found dead KittlnR upright in a chair. AufopHi/.- Body that of a hunciiback. Tlicre was inten.se conge tion of the head and upper put of tl»e holy, witli numerous .small ecchy moses In the skin over the chest and shoulderH. Tlie ves.sels of the 1(^1 brain were found gorged with dark fluid lilood, and tlic lungs were \C dark, intensely cougeslL'l. witli extt'iisive patches of extravasation of Q blood in their substance. The bronchi were filled with froth. The other organs were noruial. No signs of injury. (Evidently *^.he iininediate cause of death was asphyxia, but what j^ was the primary cause of this asphyxia f A chemical analysis was 1', made for opium and morphia, but vvitli negative results. I am Inelined '.^^^ to put down alcohol a^ the cause, as there appeared to be no mechanical ; '^i, explanation. " '^^ In this case I found markel evidences of bronchitis, the bronchial ''\ mucosa being co irse and swollen and the t ibes filled with mucu.s. The .evidence taken by the coroner showeJ, however, that, though the de- cease:! h:i'i sulFksre I for sever.il years back frorn bronchitis and asthma, .his cou:^h hi:l buen much bittjr for soin3 niinthn back, and none of tho^e who ha 1 seen him in the last days of his lif j had noticeJ him to . cough much.) CHLOROFORM INHALATION. Cise No. 8'J.— D. L., male, a.?3d 2i, laborer. Died suddenly while - under cliloroform, at the Notre Dame Hospital, for the reduction of a • dislocation of the right shoulder. Had inhaled less than 3ii. Took the anaesthetic badly. ^w/ojosj/.— Moderate dilatation of the heart, with slight hypertrophy. Microscopically, no fatty degeneration. Slight did'use fibrosis of kid- ''-% neys. Lungs show abundant reddish froth on cut surface. Bronchi 4 contain reddish froth. Other organs normal. (The opinion given was that, while the heart and kidneys were not perfectly normal, there was not sufficient change in them to indicate I that chloroform inhalation would be dangerous.) I may append another case of death under chloroform, not in the , ;|| present series. S. L., aged 25, male. Died after inhaling 3iv. of chloroform from a iJunker inhaler, preparatory to operation for removal of a bronchocele, |in the Montreal General Hospital. The operation had not been com- lenced. At the autopsy, the only abnormability noted was a decided enlarge- lent of the spleen, which weighed liOO grammes, and a slight enlarge- lent of the kidneys, which weighed 210 grammes each. The heart wa jfound to be absolutely normal. In both these cases the chloroform used was Duncan and Flock- lart's. No analysis of the anesthetic was ordered- w In answor to a question from tli roronpr an to whether ohloroform waH liablo to cauHe lU'ath in hcaltliy iM'opIc, I stated tlnvt It wan re ({arded by many as a dan^fcnnis anient lielie, wlicme nsc was only /idvis able where for Home reason etlierconld not be emi)loyed. The oeour rence of twodeathw from eliloroform In a city where no death from ether has been recorded for Heveral yearn, thouKli ether is Kiven |)robal)ly Hve times a.s often as eldoroform, seems to me to i)ear out tills statement. In neither of tliese cases waH tlie deatii siiown to i)e in any way due to carelessness or want of sliill on the part of those administering It. Tiie usual restoratives Including iiypodermies of Htryelinine were employed, but, a» usual, witliout result. ILLUMINATING GAS. One case of death from this cauao, Included In my hundred caAes, is sufllclently typical. W., aged 74, who had never lieen In a city l)efore, was told l>y the bell-l)oy in a Montreal hotel tliat lie "could not" blow out the gas, He was found dead In l)ed ne.xt morning, having apparently perished througli the attempt to demonstrate the falsity of the lieli-boy's state ment. The room was small and smelt strongly of ga;,. The body, when viewed by me 48 hours after deatli, allowed nothing unusual beyond an extensive rose-red coiourati'^n of tlie skin in the dependant parts. I was unable liere to state that this was due to the characteristic change in the blood from tlie presence of carbon-monoxide, as tlie body had remained for so long a time in a very cold place, and in bodies kept in the cold a rosy-red change of tlic superficial parts atlecled by post-mortem lividity is very common. No autopsy was asked for, and the verdict was death from inhaling illuminating gas. Some blood obtained after the Inquest from tlie femoral vein w.as briglit cherry-red in colour. On diluting and examining with a hand spectroscope, two difttinct absorption bands are seen, which appmr practically identical untfi those of uxyhamoglobin. After adding excess of strong solution of ammonium sulphide, these bands becoxu somewhat fainter, but still remain insible, and the band of redurni hcemoglobin does not appear. On testing In the same manner bjddil obtained from a healthy person, the band of reduced hfemoglobin ap pears promptly on adding a very small quantity of ammonium sulpliidf I have underlined part of the above paragraph because 1 finti that this simple and easily recognized means of establishin;: beyond doubt the presence of carbon monoxide poison is not as generally known as it should be. It should be borne in mind that: (1) The spectrum of carbon-monoxide is practicallj indistinguishable from that oxy haemoglobin, but (2) on adding, a reducing agent the bands of oxyhaemoglobin become altered while those of carbon- monoxide persist.* •A freshly prep ired so'ution of ffrro-iitnmonium-tarturte works more rapidly tha«| ammuniuui-8uiphide as a reducing agent. 81 Other tests for the detection of cnrhonmonoxide are the addition of caustic alkali, tannin sohition, and other suhstances wliich f;ivo a diffiTcnt colour reaction v.lien CO is present, owiiij; to the fact timt tlio monoxidehnemo^lobin resists the action of the reagent more than nortnai hlood. I did not myseM find that these reactions were at all as satisfactory as the spectrum test. It must be remembered that if a victim lives a few hours after removal from the air containing the gas it will have dis- appeared from the blood. Hence the collection of a sample of blood should not be delayed. Placed in a well corked bottle, however, the blood will remain for a long time (over two years) without becoming altered, especially if diluted with an equal volume of satu ted solution of borax. Properly speaking, spectrum analysis of the blood ought not to be looked upon as part of an external examination of the body, though, as a rule, in other countries it is expected to be done by the j)hy8ician making the autopsy and not left to the chemist. For practical reasons, however, I now make a spectroscopic examination form part of the view whenever death is supposed to be due to inhalation of gas, as it seems, in the interests of the public, preferable to do so than to have death attributed jto this cause without any direct proof being brought forward. I may cite two other recent cases of gas inhalation where the Jause appeared to lay in the defective nature of the stop cock, [n which the catch was so worn away that it could not be known rith certainty whether the tap wasi turned off or not. Cases 116-117. —Mrs. B., aged (JO. Came in to Montreal on a visit rom tlic country and went to l)ed .vith iier little grandchild in good Jiealth and spirits. Both found dead in bed next day. Strong smell of is in the room six hours later, although windows were open. External Examination.— 'Rigor mortis present. Both bodies show )8y-red patches in skin of dependent parts. The lit^tie girl's body lows white, thick froth about the nose and mouth. No marks of Itolence. Bodies both lying faces upwards. Blood obtained in both cases is of a bright cherry-red colour. Eamined with spectroscope shows two absorptive bands in the green id ye'''>w spectrum resembling those of oxyhajmoglobin. On addi ig Kess Oj j«mnionium sulphide the lines persist and are still distinctly sible several hours later, though somewhat fainter. 32 III.— Death from Injuries (40 Cases). Death was due to homicide in 1 case, to suicide in 3 cases, and to accidents in 36 cases. The injuries were caused as follows : — .Homicide by blow, 1 ; railway accidents, 10 ; street railway accidents, 2 ; runaway horse, 2 ; toboggan, 1 ; other vehicles, 1 ; elevator accidents, 3 ; machinery accident, 1 ; falling bodies, 5 ; falls from a height, 2 ; firearms, 3 ; explosion, 1 ; burns, 4 ; asphyxia by food, 1 ; haemorrhage from umbilical cord, 1 ; sur- gical operation, 1 ; hanging, 1. Total, 40. The causes of death were : — j^racture of skull (alone, or associated with multiple injuries) 14 ; penetrating wound of brain, 1 ; dislocation of neck, 3 ; gunshot wound of heav' , 2 ; gunshot wound of neck, 1 ; crash of chest, 2 ; rupture of abdominal organs, 2 ; peritonitis, 1 ; um- bilical haemorrhage, I ; asphyxia, 2 ; burns, 4 ; concussivin, shock and doubtful causes, 5. Fracture of Skull (14 Cases). Case 7. -C. S., aged 22, brakeman, was missing after train had passed tlirough Victoria Bridge, Feb. (5, 1893. Tlie body was found just at the entrance to the bridge. Euieri. Examination. — Both legs lacerated and crushed, being nearly detached froni body. Body and arms unin.jured Thin, reddish, bloody fluid oozing from right ear. Laceration of scalp in right poste- rior region, beneath which mobility and crepitus of the parietal bone can be felt. Tissues about l^ft orbit ecchymoscd. Verdict — Accidental death. Apparently the blow on the left side of the face caused him to lose his balance and fall between the cars, the skull beiiig frac- tured in striking the floor of the bridge, and the wheels passing over the legs. Cask 12. — Tobogganing Accident — Fracture of the Base. — J. C, a girl aged 16, thrown violently against a telegraph \.o\e on Cote des Neiges Hill, Feb. 11, 1893. External Examination. — Bloody fluid oozing from nose and right ear. Marked cutis anserina. No crepitation can be felt in cranial bones. Slight prominence of second curvical vertebrae, with increased mobility of neck. No dislocation made out. Diffuse ecchymosis over right mastoid region. Verdict— Accidental death. I 88 In this case death was stated to have been inBtantaneous, which is rare in fractures of the base of the skull. Cask If), -h'fevator Acriiloif. -.1. ('. M., luiiU?, uKcd ;!'.). Head cawK'it between oU'viitor and wall of shaft, Alurch 1st, WM. Fell downwards into lower compartment of elevator, where the body was found. h'.i'tmuif K.iumhiiition. Hlood stains about head and hands ; cloth- ing blood-stained. In right teniporal region extensive ecchyniosis ; an extensive depressed fracture felt at junction of right frontal and tem- poral bones. In the occipital region a large (4" diameter) triangular llai> of the scalj) is torn nearly olf, being attached by its apex only, licft thundt nearly torn from the hand. Vci'.s.y, made jointly with Dr. G.ecn-ge Villeneuve, 32 hours after death, on June U)th, IHSKi. Incision made by undertakers for injecting the body ; in the right brachi;.'. artery and in i)eritonenm. Xo external evidences of contusion o'l'her injury about the head. A yellowish dried crust in right auditory meatus. A few small ecchy moses of the skin over right thigh, left knee and right iliac crest. On removing seal]), a narrow line of eccliymosis ext ends foi* 4 inches I'.orizontally along the lower border of the right parietal bone, averaging i inch in width, and situated in the subcutaneous tissue, immediately beneath *he skin. No evidences of decolorization of the extravasated blood. / 'ine of fracture extends downwards from the ujiper edge of the right s<|uaino-temiioral boiu" into tin glenoid fossa. Beneath the subcutaneous eccliymosis is a reddish area i inch in diameter lying in the bone near the corona! suture. On removing the skull cap and brain this is seen to corresjiond to a straight linear frac- ture -('in. long, near which is a curved fracture I inch long, both confined to the inner table of the right i)arietal bone. At this point there is a circumscribed spot of ecchymosis outside the dura. 'riu> thickness of the fractured bone averages from .'{ to 5 mm. The fracture of tlie tem- poral bone is seen to extend across the petrous bone into the basi- sphenoid. The ])ia is opaijue and yellowish, with abundant sticky lymph over the base and convolutions. This exudation is most abundant on the ;e''t side, esju'cially near the left Casserian ganglion, where it is dis- tmctly purulent. The subjacent bone and nasal cavities are normal. \o su])i)urat Ion in either tyniiianic cavity. Mieroscojiii; examination of the arteries of the pia shows an intense cellular arteritis. No ap- pearance of tubercles. Hivond the styjitic eflects of ilie chloride of zinc embalming fluid, the other organs were normal. Couvtiisious.'VrmMWw condition found at the autopsy, in spite of some peculiarities in the lesions found, there seems to be no reasonable doubt that death has been due to a meningitis which has resulted from a blow upon the right side of he head, fracturing tlie skull. 85 Tlie rase was jiresontcd before the pcnind jury, who found a No Bill. An interesting point was the fact that the meningitis was most severe on the side opposite the fracture, and that it arose w'thout any intervening suppuration of the middle ear. Upon being questioned as to whether the injury was the result directly of the blow or of the fall which followed it, we were inclined to consider the linear ecchymosis beneath the scalp, with a distinct fracture and ecchymosis of the dura lying directly beneath it, sufficient evidence that the fracture showed the effects of a blow from a narrow, smooth instrument. There are probably few more difficult points arising in coroners' cases than are involved in deciding whether fractures are due to the effects of a blow or a fall when both are shown to have taken place, as almost any form of fracture of the skull may result from a fall. The absence of any signs of decolorization in the ecchymoses, presumably produced ten days previously, was also confusing. Finally, the injection of the body, officiously made by the undertaker, further tended to complicate matters. The clinical history of the case was kindly furnished by Dr. J. M. Elder. Cask AK—Fvacture of tlic Skull and liodij of Uth Dorsal Vcrfcbra, vifhout c.i'fcnuil s'mnsi. — I). M., sailor, a>j;( ^ 2:^, fell 1« foot into the hold of a ship, strikiii}^ the head upon some iron rails. Was removed ini- niediately, hut was found to he hreathinji; l>is last. External Exainination. — Whitish fo mi about nostrils. Skin of nose lacerated and left nasal bone brok 'n ; a lacerated and contused wound izi K. parietal ref^ion. Internal Examination .—^In right parietal region the subcutaneous tissue of the scalp and tht; i)erl(raniuni are extensively eechyniosed, the extravasated blood extending behind the right ear down the sheath of the right sterno-mastoid. A line of fracture extends downwards along the posterior border of the right parietal bone, iind through the occipital bone to \.\w forotncn )iiiH))i, and a branch fracture extends through the nuistoid and petrous bone into the sjihenoidal (issure. fieneath the pia an extensive ditl'used hicinorrhage fills the sulci over the right parietal region, the inner surface of the right hemisphere, the lower surface of the left temporal lobe, and the upper surface of the cerebellum. Punctate luvmorrhages are seen in the ganglia at the base. Heart normal. Lungs crepitant ; intensely congested, with small haMuorrhagic foci scattered through their substances. Numerous snuill 36 oniphyseinatouH hubbies bcnoatli tlie pli'urir. Urom-hi fllli'd witli fine reddish froth. A liirgc aim of hji'morrliaj^e bdiiiid tlie aorta Just above the diaphragm on the rigid side, extending bfidiid the pleura. The body of the 11th vertebra is sei-ii to Ik- fraetured. and at this |)oint there is ha'uiorrhafj^e into the spinal eanal, but the cord is apparently neither lacerated nor compressed. Spleen large and soft ; weighs ;«H) grammes. Other organs nornuvl. An interesting point in this case was that the only injuries detected, on external examination, were the injury to the riose and the laceration of the scalp. No signs of the fracture of the vertebra or skull could be made out externally. The condition of the spleen possibly explained the ff'^t that the man walked in a remarkably stupid manner into the hatch- way, although there was a plank across it, by suggesting that he may have been in the early stage of some acute febrile dis- order. Frac/iire of Skid I triffi Midtiplc ('riishiiuj Jiijuries. .1. T. and L. L., workmen employed in tearing down the walls of a building destroyed by fire, were killed by a wall falling uj)on them. K.i:fcr)iiif K.v(t}iii nation Feb, 7, \fSY,\, 4 hours after death, which was nearly instantaneous. Cask 8. -,I. T. -A little clotted blood about nostrils. The skull felt to be extensively shattered, so that the head can be moulded into any desired shape. The superior maxilla felt to be fractured on both sides. Chest flattened on left side and crepitus felt over 7th, 8th and tith rilw in left axillary region. Comminuted fracture of left hume.us in ui)i)er third ; dislocation of left shoulder, with sejjaration of coracoid i)rocess. Kxtensive lacera- tion of left thigh on anterior surface from l'oui)art's ligament nearly to knee. Comi)ound fracture of left femur, tibia aiul libula. Luxation of right k.iee. Verdict— A cridentcd death. Cask!).— L. L. -Hlood oozing from ears. A depressed comminuted fracture of the left parietal bone near the vertex, with laceration of the scalp. Fracture of right sujierior maxilla and nasal bones. Fracture of right radius in middle third. Vi rd if t—Arcidcnttil death. An interesting point in connection with cases 9 and 48 was that the nasal bones were fractured, an injury often absent in the ordinary " broken nose." Cask 20. -M. O., aged 25, killed by falling of a derrick at the Wel- lington Street bi-idge, March 2i5th, 1893. Kcteriifd h\i;nn inaf ion. —Extvnuive connninuted fracture of skull, extending over the vertex from the level of coronal suture to occipital prominence, and laterally to lower border of parietal bones. Blood I 87 oozinjj; from nose unci H. our. Fiacture of II, tibia in lower third, and of H. libnla in npiu-r Miird. Vvnlivt ArcidfnIdI tUdfh. Casi;21.— P. G., aged 37, killed hv same accident. Numerous sub- cutaneous ecchymoses on side of trui..^, ri^ht arm and right leg. Serous bloody fluid about nose and both ears. Hight side of cliest (lattened, and crei)itus Is felt in right axillary region from the level of third rib downwards. Fracture of right thigh in lower third, and compound fracture of left tibia and libula in upper third. Verdict — . I rridentcif death. Case lo.- Crush of Head mid Cheat.— A. B., emjjloye of lloyal Elec- tric Co. Body was found extensively lacerated, having apparently been entangled in tlie machinery. No witness to accident. E.vternal K.rdmiiKition, .July 12th, IHIW. Scratches about hands, from which hiemorrhage has taken place. Comnunuted fracture felt in occipital region. Hlood oo/ing from both ears. A jagged, lacerated wound exten3. H.rtern((t h'.irnni nation. Head almost decapitated, being attached nu rely by«a strip of skin at occiput. Dislocation and crushing of cervi- cal vertebra*. Cervical vessels severed. Bruising and excoriation of skin about u))i)er part of sternum. Vertlivt -Accidental death. Case 23.— F. S., aged (53, female. Knocked down and trampled on by a runaway horse. External Ejcamination,- Bleeding from ears, nose, and mouth. 38 Honen of faco nuslicd. t'ppcr jiart of skull fri'cly movable on the base. Virilicf—A cr!(hnf((f thctlli. Casio \'\ Haihviiii Iniiifirs (/irixg fisc fo siisiHcion of llotnicidr Ity liloirs -Aiilojisj/.- V. li., a^j;('(l ;{(), a liiu'iuaii oini)loy»'(l by (ho Ufll Tele phone Company, left his homo to striuK some wires in the conntiy. Two days later his dead body was sent to his relations with injnnetions "not to oju-n the collln, as the eori)se was so horribly nian^^led by a railway aecident as to be seareelv reeoj^nizable as that of a human beinj^." The friends learninj^ that the wateh had been found on the railway track, ten miles from the spot where the body was found, sus pectedfoul play, and ujion openiuK the collin found no signs of injury to the body exeejjt a severe wound at the back of the head. An iiKpU'st was accordin}j;ly demanded. Autupsy made jointly by Dr. George Villeneuve and myself on June 1st, ISiW. Rvfrnidl Exdiiihi .,io/(.— The body was considerably decomposed. The clothing was smeared with blood, but not much torn or disarranged. The right external ear tilled with clotted l)lood. A lacerated scalp wound extended from the right frontal eminence to behind the right ear. The bones of the skull were exposed, and showed a small smear of black grease. A vertical scalp wound 1 inch long was foiind in the left jiarietal region. The bones of the skull could be felt to be crushed in, and were movable on i)ali)ation. Abrasions were found on the right forehead, chin, right cheek, right upjier arm and fore arm, left thigh, left patella, left poj)liteal region and left shin. These were free from ecchyniosis. Several contused areas of ecchymosis were found about the fingers of the left hand. Inlcnuil K.i-(itiil)iation. — A very extensive fracture of the skull was found in the right tenii)oro-])arietal legion, the bones being shattered into fragments not larger than 2" in diameter for an area of over a hand's breadth. The sagittal, coronal and lambdoidal sutures were separated. A line of fracture extended downwards to the left jugular fossa from the left extremity of the landxloid suture. From the right mastoid region a fracture extended downwards across the right petrous bone and basi-sphenold to the left si)lienoidal tissure. A third line of fracture extended down from the junction of the right coronal and sagittal sutures across the right orl)ital plate to the sella turcica. The brain cortex was much lacerated in tlu' right jjarietal region and about the posterior limb of the sylvian tissure, the right supra mar ginal and upper temporal convolutions being most injured. Corre sponding to this region, the dura was torn. No apjjearance of severe hicmorrhage at this point. The rest of the brain ajipeared normal. In i)ericardium several ounces of dark fluid blood. Near' the tip of the auricular appendix was a ragged laceration i an incli long. The heart was otherwise normal, l^ungs normal. Larynx and organs nf neck normal. Spleen normal. Half a pint of fluid blood in peritoneum. About the right kidney an extensive extravasation of blood behind the peri- toneum. Substance of kidney lacerated near the hilus. (Tliis condi a9 t ion was (ip|)ai'»'iit ly iliii' In u tractuic of llic lumbar vcrteljra-.) licft kidney in I act. Liver presents live lacerations running parallel along the npper sur- face of the ri^lil Iniie. Stoniacli and intestines showed no signs of injury. ('iK2'L liiipturr of Livn:—Pefi.tonitis. -,1. B. V., aged .30, when riding on top of a load of compressed hay, was squeezed l)etween the load and the roof of an archway in the Shedden stables. Died in Notre Dame hos]Mtal 4 days later with symptoms of septic peritonitis. A lit op^ii/ o\i Maicli 27th, hSiW, HO hours after death. Abdomen swol- len and dark-coloured. No external signs of injury. In peritoneal cavity three pints of dark, slightly fo'tid, bloody fluid. In places sliglit roughening of the peritoneum from recent lymph. In hyi)ochondria gi-eenish brown staining, ai)parently from bile pigment. Lirer An irregular, wedge-shaped line of rupture extends :{ inches backward fTom the anterioi edge of the right lobe, just to the left of the gall bladder. The edges of the wound are rounded and retr- "ted, and covered with fibrinous exudation. On making sections across the line of rupture a wedge-shaped area of Inemorrhage is seen to penetrate the liver substance almost to the posterior border. In tJie centre of this, posterior to the rupture is a pale aiuemic, wedge-shaped area cor- 46 rpspondiiiR to which is u grayish throiiil)ns occhKliiiK ii Inrp;e hriuich ni the portal vein, and iuosi'ly altachi'd to I In- liiLlma. Liver Hulmtaiice looliH iioi-iiihI. (lall liladder contains a talilespoonfni of clear K^iyisli mucus, ('oin- mon pill and cystic ducts intact and juTvious. Intestines contain K>'iiy- ish ticces apparently free from bile. Kidneys sliow slijilit |)arencliyinatouH swelling, afreet ing <'hieHy the colums of Hcrtini. Other organs normal. Unfortunately this specimen could not be obtained for further study, but evidently the presence of bile in the peritoneum, and its absence from the intestine without any injury to the common or cystic ducts, pointed to a laceration of one of the larger hep- atic ducts. The complete absence of external bruises is not at all uncommon in injuries of abdominal viscera. The verdict was " accidental death.^^ Cash {}M -Kffenaiir Genrnd Cnishiiiy and Liirmitioii.—A. H., aged 20, Itrakesman, fell between cars and was run over by two trains. h'.rfeninl Examination made August IT, IHSW. The head and right arm have been completely severed from the trunk. The left up])er arm is broken in several phtces. A large area of parchmentation occu- pies the right side of the chest and abdomen. A transverse lacerated wound penetrating skin and cellular tissue above each knee. The hmgs and heart are exposed by the laceration in upper part of thorax. Verdict Avcidnttal ditit/i. Cask HQ.-—Ktt<'ii.sire Crit.sh of Clwst and Abdoinoi.—M. I)., aged 2.5, was run over by a train near St. Henri, while walking on the track. Death was instantaneous. External Examination made August :?rd, 189H, 20 hours after death. Body in state of marked and advanced decomposition, attracting swarms of Hies. ]{igor mortis in smaller Joints. Chest and abdomen greenish. Chest comi)letely crushed in ; all the ribs apparently being fractured. Multiple fractures of both legs and arms. A few cuts and scratches aliout face and head. Verdict— A ccidental decdii. In this case the unusually early and rapid decomposition was doubtless due to rupture of the intestines and escape of their contents. Cask 3(5.— r/'it,s7i q/T/u',s7.— II. T. A., aged l{5, struck by an engine near Montreal .Junction. Apparently paid no attention to repeated whistles blown. E.eternal Examination, May 22, 1S9;{. Ilight side of thorax de- pressed in the axillary .and infra-scapular regions. The tissues in this region felt U) be emphysematous. The ribs from the .oth to 8th are felt to be fractured Just anterior to their angles. An area of ecchymosis, 3" in diameter, in the right tlank. Several deep scratches on forehead and nose. Verdict— Accidental death. 41 Owing to the question being raised of the man being deaf, I examined the tympanum by means of a specuhim and mirror, while making the external examination. There was no perfora- tion, but the drum looked dull, livid, and bad very much the appearance met with in chronic catarrhal otitis media. On ex- amining, for the purpose of contrast, the drums of two other bodies lying at the same time in the mortuary (both patients had been treated in hospital and were stated not to be deaf) the same dull and sunken appearance of the drum was noted, go that it appeared to be merely a post-mortem change. Dislocation of Negic and Fuaoture of Cervical Vertebra (3 Cases). Casio .5. .7. V., while driviiijj; in ii slci^li acroHs a railway tra<;k, was struck by the tcndi'r of an i-njiiinc ninninn backwards at tiic rate of Hu miles an lionr. The l>ody was thrown a distance of about 'M) feet. Death oecui'red in a few moments. KifniKil h\i(iiiiiiitifi(Hi, l"'eb. 1st, 1H!(3. On movinjj; the head, undue moiiility and crepitation felt in ui)per cervical region, about level of Srd cervical vertebra. Fractuie of left tlii^h. No other injuries. Verdict ~Acci(leiti'((l diath. Case 6.— A. 13., female, killed in same accident, body beint^ thrown a distance of 25 feet. Hlood oo/inj^ from nostrils. A scalp wound 3'' lonj^ in kift parietal rej^ion. On moving an, wiis iiivnlvi-d in .soiim- hiisiiH'.ss tniultlfs ; hIho (■(iniplaincd of piiiiis tit tlir luick of tlit' Iwud for some mniillis past. Was imlici'd liy his laiiiilv to be altcrrd in cliaiac tcr, and to liasf lost liis nicnioiv. Latterly In- Ui'pl '>'• rfpcatiiiK tlic saint' tliiuK' over and over, lie was foinul dead in his olllc*- on the morning,' of AuKiist i»lh, ISlKt, with a MH caliiitc revolver lyin^ close heside him. Aiifnpsji, inaiie uhont I'J hours after death. Hody of a well-noiir ished, elderly man. I''ully dressed. NothiuK ahont liody or clothinj^ to indicate a stniKu'"'- On the left sid(> of th<> head, 1 inch aliove the external auditory meatus, is a ra^Ucd, lacerated v\'oniid, I inch in diameter. The (h-eper parts of the wiaind are hIacUened, hnt (here is no powder tatooiiiK, ItlackeniiiK, or hurninK of the haii- or skin near I lie wound. On the rinht side of the head, li iuclies .ihove the meatus, is a rajiKfxii>- HiKlit «'Ii) of iiiH liead, on •liine ITtli, h'.iii'rna/ l''.ra mi natioti. ('lott(rd hlooil mixed witli disiiite)j;rate(l l)niin matter over I lie ri^lit slioiilder and ri^j;lit ^ide of luad. A iar^e huu-rau'd wound lA incheis in diameler involves tiie antt'iior half of the rif^ht car and the adjacent skin of the cheek, and from it hraiii tissue protrudes. The edfj;es of the wound are hiackened, and a sooty-locdiinj^ zone extends for 1 inches about the periphery. Hair aliout ri^ht ear singed. The whole rejj;ioii of the petrous hone ajipears shattt'red. The llooi' of the auditory meatus is intact. No wad or shot found. The hones of tlie skull can be felt to be fractured in many jilaces, and the head e.i.; be moulded in any desired shape. On opening the mouth, superior maxilla and hard palate felt to be fractured on the ri^ht side. On the rijjcht forearm a sooty mark extends across the radial side, ',\ inches above the wrist, the skin beinj; scorched and the hairs singed. The medical point of chief interest in this case was the line of powder smut across the radial surface of the right wrist, at a point where the skin would have been directly over the vent of the breech-loading shotgun used, had the deceased reached along the barrel to pull the trigger, after placing the muzzle against his head, as he was stated to have done by the chief witness at the inquest, who was present at the time of the suicide. Verdict, " Suicide ivhih insane.^' Cask 90. -J. I*., aj.;ed 20, accidentally sliot in the neck by an intoxi- cated friend with a shotKun, at 10 feet. Died almost instantly. External Examination, August 5th, 181)3.— Clothing about neck u hiiicaumI witli Itlixiil. [ii nnlcrior region of nock, at lovol of larynx, in A lai'K*'. «l««'p, huipnitt'd woiiihI. TIio i-dnoH of llir wiiiind nro inverted, and hIkiw powder tatooiii^ and lilackiMiin^ for a distanc)- of I inch from tlic wound. 'I'lic wound i.s l:i inclii's in dianu'tfr, and tin- larynx and Irarlifa arc torn opt>ii and Nt>t>n lo Im' tilled with hloody froth. No i.solate-' :itt)])s\i upon the body of a new born infant found at St. Lo i Knd, April !»th, WM. Mody of a female. ,1, I:J inches. No signs of violence. A little verni.x present in ti .npits and groiufi. The umbilical cord has been encircled with a piece of knitting wool, tied in a loose knot, but too loosely to compress it. The ligature can be readily slipped olF without untying it. The cord ai)pears to have been cut. The mnbilical vein and arteries contain a little soft clot. Large intestines filled with meconium. Stomach con tains air, but no traces of food. Small intestines empty, and sink in water. The lungs liglit pink ; an; fully distended ; lloat as a whole, and also when cut in pieces, except at the base, i'ortious compressed l)e- 45 I twoon hoards Htlll float. Tlwy nw ann'mic. Thv heart Is Mahhy and (■iillHpHtMl, and Km nivitit's inactically cinplv of hlood. Kirtal oi'ltiri-s pcrsiNt. S|ilct>n, kidncv.s, livt-r and liiiiiii arc all iiiti-iiscly anii'ink' and ainiiiHt hliiodl'.'iHH. ONHlllcalion in ^sl^rnunl and astraKnIns; none in lower (•pIphy.sJM of t'l innr. ( 'inirhtniiinn. 'riic I) "ly is that nf a firlns at almiil tlu> Mcvcntii ninnlh. Dfalli has appan-ntly i>f(>n dnt* to ha'innrrhaKc from thttiini- hilkal curd. 'I'licrc arc no sj^^ns of violence, The child has hreatht;d. \'iral I'seaped from his attendant and entered a svater closet, wiiere \\i' sin-ceed d in han^in^ himself npon ii liook liy means of a line made l)y Ids liracc a necktie and a piec(; of niailine, I'pun l)reiikinp; open the door a fe ndnntes later, he was found to lie dead. /•'.ifrrnii/ h'.ni iiiiii(i/li)ti, .Fnne 'Si, iXU',\. Hody of a heavy, noiscular man. On the head, left liand, left sliin, sacium and left hip are 'tried hlood crusts, Homo of which have heen detached, leaving a sli^^ht scar. Conjunct ivie pale ; not cccliymo;>cd. I'assin^i nnin'r tlie chin, just over the thyrohl cartilaKi-'i and terminal in^ in I he hair over the occiput, is a narrow livid Kn)ove U mm. in diameter honU'red l)y an ecehymotic /one. Viscid greyish lliiid exudes from meat us urctliije on pi'cssnre. Verdict Sidcidr hi/ /imii/iiij/, ir/dir iiiHdiic. Asphi/xiii Itji Fiiiiil. (i. M., aK»'d 2r». Found dead in l)ed. Supposed to have committi-d Huieide, lieinjj; out of work. The liody was stated to have heen found lyinj:, half out of hed, with the arms thrown out. Aii/o/isi/, May2i)th, IMili!. about 20 hours aflei' death. Bloody froth al>out nose and mouth. Nunu'rous ecchymotic spots in s'cin of hack. Intense lividity. Stomach half full of partly lii^icsteu !o(„i. Some food in (csophaj^us and |)haryn.\. All the orf;ans normal, with the exception of the huiKs, wluuh were almost coal-black in colour and had u f.ost severed from the body. Skill not greatly blanched. (\)tirhisu)it,s. 'I'hvrL' are se\i're marks of violence from crushing of the feet and ankles, with possibly an injur ■ to the vertebra'. The ex- ternal examination does not show the cause of death. Verdict Aeeidenldt didfli. Ca.se 1. — A. li., aged 40., streetcar driver. His cfvr collided with a railway train at a grade crossing and was completely wrecked. Died half an hour after reaehlng the Notre Dame liospilal on .Fan. Stii, 18!);{ Krteriinf I'J.ra iniiuilinn, IS lionrs after death, (ireenish tinge altont neck and abdomen. Large lacerated wound extending from right gluteal region downwards along outer surface of thigh and upwards over iliac ; crest into abdominal wall, A probe can be passed through this wound ; into the isehio-reetal fossa, and the right ischium is felt to be fractured. A distinct fa'cal odour noticed about the wound. Verdiet — Aevideutal (froth. There had apparently been internal haemorrhage from the vessels of the pelvis, with rupture of the bowel. Case 91.— A. M., aged 55, Was struck by an engine moving very 48 slowly, and knocked into ii cjittlp Kn-'iril at the wide of a ero,s.sinpj. Was able to walk home, ("oiiiplained of i)aiii in the right leg and rijziht side. Hefnsed to see a pliysician, l)nt was Ireatcid i)y a quaek. Stayecl in bed olVand on for S days, and afterwards went al)out. Four days later he- eanie nneonscions, on Auk- •">th, IS!).'}, and died dnriiiKlhe night. Hefore (h'atha i)hysi(ian was summoned, hut was unalile to make a diagnosis. h'.rfiriKf/ h\r(iiiiinii/ioii, Aug. S, IHiC}. Maritling of superheial veins. Mmphysem.i about neck and right side. The lower rii)fi on right side feel less resistant than normal, and give indistinct crei)itati()n. IJeyond a slight altrasion of left hip, which has nearly healed, no external signs of injury. ('(Hit/KHioitN.—Thi' cause of death cannot be determined without an autopsy. (Xo autopsy ordered.) \'rr(/icf Dcd/h fnitit fhc i-rmiKfi of /lin oirii liiiprii(frnrc. Cask 82. L. II., a boy, aged l;{. While out riding, horse took fright. The boy fell from saddle and was dragged along by the stirrup. Death oecuried 'M houis later. Verdict— At(i(frnti(/ dcdf/i. Pn'rafc A iifo/is//, made aftei' the incpiest.- At the back of the head is a laige lacerated wound, exposing the occii)ital bone for a distance of Ii inches. The edges look foul and dirty, and there is dirt in the deep tissues exposed. There is ecchymosis about the lower Jaw on the right side. Severe contusions and laceratiens of ilie skin ovei' the shoulders and lower abdomen. Fracture of the right thigh in middle third. Deep lacerated wound of left thigh in region of Hunter's canal. Feinora vessels not injured. Laceration of iilnar side of left wrist. On removal of scalp, extensivi' subcutaneous n of viol nice and Sfarrrition.— H. S., cigcd "0, an old man of intiMiii)eratt' lialnts was found dead in bed. Tlu' body was seen l)y a doctor who reported to the prcseiiee of brui.se.s on tlie I)aek (wliieli proved to be only post-mortem lividity,) and suspected a violent death, Anotiier theory was tiiat the old man liad been .starved to death. The jury met and adjourned several times and listened with* mucii attention to a great deal of circumstantial evidence. Finally they decided to authorize an autopsy of which the following is a condensed report :— Moderate lividity i)osteriorly. Xomarlvs of violence. Right pleura sliovvs trace of recent lympli in axillary region. Heart, right chamber.s moderately di.stended contain long stringy i)ale clots which extend into the Iminehe.s of the vena cava and pulmonary arteries. Right lung weighs 1920 grammes. The whole of upper loljc e.\cept anterior border completely solid and airless. On section, cut surface coarsely granular and gray, bathed with grayish yellow lluid containing small Jibrinous l)art icles. The rest of lung intensely engorged but crepitivnt. Left lung weighs 5.';0 gms., slightly hypera'mic throughout. Kidneys of natural size, .show a few cysts on surface, capsules adherejit. St;)inach contains food. Intestinal contents of ordinary amount and appear- ance. Brain, subarachnoid fluid abundant, otherwise normal. Other 52 regions show no I'vidcncrs of diaeaso. Tlie Inxly ihrongliout shows fatty tissue in norniai nniount. C(mHH,siontt.—\. Death has hccn caused by ])ncunionia. 2. There i'j no proof of starvation < .' of violence. Sinujularly enough in view of this niodicul Hltitomcnt tho jury returned a verdict that the dccoubed died of consumptioti, unci that nobody was to blame. Cask \.—Pnrinnoni(i--Su.si)r(frif I'oisoiihKj.—^. M., a woman aged fifty, of intemperate hahits, found dead in l>ed. l<\)r some reason susiiicions arose that slie liad lieen poisoned. AitfopN)/, — Ian. 25th, ISiKJ. Hody sliglitly jaundiced. No external signs of violence. Liver extends down to level of unihilieus. Heart nnisele brown, valves normal. Ilight lung emphysematous anteriorly, an area of consolidation found posteriorly, partly in the upjjer and part iy in the adjacent portion of the lower Ir.he. On section this is found to l)e grayish in colour, and g-anular; the surface bathed with a turbid grayish lluid, rest of lung n\odeiately congested throughout but crepitant. Kidneys small and slightly fibroid. Spleen nornuil. Intestines normal. Stomach contains a little curdled milk. Liver large, friable, pale and greasy, of orange colour, evidently in advanced stage of fatty degeneration and jaundiced. Coiirliisifnis. Thvre are evidences of a severe acutt pneumonia which has lasted several days and is sutlicient to explain the death. There is nothing to indicate poisoning. Cask H(7.— E. P. a't.40. A dissolute anj)si/.Mny '.mih, IHlKJ. -Mcscntric kIiukIm swollon iiiid Hiu'culfiit. (^onpjcst iiiM of serosa of stoiniuh. In rip;lit pleiini ifcfiit soft ii liltrin- ous particles. Mronchi reddened and contain a little nun^us. Left lun^ intensely con^^ested and u'deniatous ; near the base a few scattered j^rannlar areas of consolidation ran^inK in size from a cherry to a walnut. Jleart moderat My destemled, valves nonnal Spleen normal. Kid- neys slijz;hlly granular. Stomach, mucosa thickened and i-ed, covered with grayish mucus; mucosa of colon and lower ileum ri'ddened and swollen, liiver larj;e and i)ale, (Mit surface ^''I'Hsy, periphery of lobules whitish, tiall-bladder snows a small ))atcli of croupous exudation in the upper surface I inch in diameter. In thiH ctiHO Jilthou^h tho condition of the stomach suggested the etlect.s of alcoiiolism, the presence of a sevoi'e enteritis and ci'oiipous cholecystitis could not be explained in that way. Burial in consecrated ground which had been refused on account of tho verdict of the jury, was now sanctioned. Cask 'A.— Pnruinoiiia, alleged tUal/i frotn nt'i/lecf.—E, M., aged 3.J years, stated to have died on account of neglect by her parents. Aidnpsii, >]an. 2:f!/sis J'rotii ((.iinirj/s)ii of pidmonaif/ arlfnj. Uid^w//.— April 2i»th, lSi);{. Hody of a small, emaciated man about 40 years ohl. Recent blood stains about coat and shirt. Mouth filled with clotted blood. Xo mai'ks of violence. In thorax lungs project and appear inliatcd to an extreme degree. Numerous small areas of haemorrhage into the lung tissue near the anterior margins (|)nlmonary apoplexy). Bronchi and trachea full of fluid blood and soft clot. An old cicatrix at the right apex ; at apex of left lung a cavity the size of an apple, with thick firm grayish walls, which are for the most part smooth but in places covered with a thick layer of shreddy loosely attached decolorized librin apparently the residiu' of former luemorr- hages. i'ro.jecting from the wall of the cavity is a small sessile aneurysmal projection as large as a cherry stone sjn-inging from a branch of the pulmonary artery the size of a goose (piill. The walls of the aneurysm are very thin and llexiltle and a small laceration 2 mm., hmg is seen along its most i)ronunent jtart. An old cicatrix seen in the region of the cricoid cartilage, extend- ing across the neck. Cask 2;^.Siufrl,t liiiiK ill Niuno condition, the ohst met ions hciuK chicllv in the liii>r,.r Itriinclies of the ))nlnii»niiry artery. Spleen liirKc iintl soft, 2r»() f>;. Kid- neys top'Lher weiKJi \'A) Kriuinne.s. Uterus projects ahove lirini of j)elviH. Lenylh 12 cm., from fundus to internal os. Placental site anterior, covered hy a thicU j,'rayisli diptherilic lookiuK mendtrane. Slight I'o'tor. A few old erosions ahout cervix. Left ovary contains a corpus hitiMim H mm. in diameter. Pelvic and uterine veins free from thromiiosis, as are also the iliac and femoral veins. In ri)j;lit sajjhena vein a soft Ki'iiyinh red adherent thrond)Us. Ihain normal. Other organs normal. A ])oint ofiiitoi-eHt in iluH cuho wtis the Houi-ce of tlui embolus in the bJiphenu vein and not in the pelvic veinn. Heart Disease (3 (-ases). Cask 7i>. .1. a't. 50, ani((fi()ii. -An irregular laceration 1 inch long and 1 inch deep beneath left malar process. No (edema. Pra'cordial dulness not increased. ('oticlitsiDii.s, Thv external examination does not show the cause of death. Cask IW. S. 1)., aged 31. Had suffered from acute rheumatism wlu'n a young man. Lately very short of breath, obliged to sit up at night owing to a feeling of sufFocation. Had a cough. The day previous to death dyspncrn was very severe. Died during the early morning. E.itcniitI Km III i >i(i f ion .— Viu^i'r ends clubbed, and nails incur- vated. (Edema of both feet and ankles, none of face. < 'on elusion fi.— The \iody shows marked evidences of chronic inter- ference witli the circulation, probably from heart disease. In this c'iise the external evidence of serious organic disease present, combined with the history, left little doubt as to the cause of death. Cask 77. Mrs. (r.. aged 40. Found dead in bed. Had been in poor health for some time and was short of breatli. Habits intemperate (?) Aafo/)S!/. .luly l.lth, IHiW. \o signs of injury. Subcutaneous fat abundant. Heart larger than normal, chambers distended with blood. Left ventricle shows an extreme degree of hypertrophy and dilatation Aortic and mitral valves show extensive tibroid changes. The nuddle and right aortic segments are fixed and jierfectly rigid, being evidently incompetent. On the ventricular surface of the mitral valve just M lu'noalli tlio iioitip ruK)) is n iirojrctiiiK cnlciinHnis inasH, OriflccM of nrtrnml size. Ilcnrl lMll^(•l(• is of k«>o<1 I'hrrdfitni of (\>Iu)i — Mi(ffi/ifr S((rc()iiiii M. K., an elderly woman of intemperate habits. Refused hos])ital treatment and died in a stuteof jrieut s(iualor. Iixiuest held. Aufojjsi/, AuK-. '"^th, IS!);{." ("onsidei'uhle emaciation. Skiti rouKh anrl sallow. Surface ana-nnc. Marked urinous odor of l)ody. No marks of violence. Heart: riji;ht chambers distended with very i)ale, gi'liitincms (dot which is i)artly colourless or in jilaces very pale translucent red and evidently formed from extremely ana-mic blood. Wall of left ventricle over •/ inch thick. Muscle brownish, does not look fatty. Valves normal. Lunfi;s emphysematous, crepitant throughout. Organs of neck normal. Spleen normal. Liver small and brown. Kidneys greatly reducetl in size, weighing both together only C)t] grammes or aboutone fifth of the normal weight. Capsules adherent and thickened. Surface rough and granular, on section cortex seen to be greatly reduced and the organs cut w ith greatly increased resistance. 57 Small liit.'sttr.<' liit.'iiM.'ly .'■on^'CHh-d throu^'lioiii. TliroiiKlioiit law IkiwoI, Iroiii 111*' ni'cum to llic .iiiiis tm- foiinil rxtniNiv.' iilciTiilcd piltcheH, till" l»Hs»'s of wlilcli lire covt-n-d uith fxiilu-ntnt fmiKiilinj;, Kraiiiilalioiis, Ini iii^ I lie uppciiiaiiic nl new ki'<)\vUi. Ill (li(^ skull cap, nuini'roiis ikkIiiIch of solt j^'ravisli Ijssiic ur«' scatlcrod tliroiiKli the (liplno and I'licmacli upon the inm-r lalilc wliicli is in places complclt'ly ahsorlicd. The niaHscM rnnnv, in Hi/e I'l'oin .i pea i,, a cherry ami are evident ly secondary deposits of a niallKiiaiit Ki"<»wlh. Mrain normal. <'(iiirliim'.()iis. Death has proliahly iieen due to iiricmia Ironi cirr liosisof the kidney. The deceased was also t he siilijecl of cancer. The diseHSes |U'eseiit would ulliiiiately have heen fatal in spile of any medi- cal treatiiu'iit. MicroHCopic examination hIiowocI tho growths in the hUuII- cap to bo lympowarcoma. Microncopic, Hoetionn of tlio uIcoi-h in tho intOHtino showed no ovidonco of now growth. Tho diagnosis of ur!i>mia as tho itnniodiato caiiso of doath app('ar(ul justified from tho fact of coma and corwulsions hiiving pro- coodod death. The anaemia was jjrohabiy duo to the cancerouw disoaHO of the bono marrow. Cerebeai, II.kmorriiage (5 Cases). ("asm .'{7. — Circhrdl //iniion/iaf/c — Conginitnl ('j/.s/if Kidnri/.—A. I-., aK*'*!'^!. Became suddenly iinconscioUH and died in a few houis on May 2;{rd, IWCi. .1 iifdjisj/. — Hoth kidneys eiiorniously enlarged, weijjthinj; H(K)and !HK) Krammea each. They are transformed into a series of cysts set so closely together that no renal tissue can he seen with the naked eye. Ifretersand bladder normal. ThrouKhout the liver numerous small cysts rangiiij^ from pin head to peas in size and tilled with clear (liiid. Microscopically these are seen to he dilatations of the minutehile ducts. On removing brain an extensive recent lia'morihaKi' is seen orij^in- atiiij; in the rej.!;ion of the left external capsule. The lateral ventricles are full of blood. The vessels at the biise are not atheromatous. The smaller vessels examined microscopically ;ii'e found to be fatty. In this case the disease of the kidneys was so striking that this might have been thought to exphiin tho death, had the brain not been examined. There was no history of any renal symptoms. The coincidence of cystic kidney with cysts in the liver is stated to bo tho rule. Cask Wy.—Riijjfurc of (,'nrh>il(ir Ai-trri/.—.l. C, ayed .")(), a saloon- keeper, dropj)ed suddenly dead. Was a heavy eater and drank a f;ood deal. Ai(f()jtsy.~,Jnne 2Hth, IHIKJ. Heart greatly hypertrophied. Kidneys large, dark, hog-back in shajjc and cut with resistance. JJraiu, extensive sub-arachnoid ha'morrhage about base, most abun- dant posteriorly, and evidently compressing the 4th ventncle. Vessels at, base thick and rigid. On the right anterior inferiorcerebellar artery A8 is iin iitlifntmalolis |iiUrli, iit wliirli the vi-sscl pri'sfiils ii Inccnitcd Hpol (tf niplurt'. Cahk 7M. Cii'ihnil Aiiiiiri/sin. .1. <'.. iiKcd 1.*. Died smltli-nly in n linitlii'l wIm'Ic she uiis iiii iiiiiiiiti'. Aiifii/i'*!/. -'illy mil, lf^t':<. On ii' \iii|j; luiiiii ilu- t'litirc Itasc ntvert'd willi ii sulHinu'lmoid liii'iimrrhiiKf fXlcmliiiK uIoiik tin- Nylviiiii llsHiiicH and over till' iMf<'riur MirfiUT of Mir (•(•rilu'llmii. Tin' Itli vni (liclf lillcd Willi diilU clot inoiildiMl to llic sliiipi' of llic vciil ricl«'. I.iilfnil vi'iilriclfs iii'i- Ironi cldt. A yellow l»n>\vii iirrii (d' soflt'iniiK I iiicli ill diiuiH'tcr ill the lidl cMfrniil inpsulf .iraillif ln'ud of I lie ojitir tlialainiis. Tin- ccifhial arlciii-s thick and at luTomatoiiH willi Ki'dly calcilit'd plali's. On Ilu- inferior Hiiiiacf of tin" imU'ridrnMiimiuiirutinK urtJ'ry In a Hacculiited imcurysni I lie Hize of a larp' Ifn I" wliicli a laeer atloii Is seen. On the inferior surface of the ri^^lil temporal IoIh' is a recent reddish spot of sid'teniiiK in the centre of which is a Ihroinlai.s occ'lndiiiK a spot id' laceration in the wall of a small artery, lii^art. larKo. Left xeiilricle thl(l<. Kidneys Itelow normal size, Hiirfaces Kranularand cortex greatly reduced. I.iverof a\ era^*' siz«S fiialdc, and pale ytdlow ; in advanced slate of fatty rh-j^eiieral ion and show calcar- eous cliaii;;*'^'- Holh ovaries ari^ surrounded hy deiiHc adhesions. Ill this cuso it was ofiiitoroHt to note tlio cxiHtonoo of two luomofi'luigoH which must have occuffcd ii week (»r ho boforo the fatal hiomori-ha^o, witho'it tho ac(juaiiitanceH of the (JecoaHod having noticed any symptoms. GasI'; li. — h'a/iditr (if Si/lrltni Arfrri/. N. I'., af?('d •'lO. Died sud- denly. /I »/^oy>.s//— July 11th. IH!):?. A line woolly lookiiif^ while froth ahout nostrils. Over sternum is a mustard plaster, heueath which no sij^n of redness or vesication is seen. Lun^^s voluminous. Siili pleural ecchy- moses. Ileait lar^e, wei^iil is .").")() j^raiiimes. Left ventricle dilatt'd and its wall hypcrtrophied. Helow the cus|)s of the aortic valves is a rough calcarceous ytdlow iirojectinp; mass, winch almost occludes the oritice. On ventricular surface of mitivil a few small recent lihrinous ve^^eta) ions. liUngs (edematous, cut surface rusty looUing. Hroiuhi ftill of froth. Xear lower ext remit y of s])leen a jiartly decolourized hieinorrha^'ic nfarct t he size of an v^^f. Brain. On removal, an extensive dark tirni dot covers tlu' entire base. A little clot in ttli ventricle. The source of the ha-morrha^^e is seen to be a rupture of the right sylvian artery at a j)oint where the vessel is extremely atheromatous. Thus, in three out of the four cascH, tho source of the haimorrhiigo was readily discovered, which is always a source of satisfaction in giving evidence. The verdicts in each case was of course apoplexy. In some cases when the vessels are atheromatous it often is a point of extreme difficulty to determine whether a fatal haemorrhage has been due or not to somci intervening act of violence involving a slight blow or a fall. This complication did not arise in my ca^es. 59 AnsnEss OF UiiAiN KKOM Mn»i»i,K Kaii I>iheask, Cask Ns as lat'Kc as a lien's van, lillt>d with );;ri>«>niHli yellow |ins, is sitnuted in the riKhl liendsphen>, lyin^ iiehind I he lissni-c of Rolando, and has imrst into tlu' liKliI lateral ventricle near the desecnd- inK horn. The cortex external to the ahscc.s.s Is no thicker than a sheet of liioltiiiK paj)er. Tlu' alisccss wall is formed of thick reddish Ki'iiy py;>)^enic nieiiil)rane. A little |)ns is t'ound in the left lateral, as well as tlielh'dand !lh ventricles. About the optic chiasm and sylvian iissures and over the c«'reliellum id»undanl creamy pus lies lieneath the arach- noid. Iliemorrha^ic inliltrat ion of cortex in ri^ht temporal lohe. The 'nlernal ear, and on liolh sides, shows ahnndant reddish K"iy Krunnla- tioiiH, in which the osnicles are imbedded. Moth diiims are jierforaU'd. Mastoid antrum contains a little mucoid lluid. The ri^bt mastoid cells are soft and appear carious. Sinuses at l)ase of skull normal. All other organs look liealthy. Still Births (2 Cases.) Casio W.— Crrvbral /Iiinii>rr/iii(/r in a niirlxtni Infnnf, .1 m/o/>.'7/.— On an unknown male infant found at Cote St. J'ail, on Feb. 2llh, 1H!«. Hody fro/en, Lenj.;tli IH inches. Wei^;lit .") lbs. 2 oz. ConI lipitured with white cotton thread. Head ol)li(piely llattened on the rJKbt side. A little veruix about armpits and Ki'oii''^' Mecoiuum about anus. Scrotum lar};e and odemalous. Testes descendi-d. Xo si;;ns of in.jury to sialj). Ijaige, caput succedaneum in left te:-ni7oral rej^iou. Bones of skull not broken. At the base of the brain is a blood clot the size of a pip'on's (>^;;-. lyiuK near the medulla. A little ha-morrhafie about sylvian Iissures. liUngsdark red, contain no air, portions excised sink. Stonuich empty. Meconium in larj^e and smaller bow-'ls. i'ipiljhysis of femur shows a reddish vascular area, but no delinite ossilicat ion. Hands and nails well formed. (.'oiuiuHlons, The child is not (piHe at term but is viable. There is no proof that it has bicathcd. Death has been due to cerebral ha-m- orrhaj^e, there is no j)roof that this has not occurred durinj^' labour. In tluH case 1 was obliged to examine the l)rain while it was still frozen, contrai-y to the usual directions laid down. I found the examination could be tnade very well in the ffozen state whereas as soon as tliawing set in the brain substance melted into a gi-nyiwii fluid. It has occuiTed to me that the examination of brain lesions when thei'o is reason to expect 00 softening from JcoompoHilion, ini tilled with coai'se granules blackened hy osmic acid and soluhle in c'hioroforn:. Valves normal, fictal orilices open, l.ungs, )tale grayish while, feel solid and heavy, sinking in water. On section are dry and granular, alveoli are seen uiidei' microscope to he- disteiuled in places by small cell exudation (wliite hepati/ation). A little grayisli mucus in stomach. Brain, sylvian lissure seen as a broad groove. No other lissures visible. A centre of ossilication in calcancum : none in astragulus or stermnn. I'lacenta not obtained. r'(mr/w.s-/(>n.s.— The body lias not reached the sixth month. Death lias been due to hetal jineurnouia with degenerat ion of Ihi' heart muscle, both j)robably syiihilitic. Death from Unknown Causes (10 Cases). Case Wh~(ktpUUi nj Thntmhusin of liritin. I'mir/ifonn Iltvmovr- h(i(/es.—,T.S., aged .it). Out of sorts for some days but alile to work. Wliile at work was taken with vomiting and convulsions. Soon became comatose, and died within 'M\ hours. I'liiie was alliuminous, passed in fair amount. A 11/0//^!/, Aug. 21st, ISiCH. Hody ])oorly nourished. No external marks of violence. Thoracic and alxlondnal organs apparently healthy. Microscopic examination of kidneys shows no evidences of disease. Hrain, on dissection shows, in the region of the basal ganglia and the internal capsule numerous (12) areas of punctiform ha'mon-hage, giving the appearance, on section, of angiomata, the areas ranging . from k to 1 inch in diameter. The main vessels of the brain look iiealthy and the organ apjiears '/therwise normal. Miscroscopical examination of the ha-morrhagic areas shows the minute aiterioles tilled with liyaline throndii and surrounded l»y extravasated bh'od, in which the corjiusdes appear normal. On being asked for my opinion I could only state that there was extensive obstruction of the minute vessels of the brain with no evidence that this condition was duo to violence, but that this did not satisfactorily explain the death. A verdict of death from natural causes was returned. The * Dr. Cattell, of Philadelphia (Vainimilii Med. Maga::ln<), has also recently called attention to the advisability of freezing the braii: under th&so oircum.' \\e other hand in the EegiBtratiition Eeports for Massa- 62 chusettH, epilepsy Ih assigned as thecauso of 112 deat'^'! out of a total of 42,087, the total for the year 1888, i,s 1 to 374, and in 1887, 1 to 371>. In 181>1, the proportion vvaH about the same, being 1 to 304. In New York, for 18!)1, the ratio wan 1 to 28f;. In Paris, Uorthillon's Statistic lor 1888 gives 1 in every 1,222 deaths from all causes as tlie proi)ortion duo to epilepsy. Of course the proportion of deaths from epilepsy among sudden deaths alone, would be much greater. Lessor ( Vierteljahrachr. Gerichti M'ul., ,lan 1888), in ar, analysis of 171 autopsies in sudden deaths gives 17 as the proportion due to epilepsy. Wynn Wostcott, (British Med. Jour. Ort. 17th, 18!) 1), in an analysis of 303 cases of sudden death, mentions 8 cases whore epilepsy was assumed to be the cause. Vibort joports a case where a marked congestion was found in tlie brain of a woman, supposed to have died in an epileptic tit. Of course a cerebi-al hremorrliage might be brought on by an epilei)tic seizure. That it is not safe to jump at conclusions as to causes of death was shown by a subsequent case (No. lOG), where an 0])ileptic girl, in whom the seizures were stated to have become alarmingly frequent had died shortly after a violent convulsion. In this case I gave the stereotyped evi- dence that the cause of death could not be stated without an autopsy and found afterwards upon making a private autopsy, advanced cirrhosis of the kidneys, the convulsions having apparently been uncmic and not epileptic. 1 do not think a medical witness is justified in ascribing death to epilepsy until he has satisfied himself by an autop.sy that it is not due to some organic disease and even then the statement should only be that the sym])toms point to epilepsy and nothing is found at the autopsy to indicate othei-wise. Deuility (?) t'ASK 11.— F. G., a^c'd 5 mouths. Stated to liuvo died from m-gli-ct of Ikt paiTiits. Krfrnid/h'.raiii i nation.— i\n'n\ emacialioii. Skin rouwli and locse. No si^iis of violence. Coiicluslaii.—Tha cause of death camiot l>e slated witliout an autop.sy. Tliecliaiices of recovery had a i)hysiciaii Ih'cu summoned .shortly l)efore death would liave been diminislied l>y the previous ill- health of the child. Verdict. -Ko criminal blame attached. Case 95— S. C, aged about Go. A feeble-minded old woman was 63 lost sIrIU of at a iMciiic and disiipiM'arod. The body was found in a tliickot near-l)y 5 weeks later, and was (luite naked, tlie clotliin^- lyin^ in a heap upon it. Aiitopsi/. Auj:;. l(i, ]mi. Intense and far advanced putrefaction and deninlation of li.-ad, and the soft parts of the face and neck liave been almost entirely destroyed. These i)arts are swarndng witli niagK<)ts. No evidence of violence or injury. The l)rain is represented by a cn])-full of thick ^^'yish lliiid. The muscles are deej) red, resend)linj; corned beef and are well pre- served. Subcutaneous and omental fat al)nndant. 'I'he abdondnal organs are almost free from deconii)osition and apjtear healthy. 'J'he stomacli contains a little collee colored llnid. Heart empty. Lun^s dried, and shrivelled, the air entering freely aljout the neclv. Organs seem liealthy. Conrlusloius. There are no evidences of violence, but tlieii' altsence cannot be positively allirmed owing to advanced decomposition. The cause of di'atM cannot be stated. Tho jury camo to the deci.sion that slio died pjii-lly from fright and partly from oxhuustioii through having walked too fai'. ThiH did not explain in any way the curious fact of the clothing having been I'emoved. Dr. Jiuttan kindly examined tho viscera for mineral poisons, but with a negative i-osult. Case Ho. — P. C, aged S7. I'reviously healthy. Found (h-ad. Kvfn'ufd Kmniind/ioii. — ^.July 'M, 1H1K5. Shows no marks of violence and nothing to indicate the cause of death. Verdict.— Died from Heart J)isen,se, Cask (H). M. (I., female, aged 75. Died suddenly while in apparent good liealth and spirits. External Kvaitii)i<(tion. — June liJtli, iHiKJ. Hody of ext remely stout woman. No evich-nces of violence or disease externally. Cuiitiuaioti. — The cause of death cannot be stated without an autopsy. In this case the jury having been firmly convinced that the deceased had died ^' parce que le bon D'leu (i voulu la rctirer de la terre,^' returned a verdict of death from natural causes through that sense of propriety which keeps jurymen from Hnding fault with the decrees of Providence when doing so involves a loss of time. _;, ,' - . ' , ,•■ • •^' . . .'• • A;'»f)riE'xY ,(i)' , , L. C, aged «ti1, ,*ed |)i-oleHNi()naliy for 12 years. Tho reason lie aHsi,i,nied I'or tiie cause being apo- plexy was that the deceased had a very short ihick neck. Cask 24. A. M.. mfilf, fined is. h'alhiT iiilciiiiicralc. Suh.ji'Ct to t'ljilcptic tits Hoci'iidy luul fin al tack of licMiipli'L'ia. Was picked iij) d.viii^' oil" "n-ily moriiiiiK lifiviiif; Ifiiii on the road till iii^lit. r:.itriiiiil E.rain'nuitiiiu.' \\n-\\ 2nd. IS!i:i. IlccenI scmtchcs on hacks of liands, forclicfid, left oir and ddn. No (itlicr iniiiksof violence, ('tni('hiKi(tn.—\{ is Jinpossil)le to stfite the cfuise of deatli from t'Xleiiifii exfiniinat ion. VcrdicI Dfdtli I'ruin /lara/i/sis in/i/riiidtid hi/ i.r/ipeiired for 2(1 dfiys and fifterwfirds Wii^ firresled find Wfis I lie chief witness at the iiKpiest. h'.i/rrnal I'J.fdinindfiiDi.—^ltuvh llth. 1S!>.'!. Contused lacerated wound over the left orbit. Mehind the rifjlit etirllicre is coiitnsion find iilinision of the skin. CuHclusloii. The e.MeriifU e.Xfiminat ion docs not Just ify