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UNIVERSITY
OF CALIFORNIA
LOS ANGELES
SCHOOL OF LAW
LIBRARY
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MEDICAL
JURISPRUDENCE
FORENSIC MEDICINE
AND
TOXICOLOGY
R. A. WITTHAUS, A.M., M.D.
Professor of Chemistry, Physics, and Hygiene in the University of the City of Neiv York, etc., etc,
AND
TRACY C. BECKER, A.B., LL.B.
Counsellor at Law,
Professor of Criminal Law and Medical Jtirispritdence in the University of Biiffalo
WITH THE COLLABORATION OF
August Becker, Esq.; Chas. A. Boston, Esq.; W. N. Bullard, M.D. ;
J. Clifton Edgar, M.D. ; D. S. Lamb, M.D. ; W. B. Outten, M.D. ;
Hon. Wm. A. Poste; Edward S. Wood, M.D. ;
E. V. Stoddard, M.D. ;
Hon. Goodwin Brown; J. C. Cameron, M.D. ; E. D. Fisher, M.D. ;
H. P. LooMis, M.D. ; Roswell Park, M.D. ; Irving C. Rosse, M.D. ;
F. P. Vandenbergh, M.D. ; J. H. Woodward, M.D. ;
George Woolsey, M.D.
VOLUME ONE
NEW YORK
WILLIAM WOOD & COMPANY
1894
Copyright, 1894,
By WILLIAM WOOD & COMPANY
PRESS OF
THE PUBLISHERS' PRINTING COMPANY
132-136 W. FOURTEENTH ST.
NEW YORK
CONTENTS.
PAGE
Introduction, v
Medical Jurisprudence, . ' 1
The Legal Relations of Physicians and Surgeons. T. C.
Becker, 3
The Law of Evidence Concerning Confidential Communica-
tions. Chas. a. Boston, 89
Synopsis of the Laws Governing the Practice of Medicine.
W. A. PosTE and Chas. A. Boston, 135
Forensic Medicine.
Thanatological, 293
The Legal Status of the Dead Body. T. C. Becker, . . 295
The Powers and Duties of Coroners. A. Becker, . . . 329
Medico-Legal Autopsies. H. P. LooMis 349
Personal Identity. J. C. RossE 383
Determination of the Time of Death. H. P. LooMis, . . 437
Medico-Legal Consideration of Wounds. G. Woolsey, . . 457
Medico-Legal Consideration of Gunshot Wounds. Roswell
Park, 591
Death by Heat and Cold. E. V. Stoddard, . . .627
Medico-Legal Relations of Electricity. W. N. Bullabd, . . 661
Medico-Legal Consideration of Death by Mechanical Suffoca-
tion. D. S. Lamb 705
Death from Submersion or Drowning. J. C. Rosse, . . 793
Death from Starvation. E. V. Stoddard, 813
II^TEODUOTIOK
The terms Forensic Medicine, Legal Medicine, and
Medical Jurisprudence have heretofore been used inter-
changeably to apply to those branches of state medicine and of
jurisprudence which have to deal with the applications of med-
ical knowledge to the elucidation of questions of fact in courts
of law, and with the legal regulation of the practice of medicine.
Medico-legal science therefore includes all subjects con-
cerning which members of the legal and medical professions
may seek information of one another, each acting in his profes-
sional capacity. It consists of two distinct branches: that
treating of medical law, to which the designation of Medical
Jurisprudence properly applies; and that relating to the ap-
plication of medical, surgical, or obstetrical knowledge to the
purposes of legal trials. Forensic Medicine.'
The term State Medicine, which is sometimes erroneously
used as synonymous with forensic medicine, properly applies to
a more extended field of medical inquiry; i.e., to all applica-
tions of medical knowledge to the public welfare. State medi-
cine, therefore, while excluding medical jurisprudence, includes,
besides forensic medicine, public hygiene, medical ethics, med-
ical education, and military and naval medicine.
Toxicology, the science of poisons, may be divided into
' The distinction made in the text medical topics, rather than an ac-
and in the title of this work is not quaintance with the medical science
new. It was recognized by the necessary for the elucidation of legal
father of medico-legal science, Zac- subjects. As it is our peculiar ob-
chias. in his two prefaces, one to ject to unite the sciences and to show
the " lector medicus, " the other to their mutual relevance, the title be-
the " lector legumperitus" ("QujBst. comes most applicable to this, al-
Med. Leg. ," Ed. Venet. , 1727, fol.). though it may have been improperly
In a note to the introduction of the affixed to former works. " The title
"Medical Jurispi-udence" of Dr. of one of two existing French works
Paris and Mr. Fonblanque (the first in wliose authorship a lawyer is as-
work produced by joint authorship sociated is : "Traitede Medeciue le-
of a physician and a lawyer, in 1823) gale, de Jurisprudence medicale et
is the following (p. i.) : "Someau- de Toxicologie, " par Le Grand du
thors have objected to the term Med- Saulle, Geo. Berryer et Gab. Pou-
ical Jtirifipruflcnce, as impljnng a chet, 2ded., 8vo, Paris, 1886.
knowledge of the laws relating to
VI INTRODUCTION.
medica„ Toxicology, whose object is the prevention or cure of
all forms of poisoning, and forensic toxicology, whose aim is
the detection of criminal poisoning. In its last-named relation
toxicology differs from forensic medicine in one important par-
ticular. In all cases other than those of poisoning in which
questions involving medical knowledge arise, the answers are
entirely within the functions of the physician, the surgeon, or
the obstetrician, but the problems of forensic toxicology require
for their solution the further aid of the chemist and the phar-
macologist.
Forensic medicine is an applied science, partly legal, partly
medical, calling for information and investigation in widely
divergent lines, and becoming more minutely ramified with the
progressive advances in medical knowledge and in those
sciences of which medicine is itself an application. Its devel-
opment has been dependent partly upon the slow though pro-
gressive tendency of medicine from the condition of an empiri-
cal art toward that of an exact science, and partly upon the
more rapid and more advanced development of criminal juris-
prudence. Medical jurisprudence had reached a high develop-
ment during the early history of the Roman Empire, and at a
period long anterior to the first recognition of forensic medicine.
Although the literature of modern medico-legal science is
very largely written from the medical point of view and by
physicians, its earlier history is to be found in fragmentary
form, partly in medical literature, but principally in the writ-
ings of historians, in the earlier criminal codes, and in the early
records of legal proceedings.
In the earliest historical periods the functions now exercised
by the priest, the lawj^er, and the physician were performed by
the same person, who, presumably, made use of what medical
knowledge he possessed in the exercise of his legal functions.
Among the Egyptians at a very early period it is certain that
medical questions of fact were considered in legal proceedings,
and that the practice of medicine was subject to legal regulation.
According to Diodorus, ' " when a pregnant woman was con-
demned to death, the sentence was not executed until after she
was delivered. " The same author tells us '^ that " the physicians
' "Bibl. Hist.," I., ii., 77; Miot's ' L. c, I., ii.,82; transl., i., 165.
trausl., Paris, 1834, i., 157.
INTRODUCTION. Vli
regulated the treatment of the sick according to written pre-
cepts, collected and transmitted by the most celebrated of their
predecessors. If, in following exactly these precepts which are
contained in the sacred books, they did not succeed in curing
the sick, they could not be reproached, nor could they be prose-
cuted at law ; but if they have proceeded contrary to the text of
the books, they are tried, and may be condemned to death, the
legislator supposing that but few persons will ever be found
capable of improving a curative method preserved during so
long a succession of years and adopted by the most expert mas-
ters of the art. " With the system of legal trial in use among
the Egyptians ' it is difficult to imagine that the question of the
existence of pregnancy in the one case, or of malpractice in the
other, would not be the subject of contest, and, if contested,
determined without the testimony of obstetricians or of physi-
cians."
Medical knowledge among the Hindoos was further advanced
than among the Egyptians. In the Rig Veda (about 1500 B.C.)
occur a few medical references, among which is the statement
that the duration of pregnancy is ten (lunar) months.
The earliest purely medical Sanskrit texts are the Ayur
Vedas of Charaka and Susruta, which were probably written
about 600 B.C., but which are undoubtedly compilations of in-
formation which had been handed down during many centuries
before that time. In each of these is a section devoted to
poisons and their antidotes (Kalpa) , in which it is written that
a knowledge of poisons and antidotes is necessary to the physi-
cian " because the enemies of the Rajah, bad women, and un-
grateful servants sometimes mix poison with the food." Full
directions are also given for the recognition of a person who
gives poison, and to differentiate the poisons themselves, whose
number, from all the kingdoms of nature, is legion. The age
at which women may marry is fixed at twelve years, while men
' Z,. c, I., ii., 75, 76; transl. , i., scriptions of remedies, and their
153. uses, inchidinK the incantations to
^ The "Papyros Ebers, " in the be used with them. (See"Papyros
University of Leipzig, the most Ebers, " H. Joachim, Berlin. 1890.)
ancient medical text known, was The same is true of the Berlin and
written about 1550 B.C. , and is prob- Leyden papyri. The Bibl. Nat.
ably one of the books referred to by (Tf. 2) possesses a Chinese manu-
Diodorus. It contains no statement script on legal medicine. The cat-
bearing upon our subject. It is, alogue does not, however, state to
however, simply a collection of de- what period it belongs.
Vlll INTRODUCTION.
may not marry before twenty -five. The duration of pregnancy
is ^iven as between nine and twelve lunar months, the average
being ten. The practice of medicine is restricted to certain
castes, and requires the sanction of the Rajah, and the method
of education of medical students is prescribed.'
It is singular that the Greeks were apparently destitute of
any knowledge of legal medicine. Although medicine and
jurisprudence were highly developed among them, allusions to
anj' connection between the two are of very rare occurrence and
uncertain.
The Hippocratic writings (ca. 420 B.C.) contain many facts
which are of medico-legal interest : the possibility of superfce-
tation was recognized ; '^ the average duration of pregnancy was
known, and the viability of children born before term was
discussed,^ the relative fatality of wounds affecting different
parts of the body was considered,^ and the Hippocratic oath
makes the physician swear that he " will not administer or
advise the use of poison, nor contribute to an abortion." The
position of the physician in Greek communities was an exalted
one. No slave or woman might be taught medicine,^ although
later free-born women were permitted to practise in their
native places. Homer also refers to physicians as men of
learning and of distinction." The Greek physician was there-
fore in a position, both from his information and from his
standing in the community, to aid in the administration of
justice.
The Greeks were also extremely litigious and possessed a
code of criminal procedure which was elaborate, and in many
respects resembled those now in use in England and the United
States." The writings of the Greek orators, Demosthenes, JEs-
chines, Lysias, Antiphon, Isocrates, etc., which have comedown
to us substantiate the claim of ^lian that " to Athens mankind
' For an account of early Indian partu, " ed. Littre, viii., 432, 436,
medicine, see Th. A. Wise, "Re- 452.
view of the Hist, of Med.," Lond., * "Aphorism i," \i., 18, 24; "De
1867, i., 272 et passim: "Hindu Morbis," ed. Littre, vi., 144.
System of Medicine," 1845, by the ^ petit, S. : "Leges Attica?, " Lugd.
same author: Haeser, "Lehrb. d. Bat., 1742, lib. iii., tit. 8.
Gesch. d. Med.," 3. ed., i., 5-40. « "Od.," iv., 229; xvii., 384.
- Hippocr. : " De Superf cetatione, " ' For an excellent account of Attic
ed. Littre, viii., 472. criminal procedure, see Kennedy,
"Hippocr.: " De Septimestri C. R. : "Demosthenes' Orations,"
partu:" Ibid., "De Octimestri ed. Bohn, iii., 326-372.
INTRODUCTION. IX
is indebted for the olive, the fig, and the administration of
justice." '
The writings of the Greek physicians contain no refeience
to any legal application of their knowledge, and certain passages
in the writings of the orators seem to indicate that, while a
phj'sician was called to inspect and treat a wounded person, the
testimony as to the patient's condition was given in court by
others.
Thus in the case against Euergos and Mnesibulus, in which
an old woman had died some dajs after an assault, Demos-
thenes ^ states that he notified the accused to bring a surgeon
and cure the woman ; but that as they did not do so, he himself
brought his own surgeon and showed him her condition in the
presence of witnesses. Upon hearing from the surgeon that
the woman was in a hopeless condition, he again explained her
state to the accused and required them to find medical aid.
Finally, on the sixth day after the assault the woman died. He
further asserts that these statements would be proved by the
depositions.'
The third Tetralogy of Antiphon' (B.C. 480) relates to a
case in which the defence was essentially the same as that which
was the subject of a vast amount of medical expert testimony
in a celebrated trial for murder in New York not many years
ago. A person wounds another, who dies some days afterward.
The assailant is accused of murder and sets up the defence that
the deceased perished, not from the wounds inflicted, but in
consequence of unskilful treatment by the physicians.
In neither of these cases is any mention made of physicians
having been called upon for testimony ; indeed, the statements
would lead to the inference that they were not. In another case
in which a poor and sick citizen is accused of malingering to
obtain the customary pecuniary aid from the State, Lysias^
summons no medical evidence but relies entirelj* upon a state-
ment of his client's case.*
' " Var. Hist.," iii., 38. at a preliminary trial, and referred
^Kennedy's transl., ed. Bohn, to at the trial by the orator.
v.. 95. -"Oratores Attici," C. Miiller,
^ What the contents of these depo- Paris, 1877, i., 20.
sitions were and by whom made is - "Oratores Attici, "C. Miiller, ed.
unknown, as the papers referred to Didot, Paris. 1877, i., 200-203.
by the orator are not given. In the " In a doubtful fragment of Lysias
Attic courts the testimony was taken the expression "as physicians and
X INTRODUCTION.
Medical legislation was not more advanced during the as-
cendancy of the Roman Empire, although medical science was
greatly developed, principally by the labors of Celsus, and of
Galen and other Greek physicians. A few cases are mentioned
by the historians which would seem to indicate a closer connec-
tion between law and medicine than had existed among the
Greeks, but the}' refer rather to the custom of exposing the
bodies of those who had died by violent means to public view,
in order that any one might express his opinion as to the cause
of death, than to any appeal to medical science in the adminis-
tration of justice. Thus Suetonius ' sajs that the physician
Antistius examined the dead body of Julius Caesar (b.c. 44),
and declared that of all the wounds only that received in the
breast was mortal.
Pliny ^ cites an early instance of contested interpretation of
post-mortem appearances in the case of Germanicus, who died
A.D. 19, by the action of poison, said the enemies of Piso, be-
cause the heart did not burn. The friends of Piso, while ad-
mitting the fact of non-consumption, attributed it to the de-
ceased having had heart disease. The same author^ quotes
Masurius as having declared a child born after thirteen (lunar)
months to be legitimate, in an action for the possession of
property, on the ground that no certain period of gestation was
fixed. The Emperor Hadrian (a.d. 117-138), according to
Gellius, sought medical information in a similar case, and
decreed the legitimac}' of a child born in the eleventh (lunar)
month, " after having considered the opinions of ancient philos-
ophers and physicians." '
Although the Justinian collections, the "Codex" (a.d. 529),
the "Institutes" (a.d. 533), the "Digests," or "Pandects" (a.d.
534), and the "Novels" (a.d. 535-564), prepared by the best legal
talent of the age, under the direction of Tribonian, do not pro-
vide for the summoning of physicians as witnesses ; they con-
tain an expression which indicates that at that time the true
midwives declare" {uffTrepollarpolKal - "Hist. Nat.," xi., 71.
al fialat a-eprjvavro) is used in con- *"Hist. Nat.,"vii., 4.
nection with the question whether •* A. Gellius: "Noct. Att. ," 1. 3,
a foetus has life and maybe niur- c. 16: "requisitis veterum philoso-
dered. Cf. "Orat. Attici," Miiller phorum et medicorum sententiis."
and Hunziker, Paris, Didot, 1858, The word " refer2a?i" seems to indi-
ii., 257. cate that the emperor consulted
^ "Jul. Cses.," 82. books, not living physicians.
INTRODUCTION. XI
function of the medical expert was more correctly appreciated
than it is to-day. His function was stated to be judicial rather
than that of a witness.' There is also a provision that in cases
of contested pregnane}', midwives (who were considered as be-
longing to the medical profession) should, after examination of
the woman, determine whether or no pregnancy exist, and that
their determination should be final. The practice of medicine,
surgery, and midwifery was regulated. Those desiring to
practise must have been found competent by an examination.
The number of phj^sicians in each town was limited. They
were divided into classes, and were subject to the government
of the Archiatri. Penalties were imposed upon those guilt}' of
malpractice or of poisoning. The Justinian enactments contain
abundant internal evidence of having been framed in the light
of medical knowledge. They contain provisions relating to
sterility and impotence, rape, disputed pregnancy, legitimacy,
diseased mental conditions, presumption of survivorship, poi-
soning, etc., which indicate that the medical knowledge of the
time was fully utilized in their construction."
The Germanic peoples at about the same period possessed
codes in which traces of a rudimentary inedical jurisprudence
existed. The most ancient of these was the Salic law (a.d.
422), in which the penalties to be paid for wounds of different
kinds are fixed. The Ripuarian law, of somewhat later date,
takes cognizance of the crime of poisoning. The laws of the
Bavarians, Burgundians, Frisians, Thuringians, and Visigoths
contain practically nothing of medico-legal interest. The Lex
Alamannorum has numerous provisions relating to wounds, and
expressly provides that the gravity of the injury shall be deter-
mined by a phj'sician.^
During the period of about a, thousand years, intervening
between the Justinian and Caroline (vide infra) codes, the
advancement of medicine and jurisprudence suffered almost
complete arrest. The guilt or innocence of an accused person
' " Medici non sunt proprie testes, burg. 1838: M. F. Eller. Bull. Med.-
sed majis est judicium quam testi- Leg. Soc. N. Y., 1879. i., 220-287;
moniuni."' and Friedi'eich. Bit f. ger. Anthr.,
- For accounts of the medico-legal Niirnberg, 1850, I., iii., 1-64; 18(52,
provisions of the Justinian enact- xiii., 188-215.
ments, see: G. A. v. d. Pfordten, ^ See Mende : "Handb. d. ger.
"Beitriige z. Gesch. d. ger. Med. Med.." Leipzig, 1819, i., 83-87.
riKs d. Justin. Rechtssam.," "Wiirz-
Xll INTRODUCTION.
was determined rather by his own confession under torture, or
by " the judgment of God" as shown by ordeal or by judicial
combat, than by testimony either expert or of fact.
Even during the night of the Middle Ages, instances are
recorded in which the opinions of phj-^sicians were sought to
determine questions of fact in judicial proceedings.
In the duchy of Normandy, in 1207-45, the laws provided
for the examination of those claiming to be sick (to evade
military service or appeal to judicial duel), of persons killed,
and of women.'
In a decretal of Innocent III., in 1209, the question whether
a certain wound was mortal was determined b}- phj'siciaus.'
There is extant in the statutes of the city of Bologna, under
date of 12-49, an entry to the effect that Hugo di Lucca had
been assigned the duty, when called upon by the podesta, and
after having been sworn, to furnish a true report in legal cases. ^
In the kingdom of Jerusalem (ca. 1250) a person claiming
exemption from trial by battle because of sickness or of wounds
was visited by a physician {fisicien au miege) and a surgeon
[serorgien) , who examined him and made oath as to his con-
dition.'
Sworn surgeons to the king are also mentioned in letters
patent of Philippe le Hardi in 12T8, of Philippe le Bel in 1311,
and of Jean II. in 1352.' That of Philippe le Bel refers to Jean
Pitardi as one of " his well- beloved sworn surgeons in his
Chastelet of Paris," whose functions are partly indicated by
the extracts from the registers given below.
The registers of the Chatelet at Paris from 1389 to 1393
record several instances in which medical aid was rendered in
judicial proceedings. Under date of March 22d, 1389-90,
*'Maitre Jehan Le Conte, sworn surgeon to the king our sire,"
reports to Maitre Jehan Truquam, lieutenant to the provost,
that " upon that daj' in the morning one Rotisseur had gone
' ■' Etablissements et Coutuines. fuisse letalis, " Mende, " Handb. d.
Assises et Arrets de I'Echiquier de ger. Med.," i., 91.
Normandie au xiii. Siecle." A. J. ^ Hensschel. in " Janus, " Breslau,
Marnier, Par., 1839 : "veued'homme 1847, ii., 135.
en langueur, veue de mefaits. veue * " Assises de Jerusalem, " Beu-
d'homme occis et veue de femme gnot. Paris, 1841-43, quoted by Orto-
despucelee. " Ian. I.e., infra.
'-'"Ut peritorum judicio medico- * Ortolan : ''Debuts d. 1. Med.
rum talis percussio asseveretur non leg.," Ann. d'Hjg. . Par., 1872, 2
s. , xxxviii. , 361.
INTRODUCTION. xiii
from life unto death in consequence of the wounds which he
had received on the Monday evening preceding." ' Under date
of July^2d, 1390, is an account of the examination of one Jehan
le Porchier, accused of intent to poison the king (Charles VI.),
in which there is reference to a very early instance of toxicologi-
cal expert evidence. In the wallet of the accused certain herbs
were found. The account proceeds: "Richart de Bules, herb-
alist, was summoned, to him the above-mentioned herbs were
shown, and he was commanded that he should examine them
and consider well and dul}^, reporting the truth of what he
should find. The said Richart, after having examined them
with great diligence, reported that in the box in which these
herbs were he had found six leaves, namely : one leaf of jacia
nigra, and one of round plantain, called in Latin p^antago
mitior, and four of sow-thistle {lasseron), called in Latin rosti
poterugni, and says that the leaf oijatria nigra is poisonous,
but that in the others there is no poison known to the depo-
nent."'^ On August 12th, 1390, "Jehan Le Conte and Jehan
Le Grant, sworn surgeons of our sire the king," are present at
the torture of a prisoner, but for what purpose does not appear.
In another case the same Jehan Le Conte testified that a wound
in the head of a deceased person was made with an axe.^ At a
later period in Ital}', the infliction of " the question" took place
under medical supervision. Zacchias devotes a chapter, De
Tormentis et Poenis,* to the consideration of the different
methods of torture, the degrees of pain and danger attending
each, and the conditions of age, sex, and health which render its
application inadmissible.^
During this period, as indeed from the earliest times, the
practice of medicine was regulated hj law. Thus a law of King
Roger of Sicily (1129-54) punished those who practised med-
icine without authority with imprisonment and confiscation of
goods; and an edict of Frederick II. (1215-46) imposed like
penalties upon those who presumed to practise except after
graduation at the school of Salernum.*
■ "Registre Criminel du Chatelet ^ See also "Reg. Crim. Chat, de
de Paris, " Par. , 1861, i., 255. Paris.," i., 204. ii.. 429: Desmaze :
- Ibid., i., 313. "Hist. Med. Leg.," 11-20. 33-41.
^Ibid., i., 375, 409. « Isensee : "Gesch. d. Med.," i..
^"Quajst. Medico-Iegales,"t. ii., 316.
lib. vi., tit. ii. ; vol. ii., pp. 33-49,
ed. Venet., fol., 1737.
XIV INTRODUCTION.
Medico-legal science was formed in the middle of the six-
teenth century by a simultaneous awakening of jurists and
physicians to the importance of the subject.
It was in Germany that expert medical testimony was first
legally recognized. In 1507, George, Bishop of Bamberg, pro-
claimed a criminal code in his domains. This was subse-
quently adopted by other German states, and finally was the
model upon which the Caroline Code, the first general criminal
code applying- to the whole empire, was framed and proclaimed
at the Diet of Ratisbon in 1532.'
These codes, particularly the Caroline, distinctly provide
for utilizing the testimony of physicians. Wounds are to be
examined by surgeons who are " to be used as witnesses ;" ^ and
in case of death one or more surgeons are to " examine the dead
body carefully before burial."^ Thej' also contain provisions
for the examination of women in cases of contested delivery, or
suspected infanticide ; * for the regulation of the sale of poisons ; *
for the detection and punishment of malpractice;^ and for ex-
amination into the mental condition in cases of suicide and of
crime.'
An early work on the practice of criminal law, based on the
Caroline Code, was published by the Flemish jurist, Josse de
Damhouder, in 1554. It contains a chapter treating of the
lethality of wounds, which should be determined by expert
physicians and surgeons,^ and describes the course which is to
be pursued in the judicial examination of dead bodies. This
is probably the earliest printed book (other than the laws them-
selves) containing reference to medico-legal examinations,^ and
antedates the writings of physicians upon the subject.
Although it was only in 1670 that the Ordinances of Louis
XIV. gave to France a uniform criminal code, medico-legal
reports were made by physicians and surgeons to the courts
' "Constitutio criminalis Caro- ^ "Con. cr. Car.," art. 37.
lina." The first edition was printed " /6«d., art. 134.
atMayence, 1533, fol., by J. Schof- ''Ibid., arts. 135, 179, 219.
fer. See also Kopp, "Jahrb. d. ^"Non perquoslibet, uecper insi-
Staatsarznk. , " Frankf., 1808, i., pidos et imperitos, sed tantum per
183. peritos ac doctos medicos aut chi-
•2 "Con. cr. Car.," art. 147. rurgos," p. 245.
^ Ibid., art. 149. * "Praxis Rerum Criminaliuni, "
"^ Ibid., arts. 35. 36, 131, 133; Antw., 1554 (the dedicatory epis-
" Bambergische Halssgerichts-Or- tie is dated 1551), pp. 245-252,
denung," Bamb., 1507, art. 44. 223-228.
INTRODUCTION. XV
more than a century before. Indeed, the earliest medico-legal
work written by a physician ' is the 27th book of the QEuvres
d'Ambroise Pare, first printed in 1575, in which he directs the
forms in which judicial reports shall be made in various
medico-legal cases." During the remainder of the sixteenth
centurj' France produced but three treatises on medico-legal
subjects.^ One of these, written by the jurist A. Hotman,
distinctly mentions the employment of physicians to determine
questions of fact.
In Italy works on medical jurisprudence were published at
the close of the sixteenth and beginning of the seventeenth cen-
tury. The earliest of these was a chapter of Codronchius,
treating of the "method of testifying in medical cases,'' in
1597.^ At about the same time, but certainly later, appeared
the work of Fortunatus Fidelis, to whom the honor of being
the first writer on medical jurisprudence is given by many.^
The great work of Paulus Zacchias, physician to Pope Inno-
cent X., was first printed at Rome, 1621-35. This medico-
legal classic contains in the first two volumes the " Qiicestiones"
and in the third the decisions of the Roman Rota, It treats of
' Wildberg, "Bibl. Med. -for.," printed in 1562, Pare is referred
Berl., 1819, Nos. 553, 554, 1,124, to as "chirurgien ordinaire du Roi,
1,125, 1,126, 1,304, 1,835, 1,836. et Jure a Paris. " Ploucquet, "Lib.
2, 342, cites nine works earlier than Med. dig.," Tiib. , 1809, iv., 349,
1575. Tliese are, however, mono- mentions a monograph by "Tygeon,
graphs on the period of gestation, Th. , " printed at Lyons, 1575.
witchcraft, fasting girls, drunken- ^ S. Pineau : " De notis Integritatis
ness, and wounds of the head. et Corruptionis Virgiuum," Paris,
Works on toxicology were written 1598; A. Hotman: "Dela Dissolu-
at a much earlier date : the QiipinKa tion duMariagepar I'lmpuissance,"
and AlE^updpfima, of Nicander, ca. etc. , Paris, 1581 ; delaCorde, "Ergo
B.C. 135; the T^epl (5>/h/-?/piuv (papfia- Virgo . . . lac in mammis habere
«Ji, of Dioscorides, ca. A. D. 50 ; the potest, " Paris, 1580. Wildberg, I.
treatises, "De Venenis, " of Petrus c. , Nos. 555, 1,308, 1,309, are not
de Abbano {ca. a.d. 1250), first properly medico-legal,
printed Mantua, 1472; of Arnoldus •'In his "De Vitiis Vocis, " etc.,
da Villanova {ca. a.d. 1300), first Frankf. , 1597. He had previously
printed {sine loc. et an.) ca. 1470 ; published a treatise, "De morbis
of Santes deArdoynis, Venice, 1492, veneficis ac veneficiis, " Venet. ,
and of F. Ponzetti, Venice, 1492, 1595.
are among the earliest. Works on ''"De relationibus medicorum
toxicology are not considered in ... in quibus ea omnia (juie in
this Introduction, the historical forensibusac publicis causis luediri
sketch of that science being reserved referre solent. " etc. , Panorm i .
for a later voluine. 1603. Mongitore, " Bibl. Sic. , "
-Ed. Malgaigne, 1840, t. iii., 1. Panormi, 1707-14. i.. 199, mentions
xxvii., pp. 651-658; ed. princ, an edition of 1598, Pan., under tlie
Paris, 1575, fob, pp. 931-944. On title : "Bissus [Birrus?], sive med-
the title-page of an earlier work, icoruni patrocinium, " etc.
XVI INTRODUCTION.
every branch of medico-legal science, and discusses physiologi-
cal questions of legal interest, besides dealing with questions
such as the infliction of torture and miracles.'
Although the " Qusestiones Medico-legales" of Zacchias was
the first systematic work upon medical jurisprudence, his coun-
trymen in succeeding centuries have contributed but little to
this science. It is only during the latter part of the present
century that Italians have again become prominent in medico-
legal literature.
In France legal medicine progressed but little from the time
of Pare to the latter part of the eighteenth century. Several
treatises appeared, being chiefly upon legitimacy and kindred
subjects,^ with a few treating of reports, signs of death, etc'
Toward the end of the eighteenth century the labors of
Louis, Petit, Chaussier, and Fodere elevated legal medicine to
the rank of a science. The investigations of Louis (Ant. L.)
were numerous and important in this as in other subjects,^ and
the " causes celebres" contain reports of many trials in which he
threw light upon doubtful medical questions.^ Antoine Petit,
a contemporary of Louis, contributed an extensive work on the
duration of pregnancy as affecting legitimac5\ ''
Somewhat later Fr. B. Chaussier, between 1785 and 1828,
published at Dijon a number of treatises on infanticide, viabil-
ity, surgical malpractice, etc' Fodere, a Savoyard, was the
first to publish a systematic treatise on medical jurisprudence
in France, which was first printed in 1798 and in a much en-
' "Qusestiones Medico-legales," murder by hanging, 1763; on the
Rome, 1612-35, 3 t., fol. See also duration of pregnancy, 1764, etc.
Kerscliensteiner ; Friedr. Bl. f. ger. These and other articles on drown-
Med. , etc., Niirnb., 1884, 'xxxv. , ing, etc., are collected in his
401-410. "(Euvres diverses de Chirurgie, '" 3
sWildberg, "Bibl. Med. -for.," vols.. Par., 1788.
gives the titles of thirty-four trea- ^ Cases of Monbailly, Syrven,
tises on legitimacy, impotence, Galas, Cassaigneux, Baronet, etc.
sterility, signs of virginity, etc., ^ "Hecueil de pieces relatives a la
published in France during this question des naissances tardives,"
period. Amst. and Par. , 1766, 2 vols.
3 On reports: Rene Gendri, 1650; ^ "Consult. Med. -leg. s. u. Accus.
Nicolas deBlegny, 1684; J. Devaux, d'Infanticide, " 1785; "Obs. Chir.-
1693; Prevot, 1753; H. M. Maret, leg.," 1790; "Med. -leg.," 1809;
1757. On signs of death: P. E. "Consult, et Rapp. surd i verses obj.
Dionis, 1718 ; J. B. Winslow, 1740; d. Med. -leg.," 1824; "Mem. med.-
S. J. Bruhier, 1745. leg. s. 1. Viabilite, " 1826 : " Consult.
^ On the signs of death, 1752; on Med. -leg. s. u. cas d'amp. d. 1.
the distinction between suicide and Cuisse, " 1828.
INTRODUCTION. XVll
larged form in 1S13.' This last edition is an exhaustive treatise
upon all branches of legal medicine and public hygiene, and
won for its author the appointment as Professor of Forensic
Medicine in the University of Strassburg.
At about the same period appeared the works of Mahon'
and of Belloc, " both of which went through three editions in ten
years, and those of Biess3^'
The most industrious and original of French professors of
legal medicine was Orfila. A native of Minorca, he graduated
in medicine at Paris in 1811, and devoting himself to chemical
and toxicological investigations, published the first edition of
his " Traite des Poisons" in 1814. This work, which may be
regarded as the foundation of experimental and forensic toxi-
cology, went through five editions to 1852, and was translated
into sevei-al foreign languages. The first edition of his " Legons
de Medecine legale" appeared in 1821, and the fovirth in 1848.
Besides these Orfila published a work on the treatment of
asphyxia and a great number of papers on medico-legal subjects,
principally in the Annales cV Hygiene, of which he was one of
the founders with Andral, Esquirol, Leuret, and Devergie.
Orfila occupied the chair of chemistry and medical jurispru-
dence in the University of Paris for upward of thirty years, and
was employed as expert in innumerable cases before the courts.
Contemporaneous with Orfila, and almost as prominent, was
Devergie, the first edition of whose "Medecine legale," in three
volumes, appeared in 1836, and the third in 1852.
In 1820 the first edition of the Manual of Briand and Bros-
son was published. This work, the tenth edition of which was
published in 1879, is the first in which a jurist was associated
with a phj'sician in the authorship, '" and is one of five of which
one of the authors is a lawyer."
'"Les Lois eclairees par les Sci- * lu the later editions Chaude took
ences physiques, " Par. , 1798, 3 vols., the place of Brosson, and a chemist,
8vo ; "Traite de Med. -leg. etd'Hyg. J. Bonis, was added,
puhl.," Par., 1813, 6 vols., 8vo. « Devergie, "Med. -leg.," 1836,
■^ "Med. -leg. ," etc., Rouen, 1801; contains a legal chapter by de
Paris, 1807, 1811. Robecourt. Paris and Fonblanque,
■'"Cours. de Med. -leg. ," Paris, "Med. Jurispr. ," Lond., 1823;
1809,1811, 1819. Wharton and Stille, "Med. Jur.."
•* " Apergu et obs. s. 1. Med. -leg. ," Phila. , 1855; Le Grand du Saule,
Lyon, 1811; "Secours aux Asphyx- Berryer et Poucliet. "Tr. de Med.-
ies, " Lyon, 1818; "Man. d. Med.- leg. de Jur. med. et de Tox.," 2d
leg.," Lyon, 1831. ed., Par., 1881.
2
XViil INTRODUCTION.
Special treatises on the medico-legal relations of insanity
were published by Georget (1821), Falvet (1828), Esquirol
(1838), and Marc (1840), and on midwifery by Capuron (1821).
Tardieu, Professor of Legal Medicine in the University of
Paris (1861-79), published a most important series of mono-
graphs on hygienic and medico-legal subjects,' besides man}-
papers, principally in the Annales d^ Hygiene, etc., and testi-
fied before the courts in many " causes celebres.'^
The first work of medico-legal interest to appear in Ger-
many was the " Medicus-Politicus" of Rodericus a Castro, a
Portuguese Jew living in Hamburg, printed in 1614, which
deals principally with medical ethics and the relations of physi-
cians, but contains chapters on simulated diseases, poisoning,
wounds, drowning, and virginit}".''
It was only toward the end of the seventeenth century that the
subject was scientifically treated, and during the latter part of the
seventeenth century and the beginning of the eighteenth great
progress was made in the development of forensic medicine in
Germany. Johannes Bohn, one of the originators of the experi-
mental method of investigation in physiological chemistry and
physics, at the University of Leipzig, was also one of the earli-
est German contributors to the literature of legal medicine.
Besides smaller works he published two noteworthy treatises :
in 1689 a work on the examination of wounds and the distinc-
tion between ante-mortem and post-mortem wounds, and be-
tween death by injur}', strangulation, and drowning.' In 1704
a work giving rules for the conduct of ph3'sicians in attending
the sick and in giving evidence in the courts.^ At about the
same period M. B. Valentini, professor in the University of
Giessen, published three important works, containing collec-
tions of medico-legal cases, and of the opinions and decisions
'" Sur les Attentats aux Moeurs, " fuit exhibitiim ; cap. xi. : testifi-
1st ed., 1857; 7th ed., 1878; "Sur candi ratio Id viilneribus capitis;
I'Avortement, " 1856, 1861, 1868 ; et in iis qui aqua fueiunt suflFocati ;
"SuriaPendaison,"etc., 1865, 1870, cap. xii. : Quomodo amissa virgin-
1879; "Sur rEnipoisounement" itas : et alterius utrius conjugis
(with Z. Roussin), 1867, 1875 ; "Sur sterilitas deprehendatur.
rinfanticide, " 1868 ; "Sur laFolie, " ^"De renuuciatioue vulnerum,"
1872 ;" Sur lesBlessures," 1879; "Sur etc.. Lips., 1689, 8vo ("Egregium
les Maladies, etc. , " 1879. opus, " Haller) .
'-' Lib. iv. , cap. ix. : Qua ratione •* "De officio niedici duplici, cliu-
morbum siniulantes d e p r e h e n d i ico niniirum et foreusi, " Lips. , 1704,
queaut ; cap. x. : testiiicandi me- 4to ("Eximius liber, " Haller) .
thodus circa eos, quibus venenum
INTRODUCTION. xix
of previous writers. ' Another extensive collection of cases and
decisions was published in ITOG by J. F. Zittmann, from a MS.
left b}^ Professor C. J. Lange, of the University of Leipzig;'
and still another b}' J. S. Hasenesf* appeared in 1755.
During the latter part of the eighteenth century, the Ger-
mans cultivated legal medicine assiduousl}^ and a great number
of works upon the subject were published. Among these may
be mentioned those of M. Alberti, professor at the University
of Halle; ' H. F. Teichmej-er, of the University of Jena; ' A. O.
Golicke, of the universities of Halle and Duisburg, who was
the first to prepare a bibliography of the subject ; ° J. F. Fasel
(Faselius), professor at Jena;' J. E. Hebenstreit and C. S.
Ludwig, professors at Leipzig;* C. F. Daniel, of Halle;* J.
D. Metzger, professor at Konigsberg, the author of a number
of works, one of which, a compendium, was translated into
several other languages; '° J. V. Mliller, of Frankfurt ; " J. C.
T. Schlegel, who collected a series of more than forty disserta-
tions by various writers;'" M. M. Sikora, of Prague;'^ J. J.
von Plenck, professor in Vienna, who published a work on
forensic medicine and one on toxicology;" K. F. Uden, sub-
sequenth" professor in St. Petersburg, who was the first to
publish a periodical journal devoted to legal medicine, Avhich
' "PandectfB Medico-legales, " ' "Elementa Medicinfe forensis, "
etc.. Francof. , 1701, 4to ; ''NovellEe Jena, 1767, published posthumously.
Medico-legales, " etc., Francof., ** Hebenstreit : " Anthropologia
1711, 4to ; "'Corpus Juris Medico- forensis," Lips., 1753; Ludwig:
legale, " etc. , Francof., 1723, fol. "Institutiones Medicinae forensis,"
- "'Medicina forensis, hoc est re- ed. 2, Lips., 177-1.
sponsa facultatis niedicEe Lipsiensis '"'Beitrage zur medicinischen
ad qua?.-itiones et casus medicinales, Gelehrsamkeit, " etc., Halle. 17-18-
ab anno 1650 usque 1700, " Francof. , 54; "Samnilung medicinischen
1706, 2 vols. , 4to. . . . Zeugnissen," etc., Leipz.,
^ "Der medicinischeRichter, oder 1776; " lustitutionum Medicinae
Acta phvsico-medico forensia Col- publicfe, " etc., Lips.. 1778.
legii medici Onoldiui," Onolzbach, '" " Kurzgefasstes System der ge-
1755, 4to. richtlichen Arznej'wissenschaf t, "
* "Systema Jurisprudentiae Med- Konigsb. u. Leipz.. 1793.
icae, " etc., 6 vols., 4to, Halle, Leip- " "Entwurf der gerichtlichen
zig, and Gorlitz, 1725-47. Arznoiwissenschaft, " etc., Frankf.,
* "Institutiones Medicinae legalis 1796-1801, 4 vols.
et forensis, " Jena, 1723, 1731, 1740, '- " Collectio Opusculorum selecto-
1762. rum ad Mediciuain forensem spec-
* "Medicina forensis demonstra- tantium," Lips., 1785-90, 6 vols,
tiva, " etc., Frankf., ad Viadr., ^^ "Conspectus* Medicina? legalis, "
1723; "lutroductio inhistoriani lit- etc., Prague, 1780.
terariamscriptorumqui medicinam '■* "Elementa Medicinae etChirur-
forensem commentarius suis illus- giae forensis, " Viennse, 1781; "Tox-
traverunt, " Frankf., 1723, 1735. icologia, " etc. . Viennae, 1785.
XX INTRODUCTION.
was afterward continued by J. F. Pyl at Stendal;' and J. C.
Fahner.'
At this period compends for students were published in Ger-
many, which indicate by their number the extent to which this
science was the subject of study. Among these those of Ludwig
(17G5), Kannegieser (1768), von Plenck (1781), Frenzel (1791),
Loder (1791), Amemann (1793), Metzger (1800), and Roose
may be mentioned.
The Germans of the present century have maintained the
pre-eminence in legal medicine achieved by their forefathers.
Among a great number of investigators and writers a few may
be mentioned : C. F. L. Wildberg, professor at Rostock, was a
most prolific writer, edited a journal devoted to state medicine,
and contributed a valuable bibliographj' of the subject;' A. F.
Hecker, professor at Erfurth and afterward at Berlin, and J.
H. Kopp each edited and contributed extensively to a medico-
legal journal." A much more important periodical was estab-
lished in 1821 by Adolph Henke, professor in Berlin, and was
continuously published until 1864. Henke also wrote a great
number of articles and a text-book on legal medicine." Jos.
Bernt, professor at Vienna, published a collection of cases, a
systematic treatise, and a number of monographs," as well as
the MS. work left by his predecessor in the chair, F. B. Vietz.
A handbook containing an excellent history of medico-legal
science was published by L. J. C. Mende, professor at Grief s-
wald,' who also contributed a number of monographs, chiefly
on obstetrical subjects. K. W. N. Wagner contributed but lit-
tle to the literature of the subject, but it was chiefly by his
' Magazin fiir die gerichtliche and 1849 Wildberg published fifteen
Arzneikunde und niedicinische Po- books and treatises on medico-legal
lizei, Stendal, 1782-87, 6 vols. Pyl subjects.
also published "Aufsatze und Be- ■» Kritische Jahrb. f. d. Staats-
obachtungen aus der gerichtlichen arznk. f. d. xix. Jahrh. , 1806-09.
Arzneiwissenschaft, ■" Berlin, 1783- Jahrb. d. Staatsarznk. , 1808-19.
9.3, 8 vols. Uden was the first to ^ Zeitschrift fiir die Staatsarznei-
edit a medical journal in Russia. kunde, Erlangen, 1821-64, 118 vols. ;
2 "Vollstandiges System der ge- "Lehrbuchderger. Med.," Ite Aufl.,
richtlichen Arzneykunde, " Stendal, Berlin, 1812, 13te Aufl. , Berlin,
1795-1800: ^'Beitrage zur prakti- 1859.
schen und gerichtlichen Arznei- « "Visa Reperta," Wien. 1827-45,
kunde," Stendal. 1799. 3 vols. ; "Systematisches Handb. d.
■ Jahrb. der gesam. Staatsarznei- ger. Med.," Wien, Ite Aufl., 1813,
kunde. Leipzig, 1835-40, 7 vols.; 5teAufl. , 1846.
• Bibliotheca Medicinte publicje." ' "Ausfiihrl. Handb. d. ger.
Berol., 1819, 2 vols. Between 1804 Med.," Leipzig, 1819-32, 6 vols.
INTRODUCTION. xxi
efforts, while professor in the University of Berlin, that a
department for instruction in state medicine was established
there in 1832. A. H. Nicolai, also professor at Berlin, pub-
lished a handbook ' besides numerous articles in the journals.
F. J. Siebenhaar published an encyclopsBdia of legal medicine,
and in 1842 established a journal devoted to state medicine,
which in its continuations was published until 1872." J. B.
Friedreich, professor at Erlangen, after editing a journal de-
voted to state medicine from 1844 to 1849, established one of
the most important of current medico-legal periodicals in 1850,^
to both of which he was a frequent contributor until his death
in 1862. Ludwig Choulant, professor at Dresden, and more
widely known as the author of important contributions to the
history of medicine, published two series of reports of medico-
legal investigations."
The foremost forensic physician of this period in Germany
was unquestionably John Ludwig Casper, professor in the
University of Berlin and "forensic physician" (gerichtlicher
Physicus) to that city, who greatly extended the department
established in the university under Wagner. He made in-
numerable investigations, some of which are preserved in sev-
eral collections of cases, '^ others in his classic Handbook," and
still others in the periodical which he established in 1852, and
which is now the most important current medico-legal journal.'
It is necessary in this place to make mention of one work
by living authors, as its appearance marked a new departure in
medico-legal literature, and as in it the fact that forensic med-
i"Handb. d. ger. Med.," Berlin, Statistik," etc., Berl., 1846; "Ge-
1841. richtl. Leichen-Oeffnungen, " Berl.,
- "Enzyklop. Haudb. d. ger. Arz- 1851-53, 1850-52; "KlinischeNovel-
neyk.," Leipzig, 1838-40, 2 vols. ; len,"etc., Berl., 1863.
Magazin f . die Staatsarzneykunde. "^''Tract. Handb. d. ger. Med.,"
3 Ceutralarch. f. d. ges". Staats- Berl., Ite Aufl. , 1857-58 ; 8te Aiifl.,
arznk. , Ansbach, 1844-49; Blatter Berl., 1889, also translation of (reo.
f. d. gerichtliche Anthropologie. Balfour, New Sydenham Soc. . Lon-
Erlangen, 1850, now published at don, 1861-65. The fourth and suc-
Erlangeu under the title Fried- ceeding editions, published after
reich's Blatter f. ger. Med. u. Sani- Casper's death (1864). were edited by
tatspolizei. Karl Liman, his successor in the
^ "Gutachten u. AufsJitze, " etc., chair of medical jurisprudence (d.
Leipzig, 1847; "Auswahl von Gut- 1892).
achten," etc., Dresden. 1853. ' Vierteljahresschr. f. ger. u. of-
'"Beitrage z. medicin. Statis- fentl. Med. . Berl. . 1852, edited after
tik," etc., Berl.. 1825-35, 2 vols.; Casper's death by Horn. 1865-70,
" Denkwiirdigkeiten z. medicin. Eulenberg, 1871-90, Wernicli, 1891.
XXll INTRODUCTION.
icine extends over so wide a field of inquiiy as to require
treatment at the hands of specialists was first recognized. To
Josef von Maschka, professor in the University of Prague, the
credit -is due of having been the first to produce, with the col-
laboration of twenty-two colleagues, a trul}' systematic work on
modern forensic medicine.'
English works upon this subject did not exist prior to the
present century, '^ although physicians were emplo3'ed b}" the
courts to determine medical questions of fact at a much earlier
date. Paris and Fonblanque, in the third Appendix of their
" Medical Jurisprudence, " give the text of reports by the Colleges
of Physicians of London and of Edinburgh concerning the cause
of death as early as 1632 and 1687 respectively.'
Lectures on medical jurisprudence were given at the Uni-
versity of Edinburgh by A. Duncan, Sr., at least as early as
1792.* The title of Professor of Medical Jurisprudence in a
British university was conferred for the first time, however,
upon A. Duncan, Jr., at the University of Edinburgh in
1806.'
The first English work on medical jurisprudence worthy of
consideration is the medical classic known as Percival's " Med-
ical Ethics." This was first published in 1803, and contains in
1 "Handb. d. ger. Med.," Ti'ibin- his " Elements of Medical Jurispru-
gen. 1881-83, 4 vols. dence, " to which Percival ("Med.
■-■ Daniel: "Bibl. d. Staatsarznk. , " Ethics," Oxford, 1849, p. 102) justly
Halle. 1784, No. 107, mentions: refers as " a valuable epitome of S.
"E. Prat, Rationarium chirurgi- F. Faselii's "Elementa Medicina?
cum, oder nothwendiges Handbuch Forensis [Regiom., 4to, 1787], in
des Wundarztes, wie er Bericht an English by Dr. Farr. "
die Obrigkeit thun soil u. s. w., aus ^ "'Med. Jur. ," iii., p. 226 seq.
dem Engl.," Harab., 1684. 4, 690. 8. Report that Joseph Lane died of poi-
The same title is reproduced by son (1628). Report that Sir James
Wildberg (No. 239) in 1819, and the Standsfield was strangled and not
edition of 1684 is mentioned by drowned, with account of autopsy
Ploucquet, "Initia" (1803), Suppf. (1687). Also extracts from the
iv., 36, and "Lift. med. dig." medical evidence in the cases of
(1809), iii., 54, the name of the au- Spencer Cowper (from 13 Howell's
thor being given as "Pratt (Elias)." "State Trials") : Mary Blandy (Ox-
This may be an early work by Ellis ford, 1752) ; John Donellan (War-
Pratt, but we can find no mention wick, 1781) ; and R. S. Donnall
of it elsewhere. In the years 1734, (Launceston, 1817).
1761. and 1787 dissertations onabor- •* "Heads of Lectures on Medical
tion were defended at Edinburgh Jurisprudence, or the Institutiones
by Arnot, Harris, and Murray. Medicinge legalis," vi., 24 pp., 8vo,
Three treatises on death from suffo- Edinb. , 1792.
cation by Goodwyn. Frank, and ^ ggg. g^p]^ . "Med. Jur. ," 7th ed.,
Coleman "appeared in 1788-91. In xvi. , and note.
1788 S. Farr published at London
INTRODUCTION. XXlll
its fourth chapter an admirable epitome of legal medicine. ' A
more elaborate work, based very largely, however, upon the
writings of continental authors, was published by G. E. Male
in 1816.'' In 1821 Professor John Gordon Smith published the
first systematic treatise on forensic medicine,^ and was one of
the first in Great Britain to show the importance of the subject.
Two years later, in 1823, appeared the elaborate and
scholarly work of Dr. Paris and Mr. Fonblanque, the first in
the English language in whose authorship members of the
medical and legal professions were associated.* In 1831, Prof.
Michael Ryan published the first edition of his " Manual of
Medical Jurisprudence" from the memoranda of his lectures on
the subject in the Westminster School of Medicine.^ A similar
work was published by Professor T. S. Traill, of the Univer-
sity of Edinburgh, in 1836." The awakened interest in medico-
legal subjects among the medical profession during the decade
1830-40 is evidenced bj^ the publication in the medical jour-
nals of the lectures of A. Amos, in 1830-31; of A. T. Thomson,
at the London University, in 1834-35; of H. Graham, at West-
minster Hospital, in 1835; of W. Cummin, at the Aldersgate
Street School, in 1836-37; and of T. Southwood Smith, at the
Webb Street Theatre of Anatomy, in 1837-38.'
' In the preface Dr. Percival says : Edinb. M. andS. Jour., and "Hints
"'This work was originally entitled for the Examination of Medical
'Medical Jurisprudence, ' but some AVitnesses. " Lond., 1839, died at
friends having objected to the term the age of forty-one in 1833, after
Juviapritdence it has been changed fifteen months' imprisonment in a
to Ethics.'' An unfinished and un- debtors' prison.
pnhlished edition, written prior to ^ "Med. Jur. ," 3 vols. , 8vo, Lon-
1794 and containing Chapter IV., don, 1823. See note 1, p. v.
was printed about 1800 (see Editor's = "A Manual of Med. Jur.," Lon-
Preface, p. 2, and note. Author's don, 1831, 2d ed., 1836, Amer. ed.,
Preface, pp. 25. 26, ed. Oxford, 1849). with notes by R. E. Griffith, Phila.,
- " An Epitome of Juridical or Fo- 1832.
rensic Medicine," etc., viii., 199 •*" Outlines of a Course of Lectures
pp., 8vo, i^ondon, 1816, also in Th. on Med. Jur.," Edinb., 1836, 2d ed.,
Cooper's "Tracts on Med. Jur.," 1840, Amer. ed., Phila., 1841.
Phila., 1819. In the preface the 'A. Amos, Loud. M. Gaz., 1830.
author refers to the lectures of Prof . vii. ; 1831, viii. A. T. Thomson,
Duncan. Lond. M. and S. J., 1834-35. vi. ;
^ This excellent work ("ThePrin- 1835, vii. ; also Lond. Lancet. 1836-
ciples of Forensic Medicine") went 37, 1., ii. (Thomson's lectures were
through three editions in six A'ears. printed in (rernian in book form,
Dr. Smith, who was a teacher of Leipzig, 1840.) H. Graham, Lond.
medical jurisprudence in the Royal M. and S. J.. 1835, vi., vii. W.
Institution, Westminster Hospital, Cummin, Lond. M. (xaz. , 1836 37,
and University of London, aud also xix. T. S. Smith, Lond. M. Gaz.,
published a number of papers in the 1837-38, xxi. ; 1838, xxii.
xxiv INTRODUCTION.
Among the uofceworthy contributions to the science previous
to 1850 are the sA'-ritings of Dease (1808), Haslam (1817,)' Cliris-
ti&on, the successor of Professor Duncan in the University of
Edinburgh, and best known as a toxicologist, Forsyth (1829),*
Chitty (1834),= Watson (1837),^ Brady (1839),^ Skae (1840),"
Pagan (1840),' and Sampson (1841).'
In 1836, Dr. Alfred Swaine Taylor (b. 1806, d. 1880), the
first Professor of Medical Jurisprudence in Guy's Hospital, pub-
lished his "Elements of Medical Jurisprudence." This, the
most important work upon the subject in the English language,
is now in its twelfth English and eleventh American edition.
During forty years of devotion to forensic medicine Dr. Taylor
also contributed other important works and numerous papers,
published for the most part in the Reports of Guy's Hospital.'
In 1844, Dr. Wm. A. Guy, Professor of Forensic Medicine in
King's College, published the first edition of his excellent
work." In 1858, Fr. Ogston, Professor of Medical Jurispru-
dence in the University of Aberdeen, published a syllabus and
subsequently (1878) a complete report of his lectures." In 1883,
CM. Tidy, Professor of Chemistry and Forensic Medicine in
the London Hospital, who had previously (1877) been associ-
ated with W. B. Woodman in the authorship of a valuable hand-
book, began the publication of a more extended work, which
was interrupted by his death in 1892.'''
' Dease : " Med. Jur. , " and Has- ed. , Lond. , 1875. " Lectures on
lam: "Med. Jur. Insanity," along Med. Jur.," Lond. M. Gaz., 1846,
with the treatises of Farr and of n. s., ii., iii. ; 1847, n. s., iv. Ar-
Male, are reprinted in Cooper's tides on arsenic, antimony, strych-
"Tractson Med. Jur.,"Phila., 1819. nin, and other toxicological sub-
'^ "Synop. Mod. Med. Jur., "Lond., jects, strangulation, blood-stains,
1829. etc., in Guy's Hosp. Repts.
3 "Treatise on Med. Jur.," Lond., '»" Principles of Forensic Medi-
1834; Phila., 1836. cine," Lond., 1844. The work is
" " Homicide by External Vio- now in its sixth edition, Prof. D.
lence, " Lond., 1837. Ferrier, Dr. Guy's successor in
* "Med. Jur.," Dublin, 1839. King's College, having been associ-
^ " Cases in Leg. Med. , " Edinb. , ated in the authorship of the 4th ed.
1840. in 187.5 and subsequently.
' " Med. Jur. of Insanity, " Lond., " " Lectures on Med. Jur. , " edited
1840. by Fr. Ogston, Jr., Lond., 1878.
* " Criminal Jurisprudence in re- '- Woodman and Tidy : " A Handy-
lation to Mental Organization, " Lon- book of Forensic Medicine and Tox-
don, 1841. icology, " Lond. and Phila., 1877.
'•' Principles and Practice of Med. Tidy, "Legal Medicine, " 3 vols.,
Jur.," 1st ed., Lond., 1865; 8ded., Lond.. 1882-83; also, Phila., 2
Lond., and Phila., 1883. "On vols., 1882-84: New York, 3 vols..
Poisons," 1st ed., Lond., 1848; 3d 1882-84.
INTRODUCTION. XXV
The first Spanish work on legal medicine was that of Juan
Fernandez del Valles, printed in 1796-97. ' No further contribu-
tion to medico-legal literature was furnished by Spain until the
appearance in 1834 of the work of Peiro and Rodrigo, which
went through four editions in ten years.' Ten years later, in
1844, Pedro Mata, Professor of Legal Medicine and Toxicolog}-
at Madrid, published the first edition of a work, which in the
development of its subsequent editions, has become the most
important on the subject in the Spanish language.^
The first Portuguese medico-legal treatise was that of Jose
Ferreira Borjes, first printed at Paris in 1832."
A posthumously published report of the lectures of Albrecht
von Haller was the earliest Swiss work on forensic medicine.*
In Sweden the earliest medico-legal publication was a com-
prehensive treatise by Jonas Kiernander, in 1776," which was
followed in 1783 by a translation of Hebenstreit, by R. Mar-
tin. The voluminous writings of the brothers Wistrand (A.
T. and A. H.), including a handbook, were published at Stock-
holm, between 1836 and 1871. Between 1846 and 1873, several
articles upon medico-legal subjects were published at Helsing-
fors, in Finland, by E. J. Bonsdorff, O. E. Dahl, and J. A.
Estlander. In 1838 Skielderup^ published his lectures on legal
medicine, delivered at Christiania, and Orlamundt * published
a handbook at Copenhagen in 1843. The earliest recognition
of medico-legal science in Russia was in the lectures of
Balk," begun in 1803 at the then newly founded University of
Dorpat.
Although dissertations upon subjects of medico-legal inter-
est were published at the University of Leyden as early as the
' "CirurgiaForense, "etc., Svols. , •* "Instituigoes de Medicina fo-
12ino, Madrid, 1796-97. Wildberg rense, " Paris, 1832 ; 2d ed. , Lisbon,
mentions two earlier monographs : 1840.
"De partu Septimestri," Antvv. , ^ " Vorlesungen iiber die gericht-
1568, by F. Mena, phjsician in or- liche Arzneiwisseuschaft, " 3 vols.,
dinary to Philip II. ; and "Diez 12mo, Bern, 1728-84.
privilegios para mugeres prennan- "^ "Utkasttil Medicinal-Lagfaren-
t€s, " Complut., 1606, by J. A. de heten, " etc. (Project of medical
Fontechia, professor at Alcala de jnrisprudence, etc.) Stockh., 1776.
Henares. " " Forelaesninger over den legale
- "Elementos de Medicina y Medicin," Christiania, 1838.
Cirurgia legal," etc. , Madrid, 1834; s"Haandbog i don legale Medi-
4th ed., Zaragossa, 1844. cin, " Kj^benhavn, 1843.
" "Tratadode Medicina y Cirurgia ^"Versuch eines Umrisses der
legal, " etc. , Madrid, 1844; Hthed., philosophisch. -medizinischeu Ju-
4 vols. , 8vo, Madrid, 1874-75. risprudenz, " u. s. w., Dorpat, 1803
XXVI INTRODUCTION.
middle of the seventeenth century,' and the works of Pineau,"
Zacchias," Ludwig,' von Plenk/ and Metzger* were printed in
Holland, either in Latin or in the vernacular, no original sys-
tematic work on legal medicine in the Dutch language has yet
appeared.
The onlj^ Belgian contribution to the literature of forensic
medicine, other than articles in the journals, is a text-book by
A. Dambre, first published at Ghent in 1859.'
Two medico-legal works have been printed in the Japanese
language, one a report of the lectures of Professor Ernst Tiegel,
at the University of Tokio," the other a treatise by Katayama.*
In the United States the development of forensic medicine
has kept pace with that in the mother country. In an intro-
ductory address delivered at the University of Pennsylvania in
1810, the distinguished Dr. Benjamin Rush dwelt eloquently
upon the importance of the subject.'" In 1813, Dr. James S.
Stringham was appointed Professor of Medical Jurisprudence in
the College of Physicians and Surgeons of New York, and a sylla-
bus of his lectures was published in the following year. " At
the same period (1812-13) Dr. Charles Caldwell delivered a
course of lectures on medical jurisprudence in the University
of Pennsylvania.'^ In 1815, Dr. T. R. Beck was appointed Lec-
turer on Medical Jurisprudence in the College of Physicians and
Surgeons of the Western District of the State of New York;
and soon after Dr. Walter Channing was appointed Professor of
Midwifery and Medical Jurisprudence in Harvard University.
In 1823, Dr. Williams, in the Berkshire Medical Institute, and
Dr. Hale, of Boston, each lectured upon the subject.'^
In 1819, Dr. Thomas Cooper, formerly a judge in Pennsyl-
' See "Wildberg: "Bibl. med. ' "Saiban igaku teiko" (Medical
leg.,"Nos. 1,198. 1.143, 1,215. Juris.), 3 vols., Tokio, 1882-84.
'^ Lugd. Bat., 1610, etc. '•'"Sixteen Introductorv Lec-
3 Amstel. 1615. tures." etc., Phila., 1811, pp. 363-
4Rotterd., 1767. 395.
^ Lugd. Bat., 1768. " Amer. Med. and Phil. Reg., N.
6 S. Gravenh. , 1815. ^ Y. . 1814, iv. , 614. It is to be re-
' "Traite de Medecine legale etde gretted that instruction in medical
Jurisprudence de la Medecine, " 2 jurisprudence is not now given at
vols, in 1, Gand., 1859-60; 2d ed., this school (1893).
Paris, 1878 : 3d ed. , Bruxelles, 1885. ''^ Beck : "Med. Jur. , " 7th ed. ,
(See Toxicology.) xix. The Index Catalogue contains
''"Yei sei honron " (Lectures on the titles of forty-nine works by
medical jurisprudence, translated Caldwell, none of which are medico-
by Gento Ove), 3d ed., 2 vols., legal.
Tokio, 1880. " 's geek, loc. cit.
INTRODUCTION. XXvii
vaiiia, and at that time Professor of Chemistry and Mineralogy
in the University of Pennsylvania, reprinted,, with nores and
additions, the English works of Farr, Deaso, Male, and Haslam."
The works of Ryan, Chitty, Traill, and Guy were also reprinted
in this country shortly after their publication in Kngland.
In 18"2:), Dr. Theodric Romeyn Beck published at Albany
the first edition of a treatise as admirable for scholarly elegance
of diction as for profound scientific research. This remarkable
work, facile princeps among English works on legal medicine,
has had twelve American and English editions, and has been
translated into German and Swedish.^
Papers upon medico-legal subjects or reports of lectiu-es
were published by J. W. Francis,' J. Webster,' R. E. Griffith,'
R. Dungiison,' J. Bell,' and S. W. Williams' between 18-^:] and
1835. In 1840, Amos Dean, Professor of Medical Jurispru-
dence at the Albany Medical College, published a medico-legal
work, followed by another in 1854, which with the later work
of Elwell are the only treatises on forensic medicine upon the
title-pages of which no physician's name appears."
iSTumerous papers and tracts upon medico-legal subjects were
published by J. J. Allen, T. D. Mitchell, H. Howard, D. H.
Storer, J, S. Sprague, J. S. Mulford, J. F. Townsend, and A.
K. Taylor between 1840 and 1855. In the latter year appeared
the first edition of the admirable work of F'rancis Wharton and
Dr. More ton Stille, the first American product of the collabora-
tion of members of the two professions, now in its fourth edition. '"
Between 1855 and 18(30 no systematic treatises on legal
'''Tracts on Medical Jurispru- Phila., 1829, and "Syllabus of a
denc3, "etc., Phila., 1819. Course of Lectures on . . . Medical
'^ " Elements of Medical Jurispru- Jurisprudence in the Philadelphia
deuce," 3 vols., 8vo, Albany, 1823; Medical Institute" [n. p., n. d.J.
12th ed., 2 vols., 8vo, Phila., 1863. >* -'A Catechism of Medical Juris-
A chapter on Infanticide by John prudence, " etc., Northam])tou. 1835.
B. Beck was added to the third edi- " Dean (A.) : "Mainial of IMedical
tion. This and later editions are Jmisprudeuce," Albany, 1840 ; Dean
"byT. R. and J. B. Beck." (A.) : "Principles of ' IMedical Ju-
' N. Y. Med. and Phys. Jour.. risi)rudence," Albany, 18.~)4 : Elwell
1823, ii., 9-30. (J. J.) , "Medicolegal Treatise on
- "An Essay on Medical -Airispru- Malpractice and Evidence." Np\v
dence, " Phila. , 1824. York, 1S60; 4th ed.. New York
'- Pliila. J. M- and Pliys. Sc. , 1825, 1881 .
X. , 3(5— 1(). "' " M H d i c a 1 Jurisprudence. "
""Syllabus of Lectures," etc., Phila.. 1855. 4th ed . ►^dited by R
Univ, of Va. , 1827. .Atnnry and K .S Wood, 3 vols..
' " An Introductory Address, " etc. , Pliila . , 1884.
XXVin INTRODUCTION.
medicine were published, although the medical journals con-
tained numerous articles bearing upon the subject. In 1860
the first edition of a treatise written from the legal aspect was
published by J. J. El well.' In 1801) Dr. J. Ordronaux, recently
deceased, widely known as a teacher of legal medicine and a
graduate in law r,s well as in medicine, published a treatise
which has been extensively used as a text-book.^ At the pres-
ent time the great number and variety of articles published in
the medical and legal journals, bearing upon every branch of
forensic medicine and of medical jurisprudence, and written for
the most part by specialists, is evidence of the assiduity with
which the science is cultivated.
The wide appreciation of the importance of medico-legal
science in the United States is also indicated b}" the fact that
at the present time there are but few medical schools in which
the subject is not taught. To ascertain the extent of medico-
legal instruction at the present time, a circular of inquiry was
sent to the deans of 124 medical schools and of 56 law schools in
the United States and British provinces. Answ^ers w^ere received
from 103 medical colleges. Of these only 3 are without a teacher
of "medical jurisprudence." In 38 the teacher is a phj'sician,
in 50 he is a lawyer, in 5 he is a graduate in both professions,
and 3 have two teachers, one a lawyer, the other a physician
The average number of lectures given is 21, and the average in
those schools in which the teacher is a lawj^er, and therefore
presumably teaches only medical jurisprudence, is 15. The
medico-legal relations of their subjects are taught in their lec-
tures by the neurologist in 62 schools, by the surgeon in 66, by
the obstetrician in 69, and by the chemist (toxicology) in 91.
It appears from these reports that not only is the importance of
medico-legal science appreciated, but that in the majority of
our medical schools the distinction betw^een medical jurispru-
dence and forensic medicine is recognized in the fact that the
instructor is a lawyer, who presumably teaches medical juris-
prudence, wdiile the different branches of forensic medicine and
toxicology are taught by the specialists most competent to
deal with them. Eveiy practising physician requires thorough
' "A Medico-legal Treatise on ^ "Tlie Jurisprudence of Medi-
Malpracticeand Medical Evidence," cine," etc., Phila., 1869.
N. Y. , 1860; 4th ed., N. Y., 1881.
INTRODUCTION. xxix
instruction in medical jurisprudence, which, being strictly legal,
is best taught by one whose profession is the law. The general
practitioner only requires so much knowledge of the different
branches of forensic medicine as will enable him to intelligently
fulfil his obligations in such medico-legal cases as will be forced
upon him as results of his ordinary practice. He can become
a medical exjDert only by a particular study of and a large ex-
perience in some particular branch of the subject.
In our law schools the teaching of medico-legal science is
not as general as in schools of medicine. Of 35 law schools,
only 10 have professors of medical jurisprudence. Of these
are law3^ers, 1 is a physician, 2 are graduates in both profes-
sions, and 1 is a doctor of divinity.
In this work the existence of specialists in the various
branches of medico-legal science has been recognized for the
first time in a treatise in the English language. Each branch
has been assigned to a specialist in that subject, or at least to
one who has made it a particular study.
In the arrangement of the matter, the primary division into
the three sciences of medical jurisprudence, forensic medicine,
and toxicology has been adopted. The division of pure medical
jurisprudence is contained in the present volume, while the
legal aspects of neurologj^ obstetrics, etc., will be treated of in
future volumes along with the subjects to which thej' relate.
In the division of forensic medicine the classification of Casper
has been followed: «'.e., Thanatologicalj including those
branches in which the subject of inquiry is a dead body (con-
tained in the present volume). Bio-thanatological; relating
to questions concerning both dead bodies and living persons (in
the second volume). Biological; relating to living persons (in
the second and third volumes). The applications of the micro-
scope to forensic medicine will be treated of in the second vol-
ume. The fourth volume will contain the division relating to
toxicology.
R. A. W.
MEDICAL JURISPRUDENCE.
THE LEGAL RELATIOl^S
PHYSICIANS AND SURGEONS,
INCLUDING
THEIR ACQUIREMEXT OF THE RIGHT TO PRACTISE MEDICINE AND
SURGERY; THEIR LEGAL DUTIES AND OBLIGATIONS; THEIR RIGHT
TO COMPENSATION; THEIR PRIYILEGES AND DUTIES WHEN
SUMMONED AS WITNESSES IN COURTS OF JUSTICE,
AND THEIR LIABILITY FOR MALPRACTICE.
BY
TRACY C. BECKER, A.B., LL.B.,
Counsellor-at-Law; Professor of Criminal Law and Medical Jurisprudence in the Law
Department of the University of Buffalo; Chairman Executive Committee
New York State Bar Association, etc.
LEGAL STATUS OF PHYSICIANS.
CHAPTER I.
OF THE RIGHT TO PRACTISE MEDICINE AND SURGERY.
Legal Definition and History of the Terms
Physician and Surgeon.
At common law the right to administer drugs or medicines
or to perform surgical operations was free to all. And such
was the rule of the Roman civil law. But the importance of
prescribing certain educational qualifications for those who
made such practices their means of gaining a livelihood soon
became apparent, and as early as the year 1422, during the
reign of Henry the Fifth in England, an act of Parliament was
adopted forbidding any one, under a penalty of both fine and
imprisonment, from " using the mysterie of fysyck unless he
hath studied it in some university and is at least a batchellor
of science."
As a result of this and other statutory regulations, a class
of professional men grew up, who were called "physicians,"
because they professed to have the qualifications required by
such legal regulations to wisely prescribe drugs and medicines
for the cure of diseases. A chirurgeon or surgeon — Latin, chi-
rurgus ; Greek, /scpoupyo's^ compounded of x^^Pj the hand, and
ipY^t'^, to work — as the derivation of the word shows, was one
who professed to cure disease or injuries by manual treatment
and appliances.
It would be more interesting than profitable to trace the
history of these terms, and of the professions of medicine and
surgery from the early times, when the clergy administered
healing to the body as well as to the soul, and when barbers
were generally surgeons, and blood-letting by the knife-blade
and the use of leeches caused the common application of the
term "leech" to those who practised surgery.
6 LEGAL STATUS OF PHYSICIANS — BECKER.
Definition. — For the purposes of this treatise, however, it
will be sufficient to define the term "physician," as meaning
any one who professes to have the qualifications required by
law to practise the administration of drugs and medicines, and
the term "surgeon,"' as meaning any one who professes to have
the like qualifications to perform surgical operations, for the
cure of the sick or injured.
For a list of the early statutes of England relating to the
practice of medicine the reader may consult Ordronaux' "Ju-
risprudence of Medicine," p. 5, note 2.
The present statu torj^ regulations throughout the United
States and in England and Canada will be more particularly
referred to and synopsized hereafter in this volume.
CHAPTER II.
ACaUIREMENT OF LEGAL RIGHT TO PRACTISE MEDICINE
AND SURGERY.
Now Generally Regulated by Statute. — In nearly aU of the
United States, as well as in England, France, Germany, and
other civilized and intelligent communities, the legal right to
practise the administration of drugs and medicines, or to per-
form operations in surgery for the purpose of curing diseases or
injuries, has for many years been the object of statutory legis-
lation. The necessity and propriety of regulating by law such
practices is generally conceded. It is manifest to all that a
person engaging in the practice of medicine or surgery as a
profession is holding himself out to the world, and especially
to his patients, as one qualified by education and experience to
possess more than ordinary skill and ability to deal with the
great problems of health and life. He professes to the world
that he is competent and qualified to enter into the closest and
most confidential relations with the sick and afflicted, and that
he is a fit and proper person to be permitted freely, and at all
hours and all seasons, to enter the homes, the family circle, and
the private chamber of persons suffering from disease or injury.
All this he professes and does upon his own account, and for
his own profit.
Statutory Regulation of the Right to Practise,
Constitutional. — The exercise by the States of these statutor}-
powers is upheld as a valid exercise of the "police power," to
protect the health of the communit}'. When the constitution-
ality of such enactments has been questioned, it has been at-
tacked upon the alleged ground that the statutes under ques-
tion unjustly discriminated in favor of one class of citizens and
against another class ; and as depriving those already engaged
in the practice of medicine or surgery of "their property with-
out due process of law." State v. Pennoyer, 18 Atl. Rep.,
8 LEGAL STATUS OF PHYSICIANS — BECKER.
878; ex parte Spinney, 10 Nev., 323; People v. Fulda, 52 Hun
(N. Y.), Go-G7; Brown v. People, 11 Colo., 109.
Opinion of United States Supreme Court. — This subject
has been carefully considered by the United States Supreme
Court in a recent case, and the broad extent of the legislative
powers of the States to regulate such matters clearly and fully
declared. Dent v. West Va. (129 U. S., 114). The Court say—
pp. 121 et seq. — Mr. Justice Field delivering the opinion, in
which all the other Justices concur : " The unconstitutionality as-
serted consists in its [the statutes] alleged conflict with the clause
of the Fourteenth Amendment, which declares that no State
shall deprive any person of life, liberty, or property-, without
due process of law ; the denial to the defendant of the right to
practise his profession, without the certificate required, consti-
tuting the deprivation of his vested right and estate in his pro-
fession, which he had jDreviously acquired.
" It is undoubtedly the right of every citizen of the United
States to follow any lawful calling, business, or profession he
may choose, subject only to such restrictions as are imposed
upon all persons of like age, sex, and condition. This right
may in many respects be considered as a distinguishing feature
of our republican institutions. Here all vocations are open to
every one on like conditions. All may be pursued as sources
of livelihood, some requiring years of study and great learning
for their successful prosecution. The interest, or, as it is some-
times termed, the estate acquired in them, that is, the right to
continue their prosecution, is often of great value to the pos-
sessors, and cannot be arbitrarilj' taken from them, any more
than their real or personal property can be thus taken. But
there is no arbitrary deprivation of such right where its exer-
cise is not permitted because of a failure to comply with condi-
tions imposed bj" the State for the protection of societj'. The
power of the State to provide for the general welfare of its
people authorizes it to prescribe all such regulations as, in its
judgment, will secure or tend to secure them against the conse-
quences of ignorance and incapacity as well as of deception and
fraud. As one means to this end it has been the practice of
diiferent States, from time immemorial, to exact in manj- pur-
suits a certain degree of skill and learning upon which the
communitj' maj^ confident!}' rely, their possession being gener-
STATUTORY REGULATION OF THE RIGHT TO PRACTISE. 9
ally ascertained upon an examination of the parties by com-
petent persons, or inferred from a certificate to them in tlie
form of a diploma or license from an institution established for
instruction on the subjects, scientific and otherwise, with which
such pursuits have to deal. The nature and extent of the qual-
ifications required must depend primarily upon the judgment
of the State as to their necessity. If they are appropriate to
the calling or profession, and attainable by reasonable study or
application, no objection to their validit}^ can be raised because
of their stringency or difficulty. It is only when they have
no relation to such calling or profession, or are unattainable by
such reasonable study and application, that they can operate to
deprive one of his right to pursue a lawful vocation.
" Few professions require more careful preparation by one
who seeks to enter it than that of medicine. It has to deal
with all those subtle and mysterious influences upon which
health and life depend, and requires not onlj' a knowledge of
the properties of vegetable and mineral substances, but of the
human body in all its complicated parts, and their relation to
each other, as well as their influence upon the mind. The phy-
sician must be able to detect readily the presence of disease, and
prescribe appropriate remedies for its removal. Every one inay
have occasion to consult him, but comparatively' few can judge
of the qualifications of learning and skill which he possesses.
Reliance must be placed upon the assurance given by his
license, issued bj' an authorit}' competent to judge in that
respect, that he possesses the requisite qualifications. Due con-
sideration, therefore, for the protection of society, may well
induce the State to exclude from practice those who have not
such a license, or who are found upon examination not to be
tullj qualified. The same reasons which control in imposing
conditions, upon compliance with which the physician is al-
lowed to practise in the first instance, may call for further con-
ditions as new modes of treating disease are discovered, or a
more thorough acquaintance is obtained of the remedial proper-
ties of vegetable and mineral substances, or a more accurate
knowledge is acquired of the human system and of the agencies
b}' which it is affected. It would not be deemed a matter for
serious discussion that a knowledge of the new acquisitions of
the profession, as it from time to time advances in its attnin-
10 LEGAL STATUS OF PHYSICIANS — BECKER.
ments for the relief of the sick and suffering, should be required
for continuance in its practice, but for the earnestness with
which the plaintiff in error insists that, by being compelled to
obtain the certificate required, and prevented from continuing
in his practice without it, he is deprived of his right and estate
in his profession without dvie process of law. We perceive
nothing in the statute which indicates an intention of the legis-
lature to deprive one of any of his rights. No one has a right
to practise medicine without having the necessary qualifications
of learning and skill ; and the statute only requires that who-
ever assumes, by offering to the community his services as a
physician, that he possesses such learning and skill, shall pre-
sent evidence of it by a certificate or license from a body desig-
nated by the State as competent to judge of his qualifications.
As we have said on more than one occasion, it may be difficult,
if not impossible, to give to the terms 'due process of law ' a
definition which will embrace every permissible exertion of
power affecting private rights and exclude such as are forbid-
den. They come to us from the law of England, from which
country our jurisprudence is to a great extent derived, and
their requirement was there designed to secure the subject
against the arbitrary action of the crown and place him under
the protection of the law. They were deemed to be equivalent
to 'the law of the land.' In this country the requirement is
intended to have a similar effect against legislative power,
that is, to secure the citizen against any arbitrary deprivation
of his rights, whether relating to his life, his liberty, or his
property. Legislation must necessarily vary with the different
objects upon which it is designed to operate. It is sufficient,
for the purposes of this case, to saj^ that legi;;lation is not open
to the charge of depriving one of his rights without due proc-
ess of law, if it be general in its operation upon the subjects
to which it relates, and is enforceable in the usual modes estab-
lished in the administration of government with respect to
kindred matters : that is, by process or proceedings adapted to
the nature of the case. "
early common-law rule. h
Early Common-Law Rule Concerning Suits by
Physicians.
The common-law rule was that the physician could not sue
and recover for his services, though he might for the medi-
cines he furnished. The theory of the law followed the eti-
quette of his profession and forbade him from making a spe
cific contract for pay for his services, and obliged him to
receive what his patient chose to give him, which was called
his "honorarium.^''
The Early Commoii-Laiv Rule No Longer in Force. —
As time went on this theory vanished from the law. For
many years it has lost its place among the rules of professional
etiquette. In its stead statutory provisions have been adopted
which forbid a recovery for services performed by persons
not legally authorized to practise. The right to contract with
the patient or with those who employ the medical man, and his
remedies to enforce such contracts, will be treated of hereafter.
Statutory Regulations in New York State. — Most of the
States of the United States have enacted statutory regulations
prescribing in one form or another the necessary qualifications
which entitle a physician or surgeon to practise, and prescrib-
ing penalties for practising without having complied with such
statutory requirements. In the State of New York such mat-
ters were regulated for the first time by statute in 1787. This
was followed by a general enactment on the subject of the
organization of county medical societies, and of State medical
societies having boards of censors, to whom was committed
the power to examine applicants for license to practise, and of
issuing licenses (Laws of 1813, p. 91). This law remained in
force, with certain modifications, until 1814, when all acts reg-
ulating the practice of medicine and surgery were repealed.
A history of the statutory regulations in New York State up to
the act of 1811 on this subject will be found in the case of
Bailey v. Mogg, 4 Denio, GO.'
At the time of the passage of the act of 1813, and for many
' In that case (Bailey v. Mogg) , nostrums of every description and
the Court says of that statute (Laws admixture could now be safely pre-
of 1844, p. 406) : "The triumph was scribed, and payments therefor ex-
uow complete, for the legislature acted by authority of law. "
had made every man a doctor, and
12 LEGAL STATUS OF PHYSICIANS— BECKER.
years afterward, nearly all of the physicians in New York State
practised in accordance with the theories and precepts of what
is now called the regular or allopathic school of medicine.
That act provided that the physicians in the respective counties
of the State of New York should meet in the respective coun-
ties and organize county medical societies. As a consequence
of the fact that the physicians of that day were chiefly of the
allopathic school, they necessarily obtained the control of the
county medical societies and State medical societies. Hence
it became difficult, if not impossible, for physicians who wished
to practise upon other theories and tenets than those obtaining
in that school, to obtain licenses to do so. With the growth
■of the homoeopathic school of medicine and the eclectic school
of medicine, came applications to the legislature asking for
those practising under those schools the same rights and priv-
ileges of organizing county and State societies as had been ex-
tended to physicians generally by the act of 1813; so that in
1857, by Chapter 384, the legislature of New York State enacted
that the homoeopathic physicians might meet in their respective
counties and organize county medical societies, with boards of
censors having the same powers and privileges which were
granted by the act of 1813; and by other laws similar privileges
were granted to the so-called eclectic school. After the pas-
sage of the act of 1844, down to about 1874, as hereinbefore
stated, there was no limitation upon the right to practise medi-
cine or surgery in this State.
The inharmonious and injurious effect of such policy of the
State becoming manifest, the legislature, by Chapter 436 of Laws
of 1874, required all persons desiring to practise medicine or
surgery to obtain a certificate as to their qualifications from
the censors of some one of these medical societies. By the Laws
of 1880, Chapter 513, additional and more extensive and partic-
ular provisions were made in reference to this matter, and all
the physicians then practising were required, on or before the
time limited in the act, to file with the county clerks of their
respective counties their licenses to practise granted by the
censors of their county medical societies, or a diploma of some
chartered school of medicine ; and those persons who desired to
become licensed who were not in practice were likewise re-
quired to obtain similar licenses or certificates and file the same.
RECENT LEGISLATION IN NEW YORK STATE. 13,
A diploma of a chartered school or medical college was given
the same effect as a license issued by the censors.
Recent Legislation in New York State. — The whole mat-
ter, however, of licensing physicians to practise has, in the
State of New York, been recentl}'- regulated by Chapter 468,
Laws of 1889, and 499 of 1890, which have reference to the
qualifications of persons becoming medical students, and Chap-
ter 507 of 1890, which gives to the Regents of the University
of the State of New York power to select boards of examiners
from persons nominated by each of the three State medical
societies, viz., the New York State Medical Society, Homoe-
opathic Medical Society, and Eclectic Medical Society. These
boards prepare questions which are to be approved by the State
Board of Regents ; examinations are held in different parts of
the State upon these questions, the examination papers are
certified to that one of these boards of examiners which the
student may elect, and that board in turn certifies whether or
not the examination has been successfully undergone ; and upon
its certificate the Board of Regents licenses the student to prac-
tise, and his examination papers are filed in the office of the
Board of Regents and become a matter of record. These pro-
visions have been enlarged and modified slightl}' by various stat-
utes since enacted. They are all now embodied in Chapter 601
of Laws of 1893. They will be found carefulty synopsized below.
Penal Provisions in Neiv York State. — The New York
Penal Code, which went into effect in 1882, enacted that a
person practising medicine or surgery, or pretending to be a
physician or surgeon, without a license or a diploma from some
chartered school, should be deemed guilt}' of a misdemeanor
punishable by fine or imprisonment (Penal Code, Section 356);
and the same statute, 357, made it a misdemeanor for a person,
whether licensed or not, to practise medicine or surgery, or do
an}' other act as a physician or surgeon, while intoxicated, by
which the life of any person is endangered or his health seri-
ously affected.'
' Notwithstanding these statutory violated the provisions of the statute
enactments, it has been held that one against practising medicine or sur-
■who undertakes to cure disease by gery without a license. Smith i;.
rubbing, kneading, pressing, and Lane, 24 Hun (New York Supreme
otherwise manipulating the body Court), 32.
(massage) is not liable for having
14 LEGAL STATUS OP PHYSICIANS — BECKER.
Giving " Patented " Medicines No Exception. — At one
time an attempt was made to claim, that under the patent laws
of the United States a person had the right to administer patent
medicines without being punishable for practising without a
license, but this doctrine was repudiated by the courts. Thomp-
son V. Staats, 15 Wend., 395; Jordan ^'. Overseers, etc., 4 Ohio,
205.
Coui'ts may Compel Granting of License. — A person who
is qualified and complies with reasonable rules of a licensing
body, can compel such body to license him. This was held to
be the law in the case of The People ex rel. Bartlett v. The
Medical Society of the County of Erie, which is also an impor-
tant authority in respect to a vexed question of medical ethics.
It appeared in that case that under the general laws of New
York in regard to the organization of medical societies, a med-
ical society had refused to receive as a member a person other-
wise qualified, because he had advertised in the public prints a
certain cure, including a mechanical appliance used in treating
throat troubles; it being forbidden by the code of ethics of the
American Medical Association, which the County Medical
Society had adopted as one of its by-laws, that a physician or
surgeon should advertise. The Court of Appeals of the State
of New York held that this constituted no defence to a proceed-
ing instituted by such person to obtain a mandamus compelling
the society to admit him to membership, if otherwise qualified.'
' Analysis of this decision shows personal, professional, and public
that the main ground, upon which relations. They are regulations in
the court of last resort sustained the the various departments of morals
right of the applicant for admission and manners, of courtesy and eti-
to be admitted as a member of the quette, of delicacy and honor. They
society, was, that the provisions of bind those who pledge themselves
the by-law in question were not to their observance, but cannot be
specifically made applicable to a recognized in law, as conditions
person applying for membership, precedent to the exercise of an hon-
The Court observed, pp. 192 et seq. : orable profession, by learned, able,
"The regulations embodied in the and upright men, who have not
so-called code are admirably framed, agreed to abide by them. The non-
aud commend themselves to every observance of such regulations may
reader, as tending to raise to a still be made cause for exclusion or dis-
higher elevation the character of franchisement ; but it must be either
the learned and honorable pi-of ession by the agreement of parties or bj" the
to which they were submitted for exercise of the law-making power,
approval and adoption. They are " The applicant was not a member
not limited in their scope to the either of the American Medical As-
range of moral obligation, but era- sociation or of the Erie County
brace express rules of conduct, in Medical Society, at the time of his
COURTS MAY COMPEL GRANTING OF LICENSE.
15
It has also been decided that a medical society had no right
to make a by-law establishing a fixed fee-bill, or tariff of
charges, and providing for the expulsion of a member charging
at a different rate than that prescribed. Such a by-law was
declared unreasonable and void in the case of People v. Medical
Society of Erie County, 24 Barb., 570.
The effect of these decisions was, so far as they affect the
validity of bj'-laws, attempted to be avoided in that State by
Chapter 445 of Laws of 186(3, by which it is expressly enacted
that the county medical societies of the State of New York
may make such rules and by-laws as they see fit, " not incon-
sistent with the laws of said State, and may enforce them by
expulsion or other discipline." It may be considered doubtful
whether this legislation can accomplish its purpose in the case
of the adoption of a bj^-law void as against public policy.
No Particular Schools Recog:nized by the Courts. —
The general trend of the decisions in all the States, whenever
alleged deviation from the formu-
las prescribed by these conventional
rules. He was under no legal obli-
gation to observe them, and had
neither actual nor constructive no-
tice of their existence. Those who
were members of the society could
not lawfully be expelled for antece-
dent deviation from the code (Faw-
cett V. Charles, 13 Wend., 477).
Much less could such deviation be
alleged, as cause for exclusion,
against one who had never agreed
to be bound by it, and as to whom it
was not merely an inoperative but
an unknown law.
" As the relator demanded admis-
sion to the enjoyment of a fran-
chise to which he was presumptively
entitled, his exclusion could be jus-
tified only by facts repelling the
presumption that he was duly qual-
ified for admission, or by extrane-
ous facts, showing that, if his ap-
plication was granted, there were
then subsisting causes, making 'a
clear case' for immediate expulsion
{Ex parte Paine, 1 Hill, 665) .
"The burden was upon the appel-
lant to establish affirmatively the
existence of svich present cause for
expulsion. The societj' waived the
right of making a return and taking
a formal issue on the claim of the
relator, to be determined as matter
of fact by a jurj^, under the direc-
tion of the court ; but submitted its
objections in the form of affidavits,
which failed to establish cause either
for exclusion or expulsion.
"The only specific fact alleged in
the opposing affidavits, as ground
of objection, was the publication by
the relator of a professional adver-
tisement, which was inserted in one
or more of the Buffalo journals in
May, 1855, and discontinued in Jan-
uary, 1857, more than two years be-
fore his ajiplication was presented.
It is charged that the printing of this
notice was an empiricism, and in
conflict with the code of ethics
adopted by the Erie County Medical
Society.
"There is nothing in the terms
of the advertisement from which
any inference can justly be drawn
against the relator, in respect either
to his personal character or his pro-
fessional skill. There is no sug-
gestion, in the affidavits, that any
of the statements of fact contained
in the notice are untrue, and there
is nothing in its contents inconsist-
ent with perfect good faith on the
IJart of the relator. It refers to the
IG
LEGAL STATUS OF PHYSICIANS — BECKER.
any questions in reference to schools of medicine have been
before our courts, is to avoid recognizing an}^ particular system
or school. The theory of the New York courts upon this sub-
ject is well expressed by the liberal-minded and learned Judge
Dal}^ in the New York Court of Common Pleas, in the case of
Corsi V. Maretzek, 4 E. D. Smith, 1-5. In that case it was
claimed that a certificate of incapacity because of sickness,
given by a " homoeopathic" physician to an opera-singer, was
not binding. It was argued that the employment of a " homoe-
opathic" physician under the contract did not fulfil a provision
thereof which required the event of the singer's sickness to be
certified to by " a doctor," to be appointed by the director.
The Court said : " The system pursued by the practitioner
is immaterial. The law has nothing to do with particular sys-
tems. Their relative merit may become the subject of inquirj^,
when the skill or ability of a practitioner in any given case is
to be passed upon as a matter of fact. But the law does not,
and cannot, supply any positive rules for the interpretation of
treatment of bronchitis, asthma, and
consumption, as a special depart-
ment of tlie profession to whicli he
had directed liis particular atten-
tion ; and it alludes to his use of
the method recently introduced, of
medicated inhalation, through an
instrument appropriate to that pur-
pose, in aid of such general ti-eat-
ment as experience had proved to
be beneficial in that class of diseases.
It is not denied that the relator pos-
sessed peculiar skill in this depart-
ment of the profession ; and the
case discloses the fact that the
method of auxiliaiy treatment, in-
troduced by him in the countj^ of
Erie, was not onlj^ successful in his
own practice, but was adopted,
with beneficial results, by members
of the county society of high pro-
fessional standing, and that it was
accepted by a large proportion of
the physicians of Western New
York. If, at the time this remedy
was introduced, he had been a
member of the County Society or of
the American Medical Association,
he would not have been at liberty
to direct attention, through the
medium of tlie public journals, to
the benefits resulting from its use.
This would, perhaps, have been un-
fortunate for those who were suffer-
ing, in that vicinity, from this par-
ticular class of diseases ; but it is
undoubtedly true that the suppres-
sion of such an advertisement would
have been more considerate toward
his professional brethren, and more
in accordance with the rules of deli-
cacy and good taste. But an error,
in this respect, by one who had no
notice of the society regulation is
not cause for disfranchisement. The
act of the relator was neither im-
moral nor illegal. It was no viola-
tion of the by-laws ; for, as to him,
they were wholly inoperative. It
was no present cause for e.vchision:
for the publication of the objection-
able notice had been discontinued
for more than two years. Wlien he
applied for admission, he proposed
to become bound by the by-laws ;
and this the society refused to per-
mit, for the sole cause that he had
not observed them before they be-
came rules of conduct for him.
' Where there is no law, there is no
transgression. ' The relator, there-
fore, had been guilty of no legal
wrong which could bar his claim tO'
the franchise. "
NO PARTICULAK SCHOOLS RECOGNIZED BY THE COURTS. 17
medical science. It is not one of those certain or exact sciences
in which truths become established and fixed, but is essentially-
progressive in its nature, enlarging with the growth of human
experience, and subject to those changes and revolutions inci-
dent to any branch of human inquiry, the laws of which are
not fully ascertained. The labors of the anatomist, the physiol-
ogist, and the chemist have contributed an immense storehouse
of facts; but the manner in which this knowledge is to be
applied in the treatment and cure of diseases has been, and will
probably continue to be, open to diversity of opinion. No one
system of practice has been uniformly followed, but phj^si-
cians from the days of Hippocrates have been divided into
opposing sects and schools. The sects of the dogmatists and
the empirics divided the ancient world for centuries, until the
rise of the methodics, who, in their turn, gave way to innu-
merable sects. Theories of practice, believed to be infallible in
one age, have been utterly rejected in another. For thirteen
centuries Europe yielded to the authority of Galen. He was
implicitly followed — his practice strictly pursued. Everything
that seemed to conflict with his precepts was rejected ; and yet,
in the revolutions of medical opinion, the works of this un-
doubtedly great man were publicly burned by Paracelsus and
his disciples; and for centuries following, tlie medical world
was divided between the Galenists and the chemists, until a
complete ascendency over both was obtained by the sect of the
"Vitalists. This state of things has been occasioned by the cir-
cumstance that medical practitioners have often been more
given to the formation of theories upon the nature of disease
and the mode of its treatment, than to that careful observation
and patient accumulation of facts, by which, in other sciences,
the phenomena of nature have been unravelled. I am far from
undervaluing the great benefits conferred upon mankind by the
study of medicine, and have no wish to minister to any vulgar
prejudice against a useful and learned profession, but it is not
to be overlooked that, as an art, it has been characterized, in a
greater degree, by fluctuations of opinion as to its principles
and the mode of its practice, than, perhaps, any other pursuit.
That it has been distinguished by the constant promulgation
and explosion of theories, that it has alternated between the
advancement of new doctrines and the revival of old ones, and
2
18 LEGAL STATUS OF PHYSICIANS — BECKER.
that its professors in every age have been noted for the tenacity
with which they have clung to opinions, and the unanimity
with which they have resisted the introduction of valuable dis-
coveries. They still continue to disagree in respect to the treat-
ment of diseases as old as the human race ; and at the present
day, when great advances have been made in all departments
of knowledge, a radical and fundamental difference divides the
allopathist from the followers of Hahnemann, to say nothing of
those who believe in the sovereign instrumentality of water.
" In fact, nothing comparatively is known of the philosophy
of disease. Its eradication or cure, where the result of human
agency is, in the great majority of instances, attributable
rather to the careful observation, judgment and experience of
the particular practitioner, than to the application of general or
established methods available to all. The popular axiom, that
'doctors differ, ' is as true now as it ever was, and as long as
it continues to be so, it is impossible for the law to recognize
any class of practitioners, or the followers of any particular
system or method of treatment, as exclusively entitled to be
regarded as doctors. In adverting to the conflicting views and
differences of opinion, that exist and have ever existed in the
practice of the healing art, it is not to call in question the value
of learned, skilful and experienced physicians, but merely to
show the error of attempting, in the present state of medical
science, to recognize, as matter of law, any one system of prac-
tice, or of declaring that the practitioner who follows a partic-
ular system is a doctor, and that one who pursues a different
method is not." And see also White v. Carroll, 42 N. Y., 161 ;
Ordronaux' "Jurisprudence of Medicine," 27.
This decision was prior to the statute of 1874 and the pro-
visions of the Penal Code before noted. Since those statutes,
it is a misdemeanor to practise except as permitted hj the
provisions of those statutes.
In New York and Elsewhere Practitioner Without
License Cannot Sue and Recover for His Fees.
Since the passage of the New York Act of 1844 (Laws of
1844, p. 406), there has been no precise statutorj^ provision in
that State prohibiting in terms persons who practise physic or
IN NEW YORK AND ELSEWHERE. 19
surgery without a license, from suing to obtain a recovery for
services performed. But this is of little consequence, for, as we
have already stated, so practising has been declared to be a
misdemeanor by the Penal Code of New York.
It is a well-settled principle that when any act is declared
by statute to be criminal, a contract calling for the perform-
ance of such an act is illegal and void. The early English
authorities on this point are fully collated in Wheeler v. Russell
(17 Mete, Mass., 258), and the later English and American cases
maj^ be found in " American and English Cyclopaedia of Law, "
title "Contracts," Vol. III., p. 872 et seq.; see also id.. Vol.
XVIII., p. 440. Further consideration of the validity of con-
tracts for medical and surgical services will be had hereafter.
A full sjaiopsis of the statutes of the different States regulating
the licensing of physicians and surgeons in force at the time
this volume goes to press will be placed in another chapter.
In a suit between a person who has performed medical and
surgical services, and one who employed him, it is said that
the person performing the services is presumed to have been
licensed to do so.' If the State sues for a penalt}', a different
rule is claimed to prevail.'^
' In Macpherson v. Cheadell (24 also Thompson v. Sayre (1 Denio,
Wend. , N. Y. , 15) the Court said, N. Y. , 75) , where this principle
p. 24 : seems to have been assumed as cor-
"In the first place I doubt much rect without question upon the
whether the defendant below, after strength of the decision quoted
retaining tlie plaintiff as a physi- above. A similar doctrine appears
cian and accepting his services as to have been enunciated in the State
such, could call upon him in the of Illinois in Chicago v. Wood, 24
first instance to jorove a regular 111. Apj:). , 42; and Williams i\
license. In other like cases, the People, 20 111. App., 92. It may
presumption is against the defend- be sound, and undoubtedly the Eng-
ant. It is so as between attorney lish cases cited in Macpherson v.
and client, in a suit for services Cheadell, supra, tend to support it.
performed uuder a retainer. Pearce But in a case iu which the physi-
V. Whale, 7 Donl. & Ryl., 512, 515, clan's right to practise is denied, the
per Bayley, Judge ; 5 Barn, z' Cress. , safe course will be for him to have a
38, S. C. There, if the objection duly authenticated copy of his li-
sound in the fact that the plaintiff cense ready to be offered in evi-
was never admitted, or that his ad- dence. The general rule is that the
mission has become inoperative, it burden is on the plaintiff toshow all
lies with the defendant to sho^y it. tlie facts which make uj) his right
Id., and see Berrvman ii. Wise, 44 of recovery. See Bliss v. Brainard,
T. R., 566, and other cases ; 1 Phil. 41 N. H., 256 ; Salomon r.Dreschler.
Ev., 227, Cowen v. Hill's ed. Be- 4 Minn.. 278; Kane v. Johnston, 9
sides, the conti-ary would be doing Bosw., N. Y. Superior Ct., 154.
great violence to the presumption - That is, the burden devolves
that no man will tran.sgress the upon the defendant, and tliis not-
command of a positive law." See witlistanding the presumption of
20 LEGAL STATUS OF PHYSICIANS — BECKER.
How MAY A Diploma or License be Proved in a Court
OF Law?
It is evident from the foregoing considerations that in any
proceedings to punish for practising without license or legal
authority, and in actions to recover payment for professional
services in the States and countries, where a license or diploma
of a regularly chartered school or college is required by statute
to entitle the person to practise, it may become important to
establish — first, the legal authority to grant the license or
diploma ; and second, the genuineness of the license or diploma
produced. It frequently happens that the diploma or license
has been obtained in another State or country. Under the New
York statutes, especially the laws of 1880 and 1890, it was
made necessary to file a diploma. When it had been issued by
a chartered school of another State it must be certified to by
some lawfully incorporated medical college in this State, before
being received for filing, or regarded by the law as confer-
ring upon its possessor the right to practise in that State.
As to the chief element of authenticity, namely, the legal
incorporation or authority of the body or institution granting
the diploma, it is clear that the act of incorporation itself would
be the best evidence of the incorporation of the college or school,
and a special act granting the power to license to a board of
censors or other official body or board would have to be pro-
duced to show the right vested in that board or body to grant a
license. In Georgia it has been held (Hunter v. Blount, 27
Ga., 76), that to prove a diploma given to a physician in an-
other State, the existence of the college, and the fact of its being
a chartered institution, must be shown bj'' producing its act of
incorporation.
In Thornton's case (8 Term Rep., 303; same case, 3 Esp.,
4), it was held that the mere production in court of a diploma
under the seal of one of the universities, is not of itself
evidence to show that the person named in the diploma re-
ceived the degree which the diploma specified. In another
innocence, of showing what must N. Y. , 298, and cases cited ; 1 Green-
be peculiarly within his own knowl- leaf on Ev. , §79, and cases cited,
edge, namely, that he has been duly See, contra, State v. Evans, 5 Jones,
licensed. Peoples. Nyce, 34 Hun, N. C. , 350.
HOW MAY A DIPLOMA BE PROVED IN COURT ? 21
and later case, however, Simpson v. Dunmore(9 M. & W,, 45;
same case, 5 Jurist, 1012), it was held that it was unnecessary
for the person producing a license from the Apothecaries' Com-
pany (an incorporated body) to practise as an apothecary, the
seal on which license was proved to be genuine, to give any
additional evidence of his identity with the person named in
the license. The reason for this doctrine is probably to be
found in the well-known rule of evidence, that identity of both
christian name and family name, is sufficient to raise a pre-
sumption of fact that the person bearing the name is the iden-
tical person so named in any written instrument.
In Walmsley v. Abbott (1 K. & P., 309; same case, 5 D.
& R., 62), proof of the signature of one of the examiners who
signed a certificate of examination was held sufficient to war-
rant the acceptance of the certificate in evidence in the first
instance. In another case the proof was that a person previ-
ously a stranger to the place went to a town which was the seat
of a university, and was told that a certain building was the
college, and that a certain person whom he saw there was the
librarian, and that this librarian showed him what purported
to be the seal of the -university, and also a book which the
librarian stated was the book of acts or records of the univer-
sity, and the seal so shown him was compared with the seal of
a certain diploma, the genuineness of which was in question,
and a copy was made from the said book of acts, of an entry
stating that the degree of M. D. had been conferred b}' the
university upon a person bearing the same name as that in the
diploma, and this proof was held a sufficient authentication of
the diploma, and of the act or authority of the university con-
ferring the degree. Collins case, 1 Addison & Ellis, G95; same
case, 3 N. & M., 703.'
The Rule in Criminal Prosecutions. — We have seen above,
' In Finch 15. Gridley's Executors Though he did not actuallj^ see them
("25 Wend. , N. Y. , 469-471) , Nelson, subscribe the paper, he had every
(h.J. , said: *'I am also inclined to means of becoming acquainted with
think the evidence which was given tlieir signatures; the deliver!/ of it
competent to prove the diploma to him was an acknowledgment
from Fairfield College. The wit- they liad signed it. Besides, he was
ness identified the corporate seal, familiar witli diplomas from the in-
mid had himself receired a diploma stitutionundertheirsignature, " etc.
from that institution subscribed by And see, also, Rayuor v. State, 62
the same president and secretary. Wis., 289; Wendel-y. State, yd. , 300.
22 LEGAL STATUS OP PHYSICIANS — BECKER.
that in a criminal prosecution the burden is on the defendant
to produce and prove his license, but to warrant a conviction for
practising without a license it must be shown that the accused
actually practised. It is not enough to show that he is called
by persons whom he attends personally, that is, for whom he
prescribes, or to whom he gives medicine or whom he treats.
There must be proof shown that he has done this on his own
account or for his own profit. But proof of a single act con-
nected with other circumstances, such as tend to show that he
held himself out as a physician, is enough. Burham v. State,
116 Ind., 112; Hill v. Bodie, 2 Stew, and P. (Ala.), 50; Ped-
grift V. Schiller, 8 C. B., N. S., 200 (same case, G Jurist, N.
S., 1341). And if he simply practises "massage," he does not
fall within the acts against practising medicine, even though
he pretends to accomplish as much good as could have been
accomplished by a regular ph3^sician. Smith v. Lane, 24 Hun,
IST. Y., 632. But see also Leech v. Ripon, 12 Cent. L. J., 479;
State V. Schultz, 11 Reporter, 701.'
Falsely Pretending to he a Licensed Practitioner Gen-
erally a Misdemeanor. — In some of the States, and in England,
it is not only made a misdemeanor to practise without a license,
but falsely pretending to be a licensed practitioner is made a
misdemeanor. Such is the provision of the Penal Code of New
York heretofore cited. In England such a statute has been
somewhat strictly construed in the case of Carpenter v. Hamil-
ton (37 Law Times Rep., 157). In that case it appeared that
a person advertised himself as "John Hamilton, M.D.," of the
"Metropolitan Medical College of New York." It further ap-
peared that he was not registered as required by the law of
England. In a prosecution against him for falsely pretending
to be a licensed physician, the onh' proof of his practising being
' In some of the States, persons and herbs within the meaning of
who simply administered roots and the statute, or whether, under tlie
herbs in treating disease, have been guise of so doing, he really held
excepted from that portion of the himself out as and acted as'a reg-
statute which forbids the practice ular practitiouer. All such penal
of medicine and surgery without a statutes are to be construed, like all
license. The proper construction other penal statutes, with due regard
of such an exception is, that it is a to the rights of the individual, and
questionof fact for the jury, whether at the same time with such degree
the person accused who claims the of liberality as will tend to preserve
benefit of the exception, simply ad- the public safety,
ministered a concoction of roots
STATE AND LOCAL BOARDS OF HEALTH. 23
as just stated, an acquittal was sustained by a majority of the
court, which held that it was a question of fact to be determined
by a trial, court whether or not what he did was ]jretending
to be a physician authorized to treat a patient. The Court in-
timated that the person simply pretended to be what he really
was, namely, a doctor of medicine of the Metropolitan Medical
College of New York.
State and Local Boards of Health— Powers
Governed by Special Statutes.
In addition to the rules and regulations prescribed hj the
general statutes, modern sanitary science has developed so
broadly throughout most of the civilized states and countries,
that the different governments have established state boards of
health, and in many instances local boards of health, the latter
being limited in their authority and operation to specific munic-
ipal divisions, to which boards the government has committed
the power to pass certain sanitary rules and regulations, which
rules and regulations maj' have an important bearing upon and
relation to the practice of medicine and surgery. The jurisdic-
tion and powers of these boards are to be found in the special
statutes creating them, and prescribing their powers and duties,
and cannot be treated of extensively here. They will be con-
sidered further under the special subjects to which they relate.
Physicians Bound to Report Contagious Cases and Not
Liable for Mistaken Report. — The duty to promptly report ' to
^ It has been held that the act of a which presents to him the appear-
physician in reporting to a health- ance of small-pox. It may be said
board in good faith that his patient that he may call in counsel. It
is suffering from small-pox, is not cannot, however, be said that pri-
actionable. Brown v. Purdy, 8 N. vate counsel should be called in
Y. St. Rep., 143. The Court said rather than such as the law lias
(per Sedgwick, J.) : "In order to appointed. Certainly, if he really
give the public the protection due thinks the case to be one of small-
to it, according to the intention of pox, it is his duty to communicate
the statute, any physician that pos- his opinion to the public authori-
sesses in fact an opinion that a pa- ties, wlio furnish skilled physicians
tient has a contagious disease, is peculiarly competent to pass upon
bound to report the ease, whether the case. They are the experts the
he Juts or has not used ordinary pro- law points out for tlie physician,
fessional skill and knowledge. A The attendance of these experts
physician of skill in everything but upon a patient can cause no injury,
cases of small-pox, which happily and thereafter the responsibility
are not numerous, may, unexpect- rests solely upon the public officer. "
edly to himself, be called to a case As to how far the decision of an
24
LEGAL STATUS OF PHYSICIANS — BECKER.
boards of health every case of contagious or infectious disease
is manifest.
inspector appointed by a board of
health is regarded by the law as
quasi -judicial, and therefore con-
clusive, see Underwood v. Green, 42
N. Y. , 140 ; Raymond 'O. Fish, 51
Conn., 80. Health officers who were
guilty of gross negligence in remov-
ing infected jjersons from a city in
stormy weather, and putting them
in an unprotected and unsafe struc-
ture, so that such persons died from
the exposure, have been held liable.
Aaron «. Broiles, 64 Tex., 316.
The latest and most complete
statute laws creating or regidating
health boards are : England, 38 and
39 Victoria, chap. 55 ; United States
(National Board of Health), 20 Stat.
L. , 484, suppl. to U. S. Rev. Stats. ,
chap. 202, passed March 3d, 1889;
Mass., chap. 79, Mass. Rev. Stats. ;
Pa. , Laws of 1885, chap. 56 ; New
York (State Board of Health), 2
N. Y. Rev. Stats., 1195; Local
Boards, id., 1191-1193. chap. 270,
Laws of 1885. The statutes of New
Jersey are considered in Lozier v.
Newark, 19 Vr. , 453. In Missouri
the power to license physicians is
conferred upon the State Board of
Health, and the Supreme Court of
that State has held that the act of
that board in granting or refusing
a license is discretionary and its
action in such a matter will not be
enforced by a writ of viandamus
(State V. Gregory, 83 Mo. , 123) ; and
a similar doctrine prevails in Min-
nesota, State V. State Med. Board,
32 Minn. , 324. The latest and best
work on the general subject of the
organization and powers of boards
of health is Parker & "VVorthing-
ton's "Public Health and Safety,"
M. Bender, publisher, Albany, N.
Y., 1892.
CHAPTER III.
OF THE CONTRACTUAL RELATION BETWEEN PHYSICIAN
AND PATIENT.
Employment and Rights in Regard to Compensation.
Legal Character of the Employment. — Whatever may
have been the theories of the Roman civil law, and following
it of the early English common law, as to the character of the
employment of physicians and other professional men, it is now
so well settled that the reciprocal duties and obligations arising
between physician and patient, or attorney and client, and the
like, are to be classed under and governed by the law of con-
tracts, that any extended discussion of these theories is un-
necessary here.' Mr. Ordronaux, in the second chapter of his
interesting work on the "Jurisprudence of Medicine," has
considered them fully, and has quoted amply from the books of
the earlier and later text- writers, and from the expressions of
the judges, to show what these theories and rules were ; and he
and all later authorities agree that the ancient notion, that pro-
fessional services are alwaj^s gratuitous unless a special con-
tract to pay for them is made, has long been abandoned. He
observes (pp. 13 and 14): "But in our day the increase in the
number of professional practitioners, and their exclusive devo-
tion to a special class of services as a means of living, has
essentially modified the practical character of the contracts with
their patrons. Although in legal acceptation a mandate, yet
from force of circumstances growing out of an altered state of
society, the mandate is practically changed into a contract of
hire {locatio operis). This doubtless reduces prof essions to
the status of artisanship, and places them on a par with
manual labor, conjoined to the special skill of a particular call-
ing. But it also simplifies the contract, removes it from the
category of innominate or imperfect obligations, requiring the
' Consult, as to this, Parsons on "Contracts," vol. ii., p. 56.
25
26 LEGAL STATUS OP PHYSICIANS — BECKER.
intervention of legal fictions to furnish a means for their en-
forcement, and brings it within the pale of consensual agree-
ments based upon a sufficient consideration."
The i)liysician's right to sue on contract in England was
declared by legislative enactment by Chap. 90 (Sec. 31), 21 and
22 Victoria. It has never been denied in the United States.
Adams v. Stephens, 26 Wend., 451-455.
Physicians' and Surgeons' Service in a Sense Voluntary .
— Though it is true, as in the case of many other doctrines of
ancient law which were formulated under social conditions far
different from those which prevail in modern times, that these
rules and theories have long since lost their potency as distinct
rules governing actions at law, nevertheless the legal aspect
of the peculiar relationship between physician and patient, is
still affected by the idea that the service on the part of the
physician is voluntary — that is, the physician or surgeon is not
bound to come and perform services whenever or wherever he
is called. He is at liberty to refuse any and every patient who
attempts to employ him.
Patients may Cease Employing at Any Time^ unless
there is a Contract for a Certain Period. — And when he is
employed, the patient may at any moment discharge him,
without incurring liability in damages, unless a special contract
has been entered into between them that the services shall be
rendered for a fixed period.
Service once Begun by Physician must be Continued
until Notice of Intention to Cease is Given by Him. — If,
however, the services are begun, they must be continued until
notice has been given of the intention to discontinue them, and
a reasonable time allowed the patient to obtain the services of
another person. The reasons for this rule will be considered
more fully below.
Contracts either Express or Implied. — The contract be-
tween the physician and patient may be an express one, that is,
one in which all the terms are agreed upon or expressed be-
tween the parties, or it may be what is called an implied con-
tract, or one in which the patient, or another person, simply
calls on the phj^sician or surgeon to come and perform services,
and neither party specifically stipulates or agrees upon any of
the terms of the employment.
CONTRACTS. 27
Express Contracts may Include any Stipulation Not
Contrary to Public Policy. — lu the case of an express contract
the agreement of the parties settles and determines their mutual
obligations, whether it be written or merely verbal. But an
express contract may also be made in such a form that certain
conditions are required to be performed by the physician before
he becomes entitled to any compensation for his services. It
may also embody an agreement that the patient shall pay cer-
tain sums at certain times as the treatment goes on, or that no
other physicians shall be employed without the consent of the
attending physician, or if so employed that they shall be under
the direction of the attending physician.
Almost anything may be stipulated which is not contrary
to public policy, and a breach of any such stipulation entitles
the aggrieved party to rescind the contract and cease from per-
forming it.'
Qualifications of the Rule that Express Contracts may
Include any Stipulation. — Some qualifications of this rule of
law must, however, be noted. A breach by the patient of any
one of these stipulations would entitle the physician to treat the
engagement as terminated like any other contractual relation,
and to bring his action for a recovery for services rendered up
to the time of the breach ; but it is doubtful whether he would
have any action for damages for failure to permit him to per-
form further services. This doubt arises from the legal doc-
trine, hereinbefore referred to, that a patient is always at
liberty to dismiss his physician at any time without notice, and
without assigning any cause, which recognizes and grows out
of the fact that if the trust and contidence of the patient are
destroyed, or impaired, no matter how unreasonably or unjustly,
the relation between them must thereafter be unprofitable to
both parties, and dangerous to the patient. On the other hand
there is little doubt but that whenever an express contract is
made by a physician to treat a patient for a certain length of
time for a particular disease or injur}', the physician is not at
liberty to arbitrarily terminate that relation or his connection
' Of course in those States or coun- statute) , unless such contracts are in
tries in which statutes of fraud writing and duly signed, contracts
render void, contracts for personal sliould be drawn and entered into
services for a longer period than one with regard to those statutes,
year (or any period named in the
28 LEGAL STATUS OF PHYSICIANS — BECKER.
with the case, unless he has in the contract specifically reserved
the right so to do.
Contracts Making Payment Contingent upon Successful
Treatment Valid. — The express contract between the parties
may also contain a stipulation, by which the physician makes
his compensation contingent upon his effecting a cure. Smith
V. Hyde, 19 Vt., 54; Mack v. Kelly, 3 Ala., 387. See also
CoughUn V. N". Y. Cen. R. R. Co., 71 N. Y., 443. In such a
case, however, if the patient does not permit the physician op-
portunity to treat him during the time named in the contract, or
for a reasonable time, if no specific time is fixed, the courts
would probably permit the physician to recover a reasonable
compensation for his services for the time during which he
treated his patient.
Physician must Allow Reasonable Time to Supply his
Place if he Quits his Patient.- — In any event, whether the
contract be express or implied, conditional or unconditional, the
law through motives of public polic}^ and with a just regard
for the welfare of the sick and injured, undoubtedly requires
that if a physician has once taken charge of a case, and deter-
mines to abandon it, he must give the patient reasonable notice
and reasonable opportunity to supply his place. If he fails to
do this he is liable in damages for the results that follow as the
proximate consequence of his abandoning the case.
This Rule Ti'ue even in the Case of a Charity Patient. —
This is true, it is believed, even when the patient is a charity
patient, and the services are gratuitous. Shiels v. Blackburn
(1 H. Blacks., 159). For any other ruleless strict might entail
the most serious consequences. Ordronaux, "Jur. of Med.,"
13 and 14, citing Inst., lib. 3, 26, 11; Pothier, "Du Contrat
Mandat," Chap. I., § 4.
Elements of the Contract Between Physician and
Patient.
Duties of Physician. — When the relations between physi-
cian and patient are not defined otherwise by express contract,
the implied contract is, and the law presumes, that the physi-
cian contracts, first, to use the necessary care and attention ;
CONTRACT BETWEEN PHYSICIAN AND PATIENT. 29
second, to use the necessary skill ; third, in case the physician
furnishes his own medicines (and the obligation to furnish
them would probably be imposed, if it was the custom of the
school or class of physicians to which the particular physician
belonged to do so), that the medicines are proper and suitable.
As a corollary of these duties it necessarily follows, also, that
the physician contracts that the instruments or appliances
which he uses are free from taint or contagion, and are suitable
and proper for the uses to which they are put. Upon this
theory an action could be maintained against a physician for
using impure vaccine.
Duties of Patient. — The patient on his part contracts,
first, to give the physician information concerning the facts and
circumstances of the case, and full opportunity to treat him
properly ; second, to obey his instructions and follow his direc-
tions, and, third, to pay him the reasonable worth and value of
his services. The different branches of this contract are recip-
rocal. The failure of either party to fulfil the obligation of any
one of them which is imposed upon him, would bar him of his
remedies against the other party to recover damages for any
breach, or any proximate result of his breach, of such obliga-
tions. The necessary care and attention required of the physi-
cian in such a case are measured by the requirements of the case
and the physician's duties to his other patients, modified, how-
ever, by the rule that the physician is presumed to know, at the
time he takes up the case, the condition and situation of his
other patients at that time. Consequently, if those who have
first employed him are so situated at the time that his services
for them are likely to be soon and continuously required, he
cannot without making himself liable in damages undertake
another case and then neglect it, but he should either decline to
take it, or should with the full knowledge and consent of the
patient make provision for the temporary substitution of some
other physician, during the time that his prior obligations en-
gross his attention. Nevertheless, if the situation and condi-
tion of those to whom he has first contracted his services is such
that he had, although he exercised due professional knowledge
and skill, no reason to apprehend that these patients would need
his exclusive service, and by a sudden development, arising
from those occult causes which obtain in all serious diseases
30 LEGAL STATUS OF PHYSICIANS — BECKER.
and injuries, any of his prior patients suffer a sudden and dan-
gerous relapse, or from an accession of new and dangerous
sj'inptoms and conditions so that he must fly to their aid, he
would not be liable to another patient, to whom he had after-
ward contracted his services, for neglecting his case ; still he
should in such instances use extra means to obtain the services
of some other and equally skilful man.
Only Ordinary and Usual Skill Required. — The degree
and character of necessary skill contracted for has been vari-
ously defined by the courts. When malpractice is discussed, a
more extended consideration of this matter will be required.
At present the doctrine laid down in Shearman and Redfield
on "Negligence," paragraphs 433-435, maybe adopted. It is
as follows :
"Although a physician or surgeon may doubtless by ex-
press contract undertake to perform a cure absolutely, the law
will not imply such a contract from the mere employment of
a physician. A physician is not an insurer of a cure, and is
not to be tried for the result of his remedies. His only contract
is to treat the case with reasonable diligence and skill. If more
than this is expected it must be expressly stipulated for. . . .
The general rule, therefore, is, that a medical man, who attends
for a fee, is liable for such want of ordinary care, diligence or
skill on his part as leads to the injury of his patient. To render
him liable, it is not enough that there has been a less degree of
skill than some other medical man might have shown, or a less
degree of care than even himself might have bestowed ; nor is
it enough that he himself acknowledged some degree of want of
care ; there must have been a want of competent and ordinarj'
care and skill, and to such a degree as to have led to a bad
result. . . . But a professed physician or surgeon is bound to
use not only such skill as he has, but to have a reasonable
degree of skill. The law will not countenance quackery ; and
although the law does not require the most thorough education
or the largest experience, it does require that an uneducated,
ignorant man shall not, under the pretence of being a well-
qualified physician, attempt recklessly and blindly to adminis-
ter medicines or perform surgical operations. If the practi-
tioner, however, frankly informs his patient of his want of
skill, or the patient is in some other way fully aware of it, the
AVERAGE STANDARD OF SKILL REQUIRED. ol
latter cannot complain of the lack of that which he knew did
not exist." '
Average Standard of Skill of any Professed School must
be Attained. — It is also a rule that one who professes to adhere
to a particular school must come up to its average standard,,
and must be judged by its tests, and in the light of the present
day. Thus a physician who would practise the reckless and
indiscriminate bleeding which was in high repute not very
many years ago, or should shut up a patient in fever and deny
all cooling drinks, would doubtless find the old practice a poor
excuse for his imbecility. So, if a professed homoeopathist
should violate all the canons of homoeopathy, he would be
bound to show some very good reasons for his conduct, if it
was attended with injurious effects. Upon many points of
medical and surgical practice all of the schools are agreed, and
indeed common sense and universal experience prescribe some
invariable rules, to violate which may generally be called gross
negligence. Yet the patient cannot justly complain if he gets
only that quality and kind of service for which he bargains. If
he employs a cheap man, he must expect cheap service. Puf-
fendorf, in his "Law of Nature and Nations," observes: "We
read a pleasant story of a man who had sore eyes and came to
a horse-doctor for relief. The doctor anointed his eyes with the
same ointment he used among his horses, upon which the man
falls blind, and the cause is brought before the judge, who
acquits the physician. For if the fellow, says he, had not been
an ass he had never applied himself to a horse-doctor." See
also Jones on Bailments, 100; 1 Field's " Lawyers' Briefs," sub.
Bailments, Sec. 573; Musser ■?;. Chase, 29 Ohio St., 577; Lan-
phier v. Phipos, 8 Carr. & Payne, 478.
Degree of Care and Skill Used a Question of Fact. — In
'See also "Field's Medico- Legal Grover, 28 Me., 97. Illinois, Mac-
Guide," 208-210, where the follow- Nevins v. Lowe, 40 111., 209. Kan-
ing cases are cited as sustaining sas, Teft v. Wilcox, 6 Kan., 4f).
this doctrine : New York, Carpenter Massachusetts, Com. v. Thompson,
V. Blake, 60 Barb., 488; same case 6 Mass., 134; Small ■». Howard,
on appeal, 75 N. Y. Court of Ap- 138 Mass., 131, 35 Am. Rep., 363.
peals, 12. Connecticut, Landon v. Pennsylvania, Potter v. Warner, 91
Humphrej', 9 Conn., 209. Iowa, Pa. St., 362, 36 Am. Rep., 668.
Smothers ■». Hawks, 34 la. , 286. In- Wisconsin, Reynolds «. Graves, 3
diana. Long v. Monison, 14 Ind. , Wis. , 416. Vermont, Briggs v.
595. Maine, Leighton v. Sargeant, Taylor, 28 Vt. , 180.
27 Me. (7 Fost.), 468; Howard v.
32 LEGAL STATUS OF PHYSICIANS— BECKER.
an action at law, whether brought by a physician to recover
for his services, or by a patient to recover for malpractice or
neglect, it is always a question of fact, to be determined by the
jury under proper instructions as to the measure of care and
.skill required, whether or not the physician has in a given case
used that degree of care and displayed that amount of skill
which might reasonably be expected of a man of ordinary
ability and professional skill. These same rules apply to the
surgeon. He must possess and exercise that degree of knowl-
edge and sense which the leading authorities have announced,
as a result of their researches and experiments up to the time,
or within a reasonable time before, the issue or question to be
determined is made.'
Rule in Leading Case of Lanphier v. Phipos. — In the
case of Lanphier v. Phipos, 8 C. & P., 478, already cited. Chief
Justice Tyndall enunciated the rule as to the degree of skill
required of a physician or surgeon, which has been followed by
all the courts since then. He said : " Every person who enters
into a learned profession undertakes to bring to the exercise of
it a reasonable degree of care and skill. He does not, if he i&
an attorney, undertake at all events to gain the cause, nor
does a surgeon undertake that he will perform a cure ; nor does
the latter undertake to use the highest possible degree of skill,
as there may be persons of higher education and greater advan-
tages than himself; but he undertakes to bring a fair, reasona-
ble and competent degree of skill. And in an action against
him by a patient, the question for the jury is whether the injury
complained of must be referred to a want of proper degree of
skill and care in the defendant, or not. Hence he is never pre-
sumed to engage for extraordinary skill, or for extraordinary
diligence and care. As a general rule, he who undertakes for
a reward to perform any work is bound to use a degree of dili-
gence, attention and skill, adequate to the performance of his
undertaking; that is, to do it according to the rules of the art;
spondet peritiam art is. And the degree of skill arises in
proportion to the value and delicacy of the operation. But he
1 See Shear. & Redf. on Negli- Baker, 2 Willes (Eng.), 259; Ordro-
gence, 440 ; Elwell on Malpractice, naux on Jurisp. of Med. , pp. 29 et
55; Carpenters Blake, supra; Rex pass.; 20 Am. Law Rev. , 82.
V. Long, 4 C. &P., 422; Slater «.
COMMUNICATIONS BETWEEN PATIENT AND PHYSICIAN. 33
is in no case required to have more than ordinary skill, for he
does not engage for more."
Physician Must Instruct Patient how to Care for Him-
self, etc. — A corollary of these rules is, that the physician must
give proper instruction to his patient how to take care of him-
self, how to manage a diseased or injured member, when and
how to take any medicines that may be prescribed, what diet to
adopt, and that in case the physician fails to give these instruc-
tions he is liable for any injuries that result from this failure.
Carpenter v. Blake, supra.
Patient Must Inform Physician Fully Concerning his
Case — His Communications Privileged. — On the other hand,
as we have already stated, the patient owes the duty to his
physician of informing him fully of all the varied sj'mptoms
of his disease, or the circumstances attending his injury, and
to freely and with due confidence answer all questions concern-
ing his past history which would tend to throw any light upon
his present condition. To battle with the occult forces which
play so important a part in determining the course or conse-
quences of disease, it is absolutely essential that the physician
should know all that is possible to be known of the patient's
history, and of the history of the patient's family. As we shall
see later on, all such communications are, in most of the States
of the Union and elsewhere, by statutory enactment made priv-
ileged, and without the consent of the patient the phj^sician or
surgeon is absolutel}' forbidden to divulge any communication
or information which he receives in order to enable him to
prescribe. This rule applies equally whether the physician or
surgeon is acting for hire or is treating the person as a charity
patient, and it has been extended by construction by the courts
in some States, so as to include examinations made by jail
physicians or other physicians sent by the prosecuting oflBcials
of the State to examine a prisoner, for purpose of giving evi-
dence, but who allowed the prisoner to suppose that they were
there simpl}' to treat him in their professional capacity. People
V. Murphy, 101 N. Y., 126. At the same time the courts have
been careful to make an exception in the case of advice given
for the purpose of enabling the person receiving the advice to
commit a crime, and of any information received by the phy-
sicians while the persons asking for it were engaged in a crim-
3
34 LEGAL STATUS OF PHYSICIANS— BECKER.
inal attempt. All of these interesting questions will be exam-
ined and treated of at length hereafter, '
Conditions of Contract Between Physician and Patient
Further Considered. — It has been observed that the contract
between the physician and j^atient may be conditional or un-
conditional. By this it is meant that limitations upon the
reciprocal obligations between them may be imposed, or exten-
sions of such obligations made, by special agreement. The
physician may contract to cure, and may make the cure a con-
dition precedent to receiving any reward for his services or
medicaments, and a breach of such a contract will be enforced
by the courts as a bar to an action for services rendered or
medicines furnished. The patient may agree to come to the
physician's home or to a hospital or other place agreed upon
between them, for the purpose of being treated, or of being
operated upon by a surgeon, and a failure to perform such an
agreement on the part of the patient absolves the medical man
from carrying out his agreement to treat the patient. In the
case already suggested of a request by the medical man for
information as to the patient's past history, or that of the
patient's family, or the circumstances concerning the injury or
symptoms of the disease, if the patient should give false infor-
mation, or should wilfully neglect to give true information, the
physician would have a right, upon giving reasonable and due
notice, and opportunity to employ some one else, as alreadj'
intimated, to decline to proceed further with his care of the
case, and might sue and recover pay for the services rendered.
Physicians Cannot Contract that they shall Not be Re-
sponsible for Want of Ordinary Care and Skill. — An impor-
tant and salutary exception to the general rule that all parties
maj^ contract freely as between themselves stipulations measur-
ing their reciprocal obligations, doubtless applies to the rela-
tions between physician and patient. It is an exception which
has been applied to the contract relations existing between a
common carrier and a shipper or a passenger. This is that
' On the points here suggested of. Y. , 56 ; People v. Murphy, 23 N. Y.
Edington v. Life Ins. Co., 67 N. Y., Weekly Digest, 43 ; same case, 101
185; same case, 77 N. Y., 564; Grat- N. Y., 126; Hunn -w. Hunu, 1 T. &
tan V. Life Ins. Co., 80 N. Y.. 281; C, 499; Piersou v. The People. 79
Dilleber v. Life Ins. Co. , 87 N. Y. , N. Y. , 432-435 ; People v. Carlyle
79 ; Westover v. Life Ins. Co. , 99 N. Harris, 136 N. Y. , 424.
CONTRACT BETWEEN PHYSICIAN AND PATIENT. 35
persons contracting to perform services which are to a certain
extent public in their nature, and which, as in the case of the
common carrier or in the case of the physician or surgeon, are
founded upon conventional relations, and affect the public wel-
fare, are not permitted, from reasons of public policj^ to con-
tract for a release or escape from liability arising out of their
own negligence or wrong. In short, a physician or surgeon
cannot contract with a patient that the patient shall waive any
claim for damages growing out of his want of ordinary care and
skill. Nevertheless, the physician or surgeon may frankly in-
form his patient of his want of knowledge and experience as to
the particular kind of treatment required by any special and
unusual disease or injury. If after full information on this
point, and full opportunity to employ some one else, the patient
insists that the physician or surgeon go on with such treatment
as he is able to give to the case, and injuries result which a
more skilful and experienced practitioner might have avoided,
it is probable that the courts would hold that the practitioner
was not liable under such circumsta,nces, or that such circum-
stances could be pleaded in mitigation of damages. But it
would be the duty of the practitioner in such a case to be ex-
ceedingly careful in performing any surgical operations, and not
administer any powerful drugs with the strength and medicinal
qualities of which he was not acquainted. If he should assume
to perform such operations or administer such drugs instead of
confining himself to modifying the ravages of disease by the
use of well-known simple remedies, or protecting against the
consequences of severe injury by the use of ordinary antiseptic
dressings and treatment, he would no doubt be liable for any
resulting damage, and could not recover pay for his service.
Experiments Not to be Tried on Patients — This Rule Ap-
plies to Charity Patients. — For like reasons of public policy
it has been held that a physician has no right to try experiments
on his patient.' In this respect a charity patient will be pro-
tected by law and compensated for damages received from ex-
periments on his health and person, just as much as a person
from whom a large fee could be expected. Humanity and
public policy both forbid that experiments should be tried upon
one class of patients any more than another. However this
' Patten v. Wiggin, 51 Me. , 594.
36 LEGAL STATUS OF PHYSICIANS — BECKER.
maj^ be, in a case of extreme danger, where other resorts have
failed and everything else done that could reasonably be re-
quired, and if the patient and his family consent after full in-
formation of the dangerous character of the operation, or the
unknown qualities and powers of the drug to be administered,
the practitioner would be justified and protected if some new
methods of treatment not entirely developed or known to the
profession, but supposed to be eflQcacious, should be adopted,
although the result might prove unfavorable. In such a case,
however, it would be extremely perilous for the phj^sician to
stand upon his own judgment alone. He should consult the best
talent in his profession available, and abide by the judgment of
his colleagues or a fair majority of them; and even then
should apply to his course of action the maxim. When in doubt
run no risks; better let a patient perish from disease or injury,
than while attempting uncertain experiments with the surgeon's
knife or the use of dangerous drugs. The safe rule is to take
no chances, unless there is a consensus of judgment of several
physicians. It maybe objected that if no experiments are tried
no new medicines or surgical devices could be discovered, or
their effects observed. The answer to this objection is that
vivisection, and other experiments upon live animals, permit of
experimentation to a considerable degree, and often effectually
point out the proper course of treatment of the human subjects.
In the case of drugs and medicines the practice is well known
of physicians trying the effects thereof upon their own persons,
in their zeal and anxiety to give to the world new discoveries.
But, as heretofore observed, the law does not recognize the right
of the medical or surgical practitioner to tamper with his
patients' health by the use of untried experiments, without
imposing upon the practitioner liability for all injuries proxi-
mately resulting from their use. All of such matters will,
however, fall more properly under consideration when the lia-
bility of the physician and surgeon for malpractice is considered.
CHAPTER IV,
OF THE LEGAL RIGHT OF PHYSICIANS AND SURGEONS
TO RECOVER COMPENSATION FOR SERVICES.
Liability to Pay for Services. — An important matter for
physicians and surgeons is the question as to who is responsi-
ble, or liable to pay for their services. If there is an express
contract this question does not arise; but in most instances
the person performing the services renders them upon call, and
it is necessary for him to understand his legal right to recover
pay for services in the absence of an express contract.
Person Treated, and not Person calling in Physician, Em-
ploys Him and is Liable. — In the first place, it must be stated
as a general proposition that the person for whom the services
are actually rendered, or upon whom the operation is performed,
is bound to pay for them, if otherwise capable in law of mak-
ing contracts and incurring obligations. And secondl}^, that
one who calls a physician or surgeon to attend a patient is not
presumed to have contracted to pay for the services rendered,
unless his relations with the patient are such that he would be
obligated in law to pay, even if he had not himself called in the
medical man.
In the first case it is presumed that the patient is liable,
because he receives the benefit of the services, and nothing less
than a distinct understanding that he was not to pay will
relieve him from this obligation.
31arried Women and Infants Generally Not Liable. —
"Where such a person is a married woman, unless the case arises
in States or countries where married women have been declared
by statutes to be liable the same as if single, this rule does not
obtain. Nor is an infant personally liable when he is living with
his parent or guardian. Hull v. Connelly, 3 McCord (S. C), ;
Klein ?;. La Amoreaux, 2 Paige Ch.,419; Atchinson ■?'. Bruff,
50 Barb., 384; Wilcox v. Smith, 2G Barb., 341. But the
contract of an infant for medicine and medical attendance is
37
38 LEGAL STATUS OF PHYSICIANS — BECKER.
deemed a contract for necessaries, and will be held valid and
enforced against his estate if there is no person standing in loco
parentis who can be held liable. 3 Barn. & Cress., 484; 2
Kent Com., 236. In cases when the parent of the infant or the
husband of the married woman is liable, this liability obtains
because the services rendered are deemed necessary, and fall
within the common-law obligation of such persons to provide
and pay for necessaries for those whom they are bound to sup-
port and maintain.
Burden upon Physicians Treating Minors to Show Ser-
vices Necessary. — But even in such cases the burden is upon
the person performing the services to show that they were nec-
essary, and it is his duty to know, or learn, the true legal status
of the patient, and the true legal relations of the patient to the
person other than the patient froin whom payment is to be
claimed. As said in the case of Crain v. Baudouin (55 N.
Y., 256-261), "in the case of minor children even, the law im-
poses this duty upon those who would furnish them with nec-
essaries, relying upon the credit of their fathers, and seeking
to charge them. (Hunt v. Thompson, 3 Scam., 179; Van
Valkinburgh v. Watson, 13 J. R., 480)." " A fortiori, it is so
in the case of an adult married daughter living with her hus-
band." And as to the liability of the husband of a married
woman in the absence of statute giving her legal capacity to
contract and charge her separate estate. Consult Moody v. Os-
good, 50 Barb., 628; Potter v. Virgil, 67 Barb., 578 ; Crain
V. Baudouin, 55 N. Y., 256-261.
Mother of Infant probably Liable after Father' s Death.
— It has been a much disputed question whether after the father's
death the mother becomes responsible for necessaries furnished
for her minor children. The theory of law upon which a father
is made liable proceeds upon the ground that he is bound to
support the child and has a right to the child's services during
its minority.' It has been held that the mother after the
death of the father is entitled to those services. Campbell v.
Campbell, 3 Stock. (N. J.), 265; Cain v. Dewitt, 8 Iowa, 116;
Furman v. Van Size, 56 N. Y., 435-439, disapproving Bentley
V. Richtmeyer (4 Comstock, 38), and approving In re Rj^der,
11 Paige, 185. If she is entitled to the services of her child,
^ See on this question also Bigelow's " Leading Cases, " on Torts, 295-303.
LIABILITY FOR PHYSICIAN'S FEES. 30
she must be bound to support and care for it ; and so it was
held in Furman v. Van Size cited above.
Estates of Insane Persons Liable in a Proper Case. —
Persons of unsound mind are liable for necessaries furnished
for their benefit, and can be made to pay therefor at reasona-
ble and proper rates, but they cannot make contracts for a
specific rate. It is always a question of fact as to what sum
should be charged against their estates, if they have any.
Master Not Liable for Services Rendered Servant ivithout
Special Contract. — In the case of master and servant, while at
common law as between a master and servant the master was
bound to provide medicine and food for the servant when the
servant was an inmate of the master's house, this is an obliga-
tion which a third person could not enforce, and the master can
only be held liable for services rendered to the servant, upon
proof of a specific contract with him to pay for them.
Case of Grain v. Baudouin Considered. — The case of Grain
V. Baudouin, supra, affox-ds an interesting discussion before the high-
est court of New York State, as to the question as to how far a
father calling a physician for an adult child for whom he is not
bound to provide, although lying sick at the father's house, can be
held liable for the services rendered upon such call. In that case
the plaintiff attended as a physician upon the daughter of the de-
fendant, who was sick at his house. The daughter was of full age,
married and living with her husband, but was brought from that of
her husband to that of her father in order that she might be under the
care of her mother. Defendant was present when plaintiff made his
calls, gave the latter a history of the patient's illness, and received di-
rections as to her treatment. He told others of the frequency and
length of the plaintiff's visits, and of his opinion of the case, without
any disclaimer of liabilit3\ The Court held, however, that these facts
were insufficient to imply a promise on the father's part to pay for the
services, and that the additional facts that the defendant consented to
the calling in of a consulting physician, and that a bill was sent in by
the plaintiff, unless acknowledged and acquiesced in by defendant, or
that he had before this employed other physicians, were also insufficient
to raise an implication of law of such a promise to pay. The plaintilf
relied in his argument upon the fact that the patient was a daughter of
the defendant, but the Coui^t held that any presumption which might
arise from this had the daughter been under age, was overcome by the
fact that she was past a majority, and was married and lived with her
husband and children. The plaintiff also relied to support his cause
40 LEGAL STATUS OF PHYSICIANS — BECKER.
of action upon the interest exhibited by the defendant in the course of
treatment pursued, and the other facts as to the presence of the defend-
ant when the plaintiff made his professional calls alone and in con-
sultation ; his receiving du'ections as to treatment ; his recognition to
others of the fact that the plaintiff was in attendance ; his reciting to
others a knowledge of the frequency and length of the visits of plaintiff
without any disclaimer on the part of the defendant of liability. The
Court said as to these facts : " It is true that particular acts will some-
times give rise to particular obligations, duties and liabilities. But the
party whose acts are thus to affect him must be in such predicament
as that those acts have, of legal necessity, a significance attached to
them, at the time, which he may not afterward repel. ... It has
been held that a special request by a father to a physician to attend
upon his son, then of full age but lying sick at the father's house,
raised no implied promise on the part of the father to pay for the ser-
vices rendered." See Boyd v. Sappington, 4 Watts (Pa.), 247; and so
in Veitch v. Russell, 3 Ad. & Ell. (N. S.), 927, it is said : "A physiciai;i
attends in every case on request ; that fa,ct alone is not enough for the
inference of a special contract ; " and see Sellen v. Norman, 4 Carr. &
P., 284. Still less where there has been no special request by the father
to the physician, and no more than acquiescence in his calls. As it
would be unnatural for the parent of an invalid child, though legally
emancipated, or for an intimate and confidential friend of hers, not to
know the rise and course of her malady, not to be interested in the
state of it as disclosed at any time to skilled inspection, not to be so anx-
ious as to be in waiting when scientific skill was to be applied for its
cure, not to be ready to receive directions for treatment in the inter-
vals ; so it is not to be implied in the one case more than in the other
that, from these manifestations, because unaccompanied with an ex-
press repudiation of liability, a liability may be implied. They are to
be referred to natural affection and friendly sympathj", rather than to an
acquiescence in the rendition of a personal benefit, or counted as acts
done under a sense of legal obligation." The Court further said that
"even if it should be assumed that the usage exists that the physician
called to consult with him who is in attendance, with the consent of
the person who has employed the latter, is in contemplation of law in
the hire of that person, still the assent of the defendant to the calling
in of the consulting physician, and his expression of desire to be present
when he came — until he is shown to have employed the plaintiff — is a
basis too weak for an implication of law, that he promised to pay his con-
sultation fees. Still less it is a fact from which to imply a promise to
pay the plaintiff." This case is, however, close to the border line, and
it may be well criticised and denied its apparent full weight of author-
ity, notwithstanding the very great learning and ability of the learned
Judge Folger, who wrote the opinion, upon the ground that it appears
LIABILITY OF THIRD PERSONS CALLING A PHYSICIAN. 41
that the father had as a witness expressly denied calling in the plaintiff
or authorizing anybody to call him in, or authorizing the employment
of a consulting physician, and that on the trial the Court had found
upon the whole testimony in the case that the defendant had never
employed the plaintiff. Taking the decision as a whole it cannot be
regarded as determining thai upon such a set of circumstances as is
there disclosed, the father could not in any event have been held liable,
but rather that the trial court having found upon the whole testimony
that the defendant was not liable, having witnesses before it fully
able to judge of their capability, the appellate court could not say as a
matter of law that a finding in favor of the defendant should be over-
ruled. This case is considered here at some length chiefly for the pur-
pose of affording an illustration to physicians and surgeons which will
suggest to them the advisability of care in ascertaining in all cases who
is responsible for their charge for services. See also Bradley v. Dodge,
45 How Pr. (N. Y.), 57; Smith v. Riddick, 5 Jones (N. C), 42.
Liability of Third Persons Calling a Physician —
General Rule.
As to liability for services rendered, when the medical man
is called by one person to attend another, it may be stated as a
general rule that in order to create such a liability it must
appear that the person calling either actuallj^ intended to be-
come responsible, or acted in such a manner that the phj^sician
was led to suppose that he so intended.
Liability of Railway Company Calling Physician in
Case of Accident to Employees, etc. — Another more trouble-
some question has arisen where physicians and surgeons have
been called in by employees of a railway company in case of
sudden accident or injurj^ In one case in New York, the
Superior Court of New York City held, that although the gen-
eral superintendent of a railroad company testified that he had
general authority to hire and discharge men, and that he had
employed a physician, the railroad company" was not liable.'
This doctrine seems to be opposed to the weight of authority. See
cases collated in Vol. 18, "Am. and Eng. Cyclopaedia of Law,"' p. 434 et
seq., some of which are: Toledo, etc., R. R. Co. v. Rodrigues, 47 111.,
188; Same v. Prince, 50 111., 26 ; Indianapolis, etc., R. R. i\ Morris, 67
'Stevenson v. The New York, Cases, 343; Cincinnati, etc., R. R.
etc. , Railroad Co. , 3 Duer, 341 ; Co. v. Davis, 43 Am. & Eng. R. R.
same case, 1 Am. & Eng. R. "R. Cases, 459.
42 LEGAL STATUS OF PHYSICIANS — BECKER.
111., 295 ; Cairo, etc., R. R. Co. v. Mahoney, 82 111., 73 ; Atchison, etc.,
R. R. V. Beecher, 24 Kansas, 228.
Same Rule does Not Prevail in United States in Case of Acci-
dents to Passengers. — The cases just noted were all cases of employees.
In the cases of injured passengers it has been doubted whether the same
rule applied, some State courts holding that in that case there is no
obligation to furnish medical and surgical attendance, but that the
physician attending must look to the persons whom they attended.
Union Pacific R. R. Co. v. Beatty, 35 Kansas, 265 ; Brown v. Missouri,
67 Missouri, 122.
Different in England. — In England a different rule prevails — one
more humane and in consonance with the moral obligation imposed by
the relationship of the parties. In Walker v. The Great Western R. R.
Co., a recent case (Law Reports, 2 Exch., 228), Chief -Justice Kelley, in
the course of the argument, made this remark : ' ' Must a board be con-
vened before a man who has his legs broken can have medical at-
tendance ? "
But in Cox V. The Midland Counties R. R. Co. (3 Wellsby, H. & G.,
268), the station master, employed as the chief officer of the passenger
and other departments, called in a surgeon to perform an operation
upon a passenger injured by a train. The road was held not liable.
On the other hand, in Langan v. Great Western R. R. Co. (30 Law
Times, N. S., 173), a sub-inspector of railway police was held to have
implied power to employ a surgeon for an injured employee. But i)i
Arkansas an attorney for a railroad company was held not authorized
to do so. St. Louis, etc., R. R. Co. v. Hoover, 53 Ark., 377.
Doctrine in Indiana the More Sensible One. — The more sensible
doctrine seems to be established in this country, in the State of Indiana
at least, in the case of Terre Haute R. R. Co. v. McMurray (98 Ind.,
358), in which the Court held that where there was great necessity for
the employment of a surgeon, the conductor of a train has authority to
employ the surgeon, if the conductor is the highest officer in rank on
the ground at the time. But in that case the Court expressly states
tliat this liability grows out of the exigencies of the case ; not out of
any theory of general authority.
Authority of Railroad Physician to Employ Nurses, etc. , Doubt-
ful. — It has also been disputed whether the authority of the company's
physician extended far enough to render the company liable for ser-
vices performed by nurses employed by him, or for board and lodging
engaged by him for injured employees. In Bingham v. Chicago, etc.,
R. R. Co. (79 Iowa, 534), it was held that the authority was sufficient,
but in that case testimony appeared tending to show that an agent of
the company who had authority to employ the physician had author-
ized him to employ two nurses. The converse doctrine — namely, that
the fact that a physician of the company was authorized to buy medi-
LIABILITY OF THIRD PERSONS CALLING A PHYSICIAN. 43
cines on the credit of the company does not authorize the inference
that he has power to render the company liable by a contract for board
and nursing of a person injured on the company's road — was held in
Maber v. The Chicago, etc., R. R. Co., 75 Missouri, 495 ; Brown v. The
Missouri R. R., 67 Missouz-i, 122. To the same effect, see Louisville,
etc., R. R. Co. V. McVeigh, 98 Ind., 391 ; Cooper v. N. Y. C. & C, 6
Hun, 276 ; and St. Louis, etc., R. R. Co. v. Hoover, 53 Arkansas, 377.
2 Redfield on Railways, 114 :
On the other hand, where a physician and surgeon has been duly
employed by a sub-officer or servant of the railroad company, ratifica-
tion of this employment, by those having authority to employ him
and to render the company liable, will be inferred from slight circum-
stances.
Such was the case of Louisville R. R. Co. v. McVeigh, which has
been cited.
And in another case where information of the fact of the employ-
ment had been conveyed to the company's general manager, and he
had neglected and omitted to repudiate the employment or to terminate
it, and the surgeon went on and performed services, it was held that
from these facts a ratification will be inferred. Indianapolis R.R. Co.
i\ Morris, supra. See also Toledo, etc., R. R. Co. v. Rodrigues, sti-
pra; Same v. Prince, supra; Terre Haute, etc., R. R. Co. v. Stock-
well, 118 Ind., 98.
Pi^esentation ay^d Retention of Doctor's Bill Raises No
Presumption of Liability. — The presentation of a bill to a
person containing charges against him for services rendered
another person, and his retention of that bill without disclaimer
of liability, does not raise a presumption of liability, for it is
not necessarily an account stated. To constitute an account
stated, there must be not only a statement of account, but ac-
quiescence in it ; mere retention of the account is not sufficient.
Bills Presented Not Conclusive as to Amounts Charged.
— On the other hand, if a bill is presented v^hich contains
charges which are not acquiesced in, the person making out
and presenting the bill is not absolutely bound by the charges
therein contained, although such a bill affords some evidence
as to the value of the services rendered.'
Claims Against Estates of Deceased Persons. — A bill for
a physician's services constitutes a claim against the estate of
' Bronson v. Hoffman, 7 Hun, of Med.," svpra, p. 46; but see
674 ; Williams v. Glenny, 16 N. Y. . also Danzinger v. Hoyt, 46 Hun,
389, and see Ordronaux on " Juris. 270.
44 LEGAL STATUS OF PHYSICIANS — BECKER.
a deceased person, like any other debt. In some States it is a
preferred claim.' In this connection it should be observed that
short statutes of limitation exist in most countries and States
applicable to such cases, shorter than the ordinary limitation
imposed by law upon the right to sue upon claims for services
rendered (which is six years). In order to preserve his legal
rights, the physician should as soon as possible after the death
of the person for whom his services have been rendered, as-
certain who is the administrator or executor of the estate of
such person, and file with such representative, personally, proof
of his claim.
Patient who Receives Benefit of Services of Consulting
Physician Liable. — The liability of a patient for the services
of a consulting physician is generally governed by the same
rules as his liability to the ph3'sician in immediate charge of
the case.*
Where the patient accepts the services of a consulting phy-
sician, although he has not directly requested them, he must
pay for them if he receives the benefit of them without object-
ing, because it will be presumed that he ratified the act of the
physician who was in charge of the case, in calling the other
physician into consultation.^
But, however this may be, it is a principle of professional
ethics, which has almost acquired the authority of legal doc-
trine, that a physician in charge of a case should obtain the fuU
assent of a patient, or of his family and friends, if he is too ill
to give his own consent, to the calling of another ph3'sician in
consultation.
No Other Stranger can he Called into Sick-Boom ivithout
Assent of Patient. — A limitation upon the authority and right
of an attending physician is, that if he desires or attempts to
call in a stranger not a physician, he must obtain his patient's
' And it has been held that a de- - Grain v. Baudouin, supra; Shel-
cedent's estate is liable for fees of ton v. Johnson, 40 Iowa, 84 ; Garry-
expert, who by direction of probate v. Stadlen, 67 Wis. , 512.
court examined widow and testified ^ And a physician may recover the
as to her pregnancy. This notice value of services rendered by his
was put upon the ground that his students. People v. Monroe, 4
testimony was necessary for the in- Wend. (N. Y. ) , 200 ; Jay Co. v.
formation of the court in a matter Brewington, 74 Ind. , 7. And the
before it affecting the disposition of physician in attendance is not lia-
the estate. Eollwager v. Powell, bie to the physician thus called.
S Hun, 10. Guerard-e. Jenkins, IStrobh., 171.
CONSULTATIONS. 45
consent. The obligation of a physician toward his patient of
secrecj^ and confidence is regarded as very strict, and if a phy-
sician should call in a student or other stranger, without first
consulting his patient, or those who are in some measure related
to him and connected with him, it would be a verj" severe
stretch of morals and possibly of law. In fact, in a recent case
in Michigan, a physician was held liable for damages who
called in a stranger, an unmarried man, who was an unprofes-
sional man, to be with him while he was in attendance on a
confinement case. In that case both the physician and the
person so called in, and who was present at that time, were
held liable in damages ; and it was further held that the right
to recover was not affected by the fact that the patient supposed
that the person so called in was a medical man, and therefore
submitted to his presence without objection.*
The statutes which create the privilege as to professional
communications and information necessary to enable the phy-
sician to prescribe, might not apply to students or other
strangers, and this is probably the reason for the rule of law
laid down in the Michigan case. The obligation to preserve
inviolate a communication as a privileged communication, in-
cluding in the meaning of the word " communication" all
knowledge or information received while in attendance upon a
case, would be held to have been broken by the act of the phy-
sician in bringing in a stranger who would not be privileged
from testifying.
Measure of Recovery for Services Rendered.
Terms of Express Contract Govern — Reasonable Worth
the Rule in Implied Contracts. — In case of an express con-
tract its terms necessarily measure the amount of the charges.
In the absence of an express contract fixing the value of the
services to be rendered, the measure of damages for breach of
payment is like that in any other case of personal services, the
reasonable worth and value of the services performed. So like-
wise if medicines or appliances are furnished, which are not
reasonably to be expected and furnished, according to the cus-
tom of the school to which the physician or surgeon belongs,,
' Deway v. Eoberts, 46 Michigan, 160.
46 LEGAL STATUS OF PHYSICIANS^BECKER.
the reasonable worth and value at the time of furnishing them,
and at the place of furnishing them, is the measure fixed by
the law to determine what shall be recovered for them.'
Value — Hoiu Proved. — When the medical man is com-
pelled to go into court to enforce payment for his services, it
has been questioned whether he can testify to the services ren-
dered, and the facts and circumstances surrounding the patient
at the time of the treatment, because it has been claimed that
he could not do so without violating the statute against the
disclosure b}^ physicians of information received which is nec-
essary to enable them to prescribe. The tendency of the later
decisions, however, seems to be that the breach of the patient's
contract to pay relieves the physician from his obligation of
secrecy, and consequentlj^, that if it is necessary for him to go
into court and prove the value of his services, he may testify,
within reasonable limitations, to all matters necessary to inform
the court fully as to the nature and extent of the disease or
injuries of the patient, in order that he may show the responsi-
bility imposed upon him and the extent of the services that
he has rendered. This subject will be fully considered under
the head of " Privileged Communications. " The usual course of
practice where there is not an express contract fixing the
charges, is to prove the facts and circumstances showing the
treatment and services, and then to produce other physicians
who, in answer to a hypothetical question stating the facts and
circumstances in the case, assuming them as true, are allowed,
if they state they know the value of such services, to give an
expert opinion as to what that value is.^ It has also been said
(Ordronaux, " Jurisprudence of Medicine," § 43), that if a fee-
bill of charges for such services has been established by an
association of physicians recognized hj law, such as a countj^
medical society or a State medical society, incorporated pursu-
ant to statute, such fee-bill can, if properly authenticated as
having been adopted by the association, be offered in evi-
dence on behalf of the patient and against the physician. But
such a fee-bill in such a case would not be held to be conclusive
' MacPherson'».Chedell,24Wend., presumed to be experts as to the
15; Adams v. Stevens, 26 Wend., value of other physicians' services.
451 ; Story on Bailments, § 37. Beekman v. Platner, 15 Barb. ,
* Duly licensed physicians are 550.
GENERAL ADVICE. 47
evidence of the value of the services, but will be received in
evidence, if at all, merely for the purpose of showing what was
the" usual and ordinary charge in such cases. As we shall see
later on, under "Malpractice," a judgment for services ren-
dered, however small, is a bar to an action of malpractice, be-
cause a judgment for the value of the services rendered involves
proof on the part of the plaintiff, and a finding on the part of
the court, that the services had value and were skilfully per-
formed and properly rendered.'
Custom of Physicians to Treat Each Other Gratis, En-
forceable. — Physicians frequently treat each other, and it has
been, held, where the custom exists to do so without charge,
that such a custom is binding. Of course, this rule does not
prevent phj^sicians from making an express contract to waive
the custom and agreeing that the services be compensated.
Elements to he Proved in an Action for Service, etc. —
General Advice. — The result of these rules may be thus sum-
marized, viz. : The elements to be established in an action for
services by a physician against a patient are three in number —
(1) the employment; (2) the performance of the services;" and
1 Bellinger v. Craigue, 31 Barb. , him. On the other hand, in an
534; Gates iJ. Preston, 41 N. Y., 113; action for malpractice brought l)y
Blair v. Bartlett, 75 N. Y. , 15. the patient against a physician.
The general rule is that in an action which is generally in form an action
arising on contract damages arising for a tortious act, or neglect, the
for a tort cannot be set up as a physician cannot plead the perform -
counter-claim. It follows from this ance of services and the non-pay -
that in an action of a physician for ment of his bill as a counter-claim
services, damages for malpractice or recoupment, because that arises
could not be recouped or counter- on a contract. If there is any ex-
claimed ordinarily. The way in ception to this rule it will be found
which that rule is avoided, and to grow out of the language of see-
the safer method, is for the defend- tions 549 and 550 of the Code of
ant to plead that it was part of the Civil Procedure of the State of
contract of the physician (which it New York, and of similar enact-
undoubtedly is), to perform his ser- ments in other States, which permit
vices in a faithful and skilful man- counter-claims arising out of the
ner, and that he committed a breach same subject-matter as the cause of
of it, thus charging the damages action, to be pleaded in that action,
which flowed from his acts as a In New York State, however, any
breach of contract, not as a cause of effect of that kind is negatived by
action in tort for malpractice or neg- the general provision that the ac-
ligence. If that is done the counter- tions must not only arise out of tlie
claim arising in malpractice can same subject-matter but be of the
probably be pleaded in an action for same kind and class,
services, and possibly a counter- '■ The degree of care and skill re-
claim in excess of the amount quired to be shown to entitle tlie
claimed by the physician recovered physician or surgeon to recover
as an affirmative judgment against compensation for his services has
48 LEGAL STATUS OF PHYSICIANS — BECKER.
(3) the value of the services, that value being either a fixed
value determined by the terms of the contract between the par-
ties, or the reasonable worth and value of the services deter-
mined by evidence of experts upon that subject. It is, there-
fore, important that physicians and surgeons should be advised,
when entering upon the practice of their profession, to keep a
record of their transactions and of their business generally.
Because, if they are compelled to go into court to recover for
their services, they will be called upon to describe with minute-
ness the character and extent of the services they have per-
formed in order that the value thereof may be correctly ascer-
tained and determined in the suit. Any person in active
practice who is not blessed with a most tenacious and particular
memory is liable to forget a great many details which, with a
record in hand, properly kept, could be brought to his memory
and be testified to with absolute truthfulness and conviction.
And the record itself, when properly shown to be a book of
original entry, is generally receivable in evidence, as a memo-
randum of the transaction.'
already been stated to be simply ' Foster -y. Coleman, 1 E.D.Smith,
such care and skill as are possessed 85 ; Larue v. Rowland, 7 Barb. , 107 ;
by the majority of other professional Clarke v. Smith, 46 Barb. , 30 ; Kniglit
men of the same school of practice v. Cunningham, 6 Hun, 100 ; Bay v.
at the time, or what is known as Cook, 23 N. J. L. , 343.
ordinary care and skill.
CHAPTER Y.
OF THE PRIVILEGES AND DUTIES OF PHYSICIANS AND
SURGEONS WHEN SUMMONED AS EXPERT WITNESSES
IN COURTS OF JUSTICE.!
Introductory — Distinction Between Expert Witnesses
and Other Witnesses. — One of the most important positions that
a medical man is called upon to assume by virtue of his profes-
sional character, is the position of expert witness. Most writers
on medical jurisprudence confine themselves, in the discussion
of this subject, to presenting the medico-legal rules which ap-
pertain to this position, and concede its high importance.
Before defining what is meant b}' the term expert witness, or
treating of the rules which determine the status of such wit-
nesses in court, and their duties, it seems advisable to introduce
the subject by a brief consideration of the distinction between
ordinary witnesses and expert witnesses. When medicine and
law are united in the purpose of investigating facts, and bring-
ing about a legal determination as to what are or are not facts,
they co-operate with each other in this way. The law furnishes
the machinery for the inquiry and the rules which determine
how it shall be prosecuted. The medical man, however, is
called upon as an assistant to the law, because of his skill and
experience in his profession, which enable him to ascertain and
interpret the circumstances from which the facts sought to be
established are to be inferred. Ordinary witnesses testify con-
cerning matters of observation, the court and jury being en-
dowed with the sole power to determine the credibility of their
evidence and the true result of their observations. Yet the
border line of distinction between witnesses who testify merely
to actual matters of observation, and those who give their
■ The writer is indebted for many admirable lectures on Medical Ju-
valuable suggestions concerning risprudence before the Medical De-
this svibject to Ansley Wilcox, Esq. , partment of the Universitj' of Buf-
of the Buffalo, N. Y. , Bar, and his falo.
4 49
50 LEGAL STATUS OF PHYSICIANS — BECKER.
opinions upon and draw inferences from established facts and
circumstances, is a wavering one. The general rule of evidence
is well understood, that hearsay evidence is inadmissible, and
yet, like any other rule, this has its exceptions which grow out
of the necessities of given cases. This is so because there are
and always will be, matters brought before courts for investi-
gation and determination, long after the witnesses who person-
ally saw the facts and circumstances of the particular case in
which such matters are concerned have died, or have with-
drawn beyond the reach of the process of the court. Possibly
no record in writing of such facts and circumstances has been
left, or if in writing it lacks the sanctity of being a judicial
writing, and hence is no better evidence than any other form
of hearsay evidence. For this reason in matters of family
history, pedigree, custom, and the like, hearsay evidence is
permitted, and is entitled to as much weight as any other evi-
dence, if the witnesses giving it be trustworthy.
In Matters of Common Experience Witnesses in General
Often State Conclusions. — Moreover, in matters of common
experience, the testimony of any witness, if carefully analyzed,
often shows that he is sometimes allowed to draw, and state,
his conclusions and inferences, instead of being required to
confine his evidence simpty to telling in the strictest possible
way, and with the closest limitations, what he actually wit-
nessed. A good illustration of this is the case of a person who
sees a crime of homicide committed by shooting, and is called
upon to testify in court. He would be allowed to testify that
the defendant, if he could identify the prisoner at the bar as
such, was the person whom he saw fire the shot, although he
might not have examined him with close scrutiny, and might
never have seen him before the crime. In saying that the de-
fendant was the person who fired the shot, while he would be
in terms testifying to a fact, he would still be drawing an
inference, and giving an opinion, based upon his recollection
of the person whom he saw engaged in the act of firing, and of
the likeness or resemblance of such person to the prisoner at
the bar, which would be a matter of comparison and of opinion.
So, too, although he could not see the bullet take its course
from the mouth of the gun and imbed itself in the body of the
deceased, yet if he saw the firing, heard the explosion, saw the
WITNESSES IN GENERAL OFTEN STATE CONCLUSIONS. 51
flash and smoke of the powder, observed the direction in which
the accused pointed the weapon, and saw the deceased stagger
and fall, he would be allowed to testify in answer to a direct
question whether or not the accused shot the deceased. And,
yet in making up that answer he would be testifying not
simply to a matter of actual observation, but to a conclusion.
As it is in reference to the question of identity so it is as to
many other matters which come before our courts, in all of
which the witnesses are permitted, without objection, to testify
to conclusions and to give answers which are the result of in-
ferences which they draw themselves, rather than a statement
of their actual observations. The law is not a metaphysical
but a practical science, limited and confined b}^ the practical
restrictions which experience has shown must be put upon it,
in order to enable it to accomplish its object of administering
justice between man and man. Men form such conclusions as
have been indicated, instinctively and unconsciouslj", and it
would be practicably impossible for them to narrate an}- occur-
rence without embodying in their narration some of these nat-
ural and unconscious conclusions. The law, therefore, includes
among the matters which witnesses are permitted to charac-
terize as facts, those daily and hourly inferences and deductions
which all men are accustomed to make, and concerning which
no two men who are properly constituted can greatly differ.
It is true that this practice sometimes leads to error, but it has
grown out of necessity. The greatest safeguard is, that upon
the trial of a question of fact both sides are represented by
counsel, and the opportunity which cross-examination offers to
an advocate of even reasonable and ordinary skill is such, that
these conclusions and inferences may be sifted down through
the chain of observation, and the process of drawing these con-
clusions and inferences from a series of facts, tested in such a
manner that the improbability, probability, or truth of any given
inference or conclusion may be determined with substantial
accuracy. The illustrations which have been given above
exhibit the simplest form in which so-called direct testimony
can be demonstrated to be not always positive and direct testi-
mony, but somewhat a matter of inference. Other examples
and illustrations of common occurrence will exhibit still more
closely the line between actuality and opinion. At times it
52 LEGAL STATUS OF PHYSICIANS — BECKER.
becomes essential to the determination of a question, that the
courts should know whether or not a person was angry, whether
or not he was intoxicated, or whether or not at a given time,
when his mental status was under observation, he acted ration-
ally or irrationall3^ Lay witnesses have for many years been
permitted to testify from observation, and without possessing
any special qualification to do so, as to the existence or non-
existence of such conditions as those just mentioned in a person
whose actions are under consideration. It is manifest that in
making any such inferences the witnesses' testimony is mainly
a conclusion based on inference. Take the case of anger. How
shall that be determined? It is difficult to describe anger. A
loud voice, a flushed face, the use of bitter words, nervous,
excitable, demonstrative action — all these symptoms might
occur, or but few of them might occur. So, too, in the matter
of intoxication. It is well known that some individuals exhibit
the effects of intoxicants in an entirely different manner and
degree from others. Some men who are verj' much intoxi-
cated, so as to be quite incapable, in the eye of the law, of
forming a criminal intent, or of contracting an obligation
which would be valid, may still be able to walk perfectly
straight, or to talk without much confusion. Others, whose
walk and demeanor would indicate a considerable degree of
intoxication, might be mentallj^ clear and unruffled and even
stimulated by intoxicants to precise mental co-ordination and
reasoning. Again, there are persons, as to whom a witness,
after stating that he had observed them, and after stating the
particular matters and things in which such persons were
engaged, might with apparent accuracy state that they acted
rationally or irrationally, and yet such persons might neverthe-
less, upon furthfr examination, be found to have been acting
according to a particular custom or habit, or idiosyncrasy' of
long years' standing. Thus it is apparent that in each of these
cases, when the witness attempts to state what, out of neces-
sity, the court treats as a fact — viz. , whether a given person is
or is not angrj^, or intoxicated, or irrational — the witness is
really testifying to the result, in his own mind, of his observa-
tions of the condition and conduct of the person who is under
investigation, when compared with a standard which the wit-
ness has erected for himself. Hence such results are really
WITNESSES PERMITTED TO DRAW CONCLUSIONS. 53
matters of opinion evidence, pure and simple. Other examples
of a like character are found in statements as to weight,
height, distance, speed, and the like, as to which men of com-
mon powers of observation, who are not strictly experts, are,
because of convenience and necessit}'' and the probability of
reasonable and ordinary accuracy, commonly permitted to give
their own judgment and conclusions as evidence.
All Witnesses Often Permitted to Draw and State Con-
clusions in Matters Involving Numerous and Complicated
Details. — Thus the practical necessity of the administration
of justice has led to the establishment of tlie rule, that where
the details of an occurrence are numerous and complicated, and
are incapable of precise description by ordinary observers, wit-
nesses are permitted to use, in testifying, general expressions
which really embody their conclusions from the facts or details
observed by them. Greenleaf on Evidence, Section 440, note
A; Wharton on Evidence, Section 434.
Wharton says that "the distinction between expert wit-
nesses and ordinary witnesses is this : the non-expert witness
testifies to conclusions which may be verified by the adjudicat-
ing tribunal; the expert, to conclusions which cannot be so
verified. The non-expert gives the results of a process of rea-
soning familiar to every-day life ; the expert gives the results
of a process of reasoning which can be determined only by spe-
cial scientists." See also People v. Fernandez, 35 N. Y., 49.
People V. Deacons, 109 N. Y., 374-382.
This learned writer (Wharton) also says, at Section 437 of
the same treatise :
" Where conclusions depend upon facts whose evidential
weight can only be determined by those familiar with a partic-
ular specialty, then these conclusions may be given by experts
in such specialty." Such also is the exact derivative meaning
of the word expert, it being derived from the Latin word
" expertus," meaning, literally, "experienced," and hence
skilled by experience.
Functions of an Expert Witness Essentially Judicial. —
It is the function of an expert witness to reason about facts, to
explain their connection with one another, and to draw conclu-
sions and inferences from them. Hence, a witness, however
expert in any ordinary sense in his specialt}^ when ho is called
54 LEGAL STATUS OF PHYSICIANS — BECKER.
upon merely to narrate facts which he has observed, is an ordi-
nary witness, and is governed by the same rules which apply to
the ordinary witnesses. When, however, he is called upon, in
addition to recounting facts, to explain or interpret them by
reference to assumed facts, he becomes properly an expert
witness. It thus appears that an expert witness must neces-
sarily perform a part of the duties which devolve upon the
court or the jury. His position is, therefore, essentially judi-
cial, except that he has no power to enforce his determinations
by judicial process. The importance and responsibility which
the law thus confers upon an expert are of the highest character.
He ranks the coequal with the tribunal itself in his peculiar
province, so far as relates to his individual responsibility. That
this should tend to elevate such witnesses to a high social posi-
tion, and ought to require the most exact and faithful integrity
of purpose and statement, is self-evident.
Difference Between Status of Expert Witnesses in France
and Germany and in the United States and England. — In
some foreign countries, notably in Germany and in France,
experts in medico-legal matters have an assured official posi-
tion, and are generally not allowed to be selected at hap-hazard
according to the will or the length of the purse of those who
need their services. The consequence of this method of obtain-
ing expert evidence is, that expert witnesses in those countries
command a high measure of respect and honor.
Unfortunately, however, in this country, where the opposite
practice prevails, the weaknesses of human nature are such
that the common people, newspapers, lawyers, and even the
courts in some recorded opinions and decisions, have come to
express a great want of confidence in the weight and value of
expert testimony. This deplorable result of a bad system of
procedure is universally recognized, yet our State legislatures
have as j'et refrained from attempting to correct it.
Hence, in considering the value of expert testimony in mat-
ters of medical jurisprudence, it must be conceded, in the first
instance, that the difference between the system prevailing in
this country and in England, and that which prevails on the
Continent, notably in Germany and France, has not tended to
raise but to depress the value of such testimony in the first-
named countries. In the latter countries, the experts upon
STATUS OF WITNESSES IN DIFFERENT COUNTRIES. 55
medico-legal questions are officers of the court, or are treated
as such. They form, in a sense, a part of the judicial system,
and the expression of their opinions consequently carries with
it great weight. Moreover, under the system which prevails
there, it has been possible for men to be educated up to a high
degree of skill and experience in the particular branches of
physiological or psychological or physical investigations which
they pursue, while here in America, and to a certain extent also
in England, experts are such for other reasons, and by the
operations of other causes, than the fact of their permanent
employment in that capacity. As a general thing they become
skilled in their profession or in the particular branches of it
in which they practise as specialists, and are summoned to
testify simply because they are selected by one party or another
to a lawsuit.
31r. Wha7'to7fs View of this Question in the Mairi Hostile
to the Prevailing System Here. — The effect of the methods
which thus prevail has not been entirely to the advantage of the
miedical profession or of our courts. Wharton, in his work on
"Evidence," Section 454, observes upon this point: "When
expert testimony was first introduced it was regarded with
great respect. An expert was viewed as the representative of a
science of which he was a professor, giving impartially its con-
clusions. Two conditions have combined to produce a material
change in this relation. In the first place it has been discov-
ered that no expert, no matter how learned and incorrupt,
speaks for his science as a whole. Few specialties are so small
as not to be torn by factions, and often the smaller the specialty
the bitterer and more inflaming and distorting are the animos-
ities by which these factions are possessed. Particularly is
this the case in matters psychological, in which there is no
hypothesis so monstrous that an expert cannot be found to swear
to it on the stand, and to defend it with vehemence. ^XiJiil
tarn absurdo,^ which being literally translated means that
there is nothing so absurd that the philosophers won't sa}- it!
In the second place, the retaining of experts by a fee propor-
tioned to the importance of their testimony is now as customary
as is the retaining of lawyers. No court would take as testi-
mony the sworn statement of the law given by counsel retained
on a particular side, for the reason that the most high-minded
56 LEGAL STATUS OF PHYSICIANS — BECKER.
men are so swayed by an employment of this kind as to lose
the power of impartial judgment; and so intense is this convic-
tion that in every civilized communit}^ the retention by a judge
of presents from suitors visits him not only M^ith disqualifica-
tion but disgrace. Hence it is that, apart from the partisan
character of their opinions, their utterances, now that they have
as a class become the retained agents of the parties, have lost
all judicial authority and are entitled only to the weight which
sound and consistent criticism will award to the testimony itself.
In making this criticism a large allowance must be made for
the bias necessarily belonging to men retained to advocate a
cause, who speak not as to fact but as to opinion, and who are
selected, on all moot questions, either from their prior advocacy
of them or from their readiness to adopt the opinion to be
proved. In this sense we may adopt the strong language of
Lord Kenyon, that skilled witnesses come with such a bias on
their minds to support the cause in which they are embarked,
that hardly any W' eight should be given to their evidence."
This author then proceeds to show that under the civil law
system the conclusions of experts were formerly treated as un-
assailable facts, but under the English and American common
law system this is not the case, but their testimony is to be
weighed by the court. He says : " The grounds on which the
conclusion is reached may be asked for : the expert's capacity
for drawing conclusions, as well as his premises, may be as-
sailed. Cases of conflict are to be determined, not by the nvim-
ber of witnesses, but by the weight of their testimony, and
though the opinion of an expert of high character may be
entitled to great respect, yet if questioned, its authorit}^ must
ultimately rest upon the truth, material and formal, of the
reasoning on which it depends."
Judge Davis, of the Supreme Court of Maine, in Neil's
case (cited in AVharton and Stille's " Medical Jurisprudence,"
Vol. I., Section 294), said: "If there is any kind of testimony
that is not only of no value, but even worse than that, it is in
my judgment that of medical experts. They may be able to
state the diagnosis of a disease more learnedly, but upon the
question whether it had at a given time reached a stage that
the subject of it was incapable of making a contract, or irre-
sponsible for his acts, the opinions of his neighbors, of men of
MR. WHARTON'S VIEW OF THE QUESTION. 57
good common sense, would be worth more than that of all the
experts in the country."
Such stinging- criticisms as these, and others which might
be cited, of a like character, may not be always merited. It is
certain that medical experts' opinions, if fully enlightened by
scientific research and free from partisan bias, ought to occupy
a position like that of judicial opinions in weight and decisive-
ness upon the questions submitted to them. Such was the
jDOsition occupied in the public estimation, and in that of judges
and counsel, by the great Dr. Caspar in Germany, and Foedere
or Pinel, and others'" since their time, in France. But this posi-
tion was acquired chiefly because of the fact already mentioned,
that under the system of administration of justice which pre-
vails in those countries these great men were regarded, and
acted, as a component part of the judicial system. The}- were
called in as officers of the law to assist the court in forming a
judgment, and determining disputed questions of fact, in cases
involving life and death, or the devolution of property, where
scientific experience, knowledge and skill, not possessed by
judges or by counsel, was necessary for the determination of
the questions involved. The root of the evil in America is, as
already pointed out, to be found in the sj^stem which allows
parties to retain and pay their own experts without anj' sub-
stantial restrictions. Sooner or later, among the other reforms
in our judicial system, it will be found necessary to reform this
evil by the enactment of laws requiring that the witnesses in
medico-legal cases, particularly those in which a crime is alleged
to have been committed, shall be designated by the court, or by
some public authority, and paid from the public treasury in-
stead of by the parties. Such experts would then occupy their
proper position of special counsel, advising and assisting the
legal counsel and the court, but they would not be taken out of
this sphere and put in the utterly inconsistent one of witnesses.
Their status and their duties would be as clearly distinguished
from that of expert witnesses as now known, as the status and
dat}^ of the lawj'er are from the status and duty of the judge.
The present S3'stem has been said to be very much like putting
a lawyer, who has just argued his client's case, on the bench
to decide it. Whether experts should be appointed as perma-
nent government officials, like our judges, or should be selected
58 LEGAL STATUS OF PHYSICIANS — BECKER.
specially for each case like juries, referees, or arbitrators, and
in the latter event whether they should be nominated by the
parties and selected by the court from such nominees, or other-
wise, are all questions of detail.
Our judges and lawyers seem slow to recognize the fact that
the duties of experts are judicial, or at least quasi-judicial; to
pass upon certain facts which neither the court nor the jury
can understand without their aid. But, as we have seen from
the citations just given, judges and lawyers have fully recog-
nized the unreliability of expert testimony, produced as it now
is in England and in this country at the whim and selection of
the parties and paid for, much or little, according to the means
of the parties.'
Method of Preliminary Examination of Experts— On
Medical Questions a Licensed Physician Presumed Compe-
tent. — As the system exists here, the only power that the court
nas over the selection of an expert, is to determine, in advance
of his testimony and of the elucidation of his opinions, whether
or not he is competent as an expert. But this power affords
little or no check or restriction, because in the effort to get all
the light that is possible upon the questions under consideration,
and to avoid unduly interfering with counsel in the conduct of
the case at bar, the practice has become universal, and is recog-
nized in the decisions and text writers, of permitting any medi-
cal man who has a license to practise his profession, to testify
as an expert, and to give his opinion as such on any question
cognate to his profession. This is so without regard to the
amount of study and experience he may have had in the par-
ticular matter under consideration. The naked fact that he is
licensed to practise is enough. He then — that is, after testify-
ing that he is a practising physician — is clothed with the gar-
ment of authority. The only way in which his knowledge can
' The conservatism of lawj^ers is defects of the system as it now ex-
proverbial. It is hard to convince ists has been brought to public at-
them that forms that have been long tention in the journals of the day,
in use and have been found to serve in papers read before medical socie-
a useful purpose in the past, are not ties and bar associations, and in
applicable to new conditions as they ai-guments in legislative bodies, and
arise ; for instance, that the meth- it is lioped and believed that ere
ods of procuring the attendance and long a reform, something of tlie
of examining ordinary witnesses do character indicated, maj^ be brought
not fit the necessities of expert tes- about in this very important mat-
timony. But the question as to the ter.
METHOD OF PRELIMINARY EXAMINATION OF EXPERTS. 59
be tested is by cross-examination as to his experience and skill,
and possibly by contrasting him as he appears upon the witness-
stand and his history as he gives it, with other and more or less
experienced and skilful men who follow him.
The rule is, that when a witness is produced to give an
opinion on a medical question, he is interrogated by the coun-
sel who produces him as to his qualifications. At this point,
before he is allowed to give his opinion, it is proper and cus-
tomary that the counsel ui3on the other side of the case should
be allowed an opportunity to cross-examine as to his compe-
tency, and then the court determines whether or not he is a
competent witness. If the court pronounces him competent,
a hypothetical question is put to him stating the facts of the
case, as the counsel interrogating him claims them to be estab-
lished by the evidence, and the expert is then asked to give his
opinion on the question at issue, based upon an assmnption
that the facts stated are truly stated. Then the opposing coun-
sel has the right to cross-examine, and to ask his views and
opinions- upon the same question at issue, but assuming as true
other and different facts or premises, as he claims them to be
established by the evidence. This often involves a test of wit
and intelligence, and of forensic acumen, between the • counsel
and the witness, which serves very little useful purpose, ex-
cept perhaps to elucidate more strongly than has been here
stated the defects of the system which now obtains. It is also
not unusual, and in fact is the result of the workings of human
nature, that under the manipulations of counsel skilled in cross-
examination, skilled in methods of indirection in stating facts,
and armed with the powerful weapon of the rule which permits
them to insist upon a categorical yes-or-no answer to a question,
the jury and the court become confused, the witness loses his
temper, or becomes affected more strongly than ever before by
bias against his persecutors, as he feels them to be, and the
examination ends in a farce. This is not always the case, and
the illustration given is an extreme one. Like the citations
from judicial criticism of expert testimony which have been
given, these matters are only adverted to here as danger signals,
a warning to both professions, and with an earnest suggestion
of the necessity of reform.
60 LEGAL STATUS OF PHYSICIANS — BECKER.
EXPERTS, HOW SUMMONED INTO COURT.
They Must Obey the Summons and Appear and be Sworn.
In General they need Not Give their Opinions unless Duly
Compensated. — An expert witness is brought into court like an
ordinarj^ witness by the usual process of the court. This pro-
cess is, under the American system, an ordinary subpoena, and,
being process of the court, whether or not he has been paid or
promised compensation for giving his opinion he must obey
the process to the extent at least of appearing in court when
called, to be sworn. Interesting questions have been raised as
to his obedience to the subpoena to the extent of testifying when
he has not been compensated. It has been argued, and the
argument is sustained by the decisions of courts of high author-
ity in some States, that his knowledge and skill, acquired by
study and by experience, is his property, of which he cannot
be deprived without just compensation, under his constitutional
rights guaranteed to him by the organic law of this country.
On the other hand, in some other States it has been held that he
is so far a necessary part of the judicial system that he ma}^ be
called upon to give the results of his experience, knowledge,
and skill forming his opinion, without payment other than the
ordinary compensation to witnesses. It is believed, however,
that the better opinion is the former; that he does not stand on
the same footing as an ordinary witness, whose province it is
to testify solely to matters of observation of fact, but that he
stands in the position of one who has something to give ; some-
thing to impart in the way of knowledge or experience, which
is his property as much as any other thing movable or im-
movable of which he is possessed.
A somewhat different question has arisen in the case of a
witness who, like a family physician or attending physician,
has learned facts and has been paid for his attendance, or who
exacts paj^ment for his attendance, as a physician from his
patient, and this question is ; when such a professional man has
been called upon to testify to the information he thus attained,
whether he can be asked for, and required to give, opinions
based on those facts? Necessarily, having learned the facts by
observation, such as the appearance, symptoms, and actions of
EXPERTS, HOW SUMMONED INTO COURT. 61
the patient, he is, when testifying as to these matters, nothing
more or less than an ordinary witness, because he is testifying
to matters of observation. As to these matters pubhc policy
requires, except so far as it has been modified, or rather ex-
tended, by our statutes which forbid testimony as to privileged
communications, that he must testify, the sarhe as any other
witness. But suppose that, having so testified to the facts, he
is asked to give his opinion ; for example, in an insanity case,
whether the symptoms that he found in his patient led him to
the belief as a professional man of experience and skill that his
patient was sane or insane. Tiie question is. Can he be com-
pelled to give that opinion, if he chooses to decline to give it
without the j)romise or assurance of further compensation than
the mere per diem fee and mileage of an ordinary witness?
The best authority is to the effect that he must so testify, the
reasoning of the court being that his opinion is only a part of
what he derived from his original relation of physician to his
patient. Wright v. The People, 112 111., 540; same case, 33
Alb. L. J., 79.
Same Rule in Civil and Criminal Cases. — The rule is the
same whether the professional man is called to testify as an
expert in civil or criminal cases. In either one he is not obliged
to give an opinion as such, independent of a personal knowl-
edge of the facts in the case, without being paid or assured
reasonable compensation therefor. His proper course of con-
duct is, Avhen he has obeyed the subpoena and is in the presence
of the court and has been sworn, and the questions put by
counsel disclose that the object of his examination is to elicit
from him an opinion, to state to the court that he has not been
paid any other compensation than that of an ordinary witness,
and that he respectfully declines to give an opinion in the case
as an expert, without compensation proportionate to the value
of his opinion.'
' It has been a matter of great dis- pie v. Montgomery, 13 Abb. Pr.,
cussion whether an expert is com- n. s., 207; Ex parte Roelker, 1
pellable to testify on matters of Sprague. 276 ; Buchanan v. The
opinion, without compensation, the State, 59Ind., 1; Dills t'. The State,
weight of the decisions being that Id. , 15 ; U. S. ■». Howe, 12 Cent,
he is not bound to do so. 1 Green- L. J., 193; contra, 6 Central Law
leaf on Evidence, §310; 1 Warwick Journal, 11; Ex 2mrte Dement, 53
Law Assizes, 158 ; Parkinson '15. At- Ala., 389 ; Sumner ■«. Tlie State, 5
kinson, 31 L. J. (n. s.) C. P., 199; Tex., 21 ; 6 Southern Law Review,
Webb V. Page, 1 E. &K., 25; Peo- 706. ; and see generally Wharton on
63 LEGAL STATUS OP PHYSICIANS — BECKER.
Whether Witness Competent a Question fo) Ci>i(rt in
Limine. — After the expert is placed upon the stand, as we have
seen, the counsel upon the side of the case by which he is sum-
moned interrogates him as to his capacity, the purpose of the
interrogation being that his answers shall qualify him and
show him to be an expert. Whether or not he is an expert so
as to permit the giving of his opinion as part of the case to go
to the ]nvj, is for the court to decide in limine, that is, at the
threshold, and as a matter of discretion, and the exercise of
that discretion, if fair and reasonable, will not be disturbed
upon appeal by the higher court. It is permissible, but also
discretionary, after the counsel calls the witness and has ap-
parently qualified him, for the counsel upon the other side to
cross-examine the witness as to his qualifications before he is
examined in chief, with a view of determining whether or not
there are limitations upon those qualifications which should
prevent the court from permitting him to testify as an expert.
The general rule is as stated by Greenleaf in his work on
Evidence, Sec. 440, that it is not necessary that the medical
expert should have actually practised his profession. Nor is it
essential that the witness should belong to any particular
school of medicine. The law does not undertake to pass upon
conflicting theories of medical practice, in determining the
question of the qualification of a medical expert. It is proper,
however, for counsel to inquire as to what school of medicine
the witness is an adherent, because of its importance in weigh-
ing the value of his testimony after it has been given.
Persons Not Duly Licensed Sometimes Held Not Compe-
tent. — It has also been a mooted question in those States where
it is necessary, in order to enable a person to practise ph3"sic or
surgery, that he should be licensed, whether a person practising
without a license, however extensive his reading and practice,
Evidence, sec. 380, note 66, sec. 456; his fee; that is, as to whether he
Lawson on Expert and Opinion expects to receive any additional
Evidence ; Rogers on Expert Tes- fee besides that of an ordinary wit-
tiniony. As to the compensation ness, and it has been held that
being paid before the testimony is where the expert witness testified
given, see Wharton on Evidence, that he was to receive a fee which
sees. 456, 380 ; People v. Montgom- was contingent upon the case, he
ery, 13 Abb. Pr. , n. s. , 207. was disqualified from testifying.
It is proper, although not neces- Pollock -». Gregory, 9 Bosworth, N.
sary, that upon cross-examination Y. Superior Ct. Rep., 121-124.
the witness should be asked as to
COMPETENCY OP WITNESSES. 03
would be considered qualified as an expert witness in a court of
justice. This point, so far as diligent examination discloses,
has not been determined in any reported case, although it has
been suggested at nisi prius and has been, in one instance
within the knowledge of the writer, decided that he is not to be
considered an expert in matters involving medical knowledge
and skill. The reasoning of the court was that the policy of the
State is to prohibit persons not possessing the qualifications
required to obtain a license, froin acting in any capacity as
professors and practitioners of medicine or surgery. If the
witness is a member of the profession, legally qualified as such,
it has been held that he is sufficiently qualified as an expert if
he shows that he possesses the average ability of members of
his profession. Hall v. Costello, 48 N. H., 176; Tellis ?'. Kidd,
12 Ala., 648; Wharton on Evidence, Sec. 446; Rogers on Ex-
pert Testimony, Sees. 17 and 18; Slocovich v. Orient Mutual
Ins. Co., 108 N. Y., 56.
As to the question whether it is necessary that the witness
should actually have practised his profession, see the last-cited
text-writer, Sees. 43 and 44, who seems to have entertained
views opposite to those stated by Professor Greenleaf .
Wharton on Evidence, Sec. 439, states the rule as follows :
" He must have special, practical acquaintance with the imme-
diate line of inquiry more than a mere vague, superficial knowl-
edge. But he need not be acquainted with the differentia of
the specific specialty under consideration. ... A general
knowledge of the department to which the specialty belongs
would seem to be sufficient."
Interested Persons may still Testify as Experts. — Since
the law forbidding interested persons from being witnesses has
been changed, it has been suggested that an interested person
although otherwise qualified might not be a competent witness
to give an opinion as an expert. But the established doctrine
is that he may give such an opinion ; the weight of it, however,
would be for the jury to determine. Greenleaf on Evidence,
Redfield's edition. Sec. 440, citing Lockwood ii. Lockwood, 2
Curtis, 309; Dillon v. Dillon, 3 Curtis, 96, 102, See also Dick-
inson V. Fitchburg, 13 Gray, 546.
Testimony of Expert, how Impeached. — Sometimes, on
cross-examination or otherwise, the fact becomes known that
64 LEGAL STATUS OF PHYSICIANS — BECKER.
the witness who is proposed as an expert has expressed an
opinion on the subject in hand contrary to that which he has
given upon the witness-stand, and the question has been raised
as to establishing that fact at the outset and before his testi-
mony goes before the jury, in order to enable the trial judge to
determine whether he is competent. The rule in that case is
that the testimony as to his prior expression of opinion is not
to be received at that time, but will come properly up as
rebuttal, he having been asked upon his cross-examination,
giving time and place, whether he has made the statements
attributed to him. An expert witness may in other respects be
impeached like any other witness, that is, by the oaths of persons
who know him and have known his reputation, and who testify
that his reputation for truth and veracity is bad and that they
would not believe him under oath. He may also be impeached
by producing witnesses to prove that his special knowledge or
technical skill is not reliable or adequate to the undertaking
which he has assumed. But this testimony must be from
personal knowledge of the man and not from general reputation.
Wharton on Evidence, Sec. 437 ; Le Rose v. Commonwealth, 84
Pa. St., 200.'
General Rule as to Required Amount of Skill and Expe-
rience Stated. — The general rule may be stated thus, as de-
rived from these and other authorities :
^ This latter case holds that a sec- part of his direct examination, but
ond expert may be called to testify as i^art of his cross-examination,
after the first has been thus chal- A medical expert is sometimes
lenged, to support his capacity and confronted upon the witness-stand
skill. The contrary rule, however, by long quotations from well known
obtains in Alabama (Tellis v. medical text-books, and he is asked
Kidd., 12 Ala. , 643; Pugh t5. State, whether the doctrines, opinions, etc.,
44 Ala., 33). Neither can an ex- there laid down are sound. Espe-
pert be contradicted by books of cially is this done when such doc-
ecience ; that is, by books of science triues and oj^inions are in api^arent
introduced in evidence as such discord with his evidence as he
(Wharton on Evidence, 666, 721) . gives it. In such cases as this, how-
This is so because the rule is well ever honest, however intelligent and
established that books, although of non-partisan the witness may be
great authority in themselves, may (except as any opinion on one side
aot, even if proven to be such, be or the other of a disputed question
placed in evidence. They may, may be considered partisan) , he is
however, be read to the witness, placed in a verj^ difficult position,
and so be placed upon the record, IE the citations and questions are
passage by passage, and the witness from well-known authors, and he is
may be asked whether he agrees a modest man, as most men of learn -
with that doctrine, not, however, as ing are, it will be difficult for him
SUGGESTIONS AS TO CONDUCT OF WITNESSES. 65
The extent of the previous study and investigation, and the
amount of skill and information which must be shown, will
depend upon the facts of each particular case. But some spe-
cial and peculiar knowledge or skill must be established, the
amount of it to be determined by the trial judge in his dis-
cretion. The possession of such knowledge and skill is pre-
sumed in medico-legal cases if the witness is a licensed prac-
titioner.
Some Practical Suggestions as to Conduct of Witnesses
on the Stand. — In this preliminary examination, the conduct
and demeanor of the witness are of no little importance, because
it is then and there that he makes his first impression upon the
court and jury. He should be perfectly open and unreserved
in stating his means of special information, in explaining what
are the limits of his personal experience and the extent of his
reading; but, at the same time, it would be well for him to
avoid all appearance of self-glorification and all tendency to
exaggerate his individual acquirements. Often has it occurred
that expert witnesses of undoubted capacity and honesty, who
are unfortunately grandiose and self-assertive in their manner,
have, however honest and able they might be, lost entirely their
weight with the court and jury by undue self-complacency and
exaggeration of their personal qualifications, during their pre-
liminary examination. This is a matter requiring tact and
judgment and nerve, and should be fully understood between
to deny that sucli authorities as to what insanity was, and having
these have great weight, even more stated what theories were then tlie
weight than his experience, skill, accepted ones, he was confronted by
and knowledge entitle him to counsel on his cross-examination
claim. On the other hand, if he with the question: "What do jou
takes the bold course and sticks to think of Dr. John P. Graj- as an
his opinion, he is cried down the authority on that question?" and
winds by counsel in summing him then with his own writings, quite
up, as a man of gall, boldness, au- extensive, of many years before, in
dacity and egotism. His course is which he had advocated theories
difficult whichever way he tux'us, apparently different fi'om those
but modesty as well as honesty is which he had professed upon the
usually the best policy. Perhaps witness-stand. Placed in this posi-
the best thing for such a witness to tiou, the distinguished gentleman
do under such circumstances is to simply replied: "It is ti'ue I cher-
do as once did the great mental islied those theories at that time,
alienist Dr. John P. Gray, when, but I lived to learn better, " thus
having given an opinion on a ques- substantially disarming any criti-
tion of insanity, he was cross- cism that could be made of liim in
examined as to the different theo- his capacity as a witness in that
ries from time to time prevalent as case.
5
66 LEGAL STATUS OF PHYSICIANS — BECKER.
counsel calling him and the witness, before the witness is placed
upon the stand. In that event, it will be quite safe for the
witness to closely follow the questions of counsel by his answers,
and to volunteer little or nothing. If his answers are not full
and complete enough, counsel can renew the question in the
same or in other form or carry the matter into greater detail.
If, on the other hand, his answer is tuo full or he appears too
eager, he may create a prejudice against him which nothing
can overthrow, and which the art of counsel upon the other side
in cross-examination and in making comments upon his testi-
mony when summing up before the jury, will very effectually
use to destroy his weight as an expert.'
Scope and Extent of Examination of Expert Witnesses.
— Having stated how experts may be summoned and qualified,
it remains to consider the scope and extent to which they may
be examined.
The advancement of the sciences and the progress of re-
search in special fields of knowledge have made expert testimony
of large importance during the present century. The basis of
its admission is the fact that there are certain processes of
reasoning which an ordinary jury is incapable of performing,
even with the assistance of courts and lawj^ers. 'Oftentimes
in the administration of justice in our courts, proof is given of
circumstances which although admitted would have little or no
significance in the mind of. an ordinary juror, and which he
would be unable to contrast and compare with other facts, suc-
cessfully, without the aid of those more familiar with scientific
matters and the inductive process of reasoning than he is. In
such cases it is necessary that the jury should be specially
enlightened by persons who have, throvigh training, skill
and experience, acquired the power to enlighten them. A com-
mon instance and illustration of this matter is to be found in
the case of homicide by poisoning. A human body is found
dead ; externally there may be no indicia to show positively the
cause of death. Under such circumstance the laws of all civil-
ized countries permit what is called a post-mortem examination
by skilled phj^sicians, who, finding no external evidences of the
cause of death, are permitted by the officers of the law to remove
the internal portions of the body for special and careful exam-
' For general rules for the conduct of expert witnesses see infra.
SCOPE OF EXAMINATION OP EXPERT WITNESSES. 67
ination. If this discloses traces of inflammation or of lesions
of an abnormal character, further power is vested in the author-
ities to have at the expense of the State a chemical examination
of the internal organs. If this examination, which is neces-
sarily long and excessively technical, results in the discovery
of any poisonous substance, such as would produce death, and
if it is found in sufficient quantities to produce death, these
persons who made the post-mortem examination and discovered
the outward indications of the administration and effects
of the poison, and the chemists who discovered the poison
itself in the tissues of the bg^dj^ in sufficient quantities to pro-
duce death, are called as experts before the jury. The post-
mortem examiners explain what the appearance of the body
was, as distinguished from the appearances of the body of an
individual who had died from natural causes. The chemist
describes his course of experimentation, the various deductions
which he made from his experiments, the tests which he applied
in his investigation in discovering poison, and is then allowed
to testify that the poisonous substance was found in sufficient
quantities to produce the physical appearances which the post-
mortem examiners have described, and to accomplish the death
of the human being in whose body the poison was found. It
is obvious that the power of observation and the skill, which the
skilled chemists and ph^'sicians used as the basis of their reason-
ing in this case, were such as an'brdinary man, unskilled and
inexperienced, would not possess, and the abilit}' to use them
must have come from the study of treatises on such subjects,
and from teaching and experience, to such an extent as to en-
title the persons so testif j*ing to be considered by the courts as
qualified to express an accurate and sound opinion on the mat-
ters and things under investigation. Thus it appears how, in
such cases, a departure became essential to the successful ad-
ministration of justice, from the strict rule that witnesses shall
testif}^ solely to matters of fact and observation, and why it has
long been considered that some witnesses must be allowed to
testify to opinions and conclusions.
Again, in a like case, a body is found bearing evidences of
wounds or bruises. The question to be determined is whether
the3^ were inflicted before or after death; if before death,
whether they were sufficient to cause death. Some wounds and
68 LEGAL STATUS OF PHYSICIANS — BECKER,
injuries might be sufficiently apparent and dangerous so that
the common, inexperienced eye would at once detect that they
were sufficient to cause death. But in most instances this is
not the case, and in such instances the testimony of experts is
required by the necessity of the case, to show that the wounds
and injuries were sufficient to cause death.
The General Rules Stated as to Subjects for Expert Tes-
timoni/. — Hence the general rule is, that wherever the facts to
be investigated are such that common experience and knowledge
of men do not enable them to draw accurate conclusions, but are
such that the studj'' and experience of specialists do enable
such specially endowed persons to draw accurate conclusions,
then the inferences and deductions they have drawn can be
testified to by those who qualify themselves before the court as
persons having sufficient skill and experience as such specialists
to entitle them to give opinions. The cases in which expert
testimony is permitted to be given are set forth in Rogers on
Expert Testimony, Sec. 6, quoting from Jones v. Tucker (41 N.
H., 540), as follows:
" 1. Upon questions of science, skill, or trade, or others of
like kind.
" 2. Where the subject-matter of inquiry is such that inex-
perienced persons are unlikely to prove capable of forming a
correct judgment without such assistance.
" 3. Where the subject-mMter of investigation so far par-
takes of the nature of science as to require a course or pre-
vious habit of study in order to the attainment of knowledge
of it."
So also Chief Justice Shaw of the Supreme Court of Mas-
sachusetts, in New England Glass Co. v. Lovell (7 Cushing,
319), said:
" It is not because a man has a reputation for sagacity and
judgment and power of reasoning that his opinion is admissible
in testifying as a witness. If so, such men might be called in
all cases to advise the jury, and it would change the mode of
trial; but it is because a man's professional pursuit, or his pecu-
liar skill and knowledge of some department of science not com-
mon to men in general, enable him to draw inferences where
men of common experience, after all the facts have been proved,
would be left in doubt."
RULES AS TO SUBJECTS FOR EXPERT TESTIMONY. 69
To the same effect see Muldowney v. Illinois Central R. R.
Co., 30 Iowa, 472; Wharton on Evidence, Sec. 436; Greenleaf
on Evidence, Sec. 441.
Qualifications of this General Rule. — The extent to which
an expert witness can go in giving his opinion is limited to
matters of science and skill, and does not extend to the expres-
sion of views on matters of legal or moral observation, or the
manner in which others would probably be influenced if the
parties had acted in one way rather than in another. Campbell
V. Richards, 5 B. & Ad., 345.
So it has been held that the question whether a physician
has honorablj" and faithfully discharged his duty in a given
case, either to his medical profession or to his patient, is not a
question of science but of pure ethics, upon which the jury is
as competent to decide as any one else, and in such a case an
opinion would not be allowed to be given either by another
medical practitioner or by a professor in the science of morals.
Rogers on Expert Testimony, Sec. 11, citing Ramadge v. Ryan,
9 Ring., 333.
There are also some matters of fact which apparently tran-
scend the dividing line between common experience and judg-
ment and scientific experience and judgment, as to which
expert testimony is not receivable, but the jury and court must
weigh the facts and draw the inferences for themselves. An
interesting example of this is foutid in the case of Manke v. The
People, 78 N. Y., Oil (17 Hun, 410), cited in Stephens' "Di-
gest of the Law of Evidence," p. 107, note H, decided in the
New York Court of Appeals a few years ago. In that case one
Adolf was killed by a gunshot, and pieces of paper were found
near the scene of the homicide bearing certain marks. An ex-
pert was called upon to say whether they were powder-marks,
and whether the condition of the paper was such that in his
opinion it was wadding which had been fired from a gun. This
evidence was held to be inadmissible by the General Term of
the Supreme Court, and this decision was affirmed by the Court
of Appeals. These courts held that the question as to whether
this was a wad fired from a gun was a matter which the jury
was as competent to judge of as the witness. In delivering the
opinion at General Term, Presiding Justice Talcott said that
this case was very close to the border line, but in his judgment
70 LEGAL STATUS OP PHYSICIANS — BECKER.
it was beyond the province of experts and within the province
of jurors.
Nevertheless, in that case the evidence of chemists who had
examined the wadding, and had discovered the marks on it
which were said to be powder-marks, and upon analysis had
determined that they were powder-marks, or that they were
marks of powder which had exploded, would have been clearly
admissible.
The subjects concerning which medical men may be called
upon to testify as experts are as numerous as the diseases, in-
juries, mental and physical conditions of the human race which
fall within the range of the practice of medicine and surgery.
It is therefore practically impossible to give them in detail. '
Practical Suggestions and Admonitions Embodied in
Rules. — It is deemed advisable that the following practical
suggestions and admonitions to physicians, concerning their
duties as expert witnesses, shall here be given.
First : A physician should refuse to testify as an expert un-
less he is conscious that he is really qualified as an expert.
Second: After accepting the responsibility, his first duty
should be to make a diligent examination and preparation for
his testimony, unless it is upon a subject with which he is
familiar and which he is satisfied that he has already exhausted,
by reading the best authorities that he can find, and by careful
reflection upon particular questions as to which his opinion
will be asked.
Third : Where he is to make an examination of facts, such
as the post-mortem examination of a body, a chemical analysis
or an examination of an alleged insane person, he should insist
^ The principal classes of such Also causes of alleged sterility or
subjects may, however, be briefly pregnancy; time pregnancy has ex-
stated as follows : isted ; also cases of alleged impo-
1. Causes of death; especially in tency.
cases of homicide, suicide, acci- 4. Rape, abortion, bastardy, ped-
dent, etc., including poisoning. erasty, onanism, masochism, and
!i. Causes, nature, and extent of many other matters relating to the
personal injuries, by violence, ac- sexual organs.
cidents, explosions, railway disas- 5. Malpractice cases, involving
ters, collision between vessels, etc. the degree of care and skill usual,
3. Birth of infants ; was infant and that used in the case under in-
born dead or alive ; if dead, was vestigation, and involving delicate
death the result of natural causes questions as to the propriety of the
or of internal violence ; age of in- ti'eatment adopted, etc.
fant at the time of birth or death.
PRACTICAL SUGGESTIONS AND ADMONITIONS. 71
upon having ]3lenty of time and full opportunity for doing his
work thoroughly. He should take particular pains to make
his examination open and fair, and, if possible, should invite
opposing experts to co-operate with him in it.
Fourth : He should be honest with his client before the trial
in advising him and giving him opinions, and upon the trial
should preserve an absolutely imjDartial attitude, concealing
nothing, perverting nothing, exaggerating nothing.
Fifth : On the preliminary examination as to his qualifica-
tions as a witness he should be frank and open in answering
questions. He should state fully the extent and the limits of
his personal experience and of his reading upon the subject,
without shrinking from responsibility, yet without self-glorifi-
cation.
Sixth : He should be simple, plain, and clear in his statement
of scientific facts and principles, avoiding the use of technical
language, and trying to put his ideas in such form that they
will be grasped and comprehended bj' men of ordinary educa-
tion and intelligence.
Seventh : He should avoid stating any conclusions or prin-
ciples of which he is not certain, but having an assurance that
he is right he should be firm and positive. He should admit
the limitations of his knowledge and ability. Where a ques-
tion is asked which he cannot answer, he should not hesitate to
say so ; but he should refuse to be led outside the subject of
inquiry, and should confine his testimony to those scientific
questions which are really involved in the case, or in his exam-
ination of the case.
Eighth : And finally, he should always bear in mind that at
the close of his testimony an opportunity is usually given to
him to explain anything which he may be conscious of having
said, which requires explanation ; and partial statements which
need a qualification to make them a truth. This is the physi-
cian's opportunity to set himself right with the court and with the
jury. If the course of the examination has been unsatisfactory
to him, he can then, by a brief and plain statement of the gen-
eral points which he has intended to convey b}" his testimony,
sweep away all the confusion and uncertainty arising from the
long examination and cross-examination, and can often succeed
in producing for the first time the impression which he desires
72 LEGAL STATUS OF PHYSICIANS— BECKER.
to produce, and can present the scientific aspects of the case
briefly and correctly.
Probably no man was ever so gifted as to be able in practice
to carr/ out all of these principles in giving medical testimony.
If he could, he would be the ideal expert witness. But the
principles are, after all, simple and easily followed in the main.
Any physician who knows his subject and who has a clear head
and the ordinary faculty of expression, by observing these prin-
ciples can make himself invaluable as an expert witness. There
is no branch of the profession which brings a broader fame,
greater influence, or larger emoluments than this. There is no
branch, on the other hand, in which men of real ability make
more lamentable failures.
CHAPTER VI.
MALPRACTICE.
Definition. — Malpractice may be defined to be —
1st. Wilful acts on the part of a physician or surgeon
toward a person under his care, by which such person suffers
death or injury;
2d. Acts forbidden by express statute, on the part of a phy-
sician or surgeon, toward a person under his care, by which
such person suffers death or injury ;
3d. Negligent acts on the part of a physician or surgeon in
treating a patient, by means of which such patient suffers death
or unnecessary injury.
These various divisions will be considered in the order in
which they are above set forth.
Wilful Malpractice.— The cases which fall within the
first two divisions of this definition are such acts as render
the medical man liable to punishment in a criminal prosecution,
and may not necessarily, although in some instances they may,
constitute grounds of liability in a civil suit against him.
As examples of the first class of cases may be cited those
instances, happily not numerous in the annals of the profes-
sion, where a physician or surgeon when treating a female
patient has had carnal connection with her, representing that
he was using that method of treating her to cure her disease.
Such a case was Reg. v. Case, 1 Eng. Law & Eq., 544 (s. c,
1 Den. C. C, 580).'
Honest Intent no Defence in Such Cases. — In Reg. v.
Reed, 1 Den. C. C, 377 (s. c, 2 Car. & K., 967), it was con-
tended as a defence that the defendant really believed that he
was curing his patient by treating her in this extraordinary
way. The Court, per Wildes, C. J., brushed aside this conten-
' See also 1 Bishop Crim. Law, sec. 36 ; Rex v. Romiski, 1 Moody, 19 ;
Reg. V. Ellis, 2 Car. & K. , 470.
73
74 LEGAL STATUS OP PHYSICIANS— BECKER.
tion with scorn, saying : " The notion that a medical man may
lawfully adopt such a method of treatment is not to be tolerated
in a court of justice ;" and in this case and in others, convictions
have been sustained for the crime of rape or of attempting to
commit rape.'
Another example of wilful malpractice would be wilful
neglect of a patient by his medical attendant, who became in-
toxicated voluntarily, though this will generally come under
the second subdivision, as most states and countries have enacted
statutes making it a criminal offence to practise medicine or
surgery when intoxicated.
Acts Forbidden by Statute. — Within the second sub-
division of the definition, or acts declared unlawful by statute,
fall the cases of committing or attempting to commit an abor-
tion, and cases of prescribing for or treating a patient by one
voluntarily intoxicated. If the abortion is attempted without
the knowledge or consent of the woman, and under the pretence
of performing a necessary operation upon her to cure disease,
undoubtedly the physician would be liable to a criminal pros-
ecution by the State for the offence of committing an abortion
and to civil action by her to recover damages. If the abortion
was committed with her consent, while she would have no
right of action against him for damages, he would be liable to
criminal prosecution under the statute.
Abortion Not a Crime by the Commoii Laiv. — At common
law it was not a crime to commit an abortion with the mother's
consent if the child had not quickened. In Mitchell v. Com., 78
K}'., 204 (s. c, 39 Am. Reports, 227), the Court, per Hines, J.,
says : " After a patient investigation we are forced to the con-
clusion that it was never called a punishable offence at common
law to produce, with the consent of the mother, an abortion prior
to the time when the mother became quick with child. It was
not even murder at common law to take the life of the child
at any period of gestation, even in the very act of delivery."
See also Evans v. People, 49 N. Y., 8G.
The inhumanity and danger to societA' of this rule became
manifest at a very early period, and both in England and in
' In such cases as these the patient had taken wilful and wicked ad-
would have a right of action in the vantage of his professional relation
civil courts for damages against the to her, to do her a grievous wrong,
physician or surgeon, because he
ACTS FORBIDDEN BY STATUTE. 75
this country statutes were adopted, varying somewhat in the
degree and kind of punishment and in the nomenclature of the
crime, but all of them making the offence of committing an
abortion, no matter at what stage of gestation, a crime.'
The Common-Laiv Doctrine Criticised. — Professor Elwell
in his A^aluable work on " Malpractice, Medical Evidence and
Insanity," pp. 250, 251, makes the following remarks upon this
subject : " The idea once existed quite generallj-, and it still
exists to sofne extent, that there is no offence in destroying the
embryo or foetus before there is a manifest knowledge of life by
the mother, derived from motion of the child called 'quicken-
ing. ' How absurd to suppose that there is no life until the
mother can feel the muscular motions of the child! As well
might we deny the vitalit}' of the blood because it cannot be felt.
The muscular tissues, and even the bones to which thej" are at-
tached, must have some degree of substance before there can be
motion, and of course this development depends upon life.
Though this foolish notion is now fully exploded in medicine, it
still lingers in the popular mind, and doubtless leads to much
crime. The life of the foetus or embryo immediately after con-
ception is just as positive physiologically as at any subsequent
period. Quickening being an incident or sign in the course
of development of the foetus, it indicates not the commence-
ment of a new state of existence, but only a new manifesta-
tion of pre-existing life. ... It is uncertain in its appear-
ance, sometimes coming on at three months, sometimes at six
months, and sometimes not at all."
Legal Definitions of Terms, " Quick with Child," etc. — •
In Evans v. People, 49 N. Y., 8G, following R. v. Wycherly,
8 C. & P., 262, it was held that a woman is "quick with child"
from the period of conception after the commencement of gesta-
tion, but is "pregnant with quick child" only when the child has
become "quickened in the womb." This distinction has been
discussed in State v. Cooper, 2 Zab., N. J., 52, and since the
Evans case, the same court in New York State has held that
the expression, "woman with child," means "pregnant wo-
'The Pennsj^lvania courts at an stinct with life iu embryo and the
early period refused to follow this process of K<?station has begun the
common-law doctrine, and held crime may be perpetrated. Mills y.
that the moment the womb is in- Com., 13 Pa. St., 631.
76 LEGAL STATUS OF PHYSICIANS — BECKER.
man." Eckhardt v. People, 83 N. Y., 42 (s. c, 38 Am. Rep.,
4G2).
Death of Child by Abortion. — If, in attempting to produce
an abortion, the child is caused to be born alive but before the
end of the period of gestation, and when it is not capable of
sustaining life, and it dies, the person producing the abortion
and bringing the child into the world at this time and in this
manner is guilty of murder. Wharton's Crim. Law, sec. 942;
Rex. V. West, 2 Cox Crim. Cases, 500; Com. v. Brown, 14
Gray, Mass., 419.
Death of Mother by Abo7^tion. — So also where in con-
sequence of producing an abortion the death of the mother
occurs, the person producing the abortion is guilty of murder
at common law. 4 Blackstone's Com., 201; 1 Bishop's Crim.
Law, 328. In some of the States, however, these offences are
declared to be only manslaughter.
Further consideration of the subject of abortion will be had
under that title in another part of this work.
Statutes Geyierally Except Abortions Necessary to Save
Life. — It should be noted here, however, that nearly all the
statutes which define and punish the crime of abortion, or the
crime of manslaughter or murder committed in consequence of
abortion, declare that when it is necessary to produce a mis-
carriage in order to save life, the act of doing so is excepted
from the effect of the statute.
Negligent Malpractice. — Under the third subdivision of
the definition, viz., when by reason of the negligent acts on the
part of the physician or surgeon the patient suffers death or un-
necessary injurj^, may be placed the most numerous cases of mal-
practice, according to the generally accepted meaning of the term.
Criminal Liability for Negligent Malpractice. — It is
manifest that not every degree of negligence which causes
death or injury ought to render the physician or surgeon
liable to indictment and punishment for a crime. The general
theory of the criminal law is based upon the doctrine that in
order to constitute a crime there must be either an intent to
do the wrong, or such a degree of negligence in the performance
of a given act as to supply the place of the intent to do wrong,
and require punishment for the protection of society, upon the
ground that the carelessness of the defendant is so great as to
NEGLIGENT MALPRACTICE. 77
make it necessary and proper to punish him, in order to deter
others from following his example.
Doctrine of Leading Case of Com. v. Thompson. — In
Com. V. Thompson (6 Mass., 134), Parsons, C. J., observes:
" There was no evidence to induce the belief that the prisoner by
his treatment intended to kill or injure the deceased and the
ground of express malice must fall. It has been said that im-
plied malice may be inferred from the rash and presumptuous
conduct of the prisoner in administering such violent medi-
cines. Before implied malice can be inferred, the judges must
be satisfied that the prisoner by his treatment of his patient
was wilfully regardless of his social duties, being determined
on mischief. ... To constitute manslaughter, the killing
must have been the consequence of some unlawful act. Now
there is no law which prohibits any man from prescribing for
a sick person with his consent ; and it is not a felon}^ if through
his ignorance of the qualit}^ of the medicine prescribed, or of
the nature of the disease, or of both, the patient, contrary to
his expectations, should die. The death of a man killed by
voluntarily following a medical prescription cannot be adjudged
felony in the party prescribing unless he, however ignorant of
medical science in general, had so much knowledge or probable
information of the f^tal tendency of the prescription that it may
be reasonably presumed by the jury to be an act of wilful rashness
at least, and not of honest intention and expectation to cure."
The Doctrine of the Thompson Case Too Broad. — This
lax statement of the law, made by the learned chief justice in
this case, has been much doubted and criticised. It ap-
pears to be unsound in the length to which it goes in requir-
ing, in order to constitute criminal liabilit}', what may be
termed excessive gross carelessness or wilful gross carelessness.
It apparently runs counter to the prevailing opinions of the
English judges, and to the later decisions of the courts in the
United States, although it is followed and approved in Rice v.
The State, 8 Mo., 561.
In Rex V. Long (4 Car. & P., 308-310), Park, J., said: "I
call it acting wickedly when a man is grossl}" ignorant and yet
affects to cure people, or when he is grossly inattentive to their
safety."
So in Rex v. Spiller (5 Car. & P., 353), the Court said : " If
78 LEGAL STATUS OF PHYSICIANS — BECKER.
a person, whether a medical man or not, professes to deal with
the life and health of another, he is bound to use competent
skill and sufficient attention; and if he causes the death of an-
other through gross want of either he will be guilty of man-
slaughter."
Bishop, in his work on Criminal Law, lays down the rule
that not every degree of carelessness renders a practitioner
liable to criminal prosecution, and that it must be gross, or, as
more strongly expressed, " the grossest ignorance or most crim-
inal inattention." '
Nevertheless he quotes with approval (2 Bishop Crim. Law,
264) the remark of Willes, J., that a medical man is taking a
leap in the dark if he knew he was using medicines beyond his
knowledge; and also the remarks of Bayley, J., in Rex v. Simp-
son (1 Lewin, 172), who said in that case: "I am clear that if
a person not having a medical education, and in a place where
a person of a medical education might be obtained, takes it
upon himself to administer medicines which may have an in-
jurious effect, and such medicines destroy the life of the person
to whom they are administered, it is manslaughter. The party
may not mean to cause death, or the medicine may produce
beneficent effects, but he has no right to hazard medicine of
a dangerous tendency when medical assistance can be obtained.
If he does, he does it at his peril." "^
Gross Negligence Defined. — In general it may be stated
that gross negligence is necessary to constitute criminal liabil-
ity, but this may be predicated upon, or inferred from, such
want of ordinary care and skill as shows gross ignorance, or
such want of attention as indicates wilful disregard of the well-
known laws of life and health.^
Gross Negligence Resulting in Injury a Misdemecmor. —
It has also been held that although death does not but in-
'1 Bishop Crim. Law, sec. 217, 561; Fairlee ■«. People, 11 111., 1;
citing Rex ■». Williamson, 3 Car. Holmes v. State, 23 Ala., 17; Rex
&P., 635. V. Spilling, 2 M. & Rob., 107; Fer-
' The same learned and philosoph- guson's Case, 1 Lew., 181; Thomas
ical text-writer (2 Bishop Crim. v. Winchester. 2 Selden, N. Y.
Law, sec. 664) compares the Eng- Court of App., 397; Com. ■?). Pierce,
lish and American cases and de- 138 Mass., 165, and cases cited;
clares that the difference between Stated). Hahn, 38 Ark., 605; "Wliar-
them is more apparent than real. ton's Crim. Law, sec. 1015 ; El-
^See Rice v. The State, 8 Mo., well on Malpractice, etc., 238, 239.
NEGLIGENT MALPRACTICE. 79
jury does ensue, as the result of gross negligence or inattention,
that constitutes a misdemeanor punishable criminally.'
In Determining Degree of Negligence Circumstances
and Conditions Govern. — It should be noted, however, that
the circumstances and conditions attending the act of alleged
criminal malpractice should be given much weight. So also
should due weight be given to the advancement of knowledge
and education in the world in general, and in the medical
profession in particular. In an early English case, one of the
judges remarked that not as much knowledge and skill could
be expected of a surgeon or phj^sician in a sparsely settled
country district as in a city, and that he was at a loss to know
what degree of knowledge and skill should be required of such
a person. But in Gram v. Boener, 5G Ind., 447, Worden, J.,
said : " It seems to us that physicians or surgeons practising in
small towns, or in poorly or sparsely settled country districts,
are bound to possess and exercise at least the average degree of
skill possessed and exercised by the profession in such localities
generall}^. It is not true, as we think, to saj' that if a physician
and surgeon has exercised such a degree of skill as is ordinarily
exercised in the particular locality in which he practises, that
would be sufficient. There might be but few practising in the
given locality, all of whom might be quacks, ignorant pretenders
to knowledge not possessed by them, •and it would not do to
say that because one possessed and exercised as much skill as
the other, he could not be chargeable with the want of reasonable
care and skill." ^
Unlicensed Practitioner Causing Death Guiltij of Man-
slaiighter. — Since the adoption by most civilized states and
countries of the salutary practice of regulating bj^ statute the
practice of medicine and surgery, and forbidding j^ersons not
duly licensed from practising, and making it a misdemeanor
to violate -any of these statutes, it is clear that any person not
having the requisite medical education and a license, who at-
tempted to administer drugs and medicines or to perform op-
'1 Bishop Crim. Law, sec. 558, 131 ; Gates ■». Fleisher, 67 Wis., 28fi ;
citing Groenvelt's case, 1 Lord Ray- Smothers v. Hauks, 34 Iowa, 286 ;
mond, 213; Rex v. Long, 4C. &P., Ahnond v. Nugent, 34 Iowa, 300;
398. Hairev. Reese, 7 Phila. (Pa.), 138;
^ See also Kelsey v. Hay, 84 Ind., Nelson v. Harrington, 72 Wis., 591.
189 ; Small v. Howard, 128 Mass. ,
80 LEGAL STATUS OF PHYSICIANS — BECKER.
erations, and through -want of ordinary knowledge and skill
caused the death of another, would be held guilty of man-
slaughter, because he brought about the death while he himself
was engaged in a violation of the law. In some states where
no discrimination in this respect is made between misdemeanors
and felonies, the crime would be murder, punishable by death ;
and it has always been the law that an empiric or quack holding
himself out as a regular physician is bound to have and exhibit
the degree of skill and care which he professes, and will be
strictly held to the standard of skill of educated and licensed
medical men.'
As to the legal meaning of the term " ordinary care and
skill," and the rules of evidence applicable in cases of malprac-
tice, a full discussion will be had below, when considering the
subject of civil liability for malpractice.
Civil Liability for Malpractice.
Any person holding himself out to be a physician or sur-
geon, or anj^ physician or surgeon, who is guilty of malpractice,
is liable for damages, to be recovered in a civil action, insti-
tuted by the person injured, or by those having a legal right to
such person's services. This is so whether the injured person
actually employed the defendant to prescribe or treat him, or
not. The liability flows out of the relationship, without regard
to the element of employment, and it may result from negli-
gence in treatment, or in prescribing, or in giving information
and instructions to the patient as to how to take care of himself
when under treatment. The rules of law applicable to the
duties of a physician to his patient are stated and the authorities
supporting them cited in Chapter IV. of this work.^
Ordinary Care and Skill Only Required. — The leading
cases in America on the subject of civil liability for mal-
practice are: Leighton v. Sargent, 7 N. H., 460, and Car-
penter V. Blake, 60 Barb., 485 (s. c. on appeal, 75 N. Y., 12).
In the former case the Court said : "In a science encumbered
' Ruddock V. Low, 4 F. & F. , 519 ; Roper, 2 F. & F., 783 ; Carpenter v.
Musser v. Chase, 29 Ohio St., 577. Blake, 60 Barb., 485, 50 N. Y., 696,
^ See particularly Gieselman v. 10 Hun, 358, 75 N. Y. , 12 ; Leighton
Scott, 25 Ohio St., 86; Lanphier v. v. Sargent, 7 N. H., 460.
Phipos, 8 C. & P., 475; Pym v.
CIVIL LIABILITY FOR MALPRACTICE, 81
with so many sources of error and difficulties, it is obvious
what cause we have for proceeding with the utmost caution,
and for advancing from step to step with the greatest circum-
spection. It is in consideration of those peculiar difficulties
that beset and encompass the physician and surgeon, that all
enlightened courts have held that but ordinary care and skill
shall be required of them, and that mere errors of judgment
shall be overlooked, if the general character of treatment has
been honest and intelligent, and that the result of the case shall
not determine the amount of the responsibility to which he is
held; and that when unskilfulness or negligent treatment of
his patient is charged to a surgeon, it is not enough to show
that he has not treated his patient in that mode or has not used
measures which in the opinion of others, though medical men,
the case required ; because such evidence tends to prove errors
of judgment, for which the defendant is not responsible, as
much as it goes to prove a want of reasonable skill and care for
which he may be responsible. Alone it is not evidence of the
latter, and therefore a party must go further and prove, bj^
other evidence, that the defendant assumed the character and
undertook to act as a physician without the education, knowl-
edge, and skill which entitled him to act in that capacity."
In Carpenter v. Blake, upon the last appeal (75 N. Y., 12),
it was said that the reasonable ordinary care and diligence
which the law requires of physicians and surgeons is that
which persons engaged in the same general line of practice
have and exercise in like cases. '
Story''s Statement of the Rule. — Story in his work on
Bailments, p. 433, with his usual felicitous method of state-
ment says : " In all cases where skill is required it is to be un-
derstood that it means ordinary skill in the business or em-
ploj^ment which the bailee undertakes ; for he is not presumed
to undertake for extraordinary skill, which belongs to a few
men only in his business or emploN^ment, or for extraordinary
endowments or acquirements. Reasonable skill constitutes the
measure of the engagement in regard to the thing undertaken."
Occult Influences Should be Considered by Laivyers and
'Synonymous terms with "rea- 376; "ordinary care and skill,"
sonable care " are " fair knowledge Heath v. Glisan, 3 Oregon, 64.
and skill, " Jones v. Angell, 95 Ind.,
6
82 LEGAL STATUS OF PHYSICIANS — BECKER.
Judges. — In this connection it should be borne in mind by
lawyers and judges, that in the case of a physician treating
disease, or a surgeon repairing an injury, occult influences fre-
quently play a most important part. Professor Elwell in his
work on Malpractice, etc., p. 25, lays great stress on this
element of uncertainty. He says : " In the case of physicians,
surgeons, attorneys, etc., another and important element besides
skill enters into the result, and for this reason the degree of
responsibility is to a certain extent and in a manner indicated
and influenced. This important element is the operation of
causes and influences over which the practitioner has but little
or no control. They are occult, and no human foresight is able
to anticipate them before they have completely deranged and
materially interfered with his plans by bringing about a different
result than that confidently depended upon." '
Change cmd Advancement in Medical Knoivledge also to
be Considered. — It should on the other hand be clearly under-
stood that the constant change and improvement which are go-
ing on in medical and surgical education, in the discovery of
new remedies and new methods of treatment, and in the inven-
tion of new instruments, tend constantly to elevate the average
skill and intelligence of the profession, and with them the stand-
ard by which the courts will determine liability for negligence.
"What would have been, but a few years ago, fully recognized
\)j the courts as ordinary skill in the treatment of disease and the
performance of operations, would now be regarded as antiquated
and less than ordinary skill, because of the advancement in
the knowle(Jge of means which can be devoted to the treatment
of disease and injury.*
We have already seen that what is the degree of skill to be
required of one practising in a small town or a country district
sparsely inhabited, and what is required in the case of a city
practitioner, may differ to some extent with the circumstances.
Quacks and pretenders, however, must be judged by the stand-
ard of regular practitioners.^
^ See Corsi v. Maretzek, 4 E. D. professing to treat patients as a
Smith, 1, quoted at p. 362 of this clairvoyant must be held to the
volume. standard of regular practising phy-
^ Small'?). Howard, 128 Mass. , 131, sicians in the neighborhood where
and cases cited. the clairvoyant operates. Nelson
^ Clairvoyancy of course is not v. ' Harrington, 72 Wis. , 591 ; Bib-
recognized in the courts as medical ber^. Simpson, 59 Me., 181 ; Musser
or surgical practice. And any one v. Chase, 29 Ohio St. , 577.
DEGREE OF CARE AND SKILL. S3
Degree of Care and Skill a Mixed Question of Law
and Fact. — What constitutes reasonable care and skill is a
mixed question of law and fact, like any other question of
negligence. Where the evidence is undisputed and no conflict-
ing inferences can be drawn from the facts presented, it is the
duty of the Court to determine whether or not there is sufficient
proof of want of ordinary care and skill to be submitted to
the jury. Where, however, the evidence is conflicting on that
point, or the inferences to be drawn from the facts established
might be differently drawn by different men having the same
opportunity for observation, and the same circumstances before
tbem, it is for the jury to say whether or not the defendant has
exercised reasonable care and skill, guided by proper directions
from the Court as to the measure of skill required. This in-
volves the question as to how far the practitioner is bound to be
familiar with the methods, appliances, drugs, and methods of
treatment of his profession in general."
Experimentation Not Permissible. — Experimentation,
whether upon charity patients or paj^ patients, is equally pro-
hibited by well-settled rules of law. In other words, a depar-
ture from known methods of treatment for the purpose of or by
way of trjdng unknown remedies, or operations not usually
adopted by the profession, if an unfortunate result occurs,
renders the defendant liable (McNevins v. Lowe, 40 111., 209).
Measure op Damages.
The measure of damages in cases of malpractice may vary
with the kind of malpractice. In the case of wilful malpractice,
the element of gross negligence justifies punitive or retaliatory
damages, in those States where any such damages are allowed.
That is, damages which will not only compensate for the inju-
ries inflicted, but which will, by pvuiishing the wrong done,
tend to repress similar acts in the future. The tendency of the
courts and of legal authority of the present time is, however,
to limit as often as possible the cases in which punitive dam-
ages are allowed, upon the theory that if a grossly negligent act
is committed it will require criminal prosecution, and that the
1 McCandless v. McWha, 22 Pa. St. , 261 ; Carpenter v. Blake, supra :
Leighton v. Sargent, supra.
S^l LEGAL STATUS OF PHYSICIANS — BECKER.
strong arm of the State should be invoked to punish the wrong,
rather than to line the pocket of the injured person.
On the other hand, in cases of malpractice, damages for
want of ordinary care and skill are recompensed as in any other
cases of negligence. They may include loss of time of the
patient, inability to earn his living, such sum as the jury thinks
is reasonable to be given as a compensation for the extra pain
and suffering, and, where the injury is permanent, such further
sum as will indemnify the patient for the injury or deformity
which he may suffer on account of the defendant's neglect.
Citation of authority upon this question of damages is almost
unnecessar5^ '
Liabilities of Partners, etc. — It has been held that where
two physicians were partners, and one of them committed an
act of negligent malpractice, both were liable in a civil court
for damages.''
But the declarations of the partner who is guilty of the
negligent act, made as to the act committed, and in the absence
of the other partner, are not admissible as against the other
partner. And so also is the rule as to declarations of the
partner who committed the act after its commission as to the
propriety of the treatment, and opinions expressed by him in
reference thereto.'
It has also been held that one surgeon who recommends the
employment of another during his absence from town is not
liable for acts committed during his absence."
Suits for Injuries to Married Women and Minor
Children. — When the person injured is a married woman, her
husband may sue for loss of services on account of malpractice,
and when the injured person is a minor child the parent may
sue as in any case of negligence. A third person, such as the
husband of a woman injured by malpractice, or the father of
minor child so injured, can only recover the value of the ser-
vices thereby lost, and in some cases the enhanced expense of
medical attention and nursing thereby rendered necessary.
'Kelley v. Hay, 84 Ind., 189; ^ Hyrne -y. Irwin, 23 S. Car., 226,
Stone -y. Evans, 32 Minn. , 243; Teft s. c. , 55 Am. Rep., 15; Whittaker
V. Wilcox, 6Kans., 646; Brookes. v. Collins. 34 Minn., 209.
Clark, 57 Tex.. 105; Graunis V. » Boor n. Lowrev, 103 Ind., 468.
Branden, 5 Day (Conn.), 260, s. c, 5 * Hitchcock v. Burgett, 38 Mich.,
Am. Dec, 143 : Wenger v. Calder,78 501.
111. , 275 ; Carpenter v. Blake, snpra.
INSPECTION OF THE INJURED PERSON. 85
Inspection of the Injured Person at the Trial —
Before Trial Improper. ^ — In an action in wiiich the injury is
to a portion of the body which may be seen, such as the shorten-
ing of a limb on account of improper treatment of a fracture,
the limb may be exhibited to the jury.
It has been much discussed whether the defendant in a mal-
practice or other negligence case can compel the plaintiff to
permit his person to be examined by j^hysicians before trial, to
enable the defendant to know the full extent of the injur)- so
far as it is perceptible. In the latest cases the examination
of plaintiff before trial was not allowed. '
In 1877 the Supreme Court of Iowa in the case of Schroder
V. C, R. I. & P. R. R. Co., 47 Iowa, 375, held that the court
had inherent power and jurisdiction to compel the plaintiff to
submit to such an examination.
This decision has been followed by the courts of several of the
western and southern States, while in others the power has been
denied. These cases will be found fully collected in Roberts t\
O. & L. C. R. Co. and in U. P. R. R. Co. v. Botsford cited above.
The ground of the decision of the United States Supreme
Court and of the New York Court of Appeals seems to be, that
in the absence of legislative provision permitting a court to
order such an examination, it has no inherent power to do so,
and did not derive any such powers from the common-law
courts of England, which never had exercised such powers.
In some of the cases which denj- the right to comj^el such
examination, it is claimed that if such a statute was passed as
would confer upon the courts power to compel such an exami-
nation, the statute would be unconstitutional, and much is said
in those decisions about the sacredness and immunity of the
person. It seems difficult, however, to understand why such
statutes should be considered as differing in any respect from
statutes permitting orders for the examination of witnesses and
parties before trial, or for the discovery and inspection of books
and papers, and the like, which statutes have been enacted for
many years and have never been held to be unconstitutional.
Surely an honest suitor having a just claim for damages for
iSeeU. P. R. R. Co. v. Botsford, Roberts v. O. & L. C. R. Co., 29
141 U. S., 350; McQuiggan ?■. D., Hun, 154, aud cases cited.
L. & W. R. R. Co., 129 N. Y.. 50;
86 LEGAL STATUS OF PHYSICIANS — BECKER.
personal injuries would not object to such an examination, be-
cause the result would often strengthen his case, while a dis-
honest suitor having a false and unmeritorious claim ought
to be exposed and have his false claims defeated, in the inter-
ests of justice and truth. On the other hand, a suitor who was
honestly mistaken in his belief that he had been disfigured or
injured by an act of malpractice might often discover his mis-
take, and be saved the annoyance and expense of defeat after
a trial in open court.
Some of the most frequent cases of alleged malpractice,
brought before the courts, are those in which it is claimed that
a fractured limb has been improperly set, with the result that
it becomes crooked or shortened ; when the fact is, as is con-
clusively shown by Prof. Frank H. Hamilton in a paper pub-
lished by him many years ago, and quoted with approval by
Professor Elwell, in his work on Malpractice, etc., that the
percentage of cases, in certain kinds of fractures, in which per-
fect results are obtained by even the most eminent surgeons,
is very small. In such cases as these the true state of affairs
might often be disclosed by careful inspection prior to the trial.
On the whole more good than harm would seem to be the
probable outcome of permitting such examinations, in mal-
practice cases, if not in all cases of alleged personal injuries.
Evidence in Malpractice Cases. — The prevailing trial
practice in malpractice cases is to prove the condition of the
patient prior to the employment of defendant and at the time
the treatment in question began, the methods of treatment
adopted, and instructions given, and the condition of the patient
during and after such treatment, and then to place other phy-
sicians on the witness-stand, and put to them hypothetical
questions involving the facts as established by the evidence,
and calling upon them to state whether the method of treat-
ment adopted indicated proper skill and care, or even the usual
and recognized methods of the profession.'
In some States evidence of the general reputation of the de-
fendant for skilfulness or the contrary is held admissible. In
other States such evidence is held inadmissible (see Vol. XIV.,
Am. and Eng. Encyclopaedia of Law, p. 83, and cases collected
in Note 6) .
' Olmstead v. Gere, 100 Pa. St. , 127 ; Carpenter v. Blake, supra.
EVIDENCE — CONTRIBUTORY NEGLIGENCE. 87
Contributory Negligence. — In conclusion it should be
stated that the patient is bound to follow obediently all proper
directions given him by his physician or surgeon, as to his
diet, mode of life, time of taking and quantity of medicine to
be taken, or the care of a diseased or injured member. Any
disobedience of such directions which contributes to prevent
a recovery will bar him from his right of action for malprac-
tice, even though the medical man may have been somewhat
negligent. In short, the same rule as to contributory negligence
applies in this as, in any other case of negligence. This prin-
ciple has been so long and so well settled that citation of author-
ity in support of it is unnecessary.
THE LAW OF EVIDEISTOE
CONCERNING
CONFIDENTIAL COMMUNICATIONS
BETWEEN
PHYSICIAN AND PATIENT.
BY
chari.es a. boston,
CounseUor-at-Laic, of the New York City Bar.
co:^fidei^tial commu^icatiol^s
betwee:^ physicia]^ and
PATIEl^T.
PRIVILEGED COMMUNICATIONS.
Confidential communications between physician and
patient not infrequently may relate to matters that are the sub-
jects of inquiry before judicial tribunals. When these com-
munications are by law excluded from disclosure in evidence,
they are termed privileged communications. When such a
disclosure is forbidden it is upon grounds of public policy/
" because greater mischiefs would probably result from requir-
ing or permitting its admission, than from wholly rejecting it."
COMMON LAW.
The common law required an inviolable secrecy to be ob-
served by attorneys with reference to the communications
which they had received from their clients.^ But writers upon
the law of evidence state that under the English rule protection
from disclosure in evidence in a court of justice was not extended
to communications between a medical man and his patient.^
Reasons for the Rule. — It does not clearly appear, in any
of the cases usually cited as authority, why the distinction is
' Greenleaf Ev. , s. 236 ; Taylor ^ The successive efforts made to
Ev. , s. 908 ; Bouvier's Law Diction- extend protection by judicial rul-
ary, p. 363 ; Am. and Eng. Enc. of ing to communications between
Law, vol. 19, p. 122; Code Civ. Pro. physician and patient will appear
Cal. , s. 1,881; Mills' Ann. Stats, of from a consideration of the cases
Col., 1891, s. 4,824; Rev. Stats. that are usually cited as authority
Idaho, 1887, s. 5,958; Gen. Stats. for the English rule: Annesley v.
Minn., 1891, s. 5,094; Comp. Stats. Earl of Anglesea (1743), 18 How.
Mont., 1887, s. 650; Gen. Laws Ore., St. Tr., 1,139; Duchess of King-
1892, s. 712; Comp. Laws Utah. ston's case (1776), 20 How. St. Tr.,
1888, s. 3,877. 355 (cf. p. 572, p. 585, p. 586, p.
•^TavlorEv.,s. 911; Stephen, Dig. 613); Wilson r-. Rastall (1791), 4
of Ev.', art. 115; Greenleaf Ev., s. Term R. (Durnford & East), 753:
237. Rex v. Gibbous (1823), 1 C. & P.,
92
CONFIDENTIAL COMMUNICATIONS — BOSTON.
made between legal and medical advisers, but it is apparent
that the privilege does not rest upon considerations of honor nor
of confidence/ nor even upon the urgency of the situation under
which the communication is made ; for disclosures are made to
a physician frequently to save life, or to a priest for reasons of
eternal import, while those made to an attorney insure at most
protection from temporal annoyance. The privilege of attor-
neys seems to be founded upon considerations of public policy
in the administration of justice in the courts; attorneys are a
part of the sj^stem, as are grand jurors, petit jurors, and judges,"
and even arbitrators ; ^ but physicians are no part of that system,
and ■ a disclosure of confidences made to them in no way tends
to weaken the system or render it ineffectual, while the compul-
97 ; Broad v. Pitt (1828), 3 C. & P. ,
518 ; Greenough v. Gaskell (1833), 1
My. & K. , 98. See also Wheeler v. Le
Marchant, 50 L. J. Ch., 795 (1880).
1 Phillips Ev., p. 136; Starkie
Ev., p. 40; Wharton Ev., s. 606;
Greenleaf Ev., sees. 248, 237, 239;
Taylor Ev., s. 916; Stephen, Dig.
of Ev., art. 115; Rogers' Expert
Testimony, s. 45 ; Reynolds' Theory
of Evidence, s. 86.
It is to be noted that none of the
cases which ai'e cited as authority
for the common-law rule as usually
stated are really precedents to that
extent. The cases of the Duchess of
Kingston (siqjra) ; Lord William
Russel (9 How. St. Tr. , 603) ; Dr.
Ratcliff (9 How. St. Tr. , 583) ; Earl
Ferrers (19 How. St. Tr. , 886) , and
Rex V. Gibbons {siqwa), were all
criminal prosecutions ; and in An-
nesley v. Anglesea, Wilson v. Ras-
tall. Broad v. Pitt, and Greenough
V. Gaskell (supra), which were civil
causes, the question of the privilege
of a medical man was not really in
dispute. It is well settled that
communications between attorney
and client are privileged, and yet
Judge Pitt Taylor expresses some
doubt whether the protection can-
not be removed without the client's
consent in cases where the interests
of criminal justice require the pro-
duction of the evidence (Taylor Ev. ,
s. 939). This intimation of a dis-
tinction between criminal and civil
actions, even in the case of attor-
neys, suggests the possibility of a
difference between those two classes
of actions in the case of medical
men. The cases cited establish au-
thoritatively that in criminal pros-
ecutions, at common law, confi-
dential communications between
medical man and patient are not
privileged ; but in civil causes, the
opinions of the eminent judges
seem to be obiter dicta. It is, how-
ever, established by other decisions
that mere confidential relations do
not prevent the disclosure of com-
munications. (For the case of hatik-
ers, see Loyd v. Freshfield, 2 C. &
P. , 335 ; managers, Anderson v.
British Bank of Columbia. 45 L. J.
Ch., 449; clerks, Lee v. Burrell, 3
Camp. , 337 ; Webb v. Smith, 1 C. &
P. , 337 ; stewards, Vaillant v. Dode-
mead, 2 Atk., 524; Earl of Fal-
mouth V. Moss, 11 Price, 455; Pur-
suivant of Herald's College, Slade
V. Tucker, 49 L. J. Ch., 644.)
The opinions of so many eminent
men, though strictly speaking obiter
dicta, together with the uniform
statements of text- writers based
upon them, leave no room for reason-
able doubt tnat independent of stat-
ute, in civil as well as criminal
causes, communications between
medical adviser and patient are not
entitled to protection from disclos-
ure in evidence.
'See Duchess of Kingston's case
(supra, p. 91, note 3) (cf. ib., pp.
573. 585, 586, 613). [253a.
-Greenleaf Ev., sees. 249, 352,
3 Greenleaf Ey. s. 249.
THE RULE IN THE UNITED STATES. 93
sory examination of lawyers would tend to the suppression of
the truth in litigation by discouraging confidence between at-
torney and client. This, perhaps, can be assigned as the reason
for the distinction; a distinction which does not differentiate
lawyers from physicians, but agents in the administration of
justice from all others.'
Criticism of the Rule. — Though the privilege of attorneys
was adopted to enforce respect for the law as securing the rights
of persons entitled to its protection, by establishing inviolable
confidence between them and the officer who represents them in
their dealings in the law, and though it was not the purpose of
the law to enforce sentiment or to elevate one profession above
another, the sentimental idea did not suffer neglect for the want
of advocates. Justice Buller lamented the narrowness of the
rule,'^ and Mr. Best has criticised it as harsh in itself, of ques-
tionable policy, and at variance with the practice in France and
the statute law in some of the United States of America.'
THE RULE IN THE UNITED STATES.
It is to be assumed, in the absence of statutes varj-ing the
rule, and of decisions to the contrary, in the several States of
the United States, that in those States which derived their law
from England the same rule of evidence obtains as that above
enunciated. But many of the legislatures have bj^ statute ex-
tended the privilege to communications between physicians and
their patients, as well as to other specified confidential commu-
nications which it does not fall within the scope of this work to
discuss.*
'See Barnes v. Harris, 7Cush. , a statutory privilege for commiini-
576 ; Hatton v. Robinson, 4 Pick, cations between physician and pa-
432. See also historical review of tient, tliat " in 4 Term Eep. , oWO,
the attorney's privilege and the rea- Buller, J. (to whom no one will at-
sons for it, by Judge Seldon, at Spe- tribute a disposition to relax the
cial Term, in Rochester City Bank rulesof evidence) , said it was 'much
V. Suydam, 5 How. Pr. (N.Y.), 254. to be lamented' that the iuforma-
^ Wilson V. Rastall, 4 Term R., tion specified in this section (2 R.
753. S. , p. 406, s. 73) was not privileged.
^ Best, Prin. of Ev. . s. 582. Mr. Phillips expressed the same
•*The revisers of the New York sentiments in his treatise on Evi-
Statutes in 1828 in their report (5 dence. p. 104. The ground on which
N. Y. Stats, at Large, edited bj^ communications to cojf/ise/ are priv-
John W. Edmonds, 2d ed., p. 726) ileged is the supposed necessity of
stated as their reason for suggesting a full knowledge of the facts, to ad-
^4
CONFIDENTIAL COMMUNICATIONS — BOSTON.
States and Territories in u'hich there are No Restric-
tive Statutes. — The following States and Territories have no
statute restricting the nature of the disclosures which a physi-
cian may be compelled to make in a court of justice : Alabama,
Arizona, Connecticut, Delaware, District of Columbia, Florida,
Georgia, Illinois, Kentuck}-, Louisiana, Maine, Marj^land, Mas-
sachusetts, Mississippi, New Hampshire, New Jerse}', New
Mexico, Pennsylvania, Rhode Island, South Carolina, Tennes-
see, Texas, Vermont, Virginia, and West Virginia. '
States and Territories in ivliich there are Restrictive
Statutes. — The following States and Territories have statutes
restricting disclosures by physicians : Arkansas, California,
Colorado, Idaho, Indiana, Indian Territory, Iowa, Kansas,
Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada,
New York, North Carolina, North Dakota, Ohio, Oklahoma,
Oregon, South Dakota, Utah, Washington, Wisconsin, and
Wyoming. '^
vise correctly, and to , prepare for
the proper defence or prosecution of
a suit. But surely the necessity of
consulting a medical adviser, when
life itself may be in jeopardj% is still
stronger. And unless such consulta-
tions are privileged, men will be in-
cidentally punished by being obliged
to suffer the consequences of injuries
w^ithout relief from the medical art,
and without conviction of any of-
fence. Besides, in such cases, dur-
ing the struggle between legal duty
on the one hand and professional
honor on the other, the latter, aided
by a strong sense of the injustice and
inhumanity of the rule, will inmost
cases furnish a temptation to the
perversion or concealment of truth,
too strong for human resistance. In
every view that may be taken of
the policy, justice or humanity of
the rule as it exists, its relaxation
seems highly expedient. "
These or similar reasons have pre-
vailed in many States and Territo-
ries to bring about a statutory re-
striction on disclosures.
' The following cases show or tend
to show that the English rule is in
operation in Connecticut, Maine,
Maryland, Massachusetts, New Jer-
sey, Texas, and West Virginia : Wil-
son v. Town of Granby, 47 Conn.,
59 ; Fayette v. Chesterville, 77 Me. ,
28 ; Weems v. Weems, 19 Md. , 334 ;
Morrissey V. Ingham, 111 Mass., 63;
Barber v. Merriam, 11 Allen, 332 ;
Castner v. Sliker, 4 Vr. , 95 ; Stea-
gald V. State, 3S.W. Rep., 771 ; Jar-
rett t'. Jarrett, llW.Va., 584. For
the common-law rule in the States
where statutes are now in force, see
Campau v. North, 39 Mich., 606;
Territory v. Corbett, 3 Mont. , 50 ;
Pierson r. People, 79 N. Y. , 424 ;
Edington v. JEtna L. I. Co. , 77 N.
Y. , 564 ; Buffalo Loan Tr. & S. D.
Co. V. Knights Templar, etc., 126
N. Y., 450.
2 Dig. Stats. Ark., 1884, s. 2,862;
Code Civ. Pro. Cal. , s. 1, 881 as amend-
ed Law 1893, c. 217; Mills' Ann.
Stats. Col., 1891, sees. 4,824, 4,825;
R. S. Ida., 1887, s. 5,958; Myers'
Ann. R. S. Ind. , 1888, s. 497 ; Act
of May 2d, 1890, U.S. Stats, at Large,
c. 182, making the laws of evidence
of Arkansas applicable to Indian
Territory ; McClain's Ann. Code
Iowa, 1888, s. 4, 893 ; Code Civ. Pro.
Kan. , s. 323 ; Gen. Stats. Kan. , 1889,
s. 4,418; Howell's Ann. Stats. Mich.,
1882, s. 7,516; Kellev's Gen. Stats.
Minn., 1891, s. 5,094; R. S. Mo.,
1889, s. 8, 925 ; Comp. Stats. Mont. ,
1887, s. 650 ; Code of Civ. Pro. Neb. ,
sees. 333, 334; Bailey & Hammond's
THE STATUTES. 95
The Rule in United States Courts. — In trials at com-
mon law in the courts of the United States, the laws of the
several States, except where the Constitution, treaties, or statutes
of the United States otherwise require or provide, are regarded
as rules of decision,' Section 858 of the Revised Statutes of
the United States prescribes rules with reference to competency
notwithstanding color and interest of witnesses, and in actions
by or against executors, administrators, or guardians, and then
provides that " in all other respects the laws of the State in which
the court is held shall be the rules of decision as to the compe-
tency of witnesses in the courts of the United States in trials
at common law, and in equity and admiralty." Accordingly
it has been held by the Supreme Court of the United States
that in an action in the Circuit Court of the United States for
the Southern District of New York, on a policy of life insur-
ance, the evidence of a phj'sician, inadmissible under Section
834 of the New York Code of Civil Procedure, was properly ex-
cluded.'' But in criminal prosecutions in United States Courts,
the privilege secured by State statutes does not avail.'
THE STATUTES.
As the effect of these statutes depends largely upon their
language, the construction put upon the law in one State is
chiefly serviceable in interpreting that of another State in those
particulars where the two are similar.
Statutory Declarations of Policy. — A comparative view
of the several laws shows that in the following States and Ter-
ritory there are declarations of policy prefixed to the prohibition
Gen. Stats. Nev., 1885, s. 3,406; and the date of the i^assage of tho
Code Civ. Pro. N.Y., sees. 834,836, as earlier of these laws, see note to
amended by Laws 1893, c. 295; Laws Gartside v. Connecticut Mutual L.
of N.C.Actof 1885,c. 159; Code Civ. I. Co., 76 Mo., 446.
Pro. Dak., 1883, s. 499; Smith & ' Rev. Stats. U. S., s. 721.
Benedict'sR.S. Ohio, 1890. s. 5,241; ^ Conn. Mut. Life Ins. Co. r.
Stats, of Okl., 1893, s. 4,213; Hill's Union Trust Co., 112 U. S., 250.
Gen. Laws Ore., 1892, sees. 712, 713; See also Dreier v. Continental L. I.
Code Civ. Pro. Dak., 1883. s. 499; Co., 24 Fed. Rep., 670; Adrereuo r.
Code Civ. Pro. Utah, s. 1, 156 ; Comp. Mutual Res. Fund L. I. Co., 34 Fed.
Laws of Utah, s. 3,877 ; 2 Hill's Ann. Rep., 870.
Stats. Wash., 1891, s. 1,649 : Sanborn =' Logan v. United States, 144 U.
& Berryman's Ann. Stats. Wis., S., 263: United States v. Raid, 12
1889, s. 4,075; R. S. Wyo., 1887, s. How., 361.
2, 589. For the chronological order
96 CONFIDENTIAL COMMUNICATIONS — BOSTON.
of disclosures, that show the reason of the enactment, namely :
California, Colorado, Idaho, Minnesota, Montana, North Da-
kota, Oregon, South Dakota, and Utah/ The declaration is to
the effect that there are particular relations in which it is the
policy of the law to encourage confidence and to preserve it in-
violate, and that therefore the prohibition of the statute is laid.
Analysis of the Statutes.
The common purpose of the statutes is to restrict the rule
compelling disclosures so as to protect communications with
a physician in his professional capacity; but the limit to
which the protection is extended differs in the various States.
An analytic comparison of the statutes tends to show how far
the interpretation of one is useful in construing another.
I. Nature of the Exclusion. — In Calif ornia, Idaho, Minne-
sota, Montana, North Dakota, Oregon, South Dakota, Utah,
and Washington the statutes apply only to testimony in civil
actions.'' The other statutes make no distinction between civil
and criminal proceedings.
The active words are of course different in the several stat-
utes, but they indicate a purpose to extend a privilege that the
person entitled to it may insist upon maintaining, with the sin-
gle exception of the law of North Carolina, which provides that
the presiding judge of a superior court may compel a disclos-
ure, if in his opinion the same is necessary to a proper adminis-
tration of justice.
Some of the statutes show clearly that it is the patient's
privilege, and suffer the patient or his representatives to waive
it, either expressly or by conduct which the law declares to
amount to a waiver.' Others are silent on this subject.
In California, Colorado, Idaho, Iowa, Minnesota, Montana,
Nebraska, Nevada, New York, North Dakota, Ohio, Oregon,
South Dakota, Utah, Washington, and Wyoming, it is expressly
provided that the patient's consent is necessary before a dis-
closure will be permitted.
' See references to the several ^ This seems to be the proper con-
statutes in note 2 on p. 94. struction of the Kansas and Okla-
- See Freelf. Market St. Cable Ry. homa statutes, though what seem
Co., 31 Pac. Rep., 730 (Supr. Ct. to be typographical errors in the
Cal.) . published laws render it doubtful.
ANALYSIS OF THE STATUTES. 97
In Colorado, Kansas, Oklahoma, and Oregon, if the patient
offer himself or a physician or surgeon as a witness, that is to
be deemed a consent.
In Nevada, in anj'' suit or prosecution for malpractice, if the
patient or party suing or prosecuting shall require or give con-
sent, and any physician or surgeon shall give testimony, then
the defendant may call any other physicians or surgeons as wit-
nesses without the consent of the patient or party suing or pros-
ecuting.
In Ohio and Wyoming, if the patient voluntarily testify the
physician may be compelled to testify on the same subject.
II. The Witness. — In Indiana, Ohio, and Wyoming the
privileged witness is termed a jjhysicianj in the other States
and Territories, the privilege extends to s. physician ov surgeon.
In Arkansas and Indian Territory the privilege is secured to
a person authorized to XDractise physic or surgery; in Califor-
nia, Montana, and Nevada, to a licensed physician or surgeon;
in Colorado, to a physician or surgeon duly authorized to prac-
tise his profession under the laivs of the State; in Michigan,
New York, North Carolina, and Wisconsin, to a person duly
authorized to practise physic or surgery; in Minnesota, Ore-
gon, and Washington, to a regidai^ physician or surgeon ; in
Iowa and Nebraska, to a practising physician or surgeon ; in
the remaining States and Territories, these statutes do not in
terms distinguish between licensed and unlicensed practitioners. '
In New York, by the amendment of 1893 to Sec. 836 of the
Code of Civil Procedure it is provided that in an action for the
recovery of damages for a personal injury the testimony of a
physician or surgeon attached to any hospital, dispensary, or
other charitable institution, as to information which he acquired
in attending a patient in a professional capacitj' in such insti-
tution, shall be taken before a referee. It does not appear
whether this amendment is intended to take away the privilege,
or merely to regulate the manner of taking such testimony when
it is otherwise admissible.''
III. The Evidence. — The character of the communications
which are privileged differs under the several statutes. In Ar-
' For laws regulating practice in ° Laws N. Y., Act 1893, c. 295.
the several States and Territories,
see infra, p. 137 et seq.
7
98 CONFIDENTIAL COMMUNICATIONS — BOSTON.
kansas, California, Colorado, Idaho, Indian Territory, Michi-
gan, Minnesota, Missouri, Montana, Nevada, New York, North
Carolina, North Dakota, Oregon, South Dakota, Utah, Wash-
ington, and Wisconsin, they are characterized as information;
in Indiana, as matte?' committed; in Iowa and Nebraska, as
confidential communications; in Kansas, Ohio, Oklahoma, and
Wyoming, as communications; in Iowa and Nebraska, it is
further provided that they beproper/?/ intrusted; and in Kansas
and Oklahoma, that they be with reference to a physical or
supposed physical disease.
In Kansas and Oklahoma, any knowledge obtained by a per-
sonal examination of a patient is also expressly privileged.
In Indiana, Ohio, and Wyoming, advice given by the phy-
sician is covered by the protection.
In Arkansas, Indian Territory, and Missouri, the privilege
is limited to information acquired from the patient; and in
Kansas and Oklahoma, to communications made hy the patient.
The statutes of Arkansas, California, Colorado, Idaho, In-
dian Territory, Indiana, Michigan, Minnesota, Missouri, Mon-
tana, Nevada, New York, North Carolina, North Dakota, Ore-
gon, South Dakota, Utah, Washington, and Wisconsin expressly
limit the protection to matter acquired while attending in a
professional capacity ; and all of these, save Indiana, as well as
Iowa and Nebraska, confine the privilege to information neces-
sary to enable the witness to prescribe or act for the patient.
In Ne"v\j York it is provided that " a physician or surgeon
may upon a trial or examination disclose any information as to
the mental or physical condition of a patient who is deceased,
which he acquired in attending such patient professionally,
except confidential communications and such facts as would
tend to disgrace the memory of the patient, when the protection
has been expressly waived on such trial or examination by the
personal representatives of the deceased patient, or if the valid-
ity of the last will and testament of such deceased patient is in
question, by the executor or executors named in said will, or
the surviving husband, widow, or any heir at law, or anj" of the
next of kin of such deceased, or any other party in interest." *
IN. Y. Code Civ. Pro., s. S36, as 1891, c. 381, and modified by Act
amended Act 1893, c. 295. A similar 1892, c. 514.
exception was introduced by Act
JUDICIAL INTERPRETATION OF THE STATUTES. 'JU
The notable characteristics of the several statutes which thus
far have been pointed out are discernible in the express lan-
guage of the acts. In writing or using any treatise or compi-
lation on privileged communications between physician and
patient, it is to be constantly borne in mind that the privilege
is of statutory origin; that the statutes are often dissimilar;
and that the value of a judicial interpretation of one law in the
construction of another varies with the dissimilarity.
JUDICIAL INTERPRETATION OF THE STATUTES.
The judicial decisions which are discussed here are those
that deal with the privilege secured b}^ the restrictive laws.
The analogy between the privilege of a client with regard to his
attorney's disclosures, and that of a patient with regard to the
testimony of his physician, is not so complete as to make it es-
sential to present here, for the sake of their bearing upon the
subject now under consideration, a study of the principles to be
deduced from the numerous decisions with reference to attorne3'S
as witnesses. The analogous cases of clergymen and priests
are also bej'ond the scope of this treatment.
Rules of Construction. — The restrictions are in derogation
of the common law ' and in accordance with the rule of inter-
pretation ordinarily adopted should be strictly construed, "^ but
the courts have generally looked at the policj' of the enactments,
and have construed them so as to preserve inviolably the con-
fidence existing between physician and patient, without nar-
rowing their effect to a strict interpretation of their language.
In Indiana, under a former law which protected matters con-
fided, it was said that the statute should be given a broader
scope than the word confided in a strict sense imports, so as to
cover matters learned by observation and examination. ° But,
though the statute in terms absolutely prohibits a disclosure, it
has been said, in Indiana, that it gives no right to the physi-
cian to refuse to testify where the patient waives the privilege, *
^ Supra, p. 94, note 1. Beck, 77 Ind., 203. For the con-
' Bishop, Written Laws, sees. 119, structiou of particular words and
155; Potter's Dwarris, Statutes, p. phrases, see infra, p. 115 et seq.
185; 1 Bouvier's Law Dictionary. •* For waiver of the privilege, see
"Construction." p. 386. ' infra, p. 106.
^Masonic Mut. Ben. Assn. v.
100 CONFIDENTIAL COMMUNICATIONS — BOSTON.
and that it creates no absolute incompetency, because to hold
otherwise would result in obstructing justice without subserv-
ing the purpose of the statute.' In Missouri, there is a dictum
that the privilege should be carefully limited to what the stat-
ute requires, not so much because it is in derogation of the
common law as because it is in exclusion of the best evidence,
on the ground of privilege ; ° but in this very case, the real ques-
tion was whether the word oral should be construed into the
statute so as to exclude from its protection information acquired
by inspection and observation, and it was held that no such
narrow interpretation was proper. In a later case the narrow-
ing dicta of the foregoing opinion were disapproved,^ and sub-
sequently the disposition to make a liberal construction was
shown by the highest court of the State, although a general rule
of interpretation was not announced.^ In New York, the rule
that a statute in derogation of the common law is strictly con-
strued does not apply to the Code of Civil Procedure.* But
before the enactment of this statutory rule " there was a ten-
dency to interpret liberally the law prohibiting disclosures.''
In Arkansas the tendency seems to be to construe the law
strictly.' The spirit of interpretation will be more fully illus-
trated in the discussion of particular cases which follows.
In New York it was claimed that the protection afforded by
the statute is nullified by the provision for the examination of
a party before trial,* but it was held that the statutes are con-
1 Penn Mut. L. I. Co. v. Wiler, N. Y. , 185. Cf . Kendall v. Grey.
100 Ind. , 92. 2 Hilt. , 300 ; Pearsall v. Elmer, 5
^ Lunz V. Mass. Mut. L. I. Co., 8 Redf. , 181. A disposition to con-
Mo. App. , 363. strue the statute strictly was dis-
^ Kling V. City of Kansas, 27 Mo. closed in the opinion of Earl, J. , in
App., 231. Edington v. ^tna L. I. Co., 77 N.
"•Gartside V. Conn. Mut. L. I. Co., Y. , 564, but his personal views were
76 Mo. , 446 ; said to be overruled disapproved in subsequent cases ; see
byGrollv. Tower, 85 Mo., 249, in Grattan v. Metro. L. I. Co., 80 N.
Squires v. City of Chillicothe, 89 Y. , 281 ; Renihan v. Dennin, 103 N.
Mo., 226; but followed in Thomp- Y., 573; Buffalo Loan, etc., Co. v.
son V. Ish, 99 Mo. , 160. Knights Templar, etc. , 126 N. Y. ,
* N. Y. Code Civ. Pro. , s. 3, 345. 450. See also Jones v. Brooklyn,
Disclosures by physicians are re- etc. , Ry. Co. , 3 N. Y. Supp. , 253 ;
stricted by sees. 834, 836 of said in matter of Darragh, 52 Hun, 591 ;
Code. Marx v. Manhattan Ry. Co., 56
^ Code Civ. Pro., sees. 834, 836, as Hun, 575; Treanor v. Manhattan
new existing are re-enactments with Ry. Co., 28 Abb. N. C. , 47.
modifications of 2 R. S. , p. 406, s. 73. « See Collins v. Mack, 31 Ark. , 684.
' People V. Stout, 3 Park Cr. Rep. , ^ N. Y. Code of Pro. , s. 390 ; N. Y.
670 ; Edington v. Mut. L. I. Co., 67 Code of Civ. Pro., s. 870.
CLASSES OF ACTIONS. 101
sistent and the physician cannot be made to disclose, though
his patient may be.'
Classes of Actions.
Crhninal Actions and Evidence of Crime in Civil
Actions. — The statutes confining the restriction to civil actions
have been cited above. ^ In Iowa, in an action for breach of
promise to marry, it was said that the privilege does not ex-
tend to the protection of advice for the commission of a
crime,' In New York the rule was at first embodied in the
Revised Statutes of the State,* but upon the adoption of the
Code of Civil Procedure it was included therein, ^ and subse-
quently the provision of the Revised Statutes was repealed." In
that State by law the rules of evidence in civil cases are appli-
cable also to criminal cases, except as otherwise expressly pro-
vided;'' and the statutes provide no different rule in criminal
actions as to this class of evidence. Notwithstanding this fact,
however, it has been said by the Court of Appeals, in a case
where there was an attempt to screen a murderer by insisting
that his victim's physician was not a competent witness as to
information acquired by him while attending his patient,"* that
the design of the law was to enable the patient to make known his
condition to his physician without the danger of disclosing what
would annoy his feelings, damage his character, or impair his
standing while living, or disgrace his memory when dead, but
that it was not intended to protect a murderer rather than to
shield his victim; and quoting from the opinion of Talcott, J.,
in the court below, ^ the Court said : " The purpose for which the
aid of the statute is invoked is so utterly foreign to the purpose
and object of the act and so diametrically opposed to any intent
'Edington v. Mut. L. I. Co., 5 4 2R. S., 406, s. 73.
Hun, 1 ; s. c, 67 N. Y., 185. * Act 1876, c. 448, Code Civ. Pro.,
Under sec. 873, Code Civ. Pro. , sees. 834, 836.
as amended by Law 1893, c. 721, the « Act 1877, c. 417, s. 1.
plaintiff in an action for personal ' 3 R. S., 1029, s. 19. Superseded
injuries may be compelled to sub- by Code Crim. Pro., s. 392, as
mit to a physician's inspection. Cf. amended by Act 1892, c. 279, s. 7.
Packer. Page, 51 Mich., 88. People v. Murphy, 101 N. Y., 126.
^ Siqjva, p. 96. People v. Brower, 53 Hun, 217.
^ Guptill V. Verback, 58 Iowa, 98. » Pierson r. People, 79 N. Y. , 424 ;
In this case, however, it was deter- People 7-. Harris, 136 N. Y., 423.
mined that it did not appear that a ** Pierson v. People, 18 Hun. 239.
crime was intended.
102 CONFIDENTIAL COMMUNICATIONS — BOSTON.
which the legislature can be supposed to have had in enacting
it, so contrary to and inconsistent with its spirit, which most
clearly intended to protect the patient and not to shield one who
is charged with his murder ; that in such a case the statute is
not to be so construed as to be used as a weapon of defence to a
party so charged instead of a protection to his victim." Ac-
cordingly it was held that the evidence was not to be excluded
under the statute. But the rule is still applicable to criminal
actions. In a later case, where the accused was indicted for
abortion, the same court held, that where the patient was living
and the disclosure tended to convict her too of crime or to cast
discredit and disgrace upon her, the evidence of her physician
as to information acquired by him in attendance upon her was
inadmissible in the trial of the man charged with the crime.'
In a still later case,^ the General Term of the Supreme Court
held, where the accused was on trial for murder and he had
confided to a physician what he had done, that the physician
could not disclose the confidence. The rule deducible from these
decisions seems to be that in New York the privilege extends
to criminal actions, even though they be trials for murder, and
even though the person accused be the patient, but that the
statute will be applied only for the protection of the patient, and
where it is apparent that no injury can possibly be done to the
patient or his memory by the admission of the evidence, and the
interests of justice demand the disclosure, for the punishment
of a person for an injury done to the patient involving a viola-
tion of the criminal law, and the patient is not alive to waive
the privilege, that the disclosure is not forbidden.
In New York efforts have been made to exclude from the
operation of the statute other classes of actions, to which it has
been urged that the reasons for the enactment do not apply, or
in which the mischief alleged to be wrought by its enforcement
has been suggested as ground for believing that the legislature
could not have intended to include them. Of these, actions for
divorce on the ground of adultery are one class ; but it has been
held that they constitute no exception.'
'People V. Murphy, 101 N. Y. , ^Johnson t'. Johnson, 4 Paige,
126 (1886). 460: s. p., 14 Wend., 636; Hanford
■' People V. Brower, 53 Hun, 217 v. Hanford, 3 Edw. Ch. , 468 ; Hunn
(1889) . See also People v. Stout, 8 v. Hunn. 1 T. & C, 499.
Park Cr. Rep. , 670. In Indiana, information as to
CLASSES OF ACTIONS. 103
Testamentary Causes. — In New York it was long sup-
posed that the policy of the law excepted probate proceedings ;
it was so held by the Surrogate of New York City ; ' and also
by the General Term of the Supreme Court/ by which it was
stated that the practice had prevailed for a half-century in will
cases/ but the Court of Appeals/ has decided that testamen-
tary cases constitute no exception to the rule, the judge who
delivered the opinion stating that there is no more reason for
allowing secret ailments cf a patient to be brought to light in
a contest over his will than in any other case, and that if mis-
chief be wrought by the law the remedy lies with the legislature
and not with the courts. The legislature has since afforded
the remedy, ^ but not to the extent of adopting the rule of the
earlier cases. In Indiana, in an action to set aside a will, the
testimony of the testator's physician has been excluded.* And
in Michigan and Missouri it seems that testamentary cases are
no exception to the general rule.'
Lunacy and Habitual Drunkenness. — It has been
claimed in New York that inquisitions of lunacy are an excep-
tion, and recently it has been held that the alleged lunatic's
physician may testify as to his mental condition because no one
is better qualified to testify,* but this decision seems to be at
abortion and criminal intimacy is (Supr. Ct., G. T., 1887). In matter
protected in an action for criminal of Connor (Sup. Ct., G. T.), 27 N. Y.
conversation. Harris v. Rupel, 14 St. Rep., 905 (1889) ; Mason v. Wil-
Ind., 209. In Hewitt v. Prime, 21 liams (Sup. Ct., G. T., 1889), 6N.Y.
Wend., 77 N. Y. (1839), in an ac- Supp.,479; Van Or man v. Van Or-
tion for seduction the testimony of man (Sup. Ct., G.T., 1890), 34N.Y.
a physician that he was asked for St. Rep., 824. See also In matter of
medicine to produce an abortion Halsey (N. Y. Suit.), 29 N. Y. St.
was admitted. It was stated that Rep., 533 (1890). Allen v. Pub.
such testimony is not privileged, Adm., 1 Bradf., 221, had been over-
but there were other reasons for the ruled in part by Edington v. Mut.
judgment, and the case seems to be L. I. Co., 67 N. Y., 185 (1876), but
at variance with later decisions on not on this point,
that principle. * Supra, p. 98.
See also Briggs v. Briggs, 20 "Heuston t\ Simpson, 115 Ind., 62.
Mich., 34. ■" Fraser r>. Jennison, 42 Mich.,
' Allen t). Pub. Adm., 1 Bradf., 206. In this case the testimony was
221 (1850). admitted on the ground that the rep-
'^ Staunton v. Parker, 19 Hun, 55 resentative could waive the privi-
(1879) . lege. See Thompson r. Ish, 99 Mo. ,
^ Citing the fact that no objection 160.
was raised in the noted case of Dela- ** In re Benson (Monroe County
field r. Parish, 25 N. Y., 1. Court), 16 N. Y. Supp., Ill (1891).
^Renihan v. Dennin, 103 N. Y. , Some States have statutory provi-
573 (1886), followed in Loder v. sions for the qualification of physi-
Whelpley. Ill N. Y. , 239 (1888). In ciaus as examiners in lunacy, e.g..
re Hannah, 11 N. Y. St. Rep., 807 Laws of Col., 1893, c. 119, s. 5;
104 CONFIDENTIAL COMMUNICATIONS — BOSTON.
variance with the principle of the decisions of the Court of
Appeals with reference to testamentary cases, and presents no
satisfactory reason for a distinction. In a similar case in the
Supreme Court, Chambers, it was held that a medical attendant
at an asylum could not testify.' It has also been held that a
physician cannot make an affidavit as to the appearance and
condition of his patient to support a petition for the appoint-
ment of a committee for him as an habitual drunkard.''
Fraud. — Still another class of actions in which contend-
ing principles have been invoked to make an exception in the
law of privilege, is actions on life-insurance contracts. The
contract of insurance is uberrimcB fidei, and the defence of
fraud in the application is frequently interposed to defeat a
claim under a policy. Medical testimony would often be the
most satisfactory evidence to establish the fraud, and efforts have
been made to introduce it under that excuse, but without avail.
In the case of Dilleber vs. Home Life Insurance Company, in
the Supreme Court of New York at General Term, ^ the question
seems to have been directly before the court, and Davis, P. J.,
dissenting, insisted that the suppression of a physician's testi-
mony ought not to be permitted so as to cover up a fraud, but the
majority of the court held otherwise ; the case was subsequently
overruled, but not on the ground urged b}^ Justice Davis. ^
The number of insurance cases in which the rule has been
enforced seems to leave it bej'ond question that it will not be
relaxed for the purpose of establishing fraud, ^ although that
announcement has not been specifically made. There seems no
reason that the rule should be relaxed in that regard when it is
not relaxed to establish the crime of the patient ; though the
mischief that may be done in such cases is apparent."
Laws of N. Y., 1874, c. 446, t. 1, 77 Ind., 203; Excelsior Mut. Aid
art. 1, s. 1. The bearing of these Assn. v. Riddle, 91 Ind., 84; Penn
provisions upon the statutory priv- Mut. L. I. Co. v. Wiler, 100 Ind.,
ilege has not been made clear. 92 ; ^tna L. I. Co. v. Denning. 123
iln matter of Baird, 11 N. Y. Ind., 390 ; Lunz v. Mass. Mut. L. I.
State Rep., 263(1887). Co., 8 Mo. App., 363; Edington u.
2 In matter of Hoyt, 20 Abb. N. Mut. L.I. Co., 67N.Y., 185; Grattan
C. (Sup. Ct., G. T., 1887). v. Metrop. L. I. Co., 80 N. Y., 281 ;
M3 N. Y. W. D., 505 (1880). s. p., 93N. Y., 274 ; Conn. Mut. L. I.
•*Dilleber v. Home L. L Co., 13 Co. v. Union Tr. Co.. 112 U. S., 250.
N. Y. W. D., 505 (1881). «See Renihan v. Dennin, 103 N.
^ The following cases in which the Y.. 573, dictum to same effect,
rule has been enfoi-ced have arisen As to whether a physician may
out of contracts of life insurance : contradict his patient to prevent
Masonic Mut. Ben. Assn. v. Beck, fraud, see infra, p. Ill et seq.
THE WITNESS. 105
The Witness. — The statutory provisions as to the profes-
sional status of the witness whose testimony is exchided have
ah'eady been shown/ The facts which establish the relation
of physician and patient will be treated later.* The witness is
a member of a profession, but there is very little discussion in
the cases as to what constitutes a physician or surgeon.^ The
language of the statutes as well as their policy and intent has
been said to plainl}" embrace a physician who casuall}" or in any
way attends and prescribes for a patient, whether he be a family
physician or the usual medical attendant or not.'' The spirit
of the acts would protect communications made to any person
attending the patient in the accepted capacitj^ of physician or
surgeon wherever that might have happened, though the letter
would confine it in some instances to duly authorized or duly
licensed persons. It does not seem to have been established
whether such authority or license must have been granted under
the laws of the State where the trial is conducted, nor how the
several statutes apply to communications made elsewhere, es-
pecially in States or countries where authority or license to prac-
tise is not required by law.
It has been said with reference to the New York law that it
is absolutely necessary that the witness should be a duly qual-
ified physician ; ^ and it has been held that the words " duly
authorized " mean those persons who are not prohibited by the
penal code from practising, so that an unlicensed physician may
be compelled to disclose confidential communications. " Whether
the same rule would be applied with reference to information
obtained in another State by a. physician duly authorized to
practise there although prohibited from practising in New York,
' Supra, p. 97. •* Edington v. Mutual L. I. Co. , 5
2 Infra, p. 119. Hun, 1.
3 " Physician : A person wlio has ^ People v. Stout, 3 Park Cr.
received the degree of doctor of Rep., 670 (1858). In this case the
medicine from an incorporated in- witness was undoubted!}- a duly
stitution ; one lawfully engaged in qualified physician under the State
the practice of medicine." — Bou- law.
vier'sLaw Diet., vol. ii., p. 412. « Wiel v. Cowles, 45 Huu, 307
"Surgeon: One who applies the (1887) (Supreme Ct., Gen. T.) . Sec.
principles of the healing art to ex- 356, N. Y. Penal Code, which was
ternal diseases or injuries, or to in- in 0])eration at that finite, was re-
ternal injuries or malformations. pealed by Act 1887, c. 647, s. 9. but
requiring manual or instrumental the prohibition of unauthorized
intervention. One who practises practice is now to be found in Act
surgery."— Bou vier's Law Diet., 1893, c. 661, s. 140.
vol. ii', p. 698, q. v.
106 CONFIDENTIAL COMMUNICATJONS — BOSTON.
is a question that is suggested as a case within the reason of the
law but outside of its letter, and one which does not seem to
have been answered.
In New York, in an action by a physician for compensation
for his services, it was held that a person who merely answered
for a physician at his office in his absence, and was not himself
a physician, is not a witness whose testimony is privileged.'
In Missouri it has been held that a drug and prescription
clerk is not a privileged witness.^ The question arose in the
same State, whether a dental surgeon is forbidden to testify
under the statute, but its determination was not essential to the
judgment and it was left unanswered.^
To establish the privilege it is necessary that the person who
insists upon it to exclude testimony should show by competent
evidence that the witness belongs to the class privileged under
the law.^ But where the physician testified that he was a reg-
ular practising physician and attended in that capacity, and
he was not examined further as to his due authority, it was held
that a failure to produce his license could not be urged on ap-
peal as reason for compelling him to testify.^ The Court said
that if the privilege were the physician's he might, if the objec-
tion were taken, be required to prove by the best evidence that
he was duly authorized, but as it is the patient's privilege, in the
absence of objection to the sufficiency of the proof, the patient
is entitled to the benefit of the presumption that the physician
had the license which the law requires to entitle him to practise.
Waiver of the Privilege.
Who may Waive. — Those States in whicli the law provides
for a waiver have been enumerated ; ' in others the courts have
determined that the privilege of waiving is implied in the reason
for the law. In Indiana it has been held that although the statute
contains in terms an absolute prohibition, it creates no absolute
incompetency and the privilege may be waived by the person for
whose benefit it is made or his legal representative. ' Under the
1 Kendall v. Gray, 2 Hilt. , 300 (N. = Record v. Village of Saratoga
Y. Com. PI., Gen. T., 1859). Springs, 46 Hun, 448 (N. Y. Supr.
» Brown v. Hannibal & St. J. R. Ct. , Gen. T. ) .
R. Co. , 66 Mo. , 588. e Supra, p. 96.
^ Carrington v. St. Louis, 89 Mo. , '' Penn Mut. L. I. Co. v. Wiler,
208. 100 Ind., 92; Morris v. Morris, 119
* Infra, p. 128. Ind., 341.
WAIVER OF THE PRIVILEGE. 107
Michigan law it was claimed that the physician is forbidden to
reveal confidences even though he have his patient's consent,
but it has been held that the law only creates a privilege on
the same footing with other privileged communications, which
tlie public has no interest in suppressing when there is no desire
for suppression on the part of the person concerned.' In Mis-
souri too the patient may waive the privilege."
The protection vouchsafed by the law is designed for the
benefit of the patient, and therefore the physician himself can-
not waive it.' The patient can disclose his own physical con-
dition if he so desires.^
But the physician cannot refuse to testify if the patient
waives the privilege.^
The patient can waive the privilege during his life."
As it existed prior to 1891 the New York law provided that
the prohibition should operate unless it was expressly waived
upon the trial or examination by the patient.' This was inter-
preted to mean that the patient himself was the only person who
could make a waiver; and that, therefore, the possibility of
waiver ceased with the death of the patient, while the privilege
of secrecy continued unabated, so that those claiming under the
deceased patient could not waive the privilege, nor insist upon
' Grand Eapids & Ind. R. R. Co. * Mulhado v. Brooklyn City R.
V. Martin, 41 Mich., 667; Fraser v. R. Co., .-W N. Y., 370; Heller v.
Jennison, 43 Mich., 206. Sharon Springs, 28 Hun, 344;
- Carrington v. St. Louis, 89 Mo., Winner v. Lathrop, 67 Hun, 511.
208 ; Squires v. City of Chillicothe, ^ SeePenn Mut. L. I. Co. v. Wiler,
89 Mo., 226 ; Blair v. C. & A. R. R. 100 Ind.. 93 ; Territory v. Corbett, 3
Co., 89 Mo., 334; s. p., 89 Mo., 383; Mont., 50; Johnson v. Johnson, 14
Adrereno v. Mut. Res. F. L. I. Co., Wend., 636; Babcock v. People, 15
34 Fed. Rep., 870; Davenport v. Hun, 347.
Citv of Hannibal, 18 S. W. Rep., « Barton -y. Allbright, 29 Ind., 488
1133. Campau v. North, 39 Mich., 606
^ The most of the cases in which Territory i\ Corbett, 3 Mont. , 50
the rule has been enforced are those Blair t'. Chic. & Alton R. R. Co. , 89
in which the physician has actually Mo., 334 ; Johnson v. Johnson, 14
testified without raising the objec- Wend. (N. Y.), 636.
tion himself, and in which, there- ' N. Y. Code Civ. Pro., s. 836
fore, the rule could not be enforced (Act 1876. c. 448) , as amended Act
if the physician's waiver were valid, 1877, c. 416, s. 185. Previous to the
but the following cases particularly Code of Civil Procedure the pro-
are in point : Harris tJ. Rupel, 14 vision for waiver was not in the
Ind. , 209 ; Barton v. Allbriglit, 29 statute, 3 R. S. , 406, s. 73.
Ind. , 488 ; Storrs v. Scougale, 48 The amendment of 1891 allowed
Mich. , 387 ; Lunz v. Mass. Mut. L. an express waiver of information,
I. Co., 8 Mo. App., 363; Johnson v. exce])t confidential communications
Johnson, 14 Wend., 636; Hanford r. and su(;h facts as would tend to dis-
Hanford, 3 Edw. Ch., 468; People grace the memory of tlie patient, by
r. Stout, 3 Park Cr. Rep. , 670. his personal representatives, or if
108 CONFIDENTIAL COMMUNICATIONS — BOSTON.
the testimony of the physician, even though their interests were
in jeopardy on account of his silence. ' It seems, however, that
a patient can during his hf etime waive the privilege, the waiver
to take effect after his death. ^ The express waiver required by
the statute may be given by the patient's attorney, because
of the nature of the attorney's ageucj in conducting an action
for the patient.^
None of the other statutes are in the exact terms of the New
York statute, but those of California, Colorado, Idaho, Minne-
sota, Montana, Nevada, North Dakota, Ohio, Oregon, South
Dakota, Utah, Washington, and Wyoming provide that the
testimony shall not be given unless the patient consent; in
Iowa, the waiver provided for is that of the person in whose
favor the prohibition is made ; and in Nebraska, of the party
in whose favor the provision is enacted.
In Indiana, the privilege extends beyond the death of the
patient, and it may be waived bj" the party who inaj' be said to
stand in the place of the deceased and whose interests may be
affected by the disclosure."
In Michigan, what the patient may do in his lifetime, those
who represent him after his death may also do for the protec-
tion of the interests which they claim under him.^ In Missouri
the representatives of the patient may waive ; " and where the
dispute is between devisees and heirs at law all claiming under
a deceased patient, either the devisees or heirs may call the at-
tending physician of the testator as a witness regarding infor-
mation acquired by him in his professional attendance.' In
the validity of the last will and tes- ^ See In matter of Freeman, 46
tament of the patient is in question, Hun, 548 (N. Y. Supr. Ct. , G. T. , 1887) .
by the executor or executors named See Adrereno i'. Mut. Ees. F. L.
in said will. Law 1891, c. 381. I. Co. (U. S. C. C. Mich.). 34 Fed.
The amendment of 1892 added Rep., 870.
the surviving husband, widow, ^ Alberti v. N. Y. , L. E. & W. R.
heir at law, any of the next of kin R. Co., 118 N. Y. , 77.
or any other party in interest, in * Masonic Mut. Ben. Assn. v.
case the validity of the last will and Beck, 77 Ind. , 203.
testament of the patient is in ques- * Fraseri'. Jennison,42Mich. , 206.
tion. Law 1892. c. 514. The pres- « Groll r. Tower, 85 Mo., 249.
ent law contains the same provi- ''Thompson r. Ish, 99 Mo., 160,
sions. Act 1893, c. 295. distinguishes the New York statute
' Westover v. ^tna L. I. Co. , 99 from the Missouri statute ; but
N. Y. , 56; Loder v. Whelpley, 111 seems to misinterpret Heuston v.
N. Y. , 239 : Alberti v. N. Y. , L. E. «fe Simpson, 115 Ind. , 62. which does
W. R. R. Co., 118 N. Y. , 77. Staun- not hold that representatives can-
ton V. Parker, 19 Hun, 55, is thus not waive, but that they can invoke
overruled. protection.
WAIVER OF THE PRIVILEGE. 109
Nevada it has been said that the parents of a seven-year-old
infant, may waive for the infant/
Objections to the Admission of Privileged Communica-
tions; When and by Whom Made. — Having considered who
can waive the privilege, it is material to discuss also the ques-
tion who may insist upon the enforcement of the law. If the
protection were only enforced on the claim of privilege by the
patient, the very object of the statutes would be defeated in
the large majority of instances because of the absence of the
patient and every one interested in his behalf to assert his right.
It rests, therefore, with any party to raise the objection and as-
sert the prohibition. But it seems that the physician himself,
unless a party, cannot make the objection." It seems to have been
thought in some of the cases that the right to insist upon the en-
forcement of the law is coupled with an interest derived from the
patient. This idea started from the language used in the early
cases enforcing the privilege at the instance of those claiming
under deceased patients;^ and it led to some confusion where
the right of representatives to waive the privilege was denied ;
but it seems to be clear that the right to object differs from the
right to waive in that the latter is necessarily and logically de-
pendent upon the relation between the patient and his representa-
tive, while the former is obviously suggested as the best method
of enforcing the law. In Indiana it has been said that the
statute gives to the representative of a deceased patient the right
to object ; ' but that this is not by reason of the relationship
appears from another case in the same State, where on an applica-
tion for anew trial the Court voluntarily refused to grant one
for newly discovered evidence disclosed to it by a physician's
affidavit, on the ground that if the patient should object in the
new trial the evidence would be excluded.^ In this State it has
been held that the widow of the patient cannot object to the
' State V. Depoister, 25 Pac. Rep., I. Co., 67 N. Y., 185; see Westover
1000. V. ^tna L. I. Co., 99 N. Y., 56.
-Johnson v. Johnson, 14 "Wond., Breisenmeister v. Supr. Lod^e,
636; Babcock v. People, 15 Hun, etc.,45N. W. Rep., 977 (Supr. Ct.
347; Valensin v. Valeusin, 14 Pac. Mich., 1890).
Rep., 87 (Supr. Ct. Cal., 1887) ; cf. •« Penn Mut. L. I. Co. r. Wiler.
In re Hannah, 11 N. Y. St. Rep., 100 Ind., 92.
807. 5 Harris v. Rupel, 14 Ind. , 209.
^ Penn Mut. L. I. Co. f. Wiler, See also Carthage T. Co. r. Andrews.,
100 Ind., 92; Allen r. Pub. Adm., 1 N. E. Rep., 364.
1 Bradf . , 221 ; Edington v. Mut. L.
110 CONFIDENTIAL COMMUNICATIONS — BOSTON.
disclosure, if his administrator with the will annexed waives
the privilege.'
In Michigan it has been said that the physician cannot avail
himself of the statute for his own benefit ; but that was in a
case where the communication was not really of the privileged
class.'' In New York, in proceedings to which a physician was
a party an examination of his books of accoun':; before trial has
been refused on the ground of privilege, and for the same reason
a motion to direct a physician to turn his books of account
over to a receiver has been denied.^
In Montana it has been said that when the patient consents
no one else can object to the reception of the physician's testi-
mony.*
In New York it has been said that the benefits of the law
are to be dispensed alike to those familiar with and those igno-
rant of its existence and applicability, and it is therefore no
reason to refuse its enforcement, that the patient did not know
that his communication was privileged."
But, as in other cases of the receipt of improper evidence, it
would seem that the objection should be made at the time it is
offered, and if the objection is not then made, it will not avail
to raise it later or on appeal. " It should not be prematurely made. '
In New York where in pursuance of a special feature of practice
in probate proceedings," certain witnesses are regarded as the
surrogate's witnesses though produced at the instance of the con-
testant, and the contestant, after giving notice that the evidence
of physicians as such witnesses was material, refused to exam-
ine them, and the surrogate required the proponent to suggest a
line of examination, it was held that it did not lie with the con-
testant to object to the physicians', testimony as privileged,
because she had lost her right to object by giving notice that
the evidence of those witnesses on these points was material.^
Objection cannot be raised in the progress of an examination
' Morris tJ. Morris, 119 Ind., 341. Breisenmeister v. Supreme Lodge,
" Scrippsv. Foster, 41 Mich., 743. etc., 45 N. W. Eep., 977 (Supr. Ct.
3 Mason v. Libbey, 2 Abb. N. C, Mich., 1890).
137; Mott V. Consumers' Ice Co., 2 ' Valensin v. Valensin, 14 Pac.
Abb. N. C, 143. Rep., 87 (Supr. Ct. Cal., 1887).
^ Territory v. Corbett, 3 Mont., 50. » N. Y. Code Civ. Pro., s. 2,618.
5 People V. Stout, 3 Park Cr. « Hoyt v. Hoyt, 9 N. Y. St. Rep. ,
Rep. , 670 (N. Y. , Oy. and Ter. , 1858). 731 (N. Y. Supr. Ct. , G. T. ) , affirmed
« Johnsons. Johnson, 14 Wend., 112 N. Y., 493.
636 (overruling s. c. , 4 Paige, 460) ;
WAIVER OF THE PRIVILEGE. Ill
after the forbidden testimony has been in part received without
objection; for that would unjustl}' enable a party to open
the door and get in all he desired and then to close it to the dis-
advantage of his adversary; when the door is once properly
opened the examination may be continued until it is complete,
despite the objection of the party at whose instance it was
begun.'
In Indiana, where there was no objection, it was held that
the evidence should not be withdrawn from the consideration
of the jury or its weight diminished by comments on its value
as matter of law.^
But when such evidence has already been admitted in the
face of objection, it is not necessary for the party to object again,
as nothing is waived by conforming with a rule already- laid
down.^ Where it is apparent that no harm is done to the ob-
jecting party by an improper ruling on the receipt of privileged
communications, no weight will be given to an exception to
such ruling.^
What Constitutes a Waiver of the Privilege. — The stat-
utory provisions as to what constitutes a waiver have been set
forth above. ^ In California it has been held that cross-exami-
nation of the physician by the patient, calling for privileged
matter, is a waiver of privilege." In Indiana it has been held
that consent to disclosure cannot be inferred from the patient's
simply giving the name of his family physician in applying for
a policy of insurance on his life, and that a waiver in such an
application should be evidenced by a stipulation too plain to be
misunderstood.' And a physician's statements of the cause of
his patient's death, furnished to an insurance companj^ in pur-
suance of a stipulation of a policj" that satisfactory proof of
death shall be submitted to the company, are not rendered ad-
missible by that stipulation.*
It has also been held that consent to the evidence of one phy-
sician is no consent that another physician may divulge confi-
1 Hoytv. Hovt, 9 N. Y. St. Rep., sValensin v. Valensin, 14 Pac.
731 (N. Y. Sup'r. Ct., G. T.). Rep.. 87 (Supr. Ct. Cal., 1887).
' Vau Valkenburg v. Van Valken- '' Masonic Mut. Ben. Assn. v.
burp:, 90 Ind. , 433. Beck, 77 Ind. . 208.
' Dilleber v. Home L. I. Co., 69 « Dreier v. Continental L. I. Co.,
N. Y., 256. 24 Fed. Rep.. 670; cf. Breiseumeister
••Loderv. Whelpley, 111 N. Y. , 29. v. Supr. Lodge, etc. , 45 N. W. Rep.,
* Supra, p. 96. 977 (Supr. Ct. Mich. , 1890) .
112 CONFIDENTIAL COMMUNICATIONS — BOSTON.
dential communications ; ' and that the physician cannot testify
that he found no evidence of injury on the examination of his
patient, in order to contradict her;'^ the patient had already
testified as to her condition and what the physician had done,
but not as to anything said to her by her physician; she had
expressly declined to testify concerning- communications except
as to his prescription for her injury, and without asking him
to disprove her assertions the trial Court permitted him to say
that he had found no evidence of injury; this was held to be
error. It has also been held that the taking of a physician's
deposition and filing it, for the purpose of breaking the force of
his testimony in a deposition taken by the opposite party, is
no consent in itself to the reading of the other party's depo-
sition." But when, in an action against a phj^sician for mal-
practice, the patient testifies as to the manner of treatment, the
physician is then at liberty to introduce the testimony of him-
self or another physician as to the facts thus put in issue by
the patient/
In Iowa it has been held that the testimony of a patient re-
garding the condition of his health is not a waiver of privilege,
so as to allow his opponent to introduce the testimony of his
physician to contradict him.^
In Michigan a physician has been allowed to contradict his
patient as to the time when her trouble commenced, but on the
ground that it had not been shown that the information was
necessary to enable him to prescribe." But it has been held that
waiver as to one physician is not waiver as to another regarding
a different time.^
In Missouri, the calling of a physician by the patient as a
witness to testify as to information acquired while attending, is
a waiver.® But offering one physician as a witness is not a
waiver of the privilege with reference to another.^ An appli-
cant for insurance maj^, by an express waiver in his application,
' Penn Mut. L. I. Co. v. Wiler, « Campau v. North, 39 Mich. , 606.
100 Ind. , 93. ' Dolton v. Albion, 24 N. W. Rep. ,
2 Williams v. Johnson, 113 Ind. , 373. 786.
^Mtna L. I. Co. V. Denning, 133 ^ Qj^j-j-jugton v. St. Louis, 89 Mo.,
Ind. , 390. 308 ; Squires v. Chillicothe, 89 Mo. ,
*Lane v. Boicourt, 37 N. E. Rep., 336: Thompson v. Ish, 99 Mo., 160.
1111. niellor V. Mo. Pac. Ry. Co., 14
^McConnell v. City of Osage, 45 S. W. Rep., 758; 16 S. W. Rep.,
N. W. Rep., 550. 849.
WAIVER OF THE PRIVILEGE. 113
make an efficient waiver, binding upon any one claiming under
the contract of insurance. '
In Nevada a waiver has been implied from the testimony of
the patient and her mother, where the patient was an infant
seven years of age." And it was said that the parents of such
an infant may make the waiver.
In New York it has been held that reference to a family
physician when answering questions on an application for in-
surance, is not a waiver ; '' nor is the presence of a third person
in aid of the patient ; ' nor is the bringing of an action for
damages for an injury ; ' nor is the examination of the physi-
cian in a former trial by the opposing party ; " but where the ban
of secrecy is once removed in an action and the information
once lawfully made public, at the instance of the patient, it
cannot be restored, and the disclosure may then be compelled in
any subsequent action ; ' it would seem, too, that a physician
who becomes a witness to his patient's last will and testament
at the patient's request is then subject to a thorough examina-
tion on all points involving thepatient's testamentary capacity.'
Where the patient testified herself and called an attending
physician to prove her physical condition, this was not a con-
sent to the examination of another attending physician, and it
was said that the opposite party by tactics on cross-examina-
' Adrereno v. Mut. Res. F. L. I. in People v. Schuyler, 106 N. Y.,
Co. . 34 Fed. Rep. , 870. 298.
- State V. Depoister, 25 Pac. Rep., * See In re Freeman, 46 Hun, 458,
1000; but see dissenting opinion of in which a will was admitted to pro-
Bigelow, J. ; see also McKinnev v. bate on the concurrence of Learned,
Grand St. R. R. Co., 104 N. Y., 353. J., who held that the relation of
^ Edington i\ Mut. L. I. Co., 5 physician and surgeon was not es-
Hun, 1 (reversed in part by Eding- tablished, and Landon, J. , who held
ton V. Mut. L. I. Co., 67 N. Y., 185, that the request to sign constituted
but affirmed on this point). a waiver ; Williams, J., dissenting,
* Calien r. Continental L. I. Co. , on the ground that the relation was
41 N. Y. Super. , 296 (overrviled on established in the case, and the
another point but affirmed on this waiver could not be assumed with-
in 69 N. Y., 300). out proof of the patient's mental
■* Jones V. Brooklyn, B. & W. E. capacity' to comprehend the waiver;
Ry. Co., 3 N. Y. Supp. , 253. that it was not proper to assume
^ Grattan v. Metrop. L. I. Co., 92 testator's competency to waive in
N. Y. , 274. order to enable the witness to testify
' McKinney v. Grand St. R. R. that the ]iatient was competent to
Co. , 104 N. Y. , 352 ; see criticism of make a will.
this case in Breisenmeister v. Supr. On the analogous case of an at-
Lodge, 45 N. W. Rep., 977 (Supr. torney as witness to a will, see Blnt-
Ct. of Mich., 1890). 'See also Mason ter of Coleman, 111 N. Y., 220 : and
1'. Libbey, 2Abb. N. C, 137;seeun- N. Y. Code Civ. Pro., s. 836, as
answered queries on similar points amended Act 1893, c. 295.
114 CONFIDENTIAL COMMUNICATIONS — BOSTON.
tion could not compel the patient to abandon a privilege which
she refused to waive.' Fish, J., in delivering the opinion of
the Court in the last-mentioned case, said of the operation of
the statute, that it allows the patient to use the testimony
of the attending physician if he thinks his evidence will bene-
fit his case, and to object and exclude it in case he thinks it
will not benefit him ; he may call to his aid the testimony of
any one whose views he approves and exclude that of another
whose testimony might tend to controvert that given with the
consent of the patient ; that in this case the excluded witness
was the best witness and could tell nothing else than the patient
had disclosed if she had told the truth and it would relate solely
to what she and the other physician had described, but that the
Court could not consider whether the statute tended to promote
the cause of justice, and he distinguished McKinyiey v. Grand
Street Railroad Company,'^ on the ground that there the con-
sent had been that the same phj^sician should disclose what
he knew, while here the waiver of the excluded physician's testi-
mony had been constantly withheld.
A decision which seems to be at variance with Record i\
Village of Saratoga Sjjrings is Treanor v. Manliattan Rail-
ivay Company ^'^ where it was said that the patient cannot pro-
mulgate and uncover his maladies and infirmities in court and
keep his physician under obligations to silence, and that he can-
not, to mulct another in damages, inflame a jury with a false or
exaggerated stor}- of his injuries and sufferings and preclude
the phj^sician from making a truthful statement of the case.
But where the patient testifies as to what passed between
him and his physician, the phj-^sician maj' testify on the same
subject, as a waiver is inferred from the circumstances ; for the
reason, that the patient, having gone into the privileged domain
to get evidence on his own behalf, cannot prevent the other party
from assailing such evidence by the onXj testimony available,
and the rule is no longer applicable when the patient himself
pretends to give the circumstances of the privileged interview.*
^ Record v. Village of Saratoga ^ Supra, p. 113, note 7.
Springs, 46 Hun, 448 (Supr. Ct. , ^ 28 Abb. N. C. , 37 (N. Y. Com.
Gen. T., N. Y.). See also Hope u. PL, Gen. T., 1891).
Trov and Lansingburg R. R. Co. , 40 ^ Marx v. Manhattan Rv. Co. , 56
Hun, 438 : Jones v. B. , B. & W. Hun, 575 (N. Y. Supr. Ct. , Gen.
E. R. R. Co., 3N. Y. Supp., 253. T.).
THE EVIDENCE EXCLUDED. 115
The requirement that a physician jEile with a board of health a
certificate of the cause of death does not abrogate the privilege
in a judicial proceeding. '
The Evidence Excluded.
^'Information.^'' — In Arkansas, California, Colorado, Idaho,
Michigan, Minnesota, Missouri, Montana, Nevada, New York,
North Carolina, North Dakota, Oregon, South Dakota, Utah,
Washington, and Wisconsin the privileged matter is character-
ized as information.''
In Arkansas it seems that the information must be a confi-
dential communication J ^ biit in the other States where it has
been necessary to construe the word it has received a broader
interpretation.
In Michigan information is not confined to confidential
communications made by the patient, but includes whatever in
order to enable a physician to prescribe was disclosed to any of
his senses and which in any way was brought to his knowledge
for that purpose;^ it covers a letter written to a physician,"
and matters observed by him ; ® but it does not include infor-
mation acquired by a third person; for instance, the time when
a physician saw his patient may be disclosed by her mother ; '
and the fact of treatment or non-treatment is not information; "
nor are the facts that the physician was the patient's famil}' phy-
sician, and that he attended him professionally; nor are state-
ments of the dates of such attendance and the number of such
visits ; " nor the facts that the phj'-sician has been called upon
to examine and prescribe for a person and that his patient had
told him that she would want him to testify for her in a law-
suit."
In Missouri the statute protects information received from
' Buffalo L. & T. Co. v. Masonic 206 ; Breisenmeister v. Supr. Lodge,
Mut. Aid Assn. , 126 N. Y. , 450. etc., 45 N. W. Rep., 977 (Supr.
2 Supra, p. 98. Ct. Mich., 1890).
» Collins V. Mack, 31 Ark., 684. ' Dalman v. Koning,54 Mich.,32L
The main point of this decision was * Brown v. Mut. L. I. Co. , 05
that the information was not neces- Mich. , 306.
sary ; see irifra. p. 124. * Breisenmeister v. Supr. Lodge,
■* Briggs V. Briggs, 20 Mich., 34. etc., 45 N. W. Rep., 977.
6 Ihid. '° Cooley V. Foltz, 48 N. W. Rep..
^Fraser v. Jennison, 42 Mich., 176.
116 CONFIDENTIAL COMMUNICATIONS — BOSTON.
the patient; but this is not confined to oral communications,
and includes knowledge gained by inspection of the patient's
person.' In Lunz v. Massachusetts Mutual Life Insurance
Company protection was said not to extend to information of
this sort apparent on casual inspection, which any one might
make, nor to symptoms which are obvious before the patient sub-
mits himself to any examination, such as an inflamed face, a
bloodshot eye, alcoholic fumes, or delirium ; nor to facts so su-
perficial that in regard to them no confidence could have been
reposed. But this distinction between hidden and patent facts
is disapproved in Kling v. City of Kansas,'^ and the state-
ment is made that the law does not rest on the confidence im-
posed. Knowledge or communications concerning the cause of
a patient's condition and the extent of his injuries have also
been held to be included in the term information, because the
disclosure of these matters involved the indirect disclosure of
the condition ; ^ but it was said that the physician may testify
as to knowledge acquired independent of communications from
the patient and of examination or inspection made by the wit-
ness for the purpose of treatment.^ As divulging privileged
information, a physician has not been allowed to answer what
his patient's hurts were, why he left a hospital, or whether he
required longer treatment ; ^ and it has also been held that a
physician cannot give his opinion as to the mental condition of
his patient based upon privileged knowledge. °
In New York information comprehends all knowledge ac-
quired by the physician by communication, observation, or in-
spection ; ^ it has been said to extend to all facts which neces-
sarily come to the knowledge of the physician in a given
professional case ; ^ and it includes as well the opinion of the
physician based upon his knowledge as the knowledge itself.*
1 Lunz V. Mass. Mut. L. I. Co. , 8 •* Ibid.
Mo. App., .363; Gartside r. Conn. ^ Corbett v. St. L., I. M. &S. Ry.
Mut. L. I. Co., 76 Mo., 446 (said to Co., 26 Mo. App., 631.
be overruled by 85 Mo., 249 ; see 89 « Thompson v. Ish, 99 Mo., 160.
Mo. , 226, but followed in Tlioinpson ' People v. Stout, 3 Park Cr. Rep. ,
V. Ish, 99 Mo., 160). For an argu- 670.
ment on the distinction between * Edington v. Mut. L. I. Co. , 5
information and communications, Hun, 1 ; s. p. , 67 N. Y. . 185 ; Grattan
see brief of respondent's counsel in v. Met. L. I. Co., 80 N. Y. , 281.
Gartside v. Conn. JMut. L. I. Co. '^ Grattan v. Met. L. I. Co. , 80 N.
'' 27 Mo. App. , 231 (1887) . Y. , 281 ; Van Orman v. Van Orman,
3 Streeter v. City of Breckenridge, 34 N. Y. St. Rep. . 824 (Supr. Ct. , G.
23 Mo. App. , 244. T. ) ; Wilcox v. Wilcox, 46 Hun, 32.
THE EVIDENCE EXCLUDED, 117
The physician cannot disclose the nature of his patient's dis-
ease, whether he learned it by observation or examination or
from what his patient told him ; ' nor can he testify as to what
he told his patient. ' In Edington v. ^tna Life Insurance
Company^ it was said b}^ Judge Earl that the statute was
aimed at confidential communications and secret ailments, and
that it did not extend to matters superficially apparent, such as
a fever, a fractured leg or skull, or raving mania apparent to
all;^ but this view was disapproved expressly in the later case
of Renihan v. Dennin. ^
The privileged information has been said to include knowl-
edge acquired through the statements of others surrounding the
patient/ But it would seem that the fact that a third person
was present during a physician's visit may be shown b}- the
physician, as well as what passed between the patient and the
third person, if it was such information as a layman would have
gathered/ The information from the third person regarding
the patient is protected even though the patient be absent ;" but
not if the third person does not employ the physician, and the in-
formation thus acquired is not necessary to enable the physician
to act in a professional capacity/ It is suggested in one case,
but not determined, that it would be improper for a physician
to state the value of the services of a nurse in attendance upon
his patient, as that would involve a consideration of the con-
dition of his patient; '" but it has been held that a physician can
testify to the fact of a nurse's services/*
But it is information regarding the patient that is privileged,
and therefore a physician may disclose what his patient told
him about another, even though the subject of inquirj^ be the
attitude of the patient toward the other ; '^ and likewise the
physician may disclose what he told his patient about a third
' Sloan V. N. Y. C. R. R. Co.. 45 L. I. Co., 5 Hun, 1 ; see s. c, 67
N. Y. , 125 ; Dilleber v. Home L. I. N. Y. , 185.
Co., 69 N. Y., 256. 'Per Smith, J., in Steele r. Ward,
2 Cahen x\ Continental L. I. Co. , 30 Hun, 555.
69 N. Y. , 300. « People v. Brower, 53 Hun, 217.
3 77 N. Y. , 564. » People v. Harris, 136 N. Y., 423.
•» See also Staunton v. Parker, 19 '" Burlev v. Barnhard, 9 N. Y. St.
Hun, 55. Rep., 587'(Supr. Ct., G. T., 1887).
5 103 N. Y., 573 ; see also Grattan " Pandjiria r. MoQuillen, 37 N. Y.
V. Met. L. I. Co., 80 N. Y., 281. St. Rep., 002 (Supr. Ct., G. T., 1891).
« Grattan v. Nat. L. I. Co. of '^ Hoyt f. Hoyt, 9 N. Y. St. Rep.,
U. S., 15 Hun, 74; Edington r. Mut. 731 (Supr. Ct, G. T., 1887).
118 CONFIDENTIAL COMMUNICATIONS — BOSTON.
person ; ' so also the physician may testify as to family events
in no way connected with physical complaints.^ It has been
held, too, that admissions made by a patient to his physician,
tending to show contributory negligence on the part of the pa-
tient, at a time when the communication could not well have
been made to enable the physician to prescribe, namely, on the
physician's third and last visit, may be proven by the physi-
cian/
The physician may properly testify that he did attend as
physician,^ and that the patient was sick, and he can state
when and how often he attended him, ^ and whether his knowl-
edge was acquired while in professional attendance, ° but it is
open to the Court to determine from the evidence whether it
was so acquired.'
''^Matter Committed.^'' — In Indiana the protection covers
matter committed. It would seem that the use of the word
committed implies confidence and that the protected matter is
only confidential communications; but an earlier statute in that
State applied to "matters confided," and it was held to cover
matters learned b}' observation or examination, or by commu-
nication from the patient, whether learned under an injunction
of secrecy, express or implied, or not ; * and it has been held
that the present law forbids the disclosure of matters learned in
a sick-room, no matter how the knowledge may have been ac-
quired.^
" Confidential Communications." — The laws of Iowa and
Nebraska protect confidential communications properly in-
trusted. The construction put upon the word confided in In-
diana has been shown. In Iowa it has been said that a confi-
dential inquiry for advice to facilitate the commission of a crime
or the infraction of law, is not properly intrusted and is not
privileged;'" but where the advice is sought for a purpose
' Hoyt V. Hoyt, ibid. ^ In matter of Darragh, 15 N. Y.
- In matter of Boury, 8 N. Y. St. St. Rep., 452 (N. Y. Sm-r.).
Rep., 809 (Supr. Ct.. G. T., 1889). ' In matter of Darragh, 52 Hun,
3 Brown v. R. W. & O. R. R. Co., 591 (Supr. Ct., G. T.), see infra, p.
45 Hun, 439. 128.
■* Numirich v. Supr. Lodge K. & L. * Masonic Mut. Ben. Assn. v.
of H. . 3 N. Y. Supp. , 552 (Trial Beck, 77 Ind. , 203.
Term, City Ct. of N. Y., 1889) ; Pat- « Heuston v. Simpson, 115 Ind.,
ten V. U. L. & A. Ins. Assn., 133 62: Penna. Co. v. Marion, 28 N.
N. Y., 450. E. Rep., 973.
5 Patten v. United L. & A. Ins. '° Guptill v. Verback, 58 Iowa, 98.
Assn., 133 N. Y., 450.
THE EVIDENCE EXCLUDED. 119
which maj'" or may not be lawful, the presumption is that it is
lawful, and the communication is privileged.' It has been said
that whether or not a physician treated a person for a particular
disease, is not a confidential communication.^
The word confidential is not narrowly construed, for a phy-
sician has been prevented from disclosing whether his patient
said that a car was in motion when he was injured, because the
injury would be more severe if in motion ; ^ and the fact that
the physician's pai-tner was present does not remove the seal of
secrecy, or permit the partner to testify.^
" Communications.^'' — In Ohio and Wyoming commit ni ca-
tions are -privileged ; and in Kansas and Oklahoma communi-
cations with reference to a physical or supposed physical disease
and any knowledge obtained by a personal examination of a
patient. It does not appear whether a narrower construction
would be given to the term communications than to the term
information; but it would seem not, if a person deprived of
speech is to be protected,^ or if the term communications is
not to be construed as meaning oral communications.
''From the Patient; by the Patient." — The former quali-
fying terms are used in the statutes of Arkansas, Indian Terri-
tory, and. Missouri ; the latter in the statutes of Kansas and
Oklahoma. The liberal interpretation put upon this term in
the Missouri law has already been shown." The law of the
Indian Territorj?^ is adopted from Arkansas.' The statute is
stricth^ construed in Arkansas,' but this term does not seem
to have received interpretation.
" Advice."— The laws of Indiana, Ohio, and Wyoming ex-
pressly cover the physician's advice. In New York it is in-
competent for the physician to disclose what he told his patient ; "
but advice to a patient concerning a third person is not privi-
leged.'"
The Relation of Physician and P«f?enf.— Under each of the
' Guptill V. Verback, 58 Iowa, 98. in brief for respondent. Gartside v.
-'McConnell v. City of Osage, 45 Conn. Mut. L. I. Co., 76 Mo., 446.
N. W. Rep., 550. ^ Supra, p. 115.
3 Raymond v. Burlington, C. R. & ■" Act of Congress, May 2d, 1890,
N. Ry. Co., 65 Iowa, 152. c. 182.
4 ihid. " Collins V. Mack, 31 Ark.. 684.
^ See argument in Edington v. ^ Cahen v. Continental L. I- |~"o..
Mut. L. I. Co., 67 N. Y., 185. See 69 N. Y., 300: see Grattan v. Met.
argument for difference between L. I. Co., 24 Hun. 43.
information and communications '" Hoyt r. Hoyt, 112 N. Y., 49d.
120 CONFIDENTIAL COMMUNICATIONS — BOSTON.
statutes, the relation of physician and patient must have existed
at the time the information was acquired. In those cases where
the relation is established by contract and is recognized by both
physician and patient as existing, no difficulty arises in deter-
mining that it does exist. It is in those cases where some one
of these elements is lacking that the difficulties are met. In
California it has been held that the relation exists where a phy-
sician attends and prescribes for a person, notwithstanding he
was employed by another, who seeks to disclose the evidence.*
In Michigan, where the physician was employed by direction of
the prosecuting attorney to examine the defendant in jail, and
so notified the defendant at the outset of the examination, and
he submitted voluntarily to a personal examination, and there
was no intention to prescribe or to act as the defendant's phy-
sician, it was held that the relation did not exist, and that the
physician could testify as to the defendant's physical condition."
In one New York case it has been said that the relation is
one of contract, and that the test is whether the physician would
be chargeable with malpractice or negligence for failure to ad-
vise or prescribe in case the alleged patient were in urgent need
of it at the time.^ But the decisions of the Court of Appeals
extend the privilege to cases where this test would lead to a
different conclusion.^
Where the physician to a county jail was called in to attend
a prisoner and examined him, though there was no prescription
at the time, but it appeared that the doctor told the prisoner
what he should prescribe, and subsequently two phj^sicians
came to see the prisoner at the instance of the coroner and ex-
amined him as they would have examined one of their patients,
though they did not prescribe and had no conversation about a
prescription, it was held that the prisoner had, under the circum-
stances, reason to suppose that the relation of physician and pa-
tient did exist between him and all three of the physicians, and
that their testimony as to what they learned on such visits
should have been excluded ; and the rule is thus stated : when-
ever the patient has reason to suppose that the relation exists
and does in fact and truth so suppose, in a case where the phy-
' Freel v. Market St. Cable Ry. Freeman, 46 Hun, 458 (Supr. Ct. ,
Co., 31 Pac. Rep., 730. Gen. T., 1887).
- People V. Glover, 71 Mich., 303. ^ Renihan v. Dennin, 103 N. Y.,
^ Per Learned, J. , In matter of 573 ; and cases in notes following.
THE EVIDENCE EXCLUDED. 121
sician attends under circumstances calculated to induce the
opinion that his visit is of a professional nature, and the visit
is so regarded and acted upon by the person attended, the
relation of physician and patient contemplated by the statute
may fairly be said to exist/
But the fact that it is the duty of a physician to prescribe
for a person in case of need, does not constitute the relation,
though the position of the physician gives him the opportunity
to observe such person ; so, therefore, a jail physician was not
precluded from testifying as to what he had observed of a pris-
oner, where it did not appear that he Jiad ever attended the
latter in a professional capacity or had ever been called on to
attend him/
It would seem, however, that where it is the duty of a phy-
sician to attend a person in a professional capacity or to acquire
knowledge concerning him in such capacity, he cannot dis-
close information actually acquired in the performance of his
duty. It has been said that a medical attendant at an in-
sane asylum cannot testify as to the mental condition of an in-
mate ; ' and that a physician employed in a hospital to notice
and enter in its records the arrival and condition of the patients
coming in, cannot testify as to information so acquired.^
It is immaterial that another person employs the phj^sician
to examine the patient, and to report to the employer, and that
the person examined does not appear to desire any knowledge
as to his condition; if the examination is made as a professional
act, the relation of physician and patient is established between
the physician and the person examined, even though it be the
only interview.^
And in a case where the public prosecutor sent a physician
to a person for the purpose of making a professional examina-
tion, so as to obtain evidence against another person charged
with crime, and the person examined accepted the services of
1 People V. Stout, 3 Park Cr. ^ In matter of Baird. 11 N. Y. St.
Rep., 670 (N. Y. Oy. andTer., 1858) ; Rep., 263 (N. Y. Supr. Ct.. Cham-
see Grossman r.Siijneme Lodge, etc. , bers, 1887, per Donohue, J.).
6 N. Y. Supp., 821 (Gen. T. Supr. * See 28 Abb. N. C. 55. note.
Ct. , 1889), visiting- physician at a ^ Grattan v. Met. L. I. Co.. 24
hospital attending out of curiosity Hun, 43 (Supr. Ct., Gen. T., 1881) ;
with regular plivsician. 92 N. Y., 274.
•^People V. S^lnlvler, 106 N. Y.,
298, affirming 43 Hun, 88.
122 CONFIDENTIAL COMMUNICATIONS — BOSTON.
the physician in a professional character, it was held that h&
could not testify as to the results of his examination.'
But where the district attorney sent a physician to jail to
make an examination of a prisoner's mental and physical con-
dition, and he made such examination, and it did not appear
that he prescribed for or treated the prisoner or that the prisoner
accepted his services, the opinion of the physician as to his
mental condition was admitted. "^
Where the defendant employed a physician to examine the
plaintiff, and he went as coming from the defendant for that
purpose, and examined i;he plaintiff in the presence of his attend-
ing physician, but not as the plaintiff's physician and not for
the purpose of prescribing, the relation of physician and patient
was not established.'' Where a physician examined the plain-
tiff at the instance of the plaintiff's physician, but it was not
shown that he was requested or expected to treat or prescribe
or to advise in respect to either, or that he did either, it was
held that the relation was not established;'' but a physician
consulted by the patient's regular physician for the purpose of
advice concerning his treatment is a physician contemplated by
the statute ; ^ as is also the partner of a physician who is pres-
ent during a conference with the patient or who overhears such
a conference." Attendance at the patient's house is not con-
templated as essential by the law, and it makes no difference
where the examination is conducted.'' But where the physi-
cian was also a county clerk and the alleged patient was an at-
torney, and the consultation took place in the clerk's office and
consisted of an examination of an eruption on the skin, which
was made gratuitously and without a prescription being made
or asked for, the relation was held not to have been established,
notwithstanding that the clerk made use of his knowledge and
learning as a physician in forming his opinion, and that it was
1 People V. Murphy, 101 N. Y., R. Co., 57 Hun, 76 (Supr. Ct., Gen.
126. T., 1890).
2 People V. Kemmler, 119 N. Y., ^ Reuihan v. Dennin. 103 N. Y.,
580; People V. Sliney, 187 N. Y., 573; Jones -y. B., B. & W. E. Ry.
570. Co., 3N. Y. Supp., 258.
^ Heath v. Broadway & S. A. Ry. ^ ^^tna L. I. Co. v. Deming, 123
Co., 8 N. Y. Supp., 863 (Super. Ct., Ind., 390 ; Raymond v. B., C. R. &
Gen. T., 1890). N. Ry. Co., 65 Iowa, 153.
* Henry t). N. Y., L. E. & W. R. ■ Grattan v. Metr. L. I. Co., 24
Hun, 48 (Supr. Ct., Gen. T., 1881).
THE EVIDENCE EXCLUDED. 123
in confidence that he possessed medical skill that the person re-
quested the examination.'
It does not follow that the relation once established continues
always ; the secrecy growing out of the relationship, as to knowl-
edge then acquired, always continues unless properly waived;
and the physician will not be allowed to testify in regard to
matter Avhich is partly the result of such information, though an-
other part may have been acquired independent of the relation ; ^
but where it is clear that the matter desired is independent of
the relation of physician and patient, such evidence is admissi-
ble if otherwise competent.^ ,
'■' Professional Capacity.'' — The States in which the statutes
limit the privilege to information acquired in a professional ca-
pacity have been enumerated." As to what constitutes a pro-
fessional capacity, the discussion of the facts that establish the
relation of physician and patient, and of the information neces-
sary to enable a physician to prescribe or a surgeon to act, makes
it unnecessary to discuss at length the meaning of this phrase.
The decision in Lunz v. Massachusetts Mutual Life Insurance
Companij ^ would make it appear that in Missouri information
apparent on a casual inspection which any one might make is
not received in a professional capacity, but this idea is disap-
proved in the later case of Kling v. City of Kansas." Infor-
mation acquired by the physician b}' observing the patient on
the street anterior to his employment as a physician is not re-
ceived by him in a professional capacity.'
In New York, where the physician had not seen the patient
before or since his interview for the purpose of treatment, and
he was asked what his opinion was, based on a general sight of
the man before the examination, it was held that the physician
could not properly answer, as all the information upon which
'Edingtont). ^tna L. I. Co., 13 ham v. Gott, 3 N. Y. Supp., 518
Hiin, 543 (Supr. Ct., Gen. T., 1878), (Supr. Ct., Gen. T., 1889).
affirmed 77 N. Y., 564. The broad =* Stowell v. American Co-op.
expressions of this latter case were Assn., 23 N. Y. St. Rep., 706 (Supr.
disapproved in Renihan v. Dennin, Ct., Gen. T., 1889).
103 N. Y., 573, but it does not appear ■* Supra, p. 98.
that this point was not properly de- * 8 Mo. App., 363.
cided. «27Mo. App., 231.
2 In matter of Darragh, 52 Hun, ' (rartside v. Conn. Mut. L. I. Co.,
591 (Supr. Ct., Gen. T., 1889), 15 N. 76 Mo., 446: see also Burlev v.
Y. St. Rep., 452 (N.Y. Surr.) : Brig- Barnhard. 9 N. Y. St. Rep., 587 (N.
Y. Supr. Ct., Gen. T.).
124 CONFIDENTIAL COMMUNICATIONS — BOSTON.
the opinion would be based must have been acquired in a pro-
fessional capacity ; ' but in another case a physician was per-
mitted to express his opinion as to the mental condition of a
patient whom he had seen at various times when not in attend-
ance, excluding from his mind any knowledge or information
obtained while acting as her medical attendant and confining
his answer to such knowledge and information as he had ob-
tained by seeing her when not his patient.^ It has been said
that where information is not such as is obtained on sight by any
person, but by removing clothing and by percussion and listen-
ing to the action of the lungs, these are professional acts and
the information may be considered as obtained professionally.*
It has been said that information received in a professional
capacity involves a decision, though it may be negative ; and
that signing as witness to a will is not a professional act.^
Matter Necessar^y to Enable a Physician to Prescribe or
a Surgeon to Act. — A list of those States whose laws limit the
privilege to matter necessary to enable the witness to prescribe
or act for the patient is to be found in another place. ^
In Arkansas, where six hours after deliver}", the patient
stated to her physician who attended at accouchement, that she
had never been engaged to marry and never had promised to
marry, the statements were held not to be necessary to enable
the physician to act.''
In Iowa, a physician who had treated a patient for injuries
was not allowed to testify whether his patient told him that the
car on which he was injured was in motion at the time, because
as the injury would be likely to be more severe if the car was in
motion, that information was necessary to enable the physician
io prescribe.'
In Michigan, a phj^sician was allowed to contradict his pa-
tient as to when her trouble commenced, in the absence of evi-
dence that such information was necessary to enable him to act.®
Where a physician was asked whether he treated a person for
'Grattan v. Metr. L. I. Co., 92 * Per Learned, J., In matter of
N. Y., 274. Freeman, 46 Hun, 458.
2 Fisher v. Fisher, 129 N. Y., ^ Supra, ]). ^?<.
654. « Collins v. Mack, 31 Ark., 684.
^Grattan v. Metr. L. I. Co., 'Raymond v. B.. C. R. & Nor.
34 Hun, 43 (Supr. Ct., Gen. T., Rv. Co., 65 Iowa, 152.
1881) . '» Campau v. North, 39 Mich., 606.
THE EVIDENCE EXCLUDED. 125
typhoid fever, and he answered that she was not so diseased,
it was held that this information was not necessary to enable
him to act.' And the same was held to be true where a phy-
sician examined a prisoner at the jail and testified that he was
diseased, the prisoner having been notified at the time of the
examination that it was made by direction of the prosecuting
attorney and there being no intention to prescribe or act for the
prisoner. "^ But it has been stated that all disclosures by a pa-
tient to a phj^sician respecting ailments are privileged whether
necessary to enable the physician to prescribe or not.^
In Minnesota, a physician was allowed to disclose statements
as to suffering made by his patient, but not for the purpose of
enabling him to prescribe or act.^
In Missouri, it has been said that information as to the way
in which an injury was inflicted is of the greatest necessit}^ for
successful treatment ; and that it is information which physi-
cians universally demand and receive.^ In another case, with
reference to the cause of a patient's condition, it was said that
while knowledge of the cause may not be necessary, the disclos-
ure of the cause cannot be made without a disclosure of the
condition, and that as a medical person cannot tell indirectly
what he is forbidden to tell directly, the physician's evidence of
the cause is inadmissible.'' In another case it was said that
any information, necessarily coming to a physician in order to
treat his patient, is to be regarded as necessary information
though unimportant, and that the test is how it was acquired, not
whether it could have been acquired in a different way, and
therefore it was incompetent for a physician to testify that his
patient was drunk when he treated him.'
In New York, in an earlj'^ case,* where a man consulted a
physician with reference to committing an abortion and told
him that a certain woman was pregnant by him, this admission
was said not to be essential to enable him to prescribe, even if
' Brown 1). Metr. L. I. Co., 65 ^ Streeter ■?;. City of Breckenridge,
Mich., 306. 23 Mo. App., 244.
2 People -y. Glover, 71 Mich., 303. ' Kling v. City of Kansas, 27 Mo.
^ Breisennieister r. Supr. Lodge, App., 231.
etc., 45 N. W. Rep., 977 (Supr. Ct. « Hewitt v. Prime, 21 Wend.. 77
Mich., 1890). (N. Y. Supr. Ct. of Judic. 1839).
•* Jacobs V. Cross, 19 Minn., 523. See Edinp:ton v. Mut. L. I. Co., 67
5 Norton v. City of Moberly, 18 N. Y., 185.
Mo. App., 457.
126 CONFIDENTIAL COMMUNICATIONS — BOSTON.
the relation of physician and patient were considered established ;
but this seems to be at variance with the later case of People v.
Brower,^ where the accused consulted a physician with refer-
ence to the treatment of a woman on whom he had attempted to
commit an abortion, and admitted that he had done so, and the
physician was not permitted to disclose it. A broader view
is now taken of the word necessary. It has been held by the
Court of Appeals that a physician could not testify that his
patient had a venereal disease while under his care as a physi-
cian, the presumption being that he learned it for the purpose
of prescribing;^ and again, that it is assumed from the rela-
tionship that the information would not have been imparted ex-
cept for the purpose of aiding the physician to prescribe." But
this presumption does not attach to information regarding a pa-
tient, communicated by a third person."
Where a person went to a physician to call for medicine,
and it appeared that he was not consulting for himself and was
not representing any one else who needed or desired medical
assistance, the physician was allowed to testify as to a conversa-
tion which took place at that time.^
In the case of Edington v. ^tna Life Insurance Company,"
it was said that before the exclusion, the facts on which it is
justified must appear in some way, and the Court must know
somewhat of the circumstances ; from the opinion it is easy to
infer that it is only confidential communications and informa-
tion as to secret ailments which may be regarded as necessary
within the statute ; but this view was overruled in Grattan v.
Metropolitan Life Insurance Company,'' andthere it was dis-
tinctly stated that it is enough that the witness acquired the
information in his character as physician and in the due and
proper exercise of his calling, and that it is not incumbent on
the person objecting, to show by formal proof that the informa-
tion was necessary to enable the witness to prescribe. In this
case the examination of the witness was as to the cause of his
' 53 Hun, 217 (Supr. Ct., Gen.T., * People v. Harris, 136 N. Y.,
1889) . 423.
^ Sloan V. N. Y. C. R. R. Co., 45 ^ Babcock v. People, 15 Hun, 347 ;
N. Y., 125. see also People v. Harris, supra.
3 Edington v. Mut. L. I. Co.. 67 « 77 N. Y., 564; see also s. p., 17
N. Y., 185. See also People v. W. D., 566.
Stout, 3 Park Cr. Rep., 670 (N. Y. ' 80 N. Y., 281.
Oy. andTer.. 1858).
THE EVIDENCE EXCLUDED. 127
patient's death, and the argument urged upon the attention of
the Court was that information regarding the cause of death
could not be necessary to enable the physician to prescribe, as
the utility of the prescription ceased with the death and before
the cause was determined ; but the Court held that the privilege
attached, because, although the death was the result of the cause,
the facts constituting the cause were learned while the physician
was attending the living patient in a professional capacity and
from the symptoms manifested at that time.
In consonance with the decision in Grattanv. Metropolitan
Life Insurance Company,^ it has been held that a phj-sician
who amputated a patient's leg could not testify as to its condi-
tion at the time it was amputated."
The fact that the physician does not prescribe does not de-
feat the privilege ; if the information is acquired in the course
of professional employment the statute operates, for the decision
that neither advice nor medicine is needed is a professional act
within the spirit of the law.^ Medicus optimns, medicanien-
tum minimum, is the maxim used in another case to illustrate
this point. "
But it cannot be predicated as matter of law that a physician
cannot exclude from his consideration facts learned or opinions
formed while attending as physician ; therefore he can testify
as to his opinion on hypothetical facts which might be deemed
to relate to another person as well as the patient ; and where
the physician testified that he could so form an opinion, his
opinion of such assumptions was held to be admissible in evi-
dence as expert testimony.^
But it is not all information which will be presumed to have
been necessary to enable the physician to act; it seems that
where the knowledge is such that it is evidently immaterial to
the physician's decision, it will be admitted. Such a case is
that of Hoijt V. Hoyt,' where the testimonj^ of physicians was
admitted to show the attitude of their patient toward his daugh-
' 80 N. Y., 281. ' People v. Sclmyler, 43 Hun. 88,
'•'Jones V. Brooklyn, Bath and affirmed 106 N. Y.,' 298.
West End Rv. Co., 3N.Y. Supp., 253 « 9 N. Y. St. Rep., 731 (Supr. Ct..
(City Ct. of Brooklyn, Gen. T., 1888). Gen. T.), affirmed 112 N. Y., 493.
^ Grattan v. Metr. L. I. Co., 24 Although this point was discussed,
Hun, 43 (Supr. Ct.. Gen. T., 1881). the case was really decided on the
■* In matter of Freeman, 46 Hun, ground that the ohjector had lost
458. her right to object if she ever had it.
128 CONFIDENTIAL COMMUNICATIONS — BOSTON.
ter and their advice to him concerning her, the evidence being
for the purpose of showing the testator's opinion and not th&
physicians'. It has also been held that a statement made by a
patient on the physician's last visit as to what occurrred at the
time the patient was injured, tending to show contributory neg-
ligence, was not necessary information.' And a physician's
evidence of the declaration of his patient as to making a will
and the doctor's advice on that subject have been admitted.^
THE PROVINCE OF THE COURT IN DEALING WITH THE
PRIVILEGE.
All questions of the competency of evidence are solved hy
the Court and not by the jury.^ The facts establishing the
privilege are presented to the Court for its consideration. In
Iowa it has been held that a fair trial demands that it should
not be made to appear to the jury in an action that the patient
is reluctant to waive his privilege, and that therefore the sub-
ject-matter of waiver has no place in the taking of testimony
except when introduced by the party permitted to make it, and
the Court should not allow the patient to be asked to answer
under oath whether he is willing to waive his privilege.^
Whether it is the duty of the Court to enforce the privilege
where it is apparent and the patient is not present to object, is
a question that seems to be variously regarded. In Indiana a
court has refused a new trial for newly discovered evidence of
the privileged sort, on the ground that if objection were made
on the new trial it would be rejected.^ But where the evidence
of a physician to contradict another physician, who was witness
to a will, was received without objection, it was said that it
should not be withdrawn by the Court from the consideration
of the jury or its value commented on as matter of law.*
In Michigan, it has been said that a commissioner, whose
ordinary duty is to take all evidence offered, should refuse to
take this privileged evidence ; and that it should be stricken out
1 Brown v. R. W. & O. R. R. Co., •* McConnell v. City of Osage, 45
45 Hun, 439 (Supr. Ct., Gen. T.). N. W. Rep., 550.
2 In matter of O'Neil, 26 N. Y. ^ Harris v. Rnpel, 14Ind., 209.
St. Rep., 342 (N. Y. Surr., 1889) . « Van Valkenberg v. Van Valken-
3 Taylor, Ev., s. 2; Greenleaf, berg, 90 Ind., 433.
Ev., s. 2.
THE PROVINCE OF THE COURT. 129
without motion bj^ the judge when returned by the commissioner,
and that the physician should not be allowed to violate the priv-
ilege. ' It has also been held that an order for the compulsory
physical examination of a person by a physician for the purpose
of testifying should not be granted, and that evidence so obtained
should be stricken out, but on the ground that it was a violation
of personal liberty, rather than of statutory privilege.^
But in New York it has been held that where a person vol-
untarily in an action exhibits an injured part as evidence, the
adverse party is entitled to follow it up by a personal or profes-
sional inspection of the injured part.'
In Missouri, it has been said that the physician should be
told that he is not at liberty to testify as to ])rivileged informa-
tion.^
In New York, in an early case in chancery, the chancellor
said that a master was wrong in supposing there was legal evi-
dence before him, where a phj^sician had given evidence privi-
leged under the statute ; ^ but this decision was reversed on ap-
peal, the Court of Errors saying that as no objection was made
before the master by a partj", the evidence was competent and
legal." This question seems to have been settled in New York
by the decision in Hoyt v. Hoy f, '' tliEit the law does not prohibit
the examination of a physician but it prohibits the evidence be-
ing received in the face of objection, so that if no objection is
made by a party it is not the province of the Court to reject the
evidence.
Where it appears that privileged information was improperly
admitted, it is not ground for reversal on appeal if it is appar-
ent that the appellant was not injured by its reception.*
Where the Court is not empowered to reject the evidence of
' Storrs V. Scougale, 48 Mich., ■» Lunz D. Mass. Mut. L. I. Co., 8
387; see also Dolton v. Albion, 24 Mo. App., 363.
N. W. Rep.. 786. ^ Jolmson v. Johnson, 4 Paige, 460
-Page V. Page, 41 Mich., 88; see (Chancery, 1834) ; see also Hanford
also McQuigan v. D. & L. R. R. Co., v. Hanford, 3 Edw. Ch., 468 (Vice
129 N. Y., 50; Roberts v. Ogdens- Chan., 1841).
burgh, etc., Ry. Co., 29 Hun, 158; « 14 Wend., 636 (Ct. of Errors.
McSwyny v. Broadway & 8. A. Ry. 1835) .
Co., 7 N. Y. Supp., 459; and cf. ' 112 N. Y., 493.
N. Y. Code Civ. Pro., s. 873, as -* Edingtoij v. yEtua L. I. Co.. 17
amended Act 1893, c. 723. W. D., 1883 (N. Y. Supr. Ct., Gen.
■^Winner v. Lathrop, 67 Hun, T.) ; Hoyt v. Hoyt, 9 N. Y. St.
511. Rep., 731 (Supr. Ct., Gen. T.), af-
firmed 112 N. Y., 493.
9
130 CONFIDENTIAL COMMUNICATIONS — BOSTON.
its own motion, the objection upon which it can reject is the
objection of a party to the suit, and doubtless of the patient,
but not of the physician.' But because of the privilege, it has
been held that a phj^sician will not be ordered to turn over his
books of account to a receiver appointed in proceedings supple-
mentary to an execution on a judgment against him.^ Nor
will examination of his books of account before trial be com-
pelled/
It is the province of the courts, however, to enforce the law
and not to legislate b}^ grafting exceptions upon it." They have
refused therefore to except, by judicial decision, from the opera-
tion of the law, criminal proceedings, testamentary causes, evi-
dence' of crime in civil actions, cases of lunacy and habitual
drunkenness and fraud, ^ in all of which it was urged in argu-
ment without effect that the administration of justice was im-
peded by the privilege; but where the spirit of the law was
violated by an enforcement of its letter and the privilege made
a cloak to shield the murderer of the patient, it was held to be
inapplicable." The courts have also refused hj mere judicial
decision to limit the privilege to the life of the patient.'
THE EFFECT OF ENFORCING THE PRIVILEGE.
The courts are not warranted in admitting incompetent evi-
dence in order to prevent the failure of justice by the exclusion
of the privileged testimony. A letter written by a physician is
inadmissible as evidence of the privileged facts which it states ;*
and a certificate of the cause of death, required by law to be
signed by the physician and filed, is not admissible to prove
the cause of death in an action in which the physician cannot
testify.^
The making of the objection does not raise a presumption
'^ Johnson v. Jobnson, 14 Wend., Y., 573; Record'?;. Village of Sara-
636; Babcock v. People, 15 Hun, toga Springs. 46 Hun, 448 ; Lodert).
347; Valensin v. Valensin, 14 Pac. Whelpley, 111 N. Y., 239.
Eep.,87 (Supr. Ct. Cal., 1887). ^ Siqjra, p. 101 et seq.
2 Kelly V. Levy, 8 N. Y. Supp., ^ Supra, p. 101 et seq.
849 (G. T. N. Y. City Ct., 1890). ' Sujira, p. 10>7.
^Mott ■». Consumers' Ice Co., 3 ^ Grattan -y. Nat. L. I. Co. of U.
Abb. N. C, 143 (N. Y. Com. PL, S., 15 Hun, 74.
Sp. T., 1877). s Buffalo L. T. & S. D. Co. v.
^Edington v. Mut. L. I. Co., 5 Knights T. & M. M. Aid Assn., 126
Hun, 1 ; Renihan v. Dennin, 103 N. N. Y., 450.
THE EFFECT OF ENFORCING THE PRIVILEGE, 131
against the person making it.' In Iowa it has been held that
the patient should not be interrogated under oath as to whether
or not he will waive his privilege, for the jur}^ ought not to be
prejudiced against him by any show of reluctance/ In Michi-
gan, however, it has been held that a patient's failure to pro-
duce his physician as a witness is a legitimate fact for the
jury to consider.^
THE CHARACTER AND "WEIGHT OF THE EVIDENCE TO
SUSTAIN THE OBJECTION.
Where the objection is made, the burden of proof to estab-
lish the grounds of privilege is upon the person objecting."
In Missouri it has been said that the statement of the physician,
that he cannot separate his impressions received in his relation
of physician from those received at other times, is not in itself
sufficient to justify the exclusion of his evidence ; that the facts
themselves must appear to the Court, and it might be developed
on proper cross-examination that discrimination could be made. ^
But it would seem that because of the necessarily delicate
nature of the inquiry, to avoid disclosing what the statute for-
bids, the burden is overcome with slight evidence, and infer-
ences and presumptions are freely indulged in aid of the privi-
lege; for instance, where the physician was not permitted to
answer whether he did converse with his patient about an in-
jury, or whether he made an examination with reference to it,
it was urged that the objection was prematurely made, but it
was held that the fact that the patient consulted a physician on
the occasion to which the inquiry related, when considered with
the nature of the questions, justified the exclusion in the absence
of other proof. ° But the physician may testify that he did
lEdin^ton v. Mtna L. I. Co., 13 Rep., 706 (N. Y. Supr. Ct., Gen.
Huu, 543 ; see Grattau v. Nat. L. I. T.) ; Henry v. N. Y., L. E. & W. R.
Co. of U. S., 15 Hun, 74. R. Co., 57 Hun, 76 (N. Y. Supr. Ct.,
nicConnell v. City of Osage, 45 Gen. T.) ; Edington v. MirwL L. I.
N. W. Rep., 550. Co., 77 N. Y., 564; Gartside v.
^Cooley V. Foltz, 48 N. W. Rep., Conn. Mut. L. I. Co., 8 Mo. App..
176. 592.
•i People V. Schuyler, 43 Hun, 88 * Gartside i). Conn. Mut. L. I. Co.,
(N.Y. Supr. Ct., Gen. T.), affirmed 8 Mo. App., 592.
106 N. Y., 298 ; Stowelly. American « Feeny v. Long Island R. R. Co.,
Co-operative Assn., 23 N. Y. St. 116N. Y., 375.
132 CONFIDENTIAL COMMUNICATIONS — BOSTON.
attend his patient as physician ; ' and he may answer the ques-
tion whether the information was necessary to enable him to
act in his professional capacity ; ' for while his testimony on
that point is not conclusive, and the Court uses its own judg-
ment in reaching a determination, his testimony is competent
evidence. ^ He may also testify that a person was ill and was
his patient, that he attended as physician, and he can state when
he attended and how many times.*
It has been said that where the evidence justifies the con-
clusion that information regarding the patient is acquired
while attending in a professional capacitj^, it is not essential to
shoW by formal proof that the information was necessary.^
THE RIGHTS AND DUTIES OF THE PHYSICIAN WITH REF-
ERENCE TO THE PRIVILEGE.
The privilege established by law is a rule of evidence, and
not a regulation of a physician's general conduct outside of a
proceeding in which rules of evidence are applicable.' The
courts have, however, not hesitated to intimate that it is a phy-
sician's duty to observe the same secrecy in his general walk
and conversation. '
The physician maj'' testify as an expert on hypothetical ques-
tions submitted to him regarding facts which might be equally
true of any other person than his patient, and excluding from
his consideration privileged knowledge.* And he may also
testify as to matters which came to his knowledge before or
after or independent of his employment as physician,^ or which
were immaterial to his acting in a professional capacity, and as
» Numirich v. Supr. Lodge K. & « Buffalo L. T. & S. D. Co. v. K.
L. of H., 3 N. Y. Supp., 553 (Trial T. & Mas. 3Iut. Aid Assn., 126 N.
Term, City Ct. of N. Y., 1889) ; see Y., 450.
also supra, p. 115. '' Harris v. Rupel, 14 Ind., 209;
^ Herrington v. Winn, 60 Hun, Sullings v. Shakespeare, 46 Mich.,
235 (Supr. Ct., Gen. T., 1891). 408; Storrs v. Scougale, 48 Mich.,
3 In matter of Halsey, 29 N. Y. 387 ; Buffalo, etc., Co. v. Knights T.
St. Rep., 533 (N. Y. Surr., 1890) ; & Mas. Mut. Aid Assn., 126 N. Y.,
of. Matter of Darragh, 52 Hun, 591. 450.
4 Patten v. United L. & A. Ins. » Corvell v. Stone, 62 Ind.. 307;
Assn., 133 N. Y., 450. People ^t;. Schuyler. 43 Hun, 88, af-
5 Brigham v. Gott, 3 N. Y. Supp., firmed 106 N. Y., 298.
518 (Supr. Ct., Gen. T., 1889); ^ Supra, -p. 123.
supra, p. 124.
THE RIGHTS AND DUTIES OF THE PHYSICIAN. 133
to which his patient could have had no reasonable ground for
believing that they were necessarily disclosed in order that the
physician might so act.' It is the patient's privilege and not
the physician's; and, therefore, the physician is not absolutely
incompetent as a witness, and has no right to refuse to testify."
But where he is a party he may object and then he will not be
forced to disclose his patient's confidence.^
In Indiana it has been held that where the patient testifies
in an action against his physician for malpractice the phj'sician
is then at liberty to testify or to introduce any other witness to
testify concerning the matters in controversy.^
In Michigan, a physician who was plaintiff in a libel suit
was not permitted to insist upon the privilege to prevent the
disclosure of his maltreatment of his patient or what other
physicians had discovered with regard to it by visits to his
patients. '
The measure of the physician's exemption and liability in
testifying is the language of the statute, and not his idea of his
dutj^ to his patient or the patient's injunctions of confidence or
secrecy."
In some of the States there are statutory provisions entitling
physicians to sue for compensation for their professional ser-
vices.' The statutes regarding privileged communications are
to be construed together with these. There seems to be no
reason whj- a physician's right of action for his services and
medicines should not survive the prohibition of his evidence;
but it would seem that he cannot as a witness in such an action
testify regarding privileged matter. But he can prove it by
other witnesses.'
' Supra, p. 119. « Grattant). Metr. L. I. Co.. SO N.
''Penn Mut. L. I. Co. v. Wiler, Y., 281.
100 Ind., 92. Valeosint). Valensin, '' See p. 137, this volume, for tlie
14 Pac. Rep., 87 (Supr. Ct. Cal., medical laws of the several States
1887) ; cf. In re Hannah, UN. Y. and Territories ; for history of pliy-
St. Rep., 807. sician's right of action for services.
^ Mason v. Libbey. 2 Abb. N. C, see Graham v. Gautier, 21 Tex.,
137; Mott V. Consumers' Ice Co., 2 117; see Wood v. Munson. 70 Hun.
Abb. N. C, 143. 468. In Georgia and Alabama a
^Lane"?). Boicourt, 27 N. E. Rep., physician's books are evidence in
1111; see also Winner v. Lathrop, such actions. Code Ala., 18SG, s.
67 Hun, 511 (N. Y. Supr. Ct., G. T.) . 2,777 ; Code Ga., 1882, s. 3,777.
" Scripps v. Foster, 41 Mich., 742. * Kendall v. Grey, 2 Hilt., 300.
134 CONFIDENTIAL COMMUNICATIONS — BOSTON.
THE RESULT OF THE LEGISLATION.
It is doubtless due to considerations of public policy that the
statutes changing the common-law rule have been enacted;' but
they have not proved an unalloyed benefit, and some of their
features have brought about conditions which in some cases have
embarrassed the administration of justice. The law in New York
ma}^ be taken for illustration ; it formerly cut off the safest means
of ascertaining the mental condition and competency of a testa-
tor ; ^ it now precludes a physician from disclosing the condition
of his patient who is a lunatic or habitual drunkard/ though it
be the most satisfactory evidence ; it shuts out much testimony
tending to show fraud in insurance cases ;* it precludes a phy-
sician from stating the cause of his patient's death, ^ though there
is no longer any secrecy connected with it, for the law makes it
the duty of the phj^sician to make, for filing with the local board
of health, a certificate of the probable cause of the death of a
patient.^ It has been the subject of much adverse criticism,'
but all such considerations are properh' to be addressed to the
legislature and not to the courts. It seems to be the most far-
reaching in its exclusion, and though it has been the longest in
existence, was modified at the legislative sessions of 1891, 1892,
and 1893, a fact which tends to show that there was sound
reason in the criticisms.
' Kling V. City of Kansas, 27 Mo. certificates of the fact of birth for
App., 23i ; Pierson ■«. People, 79 N. registration (Act 1893, c. 661, sees.
Y., 424. 22, 31), and to certifj^ the existence
'^ Suj)ra, p. 103. Matter of Cole- of contagious and infectious dis-
man, 111 N. Y., 220. eases (*., s. 24).
3 Siqjra, p. 103. '' See suggestions on the policy of
* Siqwa, p. 104. the New York law in Conn. Mut.
^ Supra, p. 127. L. I. Co. v. Union Tr. Co., 112 U.
« Laws of N. Y., Act 1893, c. 661, S., 250 ; Pearsall v. Elmer, 5 Redf.,
sees. 23, 31. In New York physi- 181 ; and contra, Edington v. Mut-
cians are also required to attest L. I. Co., 5 Hun, 1.
A SYNOPSIS OF THE LAWS
OF THE
SEVERAL STATES AND TERRITORIES OF THE UNITED STATES OF
AMERICA, AND OF GREAT BRITAIN AND IRELAND, AND
OF THE NORTH AMERICAN PROVINCES OF GREAT
BRITAIN, REGULATING THE PRACTICE
OF MEDICINE AND SURGERY,
PEEPARED FROM THE LATEST STATUTES.
BY
WILLIAM A. POSTE,
Late First Deputy Attorne y-General of the State of Neiv York,
AND
CHARLES A. BOSTON, Esq.,
of the Neto York City Bar.
SYNOPSIS OF THE EXISTIE^G STATUTES
WHICH REGULATE
THE ACaUIREMENT OF THE RIGHT TO PRACTISE MEDI-
CINE AND SURGERY IN THE UNITED STATES, GREAT
BRITAIN AND IRELAND, AND THE CANADIAN PROV-
INCES.
[Note. — This synopsis is designed to contain especially those
provisions of the statutes which regulate the right to practise
medicine and surgery. It is not intended to include provisions
regulating apothecaries, druggists, chemists, and dentists, or
the sale of drugs, medicines, and poisons ; nor provisions for the
organization and procedure of boards of medical examiners, ex-
cept so far as they regulate the requirements demanded from
applicants for permission to practise ; nor provisions with refer-
ence to the duties of clerks or registrars in the preparation and
safe-keeping of records in their care; nor those defining the
duties of members of boards, and punishing the misconduct of
such members; nor those prescribing qualifications for appoint-
ment to the public medical service ; nor former laws not now
applicable to candidates; nor regulations of the form of cer-
tificates or licenses, where the issuing of them is committed to
some public functionary or body ; nor provisions with reference
to the powers and disabilities of local institutions to confer
diplomas or degrees, nor with reference to medical students ex-
cept as candidates for admission to practise. In the synopsis
words of the masculine gender are uniformly used except when
the law by its terms makes a distinction between men and
women, in which case the distinction is indicated.]
Alabama.
Qualification. — The board of censors of the Medical As-
sociation of the State of Alabama and the board of censors of the
county medical societies in affiliation with the said association
are boards of medical examiners (Code 1887, s. 1,301). In the
absence of such board of medical examiners in any county, the
137
138 SYNOPSIS OF LAWS — POSTE AND BOSTON.
county commissioners may establish a board of from three to
seven physicians of good standing, resident in the county,
whose autliority shall terminate whenever a board is organized
in accordance with the constitution of and in affiliation with
said association {ib., s. 1,296). Where the board of examiners
is constituted as provided in sec. 1,296, it must issue a license
to practise medicine in an}^ one or more of its branches in the
county, if on examination the applicant is found duly qualified,
and is of good moral character {ib., s. 1,297).
In a county having only the medical board provided for in
sec. 1,296, a regular graduate of a medical college in the United
States, having a diploma, is entitled to practise medicine with-
out a license, upon recording his diploma in the office of the
judge of probate of the county {ib., s. 1,298).
A license issued by the last-mentioned board must be re-
corded in the office of the judge of probate of the county {ib.,
s. 1,299). The license or diploma, after record, is evidence of
authority ; if the original be lost, a certified copy of the record
is sufficient evidence {ib., s. 1,300). Without a certificate of
qualification from the board provided for in sec. 1,301, except as
above provided, no person can lawfully practise medicine in
any of its branches or departments as a profession or means of
livelihood {ib., s. 1,302). The standard of qualification, method
or system, and subjects of examination are prescribed by the
medical association of the State {ib., s. 1,303).
The board of medical examiners, on application, must ex-
amine an applicant for a certificate of qualification as a practi-
tioner of medicine, and if he be found qualified, and of good
moral character must issue a certificate {ib., s. 1,304).
Physicians having a license as above before the organization
in a county of a board, are on application thereto entitled to a
certificate without examination and to be registered as licensed
practitioners of medicine {ib., s. 1,305).
The certificate is a license throughout the State. It must
be recorded in the office of the judge of probate of the county
in which the person resides at the time of issue. Upon record-
ing it, the judge must indorse a certificate of record and sign
it and affix the seal of the court {ib., s. 1,306). Such certificate,
or, if lost, a certified copj^ of the record, is evidence {ib., s.
1,307).
ALABAMA — ARIZONA. 139
Penalty. — A contract for the services of a physician or
surgeon is void unless he has authority to practise ; proof of
authority is not required at trial except on two days' notice (^6.,
s. 1,318).
Practising medicine or surgery without a certificate is a mis-
demeanor under a penalty of a fine of from $25 to $100. This
provision is not applicable to physicians practising medicine
in Alabama in 1890, who are graduates of a respectable medi-
cal college and have complied with the law by having their
diplomas recorded by the judge of probate in the county where
they practise ; nor to a phj^sician who has practised in the State
for the past five years (Act 1890-91, c. 376) ; nor to women
practising midwifery (Code 1887, s. 1,308).
Fees. — The statutory fees are as follows:
To judge of probate, for record of diploma, or license or
certificate, $1 {ib., s. 1,298, 1,299, 1,306).
To board of medical examiners, for examination, actual ex-
penses {ib., s. 1,304).
Arizona,
Qualification. — It is unlawful for any person to practise
medicine, surgery, or other obstetrics unless he have a diploma
regularly issued by a medical college lawfully organized under
the laws of the State wherein it is located, or a license issued
and authorized by a board of medical examiners under and by
virtue of the laws of any State or Territory. The diploma must
state that the person named is qualified to practise medicine and
surgery in all of its departments (Penal Code, 1887, s, 617, as
amended Act of April 11th, 1893).
A diploma granted for moneyed consideration or other arti-
cle of value alone, or revoked or cancelled by the college by
which it was issued or by act of the legislature, is not a sufii-
cient qualification {ib., s. 618).
Every practitioner of medicine, surgery, or obstetrics must
register in the county recorder's office his name, residence, and
place of birth, and present his diploma or license, and the county
recorder must make a copy of it under the record of his name,
residence, and place of birth. The person registering must sub-
scribe and verify an affidavit in writing, annexed to the copy
140 SYNOPSIS OF LAWS — POSTE AND BOSTON.
US transcribed, that he is the identical person named in the
diploma {ib., s. G19, as amended by Act of April 11th, 1893).
Definition, Exception. — Any person is regarded as prac-
tising medicine who professes publicly to be a physician or ha-
bitually prescribes for the sick, or appends to his name " M.D.,"
but the act does not prohibit gratuitous services in cases of
emergency ; nor apply to lawfully commissioned surgeons and
assistant surgeons of the United States armj- and those who
w ere commissioned and mustered into the United States service
in the great rebellion, or physicians or surgeons who have been
in active practice for ten years and at least three years in the
Territory", nor prevent practice and receiving pay in localities
fifteen miles or more from the residence or office of a regular
phj'sician {ib.,s. 620).
Offence. — Violation of the act is a misdemeanor {ib., s.
621).
Fees. — To the county recorder, for registration, 85 {ib.,s.
619).
Arkansas. '
Qualification. — It is unlawful for any one to engage in the
practice of medicine and surger}', or either, as a calling except
as provided in the statute (Act April 14th, 1893, s. 1).
A person engaging in the practice of medicine or surgery
must be of good moral character, twenty-one years of age, and
a graduate of some reputable college of medicine and surgery
that requires for graduation not less than two courses of lec-
tures, each in a different year {ib., s. 2).
Before engaging in practice, such person must exhibit his
diploma to some county clerk of the State and have it recorded.
The clerk must give him a certificate of record, which may be
attached to the diploma {ib., s. 3).
In all cases of doubt as to the reputability of a college, it is
the duty of the cierk of the county court, when a diploma is
offered for record, to make inquiry of the Secretary of the State
where the said college exists as to its reputability and require-
ments for graduation, and if the said clerk shall find that the
said college does not conform to the requirements of this article,
he shall not receive the diploma and the holder shall not be
allowed to practise in the State. The aggrieved applicant may
ARKANSAS— CALIFORNIA. 141
apply to the State board of medical examiners, whose decision
shall govern the clerk in his action {ib., s. 4).
If after recording any diploma it shall come to the knowl-
edge of the clerk making the record, or any other judicial or
executive officer of the State, that the record was obtained by
fraud or misrepresentation, it shall be his duty to institute
before the said court of record proceedings to have such record
reversed, and the holder of the diploma shall be judged guilty
of a misdemeanor {ib., s. 5).
Exceptions. — The act does not affect the standing of any
one practising at the time of its passage by virtue of a license
under the then existing law, nor any one then legally engaged
in the practice of medicine and surgery, nor does it prevent
midwives from practising their calling or any one else from
giving such simple domestic remedies as they are in the habit
of using (ib., s. 6).
Examinations. — The constituted State board of medical ex-
aminers is authorized to examine persons having no diploma
from a medical college, and if found qualified to practise med-
icine and surgery issue a certificate entitling the holder to
practise in this State {ib., s. 7).
Systems, Definition. — No discrimination of schools of
medicine is allowed. Any person who prescribes or administers
medicine except as provided in sec. 6 is deemed a physician
{ib., s. 8).
Penalty. — The violation of this act is a misdemeanor pun-
ishable with a fine of from $25 to $100. Each day of practice
is a separate offence {ib., s. 9).
Date. — The act took effect ninety days after its passage {ib.,
s. 10).
Fees. — To the county clerk, for recording, $1.50.
For certificate of record the county clerk is not allowed to
charge a fee {ib., s. 3).
California.
Qualification. — Every person practising medicine or sur-
gery in any of its departments must present his diploma to the
board of examiners with affidavits. If the board finds all facts
required to be stated in the affidavit to be true, it issues a
143 SYNOPSIS OF LAWS — POSTE AND BOSTON.
certificate conclusive in any part of the State (Act 1877-78, c.
576; amending Act 1875-70, c. 518).
The secretary of the board receives applications. The board
issues certificates to all who furnish satisfactory proof of hav-
ing received diplomas or licenses from legally chartered medi-
cal institutions in good standing (Act 1875-76, c. 518, s. 3).
The medical society of the State, the eclectic medical society
of the State, and the State homoeopathic medical society each
appoint annually a board of seven examiners who must be regu-
lar graduates (Act 1877-78, c. 576; amending Act 1875-76, c.
518).
The board examines diplomas as to genuineness. The affi-
davit accompanying the diploma must state that the applicant
is its lawful possessor, and the person therein named ; that the
diploma was procured in the regular course of medical instruc-
tion and without fraud or misrepresentation of any kind, and
that the medical institution granting it had, at the time of
granting the same, a full corps of medical instructors, and was
at said time a legally incorporated institution, actually and in
good faith engaged in the business of medical education, and
in good standing as a medical institution, and that the appli-
cant had complied with all the requirements of said institution.
The affidavit may be taken before any person authorized to
administer oaths, and must be attested under the hand and
official seal of the officer, if he have a seal. The board may
hear such further testimony as they deem proper to hear as to
the verification of the diploma or the identity of the person, or
the manner in which the diploma was procured, and if it ap-
pears that any fact stated in the affidavit is untrue, the appli-
cation is rejected. No board entertains an application rejected
by another; a rejected application cannot be renewed for at
least one year {ib., s. 4, as amended by Act 1877-78, c. 918) ; no
certificates are granted except to persons presenting diplomas
or licenses from legally chartered medical institutions in good
standing (ib., s. 5).
Certificates must be recorded in the county of residence and
the record indorsed thereon. A person removing to another
county to practise must procure an indorsement to that effect
on his certificate from the county clerk, and must record the
certificate in the county to which he removes {ib., s. 6).
CALIFORNIA. 143
The board refuses certificates to individuals guilty of un-
professional conduct. The applicant is given an opportunity to
be heard, by citation ; the attendance of witnesses may be com-
pelled by subpoena ; witnesses may be examined at the hearing
by either side, and either side may examine medical experts as
to whether such conduct is unprofessional ; if it appears to the
satisfaction of the board that the applicant is guilty of the
unprofessional conduct set out in the citation, no certificate
can be granted. No application is refused for unprofessional
conduct more than one year before the application. If the
holder of a certificate is guilty of unprofessional conduct, the
certificate must be revoked by board granting it; no revoca-
tion is valid without similar proceedings to the foregoing (?'6.,
s. 10).
Definition. — Any person is regarded as practising medicine
who professes publicly to be a physician, or habitually pre-
scribes for the sick, or appends to his name " M.D."
Exceptions. — The act does not prohibit gratuitous services
in cases of emergency; nor apply to lawfully commissioned
surgeons of the United States army or navy practising their
profession {ib., s. 11, as amended 1877-78, c. 576).
Itinerant Venders. — A license of $100 a month is exacted
from itinerant venders of drugs, nostrums, ointments, or ap-
pliances for treatment of disease, and from persons publicly pro-
fessing to cure or treat disease, injury, or deformity by any
medicine, drug, or drugs, nostrum, manipulation, or other ex-
pedient (Act 1877-78, c. 576, amending Act 1875-76, c. 518,
s. 12).
Penalty. — The penalty for violation of the act is a fine of
from $50 to $500, or imprisonment in the county jail from 30
to 365 days, or both, for each and every offence. Filing or at-
tempting to file the diploma or certificate of another, or a
forged afiidavit of identification, is a felony, punishable the
same as forgery (ib., s. 13; Act 1877-78, c. 918, s. 7).
Former Practitioners. — Holders of certificates theretofore
granted by the board of examiners existing by the appointment
of the California State Medical Society of Homoeopatbic Prac-
titioners are excused b}^ the Act 1877-78, c. 918, s. 7, from ob'
taining new certificates.
Rejected Applicant. — A certificate issued bj^ one board
144 SYNOPSIS OF LAWS — POSTE AND BOSTON.
to an applicant rejected by another within a 3"ear is null and
void (/6., s. 9).
Fees. — To secretary of board, for examining genuine di-
ploma, $5.
If diploma fraudulent or property of another, $20 (Act
1877-78, c. 576, s. 3; amending Act 1875-76, c. 518, s. 4).
To county clerk, for recording certificate, usual recording
fees (Act 1875-76, c. 518, s. 6).
Colorado.
Board of Examiners. — The State board of medical ex-
aminers is composed of nine practising phj^sicians of known
ability and integrity, graduates of medical schools of undoubted
respectability, six of the regular school, two of the homoeo-
pathic, and one of the eclectic school or system, appointed by the
governor (Mills' "Annotated Statutes" 1891, s. 3,547).
Qualification. — Every person practising medicine must
possess the required qualifications. If a graduate in medicine,
he must present his diploma to the State board of medical ex-
aminers for verification, or furnish other evidence conclusive of
his being a graduate of a legally chartered medical school in
good standing. The board issues its certificate, and such diploma
or evidence and certificate are conclusive. If not a graduate of
a legally chartered medical school in good standing, the person
must present himself before the board for examination. AIL
persons who have made the practice of medicine and surgery
their profession or business continuously for ten years, and
can furnish satisfactory evidence thereof to the State medi-
cal examiners, shall receive a license to continue (z6., s.
3,550).
Examinations of persons not graduates are made by the
State board, wholly or partly in writing, in anatomy, physiol-
ogy, chemistry, pathology, surgerj', obstetrics, and practice of
medicine (exclusive of materia medica -and therapeutics) (ib.,
s. 8,553).
The Jiolder of a certificate should have it recorded in the
office of the clerk of the county in which he resides, and the
record indorsed thereon, and on removing to another county to
practise should procure an indorsement to that effect on the cer-
COLORADO — CONNECTICUT. 145
tificate from the county clerk, and record this certificate in the
county to which he removes {ib., s. 3,554).
The board may refuse certificates to persons convicted of
conduct of criminal nature ; and may revoke certificates for like
cause {ib., s. 3,356).
Definition. — Professing publicly to be a physician and
prescribe for the sick, or attaching to name "M.D.," or "sur-
geon" or " doctor" in a medical sense, is regarded as practising
medicine. Gratuitous services in case of emergency are not
prohibited {ib., s. 3,557).
Penalty. — The penalty for violation of the act is a fine of
from $50 to $300, or imprisonment in the county jail from ten
days to thirty days, or fine and imprisonment for each offence ;
filing or attempting to file the diploma or certificate of another,
or false or forged evidence, is a felony punishable the same as
forgery {ib., s. 3,558).
System of Medicine. — Certificates are issued without prej-
udice, partialitj', or discrimination as to schools or systems of
practice or medicine, including the electropathic school {ib., s.
3,561).
Pees. — To treasurer of board b}^ graduates and practitioners
of ten years' standing, $5. By candidates for examination,
$10 {ib., s. 3,552).
To county clerk, for recording certificate, $1 {ib., s. 3,554).
Connecticut.
Qualification, Exceptions. — After October 1st, 1893,
no person shall for comi^ensation, gain, or reward, received or
expected, treat, operate, or prescribe for any injury, deformity,
ailment, or disease, actual or imaginarj', of another person, nor
practise surgery or midwifery unless or until he has obtained
a certificate of registration, and then only in the kind or branch
of practice stated in the certificate, but the act does not apply
to dentists practising dentistry only, nor to any person in the
employ of the United States Government while acting in the
scope of his employment, nor to medical or surgical assistance
in cases of sudden emergency, nor to any person residing out
of the State who shall be employed to come into the State to
assist or consult with any physician or surgeon who has been
10
146 SYNOPSIS OF LAWS — POSTE AND BOSTON.
registered in conformity with the act, nor to any physician or
surgeon then actually residing out of the State who shall be
employed to come into the State to treat, operate, or prescribe
for any injury, deformity, ailment, or disease from which any
person is suffering at the time when such non-resident phy-
sician or surgeon is so employed, nor to an 3^ actual resident of
this State recommending by advertisement or otherwise the
use of proper remedies sold under trade-marks issued by the
United States Government, nor to any chiropodist or clair-
voyant not using in his practice any drugs, medicines, or
poisons, nor to any person practising the massage method or
Swedish movement cure, sun cure, mind cure, magnetic heal-
ing, or Christian science, nor to any other person who does not
use or prescribe in his treatment of mankind drugs, poisons,
medicine, chemicals, or nostrums (Act 1898, c. 148, s. 1).
Anj^ resident of the State who, at the time of the passage of
the act, was or previously had been actually engaged in the
State in the practice of medicine, surgery, midwiferj^, or any
alleged practice of healing, may, before October 1st, 1893, file
with the State board of health duplicate statements subscribed
and sworn to by him upon blanks furnished by said board,
giving his name, age, and place of birth and present residence,
stating whether he is a graduate of any medical college or not,
and of what college, and the date of graduation, and if practis-
ing under a license from any of the medical societies of the
State, which society and the date of such license and the length
of time he has been engaged in practice in the State, and also
elsewhere, and whether in general practice or in a special
branch of medicine or surgery, and what branch. On receipt of
such statements, the board shall issue a certificate of registra-
tion which shall state the kind or branch of practice in which
he is engaged {ih., s. 2).
Any person who shall, subsequent to October 1st, 1893, file
with said board such duplicated statements, showing that he is
a graduate of a medical college recognized as reputable by any
chartered medical society of the State, shall receive a certificate
of registration which shall state the kind or branch of practice
in which the person named therein is engaged or is to be en-
gaged {ih.^ s. 3).
Any person residing in any town in another State which
CONNECTICUT. 147
town adjoins the boundary line of Connecticut, who was actu-
ally engaged in such town, at the time of the passage of the act,
in the practice of medicine, surgery, or midwifery, or any
branch of practice, may before October 1st, 1893, obtain from
the said board a like certificate on filing such duplicated state-
ments also showing that he is entitled to such certificate under
this section (ib., s. 4).
Except as above provided, no person shall after October 1st,
1893, obtain a certificate of registration until he has passed a
satisfactory examination before a committee appointed by said
board, nor until he has filed with the said board duplicate cer-
tificates as aforesaid, signed by a majority of one of said exam-
ining commissioners, stating that they have found him qualified
to practise either medicine, surgery, or midwifery, and any
person filing said certificates shall receive from said board a
certificate of registration (ib., s. 5).
The State board of health, in January, 1894, is to appoint
three examining commissions, each of five physicians nomi-
nated respectively by the Connecticut Medical Society, the Con-
necticut Homoeopathic Medical Society, and the Connecticut
Eclectic Medical Association, and recommended by the said
societies respectively as persons competent to serve upon the
said examining commissions. Appointments are to be made
thereafter from time to time by similar nominations (ib., s. 6
and 7).
The State board of health shall designate when and where
the commissions shall hold examinations, but shall call a meet-
ing of a commission within thirty days after the receipt of an
application for examination. Applicants shall be examined in
anatomy, physiology, medical chemistry, obstetrics, hj-giene,
surgery, pathology, diagnosis, and therapeutics, including prac-
tice and materia medica. Each commission shall frame its
own questions and conduct its examinations in writing, and
both questions and answers shall be placed on file with the
board. Each applicant may choose by which of the commis-
sions he will be examined.
After rejection by any examining commission, the appli-
cant shall not be eligible to examination by another commission
until after the expiration of twelve months (ib., s. 8).
On the receipt of duplicate statements, the board shall trans-
148 SYNOPSIS OF LAWS — POSTE AND BOSTON.
mit one of them with a duplicate certificate of registration to
the town clerk of the town where the person filing the state-
ment resides, and if he does not reside in the State to the town
clerk of the town in the State nearest to his place of residence,
and said clerk shall record the same and return them to the
person who filed them with the board (^6., s. 9).
The secretary of each medical society shall file with the sec-
retary of the State board of health a list of medical colleges or
institutions recognized as legal and reputable by his society or
all of such secretaries may agree upon a single list, and such
list may be corrected from time to time {ib., s. 10).
Penalty. — The violation of sec. 10 shall be a misdemeanor,
punishable with a fine of from $100 to $300 for the first offence,
and for each subsequent offence by a fine of from $200 to $500
or imprisonment in the county jail for from thirty to ninety
days, or both {ib., s. 11); swearing falsely to a statement is
perjury {ib., s. 12).
Fees. — To the State board of health, on filing statements or
certificates, $2 {ib., s. 2, 3, 4, 5).
To examining commission, before examination, their ex-
penses not exceeding $10 {ib., s. 8).
To the town clerk, by State board of health out of the
amount paid to it, for recording, 25 cents {ib., s. 9).
Delaware.
Qualification. — It is unlawful to practise medicine or
surgery without a license (Laws 1887, vol. 18, c. 35, s. 1, as
amended by Laws 1889, vol. 18, c. 548).
The medical board of examiners for the State must grant
a license to any person applying therefor who shall produce a
diploma from a respectable medical college, or shall, upon full
and impartial examination, be found qualified for such practice
(Rev. Stats., c. 47, s. 3). The board consists of as many fel-
lows of the Medical Society of Delaware as the society deems
proper {ib., s. 3).
The clerk of the peace of a county, on presentation of a
license issued by the board of examiners of the Homoeopathic
Medical Society of Delaware State and Peninsula, under its
corporate seal, signed by its president and countersigned by its
DELAWARE — DISTRICT OF COLUMBIA. U9
secretary, or of the license provided by sec. 3, c. 47, of the
Revised Statutes, or on the affidavit of a person that he or she
has practised medicine or surgery for eight years continuously
in the State, and upon such person registering his name, the
date of his graduation and college (if a graduate), and his place
of intended residence, must issue a license {ib., s. 2).
A person opening a transient office or assigning a transient
office by printed or written advertisement, must comply with
the foregoing provisions and pay special license fee for a license
good only for one year (Laws 1887, vol. 18, c. 35, s. 5).
Penalty. — The violation of this law is a misdemeanor
punishable by a fine of from $100 to S300 {ib., s. 7).
Exceptions. — The present law exempts those who complied
with the Act of April 19th, 1883, and also regular practitioners
of another State in consultation with a lawful practitioner of
medicine and surgery of this State {ib., s. 4, 6).
Fees. — To clerk of the peace, for issuing license to practise,
$10.50 (Laws 1887, vol. 18, c. 35, s. 4). For issuing annual
license for revenue of the State, $10.50 (Laws, vol. 13, c. 117,
as aniended, vol. 14, c. 16).
To secretary of board, for license, $10 (Rev. Stats., c. 47, s.
5).
A license fee to practise medicine, for the revenue of the
State, is also required {ib., s. 8; vol. 13, c. 117, as amended,
vol. 14, Laws, c. 16).
District of Columbia.
Registration. — It is the duty of every physician, ac-
coucheur, and midwife practising medicine, or doing business,
to register at the office of the board of health, giving full name,
residence, and place of business, and in case of removal from
one place to another in the District to make a change in the
register (Regulation of Board of Health, August 28th, 1874, s.
8, legalized by resolution of Congress, No. 25, s. 2, April 24th,
1880).
Violation. — The violation of the foregoing provision is
punishable by a fine of from $25 to $200 forevery offence {ib.,
s. 9).
Qualification. — All physicians required to register must
150 SYNOPSIS OF LAWS — POSTE AND BOSTON.
do SO upon a license from some chartered medical society or upon
a diploma from some medical school or institution {ih., s. 11
[First]).
Florida.
Boards of Examiners. — The governor appoints a board of
medical examiners for each judicial circuit, and a board of
homopopathic examiners for the State (Rev. Stats., 1802, s.
801).
The circuit board is composed of three practising physicians
of known ability, graduates in good standing of a medical col-
lege, recognized by the American Medical Association, residents
of the circuit; the homoeopathic board is composed of three
practising homoeopathic physicians of known ability, graduates
in good standing of a medical college recognized by the Amer-
ican Institute of Homoeopathy (/&., s. 802).
Qualification. — It is the duty of the board of examiners
to examine thoroughly every applicant, upon the production
of a medical diploma from a recognized college, upon anatomy,
physiology, surgery, gynaecology, therapeutics, obstetrics, and
chemistry, but no preference is given to any school of medicine ;
and it is the duty of the board of homoeopathic medical ex-
aminers to examine thoroughly every applicant, upon the pro-
duction of his diploma from a college recognized by the Amer-
ican Institute of Homoeopathy, on anatomy, physiology, sur-
gery, gynaecology, materia medica, therapeutics, obstetrics, and
chemistry, but no preference is given to any school of medi-
cine (Rev. Stats., 1892, s. 806).
When the board is satisfied as to the qualifications of the
applicant, they grant a certificate which entitles him to prac-
tise medicine in any county, when recorded {ih., s. 807).
Any two members of the board may grant a certificate. Any
member vasij grant a temporary certificate, upon examination,
until the next regular meeting, at which time the temporary
certificate ceases to be of effect (^Z)., s. 808). Before he shall
be entitled to practise, the certificate must be recorded in the
office of the clerk of the circuit court of the county in which he
may reside or sojourn ; and the clerk must certif}' thereon,
under official seal, the fact and date of the record, and return
the certificate {ih.., s. 809).
FLORIDA — GEORGIA. 151
A practitioner engaged in the practice of medicine in any
department prior to May 31st, 1889, upon the production of a
diploma from a medical college recognized by the American
Medical Association, is granted a certificate, without further
examination and without charge (ib., s. 811).
Exceptions. — This act is not applicable to persons who have
complied with prior laws, nor to females practising mid-
wifery, strictly as such. No other person shall practise med-
icine in any of its branches or departments, without having
obtained and recorded a certificate (^6., s. 812).
Penalty. — Practising as a phj-sician without a certificate
is punishable by imprisonment not exceeding six months, or a
fine not exceeding $200 (^6., s. 2,6G9).
Fees. — To clerk, legal fee for recording {ib., s. 809).
To board, $10 from each applicant whether certificate
granted or not {ib., s. 810).
Georgia.
The Code of 1882, s. 1,409 (a) as amended by chap. 413,
Laws 1882-83, provides that —
Qualification. — No person is to practise medicine, unless
he was theretofore legally authorized, or is hereafter authorized
by a diploma from an incorporated medical college, medical
school or university, or has after attending one or more full
terms at a regularly chartered medical college, been in active
practice of medicine since the year 18G6, or was by law author-
ized to practise medicine in 1866, and by compliance with the
statute.
Definition. — To " practise medicine" means to suggest,
recommend, prescribe, or direct, for the use of any person, any
drug, medicine, appliance, apparatus, or other agency, whether
material or not material, for the cure, relief, or palliation of
any ailment or disease of mind or body, or for the cure or relief
of any wound, fracture, or other bodily injury, or any deform-
ity, after having received or with the intent of receiving there-
for, either directly or indirectly, any bonus, gift, or compensation
{ib.,s. 1,409 [?;]).
Registration. — Every person now lawfully engaged in
practice must register on or before December 1st, 1881 ; every
152 SYNOPSIS OF LAWS — POSTE AND BOSTON.
person hereafter duly qualified shall, before commencing to
practise, register in the office of the clerk of the superior court
of the county wherein he resides and is practising, or intends to
practise, his name, residence, and place of birth, together with
his authority ; he shall subscribe or verify, by oath or affirma-
tion, before a person duly qualified to administer oaths under
the laws of this State, an affidavit containing such facts, and
whether such authority is by diploma or license, and the date
of the same, and by whom granted, which shall be exhibited
to the county clerk, before the applicant is allowed to register,
and which, if wilfully false, is punishable as false swearing
{ih., s. 1,409 [c]).
Removal. — A registered physician changing his residence
from county to county must register in the clerk's office of
the county to which he removes and wherein he intends to
reside and to practise medicine {ib., s. 1,409 [d]).
Penalty. — The violation of this law or practising, or offer-
ing to practise, without lawful authority, or under cover of a
diploma or license illegally obtained, is a misdemeanor, punish-
able by a fine of from $100 to $500, or imprisonment from thirty
to ninety days, or both {ib., s. 1,409 [e]).
Exceptions. — Commissioned medical officers of the United
States army or navj-, or United States marine hospital service,
and women practising only midwifery, are not affected {ih., s.
1,409 [/]).
Medical Boards. — All medical boards are abolished, and
only the qualifications of practitioners of medicine set forth
above are required {ih., s. 1,409 [g']).
Fees. — To county clerk, fifty cents for each registration
{ib., s. 1,409 [c]).
Tax. — On practitioners of physic, $5 per annum {ib., s.
809).
Idaho.
Qualification. — No person can lawfully practise medicine
or surgery who has not received a medical education, and a di-
ploma from a regularly chartered medical school, having a bona
fide existence when the diploma was granted (Rev. Stats., 188T,
s. 1,298).
A physician or surgeon must file for record with the county
IDAHO — ILLINOIS. 153
recorder of the county in which he is about to practise, or where
he practises, a copy of his diploma, at the same time exhibiting
the original, or a certificate from the dean of a medical school
certifying to his graduation (ib., s. 1,298 [a]).
When filing the cop}^ required, he must be identified as the
l^erson named in the papers, by the affidavit of two citizens of
the county, or by his affidavit taken before a notary public or
commissioner of deeds for this State ; and the affidavit is filed
in the office of the county recorder {ib., s. 1,298 [b]).
Penalty. — Practising without complying with the act is a
misdemeanor, punishable by a fine of from $50 to $500, or im-
prisonment in a county jail from thirty days to six months, or
both fine and imprisonment for each offence.
Filing or attempting to file as his own the diploma or cer-
tificate of graduation of another, or a forged affidavit of identi-
fication, is a felony; subject to fine and imprisonment {ib., s.
1,298 [c]; ib., s. 6,312).
Exceptions. — The act is not applicable to a person in an
emergency prescribing or giving advice in medicine or surgery,
in a township where no physician resides within convenient
distance, nor to those who have practised medicine or surger}-
in this State for ten years preceding the passage of this act, nor
to persons prescribing in their own families, nor to midwifery
in places where no physician resides within convenient distance
{ib., s. 1,298 [e] ; as amended by Act of February 7th, 1889).
Fees. — No special fees are enumerated in the statute. The
county recorder's fees for services are prescribed in Rev.
Stats., 1887, s. 2,128.
Illinois.
Qualification. — No person can lawfully practise medicine
in any of its departments unless he possesses the qualifications
required* If a graduate in medicine, he must present his di-
ploma to the State Board of Health for verification as to its
genuineness. If the diploma is found genuine, and from a legally
chartered medical institution in good standing, and if the person
named therein be the person claiming and presenting the same,
the board must issue a certificate conclusive as to his riglit to
practise medicine. If not a graduate, the person must present
154 SYNOPSIS OF LAWS — POSTE AND BOSTON.
himself before the said board and submit to examination, and
if the examination is satisfactory the board must issue certifi-
cate (Laws 1887, p. 225, s. 1).
The verification of a diploma consists in the affidavit of the
holder and applicant that he is the person therein named. The
affidavit may be taken before any person authorized to admin-
ister oaths, and attested under the hand and official seal of such
officer (if he have a seal). Swearing falsely is perjury. Grad-
uates may present their diplomas and affidavits by letter or
proxy (^6., s. 3).
All examinations of persons not graduates or licentiates are
made by the board ; and certificates authorize their possessor to
practise medicine and surgery (/&., s. 4).
The certificate must be recorded in the office of the clerk of
the county in which the holder resides within three months
from its date, and the date of recording indorsed. Until
recorded, the holder cannot lawfully exercise the rights and
privileges conferred. A person removing to another county to
practise must record his certificate in the county to which he
removes (f6,, s. 5).
Examinations may be wholly or partly in writing and shall
be of elementary and practical character, but sufficiently strict
to test the qualifications of the candidate as a practitioner {ib.,
s. 8).
The board may refuse to issue a certificate to a person guilty
of unprofessional or dishonorable conduct, and may revoke for
like causes. The applicant in case of a refusal or revocation
may appeal to the governor and his decision will be final {ib.,
s. 9).
Definition. — " Practising medicine" is defined as treating,
operating on, or prescribing for any physical ailment of another.
The act does not prohibit services in case of emergency, nor the
domestic administration of family remedies, and does not apply
to commissioned surgeons of the United States army, navj", or
marine hospital service in the discharge of official duty {ib.,
s. 10).
Itinerant Vender. — An itinerant vender of drug, nostrum,
ointment, or appliance intended for treatment of disease or
injury, or professing by writing, printing, or other method to
cure or treat disease or deformity by drug, nostrum, manipula-
ILLINOIS — INDIANA. 155
tion, or other expedient, must pay a license fee of $100 per month
into the treasury of the board. The board may issue such
license. Selling without a license is punishable by fine of from
$100 to $200 for each offence. The board may for cause refuse
a license {ib., s. 11).
Penalty. — Practising medicine or surgery without a cer-
tificate is punishable by a forfeiture of $100 for the first offence,
and $200 for each subsequent offence ; filing or attempting to
file as his own the certificate of another, or a forged affidavit
of identification, is a felony, punishable as forgery.
Exceptions. — The act saves for six months after its passage
the right of persons who have practised continuously for ten
years in the State prior to its passage, to receive a certificate
under former act. But all persons holding a certificate on
account of ten years' practice are subject to all requirements and
discipline of this act in regard to their future conduct; all
persons not having applied for or received certificates within
said six months, and all persons whose applications have for
the causes named been rejected, or their certificates revoked,
shall, if they practise medicine, be deemed guilty of practising
in violation of law {ib., s. 12).
Penalty. — On conviction of the offence mentioned in the
act, the court must, as a part of the judgment, order the
defendant to be committed to the county jail until the fine and
costs are paid {ib., s. 13).
Fees. — To the secretary of the board, for each certificate to
a graduate or licentiate, $5 {ib., s. 2).
For graduates or licentiates in midwifery, $2 {ib., s. 2).
To county clerk, usual fees for making record.
To treasury of board, for examination of non-graduates:
$20, in medicine and surgery; $10, in midwifery only.
If the applicant fails to pass, the fees are returned. If he
passes, a certificate issues without further charge {ib., s. 7).
Indiana.
Qualification. — It is unlawful to practise medicine, sur-
gery, or obstetrics without a license (Act April 11th, 1885,
s.l).
The license is procured from the clerk of the circuit court of
156 SYNOPSIS OF LAWS — POSTE AND BOSTON.
the county where the person resides or desires to locate to prac-
tise ; it authorizes him to practise anywhere within the State ;
the applicant must file with the clerk his affidavit stating that
he has regularly graduated in some reputable medical college,
and must exhibit to the clerk the diploma held by him, his
affidavit, and the affidavit of two reputable freeholders or house-
holders of the county stating that the applicant has resided and
practised medicine, surgerj^, and obstetrics in the State contin-
uously for ten years immediately preceding the date of taking-
effect of this act, stating particularly the locality or localities
in which he has practised during the said period, and the date
and length of time in each locality ; or his affidavit and the
affidavit of two reputable freeholders or householders of the
county, stating that he has resided and practised medicine,
surgery, and obstetrics in the State continuously for three
years immediately preceding the taking effect of this act, and
stating particularly the localities in which he practised during
the said period, and the date and length of time in each locality,
and that he, prior to said date, attended one full course of
lectures in some reputable medical college. The clerk must
record the license and the name of the college in which the
applicant graduated, and the date of his diploma {ib., s. 2, as
amended by Act March 9th, 1891).
A license issued to a person who has not complied with the
requirements of sec. 2, or one procured by anj' false affidavit, is
void (Act April 11, 1885, s. 3).
Penalty. — Practising medicine, surgery, or obstetrics with-
out a license is a misdemeanor punishable with a fine of from
$10 to $200 {ib., s. 4).
No cause of action lies in favor of any person as a physician,
surgeon, or obstetrician who has not prior to the service pro-
cured a license; and money paid or property paid for such
services to a person not so licensed, or the value thereof, may
be recovered back {ib., s. 5).
Exemptions. — Women practising obstetrics are exempted
from the provisions of the act {ib., s. 4).
Fees. — To clerk, for license, $1.50 (Act April 11th, 1885, as
amended Act March 9th, 1891).
Registration. — It is the duty of all physicians and ac-
coucheurs to register their name and post-office address with
INDIANA — IOWA. 157'
*
the clerk of the circuit court of the county in which they reside
(Act 1881, p. 37, s. 10).
Fees. — To the clerk, for registration, 10 cents (ib., s. 11).
Iowa.
Qualification. — Every person practising medicine, sur-
gery, or obstetrics, in any of their departments, if a graduate in
medicine, must present his diploma to the State board of ex-
aminers for verification as to its genuineness. If the diploma
is found genuine, and is by a medical school legally organized
and of good standing, which the board determines, and if the
person presenting be the person to whom it was originally
granted, then the board must issue a certificate signed by not
less than five phj^sicians thereof, representing one or more phy-
sicians of the schools on the board (sic), and such certificate is
conclusive. If not a graduate, a person practising medicine
or surgery, unless in continuous practice in this State for not
less than five years, of which he must present to the board sat-
isfactory evidence in the form of affidavits, must appear be-
fore the board for examination. All examinations are in writ-
ing; all examination papers with the reports and action of
examiners are preserved as records of the board for five years.
The subjects of examination are anatomy, physiology, general
chemistry, pathology, therapeutics, and the principles and
practice of medicine, surgery, and obstetrics. Each applicant,
upon receiving from the secretary of the board an order for
examination, receives also a confidential number, which he
must place upon his examination papers so that, when the papers
are passed upon, the examiners may not know by what ap-
plicant they were prepared. Upon each day of examination
all candidates are given the same set or sets of questions.
The examination papers are marked on a scale of 100. The ap-
plicant must attain an average determined by the board ; if
such examination is satisf actor}'' to at least five physicians
of the board, representing the different schools of medicine on
the board, the board must issue a certificate, which entitles the
lawful holder to all the rights and privileges in the act provided
(Laws 1886, c. 101, s. 1).
The board receives applications through its secretary. Five
158 SYNOPSIS OF LAWS — POSTE AND BOSTON.
physicians of the board may act as an examining board in the
absence of the full board ; provided that one or more members
of the different schools of medicine , represented in the State
board of health shall also be represented in the board of exam-
iners {lb., s. 2).
The affidavit of the applicant and holder of a diploma that he
is the person therein named, and is the lawful possessor there-
of, is necessary to verify the same, with such other testimony
as the board may require. Diplomas and accompanying affi-
davits may be presented in person or by proxy. If a diploma
is found genuine and in possession of the person to whom it
was issued, the board, on payment of the fee to its secretary,
must issue a certificate. If a diploma is found fraudulent or
not lawfully in possession of the holder or owner, the person
presenting it, or holding or claiming possession, is guilty of a
misdemeanor, punishable with a fine of from $20 to $100 {ib.,
s. 3).
The certificate must be recorded in the office of the county
recorder in the county wherein the holder resides, within sixty
days after its date. Should he remove from one count}' to an-
other to practise medicine, surgery, or obstetrics, his certificate
must be recorded in the count}^ to which he removes. The
recorder must indorse upon the certificate the date of record
(ib., s. 4).
Any one failing to pass is entitled to a second examination
within twelve months without a fee ; any applicant for exam-
ination, by notice in writing to the secretary of the board, is
entitled to examination within three months from the time of
notice, and the failure to give such opportunity entitles such
applicant to practise without a certificate until the next regular
meeting of the board. The board may issue certificates to
persons who, upon application, present a certificate of having
passed a satisfactory examination before any other State board
of medical examiners, upon the payment of the fee provided in
sec. 3 (ib., s. 6, as amended c. 66, Laws 1888, 22 Gen. As-
sembly).
The board may refuse a certificate to a person who has been
convicted of felony committed in the practice of his profession,
or in connection therewith; or may revoke for like cause, or
for palpable evidence of incompetency, and such refusal or
IOWA. 159
revocation prohibits such person from practising medicine, sur-
gery, or obstetrics, and can onl}' be made with the affirmative
vote of at least five physicians of the State board, in which must
be inchided one or more members of the different schools of
medicine represented in the said board; the standing of a
legallj" chartered medical college from which a diploma may be
presented must not be questioned except by a like vote {ib.,
s. 7).
Definition, Exceptions. — Any person is deemed practis-
ing medicine, surger}-, or obstetrics, or to be a physician, who
publicly professes to be a physician, surgeon, or obstetrician, and
assumes the duties, or who makes a practice of prescribing, or
prescribing and furnishing medicine for the sick, or who pub-
licly professes to cure or heal by any means whatsoever ; but the
act does not prohibit students of medicine, surgery, or obstetrics
from prescribing under the supervision of preceptors or gratui-
tous services in case of emergency ; nor does it appl}' to women
at the time of its passage engaged in the practice of midwifery,
nor does it prevent advertising, selling, or prescribing natural
mineral waters flowing from wells or springs, nor does it apply
to surgeons of the United States army, navy, or marine hospital
service, nor to physicians defined therein who have been in prac-
tice in this State for five consecutive years, three years of which
must have been in one locality, provided such physician shall
furnish the State board with satisfactory evidence of such prac-
tice and shall procure a proper certificate, nor to registered
pharmacists filling prescriptions, nor does it interfere with the
sale of patent or proprietary medicines in the regular course
of trade {ib., s. 8).
Penalty. — A person practising medicine or surgery with-
out complying with the act, and not embraced in the exceptions,
or after being prohibited as provided in sec, 7, is guilty of a
misdemeanor punishable with a fine of from $50 to $100, or
imprisonment in the county jail from ten to thirtj^ days {ib.,
s. 9).
Filing or attempting to file as one's own the diploma of
another, or the certificate of another, or a dijjloma or certificate
with the true name erased and the claimant's name inserted,
or a forged affidavit of identification, is forgery {ib., s. 10).
Fees. — To count)^ recorder, 50 cents {ib., s. 4).
IGO SYNOPSIS OF LAWS — POSTE AND BOSTON.
To State board, for certificate to holder of diploma, $^ {ib.,
s. 3).
To secretary of State board, in advance, by candidate for ex-
amination, $10 (lb., s.. 0).
By practitioner for five years, $2 {ib., s. 8).
Kansas.
Qualification. — it is unlawful for a person who has not
attended two full courses of instruction and graduated in some
respectable school of medicine, either of the United States or of
some foreign countrj', or who cannot produce a certificate of
qualification from some State or county medical society, and is.
not a person of good moral character, to practise medicine in
any of its departments for reward or compensation, for any sick
person ; provided in all cases when any person has been con-
tinuously engaged in practice of medicine for ten years or more,
he shall be considered to have complied with the provisions of
the act (Gen. Stats., 1889, s. 2,450).
Penalty, — Practising or attempting to practise medicine
in any of its departments or performing or attempting to per-
form any surgical operation in violation of the foregoing is
punishable with a fine of from $50 to $100; and a second viola-
tion, in addition to a fine, is punishable with imprisonment in
the county jail for thirty days ; and in no case wherein the act
is violated shall the violator receive a compensation for services
rendered {ib., s. 2,451).
Kentucky.
Qualification. — It is unlawful for any person to practise
medicine in any of its branches who has not exhibited and
registered in the county clerk's office, in the county in which
he resides, his authority to practise, with his age, address, place
of birth, and the school or system of medicine to which he pro-
poses to belong. The person registering must subscribe and
verify bj^'oath before such clerk an aflSdavit containing such
facts, which, if wilfully false, subjects the affiant to punish-
ment for perjury (Act 1893, April 10th, s. 2).
KANSAS — KENTUCKY. 161
Authority to practise shall be a certificate from the State
board of health issued to any reputable physician who is prac-
tising, or who desires to begin to practise, who possesses a
diploma from a reputable medical college legally chartered
under the laws of this State, or a diploma from a reputable and
legally chartered medical college of some other State or countrj'-,
indorsed as such by said board, or satisfactory evidence from
the applicant that he was reputably and honorablj^ engaged in
the practice of medicine in the State prior to February 23d,
18G4, Applicants may present their credentials by mail or
proxy [ib., s. 3).
Nothing in the law authorizes any itinerant doctor to regis-
ter or practise medicine {ib., s. 4).
The board may refuse a certificate to any individual guilty
of grossly unprofessional conduct of a character likely to de-
ceive or defraud the public, and may, after due notice and hear-
ing, revoke such certificates for like cause. In cases of refusal
or revocation the applicant may appeal to the governor, whose
decision affirming or overruling the decision of the board shall
be final {ib., s. 5).
Systems, Exceptions. — The law does not discriminate
against any peculiar school or system of medicine, nor pro-
hibit women from practising midwifery, nor prohibit gratui-
tous services m case of emergency, nor apply to commissioned
surgeons in the United States army, navy, or marine hospital
service, nor to a legally qualified physician of another State
called to see a particular case or family, but who does not open
an office or appoint a place in the State to meet patients or re-
ceive calls {ib., s. 6).
Penalty. — Anj^ person living in this State or coming into
this State who shall practise medicine or attempt to practise
medicine in any of its branches, or perform or attempt to per-
form any surgical operation for or upon any person for reward
or compensation in violation of this law, shall be punished
with a fine of $50, and on each subsequent conviction by a
fine of $100 and imprisonment for thirty days, or either, or
both ; and in no case where any provision of this law has been
violated shall the violator be entitled to receive compensation
for services rendered. To open an office for such purpose or
to announce to the public in any other way a readiness to
11
162 SYNOPSIS OF LAWS — POSTE AND BOSTON.
practise medicine in any county shall be to engage in the
practice of medicine {ib., s. 8).
Fees. — To the county clerk, for all services required, 50
cents {ib., s. 1).
Louisiana.
Constitutional Provision. — The general assembly must
provide for the interest of State medicine in all its departments,
and for the protection of the people from unqualified practi-
tioners of medicine (Const. 1879, Art. 178).
Qualification. — No person is allowed to practise medicine
or surgery as a means of livelihood in any of its departnients,
without first making aflBdavit before a judge, justice of the peace,
clerk of district court, or notary public in the parish wherein he
resides, of his having received the degree of doctor of medicine
from a regularly incorporated medical institution of respectable
standing, in America or in Europe, and designating its name and
locality, and the date of his diploma ; the degree is manifested
by the diploma, and the respectable standing of the institution
is evidenced by the indorsement or certificate of the State board
of health, written on the face of the diploma, and signed by its
secretary ; the affidavit must contain the full name of the per-
son making the same, the date and place of his birth, and the
names of the places where he may have previously practised
medicine or surgery ; a record of the diplomas certified must be
presented by the State board of health, and copies thereof, cer-
tified by the secretary, are received in evidence. The State
board of health is required to certify the diploma of any medi-
cal institution of credit and respectability without regard to its
sj^stem of therapeutics and whether the same be regular, homoe-
opathic, or eclectic (Act 1882, No. 31, s. 1).
The affidavit required by sec. 1 must be recorded in the
office of the clerk of the district court of the parish ; the clerk
must certify the recordation by indorsement on the original
affidavit, which the affiant must transmit to the State board of
health; a copy of the original affidavit, dul}^ certified by the
clerk of the court, is admissible in evidence {ib., s. 2).
Exceptions. — The provisions of the act do not apply to
female practitioners of midwifery as such, nor to persons who
had been practising medicine or surgery in the State without
LOUISIANA. 103
diplomas for five years prior to the passage of the act, nor to
persons who had been practising medicine or surgery from a
regularly incorporated medical institution of reputable standing
in America or in Europe, for ten years prior to the passage of
the act, provided such a practitioner make affidavit before a
judge, justice of the psace, notary public, or the clerk of the court
of the parish wherein he resides, setting forth the full name of
the affiant, the date and place of his birth, the date of his di-
ploma, if he have any, the name and locality of the institution
by which it was made, the date and place where ho began the
practice of medicine in Louisiana, and the names of the places
where he may have previously practised medicine or surgerj
such affidavit must be transmitted or delivered to the State
board of health, and entitles the affiant to be placed on the list
of registered physicians or surgeons. The State board of health
must preserve said affidavits, and a copy signed by the secretary
is received in evidence by the courts. To make a false affidavit
is perjur}^ {ih., s. 3).
Evidence. — A copy of the affidavit recorded by the clerk
of the district court, certified by him, is prima facie evidence
that the person making the affidavit is a duly registered phj-si-
cian or surgeon, and a certified copy of the original affidavit
filed with the State board of health, or a certificate emanating
from the said board, that the name of the person mentioned in
the certificate is on the list of registered physicians and sur-
geons, is conclusive evidence {ih., s. 4).
It is the duty of the State board of health to publish annually
in the official journal of the State, and if there is none, in one
of the daily newspapers published in New Orleans, a list of the
registered physicians and surgeons, and their places of resi-
dence, and such published list is evidence in the courts that the
person is duly registered. The board is required to strike from
said list the names of persons convicted of any infamous crimes
by any court of this State or of the United States, or of any
State of the United States, whether prior or posterior to regis-
tration; and is empowered to strike from the list persons who
die after registration {ih., s. 5).
Civil Penalty. — A practitioner of medicine or surgery fail-
ing to comply with this act shall not be exempt from military
or jury duty, nor be permitted to collect fees for services rendered,
164 SYNOPSIS OF LAWS — POSTE AND BOSTON.
nor be allowed to testify as a medical or surgical expert in legal
or State medicine, in any court, nor to execute any certificate as
surgeon or physician, nor to hold any medical office, nor to be
recognized by the State, or any parish, or municipal corporation,
as a phj^sician or surgeon, nor entitled to enjoy any of the
privileges, rights, or exemptions granted to physicians and sur-
geons by the laws of this State; and shall forfeit SlOO for
each violation, to be recovered in a civil action in the name of
and for the benefit of the Charity Hospital at New Orleans, and
in addition shall be subject to criminal prosecution (ib., s. 6).
Exceptions. — The act is not applicable to practitioners of
medicine or surgery residing and practising in other States,
who may be summoned in special instances to attend patients
in the State of Louisiana by any registered physician {ib., s. 7).
Penalty. — Whoever shall practise or offer to practise med-
icine or surgery, for pay, without complying with the foregoing
act, is guilty of a misdemeanor, punishable hj a fine of not less
than $50 or imprisonment for not more than three months, or
both, at the discretion of the court (Act 1886, No. 55, s. 1).
No criminal prosecution shall bar the imposition of a fine
by civil process, nor shall the imposition of such fine bar crim-
inal prosecution {ib., s. 2).
Exceptions. — This act is not applicable to practitioners of
medicine or surgery residing and practising in other States,
who may be summoned in special instances to attend patients
in the State by any registered phj^sician {ib., s. 3).
Fees. — To board of health, for every diploma certified, 50
cents {ib., s. 1).
To officer before whom affidavit is made, 50 cents {ib., s.
2, 3).
Recording same, 81 {ib., s. 2).
To clerk of court, for copy of original affidavit, 50 cents
{ib., s. 2).
To State board of health, for copy of original affidavit, 50
cents {ib., s. 3).
Maine.
Qualification, Penalty. — No person who has not received
a medical degree at a public medical institution in the United
States, or a license from the Maine Medical Association, shall
MAINE — MARYLAND. 165
recover compensation for medical or surgical services, unless
previous to such service he had obtained a certificate of good
moral character from the municipal officers of the town where
he then resided (Rev. Stats., 1883, c. 13, s. 9).
Maryland.
Qualification. — By the Act of 1892, c. 296, s. 1, 39, it is
provided that every person not now practising medicine and
surgery, who shall hereafter begin to practise medicine and
surgery in any of its departments, shall possess the qualifications
required by the act.
There are two boards of examiners, representing the medical
and chirurgical faculty of the State and the State Homa?opathic
Medical Societ}" respectively ; each consists of seven members,
appointed respectively by those societies, physicians actually en-
gaged in the practice of medicine, and of recognized abilit}' and
honor; but no physician having a pecuniary interest in the
trade of pharmacy can be appointed {ib., s. 2).
Suitable provisions must be made by each examining board
to prepare a schedule of written examination upon anatomy,
physiology, chemistry, surgery, practice of medicine, materia
medica and therapeutics, obstetrics, gyngecology, pathologj'',
medical jurisprudence and hygiene ; the same standard of ex-
cellence is required from all candidates; in therapeutics and
practice, the questions must be in harmony with the tenets of
the school selected by the candidate ; and the standard of ac-
quirements therein is established by each board itself. The
examination must be fundamental in character and such as can
be answered in common by all schools of practice (ib., s. 1, 42).
Application for license is made in writing to the president
of either board of medical examiners which the applicant may
elect, with satisfactory proof that the applicant is more than
twenty-one years of age, is of good moral character, has ob-
tained a competent common-school education, and has either
received a diploma conferring the degree of Doctor of Medicine
from some legally incorporated medical college in the United
States, or a diploma or license conferring the full right to prac-
tise all the branches of medicine and surger}' in some foreign
country, and has also both studied medicine three years and
166 SYNOPSIS OF LAWS — POSTE AND BOSTON.
attended three courses of lectures in different years in some
legally incorporated medical college or colleges prior to the
granting of the diploma or foreign license ; two courses of med-
ical lectures both begun or completed within the same calendar
3"ear do not satisfy the requirement; this condition is not ap-
plicable to students who shall be in their second year in a med-
ical college, nor to physicians practising at the time of the
passage of the act. Such proof is made, if required, upon aflB-
davit, upon making the application and proof and paj^ment of
the fee. The president of the board, if satisfied, must direct
the secretary to issue an order for examination, and when the
applicant shall have passed an examination as to proficiency
satisfactory to the board, the president must grant a license to
practise medicine and surgery {ib., s. 1, 43).
All of the examinations are conducted so that the name,
school of graduation, and preparatory training of the applicant
shall not be made known to the board till his examination
papers have been graded. ' An applicant receiving a majoritj^
of the votes of the board is considered to have passed a satis-
factory examination and is entitled to a license {ib., s. 1, 44).
The board must refuse a license to an applicant radically
deficient in any essential branch. In case of a failure, the can-
didate must have the privilege, after the expiration of one year
from his rejection, of another examination by the board to
which his application was first made {ib., s, 1, 46).
A license, or a certified copy, must be filed with the clerk
6t the circuit court of the county or city in which the licensee
may practise ; the number of the book and page containing the
recorded copy must be noted in the body of license.
Evidence. — The records have the same weight as evidence
that is given to the record of conveyances of land {ib., s. 1, 48).
Exceptions. — The act does not apply to commissioned
surgeons of the United States army, navy, or marine hospital
service, to physicians or surgeons in actual consultation from
other States, nor to persons temporarily practising under the
supervision of an actual medical preceptor, nor to a midwife or
person who may render gratuitous services in case of emergency
{ib., s. 1, 49, 51).
Penalty. — Practising, or attempting to practise, without
a license is a misdemeanor punishable with a fine of from $50
MARYLAND — MICHIGAN. 1(37
to $200 for each offence, with confinement in jail, in default of
payment, till fine and costs are paid ; a person so practising is
debarred from recovering compensation (^6,, s. 1, 50).
Fees. — To secretary of board, before examination, $10 {ib.y
s. 1, 45).
To clerk of court, for registration, $1 {ib., s. 1, 48).
Massachusetts.
In Massachusetts there is no statute upon this subject.
Michigan.
Qualification. — It is unlawful to practise medicine or
surgery or any branch except dentistry, without the prescribed
qualifications and registration in the office of the county clerk
(Laws 1883, c. 167, s. 1).
A person who was practising when the law took effect, and
had been practising continuously for at least five years prior
thereto in the State, is deemed qualified to practise medicine
after registration (ib., s. 2, as amended 1887, c. 268).
A graduate of a legally authorized medical college in the
State, or any of the United States, or any other countr}^, is
deemed qualified to practise medicine and surgery in all de-
partments after registration. A student or undergraduate is
not prohibited from practising with and under the immediate
supervision of a person legally qualified to practise medicine
and surgery (ib.).
A person qualified registers by filing with the county clerk
of the count}'" where he practises, or intends to practise, a sworn
statement setting forth, if actually engaged in practice, the
length of time he has been engaged in such continuous practice ;
if a graduate of a medical college, the name and location of the
same, when he graduated and how long he attended the same,
and the school of medicine to which he belongs; if a student or
undergraduate, how long he has been engaged in the study of
medicine and where, and if he has attended a medical college,
its name and location and the length of his attendance, and
when, and the name and residence of the physician inuler
whose instruction he is practising, or intends to practise. The
statement is to be recorded by the clerk (ib.).
168 SYNOPSIS OF LAWS — POSTE AND BOSTON.
Penalty. — No person practising medicine, surgery, or mid-
wifery can collect pay for professional services unless at the
time of rendering such services he was duly qualified and reg-
istered {ih., s. 4).
Advertising, or holding out to the public, as authorized to
practise medicine or surger}-, when not authorized, is a misde-
meanor punishable with a fine of from $5 to $50 for each offence
{ih., s. 7).
Fees. — To county clerk, for recording statement, 50 cents
{ih., s. 2).
Minnesota.
Board of Examiners. — The governor appoints a board of
medical examiners of nine members, no one of whom can be
a member of a college or university having a medical depart-
ment, and two of whom must be homoeopathic physicians (Act
1887, c. 9, s. 1).
Qualification. — Persons commencing the practice of med-
icine and surgery in any of its branches must apply to the board
for a license, and at the time and place designated by the board,
or at a regular meeting, submit to an examination in anatomy,
physiology, chemistry, histology, materia medica, therapeutics,
preventive medicines, practice of medicine, surgery, obstetrics,
diseases of women and children, of the nervous system, of the
eye and ear, medical jurisprudence, and such other branches as
the board deems advisable, and present evidence of having at-
tended three courses of lectures of at least six months each ; the
examination must be scientific and practical, but of sufficient
severity to test the candidate's fitness to practise medicine and
surgery. When desired, the examination may be conducted in
the presence of the dean of any medical school or the president
of any medical society of this State. After examination, the
board must grant, with the consent of at least seven members,
a license to practise medicine and surgery, which may be refused
or revoked for unprofessional, dishonorable, or immoral con-
duct; and in case of refusal or revocation, the applicant may
appeal to the governor {ih., s. 3).
The license must be recorded with the clerk of the district
court in the county in Avhich the licensee resides ; if he moves
into another county he must procure a certified copy of his
MINNESOTA — MISSISSIPPI. 109
license from the said clerk and file it with the clerk of the dis-
trict court in the latter county {ib., s. 4).
Penalty. — To practise without a license is a misdemeanor,
punishable by a fine of from $50 to $100, or imprisonment in
county jail from ten to ninety days, or both. Appending " M. D. "
or " M.B." to name, or prescribing, directing, or recommending
for use any drug or medicine or other agency for the treatment,
care, or relief of any wound, fracture, or bodily injury, infirm-
ity, or disease, is regarded as practising medicine.
Exceptions. — The act is not applicable to dentists {ib., s.
6), nor to commissioned surgeons of the United States army or
navy, nor to physicians or surgeons in actual consultation from
other States or Territories, nor to actual medical students prac-
tising medicine under the direct supervision of a preceptor
{ib., s. 5).
All persons licensed under the Act of 1883, c. 125, are re-
garded as licensed under this act {ib., s. 7).
Fees. — To treasurer of board, for examination, $10.
Mississippi.
Qualification. — A practitioner of medicine must obtain
a license from the State board of health (Code 1892, s. 3,243).
Application is made in writing; and an examination is
made in anatomy, chemistry, obstetrics, materia medica, phys-
iology, pathology, surgery, and hygiene, and if the applicant
is found b}?^ the board to possess sufficient learning in those
branches, and of good moral character, the board issues a license
to practise medicine, signed by each member who approves
{ib., s. 3,244).
The application must state the applicant's full name, place
of residence, and post-office address, nativity and age, time
spent in medical studies, name and post-office address of the
preceptor under whom his medical studies were pursued, the
courses of medical lectures attended, the name of medical
schools attended ; if a graduate of n medical college, the name
thereof; the time spent in a hospital, the time spent in the
practice of medicine, if an 5% the school or s^^stem of practice
chosen, and references as to his personal character {ib., s.
3,245).
170 SYNOPSIS OF LAWS — POSTE AND BOSTON.
Examinations are to be conducted at the capital on the first
Tuesday in April and October annually, and continue until all
applicants are examined and the examinations are approved or
disapproved; they are upon written questions and answers, and
no distinction can be made between applicants because of differ-
ent systems or schools of practice.
The license must be filed in the office of the clerk of the
circuit court of the county in which the licensee resides, within
sixty days from the date of its issue ; otherwise it becomes void.
The clerk must record the same with his certificate of filing and
deliver the original to the licensee. When the licensee changes
the county of his residence and usual practice, he must file the
original or a certified copy of license, or record, in the office of
said clerk in the county into which he shall move and practise
within sixty days of the time of his removal, to be there re-
corded (^&., s. 3,249).
The board may issue a duplicate in place of a lost license
{ib., s. 3,250).
The secretary of the board may issue a temporary license
which shall be valid until the next succeeding meeting of
board, such license to show its date of issue, otherwise to be
void ; it must be recorded as a permanent license is required
to be ; only one temporary license shall ever be issued to the
same person, and it shall always be made to an individual and
not to a partnership (ib., s. 3,251).
Physicians practising by virtue of a license under prior laws
are not required to obtain a license under this law and may
continue in practice under their licenses, but they must comply
with the requirements of this law with reference to recording
{lb., s. 3,252).
Penalty. — To practise without an examination and a license
is punishable with a fine of from $20 to $200, or to imprison-
ment in the county jail not to exceed thirty days {ib., s. 1,258).
Exceptions. — Females engaged in the practice of mid-
wifery need no license for that emploj'ment (ib., s. 3,253).
Non-Residents. — Licensed physicians residing without the
State, and whose practice extends into it, may obtain a license
without examination by presenting an application in the form
prescribed ; whereupon the secretary of the board must issue
a license in the name of the board and the license must be re-
MISSISSIPPI— MISSOURI. 171
corded as hereinbefore provided, in each county in which the
licensee shall practise {ih., s. 3,254).
Fees. — To board, before examination, $10.
To secretary, before examination, 25 cents {ih.^ s. 3,247).
To secretary, for temporary license, 25 cents (^7)., s. 3,251).
To secretary, for license to non-resident, 25 cents {ib., s.
3,245).
To the clerk of the court, for recording, his legal fees {ih.,
s. 3,249).
Missouri.
Qualification. — Every person practising medicine and
surgery, in any of their departments, must possess the quali-
fications required. If a graduate of medicine, he must present
his diploma to the State board of health for verification as to
its genuineness. If the diploma is found to be genuine, and
the person named therein to be the person claiming and pre-
senting the same, the board must issue a certificate which
is conclusive of the right to practise. If not a graduate, he
must submit to such examination as the board shall require,
and if the examination is satisfactory to the examiners tlie
board must issue its certificate in accordance with the facts,
and the holder shall be entitled to all the rights and privileges
herein mentioned (Rev. Stats., 1889, s. 6,871).
The board must issue certificates to all who furnish satis-
factory proof of having received a diploma or license from a
legally chartered medical institution in good standing, of what-
ever school or system of medicine, and shall not make any
discrimination against the holders of genuine licenses or di-
plomas under any school or system of medicine {ih., s. ri,872).
The verification of a diploma consists in the aflSdavit of the
holder and applicant that he is the lawful possessor of the same,
and the person therein named; the affidavit may be taken
before any person authorized to administer oaths, and shall be
attested under the hand and official seal of such officer, if he
have a seal. Graduates may present their diplomas and affi-
davits by letter or proxj^ {ih., s. 6,873).
All examinations are made directlj^ by the board, and the
certificates authorize the possessor to practise medicine and
surgery in the State {ib., s. 6,874).
173 SYNOPSIS OF LAWS — POSTE AXD BOSTON.
The certificate must be recorded in the office of the county
clerk of the county in which the holder resides and the record
must be indorsed thereon ; a person moving to another county
to practise must procure an indorsement to that ejffect on the
certificate from the said clerk, and have the certificate recorded
in the office of the clerk of the county to which he removes
{lb., s. 6,875).
Examinations may be made wholly or partly in writing and
must be of an elementary and practical character, but suffi-
ciently strict to test the qualifications of the candidate as a
practitioner {lb., s. G,877).
The board may refuse a certificate to an individual guilty
of unprofessional or dishonorable conduct, and may revoke a
certificate for like causes after giving the accused an opportu-
nity to be heard {lb., s. 6,878).
Definition, Exception. — A person is regarded as practis-
ing medicine who professes publicly to be a physician and to
prescribe for the sick, or who appends to his name "M.D.,"
but students are not prohibited from prescribing under the
supervision of a preceptor, and gratuitous services may be ren-
dered in case of emergencj", and the act does not apply to
commissioned surgeons of the United States army or navy or
marine hospital service {ib, s. 6,879).
Itinerant Venders. — Every itinerant vender of any drug,
nostrum, ointment, or appliance intended for the treatment of
disease or injury, or who publicly professes to cure or treat
disease, injury, or deformity by any drug, nostrum, manipula-
tion, or other expedient, must pay a license fee of $100 per
month; the violation of this section is a misdemeanor, punish-
able with a fine not exceeding 8500 or imprisonment in the
county jail not to exceed six months, or both {ib., s. 6,880).
Penalty. — The violation of the provisions of this act is a
misdemeanor punishable with a fine of from $50 to $500, or im-
prisonment in the county jail for from thirtj' to three hundred
and sixty-five daj^s, or both, for each offence ; filing or attempt-
ing to file the certificate of another, or a forged affidavit or
identification, is a felony punishable as forgery in the second
degree, but the provisions of this article do not apply to persons
who had been practising five years in the State prior to 1883
(ib., s. 6,881).
MISSOURI — MONTANA. 173
Fees. — To the secretary of the board, for examining a
genuine diploma, SI.
If fraudulent or not owned by the possessor, 820 (ib., s.
6,873).
To the clerk, for recording, the usual fees {ib., s. 6,875).
Montana.
Board of Examiners.— The governor, with the advice
and consent of the council, appoints seven learned, skilled, and
capable physicians who have been residents for not less than
two 3"ears, no more than two from the same county, to con-
stitute the board of examiners (Act of February 28tli, 1889,
s. 1).
Meetings of the board for examination are required to be
held at the capital and such other central points as the board
may select, on the first Tuesday of April and October in each
year, and at other times as the board may determine. The
board must keep a record of all applicants for a certificate, with
their age, time spent in the study of medicine, name, and the
location of all institutions granting to applicants degrees or
certificates of lectures in medicine or surgery, and whether the
applicant was rejected or received a certificate, and the register
is prima facie evidence of matters therein recorded {ib., s. 2).
Qualification. — Every person wishing to practise med-
icine or surger}'^ in an}' of their departments shall do so only
upon complj'ing with the requisites of this act. If a graduate
in medicine, he must present his diploma to the board for veri-
fication as to its genuineness. If it be found genuine and
issued by a medical school legally organized and in good
standing, whose teachers are graduates of a legally organized
school, which fact the board determines, and if the person
presenting and claiming the diploma be the person to whom it
was originally granted, the board must issue its certificate,
which shall be conclusive of the holder's right to practise.
Any person coming to the State may present his diploma to any
member of the board, who maj'" issue a certificate good till the
board's next regular meeting. If not a graduate, the person
must present himself to the board for such examination as may
be required, unless he shall have been in continuous practice
174 SYNOPSIS OF LAWS — POSTE AND BOSTON.
in the State for not less than ten years, of which fact he must
present satisfactory evidence in the form of affidavits to the
board {ib., s. 3).
All persons entitled to practise under the ten-year provision
and all persons commencing the practice of medicine and sur-
gery in any of its branches shall apply to the board for a certifi-
cate, and at the time and place designated by the board, or at the
regular meeting, be examined in anatomy, physiology, chemis-
try, histology, materia medica, therapeutics, preventive medi-
cines, practice of medicine, surger}^, obstetrics, diseases of
women and children, diseases of the nervous system, diseases
of the eye and ear, medical jurisprudence, and such other
branches as the board may deem advisable, and present evidence
of having practised the required term of ten years, or of having
attended three courses of lectures of at least four months each ;
the examination must be both scientific and practical, and of
sufficient thoroughness and severity to test the candidate's fit-
ness to practise medicine and surgery. The examination may
be held in the presence of the dean of any medical school or of
the president of any medical society of the State. After the
examination, the board must grant to a candidate who is found
qualified, a certificate to practise medicine and surgery. The
board may refuse or revoke a certificate for unprofessional,
dishonorable, or immoral conduct, or maj" refuse a certificate to
any one who may publiclj^ profess to cure or treat diseases, in-
juries, or deformities in such manner as to deceive the public.
In cases of refusal or revocation, the aggrieved ap^Dlicant may
appeal to the district court of the county of his application
{ih., s. 4).
Certificates must be recorded within sixty days after their
date in the office of the county recorder in the county where the
holder resides ; or in case of removal certificates must be re-
corded in the county to which the holder removes. The county
recorder must indorse on the certificate the date of its record
{ih., s. 5).
Exceptions. — The act does not apply to midwives of skill
and experience attending cases of confinement, nor to com-
missioned surgeons of the United States army or navy in the
discharge of their official duties, nor to physicians or surgeons
in actual consultation from other States and Territories, nor to
MONTANA — NEBRASKA. 175
students practising medicine under the direct supervision of a
preceptor, nor to gratuitous services in cases of emergency {ib.,
s. 6).
Penalty. — Violation of the act is a misdemeanor, punish-
able with a fine of from $100 to $500, or imprisonment in the
county jail from thirty to ninety days, or both.
Definition. — Any person is regarded as practising within
the meaning of the act who appends "M.D." or ''M.B." to his
name, for a fee prescribes medicine, operates in surgery, attends
in obstetrics, or recommends for the use of any sick person the
use of any drug or medicine or other agency of treatment, cure,
or relief of any wound, fracture, or bodily injury or disease, as
a physician or surgeon (ib., s. 7).
Be-examination. — Any one failing to pass the examina-
tion is entitled to a second examination within six months
without fee {ib., s. 8).
Fees. — To the treasurer of the board, for examination, $15
(i&., s. 4).
To the secretary of the board, for examination, in advance,
$15 (ib., s. 8).
To the county recorder, for recording, the usual fee (ib.,
s. 5).
To the count}^ attorney, for prosecuting a violation, to bi-
charged as costs, $5 [ib., s. 7).
Nebraska.
Qualification. — It is unlawful for any person to practise
medicine, surgery, or obstetrics, or any of their branches, with-
out having obtained and registered a certificate. No person
is entitled to a certificate unless he be a graduate of a legally
chartered medical school or college in good standing. The
qualifications are determined by the State board of health. The
act does not prevent physicians residing in other States from
visiting patients in consultation with resident physicians who
have complied (Act of 1891, c. 35, s. 7).
A medical school is defined as a medical school or college
which requires a previous examination for admission to its
courses of study, and which requires for granting the degree of
"M.D." attendance on at least three courses of lectures of six
176 SYNOPSIS OF LAWS — POSTE AND BOSTON.
luouths each, no two of said courses to be held within one
year, and having a full faculty of professors in anatomy, phys-
iology, chemistry, toxicology, pathology, hygiene, materia
medica, therapeutics, obstetrics, gynaecology, p^^^^^c^pZe (sic)
and practice of medicine and surgery, and clinical instruction
in the last two named. But the three-year clause does not
apply to degrees granted prior to Julj^ 1891 {ib., s. 8).
A person intending to practise medicine, surgery, or obstet-
rics must present his diploma to the said board, with his affi-
davit that he is the lawful possessor of the same and has at-
tended the full course of study required for the degree of
"M.D.," and that he is the person therein named. Such affi-
davit may be taken before any person authorized to administer
oaths, and it shall be attested under the hand and official seal
of the official, if he have a seal. False swearing is perjury
{ib., s. 9).
If investigation of the diploma and affidavit proves the
applicant entitled to practise, the board issues its certificate,
which must be filed in the office of the county clerk of the
county where he resides, or intends to practise {ib., s. 10).
The act gave physicians entitled to practise at the time of
its enactment six months in which to comply with its provi-
sions with reference to them {ib., s. 11).
The secretaries of the board may issue certificates, without
a vote of the board, when the proof upon which certificates are
granted may have been on file in its office for ten days without
a vote of the board, when no protest has been filed, and if, in
their opinion, the proof complies with the act {ib., s. 12).
When the holder of a certificate removes to another county,
he must file and record it in the office of the county clerk in the
county to which he removes {ib., s. 13).
The board may refuse certificates to persons guilty of un-
professional or dishonorable conduct, and may revoke for like
causes provided they give the person an opportunity to be heard
{ib., s. 14).
Penalty. — No person is entitled to receive any sum of
money for medical, surgical, or obstetrical service unless he shall
have complied with the act {ib., s. 15).
Violation of the act is a misdemeanor, punishable with a
fine of from $50 to $300 and costs of prosecution, and a person
NEBRASKA — NEVADA, 177
convicted shall stand committed till the fine and costs are paid
(lb., s. 16).
Definition, Exceptions. — To operate on, profess to heal,
prescribe for, or otherwise treat any physical or mental ailment
of another, is to practise medicine under this act. But it does
not prohibit gratuitous services in cases of emergency, nor
apply to commissioned surgeons in the United States army or
navy, nor to nurses in their legal occupation, nor to the admin-
istration of ordinary household remedies {ib., s. 17).
Itinerant Vender. — To be an itinerant vender of any drug,
nostrum, ointment, or appliance for the treatment of disease or
injury, or for such an one to publicly profess to cure or to treat
disease or injury or deformity by any drug, nostrum, manip-
ulation, or other expedient, is a misdemeanor punishable with
a fine of from $50 to $100, or imprisonment in the county jail
from thirty days to three months, or both, for each ollPence
(ib., s. 18).
Fees. — To the secretaries of the board of health, for certifi-
cate at time of application, $5.
To the secretaries of the board of health, for taking testi-
mony, same fees as a notary public is allowed for same ser-
vice (ib., s. 19).
To county clerk, for recording, usual register's fees for re-
cording (lb., s. 10).
Nevada.
Qualification. — No person can lawfully practise medicine
or surgery who has not received a medical education and a
diploma from some regularly chartered medical school having
a bona fide existence when the diploma was granted (Act of
1875, c. 4r3, s. 1).
A copy of the diploma must be filed for record Avith the
county recorder of the county in which the person practises,
and at the same time the original, or a certificate from the
dean of the medical school of which he is a graduate, certif j4ng
to his graduation, nmst be exhibited {ib., s. 2).
The person filing a copy of a diploma or a certificate of
graduation must be identified as the person named therein, by
the affidavit of two citizens of the count}', or his fiffidavit taken
before a notary public or commissioner of deeds for this State,
12
178 SYNOPSIS OF LAWS — POSTE AND BOSTON.
which affidavit must be filed in the office of the county recorder
(^■^)., s. 3).
Penalty. — Practising without complying with this act is a
misdemeanor punishable with a fine of from $50 to $500, or
imprisonment in the county jail from thirty days to six months,
or both, for each offence. Filing a diploma or a certificate of
another or a forged affidavit of identification is a felony (i6.,
S.4).
Exceptions. — The act does not apply to a person who in an
emergency may prescribe or give advice in medicine or surgery
in a township where no physician resides, or when no physi-
cian or surgeon resides within convenient distance, nor to those
who had practised medicine or surgery in the State for ten
years next preceding the passage of the act, nor to persons pre-
scribing in their own family {ib., s. 6).
New Jersey.
Board of Examiners. — The State board of medical ex-
aminers, appointed hj the governor, consists of nine members,
persons of recognized professional ability and honor, five of the
old school, three of the homoeopathic, and one of the eclectic,
among whom can be no member of any college or university
having a medical department (Act 1890, c. 190, s. 1).
The board must hold meetings for examination at the capital
on the second Thursday of January", April, July, and October
of each year and at such other times as they deem expedient ;
they shall keep a register of all applicants for examination,
showing the name, age, and last place of residence of each can-
didate, the time he has spent in medical study in or out of a
medical school, the names and locations of all medical schools
which have granted the said applicant any degree or certificate
of attendance upon lectures in medicine, and whether the appli-
cant has been rejected or licensed, and it shall he prima facie
evidence of all matters contained therein {ih., s. 2).
Qualification. — All persons commencing the practice of
medicine or surgery in anj- of its branches must apply to the
board for a license. Applicants are divided into three classes :
1. Persons graduated from a legally chartered medical school
not less than five years before the application.
NEW JERSEY. 170
2. All other persons graduated from legally chartered med-
ical schools.
3. Medical students taking a regular course of medical in-
struction.
Applicants of the first class are examined in materia medica,
therapeutics, obstetrics, gynaecology, practice of medicine, sur-
gery, and surgical anatomy; those of the second and third
classes are examined in anatomy, physiology, chemistr}-, ma-
teria medica, therapeutics, histology, pathology, hygiene, prac-
tice of medicine, surger}^, obstetrics, gynaecology, diseases of
the eye and ear, medical jurisprudence, and such other branches
as the board may deem advisable ; questions for applicants of
the first and second classes are the same in the branches com-
mon to both. The board after January 1st, 1892, cannot license
applicants of the second or third classes without satisfactory
proof that the applicant has studied medicine and surgery three
years, is of good moral character, and over twenty-one years of
age ; applicants of the third class, after they shall have studied
medicine and surgery at least two years, can be examined in
anatomj^, physiology, chemistry, histology, pathology, materia
medica, and therapeutics ; if the examination is satisfactory^ to
all the members of the board, it may issue a certificate that the
applicant has passed a final examination in these branches, and
such certificate, if presented by the applicant when he shall
make application for a license to practise, shall be accepted by
the said board in lieu of examination in those branches. All
examinations shall be both scientific and practical, but of suffi-
cient severity to test the candidate's fitness to practise medicine
and surger}' (?'&., s. 3).
All examinations shall be in writing; the questions and
answers, except in materia medica and therapeutics, must be
such as can be answered in common by all schools of practice,
and if the applicant intends to practise homoeopathy or eclec-
ticism, the member or members of the said board of those
schools shall examine the said applicant in materia medica and
therapeutics ; if the examination is satisf actorj^, the board shall
issue a license entitling the applicant to practise medicine. A
license shall not be issued unless the applicant passes an exam-
ination satisfactory to all members of the board ; the examina-
tion papers kept on file by the secretary of the board are prima
180 SYNOPSIS OF LAWS — POSTE AND BOSTON.
facie evidence of all matters therein contained ; on refusal of
the board to issue a license for failure on examination, the
applicant may appeal to the governor, who may appoint a med-
ical commission of review of three members, one from each
school of medicine, who shall examine the examination papers
of the applicant and from them determine whether a license
should be issued, and their decision shall be final ; if the said
committee by unanimous vote reverse the determinatioii of the
board, the board shall issue a license ; the expenses of the ap-
peal are borne by the applicant {ih., s. 4).
The board may, by unanimous vote, refuse or revoke a
license for chronic and permanent inebriety, the practice of
criminal abortion, conviction of a crime involving moral turpi-
tude, or for publicly advertising special ability to treat or cure
disease which, in the opinion of the said board, it is impossible
to cure.
In complaints for violating this section, the accused shall be
furnished with a copy of the complaint and giA'en a hearing
before the said board in person or by attorney {ib., s. 5).
A person receiving a license must file it, or a certified copy
thereof, with the clerk of the county in which he resides ; and
in case of removal into another county he must procure from
the said clerk a certified copy of the said license, and file it with
the clerk in the countj^ to which he shall remove (*7>., s. 6).
Exceptions. — The act does not appl}^ to commissioned sur-
geons of the United States army, navy, or marine hospital ser-
vice, or to regularly licensed phj'-sicians or surgeons in actual
consultation from other States or Territories, or to regularly
licensed physicians or surgeons actually called from other
States or Territories to attend cases in this State, or to any one
while actually serving as a member of the resident medical
staff of anj- legally incorporated hospital or asylum in this
State, or to any person claiming the right to practise in this
State who has been practising therein since before July 4th,
1890, provided the said right or title was obtained upon a di-
ploma of which the holder and applicant was lawfully possessed
and it was issued by a legally chartered medical institution
in good standing {ih., s. 7, as amended Act 1892, c. 212).
Definition. — Any person is regarded as practising medicine
or surgery who appends "M.D." or "M.B." to his name, or pre-
NEW JERSEY — NEW MEXICO- 181
scribes for the use of anj- person any drug or medicine or odior
agency for the treatment, cure, or relief of any bodily injury,
infirmity, or disease {ih., s. 8).
Penalty. — Commencing the practice of medicine or surgery
without a license or contrary to the act is a misdemeanor pun-
ishable by a fine of from 650 to $100, or imprisonment in the
county jail from ten to ninety days, or both {ib., s. 0).
Fees. — To the treasurer of the board, for examination, for
applicant of first and second class, $15.
To the treasurer of the board, for examination, for applicant
of third class, $20 (?'6., s. 4).
To the county clerk, for registering license, 50 cents {ih.,
s. 6).
New Hampshire.
In New Hampshire there is no statute on this subject.
New Mexico.
Board of Examiners. — The board of medical examiners
is composed of seven practising physicians of known abilitj" and
integrity, graduates of some medical school, college, or uni-
versity duly established under and by virtue of the laws of the
country in which it is situated, four allopathic members, three
homoeopathic members, and one eclectic member (Compiled
Laws 1884, s. 2,553).
Qualification. — Applications for certificates and exami-
nations are made to the board through their secretary (?'6., s.
2,555).
The board must examine diplomas as to their genuineness;
the verification consists in an affidavit of the holder and appli-
cant that he is the lawful possessor of the diploma and the
person therein named ; the affidavit may be taken before any
person authorized to administer oaths, and shall be attested
under his hand and official seal if he have a seal. Graduates
may present their diplomas and affidavits by letter or by proxy
(^&., s. 2,556).
Examinations of persons not graduates or licentiates must
be made by the board, and certificates by a majority of the board
182 SYNOPSIS OF LAWS — POSTE AND BOSTON.
authorize the possessor to practise medicine and surgery {ib.,
s. 2,557).
The certificate must be recorded in the county clerk's office
in every county in which the holder practises or attempts to
practise medicine or surgery {ib., s. 2,558).
When a certificate is filed, the clerk must record it and at-
tach his certificate thereto, showing the date of filing and re-
cording and the number of the book and the page of the
record {ib., s. 2,559).
Examinations of persons not graduates must be made by
the board and may be wholly or partly in writing, in anatomy,
physiology, chemistry, pathology, surgery, obstetrics, and the
practice of medicine (exclusive of materia medica and thera-
peutics) {ib., s. 2,561).
The board may refuse or revoke a certificate to an individ-
ual guilt}^ of unprofessional or dishonorable conduct {ib., s.
2,562).
Definition, Exceptions. — Practising medicine is defined
as professing publicly to be a physician and prescribing for the
sick or appending to a name the letters "M.D." The act does
not prohibit students from prescribing under the supervision
of a preceptor, nor prevent women from practising midwifery,
nor prohibit gratuitous services in cases of emergency', nor apph-
to commissioned surgeons or acting surgeons of the United
States army or navy {ib., s. 2,563).
Penalty. — Practising medicine or surgery without com-
plying with the act is punishable with a fine of from 650 to
$500 for each offence; and filing a diploma or a certificate
of another, or a forged affidavit of identification, is a felony
punishable the same as forgery.
Exception. — The provisions of the act do not apply to those
who have been practising medicine ten years in the Territory
{ib., s. 2,564, Act passed 1882).
Professional Conduct.— The code of ethics of the United
States Medical Association is the standard, and the rule of de-
cision, concerning professional conduct {ib., s. 2,565).
Penalty. — Persons unlawfully collecting or receiving fees
or compensation for services as phj^sicians or surgeons in viola-
tion of this act, are liable to the partj^ paying it for double
the amount thereof {ib., s. 2,568).
NEW MEXICO — NEW YORK. 183
Fees. — To the secretary of the board, from each graduate or
licentiate if the diploma is genuine, $5.
To the secretary of the board, from each graduate or
licentiate if the diploma is fraudulent or not owned by the pos-
sessor, $20 {ib., s. 2,556).
To clerk of the county, for filing and recording certificate,
the usual fees (ib., s. 2,559).
To the secretary of the board, for examination, in advance,
$10 {ib., s. 3,561).
New York.
Prohibition. — No person can lawfully practise medicine
unless registered and legally authorized prior to September
1st, 1891, or unless licensed by the regents of the University
of the State of New York and registered as required by the
present law; nor can any person lawfully practise medicine
who has ever been convicted of a felony by any court, or whose
authority to practise is suspended or revoked by the regents on
the recommendation of a State board (Laws of 1893, c. 661, s.
140).
Boards of Examiners. — There are three separate State
boards of medical examiners of seven members each, represent-
ing respectively the Medical Society of the State, the Homoeo-
pathic Medical Society of the State, and the Eclectic Medical
Society of the State.
The regents appoint examiners from lists of nominees fur-
nished by the said societies. Each nominee before his appoint-
ment is required to furnish to the regents proof that he has
received the degree of doctor of medicine from some registered
medical school, and has legally practised medicine in this State
for at least five years. If no nominees are legally before them,
the regents may appoint from the members in good standing of
such societies without restriction (ib., s. 141).
At any meeting of the boards of examiners a majority con-
stitute a quorum, but questions prepared by the boards may be
grouped and edited, or answer papers of candidates may be
examined and marked, by committees duly authorized by the
boards and by the regents (ib., s. 144).
Qualification. — The regents are required to admit to ex-
184 SYNOPSIS OF LAWS — POSTE AND BOSTON.
amination any candidate who pays a fee of $25, and submits
satisfactory evidence, verified by oath, if required, that he —
(1) Is more than twenty-one years of age; (2) is of good
moral character ; (3) has the general education required in all
cases after August 1st, 1895, preliminary to receiving the
degree of bachelor or doctor of medicine in this State ; (4) has
studied medicine not less than three full years, including three
satisfactory courses in three different academic years in a med-
ical school registered as maintaining at the time a satisfactory
standard; (5) has either received the degree of bachelor or
doctor of medicine from some registered medical school or a
diploma or license conferring the full right to practise medicine
in some foreign country.
The degree of bachelor or doctor of medicine shall not be
conferred in the State before the candidate has filed with the
institution conferring it the certificates of the regents that
three years before the date of his degree, or before or during his
first year of • medical studies in the State, he had either grad-
uated from a registered college or satisfactorily completed not
less than a three years' academic course in a registered academy-
or high school ; or had a preliminary education considered and
accepted by the regents as fully equivalent ; or had passed a
regents' examination in arithmetic, elementary English, geog-
raphy, spelling. United States history, English composition, and
physics. Students who had matriculated in a New York med-
ical school before June 5th, 1890, are exempt from this pre-
liminary education requirement provided that the degree be
conferred before August 1st, 1895.
The regents may in their discretion accept as equivalent for
anj" part of the third and fourth requirements evidence of five
or more years' reputable practice of medicine, provided such
substitution be specified in the license {ib., s. 145).
Each board is required to submit to the regents as required
lists of suitable questions for a thorough examination in anat-
omy, physiology, and hygiene, chemistry, surgery, obstetrics,
pathology and diagnosis and therapeutics, including practice
and materia medica. From these lists the regents are required
to prepare question papers for all these subjects, which at any
examination are required to be the same for all candidates,
except that in therapeutics, practice, and materia medica all
NEW YORK. 185
questions submitted to any candidate shall be chosen from those
prepared by the board selected by that candidate, and shall be
in harmony with the tenets of that school as determined by its
State board of medical examiners {ib., s. 140).
Examinations for a license are required to be given in at
Jeast four convenient places in this State at least four times
annualh" in accordance with the regents' rules, and exclusively
in writing and in English. Each examination is conducted by
a regents' examiner who shall not be one of the medical exam-
iners. At the close of each examination the regents' examiner
in charge is required to deliver the question and answer papers
to the board selected by each candidate, or its duly authorized
committee, and such board, without unnecessary dela}", is re-
quired to examine and mark the answers and transmit to the
regents an official report stating the standing of each candidate
in each branch, his general average, and whether the board
recommends that a license be granted. Such report must in-
clude the questions and answers and is filed in the public records
of the university. If the candidate fails on a first examination,
he may, after not less than six months' further stud}", have a
second examination without fee. If the failure is from illness
or other cause satisfactor}^ to the regents they may waive the
requirement of six months' study {ib., s. 147).
On receiving from a State board an official report that the
applicant has successfully passed the examinations and is recom-
mended for license, the regents are required to issue to him, if
in their judgment he is duly qualified therefor, a license to
practise medicine. The contents and execution of the license
are regulated in detail by the act.
Applicants examined and licensed by other State examining
boards registered by the regents as maintaining standards not
lower than those provided by this article, and applicants who
matriculated in a New York State medical school before June
5th, 1890, and who shall have received the degree of "M.D."
from a registered medical school before August 1st, 1895, may,
without further examination, on the payment of ten dollars to
the regents, and on submitting such evidence as they may re-
quire, receive from them an indorsement of their license or
diploma conferring all the rights and privileges of a regents'
license issued after an examination.
186 SYNOPSIS OF LAWS — POSTE AND BOSTON,
If any person whose registration is not legal because of
some error, misunderstanding, or unintentional omission shall
submit satisfactory proof that he had all the requirements pro-
vided by law at the time of his imperfect registration, and was
entitled to be legally registered, he may, on the unanimous
recommendation of a State board of medical examiners, receive
from the regents under seal a certificate of the facts, which may
be registered by any countj^ clerk and shall make valid the
previous imperfect registration.
Before any license is issued, it must be numbered and re-
corded in a book in the regents' office, and its number noted in
the license. This record in all legal proceedings has the same
weight as evidence that is given to a record of conveyances of
land {ih., s. 148).
Every license to practise medicine is required, before the
licensee begins to practise, to be registered in the county clerk's
office, where such practice is to be carried on, with his name,
residence, place and date of birth, and the source, number, and
date of his license. Before registering, each licensee is re-
quired to file an affidavit of the above facts, and that he is the
person named in the license, and had, before receiving the same»
complied Avith all the requisites as to attendance, terms, and
amount of study and examinations required by law and the
rules of the university as preliminary to the conferment thereof ;
that no money was paid for such license except the regular fees
paid by all applicants therefor ; that no fraud, misrepresenta-
tion, or mistake in any material regard was employed by any
one or occurred in order that such license should be conferred.
Every license, or if lost a copy, legally certified so as to be
admitted as evidence, or a duly attested transcript of the record
of its conferment, shall before registration be exhibited to the
county clerk, who, only in case it was issued or indorsed as a
license under seal by the regents, shall indorse or stamp on
it the date and his name preceded by the words, " Registered
as authority to practise medicine in the clerk's office,
Count}'." The clerk is required thereupon to give to every
physician so registered a transcript of the entries in the register
with a certificate under seal that he has filed the prescribed
affidavit {ih., s. 149).
A practising physician having registered a lawful authority
NEW YORK. 187
to practise medicine in one countj^ and removing such practice,
or a part thereof, to another county, or regularly engaged in
practice or opening an office in another county, must show or
send by registered mail to the clerk of such other county his
certificate* of registration. If such certificate clearly shows
that the original registration was of an authority issued under
seal by the regents, or if the certificate itself is indorsed by the
regents as entitled to registration, the clerk is required there-
upon to register the applicant in the latter county, and to stamp
or indorse on such certificate the date, and his name preceded
by the words, " Registered also in County, " and return
the certificate to the applicant {ib., s. 150).
Every unrevoked certificate and indorsement of registration
is presumptive evidence that the person named is legally regis-
tered. No person can register any authority to practise medi-
cine unless issued or indorsed as a license by the regents. No such
registration is valid unless the authority registered constituted
at the time of registration a license under the laws of the State
then in force. No diploma or license conferred on a person not
actually in attendance at the lectures, institution, and examina-
tions of the school conferring the same, or not possessed, at the
time of its conferment, of the requirements then demanded of
medical students in this State as a condition of their being
licensed, and no registration not in accordance with this article,
shall be lawful authority to practise, nor shall the degree of
doctor of medicine be conferred causa honoris or ad eundiim,
nor if previously conferred shall it be a qualification for prac-
tice {lb., s. 151).
Exceptions. — The law does not affect commissioned medical
officers serving in the United States army, navy, or marine hos-
pital service while so commissioned ; or anj^ one while actually
serving on the resident medical staff of any legally incorporated
hospital; or any legally registered dentist exclusivel}' engaged
in the practice of dentistry ; or any manufacturer of artificial
ej^es, limbs, or orthopaedic instruments or trusses in fitting such
instruments on persons in need thereof ; or any lawfully qualified
physician in other States or countries meeting legally registered
physicians in this State in consultation ; or any physician resid-
ing on a border of a neighboring State and duly authorized
under the laws thereof to practise medicine therein whose prac-^
188 SYNOPSIS OF LAWS — POSTE AND BOSTON.
tice extends into this State, and who does not open an office or
appoint a place to meet patients or receive calls within this
State ; or any physician duly registered in one county called to
attond isolated cases in another county, but not residing or
habitually practising therein (ib., s. 152).
Penalty. — A person practising without lawful registration
or in violation of this article forfeits to the county $50, for each
violation and for every day of unlawful practice. To practise
under a false or assumed name or falsely personate another
practitioner of like or different name is a felony. The violation
of the other provisions of the act, or buying, selling, or fraudu-
lently obtaining a medical diploma, license, record, or registra-
tion, or aiding or abetting such buying, selling, or fraudulently
obtaining, or practising medicine under cover of a diploma or
license illegally obtained, or signed and issued unlawfulh' or
under fraudulent representation or misstatement of fact in a
material regard, or after conviction of a felony attempting to
practise medicine, or appending "M.D." to the name or assum-
ing to advertise the title of doctor in such manner as to conve}^
the impression that one is a legal practitioner of medicine or anj-
of its branches without having legally received the medical
degree, is a misdemeanor punishable with a fine of not less than
$250, or imprisonment for six months for the first offence, and
for subsequent offences with a fine of not less than $500 or im-
prisonment for not less than one year, or both fine and im-
prisonment {ib., s. 159).
Definitions. — As used in the article, university means the
University of the State of New York. Medical school means
any medical school, college, or department of a university
registered b}' the regents as maintaining a proper medical
standard and as legally incorporated. Medicine means medi-
cine and surgery; physician means physician and surgeon {ib.,
•definitions).
Fees. — To regents, for examination, $25 {ib., s. 145).
To regents, for license without examination under sec. 148,
$10 {ib., s. 148).
To county clerk, for registering affidavit and certificate, $1
{ib., s. 149).
To county clerk, for registration in an additional county, 25
•cents {ib., s. 150).
NEW YORK— NORTH CAROLINA. 189
North Carolina.
Qualification. — No person can lawfully practise medicine
or surgery, or any of the branches thereof, nor in any case
prescribe for the cure of disease for a fee or reward unless he
shall have been first licensed (Code 1883, s. 3,122, as amended
Act of 1885, c. 117, s. 1).
The board of medical examiners of the State consists of reg-
ularly graduated physicians appointed by the medical society of
the State {ib., s. 3,123, 3,12G).
The board must examine all applicants for a license to prac-
tise medicine or surgery, or any of the branches thereof, on
anatomy, physiology, surgery, pathology, medical hygiene,
chemistry, pharmac}^, materia medica, therapeutics, obstetrics,
and the practice of medicine, and grant to a competent appli-
cant a license or diploma authorizing him to practise medicine
and surgery or any of the branches thereof {ib., s. 3,124).
Where he has not been refused a license hj the board, two
members of the board ma}^ grant a temporary license to any
applicant to continue in force no longer than the next regular
meeting of the board {ib., s. 3,125, as amended Act of 1889, c.
181, s. 3).
The board of examiners must assemble when and where the
medical society assembles, which society must assemble at least
once a year ; the board must remain in session from day to day
till all applicants during the first five days after its meeting-
have been examined and disposed of {ib., s. 3,127).
Penalty, Exceptions. — A person practising without ob-
taining a license from the board shall not be entitled to sue for
or recover any medical bill for services; -and a person who has
begun the practice of medicine or surgery in the Stats for a fee
or reward since February 23d, 1885, without first obtaining
such a license, shall in addition be guilty of a misdemeanor and
punishable with a fine of from $25 to $100, or imprisonment at
the discretion of the court for each offence ; but the act does not
apply to women pursuing the avocation of midwife, nor to any
reputable physician or surgeon residing in a neighboring State,
coming into this State for consultation with a registered phy-
sician resident therein, except a physician residing in a neigh-
190 SYNOPSIS OF LAWS— POSTE AND BOSTON.
boring State regularly practising in this State, nor does it apply
to physicians who have a diploma from a regular medical college
priorto January 1st, 1880 {ib., s. 3, 133, as amended Act of 1885,
c. 117, s. 2; Act of 1885, c. 261, s. 1; Act or 1889, c. 181, s. 1).
The board may rescind a license upon satisfactory proof
that a licensee has been guilty of grossly immoral conduct {ih.,
s. 3,133).
Qualification. — Every person practising medicine or sur-
gery in the State was required before January 1st, 1892, to ap-
pear personally before the clerk of the superior court of the
county where he resided or practised, for registration, and all
persons beginning to practise are likewise to appear and register
within thirty days after obtaining a license (Act of 1889, c. 181,
s. 3, as amended Act of 1891, c. 90).
Any person applying for registration must produce and
exhibit before the clerk a license from the board of medical
examiners, or make oath that he was practising medicine or
surgery in this State prior to March 7th, 1885, and thereupon
the clerk shall register the date, with the name and residence
of the applicant, and shall issue a certificate of registration.
The certificate entitles the recipient to practise in any county
in the State, but if he removes his residence to another county
he must exhibit his certificate to the clerk of such county and
be registered. Persons having a temporary license are not
entitled to register but may practise so long as the license is in
force (Act of 1889, c. 181, s. 4, as amended Act of 1891, c. 420).
Penalty, Exceptions. — To practise without registration
and a certificate is a misdemeanor punishable with a fine of
from $25 to $100 or imprisonment for each offence, but this act
does not apply to women pursuing the avocation of midwife
nor to reputable physicians or surgeons residing in a neigh-
boring State coming into the State for consultation with a
registered physician of this State (Act of 1889, c. 181, s. 5).
License Fee. — A license of $10 for each county in which he
carries on business is exacted from every (itinerant?) medical
practitioner, one-half for the use of the county and one-half for
the use of the State; but a State license may be obtained from
the State treasurer for $30 good for twelve months, and he is
then exempt from the portion of above tax due the State (Act
1891, c. 323).
NORTH CAROLINA — NORTH DAKOTA. 191
Fees. — To the secretary of the board, before issuing a
license or diploma, 610.
To the secretary of the board, for temporary license, $5
(Code, 3,130).
To clerk of the court, for registration and certificate, 25
cents.
To clerk of the countj^, for registration on removal, no fee
(Act 1889, c. 181, s. 4).
North Dakota.
Board of Examiners. — The governor appoints a State
board of examiners of nine members, eight of whom are practis-
ing physicians in good standing ; no member of any college or
university having a medical department shall be appointed.
Two members shall be homoeopathic physicians and one a
lawyer (Act 1890, c. 93, s. 1).
The board must hold meetings for examination at such place
or places as it may designate on the first Tuesday of January,
April, July, and October of each year, and such other meetings
as it may appoint and must keep a record of its proceedings
with a register of every applicant for a license with his or her
age, the time spent in the study of medicine, and the name and
location of all institutions granting to such applicant a degree
or a certificate of lectures in medicine or surgery, and whether
the applicant was rejected or licensed ; and said books and reg-
ister shall be jjrinia facie evidence of all matters therein re-
corded (ib., s. 2).
Qualification. — All persons hereafter commencing the
practice of medicine, surgery, and obstetrics in any of its
branches shall apply to the board for a license, and at the time
and place designated by the board, or at its regular meeting,
be examined in anatom}'', physiology, chemistry, histology,
materia medica, therapeutics, preventive medicines, practice of
medicine, surgery, obstetrics, diseases of women and children,
of the nervous system, of the eye and ear, medical jurisprudence,
and such other branches as the board shall deem advisable, and
produce evidence of having attended three courses of lectures of
at least six months each ; the examination must be both practical
and scientific, but of sufficient severity to test the candidate's
192 SYNOPSIS OP LAWS — POSTE AND BOSTON.
fitness to practise medicine, surgery, and obstetrics. When
desired, the said examination may be conducted in the presence of
the dean of any medical school or the president of any medical
society of the State. After examination the board must grant
a license to practise medicine, surgery, and obstetrics ; seven
members must consent. The board may revoke or refuse a
license for unprofessional, dishonorable, or immoral conduct,
chronic or persistent inebriet.y, the practice of criminal abortion,
or for publicly advertising special ability to treat or cure
diseases which, in the opinion of the board, it is impossible
to cure. In complaints for violating the provisions of this
section, the accused shall be furnished with a copy of the com-
plaint, and given a hearing before the board in person or by at-
torney. Appeal lies from refusal or revocation to the appoint-
ing power (^6., s. 3).
The person receiving a license must file it, or a certified
copy, with the register of deeds where he resides. On removal
into another county he must procure from said register a cer-
tified copy of his license and file it with the register of deeds in.
the county to which he shall remove {ih., s. 4).
Exceptions. — The act does not apply to commissioned sur-
geons of the United States army or navy, to physicians or sur-
geons in actual consultation from other States or Territories, or
to actual medical students practising medicine under the direct
supervision of a preceptor {ih., s. 5).
Penalty. — Practising without a license or contrary to the
act is a misdemeanor punishable with a fine of from $50 to
$200, or imprisonment in a county jail from ten to sixty days,
or both.
Definition. — Any person is regarded as practising who ap-
pends the letters "M.D." or "M.B." to his name, or who for
a fee prescribes, directs, or recommends for the use of any
person any drug or medicine or other agency for the treatment,
cure, or relief of any wound, fracture or bodily injury, infirmity,
or disease {ih., s. 6).
Former Law. — The former law is repealed only so far as it
is inconsistent with the foregoing act {ih., s. 7).
The former law prohibited persons from practising medicine
in any of its branches unless graduates of a medical college or
unless thej" were shown by examination to be qualified and had
NORTH DAKOTA — OHIO. 193
been actually engaged in practising for at least ten years (Com-
piled Laws of Dakota, s. 205).
Fee.*— To the treasurer of the board, for examination, S20
(Act 1890, c. 93, s. 3).
Ohio.
Qualification. — No person who is not a graduate of a
reputable school of medicine in the United States or a foreign
country, or who cannot produce a certificate of qualification
from a State or county medical society and is not a person of
good moral character, can lawfully practise or attempt to
practise medicine in any of its departments or prescribe medi-
cine for reward or compensation ; except a person who has been
continuously engaged in the practice of medicine for ten years
or more. The law allowed persons in continuous practice for
five years or more, two years to comply with its provisions. In
case a person is a graduate of a school of medicine in any State
or foreign countrj' in which any condition or restriction is im-
posed by law upon the practice of medicine by graduates of med-
ical schools in Ohio, he is subject to the same restrictions or con-
ditions. A person violating this section is not entitled to any
compensation for services (Smith & Benedict's Revised Statutes
of 1890, s. 4,403).
Penalty. — Whoever prescribes or practises or attempts
to practise medicine in any of its departments, or performs or
attempts to perform a surgical operation without having attended
two full courses of instruction and graduated at a school of
medicine either in this or a foreign country, or who cannot
produce a certificate of qualification from a State or county med-
ical society, except a person who has been continuous^ en-
gaged in the practice of medicine for ten years or more, is pun-
ishable with a fine of from $50 to $100 and for a subsequent
offence with imprisonment for thirtj^' days. Persons in con-
tinuous practice for five years or more were allowed two years
to comply with this act (^6., s. 6,992).
Oklahoma.
Qualification. — No person can lawfully practise medicine
in any department unless he be a graduate of a medical college,
or unless upon examination before a board composed of the
13
194 SYNOPSIS OF LAWS — POSTE AND BOSTON.
superintendent of public health and two other phj'sicians to be
selected by the territorial board of health, he be found proficient
in the practice of medicine and surgery, and shall be found
upon proof to have been actually engaged in the practice of
medicine not less than five years. No person shall practise
medicine unless he be of good moral character, and is not an
habitual drunkard.
A person possessing these qualifications shall, on presenta-
tion of his diploma, or proof thereof by affidavit if it be lost or
destroyed, and the affidavit of two reputable citizens from the
county where he resides that the applicant possesses the quali-
fications of a physician, as prescribed herein, to the superin-
tendent of public health, receive from him a license, which shall
be recorded in the office of the register of deeds in the county
where such physician resides.
Offence. — To practise without complying with this law,
or to violate any of its provisions, is a misdemeanor.
Definition. — A person is regarded as practising medicine
who professes publicly to be a ph^-sician and to prescribe for
the sick, or who appends to his name M.D.
Exceptions. — The law does not prohibit students from pre-
scribing under the supervision of preceptors, nor prohibit gra-
tuitous services in case of emergency, nor apply to commis-
sioned surgeons in the United States army and navy.
Cancellation of License. — The district court has power
on complaint of a member of the territorial board of health, or
the county board of health where he resides, to cancel any
license issued to a person to practise medicine, where such
license was fraudulently obtained, or where the person to whom
it was issued has been guilty of violating any provision of this act.
Fee.^ — To superintendent of board of health, for license, 82
(Comp. Stats., 1893, s. 352).
Oregon.
Qualification. — Every person practising medicine and
surgery in any of their departments must possess the qualifica-
tions required by the act. If a graduate of medicine he must
present his diploma to the board of examiners for verification
as to its genuineness. If found genuine and the person named
OKLAHOMA— OREGON. 195
therein be the person claiming and presenting the same, the
board issues its certificate, which is conchisive. If not a
graduate, he must submit to an examination as the board shall
require, and if the examination be satisfactory the board issues
its certificate, and the lawful holder is entitled to all the rights
and privileges mentioned in the act (Act February 28th, 1889,
s. 1).
The governor appoints three persons from among the most
competent phj'siciaus of the State, residents of the State for
seven years and of at least five years' practical experience in
their profession, to be the board of examiners {ib., s. 2).
The board must issue certificates to all who furnish satisfac-
tory proof of having received a diploma or license from a
legally chartered medical institution in good standing of what-
ever school of medicine, and they are not permitted to make
discrimination against holders of a general license or diploma
under anj^ school or system of medicine in good standing {ib.,
s. 3, as amended February 21st, 1891).
The verification of a diploma consists in an affidavit of the
holder and applicant that he is the person therein named, taken
before any person authorized to administer oaths, attested
under the hand and official seal of the official, if he have a seal;
graduates may present their diplomas and affidavits by letter or
proxy. The act allows persons taking advantage of section 13
ninety days after its passage in which to procure a certificate
{ib., s. 4, as amended February 21st, 1891).
All examinations of persons not graduates or licentiates
must be made directly by the board, and certificates authorize
the person named to practise medicine and surgery {ib., s. 5).
The holder of a certificate must have it recorded in the office
of the county clerk of the county in which he resides, and the
record must be indorsed thereon. On removal to another county
to practise he must procure an indorsement to that effect on the
certificate from the clerk, and have the certificate recorded in
the office of the clerk of the county to which he removes {ib.,
s. 6).
The examinations may be wholly or partly in writing and
must be of an elementarj- and practical character, but suffi-
ciently strict to test the qualifications of the candidate as a
practitioner {ib., s. 8).
196 SYNOPSIS OF LAWS — POSTE AND BOSTON.
The board may refuse a certificate to an individual guilty of
unprofessional or dishonorable conduct, and may revoke for
like causes, after giving the accused an opportunity to be heard
in his defence before the board {ib., s. 9).
Definition, Exceptions. — An}- person is regarded as prac-
tising medicine who professes publicly to be a physician and to
prescribe for the sick, or appends to his name the letters
" M.D. ;" but the act does not prohibit students from prescribing
under the supervision of a preceptor, nor gratuitous services in
cases of emergency, nor does it apply to commissioned surgeons
of the United States army, navy, and marine hospital service
{ib., s. 10).
Itinerant Vender. — Any itinerant vender of any drug,
nostrum, medicine, ointment, or appliance of any kind intended
for the treatment of disease or injury, who shall publicly profess
to cure or treat diseases, injuries, deformities, or ailments by
any drug, nostrum, medicine, or other appliance, shall pay a
license to the Secretary of the State of 8100 per month.
Violation of this section is a misdemeanor punishable by a
fine of not more than $500 or imprisonment in a county jail for
not more than six months, or both. Such licenses to any firm
or company do not permit the transaction of business in differ-
ent places at the same time {ib., s. 11, as amended February
21st, 1891).
Penalty. — Practising medicine or surgery without com-
plying with the act is a misdemeanor punishable with a fine of
from $50 to $500 or imprisonment in a county jail from thirt}'
days to three hundred and sixty-five days, or both, for each
offence. Filing or attempting to file as his own the certificate
of another, or a forged affidavit or identification, is a felony
punishable the same as forgery in the second degree {ib., s. 12).
Former Practitioners. — Persons practising in the State
at the time of the passage of the act were allowed sixty days
afterward to register {ib., s. 13).
Fees. — To the secretary of the board, for examining a genu-
ine diploma, $1.
To the secretary- of the board, for examining a fraudulent
diploma, or a diploma not owned b}^ the possessor, $20 {ib., s. 4).
To the county clerk, for recording certificate, usual fee {ib.y
s. 6).
OREGON — PENNSYLVANIA. 197
To board of examiners, for examination, $10 {ib., s. 8).
To the Secretarj^ of the State, from itinerant vender, for
license, $100 per month {ib., s. 11, as amended February 21st,
1891).
Pennsylvania.
[Present Law. — The following is the law at present in
effect ; for the new law which goes into effect hereafter, see
below.]
Qualification. — The standard of a practitioner of medi-
cine, surgery, or obstetrics consists of a good moral character,
a thorough elementary education, a comprehensive knowledge
of human anatomy, human physiology, pathology, chemistry,
materia medica, obstetrics, and practice of medicine and sur-
gery and public hygiene (Act March 24th, 1877, s. 1).
It is unlawful for any person to announce himself as a prac-
titioner of medicine, surgery-, or obstetrics, or to practise as such,
who has not received in a regular manner a diploma from a
chartered medical school, duly authorized to confer upon its
alumni the degree of doctor of medicine. The act does not
apply to a resident practitioner who has been in continuous
practice in the commonwealth for not less than five years prior
to its passage {ib., s. 2).
Before any person can lawfully engage in the practice of
medicine, surgery, or obstetrics, or who has not a diploma as
provided in sec. 2, he must make an affidavit under oath, or
affirm before the prothonotary of the county in which he in-
tends to practise, setting forth the time of continuous practice
and the place or places where such practice was pursued in
the commonwealth, and it shall be entered of record {ib., s. 3).
Transient Practitioner. — Any person attempting to
practise medicine or surgery for a valuable consideration by
opening a transient office within the commonwealth, or by
handbill or other form of written or printed advertisement,
assigning such transient office or other place to persons seeking
medical or surgical advice, or prescribing or itinerating from
place to place or from house to house and proposing to cure
any person sick or afflicted, by the use of any medicine, means,
or agency whatsoever, for a valuable consideration, shall before
being allowed to practise in this manner appear before the clerk
198 SYNOPSIS OF LAWS — POSTE AND BOSTON.
of the court of quarter sessions of the county where he desires
to practise and furnish satisfactory evidence to such clerk that
this act has been complied with, and shall take out a license for
one year and pay $50 therefor {ib., s. 4).
Penalty. — To violate this act is a misdemeanor punishable
with a fine of from $200 to $400 for each offence (ib., s. 5).
Qualification. — Every person who shall practise medicine
or surgery, or any of their branches, for gain, or shall receive
or accept for his services any fee or reward directly or indirectly,
shall be a graduate of a legally chartered medical college or uni-
versity having authority to confer the degree of doctor of
medicine (except as provided in sec. 5) , and shall present to the
prothonotary of the county in which he resides or sojourns his
medical diploma as well as a true copy of the same, includ-
ing any indorsements thereon, and make affidavit before him
that the diploma and indorsements are genuine ; thereupon the
prothonotary shall enter in the register the name in full of
the practitioner, his place of nativity, place of residence, the
name of the college or university that has conferred the degree
of doctor of medicine, the year when it was conferred, and in
like manner any other degree or degrees that the .practitioner
may desire to place on record ; to all of which the practitioner
shall make affidavit before the prothonotar}- and the prothono-
tary shall place the copy of the diploma and indorsements on
file (Act June 8th, 1881, s. 2).
Any person whose medical diploma has been destroyed or
lost shall present to the prothonotar}^ of the county in which he
resides or sojourns a duly certified copy of his diploma, but if
the same is not obtainable a statement of this fact, with the
names of the professors whose lectures he attended and the
branches of study upon which each professor lectured, to all of
which the practitioner shall make affidavit before the prothono-
tarj^ ; after which the practitioner shall be allowed to register
and the prothonotary shall place such certificate or statement
on file {ib., s. 3).
Any person desiring to commence the practice of medicine
or surger}', having a medical diploma issued by any college,
university, society, or association in another State or foreign
country, shall lay the same before the faculty of one of the
medical colleges or universities of this commonwealth for in-
PENNSYLVANIA. 199
spection, and the faculty being satisfied as to the qualifications
of the applicant and the genuineness of the diploma shall direct
the dean of the facult}' to indorse the same, after which such per-
son shall be allowed to register as required by sec. 2 {ib., s. 4).
The act extends the privilege of continuing to practise to
those who have been in the continuous practice of medicine or
surgery in the commonwealth since 1871, but such a person
must make aSidavit to a written statement of the facts before
the prothonotary of the county in which he resides ; and the
prothonotary shall enter in the register the name in full of the
jiractitioner, his place of nativit}', place of residence, the time
of continuous practice in the commonwealth, and the place or
places where such practice was pursued, to all of which the
practitioner shall make affidavit, and the prothonotary shall
place the certificate or statement on file in his office {ih., s. 5).
Penalty. — Presenting to the faculty of an institution for
indorsement or to the prothonotary a diploma which has been
obtained by fraud, or in whole or in part a forgery, or making
an affidavit to a false statement, or practising without conform-
ing with the act, or otherwise violating or neglecting to comply
with the act, is a misdemeanor punishable with a fine of 6100
or imprisonment in the county jail for not more than one 3'ear,
or both, for each offence {ib., s. 7).
Exception. — The act does not prevent any physician or
surgeon, legally qualified to practise medicine or surgery in the
State where he resides, from practising in the commonwealth,
but a person opening an office or appointing a place to meet
patients or receive calls is a sojourner and must conform to its
requirements {ib., s. 8).
Fees. — To the prothonotary, for affidavit of continuous prac-
tice, $2 (Act March 24th, 1877, s. 3).
To count}' treasurer, for transient license, $50.
To clerk of the court of quarter sessions, for issuing tran-
sient license, $5 {ib., s. 4).
To the prothonotary, for registration, $1 (Act June 8th,
1881, s. 6).
[New Law. — The following law has been enacted whose
practical application does not begin until March 1st, 1894 :]
Medical Council. — The law provides for a medical council
of the State (Act of May 18th, 1893, s. 1).
:;iOO SYNOPSIS OF LAWS — POSTE AND BOSTON.
The council is to supervise the examinations conducted by
the State boards of medical examiners for licenses to practise
medicine and surgery, and issue licenses to applicants who shall
have presented satisfactory and properly certified copies of
licenses from the State boards of medical examiners or State
boards of health of other States, or who shall have successfully
passed the examination of one of the State boards established by
this act {lb., s. 5).
Medical Boards. — From and after March 1st, 1894, there
are to be three separate boards of medical examiners, one repre-
senting the medical society of the State, one representing the
homoeopathdc medical society pf the State, and one representing
the eclectic medical society of the State. Each board is to consist
of seven members appointed by the governor from the full lists
of the members of the said medical societies, and is to be com-
posed exclusiveh^ of members of the same medical society.
Each appointee must be a registered physician in good stand-
ing, and shall have practised medicine or surgery under the laws
of the State for not less than ten years prior to his appointment.
The governor is to fill vacancies and ma}' remove a member
for continual neglect of duties or on the recommendation of the
medical society with which he may be in aflfiliation, for unpro-
fessional or dishonorable conduct {ih., s. 6).
Examinations. — For the purpose of examining applicants
each board is to hold two or more stated or special meetings in
each year after due public notice. A majority constitutes a
quorum, but the examination may be conducted by a committee
of one or more members authorized by the board {ih., s. 9).
The boards not less than one week prior to each examination
must submit to the council questions for thorough examination
in anatomy, physiology, hygiene, chemistry, surgery, obstetrics,
pathologj-^, diagnosis, therapeutics, practice of medicine, and
materia medica ; and the council must select therefrom the ques-
tions for each examination, and such questions for each exam-
ination shall be the same for all candidates, except that in the
departments of therapeutics, practice of medicine, and materia
medica the questions shall be in harmony with the teachings
of the school selected by the candidate {ih., s. 10).
The examinations are to be in writing under rules pre-
scribed b}- the council. After an examination the board must
PENNSYLVANIA. 201
act on it without unnecessary delay and transmit to the council
an official report of its action stating the examination average
of each candidate in each branch, the general average, and the
result, and whether successful or unsuccessful. The report
must embrace all the examination papers, questions, and an-
swers, which shall be kept for reference and inspection for not
less than five years (^7>., s. 11).
Qualification. — The council must forthwith issue to each
applicant returned as having successfully passed said examina-
tion, and adjudged by the council to be duly qualified, a license
to practise medicine and surgery. The council must require the
same standard of qualifications from all candidates except in
therapeutics, practice of medicine, and materia medica, in which
the standard shall be determined by the boards respectively.
Before the license is issued, it must be recorded in a book in
the office of the council, and the number of the book and page
containing the record noted on the face of the license; the
records shall have the same weight as evidence as that given to
conveyance of land (ib., s. 12).
On and after July 1st, 1894, any person not theretofore
authorized to practise medicine and surgery in the State may
deliver to the secretar}^ of the council a written application for
a license with satisfactory proof that the applicant is more than
twenty-one years of age, is of good moral character, has ob-
tained a competent common-school education, and has received
a diploma conferring the degree of medicine from some legally
incorporated medical college of the United States, or a diploma
or license conferring the full right to practise all the branches
of medicine and surgery in some foreign country. Applicants
who have received their degree in medicine after July 1st, 1894,
must have pursued the study of medicine for at least three
years, including three regular courses of lectures in different
years in some legally incorporated medical college or colleges
prior to the granting of said diploma or foreign license. Such
proof shall be made, if required, upon affidavit, and if the coun-
cil is satisfied with the same it shall issue to the applicant an
order for examination before such one of the boards of exami-
ners as the applicant may select. In case of failure at the exam-
ination the candidate, after the expiration of six months and
within two j^ears, shall have the privilege of a second exami-
202 SYNOPSIS OP LAWS — POSTE AND BOSTON.
nation by the same board without additional fee. Applicants
examined and licensed by State boards of medical examiners or
State boards of health of other States, on filing in the office of
the medical council a copy of said license certified by the affi-
davit of the president and secretary of such board, showing
also that the standard of acquirements adopted by said board is
substantially the same as is provided by sees. 11, 12, and 13 of
this act, shall without further examination receive a license
conferring on the holder all the rights and privileges provided
by sees. 14 and 15 (ib., s. 13).
From and after March 1st, 1894, no person shall enter upon
the practice of medicine or surgery unless he has complied with
this act and shall have exhibited to the prothonotary of the
court of common pleas of the county in which he desires to
practise a license duly granted, which shall entitle him to be
duly registered in the office of such prothonotar3\
Penalty. — Violating the provisions of this act shall be a
misdemeanor punishable with a fine of not more than $500 for
each offence {tb., s. 14).
Exceptions. — The act does not interfere with or punish
commissioned medical officers serving in the army or navy of the
United States, or its marine hospital service, while so com-
missioned, or medical examiners of relief departments of railroad
companies, while so employed, or any one while actually serv-
ing as a member of the resident medical staff of any legally in-
corporated hospital, or any legally qualified and registered dentist
exclusively engaged in the practice of dentistry, nor interfere*
with or prevent the dispensing and sale of medicine or med-
ical appliances by apothecaries [or] pharmacists, nor interfere
with the manufacture of artificial eyes, limbs, or orthopsedical
instruments or trusses of any kind for (sic) fitting such instru-
ments on persons in need thereof, or any lawfully qualified phy-
sicians and surgeons residing in other States or countries meet-
ing registered physicians of this State in consultation, or any
physician or surgeon residing on the border of a neighboring
State and duly authorized under the laws thereof to practise
medicine and surger}^ therein, whose practice extends into the
limits of this State, provided such practitioner shall not open
an office or appoint a place to meet patients or receive calls
within the limits of Pennsylvania, or physicians duly registered
PENNSYLVANIA — RHODE ISLAND — SOUTH CAROLINA. 203^
in one county of this State called to attend cases in another,
but not residing or ojDening an office therein.
The act does not prohibit the practice of medicine and sur-
gery by any practitioner who shall have been duly registered
before March 1st, 1894, according to the Act of June 8th, 1881,
and one such registration shall be sufficient warrant to practise
medicine and surgery in any county {ih., s. 15).
Former Laws. — All acts or parts of acts inconsistent with
this are repealed («6., s. 17).
Fees. — To the secretary of the council, upon application for
a license, $25.
To the secretary of the county, upon application for a
license by licensees in other States, $15 (i6., s. 1.3).
To the prothonotary, upon exhibition of a license, for reg-
istry, $1 {ih., s. 14).
Rhode Island.
Registration. — Every physician must cause his name and
residence to be recorded in the town clerk's office of the town
where he resides (Public Statutes, 1882, c. 85, s. 12).
Penalty. — Wilful neglect or refusal to perform this duty is
punishable with a fine not exceeding $20 {ih., s. 11).
South Carolina.
Qualification. — All physicians engaging in the practice
of ^nedicine or surgery, before doing so, must submit their di-
plomas to a board consisting of three reputable physicians in
each county. The board is appointed by the governor on the rec-
ommendation of the medical societies of the counties, and
where no medical society exists, upon the recommendation of
the senator and members of the House of Representatives for
such counties (Act of 1890, c. 454, s. 1).
The said board must examine said diploma, when submitted,
and if the holder is a hona fide holder, and if the college issu-
ing said diploma is a reputable medical college, and if he also
submits a certificate of good moral character, the board must
certify to the fact, and upon such certificate the diploma shall
be registered by the clerk of the court of the county in which
the applicant resides (/&., s. 2).
204 SYNOPSIS OF LAWS — POSTE AND BOSTON.
Exception. — The act does not apply to physicians and sur-
geons ah-eady registered under former laws {ib., s. 4).
South Dakota,
Prohibition. — It is unlawful for any person to practise
medicine, surgery, or obstetrics in any of their dejoartments
without having received a license to practise medicine from
the board of health, and having it recorded in the office of the
register of deeds in the county where such person resides (Act
February 16th, 1893, s. 1).
Exceptions. — The act does not affect those in the lawful
practice of medicine, surger}', or obstetrics in this State at the
time of its passage {ib., s. 2).
Nor does it prohibit students from prescribing under the
supervision of a preceptor, nor prohibit gratuitous services in
case of emergency, nor apply to commissioned surgeons in the
United States army and navj- {ib., s. 3).
Penalty. — Violation of the act or practising without the
license is a misdemeanor punishable with a fine of from 825 to
$100 or imprisonment in the county jail not more than thirty
days or both {ib., s. 4).
Qualification. — The State board of health is constituted
a board of public examiners ex-officio to examine and license
phj^sicians to practise medicine. Any person who is a
graduate of a lawful medical college, who has attended three
full courses of medical lectures of six months each, no ^wo
full courses within the same year, and who is of good moral
character, and is not an habitual drunkard, shall, upon proof of
such facts to the superintendent of the State board of health,
as the board shall require, receive from said superintendent a
license; which shall be recorded as above. The requirement
of three courses of lectures does not apply to those who had
graduated prior to the passage of the act {ib., s. 5).
Cancellation of License.— The State board of health,
upon complaint made to it on oath by one responsible person,
has power to cancel any license that may have been fraudulently
obtained or when the person to whom such license was issued
is an habitual drunkard, or is guilty of immoral practices or
gross unprofessional conduct. Such license shall not be can-
SOUTH DAKOTA — TENNESSEE. 205
celled except after a hearing before such board of health, at
which a majority of such board shall be present, and of which
the person holding the license to be cancelled shall have had
at least ten days' notice, and only upon due proof of the facts
stated in the complaint. An appeal may be taken to the circuit
court of the county in which the person whose license is can-
celled lives by any person aggrieved, in the same manner as
now provided by law in case of appeal from the decisions of the
county commissioners (ib., s. 6).
Fee. — To the superintendent of the State board of health,
for a license, $5 {ib., s. 5).
Tennessee.
QUAUPICATION. — No person can lawfully practise medicine
in any of its departments, except dentistry, unless he possesses
the qualifications required by the act. If a graduate in med-
icine, he must present his diploma to the State board of med-
ical examiners for verification as to its genuineness. If found
genuine and from a legally chartered allopathic, homoeopathic,
or eclectic medical college in good standing with the school of
medicine in which said college is classed, of which the State
board of medical examiners shall be the judge, and the person
named therein be the person claiming and presenting it, the
board must issue a certificate to that effect, conclusive as to the
rights of the lawful holder to practise medicine (Act of 1889, c.
178, s. 1).
^Persons in actual practice at the time of the passage of the
act were allowed till July 1st, 1891, to comply with the pro-
visions of the act respecting them (ib., s. 2, as amended Act
1891, c. 109, s. 1).
A person wishing to enter upon the practice of medicine
must present to the board of medical examiners a diploma from
some medical college in good standing as provided by sec. 1, or
shall present himself to the said board for examination upon
anatomy, physiology, chemistry, pathology, surgery, obstetrics,
and therapeutics. If the diploma be found genuine, or if the
applicant for examination be found worthy and competent, the
board shall issue a certificate which shall entitle the lawful
holder to all the privileges of this act {ib., s. 3, as amended
Act 1891, c. 109, s. 2).
20G SYNOPSIS OF LAWS — POSTE AND BOSTON.
The governor appoints six graduate physicians as a State
board of medical examiners ; the three schools allopathic, homoe-
opathic, and eclectic must be represented on the board ; five con-
stitute a quorum and a majority of those present are necessary
to reject an applicant, but such rejection shall not bar a re-
examination after the lapse of three months; provided the mem-
bers representing each school shall have the right to examine
all applicants of that school, and the board shall issue the cer-
tificate to applicants who are recommended by the member or
members of the board who belong to said school after such
examination (i7)., s. 4).
To prevent delay and inconvenience two members of the
board may grant a temporary license to any applicant if the
applicant has not been refused a license by the board within
six months, which shall be in force till the next regular meeting
of the board {ib., s. 5).
The members of the board shall not be members of the State
board of health, nor any medical faculty {ib., s. 6).
The regular meeting of the board shall be once in each year
at such time and place as the board may decide, but the presi-
dent of the board may call a special meeting when demanded
bj'' public necessity {ib., s. 7).
Every person holding a certificate must have it recorded in
the office of the county court clerk where he resides, and the
date of record must be indorsed thereon. Until such record is
made the holder shall not exercise any of the rights and privi-
leges conferred. A person removing to another county to. prac-
tise shall record his certificate in like manner in the county to
which he removes. Practitioners may go from one county
to another on professional business, without being required to
register, if they have done so in the county in which they reside
{ib., s, 9).
Itinerant Physician or Vender. ^ — It is unlawful for an
itinerant physician or vender of any drug, nostrum, ointment,
or appliance of any kind intended for the treatment of disease
or injury to sell or apply the same, or by writing, printing, or
other method to profess to cure or treat disease or deformity by
any drug, nostrum, manipulation, or other expedient.
A violation of this section is punishable with a fine of
$100 to $400, but this section does not apply to merchants
TENNESSEE — TEXAS. 207
and druggists, and this act does not apply to veterinary sur-
geons and stock doctors {ib., s. 13, as amended Act 1891, c.
109, s. 3).
Penalty, Exception. — To practise medicine or surgery
without a certificate is a misdemeanor punishable with a fine
of from $10 to $25.
To file or attempt to file as his own the diploma or certificate
of another or a forged affidavit of identification is a felony
punishable same as forgery. The act does not apply to women
who pursue the avocation of midwife {ib., s. 1-4, as amended
Act 1891, c. 109, s. 4).
Fees. — To the county court clerk, for recording certificate,
the usual fee {ib., s. 9).
To the board of examiners, for issuing a certificate, $1,
To the board of examiners, for examination of non-grad-
uate, $10.
If applicant fails to pass a satisfactory examination, and no
certificate or license is issued to him, $5 only is retained.
For a certificate of temporarj' license, $1, which is to be
credited to the applicant when he applies for a permanent
license (?7>., s. 12, as amended Act 1891, c. 109, s. 2).
Texas.
Constitutional Provision. — The legislature may pass
laws prescribing the qualifications of practitioners of medicine,
but no preference shall ever be given by law to any schools of
medicine (Const. 1876, art. xiv., s. 31 in part).
Boards of Examiners. — A board of medical examiners for
each judicial district is appointed by the judge of the district
court (R. S., art. 3,025).
Each board is composed of not less than three practising
physicians of known ability, graduates of some medical college
recognized by the American Medical Association, residents of
the district from which they are appointed {ib., art. 3,026).
The boards are required to meet regularly semi-annually at
some central point in their districts to conduct examinations
and grant certificates, and after at least one month's public
notice of the time and place of meeting by publication in at
least one newspaper published in the district {ib., art. 3,629).
208 SYNOPSIS OF LAWS — POSTE AND BOSTON.
Qualification. — The board is required to examine thor-
oughl}' all applicants for a certificate of qualification to practise
medicine in any of its branches or departments, whether fur-
nished with medical diplomas or not, upon anatomy, physi-
ology, pathological anatomy and pathology, surgery, obstetrics,
and chemistry ; but no preference shall be given to any school
of medicine (ib., art. 3,632).
When the board is satisfied as to the qualifications of an
applicant, they are required to grant a certificate, which en-
titles him to practise medicine in any county when it has been
recorded (ib., art. 3,633).
Any two members of the board may grant a certificate, and
any member may grant a temporary certificate upon examina-
tion, which shall be in force until the next regular meeting of
the board (ib., art. 3,634).
The certificate must, before the person to whom it was
granted is entitled to practise, be recorded in the office of the
clerk of the district court of the county in which such prac-
titioner resides or sojourns, and when recorded the clerk
shall certify thereon under his official seal the fact and date of
record, and shall return the certificate to its owner {ib., art.
3,635).
Exceptions. — This title does not apply to those who have
already qualified under the act of May 16th, 187^, nor to those
regularly engaged in the general practice of medicine in the
State in any branch or department for five consecutive years
prior to January 1st, 1875, nor to females who follow the
practice of midwifery strictly as such {ib., art. 3,637).
Penalty. — No person except those named in art. 3,637 can
lawfully practise medicine in any of its branches or departments
without having first obtained and recorded a certificate of quali-
fication as above provided. A person so offending shall be
punished as provided in the Penal Code {ib., art. 3,638).
If any person shall practise for pay or as a regular practi-
tioner medicine in any of its branches or departments, or offer
or attempt to practise medicine without first having obtained a
certificate of professional qualification from some authorized
board of medical examiners, or without having a diploma from
some actual medical college chartered by the legislature of the
State, or its authority, in which the same is situated, he shall
TEXAS — UTAH. 209
be punished by a fine of not less than $50, nor more than $500
(Penal Code, art. 30(!).
Each patient visited or prescribed for, or each day's offer to
practise constitutes a separate offence {ib., art. 397).
If any person shall engage in the practice of medicine in any
of its branches or departments for pay or as a registered practi-
tioner, without having first filed for record, with the clerk of the
district court of the county in which he resides or sojourns, a
certificate from some authorized board of medical examiners or
a diploma from some actual medical college, he shall be pun-
ished as prescribed in art. 390 (ib., art. 398).
Fees. — To the clerk of the district court, for recording
certificate, $1 (R. S., art. 3,035).
To the board of examiners, for examination, $15, whether
certificate is granted or not (R. S., art. 3,636).
Utah.
Board of Examiners. — The governor appoints by and
with the advice and consent of the council a board of seven
medical examiners from the various recognized schools of
medicine ; appointees are required to be graduates of a legally
chartered medical college in good standing (Act 1892, c. 72,
s. 1).
Qualification. — The board has power to issue certificates
to all who furnish satisfactory proof of having received degrees
or licenses from a chartered medical college in good and
legal standing, and pass examinations before said board (ib.,
s. 2).
Graduates of respectable medical colleges at the time of the
passage of the act engaged in actual practice in the Territory
shall be licensed on presenting their degree to the board, and
producing satisfactory evidence of identit)^ (i6., s. 4).
Every person holding a certificate from said board must
have it recorded in the office of the recorder of the county in
which he resides within three months from its date, and the
date of record must be indorsed thereon. Until the certificate
is recorded, the holder shall not exercise any of the privileges
conferred. A person removing to another county to practise
must record his certificate in like manner in the county to
which he removes {ib., s. 5).
u
210 SYNOPSIS OF LAWS — POSTE AND BOSTON.
Examinations shall be wholly or partly in writing {ib., s. 7).
The board may refuse to issue certificates to individuals
guilty of unprofessional or dishonorable conduct, the nature of
which shall be stated in writing, and it may revoke certificates
for like causes to be stated in writing {ib., s. 8).
Definition. — Any person is regarded as practising medicine
who treats, operates upon, or prescribes for any physical ailment
of another for a fee, or who holds himself out by means of signs,
cards, advertisements, or otherwise ns a phj^sician or surgeon.
Exceptions. — The act does not prohibit service in case of
emergency or the administration of family remedies, and does
not apply to commissioned surgeons of the United States army
in discharge of their official duties, or to visiting physicians in
actual consultation {ib., s. 9).
Offence. — Practising medicine or surgery without a cer-
tificate or contrary to this act is a misdemeanor {ib., s. 10).
Persons not graduates who had practised continuously for
ten years in the Territory prior to the taking effect of the act
were allowed six months in which to comply with its provisions
concerning them. Practising without complying with these
provisions, and practising after rejection of an application or
the revocation of certificate, is a violation of the law {ib., s. 11).
Obstetricians. — Persons practising obstetrics were re-
quired within three months after the passage of the act to apply
to the board for a certificate, and after passing a proper exami-
nation were entitled to one.
Practising obstetrics without first obtaining a license or
contrary to this act is a misdemeanor ; provided all persons who
furnish to said board satisfactory evidence by affidavit or other-
wise of having practised obstetrics previous to the passage of
the act, shall receive a license without an examination. This
section does not apply to phj'sicians holding certificates nor
prohibit services in cases of emergency, nor apply to persons
practising obstetrics in communities where there are no licensed
practitioners {ib., s. 12).
Board Meetings. — The board is required to meet at the
territorial capital on the first Monday of Januarj^, March, June,
and September of each year at 10 a.m., and such other times
as the president of the board shall deem necessary {ib., s. 13).
Colleges. — "Respectable medical colleges" include col-
UTAH — VERMONT. 211
leges in legal standing of any recognized school of medicine
(//>., s. 15).
Fees. — To the treasurer of the board of examiners, for ex-
amination and certificate, $25 (z7>., s. 3).
To the treasurer of the board of examiners, for license to a
graduate, $5 {ib., s. 4).
The secretary of the board is required to enter without fee,
on the register to be kept by him, the names of all persons to
whom licenses are issued as physicians and surgeons {ib. , s. 4) .
To the county recorder, for recording, his usual fees (ib.,
s. 5).
To the treasurer of the board of examiners, upon examina-
tion for license to practise obstetrics, $10.
To the treasurer of the board of examiners, upon license to
practise obstetrics without examination, $1 {ib., s. 12).
Vermont.
Qualification. — The medical societies organized under a
charter from the General Assembly at each annual session
elect a board of censors of three members, who may examine
and license practitioners of medicine, surgery, and midwifery
(Revised Laws, 1880, s. 3,908).
A practitioner of medicine, surgery, or midwifery who by
sign or advertisement offers his services to the public as a prac-
titioner of medicine, surgery, or midwifery, or who by such
sign or advertisement assumes the title of doctor, shall obtain a
certificate from one of such medical societies, either from a
county, district, or State society {ib., s. 3,909).
A person not a resident of the State who has not received a
diploma from a chartered medical college must obtain a certifi-
cate from a board of censors before he shall be permitted to
practise the medical art in the State {ib., s. 3,910).
Each board of censors must issue certificates without fee to
physicians and surgeons who furnish evidence by diploma from
a medical college or university, or bj' a certificate of examina-
tion by an authorized board, which satisfies said censors that
the person presenting such credentials has been, after due ex-
amination, deemed qualified to practise the branch mentioned
in such diploma or certificate {ib., s. 3,911).
212 SYNOPSIS OF LAWS — POSTE AND BOSTON.
The censors in their discretion shall notify the practitioner
of medicine, surgerj^, or midwifery of this chapter, and require
such persons to comply therewith within thirty days after noti-
fication or such further time as is allowed by the censors not
exceeding ninetj^ days [ib., s. 3,912).
The certificate must set forth the branches of the medical
art in which the person is qualified to practise (I'fo., s. 3,913).
The certificate must be recorded in the clerk's office of the
county in which the holder resides, or, if not a resident of the
State, in the county in which he obtained his certificate {ib.^
s. 3,914).
A certificate issued by a board of censors is valid through-
out the State after being duly recorded. The censors may
revoke or annul a certificate if in their judgment the holder has
obtained it fraudulently or has forfeited his right to public con-
fidence by the conviction of crime (^7>, s. 3,915).
Penalty, — To practise medicine, surgery, or midwifery in
the State, or sign a certificate of death for burial or removal
unless authorized by a certificate issued and recorded, is pun-
ishable with a fine of from $50 to $200 for the first offence, and
for subsequent offences with a fine of from $200 to $500, re-
coverable by an action of debt for the use of any person who
sues or by indictment («'&., s. 3,916).
No person practising either of the branches of medicine,
surgery, or midwifery is permitted to enforce in the courts the
collection of a fee or compensation for services rendered or
medicine or material furnished in the practice of any of the
branches for which he has not a certificate {ib., s. 3,917).
Exceptions. — The law does not apply to the practice of
dentistry, nor to the practice of midwifery by women in the
town or locality in which they reside, nor to practitioners of
medicine who resided and practised medicine in the State for
five years previous to November 28th, 1876 {ib., s. 3,918).
Virginia.
Board of Examiners. — There is a State board of medical
examiners consisting of three members from each congressional
district and two from the State at large, and five homoeopathic
physicians from the State at large (Code 1887, s. 1,744).
VERMONT — VIRGINIA. 213
The board is composed of men learned in medicine and sur-
gery appointed by the governor from a list of names recom-
mended by the Medical Society of Virginia, together with five
homoeopathic physicians nominated to him by the Hahnemann
Medical Society of the Old Dominion. The recommendations
are required to be by votes of a majority present at some meet-
ing of such society ; but if the governor considers any person
so recommended unsuitable he may decline to appoint him, in
which case such society shall within ninety days after notifica-
tion make another recommendation, and if the society fail to
make a recommendation the governor is required to appoint
such board in whole or in part without regard to such recom-
mendation. If any examiner cease to reside in the district for
which he was appointed his office is deemed vacant {ih., s.
1,745).
The regular meetings of the board are required to be held at
least once a year, and at such times and places as the board
may prescribe, and special meetings may be held on the call of
the president and any five members (^7)., s. 1,746).
Qualification. — The board at any of its meetings must
examine all persons making application to them who desire to
practise medicine or surgery ; when an applicant shall have
passed an examination satisfactory as to proficiency before the
board in session the president must grant a certificate to that
effect. If any applicant fail to pass a satisfactory examination
before the board he shall not be permitted to stand a further
examination within the next three months, nor shall he be re-
quired again to pay the fees prescribed, but no applicant shall
be rejected on his examination on account of his adherence
to any particular school of medicine or system of practice, nor
on account of his views as to the method of treatment and the
cure of disease.
When, in the opinion of the president of the board, the
applicant has been prevented by good cause from appearing
before the board, he shall appoint a committee of three mem-
bers who shall examine the applicant and may grant a certifi-
cate having the same effect as though granted bj^ a full board,
until the applicant have an opportunity to appear before the
board, when, if he fail to appear for examination, the president
shall have the authority to revoke said certificate; or in any
214 SYNOPSIS OF LAWS — POSTE AND BOSTON.
case the president shall have authority, at his discretion, to
grant a special permit to any applicant to practise medicine
until he shall have an opportunity to appear before the board in
session for examination, revokable at the discretion of the pres-
ident. The board has in its discretion authority to accept in
lieu of examination a certificate from a medical board of any
other State, showing that the applicant has passed a satisfac-
tory examination as to his proficienc}', and obtained a license
from said board to practise medicine and surgery in said State
(lb., s. 1,747, as amended Act 1892, c. 70).
A person obtaining a certificate from the president of the
board must cause it to be recorded in the clerk's office of the
county or the corporation court, of the count}^ or corporation
in which he resides, or, if he resides in the city of Richmond,
in the clerk's office of the chancery court of the said city (?6. ,
s. 1,749).
No person who shall have commenced the practice of medi-
cine or surgery since January 1st, 1885, or who shall hereafter
commence the practice of the same, shall practise as a physician
or surgeon for compensation without having obtained a certifi-
cate and caused it to be recorded.
Penalty. — The violation of this act is punishable with a
fine of from $50 to $500 for each ofi^ence, and the violator is
debarred from receiving compensation for services rendered as
a physician or surgeon ; a person assessed with a license tax as
a physician or surgeon by any commissiouer of revenue prior to
July 1st, 1892, shall be taken as having commenced the prac-
tice of medicine or surgery prior to that date; but an}- person
who shall not have been so assessed shall be taken as not hav-
ing commenced such practice prior to that date {ib., s. 1,750,
as amended Act 1892, c. 70).
Non-Residents. — A physician or surgeon residing in an
adjoining State within ten miles of the boundary line of this
State, is entitled to stand the examination and receive a cer-
tificate, and the certificate must be recorded in that county in
the State nearest to his place of residence, and such certificate
and recordation shall make it lawful for him to practise med-
icine and surgery in this State (ib., s. 1,751).
Exceptions. — This chapter does not affect practitioners of
dentistry, nor include physicians or surgeons residing in other
VIRGINIA — WASHINGTON. 215
States called into consultation in a special case with a physician
or surgeon residing in this State, nor does it affect in any
way the laws in reference-to the license tax {ib., s. 1,752) nor
does it apply to midwives (ib., s. 1,753).
Fees. — To the board of examiners, before examination, $5
{ib., s. 1,747, as amended Act 1892, c. 70).
To the clerk of the court, for recording, same fee as for re-
cording a deed {ib., s. 1,749).
Washington.
Examining Board. — The governor is required to appoint
a State medical examining board of nine members, learned and
skilled in the practice and theory of medicine and surgery (Act
March 28th, 1890, s. 1).
The said board is required to hold meetings for examination
on the first Tuesday of January and July in each year, alter-
nately in western and eastern Washington at such places as
the board may designate. The board may call special meetings
when, in the opinion of a majority of the board, they are nec-
essary. The board is required to keep a record of all applicants
for a license, with their ages, the time spent in the study and
practice of medicine and surgery, and the name and location of
all institutions granting to such applicants degrees or certifi-
cates of lectures in medicine or surgery, and whether such
applicant was rejected or licensed; and said register is prz'wia
facie evidence of all matters therein recorded {ib., s. 2).
Qualification. — Every person desiring to commence the
practice of medicine or surgery, or either of them, in any of
their or its branches, must make a written application to the
board for a license, supported by an affidavit of the applicant,
setting forth the actual time spent in the study of medicine
and surgery, and when ; whether such study was in an institu-
tion of learning and, if so, its name and location ; if not in such
institution, where and under whose tutorship such study was
prosecuted, the time engaged in the actual practice, if at all,
of medicine and surgery or either, and where, and the age of
the applicant at the time of the application, such application
and affidavit to be filed and preserved of record in the office
of the secretary of the board. At the time and place designated
216 SYNOPSIS OF LAWS — POSTE AND BOSTON.
by the board or at a regular meeting of the board, applicants
must be examined in anatomy, physiology, chemistry, histology,
materia medica, therapeutics, preventive medicines, the practice
of medicine, surgery, obstetrics, diseases of women and children,
of the nervous system, of the eye and ear, medical jurisprudence,
and such other branches as the board deem advisable. The ex-
amination must be both scientific and practical, and of suflficient
severity to test the candidate's fitness to practise medicine and
surgery, by written or printed, or partly written and partly
printed, questions and answers, and the same are required to be
filed and preserved of record in the said secretary's office.
After the examination, if it be satisfactory, the board shall
grant a license, by the consent of not less than five members,
except as hereinafter provided.
Refusal or Revocation. — The board may refuse or re-
voke a license for unprofessional or dishonorable conduct, sub-
ject to the right of appeal {ib., s. 3).
" Unprofessional or dishonorable conduct" means : procuring
or aiding or abetting in procuring a criminal abortion ; or em-
ploying what are popularly known as cappers or steerers; or
obtaining any fee on the assurance that a manifestly incurable
disease can be permanently cured; or wilfully betraying a
professional secret; or advertisements of medical business in
which untruthful and improbable statements are made; or ad-
vertising any medicine or means whereby the monthly periods
of women can be regulated, or the menses re-established if sup-
pressed; or the conviction of any offence involving moral turpi-
tude; or habitual intemperance {ib., s. 4).
In case of a refusal or a revocation of a license, the board is
required to file a brief and concise statement of the grounds and
reasons thereof in the office of its secretarj^, which, with the
decision of the board in writing, shall remain of record in said
office. Before a license can be revoked for unprofessional or
dishonorable conduct, a complaint of some person under oath
must be filed in the office of the secretary of the board, charging
the acts of unprofessional or dishonorable conduct and the facts
complained against the accused in ordinary and concise lan-
guage, and at least ten days prior to the hearing the board shall
cause to be served upon the accused a written notice and a copy
of such complaint containing a statement of the time and place
WASHINGTON. 217
of the hearing. The accused ma}^ appear at the hearing and de-
fend in person or by counsel, and may have the sworn testimony
of witnesses taken and present other evidence in his behalf, and
the board may receive arguments of counsel {ib., s. 5).
In case of refusal or revocation of a license by the board,
there is a right of appeal within thirty days after the
filing of the decree in the office of the secretary, to the superior
court in and for the county in which was held the last general
meeting of the board prior to the refusal of the license, in case
of refusal; and to the superior court in and for the county in
which the hearing was had upon which such license was re-
voked, in case of revocation. The person desiring to appeal
must serve or cause to be served on the said secretary a written
notice of appeal containing a statement of its grounds, and
must file in the said secretary's office an appeal bond with a
good and sufficient surety to be approved by the Secretarj^ of
the State of Washington, conditioned for the speedy prosecution
of such appeal and the payment of such costs as may be adjudi-
cated against him upon such appeal. Said secretary must
within ten days after service of said notice and filing, and the
approval of the said appeal bond, transmit to the clerk of the
court to which the appeal is taken a certified cop}-, under the
seal of the board, of the decision and the grounds, in case of
refusal, and in addition a certified copy under said seal of the
complaint, in the case of revocation, with the bond and notice of
appeal. The clerk must thereupon docket such appeal causes
and they stand for trial in all respects as ordinary civil
actions, and like proceedings are had thereon. On appeal the
cause is tried de novo. Either party may appeal from a
judgment of the superior court to the supreme court in like
manner as in civil actions within sixt}^ days after the rendition
and entry of such judgment. If the judgment be in favor of
the party appealing from the decision of the board, and the
examining board does not appeal within sixty days, in that
case at the end of sixty daj^s the board shall immediatel}' issue
to the successful party the usual license, and in addition rein-
state upon its records the name of such successful applicant,
in case of revocation. In case of appeal to the supreme court
by the board, no such license shall be issued nor reinstatement
required until the final determination of the cause. In case
218 SYNOPSIS OF LAWS— POSTE AND BOSTON.
the final decision of the supreme court be against the board,
then the said court shall make such order as may be necessary
and the board shall act accordingly. No appeal bond can be
required of the board, nor any costs adjudged or taxed against
the same {ib., s. 6).
Filing Authority. — The person receiving a license must
file it, or a copy, with the county clerk of the county where he
resides, and the county clerk is required to file said certificate
or copy and enter a memorandum thereof, giving its date and
the name of the person to whom it was issued, and the date of
filing, and on notice to him of a change of location or the death
of a person licensed or of revocation, the county clerk is required
to enter a memorandum of said fact at the appropriate place in
the record. In case of removal into another county, the person
licensed must procure from the county clerk a certified copy of
the said license, and file it with the county clerk of the county to
which he shall remove, with like effect as an original license
{ib., s. 7).
Penalty, Definition. — To practise medicine or surgery
without a license or contrary to this chapter is a misdemeanor
punishable with a fine of from $50 to $100, or imprisonment in
a county jail from ten to ninety days, or both. Any person is
regarded as practising who appends the letters ''M.D." or
"M.B." to his name, or for a fee prescribes, directs, or recom-
mends for the use of any person any drug or medicine or agency
for the treatment, care, or relief of anj^ wound, fracture, or
bodily injury, infirmity, or disease ; but the chapter does not
apply to dentists.
Regulations. — The board has authority to prescribe and
establish all needful rules and regulations to carry this chapter
into effect {ib., s. 9).
Former Practitioner. — All persons licensed under sec.
2,289 of the laws of Washington Territory, 1881, or having
complied with its provisions, are to be taken and considered as
licensed under this act, and the secretary of the board is re-
quired to enter the names of such persons upon the register kept
by him, as licensed physicians and surgeons on their written ap-
plication {ib., s. 10).
Fee. — To the treasurer of the board, for examination,
{ib., s. 3).
WEST VIRGINIA. 219
West Virginia.
Qualification. — The following persons and no others are
permitted to practise medicine :
1. Graduates of a reputable medical college in the school of
medicine to which the person desiring to practise belongs.
Such person must present his diploma to the State board of
health, or the two members thereof in his congressional district,
and if it be found to be genuine and was issued by such med-
ical college as hereinafter mentioned, and the person presenting
it be the graduate therein named, the board or said two mem-
bers, as the case may be, must issue and deliver to him a cer-
tificate to that effect, and such diploma and certificate shall
entitle the person named in the diploma to practise medicine in
all its departments.
2. Persons not graduates in medicine who had practised
medicine in this State under a certificate issued by the State
board of health prior to the passage of the act are authorized to
practise medicine in all its departments.
3. A person not a graduate of medicine and who has not
practised medicine in this State under a certificate must be
examined by the State board of health, or the two members
thereof in the congressional district where he resides, or if he
resides out of the State by the two members in the congressional
district nearest to his place of residence, who, together with a
member of the local board of health who is a physician, if
there be such a member of the local board of health of the
county in which the examination is held, shall examine him ;
and if upon a full examination they find him qualified to prac-
tise medicine in all its departments, they, or a majority of them,
shall grant him a certificate to that effect, and thereafter he
shall have the right to practise medicine in the State to the
same extent as if he had the diploma and certificate above
mentioned. The members of the State board of health in each
congressional district must, by publication in some newspaper
printed in the county in which their meeting is to be held, or
if no such paper is printed therein, in some newspaper of gen-
eral circulation in such district, give at least twenty-one days'
notice of the time and place of their meeting for the examina-
220 SYNOPSIS OF LAWS — POSTE AND BOSTON.
tion of applicants for permission to practise medicine, published
at least once a week for three consecutive weeks before the day
of such meeting.
This section does not apply to a physician or surgeon called
from another State to treat a particular case or to perform a
particular surgical operation in the State, or who does not
otherwise practise in the State (Code of W. Va., 1891, c. 150,
s. 9).
Every person holding a certificate must have it recorded
in the office of the secretary of the State board of health, and
the secretary is required to indorse on said certificate the fact
of such recordation and deliver the same to the person named
therein or his order.
The State board of health may refuse certificates to indi*
viduals guilty of malpractice or dishonorable conduct, and may
revoke certificates for like causes ; such revocation being after
due notice and trial by the said board, with right of appeal to
the circuit court of the county in which such individual resides ;
but no such refusal or revocation shall be made by reason of his
belonging to or practising in any particular school or system of
medicine {ib., s. 10).
The examination fee is not retained if a certificate is refused,
but the applicant may again, at any time within a j'ear after
refusal, be examined without an additional fee, and if a cer-
tificate be again refused he may, as often as he sees fit, on
payment of the fee, be examined until he obtains a certificate
{ib., s. 11).
Examinations may be wholly or partly in writing, and shall
be of an elementary and practical character, embracing the gen-
eral subjects of anatomy, physiology, chemistry, materia
medica, pathology, pathological anatomj^ surgery, and obstet-
rics, but sufficientl}^ strict to test the qualificatioas of the can-
didate as a practitioner of medicine, surgerj", and obstetrics.
The chapter does not apply to females practising midwifery
(ib., s. 12).
Definition, Exceptions. — Any person is regarded as
practising medicine who professes publicly to be a physician,
and to prescribe for the sick, or who appends to his name
"M.D." This act also applies to apothecaries and pharmacists
who prescribe for the sick. It does not apply to commissioned
WEST VIRGINIA. 221
officers of the United States army and navy and marine hos-
pital service {ib., s. 13).
Itinerant Physician or Vender. — Any itinerant physi-
cian or itinerant vender of any drug, nostrum, ointment, or
aj^pliance of any kind intended for the treatment of disease or
injury, or who shall by writing or printing or in any other
method publicly profess to cure or treat diseases, injuries, or
deformities by any drug, nostrum, manipulation, or other ex-
pedient, shall before doing so pay to the sheriff of every county
in which he desires to practise a special tax of $50 for each
month or fraction of a month ho shall so practise in such
county, and take his receipt in duplicate therefor. He shall
present said receipts to the clerk of the county court of such
county, who shall file and preserve one of them in his office and
indorse on the other, "A duplicate of this receipt has been
filed in my office," and sign the same. For such a person to
practise or attempt to practise in any county without having
jjaid such tax and filed such receipt and obtained such indorse-
ment, or to practise or attempt to practise for a longer time
than that for which he has paid a tax, is a misdemeanor pun-
ishable with a fine of from $100 to $500. Any person who
shall travel from place to place and by writing, printing, or
otherwise publicly profess to cure or treat diseases, injuries, or
deformities is deemed an itinerant physician subject to the
taxes, fines, and penalties of this section (ib., s. 14).
Penalty. — To practise or attempt to practise medicine,
surgery, or obstetrics without compljang with sec. 9 is a mis-
demeanor punishable, for every offence, with a fine of from
$50 to $500 or imprisonment in a county jail from one month to
twelve months, or both. To file or attempt to file as his own a
diploma or certificate of another, or a false or forged affidavit
of identity, or wilfully swear falsely to any question propounded
to him on examination or to any affidavit required to be made
and filed, is punishable with confinement in the penitentiary
from one to three years or imprisonment in a county jail from
six to twelve months, and a fine of from $100 to $500 (ib.,
s. 15).
Fee. — To the State board of health, or its examining
members, for examination, $10 (ib., s. 11).
222 SYNOPSIS OF LAWS — POSTE AND BOSTON.
Wisconsin.
Prohibition. — No person practising physic or surgery, or
both, shall have the right to collect in any action in any court
fees or compensation for the performance of any medical or
surgical service, or to testify in a professional capacity as a
physician or surgeon, unless he shall have received a diploma
from some incorporated medical society or college or shall be a
member of the State or some county medical society legally
organized in this State ; provided that in all criminal actions the
court may in its discretion and in the furtherance of justice
receive the testimony of any physician or surgeon without re-
quiring proof of the incorporation of the medical society or
college from which he graduated (R. S., 1878, s. 1,436, as
amended c. 131, 1887).
No person practising physic or surgery, or both, prohibited
by the above section from testifying in a professional capacity
as a physician or surgeon, shall assume the title of doctor, phy-
sician, or surgeon by means of any abbreviation or by the use
of any other word or words, letters of the alphabet of the Eng-
lish or any other language, or any device of whatsoever kind,
printed, written, or painted, or exhibited in any advertisement,
circular, handbill, letter, or other instrument, nor on any card,
sign, door, or place whatsoever.
Penalty, Exceptions. — A violation of this act is a mis-
demeanor punishable with a fine of from 825 to $100, or im-
prisonment in a county jail from ten days to sixty days for
each offence (s. 1, c. 256, 1881, as amended c. 40, 1882).
On complaint in writing under oath before any magistrate
or justice of the peace .charging the commission of an offence
against tlie provisions of this act in his county, it is the duty of
the district attorney to prosecute the offender, and in all such
prosecutions the burden of proof shall be upon the defendant to
establish his right to use such title under the provisions of this
act (ib., s. 2).
Any person prohibited by sec. 1 from assuming the title of
doctor, physician, or surgeon who shall practise or pretend to
practise physic or surgery, or both, is not exempted from any,
but is liable to all, of the legal penalties and liabilities ot mal-
WISCONSIN — WYOMING. 223
practice, and ignorance shall be no excuse for a failure to per-
form or for neglect or unskilfully performing or attempting to
perform any of the duties required by law of practising physi-
cians or surgeons. The act does not prevent students from
practising under the direction of a qualified preceptor, nor
women from practising midwifery, nor veterinarians from
practising in their special department {ib., s. 3).
Wyoming.
Qualification. — No person can lawfully practise medicine,
surgery, or obstetrics who has not received a medical education
and diploma from some regularly chartered medical school hav-
ing a bona fide existence when the diploma was granted (R. S.,
1887, s. 1,925).
Every physician, surgeon, or obstetrician must file for
record with the register of deeds of the county in which he is
about to practise or where he practises, a copy of his diploma,
exhibiting the original, or a certificate from the dean of the
medical school of which he is a graduate certifying to his grad-
uation {ib., s. 1,926).
When filing a copy of his diploma or certificate of gradua-
tion, he must be identified as the person named in the paper
about to be filed by the affidavit of two citizens of the county,
or his affidavit taken before a notary public or commissioner of
deeds for the State, which affidavit must be filed in the office
of the register of deeds {ib., s. 1,927).
Penalty. — To practise without complying with this chapter
is a misdemeanor punishable with a fine of from $50 to $500 or
imprisonment in a county jail from thirty days to six months,
or both, for each offence. To file or attempt to file as his own
a diploma or certificate of another, or a forged affidavit of iden-
tification, is a felony subject to a fine and imprisonment in the
penitentiary {ib., s. 1,928).
It is the duty of the police, sheriff, or constable to arrest all
persons practising medicine, surgery, or obstetrics without
complying with these provisions {ib., s. 1,929).
Exceptions. — This chapter does not apply to persons in
emergency prescribing or giving advice in medicine, surgery,
or obstetrics in a section of country where no physician, sur-
224 SYNOPSIS OP LAWS — POSTE AND BOSTON.
geon, or obstetrician resides, or where no physician, surgeon,
or obstetrician resides within a convenient distance, nor to
persons prescribing in their own families, nor to persons claim-
ing to practise medicine, surgery, or obstetrics in any section
of the State where no physician or surgeon having a diploma
or a certificate resides {ib., s. 1,930).
Evidence. — On the trial of persons charged with the vio-
lation of this chapter it shall be sufficient for the prosecution
to show that defendant has practised medicine, surgery, or ob-
stetrics within the county where the indictment is found at any
time since the passage of the act (1876), and the defendant
shall not after proof be entitled to acquittal until he show&
by the testimony of some competent witness upon oath that
the defendant has received a medical education, and a genuine-
diploma from some regularly chartered medical school ; provided
that the defendant may show such facts by depositions taken in
the same manner as depositions in civil cases {ib., s. 1,931).
The United Kingdom of Great Britain and Ireland.
Medical Acts. — The Act 21 and 22 Victoria, c. 90, and the-
amendments thereof and additions thereto, are generally spoken
of as the Medical Acts.
Medical Councils. — There is a general council of medical
education and registration of the United Kingdom, with branch
councils for England, Scotland, and Ireland (21 and 22 Vict.,
1858, c. 90, s. 3, 6).
Members of the general council are chosen as provided in 49
and 50 Vict., c. 48, s. 7; those representing the medical cor-
porations must be qualified to register under this act (21 and 22
Vict., c. 90, s. 7).
The general council appoints a registrar for England, and
the branch councils for Scotland and Ireland appoint respectively
a registrar for Scotland and Ireland {ib., s. 10, 11).
Registrar. — It is the duty of the registrars to keep their
registers correct, and to erase the names of all registered persons
who shall have died, and from time to time to make the necessary
alterations in the addresses or qualifications of persons registered.
It is lawful for the registrar to write a letter to any registered
GREAT BRITAIN AND IRELAND. 225
person, addressed to him according to his address on the regis-
ter, to inquire whether he has ceased to practise or has changed
his residence, and if no answer be returned within six months
from the time of sending the letter, it is lawful to erase the
name of such person from the register, but it may be restored
by direction of the general council {ib., s. 14).
Qualification. — Persons possessed of one or more of the
qualifications described in Schedule A, on the payment of a fee
not exceeding £5, are entitled to register on the production to
the registrar of the branch council for England, Scotland, or
Ireland the document conferring or evidencing the qualification
in respect whereof he seeks to be registered, or upon transmitting
by post to such registrar information of his name and address,
and evidence of his qualifications and of the time or times at
which they were obtained. The several colleges and bodies men-
tioned in Schedule A may transmit from time to time to the
registrar, under their respective seals, lists of the persons who
by grant of such colleges and bodies respectively, are for the time
being entitled to register, stating the qualifications and resi-
dences of such persons, and it shall be lawful for the registrar on
the payment of the said fee to enter in the register the persons
mentioned in such lists with their qualifications and places of
residences as therein stated without other application {ib., s. 15).
The general council is required to make orders for regulat-
ing the registers from time to time {ib., s. 16).
Persons actually practising medicine in England before
August 1st, 1815, were entitled to register under the act {ib.,
s. 17).
Any two or more of the colleges and bodies in the United
Kingdom mentioned in Schedule A may, with the sanction and
under the direction of the general council, unite or co-oper-
ate in conducting the examinations required for qualifications
to be registered {ib., s. 19, 37 and 38 Vict., c. 34).
The privy council ma}' suspend the right of registration in
respect of qualifications granted by any college or body {ib.,
s. 21).
After such revocation, no person shall be entitled to register
in respect to any qualification granted by such college before
revocation {ib., s. 22).
The privy council may issue an injunction directing any
15
22(3 SYNOPSIS OF LAWS — POSTE AND BOSTON.
body entitled to grant qualifications to desist from imposing
upon any candidate for examination an obligation to adopt or
refrain from adopting the practice of any particular theory of
medicine or surgery as a test or condition of admitting him to
examination or granting him a certificate ; and in the event of
their not complying, may order that such body cease to have the
power of conferring a right to be registered so long as they
shall continue such practice (ib., s. 23).
Where any person entitled to be registered applies to the
registrar of any branch council for that purpose, such registrar
is required forthwith to enter in a local register the name and
place of residence, and the qualifications in respect of which
the person is so entitled and the date of registration ; and in
case of the branch council for Scotland or Ireland, to send to
the registrar of the general council a copy of the entry, and
the registrar of the general council is required to cause the
same to be entered in the general register ; and such registrar
is required to cause all entries made in the local register for
England to be entered in the general register {ib., s. 25).
No qualification is entered on the register, on the first regis-
tration or by way of addition to a regular name, unless the reg-
istrar be satisfied by proper evidence that the person claiming
it is entitled to it. Any appeal from the decision of the regis-
trar may be decided by the general council or by the council for
England, Scotland, or Ireland, as the case may be. Any entry
proved to the satisfaction of such general council or branch
council to have been fraudulent^ or incorrectly made may be
erased from the register b}' an order in writing of such general
council or branch council {ib., s. 26).
Medical Register. — The registrar of the general council
is required to cause to be printed, published, and sold under
the direction of such council, everj^ yeai'j. a correct register of
the names with the respective residences and medical titles,
diplomas, and qualifications conferred by any corporation or
university or by a doctorate of the Archbishop of Canterbury,
with the dates thereof, of all persons appearing on the general
register as existing on January 1st in every j^ear. Such register
is called the Medical Register, and a copy of the Medical
Register for the time being is evidence that the persons therein
specified are registered according to the act, and the absence of
GEE AT BRITAIN AND IRELAND. 227
the name of any person from such copy is evidence, until the
contrary be made to appear, that such person is not so registered ;
provided, that in the case of any person whose name does not
appear in such copy, a certified copy under the hand of the reg-
istrar of the general council or a branch council of the entry of
the name of such person on the general or local register shall
be evidence that such person is so registered {ib., s. 27).
If any college or body exercise any power it possess of strik-
ing off from its list the name of any one of its members, it shall
signify his name to the general council and the said council
may, if they see fit, direct the registrar to erase from the regis-
ter the qualification derived from such college or body in respect
of which such member was registered, and the registrar shall
note the same therein, but the name of no person shall be erased
from the register on the ground of his having adopted any
theory of medicine or surgery (ib., s. 28).
If any registered medical practitioner shall be convicted in
England or Ireland of any felony or misdemeanor, or in Scot-
land of any crime or offence, or shall be after due inquiry
judged by the general council to have been guilty of infamous
conduct in any professional respect, the general council may,
if they see fit, direct the registrar to erase the name of such
medical practitioner from the register {ib., s. 29).
Every person registered who may have obtained any higher
degree or other qualification is entitled to have it inserted in
the register in substitution for or in addition to his qualification
previously registered, on the payment of such fee as the council
may appoint {ib., s. 30).
Compensation. — No person is entitled to receive for any
medical or surgical advice, or attendance, or for the perform-
ance of any operation or for any medicine which he shall have
both prescribed and supplied, unless he prove upon the trial
that he is registered under this act {ib., s. 32, as amended 23
and 24 Vict., c. 7, s. 3).
Definition. — The words "legally qualified medical practi-
tioner" or "duly qualified medical practitioner," or any words
implying a person recognized by law as a medical practitioner
or member of the medical profession in any act of Parliament,
mean a person registered under this act {ib., s. 34, as amended
23 and 24 Vict., c. 7, s. 3).
228 SYNOPSIS OF LAWS — POSTE AND BOSTON.
Exemptions. — If they so desire, registered persons are
exempt from serving on juries, and in all corporation, par-
ish, ward, hundred, and town offices, and in the militia (ib.,
s. 35).
Disqualifications. — No unregistered person is permitted
to hold any appointment as a physician, surgeon, or other
medical officer in the military or naval service, or in emigrant
or other vessels, or in any hospital, infirmary, dispensary, or
lying-in hospital, not supported wholly by voluntary contribu-
tions, or in any lunatic asylum, jail, penitentiary, house of
correction or of industry, parochial or union workhouse or
poorhouse, parish union, or other public established body or in-
stitution, or to any friendly or other society for affording mutual
relief in sickness, infirmity, or old age, or as a medical officer
of health {ib., s. 36, as amended 23 and 24 Vict., c. 7, s. 3).
No certificate required by any act from any phj^sician or
surgeon licentiate in medicine and surgery, or other medical
practitioner, is valid unless the signer be registered under this
act (ib., s. 37, as amended 23 and 24 Vict., c. 7, s. 3).
Penalty. — Wilfully procuring or attempting to procure
one's seK to be registered by making or producing or causing to
be made or produced an)- false or fraudulent representation or
declaration, or aiding or abetting therein, is a misdemeanor in
England and Ireland, and in Scotland a crime or offence, pun-
ishable by fine or imprisonment. The imprisonment cannot
exceed twelve months {ib., s. 39).
Wilfully and falsely pretending to be or taking or using the
name or title of phj-sician, doctor of medicine, licentiate in
medicine and surger}-, bachelor of medicine, surgeon, general
practitioner, or apothecary, or any name, title, addition, or de-
scription implying registration under this act, or recognition
by law as a physician or surgeon or licentiate in medicine
and surgery, or practitioner in medicine, or apothecary, is pun-
ishable on summary conviction by a penalty not exceeding £20
{ib., s. 40, 41).
Deceased Physicians. — Every registrar of deaths in the
United Kingdom, on receiving notice of the death of any medi-
cal practitioner, is required to transmit to the registrar of the
general council and the registrar of the branch council a certifi-
cate of such death with the time and place, and on the receipt
GREAT BRITAIN AND IRELAND. 229
of such certificate the medical registrar is required to erase the
name of the deceased from the register {ib., s. 45).
Exceptions. — The general council was by the act em-
powered by special order to dispense with such provisions of
this act or such part of any regulations made by its authority
as to them should seem fit, in favor of persons at the time of its
passage practising medicine or surgery in any part of Her Maj-
esty's dominions other than Great Britain and Ireland by virtue
of any of the qualifications in Schedule A, and in favor of persons
practising medicine or surgery within the United Kingdom on
foreign or colonial diplomas or degrees before the passage of
this act, and in favor of any persons who had held appointments
as surgeons or assistant surgeons in the army, navy, or militia,
or in the service of the East India Company, or who were act-
ing as surgeons in the public service, or in the service of any
charitable institution, and in favor of medical students who
commenced their professional studies before its passage {ib.,
s. 46).
The qualifications specified in Schedule A are as follows :
1. Fellow, member (inserted 22 Vict., c. 21, s. 4), licenti-
ate, or extra licentiate of the Royal College of Physicians of
London (this is declared by 23 and 24 Vict., c. 06, s. 1, to de-
note the corporation of " The President and College or Com-
monalty of the Faculty of Physics in London"). (The act
makes provision for a new charter with change of name to "The
Royal College of Physicians of England," or retention of old
name: ib., s. 47, as amended 23 and 24 Vict., c. 66, s. 2.)
2. Fellow, member (inserted 22 Vict., c. 21, s. 4), or
licentiate of the Royal College of Physicians of Edinburgh.
(The act makes provision for the granting of a new charter to
the Royal College of Physicians of Edinburgh, whereby its
name is to be changed to " The Royal College of Physicians of
Scotland," or its old name may be retained: ib., s. 49, as
amended 23 and 24 Vict., c. 66, s. 2.)
3. Fellow or licentiate of the King's and Queen's College of
Physicians of Ireland. (The act makes provision for the grant-
ing of a new charter to this college, whereby its name is to be
changed to " The Royal College of Physicians of Ireland , " or
its old name may be retained: ib., s. 51, as amended 23 and 24
Vict., c. m, s. 2.)
230 SYNOPSIS OF LAWS — POSTE AND BOSTON.
4. Fellow or member or licentiate in midwifery of the Royal
College of Surgeons of England.
5. Fellow or licentiate of the Royal College of Surgeons of
Edinburgh (see G, below).
G. Fellow or licentiate of the Faculty of Physicians and
Surgeons of Glasgow. (The act makes provision for the possible
amalgamation of the Royal College of Surgeons of Edinburgh
with the Faculty of Physicians and Surgeons of Glasgow, in
which case the united corporation is to be named " The Royal
College of Surgeons of Scotland:" ih., s. 50.)
7. Fellow or licentiate of the Royal College of Surgeons in
Ireland.
8. Licentiate of the Society of Apothecaries, London.
9. Licentiate of the Apothecaries' Hall, Dublin.
10. Doctor or bachelor or licentiate of medicine, or master
in surgery of any university of the United Kingdom ; or doctor
of medicine, by doctorate granted prior to the passage of the
act by the Archbishop of Canterbury.
11. Doctor of medicine of any foreign or colonial university
or college, practising as a phj^sician in the United Kingdom
before October 1st, 1858, who shall produce certificates to the
satisfaction of the council, of his having taken his degree of
doctor of medicine after a regular examination, or who shall
satisfy the council under sec. 46 (amended 22 Vict., c. 21, s. 5)
of this act, that there is sufficient reason for admitting him to
be registered.
Nothing in the above act shall prevent any person, not a
British subject, who shall have obtained from any foreign uni-
versity a degree or diploma of doctor in medicine, and who
shall have passed the regular examinations entitling him to
practise medicine in his own country, from being and acting as
the resident physician or medical officer of any hospital estab-
lished exclusively for the relief of foreigners in sickness ; pro-
vided always such person is engaged in no medical practice
except as such resident physician or medical officer (22 Vict.,
c. 21, s. 6).
The following qualification was added by 23 and 24 Vict.,
c. 7, s. 1:
A diploma or license in surgery granted by any university
in Ireland legally authorized to grant the same.
GREAT BRITAIN AND IRELAND. 231
The act 39 and 40 Vict., c. 40, in sec. 3, provides that all
persons who have obtained from any university of the United
Kingdom legally authorized to confer the same, the degree of
bachelor in surgery, shall be permitted to register the same as
a qualification under 21 and 22 Vict., c. 90.
The diploma of a member of the King's and Queen's Col-
lege of Physicians in Ireland, and the degree of Master in Ob-
stetrics of anj^ university in the United Kingdom are added to
the qualifications in Schedule A of the Medical Act of 1858
(49 and 50 Vict., c. 48, s. 20).
The change of name of any of the corporations named in 21
and 22 Vict., c. 90, is not to alter or afi^ect the qualifications
constituted by the act (23 and 24 Vict., c. G6, s. 3).
Revocation of License.— The Society of Apothecaries may
strike off from the list of licentiates of said society the name of
any person who shall be convicted in England or Ireland of any
felony or misdemeanor, or in Scotland of any crime or offence,
or who shall, after due inquiry, be judged by the general council
to have been guilty of infamous conduct in any professional
respect, and the said society shall forthwith signify to the gen-
eral council the name of the licentiate so stricken off (37 and 38
Vict., c. 34, s. 4).
Women. — The Society of Apothecaries is not relieved from
any existing obligation, nor deprived of any right, to admit
women to the examinations required for certificates to practise
as apothecaries, or to enter the lists of licentiates of said society,
any women who shall have satisfactorily passed such examina-
tions, and fulfilled the other general conditions imposed upon
persons seeking to obtain from the said society a qualification to
be registered under 21 and 22 Vict., c. 90 {ih., s. 5).
The act 39 and 40 Vict., c. 41, extends the powers of every
body entitled under 21 and 22 Vict., c. 90, to grant qualifica-
tions for registration so that it may grant any qualification for
registration granted by such bodj- without distinction of sex —
but nothing in this act is compulsory.
The Medical Act of 1886 (49 and 50 Vict., c. 48) modified
the foregoing acts as follows :
Examination. — A person cannot lawfull}" be registered
under the medical acts in respect of any qualification referred
to in any of those acts unless he has passed such qualifying ex-
232 SYNOPSIS OF LAWS — POSTE AND BOSTON.
amiiiation in medicine, surgery, and midwifery as is in this
act mentioned (49 and 50 Vict., c. 48, s. 2).
A qualifying examination shall be an examination in medi-
cine, surgery, and midwifery held for the purpose of granting
a diploma or diplomas conferring the right of registration under
the medical acts, by any of the following bodies :
(a) Any university in the United Kingdom, or any medical
corporation legally qualified at the time of the passage of this
act to grant such diploma or diplomas in respect of medicine
or surgery ; or
(b) Any combination of two or more inedical corporations
in the same part of the United Kingdom, who may agree to
hold a joint examination in medicine, surgery, and midwifery,
and of whom one at least is capable of granting such diploma
as aforesaid in respect of medicine, and one at least is capable
of granting such diploma in respect of surgery ; or
(c) Any combination of any such university as aforesaid
with any other such university or universities, or of any such
university or universities with a medical corporation or cor-
porations ; the bodies forming such combination being in the
same part of the United Kingdom {ib., s. 3 [1]).
The standard of proficiency at said examinations shall be
such as suffices to guarantee the possession of knowledge and
skill requisite for the efficient practice of medicine, surgery,
and midwifery. It is the duty of the general council to secure
the maintenance of such standard of proficiency, and it may
appoint such number of inspectors as it may determine who
shall attend at all or any of the said examinations {ib., s. 3 [2]).
The inspectors are not to interfere with the conduct of any
examination, but to report to the general council their opinion
as to the sufficiency or insufficiency of every examination which
they attend, and such other matters in relation thereto as the
general council may require {ib., s. 3 [3]).
If it appears to the general council that the standard of pro-
ficiencj'^ in medicine, surgery, and midwifery, or in any of those
subjects or any branch thereof required at such examinations
by any such body, is insufficient, the privy council, on a report
from the general council after considering such report, and any
objection thereto by any body to which it relates, may by order
declare that the examination of such body or bodies shall not
GREAT BRITAIN AND IRELAND. 233
be deemed a qualifying examination for registration, and Her
Majesty, with the advice of the privy council, may revoke such
order if upon further report from the general council, or any
body to which it relates, it seems to her expedient {ih.^ s.
4 [1]).
During the continuance of such order, the examinations held
hj the body or bodies to which it relates shall not be deemed
qualifying examinations, and a diploma granted to a person
passing such examinations shall not entitle such person to
registration {ib., s. 4 [2]).
If a medical corporation represent to the general council
that it is unable to enter into a combination for holding a qual-
ifying examination, and the general council is satisfied that the
said corporation has used its best endeavor to do so on reason-
able terms, the general council may on the application of such
corporation appoint any number of examiners to assist at the
examinations for granting a diploma conferring on the holder
the right of registration {ih.^ s. 5 [1]).
It is the duty of the said assistant examiners to secure at
the said examinations the maintenance of such standard of
IDroficiency in medicine, surgery, and midwifery as is required
from candidates at qualifying examinations, and any exami-
nation held subject to this section shall be deemed a qualifying
examination {ih., s. 5 [2]).
Practitioner's Rights. — A registered medical practitioner
shall be entitled to practise medicine, surgery, and midwifery
in the United Kingdom, and subject to any local law, in any
other part of Her Majestj^'s dominions, and to recover in due
course of law in respect of such practice, any expenses or
charges in respect of medicaments or other appliances, or any
fees to which he may be entitled, unless he is a fellow of a
college of physicians, .the fellows of which are prohibited by by-
law from recovering at law their expenses, charges or fees, in
which case such prohibitory by-law, so long as it is in force,
may be pleaded in bar of any legal proceeding instituted by such
fellow for recovery of expenses, charges, or fees {ih., s. 6).
Members of General Council. — The constituent members
of the general council are designated by this act in sec. 7.
Members of the general council representing the registered
medical profession must themselves be registered medical prac-
234: SYNOPSIS OF LAWS — POSTE AND BOSTON.
titioners, and members of the branch council for the part of the
United Kiugxlom in which they are elected {ib., s. 8).
Colonial and Foreign Practitioners. — When a per-
son shows to the satisfaction of the registrar of the general
council that he holds some recognized colonial medical diploma
or diplomas granted to him in a British possession to which this
act applies, and that he is of good character, and is by law
entitled to practise medicine, surger}^, and midwifery in such
British possession, he shall on application to the said registrar,
and on the paj^ment of such fee not exceeding £5, as the general
council may determine, be entitled without examination in the
United Kingdom to be registered as a colonial practitioner in
the medical register ; provided he proves to the satisfaction of
the registrar :
(1) That the said diploma or diplomas was or were granted
to him at a time when he was not domiciled in the United
Kingdom, or in the course of a period of not less than five years
during the whole of which he resided outside of the United
Kingdom; or
(2) That he was practising medicine or surgery or a branch
of medicine or surgery in the United Kingdom on the pre-
scribed day, and that he has continued practising the same
either in the United Kingdom or elsewhere for not less than
ten years immediately preceding the prescribed day {ib., s.
11).
When a person shows to the satisfaction of the registrar of
the general council that he holds some recognized foreign med-
ical diploma or diplomas granted in a foreign country, to which
this act applies, and that he is of good character, and is by law
entitled to practise medicine, surgery, and midwifery in such
foreign country, he shall on application to said registrar, and
on payment of such fee, not exceeding £5, as the general coun-
cil may determine, be entitled without examination in the
United Kingdom to be registered as a foreign practitioner in
the medical register; provided he proves to the satisfaction of
the registrar :
(1) That he is not a British subject; or
(2) That, being a British subject, the said diploma or
diplomas was or were granted to him at a time when he was
not domiciled in the United Kingdom or in the course of a
GREAT BRITAIN AND IRELAND. 235
period of not less than five years, during the whole of which
he resided out of the United Kingdom ; or
(3) That, being a British subject, he was practising medi-
cine or surgery, or a branch of medicine or surgery in the
United Kingdom on the prescribed day, and that he has con-
tinued practisiug the same in the United Kingdom or elsewhere,
for not less than ten years immediately preceding the said pre-
scribed day (?'&., s. 12).
The medical diploma granted in a British possession or for-
eign country to which this act applies, which is to be deemed
requisite, shall be such a diploma as ma}^ be recognized by the
general council as furnishing a sufficient guarantee of the pos-
session of the requisite knowledge and skill for the efficient
practice of medicine, surgery, and midwifery.
When the general council have refused to recognize any
such diploma, the privy council may, on appeal, after commu-
nicating with the general council, order the general council to
recognize such diploma.
If the refusal of the registration of a colonial or foreign
practitioner be on any other ground, the registrar of the gen-
eral council shall, if required, state in writing the reason for
the refusal, and the person refused may appeal to the privy
council, which, after communicating with the general council,
maj^ dismiss the appeal or order the general council to enter the
name of the applicant on the register.
A person may be registered both as a colonial and foreign
practitioner (z6., s. 13).
The medical register shall contain separate lists of the names
and addresses of colonial and foreign practitioners, and the
provisions of 21 and 22 Vict., c. 90, relating to persons regis-
tered and to the medical register, and to offences, shall applj^ in
the case of colonial and foreign practitioners registered under
this act so far as may be (ib., s. 14).
Any registered practitioner on the list of colonial or foreign
practitioners who is in possession of or obtains any recognized
colonial or foreign medical diploma granted in a British pos-
session or foreign country to which this act applies may cause
a description of such diploma to be added to his name in the
medical register {ib., s. 15).
An}' registered medical practitioner on the medical register
236 SYNOPSIS OP LAWS — POSTE AND BOSTON,
by virtue of English, Scotch, or Irish quahfications, and in
possession of a foreign degree in medicine, may cause a descrip-
tion of such foreign degree to be added to his name as an addi-
tional title in the medical register, provided he satisfy the
general council that he obtained such degree after a proper
examination and prior to the passage of this act {ib., s. 16).
Her Majesty may from time to time, by order in the coun-
cil, declare that this act be deemec\ to apply to any British pos-
session or foreign country which in the opinion of Her Majesty
affords the registered medical practitioners of the United
Kingdom such privileges of practice in the said British pos-
sessions or foreign countries as to Her Majesty may seem just;
and on and after the day named in such order such British
possession or foreign country shall be deemed to be a British
possession or foreign country to which this act applies. Her
Majesty may also renew or revoke any such order, and upon
such revocation such possession or foreign country shall cease
to be a possession or country to which this act applies without
prejudice to the right of any person whose name has already
been entered on the register {ib., s. 17).
Nothing in the Medical Act of 1858 shall prevent a person
holding a medical diploma, entitling him to practise medicine
or surgery in a British possession to which this act applies,
from holding an appointment as a medical officer in any vessel
registered in that possession {ib., s. 18).
Default of General Council. — In default of the gen-
eral council to perform any duty, the privy council may notify
their opinion to the general council, and on the failure of the
general council to comply with any direction of the privy
council, the privy council may themselves give effect to such
direction, and for that purpose exercise any power vested in
the general council, and of their own motion do anything which
they are authorized to do in pursuance of a report or suggestion
from the general council {ib., s. 19).
Sanitary Science. — Every registered medical practitioner
to whom a diploma for proficiency in sanitarj" science, public
health or state medicine has after special examination been
granted, by any college or facultj^ of physicians or surgeons or
university in the United Kingdom, or by anj- such bodies act-
ing in combination, shall, if such diploma appear to the privy
GREAT BRITAIN AND IRELAND. 237
council or general council to deserve recognition in the medical
register, be entitled on the payment of such fee as the general
council may appoint, to have such diploma entered in the said
register in addition to any other diploma or diplomas in respect
of which he is registered {ib., s. 21),
Evidence. — Any act of the privy council shall be suffi-
ciently signified by an instrument signed by the clerk of the
council, and every order and act signified by an instrument
purporting to be signed by the clerk of the council shall be
deemed to have been dulj" made and done by the privj- council,
and every instrument so signed shall be received in evidence
without proof of the authority or signature of the clerk of the
council or other proof (^7>., s. 22).
The following copies of any orders made in pursuance of
medical acts or this act shall be evidence :
(1) Any cop3" purporting to be printed by the Queen's
printer, or by any other printer in pursuance of an authority
given by the general council,
(2) Any copy of an order certified to be a true copy by the
registrar of the general council, or by any other person ap-
pointed by the general council, either in addition to or in exclu-
sion of the registrar, to certify such orders (i6., s. 23).
Rights Unaffected. — This act does not vary the rights of
persons practising as registered medical practitioners on the
day preceding the day when it goes into effect {ih., s. 24).
In consequence of the repeal of any enactment repealed by
this act, no person legally entitled to practise as a medical prac-
titioner in any colony or part of Her Majesty's dominions other
than the United Kingdom shall cease to be so entitled if he
would have been entitled if no such repeal had taken place
{ih., s. 25).
Definitions. — In the act the word diploma means any
diploma, degree, fellowship, membership, license, authority to
practise, letters, testimonial, certificate or other status or
document granted by any university, corporation, college, or
other bod}^ or by any departments of or person acting under
the authority of the government of an}' countr}^ or place within
or without Her Majesty's dominion (/6., s. 27),
Fees. — The fees are to be determined by the general council
within the limits set by the various sections authorizing fees.
238 SYNOPSIS OF LAWS — POSTE AND BOSTON.
British Columbia.
Medical Council. — There is a body styled "The Medical
Council of British Columbia, " composed of seven members who
are registered medical practitioners elected by the votes of
registered medical practitioners (Cons. Acts 1888, c. 81, s. 2,
3, 4, 5).
No person can lawfully vote at such election unless his fees
to the council have been paid ; and no person is eligible to elec-
tion unless qualified to vote at such election {ib., s. 1-1).
A register of such qualified voters is required to be prepared
by the registrar of the council and no person is entitled to vote
whose name is not on the register ; it is the duty of the regis-
trar to examine into the written complaint of any medical prac-
titioner as to the improper omission or insertion of any name
in the list ; and appeal from his decision lies to a judge of the
supreme court in a summary way, whose decision shall be final,
and no unregistered person may vote {ib., s. 16, 17).
Register. — The council is required to appoint a registrar
and to cause a register to be kept by him of the names of all
persons who have complied with this act and with the rules and
regulations made by the council respecting the qualifications of
practitioners of medicine or surgery, and those persons only
whose names are inscribed in the said register, are deemed
qualified and licensed to practise medicine or surgery except
as hereinafter provided (i5., s. 26).
The registrar is required to keep his register correct, and to
make the necessary alterations in the addresses and qualifica-
tions of registered persons (ib., s. 27).
Qualification. — Every person at the passage of the act
(1886) registered under the medical ordinance of 1867 is entitled
to be registered under this act {ib., s. 28).
The council is required to admit upon the .register any per-
son who shall procure from any college or school of medicine
and surgery requiring a three-years' course of stud}^, a diploma
of qualification, provided he furnish to the council satisfactory
evidence of identity and pass before the members thereof a sat-
isfactory examination touching his fitness and capability to
practise as a physician and surgeon {ib., s. 29).
BRITISH COLUMBIA. 339
The council is required to admit upon the register every
person mentioned in -tO and 50 Vict., c. 48, of the Acts of Par-
liament of the United Kingdom, duly registered under the im-
perial Medical Act, prior to and inclusive of June 30th, 188.7,
upon complying with the orders, regulations or by-laws of the
council and giving due proof of such registration, and that the
person applying for registration has not lost the benefit of same
by reason of misconduct or otherwise, and upon payment of the
fees fixed by the council, not to exceed one hundred dollars
(Act 1893, c. 27, s. 2).
Duties of Council.— The council is required to make
orders, regulations, or by-laws for regulating the register and
the fees to be paid for registration, and to make rules and
regulations for the guidance of examiners, and may prescribe
the subjects and modes of examination, and make all such
rules and regulations in respect of examinations not contrary
to this act as they deem expedient and necessary (Cons. Acts
1888, c. 81, s. 31).
Forfeiture of Right. — Any registered practitioner con-
victed of any felony thereby forfeits his right to registration
and by direction of the council his name is required to be erased
from the register, or in case a person known to have been con-
victed of felony presents himself for registration, the registrar
has power to refuse such registration {ih., s. 32).
Rights of Registered Practitioner. — Every person
registered under the act is entitled to practise medicine and
surgery, including midwifery, or an}^ of them as the case may
be, in British Columbia, and to demand and receive in any
court of the province, with full costs of the suit, reasonable
charges for professional aid, advice, and visits, and the costs
of any medical or surgical appliances rendered or supplied by
him to his patient {ih., s. 33).
Evidence. — The registrar of the council, under the direction
of the council, is required to publish a correct register of the
names and residences with the medical titles, diplomas, and
qualifications conferred by any college or body, of all persons
appearing on the register at the date of publication. Said register
is called " The British Columbia Medical Register. " A copy
of such register for the time being, purporting to be so printed
and published, shall be prima facie evidence that the persons
240 SYNOPSIS OF LAWS — POSTE AND BOSTON,
therein specified are registered according to the provisions of
this act ; and, subject to sub. sec. 2 of this section, the absence
of the name of any person from such copy shall be prnma facie
evidence that such person is not registered according to this
act {lb., s. 34).
In the case of a person whose name does not appear in such
copy, a certified copy under the hand of the registrar of the
entry of the name of such person on the register shall be evi-
dence that such person i« registered under this act (ib., s. 34,
sub. s. 2).
Homoeopathic Physicians. — Any homoeopathic physician
holding a diploma of qualification from any authorized school
or college requiring a three-years' course of stud}" may be regis-
tered, and shall not be bound to pass the examination required
by sec. 29, but in lieu thereof, shall pass before the council, or
such of them as may be appointed for that purpose, a satisfactory
examination in anatomy, physiology, j^athology, chemistry, ob-
stetrics, and surgerj" (ib., s. 35, as amended. Act 1890, c. 30, s. 2).
Neglect to Register. — Those entitled to register and
neglecting to do so are not entitled to any of the rights and
privileges conferred by registration and are liable to all penalties
against unqualified or unregistered practitioners (ib., s. 37).
Fraudulent Registration. — If a person procures or
causes to be procured his registration by means of any false or
fraudulent representation or declaration, the registrar may, on
receipt of sufficient evidence to that effect, report the matter to
the council and, on the written order of the president, attested
by the seal of the council, erase the name of such person from the
register and make known the fact and the cause thereof in the
British Columbia Gazette, and after such notice has appeared
such person shall cease to be a registered practitioner, and to
enjoy any of the privileges conferred by registration, without
the express sanction of the council {ib., s. 39).
To wilfully procure or attempt to procure registration by
false representations or declarations is punishable by a penalty
not exceeding $100. To knowingly aid or assist therein is pun-
ishable with a penalty of from $20 to $50 for each offence {ib.,
s. 40).
Unlawful Practices. —It is not lawful for any person
not registered to practise medicine or surgery for hire, gain.
BRITISH COLUMBIA. 241
or hope of reward. To so practise or profess to practise, or
advertise to give advice in medicine or surgery, is punishable
with a penalty of from $25 to $100 {ib., s. 41).
For a person to wilfully or falsely pretend to be a phj'sician,
doctor, or medical, surgical, or general practitioner, or assume
any title, address, or description other than he actually possesses
and is legall}' entitled to, is punishable by a penalty of from $10
to $50 {ib., s. 12).
A person not registered who takes or uses any name, title,
addition, or description implying or calculated to lead people to
infer that he is registered or recognized b}' law as a physician,
surgeon, or licentiate in medicine or surgery is punishable with
a penalty of from $25 to $100 {ib., s. 43).
Costs may be awarded in addition to the penalty against an
offender, and on default of payment he may be committed to
the common jail for one month unless the costs are sooner
paid {ib., s. 47).
Unregistered Persons. — No one but a person registered
under this act is entitled to receive any charge for an}- medical
or surgical advice or attendance or the performance of any opera-
tion or for any medicine that he may have prescribed {ib., s. 44).
Appointments as medical officers, physicians, or surgeons in
any branch of the public service, or in ^ hospital or a charitable
institution not supported wholly by voluntary contribution, are
conferred on registered persons only {ib., s. 45).
No certificate required from any physician or surgeon or
medical practitioner is valid unless the signer is registered {ib.,
s. 46).
Evidence. — In a prosecution, the burden of proving regis-
tration is upon the person charged {ib., s. 48).
Registration may be proved by the production of a printed
or other copy of the register certified under the hand of the
registrar of the council for the time being, and any certificate
on such copy purporting to be signed by any person as registrar
is prima facie evidence that he is registrar without further
proof {ib., s. 49).
Limitations. — Prosecutions under the act must be com-
menced within six months from the date of the offence {ib., s. 50).
Stay. — The council may stay proceedings in prosecutions
{ib.,s. 51).
16
242 SYNOPSIS OF LAWS — POSTE AND BOSTON.
Prosecutor. — Any person may be prosecutor or complain-
ant under the act (^6., s. 52).
Fees. — To the registrar, for registration under this act, such
sum as may from time to time be fixed by the council by reso-
lutions or by-law, but not exceeding $100 {ib., s. 36, as amended,
Act 1893, c. 27, s. 1).
To the medical council, on or before March 1st, annually,
$10, or such other sum as may from time to time be fixed by
the council {ih., s. 53, as amended, Act 1890, c. 30, s. 3).
For registration, by persons registered under Act 1893, c.
27, s. 2, a fee fixed by the council not to exceed $100 (Act 1893,
c. 27, s. 2).
Manitoba.
College of Physicians and Surgeons.— The medical
profession is incorporated as " The College of Physicians and
Surgeons of Manitoba" (Rev. Stat, of Man., 1891, c. 98, s. 2).
All persons lawfully registered under previous acts or the
present act are members of the said college {ib., s. 3, 4).
Council. — There is constituted by law a council of the said
college composed of representatives selected as provided in the
act, each of whom must be a practitioner licensed under this
act {ib., s. 5 to 8).
No member of the college who is in arrears for his annual
fees or any part thereof is entitled to vote at the election for
members of the council or be eligible for election as a member
thereof {ib., s. 15),
Register. — The council is required to appoint a registrar
and to cause a register to be kept in which shall be entered the
name of everj^ person registered under this act or under the
Consolidated Statutes of Manitoba, chap. 9, and the acts amend-
ing the same, and of all persons who comply with this act, and
the rules and regulations made by the council respecting the
qualifications of practitioners of medicine, surgery, and mid-
wifery. Only those whose names are inscribed in the book are
deemed qualified and licensed to practise medicine, surgery, or
midwifery {ib., s. 17, 24, 25).
Qualification. — All persons duly registered under exist-
ing laws when the revised statutes took effect are deemed regis-
tered under the present law {ib., s. 27).
MANITOBA. 243
The registrar was required immediately upon his appoint-
ment to register the name of every person registered under pre-
vious acts {ib., s. 28).
Every person who possesses one or more of the following
qualifications shall, upon the payment of the fee, to be fixed for
each particular class by by-law of the council, be entitled to be
registered on the production to the registrar of the document
proving such qualification :
1. Persons entitled to be registered at the time of the coming
into force of the revised statutes.
2. Any member of any incorporated college of phj^sicians
and surgeons of any province of the Dominion of Canada, or any
member of any other incorporated body of medical men in
Canada, exercising powers similar to those conferred by this
act on the College of Physicians and Surgeons of Manitoba,
where, by the laws of the province under which the said
incorporated body exists, similar rights to register and to prac-
tise medicine are granted to the persons incorporated under
this act.
3. Every person mentioned in chap. 48 of Act 49 and 50
Vict, of the Parliament of the United Kingdom.
4. Every graduate in medicine upon examination of the
University of Manitoba.
5. Every person who produces to the registrar the certificate
under the corporate seal of the University of Manitoba herein-
after provided for (ib., s. 29).
The registrar is required to keep his register correct, and to
make from time to time the necessary alterations in the ad-
dresses or qualifications of the persons registered {ib., s. 30).
Every person registered who obtains a higher degree or
other qualification is entitled to have it inserted in the register
in substitution of or in addition to the qualification previously
registered, on the payment of such fees as the council may ap-
point {ib., s. 34).
No qualification is entitled to be entered on the register
unless the registrar be satisfied bj" proper evidence that the
person claiming it is entitled thereto. Appeal lies from the
registrar's decision to the council {ib., s. 35).
The registrar, if dissatisfied with the evidence adduced,
may, subject to appeal to the council, refuse registration until
244 SYNOPSIS OF LAWS — POSTE AND BOSTON.
proper evidence is furnished, duly attested by oath or affirma-
tion before a judge of any county court {ib., s. 30).
Fraudulent Registration. — Any entry proved to the
satisfaction of the council to have been fraudulently or incor-
rectly made may be erased from the register by order in writ-
ing of the council {ib., s. 38).
If a person procures or causes to be procured his regis-
tration by false or fraudulent representations or declarations,
the registrar may, on the receipt of sufficient evidence of
the falsity or fraudulent character, represent the matter to the
council, and may on the written order of the president, attested
by the seal of the college, erase his name from the register,
and cause notice of the fact and cause to be published in the
Manitoba Gazette, and after such notice has appeared such
person shall cease to be a member of the College of Physicians
and Surgeons, and to enjoj^ any privilege enjoyed or conferred
by registration at any further time without the express sanction
of the council (ib., s. 39).
Forfeiture of Rights. — An}- registered medical practi-
tioner convicted of felony or misdemeanor before or after the
passage of the act or his registration forfeits his right to regis-
tration, and by direction of the council his name shall be
erased. If a person known to have been convicted of felony
or misdemeanor presents himself for registration, the registrar
may refuse registration. If any person registered be judged,
after due inquiry' by the council, to have been guilty of in-
famous or unprofessional conduct in any respect, the council
may direct the registrar to erase his name {ib., s. 40).
The council may, and upon the application of any three
registered medical practitioners shall, cause inquiry to be made
into the case of a person liable to have his name erased from
the register, and on proof of such conviction or such infamous
or unprofessional conduct shall cause his name to be erased ; but
no erasure shall be made on account of his adopting or refrain-
ing from adopting the practice of any particular theor}- of med-
icine or surgery, nor on account of conviction for a political
offence out of Her Majesty's dominions, nor on account of the
conviction which ought not in the opinion of the council or
committee disqualify him from the practice of medicine or
surgery {ib., s. 41).
MANITOBA. . 245
The council may order to be paid, out of funds at their dis-
posal, such costs as to them may seem just, to any person against
whom any complaint has been made which, when fully deter-
mined, is found to have been frivolous and vexatious (^6., s. 42).
An entry erased by order of the council shall not be again
entered except by order of the council or a judge or court of
competent jurisdiction {ib., s. 43).
If the council think fit, they may direct the registrar to restore
any entry erased, without a fee, or on payment of a fee not ex-
ceeding the registration fee, as the council may fix {ib., s. 44),
The council is authorized to ascertain the facts of any case
for the exercise of its powers of erasing and restoring by com-
mittee {ib., s. 45).
The act provides in detail for proceedings before such com-
mittee {ib., s. 46 to 50).
No action shall be brought against the council or committee
for anything done bona fide under the act. Appeal from the
decision to erase lies to any judge of the court of Queen's Bench
for Manitoba, and such judge may make such order as to resto-
ration or confirmation of erasure or for further inquiry, and as
to costs, as to him may seem right {ib., s. 51).
Evidence. — In a trial under this act the burden of proof
as to registration is on the person charged {ib., s. 53).
The production of a certificate that the person named is duly
registered, certified under the hand of the registrar, is sufficient
evidence of registration, and his signature in the capacity of
registrar is prima /oc/e evidence that he is registrar without
proof of signature or that he is registrar {ib., s. 54).
The registrar is required to print and publish from time to
time under the direction of the council a correct register of the
names and residences, with medical titles, diplomas, and qualifi-
cations conferred by any college or body, with the date thereof,
of all persons appearing on the register as existing on the day
of publication {ib., s. 55). The register is called "The Man-
itoba Medical Register ;" a copy thereof for the time being pur-
porting to be so printed and published is prima facie evidence
that the persons specified are registered {ib., s. 56).
In the case of any person whose name does not appear in
such copy, a certified copy under the hand of the registrar of
the council of the entry of the name of such person on the reg-
246 SYNOPSIS OF LAWS — POSTE AND BOSTON.
ister is evidence that such person is registered {ib., s. 57). The
absence of the name of any person from such copy is prima
facie evidence that he is not registered {ib., s. 58).
Practitioner's Eights. — Every person registered is en-
titled according to his qualifications to practise medicine,
surgery, or midwifery, or any of them as the case may be, and
to demand and recover full costs of suit, reasonable charges
for professional aid, advice, and visits, and the cost of any med-
icine or other medical appliances rendered or supplied by him
to his patient {ib., s. 59).
Neglect to Register. — A person neglecting to register is
not entitled to the rights and privileges conferred, and is liable
to all penalties against unqualified or unregistered practition-
ers {ib., s. 60).
Unregistered Persons. — It is not lawful for any person
not registered to practise medicine, surgerj^ or midwifery for
hire, gain, or hope of reward {ib., s. 61).
No person is entitled to receive any charge for medical or
surgical advice or attendance, or the performance of any oper-
ation, or for any medicine which he may have prescribed or
supplied, unless he be registered, but this provision does not
extend to the sale of any drug or medicine by a licensed chem-
ist or druggist {ib., s. 62).
No person can be appointed as a medical ofiicer, physician,
or surgeon in the public service, or in any hospital or other
charitable institution not supported wholly by voluntary con-
tribution, unless he be registered {ib., s. 63).
No certificate required from any physician or surgeon or
medical practitioner is valid unless the signer be registered
{ib., s. 64).
Definition. — The expression "legally qualified medical
practitioner," or any other words importing legal recognition
as a medical practitioner or member of the medical profession,
in any law, is construed to mean a person registered under this
act {lb., s. 65).
Immunities. — A person registered under this act is exempt
from jury and inquest duty if he desire it {ib., s. 66).
Limitations. — No dul}^ registered member of the College of
Physicians and Surgeons is liable in an action for negligence
or malpractice by reason of professional services requested or
MANITOBA. 247
rendered, unless it be commenced within one year from the
termination of such service {ib., s. 67).
Examinations. — The University of Manitoba is the sole
examining body in medicine, and the council of the university
may grant to any person a certificate under the seal of the
university that the council of the university have been satisfied
that the person mentioned in the certificate is, by way of
medical education and otherwise, a proper person to be regis-
tered under this act ; but such certificate shall not be granted
until the person making such application shall have given
evidence of qualification by undergoing an examination or
otherwise, as the statutes of the university require, and the ap-
plicant shall in all other respects first comply with the rules
and regulations of the university in that behalf (ib., s. 68).
HoMCEOPATHiSTS. — Until a homoeopathic medical college
for teaching purposes is established in Manitoba, in the case
of candidates wishing to be registered as homoeopathists, the
full time of attendance upon lectures and hospitals required by
the university statutes may be spent in such homoeopathic
medical colleges in the United States or Europe as may be
recognized by the University of Manitoba {ib., s. 69).
Every candidate who at the time of his examination signifies
his wish to be registered as a homceopathic practitioner shall
not be required to pass an examination in materia medica or
therapeutics, or theory or practice of physic, or in surgery or
midwifery, except the operative practical parts thereof, before
any examiners other than those homoeopathic examiners who
shall be appointed by the University of Manitoba {ib., s. 70).
Unlawful Practices. — To wilfully procure or attempt
to procure registration by false or fraudulent representation or
declaration, is punishable by a penalty not exceeding $100. To
knowingly aid or assist therein, is punishable by a penalty of
from $20 to $50 for each offence {ib., s. 73).
Persons not registered, for hire, gain, or the hope of reward,
practising or professing to practise medicine, surgery, or mid-
wifery, or advertising to give advice in medicine, surgery, or
midwifery, are liable to a penalt3^of from $25 to $100 {ib., s. 74).
A person wilfully or falsely pretending to be a physician,
doctor of medicine, surgeon, or general practitioner, or assum-
ing a title, addition, or description other than he actualh' pos-
248 SYNOPSIS OF LAWS — POSTE AND BOSTOTST.
sesses and is legall}' entitled to, is liable to a penalty of from
$10 to $50 (ib., s. 75).
For a person to assume a title calculated to lead people to
infer that he is registered, or is recognized by law as a physi-
cian, surgeon, or accoacheur or a licentiate in medicine, surgery,
or midwifery, is punishable with a penalty of from $25 to $100
{ib., s. 70).
On prosecution, costs may be awarded in addition to the
penalty, and the offender may be committed to the common
jail for one month, unless the penalty and costs are sooner paid
{ib., s. 78).
Prosecutor. — Any person may be prosecutor or complain-
ant under the act {ib., s. 80).
Limitations. — Prosecutions are limited to comrnence within
six months after the date of the offence {ib., s. 81).
Appeal. — A person convicted under this act, giving notice
of appeal, must before being released give satisfactory security
for the penalty and costs of conviction and appeal {ib., s. 83).
Stay. — The council may stay proceedings in prosecutions
{ib., s. 84).
Fees.— The council is authorized to determine by by-law an
annual fee, which is required to be paid by each member of the
college — the fee can be not less than $2, nor more than $5, is
payable on January 1st, and may be recovered as a debt by the
college {ib., s. 32).
The fee for registration is subject to regulation by the
council {ib., s. 33).
New Brunswick.
Medical Society. — All persons registered under the act con-
stitute the New Brunswick Medical Society (Act 1881, c. 19, s. 2).
Council. — There is a medical council called the Council of
Physicians and Surgeons of New Brunswick, of nine legally qual-
ified medical practitioners, of not less than seven years' standing ;
four are nominated and appointed by the governor in council,
and five by the New Brunswick Medical Societ}" {ib., s. 3, 5).
The secretary of the council is the registrar {ib., s, 7).
Register, Evidence. — The registrar is required before May
1st annuall}" to print and publish in the Royal Gazette of
the province, and such other manner as the council shall ap-
NEW BRUNSWICK. 249
point, a correct register of the names and residences and
medical titles, diplomas, and qualifications conferred by any
college or body, with the dates thereof, of all persons appearing
on the register on the 1st of January. The register is called
the Medical Register; a copy for the time being purporting to
be so printed and published, or a certificate signed by the
president of the council, and attested by the registrar with
the corporate seal of the council, is p?"//» a /ac/e evidence that
the persons therein specified are registered and qualified ; the
absence of a name from such copy or the want of such certificate
is prima facie evidence that such person is not registered.
If a name does not appear on the copy, a certified copy, under
the hand of the registrar of the council, of the entry of a
name on the register is evidence of registration {ih., s. 8).
Entrance upon Study. — A j)erson beginning or entering
on the study of physic, surgery, or midwifery, for the purpose
of qualifying to practise in the province, must have obtained
from the council a certificate that he has satisfactorily passed
a matriculation or preliminary examination in the subjects
enumerated in the act, unless he has passed a matriculation ex-
amination for the medical course in arts and science at some
college in Great Britain, Ireland, Canada, the United States
of America, or the Continent of Europe {ih., s. 10).
The act prescribes formalities for admission to such prelim-
inary examination {ih., s. 10).
Qualification. — Subject to the exceptions hereinafter, no
person can lawfully practise physic, surgery, or midwifery un-
less he be registered, or unless he shall have received from the
council a license to practise {ih., s. 11).
No person is entitled to registration or license unless he shall
satisfy the council that he has passed a matriculation or prelim-
inary examination ; that after passing such examination he has
followed his studies for not less than four years, one of which
may be under the direction of one or more general practitioners
duly licensed ; that during such four years he has attended at
some university, college, or incorporated school of medicine in
good standing, courses of lectures amounting together to not
less than twelve months on general anatomy, on practical anat-
omy, on surgery, on practice of medicine, on midwifer}', on
chemistry, on materia medica and pharmacy, and on the insti-
250 SYNOPSIS OP LAWS — POSTE AND BOSTON.
tntes of medicine or physic, and one three-months' course of
medical jurisprudence; that he has attended the general prac-
tice of an hospital in which are not less than fifty beds under
the charge of not less than two physicians or surgeons, for not
less than one year or two periods of not less than six months
each; that he has also attended two three-months' courses or
one six-months' course of clinical medicine, the same of clinical
surgery; that he has, after an examination in the subjects of
the course, obtained a degree or diploma from such universitj^,
college, or incorporated medical school if such institution require
a four-years' course for its diploma, or for the want of such
degree or diploma that he has satisfactorily passed an exami-
nation in the various branches hereinbefore specified before the
examiners appointed by the council ; that he is not less than
twent3'-one years of age; that he has paid to the registrar of
the council a fee of ten dollars. The council has power, subject
to the approval of the governor in council, to make alterations
as may be required in the foregoing curriculum. If any person
apply for registration as a practitioner of any system of medi-
cine, the registered practitioners of that system have the right
to appoint an examiner or examiners on the subjects peculiar to
that sj'stem, viz., materia medica, pharmacy, and therapeutics,
and if they neglect so to do the council has the power to appoint
such examiner or examiners (ib., s. 12).
The last preceding section does not applj^ to persons in
actual practice entitled to register under sec. 38. Any person
producing to the council conclusive evidence that he has passed
a matriculation or a preliminary examination, as required by
this act for persons beginning medical studies in New Bruns-
wick, that he has before graduating or taking a diploma studied
at least four years as provided in sec. 12, or pursued what the
council deem an equivalent course of study and has passed a final
examination in the subjects of such course, or, for the want of
such requirement, shall have fulfilled such conditions as the
council may determine, and shall pay a fee of ten dollars, shall
be entitled to registration and to receive a license to practise
{ib.,s. 13).
The act makes special provision for residents of the prov-
ince who began study before January 1st, 1881 {ib., s. 14, as
amended 1882, c. 30, s. 1).
NEW BEUNSWICK. 251
Duties of Council. — The council is empowered and re-
quired to regulate the study of medicine, surgery, and midwife-
ry, with regard to preliminary qualifications, course of study,
final examination, and the evidence to be produed before the
council ; to appoint a registration committee ; to examine all de-
grees, diplomas, licenses, and other credentials presented or given
in evidence under the act to enable the owner to practise in New
Brunswick, and to oblige the owner to attest on oath or affirma-
tion that he is the person whose name is mentioned therein, and
that he became possessed thereof properly and honestly ; to cause
every member of the profession practising in New Brunswick
to register his name, age, place of residence, place of nativit}",
date of license or diploma, and the place where he obtained it ;
to appoint medical examiners, who may be members of the
council, to hold final examinations, who shall be regularly
qualified practitioners of not less than five years' professional
standing and three years' residence in the province {ib., s. 15,
as amended 1882, c. 30, s. 2, 3).
Correction op Register. — The registrar is required to erase
the names of all registered persons who shall have died, left
the province without the intention of returning, or ceased to
practise for five years; and from time to time to make the
necessary alterations in the addresses or qualifications of reg-
istered persons. Any name erased shall be restored by the
order of the council on sufficient cause duly shown {ib., s. 18).
Neglect to Register. — Persons entitled to registration,
neglecting or omitting to register, are not entitled to any rights
or privileges conferred by the act {ib., s. 19).
System of Practice. — No person otherwise qualified shall
be refused registration or license on account of the adoption or
the refusal to adopt the practice of any particular theory of
medicine or surgery. In case of refusal the aggrieved party
may appeal to the governor in council, who is required, on
due cause shown, to issue an order to the council to register his
name and grant him a license to practise, and thereupon the
council shall forthwith register his name and grant him a
license to practise {ib., s. 20).
Evidence of Qualification, Fraudulent Registra-
tion. — No qualification can be entered unless the registrar be
satisfied by proper evidence that the person claiming it is entitled
252 SYNOPSIS OF LAWS — POSTE AND BOSTON.
to it. An appeal may be made from the registrar's decision to
the council. Any entry proved to the satisfaction of the
council to have been fraudulent!}' or incorrectly made may be
erased by the order in writing of the council, and the name of
such person fraudulently registering, or attempting to register,
may, at the discretion of the council, be published in the next
issue of the Royal Gazette {ib., s. 21).
Forfeiture of Right. — A registered medical practitioner
convicted of felony, or after due inquiry judged by the council
to have been guilty of infamous conduct in any professional
respect thereb}', subject to appeal to the governor in council,
forfeits his right to registration, and by the direction of the
council his name shall be erased from the register {ib., s. 22).
The time and place of inquiry under "the preceding section
must be fixed by the council, and at least fourteen days' notice
given to the party against whom inquiry is ordered (Act 1886,
c. 82, s. 6).
The Act of 1886, c. 82, regulates the procedure on such
inquiry.
Additional Qualifications. — Every person registered
who may obtain a higher degree or other qualification is en-
titled to have it registered in substitution for, or in addition to,
the qualifications previously registered, on the payment of such
fee as the council may demand (Act 1881, c. 19, s. 23).
Practitioner's Rights. — Every person registered under
the act is entitled according to his qualifications to practise
medicine, surgery, midwifery, or dentistry, or either or anj^ of
them as the case may be, and to demand and recover reasonable
and customary charges for professional aid, advice, and visits,
and the cost of any medicine or other medical or surgical ap-
pliances rendered or supplied by him to his patients (ib., s. 24).
No person is entitled to recover any such charge unless he
shall prove upon the trial that he is registered under this act
{ib., s. 25).
Definition. — The words "legally qualified medical practi-
tioner," or "dulj" qualified medical practitioner," or other words
implying that a person is recognized by law as a medical practi-
tioner or member of the medical profession, when used in a
legislative act or a legal or public document mean a person reg-
istered under this act {ib., s. 26).
NEW BRUNSWICK, 253
Unregistered Persons.— No person shall be appointed a
medical officer, physician, or surgeon in the public service or
in any hospital or other charitable institution unless registered
{lb., s. 27).
No certificate required from any phj^sician or surgeon or
medical practitioner is valid unless the signer be duly registered
{ih., s. 28).
A person not registered or licensed, and not actually em-
jDloyed as a physician or surgeon in Her Majesty's naval or
military service, practising physic, surgery, or midwifery for
hire, gain, or hope of reward, forfeits twenty dollars for each
day of such practice {ib., s. 29).
The sum forfeited is recoverable with costs. The proced-
ure in reference to all penalties is regulated by Act of 188G, c. 82.
Persons liable as provided in sees. 29 and 30 are not en-
titled to or subject to the provisions of any act for the relief of
debtors (Act 1882, c. 30, s. 4).
On the trial of such cause, the burden of proof as to license
or right to practise is upon the defendant (Act 1881, c. 19, s.
31; Act 1886, c. 82, s. 3).
Fraudulent Registration. — Wilfully procuring or at-
tempting to procure registration by making or producing, or
causing to be made or produced, a false or fraudulent representa-
tion or declaration, or aiding or assisting therein, is punishable
with a forfeiture of not less than $100 (Act 1881, c. 19, s. 33).
Wilfully or falsely pretending to be or using anj'- name or
description implying registration is punishable with a forfeiture
of from $50 to $100 {ib., s. 34).
Limitations. — No prosecution can be commenced under
the act after one year from the date of the offence (Act 1886,
c. 82, s. 4).
Exceptions. — The act does not prevent persons from giving
the necessary medical or surgical aid or attendance to anj' one
in urgent need of it, provided it be without gain, and the giv-
ing of it be not made a business or way of gaining a livelihood;
nor does it prevent any woman from giving the necessary aid
in cases of confinement as heretofore accustomed (Act 1881, c.
19, s. 36).
Examination. — All persons who subsequent to the passage
of the act pass the examination prescribed by the council of
254 SYNOPSIS OF LAWS — POSTE AND BOSTON.
physicians and surgeons, or presenting approved credentials,
certificates, or diplomas equivalent to such examination, are
entitled to register and receive a license to practise {ib., s. 38),
Physicians in Army or Navy. — A person while employed
in actual service in Her Majesty's naval or military service as
a physician or surgeon, may practise physic, surgery, or mid-
wifery with registry or license (ib., s. 39).
Non-Residents. — Non-resident registered practitioners of
medicine residing in the State of Maine or in the Province of
Quebec or Nova Scotia near the boundary line of this province
whose regular practice extends into any town, parish, or county
in New Brunswick may register under the act {ib., s. 44).
No other non-resident practitioner of medicine is entitled to
register (Act 1884, c. 17, s. 1).
Exceptions. — The act does not extend to clairvoyant physi-
cians practising at the time of its passage in the province, nor to
midwives (Act 1881, c. 19, s. 45).
Students. — The act establishes a uniform standard of
matriculation or preliminary examinations {ib., Sched. B).
Oaths. — Any oath or affidavit required by the medical act
may be taken before any justice of the peace or person by law
authorized to take any oath or affidavit (Act 1882, c. 30, s. 6),
Fees. — To the registrar, for registration under sees. 12 and
13, $10 (Act 1881, c. 19, s. 12 and 13).
To the registrar, for the registration of an additional quali-
fication, such fee as the council may demand (Act 1881, c. 19,
s. 23).
To the registrar, or his deputy, annual fee from each prac-
titioner, to be fixed by the council, not more than $2 nor less
than $1 (Act 1882, c. 30, s. 5).
Each registered medical practitioner must, if required by the
council, pay to the registrar, or a person deputed by him, an
annual fee determined hj the council, not less than $1 nor more
than $2, payable January 1st each year, and recoverable as a
debt with costs in the name of the council (Act 1882, c. 30,
s. 5).
If any practitioner omit to pay the registration fee before
the registrar causes the register to be printed in the Royal
Gazette, the registrar shall not cause the name of such practi-
tioner to be printed, and he shall thereupon cease to be deemed
NEW BRUNSWICK — NEWFOUNDLAND. 355
a registered practitioner ; but afterward, on paying such fee, he
shall be entitled to all his rights and privileges as a registered
practitioner from the time of payment (Act 1884, c. 17, s. 2).
Newfoundland.
Medical Board. — There is a board composed of seven
regularly qualified medical practitioners of not less than five
years' standing, appointed as provided in the act, and known
as the "Newfoundland Medical Board," whose duties relate,
among other things, to the making and enforcing of measures
necessary for the regulation and the practice of medicine (Act
1893, c. 12, s. 2, 3, 19).
The board is authorized to appoint examiners and fix times
of examinations {ib., s. 5).
The secretary of the board is the registrar {ib., s. 7).
Register, Evidence. — It is the duty of the registrar on
or before January 1st in each year to cause to be published
in the Royal Gazette of Newfoundland a list of the names of
all persons appearing on the register at that date, with their
places of residence, titles, diplomas, and qualifications as con-
ferred by any college or body, with the date {ib., s. 8).
Such register is called the Medical Register, and a cop}-
thereof is prima facie evidence that the persons therein speci-
fied are registered according to the act ; and the absence of a
name therefrom is prima facie evidence that such person is
not so registered {ib., s. 9).
Qualification. — The members of the board form a body of
medical examiners of diplomas and degrees, whose certificate
shall be the only license permitting the practice of medicine,
surgery, or midwifery, except as hereinafter provided, provided
the applicant for such license shall previously have obtained a
medical diploma from a recognized college or universit}*, or as
hereinafter provided {ib., s. 10.)
Every person is entitled to have his name entered on the
register on satisfying the board that he holds a degree or
diploma from some regular university or school of medicine
in good standing, and he shall then receive from the board a
license bearing its seal, on the payment to the registrar of $5,
and shall have his name entered on the register {ib., s. 11).
256 SYNOPSIS OP LAWS — POSTE AND BOSTON.
No such licensed practitioner shall be entitled to practise in
•Ally year without taking out from the board, before the 1st of
January in every year, a certificate of practice for which he
shall pay $1 {ib., s. 12).
Students. — The act provides the requirements for entering
on the study of medicine, surgery, or midwifery in the colony
{ib., s. 13, 14, 17).
Duties of Board. — The board is required to examine all
degrees and other credentials produced or given in evidence
under the act for the purpose of enabling the owners to practise,
and, if it be deemed necessary, to oblige the owner to attest on
oath or affidavit that he is the person whose name is mentioned
therein, and that he has become possessed of the same by lawful
means (ib., s. 16).
The board is required to cause every member of the profes-
sion practising in Newfoundland to enter his name, age, place
of residence, date of license or diploma and where it was ob-
tained, on the register {ib., s. 18).
Neglect to Register. — A person entitled to be registered,
who neglects or omits to apply, is not entitled to any of the rights
or privileges conferred by the act so long as the neglect or
omission continues {ib., s. 25).
Additional Qualification. — A person registered who
obtains a higher degree or diploma is entitled to have it inserted
in the register in addition to or in substitution for those pre-
viously registered {ib., s. 26).
Rights of Registered Persons. — A person properly
registered under the act is entitled to practise medicine,
surgery, and midwifery in any part of the colony, and to de-
mand and recover reasonable charges for professional aid or
advice with the cost of medicine or other medical and surgical
appliance supplied by him {ib., s. 27).
Unregistered Persons. — No person whose name is not reg-
istered under the act is entitled to recover any fees for any medi-
cal or surgical advice, or for any services whatsoever rendered
in the capacity of a medical man, nor to recover the payment of
charges for any medicine or medical or surgical appliance which
maj^ have been both prescribed and supplied bj^ him. This
clause is not intended to interfere with the practice of midwifery
by competent females as hereinafter provided {ib., s. 28).
NEWFOUNDLAND. 257
Offences and Penalties. — Except as hereinafter provided,
if a person not registered or licensed under the act practises
medicine, surgery, or midwifery for hire, gain, help [sic] or
reward, or wilfully and falsely pretends to be a physician, doctor
of medicine, surgeon, or general practitioner, or takes or uses
any name, title, addition [or] description, implying or calculat-
ing [sic] to deceive or lead the public to infer that he is regis-
tered under this act, or who proposes by public advertisement,
card, circular, or otherwise, to practise medicine, surgery, or
midwifery, or give advice therein, or in anywise lead people
to infer that he is qualified to practise medicine, surgerj^, or
midwifery, he shall forfeit $20 for each daj' that he so prac-
tises or leads people to infer that he is a practitioner, or shall
suffer imprisonment not exceeding twelve months (ib., s. 29).
Persons violating the above regulations are subject to the
penalties of the act^ and in all cases the burden of proof as to
qualification is upon the defendant or practitioner {ib., s. 30).
Expulsion of Member. — The Newfoundland Medical
Board may try and expel any member of the profession for
acts of malpractice, misconduct, or immoral habits, provided
five-sevenths of the whole number record their signatures to
such a measure {ib., s. 32).
Exceptions. — The act does not prevent private persons
from giving the necessary medical or surgical aid in times of
urgent need, provided such aid or attention is not given for
gain or hire, nor the giving of it made a business or a way of
gaining a livelihood {ib., s. 34).
Every person residing in the colony and who shall have
practised medicine, surgery, and midwifery for five years con-
secutively in one locality previous to the passage of the act, on
the proof of the same, shall have his name registered and receive
a license to practise under the act ; provided, the board may
grant a license to any person who may have practised for a
shorter period, on being satisfied b}^ examination, or inquiry,
that such person is reasonably competent and fit; and further
provided, that the board may, after examination and inquiry,
license persons with a reasonable amount of competence to prac-
tise in specified localities, in which no qualified practitioners
reside {ib., s. 37).
Any person while employed in actual service in any naval
258 SYNOPSIS OF LAWS— POSTE AND BOSTON.
or military service as physician or surgeon may practise medi-
cine, surgery, and midwifery after having been registered {ib.,
s. 38).
Definition. — The words " legally qualified medical practi-
tioner" or " duly qualified medical practitioner, " or any other
words importing a person recognized by law as a medical
practitioner or a member of the medical profession, when used
in any act of the legislature or legal or public document, mean
a person registered under this chapter, unless as otherwise pro-
vided {ib., s. 39).
Medical Appointments. — No person shall be appointed as
a medical officer, physician, or surgeon in any branch of the
public service or any hospital or other charitable institution un-
less he be registered under the provisions of this chapter (^6,,
s. 40).
Theories of Medicine orSurgerv. — No person otherwise
fully qualified shall be refused registration, or a license to
practise, on account of his adopting or refusing to adopt the
practice of any particular theory of medicine or surgery. In
case of such refusal by the board, the part}^ aggrieved may
appeal to the governor in council, who, on due cause shown, shall
issue an order to the board to register the name of such person
and grant him a license (ib., s. 41).
MiDWivES. — The act does not prevent competent females
from practising midwifery {ib., s. 42) r
Fees. — To the registrar, for license, $5 (ib., s. 11).
To the board, each year, for a certificate of practice, $1 {ib.y
s. 12).
Northwest Territories.
College of Physicians and Surgeons. — The members of
the medical profession are a body corporate under the name
of "The College of Physicians and Surgeons of the North-
west Territories" (Ord. 5 of 1888, s. 2).
Every person registered according to Ordinance 11 of 1885
is a member of the said college and shall be held to be registered
under this ordinance from the date of its passage {ib., s. 3, as
amended Ord. 9 of 1891-92).
Every person registered under this law is a member of the
college {ib., s. 4).
NEWFOUNDLAND — NORTHWEST TERRITORIES. 259
Council. — There is a council of said college elected by the
members from the members registered in pursuance of this
ordinance {ib., s. 5, 6, 7).
The council appoints among other officers a registrar {ib.,
s. 26).
Register, Qualification. — Persons registered under Or-
dinance 11 of 1885 are entitled to register under this ordinance
{lb., s. 31).
The council is required to cause the registrar to keep a
register of the names of all persons who have complied with
this ordinance, and the rules and regulations of the council
respecting the qualifications required from practitioners of med-
icine or surgery. Only those persons whose names are inscribed
in the register are deemed qualified and licensed to practise
medicine or surgery, except as hereinafter provided {ib., s. 32).
The registrar is required to keep his register correct and to
make the necessary alterations in the addresses or qualifica-
tions of persons registered {ib., s. 33).
The council is required to admit on the register :
(a) Any person possessing a diploma from any college in
Great Britain and Ireland (having power to grant such di-
ploma) entitling him to practise medicine and surgery, and who
shall produce such diploma and furnish satisfactory evidence
of identification ;
(6) any member of the College of Physicians and Surgeons
of the Provinces of Manitoba, Ontario and Quebec upon pro-
ducing satisfactory evidence of the same and of identification ;
(c) any person who shall produce from any college or school
of medicine and surgery in the Dominion of Canada requiring a
four-years' course of study and {sic) a diploma of qualification ;
provided he furnish to the council satisfactory evidence of iden-
tification, and pass if deemed necessary, before the members
thereof, or such examiners as may be appointed for the purpose,
a satisfactory examination touching his fitness and capacity to
practise as a physician and surgeon, upon payment to the regis-
trar of fifty dollars {ib., s. 34, as substituted by Ord. 14, 1890,
amended by Ord. 9, 1891-92).
Powers of Council. — The members of the council are
required to make orders, regulations, or by-laws for the regula-
tion of the register and the guidance of examiners, and may
260 SYNOPSIS OF LAWS — POSTE AND BOSTON.
prescribe subjects and modes of examination, and may make
all regulations in respect of examinations, not contrary to the
ordinance, that they may deem expedient and necessary (ib.,
s. 36).
The council may by by-law delegate to the registrar power
to admit to practice and to register any person having the nec-
essary qualifications entitling him to be registered by the coun-
cil (Ord. 24, 1892, s. 4).
The council may direct the name of any person improperly
registered to be erased from the register and such name shall
be erased by the registrar (Ord. 24, 1892, s. 5).
Forfeiture of Rights. — If a medical practitioner be con-
victed of any felony or misdemeanor or after due inquiry be
judged by the council to have been guilty of infamous conduct
in any professional respect, the council may, if it sees fit, direct
the registrar to erase the name of such practitioner from the
register, and the name shall be erased (Ord. 5, 1888, s. 37, as
substituted by Ord. 24, 1892, s. 1).
Rights of Registered Persons. — Every person registered
under the ordinance is entitled to practise medicine and surgery,
including midwifery, or anj^ one of them, as the case may be,
and to demand and recover with costs his reasonable charges for
professional aid, advice, and visits, and the cost of medical or
surgical appliances rendered or supplied by him to his patients
[ib., s. 38).
Limitation. — A period of one year after the term of pro-
fessional service is established as a limitation to actions for
negligence or malpractice against members of the college {ib.,
s. 39).
Register, Evidence. — The registrar, under the direction
of the council, is required to publish a register of the names and
residences and the medical titles, diplomas, and qualifications
conferred by any college or body, of all persons appearing on the
register on the day of publication. The register is called
"Northwest Territories' Medical Register," and a copy for the
time being, purporting to be so printed and published, is prima
facie evidence that the persons therein specified are registered
according to the act. The absence of a name from such copy is
prima facie evidence that such person is not so registered.
In case a person's name does not appear on such copy, a cer-
NORTHWEST TERRITORIES. 201
tified copy under the hand of the registrar of the entry of the
name of such person on the register is evidence that such person
is registered {ib., s. 40).
Neglect to Register. — A person neglecting to register is
not entitled to the rights or privileges conferred and is liable to
all penalties against unqualified or unregistered practitioners
{ib., s. 4).
Offences and Penalties. — To practise or jDrofess to prac-
tise without registration, for hire or reward, is punishable with
a penalty of $100 {ib., s. 42).
To wilfully or falsely pretend to be a physician, doctor of
medicine, surgeon, or general practitioner, or assume any title
or description not actually possessed and to which the person is
not legally entitled under this ordinance, is punishable with a
penalt}^ of from $10 to $50 {ib., s. 43, as amended by Ord. 24,
1892, s. 2).
To take or use a name or description implying or calculated
to lead people to infer registration or recognition by law as a
physician, surgeon, or licentiate in medicine or surgery is pun-
ishable with a penalty of from $25 to $100 {ib., s. 44).
Unregistered Persons. — No person is entitled to recover
for any medical or surgical advice or attendance or the perfor-
mance of anj' operation or medicine which he may have pre-
scribed {ib., s. 45) ; nor to be appointed as medical officer, physi-
cian, or surgeon in any branch of the public service or in any
hospital or other charitable institution not supported wholly bj'
voluntary contributions, unless registered {ib., s. 46).
No certificate required from a physician or surgeon or med-
ical practitioner is valid unless the signer is registered {ib.,
s. 47).
Costs. — In prosecutions, payment of costs may be awarded
in addition to the penalt}^ and in default of payment the offender
may be committed to the common jail for not more than one
month {ib., s. 48).
Burden of Proof. — In prosecutions, the burden of proof
as to registration is upon the person charged {ib., s. 49).
Proof. — The production of a printed or other copj' of the
register, certified under the hand of the registrar, for the time
being is sufficient evidence of all persons [registered] ; a certifi-
cate on such copy purporting to be signed by any person in the
202 SYNOPSIS OF LAWS— POSTE AND BOSTON.
capacity of registrar of the council under this ordinance isprima
facie evidence that he is registered without proof of his signa-
ture or of his being in fact registrar {ib., s. 50).
Limitation of Prosecutions. — Prosecutions must be
commenced within six months from the date of the offence
{ib., s. 51).
Stay. — The council may stay proceedings in prosecutions
where deemed expedient {ib., s. 52).
Prosecutor. — Any person may be prosecutor or complain-
ant {ib., s. 53).
Definition. — ''Legallj^ qualified medical practitioner" or
" duly qualified medical practitioner," or any other words im-
plying legal recognition as a medical practitioner or member of
the medical profession, when used in any law or ordinance,
mean a person registered under this ordinance {ib., s. 55).
Homceopathists. — Homoeopathic physicians may be regis-
tered under this ordinance on complying with the terms of sec.
34 {ib., s. 58).
Fees. — To the council from each member annually as the
council may determine, not more than $2 and not less than $1
{ib., s. 35).
To the registrar, for registration, $50 {ib., s. 56, as substi-
tuted by Ord. 24, 1892, s. 3).
Nova Scotia.
Medical Board. — There is a provincial medical board con-
sisting of thirteen regular qualified medical practitioners of not
less than seven years' standing, seven nominated and appointed
by the governor in council, and six by the Nova Scotia Medical
Society (R. S., 5th ser., c. 24, s. 1).
The board appoints a secretary who is the registrar of the
board {ib., s. 3, 4).
Register, Evidence. — The registrar is required before the
1st of August each year to cause to be printed and published
in the Royal Gazette of the province, and in such other
manner as the board shall appoint, a correct register of the
names and residences and medical titles, diplomas, and qualifica-
tions conferred by any college or body, with the dates thereof
of all persons appearing on the register as existing on June
NORTHWEST TERRITORIES — NOVA SCOTIA. 263
30th, Such register is called "The Medical Register," and a
copy thereof for the time being, purporting to be so printed
and published, is xjrima facie evidence that the persons
specified are registered according to this chapter. The absence
of a name &'om such copy is prima facie evidence that such
person is not so registered. In the case of a person whose
name does not appear in such copy, a certified copy, under the
hand of the registrar, of the entry of his name on the register
is evidence that such person is registered under the provisions
of this chapter {ib., s. 5).
Students. — ISTo person can begin or enter on the study of
physic, surgery, or midwifery, for the purpose of qualifying
himself to practise in the province, unless he shall have obtained
from the provincial medical board a certificate that he has satis-
factorily passed a matriculation examination in the subjects
specified in the chapter {ib., s. 6).
The chapter prescribes the prerequisites to admission to
preliminary examinations (ib., s. 7, 12).
Qualification. — Subject to the exceptions hereinafter, no
person can lawfully practise physic, surger}^, or midwifery unless
his name be registered and unless he shall have received from
the provincial medical board a license to practise (ib., s. 8).
No person is entitled to be registered or to receive a license
to practise unless he satisfy the board that he has passed the
matriculation or preliminary examination; that after passing
such examination he has followed his studies during a period
not less than four years (one of which ma}^ be under the direc-
tion of one or more general practitioners duly licensed) ; that
during such four years he has attended at some university,
college, or incorporated school of medicine in good standing,
courses of lectures amounting together to not less than twelve
months on general anatomy, on practical anatomy, on surger}^
on the practice of medicine, on midwifery, on chemistr}-, on
materia medica and pharmacy, and on the institutes of med-
icine or physiology, and one three-months' course of medical
jurisprudence; that he has attended the general practice of a
hospital in which are not less than fifty beds under the charge
of not less than two physicians or surgeons, for a period of not
less than one year or two periods of not less than six months
each ; that he has also attended two three-months' courses or
264 SYNOPSIS OF LAWS — POSTE AND BOSTON.
one six-months' course of clinical medicine, and the same of
clinic;al surgery ; that he has, after an examination in the sub-
jects of the course, obtained a degree or diploma from sucli
university, college, or incorporated medical school, or, for want
of such degree or diploma, that he has satisfactorily passed an
examination in the various branches hereinbefore specified before
examiners to be appointed by the provincial medical board;
that he is not less than twenty-one years of age ; and that he
has paid the registrar twenty dollars.
The provincial medical board has power, subject to the
approval of the governor in council, to make such alterations
in the foregoing curriculum as may from time to time be re-
quired {ib., s. 9).
The last preceding section does not apply to any person in ac-
tual practice duly registered under chap. 56 of Revised Statutes,
3d series ; such persons are entitled to be registered and receive
a license to practise under this chapter without fee. Notwith-
standing such section, any person on producing to the said
board conclusive evidence that he has passed a matriculation
or preliminary examination such as is required for persons be-
ginning their medical studies in Nova Scotia; that he has,
before graduating or taking a diploma, studied for at least four
years in the manner provided in sec. 9 or pursued what the
board deem an equivalent course of stud}", and has passed a
final examination in the subjects of such course ; or, for the
want of any of such requirements, shall have fulfilled such con-
ditions as the board may determine and shall pay a fee of
twenty dollars, shall be entitled to be registered and to receive
a license to practise {ib., s. 10).
Powers of Board. — The said board among other powers
has the power to examine all degrees, diplomas, licenses, and
other credentials presented or given in evidence for the purpose
of entitling the owner to practise in Nova Scotia; and to
oblige the owner to attest on oath, or by affidavit, that he is
the person whose na.me is mentioned therein, and that he
became possessed thereof honesth" ; to cause every member of
the profession practising in Nova Scotia to enregister his
name, age, place of residence, place of nativity, date of license
or diploma, and the place where he obtained it, in the regis-
ter of the board ; to appoint medical examiners to hold final ex-
NOVA SCOTIA. 265
aminations, such examiners to be regular qualified practitioners
of not less than five years' professional standing, and three
years' residence in the province (ib., s. 12).
Register. — The registrar is required to keep his register
correct, and to erase the names of all registered persons who
shall have died, left the province without an}^ intention of re-
turning, or ceased to practise for five years, and to make from
time to time the necessary alterations in the addresses or quali-
fications of persons registered. A name erased is required to
be restored by the order of the board upon sufficient cause duly
shown {lb., s. 15).
Neglect to Register. — Persons entitled to register and
neglecting or omitting to register are not entitled to any of the
rights or privileges conferred so long as the neglect or omission
shall continue {ib., s. 16).
Theories of Medicine or Surgery, — No person shall be
refused registration or a license on account of the adoption
or the refusal to adopt the practice of any particular theory of
medicine or surgery. In case of such refusal the party aggrieved
has the right to appeal to the governor in council, who, on due
cause shown, is required to issue an order to the board to register
the name of such person and to grant him a license {ib., s. 17).
Powers of Registrar. — No qualification is entered unless
the registrar is satisfied by proper evidence that the person
claiming is entitled to it, and anj^ appeal from the decision of
the registrar may be decided by the board, and any eutr}'
proving to the satisfaction of the board to have been fraudulently''
or incorrectly made may be erased from the register by order
in writing of the board {ib., s. 18).
Forfeiture of Rights. — A medical practitioner convicted
of felony or, after due inquirj^, judged by the board to have
been guilt}^ of infamous conduct in any professional respect,
thereby forfeits his right to registration, and if registered his
name shall, by the direction of the board, be erased from the
register {ib., s. 19).
Additional Qualifications. — A registered person maj^
have a higher degree or an additional qualification obtained by
him, inserted in the register in substitution for or in addition to
a qualification previously registered, on the payment of such
fee as the board may appoint [ib., s. 20).
266 SYNOPSIS OF LAWS — POSTE AND BOSTON,
Rights of Registered Persons. — Every registered person
is entitled according to his qualifications to practise medicine,
surgery, or midwifery, or either or any of them as the case
may be, and to demand and receive reasonable charges for pro-
fessional aid, advice, and visits and the cost of any medicine or
any medical or surgical appliances rendered or supplied by him
to his patients (ib., s. 21).
No person is entitled to recover such charge unless he shall
prove on the trial that he is registered under this chapter.
This does not interfere with the sale by qualified druggists or
chemists of articles properly belonging to their business {ib.,
s. 22).
Definition. — The words " legally qualified medical practi-
tioner" or "duly qualified medical practitioner," or any other
words importing a person recognized by law as a medical prac-
titioner or a member of the medical profession, when used in
any act of the legislature or legal or public document mean
a person registered under this chapter {ib., s. 23).
Unregistered Persons. — No person shall be appointed as
a medical officer, physician, or surgeon, in any branch of the
public service, or in any hospital or other charitable institution,
unless he be registered under the provisions of this chapter
{ib., s. 24).
No certificate required from any physician or surgeon or med-
ical practitioner is valid unless the signer be registered {ib. , s. 25).
Offences and Penalties. — For a person without regis-
tration or license to practise physic, surgery, or midwifery for
hire, gain, or hope of reward, or wilfully or falsely pretend to
be a physician, doctor of medicine, surgeon, or general practi-
tioner, or to take or use any name or description implying or
calculated to lead people to infer that he is registered, or to pro-
fess by public advertisement, card, circular, sign, or other-
wise to practise physic, surgery, or midwifery, or to give
advice therein or in anywise to lead people to infer that he is
qualified to practise physic, surgery, or midwifery, is punisha-
ble with a forfeiture of 820 for each day that he so practises or
leads people to infer that he is practising {ib., s. 26).
On trial of such cause the burden of proof as to the license
or right of the defendant to practise physic, surgery, or mid-
wifery is on the defendant {ib., s. 28).
NOVA SCOTIA. 267
If a person wilfully jDrocures or attempts to procure regis-
tration by making or producing, or causing to be made or pro-
duced, a false or fraudulent representation or declaration, he,
and all persons knowingly aiding or assisting therein, are each
punishable with a forfeiture of not less than $100 {ib., s. 30).
To wilfully and falsely pretend to be or take or use any
name or description implying registration, is punishable with a
forfeiture not exceeding $100 {ib., s. 31).
Suits under this chapter are not to be begun after one
year from the date of the offence or cause of action (^6.,
s. 32).
Exceptions. — This chapter does not prevent a competent
female from practising midwifery in Nova Scotia, except that
she must satisfy the board of her competency, and obtain a
certificate from the registrar before she can lawfully practise
in the city of Halifax {ib., s. 33).
Nothing in the chapter prevents any person from giving
necessary medical or surgical aid or attendance to any one in
urgent need of it, provided such aid or attendance is not given
for hire or gain, nor the giving of it made a business or way of
gaining a livelihood {ib., s. 34).
Every person residing in the province and who shall have
practised therein prior to Januarj' 1st, 1850, is entitled on
proof thereof to have his name registered and receive a license
to practise under this chapter {ib., s. 36).
A person while employed in active service in Her Majesty's
naval or military service as a physician or surgeon may prac-
tise physic, surgery, or midwifery with {sic) registration or
license {ib., s. 37).
Schedule B of the chapter prescribes the subjects for a
matriculation or preliminary examination of those commencing
the study of medicine.
Fees. — To the registrar, for registration under sees. 9 and
10, $20.
To the registrar, for a preliminary examination under sec.
7, $10.
For registering additional qualifications, such fee as the
board may appoint {ib., s. 20).
268 synopsis of laws — poste and boston.
Ontario.
College of Physicians, etc. — There is a corporation styled
" The College of Physicians and Surgeons of .Ontario" (Rev.
St., 1887, c. 148, s. 2).
All persons registered according to the provincial acts 29
Victoria, c. 34, and 37 Victoria, c. 45, and amendatory acts, are
members of said corporation {ib., s. 3); as well as all persons
registered under this act {ib., s. 4).
Council. — There is a council of said college composed of
representatives chosen from every university, college, or body
in the province authorized to grant degrees in medicine and
surgery, and which establish and maintain to the satisfaction
of the College of Physicians and Surgeons of Ontario a medical
faculty in connection therewith, with five members elected by
the registered licensed practitioners in homoeopathy, and twelve
members elected from among and by the other registered mem-
bers of the profession (ib., s. 6).
No teacher, professor, or lecturer of any such college or body
shall hold a seat in said council except as a representative of
the college or body to which he belongs {ib., s. G, subd. 2, as
amended Act 1893, c. 27, s. 2).
All members of the council representing the colleges or
bodies aforesaid must be practitioners duly registered {ib., s. 6,
subd. 3, as amended Act 1893, c. 27, s. 2).
All dulj^ registered practitioners are entitled to vote at any
election for members of the council {ib., s. 8).
Any member of the college may have his name transferred
from one class of voters to any other on presenting to the reg-
istrar a certificate duly signed by the member or members of
the board of examiners to examine candidates on subjects spe-
cified as peculiar to each school of medicine, testifying that the
member so applying has shown a sufficient knowledge of the
system of medicine he desires to connect himself with, to en-
title him to be admitted to the class he desires, and being
so admitted he is entitled to vote in that class only (ib., s.
9 [1]).
No member is entitled to return to the class from which he
has been transferred without the sanction of the council {ib.,
s. 9 [2]).
ONTARIO. 269^
The council appoints officers including a registrar {ib.,
s. 13).
The council must appoint an executive committee to take
cognizance of and action upon all matters delegated to it by the
council or which may require immediate attention or interfer-
ence between the adjournment of the council and its next meet-
ing, and all such acts shall be valid only till the next ensuing
meeting of the council {ib., s. 4).
Division Association. — In each territorial division estab-
lished by the act there may be established a Division Associa-
tion, of which every member of the said college residing within
the said territorial division shall be a member {ib., s. 15).
Professional Fees. — The division association may submit
to the council a tariff of professional fees suitable to their divi-
sion, and on the said tariff receiving the approval of the council,
signed by the seal of the college and the signature of the presi-
dent, such tariff shall be held to be a scale of reasonable charges
for the division or section of a division where the members of
the association making it reside {ib., s. IG).
Registration. — In a register kept by the registrar the coun-
cil is required to cause to be entered the name of every person
duly registered and all persons who have complied with the act
and the rules and regulations made b}' the council respecting the
qualifications of practitioners of medicine, surgerj*, and mid-
wifery ; and those persons only whose names are inscribed in the
register shall be deemed to be qualified and licensed to practise
medicine, surgery, or midwifery, except as hereinafter provided
{ib., s. 21).
The registrar is required to keep his register correct and to
make the necessary alterations in the addresses or qualifications
of persons registered. And he may write to any registered
person at his address on the register, to inquire whether he
has ceased to practise or has changed his residence, and if no
answer be returned within six months, may erase the name
of such person; the name shall be restored on compliance with
the other provisions of the act {ib., s. 22, as amended Act 1891,
c. 26, s. 9).
It is optional for the council to admit to registration all such
persons as are duly registered in the medical register of Great
Britain, or otherwise authorized to practise medicine, surgerj',
270 SYNOPSIS OF LAWS — POSTE AND BOSTON.
and midwifery in the United Kingdom of Great Britain and
Ireland, upon such terms as the council may deem expedient
{ib., s. 23 [1]).
Any person actually practising medicine, surgery, or mid-
wifery, or any of them, in Ontario prior to January 1st, 1850,
and who has attended one course of lectures at any recognized
medical school, on such proof as the council may require, is
entitled to register {ih., s. 23 [2]).
Any person actually practising medicine, surgery, or mid-
wifery according to the principles of homoeopathy before
January 1st, 1850, and for the six years preceding March
24th, 1874, in Ontario, may in the discretion of the representa-
tives of the homoeopathic system of medicine be registered
{ih., s. 23 [3]).
Ax\y person who possesses any of the qualifications described
in Schedule B, dated prior to July 23d, 1870, on the payment
of the fee, is entitled to register on producing to the registrar
the document conferring or evidencing his qualification or qual-
ifications, or on transmitting by post to the registrar informa-
tion of his name and address and evidence of the qualification
or qualifications in respect whereof he wishes to be registered,
and of the time or times at which the same was or were at-
tained. No one registered under the acts mentioned in sec. 3
is liable to pay for registration (i6., s. 24).
Every person wishing to be registered, and not possessed
before July 23d, 1870, of one of the qualifications in Schedule
B, must present himself for examination as to his knowledge
and skill for the efiicient practice of his profession before the
board of examiners mentioned in sec. 28, and upon passing
the examination ^required and proving to the satisfaction of the
board of examiners that he has complied with the rules and
regulations of the council, and on payment of such fees as the
council may establish, he shall be entitled to register and in
virtue of his registration to practise medicine, surgery, and
midwifery {ih., s. 25).
When it appears that there has been established a central
examining board similar to that constituted by this act, or an
institution duly recognized by the legislature of any of the
provinces of the Dominion of Canada as the sole examining
body for the purpose of granting certificates of qualification,
ONTARIO. 271
and wherein the curricuhim is equal to that established in
Ontario, the holder of such certificate shall, upon due proof, be
entitled to registration by the council of Ontario if the same
privilege is accorded by such examining board or institution to
those holding certificates of Ontario {ib., s. 2G^.
Board of Examiners. — The council is required at its
annual meeting to elect a board of examiners whose duty it is
to examine at least once in each year all candidates for registra-
tion in accordance with the by-laws, rules, and regulations of
the council; such examinations are to be held at Toronto or
Kingston at such times and in such manner as the council may
by by-laws direct {ib., s. 28).
The board of examiners is composed of one member from
each existing teaching body enumerated in sec. 6 and one from
every other school of medicine organized in connection with any
university or college empowered by law to grant medical or
surgical diplomas and not less than six members chosen from
the members of the College of Physicians and Surgeons of
Ontario unconnected with any such teaching body {ib., s. 29,
as amended Act 1893, c. 27, s. 5).
HOMCEOPATHISTS. — Every candidate who, at the time of the
examination, signifies his wish to be registered as a homoeopathic
practitioner shall not be required to pass an examination in
materia medica or therapeutics, or the theory or practice of
physic or surgery or midwifery except the operative parts
thereof, before any examiners other than those approved of by
the representatives in the council of the homoeopathic S5^stem
{ib., s. 30).
Duties of Council. — The council is required to make
orders, regulations, or by-laws for regulating the register and
fees for registration and for the guidance of the board of ex-
aminers, and may prescribe the subjects and modes of examina-
tion and the time and place of holding the same, and may make
all such rules and regulations for examination not contrary to
the act as they deem expedient and necessary {ib., s. 31).
Additional Qualification. — Every person registered who
obtains a higher degree or other qualification is, on the pay-
ment of the fee, entitled to have it inscribed in the register in
substitution for or in addition to the qualifications previously
registered {ib., s. 32).
272 SYNOPSIS OF LAWS — POSTE AND BOSTON.
Powers op Registrar. — No qualification is to be entered
on the register unless the registrar be satisfied by proper evi-
dence that the person claiming it is entitled to it. Appeal
from the decision of the registrar may be decided by the
council; any eniry proved to the satisfaction of the council to
have been fraudulently or incorrectly made may be erased from
the register by order of the council in writing {ib., s. 33 [1]).
If the registrar be dissatisfied with the evidence adduced by
a person claiming to be registered, he has power, subject to ap-
peal to the council, to refuse registration until such evidence is
furnished, duly attested b}^ oath or affidavit before a judge of
the county court of any county {ib., s. 33 [2]).
Erasure and Restoration of Name. — A practitioner is
liable to have his name erased from the register where he has
been convicted before or after registration of an offence which,
if committed in Canada, would be a felony or misdemeanor, or
where he has been guilty of any infamous or disgraceful con-
duct in a professional respect {ib., s. 34 [1]).
The council may, and on the application of any four regis-
tered medical practitioners must, cause inquiry to be made into
the case of a person alleged to be liable to have his name
erased under this section, and on proof of such conviction or
conduct shall cause his name to be erased from the register.
The name of a person shall not be erased on account of his
adopting or refraining from the practice of any particular
theory of medicine or surgery; nor on account of a conviction
for a political offence out of Her Majesty's dominions, nor of
conviction for an offence which ought not either from its trivial
nature or its circumstances to disqualify a person from prac-
tising medicine or surgery {ib., s. 34 ['i]).
The council may order to be paid out of any funds at their
disposal such costs as thej^ may deem just to any person against
whom any complaint has been made, which, when finally deter-
mined, is found to have been frivolous and vexatious {ib., s. 34
[3]).
When the council direct the erasure of any name or entry,
it shall not be again entered except by direction of the council
or any of the divisions of the high court of justice {ib., s. 35
[1], as amended Act 1891, c. 26, s. 3).
If the council think fit, thej' may direct the registrar to
ONTARIO. 273
restore anj^ name or entry erased, without fee, or on payment
of such fee not exceeding the regular fee as the council may fix
{ib., s. 35 [2]).
The council is required to ascertain facts, in the exercise of
its powers of erasing and restoring, by a committee of their own
body of not more than five, and a written report of the com-
mittee may be acted on by the council {ib., s. 3G [1], as
amended Act 1891, c. 26, s. 4).
At least two weeks' notice of the first meeting of the com-
mittee for ascertaining the facts of any case must be served on
a person whose conduct is subject to inquiry, and such notice
must embody a copy of the charges or a statement of the sub-
ject-matter of the inquiry, and specify the time and place of
meeting. The testimony is under oath, and subject to cross-ex-
amination and the full right to call evidence in defence and
reply. In the event of the non-attendance of such person the
committee, on the proof of personal service of the notice, maj'
proceed with the inquiry in his absence and without further
notice {ib., s. 36 [5]).
No action can be brought against the council or committee
for anything done bona fide under this act notwithstanding
want of form in the proceedings. Any person whose name has
been ordered erased may appeal from the decision of the coun-
cil to any division of the high court at any time within six
months from the date of the order of erasure, and the judge
may make such order as to restoration, confirmation, or further
inquiries by the committee or council and as to costs, as to him
shall seem right {ib., s. 37, as amended Act 1891, c. 26, s. 5).
The appeal may be by a summons served .on the registrar to
show cause, and is founded upon a copy of the proceedings
before the committee, the evidence taken, the committee's
report, and the order of the council certified by the registrar.
The registrar is required to furnish to an}" person desiring to
appeal a certified copy of all proceedings, reports, orders, and
papers on which the committee acted, on paj'ment of five cents
a folio {ib., s. 38, as amended Act 1891, c. 26, s. 6).
The Act of 1891, c. 26, s. 7, provides for procuring the
attendance of witnesses before the committee, and for paj^-
ment of costs by the person whose name has been directed to
be erased.
18
274 SYNOPSIS OP LAWS — POSTE AND BOSTON.
Rights OF Registered Persons. — Every person registered
is entitled according to his qualifications to practise medicine,
surgery, or midwifery, or any of them, as the case may be,
and to demand and recover with full costs reasonable charges
for professional aid, advice, and visits and the cost of any
medicine or other medical or surgical appliances rendered or
supplied by him to his patient (?7>., s. 39).
Limitations. — One year after the termination of professional
services is established as a period of limitations to an action for
negligence or malpractice by reason thereof against duly regis-
tered members of said college (^7>., s. 40).
Evidence. — The register is required to be printed and
published, and a copy thereof purporting to be so printed and
published isprima facie evidence that the persons specified are
registered; and, subject to the provisions of subsection 2 of this
section, the absence of the name of any person from such copy
shall be prima facie evidence that such person is not regis-
tered {ib., s. 41 [1]).
In case of the name of a person not appearing in such copy,
a certified copy, under the hand of the registrar, of the entry
of the name on the register is evidence that such person is
registered {ib., s. 41 [2]).
x4.nnual. Certificate of Registration. — Every regis-
tered medical practitioner is required to obtain from the reg-
istrar annually, before December 31st, a certificate under seal
of the college that he is a duly registered medical practitioner
(Act 1891, c. 26, s. 8).
On payment of all fees and dues payable by such practitioner
to the college, the registrar is required to write his name and
the date on the margin of the certificate, and the certificate is
deemed to be issued only from such date; any fees properly
charged during the time in which a name was erased from the
register are legally recoverable on production of the certificate
of registration at time of suit (ib.).
No certificate is issued to any practitioner indebted to the
college, nor until the annual fee for the certificate prescribed by
the statute and the by-laws of the college is paid (ib.).
If a practitioner omits to take out such certificate, he shall
not be entitled thereto until he pays the certificate fee, and any
other fees or dues which he owes the college (ib.).
ONTARIO. 275
After twelve months' default in taking out such certificate,
and two months' notice of default b}- registered letter to the reg-
istered address of the defaulter, if payment is not made, the
registrar is required to erase his name and the provisions as to
unregistered practitioners forthwith applj" (ib.).
Such practitioner may, unless otherwise disqualified, obtain
re-registration and re-instatement to full privileges b}" appljing
to the registrar and paying up the fees and dues and taking out
his certificate (I'b.).
Neglect to Register. — Those entitled to register and
neglecting so to do are not entitled to any rights or privileges
conferred b}' registration, and are liable to all the penalties
against unqualified or unregistered practitioners (Rev. St.,
1887, c. 148, s. 42).
Fraudulent Registration. — If a person procures registra-
tion by means of false or fraudulent representations it is lawful
for the registrar, on a receipt of sufficient evidence of such
falsity or fraud, to represent the matter to the council, and on
the written order of the president, attested by the seal of the
college, to erase his name from the register and publish the fact
and cause of erasure in the Ontario Gazette ; and after such
notice such person ceases to be a member of said college and to
enjoy the privileges conferred by registration without the ex-
press sanction of the council {ib., s. 44 [1]).
Offences and Penalties. — Wilfully procuring or attempt-
ing to procure registration by false or fraudulent representations
is punishable with a penalty not exceeding $100. Knowingly
aiding and assisting therein is punishable with a penalty of
from 820 to $50 for each offence (ib., s. 44 [2]).
Practising without registration for hire, gain, or hope of
reward is punishable with a penalty of from $25 to $100 (ib.,
s. 45).
A person wilfully or falsely pretending to be a physician,
doctor of medicine, surgeon or general practitioner, or assum-
ing any title, addition, or description other than that he actually
possesses and is legally entitled to, is punishable with a penalty
of from $10 to $50 {ib., s. 46).
A person taking or using a name, title, addition, or descrip-
tion implying or calculated to lead people to infer that he is
recognized by law as a physician, surgeon, accoucheur, or licen-
276 SYNOPSIS OF LAWS — POSTE AND BOSTON.
tiate in medicine, surgery, or midwiferj^ is punishable by a
penalt}- of from $"^5 to $100 {ib., s. 47).
Unregistered Persons. — No person is entitled to recover
a charge for medical or surgical advice or attendance or the
performance of any operation or any medicine prescribed or
supplied unless he produces to the court a certificate that he is
registered; but this section does not extend to the sale of drugs
or medicines by a licensed chemist or druggist {ib., s. 48, as
amended Act 1891, c. 26, s. 2).
No person shall be appointed as a medical officer, physician,
or surgeon in any branch of the public service, or in anj- hos-
pital or other charitable institution not supported wholly by
voluntary contribution, unless he be registered {ib., s. 49).
No certificate required from any physician, surgeon, or
medical practitioner is valid unless the signer be registered
{ib., s. 50).
Costs. — The justice of the peace having jurisdiction of a
prosecution may award payment of costs in addition to the
penalty, and in default of payment may commit to the common
jail for a period not exceeding one month unless the penalty
and costs are sooner paid {ib., s. 51).
Appeal. — Any person convicted who gives notice of appeal
must give satisfactory security for the amount of the penalty
and the costs of conviction and appeal {ib., s. 52).
Proof. — In any trial under the act, the burden of proof as
to registration is on the person charged {ib., s. 53).
Where proof of registration is required, the production of a
printed or other copy of the register certified under the hand of
the registrar for the time being is sufficient evidence of all per-
sons who are registered practitioners, and any certificate upon
such copy purporting to be signed by any person in his capacity
of registrar is prima facie evidence that such person is regis-
trar without proof of his signature or of his being registrar
{ib., s. 54).
Limitations of Prosecutions. — Prosecutions are limited
to commence within one year from the date of the offence {ib.,
s. 55).
Stay. — The council may, b}' order signed by its president
having the seal of the college appended, stay proceedings in
any prosecution when deemed expedient {ib., s. 56).
ONTARIO. 277
Prosecutor. — Any person maj' be prosecutor or com-
plainant {lb., s. 57 [2]).
Qualification. — Schedule B referred to in the act is as
follows :
1. A license to practise physic, surgery, and midwifery, or
either, within Upper Canada under the acts of Upper Canada,
50 G., III., c. 13, and 8 G., IV., c. 3, respectively.
2. A license or diploma granted under 2 Vict., c. 38, or
under the Consolidated Statutes for Upper, Canada, c. 40, or
any act amending the same.
3. A license or authorization to practise physic, surgery,
and midwifery, or either, within Lower Canada, whether
granted under ordinance 28 G., Ill-, c. 8, or act 10 and 11
Vict., c. 26, and acts amending the same, or under c. 71 of the
Consolidated Statutes for Upper Canada, or any act amending
the same.
4. A certificate of qualification to practise medicine, surgery,
and midwifery, or either, hereafter granted by any colleges or
bodies named or referred to in sec. 6.
5. A medical or surgical degree or diploma of any univer-
sity or college in Her Majesty's dominions or of such other uni-
versities or colleges as the council may determine.
6. A certificate of registration under the Imperial Act 21
and 22 Vict., c. 90, known as "The Medical Act," or any act
amending the same,
7. A commission or warrant as physician or surgeon in Her
Majesty's military service.
8. Certificates of qualification to practise medicine under
any of the acts relating to homoeopathy or the eclectic system
of medicine.
Fees. — To registrar, for transfer under sec. 9 (2), $2.
To registrar, for registration under sec. 24, not more than
$10, to be fixed by the by-laws of council.
To registrar, for registration under sec. 25, such fees as the
council may by general by-law establish.
To registrar, for copies under sec. 38, 5 cents a folio.
Members are required to pay an annual fee to the college ;
the amount and means of enforcing which are in the discretion
of the elected members of the council (Act 1893, c. 27, s. 6).
278 synopsis of laws — poste and boston.
Prince Edward Island.
Medical Society. — The members of the medical profession
constitute a body corporate under the name of the " Medical
Society of Prince Edward Island" (Act 1892, c. 42, s. 1).
Persons registered under the act o-t Vict., c. 25, or 37 Vict.,
or the Prince Edward Island Medical Act of 1890, are mem-
bers of the society and entitled to register under this act with-
out a fee {ib., s. 2).
All persons registered under this act are members of the said
society {ib., s. 3).
Registration. — There is a council of said society, composed
of seven members of the society elected by the society {ib., s.
4), which is required to appoint a registrar among other officers
{ib., s. 6); and to cause him to keep a register of the name of
every person registered under this act, or the acts mentioned in
sec. 2, and from time to time of the names of all persons who
have complied with this act and the rules and regulations made
by the council respecting the qualifications of practitioners of
medicine, surgery, or midwifery, which is called the Prince
Edward Island Medical Register ; and only those persons whose
names are inscribed therein are qualified and licensed to practise
medicine, surger}-, or midwifery, except as hereinafter provided
{ib., s. 8).
The registrar is required to keep his register correct, and to
make the necessarj^ alterations in the addresses and qualifica-
tions of persons registered {ib., s. 9).
The council is required to admit to registration, on the pay-
ment of the registration fee, all persons duly registered by the
medical council of Great Britain or otherwise authorized to
practise medicine, surgery, or midwifery in the United King-
dom of Great Britain and Ireland {ib., s. 10).
Every person who holds a medical or surgical degree or
diploma dated prior to January 1st, 1880, from any university,
college, or school of medicine in Great Britain, Ireland, or
Canada, or any of the universities or colleges in the United
States mentioned in Schedule A, is entitled to register on pro-
ducing to the registrar such diploma or satisfactory' evidence of
the qualification in respect whereof he seeks to be registered
{ib., s. 11).
PRINCE EDWARD ISLAND. 279
Every person desirous of being registered, not registered
under the acts mentioned in sec. 2, and who had not become
possessed of a diploma as provided in sec. 11, must, before being
entitled to register, be examined as to his knowledge and skill
for the efficient practice of his profession before the medical
council, and on passing the examination required and produc-
ing proof of study in medicine, surgery, and midwifery four
years, one of which may be with a registered medical practi-
tioner, shall, subject to the next section, be entitled to register
and by virtue of such registration to practise medicine, sur-
gery, and midwifery ; provided, the council may, if it see fit,
dispense with the examination in any case {ih., s. 12).
No person commencing the study of medicine on or after
September 1st, 1892, shall be entitled to register unless he has
passed a matriculation examination equivalent to that of the
College of Surgeons of London, or shall hold a license as a first-
class teacher in this province, or shall have obtained from tht
council a certificate that he has satisfactorily passed a matricu-
lation examination in the subjects specified in Schedule B.
Any graduate or student matriculated in the arts in anj'
university in Her Majesty's dominions shall not be required to
pass the matriculation examination (z7>., s. 13).
The council may grant a license to practise medicine, sur-
gery, or midwifery to an applicant at the time of the passage of
this act practising medicine, surgery, or midwifery, or any of
them, in Prince Edward Island, on a preliminary examination
as the council may think necessary for the public safety,
provided such person shall have practised five years in the prov-
ince, but such person is not thereby entitled to registration
{ib., s. 15).
When there has been established an authorized examining
body or an institution recognized by the legislature of any
other province of the Dominion of Canada as the sole examin-
ing body for granting certificates of qualification, and where the
curriculum is equal to that appointed by the medical council
of Prince Edward Island, the holder of such certificate shall,
upon due proof, be entitled to registration by the council of
Prince Edward Island, if the same privilege is accorded in
such other province to those registered in Prince Edward Island
(«6., s. IG).
280 SYNOPSIS OF LAWS — POSTE AND BOSTON.
The council is required to hold examinations at least every
three months, if required, for candidates for registration, at
such places and times and in the same manner as the council
may direct {ib., s. 18).
Every person registered who obtains a higher degree or other
[qualification shall, on the payment of such fees as the council
shall appoint, be entitled to have it registered in substitution
for or in addition to the qualification previously registered {ib.,
3. 19).
No qualification is entered unless the registrar be satisfied,
by proper evidence, that the person claiming is entitled to reg-
ister it. There is an appeal to the council ; any name proved to
the council to have been fraudulently or incorrectly entered
may be erased by an order in writing of the council {ib.,
s. 20).
If the registrar is dissatisfied with the evidence he ma}^, sub-
ject to appeal to the council, refuse registration until the person
claiming it has furnished evidence to the satisfaction of the
registrar, duly attested by oath or affidavit before a notary
public or justice of the peace {ib., s. 21),
A medical practitioner guilt}^ of infamous or disgraceful
conduct in a professional respect is liable to have his name
erased, and if he apply for registration the council may refuse
it {ib., s. 22).
The registrar may publish in a newspaper or newspapers of
Prince Edward Island the fact that the name of such person
has been erased, and the cause of the erasure, but not until the
appeal, if any has been taken within the time allowed, has been
disposed of {ib., s. 23).
Where the council refuse to register, or direct an erasure,
the entry shall not be again made except by direction of the
council or the order of the supreme court or a judge thereof
{ib., s. 24).
Five days' notice of the meeting of the council for the hear-
ing of an appeal under sec. 2 must be served on the person
charged, embodying a copy of the charges or a statement of the
inquiry and the time and place of meeting {ib., s. 25).
Rights of Registered Persons. — Every person licensed
or registered under the act is entitled according to his qualifi-
cations to practise medicine, surger}', and midwifery, or anj- of
PRINCE EDWARD ISLAND. 281
them, as the case may be, and recover with costs his reasonable
charges for professional aid, advice, and visits, and the cost of
medicines or medical and surgical appliances rendered or sup-
plied by him to his patient {ib., s. 26).
Limitations. — Twelve months is established as the period
of limitations for an action from negligence or malj)ractice
against a person registered {ib., s. 27).
Evidence. — The registrar is required, under the direction
of the council, to print and publish once in two years a register
of the names of all persons registered, with the residence and
medical title, diploma, and qualification conferred by any college
or body, with the dates thereof, as existing on the day of the
publication. A copy of such register, for the time being, pur-
porting to be so printed and published, isj)rima facie evidence
that the persons specified are registered. The absence of a name
from such copy is prima facie evidence that such person is not
registered.
In case a name does not appear in the copy, a certified copy,
under the hand of the registrar of the council, of the entry of a
name is evidence that such person is registered {ib., s. 28).
Fraudulent Registration. — If a person be registered by
false or fraudulent representations the registrar ma}', on the
receipt of sufificient evidence thereof, report the matter to the
council, and on the order of the council erase his name from
the register and make known the fact and cause by a notice in
the newspaper or newspapers on Prince Edward Island {ib., s.
29 [1]).
Offences and Penalties. — Wilfully procuring or attempt-
ing to procure registration by false or fraudulent representation
is punishable with a penalty not exceeding $50. Knowingly
aiding and assisting therein is punishable with a penalty of
from $10 to $25 for each ofPence {ib., s. 29 [2]).
Without registration or license, practising for hire or hope
of reward or advertising to give advice in medicine, surgery,
or midwifery is punishable with a penalty not exceeding $25
(ib., s. 30).
Wilfully or falsely pretending to be a physician, doctor of
medicine, surgeon, or general practitioner, or assuming a title,
addition, or description not actually possessed, or pretending to
be recognized by law as a physician, accoucheur, or a licentiate
282 SYNOPSIS OF LAWS — POSTE AND BOSTON.
in medicine, surgery, or midwifery, is punishable with a penalty
not exceeding $35 {ib., s. 31).
Unregistered Persons. — No person is entitled to recover
a charge for medical or surgical advice or attendance or for the
performance of a surgical operation unless registered, licensed,
or otherwise authorized under this act {ib., s. 32).
No person is to be appointed as a medical officer, physician,
or surgeon in any branch of the public service, or any hospital
or other charitable institution unless registered, {ib., s. 33).
Costs. — On prosecution, costs may be awarded and the
offender may be committed to a common jail in default of
pa3dng the penalty and costs, for not exceeding one month
{ib., s. 34).
Appeal from Conviction. — A person appealing from con-
viction is required to give satisfactory security for the penalty,
costs of conviction, and appeal before released from custody {ib.,
s. 35).
Limitation of Prosecutions. — Prosecutions are required
to be commenced within six months from the date of the offence
{ib., s. 36).
Prosecutor. — Any person may be prosecutor or comj)lain-
ant {ib., s. 37).
Appeal from Registrar's Decision. — A person aggrieved
by the decision of the registrar may appeal to the council, and
persons aggrieved by the decision of the council may appeal to
the supreme court of the province, which decision shall be final.
The act prescribes the procedure on apjDeal {ib., s. 38, 39).
Powers of Council. — The council may make by-laws for
carrying out the act, to be approved by the lieutenant-governor
in council, but nothing shall prevent any registered medical
practitioner from giving medical treatment or advice to any
person by reason of such person having previously engaged the
services of any other physician {ib., s. 40).
The council is authorized to make regulations regarding the
holding of examinations and the subjects of examinations {ib.,
s. 41).
Exceptions. — The act does not prevent any person from
giving necessary medical or surgical aid or attendance to any
one in urgent need of it provided it be not for hire or gain, nor
the giving of it be made a business or means of livelihood ; nor
PRINCE EDWARD ISLAND. 283
does it prevent women from practising midwifery, or any person
from practising dentistry or treating cases of cancer by external
application, and charging for such service and suing for and
recovering reasonable charges ; nor does it prevent a druggist,
apothecary, or storekeeper from suing for and recovering the
price of drugs or chemicals supplied or sold by him (?'&., s. 42).
The act does not prevent a person not holding a medical
degree, license, or diploma from a university or college from
practising medicine, surgery, or midwifery provided he was
engaged in such practice in the province for five years imme-
diately before the passage of the act, nor from recovering with
costs his reasonable charges for professional aid, advice, and
visits and the cost of medicine or other medical or surgical ap-
pliances rendered or supplied by him to his j^atients (ib., s. 43).
Appeal on Prosecution. — Appeal from the decision on
prosecution may be taken to the supreme court (^6., s. 44).
Schedule A :
Universitj^ of Pennsylvania, Philadelphia, Pa.
Jefferson Medical College, Philadelphia, Pa.
Bellevue Medical College, New York, N. Y.
University of New York, New York, N. Y.
College of Phj^sicians and Surgeons, New York, N. Y.
Harvard University. c
University of Michigan.
Schedule B specifies at length the requirements for the ex-
amination mentioned in sec. 13.
Fees. — Persons registered under sec. 2 are not required to
pa}^ a fee.
For registration under sees. 11 and 12, not exceeding $30,
to be fixed by the society.
To the council, for a license under sec. 15, $5.
An annual fee is required to be paid by members of the
society, not more than $5 annually, as levied by the council
{ib., s. 17).
For registration under sec. 19, such fees as the council may
appoint.
284 synopsis of laws — poste and boston.
Quebec.
College of Physicians, etc. — All persons residing in the
province authorized to practise medicine, surgery, or midwifery
therein, and registered under this law, are constituted a corpora-
tion by the name of " The College of Physicians and Surgeons of
the Province of Quebec" (R. S., 1888, art. 3,969).
The affairs of the college are conducted bj^ a board of gov-
ernors, forty in number, chosen as provided in the act and
known as the " Provincial Medical Board" {ib., art. 3,972 to
3,975).
Qualification. — No person can lawfully practise medicine,
surgerj", or midwifery unless he has obtained a license from the
said board and unless he be registered {ib., art. 3,976).
Every person who obtains a medical degree or diploma in
any university or college mentioned in art. 3,972 is entitled to
such license without examination as to his medical knowledge
or skill, provided such diploma has only been given after four
years of medical studj' from the date of admission to study and
according to the requirements of the act; provided, the said
board has power to grant the same privileges to holders of
degrees or diplomas of medicine and surgery from other British
colonial or French universities or colleges {ib., art. 3,977).
The colleges referred to in art. 3,792 are: Laval Univer-
sity at Quebec, Laval University at Montreal, University" of
McGill College, University of Bishops College, The Incor-
porated School of Medicine and Surgery of Montreal affiliated
with the University of Victoria College or with any other British
university. The privilege above conferred on holders of de-
grees or diplomas from British colleges and universities is ex-
tended to every person whose name is entered upon the medical
register under the Imperial Medical Act of 1886 (49-50 Vict.,
c. 48) or of any act amending the same {ib., art. 3,977 a, as
added by Act 1889, c. 39).
The law prescribes the preliminary qualifications for admis-
sion to study medicine, surgerj', or midwifery to be ascertained
by examination. No one is entitled to the license of the college
on presentation of a diploma unless previously admitted to study
in accordance with these conditions, or unless he has passed an
equivalent preliminarj^ examination before a college, school or
QUEBEC. 285
board authorized by law to requite and cause such preliuainary
examinations to be passed in Her British Majesty's other pos-
sessions {ih., arts. 3,978, 3,979).
A candidate for a license to practise desiring to be regis-
tered, and who has not obtained a degree or diploma in medi-
cine from any institution mentioned in art. 3,972 {supra)
must, before being entitled to such license and to register, pass
an examination before the board as to his knowledge and skill
for the efficient practice of medicine, surgery, and midwifery.
Upon passing the examination and proving to the satisfaction
of the examiners that he has, in an institution for the teaching
of medicine in Her Majesty's possessions, complied with the
rules and regulations made by the provincial board, and on pay-
ment of such fees as the board may by general by-law establish,
such person shall be entitled to a license {ih., art. 3,980).
All persons coming from any recognized college outside of
Her Majesty's possessions desirous of obtaining a license from
the College of Physicians and Surgeons of the province must
previously pass a preliminar}- examination before the examiners
appointed by the board or establish to the satisfaction of the
board that they have already passed equivalent examinations,
and they must moreover follow in one of the schools of medi-
cine in the province a complete course (for six months) of lec-
tures, and such other course or courses as shall be necessary to
complete the curriculum required bj^ the board. They may
pass their professional examination immediately after their
preliminary examination {ih., art. 3,981).
Powers of Medical Board. — The board of governors of
the College of Physicians and Surgeons has among other powers
the power to examine all credentials and documents purporting
to entitle the bearer to a license to practise and all diplomas,
degrees, or other qualifications sought to bo registered, and to
require the bearer to attest on oath, to be administered by the
chairman, that he is the person whose name is mentioned
therein, and that he became legally possessed thereof ; and to
register in the books of the college the name, age, place of
residence and birth of every member of the profession practis-
ing in the province, the date of his license and the place where
he obtained it {ih., art. 3,982).
The provincial medical board, among other powers, has
286 SYNOPSIS OF LAWS — POSTE AND BOSTON,
the power to make regulations respecting the tariffs or rates
to be charged in towns and counties for medical, obstetrical,
or surgical advice, or for attendance or for the performance of
any operation or for any medicines prescribed or supplied.
The tariff must be approved by the lieutenant-governor in
council, and can only come into force six months after its pub-
lication once in the Quebec Official Gazette, and that of the
order in council approving the same. The tariff does not, in
case of suit, obviate the necessity of proof of giving the advice,
care, prescriptions, medicines, and other things therein men-
tioned (?6., art. 3,983),
The said board has power to fix the fees for license and
registration {ib., art. 3,984).
Qualifications of Candidate. — The qualifications of a
candidate for a license are :
1. That he holds a certificate of study from a licensed phy-
sician for the period intervening between the courses of lectures
which he has followed.
2. That he has reached the age of twenty-one years.
3. That he has followed his studies during a period of not
less than four years, commencing from the date of his admission
by the board to study medicine.
4. That during said four years he attended at some univer-
sity, college, or incorporated school of medicine within Her
Majesty's possessions not less than two six-months' courses of
general or descriptive anatomy, of practical anatomy, of sur-
gery, of the practice of medicine, of midwifer}-, of chemistry,
of materia medica and general therapeutics, of the institutions
of medicine or physiology and general pathology, of clinical
medicine, and of clinical surgery; one six-months' course or
two three-months' courses of medical jurisprudence, one three-
months' course of botany, one three-months' course of hygiene,
and a course of not less than twenty-five demonstrations upon
microscopic anatomy, physiology, and patholog}'.
0. That he attended the general practice of a hospital in which
are contained not less than fift}' beds under the charge of not less
than two physicians or surgeons, for not less than one and one-
half years or three periods of not less than six months each.
6. That he has attended six cases of labor and compounded
medicines for six months.
QUEBEC. 287
Each six-months' course shall have consisted of one hundred
and twenty lectures except in the case of clinical medicine,
clinical surgery, and medical jurisprudence.
Of four years' study required by this section, three six-
months' sessions, at least, must be passed in attending upon
lectures at a university, college, or incorporated school of med-
icine recognized by the board.
The first of such courses must have been attended during
the session immediately succeeding the preliminary^ examina-
tion, and the last during the fourth year of study, and the can-
didates must undergo an examination on the final subjects of
the curriculum at the end of the session in the fourth year of
study {lb., art. 3,985).
Members of College. — All persons obtaining a license to
practise from the College of Physicians and Surgeons of the
province are members of the college, but are not eligible for
governors within four years from the date of their admission
as members [ib., art. 3,086).
Women. — The provincial medical board has power to
make regulations respecting the admission of women to the
study and practice of midwifery. Women who were legally
qualified on the 31st of October, 1879, to practise as midwives
in the province, while required to conform to the rules of
said college, retain their right. Nothing in the act or the reg-
ulations shall prevent women in the country from practising
midwifery or assisting at accouchements without being ad-
mitted to the study or practice of midwifery ; but they must ob-
tain a certificate from a duly licensed phj^sician certifying
that they have the necessary knowledge {ib., art. 3,987).
Register. — The medical board is required to cause to be
kept by the registrar a register of persons duly licensed and reg-
istered, and who have complied with the law and the regula-
tions of the board, and those persons only whose names are in-
scribed therein are deemed to be qualified and licensed (?"&.,
art. 3,988).
The registrar is required from time to time to make the
necessary alterations in the register {ib., art. 3,989).
Evidence. — The registrar, under the direction of the board of
governors, causes to be printed, published, and distributed to the
members, from time to time, a copy, called 2Vie Quebec Medical
288 SYNOPSIS OF LAWS — POSTE AND BOSTON.
Register, of the register, containing names, surnames, resi-
dences, medical titles, diplomas, and qualifications conferred by
a college or other medical body, with the dates of the same. A
printed copy, certified under the hand of the registrar as such,
{■s, prima facie evidence that the persons named and entered
have been registered in accordance with this law. The absence
of the name of any person from such copy is prima facie
proof that such person has not been lawfully registered ; pro-
vided always in case a person's name does not appear on such
printed copy, a copy or extract from the register certified by
the registrar of the college of the entry of such person's name
on the register is proof that such person is duly registered {ib.,
art. 3,990).
A certificate under the hand of the registrar of the payment of
the annual contribution of members of the college i's, prima facie
evidence that such payments have been made {ih., art. 3,991).
Neglect to Register. — A person entitled to register who
neglects to register is not entitled to practise medicine, surgery,
or midwifery, or to claim any of the rights and privileges con-
ferred, and is liable for all penalties imposed for practising
without registration, saving the right of certain members hold-
ing a license from the College of Physicians and Surgeons of
Lower Canada {ih., art. 3,992).
Established Practitioner. — A person who has attended
medical lectures during three sessions of a medical school in
the British possessions, and who has actually been engaged in
the practice of medicine for over thirty years in the province,
may, on proof of these facts to the satisfaction of the provincial
medical board, and producing a certificate signed by two resi-
dent medical practitioners in the neighborhood where he has
practised that he has succeeded in his profession, and is entitled
to the consideration of the board, be entitled to a license and to
registration without an examination {ih., art. 3,993).
Unregistered Persons. — No person unless otherwise
authorized is entitled to recover any charge for medical or sur-
gical advice, or professional service, or for the performance of
any operation, or for any medicines prescribed or supplied, nor
is he entitled to any of the rights or privileges conferred, un-
less he has registered according to law and paid his annual con-
tribution to the college {ih., art. 3,994).
QUEBEC, 289
No certificate required from any physician or surgeon or
medical practitioner is valid unless the signer is registered (/6.,
art. 3,995).
Persons Guilty of Felony.— Any registered member of
the medical profession convicted of felony forfeits his right
to registration, and the medical board causes his name to be
erased from the register {ib.^ art. 3,996).
If a person known to have been convicted of felony presents
himself for registration, the registrar is required to refuse him
registration {ib., art. 3,997).
Offences and Penalties. — A person not entitled to reg-
ister convicted of having practised in contravention of this
law, for reward or the hope of reward, is liable to a penalty
of $50.
A like penalty is incurred by every person assuming the
title of doctor, physician, or surgeon, or any other name imply-
ing that he is legally authorized to practise, if unable to estab-
lish the fact by legal proof, and by every person who in an ad-
vertisement in a newspaper or in a written or printed circular,
or on business cards or on signs, assumes a designation so as
to lead the public to believe that he is duly registered or quali-
fied ; and by every person who offers or gives his services as a
physician, surgeon, or accoucheur for gain or hope of reward,
if he be not duly authorized and registered.
Burden of Proof. — In every prosecution, proof of registra-
tion is incumbent on the party prosecuted.
"Witnesses. — Members of the college are not incompetent
witnesses by reason of their membership.
Costs. — The court imposing a penalty adds costs, and, in
default of payment within a delay which it fixes, condemns the
defendant to imprisonment in a common jail of the district for
sixty days (^Z>., art. 3,998).
Evidence, — In cases where proof of registration is re-
quired, the production of a printed or other copy or extract
from the register, certified under the hand of the registrar of
the college, is sufficient evidence that all persons named therein
are registered practitioners and any certificate upon such
proof, or other copy of the register or extract from such register,
purporting to be signed by any person in his capacitj" of regis-
trar of the college, \^ prima facie evidence that such person is
19
290 SYNOPSIS OF LAWS — POSTE AND BOSTON.
registrar without proof of the signature or of his being in
fact such registrar (ib., art. 3,999).
HoMGEOPATHiSTS. — The rights of homoeopathists are not
affected by the foregoing sections {ib., art. 4,002).
The homcBopathic physicians and surgeons of the province
form a corporation under the name of the Montreal Homoeo-
pathic Association {lb., art. 4,003).
The corporation has power to appoint three medical grad-
uates of a British or provincial university or medical licentiates
of a British or provincial college or board legally incorporated
to be a board of examiners, to examine all persons who may
desire to obtain a license to practise homoeopathic medicine {ib.,
art. 4,008).
A person desiring to be examined touching his qualifications
to practise according to the doctrines and teaching of homoeop-
athy shall give notice in writing of at least one month to the
secretary or treasurer of the association, and show that he is not
less than twenty-one j-ears of age ; has followed medical studies
for not less than four years under the care of one or more duly
qualified medical practitioners ; has attended at some recognized
university or incorporated school of medicine not less than two
six-months' courses of anatomy, physiology, surgery, theory
and practice of medicine, midwifery, chemistry, materia
medica, and therapeutics respectively, and not less than one
six-months' course of clinical medicine and medical jurispru-
dence respectively, or their equivalents in time ; and shall have
complied with the regulations of such university or incorporated
school of medicine with regard to such courses, and shall have
followed such other course or courses as may hereafter be con-
sidered by the board of examiners requisite for the advancement
of a medical education.
All such persons shall, at a regularlj" appointed time and
place, be examined on all the aforesaid branches by the board
of examiners {ib., art. 4,009).
If the board be satisfied by examination that a person is
duly qualified to practise either or all of said branches of medi-
cine, as taught and practised by homoeopathists, they shall cer-
tifj^ the same under the hands and seals of two or all of such
board.
The lieutenant-governor, on receipt of such certificate, may,
QUEBEC. 291
if satisfied of the loyalty, integritj^, and good morals of the ap-
plicant, grant to him a license to practise medicine, surger}-,
and midwiferj^, or either of them, conformably to the certificate,
and all such licensees are entitled to all the privileges enjoyed
by licentiates of medicine {ib., art. 4,010).
The corporation appoints a secretary who keeps a register of
names of all persons duly licensed to practise medicine, surgery,
and midwifery, or either of them, according to the doctrines
and teachings of homoeopathy.
Only those whose names are inscribed in said, register are
qualified and licensed to practise according to the doctrines and
teachings of homoeopathy {ib., art. 4,015).
The said secretarj^ is required to make the necessary altera-
tions in the addresses or qualifications of the persons registered
{lb., art. 4,016).
Offences and Penalties. — A person practising according
to the homoeopathic doctrines for reward in contravention of
this act, or assuming a' title implying that a person is legally
authorized to practise according to homoeopathic doctrines, if
unable legally to establish such authorization ; or by advertise-
ment published in a newspaper or in a written or printed
circular, or on business cards or signs, assuming a designation
to lead the public to believe that he is duly registered and
qualified to practise according to the doctrines of homoeopath}' ;
or offering or giving his services as physician, surgeon, or ac-
coucheur for gain or hoj^e of reward, if not duly authorized
or registered, is punishable with a penalty of $50.
Burden of Proof. — In every prosecution, the proof of
registration is incumbent on the party prosecuted.
Costs. — The court may condemn the defendant to pay $50
in addition to costs within a delaj^ which it determines, and to
imprisonment of sixty days in a common jail of the district on
default of payment within the dela}' {ib., art. 4,017).
Witnesses. — A member of the corporation is not an incom-
petent witness on account of his membership {ib., art. 4,018).
Fees. — The provincial board of medical examiners may es-
tablish examination fees {ib., art. 3,981).
Members of the College of Physicians and Surgeons of the
Province of Quebec are required to pay an annual fee of $2
{ib., art. 3,986).
ff
FORENSIC MEDICINE.
THANATOLOGICAL.
THE
LEGAL STATUS OF THE DEAD BODY;
THE DISPOSAL AND OBLIGATION TO DISPOSE OF THE SAME; HOW
AND BY WHOM IT MAY BE EXHUMED OR REMOVED;
AUTOPSIES, BY WHOM ORDERED; THE RIGHTS
OF RELATIVES AND ACCUSED PERSONS.
INCLUDING
AN APPENDIX COxNTAINING A SYNOPSIS OF THE STATUTES OF THE
DIFFERENT UNITED STATES AND TERRITORIES
CONCERNING SAME.
BY
TRACY C. BECKER, A.B., LL.B., etc.,
Counsellor at Law, etc. ; Professor of Civil Law and Medical Jurisprudence, Law
Department, University of Buffalo.
LEGAL STATUS OF THE DEAD BODY.
Disposal and Obligations to Dispose of the Same. —
There is no right of property, in the ordinary sense of the word,
in a dead human body ; but for the health and protection of
society it is a rule of the common law, and which has been con-
firmed by statutes in civilized states and countries, that public
duties are imposed upon public officers, and private duties upon
the husband or wife and the next of kin of the deceased, to pro-
tect the body fi^m violation and see that it is properly interred,
and to protect it after it is interred. A parent is bound to pro-
vide Christian burial for a deceased child, if he has the means,
but if he has not the means, though the body remains unburie^
so long as to become a nuisance, he is not indictable for the
nuisance although he could obtain money for the burial ex-
penses by borrowing it of the poor-law authorities of the parish,
for he is not bound to incur a debt. (Reg. v. Vann, 2 Div. C.
C, 325; 15 Jur., 1,090.) On the other hand it has been held
in England, that every householder in whose house a dead body
lies is bound by the common law, if he has the means to do
so, to inter the body decently, and this principle aj^plies where
a person dies in the house of a parish or a union. (Reg. v.
Stewart, 12 A. & D., 1,272.) And the expense may be paid
out of the effects of the deceased. (Tugwell v. Hayman, 3
Camp., 298, and note.)
In Pierce v. The Proprietors Swan Point Cemetery, 10 R.
I., 227, s. c, 14 Am. Rep., 667, the Court said: "That there is
no right of property in a dead body, using this word in its
ordinary sense, may be well admitted, yet the burial of the dead
is a subject which interests the feelings of mankind to a much
greater degree than many matters of actual property. There is
a duty imposed by the universal feelings of mankind to be dis-
charged by some one toward the dead ; a duty, and we maj'' also
say a right, to protect from violation; it may, therefore, be
considered as a sort of quasi property, and it would be discred-
297
298 LEGAL STATUS OF THE DEAD BODY — BECKER.
itable to any system of law not to provide a remedy in such a
case; . . . but the person having charge of it cannot be con-
sidered as the owner of it in any sense whatever, he holds it
only as a sacred trust for the benefit of all who may from fam-
ily or friendship have an interest in it." See also Wyncoop v.
Wyncoop, 42 Pa. St., 293; 4 Albany Law Jour., 56; Snyder v.
Snyder, 60 How. Prac, 368; Weld v. Walker, 130 Mass., 422;
Guthrie v. Weaver, 1 Mo. Apps., 136; Johnson v. Marinus,
18 Abb. N. C, 72, and note.'
The law casts the duty of burial of the wife upon the hus-
band, and of the husband upon the wife. In Secord v. Secord
(cited in note 1 above), the Court said: "There are cogent rea-
sons connected with public policy and the peace of families,
where in the absence of testamentary disposition the possession
of a corpse and the right to determine its burilil should follow
the administration of the estate." Inasmuch as the husband
has the first right to administer upon the estate of the wife,
and the wife upon the estate of the husband, the law imposes
the correlative duty of burial upon the person having such
right ; and so it has been held that the husband is liable for the
necessary expense of the decent interment of his wife from
whom he has been separated, whether the party incurring the
expense is an undertaker or mere volunteer.^
Where the deceased leaves a will appointing executors, the
executors have a right to the possession of the body, and the
duty of burial is imposed upon them, but it has been doubted
whether at common law a direction by will concerning the dis-
posal of the body could be enforced, and therefore the right to
make such direction has been conferred by statute in several
States.'
^ A valuable note is appended to ^ In New York State, section 305
this last case, citing the law litera- of the Penal Code provides : "A per-
ture of burial-grounds, burials, etc. , son has the right to direct the man-
and also giving in fvill the opinion ner in which his body shall be dis-
of the Special Term of the New York posed of after his death ; and also to
Supreme Court, in the case of Secord dii'ect the manner in which any
V. Secord, not elsewhere reported. part of his body, which had become
And see also The Law of Burial, 4 separated therefrom during his life-
Bradf. ,503. (Matter of Beekman St.) time, shall be disposed of; and the
'■'Ambrose v. Kerreson, IOC. B. , provisions of this chapter do not ap-
776 ; Bradshaw v. Beard, 13 Com. ply to any case where a person has
B., n. s., .344; Johnson ». Marinus, given directions for the disposal of
18 Abb. N. C. , 72; Hewitt v. Bron- his body or any part thereof incon-
son, 5 Daily, 1; Cunningham v. sistent with those provisions." See
Reardon, 98 Mass., 538. also Patterson v. Patterson, 59 N.Y.,
DISPOSAL AND OBLIGATIONS. 299
And where a widow ordered a funeral of her husband, it
was held that she was liable for the expense, although she was
an infant at the time, the Court holding that the expense fell
under the head of necessaries, for which infants' estates are
liable."
If there be no husband or wife-of the deceased, the nearest
of kin in the order of right to administration is charged with
the duty of burial.'^ «
Such acts as casting a dead human body into a river with-
out the rites of sepulture (Kanavans Case, 1 Me., 226); steal-
ing a corpse (2 East, PC, 652) or stealing for dissection a dead
body of one executed when the death sentence did not direct
dissection (Eex v. Cundick, D. & R., n. p., 13), were indict-
able offences at common law.^
In the works of the early dramatists, and by some writers of
fiction, it has been stated, or implied, that the body of a de-
ceased person could be seized and detained to compel the pay-
ment of his debts. This was never the law. In Jones v. Ash-
burnham, 4 East, 4G0, it was held that to seize a dead body on
pretence of arresting for debt would be contra bonos mores,
and an extortion on the relatives, and that case distinctly over-
rules any authority to be derived from the case of Quick v.
Coppleton, 1 Vent., 161, to the effect that forbearance to seize
or hold a body upon such a pretence would afford any consid-
eration for a promise to pay a debt. So, also, where a jailer
refused to give up a body of a person who had died while a
prisoner in execution in his custody, to the executors of the
deceased, unless they would satisf}" -certain claims against the
deceased due the jailer, the Court issued a peremptory manda-
mus in the first instance, commanding that the body should be
delivered up to the executors (Rex v. Fox, 2 Q. B,, 247). And
inR. V. Scott, 2 Q. B,, 248, it was said, that a jailer who should
583; Me. R. S., ch. 13, sec. 1 ; Minn. '^Secord v. Secord, sv2:)ra; Wvn-
Gen. Stats., sec. 6,220; N. D. Comp. coop tJ. Wyncoop, 42 Pa. St., 293;
Laws, sec. 6,549; Oklahoma Stats., Bogert r. Indianapolis, 13 Ind., 135 ;
sec. 2, 188. See also Williams r. Wil- Snyder r. Snyder. 60 How. Prac,
liams. Law Rpts., 20 Ch. D., 659 ; 2 368 ; Law of liurial, 4 Bradf., 503.
Wms. on Exrs. . p. 968; Secord v. M Bishop Crim. Law, sec. 506 ; see
Secord, supra. also Roscoe's Cr. Ev., 445, 446 ; Ste-
' Chappel V. Cooper, 13 M. & W., phens' Dig. Crim. L., sec. 292 ; Reg.
252. . V. Clark, 15 Cox C. C, 171.
300 LEGAL STATUS OF THE DEAD BODY— BECKER.
attempt to do so would be guilty of misconduct in his public
character, for which he would be liable to prosecution.'
How and by Whom the Dead Human Body may he Re-
moved or Exhumed. — Where the right of burial has been ex-
ercised, and the body interred in its final resting-place, no per-
son has any right to interfere with it without the consent of the
owner of the grave, or of the properly constituted public author-
ities. In Foster?;. Dodd, 8 D. & E., 842-854, it was held, that
a dead body belongs to no one, and is, therefore, under the
protection of the public. If it lies in consecrated ground, eccle-
siastical authorities will interpose for its protection ; but whether
in ground consecrated or unconsecrated, indignities offered to
the remains or the act of indecently disinterring them, are the
ground of an indictment."
Even the purchaser of land upon which is located a burial-
ground may be enjoined from removing bodies therefrom, if
he attempts to do so against the wishes of the relatives or next
of kin of the deceased. Every interment is a concession of
the privilege which cannot afterward be repudiated, and the
purchaser's title to the ground is fettered with the right of
burial.^
On the other hand, the right of the municipal or state
authorities, with the consent of the owner of the burial lot or
in the execution of the right of eminent domain, to remove dead
bodies from cemeteries is well settled.'
After the right of burial has once been exercised by the per-
son charged with the duty of burial, or where such person has
consented to the burial by another person, no right to the corpse
remains except to protect it from unlawful interference.''
^ Some of the United States have been committed ; " Earth to earth,
enacted statutes declaring it to be a ashes to ashes, dust to dust."
misdemeanor to attach or seize un- ^ 1st Pres. Ch. v. 2d Pres. Ch. , 3
der execution a dead body. Ari- Brewster, 372 ; and see also Pierce
zona Pen. Code, 491, etc. ; Cal. v. Proprietors Swan Point Cem.,
Pen. Code, sec. 295; Me. R. S. , supra.
chap. 124, sec. 26; Mass. Pub. Stat., ■* Craig, v. 1st Pres. Ch., 88 Pa. ,
chap. 207, sec. 46; N. Dak. Comp. St., 42; Charleston v. Wentworth
Laws, sec 6, 563; Oklahoma Stat. , Cem.,4Strob. (S. Car. ) , 306 ; Coates
sec. 2, 202 ; R. I. Pub. Stat. , sec. 3, 222. v. New York Citv, 7 Cow. , 585 ; Ham-
2 So in Meagher v. Driscoll, 96 ilton r. New, Albany, 30Ind., 482;
Am. Dec, 759, it was held that a Paige t). Symonds. 63 N. H. , 17.
dead body is not the subject of prop- '^Peters u. Peters, 43 N. J. Eq.,
erty, and after burial it becomes a 140 ; Lowry ?•. Plitt, 11 Phila. , 303 ;
part of the ground to which it has Weld v. Walkei' supra; In re
AUTOPSIES. 301
On the other hand, where a husband did not freely consent
to the burial of his wife in a lot owned by another person, it
was held that a court of equity might permit him, after such
burial, to remove her body, coffin, and tombstones to his own
lot, and restrain any person from interfering with such re-
moval.'
In Rhodes v. Brandt, 21 Hun, N. Y., 1, the defendant
brought an action against one Beelard to recover for services
rendered by him, as a physician, in treating a child of Beelard's
for a fracture of the thigh-bone, in which action Beelard set up
malpractice on the part of the defendant as a defence. During
the pendency of the action the child died and was buried.
Subsequently Beelard, the father, acting under the advice of
his counsel, directed and allowed the plaintiff, a physician, to
cause the body of the child to be exhumed, and a portion of the
thigh-bone to be removed, in order that it might be used in evi-
dence on the trial of the question of malpractice. After the
bone was removed, the body was returned to the grave. The
defendant thereupon caused the plaintiff to be arrested for un-
lawfully removing the body from the grave contrary to the
provisions of the statute, and the plaintiff" sued the defendant
for malicious prosecution. The Court held that the plaintiff
had not removed the body from the grave " for the purpose of
dissection or from mere wantonness," as these terms were used
in the statute (3 R. S., Gth ed., 965), for violation of which he
had been arrested, nor had he committed any offence against
public decency or the spirit of the statute.^
Autojjsies, by Whom Ordered; the Rights of Belatives
and Accused Persons. — As shown in a previous article in this
volume, on the Powers and Duties of Coroners and Medical
Examiners, in cases of sudden or suspicious death, it has been
Downs, 14 N. Y. St. Rep. , 189 ; Mor- form of an elaborate maiisoleiim and
land -y. Richardson, 23 Beav. , 596; built above the surface of the
s.c. 24 id., 33; Guthrie r. "Weaver, ground, was not a "building, erec-
1 Mo. App. , 136 ; 4 Step. Com., 371 ; tion or enclosure, " withiu the mean-
Reg. V. Theiss, 10 B. &S., 298. ing of the criminal statutes defining
' Weld V. Walker, supra; see also the crime of burglary in entering a
Johnson B. Marinus, .stipra. "building, erection or enclosure;"
'^ See also Com. v. Slack, 19 Pick., and hence that entering such a tomb
304; People V. Fitzgerald, 105 N. Y. , and taking therefrom a dead body
146; Peoples. Richards, 138 N. Y., with its grave-clothes and cerements
137. In this last case it was held that would not amount to the crime of
a tomb, althougl»constructedin the burglary.
302 LEGAL STATUS OF THE DEAD BODY — BECKER.
the law for nearly a thousand years that an inquisition or in-
quest super visum corporis must be held by an officer known
as a coroner, and that this office and its powers and duties were
inherited by this country as part of the English common-law
system in force at the time of the formation of the republic of
the United States. When a body has been buried, and the
coroner believes that an inquest is necessary, he has power to
disinter the body and hold an inquest, and he may direct a
post-mortem examination to be made, but after having done so
he must cause the body to be reinterred. It is now well settled
that in holding such an inquest, and making such an autopsy
or post-mortem examination required by his official duty, the
coroner has authority to employ, and it is his duty to employ,
professional skill and aid, and his contract will bind the county
to pay a reasonable compensation for the same.'
As will be seen below from a synopsis of the statutes relat-
ing to this matter, many of the States have enacted statutes
defining and prescribing the duties of the coroner and other
public officers in such cases. At an early period in England
(see 2 and 3 Will. IV., chap. 75, sec. 7) it was enacted by the
English Parliament that any executor or other person having
lawful possession of the body of a deceased person, and not
being an undertaker or other party entrusted with the body for
the purpose only of interment, might lawfully permit the body
of such deceased person to undergo an anatomical examination,
unless to the knowledge of such executor or other partj^ such
person should have expressed his desire during his life in writ-
ing, or verbally in the presence of two or more witnesses dur-
ing his illness whereof he died, that his body after death might
not undergo such examination, or unless the surviving husband
or wife or known relative of the deceased shall require the body
to be interred without such examination. By another section
of this statute (sec. 10), professors of anatomy and other persons
duly licensed were declared not liable to punishment for hav-
' County of Northampton v. Board of Com. -». Jameson, 86 Ind.,
Innes, 2 Carey (Pa.), 156 ; Com. t5. 154; Mo. Rev. Laws, sec. 2,469;
Hannan, 4 Barr. (Pa.), 269 ; Alleg. No. Car. Laws, 1687, chap. 2o9 ;
Co. r. Watts, 3 Barr. (Pa.), 468; Tenu. Code, sec. 6,lo0; N. Y. Laws
Van Hovenbergh v. Hasbrouck, 45 of 1874, chap. 535, sec. 2; N. Y.
Barb. (N. Y.), 197 ; Cosfordr. Board Laws, 1889, chap. 500, amending see.
Supervisors, 38 N. Y. St. Rep., 964 ; 308 of the Pen. Code.
Co. of Alleg. V. Shaw, 34 Pa. St., 301 ;
AUTOPSIES. 303
ing in their possession human bodies when having such pos-
session according to the provisions of the act.
Section 308 of the New York Penal Code, subdivision 3, as
amended by chapter 500, Laws 1889, enacts that whenever and
so far as the husband, wife, or next of kin of the deceased, being
charged by law with the duty of burial, may authorize dissec-
tion for the purpose of ascertaining the cause of death and no
further, the right exists to dissect tli^ dead human body. The
same statute also provides that whenever any district attorney
of that State, in the discharge of his official duties, shall deem
it necessary, he may exhume, take possession of, and remove
the body of a deceased person, or any portion thereof, and sub-
mit the same to a proper physical or chemical examination or
analysis, to ascertain the cause of death, which examination or
analysis will be made on the order of a justice of the Supreme
Court of the State, or the county judge of the county in which
the dead bodies shall be, granted on the application of the dis-
trict attorney, with or without notice to the relatives of the
deceased person, or to any person or corporation having the
legal charge of such body, as the court may direct. The dis-
trict attorney shall also have power to direct the sheriff, con-
stable, or other peace officer, and employ such person or persons
as he may deem necessary' to assist him, in exhuming, removing,
obtaining possession of, and examining physicallj' or chemically
such dead body, or any portion thereof ; the expense thereof to
be a county charge paid by the county treasurer on the certifi-
cate of the district attorney.
The matter of ordering autopsies and dissections of dead
bodies, or exhuming the same for that purpose or other pur-
poses, is a matter of so much public importance that it has been
regulated in nearly all of the United States by statutory enact-
ments, which together with the other statutes relating to the
subject-matter of this article are hereunto appended.
The author of this article is greatly indebted for assistance
in preparing the same, and in compiling these statutes, to Mr.
Amasa J. Parker, Jr., of the Albany, N.Y., bar.
304 LEGAL STATUS OF THE DEAD BODY — BECKER.
APPENDIX.
Statutory Regulations Concerning Dead Bodies.
The coroner has power to hold inquest and direct autopsy.
Ala., Code, sec. 4,801 et seq.
Ariz., Pen. Code, sec. 2,309 et seq.
Ark., R. S., sec. 692.
Cal., Pen. Code, sec. 1,510.
Col., Mill's Stat., sec. 870.
Conn., Gen. Stat., sees. 2,005, 2,008.
Del., R. S., ch. 33.
Fla., R. S., sees. 3,011, 3,019.
Ga., Code, sees. 590, 591, 4,101 et seq.
Idaho, R. S., sec. 8,377.
111., S. & C. Am. Stat., v. 1, 606.
Ind., R. S., sees. 5,878, 5,879.
Iowa, McCl. Am. Code, sec. 487.
Kan., Gen. Stat., sees. 1,780, 1,784.
Ky., Gen. Stat., ch. 25, sees. 3, 11.
La., Voorh. Rev. L., sec. 653.
Me., R. S., ch. 139, sec. 1.
Md., Code, art. 22, sees. 3, 4.
Minn., Gen. Stat., sec. 1,011 et seq.
Miss., Am. Code, sec. 816.
Mo., R. L., sec. 2,438 et seq.
Mont., Crim. L., sees. 869, 883.
Neb., Consol. Stat., sec. 3,144.
N. H., Pub. Stat., ch. 262, sec. 1 et seq.
N. J., Rev. Stat., p. 170 et seq.
N. C, Code, sec. 657.
N. Dak., Comp. Laws, sec. 664 et seq.
Ohio, R. L., sec. 1,221 et seq.
Oklahoma, Stat., sec. 1,745 et seq.
Ore., Crim. Code, sec. 453 et seq.
Pa., Bright Pen. Digest, 1536, sec. 37.
R. I., Pub. Laws, 1884, ch. 420, sec. 17.
S. C, R. S., sees. 711, 2,664 et seq.
Tenn., Code, sec. 6,139 et seq.
Va., Code, sec. 2,928 et seq.
"Wash., Hill's Am. Stat., v. 1, sec, 245 et seq..
APPENDIX. 305
W. Va., Code, ch. 154.
Wis., S. & B. Am. Stat., ch. 200.
Wyo., R. S., sec. 1,870 et seq.
Medical examiner shall hold inquest and direct autopsy.
Mass., Pub. Stat., ch. 26, sees. 10, 11.
R. I., Pub. Laws, 1884, ch. 420.
Justice of the peace shall hold inquest and direct autops5^
Mich., How. Am. Stat., v. 2, sec. 9,583 et seq.
Nev., Gen. Stat., sec. 225 et seq.
N. M., Comp. L., sec. 443 et seq.
Texas, Code Crim. P., art. 988 et seq.
Vt., Rev. L., sec. 3,934 et seq.
Wis., S. & B. Am. Stat., ch. 200.
And ma}^ order a body to be disinterred for the purpose of
holding such inquisition.
Ark., R. L., sec. 718.
Cal., Pen. Code, sec. 1,510.
Del., R. L., ch. 33.
Ga., Code, sees. 590, 591, 410 et seq.
Idaho, R. L., sec. 8,377.
S. C, R. S., sec. 2,687.
Texas, Code Crim. P., art. 989.
And when not claimed by friends and relatives, to ury the
body decently, and when the property of deceased is not suffi-
cient to defray expenses, this may be done at public expense.
Cal., Pen. Code, sec. 3,094.
Col., Mill's Stat., sec. 882.
Conn., Gen. Stat., sec. 2,015.
Idaho, R. L., sec. 2,081.
111., S. & C. Am. Stat., v. 1, 606.
Iowa, McCl. Am. Code, sec. 501.
Kan., Gen. Stat., sec. 1,792.
Ky., Gen. Stat., ch. 25, sec. 6.
La., Voorh. Rev. L., sec. 660.
Me., R. S., ch. 139, sec. 11.
Md., Code, art. 22, sec. 7.
Mass., Laws, 1887, ch. 310.
Mich., How. Am. Stat., v. 3, sec. 9,593.
Minn.. Gen. Stat., sec. 1,021.
Miss., Am. Code, sees. 3,145, 3,146.
20
306 LEGAL STATUS OF THE DEAD BODY — BECKER.
Mo., R. L., sec. :i,45C.
Mont., Gen. Laws, sec. 881.
Neb.,Consol. Stat., sec. 3,144.
Nev., Gen. Stat., sec. 2,269.
N. H., Pub. Stat., ch. 262, sec. 16.
N. J., Rev. Stat., p. 170, sec. 5.
N. M., Comp. Laws, sec. 447.
N. Dak., Comp. Laws, sec. 676.
Ohio, R. L., sec. 1,227.
Oklahoma, Stat., sec. 1,759.
Ore., Grim. Code, sec. 462.
R. I., Pub. Laws, 1884, ch. 420, sec. 24.
Tenn., Code, sec. 6,150.
Va.,Code, sec. 3,946.
Wash., Hill's Am. Stat., v. 1, sec. 257.
W. Va., Code, ch. 154, sec. 8.
Wis., S. & B. Am. Stat., ch. 200.
Wyo., R. S., sec. 1,886.
Removal or disinterment of a dead body without authority
of law or consent of relatives, for the purpose of selling such
body 6r for dissection or for mere wantonness, is —
(a) A felony.
Cal., Pen. Code, sec. 290.
Ga., Laws, 1882, v. 2, p. 87.
111., S. & C. Am. Stat., v. 1, p. 794.
Ind., R. S., sec. 2,166.
Mo., R. S., sees. 3,842, 3,845.
Mont., Law^s, 1889, p. 114.
N. C, Laws, 1885, ch. 90.
(b) A misdemeanor.
Ark., R. S., sees. 1,902, 1,903.
Del., Laws, 1883, ch. 234.
Kan., Gen. Stat., sec. 2,372 et seq.
Md., Code, art. 27, sees. 133, 134.
Pa., Bright Pen. Digest, 229, sec. 11.
Tenn., Code, sees. 5,659, 5,660.
(c) Is punishable by various sentences.
Ala., Code, sees. 4,023, 4,028.
Ariz., Pen. Code, sec. 491.
Col., Mill's Stat., sec. 1,367.
APPENDIX. 307
Conn., Gen. Stat., sec. 1,880.
Fla., K. L., sec. 3,625.
Iowa, McCl. Am. Code, sec. 5,328.
Kj., Gen. Stat., ch. 29, art. 17, sec. 16.
Me., R. S., ch. 124, sec. 27.
Mass., Pub. Stat., ch. 207, sees. 47, 48.
Mich., How. Stat., v. 2, sec. 9,297.
Miss., Am. Code, sees. 1,023, 1,024.
Neb., Consol. Stat., sec. 5,847.
N. H., Pub. Stat., ch. 266, sec. 7.
N Dak., Comp. Laws, sec. 6,559.
Ohio, R. L., sec. 7,034.
Oklahoma, Stat., sec. 2,198.
Ore., Crim. Code, sec. 656.
Texas, Pen. Code, art. 345.
"Vt., Rev. L., sees. 4,194, 4,196.
Va., Code, sec. 208.
W. Va., Code, ch. 149, sec. 13.
Wis., S. & B. Am. Stat., sec. 4,593.
Wyo., R. L., sec. 1,029.
(d) A high misdemeanor.
N. J., Rev. Stat., p. 249, sec. 122.
Bodies of criminals executed under sentence, and those
dying in jail, poor-house, etc., when to be delivered over for
dissection.
Ark., R. S., sec. 2,552.
Cal., Pen. Code, sec. 3,094.
Col., Mill's Stat., sees. 1,547, 1,548, 1,204.
Conn., Gen. Stat., sees. 1,729, 1,732.
Ga., Laws, 1887, v. 2, p. 87.
111., S. & C. Am. Stat., v. 1, 869.
111., Crim. Code, sec. 503.
111., S. & C. Am. Stat., v. 3, p. 867.
Ind., R. L., sec. 4,258 et seq.
Iowa, McCl. Am. Code, sec. 5,329.
Kan., Gen. Stat., sec. 3,758.
Me., R. S., ch. 13, sec. 2.
Me., Laws, 1893, ch. 254.
Mass., Laws, 1891, ch. 185.
Mass., Pub. Stat., ch. 202, sec. 8.
308 LEGAL STATUS OF THE DEAD BODY — BECKER.
Mich., How. Stat., v. 3, sec. 2,284.
Minn., Gen. Stat., sec. 678.
Mo., R. S., sec. 6,883.
Neb., Consol. Stat., sees. 3,299, 3,301, 5,848.
N. H., Pub. Stat., ch. 136.
N. J., Rev. Stat., p. 239, sec. 69.
N. C, Laws, 1891, ch. 129.
N. Dak., Laws, 1890, ch. 92.
Ohio, R. S., sec. 3,763.
Ore., Hill's Am. Laws, sec. 3,730 et seq.
Pa., Bright Pen. Dig., p. 94, sec. 1 et seq.
Vt., Laws, 1884, ch. 85.
Va., Code, ch. 80.
Wash., Hill's Am. Stat., v. 1, sec. 2,428 et seq.
Wash., S. & B. Am. Stat., sec. 1,437.
Duty of burial, etc.
Ariz., Pen. Code, sec. 493.
Cal., Pen. Code, sec. 292.
Minn., Gen. Stat., sec. 6,221.
N. Dak., Comp. Laws, sees. 6,550, 6,556.
Oklahoma, Stat., sec. 2,189.
Concealing birth of child which, if born alive, would be a
bastard, is punishable.
Col., Mih's Stat., sec. 1,195.
Fla., R. L., sec. 2,393.
Mass., Pub. Stat., ch. 207, sec. 11.
Mich., How. Am. Stat., sec. 9,284.
Mont., Crim. L., sec. 41.
Neb., Consol. Stat., sec. 5,582.
Nev., Gen. Stat., sec. 4,597.
N. H., Pub. Stat., ch. 278, sec. 14.
N. Dak., Comp. L., sec. 6,947.
Oklahoma, Stat., sec. 2,179.
Ore., Crim. Code, sec. 649.
Pa., Bright Pen. Digest, 431, sec. 158.
R. I., Pub. Stat., ch. 244, sec. 8.
Wis., S. & B. Am. Stat., sec. 4,585.
Is a misdemeanor.
Minn., Gen. Stat., sec. 6,210.
N. J., Rev. Stat., p. 241, sec. 83.
ALABAMA — ARKANSAS. 309
Is a felony.
Mo., R. S., sec. 3,479 (whether born dead or alive
Alabama.
Removal of body wantonly for dissection or sale, purchase
of a body unlawfully disinterred, violating grave with intent to
steal body, etc., or wantonly mutilating body, is punishable by
fine or imprisonment (Code, sees. 4,023, 4,028).
Coroner, or in his absence justice of the peace, to hold in-
quest and direct examination of bodj^ by surgeon, etc. (Code,
sec. 4,801 et seq.).
Arizona.
Mutilation, etc., of dead body is a felony (Pen. Code, sec.
491).
Removal of a part of body unlawfully is punishable (Pen.
Code, sec. 492).
Duty of burying body is, if a married woman, on husband ;
if not a married woman, on nearest of kin who is an adult pos-
sessed of sufficient means. If deceased has no relatives, on cor-
oner holding inquest or overseers, etc., of poor (Pen« Code,
sec. 493).
Refusal of one on whom dutj'^ of burial is imposed by law,
is punishable (Pen. Code, sec. 494).
Arrest or attachment of a dead body is a misdemeanor
(Pen. Code, sec. 496 et seq.).
Coroner to hold inquest and direct autopsy (Pen. Code, sec.
2,309 et seq.).
Person whose duty it is to bury is entitled to custody except
where coroner holds it until inquest is completed (Pen. Code,
sec. 495).
Arkansas.
Bodies of persons dying in alms-house, prison, house of cor-
rection, or jail shall be surrendered to a ph3^sician for dissection,
etc., unless the deceased request to be buried or the body is
claimed by relatives, or unless deceased died suddenly and un-
known ; and after such use for dissection it shall be decently
buried (R. S., sec. 2,552).
Removal of dead body for the purpose of dissection, or steal-
ing, or from wantonness, or receiving same knowing it to have
310 LEGAL STATUS OF THE DEAD BODY — BECKER.
been unlawfully disinterred, is a misdemeanor (R. S., sees.
1,902, 1,903).
Dead bod}- can be transported out of county in which death
occurred on permit of State board of health (R. S., sec. 480).
Coroner to hold inquest and direct autopsy, etc. (R. S., sec.
692).
And may order a body to be disinterred for inquisition (R.
S., sec. 718).
California.
Removal, mutilation, or disinterment of dead body without
authority of law is a felony (Pen. Code, sec. 290).
Removal of part of body for sale, dissection maliciously or
wantonly is punishable (Pen. Code, sec. 291).
Duty of Burial. — Of married woman, on husband ; not a
married woman, nearest of kin who is an adult with sufficient
means ; where no relatives, on coroner who held the inquest or
overseers, etc., of poor (Pen. Code, sec. 292).
Refusal to bury by person on whom duty rests by law to
bury, is a misdemeanor and he is liable for treble the expenses
(Pen. Code, sec. 293).
Custody of body is on him on whom duty to bury is imposed
by law, except where coroner detains remains for inquest (Pen.
Code, sec. 294).
Arrest or attachment of dead body for any debt or demand
is a misdemeanor (Pen. Code, sec. 295).
One who disinters or exhumes a body without permit of
board of health, health officer, or ma^'or, or transports such ex-
humed remains through streets of town, city, etc., except in a
sealed coffin, guilty of a misdemeanor (Laws, 1878, ch. 073).
A sheriff, coroner, or keeper of countj^ poor-house, public
hospital, county jail, or State prison, etc., must surrender bodies
of those who are to be buried at public expense, to any phj'sician
or surgeon for dissection, etc., unless deceased during his last
sickness requested to be buried or body is claimed by relatives,
etc., or deceased was a stranger or traveller, died suddenly
(Pen. Code, sec. 3,091).
Coroner to bury body when no other person takes charge of
same (Pen. Code, sec. 4,286).
Coroner to hold inquest, direct autopsy, and may exhume
(Pen. Code, sec. 1,510).
COLORADO— CONNECTICUT. 311
Colorado.
Concealment of death of issue which, if born alive, would
be a bastard, is punishable (Mill's Stat., sec. 1,195).
Body of criminal executed for capital offence shall be deliv-
ered to a physician or surgeon unless claimed by relative or
friend (Mill's Stat., sec. 1,204).
Board of health, mayor, etc., or officer, etc., having control
of any alms-house, prison, hospital, jail, etc., shall surrender
bodies to be buried at public expense to any physician or sur-
geon for dissection, etc., unless deceased during last illness
requested to be buried, or body is claimed by relatives or friends,
or deceased was a stranger or traveller who died unknown
(Mill's Stat., sees. 1,547, 1,548).
Non-resident poor person to be decently buried (Mill's Stat.,
sec. 3,391).
Coroner to hold inquest, etc., or, if none, bury it decently at
expense of county (Mill's Stat., sees. 870-882).
Removal of body unlawfully for sale, dissection, etc., pun-
ishable (Mill's Stat., sec. 1,367).
Board of health may direct removal of dead bodies from
cemetery within a city (Laws, 1893, ch. 113, sec. 54).
Connecticut.
No body shall be buried or disinterred or removed beyond
limits of any town unless a permit is obtained, and where de-
ceased died of an infectious disease body shall be in a hermet-
icallj' sealed case (Gen. Stat., sees. lOG, 108, 113).
Custody of remains is in husband or wife or next of kin
(Gen. Stat., sec. 536).
Coroner to hold inquest, etc. (Gen. Stat., sees. 2,005, 2,008).
And deliver body to friends or, if none, to town authorities
for burial (Gen. Stat., sec. 2,015).
Mayor, etc., may deliver bodies of those not buried within
twenty-four hours after death to medical college for dissection,
etc., unless relatives or friends do not consent, or deceased
requested to be buried, or was a stranger or traveller (Gen.
Stat., sec. 1,729).
Bodies of convicts dying in State prison and not having any
312 LEGAL STATUS OF THE DEAD BODY — BECKER.
known relatives, shall be delivered to medical institution of
Yale College (Gen. Stat., sec. 1,732).
Body of one dying in a hospital shall not be examined unless
father, etc., consent, or if none, within forty-eight hours after
death (Gen. Stat., sec. 1,735).
Removal of body from grave unlawfully, or receiving,
secreting, or dissecting same, is punishable (Gen. Stat., 1880).
Body of executed criminal shall be buried by sheriff (Gen.
Stat., sec. 1,G40).
Delaware.
Coroner to hold inquest, etc., or maj^ cause body to be dis-
interred (R. L., ch. 33).
Removal of body from grave unlawfully, a misdemeanor
(Laws, 1883, ch. 204).
Florida.
Buying, selling, or having possession for purpose of buying
or selling, a dead body is punishable (R. L., sec. 2,625).
Concealing birth of issue which, if born alive, would be a
bastard, is punishable (R. L., sec. 2,393).
Coroner to hold inquest, etc. (R. L., sees. 3,011, 3,019).
♦
Georgia.
Coroner to hold inquest or to disinter same for inquisition
(Code, sees. 590, 591, 410 et seq.).
Public officers and their assistants, and their deputies of
every county, cit}", town, or other municipality, or of every
prison, chain gang, penitentiary, county morgue, public hospi-
tal, having control of dead body to be buried at public expense
(not dying of infectious disease) shall deliver same to medical
college for dissection, etc., unless claimed by friends or relatives
or such friends or relatives request same to be buried, or unless
deceased was a stranger or traveller (Laws, 1887, vol. 2, p. 77).
Removal of body from grave, etc., unlawfully for dissection
or sale is felonj^, or receiving or purchasing it knowing it to
have been so taken, or trafficking in dead bodies, or having them
conveyed without the State for sale, etc., is a felony (Laws,
1882, vol. 2, p. 87).
idaho — indiana. 313
Idaho.
Coroner to hold inquest, etc., and may exhume it for that
purpose (R. L., sec. 8,377).
Coroner to bury body decently when not claimed by rela-
tives, etc., and if necessary, at expense of county (R. L., sec.
2,081).
Illinois.
Removal of body unlawfully or aiding in such removal is
punishable as a felony — one to ten years (S. & C. Am. Stat.,
vol. 1, p. 794).
Coroner to liuld inquest, etc. (S. & C. Am. Stat., vol. 1, p.
G06).
And to deliver body to friends or bury decently if no friends
claim it, if necessary at county expense (S. & C. Am. Stat., vol.
1, p. G0()).
Body of executed criminals may be delivered to any physi-
cian or surgeon for dissection unless friends object (S. & C.
Am. Stat., vol. 1, p. 869; Crim. Code, sec. 503).
In cities and counties where population exceeds one hundred
tliousand, superintendents of penitentiaries, wardens of poor-
houses, coroner, city undertaker, having body required to be
buried at public expense, may deliver remains to medical college
or any physician or surgeon for dissection, unless claimed by
relatives (S. & C. Am. Stat., vol. 3, p. 807).
Indiana.
RemoA'^al of dead body or part of same unlawfully is a felony
{R. L., sec. 2,105).
Concealment of body or part thereof, which has been unlaw-
full}" used for dissection, is a felony (R. L., sec. 2,107).
Receiving or buying a bod}- knowing it to have been unlaw-
fully disinterred is a felony (R. L., sec. 2,1G8),
Dead body of one dying in a State, city, or county prison or
jail, or county asjdmn or infirmary or public hospital, or dead
body of an executed criminal, or dead body of a vagrant, or one
killed while committing a felony or escaping from prison or
officers, may be delivered to the facult}' of a medical college in
State for dissection, etc. , unless deceased requested to be buried
or body is claimed by next of kin (R. L., sec. 4,258 et seq.).
314 LEGAL STATUS OF THE DEAD BODY — BECKER.
Dissecting or possessing body for dissection except as pre-
scribed by law is a felony (R. L., sec. 4,271).
Coroner to hold inquest, etc. (K. L , sees., 5,878, 5,879).
Iowa.
Coroner to hold inquest, etc. (McCl. Am. Code, sec. 487).
To bury body decently at expense of county, if necessary, or
ueliver it to relatives (McCl. Am. Code, sec. 501).
Removal, etc. , of dead body unlawfully, or aiding such re-
moval or knowingly receiving body so removed, etc., is punish-
able (McCl. Am. Code, sec. 5,328).
Coroner, undertaker, superintendent of public asylum, hos-
pital, poor-house, or penitentiary, may deliver body to medical
college or physician for dissection, etc., unless relatives, etc.,
refuse or deceased desired to be buried (McCl. Am. Code, sec.
5,329).
Bodies of those executed, or dying in hospitals or prisons
under sentence for crime, shall be delivered to medical college or
association or any physician or surgeon for dissection, etc.,
unless relatives or friends do not consent, or body shall have
been interred, or is not claimed by relatives, or deceased ex-
pressed a wish to be buried, and after such use the remains
shall be interred (Gen. Stat., sec. 3,758).
State board of health shall issue permits for transportation
of bodies beyond county where death occurred (Gen, Stat., sec.
6,030).
Kansas.
Coroner to hold inquest, etc. (Gen. Stat., sees. 1,780, 1,794).
To bury body if not claimed b}'- friends, etc., and at public
expense, if necessar}^ (Gen. Stat., sec. 1,792).
Removal of a body unlawfully for dissection or wantonly, or
receiving body knowing it to have been so removed, is a mis-
demeanor (Gen. Stat., sec. 2,372 et seq.).
I Kentucky.
Coroner to hold inquest, etc. (Gen. Stat., ch. 25, sees. 3, 11).
To bury the body or deliver to friends (Gen. Stat., ch. 25,
sec. 6).
Body of one dying on a steamboat, or other craft, if not
LOUISIANA— MARYLAND. 315
claimed by friends, shall be buried by master or officer in com-
mand on shore, at least four feet deep (Gen. Stat., ch. 29, art.
17, sec. 15).
Removal of body unlawfully from grave is punishable (Gen.
Stat., ch. 29, art. 17, sec. IG).
Louisiana.
Coroner shall hold inquest, etc., and bury body when not
claimed by friends (Voorh. Rev. L., sees. 653, GOO).
Maine.
Coroner to hold inquest, etc. (R. L., ch. 139, sec. 1).
To bury the body at State or town expense (R. L., ch. 139,
sec. 11).
Seizure of body on execution, punishable (R. L., ch. 121,
sec. 2G).
Removal, etc., of body unlawfully, or receiving it know-
ingly, or exposing, etc., body, is punishable (R. L., ch. 121,
sec. 27).
Bodies may be buried and the expense recovered from the
town (R. L,, ch. 24, sec. 34).
If any resident request or consent that his bodj- be deliv-
ered to a physician or surgeon for dissection, it may be so de-
livered, unless kindred or family connection objects (R. L.,
ch. 13, sec. 1).
Body of criminal dying in State prison or jail, or who was
executed, maybe delivered to medical college or physician, etc.,
for dissection, unless deceased or kindred request to be buried
(R. L., ch. 13, sec. 2).
Body of person dying in the State, which is not claimed by
relatives, notice having been given, shall be delivered to medical
school unless ten voters of the town object to such disposition
in writing (Laws, 1893, ch. 251).
Maryland.
Coroner to hold inquest, etc. (Md. Code, art. 22, sees. 3, 1).
Shall bury the body when necessary at public expense (Md.
Code, art. 22, sec. 7).
Removal, etc., from grave5"ard, etc. (except potter's field),
of a body is a misdemeanor (^Id. Code, art. 27, sees. 133, 131).
316 legal status of the dead body — becker.
Massachusetts.
Medical examiners shall hold inquest, etc. (Pub. Stat., ch.
26, sees. 10, 11).
And shall deliver it to relatives or friends, or if no one
claims it, to overseer of poor etc., for burial (Laws, 1887, ch.
310).
Body shall not be buried in city or town or removed there-
from without a permit (Laws, 1888, ch. 30(j).
Body of one dying of infectious disease shall not be trans-
ported without permit, and only in a sealed case (Laws, 1883,
ch. 124, sec. 2).
Body shall not be cremated without permit and inquest by
medical examiner, or within forty-eight hours after death, un-
less death was occasioned by contagious disease (Laws, 1885,
ch. 265, sec. 4).
Overseers of poor, mayor and alderman of city, or superin-
tendent of State alms-house, may deliver body of person required
to be buried at public expense, to any physician or surgeon or
medical college unless deceased requested to be buried, or rela-
tive request burial or claim it, or deceased was a stranger or
traveller (Laws, 1891, ch. 185).
Body of criminal executed shall be delivered for dissection
to a medical college if requested ; if not, to friends or relatives,
or, if none, to any physician or surgeon (Pub. Stat., ch. 202,
sec. 8).
Removal of body unlawfully from grave is punishable, or
buying, selling, or possessing for such purpose, is punishable
(Pub. Stat., ch. 207, sees. 47, 48).
Concealing birth of child which, if born alive, would be
a bastard, is punishable (Pub. Stat., ch. 207, sec. 11).
Seizing dead body on execution is punishable (Pub. Stat.,
ch. 207, sec. 4G).
Body of a prisoner shall be buried by sheriff at town ex-
pense if not claimed by relatives or friends (Pub. Stat., ch. 220,
sec. 31).
Michigan.
Justice of the peace to hold inquest, etc. (How. Am. Stat.,
vol. 2, sec. 9,583 et seq.).
MINNESOTA — MISSISSIPPI. 317
And shall bury the body at the State or town expense (How.
Am. Stat., vol. .3, sec. 9,593).
Woman concealing death of issue which, if born alive,
would be a bastard, is punishable (How. Am. Stat., vol. 3, sec.
9,284).
Board of health, officers, sheriff, etc., of any prison, etc.,
poor-house, alms-house, having body required to be buried at
public expense, shall, if not claimed by relatives, or if it have
died of any infectious disease, deliver it to University of Michi-
gan, etc., for dissection, etc. (How. Am. Stat., vol. 3, sec. 2,284).
Bod}' shall not be shipped out of State nor used in State for
any purpose but anatomical study (How. Am. Stat., vol. 3,
sec. 2,286).
Removal of body unlawfullj' is punishable (How. Stat., vol.
2, sec. 9,297).
Minnesota.
Gen. Stat., sees. 6,220, 6,230, same as N. Y. P. C, sees. 305-
315.
Concealing birth of child which died before or after birth
is a misdemeanor (Gen. Stat., sec. 6,210).
Coroner to hold inquest, etc. (Gen. Stat., sec. 1,011 et seq.).
And cause body to be buried at expense of county (Gen.
Stat., sec. 1,021).
Section 6,216, same as 303, N. Y. P. C.
Body must be buried within four days, and if death was
from contagious disease, within twenty-four hours and in a
tightly sealed coffin which must not be reopened (Gen. Stat.,
sec. 607).
Wardens, superintendents of poor, and other persons having
control of bodies shall deliver same to medical college com-
mittee, for dissection, unless claimed by relatives or friends,
or relatives or friends do not consent, or one detained as a
witness or on suspicion of having committed a crime, or de-
ceased requested to be bfiried (Gen. Stat., sec. 678).
Mississippi.
Body of paupers and strangers to be buried (Am. Code, sees.
3,145, 3,146).
Coroner to hold incjuest, etc. (Am. Code, sec. 816).
318 LEGAL STATUS OF THE DEAD BODY — BECKER.
Removal of body unlawfully and wantonly, for sale or re-
ceiving same, is punishable (Am. Code, sees. 1,023, 1,024).
Missouri.
Coroner to hold inquest, etc. (R. L., sec. 2,438 et seq.).
And shall bury the body, if not claimed by friends, at public
expense (R. L., sec. 2,456).
And may direct a chemical analysis and microscopical ex-
amination of body (R. L., sec. 2,409).
Superintendents or wardens of penitentiary, houses of cor-
rection, insane asylums, poor-houses, and coroners, sheriffs, city
and county undertakers, having charge of a body required to
be buried at public expense, shall deliver the same to medical
college for dissection unless claimed by relatives or friends, and
trafficking in such bodies is a misdemeanor (R. L., sec. 0,883
et seq.).
Concealing birth of child, so that it may not be known
whether it was born alive or dead, is a felony (R. L., sec.
3,479).
Removal of dead body from grave without authority (except
that of criminal executed for crime), for purpose of sale, etc.,
or receiving such body knowingly, is a felony (R. L., sees.
3,842, 3,845).
Montana.
Concealing birth of child which, if born alive, would be a
bastard, is punishable (Crim. Laws, sec. 41).
Coroner to hold inquest, etc. (Gen. Laws, sees. 809, 883).
And bury bodj^ at public expense if not claimed by relatives,
etc. (Gen. Laws, sec. 881).
Removal, etc., of dead body from grave without authority,
and for the purpose of sale or dissection, or from wantonness,
is a felony (Laws, 1889, p. 114).
Nebraska. •
Coroner to hold inquest, etc. (Consol. Stat., sec. 3,130 etseq.).
To bury body if not claimed by friends (Consol. Stat., sec.
3,144).
Removal of body from grave without authority for sale,
dissection, etc., is punishable (Consol. Stat., sec. 5,847).
NEVADA — NEW HAMPSHIRE. 319
Foeticide is punishable (Consol. Stat., sec. 5,582).
Bodies of paupers or criminals unclaimed by friends or rela-
tives may be delivered to medical college or physician for dis-
section, etc., and such body shall not be transported out of State
(Consol. Stat., sees. 3,299, 3,301, 5,848).
Nevada.
Justice of peace to hold inquest, etc. (Gen. Stat., sec. 2,256
et seq.).
And cause the body to be buried at public expense (Gen.
Stat., sec. 2,2G9).
Body shall not be buried without certificate of physician or
coroner (Gen. Stat., sec. 4,872 et seq.).
Body shall not be transported out of State without a permit
(Gen. Stat., sees. 4,870, 4,871).
Concealing birth of child which, if born alive, would be a
bastard, is punishable (Gen. Stat., sec. 4,597).
Non-resident, et al., to be buried at public expense (Gen.
Stat., sec. 1,986).
New Hampshire.
Coroner to hold inquest, etc. (Pub. Stat., ch. 262, sec. 1
et seq.).
And bury body if a stranger, at public expense (Pub. Stat.,
ch. 262, sec. 16).
Concealing birth of child which, if born alive, would be a
bastard, is punishable (Pub. Stat., ch. 278, sec. 14).
Body of person dying in a county, city, or town, or State
prison or jail, required to be buried at public expense, shall be
delivered to any physician or medical college for dissection,
etc., unless deceased requested to be buried, or friends claimed
it or request burial, or deceased was a stranger or traveller who
died suddenly (Pub. Stat., ch. 136).
Body not to be buried without permit or disinterred (Pub.
Stat., ch. 173, sec. 6).
Removal of dead body without authority, or concealing it,
knowing it to have been so dug up, is punishable (Pub. Stat.,
ch. 266, sec. 7).
320 legal status of the dead body — becker.
New Jersey.
Coroner to hold inquest, etc. (Rev. Stat., p. 170 et seq.).
And bury body if not claimed by friends (Rev. Stat., p.
170, sec. 5).
Concealing birth of child which, if born alive, would be a
bastard, is a misdemeanor (Rev. Stat., p. 241, sec. 83).
Body of executed criminal may be delivered to physician,
etc., for dissection unless claimed by relatives (Rev. Stat., p.
239, sec. 69).
Removal of a body without authority for sale, dissection,
etc., is a high misdemeanor (Rev. Stat., p. 249, sec. 122).
Exposing body of an executed murderer is a misdemeanor
(Supp. Rev. Stat., p. 194, sec. 19).
Body must not be buried without a permit; nor body
brought into the State without permit ; nor taken out of State
without permit (Laws, 1888, ch. 39, sees. 5-8).
New Mexico.
Justice of the peace to hold inquest, etc. (Comp. Laws, sec.
443 et seq.).
And bury the body (Comp. Laws, sec. 447).
Body of one dying of a contagious disease shall not be
carried in an open coffin, or be exposed (Laws, 1889, ch. 79,
sec. 8).
Body shall not be buried within fifty yards of running
stream (Laws, 1891, ch. 93).
New York.
Duty of burial, etc. (Pen. Code, sec. 305 et seq.).
Attempt at sexual intercourse with dead body is a crime
against nature (Pen, Code, sec. 303).
Transfer of body of one who died of a contagious or infec-
tious disease shall be in hermetically sealed casket (Laws,
1893, ch. 661, sec. 23).
Bodies of those djdng in, or in custody of managers, etc., of
any prison, asylum, morgue, hospital, or in possession of un-
dertakers, shall be delivered to medical college of this State, etc. ,
for purpose of medical study, unless claimed by relatives or
friends, or friends or relatives do not assent to such disposal, or
NORTH CAROLINA— NORTH DAKOTA. 321
deceased requested during last illness to be buried (Laws, 1893,
ch. 661, sec. 207).
In certain cases bodies of convicts, unless claimed, shall be
delivered to certain medical colleges (R. S., pt. 4, ch. 3, sees.
132, 133).
District attorney may cause body to be exhumed, examined,
etc. (Pen. Code, sec. 308).
North Carolina.
Coroner to hold inquest, etc. (Code, sec. 657).
Concealing birth of child, by burying dead body, is a mis-
demeanor. Opening grave without authoritj'- for purpose of
taking body is a felony (Laws, 1885, ch. 90).
Coroner may order a chemical analysis of remains (Laws,
1887, ch. 269).
Dead body of convict, unclaimed by friends, shall be deliv-
ered to medical college except such dying of contagious disease
(Laws, 1&91, ch. 129).
Body of one dying of contagious disease must not be trans-
ported by common carrier until disinfected, nor shall permit for
removal be issued until such disinfection (Laws, 1893, ch. 214,
sec. 16).
North Dakota.
Coroner to hold inquest, etc. (Comp. Laws, sec. 664 et seq.).
And bury the bod}- if not claimed by friends, etc. (Comp.
Laws, sec. 676).
Concealing birth of child which, if born alive, would be a
bastard, or of child dying within two years after birth, is pun-
ishable (Comp. Laws, sec. 6,947).
Comp. Laws.
Sec. 6,549 same as 305 N. Y. P. C.
6,550 " 306
6,551 " 307
6,552 " 308 (1-3)
6,553 " 309
6,554 " 310
6,559 " 311
6,560 " 312
6,563 " 314
31
333 LEGAL STATUS OP THE DEAD BODY — BECKER,
Duty of burial of married woman, on husband. If not mar-
ried woman, on nearest of kin who is an adult or has means
sufficient (Comp. Laws, sec. 6,556).
Refusal to bury by one on whom duty is imposed by law, a
misdemeanor (Comp. Laws, sec. 6,557).
Custody of body pertains to one whose duty it is to bury
(Comp. Laws, sec. 6,558).
When cemetery is by law changed to other place, duty is on
relative to move body (Comp. Laws, sec. 6,562).
Body of executed criminal, and those dying in State peni-
tentiary or county jail under sentence, shall be delivered to
medical college or any physician for dissection, unless deceased
requested to be buried, or friends ask to have it buried, or
deceased was a stranger or traveller (Laws, 1890, ch. 92).
Ohio.
Coroner to hold inquest, etc. (R. L., sec. 1,221 et seq.).
And burj^ bod}^ etc. (R. L., sec. 1,227).
Body of pauper or unknown, not an inmate of any penal,
charitable, or reformatory institution, and not claimed by rela-
tive or delivered for dissection according to law, shall be buried
at public expense (Laws, 1890, p. 283).
Corpse shall not be conveyed to or from a city without a
permit (R. L., sec. 2,119).
Bodies of those dj^ing in city hospitals, city or county in-
firmaries, work-houses, asylums, charitable institutions, peni-
tentiaries, or jails, which are required to be buried at public ex-
pense, shall be delivered to medical college or society for study,
etc., unless claimed by relative, or deceased was a stranger or
traveller (except tramps) (R. L., sec, 3,763),
Removing body from grave without authority for dissection
or receiving such body is punishable (R. L., sec. 7,034).
Body of executed criminal, if not claimed by relative or
friends, may be delivered for dissection, etc. (R. L., sec,
7,343, 1).
Oklahoma,
Coroner to hold inquest, etc. (Stat., sec. 1,745 et seq.).
And bury the body at public expense if not claimed by rela-
tives (Stat,, sec, 1,759).
OREGON — PENNSYLVANIA. 323
Concealing birth of issue which, if born alive, etc., or dying
within two years after birth, is punishable (Stat., sec. 2,179).
(except subd. 4)
(ex. punishment)
2,188-2,190.
. same as
. 305-307 N. Y. P. C
2,191
. 308
2,192-2,193.
. 309-310
2,198
. 311
2,199
. 312
2,202
. 314
Custody is in him whose duty it is to bury (Stat., sees. 21,
97).
Duty of burial of married woman, on husband ; if not mar-
ried woman, on nearest of kin who is an adult and has suffi-
cient means (Stat., sec. 2,195).
Refusal to bury by one oai whom duty rests, is a misde-
meanor (Stat., sec. 2,196).
Oregon.
Coroner to hold inquest, etc. (Crim. Code, sec. 453 et seq.).
And bury body if not claimed by friends (Crim. Code, sec.
462).
Unmarried woman concealing birth of child so that it may
not be known whether it was born alive or not, is punishable
(Crim. Code, sec. 649).
Bodies of criminals executed, those dying in hospitals, in-
sane asylums, alms-houses, or penitentiaries, may be delivered
to medical college or physician for dissection, etc., unless they
shall have been interred, or claimed by relatives, or relatives
and friends do not consent, or deceased expressed a wish to be
buried; and they shall be used for such purpose only and in
this State (Hill's Am. Laws, sec. 3,730 et seq.).
Removal of body without authority, etc., is punishable
(Crim. Code, sec. 656).
Pennsylvania.
Coroner to hold inquest in Philadelphia County only in case
of a violent death (Bright Pen. Dig., 1536, sec. 37).
And may in Berks and Lancaster Counties order a post
mortem (Bright Pen. Dig., 1536, sec. 38).
324 LEGAL STATUS OF THE DEAD BODY — BECKER.
Concealing death of child which, if born alive, would be a
bastard, is punishable (Bright Pen. Dig., 431, sec. 158).
Removal of body from grave without authority is a misde-
meanor (Bright Pen. Dig., 229, sec. 11).
Bodies of those dying in alms-house, hospital, prison, or
public institution, or those in morgue, which are required to be
buried at public expense, shall be delivered to medical college,
physician, etc., to be used for scientific purposes only, unless
claimed b}^ relatives or deceased was a traveller, and trafficking
in such bodies is a misdemeanor (Bright Pen. Dig., p. 9, sec.
1 et seq.).
Rhode Island.
Concealing death of child Avhich, if born alive, would be a
bastard, so that it may not be knf)wn, etc., is punishable (Pub.
Stat., ch. 244, sec. 8).
Seizing dead body under execution is punishable (Pub. Stat.,
ch. 223, sec. 2).
Bodies of those dying in jail shall, if not claimed by relatives,
be buried at public expense (Pub. Stat., ch. 201, sec. 30).
Medical examiner to make autopsy (Pub. Stat., 1884, ch.
420).
And bury body of stranger at State expense if necessary
(Pub. Laws, 1884, ch. 420, sec. 24).
Coroner to hold inquest if, in opinion of medical examiner,
death was caused by act of some one other than deceased (Pub.
Laws, 1884, ch. 420, sec. 17).
South Carolina.
Coroner to hold inquest, etc. (R. L., sees. 711, 2,664 et seq.).
And may have body disinterred for inquisition (R. L. , sec.
2,687).
Tennessee.
Coroner to hold inquest, etc. (Code, sec. 6,139 et seq.).
And may order a chemical analysis of remains, etc. (Code,
sec. 6,150).
Body to be buried, if not claimed by relatives, etc. , at public
expense if necessary (Code, sec. 6,160).
TEXAS — VIRGINIA. 325
Wilfully and improperly exposing or abandoning a dead
body is a misdemeanor (Code, sec. o,G58).
Removing or purchasing dead bodies without authority is a
misdemeanor (Code, sees. 5,659, 5,060).
Body of deceased convict to be buried unless claimed by
friends (Code, sec. 6,403).
Texas.
Justice of the peace to hold inquest, etc. (Code Crim. P.,
art. 988 et seq.).
And ma}" disinter the body for such inquisition (Code Crim.
P., art. 989).
Removal, etc., of dead body from grave without authority
is punishable (Code, art. 345).
Bodies of convicts to be buried (Rev. C. Stat., art. 3,561).
Vermont.
Justice of the peace to hold inquest, etc. (Rev. Laws, sec.
3,934 et seq.).
Removal, etc., of dead body without authority, is punishable
(Rev. Laws, sees. 4,194, 4,196).
Bodies of those dying in poor-house or other public institu-
tion, which are required to be buried at public expense, may be
delivered to any physician for dissection, etc., unless deceased
requested to be buried, or friends or relations request burial, or
deceased was a stranger or traveller. Such body shall not be
removed from State, and shall be used for scientific purposes
only (Laws, 1884, ch. 85).
Virginia.
Coroner to hold inquest, etc. (Code, sec. 3,938 et seq.).
And to bur}?^ the body at public expense (Code, sec. 3,946).
Removal, etc., of dead body from grave without authority,
is punishable (Code, sec. 3,794).
Bodies of those dying on vessels in State, shall be buried by
master on the shore above high-water mark (Code, sec. 2,002).
Bodies of those dying in alms-house, prison, morgue, hos-
pital, jail, or other public institution, which are required to be
buried at public expense, and bodies of criminals executed for
326 LEGAL STATUS OF THE DEAD BODY — BECKER.
crime shall be delivered to medical college, etc., and physician
or surgeon for anatomical study, unless (except criminals)
relatives and friends claim the body or deceased was a stranger
or traveller ; and such bodies shall not be sent out of the State
(Code, ch. 80).
Washington.
Coroner to hold inquest, etc. (Hill's Am. Stat., vol. 1, sec.
?45 et seq.).
And bury body, if not claimed by friends, at public expense
(Hill's Am. Stat., vol. 1, sec. 257).
Bodies of those dying in j^oor-house, public hospital, county
jail, State prison, etc., which are required to be buried at public
expense, shall be delivered to medical college, physician, sur-
geon, etc., for studj", unless deceased requested to be buried, or
it is claimed by friends or relatives, or deceased was a stranger
or traveller; and such body shall be used onlj' in the State
(Hill's Am. Stat., vol. 1, sec. 2,428 et seq.).
Removal, etc., of body from the grave without authority
is punishable (Pen. Code, sec. 208).
West Virginia,
Coroner to hold inquest, etc. (Code, ch. 154).
And bury the body at public expense, or if of a stranger,
may forward it to its destination or bury it (Code, ch. 154,
sec. 8).
Removal, etc., of a body from grave is punishable (Code,
ch. 149, sec. 13).
Wisconsin.
Justice of the peace or coroner to hold inquest, etc. (S. &
B. Am. Stat., ch. 200).
And shall cause the body to be buried at public expense (S.
& B. Am. Stat., ch. 200, sec. 4,877).
Dead body of convict shall, if not claimed by relatives or
friends, be buried (S. & B. Am. Stat., sec. 4,926).
Removal, etc., of body from grave without authority is
pimishable (S. & B. Am. Stat., sec. 4,592).
Concealing death of child which, if born alive, would be a
bastard, is punishable (S. & B. Am. Stat., sec. 4,585).
WISCONSIN, 327
A public officer having in his charge a body required to be
buried at public expense, shall deliver same to member of State
or county medical society, etc., for anatomical stud}^, unless
claimed by relatives, or they consent to such disposal, or de-
ceased requested to be buried, or was a stranger or traveller
(S. & B. Am. Stat., sec. 1,437).
THE POWERS AND DUTIES
OF
CORONERS AND MEDICAL EXAMINERS.
BY
AUGUST BECKER,
Of the Buffalo (iV. Y.) Bar.
POWEES AITD DUTIES OF CORONEES
AI^^D MEDICAL EXAMIl^EES.
I. The Coroner and his Court.
Coroner an Ancient Officer. — The office of coroner is one
of the most important and ancient known to the common law.
A coroner, or coronator, was so called because he had princi-
pally to do with the pleas of the crown, or suit wherein the
king was immediatel}" concerned. ' The office is first mentioned
in a charter granted in the year 925 by King Athelstan, to the
authorities of BeverleJ^ The office as at present constituted
was not clearly established until after the Norman conquest.
Under this head come the lord chief justice and puisne jus-
tices of the King's Bench, who are supreme and sovereign cor-
oners respectively.^ The duties of the office of coroner involve
questions of the greatest interest to society, to government, and
to the rights and privileges of the individual citizen. The office
has lost much of the honor and respect which formerly apper-
tained to it. Its character and importance have been much
diminished in latter times, making striking contrast with the
high estimation it was held in by our ancestors in days when
none but the gentry and knights of the shire were" deemed
eligible.
In fact so great was the dignity of this office in ancient
times, that it was never presumed that coroners would conde-
scend to be paid for their services.' They were chosen by all
the freeholders of the county court for life or good behavior,
and were liable to be removed for cause b}^ the writ de corona-
tore exonerando. There were three kinds of coroners at
common law: Virtufe officii; virtiite cartce sive commis-
sionis; and virtute electionis." The office of coroner was
'Am. & Eng. Enc. of Law, vol. » j Black. Com., 347.
4. p. 171. ■* Am. & Eng. Enc. of Law, vol.
M Co., 57 ; 3 Com. Dig., 242. 4. p. 173.
332 POWERS AND DUTIES OF CORONERS — BECKER-
brought to America by the colonists along with the institutions
of the common law, and may be said to exist in the several
States with all the common-law incidents, except so far as they
may have been modified by statute. The present defined
powers of coroners in Great Britain and the United States,
unless modified by British statutes and American acts, are de-
rived from the English Stat, de Officio Coronatoris, 4 Edward
I., s. 2. Coroners vii^tute officii and virtute cartce sive com-
missionis are unknown to our institutions. Here the office of
coroner may be classed under the head of coroners virtute elec-
tionis. Generally speaking the coroner is a county officer.
Coroner's Duties both Judicial and Ministerial.
By the common law his powers and duties are both judicial
and ministerial. In his ministerial capacity he is merely a sub-
stitute for the sheriff, as when the sheriff is a party.' His
powers and duties thereunder it is not the present purpose to
state and define. His judicial authority relates to inquiries into
cases of sudden death, bj' a jury of inquest, super visum cor-
poris, or, as it is more commonly defined, an inquisition, with
the assistance of a jury, over the body of an}^ person who may
have come to a sudden or violent death, or who may have died
in prison.* It is not necessary that the death should be both
violent and sudden, and that both these circumstances must con-
cur to give the coroner jurisdiction. It is sufficient to give the
coroner jurisdiction if the death occurs from any violence done
to a person by another, although such violence maj^ not have ter-
minated the life of a party suddenly, and it is still the dut}^ of
the coroner to hold an inquest. ' Indeed the presumption is that
he has acted in good faith and on sufficient cause. ^ And so when
' Giles V. Brown, 1 Mill (S. C.) eye, and penetrating the brain.
Const., 230; People v. Devine, 44 Surgical aid was immediately called
Cal. , 452. in, and the woman received all the
^Bouvier's Law Diet., vol. 1, p. care and attention that the exigen-
405. cies of the case required till five
^Lancaster County v. Dern, 3 days afterward, when she died in
Grant (Pa. ) , 262. In this case a consequence of the woimd received,
concussion or collision took place in On the sixth day the coroner held
a street between the sleighs of two an inquest, and in this, an action to
parties, whereby a woman sustained recover for his services against the
an injury bj- the shaft, orsome other county, it was Jield he could recover,
part of one of the parties' sleigh, ■'Co'uutvof Lancaster t\ Mishler,
striking her immediately above the 100 Pa. St., 624. In this, a suit by
coroner's duties both judicial and ministerial. 333
several persons have been suddenly killed by the same violent
cause, under circumstances proper to be inquired of by a coro-
ner's inquest, it is proper and necessary for the coroner, acting
in good faith, to hold a separate inquest over each body.' A
coroner's inquest is a judicial investigation. The coroner can-
not delegate his authority to any one. Neither can he appoint
a deputy under the common law. He must act in person as
any other judicial officer ; and it may safely be said that a cor-
oner has no power to appoint a deputy coroner, except where
special provision is made therefor bj' statute." In England, a
coroner's court is a court of record, and it has according]}^ been
held that trespass cannot be maintained for turning a person
out of a room where the coroner is about to take an inquisition.^
But in this country, it may safely be said that a coroner's court
is not one of record, but of inferior jurisdiction.^ The perform-
ance of the functions of a coroner are judicial in their character ;
so judicial that he is protected under the principles which pro-
tect judicial officers from responsibility in a civil action brought
by a private person. His proceedings amount to entries con-
the coroner against the county to re-
cover his fees, it was held that this
presumption was not conclusive,
and evidence was admissible to
show that he acted in bad faith and
knowingly without sufidcient cause
or reason. The Court said : "The
duty of a coroner to hold an inquest
rests on sound reason, on that reason
which is the life of the law. It is
not a power to be exercised capri-
ciously and arbitrarily against all
reason. The object of an inquest
is to seek information, and obtain
and secure evidence, in case of death
by violence or other undue means.
If there be reasonable ground to
suspect it was so caused, it becomes
the" duty of the coroner to act. If
he has no grounds for susi^ecting
that the death was not a natural
one, it is a perversion of the whole
spirit of the law to compel the
county to pay for such services."
' County of Fayette v. Batton,
108 Pa. St., 591. Itappeared in this
case, that nineteen ))ersons came to
their death suddenly and almost
simultaneously by an explosion of
fire-damp in a coal-mine. The cor-
oner held a separate inquest over
each body at the respective homes
of the deceased, qualifying the same
jury separately over each body, and
the inquest returned a separate find-
ing in each case. It was Jield that
this was the necessary and proper
course to pursue under the circum-
stances, and that the coroner was
entitled to the legal fees in each
case. In Boislinieu ^'. Board of Co.
Commissioners, 32 Mo., 375, it was
Jiekl that the coroner is the sole judge
as to the propriety or necessity of
holding the iucpiest, and his action
in that respect is not subject to re-
vision by the county commission-
ers, and he is entitled to fees under
the statute notwitlistanding the ver-
dict of th(i coroner's jury discloses
tliat the deceased died of a natural
death, and not by casualty or vio-
lence.
-' Am. & Eng. Enc. of Law, vol. 4.
p. 175.
'Garnett v. Ferrand, 6 Barn. &
Cress., (511.
^ People v. Fitzgerald, 43 Hun
(N. Y.), 46.
334 POWERS AND DUTIES OF CORONERS — BECKER.
cerning matters of public interest, made under the sanction of
an official oath, and in compliance or presumed compliance of
the law.'
Of his AutJiority to Hold an Inquest. — His authority to
hold an inquest is not confined to the body of a person who may
have died within his territorial jurisdiction, but extends to all
bodies brought within his jurisdiction, no matter where death
may have taken place." So in any case where, after burial, an
inquest becomes necessary to determine the manner of the death
of a person who, dying in one, is buried in another county, the
coroner of the latter county is the proper officer to hold the in-
quest.' A coroner cannot hold a second inquest while the first
is existing. As we have seen, in holding an inquest the coroner
performs a judicial duty, and he is functus officio as soon as
the verdict has been returned. He can hold no second inquest
in the same case unless the first has been quashed hj a court of
competent jurisdiction, and a new inquiry ordered. He can-
not set aside or quash his own inquest. If he were allowed to
hold two inquests, not only might the greatest inconvenience
arise from the inconsistent findings of the respective juries, but
such a practice would be liable to great abuse, and as the ob-
ject of the proceeding is merely preliminary, the main purpose
being to ascertain whether it is probable that a crime has been
committed, and to examine the facts and circumstances and
preserve the evidence, all the ends of this inquiry are answered
by one inquisition, super visum corporis. We believe no
reported case is to be found in this country where a second
inquisition has been held, the first remaining undischarged, nor
is any such practice known to or recognized by our laws.*
'People V. Devine, 44 Cal., 452; ParkCrim. Rep. (N.Y.),519, acoro-
Common wealths. Hawkins, 3 Gray ner's jury found that the death was
(Mass.), 463. caused by suicide, and nearly four
■^ Peoples. Fitzgerald, 105 N. Y., months afterward the coroner sum -
146. moned another jury and held a
^Jameson v. Board of Comrs., second inquest, at which the jury
64 Ind. , 524. found that the deceased was killed
* Regina v. White, 3 Ellis & Ellis by another, whereupon the coroner
(Eng.), 137. In this case a second issued a warrant of commitment
inquisition found by a coroner's under which the accused was im-
jury was quashed by the court upon prisoned, but on habeas coi-2ms he
application of the defendants who was discharged from imprisonment
were charged therein with wilful on the ground that the second in-
murder. In People v. Budge, 4 quisition was unauthorized.
coroner may employ professional skill. 335
The Inquest must be Held upon View of the Body.
The coroner can in no case hold an inquest except upon view
of the body. This is jurisdictional and cannot be waived by
any one. He is not bound to hold a inquest before burial of the
body takes place. When it has been buried, and he believes an
inquest necessary, he is vested with authority to have the body
disinterred and hold his inquest, and if necessary direct a post-
mortem examination to be made, but after having done so, he
must cause it to be reburied.' Deep interests are involved in
the proper discharge of the duties of coroners; the character,
liberty, and perhaps the life of a citizen accused of crime on
the one hand, and on the other the aiding of public justice in
establishing the guilt and securing the punishment of the actual
criminal. Many of the questions which fall within the scope of
a coroner's inquisition are of an intricate and most perplexing
character, a correct solution of which can only be arrived at by
minds the best instructed and habituated to their investiga-
tion. In many cases some of these questions can be satisfac-
torily settled by the evidence of persons having cognizance
more or less direct of the facts; in others, however, they can
onlj^ be solved by the facts deduced from pathological anatomy,
and other circumstances connected with the dead body, the
cause of the extinction of life in which is the subject of the
inquest.
In Massachusetts Office of Coroner Abolished. — Indeed,
in Massachusetts the office of coroner was abolished in 1877,
and the governor was invested with power, and it is his duty,
to appoint, by and with the advice and consent of the council,
able and discreet men, learned in the science of medicine, to
be medical examiners, whose duties are to make examinations
as provided in the statute upon the view of the dead bodies of
such persons only as are supposed to have come to their death
by violence.^
Coroner may Employ Professional Skill. — A thorough ex-
amination aided by professional skill is in general absolutely
necessary to the proper administration of justice. It would no
doubt be strange if a coroner had no authority to pledge the
'The King v. Ferrand. 3 Barn. & = Mass. Pub. Stat, chap. 26, §§ 1
Aid. (Eng.), 260 ; 2 Hawk P. C, 77. and 10.
336 POWERS AND DUTIES OF CORONERS — BECKER.
responsibility of the county for the compensation of all auxil-
iary services which are necessary to the proper execution of his
office, and which he can by no other means command ; for in-
stance, when his duty requires him to disinter a body, he can-
not be expected to do it with his own hands, or by hands paid
for with his means. Indeed it has been said that, in this en-
lightened age, a coroner who would consign to the grave the
body over which he had held an inquest, without availing him-
self of the lights which the medical science has placed within
his reach, would in most cases fall short of what his official
duty requires.' It is the generally accepted view of the law
now that it is the duty of a coroner holding an inquest super
visum corporis to avail himself of professional skill and aid,
and his contract will bind the county to the payment of a rea-
sonable compensation for making a post-mortem examination.^
PosT-MoRTEM Examination.
Whether such examination should take place before the cor-
oner has empanelled a jury seems to be an open question. We
would venture the opinion that it should not, inasmuch as the
jury ought to see and view the body in the same condition, as
near as may be, as it was when found, and not after it has been
mutilated, as it must need be by a post-mortem examination.
' County of Northampton r. Innes, tion. County of Allegany v. Shaw,
2 Casey (Pa.), 156 ; Commonwealth 34 Pa. St., 301. It has been held
V. Hannan, 4 Barr (Pa.), 269. that the authority of a coroner to em-
* Allegany County v. Watts, 3 ploj" a chemist to discover whether
Barr (Pa.), 462; Van Hoevenbergh poison caused the death of one on
V. Hasbrouck, 45 Barb. (N. Y. ) , whose body he holds an inquest does
197. The New York legislature has not restrict him to the employment
made provision making the physi- of a resident of the county, and
clan's services in such a case a that the analysis of the chemist
charge against tlie county and the must not be made in the county
physician must look to the county of the coroner, and that even though
for his pay. Cosford v. Board of tlie latter was, by corrupt applian-
Supervisors, 38 N. Y. St. Rep. , 964 ; ces of others, induced to employ a
15 N. Y. Supp. , 680. In Pennsyl- chemist, it is no defence to a suit by
vania a physician or surgeon, em- the chemist to recover compensation
ployed by the coroner to make a post- for his services. Board of Commis-
mortem examination, may recover sioners v. Jameson, 86 Ind. , 154.
from the county a reasonable com- In New York he is empowered
pensation for his services ; and the by statute to employ not more than
county commissioners have no two competent surgeons to make
power to appoint a surgeon to per- post-mortem examinations and dis-
form such services, so as to preclude sections and to testify to the same,
tlie coroner from selecting a proper N. Y. Laws of 1874, chap. 535, § 3.
person, in the exercise of his discre-
POST-MORTEM EXAMINATION. 337
It is, however, settled that the post mortem should not be in the
presence of the jury, and that they are to be instructed by the
testimony of the physicians who are designated by the coroner
to make the examination.' The coroner's right to dissect the
dead body of a human being does not extend to all cases. Such
a power could be wielded with the most injurious effects upon
a community. His power to dissect is confined to those cases
where he is authorized by law to hold an inquest upon the body.
But a post-mortem examination, conducted by surgeons em-
ployed by a coroner holding an inquest, is not a part of the in-
quest in such a sense as that every citizen has a right freely
to attend it. At common law it was essent^'al to the validity of
a coroner's inquisition that the jury should view the body.
And so is our law. But it M'-as never required that the body
should be dissected in any case. It is discretionary with the
coroner to cause a dissection to be made, and to select the sur-
geons. He has also a discretion to determine whether any
person, and what persons, may be present besides the surgeons.
Not even the jurors have a right to witness the examination.
They are to be informed of what it discloses by the testimony
of the surgeons. Indeed, no person has a right to be present at
the post-mortem examination upon the ground that he is sus-
pected of having caused the death. He loses no legal right by
being excluded. He has no right to dissect the body. If the
coroner's jury pronounce him guilty, the inquest, like the in-
dictment of a grand jury, simply makes him liable to arrest. "^
'Peoples. Fitzgerald, 105 N. Y., ceeding to have been irregular, a
146. In this case, iipon application conviction under that provision of
of the defendant and upon affidavits the Penal Code could not be sus-
showing sufficient reasons therefor, tained, and this, without regard to
a coroner of Chemung County, the motives which actuated tlie de-
N. Y. , directed the exhumation of fendant ; that if she had committed
the body of a man, who died in any offence it was not that of body-
California about one year previous stealing.
and was buried in Chemung County; '^ Crisfield r. Perine, 15 Hun, 200,
for the purpose of a post-mortem ex- affirmed 81 N. Y. , 622. This was
amination to determine whether the an action of assault and battery
deceased was murdered, and the and it appeared that the defend -
body was accordingly exhumed, and ant was a coroner, and that he held
an examination had without em- an inquest on the dead body of a jnan
panelling a jury. An indictment wlio died after receiving personal
was found against the defendant injuries in an affray which he had
charging her with body -steal iugun- with his nephew. A post-mortem
der section 311 of tlie New York examination was about to be made
Penal Code, against body-stealing. by two surgeons employed by the
It was //dd that conceding the pro- coroner for that purpose. The plain-
338 powers and duties of coroners — becker.
Massachusetts Statutory Provisions.
The statute law of Massachusetts has already been referred
to. It has abolished the office of coroner and in its place put
medical examiners, so called, who are presumed to be learned
in the science of medicine. Their powers, however, are not
co-extensive with those of coroners. A medical examiner can-
not hold an inquest. He cannot hold an autopsy without being
thereto authorized in writing by the district attorney, mayor, or
selectmen of the district, city, or town where a dead body lies.
He can only upon receiving notice that there has been found,
or is lying within the county, the dead body of a person who is
supposed to have come to his death by violence, repair to the
place where such body lies, view and take charge of the same.
If he deems a further examination necessary and is authorized
so to do, he must make an autopsy in the presence of two or
more discreet persons, whose attendance he may compel by sub-
poena if necessarj^ and he must then carefully reduce or cause
to be reduced to writing every fact and circumstance tending
to show the condition of the body and the cause and manner of
death, together with the names and addresses of the witnesses.
If he deems it necessary, he may employ a chemist to aid in the
examination of the body or of substances supposed to have
caused or contributed to the death,' the record of which he must
subscribe.^ Such an autopsy does not, however, upon the trial
of an accused render other competent evidence, as to the con-
dition and appearance of the dead body at the time of the
autopsy, inadmissible." The autopsy may be followed by an
inquest held, not by the examiner, but by a justice of the dis-
trict, police, or municipal court for the district or city in which
the body lies, or a trial justice. One of these functionaries
must hold an inquest upon being notified by a medical examiner
that in his opinion a death was caused by violence, and after
hearing the testimony draw up and sign a report and issue
process for apprehension of a person charged by the report with
tiff, who was also a physician and of the room. For this act this suit
surgeon, was in the room when the was brought. It was held that the
examination was about to be entered suit could not be maintained,
upon and said that he wished to re- ' Mass. Pub. Stat., chap 26, § 19.
main and witness it, but the coro- -/Z>. , chap. 26, t^ 11.
ner asked him to leave, and on his ^Commonwealth v. Dunan, 128
refusing caused him to be put out Mass. , 432.
NEW YORK'S STATUTORY PROVISIONS. 339
the commission of an offence, if he is not in custody.' Even
though a medical examiner reports that a death was not caused
by violence, and the district attorney or the attorney-general is
of a contrary opinion, either one may, notwithstanding such
report, direct an inquest to be held in accordance with the pro-
visions of the statute/
New York's Statutory Provisions.
In New York the powers and duties of coroners are defined
by statute. Coroners in the city of New York are governed by
a special act relating to that city exclusively. For the State at
large it is provided that whenever a coroner is informed that a
person has been killed or dangerously wounded by another, or
has suddenly died under such circumstances as to afford a rea-
sonable ground to suspect that his death has been occasioned
by the act of another by criminal means, or has committed sui-
cide, he must go to the place where the person is, and forthwith
inquire into the cause of the death or wounding, and summon
not less than nine nor more than fifteen persons, qualified by
law to serve as jurors, if such death or wounding be of a crim-
inal nature, to appear before him forthwith at a specified place,
to inquire into the cause of death or wound, and if it appears
from the evidence taken or during the inquisition, that any
person or persons are chargeable with the killing or wounding,
or that there is probable cause to believe that any person or
persons are chargeable therewith, and if they are not in custody
the coroner must forthwith issue a warrant for the arrest of the
person or persons charged with such killing or wounding, who
must be arraigned before the coroner for examination, and the
coroner has power to commit the person or persons so arrested
to await the result of the inquisition. A coroner is disqualified
from acting as such in any case where the person killed or
dangerously wounded is a co-emplo3'ee with the coroner of any
person or persons, association or corporation, or where it appears
that the killing or wounding has been occasioned, directly or
indirectly, by the employer of the coroner.' It is further pro-
vided that whenever a convict shall die in any State prison, it
shall be the duty of the inspector having charge of the prison
' Mass. Pub. Stat. , chap. 26, gg 13, - IMass. Pub. Stat. . chap. 26, g 18.
13, 17. 2]sf. Y. Criminal Code, § 773.
340 POWERS AND DUTIES OF CORONERS — BECKER.
and of the warden, physician, and chaplain of the prison, if
they or either of them shall have reason to believe that the death
of the convict arose from any other than ordinary sickness, to
call upon the coroner having jurisdiction to hold an inquest
upon the body of such deceased convict/ The New York Crim-
inal Code further provides that when six or more of the jurors
appear, they must be sworn by the coroner to inquire who the
person was, and when, where, and by what means he came to
his death or was wounded as the case may be, and into the cir-
cumstances attending the death or wounding, and to render a
true verdict thereon according to the evidence offered to them
or arising from the inspection of the body.^ The coroner may
issue subpoenas for and summon and examine as witnesses
every person who in his opinion, or that of any of the jury, has
any knowledge of the facts ; and he must summon as a witness
a surgeon or physician, who must, in the presence of the jury,
inspect the body, and give a professional opinion as to the cause
of the death or wounding. ^ The jury, after inspecting the body
and hearing the testimony, must render their verdict, and cer-
tify it by an inquisition in writing, signed by them, and setting
forth who the person killed or wounded is, and when, where,
and by what means he came to his death or was wounded, and
if he were killed or wounded, or his death were occasioned by
the act of another by criminal means, who is guilty thereof,
in so far as by such inquisition they have been able to ascertain.*
The testimony of the witnesses examined before the coroner's
jury must be reduced to writing by the coroner, or under his
direction, and must be forthwith filed by him, with the inquisi-
tion, in the office of the clerk of the court of sessions of the
county, or of a city court having power to inquire into the offence
by the intervention of a grand jury.^
If, however, the defendant be arrested before the inquisition
can be filed, the coroner must deliver it with the testimony to
the magistrate before whom the defendant is brought.' If the
jury find that the person was killed or wounded by another
under circumstances not excusable or justifiable by law, or that
his death was occasioned by the act of another by criminal
' N. Y. Revised Statutes, part iv. , *Ib., % 777.
chap, iii., §102. Ub., 8 778.
■ N. Y. Criminal Code, § 774. « i6. , § 779.
Ub., §775.
THE JUKY AND INQUEST. 341
means, and the party committing the act be ascertained by the
inquisition and is not in custody, the coroner must issue a war-
rant signed b}^ him with his name of oflSce, for the arrest of the
person charged.' The coroner has power to compel the attend-
ance of a witness and testify, and he ma}^ punish a witness for
disobedience, as upon a subpoena issued by a magistrate.^ The
coroner's warrant may be served in any count}' ; and the officer
serving it must proceed thereon, in all respects, as upon a war-
rant of arrest on an information, except that when served in
another county it need not be indorsed by a magistrate of that
county.^ When the defendant is brought before the coroner,
he must proceed to examine the charge contained in the inqui-
sition or information, and hold the defendant to answer, or dis-
charge him therefrom, in all respects as upon a warrant of
arrest on an information.^
II. The Jury and Inquest.
Jurors Must be Sworn by Coroner. — The jurors summoned
by a coroner to attend an inquest must be from the county or
jurisdiction wherein the coroner is empowered to act. He can-
not proceed with the inquest until he has summoned and sworn
the jury. The jurors are not challengeable, and therefore they
should be carefully selected and sworn by the coroner himself.
His duties are judicial and he can only take an inquest super
visum corporis, and an inquest in which the jury is not sworn
by himself is absolutely void and of no effect. '"
They Must Investigate and Determine the Facts. — After
being sworn by the coroner they must investigate and deter-
mine and are the sole arbiters of the facts ; the coroner's duty
being to instruct them in the law. The}' must go, view, and
examine the body together, and not separately. It is essential to
the validity of the inquest that the jury should view the body.'
Coroner may Compel Attendance of Witnesses. — When
the coroner sits to hold an inquest, he sits as a judicial officer,
armed with all the ordinary' powers possessed by judicial officers.
He may compel the attendance of jurors whose qualifications
1 N. Y. Crim. Code, § 780. "* 2 Hawk P. C. , 77 ; King v. Fer-
2 76., §776 rand, 3 Barn. & A. (Eng.), 2G0.
3J6., §782. «Rex v. Ferrand, 3 B. «&: Aid.,
< lb., §783. 260.
342 POWERS AND DUTIES OF CORONERS — BECKER.
are usually such as are required of jurors in a court of record.
It is his duty to present before the jury all the material testi-
mbny within his power, touching the death as to the manner
whereof the jury are to certify, and that which makes for as well
as against the party accused. It is his duty to summon before
his inquest every person whom he has any reason to believe
possesses anj^ knowledge relative to the death which he is inves-
tigating. He is to summon such persons to attend before him
for examination. He has full authority to compel obedience to
his subpcenas. He has this power by the common law.' If a
post-mortem examination is made, the examining surgeons
should testify before the jury as to the matters disclosed by
the examination.^ The witnesses produced must be sworn by
the coroner, and their testimony reduced to writing by him or
under his direction.
Eights of Accused Party.
The coroner is not required to take the testimony of the
witnesses who are examined before the jury in the presence of
the party accused. The accused has not the right to be repre-
sented by counsel, or to cross-examine the witnesses.^ He is
not permitted to produce witnesses before the coroner to show
himself innocent of the crime. The coroner is not required to
examine any witnesses to establish the guilt of such party when
brought before him by virtue of process issued after the finding
of the inquisition."
Deliberation by Jury and Return of an Inquisition. —
After the evidence has been taken, and the jury instructed in
the law by the coroner, the jury should retire to deliberate upon
their verdict. During such deliberation and until they have
arrived at their verdict the coroner should not be present in the
room where the jury is deliberating. After they have agreed
on their verdict it should be reduced to writing, and the coroner
^In re Coroners, 11 Phila. (Pa.), person charged with murder is not
^87. void for the omission of the allega-
•^ Crisfield v. Ferine, 15 Hun, 200, tiou that he caused the death "fe-
aflftrmed 81 N. Y. , 632. loniously, " if it is such that the fact
•^2 Hawk P. C, 77. that he caused tlie death feloniously
^ Matter of Collins, 11 Abb. Pr. mav be collected on its face. And
(N. Y.), 406; 20 How. Pr., 111. In see People r. Beigler, 3 Park Crim.
this case it was held that a commit- Rep. (N. Y.), 316.
ment issued by a coroner against a
THE EFFECT OF THE EVIDENCE AND VERDICT, 343
is bound to accept it as final in his court. The inquisition
should then be signed by the coroner and jury.' If the inquest
is signed by the coroner and duly certified by him, the jurors
having signed by making their cross marks, and the whole
being certified by the coroner, his certificate of the signatures
of the jurors is sufficient and the inquisition is properly made."
If several jurors on the inquest have the same christian and
surname, it is not necessary in the caption of the inquisition to
distinguish them by abode or otherwise.'' The law requiring
the coroner to make a return of the testimony with the inquisi-
tion cannot be satisfied short of some official certificate indi-
cating that the witnesses named were sworn before him, to the
matter insisted on as evidence against a prisoner. At least if
there be no formal authentication, there should be proof aliunde
that the memorandum presents the testimony of the witness
truly.'
III. The Effect of the Evidence and Verdict.
Under the common law formerly, a coroner's inquisition
was equivalent to an indictment by a grand jury upon which
the accused might be tried. But in this country no person can
be tried upon a coroner's inquisition, yet the inquisition of a
coroner's jur}' finding a person guilty of murder has about the
same force against him, until the grand jur}^ passes upon his
case, that an indictment found by them has thereafter, prior to
his trial.
Coroner has Power to Issue Process of Apprehension. —
If a person is charged with the crime in the inquisition, the
coroner has power and he issues his process for the apprehen-
sion of the accused when not in custody solely upon the inqui-
sition. The inquisition, though taken in the absence of the
prisoner, and upon the testimony of witnesses he could not
cross-examine, settles the question of his guilt until the grand
jury passes upon the case. It justifies the commitment of the
prisoner to jail, in the same manner that the testimony of wit-
nesses does taken before a justice of the peace. The coroner
can only examine the prisoner in the same manner as upon a
' Rex V. Bowen, 6 Car. & P. , 602 ; ' Rex v. Nicholas, 7 Carr & Payne
Rex V. Bennett, 6 Car. & P., 179, (Eng.), 538.
^ States. Evans, 27 La. An., 297. ••People v. White, 22 Wend. (N.
Y.), 167.
344 POWERS AND DUTIES OF CORONERS — BECKER.
warrant of arrest or on information, and is not authorized to
examine witnesses either against the prisoner or for him, when
he is apprehended by virtue of process issued subsequent to the
finding of the inquisition by the jury, or in custody of the cor-
oner without process at the time the same is found.
Privilege of Prisoner upon Arrest. — The prisoner has the
privilege of telling his own story before the coroner, which is
to be returned with the inquisition, and that is all. He cannot
be discharged on it, however plausible it may be ; and he has
not the privilege of proving it true before the coroner. He
should, therefore, not be discharged, and he cannot have the
case investigated again before it is passed upon by the grand
jury.'
Under the provisions of the Neiv York Criminal Code
the defendant against whom an inquisition has been found by a
coroner's jury is entitled to a hearing before a magistrate,
whether he has been arrested before the inquisition has been
filed or is arrested after such filing. Under the provisions of
sec. 779, in the case of a defendant who has been arrested be-
fore the inquisition can be filed, the prisoner is entitled to be
examined before the magistrate, before whom he may be
brought, as provided in sec. 781, and in the case of a prisoner
who has not been arrested until after the inquisition was filed,
UTider sees. 781 and 783 the defendant is entitled to be heard
before a magistrate in all respects as upon a warrant of arrest
on an information. The magistrate must proceed to examine
the charge contained in the inquisition, and hold the defendant
to answer or discharge him therefrom.'^ The information is
the allegation made to a magistrate that a person has been
guilty of some designated crime. ^
When Evidence taken before Coroner of a Party
Charged with Crime Admissible in Evidence upon
His Trial Subsequently.
There is nothing which distinguishes between the proceed-
ings of a coroner's inquest and any other official proceedings
'Matter of Collins, 11 Abb. Pr. ment issued by a coroner, he not
(N. Y.), 406; 20 How. Pr. , 111. having had an examination, and
-Matter of Ramscar, 10 Abb. N. the Court dii-ected an examination
C. (N. Y. ) , 443. The prisoner in before a magistrate,
this case was detained on a commit- ^N. Y. Code Crim. Pro., § 145.
EVIDENCE TAKEN BEFORE CORONER. 345
taken and returned in the discharge of official duty as to their
admissibility in evidence. A witness, therefore, may be con-
tradicted by the production of a deposition thus given by him
before a coroner. ' But the line is sharpl}^ drawn in what cases
the testimony of a witness examined before a coroner's inquest
can be used on his subsequent trial, and in what cases it can-
not. When a coroner's inquest is held before it has been as-
certained that a crime has been committed, or before any person
has been arrested charged with the crime, and a witness is
called and sworn before the coroner's jury, the testimony of that
witness, should he afterward be charged with the crime, may
be used against him on his trial, and the mere fact that at the
time of his examination he was aware that a crime was sus-
pected, and that he was suspected of being the criminal, will
not prevent his being regarded as a mere witness, whose testi-
mony may be afterward given in evidence against himself. If
he desires to protect himself he must claim his privilege. But
if, at the time of his examination, it appears that a crime has
been committed, and that he is in custody as the supposed
criminal, he is not regarded merely as a witness, but as a party
accused, called before a tribunal vested with power to investi-
gate preliminarily the question of his guilt, and he is to be
treated in the same manner as if brought before a committing
magistrate, and an examination not taken in conformity with
the statute cannot be used against him on his trial for the
offence.'"' So the doctrine as to silence being taken as an im-
plied admission of the truth of allegations spoken or uttered in
the presence of a person, does not apply to silence at a judicial
proceeding or hearing, and since the proceedings at a coroner's
inquest are of a judicial character, what there transpired must
be considered as a part of the proceedings." The leading cases
' People V. Devine, 44 Cal. , 453 ; called at hev house and asked the
Commonwealths. Hawkins, 3 Gray way to Sandy Hill, and also for a
(Mass.). 463. drink of water; that the prisoner
i People V. Monden, 103 N. Y. , witli a number of others was placed
211. arovmd a room, and the witness
'People V. Willett, 93 N. Y. , 39. pointed out the prisoner as the one
In this case upon the trial of an in- who so called ; also that a number
dictment for murder, evidence was of persons, including tlie prisoner
received on the part of the prosecu- passed behind her, each one repeat-
tion, imder objection and exception, inp; the question asked lier by the
to the effect that upon the coroner's stranger, and slie identified tlie
inquest a witness testified that prisoner bj- his voice, and that the
shortly after the murder a stranger prisoner on that occasion did not
346 POWERS AND DUTIES OF CORONERS — BECKER,
which have been before the New York Covirt of Appeals upon
this important question, and from which that court has
finally deduced that rule, may be here referred to.
Hendrickson Case. — In the first case the wife of the defendant died
suddenly in the morning, and in the evening of the same day a coro-
ner's inquest was held. The defendant was called and sworn as a wit-
ness upon the inquest. At that time it did not appear that any crime
had been committed, or that the defendant had been charged with any
crime, or even suspected, except so far as the nature of some of the
questions asked of him might indicate such a suspicion. On his subse-
quent trial on an indictment for the murder of his wife, the statements
made by him at the coroner's inquest were held admissible, on the
ground that he was not examined as a party charged with the crime;
that it had not appeared even that a crime had been committed, and
that he had simply testified as a witness on the inquiry as to the cause
of the death. '
McMahon Case. — Following this came the McMahon Case., in which
it appeared that the defendant was arrested by a constable, without
warrant, on a charge of having murdered his wife. The constable
took him befoi*e the coroner, who was liolding an inquest on the body,
b}' whom he was sworn and examined as a witness. It was held that
the evidence thus given was not admissible on the prisoner's trial for
the murder, and his conviction was rever.sed vipon that ground.'^
Teachout Case. — The doctrine of this case was more clearly defined
and somewhat limited in a later case, the Teachout Case. In that case
the defendant appeared at the coroner's inquest in pursuance of a sub-
poena to testify, and voluntarily attended; he was not imder arrest, but
was informed by some one that it was charged that his wife had been
lX)isoned and that he would be arrested for the crime. Before he was
deny that he was such stranger. It was erroneously received. It is
was held that the prisoner was not very apparent that the examination
bound to speak and his silence could before the coroner partook of a ju-
not be regarded as an evidence of dicial character, and what then
guilt, and that the evidence was im- transpired must be considered as a
proi3erly received. The Court said : part of the proceedings ; the coro-
"The question whether the defend- ner was there, a jury had been em-
ant was bound to speak, and under- panelled, and witnesses were exam-
stood that he was at liberty to speak, ined whose testimony was returned
if he chose, was submitted to the as a portion of the coroner's pro-
jury bj' the Court in his charge, and ceedings. It is difficult to see
an exception taken thereto. The upon what ground it can be claimed
doctrine as to silence being taken that the experiments which were
as an implied admission of the truth made were not in connection with
of allegations spoken or uttered in the proceedings before the coroner
the presence of a person, does not ap- and a part thereof. "
ply to silence at a judicial proceed- ^Hendrickson v. People, 10 N.
ing or hearing. And if the pro- Y. . 13.
ceedings before the coroner were of ■ People u McMahon, 15 N. Y. ,
a judicial character the evidence 384.
EVIDENCE TAKEN BEFORE CORONER. 347
sworn he was informed by the coroner that there were rumors that his
wife came to her death by foul means and that some of those rumors
implicated him, and that he was not obliged to testify unless he chose.
He said he had no objection to telling all he knew. The Court in de-
livering its opinion preludes it by a reference to these facts as showing
that the statements made were voluntary in every legal sense, and held
that a mere consciousness of being suspected of a crime did not so dis-
qualify him that his testimony, in other respects freely and voluntarily
given before the coroner, could not be used against him on his trial on
a charge sixbsequently made of such crime. On that ground it held
the evidence properly admitted, at the same time referring with ap-
proval to the McMahon Case, and distinctly limiting the rule of ex-
clusion to cases within its bounds. '
Mondon Case. — Then followed the Mondon Case, where on the find-
ing of the body of the deceased, the defendant was arrested without war-
rant as the suspected murdex^er. While he was thus in custody the
coroner empanelled a jury and held an inquest, and the defendant was
called as a witness before the inquest and was examined by the district
attorney and by the coroner. The prisoner was an ignorant Italian
laborer unfamiliar with the English language. He was unattended
by counsel, and it did not appear that he was in any manner informed
of his rights, or that he was not bound to answer questions tending to
criminate him. He was twice examined; on the first occasion the ex-
amination was taken by questions put either by the district attorney or
by the coroner, and the result written down by the coroner, who then
read the evidence over to him, line by line, and asked him if he under-
stood it and if it was the truth, and he said it was, and the coroner then
reswore him to the deposition. The coroner, after taking the de-
fendant's testimony on the first day, came to the conclusion that the
defendant did not understand English well enough to be examined,
and that it ought to be taken through an interpreter, which was done,
in order that they might get it a little better and a little fuller. It was
held that the defendant's testimony was not admissible upon his trial
on the indictment.^ It will be seen that this latter case follows in direct
line with the rule announced in the McMahon Case and clearly dis-
tinguishes another case, the McGloin Case, u])()n the authority of which
the trial court held the testimony of the prisoner in the Mondon Case
admissible.
McGloin Case. — The case of McGloin was not that of the examina-
tion of a prisoner on oath before a magistrate before whom he was taken
involuntarily, while in custody, and interrogated by the magistrate,
who to all appearance had ])ower to require him to answer, but wliile
under arrest the prisoner said to the inspector of police who had him
in charge that he would make a statement. The inspector then said
' Teachout v. People, 41 N. Y., 7. '^People v. Mondon, 103 N. Y., 211.
348 POWERS AND DUTIES OF CORONERS — BECKER.
that he would send for a coroner to take it. The coroner was then sent
for and came to poUce headquarters and took down in writing the con-
fession dictated by the prisoner, the coroner asking no questions and
not acting in any official capacity, but as a mere amanuensis to take
down the confession and prove the contents. It was held that the con-
fession of the prisoner was admissible in evidence upon his trial for
murder. '
Rule in Pennsylvania. — The rule in Pennsylvania is sub-
stantially that when the testimony given by the prisoner under
oath before a coroner's inquest, previous to him being charged
or suspected of the murder of the individual upon whose body
the inquest was sitting, may afterward be given in evidence
against him, on his trial for the murder of such person.^
Rule in Nebraska. — The statements of a prisoner to be com-
petent evidence must have been voluntarily made. In cases of
declaration made on an examination before a coroner's inquest
by a person under arrest or charged vsrith the crime and also
under oath, they are not admissible. But when the person,
although he be subsequently charged with the offence, appears
voluntarily, and gives testimony, before any accusation has
been made against him, his statements are admissible in evi-
dence against him on the trial of an indictment for the crime. ^
' People V. McGloin, 91 N. Y. , cused man in entire silence, appears
241. in beautiful contrast to the conti-
" Williams v. Commonwealth, 29 nental systems, which permit the
Pa. St. , 102. In this case the pros- criminal to be racked by inquisito-
ecution was permitted to prove upon rial skill, until something be wrung
the trial that a justice of the peace from him which maybe patched up
had held an inquest on the body of into proof of guilt. This case shows
a dead person, and appointed an- nothing of the kind. The phrase
other person foreman of the inquest, 'called up' commented on by the
and directed him to swear wit- counsel, does not appear in the rec-
nesses ; and while the inquest was ord, and if employed by the wit-
still sitting, the foreman called upon nesses related doubtless to the or-
and requested the defendant to be dinary case of calling forth a wit-
sworn and give evidence as a wit- ness, and not awakening him from
ness, and he was duly sworn and slumber. When the defendant was
was examined by the foreman, in sworn before the inquest, he had
presence of the inquest. It was held neither been charged with nor sus-
on appeal that his evidence was ad- pected of crime. He might have
missible. On this point the Court declined to testify, and this would
said : " If the defendant had been have pointed suspicion directly to
awakened out of sleep, charged with him. He took the risk of a state-
crime, and then, in the necessary ment, and cannot complain that he
confusion of his faculties sworn to met the legitimate consequences of
testif}', I should have steadfastly the act. In the eye of all the au-
resisted the subsequent introduction thorities, it was a voluntary state-
of the testimony against him. The ment. "
common law, which justifies an ac- ^ Clough v. The State, 7 Neb. , 320.
MEDICO-LEGAL AUTOPSIES.
BY
H. p. LOOMIS, A.M., M.D.,
Professor of Pathology in the University of the City of New York; Visiting Physician
and Curator to Bellevue Hospital, New York; Pathologist to the
Board of Health, Neiu York City; President Neio
York Pathological Society, etc., etc.
AUTOPSIES.
A MEDICAL examiner before proceeding with an autopsy,
especially if called before the body has been removed from the
place where it was found, should carefullj' note certain facts.
These should be entered by himself or an assistant with great
care, in a note-book, as this book can be introduced as evidence
in any trial. A satisfactory way is to dictate to the assistant
as the examination proceeds, and at the conclusion the assistant
reads the notes taken, and the examiner verifies them.
SURROUNDING OBJECTS— POSITION OF THE BODY.
These should be first noted. The character of the soil; the
condition of the ground, and whether it shows footprints ; if so,
their direction; the evidence of any struggle; the presence of
any weapon ; and finally, the exact position in which the bod}'
lies, especially the position of the hands and feet. This is im-
portant, for the body may be found in a position which the
deceased could not have assumed on the supposition of the
wound or injury having been accidental or homicidal. If pos-
sible a photograph should be taken of the body in the exact
position in which it is found. If it is absolutelj' necessary- to
remove the body, it should be done with great care, keeping the
body in as horizontal a position as possible.
The character of the surrounding soil should be noted. This
is of special importance when the body to be examined has been
exhumed : for the question of preservation of the bodj^ and the
ability to recognize pathological changes may be brought up at
a trial. This was an important point raised in the Buchanan
case (New York, 1893).
If a body be found in the water, examine the character of
the water and the temperature, and if found near the shore, the
character of shore and bottom.
Blood. — The situation of blood-stains, and their mmiber
and extent, on clothing or surrounding objects should be noted.
352 MEDICO-LEGAL AUTOPSIES — LOOMIS.
This will often show whether a struggle has taken place after
receiving the fatal wound, and is also of medico-legal impor-
tance if made at the time the body is found, for it may be so
situated as to show that the bod}* has been interfered with
after death.
Again, spots of blood found upon articles of clothing or
upon surrounding objects should be noted as to their form and
direction, for they may serve to furnish an indication of the
position of the person with respect to them when the wound
was inflicted. For example, if the spot was oval, the presump-
tion is that the person was placed obliquely with respect to the
stain while the hemorrhage was occurring. The force with
which the blood was thrown out will in some measure be indi-
cated by the obliquity or length of the spot. The amount of
blood will also often indicate whether the person has died sud-
denly, the exact spot where death occurred, whether a struggle
took place, and will also preclude the possibility of a person
moving after receiving the fatal injur3^ When we examine a
body, especially when found in a room, care must be taken not
to be misled by the accidental diffusion of blood by persons
going in and out, or touching the body (see Bood-Stains, Vol.
n.).
Clo thing. — The examination of the clothing should be
thorough. A description of each article should be noted, and
the order in which it is removed ; for often it is important to
prove that the garments were worn by or belonged to the de-
ceased. If any blood is on the clothing, note whether the blood
is in large patches, or whether it is sprinkled over the garment :
the amount of the blood and what garments are stained by it.
Note and examine whether the blood has flowed down the front
of the clothing, whether it has soaked the inner garments, or
agaip, whether it has collected along the back; for these ap-
pearances will sometimes demonstrate whether a wound was
inflicted while the person was sitting, standing, or lying down.
For example, if the throat is cut while the person is lying
down, the blood will be found on each side of the neck along
the back and not down the front of the body. Few suicides cut
their throats in a recumbent position, and this distribution of
the blood may serve to distinguish a suicidal from a homicidal
wound.
WEAPONS. 353
The condition of the clothing may also serve to show
whether there has been any struggle, and the presence of dry
spots or mud on it may sometimes serve to connect an accused
person with an act of murder. This is well illustrated in the
case of Reg. v. Snipe, reported in Beck's " Medical Jurispru-
dence," where evidence was adduced to show that some spots of
mud on the boots and clothing of the prisoner, when examined
microscopically, contained infusoria, shells, and some rare
aquatic vegetables. The mud of the ditch close to where the
body was found, as also the mud on the clothing of the dead
body, presented the same microscopical appearances. The med-
ical expert who gave this evidence swore that in his opinion
the mud spots on the body and on the prisoner's boots were
derived from the same ditch, for the mud of all the other ditches
in the locality was found, on microscopical examination, to be
different. The well-known case which occurred in New York
a few years ago, known as the "Shakespeare case," furnishes
an example of the importance of carefully examining all stains
on the clothing found on bodies.
If there are several stabs or cuts on the body involving the
dress, it should be noted whether they are blood-stained, and if
so, whether the stain is on the inside or outside of the garments,
for sometimes in simulated personal injury a stain of blood may
be inadvertently applied to the outside of the dress, as in wip-
ing a weapon.
Weapons. — If a weapon is found, the character of the
weapon and its exact position should be noted. This is fre-
quently of importance in telling whether a person has died from
an accidental or self-inflicted wound. In a case whore death
occurs immediately or within a few minutes, the weapon is
found near the body, or often so tightl}^ grasped in the hand
that it can be with difficulty removed. If the weapon is found
near the body it should be noted on which side and at what
distance, and it must be questioned whether it could have fallen
on the spot or been thrown there by the deceased. It is com-
patible with suicide that the weapon should be found at some
distance from the body. An instance has been recorded where
an individual was discovered in bed with his throat cut, and
the bloody razor was found closed and in the pocket of the
deceased. If a weapon cannot be discovered, or is concealed,
23
354 MEDICO-LEGAL AUTOPSIES — LOOMIS.
it is strong presumptive evidence of homicide ; especially when
the wound is such as to produce speedy death.
Note whether the weapon is sharp or blunt, straight or
curved. If a knife, the handle and inner portion should be ex-
amined, for the blade ma}^ have been washed.
If the wound has involved any large vessels, it is improbable
that the weapon can have been thrown any distance from the
body, and when it is, there are always fair grounds to expect
interference with the original position of the body. One cir-
cumstance which always strongly points to suicide is the find-
ing of the weapon firmly grasped in the hand of the cadaver.
The hand of a dead person cannot be made to grasp or retain a
weapon as does the hand which has grasped it at the last mo-
ments of life. The amount of blood on the weapon should be
noted, but it must be remembered that a knife may have pro-
duced a fatal stab wound and still no blood be found on it.
This is explained by the fact that in a rapid plunge the vessels
were compressed, and only after the drawing of the knife and
relieving of the pressure blood began to flow, or possibly the
blood may have been wiped off the knife by the elasticity of the
skin.
When a person has died of a gunshot wound, especially at
close range, it is important to look for any wadding or paper
found in the wound, as in a number of instances the finding
of such has led to the detection of the criminal. For example,
handwriting has been found on the paper, or it has formed
part of a printed page the rest of which has been found in pos-
session of the accused. When a gun is discharged near the
body, a portion of the wadding is almost always found in the
irregular wound produced.
POST-MORTEM EXAMINATION.
Having completed the examination of the surroundings, one
next proceeds with the post-mortem examination, which should
be conducted according to a well-defined plan, following which
the results obtained will always be satisfactory.
If possible the body should be removed to a large, well-
ventilated, and especially well-lighted room. No artificial light,
if it can possibly be avoided, should be used when performing
POST-MORTEM WOUNDS. 355
the autopsy ; artificial light is especially bad on account of its
yellowness and its power to modify natural color. Many dis-
eased conditions cannot be satisfactorily determined by artificial
light. The bod}^ should be placed on a high table, and the
facility with which the autopsy is made will often depend on
having the table high enough to render stooping unnecessary.
Never make an autopsy, if it can possibly be avoided, on a
body while in a coffin, as the examination is always unsatisfac-
tory. The size and surroundings of the room, and how it is
lighted, should be entered in the note-book.
Instruments. — If possible the following instruments should
be at hand before proceeding with an examination, although
some of them may be dispensed with :
(1) Large section knife; (2) scalpels; (3) enterotome (for
opening intestines and stomach) ; (4) costotome, or large bone
forceps (for cutting ribs) ; (5) scissors, large and small (one
blade blunt); (G) saw; (7) chisel; (8) dissecting forceps; (9)
probe; (10) blowpipe; (11) curved needles and strong twine;
(12) measuring and graduated glass; (13) small scales.
Besides the above instruments, some basins containing
water; sponges, bottle of flexible collodion, Lugol's solution of
iodine for the amyloid test, will be needed.
Post-Mortem Wounds. — Various plans have been pro-
posed to protect the operator's hands from the post-mortem
wounds which are often so dangerous, such as wearing rubber
gloves, smearing the hands with carbolized vaselin, both of
which have their disadvantages : the gloves being too clumsy,
and the vaselin rendering it almost impossible to hold the knife
steady. Gloves should always be worn, however, where the
body has undergone much decomposition, or where the person
may have died from any septic disease. A method which I
have found satisfactorj^ is to cover all cuts and hangnails with
flexible collodion, and then to have a basin of clean water at
hand, and from time to tiAie to rinse one's hands in the water.
It is from bathing the hands in the cadaveric fluids and not
from cuts that most of the danger comes. If possible an abso-
lutely new board, large enough upon which to examine the
organs, should be at hand, for it ma}' be claimed at a trial that
the organs and tissues, if placed and examined on surrounding
objects, have become contaminated.
356 MEDICO-LEGAL AUTOPSIES — LOOMIS.
Toxicological. — If a chemical analysis of the various
organs and tissues is to be made, and it is impossible to liave
the chemist present, the medical examiner should obtain some
new glass jars of suitable size, with close-fitting glass covers.
These jars shoud be rinsed with distilled water, and in them the
various organs are to be placed ; if possible with no preserving
fluid on them. But if it is found impossible to deliver the jars
to the chemist at once, alcohol may be poured over the organs
in the jars, but it is specially important that a sample of this
alcohol should be retained, that a chemist may at a future date
test the same for any impurities. After the organs and tissues
have been placed in the jars, the mouths should be closed and
sealed, and the seal remain in the custod}^ of the examiner until
the jars are delivered to the chemist.
Parts to be Preserved for the Chemist. — In cases of
suspected poisoning, it is not sufficient that the stomach and
intestines alone should bo preserved for the chemist as has been
indicated, each part by itself; for it should be remembered that
the portion of poison remaining in the alimentary tract is but
the residue of the dose which had been sufficient to destroy life,
and if the processes of elimination have been rapid no trace of
the poison will be found in the alimentary canal but can readily
be detected in other organs. Again, the poison may not have
been introduced by the mouth, in which case none may be
found in the digestive tract.
The chemist should receive, besides the stomach and entire
intestinal canal, the liver, one or both kidne3'S, the spleen, a
piece of muscle from the leg, the brain, and any urine found in
the bladder.
When it is impossible for any reason to obtain the whole of
any organ, the part removed should be carefully weighed and
its proportion to the rest of the organ noted.
It is also of extreme importance to preserve in sealed and
labelled jars those parts of a bod}'' which maj' show the evi-
dence of disease, or on the appearance of which one's evidence
is fovmded.
ORDER OF AUTOPSY.
In making the autopsy, the operator should stand on the
right side of the body and make the incision by grasping the
ORDER OF AUTOPSY. 357
knife firmly in the hand, and cutting with the whole of the
blade and not with the point. The knife should be swept along
from the shoulder rather than from the wrist, thus making a
long, smooth, deep cut ; never a jagged one.
The method of examining the human body after death will
vary somewhat according to the objects in view. These objects
may be threefold: (1) To ascertain whether a person has died
from violence or poison; (2) to establish the cause of death,
especially if it has been sudden ; and (3) to ascertain the lesion
of a disease, or to confirm a diagnosis.
The only difference between a medico-legal and pathological
autopsy is that in the former case everything which might
subserve the ends of justice should be carefully noted, and the
changes found most accurately described ; especially any abnor-
malities found on the external examination of the body. A
photograph should be taken of the body.
The head should be opened and the brain examined first, and
not last, as is^ often done in the ordinary autopsy.
Careful notes should be taken during each step of the exam-
ination, to be reread, verified, and signed at the completion of
the autopsy.
It must be remembered that most of the lesions of disease
which are found, indicate the disease rather than the cause of
death ; that often the lesion found will seem hardly extensive
enough to cause death, and that from accidents and injuries
apparently trivial, death may result. It must often be acknowl-
edged that no sufficient cause of death can be found, but the
more accurate and careful the examinations (especially when
a microscopical examination of the organs is made) the fewer
will be the number of such cases. If no apparent lesion is
found, it must not be forgotten that many poisons destroy
life and leave no trace that the pathologist can discover.
Care should always be exercised not to mistake the ordinary
post-mortem appearance which we find at autopsies for the
lesions of disease.
The examination of the human body, whether it be made
from a medico-legal or pathological standpoint, is divided into
two main divisions :
(1) The external examination, and
(2) The internal examination.
358 MEDICO-LEGAL AUTOPSIES — LOOMIS.
EXTERNAL EXAMINATION.
Its minuteness will depend on the character of the case, as
when the person is unknown, or when suspected to have died
from unnatural causes. In such cases the external examination
is very important.
The following are the steps to be followed :
(1) Give a general description of the body; apparent
age, height, and weight of the individual; color of the hair and
eyes ; condition of the teeth ; and the evidence of any personal
peculiarities or abnormalities.
(2) Note the color of the skin and observe whether there
are an}^ spots of cadaveric lividity, and if present where
situated.
(3) Contusions. — Note whether there are any contusions,
and, if present, their character, situation, length, breadth, and
depth should be described, and whether they are accompanied
by inflammation or by the evidences of gangrene.
It is often important to determine whether a contusion has
been inflicted before or after death. This is to be done by cut-
ting into the ecchymoses and if the extravasated blood or the
coloring matter of the blood is found free in the tissues, one can
be almost certain that it is an ante-mortem injury. In post-
mortem discolorations the blood is found in the congested ves-
sels. The situation of ante-mortem contusions will not gener-
ally correspond to the discolorations produced by decomposition ;
the latter being confined to the most dependent parts. It should
be remembered that the contusions produced bj^ blows on a body
dead onh" a few hours cannot be distinguished from those
which were received during life; and also that putrefactive
changes make it well-nigh impossible to distinguish between
ante-mortem and post-mortem injuries. It should also be borne
in mind that blows or falls sufficient to fracture bones or rup-
ture organs may leave no mark on the skin (see Wounds, Vol.
I., pp. 467, 4T4, et seq.).
(4) Wounds. — The situation, depth, extent, and direction of
any wound should be recorded, as also the condition of its edges ;
the changes in the surrounding tissues, and whether inflicted
by a cutting, pointed, or rounded instrument ; or by a bullet.
In the latter case the course and direction of the ball should be
EXTERNAL EXAMINATION. 359
ascertained by dissection rather than by^ the use of the probe,
and the character of foreign bodies, if an}' are found in the
wound, should be noted. What nerves or blood-vessels, partic-
ularly arteries, have been injured, should be ascertained. It is
often important to determine whether a wound was made before
or after death. The following may serve as a differential point :
In all wounds made after death there is slight bleeding, non-con-
traction of the edges, and absence of blood in the tissues. This
is the opposite of ante-mortem wounds. Again, wounds inflicted
within two hours after death cannot be differentiated from
those made during life (see Gunshot Wounds, Vol. I., p.
GIO et seq.j Wounds, Vol. I., p. 476 et seq.).
(5) Fractures. — If there are any evidences of fractures, the
situation of the bones involved should be noted, and whether
they are accompanied by contusions of the soft parts. Frac-
tures which are inflicted during life are always accompanied
by much more extravasation of blood, more injury to the soft
parts, and more evidences of reaction than those occurring after
death. It is a well-known fact that it is much more difficult to
produce a fracture in a dead than a living body (see Wounds,
Vol. II., p. 482 et seq.).
(6) The temperature of the body should be taken,
(7) The rigidity and flexibility of the extremities
should be ascertained.
(8) The state of the eyes should be noticed, and the rela-
tive size of the pupils.
(9) Attention should be paid to the condition of the cavities
of the mouth and nose. The neck should be speciall}' examined
for marks of external injury, or signs of ecchymosis or com-
pression.
(10) Genitals, — The external genitals should be very care-
fully examined for evidence of injury, the presence of sj'philitic
lesions, and in the female the condition of the vagina should be
particularly ascertained.
(11) (Edema of the Feet. — If there is evidence of oedema
in any part of the body, especiallj" about the ankles, its situa-
tion and extent should be noted.
(12) Ulcers and Abscesses.— The situation and extent of
any ulcer found on the body should be recorded, as also the pres-
ence and situation of any abscess.
360 MEDICO-LEGAL AUTOPSIES — LOOMIS.
(i;}) Burns. — The ^extent of a burn, as also the state of the
parts involved, should be noted. For example, whether they
are inflamed or show blisters, etc. (see Heat and Cold, Vol.
I., p. G47 et seq.).
(14) Hands. — In medico-legal cases the hands of a dead
person should always be examined for the presence of cuts,
excoriations, or foreign substances found upon them ; especially
should the dorsal extremities be examined. This examination
will often indicate that there has been a mortal struggle before
death. The impression of a hand or of some of the fingers is
often found on the skin of a dead bod}". The exact situation
where found should be noted. This may be of importance, as
when it occurs where it would have been impossible or improb-
able for the deceased to have caused it.
For appearances in death from lightning or electricity, see
Vol. I., p. 701 et seq., and in death from hanging, strangula-
tion, and garroting, see Vol. I., pp. 713, 746, 781, et seq.
INTERNAL EXAMINATION.
Having completed the examination of the external parts of
the body, the next proceeding is to open the body and make an
internal examination.
This should be done by following a regular method, so as to
examine the relations of parts and not to injure one organ while
removing another.
In opening the various organs an incision should be made
which will expose the greatest amount of surface at one cut.
Never make a number of small and alwaj's unsatisfactory inci-
sions in an organ. In opening certain organs like the brain
and heart, the incisions are so planned that the parts of the
organ may be folded together, and, if necessary, their relations
to one another and the whole organ studied. Such organs are
opened as one would open a book to examine its pages.
It is important to remember that after death the blood leaves
the arteries and left side of the heart, and collects in the veins
and the right cavities of the heart. Especially does it collect
in the vessels of the most dependent portions of the bod}' and
of the various organs, so that local congestions may often dis-
appear after death; and again, they may be found at an
THE HEAD. 361
autopsy where they were not present during life. Especially is
this true of the mucous membranes such as those of the trachea
and bronchi, and also of the blood in the sinuses of the dura
mater.
In making autopsies it is a cardinal rule that all the cavities
of the body should be examined, and not alone the one where
one might expect to find a lesion. At medico-legal autopsies,
the great cavities — the head, the thorax, and the abdomen —
should be examined in their successive order from above down-
ward. The reason for beginning with the head is that the
amount of blood in the brain and its membranes may be deter-
mined accurately ; for, if the heart and great vessels of the neck
are opened first, the blood will drain away from the brain and
local congestions disappear. In pathological autopsies, the
opening of the head first is not so important, and often the
vertebral column need not be opened at all, for it is a compli-
cated process and takes time; but in medico-legal cases, espe-
cially where a question as to the cause of death may arise, and
has not satisfactorily been determined, after all the other cav-
ities are examined the vertebral column should always be opened
and the cord removed.
The Head.
Make an incision across the vertex of the skull from ear to
ear. Dissect the anterior flap forward until within about three
inches of the bridge of the nose, and the posterior flap back-
ward to the external occipital protuberance. Examine the in-
ternal surface of the scalp for ecchymosis and evidences of in-
jury. A circular incision is then made with a saw through the
cranium as far backward and forward as the flaps have been
reflected. An incision through the temporal muscle is neces-
sary so that the teeth of the saw may not become clogged by
the muscle fibres. When the cranium has been sawed through,
a stout hook is inserted under its upper edge and it is removed
with a quick jerk. If the dura mater is verj' adherent to the
calvaria, it may be necessary to remove it with the bone, by
cutting through it at the level of the cranial incision. Exam-
ine the calvaria as also the other bones of the skull after the
brain has been removed and the dura stripped off, for evidence
of fracture.
362 MEDICO-LEGAL AUTOPSIES— LOOMIS.
Note the symmetry, thickness, and density of the cranial
bone, and remember that depressions along the sagittal suture
are for the Pacchionian bodies, and are not pathological.
Dura Mater. — The dura mater may be slightly adherent
to the bone of the cranium. This is especially seen in old
people and does not indicate disease. The Pacchionian bodies
are seen along the longitudinal sinus. Examine the internal
surface of the dura mater for the presence of clots, tumors, or
inflammatory lesions. Open the longitudinal sinus and exam-
ine for thrombi. Remove the dura mater by an incision fol-
lowing the cranial incision, the falx cerebri between the an-
terior lobes being drawn back and divided. Note whether the
dura mater is adherent to the pia mater, and the condition of
its internal surface.
Pia Mater. — The brain, covered by the pia mater, is now
exposed. Note the degree of congestion of the membrane, its
adherence, and the existence of pus, blood, or serum on its sur-
face or in its meshes. Remember that a considerable amount
of serum may be present within normal limits, especially in
cachectic subjects, without indicating disease, but when the
serum is so extensive as to raise the pia mater and to depress
the convolutions, we have a pathological amount which may be
a simple dropsy due to some general cause, or the result of a
chronic meningitis. Enough serous effusion in the pia mater
to produce a condition which has been called by some writers
" serous apoplexy, " I believe never occurs as a primary con-
dition.
Loss of transparency and thickening of the pia mater, espe-
cially along the longitudinal fissure, is often seen in old people
and does not indicate disease.
Brain. — Remove the brain by raising the anterior lobes with
the fingers of the left hand and cutting through the nerves,
vessels, and the tentorium as they appear. The medulla is
cut as low down as possible, and the brain as it rolls out is
caught in the left hand.
After being placed on a clean board or in a large clean dish,
it is minutel}' examined. The average weight of an adult male
brain is forty-nine and one-half ounces; of the female, forty-
four ounces. Its proportional weight to that of the rest of the
body is as 1 to 45.
BRAIX. 363
Lay the brain first upon its convex surface and examine the ar-
teries at the base for atlieroma, thrombi, emboli, and aneurisms.
Examine the pia mater of the base, especially for the evidences
of hemorrhage, tumors, tubercles, and inflammatory lesions.
Next turn the brain over on its base, and proceed to open its
various cavities and examine its internal structure. Separate
the two halves of the cerebrum, until the corpus callosum is
exposed. Make an incision downward and outward at the
junction of the corpus callosum with the cerebrum, and the roof
of the lateral ventricles will be cut through and their cavities
exposed. Prolong the incision forward and backward so as to
expose the cornua. The size and contents of the ventricles
should be noted, as also the condition of the epend3^ma. The
floor of the lateral ventricles being the most frequent spot of
hemorrhage, if one is found its extent and the parts involved
by it should be noted; especially its relation to the internal
capsule.
Transverse incisions (about one-sixteenth of an inch apart)
are made through the ganglia seen on the floor of the lateral ven-
tricles. Thus any lesions in the substance of the ganglia will
be disclosed. Three or four longitudinal incisions are now
made outward into the hemispheres nearly to the pia mater.
These will divide the hemispheres into long, prism-shaped
pieces held together by the pia mater and a little of the cortex,
thus enabling the brain afterward to be folded together, and the
relations of lesions to the brain as a whole studied. The third
ventricle is now exainined by cutting through the fornix and
corpus callosum at the foramen of Monroe. Next, the fourth
ventricle is opened by a longitudinal incision through the lower
portion of the vermiform process ; its contents, the condition of
its vessels and ependyma noted. Then the floor of the fourth
ventricle is divided by transverse incisions one-sixteenth of an
inch apart, and careful examination made for the presence of
minute hemorrhages: for here is a place in the body where
almost a microscopical lesion (hemorrhage) may cause sudden
death. Each hemisphere of the cerebellum is now opened by a
number of incisions starting from the fourth ventricle and
passing outward into its substance. The presence of an}^ tumors
or hemorrhage in the cerebellum will now be recognized.
In opening the brain, when clots, areas of softening, tumors,
364 MEDICO-LEGAL AUTOPSIES — LOOMIS.
etc., are discovered, their exact location in relation to surround-
ing parts should be noted and the blood-vessels examined for
areas of degeneration or aneurism. This examination can be
facilitated by allowing a stream of water to flow over the affected
part. This will wash out the affected area and allow the ves-
sels to appear.
Eye. — In rare cases it may be necessary to remove the eye.
This can be done by breaking through the roof of the orbit
with a saw or chisel and dissecting away the muscles so as to
expose the optic nerve and the posterior portion of the organ.
Thorax and Abdomen.
The body being placed on its back, and the operator stand-
ing on the right side, an incision is made through the skin,
fascia, and muscles from the top of the sternum to the pubic
bone, passing to the left of the umbilicus and dividing every-
thing down to the sternum and the subperitoneal tissue. A
small incision is now made through the peritoneum below the
ensiform cartilage. Into this opening two fingers of the left
hand are inserted, and by spreading the fingers and holding the
knife horizontally the peritoneum can be divided to the pubes
without injuring the intestines. The skin and muscles are now
dissected from the chest as far back as the false ribs. This
dissection may be facilitated by keeping the skin and muscles
on the stretch and cutting with the flat part of the knife. In
order to better expose the abdominal cavity, the recti muscles
are divided beneath the skin at their insertion in the pubic
bone. Examine the cut surface of the chest and abdominal
muscles, and note their color, amount, and consistency. Ob-
serve whether the chest muscles show the evidence of any para-
sitic disease such as trichinosis. The mammarj- glands are
now examined from behind and opened if necessary.
Superficial Examination of Abdominal Cavity. —
This should be done before opening the chest cavity, because
the position of organs may become modified, and blood and
other fluids are liable to find their way from one cavity into
another; and again, the blood in the presenting portion of the
abdominal organs will change its color after exposure to the air.
Note the Following Points : (a) The relative position
and general condition of the abdominal organs.
THORAX. 365
(b) The color and amount of blood in the presenting parts.
(c) Whether there are any signs of injlammation or the
evidence of foreign bodies or tumors.
(d) Examine the vermiform appendix.
(e) The amount of fluid in the abdominal cavity. Nor-
mally a small quantity of reddish serum will be found, partic-
ularly in warm weather, at the most dependent portion of the
abdominal cavity. If the quantity is small it can onl}- be as-
certained b}' raising the intestines from the pelvis. When the
fluid is considerable, the exact amount should be ascertained
and its character noted.
(/) Perforation, invagination, and hernia of the intestines
should be looked for.
[g) Determine the height of the diaphragm. Normall}-, on
the right side, it is at the junction of the fifth rib with the
sternum, and on the left it reaches as high as the sixth. A
variety of pathological conditions change its position. For
instance, it may be raised when the contents of the abdomen
are greath^ increased in volume, and in new-born children who
have never breathed. It maj^ be depressed by enlargement of
the lungs, disease of the heart, or fluid in the pleural or peri-
cardial cavities. The presence of air or gas in the pleural
cavity can be determined either by filling the abdomen with
water and puncturing the diaphragm beneath the fluid so that
the air will bubble up, or a puncture may be made through the
thorax between the ribs, and the flame of a match will be de-
flected by the escaping air.
Thorax.
The thorax is opened by cutting the sterno-costal cartilages
as close to the end of the ribs as possible, the cut being made
downward, outward, and backward, and the knife held obliquely
so as not to injure the underlying parts. Quite often the carti-
lages will be found ossified and it will be necessary to divide
them by a costotome. Next, separate the clavicles by a semi-
lunar incision at their attachment to the sternum.
Raise the sternum with the left hand and separate it from
the underlying parts. If there is any adherence of the sternum
a slight twist will be sufficient to remove it.
366 MEDICO-LEGAL AUTOPSIES— LOOMIS.
Superficial Examination of Thorax. — Observe the
position, color, and degree of distention of the lungs. It should
be remembered that healthy lungs, as soon as the chest is
opened, owing to their inherent elasticity, will collapse, and when
this normal collapse is not seen it is generally due to a loss of
elasticity as occurs in emphysema, to inflammatory diseases
binding the lung to the chest wall, or to the alveoli being filled
with solid or fluid substances or pent-up air. Most complete
distention is seen when death is due to drowning or suffocation.
The area of the heart uncovered will vary according to the
degree of collapse of the lungs and to the abnormal size of the
heart. Normally the cardiac area exposed is quadrangular in
shape, and about three and a half inches in its longest diameter.
Examine the pleural cavities for the presence of adhesions,
foreign bodies, or fluid. If fluid is found it should be removed,
measured, and its character noted. It is to be remembered that
in warm weather, or when putrefaction has commenced, a mod-
erate amount of reddish serum is found in the pleural cavities
which has no pathological significance. Lastl}^, examine the
mediastinum as to the condition of the thymus gland and great
vessels outside the pericardium.
Pericardium. — Open the pericardium b}^ an oblique inci-
sion along the anterior wall, and prolong this incision down-
ward and outward toward the diaphragm and upward to its
reflection from the great vessels. Normally, about a drachm
of clear serum, sometimes, however, blood-stained from decom-
position, will be found in the pericardial sac. The amount is
best ascertained by raising the heart. Note next the contents
of the pericardium and whether there is any serous, fibrous, or
purulent exudation. If an abnormal amount of fluid isjjresent,
remove, measure, and note its character. Observe whether
there are an}" adhesions between the two surfaces of the peri-
cardium. White patches are often seen on the visceral surface
of the pericardium, especially over the ventricles. These have
no pathological significance and are due to slight thickenings of
the pericardium.
The Heart. — Having passed the hand over the arch of the
aorta and noticed whether there is any evidence of aneurism or
dilatation, we grasp the heart firmly by the apex, raising and
drawing it forward. We remove it by cutting through the
THE HEART. 367
vessels at its base. Test the sufRciency of the aortic and pul-
monary valves by allowing a stream of water to flow into these
vessels, the heart being held in a horizontal position and care
being taken not to pull the valves open.
To apply the water test to the mitral and tricuspid valves,
the auricles are first opened so as to expose the upper surface of
these valves, and bj^ allowing a stream of water to flow through
the aortic and pulmonary valves into the cavities of the ventri-
cles, the degree of sufficiency of these valves can readily be
ascertained.
Another rough test is what is known as the "finger test."
The mitral valve will normally allow two fingers, held flat and
in contact, to pass through its opening. The tricuspid in the
same way allows, normally, three fingers to pass ; or if a more
accurate test of the degree of insufficiency is desired, the val-
vular orifices should be measured. Normally, the aortic orifice
is one inch across; the mitral, one and eight-tenths inches;
pulmonary, one and two-tenths inches; and the tricuspid about
two inches.
We open first the cavity of the right ventricle by making an
incision over its anterior border close to the septum. Prolong-
ing the incision downward to the apex and upward through the
pulmonary artery, the cavity of the ventricle will be fully
exposed. The left ventricle is similarly opened by an incision
through its anterior wall which is prolonged upward through
the aortic valve. The cavities of the auricle and ventricle, espe-
cially those of the right side, will often contain blood-clots.
These clots are usualUj post-mortem clots formed during the
last hours of life or after death. It may sometimes be neces-
sar}" to distinguish these post-mortem clots from what are
known as ante-mortem clots. The latter are usually of firm
consistencj% dry, of a whitish color, and closel}' entangled in
the trabeculae, while the former are succulent, moist, of a red-
dish-3^ellow color, and are easily detached from the walls of the
heart cavities. Ante-mortem clots are rarel}" seen, and the
medical examiner should be careful not to attribute the cause of
death to the post-mortem clots which are so often seen. After
the heart is opened we can with more care and greater accu-
racy examine the condition of the valves and recognize the
extent of valvular lesions.
368 MEDICO-LEGAL AUTOPSIES — LOOMIS.
The condition of the endocardium should now be examined
and any abnormahtj^ noted. Often it will be seen stained a
deep red color. This is not due to disease, but is caused by the
absorption of the coloring matter of the blood which has been
set free by decomposition. The size of the heart cavity and
the thickness of the heart walls should be noted, as also their
consistency and color. It should be remembered that the heart
walls may appear unusually flabby as the result of decomposi-
tion, or apparently thickened when death occurs in extreme
systole. The interior of the heart can be further examined by
passing the enterotome into each auricle, carrying the incision
through the mitral and tricuspid valves to join at the apex with
the previous incision, which has been prolonged through the
ventricles to the apex. Thus tlie auriculo- ventricular valves
are completely exposed.
Having removed the blood from the heart it is next
weighed. The average normal weight of the human heart is
about twelve ounces in the male, and a little less in the female :
its size roughly corresponding to the closed hand of the individ-
ual. Normally, the thickness of the walls of the left ventricle
about its middle is five-eighths to two-thirds of an inch, and of
the right ventricle one-eighth to one-quarter of an inch.
Note the condition of the aorta above the heart, whether it
is dilated, atheromatous, or shows calcareous deposits. Exam-
ine the coronary arteries by opening them with a blunt-pointed
scissors. Disease of these vessels with thrombosis is one of
the causes of sudden death which is often overlooked.
The Lungs. — The lungs are removed by lifting them from
the pleural cavity and cutting through the vessels and bronchi
at their base. If a lung is very adherent it is sometimes better
to remove the organ with the costal pleura attached so as not
to tear the lung substance. Examine the external surface of
the lung as to its shape, color, and consistency. Next open the
large bronchi with a blunt-pointed scissors, and prolong the
incision into the pulmonarj' substance along the minute bronchi.
Observe the contents of the bronchial tubes, the appearance of
the mucous membrane, and their relative thickness. Remember
that it is very difficult to tell the condition in which the mucous
membrane was during life on account of the early post-mortem
changes which affect it, and also because the contents of the
THE LUNGS. 369
stomach may have been forced after death up the oesophagus
and down the bronchi, giving the tubes a peculiar reddish and
gangrenous appearance.
Having examined the bronchi, the hmg is turned over and its
base grasped firmlj- in the left hand. An incision is made from
apex to base, which will expose at a single cut the greatest extent
of pulmonary surface. Note the color of the lung substance,
and whether the alveoli contain blood, serum, or inflammatory
products. Blood and serum can easily be forced from the lungs
by pressure between the fingers, while inflammatory exudations
cannot. Examine carefully for the presence of miliary tubercles.
If a question should arise whether a portion of a lung is
consolidated, this part can be removed, placed in water, and if
the air cells are consolidated the portion will sink; if there is
only congestion it will float. B3' squeezing the lung between
the fingers an inflammation of the smaller bronchi (bronchitis)
can be recognized by the purulent fluid which will exude at
different points. It should be remembered that in normal con-
dition the lower lobes and posterior aspect of the lungs will
apparently be very much congested as a result of gravity.
Neck, Larynx, and CEsophagus. — Throw the head well
backward, and place a block beneath the neck. Make an inci-
sion from the chin to the upper part of the sternum. Dissect the
soft parts away on each side from the larj'nx and thyroid body,
then cut along the ijiternal surface of the lower jaw from the
symphisis to its angle. Through this incision introduce the
fingers into the mouth, and grasp and draw down the tongue.
By dividing the posterior wall of the pharj-nx and pulling
downward these parts, the trachea and oesophagus can readily
be removed together, a ligature having been first placed around
the lower portion of the oesophagus. Open now the phaiynx and
oesophagus along their posterior border. Examine the mucous
membrane carefully for the evidences of inflammation, caustic
poison, tumors, foreign bodies, or strictures. With an entero-
tome open the larynx and trachea along their posterior wall.
Observe if there is anj^ evidence of oedema of the glottis, and
note the condition of the mucous membrane. Remember that
redness of the larynx is verj" commonly the result of post-
mortem changes and is also seen in bodies which have been
kept cold. Dissect off and examine the th5'roid gland.
24
370 MEDICO-LEGAL AUTOPSIES — LOOMIS.
Abdomen.
Having completed the examination of the organs of the
thorax, we next proceed to examine those contained in the ab-
dominal cavity. We first raise and dissect off the omentum,
noting if it is abnormally adherent.
The first organs to be removed are :
The Kidneys. — Drawing the intestines aside we cut
through the peritoneum over the kidneys, and introducing our
left hand we grasp the organs with their suprarenal capsules
attached. Raising first one kidney and then the other, we
easily divide the vessels and the ureters as close to the bladder
as possible. The kidneys are often found imbedded in a mass
of fat which must first be removed. Their surface is some-
times of a greenish color owing to the beginning of putrefac-
tion. We note the size of the organ, its color and weight. A
normal kidney weighs from four and one-half to five ounces.
Grasping the kidney firmly in the left hand, we make an inci-
sion in its capsule along its convex border, and with a forceps
strip off the capsule and note its degree of adherence and the
condition of the surface of the organ; whether it is smooth or
granular. Prolonging our incision already made through the
cortex of the organ, inward toward the pelvis, we divide the
organ into two halves and now closely examine the internal
structure. The average thickness of the cortex, which should be
about one-third of an inch, is noted ; as also its degree of con-
gestion, and whether the normal light (tubes) and reddish
(vessels and tufts) lines are seen running through it. If these
alternate light and dark markings are lost and the organ has
not undergone decomposition, the presence of some of the forms
of Bright's disease may be suspected. If the cut surface of the
organ presents a waxy appearance, the amjioid test should be
applied by first washing the cut surface of the organ and drop-
ping upon it a few drops of Lugol's solution of iodine, when
the amyloid areas will appear as dark mahogany spots on a
5'ellow background.
The pelvis of the kidneys should be examined for calculi and
the evidence of inflammatory lesions. The suprarenal capsules
readily decompose, but if the autopsj' is not made too late
THE INTESTINES. 371
liypertrophy, tuberculosis, tumors, and degeneration in them
may be recognized.
The Spleen. — This organ will be found in an oblique posi-
tion at the left side of the stomach. Grasping it firmly in the
left hand and drawing it forward, it can easily be detached.
Normally in the adult it is about five inches in length by
three inches in breadth by one inch in thickness, and weighs
about seven ounces. The size, color, and consistency of the
organ should be noted, as well as abnormal thickenings of its
capsule and the presence of any tubercles or tumors in its sub-
stance. The spleen softens very earl}- as the result of decom-
position, and this decomposition should not be mistaken for a
pathological condition.
The Intestines. — In cases of suspected poisoning the
greatest care should be taken in the removal of the intestines
and the stomach. Double ligatures should be placed in the fol-
lowing situations so as to preserve the contents of the organs
intact: (1) at the end of the duodenum; (2) at the end of the
ilium ; and (3) at the lower portion of the rectum ; and an in-
cision should be made with a pair of scissors between these
ligatures. The jejunum and ilium should first be removed to-
gether by seizing the gut with the left hand, keeping it on the
stretch, and cutting with a pair of scissors through the mesen-
tery close to its intestinal attachment. The csecum, colon, and
rectum should then be removed in a similar manner.
The intestines being placed in large absolutely clean dishes,
which have previously been rinsed with distilled water, are
opened ; great care being taken that none of the intestinal con-
tents are lost. The small intestines should be opened in one
dish and the large intestine in another. A portion of the in-
testines where morbid appearances are most likeh' to be seen in
cases of poisoning are the duodenum, the lower part of the
ilium, and the rectum. The comparative intensity of the ap-
pearances of irritation should be especially noted. For exam-
ple, if the stomach appears normal and the intestines are found
inflamed the possibilitj' of poison from an irritant may be
denied.
The intestines are opened along their detached border by
the enterotome. Care should be taken to distinguish the post-
mortem discolorations which are usually seen along the intes-
372 MEDICO-LEGAL AUTOPSIES— LOOMIS.
tines from those produced by disease. The former are most
marked in the dependent portions. They are apt to occur in
patches which can be readily recognized by stretching the wall
of the gut. The darkish brown or purple discolorations which
are sometimes seen as the result of decomposition are due to the
imbibition from the vessels of decomposed haemoglobin. Much
care and experience are necessary to tell the amount of con-
gestion which is within normal limits and to recognize changes
of color produced by decomposition.
The pathological lesions ordinarily looked for in the exam-
ination of the intestines are ulcers, perforation, hemorrhages,
strictures, tumors, and the evidences of various inflammations.
To obtain an accurate idea of the various portions of the mucous
membrane of the intestines, it is sometimes .necessar}'' to remove
their contents. When very adherent this should be done by
allowing as small a portion of distilled water as possible to flow
over their surface. If anj'^ abnormalities are noticed along the
intestinal tract, an accurate description should be given of their
situation and extent ; as also the amount of congestion seen in
different portions of the intestinal tract.
If possible the different portions of the intestines, as well as
the stomach, should be examined immediately after being ex-
posed to view, as under the influence of the air those parts
which are pale may become red, and slight redness may be-
come very pronounced. In this way only can we estimate the
degree of vascularity' of the various parts after death. How-
ever, in cases of suspected poisoning, when it is impossible for
the chemist to he present at the autopsy, the medical exam-
iner should not open the stomach and intestines, but place
them in sealed jars. As soon as possible afterward, the chemist
being present, they should then be examined in the manner in-
dicated. What may be lost by waiting, in changes of color
which have taken place, will be more than counterbalanced by
the data which the chemist will obtain from observing the con-
tents and mucous membrane of the stomach and intestines
when they are first exposed. The characteristic odors of cer-
tain poisons are so evanescent that they quickly disappear after
opening of the stomach and intestines.
After a thorough examination of the intestines, the}" are
to be put with their contents into wide-mouthed vessels, each
THE STOMACH. 373
part by itself, and the basins in which they were opened
washed with distilled water and the washings put into the
same bottle. As soon as the intestines are transferred to the
jars they should be sealed.
The Stomach. — The stomach and duodenum are removed
together. They are opened by passing the enterotome into the
duodenum and dividing it along its convex border, the incision
being continued along the greater curvature of the stomach as
far as the oesophageal opening. They should be opened in a
large glass dish which has been carefully washed with distilled
water. The chemist and medical examiner will carefully note
the quantity, odor, color, and reaction of the stomach contents ;
also whether luminous or not in the dark; the presence or
absence of crystalline matter, foreign substances, undigested
food or alcohol.
Portions of the contents should be placed in a small glass
bottle and sealed, so that at a future time they may be examined
microscopically. Only in this way can an absolute knowledge
of the character of the stomach contents be obtained. In cer-
tain medico-legal cases the ability to decide the character of the
stomach contents is of the utmost importance. The mucous
membranes of the stomach and duodenum must be next care-
fully examined for evidences of hemorrhages, erosions, tumors,
and of acute or chronic inflammations. The appearance of the
rugae and their interspaces, principally in the region of the
greater curvature, should be noted ; because here traces of poison
and its effects are most frequently seen. If the stomach is in-
flamed, the seat of the inflammation should be exactly specified,
as also that of any unusual coloration.
The condition of the blood-vessels are also noted. Vascu-
laritj- or redness of the stomach after death should not be con-
founded with the effects of poison or the marks of disease. It
may occur in every variet}" of degree or character and still be
within normal limits. Vascularities which we might call nor-
mal are seen in the posterior part of the greater end and in the
lesser curvature, and may cover spaces of various extent.
Rigot and- Trosseau have proven b}' experiment that various
kinds of pseudo-morbid redness may be formed which cannot
be distinguished from the varieties caused by inflammation;
that these appearances are produced after death and often not
374 MEDICO-LEGAL AUTOPSIES— LOOMIS.
until five or eit^-lit hours afterward, and that tliey may be made
to shift their place and appear where the organ was previously
healthy, merely by altering the position of the stomach. Ulcers,
or perforations of the stomach as the results of disease, as also
the digestion of the stomach after death, have been mistaken
for the effects of irritant poisons.
When perforation of the stomach is the result of caustic
poisons, the edges of the opening are very irregular, and are of
the same thickness as the rest of the organ. The parts not
perforated are more or less inflamed, and traces of the action of
the caustic are found in the mouth, pharynx, and oesophagus.
This is the opposite condition to that seen in spontaneous per-
foration.
In considering perforation of the stomach the following
points given by Taylor are well to remember :
(1) A person may have died from perforation of the stomach
and not from poisoning.
(2) A person laboring under disease may be the subject of
poison.
(3) A person laboring under disease may have received blow^s
or injuries on the abdomen, and it will be necessary to state
whether the perforation did or did not result from the violence.
(■4) The perforation of the stomach from post-mortem
changes may be mistaken for perforations from poison.
Corrosives, if they do not produce perforation of stomach,
will generally cause intense inflammation accompanied by soft-
ening of the inner coat, sometimes ending in gangrene. The
inflammation varies as to its extent and intensity, sometimes
affecting principally the mouth and oesophagus, but generallj'
the changes are more pronounced in the stomach and duodenum,
while in rare cases the inflammatory process may extend
through the whole alimentary canal. The mucous membranes
are sometimes bright red with longitudinal or transverse patches
of a blackish color, formed by extravasated blood between the
coats. Carbolic acid often produces in the stomach and oesoph-
agus white patches — when these patches are carefully exam-
ined, an ulcerated surface beneath them is generalh* seen.
Narcotic Poisons. — It is a common but mistaken idea that
these poisons produce some mark or characteristic effect upon
the stomach walls ; that they induce a rapid tendency to putre-
LIVER — PANCREAS. 375
faction ; that the blood is in a fluid state ; that hemorrhages are
seen in various parts; that the stomach and intestines sliow
sloughing without any inflammation. Some of these conditions
may and probably do occur, but they are far from being in-
variable in their appearance. Experiments made by Orfila on
animals with narcotic poisons prove the above statement. In
conclusion, I would emphasize the fact that the narcotic poisons
produce no characteristic changes in the stomach that can
he detected.
The liiver. — The liver should be removed from the body
and no attempt made to examine the organ in situ. After
raising flrst one lobe and then the other, the diaphragm should
be cut on either side and the suspensory and lateral ligaments
divided, then the organ can easily be removed. The weight of
the organ is ascertained, as also the measurements of its size
recorded. The normal weight is from fift}' to sixty ounces.
The organ is normall}?' about twelve inches in length by seven
inches in depth by three and one-half inches in thickness.
The gall bladder is first examined to determine the character
and amount of the bile and the presence or absence of gall
stones, inflammatory lesions, and tumors.
At autopsies the surface of the liver, especiall}" along the
free border, is generally seen to be of a greenish or dark-brown
color. This discoloration is due to the action of the gases de-
veloped by decomposition on the coloring matter of the blood,
and has no pathological significance. The character of the sur-
face of the liver is now noted, whether smooth or rough. The
organ is opened by deep incisions in various directions, and the
color, consistency^ and blood supply of the liver tissue care-'
full}^ recorded. The presence of new connective tissue, amy-
loid degeneration, abscesses, or tumors should not be overlooked.
It should be remembered that, of all the poisons, phosphorus
alone leaves characteristic appearances in the liver.
The Pancreas. — The pancreas is now easily removed, and
its size and weight recorded. Normally it should weigh three
ounces and measure eight inches in length by one and one-half
inches in breadth by one inch in thickness. The organ should
be opened by a longitudinal cut and examined for evidences of
acute or chronic inflammation, fat-necrosis, tumors, calculi, and
amyloid degeneration.
376 MEDICO-LEGAL AUTOPSIES— LOOMIS.
Geni to-Urinary Organs. — It is very important in medico-
legal cases that all the urine should be preserved and obtained
uncontamiiiated ; therefore before the bladder is opened a cathe-
ter should be introduced and the urine dravrn off into a clean
bottle which has previously been rinsed with distilled water.
If more convenient the bladder itself can be punctured at its
upper portion, a pipette introduced, and the urine drawn off in
this manner.
The genito-urinary organs are removed together. This is
done in the following manner. The body of the penis is
pushed backward within the skin and cut off just behind the
glans penis; the remaining portion of the rectum is raised.
This with the prostate gland, bladder, and penis attached is
removed by carrying the knife around the pelvis close to the
bone and separating the pubic attachments. The organs are
then laid on a clean board and the urethra is opened on a
grooved director passed into the bladder, and the incision pro-
longed so that the internal surface of the bladder itself will be
completely exposed. Examine the urethra for strictures, in-
flammator}' lesions, and ulcers. Examine the bladder for con-
gestion, hemorrhages, inflammation, and ulcers of its mucous
surface, and note the thickness of its walls. Open the rectum
and examine for ulcers, strictures, tumors, and the evidence of
hemorrhage. The prostate gland is opened by a number of
incisions into its substance. Examine for hypertrophies,
tumors, and inflammatory lesions. Force the testicles tlirough
the inguinal canal, and cut them off. Weigh, open, and exam-
ine them for evidence of inflammation, tuberculosis, and tumors.
Female Organs. — Before removing these organs, any
abnormalities such as adhesions, malpositions, and tumors
should be noted. Dissect the organs away from the pelvic
bones by carrying the point of the knife around the pelvis close
to the bone. Cut through the vagina at its lower third, and
the rectum just above the anus. The organs can now readily
be removed. Examine the vulva for ulcers, hypertrophies, and
tumors. Open and examine the bladder. Open the vagina
along its anterior border and carefully examine its mucous sur-
face for evidences of inflammation.
The Uterus. — Before opening the uterus, its size and shape
should be recorded. The average normal weight of the organ
THE SPINAL CORD. 377
is about one and one-quarter ounces ; ii^ length three inches,
breadth two inches, and thickness one inch. Open the organ
along its anterior surface bj^ a blunt-pointed scissors passed
through the cervix, and the incision carried as far as the
fundus. Note the thickness of its walls and anj^ abnormalities
of its mucous membrane. During menstruation, the mucous
membrane of the body is thickened, softened, and covered with
blood and detritus. Retention cysts are found in the mucous
membrane of the cervix and are not generally of pathological
significance.
Remove, measure, and weigh the ovaries. Their normal
weight is about one drachm each ; their size, one and one-half,
by three-quarters, by one-half inch. Open the organs b}^ a
single incision and examine for the evidences of acute and
chronic inflammations, tumors, and cysts. The corpora lutea
in various stages can be easil}' recognized in the substance of
the organ. Open the Fallopian tubes and examine their con-
tents and the condition of their membranes (see Disputed
Pregnancy and Delivery, Vol. II.).
The Spinal Cord.
To remove the cord, the body should be placed on its face
with a block beneath the thorax. An incision is made through
the skin and muscles along the entire length of the vertebral
column and the soft parts dissected away so as to expose the
transverse process of the vertebrae. The lamina are divided
with a saw through the articulate process (a double-bladed saw
specially adapted for this work can be obtained). After the
lamina have been complete!}' severed, these together with the
spinoiis process can now be readily torn away with a stout hook
and the cord exposed. A long chisel with a wooden mallet will
often greatly facilitate this work. Great care should be exer-
cised not to injure the cord. The roots of the spinal nerves are
now severed, and the cord removed within its membrane. It
should be remembered that serous fluid within the membranes
of the cord, as also intense congestion, especiall}' along its pos-
terior aspect, is often seen as the result of post-mortem change.
The cord is laid on a clean board and the dura mater opened
with a blunt-pointed scissors along its anterior aspect, and an
examination made for the presence of hemorrhage, inflamma-
378 MEDICO-LEGAL AUTOPSIES — LOOMIS.
tory lesions, and tumqrs. Softening of the cord can generallj-
be detected by the finger passed along it. This, however, is
not a perfectly accurate test, especially if the body has been dead
some time. The cord is now cut by transverse incisions about
half an inch apart throughout its entire length, and the cut sur-
face examined for the evidences of disease such as hemorrhages,
softening, and inflammatory lesions.
After the cord has been removed, examine the vertebral col-
umn for the evidences of fractures and displacements.
LATE AUTOPSIES.
Late autopsies are those performed after partial or complete
destruction of the soft parts of the body, through the natural
processes of decomposition, or the examination of bones ex-
humed long after interment. The term may be employed also
to mean the inspection of an embalmed body, dead for some
time.
The object of late autopsies is to determine identity, or
to establish the guilt or innocence of suspected persons. An
examination of the skeleton even many years after death may
give important information as to the manner in which the
deceased came to his end. This cannot better be illustrated
than by the citation of one or two cases.
In the celebrated case of "Eugene Aram," the bones of his
victim were discovered thirteen years after the crime had been
committed. A man who afterward proved to be Aram's accom-
plice was arrested on suspicion. He confessed the crime, and
the opinion formed by the medical witnesses was confirmed by
his statements. The skull presented evidence of fracture and
indentation of a temporal bone. Aram argued the case in his
own behalf, but the testimony was too strong against him : he
was convicted and executed.
Taylor records the case of a man, Guerin, who was con-
victed of the murder of his brother from evidence obtained
from an examination of the skeleton three j^ears after inter-
ment. Here, again, blows upon the head were the cause of
death, and the fractures were plainlj- perceptible upon the ex-
humed skull.
An autopsy upon a bod}' before the soft parts have been
LATE AUTOPSIES. 379
entirely destroyed, or upon an embalmed body, should be con-
ducted in much the same manner as ordinary autopsies. In
these cases the method of burial should be noted. If it be
a case of murder, and the body has been hurriedly put into
the ground, it is not likely that the custom of Christian nations
has been observed — that of laying the body full length, with the
head to the west.
In the case of partially destroyed bodies, the remaining soft
parts will give little evidence of the mode of death unless the
violence has been very extensive, and even then it may be im-
possible to determine whether a wound was inflicted prior to or
after death. Recourse must be had to the skeleton, and the
only evidence it can furnish is of fractures, unless, as hap-
pened in one case, a rope be found about the cervical vertebrae.
When the skeleton only is found, Taylor lays stress upon
the following points :
(1) Whether the bones belong to a human being or one of
the lower animals.
(2) If a human being, whether male or female.
(3) The length of time they have probably remained in the
ground.
(4) The probable age of the individual to whom they be-
longed. If the maxillary bones be found, much information
may be obtained from an examination of the teeth.
(5) The probable stature of the individual during life.
(6) The race to which he belonged. The conformation of
the skull and thickness of the bones will give important infor-
mation on this point.
(7) It should be determined whether solitary bones belong
to the right or left side, and whether they form parts of one or
more than one skeleton.
(8) Whether they have been fractured, and if so, whether it
occurred during life, or by accident at the time of the exhuma-
tion. If it occurred during life, whether it be recent or of long
standing.
(0) The presence or absence of personal deformities, of
supernumerary fingers or toes, of curvature of the spine, of
ankylosis of one or more joints.
(10) Whether they have been calcined, as murderers some-
times try to make away with the bodies of their victims by
380 MEDICO-LEGAL AUTOPSIES— LOOMIS,
burning. Especially is this the case in infanticides (see
Identity, Vol. I., p. 408 et seq.; Time of Death, Vol. I., p.
452 et seq.).
AUTOPSIES or FRAGMENTS.
These cases are usually cases of murder in the perpetration
of which the criminal has mutilated the body with a view to
destroying all traces of identit5^
The importance which attaches to autopsies of fragments
rests upon the fact that parts of a body may be found widely
separated, and that one portion may be found before the others.
In such cases it will be necessary to determine if they belong
to one and the same body. The examination is conducted
chiefly with a view to establishing this.
The examiner must note the manner in which the fragment
has been separated; whether it is clean cut, as by one who
understood something of anatomy, or, whether it has been sep-
arated roughly and by one ignorant of the body structure. The
determination of this point will be one link in the chain of
evidence which may lead to the detection of the criminal, or the
acquittal of one accused. An anatomist or a butcher would be
likely to cut through at a joint, and to do it neatly. The exact
point at which the severance has taken place should be noted.
The place of finding, the circumstances under which found, the
condition and general appearance of the fragment should all be
carefully recorded. The color of the skin will indicate with
some accuracy the race to which the individual belonged. The
probable sex may be determined bj^ the presence or absence of
hair, and the general conformation. This, however, will not
apply in the case of children. The probable age may be fixed
upon from the size and degree of development of the fragment.
The cut surface should be carefully described, and if possible a
drawing should be made of it.
There are special considerations which apply to certain parts
of the body.
The Head. — The exact point of severance should be re-
corded. The number of vertebrae which remain attached to
the head should be counted, and if the section pass through a
vertebra, its number and the amount of it missing should be
stated. The sex will be apparent in all instances; the race may
MEDICO-LEGAL REPORTS. 381
be determined both by the color of the skin and by the shape of
the head ; the age may be approximated, though care must be
had in expressing an opinion, for the manner of hving is well
known to affect the appearance of age. Evidence of violence
prior to death should be noted, and the presence or absence of
fractures ascertained; also observe the color of the hair and
whether it be thin or abundant; the presence or absence of
beard or mustache, and if present the color; and the color of
the eyes.
The Arm. — The following points should be determined:
the color of the skin as indication of race; the probable sex
from its shape and general conformation; the probable age
from its size and degree of development ; marks of any kind,
such as tattooing; and deformities, such as signs of old or
recent fracture, or dislocation; and supernumerary fingers.
The Leg. — The examination of the leg should be conducted
in much the same manner as that of the arm.
The Trunk. — An examination of the trunk will reveal the
race, sex, and probable age, and may give evidence as regards
the manner in which the deceased came to his or her death.
Any marks or deformities should be recorded, and in all cases
the viscera should be examined.
MEDICO-LEGAL REPORTS.'
After making a medico-legal autopsy, it will be necessary
for the medical examiner to draw up a report of his findings,
and the conclusions based thereon. The report should be clear
and concise, and the language such as a coroner's jury can
understand. Technical terms should be avoided, and when
their employment is necessary they should be explained in the
margin or in parentheses.
The report should be drawn up in somewhat the following
manner :
1. When and under what circumstances the body was first
seen; stating hour of day, day of week and month.
2. When deceased was last seen living, or known to be alive.
' The facts upon which the follow- Stevenson's Taylor, vol. i.,p. 204 et
ing statements are based have been seq.
largely drawn from Taylor. See
382 MEDICO-LEGAL AUTOPSIES— LOOMIS.
3. Any circvimstances that would lead to a suspicion of
suicide or murder.
4. Time after death at which the examination was made, if
it can be ascertained.
5. The external appearance of the body: whether the surface
is livid or pallid.
6. State of countenance.
7. An}' marks of violence on the person, disarrangement of
the dress, blood -stains, etc.
8. Presence or absence of warmth in the legs, abdomen,
arms, armpits, or mouth.
9. Presence or absence of rigor mortis.
To give any value to this point it is necessary for the
witness to observe the nature of the substance upon which the
bod}^ is lying ; whether the bod}' be clothed or naked, young or
old, fat or emaciated. These conditions materially influence
the rapidity of cooling and the onset of rigor mortis.
10. Upon first opening the body the color of the muscles
should be noted. Carbon monoxide poisoning causes them to be
of a cherry-red color.
11. The condition of the blood and its color.
12. The state of the abdominal viscera, describing each one
in the order in which it is removed (seep. 370). If the stomach
and intestines are inflamed the seat of the inflammation should
be exactly specified; also all evidences of softening, ulceration,
effusion of blood, coiTosion, or perforation. The presence of
hardened faeces in the rectum will bear evidence that no purging
occurred immediately before death.
13. The state of the heart and lungs. (For special consider-
ation of the lungs in cases of suspected infanticide, see Vol. II. ;
and of persons drowned, see Vol. I., p. 805 et seq.).
14. The state of the brain and spinal cord.
After a thorough consideration of the results of the exam-
ination, conclusions must be drawn from this examination;
never from the statements of others. The conclusions com-
monly relate to whether death was due to natural or imnatural
causes ; if to unnatural causes, what are the facts which lead
the examiner to this opinion. As the conclusions are intended
to form a summary of the whole report, they must be brief and
tersely stated.
PERSONAL IDENTITY,
INCLUDING
THE METHODS USED FOR ITS DETERMINATION IN THE
DEAD AND LIVING.
BY
IRVING C. R03SE, A.M., M.D., F.R.G.S. (Eng.),
Prof essor of Nervous Diseases, Georgetown University; Membredu
Congres International cV Anthropologie Criniinelle, etc.
PERSOI^AL IDENTITY.
GENERAL CONSIDERATIONS.
Identity is the determination of the individuality of a per-
son. In jurisprudence the term is applied to the recognition
of a person who is the object of a judicial action. The estab-
lishment of the individuality of a person is known as absolute
identity ; while the relations of a person with some particular
act is known as relative identity.
The great number and variety of facts concerned in the
investigation of questions of identity are of considerable gravity
and importance in their juridical bearing, and at the same time
they are among the most interesting and most useful of the
applications of modern medicine to the purposes of the law.'
Among the varied researches of legal medicine looking to
an interpretation of facts, no other question ocgurs in which
the solution depends more upon morphological and anatomical
knowledge, and none is more dependent upon purely objective,
visible, tangible facts.
Personal identity often constitutes the entire subject-matter
of dispute in a civil case. Upon it may depend the question of
absence or of marriage, of kinship or of filiation involving the
possession of an estate, in which case the court often requires
the most subtle of scientific evidence to assist in its decision.
Many anthropological and medical facts, now appropriated by
criminology and penal science, are useful in proving not only
the present but in attesting future identity, thereby preventing
in great lueasure the dissimulation of prisoners, deserters, false
claimants to life insurance, fraudulent pensioners, and the like.
Such matters are of daily occurrence. The special agents
of the U. S. Pension Office detect and cause the punishment of
'Recent attention to such sub- from our own, this fact does not les-
jects by Italian writers places them sen tlie vahie of their medico-foren-
iu tlie foremost rank. Altliough sic literature,
their system of judicature differs
25
;58G IDENTITY — ROSSE.
many fraudulent claimants. Stratagems and conspiracies to
defraud life-insurance companies go much further than mere
substitution. Instead of a " fraudulent" a positive death may
come up for investigation, and in order to defraud an insurance
company of a large amount, a bod}' may even be procured by
homicide to consummate the deception, as was done in the
Goss-Udderzook tragedy near Baltimore in 1872.
A celebrated case now before the Supreme Court of the
United States and involving the question of personal identity
is that of the Mutual Life Insurance Company of New York,
the New York Life Insurance Company, and the Connecticut
Mutual Life Insurance Company of Hartford, Connecticut
(Consolidated), plaintiffs in error, vs. Sallie E. Hillmon.
It is pre-eminently in criminal trials that the personal iden-
tity of the victim often constitutes an essential connecting link.
Before it can move, the law requires, at the outset, proof of the
individuality of both the author of a crime and of the victim.
I shall, therefore, not touch upon such elusive individuals as
Charlie Ross and Jack the Ripper, but limit my remarks to
a sj'uthetical exposition of the best-known facts regarding
identification of the dead body and the interpretation of its
organic remains.
The identity of a living person, or even our own identity,
is often a difficult point to establish. It may also require medi-
cal evidence, oftentimes of a most involved character, to estab-
lish the fact of death. Hence the medico-legal process of con-
necting a dead body, or the remains or traces of the same, with
a human being once known to have lived and moved on earth,
is beset with difficulties that may give rise to still greater
antagonisms of evidence. The question of personal identity is
one of the hardest that could possibly come before a court.
Celebrated cases and judicial errors have given it great noto-
riety. There are consequently few questions in forensic medi-
cine that require more attention and sagacity, and none upon
which the medical legist should pronounce with more reserve
and circumspection. Medical men are absolutely the only
persons qualified to assist in resolving the really delicate ques-
tion of personal identity; yet the phj^sician and the lawyer
pursue the same line of logic and of inquiry. As the former
must have a subject to dissect or to operate upon, so must the
GENERAL CONSIDERATIONS. 387
lawyer in pursuing a criminal investigation first prove a visible
material substance known in legal phraseology as the corpus
delicti, which he must connect with some personality, with
some human being once known to have lived. In this impor-
tant process the physician's testimony being the indispensable
guide of the court's inference, he should limit himself to purely
anatomical and material knowledge. The medical expert has
absolutely nothing to do with guilt or innocence, as that is a
question for the jury. He should, above all things, be abso-
lutely free from prejudice, suspicion, or undue suggestion, and
should remember that in thus sinking his personality his sole
function as a skilled witness in cases of identity is to furnish
testimony which, when taken in connection with other evidence
in the case, may establish such a corpus delicti Si^ would justify
the inference of a crime.
A nice point may arise as to dispensing with the proof
from the body itself, when the substantial general fact of a
homicide is proved aliunde, as in the case of a criminal caus-
ing the disappearance of his victim's body by means of its
decomposition in lime or other chemical menstrua, or by sub-
inerging it in an unfathomable spot in the sea. Under cir-
cumstances such as the following : a person is seen to enter a
building and is not seen to leave it, although all means of
egress therefrom are watched ; another person is seen to ignite
the building, which thereupon burns down, and the charred
remains of a human body are found in the ruins ; the proof of
identity from the body itself might be dispensed with in view
of the substantial general fact of a homicide having been com-
mitted. In a delicate case where the man of art hesitates and
finds no corpus delicti, the investigation of imprints and stains
may give a clew of great value to the expert. Yet it is only
upon absolute evidence, and in the strongest possible case, that
the fundamental principle of the corpus delicti is disregarded.
In the case of Ruloff, the child's body was not produced
and no trace of it could be alleged to have been found ; never-
theless the prisoner was found guiltj^ of murder. This case
was speedily overruled (18 N. Y., 179), on the ground that a
dangerous precedent had been pronounced.
So indispensable is the showing of the corpus delicti in
cases of recognition that lawyers have come to regard even the
388 IDENTITY — ROSSE.
judicial confession of an accused as often the flimsiest and
most unsatisfactoiy kind of evidence. Numerous cases of
demonstrated fallibility of confessions are cited in the books,
where the statement was utterly lacking in anything except
motive or hallucination. In the Proceedings of the New York
Medico-Legal Society, December 6th, 1876, Mr. James Appleton
Morgan mentions the case of a German servant-girl who as-
sured her mistress, whose little boy, a child of seven, had just
died and been buried, that she (the servant) had poisoned the
boy. The servant swore to her crime and was taken into cus-
tody, and it was only when no poison was discovered upon
exhuming the child's body and examining its stomach that
against her own protest she was acquitted of the possibility of
the crime. Another case of the kind that has had medico-legal
notoriety was tried a few years ago before a court in Brittany.
The accused declared that he had killed his servant and thrown
the body in a pond. His guilt seemed certain, when the alleged
victim put in an appearance, thus reducing the evidence to the
strange hallucination that had prompted the confession.
But the most wonderful of these is the celebrated case of
Boorn, in which medico-legal evidence took no part. In view
of the seeming hopelessness of his case, the accused confessed
to murder in expectation of mercy frora the court, but was
finally acquitted on the alleged victim walking into court and
confronting the man who had sworn to having killed him.
Although wisdom and experience point to the necessity of
showing something corporal and material in cases involving
questions of life and death, yet very small traces or minute
remains of a human body may, in certain circumstances, con-
stitute a corpus delicti that may lead to trial if not to convic-
tion. In 1868 the Lambert case, for murder on the high seas,
was tried before Judge Benedict in the United States Court,
the only corpus delicti alleged being a large pool of blood and
brains found on the forecastle of a ship at sea, out of sight of
land or other vessel. Circumstances, acts, and words pointed
strongly to the murder of one of the crew, who was believed to
have been brained with an axe and thrown overboard. Not-
withstanding the fact that animosity was known to exist be-
tween the accused and the missing man, it further appeared
that the accused, in a state of great excitement, had followed
IDENTITY OF BURNT REMAINS. 389
the missing man forward and returned alone with a hatchet in
his hand, yet the jury in this instance were not satisfied as to
the establishment of a corpus delicti beyond a reasonable doubt
and accordingly failed to convict.
Two classical cases, that of Gardelle and of Dr. Webster,
mentioned in many of the books, stand forth as instances of
conviction where fragments of the human body were recognized
after attempts to destroy" them by intense heat. The conviction
of Dr. Webster rested almost entirely upon medico-legal evi-
dence; but it is probable that upon the same circumstantial
evidence the increased industry of counsel would have so rung
the changes in regard to its uncertain and unsafe nature, and
would have so used the knowledge gained from advanced dis-
coveries in the regions of the probabilities of science, as to
have secured the acquittal of the prisoner had the trial taken
place at the present time.
A similar affair of great medico-legal interest is the Goss-
Udderzook tragedy, already referred to, an account of which is
given by Drs. Lewis and Bombaugh among the " Remarkable
Stratagems and Conspiracies for Defrauding Life Insurance
Companies," New York and London, 1878.
IDENTITY OF BURNT REMAINS.
The medical jurist will no doubt find cremation a formida-
ble barrier in elucidating the question of identit}^, although the
entire destruction of a dead body is a matter of extreme diffi-
culty.
In the case of calcination chemical analysis of the ash
"would detect the phosphate of lime, but this would throw no
light upon the subject, since the ash of human bones and that
of the lower animals is identical. If the burnt bone is entire,
the state of the epiphyses may enlighten the question of the
determination of age. The following two cases, in which frag-
ments or portions of bone had been submitted to the action of
fire, show how medical training and some knowledge of com-
parative anatomy may contribute to the establishment of guilt
or ma}' attest innocence.
In the case of The Queen vs. John Henry Wilson, for
murder, the accused burnt his step-father in a lime-kiln foi
;J90 IDENTITY — ROSSE.
over a week, and on strewing ashes from the kiln fine frag-
ments of bono picked up wore afterward identified as human.
At the trial identity rested on the fact of finding two buttons
and a buckle, which were recognized as part of the deceased's
wearing apparel when last seen.
In the second case, that of a young woman supposed to be
in the family way who should not have been, it was thought
that she had been confined and made away with the infant.
Under this supposition the premises where she lived were
searched by the chief constable, who found in the stove some
bones and fragments of bones that had been burnt. On exami-
nation by a qualified medical man, the fragments turned out
to be not human bones, but those of some other animal, presum-
ably those of a pig and of a chicken, which the family, who
lived in a tenement-house without a back yard, had put in the
stove to get rid of the refuse. '
IDENTIFICATION OF HUMAN BONES.
In deciding whether certain bones are human or not, the
medical jurist should exercise great caution in venturing an
opinion as to the precise animal of which he may believe they
formed a part. There is no great difficulty in detecting the-
smallest fragments of bone by means of the microscope, but we
cannot say with safety whether the fragments belonged to
a mouse, a man, or an elephant. A real difficulty occurs in
recognizing the nature and origin of the bony remains when
only a small fragment or a single bone is submitted for report.
If a sufiicient portion of the skeleton be submitted it can be
easily recognized as human, as in the imbedded remains of the
troglodyte found in the limestone deposit of Luray Cave, Vir-
ginia, and only in the exceptional case of the bones of one of
the manlike apes could a difficulty of distinction arise. The
characteristic signs that distinguish a goriUa skeleton, for in-
stance, are the smaller thumb ; notable length of tibia and of
radius, although this relative length of extremities has been
remarked in negroes ; small facial angle, 30° to 40° in the mon-
key, 70° to 80° in man; ver}' inferior cranial capacity, the
maximum in a gorilla being 550 cubic centimetres, while the
'Canada Med. and Surg. Journal, 1875, vol. iii., pp. 56-60.
IDENTIFICATION OF HUMAN BONES. 391
minimiim in the human species is from 970 with a maximum
of 1,500 to 1,900 centimetres; a low index of the foramen mag-
num ; convexity of the squamo-parietal suture, and larger and
more salient canines and incisors. The volume of the endo-
cranium in the female gorilla, like that of the human species,
is smaller than that of the male ; this difference being almost
80 c.c. for the anthropoid female.
In studying the osseous system it should be remembered
that certain modifying elements, as artificinl compression, patho-
logical deformities, . posthumous distortions, and hygrometric
conditions, may affect particularly the skull, and if due allow-
ance be not made for these the study may lead to glaring absurd-
ities. Not longer ago than 1725 there was found in a quarry
at CEningen the skull of a fos'feil batrachian compressed into
rude resemblance to the human cranium, which was announced
to the world as Scheuchzer's "Homo diluvii testis et theo-
scopos," and as the remains of one of the sinful antediluvians
who perished in the Noachic deluge.
Are the Bones Old or Recent?
An important point may arise in questions of identification
of bones as to the oldness: whether they are old or recent.
The first indication is furnished by the presence or by the
absence of the soft parts. The existence of the periosteum and
of the spinal marrow is the most persistent proof of a recent
state ; but these alone with the soft parts are usually destroyed
in two or three years. In ordinary circumstances a body be-
comes skeletonized in about ten years, although in exceptional
cases the cadaver may resist decomposition after many years.*
This summer in transferring an old cemetery in George-
town, D. C, the remains of the grandmother of one of the
writer's patients were found in such a state of preservation as
to be easily recognized after fifty years of burial. More re-
cently, in unearthing the remains of an old grave-yard in East
Washington, a striking peculiarity was noticed in the fact that
many bodies of young people buried in recent years when taken
up consisted of a few blackened bones and shreds of grave-clothes,
' Some interesting facts by Dr. be found in the Boston Med. axid
W. H. Holmes regarding "The Con- Surg. Journal, July 28d, 1891.
dition of Bodies Long Buried " may
392 IDENTITY — ROSSE.
while the remains of many older people buried long before the
Civil War were found in an excellent state of preservation. One
of these was a Mr. Fullin, who died from the effects of a sun-
stroke forty years ago and was buried in a metallic case. An
old ladj' who attended his funeral was present when his re-
mains were unearthed and said thej" looked as natural as when
he was laid away in 1852. The features were well preserved
and even the white linen of the shroud was unsoiled.
Alterations in the texture of the bone, such as that caused
by dryness and by diminution in the proportion of organic
matter, may be ascertained by histological examination, and
one of the characters of age may be furnished b}' taking into
consideration the specific weight. Placing the skull at an
average density of 1,649, that 6f an infant would be 1,515, an
adult 1,726, and that of old age 1,636.
Ascertaining the proportion of organic and inorganic mat-
ter, the phosphates and carbonates, by chemical means may
furnish an additional help in the interpretation of the remains.
With all these diagnostic methods it may still be impossible
to establish identity either absolute or relative, even where a
whole skeleton is in question. The evidence may, however, be
of great juridical use to the accused, as in the case of Van
Solen, tried for the murder of Dr. Henry Harcourt, where the
collective facts pointed to the identification of a body dead two
years. The jury, however, after a second trial, were instructed
to acquit unless they were certain that the remains were Har-
court's. They acquitted, as no one decided and apparent fea-
ture was known to have existed by which the remains could be
identified beyond a doubt.*
Identity in Case of Entire Skeleton or in Case of
Isolated Bones,
Where an entire human skeleton ,has been discovered, the
objects of inquiry here, as in the case of fragments or remains,
are to establish the identity of the victim and that of the author
of the act, and to collect all available information relative to
the nature of the death and to the diverse circumstances attend-
ing the commission of the deed.
'Quar. Journal of Psychological Medicine, N. Y., 1869. vol. iii.. p. 691.
DETERMINATION OF RACE. 393
In gathering evidence from the examination of the skeleton
or of isolated bones, with a view to find out the proba,bl<^ cause
of death of the person of whom they form a part, a great vari-
ety of questions will arise for consideration, such as those relat-
ing to race, stature, age, sex, and trade or occupation; the
exterior signs furnished b}' dentition ; the traces of congenital
peculiarity or of injury, and the signs of disease either heredi-
tary or acquired.
Determination of Race.
The question of race in connection with the subject of iden-
tification is of more than usual importance in the United States,
owing to our motley population, composed as it is of aboriginal
Americans, Chinamen, negroes, and of Europeans and their
descendants. I well remember the first human bones that I
saw exhumed. They were discovered in digging the foun-
dation of a building near a kitchen-inidden on one of the
tributaries of the Chesapeake Bay. The apparent oldness of
the bones and the finding of stone arrow-heads, tomahawks,
and fragments of aboriginal potterj" in the immediate vicinity
were additional accessor}' facts that strengthened the presuinp-
tion of the bones being those of a Choptank Indian.
Roughly speaking, there is not much trouble in recognizing
the platycnemic tibite of the mound-builder, the skull of a
Flathead Indian, an Inca skull, a negro skull, or even the
skull peculiar to the lower order of Irish.
In many very old skulls a considerable portion of hair is
often found attached. This of course may lend assistance in
the matter of race identity. A few years since I undertook
at the Smithsonian Institution a series of micro-photograijhs
of the structure and arrangement of hair, with a view to race
classification as suggested by Professor Huxley. Various
specimens of hair from the yellow races were compared with
that of fair and of blue-ej^ed persons, with the hair of negroes,
with reindeer hair, and with the hair-like appendage found on
the fring}' extremity of the baleen plates in the mouth of a
" bowhead" whale. The experiments, though far from satisfac-
tory, were sufiicientl.y conclusive to enable one to recognize ap-
proximately the horse-like hair of some of the j^ellow races,
that of the negro, and that of a blond Caucasian.
394 IDENTITY — ROSSE.
Beyond the forementioned characteristics, the task of race
recognition from observation of the skull is one of great diffi-
culty and perplexity with illusory results. A considerable ex-
perience of several years with the large collection of skulls in
the Army Medical Museum enables me to speak advisedly on
this point.'
Although the technical procedures of craniometry require
special measurements and employ an arsenal of special instru-
ments, the results are far from conclusive as regards the deter-
mination of human types. Time and space do not permit the
mention even in epitome of the various methods most relied
upon by trained craniologists. Among the oldest operations of
cephalometry, as well as the most incomplete, is the measure-
ment of the so-called facial angle, which is employed to distin-
guish the skull of a lower order of animal from that of the
negro and the white man. This angle, acute in the skulls of
the lower animals, approaches a right angle as w^e ascend the
zoological scale; being from 30° to 65° in the various apes; 75°
in the Mongolian ; about 70° in the negro, and between 80° and
90° for whites. The prognathous (projecting) jaws of the negro
cranium are distinctive, as well as the shape of the nasal open-
ing, which in the black is an equilateral triangle, while it is
isosceles in the white. The books usually speak of the Eskimo
skull as pyramidal, which in point of fact is not true. Inspec-
tion and examination of a large collection of Eskimo crania has
changed and greatly modified some of the previous notions of
the conventional Eskimo skull. Froin more than one hundred,
collected in the vicinity of Bering Strait," I find that the skulls
present very considerable variations among themselves ; some
being brachycephalic, others dolichocephali(\ In many the
facial angle is 80°, and in one instance 84°, which exceeds that
observed by me in many German skulls. Nor is the promi-
nence of the zygomatic arches such a constant difference in the
configuration as to justify one in speaking of the skull as pyra-
midal. On the contrary, in many of the specimens lines draw^n
from the most projecting part of the zygomatic arch and touch-
ing the sides of the frontal bone, instead of forming a triangle
'See writer's article, "Cepha- "-See writer's "Cruise of the
lometry, Craniometry," in "Refer- Corwin " to Alaska and the North-
ence Handbook of the Medical west Arctic Ocean, Washington,
Sciences. " 1883.
DETERMINATION OF RACE. 395
on being elongated, might, like the asymptotes of a parabola,
be extended to infinitj- and never meet. The index of the fora-
men magnum in these skulls is about the same as that of
European crania. The internal capacity shows marked differ-
ence, the cubic contents of the endocranium averaging that of
the French or Germans.
As some modern writers lay great stress on the measure-
ment of the cranial capacitj^, not onty as an aid to race identifi-
cation, but as an adjunct in the study of the criminal and
insane classes, it may not be amiss to give the salient facts
relative thereto.
It is admitted that the cranial capacity may vary with the
intellectual state, hydrocephalic skulls, of course, being ex-
cluded. Microcephalic adults give a figure inferior to that of
gorillas, some being as low as -419 c.c. Andaman Islanders
and autochthonous Australians appear, in respect to cranial
capacity, to be most badly off. The capacitj- of an Andaman
has been found as low as 1,094 c.c. ; while that of Australians
(autochthonous) and of some American tribes show an average
capacity of 1,224 c.c. in the normal as well as in their deformed
crania. The cranial capacity increases in the yellow races and
attains its maximum in the white races. In the middle Euro-
pean race 1,500 c.c. maj^ be accepted as the average; 1,750 c.c.
is the maximum, and anything above is macrocephalic ; while
the minimum is 1,206 c.c, which is rather too low than too
high. According to Topinard's nomenclature of the cranial
capacity, macrocephalic in the adult European male are those
having a capacity of 1,950 c.c. and above; a large skull is one
of 1,950 to 1,650 c.c. ; average or ordinary, 1,650 to 1,450 c.c. j
small, 1,450 to 1,150 c.c. ; microcephalic 1,150 c.c. and below.
It would seem that the skulls of the insane are below the type,
a measurement of sixteen male skulls giving an average of only
1,449 c.c. Scotchmen head the list with the most voluminous
skulls, and according to a tabular statement made up from
Welcker, Aitken, Broca, and Meigs, the English come next,
with a capacity of 1,572 c.c. Then follow Eskimo, 1,483 c.c. ;
Germans, 1,448 c.c. ; French, 1,403 to 1,461 c.c. ; South African
negroes, 1,372 c.c, ; Ancient Peruvians, 1,361 c.c. ; Mala}", 1,328
c.c. ; Mexican, 1,290 c.c. ; Hottentot and Polynesian, each 1,230
c.c. ; Australians, 1,364 c.c. ; and Nubians, 1,313 c.c. The cranial
396 IDENTITY — ROSSE.
capacity in man, like that of the anthropoid apes, varies accord-
ing to sex, the difference being so great that it is necessary to
measure separatel}'.
In the troglodyte skulls of prehistoric times the variation is
not more than 99,5 c.c. ; but in the contemporaneous races the
difference varies from l-io to 220 c.c. French craniologists
usually speak of the Auvernats as possessing the highest cere-
bral capacit}' (1,523 c.c), and mention the skull of a Parisian
of 1,900 c.c. as the highest known. Some Eskimo skulls, how-
ever, measure from 1,650 to 1,715 c.c, and two eurycephalic
Indian skulls in the anatomical section of the Army Medical
Museum measure respectively 1,785 and 1,920 c.c.
Mr. Havelock Ellis, speaking of the psychic characteristics
of criminals, saj's that the lower human races present a far
larger proportion of anatomical abnormities than the ordinary
European population; and Sir William Turner writes of the
skulls collected during the Challenger expedition that although
their number is certainly too limited to base any broad general-
ization on, as to the relative frequency of occurrence of partic-
ular variations in the different races, there is obviously a larger
proportion of important variations than would occur in a cor-
responding number of skulls of the white races. Thus, for
example, the squamo-frontal articulation is found in less than
two per cent of European skulls, while it is found in twenty
per cent of negroes, according to Ecker, and 16.9 in Australian
skulls, according to Virchow. Again, the spheno-pterygoid
foramen is found in 4.8 per cent of European skulls and in 20
per cent of American Indians; 30 per cent in Africans; 32 per
cent in Asiatics, and 50 per cent in Australians. The wormian
bones are also more common among the lower races ; as a rule,
the cranial sutures coalesce much earlier and the teeth are
more precocious.
Photography, though of undoubted service in craniom-
etry, has been applied as a crucial test in the matter of identity
and found wanting. It is objected to on the ground that it has
no character of precision, and that photographs of the skull
have the common defect of being central, not orthogonal pro-
jections, such as anthropometry requires. Besides, the lenses
of cameras are not uniformly perfect. Anatomists know, more-
over, that salient differences in any collection of crania prevent
DETERMINATION OF RACE. 397
methodical enumeration and constitute tiie stumbling-block of
ethnic craniology. Cephalometry shows, further, that dolicho-
cephalic, mesaticephalic, and brachycephalic skulls do not be-
long exclusively to the white, the yellow, or the black race, but
exist among the three as a result of evolution.
On this subject Professor Lombroso, among the foremost
contemporaneous medico-legal writers, cites the cranial asym-
metry of Pericles, of Romagnosi, of Bichat, of Kant, of Chene-
vix, and of Dante, who presented an abnormal development of
the left parietal bone and two osteomata on the frontal bone.
Besides, there is the Neanderthaloid skull of Robert Bruce and
the ultra-dolichocephaly noticeable in the skull of O'Connell,
which contrasts with the mesocephaly of the Irish. The me-
dian occipital fossa is noticeable in the skull of Scarpa, while
Volta's skull shows several characteristics which anthropolo-
gists consider to belong to the lower races, such as prominence
of the styloid apophyses, simplicity of the coronal suture, traces
of the median frontal suture, obtuse facial angle (73°), and
moreover the remarkable cranial sclerosis, which at places at-
tains a thickness of IG mm. (five-eighths of an inch). Further
mention is made of the submicrocephaly in Descartes, Tissot,
Hoffman, Schumann, and others.
De Quatrefages noted the greatest degree of macrocephaly
in a lunatic, the next in a man of genius. Cranial capacity in
men of genius is usually above the average, having been found
as high as 1,6G0 c.c. in Thackeray, 1,830 c.c. in Cuvier,
and 2,012 c.c. in Tourgueneff. The capacity is often found
above the average in insanity, but numerous exceptions occur
in which it drops below the ordinary average, as in the submi-
crocephalic skulls of Liebig, Dollinger, Hausmann, Gambetta,
Dante, and Shelley.
From what has just been said, it follows that skull measure-
ments for medico-legal purposes have no more significance than
the fact that some men are taller and some shorter than others.
The medical jurist should, therefore, not be too dogmatic in
drawing conclusions as to race from the skull alone. To com-
plete the diagnosis in the matter of skeletal race peculiarity, the
splay foot of the negro with the unusual backward projection of
the heel-bone, as well as the greater relative length of the tibia
and of the radius, may be taken into consideration. There are
398 IDENTITY — KOSSE.
other characteristics of the lower jaw and of the facial bones
generally, the study of which leads up to the realm of tran-
scendental anatomy ; so their further consideration would hardly
appeal to the " dispassionate, sympathetic, contemplative jury"
of our enlightened countrymen.
Determination of Height or Stature.
When we have the entire skeleton to deal with, the height
or stature ma}^ be determined with a reasonable degree of cer-
tainty by allowing from one to two inches for the soft parts.
Most of the proportions given in works on artistic anatomy
approach mathematical exactness. For instance, if both upper
and lower extremities are extended after the manner of spokes
in a wheel, and a point corresponding to the umbilicus be taken
as a centre, the circumference of a circle described therefrom
should touch the bottom of the feet and the tips of the middle
fingers. When the arms are extended horizontally the line
included in the middle-finger tips equals the height in the
generality of men, although in exceptional cases it may var}'.
The negro giant, Nelson Pickett, is reported to have been eight
feet four inches high, w^hile his outstretched arms measured
nine feet from tip to tip. Ordinaril}" the upper part of the
symphysis pubis is the centre of the bod}'. Some anatomists
contend that this important point is realh' below the symphysis
in the average man. The length of the foot about equals that
of the head. According to Quetelet, its length is just one-ninth
of the body in women, a little more than one-ninth in men.
The conventional representation of the human foot with a sec-
ond longer toe is, according to Professor Flower (see " Fashion
in Deformity ") , of negro origin and does not represent M'hat is
most usual in our race and time. Statistics of measurements
made in England by several observers on hundreds of barefooted
children fail to show one instance in which the second toe is
the longer.^
Taken singly the bones may enable an approximate estimate
of the height of the person when alive; but it should be remem-
bered in connection with this subject that the height is not a
' See wi-iter's article, "Feet," iu cal Sciences :" also, Ellis, T.S., "On
"Reference Handbook of the Medi- the Human Foot. " London, 1889.
DETERMINATION OF AGE. 399
fixed quantity, since it differs according to upright or recum-
bent position, also before and after a night's rest. Moreover,
the alleged height of the deceased may have been taken in boots
and is probably incorrect.
Many tables of measurements have been constructed for the
purpose of determining the height from the dimensions of the
bones; but the relation that exists between the total height and
the dimensions of different bones varies according to age, sex,
asymmetry, and individual peculiarities, hence the tables will
not bear the critical examination that warrants their use with
assur^ correctness, even in a majority of cases. The femur
is the bone that gives the best results in these measurements.
Isolated fragments have been included in the enumeration ; the
nose and the middle finger multiplied by 32 and by 19 or 20
giving the approximate height. While the foregoing calcula-
tions will not bear scientific scrutiny, they are of sufficient im-
portance to be taken in connection with other facts in deter-
mining the probable length of the skeleton. Among the most
trustworthy of these tables are those of Dr. Dwight, of Harvard
University.
Determination op Age.
The age is a still more difficult matter to state precisely.
Even during life one may be as much as ten years out in guess-
ing tlie age of an adult, while the error may be from fifteen to
twenty years in the case of a corpse. Dr. Tourdes mentions a
case where the age was guessed as sixty and sixty-five in a
deceased person aged eighty-five.
The state of the osseous system and the condition and num-
ber of the teeth, which strictly speaking are not bone, are
among the surest guides in the determination of age. The
signs furnished thereby may vary according to the periods of
increase, maturity, and decline.
During foetal life and even at the epoch of birth the bone
centres are few. The distal end of the femur, the proximal
end of the tibia, and the astragalus are ossified at birth. Points
of ossification appear in successive order of development. The
exact period at which the bones begin to ossify and the prog-
ress of bony union being detailed in standard works on anat-
omy, it would be superfiuous to repeat them here. These
400 IDENTITY — ROSSE.
changes are, however, not absokitely certain as to time and or-
der, as the tip of the acromion process of the scapula sometimes
remains ununited throughout life ; the ossification of the sternum
and of the costal cartilages is very uncertain, while the teeth,
like certain railway trains, are only due when they arrive.
From the character of the progress of consolidation of the
skeleton the age may be estimated with a reasonable approach
to accuracy up to twenty-five or thirty years, which is the sta-
tionary period as regards alteration in the osseous system.
Above this period it is difficult to arrive at the age. About
forty the cranial sutures ' begin to disappear, although i^e time
of the closure of the sutures varies within large limits; the
coccyx becomes consolidated ; ossification begins in the thyroid
cartilage and in that of the first rib (although this state of the
rib is regarded by many as pathological) ; the lower jaw, which
in the foetus and in infancy formed an obtuse angle, now as-
sumes nearly a right angle. As senility progresses toward
decrepitude, the bones become lighter and more brittle, owing
to fatty atrophy, and their medullary canal larger; the jaw
returns to its infantile shape from loss of teeth and atrophy of
the alveolar processes ; the bodies of the vertebrae (according to
some authorities) bevel off in front; osteophytes are formed,
and the neck of the femur approaches the horizontal. (See
Abortion and Infanticide.)
Determination of Sex.
In the matter of sex there should be no difficulty, after
noting the proof furnished by the aggregate characteristics of
both male and female skeletons. The points of contrast between
the two skeletons are not so striking before the age of puberty.
Generally speaking the cranial capacity of an adult woman is
less, although it is contended that since the great majority of
males of the human species are taller, heavier, and larger than
the females, it follows that if due allowance be made for these
variations, it will appear that the brain capacity of woman is
relatively very little, if at all, inferior to that of man. The
mastoid processes of the female skull are smaller; the lower
^ See Dwight : "The Closure of Age, " Boston Med. and Surg. Jour-
the Cranial Sutures as a Sign of nal, April 29th, 1890.
DETERMINATION OF SEX. 401
jaw-bone is relatively smaller and lighter; the ribs are lighter
and compressed ; the spine is relatively longer ; the collar and
shoulder bones and the sternum ' are smaller and lighter ; there
is a less pronounced angle in the femur, the neck of which
approaches a right angle, while smallness of the patella in front
and narrowness of the articulating surfaces of the tibia and
femur, which in man form the lateral prominences, are said to
make the knee-joint in women a sexual characteristic. But it
is the striking contrast in the pelvis that furnishes a sexual
significance that is of greater value than all the rest of the skele-
ton together. From a glance at the text-book account of the
pelvis, it does not appear that much anatomical knowledge is
necessary to identify the important points that give shape to
the female pelvis. Its greater diameter (except the vertical),
larger and more curved sacrum and coccyx, and great spread
of the arch of the pubes are well-nigh incontestible signs. The
differences as detailed in the books can be objected to only on
the possibility of a so-called hermaphrodite pelvis in one of the
other sex. We sometimes see a very large pelvis in a subject
who by a teratological freak became a man. Masculine char-
acteristics are, however, oftener found in women than feminine
characteristics in men ; hence the conclusion that the presence
of feminine characteristics leaves but little doubt as to the sex,
but that certain masculine indications, while giving a great
probability for the male sex, are not absolutely decisive. (See
Hermaphroditism.)
The finding of foetal bones around or about the supposed
female skeleton is suggestive. It could not be inferred from
this fact alone that the woman was or was not pregnant at the
time of death, since the absence of foetal remains on the one
hand might imply their entire decomposition in advance of
those of the adult; on the other hand, the indiscriminate habit
of undertakers, who often bury still-borns with adults, may
account for their presence.
Accidental Signs and Evolution of the Teeth.
The trade or occupation leaves but few marks on the bones
that are useful in the matter of identification. It is in the
' See Dwight : " The Sternum as Journal of Anatomy and Physrol-
an Index of Sex, Height, and Age," ogy, vol. xxiv.
26
402 IDENTITY — ROSSE.
recent and well-preserved cadaver, or, better still, in the living
subject, that the professional signs are of importance. As a
rule, the relatively larger scapulae point to the fact of a day-
laborer; necrosis of the lower jaw suggests a worker in phos-
phorus ; worn and discolored teeth a user of tobacco, and auri-
tication of the teeth might suggest the previous social condition.
Gold crowns and fillings and dental prosthesis generally are
among the most common and, at the same time, among the most
useful signs of identification. By this means the bones of per-
sons killed by Indians on the Western plains have been recog-
nized years afterward. The traveller Powell, massacred in
Abyssinia, was recognized in this way. From the presence of
artificial teeth and the mechanical appliances for fixing them,
dentists may recognize their own work beyond a doubt. One
of the most common-hackneyed of these cases is that of Pro-
fessor Webster.' Later cases, in which this kind of proof es-
tablished convincing and conclusive identification, are those of
Dr. Cronin, assassinated in Chicago in 1889, and of the bomb-
thrower, Norcross. Every now and then accounts appear in
the daily press of corpses having been recognized by inspection
of the teeth. In Washington, only a short time since, the re-
mains of an unknown man were exhumed from the Potter's
Field for judicial reasons. The unrecognized body had been
found in the Potomac in an advanced stage of decomposition.
From the signs furnished by the teeth the remains were identi-
fied as those of a person who had disappeared mysteriously and
under circumstances that pointed to his having been murdered
at a Virginian gambling den, and his body thrown into the
river. In connection with this subject the Goss-Udderzook
tragedy is of instructive interest.
In every important case a cast of the mouth should be taken,
in order to set at rest any question that may subsequently arise
as to the condition of the jaw, the absence of teeth, their irreg-
ularity or other dental peculiarities. A cast of the mouth of
the deceased in the Hillmon case showed all the teeth to be
regular and perfect, while it is alleged that Hillmon 's teeth
were just the opposite. External signs furnished by dentition
may assist greatly in fixing both age and identity. The evo-
lution of the human dental system has been so well studied
' Boston Med. and Surg. Journal, March, 1850, toI. xii., p. 162.
ACCIDENTAL SIGNS. 403
from intra-uterine life to old age that we maj^ approximately
tell the age, especially of children, from the teeth alone. This
sign, so valuable in childhood, loses its value as the dentition
progresses. Elaborate tables and dental formulte to be found
elsewhere deal with the two periods of dentition, the relative
position and number of the teeth, and the like.
At birth the jaws show points of ossification only ; but chil-
dren are sometimes born with central incisors, as the writer has,
in common with others, noted in several instances. The first
dentition takes place from the seventh to the thirtieth month;
the second between four and five years. In rachitic children
these periods are later ; but a syphilitic taint may hasten their
development. The twenty-eight teeth characterize early youth.
Wisdom teeth appear between eighteen and twenty-five, some-
times as late as thirty j-ears. The presence of thirty-two teeth
indicates maturity. This number is sometimes exceeded. Dr.
Tidy, in his work on "Legal Medicine," reports having seen
several children between six and seven years with forty-eight
teeth. Instances are recorded of cutting the teeth at advanced
age, seventy and one hundred and eighteen years; of adults
who have never had teeth ; of supernumerary teeth, and of a
third dentition. What purported to be a third dentition came
under my notice some years ago, in the person of an old negro
"voodoo doctor." A more recent case, said to have occurred in
an old man of seventy-four, at Se^anour, Ind., is reported in
the Weekly Medical Bevietv, St. Louis, Mo., April IGth, 1892,
p. 314.
The pathological signs furnished by the teeth should, of
course, be looked upon as a personal characteristic that may
lend additional light in the question of identity.
Congenital Peculiarities, Deformities, and Injuries.
But congenital peculiarities or injuries of other parts of the
skeleton are studied to greater advantage in determining proof
or disproof of identity. We may recognize cranial asymmetry ;
the peculiar conformation of the idiot skull; the prognathous
skull of the negro ; the pyramidal skull of some of the yellow
races, and the oval head of the white man ; besides the ethnic
artificial deformities already touched upon in considering the
404: IDENTITY— ROSSE.
question of race. A metopic cranium, a cleft palate, a deformed
spine or pelvis, a larger left scapula — indicative of left-handed-
ness; a shortened extremity; bowed legs, club foot, the pres-
ence of extra fingers or toes, and the relative length of the
fingers are each and all valuable facts in judiciary anthropology.
In women of Spanish extraction the fifth finger is almost as
long as the fourth — a fact so well known that glove-makers
take advantage of it in sending gloves to Mexico, the Antilles,
or to South America.
An estimate of the length of the hand seems to be a matter
of difficult}^, notwithstanding the extensive observation of high
authority. In the majority of cases the ring-finger is longer
than the index.
Important evidence is furnished from the existence of in-
juries such as fractures, whether old or recent ; the marks of
gunshot wounds, of trephining, amputation, excision, or other
surgical operation on the bones. The remains of an old, un-
united fracture in his left humerus enabled Sir William Fergus-
son to verify and settle all doubt as to the identity of the body
of the great missionary and explorer, Dr. Livingston.' The
existence of an injury may constitute evidence of great impor-
tance to the accused, as happened in the case of an English gen-
tleman charged with murder, where the trial turned on the
deposit of callus in a broken rib, the only bone produced in
court. From the state of this callus there could be no doubt
that the fracture must have been produced about eight or ten
days before death, and could not have belonged to the deceased.
There was, therefore, complete failure of the identity, and the
accused was discharged.^
On the other hand, circumstances may arise in which the
existence or not of an injury is a fact of great importance to the
prosecution. Among other specimens in the Army Medical
Museum at Washington, the bones of the forearm of Wirtz,
executed for inhuman treatment of prisoners during the Civil
War, show no remains or trace of fracture; yet it was claimed
in defence at the trial that he could not have been guilty of the
atrocities attributed to him, for the reason that this arm was
disabled from a fracture.
'The British Medical Journal, - Taylor's "Med. Jurisprudence, "
April 18th, 1874, p. 527. vol. i., p. 157.
DURATION OF BURIAL. 405
Disease of the bones, whether hereditary or acquired, is
an essential descriptive element in reconstituting individuality.
Caries and necrosis, rickets, spinal disease, ankylosis, and other
external manifestations of bone lesion may furnish pointers of
such value as often to be incontestible. They are so evident as
not to require detailed mention ; but much care in such cases is
necessary to distinguish between disease, decay, and violence,
and. artefacta. The last may have resulted from the axe or
spade of the grave-digger or from post-mortem lesions made
at the necropsy, as in the remains of the notorious Beau Hick-
man of Washington, whose body on being exhumed showed
that sundry amputations and reamputations had been made
on the principal limbs. Having died in a public hospital, the
cadaver had been utilized in rehearsal of these operations previ-
ous to its burial in the Potter's Field.
Injuries of the phalanges, known as "baseball fingers," are
valuable indications. This was one of the facts of identifica-
tion in the celebrated Cronin case.
Duration of Burial.
The condition of the exhumed bones may throw some light
on the question as to the probable length of time thej^ have
been under ground, as well as the probable cause of death. If
the bones were entirely denuded of soft parts we should hardly
expect them to be those of a corpse buried onl}^ three or four
months previously. The noting of such an injur}' as a fracture
inflicted by some sharp instrument on a skull found in a cess-
pool was sufficient, with other evidence of a general character,
to convict a prisoner tried at the Derby Lent Assizes in 1847.
In all cases of the kind under consideration, special atten-
tion should be paid to the surroundings, every little detail of
which should be noted with the utmost accurac}^; for such
articles as clothes, jewelry, buttons, and in fact anything that
may furnish an inference,* may not only throw light on the
identit}' of the person, but otherwise assist justice. Cases are
recorded in which the identity has been established principally
b}^ the clothing found with the skeleton. In Taylor's " Medical
' Theatre-goers are familiar with tity by means of traces of a perfume
the establishment of personal iden- in the play of "Dii^lomacy."
406 IDENTITY — ROSSE.
Jurisprudence" a case is mentioned where the skeleton, por-
tions of clothes, buttons, and boots of a Cornish miner were
identified after twenty-six years' submersion in water. Some-
what similar circumstances, a few years ago, enabled the arctic
explorer, Lieutenant Schwatka, and others to identify the re-
mains of Lieutenant Irving, of the ill-fated Franklin part}'.
In exceptional circumstances, as that of great cold, for in-
stance, organic remains ma}^ be preserved indefinitely. Visitors
to the Junior United Service Club in London may remember
the mammoth bones discovered in digging the foundation of
the club-house. Accounts of remarkable preservation of bodies
discovered a long time after the occurrence of Alpine accidents,
and the finding of well-preserved mammoth remains in the
Siberian ice, are matters of common knowledge. A few years
since, in assisting to take the remains of a mammoth from an
ice cliff in Escholtz Bay, Alaska, I came across the skull of a
musk-ox and the rib of a reindeer which showed the deformit}'
and callus of a united fracture, yet there are geological reasons
for believing that thousands of years must have elapsed since
these remains were entombed in the ice.
A precaution to be taken in judicial investigation of bones
is to ascertain whether thej" belong to more than one body, as
they may have been put together with a view to deceive. Each
bone should be examined separately, to ascertain whether it is
a right or left bone or belongs to the same skeleton. They
should be put together with intelligence and care, and if in-
complete parts of a skeleton they may be laid in sand or putty
and photographed, or the medical man may go further and,
Agassiz-like, reconstruct the skeleton from the fragments. In
the case of a fracture the bones should be sawn longitudinally
in order to study the callus.
THE HAIR AND NAILS.
Since the hair and nails resist decomposition an unusually
long time, and are even believed to grow after somatic death,
they may be considered as accessories of such value in the
question that occupies us as to make it possible to verify certain
characteristics regarding the remains of the cadaver even after
years of inhumation. For instance, hypertrophy of the great
THE HAIR AND NAILS. 407
toe-nail, the length and color of the hair, baldness, or a long
beard might furnish evidence of the beet kind. Both hair and
nails ma}^, however, change after death, A case is mentioned '
in which the hair changed from a dark brown to red after
twenty years of burial. Accredited cases of the growth of hair
after death are also on record. Dr. Caldwell, of Iowa, states
that he was present in 1862 at the exhumation of a body which
had been buried for four years. He found that the coffin had
given at the joints and that the hair protruded through the
openings. He had evidence to show that the deceased was
shaved before burial, nevertheless the hair of the head measured
eighteen inches, the whiskers eight inches, and the hair of the
breast four to six inches." Quite recently in unearthing the
remains of an old cemetery in Washington, D. C, a number of
persons noticed that when the body of a young girl, supposed
to be about twelve or thirteen years of age, was taken up it
was found that her hair had grown until it extended from her
crown to her feet. Many careful observations seem to prove
the molecular life of the hair and nails after somatic death. I
suffices to quote the well-known case mentioned in Ogston's
"Medical Jurisprudence," of several medical students who were
brought to trial for having in custody the dead body of an idiot
bo3\ When found on the dissecting-table the body was so
disfigured that there was only one means left of proving its
identity. The boy had a whim during life of permitting his
nails to grow, and had not allowed them to be cut for many
years previous to his death. They had completely curled round
the tips of his fingers and toes till the}^ had thus come to extend
along the palmar and plantar surfaces in a strange way. The
counsel for the prosecution availed himself of the knowledge of
this fact, and his proof seemed to be complete, when a medical
man came forward and gave in evidence that it was not an
unusual circumstance for the nails to grow for several inches
after death. This astounding statement so nonplussed the
judge that the case was allowed to drop as not proven.
In exceptional cases the hair may be green. I saw a case
some years since, for which no cause could be assigned, and
only a few days ago I saw another in a man who worked in a
' New York Med. Journal, vol. x., ^ New York Med. Record, August
p. 412. ISth, 1877.
408 IDENTITY — ROSSE.
brass-foundry. At the Cronin trial a barber, who had counted
the victim among his customers, recognized the shape of the
head and textui-e of the hair. Subsequent evidence of medical
experts was conclusive as to the identity of hair found clinging
to a trunk, the hair cut from the head of the murdered man,
and that of a single hair discovered on a cake of soap. This
single strand, being lighter in color in some portions than in
others, seemed to indicate that it could not have come from the
head of the deceased, whose hair was brown. But it was shown
that hair placed on soap or other alkaline substances becomes
bleached in a manner similar to the color of a single thread.
This evidence of vital importance linked the hair found in the
trunk with that cut from Dr. Cronin's head, and went far
toward proving that one of the inurderers had washed his hands
with the soap after the deed had been done.
Reviewing the signs furnished by the osseous system, it
will be seen that the study of the skeleton alone is beyond con-
tradiction more satisfactory and more important in establish-
ing identity than that of all the other organs. Consequently a
correct interpretation of the facts observed and judicious appli-
cation of the rules deducible therefrom may in the matter of a
human skeleton put its identity beyond a reasonable doubt.
But the expert should remember that as no two cases are just
alike, unexpected questions and unforeseen features may pre-
sent themselves, giving to each case merits of its own. At best
the medical man's conclusions will be probabilities, not certain-
ties ; therefore his expressions of opinion should be the more
guarded, as upon it may hang the life of an innocent man.
IDENTIFICATION OF MUTILATED REMAINS.
Many of the foregoing remarks on the identity of the skele-
ton apply in cases where mutilated remains or a portion only
of the body has been recovered. Circumstances often occur in
which bodies may require identification after having been
drowned and partly eaten by fishes or crabs, or after having
been partly eaten by buzzards, or torn into fragments by ani-
mals, as has happened in the remains of a dead infant partly
devoured by a dog, and in the case of a farmer who died in
the woods and was subsequently eaten by his own hogs. After
IDENTIFICATION OF MUTILATED REMAINS. 409
accidents and fires where manj^ persons perish; after a railway-
disaster where bodies have been mangled, drowned, burnt, and
frozen, all in the same accident; or after an explosion from
steam or gas or in a mine, or from gunpowder, dynamite, or
other substance, the human remains are generally in such a
state as to defy all attempts at recognition.
To dispose of a dead body in order to avoid detection, crimi-
nals will mutilate, disfigure, and chop into fragments the re-
mains, which they afterward place in a trunk, a wardrobe, or
throw into a sewer or other hiding-place. Scarcely a year
passes that judiciary medicine is not concerned with cases of
the kind. The frequency of such crimes has been attributed by
some to the so-called contagion of murder; others offer the
simple law of the series in explanation ; others still believe that
imitation is the principal cause. While there is no doubt a
grain of truth in each of these, less philosophic minds will look
upon such a beastly proceeding as a mark of the complete satis-
faction sought by the destructive instinct.
Why such things should be is of less concern than the fact
that criminal mutilation of the dead body is not confined to any
age or country'. Though more frequent in the last fifteen years,
it takes up quite a space in the history of human cruelty. The
violent passion, wrath, and vengeance that caused the prophet
Isaiah to be sawn in two at the age of one hundred years b}'
order of Manasses and Agag cut into pieces by Samuel have
not materially changed in the days of Jack the Ripper ; and we
find such crimes in antipodal parts of the world, among varied
sociological conditions, no matter whether it be the North
American Indian, who scalps and mutilates his enemy and
places the severed penis in the mouth, or the civilized European,
who cuts up the body of his victim and serves it in a curry at
a feast of assembled friends.'
This new point of judiciary medicine has lately been elabo-
rated by European writers under the title of Depegage Crim-
inel, a term which applies to the operation resorted to by an
assassin having for its end the getting rid of the bodj^ of the
victim and to render more difficult the establishment of its
identity.
The cleverness of experts scarcely keeps pace nowada3'S
' Annales d'Hygieue Publique, 1883.
410 IDENTITY — ROSSE.
with the more complicated proceedings adopted by criminals.
In fact, at a trial of this kind truth and science are often the
under dogs in a fight, than which none in forensic medicine is
longer and more embarrassing. To cause a rapid disappearance
of the proofs of a homicide, with a view to escape the investi-
gations of justice, murderers have been known literally to make
hash of the victim which was subsequent!}^ eaten by themselves
and others. Gruner relates the case of a man who, having
killed and cut into pieces his victim, boiled and roasted the
fragments and ate them with his wife. Such examples, how-
ever, suggest morbid rather than passional phenomena, which
manifestly call for rigid scrutiny into the mental state of the
culprit, who may be more of a lunatic than a malefactor.
In cases of infanticide new-born children are sometimes cut
into pieces and the fragments burnt in order to facilitate the
disappearance of the cadaver. There does not appear to be,
however, any well-authenticated instance of the operation hav-
ing been done on a living child. Generally the dismember-
ment is done in order to cause more ready disappearance of the
remains.
The medico-legal problem to be solved in cases of criminal
mutilation is to establish the identity of the victim and that of
the author of the crime.
Man}^ apparently trivial circumstances may assist in the
formation of an opinion as to the identity of the culprit. If
the victim be an adult, a man is the author of the deed ; if an
infant, a woman, the mother, is almost always the guilty one.
The London Lancet (May 30th, 18G3, p. G17) reports a case in
which the body of a child, of apparentl}^ four to six months,
was found in the sewage of a water-closet, minus an arm cut
off below the shoulder, presumably that a vaccination-mark
might not be adduced as evidence. A young woman was sus-
pected. Several women deposed having seen a dusky-brown
mother's mark near the child's navel. After steeping in pure
water a portion of the skin said to include the mark, and after
washing, the mark gradually reappeared at the end of three
days, perfectly distinct. It was recognized b}^ witnesses and
produced at the trial as corroborative evidence. The accused
was found guilty.
In a case of infanticide at Tarare, in 1881, the upper ex-
IDENTIFICATION OF MUTILATED REMAINS. 411
tremity of a foetus was found to have been disarticulated after
the manner of carving the wing of a fowl. This having sug-
gested to Dr. Lacassagne a cook as the author of the crime, she
was speedily discovered and convicted. A few years later an
analogous case occurred in Florence and was reported by Dr.
A. Montalti.
The instrument used for mutilating the body may furnish a
suggestion of identity, to be dispelled or affirmed upon further
investigation. The mode of section observed in various in-
stances has led to the recognition of a butcher as the culprit.
An expert would have but little trouble in distinguishing the
hacking and mangling of a body from the careful cutting and
preservation of muscles and blood-vessels in dissections made
b}' medical students, whom the public, by the way, invariablj"
suspect in cases of mutilation. If it can be ascertained that
the instrument used was operated either by a left-handed person
or by an ambidexter, such a fact may prove of importance.
Sometimes the fragments are tied or sewn up in a package.
The manner in which the knot is tied may indicate the occupa-
tion of the culj^rit. In one case the regularity of the sewing
revealed that it was the work of a woman. Examination of
the remains of clothing and of neighboring objects where the
crime was committed may result in the identification of the
victim or of the murderer. Indeed, it is the careful noting of
trivial facts and their combination that is so valuable in all
investigations of this class. A compound fact made up of
minor facts, which considered severally would possess but
little value, may sometimes solve the puzzle in a case where no
single fact of conclusive value is obtainable.
Having collected as much of the mutilated remains as
possible, the first stej) toward identification is to replace the
pieces in anatomical order, to note carefully their correspond-
ence or otherwise, and to ascertain whether the fragments be-
long to the same bodj" or to two or several individuals. This
is often a delicate and difficult matter, especially where decom-
position is advanced or where the horror has been pushed to
its utmost limits, as in the case of a fratricide committed in
France by several persons, who fragmented the cadaver with a
saw and hatchet ; boiled the remains and fed them to hogs ; and,
after crushing the bones with a hammer, threw the fragments
412 IDENTITY— ROSSE.
into a deep gorge. Again, the body may be divided into
numerous pieces, a hundred or more, and disposed of in widely
different locahties, as in a pond, a manure-heap, a river, or a
cesspool. The chopped- up remains of infants have been boiled
in lye and afterward thrown into a privy or put in a barrel of
vinegar. A mother has also been known to cook with cabbage
the dismembered remains of her six-months' child and serve it
at a meal of which both she and her husband partook. •
Numerous counterparts of such cases happening in late
years could be cited where the object was to favor the disap-
pearance of the cadaver, and in which the establishment of
the identity turned on the examination of some small part of
the organism; the uterus, the spermatic cord, the lobe of the
ear, the hair, or the teeth furnishing a positive demonstration
that led to judiciary results.
Putrefaction goes on very fast in a corpse that has been
mutilated ; but it is slower in parts which, on being separated
just after death, have become bloodless in consequence of the
hemorrhage. After submersion the outward signs of putrefac-
tion put a notable obstacle in the way of identification, and
after drowning the body becomes rapidly unrecognizable.
Supposing it impossible to reconstitute the cadaver in all its
essential parts, it is always possible, by following the instruc-
tions already given for examining the skeleton, to infer from
one or several parts of the cadaver the sex, age, height, and
sometimes pathological peculiarities of the victim. Examina-
tion of the skeleton and teeth is of capital importance in an
investigation of this class. The indications furnished thereby
having already been touched upon, and being about all that
we are justified in saying, it is onty necessary to repeat that
many of the details relative to these special indications are so
confusing as to suggest caution in using the statistical tables
of even high authorit}", as the observations the}'^ rest on are
not of sufficient extent to deserve confidence.
A survey of the head, limbs, trunk, and genital parts will
give the most useful indications. The head, in fact, is the
surest index for justice, and one that lends promptness in the
discovery of the assassin. Typical illustrations of this occur
in the Goss-Udderzook case and in the recent example of the
bomb-thrower, Norcross. In the case of a woman murdered by
IDENTIFICATION OF MUTILATED REMAINS. 41^
her husband at Antwerp in 1877 and cut into one hundred and
fifty-three pieces and her remains thrown into a priv}", the
color of the hair, the lobule of a torn ear, and the uterus of a
woman having had children furnished special signs that led to
identity and condemnation. Examination of the brain and its
membranes, though furnishing no -^-ery notable characteristics
in the matter of identification, may nevertheless be regarded as
a natural corollary to that of the skull. Brain weight, which
is greatest between thirty and forty years, 1,200 to 1,450 grams
in man, 1,100 to 1,500 in woman, diminishes toward the six-
tieth year. It is said that the diminution takes place a few
years sooner in the opposite sex. The estimated loss of weight
in a person of eighty years is admitted to be from 90 to 150
grams. Another sign of age is the tendency to degeneration
found in the pineal gland, the cortical substance, the optic and
striate thalami, and in the brain capillaries.
The state of the eyes, if not too decomposed, may still be-
come a sign of identity. For instance, the color of the iris, an
arcus senilis, a pterygium, a cataract or an operation for the
same, an iridectomj', etc., are signs that occasion may utilize.
The TRUNK may show, as it has in several instances, incised
wounds that caused death before the mutilation. Besides, the
organs therein contained may by their weight, dimension, and
tissue alteration indicate the progress of age and of degenera-
tion. Modifications of the circulatory and respiratorj" appa-
ratus are obviousl}' characteristic. As age advances the only
organ whose weight increases with the number of years, the
heart, may become hypertrophied or dilated ; its coronarj- arte-
ries may undergo an alteration ; the pericardium thickens, and
in fact arterial atheroma and degeneration generally may begin
between thirty-five and forty j^ears. It should, however, be
borne in mind that these signs of senility maj' come much later
or even not at all. In a man of eightj'-four years Tourdes
found no notable tissue lesion ; in another of one hundred and
four Lobstein found no trace of ossification of the arteries of
the trunk and upper extremities, and in Thomas Parr, aged
one hundred and fifty-two years, Harvey found absolutely no
lesion of this kind. Although toward eighty years the heart
increases in weight in both sexes, the opposite has been observed
in exceptional cases. Placing the average weight of this organ
414 IDENTITY — KOSSE.
in the adult at 2G6 grams for men, 220 for women, it will be
found that progress in weight gives toward the eightieth year
an increase of 90 grams for men and 60 for women. Yet a
case of cardiac atrophy is reported in a woman of eighty whose
heart weighed but 170 grams.
Diminished weight of the lungs becomes accentuated with
years. Especially is this the case after pseudo-melanosis and
senile emphysema. The state of the lungs of stone-cutters and
miners and various thoracic and abdominal diseases may like-
wise become signs of identity. A cirrhosed liver, an en-
larged spleen, a senile kidney, and the like, are sufficiently
obvious in their bearings on this question.
Like the trunk, the arms and legs, in cases of the class
under consideration, show but few traces of disfigurement
other than the fact of their having been disjointed. The man-
ner in which the sections were made and the proceedings em-
ployed for the disarticulation would equally affirm an expe-
rienced hand or the reverse. Such facts have of late years
assisted in the discovery and condemnation both of a farmer
and of a medical student, and also in the case of the cook
alreadj^ mentioned, who cut off her child's arm after the man-
ner of carving the wing of a fowl. The existence of deformity,
injur}^, and disease in the limbs should, of course, claim atten-
tion, but their relativity in an investigation of the kind is too
apparent to require further comment.
Mutilation of the genital organs is not so common. Per-
sons familiar with border warfare have observed the savage
custom of cutting off the victim's penis and placing it in his
mouth. In more civilized communities the culprits are gener-
ally women in whom hatred and ferocity prompt an act that
marks the evident satisfaction sought by the destructive in-
stinct. Sometimes, however, the genital organs have been cut
from the cadaver of a woman, presumabl}^ for the purpose of
concealing traces of rape that may have preceded the murder.
The signs furnished by the female genital organs as to virgin-
ity, maternity, and the menopause are so easily demonstrated
at the necropsy as to become positive proofs of identity. The
uterus loses both in size and weight with age. This along
with hard, atrophied, and germless ovaries attests the stoppage
of menstruation. The question of identity may turn on the age
ENTIRE CADAVER DEAD BUT A SHORT TIME. 415
at which menstruation ceases, as happened in an action of
ejectment in the case of Doe on the demise of Clark vs. Tatom.
The period known as change of life, when the uterus and ovaries
lose their function, though placed at forty-five and fifty years,
is quite uncertain. In spite of averages, menstruation is occa-
sionally continued to seventy and upward.'
The signs furnished hy the genital organs of the male are
of less importance. Atrophy and diminished weight of the
testicles and rarity or absence of the spermatozoids are indica-
tions of senility ; although spermatozoids have been observed at
ninety-four years. The structure of the spermatic cord at dif-
ferent periods of life from the last of intra-uterine to the first of
extra-uterine life, in puberty, and in old age, is accompanied
by characteristic modifications of development and regression,
which are of interest on the question of medico-forensic diagno-
sis of identity, as shown by Dr. Pellacani.''
Congenital deformity of the genital parts, as epispadias or
hypospadias; marks of circumcision, useful in India to iden-
tify Mussulmans above eleven years; traces of disease that
may have left extensive cicatrices, as phagadenic chancre, sup-
purating buboes, etc., may also furnish characteristics of evi-
dential value.
ENTIRE CADAVER DEAD BUT A SHORT TIME.
In the case of a body that has been dead a short time only,
recognition from the features, even by the nearest relatives, is
often a matter of the greatest difficulty. The change produced
in the color and form of the bodj", especially after drowning, is
a formidable obstacle to identification by likeness and general
type of face. Pages could be filled with the mere mention of
the multiplied instances of mistaken identity of the living,
many of whom have been punished because they had the mis-
fortune to resemble some one else. How much more careful,
then, should be the medical examination of the remains in the
progress of decay, with the distortion and discoloration of the
features, and the consequent change or destruction of the pecu-
liar expression of the countenance by which human features are
usuallv distinguished and identified.
■ 4
'Med. Gazette, vol. xli., p. 650. - In a series of papers to Riv. Sper.
di freniat, Reggio-Emilia, 1883.
410 IDENTITY — ROSSE.
Among the innumerable instances of mistaken personal
identity and cases of resemblance mentioned in history and
fable, from the time of Ulysses down to the days of Rip Van
Winkle's dog Schneider, it appears that this animal is credited
with more sagacity than man in the matter of recognizing his
master even after years of absence. Indeed, recognition by
animals may be considered a proof of identity. Many persons
can recall instances of the kind, though perhaps not so dramatic
as the one of the dog in the Odyssey, who recognized his mas-
ter after twenty years of absence and died immediately there-
after.
As a matter of fact, time and circumstances will so alter
resemblance as to account for some of these most striking
proofs of the fallibility of human testimony that we see illus-
trated in chapters on mistaken identity. We easily forget the
true image of persons and things, and time promptly modifies
them. The evidence of the senses may be so little trusted in
this regard that father, mother, husband, and nurse may attest
a false identity in the case of their own children. A nurse has
been known to testify to the identity of the severed head of a
woman whom thirteen other persons were sure they recognized
from characteristic signs, when the supposed victim put in an
appearance and thus attested her own existence. The head of
the unrecognized victim of this strange controversy is preserved
in the museum of the Strassburg Faculty.
In another case of historical notoriety in France, forty wit-
nesses on each side swore to the personality ; while .in the cel-
ebrated Tichbourne trial no less than eighty-five witnesses
maintained positively, under the most rigid and scrutinizing
cross-examination, that a certain person was Sir Roger Charles
Doughty Tichbourne, a baronet; at the same time a corre-
sponding number were equally unshaken in their conviction
that he Avas a Wapping butcher, Arthur Orton.
Resemblances often bring about remarkable coincidences.
A case is said to have occurred in Covington, Ky., where two
men met, each the double of the other in form, stature, and
feature, each having lost a right leg, amputated at the knee,
and ea'ch being blind in the left eye from accident.
Puzzle and perplexity are not confined to remarkable cases
and judicial errors; for so many people are unskilled in correct
ENTIRE CADAVER DEAD BUT A SHORT TIME. 417
observation that it is a matter of common occurrence for two
individuals to be mistaken the one for the other. The writer
for some years has f requentl}^ been mistaken for a certain naval
officer he is said to resemble, while the officer in question has
become so accustomed to being called " Doctor" that he answers
to the title without protest.
A case that has of late been much quoted in the journals is
that of Tiggs. What was supposed to be his mangled body
was identified by his wife, and further identification was forth-
coming from one of his children and the employer of the de-
ceased. The coroner had granted a certificate for burial, and
as the hearse neared the door, to the surprise of all parties the
real Tiggs entered the house and gave a satisfactory account
of his absence.
Most mistakes of this kind are the result of existing imper-
fections in the average human mind or in its use. So few
people are skilled in minute observation that Lord Mansfield's
dictum regarding the "likeness as an argument of a child
being the son of a parent " should be received with a certain
degree of reserve, especially in the question of identity from
likeness after death. In Ogston's "Medical Jurisprudence" a
case is related of a father who could not recognize the bod}^ of
his son drowned at sea ten days previously. The mother, how-
ever, identified her boy from the existence of two pimple-looking
projections on the front of the chest, which proved to be sup-
plementary mammsB.
As a rule, the changes in the face and countenance two
weeks after death are such that it is well-nigh impossible to
establish identity from the features alone. Yet in exceptional
cases the external results of putrefactive decomposition have
been so delayed or modified as to produce very small changes
in the features even after many years of burial. Bodies have
been known to retain a remarkable state of preservation for
long periods in such circumstances as burial in a peat bog, in
the sand of the desert, and in the frozen ground of cold coun-
tries.
Even photography in the matter of identity is not to be
trusted. Though an important accessory to other evidence, it
is often, and very properly, objected to bj^ lawyers on the
ground of being incompetent, irrelevant, and immaterial. The
27
418 IDENTITY— ROSSE.
picture presented for comparison may not be an original one or
it may have been taken years previously. The difficulty in
recognizing one's own most intimate friends from pictures
taken only a few years back is a matter of common knowledge.
Besides, the negative from which the picture was taken may
have been retouched or altered, consequently it would not be
the same as produced by the camera, and is, therefore, value-
less as evidence. It is held to be incompetent to prove a photo-
graph by merely asking a witness whether or not he recognizes
the picture in question as that of a certain person.
In all cases where photographic pictures are required in a
court of law the authorities are that the artist who took the
picture must be produced and show that he took the picture,
and that it is a correct representation of the original of which
it claims to be a picture. If possible the negatives themselves
should be called for and reproduced. Dr. Tidy states that he
has known a volume of smoke appear in a print as issuing from
a chimnej', and used as evidence of the existence of a nuisance,
when no smoke existed in the original negative. Only slight
familiarity with the method of taking photographic pictures
and the chemistry involved in the process suffices to show that
many little details of sensitizing, exposing, developing, and
printing greatly change the general appearance of the face.
iSome of the tricks that may be played with photography, illus-
trating its comparative incompetency as evidence in the matter
■of personal identification, I have seen in a series of pictures at
the Department of Justice in Washington. All were photo-
graphs of the same person taken in such varying circumstances
that no two are alike or recognizable as the same person, until
scrutiny is brought to bear on the profile of the nose.' In con-
sidering photography in its bearing on this branch of medi-
cine, it must also be borne in mind that a certain degree of
imperfection arises 'from want of uniformity in the lenses of
cameras. I have already mentioned the want of precision in
photographing the skull, the common defect being central not
orthogonal projection such as anthropometry requires.
'See Mr. Galton's paper iu Na- his recent work on Finger Prints,
ture, June 31st, 1888, p. 173 ; also in
SURFACE SIGNS OF IDENTITY. 419
SURFACE SIGNS OF IDENTITY.
Examination of the surface of the skin and of its append-
ages may in certain cases take decisive importance. Valuable
medical proof is often furnished by scars, nsevi, growths on the
skin, pock-marks, traces of skin disease or of scrofula, and by
the so-called professional stigmata which would suggest the
trade, character of work, or occupation of the deceased. Thus
cigarette-stains on the fingers of smokers, or silver-stains on
the hands of photographers, the horny palm of the laborer, or
the soft, delicate hand of one not accustomed to work, would
be indicative. The alterations in the hand make it, so to speak,
the seat of election ; for in the majority of trades that may be
mentioned it is the hand alone that bears the principal marks of
daily work that indicate the calling. A case is recorded of a per-
son who previously to his assassination was lame and walked
with a crutch. Although the body was cut into fragments, an
examination revealed in the palm of the hands characteristic
callosities, showing prolonged use of support of this kind. In
another instance of criminal mutilation a tattoo-mark found on
the arm proved an overwhelming charge against the assassin
and drew forth his confession. An accused was also convicted
of murder after establishing the only missing link, the ques-
tion of identity, which turned on the finding of cupping-marks
and a tattoo on the body of the murdered man. Personal iden-
tity of the bodies of infants has, moreover, been proved by means
of a small blister ; by a patch of downy hair ; by the similarity
existing between two pieces of thread used to tie the umbilical
cord; and by the severed end of that part of the funis attached
to the infant fitting precisely to the corresponding portion at-
tached to the after-birth. In addition to these a methodical
examination may put in evidence other f^cts that may be de-
rived from diverse influences that leave characteristic traces.
SIGNS FURNISHED BY MARKS, SCARS, STAINS, ETC., ON
THE SKIN.
But of all the surface signs, whether congenital or acquired,
that may throw light on the antecedents of the decedent, birth-
marks, freckles, cicatrices, tattooes, and the professional signs
420 IDENTITY — ROSSE.
furnish the best indications. Birth-marks {ncevi materni)y
from their supposed indelibiHtj', have given rise to discussion
at many celebrated trials. As a rule, these marks are perma-
nent and seldom lose their distinctness, though in exceptional
cases they may undergo atrophy in the first years of life.
Hence testimony as to the existence of birth-marks may often
be uncertain when it has reference to a period a long way back.
In a recorded case of supposed recognition of a person having a
mark of this kind on her face, the alleged victim turned up and
established her identity as well as the fact that she did not have
the birth-mark attributed to her.
Before the introduction of the electrolj^tic method it was
customary to resort to cauterization, excision, vaccination, and
tattooing the pigmentary spot in order to modify or remove
these congenital marks. Such proceedings usually left more or
less of an indelible scar which occasion might utilize in the
matter of medico-legal diagnosis. The traces of nsevi may,
however, be entirely removed by electrolysis. I have recently
seen a nsevus of large dimension on the face of a young woman
so completely destroyed as to leave no trace of the operation.
The possibility of the disappearance of a scar in such
circumstances depends here, as it does in other instances, on the
depth of the wound. A cicatrix being the result of a solution
of continuity in the derma, the question arises whether a wound
that has divided the derma without loss of substance and healed
by first intention leaves any perceptible scar. Some are of the
opinion that a cicatricial line persists, but grows fainter with
time. Histological examination in a question of this kind
might prove conclusive by showing the structure of the fibro-
cellular tissue that constitutes the cicatrix. In the case of very
superficial burns or wounds, the scar may completely disappear
if the epidermis alone or the superficial part of the derma is
attacked ; on the other hand, if there has been long suppura-
tion or loss of substance from ulcers, chancres, or buboes,
especially on the neck, groins, legs, or genital parts, traces of
their lesion will be found. It may, therefore, be asserted as a
general rule that all scars resulting from wounds and from skin
diseases which involve any loss of substance are indelible.
A scar on the face is one of the points at issue in the celebrated
Hillmon case already mentioned.
TATTOOING. 421
As the matter of cicatrices is treated in the section on
Wounds, further mention here would be superfluous.
Tattooing.
Of all the scars that speak, none in judiciary medicine affords
better signs of identity by their permanency and durable char-
acter and the difficulty of causing their disappearance than
those furnished by tattoo-marks.
The custom of tattooing having existed from the earliest
historical epochs is of interest not only from an ethnological
but from a medical and pathological point of view, while it is
of great importance in its relation to medical jurisprudence in
cases of contested personal identification which may be either
established or refuted b}' this sign. So trustworthy is it in
many instances as to become a veritable ideograph that may
indicate the personal antecedents, vocation, social state, certain
events of one's life, and even their date.
Without going into the history of a subject mentioned b}'
Hippocrates, Plato, Caesar, and Cicero, it may be pertinent to
say that tattooing is prohibited by the Bible (Leviticus xix.,
28) and is condemned by the Fathers of the Church, Tertullian
among others, who gives the following rather singular reason
for interdicting its use among women: " Cerhim siouiis
Spiritum Sanctum magis masculis tale aliquid subscribere
potuisse si feminis siibscripsisset." {De Virginibus velan-
dis. Lutetise Parisorum, 1G75, f°, p. 178.)
In addition to much that has been written b}^ French,
German,' and Italian authors, who have put tattooing in an
important place in legal medicine, the matter of tattoo-marks a
few years since claimed the attention of the law courts of Eng-
land, the Chief Justice, Cockburn, in the Tichbourne case,
having described this species of evidencfe as of " vital impor-
tance," and in itself final and conclusive. This celebrated trial
has brought to light about all the knowledge that can be used
in the investigation of this sign as a mark of identity. Ab-
sence of the tattoo-marks in this case justified the jury in their
finding that the defendant was not and could not be Roger
' For a few classical citations that Zeitschrift fiir Ethuologie, Berlin,
are more erudite than profitable see 1888, xx. , j). 412.
422 IDENTITY — ROSSE.
Tichbourne, whereupon the alleged claimant was proved to be
an impostor, found guilty of perjury, and sentenced to penal
servitude.'
The practice of tattooing is found pretty much over the
world, notably in the Polynesian Islands and in some parts of
Japan. It is, however, not found in Russia, being contrary to
the superstitions of the people, who regard a mark of this kind
as an alliance or contract with evil spirits. Its use appears to
be penal only, and is limited to Siberian convicts. The
degrading habit, confined to a low order of development,
exists at the present time as a survival of a superstitious prac-
tice of paganism, probably owing to perversion of the sexual
instinct, and is still common among school-boys, sailors, sol-
diers, criminals, and the lowest order of prostitutes living in
so-called civilized communities. Indeed, unanimity of opinion
among medical and anthropological writers assigns erotic pas-
sion as the most frequent cause of tattooing, and shows the
constant connection between tattoo-marks and crime. Penal
statistics show the greater number of tattooed criminals among
the lowest order, as those who have committed crimes against
the person ; while the fewest are found among swindlers and
forgers, the most intelligent class of criminals. Even amid
intellectual advancement and eesthetic sensibility far in ad-
vance of the primitive man, such as exists in London and New
York, for instance, are to be found persons who make good
incomes by catering to this depraved taste for savage ornamen-
tation. Persons who have been to Jerusalem may remember
the tattooers, w^ho trj" to induce travellers to have a cross tat-
tooed on the arm as a souvenir of the pilgrimage. If a writer
in the Revue des Deux Mondes, 15th June, 1881, is to be be-
lieved, it appears that the Prince of Wales on his journey to
the Holy Land had a Jerusalem Cross tattooed on his arm,
April 2d, 1862. The " Cruise of the Bacchante" also tells how
the Duke of York was tattooed while in Japan.
The process is now rapidly done, an Edison electric pen
being utilized for the purpose, and some of the wretched mar-
'See "Guj-'s Hospital Report," 1869. A later study on the medico-
xix., 1874; also " Histoire Medicale legal importance of tattooing may
de Tatouage " in Aichiv. de Mede- be found in Lo Spallanzani, Roma",
cine Navale, torn. 11, 12, Paris, 1891, 2s, xx., 169, 208.
TATTOOING. 423
tyrs have the hardihood to be tattooed from head to foot with
grotesque designs in several colors. I know of several in-
stances : one of a man in Providence, R. I. ; another of a Por-
tuguese barber, who has striped poles, razors, brushes, and
other emblems of his calling over the entire body. Another
man has likenesses of Abe Lincoln and of Kaiser Wilhelm of
Germany on his respective shins. A Nova Scotian, tattooed
from head to foot, has among other designs that of " St. George
and the Dragon " on his back ; while a Texas ranchman, six
feet two inches tall, underwent the torture of eight weeks'
profanation of his body in order to appear in blue, brown, and
red, with an irreverent image on his back of the Immaculate
Conception and thirty-one angels.'
A singular mixture of erotic and religious emblems is often
found among the varied and fantastic signs used in tattooing.
I recall the case of a man who had represented on his back a
fox-hunt, in which riders followed the hounds in full pursuit of
a fox about to take cover in the anus. In another case of a
man accused of criminal attempt on two little girls, examina-
tion of the sexual organs revealed a tattoo on the back of the
penis representing the devil with horns and red cheeks and
lips. When the little girls were asked if the accused had
shown them his virile member, they answered, " This man un-
buttoned himself and said to us: 'I am going to make you see
the devil. ' " In the face of such affirmations, the accused con-
fessed his crime and was condemned. Other tattoo signs of
the grossest emblems of unnatural passion have been found
among low prostitutes, pederasts, and tribades.
Statistics founded on numerous facts, show many cases of
tattooing of the penis and even of the labia majora in the low-
est order of prostitutes, but these unclean images and revela-
tions of lustful instinct do not occur in the same order of fre-
quency as those noted on the forearm, the deltoid, or the inferior
extremities. So valuable are these marks in their bearing on
the class, vocation, character, and tastes of a person that the
finding of anchors and ships would indicate a sailor; while
flags, sabres, cannon, and other warlike signs would indicate a
1 According to Lombroso, all who either been among the Pacific Isl-
are tattooed on the back or the sex- ands or sojourned in a prison,
ual organs have without exception
424 IDENTITY — ROSSE.
soldier, etc. It is also noticeable that in the tattooing prac-
tised by lunatics the image relates in some way to the nature
of the peculiar form of mental disease from which they suffer,
and it is chiefly among the more severe and incurable cases of
mental degeneration that these signs are found. (See Dr. Riva's
article, "Iltatuaggio nel Manicomio d'Ancona," Cronica del
Manicomio d^ Ancona, November, 1888.)
Almost always the motive that prompts these disfigurements
of the skin is the result of impulse, of thoughtlessness, or of
orgy, and almost all the tattooed come to repent of their folly.
The subject of detatouage has of late taken a polemic turn in
some of the Continental journals. There are besides many
cases on record of severe accidents and complications following
the operation, such as severe inflammation, erysipelas, abscess,
and gangrene. Dr. Beuchon gives statistics of forty-seven cases,
in which four were followed by mutilation and eight by death
either directly or in consequence of an amputation. A certain
proportion of what is known as syph ilis insontium is to be found
among the reported statistics of tattooing. Dr. Bispham, of
Philadelphia, informs me that while at Block] ey Hospital he
saw thirty cases of syphilis that had been communicated by the
same tattooer.
Tattooing may sometimes be accidental. I have seen a
departmental clerk with an elongated tattoo on the back of his
hand caused by accidental wounding with an inked pen. A
bursting shell during a naval engagement has caused a char-
acteristic tattoo on the face of a well-known ofiScer to be seen
any day in Washington. Two cases of the bluish-black dis-
coloration of the skin from taking nitrate of silver have also
come under my observation. Both occurred in medical men,
one of whom lives in Florida, the other in the District of
Columbia. Silver discolorations of this kind are indelible, but
I learn from one of these gentlemen that large doses of iodide
of potassium cause temporary fading of the discoloration, which
returns on stopping the medicine.^
The indelihilitij of tattoo-marks is such that their traces
may be easily recognized in the cadaver, though in a somewhat
'A paper by Dr. J. N. Hall ou with a report of cases, may be found
"The Medico-Legal Value of Pow- in the Trausactions of the Colorado
der-Stains in Gunshot Wounds," Medical Society, 1890, xx., 94.
TATTOOING. 425
advanced stage of putrefaction. The}" have even been recog-
nized on a gangrenous limb. Sometimes, however, it is im-
possible to recognize at first sight whether there has or has not
been a tattoo. A strong light and a magnifying glass and a
microscopic examination of the neighboring ganglia to detect
the presence of coloring matter may assist in removing doubt.
It has been found on the bodies of tattooed cadavers that the
ganglia are filled with grains of coloring matter of the same
nature as that employed in making the tattoo. Attempts to
remove tattoo-marks generally leave a vicious scar that is
equally indelible. An efficacious method is to tattoo the mark
with a solution of tannin, which is followed by brushing over
with nitrate of silver. A red cicatrix follows, and when the
epidermis separates the tattoo disappears. A better meihotl,
however, is by means of the electric needle already mentioned
in speaking of the electrolysis of ngevi.
That a tattoo-mark may disappear by the effects of time
and leave no trace is a matter that Cooper reports after exam-
ining the mutilated remains of a cadaver, and the statistics of
Caspar. Tardieu, and Hutin place it as high as nine in the
hundred. An officer of the United States Revenue Marine
lately called my attention to several superficial tattooes on the
back of his hand which had disappeared. The deeper ones,
however, remained. The spontaneous disappearance of a
tattoo seems to be possible when the operation has been done
in such a superficial way as not to have passed the rete Mal-
pighii, or when the tattooing has been done with some sub-
stance not very tenacious, as vermilion, which appears to be
easily eliminated. But when the particles of coloring matter
penetrate into the fibro-elastic tissue of the derma, the disap-
pearance of the tattoo is rare.
In seventy-eight individuals tattooed with vermilion alone,
Hutin found eleven upon whom the tattoo had disappeared.
Out of one hundred and four tattooes made with a single color,
India-ink, writing ink, blue or back, not a single one had com-
pletely disappeared. The results are identical if the tattooes
are made with two colors. Thus in 153 tattooes with vermilion
and India-ink, one instance showed a fading of the black, in
another it had completel}' disappeared, the red being well
marked ; twenty times the red was partly effaced, the black
426 IDENTITY — ROSSE.
being well marked ; and in sixteen cases ths red had completely-
disappeared, the black remaining visible.'
A tattoo-mark may sometimes be altered, in which case it
proves deceptive as an index. A workman changing his trade
seeks to transform the insignia of his first calling into those
of the second, or a criminal in order to avoid identity will
make a change. In the former instance the transformation is
not difficult to detect, but in the latter so much care is re-
quired to recognize the change that penal science has relegated
the sign to a secondary place.
As to the length of time since a tattoo-mark has been exe-
cuted, authorities are that it is impossible to tell after two or
three weeks. Whether a tattoo-mark is real or feigned is easily"
settled by simply washing the part. This question, as well as
that of the judicial consequences of such marks, is hardly per-
tinent to the matter in hand.
Value of Professional Stigmata.
The so-called professional signs are of undoubted value in
the surface examination for establishing identity, but it does
not seem that their importance warrants the extreme prolixity
given to them by some Continental writers, and even by one in
the city of Mexico, Dr. Jose Ramos. ^ For instance, it is pre-
tended that cataract is more common among jewellers because
of the fineness of their work; yet out of 952 cataracts, of which
a record has been kept, only two cases occurred in jewellers.
Besides, there is not one special sign or physical trace left on
the body by which a prostitute may be knov/n, notwithstand-
ing the fact that in life the collective appearance would seldom
deceive an experienced man.
Only in the case of sodomy, where anal coitus has been
frequent, would characteristic signs be found. On anal exam-
ination of 446 prostitutes. Dr. Coutagne' found the signs of
post-perineal coitus in 180. He cites the case of a young pros-
titute presenting the astonishing contrast of a gaping anus
surrounded by characteristic rhagades, with the genital parts
of an extreme freshness, a very narrow vagina, and non-
' Bulletin de I'Acad. de Med., 17 - La Escula de Medicina, Mexico,
Janvier, 1853, t. xviii., p. 348. 1880-81. » Lyon Medical, 1880.
VALUE OF PROFESSIONAL STIGMATA. 427
retracted hymen, constituting by their reunion a still firm ring.
A fact yet more curious is shown by a specimen in the collec-
tion of the museum of the laboratory of legal medicine at
Lyons. The genital organs of the cadaver of a woman of
twenty-eight or thirty years showed a hymen intact and firm,
but on examining the anal region it was surprising to find an
infundibuliform deformity with all the signs of sodomitical
habits, which of course rectified the opinion that had been made
regarding the chastity of this woman.
Many of the signs enumerated as peculiar to different call-
ings have no special anatomical characteristic that is easy to
distinguish with precision, consequently they do not present a
degree of certainty or constancy sufficient to be invoked as
strong medico-legal proof of identity. Moreover, the effects of
time or treatment may have caused alteration or disappearance
of many of the signs in question, which would at best be of
negative rather than of absolute value.
To arrive at an impartial appreciation of the relative value
of the professional stigmata as signs of identity, a certain
number of the signs should be thrown aside as illusory.
Others, on the contrar}^ are durable, special, and constant, and
assist in establishing the identity accordingly as the lesions or
alterations are complete or evident; but it should be borne in
mind that the physical alterations and chemical modifications
resulting from the exercise of certain trades are not in our
country so important from a medico-legal point of view as they
are in Europe, where class distinctions are more defined.
VALUE OF STAINS AND DIFFERENT IMPRINTS.
In the same manner that a very small portion or fragment
of the human body ma}" suffice to establish . the corpus delict i^
so will minute remains or traces, as finger-marks, footprints,,
and other material surroundings, even smells or traces of per-
fume, be of great assistance to justice in determining the iden-
tity of both culprit and victim, and at the same time throw
light on the attendant circumstances of the deed. The traces
of a blood}' hand or foot, smears of tar or paint, the various
spots or stains found on fabrics, instruments, etc., may involve
questions of great nicety the relativity of which is apparent,.
428 IDENTITY — ROSSE.
especially in criminal trials. Newspapers have familiarized
the jjublic with many cases of the kind, in which medical ex-
perts have demonstrated blood and other stains with sufficient
accuracy and positiveness to satisfy a jur}'. The Cronin case
is a notable instance.
Imprints made by finger-tips are known to be singularly
persistent. In four specimens of inked digit marks of Sir
William Herschel, made in the years 1860, 1874, 1885, and
1888 respectively, though there was a difference of twenty -eight
years between the first and last, no difference could be per-
ceived between the impressions. The forms of the spirals re-
mained the same, not only in general character, but in minute
and measurable details, as in the distances from the centre of
the spiral and in the direction at which each new ridge took its
rise. Sir William Herschel has made great use of digit-marks
for the purposes of legal attestation among natives of India.'
The extraordinary persistence of the papillary ridges on the
inner surface of the hands throughout life has been a theme of
discussion by the Royal Society,^ and Mr. Galton has devised
a method of indexing finger-marks.'
The IMPRESS OF A NAKED FOOT covered with blood maj^
serve to direct the investigations of justice. In a criminal
affair in France, where eight individuals were implicated, com-
parative experiments upon the identity of the foot, made with
a view to determine to which of the individuals ought to be
attributed the bloody footprints found near a wardrobe, it was
shown that a degree of recognition could be established on repro-
ducing the footprints with defibrinated blood . From the eight
imprints of the left foot of each individual, impregnated with
blood, measures and comparisons could be made, thus helping
to establish the difference or the resemblance with those found
near the wardrobe. .
Imprints thus obtained may be looked upon as a kind of
documentary evidence, but too much importance should not be
attached to them as articles tending to prove criminality. The
futility of such evidence is shown in the varying sizes of differ-
ent impressions of the foot of the same person — first in rapid
>Med. Press and Circular, May May 28th, 1891. A medico-legal
30tli, 1888, p. 576. study of imprints maj' also be found
'^Phil. Trans., B., 1891. in Archiv d'Anthropologie Crimi-
3 See Proc. Roval Soc, London, nel, 15th July, 1891.
VALUE OF STAINS AND DIFFERENT IMPRINTS. 439
progression, secondly by standing, and third by slow advance.
The results ajDpear less sure in the case of footprints made in
mud, sand, dust, or snow. Nevertheless many facts relating
thereto may be noted with great certainty. The question has
been mooted as to whether or not the impress left upon the soil
gives always the exact dimensions of the foot that has made
them. One side has contended that the footprints are a little
smaller, while the other refutes this opinion and thinks that
they are a little larger. The consistency of the soil, which
does not seem to have entered into the discussion, doubtless ac-
counts for the small differences that have given rise to this
discrepancy of opinion. The outline of the sole of the foot and
the relative position of the toes are more or less neatly designed
as the ground is more or less wet or soft. The means employed
for taking impressions of foot or other tracks in mud, etc.,
show considerable ingenuity on the part of those who have
elaborated the subject. To discover foot-marks in mud, pow-
dered stearic acid is spread over the imprint and a heat of at
least 213° is applied from above. By this means a solid mould
may be taken of the imprint. These researches have been ex-
tended to the exact reproduction of imprints left upon snow by
pouring melted gelatine upon the imprint previously sprinkled
with a little common table salt, which rapidly lowers the tem-
perature of the snow about fifteen degrees and permits the
mould to be taken without too much hurry. The study has
been extended to the configuration of the plantar imprints in
tabetics, but it does not appear so far to be of much medico-
legal value.
The question may arise as to the length of time since the
imprints were made. This would, of course, depend upon
many circumstances, as weather, temperature, and the like. It
is a fact that in Greenland footsteps in snow have been recog-
nized many months after they were made. A few summers
ago, on an arctic expedition, I climbed Cape Lisbourne,
Alaska, in company with another person. The ground being
thawed in many places, our feet left very decided imprints in
the mud. A year afterward I visited the same spot, and on
again making the ascent was astonished to recognize the foot-
steps made the year before.
Circumstances sometimes direct expert attention to vestiges
430 IDENTITY — ROSSE.
of other animals. The tracks of a dog or of a horse may become
the object of a medico-legal inquest. The books record a case
in which it was necessary to ascertain whether a bite had been
made by a large or a small dog. This question was settled by
producing the dogs and comparing their teeth with the scars.
Persons familiar with border life know the importance of trails
and the minute observation that is brought to bear on them by
the experienced frontiersman. In following cattle-thieves and
murderers, while with the Fourth United States Cavalrj^ on the
Rio Grande frontier, I have known the peculiarity of a horse's
footprint in the prairie to tell a tale of great significance.
Observation in this respect may extend to such apparently
trivial objects as the tracks of wheels, as those of a wagon, a
wheelbarrow, or a bicycle, or to the singular imprints left by
crutches or a walking-stick. The imprint left in the ground
by a cane usually occurs in the remarkable order of every two
and a half or every four and a half steps. Investigation of
such circumstances may result in material facts that may be of
great assistance in establishing the relation of one or several
persons with some particular act.
DEFORMITIES AND PATHOLOGICAL PECULIARITIES.
The existence of deformities or injuries is so apparent in
serving to establish identitj^ that it seems almost superfluous to
mention them, except for the purpose of deciding whether the
wounds were made during life or after death. In the matter
of gunshot wounds on persons who took part in the late Civil
War, many of whom unfortunately belong to the vagrant class
and are often found dead, their wounds sometimes afford excel-
lent means of identification. In many instances the multiple
character of these wounds is almost incredible. When on duty
at the Army Medical Museum, in connection with the prepara-
tion of the " Medical and Surgical History of the War of the
Rebellion," I saw a man who was literally wounded from the
crown of his head to the sole of his foot, the scars being fifty-
two in number.
Wounds made during life might show the suggillation
peculiar to bruises or traces of inflammation. Besides, the
gaping nature of the lips of the wound, the fact of hemorrhage
DEFORMITIES AND PATHOLOGICAL PECULIARITIES. 431
having taken place and the coagulation of the blood, the infil-
tration of blood into the cellular tissue, etc., are surgical facts
that would leave but little doubt as to the infliction of the
wounds during life.
The cause of death is often a difficult matter to determine,
as it may have been accidental, suicidal, or the result of homi-
cide. The causes relating thereto are, moreover, so many and
varied that space and time compel a reference to other headings
of this work. In forming an opinion as to the prohahle date of
death the extent of putrefaction is the chief g-uide. If death
is quite recent, we may be guided by the post-mortem rigidity
or the extent to which the body has cooled. The march of
putrefactive decomposition would, of course, be regulated by
circumstances. It takes place very rapidly in persons who
have succumbed to excessive fatigue or to any disassimilative
excesses or derangement resulting in ante-mortem change of
the tissues, such as those occurring in virulent or infectious dis-
eases. The body of an infant decays more rapidly that that of
an adult. The course of putrefactive phenomena is also influ-
enced by the seasons, the extent of the exposure to air, and to
other mesological causes. There is a manifest difference in the
special putrefactive change accordingly as a body is buried in
the earth, submerged in a fluid, thrown into a cesspool, or
buried in a dung-heap.
In certain cases, especially where the body has been much
mutilated, it may be desirable to know whether there was one
or several murderers. While no definite rule can be laid down
on this point, we are justified in supposing that there were two
or more assassins when the body of the victim shows both gun-
shot and knife wounds, or that two persons were concerned in the
dismemberment and mutilation of a body which shows the
simultaneous presence of parts skilfullj^ cut, while others show
evident awkwardness.
Where there is more than one mortal ivound on the same
dead body, a question of medico-legal significance maj^ arise.
This occurred in the Burton murder case at Newport, R. I.,
in 1885, which gave rise to discussion of the following abstract
question : " Whether it is jsossible for an individual, with sui-
cidal intent, and in quick succession, to inflict a perforating
shot of the head and another of the chest implicating the heart.
432 IDENTITY — ROSSE.
Or, reversing the proposition, is it incredible that a person bent
on self-destruction can, with his own hand, shoot himself in
the heart and in the head?"
After consideration of the case referred to and reversal of
the previous decision of the coroner, the supposed suicide jiroved
to be a homicide. Yet if the abstract question of possibilities
is alone regarded, there is no doubt of the fact that a suicide
could shoot himself in such manner, both in the head and the
heart, or, changing the order, of shots in the heart and in the
head. The number of cases recorded establishes beyond a
doubt the feasibility of the self-infliction of two such wounds,,
and make it clear that the theory of suicide may be maintained
in such circumstances.'
JUDICIAL ANTHROPOMETRY.
Of late years the subject of anthropometric identification
has taken such a place before justice that it cannot be ignored
by the medical legist. The facts of scientific anthropology
have here been applied in such a way as to establish with great
certainty both the present and future identity of individuals
who attempt dissimulation of their name and antecedents.
The method used principally in the identification of criminals
and deserters from the army has been adopted in the public
service ^ and by most municipalities, with the exception of New
York, where the subsequent identification of persons connected
with municipal affairs has been and maybe a source of no little
embarrassment.
The system is based on three recognitory elements : photog-
raphy, anthropometric measurements, and personal markings,
from which a descriptive list is made that gives absolute cer-
tainty as to individual identity.
Owing to the illusory nature of photography and the difii-
culty in finding the portrait of any given individual in the
large and constantly increasing collection of a " rogues' gallery,"
the matter has been simplified and facilitated by grouping the
photographic collection according to the six anthropological
' See Annual of the Universal ^ See paragraph II. , General Or-
Medical Sciences, 1888, vol. v., pp. ders No. 33, Adjutant-General's
1^3-147. Office, April 1st, 1889.
JUDICIAL ANTHROPOMETRY. 433
coefficients of sex, stature, age, and color of the eyes. Each of
these primordial groups is again subdivided in such a way as
to reduce the last group to a small number, when the portrait
is easily found and verified on comparing the measurements of
the head, of the extended arms, the length of the left foot, and
that of the left middle finger.
The photographic proof for each individual consists of two
portraits side by side, one of which is taken full face, the other
in profile of the I'ight side. On the back of the photographic
card is recorded with rigorous precision all personal markings
or peculiarities.
The measurements, which can be made by any person of
average intelligence in three or four minutes, are extremely
simple. The inght ear is always measured, for the reason that
this organ is always reproduced in the traditional photograph
which represents the right face. Other special measurements
are taken on the left side. The height sitting, dimensions ar d
character of the nose, color of eyes, etc., are also noted.
It is contended that by these measurements alone the iden-
tity of an individual whose face is not even known may be
established in another country by telegraph. The application
of the system has proved of great service in the apprehension
of deserters from the United States army (when the authorities
have been able to find the card), while it is claimed to have
caused the disappearance of numerous dissimulators of identity
in the prisons of Paris. The police authorities of that city
report that out of more than five hundred annual recognitions
by the foregoing means, not one mistake has yet occurred.'
To avoid a possible source of error mensuration of the
organs and the ascertainment of their form may be resorted to
in the case of a cadaver that is much decayed, or in one that
has been purposel}^ mutilated or burned by the assassin in order
to prevent recognition. A sufficient number of cases ma}^ be
cited in which the measurement of a limb or a bone of a
deceased person known to have been lame or deformed during
life has resulted in the establishment of identity or the re-
verse.
A mistake may be prevented in the case of supposed mutila-
tion of a drowned body, which may have been caused by the
' In 1892 only three failures ai-e recorded.
28 ^
434 IDENTITY— ROSSE.
screw of a passing steamer. Other errors may result from
carelessness, incorrect observation of signs, and neglect to fol-
low the ordinary precautions that should obtain in all researches
on identity of the dead body.
Certain cii'cumstances indicative of the mental state of the
culprit may throw light on the identity, A person of unsound
mind would certainly be suggested as the perpetrator of such a
deed as that of the woman already mentioned, who after killing
and cutting up her infant, cooked portions of the remains with
cabbage and served them at a meal of which she herself par-
took. Equally conclusive should be the inference in the case
cited by Maudsley of a person who, for no ascertainable motive,
kills a little girl, mutilates her remains, and carefully records
the fact in his note-book, with the remark that the body was
hot and good.
The handwriting left by the assassin might also furnish a
strong presumption as to the existence of a mental lesion, since
the writing of the insane is often characteristic, especially in
the initial stage of dementia, I recall the case of a former
patient, an aphasia, imprisoned for having stabbed a man in
the abdomen and for having wounded his wife in such a way
that her arm had to be amputated. Having lost the power to
express himself phonetically, this man used a book and pencil,
but his writing showed a degree of agraphia which alone
Avould establish his identity beyond a doubt.
While it is quite possible that dishonest transactions, and
even theft, may take place by telephone and the voices of the
perpetrators may be unmistakable between distant cities, it is
more likely that the phonographic registration of speech or
other sound by means of a gramophone should become a matter
of medico-legal investigation and a possible means that may
lend great assistance in establishing personal identity. Al-
though no precedent may be cited, it is not going into the
domain of theoretical hypothesis to mention a discover}- of
such real scientific certainty that for years after death, and
thousands of miles awaj^, gives an indefinite number of repro-
ductions that cannot possibly be mistaken b}" any one familiar
with the voice before it had become "Edisonized." Some
gramophone disks lately shown me from Germany registered
greetings and messages to relatives in Washington, who were
JUDICIAL ANTHROPOMETRY. 435
delighted to recognize the exact reproduction of familiar tones
and accents of the Fatherland.
So limitless is the field of research in this direction that
there is scarcely an anthropological, biological, or medical dis-
covery that may not sooner or later be applied with profit in
the investigations of personal identity where the combined
efforts of an attorney and an expert are required.
After the most rigid and scrutinizing anatomical and
material examination is made and the closest inquisition entered
on, it may often be impossible to give a reasonable explanation
for the cause of the physical facts observed. The medical man
should remember that his is the one great exception to the rule
that rigidly excludes opinions, and that scientific men called as
witnesses may not give their opinion as to the general merits
of the case, but only as to the facts already proved. This quali-
fying rule being altogether reversed in investigations into
personal identity, and the physician's opinion as to identity
being indispensable, it becomes a matter of most serious import
that this opinion should be grounded upon absolute and well-
attested facts.
MEDIOO-LEGAL DETEEMI^ATIOJ^
OF
THE TIME OF DEATH.
BY
H. P. LOOMIS, A.M., M.D.,
Professor of Pathology in the University of the City of New York; Visiting Physician
and Curator to BeUevue Hospital, Netv York; Pathologist to the
Board of Health, New York City; President New
York Pathological Society, etc., etc.
MEDICO-LEGAL DETEEMIl^ATIOi^ OF
THE TIME OF DEATH.
SIGNS OF DEATH.
The cessation of respiration and the absence of audible heart-
beats are signs generally regarded as sufficient in themselves to
determine the reality of death. But persons have been resusci-
tated from a state of asphyxia or have recovered from a state of
catalepsy or lethargy in whom, to all appearances, the respira-
tory and circulatory processes have been arrested.
So it is advisable that we should be acquainted with some
absolute tests of death which are not connected with the heart-
sounds or the respiration.
It is well known that these important functions, although
apparently held in abeyance, must be speedily re-established so
as to be recognized, or death will rapidly follow. This condi-
tion of apparently suspended animation is seen among hibernat-
ing animals ; the bear, for instance, will remain for four or five
months without food or drink in a state of lethargy — the heart-
action and respiration hardly appreciable. Yet it will be suffi-
ciently rapid to sustain life during the slow metabolic processes.
A number of well-authenticated cases are reported in which
persons could slacken their heart-action, so that no movement
of the organ could be appreciated. The case of Colonel Town-
send, reported by Cheyne, is an example. He possessed the
power of apparently dying, by slowing his heart so that there
was no pulse or heart-action discernible. The longest period
he could remain in this inanimate state was half an hour.
Instances have occurred in the new-born child where
without question there have been no heart-beats or respirator}-
movements for a number of minutes, the limit being set at
five.
These are exceptional cases, and it is setting at defiance
4^9
440 TIME OF DEATH — LOOMIS.
all physiological experience to suppose that the heart-action and
respiration can be suspended entirely when once they are estab-
lished, for a period as long. So, then, if no motion of the heart
occurs during a period of five minutes — a period five times as
great as observation warrants — death may be regarded as
certain.
The respiratory movements of the chest are sometimes very
difficult to observe. They can always be better appreciated if
the abdomen and chest are observed together. There are two
methods to determine whether respiration is absolutely sus-
pended or not. First, by holding a mirror in front of the open
mouth, observing whether any moisture collects on its surface.
Second, by placing on the chest a looking-glass or basin of
water, and reflecting from it an image by artificial or sun light.
The slightest movement would be registered by a change in
position of the image. While the writer considers the absence
of heart-beats and of respiratory movement an absolute test of
death, still some cases may occur in which the establishment
of this test is very difficult, and the following additional tests
may be employed :
1. Temperature of the body same as surrounding air.
2. Intermittent shocks of electricity at different tensions
passed into various muscles, giving no indication whatever of
irritability.
3. Careful movements of the joints of the extremities and of
the lower jaw, showing that rigor mortis is found in several
parts.
4. A bright needle plunged into the body of the biceps mus-
cle (Cloquet's needle test) and left there, showing on withdrawal
no signs of oxidation.
5. The opening of a vein, showing that the blood has under-
gone coagulation.
6. The subcutaneous injection of ammonia (Monte Verde's
test), causing a dirty-brown stain indicative of dissolution.
7. A fillet applied to the veins of the arm (Richardson's test),
causing no filling of the veins on the distal side of the fillet.
8. " Diaphanous test :" after death there is an absence of the
translucence seen in living people when the hand is held before
a strong light with the fingers extended and in contact.
9. " Eye test :" after death there is a loss of sensibility of the
POST-MORTEM CHANGES. 441
eye to light, loss of corneal transparency, and the pupil is not
responsive to mydriatics.
POST-MORTEM CHANGES.
The human body after death undergoes certain changes
which will be discussed under the following heads;
1. Cooling of the bodj\
2. Flaccidity of the body.
3. Rigor mortis.
4. Changes in color due to
(a) Cadaveric ecchymoses.
(&) Putrefaction.
Cooling of the Body.
Immediately after death there is a slight rise of tempera-
ture, supposed to be due to the fact that the metabolic changes
in the tissues still continue, while the blood is no longer cooled
by passing through the peripheral capillaries and lungs.
The body gradually cools and reaches the temperature of the
surrounding air in from fifteen to twenty hours; this is the
ordinary course, but the time may be influenced by a variety of
causes, such as the condition of the bod}' at the time of death,
manner of death, and circumstances under which the body has
been placed.
In certain diseases, as yellow fever, rheumatism, chorea, and
tetanus, the temperature of the body has been known to rise as
high as 104° F. and remain so for a time. Again, it has been ob-
served that when death has taken place suddenh', as from acci-
dent, apoplex}', or acute disease, the body retains its heat for a
long time. The bodies of persons dying from hanging, electro-
cution, suffocation, or poisoning b}' carbon dioxide, do not gen-
erally cool for from twentj'-four to forty-eight hours, and cases
are recorded where three da3's have elapsed before the body was
completely cold. On the other hand, bodies dead from chronic
wasting diseases or severe hemorrhage cool very rapidlj'", even
in four or five hours.
In determining the temperature of a dead body the hand is
not a reliable guide: the thermometer should always be used.
442 TIME OF DEATH — LOOMIS.
Flaccidity.
The first effect of death from any cause is general relaxation
of the entire muscular system. The lower jaw drops, the eye-
lids lose their tension, the limbs are flabby and soft, and the
joints become flexible.
In from five to six hours after death, and generally while
the body is in the act of cooling, the muscles of the limbs are
observed to become hard and contracted, the joints stiff, and the
body unyielding. Muscles which are contracted in the death-
agony do not necessarily become relaxed at any time.
The muscular tissues in the dead body can be considered
as passing through three stages: (1) flaccid but contractile,
(2) rigid and incapable of contraction, (3) relaxed and incapable
of further contractility.
Rigor Mortis.
This is sometimes called cadaveric rigidity , and occurs gen-
erally within six hours after death and disappears within six-
teen to twenty-four hours. Many theories have been advanced
to account for it, but the most probable one is that the rigidity
is due to the coagulation of the myosin in the muscles by the
weak acids which are no longer removed from the system ; the
muscles always give an acid reaction and are opaque instead of
transparent; after putrefaction has set in ammonia is devel-
oped, the myosin dissolved, and so flaccidity results.
Rigor mortis occurs first in the muscles of tlie eyelid, next the
muscles of the lower jaw and neck are affected, then the chest
and upper extremities; afterward it gradually progresses from
above downward, affecting the muscles of the abdomen and
lower limbs. The rigidity disappears in the same sequence.
The period after death when rigor mortis manifests itself,
together with its duration, is chiefly dependent upon the previ-
ous degree of muscular exhaustion. Brown-Sequard has dem-
onstrated that the greater the degree of muscular irritability at
the time of death, the later the cadaveric rigidity sets in and
the longer it lasts. He has also shown that the later putrefac-
tion sets in, the more slowly it progresses.
FLACCIDITY — RIGOR MORTIS. 443
The more robust the individual and the shorter the disease,
the more marked and persistent is this muscular rigidity. It
has been noticed that the bodies of soldiers killed in the begin-
ning of an engagement become rigid slowly, and those killed
late quickly. This explains the reason why bodies are some-
times found on the battle-field in a kneeling or sitting posture
with weapons in hand.
If the rigidity of rigor mortis after it is once complete is
overcome, as in bending an arm, it never returns ; but if in-
complete it may return. This will serve at times to distinguish
real death from catalepsy and its allied conditions. While the
average duration of rigor mortis has been given as sixteen to
twenty-four hours, iu must be remembered that in some cases
it has been known to last only a few hours, as in death by light-
ning or by electrocution. In other cases it has persisted for
seven and fourteen daj^s.
This long continuance of rigor mortis has been noted in
death from strychnine and other spinal poisons, in suffocation,
and in poisoning by veratrum viride.
Atmospheric conditions modify to a large extent the dura-
tion of rigor mortis. Dry, cold air causes it to last for a long
time, while warm, moist air shortens its duration. Also im-
mersion in cold water brings on rigor mortis quickly and
lengthens its duration.
Cadaveric Ecchymosis — Cadaveric Lividity or
Hypostasis.
Within a few hours after death the skin of the body, which
is of a pale, ashy-gray color, becomes covered b}^ extensive
patches of a bluish or purple color, which are most pronounced
and are first seen on the back part of the trunk, head extremi-
ties, ears, face, and neck, and are due to the blood, before coag-
ulating, settling in the most dependent parts of the body, pro-
ducing a mottling of the surface with irregular livid patches.
There is also a stagnation of blood in the capillary vessels, es-
pecially in those in the upper layer of the true skin or in the
space between the cuticle and cutis. The discoloration con-
tinues to increase until the body is cold, when it is entirely
arrested. Later on, just before putrefaction begins, the color
444 TIME OF DEATH — LOOMIS.
deepens, and the change appears to proceed from an infiltration
of blood pigment into the dependent parts of the body.
At the same time the discolorations are appearing on the
surface of the body, internal hypostasis is also taking place,
most marked in the dependent portions of the brain, lungs, in-
testines, kidneys, and spinal cord.
This condition in the brain may be mistaken for so-called
congestive apoplexy ; in the lungs, for pulmonary apoplex}' or
tlie first stage of lobar pneumonia; in the intestines and spinal
meninges, for the beginning of inflammatory changes.
The position of these hypostases will afford the best correc-
tion for this possible error. The appearances presented by
cadaveric ecchymoses have often been mistaken for the effects
of violence applied during life. Innocent persons have been
accused and tried for murder or manslaughter on charges after-
ward proved to be groundless. Therefore it is of the utmost
importance that the medical jurist should be able to distinguish
between ante-mortem and post-mortem ecchymoses.
The following are the points of difference :
1. Situation. Post-mortem ecchymoses are seen on that por-
tion of the body which has been most dependent, generally the
posterior aspect, and they involve principally the superficial
layers of the true skin ; ante-mortem ecchymoses may occur any-
where, and generally the deeper tissues are discolored.
2. In cadaveric lividity there is no elevation of the skin
and the discoloration terminates abruptly.
3. After cutting into the tissues where an ecchymosis has
been produced by violence, the blood without the vessels is free
in the tissue ; this is not so in cadaveric ecchymosis.
4. Post-mortem ecchymoses are very extensive, ante-mortem
generally limited in area.
A peculiar appearance of cadaveric lividity is observed in
bodies which have been wrapped in a sheet and allowed to cool
or that have cooled in their clothing. It occurs in the form of
bands or stripes over the whole surface, and often gives an
appearance as of a person flogged. The explanation of this
appearance is that the congestion of the vessels takes place in
the interstices of the folds, while the parts compressed remain
whole. The unbroken condition of the cuticle, together with
the other characteristics just mentioned, are sufficient to distin-
CADAVERIC ECCHYMOSIS — PUTREFACTION. 445
guish these ecchymoses from those produced by violence. While
cadaveric lividity is seen in all bodies after death, it is espe-
cially pronounced in those persons who have died suddenly in
full health or by violence, as from apoplexy, hanging, drown-
ing, or suffocation. It is very slight in the bodies of those
who have died from hemorrhage or anaemia.
The time at which cadaveric lividity appears varies greatly.
Casper, who has investigated the subject thoroughly, sets the
time at from twelve to fifteen hours after death.
Putrefaction.
At a period varying from a few hours to three days after
death, certain changes are seen in the human body which show
that putrefaction has commenced. A change of color appears
first upon the middle of the abdomen and gradually spreads
over the rest of the body ; it is first pale green, which gradually
deepens, and finally becomes purplish or brown. This change
in color is due to the action on the haemoglobin of the gases
developed by decomposition. Similar discoloration makes its
appearance on the chest, between the ribs, on the face, the neck,
the legs, and lastly on the arms, where it is more marked along
the large venous trunks, and has sometimes been mistaken for
marks of violence. The eyeballs become flaccid, and if exposed
to the air the conjunctiva and cornea become dry and brown.
Gases are formed, not only in the hollow organs of the abdo-
men but also in the skin. Those developed in the cavities of
the head and face force frothy, reddish fluid or mucus from the
mouth and nostrils, and may cause swelling of the features and
protrusion of the eyes and tongue. It must be remembered
that the gases while producing distention of the abdomen may
also cause changes in the position of the blood and slight dis-
placement of the organs; they may also force undigested food
into the mouth and into the larynx, and so lead to suspicion of
death from suffocation.
As putrefaction advances, after a period of five or six days
the entire surface of the body becomes green or brown, the cuti-
cle becomes loose and easily detached ; the tissues flaccid and
often bathed in a reddish serum in such situations as the neck,
the groin, and the back part of the scalp. The thorax and
446 TIME OF DEATH — LOOMIS.
abdomen become enormously distended, the features distorted
and scarcely recognizable, and the hair and nails loosened.
Beyond this, it is impossible to follow the changes leading to
disintegration with any degree of certainty. The changes
which I have just described as produced by putrefaction are the
ordinary ones seen in a body exposed to the air at a moderate
temperature, but it must be remembered that the time and
rapidity of the development of these changes may be influenced
by a large number of factors, and that they are of very little
importance in estimating the time of death. I have seen bodies
buried two months that have shown fewer of the changes pro-
duced by putrefaction than others dead but a week.
The appearance of a body buried in a coffin will be as
follows after a period varying from a few months to one or two
years. The soft tissues will have become dry and brown and
the face and limbs covered with a soft white fungus. Hard
white crystalline deposits of calcium phosphate will be found
on the surface of the soft organs, and when found on the surface
of the stomach care should be taken not to confound them with
the effects of poison. . In time the viscera become so mixed to-
gether that it is diflficult to distinguish them. For the most part
the changes that take place in a body buried in a coffin are
similar, but much slower, to those that occur if the bod}' is
exposed to the air or buried in soil. Even under apparently
identical circumstances the most varied results have been ob-
served, so it is not possible for a medical jurist to fix a definite
period of death or the time of burial from the appearance of an
exhumed body. For example, Taylor records a case where after
thirtj'-four years' interment an entire and perfect skeleton was
discovered, surrounded by traces of shroud and coffin, while in
an adjoining grave all that remained of a body that had been
dead twenty-five years were the long bones and base of the
skull. In one case a body was found well preserved after six
years' burial and in another after even thirty j'ears' interment.
This brings us next to a consideration of those factors that
favor or retard decomposition.
CIRCUMSTANCES FAVORING PUTREFACTION. 447
Circumstances Favoring Putrefaction.
1. Temperature. — Putrefaction advances most rapidly at
a temperature between 70° and 100° F, It may commence at
any temperature above 50° F., but it is wholly arrested at 32° F.
So one day's exposure of a body in summer may effect greater
changes than one week in winter. After freezing, putrefaction
takes place with unusual rapidity upon the thawing out of the
body. A temperature of 212° F. stops all putrefactive changes.
2. Moisture. — Putrefaction takes place only in the presence
of moisture. An excess of moisture, however, seems to retard
the process, possibly by cutting off the excess of air. The vis-
cera according to the amount of water they contain decompose
at different times after death — for instance, the brain and eye
rapidly, the bones and hair slowly.
3. Air. — Exposure to air favors decomposition by carr3^ing
to the body the micro-organisms which bring about putrefaction ;
absence of air soon arrests the changes : this is seen in bodies
hermetically sealed in lead coffins, which remain unchanged for
a long period of time. Moist rather than dr}" air favors putre-
faction by lessening evaporation. Air in motion retards while
still air favors the change.
It is to be remembered that a body decomposes more rapidly
in air than in water or after burial. Given similar tempera-
tures, the amount of putrefaction observed in a body dead one
week and exposed to the air will about correspond to one sub-
merged in water for two weeks or buried in a deep grave for
eight weeks.
4. Age. — The bodies of children decompose much more
rapidly than those of adults ; foetuses still more rapidly. Aged
bodies decompose slowh", probabl}^ on account of a deficienc}^ of
moisture. Fat and flabbj" bodies decompose quickly for the
same reason.
5. Cause of Death. — In cases of sudden death, as from
accident or violence, the body decomposes more rapidly than
when death results from disease. Putrefaction sets in early in
death from the infectious fevers, such as typhus, pyaemia, and
typhoid fever, also in death from suffocation bj' smoke or coal
gas, by strangulation or after narcotic poisoning. Those parts
448 TIME OF DEATH — LOOMIS.
of a body which are the seat of bruises, wounds, or fractures
decompose rapidl}' ; this is especially seen in parts after a sur-
gical operation.
G. Manner of Burial. — When a body is buried in low
ground in a damp, swampy, clay soil, decomposition advances
rapidlj', as also when the grave is shallow so the body can be
exposed to constant variations of temperature. A porous soil
impregnated with animal and vegetable matter favors putrefac-
tion, as also burying a body without clothes or coffin ; this is
especially seen where infants have been thrown into the ground
and loosely covered with earth.
Circumstances Retarding Putrefaction.
1. The Temperature.— Below 32° F. and above 212° F.
putrefaction is entirely arrested. The rapiditj" of the change
considerably lessens as the temperature advances above 100° F.
A remarkable instance of the preservative power of cold is
given by Adolph Erman, who states that the body of Prince
Menschikoff, a favorite of Peter the Great, exhumed after
ninety-two years' burial in frozen soil, had undergone hardly
any change. Buried in hot sand as is seen in the desert, a body
putrefies very slowly and generally becomes mummified.
2. Moisture. — Absence of moisture retards decomposition.
In the dry air of the desert bodies have been preserved for a
long period of time.
3. Air. — If access of air to a body be prevented in any way
by its inclosure in a coffin, by closel}^ fitting clothes, or by com-
plete immersion in water, putrefaction is retarded.
4. Age. — Adults and old people decompose more slowly
than children. Males are said to change less rapidly than
females, lean people than fleshy ones.
5. Cause of Death.— Putrefaction is delayed after death
from chronic diseases unless they are associated with dropsy.
Poisoning by alcohol, chloroform, strychnine, and arsenic retard
putrefaction. In the latter case the putrefactive changes seem
to stop after they have once commenced, and often a result very
similar to mummification is seen. Death from the mineral
acids, especially sulphuric, appears to delay putrefaction.
6. Manner of Burial.— Putrefaction is retarded by burial
CIRCUMSTANCES RETAEDING PUTREFACTION. 449
a short time after death; by interment on high ground, in dry,
sandy, or gravelly soil ; by having the grave deep, over six feet
in depth if possible ; by the body being well wrapped and secured
in a tight coffin, a lead one being the best in this respect. Lime
or charcoal applied freely about a body will retard decomposi-
tion, as will also injection of the body through the arteries with
such substances as arsenic, chloride of zinc, or antimony. The
ultimate effect of putrefaction is to reduce all bodies to inor-
ganic compounds, chiefly water, ammonia, and carbon dioxide.
Three conditions are necessary for its establishment, (1) a given
temperature, (2) moisture, (3) free access of air.
The order in which the various organs and tissues undergo
decomposition, as given by Casper, who has investigated the
subject carefully, is as follows: Trachea and larynx, brain of
infants, stomach and intestines, spleen, omentum and mesen-
tery, liver, brain of adults, heart and lungs, kidney, bladder
and oesophagus, pancreas, large vessels, and last of all the
uterus.
As the result of putrefaction, fluids, generally blood-stained,
collect in the serous cavities of the body, and should not be con-
founded with serous effusions occurring during life. So also
the softening of the organs and tissue resulting from decompo-
sition should be carefully distinguished from those resulting
from inflammation. These cadaveric softenings are most fre-
quently found in the brain, spleen, and gastro-intestinal mucous
membrane. Inflammatory softenings are differentiated by being
rarely general but almost always limited, by the substance of
the inflamed part being infiltrated with serum or pus and
showing traces of vascular injection. In doubtful cases the
pathologist should have recourse to the microscope.
As the result of putrefaction, various changes take place in
the mucous membrane of the stomach and intestines which
simulate the effects of poisons. The color of the stomach varies
from red, which becomes brighter on exposure to the air, to a
brown, slate, or livid purple. We can only presume that these
color-changes are the result of irritant poisons when they are
found in non-dependent parts and parts not in contact with
organs engorged with blood, when they are seen soon after
death, and when the membrane is covered with coagulated
blood, mucus, or flakes of membrane.
29
450 TIME OP DEATH — LOOMIS.
Effects on Putrefaction of Submersion in Water.
There are certain modifications of the putrefactive changes
when bodies have been submerged in water. In the first place,
the changes are much less rapid ; they often do not show them-
selves until about the twelfth day, and then as discolorations
appearing generally first about the ears and temples, then on
the face, from which they spread to the neck, shoulders, chest,
abdomen, and finally to the legs. This is almost the inverse
order of the putrefactive changes in bodies exposed to the air.
As a result of the formation of gases, the body in a short time
becomes buoyant ; after floating on the surface of the water for
a time, the gases escape and the body sinks, rising a second
time when fresh gas has formed.
The rapidity of decomposition in water varies, being most
rapid when the temperature is from G4° to 68° F. Stagnant as
well as shallow water favors putrefaction. If a body becomes
coated with mud the change is delayed. Submersion in a cess-
pool also retards it, and the conditions are such as to favor the
formation of adipocere.
After a body has been removed froin the water an exposure
of a very few hours to the air causes rapid decomposition, so
that in twenty-four hours more marked changes may occur than
would have resulted from a fortnight's longer submersion. The
face soon becomes bloated and black, so that identification is
well-nigh impossible. It is quite important in medico-legal
cases to estimate the time which has elapsed since death in
bodies found submersed in water. The following are the vari-
ous changes ordinarily seen at different periods of time, as
estimated by Devergie, who has especially investigated the
subject :
First Four or Five Days. — Little change : rigor mortis
may persist, particularly if the water is cold.
Fourth or Fifth Day.— Skin of the ball of the thumb and
little finger, also the lateral surface of the fingers, begins to
whiten. This whitening gradually extends to the palms of the
hands and soles of the feet. The skin of the face will appear
softened and of a more faded white than the rest of the bodj".
Fifteenth Day. — Face slightly swoUen and red ; a greenish
EFFECTS OP SUBMERSION IN WATER — SAPONIFICATION. 451
spot begins to form on the neck and skin^ of the mid-sternum.
The skin of the hands and feet is quite white and wrinkled.
The subcutaneous ceUular tissue of the thorax is reddish and
the upper part of the cortical substance of the brain of a green-
ish tint.
At One Month. — The face is reddish-brown, the eyelids
and lips green and swollen, and the neck slightly green. A
greenish discoloration is also seen over the upper and middle
part of the sternum. The skin is wrinkled. The hair and
nails still remain intact. The scrotum and penis are distended
by gas. The lungs become very emphysematous and overlap
the heart.
Saponification.
When the bodies were removed from the Cimetiere des Inno-
cents in Paris, in 1786, Fourcray observed that many of them
had been converted into a substance which he termed adipo-
CERE. He gave it this name because it resembles both fat
{adeps) and wax {cera). Under certain circumstances which
will be considered later, it is known to be a late jjroduct of the
putrefactive processes. Adipocere is a substance of a cheese-
like consistency, yellow or yellowish-brown in color, and com-
posed chiefly of a mixture of the fatty acids. Chevreul has
shown by analysis that it is a true ammoniacal soap, but that
when formed in water impregnated with lime a calcareous
may be substituted for an ammoniacal base. This may take
place either in a body exposed to river-water or buried in a grave
wet by water containing calcium carbonate or sulphate. Sapon-
ification can only take place when animal fat is in contact with
nitrogenous matter. Neither fat nor fibrin when kept separate
will saponify. Skin deprived of all its fat will not be trans-
formed into adipocere.
Saponification commences in the fat of the female breast, of
the cheeks and other parts of the body where large accumula-
tions of fat are found, such as around the kidneys and in the
omentum. As fat is distributed extensively^ throughout the
body, nearly all parts may undergo this transformation. Taylor
gives the following conditions as favorable to the change :
1. Bodies of young persons, because the fat is abundant and
chiefly external.
452 TIME OF DEATH — LOOMIS.
2. Bodies of corpulent adults.
3. Exposure of bodies to the soil of water-closets.
4. The immersion of bodies in water, the change taking
place more rapidly in running than in stagnant water.
5. Humid soil, especially when bodies are placed in it one
upon the other. In this case the lowest of them is first changed.
When a body has been completely saponified it may remain
in this state for years. In one instance, after seventeen years'
burial many of the organs could still be recognized.
The time required for saponification to take place is some-
times of medico-legal importance. Three years are usually
necessary for bodies buried in the earth. The change occurs
more rapidly in water. Cases are recorded where the body of a
new-born child was completely saponified in six weeks, and
again, the change had commenced in a body which had been in
the water about four months ; but these are unusual cases.
DATA UPON WHICH OPINION AS TO TIME OF DEATH IS
FORMED.
The changes which take place in a body before putrefaction
sets in may enable a medical jurist to form an opinion as to the
probable time which has elapsed since death ; yet it must be
remembered, to pronounce the time which has elapsed can only
be done approximately, for very many conditions will have to be
considered, which will vary in each individual case. The im-
portance of considering the minutest detail is well illustrated
by the death of Prince de Conde, Duke of Bourbon, who was
found dead in his bedroom in the chateau of St. Cyr. When
discovered at 8 o'clock in the morning the deceased was found
partly undressed, hanging by his cravat to one of the window
shutters. The body was cold and the lower extremities rigid.
As in asphyxia from hanging the warmth of the body is usually
preserved longer than under common circumstances, viz. , from
twelve to fifteen hours, before which period rigidity is seldom
complete, the medical examiner inferred that the deceased must
have died very soon after he retired to his bedroom on the pre-
vious night. As this was proven to have been 10 p.m., it fol-
lowed that only ten hours had elapsed — a short time for cooling
and rigidity to have taken place. It was thus rendered proba-
DATA AS TO TIME OF DEATH. 453
ble that the hanging took place soon after deceased reached his
bedroom. It was alleged that the duke had been murdered,
and that his body had been afterward suspended to create a
suspicion of suicide. The condition of the body was, among
other things, adverse to this opinion. From 10 to 12 o'clock
it was proved there were numerous attendants moving about
near the duke's apartments. They would have heard an 3^ un-
usual noise the duke must have made in resisting his assailant.
But no noise was heard in the room at that or any other time,
and the presumption of this being a homicide was thus strongly
rebutted.
Cadaveric rigidity, while often it will aid to, is not a
reliable guide. When once it is established it may remain
two, three, or four days, according to the season of the year and
other circumstances, and when it exists there is no rule by
which it can be determined whether a body has been in this
state three hours or three days.
Putrefaction, while appearing on an average, under a
mean temperature, in from three to six days, is yet influenced
by many circumstances. The heat and moisture of the sur-
roundings, the age, sex, amount of flesh on the bod}^ mode of
death, position and coverings of body, all must be considered.
The temperature of the body aids us, yet the retention of
warmth by the abdominal viscera may be met with in a marked
degree twenty hours after death ; in one case, personally known
to me, the thermometer registered 76° F. seventeen hours after
death.
The temperature of the body, its rigidity, and the evidences
of putrefaction all furnish data from which we can estimate
the probable time which has elapsed since death. It must be
remembered that no one of them furnishes any positive proof.
Some medical jurists have attempted to give a more definite
character to these changes in the recentlj^ dead body by divid-
ing the interval between the stopping of the heart's action and
the beginning of putrefaction into three periods. In the first,
the warmth, pliabilitj', and muscular irritability remain. In
the second, these conditions are lost and the body is cold and
rigid. In the third, the body is cold and pliant, the muscles
are relaxed, and the joints are flexible, the cadaveric rigidity
having entirely ceased.
454 TIME OF DEATH — LOOAIIS.
There can be no doubt about the existence of these stages,
but when we come to define the precise time at which one
begins and the other ends, we find it impossible. For example,
the first stage embraces a period which cannot be more closely-
defined than by stating that the person may have been dead
from a few minutes to twenty hours — a statement too vague to
be upheld by a counsel who defends a prisoner.
The changes which take place in these periods and the
average time they last have been given as follows by Devergie :
First Period, Few Minutes to Twenty Hours. — Character-
ized by warmth of the body and general or partial relaxation of
the voluntary muscles. To what portion of this period the special
case belongs must be estimated according to the degree of heat
in the trunk and extremities and the degree of' rigidity in the
muscles, the neck and the jaws commonly showing this condi-
tion first, the legs last. Warmth of the body rarel}^ remains as
long as twenty hours ; in general it is sensibly cold in from ten
to twelve hours. During this period the muscles are suscepti-
ble of contraction under the galvanic current, and in the early
stage under the stimulus of blows.
Second Period, Ten Hours to Three Days. — The body is
perfectly cold throughout and rigidity is well marked. The
muscles no longer respond to stimuli. The duration of this period
seems long, yet in one instance the body will be found cold and
rigid nine hours after death. Again, cooling and rigidity may
not come on for three or four days.
Third Period, Tliree to Eight Days. — The body is per-
fectly cold. The limbs and trunk pliant and free from cadaveric
rigidity. The muscles are not capable of contracting. In sum-
mer this period is much shorter ; often it will come on before
three days.
Putrefaction commences when a body is kept under the
most favorable conditions, in from six to twelve days, as a slight
greenish discoloration of the abdomen which gradually spreads
throughout the body. The time at which putrefaction shows
itself and the rapidity with which it advances is dependent
upon so many factors, many of which it is impossible often for
the medical examiner to ascertain, that too much reliance must
not be placed upon it. Casper estimates the following to be the
average changes generally found in the periods of time given :
DATA AS TO TIME OF DEATH. 455
Twenty-four to seventy-two hours after death a slight
green color is visible over the centre of the abdomen. The eye-
balls are soft and yield to external pressure.
Three to five days after death the green color of the
abdomen becomes intensified and general, spreading if the body
be exposed to the air or buried in the ground in the following
order: genitals, breast, face, neck, upper and lastly lower ex-
tremities.
Eight to ten days after death the discoloration becomes
more intense, the face and neck presenting a shade of reddish-
green. The ramifications of the superficial veins on the neck,
breast, and limbs become ver}' apparent. Finally the patches
congregate. Gases begin to be developed and distend the ab-
domen and hollow organs and to form under the skin in the
subcutaneous and intermuscular tissue. The cornea falls in
and becomes concave. The sphincter ani relaxes.
Fourteen to twenty -one days after death the discolora-
tion over the whole body becomes intensely green, with brown-
ish-red or brownish-black patches. The body is bloated and
appears greatly increased in size from the development of gases
within the abdomen, thorax, and scrotum, and also in the cel-
lular tissue of the body generally. The swollen condition of the
eyelids, lips, nose, and cheeks is usually of such extent as to
obliterate the features and to destroy the identity of the body.
The epidermis peels off in patches, while in certain parts, more
particularl}^ the feet, it will be raised in blisters filled with red
or greenish liquid, the cuticle underneath frequently appearing
blanched. The color of the iris is lost. The nails easily sepa-
rate and the hair becomes loosened.
Fourth to sixth month after death the thorax and ab-
domen burst and the sutures of the skull give way from the
development of gases within the head. The viscera appear
pulpy, or perhaps disappear, leaving the bones exposed. The
bones of the extremities separate at the joints. At an advanced
stage the soft parts gradually disappear.
In giving an opinion as to how long a time has elapsed
since death when a body has undergone marked putrefactive
changes, we must consider carefully not only the conditions
of the organs, but the mode of death and the "surroundings."
By these I mean the quantity of clothing worn, the depth of the
456 TIME OF DEATH — LOOMIS.
grave in which the body has been interred, the season of the
year, the heat and moisture of the atmosphere. The question
sometimes presents itself to the medical examiner, Of two per-
sons found dead, which died first? The importance of this
point was well illustrated in the " Lizzie Borden case." By a
careful consideration of all the conditions presented by each
body in the ways I have indicated, the question will not ordi-
narily be a difficult one to decide.
THE
MEDICO-LEGAL COT^TSIDEEATIOjST
OF
WOUNDS,
INCLUDING
PUNCTITKED AND INCISED WOUNDS, AND AYOUNDS
MADE BY BLUNT INSTRUMENTS OTHER
THAN GUNSHOT WOUNDS.
BY
GEORGE WOOLSEY, A.B., M.D.,
Professor of Anatomy and Clinical Surgery in the Medical Department of the Uni-
versity of the City of New York ; Surgeon to Bellevue Hospital ; Member
Medical Society of the County of Neiv York, New York Academy
of Medicine, New York Surgical Society, etc. , etc.
AVOUXDS.
GENERAL CONSIDERATIONS. THE DIFFERENT KINDS OF
WOUNDS.
The surgical and medico-legal ideas of wounds are quite
different, the latter including the former as well as other varie-
ties of injuries.
Definitions. — Surgically a ivouncl means a solution of con-
tinuity and refers to every such lesion produced by external
violence or developing spontaneously. The medico-legal ac-
ceptation of the term is much broader and includes any injur}^
or lesion caused by mechanical or chemical means. Vibert *
quotes Fodere as defining a wound medico-legally as, " Every
lesion of the human body by a violent cause of which the results
are, singly or combined, concussion, contusion, puncture, inci-
sion, tear, burn, twist, fracture, luxation, etc. ; whether the
cause is directed against the body or the body against the
cause. " The same author quotes another definition of a wound
as, " Every lesion however slight, resulting in concerning or
affecting the body or health of an individual." Taylor ^ defines
a wound in a medico-legal sense as " a breach of continuity in
the structures of the body whether external or internal, sud-
denly occasioned by mechanical violence." Thus, the term
wound in its medico-legal acceptation includes not only sur-
gical wounds but contusions, fractures, burns, concussion, etc.
In France at least the voluntary inoculation of syphilis has
been considered as coming under the category of wounds.'
Medico-legallj^, the severity of a wound is much more im-
portant than the kind of wound. Thus we may consider
wounds according to their comparative gravity, as mortal,
severe, or slight.
' " Precis de Med. Leg. , " 2d Ed. , ' Arret du tribunal de Lyon, 8 et
1890. ISdecembre, 1859.
-"Med. Jurisprud. ," 11th Amer.
Ed., 1892.
460 WOUNDS — WOOLSEY.
A mortal wound is one which is directly fatal to life in a
comparatively short time, usually from hemorrhage, shock, or
the injury of a vital part. A wound may result fatally with-
out being a mortal wound, as when a slight wound causes death
on account of some wound infection.
Severe ivounds, or " wounds causing grievous bodily harm,"
as they have long been called, do not put life in imminent dan-
ger, though they may be inconvenient or detrimental to health.
Pollock, C. B., says that a wound causing grievous bodily harm
is " any wound requiring treatment. "
A medical opinion or certificate may be required as to the
danger of a given wound, and on this opinion may depend the
question of bail for the prisoner. By the danger of a wound in
such a case is usually meant imminent danger, as any wound
maj^ be remotely dangerous to life.
Slight wounds, as already stated, may result fatally under
certain conditions. Under the French practice a slight wound
is one which does not incapacitate one from work for more
than twenty days. Looked at in another way, slight or severe
wounds may be classified according as they are completely
curable, leaving no infirmity or disturbance of function, or not
completely curable. The latter are such as are necessarily fol-
lowed by permanent or temporary infirmity.
The question as to the severity of any given wound may
sometimes be left to the jury to decide from the description of
the wound, or a medical opinion may be required.
Although the intent of the assailant is often of equal or
greater importance than the severity or kind of wound, yet
this can only occasionally be inferred from the surgical aspects
of the wound.
The classes of wounds to be treated in the following pages
are incised and punctured wounds and wounds with blunt in-
struments, some of the characteristics of which we will now
consider.
Incised "wounds are such as are produced by a cutting in«
strument, and they are distinguished b}^ the following charac-
teristics: They measure more in length than in the other
dimensions. They are usually straight in direction, though
not infrequently curved, and they may even be zig-zag, espe-
cially where the skin lies in folds. The edges of an incised
INCISED WOUNDS. 4G1
wound are linear, and show no signs of contusion. They are
either inverted or everted and the edges and sides of the wound
are retracted. The eversion of the skin is due to its elasticity,
but in some regions of the bodj', e.g., in the scrotum, etc., the
skin is inverted owing to the contraction of the muscle fibres
immediately beneath. The gaping of the wound is due to the
retraction of the divided muscles and fibrous structures. It
varies according as the muscles are cut directly across or more
lengthwise, and in proportion to the distance of the wound
from the points of attachment of the muscles.
The fibrous tissues, fascije, and aponeuroses retract less,
and so give a somewhat irregular surface to a large wound.
Ogston ' divides incised wounds into three parts, the com-
mencement, centre, and end, of which the end often has two or
more serrations differing from the commencement, which has
but a single point. There are often one or more slight, super-
ficial, tentative incisions situated almost always, though not in-
variably, near the commencement.^ The deepest part of the
wound is more often near the commencement. If there are
angular flaps on the edges their free angles point to the com-
mencement of the wound.
Coagula and clots of blood are to be found in the wound,
more or less filling it up if it has not been interfered with. On
examination the ends of the divided vessels are found plugged
with clots which may protrude somewhat from their openings.
If the wound is seen very shortly after its infliction, hemor-
rhage is in progress, and the divided arteries show their posi-
tion by their individual, intermittent jets of blood. The sever-
ity of incised wounds depends upon the amount of hemorrhage,
which is greater the deeper and larger the wound, and the
more vascular the tissues in which it occurs, especially if large
and important vessels are concerned. In the latter case an
incised wound may be very rapidly fatal.
Incised wounds present the least favorable conditions for the
spontaneous arrest of hemorrhage of any form of wounds. The
edges of an incised wound may be quite rough and even dentated
or lacerated if the edge of the weapon be rough and irregular.
The kind and condition of a weapon which has produced a
'"Lectures on Med. Jurisprud. , " '^ See Figs. 10 and 11.
1878, pp. 422, 423.
4G2 WOUNDS — WOOLSEY.
given incised wound may often be learned by an examination
of the characteristics of the wound.
Weapons cutting by their weight as well as by the sharp-
ness of their edges, such as axes, etc., may cause a certain
amount of contusion about a wound ; they crush the soft parts
to a certain extent, and the bones may be indented or even
fractured.
Wounds caused by fragments of bottles, pieces of china,
earthenware, or glass, though strictly speaking incised wounds,
are often curved, angular, and irregular, and their edges jagged
and contused.
Wounds caused by scissors may sometimes be of the nature
of incised wounds. When they present a double wound of
triangular shape, with the apex of the triangle blunt, they are
more of the nature of punctured wounds. In general a "tail"
or long angle in the skin at one end of an incised wound indi-
cates the end of the wound last inflicted, and some light may
thus be thrown upon the inflicter of the wound.
Incised wounds present very favorable conditions for healing
by primary union, but often fail in this and heal by secondary
union. When an incised wound fails to unite by primary
union, bleeding continues for several hours or even as long as a
da}^ the blood being mixed more or less with a serous dis-
charge. The latter continues until the third day or so. By the
fourth or fifth day the surface has begun to granulate, and there
may be a more or less profuse purulent discharge from the sur-
face. The granulating surfaces do not necessarily discharge
pus, however. For some days, therefore, after the infliction of
an incised wound, or until the surface is covered with granu-
lations, the characteristics of the wound permit of a diagnosis
as to the nature of the wound.
The diagnosis of an incised wound is generally without
difficulty. Some wounds by blunt instruments, however, in
certain regions of the body, resemble incised wounds very
closely. Such instances are found where a firm, thin layer of
skin and subjacent tissue lies directly over a bony surface or a
sharp ridge of bone. These are seen most often in the scalp or
in wounds of the eyebrow where the sharp supra-orbital ridge
cuts through the skin from beneath. The diagnosis of an in-
cised wound can often be made with great probability from the
PUNCTURED WOUNDS, STABS, ETC. 463
cicatrix. This is especially the case if the wound has healed
by primary union and the cicatrix is linear.
The prognosis in incised wounds is good as to life unless a
large vessel has been divided or unless an important viscus
has been penetrated. The prognosis as to function varies with
the position and extent of the wound, and the circumstance of
the healing of the wound.
Punctured Wounds, Stabs, etc. — These are character-
ized by narrowness as compared to depth, though the depth is
not necessarily great. They are more varied in character than
incised wounds owing to the great variety of form of the weapons
by which they may be made. From the form, etc. , of a partic-
ular wound we may often infer the variety of weapon by which
it was produced. According to the weapon used, punctured
wounds have been divided into several classes, of which M.
Tourdes distinguishes four: 1st. Punctured wounds by cylin-
drical or conical instriiments like a needle. If the instru-
ment be very fine like a fine needle, it penetrates by separating
the anatomical elements of the skin, etc., without leaving a
bloody tract. Such wounds are generally inoffensive, even when
penetrating, if the needle is aseptic, and they are difficult to ap-
preciate. On the cadaver it is almost impossible to find the tract
of such a wound. If the instrument be a little larger it leaves
a bloody tract, but it is difficult to follow this in soft tissues,
more easy in more resistant structures, such as tendon, aponeu-
rosis, cartilage, or serous membrane.
If the instrument be of any size this variety of punctured
wounds presents a form quite different from that of the weapon.
Instead of a round wound it is generally a longitudinal wound
with two very acute angles and two elongated borders of equal
length, showing but little retraction. This is the shape of the
wound even when the instrument producing it is so large that
the resulting wound resembles that made by a knife (see Fig.
2). The direction of the long axis of these wounds varies in
different parts of the body and is uniform in the same part.
Their shape and direction are explained by the tension of the
skin or still more clearly by the direction of the fibres of the
skin, just as with the same round instrument in a piece cf wood
a longitudinal opening or split would be made parallel to the grain
(see Fig. 1). In some regions, as near the vertebrae, the fibres
464
WOUNDS — WOOLSEY.
may run in dififerent directions, and the resulting wound is stel-
late or triangular in shape as if a many-sided instrument had
caused it. As the direction of the fibres of the various tissue
layers, such as aponeuroses, serous and mucous membranes, etc.,.
Fig. 1.— Direction of the Long Axis of Wounds of the Back caused by Conical Instruments.
(After Longer.)
may be different, a deep wound involving several such layers
would have a different direction for each layer. In illustration of
this, examine the figure of a wound through the wall of the
stomach (see Fig. 3) .
The wounds above described when large are smaller than
PUNCTURED WOUNDS BY INSTRUMENTS.
4G5
the weapon, as the splitting of the skin has certain limits and
also owing to the elasticity of the skin, which is put on the
stretch by the weapon and relaxed on its withdrawal. When
Fig. 2.— Slit-like Wound caused by a Pointed
Conical Instrument 2.5 cm. in Diameter. Nat-
ural size.
Fig. 3.— Wounds of Stomach Wall'by
a Conical Instrument, showinf? the Dif-
ferent Direction of the Long Axis of the
Wounds in Different Layers.
such wounds are small they are larger as a rule than the in-
strument causing them.
2d. Punctured wounds by instruments both sharp-pointed
and cutting, like a knife or dagger. If these wounds are per-
pendicular to the surface, they have
more or less the form of the weapon
used. The angles may show whether
the knife, etc., had one or two cut-
ting edges, but even though the
back of the knife is broad the wound
may resemble one caused by a
double-edged weapon. Thus stab-
wounds from a common pocket-
knife show only exceptionally a
wedge-shape, but regularly a slit,
the edges of which are slightly
curved to one another and end in
two acute angles. The reason of
this lies in the fact that the wound
is only caused by the cutting edge of
the knife, so that we cannot tell as a
rule which angle was occupied by the back of such a knife (Figs.
4 and 5) . The depth of these wounds may equal the length of
the weapon or be almost any degree less, but the depth may
30
Fig. 4.— stab-Wound of the Skin
with a Knife a Few Minutes before
Death.
466
WOUNDS — WOOLSEY.
Fig. 5.
-Nine Suicidal Stab- Wounds in the Region of the Heart
made by a Knife used for Cutting Rubber.
even be greater than the length of the weapon by reason of a
depression of the parts at the time of the blow. The wound
is often shorter and broader than the weapon causing it,
__^^__^^^ though more often
■•''^ - -- . • :-S:^-ix^;^£L-.'^ ^^ ^g larger than the
weapon from the ob-
1 i q u i t y of the
wound and the
movement of the
weapon on being
withdrawn. The
wound is smaller
than the instrument
where the parts are
on the stretch at the
time the wound is
inflicted.
This variet}' of
punctured wounds
may resemble the
former class in the direction of its long axis, if the cutting
edge of the instrument is blunt. The regularity and smoothness
of the edges distinguish them from certain contused wounds.
3d. Wounds tnade by instru-
ments with ridges or edges, files,
foils, etc. If the edges are cutting
the wound presents more or less the
shape of the weapon (Fig. 6). But
this is not alwaj^s so, probably from
the instrument puncturing oblique-
ly or from the tissues being unequal-
ly stretched (Fig.7) . If the edges
are not cutting the wound resem-
bles those of the first class, though
the edge often presents little tears,
and the wound may thus be more
or less elliptical with two un-
equal angles. The wound of entrance and exit may be different.
4th. Irregular perforating instruments, the wounds from
which resemble contused wounds.
Fig. 6.— stab- Wounds caused by a
Three-Sided Sharp-Edged Pointed In-
strument.
CONTUSIONS AND CONTUSED WOUNDS.
467
Contusions and Contused Wounds. — A contusion is a
wound of living tissues by a blow of a hard body, not sharp-
edged or pointed, or by a fall, crushing, or compression, and
without solution of continuity of the skin. A contusion usually
involves a moderately large surface in comparison to the two
other classes of wounds. Contusions are of all degrees of sever-
ity. If the blow or injury is slight, there is only slight redness
and swelling of the skin with pain, disappearing in a few hours,
and leaving no traces. If the blow be harder it produces more
or less crushing of the
tissues, accompanied
by ecchymosis with or
without a wound or ex-
coriations of the skin,
etc. The contusion
may have the shape of
the contusing body,
such as a whip, the
fingers, etc.
Ecchymosis. —
This is characteristic,
as a rule, of contused
wounds. It consists in
the infiltration of blood
into the tissues, espe-
cially the cellular tis-
sues. The source of the
blood is from the rupture of blood-vessels, and the size of the
ecchymosis varies partly with the number and size of the blood-
vessels, or with the vascularity of the part. The size of the ec-
chymosis also varies with the looseness of the tissues into which
it is infiltrated. This looseness of the tissues may be natural as
in the scrotum and eyelids, or it may be due to the attrition of the
tissues caused by the blow. An ecchymosis is larger when the
contused parts cover a bony or resisting surface, and there may
be no ecchymosis whatever, even from a severe blow, where the
underlying parts are soft and yielding, as is the case with the
abdominal parietes. Here we may have rupture of the viscera
without any signs of ecchymosis superficialh'. An ecchymosis
may be infiltrative or it may mostly occupy a cavity usually
Fig. 7.— Stab-Wounds caused by an Eight-Sided
Sharp-Edged Instrument. Some show a transition
stage to wounds made by a conical instrument.
468 WOUNDS — WOOLSEY.
formed by a traumatic separation of the tissues ; this is espe-
cially the case in the scalp and extremities when the injury is
severe. These tumors, which are called liematomata, may be
rapidly absorbed or they may remain a long time and occasion-
ally suppurate. Sometimes the anatomical conditions, espe-
cially of the connective-tissue spaces, allow the extension or
migration of the ecchymosis under the action of gravity, even
to a considerable distance. When it meets an obstacle it accu-
mulates above it, as in the inguinal region for abdominal ec-
chymosis and at the knee for those of the thigh. The course
along which the ecchymosis travels is indicated externally by a
yellowish stain, soon disappearing, so that soon no sign persists
at the site of injury, but only below where the blood is arrested.
An ecchymosis becomes visible at varying times after the
injury according to the depth of the ecchymosis and the thinness
of the skin, for the ecchymosis is mostly beneath, not in the skin.
If the ecchymosis is superficial it shows in one or two hours or
even in less time where the skin is very thin, as in the eyelids
and scrotum. In such cases it increases for thirtj'" or forty
hours and disappears in a week, but may last longer, i.e., as
long as fifteen to twenty-five days.
An ecchymosis may not show at the point struck, at least
not until several days have elapsed, or it may only show on the
under surface of the subcutaneous fat until it has imbibed its
way, as it were, to the surface. This may explain the discrep-
ancy in the description of an injury examined by two medical
experts at different times.
If an ecchymosis is extensive and deep, especially if it occu-
pies a cavity, there may be nothing to see in the skin for four
or five days, and then often only a yellowish discoloration in-
stead of a dark blue color. In such cases, too, the appearance
in the skin may be more or less remote from the injury, having
followed the course of the least anatomical resistance. Between
these two extremes, an ecchymosis may become visible at
almost any time. Rarely an ecchymosis occurs only deeply be-
tween muscles (pectorals, etc.) and not superficially at all.
The extravasation of blood which forms an ecchymosis has
sometimes been given different names, according to its extent
or position, for instance, parenchymatous or interstitial hemor-
rhages or apoplexies, suffusions, ecchymoses, petechise or vibices.
ECCHYMOSIS. 469
All such may, however, be called ecchymoses or hematomata.
When blood is effused into the serous cavities of the body,
special names are sometimes applied according to the position,
such as hemothorax, hematocele, etc.
The color of an ecchymosis is at first a blue-black, brown, or
livid red. This color changes first on the edges, later in the
darker centre, and becomes in time violet, greenish, yellow,
and then fades entirely. This change in color is owing to a
gradual decomposition of the haemoglobin of the blood. We
can tell the age of an ecchymosis from its coloration only
within uather wide limits, for the rapidity of change of color
varies widely according to a large number of circumstances,
especially according to whether the ecchymosis is superficial or
deep. We can only say that the first change, i.e., that to vio-
let, in a superficial ecchymosis, occurs in two or three days.
As an exception to the above color change, we may mention
sub-conjunctival ecchymosis, which always remains a bright
red, as the conjunctiva is so thin and superficial that the color-
ing matter of the blood is constantly oxidized.
The form of an ecchymosis often reproduces well enough
that of the instrument, except if the latter be large it cannot all
be equally applied to the surface, and its form is not distinctly
shown by that of the ecchymosis. After its first appearance
an ecchymosis spreads radially, the edges becoming less clear.
This change occurs more rapidly the looser the surrounding
tissues, and at the end of a few days the first form of an ecchy-
mosis may be changed, so that an examination to determine
the nature of the weapon should be made as early as possible.
Ecchymoses are more easily produced in the young, the
aged, and in females, also in the case of such general diseases
as scurvy, purpura, hemophilia, etc. In fact, in the last three
classes they may occur spontaneously. This fact should never
be lost sight of, as the attempt may be made to explain a trau-
matic ecchymosis in this way. The diagnosis between the
traumatic variety and such cases of spontaneous ecchymoses is,
in general, eas}^ for in the latter case their number, form, size,
and occurrence on parts little exposed to injury and on the
mucous membranes, as well as the general symptoms of the
disease, leave little or no room for doubt.
From an oblique or glancing blow a considerable area of
470
WOUNDS — WOOLSEY
skin may be stripped up from its deep attachments forming a
cavity which may be filled by a clear serous fluid alone, or with
some admixture of blood. These cases have been studied espe-
cially by Morel Lavallee and Leser, and the fluid has been
thought to be lymphatic in origin, hence the name " lymphor-
rliagia.''^ Carriage accidents, especially where the wheels do
not pass directly but obliquely across or merely graze the body,
are especially liable to show this form of extravasation, which
is thought to be more common than is generally supposed, being
often obscured by a small qviantity of blood.
Contused Wounds.— If with the contusion we have a
solution of continuity of the skin, then we have a contused
wound. This may sometimes resemble an incised wound if
Fig. 8. — Linear Wound with Nearly Clean-Cut Edges, with Strands of Tissue bridging across
at the Bottom and caused by a Fall on the Head on a Smooth Surface.
the weapon has marked angles or edges, as a hammer, or, as
we have already seen, in wounds of the scalp or eyebrow (Fig.
8). Careful examination, however, by a small lens if neces-
sary, is sufficient to distinguish them if they are fresh.
If they are four or five days old and have begun to granulate,
it may be impossible to distinguish them. Contused wounds
present on examination small tears on the edges which are
widely separated and more or less extensively ecchymosed.
Contused wounds are often irregular, and have thickened or
swollen and ragged borders. They may, like simple con-
tusions, show b}'- their shape the form of the instrument
which caused them. In contused wounds, unless they be per-
fectly aseptic, we usually find sloughing of the contused,
necrotic tissues. This leaves a cavity to be filled up by granu-
LACERATED WOUNDS. 471
lation like wounds with loss of substance. They therefore
often present large cicatrices which may be mistaken for those
of ulcers. In contused wounds the bone may sometimes show
the impression of the instrument causing the wound.
A variety of contused wounds is that where the wound of
the skin consists merely of an erosion or excoriation with an
ecchymosis beneath. The wound may reproduce the shape of
the weapon, i.e., finger-nails, etc. After death the skin be-
comes brownish-yellow, hard, and dry, and then they are called
by the French "plaques parcheminees." They are distin-
guished, as a rule, from those produced after death, by the
ecchymosis beneath.
Lacerated wounds resemble contused wounds very
closely, but are not ecchymosed to any considerable extent.
The solution of continuity is sometimes very extensive and
irregular, and may present several flaps. The bone or bones
are often fractured at the same time. Thej seldom bleed much.
The course of repair resembles that of contused wounds as a
rule. The prognosis is variable, for there may be slow and
extensive cicatrization and impairment of function, etc. These
wounds usually result from machinery accidents and accidental
tears, etc. They are therefore seldom the occasion of criminal
proceedings but more often of a civil suit, and thus require
medical examination.
The injury which causes a contusion or contused wound
may not infrequently produce effects far more serious and more
or less remote from the contusion. Some of these effects it
may be well to particularize. Blows on the abdomen are some-
times quicklj^ followed by death without visible lesion to ac-
count for it. That authentic examples of this exist has been
denied by Lutaud, except for cases of rapid death following
contusions of the abdomen which had caused extensive rupture
of the viscera and abundant hemorrhage. But Vibert gives
two cases from his own experience, which are as follows :
A young man, twenty years old, received a kick in the
stomach at a public ball. Numerous witnesses of the scene
testified that he only received this one blow. The man collapsed
immediately and died in a few minutes. On autopsy nothing
was found but two small ecchymotic spots in the peritoneum
covering the intestine, the largest not the size of a bean.
472 WOUNDS — WOOI.SEY.
In the second case, the injury was also a kick in the stom-
ach and the man died almost immediately. Absolutely no
lesion was found on autopsy. Both were in full digestion.
Konig' says: "A number of severe contusions of the
belly run a rapidly fatal course without the autopsy showing
any definite anatomical lesion of the viscera." He also adds
that the less severe cases at first often show .very profound
shock, which is out of proportion to the force of the injury.
The cause of death has been explained, like that of sudden
death from a blow on the larynx, by the theory of inhibition.
These cases are often illustrated experimentally on fro^s, where
the same result is obtained under similar conditions. Such
cases are the more remarkable from the fact that the fatal blow
maj' cause no ecchymosis or other mark of injury to appear on
the abdominal walls.
Blows on the head may produce a variety of results besides
that of the contusion itself. In fact, death itself may result
though the marks of contusion are very slight or even imper-
ceptible. Intracranial hemorrhage, laceration with ecchymo-
sis of the brain, on the same or opposite side to the injury, and
concussion of the brain may result. Of these only concussion
will be considered now.
Concussion has been defined as a shock communicated to
an organ by a blow or fall on another part of the body, which
may or may not be remote, and without producing a material or
appreciable lesion. According to Lutaud,' English pathologists
understand by it a temporary or permanent nervous exhaustion
resulting from a sudden or excessive expense of nervous energy.
Its effect is observed in the function of an organ and especially
in the brain. Concussion of the brain causes stupidity, loss of
consciousness, amnesia, coma. The intracranial lesion most
often associated with concussion is ecchymosis and laceration
on the surface of the brain, but there may be no lesion visible
even if the case is a fatal one. Fatal concussion has been ob-
served where the marks of external violence were very slight or
even failed entirely, as illustrated by the two following cases
cited by Vibert : ^
Vibert made an autopsy on a man who had been struck by a
' "Lehrbuch der Speciellen Chi- «" Manuel de Leg. , " 5th Ed., 1892.
rurgie. " ^ " Pr^cis de Med. Leg. , " 2d Ed. , 1890.
CONCUSSION. 473
pitchfork, one of the teeth of which struck behind the ear, the
other two in the face, only producing slight skin wounds.
The man immediately lost consciousness and died in two days
in coma. No lesion whatever was found within the skull, and
only three slight ones externally.
He observed another case where the man fell three or four
metres into an excavation, landing on his feet, and died in a
short time. On autopsy only slight erosions and no intra-
cranial or extracranial lesions were found.
This case belongs to a rare class where the blow is trans-
mitted through the spinal column without sign of injury exter-
nally or internally to the head.
The following case cited by Vibert is even more remarkable
in the production of the severe though not fatal concussion :
An officer was riding at full speed on horseback, when his horse
suddenly stopped short. By great exertion the officer clung to
the horse, but immediately lost consciousness. His fall from
the horse was broken by those about him, and the concussion
he received was not due to the fall, but to the shock of stopping
suddenly when his momentum was great.
As a rule, however, the diagnosis of concussion, especially
if it is severe enough to be fatal, is easily made by the marks
of external violence with or without intracranial lesions. The
effects of concussion may be transient and leave no trace, but,
on the other hand, they maj^ be prolonged and severe, i.e.,
paralysis, aphasia, loss of memory, imbecility, etc. The medi-
cal examiner should be on his guard against simulation in
respect to these prolonged effects of concussions. One of the
most frequent consequences of concussion is temporary amnesia,
which ordinarily succeeds immediately after the injury, but
sometimes develops more slowly. The following curious case is
quoted from Lutaud as cited by Brouardel :
A woman in getting out of a train at Versailles, where she
had gone to attend the funeral of a relative, was struck by the
door of the compartment. She fell, but did not lose conscious-
ness, and picked herself up, but forgot what she had come for.
Another result of an injurj^ which has caused a contusion
or contused wound may bo a fracture or dislocation. Frac-
tures and dislocations of special parts will be referred to later,
in considering injuries of the several regions of the body, but
474 WOUNDS — WOOLSEY.
it seems appropriate here to refer to some of those general con-
siderations relating to these injuries which may especially
demand the attention of the medical expert.
Fractures may be produced by blows or falls, or from mus-
cular action. The medical witness may be questioned as to the
cause of the fracture or, if it was produced by a blow, whether
a weapon was used or not, as the defence is likely to assert
that it was caused by an accidental fall. The nature of the
associated wounds and contusions, if any exist, may, as we
have seen, indicate the weapon used. If anything exists to
indicate that a fall which caused the fracture was not acci-
dental, this should be noted, as the assailant is responsible for
the effects of the fall.
A number of conditions influence the ease with which a
fracture is produced and account for a fracture being due to a
slight injur}', and so are mitigatorj" circumstances in the case.
Fractures are more easily produced in the old and young,
especialh' the former, than in the adult from the same force.
This is due tobrittleness of the bones in the old and their small
size in the young. Certain diseases like syphilis, arthritis,
scurvy, carcinoma, and rickets make the bones more frangible,
and there is a peculiar brittle condition of the bones known as
fragilitas ossium, more or less hereditary, in which the bones
become fractured from very slight violence. Mercer is quoted
by Taylor as stating, but on how good authorit}' it does not ap-
pear, that in general paralysis of the insane the bones are
particularly liable to fracture. Certain it is that not uncom-
monly insane patients are found dead with single or inultiple
fractures, but the attendants are generally convicted.
In some parts, like the orbital plate of the frontal bone, the
bone is very thin and brittle, but brittleness from any cause
only mitigates, it does not excuse.
Taj'lor ' reports a case in point where it was proved that the
bones of the skull were thin and brittle, and the fractured skull
proved fatal from inflammation of the brain. The punishment
was mitigated owing to the circumstance of the brittleness of
the bones.
Spontaneous fractures may occur from only a moderate
degree of muscular action, and even where there is no disease
'Taylor: " Medical Jurisprudence, " 11th American Edition (1892).
SPONTANEOUS FRACTURES. 475
of the bones, but the above-mentioned condition of fragilitas
ossium, rendering the bones more brittle, aids in the production
of such fractures. The olecranon, patella, and os calcis are par-
ticularly liable to such fractures, but the long bones of the ribs
and extremities are sometimes so fractured, as instanced in the
following cases cited by Taylor : '
The humerus of a healthy man has been broken by muscular
exertion simply by throwing a cricket ball." In 1858 a gentle-
man forty years old, during the act of bowling at cricket,
heard a distinct crack like the breaking of a piece of wood.
He fell immediately to the ground, and it was found that his
femur was fractured.
Again, in 184C, a healthy man, set. 33, was brought to
Gray's Hospital with the following history: He was in the act
of crossing one leg over the other to look at the sole of his foot,
when something was heard to give way; his right leg hung
down and he was found to have received a transverse fracture
of the femur at the junction of the middle and lower thirds.
The writer had a case in Bellevue Hospital during the past
winter (1892-93) of a man who stated that he had been well and
active until some weeks previously, when, from muscular force
alone, he sustained a fracture of the neck of the femur. Some-
thing abnormal in the bone may be present in such cases.
In cases of spontaneous fractures there are no marks of ex-
ternal violence which, if present, would remove the idea of
spontaneity.
Fractures of the extremities are not dangerousper se, unless
they are compound or occur in old, debilitated, or diseased per-
sons, and thej^ are more severe the nearer thej^ are to a joint.
The healing of fractures is more rapid in the young than in the
old and in the upper than in the lower extremity. It is not
proven that adiposity of itself impedes union.
The question may be asked, how long before examination a
given bone was fractured. As a rule, we can only say as to
whether the injured person has lived a long or short period
since the injury, as the process of repair varies according to
age and constitution. No changes occur until eighteen to
twenty-four hours, when lymph is exuded. According to Vil-
' Taylor : " Medical Jurisprudence, " - London Med. Gaz. , vol. xvi. ,
11th American Edition (1892) . p. 596.
47G WOUNDS — WOOLSEY.
lerme the callus is cartilaginous anywhere between the six-
teenth and twenty-fifth days, it becomes ossified between three
weeks and three months, and it takes six to eight months to
become like normal bone.
The question may also be asked : Has a bone ever been frac-
tured? The existence and situation of a fracture can often be
recognized long after the accident, by the callus or slight un-
evenness due to projection of the edges or ends of the fragments
Where the bone lies deeply covered by soft parts, it is difficult
and often impossible to tell, long after union has taken place,
whether or where a fracture has occurred.
The answering of this question may sometimes be of im-
portance in identifying the dead, especially in the case of skele-
tons. In the latter instance by sawing the bone longitudinally
we can tell by the thickness, irregularity, or structure of the
bone tissue whether a fracture existed, and if it were recent or
old at the time of death.
Dislocations call for a medico-legal investigation less
often than fractures. They are less common in the old and
where the bones are brittle, when fracture occurs more readily.
They are seldom fatal per se, unless between the vertebrje or
when compound. They may occur from disease in the affected
joint or even spontaneously. The diagnosis of a dislocation is
easy until it has been reduced, and then it may leave no trace
except pain in and limitation of the motion of a joint besides
swelling and ecchymosis. These effects are transient, and after
they have disappeared it may be impossible to say whether a
dislocation has existed on a living body, unless, as sometimes
occurs, especially in the shoulder joint, there may be a tempo-
rary or permanent paralysis of a nerve and muscular atrophy.
After death, the existence of an old dislocation may often be
recognized on dissection by scar tissue in and about the capsule.
EXAMINATION AND DESCRIPTION.
The examination of wounds or injuries in a case which is
or may become the subject of a medico-legal investigation
should be made with particular care and exactness.
As the examination of the wounded person is to give most,
and in some cases all, the information to the medical expert on
EXAMINATION AND DESCRIPTION. 477
which he is to base his testimony, it should be made with
reference to all the possibilities of the case.
The particular variety of wound as described in the forego-
ing section should be noted, and any peculiarities as to its situa-
tion, shape, extent, length, breadth, depth, direction, and the
parts involved. Besides these points, the condition of the edges
of the wound, whether swollen and ecchj^motic, smooth and
straight or dentated and irregular, and whether inverted or
everted and gaping, are matters of importance. The presence
or absence of coagula and clots, the staining of the tissues with
blood, the presence of ecchymosis and its comparative age, as
shown by its color, should also be noted.
Many of the above points help us in solving another prob-
lem, namely, the form of the instrument used. This question
will be discussed in a subsequent section, but the basis for our
opinion is founded, of course, on an examination of the partic-
ulars of the wound. The solution of still another question
which often arises and which will be discussed in the next
section, namely, whether a wound was produced before or
after death, is based upon particular features of the wound such
as the fluid or clotted condition of the blood on the surface, or
ecchymosed in the tissues, also the amount of the hemorrhage
as compared to the vascularity of the part as well as the greater
or less staining of the tissues with blood, and the conditions of
the edges, whether inverted or everted and whether or not re-
tracted. The question as to whether a wound was directly,
secondary or necessarily the cause of death, is determined, in
part at least, b}^ examination of the wound. In this connection
we take note as to whether a wound has opened or divided a
large vein or artery or is situated in such a vascular part as to
be fatal from hemorrhage. We also note whether death could
have been due to shock from the situation of the wound, or
whether an inflammation wdiicli was directly responsible for
death was necessarily due to the wound, as in case of a pene-
trating wound of the viscera, etc. Further, we note whether
one of the manj^ forms of wound diseases from infection of the
wound has complicated the case and caused death in the case
of a wound not otherwise necessarily fatal. It may be added
that often the necropsy aids us in the solution of the ouestion
as to whether the wound was the necessary and direct cause
478 WOUNDS — WOOLSEY.
of death, by showing a healthy or diseased condition of the
viscera.
The question as to which of a number of injuries was first
inflicted, also as to the relative position of the victim and
assailant, can be answered, if at all, only by an accurate and
close examination of the wounds.
Finally, the most important question of all, from a medico-
legal standpoint, namely, the distinction between homicidal,
suicidal, and accidental wounds, is decided or inferred from the
characteristics of the wound after careful examination.
All the foregoing questions contribute to the solution of this
the most important one. The various questions referred to
above will be considered at greater length in the subsequent
sections. They have been merely referred to in brief above,
to show the various lines of thought a medical examiner must
have in mind in making an examination.
As to the act of examination itself, the phj^sician should
conduct it in such a way as not to harm the wounded person.
Often simple inspection is the most that can be done, or the
examination may have to be deferred altogether until the phy-
sician in charge informs the court that an examination may be
safely made. It is often necessary for the expert to get infor-
mation as to the original lesion from the physician in charge.
If the wound has been a fatal one and if we are called in after
death, we may examine the wound on the dead body with much
more freedom. Here we may examine the depth, direction,
etc., of a punctured wound by cutting down on a probe or
director. After careful inspection of the wound we may ex-
amine it by palpation, and go on to the dissection of the wound
and the surrounding parts, tracing and noting the various
vessels, muscles, etc., involved in the wound, and looking for
the presence of any foreign body in the wound.
Furthermore, if the cause of death be at all obscure, we
should examine not only the wound itself and the parts about
the wound, but also, by an autopsy, all the cavities and organs
of the body. For death may have been due to natural causes
in an organ not examined, if the examination has not included
all, and the physician has to disprove it.
In examining at an autopsy the depth of a wound in refer-
ence to the instrument which caused it, it should be borne in
EXAMINATION AND DESCRIPTION. 479
mind that the wound may be deeper than the weapon owing to
a depression of the surface by the handle of the weapon. This
may appear especially marked in the case of the movable viscera,
as at the time of the accident the viscus may have been as near
as possible to the surface, and at the examination as far as
possible from the surface, as in the case of a given coil of the
intestines. Also the thorax when opened at autopsy enlarges
or expands a little, so that the measured depth of a wound may
be greater than the weapon which caused it. Vibert * mentions
a case of a penetrating wound of the thorax involving the heart,
where the measured depth of the wound was 0"'.035 greater
than the length of the instrument. This may also be accounted
for by a depression or flattening of the thorax by the blow, as
in the case of soft parts. It is often difficult in an examination
to measure accurately the depth of a wound, for one may find
it hard to determine the precise end of a wound. Also, for
exact measurement it is necessary to have the parts in the same
position as at the time of the accident, and these parts are more
or less displaced by the necessary dissection.
Besides the examination of the wound there are other points
the examination of which may aid us in solving the problems
presented by a case. Among these, the examination of the
clothing or dress is perhaps the most important. This may in-
dicate the weapon used in an incised or punctured wound.
Contused and lacerated wounds or fractures, etc., may be pro-
duced without injuring the clothing. Blood, dirt, or grease on
the clothing may throw light on the case. In self-inflicted
wounds the wound in the clothing and that on the body may
not and often do not correspond, as an intending suicide often
(a murderer rarely) opens the clothing to select the spot for the
wound. The wound in the dress is then added by a second
blow not corresponding to the first. In this way we may
sometimes distinguish between a homicidal and suicidal wound,
and thus remove a false suspicion of murder or show that a
wound was self-inflicted to conceal other crimes or to falsely
impute it to another. The suspicion of homicide in accidental
wounds maj^ be cleared up by an examination of the dress, as in
the following instance related by Taylor : *
' Cli. Vibert : " Precis de Medecine '^ Taylor's " Medical Jurispru-
Legale," 2d Ed., p. 205. dence," 11th Amer. Ed., 1892.
480 WOUNDS — WOOLSEY.
A woman was found dead in bed with two indentations
about the middle of the right parietal bone, a large superficial
clot here and three ounces of clotted blood between the dura
mater and skull, which latter was fractured over an area of four
inches. No other cause of death was found. The evidence
brought out the facts that she had been knocked down the
evening before, about 7 : 30 o'clock, by a man accidentally run-
ning into her. She fell on the back of the head, was stunned,
raised up, and stimulated ; she then walked home, ate her supper,
and was last seen at 9 o'clock by a fellow-lodger who let her in
and noticed nothing unusual. The next morning she had evi-
dently been dead some time. Suspicion fell upon the lodger,
who had often quarrelled with her, and the two claws of a ham-
mer found in his room corresponded more or less closely with
the two indentations found in the skull. At the adjourned
inquest, however, the bonnet worn by the deceased at the time
of the accident was found to have two indentations on the back
of it corresponding to those on the woman' s skull and contain-
ing dust and dirt, and rendering probable what from the history
seemed unlikely, that the fall in the road caused the fatal
injury. The examination of the dress thus avoided an unjust
accusation of murder.
Contused and lacerated w^ounds and fractures or dislocations
may be produced without injury to the dress, especially if the
latter be elastic or yielding. The comparison of the wound in
the clothes with that on the body may indicate the position of
the body at the time of the blow. The examination of the
clothes of the injured person may indicate a struggle which
would support the idea of homicide. A blunt instrument may
indirectly cause an injury by striking something in or on a
person's clothes. Instances have been reported where a wound
has been caused by an article in the pocket, or worn outside the
clothing, without any trace of an injury to the clothes or pocket
lining.'
The examination of the dress may further show which of
several cuts or stabs was first inflicted. This is shown by the
staining of the edges of the cuts in the clothing, the edges of
the first cut or stab showing no blood-stain or onlj'^ on the inner
' London Lancet, Jan. 21st, 1893, and N. Y. Med. Journal, March 11th,
1893, and May 13th, 1893.
EXAMINATION AND DESCRIPTION. 481
surface, as the knife is clean of blood on entering and all that is
removed by the clothing on its withdrawal is found on the
inner edges. If the edges of the cuts in the outer layers of
clothing are bloody, it is evident that the knife was already
bloody when used, and the corresponding wound was not the
first inflicted.
The imprint of the bloody hand of the assailant may some-
times be found on the clothing of the one injured, and is espe-
cially important as evidence, when the hands of the assaulted
are not bloody. In the case of a severe wound, especiall}' if
it is likely to become the object of a criminal investigation, the
physician should always require to see the dress of the wounded.
The examination of the clothing which the accused wore at the
time the assault took place may give important evidence by
showing evidences of a struggle or blood-stains. Absence of
the latter would not prove the innocence of the accused, as the
clothes actually worn may be destroyed and others substituted,
or the marks and stains may be removed. In the latter case,
the eye of a medical man may detect traces of blood which
otherwise would go unnoticed, and a microscopical and chemi-
cal examination would reveal the real character of the stain.
Besides the examination of the clothing of the accused, the
examination of his person may furnish evidence of his being
engaged in a more or less desperate struggle by the scratches,
marks of nails, contusions, bites, etc., on the face, neck, front
of chest, forearms, and hands. If the accused should attempt to
explain these wounds and spots, the latter may or may not
verify the explanation, and thus additional evidence may be
obtained as to the guilt or innocence of the accused.
It is well for the medical expert, as well as for others, to
collect the statements of the wounded person relative to the
circumstances of the injury. Also, if the accused will vouchsafe
any such statements we may compare these with one another
and with the facts indicated by the wound, etc.
Other points to examine, especially in cases of suspected
suicide, may be briefly mentioned. The presence of the weapon
in the hand of the victim and firmly grasped in general indi-
cates suicide, if it corresponds to the weapon causing the
wounds, for otherwise it may have been used for defence. If
not in the hand, note the spot where the weapon was found.
31
483 WOUNDS — WOOLSEY.
In the case of a suicide, the hand as well as the weapon held
by it is likely to be bloody, also in case of murder the generally
empty hand is apt to be bloody, as the hand is naturally carried
to the wound.
We cannot further describe the many points which the
medical examiner should bear in mind in making an examina-
tion in a medico-legal case, without repeating too fully what
will be given at greater length in subsequent sections, reference
to which should be made for further particulars. Tardieu pro-
posed as a basis for examining and studying wounds, (1) to
visit the wounded person and see what state he is in, and to
determine (2) the nature, (3) the cause, (4) the consequences
of the wound. Also if the wounded person is dead (5) to ex-
amine the body for the cause of death in order to see if the
latter is due to the wound. Also (6) to determine thee ircum-
stances of the affray.
The description of a wound should be given in plain
language, avoiding the use of scientific terms or expressions, so
as to be readily understood by judge and jurors. Otherwise
the usefulness of the medical expert is very much decreased.
The description should also be precise and sufficient to justify
the conclusions arrived at as to the cause of a wound, its gravity
and results, and the weapon used. With a view to exact state-
ment in description, it is well to take notes as to the result of
the examination and not depend merely on memory. The ob-
ject of the witness should be to be understood and not to be
thought thoroughly scientific.
WAS THE INJURY INFLICTED BEFORE OR AFTER DEATH?
This is a question which may often be asked in cases of fatal
injuries, and it is one which must be answered as definitelj' as
we are able, for the defence may rest on the assertion that the
wound or injury was post mortem and not ante mortem. What
are the means we have to enable us to answer the above ques-
tion? The most important factor is the condition of the blood
and the changes that it undergoes after death. For some hours
after death the body retains its animal heat. As long as this
is retained rigor mortis does not set in and the blood is more
or less fluid. This period varies, but on the average it does not
HEMORRHAGE. 483
last longer than eight or ten hours. Before this time, however,
the blood has begun to undergo certain changes. These changes
result in the inability of the blood from a post-mortem wound
to coagulate completely. At first the greater part may coag-
ulate, but after a time coagulation is less and less complete,
and the coagula are not as firm as those from the blood of a
living person. The period at which these changes occur also
varies, but they may generally be clearly noticed in from three
to four hours after death, or even sooner. In the first two to
four hours after death, therefore, as far as the condition of the
blood is concerned, it may be difficult or impossible to say
whether a wound was made before or soon after death. In
other words, this difficulty exists as long as the tissues of the
body live after the body as a whole is dead.
There are certain general pathological or occasional condi-
tions of the body in which the blood during life does not coag-
ulate at all or only imperfectly, as in scurvy and in the case of
the menstrual blood. Also blood in a serous cavity, especially
if it be abundant or there exists inflammation, is found not
to coagulate or onty imperfectly. Post mortem the blood re-
mains liquid long after death in cases of death by drowning,
asphyxia, etc., and in such cases hemorrhage may be free in
a wound made some time after death. Furthermore, after
putrefaction has set in the blood again becomes more or less
liquid, and may flow away from a wound like a hemorrhage,
but it no longer coagulates.
The principal signs of a wound inflicted during life are (1)
hemorrhage, (2) coagulation of the blood, (3) eversion of the
lips of the wound, and (4) retraction of its sides.
1. Hemorrhage varies in amount with the size of the
wound, the vascularity of the part, and the number and size of
the large vessels involved. In incised or punctured wounds the
amount, as a rule, is quite considerable. If there is a free exit
most of the blood runs off; the rest stays in the wound, Avhere it
soon coagulates with the exceptions mentioned above. But be-
sides partly filling the wound in the form of a clot, the edges of
the wound are deeph' stained with the coloring matter of the
blood, and this stain cannot be removed b}' washing. This
staining involves especially the muscular and cellular tissues.
Further, a hemorrhage during life is an active and not a
484 WOUNDS — WOOLSEY.
passive one; the blood is forced into the interspaces of the
tissues in the vicinity of the wound, and is found infiltrated in
the cellular tissue, the muscles, the sheaths of the vessels, etc.
It is here incorporated, as. it were, with the tissues so that it
cannot be washed away. In an ante-mortem wound the arte-
rial nature of the hemorrhage may show by the marks of the
jets of blood about the wound or on the clothes or surrounding
objects. When a large vessel has been divided and the exit
for the blood is free, this may run off without infiltrating the
tissues or even staining the edges to any considerable extent,
and there may remain but little in the wound. In the case of
lacerated and contused wounds the amount of hemorrhage is
less, but rarely fails entirely, and if the wound is in a vascular
part it is liable to cause death from hemorrhage, though a whole
limb may possibly be torn off without much hemorrhage. In
the latter case, however, there are usually found clots of blood
adhering to the edges of the lacerated wound and the ends of
the vessels. In contusions where there is no wound of the
skin the blood is prevented from flowing externally, and its
accumulation and distribution form an ecchymosis. Here
again we see the active power of the hemorrhage which infil-
trates between the tissues, stains them deeply, and appears
either as a mere stain or in fine clots incorporated, as it were,
with the tissues or partly occupying a cavity formed by an
extensive displacement of the surrounding parts. The amount
of blood varies under the same conditions as in incised wounds,
and also according to the greater or less disintegration of the
tissues by the blow, allowing a larger or smaller central cavity
to be formed. In "bleeders" the amount of the hemorrhage
does not vary under the normal conditions, but a fatal hemor-
rhage may occur from a very insignificant wound. After hem-
orrhage from a wound made during life the veins are empty
about the wound, especially those situated centripetally, while
normally after death the blood is mostly aggregated in the veins.
They are the source of post-mortem hemorrhage, but do not
empty themselves to any great extent.
The hemorrhage from a ivound made after death may be
extensive if the blood remains fluid as in the cases mentioned
above, i.e., after death from drowning or asphyxia or after
the commencement of putrefaction. Otherwise the amount of
CADAVERIC ECCHYMOSES. 485
hemorrhage decreases with the length of time after death, until
the blood loses its fluidity and hemorrhage no longer occurs.
In general, it is slight unless a large vein is opened, for the
veins are the source of the hemorrhage. There is usually
scarcely any hemorrhage after the first two to four hours. This
applies also to subcutaneous hemorrhages or ecchymoses. These
post-mortem hemorrhages are passive and not active, conse-
quentlj' there is less infiltration of blood into the surrounding
tissues, which merely imbibe it, and the stain is less deep and
may be washed off the edges of the wound, in contrast to the
stain of ante-mortem wounds. After putrefaction has set in
the hemorrhage may be more abundant, as the blood is driven
to the surface by the formation of gas in the abdomen and
thorax. At the saiue time, the coloring matter of the blood
transudes through the walls of the veins and is imbibed by
and stains the tissues, so that it may be impossible to dis-
tinguish it from a true ecchymosis. Fortunately these con-
ditions are of small moment, as an examination is seldom
deferred so long.
Cadaveric ecchymoses show almost invariably while the
body is still warm and the blood more or less liquid, i.e., during
the first eight or ten hours after death. They are not due to
injury or violence before or after death, but they may closely
resemble ecchymoses produced on the living body and be mis-
taken for them. This is the more important as they are quite
constant on the cadaver.
In this connection, it may be said that an ecchymosis due
to a blow before death may not show till after death, as it
requires some time for a deep ecchymosis or even an ecchymosis
covered by a thick layer of skin to show superficially. Thus a
man kicked in the abdomen died thirty-five hours after the in-
jury from peritonitis, due to a rupture of the bladder. No
ecchymosis appeared at the site of the injuries until after death.
It is not uncommon in cases of hanging to observe an ecchy-
mosis along the course of the cord appearing only after death.
Huize met with a case of this description. Devergie remarked
that on the bodies of those drowned ecchymoses are often hidden
for a time on account of the sodden state of the skin, and they
appear only after the water has evaporated, which may require
some days. Furthermore, it is not necessary to survive long
486 WOUNDS — WOOLSEY.
after an injury in order that an ecchymosis may show post
mortem. If the blood is fluid at the time of the blow and any
capillaries or larger blood-vessels are torn, then we may have
an ecchymosis though death be almost instant. Casper thought
that it required some time before death for an ecchymosis to
develop, and that if the person injured by a contusion died soon
after the injury, an ecchymosis would not appear after death.
There are many well-authenticated cases to prove that Casper's
opinion is wrong. Among the most famous of these is that of
the Duchesse de Praslin.' She was attacked and killed by her
husband while she was asleep in bed. The thirty or so wounds
showed a mortal conflict, and she could not have survived more
than one-half hour, and yet after death there were 'numerous
ecchymoses from the contusions.
Another case is also mentioned by Taylor.* A young man
died suddenly after a blow from a companion, having been
struck in the side a fortnight before by a heavy box, which
knocked him senseless and nearly killed him. The post mortem
revealed an ecchymosis on the side which on the authority of
Casper's opinion was attributed to the old injury. The color
of the ecchymosis would be sufiicient to settle all such doubts,
as the changes of color would have fully developed or the
color even disappeared in part in fourteen days' time.
An ecchymosis made post mortem does not undergo the color
changes seen in ecchymoses during life, unless the tissues are
oedematous in which the ecchymosis occurs. These changes in
color have already been described, the deep blue changing to
violet in eighteen to twenty-four hours at the earliest. In sup-
port of the foregoing and disproving Casper's views, Christison
found that within two Jiours after death severe blows on a dead
body are followed by a livid discoloration, similar to those pro-
duced by a blow shortly before death. This livid discoloration is
due to the effusion of a very thin layer of blood external or super-
ficial to the true skin, sometimes in a stratum of the true skin
or more rarely into the cellular tissue, staining deeply the par-
tition walls of the fat-cells. Of course, a more or less recent
contusion or ecchymosis on a dead body was not necessarily
produced at the same time as the cause of death. It should
'Ann. d'Hyg., 1847, t. 2, p. 377. ^ Tajdor : "Medical Jurispru-
dence," 11th Amer. Ed., 1892.
POST-MORTEM ECCHYMOSES. 487
be borne in mind in this connection that ecchymcsis is not a
necessary result of a blow or contusion.
According to Devergie, ecchymosis does not appear when a
blow inflicted post mortem is received by skin directly covering
a bony surface beneath, and rarely appears where there is a
large amount of fat and no solid point of resistance beneath the
site of the blow.
We have already referred to the fact which Portal long ago
remarked, namely, that the spleen has been ruptured without
ecchymosis or abrasion of the skin. The same absence of
ecchymosis has been noticed in cases where the liver, stomach,
intestines, bladder, etc., have been ruptured as the result of con-
tusing blows.
The following case cited by Taylor ' illustrates this point.
Henke reported the case of a man who died of peritonitis a few
hours after fighting with another man. There was no mark on
the skin or ecchymosis, though there existed peritonitis from
rupture of the small intestine. The blow was proven by direct
evidence, and though some medical witnesses on account of the
absence of external signs thought that no blow could have been
struck, others of more experience admitted that it could have
been the cause of the rupture.
Watson "^ reports a similar case of a girl nine years old who
received a blow from a shoe on the abdomen. This was fol-
lowed by great pain, collapse and death in twenty-one hours.
No marks of injury were visible externally, but peritonitis
existed from rupture of the ileum.
A similar case is reported by Williamson,' where peritonitis
resulted from complete rupture of the ileum without any trace
of injury externally, though the blow was struck by the hoof
of a horse.
Another case was brought into Guy's Hospital * who had
been run over by an omnibus. No injury was discoverable,
though the wheel had passed over the chest and abdomen. He
died of peritonitis, however, which set in on the second day,
and on post-mortem examination the liver and small intestines
were found ruptured.
'"Med. Jurisprud.," lltli Amer. ^Med. Gaz.. May, 1840.
Ed., 1892. •»Guy'sHosp. Gaz., 1873.
•^"On Homicide," p. 187.
488 WOUNDS — WOOLSEY.
Christison thought as the result of his experiments and ex-
perience that the most reliable signs of an ecchymosis made
during life, and distinguishing it from one caused by a blow
after death, were as follows : The skin of the ecchymosed area
is generally much darkened and discolored from blood infil-
trated through its entire thickness; the skin is also much
firmer and more elastic from swelling of the part if the contu-
sion is received some hours before death. But we may have
an effusion beneath and not in the substance of the skin, and
the above signs might possibly be due to an injury inflicted
only a few minutes after death. The above signs may there-
fore be absent, and when present are not absolutely indicative
of an injury received dviring life. In general, the effects of
severe contusions inflicted soon after death may closely resem-
ble those of slight contusions received during life.
There is little danger of contusion if the blow be inflicted
on a dead body after the loss of body heat and the beginning
of rigor mortis.
2. Coagulation of Blood. — As stated at the beginning of
this section, blood from a wound inflicted during life coagulates
with the exception of that from those suffering from certain
pathological or occasional conditions or in certain locations,
already mentioned. This coagulation is not immediate, but is
complete in about five minutes. The entire amount of blood
lost is thus coagulated and the coagula are firm. These coagula
(if the wound is not interfered with) occur in the opening of a
wound and on its edges, especially at the mouths of the blood-
vessels, which are thus plugged. The blood which infiltrates
the interspaces of the tissues is coagulated in the form of these
interspaces. The same is true of the blood of an ecchj^mosis
whether there be a hematoma or only an infiltration between
the tissues, or both. These clots represent more or less the
form of the space occupied by the blood. In the case of the
scalp a subcutaneous clot maj" be mistaken for a depressed frac-
ture of the skull from the fact that the edges of the clot become
very hard while the centre is still quite soft. A wound in
which a large arterj^ has been divided may present very little
clotting in the wound if the opening is free and the blood has
mostly escaped in a jet.
In a wound jjroduced soon after death there may be some
COAGULATION OF BLOOD. 489
clotting, but less in amount, firstly, because there is less hemor-
rhage, and, secondly, because not all the blood clots. These
conditions increase with the length of time after death, so that
after a time a wound made on a cadaver would show very
little if any clotting owing to very slight hemorrhage, and lit-
tle or no clotting of the blood extravasated. When the body
has lost its animal heat and rigor mortis has begun to set in,
then there is no more coagulation of the blood and no more
hemorrhage, under normal conditions, for the blood has mostly
become clotted in the vessels of the body. Consequenth^, with
the exception of wounds inflicted very soon after death, we can
distinguish an ante-mortem from a post-mortem wound by the
condition in which the blood is clotted. If there is any hemor-
rhage, the wound being inflicted before the loss of animal Jieat
and the blood remains entirely fluid on the surface or in an
ecchymosis, we know that the wound was produced after death
and some hours after death unless any of those conditions exist
in which the blood does not normally coagulate. If the hem-
orrhage is slight or quite moderate in amount and venous in
character, if the blood is only clotted in part and the clots are
rather soft and do not form a plug at the mouth of each artery,
and especially if the staining of the walls of the wound can
be washed off, then the wound was probably produced post
mortem, but not so long after death as in the first case supposed.
If the characters of the hemorrhage and the clotting are still
more like those normal to a wound inflicted during life, then,
as a rule, it is impossible to say from these two features of the
wound, hemorrhage and clotting, whether the wound was in-
flicted during life or a very short time after death.
3. EvERSiON OF THE LiPS OF THE WouND. — The edges or
lips of a wound inflicted during life may be inverted, instead of
everted, if a thin layer of muscular flbres is attached directly
to the deep surface of the skin, as is the case in the scrotum.
The eversion of the edges of the skin is due to their elasticity,
and ceases to occur as soon as the skin loses its vitality. Con-
sequently eversion ceases to occur soon after death, within a
very few hours. A wound in which the edges are neither in-
verted or everted was therefore inflicted after death. If this
sign is present and marked, the wound was inflicted during life
or within two or three hours or less after death. If this sign is
490 WOUNDS — WOOLSEY,
present but very slightly marked, the wound may have been
made even somewhat longer after death.
4. Retraction of the sides of the w^ound is also de-
pendent on their vitality and ceases to occur when this is lost a
few hours after death. In the retraction of the edges of the
wound we have all the parts involved, but unequally. The
muscles, arteries, skin, and layers of connective tissue all re-
tract, varying in the degree of retraction according to the order
in which they are named. In different parts of the body this
comparative order of retraction is liable to more or less varia-
tion. Every surgeon is familiar with this retraction of the
tissues, which necessitates certain rules in the technique of oper-
ations, especially of amputations. Muscles retract the more
the longer they are and the farther the incision is made from their
attachment. Without specifying a definite time, we may say
that, as a rule, this retraction lasts no longer than about two
hours after death, consequently when it is absent we may infer
that the wound was inflicted two hours or more after death. The
amount of retraction grows less and less after death for about
two hours, after which it is very slight if it occurs at all, owing
to the loss of elasticity of the tissues. This sign is especially
useful in the case of a mutilated body where, by examining the
degree of retraction of the muscles, we may infer whether the
mutilation was done before or after death. The sides of a cut
made on the cadaver are comparatively smooth and even, owing
to the absence of the unequal retraction of the various elements,
which makes the surfaces of a gaping ante-mortem wound un-
even and irregular. Relying on these circumstances in the
"affaire Ramus," cited by Vibert,* one was able to recognize
the order in which the body had been mutilated.
Other minor signs of a wound inflicted during life may be
briefly mentioned. If the edges of the wound are swollen, or
show signs of inflammation or gangrene, or if pus or adhesive
material is present on the edges of the wound, we may infer
that the wound was inflicted some little time before death.
Of course, if cicatrization has commenced, some days must
have elapsed before death after the wound was received. If
the blow causing a contusion was inflicted some time before
death, there will be more or less of a general swelling of the
' Vibert : " Precis de Medecine Legale, " 2d Ed. , 1890.
OTHER MINOR SIGNS. 491
region, partly due to the blood effused, but also partly due to
oedema.
It is not always easy to say whether a fracture was pro-
duced while the body was living or dead. If the body was stiU
warm when a post-mortem fracture was produced there is little
difference from an ante-mortem fracture, except that there
may be a little less blood effused. In a fracture produced after
rigor mortis has set in there is little or no blood effused. In
the case of fractures the presence of callus, indicating the
process of repair, shows that the accident occurred during
life, and, as we have already seen, we may form some idea of
the length of time elapsed between the injury and the time of
death. On the cadaver it is said to be harder to cause fractures
and lesions of the skin than on the living body. Casper says
that fractures of the Iiyoid bone and the larynx are impossible
after death, and he also was not able to rupture the liver or
spleen.
In distinction to the characteristic signs of a wound inflicted
during life, we may mention briefly some of the signs of post-
mortem wounds when the wound has been inflicted from two
to ten or twelve hours or more after death :
(1) The hemorrhage is slight in amount and may fail alto-
gether.
(2) The character of the hemorrhage is venous, correspond-
ing to the source of the hemorrhage from the veins, the arteries
being nearly empty after death.
(3) The edges of the wound are not deeply stained, and this
staining may be removed by washing. The spaces between
the tissues are not infiltrated with blood.
(4) The blood remains either entirely fluid or, if there are
clots, these are softer than those in an ante-mortem wound, and
only a portion of the blood is thus clotted. There are no clots
plugging the open mouths of the arteries on the surface of the
wound ; the veins may or may not be closed by an imperfect clot.
(5) The skin of the edges is not everted or inverted.
(6) The sides of the wound do not gape and their surfaces
are smooth and even, as the tissues are not unevenly retracted.
Resume. — It is very easy from the foregoing to distinguish
between a wound inflicted before death and one ten or twelve
hours after death.
492 WOUNDS — WOOLSEY.
If the hemorrhage has been abundant and arterial, if it has
infiltrated between and deeply stained the tissues and the stain
cannot readily be washed off; if the blood coagulates com-
pletely and the coagula are firm and are found lying in the
wound, plugging the vessels, and incorporated with the tissues
between which they lie ; if the edges of the skin are everted
and the sides of the wound are retracted and uneven — under
these circumstances, we may be sure that the wound was in-
flicted during life or a very short time after death. If, on the
contrary, the hemorrhage is slight in amount or almost fails
altogether ; if it is venous in character ; if the edges of the
wound are only stained by imbibition of the blood, which is not
infiltrated between the tissues, and the stain may be washed
off; if the blood is not at all or only slightly clotted and the
clots' are soft ; if the skin is not everted and the sides of the
wound are smooth and lie nearly in contact ; if there are no
clots plugging the divided arteries on the surface — then we
need have little hesitancy in saying that the wound was pro-
duced after death, but probably not later than ten or twelve
hours after death. If the wound was inflicted still longer after
death and before putrefaction, then we would have a lack of
the signs due to hemorrhage, clots, staining, etc. If we find
the conditions more or less midway between the first two, we
may be left in some doubt as to the date of the injury. Thus
if the hemorrhage is moderate, the blood mostly but not alto-
gether clotted and the clots moderately firm, the skin slightly
everted, and the sides slightly separated and not altogether
smooth on their surface ; if the surfaces are fairly deeply stained
and the stain cannot be easily washed off — then we can onlj^
say that the wound was inflicted during life or within two
hours or so after death, and this fact is often enough for the
purposes of the medico-legal inquiry.
The same is the case with contusions where there is no
bleeding externally. If we have a bluish, violet, green, or yellow
tumor with or without more or less superficial oedema ; if this
tumor fluctuates or is hard, but in either case is elastic ; if on
incision the skin and the tissue spaces are infiltrated with blood
which is coagulated, or if there is a cavity filled with clotted
blood, the coagulum being firm and the entire amount of blood
coagulated — then the wound was inflicted during life. If, how-
CERTAIN ACTS AFTER FATAL INJURT. 493
ever, the surface shows a bhiish or violet color, little or no
swelling of the skin, which is of natural thickness, and the
ecchymosed area is not tense and elastic to the touch ; if further
the blood is found on incision to be fluid or if coagulated only
partly so, and the blood is not infiltrated into the tissue spaces,
but merely imbibed by the tissues — then the blow was inflicted
after death, and probably more than two or three hours after.
In contusions especially we may have difficulty, as the sign
of fluidity of the blood may fail and putrefaction may modify
the conditions of the wound unless parts deep beneath the sur-
face be examined.
We see, then, that in some cases it is very easy to say that a
wound was inflicted post mortem. If a wound was not inflicted
until ten or twelve hours after death or even sooner, we cannot
easily mistake it. But in many cases it may be hard or im-
possible to say whether a wound was inflicted during life or
within an hour or two after death. Here we must be cautious
in expressing an opinion which should be guarded. But we
should remember that it is important to be able to state that a
wound was inflicted before or immediately after death, as no
one but a murderer would think of inflicting a fatal injur}" on
a body immediately after death. In such cases a well-guarded
medical opinion may often meet all the requirements of the
case.
Granted that a given wound was produced before death.
There are, then, one or two questions which may arise, and
which depend for their answer on the length of time the
wounded person could have lived and the phj^siological or mus-
cular acts which he could have performed after receiving the
injury and before death. The first of these questions may
be expressed as follows :
Could the Victim have Performed Certain Acts after
Having Received his Fatal Injury? The term "certain
acts " here refers to almost any thing or things which would
require time and strength — in other words, the continuance of life
with bodily and mental powers for a certain time after receiv-
ing a mortal injury.
This question may be raised in relation to an attempted
alibi of the accused, who may have been proved to be in the
presence of the victim a moment before death. If after this
494 WOUNDS — WOOLSEY.
moment the victim has moved from the spot or performed cer-
tain acts before death, the attempted alibi may depend upon
the answer to the question as to whether the given acts of the
victim were compatible with the fatal character of the wound.
An alibi can aid in the acquittal of the accused only when the
nature of the injury was such that death would be supposed to
be immediate or nearl}'- so. Great care should be taken on the
part of the medical witness in answering this question, for after
very grave wounds, proving speedily fatal, the victim some-
times can do certain acts requiring more or less prolonged
effort, as shown by numerous examples. Wounds of the brain
are especially noticeable in allowing a survival of several hours,
days, or even weeks, during which time the injured person may
pursue his occupations. Where the survival has lasted da^'S or
weeks, the alibi has no importance, but not if the survival is
of shorter duration. The following case is cited by Vibert*
and may be mentioned in this connection, though the wound
was caused by a bullet which traversed from behind forward
the entire left lobe of the brain. After the injury the victim
was seen by several witnesses to climb a ladder, though with
difficulty, for he had right-sided hemij)legia. He was found
insensible more than half a mile away, and did not die until
six or eight hours after the injury. Severe injury of impor-
tant organs is sometimes not incompatible with an unexpectedh'
long survival. Devergie cites two illustrations of this which
are quoted by Vibert.' A man received several extensive
fractures of the skull, with abundant sub-dural hemorrhage,
and rupture of the diaphragm with hernia of the stomach.
The stomach was ruptured, and nearly a litre of its contents
was contained in the left pleural cavity. Notwithstanding all
this, he was able to walk about for an hour or so and answer
several questions. He died only after several hours. Another
man, crushed by a carriage, received a large rupture of the dia-
phragm, complete rupture of the jejunum, and rupture and
crushing of one kidney. Yet he walked nearly five miles, and
did not die until the next day.
More rarelj' wounds of the great vessels are not immediately
fatal. M. Tourdes is quoted by Vibert ' as citing the case of
a man who descended a flight of stairs and took several steps
1 Vibert : " Precis de Medecine Legale, " 2d Ed. , 1890.
CERTAIN ACTS AFTER FATAL INJURY. 495
after division of the carotid artery ; also of one who lived ten
minutes after a bullet-wound of the inferior vena-cava.
Even wounds of the heart are not as speedily fatal as is
commonly supposed, and often permit of a comparatively long
survival.
Fischer ' found only 104 cases of immediate death among
452 cases of wounds of the heart, and healing occurred in 50
cases among 401. Vibert^ mentions two striking cases of long
survival after wounds of the heart. A woman received a stab-
wound which perforated the right ventricle, causing a wound
one centimetre long. She did not die until twelve days later,
when on autopsy there was found an enormous extravasation
of blood in the left pleural cavity and pericardium. The second
case, though one of bullet-wound, is equally applicable and
instructive in this connection. A man received a bullet-wound
which perforated the left ventricle, the bullet being found
later in the pericardium. After being wounded he threw a
lamp at his assassin which set fire to the room. He then
went into the court-3'ard, drew some water, carried it back
in a bucket, extinguished the fire, and then lay down on his
bed and died.
In studying the wounds of different regions of the bod}',
we may find many other mortal wounds which, though speedily
fatal, leave the possibility of more or less activity before death.
We see, therefore, that even in those wounds which are com-
monly supposed to be immediately fatal, even by man}- medical
men where attention has not been called to the exceptions, such
exceptional cases are not uncommon in which death is not
immediate. Time and even strength may thus be allowed for
more or less complicated activity. An alibi cannot, therefore,
be allowed without question on the part of the medical expert,
who must exercise great caution in expressing an opinion.
The second question which may sometimes arise in connection
with the last, but having little to do with the subject of this
section, is the following:
How Long before Death had the Deceased Accoji-
PLisHED Certain Physiological Acts? For instance, how
' Vibert :" Precis de Medecine Le- * Quoted bv Vibert from the
gale," 2d Ed., 1890. "Traite do pa'thologie extenie " of
Folliu and Duplay.
496 WOUNDS — WOOLSEY.
long after a meal did he die? This is hard to answer with pre-
cision, as digestion varies with the individual, and digestion
begun during life may go on to a certain extent after death. We
may be able to say if digestion has just commenced, is well ad-
vanced, or has terminated. What was eaten at the last meal
may be learned by the naked eye, the microscope, the color of
stomach contents and their odor. The state of the bladder and
rectum is sometimes called in question. All the above facts
have less bearing on the case than those in relation to the
former question.
THE CAUSE OF DEATH FROM WOUNDS.
The cause of death should be certain and definite. In reality,
there is only one real cause, though one or many circumstances
may be accessory causes. In most cases of death from the class
of wounds which we have been considering, there is no difficulty
in determining the cause of death so as to be able to state it
definitely. But if the deceased had recovered from the first
effects of the wound and then died, or if death seems as much
due to disease as to injury, then the real cause of death may
be obscure. If the medical witness is in doubt as to which of
two causes was the primary cause of death the doubt should be
stated at once, as it may weaken the testimony if brought out
later.
Wounds may be directly or indirectly fatal. They are
directly fatal if the victim dies at once or very soon after the
wound, with no other cause internally in his body or externally
from his environment. Wounds are indirectly or secondarily
fatal if the injured person dies from a wound disease or com-
plication, the direct consequence of the wound, or from a surgi-
cal operation necessary in the treatment of the case. Wounds
may also be necessarily fatal either directly or secondarily, or
not necessarily fatal. In the latter case death may be due as
much, if not more, to other causes than the wound, and some-
times not at all to the wound itself. Thus death may be due to
natural causes, latent disease, an unhealthy state of the body,
imprudence or neglect of treatment, or improper treatment, etc.
These various degrees of responsibility of a wound as the cause
of death we will now consider more at length.
THE CAUSE OF DEATH FROM WOUNDS. 49?'
I. Was the Wound the Cause of Death Directly?
If so, it must have caused death in one of the following-
ways:
1. Hemorrhage. — This may act by producing syncope.
But the amount of the hemorrhage may not be suflScient for
this result, and still cause death by disturbing the function of
the organ into which it is effused, as in the brain or in the
pleural or pericardial cavities. The blood here acts mechani-
cally. Blood in the trachea may also kill mechanically by
causing asphyxia.
The amount of hemorrhage required to produce syncope
varies under a variety of circumstances. Less is required in
the very young, the aged, and the diseased, also less in women
than in men. Young infants may die from hemorrhage from
very slight wounds, even from the application of a leech or the
lancing of the gums. A sudden loss of blood is much more
serious than an equal amount lost slowly. This is the reason
that the wound of an artery is more serious and more rapidly
fatal than a similar loss of blood from other sources. It is hard
to specify the absolute quantity which must be lost in order to
cause death by syncope. The total blood in the body is about
one-thirteenth of the weight of the body, making the total amount
of blood weigh about twelve pounds. Of this, about one-fourth
is in the heart, lungs, and large blood-vessels. According to
Watson, the loss of an amount varying from five to eight
pounds is enough to be fatal to an adult. But less is enough to
prove fatal in many cases, as the rapidity of the loss of blood
and the age, sex, and bodily condition of the wounded person
affect the amount necessary. Though death from a small artery
is slower than that from a large one, yet it may occur in time,
as shown in the instance quoted by Taylor, ' where a man bled
to death in thirty-eight hours from the wound of an intercostal
artery. Thus, too, a wound of the branches of the external
carotid artery is often enough to cause death, and a wound in
a vascular part may cause death from hemorrhage, though no
vessel of any size be divided.
Internal hemorrhage may be fatal from mechanical in-
'"Med. Jurisprud. , " 11th Amer. Ed., 1892.
32
498 WOUNDS — WOOLSEY.
terference with the function of an organ, as well as from syn-
cope. Thus we may have death from syncope due to hemor-
rhage into the peritoneal cavity or, after contusions, into the
intercellular spaces and the cavity due to the blow, into which
several pounds of blood may be extravasated. Internal hemor-
rhage is most fatal when due to the rupture of a viscus such as
the heart, lungs, liver, kidney. Taylor ^ cites a case of a man
run over and brought to Guy's Hospital in November, 1864.
He had pain in the back, but there were no symptoms or marks
of severe injury. He left the hospital and walked home, where
he was found dead in bed a few hours later. His abdomen
contained a large amount of blood from the rupture of a kidney.
After severe flagellation blood may be effused in large quan-
tity beneath the skin and between the muscles, which is just as
fatal as if it had flowed externally from a wound. In fact, if
the injuries are numerous the loss of much less blood is enough
to prove fatal, the element of shock here assisting that of hem-
orrhage.
Hoiv are ive to ascertain tvhether a person has died from
hemorrhage ? This may be more difficult in the case of an
open wound, for the body may have been moved from the spot
where it lay after the wound was received, and the blood on
the body, clothes, and surrounding objects may have been re-
moved. Then the case may be presumptive only, but we may
arrive at a definite conclusion by attention to the following
points : If the wound was in a very vascular part and of some
size, or if a large vessel or many moderately large vessels were
divided and the vessels, especially the veins in the neighbor-
hood, are empty, then we may be quite sure of death from
hemorrhage. If there is no disease found which could be
rapidly fatal the case is still stronger. The body should be
pallid after fatal hemorrhage, but the same may be the case
from death from other causes. In case the body and surround-
ing objects have not been disturbed, then the amount of clotted
blood in the wound, on the body and clothes, and about the
body, taken in connection with the foregoing points, can leave
no doubt. We should remember, however, that not all the
blood about the bod}^ was necessarily effused during life, but a
little hemorrhage may have occurred after death while the
'"Med. Jurispmd.," 11th Amer. Ed., 1892.
SEVERE MECHANICAL INJURY OF A VITAL ORGAN. 499
body was still warm and the blood fluid, i.e., during the first
four, eight, or ten hours. But the amount thus lost is small.
In cases of death from internal hemorrhage we do not have so
much difficulty in pronouncing an opinion, as by post-mortem
examination we can determine the amount of the hemorrhage.
We can judge, too, from its position, whether it iias acted
mechanically to interfere with a vital function, and has thus
caused death, or whether the latter was due to syncope from
the quantity lost.
2. Severe mechanical injury of a vital organ, such
as crushing of the heart, lungs, brain, etc. This crushing
may be accompanied by hemorrhage, but death may be more
immediate than the hemorrhage would account for. The me-
chanical injury done to the vital centres in the medulla by the
act of pithing is the direct cause of the sudden death which
follows it. Exceptionally slight violence to a vital organ is
fatal, but this may be better explained by attributing it to shock.
3. Shock. — An injury is often apparently not enough to
account for the fatal result so speedily. The marks of external
injury may fail entirely or be very trifling. Thus more than
once persons have died in railway collisions with no external
marks of violence. So, too, a blow on the upper abdomen, on
the " pit of the stomach, " has been rapidly fatal without any
visible injury to the viscera. Death is attributed to the effect
on the cardiac plexus, and there may be no marks externally
or only very superficial ones. In Reg. v. Slane and Others
(Durham Wint. Ass., 1872), quoted by Taylor,' the deceased
was proved to have sustained severe injuries to the abdomen
by kicks, etc., but there were no marks of bruises. All organs
were found healthy on post-mortem examination, but the in-
jured man died in twenty minutes. Death was attributed to
shock and the prisoners were convicted of murder.
Death from concussion of the brain is another example of
death from shock. This may occur with only a t)ruise on the
scalp and with no intracranial hemorrhage or laceration of the
brain. The medical witness should be cautious in the above
classes of cases in giving evidence, as the defence may rely
upon the absence of any visible signs of mortal injury to prove
that no injury was done, a principle fundamentally wrong.
'"Med. Jurisprud. , " 11th Amer. Ed., 1892.
500 WOUNDS — WOOLSET.
Also a number of injuries, no one of which alone could be
the direct cause of death, may cause death on the spot or very-
soon afterward. Death in such cases, where there is no large
effusion under the skin, is referred to exhaustion, which, how-
ever, is merely another term for shock. Such cases are exem-
plified by -prize-fighters who, during or after the fight, become
collapsed and die of exhaustion. Having sustained numerous
blows on the body during the many rounds, the body presents
the marks of various bruises, but there may be nothing else
to explain the sudden death. No one injury or bruise is mortal,
and yet, when the deceased was previously sound and in good
health, death must be referred directly to the multiple injuries
received in the fight. We have already stated above that if
the injuries are numerous, the loss of a smaller amount of blood
may be fatal. We see, therefore, that there is not always a
specific and visible "mortal" injury to account for death. This
is a well-kno\^Ti medical fact, but it does not accord with the
erroneous popular prejudice that no one can die from violence
without some one visible wound which is mortal. In other
words, the non-professional mind leaves out of account the idea
of shock, only regarding material injury and not functional dis-
turbance. If the circumstances accompanying death are un-
known, it is well to be cautious. But if the deceased was in
ordinary health and vigor and there was no morbid cause to
account for the sudden death, we need not hesitate to refer
death to the multiple injuries.
II. Was the Wound the Cause of Death Necessarily?
This brings up a number of interesting questions to be con-
sidered. In medical jurisprudence there is probably no condition
so common as that the injurj'- is admitted, but death is attrib-
uted to some other cause. Thus if there are several ivounds it
may be hard^to decide on the relative degree of mortality of an}-
particular one, so as to be able to say that death was directly or
necessarily due to this or that one. The defence may plead that
death was not necessarily due to the particular wound attrib-
uted to the prisoner. This brings up the question —
Which of two or more Wounds was the Cause of
Death? No general rule can be laid down for all cases, but
WAS THE WOUND THE CAUSE OF DEATH ? 501
each case must be judged by itself. Another way of put-
ting the question is : " Which of two or more icounds ivas
mortal?" The questions are not quite synonymous, for two
or more of the wounds might be " mortal" but not equally the
cause of death. In fact, as we have alread}- seen, no one of the
wounds if they are multiple may be of itself mortal, but taken
together they are so. Consequently we will suppose that there
are but two wounds, and not multiple ones, and the question
remains which of these wounds was the cause of death. A
wound may be said to be of itself mortal when it is the cause
of death directly or indirectly in spite of the best medical as-
sistance. In some continental states mortal wounds are divided
into two classes, those absolutely and those conditionally mor-
tal, the former including those in which the best medical as-
sistance is at hand, sent for or timely rendered without everting
the result. The mortal result in the second class is conditional
on want of treatment, improper treatment, or accidental cir-
cumstances. As Taylor says, it is better to look at the effect
of the wound and the intent of the assailant, as is done in
English law, rather than at accidental relations of the
wound.
To return to the question, we can readily imagine that a
man may receive two wounds at different times or from differ-
ent persons, and die after the second wound. Taylor ' mentions
the following case in which the question arose as to which of
two injuries caused death: In Reg. v. Foreman (C.C.C. Feb-
ruary, 1873) the prisoner had struck the deceased some severe
blows on the head. A fortnight later, having partially recov-
ered, another man gave him some severe blows on the head.
A fortnight later still he had left hemiplegia, and died a few
days later of a large abscess in the brain. The question arose
which set of blows had been the cause of the abscess. The
prisoner, the first assailant, was acquitted, as the deceased had
had no serious symptoms until the second assault, and there
was no satisfactory medical evidence as to the relation of the
two assaults to the abscess formation. The same author also
supposes the following case : A man having received a gunshot
wound of the shoulder is doing well, when in another quarrel
he receives a penetrating stab- wound of the thorax and abdo-
' Taylor: "Medical Jurisprudence," 11th Amer. Ed., 1893.
502 WOUNDS — WOOLSEY.
men. He dies after lingering for a timo, under the effects of
these wounds. If the wound of the shoulder could be proven
to be the cause of death, the second assailant could not be con-
victed of manslaughter, and so too with the first assailant if
it could be shown that the victim died of the stab-wound. It
might be possible for a surgeon to decide the question definiteh'
at once if death occurred soon after the stab, which was found
to have penetrated the heart, a large blood-vessel, or one of the
viscera ; or, on the other hand, if the stab- wound was found to
be superficial and not penetrating, and the wound in the shoul-
der had suppurated and caused septicemia.
In either or any case, everything would depend upon the
evidence furnished by the medical witness. His knowledge
and judgment are required to distinguish the guilty from the
innocent.
Again, sometimes death may appear to be equally the result
of either or both wounds, in which case, as far as the medical
evidence goes, both assailants would be liable to the charge of
manslaughter. Or the second wound may be accidental or sui-
cidal, and again the question would arise as to the cause of
death. A case illustrating this is told by Taylor * substantially
as follows : A grocer's assistant pursued a thief, who had stolen
from a cart, into a coal-shed, where he was stabbed twice in
the abdomen. The larger wound suppurated, the smaller wound
healed up, and the man died of peritonitis. On post-mortem
examination the suppurating wound was found not to involve
a vital part, while the small healed wound had wounded the
liver and gall bladder and had set up the fatal peritonitis.
The large suppurating wound had apparently been inflicted
purposely; the fatal wound, directed upward and backward,
might have been accidental by the deceased rushing upon the
knife held more or less in self-defence. The case never came
to trial, as the assailant was never found, but it can be readih'
Imagined what complications might have arisen.
Furthermore, the wounded person may have taken poison or
been subsequently ill-treated, and he may have died from these
causes rather than the injury. But the question arises as to
whether the wound was necessarily the cause of death. Here,
in order to exculpate the assailant, the supervening disease or
'Taylor: " MedicalJurisprudence, " 11th Amer. Ed., 1893.
WAS DEATH DUE TO NATURAL CAUSES? 503
maltreatment must be such as to account for sudden or rapid
death under the symptoms which actually preceded death.
Was Death Due to Natural Causes? Again, the injury
may be admitted, but it may be claimed that death is due to nat-
ural causes. It is not unusual for wounded persons to die from
natural causes, though the case may appear otherwise to lay-
men. This is often seen with suicidal wounds, especially those
inflicted during the delirium of a disease, or the disease may
supervene later and cause death without relation to the wound.
Where the wound was inflicted by another, accurate discrimi-
nation is especially important in order to save the accused from
imprisonment under false accusation and consequent loss of
character. A careful examination is the only way to determine
such cases, which depend therefore on the medical testimony.
Again, the question may arise as between death from
WOUNDS OR LATENT DISEASE, the wound perhaps being ad-
mitted, but death being attributed to latent disease. Here a
close attention to symptoms and a careful post-mortem exami-
nation can alone decide. A man may die from the rupture of
an aneurism, from an apoplexy or some other morbid condi-
tion after receiving a severe wound. Or a man with a hernia
may receive a blow upon it causing a rupture of the contained
intestine followed by peritonitis and death, or the recipient of
a blow may have a calculus in the kidney which ma}' perforate
a blood-vessel or the kidney tissue and set up a fatal hemor-
rhage as the result of a blow.
Thus, medically speaking, the result of the injury is un-
usual and unexpected, and due to an abnormal or unhealthy
state of body of the wounded person.
If it can be clearly shown by the medical testimony that
death was due to the above or anj^- other latent diseases, the
responsibilitj^ of the assailant may be lessened or removed.
The law looks to this point and is lenient in its punishment
in the absence of malice on the part of the assailant. The
crime is still manslaughter and may even be murder if the
assailant was actuated by malice and the abnormal or unhealthy
state of the body of the victim was taken advantage of.
Generally there is no intention of murder, but the nature of
the wound and the means of infliction will help to show this,
which is for the jury rather than the medical witness to decide.
504 WOUNDS — WOOLSEY.
There is less ground for mitigation of the punishment if the
assailant was aware of the peculiar condition of the wounded
person, especially in the case of those notoriously ill or of
pregnant women.
Closely allied with this subject are those rare cases where
ABNORMAL ANATOMICAL CONDITIONS, SUch aS a thin skuU or
brittle bones, cause a slight injury to be followed by unexpect-
ed and untoward results, not to be looked for in the average in-
dividual. In such cases the evidence of the abnormal condition
furnished by the medical witness may diminish the responsi-
bility and mitigate the punishment.
Furthermore, the responsibility of the assailant may not be
altogether removed, for the question naturally arises. Was death
accelerated by the wound? This depends upon the circum-
stances in each case upon which the medical witness must base
his opinion. Maliciously accelerating the death of another is
regarded as criminal on the principle that that which acceler-
ates causes. The following cases are quoted from Taylor * to
illustrate the above distinctions. In Reg. v. Timms (Oxford
Lent Ass., 1870) the deceased had been struck on the head by
the accused with a hatchet, from which injury he had partly
recovered under treatment in twelve days. But six weeks later
he was seized with inflammation of the brain, with convulsions,
and died. At the autopsy disease of the kidneys was found,
and death was referred to this and the inflammation of the
brain due to the blows. The prisoner was convicted after the
judge had charged the jury that it was manslaughter if they
believed that the blows conduced in part to the death of the
deceased.
In the following cases there was no connection between the
violence and the cause of death. A man struck his father on
the head with a hammer and was sentenced to two months' im-
prisonment, as the injury did not appear serious. The father
thought the punishment too little, became much excited, and
was hemiplegia six days after the wound was inflicted and
died three days later. No injury of the brain was found under
a fracture of the inner table at the site of the blow, but a large
clot was found in the lateral ventricle which, in the opinion of
the medical witnesses, was not dependent on the blow, and the
1 Taylor: "MedicalJurisprudence," 11th Amer. Ed., 1892.
WAS DEATH DUE TO NATURAL CAUSES? 505
prisoner was acquitted (see Reg, v. Saxon, Lancashire Sum.
Ass., 1884). Also in Reg. v. Hodgson (Leeds Sum. Ass., 187G)
the prisoner had struck his wife with a belt, a short time after
which she fell back and died suddenly. The cause of death
was found to be heart disease, and the blow not being causative
in producing the fatal result, the prisoner was acquitted. Or
again in Reg. v. Thompson (Liverpool Sum. Ass., 1876): The
prisoner had stabbed his wife in the cheek. The wound was
severe but not mortal. Two days later she was delivered of a
child in the infirmary to which she was taken. She died nine
days later of puerperal fever. The prisoner was acquitted on
the charge of murder, as there was no necessary connection
between the wound and the puerperal fever. Acquittals have
taken place in cases of death occasioned by terror or dread of
impending danger produced by acts of violence, as in the case
of Reg. V. Heany (Gloucester Lent Ass., 1875). Here the pris-
oner in an altercation with his wife, who was suffering from
cancer, held up a knife in a threatening 'manner, but did not
touch her. This gave her a shock ; she died two days later
from fright. As there was no distinct proof that death was
accelerated by this act, the prisoner was acquitted of the charge
of murder. Taylor ' found among a large number of cases
occurring in England during twenty years that the latent
causes of death, as registered in wounded persons, were chiefly
inflammation of the thoracic or abdominal viscera, apoplexy,
diseases of the heart and large blood-vessels, phthisis, ruptures
of the stomach and bowels from disease, internal strangulation,
and the rupture of deep-seated abscesses. Sometimes the person
was in good health up to the time of injur}', while in other cases
there was merely a slight indisposition. It was only by care-
fulness on the part of the medical experts that the true cause of
death was ascertained.
Again, it may be claimed that death was not necessaril}'
the result of the wound and was avoidable by good medical
TREATMENT. There are many cases of wounds not mortal with
proper and skilled treatment which might become so by im-
proper treatment. They may thus become directly mortal by
interfering with a source of hemorrhage which had been ar-
rested, or secondarily mortal by infection of the wound by med-
» Taylor : " Medical Jurisprudence, " 11th Amer. Ed. , 1893.
506 WOUNDS — WOOLSEY.
dlesome treatment. It would depend on the medical witnesses
to determine whether and how far the treatment had been
responsible for the fatal result. If the wound is not of itself
mortal and it has only become so from improper treatment,
this should be a mitigating circumstance in favor of the ac-
cused. Medically speaking, we can seldom make the sharp
distinction which Lord Hale did legally between a wound
becoming mortal from improper treatment and one in which
improper treatment causes death irrespective of the wound. In
case of a slight wound this distinction might be possible, but
not so in case of severe wounds. Also there would probably
be no conviction, as far as the medical evidence is concerned,
if the wound was only mortal in consequence of improper treat-
ment and not mortal as its usvial and probable result. This may
naturally introduce the question of the comparative skill in
TREATMENT. If death is entirely or partly due to a wound the
responsibility of an assailant is not altered by unskilful treat-
ment. The entire question of the relation of the wound to the
fatal result and the effect on this result of the treatment em-
plo3^ed is left to be determined by the medical experts, and
in its solution great care and judgment must be used. Al-
though a given fatal wound might not have caused death under
the best possible treatment and surroundings, yet, according to
the above rule, the assailant is held responsible as long as the
fatal result is due partlj^, at least, to the wound. Therefore
we see the responsibility of the surgeon not only for the life of
his patient, but also for that of the prisoner. He should, there-
fore, not deviate from the ordinary and most accepted practice
in such cases, as any such deviation is taken hold of by the
counsel for the defence. In fact, every point of the treatment
is subjected to criticism.
In a lacerated wound of the foot, if death occurs from
tetanus, it may be claimed that death would not have occurred
if the foot had been amputated, or, if the foot were amputated
and death followed, it may be claimed that amputation was
unnecessary and was the cause of death. The surgeon should,
therefore, be able to give the best reasons for every step of
treatment.
Again, it may be claimed that death was not a necessary
result of the wound and was avoidable but for imprudence
DEATH FOLLOWING SLIGHT PERSONAL INJURIES. 507
OR NEGLECT on the part of the wounded person. A man after
being wounded may refuse to receive medical assistance, or,
after receiving it, may disobey instructions or refuse to submit
to an operation proposed. Thus with a compound depressed
fracture of the skull the patient may either refuse to see a sur-
geon, or he may refuse to submit to an operation proposed, or
he may with or without operation disobey the instructions as
to diet and quiet, and eat or drink heavily and refuse to go to
bed. Such a case we can readily imagine might die of menin-
gitis, etc.
If the symptoms of a wound are unfavorable from the start,
or if the wound of itself is likely to prove mortal, the responsi-
bility of the assailant is unmitigated by imprudence or neglect "
of medical assistance by the wounded person. This is not
allowed as mitigatorj-, as a sane man is a free agent and is not
obliged to call in or submit to medical treatment. Moreover, a
medical witness in many cases could not swear that an opera-
tion or other plan of treatment would certainly save life. Thus
an amputation of the leg for wound of the foot causing tetanus
is by no means a certain means of cure. But we can readily
imagine a case where the refusal to submit to the treatment
proposed might be an important element in causing death.
Thus in a compound depressed fracture of the skull with com-
pression, the medical witnesses would agree that the operation
would in all probability save life. This fact would probably
be only mitigatory in diminishing the penalty, and, as stated
above, would not secure acqviittal. But it is none the less im-
portant for the medical witness to bear these facts in mind and
bring out the fa,cts and conclusions clearly in his testimony.
Death Following Slight Personal Injuries. — Here
again the claim might apparently be justified that death was not
necessarily due to the trifling injury. And in reality there is
commonly some unhealthy state of the body to explain such an
unexpected result. When the disease accounting for this un-
healthy state of the body is in some other part than the injury,
an examination with ordinary care will explain the case. But
if the disease and injury are located in the same part, especially
in the head, the case is more perplexing, but may be cleared up
by careful and thorough examination. Also the usual results
of such an injury should be considered, and whether the disease
508 WOUNDS — WOOLSEY.
would be a usual result of the injury, or whether the sum total
of the pathological conditions found would be accounted for by
the violence. It shovild be remembered that the presence of
chronic disease is no excuse. Thus Taylor ' cites the case of
Reg. V. Haj^ley (Lewes Aut. Ass., 18G0), where a boy with
chronic disease of the brain suffered from no unusual s3'mptom
until he received a severe flogging, which was followed by
death in less than three hours. The same author mentions also
the following case to show that fatal results may follow very
slight and trivial blows. Annan ^ tells of a healthy four- year-
old girl who received a slight blow from the shaft of a wheel-
barrow on the skin about three inches below the knee. There
was even no external mark of violence, and the injury was
thought to be so slight as not to require treatment. There
was pain, however, which increased on the following day,
marked constitutional symptoms appeared, and the child died
on the fourth day. Even to the punishment inflicted by school-
masters death has been imputed.
When DEATH occurs from wounds after long periods
the injury may be admitted, but it may be claimed that death was
not necessarily due to the wound. Medically speaking, death
is just as much the result of the injury as if it occurred on the
spot. Of course, death must be clearly traceable to the usual
and probable results of the injury, and not be dependent on any
other cause. An examination of the wounded part and of the
whole body will enable the medical witness to determine the
cause of death and whether it is clearly traceable to the injury.
A doubt on this point may lead to acquittal. Certain forms of
wounds or wounds in certain localities are especially liable to
end fatally after a long delay, but as the direct result of the
wound. These are wounds of the head and of the spine. As
to the first class, the injured person may apparently recover
and be doing well, when he maj- suddenly die from a cerebral
abscess, for instance. This is the result of the injury, but re-
mains a longer or shorter time latent. In wounds of the spine
the patient is generally paralyzed below the point of fracture,
but is apparently in good health. In a longer or shorter time
he may die of a pneumonia, cystitis, or bedsores, which are the
' Taylor : " Medical Jurisprudence, " ^ Med. Times, 1854, ii. , p. 238.
llthAmer. Ed., 1893.
WAS A WOUND THE CAUSE OF DEATH SECONDARILY? 501>
known and regular consequences of the injury or injured con-
dition. Astley Cooper cites the case of a man who was in-
jured on the head and died two years later from the effects of
the injury, as was clearly made out by the continuance of brain
symptoms during the entire period. An interval of eleven
years occurred in another head injury between the injury and
the fatal result. The first result of the injury was concussion
of the brain, and the case is mentioned by Hoffbauer. ' This
long interval is unusual. There is a rule in English law by
which the assailant cannot be indicted for murder if the victim
of the assault lives a year and a day. Practically this makes
little difference, as nearly all cases would die within that time;
but the principle is wrong as looked at from the medical stand-
point. The protracted cases concern, as above stated, mostly
injuries of the head, spine, and chest, among which there are
some cases, like the examples cited, where, according to Eng-
lish law, justice would fail to be done.
III. Was a Wound the Cause of Death Secondarily?
A wound is secondarily the cause of death when the victim,
having recovered from the first ill effects, dies from some wound
disease or accident or from a surgical operation rendered nec-
essary in the proper treatment of the wound. There may be
much difficulty in establishing the proof of death from a wound
]jy means of secondary causes, for, 1st, the secondary cause
must be in the natural course of things ; and, 2d, there must be
no other accidental circumstances to occasion the secondary
cause.
The secondary cause may be partly due to the constitution
of the deceased from habits of dissipation, which fact would
serve as an expiatory circumstance in the case. Among the
secondary causes of death may be mentioned septicaemia, pya?-
mia, erysipelas, tetanus, gangrene, that is, wound diseases, also
the wound accident — as we may call delirium tremens, and sur-
gical operations rendered necessary to the treatment of the case.
We may add, besides the regular wound diseases, inflammation
in and about the wound, septic in character, perhaps not justi-
fying the title of septicaemia, but which, with its accompanying
fever, may be the " last straw" in a case which might otherwise
1 " Ueber die Kopf- Verletzungen, " 1842, p. 57.
510 WOUNDS — WOOLSEY.
recover. Some of these secondary causes will now be considered
more at length.
Septicemia is a general febrile disease due to the absorp-
tion into the system from a wound of the products of bacteria
or due to the introduction into the blood and tissues of the bac-
teria themselves. Depending on the two sources of origin, we
have two forms of septicaemia : 1. Septic intoxication or sapre-
mia, due to the absorption of a chemical poison, ptomaines, and
often readily influenced and cured by the removal of the source
of these ptomaines in decomposing blood-clots, secretions, etc.
2. Septic infection comes on less rapidly but is more serious
than the former is, if properly and quickly treated, because the
source of the trouble cannot be removed, but is in the blood and
the tissues. The latter form is the more common one in wounds,
though the former may occur in abdominal wounds, especially
when a blood-clot is present. The first form begins acutely, the
second form more gradually. The infection in septicaemia
takes place through a wound and may be due to the weapon
which caused the wound, the unclean condition of the parts
wounded, or to the subsequent treatment or want of treatment.
It may even take place through the intestinal mucous mem-
brane as in cases of tyrotoxicon poisoning. It is most likely to
occur during the first four or five days before the surfaces of
the wound granulate, and it consists in the introduction of bac-
teria, especially staphylococci and streptococci. The disease is
characterized by severe constitutional symptoms, acute contin-
uous fever, inflammation of certain viscera and of the wound,
and nervous disorders. A pronounced chill ushering in the
fever is generally absent. Prostration is especially marked, the
patient finally passing into a typhoid condition indifferent to
surroundings. Anorexia and headache are usually present;
diarrhoea is common, vomiting is not. The skin is pale and
dusky, but not commonly icteric ; at first it is hot and drj^, later
moist and finally cold and clammy. The spleen is often en-
larged. The pulse becomes weak and rapid and delirium is
followed by coma. The prognosis is grave. Antiseptic treat-
ment generally prevents and often cures the disease, as is the
case with many other of the wound diseases ; hence the failure
to employ it may be alleged by the defence in mitigation of the
responsibility of the assailant for the fatal result.
SEPTICAEMIA — PYEMIA — ERYSIPELAS. 511
Pyemia is closely allied to septicaemia. It is due to the
setting free of bacterial emboli or septic emboli from a broken-
down, septic thrombus in the neighborhood of the wound, and
the circulation of these emboli in the blood until they are ar-
rested and form the characteristic metastatic abscesses, espe-
cially in the lungs, joints, abdominal viscera, and parotid gland.
Almost always the source of infection is an infected woimd.
Granulation does not prevent the occurrence of pyaemia, which,
as a rule, commences at a later stage than septicaemia. It is
most important, however, for our purpose to remember that
there is such a thing as spontaneous pyaemia. An injury not
causing a wound ma}' here be the exciting cause, but the result-
ing pyaemia is an unexpected consequence. A bruise of a bone,
for instance, by allowing bacteria, which in certain conditions
may be circulating in the blood, to find an exit from the ves-
sels into the bruised part, may develop an acute osteo-myelitis,
which may be a starting-point of a pyaemia. It is but proper
to state, however, that spontaneous pyaemia is a rare occurrence.
In fact, it is so rare that if pyaemia occurs and we find ever so
trifling an infected wound, we can safely attribute the pyaemia
to the wound and not to a spontaneous origin.
Pyaemia begins, as a rule, in the second week of the healing
process or even later. It usually begins with a chill, which may
be frequently repeated. The fever is very irregular and exacer-
bations occur with each metastatic abscess. The skin is icteric,
the icterus being hematogenous. The pulse is rapid and be-
comes weaker. Infective endocarditis may develop, which in-
creases the danger of metastatic abscesses, which may then
occur in the brain. Otherwise the mind is clear and unaf-
fected until the final delirium and coma. The disease may
become chronic, but usually lasts a week or ten days. The
prognosis is very grave.
Erysipelas is a still more frequent complication of medico-
legal wounds, and though not so fatal as the two preceding, it
is probably more often the secondary cause of death on account
of its far greater frequence. It too is an acute infective in-
flammation due to the presence of a micro-organism, strepto-
coccus erysipelatis. This occurs mostly in the lymphatics of
the skin, and effects an entrance through some wound or abra-
sion of the skin or mucous membrane, which may be almost
512 WOUNDS — WOOLSEY.
microscopic in size. Probably there is no such thing as trne
spontaneous erysipelas^ though the wound may be often
overlooked and only visible on the closest examination. If a
wound has been inflicted, the size and severity of it cannot be
alleged as a reason why it was not the starting-point of an
erysipelas. The erj^sipelas must be clearly traced to the injury.
That is, it must occur before recovery from the wound or not
later than a week after it has healed, for the incubation is prob-
ably not longer than this. It is difficult to connect an erysip-
elas with a wound if it occurs some time after it has healed or
if it occurs at a different place and not about the wound.
Wounds of certain regions, as, for instance, scalp wounds, are
especially liable to develop erysipelas, but this is probably owing
to the imperfect antiseptic treatment or delay in applying it.
Certain individuals are more prone to it than others; thus it
has been stated that blondes and those suffering from Bright's
disease are more susceptible, though how true this is it is hard
to say. It is also probably more prevalent at certain times of
the year, particularly in the spring. A wound after it has
scabbed over or has begun to granulate, that is, after the first
four or five days, is very much less apt to serve as the avenue
for infection. Erysipelas usually'' begins with a chill, or a con-
vulsion in children. Nausea and vomiting are the rule. The
fever is remittent and ranges from 102° to 104° F. , and the tem-
perature may be subnormal when the inflammation is subsid-
ing. Prostration is marked and the pulse more or less weak.
There may be delirium while the fever is high. Locally there
is rarely anything characteristic until twent^'-fonr hours or so
after the chill. Then we have a reddish blush with some ten-
sion, burning and itching of the skin. At first the redness is
most marked about the wound, later at the edge of the advanc-
ing, serpentine margin. It spreads widely and rapid]}", and
after three or four days the part first attacked begins to im-
prove. Desquamation follows. The duration may be a week
or ten daj^s or as long as a month. The inflammation may be
much more severe, involving the subcutaneous connective tissue
in phlegmonous erysipelas.
Facial erysipelas is a common variety and was once re-
garded as idiopathic, but a wound on the skin or mucous mem-
brane is probably always present. The prognosis of erysipelas
FACIAL ERYSIPELAS — TETANUS. 513
is usually favorable. Since the use of antiseptics it is far less
common than formerly, though still the most common of the
infective wound diseases.
If a man wounded in an assault is taken to a hospital where
erysipelas prevails, the question of responsibility arises, for,
medically speaking, he is subjected to great and avoidable
risks.
Tetanus is an infective bacterial disease affecting chiefly the
central nervous system and almost always, if not always, origi-
nating from a wound. Tetanus, like erysipelas, is probably
always traumatic and never • strictly idiopathic. The wound
may be so slight as to escape notice. When it follows such in-
juries as simple fracture internal infection probably occurs,
though such cases are extremely rare. It is said that the
weather influences the development of tetanus, and that it is
more common in the tropics. There are also certain sections
where tetanus is much more common than elsewhere and where
it may be said to be almost endemic. Punctured wounds are
most likely to be followed by tetanus, for they offer the best
opportunity for the development of the bacteria, which are an-
aerobic. Wounds in dirty parts of the body, like the hands
and feet, are more apt to be followed by tetanus than those
elsewhere. Tetanus usually appears about the end of the first
week after a wound has been received, but it may not appear
for a longer period, even three or four weeks, so that the wound
may have been some time healed. To connect tetanus with a
particular wound, note (1) if there were any symptoms of it
before the wound or injury, (2) whether any other cause inter-
vened after the wound or injury which would be likely to
produce it, and (3) whether the deceased ever rallied from the
effects of the injury. Tetanus comes on suddenly without
warning. The injured person first notices that he cannot fully
open the mouth, he has lock-jaw, and the back of the neck is
stiff. The muscles of the abdomen and back are next involved
so that the back is arched in the position known as opisthot-
onos^ and the abdomen presents a board-like hardness. The
muscles of the fauces, pharynx, and diaphragm maj^ next be-
come involved, causing difficulty in swallowing and breathing.
The thighs may or may not be involved, but the arms and legs
almost never. Owing to the spasm of the abdominal muscles,
33
514 WOUNDS — WOOLSEY.
micturition and defecation are difficult and respiration is hin-
dered. The muscles are in the condition of tonic spasm which
permits the patient no rest, the face bears the " risus sardon-
icus, " and the suffering is extreme. If the patient lives more
than two or three daj's the tonic spasm partly gives way to
increased reflex irritability, in which a noise, jar, or draught of
air may give rise to clonic and tonic spasms in the muscles
affected. The patient may die at such times from tonic spasm
of the respiratory muscles, or he may die of prostration from
want of food and sleep, worn out by the suffering and muscular
spasm. The mind is usually clear to the last. Fever is not
characteristic of the disease. Tetanus may be rapidly fatal ; in
two or three days, or it may be or become more chronic. The
prognosis of acute tetanus is almost invariably fatal; that of
chronic tetanus is grave, but a certain proportion of cases
recover.
Diagnosis. — This is easy. It differs from a true neuritis
in the peripheral nerves in that no matter where the wound is sit-
uated the first symptom is in the muscles of the jaw and the
back of the neck, and not at the site of the injury and distally
from this point. Trismus is applied to a milder form of the
disease in which only the face and neck muscles are involved
and " lock-jaw" is a prominent symptom. Some cases of tetany
may be mistaken for so-called spontaneous tetanus. Tetany
may follow child-bed, fevers, mental shocks, exposure to cold
and wet, extirpation of goitre, intestinal irritation, etc. It
consists of painful tonic spasms of the muscles of the arms and
feet. The attacks last one-half to two hours or more, and may
be preceded by a dragging pain. They may be brought on by
pressure on the nerve leading to the muscles affected. Striking
the facial nerve often causes contraction of the face muscles.
There is no trismus but there may be opisthotonos. The patient
seems well between the attacks and most cases recover without
treatment.
Delirium tremens may occur as a secondary consequence
of injuries, or necessary surgical operations in the case of those
who are habitually intemperate. Those who habitually use
opium, tobacco, cannabis indica, or even tea or coffee to excess
are said to be subject to it. It may, therefore, be justly alleged
that death is avoidable in very many cases, but for an abnormal
DEATH FROM SURGICAL OPERATIONS. 515
and unhealthy state of the body. The disease is characterized
by delirium, a peculiar tremor of the muscles, insomnia, and
anorexia. Pneumonia may complicate the case. The patients
die in fatal cases from exhaustion due to insomnia, lack of
nourishment, and their constant activity of body and mind.
The prognosis is usually favorable, taking all cases together,
but in delirium tremens secondary to surgical injuries or oper-
ations the prognosis is serious.
Death from surgical operations performed for the
treatment of wounds. The operation is a part of the treatment,
and if it is done with ordinary care and skill the accused is
responsible for the result. The necessity and mode of operation
must be left to the operator's judgment. As the defence may
turn on the necessity for and the skilful performance of the opera-
tion, it is well to wait for the advice and assistance of others if
practicable, for death is not unusual from severe operations.
The patient may die on the operating-table after losing little
blood, from fear, pain, or shock. Or he ma}^ die from second-
ary hemorrhage or any of the secondary causes of death from
wounds enumerated above. The evidence of the necessity of
the operation must, therefore, be presented by the operator. If
an operation is necessary and not performed, the defence might
allege that death was due to the neglect of the surgeon. An-
other question for the medical witnesses to determine is whether
the operation was rendered necessary because of improper pre-
vious treatment, for if it was the responsibility of the assailant
may be influenced. The meaning of the term " necessity" is
here a matter of importance. Unless an operation is necessary
to the preservation of life, if death occurs there is some doubt
whether the assailant is responsible. But, medically speaking,
we would not hesitate to urge an operation on a wounded man in
order to preserve function, or even to save deformit}- as well
as to save life. In the case of operations done under a mistaken
opinion, neither necessary to save life nor, as the result proves,
to save function or guard against deformity, if death follows
the assailant may be relieved from responsibility. Thus an
aneurism following an injury might be mistaken for an abscess
and opened with skill but with a fatal result. It is also for the
medical experts to determine whether an operation was unnec-
essary or unskilfuUy performed, for if it were and death re-
51 G WOUNDS — WOOLSEY.
suited from it, the responsibility of the prisoner is affected
unless the original wound would be likely to be fatal without
operation. According to Lord Hale, if death results from an
unskilful operation and not from the wound, the prisoner is
not responsible. But yet death may occur as the result of the
most skilful operation necessary to the treatment of a wound,
and not be dependent at all on the wound itseK. If the opera-
tion is skilfully performed, and yet the patient dies from sec-
ondarj^ causes, such as those above enumerated or any others,
the prisoner is still responsible, and the medical testimony is
concerned with the performance of the operation and the sec-
ondary causes of death. The relative skill of the operator or
surgeon i§ probably not a question for the jury in criminal
cases, on the ground that the man who inflicts the injury must
take all the consequences, good or bad. In a civil suit, for in-
stance an action for malpractice, the case is otherwise, and all
the medical facts and opinions are submitted to the jury. The
law regards three circumstances in death after surgical opera-
tions : (1) The necessity of the operation, (3) the competence of
the operator, and (3) whether the wound would be fatal without
operation.
Death may occur from ancesthetics used in an operation
without any recognizable contributing disease of the patient, or
carelessness or lack of skill in the administration of the anaes-
thetic. Of course, the question of absence of contributing dis-
ease on the part of the patient and of its proper administration
must be satisfactorily answered in cases of death from the an-
aesthetic in an operation rendered necessary in the treatment of
a wound. Death from an anaesthetic may occur before, during,
or after an operation itself. Medically speaking, the neces-
sity of the use of an anaesthetic in operations cannot be ques-
tioned, and in emergencies where an operation becomes neces-
sary, and not a matter of choice, its use, with special care, is
justifiable even with existing organic disease, which usually
contraindicates it. As death may be alleged to be due to the
use of a particular anaesthetic, it is always best in operating on
account of an injury which may require a medico-legal investi-
gation, to use that anaesthetic which is most generally used
and indorsed in the particular section of country in question.
Of course, it is not lawful to operate against the will of a person
WAS WOUND MADE BY THE INSTRUMENT DESCRIBED? 517
who preserves consciousness and will. It may be added in this
connection that if a medical man be guilty of misconduct, aris-
ing either from gross ignorance or criminal inattention, where-
by the patient dies, he is guilty of manslaughter, according to
Lord Ellenborough. Omissions or errors in judgment, to
which all are liable, are not criminal.
IV. Was THE Wound made by the Instrument Described?
It is not often necessary to prove that a weapon was used,
though it may affect the punishment. For the use of a weapon
implies malice and intention and a greater desire to do injury.
The prisoner may swear that no weapon was used when the
nature of the wound clearly proves that one was used. The
explanation of the prisoner of the origin of the wound may thus
be discredited. We cannot often swear that a particular weapon
was used, but only that the wound was made by one similar to
it in shape and size. Thus Schworer tells of the case of a man
stabbed in the face by another. The medical witness testified
that the wound was caused by a knife shown at the trial which
had a whole blade, but a year later the point of the knife which
had really caused the wound was discharged from an abscess
in the cheek at the site of the wound. The surgeon thus made
a too definite statement in regard to the knife shown.
It is often very difficult to answer the above question. We
base our opinion chiefly on two sources: 1st, and most impor-
tant, by an examination of the wound, and, 2d, by an examina-
tion of the instrument said to have been used. Certain particu-
lars of the wound may furnish indications as to the weight,
form, and sharpness of the instrument used. There are certain
wounds which must have been made by an instrument, namely,
incised and punctured wounds. The above question is deter-
mined more or less by what has been said in a former section
on wounds, but we will now consider what special features of
these and other classes of wounds indicate the nature, shape,
size, etc., of the weapon used.
Incised wounds must be made by a cutting instrument.
We would here exclude those contused wounds of the scolp and
eyebrows which closely resemble incised wounds, but we have
already seen that we can diagnose between these wounds and
518 WOUNDS — WOOLSEY.
incised wounds by careful inspection. But the locality should
put us on our guard, so that in case of wounds of these two
regions we should be especially careful in making the exami-
nation.
In the case of incised wounds we cannot often tell the shape
or size of the weapon, but we are able to tell certain character-
istics about it. The sharpness of the instrument may be in-
ferred from the clean and regular edges. The depth of the
wound may also indicate the sharpness of the weapon. A long
" tail" in the wound indicates that the weapon was sharp as well
as that this was the part of the wound last made. If the edges
of the wound are rough, we may infer that the edges of the
weapon were rough and irregular. Wounds caused by bits of
china or glass or fragments of bottles, besides having rough
and lacerated edges, are characterized by an irregular or angu-
lar course in the skin.
Some cutting weapons, like an axe, act as much by means
of their weight as by their cutting edges. Wounds caused by
such weapons we can often distinguish by the following signs :
The edges are not as smooth as is the case with a cutting instru-
ment, and they may be more or less lacerated and show signs
of contusion. The wound is often deep in comparison with
its length, and the ends of the wound abrupt instead of slanting
up from the bottom to the surface. The section of resisting
organs and the impression of the edge of the weapon on the
bone are further signs of the use of such a weapon.
The form and direction of a wound may possibly give some
indication of the form of the instrument — -for instance, whether
it be straight or curved like a pruning-knife, as in the case cited
by Vibert ' of a wound of the neck which suddenly became
deeper toward its extremity and changed its direction; the
whole being explained on the supposition that it was made by
a pruning-knife.
But it is in punctured wounds especially that we are en-
abled most often and most accurately to determine the kind of
a weapon used. Here from the form of the wovmd we may
judge of the form and size of the weapon. In speaking of
punctured wounds in a former section we divided them into
four groups, reference to which may here be made. In the first
■"Precis de Medeciue Legale," 2d Ed., 1S90, p. 203.
PUNCTURED WOUNDS, 519
group, or those caused by cylindrical or conical weapons, when
tlie Aveapon is very fine it may leave no track at all; if a little
larger, we may infer from a linear bloody track that the weapon
was needle-like in shape. The length of the instrument or the
depth to which it penetrated may be found, as a rule, only by
dissection. If the weapon were larger and conical, we have
seen that the wounds would be linear with two angles, the
length of the wound being parallel to the direction of the fibres
in the skin.
Here we may judge of the form of the weapon from the
following circumstances: From a comparison of the depth
with the size of the opening, we know that it was a punctured
wound. The edges and angles are not smooth and even enough
for a stab-wound with a knife, for the edges are torn and not
cut, and a stab- wound would be the only form of wound with
which we would be likely to confuse it. Furthermore, the di-
rection of the long axis of the wound parallel to that of the skin
fibres in the region in which it occurs and the very slight re-
traction of the edges distinguish it from a stab-wound. By
these signs we can almost alwaj^s distinguish such wounds
from stab- wounds, and thus tell the form of the weapon used.
As to the size of weapon used, these wounds if of any size
are generally smaller than the weap6n, for the skin is put on
the stretch by the weapon and yields to a certain extent.
The actual wound, therefore, is smaller in circumference than
the weapon. The size of the wound is smaller than that part
of the weapon occupying the wound when the weapon was
arrested; it may be very much smaller than the weapon at its
largest point. Small wounds of this kind are generally larger
than the instrument producing them.
The second group of punctured wounds, or stab-ivounds, are
by far the most common and, therefore, the most important
variety of punctured wounds. If the stab- wound is perpen-
dicular to the surface the fotnn of the wound may represent
pretty closely that of the weapon at the point where the latter
was arrested, wb ether it has a single or double cutting edge.
But even here there are exceptions. Frequently a weapon
with a broad back and only one cutting edge may produce a
wound resembling that of an instrument with two cutting
edges, the second angle tearing as in the former class. Here
520 WOUNDS — WOOLSEY.
on close examination we can sometimes distinguish the differ-
ence between the two angles, and judge correctly of the shape
of the weapon. In fact, wounds made by common pocket-
knives are regularly slit-like and not wedge-shaped, as the
wound is caused only by the cutting edge of the knife. Again,
if the single cutting edge is blunt, in rare cases the wound is
produced in the same manner as those of the first group, or
conical and cylindrical instruments. We would be led to sup-
pose that the wound was produced by such an instrument, as
both angles are torn, unless the direcion of the wound might
not follow that of the fibres of the skin, in which case we
would be left in doubt. Stab-wounds are sometimes angular
from the knife being withdrawn in a slightly different direction
from that in which it was introduced or from an unequal
retraction of the skin (see Fig. 9). If the stab-tvound is
obliquely directed, we can still judge of tlie general shape of
the weapon, with exception of the cases above mentioned. The
dimensions and size of the weapon are here much harder to
determine. The di?nensions of a stab-wound in the skin may
be the same as those of the weapon, or of that part of the
weapon which is arrested in the wound, but often they are not
so. To measure the size of a wound exactly so as to get at the
exact size of the instrument, we should place the region of the
wound in the same position, etc., that it was when the wound
was inflicted, and this we cannot often do. As the skin was
tense or relaxed at the time the wound was inflicted, so the
wound in the skin appears smaller or larger, just as with a
sheet of rubber under similar conditions. If the instrument is
very blunt, the wound in the skin may be smaller than the
weapon whether the skin near the wound is tense or not. Thus
Hofmann saw the wound from a blunt bayonet one centimetre
shorter than the weapon.
The wound of the skin may be shorter and broader than the
weapon used on account of retraction of the edges of the wound,
and this is especially marked when the wound lies transversely
to the direction of the skin fibres. On the other hand, the
length of the external wound is more often greater than that
of the weapon, because the wound is elongated by making pres-
sure toward the cutting edge on withdrawal of the weapon, and
an oblique wound measures longer than the weapon. If the
PUNCTURED WOUNDS.
521
blow is from above downward and the cutting edge of the
Aveapon is uppermost, the length of the wound is not so likely
to be increased much beyond the measurement of the weapon
as when the cutting edge is directed downward. There is but
one condition in which a stab-wound is at all likely to corre-
spond in dimensions with that of the weapon, and that is when
the wound is perpendicular to the surface. Even here the
wound may be lengthened on withdrawal of the weapon, and
we have to allow for retraction of the edges and try to put the
i
^ -"-^/Z^
Fig. 9.— Angular Stab- Wounds of the Anterior CliestWall caused by a Strong Pocket-Knife.
parts in the same condition of tension or laxity as at the time
of wounding. Even in the most favorable case, therefore, we
cannot with certainty tell the exact size of the weapon. If a
stab- wound be directed obliquely to the surface, then the length
of the wound is greater than that of the weapon, unless this in-
crease be exactly counterbalanced by the lateral retraction of
the wound. The size of the weapon in such oblique wounds is
further obscured by the changes of size duo to withdrawal of
the weapon, retraction of the edges, and the condition of the
tension of the skin at the time the wound was inflicted.
Dupuytren remarks that stab- wounds are smaller than the
weapon owing to the elasticity of the skin, but a lateral motion
of the weapon may cause considerable enlargement of the
523 WOUNDS — WOOLSEY.
wound. If a stab-wound has traversed a part of the body, the
wound of exit is smaller than that of entrance.
The depth of a punctured wound may be any part of the
length of the weapon, or it may even be deeper than the
length of the weapon owing to a depression of the surface
by the force of the blow, or the pressure of the handle of the
weapon or the hand holding it. We have already seen that
this may occur in a marked degree in penetrating wounds
of the abdomen involving one of the movable viscera, also
in wounds of the thorax, partly from depression of the sur-
face and partly from an expansion of the thorax when
opened at the autopsy, thus increasing the measured depth
of the wound. Punctured wounds of the third class made by
instruments with ridges or edges, like foils, files, etc., pre-
sent more or less the shape of the weapon if the edges are
cutting, but not always so if the direction of the wound be
oblique or the parts unevenly stretched. If the edges are not
cutting they cause wounds more or less like the first class of
punctured wounds, but we can often distinguish them from the
latter by little tears in the edges. The entrance and exit
wounds may not be alike.
Wounds made by bits of glass and earthenivare have irreg-
ular and uneven edges. Taylor ' relates a case, Reg. v. Ankers
(Warwick Lent Ass., 18-i5), where the wound was attributed
to a fall on some broken crockery, but the wound was cleanly
incised and the prisoner was convicted. As it may be alleged
in defence that a given wound was caused by a fall on broken
Crocker}" or other substances capable of producing a punctured
wound, it is important to notice whether the edges are lacerated
and irregular or smooth and clean. The author quoted above
cites another case which occurred to Watson, where the pris-
oner alleged that a deep, clean-cut wound of the genitals of a
woman which had caused her death was due to a fall on some
broken glass. The character of the wound disproved this de-
fence. Another feature of such wounds, especially if they be
deep in comparison to their length, is that they are very apt to
contain small particles of the glass or earthenware which caused
them. In fact, in all wounds it is well to search for anj' small
fragments which will throw light upon the weapon used.
'"JMed. Jurisprud.," 11th Amer. Ed., 1892.
f
LACERATED WOUNDS — CONTUSIONS. 523
Wounds caused by scissors are often of characteristic -shape.
If the scissors were open we find two symmetrical, punctured
diverging wounds, presenting more or less clearly the form of
the blades of the scissors. If the blades have been approx-
imated there is a triangular interval between the punctures, the
apex of which is truncated if any skin remains between the
punctures.
Lacerated ivounds may not indicate the weapon used as
clearly as punctured wounds, but the agent which produced
them is often indicated by the appearance of the wound. They
are generally accidental. But where they occur, as they not in-
frequently do, on the bodies of new-born children, they may
give rise to the charge of infanticide. In some cases the
weapon which caused the wound fits the wound produced, and
thus important evidence may be furnished the prosecution.
Taylor ' cites the case of Montgomery (Omagh Sum. Ass., 1873),
where a bill-hook which fitted the injuries on the skull of the
deceased was found buried in a spot to which the prisoner was
seen to go. These facts connected the prisoner with the weapon
and the weapon with the murder. In other cases the wounds
may be so lacerated or contused that the indications of the
weapon are obscured.
Contusions and Contused Wounds. — The shape of a
contusing body is sometimes reproduced by the contusion and
the ecchymosis. Thus we are enabled to distinguish the marks
of a whip, the fingers, the fist, etc. This is best seen when
the ecchymosis is fresh, for soon the edges extend and the out-
line is less clearly marked. Plaques parcheminees, which we
have already described as the marks of contused erosions, may
show the form of finger-nails, etc. Contused wounds like sim-
ple contusions may show the shape of the weapon.
If the contusing body has a large area, the whole of this
area cannot often strike the body at once, so that the outline
of the contusion does not represent that of the weapon. But in
general, severe contusions present greater difficulties than the
preceding classes of wounds. We must generally be content if
we can determine whether the wound was caused by a weapon,
including the fist, or by a fall, and we are often unable to say
even this. A fall is often alleged by the defence as the cause
'Taylor, "Med. Jurisprud.," 11th Amer. Ed., 1892.
624 WOUNDS — WOOLSEY.
of the injury, but of course if the prisoner was responsible for
the fall he is responsible for the results of the fall. If there
are contusions or contused wounds on several parts of the
head, or if the wounds are on the vertex of the head, it is pre-
sumptive of the use of weapons. We cannot often swear that
each and every wound on the head was due to the use of a
weapon. On the other hand, the presence of grass, sand,
gravel, etc., in a wound is presumptive of a fall and of the
origin of the wound in this manner. In case of a fall from a
height the wound or wounds might be in almost any part of
the body, on the vertex or elsewhere. Such a fall may be the
result of accident, suicide, or murder. It is not unusual for
female complainants to ascribe their wounds to a fall to excul-
pate the prisoner, especially if this happens to be her husband.
We should remember that in the scalp or over the eyebrows a
contused wound caused by a blunt instrument may resemble an
incised wound. As already stated, however, if the wound is
fresh careful examination will lead to a correct opinion, and
the use of a sharp instrument may be disproved. If the wound is
not recent there is great difficulty in judging of the cause. It
is well to caution against accepting the interested statements
of others in regard to the use of a weapon, unless the character
of the wound bears them out very strongly. There may be a
bad motive for imputing the use of a certain weapon to the
assailant. It is far better to rely solely upon the evidence fur-
nished by the wound in such cases.
It would be useful if we could lay down some general rules
to discriminate between wounds caused by the blow of a weapon
and those caused by falls, but this we are unable to do so as to
cover all cases. Each case must be judged by itself.
If the question is asked luhich of two iveapons caused cer-
tain contusions or contused wounds, we are still less likelj'' to
be able to answer it. In such a case we must make an accu-
rate examination of the form of the wound and compare it
closely with that of the weapon. In such cases also the second
source of information on which we base our opinion as to the
relation of a weapon to tlie wound may be of use, namely, the
examination of the weapon. The presence of blood, hair, cot-
ton or woollen fibres on one of two weapons indicates that this
was the weapon used. The presence of blood is particularly to
WAS A WOUND SELF-INFLICTED? 525
be looked for, and in those parts of the weapon from which it
could be washed off least easily. We should further note the
condition of the point and edge of the weapon, and if the edge
is broken or nicked at all, whether this condition is old or
recent. The sharpness of the edge should further be noted,
and if the edge is sharp note whether it has recently been
sharpened. All these points have a certain bearing on the case.
Also the location, shape, depth, etc., of the wound should be
carefull}' noted to see if an accidental fall would be likely to
account for it. For these features of the wound may be such
that no fall could cause it.
We see, therefore, that in incised and punctured wounds the
use of a weapon may not be hard to make out, but that in gen-
eral the question M^hether a particular instrument caused the
wound is often difficult or impossible to answer. Often the
best we can do is to say that the wound could have been pro-
duced by the weapon.
IV. Was a Wound Self-Inflicted or was it Inflicted
BY Another ?
In other words, was it suicidal or homicidal f Speaking
of suicide in general, its most common cause is alcoholism.
It is not infrequent in youth. Lutaud ' states that in fifteen
years, presumably in France, there were 1,065 cases of suicide
between the ages of ten and fifteen years. This seems to
be only explicable on the ground of heredity or of cerebral
affections. Among 27,737 cases of suicide, observed in
France, the same author gives the following commonest causes
in the order of greatest frequence : Drowning, strangulation,
pistol-wounds, incised and punctured wounds, poison. The
age, sex, and social conditions influence the choice of means.
Thus among males drowning is preferred by the young, pistol-
wounds by the adult, and hanging by the aged, while among
females asphyxia is the favorite method, as there is no pain
and no disfigurement.
While many pathologists consider suicide an act of mental
alienation, and though such may be the case in a large number
or even in a majority of cases, yet in a considerable number it is
'Lutaud: "Mau. d. Med. Leg. , " 5th Ed. , 1892.
52G WOUNDS — WOOLSEY.
a voluntary and rationally planned act. The question, Is it sui-
cide or homicide? may bo put in all cases of death by cutting
instruments, and in many from other kinds of wounds. It is
often, if not generall}^, impossible to answer it with absolute
certaint}'. It is hardly suitable for the medical witness to try
to reconstruct the scene of the crime from the medical facts,
for he should abstain from everything not medical and should
distinguish that which is positively proven from that which is
merely probable.
Suicides often leave a letter or some such indication to show
that the wound was self-inflicted. If such is not the case, the
question as to the cause of the wound may or may not be med-
ical. If the question is a medical one, there are certain
points to notice as to the wound, such as its nature, situation,
direction, and the number and extent of the wounds, from
which we are to form an opinion. There are also other cir-
cumstances which furnish evidence and thus assist us in an-
swering the question. This evidence is furnished by the
weapon, the signs of struggle, the examination of the clothes
and body of the deceased and the accused, the position and
attitude of the body, and any organic lesions, etc. , predisposing
to suicide.
The nature of the wound bears upon the question of the
homicidal or suicidal origin in the following way: Most sui-
cidal wounds are incised or punctured wounds. Incised woiinds
of the throat are generally presumptive of suicide, but a homi-
cidal wound may be inflicted here to conceal the source of in-
fliction of the wound. Such a wound if homicidal would imply
malice, on account of the attempt at deception and concealment,
and would convict the assailant of murder. Unless the de-
ceased was asleep or drunk or was otherwise incapable of resist-
ance, such a homicidal wound can often be distinguished from
a similar suicidal wound by the form and direction of the
wound, by its irregularity, and by other wounds on the hands or
person of the deceased. Taylor ' mentions a case in which the
peculiar form of the wound, like that made by butchers in kill-
ing sheep, led to the suspicion that homicide had been com-
mitted by a butcher, who was subsequently arrested, tried, and
convicted of murder. The regularity of the wound has been
'"Med. Jurisprudence," 11th Amer. Ed., 1892.
THE NATURE AND POSITION OF THE WOUND. 527
taken to indicate suicide rather than homicide. That it does
so is not questioned, but it is more or less fallacious if resistance
is impossible, in which case a murderer may easily make a
regular, clean, incised wound here. Contused ivounds are sel-
dom suicidal, for they are not sufficiently speedily or certainly
fatal. They are also more painful and disfiguring. Contused
wounds usually indicate murder or accident, though there are
not wanting cases of suicide by such weapons as a hatchet or a
hammer. There is more difficulty in the case of a contused
wound from a fall instead of from a weapon ; for here we have
to decide whether the fall was accidental, suicidal, or homi-
cidal. The nature of the wound is of little assistance in the
case of insane or delirious patients, who may commit suicide
in the most unusual and curious manner.
Taylor' relates the case of a delirious patient in Guy's
Hospital, in 1850, who tore away the whole of the abdominal
muscles from the lower part of the anterior abdominal wall.
If the case had not occurred in the hospital or where there Avere
witnesses of the deed, the nature of the wound would have in-
dicated homicide except for the delirium. The following case,
quoted by the same author, illustrates a wound of very unusual
nature and situation, which might have been taken for a homi-
cidal wound with intent to conceal as far as the situation of the
wound was concerned. The wound was accidental and occurred
in the following way. A girl fifteen years old jumped on
to her uncle's knee while he was holding a stick between his
legs which she did not notice. The stick passed up her anus,
but she withdrew it and went on playing, though she com-
23lained of pain. On the following night acute S3'mptoms of
peritonitis set in, and she died of it in fortj^-eight hours. On
post-mortem examination a rent was found in the anterior part
of the rectum penetrating the peritoneal cavity.
The Situation or Position of the Wound. — A suicidal
wound must be in such a position that the deceased could have
inflicted it himself. Such wounds are, therefore, generally an-
teriorly or laterally situated. The " site of election" for suicidal
wounds is the neck for incised wounds and the chest, espe-
cially in the region of the heart, for punctured wounds.
The situation of suicidal wounds, of lunatics, etc., shows all
»"Med. Jurisprudence," 11th Amer. Ed., 1892.
528 WOUNDS — WOOLSEY.
kinds of fantasies. The mere situation does not suffice to dis-
tinguish suicidal wounds, as a murderer may simulate a suicidal
wound for purposes of concealment. Some regard a wound in
the back as proof against suicidal origin, but it is not so much
the situation of a wound as the situation taken in connection
with the direction which furnishes the proof against suicide in
such wounds.
As a rule, a suicidal wound, besides being in an accessible
part of the body, is also in a part commonly known to be rapidly
mortal, as the neck and heart. But suicidal wounds are not
always in the situation which is anatomically best for being
rapidly fatal. Concealed wounds or wounds in inaccessible
parts presumptive of murder may be suicidal and so placed
to impute them to another and give rise to the suspicion of
murder. The blood-vessels of the arms and legs may be selected
as the site of a suicidal wound. This situation is often re-
garded as uncommon, though the writer has met with it in one
or more cases of attempted suicide. It is illustrated in the
famous case of Abdul Aziz, the Sultan of Turkey. He was
found dead under suspicious circumstances with two oblique,
ragged wounds at the bend of each elbow, directed from above
downward and from within outward. The joint on the left
side was penetrated, while only the skin and veins were in-
volved on the right side. Death was due to bleeding from
the ulnar artery and the veins. The clothing was soaked
with blood and scissors stained with blood were found on
the sofa. These wounds were consistent with suicide, though
not what would be expected. Nineteen physicians who ex-
amined the body agreed in reporting it as suicidal, though,
one reason given for this opinion, namely, " that the direction
and nature of the wounds, as well as the instrument which
might have effected them, lead to the conclusion of suicide,"
was hardly a valid one, for the wounds were not typical of sui-
cide in nature, direction, or position. Such wounds are rarely
homicidal, though at least one such case is mentioned.
Suicidal incised wounds, as has been said, are usually in the
neck, where they may sometimes be arrested by the larynx,
especially if it be ossified, though the incision often divides the
larynx. The situation of the wounds is often between the
larynx and the hyoid bone, and then meeting no bony resist-
DIRECTION OF THE WOUND. 529
ance, they may divide the great vessels and even nick the ver-
tebrae. But it is rare to be so deep, at least on both sides at
once. As a rule, it is deepest on the side on which it is begun
and ends more superficially. As far as the situation of a
wound is concerned, there is no wound which a suicide can
inflict but what may also be inflicted by a murderer. The re-
verse, however, is not true. We cannot always certainly dis-
tinguish between suicidal and homicidal wounds from their
situation.
The direction of the ■wound is one of the most impor-
tant points to notice. It is considered by some to furnish pre-
sumptive evidence for the medical jurist, and taken in connec-
tion with the nature and situation of the wound may often
lead us to a positive opinion as to the question of the suicidal
or homicidal nature of a wound. The evidence from the direc-
tion of wounds is only furnished by incised and punctured
wounds, rarely by contused wounds. Suicidal incised wounds
of the throat are almost always directed from above downward
and from left to right if the suicide be right-handed, and in the
same direction from right to left if the person be left-handed.
Transverse wounds in this situation without obliquity are also
compatible with suicide, though perhaps more common in homi-
cide, while obliquely transverse wounds from above down-
ward and from right to left in a right-handed individual are
indicative of their infliction by another. Homicidal incised
wounds of the neck inflicted from behind or the right side, if
the victim and assailant are right-handed, or from the left side
if they are left-handed, may have the same direction as similar
suicidal wounds. Such a wound may be inflicted by a mur-
derer to deceive as to the cause of the wound by raising the
suspicion of suicide. If an incised wound of the throat be in-
flicted' b}^ another from in front, then its direction is usually the
reverse of a similar self-inflicted wound.
Homicidal incisions, especially in the throat, may extend at
one or the other end beyond the skin wound. In similar sui-
cidal wounds at both angles of the wound the skin is the first
and the last part injured, and in such wounds the spine is sel-
dom reached. It should be borne in mind in this connection
that a given suicide may be ambidextrous and this fact may
be unknown to the friends of the deceased. This is especially
84
530 WOUNDS — WOOLSEY.
the case in the use of the razor from practice in shaving, and
the razor is the usual weapon used in such incised wounds of
the throat. Neglect of this point may lead to an unwarranted
suspicion of murder. The two following cases cited by Taylor '
well illustrate this fact :
In the case of Sellis," the man was generally supposed to be
right-handed, though he was found dead in bed with his throat
cut and the razor on the left side of the bed. In point of fact,
he was ambidextrous in the use of the razor. The second case,
which occurred in London in 1865, was still more remarkable.
A publican was found dead in bed with his throat cut in a
left-handed manner. He was supposed to be right-handed and
there was bloody water in a basin in the room. His wife, who
gave the alarm, had marks of bruises on her, and though she
said she had found her husband dead in bed after having left
it for a short time, suspicion fell upon her, especially as they
were in the habit of quarrelling. The suspicions were removed,
however, by the explanation that he had been brought up as a
wood-carver, which required him to use both hands equallj-, and
that he had frequentl}^ threatened to kill himself, and further
that the bloody water in the basin was due to a daughter wash-
ing her hands after having touched her father. It is even con-
ceivable that an ambidextrous person, to avoid suspicion of sui-
cide or to impute murder to another, might inflict a suicidal
wound from right to left. Notwithstanding all this, the above
cases are very rare exceptions, and the rules stated above as to
incised wounds in the throat hold in almost every case.
In the case of stab-wounds of the chest, especially in the
cardiac region, the same rule as to the direction holds good,
and in these wounds we can often define the direction more
accurately than in the case of incised wounds. If the suicide
is right-handed the wound is regularly on the front or side of
the body and directed obliquely from above downward and from
right to left, while it is from left to right in case of a left-
handed suicide. A murderer from behind, or from that side
the hand of which the victim would use, may inflict a w^ound in
the same situation and direction as a suicidal one. Here again
this ma}^ be done with the motive of concealment of the nature
'Taylor: "Med. Jiu-ism-udence, " '■* Willis: "Circumstantial Evi-
11th Amer. Ed., 1892. " dence," p. 97.
THE NUMBER AND EXTENT OF WOUNDS. 5:31
of the crime. Homicidal stab- wounds inflicted from in front, as
they generally are, are usually directed from left to right, and
they may be directed from above downward or in the oi^posite
direction. Oblique wounds from above downward may be either
suicidal or homicidal; those directed from below upward are
almost always homicidal.
When a wound is caused by an instrument both cutting and
puncturing, suicide cannot be admitted unless the direction of
the wound is compatible with that which the weapon which
inflicted the wound, held in the hand of the deceased, might
cause. Ta^'lor recommends to place the weapon in the hand
of the deceased to see if the direction of the wound could possi-
blj^ correspond with that which could be taken by the weapon
in the liand of the deceased with any position possible for the
arm and hand. Therefore certain wounds by position and di-
rection exclude suicide, but if a wound is possibly suicidal it
is also possibly homicidal.
Though suicidal wounds vaiy, the above points are some-
times of real assistance in distinguishing between suicide and
homicide, especially if the bod}' has not been moved.
Evidence Furnished by the Number and Extent of
"Wounds. — Multiplicity of wounds, as a rule, indicates homi-
cide, and indeed the reverse is true in a majoritj'of cases that a
single wound points to suicide. There are many exceptions,
however, to both statements. Multiple wounds are possible in
suicide, and that, too, with dijfferent weapons; even drowning or
hanging may be resorted to after self-inflicted wounds have
failed. If several wounds are found, each one of which or more
than one of which may be considered grave, it is usual to con-
clude that the wounds were not self-inflicted, but the medical
expert should not judge too hastily from this fact alone, for
most wounds do not kill instantly. With the presence of sev-
eral wounds in a case of suicide only one of these, as a rule, is
"mortal" in character. This being so, some have asserted that
if two mortal wounds are present, especially if one of them is
stupefying, such as a wound about the head, such wounds are
incompatible with suicide. A definite statement of this kind
cannot go unchallenged unless the two wounds are in different
parts of the body, and both of such a ^)ature as to be imme-
diately or very rapidly fatal. For all cases of suicide or liomi-
532
WOUNDS — WOOLSEY.
'■rn ^
cide do not die immediately from wounds commonly called
mortal ; in fact, this may be said to be the exception rather than
the rule. We may safely say, however, that if there are sev-
eral distinct wounds on the throat, each involving the large
vessels, the inference is plainly murder.
Several wounds by the same or different weapons cannot,
therefore, be proof of homicide. The case of a lunatic suicide
is reported who inflicted thirty wounds upon his head. In a
case of homicide with multiple wounds the situation or direc-
tion of some one or more of them may give evidence as to the
origin of the wounds. Ogston, Sr.,' states that especially in the
case of incised wounds
of the throat a suicide
may make a number
of small or superficial
tentative cuts besides
the principal one, but
these incisions are all
usually parallel (see
Fig. 10). In the case
of multiple homicidal
incised wounds of the
throat, on the other
hand, the wounds are
not parallel, o w i n g
probably to the resist-
ance of the victim in
this case and his remaining passive in the former. The
extent of the wound refers to the number and importance of
the parts injured. In regard to incised wounds of the neck,
this point has been thought by some to furnish presumptive
evidence of suicide or homicide — of homicide if the wounds
are deep, of suicide if they are not. While it is true that
suicidal wounds of the neck are, as a rule, not very deep, and
that they seldom reach the vertebrae and generally do not di-
vide the vessels on more than one side, yet sometimes such
wounds are as deep and extensive as homicidal ones.. This
may imply a determined purpose not to be foiled in the attempt
at suicide. Thus Marc reports a case of suicide by an incised
' "Lectures on Med. Jurisprudence," p. 424.
N.
Fig. 10.— Suicidal Cut Throat from Left to Right,
showing the Tentative Cuts at the Commencement and
the Serrations at the Termination of the Wound.
EVIDENCE FURNISHED BY THE WEAPON.
533
wound of the neck, where the wound was so deep as to reach
the vertebrae or their anterior ligaments and to divide the
trachea and oesophagus, both carotids and jugular veins. The
extent of this wound was greater than in most suicides, but
still we can hardly lay down a hard-and-fast rule of much
practical value according to M^hich extensive wounds are evi-
dence of murder. Such wounds are, however, presumptive of
murder taken in connection with other signs pointing that way.
The question may arise in regard to a wound, whether the
victim tvounded himself by precipitating himself on the
weapon. This may bo alleged by the defence, but it is diffi-
cult to believe if the wound is deep, for the body would natu-
rally repulse the weapon.
If the wound is deep the
weapon must at least have
been strongly held, which
may or may not be consist-
ent with the theory of self-
defence. If the direction
of" the wound is oblique
from above downward, or if
there is one external wound
and two separate tracts
internally, from a second
use of the weapon on the
part of the person hold-
ing it, then the above allegation is doubtful, if not impossible.
By comparing the relative positions of the deceased and
accused, as indicated by the witnesses and accused, with the
position and direction of the wound, we may often judge
whether the allegation is possible or probable.
Besides the above points derived from the w^ound itself,
there are several other factors which belong to the categor}- of
circumstantial evidence, but which come within the province
of the medical expert. These latter points of evidence are
sometimes almost as important as the former, while taken in
connection with them they help to make the evidence far more
conclusive.
Evidence furnished by the weapon as to the origin
of wounds.
Fig. 11.— Homicidal Cut Throat from Right
to Left, showing a Tentative Cut at the Coin-
iiiencement and the Serrations at the Termina-
tiiin of the Wound.
534 WOUNDS — WOOLSEY.
We have already seen in a former section that we can often
tell, by various signs of the wound, with what kind of a weapon
it was made. We may thus be able to say that a wound was
made by a weapon similar to one exhibited. Also by examina-
tion of the weapon itself and from the circumstantial evidence
of where and how it was found, we may sometimes say that
the wound was inflicted almost certainly with a particular
weapon. All this evidence ma}' sometimes be made use of in
judging between the suicidal and homicidal origin of a wound.
The POSITION of the iveapon or the place where it is found is
a matter of considerable importance. If it has not been touched,
its position should be carefully examined, or inquired about if it
has been moved. The presence of a weapon which might have
caused the wounds in the hand of the victim is in general proof
of suicide. The weapon must not merel}' lie in the hand, it
mast be gripped by the hand. One might suppose that the
weapon placed and held in the hand until rigor mortis sets in
would still be firmly held. Casper says that this is not so,
but that the weapon falls from the grasp as soon as the hand
is unbound. Also Hofmann's ' experiments proved the satne
point. By the use of ligatures and several artificial means he
tried to confine a weapon in the hand of a recenth' dead body
so that it would be as firmlj' held as hj a contraction of the mus-
cles during life. These experiments were entirely unsuccessful,
for though the fingers remained closed, the object was simply
held and not grasped, and fell from the hand on the release of
pressure.
In suicide the weapon is sometimes held so firmly that force
is required to dislodge it. It seems as if the muscular spasm
or grip persists after death, as cadaveric spasm, until rigor
mortis occurs and sets it, as it were. The murderer, therefore,
cannot imitate this grip, and an unsuccessful attempt to do so
would indicate murder. It should be borne in mind that the
weapon in the hand of the deceased maj have been for the pur-
poses of defence ; therefore it is necessary to note whether the
wounds on the body correspond to those which could be made
by the weapon. Indeed, this fact is most important to note in
all cases of suspected suicide where the weapon is found. If
the weapon is not in the hand of the deceased, note carefuUy
'See "Med. Leg. ,"ti-ad. par Brouardel, p. 601.
EVIDENCE FURNISHED BY THE WEAPON. 535
where it lies. If death is due to a suicidal or accidental wound
which is immediately or very rapidly fatal, the weapon is gen-
erally found near the body. If so, it is well to note on which *
side it lies, and if it lies near, whether it has apparently fallen
or been thrown or placed there. If the relation of the body and
the weapon has been disturbed by moving either, the position
of the weapon as found by the medical witness is of little value.
In cases of suicide the weapon may possibl}^ be found at some
distance or even concealed, though this is exceptional. Thus
Taylor ' states that the razor in one instance was found shut at
the side of the deceased, who had committed suicide by cutting
his throat. In another instance the razor was found in the
pocket of the deceased, bloody and closed. As a rule, the
weapon is found Ijnng at the side of a suicide if it is not grasped
in the hand. If the weapon is far from the bod}' and the wound
was quickly fatal, especially if the weapon is hid or cannot be
found, it is strongly presumptive of murder. If the weapon is
found near the body it is well to note whether the edge is sharp
or blunt, straight or bent, or notched, as these points maj^ assist,
us in forming a judgment as to suicide or murder.
A weapon belonging to the victim ma}' be substituted by
the murderer for the one really used, and the former may be
placed by the side of the bodj-. Therefore the weapon found
should correspond to the wounds as to length, depth, sharpness,
etc., to be compatible with suicide.
Generally a suicide foiled in the attempt to take his life
uses the same weapon over again if he persists in the attempt.
But he may not do so ; on the contrary, if the first attempt was
made with a knife, the second ma}' be made with a pistol, etc.
Several wounds by the. same or different weajwns cannot
therefore be an absolute proof of homicide.
The presence of blood, hair, and other substances
on the weapon used, or probably used, is a matter of some
importance. Blood is not necessarily found on the weapon used
to inflict a mortal wound, especially in the case of blunt instru-
ments. In stab-wounds, too, the vessels may be compressed by
the blow or the weapon may be wiped as it were on withdrawal
by the elasticity of the skin and by the clothing, except for a
thin yellowish film. Thus it is that the first stalvwound shows
'"Med. Jurisprudence," 11th Amer. Ed., 1892.
636 WOUNDS — WOOLSEY.
110 blood on the outside of the clothes but only on the inside,
but the outside of the second is usually bloody but may be but
'little so. To make sure whether or not there is blood on a knife
or other weapon it is necessary to examine all the depressions
on the instrument, as the blade itself may have been washed,
and only those traces of blood remain which are less accessible
to cleaning by washing. Blood coagulated on a blade indicates,
as a rule, blood from a living animal, but it may not do so.
Furthermore, it may be hard to distinguish between a thin
layer or spots of dried blood not coagulated or coagulated and
dried blood in a similar form.
If blood is not found on a weapon, hair and other substances
which can be identified may be. This is especially the case
with blunt weapons, on which, as we have seen, blood usually
fails. A fragment of the weapon may break off in the wound,
as in stab-wounds, and may be identified as belonging to one in
the murderer's possession.
The signs of a struggle furnish important evidence, as
they are not likely to be found in the case of suicide. If the
wounds were inflicted by a cutting instrument, the existence
of a struggle may be indicated by incisions on the palm of the
hand or fingers or on the dorsum (see Fig 12). Such wounds
would not be self-inflicted and would indicate a struggle with the
murderer. Or if contusions or ecchymoses indicating the form
of the foot, fist, fingers, or finger-nails are found on the face, neck,
chest, forearm, or hand of the deceased, this again indicates a
struggle with the assailant, and goes far to prove murder. The
same is true of the imprint of a bloody or dirty hand on the clothes
of the victim when the victim's hands were not bloody. Also
such an imprint in a position where the deceased could not have
reached with the particular hand indicated, as is the case if the
impression of a right hand be found on the victim's right arm;
this indicates a struggle with a murderer, etc. In one case of
murder, on the back of the left hand of the deceased there was
found the bloody mark of a left hand evidently not tjiat of the
victim himself. The presence of marks of violence about the
mouth of the deceased, done to close it to prevent the victim
from giving an alarm, especially if surprised during sleep, is
presumptive of murder. Sometimes hair or fragments of cloth-
ing belonging to the accused are found in the grasp of the de-
THE SIGNS OF A STRUGGLE. 537
ceased, indicating a desperate struggle, and they are very sus-
picious of murder. Thus Taylor ' cites the case of a murder
trial in Ireland, in 1877, where hairs found firmly grasped in
the hands of the deceased were found to correspond to the hair
of the accused. The clothes of the deceased, as well as those
of the accused, often indicate a struggle unless the accused can
Fig. 12.— Incised Wounds of Right Hand in the Struggle of Defence. Homicide.
satisfactorily account for the condition of his own clothes in
some other way.
The examination of the clothes and body of the de-
ceased and the accused may furnish important evidence.
If suicide is accomplished by a weapon like a knife, it is
rare for the hand not to be bloody. If it is not bloody we may
well suspect a case of supposed suicide. The presence of blood
on the hand does not prove suicide, though its absence may
'"Med. Jurisprudence," 11th Auier. Ed., 1892.
538 WOUNDS — WOOLSEY.
disprove it, as the hand is generally bloody in case of murder
by being carried to the wound.
The examination of the clothing of the deceased is of great
importance. As we have noticed before, a suicide generally
opens them, a murderer rarely. A suicide is often partly or
even wholly undressed when he inflicts the wound, while mur-
der is usually committed on those entirely dressed. The wound
of the clothes should correspond to that of the body in case of
murder. In suicide the wounds of the body and of the clothes
may not correspond, especially if there exists a motive to falsely
impute the crime. The clothes of the deceased as well as those
of the accused may indicate a struggle, as we have already
noticed. Of course, in regard to the clothes examined, it is
necessary to clearly prove that they were worn at the time by
the deceased or accused, otherwise serious mistakes may be and
sometimes are made. In examining the blood-spots on the
clothing, note whether the blood occurs in large patches or
sprinkled as by a spurting vessel or by continued violence.
The body of the accused may present scratches, marks of
nails, contusions, bites, or other wounds indicative of a struggle.
It would be well to ask the accused how he received the wounds
or scars, to see if his explanations tally with the injuries. It
is hard to tell when wounds which have cicatrized were in-
flicted ; we can only distinguish between old and recent ones,
and thus control the statements of the accused. An examina-
tion of the finger-nails of the prisoner soon after the crime may
reveal blood underneath when the rest of the hands and person
are free from it. Note also the site and shape of the blood-
spots, if they exist, and whether or not they came from an
arterial jet. These spots may be on the body or clothes of the
accused. The account of the accused as to these spots may or
may not correspond to the facts as indicated by them. The
above leads us to the more or less important question :
Could the Assailant have Escaped without Stains?
It is possible for the murderer to escape without being spotted
with blood, but the probability of this occurrence depends on
the nature of the wound and the relative positions of the de-
ceased and the assailant at the time the wounds were inflicted.
This latter fact is very largely, if not altogether, a matter of
BLOOD-STAINS ON THE ASSASSIN. 530
speculation as far as the medical evidence goes. It is a popu-
lar, though false, idea that a murderer's clothes must be bloody,
and the police may be misled in expecting to find them so in
every instance. Taylor ' cites several cases in which either no
blood was found on the murderer's clothes, or only small spots
whollj^ out of proportion to the amount of blood which must
have spurted or flowed from the wound. Absence of blood on
the prisoner's clothes is often made use of by the defence to
prove the prisoner's innocence, whereas, besides the possibilities
of having had no spots in the first place, the clothes may have
been changed or washed before the examination was made.
This has occurred in more than one murder trial. Taylor'
mentions the following cases in illustration :
It was alleged that the absence of blood-stains on the pris-
oner's clothing was a strong proof of his innocence in the trial
of Sub-Inspector Montgomery for the murder of Mr. Glasse
(Omagh Ass., July, 1873). In this case the weapon was a
bill-hook which had produced contused wounds on the head.
There was blood on the floor about the body, but the w^ounds
were not likely to have been accompanied by much spurting.
Yet it was assumed that the assailant in this case must have
been covered with blood. Much stress was laid upon the ab-
sence of blood-stains. On the first two trials the jury could
not agree, owing chiefly to the absence of blood- stains, but on
the third trial he was convicted and afterward admitted that he
had removed the blood -stains from the clothes with cold water.
Also in the case of Reg. v. Courvoisier (C.C.C, 1840) the ac-
cused, who was tried for the murder of Lord William Russel,
had no blood-stains on his clothes. All the vessels of the throat
of the deceased had been cut to the vertebra3 while he was
asleep. It was contended most strongly that the accused could
not possibly have committed the crime, as he had no blood-
stains.- But after conviction he confessed that he wore no
clothes when he committed the murder, and he only had to
wash his hands and the carving-knife he used. Again, in the
case of Reg. r. Thompson (Durham Wint. Ass., 180.')) the de-
fence mainly relied on the absence of blood on the prisoner's
clothing. The wound in the throat of the wife of tlu^ accused
was five inches long, directed from left to right, dividing all
1 " Med. Jurisprudence, " 11th Amer. Ed. , 1893.
540 WOUNDS — WOOLSEY.
the vessels and nerves of the neck. The medical witness stated
justly that no such wound could be self-inflicted. It was rap-
idly fatal. No weapon was found near the body. The prisoner
was convicted.
The same author cites the case of a prisoner on whose
trousers worn soon after the murder no blood-marks were found,
but the trousers actually worn by him were found with blood
upon them. Juries have even acquitted the prisoner apparently
only because no marks of blood were found, though the other
circumstances were explicable only on the theory' of murder.
It should be remembered in this connection that blood-stains
may be found on the clothing of many, especially on the coarse
clothing of working-people. This may be accounted for by the
occupation, flea-bites, accidental circumstances, or it may occur
without definite explanation. Such persons may be accused of
murder and yet the blood-stains be consistent with innocence.
Too much importance should not, therefore, be attached to
them, even if the accused cannot satisfactorily explain them
and if he does not attempt to do so in a suspicious way. That
blood on the clothing even under suspicious circumstances may
be consistent with innocence is illustrated by the case of a suicide
by cutting the throat, in 1872, cited by Taylor.' In this case
the son first found his father dead, and thought that he had
broken a blood-vessel. He raised the body, staining his hands
and clothes, then went for help. At the inquest he was closely
questioned as to the presence of the blood-stains, but there could
be no doubt that the case was one of suicide.
In general, we may say that a murderer is much more likely
to escape without blood-stains in contused wounds, and more
likely in the case of punctured wounds than in incised wounds,
for in punctured wounds the bleeding is much less free and is
less likel}^ to spurt from the wound. In the case of incised
wounds ho is most apt to escape without stains if he is behind
or to the side of the victim when he inflicts the wound — in other
words, when a part of the body of the deceased was between the
assailant and the wound inflicted. Furthermore, the assailant
is more likely to escape without blood-stains if there is a single
wound than if there are several, and each additional wound
makes it more likely that he will be spotted with blood.
'"Med. Jurisprudence," 11th Amer. Ed., 1892.
EXAMINATION OF THE GROUND, FLOOR, ETC. 5-il
The examination of the ground or floor and the furni-
ture, etc., may furnish some evidonce as to the nature of the
crime, and also help the witness to answer the questions which
may sometimes be asked, i.e., At what spot was the victim
"svouNDED? and Where did he die? This question is some-
times settled by examination of the spot where the deceased la}'-
and the furniture, etc., about. Sometimes the floor or ground
and the furniture or surrounding objects at a distance give the
requisite evidence. The examination of the cracks and corners
of the floor and furniture should not be neglected, and Taylor
instances a case where the hair of a dog helped to clear up the
case. If the bod}^ has not been disturbed the most blood is
usually found where the deceased died. If the victim succumbs
at the spot where he was wounded, blood is found onh' in the
immediate neighborhood, except for arterial jets, which ma}' be
as far distant as two metres. The separate blood-spots ©f an
arterial jet are circular if the jet strikes-the object perpendicu-
larly, oval or wedge-shaped with the larger end away from the
body if it strikes the object obliquely.
If the blood-stains are more diffused and are found in other
places, careful notice should be taken as to whether the differ-
ent places communicate with one another by traces of blood.
If they do not communicate, it goes to show that the body was
moved after active bleeding had ceased, that is, after death,
but this indication is not absolutely positive. If traces of blood
do connect the larger blood-spots, it is of interest and importance
to know where the deceased was wounded and where he died,
also whether he moved or if he was moved before or after
death. This question is not ahvays capable of solution. Some
injuries exclude the possibility of active motion. Stupefying
contused injuries of the head or an incised wound opening a
great artery are both inflicted where there is the greatest
hemorrhage, and the spot where the deceased was wounded and
died shovdd be identical. In such cases a second large sj^ot of
blood, connecting or not with the first wound, indicates that the
body has been moved. But if the wound does not bleed much
or rapidly, the wounded person may fall at a distance from the
spot where he was injured, and death occurs, as a rule, where
there is the greatest amount of blood ; for a certain amount of
bleeding occurs for a short time after the victim falls or even
542 WOUNDS — WOOI.se Y.
after death. One can find in many i)laces the signs of arterial
jets marking the movement pi the deceased from one blood-spot
to another. This is quite different from the tracks caused by
dragging a bleeding body. All this it is important to notice,
for the dragging or passive moving of the body strongly indi-
cates murder. Blood at a distance may indicate the occurrence
of a struggle, or that the body was moved, or it may. show the
tracks of a murderer. As to the latter point, tJie imprints of
the hands and feet, whether bloody or not, may indicate murder
and establish the identity of the murderer. We have already
seen how they may occur on the deceased and indicate a strug-
gle, and thus be presumptive of murder. When the marks are
made by the naked foot, it is well to examine it by lining it off
in squares, and so to compare it with the imprint of the foot of
the accused. Simple inspection can sometimes give the required
evidence. We may even get an impression of such imprints in
the snow. Imprints of the boots or shoes worn by the accused
compared with those imprints found at and near the scene of
the crime may sometimes help to clear up the case, but this
may perhaps be considered outside of the sphere of the med-
ical witness. Such and other signs of a struggle about one of
the blood-spots would indicate that the wound Avas received
there, though death may have occurred at another spot. In
such a case it would be well to examine to see if there was
much blood where the body was found, for if there was not it
would indicate that the body had been moved there after death,
and thus be strongly presumptive of murder.
As furnishing some evidence which may help to distinguish
between suicide and homicide in the origin of wounds, the
question may be asked, What was the position of the
VICTIM when injured OR DYING? and also. What were
the relative positions of the VICTIM AND ASSAILANT?
The position of the victim at the moment of the injury is
sometimes indicated by the position of the wound, the direction
of its tract, and the direction from the wound of the blood on
the body and clothes. On the neck or extremities the course
and form of the wound may indicate the position of these parts
when the wound was inflicted, for sometimes in flexions of
these parts the skin lies in folds, and a wound inflicted when
these parts were so flexed would be irregular, wavy, or zig-zag.
RELATIVE POSITIONS OF THE VICTIM AND ASSAILANT. 540
Further, the position and movement of these parts necessary
to restore directness to the woun^ niaj^ indicate the position
of the parts when the wound was inflicted. The examination
of the relative positions of the wound in the clothes and the body
may help to indicate the position of the body when wounded.
The position of the blood on the body and the direction of the
blood from the wound, whether below or at the sides, etc.,
tends to show the position of the body when bleeding. Thus
if the body was at any time in tlie erect position, some of the
blood-stains will be vertically below the wound, or if the victim
was lying on the back then the stain would be at the sides only
and not below the wound, except such stains as indicate that
the}' were produced by arterial jets. Few suicides cut the
throat in the recumbent position ; therefore it maj' be consid-
ered in the light of an indication of homicide if the blood-stains
show that the victim was not erect after the wound was in-
flicted. It is well also to note the form, direction, and obliquitj^
of the blood-spot. This would indicate, by comparison with
the wound, the relative position of the wounded person and the
blood-spot, and thus show whether the body had been moved
or not, as, for instance, b}' the murderer for the purpose of
robbery. The force of the bleeding is also indicated b}^ the
form of the spot, and this would indicate how rapidlj^ death
probably ensued. This fact might thus help us to judge
whether the victim ];)robably died where he was wounded, and
whether other and remote blood -spots would not be presumptive
of murder. If the victim is found in night-clothes, this fact
would help to show that he was lying down when wounded.
The medical evidence as to the position of the victim when in-
jured is, therefore, circumstantial and not very positive ; that
in regard to the relative position of the victim and assailant
is even less positive. We presuppose in this question that the
case is one of jnurder. We are not to prove murder or refute
suicide. We can rarely be positive as to the relative position
of the assailed and the assailant. A wound in the back may
be caused by some one in front with an arm behind. The
direction of the wound would indicate this, for if the assailant
is right-handed and inflicts a wound on the back from in front,
a stab-wound would almost always be directed from left to
r^ght, an incised wound from riglit to left, both from above
544 WOUNDS — WOOLSF.Y.
downward. With a left-handed murderer the direction would
most likely be from right to left and from above downward for
a stab- wound, and from left to right and from above downward
for an incised wound. If the assailant were at the back of the
victim and wounded him in front, the direction of these wounds
would be the opposite of the above, i.e., from right to left for
a stab- wound and from left to right and from above downward
for an incised wound with a right-handed assailant and vice
versa with a left-handed assailant. These wounds occur more
commonlj^ than those of the back, and are especially noticeable
in incised wounds of the throat. In the case of these incised
wounds of the throat inflicted from behind, the direction from
left to right and from above downward resembles that of self-
inflicted wounds in the same situation. As a general rule,
wounds are on the same side of the victim that the assailant
was; the facts given above help to show us the exceptions.
Thus a wound on one side is presumptive that the murderer was
on that side, or possibly at the front or back and only excep-
tionally on the opposite side. The presence of wounds on one
side only may help to confirm the testimony of a witness that
the victim was against a wall or some other obstacle which
protected the other side. The question of the relative position
of the combatants in duels and the nature of the weapons used
as shown by the wounds has sometimes come up, especially in
other countries, to determine whether the combat was regular
and fair.
In all cases of suspected suicide, but where a doubt exists
between suicide and murder, or even accident, hereditary dis-
position and organic affections of the body, such as alcohol-
ism, incurable or painful diseases, chronic inflammation of the
brain and meninges or of the genito-urinary organs — all such
and hereditary predisposition may support the idea of suicide.
Imputed or Self-Inflicted Wounds.
Closely allied with the question of the suicidal or homicidal
origin of wounds is the question whether a wound imputed to
another is self-inflicted or inflicted by another. These wounds
are seldom fatal. In discussing the question whether a wound
is self-inflicted or inflicted by another, we have referred oc-
IMPUTED OR SELF-INFLICTED WOUNDS. 545
casionaliy to suicidal wounds where the circumstances were
such as apparently purposely to imply murder and impute the
cause of death to some one else. This happens more often in
cases of unsuccessful suicide. Here we have recourse to the
same evidence that we have gone over in the present section
which helps to distinguish between a suicidal and a homicidal
wound. The case may be somewhat more difficult, as the
unsuccessful suicide may manufacture evidence against the
accused and hide to some extent the evidence of suicide.
These cases can usually be decided, however, in connection
with the circumstantial and other evidence. The majority of
cases of imputed but self-inflicted wounds are very superficial,
often not below the true skin. Being self-inflicted the^" have
many of the characters of suicidal wounds. Thus they are
usually situated in front and on the left or right according
as the wounded person is right or left handed, and the direc-
tion is usually similar to that in suicidal wounds. Such
wounds are generally incised or punctured wounds, seldom con-
tused wounds, and in this respect they resemble suicidal
wounds. As exceptions to this rule, Bergeret ' mentions some
cases where females in attacks of hysteria have inflicted severe
contusions on themselves, and have preferred charges of at-
tempted murder against innocent persons. Like suicides also
the hands are seldom injured, though they may bo much so
in resisting homicide.
In other respects, however, these wounds dift'er from suicidal
wounds. . Thus they are not usually situated over a " mortal"
spot, and they are often numerous and scattered, sometimes
parallel and sometimes not. The wounds in the dress do not
correspond even as often as in suicide. In comparing cuts in
clothing with those on the body, it is important to find what ar-
ticles were worn at the time the assault was alleged to have taken
place, and to make sure that the clothes examined were those
worn or alleged to have been worn , It may not be necessary- that
the clothes examined should have been really worn, for if they
were alleged to have been worn and were not, the examination of
them will almost always show the deception or the self-inflicted
nature of the wounds. Then take careful note of the position,
direction, form, and size of the cut and the apparent sharpness of
'Anu. d'Hyg., 1863, t. 1, p. 463.
35
54G WOUNDS — WOOLSEY.
the weapon in the several layers, and see if they correspond with
one another and with the wounds on the body in those various
particulars. In imputed wounds the clothes are generally cut
when off the body and can seldom be done so as to deceive a
careful examiner. Several wounds cannot exist in the same
region of the body without some being bloody and showing the
marks of it on the clothes. Even a single wound of the clothes
generally shows blood on the inner surface if there is a corre-
sponding wound of the body underneath. In simulated and
imputed injuries the blood-stain may be on the outside of the
clothing instead of on the inside, showing that it was artificial
and not natural. An impostor may either do too much or too
little, and the medical witness should be on guard against both
alternatives. Taylor ' mentions a case which occurred in Lon-
don some time ago, in which there were two cuts in the shirt
near together exactly alike in size, form, and direction, making
it evident that the weapon had gone through a fold of the shirt.
This proved that the shirt could not have been worn at the time
it was cut, for if the shirt was folded while on the body the
weapon must have gone through the fold and then through
another layer of shirt, making three cuts instead of two, or five
instead of four, before it could have reached the body. This
and other facts made self-infliction of the slight wound on the
chest probable. The same author cites another case showing
the imperfect manner in which the cuts in the clothes are made
in imputed wounds, the clothes being off the body at the time.
The case occurred in Nottingham in 1872, the accused being
charged with wounding the plaintiff on the highwaj' bj" stab-
bing him in the arm, though there was no robbery or other
motive for the act. The coat and shirt sleeve were found cut,
but there was no corresponding cut in the lining of the coat
sleeve. The charge was clearl}' false, and was trumped up bj'
the youth who was the plaintiff because he wished to leave the
place where he had been sent for private studj'.
In examining a case where the self-inflicted nature of im-
puted wounds is in question, the following are some of the
many points to keep in mind in the examination and to be
ascertained by the examination: (1) The relative position of
the plaintiff and the assailant at the time of the alleged attack.
' "Med. Jurisprudence," 11th Amer. Ed., 1892.
WAS A WOUND ACCIDENTAL? 547
This can be compared with the position as stated by the phxintiff
or other witnesses. (2) The situation, direction, depth, nature,
and number of the wounds. (3) The situation and direction
of blood-marks or wounds on the dress or person of either or
both. (4) The marks of blood and the quantity of it at the
spot of the alleged struggle. (5) The signs of a struggle and
the various other points of circumstantial evidence gone over
in considering suicidal and homicidal wounds.
Though a severe blow may cause a slight mark, it does not
follow that a slight mark implies a severe injury, else the excep-
tion is made the rule. The inconsistency of the story of the
plaintiff is generally so paflpable that imposture is evident, but
prejudice and unjust suspicion are often excited against those
accused. Thus Taylor ' states that " a strong suspicion was
raised against the then Duke of Cumberland, in 1810, in refer-
ence *to the death of Sellis, when a skilful examination of the
wounds on the deceased would have shown that they might
have been self-inflicted." The same author also cites the case
of M. Armand, a merchant of Montpelier, whoat Aix in March,
1864, was tried for an alleged murderous assault on, or imputed
murderous strangulation of, his servant. The excoriation on
the back of the neck was so slight as to escape the observa-
tion of some medical men, and it was evidently self-inflicted,
either accidentally or purposely, as the facts showed. The
assertions of a number of medical men were taken by the court
to support the servant's story to the effect that his master had
struck him a severe blow on the back of his neck, rendering
him insensible for many hours from concussion of the brain.
The evidence given chiefly by Tardieu for the defence showed
the story of the complainant to be a fabrication, and the ac-
cused was justly acquitted.
Was a Wound Accidental?
In answering this question we must distinguish accidental
wounds from those self-inflicted and those inflicted by another.
These three classes comprise all wounds. In case of a trial for
murder it may be alleged by the defence that the wound was
caused by accident or that it was due to suicide from a fall,
'"Med. Jurisprudence." 11th Amer. Ed.. 1892.
548 WOUNDS — WOOLSEY.
falls being a common class of accidental wounds. So we have
to judge between accident on the one hand and homicide and
suicide on the other hand. The question arises especially in
cases where the injury causing death is one commonly due to
accident.
As to the QUESTION BETWEEN ACCIDENTAL AND SUICIDAL
WOUNDS, they are often easily distinguished, especially if the
body has not been disturbed. In suicide there is clear evidence
of design, and the circumstantial evidence helps to make the
case clear. It may not always be possible to decide, however,
as an accidental wound may sometimes resemble a suicidal or
homicidal one. Accident is often shown by the nature of the
wound. Thus it is rare for an accidental mortal wound to be
caused by a knife or similar weapon held in the hand and forced
into the body by a fall, the blow of an opening door, etc. But
such exceptional cases have been reported. Incised and*punc-
tured wounds are, therefore, very rarely accidental, and most
accidental wounds are contused wounds or contusions.
Again, accident is often shown by the situation of the
wound, which should be on an exposed part of the body unless
the accident is due to a fall from a height, when the wound
may be ahnost anywhere. But such injuries are easil}' shown
to be due to falls. The fall, of course, may be accidental, sui-
cidal, or homicidal. Some wounds in exposed parts forbid acci-
dent on account of their nature, i.e., deep incised wounds of the
throat. If the deceased has a life insurance, suicide is less
probable, as the insurance is not paid in case of suicide. In
fine, accidental wounds are distinguished from suicidal by — (1)
Their nature; accidental wounds are almost always contused,
suicidal very rarely so, only in cases of lunatics and delirious
persons and where suicide is accomplished by a fall. ('2) The
situation of the wound or wounds indicates their origin. We
have already studied the situation of suicidal wounds and have
also seen that accidental wounds are only on exposed parts,
except when the injury clearly indicates a fall from a height.
The evidence from the direction of wounds rarely applies, as
this is valuable only in incised and punctured ^vounds, which
are seldom accidental. Both kinds of wounds are usually few
in number except in case of a fall from a height or a crush,
though sometimes suicidal wounds are multiple.
WAS A WOUND ACCIDENTAL? o4y
The evidence from weapons, if there be any, points strongly
to suicide. The signs of a struggle are hardly consistent with
either suicide or accident. The only case in which they might
occur would be where a struggle occurred to prevent a suicide
from throwing himself off a height or .before a vehicle or rail-
way train. In such a case accident would be excluded by the
signs of a struggle, and the question would lie between homi-
cide and suicide. The examination of the clothes of the de-
ceased would furnish no evidence unless some letter or paper
were found stating the purpose of committing suicide. Little
or no evidence would be furnished b}' the position of the body
when found in cases which might otherwise be doubtful. Or-
ganic lesions or other facts predisposing to suicide would fur-
nish presumptive evidence against the wounds being accidental.
Of all these various points the first, as to the nature of the
wounds, is by itself the most valuable and conclusive. But
this gives us no assistance in clearing up a case where it is
doubtful whether a fall from a height or a crush by a vehicle
or railway train was accidental or suicidal. Some of the other
points mentioned may aid us in such a case, and also the fact
that such injuries are far more often accidental than suicidal.
But in these cases, also, certain circumstances may show that
the fall was not the result of accident.
Accidental wounds are generally caused by a fall or a crush,
and the fact of their accidental character is generally estab-
lished by the circumstances of the event. Certain accidental
wounds present characteristics which allow the true nature of
the wounds to be determined. But in some cases a suspicion
may arise and the question may be asked as to whether the
WOUND WAS ACCIDENTAL OR HOMICIDAL. For instance, if a
person receives fatal homicidal injuries, and just before or after
death the body is thrown from a height or is run over and
crushed, it may be hard to determine the murderous element
among the many wounds. This is the case if the homicidal
wounds were contusions or were caused by blunt instruments,
but rarely, if ever so, if thej^ are incised or punctured wounds
or both. But even in the former instance, a close examination
of the lesions and of the locality of the injury can often clear
up the case. Thus in a case mentioned by Vibert,' as cited by
' Vibert : " Precis ile Med. Leg. , " ~\l Ed. . 1890.
550 WOUNDS — WOOLSEY.
Hofmann after Taylor, a woman was found dead at the foot of
some stairs in a cave. She had died of a fracture of the skull
and of the spine, produced by the fall. But about four or five
feet above the level of the top step there was found on the wall
the fresh marks of an arterial jet of blood. Examination
showed a wound in the right temporal region which had opened
the temporal artery, and it was therefore thought that the
woman was wounded at the top of the stairway and then
thrown down, which was afterward proved to be true. In an-
other case, reported by M. Tourdes, a man knocked down and
killed by an axe, which crushed his skull and caused the brain
to exude, was placed in a road frequented at night by heavy
wagons. The head was placed in the rut, but the coagulated
blood and brain formed a puddle which did not appear on the
wheels or their track, and no bloody furrow was caused by
their passage. The same author mentions the case of a woman
plainly strangulated by the hands and then thrown into the
ditch of the fortifications of Paris.
It is especially with regard to fractures of the skull that
the question often comes up as to the accidental or homicidal
nature of the injury, as to whether it is due to a fall or a wound.
Sometimes a depressed fracture may show the form of the in-
strument. An extensive comminuted fracture of the skull may
indicate greater violence than would be received from a fall
from the little height which the circumstances may allow. As
to the slighter degrees of fracture, the disposition of the fracture
itself often shows less than the form and site of the ecchymosis,
the lesion of the scalp, and the place and position of the body
when found. In such cases the traces of a struggle, the exist-
ence of other wounds, etc., may be of great importance. In
distinguishing between homicide and accident, as in distin-
guishing between the fetter and suicide, the most obscure and
difficult cases are those where the injury has been caused by a
fall from a height or by a crush.
This is illustrated by the case of Madame de Tourville, which
is quoted by Taylor.' She was killed in July, 1876, by a fall
from a precipice. Her husband, a lawyer, was accused of mur-
der committed by pushing her over a precipice in the Stelvio
Pass. The place where her dead body was found was at a con-
'"Med. Jurisprudence," 11th Amer. Ed., 1893.
WAS A WOUND ACCIDENTAL y 551
siderable depth below, and the injury was chiefly in the head,
which had been crushed by the fall. The body showed no evi-
dence of intentional violence. The prisoner's guilt was estab-
lished on the following points: (1) The false and inconsistent
statements made as to the occurrence; (2) the marks of the
body having been dragged some distance so that a part of the
dress was found, in a bloody condition, some way from tl:e
body; (3) there were marks of blood on the prisoner's hands
and clothing. After a long trial he was convicted, though the
sentence was afterward commuted to imprisonment for life.
Of course, as we have already stated, if a person is responsible
for a fall he is also responsible for the results of the fall. This
applies to many of the contused injuries and deaths from falls
in prize-fights and drunken brawls.
We may sum up the points of evidence which help us to
distinguish between an accidental and a homicidal injury much
as we did when the question lay between accident and suicide.
(1) The evidence from the nature of the wound is not quite so
conclusive as when the question lies between suicide and acci-
dent. For contusions and contused wounds are far more often
homicidal than suicidal, and accidental wounds are almost
always of this class. If, however, the wounds are incised or
punctured, this fact points almost certainly to homicide. (2)
As to situation, a homicidal wound ma}- be situated almost any-
where ; an accidental wound, except in falls from a height, only
on an exposed place. (3) The direction of the wound can sel-
dom help us in the case of contused wounds which, practically,
are the on\y ones in question, though it ma}^ possibly be incom-
patible with accident. (4) As to the number of wounds, homi-
cidal wounds are far more apt to be multiple either in a small
area or scattered in such a way that an accident could hardly ac-
count for them all. (5) A weapon may give evidence more often
here than when suicide is in question, for a weapon may be
used to inflict contused wounds which may resemble those re-
ceived in a fall. The evidence furnished by a weapon or blood,
hair, etc., on the weapon, etc., is strongly in favor of murder.
(6) The evidence from a struggle is also more important be-
cause it is more often found. A struggle may occur in homi-
cide, and only in homicide, as a rule, so that signs of a struggle
are strong evidence of murder and against the idea of accident.
553 WOUNDS — WOOLSEY.
(7) The examination of the clothes and body of the deceased
may give valuable evidence, showing, as it may, signs of a
struggle or other marks of an assailant and indicating murder.
(8) Examination of the position and attitude of the body and
of the spot where it lay and the ground around, may furnish
more or less proof of murder, as in the case quoted above.
Thus the track of the murderer may be discovered or the body
may have been interfered with and moved or robbed, all indi-
cating homicide.
In any case, whether it is desired to distinguish accidental
from suicidal or homicidal wounds, those cases present the most
difficulty which result from falls from a height or crushes.
But, as the crse of Madame de Tourville shows, the above given
and other circumstances may often show even then that the fall
or the crush was not the result of accident.
Falls from a height may, therefore, be the result of sui-
cide, homicide, or accident. The injuries are similar in all
three cases. A fall of six to eight metres causes, as a rule,
numerous lesions, and shows such a traumatism that the case
usually excludes the possibility or, at least, the probability that
the wounds resulted from blows. Sometimes, however, the
gravit}^ of the lesion is not i)roportional to the height of the fall.
Thus Vibert ' relates the case of a man, afterward emploj'ed
for several years in the Ecole de Medicine, who jumped from
the top of the column of the Bastile, a height of fifty metres.
He rebounded on to some canvas stretched at the foot of the
monument, then fell to the ground, and was able to get up and
walk away. Curiously enough, he killed himself later by jump-
ing from the top of an omnibus in motion. In the case of falls
from a height, it is especially true that with grave lesions in-
ternally the skin may be intact or only slightly ecchymosed or
eroded, or the ecchymosis may be only deeplj' seated so as not
to appear superficially. In the latter case, if life had continued
the ecchymosis might have shown itself at some spot on the
surface in a few days, but these falls from a height are fatal
as a rule. In falls from a height, besides ecchj'moses, which
may occur where there are no other injuries or may fail where
there are many injuries, the lesions consist of fractures of bones
and ruptures of internal organs, with or without surface
' " Precis de Med. Leg. , " 2d Ed. , 1890, p. 264.
INJURIES FROM A FALL. 553
wounds. The fractures may be of a number of bones, and
especially of those which first touched the ground, though the
skull may be fractured at some part whether or not it was
struck»in the fall. These fractures are often comminuted, espe-
cially fractures of the skull and pelvis, and when the fall is
from a great height. Ruptures of muscles may occur with the
fractures.
Ruptures of internal organs are not rare in such cases. Ac-
cording to Vibert,' the order of frequency of rupture of the
various organs is as follows : liver, spleen, kidnej^s, lungs, heart,
stomach, intestines, bladder, brain. Rupture of the liver occurs
especially on the anterior and inferior surfaces and the bleeding
is rather abundant. The healthy spleen does not rupture read-
ily, except from a severe traumatism, but if it is hj-pertrophied
it may rupture spontaneously from muscular violence. The
lung may be ruptured internally without showing the rupture
on the surface and with the ribs intact. Two such cases are
mentioned by Vibert,^ and he refers to others mentioned by
Nelaton and Holmes. Rupture of the brain without fracture
of the skull is ver}" rare, though cases have been observed and
reported, among others by Casper-Liman. In falls from a
height the rupture of the aorta, mesentery, diaphragm, and
larynx have been noted. It should be remembered in this con-
nection that rupture of the liver, intestine, bladder, etc., may
be caused by contusions without sign of violence externally, and
such cases cannot, therefore, be attributed to falls unless there
are other signs of the latter.
In crushes caused by a heavy vehicle, the lesions resemble
in many respects those due to a fall from a height. Thus we
find fractures and internal ruptures, but we more often and
regularly find subcutaneous ecchymoses and ecchymoses be-
tween the muscles. The skin is often stripped up extensivelj-
and the injuries are generally limited to the region injured. It
is rare to find that the cause of the injury leaves no trace on
the skin, for it usually gives the form to the erosions or ecchy-
moses. Sometimes, for instance, the marks of a horseshoe are
clearly visible. Ruptures of internal organs maj' occur here
too when there are slight external marks of violence or even
'"Precis de Med. Leg.," 2d Ed., -"Precis de ]\Ied. Leg.." 2d Ed.,
1890. 1890, 1). 246.
554 WOUNDS — WOOLSEY.
none at all. Thus Vibert ' relates the case of a man with the
head crushed, but with no signs of injury to the trunk save
a few erosions at the level of the sternum, who had not only
rupture of the kidneys, the liver, and the spleen, but also of
the lungs and of the heart. In the heart the apex was com-
pletely detached and floating in the pericardium, which was
intact. There was no fracture of the ribs nor subcutaneous
or sub-muscular ecchymoses. The age of the subject was
thirty-two, so that the costal cartilages were not probably ossi-
fied, which may have accounted for the absence of fracture of
the ribs.
Crushes by the fall of heavy tveights resemble the latter
class of crushes, and differ from falls from a height in the fact
that the wounds are usually limited to one region. The lesions
themselves are more or less similar. Similar internal lesions
may be caused by the compression of the chest and body by the
knee of a murderer, which may occasion rupture of the internal
organs, fractures of ribs, etc. Thus, too, from the pressure of
a crowd the ribs may be fractured and the lungs injured. It is
particularly in these cases of injury from crushes or falls from
a height that we may have most difficulty, as far as the medical
evidence goes, of distinguishing between accident, suicide, and
murder. But the various points and considerations mentioned
above will sometimes enable the medical witness to clear up
the case. In some cases the non-medical evidence, circum-
stantial and otherwise, may be suflQcient of itself, or at least in
conjunction with the medical evidence.
In falls from a less high place the difficulty is somewhat
different, for here there may arise the question between a fall
and a contusion or contused wound, and the question generall}^
lies between accident and murder, or, very rarel}^, between ac-
cident and suicide. We have referred to both of these ques-
tions above, and from the facts mentioned the case can often
be solved.
Of more than One Injury which was the First In-
flicted ?
We can sometimes tell the order in which wounds were re-
ceived, but the question is rarely answerable with certainty,
' "Precis de Med. Leg.," 2d Ed., 1890.
THE CONSEQUENCES OF WOUNDS NOT FATAL. ooJ
If one wound is mortal and one or more are not, whether the
wounds are suicidal or homicidal, it has sometimes been con-
sidered that the former must have been inflicted last. But we
cannot admit that as a general rule the most grave wound was
the last inflicted. For the murderer or suicide, especially the
former, may go on wounding after the infliction of a mortal
wound, especially as it is the exception, and not the rule, to die
instantly after a mortal wound. Several assailants may have
inflicted wounds at the same time, which would still further
increase the difficulty. The question might then arise. Which
assailant had inflicted the mortal wound or which had first
inflicted a mortal wound? Under such circumstances, it would
not be easy to give a specific answer. There are several signs
which may indicate which wound was first inflicted in certain
cases. An instrument may become duller or even bent or
twisted after and on account of the first wound, and the subse-
quent wounds would vary accordingly. The wound of the
clothes corresponding to the first stab- wound may be and often
is only bloody internally, while the second and following
wounds are bloody on both sides. The following case quoted
by Taylor ' from the Annales d ^Hygiene, 1847, p. 401, illustrates
this point. A man received three stabs from an assailant, one
in the back at the level of the eighth rib, traversing the lung
and heart and causing rapid death, and two on the left elbow,
cutting the coat and shirt but only grazing the skin. The first
one was evidently the first inflicted, for both the wounds in the
clothing on the arm were bloody externally at the edges, al-
though there was no blood effused here. The correctness of this
opinion was confirmed at the trial.
The point of a knife arrested and broken off in a bone may
show that this was the last wound. The amount of bleeding
may show which was the first wound. Thus if several severe
wounds have been inflicted, all or several of which would nat-
urally cause profuse hemorrhage, and one showed signs of such
hemorrhage while another did not, the former would be likely
to be the first wound inflicted. Or if one showed slight hem-
orrhage where much would be expected, this fact would indicate
that it was one of the last inflicted. The absence of the signs
of spurting blood may tell which of two or more fatal wounds
'"Med. Jurisprudence," 11th Amer. Ed., 1892.
556 WOUNDS — WOOLSEY.
were first inflicted, for this would indicate that this wound was
inflicted when the heart action was weakened by loss of blood
or even after death, and the other wound or wounds which did
not present this sign would have been the first received. In
fact, if any of the signs are present about a wound which we
have seen to indicate that a wound was inflicted at any time
after death, this would show that this wound was not the first
received, and that the other or others were inflicted earlier.
Questions as to the consequences of wounds not fatal
may often be brought up in civil actions for damages. In cer-
tain countries the question of the consequences as to incapacity
may determine whether an injury shall be the ground of a
criminal as well as of a civil action. Thus in France an injury
which involves an incapacity of twenty days or more subjects
the assailant to a criminal action. The term " incapacity" in
this instance refers to general incapacit}" and not to incapacity
for fine and i^rofessional work. The latter, however, comes in
under the civil action which may be instituted against the as-
sailant or those directly or indirectly responsible for the injury.
The amount of the incapacity, its causes, whether duewhoUj- or
partly or not at all to the given injury, the probable duration of
the incapacity, the treatment which it has and will necessitate,
and many other such questions form part of the medical testi-
mony required in such cases. Sometimes with slight wounds
the results, accompaniments, and complications may prolong
the incapacity very greatly, as also the state of health and the
habits of the wounded person, the neglect of treatment, improper
treatment, etc.
Any bodily or mental infirmity or ill-health which may
result from an injury and its necessary treatment in the past
and future, all these questions and many more unnecessary to
mention may be required of the medical witness. No general
rules can be laid down for all such cases. In giving his testi-
mony the medical man must depend in any particular case upon
his knowledge, judgment, and experience.
We can seldom give a precise solution of the question of
sui'vival to determine the succession or inheritance if several
of a family die together in an accident. In case of death from
inanition, cold or heat, or in drowning especially, if some have
wounds more or less grave in themselves, we can sometimes
INCISED AND PUNCTUBED WOUNDS. 55?
form an opinion. With wounds we cannot often do so, al-
though in case of murder, the nature of the wounds, the posi-
tion of the bodies, the examination of the spot of the accident
or tragedy, may sometimes help us to form an opinion.
INCISED AND PUNCTURED WOUNDS AND WOUNDS OF
BLUNT INSTRUMENTS REGIONALLY CONSIDERED.
The several varieties of wounds which we have been con-
sidering vary considerably in their nature, their effects, their
danger, and in many other ways according to the region of the
body in which they are situated. Some of these varieties are
common in one situation and almost never occur in others.
Although the nature of wounds found in the several regions of
the body is not as important for a medical jurist as their danger
and their influence in causing death, we will now consider the
differences they exhibit on account of the region in which they
occur.
WOUNDS or THE HEAD.
These are often characterized by their apparent harmlessness
and their real gravity sooner or later. We might almost make
the opposite statement and say that those apparently grave
are often virtually harmless, though this would be true only in
a limited sense and in certain cases.
As to their nature, we find punctured wounds extremely
rarely, incised and lacerated wounds often, while contusions
and contused wounds are still more common. Incised and
lacerated wounds of the head involve the scalp almost exclu-
sively. These wounds heal remarkably well, even when the
attachment is merely by a narrow pedicle, owing to the abun-
dant blood-supplj-. Hemorrhage from the incised wounds is
often free, for the vessels cannot retract, but it is seldom dan-
gerous unless the wounds are very extensive. The only way
in which they differ materially from similar wounds elsewhere
is in the greater frequency of complicating erysipelas here than
elsewhere. This is probably owing to the presence of septic
conditions, as the head is generally dirtier than other parts of
the body, and slight wounds especially are neglected. If the
scalp is shaved over a wide margin and cleaned like other parts
558 WOUNDS — WOOLSEY.
•
of the body, erysipelas is found little or no oftener than with
similar wounds elsewhere. The density of the scalp is so great
that the redness and swelling accompanying intiammations is
comparatively slight. If erysipelas follows slight wounds of
the head, there is some reason to suspect constitutional predis-
position or careless treatment. From infection of such wounds
of the scalp abscess or diffuse cellulitis of the scalp may develop
as well as erysipelas. The constitutional symptoms in such a
case may be marked or even severe, but the prognosis is favora-
ble. In very rare cases necrosis of the skull may result or the
inflammation may even extend to the brain. These incised and
lacerated wounds of the scalp are usually accidental or inflicted
by another; they are rarely self-inflicted. Contusions and
contused u'ounds are the most common forms of injury to the
head. These two kinds of injuries are almost invariably in-
flicted by another or are accidental. We have already seen
that contused wounds of the scalp or over the eyebrow may
closely resemble incised wounds in these localities. This fact
should be borne in mind, as careful examination can usually
distinguish them if they are fresh and until they begin to gran-
ulate. These wounds are liable to the same complications as
incised wounds, in fact more liable, as the contusion makes the
wound more susceptible to inflammation and the edges are more
apt to be infected at the time of the injur}'.
One of the results of contusions of the head is the extrava-
sation of blood, most often between the aponeurosis of the
occipito-frontalis inuscle and the pericranium. These extrav-
asations are usually in the form of a hematoma. Such hema-
tomata often present a hard circular or oval rim with a softer
centre, and may readily be mistaken for fracture of the skull
with depression. The diagnosis between hematoma and de-
pressed fracture is not usually difficult, however, for with
hematoma the ridge is elevated above the level of the skull and
is movable on the surface of the skull ; also the wounded edges
often pit on pressure. With depressed fracture, on the other
hand, the edge is at or about the level of the rest of the skull ;
it is sharper, more irregular, and less evenly circular. Contu-
sions and the resulting hematoma maj' occasionally end by
suppurating, but this event is rare. Contusions and contused
wounds may occasionally show the marks of a weapon, indicat-
WOUNDS OF THE HEAD. 559
ing that they were inflicted bj' another. Also the position of
the injury will indicate its origin, whether it is accidental or
inflicted by another, for the former would not naturally occur
on the vertex unless the fall was from a considerable height.
Another result of injuries to the head, especially of contu-
sions and contused wounds, is fracture of the skull. This
ma}' be simple or compound, depressed or not, etc. Fractures
are serious inasmuch as they imply a degree of violence which
may do damage to the brain. The fracture itself, especially if
properly treated, affords a good prognosis, irrespective of any
brain lesion. One variety of fracture of the skull ofl^ers an
exception to this favorable prognosis, and that is fractures of
the base of the skvill. These may be fatal directly from injur}"
of the vital centres at the base of the brain or soon fatal from
hemorrhage in these parts. Or the fatal result may be second-
ar}- to an inflammation or meningitis which good treatment is
often unable to prevent. It should not be considered that these
fractures are uniformly fatal, for quite a considerable proportion
recover. Fracture of the base usually occurs as the result of
a fall. The injured person may land on the feet or buttocks,
and yet receive a fracture of the base of the skull, the force of
the fall being transmitted through the spine to the base of the
skull. Fracture of the base of the skull usually occurs from
an injury to the vault, not by contre coup, but by extension of
a fissure found higher up in the skull. This extension takes
place in the same meridian line of the skull with that of the
force which produced the fracture, and in this waj' the base of
the skull is fractured in different parts according to the point
and direction of the application of the force. Thvis in case the
force compresses the skull antero-posteriorly the fracture will
pass antero-posteriorly toward the base from the front or the
back, whichever received the blow (see Fig. 13). Fractures of
the vault of the skull occasionally occur opposite to the point
struck ; this may occur by contre coup, but not always so, as
not infrequentl}' in such rare cases a close examination may re-
veal an extension of a fissure from the point injured to the oppo-
site pole of the skull. The shape and rarely the size of a fracture
of the skull, especially if punctured in character, may show the
shape and more rarely the size of the instrument or object
which produced it. Apart from fracture of the base, the prog-
500
WOUNDS — AVOOLSEY.
nosis in fracture of the skull is serious, mainly on account of
the danger of inflammation, which is greater in compound frac-
tures, and also on account of the more remote danger of irrita-
tion from depressed fragments causing epilepsy, insanity, etc.,
at a later period.
A circumstance that Taylor ' says is connected with fracture
of the skull with depression — namely, that the person, sensible
as long as the object producing the fracture remained wedged
Fig. 13.— Several Fractures of the Left Half of the Base of the Skull, Running Paral.
lei to One Another and Approaching One Another, also Separation of the Mastoid Suture.
The injury was caused by a fall on the left side of the back of the head.
in, became insensible and began to manifest other fatal symp-
toms as soon as it was removed — must be extremely exceptional.
It may be explained, if it occurs, by the occurrence of hem-
orrhage after the object which occluded an open vessel by its
presence or its pressure was removed. For it should be remem-
bered that the symptoms of compression in a depressed fracture
of the skull are very rarely due to the compressing effect of the
depressed bone, but rather to an injury of the brain, intracra-
' "Med. Jurisprudence," 11th Amer. Ed., 1892, p. 334.
CONCUSSION.
5G1
nial hemorrhage, or a local and temporary interference with the
circulation.
AVe may trul}' say that wounds of the head are dangerous
in proportion as thej^ affect the hrain. The existence of affection
of the brain may be hard to tell from
the appearances, for an injured person
may recover from the first effects of a
comparatively slight wound and yet
die suddenly later.
Concussion is the name applied
to one of the effects on the brain of a
more or less violent blow directlj' on
the head or transmitted indirectly to
the head. Though the term " concus-
sion" implies a functional rather than
an organic lesion, yet in the majority
of cases it is equivalent to laceration
of the brain. With laceration of the
brain there is usually more or less effu-
sion of blood which may be limited to a very thin layer. Con-
cussion may exist without laceration of the brain. Even death
has been known to occur from concussion of the brain without
any visible signs of injury to the brain, so that the concussion
Fig. 14.— "Terraced" Fracture
of the Left Parietal Bor.e near
the Sagittal Suture, caused bj- the
Lower Part of the Kim of a Rouud-
Headed Hammer. The blow was
struck from the right side. ]4
natural size.
-^^.
Fig. 15.— Fractures of the Skull caused
by a Four-sided Hammer, One caused by
tlie Corner, the Other by the End of the Head
of the Hanmier. 14 natural size.
Fig. 16.— Four-sided Fraetiu'e caused by
a Hatchet-Shaped Instrument, the Edjres
Formed by Depression of tlie Broken Outer
Table of the Skull.
must have been functional and the fatal result due to shock of
the nervous system. Fatal concussion does not, therefore, ne-
cessitate the existence of compression or visible injury of the
brain. Concussion may sometimes be due to a violent fall upon
the feet, in which case the shock is transmitted through the
36
562 WOUNDS — WOOLSEY.
spinal column to the head with or without fracture of the base
of the skull. It was in this way that the Duke of Orleans, the
son of Louis Philippe, died.
The symi^toms of concussion show all degrees of severity'.
Thus the injured person may become confused and giddy with
or without falling, he may become pallid and nauseated and
may vomit, but after a short period he recovers gradually.
With a more severe injur}", with which there is generally
some laceration of the brain, the injured person falls and lies
quiet and relaxed, apparently unconscious, though often he can
be partly roused. Paralysis and anaesthesia are absent. The
Fig. 17.— Fracture of I'arictal Bone with Depression, caused by the Blow of an Axe.
heart is feeble and fluttering, the skin cold and clammy. The
pupils, as a rule, react to light, but otherwise vary considerably.
Urine and fseces may be passed involuntarily. As he begins
to regain consciousness, vomiting usually occurs. Conscious-
ness usually returns within twenty-four or forty-eight hours,
when headache and indisposition to exertion are complained
of, and this may last for a long time. Occasionall}" the symp-
toms instead of abating increase, and coma supervenes, often
indicating meningitis, encephalitis, or intracranial hemorrhage.
In other cases the person irvs.j die almost immediately on the
spot where he fell, while in still others apparent recovery takes
place and death occurs later either suddenly or after a reap-
ABSCESS OF THE BKAIN.
563
pearance of symptoms. In such cases, abscess of the brain
may occur and be the cause of the fatal result. These abscesses
are the result of the injury, which may be almost anything
from a compound fracture to a slight contusion not leaving any
scar. The abscess may occur within a week * or not until after
months or years. This interval of apparent recovery may lead
to the false supposition that death was not due to the injury,
but to some intervening cause. It is well to bear in mind that
about half of the cases of abscess of the brain are not trau-
FiG. 18.— Wounds of the Vault of the Cranium caused by Artillery Side- Arms, followed
by Death shortly after.
matic. A large majority of these are due to suppuration in the
middle ear, a few to septic diseases or tuberculosis. The situ-
ation of the abscess often distinguishes between the traumatic
and non-traumatic varieties. The traumatic variety is usuall}'
found beneath the injury or sometimes directly opposite, where
the brain is injured by a kind of focussing of the radiated effects
of the blow. The cases of abscess of the brain due to ear dis-
ease are usually found in the temporal lobe of the brain lying
over the position of the ear or in the cerebellum behind it. The
uncertainty of the nature and the extent of the cerebral injury
'Londou Lancet, 1873, i., p. 697.
564 WOUNDS — WOOLSEY.
in so-called contusion of the brain renders it necessary to be
very careful in giving a prognosis. Any injury should be con-
sidered serious which has produced unconsciousness, for such
an injury may produce enough laceration of the brain to render
serious danger possible or even probable. We have seen that
as a rule the symptoms of concussion come on immediately, but
it is possible that symptoms at first so slight as to escape notice
ma}' become serious in a few hours or days. A gradual hemor-
rhage may sometimes account for this. The knowledge of
certain acts performed or a conversation held at the last mo-
ment before the injury may be retained after recovery from con-
cussion of the brain. This is not necessarily the case, for in-
stead of remembering up to the moment of the injury, the
injured person may remember only up to a certain time shortly
before, or a part and not everj^thing may be remembered.
The diagnosis of concussion of the brain from alcoholism
is sometimes a matter of medico-legal interest or importance.
Concussion may be so slight as to simulate intoxication. The
history often clears the case up. The history of a blow or a fall
or the presence of marks of violence on the head indicates con-
cussion, though the blow or fall may not have caused the symp-
toms, which may be due to alcoholism. The odor of the breath
may indicate alcoholism, but here too we may have both
present and the concussion may be responsible for the symj)-
toms. Or again the alcohol may have been given as a heart
stimulant after the accident. This combination often occurs.
If there is no odor in the breath, the presumption is in favor
of concussion. As mistakes are still not infrequently made in
diagnosis, those cases in which there is any ground for doubt
should be carefully watched for developments. In general, the
existence of concussion is more often overlooked than the coex-
isting alcoholism, so that if there is any doubt in a given case
it should be treated as one of cerebral injury-. The injury
which causes the concussion in such cases is often due to the
alcoholism. We may be able to verify this supposition if the
injury is such as would be likely to be caused by a fall. There
may be nothing found in the brain after death to distinguish
between concussion and alcoholism. A bruise on the head only
indicates a probability of concussion, for the bruise and alco-
holism may both be present, the former perhaps due to the
EXTRAVASATION" OR EFFUSION OF BLOOD. o65
latter. The presence of alcohol in the stomacli would indicate
the existence of alcoholism.
Another effect of an injury which has caused concussion of
the brain is an extravasation or effusion of blood. Extrav-
asation of blood in or on the brain is one of the commonest
causes of death from injur}" to the head. It may occur with or
without marks of external injurj^. A person suffering from
such an extravasation of blood may recover from the first
effects of the injury, and at a varying time afterward the
symptoms may return and increase so as to result fatally. In
such a case the opening of the bleeding vessel may have be-
coine plugged until some exertion, emotion, or excitement on
the part of the injured person has loosened the plug. A hemor-
rhage ma}^ have ceased from partial sj^ncope and return with a
stronger heart action due j^erhaps to the administration of alco-
hol. This effusion may occur on the surface of the brain in
connection with a superficial laceration of the brain or just be-
neath or outside the dura mater and not involving the brain
directly. The latter cases are almost alwaj^s due to the effects of
violence, though there is at least one case of apparently sponta-
neous rupture of the middle meningeal artery. The violence
which causes a rupture of the branches of this artery may be
so slight as to leave no bruise or so severe as to cause fracture
of the skull. The most important symptom of such extradural
hemorrhage is a period of consciousness after recovery from
the first effects of the injury, then stupor ma}- appear and deepen
into coma. A subdural hemorrhage ma}' cause almost the
same symptoms, though the injury is usually such as has pro-
duced a depressed fracture. This hemorrhage is most often
due to the rupture of a number of small vessels under the frac-
ture, though if one larger vessel is rujatured it is most often the
middle cerebral. A thin layer of hemorrhage in connection
with a superficial laceration of the brain is of frequent occur-
rence with or without the other two forms of intracranial
hemorrhage. If the brain is lacerated we may have convulsions
in addition to other symptoms. Death occurring during or soon
after a prize-fight may occur from some of the above classes of
intracranial extravasations. It ma}^ be questioned whether the
blows or a fall caused the hemorrhage. It is generally due to
a fall in such cases, but may be due to blows, but tlie guilt is
566 WOUNDS — WOOLSEY.
the same unless the fall was accidental. As the result of severe
traumatism the vessels of the interior of the cerebrum may be
ruptured or hemorrhage may occur into the ventricles of the
brain. In such cases the symptoms will resemble those of
ordinary apoplexy, only the cause is different from the latter
and the injury is usually so severe as to leave no doubt as to
the existence of a traumatism. The following question may
arise in cases of intracranial hemorrhage and especially in the
latter class of such cases, i.e., in cerebral hemorrhage:
Was the Extravasation of Blood due to Disease
OR Violence? — It may be alleged in defence that the hemor-
rhage was the natural result of disease. Where the hemor-
rhage is extradural or subdural or in connection with a super-
ficial laceration of the brain, the cause is almost always
traumatic. We have referred to one case of extradural hem-
orrhage from spontaneous rupture of the middle meningeal
artery.' Subdural hemorrhage may occur from Pachymen-
ingitis hcemoi^rhagica interna, but this condition is readily
diagnosed on post-mortem examination and often with consid-
erable certainty during life. A history of alcoholism, head-
ache, impaired intellect, unsteady gait, occasional losses of
consciousness, stupor increasing to coma, etc. , indicates such a
condition.
It is in cases of cerebral hemorrhage that there is the most
difficulty in discriminating between that due to disease and
that due to injury. It may be alleged that the hemorrhage
was from diseased vessels, or that the effects of a blow, which
cannot be denied, were aggravated by disease of the cerebral
vessels or by excitement due to intoxication or passion. Cere-
bral hemorrhage from disease is rare before 40 j^ears of age,
except in alcoholics. When the hemorrhage is due to disease
the blood-vessels are diseased. The most frequent site of such
hemorrhages is the course of the lenticulo-striate artery in the
ganglia of the base or the white substance of the centrum
ovale.
When injury is the cause of the hemorrhage it is usually
found beneath the point injured or directlj^ opposite to this.
External signs of the blow are generally visible if it be severe
enough to cause a cerebral hemorrhage. The vessels may be
' "An American Text-Book of Surgery, " p. 496.
WAS EXTRAVASATION OF BLOOD DUE TO VIOLENCE? 567
perfectly healthy and the victim (^uite young if the hemorrhage
is due to an injury, also the ruptured vessels may be jjlainly
torn. The most difficult cases are those where there is the
history of an injury and at the same time such a condition of
disease of the cerebral vessels, etc., as would account for spon-
taneous hemorrhage. Where the injury was slight in the case
of alcoholics or aged people the medical witness should be
especially careful in stating that a cerebral hemorrhage was
due to the injury. Then, too, in the act of falling from the
occurrence of a cerebral hemorrhage due to disease the head
may be injured and show marks of violence. It should bo
borne in mind that an injury to the head may be inflicted when
disease of the brain, vessels, or membranes already exists. In
such a case a slight blow might cause extensive hemorrhage,
but as that which accelerates causes, death, even though it
might sooner or later have occurred in the same manner with-
out injury, is due to the injury inflicted.
From the above considerations we see that spontaneous
cerebral hemorrhage and that due to disease are not always
easily distinguished from that due to violence. In severe in-
juries the structure of the brain is plainly bruised, etc., but the
greatest difficulty exists in cases of slight violence where
arteritis of the cerebral blood-vessels coexists. The spontaneous
extravasation of blood in or upon the brain from excitement
does not usually occur except with diseased vessels, old age, or
alcoholism. It is rare, therefore, in the young and healthy.
If there is any doubt as to the origin of the hemorrhage, the
medical witness should state the cause most probable in his
judgment. Taylor ' supposes the case of a man excited by pas-
sion, alcohol, or both, who becomes insensible and dies after
being struck a blow so slight that it would not have affected a
healthy person. If examination reveals a quantity of blood
effused into the substance of the brain, there can be little doubt
in the mind of the medical man that the excitement was the
principal cause of the effusion. On the other hand, if a severe
blow or a violent fall on the head had been received in a per-
sonal conflict with another and it is found that death was due
to an effusion of blood upon the surface, there can be little
doubt in the mind of the medical examiner that death was due
'"Med. Jurisprudence," 11th Amer. Ed., 18fl2.
568 WOUNDS — WOOLSEY.
to the blow, which would satisfactorily account for the condi-
tions found without reference to coexisting excitement, etc.
In fact, in all cases where a question is raised as to the cause
of the hemorrhage, it is most important to consider whether the
violence was not sufficient to account for the hemorrhage with-
out the coexistence of disease or excitement. It is also most
important to bear in mind that after severe injuries, as after a
fall, causing extensive fracture of the skull, followed or not
with extravasation of blood, the injured person may walk about
and die some distance from the place of the accident and where
no chance for a similar accident exists. In this way the
suspicion of murder may be occasioned, as illustrated in the fol-
lowing case cited by Ta3dor : ^ A man was accused of the
murder of his cbmiDanion, who was found dead in a stable with
fracture of the temporal bone which had caused rupture of the
middle meningeal artery. The accused stated that the deceased
had been injured b}^ falling from his horse the day before.
After the fall, however, the deceased had gone into a public-
house, where he remained some time drinking before returning
to the stable. The extravasation had here taken place gradu-
all}', as is characteristic of hemorrhage from the middle menin-
geal artery, and perhaps the excitement due to the drinking
had influenced it.
The date of an effusion op blood may sometimes
be a matter of importance in determining whether a given ex-
travasation of blood in or on the brain w^as caused by a recent
blow or had existed previoush*. The color and consistence of
these effusions indicate whether the}' are old or recent ; the pre-
cise date we cannot state, but the information we can give is
often all that is required. The color of recent effusions is red,
which changes after some daj's to a chocolate or brown, which
generally turns to an ochre color (see Plate I.). This latter
color may be met with from twelve to twenty- five days after
the injury. The consistence of the coagula also becomes firmer
with age, and as the coagula become firmer they are more or
less laminated and the expressed lymph may lie between the
laminae or around the coagula.
On account of the many laj^ers of the brain coverings, a
rough diagram of the coverings as given bj' Taj-lor ' may be of
'"Med. Jurisprudence," 11th Amer. Ed., 1892.
MEDICAL JURISPRUDENCE— PLATE I.
Extravasations in several portions of the Arachnoid, with hemorrhages in neighboring
PORTIONS OF the BRAIN. DEATH IN FOUR DAYS.
Cerebral abscess. Epilepsy, Paresis. Death 3m years after the injury.
RECENT AND OLD CEREBRAL EFFUSIONS.
ilkelmtLilJioColl.?.
WOUNDS OF THE BKAIX AND FACE.
5G9
Fig. 19.— Diagramalie Repre-
sentation of the Skull and IMem-
branes of the Brain for Exhilii-
tion in Court, a. Skull with
outer and inner tables and dip-
loe ; 6, dura mater ; c, arachnoid
membrane ; d, pia mater.
much use to the medical expert in ilhistrating his evidence so
as to make it clear to the court (see Fig. 19).
Wounds of the brain vary very widely in their imme-
diate results according to the part of the brain injured. Thus
sometimes a slight wound of the brain may be instantly fatal
and often a severe wound in another
part is not so. Extensive wounds may
occur especially in the frontal lobes
with remarkably slight disturbance.
If a person with a wound of the brain
survives the first effects of the injury
the danger of inflammation remains.
This danger may not be removed for
a long time, for the inflammation may
develop very slowl}', not showing
itself for "from throe to ten weeks or
even later. Thus Taylor ' cites the
case of a child who was accidentally shot through the brain.
The symptoms of inflammation did not appear until the twenty-
sixth day and death occurred on the twenty-ninth da3\
Wounds of the face heal remarkably well on account of
its great vascularity. If severe they may leave great deformity
or disfigurement, which may be the ground of a civil suit and
thus require the testimony of a medical expert. If the wound
involves the orbit or its contents it ma}^ be more serious, either
from a fracture of the thin upper or inner wall of the orbit,
separating it from the brain, or from extension of a secondar}-
inflammation of the contents of the orbit to the brain. Wounds
of the eyebrow may cause supraorbital neuralgia or amaurosis
from paralysis of the upper lid. Some fractures of the nose,
especially those due to severe injur}' near the root of the nose,
maj' be more serious than they appear. For in such cases, of
Avhich the writer has seen several, the fracture is not confined
to the nose, but involves also the ethmoid bone and its cribriform
plate forming part of the base of the skull. In such a case a
fatal meningitis is a common result.
Wounds of the neck are verj" rarely accidental, more
often homicidal, but most often suicidal. In nature they are
most often incised wounds. As we have alread}' seen, the kind
'"Meil. Jurispviulence," 1 1th Amer. Ed. . 1892.
570
WOUNDS — WOOLSEY,
■%>,.
-#
V:
and condition of the weapon used is often indicated by the
character of the wound. We have also seen that in many cases
a suicidal wound of the neck can be distinguished from a
homicidal one with more or less probability or even certainty.
Wounds of the neck are often dangerous, and they may be
rapidly fatal if they divide the main vessels, especially the
carotid arteries. Wounds of the
larynx, trachea, and oesophagus are
grave and often fatal from entrance
of blood into the air-passages or
from subsequent oedema or inflam-
J^, mation occluding the air-passages.
Wounds of the sympathetic and
pneumogastric nerves may be fatal,
and those of the recurrent laryngeal
nerves cause aphonia. The situa-
tion of the average suicidal or homi-
cidal cut-throat wound is in front,
generally across the thyro-hyoid
membrane, sometimes dividing the
cricoid-thyroid membrane, and not
at the side of the neck where the
great vessels lie and would be more
easily divided. The force is ex-
pended, as a rule, before the great
vessels are reached. The epiglottis
may be cut or detached and the in-
cision may even reach the posterior
wall of the pharynx, but the ma-
Thyroid and Cricoid Cartilages of the jority of the Suicidal CaSCS rCCOVCr
Larynx, from the Blow of a Plat- Iron. . , i , , i. nm i •
r With proper treatment, i he homi-
cidal cases are more often fatal from division of the great ves-
sels, though, as-already stated, in either class of cases a fatal
result may occur if the air-passages are opened from the en-
trance of blood into them and the consequent asphyxia.
Contusions of the neck may be so severe as to cause un-
consciousness or even death. The latter may be due to a
reflex inhibitory action, as in cases of death from a blow upon
the pit of the stomach. As a result of such contusions we may
have a fracture of the larynx usually confined to the thyroid
V-
Fig. 20.— Double Fracture of the
CONTUSIONS OF THE NECK, 571
and cricoid cartilages (see Fig. 20). This may be followed by
hemorrhage from the larynx, some of which may pass down into
the trachea and threaten death from asphyxia. Later emphy-
sema often develops throughout the tissues of the neck, and there
is great danger of oedema of the larynx. The prognosis is
serious unless tracheotomy is performed early or the case is
closely watched. It is most serious where the cricoid cartilage
had been fractured, as this requires a greater degree of violence.
Whereas incised wounds of the throat are most often suicidal,
contusions are most often accidental or inflicted by another.
Among the latter class of injuries may be included the so-called
garroting, by which a person is seized violently around the
throat, usually from behind, and generally with a view to
strangle and rob. In such cases the larynx or trachea may be
injured in the same way as by a contusing blow.
WOUNDS AND INJURIES OF THE SPINE AND SPINAL CORD.
Injuries of the spine resemble more or less closely those of
the head. Fractures op the spine generally occur in com-
bination with dislocation, as fracture-dislocation. Thus dis-
placement is generally present and causes a fatal compression
or crushing of the cord. When the cord has once been crushed
at the site of the displacement of the fracture-dislocation there
is no hope of its ever healing. Therefore the lower end of the
cord is never again in functional connection with the brain.
These injuries are more rapidly fatal the higher up they are.
If the injury is above the fourth cervical vertebra death is
nearly immediate, for then even diaphragmatic breathing is
impossible, and the injured person dies of asphyxia. Fracture
of the odontoid process of the axis, which .regularly occurs in
hanging, may occur from falls on the head, etc., and is not
alwaj's immediately fatal. Thus in one case* the person lived
fifteen months and in another case sixteen months. In the
latter case the fracture was due to the patient turning in bed
while his head was pressed on the pillow. In some cases it
may be questioned how far this injury may result from disease
of the bones or ligaments. Therefore a careful examination of
these parts should be made after death, which will usuallj"
'Edin. Med. and Surg. Jour., Oct., 1845, p. 527.
572 AVOUNDS— WOOLSEY.
enable us to answer this question, which may be brought up by
the defence. It is hardly necessary for our purpose to enumer-
ate the symptoms of fracture-dislocation of the spine. Of
course the patients are almost always unable to walk and so
are bed-ridden. A marked feature of fracture-dislocation of
the spine is the length of time intervening between the injury
and the fatal termination, and yet the injury is wholly respon-
sible for the death of the injured person. This delay may
last for months or even for years with careful treatment. But
sooner or later the case generally ends fatally, though not
necessarily so. Where the cord has been entireh' crushed the
result is almost alwaj's fatal ; where the cord is not so injured
recovery may and often does occur. According to Lutaud,'
fractures of the spine are sometimes followed by secondary'
paralysis coming on after healing of the fracture. At the out-
set we can seldom give a de^nite prognosis, which can onlj- bo
given after watching the developments of the case. The prog-
nosis is more favorable in fracture of the arches alone or when
the injury is in the lower part of the spine and not very severe.
The commonest cause of fracture-dislocation of the spine is
forced flexion of the spinal column. Injuries to the spine are
generally the result of falls or blows on the spine, especial!}" in
its lower part. Lutaud ^ states that after forced flexion of the
spine without fracture paraplegia may sometimes occur, which
is attributed to forced elongation of the cord. This paraplegia,
which may seem to be grave, is completelj^ recovered from as
a rule.
Incised or punctured wounds of the spinal cord are rare, as
it is so well protected except in the very highest part behind.
Here between the occiput and the atlas and between the latter
and the axis, and to a less extent between the axis and the third
cervical vertebra, the cord is more exposed, owing to the nar-
rowness of the laminae. It is here that pithing is done, which
is almost instantly fatal, as the medulla oblongata and upper
part of the spinal cord are the parts injured, and they con-
tain the respirator}' and other vital centres. Pithing may
be done with such a small needle-like instrument as to leave
scarcely sinj trace. Only a slightly bloody streak may persist,
which may' appear superficial if the instrument is introduced
'."Manuel de Med. Leg.," 5th Ed., 1892.
WOUNDS OF THE SPINE AND SPINAL CORD. 573
obliquely. Such a mark in this location with no other apparent
cause of death should always lead to an examination of the upper
part of the cord, which will always reveal the cause of death
in such cases. Pithing is practised especially in infanticide.
As with the brain, so with the spinal cord, we ma}^ have
CONCUSSION due to the shock of a contusing blow. Concussion
of the spinal cord, as of the brain, may be fatal without showing
scarcely a mark of violence externally or internally. As the
cord is so well protected from injury, it must be extremely rare
to have concussion of the cord without some actual lesion of its
substance. As concussion of the cord is not often the result of
the injuries of which we are treating, but rather of railroad
injuries and the like, it will not be considered at length in this
connection. As a result of a blow or fall on the spine or com-
municated to it, hemorrhage may occur in the substance of the
cord or around it between or outside its membranes. In very
rare cases such a hemorrhage may occur spontaneousl}' as the
result of disease, of which the writer has seen one case. It
may be associated with concussion or laceration of the cord.
It may destroy life directly by extension or indirectly by lead-
ing to a spreading inflammation. Hemorrhage in or about
the cord causes a gradual compression of the cord, and in cases
of fracture of the spine often adds to the compression due to
the displacement of the bones. In hemorrhage into the sub-
stance of the cord paralysis comes on early or immediately and
may be complete while symptoms of irritation fail. The latter
sj'^mptoms are most marked in meningeal hemorrhage in which
paralysis is delayed in appearance and generally incomplete.
The products of an inflammation due to an injury may com-
press the spinal cord in the same way that hemorrhage does.
Wounds and injuries of the varieties we are considering,
affecting the spine and spinal cord, are generally accidental, less
often homicidal, and almost never suicidal. *
WOUNDS OF THE THORAX AND THORACIC ORGANS.
Wounds of the thorax caused by incising, punctur-
ing, or blunt instruments. These wounds are most often
punctured wounds; contused wounds are common 'and incised
wounds are not rare. They are perhaps most often homicidal
574 WOUNDS— WOOLSEY.
in origin or at least inflicted by another, and the accidental
origin of these wounds is probably the least common.
Incised or punctured non-penetrating wounds of the thoracic
wall are rarely grave. Bleeding, as a rule, is not serious,
though it may be quite free. Such wounds may be accompa-
nied by emphysema, though not penetrating, owing to the
movements of the chest and a valve-like action of the edges of
the wound. Contused wounds of the thorax are more danger-
ous, especially if the violence was great, owing to the compli-
cating fracture of the ribs, rupture of the thoracic viscera, etc.
Fracture of the ribs is a' common result of contusions
of the chest. It is more dangerous when due to a direct blow
or injury, as then the splintering occurs internally and may
wound the lungs, heart, or large vessels, while with fracture
from indirect violence, from compression of the chest, the
splintering of the ribs occurs externally. Fracture of the
upper ribs requires more force than that required to fracture
the lower ones, and consequently the former is the more dan-
gerous. The diagnosis of fracture of the ribs is generally quite
easy by means of crepitus felt or heard, false motion, local ten-
derness, etc. Fracture of the sternum may be serious if
depressed on account of the wounding of the viscera behind it.
Devergie ' cites such a case where the depressed portion of the
sternum produced a transverse non-penetrating wound of the
heart about an inch in length, which had caused death in
thirteen days. Simple fracture of the sternum without dis-
placement of the fragments is rarely serious unless injury of
the thoracic viscera is produced by the same violence. Wounds
or injuries of the thorax are grave or not according as they
penetrate or injure the thoracic viscera or do not do so. A
wound may just penetrate the thoracic wall without wounding
the thoracic viscera, and is then serious as a rule only when
followed by inflammation. In fact, many of the penetrating
wounds of the thorax wounding the viscera are onh^ grave on
account of consecutive inflammation. We have alread}' seen
that various characteristics of wounds of the thorax, especially
of stab- wounds, enable us to determine the kind of weapon used,
its size, sharpness, etc., and sometimes to identify the weapon
itself. In much the same way we can often determine whether
i"Med. Leg.," t. 2, p. 343.
WOUNDS OF THE LUNGS. 575
the wound was suicidally or homicidally inflicted. The cause
of death in wounds of the thorax may be directly due to the
wounding of one or more of the thoracic viscera, or it ma}' be
due to the inflammation occasioned b}' it. Wounds of the
lower part of the thorax may involve at the same time the
thoracic cavity proper and its contained viscera, the diaphragm
9nd the abdomen and its viscera. This is the order in which
the different parts would be met with in a Avound from behind
forward ; the order might be the reverse of this in a wound
from before backward. Penetrating wounds of the thorax
may involve the lungs, heart, or great blood-vessels. Of these,
the lungs are most often injured, which is easily accounted for
b}" the greater size of the lungs. In wounds of the lungs
the immediate danger is from hemorrhage. The hemorrhage
appears externally through the wound and from the mouth,
being coughed up. Where the lungs are injured by a blow,
fall, or crush without external injury, blood appears in the
mouth only. The blood coughed up from the lungs is bright
red and frothy, and it ma}- also be frothy at the external
wound. Hemorrhage from the external wound may be slight,
especially if the wound is oblique and acts as a valve. In
wounds of the lungs most of the blood may collect in the pleura
or in the lungs, and thus, b}- compression from without or by
displacement by the blood within it, prevents air from entering
the lungs and produces asphyxia, which may be fatal. More
or less dyspnoea usually occurs at first. Emphysema is gen-
erally present in the cellular tissues, but this latter symptom
may also occur at times with non-penetrating wounds of the
chest. If death does not occur speedily from hemorrhage by
compression of the lungs or heart, there are good hopes of
saving the patient, but the prognosis should be reserved.
For even when the first effects of the wound of the lung are
survived, the patient may die from the effects of inflammation,
recurring hemorrhage, or a too sudden relaxation of regimen.
Thus, for instance, if too much food, talking, or exertion are
indulged in the case may on this account terminate fatally, and
such aggravating causes of death may mitigate the sentence.
Wounds of the heart are among the most fatal. Al-
though it was once considered, and is usually thought now by
laymen, that wounds of the heart must be necessarily and in-
576 WOUNDS — WOOLSEY.
stantly fatal, the facts are otherwise. If the wound is small
and obli(iue life may bo prolonged, and cases are recorded ' in
which wounds of the heart were not directly fatal, and in some
of which recovery would have probably resulted if not for other
diseases. Cases in which the heart wall was wounded but not
penetrated, and in which healing took place, are not very rare.''
Thus Callender removed a needle from the substance of the
heart. But there is perhaps onl}' one case ' on record in which
a wound penetrating the cavities of the heart was recovered
from. It is the rule rather than the exception that wounds of
the heart, penetrating or not, are not immediately fatal. Thus
in a series of twenty-nine cases of penetrating wounds men-
tioned by Devergie,' as collected b}" Ollivier and Sanson, only
two ended fatally within forty-eight hours, the rest in periods
ranging from four to twenty-eight days. This delay in the
fatal result has been attributed to the arrangement of the muscle
fibres crossing one another and tending to close the wound, or
at least to make it smaller. As to the various parts of the
heart wounded, the right side, especially the ventricle, is most
often wounded. Thus out of fifty-four cases of wounds of the
heart, Taylor ' states that the right ventricle was wounded in
twenty-nine cases, both ventricles in nine, the right auricle in
three, and the left auricle in one case. This greater frequency
of wounds of the right side of the heart is easily accounted for
by its more exposed position anteriorly, just beneath the chest
wall in a part of its extent. The rapidity of death depends
largely upon the site and extent of the wound. Lutaud ^ states
that out of twenty-four cases of wounds of the right ventricle
only two were fatal within forty-eight hours, and out of twelve
cases of wounds of the left ventricle three were not immediately
fatal. Wounds of the auricles are generall}" fatal immediately,
especially if the cavitj" is extensively laid open. It is the
general opinion that wounds of the auricles are most rapidly
iBeck, vol. ii., pp. 329, 333; 1861, p. 292. Case of bullet in heart
Wharton and Stille, 2d Ed., p. 580; wall for twenty years.
N. A. Med. and Chir. Review, ^Edin. Med. and Surg. Jour.,
March, 1859, p. 299; N. Y. Med. Oct., 1844, p. 557.
Times, Apr. and May, 1855; Amer. -"'Med. Leg.," t. 2, p. 253.
Jour. Med. Sciences, Julv, 1861, p. '^•'Med. Jurisprudence," 11th
292, and Aug., 1829. p. 307. Amer. Ed., 1892.
-Amer. Jour. Med. Sci., Julv, •*" Manuel Med. Leg.," 5th Ed.,
1892.
WOUNDS OP THE HEART. 577
fatal, next those of the right ventricle, and lastly those of the
left ventricle. This difference is probably due to the compara-
tive thickness of the walls of these parts. Thus the wall of the
left ventricle is so thick as to tend to close a wound unless it be
extensive. In wounds of the heart death rarely occurs from
external hemorrhage, which ma}^ be quite slight or even alto-
gether wanting where the wound is due to a crush or fracture
of the ribs. Death is usually due to the compression of the
heart by the blood in the pericardium. This usuall}'- causes
syncope, or a slighter pressure may be fatal by causing cerebral
or pulmonary anaemia or shock. Death may occur suddenly
in this manner or not until after some time. Thus in penetrat-
ing stab- wounds little or no blood probably escapes at first, in
most cases, but it ma}- ooze or, later on, suddenly burst out into
the pericardium. Therefore after a wound of the heart the
patient does not, as a rule, die immediately, as formerly and
often at the present time erroneously supposed. This fact is
of little importance as a rule in surgery, for the patients gener-
ally die sooner or later, but it is of importance in medical
jurisprudence, for upon it may hang the solution of questions of
murder, suicide, or justifiable homicide. It also accounts for
the fact that the injured person can exercise voluntary power
after the injur}'. Thus Watson ' met with a case where a man
ran eighteen yards and died six hours after a stab-wound of
the right ventricle. The coronary artery was divided and the
pericardium was filled with blood. Also Boileau met with an
accidental penetrating stab-wound through both ventricles in a
soldier who ran two hundred yards, then fell and died in five
minutes. A boy admitted to Guy's Hospital in 1879 lived
forty-two hours with a bayonet-wound transfixing the right
auricle, the septum, the left ventricle, the mitral valve, and
entering the left auricle.
Minute wounds of the chest are sometimes made by needles,
etc., in the region of the heart with the intention of killing
infants or children. Taylor" also mentions the case of a fatal
wound of the heart from a needle, the result of accident. We
have already cited the case of a needle lodged in the heart wall
' Quoted by Taylor, "Med. Juris- '-"Med. Jurisprudence," 11th
prudence," 11th Amer. Ed., 1892, p. Amer. Ed., 1892, p. 351.
340.
37
578 WOUNDS — WOOLSEY.
and removed by Callender by operation. That the puncture of
the heart by a small instrument is not necessarily serious is
proved by the experiments of Senn,' by which he found that
"the heart can be punctured with a perfectly aseptic, medium-
Sized aspirator needle without any great immediate or remote
danger."
In cases of rupture of the heart the question may
come up as to whether it was the result of disease or violence.
We have already seen that rupture of the heart may occur from
falls or crushes without marks of violence to the chest. In
general, we may say that in rupture of the heart from violence
the right side and base are most often involved, while in rup-
ture from disease the left ventricle is generally ruptured,
especially near the apex. The exciting causes of rupture of a
diseased heart are often violent emotions or exertion, which
majT" both be present in a quarrel with another and cause rup-
ture without direct violence. The cause need be but slight if
the heart is diseased, whether the cause is a natural one or out-
ward violence. Rupture from disease may therefore excite
suspicions of murder, but those cases can usually be satisfac-
torily solved by examination of the organ post mortem. A
slight degree of violence may cause rupture of a diseased heart
about ready for rupture from natural causes. When a diseased
heart ruptures during a quarrel, the symptoms of rupture of the
heart may be observed to come on suddenly before and without
the infliction of any violence.
Wounds of Arteries and Veins, especially within the
thorax. — Wounds of large trunks are generally speedily mortal.
In the chest we may occasionally meet with wounds of the in-
tercostal or internal mammary vessels or the vena azygos veins.
These wounds are often serious and ma}' be fatal. We have
a,lready seen that blood in the large cavities of the bod}", like
the chest, is commonly not coagulated, or at least the greater
part of it. We have already seen, too, that after wounds of the
carotid artery the victim may preserve the power of locomotion
for a short time, but not the power of struggling. This fact
may be important to help distinguish between murder and
suicide. In such wounds of the carotid the voice may be lost,
as the trachea is often divided. Death from wounds of large
'Senn, "Experimental Surgery." 1889.
WOUNDS OF THE ARTERIES, VEINS, AND DIAPHRAGM. 579
vessels ma}" be due to loss of blood, and if this danger is passed
the case may still terminate fatally, as in a case where the
brachial was tied for injury and death occurred in three days
from gangrene. The wounds of comparatively small vessels
may prove fatal from hemorrhage, etc.
In wounds of blood-vessels death may occur from the en-
trance of air into them. In some cases where this is supposed
to have occurred it is quite probable that death was really due
to hemorrhage. A considerable quantity of air may enter the
circulation, especially the arterial circulation, without a fatal
result. When death does occur it is owing (1) to "mechanical
over-distention of the right ventricle of the heart and paralysis
in the diastole," or (2) to "asphyxia from obstruction to the
pulmonary circulation consequent upon embolism of the pul-
monary artery." Senn found that fatal air embolism could
hardly occur spontaneously in a healthy jugular vein, as the
walls collapse readily from atmospheric pressure.
Wounds and Ruptures of the Diaphragm. — These
may be due to weapons, fracture of the ribs, falls or crushes,
and disease. They also occur as the result of congenital mal-
formation, though these cases seldom survive long. These
injuries are generally homicidal or accidental in origin. As
a rule, the viscera are wounded at the same time, or, if not
Avounded, at least herniated, and may thus become strangulated.
It is therefore hard to estimate the danger in such cases, but
the prognosis is at all times serious. The most serious cases
of such injury to the diaphragm are due to violent contusions
or falls when the stomach and intestines are full. The hemor-
rhage is usually slight, but hernia of one or more of the ab-
dominal viscera usually occurs in such cases, and is said to be
more readily produced during inspiration when the fibres are on
the stretch. According to Devergie, rupture of the diaphragm
with hernia is more common on the left side in the central
tendon in front of the crura and at the junction of the left mus-
cular leaflet. Also on either side of the ensiform cartilage and
especially on the left side there occurs an area of the diaphragm
which may be congenitally weak or even absent, and here too
rupture and hernia are likely to occur. Phrenic or diaplirag-
niatic hernia occurs especially after lacerated wounds, even
' Senn, "Experimental Surgery," 1889.
580 WOUNDS — WOOLSEY.
after the wounds have apparently healed. If hernia occurs
long after the injury was inflicted, it may be asked whether
the wound was the cause of the hernia, and so of death. This
can only be determined by examination. Almost any or all of
the movable abdominal viscera may be found in a diaphrag-
matic hernia. It was once supposed that this accident would
be immediately fatal, but this is far from the truth. Devergie
relates the case where a person lived nine months with the
stomach and colon in the chest and died from another cause.
Thus a person may have a phrenic hernia and die from another
cause, or having had a rupture or wound of the diaphragm he
may suddenly acquire a diaphragmatic hernia by reason of a
blow or sudden exertion, or the latter may strangulate an exist-
ing hernia. A person with a diaphragmatic hernia may have
the power of moving or walking, but is more or less incapaci-
tated owing to the compression of the lungs which exists and
the consequent dyspnoea, etc.
WOUNDS AND CONTUSED INJURIES OF THE ABDOMINAL
WALL AND VISCERA.
Such wounds and injuries of the abdominal wall may be in-
cised, punctured, or due to blunt instruments, etc. They are
usually homicidal or accidental, seldom suicidal except in
delirious patients or lunatics. The cause of death in such cases
may be due to hemorrhage, shock, etc., or to secondary inflam-
mation, which is especially likely to occur in penetrating
wounds. The kind of weapon used may often be judged from
the nature of the wound. Incised and non-penetrating punc-
tured wounds are usually simple and not grave, but may be
otherwise from hemorrhage from the deep epigastric artery, or
from inflammation in or between the muscles, or in the sub-
peritoneal connective tissiie. In the latter case peritonitis may
occur, but is rare. A ventral hernia may, however, result
later on, as also from a cicatrix, especially if it is transverse.
In such cases the question arises whether the natural results of
the wound were aggravated by unskilful or improper treat-
ment or even wilful neglect on the part of the patient or
practitioner.
Contusions of the abdomen are more serious often than
those of the chest, for there is less power of resistance. We
WOUNDS OF THE ABDOMINAL WALL AND VISCERA. 581
have already seen that death may occur from a contusion of
the abdomen too slight to show a mark of ecchymosis or a
serious injury internally. This has been attributed by some to
an effect on the solar plexus or reflexly on the cardiac plexus
causing a fatal inhibition. Lutaud and others have expressed
the doubt whether the cases reported by Travers, Allison,
Watson, Cooper, Vibert, and others were carefully examined,
and have inferred that some visible organic change must have
been present. Some such cases, however, have been examined
with especial reference to this point, and no physical injuries
and no other cause of death elsewhere has been found. There
is no ground, therefore, for a jury to doubt that a contusion of
the abdomen was the cause of death because there are no visible
marks of injury.
Again, it is a well-known fact that the blows severe enough
to cause rupture of the abdominal viscera may sometimes leave
no trace of violence in or on the abdominal wall. On the other
hand, it must be remembered that effusions of blood may be
found post mortem in the sheaths of muscles without indicat-
ing violence, so that blood ma}" be found effused in considerable
quantity in and around the abdominal muscles without violence
having been done. In such cases, therefore, we should note
whether abrasions or ecchymoses of the skin are absent or not.
If they are absent and there is no other evidence of a blow, the
medical witness should hesitate to attribute such an effusion of
blood between the muscles to an act of violence.
As in the case of the chest, so wounds of the abdomen are
serious, as a rule, mainly as they involve the abdominal viscera.
The viscera may be wounded by a penetrating wound or by
rupture, and the fatal result is due sometimes to internal hemor-
rhage or to shock, but generally to secondary septic peritonitis,
which may be fatal in a few hours or onl}' after days or weeks.
Occasional!}^ wounds of the abdominal viscera undergo sponta-
neous cure without surgical interference and with or without
medical treatment. But as a rule they are fatal unless the}'
receive proper surgical treatment. A wound of the abdominal
wall may be penetrating without wounding any of the viscera.
Such wounds may be fatal if they are infected, otherwise they
usually heal readily and witliout danger unless they are exten-
sive and the abdominal contents are exposed to the air. The
582 WOUNDS — WOOLSEY.
gravity of penetrating wounds varies somewhat with the par-
ticular viscus or viscera injured. It is well not to examine
wounds of the abdomen by the finger or probe too freely unless
a laparotomy is anticipated; for a simple wound or penetrat-
ing wound without wounding of the viscera may thus be in-
fected. Enough examination is necessary to diagnose between
a simple and a penetrating wound of the abdominal wall.
RUPTURE OR WOUNDS OF THE ABDOMINAL VISCERA.
The Liver is most often wounded of any of the abdominal
viscera, with the possible exception of the intestines, because of
its size, and it is most often ruptured partly because of its size,
but mostly owing to its friable consistence. Such injuries
most often involve the right lobe, as it is much the larger of the
two principal lobes. The anterior surface and inferior border
is the most frequent site both of wounds and ruptures of the
organ. Ruptures rarely pass entirely through the organ, but
are generally not more than an inch or two in depth. They
are usually directed antero-posteriorly or obliquely, rarel}^ trans-
versely, and the lacerated granular edges are not much separated
as a rule (see Fig. 21). Rupture of the liver may be due to a
blow, crush, or fall, or even to sudden muscular action if the organ
is large and fatt}^. Thus Taylor ' relates the case of a woman
who died after child-birth of ursemic convulsions, and in whom
there was quite an extensive hemorrhage into the liver beneath
its capsule, and apparently due to violent muscular contraction.
As we have already seen, the liver may be ruptured without
the abdomen showing the marks of external violence. Rup-
ture or wound of the liver is one of the causes of the fatality of
wounds and injuries of the abdomen. The fatal result ma}' be
and often is due to hemorrhage; in other cases it is due to
shock or the occurrence of peritonitis. Wounds of the liver
heal readily and hemorrhage is arrested at once, as a rule, by
the approximation of the edges. There may be little blood in
and about the wound, but it collects in the right iliac region or
in the pelvis and is not wholly coagulated. Unless the wound
or rupture involves the vena cava, portal vein, or a large branch
of either of these, the hemorrhage is apt to be slow and the
'"Med. Jurisprudence," 11th Amer. Ed., 1892.
RUPTURE OR WOUNDS OF THE ABDOMINAL VISCERA. 583
victim may survive hours or even clays, except for active exer-
tion or repeated violence. Two cases illustrating the slowness
of the hemorrhage have occurred in Guy's Hospital. In one '
the man, showing no urgent sj-mptoms at the time, was sent
away, and died a few hours later in a police-station. In this
Fig. 21.— Ruptures of the Liver from a Fall from a Considerable Height, causing Imme-
diat« Death.
case the liver was ruptured nearly through its thickness, and a
basinful of blood had been effused, causing death. In the other
case,'' which occurred to Wilks, the patient survived the acci-
dent ten days, and Taylor ' cites a case which was reported to
'Med. Times and Gazette, 1864, '"'Med. Jurisprudence," 11th
ii., 527. Amer. Ed., 1892, p. 347.
' Med. -Chir. Rev. , 1836, p. 296.
584 WOUNDS — WOOLSEY.
have ended fatally eight years after the accident. As a rule
the injury is fatal, without treatment, within forty-eight hours.
Not being immediately fatal as a rule, the victim of a rupture
or wound of the liver can walk about, and may be capable of
more or less severe muscular exertion after the injur}', though
the fact of such exertion has sometimes been used by the defence
to prove that the rupture was not due to the particular violence
in question.
Wounds and ruptures of the gall-bladder result in the
effusion of bile. While rupture of the liver is not necessarily
followed by peritonitis, rupture of the gall-bladder with the
effusion of bile generally causes peritonitis, and is fatal in this
way and not from hemorrhage. Rupture of the gall-bladder
may be favored by the presence of gall-stones, but the result is
still attributable to the injury.
Spleen. — Ruptures of the spleen may be due to a bruising
violence in this region, and here too the skin may not show the
marks of the contusion, though this fact is still employed b}' the
defence to try to disprove the connection between the injury
and the result. It is important to remember, from a medico-
legal point of view, that an enlarged and softened spleen may
be ruptured from a comparatively slight muscular exertion.
This might occur in a sudden movement to avoid a blow, and
the charge of manslaughter might be affected by the mode of
the production of the injury and the previous abnormal condi-
tion. Only direct violence is liable to rupture the healthy nor-
mal spleen. Rupture and wounds of the spleen may be and
generally are fatal from hemorrhage, owing to the vascularity
of the organ ; more rarely are they fatal from shock. Peritoni-
tis is not a result to be expected.
The hemorrhage accumulates in the lower and left side of
the abdomen or in the pelvis, and coagulation is imperfect if
present at all.
Kidneys. — These are occasionally ruptured from violence,
but more often from accident. Wounds of the kidney are rare,
owing to the depth from the surface at which they lie. They
are more accessible from behind. A wound from behind is
generally extra-peritoneal unless it perforates the organ; not
so a wound from in front. Accidents in which the lumbar
region is forcedly flexed are most apt to be followed by injury
SPLEEN — KIDNEYS — BLADDER. 585
to the kidney. The injury may cause no prominent symptoms,
but usually lumbar pain and tenderness, frequent micturition
and hematuria, and in severe cases the symptoms of hemor-
rhage and shock are present. The injury may be speedily fatal
from hemorrhage or collapse, or more slowlj'- fatal from peri-
tonitis, when the peritoneum is involved, or from abscess and
septic infection, or from uraemia if the other kidney is diseased.
Slight injuries are generally recovered from. As is the case
with the liver and spleen, so after injuries of the kidney the
victim may walk about, etc. , unless there is copious and imme-
diate hemorrhage.
The bladder may be wounded directly through the hypo-
gastrium, vagina, or rectum ; it may be punctured by a broken
fragment of the pelvis, especially the pubis, or it may frequently
be ruptured from blows, crushes, or falls. The latter accident
occurs especially where the bladder is distended. The bladder
may also rupture spontaneously from over-distention, which
may or may not be favored by disease of the bladder wall, in
which case rupture occurs more easily, Medico-legally the
question may arise whether the rupture was spontaneous or due
to injury. In this connection it should be remembered that the
injury may leave no external mark of violence, and a case is
recorded in which the bladder was ruptured by a fall in wres-
tling ; but the question can be determined only by an examination
of the bladder. If the wall of the bladder is thinned by the pres-
sure of a calculus or from other causes, or if it is weakened by
tubercular, syphilitic, or carcinomatous deposits or ulcerations,
it may be spontaneously ruptured from slight distention or a
slight degree of violence may rupture it. If violence has been
employed it is responsible for the rupture, though the diseased
condition may act as a mitigating circumstance ; not so a dis-
tended bladder, as the latter is not abnormal. In spontaneous
rupture from over-distention without disease of the bladder
wall, stricture, hypertrophied prostate, or some such condition
must be present to account for the over-distention. Spontane-
ous rupture of the bladder can, therefore, only occur when
either disease of the bladder wall or obstruction of the urethra
is present. No condition excludes rupture from violence. If
there is an injury followed by the symptoms of rupture of the
bladder and death and the bladder and urethra are healthy,
58G WOUNDS — WOOLSEY.
there can be little doubt that death was due to the injury.
Wounds or rupture of the bladder may be extra-peritoneal or
intra-peritoneal. Rupture from disease of the bladder wall
occurs at the site of the diseased and weakened spot, which is
most often at the base of the bladder. Rupture of the bladder
from violence occurs most often on the postero-superior wall,
running downward from the urachus, in which case the peri-
toneum would be involved. A punctured wound of the bladder
wall may be so minute that the leakage is very slow and the
customary symptoms may be obscured, or the opening may be
valvular in character, perhaps allowing escape of urine only
when the bladder is not distended. The symptoms consist of
pain, inability to micturate, and the presence of blood in the
little fluid which can be drawn by a catheter. Fluid injected
is not all returned and the bladder cannot be distended. After
a time varying from a few hours to a few days, depending upon
the size of the opening and the condition of the urine, peritoni-
tis or peri-vesical cellulitis is set up, the former being generally
fatal, the latter not necessarily so. Prompt surgical treatment
may save the patient's life by avoiding peritonitis. Extra-
peritoneal ruptures are far less dangerous than intra-peritoneal,
as in the former case cellulitis and abscess in the cellular tissue
around the bladder, which may subsequently be treated by oper-
ation and drainage, take the place of peritonitis in the latter
case, for which prevention is the only safe treatment. In extra-
peritoneal rupture death, if it occurs, is generally due to septi-
caemia ; in the intra-peritoneal variety it is due to peritonitis.
These cases of injury to the bladder may die suddenly and
speedily from shock or from peritonitis in three to seven days,
or not until fifteen days or so. In punctured and incised
wounds the urine escapes more slowly, peritonitis develops less
early, and death is longer delayed. Hemorrhage in injury to
the bladder is not visually serious; the blood is found partly in
the bladder, partly in the pelvis, where the fluid extravasated
by peritonitis is also found. The victim of a wound or rupture
of the bladder may often walk about for some time after the
injury.
Stomach and Intestines.— Punctured wounds, or, more
rarely, incised wounds of the abdomen may involve these
organs, or they may be ruptured by blows, crushes, and falls, or
STOMACH AND INTESTINES. 587
from disease. Stab-wounds of these viscera may be multi-
ple from a single stab, the instrument traversing one coil,
perhaps, and then wounding others, though this is less often
the case than with gunshot wounds. Ruptures too may be
multiple, though less often so than wounds. The ileum is most
liable to rupture, though several cases of rupture of the jeju-
num are on record. Like the bladder, the stomach and, to a less
extent, the intestines are more liable to be ruptured when dis-
tended. Ruptures of the stomach or intestines are seldom
attended with much hemorrhage, while wounds may occasion-
ally cause a serious and fatal hemorrhage from the wounding
of a large blood-vessel. The principal danger lies in the leakage
of the contents of the stomach and intestines, which almost
always sets up a septic peritonitis. This may sometimes be-
come localized and go on to spontaneous cure, though as a rule
it becomes general and is fatal. In such cases early operation
may avoid the fatal peritonitis. A punctured wound may be
so small as to be closed by the mucous membrane, avoiding the
escape of the contents of the gut. Or a wound may not entirely
penetrate the wall of the stomach or intestines, which only
gives way some days, perhaps, after the injury, though the in-
jury is entirely responsible for the delayed result. These in-
juries are sometimes fatal immediately or very speedily from
shock, while in other cases of very extensive injury there may
be almost no shock, and the victim is aware of no serious
injury. It is an important point to remember medico-legally
that spontaneous rupture of the stomach or intestines may occur
owing to ulceration due to disease. This can be determined by
a careful examination of the wall of the stomach or intestines at
the site of the rupture. A slight injury may also cause rupture
if the wall of the gut is weakened by disease, as the disease
causes greater liability to rupture. Here too it is to be remem-
bered that a severe injury causing rupture may leave no mark
of violence on the abdominal wall. The power of walking or
other muscular exertion after such injuries of the stomach or
intestines is not infrequently preserved, as recorded in numer-
ous cases.' The prognosis in such injuries of the stomach and
intestines is always extremely grave.
'Lancet, 1873, ii., p. 10.
588 WOUNDS — WOOLSEY.
Incised, Punctured, and Contused Wounds of the
Genital Organs.
These are not common as medico-legal cases. Self -castra-
tion or mutilation is sometimes practised by lunatics, idiots,
or even intoxicated persons. Thus a man who, while intox-
icated, cut off his genital organs and died the next day from
the effects of hemorrhage was seen by Demarquay.' Circum-
cision in infants is also sometimes fatal from phlegmonous in-
flammation. °
Incised, lacerated, or contused wounds of the female genitals
may be fatal from hemorrhage from many small vessels.
Deeply incised wounds of the female genitals proves wilful and
deliberate malice ; accident is out of the question and suicide
is improbable in such cases. But we sometimes have to deter-
mine between accidental, self-inflicted, and homicidal wounds
of these parts, as accidental wounds may occasionally resemble
those made by design and so may furnish more or less difficulty,
unless all the circumstances are known. Thus Tajdor ' relates
the case of a child in whom a sharp-pointed stick entered and
passed through the posterior wall of the vagina as she fell from
a tree. The stick was removed by a woman, and the child died
in a little over a day from peritonitis. Unless the circum-
stances were known, this case might have caused suspicion of
homicide.
Lunatics, idiots, and drunkards sometimes inflict on them-
selves wounds unlike ordinary suicidal ones.* In other cases the
various points we have enumerated in a previous section to
distinguish between suicide, homicide, and accident may be
applied to solve the case.
Contused wounds, such as kicks, etc., of the female genitals
may be fatal from hemorrhage due to the laceration of the parts. ^
Like the wounds of the eyebrows, contused wounds of the vulva
may sometimes resemble incised wounds owing to the sharp
bony surfaces beneath. Careful examination allows a discrimi-
nation to be made from incised wounds. If hemorrhage occurs
^Lancet, 1870, ii., p. 471. ^"Med. Jurisprud.," 11th Amer.
-See Taylor, "Med. Jurispru- Ed., 1892.
deuce," 11th Amer. Ed., 1892, p. ■» See Taylor, "Med. Jurisprud.,"
348. 11th Amer. Ed., 1892, p. 351.
WOUNDS OF THE GENITAL ORGANS AND EXTREMITIES. 589
a long time after the alleged violence, it is probably due to
natural causes, especially in cases of metrorrhagia, etc. It may
be alleged in defence that contused wounds of the female geni-
tals were inflicted post mortem, but besides the other features
which we have already seen help to distinguish between ante-
mortem and post-mortem wounds, we may add that kicks and
other contusions of the vulva, if fatal, are so from hemorrhage
or effusion of blood, and no post-mortem hemorrhage is enough
to cause death.
INCISED, PUNCTURED, AND CONTUSED WOUNDS OF THE
EXTREMITIES.
These may be fatal if a large blood vessel or vessels are
opened, or sometimes if a compound fracture or wound of a
joint becomes infected. They ma}^ also in some cases be
fatal from shock, from the severity of the injur}''. As a rule
they are the cause of civil suits, not of criminal ones. The
various injuries may cause disability for a longer or shorter
time, or even permanently, and more or less deformity may also
remain. This may be the case with fractures, especially if they
occur near the joints, in which case great caution should be
exercised in giving an opinion or prognosis. It is a common
mistaken idea of the laity that a fractured or dislocated limb
can be made in every case as good as before the injury. On
the contrary, they not infrequently leave a slight deformity and
impairment of function, sometimes even under the best treat-
ment. Dislocations may also leave a lasting disability or
weakness, often owing to the carelessness of the injured person.
Wounds of an arter}'- or vein, or both, may result in an
aneurism or an arterio- venous aneurism. Wounds of nerves
may cause paralysis and anaesthesia of the parts supplied.
Wounds of muscles or tendons may cause weakness or com-
plete loss of motion of particular joints. Wounds of the soft
parts, if infected, may lead to cellulitis and phlegmonous in-
flammation, which may result in much injur}-. Wounds of
joints, if penetrating, are serious, for without the proper treat-
ment they may result in suppuration in the joint, disorganiza-
tion of the joint, and final ankylosis. Before the use of antiseptic
treatment such wounds were not uncommonly fatal. Fractures,
500 WOUNDS — WOOLSEY.
simple or compound, or contusions of bone especially in young
subjects, may be followed by osteo-periostitis and its conse-
quences, which may require a long time for recovery after the
fracture is entirely recovered from, and a still longer time be-
fore the limb can be used. These and many other of the vari-
ous results of wounds and injuries of the extremities, causing
deformity or disability, or both, can often be cured or improved
by surgical treatment or operation.
THE MEDICO-LEGAL COIsrSIDERATIO]^
OF
GUNSHOT WOUNDS.
BY
ROSWELL PARK, A.M., M.D.,
Professor of Surgery in the University of Buffalo; Attending Surgeon to the Buffalo
General Hospital; Fellotoof the German Congress of Surgeons: of the Ameri-
can Oi-thopasdic Association; of the American Genito-Urinary
Surgeons'' Association; of the New York Academy
of Medicine, etc. , etc.
GU]:^SHOT AYOTJE'DS.
GENERAL CONSIDERATIONS.
Few medical men there are who have long engaged in prac-
tice who have not been compelled to take part in some medico-
legal controversy in cases of accidental or alleged homicidal
gunshot wounds. So soon as death occurs the surgeon ceases
to work as such, but may continue to work as a medical jurist,
and in preparation for this event must be read}' to answer any
questions bearing upon the case which, though possibly ridicu-
lous in surgery, are or may be necessary in law. He may be
called upon to testify as to the precise nature of a wound in-
flicted upon the body of a man seen before or after death ; as to
the means by which it was inflicted ; whether the purport was
suicidal or homicidal ; how much blood was lost ; whether the
weapon was near to or at a distance from the body when fired ;
whether it were possible that the deceased could have fired it
himself ; whether after the reception of the wound the person
could have moved or performed any act — in other words, whether
death was instantaneous. He may be asked also as to genuine
or spurious blood-stains, whether genuine blood-stains were
human or from some other animal; whether possibly they were
from the body of the deceased. He will be expected to tell
from what direction the bullet or missile was fired ; which the
wound of entrance and which of exit, and many other things
possible concerning the circumstances under which death oc-
curred. It is unnecessary to state that questions of this nature
call not only for conventional surgical skill, but for the highest
degree of shrewdness and general information, as well as some-
times for expert knowledge with regard to small-arms and their
ballistics.
It has been well said that the first duty of a medical jurist
is to cultivate a habit of minute observation. When this is com-
bined with a knowledge of what the law requires and with the
38
594 GUNSHOT WOUNDS — PARK.
results of a technical education, he will be able to meet all or
nearly all of the scientific questions which may be asked of
him. A learned judge once said that " a medical man when he
sees a dead body should notice everj^thing. " Certainly he
should make a minute scrutiny of the body to note whether
there are upon the dress or hands of the deceased marks of
blood, or whether blood-stains are noted in different parts of
the room ; whether the body or any part of it is cold or warm ;
whether the limbs are cold or rigid or pliant, since by these
means the accurate date of death may be more accurately deter-
mined.
EXAMINATION AND DESCRIPTION.
In determining facts attending a suspicious case of gunshot
wound, there should be noted, if known, 1st, the exact time of
death, as well as of infliction of the wound; 2d, location and
attitude of the body ; 3d, condition of clothing ; 4th, anything
of importance in its environment ; 5th, external appearance of
the body, as well as state of countenance ; 6th, exact description
of all marks of violence and of blood-stains; 7th, the presence
of cadaveric rigidity and the surface upon which cadaver has
been lying, as well as its age and condition of general nourish-
ment ; 8th, time when deceased was last seen alive or known to
have been alive ; 9th, time after death at which examination is
made ; 10th, all physical circumstances corroborating or arous-
ing suspicions of suicide or homicide; 11th, account of an ac-
curate internal post-mortem examination, in which direction
of the bullet or missile is noted, along with a careful description
of parts disturbed or injured in its course, large vessels or nerves
cut across, efifusions of blood, and in every way as accurate a
description as possible of the exact damage done. To this also
should be added a minute scrutiny of other parts, in order to
establish clearl}' that death was due to the alleged injury, or on
the other hand that it may have resulted from natural causes,
and that the injurj^ in question was only a consecutive and
contributing cause. Especially should there be examined those
organs in which occur the most common causes of death,
namely, the brain, the heart and great blood-vessels, and the
viscera. Moreover, if an operation has been performed the
post-mortem examiner should be prepared to speak with reason-
EXAMINATION AND DESCRIPTION. 595
able positiveness as to whether said operation was, in the first
place, necessary if life were to be preserved, and, in the second
place, whether death were due to the injury proper or to the
attempt to save life thus made necessarj^. For the determina-
tion of all this, obviously the best time for the performance of
the examination is the earliest possible moment after death.
ISTevertheless, bodies are sometimes exhumed for this purpose,
and much information is obtainable even after a considerable
interval of time.
If death has been caused by a bullet which has not passed
through the body, but lodged, it should by all means be obtained,
since evidence of the greatest value ma}^ inhere in it. More-
over, in first noting the position of the body, the direction of
the wound, or the location of a blood-clot upon the floor or
clothing or elsewhere, may indicate to the surgeon or other
astute person the point at which the bullet may be found con-
cealed or buried in some soft or hard object. This bullet should
be recovered, if possible, at all events, although if taken from
the body itself the evidence it conveys may possibly weigh more
heavily than if removed from some object outside the body.
The exact number of gunshot wounds with a minute description
and location of each should be committed to paper at once, as
well as any statement, if at all reliable, concerning the number
of shots fired, since valuable deductions may be reached as to
the number of bullets which have passed through or which have
lodged within the body. It is well sometimes, also, before dis-
secting out the bullet- wound, to insert first a stiff and then a
flexible probe or something which shall, if possible, follow the
bullet-track, since occasionallj" a question comes up of the direc-
tion in which it was fired. Even though surgeons weU know
that such questions are impossible of satisfactory answer, owing
to the manner in which a bullet is diverted in its course b}'^ the
various tissues of the body, it will nevertheless create a good
impression as to the thoroughness and exactness of an exami-
nation should it be brought out, in answer to questioning, that
this had been done. Many an excellent surgeon has been sur-
prised upon the stand by the question from one of the counsel
as to whether he knew that some certain writer had stated that
it was always well, in trying to determine the course and direc-
tion of a bullet, to put the patient or the body, as the case might
596 GUNSHOT WOUNDS — PARK.
be, in the exact position in which it was when the shot was
fired, providing this be known. The accomplished surgeon
knows that this is a matter of very trifling import, but the
witness' status will be much better established with the jury if
he can show himself familiar with this possible method of ex-
amination.
When a suspected person is brought before a magistrate,
accused of homicidal attempt, it is very likely that the judge
will require a written statement or opinion from the surgeon in
attendance as to the extent and danger of the victim's injuries,
and especially as to whether these are of a character dangerous
to life. The meaning of these words is left entirely to the
sagacity of the surgeon. A mere naked declaration of this fact
is insufificient. He must, if called upon by the court, give his
grounds for his belief, and these may be rigorously examined by
counsel. He will also probably be asked as to the presumable
duration of life and possibly the effect of operation. Thus the
prisoner's immediate liberty or restraint may depend upon the
surgeon's words. Perhaps the only advice which can be offered
here is to qualify between injuries directly dangerous to life and
those in which life is endangered merely by possible complica-
tions, such as sepsis, gangrene, etc. Still, aside from wounds
which are either fatal or may be nearly completely recovered
from, there is another quite large class of those causing griev-
ous bodily harm in which it is a question for the jury always
to decide what was the intent of the accused. A medical wit-
ness may thus in such a case be of great assistance to the court
by giving an account of the injury devoid of technicalities, and
of its possible consequences. It should also always be stated,
if known, whether the patient was under the influence of liquor
or any narcotic at the moment of injury.
In the examination of wounds either of the living or dead
body, it should always be determined for medico-legal purposes
whether there is about them fluid or coagulated blood or ecchy-
mosis, that is, livid discoloration of the skin from effused
blood. The color of the ecchymotic spot will give a valuable
clew as to the time between the infliction of the wound and
death. Putrefaction of such a wound must not be mistaken
for gangrene. In giving reports on such cases care should be
taken to distinguish between facts and inferences. In fact,
EXAMINATION AND DESCRIPTION. 597
the inferences had better be kept unreported or confined to a
separate statement.
Should there be any possible suspicion of a combination of
poisoning and gunshot wound, the stomach-contents should be
carefully preserved and sealed up in the presence of witnesses
before turning over the same to the analytical chemist, whose
receipt for the package, with a careful description of the same,
will probably have to be placed in evidence. Any fact on the
condition of the stomach with regard to digestion is always
worth noting. In the case of Reg. v. Spicer (Berks Lent As-
sizes, 184G) a most important point hinged on the examination
of the stomach. The bod}^ was found at the foot of a stairway.
The prisoner stated that after he and his wife had had their
dinner he heard a fall. The woman had died instantaneously
and the death occurred about the dinner-hour. Upon exami-
nation the stomach was found empty, without a trace of food.
It was, therefore, clear that a part at least of the prisoner's
story was untrue.
Evidence as to whether the wounds were superficial or deep
may be of value. If the edges are swollen or large, or if gran-
ulation or cicatrization have commenced, it is evident that the
person must have lived some hours or some days after their
reception. The same is true of suppuration, adhesion, or gan-
grene. It must also be remembered in this connection that xevy
few gunshot wounds will show much change in less than ten or
twelve hours save that due to the extravasation of blood.
Should the question come up as to whether a gunshot wound
had been inflicted before or after death, we may remember the
principal characteristics of a wound inflicted during life, which
are more or less eversion, more or less hemorrhage with diffu-
sion of blood into the tissues, and the presence of clots. In a
wound made after death little or no blood is effused, unless it
come from some vessel very near the surface, in which case it
will be venous in character and will not coagulate as does that
which is poured out of a wound in the living. The track of
the bullet also will not be found filled with coagula. In these
respects a little will depend upon whether the body has lost its
animal heat or not. The gunshot puncture of a divided arterj-
in a dead body will present a very different appearance from
one inflicted before death, even though it be the cause of death.
598 GUNSHOT WOUNDS — PARK.
Bleeding after death is exclusively venous, and there does not
occur extravasation of blood in the cellular tissues, nor does it
coagulate. Questions of this character come up sometimes in
the case of multiple wounds or injuries, and it is, at times, of
importance to be able to determine whether the assault or injury
has been continued after death. Changes in color of an ecchy-
mosed spot rarely begin until after the expiration of twenty- four
hours, when its dark margins become lighter, and as time goes
on the whole area passes through successive shades of violet,
green, and yellow; its area may also increase sometimes to
remarkable proportions, but the central portions are always
darker than the periphery, the darkest spot corresponding to
the centre of violence. Ecchymosis is longer in disappearing
in the old than in the young. Its various features also will
vary a little in accordance with the tissues bruised.
Gunshot wounds pertaining to spurious suicidal attempts
are usually found not to involve vital parts, while they will have
most of the characteristics of injuries inflicted from a weapon
near at hand. The skin or the clothing will show powder-
marks, and if a wad is a feature of the cartridge used, it may
be found in one place or the other. In these cases there is also
relatively more laceration and bruising, while sometimes the
hand which held the weapon may be blackened or burnt by the
discharge of the same. Self-inflicted wounds, in other words,
must necessarily partake of the character of near wounds.
EVIDENCE FROM THE SITUATION OF THE WOUND.
It has been generally noted that suicidal wounds are for the
most part confined to the front or lateral parts of the body ;
gunshot wounds of this character being found usuall}^ in the
region of the heart, the face, and the temples. The presence of
an injury to these parts is not necessarily indicative of suicide,
but the existence of such injuries in other parts of the body is
at least negative evidence of homicidal attempt. Moreover,
Orfila has observed that it is not so much the situation as the
direction of the wound which gives evidence for or against the
presumption of suicide. The question has been raised whether
it were possible to have a gunshot wound without external evi-
dence. There has been recorded more than one case where a
EVIDENCE FROM THE SITUATION OF THE WOUND. 599
bullet entering through the open mouth has penetrated the brain
without passing through the vertex of the skull and has killed
instantly without leaving any external mark.
It is very necessary to establish, if possible, the direction of
such a wound, and this may be coupled with a knowledge of
the right-handedness or the left-handedness of the person who
inflicted it, or may shed light in this way upon some personal
peculiarity which may lead to the detection of the guilty person.
Thus it is said of Sir Astley Cooper that in one instance he
remarked that a certain wound could not have been inflicted
except by a left-handed person, and that his observation led to
the detection of the murderer. It has been stated that for the
detection of the weapon or instrument used it should be placed
first in one hand of the deceased and then in the other, while
the other extremities are so manipulated that it may be clearly
determined whether suicidal attempt were possible or no. There
is ordinarily little difficulty experienced in distinguishing sui-
cidal from accidental wounds. In the former case extraneous
signs and circumstances point more clearly to the intent of the
deceased than do, perhaps, the peculiarities of the wound itself.
This is to be settled mainly by the evidence of those who find
the bod}^; in other words, by circumstantial evidence.
In suicides ordinarily one wound only is met with. At any
rate, probably one only that has destroyed life. Consequently
the presence of several wounds, each of which was necessarily
fatal, constitutes almost conclusive evidence of murder, the
strength of the same depending upon the necessary fatality
of more than one of these. Thus it is hardly conceivable that
a suicide should shoot himself through the heart and through
the brain; the coexistence of two such wounds would be almost
conclusive of homicide. The existence of multiple wounds is a
rather strong presumption of insanit}' or drunkenness of the
person who inflicted them. Men who kill when under the in-
fluence of liquor not infrequently inflict injuries enough to be
several times fatal.
The coexistence of wounds made by cutting weapons, as
well as firearms, is not unknown. These are occasionally sui-
cidal, ordinarily thej" betoken murderous attempt. If suicidal
the deceased will ordinarily be found to have been a lunatic.
But evidence is to be obtained also from signs and circum-
GOO GUNSHOT WOUNDS — PARK.
stances separable from the wound itself. Thus the position of
the body may be such as to invalidate the theory of accident or
suicide. The position of the weapon, too, is something to be
noted with great care. Whether, for instance, this be firmly
held within the hand of the corpse, or whether it had been
simply placed there after his death ; whether it be found where
it would seem to have been most naturally dropped after its
discharge, or found somewhere M'here it could scarcely have
been placed or thrown by the deceased ; whether it be found at
such a point that it is clearly evident from other signs it could
not have been dropped by the deceased, since death must have
been caused too quickly for him to have traversed the interven-
ing space.
EVIDENCE FROM THE WEAPON AND PROJECTILE.
Evidence of great value may be obtained often from the
weapon itself. First of all, from the position in which it is
found, as stated above ; second, from a careful examination of
itself. It should be noted whether there be any blood upon it,
and whether this be so fresh as not to have caused any rust;
whether it may possibly be so smeared with blood as to indicate
a hand-to-hand conflict; or whether any part of the weapon
may have been used as a club or bludgeon, as would be
shown by the presence upon it of hair entangled in dry blood.
When such blood is removed from the weapon it should be
carefully examined with the microscope, since from the detec-
tion and identification of hair or fibres of fabric evidence of the
greatest value may be adduced. Next it should be ascertained
whether a weapon shows signs of having been recently dis-
charged or whether it be evident that it could not have been so,
and such determination of the time element as ma}^ be afforded
by a study of this kind should be contrasted with that made
after a study of the wound. If the weapon be a revolver or
a repeating arm of any kind, it should be determined if possible
how man}^ cartridges or bullets have been fired, and whether at
or about the same time, and this information should be com-
pared with the evidences obtained from the body and from the
room or localitj^ in which the suicide or murder occurred. If,
for instance, it be determined that three cartridges have been
EVIDENCE FROM THE WEAPON AND PROJECTILE. 601
fired and but two bullet-wounds are found in the body, an
examination of the room may show where went the third bullet.
Next the calibre of the weapon should be noted and the weight
of the ball which it discharged and its dimensions should bo
comjiared with any which may be found in or about the body.
The weight of the bullets attached to cartridges of various sizes
and makes is usually stamped upon the packages in which they
are sold, or can readily be obtained from the makers of the
same. A bullet taken from a body weighing after its removal
more than do the other bullets undischarged in the weapon by
which an injury is alleged to have been inflicted i^ rather pre-
sumptive evidence against the injurj^ from that source.
Can a Bullet Lose in Weight between the Time
WHEN IT Leaves the Bore of a Gun and its Discovery
IN A Body? — Here springs up a question upon which some very
interesting evidence has been adduced in different trials. To
discuss this matter completely the question should be divided
into two, the first being :
Does a Bullet Suffer Loss of Weight during its
Course through the Piece and the Air before it comes
IN Contact with the Body? — A personal letter received from
Captain Charles Shaler, of the Ordnance Department of the
United States Army, in reply to certain questions, tends to fully
settle that a lead bullet suffers a certain loss of weight in the
barrel due to the friction between the bullet and the bore; this
is known as " leading" and varies according to circumstances.
" Patching" the bullet is often resorted to in order to reduce the
leading; lubrication is also practised. The fusing of a bullet
takes place especially with lead bullets. A ball which has been
partly fused in the bore will lose the fused portions in the bore
or in flight, and will move irregularly on account of the result-
ing ii'regularity of form. A .45-calibre, 500-grain service bul-
let, lead alloyed with tin, was weighed without lubricant and
was found to weigh 500.5 grains. It was then lubricated in tlu'
cannelures and was fired into a butt composed of three barrels
placed end to end and filled with sawdust. The bullet was
recovered, no lubricant being found in the cannelures, and re-
weighed, the weight obtained being 485.5. The loss of weight
was, therefore, 15 grains or three per cent, some of which may
have been due to the bullet penetrating the sawdust. A Ger-
G03 GUNSHOT WOUNDS — PARK.
man-silver "jacketed" .30-calibre bullet, weighing before firing
231 grains, fired without lubrication, when recovered and re-
weighed was found to have suffered a loss of weight of one-half
grain or one-quarter of one per cent. The other part of the
main question is :
Does the Bullet Lose in Weight in its Course
THROUGH the Body? — This is, of course, intended to pertain
only to those instances in which there is no evidence of splitting
or division of the bullet, and refers only to the effect of friction
or attrition. June 5th, 1878, in Saratoga County, Mrs. Jesse
Billings was accidentally killed by a bullet. Her husband was
arrested and tried for murder. On the first trial he was ac-
quitted. A second trial, however, was held, and some very in-
teresting expert testimony was brought out on matters pertain-
ing to these questions. The medical evidence is published in
full bj" Dr. Lewis Balch, of Albanj-, in the Transactions of the
Medical Society of the State of New York for 1881. The rifle
from which the bullet was supposed to have been fired was
found in a well, and was sworn to have belonged to Jesse
Billings. In it was found a cartridge of the type known as the
Commercial Long No. 44. This gun became an important
factor in the case, and most of the evidence as to whether it
was the weapon with which the murder had been committed
was referred to the medical experts. The defence in the first
trial claimed that all the lead fired was found in Mrs. Billings'
head. On the second trial the same claim was not made, but
that it was a smaller bullet than a .44 and its weight less than
220 grains; that in consequence this rifle could not have been
that from which the shot was fired, for it only called for a .44
ball, and that it would have thrown a bullet with such force
that it must have gone entirely through the head. They further
claimed that powder-marks and grains of powder were found
in the window-sash, showing that the weapon was fired near the
window, and that the hole in the glass was not large enough
to admit a full-sized .44 ball. The verdict was mainly won upon
these statements. A question for the medical experts to answer
was, what would be the effect upon the skull of a .44-calibre ball
fired from a Ballard rifle, the ball weighing 220 grains and the
charge of powder being 28 grains? also what would be the
effect upon the ball? Experts from the Ordnance Corps and
EVIDENCE FROM THE WEAPON AND PROJECTILE. 603
from the rifle factories were able to testify that the bullet found
in Mrs. Billings' head was originally a .44-calibreball; also that
its markings showed the peculiar left-handed twist used in
rifling this particular arm. The defence maintained that it
could not have been a .44, claiming that the hole in the window-
pane showed that. The original window produced in court
was no criterion, since from repeated handling the hole made
by the bullet had become enlarged and changed in shape. Both
of the experts for the defence believed that the ball could not
make a hole smaller than itself when passing through glass.
This necessarily supposes that the ball after being fired is the
same calibre as before, which, as shown above, is not always
the case. So Dr. Balch fired forty- five rounds from the Billings
rifle with 220 grains of lead and 28 grains of powder. The
shots were fired through glass set in sashes, the glass being
28x13^, double thick and American make. The rifle was dis-
charged at varying angles and at distances varying from two
to seventy feet, and he obtained one shot where the hole made
would not admit a full-sized ball. His summary was as fol-
lows :
Balls unable to pass through 1
Balls partly passed 3
Balls passed 18
Cartridge passed 21
Glass broken out 2
Total 45
Other rounds were fired from a Colt's navy revolver, old
stj'le, .30 calibre, at distances varying from ten to twenty feet.
The holes made were so large that the barrels and ramrods
could be passed without touching. The examination of the one
instance noted above where the aperture in the glass was smaller
than the ball is explained by Balch as follows : " A ball conoidal
in form, passing with great velocity, strikes glass, penetrates,
but does not break the glass at the point of entrance. The point
struck is instantly disintegrated, and so rapid is the stroke that
it has not time to call upon the surrounding particles for sup-
port; hence the smallness of the hole. As glass is made it
varies in elasticitj'- ; some parts which are to bo cut into panes
cool faster than others. A bullet striking the portion of the
glass which has cooled quickly strikes an object which will
604
GUNSHOT WOUNDS — PARK.
yield somewhat to the force; in doing this a hole will be made
smaller than if that more brittle had been struck. Further-
more, all rifles taper more or less from breech to muzzle, that
is, the muzzle will measure one or more thousandths or hun-
dredths less than the breech. The bullet being forced through
the narrow aperture yields to the pressure and becomes smaller.
The gun under consideration was measured at the New York
Armorj^, and found to be .44 at the breech or chamber and
.423 at the muzzle. Considering these various facts, statements
that a ball of known size will make a hole through glass smaller
than the size of the ball when fired do not admit of doubt as to
their verity. Some statements bearing on this same point con-
tained in a recent letter from Captain Shaler, of the United
States Armj^, deserve mention here. The following experiment
was made in Washington by Captain Lyon in October, 1880:
" Noticing a statement in a newspaper to the effect that a
ball fired from a rifle would, in passing through glass, make a
round hole smaller than the diameter of the ball used, the fol-
lowing experiment was made :
"Service ammunition used, in a calibre .45 Springfield rifle
to penetrate glass.
Time Fired.
Size of Hole made
in Glass, inches.
Remarks.
1
0.570
2
0.550
3
0.600
4
0.600
5
0.575
6
0.575
The frame holding the
7
0.590
glass was placed 25
8
0.620
vards from the muzzle
9
0.600
of the gun.
Average size of hole
0.586
Calibre of bullet
0.458
Difference
0.125
" From the above it will be noted that there is no uniformity
in the size of the holes and that they all exceed the diameter of
the bullet.
" These experiments were supplemented by some made re-
cently in which a sash containing six panes of ordinary window-
EVIDENCE FROM THE WEAPON AND PROJECTILE. 605
glass was placed at twenty-five yards from the firer and the
glass was successively penetrated (a separate pane being used
in each case) by bullets from a service .45-calibre Springfield
rifle, a .30-calibre Springfield rifle, a .45-calibre Colt's revolver
and a .22-calibre revolver. In every case the hole made was
much larger than the bullet making it."
With reference also to the effect of a ball being smaller than
its original diameter after it leaves the piece, Captain Shaler
states : " All very compressible bullets forced by inertia lose a
certain amount even though they also gain force by slugging.
Forcing by inertia tends to shorten the bullet and increase
the diameter, while slugging tends to lengthen the bullet and
reduce its diameter. Whether the bullet is smaller after it
leaves the piece depends upon the bullet used and the method of
forcing employed."
To return to the Billings case, it was claimed that the bullet
was also too small. It weighed 165 grains, 55 less than when
it was fired from the rifle. Balch found in firing at human
skulls, the subjects in all the trials but two being placed in a
sitting posture, sometimes with a sash like the Billings window
in front of the subject, that the ball lost lead in accordance with
the resistance it met with and the amount of bone ploughed in
its passage. These experiments conclusively prove that the
weight of a ball taken from a body after being fired, it having
traversed a bone in its flight, is b}^ no means evidence of its
weight before firing ; in other words, a ball always loses some
lead when passing through bone. With the same rifle as that
produced at the trial he made a series of experiments in the
dissecting-room, endeavoring to make a bullet enter the skull
at the same point and in nearly as possible the same direction
as in the case of the murdered woman. In six such experi-
ments there were var3'ing losses of lead, all the bullets used
being the same general weight. In two trials the distance was
but ten feet from the muzzle, yet more lead was lost than in
any of the other four. The least loss recorded took place at
the longest distance, thirty-five feet. This in part accounts for
the loss of lead, for at ten feet the bullet has not acquired its
greatest penetrating power, for he showed bj^ experiment that
a 220-grain bullet fired at a human skull will lose more lead
than was missing from the Billings bullet, thus disposing of
606 GUNSHOT WOUNDS — PARK.
-the question raised by the defence that a ball could not have
weighed 220 grains before being fired.
Just how to account for the missing lead has never been
clearly established. We have to remember that a few grains
may be left in the bore of a rifle, especially if rust}^ ; that in
passing through glass another portion is lost, and finally it is
scarcely conceivable that any bullet should penetrate an adult
skull, especially in the neighborhood of the mastoid processes,
without losing quite a perceptible percentage of its mass by
friction.
It was also claimed by the defence that the ball taken from
Mrs. Billings' head had been fired from a weapon of low veloc-
ity, which was held to account for the fact that the ball failed
to pass out of the skull. The rifle when tested at the Govern-
ment Arsenal showed a mean velocity of 999 feet per second.
Had it been as high as was supposed by the defence, namely,
1,300 or 1,400 feet, the argument that a bullet driven with this
force would always go through the skull would have more
weight, but with the velocity found by actual test the energy
of the ball was lessened to nearly one-half of that supposed.
The bullet which killed Mrs. Billings did not pass entirely
through the skull. It ploughed into the opposite side and broke
before it a triangular piece of bone which broke the skin exter-
nally. This shows the resistance of external fascia against per-
foration. A study of the lines of fracture in this particular
case proved very interesting, but perhaps would be somewhat
irrelevant here. A measurement of the skull and of the bullet-
track through it shows the former to have been of more than
ordinary thickness and density, and the channel ploughed in the
bone by the bullet along the base of it to have been nearly two
inches in length. Dr. Balch gives the following conclusions
to his very interesting evidence : 1st. A leaden ball passing
through bone loses lead in proportion to the amount of bone
traversed. 2d. If the petrous portion of the temporal bone be
the part struck by the ball and struck squarely at the base,
that portion of the bone is crumbled or broken in such exceed-
ingly'' fine pieces as to defy restoration. 3d. That if the ball
struck any part of the skull the petrous portion will be broken,
but can be usually recognized and generally put together again.
4th. That a ball of given calibre fired through glass may make
EVIDENCE FROM THE WEAPON AND PROJECTILE. 607
a hole enough smaller than the full size of the ball before firing
to prevent an unfired ball of like calibre passing.
In all this kind of experimentation upon cadavers for the
purpose of eliciting evidence by reproducing as nearly as possi-
ble ante-mortem injuries, we must not forget that Casper has
strongly insisted that " it is extremely difficult to break up the
organic cohesion of dead organs. ... If we endeavor to frac-
ture the skull of a dead adult we shall find that an amount of
force which if applied in life would indubitably produce fissures
if not fracture, or complete crushing of the skull, leaves the
dead skull quite uninjured. . . . The most powerful blows
struck down upon the body, laid down horizontally, were with-
out result, and only after repeated violent blows were we able
to produce perhaps one or a few fissures in the occipital or
parietal bone, or in the temporal bone (squamous portion), and
usually in the latter. We were unable to produce more consid-
erable effects, such as complete smashing of the skull or fissures
of its base, even in one single instance. The dead skull seems
to have considerably more power of resistance, and after its
removal fissures of the bone were more easily produced by simi-
lar blows" (Vol. I., p. 245). And again: "The result of my
experiments on the dead body in regard to gunshot wounds
could only be to make more complete the proof of the resistance
of the dead corporeal tissues, in contradistinction to the tissues
wheix d-live. After I had already learned this peculiarity from
my experiments with contused wounds, this peculiar resistent
property was found to be confirmed in a most remarkable
manner" ("Forensic Medicine," Vol. I., p. 271).
If the number of bullets known to have been fired, or, more
important still, which have been found exceeds the number
which could have been discharged from the weapon in ques-
tion, a very large element of doubt and uncertaintj" is introduced
which must be quieted by other and more circumstantial evi-
dence. Should two different weapons be in question, it is very
necessary to establish from which of them the bullets have been
discharged. This can be done mainly by weight and evident
calibre of the bullets, or some other peculiarity; possiblj^ in
disputed cases even by analysis of the metal.
Wounds by Shot-Guns. — In most of what has been said
it has been supposed that the injury has been inflicted by an
60S GUNSHOT WOUNDS— PARK.
arm of the kind commonly described under the terms pistol,
revolver, or rifle. Gunshot wounds are, however, occasionally
inflicted with shot-guns and a charge of shot varying in size
from small bird-shot up to that generally known as buck-shot.
It is characteristic of such missiles that they separate after
their discharge from the gun, and a determination of the degree
of their separation is approximately a determination of the dis-
tance of the mark from the muzzle of the weapon. In suicide
or accidental discharges of a shot-gun the muzzle is so near the
body that the charge of shot acts very much as would a single
buUet of the size of the bore of the gun, and near wounds thus
inflicted, wlrile necessarily large, have about them a minimum
laceration and disturbance of tissue, so that perhaps only by
their size could one say, viewing the wound alone, that the
weapon used had been a shot-gun. On the other hand, at a
distance of a few feet the shot begin to separate to such an
extent that there is much more laceration of tissue, and after
separation to an indeterminate, because variable, number of
feet we get such marks as individual shot may make. This
distance is indeterminate because it is predicated on the size
of the gun, the dimensions of shot, and the weight of the
charge of powder. The writer, for instance, has recently seen
one case where the muzzle of the gun could not have been more
than two feet away from the surface of the foot at which it was
discharged, the consequence being a round and very slightlj"
ragged hole through the mid-tarsal region from dorsum to sole.
It is possible for a single grain of shot to produce death. Such
a case is related by Ollivier d' Angers : a thief scaling a wall
received at a distance of fifteen paces a charge of shot from
a fowling-piece; he fell dead immediately. The charge had
struck him in the breast, centring over a space of three or four
inches, but one shot had penetrated the aorta over the attach-
ment of the sigmoid valves, and another had traversed the en-
tire wall of this vessel.
Powder-Marks. — A very important part of evidence in
case of near wounds of gunshot character pertains to the pow-
der-marks upon the clothing and skin. Naturally every one
knows that when a weapon is discharged near a given surface
there will be more or less powder-marking upon that surface, the
same being due to particles of gunpowder which are incom-
POWDER-MARKS— DIMENSIONS OF PEKFORATIOXS. GO.!)
pletely or not at all consumed, and which are black because of
the charcoal they contain ; but the circumstances under which
powder-marks of a given character can be inflicted are so ex-
tremely variable that no statistics or information of value in a
general way can be given. Thus the fineness of the marks will
depend upon the fineness of the powder, and the area covered and
the depth of the marking upon the same, upon the distance of
the muzzle from the surface ; and the only way to make out the
exact distance of the muzzle from the surface at the time of the
infliction of a given wound is to use the same weapon, if possi-
ble, with cartridges or charges out of the same lot as that used
at the time of injury. Distances could, perhaps, «be stated in
round numbers, but their value would only be remotely approx-
imate, and in a given case the best evidence is to be obtained
by experiment with the fire-arm in question.
Dimensions of Perforations. — Atdifl^erenttimesa great
deal of weight has been attached to the dimension of the per-
foration through such objects as wood, glass, or even through
the bones of the body, made by the bullet which is supposed or
known to have destroyed life. Wrong inferences have been
drawn sometimes from a study of undischarged bullets or car-
tridges similar, at least before firing, to that which has been
taken from a given body. It has been stated, for instance, that
such a bullet was too large to have passed through such an
aperture or to have made such a hole, or that it was so much
smaller than a certain hole that it was not the particular mis-
sile which made that perforation. Upon this matter has hinged
a great deal of uncertainty and consequently a good deal of
study. The size of opening which a bullet of given calibre will
make through wood depends upon the distance of the weapon,
the firing charge, the velocity of the bullet, the extent to which
its shape has been altered by passing through the given barrier,
by the heat of the explosion, by the im})act of the air upon the
heated and consequently softened metal, and by the density and
thickness of the wood, as well as by the resistance which it
may have offered mainly from its being fixed in place or mova-
ble. There is, however, ordinarily less question about the size
of a similar hole through a piece of glass or bone. It is gen-
erally supposed that a bullet passing through a window-pane
will shatter it. This depends, however, mainlv upon the per-
3<J
GIO GUNSHOT WOUNDS — PARK.
fection of fixation of the glass in its resting-place. If for pur-
poses of experiment panes of glass be tacked into a shutter and
bullets be fired at them from varying distances, they will be
practically invariably shattered. It is, however, quite different
if the pane of glass be firmly fixed in a frame by means of
putty which has become old and hard, and especially if the
window-frame itself be closely fitted in the casing. Under
these circumstances a bullet will often make a clearly punched
hole, or one with very few radiating lines of fracture. Experi-
ment, therefore, to secure evidence should be made under cir-
cumstances exactly parallel to those which necessitate such
evidence.
EVIDENCE FROM EXAMINATION OF THE DEAD BODY.
Fractures. — Considerable evidence of great interest with
respect to the effect of a bullet-wound upon the skull and the
possibility of fractures being produced at the base by contre
coup will be found in the statement of the case of The People?;.
Elisha B. Fero, published by Dr. Charles T. Porter, of Albanj-,
in the Journal of Psychological Medicine, April, 1870. Mrs.
Fero was murdered while in her bed and was found to have
been bruised about the head and body, her husband claiming
that the deed was that of a robber who had attacked them both.
He was found with slight bruises or scratches about the face
and black marks as if from burnt powder between the middle
fingers of his right hand. The first autopsy appears to have
been carelessly made, but a flattened conical ball weighing
twenty-six and one-half grains was found lodged in the middle
of the right cerebral hemisphere. It had not gone completely
through the brain. Its base fitted the shells of the metallic
cartridges used in Fero's revolver. Eight days after death a
second examination was made, after which the head was re-
moved and preserved in 95,^ alcohol. A theory of the prosecu-
tion was that Mrs. Fero was murdered by her husband ; that he
shot her, as well as struck her numerous blows upon both sides
of the head and its front and back with some broad, heavy,
and elastic body, making fractures found on autopsy. Not the
least interesting part of the testimony is that referring to the
condition of tissues alleged to have been bruised after long
EVIDENCE FROM EXAMINATION OF THE DEAD BODY. 611
preservation in alcohol. The expert testimony in this case
appeared to show that such fractures as were found, without
reference to the fact of external bruises, were due to the unskil-
ful manner in which the skull-cap was removed. In this con-
nection it is well right here to emphasize the fact that fresh
fractures can be produced in the skull by too forcible or injudi-
cious efforts to remove the calvarium when making autopsies,
or that fractures previously existing can be extended or compli-
cated in the same way. Shaw in his "Manual of Anatomy"
says : " The question whether there has been a fracture of the
cranium previous to death is sometimes more difficult to decide
than a person not accustomed to make dissections might imag-
ine. If the fracture has occurred immediately before the patient's
death, there will be found coagulated blood upon the bones and
in the fissures. If the patient has survived for some time, there
will be marks of inflammation and, perhaps, pus in contact
with the skull, but if a fracture has been made in making the
examination, which sometimes happens in even very careful
dissectors' hands, the blood in the fracture will not be coagu-
lated, nor will there be any effusions around the portions. In
Beck's Medical Journal, Vol. XXII., p. 28, Mr. Alcock some
time since stated in a public lecture in London that he had known
a fracture of the base of the skull produced by the awkward and
violent tearing of the upper portion by the saw in penetrating
enough to divide the bones, and this to be mistaken by the
inexperienced operator for fracture of the skull producing death.
Being a medico-legal case, it might have led to melancholy
consequences had not the error been detected by an observer."
That an extensive and often complicated fracture by contre
coup can occur as the result of gunshot injuries of the skull is
a fact well known to all surgeons of experience and laid down
in all text-books and illustrated in all large museums.
In view of these well-known facts, it would always bo well
to insist in cases of this kind that the saw alone should be used
and not the hammer nor the chisel. When a cranial bone is
fractured blood is poured out from the ruptured vessels, as is
always the case with any bone. Its amount varies indefinitely
with the number and size of the ruptured vessels, the activity
of circulation, the length of time a person lives, etc. The blood
maj' collect in circumscribed masses or become infiltrated in
G12 GUNSHOT WOUNDS — PARK.
the surrounding tissues, although usually both phenomena are
observed. The extent to which infiltration takes place depends
upon the quantity of blood and the nature of the surrounding
tissues. In loose tissues like those about the orbit infiltration
is much more rapid and extensive.
Examination of the "Weapon. — French medical jurists
have tried to indicate how we may determine the time elapsed
between the death of a person and the discharge of a weapon
found near the body, but exact statements in this matter are
utterly out of the question. Certain facts bearing on the sub-
ject are these : When recently discharged there will be found
adhering to the barrel of the piece and consisting of the fouling
of which sportsmen complain, a quantity of potassium sulfid
mixed with charcoal. This is shown by its forming a strong
alkaline solution Avith water, evolving an odor of hydrogen
sulfid, and a dark precipitate with a solution of acetate of lead.
Depending upon the degree of exposure to air and moisture,
after some hours or days this sulfid becomes converted into
potassium sulfate, which forms a neutral solution with water
and gives a white precipitate with acetate of lead ; but if a con-
siderable time has elapsed since the discharge of the piece oxid
of iron (iron rust) with traces of sulfate may be found {Ann.
cV Hygiene, ISS-t, p. 458; 1837, p. 197; 184-2, p. 308).
Was the Weapon Fired from a Distance or Near
By? — A gunshot injury from a bullet implies at least one
wound, namely, that of entrance, and perhaj^s another, that of
exit. It does not always happen that the bullet passes through
the body. The appearance of the wound of entrance is usuall}'
one of irregular circular puncture, its edges perhaps slightly
torn or lacerated, with a purplish or dark areola, varying in
width from a line or two to one-half inch. When the weapon
is fired close to the body. there are likely to be more or less
powder-marks, and possibl}" actual burning from the heat and
flame of the gunpowder. If the part of the body injured had
been covered by clothing at the time, the marks of powder and
of burning would probablj" be confined to the same. Bleeding
is usuall}" slight and occurs more commonly from the wound of
entrance than from that of exit. Regularity of either of these
wounds depends in large measure upon the angle at which the
bullet has struck the surface. When striking very obliquely
EXAMINATION OF THE WEAPON — POWDER-MAKKS. G13
the wound may be more oval or the buhet may have ploughed
a furrow or a channel, b}' a study of which the relative position
of the assailant and the assailed at the moment of injury may,
perhaps^ be determined. It is of importance to determine if
possible the approximate distance at which the bullet was fired,
since the question of self-defence, fcr instance, may hinge upon
evidence of this character. The charge of powder and the
weight of the bullet being known, one may sometimes estimate
this distance by the depth of penetration or the appearance of
the bullet. Still, the nature of the tissues must figure largely
in such consideration. Manj^ suicides who shoot themselves in
the head show only one wound of entrance and none of exit.
Experiments Testing Pcwder-Marks. — Powder-marks
and burns from weapons ordinaril}' used will scarcely appear
when the distance has exceeded ten or twelve feet. LaChese, of
Antwerp, found that in firing a gun even from a distance of
only four feet the skin was only partiallj" blackened.
As the result of experiments made with a Ballard rifie, old
style, .4:4: calibre, with bullets of 220 grains and 28 grains of
powder. Dr. Balcli, of Alban}-, found that powder-marks were
made at distances as follows :
At two feet, particles too numerous to count, with some of
the lubricant blown upon the board ;
At four feet the same ;
At six feet the same ;
At eight feet, nine grains of powder ;
At ten feet, five grains of powder in one case and six in
another.
That these were powder-grains were shown in court by
picking some of them out, placing them on a glass, and igniting
them with a galvano-caustic point. From those at ten feet no
distinct flash could be elicited ; from those obtained at eight feet
distinct flashes were seen (Trans. New York State Med. Soc,
1881).
In the celebrated case of Peytle, brought in 1839 for the
murder of his wife, who had been killed by two buflets entering
near the nose, the eyebrows, lashes, and lids were completely
burned, and a large ninnber of powder grains were imbedded
in the cheeks. Experiments being made in order to ascertain
the distance necessary to produce these effects, it was found
G14 GUNSHOT WOUNDS — PARK.
that the weapon must have been held within a distance of
twelve inches.
Wounds of Entrance and of Exit. — A great deal has
been written in time past about the peculiarities of the wounds
of entrance and of exit, much of which cannot be maintained
under expert criticism. It is true that the wound of entrance
will usually be well defined, the skin slightly depressed and
appearing as above noted. It is true also that powder-marks
will appear about this wound rather than that of exit. Usually,
too, the orifice of exit is larger, less regular, its edges everted
slightly, with more or less laceration of the skin, and quite
free from any powder-marks or evidence of burning. The de-
pression at the border of the wound of entrance differs after
some days, by which time the contused margins slough away,
and its appearance is daily changed by a process of granulation
providing the individual recover or live long enough. Accord-
ing to Dupuytren, the hole in the clothing is smaller than that
made by the same buUet in the skin. These are all points
worth remembering when fitting bullets into wounds which
they are supposed to have made ; but the conditions under which
gunshot punctures occur are constantly varying, and the sig-
nificance of local markings is mainly the product of experience,
care, observation, and reasoning. Thus the shape of either of
these wounds will depend naturally upon the integrity of the
bullet and its original shape and dimensions. Matthysen's
experiments give the following : A pistol fired at twelve paces
distance, with a ball 15 mm. in diameter, made a wound in
chest of 8| mm. diameter, and at its point of exit at the back
one of 10 mm. In two experiments at the same distance
as above, the entrance wound was 4 mm. larger in diameter
than that of exit, and when a larger ball with a diameter
of 17 mm. was used the same results were preserved, both
wounds being less in size than the ball which made them. A
spherical ball will usually cause more loss of substance than a
conical, while the latter will cause usually more irregularity of
outline and may even give the wound of entrance a slit-like
appearance. Complications may also occur from other sources ;
a single wound of entrance may give rise to two or more wounds
of exit due to splitting of the bullet, or if the bullet have been
divided and the larger part lodged in the bone, only the smaller
COURSE OF THE PROJECTILE. G15
portion passing out, the wound of exit may in reality be much
smaller than that of entrance. Again, a bullet may split into
fragments before striking the body, and of these one may enter
the body, or one or more of them lodge. Multiple wounds are
possible even from one bullet, as when it passes through two
different parts of the body. Again, when two wounds, for in-
stance, are discovered, one of them maj^ be regarded as that of
exit, when in reality they may be two wounds of entrance,
neither bullet having left the bodj^. So while it is possible in
some cases to decide which is which, too much dependence
should not be placed upon appearances of this kind, least of
all until after a careful autopsy has been made.
Course of the Projectile. — When a bullet traverses a
body the two apertures may be nearly opposite to each other,
although the bullet may not have taken a direct course between
them, having been deflected by tissues of varying density in its
course. This leads to the mention of the effect of animal tissues
upon the course of bullets, with which works on militar}" surgery
deal extensivelj'.
The following is a remarkable illustration, yet authentic, of
a devious path of a ball. In a duel with pistols between two
students at Strasburg one fell, apparently mortally wounded in
the neck, but recovered without feeling an}" inconvenience from
his wound. It was found that the bullet had strnck the larj^nx
and had gone completely around the neck. It was taken out
by simply making an incision over it. Other instances may be
cited where bullets have made a circuit around the head, thorax,
or abdomen. The ball may make a half circuit of the bodj^ and
lodge or emerge at a point opposite that at which it entered,
thus leading one to suppose that it must have passed directly
through (Wharton and Stille).
As the writer of a chapter on the effect of projectiles of small-
arms, in the Third Surgical Volume of the " Medical and
Surgical History of the War of the Rebellion," p. 709, says:
" Such bullets attain great range and effectiveness as oppose least
frontage of resistance to air; their velocity consequently is
greater. Rotation upon their long axes tends to give them
steadier flight and more direct course. By their pointed apices
they pierce more easily the structures opposed to them. Such
buUets, owing to the elasticity of the skin, make a wound of
GIG GUNSHOT WOUNDS — PARK.
entrance perhaps a trifle smaller in diameter than themselves,
while spherical balls are more likely to carry a portion of the
integument in with them."
The differences of structure and density of the muscle tissues
and their aponeuroses encountered by a bullet in its passage
materially influence the directness of its course unless its veloc-
ity be very great, while round bullets are the more easily de-
flected from their course. The track of a small conical bullet
passing swiftly through a muscle is more cleanly cut than that
made by a round bullet, but in all gunshot wounds there is usually
found a regular canal, with lacerated walls, with more or less
destruction along the area of injury, shading off concentrically
until lost in healthy tissue. There is always loss of substance
dependent on muscle tension or direction of the bullet, whether
transverse or obliquely to the direction of the muscle fibres ; the
more fibrous structures are torn and lacerated or simply per-
forated, mainly owing to their different tension at the instant ;
their openings seldom correspond to those of the muscle tissues
or those upon the surface of the body, because of the constant
change in the relation of the parts due to muscle action. This
makes it often difficult to follow the course of a bullet with
accurac}'. The irregularity of a bullet-track due to these causes
constitutes one of the great sources of danger, since cavities and
pouches thus formed give lodgment to foreign matter driven in
with the bullet, by retention of which a fertile source of sepsis
is maintained. Gunshot injuries of bone may be classified as
contusions, simple fractures, partial fractures, penetrations, per-
forations, and complete fractures with more or less comminution
or loss of substance, all of these, of course, in the surgical sense
compound. These are all manifestations of mechanical force
acting in accordance with established laws. On autopsy these
will be ascertained, while one or more portions or all of a bullet
may be found imbedded in or attached to some bone. The best
illustration of such accidents will be found in the " Medical
and Surgical History of the War of the Rebellion."
Such questions as pertain to the position of the wounded
person when shot or that of his antagonist, and other similar
inquiries, can only be settled by reference to particular circum-
stances of individual cases. Position of the wound may help a
little, A bullet- wound directly in the centre of the top of the
WOUNDS BY SMALL SHOT. Gl T
head could scarcely be received by a person standing unless his
assailant occupied an elevated position. If accompanied by
evidence of severe blows by which the deceased might have
been knocked down, it might show that he had been shot after
falling.
Wounds by Small Shot. — Small shot rarely traverse the
entire body unless discharged from such proximity as to make
a clean, round opening. Paley relates the following instance :
A boy was shot in the neck by the accidental explosion of his
own gun, No. 8 shot. He died instantly. He was lying for-
ward of the muzzle so that it was nearly in contact with the
skin of the neck. A large round hole was produced, in diame-
ter one and one-half inches, whose edges were slightly darkened
by powder. The wound of exit at the back of the neck, at the
third vertebra, was a mere slit in the skin scarcely an inch in
length with the diameter placed vertically. The smallness of
this aperture may have been owing to the greater part of the
charge being lodged in the body. Dr. Lowe states that in some
experiments it was found that a round aperture might be pro-
duced by a discharge of small shot at a much greater distance
than that assigned b}' Dr. LaChese, namel}', ten to twelve
inches. Even admitting such exceptional instances, it will
scarcely ever occur that a wound from a small shot can be mis-
taken for one produced by a leaden bullet.
De Vergie has shown that when the ball enters a portion of
the body well covered with fat, this often protrudes between the
edges of the wound and may alter its character. If clothing
have been carried in some shreds of it may show upon the
wound, and such fragments of texture will nearh' alwaj^s
characterize the wound at once as that of entrance.
Wounds by Blank Charges. — Experience has shown
that no matter with what the piece is charged, it is capable,
when fired close b}^ of producing a wound which may prove fatal.
Thus a gun loaded with wadding or gunpowder only may
cause death. A portion of clothing may be carried into the
wound and lead to death from hemorrhage, or death may occur
from many secondary causes, such as tetanus or sepsis. Ac-
cidents so frequently occur from weapons discharged in sport,
not loaded with ball or shot, that it is worth while to bear this
in mind. It has been observed, for instance, that persons at-
618 GUNSHOT WOUNDS — PARK.
tempting to commit suicide have forgotten to put a bullet in
tlie pistol, nevertheless the discharge of the weapon into the
mouth has sufficed, from the wadding alone, to produce a con-
siderable laceration and hemorrhage (Taylor). Many fatal ac-
cidents have taken place by the discharge of wadding from
cannon. LaChese has ascertained by experiment that a piece
charged with gimpowder alone is capable of producing a pene-
trating wound somewhat resembling that produced by gun-shot,
when the piece is large and fired within six feet of the body
{Ann. d' Hygiene, 1836, p. 368). This arises from unexploded
grains of powder acting as pellets of small shot. Sweet has
experimented with pistols loaded with gunpowder and wadding
in order to determine the effect of their discharge at different
distances. At twelve inches he found that the clothing was
lacerated and the skin abraded, but the wadding did not pene-
trate ; at six inches the clothes were lacerated and the wadding
penetrated to the depth of one-half inch ; at one and one-half
inches from the chest the wadding passed into the thoracic cavity
between the ribs, and at a second experiment carried away a
portion of the ribs.
It is probable that an ordinary wadding such as loosely
wrapped paper, rag, or similar material, especially as prepared
by one not accustomed to military use of a weapon, would not
produce a wound which would resemble that made by a bullet,
and it is doubtful whether such a wound could be produced at
a greater distance than six inches from the body.
It is on record that in Paris, in 1858, a circus cannon of four
inches bore, loaded with three ounces of grain powder retained
by a wad of old theatre bills loosely folded together and rammed
home with only moderate force, was discharged in the direction
of the boxes at a distance of about one hundred and fifty feet.
A man seated in one of these boxes opposite the muzzle of the
gun, leaning forward, his arms crossed upon the handle of his
umbrella, had his arm broken above the elbow immediately
upon its discharge. Several portions of wadding were found
beneath the place where the man sat, but no marks existed upon
his clothing nor upon the anterior part of the arm, which must
have been inaccessible to any projectile that did not first strike
the forearm. It was concluded that the fracture had been
caused by the violent and sudden starting of the man backward,
THE MANNLICHER RIFLE. 019
which must have brought his arm against the hard part of the
partition. An experiment tried with the cannon proved that
any wadding that could be made with paper was dispersed in
passing, or lost all power of mischief, at much less distance
than one hundred and twenty feet {Annales d^Hygiene, 1859,
p. 420, Wharton and Stille).
The Mannlicher Rifle. — It may be of interest here to note
the effects of the rifle-bullets used in the most recently invented
improved arms. The last new projectile used in the German
army, 1892, with the Mannlicher rifle, has an inner core of lead
inclosed in a casing of steel or firm metal, which prevents the
lead, even when softened by heat, from becoming deformed and
enlarged by contact. The weight of the bullet is much less than
any of the old, but to its higher rate of velocity and its pointed
shape, which is preserved, must be ascribed its greater perforat-
ing power. Owing to this immense velocity and the small sur-
face of contact, it meets with little resistance on striking a person,
has no time to stretch the various tissues it encounters, causes
little or no commotion of the neighboring parts, and merely
punches a hole, carrjnng the contused elements before it clear
out of the wound without seriously damaging the surrounding-
wall of the bullet-track. This absence of contusion must lead
to more frequent deaths from hemorrhage, while when this arm
is used we shall hear very little of deflection or deviation of the
bullet from its path, since it has sufficient power to pass directly
through awy part of the body which it may meet on its way.
The result in battle will be a reduction of the list of wounded,
but a terrible augmentation of that of the dead.
IDENTITY FROM A FLASH OF GUNPOWDER.
Taj'lor states the following: " Among the singular questions
which have arisen out of this subject is the following : whether
the person who fires a gun or pistol during a dark night can be
identified by means of the light produced during the discharge.
This question was first negativel}" answered by a class in phys-
ical science in France, whereas later a case tending to show
that their decision was erroneous was subsequently reported by
Fodere. A woman positive!}' swore that she saw the face of
the prisoner, who fired at another during the night, surrounded
-620 GUNSHOT WOUNDS — PARK.
by a kind of glory, and that she was thereby enabled to identify
him. This statement was confirmed by the deposition of the
wounded party. Desgranges, of Lyons, performed many experi-
ments on this subject, and he concluded that away from every
source of light the prisoner who fired the gvm might be identified
within a moderate distance ; if the flash were very strong, the
smoke very dense, and the distance great, the person firing
the piece could not be identified. The question was raised in
England in the case of Reg. v. White at the Croydon Autumn
Assizes, 1839. A gentleman was shot at while driving home
on a dark night, being wounded in the leg. When he saw the
flash of the gun he saw that the piece was levelled toward him,
and the light of the flash enabled him to recognize at once the
features of the accused. In cross-examination he said he was
quite sure he could see the prisoner and was not mistaken as to
his identity; but the accused was skilfully defended and he
was acquitted. A similar case was tried at the Lewes Lent
Assizes, 18G3, Reg. v. Stapley. The prisoner shot at the pros-
ecutor on a dark December evening, and the latter swore that
he distinctly saw the prisoner by the flash of the gun and could
identify him by the light on his features. His evidence was
corroborated and the man was convicted. A case is also quoted,
Rex V. Haines, in which some police officials were shot at by
a highwayman during a dark night. One of these stated that
he could distinctly see from the flash of the pistol that the robber
rode a dark-brown horse of remarkable shape, and that he had
since identified the horse at a stable in London. He also was
positive that the prisoner had on a rough brown great-coat.
There seems to be enough evidence in this direction to show
that identification under these circumstances is occasionally
possible.
GENERAL MEDICO-LEGAL CONSIDERATIONS.
The result of the wonderful advance in the practice of sur-
gery made during the past fifteen years has been in a large
measure to revolutionize the treatment of gunshot wounds, and
inasmuch as the result of many homicidal attempts will depend
in large measure upon what the surgeon can do for the victim
of assault, it may not be amiss to very briefly epitomize in this
place something of what modern surgeons believe with regard
GENERAL MEDICO-LEGAL CONSIDERATIONS. 621
to the best treatment of bullet-wounds, expressed in a general
way. They have learned, among other things, that the harm
which a bullet does is done by it during its flight, and that
after it has come to a stop it is, per se, an almost invariably
harmless foreign body. This is practically always the case
unless it has carried in with it foreign material which may
serve as a source of septic infection.
In time past there has always been a strong feeling, which
had, however, nothing scientific to justify it, that every gun-
shot wound was a poisoned one. Of late, since bacteriology
has attained the proportion of a science, it has been held that
bullets were necessarily sterilized by the heat of the discharge
of powder behind them. Very recently Dr. B. Von Beck,
Medical Director of the 14th German Army Corps, has made
experiments upon the amount of heat imparted to leaden and
other bullets after firing. After making an allowance for
specific heat and the conductivity of the different metals used,
he found that even when the projectiles encountered resistance
from three to four times greater than that offered by the human
body the results were as follows: Temperature of leaden bul-
lets of .45 calibre, when recovered, G9° C. ; of .30 calibre, covered
with steel, when recovered, 78° C"; of .30 calibre, covered with
copper, when recovered, 101° C. He states that these experi-
ments disprove the theory that certain lesions in wounds can
be in any wa}^ attributed to the heat imparted by the bullet.
While these experiments prove that the bullets may be heated
to the above degrees when recovered, the}' by no means prove
that they are so heated at the time when they inflicted the
wound. During the j^ear 1892 some very interesting experi-
ments were carried on by Dr. Lagarde, of the Armj' Medical De-
partment {Neiv York Medical Journal, Oct. 22d, 1892, p. 458).
He experimented by deliberately infecting bullets and then
firing them into cotton, and animals as well, studying the effect
both on the bullets themselves and upon the animals. Some of
these bullets were taken from the original packages, while others
had been intentionally rolled in dirt. The experiments were
carefully carried out and appear reliable, and the conclusions
given by the author, which interest us here, are as follows:
(1) The vast majority of cartridges in original packages are
sterile or free from septic germs because of the disinfection
622 GUNSHOT WOUNDS — PARK.
and absolute cleanliness observed in the process of their man-
ufacture.
(2) The majority of gunshot wounds are aseptic because the
vast majority of the projectiles inflicting them are either sterile
or free from septic germs.
(3) The heat developed by the act of firing is not sufficient
to destroy all the organic matter of the projectile, the cherished
notions of three centuries or more to the contrary notwith-
standing.
The results as set forth justify the assumption that a septic
bullet can infect a gunshot wound. The average bullet-wound,
however, is sterile so far as infection from the bullet is con-
cerned, and in accordance with this view of its usual innocence
there need be no longer the clamor for removal of the missile
which the fears of previous generations have nearly always
called for; and the best practice among military surgeons
of to-day is rather to let the bullet remain where lodged than
to make a more serious wound for its removal. Exceptions to
this rule occur only in cases where operation is called for on
account of injury done by the bullet while still in motion. It
is also held to be a violation of simple physiological and surgi-
cal rules to probe or carelessly search for a bullet whose location
cannot be made out from a study of signs and symptoms in
a given case. The act of probing breaks up blood-clot, often
brings on fresh hemorrhage, is in a majority of cases unsatis-
factory, frequently introduces specific elements from without,
and reallj" gives little, if any, more information than can be
gathered from a stud}^ of the case without the use of the probe.
If every ordinary bullet-wound which did not call for imme-
diate operation because of injury to some essential or vital part
— such as a large blood-vessel or nerve- trunk, or some of the
viscera — were antiseptically and hermeticalty sealed at the very
outset, there would be a much smaller percentage of death from
gunshot wounds, either in civil or military practice, than now
obtains. And it might be a matter upon which to go to the
jury whether violation of such rules, to-daj^, does not mitigate
the offence of the accused.
Recent discoveries in so-called cerebral localization have
instigated numerous operations upon the skull and brain for
the relief of pressure, as from blood-clot, or for removal of de-
GENERAL MEDICO-LEGAL CONSIDERATIONS. 023
pressed bone or a bullet which twent}^ years ago would have
been impossible. The brain is no longer the terra incognita
of the past generation of medical men, and it is now often pos-
sible for the surgeon to intervene in such a way as to save life
in cases previously considered hopeless; in fact, such is now^ his
duty when consent can be gained, and it should be held that he
is culpable when deficient in general knowledge in this respect.
In wounds of the thoracic cavity it should now be held that
so long as air has entered through a bullet -w^ound there are
cases where free incision, even with removal of ribs, can
scarcely increase the dangers, while permitting ojiijortunity
for much more accurate exploration and determination of
life-saving methods. The experiments of numerous investiga-
tors, the writer included, have shown that bullet-wounds of the
heart need not be always and invariably fatal, and have afforded
an element of hope from the possible surgery of even this organ.
The writer looks forward to the time when some accomplished
yet daring surgeon, getting the right patient at the right time
and in the right place, i.e., where conveniences are at hand,
shall, in some case of perforating wound of the pericardium or
of the heart itself, resect some portion of the anterior thoracic
wall, lay open the pericardium, maintaining meanwhile artifi-
cial respiration if necessary, and suture a wound in the heart-
substance, thereafter closing the pericardium and external
wound, and save life which would otherwise be surely sacri-
ficed. With others he has done this upon animals, hence why
may it not be done in man?
In the mean time for, first, the recognition and, second, the
surgical treatment of perforating wounds of the abdominal
viscera, American surgeons have w^on for themselves the great-
est credit, and an already long list of successful laparotomies
after gunshot wounds of the intestines, wnth intestinal suture
or resection, has shown the very great value of this procedure,
even though it has kept some would-be murderers from the
gallows.
These lines are inserted here because the time and effort
wdiich surgeons have devoted to this kind of surgery deserve
only the highest encomiums and encouragement from the legal
profession, although to our deep regret they have not always
met with the same.
624 GUNSHOT AVOUNDS— PARK.
OF THE VARIOUS CONDITIONS WHICH COMPLICATE
GUNSHOT WOUNDS AND MAKE THEIR RE-
SULTS UNCERTAIN,
Delirium Tremens is one of the commonest and must
always be regarded as one of the most serious. It is well
known to surgeons that a slight injury even, and often a severe
one, is enough to provoke manifestations of this character in in-
temperate persons. The medico-legal question under these cir-
cumstances is this: Would the same amount of injury have
been likely to cause death in a person of ordinary health and
vigor? The law as applied to these cases has been stated by
Lord Hale : " It is sufficient to prove that the death of a person
was accelerated by the malicious acts of the person, although
the former labored under a mental disease at the time of the
act. The intent of the accused may often be judged by the
character of the wound and the means of its infliction. Drunk-
enness of the victim admits of no excuse when his assailant is
aware, or ought to have been aware, of the condition of his
victim. It is held that the assailant ought to have known that
violence of any kind to such a person is likely to be attended by
dangerous results. It is known also that a wound which accel-
erates death causes death." The commissioners who were ap-
pointed to define criminal law on the subject of homicide have
thus expressed themselves : " Art. 3. It is homicide although
the effect of the injury be merely to accelerate the death of one
laboring under some previous injury or infirmit}', for although
if timely remedies or skilful treatment had been applied, death
might have been prevented" (Taylor, p. 327).
Death from Surgical Operations Necessitated by-
Gunshot Wound. — The modern treatment of serious or so-
called penetrating gunshot wounds where the cranium, tho-
racic viscera, or the abdominal viscera, especially the intestines,
have been perforated one or more times, calls for surgical pro-
cedures which are of severity and danger in proportion to the
gravity of the w^ound which necessitates them, and w^iich, while
they often save life, must necessarily often fail. Indeed, such
operations may prove fatal upon the operating-table, i.e., pa-
tients may die before the conclusion of the operation. The
question may, therefore, arise whether the person who inflicted
the wound should be held responsible for his act, or whether b}^
DEATH FROM SURGICAL OPERATIONS. 625
the intervention of the surgeon the responsibility may not at
least be shifted from the shoulders of the accused. The law in
this respect is explicit and regards such operation as the out-
come of necessity and a legitimate part of treatment, so that if
it be undertaken in good faith, with reasonable care and skill,
the accused will be held responsible, be the result what it may.
The question of necessity and the plan of operation are left to
the judgment of the surgeon in charge. Considering the re-
sponsibility involved in such cases and the possibility of a suit
being raised, we should always advise the operator to secure
the counsel c2 other surgeons or practitioners in his vicinity.
The verdict of such a counsel of talent will always stand. Ac-
cording to Lord Hale, when death takes place from an unskil-
ful operation under such circumstances, and not from the
wound, the responsibility of the prisoner naturally ceases, but
the burden of proof that such has been unskilfully performed
rests naturally with the defence. It is much better also in
these cases that the primary responsibility be borne by one sur-
geon from the beginning of the case, though he may associate
with himself as many others as he chooses, since the ends of
justice have more than once been defeated by a division of such
responsibilities. Should it be made to appear that the surgeon
in charge has not availed himself of such means as are supposed
to be in the hands of exerj competent practitioner and has
neglected ordinary antiseptic precautions, it would not be diffi-
cult to show that the operation had been unskilfully performed,
and the prisoner would naturally get the benefit of such defence.
At the present date of writing there exists a large class of the
profession who still continue to do surgery according to the
views and practices of twenty or thirty years ago, and who,
while perhaps carrying out some of the forms of antiseptic
surgerj^, are still ignorant of its fundamental principles and
consequently guilty of neglect, since there is now no reason
why all should not practise them. The writer holds to the view
that if it can be shown that these precautions were not adopted
when others would have adopted them, it constitutes criminal
neglect.
On the other hand, circumstances maj^ arise where a simple
or a more serious operation would have saved life, as, for in-
stance, in cases of hemorrhage, and where a surgeon from
40
626 GUNSHOT WOUNDS — PARK.
timidit}^ or carelessness has failed to take the necessary steps.
Such neglect as this should inure to the benefit of the accused,
but when at any time it can be shown that the possible benefits
of operation have been offered to the deceased before his death
and have been declined, the surgeon at least is relieved of all
further responsibility. Among the dangers of operations under
these circumstances are of course to be reckoned those pertain-
ing to the use of anaesthetics. The surgeon in charge, however,
is responsible for the selection of his assistants, at least when
assistants are at hand, and must be regarded as equally com-
petent in this as in other features of the operation ; and even
though the patient die from collapse or the antesthetic, the bur-
den of proof must rest with the defence to show that it had
been unskilfully administered.
Note. — The assistance which the microscope may afford in
the procurement of evidence in cases of gunshot wound is
beautifully illustrated in the expert testimony reported by Dr.
James, of St. Louis, in the presidential address before the
American Society of Microscopists, in Washington, August,
1891, printed in Vol. XIII. of its Transactions. It occurred in
St. Louis, in the case of The People v. Vail, who had a pistol in
his pocket at the instant when his wife fell from a wagon
against him, knocking him, as he claimed, against the wheel of
the wagon, the pistol being discharged by accident. By a mi-
nute study of the fibres of the various textures making up his
overcoat and of the effect of the explosion of powder upon textile
fabrics almost in contact with it, he was enabled to establish
the accident and secure the acquittal of the accused.
DEATH
BY HEAT AND COLD,
INCLUDING
INSOLATION IN ITS MEDICO-LEGAL ASPECTS.
BY
ENOCH V. STODDARD, A.M., M.D.,
Emeritus Professor of Materia Medica and Hygiene in the University of Buffalo;
Member of the Medical Society of the State of New York and of the Central
New York Medical Association; Fellow of the New York Academy
of Medicine and of the American Academy of Medicine;
Late Surgeon 65th Regt. N. Y. Vols, ; Late
Health Commissioner, Rochester,
N. Y. ; etc. , etc.
DEATH BY HEAT ANJ) COLD.
TEMPERATURE OF THE BODY.
The production and regulation of heat in the body is a
problem by no means elucidated. We consider heat production
to be of internal origin, by a complex process involving tissue
metamorphosis, chemical changes in nutrient elements, mus-
cular movements, etc. Heat regulation is accomplished, not
only by variation in the loss of heat by the body, but by what
is more important, variations in the amount of heat generated.
It is an accepted physiological conclusion that there exists in
the body a thermotaxic nervous mechanism which controls its
normal, as well as its abnormal, manifestations of heat.
The average temperature of the body in health is 37° C.
(98.6° F.), in the axilla. Taken in the vagina or rectum, .9° C.
(1.3° F.) higher is noted. The daily average range of varia-
tion is about 1° C. (1.8° F.).
In disease or injury considerable variations occur; very
high, as well as very low, temperatures are met. In severe
neuroses and some forms of malarial disease a temperature of
42.2° C. (115° F.) has been recorded, and after an injury 71°
C. (122° F.).'
Very low temperatures are reported in several cases of acute
alcoholism, accompanied by exposure to cold, where a tempera-
ture of 28.8° C. (75° F.) in the rectum was noted, recovery
following. *
Such extreme temperatures, though authentic, are excep-
tional.
Very high temperatures in febrile conditions are borne be-
cause remitting; and low temperatures, subject to periods of
elevation, are met in wasting and other conditions. Very
high and very low temperatures are also noted, just before
'Reported by Teale, Lon. Clin. '^Reineke. Brit, and For. Med.
Society, Feb. 26tli, 1875. and Surg. Rev., April, 1876.
(330 HEAT AND COLD — STODDARD.
death, in acute diseases and conditions specially involving the
nervous system.
The degree to which the temperature may be raised without
destroying life has been investigated by Berger, Bernard,
Chossat, and others.'
Their experiments show that if an elevation of temperature
of the body 7.20° C. (13° F.) be maintained for any length of
time in warm-blooded animals, death ensues. Depression of
the temperature of warm-blooded animals 12° C. (20° F.), or
even less than these degrees below the normal, results fatally.
Portions of the bod}" may be frozen and yet, under appropriate
treatment, recover. But freezing of the whole body must nec-
essarily prove fatal.
Great differences in ability to endure extremes of heat and
cold appear among different nations and in different individ-
uals. The very young and the very old are unable to bear ex-
posure to extreme cold. In both, the capacity for heat produc-
tion is low and the vital powers are soon enfeebled to a critical
degree. The healthy adult can, with proper precautions, safely
endure great extremes of heat and cold. The experience of
arctic explorers in the expeditions of Kane, Nares, Greely, and
others has demonstrated the power of endurance, for a consid-
erable period, of a temperature from 00° to 100° F. below the
freezing-point. On the other hand, laborers employed in pottery
and other establishments, using ovens raised to 148° to 315° C.
(300° to 600° F.) or higher, are often exposed for some time
without injury to temperatures approaching these intense
figures.
EFFECTS OF EXTREME COLD.
Legal inquiry into the conditions of death from cold occurs
almost entirely in cases of unintentional exposure. Cold has
been employed, however, with homicidal intent. The depress-
ing influence of continued low temperatures is observed in the
death-rates of cities, in winters of protracted severity, where
the proportionate mortality among infants, the aged and en-
feebled shows marked increase. While age is a prominent
predisposing and contributing factor, other causes exist. Ex-
' "Experiences sur les effets de chaleur, etc.," Jour, de Physique, Ixiii.,
p. 77. Paris, 1805.
EFFECTS OF EXTREME COLD. 631
haustion from severe and prolonged exertion, deprivation of
food, intoxication, former illness, and other conditions of depres-
sion lessen the powers of the body to resist cold. Thus an
exposure which might be safely borne in perfect health might
result fatally in the same person in conditions of depression
just referred to (Case 1).
Investigation may be demanded in case of the death of
A. Young children.
B. The injured.
C The insane.
A. In Young Children.— This may be in the new-born
or older children.
In the new-horn exposure to cold soon causes death, as
warmth is essential to the life of the young being. The length
of time necessary to a fatal issue is modified b}' several condi-
tions. In the immature or prematurely born infant the resist-
ing power is much less than in the child born at full term and
otherwise healthy. In cases of suspected infanticide by ex-
posure the question of the maturity of the child at birth is to
be decided. Careful examination of the place in which the
body was discovered should be made as to its lack of warmth ;
and the degree of external cold at the time of probable ex-
posure should be recorded. The circumstances as to whether
the exposure was inadvertent or accidental, as in cases of pre-
mature or unexpected delivery, or whether from intentional
and deliberate purpose or from culpable neglect, should be care-
fully considered. The post-mortem examination should decide
whether the appearances and conditions of the body are those
peculiar to death from cold (Case 2).
Death ma}^ occur from culpably careless exposure to cold,
as a contributory if not as a direct cause, in such conditions of
enfeeblement. Criminal neglect to provide medical attendance,
food, and other essentials has been proven in some cases of the
so-called "faith cure" or "prayer cure." Exposure may be
resorted to with deliberate homicidal intent. It ma}', in some
cases of death, become an important legal question to decide
whether a studied and persistent neglect of this nature may
not have been followed, with the purpose of getting rid of a
troublesome care (Cases 2 and 13).
B. Exposure of the injured or -wounded, thereby in-
632 HEAT AND COLD — STODDARD.
ducing some grave condition or complication which under
proper care would have been avoided, may raise an important
question in injuries inflicted by another, with or without crimi-
nal intent. It is undeniable that serious or fatal results may
follow a slight wound, otherwise trivial, where the injured person
was subjected, accidentally or intentionally, to extreme cold for
a considerable period. "While such cases are comparatively
rare, they may demand investigation,
C. Exposure of the Insane. — While it must be admitted
that the insane subject is usually indifferent to matters of tem-
perature, death from exposure to cold may call for special
examination. Carelessness, incompetence, or wilful neglect on
the part of nurses or keepers of insane hospitals, or deliberate
criminal intent in such or others having the care of or an in-
terest in the death of an insane person may lead to a judicial
inquiry.
Sudden death has been reported as occurring, in several
cases, after the ingestion of large quantities of cold water
when the person was greatly heated. It is somewhat difficult
to explain all such cases reported on a single line of causation.
Some observers have attributed death to syncope or asthenia by
the shock produced, in the sudden effect of the cold upon the
sympathetic nervous system inducing heart failure. This
seems the most natural explanation.
Others consider the causative factor to be the formation of
thromboses in the capillaries of the brain, lungs, and other
organs, inducing active and obstructive congestions causing
death by apnoea or coma. Others regard these cases as similar
to "heat apoplexy."
Symptoms.
Under the influence of external cold, the vessels of the skin
are contracted and the internal splanchnic areas dilated. Thus
the surface of the body contains less blood and the internal
organs a larger proportion. This vascular change is one of the
important factors in maintaining the uniform temperature of
the body. The thermometer, placed in the mouth, in such con-
ditions frequentl}' indicates a rise of temperature. This is
probably due, not only to the increased volume of blood collected
TREATMENT. 033
in the internal organs, but also to an increased production of
heat through a thermogenic action.
In exposure for a time to severe cold the nose, ears, cheeks,
hands, feet, and other portions of the body, after the first ap-
pearance of dusky lividity, become bloodless and white, lose
sensation, and become congealed ; a condition known as " frost-
bite." From this, recovery without injury is possible under
appropriate treatment, by which the temperature is gradually
raised and the circulation restored. Where the latter result is
not secured, the part becomes gangrenous and is ultimately re-
moved by a process of inflammation and sloughing.
If the application of cold be protracted and the temperature
extreme, the loss of heat becomes rapid and symptoms of de-
pression of the heart's action appear. Painful sensations of the
surf ace and other portions of the body are experienced, succeeded
by impaired sensation and ansesthesia. The skin acquires a
dusk}', reddish, and livid appearance, with the formation oc-
casionally of vesicles or blisters. With the lessened sensation
stiffness of the limbs appears, due to failing muscular contrac-
tility. The congestion of the central portions of the nervous
system induces a condition of advancing stupor, resulting in
complete coma with ultimate suspension of respiration and the
heart's action.
Death from exposure to cold maj' be rapid or slow. In cases
of recovery the period of reaction is a critical one. The de-
pression of the heart is apt to continue, and gangrene of parts
of the body is likely to occur. Ulcers and sores healing with
difficulty develop in some cases.
Treatment.
In the treatment of those who are suffering from the effects
of extreme cold, the restoration of the congealed or " frost-bit-
ten" portions of the body should be gradually accomplished.
Raising the temperature rapidly is liable to induce the death
and destruction of the affected parts. Ice or snow should, at
first, be rubbed upon the frozen part, to be succeeded later by
cold water. The patient should be placed in a cool room and
distant from the fire or source of heat. As soon as warmth
begins to return the part should be enveloped in wool, cotton.
634 HEAT AND COLD — STODDARD.
or some substance of poor conducting powers. If the whole
body be chilled, frictions of the surface with stimulating lotions
are of benefit, wrapping the person in woollen or fur coverings
or garments afterward.
Hot coffee or alcoholic stimulants are of value as restora-
tives, but the latter are to be avoided during an exposure to
cold.
PosT-MoRTEM Appearances.
The appearances indicative of death from cold are suffi-
ciently marked to enable one to decide whether exposure to cold
was the chief determining cause of death, provided that a care-
ful consideration of the circumstances of season, temperature,
place, and other conditions be also had.
In the examination of a body in a case of apparent death
from cold, the limbs and internal organs may be found frozen.
It must be remembered that this occurs after, not before, death ;
and the frozen condition must not be mistaken for "rigor
mortis. "
In cases where a body is found, in freezing conditions of
atmosphere, showing commencing putrefaction, the death must
not be hastily attributed to cold, which prevents putrefaction.
It is evident that if cold was the cause of death the tempera-
ture of the body had been raised since that event, or, more prob-
ably, death occurred from other causes and the body remained
some time before becoming frozen.
The finding of a body in the snow or frozen in severe
weather must not preclude the search for other causes of death,
such as apoplexy, etc., which may have occurred anterior to the
freezing.
Observers generally have agreed upon the presence of cer-
tain post-mortem conditions in cases of death from cold.
Externally. — Upon the skin are found dusky reddish
patches, irregular in outline, which are in sharp contrast with
the general pallor of the surface. Krajewskey,' Ogston,° Die-
berg,^ and others, in the several series of cases reported by them,
all describe this condition. The skin otherwise is pale.
' Henke's " Zeitschrift, " 1860. ■' Caspar's " Vierteljahrsclirift, "
■' Brit, and For. Med. -Chir. Rev. , 1864.
1855.
EFFECTS OF EXTREME HEAT. (335
Internally. — The viscera, including the brain, are con-
gested. The heart contains a large quantity of blood in the
cavities of both sides, and the large vessels leading from it are
also full. The color of the blood is a bright red, resembling its
arterial hue. This condition has been generally noted and de-
scribed ; but some excellent observers have not referred to it.
EFFECTS OF EXTREME HEAT.
The application of moderate heat to the surface of the body
causes dilatation of the cutaneous capillaries. In such applica-
tion the exhalant and perspiratory function of the skin is in-
creased, by which means a rise in general body temperature is
prevented. If, however, severe physical exertion accompany
the exposure, a more pronounced result is induced and a de-
pressing effect upon the nervous system becomes manifest. If
the degree of heat be raised and the exertion increased and
prolonged, marked depression ensues. Under circumstances
of quiet and rest a high degree of temperature is borne by man
without depression or discomfort, but with continued and severe
muscular effort the rise in animal temperature is productive of
distress and depressing conditions. In the Turkish or Russian
baths, in the healthy subject, a temperature of 48.8° to 54.4° C.
(120° to 130° F.) produces profuse perspiration but no depres-
sion, and a plunge in or affusion of cold water is not only
borne with impunity but is acceptable. In conditions of heat
accompanied by phj^sical exhaustion, such sudden exposure to
cold would prove extremely dangerous.
In the condition of rest, exposed to external heat, the ten-
dency to elevation of body temperature arises from the external
causes alone, which in no way specially modify the nutritive
functions. But in the second condition the internal processes
of nutrition, which have been subject to great stimulation, are
suddenly embarrassed by suppression of the compensating
activity of the cutaneous surface, and severe organic and ner-
vous derangements follow.
In the summer season the temperature rises to 32.3° C
(90° F.) and even much higher in certain localities. During
the prevalence of such heat, tlie mortality among young chil-
dren, the aged and enfeebled is ver}- marked ; these two periods
636 V HEAT AND COLD — STODDARD.
of life being very susceptible to the depressing effects of heat.
A high temperature is easily borne if the air be pure and the
atmosphere be not saturated with moisture. Telluric electric
conditions also have a modifying influence, undoubted though
obscure.
In certain occupations an intensely heated atmosphere is
endured with impunity for a considerable time, provided the
air be maintained in a condition of purity and water be sup-
plied to the person exposed. The stokers upon ocean steam-
ships, where a forced draught is employed, are subjected to ex-
treme heat, sometimes reaching 60° C. (140° F.). Resort to
forced and continuous ventilation of the stoke-roums, with short
hours of duty, renders tolerance of the high temperatures
possible.
SUNSTROKE.
The terms "sunstroke,'^ "insolation," "coup de soleil,"
are applied to conditions induced, not alone by exposure to the
rays of the sun, but rather by a combination of great heat with
other exciting causes. They are used to designate attacks oc-
curring in very hot weather after exposure to solar or other
sources of extreme heat. The striking and usual phenomena
are exhaustion, unconsciousness, stertorous respiration, and
death, occurring by syncope, within a few moments or hours.
In a number of cases the symptoms of cerebral apoplexy with
death by coma are present.
In others, the condition seems one of complete exhaustion.
The majority of cases seem to be a combination of these several
conditions, with death resulting from syncope.
The ordinary phenomena of the attack are pain in the head,
hurried respiration sometimes stertorous, violent beating of the
heart with failing of its power, oppression within the chest and,
occasionally, nausea and vomiting. The pupils are sometimes
dilated and sometimes contracted, but in all cases exhibit less-
ened sensitiveness to light. The suddenness of the attack mod-
ifies the symptoms developed.
Pathological Conditions.
These are exhaustion with syncopic tendency and a rapid
rise in the temperature of the body to a point destructive to
TREATMENT. 637
the activity of the nervous centres. This is accompanied by
an abnormal condition of the blood, resulting from loss of its
watery portions, with retention of effete products and impaired
aeration. A tendency to general stasis, specially marked by
congestions of the lungs and brain, is present. The change in
the blood is a very important factor. In some cases, not fatal
at the outset, this induces a septic condition.
The greatly elevated temperature of the body undoubtedly
produces certain modifications which type it, in some respects,
as a febrile disease; but this, with the septic tendency due to
blood changes, is not sufficient to designate it as a purely
" thermal fever^" as some have claimed. It is something
more than this.
Sunstroke occurs more commonly in tropical than temperate
climates ; ' and usually in the day-time, at the period of greatest
solar activity, those attacked being engaged in labor involving
considerable exertion. It occasionally, though rarely, occurs at
night. The military service affords abundant opportunity' for
observation. Here the seizures are on the march, rarely in
camp. Fatigue, prolonged and extreme exertion, ill-adjusted
clothing and accoutrements, with the deprivation of cool water,
are fully as active factors as the heat of the sun. The death-
rate ranges between forty and fifty per cent, the mild cases
being excluded. Death in some cases is marked by syncope,
in others by apnoea, though the majoritj'' seem to die by a com-
bination of both, as in most cases the pulmonarj" congestion is
more or less pronounced. Undoubtedly the character of the
symptoms and mode of death are influenced, in many cases, by
individual tendencies leading to apoplectic conditions or to car-
diac or other complications.
Treatment.
This must be adjusted to the pathological conditions of the
patient. As already indicated, two classes of cases are met:
one marked by exhaustion, with tendency to death by syncope",
the other, a state of or tendency to cerebral congestion or apo-
plectic conditions. Exactly opposite methods of treatment are
'Fliut, " Practice of Medicine, " p. 685; Aitken, "Practice of Med-
icine," vol. ii., p. 388.
638 HEAT AND COLD — STODDARD.
demanded. In the first, frequenc}' and feebleness of the heart's
action, with faintness of the heart sounds and embarrassment
of respiration, indicate the tendency to death by nervous ex-
haustion, and must be met by placing the patient in a condition
of absolute rest and quiet in a cool place. Stimulants must be
promptly administered, though cautiously on account of the
tendency to nausea and vomiting. Hypodermic injections of
alcohol or ether, or rectal enemata of turpentine, alcohol, or
other stimulants, afford means of securing speedy effects when
the stomach is irritable. Carbonate of ammonia and other
cardiac stimulants are recommended. Depleting agents, or
such as prove depressing, are to be avoided. In some cases,
hypodermic injections of small doses of morphine prove bene-
ficial. Individual cases must modify therapeutic procedures.
In the second class of cases the tendency to cerebral conges-
tion indicates sedative and depleting procedures. Blood-letting
has been recommended by some authors, if employed with ex-
treme judgment and discrimination.' Cold applied to the head
and also to the whole body by rubbing with ice '^ or by effusion
and the wet sheet, or other means, is indicated if the tempera-
ture is high (104:° to 105° F.). Active catharsis, by promptly
acting purgative enemata, is also to be resorted to in most
cases. The convulsions occurring in some cases are success-
fully modified and controlled by inhalations of small quantities
of chloroform.
PosT-MoRTEM Appearances.
These, though not clearly characteristic, are pronounced.
In some cases no distinct conditions are found. ^ Local conges-
tions are present in nearly all cases. Upon the skin are found
petechial and livid spots, pallor being occasionally noted. Ec-
chymoses and subserous hemorrhages are also common. These
conditions have been described as resembling those of spotted
typhus (Levick).
Rigor mortis is marked and occurs early, putrefaction be-
ginning soon after death. The lungs are highly congested and
'Flint, "Practice of Medicine," -Levick, Amer. Jour. Med.
p. 685 ; Aitken, " Practice of Med- Sciences, Oct. , 1866.
icine, "vol. ii., p. 391. ^Katzenbach, New York Med.
Jour., vol. xvii., p. 91.
BURNS AND SCALDS. G39
often oedematous, and effusions of serum are frequently found
in the pleural cavities/
The heart is usually changed in color and consistence, with
the left ventricle contracted and the aorta empt}', while the
right ventricle and pulmonary arteries are dilated and engorged.
The blood is fluid and dark." The large vessels of the pia and
dura are full of dark blood. Congestion of the cerebral mass
is not always noted. The ventricles contain serum; and ex-
travasations of blood into the cervical sympathetic ganglia and
vagus are sometimes found. The kidneys are usually moist
and oedematous ; the liver and spleen congested and dry.
BURNS AND SCALDS.
For all purposes of practice it is unnecessary to draw any
distinction between a burn and a scald, for in reality none ex-
ists, except as regards the nature of the causative agent. In
some cases requiring investigation, this may prove to be a mat-
ter of much importance.
Definition. — A burn is an injury produced by the apjolica-
tion to the body of a heated substance, flame or radiant heat.
A scald is an injury produced by the application of a
liquid at or near its boiling-point.
Appearances as Indicating Origin.
A hot body maj- produce a burn of any intensity, ranging
between reddening of the skin and complete charring of the
tissues, according as its temperature is elevated and the period
of contact prolonged : the shape of the object and its size being
indicated by the form of the burn. Metallic substances heated
to a temperature of 100° C. (212° F.) are capable of producing
redness and vesication and other injurious effects. At this
temperature the albuminous elements of the blood and other
fluids undergo coagulation. Some bodies require to be heated
to redness, or nearly so, in order to produce a defined burn.
Very hot and partiallj^-fused solids cause burns of greater
severity than where the heated body is of a character favoring
' Wood, Phil. Med. Times, Aug. ■ Hanfield Jones, Brit. Med.
5th, 1876. Jour., July, 1870, p. 35.
640 HEAT AND COLD — STODDARD,
prompt removal. In such cases their adhesion to the skin in-
volves the tearing away of the superficial portions of the derma
in their removal, or they by their adherence prolong the con-
tact of the heated body, thus intensifying their destructive
action.
Metals in a state of fusion produce burns which can-
not be easily distinguished from those caused by solid bodies.
Such burns are classed as scalds. Their effects may vary in
any degree between slight redness and complete destruction of
the tissues with charring. Burns caused by melted solids are
less regular in form and outline than those caused by heated
solids. They are usually of greater severity on account of the
high temperature to which they have been raised.'
Boiling Water. — Scalds by boiling water maybe so slight
as to produce redness only, or they may be so severe as to cause
marked and characteristic symptoms. Those noted in severe
cases are an ashy hue of the skin, accompanied by a soaked or
sodden appearance and the production of blisters. Occasion-
ally these features are not easily distinguished from those of
burns from other sources. Blackening of the skin and charring
of the tissues never result from burns by boiling water. As in
all burns, a large surface involved renders an early fatal issue
probable. In severe cases, not necessarily fatal, gangrene of
the parts injured sometimes occurs. Most of those met with
are accidental, yet cases of scalding by hot water with intent
to injure are not uncommon, aside from injuries and death
resulting from explosion of boilers, bursting of steam-pipes, etc.
Occasional instances are recorded of death of children, the in-
sane or feeble persons by inadvertent immersion in a bath of
hot water (Case 21).
Severe and fatal burns of the mouth, fauces, and larynx in
j'-oung children occur from inhaling steam or swallowing boil-
ing water from a teapot or kettle in an attempt to drink
(Case 5).
Burns by burning oil produce effects and appearances
similar to those b}' melted metals.
Burns by flame are specially characterized by scorch-
ing of the surface. Hairs upon the part actually burned are
scorched and usually also those in the vicinit}^ of the burned
' Pouillet, Comptes Reudus, 1836, p. 782.
APPEARA^XES AS INDICATING ORIGIN. 641
patches. Such conditions could not result from scalds by hot
water, boiling oil, or from a hot body only.
Burns by petroleum or its derivatives resemble the
burns from flame, except that the injured portions of the body
are not only scorched but blackened and are usually burned
more severely than by flame alone, as the clothing holds the
burning substance in contact with the parts. The odor of the
agent is also very noticeable.
Burns by Acids and Corrosive Agents. — The injury
produced by a mineral acid, the caustic alkalies, etc., has fre-
quently been the source of judicial inquiry. " Vitriol-throwing, "
as it has been termed, has been and occasionally is resoited to
with malicious intent to injure. No case of death resulting
directly and solely from this cause is recorded, but grave in-
juries, involving loss of sight, etc., have resulted. A case is
referred to by Taylor ' where sulphuric acid was poured into
the ear of a woman while asleep by her husband. Death en-
sued, after six weeks, from disease of the brain resulting in-
directly from the use of the acid.
The appearances of a burn by a mineral acid are distin-
guished from heat burns with little difficulty. The eschar
which results is not dry and leather}^, as in a burn by heat, but
soft and readily sloughing away. There is no redness around
the site of the injury, the color of the burn being uniform, and
no blisters are formed. There is no blackening of the skin and
the hairs are not scorched. The color of the skin around the
injured portion may afford valuable evidence of the nature of
the agent employed. Nitric acid produces a yellow stain, sul-
phuric acid a dark brown, and chlorohydric acid a brownish-
yellow stain. "^ The clothing also is capable of affording char-
acteristic evidence b}^ the discolorations produced; and the
destructive agent employed may be determined by a chemical
analysis of the fabric.^
It is not possible to distinguish a post-mortem from an ante-
mortem burn by an acid when no vital reaction has taken
place.
'Taylor, "Med. Jurisprudence," '^ Chainbert, Annales d' Hygiene.
8th Amer. Ed., p. 444; also the 1859.
Med. Gazette, vol. xviii., p. 89. ^Buchner, Prager Vierteljahr.,
i., p. 139.
41
642 HEAT AND COLD — STODDARD.
THE CLASSIFICATION OF BURNS.
A classification of burns according to the severity of the
injury inflicted is the most practical course. Upon this plan,
1)arns may be divided into four general classes:
I. Burns in which the skin or subcutaneous cellular tissues
only are injured.
II. Burns which involve the muscles, nerves, and blood-
vessels.
III. Burns involving the internal organs and bones.
IV. Burns in which the other three classes are variously
mixed.
Class I. — The skin in cases such as may occur from a
brief contact with a hot body or water near the boiling-point
shows a slight redness or scorching with no enduring mark.
Pain is considerable.
Class II. — In the mildest cases the cutis is destroyed in its
whole thickness, and the parts injured are occupied by eschars
of a yellowish -gray or brownish color. The surrounding skin
is reddened, and the formation of blisters occurs either imme-
diately or after an interval of a few hours. In these cases a
shining cicatrix remains after the healing, without contraction
of surrounding parts. In the severer cases the subcutaneous
cellular tissue and underlying muscles and nerves are destroyed.
The blackish eschars formed are insensible and separate by sup-
purative process, leaving a granulating surface below. Ex-
tensive redness of surrounding tissues, with more or less vesi-
cation, is usuall}" noted. The resulting cicatrices, together
with the skin and adjoining structures, are prone to contraction,
resulting in considerable deformity, according to location and
extent. So great is the deformity in injuries of the extremities,
or even some parts of the head and trunk, that extensive sur-
gical operations become necessary to relieve it.
Class III. — Burns of this class are so severe that an imme-
diately fatal issue is usually the result. Such instances in-
volve a prolonged exposure to flame or to a source of intense
heat. The appearances described as belonging to the preceding
class are in part found here with the addition of charring or
carbonizing the parts destroj^ed.
EFFECTS OF BURNS. G43
EFFECTS OF BURNS.
The effects of burns may be considered as I., Locals and
II., Constitutional.
Local Effects. — In different instances the effects vary in
accordance with the extent and severity of the burn. Redness,
bhsters, destruction of the cuticle and of the subcutaneous cel-
hilar tissue, blackening of the skin, scorching of the hair, and
roasting of portions of the body are met with in varying
degrees. In some severe cases all these are found upon a sin-
gle body. The redness produced varies in intensity and extent,
according to the nature of the agent producing the burn, its
form, and the length of time the part was exposed.
Very soon after the infliction of the burn a special lino of
redness appears between the burned parts and the uninjured
skin. This red line of demarcation is formed by intensely
injected vessels and becomes a very important medico-legal
sign in some cases. The vesication may be single or multiple,
consisting of one or two large and full blisters or a number of
large and small ones, scattered over the portions burned, some
unbroken and still holding their contents, others broken and
denuded of cuticle or with breaks from which their serum has
escaped upon the surrounding parts. In some cases of burning
cracks or fissures in the skin occur, due to the effect of the
heat, making it dry and brittle and causing it to rupture by the
movements of the patient (Case 8). These fissures are most
frequently noted in proximity to the joints.' They resemble
wounds, and it occurs occasionally that it is important to accu-
rately distinguish their character. In some cases the skin only
is fissured ; in others the subjacent tissues are also involved.
This difference depends upon the depth of the burn. In the
first condition the skin splits, leaving the subcutaneous fat
exposed, which in some instances is partially melted by
the heat and flows out over the edge of the crack upon the
surrounding skin (Cases 8, 13). The blood-vessels in such
cases usually are not burned and, owing to their elasticity,
remain stretching across the fissure (Case 14). The smaller
may be seen by careful examination with a lens : they should
'Tidy, " Legal Medicine, " vol. ii., p. 124.
644 HEAT AND COLD— STODDARD.
always bo looked for. In the second class of injuries the ves-
sels are involved in the burn and break with the cracking of
the skin. The importance of careful observation of these fis-
sures is emphasized in cases of apparent wounds associated
with burning. It may be necessary to decide whether the
wounds are the result of the action of heat as above described
or were caused by some sharp instrument or weapon. Careful
inspection of the edges of the wounds will show whether they
are ragged, as the result of fissure, or clean-cut by some sharp
instrument. The absence of evidences indicating hemorrhage
upon the surrounding parts and the detection of uncut blood-
vessels extending across the fissure will establish the differen-
tial diagnosis. Wounds of the above character resulting from
the action of fire may exist on the same body with wounds of
actual violence. It is important, therefore, in all cases to ex-
amine each wound with special care and record its position,
shape, depth, and other characteristics.
Constitutional Effects. — As in all sudden and violent
injuries, the effect of a severe burn upon the nervous system is
very marked. This is manifest in the symptoms of "shock,"
with pallor and coldness of the surface of the body, a feeble
pulse, chills or shivering, and a tendency to collapse. In other
cases, proving immediately fatal, these symptoms are followed
by obstructed respiration with death from coma succeeding.
In other cases convulsions precede death, while in such as are
not immediately fatal a reaction more or less imperfect ensues
upon the first constitutional symptoms.
Death from cerebral congestion or effusion may result be-
fore any definite evidence of reaction aj)pears. In some in-
stances pulmonary congestion or oedema occurs, with or with-
out pleural effusion, terminating in death before reaction. This
period usually covers the first two days. In some cases im-
mediate death results from the depression produced bj' the
severity of the pain. During the subsequent two weeks a
period of inflammatory reaction succeeds, when inflammations
of the thoracic and abdominal viscera, with ulcerative processes
in some organs, are developed and induce a fatal termination
(Cases 10, 11, 16).
causes of death. (345
Causes of Death.
The causes of death are due to several conditions. This fact
is explained in part by the relation which exists between the
cerebro-spinal and sympathetic nervous systems, and of the
nervous supply of the surface to that of the internal organs,
which in cases of extensive injury proportionately modify the
conditions of the visceral organs. As death in burning results
from various causes, it is convenient to consider them under
two classes :
1st. Those immediately fatal.
2d. Those fatal after an interval.
The FIRST DIVISION would include cases in which the
deprivation of fresh air and the presence of asphyxiating pro-
ducts of combustion (carbon monoxide and carbon dioxide)
were the immediate causes of death by suffocation or asphyxia
(Cases 9, 18).
Accidents in endeavoring to escape or injuries by falling
walls or timbers may cause death immediately, and burning
the body occur subsequently.
Immediate death may result from syncope or collapse from
the violence of the shock to the nervous system by the pain
resulting from the burns.
The second DIVISION includes those conditions where death
may result early, from a series of causes less immediate than
those just mentioned.
Cerebral congestion and effusion, resulting in death from
coma, is not unusual (Case 15). In this connection Ta3'lor '
cites a case of alleged poisoning by opium, in the treatment of
a burn, in a child dying comatose, and emphasizes the unde-
sirability of administering opium or its preparations to chil-
dren in cases of burns of any severity. The danger claimed to
exist is hardly to be considered. In the case referred to, Aber-
nethy, who was a witness in the case,' ascribed death to coma
induced by the effect of the burn. The powerfully depressing
influence of the pain in sensitive organizations and liability
to death from shock therefroni must be remembered.
Inflammatory conditions of the respiratory tract or organs
'Taylor, "Med. Jurisprudence," 8th Amer. Ed., p. 407.
646 HEAT AND COLD — STODDARD.
are common resuha ; pneunionia, broiichitis, and sudden con-
gestion or oedema of the lungs are frequent (Cases 11, 15,
16).
Inflammation of the intestines, inducing peritonitis and
ulcerations of the intestines with or without resulting hemor-
rhage, occurs as a, frequent lesion (Case 10).
Gangrene or sej:)ticcemia causes death in other instances.
Exhaustion, from extensive and prolonged suppuration or
from severe and long-continued pain and other conditions, ter-
minates other cases (Case 12).
Legally, burns and scalds are included among injuries en-
dangering life, but are not described as wounds. -They may bo
considered dangerous according to the extent of surface which
they cover, rather than the depth to which they involve the
tissues.
The extensive injury to the sensory nerve structures and the
suspension of function or destruction of a considerable portion
of the perspiratory tracts render large superficial burns far more
fatal than those confined to a small part of a limb, for example,
which may be deeply burned. From a medico-legal point it
is desirable to establish the fact of how large a surface must
be injured to prove fatal. The effort to reduce the subject to
a statement of an exact minimum area of square inches seems
very objectionable and liable to lead to erroneous conclusions.
It is possible to make a general statement, subject to some
qualifications, which may serve as a basis of conclusion, as
each individual case must be considered in its own circum-
stances.
A burn involving two-thirds of the body may be regarded
as necessarily fatal ; but the injury of a much less proportion,
even one-fourth of the surface, has resulted in death. The
qualifications to be made in burns of less extent are pro-
nounced. The parf q^ecfed is of much importance. Burns of
the trunk are more fatal than those of the extremities; and
those of the genital organs ' and lower par^j of the abdomen
are especially so (Case 7).
The character of the burn, whether single and continuous
or multiple and scattered over various portions of the bod}", is
a very important modifj^ing circumstance, involving the ques-
'Tidy, "Legal Medicine," vol. ii., p. 99.
TREATMENT — POST-MORTEM APPEARANCES. 647
tions of excessive pain and the difficulty in insuring necessary
treatment for all parts injured.
The physical condition of the patient and sensitiveness of
the nervous system to pain exert a powerfully determining in-
fluence. Burns in children and sensitive, nervous females are
specially serious and call for an unfavorable prognosis.
Spontaneous Combustion. — Spontaneous combustion of
the human body has been seriously discussed in this connection,
and explanations of popularly reported cases have been at-
tempted. The writer refers to the subject here for the sole pur-
pose of stating that no trustworthy evidence of the possibility
of any such condition or result exists.
j Treatment.
In cases of severe burns the constitutional as well as the
local conditions demand attention. Locally, a great variety of
applications has been employed : starch, gum, oxide of zinc,
solution of caoutchou, collodion, cotton wadding, a mixture of
linseed oil and lime-water on cotton or lint, and many other
agents are used. The important consideration is to exclude
the air from and to afford a protective covering for the injured
surface. The constitutional treatment varies in different cases ;
but its main object is to relieve pain, induce reaction from the
shock, and support the depressed nervous system.
For the first opium or its preparations in proper doses is
indicated. Alcoholic stimulants in some cases are demnnded
in addition. After the stage of reaction has occurred the
therapeutics must be governed by inflammatory conditions ; or
later by the exhaustion from continued pain, suppuration, etc.
Post-Mortem Appearances.
In the external post-mortem examination of a burned
body careful note should be made of the sex, probable age, and
every circumstance leading to the establishment of the identity
of the individual. The parts burned should be specially exam-
ined as to their condition, whether exhibiting redness, vesica-
tion, or charring. The amount of surface covered by the burns
should be computed ; also the relation of the burned parts to
G48 HEAT AND COLD — STODDARD.
those uninjured, whether separated by a sharply marked line of
redness or merging into the sound skin without a line of
demarcation. The condition of the blisters should be examined
as to whether they are full or empty and their contents as to
whether consisting of clear or turbid serum.
Internally. — In some cases no lesions are found on exam-
ination. These are usually cases where death occurred from
shock or severe pain (Case 12). Ordinarily the mucous mem-
brane of the respiratory tracts is congested. In some instances,
however, no redness has been discernible. Where death oc-
curred by suffocation and asphyxia, the trachea and bronchial
tubes have been found to contain a dark smoky or sooty mucus'
(Case 9).
The serous membranes of the brain, thorax, and abdomen
are in many cases found reddened with effusions, more or less
considerable, into the ventricles of the brain and the pleural,
pericardial, and peritoneal cavities from the sudden inflow of
blood from the surface, caused by the local injuries.
When the body has been badly charred or incinerated the
skeleton usually remains, and it is possible to determine the
age from the size and development of the bones and the sex
from the shape of the bones of the pelvis. Careful search
should be made for special articles of identity. False teeth," a
watch and chain, buttons, etc., have alone been sufficient to
identify the incinerated remains (Case 23). Where the whole
body and even the bones have been reduced to ashes, some por-
tions of bone, etc., may be found on careful search. Sifting
the ashes will give some pieces of bone, etc., which may be
sufficient to disclose the presence of human remains^ (Case
24). A chemical analysis of the ashes also will aid in estab-
lishing this fact. In cases where cremation of the body has
been resorted to to conceal crime, the length of time necessary
to entirely consume the human body may become an important
question. A period of less than ten hours has been proven
sufficient.^
'Caspar, "Forensic Medicine," ^Report of the "Druse Case."
vol. i. , p. 314; Schjerning, Vier- Trans. New York State Med. Soci-
teljahr. fiir gericht. Med., xli., 1884. etj'. 1887, p. 417.
-The "Parkman Case, " Boston, •* See the Druse Case above.
1850.
PERIOD OF THE OCCURRENCE OF DEATH. (JiO
Period of the Occurrence of Death,
As already indicated, death may occur from direct causes
during the first forty-eight hours after the infliction of the
burn, or may take place during a period extending from the
second daj' to the fifth or even the sixth week. In the great
majority of cases the fatal result occurs during the first five or
six days. In some instances it may be important to establish
the fact as to how long after the infliction of the hum the
person may have survived.
Inflammation and suppuration would not ordinarilj' begin
until about the third day, hence the existence of this condition
would indicate that the person had probably lived two days or
more; and the state of advancement of these processes would
afford some further evidence. The existence of intestinal in-
flammations and ulcerations, which require some days for their
appearance and development, would also give some indication
of the probable time elapsing.
WAS THE BURN ANTE MORTEM OR POST MORTEM ?
In describing the anatomical characters of a burn occurring
during life, vesication, the formation of blisters, is regarded
as a marked symptom.
While it is not an invariable result in a burn of the living
bod\% it is so constant as to become one of the most important
factors in answering the question as to the ante- or post-mortem
infliction of the burn. Where the burn has been caused by a
scalding fluid, or by burning of the clothing, or the direct ap-
plication of flame, blisters are more likel}^ to occur than where
contact with a highly heated body has taken place. In the
formation of a blister the cuticle is raised from the derma or
true skin by the effusion of a highly albuminous serum, and
the surrounding skin is of a bright or copper}^ red color. The
time of the appearance of such a blister is not fixed. It may
occur almost immediatel}' or may not do so for several hours,
an interval sufficiently long for death to occur from shock. It
must be remembered that a burn inflicted in a condition of
great depression of the vital powers with insensibility may be
GoO HEAT AND COLD — STODDARD.
followed by no vesication or redness, but upon reaction and
return of sensation both redness and blisters may appear
(Case 17). In the absence of blisters, therefore, it cannot be
decided that for this reason the burn was post mortem.
If from a blister formed on the living body the cuticle be care-
fully removed, the site of the blister will present an intensely
reddened base. In the dead body, if the cuticle be removed, no
red base appears, but the surface of the blister becomes dry and
of a grayish color.
On the other hand, if the presence of blisters is noted, can
it be concluded that the burn was ante mortem? While their
presence affords reason for an affirmative answer, careful exam-
ination of the blisters as to their character and contents must
be made in order to decide ; the presence of apparent blisters is
not alone sufficient (Cases 20, 18; Plate II.).
Elaborate experiments have been made in order to decide the
possibility of producing blisters post mortem.
Leuret,' in experiments upon dropsical subjects twenty-four
hours after death, shows the possibility of raising a blister
post mortem, but one which can be distinguished from one of
ante-mortem production, in that it contains a reddish serum
very slightly albuminous. He urges extreme care in deciding
this question.
Christison ' found it impossible to produce a blister a few
hours after death. In a patient unconscious from narcotic
poison, heat applied four hours before death produced a blister
and a red line was formed around the burns. In the burns pro-
duced half an hour after death, in the same patient, blisters
formed in two places only, and these were covered by dry skin
and contained air. No redness appeared around them.
Champouillon ^ agrees with Leuret in his conclusions, from
experiments upon dropsical subjects.
Kosack ^ considers blisters with albuminous contents diag-
nostic of burns during life, but states the necessity for care in
deciding in the absence of other signs of reaction.
Wright ' was able to produce blisters three and a half hours
' Annales d'Hygiene, 1835, ii., ^ Friedrich's Blatter f. gericht.
p. 387. Med., 1877, Heft iii., p. 210.
'^Edinb. Med. and Surg. Journal, ""Path. Research, on Vital and
Tol. XXXV., p. 320, April, 1831. Post-Mortem Burning, " 1850.
2 Ann. d'Hygiene, 1846, i., p. 320.
WAS THE BURN ANTE MORTEM OR POST MORTEM? 651
after death containing a small quantity of pale serum. On
the same body, similar experiments fifteen hours after death
produced blisters containing no serum.
Caspar ' states, as a result of experiments, that blisters may
be produced b}^ flame after death ; that they result from vapor-
ization of the fluid beneath the cuticle by the heat employed ;
that they are not found to contain serum and no line of redness
is found at their base. The presence after death of vesications
containing serum and surrounded by a reddish base is an evi-
dence that the burn was inflicted ante mortem. He distinctly
says : " It is quite impossible to confound a burn inflicted dur-
ing life with one inflicted after death. "
Woodman and Tidy,^ in an extended series of experiments,
conclude that while blisters can be produced post mortem, they
are readily distinguished from those formed ante mortem in
containing no serum; and even in dropsical subjects, where
blisters containing some fluid were formed, the presence of but
a mere trace of albumin was shown; and, in all, no redness
about the base of the blisters was produced, nor any appearance
of redness after removal of the cuticle,
Taylor ^ has never observed vesications in post-mortem ex-
periments on infants. He cites a case of drowning where the
person, "pulseless and apparently dead,"' was imprudently
placed in a hot bath. Blisters containing blood}^ serum were
formed over several portions of the bod3^ He concludes that
hot water on the living and recently dead body, so far as vesi-
cation is concerned, produces similar effects.
In experiments on the dead body immediately after death
the writer has failed to produce any blister containing serum
or fluid. The so-called blisters are produced by the rapid ex-
pansion and evaporation of the fluid beneath the cuticle over
the portion to which the heat was applied, and differ distinctly
from blisters caused during life, in the absence of serum or any
redness of adjacent or subjacent parts (Plate II.).
Chambert^ concludes that in living bodies and in dead
bodies within twenty-four hours after death blisters can be
produced, and that less heat will develop them in the living.
'■'Forensic Medicine," vol. iv. , ''"Med. Jurisprudence," Amer.
p. 399. Ed., lyyo, p. 40S.
-"Forensic Medicine," Ed. 1877, ^ Aniialos d'Hygiene, 1859, 2d
p. 886. ser., xi., 343, 379.
652 HEAT AND COLD — STODDARD.
He specially emphasizes the difference, in the albuminous char-
acte: of the contents, of a blister formed ante mortem and of
one formed post mortem.
Jastrowitz ' emphasizes the difference between blisters formed
during life and those occurring in oedematous conditions.
Blisters are to be distinguished from the bullae arising from
putrefaction. There is little danger of confounding such cases.
In conditions of putrefaction no redness or line of demarcation
exists, and the green discoloration and other conditions of the
skin will suffice to establish the diagnosis.
Schjerning ^ considers blisters containing highly albuminous
serum as diagnostic of burns produced during life. In some
conditions of depression of nutrition blisters occasionally form,
but are not liable to be confounded with those caused by
burning.
A second anatomical feature of much importance, even more
so than vesication, is the condition of the skin to which the
heat was applied. It assumes a dusky red color and a dry
and parchment-like condition (Case 8). Surrounding this is
an area of grayish-white skin bounded by a sharply defined
and deeply injected red line, which in turn shades into the
color of the surrounding skin. These features are more or less
pronounced according to the degree of heat applied and to the
length of time of contact ; or, in other words, to the depth and
severity of the burn (Plate I.).
MEANS OF DISTINGUISHING ANTE-MORTEM FROM POST-
MORTEM BURNS.
Differentially, a distinction is to be made between the sur-
rounding redness and the line of redness. The redness due
to capillary distention is transient, disappears under pressure
during life, and fades after death. The line of redness is per-
manent, changing but little under pressure, and remains after
death. It is a vital reactionary effort, a true line of separation
between living and dead tissue, formed in the same manner as
the line of demarcation in sphacelus or gangrene. This line
of redness, developed only during life and permanent after
' Vierteljahr. f . gericht. Med. , - Eulenb. , Vierteljahr. f . gericht.
Bd. xxxvi., Heft i., 1880. Med., xii., 1885, xlii., 1887.
MEANS OF DISTINGUISHING BURNS. 053
death, is of great significance in cases with a medico-legal
bearing. It has been already stated that in persons in a con-
dition of depressed vitality the appearance of redness and vesi-
cation is sometimes very tardy and imperfect, and that death
from shock or pain may occur before their development at all.
They are vital processes and require time for their appearance
in proportion to the activity of the powers of reaction. Hence
in cases of burning resulting fatally where vesication and red-
ness do not appear, the circumstances must be carefully con-
sidered before deciding that the burns produced were post
mortem. With these qualifications, it may be stated that the
presence of the red line is almost uniform in burns inflicted
during life and absent in those occurring after death.
If upon a body bearing evidences of exposure to heat there
be found blisters containing highly albuminous serum, and such
blisters, after the removal of the cuticle, present a bright red
base surrounded by a bright and sharp line of demarcation,
with redness of adjacent surface, we are justified in concluding
that the burns were inflicted ante mortem or, at farthest, within
a few moments of death. If, on the contrary, the red line is
absent and the blisters contain a thin watery fluid, with a yel-
lowish and dry condition of their base after removal of the
cuticle, the presumption is that the burning occurred post
mortem.
Where a number of burns are found upon a body, the ques-
tion whether they were produced simultaneously may be
raised. This can be answered by examination as to their con-
dition. If some show signs of recent infliction, while others
are in conditions of suppuration or other changes which only
occur after an interval, a difference of time in production would
be probable. But if all present mainly the same conditions,
the probability of their occurring at the same time may be con-
cluded (Plates I. and II.).
The Condition of the Blood.— Special examination of
the blood of persons dying from the effect of bums has been
made by competent observers. While it is not at present
possible to define an exact and constant condition, speciallj'-
characteristic, some features of interest have been recently
recorded.
The color of the blood has been variously reported ; in some
654 HEAT AND COLD — STODDARD.
cases as being of a dark color and in others of a bright ar-
terial hue. Death by asphyxia or suffocation, by the depriva-
tion of oxygen, and by the products of combustion, would be
accompanied by a dark or venous hue of the blood. An atmos-
phere containing an excess of carbon monoxide, resulting from
combustion, would cause death by apnoea with an arterial hue
to the blood.' But other influences must be considered. Ac-
cording to Schjerning,^ it is difficult to deduce positive conclu-
sions from the condition of the blood. The changes induced by
the spleen and kidneys, as well as the varying intensity of the
degree of heat to which the body may be subjected, tend to
render positive and constant conclusions from this source dif-
ficult.
Falk ^ refers to the bright red color of the blood found in
some cases, and explains this condition in part by the influence
of chemical changes in the tissues surrounding the vessels.
Wertheim * describes certain conditions observed by him
and mentions an increase in the number of the leucocytes, to-
gether with the presence of haemoglobin and melanin.
Hoppe Seyler meets with similar results and arrives at the
same conclusions in his observations.
Ponfik,'on the contrary, is doubtful of the constant presence
of some of these conditions and also of their diagnostic value.
Seliger " confirms the conclusions of Wertheim, in that he
describes the presence of crystalline bodies and of dark dis-
colorations (melanin).
Some spectroscopic analyses have disclosed the presence of
bands additional to those of normal blood. The lack of uni-
formity of conditions described and of conclusions reached
leaves the subject in a position of uncertainty. Examination of
the blood of those dying from burns has not been so exten-
sively and minutely followed as to enable us to decide questions
which may arise in any case.
^Tidy, "Legal Med.," vol. i., p. -iWien. med. Presse, 1868, pp.
108 ; also Buzzard, London Lancet, 309, 605.
vol. i., p. 60, 1863. ^Berliner klinische Wochen-
«Euienberg's Vierteljalir. f. ger- schrift, 1876, No. 17: 1877, No. 46.
icht. Med., xli.,p. 4A et seq. ''Eulenberg's Vierteljahr. f. ger-
3 " Die Verbrennungen und Ver- icht. Med. , xlii. , p. 47.
briihungen. "
EXPLANATION OF PLATE IL
FIGURE 1.— ANTE-MORTEM BURN.
Scald by steam from a boiler bursting, July, 1892.
From a photograph taken sixty hours after the accident. The in-
jury covered one-half of the surface of the body. The red line is
sharply marked ; the extensive blisters formed are broken and their
contents have escaped ; the serum drying has produced yellowish dis-
colorations; the blush of redness on adjacent parts is well marked.
Death resulted on the fifth day.
FIGURE 2.— POST-MORTEM BURN.
Exp. 1. (Appearances after application of a tin can containing
boiling water.) The cuticle was raised by expansion. The blisters
contained no serum and no red line is developed
FIGURE 3.— POST-MORTEM BURN.
Exp. 2. (Appearances after the application of iron at a dull red
heat.) No proper blister formed; the cuticle was raised, as in pre-
vious experiment. There was no serum and no red line or redness
of adjacent parts. The cuticle is charred at one point, where the iron
was brought into contact with it.
MEDICAL JURISPRUDENCE— PLATE
"5^1^ ^^
Burn, Two hours after death, by Iron at a dull red heat.
■<« jS'
Burn, Two hours after death, by Tin Can containing boiling water.
tftiOL
Burn by Steam, Sixty hours after injury.
POST-MORTEM AND ANTE-MORTEM BURNS.
WAS DEATH ACCIDENTAL? 657
WAS DEATH ACCIDENTAL, SUICIDAL, OR HOMICIDAL ?
Nearly all deaths occurring from burning are accidental,
very few homicidal, and hardly more than a few exceptional
cases suicidal.
It is important in cases of legal investigation to note the
position of the body when found and its relation to the ap-
parent source of fire; the parts of the body and clothing burned,
etc. ; evidences of violence should be carefully observed, such
as contusions, fractures of bones, wounds of the soft parts,
evidences of strangling, etc. (Case 22). These should be spe-
cially sought in the site of the burned portions, as burning and
cremation of the victim are sometimes a resort to conceal homi-
cide. In considering the character of the apparent wounds, it
must be remembered that extensive injuries, resembling wounds,
may result from the effects of fire,' and these must be carefully
distinguished.
Inability to detect special marks of violence need not preclude
the possibility of its commission and of its being a possible cause
of death (Case 19). The parts burned, the character and
depth of the burns, and their relation to the apparent source of
burning, with consideration of their probable simultaneous ex-
posure, are all circumstances of weight in forming an opinion.
The position of the body in relation to the fire should also be
considered. In accidental burning, except in cases of intoxica-
tion, epileptic seizures, or other sources of helplessness, the vic-
tim is quite likely to be found at a distance from the fire, owing
to his efforts to escape.
CASES.
Case 1. Death from Cold. Accidental (Dr. Hilty in Caspar's
Vierteljahrschrift, II., 1865, p. 140). — Male, a!t. 52; intoxicated.
Severe winter weather ; death from exposure. Post mortem : Blood
crimson ; both sides of heart full ; internal organs congested.
Case 2. Criminal Exposure to Cold {Ann. d' Hygiene, 1868,
Vol. II., p. 173). — Girl, unmarried; sudden delivery when at stool.
She stated that she had fainted, and found the child dead when she re-
'See page 043 of this section
42
658 HEAT AND COLD — STODDARD.
covered. The child had breathed and the cord was cut. No marks of
violence. Evidence of death being caused by wilful exposure. Im-
prisoned.
Case 3. Ill-Treatment and Criminal Exposure (Ann. d'' Hy-
giene, Vol. VI., p. 207, 1831). — Man and wife tried for manslaughter
of a child, aet. 11. Wife the stepmother. Starvation and ill-treatment
by mother, followed by forcing the child, in a cold December day, to
get into a barrel of cold water and remain there. Though removed by
a servant, she was again placed in the cold water by the mother, death
resulting. The woman was sentenced to life imprisonment.
Case 4. Sunstroke, High Temperature, etc. (Dr. A. Flint, Jr.,
Neiv York Med. Jour. , 1872, p. 168 ; Dr. Katzenbach, New York Med.
Jour., 1873, p. 93).
Case 5. Scald, Drinking from a Tea-kettle. Accidental (Mr.
Sympson, Brit. Med. Jour., 1875, June 19th, p. 809).— Boy, set. 2k
years, drank boiling water from spout of tea-kettle. Inflammation of
pharynx and glottis. Tracheotomy ; recovered.
Case 6. Fatal Scald of Insane Person in a Bath (Brit. Med.
Jour., April, 1871, p. 456). — ^An insane patient fatally scalded in a bath,
through carelessness of an attendant. The charge of manslaughter
brought against the attendant.
Case 7. Fatal Burn of Genitals. Accidental (Caspar, "Forensic
Med.," Vol. I., p. 315).— Female child, 2h years, fell on a hot flat-
iron. Genitals burned ; died in eleven days. Vagina gangrenous ;
blood fluid ; lungs aneemic and pale ; trachea bright red, etc.
Case 8. Red, Parchmenty Skin, Cracks, etc. (Caspar, "Forensic
Med.," Vol. I., p. 307). — While a chimney-sweep was cleaning a chim-
ney a fire was lighted below. Death. The entire skin was of a coppery
red color, with yellow patches. No carbonization. Skin parchmenty,
with fissures upon the edges of which the fat had melted and flowed
out.
Case 9. Asphyxia. *Soo^?/ Mwcits, eic. (Caspar, "Forensic Med.,"
Vol. I., p. 314). — Two children, aet. 3 and 7, burned; death from
asphyxia. The youngest, the girl, burned externally ; the boy was
not. Post mortem in both showed the trachea to contain frothy and
sooty mucus. Lungs and vessels of thorax and abdomen distended
with dark and fluid blood. Brain congested, etc.
Case 10. Burn of Body. Inflam,mation of Stomach (Ainer. Jour.
Med. Sciences, Jan., 1861, p. 137). — Superficial burn of lower part of
hody. Death on the thirteenth day. Post-mortem examination
showed the stomach inflamed and the intestines also.
Case 11. Accidental Scald. Pleurisy (Caspar, " Forensic Med.,"
Vol. I., p. 312). — Female child, a?t. 6; scalded with a pot of boiling
coffee overturned upon the side of neck, right axilla, thorax, and right
arm. Death on the eighth day. Post-mortem examination revealed
inflammation of right jfleura, pericardial effusion, etc. Body ansemic.
CASES. 659
Case 12. No Internal Lesion Found (Guy's Hospital Reports,
1860, Vol. VI., p. 146). —Female, ait. 9. Burn of upper part of chest
and arms by clothing taking fire. Death on the ninth day. Post-
mortem examination revealed no lesion of the internal organs.
Case 13. Cracks and Fissures of Skin (Caspar, " Forensic Med.,"
Vol. I., p. 314).— Male, aet. 83. Clothing caught fire; death. Body
carbonized. On right side were fissures opening into the abdomen ;
the viscera could be seen, etc.
Case 14. Fissures, Vessels Crossing, etc. (Taylor, " Med. Jurispru-
dence," Vol. I., p. 696). — Boy, set. 2; death in three-quarters of an
hour.- On legs were fissures and lacerations near each knee. On
right thigh a laceration 2f inches long, \ inch deep and \ inch wide ;
fatty tissue seen beneath. No blood efi'used ; small vessels could be
seen stretching across the fissures.
Case 15. Brain Congested, etc. (Caspar, " Forensic Med.," p. 316,
Vol. I.). — Boy, aet. 1^ years, set fire to his clotliing. Death in 1^
days. Post-mortem examination showed congestion of the brain, in-
flammation of the trachea, engorgement of the lungs with hepatization
of the lower part of the right lung.
Case 16. Burn of Loicer Part of Body. Death (same reference). —
Woman, tet. 81 ; burn of lower part of body, including the gluteal re-
gion, the perineum and genital organs (external). Death after several
days. Post-mortem examination showed the upper lobe of left lung
in a stage of red hepatization, etc.
Case 17. Tardy Appearance of Redness and Vesication (Tidy,
"Legal Med.," Vol. II., p. 124, Case 15).— Woman, insensible from
cold, had hot water applied in tins to her sides and feet. The flannel
coverings became displaced and the hot tins came in contact with the
body. No redness or vesication could be detected two hours after-
ward. The next day, when consciousness had returned and recovery
from insensibility had taken place, the parts had become reddened
and vesicated.
Case 18. Were the Burns Ante Mortem or Post Mortem f (Caspar,
"Forensic Med.," Vol. I., p. 317). — Woman intoxicated; clothing
caught flre ; death due to asphyxia. Some burns apparently caused
during life and some after death. The case was decided upon the
character of the vesications and their contents. Lungs and other or-
gans normal. Right side of heart engorged with dai-k blood.
Case 19. Murder. Body Burned (Dr. Duncan, Med. Gazette,
Lond., Vol. VIII., p. 170). — Man chai'ged with the murder of his wife
and attempting to burn the body afterward. The body was so exten-
sively burned as to remove all means of deciding the cause of death.
The man claimed that her clothing took fire when she was intoxicated.
Persons in the same house had heard sounds of a struggle before
smelling smoke and fire. Furniture was not burned, nor the house.
The prisoner was found guilty of murder.
GCO HEAT AND COLD — STODDARD.
Case 20. Blisters. Was the Scalding Ante Mortem f (Taylor,
"Med. Jurisprudence," 8th Am. Ed., p. 411). — The body of an infant
found in a saucepan, boiled. The prisoner admitted that the child had
breathed. The boiling water had destroyed the means of positively
deciding whether the child had breathed. Blisters found upon it con-
tained yellow serum. Was the child living when put in the water ?
The prisoner was acquitted.
Case 21. Scald of a Lunatic in a Bath (Taylor, ' ' Med. Jurispru-
dence," 8th Am. Ed., p. 411). — Insane patient placed in a hot bath.
Temperature 123" F. Death in collapse next day (1879).
Case 22. Criminal Burning, Strangling (Report of Profs. Liebig
and Bischoff, of Giessen, March, 1850). — The man StauflF was tried at
Darmstadt for the murder of the Countess of Goerlitz, whom he had
attacked and murdered in her chamber, and then fired the furniture
in order to conceal the crime. It was uncertain whether she had died
from injury to the head or from strangulation. The tongue protruded
and was swollen, as in cases of strangling, and maintained this con-
dition. He was convicted chiefly on circumstantial evidence. After
conviction he confessed that he had strangled her and then set fire to
the furniture, which he had piled up about her.
Case 23. Murder. Body Burned. Identified ("Report of the
Trial of Prof. Webster," etc., Boston, 1850).— Prof. Webster kiUed Dr.
Parkman and then burned the body, in portions, in a furnace in
his laboratory. Search among the cinders of the furnace disclosed
pieces of human bones and a set of false teeth which the dentist who
made them recognized as made by him for Dr. Parkman, etc.
Case 24. Murder. Body Eyitirely Burned. Identified (the
"Druse Case," Trans. New York State Med. Soc, 1887, p. 417).—
Mrs. Druse, with the compulsory aid of her children, killed her hus-
band with an axe. The body was burned in a wood stove, with pine
shingles. Tlie ashes were thrown into a swamp near by. They were
found and carefully sifted. Pieces of bone of various sizes, identified
as human, were found, as also a few porcelain buttons, etc. A few
hairs found, with stains, completed the identity. Experiments in this
case showed that the body could have been consumed within ten
hours. The prisoner was convicted of murder.
THE MEDICO-LEGAL RELATIONS
ELECTRICITY.
BY
WILLIAM N. BULLARD, M.D.
MEDICO-LEGAL RELATIONS OF
ELECTRICITY.
As the frequency of accidents caused by electricity is rap-
idly increasing, we have of late years been enabled to general-
ize in a manner never before possible in regard to their results,
and although our present conclusions must be recognized as
provisional and perhaps temporary — to be changed or modified
in accordance with future knowledge — yet we have obtained a
basis of fact on which we can securely rely. The general laws
of injury and accident through electricity have been fairly well
determined, although many of the details are not 3'et thoroughly
worked out or understood. The advances of knowledge in this
direction are so rapid that an article on this subject, if it deals
too closely with details, is liable to become out of date almost
before it has left the press. Like all large subjects when first
made objects of general interest and investigation, and in
regard to which we are on the threshold only of knowledge, the
facts discoverable may lead us at any time in unexpected
directions and open out new fields of thought and inquiry. We
shall try to limit ourselves here, as far as possible, to proved
facts, and leave questions doubtful or in dispute to be settled
later; contenting ourselves merely with pointing them out and,
perhaps, in some cases giving the facts on either side.
Electrical accidents and injuries may be divided into those
which are caused by the atmospheric electricity — lightning
proper, globes of fire, St. Elmo's fire — and those produced
through the agency of mechanical or artificial electricity — elec-
trical machines, batteries, dynamos, etc. The effects caused
by these different agents probably vary only in degree: the
atmospheric electricity in the form of lightning, etc., being so
much more powerful than the charges usually produced artifi-
cially as to cause some difference in the results.
664 ELECTRICITY — BULLARD.
BESULTS OF ACCIDENTS AND INJURIES FROM ELECTRICAL
MACHINES AND CONDUCTORS.
Medical Electricity. — In the ordinary use of the mild
forms of electricity employed for medical purposes, certain
phenomena may at times occur, which, although not of any
serious import or of long duration, may yet cause considerable
inconvenience, pain, or discomfort to the patient or others, and
may even be of some importance from a medico-legal point of
view. We shall not enter here into the discussion of the proper
methods of application of medical electricity, nor do more than
point out that if these be not followed with care the patient
may be not only not benefited, but made worse, and may even
suffer considerable injury. The increase of pain caused b,y the
improper application of certain currents is usually temporary
and of minor consequence. But serious and lasting inflamma-
tions may be caused by the careless, ignorant, or injudicious use
of the stronger currents internally, and metritis and peri-uterine
inflammations have been not infrequently reported from the
unskilled practice of the methods of Apostoli. These subjects,
however, scarcely come under the scope of this article.
In addition, however, to these troubles we may have ex-
ternal injuries produced. Even in cases where the current
amounts to not more than a few milliamperes burns may be
caused by the ordinary electrodes of the galvanic battery. The
faradic current when medically used does not, as a rule, pro-
duce any external injuries. Such might be caused by a spark
from a static machine, but it would be due to gross carelessness,
and is very unusual. Burns, however, from the use of the
galvanic current are not very uncommon. They usually occur
under the electrode after it has been for a few moments station-
ary in contact with the skin. They occur in certain patients
with extraordinary readiness, especially in those with organic
spinal lesions, and where the sensation is somewhat diminished,
and where also some trophic lesion might be supposed to exist.
They are not confined, however, to this class of cases, but may
occur in any one if the electrode be retained too long in any one
place, and especially if it be allowed to become dry. These
INJURIES FROM ELECTRICAL MACHINES. 665
burns are peculiar in appearance and can usually be recognized
at once. They are circular, as if punched out, about the size of
a common pencil or a little smaller, comparatively deep, gray
with perhaps a dark ring at the circumference, and frequently
surrounded by a reddened area. The edges are sharp. Their
peculiarit}^ consists (1) in their painlessness and (2) in their
size, regular form, their depth in comparison to their extent,
and the sharp limitation of the area of tissue destroyed. One
or more may occur under a broad electrode, and they are prob-
ably produced at those points where the contact is imperfect or
the conduction in some other way impeded. They heal without
much difficulty and leave no serious results.
Other unpleasant symptoms produced by currents in medi-
cal use may be mentioned for the sake of completeness, and also
as an introduction to the more serious symptoms caused by
stronger currents. Dizziness, vertigo, tinnitus, nausea, vomit-
ing, and syncope are readily caused by even slight currents.
The sensation of light in the eyes and the metallic taste in the
mouth are the results of medical currents of ordinary strength
when applied to the head or in its neighborhood, and stronger
currents applied at greater distances cause these sensations.
All the above symptoms may be readily caused by even slight
currents, whether galvanic or faradic, passed through the head.
The syncope thus produced is to be carefull}' differentiated
from the syncope caused psychically by excitement or fear of
the application of electricity. Hysterical women, and even
persons who show no special signs of nervous instability, may
faint at the suggestion of the application of electricity. I have
seen a large, strong, well-built Italian man, perfectl}' sound phys-
ically, so far as could be detected, except some slight local neu-
ralgia, faint from pure fright when the electricity was to be
applied. But even the application of moderateh' severe shocks
from the ordinary medical batter}^ are not likely to produce
serious results. These shocks are ordinarily caused by the
opening or closing of the galvanic current, and are most severe
when the current passes through some portion of the head. A
still more powerful shock may be given bj' reversing the cur-
rent in a galvanic battery by means of the commutator.
666 ELECTRICITY — BULLARD.
Currents of High Tension — Strong Artificial
Currents.
Passing on now to the consideration of the stronger cur-
rents, we come to those used for mechanical purposes, for elec-
tric lighting, electric railways, and other analogous objects.
These currents start from dynamos or from storage batteries,
and accidents are caused by them whenever they are diverted
from their proper course and are caused to come in contact
with or to pass through any portion of the human body in any
considerable strength. Accidents not infrequently occur from
direct contact with the batteries or dynamos, but still more fre-
quently they are produced in their circuit along the wires or
transmitters. They maj' also be caused, as some of the most
fatal have been, by contact with metallic or other readily
conducting objects which have themselves accidentally come in
contact with some portion of an electric circuit (usually wires)
and have diverted the whole, or more usually a portion, of the
current to themselves. Thus was killed a young man in New
York, the clerk in a store, who while lifting the metal-edged
cover of a show-case brought it in contact with the charged
wires of an electric light and received an immediately fatal
shock. As a rule, those meeting with accidents from dynamos
or electric machines directly are employees of electric com-
panies, who are presumed to have more or less knowledge of the
risk of carelessness, or they may be workers in institutions or
factories in which such machines are in use. Many of the
accidents due to wires also occur to linemen and other em-
ployees of electric, telephone, or telegraph companies or of elec-
tric railway companies in charge of wires or electric outfit. So
long as the current transmitters and terminals (wires, etc.) are
properly insulated and in their proper position in relation to
other conductors, it is unusual for accidents to occur, except in
cases of gross ignorance or carelessness. Unfortunately, how-
ever, proper insulation is not always accomplished, and fre-
quently wires and other transmitters are removed from their
proper positions by accidents and otherwise. So long as and
wherever the system of overhead wires exists, if there be among*
these wires any which are the transmitters of strong electric
CURRENTS OF HIGH TENSION — INSULATION. 667
currents, there is alwaj's a risk, and often a very serious one,
that at some time or other one of these current-bearing wires
will come into contact with some other non-current-bearing and
ordinarily harmless wire in such a manner that the current of
the first should be diverted, in whole or in part, on to the ordi-
narily innocuous wire, which thereby becomes at once charged
and dangerous. Such an accident may be due to the displace-
ment of either wire or to any other cause which brings the two
in contact, either direct or indirect, at a point where the current-
bearing wire is not sufficiently insulated. The current having
once passed out of its proper circuit will, of course, follow the
paths of best conduction, and may hence suddenly appear in
unexpected quarters and produce the most dangerous and even
fatal effects. It is accidents of this character which most fre-
quently occur among the people who are neither employees of
electric companies nor engaged in factories or buildings where
electrical machines are em^^loyed.
Insulation of Wires and Other Electrical Trans-
mitters.— We cannot mention here the various methods em-
ployed to insidate wires, as the general principles of insulation
are well known. Electric wires even with very strong currents
can be insulated and can be kept insulated if sufficient pains be
taken and sufficient money be expended. But this is very ex-
pensive and in many cases is not done. Only partial insula-
tion is attempted, and even this is not always carried to the
degree intended or stipulated. Hence so long as overhead wires
of various kinds exist, accidents from the transmission of
strong electric currents along ordinarily harmless wires are
liable at any time to occur, as practically little or no attempt at
keeping the current-bearing wires covered with a thoroughly
insulating material is in most cases made. It is usually deemed
sufficient that glass or other insulators should be so placed that
under ordinary conditions the wire will not come into contact
with any conductor which may cause any essential part of its
current to diverge. In most cases a so-called insulating mate-
rial is placed over the wire itself, but this usually is insufficient
at the outset or becomes so before very long and is then not
renewed.
It must not be supposed, however, that undergromid electric
wires or transmitters cannot produce accidents. On the con-
668 ELECTRICITY — BULLARD.
traiy, the current may be diverted from them to the gas or
water pipes or to any other conductors which come into contact
with them or can attract to themselves a portion of their cur-
rent. Severe shocks have been experienced by persons attempt-
ing to draw water at their faucet from causes of this character.
At the same time, so far as mere safety is concerned and free-
dom from electrical accidents, it would seem that underground
wires are preferable to overhead wires.
Electrical wires have not infrequently come in contact with
telegraph and telephone wires causing unpleasant results. Tel-
ephone boxes have been set on fire, and also telegraph boards
and tables, and in certain cases what might have been serious
conflagrations have been started in this manner. By means of
proper arrangements on the telegraph and telephone circuits
these dangers can be at least partially avoided, but there is
always the risk that the automatic alarms and other contriv-
ances do not act, and the still greater one that persons or things
may come into contact with these charged wires and receive
dangerous or serious injuries.
Electric Cars. — The danger from the overhead wires in
the trolley system of electric cars would not be great were these
wires properly supported, properly insulated, and properly pro-
tected. Each of these terms must be explained. Wires which
fall for any cause whatever short of being intentionally re-
moved cannot be deemed properl}^ supported in the sense in
which we use the term. Any one of these electric wires which
falls is liable to produce serious injur}^ to persons or animals
(many horses have been killed by them), or to set fire to objects
with Avhich it comes into immediate or indirect contact, the
amount of injury being in part dependent upon the nature
and the condition (wet or dry) of the object and its position in
relation to other conductors. Wires as dangerous as these car
wires should be so supported that no ordinary accident, no con-
dition of the weather, strong winds, or heavy falls of snow
should be capable of wrenching them from their supports, and
they should be placed in such positions and with such protec-
tion as not to receive blows from passing or falling objects.
Secondly, these wires should be properly insulated. This is
to be understood to mean that all the wires which carry the
electric current, or are liable to carr}- it, should be attached to
ELECTRIC CARS. 669
their poles or other support in such a manner that no apprecia-
ble quantity of electricity is under any circumstances liable to
be diverted to the poles or supports, and in this way cause de-
struction or injury. In addition to this the side wires should
be so covered that if any accident occurs, it will be difficult or
impossible for the current to pass away from them to other
objects. The middle wire on which the trolley runs cannot be
thus covered, but must be left bare, and hence, if knocked down
or brought into contact with properly conducting objects, must
be the most dangerous ; but on the other hand from its position
it is less liable to accidents.
When we say that these wires should be properly protected
we mean that such arrangements and contrivances should be
used as will prevent them while in their usual position from
coming into contact with dangerous objects, particularly with
other wires. This may be accomplished by guard wires or in
other ways. It is plainly of great importance that this should
be specially cared for, and particularly in a city where there are
many overhead wires, and perhaps a considerable number of
dead or non-used wires. If the electricity comes into contact
with one of these no one can tell where it may be transmitted
or what harm it may do.
The principles which apply to these overhead wires of course
apply ceteris paribus to all other electric overhead wires, and
in like manner the statements made in regard to the diffusion
or spreading of currents in underground wires are applicable to
all methods of transmitting electricity mechanically through
the ground so far as the conditions are similar. An electric
current will always follow the path of best conduction, and
where several paths are opened it will follow them proportion-
ally according to the excellence of their conduction or inversely
to the amount of their electric resistance.
We shall not enter here into any questions in regard to the
diffusion of electricity, its transmission through fluids, water,
air or other gases, nor shall we discuss the relations of good or
bad conductors to electricity except so far as this relates to
certain portions of the human body. An elementary knowledge
of physics and electricity must be presupposed.
We can now enter more directly upon the immediate sub-
ject of this article, that is, the effect upon the human body of
670 ELECTRICITY — BULLARD.
severe or moderately strong currents of electricity derived from
artificial sources. The accidents produced by these currents
may be divided into two classes, the direct and the indirect.
Under the direct we place all those conditions which are ap-
parently produced by the action of the electricity itself, such as
the general shock, the loss of consciousness, the burns, etc. On
the other hand, all those accidents are to be considered indirect
which are not primarily due to the action of the electric current,
but are only secondary results thereof. These are largely de-
termined by the immediate surroundings and conditions at the
time. Such, for example, are the surgical injuries due to falls
caused by the loss of consciousness produced by the electric
shock.
Indirect Accidents.
These will* be considered first, as they do not demand so de-
tailed a description as the direct. They are traumatic in char-
acter and are the result either of loss of consciousness, momen-
tary or lasting, or of the involuntary muscular contraction
which may be occasioned by the electric shock. They are
among the most frequent effects of severe electric shocks.
These accidents consist in contusions, fractures, dislocations,
wounds, and any other injuries which may be produced from
sudden loss of consciousness while in a dangerous position.
Death ma}^ readily occur either immediately or as the more or
less delayed result of such injuries. If the person shocked falls
into the water he may be drowned, or if into the fire he will
be burnt. The varieties of such accidents dependent on the
sudden loss of consciousness produced by the electricity are,
of course, innumerable, and their occurrence must largely de-
pend upon the position of the victim at the moment of the
shock. We see, perhaps, most of these accidents in linemen
on the tops of poles or houses or in other exposed places, but
persons who receive shocks when simply standing on the ground
or when sitting are not exempt from severe surgical injuries
other than burns. They are often cast to the ground with great
violence, and not infrequently are thrown to a distance of sev-
eral feet. This is caused by the violent muscular contraction
produced by the electric shock, and it may occasion, like any
INDIRECT ACCIDENTS — DIRECT ACCIDENTS. 671
violent push or fall, severe injuries from contact with the various
objects against which they may be forced. Although much
rarer, it is also possible that the violence of these muscular
contractions may be such as of themselves to cause injury, as
rupture of a muscle or tendon. As practically all these indirect
accidents are traumatic and surgical in character, thej' do not
differ from other accidents similar in kind, but otherwise
caused, and are to be treated on the same general principles as
these.
Direct Accidents.
Quite different from the indirect are the direct accidents;
those produced by the immediate (direct) action of the electric-
ity. These are of various kinds, which we shall consider sepa-
rately. They maj' be divided into immediate and late symp-
toms, and they vary much according to the severity of the shock
and the constitution of the patient, and the pftrt of the body
through which the electricit}- passes. The character of the
current which gives the shock, whether constant or interrupted,
also naturally has an influence on the effect.
General Principles. — A shock may be given in three
ways with an ordinary galvanic battery. If the current be
sufficiently strong, a distinct shock will be produced when the
circuit is closed and again when the cii'cuit is opened, while
with a current of the usual strength for medical purposes, the
sensation while the current is passing through the body steadily
is much less and is often limited to a sensation of burning at
the seat of the electrode. A shock ma}' also (thirdl}') be pro-
duced by a reversal of the current, and the shock thus caused is
stronger for the same current than that produced in either of
the other ways.
The strength of these shocks is shown both by the sensa-
tion produced and by the amount of muscular contraction
caused. When now a shock is caused by a continuous or con-
stant current which starts from an ordinary dj^namo or other
electric generator or storer, it is practically alwaj'S caused by
the opening or closing of the circuit, or, what is essentialh* the
same, the diversion of a part or the whole of the current from
its proper path to and through some portion of the human body
causes a shock at the time of the entrance of the body into the
672 ELECTRICITY — BULLARD.
circuit and another at the time of its exit therefrom. Shocks
from reversal of current when such current arises from a con-
stant machine might occur, but onl}* through some peculiar
accident. Hence the shocks (distinguished from any other
effects of electricity) which are received by the person coming
into contact with a constant current are felt only at the moment
of entering the circuit (closure) and of leaving it (opening). If
a person introduces himself between the two wires of an elec-
tric circuit in which a constant current is used, in such a man-
ner as to cause the current to pass through his body, he will
feel the shock only at the moment when he touches the second
wire and completes the circuit, and at the moment when he
lets go one of the wires and opens the circuit (unless the current
be so strong or be so placed that he can divert to himself
sufiScient electricity to cause a shock, or, in other words, close
a secondary circuit in some other way). While the current is
passing throuigh the body, although it may burn and cause
tingling and other unpleasant symptoms, there is no proper
shock. In other words, an electric shock is caused only by a
change in the amount of electricity passing through the body or
a portion thereof.
If we now consider the effects of alternating currents,
we find that we have another factor to deal with. The general
principles are exactly the same, but inasmuch as the reversal
shock is stronger than the closure or opening shocks, other
things being equal, we are likely to receive a stronger shock
from a current of the same force, and in addition to this, as in
alternating machines the reversals occur with considerable
rapidity, the person who becomes connected with this circuit
receives a number of strong shocks within a short space of time.
This is a much more serious matter than to permit a current
of equal strength to flow through the body without change.
Faradism. — The effect of this form of electricity on the
human body is first stimulating and then tetanizing to the
muscles. It consists in a very rapidly interrupted current, the
shocks being at times so frequent that they are not singly per-
ceptible. There is probably also a distinct difference in the
action of this current from that of the galvanic current aside
from its rapid interruption. This is not, however, of so defined
a character as to enable us at the present time to distinguish in
FARADISM — STATIC ELECTRICITY — RESISTANCE. 673
man the results of severe injuries and deaths caused by this
form from those caused by other strong currents. Practically
this form of current is but little used, except in medical bat-
teries and for the purposes of experimentation in laboratories.
Static electricity has, so far as we know, rarely or never
caused serious injuries or death. The sparks produced in this
way have sometimes caused burns, and it is conceivable that a
strong electric current produced in this way might be danger-
ous. The symptoms could not be distinguished from those
caused by other forms of electricity.
Summary. — The greatest source of danger from electric
currents is the shock produced by them. In ordinary constant
or continuous currents this is produced only at the moment of
the opening and the closure of the circuit. In alternating cur-
rents a shock is also produced afc each reversal of the machine.
Faradic and static currents are rarely or never used mechani-
cally or in the arts. ♦
Resistance. — The resistance of the human body to electric
currents has been very variously estimated.
The reasons for these variations are: (1) that the different
tissues present different resistances ; (2) that the resistance in
the same tissue varies greatly under different circumstances.
The tissue which offers the greatest resistance and also
practically the greatest variation is the skin, or, more properly
speaking, the epidermis. The resistance of this is many times
as great as that of the rest of the body, and when perfectly
dry it is impervious to currents of great strength. Witz
states that in using a Ruhmkorf coil with an estimated force of
250,000 volts in Guinea-pigs and rabbits, it is advisable to cut
through the skin in order to apply the electrodes directly to the
flesh, or, at least, to wet the skin thoroughly, otherwise the
shock caused by the full strength of the battery (six jars charged
from the coil) would not cause death. Various animals offer
rates of resistance which vary somewhat apparently according
to the nature of the animal, but are probably largely dependent
on the conducting power of its tissues, that is, of its skin. The
variations between the resistance of similar animals, according
to the condition of the skin at the time of the experiment, are
much greater than those which are found between animals of
different species under similar conditions, or which are refera-
43
674 ELECTRICITY— BULL ARD.
ble to specific susceptibility. Mr. Harold P. Brown testified in
the Kemmler case (Court of Appeals, State of New York — State
of New York ex rel. William Kemmler against Charles F.
Durston, agent and warden) that he had in the course of his ex-
periments seen a horse weighing 1,320 pounds, with a resistance
of 11,000 ohms, killed by an alternating current at 700 volts.
The resistance of the different cutaneous surfaces of the
human body as measured by Jolly in Siemens' units was from
400,000 down to 15,000 in the male and to 8,000 in the female
(Siemens' unit is to the ohm as 1.06 to 1.00).
Tschirfew and Watteville made the resistance from 80,000
to 3,000 ohms.
Experiments made at the Edison Phonograph Factory and
Edison Laboratory in July, 1880, on 259 males between the
ages of eleven and fifty-one, showed a resistance, measured
between the hands immersed to the wrists in a solution of
caustic potash independent of polarization, averaging 986 ohms
and varying from 1,970 to 550 ohms.
The resistance of 236 men employed at Messrs. Bergmann
& Co. 's Electrical Works in New York appears to have aver-
aged 1,184 ohms and to have varied from 1,870 to 610 ohms.
These measurements were also taken between the hands, which
were washed with soap and water and then dipped in jars con-
taining a solution of caustic potash. The battery consisted of
four chromic-acid cells each having an E. M. F. of 2 volts.
As shown in all the experiments on animals and more espe-
cially in the cases of electrocution, the continuance or duration
of the current has much effect on the resistance. As the cur-
rent continues the resistance diminishes. Thus in the case of
McElvaine the resistance between the immersed hands was
at the beginning 800 ohms and at the end of the contact of fifty
seconds had decreased to 516 ohms. In this case, when the
current of 1,500 volts was applied from the forehead to the leg,
the resistance was practicallj^ steady at only 214 ohms. Of
<3ourse the small resistance in these cases (electrocutions) de-
pends largely on the perfect contact secured.
According to the amount of resistance offered do the effects
of severe shocks of electricitj^ differ. This is shown especially
well in the action of lightning, but is also true of powerful
currents produced mechanically. If the resistance of the skin
RESISTANCE — MECHANICAL EFFECTS. G75
be slight at the moment of entering the circuit of a strong
current, the current will pass through it with comparative ease
and without causing much injury ; but if on the other hand the
resistance is great, the current will be, as it were, momentarily
retarded or stored, heat will be developed, and there will ensue
a burning and charring of the tissue of a special kind. These
burns occur principally at the places where the current is spe-
cially resisted, that is, at the point of entrance of the current to
the bod}" and at its point of exit. This is the cause of the fre-
quent burns in the heel or sole of the foot in the case of those
struck by lightning while standing, as the electricity passes
away from the body into the ground and finds a strong resist-
ance at the point of leaving the body. This is also the cause
of the burns where the current leaves the body from any other
cause, as from the contact or proximit}' of a metallic object.
The greater the resistance so long as the current passes, other
things being equal, the more severe is the burn. It is for this
reason that in medical electricity we usually use wet sponges
on the skin or electrodes moistened with salt and water or
with other fluids which will assist in rendering the passage of
the electricity through the skin more easy. Solutions of chlo-
rid of sodium and of certain other salts do this.
The mechanical eflfects of currents vary thus according
to the resistance encountered. They also vary according to the
intensit}^ or concentration of the current. If a current of mod-
erate force be applied through a small metallic point, it will
burn, pain, and produce active irritative symptoms, while if
the same amount be applied over a large surface simultaneously,
it may have little or no irritating eflFect. We have, therefore,
three factors in determining the mechanical effect of any elec-
tric current on the body: (1) the condition of the body, that is,
the amount of resistance which the current will encounter at
its entrance and exit; (2) the amount and intensity of the
current; and (3) the character of the current. For practical
purposes of the more severe currents we have only to deal with
the continuous and alternating.
676 electricity — bullard.
symptoms.
Direct Symptoms.
The direct symptoms produced by powerful mechanical cur-
rents of electricity may be divided into three classes : I. The
mechanical; II. The essential or internal ; III. The mental or
psychical.
These classes are fairly distinct, but they are not absolute,
and certain symptoms are on the borders.
The most important mechanical symptoms produced by
these currents are burns. These occur at all points of strong
resistance externally, hence especially at the points of entrance
and departure of the current. They vary from all grades, from
the lightest possible, where only the fine hairs on the skin are
singed, to those of extraordinary depth and severity. The char-
acteristic burn from powerful currents is, however, well distin-
guished. It consists in a deep hole of various shapes with clear-
cut edges surrounded by an inflamed area and containing in its
cavity a mass of blackened tissue which only separates from
the portions below after several days, and causes a wound
which, though not very painful, heals very slowly. The sever-
ity of electric burns is often at first sight underrated, and their
duration, when severe, is unexpectedly long. It occasionally
happens that after a burn of this character appears nearly healed,
the surrounding and, in appearance, healthy tissue breaks
down, perhaps under a healthy skin, and a destructive process
occurs which much retards recovery. This is evidently due to
tissue destruction from a strong electric current of such a char-
acter as to produce necrobiosis without the external appearances
of a burn. These burns are, perhaps, oftenest seen on the
hands, but this is onl}'' because these parts are more likely to
come into contact with the current. They may occur in any
portion of the body.
Eyes.— The injurious effect of electric light upon the eyes
has been carefuU}^ studied by several competent observers. So
far as known it has been caused solely by the arc light. The
symptoms produced by exposure of the eyes for a considerable
period to the electric light may be slight or severe. In the
slighter cases we find merely an acute conjunctivitis with a
SYMPTOMS. 677
slight central scotoma which passes off within twenty-four to
forty-eight hours. The symptoms are those usual in acute
conjunctivitis — photophobia, lachrymation, sensation of a for-
eign body under the lids, discomfort in the eyes, and swelling of
the lids. In the more severe cases all these symptoms are in-
creased; the photophobia and lachrymation may be intense.
There is sometimes severe pain in the supra-orbital nerve, and
occasionally a tendenc}' to somnolence. In these cases we find
an intense conjunctivitis with ch3"mosis, a central scotoma
which may render the patient for the time practically blind,
and on ophthalmoscopic examination a congestion of the ves-
.sels of the retina and choroid, a neuro-retinitis, and sometimes
even hemorrhages into the retina. There is sometimes peri-
papillary oedema and infiltration around the optic nerve. The
pupil of the eye in these cases is usually much contracted.
There is sometimes loss of epithelium from the cornea.
In certain severe cases there is produced in addition to the
eye symptoms an erythema of the face. Bresse states that this
erythema can be produced on the face, arm, or hand by exposure
to the voltaic arc at a distance of thirtj' to forty centimetres.
The blush grows deeper for three or four hours, then remains
stationary for a time, and ends in desquamation leaving a very
durable pigmentation. The erythema is accompanied bj' a sen-
sation of smarting.
The strength of the light and the length of time required to
produce these effects probably vary somewhat according to the
color of the light. Emrys Jones states that he is informed that
either excess or defect of current gives a less injurious light
than the normal current ; the excess gives a more violet, the
defect a more orange light. On the other hand, Charcot con-
sidered that the harmfulness of the electric light was due at
any rate in considerable part to the chemical or violet rays,
and Bresse found that when violet raj'S were added to an
electric light as by aluminium it was more injurious than
before to animals. What part the brilliancy of the light plays
in determining the pathological results is not yet fully settled.
The heat, however, does not, as a rule, seem to have much effect
unless in extraordinary instances where the cornea is burned.
Muscular Contractions. — Another effect of electricitj-
which is externally visible on the human system is muscular
G78 ELECTRICITY — BULLAKD.
contraction. Slight muscular contractions are produced pur-
posely in many cases in medical treatment therapeutically or
for the sake of diagnosis. When the stimuli are sufficiently
strong and follow each other with great rapidity, or when a
strong continuous current is passed through the muscles, they
are brought into a state of continuous contraction or tetanus,
and in this condition they will remain for a long period or
until the electric stimulus is removed. In cases where a severe
electric shock is received as from an electric wire, the muscles
which come in contact with the wire immediately contract and
remain contracted while the current continues to pass through
them. As a result of this we often find that when a severe
electric shock has been received through the hands by means
of a wire or other conductor the sufferer's hands are invol-
untarily closed upon the wire or conductor, and cannot be un-
closed by any voluntary effort until the current is stopped.
While thus holding the conductor the hands are often very
severely burnt. Under these circumstances a strong force is
required to remove a person from a charged wire if the current
be not turned off, and it can only be done at a considerable risk
unless by those expert and provided with special means.
Not only the muscles immediately in contact with the con-
ductor, but nearly all the voluntary muscles of the body may
be thus affected by a powerful current. Another effect of this
involuntary muscular contraction is the forcible muscular move-
ments produced by the shock. As previously stated, when a
sufficiently strong shock occurs, the voluntary muscles of the
trunk and limbs may be thrown into sudden contraction in such
a manner as to throw the person violentl}' and forcibly on to
the ground, or against some object or objects in the neighbor-
hood. In this way one may be propelled several feet, and many
varieties of surgical injury may be caused. Rarely the force
of the contraction is such as of itself to rupture muscles or ten-
dons, and it might even fracture bones or dislocate joints
already predisposed.
Essential or Internal Symptoms.
We pass now to what we may consider the internal or es-
sential conditions of electric shock, leaving the mental or psy-
chical results for examination later.
ESSENTIAL OR INTERNAL SYMPTOMS. 679
When a person receives a severe electric shock, the symp-
toms are usually as follows : In the first place there may be
little or nothing except a burn or burns, though usually there
is some sensation at the moment of the shock. This may be a
simple dizziness, and is often accompanied by the sensation of
a brilliant flash of light before the eyes, and sometimes by a
sense of impending danger. Usually, however, there is a loss
of consciousness more or less complete and more or less lasting
according to the severity of the shock and the character and
course of the current. In the less severe cases this gradually
passes awaj^ and in many cases the patient, although weak
and feeling shaken and tired, suffers no further ill effects be-
yond those of the burns and mechanical injuries. Sometimes
there follows a general tremor which may last a few hours or
for days, and occasionally a clonic rhythmical spasm of one or
more extremities. The loss of consciousness may, however, be
accompanied or followed by a condition of coUapse, in which
the pale face, profuse perspiration, cold extremities, and feeble
pulse all suggest the administration of stimulants and restora-
tives. As a rule, in the stage of unconsciousness the face is
reddened and rather cyanotic. The pupils are dilated as a ride
and the respiration stertorous or absent ; the pulse may be full
or feeble, sometimes imperceptible for a time. The uncon-
sciousness sometimes lasts for hours, and all means of stimula-
tion, electricity, artificial respiration, rubbing, have to be
applied before the patient can be restored. Sometimes this
condition is succeeded by delirium (Moj^er). In a certain
number of cases the shock is immediately fatal, and in others
the patients cannot be recalled from their unconsciousness.
The secondary results of the shock, aside from the injuries,
may be very slight or again may be serious and lasting. They
are far more apt to be of the first class, and when long or con-
tinued motor or sensory changes unconnected with injuries fol-
low, we are justified in suspecting mental or psychical phenom-
ena. One class of secondary results is the motor. In addition
to weakness, unsteadiness and tremor of the limbs and trunk, it
is not uncommon for the patient to suffer from grand rhythmi-
cal movements, at first, perhaps, of all extremities, but soon
limited to the extremity or extremities which were most exposed
or injured by the current. We have personally seen these
680 ELECTRICITY — BULLARD.
movements, and feel convinced that they can be distinguished
from most of the ordinary forms of convulsive motions and
tremors. The whole limb is moved at once and not separate
muscles, and the movement is a large, rhythmical one, slow
and co-ordinated, not at all suggestive of tremor. Movements
of this character are sometimes seen in so-called functional dis-
ease (hysteria and allied conditions). They more nearly re-
semble the movements seen in some forms of Jacksonian epi-
lepsy than any others known to me as occurring in organic
disease, but I believe them in these cases to be always strongly
suggestive, if not absolutely significant, of functional affections.
A case reported by Dr. Robert, of El Paso, well illustrates this
condition. The patient, a male, twenty-eight years old, re-
ceived a shock through a telephone wire. When seen first,
reaction was slowly taking place, the entire muscular system
was in clonic convulsions. Temperature 97° ; pulse rapid and
of low tension; respiration 50; no cerebral symptoms. An
hour later the movements were limited to the left upper and the
right lower extremities, and there was pain running from the
region of the spine down the left arm. Twenty-four hours after
the shock, temperature 99.5°; respiration 40; pulse 100. Had
slept well, but the movements in the left arm had never ceased.
The next day these motions were limited to the muscles of the
forearm, and on the fourth day they had wholly ceased. These
convulsions consisted in extensive motions of the whole extrem-
ity or of muscles or muscle-groups, and not of simple tremor.
If the movements were forcibly controlled, severe pain ensued.
Next to the motor symptoms the sensory are the most im-
portant. Pain not infrequently occurs after the recovery of
consciousness in the affected limb ; it is apt to be sharp, severe,
darting and neuralgic in character. This may last at intervals
for some days, a dull ache occurring at first between the inter-
missions. It disappears of itself in time without lasting effects.
Hypersesthesia may exist at first. Should this continue, or
if anaesthesia not due to secondary traumatic conditions should
appear later, we should be inclined to place these symptoms in
the third class.
Of other symptoms occurring in accidents from currents of
high potential, those which seem to be due to the direct action
of the electricity are not serious. Buzzing in the ears and a
ESSENTIAL OR INTERNAL SYMPTOMS. G81
metallic taste in the mouth often occur at the veiy beginning
before the consciousness is involved. Nausea and vomiting
frequently occur later. There is often considerable dizziness
and vertigo. Patients sometimes complain of sensations as of
an electric shock running through the body which occur with-
out cause some hours or even days after the real shock. Some
of these sensations are certainly to be reckoned under the mental
or psychical symptoms. Susceptibility to the effects of elec-
tricity, of lightning, and of thunder-storms, though undoubtedly
in many cases psychical, has probably in some cases an actual
foundation. This is certainly the casein lightning stroke. On
the other hand, in the large majority of cases of electric acci-
dents no such result follows, and in many we are expressly told
that such a result was looked for but not found.
The temperature, as affected by the electricity alone and not
as secondary result of injuries, is not always easy to determine.
It seems to be in most cases lowered at first, being in that of
Moyer 97.5° and in that of Robert 97°. Later it may rise to
a certain extent, usually to not more than 101°, but here again
the influence of traumata is difficult to separate.
The pulse may be full and soft or weak and compressible.
It is frequently very feeble, sometimes almost imperceptible,
and often rapid. It is apt to remain rapid and somewhat soft
for days in severe cases.
The respiration is at first rapid in severe cases unless the
shock be so great as to cause its cessation. This rapiditj- re-
mains for a varying period and then disappears.
As a typical case of the results of shock from an electric
wire, we will mention the one reported by Dr. F. W. Jackson.
The patient, a man twenty-two j^ears old, came in contact with
a live electric-light wire, touching it with his hands. He was
thrown a distance of about ten feet and then back again,
"swinging back and forth two or three times." His hands
were in contact with the wire about three minutes, when the
current broke and he fell to the ground unconscious. Was
seen two hours later by physician. Temperature 100° ; pulse
100, strong and bounding; pupils dilated; headache; nervous
and irritable; reflexes increased. The headache was accom-
panied by insomnia which continued for three days, after which
it disappeared, and he resumed work apparently' none the worse
(J82 ELECTRICITY — BULLARD.
for his accident. The pcdmar surfaces of both hands and the
anterior surfaces of the forearms were blackened from the tips
of the fingers to a point midway between the wrists and the
elbows, and these parts were exceedingly sensitive to the touch.
The least irritation of the muscles would cause them to contract
violently. This condition ceased on the second day. The cur-
rent was from a fifty-light arc circuit of about 2,100 volts; 6.8
amperes. The accident took place out-of-doors on a very rainy
night. The amount of electricity which the patient received
was, as in all such cases, very uncertain.
FATAL CURRENT.
The amount of current which will produce a fatal effect
varies with the character of the current and with the points of
contact. Currents passing through the head or those which
affect the pneumogastric nerves are much more dangerous than
others of the same character and equal strength passing through
one extremity, for example.
The same current will, of course, also produce different
effects, according to the facility of its conduction into and
through the body, and this depends again 09 the completeness
of the contact and whether the bodj^ or the portion thereof
concerned enters directly into the circuit or only forms, as it
were, a partial conductor and diverts a certain portion only of
the current to itself. Again, the condition of the epidermis,
whether dry or wet, and the position of the person in relation to
good conductors, metallic or otherwise, has much effect.
If the skin and clothes be wet, the resistance to the current
is lessened and it passes more readily into the body. In the
same way, if a person stands in close relation to a good con-
ductor and places his hand on one wire of a high-tension elec-
tric circuit, he will receive a much more severe shock than if
not connected with such conductor. Thus a person standing
in a pool of water (water is a good conductor), and more strongly
if standing on the metallic rail of a railway track, and touching
one wire of an electric circuit with one hand, receives a much
stronger shock than if he were standing on dry land, or if his
boots were rubber or he was otherwise insulated.
The accidents most frequent in practice are those in which
FATAL CURRENT — ELECTROCUTION. 683
the current has been partially diverted from its original course
and the person has not entered fully into the circuit. In such
cases it is not usually possible to estimate accurately or even
approximately the amount of current which the person has
received. No calculations can, therefore, be based on these
accidents. Again, we find that a person may be seriously or
even fatally injured by a current which another person seems
to bear with impunity.
D'Arsonval in 1887, in France, advised 500 volts as the
maximum for the continuous current and 60 volts as the max-
imum for the alternating current which might be employed
without special permission.
Our only accurate knowledge in regard to fatal currents
comes from the experience derived from electrocutions. From
these it appears that an alternating current of 1,500 volts is
deadly if it passes through the body for more than a few seconds
and if the contact is perfect.
Death. — Death may ensue immediately as the result of an
electric shock without any evident preliminary symptoms, or
it may occur later, either as the direct result of the shock or as
the consequence of the exhaustion produced by the burns and
other injuries, or directly from the injuries themselves. If
death does not occur iinmediately and if appropriate means of
aid are at hand, the sufferer usually survives and the effect of
the electric shock gradually passes away. The danger after
this arises from the burns and other injuries, and almost all the
deaths not immediate are the results of these.
ELECTROCUTION.
Electricity has been adopted in the State of New York as
the agent for the execution of condemned criminals. This has
given rise to much discussion as to what form of current were
the best adapted for this purpose and as to what amount were
required to produce death at once and painlessl3\ These ques-
tions may now be regarded as practically settled, at least so
far as regards the purposes mentioned, and we shall only refer
incidentally to the discussions and their results.
Early in 1890 a committee consisting of Dr. Carlos F.
MacDonald, Dr. A. D. Rockwell, and Prof. L. H. Laudy made
684 ELECTRICITY — BULLARD,
a report to the superintendent of prisons at Albany in regard
to the efficiency of the electrical appliances and dynamos placed
in the State prisons of Sing Sing, Auburn, and Clinton. This
report gave details of various experiments made on animals to
determine the amount of current and the time required to pro-
duce a fatal result.
On the Gth of August, 1890, occurred the first electrocution,
that of William Kemmler, alias John Hart, at Auburn Prison.
Dr. MacDonald in his official report to the governor in relation
to this says : " It is confidently believed that when all the facts
in the case are rightly understood the first execution by elec-
tricity will be regarded as a successful experiment. As might
have been expected at the first execution by this method, there
were certain defects of a minor character in the arrangement
and operation of the apparatus. But in spite of these defects
the important fact remains that unconsciousness was instantly
effected and death was painless."
The efficiency, rapidity, and painlessness of this form of
execution have been confirmed by the later experiences. Up
to the present date (May 26th, 1892) eight condemned crimi-
,nals have been executed in the State of New York. Apparently"
all the officials who are intrusted with the care and inspection
of this subject seem satisfied that this is, on the whole, the
wisest, easiest, and most effective form of death thus far prac-
tised among civilized nations. The Medico-Legal Journal of
New York, in printing the official report of the recent executions
of four men made by Drs. C. F. MacDonald and S. B. Ward
to the warden of Sing Sing Prison, states that it furnishes " in-
disputable evidence of the fact (1) that the deaths were painless
and the victims unconscious from the instant of contact; (2)
that they were certain and unattended with any of the revolt-
ing scenes so frequently witnessed at the scaffold; (3) that the
method is humane so far as inflicting physical pain or suffer-
ing, and from all sides considered infinitely preferable to the
death by hanging ; and that so long as capital punishment for
murder exists in New York, we need not desire to change the
method of punishment." These claims would seem to be thus
far substantiated.
The value of this method of execution is now beyond doubt.
When properly performed it is rapid, painless, and not repul-
ELECTROCUTION. 685
sive. The criminal has probably no physical sensation of pain
or discomfort due to the mode of death from the moment the
first shock occurs. Since the rapidity of the transmission of
the electric current through the body is in these cases much
greater than the rapidity of the transmission of sensation, it
seems just to conclude that no sensation from the electricity
reaches the consciousness. The only distress suffered by the
criminal is the unavoidable mental suffering natural to his
position.
The mechanical means employed in electrocution are prac-
tically the same at Sing Sing, Clinton, and Auburn prisons.
A special room is provided for the purpose, which should be,
if possible, in the basement with a concrete floor: this room
must be of sufficient size to admit readily the criminal with the
attendant officers, the warden and other officials in charge or on
duty at the execution, and the witnesses for whom seats are
usually provided at a little distance from the criminal's chair,
and also to allow of plenty of room for the management of the
electrical apparatus, and a good space around the chair in which
the criminal is placed. The electrical plant consists of an
alternating-current dynamo and its accessories, placed wher-
ever may be convenient, according to the arrangements of
the buildings of the institution, but connected by means of
wires with the switch-board in the execution- room. In the
execution-room also should be the voltmeter, the ammeter, and
such other instruments of measurement or precision as may be
required. In charge of these and of the switch-board during
the execution is the electrical expert, an official paid by the
State of New York. Means of communication by electric bells
or otherwise are, of course, arranged between the execution-
room and the engineer in charge of the dynamo, so that the
current can be produced as desired.
The chair in which the criminal is placed is made of stout
beams of oak and is securely fastened to the floor and insulated.
It is perfectly plain, with broad arms and an upright back,
which latter can be tilted backward a little by means of a
special arrangement and firmly fixed in the desired position.
This is accomplished by means of a bar of wood which is firmly
attached at one end to the lower portion of the back and runs
forward thence parallel to the seat of the chair and alongside of
686 ELECTRICITY— BULLARD.
it ; to the anterior end of this is fastened a perpendicular bar
running downward, which can be raised or lowered at will, and
securely fastened at any height. As this is raised or lowered,
it raises or lowers the anterior end of the horizontal beam and
correspondingly lowers or raises the opposite end to which the
back of the chair is attached, thus moving the latter. When
the anterior end of the horizontal bar is raised the posterior
end is lowered and the back of the chair is straightened. At-
tached to the upper portion of the back of the chair is a head-
rest, which can be raised or lowered as desired : it may, as in
the case of Kemmler, have a horizontal arm which projects
forward and from which the head-electrode may be suspended.
The chair is also furnished with broad leather straps firmly
attached, two of which pass around the body, one around each
upper arm, one around each lower arm, and one around each
leg. There is also a broad conjoined or compound strap which
passes over the head, encircling the forehead and the chin
and securing the head firmly to the head-rest. When these
straps are properly adjusted and fastened, any marked degree
of movement is impossible. The adjustment and fastening of
these straps can be performed very rapidlj^, in practiced hands
taking not more than forty seconds.
The electrodes used have varied slightly in different cases.
In the case of Kemmler they each consisted of a bell-shaped
rubber cup about four inches in diameter, with a wooden handle
through which passed the wires into the bell to end in a metallic
disk about three inches in diameter, faced with sponge. The
upper electrode was so arranged as to rest firmly on the top of
the head, where it was held closely by means of a spiral spring :
it was attached to the horizontal arm of the head-rest, a sliding
arrangement shaped like a figure 4- The lower electrode was
in this case attached to the lower part of the back of the chair,
and projected forward at a level with the hollow of the sacrum.
There was also connected with it a sliding arrangement, and
a spiral spring which in connection with a broad strap around
the prisoner's lower abdomen rendered contact secure.
In the later executions these electrodes have been somewhat
modified and differently applied. The head-electrode is now so
formed as to cover the forehead and temples, and can be easily
fastened in this position without a spring. The lower electrodes
ELECTROCUTION.
687
have been applied to the leg in each case, sometimes apparently
to the calf and sometimes more to the outer side, where they
are securely strapped. They are made of such a shape as to
cover a considerable portion of the surface in this region. It
is not a matter of importance to which leg the indifferent elec-
trode is attached, but they have actually been applied in most
cases to the right leg, though in some they were attached to the
left. They are thoroughly moistened, usually with a solution
of salt and water, and a drip maj- be arranged so as to keep
them wet during the passage of the current or other means em-
ployed to this effect.
The electromotive pressure, as shown by readings of the
voltmeter by Professor Laudy, in the cases of Slocum, Smiler,
Hood, Jugigo, and Lopp}', varied from 1,458 to 1,716 volts.
The ammeter showed a variation of from two to seven amperes.
The alternating current in the case of McElvaine made
roughly 150 periods per second.
The number of contacts made in each case and the duration
of each contact were as follows :
Number of
Contacts.
TIME, SECONDS.
1st.
2d.
3d.
4th.
Kemmler
Slocum
Smiler
Hood
Jugigo
2
2
4
3
3
4
2
4
17
27
10
20
15
15
50
70
26
10
20
15
11
36
10
20
15
15i
i9
Loppy
McElvaine
m
Tice
Total time, 50.
In the case of McElvaine. the first contact of fift}^ seconds
was made through the hands, the second contact of thirty-six
seconds from the head to the leg. The hands were immersed
in cells containing tepid salt water, connected respectively witli
the opposite poles of the dynamo. Kennelly states that in this
case, with the hands immersed and the electromotive force at
1,600 volts, the current began at 2.0 amperes, and in fift^- sec-
onds had increased to 3.1 amperes, indicating a resistance be-
tween the electrodes of from 800 ohms at the beginning to 516
688 ELECTRICITY — BULLARD.
ohms at the end. In the second application from the forehead
to the leg with an electromotive force of 1,500 volts, the current
amounted to 7.0 amperes during the thirty-six seconds contact,
indicating a resistance practically steady at 214 ohms.
Alternating currents of from 1,600 to 1,700 volts and up-
ward may be considered fatal currents, and as capable of pro-
ducing death when contact is perfect. Dr. MacDonald goes
so far as to say : " No human being could survive the passage
through his body of an alternating current of more than 1,500
volts for a period of even twenty seconds, contact being perfect. "
The physical phenomena caused in the body by electrocu-
tion as at present conducted are comparatively simple, and
such as we should logically expect. The instant the body of
the patient enters into the circuit of the current, all the volun-
tary muscles appear to be thrown into a condition of violent
contraction which continues so long as the current lasts, and on
cessation of the current is replaced by a condition of extreme
muscular relaxation. All consciousness is apparently lost im-
mediately on the application of the current. This probably has
never returned in any case, but on the removal of the body
from the circuit of the current the relaxation of the muscles
causes movement, and sometimes, as in the case of Kemmler,
slight spasmodic movements of the chest have occurred. The
pupils in this case were dilated. The condition of contraction
and rigidity is renewed at each new application of the current,
to cease immediately when the current is removed.
In Kemmler chest movements and possibly heart-beat oc-
curred after the first contact, the former perhaps half a minute
after the cessation of the current.
In Slocum there were chest movements and radial pulsation
after the first contact. In Smiler no movement of the chest,
but radial pulsation after the third contact. In Jugigo a slight
fluttering of the radial pulse when final contact was broken,
which rapidly ceased. In Hood no movement or pulse-beat.
In some of the patients superficial burns have been caused
by imperfect contact of the electrodes, either on the head or
at the position of the lower electrode. In Kemmler's case the
cerebral cortex was somewhat affected under the head-electrode.
The practical effect of the application of the current to the
criminal fastened in the death-chair, as seen by the bystander,
MENTAL OR PSYCHICAL SYMPTOMS. 089
is that immediately on its reaching him the whole body is
straightened and rendered rigid in extension, the extremities
tend to straighten out, and the face may grow red and turgid.
There is reported at times swelling and turgidity of the neck.
The whole body remains in this tetanic, stiffened condition until
the removal of the current, when all the muscles relax and the
body sinks back into the chair in a state of complete muscular
collapse.
MENTAL OR PSYCHICAL. SYMPTOMS.
The third class of results which are found after electrical
shocks from high-tension currents are the mental or psychical.
By the use of these terms we do not wish to imply that they
are voluntary. They are, however, so far as our present knowl-
edge of pathology reaches, largely functional. This is precisely
the class of cases which, when resulting from railway accidents,
are placed under the head of railway-brain or railway-spine.
They may be considered in the present state of our knowledge
as traumatic functional neuroses, though it is probable that
when our means of examination and investigation are more
complete we may succeed in discovering a visible or per-
ceptible lesion. The symptoms affecting motion and sensation
in these cases are frequently accompanied by others of an emo-
tional character, and in many cases there seem to be partially
or wholly voluntary conditions and symptoms with the invol-
untary. There is in man}^ cases a characteristic loss or dimi-
nution of the force and power of volition, but in others this is
not perceptible.
These conditions are so well known when produced b}" other
causes that we do not consider it proper to enter into a full
consideration of them here, but we cannot leave this important
subject without a few general remarks.
No form of affection or disease has caused more discussion
among the medical profession or figured more proininently in
the courts than this, and even now there are many questions in
relation to these conditions still under dispute. Our own view,
confirmed both by observation and experience, is that the ten-
dency in New England, at least, has been on the whole to un-
derrate the severity, the duration, and the amount of suffering
caused by these conditions. That because there have been cases
44
690 ELECTRICITY — BULLARD.
of malingering, of deception, and of rapid cure after the receipt
of damages, and because in addition to this a certain visible
emotional and at times apparently controllable element exists,
the profession, and above all the lait}", are led to conclude that
this forms the essential condition and basis of the disease. On
the contrary, in a very large proportion of cases the symptoms
are such as cannot possibly be voluntarily assumed ; they pro-
duce extreme discomfort and often much suffering for the
patient, and frequently last for years, rendering their victims in-
capable of carrying on their former occupations.
Fortunately in the patients suffering from electric shock
the severer forms of these affections are not so common. In
most of the cases reported recovery has been more or less rapid.
Cases in which previous hysteria or neurasthenia have existed
are more liable to these manifestations than persons of a pre-
viously equable nervous constitution, but these latter iire by no
means wholl}" exempt. To consider these conditions, as is
sometimes done, as the fault of the patient seems to us both
unwarrantable and unjust.
LIGHTNING.
We now come to the consideration of the action of electric-
ity in another form, that of natural electricity or lightning.
The effects of this are practicall}^ the same as those of the forms
previously described, except such differences as seem to be fairly
accounted for by the vastly greater force of the currents with
which we have to deal. Injuries and deaths from lightning
stroke have been recognized and described for many centuries,
and we have now a large collection of careful observations on
them. They occur in most temperate regions with comparative
frequency. In France the number of deaths from 1835 to 1852
inclusive (eighteen years) was 1,308. In England, including
Wales, there were in twenty years, 1865 to 1884 inclusive, 416
deaths. In 1846 Mr. Eben Merriam, of Brookline, wrote to Mr.
Arago that in the three last years about 150 persons had been
killed by lightning in the United States. In thirty years, from
1855 to 1884 inclusive, we find 101 deaths in Massachusetts
from this cause.
Exposure. — Injuries and deaths from lightning maj' occur
LIGHTNING. 691
in various places and under various conditions. The severe
lightning strokes are popularly supposed to occur only during
thunder-storms, and in this latitude this is undoubtedlj', as a
rule, true, but lightning strokes are reported to have occurred,
particularly in the South, from a clear sky, and there seems no
reason to doubt that this may happen. It is said also that dan-
gerous discharges from the earth to the atmosphere may take
place at a considerable distance from an atmospheric storm.
As a rule, the lightning is more likely to strike some tall object,
as a tree or a tower or steeple, and for this reason, and to avoid
injury from falling branches, the shelter of trees should not be
sought during thunder-storms if lightning stroke be dreaded.
Ships at sea are frequently struck by lightning, partly perhaps
on account of the height of the masts and parti}' on account of
the metal in or on them.
Lightning obeys the same general laws as the other forms
of electricity and naturally follows the paths of least resistance.
Persons, therefore, who are in the neighborhood of or in con-
tact with good conductors are in more danger of injury by
lightning than when surrounded by or in contact with poor con-
ductors. The proximity or contact of a large metallic object
exposed in a thunder-storm is consequently more or less dan-
gerous. On the other hand, the absence of tall objects or of
specially good conductors of any kind does not insure safety.
In many cases persons in fields are struck, and cases are related
of persons strvick on the prairies in the West. In Fredet's case
a shepherd was found dead in the midst of the barren moors
(landes) in Southern France.
More accidents appear to occur directly to persons out-of-
doors than to those in houses or other buildings. When inside
buildings, persons struck are usually near an open door or win-
dow through which the lightning enters, and they are more
exposed to danger from this source if there be some metal ob-
ject or good conductor in the vicinitj". Persons carrying or
wearing metallic objects render themselves thereby more liable
to be injured in this way.
Not only does the liability to injury from lightning vary
somewhat according to the exposure or position of the person,
both in relation to the free access of the atmospheric air and to
the contact with or neighborhood of metallic objects or other
692 ELECTRICITY — BULLARD.
good conductors, but also the severity of the injuries may be
largely dependent upon what they are wearing or carrying and
the condition of their clothing at the time. If the clothing be
wet it will act as a good conductor, as will also any metallic
object about the person. We have already referred to the action
of metallic objects upon the passage of the electricity to and
from the body and to the condition of the skin in relation
thereto. The laws of conduction and resistance are precisely
the same for the electricity of lightning as for the other forms.
Hence the greater the resistance to the electricity at the points
where it enters or leaves the body, the deeper will be the burn.
Thus we find not infrequently that the lightning, in its course
from the head to the feet, meets with a chain or a truss, and
almost iuA^ariably at least a portion of the current follows this,
causing a deep burn where it again passes into the skin. All
the external burns of the lightning, except the initial one, are
determined by the position and conditions of the body, the
clothing, and the conductors near. All electricity obeys the
same law and, roughly speaking, follows the path or paths of
least resistance.
The clothing w^orn by a person when struck by lightning
may be acted upon in the most various ways. Sometimes it is
wholly stripped off the unfortunate sufferer, who, as in a case
reported by Cook and Boulting, may have to be protected with
sacks or other hastily improvised coverings. In a case re-
ported by Nason, a girl of thirteen was struck while in the
street and most of her clothes stripped off and torn to shreds,
and the top of her hat, which contained steel wires, was torn
from the brim. In the case of Wilks the body was stripped
entirely naked and absolutely nothing left on except a portion
of the left arm of the man's flannel shirt. The clothing is
sometimes torn to the finest shreds, like those of a mouse's
nest, as described by Van Horn, and in another case (Claes),
where the patient was struck while on board ship, his woollen
jacket was torn into fine bits, which stuck to the ropes, and the
deck was covered with fibres of wool as fine as those of cotton-
wool. In this case the woof of the trousers was said to have
been wholly destroyed, while the web was untouched.
The clothing is also often burnt. Not only are holes burnt
in it as is usually the case at the point where the lightning
SYMPTOMATOLOGY. 093
strikes and at the point where it leaves the bodj', but it may-
be set on fire. It may be found smoking or in flames.
Of all portions of the clothing injured, perhaps the coverings
of the feet are the most frequently so, as the electricity is very
apt to leave the body through the feet, and the resistance op-
posed is great. Hence the boot or shoe is frequently injured.
Sometimes it is pierced as by a bullet, or a large hole is torn in
it, or it may be torn to pieces or reduced almost to lint, while
the foot remains uninjured. It may be torn, shrivelled, and
burnt. In one case the soles of the shoes had disappeared ; in
another the leg of the boot was clearly divided from the sole
and both straps were torn out ; while again in another the shoe
was carried wholly off.
The amount of injury to the clothing does not necessarily
correspond to the amount done to the body. A person may be
killed by lightning while the clothing is uninjured. On the
other hand, the clothing may be torn to pieces, carried away,
or even partially burnt, while the portion of the body under-
neath remains unhurt.
Symptomatology, — The symptoms of stroke by lightning
resemble, in a general way, those due to high-tension currents
of electricity. As in the case of the latter, they can be divided
into the direct, j^roduced immediately by the lightning itself,
and the indirect, or secondary, produced through the medium of
other factors.
In the milder cases the person struck feels dazed and be-
numbed and may or may not lose consciousness for a short
time. At the moment struck they may have the sensation of
a blow, and they often see a blinding flash. On recovery of
their faculties there may be a temporary anaesthesia or weak-
ness of one or more extremities, which rarely lasts more than
twenty-four hours. There is a general shock to the system,
sometimes slight loss of memory for a time, and occasionally
nausea and vomiting. There are often discolorations of the
skin of medium extent, and frequenth' burns and blisters.
These persons have usually received the stroke on one extrem-
ity or have escaped the full force. In the more severe cases
the patient loses consciousness immediatel}' and may continue
unconscious for some hours. He passes into a condition of
collapse with rapid, feeble pulse and cold extremities, and the
694 ELECTRICITY — BULLARD.
pupils are dilated. On recovery of his senses the same symp-
toms as in the less severe cases, only more pronounced, are
found. The loss of memory may be marked and the intellect
temporarily w^eakened, while the weakness and anaesthesia of
the extremities persist longer. The external injuries, bums,
and wounds are liable to be more severe.
In the fatal cases where death is directly due to the electric-
ity it is usually instantaneous or at least without recovery of
consciousness. It may be caused by shock or by apoplexy,
i.e., intracranial hemorrhage or by the direct effect of the elec-
tricity on the brain. Of course death is often due to bums or
to indirect traumatic injuries.
The indirect traumatic injuries caused by lightning are due
either to the loss of consciousness of the patient, which causes
him to fall and thus sustain injury, or to the direct action of
the electricity upon him, knocking him down or throvdng him
to some distance, sometimes with great violence, or lastly, and
perhaps the most frequent cause, to the impact or pressure of
objects which are torn or cast down by the electricity and by
striking or falling on a person produce great injury. Thus
persons have been killed by the fall of buildings, sheds, or trees
which were struck by the lightning, or their branches. Of
course all kinds of traumata may be produced thus.
The direct external injuries caused by lightning are burns,
subcutaneous hemorrhages, discolorations and markings of the
skin either dendritic or metallic, lacerations or wounds.
Burns occur in nearly all, perhaps all, severe cases of light-
ning stroke. They may be of any or all degrees, and may ex-
tend over very small points or over the whole or nearly the
whole body. They may consist in a simple singeing of the
hair, or they may be very deep and extend to the bone. As
before stated, the deep burns are found at the points of resist-
ance to the current, at its points of entrance and exit from the
body, and, to a lesser degree, at all points where its course is
impeded. This occurs wherever the clothes are fastened tightly
or pressed against the body, hence especially at the neck, waist,
knees, and sometimes at the ankles. The position of the burns
is determined, therefore, by the point at which the lightning
strikes the person, the position at the moment, and by the ar-
rangement of the dress and the presence of metallic substances.
WOUNDS — CONTUSIONS. 695
In the large majority of cases the upper portion of the body is
the part first touched by the lightning, and thence it descends
along the body to the ground. We are apt, therefore, to find a
severe burn about the upper portion of the body, the head,
neck, or shoulders ; then a scorching, singeing, or burning, more
or less severe, in the form of a stripe or stripes more or less
broad down the body : the burns being deeper where the clothes
are tighter or where metallic objects come into contact with
or are near the body ; and finally a deep burn at the nearest point
of contact with the ground, usually the heel or some portion of
the foot.
The burns, however, vary greatly. The eyes may be burnt
and severely injured or destroyed. The lightning has been
known to enter the mouth and burn the mucous membrane
within. The deeper burns not infrequently assume the form of
holes. In Heusner's cases about twenty whitish-gray spots,
varying from the size of a lentil to that of a pea, were found
on the soles of the feet. The hair is usually singed and may
be burnt off in large areas, or wholly as in a case reported by
Bernard.
Wounds. — These may be direct or indirect. We shall
speak here only of the first. Like burns they occur usually at
the points of greatest resistance, that is, the places of entrance
and exit, but they may be found in any part of the body. They
ma}" be clean- cut, as if made by a sharp knife, or they may be
lacerated and ragged with the edges contused or burnt. They
may consist of holes which look as if they had been punched
out.
Contusions or ecchymoses. These may also be produced
directly by the lightning, and like burns and wounds are most
apt to occur where the resistance is greatest. They may be of
considerable importance in a medico-legal sense, as in Fredet's
case, where there were ecchymoses on the neck similar to those
produced by the fingers of a hand applied for strangulation. In
the case related by Cook and Boulting the right side of the
body appeared like an exaggerated example of post-mortem
staining. There are sometimes found also dark- brown spots,
small or large, which may be soft and, when cut, containing
fluid blood, or they may be hard and like parchment, dr}', and
bloodless on section.
696 ELECTRICITY — BULLARD.
Closely connected with these are the so-called dendroid or
dendritic marks, which are dark-colored reddish bands or stripes,
often more or less dichotomously branched, not disappearing
under pressure, found on the bodies of those struck by light-
ning. Though usually of the form mentioned, they may as-
sume other shapes, as that of an irregular star with zigzag rays.
Balfour has figured an excellent example of these.
Metallic staining of the skin has been known to occur
where metals were in contact with it at the time of the light-
ning stroke. These stains may be permanent and are due to
the introduction of the finely divided metal. Richardson has
succeeded in producing this artificially in animals. He found
two conditions required, that the metallic conductor should be
sufficiently fine to offer resistance to the current and that the
current itself should be an electric discharge of low tension.
Loss of hair is said to have occurred from lightning, though
the hair was not burnt. One case has been reported where
after a severe stroke all the hair on the body is said to have
fallen out.
Symptoms.
Under this heading we shall consider only such symptoms
as are, so far as can be ascertained, the direct result of the elec-
tricity and not those secondary to injuries.
We will consider first those relating to the nervous system.
Loss of Consciousness. — This occurs to a greater or
less extent in all but the very mildest cases. It varies through-
out all degrees from a slight momentary benumbing of the
faculties to the most profound stupor or coma. It may then
last hours or even days. On recovery the patient is apt to have
some loss of memory, to be dazed and confused for some time,
and a certain obtuseness or blunting of the intellectual faculties
may persist for a considerable period. This loss of conscious-
ness is often accompanied by flushing of the face and dilatation
of the pupils, or on the other hand the patient may present all
the symptoms of collapse.
Loss of memory in regard to the lightning stroke after
recovery of consciousness is not rare. It is frequentlj' complete
so far as any recollection of the lightning goes, and there may
be no remembrance of the thunder-storm. Sometimes a defec-
SYMPTOMS. 697
tive memory persists together with general mental impairment
(James).
Mental Disease. — A condition of mental impairment last-
ing at least weeks or months maj^ occur. Mania and the de-
lirium of terror are said to have occurred.
Various symptoms of the disturbance of the nervous equi-
librium are not uncommon. Among these we maj' mention
tremor, insomnia, and nervous dread of thunder-storms and of
electricity. There is no doubt that some persons who have
been exposed to lightning stroke do, at least for a time, become
unusually susceptible to the influences of atmospheric elec-
tricit}'.
Loss of Motion — Paralysis. — This is a very frequent re-
sult of a stroke from lightning. Hemiplegia is not uncommon.
In Bonnet's case the patient was struck on the head by the
lightning, which caused a lacerated wound in the left temple,
but did not injure the aponeurosis. On recovery of conscious-
ness the patient was found to have a left hemiplegia involving
the face and both extremities accompanied by a diminution of
sensation over the left half of the bodj'. The sensation became
normal in two days, but a partial hemiplegia remained perma-
nently. In the case of Durand there was a nearl}* complete
right hemiplegia with accompanying hyperaesthesia and some
affection of speech. Deglutition and mastication were difficult,
and there was persistent hiccough. There was photophobia and
hyperaesthesia. The patient improved in two weeks and finally
recovered. There is often a temporary hemiplegia.
Nearly all forms of paralyses of the extremities may occur.
We may have parah'sis of all the extremities or of both arms
or legs, or monoplegias. Paraplegia occurs not very rarelj'.
It is usually of short duration. It may be accompanied b}'
paralysis of the bladder. Single muscles or muscle groups only
may be affected.
Ptosis may occur with paralj^sis of other branches of the
third nerve, causing diplopia. Facial paralysis occurs also
alone ; in one case it lasted only twentj'-four hours, in another
one month.
Difficulty in mastication is sometimes found, but much
more frequentl}^ difficulty in deglutition is reported.
Retention of urine, dysuria, or incontinentia urinse may all
G98 ELECTRICITY — BULLARD.
occur, and there is sometimes a paralysis of the rectum, usually
temporar}', and sometimes obstinate constipation, which in one
case was combined with paralysis of the bladder and mono-
plegia.
Aphasia in various degrees and various forms of dysphasia
or difficulty in speech are not uncommon. They are apt to be
temporary.
Loss of co-ordination in the lower extremities with partial
paralysis of bladder and rectum is reported.
Convulsions. — Epilepsy may be brought on by lightning :
this would be more likely to occur in a person previously sub-
ject to epileptic attacks. Hysterical convulsions and spasms
may also be produced, both immediately and as a more remote
result, usually in persons predisposed. Tetany and catalepsy
are said to occur.
Clonic spasms of the whole body and convulsive movements
of the limbs are not very infrequent. In some cases a marked
sensitiveness remains for a time in the limbs struck, so that if
touched they are immediately thrown into clonic spasms.
Disturbances of Sensation. — Pam occurs in nearly all
cases. It is most frequently a secondary result of the burns
and other injuries. Not rarely, however, it exists as a direct
symptom in the form of a burning or stinging neuralgia in the
limb or limbs affected. Sometimes the first sensation on the
recovery of consciousness seems to be pain all over the body or
confined to some portions only, but the amount and character
of the pain, aside from that produced by the injuries, varies
much. One patient had a burning pain in the back and leg
lasting only half an hour after recovery of consciousness. In
another case there were pains all over at the end of the first
week. On the whole, severe pain in some or all of the limbs,
and less commonly in the head, without paralysis and lasting
some days is not rare. In one case reported by Paige the
patient had intense pain in the head, neck, arms, and chest;
that in the head was constant, severe, and lasted seven days,
elsewhere less constant.
Pain in the arms accompanied b}^ paralysis and anaesthesia
and lasting three months has been reported.
Headache is not rare as a later or secondary symptom.
Disturbances of sensation other than pain are not rare.
CONVULSIONS — DISTURBANCES OF SENSATION. 699
A certain amount of hyperaesthesia almost always exists in
the portion affected immediately after the stroke. This is often
SO marked that it cannot be wholly due to the burns or other
injuries. It is usually very temporary and ceases in a few
hours. In some cases a permanent or lasting sensitiveness to
the action of electricity is said to remain.
Anaesthesia, loss or diminution of sensation, occurs either
with or without paralysis. In the cases reported by Balfour,
one boy said he could not feel his legs and another that his arms
were cut off. In a case reported by Free there was loss of sen-
sation in the right upper extremity from the elbow to the
fingers and in the left lower extremity from the knee to the
toes. As a rule, the loss of sensation is temporary and quickly
passes away, but it may last, in company with paralysis, for
some time. In such cases either an organic lesion or a trau-
matic neurosis is to be suspected.
Parsesthesic© are very common after lightning stroke. Most
frequent, perhaps, is the subjective sensation of numbness.
Tingling, formication, and the sense of " pins and needles" may
occur.
Beflexes. — As a rule, the deep reflexes seem to remain nor-
mal. The superficial reflexes of the parts affected are at least
temporarily increased.
Special Senses. — Sight. — Affections of the eye. The eye
and the surrounding parts may be directly injured by burning.
We also find many serious conditions caused by the lightning
the pathology of which will be considered later. When a person
is first struck he may perceive a flash of light or a ball of fire
before losing consciousness. While unconscious the pupils are
usually dilated, but react. Sight may be at once totally lost,
but this is usually only temporary. There may be amblyopia ;
photophobia, lachrymation, and pain are not uncommon for a
time. Cataract may be produced and other severe ocular affec-
tions may result.
Hearing. — Sudden and total deafness may be caused by
lightning, as in the case of Cook, where perforation of both
tympana was found. This may prove to be only temporary,
as in the case of Nason, where the patient, though totally deaf
at first, is reported as hearing fairly on the fifth daj' ; on the
seventeenth day, however, the hearing was still dull. The
700 ELECTRICITY — BULLARD.
deafness may be permanent. With deafness tinnitus is apt to
occur. Hyperacustia, or extreme sensitiveness to noise, has
also been reported in several cases.
Smell and Taste. — The person affected sometimes has
noticed a smell resembling that of sulphur, and this has also
been said to have been apparent to others. A metallic taste
in the mouth is not rare.
General Symptoms. — When first struck by lightning
and while still unconscious, the patient has usually a flushed
and reddened face, with dilated pupils. Immediately follow-
ing, or perhaps without this preliminary stage, appear the
symptoms of collapse. Cyanosis may occur, and the patient
may appear to be asphyxiated.
Fever, not caused by injuries, ma}' sometimes occur, but
certainly not to any extreme degree. In many cases the tem-
perature when taken was normal, and even in cases of severe
stroke without serious surgical injury the temperature has not
risen above 101°. In these latter cases it is hard to say how
far the temperature is affected by the burns which are always
present.
The pulse is sometimes slow, sometimes rapid and feeble, or
almost imperceptible ; at times it is irregular.
The respiration is apt to be labored. In Paige's case there
was marked dyspnoea. It maj^ be almost imperceptible. It is
sometimes slow and sometimes rapid.
Nausea and vomiting occur often after recovery of con-
sciousness. Vertigo and reeling may exist from various causes.
It is probable that seminal emissions may occur at the mo-
ment of shock.
Menstruation, when present, may be checked or may con-
tinue. Pregnant women do not necessarily abort.
Pathology and Pathological Anatomy.
A few words must be said in regard to the pathological
conditions which may be directly produced by lightning and
can be detected during life. The burns, wounds, ecchymoses,
dendritic marks, and other external signs have already been
fully considered.
Certain pathological changes, however, have been found in
PATHOLOGY — AUTOPSIES. 7Ui
the eyes which are capable of being verified during life. In
addition to swelling and oedema of the lids, to the' injuries
from burns and to the various paralyses of the ocular muscles,
changes in the tissues of the eye itself may occur. In the first
place we may find corneal opacities and adhesive iritis. Irido-
cyclitis may occur. Cataract formation is not rare, and its
causation has given rise to many theories. Optic neuritis and
neuro-retinitis are sometimes found; and we have sometimes
optic atrophy. Structural changes in the choroid may also be
caused by lightning. Rupture of the choroid, hemorrhage
from the choroid and retina, and partial detachment of the
retina may occur from the shock without the patient being
struck by the lightning and without rupture of the external
tissues.
Ears. — Perforation of the tympanum is reported in more
than one case.
Autopsies.
We shall consider here the pathological conditions found in
deaths from electricity, whether due to artificial or to atmos-
pheric sources. The results are or may be the same in either,
so far as we now know, and it is probable that the action of
the electricitj^ is practically the same in either case, onlj' vary-
ing as regards the strength and tension of the current.
Rigor Mortis. — This has generally been found in cases of
death from artificial electricity. In the case of Jugigo, who
was executed by electricity, it was present four and one-half
hours after death. As regards its occurrence in death by light-
ning and the rapidity of its onset, there has been much discus-
sion. It is certainly present in many cases, and the probability
is there is nothing diagnostic in regard to it in deaths by light-
ning. When absent, its absence is probably due to the pres-
ence of some external factor and has no relation to the form of
death. Wo have, on the other hand, no proof that the rapidity
of its onset is increased.
Coagulation of the Blood. — It has been observed fre-
quently that the blood of persons struck by lightning does not
coagulate readily. Sullivan states that in certain cases of com-
plete disorganization after lightning shock the blood is left
fluid and incoagulable and its color changed to a deep black.
703 ELECTRICITY — BULLARD.
In one of the cases of death from artificial electricity reported
by Grange, the heart was found sixty-two hours after death to
be filled with liquid blood of a rosy vermilion color, which
quickly became darker on contact with the air. A spectro-
scopic examination of the blood showed the normal lines of
oxidized blood reducible by sulphydrate of ammonium. In a
case reported by Matzinger the blood as submitted was black
and perfectly fluid, the corpuscles, both red and white, were
normal, and no fibrin was detected. In those executed by elec-
tricity the blood seems to have been fluid and not in any way
remarkable.
There seems to be no evidence that the bodies of those dying
from electricity in any form suffer unusually rapid decompo-
sition.
The only absolute sign of death from electricity is decompo-
sition of the tissues, but the usual signs are to be relied upon to
the same extent as in ordinary cases of death.
Internal Organs. — In the cases of death from mechanical
electricity no changes in the internal organs other than those
due to accidental traumata have been found, except a consider-
able degree of congestion and sometimes minute hemorrhages
in the heart substance beneath the pericardium and into the
pulmonary air-vesicles and pleura. In one of Grange's cases
the heart was filled with liquid blood ; in the other it was com-
pletelj' empty, the right ventricle collapsed, the walls of the left
ventricle hard and contracted.
Careful autopsies were made in the cases of the criminals
executed by electricity, but no important changes caused by
the electric current have been detected either macroscopically or
microscopically. A few petechial spots (Tardieu's spots) are
apt to be found underneath the pericardium in the heart tissue
and sometimes beneath the pleura. The organs were not ex-
tremely congested. In the case of Jugigo the vessels of the
spinal cord and its membranes contained if anything less blood
than usual. In this case the amount of blood found in the
brain seems to have been about normal, the vessels of the dura
were moderately dilated and those of the pia " in a medium
state of congestion." In the case of Kemmler the portion of
the intracranial contents underneath the head-electrode was
somewhat affected directly by the heat, the meningeal vessels
INTERNAL ORGANS. 703
in the dura were carbonized, and the brain cortex was sensibly
hardened to one-sixth of its depth, "where there was a broken
line of vascularity. " The post-mortem temperature in this case
seems to have remained unusually high, being 97° F. in the
fourth ventricle and 99° F. at the back of the neck three hours
after death in a room where the temperature was onh' 83°.
In autopsies after death by lightning the results are in gen-
eral analogous. The brain and its membranes may be anaemic
or congested. Effusions of blood may be found beneath the
dura or in the brain substance itself, due to the laceration or
injury of vessels. Rupture of the brain is said to have oc-
curred, and Phayre reports a case in which the left hemisphere
was entirely destroyed and changed into a dark gray homoge-
neous fluid mass, only a small portion of the corpus callosum re-
maining. No extravasation of blood, laceration of the vessels
or membranes, or injury of the bones was detected.
Ecchymotic spots are frequently found beneath the serous
membranes, pericardium, pleura, and peritoneum.
Schmitz states that parenchymatous inflammation of the in-
ternal organs may occur, and Sullivan reports a case where
the stomach was found to be gangrenous over a large sur-
face, the patient having lived several days. Cases of rupture of
the heart, the liver, and the spleen are reported.
THE MEDICO-LEGAL CONSIDERATIO]^
OF
Death by Mechanical suffocation
INCLUDING
HANGING AND STRANGULATION.
BY
DANIEL SMITH LAMB, A.M., M.D.,
Pathologist Army Medical Museum, Washington, D.C.; Professor of Anatomy Medical
Department Hoivard University, Washington; Secretary Association of Ameri-
can Anatomists; Late Acting Assistant Surgeon United States Army;
President of Association of Acting Assistant Surgeoiis
U. S. A. ; Member of Learned Societies.
MECHANICAL SUFFOCATION.
Suffocation is the name applied to both the act of and con-
dition resulting from the deprivation of atmospheric air. If
the deprivation is due to mechanical interference, the term
MECHANICAL SUFFOCATION is USed.
Mechanical interference may be by pressure upon or obstruc-
tion within some portion of the respiratory tract.' Suffocation
by pressure upon the neck is called hanging when the con-
stricting force is the weight of the bodj^ itself ; and strangula-
tion in all other cases. German writers designate strangula-
tion by cords, ropes, and the like as Erdrosselung, and by the
hand as Erwiirgungj French writers do not make this distinc-
tion. In English the word throttling is probably oftener
applied to strangulation by the hand than by cords.
The term suffocation is also applied in a special sense
to the act and result of pressure on the mouth, nose, or chest
and abdomen, stopi^ing the breathing; or of obstruction within
the respiratory tract; or of pressure upon the tract from the
oesophagus, etc. ; or of breathing of irrespirable gases.
Strangulation is almost always homicidal, hanging almost
always suicidal, and suffocation (limited) usually accidental,
but also often homicidal.
Strangulation may be admitted, therefore, as including all
cases of suffocation by pressure on the neck, whether by cords
or the hand ; but excluding hanging.
It will facilitate the study of the subject if we use the word
ligature as a general term to cover the many forms of cords,
ropes, etc., used in strangulation and hanging.
The word garroting is often used to indicate the forcible
compression of the neck b}'- the hands of thieves. The assault
is usually made from behind, and the victim is robbed while
the throttling proceeds. The brevity of the process explains
why death is not more frequent. The word garroting comes
from the Spanish; criminal execution in Spain and Italy is
708 STRANGULATION — LAMB.
usually by means of the garrote, a steel collar which is tight-
ened on the neck of the condemned b}' a screw. The notorious
thugs of the East Indies used sometimes a soft loin-cloth, at
others a lasso or long thong with a running noose. In Turkey
and some other Eastern countries the bowstring is a common
mode of execution.
An examination of the reported cases of strangulation and
hanging shows a great variety of forms of ligature: cords,
ropes, thread, thongs, lassos, flexible twigs, bamboos, leather
straps, girdles, turbans, fishing-nets, collars, cravats and other
foims of neckwear, bonnet strings, handkerchiefs, sheets, etc.
Women have even strangled themselves with their own hair
(Case 34). Stones, sticks, coal, and other hard substances
have sometimes been inserted in the ligature to increase the
pressure (Cases 36, 38, 42, 43, 44). Drunken and otherwise
helpless persons have been strangled by falling forward with
the neck against a firm substance.
strangulation.
Symptoms and Treatment.
The symptoms and post-mortem appearances in strangula-
tion will vary, according as the deprivation of air is sudden or
gradual, partial or complete; and whether there is coincident
pressure on the great arteries, veins, and nerves of the neck.
The deprivation of air disposes to asphj^xia ; pressure on the
great arteries by cutting off the supply of arterial blood to the
brain disposes to anaemia of the brain and syncope; pressure
on the great veins, b}^ preventing the return of blood to the
heart, to congestion of the brain and coma; pressure on the
great nerves, the pneumogastrics, to syncope. Statistics of
hanging show that in about seventy per cent of cases death is
by a mixture of asphyxia and coma. While it is probable that
the proportion is less in strangulation, yet it is also probable
that a mixed result frequenth' occurs.
Asphj'xia is from « priv. and fl'cr(3|.'9, pulse — absence of pulse.
Apnoea from a priv. and -v^w, I breathe — absence of breathing.
Syncope, Toyy.o-r^^ a faint; suspended animation from sudden
failure of heart. Coma, zw,aa, deep sleep. Richardson ' makes
'Asclepiad, 1890, Tii., pp. 102-117.
STRANGULATION. 709
the following distinction between asphyxia and apnoea: As-
phyxia is difficulty of taking in breath ; apnoea is breathless-
ness. There is asphyxia when the blood from the heart can go
to the lungs, but there is no access of air ; apnoea, when there
is access of air, but the blood fails to reach the lungs. In as-
ph3'xia the lungs obstruct the circulation ; in apnoea the obstruc-
tion is in the heart. In asphyxia the air cannot reach the blood ;
in apnoea the blood cannot reach the air.
Quinquaud ' and Fredericq ' conclude from experiments on
animals that asphyxia is due to the deficiency of ox5"gen, not
to the accumulation of carbon dioxide.
Page ^ divides the phenomena witnessed in an animal killed
by simply depriving it of air, without interfering Avith the
blood-vessels of the neck, into four stages :
First. A short stage. ( In the human subject this stage could
scarcely last longer than fifty seconds, which is said to be the
extreme limit of the most expert divers. The breath can be
held longest if a number of deep breaths have previously been
taken, so as to surcharge the blood with oxygen.)
Second. The stage of "besoin de respirer," when the want
of air begins to be felt ; the animal makes vigorous and violent
efforts to overcome the obstacle. This stage may continue for
three to four minutes.
Third. Unconsciousness supervenes with irregular and
spasmodic movements ; efforts at respiration continue.
Fourth. Efforts at respiration cease, but the heart still beats.
This stage maj^ last from two to four minutes. Hofmann *
says that it may last a half -hour. In new-born infants, as-
phyxiated, it may be quite long.
The post-mortem appearances in such an animal were as follows :
the lungs were pale, reddish, not much distended ; there were a few
dilated air-cells toward the anterior border ; hemorrhages irregularly
dispersed over the surface of the lung, varying in number and size.
The right cavities of the heart contained dark fluid blood, the left were
empty. The pulmonary artery and systemic veins, even the smallest
branches, were gorged with dark blood. Page adds that when the
•Compt. Rendu See. Biol., 1890, •'" On the Value of Certain Signs, "
ii . pp. 383-387. etc., Edinburgh, 1878.
-Archiv. Biol, de Gand. , 1887, ^ "Lehrbuch gericht. Med.," 1891,
vii., pp. 217-227. p. 503.
710 STRANGULATION — LAMB.
great vessels of the neck are interfered with death may occur "bj
coma, syncope, and even asthenia."
CoHn ' made twenty-five experiments on horses, and records three
of them as follows : they were all strangled with a hempen cord at
the middle of the neck. The first was quiet till the second or third
minute, then there were violent movements and strong efforts to dilate
the chest ; at four minutes, spasms ; four and one-half minutes, quiet ;
six minutes, pupils dilated, tongue hanging out, limbs flaccid; blood
black. Second horse: Carotid artery denuded to observe its action.
In fifteen seconds, blood nearly black ; four and one-quarter minutes,
no pulsation in carotids ; five and one-half minutes, no respiratory
movement ; six minutes, heart-beat ceased, except feeble contraction
of auricles, which continued till twenty-first minute. Third horse :
In five minutes respiration ceased ; tracheotomy performed, but there
was no attempt to breathe ; eight minutes, heart ceased to beat. Sim-
ilar results were obtained in ruminants and in small animals, except
that the larger animals lived longer than the smaller.
Faure made the following experiment on a large dog. He tied a
cord tightly round its neck ; for fifty-five seconds it was quiet, then
suddenly it became agitated, threw itself against the wall, rolled on the
ground, twisted itself ; bloody tiucus escaped from the nose and mouth;
the teeth were ground together ; urine and faeces were passed. The
efi'orts at respiration became very rapid. It fell dead at the end of
three and one-half minutes.
The symptoms of strangulation in the human subject resem-
ble closely those just described as occurring in the dog.
The FIRST or preliminary stage lasts a variable time,
according to the suddenness and completeness witli which the
access of air is prevented ; it lasts until there is a demand for
the air. In a case of homicide, injuries may be inflicted on
the victim in this stage which may have an important bearing on
the cause of death. Blows on the head may cause unconscious-
ness, or even apoplexy; upon the stomach, may cause syncope;
stab- wounds may tend to cause death from hemorrhage.
The SECOND stage begins with the demand for air and lasts
till unconsciousness supervenes. It is characterized bj" frantic
efforts to breathe, efforts in which the entire body takes part.
If the subject is conscious, he is intensely so ; the expression of
the face is intense; the eyes may protrude, the hands be
clinched ; the memory is unusually active, and the events of a
'Bull. Acad. Med., 1876, y., p. ' Archiv. gen. de Med., 1856, p.
763. 302.
STRANGULATION. 711
lifetime may rapidly pass before the mind in a few minutes.
The tongue may be thrust between the clinched teeth and
bitten ; and urine, faeces, and semen may be discharged.
The THIRD STAGE usually appears suddenly, and is charac-
terized by unconsciousness and irregular involuntary move-
ments, i.e., spasms; these may end in opisthotonos; the veins
become turgid, and hemorrhages may occur from the eyes,
nose, mouth, throat, ears, and into the connective tissues of
the lungs, pleura, pericardium, etc. The circulation of venous
blood in the arteries is shown by the general lividity, especially
where the skin is thin, as the lips and tips of fingers. Hof-
mann ' states that coincident with the oncoming of unconscious-
ness and convulsions the respiratory effort becomes expiratory,
followed still later by inspiratory efforts.
The FOURTH STAGE begins with the cessation of spasms and
of efforts to breathe. The subject is quiet, but the heart still
beats. The stage ends with the cessation of the heart-beat.
Discharges of semen, urine, and faeces may occur in the
first and second stages, from terror; in the second and third
from the general agitation, and in the third and fourth from
paralysis.
Strangulation according to Bernard ^ causes a rise in tem-
perature, varying from one to two degrees (Cent.). He thinks
that this is due to the changes from arterial to venous blood,
especially in the muscles.
Lukomsky ^ concluded from experiments that in asphj^xia
both arterial and venous pressure is increased in the systemic
circulation, but diminished in the pulmonary artery. The
highest degree of blood pressure coincides with the strongest
respiratory movements, especially expiration. He also con-
cluded that the Tardieu spots (subpleural ecchymoses) directly
depended on the efforts of breathing and blood pressure.
Some writers, as Taylor and Tidy, think that death occurs
sooner in the human subject than in the lower animals; where
the access of air is suddenly and completely prevented death
may be immediate. Tardieu says that death follows pressure
of the hand sooner than that of a ligature.
'"Lehrb.d.ffer.Med.,"1891,p. 500. -^Viert. f. ger. Med., etc., 1871,
^" Lemons sur les anaesthesiques, " xv., pp. 58-96.
Paris, 1875, p. 471.
712 STRANGULATION— LAMB.
Fleischmann ' placed cords round his own neck between hyoid bone
and chin, tied them tightly, sometimes at the side, sometimes at the
back, without respiration being interfered with, because there was no
pressure on the air passages. But his face grew red, eyes protruded
slightly, there was a feeling of great heat in the head, of weight, com-
mencing dizziness, and suddenly a hissing and rustling in his ears.
The experiment should stop at this point. The same symptoms occurred
from applying the cord over the larynx. The first experiment lasted
two minutes, the second a half -minute. The difference was due to the
different situation of the cord.
Dr. G. M. Hammond - gives an account of a personal experiment
in strangulation. He sat down ; a towel was passed around his neck,
and the ends twisted together, making forcible compression of the
neck. At first he had a feeling of warmth and tingling, first in the
feet, then passing over the entire body ; vision partly lost ; his head
felt as if it would burst ; there was confused roaring in ears, like the
sound heard on placing the ear to a shell ; he x'emained conscious. In
one minute twenty seconds all sensibility was abolished. After a few
minutes' rest a second similar trial was made, with similar results, ex-
cept that sensibility was lost in fifty -five seconds. A stab with a knife
drawing the blood caused no sensation.
Should the subject recover from the immediate effects of the
strangulation there may yet be serious secondary results.
Among these are convulsions and paralysis ; extreme svrelling
of face, neck, and chest ; loss of voice ; lesions of larynx and
lungs; abscesses. Death may occur suddenly and remotely
from one of the sequelae. ^
In the treatment of strangulation the first indication obvi-
ously is to remove the pressure from the neck. Artificial respi-
ration will probably be required, and may be aided by ammonia
applied to the nostrils, tickling of the fauces, and galvanism.
Colin ' states that artificial respiration is useless after cessation
of heart-beat. (See the treatment by galvanism under " Suffo-
cation.") If the body is cold, artificial heat by means of hot
bottles, etc. Venesection may be necessary. Colin strongly
advises venesection to relieve the distention of the heart. Stim-
ulants and light food are often required.
' Translation in Ann. d'Hvg. , Archiv, 1880. i., p. 648); Petrina
1832, viii., p. 433. (Prag. med. Woch., 1880, No. 39);
2 Med. Record, N. Y. , 1883, xxii. , Wagner ( Jahr. f . Psych. , 1889, viii. ).
p. 427. [Hofmann, "Lehrbuch," pp. 570-
3 See Maier (Friedreich's Blat., 573]. See Cases 17, 19, 31.
1882, p. 460); Moreaud (Virchow's -iBuU. Ac. Med., 1876, v., p. 761.
POST-MORTEM APPEARANCES. 713
Limousin ' recommends the use of oxygen. Cobos " experi-
mented on animals by injecting oxygen hypodermically, as a
means of artificial respiration. His conclusions are that the
oxygen is absorbed and carbon dioxide eliminated in the same
place. The oxygen thus introduced causes no trouble. Tes-
tevin ^ cures asphyxia by hypodermic injection of ether.
The after-treatment will depend on the after-conditions.
The prognosis is good if there is no serious injury to the
neck and treatment is promptly applied.
PosT-MoRTEM Appearances.
The post-mortem appearances in strangulation are ex-
ternal and internal.
The external appearances are of two kinds : those directly
due to violence and accident and those due to asphj^xia.
External Appearances Directly Due to Violence or
Accident. — The marks on the neck. In some fatal cases
there are either no marks at all or they are but slight; this is
more likely to be the case in suicides than homicides, and is
usually due to the ligature being soft and yielding. The vic-
tim of a homicide may, however, first be stunned and after-
ward strangled.
Marks are said to be plainer after the body has become cold
and where subjects have recovered from attempts at suicide.
The marks of the ligature in strangulation usuall}^ encircle
the neck more completely and more horizontally than in hang-
ing. These conditions may, however, be reversed, because a
body maj^be dragged by the neck after strangulation, and there
have been suicides by hanging in whom the mark of the cord
was horizontal. As a rule, however, a horizontal mark with
the knot on the same level as the cord, especially if below the
larynx, suggests strangulation rather than hanging; and if
there are several marks the probability is even greater. In
compression with the fingers the marks are not in a horizontal
but oblique line.
The mark of the ligature is usually circular, well defined,
'Ass. Fran?. Av. Sci. (1883), 1884, « Rev. d'Hyg. ther., 1890. ii., pp.
xii., pp. 1042-1045. 67-72 and 131-137.
3 Alger. Med., 1887, xv., pp. 78-90.
714 STRANGULATION — LAMB.
and corresponds closeh' to the breadth of the ligature; rather
depressed, and usually below the larynx. As a rule this de-
pression is not deep ; the skin at the bottom of the groove is
usually very pale, while the adjacent parts are red or livid.
Sometimes the bottom of the groove shows ecchymoses. Ney-
ding * says that suggillations in the groove made by the ligature
on the neck are rare, but are oftener found in strangulation
than hanging, because the conditions favoring their formation
are oftener found in strangulation. In most cases the skin and
connective tissue of the groove and of the parts in the vicinity
show, microscopically, hypersemias and hemorrhages. Liman "
states that when we find suggillation in the groove or its vicin-
ity, we may know that some other form of violence has been
applied at the same time as that of the ligature or hand. He
had not seen suggillation in the furrow either in strangulation
or in hanging, except when the injured persons had lived some
time, and in cases of twisting of the umbilical cord. The ab-
sence of suggillation and ecchymosis was due, he thought, to
the pressure on the capillaries. Bremme ^ saj^s that in the sub-
cutaneous connective tissue of the mark of the ligature there is
no hemorrhage either in strangulation or hanging, if death
occurs at once and the cord is removed at once after death;
but if the cord remains for some time after death there may be
hemorrhage, or if death does not occur at once whether the lig-
ature is removed or not. It is impossible to distinguish ante-
mortem from post-mortem hemorrhage.
The parchment skin seen in hanging is seldom seen in
strangulation. Ne3'ding * says that the dryness and induration
called parchment skin depend mainly on the amount of excori-
ation of the skin, and this is greater in hanging. Tardieu
explains this frequency as being due to the fact that the con-
striction in hanging lasts a longer time. Liman has seen the
parchment skin in those strangled.
The violence used may cause ecchymoses and abrasions of
the skin of the neck adjacent to the mark of the ligature.
The marks of very different constricting ligatures may be
'Viert. ger. und ofif. Med., 1870, n^iert. f. ger. Med., etc., 1870,
xii., pp. 340-369. xiii., pp. 247-260.
* Ann. d'Hyg., 1867, xxviii., pp. * Loc. cit.
388-402.
POST-MORTEM APPEARANCES. 715
quite similar. Taylor ' mentions a case in which a soft silk
handkerchief was used, and the appearance was the same as
that of a narrow cord, due to the tightness with which it was
tied.
Where a hard substance like a piece of coal or stone is in-
serted into the ligature, usually then a soft cloth, and presses
directly against some part of the neck, there is usually a corre-
sponding bruise.
Marks of pressure by the thumb and fingers are usually on
the front of the neck, and either just above or below the larynx.
In many cases these marks are only those of the finger-tips with
some scratches. These marks may show definitely the proba-
ble size of the assaulting hand, and whether right or left.
Marks of strangulation maj^ disappear rapidly after the re-
moval of the ligature. Assailants usually constrict the neck
much more violently than is sufficient to cause death. Marks
of violence on the neck are, therefore, greater in strangulation
than in hanging.
A great variety of external injuries other than those on the
neck have been found in the different cases reported where
other forms of violence were used. With few exceptions such
additional injuries indicate homicide.
External Appearances Due to Asphyxia. — A few
of these have already been given under the caption " Symptoms."
If death occurs quickly there may not be any signs of asphyxia.
The general lividity which comes on in the second stage usu-
ally remains after death. The face varies in color from violet
to black and ma}" be swollen. Casper'' says that the face has
the appearance of any other corpse. Liman ^ found the face
livid in only one of fourteen cases. Hofmann^says that the
cyanosis appears during the agony because of paralysis of the
circulation and gravitation of blood. The cyanosis of the face,
projection of the eyes, and congestion of the conjunctives are due
to the expiratory effort. These signs are also seen in fat per-
sons who do not die of strangulation. Tardieu ^ mentions a
dotted redness or minute ecchymosis of the conjunctivae and
'"Med. Jur.,"Amer. ed., 1892, -^Ann. d'Hyg., 1867, xxviii., p.
p. 411. 393.
' Tidy, " Med. Jur. , " Amer. ed. , •* " Lehrb. d. ger. Med. , " 1891. p. 504.
1884, iii., p. 263. ^ "Pendaison," etc., 1870, p. 169.
716 STRANGULATION — LAMB.
skin of face, neck, and chest as constant ; but this cannot be
considered characteristic, because it has been seen, though not
so well marked, in death from other causes. It has been found
in suffocation from compression of the chest and belly; and
also where there is respiratory interference in the prolonged
efforts of tedious labor and in convulsions. Liman ' found it
in those who were hung. It is due, according to Hofmann," to
increased blood pressure and consequent hemorrhages. It is of
importance as tending to show that there was stasis of blood in
the head and face during life. Liman ^ found cyanosis in the
conjunctivae, lips, back of mouth, and in the muscles. Maschka *
in 234 cases of asphj'xia found capillary hemorrhages of the
eyes and eyelids 87 times.
Dastre and Morat ^ claim that in asphyxia the cutaneous cir-
culation becomes more active than in the normal state, while
at the same time the vessels of the abdominal cavity are con-
tracted. Laffont * considers the mechanism of this peripheral
dilatation.
Post-mortem stainings (hypostases) are usually darker
in strangulation than in other forms of death. They appear
soon, as does also putrefaction, because of the quantity and
fluidity of the blood.
Signs of hemorrhage from the nose, eyes, and mouth maj"
be visible; as also bloody froth from the mouth and nose.
Che vers ' never saw bleeding from the ears in strangulation.
Taylor * states that Dr. Geoghegan informed him of a case of
suicidal strangulation by a ribbon ; the violence was great, there
was bleeding from the ear, and the drum was found ruptured.
In this case the mark on the neck, which was deep, nearly dis-
appeared after the ligature was removed. Taylor also saj'S
Wilde, of Dublin, saw a case of rupture of drum and hemorrhage
in strangulation. Pellier* says that Littre mentions a case of
rupture of tj'mpanic membrane in strangulation by a cord.
Zoufal and Hofmann have offered explanations of the occur-
rence (Case 35).
• Op. cit. , p. 393. « Compt. rend. Soc. Biol. (1881),
' Op. cit., p. 504. 1882, iii., pp. 1.59-161 and 165-168.
3 Op. cit. , p. 394. ■" Tidy, op. cit.
""Handb. ger. Med.," 1., 1881, p. »"Med. Jur.," Am. ed., 1892, p.
569. 413.
5 Compt. rend. Soc. Biol. (1879), « Lyon thesis, 1883, No. 188, p. 85.
1880, i., p. 310.
EXTERNAL xVND INTERNAL APPEARANCES. 717
The FACE usually shows pain and suffering ; although some-
times the features are calm. In the latter case there may have
been syncope.
The EYES are usually staring, prominent, and congested, and
the pupils dilated. Casper ' doubts their prominence. Budin
and Coyne ° state that in asphyxia the dilation of the pupil
progresses to a maximum and then convulsions occur. Oph-
thalmoscopic examination during the dj-spnoea of asphyxia
shows a lessened fulness of the retinal vessels.
The TONGUE is often swollen, dark, protruding, and some-
times bitten. Maschka ^ states that if the ligature lies above
the hyoid bone, the tongue will be drawn backward ; if over or
below the bone, the tip of the tongue may appear more or less
between the jaws.
The HANDS are usually clinched and may have in their
grasp articles which, under the circumstances, have a medico-
legal value.
The EXTERNAL GENERATIVE ORGANS are Sometimes con-
gested ; erection of the penis may have taken place and per-
sisted. The vagina may be moist. Tardieu, Devergie, and
Casper * deny that these appearances are usual.
Involuntary discharges of urine, faeces, and seminal
fluid may have occurred. There is nothing characteristic in
their appearance.
All the external appearances of asphyxia are usually more
marked in strangulation than in hanging.
Internal Appearances. — The mark. Usually there is
hemorrhage into the loose connective tissue under the mark and
in the subjacent muscles ; in most cases isolated and circum-
scribed, but sometimes extending be5'ond the line of the mark.
Hemorrhage from compression by the fingers is more marked
than that from ligature.^ Sometimes there is only fulness of
the subcutaneous veins.
The carotid arteries may suffer rupture of their inner
and middle coats, especiallj^ in atheromatous subjects and when
the compression has been great. Friedberg" states that the
' Tidv, op. cit. ^Tardieu, "Pendaison, " etc., p.
■Gaz. Med. de Par., 1875, xlvi., 174.
pp. 90-92. « Virchow's Archiv, 1880, Ixxix.,
^"Handb. ger. Med.," i., p. 571. p. 409. and 1878, Ixxiv., p. 401.
* Tidy, op. cit.
718 STRANGULATION — LAMB.
injury of the carotid, if there is hemorrhage into its middle and
internal coats, is a proof that the strangulation occurred during
life, and probably from pressure of the fingers on the neck,
without any regard to any disease of the artery. He reports
two cases. The examiner should be careful not to injure the
artery with his forceps. The vessels may contain clots.
The NECK occasionallj" suffers extreme injur}', and, owing
to the violence used, this occurs oftener in strangulation than in
hanging.' Occasionally the neck is broken.
The HYOID bone may be fractured (see Case 5) . Maschka '
saw one case in eighteen of Erdrosselung and five cases in
fifteen of Erwiirgen.
The TRACHEA is sometimes torn, or may be folded on itself.
The cartilages of the larynx, especially if calcareous, may
be fractured. This is more likely to affect the thyroid than
cricoid. The fracture would appear to occur only as the result
of enormous force ; especially in the young in whom the car-
tilages are so elastic. The experiments of Keiller ' on cadavers
led him to conclude that falls on the larynx, even from a height
and with superadded force, are unlikely to fracture that organ ;
that severe pressure or violent blows against the larynx from
before backward may cause fracture; but that severe lateral
pressure, as in ordinary throttling, is more likely than other
forms of violence to fracture the alae of the thyroid or even the
cricoid cartilages and also the hyoid bone. Taylor * states that
Dr. Inman, of Liverpool, had informed him of a case of splitting
of rings of windpipe from pressure (see Cases 5, 13) . Maschka *
in fifteen cases of choking found six fractures of the larynx.
Chailloux® has collected eight cases of fracture of larynx in
strangulation. They were all made with the fingers. The ex-
periments of Cavasse ' seem to show that there is no great diffi-
culty in fracturing the thyroid in strangulation.
Internal Appearances Due to Asphyxia. — The veins
of the entire body are distended with very dark and very fluid
blood, while the arteries, especially in the young, are mostly
empty. Experiments on the lower animals have shown that
■Tidy, "Leg. Med.," Am. ed., "» "jyj^jj j^j..," Am. ed., 1892, p.
iii., p. 265. 414.
-' "Ger. Med.," i., p. 623 and 632. * "Ger. Med.." i.. p. 632.
=*Edinb. Med. Jour., 1856. ii., p. « Paris thesis, 1874. No. 291.
824. •> Paris thesis, 1859, No. 9.
INTERNAL APPEARANCES DUE TO ASPHYXIA. 719
the pulmonary artery and systemic veins to the finest ramifica-
tions are distended with dark blood.'
The Heart. — The right side, especially the auricle, is usu-
ally full of dark fluid blood, due to the mechanical impediment
to the passage of blood through the lungs. If the heart contin-
ues to beat after the respiration has ceased the right ventricle is
commonly well contracted, like the left cavities, and nearly
empty, the lungs being much congested. Sometimes the left
cavities of the heart contain blood. This would be most likely
to occur if the heart should stop in the diastole. Sometimes
clots are found in the right ventricle. Maschka ° found clots in
the heart 25 times in 234 cases of asphj'xia.
The LUNGS are usually much congested, resembling red
hepatization, except that the blood is darker. Hemorrhages
(apoplexies) into the substance of the lungs are common.
Tardieu found patches of emphysema due to rupture of the
surface air-vesicles, giving the surface of the lung the appear-
ance of a layer of white false membrane. Ogston admits this
occurrence in pure strangulation but to a less extent in mixed
cases. Liman ' found the lung surface uneven, bosselated, the
prominences being of a clearer colof and due to emphysema.
The lungs were in the same condition of congestion and emphy-
sema in strangulation, suffocation, and hanging. He failed to
find the apoplexies described.
The lungs are sometimes anaemic. In healthy j^oung sub-
jects, especially children, the blood-vessels of the lungs often
empty themselves after the heart stops. The lungs may, there-
fore, be bloodless, but emphysematous from the violent efforts
to breathe. Page's experiments on the lower animals showed
the lungs of a pale reddish color and not much distended ; a few
dilated air-cells might be seen toward their anterior borders,
and there might be small hemorrhages over the surface. His
experiments appear to show that subpleural ecchj^moses occur
as a result of violent and repeated efforts to breathe. Among
other experiments^ he stopped the mouth and nostrils of a
young calf long enough to excite violent efforts at respiration ;
it was then instantly killed by pithing. The lungs were found
'Page, "On the Value of Certain ^Tardieu. "Pendaison, " etc., p.
Signs, " etc. , Edinburgh, 1873. 178.
'^ "Ger. Med.," i., 573. ■» Oj). cit., p. 29.
720 STRANGULATION — LAMB.
pale red, not congested, but showed subpleural ecchymoses.
Page believed these were due to the changed relation between
the capacity of the thorax and volume of lungs. Liman found
these ecchymoses in cases of strangulation, hanging, drowning,
poisoning, hemorrhage, and U3dema of brain, in the new-born,
etc. He failed to find them in some cases of suffocation. He
believes them due to blood pressure from stasis in the blood-
vessels. Ssabinski ' made many experiments on dogs and cats
to ascertain the presence or absence of subpleural ecchymoses
in strangulation, drowning, section of pneumogastrics, opening
of pleural sac, compression of chest and abdomen, closure of
mouth and nose, burial in pulverulent materials, etc. Similar
hemorrhages may appear on the mucous and serous membranes,
as the respiratory, digestive, and genito-urinary tracts, and
pleurae, pericardium, peritoneum, membranes of brain, and the
ependyma. These are sometimes minute and stellate, at others
irregular in shape; many are bright-colored. According to
Tardieu the punctiform ecchymoses are rarely present except
in suffocation. Maschka,'' in 234 cases of asphyxia, found
the lungs congested 135 times, anaemic 10, and cedematous
42. He thinks the subpleural ecchymoses valuable signs of
asphyxia.
The BRONCHIAL TUBES are usually full of frothy, bloody
mucus, and the mucous membrane is much congested and shows
abundant ecchymoses.
The lining membrane of the LARYNX and trachea is al-
ways congested and may be livid ; the tube may contain bloody
froth or blood alOne.
Tidy comparing strangulation and hanging concludes that
because strangulation is usually homicidal, and greater violence
is used, therefore the external marks are more complete in
strangulation and the congestion of the air passages is invaria-
bly much greater.
Maschka found the pharynx cyanotic in 216 of 234 cases of
asph3^xia.
The other mucous membranes are generally much con-
gested. Serum is found in the serous cavities.
Maschka ' considers the rounded, pin-head ecchymoses of the
' Vier. f. ger. Med., etc., 1867, '"'Ger. Med.," i., p. 576.
vii., pp. 140-174. 'Ih., p. 572.
INTERNAL APPEARANCES DUE TO ASPHYXIA. 721
inner surface of the scalp and pericranium valuable evidence
of asphyxia.
The BRAIN and membranes are sometimes congested ; occa-
sionally apoplectic. Maschka ' found congestion of brain and
membranes 48 times and ansemia 30 times in 234 cases of as-
phyxia.
The ABDOMINAL ORGANS are generally darkly congested,
although Maschka denies this for the liver and spleen in as-
phyxia.
The congestion of the viscera generally is doubtless due
largely to the prior congestion of lungs and engorgement of
heart.
Page ^ experimented on six kittens, strangling three of them by the
hand, the other three by ligature. The results of the post-mortem ex-
aminations were nearly similar : the veins were full of dark fluid blood ;
the right cavities of the heart were similarly gorged, the left empty ;
lungs pale red, not congested and not distended. Brain normal. The
differences were in the lungs ; in the first series there were many
small, irregular, circumscribed, dark -red ecchymoses scattered over the
general surface ; in the second, a small number of bright-red ecchy-
moses, somewhat larger than a large pin-head.
Langreuter^ made some experiments on a cadaver from which
enough of the posterior part had been removed to enable him to view
the throat. He saw that the lateral digital pressure on the larynx closed
the glottis ; stronger pressure made the vocal cords override each other.
Similar pressure between the larynx and hyoid bone caused apposition
of the ary-epiglottic folds and occlusion of the air-passages. He experi-
mented on sixteen bodies to ascertain the effect of blows and pressure
on the larynx, with the following results : In eight cases, women, the
thja'oid cartilage was injured three times, the cricoid four ; in eight,
men, the thyroid eight and cricoid five. Whence he concluded that
the larynx is better protected in women. In the sixteen cases the hyoid
bone was fractured ten times.
The Proof of Death by Strangulation.
Tidy " says that " nothing short of distinct external marks
would justify the medical jurist in pronouncing death to be the
result of strangulation." On the other hand, Taylor ^ considers
•"Ger. Med.," i., p. 575. •»"Leg. Med.," Am. ed., ill., p.
2 " On the Value of Certain Signs, " 267.
etc., Edinburgh, 1878, p. 24. 6"Med. Jur.,"Am. ed., 1892, p.
»Vier. f. ger. Med., etc., 1886, 415.
xlv., p. 295.
46
722 STRANGULATION — LAMB.
the condition of the lungs described as characteristic. Liman '
did not think there were any internal appearances which could
distinguish suffocation, strangulation, and hanging from each
other.
In estimating the value of testimony it will be well to con-
sider the following facts :
A victim may be strangled without distinct marks being
found. The practice of the thugs shows that this may be done
with a soft cloth and carefully regulated pressure without
making marks. Taylor,^ while admitting the possibility, states
that this admission " scarcely applies to those cases which re-
quire medico-legal investigation."
The subject while intoxicated or in an epileptic or hysterical
paroxysm may grasp his neck in gasping for air, and leave
finger-marks.
Different constricting agents may make quite similar marks.
Marks may be made on the neck within a limited time after
death, similar to those made during life. Tidy's experiments
led him to fix this limit at three hours for ecchymoses and six
hours for non-ecchymosed marks. Taylor, Miowever, doubts if
such marks could be made one hour after death. He says that
the period cannot be stated positively, and probably varies ac-
cording to the rapidity with which the body cools.
It is, however, unlikely in such post-mortem attempts at
deception that the other conditions usual in strangulation would
be found — such as lividity and swelling of face; prominence
and congestion of eyes; protrusion of tongue; rupture of sur-
face air- vesicles and apoplexies in the lung; congestion of
larynx and trachea, etc.
No conclusion can be drawn from the presence or absence of
any single appearance.
A cord may be found near a body or even around its neck;
there may even be a mark around the neck. These may be
attempts at deception.
Marks much like those of violence may be made by tight
collars and handkerchiefs remaining until the body is cold.
Cases are reported of bodies having been first strangled and
1 Ann. d'Hyg., 1867, xxviii., pp. ^ujyjgjj Jur.," Am. ed., 1893, p.
388-402. 416.
3 7Z>., p. 415.
THE PROOF OF DEATH BY STRANGULATION. 723
then burnt or hung to cover the crime ; and of partial suffoca-
tion by gags, followed by or coincident with strangulation (see
Cases 18, 20, 24).
In apoplectics with short and full neck we may find at the
borders of the folds of skin in the neck one or more depressions,
red or livid, that bear some resemblance to the marks of a liga-
ture ; but on section there are no ecchymoses.
Froth, tinged with blood, in the air-passages is considered
by Tardieu ' one of the most constant signs of strangulation.
The marks of topical medical applications, as plasters, sina-
pisms, etc. , must not be confounded with marks of violence.
In strangulation by ligature the marks are usually hori-
zontal; in hanging, oblique. In hanging too they are usually
dry and parchmenty. Ecchymoses are more marked in stran-
gulation.
The dotted markings of face, neck, and conjunctivae described
by Tardieu are more characteristic of strangulation.
The principal distinctions between strangulation and suffo-
cation would be the absence in the latter of marks on the neck.
Taylor ^ quotes the case of Marguerite Dixblanc, in which
the question was raised whether she had strangled her mistress,
Madame Riel, or whether the body had been dragged by a rope
around the neck. The question was left unsettled by the med-
ical evidence.
The only motive for attempting to simulate strangulation on
a corpse would seem to be to inculpate an innocent person.'
Both suicides and murderers are usually more violent than
is necessary to destroy life ; murderers more than suicides.
Putrefaction may cause external marks to disappear.
All marks on a body should be carefully noted ; the cavities
of the skull, thorax, and abdomen carefully examined ; the pos-
sibility of death having occurred from other causes, even in
strangulation, must be considered.
As Taylor well says, our judgment must not be swayed to
the extent of abandoning what is probable for what is merely
possible.
In all cases the cord or strangulating ligature should be
carefully examined for marks of blood, for adherent hair or
i"Pend.,"p. 186. ^ Op. cit., p. 415.
» "Med. Jur.," Am. ed., 1892, p. 415.
724 STRANGULATION — LAMB.
other substances. The precise manner in which the cord has
been tied should be noted.
Strangulation: Accidental, Suicidal, Homicidal,
Slmulated.
The question whether a case of strangulation is accidental,
suicidal, or homicidal is very difficult to answer.
Accidental strangulation is rare. If the body has not
been disturbed, there is usually no difficulty in arriving at a
conclusion ; but if disturbed a satisfactory conclusion may not
be reached.
It is worthy of mention that the umbilical cord may be
twisted around the neck of a new-born infant and may have
caused strangulation; the mark may give the appearance of
death by violence.
Suicidal strangulation is rare. The experiments of Fleisch-
man (supra) suggest that one may commit suicide by compress-
ing his throat with his fingers (see Case 48).
Where a ligature of any kind has been used it is important
to notice the number and position of the knots. In a general
way a single knot either in front or at the back of the neck
might suggest suicide; more than one would suggest homicide.
There are, however, exceptions.
Suicide has been committed by mere pressure of a cord fixed
at both ends a shore distance from the ground ; by twisting a
rope several times around the neck and then tying it (the coils
may continue to compress even after death) ; by tightening the
cord with a stick or other firm substance; by tightening the
cords or knots by means of the hands or feet or some portion of
the lower limbs ; by the use of a woollen garter passed twice
around the neck and secured in front by two simple knots,
strongly tied one to another.
It is difficult to simulate suicide; requires great skill and
premeditation on the part of a murderer. " The attitude of the
body, the condition of the dress, the means of strangulation,
the presence of marks of violence or of blood on the person of
the deceased, on his clothes or the furniture of the room, or
both, rope or ligature, are circumstances from which, if ob-
served at the time, important medical inferences may be
STRANGULATION. 725
drawn." The assassin either does too little or too much.
Taylor ' cites a number of cases of simulation.
Strangulation is generally homicidal. The marks of fin-
gers or of a ligature on the neck suggest homicide. This is
true even if the mark is slight; because infants and weakly
persons may be strangled by the pressure of the hands on the
throat. Even a strong man, suddenly assaulted, may lose his
presence of mind and, with that, his power of resistance ; with
approaching insensibility his strength still further diminishes.
This is true even if his assailant is the less powerful. It re-
quires more address to place a ligature on the neck than to
strangle with the hand.
A victim may be made insensible by drugs or blows and
then strangled by a small amount of compression ; or suffoca-
tion by gags and strangulation may both be attempted.
The importance of considering the position and number of
the knots in a cord is inentioned under suicidal strangulation.
In homicide, in addition to the marks on the neck, there is
likely to be evidence of a struggle and marks of violence else-
where on the body. It is important, therefore, to notice any
evidence of such a struggle.
The nature of the cord may assist in identifying the as-
sailant.
It must be remembered that homicidal strangulation may be
committed without disturbing noise even when other persons
are near.
Simulation. — False accusations of homicidal strangulation are on
record. Tardieu '^ states that a distinguished young woman (for some
political purpose) was found one evening at the door of her room ap-
parently in great trouble and unable to speak. She first indicated by
gestures and then by writing that she had been assaulted by a man who
tried to strangle her with his hand, and also struck her twice in the
breast with a dagger. She was absolutely mute — did not even attempt
to speak — quite contrary to what is always observed in unfinished
homicidal strangulation. On examination by Tardieu, no sign of at-
tempt to strangle was found, and the so-called dagger-openings in her
dress and corset did not correspond in position. She confessed that
she had attempted deception.
The celebrated Roux-Armand'' case was another instance of at-
i"Med. Jur.," Am. ed., 1892. p. • "Pend.." p- 208.
419. Ub., p. 242.
726 STRANGULATION — LAMB.
tempted deception. A servant named Roux was found on the ground
in the cellar of his employer Armand ; his hands and legs were tied
and there was a cord around his neck. He was partly asphyxiated,
but after removal of the ligature from his neck he rapidly recovered,
except that he was weak and voiceless. He stated by gestures that he
had been struck by his employer on the back of the head with a stick
and then bound as described. The next day he could speak. Armand
was imprisoned. Tardieu examined carefully into the case and the re-
sults may be stated as follows : The asphyxia was incipient, else he
could not have so rapidly recovered. The cord around his neck had
not been tied — simply wound around several times ; the mark was
slight and there was no ecchymosis. Although the legs and hands
were tied, the hands behind the back, there was no doubt but that Roux
could and did tie them himself. He had stated that he had been eleven
hours in the cellar, in the situation in which he was found. This could
not be true, for a veiy much shorter time, an hour probably at the fur-
thest, would have caused death, in view of the condition of asphj-xia
in which he was found. Again, if his limbs had been bound for so
long, they would have been swollen and discolored ; but ' they were
not. Again, if the ligature had been around his neck so long as he
said, the impression of it would have been more marked. Again, if liis
stertorous breathing had lasted long it would have been heard by neigh-
bors. The injury on the back of the head, said to be due to a blow,
was believed by Tardieu to be due to dragging him on the ground. He
further had stated that when he received the blow on the head he be-
came unconscious, and yet he also described how Armand bovmd him
after knocking him down. Again, he had made no outcry ; but if he
had been strangled while partly unconscious and afterward recovered
his senses, he wovild have been unable to give an account of the matter ;
if, however, he had been strangled while conscious, there was no rea-
son why he should not have cried out. His inability to speak the first
day was assumed, because what was a simulation of absolute mutism
should have been simply a loss of voice. The innocence of Armand
was ultimately established.
ILLUSTRATIVE CASES.
Homicide.
1. Cullingworth : Lancet, May 1st, 1875, p. 608.— Woman. Believed
to have been intoxicated. Face, especially right side, swollen and
livid; a little blood had oozed from mouth, nose, and inner angle of
each eye. Immediately over (in front of ?) larynx and on each side
of middle line were marks of irregular outline such as might be caused
by pressure of thumb and fingers. Several dark, bruise-like discolor-
ILLUSTRATIVE CASES — HOMICIDE. 727
ations on flexor surface of each forearm. Hands clinched. Elbows
flexed. Discharge of faeces by rectum. Necroscopy : Brain and mem-
branes normal. Hyoid bone and laryngeal cartilages uninjured. Mu-
cous membrane of larynx and trachea congested and covered with
frothy mucus. Lungs intensely congested. Several hemorrhages ;
masses of tissue of each lung, chiefly toward base, were solidified by
effused blood. All the heart cavities empty. Stomach normal, empty.
No congestion of abdominal viscera.
2. Taylor: ''Med. Jur.,'" Am. Ed., 1892, p. 412.— Man and woman.
Strangled by cord, tied so tightly that there was hemorrhage from
mouth and nose.
3. Harvey: Indian Med. Gaz., December Isi, 1875, p. 312. — Hindoo
woman, age 45. Strangled with the right hand. Necroscopy : Two
contusions and abrasions on temple. Neck discolored from right to
left jugulars ; marks of thumb on right side and three fingers on left,
extending from jugulars to windpipe. Eyes half protruded. Tongue
discolored. Blood-vessels full of clots. Brain congested (?) and showed
external hemorrhages (?). Lungs normal. Heart empty. Liver rup-
tured to the extent of four inches, with adherent blood-clot. Spleen,
stomach, and intestines normal. Muscles of chest, both sides, congested,
discolored, and there were clots of blood over and under them. First
six ribs of left side and first three of right fractured.
4. Harris: Ibid., p. 313. — Boy, age 10. Abrasions over front of
neck, especially near left ear, probably from ligature ; also abrasion
on upper part of chest, probably from forcible pressure. Underneath
these marks the veins were much distended. Trachea minutely con-
gested ; contained much frothy fluid. Lungs showed rupture of some
of the air-vesicles ; entire tissues distended with blood and frothy fluid.
Dark fluid blood in both sides of heart. Large quantity of fluid in
pericardium. Brain much congested. Eyes congested. Tip of tongue
between teeth. Other organs normal.
5. Mackenzie: Ibid., February, 1889, j>. 44. — Hindoo woman, age
not given, strangled by another, stronger woman. Necroscopy :
Abrasion on front and lower part of neck just above sternum and clav-
icles ; four inches long, three broad; five superficial lacerated wounds
on sides of neck, four on left, one on right, apparently nail scratches.
Two contusions below and behind lower jaw. Also contusions on
thighs. No spots of ecchymosis on neck. Contusion under skin of
lower part of neck and upper part of chest, eight inches long, four
broad. Left greater cornu of hyoid bone fractured. Both upper cornua
of thyroid cartilage fi-actui-ed; cricoid fractured on each side. Larynx,
trachea, and bronchi contained pink frothy mucus ; mucous membrane
congested. Lungs much congested ; pink frothy mvicus in bronchi ;
no emphysema nor apoplexies. Right side of heart full of dark blood ;
left side empty. Liver, spleen, and kidneys congested. Stomach and
728 STRANGULATION — LAMB.
intestines normal. Bladder empty. Internal genitals normal. Brain
congested.
6. Mackenzie : Ibid. , August, 1888, p. 232. — Hindoo man, age about
30. Strangled by soft cloth cord. Necroscopy: Circular mark of
cord, one-fourth inch diameter around lower part of neck; indistinct
in front, but distinct at sides and back. Superficial abrasions of lix^s
and right cheek as from a gag. Faint marks of blisters on tem-
ples. Fingers not clinched. Face livid, swollen. Eyes closed; con-
junctivas congested; cornesehazy; pupils normal. Tongue protruding
and bitten; not swollen. Fluid blood oozing from mouth and nose.
Clotted blood under scalp of left temple. Skin beneath cord had the
color and consistence of parchment. Muscles not torn. Hyoid, thyroid,
and cricoid not injured. Larynx, trachea, and bi'onchi empt}"; con-
gested. Lungs much congested. Some dark fluid blood in right side
of heart; left side emj)ty. Liver, spleen, and kidneys congested.
Small patch of congestion in stomach. Intestines normal. Bladder
normal, contained some urine. Brain congested.
7. Ibid., p. 234. — Hindoo woman, age about 40. Broad, circular,
depressed ' ' parchment " mark, one inch broad, around the neck, be-
tween hyoid bone and thyroid cartilage; made by two pieces of cloth,
each three feet seven inches long and one inch broad, twisted into a
single cord and tied tightly by three ordinary knots on right side of
neck. Superficial wound on left side of head above ear. Face turgid,
swollen. Eyes closed. Tonguebetween teeth and bitten; not swollen.
Muscles of neck uninjured. Trachea uninjured. Lungs congested.
Right side of heart full of dark fluid blood; left side empty. Liver
and spleen congested. Other organs, includitig brain, normal.
8. Ibid., p. 235. — Hindoo woman, age about 25. Piece of cloth
twisted tightly twice around mouth. Double cord made of two twists
of thin coir rope tied tightly around middle of neck just below thyroid
cartilage; beneath the cord the skin was "parchment" like. No in-
jury to muscles of neck nor windpipe. Eyes closed. Face not flushed.
Tongue not ruptured nor bitten. Hands not clinched. Larynx, tra-
chea, and lungs congested. Right side of heart full of dark fluid blood ;
a little fluid blood in left. Liver, spleen, and kidneys congested. Other
organs, including brain, normal. Dr. Mackenzie considered death to
be due to "asphyxia or suffocation."
9. Harvey : Ibid., January Isi, 1876, p. 2. — Hindoo woman, age 12
oris. Faint mark on front of neck; none at back. Severe bruise on
top of head, under which was much clotted blood, but no fracture.
Lungs congested. Clots in right ventricle; left empty. Brain, larynx,
and trachea congested. The examiner believed that she had been
stunned and then suffocated by pressure of some soft substance against
the neck.
10. Ibid. — Hindoo man, age 20. Dead seven days; muchdecompo-
ILLUSTRATIVE CASES — HOMICIDE. 729
sition and discoloration. Wrists and ankles were bound. The two
corners at one end of a cotton lungi (turban) were passed one on each
side of the neck and fastened in a knot under left angle of jaw. The
hingi was then passed around the body under the arms, etc., so as to
draw upon the neck and be buried deeply in the swollen flesh. Under
the bands the skin was blanched; the tissues above the bands were
black and much swollen. Lungs, larynx, and trachea much congested.
Heart empty.
11. Ibid. — Cases of strangulation by sticks and other hard substan-
ces. Boy, age 7 or 8. No external marks of violence. There was
hemorrhage from mouth and nose. Face swollen and crepitant. Con-
gestion of subcutaneous tissues and bruising of muscles of right side of
neck. Mucous membrane of larynx and trachea covered with blood.
Lungs much congested; blood in both pleural cavities. Heart empty ;
bloody serum in pericardium. Brain congested; slight hemorrhage
on surface. Abdominal organs normal. Dr. Harvey states that the
boy was no doubt strangled by pressure of a lathi on his neck.
12. Ibid. — In another subject two sticks were tightly tied together,
one pressing on the front, the other on the back of the neck, flattening
larynx and other soft parts. In the following case some hard sub-
stance, like a brick, had been wrapped in a cloth and used for compres-
sion. Boy, age 15. Necroscopy : Large dark ecchj^mosis in subcuta-
neous tissue of front of neck and upper part of chest. Also marks of
violence on chest and left side of face. Dissection of neck showed blood-
ciot and also laceration of muscles. Trachea folded on itself, show-
ing that compression had lasted several minutes. Tongue protruding
and bitten. Eyes closed. Features calm. Trachea much congested.
Lungs congested. Great veins of heart and neck full of fluid blood.
Heart, dark fluid blood in both sides, mostly in right. Brain and
membranes much congested.
13. Pemberton: Lancet, May 22(\, 1869, p. 707. — Woman, age 60.
Found dead. Nose partly displaced and cartilages injured. Lips pale.
Mouth closed. Lividity of front of neck from jaw to sternum. Cri-
coid cartilage ossified (cretified ?) and broken on left side ; hemorrhage
in surrounding tissues. Lungs and heart as usual in suffocation.
14. Cullingicorth : Med. Chron., Manchester, 18Si-S5, i., p. 577. —
Woman, married, found dead. Bruise and ecchymosis beneath the
ear ; effusion of blood in underlying tissue. Other bruises on face,
etc. Several bruises in mouth, on lips and tongue. Blood dark and
fluid. Brain and membranes much congested. No marks of injury
on throat. Lungs congested ; surfaces emphysematous. Heart con-
tained dark fluid blood. Urine and fieces had been discharged.
15. The Gouffe Case. — Murdered by Eyraud and Bonij^ard in 1889.
Archiv anthropologic criminelle, Paris, 1890, i'., pp. 642-716; in.,
1891, pp. 17 and 179. Reports by Bernard, Lacassagne, and othei*s.
730 STRANGULATION — LAMB.
GoufFe was decoyed into a rooin and strangled ; afterward Ids body
was tied up, placed in a ti'unk, and taken some distance away. The
murderers fled to America ; but eventually Bompard returned to France
and Eyraud was captured ; both confessed. When found, the body
was well advanced in putrefaction ; after a very careful examination
was identified. He was strangled by the j)ressure of fingers ; the head
was afterward wrai)ped in a cloth which w^as held in place by five
turns of a cord around the neck ; traces of the furrows made by these
cords were found. Heart empty ; no blood in muscles of neck ; hyoid
bone intact but superior thyroid cornua fractured at base.
16. Horteloup: Ann. d' Hygiene, 1873, xxxix., pp. 408-416. — Man
found dead on some leaves in a fountain at bottom of staircase ; skull
and spine fractured. The murderers stated that they had struck him
on the head with a crutch; then, believing him to be dead, carried him
and threw him into the foxmtain. When examined, his face was livid,
tongue between teeth and bitten nearly in two ; and three parallel
abrasions on left side of neck and one on right ; slight wounds about
the face in addition to the fractures mentioned. No report of examina-
tion of lungs or larjTix. Horteloup concluded that the man had been
strangled to death, and that when thrown into the fountain, alighting
on his head, the jaws were brought together and tongue bitten.
17. Laennec: Journ. de med. Vouest, 1878, xii., pp. 68-71. —
Woman, age 53 ; attempted strangulation by her husband. There were
slight ecchymoses on each side of neck under angle of jaw, most
marked on left side ; when seen, she compla;ined of lassitude and lively
pain in hj-pochondria and region of lower ribs antero-laterally ; no
sign of lesion. She stated that she was awakened from sleep by pres-
sure on neck and chest and feeling of suffocation ; she soon lost con-
sciousness and so remained for some hours. Her statements Avere cor-
roborated by other testimony. Laennec considered the case one of
prolonged syncope from pressure on carotids.
18. Lancet, ii., 1841-42, p. 129. — Woman, found dead, her clothing
on fire and lower part of her body burnt. Necroscopy showed face and
neck swollen as low as thyroid cartilage, and purple ; eyes prominent
and congested ; mouth closed ; tongue not noticed ; front of neck be-
low swollen part showed two dark-bro^vn hard marks and slight marks
also of pressure ; on incision the vessels were engorged. Blood, fluid ;
brain, congested. There were no vesications from the burns and no
sign of inflammation.
19. Algiiie: ''Etude med. and exp. de Vhoniicide reel on simule
par sfrangidation, relativement aux attentats dont Maurice Roux
a etc Vobjet,'''' Montpellier, 1864, p. 121. — This essay contains the re-
ports of many interesting experiments on animals and the cadaver.
His conclusions in this case were that the victim had first been struck
on the neck by a club ; then a ligature was placed on the neck, with
ILLUSTRATIVE CASES — HOMICIDE. 731
many turns, tied tightly, but the knots did not remain tight. [The
marks were visible four months afterward.] The assailant then tied the
limbs. The victim recovered ^dth temporary loss of voice, memory, etc.
20. Gatscher: Mittheil. d. Wien. med. Doct. Colleg., 1878, iv.,p.
45. — A man found hanging. The examiner declared that he had hung
himself. Eight years afterward, suspicion of violence. A commission
appointed. The protocol had shown the blood fluid ; a red-brown dry
furrow around the neck ; ecchymoses in connective tissues of same ;
the entu'e back and posterior parts of limbs showed post-mortem sug-
gillation. The commission declared that the man had been strangled,
had lain for at least three hours on his back, and then been hung up.
The murderer confessed.
21. Ibid., p. 46. — Woman, age 50, found dead in bed. Blood fluid ;
two ecchj'moses size of beans in ci'ico-thyroid muscles of each side ;
j)atch of heiDatization size of fist, in lung ; injury of body. The ex-
aminer declared that she had been strangled by comjiression of larynx
with two fingers, but he could not say how long the pressure had con-
tinued, that is, whether she had died of the strangulation or of the
pneumonia. The assailant stated that he had choked her and when
she seemed to be dead, had left her. The woman lived alone.
22. Waidele : Memorabilien, 1873, xviii. , pp. 161-167. — Husband
and wife quarrelled and fought; he stated that he choked her with her
neckhandkerchief, and as she turned round toward him, then choked her
with his hand until she died. The examiner declared that she died of
asphyxia; there was a browmish-red dry streak on each side of the neck
in the larjTigeal region corresponding to the handkerchief, and also two
small abrasions of skin which might have been made by the hands; he
concluded, however, that she had been choked to death by tlie hand-
kerchief, because there were no ecchymoses.
23. Rehm: Friedreich's Blatter f. ger. Med., 1883, xxxiv., 2>P- 325-
332. — Woman, age 37. Choked by the hand on the neck, and at the
same time assailant's knee pressed against her abdomen, pressing her
against a wall, causing hemoi'rhage around the jjancreas. Death stated
as due to asphyxia.
24. Schilppel: Vier. ger. off. Med.,xiii.,lS70, pp. 140-156. — Woman,
just delivered of child, and boy ten years old, were burnt to death in a
fire which consumed their house. Examination of the bodies showed
upon the neck of the boy a groove, and his tongue protruded. The hus-
band was charged with murder, was imprisoned, and ccmimitted suicide.
25. Weiss: Ibid., xxvii., 1877. pp. 239-244.— Woman strangulated
bj' the bands of her nightcap.
26. I.HnardandDieu: Rev. casjiid., Paris, 1841. p. 101.— Man, age
65. Marks of fingers on face and neck. Opinion that he had been as-
saulted by ttvo men. The two murderers confessed.
27. Friedberg: Gericht. gutacht., 1875, jip. 211-224.— Woman
732 STRANGULATION — LAMB,
found hanging to branch of tree, but in half-lying position, feet on
ground. Opinion given that she had been strangled and then hung.
^8. Tardieu: '' Pendaison,''^ p. 22B. — New-born infant. Question
whether its death was due to asphyxia from compression of neck by the
mother with her hand to hasten delivery. He doubted the possibility
of the mother thus assisting her child. But the direction of the seven
excoriations on its face contradicted the mother's statement. The traces
of finger-nails wei-e distinct. The lungs and alimentary canal showed
that the child had lived. Opmion given, infanticide.
29. Ibid., p. 219. — Woman, advanced in years, habits dissipated;
found strangled. Four excoriations on left side of lar^Tix, one on
right; blood in subcutaneous tissue. Marks of nails and long scratches
on wrist. Injuries on face and left breast. She had been strangled by
one hand on her neck while the other was over her mouth and nose.
Face li%Hd; eyes congested; frothy bloody liquid fiowmg from mouth
and nose; tongue behind teeth; bloody froth in larynx and trachea;
lungs large, much congested, splenized in places, surface emphysema-
tous, looking like white spots; black fluid blood in heart; brain some-
what congested.
30. Ibid., p. 216. — Wife of the celebrated painter Gurneray; found
dead in bed, where a fire had been placed and slowly burnt and charred
her lower limbs, belly, chest, and right hand. A running noose around
her neck. Injuries of head; face livid; tongue between teeth; brain
normal; mai'k of cord slight; subcutaneous tissue infiltrated Tvith blood.
Marks of pressure on chest; bloody froth in trachea; lungs congested;
heart contained fluid blood. Opinion given that she had been struck
on head, causing unconsciousness; then partly strangled and partly
suffocated by pressure on neck and chest. Body afterward burnt to
cover up the crime.
31. Ibid., p. 211. — Three murders by one man. All women. All
injured about the head and then strangled by both hand and ligatvire.
Two died; one had an odor of alcohol and had apparently not resisted.
The third was resuscitated. She was strong and stout, and resisted.
Marks of fingers and nails on neck. Afterward she had headaches and
giddiness for a long time.
Suicide.
32. Francis: Med. Times and Gaz., December 2d, 1876, p. 634.—
Hindoo lunatic, a giant, strangled himself. He passed two or three
coils of stout thread ai-ound his neck, attached the ends securely to his
wrists, and then extended his arms to their utmost limit. This oc-
curred during a ten-minute absence of his attendant, who, returning,
found the man had fallen to one side from a kneeling position, with his
back against a wall, quite dead. No reason to suspect homicide.
ILLUSTRATIVE CASES — SUICIDE. 733
33. Badahur: Indian Med. Gaz., December, 1882, p. 330. — Hindoo
woman, age about 17, strangled herself with the border of her saree.
Necroscopy : Circvilar depressed mark caused l)y the border of a band
of cloth, which she had passed in three coils around her neck, the coils
tightly ovei'lapping each other ; the short ends had been knotted to-
gether with a "granny" knot at the back of the neck, like the native
women tie up their hair. The coils were so tight that they had to be
cut off. Face swollen, dark purple ; conjunctivte congested. Tongue
between the shut teeth ; bloody froth issuing from mouth and nostrils
[the examination was in September, thirty hoiu-s after death]. Skin of
neck reddened in nearly a continuous line all around, both above and
below the band, about three-fourths inch vside, evidently caused by the
pressure of the three folds. Considerable ecchymosis above and below
the coils ; the neck underneath the folds was swollen and red. Brain
and membranes much congested. Trachea, pharynx, and cpsoi)hagus
congested. Lungs congested. Right cavity (auricle ? ) of heart full,
left empty. Liver, spleen, and kidneys congested. Intestinal peri-
toneum congested. Stomach contained half -digested food. Small in-
testines empty ; faeces in large intestine. Bladder empty. Uterus
and appendages congested ; no evidence of catamenia.
34. Harris: Ibid. — Woman; made a loop of her hair around her
neck, knelt down so as to pvit it on the stretch ; when fovind, was
nearly dead.
35. Geoghegan: Taylor's ''Med. Jur.,'' Am. Ed., 1892, p. 413.—
Informed Dr. Taylor of a suicidal strangulation by a ribbon. The
mark on the neck nearly disappeared after removing the ligature.
There was bleeding from one ear, from rupture of tym]:)anic membrane.
No froth from mouth or nostrils ; but little lividity or swelling of face.
36. Taylor: ''Med. Jur.,'' Am. Ed., 1892, _p. 418.— Boy: found dead
with handle of pitchfork under necktie ; marks of strangulation on
larynx ; eyes and tongue protruded ; tongue livid and marked by teeth ;
brain congested. Also man found dead with handkerchief tied around
neck and twisted by razor strop. Taylor considered both as suicides.
Also a third case (Amer. edit., 1880, p. 465). A man of unsound mind
twisted a fishing-net firmly around his neck several times ; it remained
secure without the aid of a knot.
37. Fargues: Rec. de mem,, demed., etc., Paris, 1869, xxii., pp.
443, 444. — Soldier, age 32, while drunk, strangled himself with his
handkerchief, wrapping many folds around his neck, making a deep
furrow without ecchymosis ; face pale, eyes closed, lips partly closed.
38. Borchard: Jour, de med. de Bordeaux, 1860, t'., p. 349 et seq. —
Collation of cases of suicide by strangulation: First, an otiicer who
placed his sabre scabbard under his cravat. Second, a woman strangled
herself with a silk cravat, tightly tied. Third, a man tied the sleeve of
his jacket around his neck and fastened the end to a Avindow, so that
734 STRANGULATION — LAMB.
the strangulation was partly due to suspension. Fourth, a woman
strangled by a cord.
39. Hofmann: Wien med. Presse, 1879, xx., p. 36, et seq. Also
Lehrbuch, p. 559. — Woman, age 20, found dead in bath-room, with a
thick thread passed three times around the neck, and tied tightly in
front at the second and third turns ; so tightly that even after cutting
the cords the pressure continued. No signs of violence. (Illustration.)
40. Zillner: Wien med. TFbcTi., 1880, icxo;., pj>. 969, 999.— Woman,
age 33 ; found dead on the floor ; a neck -handkerchief tied in a firm
knot in front of the neck ; and underneath, a cord passed twice around
the neck and knotted in front in the middle line between the larjTix
and hyoid bone. Blood was flowing from the ears. No sign of \\o-
lence or struggle.
41. Bollinger: Friedreich's Blatter f. ger. Med., 1889, xl., p. 3.— -
Man, age 48 ; melancholic ; found dead. Had torn up part of a sheet,
fastened it around his neck and the ends around a bedpost, then
placed his feet agamst the farther post and pressed, tightening the liga-
ture. (Illustration.)
42. Moth: Ibid., p. 9. — Man, age 68; melancholic; found dead ix
bed. Had made loose ligature of cravat, tied into it a piece of wood;
the ligature lay in front of larynx. Had attempted suicide once before.
43. Ibid. — Son-in-law at 36 years of age had committed suicide in
the same way.
44. Ibid. — ^IVIan, age 63 ; found dead in his bed; cord around neck
inclosing piece of wood.
45. Maschka: Vier. ger. off. Med., 1883, xxxviii., pp. 71-77. —
Woman, age 45. A cloth was found wound tightly three times around
her neck in front of larynx, and tied in a simple knot. There were also
injuries of the head. At first it was thought that she had been murdered,
but Maschka concluded that she had committed sviicide.
46. Ibid. — Woman; supposed to have been murdered by her son.
There were marks on the neck and other injuries, and hemorrhage
into the brain. Maschka conclvided that the marks on the neck were
not due to strangulation.
47. Hackel: Dorpat Diss., 1891, p. 34. — Man, age 48; strangled
himself with part of a mattress. Was found lying on his back, dead,
holding the ends in his hand. There was a double mark of ligature.
48. Sinner: Zeitsch f. Med-beamte, 1888, i., pp. 364-368.— Wom-
an ; suicided by choking herself with her hands.
For other cases, see Tidy, "Med. Jur.," Cases 20 to 65 ; Maschka,
"Handbuch," p. 625.
Accident,
49. Bedie: Rec. de mem. de Med., etc., Paris, 1866, xvi., pp. 482-
484. — Soldier, age 39, found dying, Ijing on his bed ; had returned to
ILLUSTRATIVE CASES — ACCIDENT. 735
his room drunk and lay down in his uniform. Face much congested ;
lips cyanosed ; eyes closed. Skin of neck below thyroid cartilage
showed deep mark from pressure of collar of uniform wliei-e the collar
was fastened ; had passed urine into his clothing. When examined
after death his face was pale yellow, lips cyanosed, eyes closed ; large
hypostatic patches ; traces of pressure on neck still visible ; lungs con-
gested ; larynx, above level of ]wessure, congested ; below was normal.
Fibrin clots in both ventricles of heart. Liver, spleen, stomach, and in-
testines congested. Brain somewhat congested. Bladder contained
uxine.
50. Liegey : Jour, de Med. chir. et pharm., Brussels, 1868, xlvi.,
pp. 339-342. — Infant, age 8 mouths, accidentally strangled ; it had been
placed in its cradle ; coverlet over it and held in place by a cord passed
across. Some time afterward it was found dead beside the cradle, its
head hanging with the right side pressing on the cord. Liegey had the
mother replace everji:hing as it had been and satisfied himself that the
aljove statement was correct. When found, the face was pale, eyes
and mouth closed ; transverse furrow on right side of neck, level of
larynx, 3.5 cm. long, one deep; muscles in vicinity congested. Lungs
congested. Right side of heart contained clotted blood ; left side nearly
empty. He concluded that the case was one of accidental strangulation.
51. Friedherg: Gericht. gutacht., p. 240. — New-born child found
dead in closet. Mother stated that she had taken the child by the
neck and drew it into the world. Opinion given that the child had
been accidentally choked to death by the hand.
For other cases, see Tidy, "Med. Jur.," Cases 15 to 19, 59, and G2;
Maschka, "Handbuch," p. 623.
HANGING.
Hanging is a form of mechanical suffocation by ligature of
the neck, in which the constricting force is the weight of the
body itself. The French call it " Pendaison" or "Suspension,"
preferably the former; the Germans, "Erhangen." The ex-
pression " incomplete hanging" is applied to those cases in which
the subject is partially supported ; kneeling, sitting, or other-
wise. The same expression has also been used for cases which
did not prove fatal.
The pathological effects of hanging are partly those of
strangulation, to which must be added the effects of the weight
or fall of the body, sustained as it is only by some form of liga-
ture around the neck. These additional injuries will, of course,
be proportioned to the weight of the body, length of rope, and
suddenness of the fall.
736 HANGnSTG — LAMB.
In some countries, as the United States, England, Germany, and
Austria, hanging is a mode of capital punishment. It is desirable that
for judicial pui'poses it should be divested, as far as possible, of un-
necessarily cruel features ; the victim should quickly be made insensible,
and death be s^ieedy. Many suggestions to this end have been made,
among which is that of Haughton, He recommended that the drop be
long, say ten feet, so that the cervical vertebrae may be dislocated. He
also advised that the knot be placed under the chin. Others advise that it
be placed under the left ear ; and others yet, as Barker, of Melbourne, '
near the spine. In any event the rope should be "freely elastic." G.
M. Hammond ^ thinks that the object in judicial hanging should be
strangulation, and that the criminal should be pulled up and left to
hang thirty minutes ; the rope should be soft and flexible so as to
closely fit the neck ; a weight should be attached to the feet of persons
under 150 pounds. Larimore ^ also advocates strangulation instead of
attempting dislocation of the vertebra?. Porter * suggests that for dislo-
cation the noose be drawn tightly around the neck at the last moment,
the knot being either at one side or, still better, in front. Dislocation
may be still further assured if a hollow wooden or leaden ball be placed
over the knot close to the neck, thus forming a fulcrum to throw the
spinal cohimn out of the perpendicular line at the point of pressure.
Hanging is a common mode of suicide, especially in insane
asylums and prisons. It is sometimes accidental, and rarely
homicidal. It is said to have been attempted for erotic pur-
poses.
The compression of the neck acts in line with the axis of the
body; while in strangulation it acts perpendicularly to that
axis.
The final cause of death will depend on: 1. The sudden-
ness and completeness of interference with the access of air*
asphyxia. 2. Pressure on the large veins of the neck, pre-
venting the return of blood from the head, causing congestion
of brain and coma. 3. Pressure on the large arteries of the
neck, preventing access of blood to the brain ; causing anaemia
of the brain and syncope. 4. Injury to spinal cord or pneu-
mogastric nerves or all of them ; causing paralysis. A com-
bination of numbers 1 and 2 is usually found in suicidal hang-
ing; and probablj^ all of them in homicidal and judicial
'Med. Times and Gaz. , 1871, i., ^ Ohio Med. Record, 1878, ii., pp.
p. 671, and 1876, i., p. 93. 350-352.
^ Med. Record, N. Y., 1882, xxii., ^Arch. Laryngol., N. Y., 1880,
p. 428. i., p. 144.
•HANGING. 737
hanging. The more protected the air-passages are from pressure
the greater part will coma or syncope have in the cause of
death. ,
Mackenzie,' as the result of examination of 130 suicidal
hangings, saj'S that 119 died of asphyxia, 8 of asphj'xia and
apoplexy, 2 of syncope, and 1 of apoplexy alone. Coutagne'^
thinks oedema of the lungs, "oedema carmine," has an impor-
tant part in causing death.
Tlie following conditions tend to produce asphyxia : a tight
ligature, or a loose ligature above the hyoid bone. To produce
coma, a loose ligature pressing against the hj^oid bone or
larynx, especially a cretified larynx. To both asphyxia and
congestion of brain, a ligature just beneath the lower jaw, or
around lower part of neck.
Hofniann ^ states that when the ligature is placed between
the larynx and hyoid bone, the base of the tongue is pushed
upward against the posterior wall of the pharj'nx, completely
stopping respiration and causing asphyxia. Ta3'lor* states
that if the rope presses on or above the larynx, the air-passages
are not so completely closed as when pressure is below the
larynx. In the latter case death would be immediate ; in the
former a slight amount of respiration might continue. The
instantaneous^ loss of consciousness is due, not to as23h3'xia
alone, but to compression of the large vessels, especiall}- the
carotids, against the transverse processes of the vertebrae, caus-
ing rupture of the middle and inner coats, and at the same
time compression of the jugular veins and pneumogastric
nerves. Immediate unconsciousness will almost certainly fol-
low compression of the pneumogastrics. He also believes that
the loss of consciousness and of power of self-help occur at the
moment that the noose is tightened around the neck. There is
no record of an}^ one who attempted suicide by hanging seek-
ing to recover himself, although no doubt some would have
done so if the speedy unconsciousness had not prevented. Hof-
mann mentions the case of a man who was found hanging, and
with a loaded revolver in his hand, apparently having intended
to shoot as well as hang himself, but lost consciousness before
• Indian Med. Gaz. , 1888, xxiii., 3"Lei„.buch f. ger. Med.," ."Jth
p. 299. ed., 1890-91.
-Archiv. anthrop. crim. , Paris, *"Med. Jur. ," Am. Ed., 1892, p.
1886, i., p. 229. 394.
47
738 HANGING — LAMB.
he had time to discharge the revolver. According to him the
causes of death are three : occlusion of the air-passages, inter-
ruption of passage of blood to brain, and compression of pneu-
mogastric nerves.
Von Buhl ' experimented on cadavers and concluded that in
hanging, the epiglottis and arytenoids are pressed over the
glottis, and the tongue and the oesophagus against the vertebra,
causing death by apnoea. When the trachea was isolated from
the vessels and tied, the air-passages below became dilated and
the lungs emphysematous and anaemic. The heart continued
to beat and blood to circulate.
The vertebral arteries being much smaller than the carotids,
the circulatory disturbance in the brain is not adjusted with
sufficient promptness. Compression of the pneumogastrics, ac-
cording to Waller," has caused subjects to fall to the ground as
if struck by lightning. He holds that the unconsciousness in
hanging is the result of the compression of the pneumogastric
nerves and not of the arteries. Thanhofer ^ knew a student who
had acquired a certain dexterity in compressing these nerves.
One day he compressed the two nerves, his pulse stopped and
he became unconscious. Thanhofer ^ tried bilateral compression
of paeumogastrics in a young man sentenced to be executed.
The pulse fell at once and the heart soon stopped; the eyes were
fixed and glassy. It was some time before he regained con-
sciousness and for two days there was malaise.
Hofmann says that the compression irritates and, in a
higher degree, paralj^zes the pneumogastric nerves and causes
disturbance of the action of the heart.
Faure ' denies that the constriction of the vessels of the neck
has any effect in the production of symptoms.
Coutagne believes that the pressure on the pneumogastric nerve is
a factor in causing death. He hung two dogs; in one the pneumogas-
tric nerves were dissected out and placed in front of the hgature; this
dog (No. 1) lived a quarter of an hour and died of pure asphyxia with
efforts at inspiration continued to the end. The other dog (No. 2), in
»Aertz. Intel. Bl., 1876, xxiii., p. ^Centralb. f. med. Wiss.. 1875,
324. xiii., p. 403.
2 Practitioner, 1870, iv., p. 193. ^Arch. gen. de Med., 1856, vii.,
3 Mitt. d. Wien med. Doct. Col- p. 310.
leg., 1878, iv. , pp. 97-112. '^ Archiv. anthrop. crim., Paris,
1886, i. , p. 229.
HANGING. 739
which the nerves were compressed, died in fire minutes. In both, the
abdominal organs were congested and the cavities of the heart were full.
The lungs of the first were dry and uniformly red; of the second were
resisting, crepitant, and quite oedematous. No subijleural ecchymoses
in either. The experiments on animals by Corin ' led him to conclude
that pressure on the pneumogastrics caused nicreased frequency of the
heart-beat and slowing of respiration. Pellier - considers the subject
quite fully. It would appear that the pressure on the pneumogastrics
disposes to stop the action of the heart and cause rapid, perhaps instant
death. The pressure on the carotids causes cerebral anosmia and is then
only a secondary cause. Le^'y '' does not think the action of the pneu-
mogastrics is sufficiently well known.
Tidy states that a dog lived for three hours suspended by a
rope placed above an opening in the windpipe; and that Smith '
mentions the case of a criminal who was hung ; Chovet tried to
save the man b}' making an opening in the trachea before the
execution and introducing a small tube. The man was alive
forty-five minutes after the drop, but could not be resuscitated,
although the surgeon bled him.
In a small proportion of cases of hanging, homicidal and
judicial, death occurs by dislocation of the spine. This is said
to have been first noticed by the celebrated Louis, who states
that the Paris executioner was in the habit of giving a violent
rotary movement to the body of the convict as the trap was
sprung, causing a dislocation of the odontoid process and com-
pression of the cord and almost instant death. Taylor '" says
that for dislocation the body must be heavy and the fall long
and sudden. Devergie " found this to occur in about two per
cent of cases. It is said that the Paris hangman placed the
slip-knot under the chin in front, which is as Dr. Haughton
suggests.
Death may occur from secondary causes after apparent re-
covery ; from congestion of brain and other lesions of the ner-
vous sj'^stem ; these may prove fatal at remote periods.
Fracture of the odontoid process according to M. de Fosse
is more common than dislocation, and the giving away of the
intervertebral substance more likely than either of the others.
'Bull. Acad. Roy. Med., 1893, * "Forensic Med.," Appendix, p
vii., pp. 831-342. 561.
2 Lyon thesis, 1883, No. 188. ^"Med. Jur.," Am. Ed., 1892, p.
=* Paris thesis, 1879, No. 172, p. 394.
39. '^Tidy, op. cit., p. 240.
740 HANGING — LAMB.
The phrenic and other respiratory nerves are likely to be para-
lyzed; the vertebral and carotid arteries may be ruptured. The
medulla oblongata is also likely to be fatally injured. Death
may also occur from hemorrhage upon the cord, causing pres-
sure.
Besides the ropes used as ligatures in judicial hanging, al-
most every conceivable article that could be made into the sem-
blance of a cord has been used by suicides ; usually, however,
some portion of the bedding or clothing. When one resolves on
suicide, all the precautions of the managers of prisons and
asylums fail to prevent.
The secondary effects in those who recover involve the
respiratory organs — dyspnoea, cough, bloody sputa, bronchial
rales, and fever; or the nervous system — aphonia, dysphagia,
numbness, chilliness, spasms, pains in neck, face, or shoulder ;
sometimes paralysis of bladder and rectum, and loss of memorj^.
The marks on the neck slowly disappear.' Verse ^ collated a
number of cases in which the hanging was not completed and
the subjects lived for var3^ing periods afterward. Wagner and
Mobius ' discuss the spasmodic seizures and amnesia, which
often appear after the restoration from hanging.
Symptoms in Hanging.
Obviously these will be in some respects identical with those
of strangulation. In considering the latter, some of the simi-
larities and dissimilarities of symptoms and post-mortem ap^
pearances of strangulation and hanging were mentioned.
Death may be immediate and without symptoms.
There is, of course, no preliminary or " waiting" stage, as
in strangulation, except in those rare cases of suicide where
the subject inclines his body forward with his neck against the
ligature, his body being near the floor or ground. The absence
of a drop makes this condition very similar to ordinary strangu-
lation. The body of a victim of homicide might be similarly
placed for the purpose of deception, and also that of a subject
previously made unconscious ; in these cases the symptoms and
appearances would resemble those of strangulation.
'Tardieu, "Pendaison,"1870, p. 16. mimch. med. Woch., 1893, xl.,
2 Lyon thesis, 1891, No. 647. pp. 87-91, 127-129, 194.
SYMPTOMS IN HANGING. 741
lu other words it is necessary that there should be a drop or
fall, or at least the weight of the body, to produce the charac-
teristics of hanging. The jerk of the fall or sudden dependence
of the body upon the ligature causes a much greater constric-
tion of the ligature on the neck, and in a different direction,
than in strangulation ; and also a much greater pressure on the
blood-vessels and nerves of the neck.
Tidy divides hanging into three stages :
First stage: Partial stupor lasting thirty seconds to three
minutes, according to the length of the drop, the weight of the
body, and tightness of the constriction. The testimony seems
to be uniform that there is no pain in this stage; indeed, that
the feeling is rather one of pleasure.' The subjective symptoms
described are an intense heat in the head, brilliant flashes of
light in the eyes, deafening sounds in the ears, and a heavy
numb feeling in the lungs. Sometimes there is a feeling of
absence of weight. In many cases efforts to breathe are made
for a time after the air-passages are closed. It is doubtful
whether there are any voluptuous feelings, as has been sug-
gested.
Chowne - reports the case of Hornshawor, "Monsieur Gouffe," who
was in the habit of hanging himself for exhibition. He fixed the noose
with a knot that would not slip, sprang into it, the rope coming behind
the lower jaw and the two sides passing up behind the ears. He would
hang for ten to fifteen nnnutes, and in addition to his own weight
would sustain one hundred and fifty pounds. Three times the rope
slipped and he would have died but for the help of spectators. He de-
scribed his sensations as follows: He lost his senses all at once. The
instant the rope got in the wrong place he felt a.s if he could not get his
breath, as if some great weight was at his feet; and could not move only
to di-aw himself up; felt as if he wanted to loosen himself but never
thought of his hands. He said: "You cannot move your arms or legs
to save yourself; you cannot raise yoiu* arms; you cannot think."
Taylor* mentions the case of Scott, the American diver, who was in
the habit of making public exhibitions of hanging. The last time he
hung for thirteen minutes, the spectatoi-s not suspecting that he had
died. It is supposed that the ligature had slipped. Taylor also rejwrts
a case (from Dr. Elliott) of a boy, age 11, Avlio, to frighten his jjareuts,
tied a knot in a handkerchief and put it around a loiob and his neck iu
one continuous ligature. The pressure against the trachea was so ef-
' Tracy, Pop. Sci. Mo., 1878. xiii., ^ Lancet. 1847, i., p. 403.
pp. 349-354. ' " Med. Jur. , " Am. Ed. . 1893, p. 39G.
742 HANGING — LAMB.
fective that he became unconscious and died before he could reheve
himself.
Second stage : The subject is unconscious and convulsions
usually occur. Tlie convulsed face, however, is a part of the
general agitation and does not indicate pain. In judicial cases
the face is covered with a cap. Sometimes there are no spasms.
Urine, faeces, and semen may be discharged in any stage.
Jaquemin, however, in forty-one cases of hanging, noted dis-
charge of urine and fseces onl}" twice. Semen has, however,
been found in the urethra where none was ejected externally.'
Third stage: All is quiet except the beating of the heart.
As a rule, the pulse may be felt for ten minutes.
Blankenship ^ rejjorts an execution of a man by hanging. After
the rope was adjusted the jjulse was 121 ; fu'st minute after droji, pulse
54 ; second minute 52 ; third 39 ; fourth 20 ; fifth ; sixth 70 ; seventh
73 ; eighth ; ninth 34 ; not perceptible afterward. Died from stran-
gulation ; neck not dislocated. The heart beat once in the nineteenth
minute ; from the ninth to the nineteenth, only two or three times. No
priapism.
In judicial executions, however, the right auricle is found in
action when the subject is taken down at the end of the usual
period of suspension (see Case 89). Tardieu mentions a case
where the heart was beating 80 to the minute one and one-half
hours after supposed death. It is probable that in these cases
the deprivation of air and compression of the vessels has not
been complete. In such cases life may sometimes be restored.
Cases are reported where restoration has been possible within a
period of a half-hour of suspension ; although the fatal period is
usually five to eight minutes at most. If, however, the tissues
and especially the spinal cord are injured, or the ligature has
compressed below the larynx, the chance of recovery is very
small, even if the body is cut down at once. According to
Faure, animals experimented upon die in twelve to twenty
minutes.
Many cases of "incomplete" hanging have been reported;
where the feet touch the floor, or would do so if the subject
should choose to have it so. Tardieu ^ collected 261 cases, in
^ See articles of Huppert. Vier. * Jour. Amer. Med. Assn., 1885, i.,
ger. Med., etc., xxiv., pp. 237-252, p. 658.
and Miiller-Beninga, Berlin, klin. ^ "Pend.," etc. , p. 22.
Woch.. 1877, xiv., p. 481.
SYMPTOMS IN HANGING.
743
168 of which the feet touched the ground, in 42 the subject was
on his knees, in 29 the body was hnng, in 29 sitting and in 3
squatting. Hackel,' in 07 cases of hanging, found it incomplete
in 34 per cent.
In one of the experiments of Faure - a large clog was hving, his feet
touching the ground. For five minutes he was quiet, breatliing with-
FiG. 22.— Suicide of Prince Cond6. (See page 763.)
out difficulty. He then tried to release himself, but instead tightened
the knot ; he made still greater efforts to release himself, became com-
atose and fell, apparently dead, at the end of ten minutes ; was really
dead in twenty-eight minutes.
In incomplete hanging the upper limbs maj' have anj'- posi-
tion ; the lower limbs are disposed according to the position of
the body (Cases 1, 10, 18, 19, 20, 22, 24, 20, 28, 37, 43, 50, 50).
' Dorpat Diss. , 1891.
-Arch. gen. de Med., 1856, vii.,
p. 315.
744 HANGING — LAMB.
Faure ' made many observations on dogs which he killed by hang-
ing. He describes the results as follows : The dog remains quiet usu-
ally twenty to thirty seconds, sometimes eight to ten minutes; then
becomes violently agitated, the body being thro^\na forward and back-
ward so powerfully that it bounds to a great height ; the head is in
motion ; the jaws i^arted ; the feet extended and flexed ; sometimes
brought up to the mouth and neck, trying to remove the obstruction ;
the inside of the mouth is ^'iolet-colored ; tongue blackish, livid, may
be bitten, often falls backward ; the teeth are ground together ; the
eyes sometimes protrude ; conjunctivae congested ; urine and faeces
discharged. The agitation lasts two to five minutes, and then the dog
gradually becomes quiet. Toward death, however, the agitation is
renewed but in a different way ; the fore-feet are raised and put for-
ward, the tongue often has a peculiar spasm, the chest is raised, the
eyes drawn back into the orbits, pupils contracted ; all of tliis is over
within two seconds. Such paroxysms may be repeated half a dozen
times. In dji^ng, the eye oscillates from side to side and the pupil
dilates. The heart beats some time longer.
Francis Bacon records that he knew a man who wanted to find out
by experience if there was any suffering in hanging. He placed the
cord around his neck and stepped off a bench, intending to step back
again, but became immediately unconscious and would have died but
for the opportune arrival of a friend. He said he saw a light before liis
eyes.
Treatment.
The first indications obviously are to let the subject down,
and remove all constriction of neck and chest. Artificial respi-
ration should then be used, and this may be assisted hj the
vapor of ammonia to the nose and tickling the fauces. If the
body is warm, cold affusions may be applied to the head and
chest, and galvanism may be used.
If the body is cold, apply warmth. Friction of the limbs
aids in restoring warmth. If the subject can swallow give
stimulants; these may also be used by rectum. Venesection
may be required to relieve cerebral congestion or distention of
the right heart and pulmonary circulation.
The following cases illustrate what may be done to resuscitate one
who has been hanged: A man, age 35, in good health, weight one hun-
dred and sixty pounds, was executed with a drop of over six feet; the
rope slipped behind the mastoid process. After thi-ee minutes liis strug-
1 Op. cit. , p. 308.
TREATMENT. 745
gles ceased; the radial beat ceased at six and one-half minutes; all signs
of life at ten and one-half minutes, aad the body was bhie. Fourteen
and one-half minutes, body let down; mark about one-fourth inch deep
on neck; swelling above and below; no fracture of vertebra^. Strong
galvanism of the pneuinogastrics after sixteen or seventeen minvites at
intervals of four seconds caused marked respiratory efforts; sixty -six
minutes, galvanism renewed; heart-beat and radial pulse recognized;
epiglottis swollen, requirmg the tongue to be dra^^^l forward; a few
ounces of blood removed; jjupils contracted. One hundred and four
minutes, galvanism renewed; subject swallowed a little brandy-and-
water. One hundred and thirteen minutes, slight muscular action;
cornea sensible. One hundi'ed and eighty -six minutes, feet warm, car-
otid pulsation. Signs of life now increased till six hours after drop,
when pupils began to dilate again. Twelve to fifteen ounces of blood
were taken and pupils again contracted and pulse beat sti-ong and
steady; breathing easy, more regular; eyes followed movements of per-
sons around the room. Died nine hours later, fifteen hours after drop.
The experiments were repeatedly interrupted by the sheriff. ' Taylor *
reports a case of recovery. Woman, age 44; found hanging from a
clothes-line, thro^Ti over a door and fastened to a handle on the other
side; her knees on the floor; white froth around the mouth; tongue
protruding and swollen; face dusky and swollen; lips dark bhie; brown
parchment mark on neck; skin abraded over larynx; conjunctiva in-
sensible; pupils dilated and fixed; fingers clinched; limbs flaccid; no
reaction from tickling feet; no respiration; faint heart-beat and fine
thready jjulse. Sj-lvester's artificial respiration method used at once
and continued for four and one-half hours; tongue held forward by
forceps. One hundred and fifteen minutes after body was first seen
there was spontaneous movement of legs. One hiindred and forty-five
minutes, conjitnctivas sensible. One hvmdi'ed and seventy-five min-
utes, retching. Two hundred and five minutes, free vomiting. She
recovered but remembered nothing of the hanging. Keen ^ reports the
results of experiments upon a criminal who was executed by hanging.
He was cut down about half an hour after the drop. Fai'adization and
galvanization of pneumogastric and recurrent laryngeal nerves caused
movements of left vocal cord, but not the right ; there was no reflex
motion in the larjTix. The left phrenic nerve made no response to
stimulus. The internal intercostal nerves caused the raising of the car-
tilage below them (iusj^iratory), the external intercostals dejjressed the
iipper seven ribs (expiratory), and i-aised the eighth. The other four
not examined. The muscles of the face retained their contractihty.
Very few, comparatively, however, have been restored after
hanging. For cases of recovery see Medical Times and
'Lancet, 1871, 11., p. 98. [387. ^ pjjiiadelphia Medical Times,
^ Glasgow Med. Jour. , 1880, xiv. , p. 1875.
746 HANGING — LAMB.
Gazette, London, 1871, Vol. I., p. OGO (Cases 12, 13, 42, 44,
47, 49, GG).
PosT-MoRTEM Appearances.
The post-mortem appearances are external and internal.
The external appearances are those due to the action of the
ligature on the neck and to other violence, if any has been
done, and those due to asphyxia or syncope.
The MARKS of the ligature. If the suspension be very brief
and the ligature soft and supple, and the body instantly cut clown
after death, there may be no mark. Allison ' questions the value
of the mark, contending that it is post mortem, and reports cases ;
says it is present only if the drop be considerable or the sus-
pension continue after death. Tidy says that the mark is, in a
measure, independent of the ligature and duration of suspen-
sion, and does not usually acquire its color for some hours after
death ; sometimes, however, it has occurred in a much shorter
time. It may be slight because the ligature has been placed
over the clothing. The longer a body hangs after death, the
more the mark shows. It can be produced upon the cadaver.
Harvey ^ says : " The characteristic mark is sometimes found
in non-fatal cases. ... In eight instances in the present re-
turns (of nearly 1,500 cases of hanging) there was a distinct
mark."
Coutagne, ^ in twenty-four necroscopies on subjects hung, found
only slight or doubtful lesions in five cases ; but of these, one was in a
condition of advanced putrefaction, another was apparently weakened
by loss of blood from wounds, and in the other three there were marks
of violence. In seventeen cases the lesions of the neck were plain;
hemorrhage in connective tissue or muscle.
The direction of the mark is usually oblique, following the
line of the lower jaw upward and backward behind the mastoid
processes ; it maj^, however, be horizontal. If the ligature en-
circles the neck more than once, one mark may be circular, the
other oblique. If a running noose is used the mark may be
circular, and be seen all the way around the neck, looking like
the mark of a strangulation. Taylor * states that if the noose
'Lancet, 1869, 1., p. 636. ^ Op. cit., p. 245.
'Indian Med. Gaz., 1876, xi., p. -"'Med. Jur.," Am. ed., 1892, p.
29. 398.
POST-MORTEM APPEARANCES. * 747
should be in front, the mark may be circular, the jaw prevent-
ing the ligature from rising upward in front as much as it does
behind. If it encircles the neck but once, its continuity is apt
to be broken by the prominence of the hyoid bone, thyroid car-
tilage, sterno-mastoid muscles, etc.
In four-fifths of the cases (117 out of 143, Tardieu) the mark
is found between the chin and larynx; in nearly all the re-
maining fifth, over the larynx; in a very few below the larynx;
the last position is due to the protection of the neck by a hand-
kerchief or beard, or where there is some anatomical or patho-
logical peculiarity which prevents the ligature from going
higher.
Hofmann ' had seen two cases of tumor of neck ; one in a woman,
where the cord was below the larynx; and in a man where it was
over the larjTix. He quotes'^ as follows: Remer, above larjTix, 38;
over larynx, 7; below larjTix, 2. Devei'gie, above larjTix, 20; over
larynx, 7; below larATix, 1. Casper, above larynx, 59; over larynx, 9.
Rotli ^ in 49 cases found the ligature mark above the hyoid bone in
5; between the bone and the larynx, 31; over the larjTix, 8; below
the larynx, 1. Hackel found the ligature in forty per cent of cases
between hyoid bone and larj-nx; in sixty per cent lower down. The
ligature alwaj's appears lower after the body is laid down than it was
in suspension. Maschka found the furrow 147 times in 153 cases above
the lainnix.
The mark will vary in character according to the kind of
ligature used, its mode of application, the vitality of the tissues,
and the period that has elapsed since death. The result is dif-
ferent according as the knot or loop is single or double, a run-
ning or slip knot.
The mark may differ in character in one part of the neck
from another. The same furrow may be soft in one part and
dry in another. The width of the mark does not necessaril}^
correspond to the diameter of the ligature. A double mark
usually means that the ligature has been twice passed around
the neck, although the marks may not be continuous or parallel.
Tardieu states that a large single leather thong pressing on the
neck only by its borders ma}' make a double mark. The mark
is usuall}' depressed. The depth of the depression, groove, or
'Op. cit., p. 523. "Deutsch. Archiv f. Staats, 1870,
"^ Op. cit., Levy's translation, xxviii., p. 1313.
1881, p. 363.
748 HANGING — LAMB.
furrow, as it is called, is greater the narrower and firmer the
ligature, the longer the suspension, and the greater the weight
of the body. The mark may be merely a slight depression,
without color, or only a red blush, if the subject is young,
tissues healthy, and suspension brief. Roth,' in 49 cases of
hanging, found the furrow of the ligature was brown in 40, red-
brown in 6, and 3 times bluish.
In about two-thirds of the cases the bottom of the furrow,
the place of greatest pressure, is white, especially so where the
knot is tied ; while the edges of the furrow are usually slightly
raised and red or livid. If the subject is verj^ fat, there may
be only a slight depression. Harvey" says that this hard,
white, shining, translucent band from compression of the con-
nective tissue is the first stage of the parchment or vellum skin,
and is chiefl}" noticed in fresh bodies. The borders are swollen
and oedematous, called by Lacassagne " bourrelet de sillon."
The skin beyond the furrow is usually violet. Authors
differ as to whether this is due to congestion or hemorrhage.
Roth ^ in 49 cases found swelling below the furrow 27 times.
Hackel found ecchymoses above the mark in thirty -five per cent
of the cases of hanging. Hofmann thinks that the lividity of
the upper border of the furrow is due to the stopping of the
venous blood descending from the head.
The drj", hard, yellowish-brown, or reddish-brown " parch-
ment" furrow, described by writers, is said to be common.
Ogston ^ found it in one-third of his cases. It is found onl}'
when the body has remained suspended for several hours after
death; indeed, may be produced by applying the ligature to
the cadaver ; is not at all, therefore, a proof of suspension dur-
ing life. Liman states that constriction by a ligature even for
some time does not necessarily cause a mummified or excoriated
furrow. He saw cases in which the mark was soft, flat,
scarcely colored, but little interrupted, and not parchmenty.
The parchment skin seems to depend very much upon a pre-
vious excoriation of the skin. Its appearance can be prevented
or delayed by examining a body soon after death or by rehang-
ing it ; and after it has appeared it will disappear on the appli-
cation of some liquid. Taylor ^ compares this parchment mark
' Op. cit., p. 281. 3 Op. cit.. p. 287.
'-'Indian Med. Gaz., 1876, xi., p. ^"Med. Jur.,"p. 527.
39. 5 " Med. Jur. , " Am. ed. , 1892, p. 399.
POST-MORTEM APPEARANCES. Ti9
to the otitis from which the cuticle has been removed for two
or three days.
Slight abrasions and ecchymoses are sometimes found in the
furrow. Ecchymoses alone do not indicate whether suspension
has been before or after death ; but abrasions with hemorrhage
strongly suggest suspension during life. Devergie regards
ecchymoses of the neck as strongly suggestive of homicide.
Neyding ' says that suggillation in the groove is oftener found
in strangulation than hanging. And Bremme ^ that there is no
hemorrhage in the subcutaneous tissue of the mark if death
occurs at once and the cord is removed at once after death ;
but if the cord remains for some time after death there may be
hemorrhage, or if death does not occur at once, whether the
ligature be removed or not.
Roth ^ found ecchj'moses or small bladders at the lower mar-
gin of the furrow, 9 times in -iO cases. Riechke found only
once in 30 cases a hemorrhage beneath and on both sides of the
mark. Chevers did not find ecchymoses of the skin of the mark
in cases of hanging. Casper found no ecchymoses in 50 of 71
cases. Maschka has seen two cases where burns on the neck
resembled mark of ligature.
The furrow, when once distinct, remains constant for a long
time after death, even in putrefaction. Marks from soft sub-
stances, however, disappear sooner than those from strong and
uniform compression.
The NECK nearly always appears stretched. According to
Roth the mobilit}^ of the head is increased by this stretching.
The HEAD is always inclined to the opposite side to that of the
knot. In suicides the head is usually bent forward on the
chest. The hands are often clinched so tightly that the nails
are driven into the palms. This occurs more especially when
the hanging has been done with violence. When the feet touch
the ground, as often occurs in suicide, the hands may be
stretched out. Roth found the hands and feet flexed in 44 of
49 cases. Taylor says that we maj' expect to find the hands
clinched when constriction of the neck is sudden and violent.
The LEGS are usually livid.
The FACE varies with the duration of the suspension; at
first it is pale, afterward livid ; congested and swollen, if the
'Vier. f. ger. Med., 1870, xii., 277, ;lg70. xiii., pp. 247-260.
pp. 340-369. ^Oj). cit.,-p. 281.
750 HANGING — LAMB.
subject has been long suspender! . Roth found the face pale
in 43 of 49 cases. In about one-half the cases the features
are calm and placid (syncope) . Maschka found the lips bluish
in 98 of 153 cases. The eyes are often prominent, staring,
and congested, and usually the pupils are dilated. Lacassagne
and Maschka ' look upon ecchymoses of the eyelids and conjunc-
tivse, '^ piquete scarlatin" as important as favoring the idea of
hanging or strangulation. Roth found in 49 cases the eyelids
closed 28 times; half open, 12; congested in 6; ecchymosed in
2. Pupils dilated in 31 ; narrowed in 2, Dilated in 97^ per
cent of Ogston's cases (Cases 85, 86; rupture of crystalline
lens). Harvey^ says the blood was found flowing from the
EAR in G cases of nearly 1,500, but no details were given,
Ogston, one case. Hofmann saw a case in which there was
bleeding from the ears. He says this is not due, as has been
supposed, to rupture of the t3^mpanic membrane, but to hemor-
rhage from subcutaneous vessels (Case 27).
The TONGUE is usually livid and swollen, especially at the
base. According to Tidy, Dr. Guy looks on this as showing
that suspension took place very probabl}" during life. In about
one-third of the cases the tongue is protruded and compressed
between the teeth ; sometimes bitten. Some observers found it
protruded only as a result of putrefaction. The protrusion of
the tongue is not believed to depend on the position of the liga-
ture. Hackel in 67 cases found the tongue lying forward in
all cases where the cord was between the larynx and the
hyoid; in 55 per cent in front of the teeth, in 18 per cent
between the teeth; where the ligature was lower down, the
tongue was behind the teeth. He found by experiment that in
the spasmodic expiratory effort the tongue was thrust forward ;
in the inspiratory movement, drawn backward. He concluded
that the forward movement was the result of reflex action.
Maschka ^ found the tongue between the teeth 58 times in 149
cases. Roth in 49 cases found the tongue projecting and bit-
ten in 22, the teeth shut in 15 others; in 15 the mouth was
open ; the tongue was retracted in 30 cases.
Harvey, after examining reports of nearly fifteen hundred hang-
ing's, says: "In the majority of instances innnediately after death
iPellier, op. cit., p. 83. ^"Handbuch," p. 571.
nnd. Med. Gaz., 1876, xi., p. 30.
POST-MORTEM APPEARANCES. 751
the features were placid, the face pale, the eyes not undvily i)rom-
inent, the mouth closed or half open, the tongue pressed against the
teeth but not protruding; the suijerficial veins full, but the head, neck,
and trunk free from lividity. After a longer or shorter time, however,
and apparently- after a very few hours, in India, all this is changed.
Livid patches appear about the chest, back, and shoulders; the face and
head become bloated and pufpy, the tongue and eyes ]>rotrude."
Bloody froth is sometimes seeu at the nose and mouth.
Saliva is invariably secreted and run§ out of the mouth
down on the chin and chest. Its presence is considered as evi-
dence that suspension occurred during life. The urine and
F^CES are sometimes found to have been expelled. These dis-
charges occur in all kinds of violent death. Tardieu found
them, however, but twice in 41 cases of hanging. Roth
in 49 cases found discharges of faeces in 17 and urine in 4; in
15 cases not noticed.
Harvey mentions a case where internal piles had burst, and
there were stains and clots of blood about the perineum and
anus. In such cases without careful examination there would
naturally be a suspicion of violence.
In about one-fourth of the cases the genital organs are
congested. The penis is large and more or less erect; seminal
fluid, generally prostatic, and sometimes mixed with blood, is
often expelled. The fluid maj" pass only into the urethra and it
may be necessary to press the urethra to secure it. The clitoris
may be found erect, and there ma}' be a sort of menstrual flow.
Orfila showed by experiment that swelling of the sexual or-
gans and emission of semen can be produced after death in
those who had been suspended during life. The flow of semen
is found in all kinds of death by violence. Roth in 39 cases of
hanging of men found the penis enlarged 18 times and ejacula-
tion in 19. Hackel found the penis swollen in 43 per cent of
cases of asphyxia. Erection may come on soon or late, even
daj'S after death.
Internal Appearances. — The connective tissue under
THE MARK is usually white and condensed, the more so if the
body has been long suspended. This dryness or condensation
was found by Hackel in 52 per cent of hangings. Deeper-seated
parts are injured only when the hanging has been violently
done. The muscles, especially'- the sterno-mastoid, are some-
752 HANGING — LAMB.
times ruptured. Hofmann ' reports several cases. Lesser'^ in
50 hangings saw 11 ruptures of muscle. Maschka never saw
the rupture in suicides. The sterno-mastoid was ruptured in
the case of Wirtz (Case 96) and Guiteau (Case 95). Hackel
in 67 cases failed to find the muscle ruptured. Hofmann^
believes that the rupture of the muscle is sometimes post
mortem. Coutagne ^ found the sterno-mastoid muscle ruptured
once in 24 cases (Cases 29, 89, 95, 96).
The LARYNX may be fractured or dislocated. These lesions
are very rare in suicide ; more frequent in homicide and judicial
hanging, and in the old where the cartilages are calcareous.
Remer found the injury in but 1 case in 101 of suicidal
hanging. Barker found the larynx lacerated in his judicial
cases. ^ Harvey says that the trachea was reported lacerated
11 times in nearly 1,500 cases; twice the laryngeal cartilages
were separated from each other. In 5 these cartilages were
fractured, but there was nothing to show under what conditions.
Hemorrhage in vicinit}' of larynx, 43 times. Pellier " reports 1
case, and adds that the existence of the lesion easily escapes
notice because of the mobility of the cornua. Roth in 49 cases
failed to find any fracture. Pellier found the cricoid was in-
jured often er than the thyroid, which is the reverse of what is
found in strangulation. Cavasse ' was unable to cause fracture
of larynx by hanging the cadaver. Chailloux* collected 6 cases
of fracture of larynx in hanging. He concluded that the frac-
ture could not be produced on the cadaver by hanging, and is,
therefore, caused during life. Coutagne' in 24 cases found
fracture of thyroid cartilage 8 times (Cases 9, 51, 82).
The HYOID BONE is rarely dislocated. Orfila mentions a
case of fracture. Barker found the bone usually fractured in
judicial cases. In the case of Wirtz {supra) the greater comu
was broken. Pellier reports 2 cases. Hofmann '° saj^s the
hyoid cornua are often fractured, especiallj" when the ligature
is between the hyoid bone and thyroid cartilage. Coutagne
'Wien. med. Presse, 1881-1882, ^ See Brit, and For. Med. Rev., ii.,
xxii., p. 1533. p. 214.
2 Vier. f. ger. Med., 1881, xxxv., ^ Op. cit.. p. 98.
p. 201. ' Paris thesis, 1859, No. 9.
»Lehrbuch, p. 532. « Paris thesis, 1874, No. 291.
*0p. cit., p. 245. ^Op. cit., p. 245.
'«0p. cit., p. 533.
INTERNAL APPEARANCES. 753
found fracture of hyoid bone 8 times in 24 cases. He attributed
the fracture to pressure against the spine. Pellier speaks of
fracture of styloid process (Cases 51, 84, 88, 89, 05, 06).
Dr. Barker, of Melbourne/ states that in 50 cases of lianging
by the old method there was not on< case ol fracture or dislo-
cation of vertebrce. After adopting his suggestion to place
the knot near the spine, he found that dislocation occurred be-
tween the second and third cervical vertebrae with fracture of
the third and pressure on the spinal cord. Death was sudden
and complete. The drop in these cases was short, three to four
feet. Coutagne thinks that the ordinary mobility of the head,
axis, and atlas on each other have led reporters into the mistake
of supposing a dislocation of vertebrae. Roth failed to find frac-
ture of vertebrae in any of 40 cases. These injuries are espe-
cially rare in suicide; but in violent hanging, dislocation or
fracture may occur and also rupture of the ligaments. Harvej'
gives 5 cases of dislocation of vertebra and 4 of fracture of
vertebra in suicides. Three of tlie latter were doubtful. Tar-
dieu says these fractures have no significance as to the hanging
having occurred during life. They can bo produced on the
cadaA^er; but infiltration of clotted blood around injured verte-
brae shows that suspension occurred during life (Cases 5, 7, 8,
68, 76 to 70, 83, 84, 01, 02, 04).'
The CAROTID ARTERIES may be injured ; usually the inner
and middle coats are torn ; and hemorrhage may occur into the
wall of the vessel. The common carotids are the ones usuallj^
affected, and just below the bifurcation, but the external is also
occasionall}^ injured. The injury is said to be due to the
stretching and squeezing of the artery, stretching being the
most effective since the rupture often occurs at a distance from
the mark of the ligature. Such injury of the artery does not
prove that hanging took place during life because it has been
produced on the cadaver; but hemorrhage into the wall of the
vessel or wound or rupture after death is very improbable.
Maschka saj^s the lesion is ver}^ rare. Tardieu says that the
injury to the carotid is rare and therefore unimportant. Pellier
reports 4 cases of rupture of carotid in a total of 23. Levy
records the experiments of Hofmann, of Vienna, and Brouardel
'Med. Times aud Gaz., 1871, i., -LvouMed., 1883. xliv., p. 11.
p. 071.
48
754 HANGING — LAMB.
and himself, of Paris, 5 in number. He concluded that com-
pression of the carotid arteries, if it produces obliteration, can
cause rapid loss of consciousness and death ; and explains why
in incomplete suicide the subject is unable to help himself.
Coutagne found rupture of carotids 10 times in 24 cases. He
insists on the importance of the lesion.
Hofmann ' says the I'upture is always transverse, may be simple or
multiple and may occm' in suicides; more apt to occur when the liga-
ture is thin. Lesser^ tabulated 50 fatal cases of suicidal hanging; in
29, he was satisfied that the lianging occurred during life. In 3 of these
the skin of the neck alone showed any lesion; there was a double mark,
the skin being otherAvise bloodless. In 5 the deeper soft jjarts were the
only ones affected. In 3 the skin showed lesions, the deeper soft parts
none, but either the hyoid bone, larynx, or vertebrse were involved.
In 12 the skin showed no mark, but the deeper soft parts and either
the larynx or hyoid bone were involved; and in 6 the hyoid bone only
or the bone and larynx were injured. In the remaining cases it was not
possible to say that the hanging occurred during life. In 2 cases there
were no marks at all ; in 9 there were changes in the skin ; in 4,
changes in the skin and deeper parts; in 2, changes in the skin, deeper
parts, and hyoid bone or larynx; in 3, changes in the skin and hyoid
bone or larynx, or both. In 14 of the 50 cases the hyoid bone was
fractured ; in 20 the larynx; and in 1 the vertebrae. The common car-
otid arteries were injured in 6. The number and severity of the le-
sions bore no constant relation to the thickness of the ligatiu'e, nor to
the force vised, but rather to the position of the body.
Ecker ^ reported a case of suicidal hanging in a man, age 40, where
the soft palate was swollen and filled up the passage so that the air
evidently could not enter.
The LARYNX and the trachea are usually deeply con-
gested, of a red color; a violet color indicates putrefaction.
Ogston reports mucus but. not bloody froth 9 times in the
pharynx, 6 in the trachea, and 4 in the lungs, in a total of 40
cases. In one case there was a quantity of blood in the larynx
and pharynx. Taylor thinks that pinkish froth in the trachea
indicates incomplete obstruction ; and Chevers that it is due to
spasmodic efforts to breathe when the obstruction is nearly
complete. Chevers always found clear mucus in the larynx and
upper part of trachea, each follicle being marked by a minute
' Lehi-buch, p. 535. ^Virchow's Archly, 1870, xlix.,
- Vier. f. ger. Med. imd off. San., p. 290.
1881, XXXV., pp. 201-248.
INTERNAL APPEARANCES. 755
globule of mucus. Harvey states that this was noted a few-
times in his reports. Baraban ' discusses the condition of the
epithelium of the air passages in hanging.
The condition of the lungs and heart varies according to
whether death is due to syncope or asphyxia. Ogston found, in
23 cases, the lungs were expanded in 4 and collapsed in 2.
Harvey says the lungs are congested in over seven-eighths
of the cases ; emphysematous in a few ; and subpleural ecchy-
moses present in a few. Patenko* experimented on dogs by
hanging them. When the constriction occurred after expira-
tion the lungs were congested; when after inspiration, not con-
gested. In the first case (p. 223) the blood flows from the
periphery to the heart and thence to the lungs, but cannot flow
from the lungs because of the difficult circulation in the dilated
pulmonary vessels and deficiency of intrathoracic pressure.
There is in both cases cerebral congestion in the region of the
bulb. Tardieu holds that punctiform ecchymoses and apo-
plexies do not occur in hanging unless suffocation has preceded.
Pellier,^ however, found these ecchymoses 14 times in 22 cases.
He says that the lesion is not characteristic of suffocation, and
quotes Lacassagne, Grosclaude, Dechoudans, Vicq, Chassaing,
and Legroux to the same purpose. Hofmann * says that the
ecchymoses are relatively rare in adults. Maschka ' found
them 18 times in 153 cases.
Harvey states that the presence of serum in the pericar-
dium seems more a matter of time elapsed after death than
anything else. Still the fact is that it is found much oftener in
strangulation than in hanging. The difference is explained
by the comparative slowness of death in strangulation. Harvey
finds that in about one-half of the cases, if the bodj- is fresh, the
right side of the HEART, pulmonary artery, and vense cavse are
full of dark fluid blood, the lungs being also much congested,
and the signs of death by asphj^xia well marked. When blood
is found in both sides of the heart, it is probable that death is
due to neuro-paralysis. When decomposition is advanced all
the cavities are often empty. Taylor says that if the examina-
tion is delayed for several days, the distention ma}^ not be
observed.
iRev. Med. do I'Est, 1890, xxii., pp. ^ Oj). cit., p. 105.
545-554. •'Lehrbuch. j). 537.
-Ann. d'Hyg.,1885,xiii.,pp. 209-228. ' Op. cit., p. GOT.
750 HANGING — LAMB.
The STOMACH is often much congested, and this fact might
sometimes suggest the possibility of poisoning. The liver,
SPLEEN, and KIDNEYS are usually much congested. Eofmann '
says that this occurs in the kidney onlj when the bod^ has been
hung a long time.
The BRAIN is rarely much congested. In 101 cases Remer
found hemorrhage but once; and in 106 cases Casper failed to
find it. Tardieu ° says the brain is oftenest anaemic. If, how-
ever, the body is cut down and placed horizontall}", the blood-
vessels of the brain may fill up. Evidence may be found in the
brain suggesting insanity and therefore an explanation of a
probable suicide. Harvey says that hemorrhages in or about
the brain are found in a much larger proportion of cases in
India than in Europe in cases of hanging. "No common con-
dition likel}' to cause extravasation is apparent, only one man
being noted as plethoric, but in many the rope seems to have
been very tight." Champouillon ' reports a case of suicide in a
man, age fifty-two; the rope broke and the body fell. The
physician who made the necroscopy reported a rupture of the
pons Varolii. Champouillon believed that the rupture must
have been made in removing the brain from the skull. Wilkie *
reports a judicial hanging in which a man age about twenty-
five, fell about three and one-half feet. A recent clot was found
in the brain. The experiments of Brouardel of hanging rab-
bits showed the brain ansemic.
The conjunction of the following appearances would suggest
that the hanging had been of some duration : lividity of face,
congestion and prominence of eyes, dryness of skin under the
ligature, deep furrow, congestion of sexual organs, swelling and
lividity of lower limbs, hypostatic congestion of lungs.
Page experimented on a young- cat and young dog; both were hung
in the same way. Examination of the cat showed the veins generally
engorged; sublingual veins much engorged; tongue protruded slightly
and much swollen; no frothy mucus in bronchi. In the dog the
tongue did not protrude and was not swollen; right cavities of heart
contained blood, left empty; brain and other organs normal. In the
cat, the lungs were uniformly congested, dark red; no ecchymoses.
In the dog, the lungs were much distended, posterior borders mottled
'Op. cif., p. 597. 3B„n Soc. Med. Leg., Paris, 1875-
Wp. cit., pp. 44, 54. 76, iv., p. 373.
•* Indian Med. Gaz., 1881, xvi., p. 275.
PROOF OF DEATH BY HANGING. 757
violet; emphysematous patches on surface; no apoplectic effusions;
subpleui'al ecchymoses bright red, irregular, cleai-ly defined in outer
surface, most numerous toward the roots and on the lower lobes.
Pellereau ' gives an account of hanging as seen by him in warm
climates. He had not seen the elongation of the neck described nor
the erection of the penis, nor subconjunctival ecchymoses, nor fracture
of larjnix, nor rupture of walls of carotid artery, nor subpleural ecchy-
moses, nor fracture of vertebra. He alwaj's found a mark on the
neck; the left cavities of the heart always empty, the right always full
of black blood. Mackenzie says that in 130 cases of suicidal hang-
ing, the protrusion of the tongue between the teeth, the open and
protruding eyes, clinched hands, and blue nails were very fi-equent,
the tongue was found bitten many times, there were urethral and
rectal discharges and rupture of carotid artery. The penis was
found erect several times. The hyoid bone fractured 24 times in 93
cases. In no case was the larynx or vertebra fractured. In 73
cases ropes were used; in 30, portions of clothing. The marks of
ropes were always well defined, indented, and parchment-like; the
marks of soft ligatures faint and reddish'. In no case were the mus-
cles of the neck, the larjTix, trachea, or large bronchi injui'ed, and
in none was there subcutaneous hemorrhage or blister.
Proof of Death by Hanging.
As in strangulation, no single sign in any given case is suf-
ficient of itself to prove that death was caused by hanging.
But the sum total of the lesions found, viewed in the light of
the surroundings of the bod}', will suffice to lead to a definite
conclusion.
The fact that a bod}' has been found suspended does not of
itself prove that hanging caused the death, because the victim
may have been killed in some other way, and the body after-
ward hung up to avert suspicion. Chevers records many cases
of this kind.
The value of the presence or absence of marks on the neck
and the characters of the marks has been questioned. Orfila,
Casper, and Vrolik have shown by experiment that if a body is
hanged within one or two hours after death the furrow, parch-
ment skin, lividity, and the density of the connective tissue
will appear just as is seen when suspension has occurred dur-
ing life; but ecchymoses and infiltration, clotted blood in the
'Ann. d'Hyg., 188G, xvi.,pp. 108-125.
758 HANGING — LAMB.
skin, connective tissue, and muscles of the neck suggest suspen-
sion during life.
If a cord is removed immediately after death, there may be
scarcely any mark at all.
Tardieu collected 261 cases of suicide by hanging where the
subject was not entirely off the ground. In 168 the feet rested
on the ground; in 42 the subject was kneeling; in 29 lying-
down ; in 19 sitting, and 3 were huddled up or squatting. Fatal
hanging may, therefore, occur in almost any position of body.
He shows incomplete hangings by thirteen plates. Tajdor also
collected reports of 11 cases in a few years; in 3 the subjects
were nearly recumbent; in -4, in a kneeling position; in 4,
sitting. Remer in 101 cases of suicidal hanging found in 14
that the body was either standing or kneeling; in 1, sitting.
Duchesne published 58 cases of partial suspension, 26 of which
were new. Some of these failures of complete suspension were
due to soft and elastic cords.'
Taylor says that " that which is difficult to a conscientious
medical jurist in confining himself to the medical facts is often
easily decided by a jury from these as well as the general evi-
dence afforded to them."
The limbs may be secured by the suicide before hanging
himself. Persons even with some disability of the hand have
suicided hj hanging. Blindness is no obstacle, nor age ; a boy
as young as nine and a man as old as ninety-seven.
Burger ^ f ullj^ discusses the question whether the hanging is
before or after death.
Hanging — Suicidal, Homicidal, or Accidental?
Hanging is usually suicidal. Lesser ' states that for three
years, 1876-79", there were admitted to the Berlin morgue 274
bodies of " hanged," of which 272 were suicidal ; 2 infants of three
and eighteen months, homicidal. One man had first tried to kill
himself with sulphate of copper ; another by cutting his throat ;
a woman by cutting her arm. The other cases were uncompli-
cated. PeUier states that the number of suicides in France
>"Med. Jur.," Am. ed., 1892, p. ^Yiev. f. ger. Med., etc., 1880,
408. xxxii., p. 232, foot-note.
* Freidreich's Bl. f. ger. Med.,
1890, xxi., pp. 149-171.
HANGING — SUICIDAL, HOMICIDAL, OR ACCIDENTAL? 759
from 1876-1880 was 13,445, and nearly all were by hanging.
Taj'lor ' states that 2,570 persons committed suicide by hanging
ill England in five years, 1863-67; four-fifths of these were
males. Harvey^ reports for three years 1,412 cases of hanging
in India, of which 2 were accidental, in 3 there was presump-
tion of homicide, the rest probably all suicidal.
Feebleness of body does not preclude subjects taking their
lives in this way. Thej' sometimes also wound or poison them-
selves first and hang themselves afterward. A subject being
found suspended in a room fastened on the inside, would be
suggestive of suicide. The absence of signs of struggling or
of any marks of injury also favors the idea of suicide.
The possibility of a suicide breaking a rope, being injured
by the fall, and rehanging himself successful!}', must be ad-
mitted (Cases 57, 58) . The possibility of blood flowing after
death must not be forgotten.
It is worthj^ of note that after beating or other violence
children and women may commit suicide from shame. Again,
as Tardieu says, many have hung themselves while partiallj"
intoxicated, and it is likeh' that some such have just previous
to the suicide met with falls or other accidents which have left
marks like those of violence. He also records the case of a
woman who fastened a cord to a bed-post, put her head in a
noose while kneeling on the bed, and made a deep wound in
her arm with a razor. She closed the razor, laid it aside, and
fainted from loss of blood. She must then have fallen forward
and died from the pressure of the cord on her neck.^
Homicidal hanging is rare but does occur. Where the
hands are tied together; where the injuries produced by the
cord are severe; where there are contusions and well-marked
ecchymoses ; where the larjmgeal cartilages and hj'oid bone are
fractured or the cervical vertebrae dislocated or fractured ; or
where the carotids are injured or there is hemorrhage into their
walls; where there are severe wounds, the hemorrhage from
which would be sufficient to threaten syncope ; where there are
man j^ marks of violence on the body ; where there is evidence
of a severe struggle — in all these cases murder may be reasona-
bly suspected. The number, situation, extent, and direction of
1 "Med. Jur.," Am. ed., 1880, p. '^Indian Med. Gaz.. 1876, xi., p. 3.
448. ^^Oj). cit., p. 132.
760 HANGING — LxVMB.
injuries must be carefully noted and weighed. If these are out
of proportion to the ligature, the suspension, etc., they strongly
suggest homicide, although they may occur in sviicide (see
Cases 4, 11, 18, 20, 28, 29, 44, 52, 55, 59, 66).
Homicidal hanging may be committed by an assailant who
is strong on a subject who is weak, on a child, a woman, an
old person ; on one stupefied by liquor or narcotic poison ; or by
many combined against one person.
Cases are reported where injuries were inflicted or poison
given, and the subject was afterward hanged to avert suspicion.
Most of these cases are those of murder either by strangulation
or suffocation (Cases 64, 65, 67, 68, 69, 70, 74).
Sometimes hanging is accidental. Children and even older
persons play at hanging successfully. Taylor mentions the case
of a boy who witnessed a hanging and afterward tried the ex-
periment himself to ascertain the sensation, and caused his
own death.
Tardieu 1 relates the case of a man, T., age 37, of small stature,
feeble constitution, very thin, of sinister face, eyes hollow but lively,
cunuing nose and mouth, who meeting a man aged 81, learned that he
had some trouble with his leg and promised to cure him. The old man
lived alone. T. told him to buy a strong cord as thick as his little
finger and one and one-half yards long, and keep the whole thing a
secret. T. would see him at his room at 7 P.M. The old man became
susjDicious and had T. arrested. The investigation showed that already
T. had made away with three old men by hanging, who were kno\\Ti
to be opposed to suicide. Their bodies showed no trace of violence.
Two others had escaped when the cord was passed around their necks.
Tardieu gives a number of cases of suicidal hanging which
were falsely attributed to criminal violence, in which the press-
ure of public opinion joined to circumstances improperh' ex-
plained by inexpert physicians caused deplorable judicial errors.
illustrative cases.
Suicide.
1. Harvey: Indian Med. Gaz., 1876, xi., p. 2. — Man, age 30. Found
hanging by turban to bars of cell door; slip-knot around neck; heai't
beating feebly; died in about a minute after being cut down. ''The
point of suspension was forty-seven inches from the ground, the posi-
' Oji. cit. , p. 66.
ILLUSTRATIVE CASES — SUICIDE. 761
tion of the iioose twenty-eight inches, and the feet were fortj'-two
inches away from the door snpijorted on the toes." Experiment showed
that the turban coukl not have borne the full weight of the bod^-. He
died from strangulation.
2. Ibid., p. 3. — Insane man, age 60. Put his neck in a V-shaped
fork of a tree and let his body swing. A broad abrasion found on each
side of neck. Scalp, brain, and membranes much congested; reddish
serum in lateral ventricles; two ounces clear fluid in pericardium.
Lungs congested; all the heart cavities contained blood.
3. Ibid., p. 5. — Woman, age 28. Two marks of ligature on neck;
one deep and circular passed up behind left ear; the other passed from
the circular mark behind, crossed it on either side under lower jaw,
thence up to chin. Appeared at first to be a case of strangulation fol-
lowing hanging; but the two marks were finally explained, that after
the body was taken down it was ordered up again until the police
should arrive.
4. Ibid., p. 5. — Man, age 45; first cut his tln-oat and then hung him-
self. "He had probably only just had time to hang himself before
dying."
5. Ibid., 2^- ^0. — Woman; hung herself with a twisted cloth. There
was much ecchymosis about the neck and upper part of chest; lungs
much congested; fibrin clot in left mitral orifice; liver, spleen, and
stomach congested; transverse ligament of atlas ruptured.
6. Ibid. — Man, age 39. Distinct mark of cord around neck; no
other mark of violence; laceration of larynx and dislocation of odon-
toid process; hands clinched; involuntary discharge of semen; thoracic
and abdominal organs normal.
7. Ibid. — Man, age 70. Mark of cord around the neck, superficial
in front, deep behind; second cervical vertebra dislocated; tongue
slightly protruding; fingers clinched; meningeal vessels engorged;
lungs tubercular, congested; right heart contained a little coagulated
blood.
8. Ibid. — Sex and age not given. Found hanging on a tree; usual
signs; odontoid process fractured; rope in a double noose without
knot, a common dooree, such as is used for drawing water.
9. Ibid., p. 32. — Man, age 50. Face livid, eyes red and protruding;
teeth clinched ; lower jaw retracted; tongue behind the teeth; hands
and feet contracted; anus covered with fcccal matter; circular de-
pressed mark of cord around neck, hard as parchment, slightly ecchy-
mosed along edges; some infiltration of blood in connective tissue be-
neath the cord; some tearing of soft parts; laryngeal cartilage tlis-
placed. Brain and membranes congested. Right cavities of heart
distended with dark blood. Trachea congested.
10. Hurpy: Ann. d'Hygiene, 1881, tv"., p/>. 359-367, in'fli illustra-
tion. — Woman, age 77, suicided by hanging in the following \\a\ •. a
762
HANGING— LAMB.
short cord was fastened by one end to a table leg; the other end was
around her neck; she lay on the floor, face downward, clothing not
disordered. The brain was congested; lungs congested and emphysema-
tous; left side of heart empty (see Fig. 23).
11. Champoiiillon: Same journal, 1876, xlvi., p. 129. — Man, age
62 ; first tried to suffocate himself with charcoal smoke and then hung
himself, but the rope broke and the body fell. He lived two days.
12. Pellier : Lyon thesis, 1883, No. 188, p. 72. — Boy, age 16, hung
himself; rope broke; he was resuscitated; reddish circular furrow on
Fig. 23.— Suicide. The cord on the neck is 44 cent, from the cord on the table leg; vertex
of head 30 cent, from table leg. Case reported by Hurpy (see p. 717, Case 10).
neck, not like parchment; he had erection and ejaculation ; buzzing in
his ears and flashes before his eyes.
13. Lacassagne: Pellier thesis {supra), p. 71. — Man; hung him-
self; was cut down and sent to hospital; was aphonic for four days:
then a severe bronchitis set in, and at the end of a week a gangrenous
expectoration. The mark of the cord lasted fifteen days.
14. Maschka: Archiv. deVanthrop. crim., Paris, 1886, i., pp. 351-
356. — Man, age about 60, found dead under a tree in the woods near
Prague. No sign of violence. A cord thick as a sugar-loaf around
the neck; another cord attached to a branch of the tree. There was at
first a strong suspicion of violence, but the conclusion reached was that
he had hung himself and that the body had fallen frona breaking of
the coi'd; that death was due to asphyxia was showTi by the furrow on
the neck, the dark liquid blood, and the congested lungs. There was
no infiltration below the furrow in the neck, and no lesion of larynx.
The man had shown signs of melancholy.
15. Friedberg: Virchow's Archiv, 1878, Ixxiv., p. 401. — Suicidal
hanging. Examination twenty-eight weeks after death. The front of
the neck showed a groove above the larynx, firm and of gray color;
ecchymosis in subcutaneous tissue.
ILLUSTRATIVE CASES— SUICIDE. 763
16. Bollinger: Friedreich's Bldtt. f. ger. Med., 1889, xl., p.7.—
Man, age 48; found dead. Had made a ligature out of a night-gown
and tied it around his neck, the other end around top of a low bed-
post; his neck hung by the ligature placed below the larjTix. Illus-
trated.
17. Med. Times and Gaz., London, 1860, ii., p. 39. — Woman; had
collected accounts of celebrated persons Avho had been hanged; finally
hanged herself.
18. E. Hoffman: Mitt. d. Wien. Med. Doct. Colleg., 1878, iv., JW-
97-112. — 1st. Woman, age about 25; found dead sitting in bed, a hand-
kerchief around her neck fastened to the bed-curtain. The police
thought she had been killed and then hung, but the physician con-
cluded that she had committed suicide. An examination of the stom-
ach showed that she had previously tried to poison herself with ar-
senic.
19. 2d. Woman, age 51; found hanging in half-lying position.
20. 3d. Man, age 50. First tried to kill himself with phosphorus,
then sulphuric acid; finally hung himself in a half -kneeling position.
21. MUller-Beninga : Berlin, klin. Woch., 1877, xiv., p. 481. —
Man, age 40; hung himself. There was no swelling of genitals and
no soiling of clothing. Necroscopy showed death from asphyxia, and
in urethra near meatus quite a quantity of seminal fluid, as shown by
microscopical examination.
22. Tardieu: Op. cit., p. 18. — The Prince of Conde was found
hanging in his room, August 27th, 1830. He was suspended by two
handkerchiefs to a window fastening, his feet, however, touching the
floor. The knot was at the back of the neck (as shown by the illustra-
tion), the face turned slightly to the left, the tongue protruding; face
discolored; mucus at the mouth and nose; arms hanging and stiff;
fists shut; heels raised; knees half bent. The text says that the knot
was nearly under the right ear, but the illustration shows a different
position (see Fig. 32, p. 743).
23. Allison: Lancet, 1869, i., p. 636. — Three cases of sviicide by
hanging, in which there was no mark: 1st. Woman, hung herself
with a piece of sheep-net band; cut down before death. 2d. Man,
hung' with plough-string; cut down in about six minixtes. 3d. A heavy
man.
24. Tardieu: Op. cit., pp. 93-105. — Woman, died of coma and as-
phyxia from suicidal hanging, according to report of Drs. Costan and
i'acieu. Tardieu approved their rej^ort. It was at first thought a case
of homicide with subsequent hanging, more especially because of the
kind of knot used, noeud d'artificier. But Tardieu showed that it Avas
also a noeiid de batalier. Her feet touched a chair, and hei- knees
were bent. There was a neckcloth in front of her mouth, but it did
not seem to have interfered with respiration.
764 HANGING — LAMB.
25. Ibid., pp. 67-72. — The famous case of Marc-Antoine Galas, who
committed suicide by hanging (see Voltaire, "Traite sur le tole-
rance," etc., in Nouv. Philos. Histor., 1772, xxxii., p. 30). He hung
himself to a door. No sign of violence. The city hangman said it was
impossible for a man to commit suicide in that way. The father was
accused and convicted of homicide. Tardieu shows that the act was a
suicide.
26. Ibid., p. 72. — Another famous case. A woman, age 30, hung
herself to the key of her bedroom door. Her husband cut her down.
He was accused and convicted of the crime and condemned to prison,
where he died. Tardieu showed that the case was one of suicide.
27. Hofmann: Wien. med. Presse, 1880, xxi., p. 201. — Man, age
68, suicide by hanging. There was profuse hemorrhage from both
ears.
28. Ibid.: 1878, xix., pp. 489^93. — Woman, found dead sitting in
bed. She first tried to poison herself with arsenic, then hung her-
self.
29. Ibid. — Man, tried to poison himself with phosphorus and sul-
phuric acid, then hung himself. There was a transverse rupture of the
sterno-cleido mastoid muscle and suffusion in its sheath.
30. Maschka: Wien. med. Woch., 1880, xxx., pp. 714,747, 1075. —
Man, age 63. It was at first a question of suicide by hanging or
homicide by strangling. He concluded that it was the former.
31. Ibid. — Also man, age 58. Similar case. Same opinion.
32. Ibid.: 1883, ^u\rm.,pjp. 1118-1120.— Woman, age 23. Question
whether she committed suicide by hanging or was strangled and then
hung. Opinion, that it was a case of suicide.
33. Hofmann: Allg. Wien. med. Zeit., 1870, .xt\, pp. 192-214. —
Man, age 60. Suicide by hanging or homicide ; opinion, that it was
the former.
34. Van Haumeder : Wien. med. Woch., 1882, xxxii., pp. 531-533.
— Suicide by hanging or homicide. There were many wounds in the
head; these occurred during the delirium of typhus.
35. Maschka: ''Sammlung gericht. Gutacht.,''^ etc. (Prag), Leipzig,
1873, p. 137. — Boy, age 9; found dead in sitting position. Injuries on
neck and elsewhere. Question, had he hung himself or been choked ?
Were the injuries inflicted before or after death ? Opinion, suicide.
36. Ibid., 2^- 144. — Boy, age 13. Found hanging in sitting position.
Question whether murder, suicide, or accident. Opinion, suicide.
37. Ibid., p. 149. — Woman, age 60; found hanging, sitting posi-
tion. Suicide or homicide. Opinion, suicide.
38. Ibid., p. 156. — Woman, age 30; found hanging. Opinion, sui-
cide.
39. Ibid., p. 165. — Man, age 63. Suicide by hanging, or homicide
by strangling ? Opinion, suicide.
ILLUSTRATIVE CASES — SUICIDE. 765
40. Berliner: Viert. f. ger. Med. und off. San., 1874, xx.,pp. 245-
253. — Woman, age 30 ; found hanging. Ojiinion, suicide.
41. Deininger: Friedreich's Blat. ^er. Med., 1884, jcxjcv., pj^- '^^~
59. — Woman, age 61 ; fouad hanging. Opinion given, suicide.
42. Mader: Bericht d. k. k. Rud. Stiff., Wien. (1875), 1876, p,
378. — Woman, age 43 ; tried to hang herself. She was at once cul
down, bled, and taken to hospital unconscious. Next day, face red;
pulse and temperature normal. Third day, conscious and could s])eak,
but not aloud ; tongue twisted and turned to right ; paralysis of right
hypoglossal nerve. Uvula drawn to left. Skin of right limb felt
"furry." Applied electricity and gave strychnine; phonation was
more distinct during the use of the battery. Two months later she was
still aphonic, but the vocal cords were in better action. The right
hemiparesis was lessened.
43. Grant: Lancet, 1889, ii., p. 265. — Man, age 48; found sitting
against a door, hung to the knob "by a handkerchief.
44. White: Lancet, 1884, ii., p. 401. — Woman, age 53, insane.
Made several attempts at suicide ; once with a stoclcing around her
neck, once with an apron; the last time by fastening a pox'tion of her
dress to a ladder. She was quickly cut down, cold affusion a])plicd,
and artificial respiration (Sylvester). The eyes were prominent and
glassy, pupils widely dilated, no reaction to light; conjunctiva? insen-
sitive ; lips livid ; tongue swollen and pale ; face pale ; oblique de-
pressed mark on neck, most marked on left side ; skin cold ; no pulse ;
no heart-beat recognizable ; no respiration ; no reflex action. Galvan-
ism failed to arouse any muscular action. The details are too numer-
ous to give all of them. There w^as redu])lication of heart-sounds for
several days, due to interference with pulmonary cii'culation. She re-
covered both bodily and mental health.
45. Richards: Indian Med. Gaz., 1886, xxi., p. 78. — Man, age 20;
suicide ; was cut down and lived for four days.
46. Kite: Univ. Med. Mag., 1888-89, i.,p. 475.— Man, age 69; sui-
cide.
47. Terrier: Prog. Med., 1887, vi., pp. 211-214.— Two men, age 29
and 25, insane. Attempted suicide by hanging. Both resuscitated.
48. Nobeling: Aertz. Intellig.-hl., 1884, xxxi.,}^. 213. — Two suicides
by hanging ; men, ages 24 and 40.
49. Ritter: Allg. Wien. med. Zeit., 1886, xxxi., p. 375.— Soldier,
found hanging. Cut down in ten minutes. Artificial respiration ap-
plied; fifteen minutes later, an effort at resinration; face changing from
blue to white and then to red; pulse small, irregular; still imconscious ;
mark of ligature distinct ; a few hours later had a maniacal seizure ;
gave morphia hypodermically and he slept ; was also aphonic. Gradu-
ally recovered and returned to duty.
50. Strassmann: Viert. f. ger. Med., 1888, xlviii., pp. 379-381.—
"66
HANGING LAMB.
Three cases of suicidal hanging in men, ages 27, 37, and 40. The
last was found kneeling.
51. Balta : Pest. Med. Chir. Presse, 1892, xxviii., p. 1244. — Man,
age 45-50; hanging; suicide. Thyroid cartilage and hyoid bone broken.
52. Hackel: Op. cit., p. 35. — Man, found hanging to a beam by a
sheet. Had previously tried to choke himself with his hands.
53. Ibid. — Two cases of suicidal hanging where the cord made no
mark. In the first the body hung free ; in the second the body was
partly supported. In the first
there was no rubbing of the
skin; in the second the body was
soon cut down.
54. Freund: Wien. Min.
TFoc/i., 1893, r?., pp. 118-121.
— Man, found hanging ; cut
'down, but could not be resusci-
tated. Ligature between hj'oid
bone and larynx, then crossed
over itself about middle line of
neck, passed up along each side
of face, knotted above the head,
then thrown over a beam, and
on the other side the loop .was
caught between his legs.
55. Hoffman: Op. cit., p. 525,
illustrated. — Case communi-
cated by Dr. Rosen, of Odessa.
Man, age 21, and woman, age
17, hung themselves by same
ligature thrown over an open
door, one of them on each side.
They had previously tried other means of suicide without success
(see Fig. 24).
56. Ibid., p. 530. — Man found hanging by handkerchief to branch of
tree but sitting on the ground. Mark of handkerchief superficial and
pale. When the necroscopy was made the mark had disappeared.
Also a similar suicide where there was no mark at all.
57. Ibid., 2^. 541. — Man found hanging to a window. Another man
cut the cord and the suspended one fell into a cellar, fracturing his
skuU.
58. Ibid. — Man found hanging ; cut down ; the fall caused rupture
of liver.
59. Ibid., p. 539. — Drunkard hung himself; there was evidence that
he had previously injured himself during his ch'unkenness.
60. Ibid. — Boy hung himself because he had been punished by the
Double Suicide (see Case 55).
ILLUSTRATIVE CASES — HOMICIDE. 7(57
schoolmaster. There were marks on his back and lower limbs from the
punishment.
See also Taylor, "Medical Jurisprudence," pp. 451-452; Tidy,
"Medical Jurisprudence," incomplete hanging. Cases 33 to 36 and Q2\
Hofmann, "Lehrbuch," p. 538.
Homicide.
61. Harvey: Indian Med. Gaz., 1876, an., p. 3.— Woman, age 20,
feeble. Her mother-in-law had kicked her; she probably had fainted;
supposing her to be dead, the husband hanged her to a tree within half
an hour after the supposed death. Autopsy: No marks of injury;
oblique mark of cord on right side of neck; tip of tongue between the
teeth; face somewhat livid; right side of heart full of dark blood: lungs
congested posteriorly.
62. Ibid., p. 4. — Woman, age 38. Kope close under the chin passed
upward behind the ears. Head bent on chest. Large wound above
clavicle. Under the rope was a depression (made after death) but no
hemorrhage. Much blood in abdomen and a hole in the liver. Kidney
bruised and blackened. Right lung torn through; Ijlood in pleurte.
Wounds were supposed to be gunshot, but the husband confessed that
he had thrust a sharp solid bamboo into her body and afterward hung
it up. She died of hemorrhage.
S3. Relim: Friedreich's Blcit. f. ger. il/ed., 1883, xxxiv., p>p- 332-
362. — Man, age 73; first roughly maltreated; afterward hung.
64. Tardieu : Op. cit., p. 125. — WoSkn found hanging in her room.
Circumstances indicated homicidal strangulation and tliat the hanging
was done to avert suspicion. Post-mortem examination showed the
base of the tongue ecchymosed, and ecchymosis extending up to the
soft palate ; mucous membrane of pharynx congested ; connective
tissue and mucous membrane between hyoid bone and larynx con-
gested posteriorly; epiglottis showed slight ecchymosis, mucous mem-
brane red. These ecchymoses were not caused b}' the cord, for the
latter was placed below the hyoid bone and this bone was not bi-okcn.
There were also marks on the collar-bone like the mai'k of two hands.
65. Ibid., p. 124. — Girl, 15 years old. Body found hanging. Post
mortem showed beyond doubt that she had been violated, then
strangled, then hung. Her head showed many ecchymoses from either
the fist or the foot; blood flowing from left ear. Brain slightly con-
gested. Tongue between teeth, bitten and bloody. On fi-ont of neck
were two marks: the lower were impressions of fingers close together,
nearly uninterrupted, and which had bruised, flattened, and tanned
the skin, which here was dry, hard, and horny. This lesion was above
the intraclavicular notch and extended toward the sides of tlie nock
Avith regularity of curve and neatness of imprint, evidently made with
768 HANGING — LAMB.
the right hand. Above the first furrow under the skin was a kind of
track, less extended, more regular, a bruising of the same nature as
the preceding, but continued, due to the pressure of the index finger
and thumb of left hand. A little below the jaw was a livid place on
the skin, which was otherwise unaffected by the ligature. There was
nothing to indicate a circular action of the ligature. Froth in larynx
and bronchi. Lungs apparently normal. Food had passed from
stomach into oesophagus and air-passages.
66. Ibid., p. 122. — Woman found hanging in her room, and was
resuscitated. She stated that the man who lived with her had tried to
strangle her and then hung her. Tardieu saw her in hospital. Res-
piration shoi't and embarrassed; pains in neck and jaw. Found nar-
row, circular, sinuous, horizontal, uninterrupted line around the neck
below thyroid cartilage; line everywhere equal, deep, and three to four
mm. wide; the skin excoriated and covered with thick crust. Below
this were several superficial excoriations. There were many contusions
on other parts of the body. Tardieu concluded that the mark on the
neck was from attempt to strangle; the wounds elsewhere to prevent
resistance. She had at the time pulmonary consumption. She died of
this disease aggravated by the assault.
67. Ibid., p. 106. — The Duroulle afi'air. Woman found hanging.
Presumption of homicide; arrest of husband; acqixitted. She was
found with her face to the fioor, one end of a cord around her neck;
another similar cord attached seven feet above to a rafter, over which
it passed three times. Bidault and Boulard reported it a suicide. The
results of the post mortem weii^as follows: Skin of a red-violet color;
face swollen; eyes prominent and congested; conjunctivae a vinous
red ; lips violet; tongue swollen, tip between teeth; froth in air-pas-
sages; lungs congested; brain congested; blood fluid. Circular de-
pression around neck with congestion of skin above and below; ecchy-
mosis in subcutaneous tissue on level of angle of jaw and about one
centimetre in size, supposed to correspond to the knot. Tardieu re-
ported that the marks rather resembled those of strangulation than
hanging; the ecchymoses were more like those produced by the hand
over the mouth. The marks on the face supposed to have been made
by a supposed fall of the body were by him considered to have been
caused by violence. He believed the woman had been strangled and
then hung.
68. Ibid., p. 130. — The Daugats afPair. Man found hanging, sitting
on the ground, head and trunk somewhat inclined to the left; legs
stretched out; clothing not disordered; the part of the cord which was
around the neck was applied to the neck of the waistcoat and shii't: on
his head a woollen cap. The ground had been recently swept. Necro-
scopy twenty-four hours afterward. Face pale; right eye open and
prominent, left closed ; mouth closed, contained food apparently from
ILLUSTRATIVE CASES — HOMICIDE. 769
the stomach; tongue retracted; shglit mark on neck under which the
tissue was normal; atlas dislocated on axis, but tissues around were
normal; no lesion in spinal canal; penis not erect; moisture having-
the odor of urine on the shirt; large ecchymosis and infiltration of left
cheek; extensive contusions on scrotum, with hemorrhagic infiltration,
especially around right testicle. Veins of head engorged with black
fluid blood. Brain normal. Some black fluid blood in right cavities
of heart, left side empty. Lungs black. Other organs normal.
Causse and Orfila concluded that the man had been suffocated and
then hung. The wife and son confessed that they had injured the
testicle through the pantaloons; he then fainted; they then suffocated
him with the woollen cap placed over the mouth and nose: the son
kneeled on the man's belly, the body was then hung up and the head
violently twisted.
69. Passauer : Viert.f. ger. Med. und off. San., 1870, xxiv.,2)p- 26-
49. — Woman found hanging in a kneeling position. The ligature on
the neck was loose. The necroscopy showed the following: Tongue
between the teeth; eyelids swollen and livid; livid spots on face and
left ear; lower lip torn; a number of marks on neck; one red stripe
not sharply limited; skin not parchmenty and no ecchymosis; ecchy-
moses of scalp; periosteum of skull reddened; hemorrhage in tem-
poral muscle ; brain and pia mater congested; much fluid in ven-
tricle. Larynx and trachea dirty red -brown; right side of heart
empty ; a little dark fluid blood in left; great vessels, including aorta,
containing much dark fluid blood. Lungs congested and ccdematous.
Liver, spleen, and kidneys congested. Wpinion given that she died of
asphyxia and was either choked or hanged. Reference to Royal Col-
lege of Medicine, Konigsberg, where the opinion was given that she
died of injuries on head and neck and was afterward hanged.
70. Becker: Same journal, 1877, xxvii., pp. 463^73. — Woman,
age 52; found hanging. Death caused by shock and incipient asphyxia
from strangulation and probably the wounds on head and limbs.
71. Maschka: '' Samm. gericht. Gutacht.,^' etc. (Prag), Leipzig,
1873, published a number of interesting cases, in each of which there
was a question raised as to the cause of death.
72. Ibid. , p. 127.— Man found dead. Had he been strangled or hung,
or had he died some other way ? Opinion, death from paralysis of the
brain.
73., Ibid., p. 133.— Woman, age 42; found hanging; a mark around
her neck. Did she hang herself or die of other injuries ? Opinion, died
of other injuries.
74. Reh7n: Friedreich's Bldtt., 1883, xxxiv., pp. 322-362.— Man,
age 73; found hanging. Opinion, while weak, sick, and suffering from
wounds inflicted by his own son, he was hanged by his daughter-in-
law.
49
770 HANGING — LAMB.
75. Hofmann: '' Lehrbuch,^^ p. 538. — A father hung his five chil-
dren, the eldest 9 years. Another man hung two children, the eldest
13 years.
See also Tidy, "Med. Juris.," Cases 40, 48, 51, 57 (?), 58 (?); "Hang-
ing after Death," Case 50.
Judicial Hanging.
76. MacLaren: Indian Med. Gaz., 1873, vin.,p. 234. — Three cases
of judicial hanging; hung at the same time and cut down and necro-
scopy begun forty minutes afterward; drop twelve inches. In the first
and third there were reflex movements for a few minutes after drop fell.
First man, age 40; pupils slightly dilated; no protrusion of tongue
or eyeballs; mark of cord above thyroid cartilage; no discharge of
semen or faeces; ecchymosis under cord, left side; dislocation of atlas
from axis; odontoid ligaments ruptured; transverse ligament unin-
jured. Brain and membranes miich congested; clear fluid in lateral
ventricles. Lungs collapsed, anaemic; one ounce straw-colored serum
(measured) in pericardium; dark fluid blood in both ventricles of heart;
liver much congested.
77. Second man, age 16; pupils widely dilated; eyeballs protruding.
Marks of cord same as in preceding case. No discharge of fseces or
semen. No ecchymosis under cord; dislocation and rupture of liga-
ments between axis and third vertebra. Brain did not show well-
marked congestion. Lungs %)llapsed and anaemic. One and one-
quarter ounces serum (measui^ed) in pericardium. Heart normal; dai'k
blood in both venti'icles; liver normal.
78. Third man, age 20; pupils slightly dilated; eyeballs and tongue
not protruded. Marks of cord as in preceding. No discharge of faeces
or semen. Slight ecchymosis under cord; mark in front of neck. Dis-
location of occipital bone from atlas. Brain and membranes much
congested. Lungs collapsed and anaemic. Half ounce serum in peri-
cardium. Heart normal; dark fluid blood in both ventricles; liver
normal.
79. Cayley: Ibid., p. 122. — Man, age 35; executed by hanging.
Scarcely any convulsive movements after drop fell. Necroscopy two
hours afterward. No congestion or protrusion or swelling of the
tongue; no muscular rigidity or contractions. About half-way around
the neck was indentation of cord, obliquely directed; hardly perceptible
in front; its surface appeared rubbed and compressed; no discoloration;
no ecchymosis under skin. Cord lay aci'oss upper part of thyi'oid car-
tilage. Larynx and trachea not injured. Fracture and dislocation of
upper cervical vertebrae. Lungs collapsed, not congested. Pericar-
dium empty; heart distended, left side with red blood just beginning
ILLUSTRATIVE CASES— JUDICIAL HANGING. 771
to clot; rig-lit side with fluid black blood. Liver and other abdominal
organs much congested. No discharge of fseces or semen.
80. Garden: Same journal, 1880, xv., p. 12. — Man, age 40, weight
about one hundred and twenty pounds; drop two feet; was in a faint-
ing condition, and had to be supported; was not probably fully con-
scious when platform fell. Thei-e were spasmodic retractions of arms
and legs for about two minutes; forty seconds after the dro]) lusjnngeas
fell off; his penis was in strong erection, and the ejaculatoiy move-
ments were seen. Necroscopy one and one-quarter houi's after drop
fell. Head and limbs cold; eyes open, natural; tongue not protruding;
fingers clinched; superficial veins contained fluid black blood. Mark
of cord extended from just below left mastoid process, where tbe knot
was applied, across the thyrohyoid membranes to a place on right side
about two inches below ear. There was .scarcely a trace of it behind.
Skin dark and ecchymosed, but no ecchymosis of subcutaneous con-
nective tissues. No discoloration nor fracture in neck. Subarachnoidal
fluid in excess; puncta vasculosa unusually numerous. Under surface
of epiglottis reddened and. showed two small dark red ecchymoses;
mucous membrane of larynx and trachea pale. Lungs showed venous
congestion; no infarctions or small ecchymoses; right lung emphyse-
matous; the left showed old firm adhesions throughout. Heart large,
flabby, pale, a very little blood in each ventricle; subpericardial ecchy-
mosis one-fourth inch square anteriorly, another larger one posteriorly;
extensive pericardial adhesions. Liver and kidneys congested.
81. See two cases of judicial hanging by Wilkie, same journal,
1881, xvi., p. 275.
82. Porter: Archiv. Laryngol., New York, 1880, i.,p. 142. — Rede-
mier hung. Drop five feet. Pulse beat rapidly a few minutes, then
lessened in frequency and stopped beating in fifteen minutes. During
this time there was violent spasm of muscles of thorax and upper limbs.
Necroscopy, dark groove around neck crossing larynx just below
po^nmn Adami. Brain congested. Lvmgs emphysematous. Cricoid
cartilage fractured diagonally. Laryngeal mucous membrane showed
ecchymosis and oedema. Vertebrae neither fractured nor dislocated.
83. Another criminal hung at the same time had dislocation of
cervical vertebrae.
84. Femvick: Canada Med. Jozir., 1867, Hi., p. 195.— Man exe-
cuted; drop six feet; second cervical vertebra torn from attachment to
third; medulla torn across; hyoid bone and tongue torn from thyroid
cartilage; general congestion of viscera; lenses normal ; eyes congested;
clot between sclerotic and choroid coats left eye.
85. Dyer: Trans. Amer. Ophthal. Soc, 1866, p. 13.— Man, age 24;
weight one hundred and seventy-four and a half pounds; drop three
feet; knot under loft ear; for two minutes at intervals, slight motion
of abdomen, like effort at respiration, and at same time knees drawn
772 HANGING — LAMB,
up a little. Death speedy and quiet. Cut down at end of thirty
minutes. Necroscopy thirty-five minutes after drop. Body and head
moist and warm; emission of semen; face livid; upper lid discolored;
abrasion of skin under right ear; deep red mark around neck. Eye-
balls not prominent; eyelids closed; corneae dull; pupils a little dilated.
Both lenses fractured. Brain normal; spinal cord normal. Heart
empty.
86. Dyer: Same Trans., 1869, pp. 72-75. — Man hung. One eye
showed fracture of lens, the other lens showed fine lines. A second
case showed dislocation of a cataractous lens. A third showed fissure
of lens.
87. Green: Same Trans., 1876, p. 354. — Man hung; drop seven or
eight feet. Died quietly and without struggle. One-half to one hour
after drop fell, eyes were examined. No lesion of capsule or lens.
88. Keen: Amer. Jour. Med. Sci., 1870, lix.,p. 417. — Two criminals
hung; drop five feet. Hyoid bone fractured in one; no fracture of
vertebrae in other.
89. Clark: Boston Med. and Surg. Jour., 1858, Iviii., p. 480. —
Execution of Magee. Man, age 28; weight 130 pounds. Drop seven to
eight feet. No struggle nor convulsion. Urine discharged at once.
Seven minutes after drop fell, heart-beat one hundred; nine minutes,
ninety-eight; twelve minutes, sixty and fainter; fourteen minutes, not
audible; twenty -five minutes, body lowered. Face purple; puj)ils dilat-
ed; eyes and tongue did not protrude. Mark of cord just above thyroid
cartilage, a deep oblique furrow except a small space under left eai*;
knot over mastoid process. Forty minutes, cord and strap removed;
body, especially face, became paler. Necroscopy a little over an hour
after drop fell. Body pale; skin mottled; small ecchymosis just above
line of cord right side. Right sterno-mastoid muscle torn. Hyoid
bone fractured; spine not injured. No seminal dischai^ge. Ninety min-
utes, pulsation in right subclavian vein; heart -beat, eighty per minute;
thorax opened, heart exposed; right auricle showed full and regular
contractions and dilatations. The spinal cord was then divided. One
hundred and twenty minutes, heart-beats forty per minute. These
pulsations of right auricle continued at intervals for three and a half
hours longer; readily excited by point of scalpel. Heart normal; left
ventricle contracted; right ventricle not so; no coagulation. Brain
normal; lungs collapsed; liver and spleen congested; mucous mem-
brane of small intestine pinkish; other organs normal. In the discus-
sion, Dr. Gay thought the absence of cerebral congestion was due to
the circulation continuing in the left carotid.
90. Hofm,ann: Wien. med. Woch., 1880, xxx., pp. 477-480. — Man,
a ci'iminal, hung; after hanging ten minutes, the body was cut down.
Examination half -hour after drop fell. He was resuscitated and partly
regained consciousness, but died three days afterward of oedema of
ILLUSTRATIVE CASES — JUDICIAL HANGING. 773
lungs after repeated severe convulsions. He liad tumors of the neck
which probably interfered with the compression of the trachea. See
also Allg. Wien. med. Zeit., 1880, xxv., p. 161, and Wien. med. Bliit.,
1880, i., pp. 423-430; translated in Ann. Mai. Oreill. and Larvnx,
Paris, 1880, vi., pp. 99-112.
91. Kinkhead: Lancet, 1885, l, pp. 657, 658, and 701-703.— Causes of
hanging. In one, the body of the third cervical vertebra was Ijroken
across and the two pieces separated; in another case dislocation of sec-
ond and third cervical vertebrae.
92. Nelson: Southern Clinic, 1885, viii., pp. 198-202.— Two col-
ored men hung; drop five feet. In one there was atlo-axoid dislocation.
93. Dercum: Phila. Med. Times, 1886-87, xvii.,p. 368.— Descrip-
tion of the brain of a man executed by hanging.
94. Kirtikar: Trans. M. and P. Soc, Bombay, 1885, vi.,pp. 104-
107. — Man, age 25, and woman, age 35. Both hanged. Droj) nine feet.
Knot tied over cricoid cartilage, a little to left side. In falling, the
knots slipped to below the ear. There was fracture of the body of third
cervical vertebra and rupture of ligaments. The cord was ruptured
in each; in the woman in two places — once at the third cervical, the
other at the dorso-lumbar junction.
95. Lamb: Med. Netvs, Philadelphia, 1882, xli.,pp. 42-45.— Exe-
cution of Guiteau. Drop six feet; knot placed under left ear, but
slipped to back of head. Yellowish furrow a few lines wide around
the neck, directed downward and forward. Sterno-mastoid muscles
torn transversely about midway of their length. Thyro-hyoid ligament
ruptured; hyoid bone and thyi'oid cartilage widely separated. Large
blood-vessels not injured. No fracture or dislocation of vertebrae.
96. Thomson and Allen : Catalog. Surg. Sec. Ai^ny Med. Mus. ;
specimens 298 to 302. — Execution of Wirtz. Rope one-half inch diam-
eter; drop five feet; knot under left ear. Several slight shrugs of
shoulders, after which body was quiet; let down in fifteen minutes.
No involuntary evacuation. Face pale, placid. Eyes partly open;
pupils dilated; slight injection of conjunctivae. Mouth open; tongue
not protruding. Just above thyroid cartilage extending on right side
from median line in front to spinous process was a dirty brown deep
furrow with congested walls; on left side a line of discoloration due to
direct action of rope. Soft parts above and below the line much swol-
len, particularly on right side. Larynx and hyoid bone unnaturally
mobile. Right trajiezius muscle torn; sterno-ma.stoid divided ti-ans-
versely, leaving an interval of two inches. Slight ecchymoses between
muscle and larynx. Ecchymoses on ligamentum nuchas. Hyoid
bone, both greater cornua fractured and dislocated from body; lesions
more marked on right side. Several small ecchymoses in vicinity.
Larynx not injured. Brain normal. No bloody or frothy mucus in
774 STJPFOCATION — LAMB.
air-passages. Lungs not congested. One drachm of straw-colored
serum in pericardium. Heart empty. Abdominal organs normal.
Bladder somewhat distended with urine.
See also Tidy, "Med. Juris.," Cases 1 to 4 '^,nd 60.
Accident.
97. Harvey : Indian Med. Gaz., 1876, xi., p. 3. — Boy, ageli years;
was swinging by two ropes attached to two posts; the ro^jes became
twisted around his neck. Necroscopy showed mark of very small rope
in front of neck from ear to ear; mucous membrane of larynx dark;
lungs much congested.
98. HacJcel: Op. cit., p. 35. — Man, age 19, sitting on a load of
wood, with the lines around his neck, fell and was hung by the lines.
99. Biggs and Jenkins: New York Med. Jour., 1890, lii., p. 30.
— Case 16; child, 6 months old, sitting on a high chau% fell between
the chair guard and seat and was asphyxiated by compression of neck.
See also Tidy (op. cit.), Cases 53 and 54.
SUFFOCATION.
The term suffocation is applied in a special sense to the act
and condition of preventing access of air in other ways than
by pressure on the neck, as b}^ pressure on the chest, b}^ obstruc-
tion at the mouth or nose, by obstruction in the air-passages or
on them from neighboring organs, by irrespirable gases, etc.
This article will consider all of these except drowning and
irrespirable gases, which are treated of elsewhere by other
writers.
Smothering is generally understood to mean the act and
effect of stopping the mouth and nose.
Causes.
External Causes.— Overlaying is a frequent cause of
suffocation in infants, which in such cases have usually occu-
pied the same bed with one or both parents. In some cases the
parents have been drunk or otherwise unable to prevent the
injury, and the infant may also be partly stupefied with the
alcohol derived from its mother's milk. Infants are also some-
times overlaid by domestic animals. Again, they have been
suffocated by being pressed too closely to the mother's breast, or
CAUSES. _ 775
by covering with bedclothes, shawls, etc. Noble' attributes some
cases of asphj-xia in the new-born to anaemia of the brain from
pressure on the skull by forceps, etc., and recommends as treat-
ment for this condition hanging the child head downward,
so that the blood may gravitate to the brain (Cases 12 and 30).
Infants are sometimes smothered for mercenary' purposes.
Persons have been suffocated by the pressure of a crowd.
Pressure on the chest combined with forcible closure of the
mouth and nose was the method of Burke and Williams, in
the notorious burking murders, (Case 58). The close applica-
tion of a hand, cloth, or plaster over nose and mouth is of itself
sufficient to cause suffocation, especially in children and feeble
persons. Pressure on the abdomen crowds up the diaphragm
and interferes with breathing. It is very likely that no exter-
nal mark will be found in cases of pressure on the chest and
abdomen, but the lungs will be marbled and emphysematous.
Taking plaster casts of the face and neck without inserting
tubes in the nostrils has caused death in some cases. Suffoca-
tion often follows the falling of walls, houses, banks of earth,
piles of coal or corn or wheat. One may fall into and be im-
bedded in some mobile substance as coal, wheat, corn, quick-
sand, or nightsoil, and be suffocated. Infants have been de-
stroyed " by burying them in manure, ashes, bran, etc. In these
cases there is not only the entrance of the foreign body into
the air-passages, but the pressure of the mass against the chest
and abdomen.
Internal Causes. — The air-passages ma}' be closed up by
foreign bodies within them, or within adjoining organs, espe-
cially the oesophagus. A great variety of substances in one of
these two ways has caused suffocation : mud, cotton, rags, corn,
meat, beans, pepper, potato skins, the fang of a tooth, artificial
teeth, buckles, shells, flint, buttons, screws, crusts of bread,
bones, fruit, stones, heads of grass, coins, slate pencils, nuts,
nut-shells, shot, penholders, worms, fish, etc. (see Cases 6 and
55). Taylor ^ states that there were eighty-one deaths in one
j-ear in England and Wales from food in the air-passages.
Should an inspiration occur in the act of vomiting, the
' Amer. Jour. Obstet., 1886, xix., -Tardicni, op. cit., p. 291.
pp. 349-352. =*"Med. Jur.," Am. ed., 1892, p.
428.
776 SUFFOCATION— LAMB.
vomitus may pass into the air-passages ; a similar accident may
occur in a person who attempts to swallow and speak at the
same time. Infants have been suffocated by inspiring vomited
milk. Fitz ' states that food may pass from the digestive tube
to the air-passages after death.
A case of suffocation in an infant by retraction of the base
of the tongue is recorded. It has been stated that negroes have
committed suicide by doubling back the tongue into the throat,
or, as it is called, swallowing the tongue.^ In giving anaes-
thetics, the subject being supine, and the head and neck some-
what flexed, the tongue, epiglottis, and soft palate may fall
backward and suffocation may follow. Howard ^ states that
pulling the tongue forward under such circumstances may
reopen the pharynx, but will not lift the epiglottis. The thorax
should be raised and head and neck extended backward. He
believes that in giving ansesthetics the head should be lower
than the shoulders. In order to avoid vomiting no food should
be taken for some hours before the anaesthetic.
Cases are recorded of artificial teeth having fallen from the
mouth into the air-passages during anaesthesia and sleep, and
in epileptic and puerperal convulsions. It would appear advis-
able that these teeth should be worn only while eating (Case
13).
Hemorrhage from the lungs, from rupture of an aneurism
or from injury of the mouth or throat, may make its way into
the air-passages and cause suffocation. So also the bursting of
an abscess of the tonsils or other part near the air-passages
(Case 7).
CEdema of the glottis from scalding or other irritation of
the fauces or glottis, or from disease of the kidneys; tumors
pressing on some portion of the air-passages; rapid, profuse
bronchial secretion in infants ; acute double pleuritic effusion ;
cheesy glands ulcerating into trachea ; simultaneous oedema of
both lungs — all of these may cause suffocation (Cases 18 and 40) .
[For cases of enlarged thymus gland, see Hofmann, op. cit.,
pp. 587, 588.]
Paralysis of the muscles of swallowing, from diphtheria or
' Trans. Mass. Leg. Soc, 1878, i., -See Ogston, p. 550.
pp. 14-24. 3 Med. Times and Gaz., 1878, i., p.
603.
CAUSES — SYMPTOMS. 777
other cause, predisposes to suffocation. Progressive asthenia
in which the muscles are exhausted; injurj- of spinal cord or
pneumogastrics ; paralysis of muscles of respiration from the
use of curare ; the spasms of tetanus and strychnia poisoning ;
the entrance of air into the pleural cavities with collapse of the
lungs — all tend to cause mechanical suffocation either by pres-
sure or by paralysis (for deaths in epileptics, see Cases 1, 10,
11, 33, and 40).
It is not necessary that the air-passages should be abso-
lutely closed to cause suffocation.
The cause of death is more likely to be pure asphj'xia, be-
cause of the absence of the complicating pressure of the hand or
ligature on the vessels and nerves of the neck, and of fracture
of larynx or vertebrae.
Symptoms. — Foreign bodies ' entering the trachea natu-
rally fall toward the right bronchial tube instead of the left
because of the size and position of the entrance of the right
tube. If then but one tube is involved, the signs will usually
be on the right side ; whereas if the foreign body stop in the
larynx or trachea, both sides will be affected. The latter con-
dition is much more dangerous. The symptoms would be
resonance over the lung with the respiratory murmur partly or
wholly absent ; less mobility ; puerile breathing on the unaffected
side. In either case there may at first be little disturbance,
especially if the shape of the foreign body is such as not to
greatly interfere with the access of air; otherwise there maj- be
at once, and almost alwaj^s will be after a time, more or less
urgent dyspnoea. Diminution of the necessary oxygen ma}*
cause convulsions, apoplexy, and other brain symptoms. Acute
emphysema of the portion of lung not obstructed may follow
its forcible distention. The local effect of the foreign body is
an irritation which causes spasm and cough. It may be car-
ried upward by the expirations and downward again by each
inspiration. Inflammation is likely to appear eventually and
may involve the lung. If the obstruction is not complete there
may follow periods of alternation of good and bad health, end-
ing perhaps in recovery. The foreign body may be expelled
after a greater or lesser interval. On the other hand death may
result from secondary causes. In the absence of correct his-
' Johnson, Lancet, 1878, ii., p. 501.
778 SUFFOCATION — LAMB.
tory the symptoms may lead to a wrong diagnosis and inappro-
priate treatment ; as where a patient whose symptoms resulted
from the presence of a piece of bone in the larynx, was treated
for syphilis. A foreign body may be coughed up from the
lung into the trachea and fall backward into the opposite lung.
Partial closure of the larynx, most likely caused by a flat or
irregular substance, rather than globular, may cause gradual
asphyxia with symptoms of apoplexy, making the diagnosis
difficult.
When a foreign body remains a long time in the larynx,
spasmodic cough aiid croupy breathing usually ensue, expec-
toration tinged with blood, hoarseness, or complete aphonia,
pain, dyspnoea, possibly crepitation and dulness over the lungs.
The case may end suddenlj' in death from closure of the
glottis, or the foreign body may pass into the trachea and set
up a new train of sj^mptoms, or it may be expelled.
The frequency with which foreign bodies in the pharjmx
or oesophagus obstruct respiration, and the facility with which
they may usually be removed, suggest a careful examination.
Otherwise the patient may be treated indefinitely for supposed
obstruction in the air-passages. Foreign bodies in the oesoph-
agus have perforated into the trachea, and even the lungs,
heart, and aorta.
In complete suffocation death Avill occur in from two to five minutes
(see remarks under Strangulation). Death may also occur instanta-
neously.
The experiments of the Committee on Suspended Animation'
showed that when the trachea of a dog was exposed, incised, and a
tube tied in, the average time covered by the respiratory efforts after
stop])ing \iY> the tube with a cork was four minutes five seconds; the
heart-beat stopping at seven minutes eleven seconds on tlie average.
After four minutes ten seconds it seemed to be impossible for the dog,
unaided, to recover. Faure - made the following experiment upon a
large dog: He fixed a cork in the trachea. At first the dog was quiet;
it then extended its neck, parted its jaws, and made efforts as if to
vomit; tlien tried to walk, but its gait was uncertain; fell do^vn and
rose up. Its eyes became dull, and finally it fell down on its side, and
became convulsed; then after several seconds stretched itself out. The
thoracic movements were at first tumultuous, then became rapidly
'Med.-chir. Trans., 1862, xlv. , p. -Archiv. gen. de Med., 1856, vii.,
449. p. 300.
SYMPTOMS — TREATMENT. 779
feeble; the heart beating very slowly. At the necroscopy the lungs
filled the thorax, were full of thick dark blood and emphysematous.
The blood was black and fluid in the left ventricle and arteries^ and in
the right cavities and veins resembled molasses. Liver darkly con-
gested. There was no mucus in the trachea and no ecchymosis in
the lungs. He also (p. 306) tried the experiment upon a large dog of
fastening boards against its thorax and tightening them by means of
cords. For some minutes it was quiet, but suddenly it became much
agitated, stood upon its hind legs, threw itself against the wall, rolled
on the ground, and uttered frightful cries; finally fell on its side.
There was no movement of the thorax, but the muscles of the neck
and belly were in full and rapid action, dry and sonorous rales were
heard, and a large quantity of mucus appeared at the nose and mouth.
The movements grew feebler, the respirations infrequent, and at the
end of thirty-four minutes it was dead. The necroscopy showed the
blood black and thick; heart x'elaxed; lungs red, a little emphyse-
matous, containing bvit little blood, and on their surface were blackish
points and small red spots.
The death of Desdemona (Shakespeare's "Othello") has been much
criticised. The declaration that she was strangled (or suffocated) does
not consist with the symptoms described (see 3Ied. Neivs, Philadel-
phia, May 1st, 1886, p. 489).
Treatment.
The obvious indication is to search for and remove the
obstruction. The means and methods of treatment are fully
treated of in surgical works, but may be briefly mentioned here.
Laryngoscopical examination may be necessarj". A curved
forceps is usually the best instrument for removing the foreign
body. A tallow candle may serve to push it into the stomach
if there is no bougie at hand. Suction maj" be used. Sneezing
may be brought on by tickling the nostrils; coughing by tick-
ling the glottis; vomiting by irritating the fauces, or by emetic;
the body of the subject may be inverted and in this position the
fauces ma}' be tickled, or fingers may bo passed back into
the pharynx. Johnson ' says that at the moment of inversion
the patient should try to take a deep inspiration; this opens the
glottis and facilitates the expulsion of the foreign body. The
inspiratory current has no appreciable effect in retarding
the movement of the foreign body in the direction of gravit}'.
Noble recommends inversion of the body in new-born infants
'Op. cif., p. 539.
780 SUFFOCATION — LAMB.
in which asphyxia may be supposed to be due to anaemia of the
brain. Tracheotomy or laryngotomy may be necessary. It
may be necessary to administer oxygen. Foreign bodies Hke
beards of grass and iSsh-heads can be withdrawn only with diffi-
culty because of their sharp projections. Intense suffering and
dyspnoea in a robust subject may necessitate venesection. Gen-
erally speaking it is better to bring up the foreign bcdy than to
push it down into the stomach. Beveridge suggests to blow
into the ear, to induce a reflex action and cause expulsion of
the foreign body. Cold affusions, artificial respiration, galvan-
ism, frictions of the limbs, artificial heat, stimulants by mouth
and rectum, may one or all be needed.
Hamilton ' says that it is useless to expect good results
from electricity if five minutes have elapsed since life ap-
peared to be extinct; Althaus," that three hours after death
the muscles will cease to respond to faradization; and Rich-
ardson, ' that a low temperature prolongs the sensitiveness of
the muscle.
With regard to insufflation, Le Bon* objects to it in
asphyxia as being hurtful and not useful. Colin ^ tamponed
the trachea of a horse; in four minutes fifty seconds it was
apparently dead; the tampon was removed and insufflation
practised for fifteen to twenty minutes without effect. He
claims that artificial respiration is useless after the circulation
ceases.
Fell* and O'Dwj^er' recommend forced inspiration.
McEwen * uses a tracheal tube by the mouth.
Dew ® offers a new method of artificial respiration in asphyxia of
the new-born; Lusk '" considers the subject of life-sa'ST.ng' in still-bnths;
Forest,'* artificial respiration in the same; Read ''^ discusses Schultze's
method with approval; Duke '^ plunges the infant into hot water; Rich-
i^'Amer. Pract.," 1872, vi., pp. ^Brit. Med. Jour., 1880, ii., pp.
193-206. 122-124 and 163-165.
2 Brit. Med. Jour., 1879, i., p. 970. » Med. Rec, N. Y., 1893, xliii.,
^ " Nature, " 1879, xx. , p. 108. p. 289.
*Gaz. hebd. Med., Paris, 1872, '"Amer. Jour. Med. Sci., 1891,
ix., p. 806. ci., pp. 109-116.
'^Bull. Acad. Med., Paris, 1876, "Coll. and Clin. Record, 1892,
v., p. 764. xiii., pp. 170-173.
*Jour. Amer. Med. Ass., 1891, ''^ Glasgow Med. Jour. ,1885, xxiv.,
xvi., p. 805. pp. 344-354.
'Trans. Amer. Tsed. Soc, 1891, '^j^led. Press and Circ, 1889,
iii., pp. 128-132. xlviii., p. 433.
POST-MORTEM APPEARANCES. 781
ardson > recommends artificial circulation by injection of vessels, or
electric excitation; Jennings^ recommends the same; Richardson ^ also
considers fully the subject of artificial respiration and electrical excita-
tion; Woillez^ has described and recommended what he cal is a spiro-
phore.
After the removal of a foreign body the irritation remaining
may cause a sensation as if the body was still lodged.
Death may occur from hemorrhage after its removal.
PosT-MoRTEM Appearances.
These are mainl}' those of asphyxia. There may also be
evidences of external violence, homicidal or accidental, as of
pressure on the chest. Persistent deformity, flattening of the
nose and lips, and excoriation of these parts may result from
forcible closure of mouth and nose.
The SKIN and CONJUNCTIVA usually show patches of livid-
ity and punctif orm ecchymoses ; especially lividity on the lips
and limbs. The face may be pale or violet; it is often placid,
especially if the suffocation is accidental. Tardieu ^ admits
that infiltration of the conjunctiva and punctif orm ecchymoses
of the face, neck, and chest ma}^ also be found sometimes in
women after severe labor, and in epileptics. He records the
result of the examination of those who died from suffocation at
the Pont de la Concorde, 18GG. The face and upper parts of
the trunk were generally light red to a deep violet or black
color, with punctated blackish ecchymoses on the face, neck,
and upper part of chest.
The eyes are usually congested. Mucus and sometimes
bloody froth are found about the NOSE and mouth. The
TONGUE may or may not protrude.
The BLOOD is usually dark and very fluid. Wounds after
death may bleed. According to Tardieu " fluidity of the blood
is most constant in compression of the chest and abdomen, as
also its accumulation in the vessels and right side of heart.
Its color varies from red to black.
754, 904; and 1881, x.,
'Asclepiad, 1885. ii., pp. 171-187.
v., pp. 611, 754, 9(
2 Lancet, 1885, 1., pp. 245-347,
pp. 847-852.
289-292.
''Op. cit., p. 279,
^Asclepiad, 1890. vii..p. 201.
" Op. cit., p. 288.
4 Bull. Acad. Med., Paris, 1876,
782 SUFFOCATION— LAMB.
The BKAix and pia mater are generally congested. This is
said to be invariable if the eyes are congested. Mackenzie in
thirteen cases found the brain congested in all.
The HEART varies much in appearance and condition. The
right side is often fall of blood; occasionally empty. Some-
times subpericardial ecchymoses are found, usually along .the
coronary vessels. The blood in the heart may be partly coag-
ulated if the agony has been prolonged and there has been a
partial access of air, which is gradually diminished. Mackenzie '
found the right cavities full and the left empty in nine out of
thirteen cases. Johnson ^ as a result of experiment on animals
claims that when access of air is prevented there is a rise in
pressure in the arteries, the right side of the heart fills, the
pulmonary capillaries become empty, and therefore the left side
of the heart becomes empty. As a result of further experi-
ments ' lie verified his former conclusion, and added that in the
last stage of asphyxia there is increased pressure on the pul-
monary artery and lessened pressure in the systemic vessels.
He thinks'' that when both sides of the heart contain blood,
there is paralysis of vaso-motor nerves and the arteries.
The TRACHEA is usually bright red and often contains bloody
froth. The larynx or trachea as well as pharynx or cesoph-
AGUS may contain a foreign body. If the latter has been
removed the resulting irritation may be seen. The lungs are
sometimes congested, at others normal; color red or pale.
Sometimes one lung only is affected. Thej^ maj' be emphyse-
matous. Mackenzie found them congested in all of thirteen
cases examined by him. The lungs of young persons may be
found comparatively small, almost bloodless, and emphj^sema-
tous. Tardieu, Albi, a,nd others believed that the p?mc/(/"o;';>i
subpleural ecchymoses indicated suffocation, and were due to
small hemorrhages from engorged vessels which ruptured in
the efforts at expiration. These spots are usually round, dark,
from the size of a pin-head to a small lentil, and well defined.
The3^ are not like the petechise in the lungs and heart after pur-
pura, cholera, eruptive fevers, etc., nor like the hemorrhages
under the scalp after tedious labor, all of which are variable in
' Indian Med. Gaz. , 1890. xxv. , ^Ih., 1891, p. 399.
P- 257. 4 Lancet, 1889. ii., p. 255.
- Brit. Med. Jour. , 1877, i . , p. 444.
POST-MORTEM APPEARANCES. 783
size. These punctiform spots are usually seen at the root,
base, and lower margin of the lungs. Hofmann states (" Lehr-
buch") that they are found in the posterior part of the lungs and
in the fissures beween the lobes. They are indisputably fre-
quent after death from suffocation, and if well marked either in
adults or infants that have breathed, the}'^ indicate suffocation,
unless some other cause of death is clear. Simon,- Ogston, and
Tidy, however, have shown that they are sometimes absent in
fatal suffocation, and are sometimes present in the absence of
suffocation, as after hanging and drowning; in foetuses before
labor has begun ; often in still-births, although some of these
are probablj' due to suffocation from inhaling fluid or from
pressure. Also in death from scarlet fever, heart disease, apo-
plexy, pneumonia, and j)ulmonary oedema. Grosclaude ' quotes
from Pinard, who declares that these ecchymoses are found in
foetuses which die from arrest of circulation. Grosclaude him-
self made a large number of experiments on animals by drown-
ing, hanging, and strangling, and fracturing the skull. The
ecchymoses were found in nearly all the cases.
The ecchymoses are partly the result of venous stasis, which
overcomes the resistance of some capillaries; and the latter
rupture, parti}' from the aspirating action of the thoracic wall,
the lung being unable to fill itself with air, but mainl}-'^ from
vaso-motor contraction and lateral pressure at the maximum
of the asphyxia, the time of tetanic expiration. If the asphyxia
is interrupted before this stage, the spots do not appear. Simi-
lar ecchymoses ma}' be found under the scalp, in the tympanum,
retina, nose, epiglottis, larynx, trachea, thymus, pericardium,
in the parietal pleura, along the intercostal vessels, rarely the
peritoneum, in the stomach, and sometimes the intestines; and
in other parts of the body, especially the face, base of neck, and
front of chest; in convulsive affections, as eclampsia and epi-
lepsy, and in the convulsions of strychnia and prussic acid
poisoning there may be suffusion and congestion of the lungs
though not the punctated spots.
Mackenzie, in thirteen cases of suffocation from various
causes, failed to find the Tardieu spots either externally or in-
ternally. Briand and Chaude' state that they are less con-
' Paris thesis, 1877, No. 327. ^"Med. Leg.," 1874, p. 406.
» Hofmann, " Lehrbuch, " p. 514.
784 SUFFOCATION — LAMB.
stant and characteristic in those who have been buried in
pulverulent substances.
Ogston ' holds that in infants that are smothered the ecchy-
moses are found in greater number in the thymus gland ; while
in adults dying from other forms of asphyxia they were found
only once in that gland. The spots are found in clusters in
infants that are smothered, but only single and scattered in
adults who die from drowning, hanging or disease. They were
wanting in the lungs of but one infant.
They may be recognized as long as the lung tissue is un-
changed. The apoplectic spots in the lungs seen in strangula-
tion are not found in suffocation.
Tardieu ^ from experiments on animals and examination of twenty-
three new-born infants who showed traces of violence around the
month, found the lungs rather pale and aneemic, subpleiiral ecchymo-
ses well marked. All the deaths were rapid. In cases of compression
of chest and abdomen ^ the congestion of the lungs was extensive, and
pulmonary apoplexy frequent; more so than in other forms of suffoca-
tion. He gave strychnia to animals which died in convulsions, and
found very irregular and partial congestions, generally not marked be-
cause death was so prompt; blood always fluid; no subpleural ecchy-
moses.
The LIVER, SPLEEN, and kidneys are generally congested;
the kidney more than the other organs named. The spleen
is said to be often anaemic. Semen has sometimes been found,
unexpelled, in the urethra.
Page * experimented on three kittens, suffocating them in cinders.
The post-mortem examinations showed the veins engorged, left side
of heart empty, right side full of dark, half -clotted blood. Lungs dis-
tended, much congested, color violet; many small fluid hemorrhages
in substance; no subpleural ecchymoses. Frothy mucus tinged with
blood in trachea and bronchi; bronchi congested. Bi*ain and abdom-
inal organs normal.
Proof of Death by Suffocation.
It is sometimes difficult in a given case to state whether
death is due to suffocation. There is no lesion which of
itself could be accepted as proof. But a collation of the lesions
' Op. cit. , p. 554. 3 Qp cif. , p. 288.
- Op. cit. , p. 275. ■* Ojx cit. , p. 2.S.
PROOF OF DEATH BY SUFFOCATION. 785
found taken in connection with the surroundings of the body
will in many if not in most cases lead toa definite conclusion.
Infants have been found alive four and five hours after
having been buried in the earth.' If the pulverulent material
has penetrated into the oesophagus and stomach, the burial has
occurred during life. Exceptionally when burial has occurred
after death and traces of the material are found in the air-
passages, thej' are not found in the oesophagus or stomach.
The committee on "Suffocation," of the New York Med. Leg. See,
reiJortecP the following group of appearances as evidences of deatli by
suffocation: The general venous character of the blood, the turgidity
of the larger veins, the congestion of the ijarenchyniatous organs,
especially at the base of the brain, the lungs congested in a variable
degree and cedematous, frothy mucus in the bronchi, the right side of
the heart alwaj's fuller than the left. Fitz ^ holds that suffocation is a
condition comiDOsed of a group of symptoms and aj^pearances due most
probably to accumulation of carbon dioxide in the blood and a defi-
ciency of oxygen. The appearances are: The blood dark and fluid
(though in gi-adual suffocation there may be clots in the right side of
the heart), the right side of the heart full, venous congestion of the
lungs (not constant), interstitial emj)hysema of the lungs, and venous
congestion of the liver, kidneys, and brain. He prefers the word en-
gorgement to congestion in this connection.
Tardieu * holds that when in infants buried in pulverulent
substances we find emphj'sema of the lungs in high degree,
bloody froth in the air-passages, abundant subpleural and sub-
pericardial ecchymoses and the blood fluid, the burial has oc-
curred during life. The same lesions are found in small ani-
mals similarly treated.
It must not be forgotten that an intoxicated person or one
in an epileptic spasm is practically helpless, and can, therefore,
be suffocated, accidentally or otherwise, under circumstances
in which one in possession of his senses would be able to escape.
Accidental, Homicidal, and Suicidal Suffocation.
Accidental sufEbcation is frequent, as has already ap-
peared. Suicidal suflFocation is very rare. Homicidal
suffocation occurs. Foreign bodies have been forced into the
'Tardieu, op. cit., pp. 296, 398. ^-jrans. Mass. Med. Leg. Soc,
2 Physician, etc., New York, 1878, i.. pp. 14-24.
1880, xiii., p. 181. * Op. cit., p. 291.
50
780 SUFFOCATION — LAMB.
air-passages. Smothering has been done by holding the face
in various materials to prevent access of air ; by pressure on
the chest; by forcible closure of the mouth and nose as in burk-
ing; by laying compresses over the face, as in the case of
King Benhadad, ' whom Hazael killed. " And it came to pass
on the morrow that he took a thick cloth and dipped it in
water, and spread it over his face, so that he died ; and Hazael
reigned in his stead." Benhadad was already quite ill and not
expected to live.
Death by suffocation '' may be considered as presumptive of
homicide unless the facts are already referable to accident.
In infants, suffocation is, of course, either accidental or
homicidal ; in adults usually accidental. The absence of signs
of a struggle in adults suggests accident ; unless there is cause
of suspicion of previous stupefying with narcotics.
Taylor ' calls attention to a dangerous practice among some
attendants upon infants, of putting into the mouth of the child
to quiet it a bag containing sugar; and instances a case in
which the child would have died of suffocation but for the for-
tunate discovery of a part of the bag protruding from the
mouth.
In ten years, 3,612 deaths were reported in the city of
London, of infants smothered by being overlaid."
Infants may be born into a mass of blood and fseces, from
which the unattended mother in her weakness may be unable
to remove them.
Page * shows by experiment that tlie inspiratory effort when violently
exerted is sufficient to convey small . objects into the air-passages.
Cinders passed thus into the trachea and oesophagus of kittens and
rabbits. Berenguier® experimented on new-born pups, i^lacing them
in ashes, plaster, and starch. In ashes they lived fifteen hours; these
found their way into the middle of the oesoi^liagus, but were stopped at
the glottis. Plaster and starch formed a paste with the oral mucus
and the movement of the mass was not so great as the ashes. In no
case did either of the materials pass beyond the glottis. Tardieu ^ ex-
amined three infants which had been buried during life. One was in
ashes; the nose was obstructed, mouth full: ashes also in the cesoplia-
' Second Kings, viii., 15. ^ Op. cit., p. 31.
-Tavlor, op. cit., p. 482. ^ Jour, de Med. de Toulouse, 1851,
■Wp. cit., p. 434. iii., p. 237.
••Tavlor. "Med. Jin-.," Am. ed., Wp.cit.,-p. 295.
1880, p. 485.
ILLUSTRATIVE CASES — ACCIDENTAL. 787
gus and stomach, but none in larynx or bronchi. The second infant
was in manure; a greenish stuff was found in the mouth and stomach.
The third in bran (confessed to by the mother); the nose and mouth
were full, but there was none in the throat; a few grains in the trachea.
Tardieu experimented on rabbits and Guinea pigs by burying them in
bran, sand, and gravel, some of them being alive and the others dead.
In those buried alive he found the substance filling the mouth and
nose to the base of the tongue; in most of the cases the oesophagus and
trachea were not f)enetrated. In the animals fu'st killed and then
buried, the substance had not passed into the mouth or nose. In one
case only he found ashes in the larjaix and trachea of a rabbit which
had been buried many hours after death in a box of ashes. Matthyssen '
held a Guinea pig, head downward, with its nose under mercury; the
lungs were full of globules of mercury (which has a specific gravity of
13.5). A dog was plunged head first into liquid plaster-of -Paris; the
plaster was found in the bronchial tubes.
ILLUSTRATIVE CASES.
Accidental.
1. Huppert: Vier. ger. Med. und off. San., 1876, xxiv., pp. 237-
252. — Two cases. A man choked by piece of bread in pharynx. Sec-
ond, an epileptic, suffocated by flexion of chin on larynx. In both
cases seminal fluid was found in urethra near meatus, unexpelled; de-
termined by microscope.
2. Johnson: Lancet, 1878, ii., p. 501. — Boy swallowed penny, be-
came black in face; eyeballs protruded; symptoms soon subsided.
Some hours afterward it was found that he could not swallow solids,
and liquids only with difficulty and coughing. Tlu-oat much irritated;
discharge of mucus sometimes tinged with blood, from mouth; moist
rattling noise in throat in respiration; frequent cough; could not sleep.
LarjTigoscope showed penny in upper pai-t of oesophagus, just below
lar.\^lgeal opening. Removed by long curved forceps.
3. Ihid. — Man suddenly fell while at dinner; face blue; breathing
stertorous. Died. Piece of tendon found under epiglottis.
4. Ibid.— Boy, age 5 years. Button in larynx. Aphonia, dyspnoea,
stridulous breathing. Distress gradually subsided. Many years after-
ward found mucous membrane of larynx thickened; vocal cords red
and uneven.
5. Ibid. — Man, drunk, swallowed a half-sovereign. Urgent dysp-
noea; pain in throat; aphonia; stridulous breathing; dysphagia; cough;
copious mucous expectoration. Laiyngoscopic examination showed
coin in oesophagus. The crico-thyroid membrane was incised and coin
pushed upward and ejected.
'Ann. d'Hyg.; 1840, xxx. . p. '225.
788 SUFFOCATION — LAMB.
6. Med. Times and Gaz., 1874, i., p. 486. — Man, age 20, had severe
dyspnoea. In taking- a living fish in his teeth (it was about four inches
long and had large dorsal fin), the fish passed into the pharynx and lay
doubled up. Impossible to remove it because of spines. Tracheotomy
at once. Twenty-four hours afterward the fish had decomposed enough
to be partly removed. Patient died of exhaustion.
7. Littlejohn: Edin. Med. Jour., 1875, xx.,p. 780. — Woman found
dead in bed. SuflPocated by pus from abscess of tonsil which burst
during sleep. Found pus in air-passages down to smallest bronchi;
lungs congested; right side of heart distended with dark fluid blood;
left side contracted and neai-ly empty. Blood everywhere fluid. Some
lividity of face. The woman had died quietly lying beside her hus-
band, who was not awakened.
8. Say re: Neio York Med. Jour., 1874, xix., p. 420. — Girl, age 7,
swallowed a bead. Had continuous cough; much pain under midtUe
of sternum. The bead moved upward and downward in resph-ation.
Tracheotomy. Four days afterward she coughed the bead out, in-
sjDired once, and apparently died. Artificial respiration used: alcohol
injected into rectum; galvanization of phrenic nerves. She finally
coughed up a piece of thick mucus and recovered.
9. Duffy: Trans. Med. Soc. No. Car., 1874, p. 126.— Boy, age 8,
swallowed a cow-pea. It lodged in the trachea. Some months after-
ward, laryngotomy performed. The boy seemed to die at once. Arti-
ficial respiration used. After a while he expelled first some mucus,
then the pea. RecoA^ered.
10. Tardieu: Op. cit., p. 290. — Man, age 50, found dead on the
floor. At base of neck and front of chest were many punctated ecchy-
moses. Brain and lungs much congested; the latter showed subpleural
spots. Tongue and lips bitten. Death was due to cerebral and pul-
monary congestion from an epileptic seizure.
11. Oesterlen: Vier. f. ger. Med. und off. San., 1876, xxiv.,x>. 10.
— "Woman, age 30, epileptic. Found dead. Examination showed signs
of asphyxia; blood-vessels engorged, marked oedema of lungs, etc.
Opinion given that she died in epileptic paroxysm, and certain injuries
observed were caused by a fall.
12. Tardieu: Op. cit., p. 322. — Two childi-en, one 2 months old,
the other 18 months old; in bed together. The older overlay the
younger, which died. Necroscopy: kings voluminous, in places con-
gested, in others j)ale; abundant subpleural ecchymoses; quite emphy-
sematous. Fluid blood in heart.
13. Blum: New York Med. Jour., 1885, xlii., p. 207. — Woman,
found dead. Vulcanite plate of usual size, with four teeth attached,
found wedged in trachea about two inches below lar}^lx.
14. Wyeth: Same journal, 1884, xl., p. 487. — Boy, age 12, inspired
a pin-dart in trjdng to blow it through a blowgun. Violent cough.
ILLUSTRATIVE CASES — ACCIDENTAL. 789
gasping for breath, lividity of face for a few minutes; sjTiiiDtoms sub-
sided leaving slight cough. The dart had lodged in right bronchus
beyond first bifurcation, as shown by hissing, fluttering sound in both
inspu'ation and expiration. Tracheotomy. The dart could not be
reached. At a later date the dart was brought up into the mouth by a
strong expiration.
15. Partridge: Same journal, 1890, IL, p. 303. — Child, 4 months
old, found dead; fluid, partly digested milk in air-pa.ssages.
16-41. Biggs and Jenkins: Same journal, 1890, Hi., p. 30. — Re-
port of many cases of fatal suffocation from foreign bodies, etc. Boy,
age 15 — collar-button in larynx .Boy, age 10 — mass of butter in larynx.
Boy, age 5 — bronchial gland discharged into trachea at bifurcation.
Boy, age 3 — screw in larynx. Boy, age 5 — rubber balloon with whistle
attached; it was partly inflated with each expiration. Girl, age 10 —
a "jack " in larynx. Man, age 45 — had been di'inking freely; piece of
meat in larjaix. Man, age 40 — piece of meat in larynx and pharynx.
Man, age 40 — ditto. Insane patient — piece of meat in trachea. Man —
piece of meat in larjTix. Man, age 40 — crackei'S and cheese in larynx.
Child — rubber nipple in larynx. During administration of ether, pa-
tient vomited; vomitus entered larynx. Two children in bed asleep;
one, 3 years old, overlay the face of the younger, age 5 months. Wo-
man, age 25, exoileptic — fell on a child and smothered it. Two children
found dead, covered with bedclothing. Man, age 21, epileptic — found
lying on his face in bed. Girl, age 12, epileptic — ditto. Woman, age
21 — ditto. Girl, age 18 — ditto. Woman, age 35, epileptic— fell on the
floor. Woman, age 28 — ditto. Man, age 35, epileptic; vomited while
in spasm; vomitus entered larjaix. From Dr Janeway : Man, epilep-
tic, fell on his face in pile of manure, which entered larynx. Man,
drunk, li^dng on his face.
42. Roy. Indian Med. Gaz., 1880, xv., p. 71. — Man, believed to be
drunk, had vomited in bed ; vomitus entered trachea and bronchi.
43-47. Mackenzie: Same journal, 1890, xxv.,p.2^7. — Reports fatal
cases : Boy — bone button in larynx. Sailor — meat in larjaix. Boy
— vomited matter in larynx. Infant — while taking the breast, a rush
of milk suddenly filled the air-passages. Also three cases of crushing
under walls; two buried in loose earth; two crushed in a crowd; one
by bags of grain.
48. Feulard: Bidl. Soc. Anat., 1883, viii., pp. 384-386. — Woman,
age 79. Piece of beef in larynx. Necroscopy showed hematoma in
dura mater.
49. Poupon: Bidl. Soc. Clin., Paris (1882), 1883, vi., pp. 236-238.
— Boy, age 5^ years. Death from cheesy gland in trachea.
50. Pons: Jour. Med., Bordeaux, 1889-1890, xix., 2ip. 57-61.—
Woman, age 24. Death from CBdema of larynx from presence of par-
ticles of food.
790 SUFFOCATION — LAMB.
51. Kemeny : Wien. med. Blat., 1890, xiii., p. 37. — Man, age 45.
Suffocated by curdled milk in air-passages.
52. Maschka: Vier. ger. Med., 1885, xliii., pp. 11-14. — Man, age
65. Accidental compression of chest.
53. Heidenhain: Same journal, 1886, xliv., pp. 96-101. — Vomited
matter passed into air-passages while subject was drunk.
54. Langstein: Wien. med. Woch., 1880, xxx., pp. 624-626. —
Child found dead in bed; had vomited food while asleep and breathed it
into air-passages.
55. Ward: Catalog. Army Med. Mus., Med. Sec, p. S3. — Soldier,
age 17; choked to death by lumbricoid worm passing from pharynx into
right bronchus. Specimen 7,737.
Suicide,
56. Sankey: Brit. Med. Jour., 1883, i., p. 88.— Epileptic; found
dead in bed, lying on his back. A round pebble in each nostril; strip
of flannel rolled up and stuffed in throat.
57. Macleod: Ibid., 1882, ii., p. 1246. — Suicidal maniac. Had to
be fed because he refused food. Was seen to be blue in the face and
breathing hard. His mouth was forced open; roll of flannel found in
throat. Macleod refers to another case, a woman in dissecting-room,
with similar roll of flannel in throat.
See Tidy, "Med. Jur.," Cases 15 to 17.
Homicide.
58. Christison: Edin. Med. Jour., 1829, xxxi., pp. 236-250.— The
famous Burking case. A woman was struck down to a sitting posture.
Burke then threw himself on her, kept her down by the weight of his
body, covered her mouth and nose with one hand and placed his other
hand under the chin for ten to fifteen minutes, till she died. Neci-o-
scopy showed a severing of the posterior ligamentous connections of
the third and fourth cervical vertebrae, with blood in spinal canal but
not under the dura mater; cord not injured. Chiistison made experi-
ments to ascertain if the injury to spine had been made during life,
59. Hackel: Dorpat Diss., 1891, p. 35.— Case of choking with pres-
sure on breast and belly. Woman found lying on floor, Avith many
injuries.
60. Tardieu: Op. cit., p. 315.— New-born infant; found buried in
earth. Mother stated that the child had not breathed. Putrefaction
had begun. There was a brownish tint of skin of upper front part of
neck below jaw; drops of sanious fluid flowing from nose; umbili-
cal cord had not been tied; subcutaneous hemorrhage in right temporal
region; brown bruised surface and contused wounds of pharynx, where
ILLUSTRATIVE CASES — SUICIDE AND HOMICIDE. 791
particles like ashes and vomited niatter were found. Lungs filled the
pleural cavities, were rose-colored and showed abundant jiunctated
subpleural ecchymoses; bloody, frothy mucus in trachea and bronchi;
some serum in pericardium; respu-ation had been complete. Opinion
given, that the infant had been suffocated by obstruction of pharjoix,
probably by fingers.
61. Tardieu: Op. cit., p. 323. — New-born infant found under a
cask, partly eaten by a dog. The head showed transverse flattening
and svibcutaneous hemorrhage. Lungs voluminous, rosy; abundant
subpleural ecchymoses; hemorrhage in left lung. Heart filled with
fluid blood. Coagulated blood in abdomen. Opinion given, suffoca-
tion by jDressure on head, chest, and abdomen. The mother confessed
that she had placed the child under the cask.
62. Ibid., p. 325. — New-born infant found buried in the earth; gravel
and earth in pharynx and oesophagus down nearly to stomach, and in
trachea and right bronchus. Lungs congested, crepitant. Opinion
given, that the child had been buried while living.
63. Ibid., p. 326. — New-born infant found in ashes; nose and lips
ohstructed, mouth filled; ashes in oesophagus and stomach; none in
lar^^lx or trachea. Lvxngs distended with air, emphysematous; sub-
pleural ecchymoses; fluid blood in heart.
64. Ibid., p. 327. — New-born infant, buried in bran; nose and mouth
filled; some in trachea; none in oesophagus or stomach. Lungs dis-
tended with air, emphysematous; subpleural ecchjonoses; heart empty.
65. Devergie and Raynaud: Ann. dHyg., 1852, xlviii., pp. 187-
206. — Man found dead on a pile of grain; mouth, no.se, and eyes con-
tained some of the grain; some also in stomach, larynx, trachea, and
bronchi. Some marks of injuiy on face and other parts of body. In-
ternal signs of asphyxia. Opinion given, that the case was homicide.
The defence ofPered was that the man had fallen into the grain.
66. Rauscher : FriedreicKs Blat., 1886, xxxvii.,2jp. 324-330. — ^Vo-
man, age 71, suffocated by a cloth over nose and mouth.
See Tidy, "Med. Jur.," Cases 1 to 11.
DEATH FEOM SUBMERSION
IN ITS
MEDICO-LEGAL EELATIOE'S.
BY
lEVING C. ROSSE, A.M., M.D., F.R.G.S. (Eng.),
Professor of Nervous Diseases, Georgetoivn University; Membre du Congres Interna-
tional d^ Anthropologie Criminelle, etc.
DEATH BY SUBMEESIO]^ OE DE0W:N'ING.
GENERAL CONSIDERATIONS.
The frequence and importance of drowning having arrested
attention from the days of Noah's Ark and those of Hippo-
crates down to the present time, it is quite possible to array in
chronological order the fictitious, transitory, and positive periods
that mark the sequence of ideas touching the subject.
Mooted questions relative to drowning have been debated
since the fourteenth century; and modern statistics show the
great development of this class of emergency, than which none
is of more startling character. In France between four and five
thousand cases of this kind of accident are officially recognized
each year, which is about one-third of all the accidental deaths,
and the number appears to increase yearly. Nearly the same
figures apply to the inland waters of England and Wales, not
including the coast. The Board of Trade Return shows that
out of 86,695 seamen who died in English ships abroad, 53,673
were drowned, and a late report of the Fisherman's Federa-
tion places the number drowned in the inland waters and upon
the immediate coasts of the United Kingdom and its adjacent
islands as 6,268 annually. The many hundreds drowned in
the late Victoria disaster and in the great storm that swept
the British Isles are matters of current knowledge. In our
own country accounts of drowning are of daily occurrence, and
help to the drowning forms the greater part of the work done
by that noble governmental branch, the Life Saving Service.
Not only does the sea claim its numerous victims, but the great
floods and cyclones have destroyed thousands, while on the
lakes and rivers drowning accidents are lamentably frequent.
If the statistics of such accidents were as available as those of
the late war, for instance, the exhibit would doubtless be sur-
prising. Where the aggregation of killed in action is shown
to be 67,058, there were drowned 106 officers and 4,838 men.
795
796 DEATH FROM SUBMERSION — ROSSE.
The small regular army lost 5 officers and 89 men from this
cause ; the negro troops, 6 officers and 289 men ; and the volun-
teers furnished a large contingent, the State of Ohio alone hav-
ing lost 14 officers and 770 men from drowning.*
Aside from the point of view of public hygiene and that of
pathology, further evidence is not wanting to show the medico-
legal value of the phenomena of drowning, and the frequency
and importance of the judicial questions that may arise in this
class of accidents.
DEFINITION AND PHENOMENA OF DROWNING.
Late studies as to the cause and mechanism of asphyxia by
submersion or drowning warrant our speaking of submersion
as immersion complete enough to menace or to extinguish life.
When an animated body or a part only of the body is im-
mersed a sufficient time in water or any liquid mediuin what-
ever in such a way as to exclude fresh air from the respiratory
orifices, suffocation follows, and death by submersion or drown-
ing takes place.
The phenomena occurring in such instances are mostly those
common to imperfect aeration or non-aeration of the blood, and
for this reason the majority of medical writers describe asphj^xia
or apnoea, that is, death beginning at the lungs, as the deter-
mining cause of death by drowning. It must not be thought
that asphyxia is always the mode of death in those submerged,
although it is commonly present in a certain number of cases.
Other causes may often modify the circumstances of the death
or directly produce it, as congestion of the brain and syncope,
or the cause of death may be a mixed one. Occasionally one
reads accounts of persons resuscitated from drowning who, on
recovering from the primar}^ effects of the asphyxia, die sud-
denly without apparent cause after a lapse of a few minutes
or several days. Such cases are explained as the secondary re-
sults of the arrested interstitial nutrition that took place during
the period while breathing was temporarily arrested. Another
secondary cause is phj^sical injury to the lungs from water
penetration, which may result in a fatal pneumonia. A case
'See writer's "Bathing and Boat- Medical Association, April 19th,
ing Accidents," Jour. American 1890.
MODE OF DEATH IN DROWNING. 797
related in England last summer is that of a drowning boy
who, on being resuscitated after submersion in contaminated
water, suddenly died of cholera.
MODE OF DEATH IN DROWNING.
Since various lesions may be found, accordingly as the death
from drowning has taken place from one or more of the fore-
going modes, it is necessary to have a clear notion of asphyxia
and to study in detail the mechanism of arrest of the thoracic
movements and of the hindrance to hgematosis.
Broadly speaking, there will be asphyxia when any obstacle
hinders air from entering the pulmonary vesicles, or when
the fluid that penetrates them is of any other nature than the
medium in which the animal is destined to live. Consequently
the name asphyxia is applied generically to all accidental con-
ditions in which life is threatened by any intervention whatever
of the respiration. (See Mechanical Suffocation, Vol. I.,
p. 705 et seq., and Asphyxiating Gases, Vol. IV.)
Submersion in any liquid medium causes asphyxia. This
condition may be caused on being surrounded by a medium de-
void of oxygen and improper to support sufficient hsematosis,
as hydrogen, nitrogen, and the protoxide of nitrogen, gases not
toxic properly speaking, but considered irrespirable. Dimin-
ished respiration from deficiency of ox3^gen is the true cause of
asphyxia. No animal can maintain the respiratory process in
an atmosphere devoid of oxygen or in one that does not con-
tain at least ten per cent of this gas, and such quadrupeds as
whales, hippopotami, and seals or the pygopodous birds would
drown in the same manner as a dog if kept submerged long
enough. The suppression of the gaseous exchange by submer-
sion is also fatal to such aquatic insects as hydrophiles, dy-
tiscidse, and the like, which drown in the same manner as the
hymenoptera, coleoptera, diptera, or other terrestrial insects.
Ants drown in less than a minute when the body is wet, and
the disappearance of apparent vitality is accompanied by con-
vulsive movements indicating functional trouble of the nervous
apparatus. Sir John Lubbock found that after eight hours of
immersion they could be restored to life, and several ants after
two days and five days were restored to momentary life wit'i
798 DEATH FROM SUBMERSION — ROSSE.
feeble motions, followed by death in two hours. Even a terres-
trial plant when submerged drowns like a terrestrial animal, the
mechanism of asphyxia by submersion being the same in plants
and aerian animals, and due to closure of the principal way of
gaseous exchange.
Notwithstanding the interruption of the gaseous exchange
necessary to support life, there is long persistence of vitality
after submersion of some creatures in which an intra-molecular
respiration or gaseous dialysis with aerated water takes place,
as in ants who have not been wetted before submersion.
The resistance of new-born animals to this mode of asphyx-
iation is especially noted in the greater time required to drown
a pup than an adult dog. One minute and a half usually suf-
fices to drown a dog, while a new-born pup often requires as
much as fifty minutes. This great difference is owing to
the less active change of tissue and the smaller consumption of
oxygen in the young animal. The more active the vital com-
bustion and the greater the demand upon the general store of
oxygen in the blood, the quicker the young animal perishes
when the respiration is obstructed.
It is observed in a general way that all kinds of death
caused by the j^rivation of respirable air have between them-
selves the greatest resemblance. Whatever be the obstacle that
intercepts the connection of the lungs with the atmosphere, the
apparent differences are only secondary and the essential symp-
toms are identical, because all act in suppressing the functions
of the blood and hsematosis. In fact, the phenomena of as-
phyxia are constant and related to disturbances in the respira-
tion, innervation, and circulation, which vary according as the
asphyxia is the result of submersion or of the absence of oxygen
in the surrounding medium, according as asphyxia is immediate
or slow. The fatal result of asphyxia is owing to the introduc-
tory arrest of the pulmonary circulation, the capillaries of the
lungs being incapable of conveying venous blood. The stagna-
tion of the blood in the lungs is followed by paresis of the respi-
ratory centre and stoppage of the heart.
STAGES AND SYMPTOMS OF DEATH BY DROWNING.
The authorities are that an individual who dies asphyxiated
by submersion passes through three stages. At first he experi-
STAGES AND SYMPTOMS OF DEATH BY DROWNING. 799
ences a violent shock, followed by an inspiration of surprise,
which results from the contact of water with the lungs causing
a reflex cough. Then for some seconds there is a voluntary
suspension of respiration, giving rise to other forcible involun-
tary expirations. In this dyspnoeic second period the face and
brain become congested, owing to slowing of the encephalic
circulation. Loss of consciousness soon follows, when the
drowning person enters the third stage, which is that of
asphyxia. In this period the individual gasps deeply, the
pupils are dilated, the sphincters paralj^zed, and the limbs are
agitated by clonic convulsions. This is followed by complete
insensibility and speedy death.
When a fatal termination in drowning results from that
form of neuro-paralysis known as syncope, in which death
begins at the heart, we infer from experiments that the sudden
loss of consciousness arises from the violent impressions that
the sensitive nerves convey to the bulb. Such a result is more
likely to occur in persons with weak heart and languid circu-
lation, who are more susceptible to fright and shock or to the
sudden collapse from intense cold. It is also shown that stam-
merers, who have a defective innervation of the phrenic and of
the pneumogastric, succumb more rapidly than others.
The importance of sj^ncope as a cause of death in drowning
is much restricted when we consider the fact that the circula-
tion is the last of the functions extinguished in an animal that
for purposes of experiment has been subjected to submersion.
This has been shown in a sensuous way by experiment, aided
by the resources of the graphic method, which registers the
respiratory modifications as shown by the pneumograph and
also the condition of the femoral artery in connection with a
kymographion. The heart continues to beat as much as three
minutes after the animal has succumbed, and recent autopsy
gives almost constant proof of asphyxia. In fact, it is held
that syncope takes but small part in this form of death, the
general agreement of opinion being that nothing short of a syn-
cope that would be fatal either in or out of the liquid medium
can account for the entire absence of some of the signs of death
from asphyxia.
Among the symptoms often present in drowning persons,
many relate to nervous phenomena and the mental state, which
800 DEATH FROM SUBMERSION — ROSSE.
may vary with individual presence of mind and moral force.
Persons who have escaped this kind of death have observed
auditory and visual hallucinations, as flashes of light, the ring-
ing of distant bells, and the like. Just before the outset of the
asphyxiation a rather curious functioning of the brain known
as hypermnesia ' takes place, in which the revivescence of ideas,
of objects, or of facts relates to anterior impressions long past
that seem to have been forgotten. According to the narratives
of many drowning persons who have escaped the last conse-
quences of asphyxia, this condition was attended by general
exaltation of the memory of such a nature that their whole pre-
vious conscious existence seemed, in an incredibly short period
and with great clearness and precision, to pass before them in
panoramic review. In Admiral Beaufort's letter to Dr. Wol-
laston, the memory impressions are said to have occurred in
retrograde succession . A medical man resuscitated from drown-
ing reports that just before losing consciousness this particular
cerebral activity, in his case, took on a most realizing sense of
the situation and of the consequences to his family. This
cerebral superexcitement is not, however, a constant thing, nor
do all subjects experience the ineffable agony of drowning.
Persons have been taken from the water apparently dead who,
on regaining consciousness, declared that they experienced
neither oppression nor suffering and had no recollection of what
had passed. A very intelligent woman of my acquaintance,
having such an experience a few years since at Newport, quotes
herself as and really believes that she is an instance of a person
once dead and afterward restored to life.
This peculiar vividness of mind has been observed in other
kinds of death than drowning, notably in chronic insanit}*.
A priest with extended experience at the Government Hospital
for the Insane tells me that he has often noticed the vatwina-
tio morientinm in the form of so-called lucid interval of the
insane when called on to administer the last rites of the Church.
The condition is explainable from the stoppage of the pulmonary
artery and the stimulus caused by circulation of non-oxj^genated
blood in the brain.
The condition known as asynesia, or amnesia, sometimes
^ See writer's article, "Memory, Diseases of," in " Reference Handbook
of the Medical Sciences. "
STAGES AND SYMPTOMS OF DEATH BY DROWNING. 801
follows the return to consciousness in persons asphyxiated and
apparently dead from drowning. Dr. F. A. Burrell reports the
case of a boy of eighteen, submerged for six minutes and resus-
citated after four and three-quarter hours, in whom the memory
of everything that had occurred from half an hour previous to
the accident up to return of consciousness had been entirel}^
obliterated. When last heard from the lapse of memory still
remained.'
The statement that death from submersion results from true
asphyxia or from asphj^xia in a more or less modified form
rests on the authority of a large number of facts. Indeed,
recent investigators make the proportion so much greater than
formerly as to warrant the statement that asphyxia is the
generic cause of death by drowning. Dr. S. Coull Mackenzie "^
reports 305 cases of drowning, in which 297, or 93.37 per cent,
died from asphyxiation; 1, or .33 per cent, from syncope; 1, or
.33 per cent, from apoplex}' and asphyxia; and in 6, or 1.9G per
cent, the mode of death could not be determined because of
advanced putrefaction.
As the post-mortem signs of drowning are known to vary
according to a number of circumstances, it is difficult to deal
with the subject unless certain fundamental points be kept in
mind. These relate more particularly to the external signs and
to the different lesions that follow the mode of death, although
they are not constant. Surgeon-Major E. G. Russell ^ illustrates
how widely the post-mortem appearances may vary in cases of
drowning, even when the outward circumstances of the period
of death are identical and the bodies have been subjected to
precisely similar conditions as regards duration of immersion,
subsequent exposure to air, and times of necropsy. He relates
that five persons were drowned while proceeding to a ship in
the Hooghley River. Three died the same death ; and at the
same time the bodies were recovered together after the same
period of immersion, and were examined together; thus from
beginning to end they had been under exactly similar conditions,
yet there were very marked differences in the state of preserva-
tion of the bodies and in the post-mortem appearances. After
' Medical Record, August 22d, 1891. ^ Indian Medical Gazette, Decem-
- " Medico-Legal Experience in ber, 1888.
Calcutta, " Edinburgh, 1891.
51
802 DEATH FROM SUBMERSION — ROSSE.
five hours' exposure in air at 88° F., one body, in which the
tissues were extremely fatty, showed beginning decomposition;
in the other two there were no signs. Decomposition in tho
scalp, face, and neck indicative of drowning had begun undc-r
water, although in ordinary cases it first invades the abdomen,
genitals, breasts, etc. Rigor mortis present in one case was
absent in the other. The penis was semi-erect in one case,
flaccid in the other, retracted and shrunken in the third.
Emission of semen and expulsion of faeces were also noted.
Tongue not swollen or protruded in any case, and cutis anserina
absent in all three, which may have been owing to the high
temperature. Water was inspired into the lungs in two cases.
The larynx, trachea, and bronchi had regular congestion and
scarlet ecchymoses in one case characteristic of asphyxia, and
there was muddy water in the stomach.
The first question likely to arise when a drowned body has
been found is the one of identit}-. All the circumstances in
which the body was observed before its removal to the place
where it lies for examination should therefore be minutely
detailed, and all lethal injuries and the like should be noted
with care, since the smallest accessories often lead to identifica-
tion. The locality in which a drowned body is found may be
a fact of considerable importance that may help to complete the
chain of evidence in which the matter of crime or of accident
turns upon the question of identity. It must be remembered
that bodies often drift many miles away from the spot where
the drowning occurred, owing to tides or currents. Such a
circumstance I noted a few j^ears ago at Brownsville, Texas,
where it was a common sight to see bloated cadavers going
down the Rio Grande. Time and putrefactive changes are also
elements that enter into the matter of recognizing the drowned
cadaver. To resolve this question with desirable precision, tlie
reader is referred to more detailed instruction in the chapter
on Identity.
TREATMENT OF THE APPARENTLY DROWNED.
Help to the drowned does not properly come within the
province of judiciary medicine, being rather a humane question
that belongs to public hygiene. Systematic writers, however,
treat the subject at considerable length, and the statistics of
TREATMENT OF THE APPARENTLY DROWNED. 803
institutions for helping tiie drowned give such marvellous re-
sults that it would manifestly not be out of place to cite briefl}'"
some of the means employed for restoring life to persons taken
from the water asphyxiated and apparently dead.
The prime object in resuscitating the drowned is the intro-
duction of air into the pulmonary vesicles, which is best accom-
plished by artificial respiration, and the employment of such
means as excite the nervous system with a view to reanimate
sensibility and develop the reflex movements that contribute to
the re-establishment of the respirator}' function.
The exigencies of drowning also call for special means to
restore the animal heat and the circulation, as well as the pre-
caution of removing mucus and fluids from the obstructed air-
passages.
As the knowledge of securing patency of the air-passages by
artificial respiration is generally diffused among medical stu-
dents and is taught in some schools, it would be superfluous to
repeat in detail the procedures of Hall, Sylvester, and others.
Laborde's method of resuscitating those apparently dead
has lately gained some notoriety. It consists in stimulating
the respirator}* reflex by regular rhythmical traction of the
tongue, which should be vigorously pulled forward fifteen or
eighteen times a minute, to correspond in frequency to the
normal respiration.
Another method, alleged to have marvellous effects over the
respiration, is that of anal dilatation. Its advocates claim that
irritation of the anus is a much more effective measure in re-
suscitating the drowning or narcotized.'
Respiration may be further promoted by alternate dashes of
hot and cold water on the face and chest, by smelling-salts,
tickling the throat and nares with a feather, and by electriza-
tion of the diaphragm and inspiratory muscles. Protracted
galvanism may, however, prove dangerous.
When signs of life appear, a warm tonic stimulating drink
should be given. A hypodermic injection of caffeine is also
recommended.
Whatever means are employed should be used on the spot
in the open air and without a moment's delay.
Restorative efforts may be kept up for two or three hours,
' Jour, of Orificial Surgery, April 1st, 1893, p. 709.
804 DEATH FROM SUBMERSION — ROSSE.
although in the majority of cases life is extinct in the human
subject after two minutes' submersion or even less, and the
chance of restoration after five minutes' complete submersion is
doubtful. To be sure, trained tank performers remain under
water longer than two minutes, and exceptional instances occur
of recovery after twenty minutes' submersion in individuals in
a state of syncope or with catalepsy.
CADAVERIC SIGNS IN CASES OF DROWNING.
The signs alleged to be common to death by drowning and
characteristic of it are difficult to deal with, for the reason that
there are no sure signs of drowning and the lesions furnished
by necropsy are of feeble importance. There is consequently
a divergence of opinion on this subject.
External Signs.
Among the external diagnostic signs consistent with the
supposition of death by drowning, the presence of froth at the
mouth and nostrils is of first importance. Cadaveric rigidity,
pallor, goose-skin, rosy or violet discolorations on various parts
of the body, retraction of the penis and scrotum, fish-like ex-
pression of the eye, peculiar position of the tongue, maceration
of the palmar and plantar epidermis, and convulsive contrac-
tion of the limbs, particularly of the hands, which may be
clinched after the manner that marks death by asphyxia, are
all signs which when united form strong presumption in favor
of submersion.
These typical and classic signs may, however, be varied by
many circumstances. Hence the dissidence of authors. Dr.
F. W. Draper states that after inspecting 149 drowned bodies,
he has never observed that important sign of death, the pres-
ence of substances grasped in the hands.' Sand or mud in the
hollow of the nails and excoriations of the fingers are also
regarded as probable, not certain, signs, since each of these
might have occurred either before or after death. The peculiar
clinched condition of the hand is not pathognomonic, though
strongly suggestive of drowning, as it may appear in asphyxi-
ation from other causes. I have lately noticed this among the
' Trans, of the Massachusetts Medico- Legal Society, vol. i., No. 8, 1885.
INTERNAL LESIONS. 805
external appearances of the bodies taken from the Pompeiian
excavations. Tlie further index of drowning known as washer-
woman's or cholera hand, with non-adherent tendency of the
epidermis, is an effect that may be produced upon the living
after a prolonged bath, notably in the aged and habitually un-
clean. Nor is the position of the tongue a special and distinc-
tive characteristic of drowning. Only a few months ago I
observed its presence in some of the victims of mechanical suf-
focation in the Ford's Theatre disaster in Washington.
The shrunken state of the genital organs is apparently of
little i^ositive value as a thanatological sign, since the negative
and opposite state of erection has been often observed, and Dr.
Ogston states that he met semi-erection in twenty-two cases.
The value of " goose-flesh" as a link in the chain of evidence
is also weakened when we consider that it frequently occurs
after other violent modes of death. Anserine skin is often met
with during life, and cases of drowning are recorded where
this appearance has been absent.
The aspect of the face and the general position of a drowned
cadaver may likewise var}" according to the mode of death.
Immobility of the body in the attitude of agony, the horrible
grimaces of asphyxia, the pale, calm features of syncope, and
putrefactive changes are further circumstances of medico-legal
detail that may complicate the problem and render an autopsy
necessary in order to invalidate or confirm the uncertain con-
clusions furnished by the external signs.
Internal Lesions.
Autopsies on the drowned are remarkable owing to their
negative signs. But as an extension of diagnostic means, the
autopsy ma}' show the vertical (though not invariable) position
of the epiglottis ; the presence of water and foreign matter in
the bronchi ; swelling and emphysema of the lungs ; hydroemic
engorgement of the liver; fulness of the right heart and empti-
ness of the left; fluidity of the blood; water in the stomach and
middle ear ; and a characteristic f rothj'^ mucus or lather more
or less bloody, which most observers and writers consider the
only constant post-mortem appearance of drowning.
Examination of the respiratory apparatus is of extreme im-
806 DEATH FROM SUBMERSION — ROSSE.
portance in a question of this kind, for it is contended that the
presence of foreign bodies is a proof of submersion.'
This opinion is in part erroneous, since it has been observed
that when a body is submerged after death water will penetrate
the larynx, trachea, and remote bronchi, as well as the stomach
and middle ear. Moreover, Dr. Ogston states that in 48.7 per
cent of cases of drowning no water was found in the lungs.
The emphysematous condition of the lungs, which are said
to force their way out of the chest on removing the sternum, is
difficult to distinguish from the result of putrefaction. Dr.
Gilberti shows that in the drowned the lungs disintegrate rap-
idly, while the heart, in which putrefaction begins chronolog-
ically, is relatively in a good state of preservation.''
Since many cases have been observed in which both sides of
the heart may be partly filled or both be empty and flaccid, or
the left side distended more than the right, we are obliged to
regard the exceptions concerning this post-mortem sign of
drowning as coextensive with the rule.
Excessive fluidity of the blood depends upon the rapidity
with which the drowning took place. Slight hydrsemia occurs
in rapid submersion, but when the drowning has taken place
slowly a large amount of water passes into the blood. In cer-
tain poisonings by opium this fluidity also exists; but it is
claimed that analysis and the spectroscope may clear up the
diagnosis.
Hydrsemic engorgement of the liver is regarded as a char-
acteristic fact by Lacassagne, who claims to be able to diag-
nosticate drowning from a single examination of this organ.'
It is now generally admitted that the presence in the stom-
ach of a certain quantity of liquid in which the body was found
immersed may be considered as a sign almost certain of as-
phyxia by submersion.
Dr. Fagerlund concludes from his experiments that liquids
do not penetrate after death either the stomach or anus unless
strong pressure be made. But when asphyxia occurs in water
the liquid is found in the stomach and the intestines, where it
'Lesser, Dr. Adolph : "Ueber die Annegamento nel Cadavere in Pu-
wichtigsten Sectionsbefunde bei trefazione, " 1889.
dem Tode durch Eitrinken in diinn- ^Barlerin, Paul, le Dr.: "Etude
fliissigen Med ien," Berlin. 1884. Medico-legale sur la Submersion,"
■'Gilberti, Dr. A. : "ISegni dell' Tarare, 1891.
ACCIDENTAL, SUICIDAL, OR CRIMINAL. 807
is helped on by peristaltic movements. The pylorus is an ob-
stacle to the passage of this water, the movement of which is
easier when the stomach is emptj- and the submersion pro-
longed.'
The quantity and quality of the water may constitute im-
portant evidence; but to be of full value the water or other
fluid found in the stomach ought to be the same as that in
which the immersion has taken place.
The liquid, which may have been taken just before drown-
ing, should not be noticed unless it exceeds half a pint ; but anj^-
thing peculiar in the fluids, either of the lungs or stomach,
should be subjected to microscopic or other examination.
Presence of water in the middle ear is regarded as a thana-
tological sign of great value. Dr. Bourgier claims as the result
of his examination that 23 cases out of 27 had water in the
middle ear. Several German observers pretend to have found
amniotic liquid in cases of foetal asphyxia. The fluid may be
aspired b}' a small pipette.
Many of the foregoing signs and lesions disappear or undergo
variable alterations after sojourn in water, putrefaction, etc.
They maj^ as they have done in the past, give rise to many
controversies, so that presumptions only can be established.
Hence the necessity for careful and detailed necropsy in such
cases, with a view not only to minimize conjecture and uncer-
taint}', but to prevent opposing counsel from entering the plea
of negligence and incompleteness.
WAS THE DROWNING ACCIDENTAL, SUICIDAL, OR
CRIMINAL?
Assuming the probabilities to be in favor of death by sub-
mersion, the question next turns upon the character of the
event.
In the absence of lesions it is almost impossible to say
whether the individual fell in, jumped in, or was pushed in the
submerging fluid. The person's antecedents should be inquired
into — whether subject to epilepsy, vertigo, intemperance, or
mental aberration. Alcoholism is an important factor in acci-
' Fagerlund, L. W. : "Ueber das jahrschrift fiir gerirhtl. Med. imd
Eindringeu von Ertrankungsfliis- off. Sanitiitswesen,'' Berlin, 1890.
sigkeit in die Cedarnic," Viertel-
808 DEATH FROM SUBMERSION— ROSSE.
dental drowning, and a person intoxicated may be drowned in
very shallow water. A few years ago a young man over six
feet tall, while bathing in a tributary of the Potomac River,
near Washington, was drowned in only three feet of water.
On considering all these circumstances, it may not be possible,
even after careful inspection of the body and minute explora-
tion of all the organs, to declare the drowning the consequence
of an accident. The existence of traces of violence or of injury
which may have occasioned death or disability, of such a nature
as to render the person unable to defend himself, would seem
to merit particular attention. But their presence leads to fur-
ther consideration — were the marks of injury caused by the
water itself, by some object in the water, or were they self-
inflicted? Dislocations, fractures, and other injuries have been
caused by jumping or falling into the water from a great
height. I know an instance of a professional Vv'ho, on jumping
from a height of ninety feet, split his upper lip on striking the
water with his mouth open. The autopsy in the case of
Odium, the Brooklyn Bridge jumper, is said to have shown
rupture of the liver. On the other hand, many persons jump
from great heights into water with perfect impunity. For
many weeks at the London Aquarium a performer has nightl}'
jumped into a tank from an elevation of 137 feet, and several
persons have successfully jumped from bridges much higher.
Objects in the water that may account for cadaveric lesions
are numerous. I have known a soldier, a good swimmer, to
break his neck on diving from a river bank.' Other traumatic
lesions may occur in a rapid current, from the breaking up of
ice, from the screw or paddle-wheel of a passing steamer, or
from aquatic animals.
A matter much discussed in connection with this subject —
that of shark-bites — may enter into the question of survivorship
where it is alleged that several persons during shipwreck or
other disasters at sea have been devoured by sharks. Though
an occasional accident, such bites are more a figment of the
mind than a reality, as the concurrent testimony of disinter-
ested observers will show. After years of investigation among
nautical people and much experience as a swimmer in widely
' Circular No. 3, War Department, Surgeon -General's Office, Washing-
ton, 1871, pp. 129-131.
ACCIDENTAL, SUICIDAL, OR CRIMINAL. 809
different parts of the world, I have no personal knowledge of
such injuries, and have met hut two persons that had any
actual personal knowledge of shark-bites.
Documentary evidence as to shark-bites is also very scanty.
During the last fifty years soldiers by the tens of thousands
have swum at Fort Monroe, Virginia, yet there is no record
of one having been bitten by a shark ; nor have I been able to
ascertain that any accident of the kind has occurred at Malta
or at Gibraltar. There does not appear to be a record of any
■one ever having been bitten off the British Isles. I have been
unable to ascertain that a single bite of the kind is reported
among the medical records of our War or Navy Department
or those of the Marine Hospital. In the West Indies but few
facts are reported indicating danger from sharks, and these are
not well authenticated. The same may be said as to newspaper
accounts, which deserve about as much credence as the reports
concerning sea-serpents. A few years ago a public journal
gave an account of a boy who was bitten while swimming near
New York and afterward died in a hospital.
But medical literature has a few reports of shark-bites. After
ten years' diligent search I have found seven references,
the earliest in the London Medical Gazette, 1823, and the
latest in the London Lancet, 1886. The bites occurred in
Australia, South Africa, and India. The Hooghley and Ganges
Rivers are the worst place in the world for sharks and alligators.
A particular kind of shark, the Carcharras Gangeticus, which
is very fierce and bold, sometimes dashes among the crowds at
the bathing ghats, and has been known to bite a boy in two
feet of water. All persons bitten at these places generally die
from the bite, for the reason that the shark, living on carrion,
portions of which stick between the teeth, carries infection to
those whom it may afterward bite. The former habit of
throwing the dead in the river is supposed to account for the
boldness of these particular sharks in attacking the human
species.
Self-inflicted wounds rather suggest suicide, as numerous
instances attest, where one or two kinds of death were intended
to make assurance doublj^ sure. I once saw an Eskimo stab
himself and then jump overboard from a ship off the Siberian
coast. But as a rule suicidal drowning is unaccompanied by
810 DEATH FROM SUBMERSION — ROSSE.
traumatic lesions, unless it be those produced by falls. Hence
the absence of lesions leads to the presumption that the indi-
vidual while living fell into the water or other fluid accidentally
or voluntarily.
Exception may be made in the case of infanticide and
homicidal submersion as the result of surprise, where a person
taken unawares is suddenly and unexpectedly pushed or thrown
into the water. A case in point is that of a man suddenly
robbed and seized by three persons, who threw him into the
river. Another is that of a man who, wishing to get rid of his
wife, gave her arsenic. The effects of the poison being slow
he induced her to take a walk along the river, and when her
back was turned he pushed her rapidly off the bank into the
stream, where she drowned. Death by submersion is rarely the
result of murderous intent, and in the case of adults it is sud-
denly resorted to in order to paralyze resistance and facilitate
the success of crime.
Submersion is oftener intended to hide a crime. A body
may be taken from the water after murder or rape. Whether
the cadaver is recent or one that has lain in the water a long
time, the expert is confronted with a question of the differences
that he may expect to find in a body drowned and one thrown
into the water after death. This difficulty can only be resolved
by considering all the signs and lesions furnished by the
autopsy. No single sign or post-mortem appearance is charac-
teristic of drowning, and none enables us surely to diagnosticate
death by submersion either in putrid or fresh cadavers. Nor
do we have any significant infallible signs that may serve as a
parallel between the immerged post mortem and the submerged.
The exterior signs being nearly the same in the two, the diag-
nosis must necessarily depend upon assembled circumstances,
and these are liable to vary.
CIRCUMSTANCES THAT MAY AFFECT THE TIME OF
SUBMERSION.
Putrid decomposition is the chief obstacle to diagnosis in a
body that has been drowned. This presents great differences.
The death happening in winter or summer, in a temperate or
intertropical country, and sojourn of the cadaver in salt or fresh
CIRCUMSTANCES AFFECTING TIME OF SUBMERSION. 811
water, are each and all important details to be considered in
studying the submergence of a bodj^.'
It is only by studying the events in this order, along with
the immediate signs of death, that the duration of the sub-
mergence may be conjectured. With anatomical appearances
as the only guide it is impossible to fix the time of immersion.
Many elements combined ma}^ affect even the gaseous putrefac-
tion that takes place in submerged bodies. Summer heat and
shallow or stagnant water hasten the development of putrid
gas and subcutaneous emphj^sema which bring the cadaver to
the surface, and that, too, sometimes in spite of precautions
taken to insure the submersion. A case in point is the body
of the Italian admiral, Caraccioli, mentioned in Sou they 's
"Life of Nelson." Bodies weighted with lead or other heavy
substance for the purpose of hiding crime have also been
known to float in consequence of the putrefactive phenomena.
At Evansville, Ind., unsuccessful efforts were made to raise
a sunken steamer with thirty head of cattle between decks. A
few days after the attempt was abandoned the steamer was
suddenly seen to float. The carcasses of the putrefying animals,
swollen by gas, had sufiiced to bring the wreck to the surface.
A great development of gas is very noticeable in what is
known as a " blasted" whale, the stomach of which assumes
balloon-like proportions. A few summers ago, at Province-
town, Mass., it was my rare fortune to be within a few feet of
an enormously distended putrid whale, which suddenly ex-
ploded.
In cold countries drowned bodies are longer in coming to the
surface. In Russia, for instance, in spring after the rivers and
lakes have thawed, the bodies of numerous victims of alcohol-
ism and accidental drowning of the previous winter are taken
from the water. Last summer, at Quebec, I was present when
the body of a man drowned the winter before came to the sur-
face of the St. Lawrence River. On a visit to the northern
lakes many persons connected with the navigation of Lake
Superior told me that bodies drowned in its waters seldom or
never came to the surface.
Specific gravity of the water itself may be an additional
' The subject has been well stud- I'Anthropolosie Criniinelle et des
ied by Dr. A. Carre, Archiv. de Sciences Penales, 15Janv., 1892.
812 DEATH FROM SUBMERSION — ROSSE.
cause for the body coming to the surface. Dr. Tidy says that
every structure of the human body floats in the water of the
Dead Sea. The same cannot be said about the buoyancy of the
water of Great Salt Lake, the accounts of which have been
greatly exaggerated. It does not " support a bather as if he
were sitting in an arm-chair and float him like a fresh egg."
Experience shows that there is no difficulty either in swimming
or in sinking in its waters, the solid constituents of which are
estimated to be about six and a half times more than that of
sea-water. Analysis of Dead Sea water places the solid con-
stituents at 24.580, while that of Salt Lake is 22.282. An-
ottier strong natural brine in the United States is said to be
that of Syracuse Saline, New York, which contains 1?.35 per
cent of sodium chloride.
It is evident from what has been stated that no positive
assertion can be made as to how soon a drowned body will rise
to the surface, and at best any conclusion as to the date of
submersion is so unsatisfactory that it ma}^ be said to be an
unscrupulous use of guessing privileges. Errors in legal med-
icine are sadder in their consequences than those of medical
diagnosis. The medical legist would therefore do well to pre-
serve the frame of mind that often doubts and rarely affirms,
and he should be circumspect enough to avoid dogmatic asser-
tions about matters of uncertainty.
DEATH FROM STARVATION.
IN ITS MEDICO-LEGAL ASPECT.
BY
ENOCH V. STODDARD, A.M., M.D.,
Emeritus Professor of Materia Medica and Hygiene in the University of Buffalo;
Member of the Medical Society of the State of New York and of the Central
New York Medical Association; Fellow of the New York Academy
of Medicine and of the American Academy of Medicine;
Late Surgemi 65th Regt. N. Y. Vols. ; Late
Health Commissioner, Rochester,
N. Y. ; etc. , etc.
STARVATIOJN".
GENERAL CONSIDERATIONS.
Physiology teaches that Hfe can only be maintained in
the living organism by a constant equilibrium between its
waste and repair. Nutrition is a term by which we describe
this double movement of renewal of the molecular structure of
the body, and in this general sense only, that nutrition is synony-
mous with the maintenance of the organism in a stable condi-
tion, is it employed here.
This condition of equilibrium is maintained by a regular
and constant supply of food.
A food may be defined to be a substance which, after intro-
duction into the bod}-, supplies material for the renewal of its
tissues or sustains some of its vital processes. Foods vary
greatly in their properties as restorative or constructive agen-
cies, some containing but few essential properties, while others
combine almost all of the elements required. As some foods
contribute elements for tissue restoration, others are specially
concerned in the calorifacient activities of the organism,' while
others are marked in their tendency to take part, almost exclu-
sively, in special chemical processes.''
The various articles used as foods contain nutritive ele-
ments combined with innutritions substances. They have been
variously classified, but are conveniently divided into
I Orrranir foods ■^"- ^^*^"Senous(C.H.O.N.). ( oieaLnnous
L Oigamcfood., ^,, Non-nitrogenous (C.H.O.), ] g^^^^^^^^^^^^^^^
TT T • ^ 1 i «• Water, HoO.
IL Inorganic foods, ] ,, Saline substances.
Nitrogen enters largety into the composition of the body, and
hence must be abundantly supplied and in combination.
'Flint's "Text-Book of Phvsiol- -Foster, "Handbook of Pliysi-
ogy," Ed. 1877, p. 517; I. Forster, ology," Ed. 1880, p. 457; Kirkc's
"Zeitschrift fiir Biologie, " tome "Handbook of Physiology,'- 11th
ix., 1872. Ed., vol. i., p. 311. '
81G STARVATION — STODDARD.
Of the non-nitrogenous elements the most important are faty
sugar, and starch.
The inorganic principles are essential to the process of nu-
trition. Water, constituting 87 per cent of the bulk of the
body, is demanded in constant supply; while the saline sub-
stances are necessary for the perfect performance of many of
its chemical processes.
It is apparent that no single element can alone carry on
the nutrition of the body, and hence variety in the supply of
food, as well as sufficiency in its quantity, is essential to nor-
mal nutrition. Nor are these the only factors in this complex
problem. Proper preparation of food, its supply at necessary
temperatures,' and other requirements enter into the question
of normal or sufficient alimentation.^
Alimentation is sufficient when it is so regulated that all
the functions of the body are performed in a complete and reg-
ular manner. Insufficient alimentation induces a series of phe-
nomena and a result which have been designated " inanition, ^^
or "starvation."
The exact amount of aliment required by each individual
can only be stated in a general way. In the circumstances in
which he is placed, the supply must be of such character and
quantity as shall be proportionate to the constructive and repa-
rative needs of his body.* It is possible, however, to state a
mean for the various ages and occupations of life.
Phj^siologists generally agree that in ordinary conditions
of exercise the following represents the amounts of the several
food elements necessary for the adult individual daily :
Albuminous substances 130 gms. = 4 oz.
Fatty substances 60 " = 2 "
Carbohydrates 360 " =12 "
Taking the fatty matters as the unit, the daily allowance
would bear the following proportions :
Fats, 1; albuminoids, 3; carbohydrates, 6.
These quantities and especially the fats and carbohydrates,
in conditions of hard muscular labor, must be increased ; and
the proportion would then stand :
' F. Spaeth, "Archiv fiir Hy- -Rochard, "Encyclopaed. d'Hy-
giene," 1886, pp.. 68-81. giene," vol. ii., p. 796.
ACUTE STARVATION. 817
Fats, 1; albuminoids, 1.7; carbohj^drates, 7,
The division of this amount of food elements into proper
portions during twenty-four hours is important. This must
be regulated b}^ the habits and other circumstances of the indi-
vidual. '
The occurrence of death solely from privation of food is
comparatively rare ; yet it is suflBciently frequent to be consid-
ered as one of the causes of violent death and to demand inves-
tigation, since circumstances may be such as to constitute a
homicide from criminal neglect or a suicide from intentional
abstinence from food.
"Starvation," or "inanition," may be considered as
being acute or chronic according as the requisite food has
been suddenly and completely or gradually withheld.
ACUTE STARVATION.
The complete deprivation of food induces a series of modifi-
cations of the functions of the body, differing somewhat from
those developed by a partial and prolonged deprivation. The
length of time during which complete absence of food can be
endured varies with circumstances. In absolute stoppage of
the food supply the acute sensatiori1K)f hunger pass away after
the first one or two days, and are succeeded by profound func-
tional disturbances with weakness and depressing sensations
over the epigastric region, accompanied by distressing thirst.^
The mouth is dry and the tongue heavily coated; the breath is
fetid; the skin is harsh, dry, and exhales a disagreeable odor;
the feces become more and more scanty until the latter da3'S of
life, when diarrhoea usually supervenes ; the face and extremi-
ties become rapidly emaciated ; the person walks with a weak
and tottering gait ; ^ the urine is small in quantity and very
acid ; muscular feebleness gradually reaches complete inability
to move ; ringing in the ears, insomnia and, in some cases, hal-
' For elaborate statements con- Ed. 1873, p. 179; Levy, "Traite de
suit Edward Smith, "Foods," Int. Hygiene, " vol. i., p. 739.
Sci. Ser., N. Y. Ed., 1878; PavJ^ ^corrigan, "On Famine and
"On Food," 2d Ed., 1881, N. Y., p. Fever." etc., Dublin, 1849.
467; Buck, "Hygiene," Ed. 1879, sDonnivan, "On Famine," Dub-
vol. i., p. 190; Parkes, "Hygiene," lin Med. Press, 1848, p. 67.
.52
818 STARVATION — STODDARD.
lucinations ' with delirium and convulsions precede death,
though these latter symptoms are not uniformly observed.^
"CHRONIC STARVATION," "CHRONIC INANITION."
This form of starvation, met with most extensively during
the prevalence of famine, also occurs in conditions demanding
legal investigation.
The symptoms are suflBciently constant and characteristic.
Emaciation becomes extreme, the skin dry and rough, exhaling
a disagreeable odor and often covered with a coating not en-
tirely attributable to filth; the breath is fetid and offensive.
With some exceptions, the victim retains his consciousness and
ability to move about, muscular efforts becoming more and
more feeble; the voice becomes faint; the evacuations infre-
quent, dry and dark ; the urine scanty and high-colored, death
occurring suddenh' at the end, with delirium in some cases.
The length of time during which these sj^mptoms are de-
veloped and their intensity depend mainly upon the amount
and character of the aliment actually supplied during the period
before death.
Upon the pulse and circulation the effects of starvation
are manifest in increased g:equency and feebleness of the car-
diac contractions and lesi^ned force of the cardiac impulse ; this
is more and more marked as the anaemic condition becomes
profound. In some cases the pulse is greatly reduced in fre-
quency, as well as in force, dropping as low as thirty-seven
beats in the minute,^ and auscultation reveals the existence of
cardiac bruits.
In connection with enfeeblement of the circulation, a ten-
dency to hemorrhagic conditions is common, with purpuric and
petechial eruptions in some cases.
Temperature. — A subnormal temperature is frequently
noted in the progress of chronic wasting disease. In inanition,
which in some respects induces a similarly profound disturb-
ance of the functions of nutrition, an analogous lowering of the
' Folet, Ann. de Hygiene et de Times and Gazette, 1861, vol. i., p.
Med. Legal, 2d ser. , vol, xlviii. 344.
'■* Sloan, London Med. Gazette, '^ Chossat. " Recherches experi-
vol. xvii., p. 265; Martin, Med. mentales sur inanition," Paris,
1843, p. 45.
CHRONIC STARVATION — CHRONIC INANITION. 819
body temperature occurs. Chossat clearly shows in his ex-
periments the influence of starvation in depressing the body
temperature. This abasement of temperature does not remain
constant, but daily oscillations appear, differing from those
occurring in conditions of normal alimentation.
While the normal diurnal variation in the fully nourished
is about 0.3° to 1.0° C. (0.5° to 1.7° F.), in the starving this
variation reaches 3.28° C. (5.4° F,). This rises to nearly double
this amount during the latter days of life, and is greatly in-
creased above this figure during the day preceding death.
The temperature at the close falls to a mean of 24.9° C. (76°
F.), and at the moment of death has been noted at 18.5° C.
(66° F.).
Emaciation. — Loss of w^eight is the most striking and con-
stant symptom of starvation. The rapidity of its production
and its extent are modified by circumstances. A very consid-
erable loss of weight can be sustained by the ordinary individ-
ual without a fatal result.
Chossat ' fully demonstrated the effects of inanition upon
the various functions and organs of the body in animals, and
has drawn the conclusion that a loss of weight exceeding four-
tenths of the entire weight of the jbody is productive of a fatal
result. These deductions may be gf^opted as applicable to the
human species. This statement must be accepted as a inean,
as it is capable of variation by circumstances, such as age,
obesity, etc.
Death may occur before so great a loss has been reached in
some cases, and in the obese the fat may disappear entirely
and cause a loss reaching five per cent of the entire weight of
the body, in a very fat animal, without a fatal result.
Bouchardat ^ considers that the important question is the
extent to which the blood and organs of the bod}' contribute to
this loss of weight. Impoverishment of the blood b}^ inanition,
which at the time of death has been found to amount to six-
tenths of its solid constituents, is one of the most vitallj" serious
elements of this loss; and a relative increase of its water}" por-
tion appears, without regard to the employment of water as a
beverage.
' "Rechei'ches experiinentales sur ^Bouchardat, "Del' Alimentation
inanition," 1845. insutiissant, " Paris, 1852, p. 10.
820 STARVATION — STODDARD.
It must be remembered that in wasting diseases extreme
emaciation may occur under a liberal diet, and may continue
for a considerable time before death.'
The muscular system becomes greatly enfeebled, atrophied,
and unable to perform its functions; the loss sustained by the
muscles least used being most marked. The extent of muscular
power possible in starvation varies in different individuals and
in various circumstances.
The vigorous and healthy adult, as a rule, retains muscular
power to a greater extent and for a longer period than the child
or aged person, under similar circumstances.
Exposure to a rigorous climate, prolonged fatigue, etc., rap-
idly reduce capacity for muscular effort in conditions of inani-
tion.
The Period at which Death Occurs.
This is influenced by many circumstances. It is difficult to
fix an exact period for the duration of life in complete depriva-
tion of food, or acute starvation, and it is certainly more so
in chronic inanition, when the modifying circumstances are in-
creased in number and con^lexity.
A large number of cases of prolongation of life during a
period of absolute deprivation of food which has been stated
to extend over weeks and even months, cannot be accepted as
free from error, and hence are not considered here.
A sufficient number, accurately observed and well attested
by unimpeachable authorities, have led to the conclusion that
the healthy adult, in a total deprivation of food, can exist for a
period not exceeding ten to twelve days. On one of the Inman
line of steamers, a young man, aged twenty years, endured ab-
solute deprivation of all food and water during eleven days, re-
covery following.^
Sarah Jacobs, a child of thirteen years ("the Welsh fast-
ing girl"), had been exhibited by her parents as a miraculous
being under the pretence that she had eaten nothing during two
yearns.
The child being placed ^under complete surveillance by four
' Greenfield, ^Brit. Med. Jour., '^Dr. McLoughlin, London Lan-
Oct. 20th, 1877. ^ cet, Nov. 2d, 1878.
THE PERIOD AT WHICH DEATH OCCURS. 821
nurses from Gu3''s Hospital for eight da3's, during which period
no food was taken, died on the ninth day.
The post-mortem examination showed all organs of the body
to be in a healthy condition. The stomach was empty, with the
exception of three teaspoonfuls of a thin acid fluid. The intes-
tines were also empty and their walls were not thinned. A
layer of fat, half an inch or more in thickness, was found under
the skin of the chest and abdomen. The liver was in a healthy
condition, as also the kidneys and spleen. The bladder wai
empty.
The parents were tried on a charge of manslaughter and
were convicted of causing death by criminal negligence. '
Caspar gives the details of a case observed b}' him of a
man aged thirty-six years, who endured total abstinence from
all food for eleven days, recovery following."
Cases are reported of miners who have been imprisoned by
accidents in mines for eight, nine, and nine and one-half days,
with recovery following rescue at the end of this time."*
While the period stated may serve as a maximum limit to
which life may be extended in acute starvation, there are cir-
cumstances which must be considered as modifying this.
Body Condition. — It need hardly be stated that the indi-
vidual in perfect health can sustain complete inanition longer
than the enfeebled or diseased. The presence or absence oi fat
modifies considerably the power of endurance.
Age. — Infants bear starvation badly and succumb more
quickly than the adult. The aged, while they bear a moderate
amount of food better than the young adult, do not endure a
complete deprivation for so long a time.
Cold. — The depressing influence of cold upon the vital func-
tions, especially in the young and feeble, renders it a powerful
factor in shortening the duration of life in starvation.
The Supply ofWater. — When all food is withheld, free
use of water as a drink tends to increase the length of the inter-
val before death. In several cases of protracted fasting, the
use of water in moderate amount has been resorted to with
'Reg. V. Jacobs and wife, Car- Syd. Soc. Pub., vol. ii., p. 29;
marthen Summer Assizes, 1890 ; Lcmdon Lancet, April 11th, 1877,
also London Lancet, 1890, vol. ii., pp. 580-620.
p. 132. ■ -^Thornhill, Med. Gazette, Nov.
'^ Caspar, " Forensic Medicine, " 28th, 1835, p. 39Q,
822 STARVATION— STODDARD.
the apparent result of amelioration of some of the distressing
symptoms and lengthening the period of endurance.
Dr. Tanner, a physician, attempted in July and August,
1880, at New York, a complete fast of forty days' duration, with
the exception of the free use of water. In this case absolute
abstinence from all nourishment is questioned, as no strict
medical surveillance was maintained.
The Italian Succi, at New York, in 1890, undertook a vol-
untary abstinence from food for forty days, under surveillance,
with the use of simple liquids and of some narcotic substance.
He completed the fast, but beyond this fact the case is with-
out scientific value.
Catalepsy. — Certain abnormal conditions of the nervous
system are met where the activity of the vital functions is very
considerably lowered and the various processes of the economy
are in a condition of semi-suspension. Cases of this character
have been observed where the supply of food has been almost
entirely suspended for a period of several days, with but little
emaciation and other symptoms characteristic of inanition.
WAS STARVATION ACCOMPANIED BY OTHER ILL
TREATMENT ?
This question may aris« where evidences of starvation are
apparent.
Such cases are met among young children neglected or
abused by parents or those in whose care they may have been
placed, or among the alienated or sick in the care of cruel or un-
sympathetic attendants.
Infants placed with " wet-nurses " or found in the so-called
"baby farms" also furnish cases which fall under this head.
A careful examination into the collateral circumstances of
the case, together with the results of a careful post-mortem ex-
amination, usually render a positive answer to this question
possible.
POST-MORTEM EXAMINATION.
The dead body exhibits appearances quite characteristic.
Emaciation is very marked and sometimes reaches an ex-
traordinary degree, surpassing that of prolonged and wasting
diseases.
POST-MORTEM EXAMINATION. 823
In extreme cases the fat entirel}' disappears throughout the
body ; the omentum and mesenteiy are entirely devoid of it, as
well as the subcutaneous and intermuscular cellular tissue.
The muscles are atrophied and the heart is sometimes consid-
erably reduced in size ; the liver and kidneys in some cases show
great reduction of volume. The spleen also is small and often
softened.
The stomach, and intestines usually display an extensive
thinning of their walls, so muali so that their contents maj' be
distinguished through them; their calibre also is frequently
found to be diminished, though occasionally they may be dis-
teuded with gas. Usually they are empty, or contain only a
small quantity of bile and fecal matter. In some cases various
foreign substances which have been swallowed by the victims
to appease hunger have been found in them.
The thinning of the walls, so constantly noted, has been con-
sidered as a specially characteristic symptom of starvation.'
The congestion, softening, and ulcerations which have been
observed in some cases cannot be considered as evidences of
starvation or as its results, but rather as being due to an enter-
itis induced by the ingestion of improper substances.
The gall bladder is usually f«und filled with dark and
inspissated bile. In death by starvation the entire organs of
the body exhibit no specific form of disease. Evidences of the
existence of an organic affection observed in the post-mortem
examination at once raise the question :
WAS DEATH CAUSED BY STARVATION OR DISEASE?
Was the original disease aggravated by a failure to supply
the patient with food, or are the lesions observed the result
of starvation? A positive conclusion can be reached in such
cases by carefully considering the results of a post-mortem ex-
amination together with other facts elicited by the inquiry.
Harriet Staunton," a 5'oung girl, had been kept in close con-
finement by four interested persons, and removed in great
'Caspar, "Forensic Medicine," '^"The Penge Case;" Reg. v.
Syd. Soc. Pub., vol. ii., p. 3G ; Staunton, Central Crim. Court.
Martin, Med. Times and Gazette, 1817.
March 30th, 1861 (Case 132).
824 STARVATION — STODDARD.
haste, when in a condition of extreme prostration, to Penge,
where she died, on the day succeeding her removal, in a state
of extreme exhaustion and emaciation. Fat was absent from
every part of the body ; the stomach and intestines were empty,
contracted, and their walls were greatly thinned.
A small deposit of tubercle was found at the summit of the
left lung and a recent deposit of miliary tubercle beneath the
arachnoid, upon the surface of one of the cerebral hemispheres.
No other tuberculous deposits were found. The opinion given
by the physicians making the post-mortem examination was
that death resulted from starvation. This opinion was shared
by Professor Virchow, of Berlin, who stated that the tubercu-
lous deposits found could not explain the cause of death.
In this case the extreme emaciation, entire absence of fat,
thinning of the intestinal walls, etc, were the determining con-
ditions. While extreme emaciation alone is not suflScient to
decide the case to be one of starvation, its existence, taken in
connection with some of the conditions found constantly in
persons known to have died of starvation, is a strongly corrob-
orative fact. Nor can its absence be taken as conclusive evi-
dence that death occurred from other cause than starvation,
since in some cases of deaSli from inanition emaciation has not
been extreme and in a few cases not at all marked,' Instances
of this character are reported by Taylor and others,
DISEASES PRODUCED BY STARVATION.
The effect of insufficient alimentation in the production of
disease has long been recognized. It is understood that this
result follows the deficiency in either quality or quantity. The
so-called "famine fever," prevalent in times of dearth, has
afforded extensive opportunity for observation of the effects pro-
duced. The symptoms developed are those directly referable to
impoverishment of the blood. Pallor, emaciation, nervous de-
pression, derangement of the digestive organs, and muscular
enfeeblement appear in every case.
The development of strumous, herpetic, and cutaneous dis-
eases generally is marked.
Of the secondary effects, the cachectic condition induced ex-
' The case of Reg. v. Jacobs and wife.
DISEASES PRODUCED BY STARVATION. 825
presses itself in pulmonary phthisis largely, while in infants
and very young children intestinal disorders are specially fre-
quent. Organic diseases already existing are seriously aggra-
vated; wounds fail to heal, become ulcerative and sometimes
gangrenous ; while all degenerative processes are rapidly hast-
ened to a fatal issue.'
'Holland, "On Morbid Effects of Deficiency of Food," London, 1839.
'^
INDEX.
PAGE
Abdomen, contusions of, 580
post-mortem examination of, 370
wounds of, 580
Abdominal viscera, rupture of, 583
wounds of, 583
Abscess of brain 563
Actions to recover for services (see Privileged Communica-
tions,) 26
amount of recovery in, 45
elements to be proved in, 47
evidence in, 23-48
Actions for malpractice, 73-87
Adipocerb, 451
Age, determination of, 399
Alcoholism, 564
Anthropometry, . . . . . f 432
APNtEA, .*'.... 709, 796
Arteries, wounds of, 578
Asphyxia, 708
by submersion, 790, 797
external appearances due to, 715
internal appearances due to, 718
Autopsies, 301, 349
in cases of poisoning, 356, 371
late, 378
of fragments 380
order of, jf . . . . 356
Bills for services, effect of, 43
Bladder, rupture of. 585
wounds of, 585
Blank charges, woui^ds by, 617
Blood, coagulation of, 488, 701
condition of, after burns, 653
extravasation of, in brain, 565
on weapons, 535
stains, 350
828 INDEX.
PAGE
Body (see Dead Body), examination of, 537
temperature of, 629
Bones, identification of human, 390
old or recent? 391
Books, medical, when and where used in court, . . . .64
of original entry, when admissible in evidence, . . . .48
of physician, see Privileged Communications
Brain, abscess of, 563
concussion of, 561
congestion of, in drowning, 796
extravasation of blood in, 565
post-mortem examination of, 362
wounds of, 569
Bui/LETS, 595
loss of weight of, 601
track of, 595
Burking, 775
Burns, 360, 639
by acids, . . . 641
burning oil, 640
corrosives 641
electrical currents, 664, 676
flame 640
fused metals, 640
lightning, 694
petroleum, 641
cases of, 657
causes of death by, 645
classification of, 642
constitutional efifects of, 644
local effects of 643
period of death from, 649
post-mortem appearances of, 647
whether ante- or post-mortem, 6^9
Cadaveric changes (see Post-mortem), ...... 441
Cadaveric saponification, 451
Cases of burns, 657
of hanging, 760
of strangulation, 726
of suffocation, 787
Catalepsy, 822
Cause of death, see Coroners
from burns, 645
severe mechanical injury, 499
submersion, 797
wounds, 496, 497
INDEX. 829
PAGE
Cause of Death,
hemorrhage as, 497
latent disease as, 503
shock as, 499
was it natural? 503
wounds as secondary, 509
Clothing, examination of, 353, 537
Cold, effects of extreme, 630
Combustion, spontaneous, G47
Communications, privileged (see Privileged Communications), . 33
Compensation, see Physician and Patient ; Expert Witness; Coi*-
oners ; Medical Examiners
Concussion, 472
of brain, 561
spinal cord, 573
Congenital peculiarities, identity from, 403
Constitutionality of statutes regulating practice of medicine
and surgery, 7-11
Contracts between physician and patient (see Physician and
Patient), 25
contre-coup, 559, 611
Contusions, 358, 467, 470, 523
by lightning, 695
of abdomen, 580
of head, 558
of neck, 570
Coroner (see Post-mortem Examinations), 331
is virtute electionis in America, 332
duties of, are both judicial and ministerial, 332
judicial authority of, relates to inquiries into cases of death, . 332
jurisdiction of, 332
kinds of, at common law, 331
presumption that he has acted in good faith, .... 332
pi'otected under same principles which protect judicial officers, 333
Effect of evidence and verdict, 343
at connuon law was equivalent to indictment by grand jury, . 343
not so now, yet inquisition has same power until grand jury
passes upon the case, . 343
Evidence before, when admissible upon a subsequent trial, . . 344
Inquest, all evidence must be presented to jury, .... 342
coroner cannot hold a second inquest while the first is undis-
charged 334
«oroner has power to hold, 332, 334
is a jvidicial investigation, 333
must be held in view of the body 335
separate inquests must be held over eacli of several bodies, . 333
Jury and inquest, coroner may compel attendance of witnesses, . 341
i>
830 INDEX.
PAGE
Coroner,
Jury and inquest, jurors must be from jurisdiction wherein coroner
is empowered to act, 341
jurors must be sworn by coroner, 341
jurors must investigate and determine the facts, . . . 341
jurors must view the body, 341
jurors not challengeable, 341
witnesses must be sworn bj' the coroner, 342
Massachusetts, see Medical Examiners
office abolished by statute in, 338
statutory provisions in, 338
who may hold an inquest, 338
New York, coroner may issue warrant of arrest of person charged
with the death 341
must, after examination of charges, hold defendant to answer
or discharge him, 341
must px'oceed to examine charges against accused upon his ar-
rest, 341
inquisition and testimony must be filed, 340
jurors must inspect the body and hear the testimony, . . 340
jury must render verdict and certify it by an inquisition, . . 340
six or more jurors must be sworn, 340
statutory i^rovisions, 339
testimony must be reduced to writing, 340
when inquest may be held, 339
Powers of,
cannot delegate authonty or appoint deputy 333
contract will bind county for payment of reasonable compensa-
tion, ............. 336
may employ professional skill to aid him 335
may have body disinterred, 335
may issue process of apprehension, 343
Return of inquisition, 342
inquisition should be signed by the coroner and jury, . . 343
should certify that witnesses before the coroner were sworn, . 343
verdict of the jury is final, . 342
Rights of accused party before, 342
has not the right to be represented by counsel or to cross-
examine witnesses, 342
is not permitted to produce witnesses to show himself innocent, 342
privilege of prisoner upon arrest 344
testimony may be taken by the coroner in his absence, . . 342
under New York criminal code defendant is entitled to a
hearing before a magistrate, 344
Craniometry, 394
Cremation, 389
Custom of phvsieians to serve each other gratuitouslv, . . .52
INDEX.
831
301
Dead Body,
autopsies,
changes in,
chemical examination of,
cooling of,
coroners' duties concerning (see Legal Status of, Appendix),
crimes against (see Legal Status of, Appendix), .
disposal of.
dissection, when permitted (see Legal Status of, Appendix),
district attorney's jjowers concerning,
duty of burial,
examination of gunshot wounds,
exhumation of,
external examination of,
flaccidity of,
internal examination of,
legal status of,
Appendix, giving statutes concerning, ....
physical examination of (see Autopsies), ....
post-mortem examination of (see Autopsies ; Post-mortem Ex
aminers), .
putrefaction of,
right of burial or removal
saponification of,
seizure for debt forbidden,
statutes regulating interment or exhumation, etc., generally,
Alabama, . . 309
Arizona, . . 309
Arkansas, . . 309
California, . . 310
Colorado, . . 311
Connecticut, . 311
Delaware, . . 312
Florida, . . .313
Georgia, . . 313
Idaho, . . .313
Illinois, . . . 313
Indiana, . . 313
Iowa, . . .314.
Kansas, . . . 314
Kentucky, . . 314
tempo ratui-e of, .
Death, apparent,
from anaesthetics,
burns, causes of, .
period of.
whether accidental
Louisiana, . .
Maine, . . .
Maryland, . .
Massachusetts,
Michigan, . .
Minnesota, . .
Mississippi, . .
Missouri, . . .
Montana, . .
Nebraska, . .
Nevada, . . .
B15
315
315
316
316
317
317
318
318
318
319
New Hampshire, 319
New Jersey, . 330
New Mexico, . 330
New York, . . 330
North Carolina,
North Dakota,
Ohio, . . .
Oklahoma,
Oregon, . .
Pennsylvania,
Rhode Island,
South Carolina,
Tennessee,
Texas, , . .
Vermont, . .
Virginia, . .
Washington,
W(>st Virginia.
Wisconsin, .
suicidal, or homicidal?
441,
, 349
441
303
441
301
299
398
303
303
298
610
300
358
443
360
397
304
303
303
445
301
451
299
304
331
331
322
323
333
323
324
324
324
325
825
335
336
336
326
453
439
516
()45
.549
657
o
832 INDEX.
PAGE
Death, from cold, 633
post-mortem appearances in, 034
electrical currents, 683
hanging, proof of, 757
latent disease, 503
natural causes, 503
slight injuries, 507
starvation, 813
strangulation, proof of, 721
submersion, 794, 798
suffocation, proof of, 784
surgical operations, 515, 624
wounds, causes of, 496, 497
signs of, 440
time of, 437
Deformities, identity from, 403
Delirium tremens, 514, 624
Diaphragm, rupture of, 57&
wounds of, 57^
Diploma or license, how proved in court, 20
Dislocations, 476
Drowning (see Submersion), 793
Ecchymoses, 467
ante-mortem, 444
post-mortem, 443, 444, 485'
Electric cars, . 668
Electric light, effects of, on eyes, 676
Electrical apparatus, injuries from, 664
Electrical currents, burns from, C64, 676
direct injuries from, 671
direct symptoms of injury from, 676
fatal, ■ . .682
high tension, 666
indirect injuries from, 670
injury from, 664
internal symptoms caused by, 678
mechanical effects of, 675
mental symptoms from, 68^
muscular contraction from, 677
Electrical resistance, 673
Electricity, 661
medical, 664
static, . 673
Electrocution, 683
Erosion 471
Erysipelas, 511
INDEX. 833
PAGE
Examination of body, 537
of clothing, 537
of surroundings 541
Excoriation, 471
Experiments, testing powder-marks, 613
with cadavers, 607
Expert witness (see Privileged Communications), . . . 49-72
compensation of, 60
competency of, 61
conduct of, in court, 65
definition of, 53
examination of, scope of, 65, 68
impeachment of, 64
in civil and criminal cases, 61
medical books, how may be used in examining, . . . .64
practical suggestions, 70
summons of court must be obeyed, 60
system in Germany and France compared with that in United
States ' 54
Exposure, effects of, 630
Extremities, wounds of, 589
Face, wounds of, 569
Falls 549
Faradism, 673
Firearms, evidence from, . . 600
examination of, 612
Flash, identity by, 619
Footprints, 427
Fractures, 359, 474, 491, 553
by gunshot wounds, 610
of ribs, 574
skull, 559
spine, 571
spontaneous, . . . ^. 474
Gall-bladder, wounds and rupture of, 584
Garrotting, 571, 707
Genital organs, post-mortem examination of, ... . 376
wounds of, 588
Gunshot wounds, see Wounds, Gunshot
HiEMATOMATA, 468
Hair, identity from, 406
on Aveapons, 535
Handwriting, 434
53
834 INDEX.
PAGE
Hanging, 707, 735
accidental, cases of, 774
cases of, 760
homicidal, 759
cases of, 767
judicial, cases of, 770
post-mortem appearances 746
proof of death by, 757
suicidal, 758
cases of, 760
symptoms in, 740
treatment in, 744
Health, Boards of, see Practice of Medicine and Surgery
physicians reporting contagious diseases to, not liable for mis-
taken reports, 23
powers, how governed, 23, 24
Head, post-mortem examination of, 361
wounds of, 557
Heart, in strangulation, 719
post-mortem examination of, 366
rupture of, 578
wounds of, 575
Heat, effects of extreme, 635
Hemorrhage, 483, 497, 716
Hypostases, 443, 716
internal, 444
Identification, 383
by flash of gunpowder 619
from congenital peculiarities, 403
deformities 403, 430
entire skeleton, 392
imprints . 427
injuries, 403
scars, 419
stigmata, 426
tattooings, 421
teeth, 401
in death from submersion, 802
of burnt remains, 389
human bones, 390
mutilated remains, 408
recently dead, entire cadaver, 415
surface signs for,' 419
Imprints, 427, 542
Incised wounds, see Wounds
Infants, liability of, for medical services, 37
INDEX. 835
PAGE
Information, duty of patient as to (see Physician and Patient), . 33
Injuries, coag-ulation of blood in, 488
fatal, actsperformed after, 493
identification from, 403
medical inspection of, 101
of abdominal walls, oSO
viscera, 580
spinal cord, 571
spine, 571
slight, death from 507
whether ante- or post-mortem, 482
Inquest, see Coroners
Insane PERSONS, liability of, for medical services, . . . .39
Insolation, 636
Insulation of electrical conductors, 667
Intestines, post-mortem examination of, 371
wounds of, 586
Kidneys, post-mortem examination of, 370
rupture of, 584
wounds of, 584
Larynx, in death from hanging, 754
strangulation, 718
post-mortem examination of, 369
License (see Practice of Medicine and Surgery), .... 7
(or diploma), how ])roved in court, 20
licensed physician presumed competent as an expert witness, . 58
licensed practitioner, pretending to be, when not a misde-
meanor, 22
statutes requiring, constitutional, 7
suits cannot be maintained by persons without, . . . .18
unlicensed practitioner not presumed competent as expert wit-
ness, 62
when may be compelled by courts, 14
when presumed, 19
Lightning, 690
burns from, 694
contusions by, 695
effects on internal organs, 702
loss of consciousness from, 696
memory from, 696
paralysis from, 697
pathology of, stroke of, 700
staining of skin V)y, 69fi
symptoms produced by, 693, 696
wounds by 695
836 INDEX.
PAGE
Liver, post-mortem examination of, 375
rupture of 582, 808
wounds of, 582
Lungs, in death from strangulation, 719
submersion, 805
post-mortem examination of, 368
wounds of, . . . 575
Lymphorrhagia, 470
Malpractice, 73-87
abortion is, . .74
civil cases concerning 80
contributory negligence in, 87
criminal cases concerning, 73
damages for, 83
definition of, 73
degree of care and skill in, 80
evidence in, 84
inspection before trial in, . 85
partners liable for, 84
Maxxlicher RiFiiE, effects of, 619
Marks of powder, 608
Married women, liability of, for medical services, . . . .37
Master, liability of, for services rendered servant, . . . .39
Massage, not practising medicine or surgery, 28
Medical examiners, see #3roners
contract of coroner with, binds county to payment of reasona-
ble compensation, 336
coroners may employ, 335
In Massachusetts:
cannot hold autopsy unless authorized, ..... 338
cannot hold an inquest, 338
in place of coroners, 338
Medical societies, by-laws of, 15
fee bill, 22
Medicine and surgery, see Physician and Patient; and Practice
of Medicine and Surgery
Muscular contraction, from electrical current, . . . .677
Mutilated remains, identification of, 408
Nails, identification from, 406
Neck, contusions of^ 570
wounds of, 569
CEsoPHAGUS, post-mortem examination of, 369
Overlying, 774
INDEX. 837
PAGE
Pancreas, post-mortem examination of, 375
Patient, rights of, concerning confidential communications, . 96
Physician, action for professional services, 133
his books containing confidential entries, 110
his rights and duties concerning confidential communications, 132
receiver not entitled to his books of account, . . . .110
what is a professional capacity? 133
Physician and patient,
contracts between, compensation for services 37
conditional and unconditional, 34
consulting physicians, 44
duties of patient, 29, 30
physician, 28
employment, how terminated, 26, 28, 30
may be declined 24
estates of deceased persons, when liable for, . . , .43
express or implied 26
express, 27
implied, elements of, 28
infants, liability of, 43
insane persons, when liable, 45
married women, generally not liable, 43
masters, liable for services rendered servants, . . .45
measure of recovery for, 45
patient presumed liable, 37
person calling in j^hysician not presumed liable, . . 36, 41
physicians treating each other, vmen they may recover, . 47
railway company, when liable for, in case of accident, . 42
railway physicians, authority of, . . . . . .42
relation of physician and patient, 119
compensation for services, right to sue for in United States, . 20
how lost, 19
students' services, 44
skill and care required of (see Malpractice), . . .28. 31, 32, 33
schools of medicine not recognized by courts, . . .15
standard of school professed must be attained, . . .31
stranger may not be called in without patient's consent, . 29
Pithing, 572
Poisoning, 597
Position of victim, 541, 540
Post-mortem appearances, in death from burns, . . . 047
cold 034
hanging 740
starvation, 822
strangulation, 713
submersion, 801, 804
sunstroke 638
838
INDEX.
Post-mortem changes,
eechymoses,
hypostasis,
lividity,
rigidity,
Post-mortem examinations (see Autopsies, Coroners),
PAGE
. 441
443, 485
. 443
. 443
442, 453
. 354
when and how made by coroner, 337
Post-mortem wounds, 355
Powder-marks, 608, 612
Practice of medicine and surgery (see Physician and Patient), 7-25
acquirement of right, regulated by statutes, .... 7
constitutionaUty of, statutes regulating, 8
criminal cases, jjroof of 19, 22
license for, may be compelled, 14
how proved, 20
medical societies and by-laws of, 14
15
22
14
fee bills,
massage not, .....
patent medicines, ....
statutory regulations concerning, in:
Alabama, .
. 137
Arizona, . .
, 139
Arkansas, .
. 140
California, .
. 141
Colorado, .
. 144
Connecticut,
. 145
Delaware, .
. 148
Dist. of Columbia, 149
Florida, . . .
. 150
Georgia, . .
. 151
Idaho, . .
. 152
Illinois, . .
. 153
Indiana, . .
. 155
Iowa, . . .
. 157
Kansas, . .
. 160
Kentucky, .
. 160
Lij^Hsiana, .
. 162
Msune, . .
. 164
Maryland, .
. 165
Massachusetts
. 167
Michigan, .
. 167
Minnesota, . .168
Mississippi, . . 169
Missouri, . . . 171
Montana, . . .173
Nebraska, . .175
Nevada, . . .177
New Jersey, . . 178
New Hampshire, 181
New Mexico, . 181
New York, . . 183
North Carolina, 189
North Dakota, . 191
Ohio, .... 193
Oklahoma, . . 193
Oregon, . . . 194
Pennsylvania, . 197
Rhode Island, . 203
South Carolina, 203
South Dakota, . 204
Tennessee, . . 205
. . 207
Utah 209
Vermont, . . 211
Virginia, . . . 212
Washington, . 215
West Virginia, 219
Wisconsin, . . 222
Wj'oniing, . . 223
Great Britain, . 224
Scotland, . . 224
England. . . 224
Ireland, . . . 224
Brit. Columbia, 238
Manitoba, . . 242
N. Brunswick, 248
Newfoundland, 255
N. W. Terr., .
Nova Scotia, .
Ontario, . . .
Prince Edw. Is.,
Quebec, . . .
258
262
268
278
284
Texas, . .
Privileged communications, 91
cause of death, Ill
communications to physician not privileged at common law, . 91
"confidential communications," 115,118
between physician and patient, when privileged, . • 94
dependent upon professional capacity, 98
INDEX. 839
PAGE
Privileged communications,
effect of excluding privileged evidence, 130
evidence admitted not to be commented on. .... Ill
in criminal actions 101
in lunacy proceedings, 103
of abortion, 102
of adultery, 102
of crime in civil actions, 101
of criminal intimacy, 102
of habitual drunkenness, 103
of value of physician's services, 133
to establish privilege, lOG
function of the court, 128
ground of privilege, 91
harmless admission no ground for exception Ill
how evidence of physician taken in New York, . . . .97
how privilege established, 131
in actions for divorce, . . . . • 102
in criminal actions, 101
"information," !»7. 115
"matters confided," 99
"matter committed," 97, 118
"matter necessary to enable a physician to prescribe or a sur-
geon to act," 124
mental condition of patient, 103
necessity, 98
objections to evidence, 109
when made, 110
objection once made need not be repeated, Ill
partner of physician, as privileged witness, 122
patient's ignorance immaterial, 110
rights concerning confidential communications, . . . .96
physician defined, 105
" duly authorized," 105
as witness to establish privilege, .• . .131
physician's advice, . . . 98
books, 1^ . 110
cannot refuse to disclose when patient waives privileg*^ . 99
knowledge, 98
presumption from failure to give privileged evidence. . 130
privilege is patient's, not physician's 107
"professional capacity," 123
purpose of statutes prohibiting disclosures 9G
relation of physician and patient, 119, 122
result of legislation, 134
rights and duties of physician, 132
statutory privileges concerning confidential communications, . 93
840 INDEX.
PAGE
Privileged communications,
statutory privileges for waiver of privilege, 96
surgeon defined, 105
testamentary causes, . • 103
waiver after death of patient, in New York, . . . .98
waiver of privilege after patient's death, 108
by application for Insurance, Ill
by proof of death to insurance company, .... Ill
by contract, 112
by Infant, . .108
by patient's attorney, 107
by representative of deceased patient, 103
by requesting physician to witness will, 113
certificate of death, . . .115
effect of 107, 110
mfant's, 113
taking physician's deposition, 112
testimony of patient, Ill
what constitutes, Ill
what evidence is excluded, 97
what is privileged, 115
when patient may be contradicted%y physician, . . 112
who may waive, 106
whose testimony is privileged, 105
witness, . . . .97
Projectile, course of, . 615
evidence from, 600
Punctured wounds, see Wounds
Putrefaction, 445, 453
circumstances favoring, 447
retarding, 448
of immersed bodies, 450, 810
PYiBMIA, 511
Race, determination of, from hair, 393
skeleton, 393
Railwa^ companies, when liable for medical services, . . .41
Railway physicians, authority as to employing nurses, . . 42
Reports, medico-legal, 381
Resistance, electrical, 673
Respiration, suspended, 439
Ribs, fracture of, . . . . . 574
Rifle, Mannllcher, 619
Rigor mortis, 442, 453, 701
Rupture of abdominal organs, . 582
bladder, 585
gall-bladder, 584
INDEX. 841
PAGE
Rupture of heart, 578
internal organs, 553
kidneys, 584
liver, 582, 808
spleen, 584
stomach, 586
Saponification, 451
Scalds, 639
Scars, in relation to identity, 419
Schools of medicine not recognized by courts, . . . .15
Septicemia, 510
Sex, determination of, 400
Sharks, bites of, 808
Shock, 499
Shot-guns, wounds by 607
Signs of death, 440
Skin, marks on, 419
Skull, fracture of, . ^. 559
measurements of, 394
Small SHOT, wounds by, 617
Smothering, . . . ? " 774
Spinal cord, concussion of, 573
post-mortem examination of, 377
wounds of, . . . . . 571
Spine, dislocation of, 572
fracture of, 571
wounds of, 571
Spleen, post-mortem examination of, 371
rupture of, 584
wounds of, 584
Spontaneous combustion, 647
Stabs, 463
Stains, could assailant have escaped without ? 538
Starvation, acute, . 817
chronic, 818
death from, ^ . 813
diseases produced by, * . 834
or disease, which was cause of death ? 823
period of death from, 820
post-mortem appearances in, 822
whether accompanied by other ill-treatment 832
Stature, determination of, 398
Sternum, fracture of, 574
Stigmata, 426
Stomach, post-mortem examination of, 373
rupture of, 586
842 INDEX.
PAGE
Stomach, wounds of, 586
Strangulation 707, 708
accidental, 724
cases of, 734
cases of, . 726
external appearances due to, 713
homicidal, 725
cases of, 726
internal appearances due to, 727
post-mortem appearances, 713
proof of death by, 721
simulated, 725
stages of, 710
suicidal, 724
cases of, 732
symptoms of 708
treatment of, 712
Struggle, signs of, 536
Submersion, 793
asphyxia by, 796
cadaveric signs in death by, 804
circumstances modifying time of, 810
definition of, 796
mode of death by, 797
post-mortem appearances, . . 801
stages and symptoms of death by, 798
• treatment of apparently drowned, 802
whether accidental, suicidal, or homicidal, . . . . . 807
Suffocation, 707, 774
accidental 785
cases of, 787
by submersion, 796
cases of, 787
external causes of, 774
Homicidal 785
cases of, 790
internal causes of, 775
mechanical, 705
post-mortem appearances, 781
proof of death by, 784
suicidal, . . . 785
cases of, 790
symptoms of, 777
treatment, 779
Sunstroke 636
Surgeon, definition of term 56
duties of, see Physician and Patient
INDEX. 843
PARE
Surgical operations, death from, 515
Survival, 556
SyivX'OPE, 796, 799
Tattooing, 42i
Teeth, determination of identity from 401
Temperature of body, 029
of dead body, 441, 453
Tetanus, 513
Thorax, post-mortem examination of, 365
wounds of, . 573
Time op death, 4:37
how determined, 452
Veins, air in, . . .579
wounds of, 578
Weapons, 853, 524
evidence from, GUO
as to origin of wounds, 533, 549
examination of, ' 613
presence of blood and hair on, 535
was it fired from a distance or near ? 612
Witness, see Expert Witness; Privileged Communications
physician as expert and ordinary -witness, 50
when must testify as, 60
Wounds, . . 1 358, 457
as directly cause of death, 497
as secondary cause of death 509
by what instrument made? 517, 524
cause of death from, . 496, 497
coagulation of blood in, 488
consequences of non-fatal, 556
contused, 467, 470, 523
death from, after long periods, f\. 508
definitions of, . . . 459
description of, 482*
direction of, 529
eversion of lips of, 489
evidence from weapon, 533, 549, 600
examination of, 476
from crushing, 553
falling 549
lightning, 695
gunshot, 593
by blank charges, 617
by shot-guns 607
844 INDEX.
PAGE
Wounds, gunshot, by small shot, 617
complications of, 624
course of projectile, 615
death from surgical operations in, 624
description of, 594
dimensions of perforations, 609
direction of, 599
examination of, 594
of body in, 610
of entrance, ......' 614
of exit, . 614
situation of, 598
treatment of, 620
imputed, 544
incised, 460, 517, 557
diagnosis of, , . . . 462
kinds of, 459
lacerated, 471, 523
mortal, 460
nature of, 548
number and extent of, 531
of abdominal viscera, 580
walls, 580
arteries and veins, 578
bladder, 585
brain, 569
^iaphragm, 579
extremities, 589
face, . .569
gall-bladder, 584
genital organs, 588
head 557, 558
heart, 575
intestines, 586
kidneys, 584
liver, 582
lungs, 575
neck, 569
spinal cord, 571
spine, 571
spleen, 584
stomach, 586
thoracic viscera, 573
thorax, 573
throat, incised, 526
origin of, evidence from weapons, 533, 549
punctured, 463, 518, 557
INDEX. 845
PAGE
Wounds, regionally considered, 557
retraction of sides of, 490
severe, 400
situation and position of, 527, 548
slight 400
whether accidental, 547
ante-mortem or post-mortem, 482
necessarily the cause of death, 500
self-inflicted or by another, 525. 544, 548
which of several was first inflicted? 554
two was cause of death? 500
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