Sji^feJ UNIVERSITY OF CALIFORNIA LOS ANGELES SCHOOL OF LAW LIBRARY ^jLmmm^ A MANUAL OF MEDICAL JURISPRUDENCE. BY ALFRED SWAINE TAYLOR, M.D., F.R.S. REVISED AND EDITED BY THOMAS STEVENSON, M. D. Lond., Fellow of the Royal College of Physicians of London ; Lecturer on Medical Jurisprudence and on Chemistry at Guy's Hospital ; Examiner in Forensic Medicine in the Univer- sity of Loudon ; External Examiner in Forensic Medicine in the Victoria University ; Official Analyst to the Home Olfice. TWELFTH AMEEICAN, EDITED WITH CITATIONS AND ADDITIONS FROM THE TWELFTH ENGLISH EDITION. BY CLARK BELL, Esq., LL.D., President of the American International Medico-Legal Congress of 1889; President of the Ameri- can International Medico-Legal Congress of 1S93 (Chicago) ; President of the Medico-Legal Congress of 1895 (New York); Honorary Member of the Medico-Legal Society of France; of the Society of Mental Medicine of Belgium ; Associate Member of the Society Medico- Psychologique of Paris; Corresponding Member of the Society of Psy- chiatry of St. Petersburg; of the Netherlands; of Lisbon, Portugal; of the Society of Freniatria of Italy ; of the Belgian Society of Anthropology ; and Ex-President of the Medico-Legal Society of New York. Quod hodie exemplis tueinur mox inter exempla erit. LEA BROTHEES & CO., NEW YORK AND PHILADELPHIA. \ Entered according to the Act of Congress, in the year 1897, by LEA BROTHERS & CO., in the office of the Librarian of Congress. All rights reserved. PREFACE TWELFTH AMERICAN EDITIOK Perhaps the early demand for a new American edition of Taylor's classical Medical Jurisprudence may in some measure be attrib- utable to the new features added at the time of the preceding Ameri- can revision. The work was then brought thoroughly to date, and the law and judicial decisions both in Great Britain and the United States were introduced, together with a tabulation of cases and a reference to authorities. These changes made the work more serviceable to all classes in the two professions which it joins, increasing its hold as a favorite text-book in schools of medicine and law, rendering it even more useful to physicians in practice, and laAvyers in the preparation of briefs ; and confirming its previous acceptance as an authority, by all English-speaking judicial tribunals. Since the issuance of the previous edition a strong impulse has been given to Forensic Medicine, by the International Congress of Medical Jurisprudence, by the Congress of Medical Jurisprudence of New York, 1895, and also by the special development of Medico-Legal Surgery in various societies. The present time, therefore, is most auspicious for the appearance of this new edition, and it is fortunate that the demand for it conies at a time when these important advances can be represented. The increasing frequency of damage cases renders this department of Medico-Legal Surgery of growing importance. The eleventh American edition included the admirable work with which Dr. Thomas Stevenson had enriched the twelfth English edi- tion, and was a thorough revision of all previous American and Eng- lish editions. This present issue aims to continue this work along the same lines to the present date. IV P H E FACE. The Editor desires to express liis tlmnks and obligations to Surg.- Gen. George M. Sternberg, of the U. S. Army ; Deputy Surg.-Gen. D. L. Huntington, M. D., U. S. Army ; Capt. Pilcher, U. S. Army ; Surg.-Gen. J. R. Tryon, M. D., U. S. Navy ; Ex-Surg.-Gen. A. L. Gihon, U. S. Navy ; Chief. Surg. W. B. Outten, Mo. Pac. Ry. ; Chief Surg. Prof. R. Harvey Reed, Editor American Academy of Railway Surgeons ; Surg. R. J. Harnden, M. D., Ex.-Pres. Erie Railway Surgeons ; Surg. Geo. Chaifee, M. D., Ex.-Pres. New York State Association of Railway Surgeons ; Capt. Zalinsky, U. S. Army ; and Chief Surg. N. Senn, M. D., of Illinois, for their aid in the prepara- tion of the chapter on " Medico-Legal Surgery ;" to Dr. J. N. Hall of Denver, Col., for valuable aid in the section on " Gunshot Wounds ;" to Prof. M. C. White, of Yale University, for valuable aid on the Microscope and the Red Blood-Corpuscle, and to many friends of both professions for suggestions which will materially increase the useful- ness of the book. C. B. PREFACE ELEVENTH AMERICAN EDITION. This edition is an entire revision of all prior American and London editions, and includes the admirable work with which Dr. Stevenson has enriched the Twelfth English edition. Much new matter has been added, many portions of the work have been amended, and some parts have been re-written. In making additions upon legal questions and the present state of tlie law bearing on Medico-legal matters the Editor has carefully cited nearly 700 cases and authorities to aid counsel in preparing briefs, and to extend the sources of information for Medico-Leg'al Jurists. The Editor is under many obligations to Doctors John J. Reese and Henry Hartshorne, and to Mr. C. B. Penrose for their labors upon previous American editions, which have been utilized as far as practicable ; and to many friends, members of both the Medical and the Legal Professions, for valuable suggestions and aid. C. B. New York, October, 1892. CONTENTS. MEDICAL EVIDENCE. CHAPTER, I. PAGE The Practice of Medical Jurisprudence. — Medical and Medico-legai Duties. — Inspec- tion of Bodies in Death from Wounds or Poisoning. — Use of Notes. — Medico-legal Reports. — Dying Declarations , 17 CHAPTEE II. Toroners' Inquests. — Trials. — Subpoenas. — Medical Fees. — Duties of Medical Wit- nesses. — Medical Secrets. — Quotations from Books. — Presence in Court. — Techni- cal Terms. — License of Counsel. — Rules for the Delivery of Evidence. — Experts, Expert Testimony, and Opinion Evidence 33 CHAPTER III. Modes of Dying. — Syncope, Asphyxia, Coma. — Sudden Death. — Signs of Death. — Cessation of Circulation and Respiration. — Cooling of the Body. — Cadaveric Ri- gidity. — Putrefaction. — Changes Produced in the Viscera. — Putrefaction Mistaken for Gangrene 64 POISONING. CHAPTER IV. Definition of the Term Poison. — Mechanical Irritants. — Influence of Habit, Idiosyn- crasy, and Disease. — Classification. — Special Characters of Corrosive, Irritant, and Neurotic Poisons 73 CHAPTER V. Evidence of Poisoning in the Living Body. — Symptoms Connected with Food or Medi- cine. — Several Persons Attacked Simultaneously. — Evidence from the Detection of Poison in the Food 82 CHAPTER VI. Evidence of Poisoning in the Dead Body. — Period at which Poisons Prove Fatal. Chronic Poisoning. — Appearances Produced by the Different Classes of Poisons. — Redness of the Mucous Membrane Mistaken for Inflammation. — Ulceration and Corrosion. — Softening. — Perforation of the Stomach from Poison and Disease . 88 (vii) \nil CONTENTS. CORROSIVE AND IRRITANT POISONS. CHAPTER VII. PAGE Sulphuric Acid, or Oil of Vitriol. — Nitric Acid, or Aqua Fortis. — Hydrochloric Acid, or Spirit of Salt. — Symptoms. — Appearances and Analysis. — Nitro-hydrochloric Acid, or Aqua Regia 96 CHAPTER VIII. Oxalic Acid. — Symptoms and Appearances. — Chemical Analysis. — Dialysis of Organic Liquids. — Acid Oxalate of Potassium, or Salt of Sorrel. — Vegetable Acids . . 105 CHAPTER IX. Alkalies and Alkaline Salts. — Potash, Soda, and Ammonia. — Nitrate and Sulphate of Potassium. — Salts of Barium Ill CHAPTER X. Phosphorus. — Red Phosphorus. — Symptoms and Appearances. — Chronic Poisoning. — Chemical Analysis 116 METALLIC IRRITANTS. CHAPTER XI. Arsenic. — Arsenious Acid. — Symptoms. — Chronic Poisoning. — Appearances after Death. — Fatal Dose. — Chemical Analysis. — Arsenites. — Arsenic Acid. — Orpiment and other Compounds 123 CHAPTER XII. Poisoning by Mercury. — Corrosive Sublimate. — Symptoms. — Chronic Poisoning.— Appearances after Death. — Chemical Analysis. — Process for Mercury in Organic Liquids. — Calomel. — White and Red Precipitates. — Other Compounds of Mercury 143 CHAPTER XIII. Poisoning with Lead. — Sugar of Lead. — Symptoms. — Appearances after Death.— Chemical Analysis. — Lead in Organic ^Mixtures. — Red Lead. — Carbonate or White Lead. — Chronic Poisoning. — Poisoning with Copper. — Blue Vitriol. — Symptoms. — Appearances. — Chemical Analysis. — Copper in Organic Liquids .... 150 CHAPTER XIV. Tartar Emetic. — Antimonial Wine.— Symptoms. — Appearances. — Chronic Poisoning. — Chemical Analysis. — Chloride or Butter of Antimony. — Poisoning with Salts of Zinc and Iron. — Poisoning with Chromates , 158 CONTENTS. ix VEGETABLE AND OTHER lERITANTS. CHAPTER XV. PAGE Vegetable Irritants. — Aloes. — Gelsemium. — Savin. — Croton Oil. — Castor Oil. — Col- chicuni. — Hellebore. — Veratrine. — Carbolic Acid. — Resorcin. — Petroleum. — Ani- mal Irritants : Cantharides. — Noxious Animal Food. — Fish. — Mussels. — Cheese. — Sausage Poison. — Pork. — TricLinosis. — Poisoned Game. — Ptomaines . . . 168 NEUROTIC POISONS. CHAPTER XVI. Opium. — Symptoms. — Appearances. — Its Action on Infants. — Poisoning with Opiate Compounds. — Opium Habit. — Morphine and its Salts. — Meconic Acid. — Process for Detecting Opium in Organic Mixtures. — Dial3'sis. — Chlorodyne. — Cocaine . . 186 CHAPTER XVII. Prussic Acid. — Symptoms and Appearances. — Tests for the Acid. — Process for Organic Mixtures. — Cyanide of Potassium. — Essential Oil of Bitter Almonds. — Nitroben- zene. — Nitroglycerine 194 CHAPTER XVIII. Alcohol. — Ether. — Chloroform. — Iodoform. — Hydrate of Chloral. — Camphor . . 202 CHAPTER XIX. Tobacco (Nicotiana Tabacum). — Nicotine. — Cocculus Indicus. — Picrotoxin. — Calabar Bean. — Mushrooms 210 CHAPTER XX. Henbane. — Atropa Belladonna, or Deadly Nightshade. — Poisoning by Atropine. — Datura Stramonium, or Thorn-apple 216 CHAPTER XXI. Nux Vomica. — Strychnine. — Symptoms and Appearances. — Chemical and Microscopi- cal Analysis of Nux Vomica and Strychnine. — Process for Organic Mixtures. — Dialysis.— Brucine . . < 222 CHAPTER XXII. Conium or Hemlock.— Conine. — Water Hemlock. — ffinanthe Crocata. — ^^thusa. — Cynapium. — Fool's Parsley. — Water-parsnip.' — Lobelia. — Foxglove. — Digitalni. — Aconite. — Aconitine. — Laburnum 230 X CONTENTS. WOUNDS AND PERSONAL INJURIES. CHAPTEK XXIII. PAGB Defiuitiou of a Wound. — Danger to Life. — Grievous Bodily Harm. — Examination of Wounds. — Description of Wounds. — Cliaracters of Wounds Inflicted on the Living and Dead Body. — Ecchymosis in the Living and Dead. — Effects of Violence on the Dead Body. — Ecchymosis not Always a Result of Violence 247 CHAPTER XXIV. Evidence of the Use of a Weapon. — Characters of Wounds Caused by Weapons. — In- cised, Punctured, Lacerated, and Contused Wounds. — Stabs and Cuts. — What are Weapons? — Examination of the Dress. — Imputed or Self-inflicted Wounds . . 255 CIIAPTEE XXY. Wounds indicative of Homicide, Suicide, or Accident. — Evidence from the Situation of a Wound. — Evidence from its Nature and Extent. — Evidence from the Direction of a Wound. — Wounds Inflicted by the Right or Left Hand. — Several Wounds. — Use of Several Weapons , 265 CHAPTER XXVI. Evidence from Circumstances. — The Position of the Body. — Of the Weapon. — Evi- dence from Blood, Hair, and other Substances on Weapons. — Marks of Blood on Clothing and Furniture, on the Deceased, and on the Assailant .... 272 CHAPTER XXVII. Examination of Blood-stains. — Chemical Analysis. — Spectroscopic Examination.— Blood-crystals. — Microscopical Evidence. — Blood of Man and Animals. — Stains of Blood on Linen and other Stuffs. — Age or Date of the Stains. — Other Stains Resembling Blood. — Blood on Weapons. — Arterial and Venous Blood. — Varieties of Blood 279 CHAPTER XXVIII. The Cause of Death from Wounds. — Wounds Directly or Indirectly Fatal. — Death from Hemorrhage. — Internal Bleeding. — Death from Mechanical Injury. — From Shock. — Death from Numerous Personal Injuries, Irrespective of any Mortal Wound . . . . . • 306 CHAPTER XXIX. Death of Wounded Persons from Natural Causes. — Distinction between Real and Apparent Cause. — Death from Wounds or Latent Disease. — Accelerating Cause.— Death from Wounds after Long Periods. — Avoidable Causes of Death. — Neglect. — Imprudence. — Unskilful Treatment. — Unhealthy State of Body .... 313 CHAPTER XXX. Wounds Indirectly Fatal. — Tetanus Following Wounds. — Erysipelas. — Delirium Tremens.— Gangrene. — Death from Surgical Operations. — Anaesthetics. — Primary and Secondary Causes of Death. — Unskilfulness in Operations. — Pi'a^mia. — Medical Responsibility in Reference to Operations. — Actions for Malapraxis . . 323 CONTENTS. Xi CHAPTER XXXI. PAQB Cicatrization ofWounds. — Evidence from Cicatrices. — Chanc;esin an Incised Wound. — Is a Cicatrix Always a Consequence of a Wound? — Aie Cicatrices when Once Formed Indelible ? — Cliaracters of Cicatrices. — Tlieir Age or Date. — Cicatrices from Bleeding. — Cupping, Setons, and Issues. — Cicatrices from Burns. — Cicatrices from Disease Distinguished from those of Wounds ........ 3.31 CHAPTER XXXII. Medical Evidence of Identity from Colored Cicatrices or Tattoo-marks. — Mode and Date of Production.— Durability of these Marks.— Their Alleged Spontaneous Dis- appearance. — Cases of Identity from Tattooing. — Simulated Marks. — Tattoo- marks on the Dead. — Medical Responsibility 341 CHAPTER XXXIII. Wounds of the Head. — Concussion. — How Distinguished from Intoxication. — Effusion of Blood as a Result of Violence, Disease, or Mental Excitement. — Wounds of the Face. — Deformity as a Consequence of Wounds of the Face. — Injuries to the Spine and Spinal Marrow. — Fractures of the Vertebrae 350 CHAPTER XXXIV. Wounds of the Chest. — Wounds and Ruptures of the Lungs and Heart. — Wounds of Large Bloodvessels. — Wounds and Ruptures of the Diaphragm. — Direction of Wounds of the Chest, — Wounds of the Abdomen. — Death from Blows on the Cavity. — Ruptures of the Liver, Gall-bladder, Spleen, Kidneys, Intestines, Stomach, and Urinary Bladder. — Wounds of the Genital Organs 361 CHAPTER XXXY. Fractures. — Produced by a Blow with a Weapon or by a Fall. — Brittleness of the Bones. — Fractures Caused by Slight Muscular Exertion. — Fractures in the Living and Dead Bod}'. — Has a Bone Ever been Fractured? — Locomotion. — Dislocations from Violence or Natural Causes. — Medical Opinions. — Actions for Malapraxis . 375 CHAPTER XXXVI. Gunshot-wounds. — In the Living and Dead Body. — Was the Piece Fired Near or From a Distance? — Accidental, Suicidal, or Homicidal Wounds. — Position of tlie Wounded Person when Shot. — Wounds from Small-shot. — Wounds from Wadding and Gunpowder 381 CHAPTER XXXVII. Death from Burns and Scalds. — Symptoms. — Stupor. — Cause of Death. — Post-mortem Appearances. — Burns on the Dead Body. — Accident, Homicide, or Suicide. — Wounds Caused by Fire. — Scalding. — Burns by Corrosive Liquids .... 389 XU CONTENTS. ASPHYXIA. DROWNING. CHAPTER XXXVIII. PAea Cause of Death. — Secondary Causes. — Post-mortem Appearances. — MedicaKProofs ot Death from Drowning. — Specific Gravity of the Body. — Coincidental Causes of Death. — ^larki of Violence. — Accidental Fractures. — Homicidal and Suicidal Drowning 398 HANGING. CHAPTER XXXIX. Cause of Death. — Death from the Secondary Effects. — Post-mortem Appearances.— Mark of the Cord or Ligature. — Was Death Caused by Hanging? — Hanging After Death. — Summary of Medical Evidence. — Marks of Violence on the Hanged. — Was the Hanging the Result of Accident, Suicide, or Homicide? — The Position of the Body 417 STRANGULATION. CHAPTER XL. Cause of Death.— Appearances After Death. — Was Death Caused by Strangulation, or was the Constriction Applied to the Neck after Death? — Marks of Violence. — Accidental, Homicidal, and Suicidal Strangulation 433 SUFFOCATION. CHAPTER XLI. Suffocation from Mechanical Causes. — Cause of Death. — Appearances after Death.— Evidence of Death from Suffocation.— Accidental, Suicidal, and Homicidal Suffo- cation. — Smothering • 448 CHAPTER XLII. Gaseous Poisons. — Carbonic Acid. — Symptoms. — Appearances. — Analysis. — Effects of Charcoal-vapor. — Carbonic Oxide. — Coal and Coke Vapor. — Sulphuric Acid. — — Vapors of Lime, Cement, and Brick-kilns. — Confined Air. — Coal-gas. — Water- gas, — Carburetted Hydrogen. — Nitrous Oxide. — Sulphuretted Hydrogen. — ElHuvia of Drains and Sewers . 461 CONTENTS. Xlll LIGHTNING. COLD. HEAT. STAEVATION. CHAPTER XLIII. PAGE Effects of Electricity. — Post-mortem Appearances. — Cold an Occasional Cause of Death. — Symptoms. — Circumstances which Accelerate Death. — Post-mortem Ap- pearances. — Effect of Heat. — Starvation a Rare Cause of Death. — Symptoms. — Appearances After Death. — Legal Relations ........ 487 PREGNANCY. CHAPTER XLIV. Signs of Pregnancy. — Suppression of the Menses. — Quickening, — Sounds of the Foetal Heart. — Feigned Pregnancy. — Concealed Pregnancy. — Pregnancy in the Dead. — Impregnation in a State of Unconsciousness. — Legal Relations .... 511 DELIVERY. CHAPTER XLV. Delivery in the Living. — Concealed Delivery. — Signs of Abortion in the Early Stages of Pregnancy. — Signs of Recent and Remote Delivery. — Feigned Delivery. — De- livery in a State of Unconsciousness. — Signs of Delivery in the Dead. — True and False Corpora Lutea. — Characters of the Ovum or Embryo. — Moles. — Concealment of Birth ... 522 CRIMINAL ABORTION. CHAPTER XLVI. Abortion from Natural Causes. — Criminal Causes. — Mechanical Means. — Medicinal Substances. — Signs of Abortion. — Specific Abortives. — Local Applications. — Feigned Abortion. — Meaning of the Word "Noxious" as Applied to Drugs. — On Inducing Premature Labor.— Proof of Pregnancy not Necessary. — Abortion of Monsters. — Moles and Hydatids 536 INFANTICIDE. CHAPTER XLVII. Nature of the Crime. — Medical Evidence at Inquests. — Uterine Age or Maturity of the Child.— Characters of the Child from the Sixth to the Ninth Month.— Signs of Maturity. — Rules for Inspecting the Body 554 XIV CONTENTS. CHAPTER XLVIII. PAOB Evidence of Life Before Respiration. — Putrefaction in Utero. — Evidence of Life After Respiration. — Color, Volume, Consistency. — Presence of Developed Air-cells, and Absolute Weight of the Lungs. — Static Test. — Weight Increased by Respiration . 559 CHAPTER XLIX. The Hydrostatic Test. — Sinking of the Lungs from Disease or Atelectasis. — Life with Perfect Atelectasis or Entire Absence of Air from the Lungs. — Erroneous Medical Inference from Sinking of the Lungs. — Floating of the Lungs from Putrefaction. — Eflfects of Putrefaction on the Lungs 566 CHAPTER L. Floating of the Lungs from Artificial Inflation. — Inflation not Distinguishable from Imperfect Respiration. — Results of Compression. — Improper Objections to the Hydrostatic Test. — Respiration Before Birth. — Respiration a Sign of Life, not of Live Birth — General Conclusions 572 CHAPTER LI. On the Proofs of a Child Having Been Born Alive. — Evidence from Respiration.— From Marks of Violence. — From Natural Changes in the Postal Vessels. — From the Discovery of Air and Food in the Stomach and Bowels. — Ear-test. — General Conclusions 577 CHAPTER LII. Causes of Death in Newborn Children. — Proportion of Children Born Dead. — Natural Causes of Death. — A Protracted Delivery. — Debility. — Bleeding from Laceration of the Navel-string. — Compression of the Navel-string. — Malformation. — Destruction of Monstrous Births. — Death from Congenital Disease 586 CHAPTER LIII. Violent Causes of Death. — SuflFocation. — Drowning. — Death of the Child from Cold and Exposure. — Starvation. — Death from Immaturity. — Wounds in Newborn Chil- (jren. — Fractures of the Skull, Accidental and Criminal. — Twisting of the Neck. — Violence in Self-delivery. — Power of Locomotion and Exertion in Females After Delivery 592 CHAPTER LIV. Death of the Child from Strangulation.— Strangulation by the Navel-string.— Acci- dental Marks Resembling those of Strangulation. — Constriction Before and After Death.— Before and After Breathing. — Before and After the Severance of the Navel- string. — Examination of Women. — Medical Responsibility 604 BIRTH. INHERITANCE. CHAPTER LV. Live Birth in Civil Cases. — Date of Birth,— Signs of Live Birth Independently of Re- spiration or Crying. — Vagitus Uterinus.— Tenancy by Curtesy. — Legal Birth. — Post-mortem Births.— Minority and Majority.— Plural Monstrous Births . . 614 CONTENTS. XV LEGITIMACY. CHAPTER LVI. PAGE Presumption of Legitimacy. — Natural Period of Gestation. — Duration of Pregnancy from One Intercourse. — Premature Births. — Short Periods of Gestation. — Via- bility. — Earliest Period at which a Child maybe Born Living. — Evidence from the State of the Child. — Protracted Births. — The Period of Gestation not Fixed by Law 625 PATERNITY. CHAPTER LYII. Disputed Paternity. — Parental Likeness. — Affiliation. — Posthumous Children. — Super- ffBtation in Relation to Legitimacy. — Supposititious Children. — Sexual Malforma- tion 642 IMPOTENCY. STERILITY. CHAPTER LVIII. Impotency. — Causes. — Procreative Power in the Male. — Puberty. — Age for Virility. — ■ Virility of Crypsorchides and Monorchides. — Sterility. — Procreative Power in the Female. — Earliest and Latest Periods for Childbearing. — Legal Relations , . 652 RAPE. CHAPTER LIX. Sources of Medical Evidence. — Rape on Infants and Children. — Marks of Violence. — Purulent Discharges from the Vagina. — Evidence from Gonorrhoea and Syphilis. — Rape on Girls After Puberty. — Defloration. — Signs of Virginity .... 670 CHAPTER LX. Rape on Married and Adult Women. — Circumstances Under which it may be Perpe- trated on Adult Women. — Loss of Physical Evidence.— Pregnancy Following Rape. — Microscopical Evidence. — Sodomy 685 INSANITY. CHAPTER LXI. What is Insanity? — Medical Definitions. — Distinction of Sane from Insane Persons. — Moral Insanity. — Legal Definitions. — " Non Compos Mentis," — Symptoms of In- cipient Insanity. — Hallucinations and Illusions. — Lucid Intervals .... 698 XVJ CONTENTS. CHAPTER LXII. PAGE Varieties of lusauily. — Mania. — Ab.stiiieiice IVom Food. — Delusions Regarding Poison. Delirium Distinguished Ironi Mania. — Primary Delusional Insanity. — Dementia. — Idioe v.— Imbecility. — Hereditary Transmission. — Feigned Insanity. — Appearanees Alter Death.— Eccentricity 707 CIIAPTEll LXIII. The Lunacy Laws. — Medical Certitieates. — Regulation of Lunatics and Idiots. — Ap- plication of Restraint. — Illegal Imposition of Restraint. — Violeuce of Temper. — Discharge of Lunatics.— Nullity of .Marriage 716 CHAPTER LXIV. Lunatics as Witnesses.— Interdiction.— Commissions in Lupacy. — Examination of Alleged Lunatics. — Medical and Legal Tests of Competency. — Conflict of Evidence and Opinion ..... ......... 731 CHAPTER LXV. Civil Responsibility. — Testamentary Capacity. — Wills Made by the Insane. — Test of Capacity. — Evidence of Delusion. — Eccentricity 738 CHAPTER LXVI. The Plea or Defence of Insanity. — Circumstances under which it is Admissible.— Homicidal Insanitj% — Moral Insanity. — Symptoms. — Legal Tests. — Medical Tests. — Delusion. — Tests of Irresponsibility. — Medical Evidence 743 CHAPTER LXVII. Puerperal Mania. ~- Pyromania. — Kleptomania. — Dipsomania. — Responsibility of Drunkards. — Delirium Tremens. — Somnambulism. — The Deaf and Dumb . . 765 LIFE INSURANCE. CHAPTER LXVIII. Principles of Life Insurance. — Medical Responsibility. — What Diseases Have and What Have Not a Tendency to Shorten Life? — Concealment of' Diseases. — Concealment of Habits. — Material Concealment. — What is Intemperance? — Proximate and Re- mote EfTects. — Opium-eatinc:. — Inveterate Smoking. — Insanity. — Voidance of Poli- cies by Suicide. — Insurance Murders 779 MEDICO-LEGAL SURGERY. CHAPTER LXIX. The Importance of this Branch of Medical Jurisprudence. — Military Surgery. — Naval Surgery. — Railway Surgery. — Accidents on Railways. — Damage Cases. — Railway Surgeons. — The Railway Hospital System. — Transportation of Dead Bodies. — Health Precautions. — Cases of Infectious Diseases 790 MEDICAL JURISPRUDENCE. MEDICAL EVIDENCE. CHAPTEE I. THE PRACTICE OF MEDICAL JtTRISPRUDENCE. MEDICAL AND MEDICO-LEGAL DITTIES. ^INSPEC- TION OF BODIES IN DEATH FROM WOUNDS OR POISONING. USE OF NOTES. MEDICO-LEGAt REPORTS. DYING DECLARATIONS. Medical Jurisprudence — or, as it is sometimes called, Forensic, Legal, or State Medicine — may be defined to be that science which teaches the application of every branch of medical knowledge to the purposes of the law ; hence its limits are, on the one hand, the require- ments of the law, and on the other, the whole range of medicine. Anatomy, physiology, medicine, surgery, chemistry, physics, and botany lend their aid as necessity arises ; and in some cases all these branches of science are required to enable a court of law to arrive at a proper con- clusion on a contested question affecting life or property. The purpose of this work is to bring as far as possible within a small compass those subjects that especially demand inquiry, and which more particularly concern the duties of the educated physician and surgeon. The definition above given necessarily implies that a medical jurist should have a theoretical and practical knowledge of all branches of the profession, a large range of experience, and the rare power of adapting his knowl- edge and experience to emergencies. He should be able to elucidate any difficult medico-legal question that may arise, and be prepared at all times to make a cautious selection of such medical facts, and a proper applica- tion of such medical principles, as may be necessary to enable a judge to place the subject in an intelligible light before a jury, and to enable a jury to arrive at a just conclusion. The variety of subjects of which a medical jurist is required to have a knowledge, may well alarm a student and lead him to suppose that, as he cannot make himself perfectly acquainted with all, he may well forego the labor of preparing himself in any. But this would be taking an erroneous view of his position. This description of the qualifications necessary to constitute a normal witness in a court of law must not deter him from entering on the study. It is assuredly beyond the mental power of any individual that he should be at the same time profoundly versed in all the principles of medicine and jurisprudence, and that he should be able to answer all possible questions, and encounter and remove all medical diffi- culties, that may occur during the trial of a civil or criminal case. All that the law expects from a medical man is a fair average knowledge, not 2 n7> 18 DUTIES OF PHYSICIANS AND mcreh^ of his profession, but of that which falls more peculiarly under the province of a medical witness. There can be no doubt that the more perfectly a man has made himself master of his profession, the better will he be fitted to follow the principles and apply himself to the practice of medical jiirisin-udence ; but he must divest himself of the notion that these principles can be spontaneously acquired, or that they are neces- sarily derived from the study of those isolated branches of medicine upon which medical jurisprudence is based. The materials for the medical jurist undoubtedly exist in these collateral sciences ; but they require to be assorted, selected, and moulded into shape before they can be applied to any useful or practical purpose. The duties of a medical jurist are distinct from those of a mere physician or surgeon. The latter looks only to the treatment of disease or accident, and the saving- of life ; but the object of the former, in a large proportion of cases, is, whether in reference to the living or dead, to aid the law in fixing on the perpetrator of a crime, or to rescue an innocent person from a falsely imputed crime. Thus he may be required to determine whether, in a particular case, the cause of death was natural or violent ; and for this purpose it will be necessary for him to make an entirely new ap- plication of his professional knowledge. He has now the difficult task ot making a selection from those parts of the medical sciences which bear upon the legal proof of crime. Some members of the profession have been inclined to look upon medico- legal practice as an unnecessary addition to their ordinary duties ; but there are few that have been long engaged in medical practice who have not found themselves occasionally placed in situations of difficulty from the occurrence of cases demanding medico-legal investigation. A medical man is summoned to attend a person laboring under the effects of poison criminally administered ; but at the time he may have no knowledge, or even suspicion, that poison is the cause of the symptoms. In spite of the best treatment, death ensues : here the functions of the medical man end, and those of a medical witness begin. It is impossible that he can now avoid giving evidence, or shift the responsibility on another — the law will insist on his appearance, first in the court of the coroner, next before the magistrates, and afterwards at the assizes. It will here be assumed that, 8s a registered member of the profession, he is fully competent to answer every question put to him by judge and counsel relative to the general effects of poisons ; the quantity required to destroy life ; and the time within which a poison may prove fatal. It may be objected to his evidence, that the deceased had died from the effects of disease and not from poison ; in which case the cross-examination will lead to a searching inquiry into all of those diseases which resemble the effects of poison in their symptoms and post-mortem appearances, as well as the means of making an unfailing distinction between them and the fallacies to which the chemical processes for the detection of poison are liable. On another occasion a medical man may be called to render assistance to one stabbed in a quarrel and speedily dying from the wound. The office of the surgeon here ceases, whilst that of the medical jurist l)egins. He must now be prepared to answer numerous questions, all bearing upon the legal proof of crime, all necessary in law, although apparently superfluous in surgery. Thus he nuiy be asked to state the precise characters of a wound inflicted upon the body of a man soon after death ; and by what means a particular wound was inflicted. Was it homicidal or accidental ? The amount of blood lost? "Whether the person could have moved or performed any act after receiving the wound ? Are SUKGEONS IN ACTING AS WITNESSES. 19 certain spots found upon his clothes, or upon a knife belonging to him, due to effused blood or to other causes? Whether any, and what state- ments were made by the dying man, and what were the precise circum- stances under which they were made ? It need hardly be observed that questions of this nature are rarely noticed, except in a cursory manner, by chemists and surgeons ; and a medical man is not likely to acquire the means of answering them by intuition. On the other hand, regarding ourselves as living in a civilized state, in which the detection and punish- ment of crimes against life and property are indispensable to the security of all, it is impossible to overrate their importance. Unless a witness is able to return answers to these questions when a public necessity occurs, a guilty man may escape punishment, or an innocent man may be con- demned. A witness may thus most seriously injure his own reputation; for it is certain that his qualifications as a physician, surgeon, or general practitioner, however great, will not shield him from general reprobation. Thus, then, it is obvious that the duties of a medical jurist are of a highly responsible nature and of great importance to society, while the cases which call them into exercise are of purely accidental occurrence. A medical practitioner who thinks himself secure in the most retired corner of the kingdom, is liable to find himself suddenly summoned as a witness on a trial, to answer questions which perhaps during a long period of practice he had been led to regard as unimportant. Under the circumstances it is scarcely possible that he can avoid exposing his deficiencies, and the final question will be. Have you ever attended to or tJwught of these subjects be/ore ? A negative answ^er to this question, while it commonly brings with it public censure, will in most instances lead to the acquittal of the accused in spite of strong presumptions of guilt. The truth of this picture will be felt and acknowledged by those who have been a few years engaged in practice. The records of our courts of law contain many unfortunate exposures, which might have been easily avoided had the witnesses only availed themselves of the opportunities afforded to them while students of acquiring a knowledge of the subject; but they had unreflectingly acted on the principle, that medical juris- prudence was a dry, dull, and useless study, and that the practice of it Avas remote and speculative. This feeling is, however, fast disappearing. Those who have been compelled by circumstances to give their attention to it have, in subsequent cases, taken care to prepare themselves for the ordeal through which every medical witness must pass. Some medical men w^ho have treated legal medicine with indifference have ventured to act as witnesses, thinking that the subjects on which they were likely to be examined were so little known to judge and counsel that even hazardous or rash statements would escape observation ; such witnesses, however, have often found to their cost that they were labor- ing under a delusion. Various circumstances have led to the acquisition of much medico-legal knowledge by lawyers, especially in relation to questions connected with wounds, child-murder, and poisoning; and they are not slow in detecting and exposing a mere pretender who attempts to shelter himself by vague or evasive statements and technical language. Another fact must be borne in mind : — there are few counsel engaged in any civil or criminal case of importance who do not take care to fortify themselves, under medical advice, with a full knowledge of the views of standard medical writers on the subject in dispute ; and with these works before them, and with their proverbial acuteness, he must indeed be a clever witness who can succeed in passing off an erroneous or evasive answer to a medico-legal question. 20 MEDICAL CONTRASTED WITH It is a frequent charge against members of the medical profession that they are the worst witnesses on matters of fact and opinion. This is an unmerited censure. Those who are ready to mal^e tliis charge overlook the number, complexity and difficulty of the questions that are put to medical men compared with those put to other witnesses. They also forget that medical men are much more frequently summoned as witnesses than the members of other learned professions. Their evidence obtains much greater publicity, and is necessarily exposed to a wider circle of criticism. The fact is, that good and bad witnesses are to be met with in every profession, and under equal conditions there is no reason to suppose that one would furnish a greater number of incompetent witnesses than another. It is certainly the fault of medical men that they are not always prepared for the questions which are likely to arise in a case on which they know they will be required to give evidence. This want of preparation frequently applies to facts as well as to opinions. Thus, in reference to a case on which a charge of murder or manslaughter ma}' be ultimately founded, a medical man who is called in omits to observe many circumstances, because at the time they appear to him to have little im- portance, although at the subsequent trial he may find, to his dismay, that they actually become the turning-points of innocence or guilt. Medical observation as a result of professional habits is, on these occasions, in general confined to only one set of circumstances — the recognition and treatment of accident or disease ; but medico-legal observation should take a much wider range than this, and should be directed to all the surrounding facts and incidents of a case. The essential difiference in the two kinds of practice is, that circumstances which are of no interest in a medical or surgical point of view, are often of the greatest value and importance in legal medicine. It is obvious that if they are not observed by a medical witness when he is first sum- moned to the injured person, whether dying or dead, it will be out of his power to meet many of the questions Mdiich must arise in the progress of the case. The non-observance of these facts is a serious evil, and often carries with it, although unjustly, an imputation of professionar ignorance. The first duty, therefore, of a medical jurist is to cultivate a faculty of minute observation of medical and moral circumstances. This, combined with a general knowledge of what the law requires as evidence, will enable him to meet satisfactorily the scientific (questions that may be necessary for the elucidation of a case. The exercise of this faculty is by no means inconsistent with the performance of his duties as a surgeon. A learned judge on one occasion remarked that " a medical man, v)hen he sees a dead bod)/, should notice everything.''^ Undoubtedly he should observe every- tliing which could throw a light upon the production of wounds or other injuries found upon it. It should not be left to policemen to say whether there were any marks of blood on the dress or on the hands of the deceased, or on the furniture in the room. The dress of the deceased, as well as the body, should be always closely examined on the spot by the medical man. It may stimulate the attention of a medical practitioner in reference to these inquiries if he is informed that one art of counsel defending persons charged with murder or manslaughter consists in endeavoring to dis- cover what the witness omitted to do. Although sometimes the omis- sion may be really of no medical importance whatever, yet it is usually placed before the jury in such a strong light that the accused obtains the benefit of a doubt. The omission may be attributed to professional igno- rance, or, what is worse, to bias — a determination to find proofs of guilt — MEDICO-LEGAL OBSERVATION. 21 when the facts might be innocently explained by a want of experience on the part of the witness in dealing with cases of this nature. If we except medical experts, who are selected according to their ex- perience in diffei'ent branches of the profession, medical men have no option respecting medico-legal practice ; for the cases which give rise to medico-legal questions are always more or less connected with the prac- tice of medicine and surgery. Thus before any inquiry is instituted by a magistrate or coroner, and before any suspicious circumstances have come to light, a medical man may be summoned to a person dying from the effects of a wound, or from the secret administration of poison. The dying person may make to him a declaration or statement as to the circumstances under which the wound was inflicted or the poison administered : he may also mention the names of the person or persons concerned in the assault or the administration. This di/ing declaration or statement, according to the circumstances under which it was made, may become of material importance in the prosecution of a party charged with murder or manslaughter. It is therefore proper that a practitioner should observe and make notes of the exact condition of the patient ; — whether, when he makes the statement, he is under the conviction or belief that he is about to die. It has been thought that it was also necessary to prove that the wounded man had lost all hope of recovery : but, as a judge has justly remarked, it is very difficult, if not impossible, to say on these occasions, when, if ever, the feeling of hope completely deserts a man. Again, a man may express an opinion that he shall " not recover," but this is not sufficient. The law" admits these declarations, not because recovery is impossible, but because the person making the statement has in his mind at the time of making it a full con- viction of approaching death. It is therefore the duty of the medical at- tendant on these occasions, to see how far the person making the statement believes that his death is imjjending or nearly approaching. This belief is considered in law to be equivalent to the obligation of an oath. Hence, when the case is likely to prove fatal, the medical man should warn the patient, in the presence of his relatives or friends, of his danger- ous condition. If the wound or poison is not likely to prove rapidly fatal, the attendance of a magistrate to take down the statement in due legal form would relieve the medical man of all responsibility. Should any statement, however, be made to him under these circumstances, it is his duty to make, on the spot, a note of the words actually used. There should be no paraphrase or translation of them, but they should be the very words of the dying man. It is not for the witness, but for the coui't, to interpret what is thus stated.* A medical man on these occa- sions should not render himself officious in extracting information. lie may receive that which is voluntarily uttered, and, either immediately or on the earliest possible opportunity, write down the statement as it was made. Any question should be simply confined to the purpose of explain- ing what may appear to be ambiguous or contradictory in the declaration itself. In reference to persons who have died from the effects of wounds, poison or other violent causes, the initiatory proceedings connected with the inquiry usually take place in the court of the coroner ; and unless the medical man in attendance is supposed to be implicated, by maltreatment or otherwise, in the death of the person, the duty of making an examination of the dead body devolves upon him. He may not have seen the person while living ; and in this case it will be necessary that he should give his attention to those circumstances which may be of importance in the future inquiry. He should note, as far as it can be ascertained ; — 1. The exact time of 22 DYING DECLARATIONS. death, if known, and thus determine how long a period the person sur- vived. 2. The attitude, position, and condition of the body. 3. The slate of the dress. 4. All surrounding objects. Any bottles, paper-packets, weapons, or spilled liquids l3'ing' about should be collected and preserved, and their position with regard to the body of the deceased should be noted. 5. Any vomited matters near the deceased should be collected.- — In mak- ing a post-mortem examination of the body the following additional points should be attended to. 6. The external ai^pearance of the body, and whether the surface is livid or pallid. 7. The state of the countenance. 8. All marks of violence on the person, discomposure of the dress, marks of blood, etc. 9. The situation, form, and direction of all wounds. 10. The presence or absence of warmth in the legs, arms, abdomen, mouth, or armpits. 11. The presence of cadaveric rigidity in any part of the body. To give any value to the two last-mentioned characters, it is necessary for the practitioner to observe the nature of the floor on which the body is lying, — whether the body is clothed or naked, young or old, fat or emaciated. These conditions create a difference, in respect to the cooling of the body and the access of rigidity. 12. If found dead — when was the deceased last seen living, or known to have been alive? 13. All circum- stances leading to a suspicion of suicide or murder. 14. The time after death at which the inspection was made. 15. The state of the abdominal viscera. If the stomach and intestines are found inflamed, the seat of in- flammation should be exactly specified ; also all marks of softening, ulcer- ation, effusion of blood, corrosion, or perforation. The stomach should be removed and placed in a separate vessel, a ligature being applied to each end. If cut open for examination at this period, this operation should be performed in a clean dish, and with such care that none of the contents are lost or are allowed to mix with the contents of the intestines. 16. The contents of the stomach, if this organ was opened during the inspec- tion, should be collected in a clean graduated vessel : — notice a, the quan- tity ; b, the odor tried by several persons ; c, the color ; d, acid or alka- line reaction ; e, presence of blood, mucus, or bile; f, presence of undigested food; and it may be as well to observe, that the presence of farinaceous matters (as bread) would be indicated by the addition of iodine water, if the contents were not alkaline — of fat, by warming ; g, other special characters. 17. The contents of the duodenum should be separatel}^ collected, ligatures being applied to it. 18. The state of the large intestines, especially the rectum, and the condition of their contents. The discovery of hardened feces in the rectum would prove that purging had not existed shortly before death. 19. The state of the windpipe, throat, and gullet, and M'hether there are in these parts any foreign substances, or marks of in- flammation and corrosion. This is of essential importance, as it throws a light upon a variety of questions which may arise respecting death by suffocation from mechanical causes, or the nature of a substance swallowed. 20. The state of the lungs and heart ; morbid changes, etc. 21. The state of the brain and spinal marrow. 22. The condition of the womb, ovaries, and genital organs, as in the female poison has been sometimes introduced into the body by the vagina, or wounds have been inflicted internally, 23. The kidneys and the spleen should be submitted to examination. 24. The liver with the gall-bladder should be removed for chemical examina- tion. 25. The urinary bladder, with any fluid contained in it, should be removed and placed in a separate jar. Such are the points to which, in the greater number of cases of violent death, a medical jurist should give his attention. By means of these data, noted according to the particular case to which they are adapted, EXHUMATION OF BODIES. 23 he will in general be enabled, without difficulty, to determine the probable time of death, and the actual means by which death was brought about. He may thereby have it in his power, if the case be one of })oisoning, to point out the dish or article of food which had contained the poison, and to throw light upon any disputed question of suicide or murder in relation to the deceased. Many cases of death from wounds or poison are rendered obscure, owing to these points not having been attended to in the first instance. It is not necessary in this place to enter into any details respecting the mode of performing an inspection. A medical })ractitioner is supposed to have acquired a knowledge of this part of his duties during his study of anatomy ; and any additional information which may be required will be found in the appropriate sections of this work. The only essential points, in addition to those above mentioned, are, 1. To examine all the important organs for marks of natural disease ; and 2. To note down any unusual pathological appearances or abnormal deviations; although they may at the time appear to have no bearing on the cause of death. It is useful to bear in mind on these occasions that the body is inspected, not merely to .show that a person has died from poison, but to prove that he has not died from any natural cause. Medical practitioners commonly give their attention exclusively to the first point ; while lawyers, defending accused parties, very properly direct a most searching examination to the last- mentioned point, i. e., the healthy or unhealthy state of those organs which are essential to life. The usual causes of sudden death have their .seats commonly in the brain, the heart and its great vessels, or in the lungs. Marks of effusion of blood, congestion, inflammation, suppuration, or a diseased condition of the valves of the heart, should be sought for and accurately noted. It has also been recommended that an examination of the spinal marrow should be made. If the cause of death is obscure after the general examination of the body, there is good reason for inspecting the condition of this organ. [In medico-legal cases, involving questions of life and death, the examination of the body cannot be too thorough and exhaustive ; the omission of any one organ is a radical and sometimes a fatal defect. This was well illustrated in 1872 by two leading cases in the United States — that of Mrs. E. G. Wharton, charged with poisoning General Ketchum, and that of Dr. Paul Schoeppe, charged with poisonino* Miss Steinnecke. In neither case was the post-mortem sufficiently complete. In the first case, where the symptoms of the deceased were certainly more in accordance with disease than with tartar emetic (the alleged) poisoning, and where competent medical authority ascribed it to cerebro- .spinal meningitis, no examination of the spinal marrow was made. In the latter case, in which the symptoms were those of apoplexy and of uraemic poisoning, the kidneys and several other organs were overlooked. In certain obscure cases it may become necessary to institute a 'micro- scopic examination, especially of the brain and heart.] Exhumation of Bodies. — Sometimes the inspection of a body is required to be made long after interment. So long as the coffin remains entire, there may be the expectation of discovering certain kinds of mineral poison in the organs ; but decomposition may have advanced so far as to destroy all pathological evidence. The inspection in such cases is com- monly confined to the abdominal viscera. The stomach is often found so thin and collapsed that the anterior and posterior walls appear to form only one coat. This organ should be removed, with the duodenum, and ligatures should be applied to each. The liver, kidneys, spleen and brain should 24 IDENTITY OF SUBSTANCES. also be removed, in order that, if necessary, they may be separately analyzed. If poison is not found in one of these parts, it is not likely that it will be discovered in other parts of the body. It has been recom- mended that a portion of earth immediately above and below the coffin should be removed for analysis, as it may contain arsenic ; but this appears to be an unnecessary piece of refinement when the coffin is entire, or when the abdominal parietes still cover the viscera. If decomposition has so far advanced as to have led to an admixture of earth with the viscera, and the poison is found in minute quantity in the tissues only, the source of the poison may be regarded as doubtful ; and in this case the earth in which the remains are found should undergo a chemical examination. The bod}^ of a deceased person, when exhumed, should be identified by some friend or relative in the presence of the medical examiner. In a case of murder by poison, the evidence almost failed, owing to this precaution not having been taken. It is important that the viscera taken from a body which has been long in the grave should be sealed up immediately. They should not be allowed to come in contact with any metal, nor with any surface except that of clean glass, porcelain, or wood. It has been recommended that they should be washed with chlorinated lime or carbolic acid ; but this is decidedly improper; the use of any preservative chemical liquid would not onh" embarrass the future analysis, but would render a .special exami- nation of an unused portion of the liquid necessar}^, the purity of which would have to be unequivocally established. Preservation from air in clean glass vessels, with well-fitted corks covered with gutta-percha tissue, is all that is required in practice. Identity of Substances. — It is necessary to observe that all legal authori- ties rigorously insist upon proof being adduced of the identity of the vomited matters and substances taken from the body of a deceased person, when poisoning is suspected. Supposing that, during the examination, the stomach and viscera are removed from the body, they should never be placed on any surface or in any vessel until it has been first ascertained that the surface or vessel is perfectly clean. [It is safer and more satis- factory that all the vessels and apparatus used ehould be perfectly new as well as clean.'] If this j)oint be not attended to, it will be in the power of counsel for the defence to raise a doubt in the minds of the jury, whether the poisonous substance found might not have been accidentally present in the vessel used. This may be regarded as a very remote presumption ; but, nevertheless, it is upon technical objections of this kind that acquittals follow in spite of the strongest presumptions of guilt. This is a question for which every medical witness should be prepared, whether he is giving bis evidence at a coroner's inquest or in a court of law. Many might feel disposed to regard matters of this kind as involving unnecessary nicety and care ; but if they are neglected it is possible that a trial may be at once stopped, so that the care bestowed upon a chemical analysis will be labor thrown away. Evidence of the presence of poison in the contents of a stomach was once rejected at a trial for murder, because they had been hastily thrown into a jar borrowed from a neighboring grocer's shop, and it could not be satisfactorily proved that the jar was clean and entirely free from traces of poison (in which the grocer dealt) Avhen used for this purpose. When the life of a human being is at stake, as in a charge of murder by poisoning, the slightest doubt is always very properly interpreted in favor of the accused. [Prof R. Bridges reports a case in which the search for arsenic in the body failed to detect that poison, but where zinc in considerable quantities was found. It turned out on inquiry PRESERVATION OF ARTICLES FOR ANALYSIS. 25 that the stomach, etc., had been carelessly thrown into an old tin can which had been formerly used for holding zinc paiut before it had been sent to the analyst.] Not only must clean vessels be used for receiving any article destined for subsequent analysis, but care must be taken that the identity of a sub- stance is preserved, or the most correct analysis, afterwards made, will be inadmissible as evidence. The suspected substance, when once placed in the hands of a medical man, should never be let out of his sight or custody. It should be kept sealed under his private seal, and locked up, while in his possession, in a closet to which no other person has a key. If he has once let the article out of his hands, and allowed it to pass through the hands of several other persons, then he complicates the evidence for the prosecu- tion, by rendering it indispensable for these persons to state under what circumstances it was placed while in their possession. The exposure of a suspected substance on a table or in a closet or room to which many have access, may be fatal to its identity ; for the chemical evidence, so important in a criminal investigation, will probably be altogether rejected by the court. When any article (e. g. a stomach) is reserved for analysis, care should be taken to at once attach immovably to it, or to the vessel con- taining it, a label, upon which is plainly written the nameof the deceased and the date of removal. This is especially necessary when there are two or more articles for analysis. The greatest inconvenience has resulted from the neglect of this simple precaution. [A striking illustration of the importance of this rule is afforded by the case of State of Ya. v. Mrs. E, E. Lloyd, charged with poisoning her daughter with arsenic. On the trial it transpired that the person who conveyed the article to the analyst had died. Although several grains of arsenic were said to have been detected, the identity of the stomach could not be positively established, and the court excluded the medical evidence for want of this single link in the chain of identity.'] Presei'ving articles for Analysis. — In removing viscera or liquids from the body and reserving them for analysis, it is necessary to observe certain precautions. A clean yessel with a wide mouth should be selected ; it should be only sufficiently large to hold the organ or liquid (the less air remaining in it the better) ; and it should be secured by a closely fitting cork, covered with gutta-percha tissue or bladder. Another piece of sheet caoutchouc or gutta-percha should then be tied over the mouth. In this way any loss by evaporation or decomposition is prevented, and the viscera may be preserved in a cool place for some time. If the mouth of the vessel be too wide for a cork, the other articles cannot be dispensed with. Paper only should not be used, as the appearances after death in the viscera may be entirely destroyed by the evaporation which takes place through the layers of paper with which the vessel containing them is covered. The practitioner should bear in mind that all these matters are likely to come out in evidence. For reasons already stated, antiseptic chemical compounds should not be used. The articles used for the preservation of viscera should be in all cases scrupulously examined. Some kinds of calico are dressed with arsenic and starch paste, and many kinds of wrapping-paper as well as wall-papers are strongly impregnated with this poison. One observation shows that this is not an unnecessary caution. A medical man was engaged in examining the body of a child, in order to determine the cause of death. The organs were healthy, and as no sufficient cause presented itself, he removed the stomach with a view of making an analysis of its contents. He was suddenly called away ; and, to preserve the stomach, he wrapped 2G USE OF NOTES. it in a piece of paper (used for paperin<^ rooms), placing it on the uncolored side, and he locked it in a closet until the following clay. Assisted by a friend, he then analyzed the contents, and found a trace of morphine with a pretty large cjuantity of arsenic. As the symptoms from Mhich the child had died w^ere not those of poisoning with arsenic, and there were no appearances of the action of this sul)stance on the body, he came to the conclusion that its presence must have been owing to some extraneous cause. He examined a portion of the wall-paper in which the stomach had been wrapped, and then found that that part of it which was colored yellow was tinted with sulphide of arsenic, or orpiment. It was therefore i'vident, as commercial orpiment contains white arsenic, that the stomach and its contents had imbibed a portion of the poison during the night. (Lancet, 1855, i. p. G32.) This satisfactorily accounted for the presence of arsenic, under circumstances which might have given rise to a false charge of murder. Many wall-papers contain arsenic, and this arsenic spreads by imbibition to other parts of the paper not so tinted. It would, of course, be proper to avoid in all cases the use of any wrapper having upon it mineral colors of any description. The above case shows in a striking point of view the danger of trusting to chemical analysis alone. Unless we look to physiology and pathology, an erroneous opiniim may be expressed. The products of an analysis, in the shape of sublimates or precipitates, should be preserved as evidence, distinctly labelled in small glass-tubes hermeticalh' sealed. They can then, if asked for, be produced for exami- nation at the inquest or trial. On the use of Notes. — As a rule in medico-legal investigations, a medi- cal practitioner should make notes of what he observes in regard to symp- toms, appearances after death, and the results of analysis. His own observations should be kept distinct from information given to him by others. He may base his conclusions on the former, but not on the latter until given in evidence. From the common forms of law in this country, a person charged with a crime may remain imprisoned, if at a distance from the metropolis, for some months before he is brought to trial. It is obvious, however clear the circumstances may at the time appear to a practitioner, that it will require more than ordinary powers of memory to retain, for so long a period, a distinct recollection of all the facts of the case. If he is unprovided with notes, and his memory is defective, then the case w ill turn in favor of the prisoner, who will be the person to benefit by the neglect of the witness. In adopting the plan here recom- mended, such a result may be easily prevented. It may be remarked that the law relative to the admissibility of notes or memoranda in evidence is very strict ; and in trials for murder is rigorously enforced by the judges. In order to render such notes or memoranda admissible, it is indispensably necessary that they should have been taken on the spot at the time the observations were made, or as soon afterwards as practicable; and further, it must be remembered that a witness can refer to them only for the pur- pose of refreshing his memory. If from indistinctness of writing or other causes a copy of the notes has been subsequently made, a witness should not destroy the original notes, but have them ready for production. [The rule of law governing a memorandum thus made, may be stated as follow^s : — A memorandum is admitted in evidence only for the purpose of showing the existence of such facts or circumstances as it contains, and for no other purpose. And it is open to explanation to the same extent that it would be if the words had been spoken instead of being written. MEDICO-LEGAL REPORTS. 27 A memorandum thus made in the usual course of business may be received in evidence, even though the witness is unable after its examina- tion to state the ])articulars from recollection : Russell v. Hudson River R. R. Co., 17 N. Y. 184; Halsey v. Sinsebaugh, 15 N. Y. 485; Guy v. Mead, 22 N. Y. 462; Howard v. McDonough, t7 K Y. 592; Mayor of N. Y. V. 2d Av, R. R., 102 N. Y. 572. But the witness must be able to state that he once knew the facts con- tained in the memorandum to be true ; that he made it at, or shortly after, the time they transpired, which he then intended to make correctly ; and that he believes it to be correct; and he must also be able to verify the handwriting as his own, and the facts stated must be facts of his own knowledge and not on information derived from others : Haven v. Wen- dell, 11 N. H. 112; Sherr v. Wiley, 18 Pick. 558; Smith v. Johns, 3 Gray (Mass.), 517; Crittenden v. Rogers, 8 Gray, 452; Stickney v. Bronson, 5 Minn. 215 ; Marely v. Schultz, 29 N. Y. 346 ; Nicoll v. Webb, 8 Wheaton (U. S.), 326; Ocean Nat. Bk. v. Caryle, 9 Hun (N. Y.), 239.] He must also be prepared to give a reasonable explanation of any altera- tions or interlineations which may appear in his original notes. So in reference to all other written memoranda connected with the case, as, for example, the medicines prescribed for the deceased, the visits made to him, etc., the witness should be prepared to produce them and explain any remarks which may be found in his books. Counsel are entitled to look at and examine all documents of this kind which are produced or used by the witness in giving his evidence in the courts. Medico-legal Reports. — One of the duties of a medical jurist is to draw up a report of the results of his examination : 1, in regard to symp- toms ; 2, in regard to appearances after death ; and 3, in regard to the results of an analysis. With respect to the first two divisions of the report, the reader is referred to the rules for investigating cases of poisoning. It need hardly be observed that the time at which the person was first seen, and the circumstances under which the attendance of the practitioner was first required, as well as the time of death, should be particularly stated. The hour, the day of the week, and the month, should be invariably mentioned. Some medical witnesses merely state the day of the week, without that of the month, or vice versa. At a trial this sometimes creates great confusion, by rendering a reference to an almanac necessary. The words yesterday, next day, etc., should never be used. The facts which it will be necessary to enter in the report are specially stated under the heads of investigation (see pp.21-2). If these facts are not observed in the order there setdown, their value as evidence of the cause of death, or of the criminality or innocence of particular per- sons, will be lost. In drawing up a report of symptoms and appearances after death, the facts should be first plainly and concisely stated seriatim., in language easily intelligible to non-professional men. A reporter is not called upon to display his erudition, but to make himself understood. If technical terms are employed, their meaning should also be stated. When a subject is thoroughly understood, there can be no difficulty in rendering it in sim- ple language ; and when it is not well understood, the practitioner is not in a position to make any report. Magistrates, coroners, and barristers easily detect ignorance, even when it appears under the mask of erudition. In recording facts the reporter should not encumber his statements with opinions, inferences, or comments. The facts should be first stated and the conclusion should be reserved until the end of the report. The lan- guage in which conclusions are expressed, should be precise and clear. It 2s MEDICO-LEQAL REl'URTS CHEMICAL ANALYSIS. must be remembered that these arc intended to form a concise summary of the whole report, upon which the judEAD BODY. CHAPTER VI. EVIDENCE OF POISONING IN THE DEAD BODY. PERIOD AT WHICH POISONS PROVE FATAL.— CHRONIC POISONING. APPEARANCES PRODUCED BY THE DIFFERENT CLASSES OF POISONS. REDNESS OF THE MUCOUS MEMBRANE MISTAKEN FOR INFLAMMATION. ULCERATION AND CORROSION. SOFTENING. PERFORATION OF THE STOMACH FROM POISON AND DISEASE. Supposing that the person is dead, and we are required to determine whether the case is one of poisoning or not, we must, in the first instance, endeavor to ascertain all the particulars which have been considered iu the last chapter as indicative of poisoning in the living body. Should the deceased have died from poison, the circumstances of the attack, and the symptoms preceding death, ought to correspond with the characters already described ; and in these investigations it is well to bear in mind the follow- ing rule: There is no one symptom of pathological condition which is peculiar to poisoning ; but at the same time there is probably no disease which presents all those characters which are met with in an actual case of poisoning. The points which require to be specially noticed under these circumstances in the living are described at pp. 21 and 22, avte. The addi- tional evidence to be derived from the death of a person may be considered under the following heads : — 1. The time at which death takes place after the firnt occurrence of symptoms. — This question requires examination, because the more common poisons, when taken in fatal doses, generally cause death within definite periods of time. By an attention to this point we may, in some instances, be enabled to negative a charge of poisoning, and in others to form an opinion of the kind of poison which has been taken. In a court of law, a medical practitioner is often required to state the usual period of time within which poisons prove fatal. It is to be observed that not only do poisons differ from each other in this respect, but the same substance, according to the form or quantity in which it has been taken, may differ in the rapidity of its action. A large dose of the ordinary solution of prussic acid, i. e. from half an ounce to an ounce, may destroy life in less than two minutes. In ordinary cases of poisoning by this substance a person dies, i. e. all signs of life have commonly ceased, in from ten to twenty minutes ; and if he survives half an hour, there is some hope of recovery. In the cases of seven epileptics, accidentally poisoned by a similar dose of this acid in one of the Parisian hospitals, the first died in about twenty minutes ; the seventh survived three quarters of an hour. Oxalic acid, one of the most energetic of the common poisons, when taken in a dose of from half an ounce to an ounce, may destroy life in from ten minutes to an hour; but if the poison is not completely dissolved when swallowed, it is a longer time in proving fatal. The strong mineral acids, in poisonous doses, destroy life in al)Out eighteen or twenty-four hours. White arsenic operates fatally in from eight hours to three or four days. It has, however, in more than one instance, killed a person in two hours. Opium, either as a solid or in the form of laudanum, commonly proves fatal in from six to twelve hours ; but it has been known, in several instances, to destroy life in less than three hours : they who survive the effects of this poison for twelve hours are considered to have a fair chance SLOW OR CHRONIC POISONING. 89 of recovery. This must be understood to be merely a statement of the averag-e results, as nearly as we are warranted in g-i\nng- an opinion ; but the medical jurist will, of course, be aware that the fatal period may be protracted or shortened, according to all those circumstances which have been elsewhere stated to affect the action of poisons. There are various forms which this question may assume. It may be said that the death of a person, alleged to have taken poison, has occurred either too rapidly or too slowly to justify a suspicion of poisoning-. The following' case will serve as an illustration : A woman was tried and convicted (Reg. v. Russell, Lewes Sum. Ass., 1826) of the murder of her husband by arsenic. The poison was detected in the stomach ; but the fact of poisoning was disputed by some medical witnesses, for this, among other reasons, that the deceased had died thi-ee hours after the only meal at which the poison could have been administered to him. Authorities were cited to show that, according to their experience, they had never known a case of poisoning by arsenic to have proved fatal in less than seven hours. This may be admitted ; but, at the same time, there was sufficient authority on the other side to establish that some cases had actually proved fatal in three or four hours. So far as this objection was concerned, the prisoner was properly convicted. In refer- ence to the medical question raised at this trial, it may be observed that two distinct cases have since occurred in which the persons died certainly within two hoin's after taking arsenic ; and several instances have been reported in which death has taken place in from three to four hours after the administration of this poison. It seems extraordinary that any attempt should have been made by a professional man to negative a charge of criminal poisoning upon so w^eak a ground as this ; but this opinion was expressed many years ago, when the facts connected with the poisoning were but little known. It is obvious that there is nothing, so far as we know, to prevent arsenic from destroying life in an hour, or even within a shorter period. These matters can be settled only by a careful observa- tion of numerous cases, and not by any a iwiori reasoning, or by a limited individual experience. In all instances of sudden death there is generally a strong tendency on the part of the public to suspect poisoning. They never can be brought to consider that persons may die a natural death suddenli/, as well as slowly ; or, as we shall presently see, that death may really take place slowly, and yet be due to poison. This prejudice continually gives rise to the most unfounded suspicions of poisoning, and, at the same time, leads to cases of chronic or slow poisoning being frequently mistaken for natural disease. One of the means recommended for distinguishing narcotic poisoning from apoplexy or disease of the heart, is the difference in the rapidity with which death takes place. Thus, apoplexy or disease of the heart may prove fatal either instantly or within an hour. The only poison likely to operate with such fatal rapidity are prussic, carbolic, and oxalic acids, strychnine and nicotine. Poison by opium is commonly protracted for five or six hours. This poison has never been know^n to destroy life instantaneously, or within a few minutes. Thus, then, it may happen that death will occur with such rapidity as to render it im- possible, under the circumstances, to attribute it to narcotic poison. Chronic poisoning. — When a poison destroys life rapidly, it is called a case of acute poisoning, to distinguish it from the chronic form, i. e. in which death takes place slowly. Chronic poisoning is a subject which has frequently required medico-legal investigation. Most poisons, when their effects are not rapidly manifested, owing either to the smallness of 90 SLOW OR CHRONIC POISONING. the dose or to timely treatment, are capable of slowly undermining the powers of life, and killing the patient by producing emaciation and ex- haustion. This is sometimes observed in the action of arsenic, corrosive sublimate, and tartarated antimony ; but it has been remarked also in cases of poisoning by the mineral acids and caustic alkalies. Death is here an indirect consequence : in poisoning by the acids or alkalies, either stricture of the gullet is induced, or the lining membrane of the stomach is destroyed, and the process of digestion imi)aired — a condition which leads to exhaustion and death. The time at which these indirect effects may prove fatal is, of course, liable to vary, A person has been known to die from a stricture of the gullet, brought on by sulphuric acid, eleven months after the poison was swallowed ; and there is no reason to doubt that instances may occur of a still more protracted nature. In cases of chronic 2^oiHoning, there is sometimes great difficulty in assigning death exclusively to the original action of the poison, since the habits of life of the person, a tendency to disease, and other circumstances, may have concurred either to accelerate or produce a fatal result. To connect a stricture of the gullet, proving fatal, with the effects of poisoning by a mineral acid, it would be necessary to show that there was no tendency to this disease before the acid was administered ; that the symptoms appeared soon after the first effects of the poison went off ; that the symp- toms continued to become aggravated until the time of death ; and, lastly, that there was no other cause to which death could with any probability be referred. These remarks apply equally to the secondary fatal effects of any poison — such, for instance, as the salivation occasionally induced by corrosive sublimate, and the exhaustion and depression which are caused by tartarated antimony, when the acute symptoms of poisoning by these substances have passed away. The characters of chronic poisoning have acquired a special interest for the medical jurist. There is a difficulty about them which no accuracy of observation or judgment can surmount. The poison or poisons, if found in the dead body at all, must usually exist in minute quantities only. This alone will be sufficient to create a doubt whether death has been caused by the poison, although it is quite consistent with medical experience that a person may die from chronic poisoning, and little or none of the poison be found in the body after death. In the case of Mrs. James (Reg. v. Winslow), not more than the tenth part of a grain of antimony was found in the whole of the tissues of the body : in the case of Isabella Banks (Reg. v. Smethurst, C. C. C, Aug., 1859), the quantity was greater than this, but less than a grain altogether ; while in the case of Mrs. Peters, none was found in the body, although a chemist had ex- tracted a quantity of antimony as sulphide from the urine of the deceased within less than nine days before her death. In this case antimony had also been found in the evacuations during life, and to the secret use of this mineral had been referred the intermittent irritation of the stomach and bowels, from which deceased had suffered. The jury returned a verdict that the deceased bad died from disease, and that death was accele- rated by some irritant: Lancet, 1860, ii. p. 119. On some trials for poisoning (Reg. v. Palmer, C. C. C, 1856 ; Reg. u. Chantrelle, High Ct. of Just. Edin., May, 18*18) it has been a contested scientific question whether a person can die from poisoning and no trace of poison remain in the body. The evidence in Mrs. Peters's case not only proves the affirma- tive, but goes to show that antimony may act fatally and be entirely eliminated from the svstem in about a week: Med. Times and Gaz., 1860, ii. pp. 190, 271, 311. REDNESS OF THE MUCOUS MEMBRANE. 91 2. Evidence f7'om the appearances in the body. — One of the chief means of determining whether a person has died from poison, is an examination of the body after death. In relation to external appearances, there are none indicative of poisoning upon which we can safely rely. It was formerly supposed that the bodies of persons who were poisoned putrefied more rapidly than those of others who had died from natural disease ; and evidence for or against poisoning was at one time derived from the ex- ternal appearance of the body. This is now known to be an error : the bodies of persons poisoned are not more rapidly decomposed, cseter^is paribus, than those of others who have died a sudden and violent death from any cause whatever. Irritant poison acts chiefly upon the stomach and intestines, which they irritate, inflame, and may corrode. We may likewise meet with all the consequences of inflammation, such as softening, thickening, ulceration, perforation, or gangrene. Sometimes the coats of the viscera are thickened, at other times thinned and softened, by the action of an irritant. Neurotic poisons do not commonly leave any well-marked appearances in the body. The stomach and intestines may present no unnatural changes. There may be greater or less fulness of the vessels of the brain and spinal marrow, as well as of their membranes ; but even this is often so slight as to escape notice, unless attention be particularly directed to these organs. Effusion of blood is rarely found. It is important to bear in mind that both irritants and neurotics may destroy life without leaving any appreciable changes in the body. To such cases as these, the remarks about to be made do not apply. The proofs of poisoning must, in such exceptional cases, be procured entirely from other sources. Any evidence derivable from the appearances in the body of a person poisoned will be imperfect unless we are able to dis- tinguish them from those analogous changes often met with as the results of ordinary disease. These are confined to the mucous membrane of the stomach and bowels. They are redness, ulceration, softening, and perfora- tion. Each of these conditions may depend upon disease, as well as upon the action of irritant poisons. Redness. — It is a main character of the irritants to produce, as a result of inflammation, redness of the mucous or lining membrane of the stomach and small intestines. This redness, when first seen, is usually of a deep crimson color, becoming brighter by exposure to air. It may be diffused over the whole mucous membrane : at other times it is seen in patches, dots, or lines (striae) spread irregularly over the surface of the stomach. It is sometimes met with at the smaller, but more commonly at the larger, end of this organ ; and, again, we occasionally find the folds or prominences only of the mucous membrane presenting this red or inflamed appear- ance. Redness of the mucous membrane may, however, be due to gastritis, active digestion, the use of stimulants, or disease ; and in order to assign the true cause of inflammation, it will be necessary to have an account of the symptoms preceding death, or some chemical proof of the existence of irritant poison in the contents of the stomach or in the tissues of the body. In the healthy state, the mucous membrane of the stomach is pale and white, or nearly so, except during digestion, when it is slightly reddened ; and redness has often remained in the stomachs of those who have died during the performance of the digestive process. "When in contact with the spleen or liver, after death, the stomach is apt to acquire a deep livid color from the transudation of blood ; and it is well known that the bowels acquire a somewhat similar color from the gravitation of blood 92 ULCERATION. which always takes place after death. In sudden death from valvular disease of the heart, the inueous membrane of the stomach is sometimes found intensely reddened. None of these appearances are likely to be mis- taken for the action of an irritant poison. There is an important class of cases in which redness of the mucous membrane of the stomach is found after death, not dependent on the action of poison or on any easily assignable cause. These cases, owing to their being so little known, and involved in much obscurity, deserve the attention of a medical jurist, since the appearances closel}^ resemble those produced by irritant poison. A person may die without suffering from any symptoms of disordered stomach ; but on an inspection of the body, a general redness of the mucous membrane of this organ will be found, not distinguishable from the redness which is so commonly seen in arsenical poisoning. Several cases of this kind have occurred ; and draw- ings which have been made of the appearance presented by the stomach are preserved in the Guy's Hospital Museum. Tidy is, however, of opinion that there is always ecchymosis of the stomach after death from arsenical poisoning. The redness of the lining membrane of the stomach, in cases of poison- ing, is so speedily altered by putrefaction, when circumstances are favor- able to this process, as frequently to render it impossible for a witness to speak with any certainty upon its cause. Putrefactive infiltration of the blood contained in the adjacent viscera and muscles will give a reddish appearance to a stomach otherwise in a healthy condition. Great dispute has arisen respecting the length of time during which redness of the stomach produced by an irritant will be recognizable and easily dis- tinguishable from putrefactive changes. It is sufficient to say that no certain rule can be laid down on the subject : it must be left to the knowl- edge and discretion of the witness. We have distinctly seen the well- marked appearances of inflammation produced by arsenic in the stomach and duodenum in exhumed bodies twenty-eight days and six months respec- tively after interment ; and, in another instance, the reddened state of the mucous membrane, in a case of arsenical poisoning, was plainly percepti- ble on removing a layer of arsenic nineteen months after interment. If, however, there should be a reasonable doubt respecting the cause of the redness, and no poison is detected, it would be unsafe to rely upon this appearance alone as evidence of poisoning. (See page 71, ante.) Ulceration. — In irritant poisoning the stomach is occasionally found ulcerated ; but this is, comparatively speaking, a rare occurrence. In such cases the mucous membrane is removed in small, distinct circular patches, under the edges of which the poison (often arsenic) may be found. Ulcera- tion of the stomach is a more common result of disease than of the action of poison. As a consequence of disease, it is very insidious, going on often for weeks together without giving any indication of its existence, except perhaps slight gastric disturbance, with occasional nausea, vomit- ing, and loss of appetite. In this case, the ulceration is commonly seen in small, circumscribed patches. It is worthy of remark, as a means of distinction, that ulceration has never been known to take place from arsenic or any irritant poison until symptoms indicative of irritant poison- ing have occurred. In ulceration from disease, the mucous membrane is commonly reddened in the neighborhood of the ulcer. In ulceration from poison, the redness is generally diff"used over other parts of the stomach as well as over the duodenum and small intestines. A case, however, occurred in Guy's Hospital, in which, with a small circular patch of ulcera- tion near the cardiac opening, the whole mucous membrane was red and I SOFTENING PERFORATION OF THE STOMACH. 93 injected ; but this singular condition of the stomach, so closely resembling the effects of an irritant poison, was unaccompanied by any marked symptoms of irritation during life. The history of a case previous to death will thus commonly enable us to determine to what cause the ulcera- tion found may be due. Care must be taken to distinguish ulceration from corrosion. Ulceration is a vital process : the substance of a part is removed by the absorbents as a result of inflammation. Corrosion, on the other hand, is a chemical action : the parts are removed by the im- mediate contact of the poison ; they are decomposed ; their vitality is destroyed, and they combine with the corrosive matter itself. Ulceration requires time for its establishment, Avhile corrosion is a very rapid effect. Softening. — The coats of the stomach are not unfrequently found so soft as to yield and break down under very slight pressure; and this may be the result either of poisoning, of some spontaneous morbid change in its structure during life, or of the solvent action of the gastric juice after death. As this condition of the stomach, when caused by poison, is pro- duced by those substances only which possess corrosive properties, it fol- lows that, in such cases, traces of their action will be perceived in the mouth, throat, and gullet. In softening from disease, the change will be confined to the stomach alone, and it is commonly found only at the car- diac or greater end of the organ. When softening is really caused by an irritant poison, it is generally attended by other striking and unambiguous marks of its operation. Softening is not to be regarded as a common characteristic of poisoning, and is only an occasional appearance. In- stances have been met with where the coats of the stomach were consider- ably hardened by sulphuric acid, or, oftener, by carbolic acid. Softening can never be inferred to have proceeded from poison, unless other well- mai'ked changes are present, or unless the poison is discovered in the softened parts. The stomachs of infants have been frequently found softened from natural causes : such cases could not be mistaken for poisoning, since the history of them during life, the want of other ap- pearances indicative of poisoning, and the total absence of poison from the viscera, would prevent such a suspicion from being entertained. Perforation. — The stomach may become perforated, either as a result of poisoning or of disease. Perforation from jyoisoniug. — This may arise : 1, from corrosion ; 2, from ulceration. The perforation by corro- sion is by far the most common variety of perforation from poisoning. It is occasionally witnessed when a strong mineral acid has been taken, especially sulphuric acid ; the stomach, in such cases, is blackened and ex- tensively destroyed, the aperture is large, the edges are rough and irregu- lar, and the coats are easily lacerated. The acid escapes into the abdo- men, and may be detected there by chemical analysis. The perforation from ulceration, caused by irritant poison (arsenic), is but little known. There are but few instances on record. In a great number of poisoned subjects examined during many years past at Guy's Hospital, not a single case has occurred. It must then be looked upon as a rare appearance in eases of irritant poisoning. Perforation from disease. — This is by no means an unusual condition. Many eases of this disease will be found reported elsewhere. (Guy's Hosp. Rep., ser. i., vol. iv., p. 8.) It is in- variably fatal when it proceeds so far that the contents of the stomach escape into the abdomen ; but sometimes the stomach becomes glued to the pancreas or other organs during the ulcerative process, and then the person may recover. Several instances of this kind of adhesion have been met with in inspections. The symptoms from perforation commonly attack a person suddenly, while apparently enjoying perfect health. 94 SPONTANEOUS PERFORATION OF THE STOMACH. Hence these cases may be easily mistaken for those of irritant poisoning-. The principal facts o))served with regard to this formidal)le disease are the following- : — 1. It often attacks young women from eighteen to twenty- three years of age. 2. The preceding illness is extremely slight ; some- times there is merely loss of appetite, or a capricious appetite, with uneasiness after eating. 3. The attack commences with a sudden and severe pain in the abdomen, generally soon after a meal. The pain usually comes on gradually in irritant poisoning, and slowly increases in severity. 4. Vomiting, if it exists at all, is commonly slight, and is chiefly confined to what is swallowed. There is no purging : the bowels are generally constipated. In irritant poisoning the vomiting is usually severe, and "purging is seldom absent. 5. The person dies commonly in from eighteen to thirty-six hours : this is also a usual period of death in the most common form of irritant poisoning, i. e. by arsenic ; but in no case yet recorded has arsenic caused perforation of the stomach within twenty-four hours, and it appears probable that a considerable time must elapse"^ before such an effect could be produced by this or any irritant. 6. In perforation from disease the symptoms and death are clearly referable to peritonitis. 7. In the perforation from disease the aperture is commonly of an oval or rounded form, about half an inch in diameter, situated in or near the lesser curvature of the stomach, and the edges are smooth. The outer margin of the aperture is often blackened, and the aperture itself is funnel-shaped from within outwards ; i. e., the mucous coat is the most removed, and the outer or peritoneal coat the least. The coats of the stomach, round the edge of the aperture, are usually thickened for some distance ; and when cut they have almost a cartilaginous hardness. These characters of the aperture will not alone indicate whether it is the result of poisoning or disease ; but the absence of poison from the stomach, with the want of .other characteristic marks of irritant poison- ing, would enable us to say that disease was the cause. Besides, the history of the case during life would materially assist us in our judgment. The great risk on these occasions is that the effects of disease may be mistaken for those of poisoning; for we are not likely to mistake a per- foration caused by irritant poison for the result of disease. Notwith- standing the weli-marked differences above described, it is common to meet with cases of imputed poisoning where death has really occurred from peritonitis following perforation. A case of this kind will be found elsewhere recorded. (Guy's Hosp. Rep., 1851, p. 226.) In another the body was exhumed after several months' burial, and the stomach was found perforated from disease in the usual situation. Spontaneous or Gelatinized Perforation. — The stomach is occasionally sul)ject to a spontaneous change, by which its coats are softened, and give way, generally at the cardiac or greater end. As the effusion of the con- tents of the organ in such a case never gives rise to peritoneal inflammation, and no symptoms occur prior to death to indicate the existence of so ex- tensive a destruction of parts, it is presumed to be a change in the dead body, and the coats of the stomach are supposed to undergo a process of solution or digestion. It is commonly attributed to the solvent action of the gastric juice, the spleen, diaphragm, and other viscera being some- times softened. Wilkes states that this post-mortem or cadaveric perfo- ration of the stomach is so rare a condition that it is not met with once in five hundred cases. In the last two cases in which it was observed by him, one patient had died from albuminuria, and the other from head- affection ; but in neither of these could there be found any peculiarities reo-arding their food, the time of the last meal, or the state of the bodies SPONTANEOUS PERFORATION OF THE STOMACH. 95 to account for the spontaneous destruction of the coats of the stomach. In January, 1845, the author met with an instance of this perforation in a child between two and three years of age. It was seized with convul- sions, became insensii)le, and died twenty-three hours afterwards. After death, the greater end of tiie stomach was found destroyed to the extent of three inches ; and the edges were softened and blackened. There was no food in the stomach, and nothing had passed into this organ for thirty- two hours before death. It was therefore impossible to ascribe death to the perforation or the perforation to poison. (Med. Gaz., vol. 36, p. 32.) An inspection of the body, with a general history of the case, will commonly suffice to remove any doubt in forming an opinion Avhether the extensive destruction, so commonly met with, has or has not arisen from poison. Thus in a post-mortem perforation, the aperture is generally situated in that part of the stomach which lies to the left of the cardia ; it is very large, of an irregular form, and ragged and pulpy at the edges, which have the appear- ance of being scraped. The mucous membrane of the stomach is not found inflamed. There is occasionally slight redness, with dark brown or almost black lines (striae) in and near the dissolved coats, which have an acid reaction. It can only be confounded with perforation by the action of corrosives ; but the well-marked symptoms during life, and the detection of the poison after death, together with the changes in the throat and gullet, will at once indicate the perforation produced by corrosive poison. Pavy has shown that after death the gastric juice dissolves the stomach. [Dr. Hartshorne comments on the vital importance, in cases of this kind, of the post-mortem being conducted by an experienced, thoroughly-trained examiner, of sufficient judgment to fully and distinctly understand the ap- pearances hereinbefore indicated, and shows how valueless the examination would be if made by ignorant and untrained practitioners. He cites the case of John Hendrickson, Jr., convicted by this latter class of evidence, as exposed by Dr. C. Lee (Am. Jour. Med. Sci., October, 1885, p. 447), and insists that medical evidence, whether as to anatomical appearances, odor and color, form, or microscopical inquiry, is and should, in the nature of things, be restricted to the very few experts who could be found com- petent to give reliable evidence in these cases. Prof. Reese claims that Chap. XI., sujDra, regarding chemical analysis in establishing the proof of poisoning, is most important and valuable, and says that it is very dangerous in a case of life and death to rely either upon symptoms or autopsic appearances, or even upon both, as affording positive proof of poison. While unwilling to claim that the chemical evi- dence is always indispensable to prove the administration of poison' in certain cases where chemical detection is impossible, yet in these excep- tional cases the other two factors — symptoms and the anatomical lesions — as well as the moral circumstances of the case, should be so positive and unequivocal as to leave no shadow of doubt. Wharton and Stille, in commenting on this subject, say: "These veri- fications (the symptoms and the autopsy) once established, and a harmony between the lesions shown by the physician and physiologist, and the substance discovered by chemical analysis being settled, then and only then can the conclusion be reached that death was due to poison :" Vol. II., p. 28t, 1873.] 96 SULTIIUKIO ACID SYMPTOiMS. CORROSIVE AND IRRITANT POISONS. CHAPTER VII. SULPHURIC ACID, OR OIL OF VITRIOL. NITRIC ACID, OR AQUA FORTIS. — HYDROCHLORICACID, OR SPIRIT OF SALT. SYMPTOMS. APPEARANCES AND ANALYSIS. — NITRO-HYDROCHLORIC ACID OR AQUA REGIA. Sulphuric Acid, or Oil of Vitriol. Symptoms. — When this poison is swallowed in a concentrated form, the symptoms produced come on either immediately or during the act of swallowing. It has, however, been taken in mistake for a magnesian mixture, without the mistake being discovered till after the lapse of some time. There is violent burning pain, extending down the throat and gullet to the stomach, and the pain is often so severe that the body is bent. There is an escape of gaseous and frothy matter, followed by retch- ing and vomiting ; the latter accompanied by the discharge of shreds of tough mucus and of a liquid of a dark coffee-ground color, mixed with blood. The vomited matters may contain shreds of mucous membrane from the gullet and stomach, and even portions of the muscular tissue of the former. These may form complete casts of .-ome portion of the gullet or stomach. The mouth is excoriated, the lining membrane and surface of the tongue white, or resembling soaked parchment ; and in one instance the appearance of the mouth was as if it had been smeared with white paint. After a time the membrane acquires a gray or brownish color ; the mouth is filled with a thick viscid substance consisting of saliva, mucus, and the corroded membrane ; this renders speaking and swallowing dif- ficult. If the poison has.been administered by a spoon, as in infants, or the phial containing it has been passed to the back of the throat, the mouth may escape the chemical action of the acid, and a child will not always scream under such circumstances. Around the lips and on the neck may be found spots of a brown color from the spilling of the acid and its action on the skin. There is great difficulty of breathing, owing to the swelling and excoriation of the throat and larynx ; and the countenance has from • this cause a bluish or livid appearance. The least motion of the abdo- minal muscles is attended with increase of pain. The stomach is so irri- table that whatever is swallowed is immediately ejected, and the vomiting is commonly violent and incessant. The matters ^?'.s^ vomited generally contain the poison : they are acid, and, if they fall on a lime-stone pave- ment, there is effervescence ; if on colored articles of dress, the color is sometimes altered to a red or yellow, or it is entirely discharged and the texture of the stuff" destroyed ; on a black cloth dress, the spots produced by the concentrated acid are reddish-brown, and remain moist for a con- siderable time. After a time there is exhaustion, accompanied by great weakness ; the pulse becomes quick, small, and feeble ; the skin cold, mottled, and covered with a clammy sweat. There is generally great APPEARANCES AFTER DEATH FATAL DOSE. 97 thirst, with obstinate constipation, and should any evacuations take place they are commonly either of a dark brown or of a leaden color, and in some instances almost black from an admixture of altered blood. There are sometimes convulsive motions of the muscles, especially those of the face and lips. The countenance, if not livid from obstructed respiration, is pale, and expressive of great anxiety and intense suffering. The intel- lectual faculties are quite clear ; and death usually takes place very suddenly, in from eighteen to twenty-four hours after the poison has been taken. Sulphate of indigo produces similar symptoms. The vomited matters are, however, bluish-black. Appearances after Death. — The appearances met with in the body of a person who has died from the effects of this acid vary, according to whether death has taken place rapidly or slowly. Supposing the case to have proved rapidly fatal, the membrane lining the mouth may be found white, softened, and corroded. The mucous membrane of the throat and gullet is commonly found corroded, having a brown-black or ash-gray color, and blood is effused in patches beneath it. The corroded membrane of the gullet is occasionally disposed in longitudinal folds, portions of it being partly detached. The stomach, if not perforated, is collapsed and contracted. On laying it open, the contents are commonly found of a dark brown or black color and of a tarry consistency, being formed in great part of mucus and altered blood. The contents may or may not be acid, according to the time the patient has survived, and the treatment which has been adopted. On removing them, the stomach may be seen traversed by black lines, or the whole of the mucous membrane may be stained black or of a dark brown color. On forcibly stretching the coats, the red color indicative of inflammation may be sometimes seen in the parts beneath, or surrounding the blackened portions. When the stomach is perforated, the coats are softened, and the edge of the aperture is commonly black and irregular. In removing the stomach, the opening is liable to be made larger by the mere weight of the organ. The contents do not always escape ; but, when this happens, the surrounding parts are attacked by the poison. The spleen, the liver, and the coats of the aorta have been found blackened and corroded by the acid, which had escaped through the perforation. In rare cases the lining membrane of the aorta has been found strongly reddened. When a person has survived for eighteen or twenty hours, traces of corrosive and inflam- matory action may be found in the small intestines. In one case the mucous membrane of the ileum was corroded. The interior of the wind- pipe, as well as of the bronchial tubes, has also presented marks of the local action of the acid. The acid has thus destroyed life without reach- ing the stomach. A remarkable instance in which the poison penetrated into and destroyed both lungs has been reported. (Med. Gaz., vol. 45, p. 1102.) It is important for a medical witness to bear in mind that the mouth, throat, and gullet are not always found in the state above described. Ogle met with a case in which the tongue was but slightly affected. Fatal Dose. — The dangerous effects of sulphuric acid appear to arise rather from its degree of concentration than from the absolute quantity taken. The quantity actually required to prove fatal must depend on many circumstances. If the stomach is full when the poison is swal- lowed, the action of the acid may be spent on the food and not on the stomach ; and a larger quantity might then be taken than would suffice to destroy life if the organ were empty. The smallest quantity which is described as having proved fatal was in the following case : Half a tea- epoonful of concentrated sulphuric acid was given to a child about a year 7 98 FATAL PERIOD ANALYSIS. old b}' mistake for castor oil. The usual symptoms came on, with great disturbance of breath i n s? ; and the child died in twenty-four hours. The quantity here taken could not have exceeded forty dro])s. (Med. Gaz., vol. 29, p. 147.) It is, however, doubtful whether this snuill quantity would have proved fatal to an adult. The smallest fatal dose which Christison states he has found recorded is oue (Iravhm; it was taken in mistake b}'" a young- man, and killed him in seven days : On Poisons. Even when diluted, the acid will riipidly destroy life, A man swallowed, on an enijit}- stomach, six drachms of the strongest acid diluted with eighteen drachms of water. He suilered from the usual svm])toms, and died in two hours and a half. (Med. Times and Gaz., 1863,^1, p. 183.) Fatal Period. — The average period at which death takes place in cases of acute poi.soning by sulphuric acid is from eighteen to twenty-four hours. The shortest case recorded occurred to Rapp. A man, set. 50, swallowed three ounces and a half of concentrated sulphuric acid; he died in three quarters of an hour. (Gaz. Med., Dec. 28, 1850.) On the other hand, there are numerous instances reported in which the poison has ])roved fatal, from secondai'y causes, at periods varying from one week to several months, and even years. Chemical Analysis. — If the acid is in a concentrated state it possesses these properties: 1. Wood, sugar, or other organic matter plunged into it, is speedily carbonized or charred, either with or without the application of heat. 2. When boiled with wood, copper-cuttings, or mercury, it evolves fumes of dioxide of sulphur ; this is immediately known by the odor, as well as by the vapor first rendering blue, and then bleaching, starch-paper dipped in a solution of iodic acid. 3. When mixed with an equal bulk of water, great heat is evolved. Sulphuric acid when diluted does not carbonize organic substances. If, however, a glass rod be dipped in the diluted acid, and a mark be made with this upon writing-paper, and the paper be then gently dried before a fire, a black mark will be left wherever the acid has touched the paper. This test is applicable to organic liquids containing sulphuric acid. The best reagent for its detection is a solution of barium — either the nitrate or the chloride of barium. Having ascertained by test-paper that the suspected liquid is acid, and contains a free mineral acid (see below), we add to a portion of it a few drops of nitric acid, and then a solution of barium salt. If sulphuric acid is jjresent, a white precipitate of sulphate of barium will fall down : this is insoluble in all acids and alkalies. If the precipitate is collected, dried, and heated to full redness for some minutes in a platinum crucible, or in a folded piece of platinum foil, with five or six parts of charcoal powder, it will, if a sulphate, be converted into sulphide of barium. To prove this, we add to the calcined residue hydrochloric acid, at the same time suspending over it a slip of filter- ing paper moistened with a solution of acetate of lead. If the precipitate obtained is a sulphate, the gas evolved will be sulphuretted hydrogen, known by its odor, and by its turning a salt of lead of a brown color. Cyanide of potassium may be used as a reducing agent in place of charcoal, in a proportion of one part to three parts of the sulphate of barium. The mixture should be heated to fusion in a reduction-tube. On breaking the glass when cold, and laying the incinerated residue on paper or card wetted with a salt of lead, a brown stain indicative of sulphide of lead is produced ; or the residue may be dissolved in water, and a solution of acetate of lead added to it. [A verv delicate test for dilate sulphuric acid is veratria, which, when introduced in small quantity, and evaporated to dr3mess, produces a beau- tiful purple color : Reese.1 DIALYSIS. 99 In liquids containivg organic matter. — If sulphuric acid is mixed- with such liquids as porter, coffee or tea, the process for its detection is sub- stantially the same, the liquid being- first rendered clear by filtration. The precipitated sulphate of barium, if mixed with organic matter, may be purified by boilin.i>- it in strong- nitric acid; but this is not commonly necessary, as the reduction of the dried precipitate may be equally well performed with the impure as with the pure sulphate. Some liquids, such as vinegar, porter, and most wines, generally contain a soluble sul- phate, but in small proportion ; therefore, if there is an abundant precipi- tate, there can be no doubt, ccetcris paribus, that free sulphuric acid has been added to them. The liquid should invariably be tested for the pres- ence of a free or uncombined mineral acid. A solution of ferric acetate is mixed with solution of potassium sulphocyanide, and diluted till the color is a very pale red. A drop or two of the suspected liquid dropped into this solution will yield blood-red streaks if a free mineral acid be present. An alcoholic solution of methyl-violet is rendered blue and then green when l-4000th of a free mineral or oxalic acid is present. Should the liquid be thick and viscid, like gruel, il may be diluted with water, and then boiled with the addition of a little acetic acid. The coats of the stomach should be cut up and boiled in distilled water. For the action of the barium test, it is not necessary that the liquid should be absolutely clear, provided it is not so turbid as to interfere mechanically with the precipitation of the sulphate of barium. Dialysis. — When the acid is mixed with milk, decomposed blood, mucus, or other substances, rendering it thick and viscid, it may be readily separated by dialysis — a process which is applicable to the other acid poisons, such as nitric, hydrochloric, and oxalic. A portion of the acid viscid liquid should be placed in a test-tube, about five inches long, and one inch in diameter, open at both ends ; the neck being securely covered with a layer of thin bladder or parch- Fig. 1. ment-paper. The tube is then immersed, mouth down- wards, in a beaker containing distilled water (Fig 1). After some hours the acid will pass through the membrane, and may be detected in the water, This process may be employed as a trial test of the con- tents of the stomach when they have a strongly acid reaction. In thus testing for sulphuric acid it must be remembered that a sulphate, such as Epsom salts, may be present in the liquid ; and that an innocent acid, like vine<>:ar or lemon-juice, mav give the acid Beaker and tube for -• „ m '^ /■ Ti " ii • 1 the dialysis of liquid reaction. To remove any fallacy on this ground, a poisons, portion of the li(|uid tested should be evaporated, and the residue incinerated, Avhen the alkaline sulphate, if present, will be obtained in the solid form. It is a medico-legal fact of considerable importance, that the contents of a stomach in a case of poisoning by sulphuric acid are sometimes entirely free from any traces of this poison, even when it has been swallowed in large quantify. Casper relates three such cases The acid is not commonly found when the person has been under treatment; when there has been considerable vomiting, aided by the drinking of water or other simple liquids; oi' when he has survived several da3^s. Sulphuric acid may be detected on articles of clothing by a similar process. The concentrated acid produces reddish-brown stains on black cloth — the spots remain damp, and the fibre of the stuff is gradually softened and corroded. The stained portion of cloth should be boiled in 100 NITRIC ACID — SYMPTOMS. Avater, and the solution filtered, tested for free acid (see p. 97, ante), and then with a salt of barium. If any free acid is present, the stained stuff and the solution obtained from it will redden litmus-paper. Sometimes the detection of the acid on clothing is the only source of chemical evi- dence in cases of poisoning. It has been thrown on the person for the purpose of producing bodily injury or injury to the clothes. In such cases it must be proved that the substance is of a corrosive nature, but it is not necessary to show that injury has been done to the person. The acid sulphates, such as alum, act as irritant poisons when given in large doses. Tardieu, Avho gives the details of two cases of fatal poisoning by alum (L'Empoisonnement, p. 218), is of opinion that from half an ounce to an ounce of the salt is a fatal dose for an adult. In 1888 Bull communicated to the editor a case in which a diphtheritic child, iBt. 3 years, died from the effects of a teaspoonful of alum given in syrup as an emetic. The child did not vomit, and died shortly after. The mucous membrane of the stomach was red and velvety, as if from the effects of a powerful irritant. Nitric Acid, or Aqua Fortis. Symptoms. — When nitric acid is taken in a concentrated state, the symptoms bear a close resemblance to those produced by sulphuric acid. They come on immediately, and the swallow' ing of the acid is accompanied by intense burning pain in the throat and gullet, extending downwards to the stomach : there are gaseous eructations, resulting from the chemical action of the poison, swelling of the abdomen, violent vomiting of liquid or solid matters, mixed with altered blood of a dark brown color, and shreds of yellowish-colored mucus having a strongly acid reaction. The abdomen is generalh' exquisitely tender; but, in one well-marked case of poisoning by this acid, the pain was chiefly confined to the throat : prob- ably the poison had not reached the stomach. The mucous membrane of the mouth is commonly soft and white, after a time becoming yellow, or even brown ; the teeth are also white or yellow, and the enamel is par- tially destroyed by the chemical action of the acid. There is great diffi- culty of speaking and swallowing, the mouth being filled with viscid mucus ; the power of sw^allowing is, indeed, sometimes entirely lost. On opening the mouth, the tongue may be found swollen, and of a citron yellow color ; the tonsils are also swollen and enlarged. As the symptoms progress, the pulse becomes small, frequent, and irregular — the surface of the body cold, and there are frequent rigors (shivering). The swallowing of liquids increases the severity of the pain and occasions vomiting. There is obstinate constipation. Death takes place in from eighteen to tw^enty-four hours, and is sometimes preceded by a kind of stupor, from which the patient is easily roused. The intellectual faculties commonly remain clear until the last. Death may occur from pneumonia, the fumes of the acid having gained access to the lungs. The vapor of this acid is destructive to life. In 1854 Mr. Haywood, an analytical chemist of Sheffield, lost his life under the following circum- stances. He was pouring a mixture of nitric and sulphuric acids from a carboy containing about sixty pounds, when by some accident the vessel was broken. For a few minutes he inhaled the fumes of the mixed acids, but it does not appear that any of the liquid fell over him. Three hours after the accident he was sitting up and appeared to be in moderately good health. He was then seen by a medical man, and complained merely of some cuts about his hands. He coughed violently. In three hours more NITRIC ACID APPKAKANCES AFTER DEATH. 101 there was a difficulty of breathing-, with increase of the coug-h. There was a sense of tightness at the lower part of the throat, and the pulse was hard. At times he said he could scarcely breathe. He died eleven hours after the accident. On inspection there was congestion of the windpipe and bronchial tubes, with effusion of blood in the latter. The heart was flaccid, and contained but little blood ; and the lining- membrane of the heart and aorta was inflamed. The blood gave a slightly acid reaction to test-paper. The windpipe was not examined. It is very probable the seat of mischief was in this organ, and that the deceased died from in- flammatory effusion, and swelling of the parts about the opening- of the windpipe. (Lancet, 1854, i. p. 430.) A similar accident occurred to Mr, Stewart and one of the janitors of an educational institution in Edin- burgh, in 1863. They both died from the effects of the acid vapor. (Chem. News, 1863, p. 132.) On Sept. 23, 1890, during- attempts to ex- tinguish a fire at some chemical stores, a bottle of nitric acid was broken. The action of the acid upon surrounding articles gave rise to abundant evolution of nitrous fumes, and two of the fire-brigade officers were so affected by their inhalation that they died the same day. (Pharm. Jour., 1890-1, p. 252.) The fames from batteries charged with nitric acid are often productive of serious results ; and the editor has met with alarming- illness arising from the inhalation of the nitrous fnmes given off during the working of such batteries in an ill-ventilated room. Appearances after Death. — Supposing death to have taken place rapidly from the liquid acid, the following- appearances may be met with : The skin of the mouth and lips will present various shades of color, from orange-yellow to brown. Yellow spots produced by the spilling of the acid may be found about the hands and neck. The membrane lining the mouth is sometimes white — more commonly of a yellow color ; and the teeth are white or yellowish in color. The throat and windpipe are much inflamed. The lining- membrane of the gullet is softened, of a yellow or brown color, and easily detached, often in long shreds. The windpipe is congested, and the lungs also. The most strongly marked changes are seen in the stomach. When not perforated, this organ may be found dis- tended with gas, its mucous membrane partially inflamed and covered with patches of a yellow, brown, or green color, or it may be even black. Its coats may be so much softened as to break down under the slightest pressure. Similar changes are found in the duodenum ; but in some cases the small intestines have presented no other appearance than that of a slight redness. It might be supposed that the stomach would be in general perforated by this corrosive liquid ; but perforation has not been often observed. In a case of the editor's there was a small aperture ia the anterior wall of the stomach, around which the peritoneum was ecchy- mosed ; but no lymph was exuded around the opening. It is probable that the rupture had taken place about the time of death, Avhich super- vened seventeen hours after the acid was taken. (Guy's Hosp. Rep., 18T2, xvii. p. 223.) In a case which proved fatal after the long period of six months, there was, at the intestinal end of the stomach, a distinct cicatrix with puckering and hardening of the surrounding mucous mem- brane, causing a slight contraction of the intestinal orifice. The only other appearance consisted in some dark longitudinal lines on the posterior surface of the lining membrane of the gullet. These had probably been caused by the acid. (Lancet, 1860, ii. p. 510.) The smallest quantity of this acid which is reported to have destroyed life, is about two drachms in the case of a boy, aged thirteen, who died in 102 FATAL DOSE CHEMICAL ANALYSIS. thirt3'-Kix hours. Death commonly takes place within twenty-four hours. Sol)erheini relates a case of poisoninj^' by nitric acid, wliicli jjroved fatal in one liottr and three-quarters. This is believed to be the most rapidly fatal instance on record where the acid acted in the ordinary mniiner. The usual well-marked ellects were found in the gullet, stomach, and small intestines. lu inlants, life may be destroyed by this poison in a few minutes, should it happen to reach the larynx. The longest case is, perhaps, that recorded by Tartra, where a woman died from exhaustion, produced by the secondary ellects of the acid eight months after having swallowed it. Chemical Analysis. — In the simple state. — This acid may be met with either concentrated or diluted. The concentrated acid varies in color from a deep orange-red to a light straw-yellow. It may be recognized : 1. By evolving acid fumes when exposed to the air or when heated. 2. By its staining- organic matter yellow or brown, the color being heightened and turned to an orange-red by contact with the caustic alkalies. 3. When mixed with copper-cuttings, it is rapidly decomposed, deep red acid va))ors are given off, and a greenish-colored solution of nitrate of copper is formed. Tin or mercury may be substituted for copper in this experiment. 4. The addition of gold-leaf and a few drops of hydrochloric acid: if nitric acid is present, the gold will be dissolved on warming the mixture. Common aqua fortis (nitric acid) sometimes contains, as impurity, a suflieiency of hydrochloric acid to dissolve gold-leaf. It strikes a deep brown color witli a solution of ferrous sulphate. In the diluted state. — This acid is not precipitated like sulphuric by any common reagent, since all its saline conil)inations are solu1>le in water. 1. The liquid has a highly acid reac- tion, and (if not too diluted), on boiling it with some copper turnings, red fumes are given off, the liquid acquiring at the same time a blue color. 2. A streak made on. white paper with the diluted acid does not carbonize it when heated; but a scarcely visible yellow stain is left. 3. The lif[uid is neither precipitated by nitrate of barium nor by nitrate of silver. These last two experiments give merely negative results ; they serve to show that sulphuric and hydrochloric acids are absent. 4. The liquid is mixed with an equal bulk of pure sulphuric acid, partially cooled, and then a solution of ferrous sulphate is gently poured on to the surface of the mixture : a deep brown ring forms at the junction of the two liquids if nitric acid or a niti'ate is present. In order to detect nitric acid when mixed with water or other liquids, the liquid should be first tested with litmus-paper, and also with ferric acetate and potassium sulphocyanate, or by means of methyl-violet, for the presence of a free mineral acid (see p. 97, ante). Two separate por- tions should then be carefully neutralized — the one with potash, the other uith soda, and then each slowly evaporated to obtain crystals. If the liquid contains nitric acid, these crystals will have the following charac- ters : 1. Those of nitrate of potassium will appear in the form of long fluted prisms, w^hich neither effloresce nor delifpiesce on exposure to air. Those of nitrate of sodium have a rhombic form and closely simulate the appearance of the cubic crystals of common salt. One drop of the solution, evaporated spontaneously on glass, will suffice to yield distinct and well- formed crystals. 2. When moistened with strong sulphuric acid, the powdered crystals of either salt slowly evolve a colorless acid vapor. By this test the nitrate is known from every other deflagrating salt. 3. A portion of the powdered crystals should be placed in a small tube and mixed with an equal bulk of fine copper filings. The mass is then to be moistened with water, and a few drops of strong sulphuric acid added. NITRIC ACID IN ORGANIC LIQUIDS. 10'] Either with or without the application of a gentle heat, decomposition immediately ensues, by which red nitrous fames are evolved, recognizable bv their color, odor, and acid reaction. In operating on a small quantity of nitrate free from chloride, the crystals may be placed in a flnsk and mixed with one or two drops of concentrated sulphuric acid and a few copper fdings. Place in the neck of the flask a slip of damp blue litmus- paper, and a slip of starch-paper moistened with a solution of iodide of potassium. After a longer or shorter interval the litmus will be reddened, and the starch-paper will assume a blue-black color. If the nitrate should be mi.xed with much chloride, then the power of dissolving gold-leaf on boiling the dry salt with strong hydrochloric acid furnishes the best means of detection. " 4. We add to the crystals a small portion of gold-leaf and hydrochloric acid ; then boil for a few minutes. If nitric acid or a nitrate is present, the gold will either partly or entirely disappear. Its partial solution will be indicated by a dark-purple or brown color on the addition of stannous chloride to the liquid after boiling. In Liquids containing Or(/(niic Matter. — Nitric acid may be adminis- tered in such liquids as tea, vinegar, or porter. In this case, besides the acid reaction, there will be a peculiar smell produced by the strong acid, when mixed with organic substances. The application of the usual tests may be here counteracted: thus, unless the quantity of nitric acid in the liquid is considerable, the orange-red nitrous acid fumes are not evolved on boiling it with copper cuttings. The action on gold-leaf will enable a chemist to detect nitric acid in coffee, tea, and similar organic liquids, even when the proportion of acid is small. Boil a fragment of gold-leaf in pure hydrochloric acid, and add while boiling a few drops of the suspected organic liquid to the mixture. If the acid is present, the gold will be dissolved. When the acid liquid is thick and turbid, a portion of it should be placed in a tube and submitted to the process of dialysis (see p. 99, ante). Vomited matters, as well as the contents and coats of the stomach (cut up), should be boiled in water, and filtered. If not cleared by filtration, thev may be submitted to dialysis, and the acid water obtained carefully neutralized with potash or soda and concentrated. If by filtration we succeed in procuring a clear acid liquid, the color is of no importance. A few drops of the neutralized and concentrated liquid may be evaporated on a glass slide, and the crystals thus obtained examined microscopically and compared with those of nitrate of potassium and of sodium. Paper dipped into the concentrated liquid and dried burns with deflagration like touch-paper. The crystals obtained by evaporating the neutralized liquid are generally colored with organic matter, but they fuse into a white mass when heated in a platinum capsule. The pure nitrate thus obtained may be tested as above described. The organic matter in the crystals does not interfere with tlie results of the copper and gold tests. When either nitric acid, or the nitrate into which it has been con- verted, is mixed with common salt, the copper test cannot be employed. The gold test will in such a case furnish the best evidence. Hydrochloric acid with a small portion of gold-leaf may be added to the dried residue, and the mixture boiled. If nitric acid or a nitrate is present, even ia minute proportion, some portion of the gold will be dissolved — a fact demonstrable by the addition of stannous chloride. Nitric acid may be detected in stains on clothing, if recent, by simply boiling the stained cloth in water. An acid liquid will be obtained, unless the stains are of old date or the stuff has been washed. This liquid, when concentrated, may be dealt with in the manner already described for 104 HYDROCHLORIC OR MURIATIC ACID. org'anic liquids. The stains from this acid on black and blue cloth are of a 3-ello\v or brownish-yellow color and are indelible. When long exposed they become dry, but the cloth is easily torn. A simple method of detect- ing the acid is to ))oil at once a piece of the stained cloth with a fragment of gold-leaf and hydrochloric acid. If nitric acid is present in the stain, a portion of the gold will be dissolved. In 1889, a man was convicted of the murder of a woman by pouring nitric acid dow^n her throat whilst in bed (Reg. v. Lipski, C. C C., July, 1888). In reality a mixture of acids, containing more sulphuric than nitric, M'a.s emploved. Such a mixture does not char cellulose (wood and cotton) like sulphuric acid, but converts it into nitro-cellulose, which substance was found by the editor in the stains on the deceased w^oman's linen, and also in wood cut from the floor of the room in which the murder was committed. Hydrochloric Acid. Muriatic Acid. This acid, which is also called muriatic acid, and is popularly known under the name of spirit of salt, is often taken as a poison. In the cases which have hitherto been observed, the symptoms and appearances have been similar to those caused by nitric acid. A woman, at. 63, swallowed half an ounce of concentrated hydrochloric acid. She was received into the hospital in three-quarters of an hour. The prominent symptoms Avere burning pain in the throat and stomach, feeble pulse, cold, clammy skin, retching, and vomiting of a brown matter streaked with blood and con- taining shreds of membrane. There w^as great exhaustion. The throat became swollen, the patient lost the power of swallowing, and died in eighteen hours. She retained her senses until the last. The appearances in the body were as follows: The mucous membrane of the mouth and throat was white, softened, and destroyed in many places by the corrosive action of the acid. The mucous membrane of the gullet was red and in- flamed. The back part of the stomach near the pylorus was dark-colored, stripped of its mucous membrane (which Avas generally softened), and marked with black lines. It w^as not perforated (Lancet, 1859, ii. p. 59). In this case the smallest quantity of hydrochloric acid was taken which has as yet been known to prove fatal. In 1885, a man, set. 37, was admitted into Guy's Hospital after swallow- ing, for suicidal purposes, a fluidounce of strong hydrochloric acid, in which he had dissolved a dram of oxalic acid. The ordinary antidotes Avere employed, and he progressed favorably till the tenth day, Avhen he died rather suddenly. On post-mortem examination the editor found a membranous exudation and minute ulcers at the back of the pharynx. The mucous membrane of the gullet Avas Avhite, thickened, and interspersed with small extravasations of blood. The stomach contained remains of food of the ordinary acidity. The mucous membrane Avas Avhite and mammillated. Towards the pyloric or intestinal end there were small ulcers Avith open bloodvessels, from the mouths of which extended con- siderable extravasations of blood blackened by the action of the acids of the stomach. Between the ulcers the surface was raw and hemorrhagic. The hemorrhage extended into the duodenum, but not beyond. Chemical Analysis. — In a concentrated state, hydrochloric acid evolves copious fumes. The pure acid is nearly colorless; the commercial acid is of a lemon-yellow color, and frequently contains iron, arsenic, common salt, and other impurities. When boiled with a small quantity of peroxide of manganese, chlorine is evolved. It does not dissolve gold-leaf until a OXALIC ACID. 105 few drops of nitric acid have been added to it, and the mixture is heated. In the diluted state, it may be recognized by the dense white precipitate which it gives when a solution of nitrate of silver is added to it. This precipitate is insoluble in nitric acid, but soluble in ammonia ; it becomes purple when exposed to light; and when heated it melts without decom- position, forming a yellowish-colored solid in cooling. If the acid is con- tained in organic liquids in moderate quantity, it admits of separation by distillation to dryness. In this case any chlorides present are left in the retort. It may also be procured by dialysis in a pure enough state for testing (see p. 99, ante). In all cases the presence of a free mineral acid must be ascertained (see p. 99, ante). Hydrochloric acid, in small quantity, as well as alkaline chlorides, is a natural constituent of the fluids of the stomach and bowels. The presence of local chemical changes in the throat and stomach would show whether the acid had been taken as a poison. If the acid is fouud only in minute quantity, no inference of poisoning can be drawn, unless there are distinct marks of its chemical action upon the throat and stomach. It darkens the blood like sulphuric acid, although it has not the same degree of car- bonizing action on organic matter. The stains produced by this acid on black cloth are generally of a reddish color. As the acid is volatile, it may disappear from the stuff. If recent, the acid may be separated by boiling the stuff in water and applying the silver test,"and the tests for a free mineral acid (see p. 99, ante). An unstained portion of cloth should be similarly tested for the sake of comparison. [Nitro-Hydrochloric Acid. (Aqua Regia.) The general symptoms, effects, and post-mortem appearances resemble those of the preceding acid. The test is its solvent power over gold. Its chlorine can be detected by the odor evolved and also by nitrate of silver; its niti-ic acid, by the action on copper in the cold. (Reese. )j CHAPTER VIII. OXALIC ACID.— SYMPTOMS AND APPEARANCES. — CHEMICAL ANALYSIS. — DIALYSIS OP ORGANIC LIQUIDS. ACID OXALATE OF POTASSIUM, OK SALT OF SORREL.— VEGETABLE ACIDS. Oxalic Acid. Symptoms. — If this poison is taken in a large dose, i.e. from half an ounce to an ounce of the crystals, dissolved in water, a hot, burning, acid taste is experienced during the act of swallowing the poison. This is accompanied by a similar sensation extending down the gullet to the stomach. There is sometimes a sense of constriction or suffocation : the countenance is livid, and the surface of the skin soon becomes cold and clammy. Yomit- ing occurs either immediately or within a few minutes. Should the poison be much diluted, there is merely a sensation of strong acidity, and vomiting may not occur until after a quarter of an hour or twenty minutes. In some cases there has been little or no vomiting, while in others this eymptom has been incessant until death. In one case, in which an ounce lOG APPEARANCES AFTER DEATH. of the acid was swallowed, the vomiting and ])ain in the stomach continued until the fifth day, when the man died suddenly (Lancet, 18G0, ii. p. 509) ; but in another, in which the poisou was much diluted, vomiting did not occur for seven hours. (Christison.) The vomited matters are hi.iihly acid, have a greenish-brown or almost black color, and consist chiefly of mucus and altered blood. The patient complains of great pain and tenderness in the abdomen, with a burning sensation in the stomach. There may be convulsions. There is in general an entire prostration of strength, so that if the person is in the errect position he falls ; there is likewise unconsciousness of surrounding objects, and a kind of stupor, from which, however, the patient may be without difficulty roused. Owing to the severity of the pain, the legs are sometimes drawn up to- wards the abdomen, or the patient rolls about on the floor or bed. The pulse is small, irregular, and scarcely perceptible ; the skin cold and clammy ; and there is a sensation of numbness in the limbs. The breath- ing is spasmodic, the inspirations being deep, and a long interval elapses between them. Should the patient survive the first effects of the poison, the following symptoms n)ay appear: soreness of the mouth, constriction and burning pain in the throat, pain in swallowing, tenderness in the abdomen, and irritability of the stomach, so that there is frequent vomit- ing, accompanied by purging. The tongue is swollen, and there is great thirst. Sometimes there is aphonia, or the patient speaks in a feeble punchinello voice. The following case is exceptional, from the fact that the symptoms throughout were chiefly referable to the brain. A man took what was supposed to be a black draught, but it contained oxalic acid instead of Epsom salts. Two hours afterwards he was found in a state of complete coma, but the symptoms set in a quarter of an hour after he had taken the draught. The man died in five hours, without recovering his consciousness. The only marked appearance on inspection was intense congestion of the brain (Lancet, 1ST2, ii. p. 41.) Oxalic acid injected into the circulation of animals acts as a cardiac poison ; and this is in accordance with its well-known rapidly-fatal effects on man. Christison says : " If a person, immediately after swallowing a solution of a crj^stal- line salt, Avhich tasted purely and strongly acid, is attacked with burning in the throat, then with burning in the stomach, vomiting, particularly of bloody matter, imperceptible pulse, and excessive languor, and dies in half an hour, or, still more, in twenty, fifteen, or ten minutes, I do not know any fallacy which can' interfere with the conclusion that oxalic acid was the cause "of death. No parallel disease begins so abruptly and termin- ates so soon ; and no other crystalline poison has the same effect." Ringer asserts that soluble oxalates precipitate calcium from the blood as insoluble oxalate of calcium ; and as soluble calcium salts in the blood are requisite for the maintenance of the muscular contractility, oxalates may kill by destroying the cardiac muscular contractility. (Practitioner, 1885, xxxiv. p. 8L) Appearances after Death. — The mucous membrane of the tongue, mouth, throat, and gullet is softened, and commonly white as if bleached; but it is sometimes coated with a portion of the brown mucous matter dis- charged from the stomach. This latter organ contains a dark brown mucous liquid, often acid, and having an almost gelatinous consistency. On removing the contents, the mucous membrane will be seen pale and softened, without always presenting marks of inflammation or abrasion, if death has taken place rapidly. The mucous membrane is soft and brittle, easily raised by the scalpel, and presents the appearance which we might suppose it would assume after having been for some time boiled in FATAL DOSE. 107 water. The small vessels are seen raniifvinp: over the surface, and filled with dark-colored blood apparently solidified within them. The lining membrane of the gullet presents the same characters, and has often a worm-eaten appearance. It is pale, and appears as if it had been boiled in water, or digested in alcohol ; it has been found s .rongly rais(>d in longitudinal folds, interrupted by patches where the membrane has be- come abraded. In a case which was ftital in eight hours, the tongue was covered with white specks ; the gullet was not inflamed, but the stomach was extensively destroyed and had a gangrenous appearance. Portions of the mucous membrane were detached, exposing the muscular coat. With respect to the intestines, the upper portion may be found inflamed : but, unless the case is protracted, the appearances in the bowels are not strongly marked. In a well-marked instance of poisoning by this acid, recorded by Hildebrand, the mucous membrane of the stomach and duodenum was much reddened, although the patient, a girl of eighteen, died in three- quarters of an hour after taking one ounce of the acid, by mistake for Epsom salts. (Casper's Vierteljahrsschr., 1853, p. 256.) In a case of poisoning-, in which two ounces of the acid had been taken, and death was rapid, the coats of the stomach presented the almost black appearance produced by sulphuric acid, owing to the color of the altered blood spread over them. In protracted cases, the gullet, stomach, and intestines have been found more or less congested or inflamed. In the case already cited, in which an ounce was swallowed, and death occurred on the fifth day, the stomach was slightly congested, and contained a bloody fluid, but the mucous membrane was entire. (Lancet, 18G0, ii. p. 509.) The glairy contents of the stomach do not always indicate strong acidity until after they have been boiled in water. Oxalic acid does not appear to have so strongly corrosive an action on the stomach as that possessed by the mineral acids. It is, therefore, rare to hear of the coats of the organ being perforated by it; but the acid, when in a concentrated state, renders the mucous coat soft and brittle, and perforation of the coats may occasionally occur either during life or after death, as a result of its chemical action. Wood has recorded the case of a woman, a^t. 21, found dead, whose death had been obviously caused by oxalic a(;id ; but the quantity taken, and the duration of the ease, were unknown. The stomach presented, at its upper and fore pai't near the cardiac opening, an irregular aperture of a size to admit the point of the finger. Fatal Dose. — The smallest quantity of this poison which lias been known to destroy life is 60 grains. A boy, set. 16, took that quantity, as he said, of the poison in a solid form, and was found in about an hour insensible, pulseless, and his jaws spasmodically closed. He had vomited some bloody matter ; his tongue and lips were unusually pale, but there was no excoriation. He died in eight hours. (Lancet, 1855, ii. p. 521.) Tai'dieu (L'Empoisonnement, p. 253) speaks of a fatal case in a young man, ast. 16, from a dose of 30 grains (2 grammes), but it is doubtful, since he gives no details, whether this is not the English case just now mentioned. Two cases occurred at Guy's Hospital, in each of which half an ounce of oxalic acid had been swallowed. Active treatment was adopted, and both patients recovered. When the dose of oxalic acid is half an ounce and upwards, death commonly takes place within an hour; but there are numerous exceptions to this rapidity of action. Christison mentions an instance in which an ounce of oxalic acid killed a girl in thirty minutes; and another in which the same quantity destroyed life 108 CHEMICAL ANALYSIS TESTS. in ten minutes; but in a third case death did not occur until the fifth day. The editor has met with cases of death in fifteen and twenty minutes respectively. O^ilvy has reported a case of poisoning by oxalic acid in which it is probable that death took place within tJiree minutes after the poison had been swallowed. The quantity of the acid taken could not be determined. Chemical Analysis. — In the simple state. — This acid may be met with, either as a solid or in solution in water. Solid oxalic acid crystallizes in long slender prisms, which, when perfect, are four-sided (Fig. 2). In this respect it differs from other common acids, mineral and vegetable. The crystals are unchangeable in air, and to the eye are precisel}^ like those of Epsom salts and white vitriol ; they are soluble in water and alcohol, forming strongly acid solutions. When heated on platinum-foil they melt, and are entirely dis- Fig. 2. sipated without blackening. Heated in a close tube they melt, and a white crystalline sublimate forms in the cold part of the tube. There should be no residue whatever if the acid is pure, but the commercial acid gener- ally leaves a slight residue of fixed impurity By this effect of heat, oxalic acid is easily distinguished from those cr3^stalline salts for which it has been sometimes fatally mistaken, namely, the sulphates of magnesium and zinc : these leave white residues. A tea- spoonful of oxalic acid in small crystals weighs seventv-six grains, and half an ounce Crystals of;oxaiic Acid, -magnified ^^ ^^^ crystals is equivalent to three tea- spoonfuls. Tests. — 1. Nitrate of silver. — When added to a solution of oxalic acid, it produces an abundant white precipitate of oxalate of silver. A solution containing so small a quantity of oxalic acid as not to redden litmus-paper, is affected by this test ; but when the quantity of poison is small, it is advisable to concentrate the liquid by evaporation before applying the test. The oxalate of silver is identified by the following properties: It is completely dissolved by cold nitric acid. If collected on a filter, thoroughly dried, and heated on platinum-foil, it is dissipated in a white vapor with a slight detonation, and a residue of silver is left. When the oxalate is in small quantity, this detonation may be observed in detached particles on burning the filter previously well dried. 2. Sulphate of calcium. A solution of oxalic acid is precipitated white by lime-water and all the salts of calcium. Lime-water is itself objectionable as a test, because it is precipitated white by several other acids. The salt of calcium, which, as a test, is open to the least objection, is the sulphate. As this is not a very soluble salt, its solution must be added in rather large quantity to the su.spected acid poisonous liquid previously concen- trated. A white precipitate of oxalate of calcium is slowly formed. This precipitate should possess the following properties: 1. It ought to be immediately dissolved by nitric or hydrochloric acid. 2. It ought not to be dissolved by acetic or any other vegetable acid, or by ammonia. In orgariic liquids. — The process is the same, whether it is applied to liquids in which the poison is administered, or to the matters vomited, or, lastly, to the contents of the stomach. Should the liquid be very acid, we must filter it to separate any insoluble matters; should it not be strongly acid, the whole may be boiled if necessary with distilled water, OXALIC ACID, ITS DETECTION. 109 filtered, and concentrated by evaporation. To the filtered liquid, acidu- lated with acetic acid, acetate of lead should be added until there is no further precipitation ; and the white precipitate formed, collected and washed. If any oxalic acid was present in the liquid, it will exist in this precipitate as oxalate of lead. Diffuse the precipitate in water, and pass into the liquid a current of sulphuretted hydrogen gas for about half an hour, taking care that the gas comes in contact with every portion of the precipitate. Black sulphide of lead will be thrown down, and with it commonly the greater part of the organic matter mixed with the oxalate of lead. Filter, to separate the sulphide of lead ; the filtered liquid may be clear and highly acid. Concentrate by evaporation, when the sul- phuretted hydrogen dissolved in the liquid is thereby expelled, and oxalic acid may be ultimately obtained crystallized by slow evaporation in a watch-glass, or on a glass slide for microscopical observation. If crystals are obtained, they must be dissolved in water and tested in the manner above directed. As oxalic acid is very soluble in alcohol, this liquid may be occasionally employed for separating it from the contents of the stomach and from many organic compounds. Crystals may be obtained from the alcoholic solution, and these may be purified and tested by the methods already described. Owing to the effect of early vomiting and treatment, it is not usual to find much oxalic acid in the contents of the stomach. From milk, gruel, coffee, blood, mucus, and other viscid liquids, oxalic acid is readily separated by the process of dialysis, as described under sulphuric acid "(see p. 99, ante). The liquid should be first boiled — the coats of the stomach (cut up) being included, if necessary. The dis- tilled water placed on the outside of the tube will receive the acid. This may be concentrated by evaporation. Prismatic crystals may thus be procured, and the silver and sulphate of calcium tests may be applied. The presence of oxalic acid in an organic liquid may be detected by another dialytic method. Place a portion of the liquid containing the poison in a l)eaker, and insert in this a tube secured with skin or parchment-paper con- Fig- 3. taining a solution of sulphate of calcium. The oxalic acid will penetrate the mem- brane, and will form inside the mouth of the latter a deposit of crystals of oxalate of calcium, known by their octahedral form (Fig. 3). Sometimes the chemical evidence may depend on stains on articles of clothing. Oxalic acid discharges the color of some dyes, and slowly reddens others ; but un- less the stuff has been washed the acid remains in the fabric, and may there be detected. It does not corrode or destroy crystals of Calcium oxalate obtained the stuffs like mineral acids In "Reo- V by dialysis of Coffee containing Ox- Lue biuii line luuieicu duu^. au i\*i^. u. alic Acid, magnified 350 diameters. Morris (C. C. C, Dec. 1886) it was proved that the prisoner had attempted to administer a liquid poison forcibly to her daughter, a girl aged six years. It was sour in taste, made the girl's lips smart, and caused vomiting. There was dryness of the lips and in- flammation of the lining membrane of the mouth. No portion of the substance administered could be procured, but a crystalline deposit of oxalic acid was obtained from some stains ou the dress of the child. The woman was convicted. 110 SALT OF SORREL VEGETABLE ACIDS. [Oxalic acid cannot be detected in the blood; and if injected into a vessel it is so readily decomposed that it cannot be recognized even after a lew minutes. (Wharton & Stili^, Med. Jnr., 1873, p. 329.)] Acid Oxalate of Potassium, or Salt of Sorrel. — Symptoms and Effects. — This poisonous salt is much used for the purpose of bleaching straw and removing ink-stains, and is sold for this purpose under the name of essential salts of lemons. Its poisonous properties are not gen- erally known, or no doubt it would be frequently substituted for oxalic acid. Out of four cases of poisoning by this substance, three proved fatal, while in the other the patient recovered. In the case of recovery, a young lady, aged twenty, swallowed an ounce of the salt dissolved in warm water. She was not seen for an hour and a half, and was then found on the floor, faint and exhausted, having previously vomited considerably. There was great depression, the skin cold and clammy, the pulse feeble, and there was a scalding sensation in thi^ throat and stomach. There was also continued shivering. Proper medical treatment was adopted, and she recovered in two days, still suffering from debility and great irritation of the ston)ach. During the state of depression, it was remarked that the eyes Avere much injected and the pupils dilated. There was also great dimness of vision. (Med. Gaz., vol. 27, p. 480.) ■This salt destroys life almost as rapidly as oxalic acid itself; and in the symptoms which it produces it closely resembles that poison. In one case, half an ounce killed an adult in so short a time as eight minutes; but probalily the fatal effects were in this instance accelerated by the de- bilitated state of the person Avho took it. In another case death took place in ten minutes. (Ann. d'Hyg., 1850, vol. 1, p. 1()2.) In some instances this poisonous substance has been supplied b}^ mistake for cream of tartar, and has thus caused death. Chemical Anabjsis. — It is not very soluble in cold water, but its solu- tion may be readily mistaken for that of oxalic acid. The tests for oxalic acid may be applied for the detection of it in this salt. When a portion is heated, carbonate of potassium is left. Vegetable Acids. The vegetable acids, such as the acetic, tartaric, and citric, are capable of acting'as poisons. The editor has met with alarming laryngeal symp- toms, besides the local corrosive action, produced by the swallowing of acetic acid. Bayard and Devergie have recorded a fatal case of poisoning with tartaric acid. (Ann. d'Hyg., xlvi. p. 433.) In 1877 a woman, set 50, died in Sheffield from taking a quantity of aromatic vinegar. ALKALINE POISONING. HI CHAPTER IX. ALKALIES AND ALKALINE SALTS. POTASH, SODA, AND AMMONIA. NITRATE AND S5t.-, the i)ulse frecpient, full, and hard. These symptoms gradually abated, and she recovered, although the pain in the head and stomach continued for a long time. (Med. Gaz., xiv. p. 448 ) A woman took a mixture of the carbonate and sugar in repeated doses, but in unknown quantity. She died on the second day, having suffered from vomiting, purging, pain, and other symptoms of irritation. On inspection, the mucous membrane of the stomach and in- testines was inflamed. The carbonate was found in the stonuvch. (Brit. Med. Jour., 1877, 1. p. 888.) This salt is used as a poison for rats and mice. Analysis. — Chloride of hariuTii crystallizes in plates, and is soluble in water. 1. The solution yields a white precipitate with sulphuric acid or an alkaline sulphate. This precipitate is insolulile in nitric acid. 2. The powdered salt, burnt on platinum wire in a smokeless flame, imparts to it a greenish-yellow color. 3. Chlorine may be detected in it by a solution of nitrate of silver. Nitrate of barium reacts like the chloride with sul- phuric acid, and imparts a similar green color to a flame. It also yields the reactions of a nitric (see nitric acid, p. 103, ante). Carbonate of barium is a white insoluble powder, entirely dissolved with effervescence (carbonic acid) by diluted hydrochloric acid. On evap- oration, this solution yields crystalline plates of chloride of barium, which may be tested by the processes above described. CHAPTER X. PHOSPHORUS. RED PHOSPHORUS. SYMPTOMS AND APPEARANCES. CHRONIC POISONING. CHEMICAL ANALYSIS. Poisoning with phosphorus is not uncommon in this country, as the result of accident and suicide ; but homicidal poisoning by it is rare. The ordinary yellow or soluble phosphorus is alone poisonous ; the red, amorphous, or insoluble variety has been clearly proved not to be poisonous. It is usually given either in the form of vermin-killer or rat- paste — a mixture of yellow phosphorus, fat, flour, and sugar — or as tips of lucifer matches infused in some liquid. The smell of yellow phosphorus, its taste, the fumes which it gives off, and its luminosity in the dark, commonly reveal its presence. At the Norwich Aut. Ass., 1871 (Reg. v. Fisher), a girl of 18 was convicted of an attempt to poison a family. She put a vermin-compound containing phosphorus into a teapot with the tea. When hot water was poured on it, the smell produced at once led to sus- picion. Phosphorus was found in the tea, taken from a pot carelessly left about the house. The girl was convicted. Casper described a case in which the luminous appearance of the poisoned food led to a suspicion of poisoning with phosphorus, and this was subsequently proved. A woman put a preparation of phosphorus into some soup, and gave it to her hus- band. He ate it in a dark room in the presence of some friends, and they PHOSPHORUS — SYMPTOMS. 117 noticed that the liquid, as he stirred it, was luminous, (Yierteljahrsschr. f. Gerichtl. Med., July, 1864.) In this way a person may be warned and a life saved. (See Ann. d'Hyg., 1870, 2, p. 203.) Symptoms. — Phosphorus acts as an irritant poison, and also specifically. The symptoms of irritation may manifest themselves in a few minutes after the ingestion of the poison. In general, however, there is a longer interval of some hours. In the first instance, the patient experiences a disagreeable taste, resembling that of garlic, which is peculiar to this poison. An alliaceous or garlic-like odor may be perceived in the breath. There is pain and oppression in the region of the stomach, malaise, eruc- tation of phosphoric vapors having a garlicky odor ; and these may be luminous in the dark. Vomiting is sometimes frequent and violent ; in other cases quiet and at longer intervals. The abdomen is distended. Purging is not common. The vomited matters are coffee-colored, or yellow and bilious, and may be luminous. There is intense thirst. The symp- toms may increase in severity, ending in death from collapse in the course of a few hours — four to eight in the worst cases. Nevertheless, in the majority of cases the progress to a fatal termination, though no less sure, is slower and more insidious. The irritant symptoms in a great measure subside ; and, though the pulse is feeble and there is a certain amount of malaise, the patient may, to a casual observer, appear to be in an almost normal state of health. But after the lapse of three or four days, jaundice sets in and rapidly increases ; there is great pros- tration of strength ; the abdomen becomes distended; the liver is observed to be greatly enlarged, and vomiting of altered blood may come on, with intense thirst ; the skin is cold ; the pulse feeble, rapid, and perhaps im- perceptible at the wrist; the urine is scanty and high-colored, and contains casts from the kidneys. The feces, previously suppressed, are now more abundant and contain blood. Coma sets in, with jactitation of the limbs, or muscular twitchings ; and the patient succumbs, generally five or six days after the administration of the poison. A female, ast. 20, took several doses of phosphorus-paste ; the first on the evening of January 11, 1877. The dose was repeated twice on the 12th. The quantity of paste taken was of the size of a large cobnut, con- taining about two grains of phosphorus. On the morning of the 13th she retched, and at midday her appetite failed at dinner, and in the evening she vomited. At 10 P.M. on the 14th she was first seen by Tyson, about seventy-two hours after the first, and forty-eight hours after the last dose was taken. She had then an excited aspect, and her breath had a phos- phoric odor. There was tenderness over the region of the stomach. On the 15th there was faint yellowness of the conjunctivte of the eyes, slight pain in the stomach, and nausea, but no vomiting. The urine was high- colored and turbid. On the Ifith there was decided jaundice, great thirst, and prostration. There was still a slight garlicky odor of the breath ; but the urine and feces showed no luminosity. There was no obvious enlarge- ment of either the liver or the spleen. On the 17th the liver was en- larged ; only a very little dark-colored urine was passed ; and there was much epigastric pain and tenderness. In the evening there was slight delirium. From this time she gradually sank, and died on the 18th, nearly a week after the administration of the first dose of the poison. On post-mortem examination the liver was found to be of the usual size, but it had undergone extensive fatty degeneration, as had the heart also. There was no marked appearance in the stomach, which was almost filled with a blackish syrupy liquid. (Guy's Hosp. Rep., 1877, xxii. p. 452.) In 1876 a woman, and her daughter aet. 5, each drank some phosphorus- 118 piiosnioRus — CHRONIC poisoning. paste in warm water. The woman was seen four days later, apparently in her usual health. Subsequently she sickened, became jaundiced, and died, a week after the poison was swallowed. The child exhibited no symptoms till 7 A. M. on the day after taking the poison. She then vomited some slimy material, and her breath had a jiarlicky odor. In a few hours she was in a state of semi-collapse. Next day she became drowsy, then thirsty, restless, and vomited constantly. There was no jaundice. She died fifty-nine hours after the administration of the poison. On post-mortem examination, the heart was found to have undergone fatty degeneration, and it and the aorta exhibited ecchymosed patches. The stomach was considerably injected, and its surface was thickly coated with tenacious nniciis. The small intestine was much congested at its commencement, and to a less degree lower down. The liver weighed twenty-six ounces, was yellow, ansemic, and showed extreme fatty degeneration, except in isolated patches. In neither of these cases coufd the dose of phosphorus taken be ascertained. (Guy's Hosp. Rep., 1877, xxii. p. 449.) Chronic poisoning. — Phospho7'us-vapo7\ — Chronic poisoning by phos- phorus is accompanied by nauseous eructations, frequent vomiting, a sense of heat in the stomach, purging, straining, pains in the joints, wasting, hectic fever, and disease of the stomach, under which the patient slowly sinks. Some interest is attached to the chronic form of poisoning with phosphorus from the researches of Strohl and others on the effects of the vajwr upon persons engaged in the manufacture of phosphorus or liicifer matches. It has been remarked that such persons have suffered from necrosis of the jaw, carious teeth, and abscesses. There has been also great irritation of the respiratory organs, and bronchitis has frequently shown itself among them. (See On Poisons, 2d edit. p. 345.) Cases of chronic phosphorus-poisoning are now of great rarity, owing to the precautions adopted among workers in phosphorus to prevent the in- troduction of the poison into the system. The fumes of phosphorus pills may cause necrosis. Appearances. — Among the appearances produced by phosphorus are marks of irritation and inflammation in the stomach and intestines. The stomach has been found much contracted, and its mucous membrane inflamed, occasionally softened, and presenting purple or violet-colored spots. In one fatal case the body was found in a state of great muscular rigidity. The membranes of the brain were congested, and there was se'i-ous eff"usion between them. The heart was flaccid and nearly empty. The mucous membrane of the stomach, gullet, and small intestines was very red, and there were patches in which the membrane was destroyed. Wlien the stomach was opened, a white vapor escaped, accompanied by a strong smell of phosphorus. This organ contained a tablespoonful of a viscid greenish matter, from which particles of phosphorus with some Prussian blue (used as a coloring ^or the phosphorus-paste) subsided on standing. (Lancet, 1857, i. p. 600.) The mucous membrane has been found raised in small bladders or vesications, but this appearance was probably owing to putrefaction, as the body was not examined until twenty-three davs after death. Schuchardt describes the blood as dark and fluid, and it does not become red on exposure to the air. Ecchymoses are sometimes found on the skin, on the surfaces of various organs, and on the lining membrane of the aorta. (Brit, and For. Med. Rev., 1857, vol. 19, p. 50r); Jour, de Chim. Med., 1857, p. 84.) _ The most re- markable appearance met with in the acute form of poisoning is fatty degeneration of the vomntary muscles and other organs. PHOSPHORUS — FATAL DOSE. 119 In the case of a girl, aet. 13, who died on the sixth day after taking phosphorus-paste beaten up with egg, there were the usual symptoms, with severe paroxysms of vomiting and pain. The matters first vomited were observed to be luminous in the dark. There were numerous ecchymosed patches in the celhilar tissue of the skin of the abdomen over the rectus muscle ; these were also seen on the chest and on the dia- phragm. The stomach contained a dark-colored thick fluid, like altered blood; the coats were not inflamed; and the surface of the iunner coat was covered with a brownish-colored mucus which had no odor of phos- phorus. At the greater curvature the surface was dotted over with numerous small dark particles, consisting of coagula of altered blood adhering to the membrane, but easily removed from it. They had the appearance of effused coagula of blood, in petechial spots. The contents of the stomach owed their color to these little masses of blood being dis- seminated through them. The duodenum contained a similar liquid. The intestines presented no abnormal appearance. The liver was in an advanced state of fatty degeneration. This condition of the liver has occurred so frequently in cases of phosphorus-poisoning that it may be re- garded as one of the characteristic appearances. (Guy's Hosp. Rep., 1868, p. 242.) In a case recorded by Habershon (Med.-Chir. Trans., 185T, vol. 50, p. 87), in which a woman died on the fifth day, the symptoms and appearances were similar to those above described. The phosphorus was ta.ken in the form of paste, and it is supposed in a dose of from three to four grains. There was much ecchymosis in patches in and about the cellular tissue of the abdomen and chest. There was fatty degeneration of the liver and kidneys. The stomach contained a large quantity of fluid, like soot and water, and was covered with a tenacious bloody mucus. There was some congestion in the mucous membrane, and there was much redness with ecchymosis in the small intestines. The fatty degeneration induced by phosphorus is usually most marked in the liver, though it may extend to the kidneys, the heart, the glands of the stomach, to the muscular tissue generally, and the arterioles and capil- laries. The editor has seen considerable enlargement of the liver produced within forty-eight hours of the time at which the poison was administered. The liver is usually enlarged, doughy, anoemic, and of uniform yellow or yellowish-white color. The acini are distinct. Wagner describes an in- terlobular hypertrophy of the connective tissue. The hepatic cells are loaded with fat. The heart and muscles generally may be soft, yellow, and of defective tenacity. In place of transverse strife, innumerable fat- globules and granules of fat are seen w-ith the microscope. The gland- ular epithelial cells of the gastric follicles, and the cortex of the kidneys, may be filled with fat-globules. Occasionally the liver is of a deep yellow color, alternating with reddish patches, simulating acute yellow atrophy of the organ. The viscera and the flesh of animals recently poisoned by phosphorus have the peculiar odor of this substance, and if the case is recent they are luminous in the dark. (Galtier, Toxicol., vol. 1, p. 184.) In a case of a woman who died w^hile taking phosphorus medicinally it was remarked that the whole of the organs w'ere luminous ; thus indicating the diffusion of this poison by absorption. (Casper's Wochenschr., 1846, pp. 115, 135.) Fatal dose. — That phosphorus is a powerful poison is proved by two cases quoted by Christison. In one, death was caused by a grain and a half in twelve days ; in the other, by two grains in about eight days. The smallest fatal dose met with is in a case quoted by Galtier. A woman, a;t 52, took in divided doses, in four days, rather less than one 120 AMORPHOUS PHOSPHORUS. grain of dissolved phosphorus. The largest does taken at once, t. e. on the fourth day, is stated to have been half a grain. Symptoms of pain and irritation appeared, and the patient died in three days. The gullet, stomach, and small intestines were found much inflamed. (Toxicol., vol. 1, p. 87.) When the phosphorus is dissolved in a liquid, or when it is finely divided, as in phosphorus-paste or in lucifer-matchcs, its action is then more powerful, as it is in a state well fitted for absorption. In general several davs elapse before a case proves fatal. Orfila met with one which terminated fatally in four hours, and Ilabershon quotes a case which is said to have proved fatal in half an hour. (Med.- Chir. Trans., 1767, vol. 50, p. 92.) This is the most rapid case on record. Chemical Analysis. — Yellow phosphorus is a solid of waxy consistency, having a peculiar odor, and a taste resembling garlic. It is the odor and taste which prevent it from being criminally employed as a poison, and render it easy of detection in articles of food. It evolves a white vapor in daylight, and a faint bluish luminosit}" in the dark. It melts and takes fire at a temperature of 112° F., burning with a bright yellow flame, and producing white, opaque, acid vapors. It is not soluble in water, but it is dissolved by alcohol, ether, chloroform, and oils ; and especially by disulphide of carbon. The smell w^hich phosphorus imparts to solids and liquids is characteris- tic. When it has been taken in a solid form the particles may sometimes be separated as a sediment, by w^ashing the contents of the stomach with water. These may be melted under water into one mass, either by plunging the tube containing them into hot water or by pouring hot water upon them in a glass. If a portion of the organic liquid is evapo- rated to dryness in the dark, the particles of phosphorus will be easily recognized by their luminosity as well as by their combustion when the surface on which the material is spread is heated Owing to its great solubility in disulphide of carbon, phosphorus may be separated from many organic matters by digestion with this liquid. It is thus procured from flour and phosphorus-paste, or from the residue of the contents of the stomach after washing and decantation. On the spontaneous evaporation of the disulphide, decanted from the organic liquid or solid, the phosphorus may be procured in small globules or beads. These ignite when touched with a hot wire, and burn with the bright flame of phosphorus. Its vapor blackens nitrate of silver. If the phosphorus is in a state of solution or in too small a quantity to be dissolved out of the material by disulphide of carbon, its presence may be indicated by distilling the liquid containing it in the dark. The vapor appears luminous as it is condensed in a glass condensing-tube. So deli- cate is this process of distillation, which w^as first suggested by Mitscherlich, that in one experiment with the head of a single lucifer-match the lumi- nosity appeared for half an hour in the condensing-tube. Absolute darkness is required for the success of this experiment. When taken in the form of matches, portions of sulphur, vermilion, or Prussian blue may be found in the sediment. The substance known under the name of red or amorphous phosphorus is not possessed of poisonous properties. This fact, long since announced by Liebig, has been confirmed by experiments, which, however, need revision. It has been given to animals in doses of thirty grains without causing symptoms of poisoning. In 1860 a woman, a^t. 26, swallowed the composition scraped from a number of lucifer-matcbes made with amorphous phosphorus. She suffered no inconvenience. She procured iCDINE. 121 other matches of common phosphorus, took a decoction of them in coffee, and died from the effects. Amorphous phosphorus is easily recognized by its red color and in- fusibility at the temperature of boiling water. When a mixture contain- ing it is heated to about 500° F., it burns like common phosphorus, and yields similar products. It is insoluble in all liquids, and by its in- solubility in disulphide of carbon it is distinguished and separated from common phosphorus. It has neither color nor taste, and is not luminous in the dark. [Iodine. SijmjDtoms. — From experiments on animals, as well as from observations of its effects on man, iodine has a strong local action as an irritant on the stomach and bowels. In large doses, it occasions a burning heat in the throat, severe pain in the abdomen, with vomiting and purging, the vomited matters having the peculiar odor of iodine, and being of a yellow color, except when any farinaceous food has been taken, in which case they are blue, or even black. The fecal matters may also contain free iodine if the poison has been taken in the solid state. Besides these symptoms, there is a great thirst, with anxiety, headache, giddiness, trembling, and convulsive movements of the limbs, and fainting, these last symptoms indicating that the poison has become absorbed. When taken for some time in small doses, it gives rise to salivation, vomiting, purging, pain in the stomach, and cramps ; the pulse becomes small and frequent ; there is a general wasting of the body, and it has been observed that, in this form of chronic poisoning, certain glands are liable to become affected and diminished by absorption — the breasts in the female, and the testicles in the male. Iodine produces these secondary effects (iodisni), whether it is taken internally or applied externally. A woman swallowed by mistake one drachm of iodine dis- solved in an ounce of alcohol. When seen soon afterwards, she com- plained of a violent pain in the throat or stomach, followed by retching and slight vomiting ; the pulse was rapid and full, the eyes prominent and suffused. Vomiting, promoted by diluents, brought no relief to the symptoms. She became much depressed, and died on the following day. There was no examination of the body. (Prov. Jour., June 30, 1847, p. 356.) For a case of recoverv after half a drachm had been taken, see Med. Times and Gaz., 1861, 11. , p. 669. Iodine is rarely used as poison. In 1864 an attempt was made by a woman to poison a fellow-servant by mixing tincture of iodine with food in a plate. The remarkable discoloration of the farinaceous food which it produced led to suspicion and prevented any ill effects from following. Iodine gives a blue, green, or dark color to the most organic liquids, and imparts to tbem a peculiar odor. It stains the skin and other organic substances yellow, the color being removed by an alkali. When in strong solution, it is corrosive, and destroys the parts which it touches ; in this state it has been maliciously employed for throwing on the person. Appearances. — As this is an irritant as well as a corrosive poison, the lining membrane of the gullet, stomach, and intestines is found inflamed and excoriated. In one instance the mucous membrane near the pylorus was corroded, and detached in a space of two or three inches. Analysis. — The odor is in general suflicient to identify it. This may be concealed by alkalies or alkaline substances. When heated, it sublimes 122 IODINE. as a purple vapor. The addition of a cold solution of starch produces a blue color, but many substances prevent this reaction. It is very soluble in disulphide of carbon, forming a rich pink solution. The sulphide has the property of removing it from water or organic liquids in which it is dissolved. It mav thus be separated for chemical examination, by decanting the watery liquid from the sulphide, which, on evaporation, leaves the iodine in crystals. Chloroform, a good solvent of iodine, may be substituted for the sulphide.] ARSENIC — ACUTE POISOiJiJSa. ] 23 METALLIC IRRITANTS. CHAPTER XI. ARSENIC. ARSENIOUS ACID. — SYMPTOMSo — CHRONIC POISONING. APPEARANCES AFTER DEATH. FATAL DOSE. CHEMICAL ANALYSIS. ARSENITES. ARSENIC ACID. — ORPIMENT AND OTHER COMPOUNDS. Wliite Arsenic. — Arsenious Acid. — This substance, when freshly pre- pared by sublimation, exists in the form of vitreous or glassy arsenic in semi-transparent white masses, which gradually become opaque on ex- posure to air and light. More commonly it is met with in commerce as the white arsenic or arsenic of shops, in the form of a white powder, not unlike flour in appearance, but visibly crystalline when examined with a lens. It is almost tasteless, and hence may be readily introduced unper- ceived, and in large quantites, into most ordinary articles of food and drink. It is sparingly soluble in cold water, a wineglassful of which will dissolve a fatal dose ; but it is much more soluble in many other liquids. Arsenic, as it is sold to the public in small quantities, is required to be mixed either with l-16th part of its weight of soot, which gives to it a grayish color, or with l-32d part of its weight of indigo, and then it is blue. Sometimes, in place of indigo, ultramarine is improperly employed as a coloring. When ultramarine is used, the article is decolorized by all acid liquids, and by the gastric juice. Symptoms of Acute Poisoning. — The symptoms produced by this poison vary according to the form and dose in which it has been administered. The time at which they usually come on is generally in from half an hour to an hour after the poison has been swallowed; but they may appear earlier or much later. In a case in which sixty grains of white arsenic had been taken on an empty stomach, no symptoms appeared for two hours; in another, that occurred to Lachese, in which a large dose was taken, there were no symptoms for seven hours. (Ann. d'Hyg., 1837, vol 1, p. 344, See also Med. Chir. Rev., 1854, p. 294.) And in a third their appearance was protracted for ten hours. [Dr. Wood cites a case where a drachm had been swallowed, and the symptoms of poisoning- were delayed for sixteen hours. (U. S. Dispensatory, 1865, p. 26.)] The maximum period yet known is eighteen hours. (Seidel.) In all cases in which arsenic enters the system from without, as by its applica- tion to the skin, or to ulcerated or diseased surfaces, the symptoms are rarely manifested until after the lapse of some hours or even days. The person first experiences a feeling of sinking or faintness, depression, nausea followed by sickness, with an intense burning pain in the region of the stomach, usually but not invariably increased by pressure. The pain in the abdomen becomes more and more severe; and there is violent vomiting of a brown turbid matter, mixed with mucus, and sometimes .streaked with blood. These symptoms are followed by purging, which is more or less violent, and this generally accompained by severe cramps in the calves of the legs. At the trial of Mrs. Maybrick (Reg. v. Florence Maybrick, Liverpool Sum. Ass., 1889) the absence of cramps in the calves and tenderness at the pit of the stomach was asserted to negative the con- 124 ARSENIC. elusion that the deceased died from arsenic ; but the prisoner was convicted. [This case has given rise to a great deal of criticism. The verdict of the jury was contrary to the general volume of public opinion on both sides of the Atlantic, and so universal was the expression of dissent that Mr. Mathews, Q. C, then Home Sccretaiy, commuted the sentence to penal servitude for life, and the following announcement was made public as to the reasons: "We are given to understand that the Home Secretary, after the fullest consideration, and after taking the best medical and legal advice that could be obtained, has advised her Majesty to respite the capital sen- tence on Florence INIaybrick, and to commute the punishment to penal servitude for life ; inasmuch as though the evidence leads clearly to the conclusion that the prisoner administered and attempted to administer arsenic to her husband with intent to murder, yet it does not wholly exclude a reasonable doubt whether his death was in fact caused by the administra- tion of arsenic." Sir James Fitz James Stephen, who presided at that trial and who had later resigned from the bench, on account of alleged mental failure, had died, but was understood to have concurred in the commutation of the sentence. Mr. Leslie Stephen, his brother and biographer, in his work says : " The sentence was afterward commuted to penal servitude for life with Fitz James' approval and I believe at his suggestion, upon the ground, as publicly stated, that although there was no doubt that she administered poison, it was possible that her husband had died from other causes." And in a new edition of his General A^iew of the Criminal Law of England published some months after the trial, the judge describes the case of Mrs. Maybrick as the only one out of a large number tried before him in which there was " a doubt as to the facts." The American Govern- ment, taking an interest in the case by reason of the fact that the accused was an American citizen ; that the verdict was generally believed not to have been supported by the evidence ; and that she had not been fairly treated by the trial judge in his charge to the jury, had interceded in her behalf, and Mr. Lincoln, the American ambassador, had an interview with Lord Salisbury on the subject before the decision w^as publicly announced, and he reported to his Government as follows : " His Lordship at once replied that the sub- ject had been anxiously considered, and that he believed he could say that the death sentence would not be executed, as all the medical evidence attainable left a reasonable doubt as to the death having been caused by the arsenic administered by Mrs. Maybrick." (Med.-Legal Jour., vol. xiv. p. 495). Mrs. Maybrick was defended by eminent counsel (Sir Charles Russell, now the Lord High Chief Justice of England), and, in response to a very strong public sentiment, opinions were taken in April, 1892, by men of eminence at the English bar, upon a very full case carefully prepared by Messrs. Lumley & Lumley at the instance of friends of the accused. The following opinions were given : " Re Mrs. F. E. Maxjhriek. — Having carefully considered the facts in the elaborate case submitted to us by Messrs. Lumley & Lumley, and the law applicable to the matter, we are clearly of the opinion that there is no mode by which in this case a new trial, or a venire de novo, can be obtained, nor can the prisoner be brought up on a habeas corpus with the view of re-trying the issue of her innocence or guilt. We say this notwithstanding the case of Regina v. Scaife (17 Q. B., 238 ; 5 Cox C. C, 243, and 2 Drew C. C, 281). We are of the opinion that in English criminal procedure there is no possibility of procuring a rehearing in the case of felony where a verdict has been found by a properly constituted jury upon an indictment which is correct in form. This rule is, in our opinion, absolute, unless circumstances have transpired, and have been entered upon the record, which when there ARSENIC. 125 appearing would invalidate the tribunal and reduce the trial to a nullity by reason of its not having been before a properly constituted tribunal. None of the matters proposed to be proved go to this length. We think it right to add that there are many matters stated in the case, not merely with reference to the evidence at and the incidents of the trial, but suggesting new facts which would be matters proper for the grave consideration of a Court of Criminal Appeal if such a tribunal existed in this country. (Signed) C. Russj:ll, J. Fletcher Moulton, Harry Bodkin Poland. Reginald J. Smith. — Lincoln's Inn, April 12, 1892." " Re Mrs. F. E. Maybrick. — I agree with my learned friends that the evidence at the trial of this case did not justify the verdict, and I further think that this is a case where every possible means of procuring a rehear- ing should be resorted to ; but I am unable at the present period of English law to assent to their proposition that in a case of felony, even if it is assumed that there is an innocent woman in an English prison, the rules of criminal procedure debar the courts from applying any remedy unless some error making the trial itself a nullity can be shown to exist on the record ; and I moreover feel that such an avowal, if made, should be made in the form of a judgment of the court and not in the form of an opinion of counsel. In reference to the questions put to us by Messrs Lumley & Lumley in this case, I am of opinion that, assuming the facts of the case and irregularities of procedure, both by judge and jury, set forth in the instructions can be conclusively proved, the court should be invited ex dehito justitice to set aside the verdict and order a new trial, especially as there is no recorded case of a refusal by the courts to grant a new trial in a case of felony. While on the other hand, the case of Regina v. Scaife (17 Q. B., p. 258, and 18 Q. B., p. 773) stands unreversed, in which case the prisoners were convicted of felony at the assizes by a properly constituted jury upon an indictment which was correct in form, and where, notwithstanding this, the Court of Queen's Bench, consisting of four judges sitting in banco, ordered that the verdict be set aside and a new trial granted, and where the prisoners, having been again convicted at such new trial, underwent a fresh sentence of the law. I deem it therefore presumptuous in me, as counsel, to advise that any court would overrule that case, or would regard the rules of criminal procedure to be so inelastic as to compel the court, under such circumstances as those set forth in the instructions, to refuse to set aside the verdict and order a new trial, in Mrs. Maybrick's case, upon the bare ground that it is a case of felony. Having regard to the provisions of the Judica- ture Act, 1873, and the rules of the Supreme Court, I am of opinion that the High Court has jurisdiction to entertain an application for a new trial of a case tried at the assizes, which are thereby constituted a court of the High Court, inasmuch as there is now no necessity for having the case removed, by certiorari or otherwise, into the Queen's Bench previous to the making of such application. (See Regina v. Dudley, 14 Q. B., p. 280, and Mellor V. Royal Exchange Shipping Company, the Times' Reports, p. G63.) I am further of opinion that, in the event anticipated by my learned friends, of the court refusing to follow the precedent of the Scaife case, an applica- tion should be made to the court to follow the precedent of the Murphy case (L. R., 2 P. C, 535), where the record was allowed to be amended, and that the court should be asked on Mrs. Maybrick's behalf to direct that an entry of the conduct of the jury, and other irregularities mentioned in the instructions, be endorsed on the record (see 2 Hale's Pleas of the Crown, 308, where Lord Hale says that an irregularity ' is to be, as it ought to be, endorsed on the record'), and that this application should be made for the purpose of putting such an error upon the record as would form a founda- 126 ARSENIC. tion for a Avrit of venire cle novo. I am further of opinion that the advice given to the Queen by the Home Secretary as to exercising lier Majesty's prerogative on the ground that the evidence k;ft a reasonable doul)t whetlier his death was, in fact, caused by the achninistration of arsenic (which in this case is equivalent to a reasonable doubt whether murder had, in fact, been committed), and also the course taken in consequence of that advice, of ajiplying to and obtaining from the court an order under the provisions of 5 Geo. iV., cap. 82, directing that Mrs. Maybrick be kej)t in penal ser- vitude for life, are unconstitutional and that her imprisonment is consequently illegal ; and, therefore, that an application can be properly made for a writ of habeas corpus with a view to obtain her discharge on the ground that she is illegally detained. In reference to the special (|uestion put by Messrs. Lumley & Lumley thus : ' Does the evidence disclose any sufficient grounds for the statement made by the Home Secretary in his advice to the Queen — viz., the evidence leads clearly to the conclusion that the prisoner adminis- tered, and attempted to administer, arsenic to her husband with intent to murder?' I can, after careful perusal of the evidence, find no sufficient ground for such a statement, Avhich is, moreover, contradictory to the summing up of Mr. Justice Stephen, who pointed out (e. g., p. 36) — 'The theory is that there was poisoning by successive doses, but I do not know that there was any effort made to point out the precise times at which such doses may have been administered. A careful perusal of the evidence makes it clear to me that no such occasion of administration, or attempted administration, of arsenic by Mrs. Maybrick, whether with or without felonious intent, can be pointed out as would afford the Home Secretary any sufficient ground for the representation he made to the Queen ; and further, that the only ground to be found in the entire proceedings for such a repre- sentation is what Mr. Justice Stephen described as 'the theory' of the prosecution as distinct from 'the evidence.' (Signed) Alexander W. MacDougall. — Lincoln's Inn, April 12, 1892." (Med.-Legal Jour., vol. xiv. p. 508 et seq.) Dr. Harriet C. Keatinge of New York, in a paper read before the Medico- Legal Society of New York, carefully reviewed the evidence in the case regarding arsenic, in which she asserts that the death was clearly not due to arsenical poisoning, and that all the evidence, when carefully weighed, precluded the belief that the death was due to arsenic ; and that there was not sufficient evidence that it was or could have been administered to the deceased by her ; and quotes the views of the Home Secretary that " The evidence does not wholly exclude a reasonable doubt whether the death was in fact caused by the administration of arsenic," and she thus describes Maybrick's death from a careful study of the evidence : " That it was the inevitable result of a life of dissipation ; that he had been long addicted to taking arsenic and strychnine to tone up his system, which rendered him very susceptible to change of diet and atmosphere ; and when taken, after an exposure, with a chill followed by fever, pain, and vomiting, every atten- tion was given him ; and that, notwithstanding twenty-one different drugs were given him by his physicians, he lived thirteen days after the attack before he died." (Med.-Legal Jour., vol. xiv. p. 257.) the case is one that shows by the post-mortem, quite conclusively, that the death could not cer- tainly be ascribed to arsenic, from the very small amount found by the analysis ; and that the Home Secretary entertained grave doubts whether the death was due to arsenic. Great sympathy is felt everywhere in America for the prisoner, and a very general belief in her innocence of the crime for which she was convicted is entertained throughout the United States, and to a large extent in the British Islands.] A R S E N I C — C IIRONIC POISONING. 127 The matters discharged from the stomach and bowels in arsenic poisoning have had in some instances a yellowish color, as it was supposed, from a partial conversion of the poison into sulphide, but more probably from an admixture of bile. The vomited matters are in some cases colored with blood, and the mixture of blood with bile has often given to them a green, yellowy or brown color. In other cases they may consist of a large quantity of mucus ejected in a flaky state and having a milky-white appearance, as if from admixture with the poison. The color of the vomited matters may be blue or black when colored arsenic has been taken ; or the admixture of bile may render them of a deep-green color. The vomiting is in general violent and incessant, and is excited b}- any liquid or solid taken into the stomach. There is tenesmus Cstraining), and the discharges by the bowels are frequently tinged with blood. There is a sense of constriction with a feeling of burning heat in the throat, commonly accompanied by the most intense thirst. The pulse is small, very frequent, irregular, and sometimes wholly imperceptible. The skin is cold and clammy in the stage of collapse; at other times it is very hot. The respiration is painful from the tender state of the stomach. There is great restlessness, but before death stupor sometimes supervenes, with paralysis, tetanic convul- sions, or spasms in the muscles of the extremities.- In one instance trismus (lockjaw) appeared in three-quarters of an hour. (Orfila.) In another, severe and prolonged nervous symptoms, among the most prominent of which were epileptoid fits. (Marshall ) Although pain is in general among the early and well-marked s^^mptoms, arsenic appears in some cases to destroy sensibility. In a case in which the stomach was found intensely inflamed after death, the patient complained of no pain during the time which she survived. In some cases purging is absent. Should the patient live for a few days, paralysis is a not uncommon symptom, due to neuritis like that met with in chronic alcoholism. Melanosis has been rarely observed. (Correspondenzbl f. Schweizer Aertze, 1890, No. 15.) [Prof Reese, a very high authority, has said that cases of poisoning by arsenic present the greatest possible variety in the character, combination, and severity of the symptoms, most frequently being those jtist described. In a second class they present those of collapse, wnth extreme prostra- tion of strength, a cold, clammy skin, a frequent, almost imperceptible pulse, or one as low as thirty to forty beats per minute. A third class, marked by the patient falling into a profound sleep, which terminates in a fatal coma.] Chronic Poisoning, — Should the person recover from the first effects, and the case be protracted, or should the dose have been small and ad- ministered at intervals, there will be tarsal irritation, inflammation of the conjunctivfe, with sufi'usion of the eyes and intolerance of light — condi- tions which are, however, often present among the early symptoms above described. There is also irritation of the skin, accompanied by a vesicular eruption which has been called eczema arsenicale. Sometimes this has assumed the form of nettle-rash or of the eruption attending scarlet fever. These conditions may, however, not all be present. Local paralysis, preceded by numbness or tingling in the fingers and toes, and other symptoms of nervous disorder, are also common consequences. Exfoli- ation of the cuticle and skin of the tongue, and falling off of the hair, have likewise been witnessed. Salivation has been observed to follow, especially when small doses of the poison have been given for a length of time. (Med. Gaz., vol. xvi., p. 790.) Strangury and jaundice have been noticed among the secondary symptoms. (Marshall on Arsenic, pp. 44, 111.) At Hyeres, in 1888, an alarming outbreak of arsenical poisoning 128 POST-MORTEM APPEARANCES. occurred, the poison having been accidentally introduced into wine, which was drunk by many persons for a considerable time. The symptoms at the outset were those of dyspepsia, Avith nausea, vomitin- as to admit of medico-legal use in en- iil)Iin,<»- a medical man to distinguish poisoning from disease. It is to the stomach and intestines that he must look as the basis of reliable evidence in iregard to appearances after death. Wilkes has pointed out an ecchy- niosed condition of the lining mend)rane of the left ventricle of the heart in cases of acute poisoning- by arsenic; and this condition may be associ- ated with a general punctated ecchymosis of the pleura and peritoneum. The editor has seen the serous membranes generally presenting an appear- ance as if they had been sprinkled over with minute drops of blood ; this condition being- due to minute sub-serous extravasation of blood. In a few instances, the mouth, throat, and gullet have been found inflamed ; but in general there are no changes in these parts to attract particular attention. The mucous membrane of the smallintestines may be inflamed throughout; but commonly the inflammatory redness is confined to the upper part, i.e. the duodenum, especially to that portion of it which joins the stomach. Of the large intestines, the rectum appears to be the most prone to inflammation. In the case reported by Murray Thomson the intestines were normal, though the stomach was bright red and inflamed, with arsenic adherent to it. The liver, spleen, and kidneys present no {i]>pearances which can be connected with the action of arsenic, except occasional fatty degeneration (Reg v. Webster, Ed. High Ct. of Just., Feb. 1891), although these, like the other soft organs, may become recept- acles of the absorbed poison. It is worth}^ of observation, in relation to the known antiseptic properties of arsenic, that the parts especially affected by this poison (the stomach and intestines) occasionally retain the well- marked characters of irritant poisoning for a long time after death. Ab- sorbed arsenic does not, however, appear to prevent the decomposition of the soft organs in which it is deposited. That putrefaction is frequently retarded or arrested in the bodies of those poisoned by arsenic is generally admitted, and this may result in mummification. Schauensteiu, however, does not consider that retardation of putrefaction is proved, and still less mummification. We entertain no doubt as to the retardation, and mum- mification appears also to be a well-established fact. (See Kornfield in Friedreich's Blatter fiir Gerichtl. Med., 1885, p. 149.) A peculiar 3'ellow pigment is often observed in the intestines of bodies exhumed after arsenical poisoning. This has usually been ascribed to the formation of yellow sulphide of arsenic (orpiment). It may be due to this pigment, but Campbell Brown is of opinion that it is due to a peculiar alteration of the pigments of the bile. (Lancet, 1884, 1. p. 421 ; Brit. Med. Jour., 1884, i. p. 600.) Action of Arsenic through the Skin. — Arsenic may destroy life as the result of external application to the skin, to any diseased or ulcerated surface, or to a wound. (Guy's Hosp. Rep., 1864, p. 220.) Some im- portance is attached to this form of arsenical poisoning from the fact that the lives of many infants were, in 1878, destroyed by the use of a powder sold under the name of violet powder. Instead of employing pure starch in the manufacture of this powder, some makers have recommended as a substitute terra alba, or powdered gypsum. In the Bradford lozenge case (On Poisons, 3d edit., p. 354), arsenic had been substituted for terra alba, and caused the deaths of many infants by external application. In twenty- 9 130 ACTION THROUGH THE SKIN — FATAL DOSE. eight cases in which this powder had been used to infants, there were twelve or thirteen deaths. (Brit. JMed. Jour., 1878, i. p. 7*)5.) It set up intlauiniation and irritation in the skin, and was then al)sorbed. In one case the child was washed and then dusted over with this poisoned powder, which was also applied to its jicnital organs. On the second day after birth the ])Owder was applied four times. There was at this time an un- natural redness of the skin. On the third day the skin was intensely red, and appeared unhealthy about the navel and vagina. The powder was then withdrawn, but the eruption became worse, and in some parts the skin had a slough}' appearance. On the tenth day of the child's life, and on the sixth day from the last application of the powder, the child died from the effects of the absorbed poison. On a post-mortem examination there was nothing remarkable in the condition of the viscera. The body was buried, but exhumed twenty-one days after death for examination. Tidy found in the liver 1.5 grain of arsenic, in the stomach and intestines one grain, and in the kidneys traces. The powder used, which should have consisted of starch and magnesia, with orris root, contained 38.5 per cent, of white arsenic, with starch and magnesia. (Lancet, 1878, ii. p. 250.) For one of the deaths thus caused the vendor of the powder was tried on a charge of manslaughter (Reg. v. King, C. C. C, 1878), but acquitted ; and it was thus decided that there was no criminal neglect or culpable ignorance in a drysalter not being able to distinguish arsenic from plaster of Paris. It was simply a case of caveat emptor. (Pharm. Jour., Aug. 1878, p. 119.) The smallest fatal dose of arsenic hitherto recorded is two gr^ains. (Prov. Med. Jour., 1848, p. 347 ; also, Med. Gaz., vol. 39, p. 116.) Under circumstances favorable to the operation of this poison, the fatal dose in an adult may be assigned at from two to th7'ee grains, though one grain may perhaps kill. The editor has seen a case of arsenical poisoning in which repeated three-quarter grain doses of w^hite arsenic, given with homicidal intent, were followed, after the usual symptoms, by general paralysis, beginning in the lower extremities, and gradually creeping up- wards till the lower intercostal and other respiratory muscles were affected. Large doses of arsenic commonly destroy life in from eighteen hours to three days. The average time at which death takes place is twenty-four hours ; but the poison may destroy life within a much shorter period. In one case death took place in two hours and a half. (Guv's Hosp. Rep., 1851, 183. See also Ann d'Hyg., 1837, vol. 1, p. 339.) Foster met with the case of a child under three years of age, that from the effects of arsenic died within two hours. Finlay met with a case which proved fatal in one hour. (Lancet, 1883, ii. p. 943.) One (a doubtful) case is said to have proved fatal in twenty minutes. On the other hand, life is occasionally protracted for many days. In 1847, a man who had swallowed 220 grains of arsenic was admitted into Guy's Hospital, and died on the seventh day. In the case of Dr. Alexander, death took place on the sixteenth day ; and though a lai'ge quantity of arsenic had been taken, no traces were found in the body. (Med. Times and Gaz., 1857, i. p. 389.) In an instance in which arsenic was applied externally to the head, the person did not die until the twentieth day. Chemical Analysis. — Arsenic as a solid. — In the simj^le state, ivhite arsenic may be identified by the following properties: 1. A small quan- tity of the powder, placed on jilatinum-foil, is entirely volatilized at a moderate heat (about 400° F.). If a small jDortion of the white powder is very slowly heated in a glass tube of narrow bore, it will be sublimed Avithout melting, and form a ring of minute octahedral and tetrahedral A R S E N I C — C IIEMICAL ANALYSIS. 131 Fig. 4. crystals, remarkable for their lustre and brilliancy. Under a microscope the appearance of these crystals is highly characteristic (Fig. 4). 2. Ou boiling a small (piantity of the powder in distilled water, it is not readily dissolved, but it partly floats in a sort of film, while a part becomes aggregated in small lumps at the bottom of the vessel. It requires long boiling in order that it should become dissolved and equally diffused through water. 3. It is not perceptibly altered in color when moistened with a weak solution of sul- phide of ammonium. 4. When a small portion of the white powder, i. e. from one-fourth to one-twentieth part of a grain, is heated with two parts of soda-flux (obtained by incinerating acetate or tartrate of sodium in a closed vessel) in a glass tube about three inches long and from one-eighth to a quarter of an inch in diameter, it is decomposed : a ring of metallic arsenic of an iron-gray color is sublimed and deposited in a cool part of the tube. In place of soda-flux a mixture of one part of C3'anide of potassium with three parts of dry (anhydrous) carbonate of sodium may be employed. During the reduction there is a perceptible odor, resembling that of garlic, wdiich is possessed by metallic arsenic only wiiile passing from a state of vapor to arsenious acid. In this experiment of reduction, there are frequently two rings deposited in the tube — the upper and larger ring has a brown color, and appears to be a mixture of finely-divided metallic arsenic and arsenious oxide ; the lower ring is small, and consists of the pure metal. The appearances presented by these sublimates are indicated in the annexed illustration (Fig. 5). By heating gently the tube containing the sublimate Ficr. 5. Crystals of Arsenioiis Acid by sub]i~ mation, luagnitjed 30 diameters. Reduction-tube, with two sublimates: the upper, brownish black ; the lower, the pure metal in an annular deposit. (reduced to powder) in another tube of larger diameter, the metallic arsenic, during volatilization, forms octahedral and tetrahedral crystals of arsenious acid, which, after examination by the microscope, may be dis- solved in a few drops of water and tested by one or two more of the liquid reagents. The metallic sublimates, or the crystals produced from them, may be further subjected to the following process : Break the glass on which the sublimate is deposited into fragments, and digest these in a few drops of the strong nitric acid previously proved to be free from arsenic. The sub- limate is thereby converted into arsenic acid. The acid solution should be evaporated to dryness, and the white residue obtained dissolved in a few drops of distilled water, and a strong solution of nitrate or of ammouio- nitrate of silver added in small quantity to the residue. A brick-red color- ation indicates arsenic acid, and thus proves Incontestably that the subli- mate was of an arsenical nature. The upper or brownish-looking sublimate may be readily converted into one of the metal by gently heating it in the flame of a spirit-lamp. 132 TESTS F 11 A R S E ^M (' 1 X S L I' T I N , Arscnions acid is then volatilized, and an iron-jiray deposit of the less volatile metallic acid a])i)ears. If the lioat is continued, tli»' whole of the metallic snl»limate is volatilized and deposited in a cool ]»art of the tuhe in transparent and colorless oetahedra of arseni(»ns acid. This is the s]»eeial character of an arsenical sublimate; it iiia\ he thus distiiijifuished from sul)limates of all metals or metalloids. The lower metallic sublimate ])ro- cured by reduction sometinies presents itself, not in an annular iorm, but in detached particles of an irreresenting triangular surfaces when viewed by reflected light (see Fig. 6). 1. Silver Test. — On adding to the solution of white arsenic ainmonio-nitrate of silver, a pale-yellow precipitate of arsenite of silver falls. The test is made I)y adding to a strong solution of nitrate of silver a weak solution of ammonia, and continuing to add the latter until the brown oxide of silver at first thrown down is almost redissolved. The yellow precipitate is soluble in nitric and acetic acids, as well as in ammonia. 2. Copper Test. — On adding to another i)or- tion of th(^ solution (uinnouio-suJpIiafe of co]>- per, a light-green precipitate (arsenite of eo])per) is formed, the tint of which varies according to the ])roportion of arsenic present and the (piaMtity of the test added ; hence, if the arsenic is in snuill i)roportion, no green precii»itate at first ai)i)ears, and the liquid simply ac(piires a bhu; color from tlu^ test. In less than an hour, if arsenic is present, a bright-green deposit is formed, which may be easily .separated from the blue licpiid by decantation. This test is mad(^ by adding ammonia to a weak solution of sulphate of copper, until the bluish-white precipitate at first i)roduced is nearly redissolved. It should not be used in large quantity if concentrated, as the deep blue color tends to ob.scure or conceal the green precipitate formed. The dried precipitate of arsenite of copper, when slowly and moderately heated in a well-dried reduction-tube, will yield a ring of octahedual crystals of arsenious oxide, Fis Crystals of Arsenious Acid, from a solution, luagnitied 124 diameters. MAILS II ,S PROCESS. 133 Fix. 7. 3. Sulphuretted Hydrogen Test. — The gas procured by addinjr to ferrous sulphide, in a proper apparatus, a mixture of one i)art of strong sulphuric acid and eight part of water, is washed by passing it through a little water made faintly alkaline with soda. The arsenical li(|uid should be slightly acidulated with jjure diluted hydrochloric acitl before the gas is passed into it. A yellow precipitate of sul])hide is produec'd if arsenic is present ; and it may be c(jllected by subsidence. It is known to be sul- phide of arsenic by the following properties : 1. It is instduble in water, alcohol, and ether, as well as in diluted hydrochIf)ric acid ; but it is decom- posed by strong nitric and nitro-hydrochjoric acids. 2. It is ininiediately dissolved by potash, soda, or ammonia, forming, if no organic matter is present, a colorless solution ; also by sulphide of ammonium. 8. When dried and heated with three parts of soda-flux, or an equal part of dry C3'anide of potassium, it yields a sublimate of metallic arsenic. 4. Marsh''s Process. Nascent Hydrogen Test. — The action of this test depends on the decomposition of arsenious acid and its soluble compounds by na.scent hydrogen, evolved from the action of diluted sulphuric or hydrochloric acid on zinc. The material should always be first proved to be free from arsenic. The apparatus used is so well known as to need no description or illustration. The arsenic may be introduced in the state of powder ; Ijut it is far better to dissolve it in water by boiling, either with or without the addition of a few drops of hydrochloric acid. The arsenic combines with X\\i\ hydrogen, forming arsenetted hydrogen gas, which possesses the following properties: 1. P"'ilter-))aper wetted with a solution of nitrate of silver is immediately blackened by the gas, and lead-paper is not changed in color. 2. It burns with a pale bluish-white flame, and thick, white smoke (arssenious acid) is evolved. 3. A slip of glass or of white porcelain held in the flame near the point (for not too long a time) acquires a dark stain from the deposit of metallic arsenic upon it. This deposit presents a metallic lustre in the centre (Fig. 7, a), a white film of arsenious acid on the outside (c), and between the two a dark ring of a pulverulent substance (b), which, when viewed b}^ transniitted light, is hair-brown in color towards i\w. margin, but opaque in the centre. In order to determine the ar.s(Miical nature of the dettosits, the following plan may be adopted. Several of the deposits should be received and accumu- lated in small porcelain capsules, held in the flame of the burning gas. To one, add a solution of chhjrinated soda: the arsenical deposit is immediately dissolved. To a .second, add a solution of sulphide of ammonium: the metallic deposit is detached, but not perfectly dissolved; and on evaporation it yields a pale-yellow film of sulphide of ansenic. To a third, add a few drops of the strong nitric acid. The deposit is dissolved. Evaporate the acid solution gently to dryness, carefully neutralize the residue with ammonia, and add one or two drops of a solution of nitrate of silver: a Ijrick-red stain or a dark-red precipitate of arsenate of silver will be produced. 5. Iteinsch^s Process. — In the application of this process, the liquid suspected to contain arsenic, or the solid dissolved in distilled water, is boiled with from one-sixth to one-eighth of its bulk of pure hydrochloric acid (proved to be free from ar.senic), and a small slip of pure copper is Deposit obtained by Marsh's Apparatus. A, Metal. B, Mi xed deposit. C. Arsenious Acid. 134 ARSENIC REIN sen's PROCESS. then introduced. A slip of polished copper-foil (electrolytic copper) about a quarter of an inch square, attached to the end of a thin platinum wire, may be employed for the experiment. The copper must be first proved to be free from arsenic, as this is a very common contamination of all comnun-cial copper in the form of foil, gauze, or wire. Copper of a high degree of purity is, however, now a commercial article. If arsenic is present in the liquid, even in small quantity, the polished copper accpiires, either immediately or within a few minutes, a dark iron-gray coating from the deposit of this metal. This is apt to scale off" if the arsenic is in large quantity, or if the liquid is very acid or long boiled. Remove the slip of copper,\vashitin water, dry it, and gently heat it in a small reduction-tube, when arsenious oxide will be sublimed in minute octahedral or tetrahedral crystals ; if these should not be apparent from one piece of copper, several may be successively introduced. When the quantity of arsenic is small, the polished copper merely acquires a faint blue or grayish tint. The deposit is in all eases materially affected by the degree of dilution, and sometimes it will appear only after the liquid has been much concentrated by evaporation. The presence of arsenic as an impurity in copper may be detected by the following method suggested by Abel. Add to pure hydrochloric acid, diluted with six parts of water, one or two drops of a weak solution of ferric chloride. Boil the acid liquid and introduce the copper, well cleaned and polished, into the boiling liquid. Arsenical copper soon acquires a dark tarnish, while the non-arsenical copper retains its red color under these circumstances. [The late Prof. Theo. G. Wormley of Philadelphia demonstrated the fallacy of this test for arsenic. (It has for many years been taught in the schools and regarded by all chemists as a crucial test for arsenic.) Prof. Wormley obtained octahedral crystals fi'om antimony by Reinsch's process, which he announced through the American Journal of the Medical Sciences. Dr. D. Benjamin of Camden, New Jersey, produced as a witness for the defence in the case of People v. Emma Bethel, charged with murder by poisoning, octahedral crystals, made by himself by Reinsch's process from antimony, which were shown to the chemist for the State, who pronounced them arsenic, not knowing of the fallacy in the test. It resulted in an acquittal at once. (Med.-Leg. Jour., vol. xiv. No. 1, p. 81.)] Arsenic in liquids containing organic matter. — Arsenic may exist in an insoluble form — i. e. as a crystalline powder — in the contents of the stomach or any liquid article of food. If coarsely powdered, it may be separated as a heavy sediment by carefully washing with distilled water, and then dried and tested by the reduction process (p. 131). Any liquid for analysis should be strained through muslin, or filtered through paper, in order to separate all insoluble matters; these should be M^ell pressed and drained. Should the liquid be colored, this is of little moment, provided it is clear. If viscid, it should be diluted with water and boiled Avith a small quantity of hydrochloric acid ; on standing, a deposit may take place, and this should be "separated by a filter. As a trial-test, we may now boil a slip of pure polished copper in a portion of the liquid acidulated with pure hydrochloric acid, and examine any deposit on the metal by the method of Reinsch above described. If the copper comes out unchanged, there is no consideral)le quantity of arsenic present. When arsenic is present in an organic liquid in large quantity, it may be precipitated as sulphide by a current of washed sulphuretted hydrogen. The liquid should be boiled, filtered, and acidulated with hydrochloric acid before passing the gas into it. When ))recipitation has ceased, the liquid should be again filtered, the precipitate collected, dried, and weighed. By SEPARATION OF ARSENIC BY DISTILLATION. 135 operating on a measured portion of the solution, the amount of white arsenic present may be determined by the weig-ht of the sulphide obtained — five parts by weight of sulphide being- very nearly equal to four parts of white arsenic. The properties of the yellow precipitate should be verified according- to the directions given at p. 134. Distillation Process. — When the poison is in so small a quantity that it does not admit of precipitation by sulphuretted hydrogen, and no solid particles of arsenic are found in the stomach, in its contents, or in any article of food, another method may be resorted to for detecting its pres- ence. This method equally applies to the detection of arsenic deposited Fig. 8. Apparatus for distilling organic and mineral substances containing arsenic as a result of absorption in the soft organs of the body, as in the liver, kidney, or heart, and to arsenic in all its forms, except the pure insoluble sulphide or orpiment. The substance, whether food, blood, mucus, the liver or other organ, should be first thoroughly dried, either in vacuo, in a current of dry air, or in a water-oven. The dried solid should then be broken into small portions and placed in a flask or retort of sufficient capacity, with enough of the strongest hydrochloric acid (free from arsenic) to drench it completely. After some hours' digestion in the cold, the retort or flask («, Fig. 8) containing the mixture — which should be of such a size that the materials should not fill it to more than one-third or one-half of its capacity — should be fitted with a long condensing-tube (e) (or a Liebig's condenser may be used), and then gradually heated by a sand-bath until the acid liquid begins to pass over. A metallic head, formed of a cone of tin-plate or sheet-copper should be placed over the retort or flask so as to concentrate the heat and prevent condensation in the upper part of the vessel. A small flask receiver (d) with a loosely fitting cork may be employed to collect the product. This should contain a small quantity of distilled water, so as to fix and condense any acid vapors that may pass over. The receiver, as well as the condensing-tube, should be kept cool by wetting its surface with cold water diffused on a laj^er of blotting-paper placed over it. A perfect condensation of the distilled liquid is insured by this arrangement. The distillation may be carried to dryness, or nearly so, on a sand-bath ; and it is advisable, in order to insure the separation of the whole of the arsenic as chloride, to add to the residue in the retort when cold, another portion of pure and concentrated hydrochloric acid, and again distil to dryness. By this pro- cess arsenic is at once separated from every metal excepting antimony, and these metals may be easily distinguished by tests applied to the dis- 136 CONVERSION OF ARSENIC INTO CHLORIDE. tillate. If a little pianoforte wire be dit^solved in dilute hydrochloric acid, and then added to the solution in the flask, no antimony will pass into the distillate. The liijuid product may be colored, turbid, and hi.iihly offensive if dis- tilled from decomposed animal matter. E.xposure to the air for a few hours sometimes removes the offensiveness, and there is a precipitation of sulphur or of some sulphide of arsenic. The distillate may be separated from any deposit by filtration, and, if still turbid, it may be redistilled to separate it from any organic matter that may have come over. If there is a yellow deposit, it should be examined for sulphide of arsenic. If" arsenic is present in the substance submitted to distillation, the dis- tillate will contain arsenic in the form of soluble chloride: this does not volatilize from a diluted solution at common temperatures. The quantity of dry organic substance used in the experiment must depend on the quantity of arsenic present, as revealed by a preliminary trial with Reinsch's process. If large, one-third of an ounce of the dried substance, or even less, will yield sufficient chloride of arsenic for further proceed- ings. For the absorbed and deposited poison, half an ounce of the dried organ, corresponding to two ounces of the soft organ, will frequently suf- fice ; but a negative conclusion of the absence of arsenic should not be drawn from a smaller quantity than from two to four ounces of the dried substance, whether liver, kidney, or heart. These tissues, it 'must be remembered, contain about 76 per cent, of water. If oily matter should be distilled over, this may be separated by passing the distillate through a paper filter wetted with water. The distilled liquid, containing chloride of arseyiic, should be submitted to a further analysis. For this purpose one-third of it should be diluted with three or four parts of water and boiled in a clean flask. When boil- ing, a piece of bright copper-foil (free from arsenic), about 1-1 6th of an inch square, should be introduced. If there is chloride of arsenic in the liquid, even the l-4000th of a grain, its presence will be indicated by a change of color and by the deposit of a dark metallic film on the cop|)er. If the quantity of arsenic present is believed to be very small, the surface of copper introduced should be proportionately small. Another portion of the distilled liquid added to the stannous chloride and boiled (see p. 132) will give a brown color or a brown precipitate, according to the quantity of arsenic present. If this is large, a dark mirror-like laA'er of metallic arsenic is deposited on the inside of the tube. The remaining two-thirds of the distilled liquid, sufficiently diluted, should now be intro- duced into a Marsh's apparatus, or into an evolution-flask provided with a funnel-tube, the capacity of which must be regulated by the quantity of acid liquid to be examined. The kind of apparatus employed in this stage is represented in the engraving (Fig. 9, below): A the flask, with funnel-tube B, and connecting-piece c ; the funnel-tube should be long enough to dip just below the surface of the acid liquid. The short con- necting-piece is bent at a right angle, and, like d, is carried through a closely-fitting cork in the neck of the flask. This tube should be only long enough to go through the cork, and its open end should be bevelled off so that any vapor which is condensed on it may drop back as a liquid into the flask. D is the drying-tube containing fragments of spongy chloride of calcium, secured by cotton wool at both ends. At the flask end of this tube should be placed some well-dried bibulous paper saturated with acetate of lead. This has the advantage of stopping any gaseous sulphur compound which may escape from the zinc or acid liquid. E E, a hard and not easily fusible glass tube, free from lead, contracted in two REDUCTION OF CHLORIDE, 137 situations, k k', to about the diameter of the tenth of an inch or less, the tube itself having a diameter of from a quarter to three-eighths of an inch. ■E F are supports made of stout wire, to prevent the tube from falling- when Fig. 9. Apparatus for testing Chloride of Arsenic obtained by distillation. FiK. 10. Portion of tube separated with a deposit of Metallic Arsenic in the contracted portion. heated to redness, g is a test-glass to hold one or two fluid drachms of a strong solution of nitrate of silver, h is a Bunsen burner ; or a spirit-lamp may be used. The arrangement being thus made, the zinc and hydrochloric acid are first tested as to their freedom from arsenic. Portions of pure zinc are placed in the flask A, the parts of the apparatus are then connected, an-d pure hydrochloric acid, diluted with three or four parts of water, is poured into the flask by the funnel b, which operates as a safety-valve. Bubbles of air and gas speedily appear in the liquid in G, if the cork fits well and the whole of the arrangements are air-tight. Pure zinc is sometimes but imperfectly acted on by the acid. In this case some clean platinum wire or foil may be wound round the bars of the zinc, and the evolution of hydrogen will be thus accelerated. It is, however, better that the hydro- gen should come off rather slowly. If the materials are pure, the solution of nitrate of silver should undergo no change of color. The glass G should be placed on a sheet of white paper, whereby the slightest tinge of brown or black is made perceptible. When all the air is expelled from the tube, the smokeless flame H may be applied to it at about one inch in front of a contraction of the tube," as indicated in the engraving, and the glass heated to redness. No metallic deposit should take place at k. If the materials are quite pure, the transparency of the glass tube at k will be unchanged. From a quarter to half an hour will be sufficient for this experiment. Now add to the acid liquid in the flask A a portion of the liquid obtained by distillation. The presence of arsenic in this will be immediately revealed by the silver solution in the glass G acquiring a brown or black color, according to the quantity of arsenic present, and at the same time deposits of metallic arsenic may be obtained by heating the glass tube E e. The silver solution is allowed to become saturated with the gas. Any escape of the gas from the glass, or by leakage from any of the junctions of the apparatus, is at once indicated by holding near to the spot filtering- paper wetted with nitrate of silver. This is blackened if arsenic is 13.S ARSENIC IN ORGANIC LIQUIDS AND SOLIDS escapin,":. The glass with the silver solution is removed, the end of the tube well washed, or another tube substituted for e e, and this is allowed to dip into about one drachm of fuming nitric acid in a test-glass similar to G, or in a small porcelain capsule. After a time the acid loses its color, and the arsenic of the gas is converted into arsenic acid, which may be obtained by evaporation.. The further testing of the products is simple, 1. The silver solution contains arsenic in the state of dissolved arsenious acid, with some excess of nitrate of silver. By filtration it is obtained colorless and clear. A weak solution of ammonia is then added to it, and n'cIIow arsenite of silver is precipitated (see p. 132). 2. The nitric acid li(|uid is evaporated to dryness in a small porcelain capsule. One or two drops of water are added to the residue, with a drop of weak ammonia if it should be very acid. A solution of nitrate of silver is then added to it; arsenate of silver, of its well-known brick-red color, is immediately produced. 3. The portions of tube k k' with the metallic deposits in them may be separated by a file, and then hermetically sealed ; or, if necessar}^, one or more of them may be tested by the methods described on pp. 133, 134. With these results the evidence of the presence of arsenic may be con- sidered to be conclusive. The poison is obtained by this process, not only in its pure metallic state, but in the distinct two forms — arsenious and arsenic acids. It will be observed that the process here employed is an improved form, in which the burning of the gas is unnecessary. The editor prefers to precipitate the liquid in the receiver, after dilution with water, by means of a stream of sulphuretted hydrogen gas, and to collect, wash, and dry the precipitate. It is then mixed with a dry flux of carbonate of sodium and cyanide of potassium, and introduced into a hard narrow glass tube, through which a stream of drij carbonic acid gas is passing. On applying heat to the mixture of yellow sulphide of arsenic and flux, a fine sublimate of metallic arsenic is obtained, even with a minute trace of arsenic ; and to this sublimate appropriate tests can be applied (see p. 133). ReinscIVs process can be employed for detecting arsenic, deposited as a result of absorption, in the liver, kidneys, or other soft parts. About four ounces of the organ, or more if necessary, cut into I'^'g- 11' small pieces, may be boiled in a flask in a mixture of one part of pure hydrochloric acid and four of water, until the structure of the organ is broken up. The flask may be of the shape represented in the annexed engraving (Fig. 11), and either a naked flame or a sand-bath may be emplo^^ed. A small glass funnel should be placed in the neck of the flask. This receives and condenses the vapors, which fall back into the flask. By this arrangement the boiling may be continued for a long time without material loss by evaporation. The flask should not be more than half full, ^^^_^ and heated gently until all froth is expelled. A fine plati- Fia^Teii] .loved ii 1^^™ wire, having a small piece of pure copper-foil, should the analysis of be immersed in the liquid when boiling. This enables Eeinseh^r prcf- ^^^ Operator to remove the copper and examine it at in- cess. tervals, after immersing it in distilled water. If it is much coated with metallic deposit, larger portions of cop- per-foil may be successively introduced until the liquid is exhausted. The deposit on the copper may then be tested by the method described at p. 134. The deposit is permanent. Some copper gauze on which arsenic had been thus deposited was examined after twenty-five years, and, al- ARSENITE OF POTASSIUM. 139 though much changed in appearance by exposure, it yielded a perfect sub- limate of octahedral crystals. It need hardly be observed that the quantity of arsenic found in the stomach or other organs can convey no accurate idea of the quantity actually taken by the deceased, since more or less of the poison may have been removed by violent vomiting and purging as well as by absorption and elimination. A large quantity found in the stomach or bovv-els indi- cates a large dose; but the finding of a small quantity does not prove that the dose was small. The value of chemical evidence does not depend on the discovery of any particular quantity of poison in the stomach — it is merely necessary that the evidence of its presence in the body should be clear, distinct, conclusive, and satisfactory. At the same time, a reas- onable objection may be taken to a dogmatic reliance upon the alleged discovery in a dead body of minute fractional portions of a grain ; and, considering the great liability to fallacy from the accidental presence at that date of arsenic in the articles used for its detection, the chemical evi- dence in the French case of Madame Laffarge (1840), in which the whole quantity discovered in the dead body was stated to be the l-130th part of a grain, was of a most unsatisfactorv kind, and should have been re- jected. No man ought to base evidence on such a minute quantity of poison in a case of life and death. The condition of the arsenic found in a stomach should be specially noticed. A witness should be prepared to say whether it is in fine powder or in coarse fragments ; whether it is mixed with soot or indigo, or whether it is in the ordinary state of white arsenic. These points may be material as evidence in reference to proof of possession, of purchase, or administration. Arsenic is not a normal constituent of the human body. Under no circumstances is it found in the tissues after death, except in cases in which it has been taken or administered during life. Arsenite of Potassium. Liquor Arsenicalis. (Fowler's Solu- tion.) — Symptoms and Appearances. — There is a case recorded in which this medicinal solution destroyed life. A woman took half an ounce ( = two grains of white arsenic) in divided doses, during a period of five days, and died from the effects. There was no vomiting or purging, but after death the stomach and intestines w^ere found inflamed. (Prov, Jour., 1848, p. 347.) A mixture of arsenic, soft-soap, and tar-water is largely used in agricultural districts for killing the fly in sheep. This has caused death, under the usual symptoms of arsenical poisoning, in at least two instances. In 18':4 the Coombs family, consisting of eight persons — the father, mother, and six children — were all poisoned by drinking water from a bucket which had contained an arsenical sheep-dipping composi- tion. The mother and three of the children died. The symptoms pro- duced were unusual — diarrhoea being a less prominent symptom than vomiting. The poison appeared to exercise a profound impression upon the nervous system, producing tetanic spasms and convulsions. An arsenical rash was a characteristic of the severest and fatal cases. In the bodies of the mother and one child the editor detected arsenic. The bodies of the other two children were not examined for poison. Analysis. — The solution has the odor of tincture of lavender, is of a reddish color, and has an alkaline reaction. One fluidounce of it contains 4^ grains of arsenious oxide. It gives a green precipitate (arsenite of copper) with sulphate of copper and a yellow precipitate with nitrate of silver. Acidulated with hydrochloric acid, and treated with a current of sulphuretted hydrogen gas, it yields a yellow sulphide j and, when boiled 140 FLY-WATER — ARSENITE OF COPPER. with that acid and i)ure copper a deposit is obtained which readily fur- nishes, by heat, octahedral crystals of arsenious oxide. Fly-water is a name applied to solutions of various arsenical com- pounds in water. Mixtures of this kind are formed by dissolving one part of the arseuite of sodium or potassium and two parts of sugar in twenty parts of water. Taper soaked in this solution, and dried, is used for killing flies under the name of Papier moure ; and perhaps this is the safest form in which arsenic can be used for such a purpose. The editor has found the fly-papers of commerce to contain from H to 10 grains each of arsenious acid in a soluble form. In 1884 two women Avere convicted (Reg. V. Flannagan and Higgins, Liverpool Winter Ass., 1884) of the murder of four persons by means of infusions of such paper. (Brit. Med. Jour., 1884, i. pp. 419, 4G9.) Arsenite of Copper. Scheele's Green. Emerald Green. — This is a metallic arsenite, met with in commerce and the arts ; and it con- stitutes, wholly or in part, a great variety of green pigments employed for paper-hangings, known as emerald green (aceto-arsenite of copper), mineral green, Brunswick, Schweinfurt, Vienna, or Paris green. It is also found in the form of oil-paint, forming cakes in boxes of water-colors, spread over confectionery, in wafers, on adhesive envelopes, in wrappers for chocolate, isinglass, etc., and lastly, and most abundantly, in various kinds of green decorative papers used for covering the walls of sitting and bedrooms Although this compound is insoluble in w^ater, it is suflficently soluble in the acid mucous fluids of the stomach to be taken up by the absorbents and carried as a poison into the blood. Roussin has traced the means by which the insoluble poison finds it way through the skin, and the circum- stances under which it may be absorbed by the unbroken skin. In two cases which proved fatal in 1865, the workmen suffered chiefly from vomit- ing and colicky pains. The skin w^as tinged of a green color and arsenic was detected in the soft organs. He found that all poisons were liable to be absorbed by the unbroken skin when, as a result of evaporation, a solid film was left on the surface. Alcohol and other solvents of fat, when used as solvents for the poisonous solid, would favor its absorption into the body. (Ann. d'Hyg., 1867, pp. 179, 182.) In a case which was the subject of a criminal trial, the substance was proved to have caused the death of a gentleman by reason of its having been employed to give a rich green color to some blanc-raange served at a pul)lic dinner — the person who employed it considering that emerald or mineral green was nothing more than an extract of spinach, which is com- monly employed for coloring confectionery and ices. It led to death under the usual symptoms, and the parties were convicted of manslaughter. (Reg V. Franklin and Randall, Northampton Sum. Ass., 1848.) The symptoms of poisoning that have been observed in persons who have inhabited rooms of which the walls were covered with this arsenical compound are as follows : dryness and irritation of the throat, bronchial cough, irritation of the mucous membrane of the eyes and nostrils, languor, headache, loss of appetite, nausea, colicky pains, numbness, cramp, irrita- bility of the bowels attended with mucous discharges, great prostration of strength, a feverish condition, and wasting of the body. These symptoms may not all present themselves in any one case ; they are derived from the examination of numerous cases. No suspicion of the cause has in manv instances been entertained until ordinary treatment had failed to im- part'relief and an analysis of the paper had l)een made. The connection of the symptoms with this cause aY)pears to have been in some instances SULPHIDES OF ARSENIC. 141 elearly established by the fact that, after the removal of the paper, espeei. ally from bedrooms, the symptoms have disappeared. (Brit. Med. Jour., IS'TG, ii. p. 653; also, 1877, i. p. 8.) Yet comparatively few of those who are exposed suffer from symptoms of poisoning. Various deaths, chiefly among children, from the use of this paper are now recorded ; and it is probable that to the noxious practice of covering the walls of our sitting and bedrooms with large quantities of arsenic in loose powder many in- sidious cases of illness and chronic disease may be referred. Men and women employed in the manufacture of these poisonous pigments sufl'er severely. Girls employed in making artificial green leaves, in which this substance is used in tine powder, may sufl'er from inflammation of the conjunctivEe, with thickening and sv/elling of the eyelids. (Lancet, 1873, i. p. 174.) The precautions now adopted render such cases rare. Children's to3^s are often colored with this poisonous compound. In one case a child, set. 5 years, was seized with sickness, diarrhoea, and great depres- sion. The cause of these symptoms was traced to a box of counters colored bright green. The child had imbibed the poison, either by hand- ling or putting the counters into its mouth. Analj/sis. — For the chemical characters of Scheele's Green, see p. 128. The wall-paper pigment called Emerald Green is a mixture of arsenite and acetate of copper. The green color is very intense, even by candle-light. The presence of arsenic in this compound may be easily detected by the test for solid arsenic (p. 130) ; but the following is a simple method which admits of speedy application : A slip of the sus- pected paper should be soaked in a moderately strong solution of ammonia. The green color is removed, and a bine compound of copper is formed and dissolved in a few minutes. This result establishes only the presence of a compound of copper soluble in ammonia. If the ammonia does not be- come blue, there is no compound of copper present ; if it does become blue, a large crystal of nitrate of silver should be placed in a white saucer and a small portion of the blue liquid poured over it. The presence of arsenic in the blue liquid is revealed by the production of yellow arsenite of silver over the surface of the crystal. Arsenic Acid. Alkaline Arsenates. — Arsenic acid is an artificial product almost entirely confined to the chemical laboratory and to the manufactory. Some authors state that it is a more powerful poison than arsenious acid ; others, that it is less poisonous. No fatal case of poisoning by it in the human subject has been recorded. The arsenates of potassium and sodium must be regarded as active poisons, although there are but few instances on record in which life has been destroyed by them. Analysis. — Arsenic acid is a white, non-crystalline, deliquescent solid. 1. It is very soluble in water, forming a highly acid solution. 2. It is precipitated of a brick-red color by ammonio-nitrate of silver. Sulphides op Arsenic. — Orpiment, or Yellow Arsenic, owes its poisonous properties to the presence of a variable proportion of arsenious acid, sometimes amounting to as much as thirty per cent, of its weight. Orpiment is much emplo3^ed in the arts, in painting, dyeing, paper-stain- ing, the coloring of toys, and formerly for the coloring of sweetmeats ; but it is not often used as a poison. In the exhumation of the bodies of persons who have died from arsenic it is common to find the yellow sul- phide in the stomach. White may be converted into yellow arsenic in the dead body, but yellow cannot be changed into white arsenic during putrefaction. Orpiment produces symptoms and appearances similar to those caused by arsenious acid ; but the dose required to destroy life varies according 142 CHLORIDE OF AB.SENIC — ARSENETTED HYDROGEN. to the proportion of arsenious acid with wliich it hapixnis to be mixed. This is not a connnon form of ])oisoning; the yellow color of the poison would lead to suspicion ; but ))y reason of this color, orpiment may be given or taken by mistake for mustard or turmeric. The editor has mt^t in his practice with one fatal case. The symptoms differed in no respect from those- of a typical case of poisoning- by white arsenic. Orpiment is largely used in tanning. Analysis. — The commercial sulphide yields a solution of arsenious acid on boiling it in water acidulated with hydrochloric acid. It readily gives the well-known sublimates of metallic arsenic, either with soda-flux or cyanide of potassium (see p. 131). Chloride of Arsenic. — This is a solution of arsenic in diluted hydro- chloric acid, used in pharmacy. It contains 4^ grains of arsenious acid in one fluidounce. It is a highly poisonous preparation. In 1857 a woman took, in three doses, thirty minims over a period of twenty-four hours. The quantity of arsenic taken was not more than the tenth part of a grain, and yet the symptoms which followed were of a severe kind, resembling those of chronic poisoning. These were constriction of the throat, pain and irritation of the stomach and bowels, tingling and numb- ness of the hands and feet, loss of muscular power, and a feeling of extreme depression. The medicine was withdrawn, and the patient slowly recovered. It seems that she had not taken arsenic previously, and there was no evidence of the existence of a peculiar susceptibility to the effects of arsenic. The quantity taken was very small to produce such alarming symptoms. The usual medicinal dose of this solution is from two to eight minims. Analysis. — This compound is the product obtained in the separation of arsenic from organic solids by distillation with hydrochloric acid (see p. 135). It may be tested by the processes of Marsh and Reinsch, as there described. When boiled with fuming stannous chloride, it is decom- posed and metallic arsenic of a brown-black color is deposited. Arsenetted Hydrogen. — This is a gaseous poison of arsenic, producing when respired, even in small quantity, very serious effects upon the system. It has caused death in several instances among chemists who have incauti- ously breathed the deadly vapor while performing scientific experiments. Trost has reported three other fatal cases with a full account of the symp- toms and appearances. These cases occurred accidentally among workmen engaged in separating silver from lead by means of zinc and h3'^drochloric acid. The latter was found to contain much arsenic, which escaped with the hydrogen. (Vierteljahrsschr. f. Gerichtl. Med., 1873, 1, p. 269. See On Poisons. Chem. i^ews, 18G3, ii. p. 307.) MERCURY CORROSIVE SUBLIMATE. 143 CHAPTER XII, POISONING BY MERCURY. CORROSIVK SUBLIMATE. SYMPTOMS. — CHRONIC POISONING. AP- PEARANCES AFTER DEATH. CHEMICAL ANALYSIS. PROCESS FOR MERCURY IN ORGANIC LIQUIDS. CALOMEL. WHITE AND KED PRECIPITATES. OTHER COMPOUNDS OF aJeRCURY. Metallic mercury is not commonly regarded as a poison. It is usually stated that a large quantity of it may be swallowed without aflfecting health, or without causing more uneasiness than that which may arise from its great weight. It rapidly passes through the bowels. A case which occurred to Gibb shows that this is not strictly true. For the pur- pose of causing abortion a girl swallowed four and a half ounces by weight of mercury. It had no effect on the womb, but in a few days the girl suffered from a trembling and shaking of the body (mercurial tremors) and loss of muscular power. These symptoms continued for months, but there was no salivation and no blue mark on the gums. (Lancet, 1873, i. p. 339.) If mercury is breathed or swallowed in a state of vapor, or if applied to the skin or mucous membrane in a state of extreme mechanical division, in which state it appears to be easily susceptible of oxidation, it is liable to be absorbed, and to produce a poisonous action on the body. The effects are principally manifested by salivation, trembling, and in- voluntary motions of the limbs, loss of appetite, and emaciation. These symptoms are occasionally seen in workmen engaged in trades in which they are exposed to the inhalation of mercurial vapors. Corrosive Sublimate. — This substance has received a variety of chemical names. It has been at various times called Oxi/rmiriate, Chlo- ride, Bichloride, Mercuric Chloride, and Perchloride of Mercury. To prevent any confusion from scientific chemical nomenclature, the old and popular name of Corrosive Sublimate, expressing the principal properties of the substance, is here retained. It is commonly seen under the form of heavy crystalline masses, or of a white crystalline i)Owder. Its taste is powerfully austere and metallic, so that no poisonous quantity of it could be easily swallowed without the person becoming immediately aware of it. Its solutions, even when very highly diluted — 1 in 20,000 — have an intensely metallic (coppery) taste. It is very soluble in water, hot or cold, and speedily sinks in it, in which properties it differs strik- ingly from arsenic. At the ordinary temperature it dissolves in about fifteen parts of water ; but the poison is more freely soluble in alcoholic liquids and ether. It is largely used as an antiseptic. Symptovis. — The symptoms produced by corrosive sublimate generally come on immediately, or within a few minutes after the poison has been swallowed. In the first place, a strong metallic taste in the mouth, often described as a coppery taste, is perceived ; and there is, during the act of swallowing, a sense of constriction almost amounting to sufl'ocation, with burning heat in the throat, extending downwards to the stomach. In a few minutes violent pain is felt in the abdomen, increased by pressure, especially in the region of the stomach. There is nausea, with freciuent vomiting of long, stringy masses of white mucus, mixed with blood, attended with severe pain in the abdomen and profuse ])urging. The countenance is sometimes swollen and flushed ; in other cases it has been 144 CORROSIVE SUBLIMATE — SYMPTOMS. pale and anxious. The pulse is small, frequent, and irregular, and is scarcely perceptible when the symptoms become aggravated. The tongue is white and shrivelled, the skin cold and clammy, the breathing difficult ; and death is commonly preceded by fainting, convulsions, or general in- sensibility. The internal parts of the mouth, when examined, are swollen, and sometimes present a white appearance, as if the cavity had been recently washed with a solution of nitrate of silver; the lips are often swollen. Suppression of urine has been frequently noticed among the symptoms : it existed in a well-marked case of poisoning by this substance where the patient lived four days, but did not pass any urine during the whole of this time. (Guy's Hosp. Rep., 1844, p. 24.) This symptom Avas observed in a case reported by Wegeler (Casper's Wochenschrift, 1846, p. 30). in which a youth, set. H, swallowed three drachms of the poison, and died on the sixth day. During the last three days no urine was secreted. The case was otherwise remarkable from the fact that no pain was experienced on pressure of the abdomen, and that the pulse underwent no change until shortly before death. In another case, in which twenty grains of corrosive sublimate in solution were swallowed, suppres- sion of urine and salivation came on the third, and the patient died on the ninth day. (Lancet, 1845, ii. pp. 650, 698.) The external application of corrosive sublimate to tumors or ulcers may destroy life with all the usual symptoms of acute mercurial poisoning. A quack was convicted of manslaughter (Winchester Lent Ass., 1859, Reg. y. Crook) by applying corrosive sublimate in powder to a cancerous tumor on the face of the deceased. The man died under the usual symp- toms. After death the bowels were found extensively inflamed and ulcer- ated. Corrosive sublimate was detected in the diseased part. At the Exeter Lent Assizes, 1878, a quack-doctor was indicted for the man- .slaughter of a woman under similar circumstances. The deceased had ulcers on her legs, and a solution of corrosive sublimate, largely diluted, was applied by the prisoner in order to cure them. The death of the woman was assigned to the absorption of the poison ; but the judge held that gross and culpable ignorance had not been proved, and under his direction the prisoner was acquitted. A girl, set. 9, died from the effects of this poison locally applied to the scalp for the treatment of ringworm. The liquid applied was alcohol containing eighty grains of corrosive sub- limate to the ounce. She suffered from mercurial poisoning in a severe form, and died on the fifth dav after the application. (Pharm. Jour., Sept. 9, 18T1, p. 216; Lancet, 18*^71, ii. p. 413 ; and Med. Times and Gaz., 1871, p. 353.) No theory of idiosyncrasy is required to account for death under such circumstances. In the first edition of the author's work On Poisons (1848), p. 394, fatal cases are related of poisoning by corrosive sublimate through the unbroken skin. Two brothers thus lost their lives, the one dying on the fifth and the other on the eleventh day. Those who deny the power of the unbroken skin to absorb corrosive sub- liinate and cause all the usual effects of acute mercurial poisoning, should make themselves and not their patients the subjects of experiment. Severe salivation sometimes follows the external application of a mercurial com- pound. In 1884 a man was tried at the Surry Sessions for putting corro- sive sublimate into a kettle of water. He was acquitted. Several persons suffered from partaking of the poisoned liquid. Corrosive sublimate differs from ar.senic : 1, in having a well-marked taste ; 2, in producing violent symptoms in a few minutes ; and 3, in the fact that the evacuations are more frequently mixed with blood. The symptoms produced by corrosive sublimate, in the first instance, resemble APPEARANCES AFTER DEATH. 145 those of cholera ; but if the person should survive several days they are more like those of dysentery — violent straining and shreddy mucous dis- charges mixed with blood being frequently observed. Slow 07' Chronic Poisoning. — The symptoms are much modified wlien the poison is taken in small doses at intervals for some days or weeks. There are colicky pains with nausea, vomiting, general uneasiness, and depression. The salivary glands become inflamed and painful; the tongue and gums are red and swollen, sometimes ulcerated, and there is fetor of the breath. A deep blue line, like that observed in poisoning by lead, is sometimes found around the edges of the gums. The patient experiences difficulty of swallowing and breathing. The constitutional effects are indicated by irritability or looseness of the bowels, difficulty of breathing, spitting of blood, cough, general trembling or convulsive movements of the limbs, and palsy, with fever and emaciation, under which the patient sinks. One of the most marked effects of slow or chronic poisoning by mercurial preparations is salivation, or ptyalism, indicated by an increased flow of saliva. This is b}^ no means a necessary symptom in cases of acute poisoning by corrosive sublimate, but it not unfrequently shows itself about the second or third day. In many instances the patient dies too rapidly for this effect to follow ; but even when he survives some days, salivation is not always observed. In placing reliance upon this symptom, it must be remembered that salivation may arise from a variety of causes irrespective of the use of mercury. (See On Poisons, 3d edit., p. 366.) Substances sold under the name of Worm Lozenges have been known to cause death by producing fatal salivation. In the salivation caused by mercurial compounds the r-aliva always contains mercury, which may be detected by Reinsch's process. The elimination of this metal takes place by all the fluid secretions, but chiefly by the urine and intes- tinal liquids. (Lancet, 1873, i. p. 476.) Workmen exposed to the vapors of metallic mercury exhibit a peculiar form of paralysis, known as mer- curial tremors or " trembles." Appearances after Death. — These, as in the case of arsenic, are chiefly confined to the stomach and bowels. Corrosive sublimate, how^ever, affects the mouth, throat, and gullet ; the mucous membrane is softened, of a white or bluish-gray color, and inflamed ; that lining the gullet is simi- larly aff"ected, and partly corroded and softened. The mucous membrane of the stomach is more or less inflamed, sometimes in patches ; and there are masses of black extravasated blood found beneath it. Occasionally this has a slate-color, and the mucous coat beneath may be found reddened. A case occurred in Guy's Hospital in which the mucous membrane was simply inflamed, much resembling the condition presented in cases of arsenical poisoning. The coats of the stomach are sometimes corroded, and so much softened that they cannot be removed from the body without laceration. Similar appearances have been met with in the small and large intestines, especially in the ctecum. In a case reported by Herapath, in which twenty grains were taken and death occurred on the ninth day, the mucous membrane of the stomach was softened, but there were no well-marked appearances of the irritant action of the poison on this organ. The ciecum had been the seat of the most violent inflammation, the whole surface being of a deep black-red color and there were patches of slough- ing in the coats. (Lancet, 1845, ii. p. 700; Edin. Month. Jour., Dec. 1851, p. 532.) Perforation of the stomach is rare as an effect of this poison : there is one case on record. Appearances like those just described have been seen in the intestines, not only where the case has terminated 10 148 CORROSIVE SUBLIMATE ANALYSIS. fatally in a few hours, but where it has been protracted for six, eight, and even eleven days. The smallest dose that is reported to have destroyed life is three grains This was in the case of a <;hild, and the quantity was accurately deter- mined from the fact of its having been made up by mistake for three grains of calomel, which a physician had Jntended to order. It is pro- bal)le that, under favorable cii'cumstances, from three to five grains, or even less, would destroy an adult. In an acute case a person commonly dies in from one to five da\'s, but death may take place much sooner or later than this. In the shortest fatal case on record the man died in less than half an hour : but the quantity of poison taken was not ascertained. (On Poisons; Corrosive Sublimate.) Chemical Analysis. — Corrosive subhmate is usually seen in heavy crystalline masses, or in the form of a white powder. In the solid state — 1. When the powder is heated on platinum-foil, it melts and is volatilized as a white vapor without leaving any residue. 2. When heated in a closed tube, unlike arsenic, it melts before subliming, and forms a sublimate consisting of stellate prismatic crystals (see Fig. 12). 3. The powder is changed in color by the following reagents : iodide of potassium pro- duces a bright scarlet, potash a yellow, and sulphide of ammonium a black compound; ammonia does not alter its color. 4. The mercury and chlorine may be discovered by one process. Mix the powder with four parts of dried carbonate of sodium free from chlorides (obtained by inciner- ating the bicarbonate), until the residue in the reduction-tube fuses and becomes white. A sublimate of metallic mercury in distinct and well- Fig. 12. Fig;. 13. Stellate Crystals obtained by heating Corrosive Sublimate, magnitied 30 diameters. Prismatic Crystals of Corrosive Sublimate from a solution in water, magnified 30 diameters. defined globules will be obtained (see Fig 14). Detach by a file the end of the tube containing the fused residue, which is chloride of sodium with some undecomposed carbonate. Digest it in water with nitric acid and apply heat until it is entirely dissolved ; then add to the solution nitrate of silver. A white precipitate of chloride of silver insoluble in boiling nitric acid will be at once produced The solid is thus proved to con- tain both mercury and chlorine, and the only compound of these elements which is soluble in water is corrosive sublimate. In solution of water. A few drops of the solution of corrosive subli- mate evaporated on a glass slide yield slender, opaque, silky prisms (see Fig. 13). When a weak solution of iodide of potassium is dropped on them they acquire a bright scarlet color. This scarlet coloration. DETECTION IN ORGANIC LIQUIDS. 147 which may be obtained from the minutest crystal and only one drop of solution, proves that the body dissolved in water is corrosive sublimate: it is thus distinguished from every other mineral poison and all otlier substances whatever. 1. Stannous chloride added to a solution of corrosive sublimate produces a gray precipitate, which, after it has been boiled, is resolved into globules of metallic mercury 2. Sulphuretted hydrogen and sulphide of iimmonium produced, after a time, a black sulphide, not solul)le in Fig. 14. alkaline or diluted acid. 3. If after the liquid has l)ecn acidulated with hydrochloric acid, bright copper-foil, wire, or gauze is plunged into it, the copper will acquire a silver-white deposit, even in the cold, but more rapidly by heat. When the copper with the metallic deposit is dried and heated in a tube, globules Qf mercury are sublimed (see Fig. 14). Tn organic liquids. — The liquids should be separated by filtration from any insoluble por- tions. The latter should be pressed, dried, and set aside for a separate analysis. The liquid portion should be slightly acidulated Globules of Mercury, with hydrochloric acid, warmed, and a slip of copper-foil introduced ; if this is not immediately coated with mercury, it may be allowed to remain for some hours. When a deposit has taken place, the copper should be removed, washed in water and afterwards in ether, and dried. If the quantity of corrosive sublimate dissolved in an organic liquid is moderately large, it may be removed by means of ether. Place the filtered liquid supposed to contain the dissolved poison in a stoppered tube ; add to it twice its volume of ether, and agitate the liquid at intervals for a few minutes. Allow the liquid to subside, pour off' the ether into a large watch-glass, and submit the liquid to spontaneous evaporation. As the ether evaporates, the corrosive sublimate Avill be deposited in white, silky-looking prisms. These may be purified, if necessary, by solution in water or alcohol, and the solution again crys- tallized. Corrosive sublimate may thus be separated from arsenic and other mineral poisons in solution. If mercury and arsenic are associated in a poisonous mixture, or in the tissues, the arsenic may be entirely removed by distillation with hydrochloric acid (p 135j. Masses of corro- sive sublimate may be sometimes locked-up in thick, viscid mucus ; and, in such cases, the coarse powder being heavy, it may be separated by simply agitating the viscid liquid in water and then decanting the upper portion suddenly. This poison is decomposed and precipitated by many organic substances, such as albumen, fibrin, mucous membrane ; also by gluten, tannin, and other vegetable substances. Thus, then, we cannot always expect to find it in the stomach in a state of solution. Other methods of analysis are chiefly directed to the separation of the mercury only. The suspected liquid is boiled, filtered, and acidulated with hydro- chloric acid. 1. To one portion add stannous chloride in excess, again boil the liquid and filter to separate the mercury, the whole of which is precipitated either as a black powder or in gray globules. On boiling this deposit in strong hj^drochloric acid, the small globules coalesce to form liquid mercury. 2. Into another portion of the liquid introduce copper foil and gently warm. The copper liecomes covered with a layer of silvery-white metal, either immediately or in a few hours. A large quantity of copper may be thus coated. The coated copper should be 148 DETECTION OF MERCURY IN THE TISSUES. digested in warm alcohol or ether, dried, and heated in a reduction-tube, when a sublimate of silvery-white globules will be obtained, well marked bv their opacity, lustre, and spherical shape when examined with the microscope (see Fig. 14, p. 147). The sublimate of metallic mercury differs from that of arsenic in the fact that, when heat('(l, it sublimes simply as metal without change. It is not oxidized (like metallic arsenic) bv h'eatinir it in a reduction-tube, but is simply transferred with its metallic lustre and globular form from one part of the tube to another. In the event of a doubt existing respecting the nature of the sii])limate, the following experiment will solve it. Cut off by a file the portion of glass on which the globules are deposited ; introduce this into a wide, short tube, with a few drops of nitric acid. Heat the acid liquid and evaporate it to dryness on a sand-bath. White crystals will remain if the sul)limate was mercury and too great a heat has not been applied. On touching the white residue cautiously with a drop of a weak solution of iodide of potassium the crystals will acquire a scarlet color. In place of copper, a Aveighed slip of gold-foil may be wound round a rod of zinc and intro- duced into the acidulated liquid. The gold is soon covered with a silvery- white laver of mercury. In doubtful cases the deposition may be allowed to go on for twenty-four or even forty-eight hours. The gold-foil must then be detached from the zinc, rinsed successively Avith water, alcohol, and ether, dried, and introduced into a reduction-tube. On gently heating the portion of the tube containing the gold-foil, a sublimate of metallic e-lobules of mercurv is obtained, and the foil resumes its original yellow color .md weiu'ht. The sublimate must be further examined and tested, as above described. In the tissues. — -Insoluble substances suspected to contain mercury, as well as the soft organs, e.g. liver and kidneys, may be cut up and boiled in one part of hydrochloric acid and four parts of water until dissolved. The mercury may then be separated by copper or by gold with zinc. This method will show the presence of mercury, but not of corrosive sub- limate, in the body. Whether the mercurial compound has acted as a poison or not must be determined from symptoms and appearances; whether it has been given or taken as a medicine or not, is a conclusion which must also be determined fi'om other circumstances. The iiroof that the mercury was really in the form of corrosive sublimate could only be derived from the discovery of some undissolved portions of the solid poison in the stomach or its contents, or from a separation of the poison itself by means of ether. If thus obtained after filtration of an organic licpiid, it would show its presence in the form of a soluble salt ; and it may be remarked that all the soluble salts are poisonous, and are rarely used internally as medicines. If undissolved, the absorbed mercury may have been derived from some mercurial medicine innocently taken by the de- ceased. Nothing is more common than to discover traces of mercury in the stomach, bowels, liver, kidneys, or other organs of a dead body. No importance can be attached to this discovery in the absence of evidence that the deceased had actually suffered from symptoms of mercurial poison- ing. As to the mercury found in the tissues, it may have been derived from a soluble or insoluble compound, or from exposure to the vapors of the metal or of its salts in various trades. Calomel. Mercxirous Chloride. — This substance, although commonly regarded as a mild medicine in small doses, may destroy life by causing excessive salivation with ulceration and gangrene ; and in large doses it acts as an irritant poison. A man suffering from eczema of the scrotum was directed to employ black wash, consisting of one drachm of calomel POISONING AVITII RED PRECIPITATE. 149 in eiij-ht ounces of lime-wator. In a few days he had fetor of the breath, swelling and tenderness of the gums, with salivation. (Brit. Med. Jour., 1878, i. p. 867.) AvalysiH.. — It is known from corrosive sublimate by its insolubility in water, alcohol, and ether. It is known from white precipitate by its insolubility in acids and by its l)eing blackened by alkalies. A mercurial sul)limate may be obtained from it l)y heating it with dry sodium carbonate. Under certain conditions, this compound may be changed into corrosive suldimate in the stomach. (Pharm. Jour., Aug. 31, ISTB, p. 1G4.) ^VriiTE Precipitate. Ammoniated Mercvry. — The symptoms which this compound produces are violent vomiting, cramps, great thirst, purg- ing, pain in the stomach and bowels, and convulsions. Tenderness of the gums and salivation have been observed. After death the results of inflammation of the stomach and bowels are seen. Experiments on dogs and rabbits have shown that this is a formidable poison. The greater number of recoveries have been probably owing to the substance being early ejected by vomiting. Rabbits (which do not vomit) were killed by doses of four and five grains in a few hours. After death, mercury was found deposited in various organs, but more in the kidneys than in the other viscera. (For additional facts connected with the action of this poison, see Guy's Hosp. Rep., 1860, p. 483.) A trial for attempting to poison b}- this substance took place in 1869. (Reg. v. Seaham, Maidstone Sum. Ass., 1869.) The compound is white, but, as the result of boiling, it gave a yellow color to the gruel in which it was administered. In Reg. V. Hargreaves (Manchester Lent Ass., 1866), a girl was convicted of an attempt to poison her father by this substance. The poison was put into milk and medicine. It produced a burning sensation in the throat and stomach, and thus led to suspicion. About ten grains of white precipitate were detected in some buttermilk. In February, 1873, a boy, set. 12, was convicted, at the Central Criminal Court, of administering this poison feloniously in medicine. The prosecutor experienced a hot sensation, un- like the bitter taste he had before perceived. A white powder was found in the medicine, which proved to be white precipitate. Anahiais. — White precipitate is a chalky-looking compound containing about eighty per cent, of mercury. It is insoluble in water and alcohol. As sold, it frequently contains, as an impurity, corrosive sublimate to the amount of one or two per cent., separable by ether or alcohol. It is sol- uble in acids, not blackened by alkalies, and yields a mercurial sublimate when heated with carbonate of sodium. Stannous chloride produces with it a black deposit of mercury. If boiled in a solution of potash, it evolves ammonia and yellow oxide of mercury is formed. It may be detected in organic liquids and solids by boiling them in one part of hydrochloric acid and four parts of water. The mercury may then be separated by means of copper (see p. 148). It is not used internally, but it is much employed by the poorer classes in the treatment of ringworm. Red Precipitate. 3Iercuric Oxide. Red Oxide of llercinv/. — This substance is poisonous, but instances of poisoning by it are rnre. One case occurred at Guy's Hospital in 1833. The patient recovered in four days. In another case a woman, aet. 20, swallowed a quantity of beer containing red precipitate. Four hours after she was in a state of stupor, with a weak, irregular, scarcely perceptible pulse, dilated pupils, cold and clammy skin, and copious discharge from the mouth. She had vomited once shortly before, and red particles were seen in the ejected fluid. There was pain in the abdomen. Under treatment the symptoms abated, but there was pain in the region of the stomach, a desire to vomit, much sali- 150 SUGAR OF LEAD — SYMPTOMS. vation, and slight diarrhoea. She gTadually recovered. (Brit. Med. Jour., 18T8, ii. p. 101.) A case of recovery after the administration of 120 grains has been recorded. (Brit. Med. Jour., 1884, i. p. 5f),) Analysis. — By its great density and insolubility in water it may be separated from all liquids. Its red color is characteristic. When heated in a closed tube, it is resolved into oxygen and mercury, the latter being deposited in globules. Other compounds of mercury, such as the nitrates, the sulphates, the cyanide, and the sulphocyanide, have given rise to accidents, and in a few instances have destroyed life, but they very rarely recpiire the notice of a medical practitioner. " In February, 1891, two men died from the external application of nitrate of mercury as a remedy for an eruption of the skin. The sulphide (vermilion), on account of its insolubility, is probably quite inert. When heated in a dry state with anhydrous carbonate of sodium, all the compounds of mercury yield sublimates of the metal in globules. All the liquid and solid compounds give a dark precipitate of mercury when boiled with stannous chloride. CHAPTER XIII. POISONING WITH LEAD. SUGAR OP LEAD. — SYMPTOMS. — APPEARANCES AFTER DEATH.— CHEMICAL ANALYSIS LEAD IN ORGANIC MIXTURES. RED LEAD. CARBONATE OR WHITE LEAD.- — CHRONIC POISONING. POISONING WITH COPPER. BLUE VITRIOL. SYMPTOMS. APPEARANCES. CHEMICAL ANALYSIS. — COPPER IN ORGANIC LIQUIDS. Sugar of Lead. Acetate of Lead. — Symptom.^. — Acetate or sugar of lead is by no means an active poison. In medical practice it has often been given in consider- able doses without any serious effects resulting. When from one to two ounces have been taken, the following symptoms have been observed : a burning, pricking sensation in the throat, with dryness and thirst, vomit- ing-, and uneasiness at the pit of the stomach, followed by severe colic. The abdomen is tense, and the skin covering it is sometimes drawn in. The pain is intermittent and relieved by pressure. There is generally constipation of the bowels. If any feces are passed, they are commonly of a dark color, indicative of the conversion of a portion of the lead into sulphide. The skin is cold, and there is great prostration of strength. The pulse is slow. When the case is protracted, the patient has been observed to suffer from cramp in the calves of the legs, pain in the inside of the thighs, numbness, and sometimes paralysis of the limbs. The affection of the nervous system is otherwise indicated by giddiness, lorpor, and even coma. A well-marked blue line has been noticed round the margin of the gums, where they join the teeth. (For a remarkable series of cases of poisoning by acetate of lead, see Lancet, 1849, i. p. 4*78.) In 1882 a woman was convicted (Reg. v. Louisa Jane Taylor, C. C. C, Dec. 1882) of the murder of Mrs. Tregelles, an aged female, by the re- peated administration of acetate of lead. The administration extended over several weeks ; and the editor found the body largely impregnated with SUGAR OF LEAD — CHEMICAL ANALYSIS. 151 lead — more especially the stomach. The symptoms were colic, vomiting-, blackeiiini;- of the teeth, paralysis, and at the last epileptiform convulsions. Apjiearances. — In one fatal case of acute poisoning the mucous mem- brane of the stomach was destroyed in several places, especially near the intestinal opening, and the greater part of the intestines were in a state of acute inflammation. In animals, according to Mitscherlich, when the dose is large the mucous coat of the stomach is attacked and corroded ; this change appears to be purely chemical, and takes place in those parts of the body with which the salt of lead comes in contact. If given in a small dose, it is decomposed by the gastric secretions and exerts no corrosive action on the mucous membrane. When acetate of lead was given in a state of albuminate dissolved in acetic acid, death took place with great rapidity ; but on inspection, the stomach was not found cor- roded. This corrosive action belongs to the neutral salt, and is not mani- fested when the dose is small or when the poison is combined with an acid. Nothing is actually known concerning iha fatal dose of this sub- stance ; but it may be taken in comparatively large quantity without pro- ducing serious efiects. Thirty or forty grains have been given daily in divided doses without injury. Chemical Analysis. Acetate of Lead as a solid. — 1. If a portion of the powder is heated in a small reduction-tube, it melts, then becomes solid ; again melts, acquiring a dark color, and gives ofl" vapors of ace- tone and acetic acid, easily recognized by their odor and reaction ou litmus-paper. A black mass is left in the tube, consisting of carbon and reduced metallic lead. No sublimate is formed. If heated on mica, yellow oxide of lead with reduced metal remains. 2. It is very soluble even in cold water ; spring water containing carbonic acid and sulphates is turned milky by it. 3. A small portion of the powder dropped into a solution of iodide of potassium acquires a bright yellow color. 4. When dropped into solution of potash it remains white. 5. In sulphuretted hydrogen water or sulphide of ammonium it is turned black, in which respect it resembles the white salts of some other metals. 6. When the powder is boiled in a tube with diluted sulphuric acid, acetic acid, known by its odor and volatility, escapes. All these properties taken together, prove that the salt is acetate of lead. Acetate of Lead in solution. — 1. A small quantity, slowly evaporated on a glass slide, will give slender white prismatic crystals (see Fig. 15), which are turned yellow by iodide of potas- sium and black by sulphide of ammonium. Fig- 15. 2. Diluted suli^huy-ic acid produces an abundant white precipitate, insoluble in nitric acid, but soluble in hydrochloric acid and in a large excess of potash. 3. It is precipitated of a yellow color by iodide of potassium. The yellow iodide of lead is soluble in potash, forming a colorless solu- tion. It is also dissolved by concentrated hydrochloric acid and by hot water. 4. Sulphide of ammonium, or sulphuretted hydrogen gas, produces a black precipitate, even when less than a 100,000th part of the salt is dissolved. 5. Place a few drops of ^^^^"'^ 1ed?o afameter'"'' "'^°'" the solution on clean platinum-foil, acidulate with acetic acid, then apply, through the solution, to the surface of the platinum a thin slip of polished zinc — dark-bluish crystals of metallic 152 DETECTION OF LEAD IN THE TISSUES. lead are instantly deposited on the zinc; by this metliod a small quantity of the metal may be detected and separated. Lead in organic liquids. — Acetate of lead is precipitated by many organic substances, especially by albumen and tannin. Thus we may have to analyze either an organic liquid containing lead, or a solid pre- cipitate consisting of mucus or mucous membrane, or albumen combined with lead. The liquid should be filtered and examined by a trial test, i. e. either by adding to a portion sulphuric acid, when sulphate of lead is ])recipitated, or by exi)Osing filter paper, dipped into the suspected liquid, to a current of sulphuretted hydrogen gas. If the paper is not stained brown, there is not much lead dissolved ; if it is stained brown, we dilute the litpiid to destroy its viscidity, should this be necessary, and pass into it a current of washed sulphuretted h^'drogen gas until a precipitate ceases to form. The black sulphide of lead should be collected on a filter, washed, and dried ; then boiled for a quarter of an hour in a mixture of one part of nitric acid diluted with four parts of water. This has the effect of transforming it, at least in part, into soluble nitrate of lead. This liquid, when filtered, may be evaporated to dryness, the crystalline residue dis- solved in water, and the tests for lead then applied to the solution. If the quantity is too small for the application of all the tests, we may first add sulphuric acid; should a white precipitate be formed, soluble in potash (free from lead), and this alkaline solution be again turned black by sul- phide of ammonium, this is sufficient evidence of the presence of lead. Should there be no lead dissolved, we must decompose the solid and in- soluble matters by boiling them with dilute nitric acid, filter, and test the filtered liquid, previously neutralized ; or we may evaporate at once to dryness, destroy the organic matter by heat, and redissolve the residue in nitric acid for testing. In the tissues. — The organic matter, such as a part of the liver or any other oi'gan, should be dried, and afterwards incinerated in a porcelain vessel. The ash should be heated with a small quantity of dilute nitric acid and evaporated to dryness. The dry residue should be dige.sted in a small quantity of distilled water (free from lead), filtered, and, after it has been slightly acidulated with nitric acid, a current of washed sulphur- etted hydrogen gas should be passed into it. The production of a brown color or a brown precipitate in a slightly acid liquid indicates the pres- ence of lead. The ])reeipitate may be dissolved in nitric acid and further examined. Lead may thus be detected in the dry residue of urine. All licjuid and solid organic substances containing lead yield the metal or its oxide by incineration in a porcelain capsule. Goulard^s Extract is a solution of subacetate of lead, containing- thirty-five per cent, of the salt ; and Goulard Water is a mixture of two drachms of this solution in a pint of water. The effects of these com- pounds, when swallowed or applied locally, are similar to those produced by the acetate, but are more severe. IIed Lead. — This is a mixture or compound of the protoxide and per- oxide of lead, much used in the arts. It has occasionally acted as a fatal poison. Dey relates the case of a woman who died from its effects in four or five hours, after convulsions. (Lond. Med. Rec, 1882, p. 117.) AViiiTE Lead. Subcarbonate of Lead. — This is an insoluble, chalky- looking compound, which, like other salts of lead, may give rise to the usual symptoms of lead-poisoning. In one instance it appears to have proved fatal. White lead has been used as a cosmetic to give a fair com- plexion. It is liable to absorption, and to cause the usual symptoms of poisoning. The cosmetic liquid of Madame Rachel consisted of a lead CHRONIC LEAD-POISONING. 153 compound with fuller 's-earth, starch, and hydrochloric acid. Such a com- pound applied to the skin clearly would set up irritation in the skin and be most injurious to health. Most of the cases of poisoning by this sub- stance have been of a chronic character, carbonate of lead being one of the products of the action of water upon lead. Buchner has also reported the history of a family poisoned by lead accidentally introduced as white lead into flour in a mill. (Freidreich's Bliitt. f. Gerichtl. Med., 1884, p. 161.) Chronic Poisoning. — Colica Pictonum, or Painter'' s Colic, may be considered as the usual chronic form of poisoning by carbonate of lead. The disease is not, however, confined to an affection of the intestinal canal (colicj, though this is the most common symptom. There is a peculiar form of paralysis — lead paralysis, or " wrist-droj) ;^^ pains in the joints, often termed " rheumatic ; " and a peculiar form of cerebral affection, of a fatal character, the prominent s^niiptoms of which are epileptoid convul- sions simulating ordinary epilepsy and ending in coma. The symptoms of lead-colic are usually well marked. There is at first pain, with a sense of sinking commonly in or about the region of the navel (the seat of the colon). Next to pain there is obstinate constipation, retraction of the skin of the abdomen, loss of appetite, thirst, a fetid odor of the breath, and general emaciation ; with paralysis of a peculiar kind affecting the extensor muscles, and causing a dropping of the wrist, or showing itself in a general paralysis of the limbs. The skin acquires a sallow color, generally well marked in the face ; and the patient experiences a sweetish, styptic, or astringent taste in the mouth, A symptom of a peculiar iiiiture was first pointed out by Burton (Med. Gaz., vol. 25, p. 687), namely, a blue line on the edge of the gums where these join the bodies of the teeth; the teeth are of a brownish color. The blue line on the gums may be regarded as a distinguishing sign of lead-poisoning. It is owing to the deposition of lead in these structures — a fact proved by the action of chromic acid on the excised gums. When touched Avith it they acquire a yellow color (chromate of lead), and when afterwards treated with an alkaline sulphide they become black from the formation of sulphide of lead. (Lancet, 1878, i. p. 913.) Lead-palsy usually comes on after several attacks of colic. It shows itself first, and most prominently, in the extensor muscles of the forearm — the muscles supplied by the musculo-spiral nerve ; hence the sujnnafor longus muscle escapes. The disease, however, is not always confined to the forearm. The dropped hand, and the inability to raise it, give rise to the term "dropped wrist." Epileptiform convulsions ending in coma are a late affection, in severe cases, as e. g. among workers in white- lead factories, and are commonly a fatal aff'ection. The editor has met with several such cases. Hair-washes generally contain a salt of lead in solution. The use of them may lead to all the symptoms of chronic lead-poisoning. Chronic poisoning with lead often kills the patient, since a great amount of mischief is usually done before the cause is discovered. The appearances found after death have been a contraction of the cavity of the large and small intestines, a considerable thickening of their coats, and degeneration of the kidneys. The contractions have been especially noticed in the colon — the seat of colic. The various circumstances under which this form of poisoning is liable to occur are elsewhere fully described. (See On Poisons, p. 400.) One of the most frequent causes of chronic lead-poisoning is the use of water kept in leaden cisterns or pipes ; or the careless employment of 154 CHRONIC LEAD-POISONING. white or red lead as a cement for pipes and cisterns. For an instructive series of cases showing the eifects of water thus poisoned, the reader is referred to a paper by De Mussey. (Dublin Quar. Jour., May, 1849; also Med. Gaz., vol. 44, p. 2G0.) These cases occurred at Claremont, among the members of the ex-royal family of France. The effects were traced to the use of water which had acquired an impregnation of lead by contact with that metal, in the proportion of one grain to the gallon. Thirteen out of thirty -eight persons were affected, and to such a degree that the nails of the toes and fingers in some acquired a bluish discolor- ation. The children of the family did not suffer. No symptoms appeared until after the water had been in use for a period of from five to seven months, and more than half of those who used the water escaped any ill effects. The presence of lead in public water-supplies has recently at- tracted great attention, in consequence of the pollution of the supplies of Sheffield, Keighly, Huddersfield, and Bacup. It appears that soft waters, especial! V if acid, are very prone to act injuriously upon leaden pipes. (Lond. Med. Rec, 1882, p. 430; Chem. News, 1882, ii. p. 88 ; Brit. Med. Jour., 1889, i. p. 992 et seq.) Cases of poisoning are sometimes observed as the result of the acci- dental introduction of lead into the system in wine, beer, cider, milk, lemonade, and other liquids. Earthenware glazed with litharge imparts lead to ftit in dripping, also to acid liquids. Snuff is sometimes adulterated with 7-ed lead to improve its color, and some cases of lead-poisoning have occurred from the use of such snuff. A spurious tinfoil, consisting chiefly of lead faced with tin, is much used as a covering or wrapper for articles of food. When exposed to damp, this metallic alloy undergoes chemical changes whereby subcarbonate of lead is produced. Children's farinaceous food has thus become impreg- nated with lead. In tinned iron vessels there is often a large quantity of lead alloyed with the tin, as it is a much cheaper metal, Hamilton has noticed that lead-poisoning has been produced in India by the use of the tinned cooking-pots. (Lancet, 187T, i. p. 253.) There is another unsuspected method by which lead may find its way into that common article of food — flour. It is sometimes a custom of millers to repair the holes in their millstones with melted lead. The lead is thus ground into and mixed with the flour. Alford states that fifteen or twenty persons, in different families, suffered from colic and other symptoms of chronic lead-poisoning, from this cause. The blue line on the gums was well marked. It was found that they had all had their own corn ground at the same mill. On examining the millstones they w^ere found to be honeycombed with lead. There was on the sur- face of the stones about ten pounds of lead. (Brit. Med. Jour., 1877, i. p. 627.) The workers in white lead, especially those engaged in the operation of stoving and grinding the compound, are most prone to suffer in a severe form from lead-poisoning. This has been made a matter of recent legisla- tion, in order to protect the workpeople from the insidious effects of lead compounds. [Judge Penrose (Philadelphia) reports that in 1886 whole families in New York were poisoned by using flour manufactured where lead had been used for filling cavities in the millstones by the mill-owners.J poisoning with copper, 155 Copper. All the salts of copper are poisonous. The two most commonly known m commerce are the Sulphate, or Blue Vitriol, and the Subacetate, or Verdigris. Blue Vitriol. Sulphate of Copper. — Symptoms. — The medicinal dose of sulphate of copper as an emetic is from five to fifteen grains, and, as a tonic, from one to three or four grains. It has been frequently given for the purpose of procuring abortion. In doses of half an ounce and upwards it acts as an irritant on adults, and a much smaller quantity would suffice to destroy infants or children. The salt speedily causes vomiting of the most violent kind ; this sometimes expels the poison from the stomach and the person recovers. There is headache, with colicky pains in the abdomen, and purging ; and in aggravated cases there are spasms of the extremities and convulsions. Perceval met with an instance in which violent convulsions were produced in a 3'oung woman by sixty grains of sulphate of copper. Paralysis, insensibility, and even tetanus, have preceded death when the poison was administered to animals. Among the symptoms occasionally met with in the human being may be mentioned jaundice. This has been observed to attend poisoning with the sulphate, as well as by Scheele's green. Two children, one eight and the other six years old, ate a quantity of wheat which had been washed in a solution of sulphate of copper. They were seized with incessant vomiting, the vomited matter being of a bluish or greenish color. The vomiting continued more or less for several days. There was no purging. The elder child recovered, but the younger was very much prostrated and died about two months afterwards. (Brit. Med. Jour., 187t, ii. p. 292.) In 1884 a girl was convicted of poisoning her mistress by intro- ducing sulphate of copper into a jug of beer. The taste of the substance was perceived ; the only results were severe vomiting. (Reg. v. Mar}^ Baker, C. C. C, Oct. 1874.) In 1886, a man was convicted of attempting to murder his wife by administering to her sulphate of copper in spruce and peppermint water. He was sentenced to twenty years' penal servitude. (Reg. v. Reynolds, C. C. C, Sept. 1886.) The vomited matters are remarkable for being generally of a blue or green color ; broken crystals of blue vitriol were discovered in them in a case in which the poison was taken in the state of coarse powder. If the green color of the vomited liquid is owing to altered bile, it will not acquire a blue tint on adding to a portion of it a solution of ammonia; but if caused by a salt of copper this change of color will serve to indicate the fact. Verdigris, or subacetate of copper, in large doses, produces similar symptoms. Chronic poisoning by copper is occasionally seen among workers in this metal and its salts. The poison enters the system partly by the lungs in the form of dust, and partly by the skin in handling the metal or its salts. The marked symptoms are a coppery taste in the mouth, giddiness, pain in the bowels, vomiting, occasional diarrhoea, and wasting of the body. Clapton has pointed out another symptom, namely, a green line on the margin of the gums. He met with this in a sailor and in some working coppersmiths. (Med. Times and Gaz., 1868, i. p, 658.) The author saw two of these cases in 1868. The green line was well marked. The men brought with them a hammer used in their work. It had a greenish color, and this was proved by tests to be owing to the presence of copper. The perspiration from the hands in working had con- 156 APPEARANCES CHEMICAL ANALYSIS. verted the copper into a basic chloride, and had thus led to its absorption by the skin. Several cases of chronic poisoning by cojjper among copper- smiths have been treated by Cameron, but this symi)toni was not noticed. (Med. Times and Gaz., 1870, 1, p. 581.) Gallipi)e (Sur le Cuivre) denies the injurious action of copper compounds upon the human body. [Prof. Jveese reports that poisoning by bronze-powder (an alloy of copper in very line powder), used for printing in gold, is not infrequent. The powder is dusted over the prepared size, and it more or less mixes with the air of the apartment; it must consequently be inhaled into the lungs. The Phila. Med. News and Abstract of Sept. 1880, quotes a case from the Bi-it. Med. Jour., July 24, 1880, of a boy aged 13, who died from in- haling bronze-powder in a printing establishment. He suffered from sickness, pain in the bowels, great distention and tenderness on pressure; no diarrhoea. He fell into collapse, and died on the twelfth day after com- mencing the work and the eighth day of his sickness. Death was found to have resulted from peritonitis ; no inflammation of stomach or bowels. Dr. Tidy detected copper in the stomach and liver.] Cases have, however, been observed of the injurious effects of preserved vegetables, the green color of which is often preserved by the use of sul- phate of copper ; and the cases of poisoning by sulphate of copper already referred to are conclusive against Gallippe's views. Appearances. — In the few fatal cases which have been hitherto ex- amined, the mucous membrane of the stomach and intestines has been found more or less thickened and inflamed, and in some cases eroded and softened. The gullet has presented an inflammatory appearance. In one case of poisoning by verdigris the stomach was inflamed and thickened, especially towards the intestinal opening, the orifice of which, from the general thickening, was almost obliterated. The small intestines were throughout inflamed, and perforation had taken place, so that part of the green liquid was effused into the abdomen. The large intestines were distended in some parts and contracted in others, and the rectum was ulcerated on its inner surface. (Orfila, Toxicologic.) The lining mem- brane of the intestines has been found throughout of a deep-green color, owing to small particles of the copper salt (verdigris) adhering to it. Chemical Analysis. — The salts of copper, whether in the solid state or in solution, are generally known by their blue or green color. Tests — 1. Solution of Ammonia gives, in a solution of a salt of copper, a bluish-white precipitate, which is soluble in an excess of the test, forming a deep violet- blue liquid. 2. Ferrocyanide of jyotassium gives, in a very diluted solu- tion, a rich claret-red precipitate. If the quantity of copper is small, the liquid acquires merely a light-red color ; if large, the precipitate is of a deep red-brown color and of a gelatinous consistency. Ferrocyanide of potassium will act on the violet-blue solution produced by ammonia, pro- vided a few drops of acetic acid are added in order to neutralize the am- monia. One portion of the liquid may thus be tried with the two tests. 3. Sulp)huretted hydrogen gas and sulphide of ammonium give a deep chocolate-brown precipitate, even in an acid solution, or, if the copper is in small proportion, merely a light-brown color. 4. A slip of polished iroyi (a common needle) suspended by a thread in the liquid slightly acidu- lated with sulphuric acid is speedily coated with a red layer of copper, even when the salt is in very small proportion. The iron thus coated may be washed, immersed in ammonia, and exposed to air. The liquid becomes slowly blue, and may then be tested with ferrocyanide of potassium as above. A minute quantity of copper may be thus easily detected. 5. The DETECTION OF COPTER IN THE TISSUES. 157 electi^olyfic test. If a few drops of the copper solution are placed on platinum-fuil, slightly acidulated with a diluted acid, and the platinum is then touched through the solution with a rod of zinc, metallic copper, of its well-known red color, is immediately deposited on the platinum. When the quantity of copper is very small, there is merely a brown stain ; but a blue liquid is formed by pouring on it ammonia and exposing it to air, A coil of fine platinum and zinc wire may be substituted for the foil. Copper in organic liquids. — Copper is liable to be precipitated by certain organic matters, e. g. albumen, fibrin, and mucous membrane ; but some of these organic compounds are easily dissolved by acids, or even by an excess of the solution of copper salt. A portion at least of the salt of copper is, therefore, commonly held dissolved. In such cases the liquid is usually of a greenish color, and has a strong coppery or metallic taste, even when the copper salt is in far less than a poisonous proportion. Having filtered the organic liquid, let a portion of it be placed in a clean platinum capsule. A few drops of diluted sulphuric acid should be added and a rod of zinc introduced. Wherever the platinum is touched by the zinc metallic copper is deposited ; and, after having in this way coated the platinum capsule, the surplus liquid may be poured oft' and the capsule well washed out. The deposited copper, which is of a deep-red color, is then dissolved in nitric acid, and the tests are applied after the excess of acid has been driven off by heat, and the residue dis- solved in water. In place of nitric acid and heat, a solution of ammonia may be poured on the metallic deposit in ibe cold. Under exposure to air tbe metal is oxidized and dissolved in a few minutes, forming a blue solution. This ammoniacal solution may be neutralized with acetic acid and ferrocyanide of potassium then added. The red color of the deposit on platinum is characteristic of copper, and the mode of testing here ad- vised renders the results conclusive. In the tissues. — Dry and incinerate the organic matter over a Bunsen burner provided with an iron tube. If the ordinary burner with brass tube be used, some copper will be volatilized from the burner and de- posited on the ashes. Digest the residuary ash in pure hydrochloric acid by heat and then evaporate nearly to dryness. This residue may be dis- solved in a small quantity of water and a polished needle immersed in it for some hours. The metallic deposit, if any, on the needle may be recog- nized as copper, either by its color or by the action of ammonia. Traces of copper have been found in many kinds of food, as well as in the tissues of the body, irrespective of the introduction of a copper salt as a poison. Thus copper has been detected in various green pickles, in preserved peas and other vegetables. It has been used in these cases as an artificial coloring. In prosecutions under the Sale of Food and Drugs Act, the question has arisen whether such a quantity of copper as 0.28 grain in a pound would render the article injurious as food. Copper is a noxious substance, and there is a penalty on the wilful admixture of any noxious substance with any article intended for food, whatever the pro- portion may be. In some cases, a grain and a half of sulphate of copper has been found in a pound of peas. The restrictions on the regreening of preserved vegetables in France have been recently removed. loS TARTAR EMETIC SYMPTOMS. CHAPTER XIV. TARTAR EMETIC. ANTIMONIAL WINE. SYMPTOMS. — APPEARANCES. CHRONIC POISONING. — ■ CHEMICAL ANALYSIS. CHLORIDE OK BUTTER OP ANTIMONY. POISONING WITH SALTS OP ZINC AND IKON. POISONING WITH CHROMATES. Tartar Emetic. Tartar Emetic, or Tartarated Antimony, is met with in commerce as a heavyish white powder, freely soluble in twenty parts of water and less soluble in alcoholic liquids. It is used in medicine, and more largely in veterinary medicine. Antimonial Wine, i. e. the official solution of tartarated antimony in sherry wine (two grains in one fluidounce), may easily be mistaken for ordinary sherry. The editor had a laboratory attendant who was made seriously ill by drinking this medicine, which he had pilfered. Tartar emetic is a constituent of many proprietary and patent cough medicines; and these, when taken in excess, may produce a powerful depressant action upon the system. Symptoms and Effects — When tartar emetic is taken in a poisonous dose, a strong metallic taste is perceived in the mouth during the act of swallowing. There is great heat, with constriction of the throat and difficulty of swallowing, violent burning pain in the region of the stomach, followed by incessant vomiting, profuse purging, faintness, and extreme depression. The pulse is small and rapid, and sometimes imperceptible ; the skin cold and clammy, and covered with a clammy perspiration ; the respiration painful. Should the case prove fatal, death may be preceded by giddhiess, insensibility, great prostration of strength, and sometimes violent spasms of the muscles of the limbs, which may assume either a clonic or a tetanic character. Such are the symptoms in an acute case of poisoning by this substance. The quantity actually required to destroy life is small. One drachm taken at a dose proved fatal in ten hours, in spite of early and frequent vomiting. (Med. Gaz., vol. 45, p. 801.) In a case in which a girl took a teaspoonful of tartar emetic by mistake, recovery took place in three weeks. She suffered from enteritis, and, as an after-eff"ect, her hair fell off". (Brit. Med. Jour., 1876, ii. p. 492.) A man took eighty grains. There was only slight vomiting an hour after he had taken it ; but this became sub.sequently very violent, attended with severe cramps in the legs and profuse perspiration. He recovered in two days. (Brit. Med. Jour., 187T, i. p. 674.) In 1881 a young man w^as killed in six hours by a dose of fifteen grains of tartar emetic. The char- acteristic pustular eruption of tartar emetic, often observed on the skin after its local application, was found on the mucous membrane of the stomach. (Friedreich's Blatt. f. Gerichtl. Med., 1882, p. 8.) On April 18, 1876, Mr. Bravo, a^t. .30, a barrister, was poisoned by tartar emetic. After dining with his wife, and whilst alone in his room at 6.30 P. M., he Avas suddenly seized with violent sickness and vomiting. When seen at 10.30 P. M., by Moore, he was lying back in a chair, totally unconscious ; the breathing was noisy, and the heart's action was barely perceptible. He did not appear to suffer pain, and his appearance was not unlike that of a person under the effects of a narcotic. He had pre- POISONING AVITII TARTAR EMETIC. 159 viously complained of pain in the stomach, and an emetic of mustard and water had been given. The pupils were widely dilated ; and he was un- able to swallow when seen shortly afterwards by Ilarrison. At 1.45 A. M. •on the 19th, he first vomited blood. At 3.30 A.M., soon after he was seen by Geo. Johnson and Roves Bell, a little consciousness returned ; and he then said, to account for his state, that he had rubbed his gums with laudanum, and that he might have taken some of this liquid. Just before becoming conscious, viz.. at 2.45 A. M , he vomited blood and passed bloody stools. Throughout the 19th, after the return of conscious- ness, he sulfered excruciating pain, and was violently purged and vomited frequently. On the 20th the patient was seen by Gull, at G.30 P. M., who found him pulseless and dying. He was told that he was dying of poison, and was asked how he came by it. He replied, "I took it myself." "What did you take?" " Laudanum." When told that he had taken more than laudanum, he made no further statement bearing upon the matter, except to repeat a second time, "I took it myself." Pain, collapse, vomiting, purging, and occasional convulsions, especially of the upper limbs, con- tinued till near the close, when the vomiting and purging ceased. He died on the 21st of April, fifty-five hours after the commencement of symptoms. At the autopsy, made next day, the following appearances were observed by Payne: There was no appearance of inflammation, congestion, or ulceration of the stomach, which contained about eight ounces of thick gruel-like matter of a yellowish color, containing small solid lumps, and had the odor of alcoholic fermentation. The gullet was natural, and contained some of the same matter as the stomach. The first portion of the bowels was very soft, being torn in tying it ; but sub- sequent careful examination showed no perforation or ulceration. The surface was pale and yellowish like that of the stomach. The whole of the small intestine was like this, except the lower part, where there were some red spots. This part of the bowels contained yellow pasty matter without any admixture of blood. Subsequent examination showed sev- eral small ulcers in the caecum, from which the bleeding had evidently taken place ; but there was no perforation. The remainder of the large intestine was very deeply blood-stained, but without ulceration. The contents were a soft dark-red material, composed of fecal matter mixed with blood. The liver and spleen were natural, as were also the pancreas, kidneys, an^ other abdominal organs. The skull and the membranes of the brain were quite natural, containing only the usual amount of blood. The brain-substance was also healthy, and contained no excessive amount either of blood or of watery fluid. The mouth and lips were natural, ex- cept that the papillae at the back of the tongue were somewhat more prominent than usual. There was no other appearance of disease in the body, except what has been noted. From the first vomit of the deceased, Redwood obtained antimony equivalent to ten grains of tartar emetic. Antimony was also detected in the liver and in fluid taken from the large intestines of the deceased, but not in the contents of the stomach. Traces of the metal were also discovered in the urine passed during life. Red- wood was of opinion that at least twenty grains of tartar emetic had been taken by deceased. A verdict of wilful murder by some unknown person was returned, no tartar emetic being traced in the hands of the deceased or any person about him. It Avas also known that Bravo was well read in medical jurisprudence, and was acquainted with the poisonous nature of tartar emetic. Some months after the return of the above ver- dict, evidence came into the possession of the editor — who watched the medical aspect of the case at the inquest on behalf of one of the persons 160 APPEAllANCES. living- in the same house as the deceased — showinpr that Bravo had tartar emetic in his possession witiiiu six or seven weelvS of his decease. He had purchased a large number of quack powders, extensively advertised as a cure for dipsonuxnia, and received instructions that these, if adminis- tered too freely to his wife, would cause vomiting. It is possible that these powders — each of them consisting of half a grain of tartar emetic with a pink vegetable pigment — may have been taken in fatal amount by the deceased, who was unaware of their poisonous nature, for the purpose of causing ejection of the laudanum which he had admittedly taken. It is probable that the laudanum would delay the ejection of the tartar emetic and thus increase the liability to a fatal result. Appearances. — The following cases, as well as those alread}^ given, show the nature of the appearances likejy to be found after death. Two children, a boy aged five, and a girl aged three years, each swallowed a powder containing ten grains of tartar emetic mixed with a little sugar. It was stated that, in twenty minutes after taking the powders, they were seized with violent vomiting and purging and great prostration of strength, followed by convulsions and tetanic spasms ; there was also great thirst. The boy died eight hours, and the girl twelve or thirteen hours after swal- lowing the poisoning. The I)odies were inspected between four and five days after death. In that of the boy there was effusion of serum in the right pleura ; the lower lobe of the right lung posteriorly was redder than natural, and the peritoneum was injected from recent inflammation. The mucous membrane of the duodenum was inflamed and covered with a whitish-yellow viscid secretion ; this was observed throughout the intes- tines, but the color was of a deeper yellow in the large intestines ; there was no ulceration. The peritoneal coat of the stomach was inflamed. The mucous membi'ane of this organ was also much inflamed, especially about the larger curvature and at the cardiac orifice ; there was no ulcera- tion, but in one case there was a patch of Ivmph. The stomach contained about two ounces and a half of a dark, l)loody fluid, having a slightly acid reaction. The tests used did not indicate the presence of antimony. With regard to other appearances, the tongue was covered with a white fur and appeared soddened ; the throat was not inflamed ; the windpipe and gullet had a natural appearance. On opening the head, the dura mater was found congested ; the longitudinal sinus contained a coagulum of lymph and but little blood. The vessels of the surface of the brain were much injected with dark-colored blood, the whole surface having a deep purple color. Every portion of the brain, when cut, presented many bloody points. The cerebellum and medulla oblongata were also congested ; there was no effusion in the ventricles or at the base of the brain. In the body of the girl the morbid appearances were similar ; and there were, in addition, on the arms, legs, and neck, patches resembling the eruption of scarlatina. The arachnoid memlirane was more opaque than usual ; and on the mucous membrane of the stomach, where the inflammation was greatest, were two or three white spots, each about the size of a split pea, which appeared to be the commencement of ulceration. (Lancet, 1846, ii. p. 460. See also case of Bravo, p. 158.) In cases o^ chronic poisoning by this substance the principal symptoms are as follows : Intense nausea ; vomiting of mucous and bilious liquids ; great depression and prostration of strength ; watery purging followed often by constipation of the bowels ; small, contracted, and frequent pulse ; loss of voice and muscular strength ; coldness of the skin, with clammy perspiration ; and death from complete exhaustion. In these cases anti- CHEMICAL ANALYSIS. 161 mony may be detected in the urine by Reinsch's in'ocess. There are several eases reported which show that tartar emetic has beea thus crimi- nally employed. (See Brit. Med. Jour., 1876, i. p. 639.) It has been supposed that the cases in which this poison has proved fatal have been few; but the author has elsewhere re])orted thirty - seven, of which sixteen were fatal. The smallest fatal dose was in a child, three-quarters of a grain (Jour, de Chimie, 1847, p. 472), and in an adult, tioo grains ; but in this latter instance there were circumstances which favored the fatal operation of the poison. (Guy's Hosp. Rep., 1857, p. 415 ; Andral's Clinique Med., 1836, p. 698.) Chemical Analysis. Tartar Emetic as a solid. — In a state of powder it is white and crystalline. — 1. It is easily dissolved by water; the solu- tion has a faintly acid reaction and an acrid, metallic taste. 2. The powder, dropped into sulphide of ammonium, is turned of a deep reddish- brown color, and is thereby known from other white metallic salts. 3. When heated in a reduction-tube it is charred, but does not previously melt like acetate of lead. The metal is partially reduced by the carbon of the vegetable acid, and the decomposed mass has a grayish-blue metallic lustre. No metallic sublimate is produced in this experiment by the moderate heat of a spirit-lamp. 4. When boiled in water containing one-sixth of pure hydrochloric acid, and metallic copper is immersed in the liquid, a deposit of antimony takes place on this metal. The color of the deposit is violet- red if the quantity is very small, but the deposit is gray, or black and pulverulent, if very large. 5. The solution acidulated with oiu'-tenth part of hydrochloric acid gives in the cold a black deposit on a surface of pure tinfoil. This serves to distinguish antimony from arsenic, which, under these circumstances, produces no deposit on pvre tin. On the other hand, tartar emetic and other antimonial compounds give no deposit when boiled with stannous chloride and fuming hydrochloric acid, unless arsenic is present as an impurity. Tartar Emetic in solution — 1. On slowly evaporating a small quan- tity of the solution on a slip of glass, the salt will crystallize in tetrahedra and in deriva- tives of the octahedron (Fig. 16). If ob- tained from a very dilute solution, this orystallizatioii is confused and resembles that of arsenic. 2. Hydrochloric, vitric, or sul- phuric acid, each gives a white precipitate, sohible in excess of the acid. This triple reaction is very characteristic of tartarated antimony. 8. Ferrocyanide of potassium. does not precipitate the solution, w^hereby tartar emetic is known from most other metal- lic poisons. 4. Sulphuretted hydrogen gas produces in the solution a reddish-orange crystals of Tl^^^^TE^ic.masuiiied colored precipitate, differing in color from so diaiueturs. every other metallic sulphide. This pre- eipi-tate is soluble in sulphide of ammonium and is dissolved by strong boiling hydrochloric acid. In liquids containing organic matter. — Tartar emetic is precipitated by tannin in all itpi forms, but not readily by albumen or mucous mem- brane ; therefore it may be found sometimes dissolved in the li((uids of the stomach, and sometimes precipitated. These insoluble conii)ounds of antimony are soluble in tartaric acid ; and thus, if there should be no antimony dissolved, it may easily be brought into a state of solution by 11 162 DETECTION OF TARTAR EMETIC IX ORGANIC LIQUIDS. means of this acid. The liquid, acidulated with tartaric acid, sliould be boiled and liltered. If it should be highly colored or turl)id, it may be concentrated and submitted to the process of dialysis. The antimonial compound may thus be obtained in a clear solution. A current of sul- phuretted gasniay now be passed into the whole or a portion of it until there is no further precipitation. Tlie sulphide is collected, washed, and dried. If it is the sulphide of antimony, it will have an orange-red or brown color, it will be insoluble in a solution of ammonia, and when dried will be dissolved Dy a small quantity of boiling hydrochloric acid (i'orm- ino- chloride of antimony), with the evolution of sulphuretted hydrogen gas. The boiling should be continued for several minutes until the liquid is colorless. On adding this solution, if not too acid, to water, a white precipitate of oxN'chloride of antimony falls down. The white precipitate is soluble in tartaric acid. This is characteristic of antimony. If the sulphuretted hydrogen is passed into a colored organic li(|uid, the orange- red color of the sulphide can be only well seen in the froth. [Prof. Reese does not regard this test as absolutely characteristic of antimony unless pure, inasmuch as the colored precipitate which may often be obtained by the action of sulphuretted hydrogen on a simple acid solu- tion of certain organic substances is more or less soluble in boiling hydro- chloric acid, and this solution when thrown into water will yield a white precipitate. ~\ The following method of detecting the metal when dissolved in any organic liquid is based upon the principle by which copper and other metals may ))e detected under similar circumstances. Acidulate a portion of the suspected liquid with hydrochloric acid and place it in a shallow platinum capsule. Touch the platinum, through the acid liquid, with a rod of pure zinc. Hydrogen is evolved, and, wherever the metals come in contact metallic antimony, in the state of a black powder, is deposited upon the surface of the platinum. The liquid should be poured off and the capsule thoroughly washed with distilled water. This may be effected without disturbing the black deposit. This deposit should be heated with strong nitric acid — evaporated to dryness — the white residue dissolved in strong hydrochloric acid, and this solution, not too much diluted, precipi- tated by a current of sulphuretted hydrogen. A reddish-colored precipi- tate indicates antimony. If a portion of this hydrochloric acid solution is added to water, it may give a precipitate of white oxychloride of antimony, soluble in tartaric acid, and this solution may be precipitated of an orange- red color by sulphuretted hydrogen. By this process antimony in small quantity may be detected in, and separated from, any liquid containing organic matter. If there is no deposit under these circumstances, a rod of zinc, or a piece of tinfoil, with a layer of thin platinum-foil wound round it, should be suspended in the sufficiently diluted acid liquid for some hours. If antimony is present, it will be deposited on both metals in the form of a black powder. In the tissues. — The antimony may be deposited in the organs in so small a quantity that neither the sulphuretted hydrogen nor the deposition on platinum process will yield any satisfactory results. The liver or other organ should be cut into small pieces and boiled in a mixture of one part of hydrochloric acid and five parts of water. After some time, the liquid may be tested by introducing into it a slip of polished copper-foil free from antimony. If antimony is present in small quantity, the copper will acquire a reddish or violet-colored deposit on its surface ; if in large quan- tity, the deposit will be gray with a metallic lustre, or sometimes in the state of a loose, black powder. These deposits, when heated in a reduc- BUTTER OF ANTIMONY. 163 tion-tube, do not yield octahedral crystals like those obtained from arsenic. A slip of pure tinfoil may be suspended in the cold acid liquid, so diluted that the hydrochloric acid forms only one-tenth part by measure. Either immediately, or in the course of a few hours, if antimony is present, the tin is covered with a black deposit of the metal. Antimony in the metal- lic state is so easily procured from a small quantity of material, by one or other of the above-mentioned processes, that on no account should this be omitted. The procuring of the metal may be made sul)sidiary to the pro- curing of the sulphide, as the metal can be easily dissolved by boiling the deposit on copper with a solution of permanganate of potassium. It can then be converted into sulphide and obtained entirely free from organic matter. A reliance on a small quantity of a colored precipitate from sul- phuretted hydrogen alone, without the production of the metal in some form, would be most unsatisfactory as chemical evidence. No chemist would rely upon the production of a yellow sulphide as certain evidence of the presence of arsenic, unless he obtained the metal arsenic from that compound. [The same reason exists why the metal should be produced in a case of alleged poisoning by antimony as in the case of poisoning by mercury, arsenic, lead, copper, etc. The general rule in such cases is the safer.] The separation of antimony from the tissues does not necessarily indicate that it has been criminally administered or has caused death ; but its presence there should be reasonably accounted for, as antimony may have been unlawfully administered. In several cases of suspected death from poison, deposits on copper, evidently of an antimonial nature, have been obtained from the liver or tissues. On inquiry it has been found that antimonial medicines had been taken shortly before death. It is best, however, in all cases to shred up the tissue and boil it wfth dilute hydro- chloric acid, a few crystals of potassium chlorate being introduced from time to time, till a clearish yellow solution is obtained. The solution is then warmed with bisulphite of sodium till it persistently smells of sulphur dioxide. The whole is then allowed to stand in a warm place till the sulphur dioxide has disappeared. The liquid is filtered and the filtrate precipitated with a stream of washed sulphuretted hydrogen gas. A pre- cipitate of sulphide of antimony falls, mixed with sulphur. This may be dissolved in boiling strong hydrochloric acid and tested as above for antimony. TerchloyHde, or Butter of Antimomj. — This is a strongly corrosive poison. It is used for browning gun-barrels and in veterinary medicine. It has caused death in several instances. Two women, mother and daughter, were tried (Reg. v. Wallis and Wallis, Worcester Sum. Ass., 1883) for the murder of the illegitimate infant child of the younger prisoner by means of terchloride of antimony, but were acquitted from insufficient evidence of administration. It was at first supposed that the child had died from poisoning by ferric chloride, which was detected in the stomach by a medical man. The editor found antimony in the viscera, and also in the matters vomited and passed from the bowels of the child. The ferric chloride was merely the impurity always met with in cora= mercial terchloride of antimony. The symptoms and appearances resemble those produced by concentrated hydrochloric acid. The terchloride gives a white precipitate when added to water. This is soluble in tartaric acid, and the solution is precipitated of an orange-red color by sulphuretted hydrogen. It has caused death in several instances. 164 ZINC, Zinc. Sulphate of Zinc. White Vitriol. — Symptoms and Appearances. — The syuiptonis produced by an ov'crdose of sulphate of zinc are a styptic taste, pain in the abdomen, and violent vomiting-, coming- on almost im- mediately, followed by purging. After death the stomach has been found inflamed. The sulphate appears to act as a pure irritant, and has no corrosive properties. This salt may cause death indirectly as the result of exhaustion from violent vomiting, when an ordinary dose has been given to a person already debilitated by disease. It does not appear to be a ver}^ energetic poison. In one case a lad}'" recovered after taking sixt3'-seven grains. (Lancet, 1856, i, p. 540.) In another, which occurred in 1872, a man, £et. 20, recovered in a few days after taking- an ounce of sulphate of zinc by mistake for Epsom salts. There was earl}'- vomiting and purging of a most violent kind, with great prostration of strength. The greater part of this large dose was no doubt thus quickly carried out of the body. Chloride of Zinc. — Symptoms and Appearances. — This, which is com- monly sold under the name of " Sir W. Burnett's fluid," is a corrosive and irritant poison, and is much used as a deodorizer. The patient experiences a sense of heat and burning in the mouth and throat, in the act of swal- lowing the licfuid, which has been frequently fatally mistaken for fluid magnesia. There is a burning and griping pain in the stomach and nausea, followed usually by violent retching and vomiting — the vomited matters being streaked with blood and mixed with much flaky mucus and shreds of mucous membrane. This has produced an appearance of frothi- ness about the mouth. Violent purging has been observed among the symptoms. A stage of collapse supervenes, and the skin becomes cold and livid. A man, set. 62, took two fluidounces of soldering fluid, made by dissolv- ing zinc in hydrochloric acid — and hence a solut-ion of chloride of zinc. An emetic was given without effect, and he speedily became collapsed. There was profuse purging. A little scanty urine was drawn off by a catheter. He retained his intellect until death, four hours and a half after taking the poison. Crosse found after death the tongue white and shrivelled, and the mucous membrane of the mouth as if charred. The gullet was contracted, with the mucous membrane white, silky, and easily detached. The stomach was contracted and rugose, the mucous membrane being of an ashy-gray color, with black patches. The stomach contained chloride of zinc and free hydrochloric acid. The whole of the bowels were hardened and contracted, the mucous membrane thickened and gray in color — the duodenum and upper part of the jejunum especially so. (Brit. Med. Journ., 1883, ii. p. 820.) After death from this poison, the lining membrane of the mouth and throat has been found white and opaque — that of the stomach has some- times been hard and leathery, at others corrugated, opaque, and of a dark leaden color. The lungs and kidneys are congested. The chloride is both a corrosive and irritant poison, exerting also a peculiar action on the nervous system. If a person survives the acute stage, he may die in the chronic stage from stricture of the gullet or pylorus, or from ema- ciation and exhaustion as a result of the local action of the poison on this organ. Analysis. — In these two compounds, the zinc is detected by their aqueous solutions giving white precipitates with a current of sulphuretted hydrogen gas, while the sulphuric acid or the chlorine may be recognized PREPARATIONS OF IRON AND CHROMIUM. 165 by their respective tests. Metallic zinc may be obtained by plunging into a weak solution of the salt a slip of magnesium. Preparations op Iron. Ferrous Sulphate. Sulphate of Iron. Gopp)eras. Green Vitriol. This compound has been administered with malicious intention. One death from it took place in 1837 or 1838. It cannot, however, be an active preparation ; for a girl who swallowed an ounce of it recovered, although she suffered for some hours from violent pain, vomiting, and purging. (Christison.) Green vitriol, or copperas, is sometimes given as an abortive. A woman of the name of Riley was indicted (Notting- ham Aut. Ass., 1859) for administering copperas to two children. She put the substance into gruel. It gave to the gruel a greenish color and a peculiar taste, which led to the discovery. It caused sickness, but no other serious symptoms. As there was no evidence of an intent to murder, and as it was then not unlawful to administer poison with any other intent, the prisoner was acquitted. This salt has been much used for criminal purposes in France. (See Med. Gaz., vol. 47, p. 307 ; also Ann. d'Hyg., 1850, vol. 1, pp. 180, 516; and 1851, vol. 1, p. 155; vol. 2, p. 337.) Ferric Chloride. 3Imnate of Iron. Perchloride of Iron — This is usually met with as an acid solution in water or in rectified spirit. These solutions are of a red-brown color, and are much employed as medicine. They are sometimes made with wood-spirit or methylated spirit, which gives to them a peculiar odor. Christison relates an instance in which a man, by mistake, swallowed an ounce and a half of such a liquid. The symptoms are somewhat like those produced by hydrochloric acid. He at first rallied, but died in about five weeks. The stomach was found par- tially inflamed, and thickened toward the intestinal end. The stronger solution of the British Pharmacopoeia is very potent when swallowed, A patient in Guj^'s Hospital swallowed in mistake a fluid drachm of the solu- tion, and was strongly purged by it in a few minutes. Comparatively small doses of these solutions may seriously affect preg- nant women ; and among the criminal uses to which they have been put may be mentioned that of procuring abortion. A druggist was convicted (Reg. V. Rumble, Lincoln Lent Assizes, 1863) of having supplied the per- chloride to a woman with the intent to procure her miscarriage. The health of the woman was greatly injured by the administration of the liquid. The editor has met with several instances of the administration of ferric chloride to pregnant women with the view of procuring abortion ; and for this purpose it is commonly combined with aloes. Preparations of Chromium. Bichromate of Potassium, or Bichromate of Potash. — Well-observed instances of poisoning by thic compound, which is now extensively used in the arts, are rare; and therefore the details of the following case (Med. Gaz., vol. 33, p. 734) are of interest. A man, get. 64, was found dead in his bed twelve hours after he had gone to rest ; he had been heard to snore loudly, but this had occasioned no alarm to his relatives. When discovered, he was lying on his left side, his lower limbs being a Itttle drawn up to his body; his countenance was pale, placid, and composed; the eyes and mouth were closed and the pupils dilated ; there was no dis- charge from any of the outlets of the body ; and there were no signs of 166 PREPAKATIONS OF CHROMIUM ANALYSTS. vomiting- or purgiiiii-, nor any stain upon the liands or person, nor upon the l)e(l-linen or furniture. The surface was moderately warm. Some dye- stulf, in the form of a black powder, was found in his pocket. On inspec- tion, the brain and its membranes were healthy and natural ; there was neither coni^estion nor effusion in any part. The thoracic viscera were healthy, as well as those of the abdomen, with the exception of the liver, which contained several hydatids. A pint of turbid, inky-lookint^ fluid was found in the stomach. The mucous membrane was red and vascular, par- ticularly at the union of the i^-reater end with the gullet ; this was ascribed to the known intem))erate habits of the deceased. In the absence of any obvious cause for death, poison was suspected ; and on analyzing- the con- tents of the stomach they were found to contain bichromate of potas- sinni. The dye-powder taken from the man's pocket consisted of this salt mi.x'ed with cream of tartar and sand. The salt does not appear to have acted so much by its irritant properties, as by its effects on the nervous system. This, however, is by no means an unusual occurrence, even with irritants far more powerful than bichromate of potassium. A boy recov- ered from the effects of a dose of this salt, but only after the lapse of four months. The first symptoms were pain, vomiting, dilated and fixed pupils, cramps in the legs, and insensibility. His recovery was due to early and active treatment. (Guy's Hosp. Rep., 1850, p. 216.) Another case in which, owing to timely treatment, a man, aet. 37, recovered from a large dose of the salt, was communicated to the author. It seems that with suicidal intent the man swallowed about tw^o ounces of the bichromate in solution, mixed with pearl-ash. In about two hours he was seen by An- drews, and he was then apparently in a dving state. He Avas suffering chiefly from severe cramps, the pupils w^ere dilated, the pulse was scarcely perccptil)le, and there was vomiting and purging, with greenish-colored evacuations. The stomach-pump was used, and olive oil and diluents were given. In about nine hours the urgent symptoms abated, and the man complained only of great pain in the shoulders and legs. There was no gastric irritation nor tenderness of the abdomen. He was discharged, cured, at the end of a week. A woman, set. 24, died from the effects of this poison taken for the purpose of procuring abortion. The symptoms were those of an irritan*^ — severe pain, vomiting, and purging. (Horn's Yierteljahrsschr., 1886, 2, s. 113.) This salt, in a state of fine powder, or in a saturated solution, has a local irritant action on the skin and on parts from which the skin has been removed. (Ann. d'Hyg., 1864, 1, 83.) It produces what are called "chronic sores," affecting the hands and exposed parts of the face. According to recent observations, workers in chrome factories — of which . there are only six in the world — suffer from a peculiar irritation of the se|)tum of the nose, apparently due to the action of bichromate of potas- sium, which leads to a perforation of the nasal sejitum (Lancet, 1882, i. p. 169.) Chromic acid is a powerful corrosive poison, destroying all organic textures. (Pharm. Jour., Jan. 1872, p. 568.) Chromate of Lead (Chrome Yellow) is a powerful irritant poison. A dose of a few grains of this pigment has proved fatal. (See case of two boys. N. Syd. Soc. Bien. Retrospect, 1873-4, p. 452.) Analysis. — The bichromate may be recognized by its orange-red color, as well as by the inten.se yellow color which it gives to water when dissolved. Its solution gives a deep red precipitate with nitrate of silver, a pale yellow with nitrate of barium, and a bright yellow with salts of lead. URANIUM. 167 Uranium. The compounds of this metal are now largely used in the arts, and cases of poisoning- by it have occurred. Indeed it has recently been proposed to place it in the official list of poisons in Ilussia. Uranium salts cause severe inflammation of the gastro-intestinal mucous membrane, and of the kidneys, and are distinguished from the metallic poisons by acting directly on the walls of the bloodvessels, and rendering also the blood reducible with difficulty. In this respect they resemble prussic acid. (See an abstract of the researches of Woroschilsky in Pharm. Jour., 1890-1, p. 20fi.) These are the principal metallic irritants ; but the compounds of tin, silver, gold, and osmium have also an irritant action. Cases of poison- ing by these substances are, however, rare. (See On Poisons, 3d edit. 1875.) 108 VEliETABLE IKKITANTS ALOES. VEGETABLE AND OTHER IRRITANTS. CHAPTER XV. VEGETABLE IRRITANTS. ALOES. GELSEMIUM. SAVIN. — CROTON-OIL. CASTOR- OIL. COI/- CHICUM. HELLEBORE. VERATRINE. CARBOLIC ACID. RESORCIN. PETROLEUM. — ANI- MAL IRRITANTS : CANTHARIDES. NOXIOUS ANIMAL FOOD. FISH. MUSSELS. CHEESE. SAUSAGE POISON. PORK. — TRICHINOSIS. POISONED GAME. PTOMAINES. General Remarks. — The poisonous substances of an irritant nature which beloug to the ve<;etable kingdom are very numerous as a class; but it will here be necessary to notice only those which have either caused death or have given rise to accidental poisoning. Aloes. Golocynth. Gamboge. Jalap. Scammony. — These different substances, which are used in small doses as medicines, are liable, when taken frequently or in large quantities, to excite severe vomiting, purging, and other symptoms of irritation. In one case a dose of colocynth (three pennyworth) proved fatal to a woman, set. 22. She was pregnant, and had taken the drug for procuring abortion, for which purpose it is often used. It operates as a violent irritant. (Pharm. Jour., June 22, 1878, p. 1035.) Christison recorded the death of a young woman from a teaspoonful and a half of the powdered pulp. Roques states that less than sixty grains of the powder, in decoction, has proved fatal ; whilst re- covery has taken place after three times that amount. (Husemann, Hand. d. Toxicol., p. 625.) Hier-apicra {Holy Bitter) was formerly a popular aloetic compound, and one death is recorded to have been produced by it in 1837-8. There is reason to believe that it is occasionally used for the purpose of pro- curing criminal abortion. A man was tried and convicted of this offence (Reg. V. White, Aylesbury Lent Ass., 1857), and the noxious properties of this compound then became a subject of legal inquiry. The dose, an^ the condition of the woman to whom it is administered, will of course affect the answer to this question. At the trial al)ove mentioned, it was properly considered to be a noxious substance within the meaning of the statute." The fact that, under the name of Piilvis Aloes cum Canelld, it was formerly admitted into the British Pharmacopoeia, cannot justify the mischievous uses to which it may be put. Hierapicra is a snuff-colored powder, of an intensely bitter taste. It consists of four parts by weight of aloes and one part by weight of powdered Canella bark. The proper medicinal dose was formerly fixed at from five to fifteen grains. Its injurious effects on y)regnant women are chiefly due to the aloes This drug specially affects the rectum, and by contiguity, under violent irritation or purging, may affect the uterus. From the taste and color which it imparts to liquids, it is not probable that it could be taken by a woman unknowingly. YELLOW Jasmine. 169 Yellow Jasmine (Gelsemium nitidum seu sempervirens). An alcoholic extract of the root of this plant, and a tincture, are used for medicinal purposes. It contains one, or perhaps two alkaloids, one of which paralyzes and the other tetanizes. Its solutions are fluorescent. It has acted as a poison and destroyed life, but its exact place as a poison cannot yet be satisfactorily assig'ned. In one case reported by Wormley (Anier. Jour, of Pharni., Jan. 1870) it appears to have acted rather as an irritant than a narcotic. A young- healthy married woman, several weeks advanced in pregnancy, took by mistake three teaspoonfuls of fluid extract of gelsemium — a con- centrated tincture of the root, containing 480 grains to the fluidounce. In two hours after taking the extract she complained of pain in the stomach, nausea, and dimness of vision. These symptoms were followed by great restlessness, inettectual efforts to vomit, and general perspiration. In four hours the pulse was feeble, irregular, and intermittent. There was great prostration, with irregular and slow breathing. The skin was dry, the limbs cold, the pupils dilated and insensible to light ; the eyes were fixed, and there was inability to raise the eyelids. The vital powers rapidly gave way, and, without convulsions, death occurred in seven hours and a half after the poison had been taken. On inspection, the membranes and substances of the brain and spinal marrow were normal. The adipose tissue was tinged with bilious-looking matter. The lungs were collapsed, but natural in appearance, and the superficial veins were congested. The heart was normal — the superficial veins were injected, and the cavities were distended with dark grumous blood, inside of which was a well- defined fibrinous deposit. The stomach contained a small quantity of ingesta ; the peritoneum and intestines were in a healthy state. The left kidney was congested. It will be seen from this account that, while death took place rapidly, there was nothing characteristic in the symptoms and appearances A muscular man, twenty-eight years of age, after a drink- ing bout, took about two ounces of fluid extract of gelsemium, to "quiet his nerves." When seen, his face was flushed; he was dozing, but could easily be roused, and talked intelligently ; the pupils were moderately dilated, reacting to light, and there was slight drooping of both eyelids. The pulse was strong and full, and about 100 per minute. An hour later, the dipsomaniac eluded his watchers, managed to get out to a drug-store, and procured half an ounce of fluid extract of gelsemium, which he drank. He was found twenty-five minutes later, sitting in a shop, with relaxed limbs and pale face ; and he was capable of speech. As he refused to SA\allow an emetic, sulphate of zinc was administered through the nose. Copious vomiting followed this and a second dose that was given. In spite of this, he speedily became unconscious; pulse 130; respiration 40, and entirely thoracic ; pupils moderately dilated, but acting. I3randy was given subcutaneously and by the rectum, and, after faradization of the diaphragm and intercostal muscles, he rallied from the state of collapse into which he had fallen, only to relapse shortly after, when the same measures were repeated. Hypodermic injections, first of atropine, then of carbonate of ammonium, and inhalation of nitrite of amyl, were employed. He died about five hours after taking the poison. (Boston Med. and Surg. Jour., Dec. 22, 1881.) Savin (Juniperus Sahina). — This is a well-known plant of a remarkable odor, the leaves of which exert an irritant action both in the state of in- fusion and powder. They yield b}^ distillation a light yellow, acrid, volatile 170 CROTON-OIL COLCJIICUxM. Fig. 17. Tips of the leaves of Savin, magnified 30 diameters. oil, on which the irritant properties of the plant depend. The powder is sometimes used in medicine, in a dose of from five to twenty grains. Savin is not often taken as a poison for the specific purpose of destroying life; but this is occasionally an indirect result of its use as a popular means of procuring abortion. It acts by producing violent pain in the abdomen, vomiting, and strangur}'. After death, the gullet, stomach, in- testines, and kidneys have been found either much inflamed or congested. It has no specific action as an abortive, but oi)erates, like other irritants, l)y causing a violent shock to the system, under which the womb may expel its contents. Such a result can never be obtained without i)]acing in jeopardy the life of a woman ; and thus, when abortion follows, she generally falls a victim. Oil of savin given with suljihate of iron and aloes in the furm of pills, is much used by criminal abortionists after instrumental interference, during the earliermonths of pregnancy. (Reg. V. Phillips, C. C. C, Feb. 1885) The presence of savin in powder in the stomach and bowels may be recognized by the peculiar odor, and by the presence of microscopic fragments (see Fig. 17) of the plant. The woody tissue of the plant has the characteristic dots of coniferous woody tissue. Yew has a similar structure, but is destitute of the true savin odor. Yew and savin are the chief poisonous coniferae of this country. Yew berries are highly poisonous ; but the luscious pulp forming the exterior of the so-called berry is innocent. Groton-oil. — This is an oil extracted from the seeds of the Croton Hglium. It is a powerful drastic purgative, producing, in a large dose, severe purg- ing, collapse, and death. A case occurred in Paris, in 1839, in which a man swallowed by mistake two drachms and a half of croton-oil. In three-quarters of an hour the surface was cold and clammy, the pulse im- perceptible, the l)reathing difficult, and the extremities and face were as ijlue as in the collapsed stage of cholera. In an hour and a half purging set in ; the stools were passed involuntarily, and the abdomen was very sensitive to the touch. The patient complained of a burning pain in the course of the gullet. He died in four hours after swallowing the poison. There was no marked change in the mucous membrane of the stomach. (For another fatal case, see Pharm. Jour., Feb. 18G3, p. 379.) Castor-oil. — The seeds of the castor-oil plant are occasionally fatally poisonous to children, who are attracted by their beautifully mottled ap- pearance. They act as a powerful drastic. Three seeds have destroyed the life of an adult (Med. Times and Gaz., 1861, i. p. 55.5. See also Ann. de Thdrap., 1872, p. 103; and Ann. d'llyg., 1871, i. p. 400.) 31eadow-Saffron (Colchicum). — Meadow-saffron (Colchicum autum- nale) contains a poisonous alkaloid — colchicine. The most noxious parts of the plant are the corms (or roots) and seeds, but the leaves and flowers have also an irritant action. Symptoms and Appearances. — The symptoms in cases of poisoning by colchicum are generally well marked. There is burning pain in the throat and stomach, intense thirst, violent-.vomiting, and purging leading rapidly POISONING WITH COLCHICUM, 171 to exhaustion, coldness and clamminess of the skin, excessive depression, and great weakness. The pulse is small, weak, and fluttering ; and death appears to take place from exhaustion without convulsions or loss of con- sciousness. Among four cases {infra) presenting these symptoms, one person died on the second, one on the fifth, one on the eighth, and one on the fourteenth day. In another case of poisoning by wine of colchicum, the s^'mptoms did not come on for an hour and a half; there was then copious vomiting of a yellow fluid, severe pain with great tenderness in the abdomen, tenesmus, and thirst. The patient died in forty-eight hours, without being convulsed or manifesting any sign of cerebral disturbance. A woman who took an ounce and a quarter of the wine recovered in about twenty-four hours. She sufi'ered chiefly from severe griping pains. The pupils were contracted, and the heart's action was very feeble. The after- symptoms were headache and nausea. (Lancet, 1877, i. p. 263.) The chief morbid appearance was a patch of redness on the mucous niemln-ane of the stomach, near the cardiac orifice; the intestines w^ere slightly inflamed. The brain was not examined. (Med. Gaz., vol. 10, p. 161 ; see also Casper, Gerichtl. Med.) In a case of poisoning by the medicinal ad- ministration of colchicum, three drachms and a half of the wine of colchicum were taken in divided doses, and caused death on the fourth day. There was no inflammation of the mucous membrane, but simply extravasation of blood into the mucous follicles. The mucous membrane has been found softened in two cases of poisoning by the tincture. In two other cases in which an ounce and a half of the tincture was taken, and death ensued in forty-eight hours, no morbid appearances were found. (Caspar, Gerichtl. Med., and see Yierteljahrsschr. f. Gerichtl. Med., 1860, vol. 1. p. 1.) Colchicum has acquired an evil notoriety as a poison. A woman (Reg. V. Catharine Wilson, C. C. C, Sept. 1862), after having been tried and acquitted for an attempt to poison, with oil of vitriol, the wife of a man with whom she cohabited, was in the following Septenibei* convicted of the murder of a Mrs. Soames, who had died suddenly while nursed by the prisoner six years previously. The body was exhumed, but no poison was found in the remains ; yet the medical and other circumstances, as well as the conduct and correspondence of the prisoner, proved to the satisfaction of the court that deceased had been destroyed by vegetable poison, most probably colchicum, with the noxious properties of which she was proved to have been well acquainted. From the facts which transpired in refer- ence to this trial, it appeared that the deceased was one of four persons who had at different dates fallen victims to the acts of this woman. 1. Peter Mawer, a master mariner of Boston, died in October, 1854: the body was exhumed in 1862, but no poison was detected. 2. Mrs. Jackson, of i3oston, who died in December, 1859 : the body was exhumed in January, 1860, and no poison detected. 3. Mrs. Atkinson, of Kirkby Lonsdale, who died in October, 1860: the body was exhumed in May, 1862, and no poison detected. 4. Mrs. Soames, above mentioned. All these persons died suddenly while in a state of health, under similar symptoms, and without any apparent natural cause to account for death. The symptoms as a whole were not reconcilable with any known disease ; and they only appeared after the prisoner was proved to have administered, under some pretence or other, food or medicine, the bottle which she em- l)loyed for this purpose being kept locked up or in her own possession. The motive for the murder in each case was the acqui.sition of money or property of which the prisoner came into possession — in Peter Mawer's case by a will made shortly before his death, and in Mrs. Atkinson's case by an act of robbery after her death. Two other attempts at murder, 172 POISONING WITH HELLEBORE. which failed, led to the inreronce that colchicum was tho substance which this woman employed, either in wine or brandy. In these four persons the symptoms were as nearly as possible of the same character — burning- pain in the throat and stomach, intense thirst, violent vomiting and purg- ing-, coldness and clamminess of the skin, excessive depression, and great weakness. The pulse was small and weak, and death appeared to take place from exhaustion, without convulsions or loss of consciousness. In most of the cases the poison was probably given in divided doses ; in the last case, the symptoms appeared regularly every evening after the deceased had taken the tea prepared by the prisoner [Grave doubts have, how- ever, been entertained by experts as to the kind of poison administered: the author's opinion as to its being colchicum is not universally shared by toxicologists. — Editor.] Colchicine. — The noxious properties of colchicum are owing to the presence of this alkaloid. It may be separated from liquids containing- it by a process similar to that described for strychnine. It is, however, but little known in toxicology. Hellebore. — Symptoms and Appearances. — According to Wilmer, the roots of the black hellebore (Helleborus niger) possess the greatest activ- ity ; but the leaves are also highly poisonous when used in the form of infusion. By long boiling the poisonous properties of the plant are di- minished, probably owing to the loss of the volatile principle. The roots and leaves have a local irritant action, producing in small doses violent vomiting and purging, with severe pain in the abdomen, followed by cold sw^eats, convulsions, insensibility, and death. The powdered root, in a dose of a few grains, acts like a drastic purgative. In a case reported by Morgagni, half a drachm of the aqueous extract killed a man, aet. 50, in eight hours. The symptoms were severe pain in the abdomen and violent vomiting. After death the w'hole of the alimentary canal was found in- flamed, but especially the large intestines. A case is quoted by the same Avriter in which a tablespoonful of the finely-powdered root (taken by mistake for rhubarb) caused severe symptoms of irritant poisoning, which did not disappear for four hours. The man recovered on the fourth day. The experiments performed by Orfila on animals show that this poison acts like a local irritant when applied to a wound. Hellebore is a favor- ite remedy for worms among quacks. It is not, therefore, surprising that it should be occasionally administered in an overdose, and cause death. Edwards met with a case in which a gentleman had swallowed experi- mentally one drachm of tincture of green hellebore ( Veratmm viride), equal to twelve grains of the powder. He was found soon afterwards in a collapsed state, with sunk features, cold skin, covered with a profuse clammy sweat, and pulse scarcely perceptible. He complained of intense pain in the region of the stomach. There was no purging. These s^niip- toms were relieved by treatment, and the next morning the patient had recovered. (Med. Times and Gaz., 1863, 1, p. 5.) Veratrine. — White hellebore (Veratrum album) owes its noxious prop- erties to the alkaloid veratrine or veratria, which is itself a powerful poison The alkaloid is prepared from the cevadilla seeds. Callaway communicated to the author the following case: A physician prescribed medicinally for a lady one grain of veratrine divided into fifty pills, and three were directed to be taken for a dose. Not long after the dose had been swallowed the patient was found insensible, the surface cold, the pulse failing, and there was every symptom of approaching dissolution. She remained some hours in a doubtful condition, but ultimately recov- POISONING WITH VERATRINE CARBOLIC ACID. 173 ered. Supposing- the medicine to have been well mixed, and the pills equally divided, not more than one-sixteenth of a grain of veratrine was here taken. The common veratrine of the shops is sometimes ij-iven medicinally, in doses of one-sixth of a grain. Poisoning by veratrine is a rare occurrence. We have not met with an instance in which this alka- loid has been indubitably administered with criminal intention. Judging- from its ettects on animals, it would cause vomiting and convulsions, with insensibility. Analysis. — In the state in which it is usually seen, it is a whitish pow- der, scarcel}- soluble in boiling- water, but dissolved by alcohol, ether, and benzene. Acids readily dissolve it, forming salts which on evaporation do not 3Meld crystals. The powder has a hot, acrid taste, and if any por- tion enters the nostrils it causes most violent sneezing, lasting- for some time. Strong nitric acid gives to the powder a light-red color, becoming ochreous after a time Hydrochloric acid, strong or diluted, with the aid of heat, produces a beautiful red tint. The best test for its presence is diluted sulphuric acid, which, on gentle heating, strikes a rich pink color, which is destroyed by a solution of chlorine, but not by stannous chloride. Strong sulphuric acid turns the powder yellow, but on heating the mix- ture the color deepens, and finally becomes a deep red ; and when the liquid is diluted it passes to a dingy yellow. Veratrine undergoes no change when mixed with iodic acid, but it gives immediately with sul- phomolybdic acid a deep greenish-yellow color passing to a brown-red. Veratrine is insoluble in water. It may be brought into solution in organic liquids by warming with acetic acid. The liquid is treated with potash and then shaken with two parts of benzene. The alkaloid, if present, is obtained by decanting and evaporating the benzene solution. The tests may then be applied to it. It has not yet been detected in the tissues. The editor had a case referred to him in which a woman died about twenty minutes after taking some gruel. A medical man thought that he detected veratrine in the viscera and in the gruel. The editor, however, detected strychnine in these articles ; and the post-mortem ap- pearances were those of strychnine. A case occurred in 1865, in which death was attributed to the action of veratrine criminally administered. The deceased, a woman, was advanced in pregnancy, and from the med- ical evidence she died from puerperal convulsions and Bright's disease of the kidney, with eft'usion of blood on the brain. It was said that verat- rine was detected in her body and in the urine, but there were no symp- toms of poisoning by veratrine, and there w^as no evidence of administra- tion by any one. The chemical analysis was not published, or it might iiave appeared that too great a reliance had been placed upon the tests employed. (Med. Times and Gaz., 1865, ii. p. 472.) It was probably a case of death from natural causes mistaken for poisoning. * Carbolic Acid. Carholic Acid, Phenic Acid, or Phenol, is a crystalline product of the distillation of coal-tar. The medicinal acid melts at 9H° F. It has a characteristic and not unpleasant odor. When a small proportion of water is added to the crystals, they liquefy. It is moderately soluble in w^ater. The commercial crystals often have an unpleasant odor, due to impuri- ties ; and they acquire a red color on exposure to light. More com- monly carbolic acid is met with as either a colorless or more or less brown liquid of nauseous odor, containing about 80 per cent, of phenol ; or as a dark-brown liquid chiefly consisting of heavy oil of tar, with about 174 SYMPTOMS AND APPEARANCES FATAL DOSE. 30 per cent, of the acid. These are largely used as disinfectants. Applied to the skin or to a mucous membrane, it coagulates the albuminous con- stituents, causing a severe burning pain and a white eschar. A death is stated to have occurred from the external use of the acid (Brit. Med. Jour., 1870, ii. p. 382) ; and its use as an antiseptic lotion has repeatedly produced serious, if not fatal, results. Deaths from the internal use of carbolic acid — usually accidental, but not infrequently suicidal — are now- common. Carbolic acid, so called, does not redden litmus. Si/mpfoms and Appearances. — When the poison is swallowed in solu- tion, or in the form of undiluted liquid, the patient experiences a hot, burn- ing sensation extending from the mouth to the stomach. This feeling is experienced during the act of swallowing, and the lining membrane of the mouth is whitened and hardened. Carbolic acid is rapidly absorbed, and in the course of a few minutes the system may be profoundly affected. In two instances the rapidity of action was comparable to that of prussic acid. Although the local application of the acid to a part is commonly followed by severe burning pain, this may be entirely absent in cases of poisoning Ijy this agent, and even a local diminution of sensibility may be produced. Nervous symptoms are those most strikingly manifested, such as dilirium, giddiness, and profound insensibility. Nausea and vomiting may be present or absent. These S3^mptoms may, however, be severe and uncontrollable. There is extreme feebleness of the pulse and dry, harsh skin, with lividity of the surface. The urine, as was first pointed out by the editor (Guy's Hosp. Rep., 1868, p. 407), is often of an olive-green or even black hue ; but this appearance is more common in subacute than in acute and rapidly fatal cases. The pupils are generally minutely contracted. Convulsions and trismus are not infrequently ob- served. A case of carbolic-acid poisoning can rarely fail to be recognized. The whitening of the mouth, the brown eschars which form on the skin at its angles where the poison trickles from the mouth, the odor of the breath, and the profound insensibility and stertorous breathing, with minutely contracted pupils, rarely leave any doubt as to the nature of the case. The editor has, nevertheless, met with a case in which. a rather pure form of the acid having been taken for suicidal purposes the odor of carbolic acid escaped notice. Fatal Period. — Death has several times occurred within twenty minutes of the administration of the poison, and in one case a man, after swallow- ing a fluidounce of the liquid acid, died in less than three minutes. (Phiiad. Med. Times, vol. ii. p. 284.) In 1886, a man suffering from dis- eased liver, the result of intemperate habits, whilst in his ordinary health, swallowed by mistake eighty grains of the crystals, dissolved in two fluid ounces of a dilute solution of bicarbonate of sodium and sal volatile. He died within the space of two or three minutes. Death usually super- venes within four hours. Occasionally in fatal cases life may be prolonged for twenty-four and even forty-eight hours. Fatal Dose. — This is unknown. There is reason to believe that, if absorbed, a few grains of the poison might prove fatal, and six or seven drops have produced serious results. Eighty grains have killed an adult (vide supra). Two fluid drachms of the liquid acid have killed a child two years of age in twelve hours. (Guy's Hosp. Rep., 1867, p. 233.) In one case a child six months old was killed by the administration of a quarter of a teaspoonful of the acid dissolved in glycerine — one part of acid to five of glycerine. (Brit. Med. Jour., 1882, i. p. 748.) Recovery has, however, taken place after large doses have been taken. A girl, set. 14, swallowed six fluid drachms of the undiluted (30 per cent.) acid. la RESORCIN PYROUALLIC ACID. 175 twenty minutes she was comatose and breathing stertorously ; her face was livid, the pulse was small and irregular ; the pupils contracted, but not so much as in opium-poisoning-. The stomach was washed out with soap and water, and then with milk and water. In an hour th(! lividity dimin- ished and consciousness slowly returned. She did not complain of any gastric irritation. (Brit. Med. Jour., 1882, i. p. 939.) A robust woman, set. 30, swallowed nearly half an ounce of an alcoholic solution of carbolic acid, containing 35.8 per cent, of the poison. It was ascertained that by the use of the stomach-pump rather more than half of the poison was re- moved from the stomach, but that at least 92 grains of the poison were left for absorption. The most prominent symptoms were insensibility within ten minutes, and dizziness speedily passing into profound coma, irregular breathing and pulse, contracted pupils, extreme blueness (cya- nosis) of the surface of the body, depression of the body temperature' to 94° F., and htemoglobinuria, i. e. the presence of unaltered blood-pigment in the urine, which contained no red blood-corpuscles. This last condition set in one hour after the poison was taken, and lasted for seven hours and a half. The urine reacted for carbolic acid during two days. The woman recovered. (Berlin, klin. AVochenschr., 1881, No. 48 ) Analysis. — Carbolic acid gives a purple color when a drop of solution of ferric chloride is added. When in solution it yields a copious precipi- tate of tribromophenol when an excess of bromine-water is added. This precipitate, when washed on a filter and treated with sodium amalgam, again yields phenol (carbolic acid) after acidification. To detect carbolic acid in viscera, vomit, urine, etc., acidulate the sus- pected material with sulphuric acid, and distil, using suitable condensing arrangement. The distillate may have the odor of phenol. It is precipi- tated with an excess of bromine water; the precipitate is washed with Avater on a filter, and, while still moist, treated with sodium amalgam in water or alcohol. After a time, on acidifying the solution, the peculiar odor of carbolic acid will be perceived. By shaking the mixture with ether, pipetting off the ether, and evaporating it in watch-glasses, oily streaks of phenol wMll be left ; these may be tested with ferric chloride as described above. Resorcin. Resorcin is an antiseptic. It is a phenol, i. e. a body closely allied to carbolic acid, crystallizing in colorless crystals, which are readily soluble in water, ether, or alcohol. Applied in the form of crystals, it acts as a powerful caustic to the skin. The commercial resorcin, which is obtained as a by-product in the manufacture of a pigment known as eosine, has a red color, and a powerful odor resembling that of carbolic acid. It is used internally as a medicine. On one occasion, in which an overdose of two drachms was given to a young woman, it produced decided toxic symp- toms — insensibility, profuse perspiration, blanched lips, lowness of body temperature, imperceptible pulse, and almost imperceptible breathing. The pupils were normal. The urine was olive-green in color. The patient recovered. (Med. Times and Gaz., 1881, ii. p. 487.) It thus appears that resorcin acts like carbolic acid on the human organism. Pyrogallic Actd (Pyrogallin). This substance is largely used in ])hotography, and also as a hair-dye. It is a poison, arresting oxidation in the body by removing and absorbing oxygen. 176 petroleum — animai irritants. Petroleum. Under the term petroleum, or rock-oil, are included various oils used for illuminating purposes, of peculiar odor, which spring from the ground in various parts of the globe, and consist of mixtures of various inflammable hvdrocarbons. The illuminants Avhich were in use prior to the introduc- tion of American petroleum, as paraffin-oil, solar-oil, photogene, etc., pos- sess analogous composition. Cases of petroleum-})oisoning are rare con- sidering the frequent use of this well-known sub.stance. The majority of cases arise from drinking out of bottles supposed to contain spirituous liquors, although there have occurred a few cases of intentional poisoning b}' this liipiid ; for instance, a case at Brescia (Jour, de Chim. M^d., Nov. 18fi6, p. 597) ; and another in the province of Fosen, particulars of which are wanting. In general the poisonous properties of petroleum, such as the purified American variety, cannot be rated very high ; but many varieties of crude petroleum, on account of their containing sulphur com- pounds, are much more poisonous, according to Bulenberg, as, for instance, crude petroleum from Canada. In adults a wineglassful may not kill, and in one case, that of Mayer, in Antwerp, five fluidounces did not cause death. According to Kohler (Physiol. Ther., p. 347), half a wine-bottle- ful is not a fatal dose for an adult. Even in the ea.se of children, among whom the editor has seen several cases, the fatal dose is a very large one ; and in the event of death supervening it is due rather to the secondary result of local action of the poison on the stomach and intestines than to the result of the absorption of hydrocarbons. In cases of poisoning, generally after vomiting follow giddiness, a sense of fulness of the head, ^vith pain and feeling of constriction ; and in chil- dren, collapse, somnolence, pallor of the face, coldness of the skin, cold sweats, and weak pulse may supervene. Neither the behavior of the pulse nor of the pupils is constant. In collapse, the latter are dilated ; and in an excited condition they appear contracted. For the diagnosis, the odor of petroleum in the breath is generally a safe guide. Eructations and vomiting also betray the presence of petroleum. Finally, the urine may acquire a peculiar odor, which may last for several day.s. In Mayer's case this odor resembled that odor of violets, which the urine acquires after the ingestion of oil of turpentine and other essential oils. Analysis. — The detection of petrcjleum, either in the vomited matters or in the contents of the stomach, is effected by distilling the suspected matters and determining the chemical and physical properties of the distillate. Animal Irritants. Cantharides. (Spanish Flies.) — Si/mpfoms — When cantharides are taken in powder, in a dose of one or two drachms, they give rise to the following symptoms: a burning sensation in the throat, great difficulty of swallowing, violent pain in the abdomen, with nausea and vomiting of a bloody mucus; there is also great thirst, with dryness of the fauces. As the case proceeds, a heavy, dull pain is commonly experienced in the loins, and there is an incessant desire to void urine; but only a small quantity of blood, or bloody urine, is passed at each effort. The abdominal pain becomes of a violent griping kind. Purging supervenes, but this is not always observed ; the matters discharged from the bowels are mixed with blood and mucus, and there is often tenesmus (straining). In these, as well as in the vomited liquors, shining green or copper-colored particles SPANISH FLIES. 177 may be commonly seen on examination, whereby the naiure of the poison taken, if it has been taken in powder, will be at once indicated. After a time, there is priapism, and the genital organs are swollen and inflamed both in the male and female. When the case proves fatal, death is usualiv preceded by faintness, giddiness, and convulsions. The tincture of can- tharides produces similar symptoms: they are, however, more speedily induced, and the burning sensation in the stomach and constriction of the throat are more strongly marked ; this symptom is often so severe as to render it impossible for the person to swallow ; and the act of swallowing gives rise to excruciating pain in the throat and abdomen. (For the symptoms and appearances in a case in which three ounces of the tincture proved fatal, see Brit. Med. Jour., 1876, i. p. 191.) Appearances. — In one well-marked case, the whole of the alimentary canal, from the mouth downwards, was in a state of inflammation. The mouth and tongue seemed to be deprived of their mucous membrane. The ureters, kidneys, and internal organs of generation were also inflamed. In another instance, in which an ounce of the tincture was swallowed, and death did not occur for fourteen days, the mucous membrane of the stomach was not inflamed ; but it was pulpy, and easily detached. The kidneys were, however, inflamed. The brain has been found congested, and ulceration of the bladder is said to have been met with. There are few fatal cases reported in which the appearances have been accurately noted ; indeed, the greater number of those persons who have taken this poison have recovered. The quantity required to produce serious symptoms, or to destroy life, has been a frequent subject of medico-legal inquiry. The medicinal dose of the tincture is from five to ten minims, but may be gradually increased to one fluid drachm ; of the powder from a quarter up to two grains. Doses above these, whether of the powder or the tincture, are likely to be in- jurious and to give rise to symptoms of poisoning. The smallest quantity of the powder which has been hitherto known to destroy life, was in the case of a young woman, quoted by Orfila ; the quantity taken was esti- mated at tiventy-four grains in two doses. She died in four days; but as abortion preceded death, this may have been concerned in accelerating that event. An ounce of the tincture taken l)y a boy, ffit. 17, caused death in fourteen days. This is the smallest recorded dose of the tincture which has proved fatal. It must not be inferred from this statement that a smaller quantity of the powder or tincture will not destroy life. The actual dose of either required to prove fatal is unknown. Many more observations are required to determine this point. In Reg. v. Hennan (Cornwall Lent Ass., 1877), it was wrongly inferred that it would require at least twenty-four grains of the powder to destroy life. There is nothing to prevent half of this quantity from proving fatal ; this is purely a matter of experience. It is at present impossible to assign any definite quantity as a minimum fatal dose. Chemical Arialysis. — For the detection of the powder, the sediment obtained from the suspected liquids should be mixed with alcohol spread on sheets of glass, and allowed to dry spontaneously. The shining scales of the powdered elytra will then be seen, on examining the glass by reflected light, either on one or both surfaces. As the powder is insoluble in water, some portion of it may generally be obtained by washing and decantation. The sediment may then be examined on a glass slide with the microscope. If no portion of the powdered beetles can be discovered, the suspected liquids or solids should be evaporated to dryness, and the drv residue digested in successive quantities of ether until exhausted. This will dissolve the 12 178 NOXIOUS ANIMAL FOOD. canthariclin, the active j^riiiciple which forms onl}'^ the l-'inOth part of the elytra of the beetle. The ethereal solutions are evaporated to an extract, and some of this extract, sj)read on oil-silk, may be applied to a thin portion of the skin of the arm or to the lips. The l)roduction of a blister, with serum, under these circumstances, is considered to indicate the presence of cantharidin. By this method Barruel discovered cantharides in chocolate, (Ann. d'Hyg., 1835, i. p. 455.) Chloroform is even a more powerful solvent of canthari- Crvstais of Cantharidin from a f^'" than ethcf, and may be used in preference solution in chloroform, magnified (Fis;. 18). As the extract Contains frequently" 30 diameters. ^ ^^^.^^^ ^jj ^^^^^ ^.^^^ ^^^j^j^.j^ prevent cantharidin from crystallizing, it has been recommended to employ disulphide of carbon in order to separate these impurities, the cantharidin not being- soluble in the disulphide, while the fat is removed. Noxious Animal Food. Certain kinds of animal food are occasionally found to produce symptoms resembling those of irritant poisoning. In some instances this poisonous effect appears to be due to idiosyncrasv ; for only one person out of several partaking of the food may be affected. These cases are of importance to the medical jurist, since they may give rise to unfounded charges of criminal poisoning. In the absence of any demonstrable poison, we must test the question of idiosyncrasy by observing whether- more than one per- son is affected, and whether the same kind of food given to animals pro- duces symptoms of poisoning. If, with this latter condition, several persons are affected simultaneously with similar symptoms, we cannot refer the effects to idiosyncrasy ; they are most probably due to the presence of an animal poison. Among the articles of food which have cau.sed symptoms of irritant poisoning may be mentioned certain, shell-fish (mus.sels), bacon, sausages, diseased pork, and animal flesh in a diseased or putrescent state. The flesh of the most healthy animal is rendered unfit for food when it is putrescent. It is not merely unwholesome, but highly irritant, rapidly causing vomiting, purging, pain, and other symptoms of a severe kind. Fortunately, these symptoms lead at once to the expulsion of the noxious food from the body, and the person then recovers: the young, the old, and the infirm may, however, l^e so prostrated by excessive vomiting and purging that they may sink from exhaustion. Thorough cooking destroys the noxious effects of such food. Animal matter in a state of partial decay, or in the transition stage of putrefaction, must also be regarded as of a poisonous nature. In 1851, the family of a surgeon near London were all affected with symptoms reseml)ling irritant poisoning, after having partaken of a hare which had been stewed in a clean earthen vessel. On the second day, the wife was seized with vomiting and purging, giddiness, beat in the throat, general numbness, and inflamed eyes. Other members of the family vomited, and in the course of a few days the symptoms dis- appeared. The vomited matter consisted of portions of the hare jrartially digested, but in a state of putrefaction, so that there was abundant evi- dence of sulphuretted hydrogen in the liquid. There was no mineral poison, although the symptoms, it will be observed, were rather like those POISONOUS FISH — MUSSELS CHEESE. 179 occasioned by arsenic. It had been remarked by tiie family that a silver spoon, which had been used in serving- out this unwholesome food, was turned of a brown color, no doubt from the chemical action of sulphuretted hydrog-en ; and this may be taken as a good domestic test of the putrefied condition of such food. Nature generally applies an appropriate remedy, in the fact that the food itself produces copious vomiting- and purging. (See Brit. Med. Jour., 1877, ii. p. 450.) Cases of this kind must be dis- tinguished from those in which poisoned game is sold to the public. The game may be quite free from putrefaction, but noxious from the poisoned grain which may have caused death. It was formerly a very common practice to steep graiu in a solution of arsenic previous to sowing, and pheasants, partridges, and other birds may be accidentally destroyed by eating such grain. In some instances grouse and other game are maliciously destroyed by the laying- of corn saturated with arsenic or other poisons in the localities where the birds abound. There is no precaution which can be taken by the purchasers of game, except by observing whether the birds have or have not been shot. It is doubtful whether the Sale of Food and Drugs Act (38 & 39 Vict, c. 62, s. 6) does not meet such cases ; but no prosecution has up to this time been instituted under that statute for the sale of poisoned game. In 1887, an outbreak of poisoning from food occurred near Carlisle, the symptoms much resembling those of arsenic (Brit. Med. Jour., 1887, i. p. 123) ; and another outbreak occurred in the same year at Winsford, in Cheshire, in which beside vomiting and purging, a great rise of the body temperature (to 104° F.) was noticeable. (Ibid ., 1887, ii. p. 521.) These cases were supposed to be due to ptomaines. Foisoyious Fish. Ifussels. — Of all the varieties of shell-fish, none has so frequently given rise to accidents as the common mussel. The symp- toms which it produces are uneasiness and sense of weight in the stomach ; a sensation of numbness in the extremities ; heat, dryness, and constriction in the mouth and throat ; thirst, shivering, difficulty of breathing, cramps in the legs, swelling- and inflammation of the eyelids, a profuse secretion of tears, and heat and itching of the skin, followed by an eruption resem- bling nettle-i'ash. These symptoms are sometimes accompanied by colic, vomiting, and purging. They may occur within ten minutes or a quarter of an hour ; but their appearance has been delayed for twenty-four hours. There is generally great exhaustion and debility. These symptoms have proceeded from the eating of not more than ten or^twelve mussels. Two cases reported by Christison proved fatal ; the one in three, the other in about seven hours. In general, however, especially when there is free vomiting, the patients recover. In the inspection of the two fatal cases above mentioned, no appearance was found to account for death. A case in which two mussels produced, in a boy aged 10, alarming symptoms, followed by an eruption resembling scarlatina and nettlerash, is reported. (Guy's Hosp. Rep., 1850, p. 213.) The active agent in mussel-poisoning is not known with certainty, but is by some asserted to be an alkaloid. Cheese. — The symptoms produced by cheese have been those of irritant poisoning. The poison is asserted by Vaughan to be in some cases a ptomaine, iijr-otoxicon (see p. 174). Again, it has been supposed that the poison is occasionally derived from certain vegetables on which the cows fed. In 1858, twenty-five persons suffered from vomiting and purging, more or less violent, owing to their having- partaking of cheese. Sausage-poison. — The symptoms caused by sausage-poison partake of a narcotico-irritant character; they are very slow in appearing — sometimes two, three, or four days may elapse before they manifest themselves. 180 PORK — BACON. This poison is of a formidable' kind; its effects have been chiefi}^ observed in Germyny. In the Medical Gazette for Nov. 1842, there is an account of the cases of three persons who had died from the ellects of liver- sausa,u"es, which had been made from an api)arently healtiiy pig shiuj^htered only a week before The inspection threw no li.i>'ht on the cause of death. The poisonous property was supposed to depend on a ])artial deooni[)osi- tion of the fatty part of the sausages. It is said that wlien extremely putrefied they are not poisonous. In one ca.se, a few slices of a German sausage, of old manufacture but not putrescent, caused the death of a child, with violent symptoms of irritation of the stomach and bowels. The author examined a portion of the sausage: it contained no poisonous matter which coukl be detected. The fatty portions were rancid, and the lean portions very dry. There was no doubt, however, that it had been the cause of the symptoms and death of the child. Tripe published a complete account of the effects produced by sausage-poison. (Brit, and For. Med. Rev., Jan. 1860, p. 197.) It ai)pears that in Nov. 1859, sausages made and sold by a pork butcher at Kingland were eaten more or less by sixty-six persons, of whom sixty-four were attacked by violent symptoms of irritation in from three and a iialf to thirty-six hours alter the meal. One case only proved fatal, on the seventh day. No symptoms appeared in this man until after the lapse of six hours. It seemed that he had eaten one of the sausages raw and three cooked. He was attacked with .severe vomiting and purging, followed by shivering ; there was pain in the abdomen, violent headache, and great prostration. The pulse was feeble and quick, and there was delirium. These symptoms underwent a remission, but he had a relapse, became comato.se, and died on the seventh day. Latterly he chiefly complained of pain in the bowels. On inspection, Letheby found no signs of inflammation, or of the action of an irritant on the stomach. The small intestines were much inflamed at the lower end, apd the gall-bladder was distended. The other organs were healthy. The viscera contained no known vegetable or mineral poison. The sausages were made of heifer-beef, pork-fat, sage, and pepper. There was no evidence of anything noxious about them, and a chemical analysis yielded nothing of a poisonous nature. There could, however, be no doubt that the sausage had caused the symptoms and death ; the food in this case acting as a narcotico-irritant poison. Other persons suffered from burning in the throat and stomach, followed by vomiting and purg- ing ; then giddiness or confusion in the head, and in some thei-e was de- lirium. In the man who died, the delirium was well marked and the eves were red. In those persons who recovered, the noxious animal matter was probably early thrown off by vomiting and purging. It is supi)o.sed that the poison is a ptoraaine. Fork. Bacon. — These common articles of food occasionally give rise to symptoms so closely resembling those of irritant poisoning as to be easily mistaken for them. In some cases the effect appears to be due to idiosyncrasy; but in others it can be explained only by supposing the food to have a directly poisonous action. The noxious effects of pork have been particularly shown by the cases published by McDevitt. (Ed. Med. and Surg. Jour., Oct, 1836.) As pork is sometimes salted in leaden ves- sels, lead may be found in it; but fresh pork has been observed to have a noxious action. In 1864, Kesteven met with a case in which all the n)em- bers of a family were attacked with symptoms of irritant poisoning after eating a leg of pork. The principal symptoms were nausea, vomiting, griping pains in the abdomen, and purging; but dogs and cats fed upon the meai did not appear to suffer. Other portions of the animal from PORK — BACON. 181 which the leg was taken were eaten by other families and no symptoms of poisoning were produced. The author examined the food without dis- covering any traces of the ordinary poisons. These cases of poisonin"- by animal food have been examined by Simon and Gamgee. They have traced the injurious effects of pork to a diseased condition of the pig, ovvin/'- to the animal having been fed on improper food. The term, "measly l)()rk," is now known to consist in a diseased condition of the flesh of the animal, in which it is filled with a parasite called cysticercus, which is the larva of the tapeworm. (Med. Times and Gaz., 1870, 1, p. 485.) This parasite undergoes full development when in the shape of food it reaches tlie human intestines. These parasites may not directly kill a person who eats this noxious food, but they favor the development of fatal disease. In reference to the possible ill eff'ects from consuming, in a well-cooked state, the flesh of animals afflicted with anthrax, or carbuncular fever, evidence is still imperfect. An opinion has been expressed that boils and perhaps other like afflictions are caused in human beings by the consump- tion of diseased meat. A large amount of diseased and unwholesome meat is sold to the pub- lic, and of the various kinds of flesh used as food, none is so subject to disease as pork. Some of the changes which it undergoes are of a micro- scopical character, and are not noticed. For an account of the diseases affecting the flesh of the pig, their mode of production and the prevention of accidents, see papers by Delpcach in the Ann. d'Hyg., 1864, vol. 1, pp. 5, 241. The parasites found in the flesh of this and other animals are apt to escape destruction by boiling, roasting, or smoking, and those are liable to suffer most who habitually eat the raw or partly-cooked flesh. The flesh of the pig containing cysticerci presents, in the cooked state, the fol- lowing appearances: when boiled it is paler than sound meat; it appears dryer in patches, and the muscular fibres are more separated than usual. When these are opened the parasites are seen in the interstices as opacpie white spots of the size of a hemp seed and presenting much the same aspect as when living. The caudal bladder attached to their bodies dis- appears when the meat is thoroughly cooked and the body of the animal then appears isolated in the middle of the muscular tissue. It is friable, and breaks down easily under pressure, with a crackling sound, owing to tlie presence of calcareous matter. In this state it does not appear to be necessarily productive of injury. (Ann. d'Hyg., 1864, l,p. 249.) All the members of a family were seized with vomiting, purging, and syncope, after having eaten a dish of pork. A medical man examined the meat and found it full of cysticeri. A pork-butcher was accused of having sold bad meat, but it was proved to have been some cheap pork bought of a hawker of provisions. (Ann. d'Hyg., 1864, 1, p. 246.) If the cysticerci did not cause the symptoms in this case, the meat had undergone some change sufficient to impart to it irritant properties. These parasites occur in all the fleshy parts of the body. They are not commonly found in the fatty portions of man or animals, and are less common in sheep and oxen than in pigs. In two instances, Ballard and Klein were able to trace con- clusively that the poisonous effects of hams which had caused illness and death were due to the presence of bacilli ; and these observations have been confirmed by other observers. In the Supplement to the Tenth Annual Report of the Local Govern- ment Board will be found instructive cases of meat poisoning which occurred at Welbeck and at Nottingham, and investigated by Ballard; in the Eleventh Supplement the Arlford sausage-poisoning case, due, according to Klein, to some soluble poison of bacterial origin. The Seven- 182 TRICHINOSIS, teenth Supplomont records an outl)rcak of poisoninc: fi'om pork pics and brawn, from wliich Klein oI)taincd and cultivated bacilli which produced the same fatal symptoms in mice as were observed when the animals were fed on the pie. Trichinosis. — The fatal malady arising from the introduction of Trichina spiralis into the human body has attracted much attention. Keller has published some important facts illustrating the symptoms produced and the mode in which this parasite causes death, lie considers that it is a question well worthy of the attention of medical jurists, whether many cases of death from suspected irritant poisoning- in which no poisonous matter could be detected in the body, may not have been really due to trichina-disease. The Trichina (from ppi^. a hair) spiralis, a flesh-worm, is found chiefly in the course of the fil)res of all the striped muscles of the trunk and limbs, most frequently on those of the front of the chest, neck, and abdomen. It has also been found in the muscular fibres of the heart and g-ullet. The parasites appear in the form of very small, white, ovoid bodies or capsules, perceptible to the eye as white specks in the midst of the muscular fibres, but only distinctly seen by the aid of a magnifying-glass. The trichina, or worm, is coiled up in the centre of each oval capsule, the greater diameter of which is parallel to the muscular fibre with which it is closely incorporated. The trichina is a parasite which passes the greater portion of its existence, in the chrysalis state, in the muscular system of animals, until, by the consumption of this muscle as food, it finds in the stomach and intestines of another warm-blooded animal a favorable medium for its full development into an intestinal worm. According to Yirchow and Zenker, the trichina not only frequently presents itself in the liuman organism, but this organism is very favorable to its development. The period of incubation of the chr3'salis in the stomach and bowels of man, or of warm-blooded animals, is from six to eight days ; and during this time it there thrives and propagates to an almost incredible extent. Keller states that in three or four days the females produce a hundred or more young ones, which begin on the sixth day to leave the parent ajiimal ; and he estimates that in a few days after the ingestion of half a pound of meat, the stomach and intestinal canal of a person may contain thirty millions of these minute worms. Herbst found the mu.sclcs of two dogs which had been fed upon parts of a badger containing worms, to be loaded with these parasites. When once introduced into the stomach and intestines, the worms leave their capsules, become free, and produce young, which migrate through the walls of the intestines into the muscles : there they become encysted, and are ultimately found appropriating and destroying the muscular substance to a greater or less extent. After a long residence in the muscle they app(;ar to acquire calcareous cysts. The sudden liberation of a large number of these woi'ms causes irritation and inflam- mation in the bowels, attended by peculiar symptoms resembling in some respects those of chronic poisoning. It is worthy of note that trichinaj are more frequently found in pork and articles of food derived from it than in any other kind of meat. Measly pork appears to be sometimes of a trichinous character. The vitality of the parasites Is not destroyed unless the meat or other sub- stance in which they are located has been subjected to the temperature of boiling water for a sufficient time to insure that every particle has been exposed to this degree of heat. Salting, smoking, or partial cooking is not sufficient to destroy the worms in all parts of the food, and they have been found living in putrefied meat. This may serve to account in some MILK PTOMAINES. 183 cases for the serious symptoms which have followed the use of pork as food, al^;o of hacon, sausages, and German sausages, which are generally iojade of raw ham. The synjptoms produced by the use of such food arc, in the first stage, those of intestinal irritation, loss of appetite, sickness, pain, general weak- ness of the limbs, diarrhoea, swelling of the eyelids and of the joints, pro- fuse clammy perspiration, and wasting fever. Death is the result of paralysis from destruction of the muscular fibres, or of peritonitis and irritative fever. During the perforation of the coat of the intestines by these worms, the mucous membrane becomes irritated and inflamed ; pus is formed on its surface, and bloody evacuations are sometimes passed. Mr. Taylor directed attention (Sept. 1862) to the serious symptoms produced by Canadian ■partridges eaten as food. A lady who had par- taken of this food was, in about two hours and a half, attacked with the following symptoms : She had sickness and became insensible ; the skin was cold and no pulse could be felt. She was in a hopeless state for ?ome hours, and only slowly recovered. The birds were quite fresh, having been packed in ice. In another case there were similar symptoms, with constriction of the throat and great pain. Animals were made ill by this food. It was believed that in these cases the birds had not been killed by poison, but that their flesh had been rendered ])oisonous by some vegetable which they had eaten. It is stated that in some parts of Australia the mutton is rendered poisonous by reason of the sheep feeding on poisonous plants. (Med. Times and Gaz., 1871, 1, 728.) Pheasants which feed upon the Kalmia shrub are poisonous when eaten as food. Milk. — Vaughan has obtained from noxious milk a substance M'hich he terms tyrotoxicon, which appears to be a definite chemical compound, diazobenzene bntyrate. Ptomaines. — A class of bodies, known as cadaverHc alkaloids or pfo- mawes, has within the last few years attracted much attention. They are found during the putrefaction of animal matters, and Selmi has directed attention to their significance in toxicology. The ptomaines are probably allied to neurine, an alkaloid obtained from the brain and from bile. Physiologically, some of them act like muscarine, the active alkaloid of the fly fungus. It is probable that some of the cases of poisoning by putrid meat are ascribable to the formation of ptomaines during decay. Ptomaines are now recognized as the poisonous products of the growth of micro-organisms. Many of them appear to be proteids — albumins and globulins. [Prof. W. B. McVey, professor of chemistry, Boston College of Physicians and Surgeons, and toxicologist of the Medico-Legal Society, has made a careful study of the chemical " Importance of Ptomaines or Cadaveric Alkaloids in Medico-Legal Analysis." " These ptomaines, or cadaveric alkaloids, possess all the characters of the vegetable alkaloids, are alkaline in reaction, and combine with acids and form salts. Some are liquid and solid, others crystalline. Some are very poisonous, while others are not. Their behavior toward the general reagents for alkaloids is similar to those used for the vegetable alkaloids in many respects. Thus it can easily be seen that from their very origin there is great difficulty in the separation of these cadaveric alkaloids, or ptomaines, on account of the very complex nature of other substances with which they are associated in great number in the decomposing mass. Many methods have been devised, but the one most commendable is as follows, 184 SEPARATION OF THE PTOMAINES. •wliich has been used with such success by the famous Italian investigator, Prof. Selmi, and indorsed by Prof. Vaughan and others, viz. : " Separation of tJie Ptomaines. — The material from which they are to be extracted is divided as finely as possible and placed in a suitable-sized glass flask, to which is added twice its volume of 90 per cent, alcohol, and if not already acid, acidulate with acid tartaric, and from time to time see that it is acid in reaction as the process goes on. This flask is now connected with a reflex condenser and placed in a water-bath, and kept at a constant tem- perature of 70° for twenty-four hours. The warm licjuid is then transferred to a specially-devised apparatus for filtering, by the aid of atmospheric pressure, as follows : The liquid is poured on a damp cloth, placed on a per- forated porcelain funnel, which is connected below with a receiver from which all air has been exhausted by an aspirator, thus securing rapid filtration, and by repeated washing the mass is thoroughly exhausted. This acid alcoholic liquid is now transferred to the following designed apparatus : A tubulated retort of suitable size is connected with a tubulated receiver by means of a suitable cork covered with membrane to exclude air. In the tubule of the retort a small perforated cork is placed, through which runs a glass tube extending nearly to the bottom, and finely drawn out to a fine point at the lower end. The tubule of the receiver is connected with a Liebig bulb, containing dilute sulphuric acid (1 to 10 per cent.), and the bulbs are connected with an aspirator, by which means a fine current of air is drawn through the liquid and keeps it constantly agitated. The retort is kept in a water-bath at a temperature of 28°. The receiver is kept cool by a current of water passing over it. In this way the distillation of alcohol goes on rapidly, and decomposition is so far prevented that volatile bases are never found in the bulbs. The aqueous extract, after the removal of alcohol by the distillation, is filtered and extracted with ether as long as anything is dissolved. It is then mixed with powdered glass and evapor- ated to dryness in vacuo. This residue is repeatedly extracted with alcohol, and the alcohol is again distilled by the process above described. The residue is then taken up with distilled water and filtered, then made alka- line with sodium bicarbonate, and repeatedly extracted with ether, benzine, and chloroform. Now, in order to obtain the base extracted by these sol- vents, if bulky, the greater part may be evaporated on water-bath and the remainder allowed to spontaneously evaporate. By this process a great many ptomaines or cadaveric alkaloids have been separated, studied, and identified. The following is a tabulated list of the ptomaines, which have been arranged according to their behavior to solvents, and the action of some of the individual tests compared with their action on the vegetable alkaloids. " Class I. — Includes ptomaines that pass from acid solution over to ether. General Tests. — 1. Tannic acid ; 2. lodo-iodide potass. The action of these two tests gives similar results to those obtained from natural vege- table alkaloids. 3. Chloride of gold — gives no precipitate. 4. On evapor- ating four or five drops of the aqueous solution, the addition of three drops of HCl and one drop of H2SO4 gives, on warming, a beautiful violet color. 5. Nitric acid colors it yellow. Ptomaines might be mistaken for digitaline, which is also taken up by ether from acid solutions. Difference — Digitaline : Evaporate to dryness and treat with H2SO4. It will give a rose color, turn- ing mauve with vapor of bromine. "Class II. — Includes ptomaines which pass from alkaline solution over to ether. This class gives various color reactions and forms crystalline pro- ducts. Physiological test produces slight dilation of the pupil and dimin- ishes the frequency of respiration. Witii the following test might mistake SEPARATION OF THE PTOMAINES. 185 inorpbia: Ptomaines: 1. Iodic acid — decomposes. 2. Phospho-molybdic acid — at first a violet, changing to a blue color reaction. 3. Platinum chloride — a precipitate. Morphia: Iodic acid — decomposes. " Class III. — Includes ptomaines not soluble in ether, but soluble in chloroform as obtained from alkaline solutions. All the bases of this class are strongly acid, and possess a pungent, bitter taste. Decompose very readily on evaporation of chloroform, even at a low temperature. Tests: 1. Iodic acid — reduces all the bases of this class. 2. Sulphuric acid — gives a red color. 3. Froehd's reagent — gives a red color reaction. " Class IV. — Includes ptomaines which readily pass from alkaline solu- tions over to amylic alcohol, and insoluble in ether and chloroform. Tests: Hydriodic acid — long needle crystals. Amylic alcohol— a base which does not reduce iodic acid, and gives no color with the usual tests, thus making a mistake with plant bases impossible Warning : Morphine can also be in this class, and with the following tests can be mistaken for ptomaines, or vice versa. Tests — 3Iorphine: Ferric chloride — immediately a blue color. Sulpho-molybdic acid — immediately a violet color, changing to blue. When heated with H2SO4, and traces of IINO3 added, a blue color, chang- ing pink, then orange, and finally yellow. When heated with HCl, and a trace of H2SO4 added, a distinct violet color, which, by adding HCl and neutralizing by sodium bicarbonate, changes to pink and turns green on addition of alcoholic solution of* iodine. Ptomaines: Immediately a blue color, but more pronounced. Immediately a violet color, changing to blue. When heated with H2SO4, and traces of IINO3 added, a blue color, chang- ing pink, then orange, and finally yellow, the color being more pronounced. When heated with HCl, and a trace of H2SO4 added, a distinct violet color, which, by adding HCl and neutralizing by sodium bicarbonate, changes to pink and turns green on addition of alcoholic solution of iodine. " Class V. — Includes ptomaines which are not extracted by either ether, chloroform or amylic alcohol, but which are soluble in water and most taste- less. Tests : Sulphuric acid — no color reaction. Chloride of gold — no color reaction. Hydriodic acid — no color reaction. " It is, of course, necessary that the solvents and all materials used in extracting and the reagents should be absolutely pure. In separating and isolating the ptomaines from the vegetable alkaloids a good microscope is indispensable, as the crystals formed by the vegetable alkaloids are very marked." (^Vide Medico-Legal Journal, vol. xiii. No. 2, p. 157.)] 186 OPIUM — SYMPTOMS. NEUROTIC POISONS. CHAPTER XVI. OPICM. SYMPTOMS. APPEARANCES. ITS ACTION ON INFANTS. POISONING WITH OPIATE COMPOUNDS. OPIUM HABIT. MORPHINE AND ITS SALTS. MECONIC ACID. PROCESS FOB DETECTING OPIUM IN ORGANIC MIXTURES. DIALYSIS.— CHI-ORODYNE.— COCAINE. Opium. Sy7nptoms. — The symptoms which manifest themselves when a large dose of opium or its tincture has been taken are in general of a uniform character. A condition of pleasurable mental excitement, usually of very short duration, is experienced ; but this is followed by weariness, head- ache, incapacity for exertion, a sense of weight in the limbs, diminution of sensibility, giddiness, drowsiness, a strong tendency to sleep, stupor, succeeded by perfect in.sensibility, the person lying motionless, with the eyes clo.sed as if in a sound sleep. In this state he may be easily roused by a loud noise and made to answer a question ; but he speedily relapses into stupor. In a later stage, when coma has supervened with stertorous breathing, it will be difficult, if not impossible, to rouse him. The pulse is at first small, quick, and irregular, the respiration hurried, and the skin warm and bathed in per.spiration ; but when the person becomes coma- tose, the breathing is slow and stertorous, and the pulse slow and full. The skin is occasionally cold and pallid, sometimes livid. In the early stage the pupils are contracted ; in the last stage, and when progressing to a fatal termination, the}^ may be found dilated. In a case referred to the author in 1846, one pupil was contracted and the other dilated. In infants and children they are generally much contracted. They are com- monly insensible to light. The expression of the countenance is placid, pale, and gha.stly ; the eyes are heavy, and the lips are livid. Sometimes there is vomiting, or even purging ; and, if vomiting takes place freely before stupor sets in, there is great hope of recovery. This symptom is chiefly observed when a large dose of opium has been taken. The pecu- liar odor of opium is often perceptible in the breath. Xausea and vomit- ing, with headache, loss of appetite, and lassitude may follow on recovery. In cases likely to prove fatal, the muscles of the limbs feel flabby and re- laxed, the lower jaw drops, the pulse is feeble and imperceptible, the sphincters are in a state of relaxation, the pupils are unaffected by light, the temperature of the body is low, there is a loud mucous rattle in breath- ing, and convulsions are sometimes observed before death, but more com- monly in children than in adults. Just before death the pupils may dilate. One of the marked effects of this poison is to suspend all the secretions except that of the skin. Even during the lethargic state the skin, although cold, is often copiously bathed in perspiration. The contracted state of the pupils furnishes a valuable distinctive sign of poisoning with opium or the salts of morphine. In relying upon it, it APPEARANCES. 187 is necessary, however, to bear in mind the fact pointed out hy Wilks, that, in apoplexy seated in the pons Varolii, the pupils are also contracted. He describes two cases of this form of apoplexy which were mistaken for poisoning with opium in conse([uence of this condition of the pupils. (Med. Times and Gaz., ISfiS, i. p. 214.) In carbolic acid poisoning- the pupils are much contracted, though seldom so minutely as in opium-poisoning; and there is coma and stertorous breathing. As a rule, the peculiar odor of carbolic acid in the breath will prevent any mistake as to the nature of the case. The symptoms of opium above described usually commence in from half an hour to an hour after the poison has been swallowed. Sometimes they come on in a few minutes, especially in children ; and at other times their appearance is protracted for a long period. If morphine, the active alkaloid of opium, be given subcutaneously, narcotic symptoms may come on within three or four minutes. It has been frequently observed that a person has recovered from the first symptoms, and has then had a fatal relapse. There is some medico-legal interest connected with this state, which has been called secondary asphyxia from opium, although there appears to be no good reason for giving to it this name, Ajypea ranees. — In a case that proved fatal in fifteen hours the vessels of the head were found unusually congested throughout. On the surface of the forepart of the left hemisphere of the brain there was an ecchymosis, apparently produced by the eifusion of a few drops of blood. There were numerous bloody points on the cut surface of the brain ; there was no serum collected in the ventricles. The stomach was quite healthy. Fluidity of the blood is mentioned as a common appearance in cases of poisoning by opium. There is also engorgement of the lungs — most frequently observed, according to Christison, in those cases which have been preceded by convulsions. Among the external appearances there is often great lividity of the skin. Extravasation of blood on the brain is rarely seen ; serous effusions in the ventricles or between the membranes are sometimes found. The stomach is so seldom found otherwise than in a healthy state that the inflammatoi-y redness said to have been occasion- ally seen may have been due to accidental causes. From this account of the appearances in the dead body, it will be perceived that there is nothing but a fulness of the vessels of the brain which can be looked upon as specially indicative of poisoning with opium ; and even this is not alwa3^s present. The medicinal dose of opium, in extract ox powder, for a healthy adult varies from half a grain to two grains. Five grains would be a very full dose. The medicinal dose of the tincture (laudanum) is from five to forty minims for an adult. Persons have taken very large doses of the tincture, and recovered from the effects. A woman, fet. 38, is said to have recov- ered after swallowing eight ounces. (Lancet, 1873, i. p. 468.) The smallest dose of solid opium which has been known to prove fatal to an adult was in the case of a man, a3t. 32, who died very speedily in a con- vulsive fit, after having taken two pills, each containing about one grain and a quarter of extract of opium. This quantity is equivalent to four grains of crude opium. (Med. Gaz., vol. 37, p. 23G.) The smallest fatal dose of the tincture in an adult that the author found recorded, is tivo drachms. (Ed. Med. and Surg. Jour., July, 1840.) The editor has known less than a grain of opium in solution destroy life in an aged person. In connection with this subject it is important for a medical jurist to bear in mind that infants and young persons are liable to be killed by very small doses of opium, and appear to be peculiarly suscepti- ble to the effects of this poison. The syrup of poppies, paregoric elixir, Godfrey's cordial, Dalby's carminative, and a variety of soothing syrujiS 188 OPIUM HABIT — MORPHINE. owe their narcotic effects to the presence of opium. The symptoms and appearances which they produce, when taken in a laru^e dose, are similar to those caused by opium or its tincture. One-sixtieth part of a grain of opium has thus destroyed the life of an infant. (Brit. Med. Jour., 1875, ii. p. 570.) It has been remarked that most cases of poisoninii- with opium prove fatal in from about six to twelve hours. Those who recover from the stupor, and survive longer than this i)eriod, generally do well ; but there may l)e a partial recovery, oi« a remission of the symi)toms, and afterwards a fatal relapse. The symptoms, however, generally progress steadily to a fatal termination, or the stupor suddenly disappears, vomiting ensues, and the person recovers. Several instances are recorded of this poison having destroyed life in from seven to nine hours. One occurred within the author's knowledge, in which an adult died in five hours after taking the drug prescribed for him by a quack. Christison met with a case wiiich could not have lasted above five, and another is mentioned by him which only lasted three hours. Barwis communicated to the author the case of an adult which proved fatal in three hours and a half This drug in all its forms is especially fatal to infants. They die rapidly from very small doses. Fatal Period. — When swallowed, opium may kill within a period of two hours ; but more commonly the patient does not succumb till after the lapse of from six to eighteen hours. Opium Habit. — It must be borne in mind by the medical jurist that persons may habituate themselves to the use of enormous doses of opium and its chief alkaloid morphine (opium-eating ; morphine habit). The practice of subcutaneously injecting morphine is very prevalent. Sixteen, grains of morphine per diem is not a very unusual quantity to be habitu- ally used by a person given to this degrading practice, and even forty- eight grains have been used per diem. Recently a unique case was tried in which the plea of morphine-taking was successfully urged as a defence in a charge of murder by morphine. The deceased man, Dr. Lyddon, a hard drinker and morphine-taker, was found in a dying condition, with an empty bottle near which had con- tained the pharmacopoeial solution of hydrochlorate of morphine. His brother was charged with administering the poison to him, and was ac- quitted. (Reg. V. Lyddon, C. C. C, March, 1891.) Morphine and its Salts. — Morphine (morphia) is the poisonous alkaloid of opium, of which it forms from five to ten per cent. The two principal salts of this alkaloid are the hydrochlorate a.nd the acetate. Opium owes its narcotic properties chiefly to the presence of morphine in combination with meconic acid. A dose of one grain of a salt of morphine has de- stroyed life. One-fourth of a grain, and even one-sixth of a grain, in- jected beneath the skin has, in the editor's experience, killed an adult. Ebertz met with a case in which an overdose of the hydrochlorate, sup- plied by mistake for quinine, destroyed the life of a lady in from forty to- fifty minutes. Symptoms of narcotism appeared in a quarter of an hour. In one case observed by the editor, a dose of ten grains destroyed the life of a woman in from half an hour to an hour ; and, when subcutaneously injected, the salts of morphine may kill in even a shorter time. (For a very full account of the appearances and analysis, see Vierteljahrsschr. f. Gerichtl. Med, 1873, 1, p. 281.) In 1888, a child, aet. 2 years, died narcotised twenty hours after tasting a ten per cent, solution of acetate of morphine. No symptoms were noticeable for at least three hours after the poison was taken, though the MORPHINE — CHEMICAL ANALYSIS. 189 child was seen by two medical men. In the urine drawn off six hours before death the editor detected morphine. Morphine and its salts rapidly destroy life by absorption when applied to a wounded or ulcerated surface. A woman thus lost her life in 1867, by reason of an ignorant druggist applying thirty grains of morphine to an ulcerated breast. Morphine is in part excreted in the urine, but ac- cording to the recent researches of Tauber, more especially in the feces, even when the alkaloid is administered hypodermically. Chemical Analysis. Opium. — There are no means of detecting opium itself, either in its solid or liquid state, except by its smell, taste, and other physical properties, or by giving a portion of the suspected substance to an animal, and observing whether any narcotic effects are produced. The smell is said to be peculiar, but a similar smell is possessed by lactucarium, which contains neither meconic acid nor morphine. The odor is a good concomitant test of the presence of the drug, whether it be in a free state or dissolved in alcohol or water, but it is not perceptible by many people when the solution is much diluted. The taste is bitter. The analysis in cases of poisoning by opium is therefore limited to the detection of mor- phine and meconic acid. Morphine. — Morphine may be identified by the following properties : 1. It crystallizes in hexahedral prisms, which are white and perfect accord- ding to their degree of purity (Fig. 19). The crystals obtained by adding weak ammonia to a solution of morphine in hydrochloric acid vary in form. When slowly produced they sometimes present the forms repre- sented in the engraving (Fig. 20). 2, When heated on platinum, the Fig. 19. Fig. 20. Crystals of Morphine, from alcohol, magni- fied 80 diameters. Crystals of Morphine, obtained by adding Ammonia to a solution of the hydrochlorate, magnified 124 diameters. crystals melt, become dark colored, and burn like a resin with a yellow smoky flame,' leavino: a carbonaceous residue. If this experiment is per- formed in a small tube it will be found, l)y employing test-paper, that am- monia is one of the products of decomposition. 3. It is scarcely soluble in cold water, as it requires 1000 parts to dissolve it; it is soluble in 500 parts of boiling water, and the hot solution has a faint alkaline reaction. By its great inl^olubilitv in water it is readily known from its salts. It is not very soluble in ether or chloroform, thus differing from narcotine ; but it is dissolved by fifty parts of cold, and thirty parts of boiling, alcohol. It is dissolved by a solution of potash or soda, from which it cannot be easily removed by ether. It is soluble in acetic ether, and this liquid has been emploved for the purpose of separating morphine from organic liquids. 4. 'it is easily dissolved by a very small quantity of all diluted 190 TESTS FOR MORPHINE — MKCONIC ACID. acids, mineral and vegetable. 5. Morphine and its solutions have a bitter taste. G. The salts of morphine arc not prcfipitatcd in a cr^'stalline form by solutions of sulphocyanido of potassium, forricyanide of potassium, or chromate of potassium. In this respect they are strikingly distinguished from the salts of strychnine, which give well-marked crystalline precipi- tates with these three reagents. Like all alkaloids, the morphine in solu- tion is thrown down white by the chloriodide of potassium and mercury (made by dissolving six grains of corrosive sublimate and twenty-two grains of iodide of potassium in a fluidounce of water). This liquid i)re-. cipitates albumen ; hence this substance, if present, should be removed by Ijoiling the liquid l)efore applying the test. In ordcn* to apply the test for morphine, the alkaloid may be dissolved in a few drops of a diluted acid, either acetic or hydrochloric. If the hydrochlorate or the acetate of morphine is presented for analysis, the salt may be at once dissolved in a small quantity of warm water. The tests- for this alkaloid are the following: 1. Nitric acid. This, when added to a moderately strong solution of a salt of morphine, produces slowly a deep orange-red color. If added to the crystals of morphine or its salts, red fumes are evolved ; the alkaloid is entirely dissolved, and the solution acquires instantly the deep red-color above described, becoming, however, lighter on standing. In order that this effect should follow, the solution of morphine must not be too much diluted, and the acid must be strong and added in rather large quantity. The color is rendered much lighter by boiling ; therefore the test should never be added to a hot solution, 2. Iodic acid. A drop or two of solution of iodic acid should be mixed with its volume of chloroform. There should be no change of color. On adding a small quantity of these mixed liquids to morphine or its salts, either solid or in solution, the iodine is separated from the iodic acid and dissolved by the chloroform, which sinks to the bottom, acquiring a pink color, varying in intensity according to the quantity of morphine present. Now make alkaline with ammonia and shake — the pink color is discharged from the chloroform, and the supernatant watery solution acquires a deep brown color. This reaction distinguishes morphine from all other alkaloids and from other bodies, such as the sulphocyanides (in saliva), which liberate iodine from iodic acid. The presence of morphine may be thus easily detected, in spite of the presence of organic matter, in one drop of the tincture of opium, in chlorodyne, or other opiate liquids. If chloro- form is not used, iodine may be detected by starch paste, which is turned blue. 3. Sulphomolybdic acid. This is made by dissolving about one- eighth of a grain of powdered molybdic acid in a drachm of warm pure concentrated sulphuric acid and cooling. The liquid should be freshly pre- pared and kept from contact with air and organic matter. When one or two drops are rubbed with dry morphine or any of its salts, an intense reddish-purple or crimson color is produced. This changes to a dingy green and ultimately to a splendid sapphire hue. 4. Sulphuric acid and bichromate of potassium. When strong sulphuric acid is poured on pure morphine in a solid state, there is either no effect, or the alkaloid acquires a light pinkish color. On adding to this a drop of solution of bichromate of potassium, or a small fragment of a crystal, it immediately becomes green, and retains this color for some time. Meconic acid — This is an acid, commonly seen in scaly white crystals. It is combined with morphine in opium, of which it forms on an average six per cent., and it serves to render this alkaloid soluble in water and other menstrua. Tests. — Many tests have been pro])osed for meconic acid ; but there is only one upon which any reliance can be placed, namely, DETECTION OF OPIUM IN ORGANIC MIXTURES. 191 ferric cliloride. This test produces, even in a diluted solution of meconic acid, a deep-red color ; and it is owing' to the presence of this acid that a salt of iron strikes a red color in tincture and infusion of opium, as well as in all liquids containing traces of meconate of morphine. The red color of the ferric meconate is not easily destroyed by diluted mineral a(nds, by a solution of corrosive sublimate, or by terchloride of gold, but it is by sul- phurous acid and stannous chloride. In liquids containing tannin, e.g. tea or beer, the action of this test is obscured ; but a small quantity of dilute sulphuric acid will remove the tannate of iron and bring out the red color of the meconate. Detection of Opium in organic mixtures. — Opium itself may be re- garded as an organic solid containing the poisonous salt which we wish to extract. It is not always that, in fatal cases of poisoning by opium or its tincture, even when these are taken in large quantity and death is speedy, we can succeed in detecting meconate of morphine in the stomach. The poison is probably removed by vomiting or absorption. Although this absence of the poison from the stomach is now a well-known fact, there is a popular prejudice that, unless found, there is a failure of proof that the death was caused by opium. In the cases of young children who are killed by a very small quantity of this drug, it is the exception to the rule to find any clear evidence of opium, but more common to find morphine in minute quantity. Its detection must in all cases depend on the quantity taken, the rate of absorption, and the time during which the person sur- vived. At the trial of Chantrelle (High Court of Just., Edin., May, 1878), no trace of opium was found in the body, but there was distinct evidence of the presence of morphine and meconic acid in certain stains on the sheets of the bed on which deceased was lying. Although made a strong- point for the defence, the absence of opium from the stomach was really an unimportant item in the case. The evidence tended to show that the poison had been administered in the form of fluid extract — a form most favorable to absorption ; that the quantity administered v/as small ; that the deceased survived fifteen or sixteen hours, and that she had vomited during this time. These conditions are all consistent with the rapid re- moval of opium from the stomach. The evidence which was here wanting was fully supplemented by the detection of morphine and meconic acid in the stains on the sheets. The prisoner was convicted and executed in spite of the strenuous efforts made to invalidate the medical evidence. If the matter is solid, it should be cut into small slices; if liquid, evap- orated to an extract ; and, in either case, digested with a large quantity of rectified spirit slightly acidulated with acetic acid. The residue should be well pressed in muslin ; the alcoholic liquid should then be evaporated at a gentle temperature until it is almost dry. The residue should be digested in water, filtered, and treated with acetate of lead until there is no further precipitation. This liquid should be warmed and filtered ; meconate of lead is left on the filter, while any morphine passes through under the form of acetate. The surplus acetate of lead, dissolved in the filtered liquid (containing the morphine), should now be precipitated by a current of sulphuretted hydrogen gas — the black sulphide of lead sepa- rated by filtration, and the filtered liquid evaporated at a very moderate temperature to an extract, so that any sulphuretted hydrogen may be entirely expelled. On treating this extract with alcohol, the acetate of morphine, if present in sufficient quantity, may be dissolved out and tested. If the alcoholic liquid is still much colored, it may be again evaporated and taken up by water. Animal charcoal deprives it of color, but at the same time it removes the morphine if this is in small quantity. If there 192 POISONING WITH ClILORODYNE. is a sufficient quantity of pure acetate present, the addition of a drop of solution of ammonia to a portion of the licjuid on a slide will produce crystals of the form of slender ])risms. The remainder may be tested by nitric and iodic as well as by sulphomolybdic acid. The prismatic crystals obtained under these circumstances have nothing peculiar or definite in form. At the Chantrelle trial (p. 191) it was stated by an analyst that the cr3\stals furnished better evidence of the presence of morphine than the color-reactions. This statement is against all experience and authority. Admitting that prismatic crystals of morphine could be obtained from a few slight stains of ojjium on a sheet, no medical jurist would rely upon the form of these crystals as evidence of the presence of morphine until after he had tested them by one or more of the acids above mentioned. This frivolous olyection to the chemical evidence was exposed and set aside in the cross-examination of the witness. (See Med. Times and Gaz., 1878, i. p. 565.) A better plan is to treat the liquid by the modified plan of Stas (vide Strychnine, post), taking care to avoid a high temperature and the presence of free mineral acids ; and then to extract with a mixture of equal volumes of acetic ether and ordinary ether, in which mixture mor- phine is freely soluble, though it is almost insoluble in ordinary ether. The alkaloidal residue obtained by evaporating the ethereal liquid may be tested, as above, for the presence of morphine. The meconate of lead left on the filter and dried is readily decomposed by boiling it with a small quantity of diluted sulphuric acid; and in the filtered liquid, neutralized if necessary by an alkali, the meconic acid is easily detected by the iron-test. The detection of meconic acid is most important, for this has been found in no substance but opium. 31orphine may be obtained in an impure state as a precipitate by adding ammonia to a concentrated solution of the opiate extract. It may be then purified by alcohol and tested. Trial tests for both the alkaloid and acid should be first applied to the organic liquid, which may for this purpose be submitted to dialysis (see p. 99). The smell of opium may be entirely absent. Meconic acid may be detected by the action of a ferric salt on the organic liquid diluted, and morphine may be found by adding to a portion of this liquid a mixture of iodic acid and chloroform (see p. 190) The chief difficulty in the de- tection of meconic acid and morphine is that the alkaloid forms only one- tenth part of opium, is easily decomposed, and the quantity of opium present in an organic liquid is generally very small. Chlorodyne. A lady, set. 23, had been accustomed to take the liquid for the relief of pain, in doses of as much as sixty drops. She was found dead in bed, and the cause of death was referred by her medical attendant to her having taken two doses without letting a sufficient interval elapse between them. (Lancet, 1871, ii. p. 697.) According to E. Smith, chlorodyne is thus constituted : chloroform four drachms, hydrochlorate of morphine twenty grains, ether two drachms, oil of peppermint eight minims, prussic acid six drachms, mixture of gum acacia one ounce, treacle four ounces. (Lan- cet, 1870, i. p. 72.) There is reason to believe that this compound is not uniform in composition. According to another formula the tincture of lobelia and capsicum and extract of liquorice are introduced. Prussic acid may be detected in it by the action of the vapor on nitrate of silver. COCOAINE QUININE — ANTIPYRETICS. 193 Crystals of cyanide of silver are obtained after some time. Morphine may be detected in it by shaking a portion with a mixture of iodic acid and chloroform (see p. 190). Cocaine. This potent alkaloid, now so largely used in medicine as an analgesic (pain-killer), has on many occasions caused alarming symptoms and in some cases death. Even one-sixth of a grain, hypodermically injected, may cause toxic symptoms. These are nausea, vomiting, headache, giddi- ness, loss of vision, profuse perspiration, lividity, cramps in the region of the stomach, a quick, irregular, feeble pulse, shallow, gasping respiration, convulsion^, paralysis, and in some cases delirium {vide Brit. Med. Jour., 1888, i. p. 151). A man, set. 40, injected beneath his skin half a grain of the alkaloid to remedy the after-effects of drunkenness. Twenty minutes later he was found lying on a doorstep, pale, with dilated pupils, and the conjunctiva of the eye insensitive. The breathing was slow and difficult, the pulse 140 in the minute. He was sensible, unable to articulate, and could not swallow, liquids being rejected from the mouth. The patient was in a serious state for some time, but recovered. This man had pre- viously had repeated doses of five and six-tenths of a grain administered by injection every half-hour till three grains had been used, without ill effects. (Brit. Med. Jour., 1887, i. p. 524.) In other cases alarming symptoms of depression have been produced by the application of solu- tions of cocaine to mucous membranes, and when injected before surgical and dental operations. (Brit. Med. Jour., 1887, i. p. 676; 1888, i. p. 151.) Generally the symptoms were nausea and vomiting ; headache, loss of vision, and deafness ; loss of taste and smell ; lividity and profuse per- spiration ; a rapid, irregular, intermittent pulse ; shallow, irregular, gasp- ing, convulsive breathing ; impairment of gait and speech ; muscular rigidity ; convulsive twitchings, and paralysis. The habit of injecting cocaine is now common. Quinine. That quinine acts as a poison in excessive doses is a well-ascertained fact. The symptoms are noises in the ears, deafness, and excessive cardiac weakness, ending in death {vide Husemann, in Therap. Monats., 1887). Antipyretics. During the last decade a large number of antipyretics (substances which lower the temperature of the body) have been introduced into medical practice, some of them as hypnotics ; and most of them are capable of act- ing as poisons. They can here be only briefly referred to. Within the editor's experience one of the safest of them, sulphonal, produced alarm- ing and prolonged coma in a dipsomaniac. 13 J94 HYDROCYANIC OR PRUSSIC AUID. CHAPTEE XVII. PEPSSIC ACID. SYMPTOMS AND APPEARANCES. TESTS FOR THE ACID. PROCESS FOR ORGANIC MIXTURES. CYANIDE OF POTASSIUM. — ESSENTIAL OIL OF BITTER ALMONDS. — NITROBENZENE. NITROGLYCERINE. Hydrocyanic or Prussic Acid. Symptoms. — The solutions of this acid have a hot, bitter taste and an odor I'esembling that of bitter almonds. The time at which the symptoms of poisoning commence varies, but it is generally very shortly after the poison has been swallowed. When a large dose has been taken, as from half an ounce to an ounce of the diluted acid (two to four per cent.), the symptoms usually commence in the act of swallowing, or within a few seconds. It is stated that a diluted is more rapidly absorbed than a stronger acid. It is rare that the appearance of symptoms is delayed beyond one or two minutes. When the patient has been seen at this period, he has been quite insensible, the eyes fixed and glistening, the pupils dilated and unaffected by light, the limbs flaccid, the skin cold and covered with a clammy perspiration ; there is convulsive breathing at long intervals, and the patient appears dead in the intermediate period ; the pulse is imperceptible, and involuntary evacuations are occasionally passed. The respiration is slow, deep, gasping, occasionally heaving or sobbing, and is generally convulsive ; but when the coma or insensibility is profound, it may be stertorous. This was observed in a case which occurred to Christison. (Edin. Month. Jour., Feb. 1850, p. 91.) Con- vulsions of the limbs and body, with a spasmodic closure of the jaw, are sometimes noticed among the symptoms. The following cases present fair examples of the immediate effects of this poison in a large and fatal dose. A medical man swallowed seven drachms of the common prussic acid. He survived about four or five minutes. About two minutes after he had taken the poison he was found lying on the floor senseless ; there were no convulsions of the limbs or trunk, but a faint flickering motion was observed about the muscles of the lips. The breathing appeared to cease entirely for some seconds ; it was then performed in convulsive fits, and the act of expiration was remark- ably deep, and lasted for an unusual time. When the dose is large the breath commonly exhales a strong odor of the acid, and this is also per- ceptible in the room. A medical student took a drachm and a half of Scheele's prussic acid (strength about four per cent.). He M'as heard to call out once or twice, and a gentleman sleeping in the next room ran to his assistance. He was heard to fall from the sofa to the floor, and when picked up was found to be already insensible. Hilton Fagge saw him a little later — fifteen to thirty minutes after the poison was taken. He was then lying on a sofa, quite, insensible. The limbs were paralyzed, and lay in any position in Avhich they were placed ; and they were free from all rigidity. The jaws were clenched. The pupils were normal. There were no convulsions, nor had there been any. The face was not livid. The pulse was very rapid, the respirations veiy infrequent. Cold water dashed on the face produced at each application deep respiratory efforts. An attempt to APPEARANCES ANALYSIS. 195 administer an emetic failed, in consequence of inability to swallow. Strong ammonia applied to the nostrils failed to produce the slightest stimulation. After a time the breathing became slower — seven respira- tions in a minute — and it was distinctly stertorous. The pulse became slower and markedly feebler ; and now cold affusion failed to produce any effect. The respirations fell to four in a minute, the face became blue, and the pulse imperceptible at the wrist. Breathing ceased in from an hour to an hour and a half after the poison was swallowed. There was a marked odor of prussic acid in the room ; but it was not noticed at first whether the breath smelt of the acid. (Guy's Hosp. Rep., 1869, p. 259.) Appearances. — The body when seen soon after death often exhales the odor of prussic acid ; but if it has remained exposed before it is seen, and if it has been exposed to the open air or in a shower of rain, the odor may not be perceptible; again, the odor may be concealed by tobacco smoke, peppermint, copaiba, or other powerful odors. Externally, the skin is commonly livid, or is tinged of a violet color; the nails are blue, the fingers clenched, and the toes contracted; the jaws firmly closed, with foam or froth about the mouth, the face often pale, but sometimes bloated and swollen, and the eyes have been observed to be wide open, fixed, glassy, very prominent and glistening, with the pupils dilated ; but a similar condition of the eyes has been observed in other kinds of violent death. Internally, the venous system is gorged with dark-colored liquid blood ; the stomach and intestines may be in their natural state ; but in several instances they have been found more or less congested. The mucous membrane of the stomach may be intensely reddened throughout. The smallest dose of this acid which is reported to have caused death was in the case of a healthy adult woman, who died in twenty minutes from a dose equivalent to nine-tenths of a grain of anhydrous prussic acid. (Med. Gaz., vol. 35, p. 896.) This corresponds to about forty- five minims of the B. P. acid. In a case reported by T. Taylor (Med. Gaz., vol. 36, p. 104), a stout healthy man swallowed this dose, i e. nine- tenths of a grain, by mistake, and remained insensible for four hours, when he vomited and began to recover. From the facts hitherto observed, we shall not be w^-ong in assuming that a quantity of B. P. acid (at two per cent.) above fifty minims {i.e. one grain of anhydrous acid), or an equivalent proportion of any other acid, would commonly suffice to destroy the life of an adult. This is the nearest approach that we can make to the smallest fatal dose. When a dose of half an ounce and upwards of the B. P. acid has been taken, we may probably take the average period for death at from two to ten minutes. In Hick's case, twenty grains of Scheele's acid (containing five per cent.) destroyed life in twenty minutes. It is only when a dose is just in a fatal proportion that we find a person to survive from half an hour to an hour. In this respect, death by prussic acid is like death by lightning — the person in general either dies speedily or he recovers alto- gether. Before the access of insensibility the person often possesses a wonderful power of exertion and locomotion, perhaps in a state of half- consciousness. Thus he may be able to cork and conceal the bottle from which he has swallowed the poison ; or he may run several yards before falling. Due allowance must be made for the performance of these vol- untary acts. (See Brit. Med. Jour., 1887, i. p. 11.) Chemical Analysis. — Two solutions of prussic acid are met with in British commerce — the British pharmacopoeial acid (' B. P.' acid), contain- ing two per cent, of the acid, and the so-called Scheele's acid, a stronger preparation containing about four per cent. These solutions are limpid 196 TESTS FOR PRUSSIC ACID, like water, possess a faint acid reaction, and the vapor has a peculiar odor, which, when the acid is concentrated, although not at lirst perceptible, is sufficient to produce giddiness, insensibility, and other alarming symp- toms. The tests which are best adapted for tiie detection of this poison, either in liquid or vapor, are equally api)licable whether the acid is con- centrated or dilated, and, so far as the detection of the tja^or is concerned, whether the acid is pure or mixed with other liquids. In the simple state, the tests are three in number — the Silver, the Iron, and the Sulphur tests. 1. The Silver-Test. Nitrate of Silver. — This, added in excess, yields with prussic acid a dense white precipitate, speedily subsiding in heavy clots to the bottom of the vessel, and leaving the liquid almost clear. The precipitate is identified as cyanide of silver by the following properties: a. It is insoluble in cold nitric acid ; but when drained of water, and a sufficient quantity of the strong acid is added, it is easily dissolved on boiling, h. It evolves prussic acid when digested in hydrochloric acid, c. The precipitate, when well dried, and heated in a small reduction-tube, yields cyanogen, which may be burnt as it issues, producing a rose-red flame with a blue halo. This is a well-marked character, and at once identifies the acid which yielded the precipitate as prussic acid. Five grains by weight of the dry precipitate correspond to one grain of anhy- drous prussic acid, to twenty-five grains of Scheele's acid, and fifty grains of the British pharmacopoeial acid. For the detection of prussic acid in vapor, hold over the liquid a watch- glass moistened in the centre with a drop of a solution of nitrate of silver. Cyanide of silver, indicated by the formation of an opaque white film in the solution, is immediately produced, if the acid is only in a moderate state of concentration. One drop of a diluted acid containing less than l-50th of a grain of the anhydrous acid produces speedily a visible effect When the prussic acid is more diluted, a few minutes are required ; and the opaque film begins to show itself at the edges of the silver solution. In this case the action may be accelerated by the heat of the hand applied to the vessel. If the vapor is allowed to reach the nitrate of silver gradually and much diluted with air, then instead of an opaque film of cyanide of silver, crystals well defined un- der the microscope will be slowly produced, and these will constitute an additional proof of the presence of the acid in a state of vapor. As shown in the illustration (Fig. 21), these crystals have the form of slender prisms with oblique terminations. They often hang to- gether in groups, and generally require a high magnifying pov/er to render them visible. 2. The Iron-Test. — The object of the ap- plication of this test is the production of Prussian blue. Add to a small quantity of the suspected poisonous liquid a few drops of a solution of ferrous sulphate and a little solution of potash. A dirty-green or brownish precipitate falls ; on shaking this with air for a few minutes, and then adding diluted hydro- chloric or sulphuric acid, the liquid becomes blue ; and Prussian blue, of its well-known color, unaffected by diluted acids, slowly subsides. 3. The Sulphur- Test. A small quantity of yellow sulphide of ammo- nium is added to a few drops of a solution of prussic acid, and the mixture is gently warmed ; it becomes colorless, and, on evaporation, ii^ ff Crysitals of Cyanide of Silver from the vapor of prussic acid, magni- fied 24 diameters. PRUSSrC ACID IN ORGANIC LIQUIDS. 197 leaves crystals of sulphocyaiiide of aninionium — the sulphocyanide being indicated by the intense blood-red color produced on adding to the dry residue a solution of nearly neutral persalt of iron ; this red color immediately disappears on adding a few drops of a solution of corrosive sublimate. The great utility of the sulphur-test, however, is in its application to the detection of the minutest portion of prussic acid when in a state of vapor. In this respect it surpasses in delicacy any other process yet dis- covered. In order to apply it, we place the diluted prussic acid in a watch-glass, and invert over it another watch-glass having in its centre one drop of 3"ellow sulphide of ammonium. No change apparently takes place in the sulphide ; but if the upper watch-glass is removed after the lapse of from half a minute to ten minutes, according to the quantity and strength of the prussic acid present, crystallized sulphocyanide of ammo- nium will be obtained on gently evaporating the drop of liquid to dryness. With an acid of from three to five per cent, the action is completed in ten seconds. The addition of one drop of neutral ferric sulphate or chloride (free from nitric acid) to the dried residue brings out the blood-red color instantly, which is intense in proportion to the quantity of sulphocyanide present. (For some remarks on the application of this process to the de- tection of prussic acid, see Med. Gaz., 184T, vol. 39, p. 165.) Prussic Acid in organic liquids. Detection by vapor without distilla- tion. — The organic liquid may be placed in a short, wide-rnouthed bottle, to which a watch-glass has been previously fitted as a cover. The capac- ity of the bottle may be such as to allow the surface of the liquid to be within one or two inches of the concave surface of the watch-glass. The solution of Nitrate of silver is then used as a trial-test for the vapor in the manner above described. If the 1 -200th of a grain of prussic acid is present, and not too largely diluted, it will be detected (at a temperature of 60° F.) by the drop of nitrate of silver being converted into an opaque white or crystalline film of cyanide of silver, the chemical change com- mencing at the margin. We may then substitute yellow suljihide of ammonium for the nitrate of silver, and proceed in the manner above de- scribed. In cold weather it may be necessary to place the bottle in a basin of warm water. If the solution of silver is tarnished by sulphur- etted hydrogen, as a result of putrefaction, the sulphur-test alone should be used. By this process prussic acid has been detected in the stomach as late as twelve days after death of a person poisoned by it. After the stomach has been exposed for a few days longer, the acid has entirely disappeared. If traces of the poison are thus found, then the organic liquid should be acidulated and distilled in a water-bath, and about one-fourth of the con- tents of the flask collected in a receiver kept cool by water. (For the form of apparatus see p. 135, ante.) The tests may now be applied to the dis- tilled liquid, which will have the odor of prussic acid. [Care should be used in the search by distillation not to employ sul- phuric acid, because this acid will decompose the sulphocyanide existing in the saliva likely to be found in the stomach, and thereby evolve traces of prussic acid. This point was made in the celebrated case of Paul Schoeppe, tried at Carlisle, Pa. The analyst found faint traces of prussic acid by distillation in which sulphuric acid had been used : Reese, 8th Amer. Ed. of Tay- lor's Med. Jurisprudence, Phila., 1880, p, 212 ; vide also Wharton & Stille, Med. Jur., 1873, p. 515.] 198 CYANIDE OF POTASSIUM. In the tissues. — Soon after death the poison may be easily detected in the blood, secretions, or any of the soft organs, by placing- them in a bottle and collecting the vapor in the manner already described. This will be found more convenient and satisfactory than the process by distillation. The poison has been thus discovered, in experiments on animals, in the blood and even in the exhalation from the chest. If the body is in a putrefied state, the residuary prussic acid may have been converted into fixed sulphocyanide of ammonium. In order to de- tect this salt in the stomach or its contents, we sliould digest the parts finelv cut up in hot alcohol, filter the alcoholic liquid, evaporate to dryness, and take up any crystalline residue with water. A solution of a persalt of iron added to this solution will indicate the presence of a sulpho- cyanide bv imparting to it an intensely red color. The editor has de- tected prussic acid as a sulphocyanide in the blood many weeks after the death of a person who died from prussic-acid poisoning. Cyanide of Potassium. Symptoms. — This salt has ja bitter taste, producing first a sense of cold- ness on the tongue, followed by a feeling of constriction and burning heat in the throat. It is one of the most formidable poisons known to chem- ists. It has destroyed life in a quarter of an hour. A dose of five grains has proved fatal in three instances. In one case the person died in two hours. (Chem. News, Sept. 5, 1863.) The symptoms which the cyanide produces are similar to those occasioned by prussic acid — insensibility, spasmodic respiration, convulsions, with tetanic stiffness of the jaws and body. They appear in a few seconds or minutes, and run through their course with great rapidity. Appearances. — In a case in which an inspection of the body was made two davs after death, there was no remarkable odor : the muscles were rigid ; the face and forepart of the trunk pale ; the back livid, except those portions which had sustained pressure. The fingers and toes were convulsively bent inwards, the nails blue, the eyelids half closed, the lips pale, the vessels of the brain filled with' bluish-red blood. On making a section of the brain and spinal marrow, numerous bloody points were ob- served. The lungs were congested posteriorly, and, on cutting into them, a strong odor of bitter almonds was perceived. A yellowish mucus was found in the stomach, which yielded on analysis cyanide of potassium. The mucous membrane was reddened near the intestinal end. The poison Avas not detected in any part of the body except the contents of the stom- ach and intestin-es. (Casper's Wochenschrift, Oct. 4, 1845, G67.) The stomach is sometimes intensely reddened. Cyanide of potassium has a local chemical action upon the skin ; and if this is abraded or wounded it may be absorbed and produce serious effects. Some accidents of this kind have occurred in the practice of pho- tography. (Ann. d'Hyg., 1863, vol. i. p. 454.) Analysis. — This substance is usually seen in hard white masses. It is deliquescent and very soluble in water; the solution, when pure, is color- less, and has a strong alkaline reaction, a soapy feel, and a powerful odor of prussic acid. It is not very soluble in cold alcohol. 1. It is decom- posed by all acids, and prussic acid is set free. 2. The potassium is pre- cipitated by tartaric acid and by platinic chloride. 3. It gives a white precipitate with nitrate of silver, which will be found to possess all the properties of cyanide of silver (ante, p. 196). This precipitate is easily redissolved by a slight excess of a solution of cyanide of potassium. 4. ESSENTIAL OIL OF BITTER ALMONDS. 199 If a solution of ferrous sulphate is added to a solution of the cyanide of potassium, and after agitation the mixture is treated with diluted sul- phuric acid, Prussian blue will be produced. Essential Oil op Bitter Almonds. This liquid, which is used for the purpose of giving- flavor and odor to confectionery, owes its poisonous properties in the crude state to the presence of prussic acid. It contains a variable quantity of this poison, w^hich has been found in it in a proportion of from eight to twelve per cent. Almond flavor, or essence of peach-kernels, contains one drachm of the essential oil to seven drachms of rectified spirit. The bitter almond itself operates as a poison. A boy who had eaten several almonds was found unconscious, c3'anotic and pale, with eyelids closed and pupils moderately dilated. The arms were stiffened with tonic spasm and the pulse trembling. Yomiting was excited by emetics. He went to sleep and recovered in eighteen hours. (Med. Times and Gaz., 1878, i. p. SY.) Peach-kernels operate in a similar manner. One ounce of the kernels is considered to be equal to one grain of prussic acid — a fatal dose. Symptoms. — The following may be taken as a summary : insensibility ; lividity of the face ; eyes glassy, prominent, fixed and staring ; pupils dilated and insensible to light ; jaws spasmodically closed ; frothy mucus about the mouth, and in some cases vomiting; coldness of the skin ; heav- ing, intermittent respiration, in some instances stertorous; absence of the pulse ; the head, and sometimes the trunk, spasmodically drawn back- wards ; general relaxation of the limbs ; an odor of bitter almonds about the mouth. Appearances. — In one fatal case no odor of almonds was perceptible, nine hours after death, in the chest, head, or heart, nor in the blood. The lungs and heart were healthy. The vessels of the brain were congested, and there was a general effusion of serum on the hemispheres. The lining membrane of the stomach was much congested. On opening it the odor of bitter almonds was quite perceptible. (Prov. Med. Jour., Sept. 11, 1844, p. 364.) The blood with which the venous system is gorged is generally liquid and of a dark color. Analysis. — The essential oil, which is sometimes called peach-nut oil, is colorless when pure, but it commonly has a pale-yellow color and a strong odor of bitter almonds, by which it may be at once identified. It has a hot, burning taste, and a feeble acid reaction. The smell and taste are generally sufficient for its identification ; but nitrobenzene possesses a similar odor and has been mistaken for it. It produces, when dropped on paper, a greasy stain, which does not entirely disappear by the appli- cation of heat. It has a sp. gr. of 1.048; hence it sinks in water, which dissolves about one-thirtieth part of its weight of it. It is soluble in alcohol and in ether in all proportions. When mixed with a few drops of strong sulphuric acid, it forms a rich crimson-red liquid, which, if exposed to the air, acquires a yellow color. Prussic acid may be detected in it by dissolving the oil in alcohol and adding solutions of ferrous sulphate and of potash. On the subsequent addition of diluted hydrochloric acid, Prussian blue is formed. Nitrobenzene. Nitrobenzene, Nitrobenzole, or Essence of Mirhane, is a liquid which is largely employed as a substitute for the essential oil of bitter almonds in 200 NITROBENZENE SYMPTOMS AND APPEARANCES. perfumery and confectioner}', and is a formidable poison. It has been mistaken for essential oil of bitter almonds, but its mode of operation is dill'erent. In 1859 Casper published an account of this liquid under the name of " A new Poison." (Vierteljahrsschr. f. Gerichtl. Med., B. 16, p. 1.) It is also largely employed in the manufacture of aniline colors. Symptoms. — The cases which have yet occurred show that this is an insidious poison, both in the form of liquid and vapor. It produces a burning taste in the mouth, followed by a sensation of numbness and ting- ling in the tongue and lips. There is no immediate insensibility, as in poisoning by prussic acid. The eyes are bright and glassy, the features pale andghiistly, the lips and nails purple, as if stained by blackberries, the skin clammy, and the pulse feeble. There is a powerful odor resembling that of oil of bitter almonds. The mind may be clear for an hour, or for several hours, after the poison has been swallowed. The patient then be- comes suddenly unconscious, the jaws fi.xed, the hands clenched and blue, and the muscles rigid and convulsed. In one case there was vomiting of a liquid having the odor of nitrobenzene. The breathing was slow and the pulse scarcely perceptible. Reaction set in in about eleven hours, and recovery took place. (Guy's Hosp. Rep. 1864, p. 192.) In a fatal case examined by Letheby, the appearances were as follows : The superficial vessels were much gorged with blood, which was black and fluid. The lungs were congested, the cavities of the heart were full of blood, the liver was of a purple color, the brain and its membranes were congested, and there was much bloody serosity in the ventricles. Lehman reported the symptoms and appearances in a fatal case. (Ann. d'Hyg., 1813, 1, p. 444.) In 1876 a man, aet. 21, was prescribed three minim doses of "benzol rect." three times a day. By mistake the dispenser read the prescription as ordering " benzol nit.," and gave nitrobenzene. The first day he took these doses the patient was observed to look a little pale and weak, but he was not conscious of feeling ill till after taking the seventh dose at 9 A.M. the next day. The aggregate amount of nitrobenzene now taken was ascertained to be twenty-three minims. At 2 P.M., five hours after taking this final dose, after walking not more than forty yards in the street from his office, he fell down. He was just able to give his address, and then became insensible. At 3.15 P.M., when seen by Gross, he was cold, and the surface of the body was bluish-purple. There was no pulse, but by the stethoscope the heart could just be heard faintly beating. The lower jaw Avas rigidly closed; but the limbs were flaccid and dropped powerless when raised ; the pupils were widely dilated. No breathing could be perceived for twenty minutes after this. He was treated as for prussic acid poisoning, it being thought that the poison was oil of bitter almonds. At 7 P.M. he became conscious and complained of headache. At 9 P.M. the skin was still blue. Next day he was fairly convalescent. From the urine collected on the morning following the accident the editor extracted a substance having the odor of nitrobenzene. (Guy's Hosp. Rep., 1876, p. 371.) This compound has a narcotic action, but it differs from the ordinary narcotics in its powerful and persistent odor, which would render it diffi- cult for a person to administer it unknowingly to another, either in liquid or vapor ; in the production of profound coma at an uncertain interval after the stupor ; and in the rapidly fatal effects when coma has followed. It operates powerfully as a poison in vapor, as well as in a liquid state. The rapidly fatal cases only would be likely to be mistaken for apoplexy, but in these the poison would be detected by its odor. NITROGLYCERINE SYMPTOMS AND APPEARANCES. 201 Anahjsis. — Nitrobenzene, or Essence of 3Ii7-bnne, is a pale lemon- colored liquid of a strong odor resembling- that of bitter almonds. It has a pungent, hot, disagreeable taste. It gives to confectionery and to soap the smell of oil of bitter almonds, and gives a greasy stain to paper. It sinks in water, and is partly dissolved, imparting to it a yellowish color. It is soluble in alcohol, ether, and chloroform ; but, when agitated with water, it is in great part separated from its ethereal and chloroformic solu- tions. It burns with a yellow smoky flame. It yields no Prussian blue when mixed with ferrous sulphate, alcohol, and potash, and then acidu- lated. It is distinguished from all other liquids, excepting the essential oil of almonds, by its odor, and from this oil by the following tests : Pour a few drops of each on a small plate, and add a drop of strong sulphuric acid. The oil of almonds acquires a rich crimson color with a yellow border; the nitrobenzene produces no color. In order to separate it from organic liquids, they may be acidulated with sulphuric acid, and submitted to distillation. It may be converted into aniline by reduction with zinc and hydrochloric acid, and submitted to further tests. Nitroglycerine (Glonoin). This is a sweet, oily, powerfully explosive liquid, well known to chemists as a substitution-compound of the innocuous liquid glycerine. It is much used in mining, under the name of "blasting oil," and has a sweet, aromatic, pungent taste. Mixed with an infusorial earth, it is known as dynamite. The medicinal dose is one or two hundredths of a grain. Symptoms and Appeai^ances. — Field states that he found one drop of the liquid dissolved in water produced insensibility and other symptoms of narcotic poisoning (Chem. News, Nov. 7, 1863); and that one-fiftieth of a minim produced in three minutes loud noises in the head and other distressing symptoms. Murrell has found that one or two minims of a one per cent, solution of nitroglycerine produce painful pulsation over the whole head ; the pulsation soon affects the whole body, and is so marked that a pen held in the hand becomes visible jerked. In five minutes these symptoms are followed by intense headache, languor, and depression. Nitroglycerine is now employed in medicine in lieu of nitrite of amyl, which it greatly resembles in its effects, except that these are more lasting. The editor has seen the most distressing results ensue from an overdose, the headache being of an alarming and fearful character. Nitroglycerine has in several instances been the cause of accidental death. It is sweet, colorless, and apparently innocent in appearance ; and these properties render it liable to be taken in mistake for other liquids of a less potent character. In 186.5, a girl, jet. 13, died after drinking some of it from a flask. A man drank a considerable quantity of the liquid in mistake for beer. An hour later he was blue in the face and insensible. When admitted into hospital he was delirious and unconscious, and speedily became comatose. The hands were frequently raised to the head, as if there was headache. The face was red and swollen. He died six hours after swallowing the poison. The brain and its membranes were congested ; and there was some yellow serous fluid in the ventricles The lungs were oedematous, the wind|)ipe, stomach, and kidneys reddened. Signs of irritation were also noted in the small intestines. There were numerous small ecchymosed spots on the fundus and larger end of the stomach. In a third case, a man drank some glonoin in mistake for brandy, and died in three hours. In a fourth case a man recovered after 202 ALCOHOL — SYMPTOMS. swallowing a considerable quantity of the poison. (Schmidt's Jahresber., 136, p. 164.) Analysis — Nitrogh'ccrine is a heavy, oily-looking liquid. It dissolves in water, but is insoluble in alcohol and ether. It explodes violently when struck or subjected to concussion. Nitroglycerine yields a red color when treated with aniline and strong sulphuric acid ; and also a red color when treated with brucine and strong sulphuric acid (free from nitric acid). CHAPTER XVIII. ALCOHOL. — ETHEK. — CHLOROFOKM. — IODOFORM. — HYDRATE OP CHLORAL. — CAMPHOR. Alcohol. Symptoms. — In general the symptoms produced in poisoning with alcohol come on in the course of a few minutes. There is confusion of thought, Avith inability to stand or walk, a tottering gait and giddiness, followed by stupor and coma. Should the person recover from this stage, vomiting supervenes. The insensibility produced by alcohol may not come on until after some time, and then suddenly. Christison met with an instance in which a person fell suddenly into a deep stupor some time after he had swallowed sixteen ounces of whiskey ; there were none of the usual premonitory symptoms. In another instance, a person may apparently recover from the first effects, then suddenly become insensible, and die convulsed. There is a ghastly or vacant expression on the features, which are sometimes sufiTused and bloated ; the lips are livid, and the pupils are dilated and fixed, and if the}^ possess the power of contracting under the influence of light, it is a favorable sign. The conjunctivae of the eyes are generally much suffused. The breath has an alcoholic odor. The more concentrated the alcohol, the more rapidly are the symptoms induced, andthej^are also more severe in their character. Diluted alcohol commonly produces a stage of excitement before stupor, while in the action of concentrated alcohol there may be profound coma in a few minutes. The cause of death may be generally traced to congestion of the brain or lungs, or both. Sometimes a large dose may be taken without causing death. A child, get. 4, swallowed between two and three ounces of brandy. He was found insensible, the breathing was scarcely perceptible, and the pupils were widelv dilated. Under treatment he recovered in two days. (Lan- cet, 1872, i'i. p. 66.) The symptoms arising from apoplexy, from concussion of the brain, the effects of opium, and those of carbolic acid, have been sometimes mistaken for those of poisoning by alcohol, and persons have been wrongly charged with being drunk. With respect to concussion, a difficulty can arise only in reference to the more advanced stage of poisoning with alcohol, i. e. in which there is profound coma. Intoxication may in general be easily distinguished by the odor of the breath, for so long as the symptoms con- tinue alcohol is eliminated by the lungs. If there should be no precep- tible odor of any alcoholic liquid, the presumption is that the symptoms are not due to intoxication. When the alcoholic odor is perceptible, the symptoms may still be combined with the effects of apoplexy or concus- ALCOHOL APPEARANCES AND ANALYSIS. 203 sion — a fact which can be cleared up only by a history of the case, or a careful examination of the head for marks of violence. In poisoning- with opium there will be a strong smell of this drug in the breath, the symp- toms come on much more gradually, and are marked by drowsiness and stupor, passing- into complete lethargy, with general relaxation of the muscles and inability to walk. In poisoning with alcohol there is either great excitement some time before the stupor, which comes on suddenly, or the person is found in a state of deep coma a few minutes after having taken the poison. In poisoning with opium the face is pale and the pu])ils are contracted ; in poisoning with alcohol the face, under excitement, is more commonly flushed and the pupils are generally dilated. Another fact to be noticed is that, while perfect remissions are rare in poisoning with opium, in poisoning with alcohol a person frequently recovers his senses and dies subsequently. When coma has supervened, the patient may be aroused by a loud noise or a violent shock in either case, and it is very difficult under these circumstances to draw a well-marked distinction. The odor of the breath, or an examination of the fluid drawn from the stomach by the pump, may then show which poison has been taken ; but the treatment is the same in both cases. In poisoning with carbolic acid there is the characteristic odor of the acid in the breath, a white furred or shrivelled tongue and white or brown stains about the angles of the mouth. Alcohol may act as a poison by its vapor. If the concentrated vapor be respired, it will produce the usual effects of intoxication. There is a case on record in which a child two years of age was thrown into an apo- plectic stupor by the alcoholic vapor of eau de Cologne. In this manner a child might be destroyed and no trace of the poison found in the stomach. Appearances. — The stomach has been found intensely congested or inflamed, the mucous membrane presenting in one case a bright red, and in another a dark red-brown color. When death has taken place rapidly, there may be the special odor of the kind of spirits taken in the contents ; but this will not be perceived if the quantity taken was small, or many hours have elapsed before the inspection is made. The brain and its membrane are found congested, and in some instances there is effusion of blood or serum beneath the inner membrane {pia mater). Analysis. — When a large dose has been taken, and the case has proved rapidly fatal, the contents of the stomach may have the odor of alcohol or of the alcoholic liquid taken. The odor, however, is not always perceptible, and it may be easily concealed by other odors. In a case of poisoning with gin, the liquid drawn from the stomach by the pump after seven hours had no odor. The smell of brandy has entirely disappeared in twelve hours. The contents of the stomach or the suspected liquid should be distilled in a water-bath with a proper condensing apparatus attached (Fig. 8, p. 135). If the liquid has an acid reaction, it should be first neutralized with a solution of carbonate of sodium. The watery distillate obtained should be submitted to a second distillation in a similar retort heated by a water-bath. The liquid obtained by the second distillation may be iden- tified by its odor, taste, and inflammaliility. Its specific gravity should be taken, and from this the percentage of alcohol may be deducted by tables. Alcohol may be recognized by the two following tests : 1. Mix a little of the distillate with enough solution of bichromate of potassium to give it a good orange color. Now pour in an equal volume of strong sulphuric acid and gently agitate the tube so as to mix the solutions; if alcohol be present, the liquid will become green and the peculiar odor of aldehyd will 204 ETHER NITROUS ETHER CHLOROFORM. be perceived. 2. To a portion of the distillnte add some solution of ])otash and tlien a solution of iodine in iodide of potassium till a permanent brown tint is obtained. Now add enough of the potash solution to discharge the color and warm gently. If alcohol be present, a turbidity will appear in the solution, but will disappear as the boiling point is approached ; and the peculiar odor of iodoform will be perceived. On cooling and standing for some hours, the iodoform will settle to the bottom of the vessel in the form of beautiful rosetted crystals. Ether. Symptoms and Effects. — Ether, in moderate doses, has a hot, burning taste, and produces during swallowing a sense of heat and constriction in the throat. It causes, like alcohol, great excitement and exhilaration, with subsequent intoxication ; but persons may become habituated to its use, and thus, after a time, it may be taken in large quantities with com- parative impunity. Ether drinking for the purpose of intoxicating is common in Ireland. (Br. Med. Journ., 1890, ii. p- 885.) The effects pro- duced on the system, when a large dose has been taken, are similar to those occasioned by alcohol. Ether as a liquid has not, as far as is known, directly destroyed the life of a human being; but when its vapor has been breathed it has caused death in several instances. (See On Poisons, 3d edit., p. 639; also Brit. Med. Jour., 1877, ii. p. 692 ; 1875, i. p. 585.) Analysis. — When ether has been taken as a liquid it may be separated from tiie contents of the stomach by the process described for alcohol. It is well known by its odor and inflammability. Spirit of Nitrous Ether. — This compound is well known under the name of sweet spirit of nitre. It may be regarded as a solution of nitrous ether in rectified spirit. In 1878 a child, about three years old, drank between three and four ounces of sweet spirit of nitre. He was soon afterwards found in a state of complete collapse — cold, pulseless, and in- sensible; both pupils were widely dilated and fixed, and the breathing was hardly perceptible. Before this the child had vomited undigested food, with a smell of spirit, and the bowels had been opened. In spite of some reaction under treatment, there was no sign of recovery : the breathing became stertorous, and the child died twelve hours after swallowing the liquid. On inspection there was a strong smell of spirit ; the mucous coat of the stomach, as well as that of the duodenum, was inflamed. The membranes of the brain were highly congested, the vessels containing a large quantity of dark-colored blood. The operation of this liquid resem- bled that of a mixture of alcohol and ether. This is the only fatal case which we have met with. Chloroform. Symptoms. — Chloroform, when swallowed, acts very uncertainly. As it is a liquid very sparingly soluble in water, and much more soluble in alcoholic liquids, it is not surprising .that the greater or less fulness of the stomach, and the nature of its contents when the poison is swallowed, greatly influence the result. The author regarded it as a not very active poison. In this opinion the editor cannot concur, since he has collected the reports of sixty-two cases, of which no less than nineteen proved fatal, or thirty per cent. Eliot has tabulated fifty-six undoubted published cases. ^New York Med. Rec, 1885, ii. p. 29.) The effects of chloroform when CHLOROFORM, 205 swallowed do not greatly differ from the severe effects of the inhaled liquid, except that the symptoms are more intensified and last longer. A man, tet. 53, of robust constitution, but given to drink, swallowed about one and a half fluidounces of chloroform with suicidal intent. Six hours later he was found in an unconscious condition. When seen by Brasch his face was flushed, the mucous membranes slightly c3'anotic, the eves closed, the breathing quiet, 20 per minute, but occasionally enil)arrassed, owing to falling back of the tongue. From time to time he vomited and passed feces involuntarily. The pulse was small, 80 per minute, the cornea insensitive, the pupils not contracted and not reacting to light or other stimuli. The patient was absolutely insensible, and could not be roused. One-thirteenth, and a quarter of an hour later one-thirty-second of a grain of strychnine was injected subcutaneously. The pulse became stronger, the patient began to move his hands and arms and to open his eyes for a moment or two ; he spoke, though unintelligibly, and vomited mucus mixed with food. The vomited matter did not smell of chloroform. Ten hours after swallowing the poison the man recovered consciousness, and complained of thirst, a feeling of internal heat, and nausea. The vomiting continued, and next day there was great pain in the region of the liver, which was enlarged and tender. The skin and conjunctivae were jaundiced, the feces slightly bloodstained. Towards the end there was great difficulty in passing water, and even with the catheter only a few drops of turbid yellowish urine could be drawn off. The patient became gradually weaker, and died sixty-seven hours after swallowing the poison of paralysis of the heart and pulmonary oedema. The temperature was normal throughout, the intelligence clear to the last. No 2wst-mortem examination seems to have been made. (Deutsch. Med. Zeitung, April 7, 1890; Br. Med. Jour., 1890, i. p. 1089.) Chloroform-poisoning is nearly always the result of accident or suicide; but in 1886, a woman was tried for the alleged murder of her husband by means of chloroform and was acquitted. (Reg, v. Adelaide Bartlett, C, C, C, April, 1886.) The pungent odor, sweet taste, and intense burning sensation which its contact with the mucous membranes instantaneously produces, would render the homicidal administration of chloroform by the mouth difficult, except the persons were first chloroformed by inhalation. That persons can be successfully chloroformed during sound sleep has repeatedly been put to the test. (Hussey, Med Times and Gaz., 1880, ii. p. 251 ; Dolbeau, Ann. d'Hyg., 1874, t. 1, p. 168; Quimby, Boston Med. Jour., June 17, 1880; Eliot, New York Med. Rec, 1885, ii, p. 29.) The most prominent symptoms of chloroform-poisoning are, after a transient state of excitement or inebriation, muscular relaxation, abolition of sensation and consciousness — which may supervene within five minutes, though it is usually longer delayed — and profound narcosis with sterto- rous respiration. The pupils of the eye may be contracted or dilated. Reflex excitability is eventually abolished. Tlsually, if the stomach be evacuated, the patient recovers ; and fortunately chloroform commonly excites vomiting. But no vomiting may be excited by even a large dose (Canada Lancet, 1874, vi, p. 209) ; and death may result under such cir- cumstances. Chloroform appears to destroy life by paralyzing the action of the heart or lungs, or both organs. A boy, £et, 4, swallowed a drachm or two of chloroform, laid his head on his mother's lap soon afterwards, and then lost all consciousness. In about twenty minutes he was insensible, cold, and pulseless. Mustard poultices applied to his legs produced no impression or sensbility. The 206 CIILOROFOKM VAPOR. breathing was sometimes natural, at other times stertorous. He died in three hours. This is the smalleat fatal do.se recorded. Hoffmann met with a case where 35-40 grammes, or 6-7 fluid drachms, proved fatal to au adult. This is the smallest fatal dose recorded in the case of an adult. One fluidounce has in several cases killed an adult. Death has ensued at periods ranging from one hour to eight days. The post-mortem appear- ances are congestion, inflammation, and even ulceration of the lining membrane of the stomach ; congestion of the mucous memV)rane of the bowels, and sometimes congestion of the lungs and of the brain. The blood is sometimes unusually fluid, and the post-mortem staining of the heart well marked. There is, however, nothing characteristic, except the odor of chloroform in the alimentary canal. H. C. Wood, Jun., nearly killed a patient by the deep injection of half a drachm of chloroform. (Therapeutics, 2d edit., p. 280.) Chloroform Vapor — This vapor, when respired in a concentrated form, is speedily fatal to life. If it is diluted with a certain proportion of air, it produces insensibility with entire loss of muscular power, and the patient rapidly recovers after the vapor is withdrawn. Cases of death from the inhalation of the vapor for surgical purposes have been numerous, and the symptoms and post-mortem appearances are not always well marked. In some instances death has taken place within two minutes from the com- mencement of inhalation. In one in which only thirty drops had been inhaled in vapor the patient died in one minute, and in another so small a quantity as fifteen or twenty drops proved speedily fatal. Its fatal effects do not depend so much on the absolute quantity, as on the propor- tion in which it is breathed in a state of mixture with atmospheric air. It has been stated that the average proportion of this vapor for medicinal purposes should not exceed 3|- per cent., and that 4^ is the maximum quan- tity to be taken with safety. The proportion should be only slowly in- creased. The vapor should not be given after a full meal, or while the person is in a sitting or erect posture. (Brit. Med. Jour., 1875, ii. p. 778.) The vapor of this liquid, operating through the lungs, has de- stroyed life more rapidly, and in a smaller dose, than any other poison known. Its fatal operation is sometimes suddenly manifested after the withdrawal of the vapor. It is thought that 20 minims in the blood at one time would prove fatal. It is to a fatty condition or flabby heart that the fatal effects are usually and often incorrectly ascribed. The theory of a flabby heart is quite unnecessary to explain the fatal results occasionally produced by chloroform vapor, even when administered by experienced persons. A case is reported of the murder of a woman by her lover by means of inhaled chloroform. The man subsequently shot himself. There is reason to think, how^ever, that this was a case of attempted simultaneous suicide. (Casper's Handb. d. Gerichtl. Med., 6 Auf. ii. p. 557.) The recent report of the Second Hyderabad Chloroform Commissioa (Lancet, 1890, i. p. 149) shows that when animals are anaesthetized by chloroform, or by ether, respiration fails before the pulse ceases, contrary to what was previously supposed to occur. The researches of MacWilliam are in conflict with those of Claude Bernard, endorsed by the Second Hyderabad Commission. He finds that chloroform exerts a direct influ- ence on the heart, and that the mode of cardiac failure under chloroform is a more or less sudden dilatation and enfeeblement of the organ. He further states that death from cardiac failure occurs where the respiration, continues for several minutes after the heart has stopped. (Brit.)Med. Jour., 1890, ii. pp. 890, 948.) IODOFORM HYDRATE OF CHLORAL. 207 In cases of alleged robbery and rape it has been sometimes stated that the person assaulted was rendered suddenly insensible by chloroform ; but chloroform vapor does not produce immediate insensibility unless it also produces asphyxia and death. There can be no doubt that several false charges of rape have been made against medical men and dentists under the alleged use of this vapor. In general the statement of the woman alone has been sufficient to show the falsehood of the charge. [It is doubtful if crime could be successfully committed, as is frequently charged, by producing unconsciousness through inhalation of chloroform, Avithout the knowledge of the recipient. The late Dr. Stephen Rogers raised that question before the New York Medico-Legal Society in 18V1, and challenged the production of one authenticated case where chloroform had been or could be administered without the knowledge of the party inhaling it. The question is sometimes discussed, but the safer opinion is, that all such charges are wholly false and impossible.] Analysis. — Chloroform is a heavy, colorless liquid, sp. gr. 1.5, neutral in its reaction, sinking in water in heavy, oily-looking globules, and only to a slight extent dissolving in this liquid. It has a peculiar fragrant odor. It is very volatile, but not readily combustible. It may be separ- ated from other liquids by distillation at a low temperature. It boils at 142° F. and evolves a vapor which, at a red heat, yields chlorine and hydrochloric acid. On this effect is founded a process for the detection of chloroform in the blood when it has proved fatal in the form of vapor. The editor has by this method succeeded in detecting chloroform in the blood of a man twenty-four hours after death from the administration of chloroform as an anaesthetic vapor. (See Princ. and Pract. of Med. Jurisp., vol. i. p. 406.) In organic liquids it may be converted into chloride by the action of alcoholic potash, and the chlorides may then be estimated by precipitation with nitrate of silver. Chloroform is miscible in all proportions with alcohol, but not with diluted spirit. Proof spirit dissolves 15 per cent, by volume of chloroform ; whereas spirit of 25 per cent, under proof — the minimum statutory strength of brandy — takes up only 2 per cent Iodoform. This antiseptic is a poison. Schede, Kocher, and others have published cases where severe and even fatal symptoms have followed its external application. Many cases have still more recently been reported where toxic .s}' mptoms were developed after its use as a surgical dressing. These symptoms were, in two cases, drowsiness and stupor ; in one, those of meningitis; and delirium in a fourth case, which terminated fatally. Symptoms and Appeajmnces. — The symptoms usually observed after poisonous doses are — faintness, headache, giddiness, confusion of ideas, drowsiness, burning pain in the stomach, delirium, convulsions, insen- sibility, general paralysis, a small pulse sometimes quickened and some- times diminished in frequency, and the skin cold and livid, bathed in per- spiration. (Brit. Med. Jour.", 1882, i. pp. 903, 913.) Hydrate of Chloral. This substance, in doses of from twenty to thirty grains, operates as a sedative and narcotic. In very large doses it has caused dangerous symptoms, followed by sudden death. Medical men who have taken it incautiously have died from its effects. Two instances of this kind are 208 HYDRATE OF CHLORAL SYMPTOMS. reported in the Med. Times and Gaz. (1811, i. p. SGI). No remarkable symptoms have preceded dissolution. The person has passed at once from sleep into death. Hunter's syrup of chloral contains 20 grains in each fluid drachm. Symptoms. — This compound produces after a short interval deep sleep, and, when carried far enough, complete loss of consciousness and sensi- bility. A lady took six doses of thirty grains each, and fell into a sound sleep. Every attempt failed to arouse her, and she slept into death. The principal ])ost-mortem appearance was great congestion of the cerebral vessels (Med. Times and Gaz., 1871, i. p. 1.^2.) A lady took, in three doses, at intervals of four hours, seventy grains of chloral. In two hours after the last dose she suffered from severe crami)s in the legs, a feeling of suffocation, swimming in the head, and inability to regulate her move- ments. Four hours after the last dose, her face was flushed, the eyelids were closed, and the conjunctivae injected; pulse 120 and bounding. She was with difficulty roused. She recovered in about sixteen hours. (Med. Times and Gaz., 1870, ii. p. 435.) A man took thirty grains and became unconscious almost immediately after swallowing it — the face and hands turned livid and cold, and breathing took place only at long intervals ; indeed, for about five hours death seemed to be impending. He recovered. (Lancet, 1870, ii. p. 402.) A dose of one hundred and sixty grains was given by mistake to a middle-aged man. He recovered. Another case of recovery after a similar dose has been reported. (Brit. Med. Jour., 1878, ii. p. 437.) A lady swallowed, in the form of syrup, one hundred and sixty grains of hydrate of chloral at eight o'clock. About three or four hours afterwards she was seen in a state of unconsciousness, lying on her back : pulse 80, regular but small ; respirations, 28 per minute ; pupils moderately contracted, but not altogether insensible to light. She had vomited, and a frothy mucus oozed from her mouth. She was tempo- rarily roused by ammonia. She could not swallow. The stomach-pump was used and the stomach freely washed out. Coffee was given by the rectum. Electricity was employed for an hour and a half, when she recovered her consciousness, and stated what she had taken. She recovered. N. Smith met with two instances in which sudden death followed ordi- nary doses, and in another case a drachm and a half thrown into the rectum produced insensibility and death. (Lancet, 1871, ii. p. 466.) It has been observed in reference to this drug, that during the sleep produced by it the pupil is contracted, but that it immediately dilates on the person awaking. In other cases, the pupil has been found dilated and insensible to light. These facts show that there is considerable uncertainty in the action of this drug, even when similar doses have been given. A slight overdose may cause sudden death by syncope (Lancet, 1873, i. p. 640) ; and ordinai-y doses long continued may seriously affect mind and body. (Lancet, 1873, i. p. 789.) After an ordinary dose of twenty or thirty grains, a patient has slept for a quarter of an hour, and has then awakened with a sense of deadly faintness, the lips livid, the face pale, the pulse scarcely perceptible, and a feeling of intense exhaustion and impending dissolution, mingled with delirium, lasting for five or ten minutes. It appears to exert a depressing action on the heart, and in cases of heart disease it may thus cause sudden death. (Lancet, 1871, ii. p. 32.) One case proved suddenly fatal by causing paralysis of the heart. (Lancet, 1871, i. pp. 227, 440, 473.) In 1889, a man was convicted of murder by hydrate of chloral, which he gave to his victim in drink. There is no doubt that the poison was given to stupefy with a view to robbery, and CAMPHOR SYMPTOMS AND APPEARANCES. 209 tliat death was not contemplated. (Res-, v. Pardon, Manchester Ass., March, 1889 ; Lancet, 1889, i. p. 598.) (For the effects of chronic poison- ing- by this substance, see Lancet, 1873, i. p. 695.) Death has ensued so late a^'i ten and even thirty-five hours after administration. Fatal Dose. — It is difficult to assign a minimum fatal dose. A dose of thirty g?'ai7is proved fatal in thirty-five hours to a young lady ag'ed twenty, while there have been two cases of recovery in which doses of one hundred and sixty g:rains were taken, and one in which a man recov- ered after taking one hundred and eighty grains dissolved in syrup. (Brit. Med. Jour., 1875, ii. p. 778.) Recovery in these cases was no doubt greatly owing to treatment. The editor met with a case in which a young man barely survived a dose of seventy grains ; he afterwards became idiotic, and never entirely recovered. A patient may die in a few minutes, but more commonly survives for a few hours. Analysis. — The hydrate of chloral is a white, crystalline solid, of a peculiar lemon-like odor, and has a pungent, bitter taste. When heated on platinum, it melts and is entirely volatilized without combustion. It is not inflammable. Heated in a closed tube it melts and does not rapidly solidify. It is distilled over in a liquid form, and after a time it sets into groups of crystals in the glass tube. It is very soluble in water. The solution is not acid, has no bleaching properties, and gives only a faint milkiness on boiling with a solution of nitrate of silver. It is dissolved by strong sulphuric and nitric acids without any change of color. Potash and ammonia added to the solution convert it instantly into chloroform, which may be recognized by its peculiar odor. It is by this conversion that hydrate of chloral may be detected in the contents of the stomach. One hundred parts will yield seventy-two parts of chloroform. The liquid should be rendered alkaline with potash, and the mixture heated in a flask by a water-bath. The vapor which escapes may be tested for chloroform by the process described at p. 207. Proctor thus detected it in a case of suicidal poisoning. The quantity of hydrate of chloral present in a strong solution, e.g. a draught, may be approximately determined by placing a measured quantity of the solution in a graduated and stoppered burette and shak- ing with a solution of soda. On allowing the mixture to stand, the chloroform formed b}^ the decomposition of the hvdrate of chloral will form a dense la3^er at the bottom. Approximately each minim of chloro- form separated represents two grains of hydrate of chloral. By adding a solution of soda of known strength to a definite volume of a solution of chloral, and when the chloral is decomposed titrating the uncombined soda, the percentage of h3'drate of chloral in a dilute solution may be determined with considerable accuracy. Camphor. Symptoms and Appearances. — Camphor operates on the brain and nervous system. In one case, a woman swallowed in the morning about twenty grains dissolved in rectified spirit of wine and mixed with tincture of myrrh. In half an hour she was suddenly seized with languor, giddiness, occasional loss of sight, delirium, numbness, tingling and coldness of the extremities, so that she could hardly walk. The pulse was quick and respiration difficult ; but she suffered no pain in any part. On the administration of an emetic she vomited a yellowish liquid smelling strongly of camphor. In the evening the svmptoms were much diminished, but she had slight convulsive fits during the 14 210 TOBACCO — NICOTINE. night. The next day she was convalescent ; the diflBculty of breathing, however, continued more or less for several weeks. This is the smallest dose of camphor which appears to have been attended with serious symptoms in an adult. Camphor has proved fatal to infants and chil- dren, the symptoms being chiefly vomiting and purging, with violent convulsions. A case of poisoning by camphor would be recognized by the odor of the breath, a symptom which would attract the attention of a non-profes- sional person. The presence of this substance in the stomach would be at once indicated by its odor. CHAPTER XIX. TOBACCO (nICOTIANA TABACUM). NICOTINE. COCCULUS INDICUS. PICROTOXIN. —^ CALABAR BEAN. MUSHROOMS, Tobacco (Nicotiana tabacum). Nicotine. Symptoms. — The eflTects which tobacco produces, when taken in a large dose, either in the form of powder or infusion, are well marked. The symptoms are faintness, nausea, vomiting, giddiness, delirium, loss of power in the limbs, general relaxation of the muscular system, trembling, complete prostration of strength, coldness of the surface, cold, clammy perspiration, convulsive movements, paralysis, and death In some cases there is purging, with violent pain in the abdomen ; in others there is rather a sense of sinking or depression in the region of the heart, passing into syncope, or creating a feeling of impending dissolution. With the above-mentioned symptoms there is dilatation of the pupils with insensi- bility to light, dimness of sight with confusion of ideas, a small, weak, and scarcely perceptible pulse, difficulty of breathing, and involuntary discharge of urine. Tobacco owes its poisonous properties to the presence of a volatile alkaloid, nicotine. Nicotine. This is a liquid alkaloid, a deadly poison, and, like prussic acid, it destroys life in small doses with great rapidity. It has the powerful odor of tobacco. It is volatile, and may be procured by distillation. The author found that a rabbit was killed by a single drop in three minutes and a half. (Guy's Hosp. Rep., 1858, "p. 35.5.) A celebrated case of poisoning by this alkaloid which occurred in Belgium in 1851, was the subject of a trial for murder — case of the Count Bocarme. (Ann. d'Hyg., 1851, t. 2, pp. 147, 167.) In another, which proved fatal in from three to five minutes, the appearances observed were a general relaxation of the muscles, prominent and staring eyes, bloated features, great fulness with lividity about the skin of the neck. There was no odor resembling nico- tine or tobacco perceptible about the body. When the body was examined between two and three days after death, putrefaction had occurred. The swelling of the neck was found to arise from an effusion of dark liquid blood, especially in the course of the veins. The scalp and the mem- branes of the brain were filled with dark-colored blood. The lungs were LEVANT NUT. 211 engorged, and of a dark purftle color. The cavities of the heart were empty, with the exception of the left auricle, which contained two drachms of dark-colored blood. The stomach contained a chocolate-colored fluid, in which nicotine was detected : the mucous membrane was of a dark crimson-red color from the most intense congestion. There was no odor excepting that of putrefaction. The liver was congested and of a pur|)lish- black color. The blood throughout the body was black and liquid, but in some parts it had the consistency of treacle. (Guy's Hosp. Kep., 1858, p. 355.) The insidious nature of this poison is proved by the fact that, in 1877, a child, tet. 3, died from using an old wooden pipe for blowing soap-bubbles. It had been used by his father for smoking, but had been put by for a year. He had washed it before giving it to his son. The child was quite well at the time, but in an hour he was seized with drowsiness and sickness, and died with the symptoms of narcotic poison- ing. The child had imbibed sufficient nicotine from the pipe to destroy life. Levant Nut (Cocculus indicus). Symptoms and Effects. — This is the fruit or berry of the Anamirta Cocculus. (Levant Nut), imported from the East Indies. The berry contains from one to two per cent, of a poisonous bitter substance (Picrotoxin). The shell or husk contains no picrotoxin, but a non- poisonous principle called Menispermin (see Fig. 22). The seeds, in powder or decoction, give rise to nausea, vomiting, and griping pains, followed by stupor and intoxication. There are only two well-authenti- cated instances of this substance having proved fatal to man. Several men suflTered from this poison in 1829, near Liverpool : each had a glass of rum *'^g- strongly impregnated with Cocculus in- dicus. One died that evening ; the rest recovered. (Traill's Outlines, 146.) Of the second case, the following details have been published: A boy, a^t. 12, was persuaded bv his companions to a, Eerry of Cocculus indicus, natural size. ■,^ e ^ '• c -i- _ 6, The same, seen in section with one-half swallow forty grains of a composition of the semi-Umar kernel. used for poisoning fish. It contained c, The kernel, containing picrotoxin. Cocculus indicus. In a few minutes he perceived an unpleasant taste with burning pain in the gullet and stomach, not relieved by frequent vomiting — as well as pain extending over the whole of the abdomen. In spite of treatment, a violent attack of gastro- enteritis supervened, and there was much febrile excitement, followed by delirium and purging, under which the patient sank on the nineteenth day after taking the poison. On inspection, the vessels of the pia mater were congested with dark-colored liquid blood. There was serous eff"usion in the ventricles of the brain, and the right lung was congested In the abdomen there were all the marks of advanced peritonitis. The stomach was discolored, and its coats were thinner and softer thaii natural. (Canstatt's Jahresbericht, 1844, 5, 298.) Porter, ale, and beer owe their intoxicating properties in some instances to a decoction, or extract, of these berries. (For some remarks on this adulteration of l)eer and other li(|uids, and a process for separatinir the poisonous principle, picrotoxin, by amylic alcohol, see Chem. News, March, 1864, p. 123.) [The late Dr. Fish, of Philadelphia, reported several cases of accidental poii^oning by this substance occurring or treated in the Philadelphia Hospital. Some of them proved fatal in half an hour, the patient dying in convulsions: 212 CALABAR BEAN. Wharton & Still^, Med. Jur., 18':3, vol. 2, p. 59G.] Cocculus indicus operates readily as a poison on animals, and it has thus been frequently used for the malicious destruction of fish and game. In one instance referred to the author, there was reason to believe that 270 young pheas- ants had been poisoned by grain soaked in a decoction of this sub.stance. Barbt'i-'s poisoned wheat for the destruction of birds owes its ])oisonous properties to Cocculus indicus. (See On Poisons, 3d edit., }). G79.) Calabar Bean (Physostigma venenosum). The Calabar bean is a large leguminous seed of a dark color, resembling a garden bean, but much thicker and more rounded in its form. It is brought from the Avestern coast of Africa, and is there employed by the natives as an ordeal bean when persons are suspected of witchcraft. The bean owes its properties to the presence of an alkaloid called Fhysostig- mine, or Eserine, which is used in surgery for contracting the pupils of the eye. Desiring to try the effects of this seed on himself, Christison took the eighth part of a seed, or six grains, one night before going to bed. There was slight sen.se of numbness of the limbs during the night, but in the morning no urgent symptoms of any kind. He then chewed and swallowed the fourth part of a bean (twelve grains). In twenty minutes he was seized with giddiness and a general feeling of torpor over the whole frame. He immediately swallowed an emetic, and thus emptied the stomach The giddiness, weakness, and faintness increased to such a degree that he was obliged to lie down in bed. In this state he was seen by two medical friends, who found him prostrate and pale, the heart and pulse extremely feeble and tumultuously irregular, the mental faculties intact, with extreme faintness threatening dissolution, but no apprehen.sion of death on the part of the patient. There was no uneasy feeling of any kind, no pains or numbness, no prickling, nor even any sense of suffering from the great feebleness of the heart's action. There was the will, but not the power to vomit ; and the limbs became chill, with a vague feeling of discomfort. Stimulants were employed: and warmth and pulsation, with a power of moving, gradually returned. Two hours after the poisgn had been taken he felt drow.sy, and slept for two hours more ; but with such activity of mind that he had no consciousness of having been asleep. The tumultuous action of the heart continued. After this the symptoms gradually disappeared, and the next day he was quite well. (Pharm. Jour., 1855, p. 474.) In 1864, fifty children were poisoned at Liverpool by reason of their having eaten these beans. The sweepings of a ship from the west coast of Africa had been thrown on a heap of rubbish ; the children found the beans and ate them. A boy, set. 6, who ate six beans, died in a very short time. The principal symptoms were severe griping pains, constant vomiting, and contracted pupils. In addition to these symptoms, the face was pale and the eyes were bright and protruding. In attempting to walk the children staggered about as if they were drunk. In 1864, two children, aged six and three years respectively, ate the broken frag- ments of the kernel of one nut. In aliout forty minutes they complained of sickness. One child held his head drooping, appeared sleepy, and his hands were powerless. He staggered and was scarceh^ al)le to walk. He complained of severe pain in the stomach, and made ineffectual attempts to vomit. Milk was given, and he then vomited. The child became quite prostrated ; the pulse was feeble and slow, and the pupils were slightly POISONOUS FUNGI. 213 contracted. Some pieces of the nut were rejected by vomiting. The other child had pain in the abdomen, and was listlesss, sleepy, and de- pressed. He vomited freely, some portions of nut being ejected. He could neither stand nor walk. His face was pale, the eyes were piercing, but the pupils and pulse were natural. In this case there was purging. The children recovered on the third day. (Edin. Month. Jour., 1864, p. 193.) In cases in which it has proved fatal to animals it has caused much irritation and congestion of the stomach and bowels. CDragendorff.) Fraser relates the case of two maid-servants who were poisoned by tasting through curiosity some of the embryos of the bean. (Edin. Med, Jour., 1863, 2, p. 131.) The editor has himself noticed a very marked diminution of respiratory depth from the hypodermic use of the salts of physostigmine (eserine), the active alkaloid of the bean. The very contracted pupil of the eye is a characteristic of poisoning by this alkaloid. Poisonous Mushrooms (Fungi). No branch of toxicology has given rise to greater differences of opinion than the study of poisoning by fungi. Some authors have considered nearly ever}^ kind of mushroom as unfit for food ; whilst others, again, seem to regard nearly every species as edible with safety. In inquiring into the causes of these discrepancies of opinion, it will be found that whilst some species of fungi are undoubtedly to be regarded as poisonous, since they contain an integral poisonous constituent or constituents which may be isolated in a greater or less state of purity, others produce injuri- ous effects only under certain conditions, such as idiosyncrasy of the indi- vidual, decomposition of the fungus, etc. The morel and Hevella escidenta are highly esteemed kinds of mushrooms, and yet Keber relates the history of six persons who, after partaking of these fungi, were attacked with vomiting and diarrhoea which lasted for sixty hours. (Preussische Yerein- zeitung, 1846, No. 32. See also Arch, f." Exp. Path. v. Pharm., 1885, xix. p. 403 ; Med. Chron., iii. p. 219.) Poisonings by the common edible mushroom {Againcus camjyestfHs) are rare, except when the mushrooms are decayed. Symptoms and Effects. — The noxious species of mushrooms act some- times as narcotics, and on other occasions as irritants. It would appear from the reports of several cases that when the narcotic symptoms are excited they come on soon after the meal at which the mushrooms have been eaten, and they are chiefly manifested by drowsiness, giddiness, dim- ness of sight, and debility. The person appears as if intoxicated, and there are sometimes singular illusions of sense. The pupils are dilated. Spasms and convulsions have been occasionally witnessed among the symptoms, chiefly in fatal cases. In some instances these have been of a tetanic character, with great difficulty of breathing. (Brit. Med. Jour., ii. 1874, p. 464 ) When the drowsiness passes off, there is generally nausea and vomiting; but sometimes vomiting and purging precede the stupor. If the symptoms do not occur until many hours after the meal, they partake more of the characters of irritation, indicated by pain and swelling of the abdomen, vomiting, and purging. In a case of poisoning by mushrooms, there was slight vomiting about an hour and a half after the meal, but no violent symptoms until after the lapse of ten hours. Several cases in which the symptoms did not appear for fourteen hours are reported. (Med. Gaz., vol. 25, p. 110.) In some instances the symp- toms of poisoning have not commenced until thirty^ hours after the meal; 214 POISONOUS FUNGI. and in these, narcotism followed the symptoms of irritation. It might be supposed that these variable effects were due to different properties in the mushrooms ; but the same fungi have acted on members of the same family, in one case like irritants, and in another like narcotics. In most cases recovery takes place, especially if there is early vomiting. In the instances which have proved fatal there has been greater or less inflamma- tion of the stomach and bowels, with congestion of the vessels of the brain. (Med. Gaz., vol. 46, p. 307; vol. 47, p. 673; and Jour, de Chim. M4(\., 18.53, p. 694.) In the Guy's Hosp. Rep., 1805, p. 382, are recorded two fatal cases — in a mother and daughter, who died from the effects of the Amanita citrina, a yellow-colored fungus, gathered in mistake for mushrooms. The woman fried the fungi, and they were eaten for supper. No symptoms appeared for seven hours. The child, when seen by a medical man, was feverish and thirsty and the pupils were strongly dilated. There was severe pain in the stomach and a sense of constriction in the throat. It became con- vulsed and insensible and died forty-one hours after eating the fungi. The mother and another child suffered from similar symptoms; the mother partially recovered, but had a relapse and died on the fifth day. No in- spection of the bodies was made. One fatal case of poisoning by fungi was attended with symptoms of irritation resembling those caused by arsenic. There was no loss of con- sciousness or sensibility. A boy, fet. 13, fried and ate for breakfast at 8.30 A.M. two fungi which he had found growing under a tree. He returned to his work without any complaint. At noon he had his dinner of pork and vegetables. At 1 P.M. he returned to work, where he remained until 6 P.M., working the whole time without any complaint. Soon after he reached home he complained of feeling ill, and vomited violently. Purging then followed, with severe spasmodic pain in the abdomen. These symptoms continued throughout the night until 6 A.M.; the bowels then ceased to act. At 11.30 A.M. he was suffering from con- stant pain in the bowels, occasionally aggravated ; there was tenderness over the abdomen generally, but especially over the course of the trans- v^erse colon, with vomiting every ten minutes, great thirst, warm, per- spiring skin, pulse 90, and great depression. At 3 A.M. on the second day he was again seen. Vomiting and purging had returned. There was great exhaustion, the pulse was imperceptible, the action of the heart feeble. He w^as lying in bed on his back, with his knees drawn up. Sensibility and consciousness were perfect. He complained of great pain in the stomach ; there was tenderness over the abdomen, but no increase in size. In another hour he died, i. e. about forty-four hours after eating the fungi, and about thirty-four after the first setting in of the symptoms. Others partook of the fungi, but in small quantity, and they did not suffer. On inspection, the heart on the right side contained a little fluid blood. The left ventricle was contracted and empty. The lungs were healthy and there was only cadaveric congestion. The lining membrane of the stomach and small intestines was throughout injected ; the bluish-red ap- pearance diminishing in intensity as it approached the caecum. There were a few ecchymosed patches near the intestinal end of the stomach. The organ contained six ounces of a brownish liquid resembling thick gruel. The large intestines were empty and pale, and the spleen was con- gested ; the other organs were healthy. (Med. Times and Gaz., 1863, 2, p. 536.) In many of its features, and in the absence of narcotic symp- toms, this case resembled a case of acute poisoning by arsenic ; the fact that nearly ten hours elapsed before the symptoms of irritation com- POISONOUS FUNGI THEIR EFFECTS. 215 rQenced, and that there was no blood in the matters discharged by vomit- ing and purging, were the most marked differences. In 1871, two children died from the effects produced by noxious fungi. Several other persons were placed in a precarious condition from the same cause. Some fowls died from eating portions of the mushrooms. Two children, a boy, set. 8, and a girl, set. 10, cooked some mushrooms for breakfast. The boy ate greedily of them, but permitted the girl to take only one mushroom. The symptoms produced in both children were similar, except that the boy had them in a severer and fatal form, and the girl recovered. Three or four hours after the meal the girl was seized with violent pains in the head and abdomen ; she vomited several times in the course of the day, was restless, thirsty, and had occasional muscu- lar twitchings of the hands. During the night the symptoms increased in severit}^ and she slept but little. Next day there was slight diarrhoea. When admitted into hospital, fifty-four hours after the mushrooms were eaten, all her symptoms had nearly subsided. The boy was then collapsed, and died twenty minutes afterwards. His stomach was found empty and contracted ; its mucous coat pink, with minute injection, and covered with a thick layer of dryish epithelium, The liver was fatty. (Guy's Hosp. Rep., 1872, p. 228.) Cases of poisoning by fungi are reported in Huse- mann's Jahresbericht, 1872, p. 534. A case in which a woman died in twenty hours from eating ordinary mushrooms was communicated to the author by Smith, of Shepton Mallet, in Aug. 1873. The syaiptoms re- sembled those already described. A man, a3t. 43, and his daughter, set. 5, suffered severely from eating the Amanita pantherina. The earliest symptoms appeared in two hours and a half after the meal. They were thirst, faintness, delirium, nausea, paleness of the face, and cold extremities. After eleven hours there was stupor, with tenderness of the abdomen. In the child there was cyanosis of the legs, with contracted pupils. It was remarked that even fourteen hours after the fungi had been eaten portions of them were discharged by vomiting from the action of emetics. Both recovered. An analysis of cases of mushroom-poisoning shows that when the symptoms are referable to the presumably decayed state of the fungi, these produce violent gastro- intestinal symptoms ; and that, as a rule, these symptoms appear only after the lapse of some hours, and then the course of the case is not unlike one of cholera. The fly-fungus {Amanita muscaria) contains a definite alkaloid {Muscarine), and when this fungus is eaten, generally in mistake for the golden mushroom {Amanita Csesarea), the symptoms appear within half an hour or an hour, though occasionally at a much later period ; and they are of a cerebral character — the gastro-intestinal symptoms being either only secondary or a,ltogether absent. Thus there is a state of excitement and in- ebriation, trismus, etc. Ponfick has made the extraordinary statement that an infusion of the ordinary mushroom is poisonous. This is contrary to common experience ; and the children of rural districts often eat with im- punity large quantities of uncooked mushrooms. Poisoning with mushrooms is usually the result of accident or mistake. They are not taken for the purpose of suicide, and the author met with only one instance in which it Vv'as alleged they were intentionally given to destroy life. In Aug. 1873, a gardener in the metropolitan district was committed on a charge of murder for causing the death of a young woman by giving her poisonous mushrooms. The accused, it was alleged, had a mo- tive for the act, but he denied tha* he knew the mushrooms to be poison- ous. The deceased fried them, ana had some for breakfast. She suffered 216 POISONING WITH HENBANE. severe pain, and died the same evening. Other persons who partook of them were also taken ill, bnt recovered. This form of homicide would be very difficult to establish. It would be necessary to show tliat the mushrooms were really poisonous, and to the knowledge of the accused. None might be forthcoming, so that there would be no botanical evidence of their poisonous nature. But as persons have died from taking edible mushrooms, it might be alleged that there was nothing criminal in the act, and that the death was owing to idiosyn- crasy. Analysis. — The discovery of portions of the undigested mushrooms in the matter vomited, or a description of the food eaten or in the stomach after death, will commonly lead to a recognition of this form of poisoning. One of the most poisonous fungi, Amanita tnuscaria, or the fly-mush- room, renders the water in which it has been boiled so poisonous that animals are killed by it, while the boiled fungus is itself inert. The liquid procured from it is used as a fly-poison, whence the name of the fungus. It is an autumnal fungus, of a rich orange-red color, and owes its deadly properties to an alkaloid (Muscarine). Much has been said and written on the methods of distinguishing the edible from the noxious fungi, but instances have occurred in which the former have produced symptoms of poisoning and have destroyed life. These fungi can be recognized only by their special botanical characters. Berkeley says, "No general rule can be given for the determination of the question whether fungi ai'e or are not poisonous. Color is quite inde- cisive, and some of the most dangerous fungi, and amongst them the Agaricus phalloides, are void of any unpleasant smell when fresh, though the most wholesome may be extremely offensive when old. Experience is the only safe test, and no one should try species incautiously with whose character he is not thoroughly acquainted." CHAPTER XX. HENBANE ATROPA BELLADONNA, OR DEADLY NIGHTSHADE. POISONING BY ATKOPINE.— DATURA STRAMONIUM, OR THORN-APPLE. Henbane (Hyoscyamus niger). Symptoms and Appearances. — The seeds (Fig. 23), roots, and leaves of this plant are poisonous. When the dose is not sufficient to destroy life, the symptoms are — general excitement, fulness of the pulse, flushing of the face, weight in the head, giddiness, loss of power and tremulous motion of the limbs, somnolency, dilatation of the pupils, double vision, nausea, and vomiting. After a time these symptoms pass off, leaving the patient merely languid. When a large quantity of the root or leaves has been eaten — an accident which has occurred from the plant having been mistaken for other vegetables — more serious effects are manifested. In addition to the above symptoms in an aggravated form, there will be loss or incoherency of speech, delirium, confusion of thought, insensibility, coma, and, sometimes, a state resembling insanity ; the pupils are dilated and insensible to light; there is coldness of the surface, cold perspiration, loss of power in the legs, alternating with tetanic rigidity, and convulsive POISONING WITH BELLADONNA SYxMPTOMS. 217 movements of the muscles ; the pulse is small, frequent, Fig. 23. and irregular, the respiration deep and laborious. (Med. Gaz., vol. 47, p. 641.) Occasionally there is nausea, with vomiting- and purging-. Death may take place in a few hours or days, according to the severity of the symptoms. The special effect of this poisonous plant is manifested in its tendency to produce a general paralysis of the nervous system. According to White, the biennial is more powerful than the annual plant. He reports the case of a woman, set. 34, who swallowed, by mistake for a black draught, an '^ «. ounce and a half of tincture of hyoscyamus. Symptoms '^ q came on in ten minutes, the most marked among them being , , ,.„ a complete loss of power to move her legs ; insensibility and ' a, Natural size. ' delirium followed; and it was six days before she began to *' diameters '^^ recover. She entirely lost her memory. Lancet, 1873, ii. p. 8.) The recent researches, however, of Gerrard show that the yield of alkaloids in the biennial does not greatly differ from that of the annual plant. (Year Bk. of Pharm., 1890, p. 347.) The poisonous properties of henbane are due to the presence of two alka- loids {Hyoscy amine and Hyoscine). These, with atropine, the active alka- loid of belladonna, are perhaps the only three known natural vegetable alkaloids that cause excessive dilatation of the pupil of the eye. Deadly Nightshade (Atropa belladonna). Atropine. Symptoms. — The symptoms which are produced by the leaves, berries, seeds, and root of belladonna are of a uniform character, and, as a sum- mary, they may be thus described : Heat and dryness of the mouth and throat, nausea, vomiting, giddiness, indistinct or double vision, delirium, great excitement, and convulsions followed by stupor and lethargy. The pupils are much dilated, and the eyes are insensible to light. In two eases which occurred to Tufnell, the pupils Avere contracted during sleep, although dilated in the waking state. (Dublin Med. Press, Jan. 5, 1853 ; Jour, de Chim. Med., 1853, p. 695.) A woman took by mistake an ounce of belladonna liniment instead of her medicine, and in about twenty min- utes had passed into a state of insensibility. Copious draughts of mustai'd and water, and salt and water, were administered without provoking vom- iting. She was in a state of coma ; the extremities Avere warm ; the abdo- men was slightly hard ; breathing was regular ; pulse 70, fairly good. There was inability to swallow ; the pupils were natural, but not sensitive to strong light. Three hours later her condition was not much changed : the coma was not so complete ; there was some struggling, incontinence of urine, and the pupils unaltered. One-fourth of a grain of morphine was injected subcutaneoush^. Eight hours later, coma had passed off, and was succeeded by delirium. Jerking of the tendons was present ; she could swallow freely. The next day all the symptoms had disappeared, except- ing some dryness of the mouth and throat. It is noticeable that through- out the pupils were unaffected. (Brit. Med. Jour., 1884, i. p. 377.) Several deaths from the poisonous effects of the berries occurred in 1846. The following case was admitted into Guy's Hospital : A boy, set. 14, ate, soon after breakfast, about thirty belladonna berries. In about three hours he had the sensation of his face being swollen ; the throat became hot and dry, the vision was impaired, objects appeared double, and they seemed to revolve and run backwards. His hnnds and face were flushed, and the eyelids swollen ; there were occasional flashes of light before his eyes. He 218 BELLADONNA SYMPTOMS. tried to eat, but could not swallow on account of the state of his throat. In endeavoring to walk home he stumbled and staggered; and he felt giddy whenever he attempted to raise his head. His parents thought him intoxicated ; he was incoherent, frequently counted his money, and did not know the silver from the copper coins. His eyes had a fixed, bril- liant, and dazzling gaze ; he could neither hear nor speak plainly, and there was great thirst ; he caught at imaginary objects in the air, and seemed to have lost all knowledge of distance. His fingers were in con- stant motion; there was headache, but neither vomiting nor purging. He did not reach the hospital until nine hours had elapsed, when the S3'mptoms were much the same as those above described. He attempted to get out of bed with a reeling, drunken motion ; his speech was thick and indistinct. The pupils were so strongl}^ dilated that there was merely a ring of iris visible, and the eyes were quite insensible to light. The eye- lids did not close when the hand was passed suddenly before them. He had evidently lost the power of vision, although he stared fixedly at ob- jects as if he saw them. The nerves of common sensation were unaffected. "When placed on his legs he could not stand. The pulse was 90, feeble and compressible ; the mouth was in constant motion, as if he were eating some- thing. His bladder was full of urine on admission. He continued in this state for two da3's, being occasionallv conscious, when by a free evacua- tion of the bowels some small seeds were passed ; these were examined and identified as the seeds of belladonna. The boy graduallv recovered, and left the hospital on the sixth day after his admission. The progress of recovery was indicated by the state of the pupils, which had only then acquired their natural size and power of contraction. In three other cases which occurred at the same time, the berries having been baked in a pie, pains in the limbs, drowsiness, insensibility, and convulsions were among the symptoms. In two instances of poisoning by the berries, related by Moll, the symptoms bore a strong resemblance to those of delirium tre- mens, but among them were some peculiar to the action of belladonna, namely, heat and dryness of the throat, loss of power of swallowing, inco- herent speech, double vision, and strange spectral illusions, with occasional fits of wild and ungovernable laughter. On the following morning both these patients recovered as if from a dream ; but they suffered for some time from languor, thirst, and dryness of the throat, and the pupils also continued dilated. (Casper's Wochen.schrift, 1846, p. 26.) Two cases, showing the poisonous effects of the berries on children, are quoted in the Edin. Med. and Surg. Jour., vol. 29, p. 452. The following case, which occurred in Nov. 1871, is remarkable for the fact that a woman recovered from a large dose of the extract. A nurse gave by mistake to a lady whom she was attending a belladonna liniment containing three drachms of the extract mixed with soap liniment. She vomited slightly, suffered from dryness of the throat, difficulty of swallowing, drowsiness, delirium, dilated pupils, fixed staring of the eyes, loss of power, and difficulty of speech. Paralysis of the extremities came on, with great pain in the back. Emetics, with brandy and cayenne pepper, were employed with success. The woman recovered, but not until after five weeks from the time of swallowing the liniment. A child, nearly four years old, swallowed only two or three drops of a liniment containing belladonna. The child went to sleep for an hour, when it was seized with tremblings and convulsions, dilated pupils, delirium, and other symptoms of belladonna-poisoning. It recovered only after three days, this being indicated among other signs by the normal state of the pupils. (Guy's Hosp. Gaz., June, 1878.) In another case, in which a lady swallowed four ounces of belladonna liniment, in addition BELLADONNA APPEARANCES AND ANALYSIS. 219 to the usual symptoms speech was lost. There was comi)lcte paralysis of the legs, and a ditt'iised scarlet rash appeared on the neck and the upper part of the chest. She fell into a state of deep sleep, and, on her recovery in three or four days, her life appeared to be a complete blank. (Brit. Med, Jour., 1876, ii. p. 678.) Such cases are common. This poison readily acts through the unbroken skin. In one case equal parts of mercurial ointment and extract of belhidonna were applied to the scrotum of a man. On the second day all the symptoms of poisoning' came on, with flushed face and i)upils dilated and insensible to light. (Brit. Med. Jour., 1877, i. p. 1G4.) The editor has seen severe cases of poison- ing- resulting- from the application of atropine ointment to ulcers. Appearances. — The appearances observed in several fatal cases of poi- soning with the berries were as follows : the vessels of the brain were congested with liquid blood ; the stomach and intestines were pale and flaccid ; there were some red spots towards the cardiac end. In other fatal cases, of which the appearances have been reported, the vessels of the brain and its membranes were found distended with thick black blood. Red spots have also been observed around the throat and gullet, and con- gested patches of a dark purple color on the coats of the stomach. In some instances the mucous membrane has been completely dyed by the juice of the berries. A boy, set. 5, after having eaten a quantity of bella- donna berries, went to bed, was very restless, vomited once, and died in convulsions about fifteen hours after having taken the poison. On inspec- tion, the eyes Avere half-open, with an intense lustre, and the pupils dilated ; the mouth was spasmodically closed, and the sphincter of the bowel relaxed. The cerebral vessels were distended with dark-colored blood ; the substance of the brain, cerebellum, and medulla oblongata pre- sented numerous bloody points. In the throat and gullet there were several patches of redness. In the stomach there was some fluid with three open berries; the mucous membrane was of a reddish-blue color in various parts. (Canstatt's Jahresb., 1854, p. 295.) Analysis. — The indigestible nature of the leaves, fruit, and seeds will commonly lead to their detention in the matters vomited or passed by the bowels, or in the contents ^'"' of the viscera after death. The seeds of belladonna ^^''v are very small, and can be distinguished by the micro- scope from the seeds of other poisonous plants. They are of a somewhat oval shape and of a dark color. Under a low magnifying power they present a honey- combed surface (Fig. 24). In henbane the surface of the seeds presents more irregular depressions, resemb- » ling those seen on certain corals or madrepores. The ® g ^ coloring matter of the berry is of a deep purple hue ; seeds of Belladonna, it is turned gi-een by alkalies and red by acids. The ?',^^^*"Va' ^\f„%. ,„„,^,., , ,,'',,'' , ,1 . I . • 1 1 . 6 Maguitied 30 diameters. leaves would be known by their botanical characters, and a decoction or infusion of them by the liquid causing dilatation of the pupil. Atropine. — Atropine is the name given to the active alkaloid of bella- donna ; it is a YJOwerful poison. It has been asserted that atropine does not exist pre-formed in the belladonna plant, but that it is a product of the chemical processes employed upon a kindred base, hyoscyamine, found in the plant. Schulte has shown that in the young plant hyoscyamine only is found ; and in old plants both hyoscyamine and atropine. (See Pharm. Jour., 1890-1, p. 207.) From a medico-legal point of view this fact is not of much importance. Symptoms of poisoning have been produced by the 220 POISONING ■WITH ATROPINE. api)lication of a weak solution of atropine to the eyes. Bowles found that al)out l-fiOth of a grain repeated twice in half an hour, making- l-30th of a grain, dro])i)ed into the eve, produced in two adults, after sonic hours, loss of vision, giddiness, soreness of the throat, loss of }>o\ver of swallow- ing, and widely dilated ])upils. The latter symptom remained for eight days. (Brit Med. Jour., 18TG, i. j). 533.) One-eighth of a grain injected beneath the skin for the relief of sciatica caused all the symj)toms of poi- soning with belladonna. (Pharm. Jour., May, 18G2, p. 583.) One grain used hypodermically nearly proved fatal at Guy's Hospital ; and in the following case (Med. Times and Gaz., 18(55, ii. p. 34) a man who swal- lowed, by mistake, a grain of sulphate of atropine in solution, had a nar- row escape. In an hour afterwards the following symptoms Avere ob- served : the pupils were enormously dilated, so that the iris of each eye was scarcely visible; the eyes moved restlessly from side to side. The pulse was very quick, and the patient appeared as if intoxicated. In another hour his hands were cold, the pulse weak, and there was loss of power in ihe limbs. He became restless, incoherent, and unconscious of preceding events. There was also delirium. In a later stage there was morbid sensitiveness to sounds and objects; the tongue was furred and the skin dry and hot. The pupils continued dilated for a week, and for several days there was a partial paralysis of the bladder. He recovered in a fortnight. A fatal case of poisoning by sulphate of atropine is recorded by Green- way. A man, set. 45, swallowed by mistake a teaspoonful of solution of sulphate of atropine equal to half a grain of the sulphate. The usual symptoms of poisoning followed, but it is remarkable that the patient did not die until the sixth day. (Brit. Med. Jour., 1818, ii. p. 516.) Cases of atropine-poisoning of a mild character are common in hospital practice, in consequence of atropine lotions, intended for the eye, being accidentally taken by children and others. In 1880, a boy, a^t. 12, was admitted to Guy's Hospital, who on the previous day had eaten some ripe belladonna berries whilst on a country excursion. On returning home he went to bed as usual, but awoke at 2 A. M. in much the same condition as on his admission at 5 A. M. He was then delirious and in such violent convulsions that he was unable to sit still a moment. He talked most incoherently. He apparently could not swallow, as he put water in his mouth and spat it out again, the effort throwing him into severe convulsions. At 10 A. M. the delirium and convulsions still continued ; there was a marked flushing on the legs and face, and the latter was somewhat swollen. The throat was red, and he showed aversion to water. The pupils were widely dilated. The delirium continued, with convulsions, all day and during the next night, though occasionally he spoke rationalh^. He was flushed, and appeared like a child in the early stage of a scarlatina rash At noon — about forty- two hours after, as was supposed, the berries were eaten — one-third of a grain of morphine was injected hypodermically. The boy soon slept, and next day awoke well In 1850, Sells forwarded to the author, for examination, the stomach of a young man who had poisoned himself by taking tw( (7rai??sof atropine. He took the dose on going to bed. He was heard to snore heavily during the night, and was found dead about seven in the morning, lying on his right side, the surface livid, the limbs rigid and contracted, and with a little brown matter issuing from the mouth. The pupils were much dilated. The mucous membrane of the stomach presented a diffused redness, whiclk POISONING WITH STRAMONIUM. 221 mig-ht have arisen from some brandy which he had swallowed. No trace of the poison could be detected in tiie stomach or the contents. A medical man was charged with attempting- to poison his wife and other persons with atropine, which it was alleged had been placed in a rabbit pie. (Reg. v. Sprague, Exeter Aut. Ass., 1865.) The evidence failed to show" at the trial that the prisoner, or any other person, could have mixed poison with the pie, much less such a poison as this, which, in the dose of one or two grains, either destroys life or produces illness continuing for some time. The symptoms, as described, resembled those caused by noxious food, and difi'ered in many respects from those of poisoning by atropine. The only fact on which this chemical theory seemed to rest was that the pupils of the eyes of those who ate of the pie and were taken ill were dilated, and a portion of the extract of the scrap- ings of the pie-dish is said to have caused a dilatation of the pupil of the analyst. (Med. Times and Gaz., 18(i5, ii. p. 168; Chem. News, 1865, ii. p. 72.) It is stated that the supposed poison was separated from the baked leg of a rabbit, by soaking it in dilute hydrochloric acid, but the whole of the scientific theory rested upon the dilatation of the pupils, and this, although presumptive, is not positive evidence of atropine having been administered. The criminal administration of atropine is a rare event in this country. A trial for murder by this alkaloid took place at the Manchester Lent Assizes, 1872 (Reg. v. Steele). The prisoner, who was a nurse in the workhouse, was charged with administering atropine to the senior surgeon, and thereby causing his death. The deceased was taken suddenly ill after his breakfast, and died in about twelve hours with the usual symptoms of poisoning with atropine. The poison, a solution of atropine in spirit, was detected in the body, and also in a liquid found in the room. Milk was the vehicle through which it was taken. The milk as sent from the kitchen contained nothing injurious, but that found in deceased's room was tasted by two of the nurses, and both suffered from poisoning by atropine. The prisoner had access to this room, and it was alleged that she had a strong motive for this criminal act, but there was no direct proof to show that she put the poison into the milk, and she was acquitted. Arialysis. — Atropine is a white crystalline alkaloid, sparingly soluble in water, but readily dissolved by alcohol, ether, and dilute acids. It does not readily crystallize, but forms readily crystallizable salts. It may be detected in, and separated from, organic liquids by the process of Stas (see p. 228, j)oiit). The test usually employed, in addition to the general tests for alkaloids, is a physiological one — the effect produced on the pupil of the eye by small quantities of liquid or extract containing traces of atropine. The ])upil becomes largely dilated and does not respond to light. There is nothing conclusive in this result, unless there is also evidence from symp- toms that belladonna has been actually taken or administered. Thorn-apple (Datura stramonium). Symptoms and Appearances. — The symptoms produced by stramonium, whether the leaves or seeds are used, are as follows : Soon after the poison has been taken there is giddiness, dimness of sight, a sense of fainting, insensibility, fixed and dilated pupils, flushed countenance, and a slow, great, and full pulse. Sometimes there is restlessness, with a hot and red skin, a wild and staring countenance, the breathing hurried and gasping, incessant talking without distinct articulation ; and there are attempts to 222 NUX VOMICA STRYCJININE. Fi^. 25. drive away, or grasp at, iniau^inar}' objects. There is picking at the bed- clothes, with paroxysms of excessive laughter, and, if the person can walk, it is with a staggering gait, and he falls to the ground as if intoxicated or completely exhausted. The seeds of two varieties of datura were used by the Thugs of India for rendering their victims i)owerless and insensible. Appearances. — In a well-marked case of poisoning with stramonium seeds, in which death took place in less than eight hours, the following appearances were found : Great congestion of the vessels of the brain and its membranes, the brain lirm and highly injected, the choroid plexus turgid, the ventricles contained serum, the sub- stance of the lungs congested, and the h(!art flaccid. The stomach contained about four ounces of digested food mixed with eighty-nine seeds of stramonium. There were two patches of extravasation in the mucous coat — one on the larger curvature and the other near the pylorus. Many seeds and fragments were also found in the intestines. (Lancet, 1847, ii. p. 298.) In another case there were marks of diffused inflammation about the cardiac end of the stomach. Analysis. — The seeds of stramonium, from which accidents have most frequently occurred, are flattened, kidney-shaped, but half oval, rough, and of a dark-brown or black color. They are liable to be mistaken for the seeds of capsicum. Of the dry Datura stramonium there are about eight seeds to a grain. They are of an oblong kidney-shape, and of a dark-brown or black color. The illustration (Fig. 25) shows their appear- ance under a low power of the microscope. The leaves of the common Datura stramonium are well characterized by their peculiar shape. Seeds of Datura Stramonium. a, Natural size. 6, Magnified 80 diameters. CHAPTER XXI. N0X VOMICA. STRYCHNINE. SYMPTOMS AND APPEARANCES. CHEMICAL AND MICROSCOPI- CAL ANALYSIS OF NUX VOMICA AND STRYCHNINE. PROCESS FOR ORGANIC MIXTURES. DIALYSIS. BRDCINE. Nux Vomica. Strychnine, or Strychnia. Symptoms. — At a variable interval after taking either nux vomica or strychnine in a poisonous dose, the person experiences a sense of un- easiness and restlessness, accompanied by a feeling of impending suff"oca- tion. There is a shuddering or a trembling of the whole frame, with twitching and jerkings of the arms and legs. Tetanic convulsions then commence suddenly with great violence, and nearly all the muscles of the body are simultaneously affected. The limbs are stretched out involun- tarily, the hands are clenched ; the head, after some convulsive jerking, is bent backwards, and the whole of the body becomes as stiff as a board. As the convulsions increase in frequency and severity, the body assumes a bow-like form (opisthotonos), being arched in the back and resting on the head and heels. The head is firmly bent backwards, the soles of the NUX VOMICA SYMPTOMS. 223 feet incurvated or arched, or everted, and the le^^s sometimes separated The abdomen is hard and tense, and the chest spasmodically fixed, so that- respiration appears to be arrested. The face assumes a dusky, livid, or congested appearance, with a drawn, wild, or anxious aspect ; the eyeballs are prominent and staring, and the lips are livid. The intellect is clear, and the sufferings, during this violent spasm of the voluntary muscles, are severe. The patient in vain seeks for relief in gasping for air and requir- ing to be turned over, moved, or held. The muscles of the lower jaw, which are the first to be affected in tetanus from disease, are generally the last to be affected by this poison. The jaw is uot always fixed during a paroxysm. The patient can frequently speak and swallow, and a great thirst has been observed among the symptoms. In some cases of poison- ing with nux vomica the jaw has been fixed by muscular spasm ; but, unlike the lockjaw of disease, this has come on suddenly in full intensity with tetanic spasms in other muscles, and there have been intermissions which are not usually witnessed in the tetanus of disease. The sudden and universal convulsion affecting the voluntar}^ muscles has sometimes been so violent that the patient has been jerked off the bed. After an interval of from half a minute to one or two minutes, the convulsions subside, there is an intermission, the patient feels exhausted, and is bathed in perspiration. It has been noticed in some of these cases that the pupils during the paroxysm are dilated, while in the inter- mission they are contracted. The pulse during the spasms is so quick that it can scarcely be counted, and the temperature of the body is much elevated. Slight causes, such as an attempt to move, a sudden noise, or gently touching the patient, will frequently bring on a recurrence of the convulsions. In cases likely to prove fatal, they rapidly succeed each other, and increase in severity and duration, until at length the patient dies, utterly exhausted. The tetanic symptoms produced by strychnine, when once clearly established, progress rapidly either to death or recovery. The person is conscious, and the mind is commonly clear to the last. He has a strong apprehension of death. The duration of the case, when the symptoms have set in, is reckoned by minutes, while in the tetanus of disease, when fatal, it is reckoned by hours, days, and even weeks. As a general statement of the course of these cases of poisoning, within two hours from the commencement of the symptoms the person either dies or recovers, according to tlie severity of the paroxysms and the strength of his constitution. Death sometimes takes places in a paroxysm. (Lancet. 1861, i. p. 572.) In 1885 (Reg. v. Day, Taunton Winter Ass.), a farmer was tried for the murder of a female relative b}' str\'chnine, but was acquitted, no red strychnine having been traced to the prisoner, although a red substance was deposed to as having been seen in the gruel which was the vehicle in which the poison was adnunistered. This is the only instance which the editor has met with of the criminal administration of strychnine as a red substance. (See Vermin-killers, p. 225, post.) In 1888, a gardener murdered his wife and son by means of pills con- taining strychnine substituted for ordinary purgative pills (Reg. v. Bowes, C. C. C, Jan. 1888). The editor has known extract of nux vomica sold and taken in mistake for extract of sarsapa.rilla, with fatal result. The time at which the symptoms commence appears from the recorded cases to be subject to great variation. In poisoning with nux vomica they are generally more slow in appearing than in poisoning with strychnine Until they set in suddenly, the patient is capable of walking, talking, and going through his or her usual occupations. In a case which occurred to 224 STIIYCJININE FATAL DOSE. Pellarin, a man swallowed about 300 grains of nux vomica, and no symp- toms appeared for two hours. He died speedily in a violent convulsive fit. (Ann. d'llyg-., 1860, t. 2, p. 431.) Macredy reports a case of poison- ing by a grain and a half of strychnine, followed by two fluidounces of tincture of opium, where the symptoms of strychnine-poisoning did not manifest themselves till after the lapse of eight hours. The patient re- covered. (Edin. Med. and Surg-. Jour., 1883, p. 157.) Generally, in poi- soning by strychnine the s3'mptoms appear in from five to twenty minutes. Appearances after Death. — In general the body is rela.xed at the time of death and stiffens afterwards ; but the commencement and duration of the rigid state depend on various conditions. In some cases the body is found rigid and arched (opisthotonos), with incurvated toes. (Reg. v. Day, p. 207.) Among the internal appearances which have been met with in diiferent cases are congestion of the membranes and substance of the brain, as also of the upper part of the spinal marrow, with congestion of the lungs. The heart is contracted and empty ; but its right cavities in some instances have been distended with li((uid Ijlood. The blood has been found black and liquid throughout the body. The mucous membrane of the stomach has occasionally presented slight patches of ecchymosis or congestion, probably depending on extraneous causes, such as the process of digestion, the presence of food or of alcoholic liquids. In most in- stances the stomach and intestines have been found quite healthy, and it is not in the nature of this poison either to inflame or to irritate the mucous membrane. Of the appearances observed in poisoning with strychnine, there are none which can be considered characteristic. Congestion of the membranes of the brain and spinal marrow is probablv the most common. Fatal Dose. — The sixteenth part of a grain of str3'chnine killed a child between two and three years of age in four hours. The smallest accu- rately recorded fatal dose in an adult was in the case of Dr. Warner. Half a grain of the sulphate of strychnine here destroyed life. (On Poi- .soning by Strychnia, pp. 138, 139.) So powerful are the effects of this drug in certain cases that ordinary medicinal do.ses cannot be borne. The editor has known one-twelfth of a grain produce poisonous symptoms. Hare states that many deaths are recorded from one-quarter to one-half a, grain dose (Boston Med. and Surg. Jour., Nov. 20, 1884, p. 482) ; but the editor has been unable to verify this statement. Symptoms of its poison- ous action have frequently been unexpectedly produced. Fra.ser states that its action is most powerful through the skin. He found that when applied to rabbits hypodermically, from one-twentieth to one-fiftieth of a grain produced violent tetanic convulsions, followed by death in a few minutes. With respect to nux vomica, three grains of the alcoholic extract have destroyed life. The smallest fatal dose of nu.x vomica in powder was in a case reported by Hoffmann (Med Rat. Syst., ii. 175). Thirty grains of the powder given in two doses of fifteen grains each, proved fatal. The poison was given by mistake for Peruvian bark to a patient laboring under quartan fever. This is about equivalent to the weight of one full- sized seed, and to only one-third of a grain of strychnine in the two doses. In fatal cases death generally takes place within two hours after the taking of strychnine. One of the most rapidly fatal cases recorded is that of Dr. Warner : the symptoms commenced in five minutes, and he died in twenty minutes. In the case of J. P. Cook, the symptoms com- menced in an hour and a (juarter, and terminated fatally in tweedy minutes. In poisoning by nux vomica, death may occur within two hours. Chris- tison mentions a case in which a man died in fifteen minutes after taking VERMIN-KILLERS. 225 a dose. This is probably the shortest period known. The long-cst period at which death has occurred was six hours after administration of the poison. The editor met ^Yith a case where death occurred in five hours and a half. (C. C. C, Reg-, v. Barlow, 1875 ; see Rep. of Trials for Murder by Poisoning-, by Browne and Stewart, p. 268.) Vermin and Insect-killei's. — Although it is diiiicult to procure strych- nine at a druggist's shop, the poison is extensively sold to the public in threepenny and sixpenny packets, under the name of Vermin-killers. Butler^s Vermin-killer consists of a mixture of flour, soot, and strych- nine. The author found the sixpenny packet to weig-h about a drachm, and to contain from two to three grains of strychnine. As the poison is mechanically mixed with the other ingredients (flour and coloring matter), and is probably manufactured on a large scale, the proportion of strych- nine is liable to variation. The threepenny packet contains about half the above quantity of strychnine, but this is quite sufficient to destroy the life of an adult. In place of soot, Prussian blue is sometimes used as a color- ing- substance. The editor finds that there are two kinds of Butler's Ver- min-killer in commerce : in one the poisonous ingredient is carbonate of barium, and in the other strychnine. A sixpenny packet of the latter weighed forty-two grains, and yielded two grains and a quarter of strych- nine. Another sixpenny packet weighed sixty-two grains, and contained one grain and three-quarters of strychnine. BattWs Vermin-killer is a powder similar to that of Butler's, containing a fatal proportion of strych- nine as it is sold in packets. The editor found a threepenny packet of Battle's Vermin-killer to weigh twelve grains, and to contain one grain and a quarter of strj^chnine ; and a sixpenny packet weighed twenty-five grains, and contained two grains and a half of strychnine. These powders are a fertile source of poisoning, either through accident or design ; they are openly sold by ignorant people to others still more ignorant, and are much used for suicidal purposes. Artificial ultramarine has been some- times improperly used instead of Prussian blue or indigo for coloring vermin-killers. A powder of this kind is prepared in Bristol. Since the color of the powder is at once discharged by any acid (such as that of the gastric juice and ordinary articles of food), the recognition of such a powder may entirely fail. The editor has met with a red vermin-killer in commerce, containing 50 per cent, of strychnine, colored with four per cent, of vermilion. Red str3'chnine — the crystals of the alkaloid super- ficially colored by a secret trade process — is expressly made for the New South Wales market; and, in 1884, a quantity of this colored strychnine found its way into English commerce. Arsenic and strychnine are used together in some vermin-killers. Chemical Analysis. — Nux vomica is well known as a flat, round kernel, about the size of a shilling, with radiating silky fibres, slightly raised in the centre. It is of a light-brown color, and covered with fine silky fibres (see Pigs. 26 and 27, p. 226). It is very hard, brittle, tough, and difficult to pulverize. The powder is of a gray-brown color, like that of liquorice, and has an intensely bitter taste ; it is sometimes met with in a coarsely rasped state. It yields to water and alcohol, strychnine, bruciue, and some other vegetable substances. Heated on platinum-foil, it burns with a yellow smoky flame. Nitric acid turns it of a dark orange-red color, which is destroyed by stannous chloride. These properties are sufficient to distinguish it from various medicinal powders which it re- sembles in color ; but the presence of any silky hairs or fibres revealed by the microscope (Fig. 28) would at once distinguish it from all other powders. They may be obtained from the contents of the stomach or any 15 226 STRYCHNINE CUEMICAL ANALYSIS. liquid article of food b\' washing and decantation. They are quite insolu- ble in water. The aqueous infusion or decoction of nux vomica is deeply Fig. 26. Fig. 27. Seeds of Nux Vomica, natural size, a, Convex surface ; 6, concave surface; c, hilum or umbilicus. reddened by nitric acid, and is freely precipitated by tincture of galls. Ferric sulphate gives with it an olive-green tint. Fig. 28. Fi-. 29. Hairs of Xux Vomica, magnified 124 diameters. Various forms of Crystals of Strychnine, as they were obtained from an alcoholic solution, magnified 124 diameters. Strychnine. — This alkaloid may be readily obtained crystallized from an alcoholic solution. The crystalline form is subject to great variation, according to the strength of the solution, rapidity or slowness of evapora- tion, the presence of foreign matters, etc. It is commonly seen in octa- hedra, sometimes lengthened into prisms of a peculiar shape, bevelled at the ends, and cros.sing each other at angles of G0° (see Fig. 29). There are as many as six or eight varieties of crystals, so that too much impor- tance must not be attached to this branch of the analysis. As strychnine is procured from the solutions of its salts by the addition of ammonia, it is usually deposited in long slender prisms (Fig. .30). 1. Strychnine is white, of an intensely bitter taste, even when it forms only the 1-30, 000th part of a watery solution, or even much less. 2. When heated on platinum, it melts and burns like a resin, with a black, smoky flame. 3. It is not perceptibly dissolved by cold water, requiring 7000 parts for its solution. 4. It is easily dissolved by acids, and it is precipi- tated from its concentrated solutions by potash or by ammonia, in which it is insoluble. 5. Strong nitric acid often imparts to commercial strych- nine a pale reddish color, owing to the presence of brucine. 6. Sulphuric acid produces no apparent change in it ; but when to this mixture either a small crystal of bichromate of potassium, of ferricyanide of potassium, a STRYCHNINE IN ORGANIC MIXTURES. 227 small quantity of black oxide of manganese, or peroxide of lead, is added, a series of beautiful colors (blue, purple, and violet) appear, passing- rapidly to a cherry-red tint. Among these substances black oxide of manganese will be found preferable for use. Fig. 30. Crystals of Strychnine obtained by adding ammonia to tlie sulpliate, magnified 124 diameters. Crystals of Chromate of Strychnine, magnified 124 diameters. Horsely suggested that a solution of strychnine should be sufficiently concentrated, and then precipitated by chromate of potassium : the crystals may be examined microscopically ; they are generally seen in tufts of radiated prisms of a yellow color (Fig. 31). On being touched with strong sulphuric acid, the color-reactions of strychnine are at once brought out. Chloride of gold is a delicate precipitant of strychnine. The precipitate, collected and dried, may be dissolved in concentrated sulphuric acid, and any of the color-tests then applied to it. Iodic acid is not decomposed by strychnine or its salts, and sulphomolybdic acid gives to it slowly only a pale blue color. It is thus readil}^ distinguished from morphine. In testing solutions of strychnine, the presence of alcohol should be avoided. In organic 'mixtures, a modification of the process originally suggested by Stas may be employed for the separation of the alkaloid. The principle of its operation consists in dissolving the strychnine out of the tissue or organ, very finely cut up, by means of rectified spirit mixed with a small quantity of tartaric or acetic acid, at a gentle temperature. The iiquid is strained, the residue well pressed and washed with alcohol ; and the acid solution of strychnine thus obtained is evaporated to dryness at a low temperature. The residue is exhausted with absolute alcohol, filtered, and the filtrate again evaporated to dryness at a low temperature. The residue is now taken up with water, filtered, and the liquid is neutralized by an alkali — potash, carbonate of sodium, or ammonia, the latter being in some respects preferable — and a slight excess of alkali is added. The alkaline liquid is then shaken in a long stoppered tube, with twice its volume of ether or chloroform, or a mixture consisting of four parts of ether and one of chloroform. These liquids dissolve the strychnine set free by the alkali. The ethereal solution is separated from the watery liijuid by a pipette or by a stoppered tube, and submitted to spontaneous evaporation, when, if strychnine be present, the alkaloid will be obtained, but generally associated wuth oily and other organic matters, which may interfere with the production of crystals. The impure residue left by the ether is heated in a water-bath, with a few drops of strong sulphuric acid ; this destroys the organic matter. Water is added, and the acid lifiuid is filtered through paper, made alkaline by potash, and again treated with ether, when strychnine will be obtained in small and slender prisms 228 AFTER-DEATH ABSORPTION OF STRYCHNINE. The crystals, after an examination Ijv the micro.-cope (see Fig. 30, p. 227), are treated with sulphuric acid and })eroxide of manganese, and the color- reactions of strychnine, if the alkaloid is present, will appear. By this method strychnine has been detected in the liver of a person who died from this poison, although the organ was in a highly putrescent state. The process of dialysis (p. 99) will allow of the separation of strychnine^ when combined with acids and in a state of solution, from blood, mucus, and other viscid organic matters found in the stomach. The liquid con- taining the salt of strychnine may be tested by evaporating a few drops and applying the color-test. If thus found to be present, it may be neu- tralized by ammonia or potash, and shaken with ether or chloroform in order to obtain pure strychnine. In allcases the physiological test should be used to supplement the chemical tests for strychnine. A frog may be employed for this purpose. Whatever process may be adopted, the analyst should l)ear in mind that it is better to operate on a small quantity of strychnine in a pure state than on a large quantity in an impure condition. Strychnine does not appear to undergo any change in the dead body from the process of putrefactioUj but it may disappear from the stomach like opium or morphine, and owing to similar causes (see p. 191). In the case of Reg. v. Pearson (Durham Sum. Ass., 1875), where death was clearly traced to strychnine, only 1-1 6th part of a grain was found in the body by Scattergood. Had the man survived a few hours longer, proba- bly none would have been found. Cameron found that in the case of a mm who died from strychnine administered by his step-mother, not a trace of the poison could be detected through the entire viscera. [The following papers by Prof. John J. Reese will be of interest and value upon this subject: "On the Influence of Morphia in disguising the Color- test of Strychnia," also " On the Comparative Bitterness of Strychnia," and " On tiie Physiological or Frog-test for Strychnia," in the Am. Journal of Med. Sciences, Oct. 1861.] This question is now in a great measure set at rest. A person may die from poison, although none may be detected in the body. Among other cases that of Chantrelle may be quoted as an illustration (see p. 191). The editor of this work believes that much smaller quantities of strychnine may be detected w4ien mixed with organic matters than the author (Dr. Taylor) admitted ; and that, with improved methods of analysis, which cannot here be given in detail, strychnine can hardly fail to be detected in the body in any case of poison- ing by this alkaloid proving fatal within a couple of hours. As a rule, it may be readily detected in the urine during the course of a case of strychnine-poisoning ; and also when the alkaloid is only being given in ordiaary medicinal doses. That strychnine is absorbed into the blood unchanged is incontestably proved by the experiments of Vulpian, who killed a dog by transfusing into its veins the blood of another strychnized animal. [After-death Absorption of Strychnine. — Dr. George B. Miller of Philadel- phia,' the chemist of the Medico-Legal Society, has contributed to that body a careful study and analysis of fifty toxicological analyses of the after-death absorption of strychnine. These results he has minutely tabulated in six tables. He has carefully given the details of each experiment and the chemical analysis, with the result that he has been successful in recovering strychnine from every important organ, tissue, and secretion attempted. He concludes : " It should be carefully noted that according to these results strychnine deposited post-mortem in the rectum can imbibe and be recovered from adjacent and remote organs, secretions, etc., in twenty-one and twelve days ; from the abdominal and thoracic cavities in ten days ; and also from POISONING AVITH BRUCINE. 229 the stomach in six and three days. Further than this I have not gone, but have not the slightest doubt of its difi'usibility in two days, and probably the process, to a limited extent, may take place in one day. This, no doubt, to some will cause surprise ; not, however, to one who is familiar with the subject. The labor in toxicological analysis is great and tedious, requir- ing careful preparation, constant application, thorough training and skill." ( Vide Medico-Legal Journal, vol. xiii. No. 3, p. 302.)] Brucine. Biucine, or Brucia, is an alkaloid associated with strychnine in the seeds of the nux vomica, but it is more abundantly contained in the bark of the tree. It is not so powerful a poison as strychnine, but the symp- toms produced by the commercial article are very similar. It is con- sidered to have from one-twelfth to one-fortieth, or, according to others, one-sixth of the strength of strychnine. Brunton 6nds that brucine acts very like strychnine, producing death by convulsions when injected into the tissues or the blood. When taken into the stomach, it often does not produce convulsions, owing to its rapid elimination by the urine. (Jour, of Chem. Soc, 1885, p. 143.) When pure, death may be produced in animals without convulsions. It is not affected by the color-tests employed for the detection of strychnine, and it acquires an intensely red color on the addition of nitric acid. The red color turns to a beautiful violet on the careful addition of a solution of stannous chloride. It is much more soluble in water than strychnine, and has a similar bitter taste. Its aqueous solution is strongly alkaline, and, by spontaneous evaporation, it yields groups of slender prismatic crystals arranged in a fanlike shape. Unlike strychnine, it cannot be cr3^stal]ized from a solution in benzene, and only imperfectly from a solution in alcohol. Hydro- chloric and iodic acids produce in it no change, either in the cold or when heated. Sulphuric acid gives to it a pink-red color without car- bonizing it. The sulphate of brucine crystallizes in well-defined prisms truncated at the ends. They are larger and longer than the prisms of strych- nine (see Fig. 32). From a case of poisoning with this alkaloid which occurred to Edwards, it is necessary to give a caution to medical men respecting the possible criminal use of brucine. The symptoms which it causes may so closely resemble those of poisoning with strychnine, that, in the event of death, the latter poison only may be sought for and not found ; the real poison, brucine, may be over- looked. The tetanic symptoms are more Fig. 32. slowly produced by brucine, and the poison is not so rapidly fatal as strychnine; but these conditions may be altered by the larger quan- tity given When, in any suspected case, the color-tests for strychnine fail to show the presence of this alkaloid, nitric acid should be added to the crystalline residue obtained (as in the process for strychnine) from ether or chloro- form-ether. The intense reddening produced by this test, with the other characters above mentioned, will indicate the presence of ^ , „ „ , , V . CI 1 I 1 1 T -J r ioo\ 1 Crystals of Sulphate of Brucme, brucnne. SuIphomolybdlC acid (p. 183) also maguifiecl 124 diameters. yields a striking distinction between the two alkaltjids. While it slowly gives a pale blue with strychnine, it rapidly gives a deep brick-red color, passing to brown-red, with brucine or its salts. 230 HEMLOCK — SYMPTOMS. CHAPTER XXII. CONItJM OR HEMLOCK. CONINE. WATER HEMLOCK. CENANTRE CROCATA. ^THUSA CYNAPIDM. fool's PARSLEY. WATER-PARSNIP. LOBELIA. FOXGLOVE.— DIGITALIN. ACONITE. — ACONITINE. LABURNUM. Common or Spotted Hemlock (Conium maculatum). Conine. Symptoms and Appearances. — The effects produced by hemlock have not been uniform : in some instances there have been stupor, coma, and slip-ht convulsions; while in other cases the action of the poison has been chiefly manifested on the spinal marrow — i.e. it has produced paralysis. The poisonous effects usually appear early and advance somewhat rapidly. A peculiar muscular debility sets in ; the lower limbs become weak and eventually paralyzed ; the paralysis advances upwards, eventually reach- ing- the respiratory muscles. There is difficulty of breathing, anxiety in the region of the heart, and, towards the close of life, convulsions, con- sciousness having- been previously intact. The pupils are dilated, though not to the same extent as when atropine or a solanaceous plant has been taken. When the respiration becomes affected, there is marked blueness of the surface of the body. A man ate a large quantity of hemlock plant, by mistake for parsley. In from fifteen to twenty minutes there was loss of power in the lower extremities ; but he apparently suffered no pain. In walking, he staggered as if he was drunk ; at length his limbs refused to support him, and he fell. On being raised, his legs dragged after him, and, when his arms were lifted, tliey fell like inert masses and remained immovable. There was perfect paralysis of the upper and lower extremities within two hours after he had taken the poison. There was loss of power of swallowing, and a partial paralysis of sensation, but no convulsions — only slight occasional motions of the left leg ; the pupils were fixed. Three hours after eating the hemlock the respiratory movements had ceased. Death took place in three hours and a quarter ; it was evidently caused by gradual asphyxia from paralysis of the muscles of respiration ; but the intellect was perfectly clear until .shortly before death. On inspection, there was slight serous effusion beneath the arachnoid membrane. The substance of the brain was soft; on section there were numerous bloody points, but the organ was other- wise healthy. The lungs were gorged with dark fluid blood ; the heart was soft and flabby. The stomach contained a green-colored pulpy mass resembling parsley. The mucous coat was much congested, especially at its greater end. Here there were numerous extravasations of dark blood below the membrane, over a space of about the size of the hand. The inte.stines were healthy, except that they here and there presented patches of congestion in the mucous coat. The blood throughout the body was fluid and of a dark color. In a case which was the subject of a trial for murder (Reg. v. Bowyer, Ipswich Sum Ass., 1848), a child died in one hour after swallowing part ANALYSIS CONINE, 231 Fi-. 33. a. Seed of Hemloeck, natural size. 6, The same, magnified 30 diameters. c, Group of seeds. of a teacupful of a decoction of hemlock, alleged to have been administered by the mother. The child sipped the decoction until it lost the power of holding the cup ; it became insensiljle and para- lyzed, and died in the chair in a sitting posture. There were no morbid apjtearances, and no hem- lock leaves were found in the body, these having subsided in the cup and been left in the dregs. The child had been poisoned by the upper stratum of clear liquid. The mother was acquitted for want of proof, the death of the child having taken place in secrecy. Analysis. — Hemlock is known from most other plants which resemble it by its large, round, smooth stem, with dark purple spots. The leaves are of a dark-green color, smooth and shining. Every portion of the plant has a peculiar and dis- agreeable smell when bruised, resembling cat's urine, or, according to some, the odor of mice. It is strongly brought out when the stem, leaves, or seeds are rubbed with a solution of caustic potash. An illustration of the seeds of hemlock is annexeed. (Fig. 33.) They are peculiar in their form, and are easily distinguished from the seeds of other umbelliferous plants. There are three common umbellifer- ous plants, indigenous in this country, that may be mistaken for hemlock Coniuin maculatum, the true hemlock, has a round, smooth stem blotched with purple, its lower leaves are smooth and lustrous, it has a general involucre of from three to seven leaflets, and a partial one of three leaflets ; the fruit has wavy, notched ridges. All parts of the plant when bruised have a special mousey odor. JElhuf^a cijnapium, fool's parsley, is distin- guished by its one-sided partial involucre of three leaflets, and the absence of a general involucre ; the stem is hairy and striated ; and the ridges on the fruit are neither undulated nor notched. Anthriscus vulgaris, com- mon-beaked parsley, has slightly hairy leaves, no general involucre, and a bristly fruit. Anthriscus sijlvestris, cow parsley, has a striated blotched stem, which is dow.ny below, a partial involucre of five or more leaflets, and a smooth fruit. A person may be poisoned by a decoction of leaves of hemlock, and no leaves be found in the stomach or bowels (case of Bowyer, p. 230). In this case the stomach had been emptied, and the contents lost, before it was sent for analysis. No trace of conia was found. Conine. — The poisonous alkaloid of hemlock is known under the names of Conine, conia, coniine, conicine, and conicina. It resembles nicotine and ammonia in its volatility, alkaline reaction, and in some of its chemical properties. It is a liquid of oily consistency, of a pale yellow color, powerfully alkaline, and has, when its vapor is diluted, a smell resembling that of mice, and an acrid, bitter taste. It gives a volatile greasy stain to paper, and burns with a yellow flame and thick smoke. [Prof. Wormley says that when strong sulphuric acid is brought into contact with pure Conine, the mixture assumes a pale red color, which increases in intensity, and, after a time, becomes nearly l)lood-red. The action of nitric and sul- phuric acids is nearly similar, especially that of the former. Micro-Chem- istry of Poisons, p. 449.] In reference to its presence in organic mixtures, it may be detected by its peculiar odor, or by distilling the liquid with a solution of potash and examining the distillate. It may also be separated b}^ the process of Stas. 232 POISONING WITH 03 NAN THE. The reactions produced by tests on small quantities should be dis- trusted, unless there is strong evidence of the action of the poison on the body from the symptoms, Water-iiemlock, or Cowbane (Cicuta virosa). Si/vi2^toms and Appearances. — The s3^mptoms produced by the roots of this plant are giddiness, dimness of sight, headache, and difficulty of breathing. There is burning pain in the stomach, with vomiting, and these symptoms are accompanied by heat and dryness of the throat. Convulsions have been observed to precede death. In the cases of three children who died in convulsions from this poison, Metzdorff found an injected state of the mucous membrane of the stomach, with redness of the air-passages, as well as of the cardia and pylorus ; the vessels of the brain and the sinuses were filled with dark liquid blood. (Wibiner, Cicuta, 119.) The roots of the five-leaved water-hemlock (Enanthe phellandtHum (Fhellandrium aquaticum) have been eaten in mistake for parsnips, and produced symptoms of poisoning. Hemlock Water-drop wort ((Enanthe crocata). This umbelliferous plant, known also as five-finger root, or dead tongue, grows on the banks of rivers, streams, and ditches. It is one of the most poisonous of the order, and is considered to be one of the most virulent of English vegetable poisons. It has often lieen mistaken for celery. Symptoms and Appearayices. — In 1857, two cases of poisoning with this plant occurred at West Bolden, in Durham. Two laborers ate some of the roots of the oenanthe. They were found soon afterwards lying insensible and speechless, with livid faces, swollen and protruded tongues, and there were convulsive movements of the jaws, with frothy mucus and blood about their mouths ; the eyes full and projecting, the pupils dilated, the breathing stertorous and labored, with occasional general convulsions. The men both died in an hour and a half from the time at which they were first discovered. On inspection, it was found that there had been bleeding from the ears; the abdomen was livid and swollen. The stomach con- tained a gruel-like liquid with some of the partly digested roots ; on re- moving this liquid the liuing membrane was found congested and softened. The lungs were engorged with dark lif[uid blood, and the blood contained in the heart was in a similar state. Boyle, in whose practice these cases occurred, forwarded to the author a portion of the roots, and there was no doubt that they were the roots of the oenanthe crocata. Drinkwater gives an account of three cases of poisoning by this plant, in 1875, two of which proved fatal. It seems that three boys ate the roots and stems of the plant, which they supposed to be wild carrots. They had a sweet, nutty taste. One boy complained of feeling cold, and was attacked with severe vomiting and purging. After this he recovered, and was able to give evidence at the inquest on his two companions. A second boy was found dead in the road about fifty yards from the brook where the cenanthe grew. He had vomited, struggled, and been violently convulsed. His face was black, and froth had escaped from his mouth. The third boy was found in a similar condition — dead, with froth about his mouth. The post-mortem examination revealed congestion of the brain with black fluid blood, en- gorgement of the lungs and heart with the same, and congestion of the mucous membrane of the stomach. This organ contained the masticated root of the oenanthe, with some of the green leaves. (For other cases, see Med. Graz., vol. 34, p. 288.) This plant is equally fatal to animals. Cam- FOOL S PARSLEY. 233 eron states that forty-three oxen, turned into a pasture in which the oenanthe <>-i'ew, were killed by eating the plant. Foaming at the mouth, shivering, difficult breathing, tetanic spasms, with pleurothotonos, or spasmodic bend- ing of the body to one side, were among the symptoms. (Lancet, 1873, i. p.^918.) It is not often that attempts are made to destroy persons by the admin- istration of these vegetable poisons ; but a case occurred in France in which a woman attempted to poison her husband by mixing slices of the root of this plant with his soup. His suspicions were excited by the acrid taste of the soup. The woman was tried for the crime, and Toulmouche deposed at the trial that the plant from which the root had been taken was the oenanthe crocata — that it was a powerful poison, and might cause death in two or three hours. The prisoner was convicted. (Gaz. M^d., Jan. 3, 1846, 18; also Jour, de Chim. Med., 1854, 533.) Analysis. — The oenanthe crocata can be identified only by its botanical characters. The leaves are of a dark-green color, with a reddish-colored border. They have no unpleasant odor when rubbed. The seeds, of which an illustration is annexed (Fig. 34), are peculiar. The plant bears a greater resemblance to celery than most of the other umbellifera?. Its stem is chan- nelled, round, smooth, and branched, of a yellowish-red color, and growing to the height of two or three feet. The root, consisting of a series of ob- long tubercules, with long slender fibres, is of a yellowish-white color, and Fig. 34. Seeds of QEnanthe Crocata. a, Natural size ; b, magnified 30 diameters, c, One-half of a Seed magnified, d, Cue-half natural size, e. Group of Seeds. not unpleasant to the taste. It is the most active part of the plant. The leaves yield much tannic acid to water, but the decoction appears to con- tain no alkaloidal base, since the chloride of potassium and mercury pro- duces no precipitate in it. The roots and stems of this plant are more frequently eaten than the leaves or seeds. Fool's Parsley (JEthusa cynapium). Fool's Parsley, or Lesser Hemlock, is very common in gardens and hedgerows. The leaves so closely resemble those of parsley that they have often been gathered by mistake. Symptoms and Appear-ances. — In May, 1845, a girl, set. five years, in good health, ate the bulbs of the sethusa by mistake for young turnips. She was suddenly seized with pain in the abdomen, followed by a feeling of sickness ; but she did not vomit. She complained of feeling very ill. On trying to eat, she could not swallow. She was incapable of answering questions, and her countenance bore a wild expression. The lower jaw became fixed, so as to prevent anything being introduced into the mouth. She then became insensible, and died in an hour from the commencement 234 WATER PARSNIP — LOBELIA, Fig. 35. of the symptoms : so far as could be ascertained, there were no convulsions. A second child, set. three years, shortly after eating the same substance, was attacked with pain in the stomach, sickness, vomit- ing, and profuse perspiration. She soon recovered, with the exception of suffering severe griping pains without purging ; but these disappeared on the fol- lowing day. A third child, of the same age, suf- fered from similar sym])toms. Recovery in the two last cases Avas prol^ably due to the plant hav- ing been eaten on a full stomach, and to the effect of early and copious vomiting. (Med. Times, Aug. 23, 1845, p. 408.) This plant is known from garden parsley by the smell of its leaves when rubbed, which is pecu- liar, disagreeable, and very different from that possessed by the leaves of parsley. The leaves of fool's parsley are finer, more acute, and of a darker green color. The seeds are also peculiar. They are represented in the annexed illustration (Fig. 35). Its flower-stem, which is striated or slightly grooved, is easily known from all other umbelliferous plants by the beard, or three long pendulous leaves of the involucrum under the flower. The flowers are white, whilst those of the garden parsley ai'e of a pale yellow color. Juo. Harley denies the existence of poisonous properties in this plant. (See On Poisons, 3d. edit., p. 745.) Seeds of Fool's Parsley. a, Natural size. b, Magiiilied SOfliameters. c, Group of Seeds. Water-parsnip. This plant (Sium latifolium and S. angvstifolivm or S. nodiflora) is not unlike the watercress, for which it has been mistaken. Two girls, aged five and three years respectively, died in 1882 from eating the leaves. After these were eaten, the younger child became suddenly ill and died ; while the other succumbed two days later, (Brit. Med. Jour., 1882, ii. p. 26.) Indian Tobacco (Lobelia inflata). The powdered leaves of Indian tobacco contain an alkaloid, loheline, capable of producing poisonous effects on the brain and spinal marrow, attended with irritation of the stomach and bowels. When administered in doses of from ten to twenty grains lobelia operates as an emetic ; but in larger quantity it may act deleteriously. In one ca.se a man lost his life by swallowing one drnchm of the powdered leaves, prescribed by a quack. This person was seen by a medical practitioner soon after taking the poison : he was evidently suffering great pain, but he was quite uncon- scious — the pulse w^as small, and the pupils were strongly contracted and insensible to light. He had vomited the greater part of the poison, suf- fered from spasmodic twitchings of the face, sank into a state of complete insensibility, and died in about thirty-six hours. On inspection, some fluid was found in the stomach, l)ut none of the powder. The gastric mucous membrane Avas intensely inflamed, and the vessels of the brain were greatly congested. (Pharra. Times, 1847, p. 182.) The seeds of lobelia are equally poisonous. In the Med. Times and Gaz., 1853, ii. p. 568, two cases are reported in which the seeds proved fatal. In one, the mucous membrane of the stomach was highly inflamed. Another case is referred to in the same journal (1853, i. p. 270). There have been many LOBELIA. 235 inquests and trials for manslaughter in this country as the result of the improper administration of the leaves of the Lobelia injiata by ij^norant quacks (Coffinites) calling themselves medical botanists, and dealers in vegetable medicines. The medical evidence given on these trials has proved that in large doses lobelia is a most noxious drug. (See Med. Gaz., vol. 44, pp. 383 and 433; vol. 4G, p. 384; Lancet, 1853, i. p. 23t ; Pharm. Jour., Aug. 1851, p. 87 ; and for some remarks on the action of the poison, see a paper by Curtis and Pearson, Med. Gaz., 1850, vol. 46, p. 285.) Those who profit by the sale of this drug among the ignorant poor maintain the doctrine that it cannot kill, and never has been known to destroy life. In 1856, one of these quacks was convicted on a charge of manslaughter for killing a woman with overdoses of lobelia. Severe pain, followed by loss of consciousness and congestion of the brain, was the chief symptom preceding death. The admission that in proper doses it was a useful remedy in spasmodic asthma was of no avail on this occa- sion. The man was sentenced to three months' imprisonment. (Reg. v. Boyden, or Jackson, Lincoln Sum. Ass., 1856.) A man named Riley Drake was convicted in the United States of having caused the death of a woman by administering lobelia in improper doses. (Wharton & Stille's Med. Jur., p. 522.) In 1882, a man suffering from heart-disease, and who was an enormous eater, took as an emetic a medicine containing lobelia prepared from Coffin's prescriptions. At the post-mortem examination, made twelve hours after death, an aperture about the size of a goose-quill was found in the lesser curvature of the st6mach, and about two pints of liquid having a milky appearance in the peritoneal cavity. The stomach itself contained lobelia seeds and cayenne pepper. The dictum of the so- called Coffinites is that "heat is life; and the want of heat, disease and death." In accordance with their principles, their drugs are lobelia and cayenne. (Brit. Med. Jour., 1882, 2, p. 24.) In 1884 (Reg. v. Wallis, C. C. C, Jan. 1884), an herbalist was acquitted when tried for the man- slaughter of an invalid woman named Sainsbury. The deceased, who was suffering from chronic lung-disease, took some of the prisoner's medicine, the essential ingredient of which was lobelia. She died in a few minutes. At this trial many herbalists, and two medical men, swore that lobelia was not a poison. The editor believes that, when full doses are given, the safety of the patient is usually insured by the copious vomiting that ensues. When vomiting does not supervene, death may ensue. The woman Sainsbury died quickly without having vomited. Lobelia is seen in the form of a greenish-colored powder (fragments of leaves). This powder acquires a reddish-brown color with strong nitric acid, and is blackened by concentrated sulphuric acid. Iodine water has no effect upon the infusion. Ferrous sulphate and ferric chloride produce with it a dark-green color — the ferric chloride very rapidly. The leaves and seeds contain an acrid substance called Lohelacrin. It acts as a powerful emetic in doses of from one- half to one grain. The leaves of lobelia are gene- rally seen in fragments which do not readily admit arts may be also selected by a nturderer, with the especial design of simulating? a suicidal attempt; therefore, the mere situation of a wound does not sullice to estab- lish the fact of suicide. Some have reg-arded it as fully established in leg-al medicine that, when wounds exist at the back of th(! l)ody, it is a positive proof that they have not been self-inflicted. This situation is certainly unusual in cases of suicide; but, as Orlila observes, it is not the situation .^o much as the direction of a wound which here furnishes evidence against the presumption of suicide. A wound traversing- the body from behind to before in a direct, line is not likely to have resulted from a suicidal at- tempt; at least, it must be obvious that it would require more preparation and contrivance on the part of a self-murderer, so as to arrange matters that such a wound should be produced, than we can believe him to possess at the moment of attempting his life. Besides, his object is to destroy himself as (piiekly and as surely as circumstances will permit; he is, there- fore, not likely to adopt complicated and uncertain means for carrying this design into execution. Nevertheless, we must not always expect to find suicidal wounds in what an anatomist would pronounce to be the most appropriate situation to produce instant destruction. An incised wound in a concealed or not easily accessible part is presumptive of murder, be- cause this kind of injury could have resulted only from a deliberate use of the weapon. Suicidal wounds are, however, sometimes found in unusual situations. Thus, tne bloodvessels of the arms or legs may be the seat of injui'y. Abdul Aziz, Sultan of Turkey, was found dead under suspicious circumstances. The arms presented two gashes at the bend of each elbow in front. The direction of both of these wounds was obliciue, from above downwards and from within outwards, and their edges were jagged. That on the left arm penetrated to the joint. The superficial veins and the deep-seated tissues were cut through, and the ulnar artery laid open, but not entirely divided. The wound on the right arm was superficial, in- volving only the skin and the veins. The bleeding from the ulnar artery and veins had led to death. The dress was soaked with ])lood. A pair of scissors stained with blood was found upon the sofa. Although the situa- tion of these v/ounds is unusual, there is nothing in them inconsistent with suicide. The body w'as examined by nineteen physicians, and they agreed in signing a report that the act was suicidal. Unfortunately, they assigned as one of their reasons, "that the direction and vnture of the wounds, as well as the instrument which might have effected them (the scissors), lead to the conclusion of suicide;" whereas, it is perfectly clear from the description that such wounds as these might have been easily produced by an assassin, and that their situation, nature, and direction were very unusual in cases of suicide. In reference to this subject it has been truly remarked that there is no wound which a suicide is capable of inflicting upon himself which may not be produced by a murderer; but i,here are many wounds inflicted by a murderer which, from their situa- tion and other circumstances, a suicide would be incapable of producing on his own person. We cannot always obtain certainty in a question of this kind — the facts will often allow us to speak only with different de- grees of probability. See the case of Elizabeth Gibbons, convicted of the murder of her husband. (See p. 270, post.) The situation of a wound sometimes serves to show whether it is of an accidental nature or not — a point often insisted on in the defence. Acci- dental wounds are generally found on those parts of the body which are EVIDENCE FROM NATURE AND EXTENT. 267 exposed. Some wounds, however, forbid the supposition of accident even when exposed; as deeply-incised wounds of the throat and gunshot wounds of the mouth and temi)le. (For the report of a ease in which an accidental wound on the head by an axe closely simulated a homicidal wound, see Casper's Wochenschrift, May 24, 1845.) 2. Evidence from the Nature and Extent of a Wound — Contused wounds are rarely seen in cases of suicide, because in producing them there is not that certainty of speedily destroying life to which a self- murderer commonly looks. There are, of course, exceptions to this remark ; as where, for instance, a man precipitates himself from a con- siderable height, and is wounded by the fall. Circumstantial evidence will, however, rarely fail to clear up a case of this description. Greater difficulty may exist when life is destroyed by a contused wound volun- tarily inflicted. When persons laboring under insanity or delirium commit suicide, they often inflict upon themselves wounds of an extraordinary kind, such as would at first view lead to a suspicion that they had been produced by the hand of a murderer; and therefore the rules which are here laid down to distinguished homicidal from suicidal wounds must be guardedly applied to cases of this kind. In 1850, a case occurred at Guy's Hospital, in which a patient in a fit of delirium tore away the whole of the abdominal muscles from the lower and forepart of the abdomen. Had the body of this person been found dead with such an unusual and serious personal injury, it is not improbal)le that it would have been pronounced homicidal and not suicidal. In 1876, a French artisan was found dead, with a severe wound in his throat. He had weighted a large knife with heavy stones, and had placed it between two upright planks, on the prin- ciple of the guillotine. He had so placed his neck that when the knife fell by releasing a string it would cause a fatal wound. In the following case, but for the facts being known, an accidental wound in a concealed part of the body might have been pronounced to be homicidal. A girl, set. 15, while jumping on to the knee of her uncle, received a severe wound under the following circumstances. He was holding a stick between his legs, and the girl did not observe it In the act of jumping, this passed up the anus. She withdrew the stick, and though she complained of pain, she amused herself as usual. On the following night acute symptoms set in, and she died in forty-eight hours of peritonitis. A rent was found in the forepart of the rectum which had penetrated the peritoneal cavity. (Brit. Med. Jour., 1874, ii. p. 403.) The body of a man was found in a lane near Rhyl. It appeared that the deceased had stretched himself on his back on the ground, unbuttoned and turned back the lower part of his vest on the left side, and had then thrust the long, thin blade of a pocket-knife into the heart, between the fifth and sixth ribs. The knife was found on his breast close to the wound. The body was warm when found. He had not been disturbed ; there had been no robbery of his person, his hat remained on his head and his gloves in his left hand. He had arrived at Rhyl that afternoon. Everything indicated great deliberation. The extent of a wound, by which we are to understand the number and importance of the parts injured, must in these cases be always taken into consideration. It has been somewhat hastily laid down as a rule that an extensive wound of the throat, involving all the vessels and soft parts of the neck to the spine, could not be self-inflicted. Although, in general, suicidal wounds of this part of the body do not reach far back or involve the vessels of more than one side, yet we find occasionally that all the soft parts are thus completely divided. These are cases in which, perhaps, with a firm hand, there is a most determined purpose of self-destruction. 268 EVIDENCE FROM THE DIRECTION OF A WOUND. In a case of suicido, observed by ]\larc, the weapon bad divided all the muscles of the neck, the windpipe and gullet — had opened the jugular veins and both carotid arteries, and had even grazed the aiiterior ligaments of the spine. A wound so extensive as this is rarely seen in a case of suicide, but there is no ground for the assertion that such extensive wounds in the throat are incompatible with self-detitruction. (See also Ann. d'Hyg., 1872, t. 1, p. 419.) Incised wounds in the throat are generally set down as presumptive of suicide, but murderers sometimes wound this part for the more ettectual concealment of crime. Circumstances connected with the form and direc- tion of a wound may in such cases lead to detection ; for, unless the per- son attacked be asleep or intoxicated, resistance is offered, evidence of Avhich may be obtained by the presence of great irregularity in the wound or the marks of other wounds on the hands and person of the deceased. The peculiar form of a wound on the throat has sometimes led to a justi- fiable suspicion of homicide. In one instance a man was found dead with his throat cut in the manner in which butchers arc accustomed to kill sheep. This led the medical man to believe that the wound had been in- flicted by a butcher. The police, guided by this observation, arrested a butcher, who was subsequently tried and convicted of the murder. In some instances, however, it is extremely difficult to say whether the wound is homicidal or suicidal, the medical facts being equallv explicable on either hypothesis. (See case by Marc, Ann. d'Hyg., 1830, t. 2, p. 408 ; another by Devergie, ibid. 414 ; and a third by Olivier, Ann. d'Hyg., 18.3G, t. 1, p. 394.) Regulai^ity in a wound of the throat has been consid- ered to be presumptive of suicide. This was the publicly-expressed opin- ion of Sir Everard Home in the well-known case of Sellis. The deceased was found lying on a bed, with his throat extensively cut, and the edges of the incision were regular and even. This condition of the wound, it was inferred, repudiated the idea of homicide ; but, as a general principle, this appears to be a fallacious criterion. A murderer, l)y surprising bis victim from behind, by having others at hand to assist him, or by direct- ing his attack against one who is asleep or intoxicated, or who from age or infirmity is incapable of offering resistance, may easily produce a regular and clean incision on the throat. 3. Evidence from the Direction of a Wound. — The direction of a wound has been considered by some to afford presumptive evidence suffi- ciently strong to guide a medical jurist in his inquiry. It has been re- marked that in most suicidal wounds which affect the throat, the direction of the cut is commonly from left to right, either transversely or passing obliquely from above downwards ; in suicidal stabs or punctured wounds the direction is commonly from right to left and from above downwards. In left-handed persons, the direction would, of course, be precisely the re- verse. Suicidal wounds are, however, subject to such variation in extent and direction that it is scarcely possible to generalize with respect to them. Nevertheless, an attention to these points may sometimes be of real assistance to the inquirer, especially when the body has not been removed from its position. It is recommended that the instrument with which the wound has been inflicted should be placed in either hand of the deceased and the arm moved towards the wounded part, so tliat it may be clearly seen whether the direction of the wound could or could not correspond to it in any position. It might happen that neither arm would reach the wounded part, so as to inflict a wound of the particular direction ol)served: this may be tlae case in wounds situated on the back. It is obvious that if a murderer makes an incised wound in the front of the throat from WOUNDS SUICIDE OR ACCIDENT? 269 behind, the direction may be the same as that commonly observed in cases of suicide. (See on this point the case of Reg. v. Dalmas, C. C C, May, 1844.) Again, if the person attacked is powerless, the wound may be deliberately made, so as to simulate a suicidal act; indeed, murderers seldom attack the throat except with the design of simulating an act of Buicide. A homicidal stab may also take the same direction as one which is suicidal, but this wound would be confined to those cases in which the assailant was placed behind or aside. If in front of the person whom he attacks, the direction would probably be from left to right ; but in suicide, when the right hand is commonly used, it is the reverse. 01)li(|ue wounds, passing from above downwards, are common to homicide and suicide, but those which take an oblique course from below upwards are generally indicative of homicide, for it is extremely rare that a person bent on suicide, unless a lunatic, thus uses a weapon. Homicidal incisions, espe- cially in the throat, are often prolonged below and behind the skin forming the angles of a wound, deeply into the soft parts. Those which are suicidal rarely possess this character; they terminate gradually in a sharp angle, and the skin itself is the furthest point wounded ; the weapon is not carried either behind, below, or beneath it. Suicides may graze the ligaments in front of the spinal column, but that they should make deep incisions into the bones, cut oft" hard bony processes, and divide the inter- vertebral substance and the vertebral arteries, is a proposition contrary to all experience and probability. The case of the Earl of Essex, Avho was found dead in the Tower in 1683, bore somewhat on these points. The deceased was discovered with his throat cut, and a razor lying near him. This razor was found to be much notched, while the throat was smoothly and evenly cut from one side to the other and to the vertebral column. Some considered this to have been an act of suicide, others of murder. Those medical witnesses who supported the view of suicide were asked to explain how it was that such an even wound could have been produced by a notched razor. They attempted to account for this by asserting that the deceased had probably drawn the razor backwards and forwards across the neck-bone ; forgetting that before this could have been done by the deceased, all the great vessels of the neck must have been divided. Ex- ceptions to these characters of homicidal and suicidal wounds may exist; but in a dark and intricate subject of this nature we have only limited rules to guide us. The instrument with which a wound is supposed to have been inflicted should be adapted to the edges of the incision, its sharpness compared with the cleanness and evenness of the cut, and its length with the depth of the incision or stab. It is no uncommon occur- rence for a murderer to substitute some instrument, belonging to the de- ceased or another person, for that which he has actually employed ; and this by its size, shape, bluntness. or other peculiarities, may not account for the appearances presented by the wound. It is not often that any difficulty is experienced in distinguishing a suicidal from an accidental wound. When a wound has really been suicidally inflicted, there are generally to be found about it clear indica- tions of design ; and the whole of the circumstances are seldom reconcil- able with the supposition of accident. But if the position of the deceased with respect to surrounding objects has been disturbed ; if the weapon has been removed, and the body carried to a distance ; then it will not always be easy to distinguish a wound accidentally received from one inflicted by a suicide or a murderer. The evidence of those who find the body can alone clear up the case ; and the medical witness may be required to state how far this evidence is consistent with the situation, extent, and direc- 270 WOUNDS SUICIDE OR HOMICIDE? tion of the wound found on the deceased. In the ease of the Uxbridge murder (Reg. v. Elizabeth Gibl)ons, C. C. C, Dec. 1884), the situation and direction of four gunsliot wounds on the deceased man were all- important considerations; and from a careful consideration of these Bowlby was enabled to arrive at a conclusion adverse to suicide, (Brit. Med. Jour., 1885, i. p. 62.) Circumstantial evidence is commonly suffi- cient to show whether a wound has l)een accidentally received or not; but as an accidental wound may sometimes resemble one of homicidal or suicidal origin, so it follows that it is not always possible for a medical jurist to decide the question peremptorily from a mere inspection of the wound. It would not be difficult to produce instances in which murderers have alleged, in defence, that the wounds observed on the bodies of their victims were of accidental origin, and the allegations have been clearly refuted by medical evidence. A witness must be prepared, therefore, in all cases in which death has taken place in secrec}', and the nature of the wound is such as to render its origin doubtful, to be closely examined by counsel for a prisoner charged with felonious homicide, on a question whether the wound might not have been accidental. The law requires that it should be made clear to a jury, before such a charge can be sus- tained, that the fatal wound could not have had an accidental or suicidal origin. The subject of wounds of the neck has been examined in relation to homicide, suicide, and other medico-legal questions, by Giiterbock. (Yierteljahrsschr. f. Gerichtl. Med., 1873, 2,'' p. 1.) Wounds injiicted by the Eight or Left Hand. — Some remarks have been made in reference to the direction of a cut or stab varying according to whether the right or the left hand has been used by a suicide. It is necessary for a medical jurist to be aware that there are many persons who are ambidextr^ous, i. e. who have equal facility in the use of the right and the left hands. This may not be generally known to the friends of the deceased ; and such persons are often pronounced, even by those who have associated with them, to have been right-handed. A want of attention to this point is said to have been one of the circumstances which led to a suspicion of murder in the case of Sellis. (Wills's Circ. Evid., p. 97.) The man was found dead on his bed with his throat cut ; the razor was discovered on the left side of the bed ; whereas, it was generally supposed and asserted that he was right-handed. The truth was, he was equally expert in the use of the razor with his left and right hands ; and thus the apparently suspicious circumstance of the razor being found on his left side was at once explained away. The importance of making due allow- ance for the characters presented by wounds in the throat is also illus- trated by a case which occurred in London in 1865. A publican and his wife had been frequently in the habit of quarrelling. One night the wife gave an alarm, and the man was found dead on the bed, with his throat severely cut. On examination, the fatal wound had all the characters of a left-handed cut, while the deceased was generally believed to be right- handed ; and there was bloody water in a wash-hand basin in the room. The wife, who had marks of bruises upon her, said that she had left her husband in the bedroom for a short time, and on her return found him dead. The suspicious facts were explained at the inquest by a daughter of the deceased by a former marriage. She stated that her father had been brought up as a wood-carver, a trade which requires a man to use both hands equally well ; that he had frequently threatened to destroy himself; and that the blood in the wnsh-hand basin was owing to her havinG: washed her hands after she had touched her father's head. This. SUICIDE OR UOMICIDE? — WEAPONS, HOW HANDLED. 271 satisfactorily explained the medical circumstance which appeared at first to point to an act of homicide. [It sometimes becomes of importance to establish whether right- or left- handedness existed, or whether both hands could be used equally well in handling a weapon, pen, or for other purposes. Dr. J. N. Hall of Denver, one of our best authorities, in treating of this subject says : " The matter has generally been settled by the production of witnesses, who have testified freely in many cases to a given condition, when an equal number of witnesses has been brought forward who have testified to an opposite condition. In many cases the question could be better settled by an examination of the prisoner, if such an examination could be obtained, or of the corpse, in case this became desirable, by a study of the cicatrices npon the hands, such as are inflicted by every man who handles tools of any kind, but especially the pocket-knife. Although most left-handed boys are taught to write with the right hand, I believe the knife is commonly handled with the left hand in such cases by the left-handed, and many tools are used in similar manner in various trades. In women the study could not be expected to be of so much value, and still it has proved to be fairly conclusive in many cases. I should say further, that in the cases of profes- sional and other men, not much given to the handling of tools, cicatrices may not be found, although in America, as long as the Yankee retains his reputation for whittling upon every possible opportunity, they will be present in most cases, and furnish more conclusive testimony than can be given orally. I have found these knife-cuts, as one would expect to find them, upon the radial side and dorsum of the forefinger, upon the ulnar side of the thumb, and to a less extent upon the dorsum, particularly about the knuckle, and in many cases upon the radial side and dorsum of the middle finger. It should be stated that, because of the fact that both hands present scars upon some parts of their surface, a decided preponderance of linear cicatrices upon one side should be necessary to justify a conclusion that implements were constantly used in the other hand, and such a preponder- ance we have found in most of the cases examined. " The proposition that Ave should find, in most cases, scars upon the hand not holding the implement seems so reasonable that it should require but little proof; but, more in order to learn in what proportion of cases we should be able to form an opinion, I have collected the following one hun- dred successive cases, with the assistance of Drs. Will F. Hassenplug and S. D. Hopkins, who have done very careful work in the examination of the fifty cases which they have contributed to my list, many of which cases they have shown to me. In the eases in which the cicatrices greatly predom- inated upon the left hand, generally in a ratio of from four to twelve or fifteen upon this hand to one to four on the right hand, we have simply stated the cases to be right-handed, as they have invariably been, Avhile in case the opposite condition existed, the great majority existing upon the right hand, we have called the persons left-handed, without error, excepting as is hereinafter stated in connection with ambidexterity. "The 100 cases were divided as follows: Males, 88; females, 12. (a) Right-handed, that is, with such a preponderance of scars upon the left hand that no doubt could exist, 78. (6) Left-handed, where the opposite condition existed, 7. (c) Cases without scars enough upon either hand to make a decision possible, 8. (d) Cases in which the comparatively even distribution of the scars between the right and left hands made the question doubtful, and in which it was correctly assumed, nevertheless, that the person had originally been left-handed, and had since tried to use the right hand, 6. (e) Case in which many scars were found upon both hands, aud 272 SUICIDE OR HOMICIDE? — SEVERAL WEAPONS. yet the patient was right-handed (our assumption of left-handedness in this case being erroneous), 1. " Thus, of the 100 patients, we may at once throw out eight who had no marks to guide us ; and one whose scars were equally distributed, who was right-handed, and six similar cases Avho were left-handed, leaving 85 cases in which a positive decision was arrived at, in every case this decision having been correct. Further, of the seven cases in which the scars were nearly evenly distributed between the two hands, and which were presumed to be left-handed, six were actually so, so that the seventh subject in this group was the only one in whose case error really existed. It must be noted further that many men claim to be right-handed who still use the knife with the left hand, which would presumably indicate that such subjects would use a weapon in attacking another person with the left hand, and especially so as, in times of excitement, it is well known that artificial habits give way to those natural to one in his earliest years. In a very large percentage of cases, one may with great certainty affirm that natural right- or left-handedness exists, and in most of the cases presenting scars upon both hands in approximately equal numbers, is safe in stating that the person was probable originally left-handed, but learned to use the right hand only after having inflicted many cuts upon it through the use of the left, or possibly continues to use the left at times. It may prove that, in some occupations, the habitual use of edge-tools in the left hand may call for a modification of these statements." Dr. J. N. Hall also cites approvingly Dr. Catharine F. Hayden, who says that in women the forefinger of the hand in which the needle is not held shows the marks of the needle, although these would wear away in a short time if sewing were suspended, not being true cicatrices. " Dr. J. N. Thomas has also mentioned that he has seen, in the hands of wood-carvers and engravers in which the tool was not held, the scars of pricks made by the implement in question. Obviously the occupation of the person would have an important bearing in this connection."] The Presence of Several Wounds. — In suicides, except in cases of cut- throat, commonly one w^ound only is seen, namely, that which has destroyed life, and the presence of several wounds on the body, or the marks of several attempts around the principal wound, have been consid- ered to furnish presumptive evidence of murder. But any inferences of this kind must be cautiously drawn, since not only may a murderer destroy his victim by one wound, but a suicide may inflict many, or leave the marks of several attempts before he succeeds in his purpose. Ogston, Sr., has pointed out (Lect. on Med. Jurispr., p. 424) that in suicidal cut- throat the principal wound is often associated with small tentative inci- sions, near and parallel to this ; but that in homicidal incised wounds of the throat the tentative cuts, if present, do not preserve the same parallel- ism — obviously because the victim does not remain passive under the attack of his assailant ; and thus the relative positions of the assailant and the assailed are continually changed. Ogston, Jr., describes a case in which a man was supposed to have committed suicide by cutting his throat and chest, finishing by drowning himself. The su[)erficial cuts in this case might easily have gnven rise to a suspicion of murder, had not moral circumstances led the examiner to conclude that the case was one of suicide. (Edin. Med. and Surg. Jour., 1885, i. p. (;89.) The Use of Several Weaimis. — In general, suicides when foiled in a first attempt continue to use the same weapon ; but sometimes, after having made a severe wound in the throat, they will shoot themselves, or adopt some other method of self-destruction. These cases can only appear WOUNDS — EVIDENCE FROM CIRCUMSTANCES. 273 complicated to those who are unacquainted with the facts relative to self- murder. Neither the presence of several wounds by the same kind of weapon, nor of different wounds by different weapons, can be considered of itself to furnish an}- proof of the act having been homicidal. In one instance, a lunatic, in committing suicide, inflicted thirii/ wounds u]Hm his head. In a case of murder, when many wounds are found on a dead body, it may happen that the situation or direction of some will be incompatible with the idea of a suicidal origin. Thus a stal) or cut may be close to a contusion or contused wound, and, although a fall or other accident might account for the latter, the former would indicate violence separately in- flicted. 2'wo or 3Tore BTorlal Woviids. — When we find several wounds on the body of a suicide, it generally happens that only one bears about it a tnortal character, namely, that which has caused death. On this account it has been asserted by some medical jurists that, when two mortal wounds are found upon the body, and particularly if one of them is of a stunning or stupefying tendency (^. e. affecting the head), they must be considered incompatible with suicide. An inference of this kind can be applied to tho.se cases only in which the two wounds, existing on different parts of the body, were likely to prove immediately fatal. It must, however, be borne in mind that all suicides do not immediately perish from wounds which are commonly termed mortal; on the contrary, they have often the power to perform acts of volition and locomotion, which might by some be deemed wholly incompatible with their condition. It is difficult to say whether one wound is likely to destroy life so rapidly as to render it im- possible for the person to have inflicted another upon himself; but when there are several distinct incisions on the throat, each involving important bloodvessels, there is good reason to infer that they have resulted from an act of murder Wounds produced simultaneously or at different times. — When several wounds are found on a dead body, the question is frequently asked, Which was first received ? If one is what is commonly termed mortal, and the others not, it is probable that the latter were first inflicted. This remark applies both to cases of homicide and suicide ; but it is apparent that when, in a murderous assault, a person has been attacked by several assailants at once, the wounds may have been simultaneously produced. This is, how- ever, a question to which it is not easy to give a specific answer. Each case must be decided from the special circumstances attending it ; and in most instances, unless some direct evidence is forthcoming, a medical opinion can be little more than conjectural. It is a question almost always put in a court of law ; and a witness should at least prepare himself to meet it by a proper examination of the medical circumstances of the case. CHAPTER XXVI. EVIDENCE FROM CIRCCM.STANCES. THE POSITION OF THE BODY. OF THE WEAPON.— EVIDENCE FROM BLOOD, HAIR, AND OTHER SUBSTANCES ON WEAPONS. MARKS OP BLOOD ON CLOTHING AND FORNITDRE, ON THE DECEASED, AND ON THE ASSAILANT. Evidence from Circumstances. — In pursuing the examination of the question respecting the homicidal or suicidal origin of wounds, the atten- tion of the reader may be called to the force of evidence which is sometimes 18 274 EVIDENCE FROM CI RCUiM STANCES. derived from the circumstances under wijich trie body of a person, dead from wounds, is discovered. It may be said that tiiis is a subject wholly foreign to the duties of a medical jurist, but we cannot agree to this state- ment. There are few in the profession who, when summoned to aid justice, by their science, in the detection of crime, do not seek for circum- stances by which to support the medical evidence required of them, A practitioner would certainly be wrong to base his ])rofessional opinion on these circumstances, but it is scarcely possible for him to avoid drawing an inference from them as they fall under his ol)servation. Care must be taken that this inference is not overstrained. The medical evidence may be of itself weak and insufficient to support a charge against the accused ; in such a case, if any suspicious circumstances have come to his knowl- edge, the witness may be often uncon.sciously induced to attach greater importance to the medical fticts than he is justified in doing. In short, he may, through a feeling of prejudice, which it is not always easy to avoid, give an undue force to the medical evidence. But if a proper degree of caution is used in drawing inferences, and the circumstances are not allowed to create a prejudice in his mind against the accused, a medical man is bound to observe and record them ; for, being commonly the first person called to the deceased, many facts capable of throwing an im- portant light on the cause of death would remain unnoticed or unknown but for his attention to them. The position of a dead body, the sudden- ness of death, the discovery of a deadly poison, the distance at which a knife or pistol is found, the position of the instrument — whether situated to the right or left of the deceased — the marks of blood or wounds about the per- son, or of blood on the clothes or furniture of the apartment, are facts which must assist materially in developing the real nature of a case, and in giving force to a medical opinion. Many of these circumstances can fall under the notice of him only who is first called to the deceased ; and, indeed, if observed by another, no advantage could be taken of them, ex- cept from the interpretation of a medical man. At the same time a person may have died suddenly and a weapon or poison be found near the body, and yet the death may have taken place from natural causes. Due allowance must be made for coincidences of this kind. The purchase and possession of a deadly poison shortly before a sudden death may create suspicion, but an analysis may show that there is no poison in the body, and, further, that the post-mortem appearances are consistent with natural disease, and, unless treated as exceptional in char- acter, they are not consistent with death from poison. A woman was found dead under very suspicious circumstances. Within half an hour of her death she had sent a boy to a shop to purchase a packet of Battle's vermin-killer (strychnine). He gave it to her and left the house. When he returned at the time mentioned, he found her leaning on the table, speechless and motionless. She was then dead. There was no rigidity and no evidence of convulsions. Some fluid was found in the stomach, but in this there was no strychnine, and none of the blue coloring matter which had been sold with the powder. No trace of the powder could be found on the premises, and no cup, glass, or vessel in Avhich the poison might have been mixed, could be seen. (Med. Times and Gaz., 1865, i. p. 34.) The absence of any characteristic symptoms, and the non- detection of the poison and its coloring ingredient under the circum- stances, negatived the suspicion of poisoning. The purchase, possession, and the non-discovery of the purchased packet after the death of the woman, were circumstances which created suspicion, but nothing more. The state of the lungs and heart was sufficient to account for sudden death. POSITION OF THE BODY. 275 Among the questions which present themselves on these occasions are the following: Is the position of a wounded body that which a suicide could have assumed? Is the distance of a weapon from the body such as to render it improbable that it could have been placed there by the deceased? In answering either of these questions, it is necessary to take into con- sideration the extent of the wound, and the time at which it probably proved fatal. Again, it may be inquired, Has the deceased bled in more places than one ? Are the streams of blood all connected ? Are there any marks of blood on his person or clothes which he could not well have produced himself? Are there any projecting nails, or other articles, which might account for wounds on the body as the result of accident? These are questions, the answers to which may materially affect the case : hence, a practitioner, in noticing and recording the circumstances involved in them, ought to exercise due caution. The rules for investigating a case of alleged death from violence have been elsewhere described (p. 21, ante). Among the additional circum- stances to which a medical witness should specially direct his attention on these occasions are the following: — 1. The Position of the Body. — 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 suicidal. The position of a dead wounded body is often only compatible with homicidal interference, either at the time of death or immediately afterwards. In order to deter- mine the probable time of death, we should always notice whether there is any warmth about the body — whether it is rigid, or in a state of decom- position, and to what degree this may have advanced. 2. The Position of the Weapon. — If a person has died from an acci- dental or self-inflicted wound, likely to cause death, either immediately or within a few minutes, the weapon is commonly found either near to the body or within a short distance of it. If found near, it is proper to notice on which side of the body it is lying; if at a short distance, we must con- sider whether it might have fallen to the spot, or have been thrown or placed there by the deceased. If there has been any interference with the body, evidence from the relative position of it and the weapon will be inadmissible. In a case which was referred to the author some years since, a woman had evidently died from a severe wound in the throat, which was homicidally inflicted ; the weapon, a razor, was found under the left shoulder, a most unusual situation, but which, it appears, it had taken owing to the body having been carelessly turned over before it was seen by the surgeon who was first called. It is compatible with suicide that a weapon may be found at some dis- tance, or in a concealed situation ; but it is much more frequently either grasped in the hand, or lying by the side of the deceased. In one instance it is stated the deceased was discovered in bed with his throat cut, the razor being closed or shut by his side. In another case, the bloody razor, closed, was found in the deceased's pocket. There is, however, one cir- cumstance in relation to the weapon which is strongly confirmatory of suicide. If the instrument is firmly grasped in the hand of the deceased, no better circumstantial evidence of suicide can be offered. It is so com- mon to find knives, razors, and pistols grasped in the hands of suicides, that it is quite unnecessary to produce cases illustrative of this statement. The grasping of a weapon appears to be owing to muscular spasm per- sisting after death, and manifesting itself under the form of what has been called cadaveric spasm — a condition, in the opinion of the author, quite distinct from rigidity, although, often running into it (see pp.69, 70, ante). 276 BLOOD AND HAIR ON WEAPONS. It does not seem possible that any murderer could imitate this state, since the relaxed hand of a dead i)ers()n cannot Ik; niiide to firasp or retain a weapon, like the hand which has firmly held it hy powerful muscular con- traction at the last moment of life. Experiments performed by Ilofmann (M^d. Leii'., trad. dar. Brouardel, p. 001) completely confirm this statement. By a variety of artificial con- trivances — the use of ligatures, etc. — attempts were made to cause the hand of a recenth^ dead body to hold a weapon firmly as if by a vol- untary contraction of the muscles durinti' life ; but these attempts utterly failed to produce any such results. Allhou.i^h the fingers were kept com- plelelv closed on the object, it was simply held, and not grasped, fnlling from the hand immediately on the release of the pressure. In reference to the weapon being found at a distance from the body, all the circumstances of the case should be taken into consideration before any opinion is expressed. If the weapon cannot be discovered, or it is found concealed in a distant place, this is strongly presumptive of homi- cide, provided the wound is of such a nature as to prove speedily fatal. If found near the body, it will be well to notice whether the weapon is sharp or blunt, straight or bent, also whether the edge is or is not notched. These circumstances may throw a light on the question of suicide or murder. 3. Blood on Weapons. — The weapon with which a wound has been inflicted is not necessarily covered Avith blood. The popular view is, that if niiieh blood is found about a dead body the weapon ought always to be more or less bloody. In reference to heavy, blunt instruments applied with force to the head, severe contusions and fractures ma}' be produced without immediate effusion of blood. Unless the bludgeon is used in a subsequent struggle, or handled by a bloody hand, no blood whatever may be found on the end which produced the injuries. In relerence to stabs, the knife is frequently without any stains of blood u])on it, or there is only a slight film, which, on drying, gives to the surface a yellowish- brown color. The explanation of these facts appears to be that in a rapid blow or plunge the vessels are compressed, so that bleeding takes place only after the sudden withdrawal, when the pressure is removed. Even if blood should be effused, the weapon, in being withdrawn, is sometimes cleanly wiped against the edges of the wound, owing to the elasticity of the skin. Thus the first stab through the dress may not present any appearance of blood on the outside, but in a second stab, with the same weapon, the outside of the dress should present a bloody mark, unless the weapon had previously been wiped (p. 262). The blood may have been removed by washing from the blade of a knife or dagger; hence the handle and inner portions, the dirt accumulated between the handle and blade, the notch for opening the blade, and the indentations of any letters stamped upon it,^shouid be closely examined with the microscope. The blood on a weapon may be" wet or dry, in a partly coagulated state, or diffused as a mere yellowish-red film. If coagulated, this would render it probable that the blood had issued from the body of a living person or animal, or from a body recently dead But the blood of a dead animal dried in small spots on the blade of a knife may sometimes present a similar appearance, and thus lead to a mistake in evidence. 4. Hair and other Substances on Weapons. — In some instances no blood may exist on a weapon, but a few hairs or fibres may be found adhering to it if the weapon is of a bruising or cutting kind. The main questions may be, in such a case, whether the hair is that of a human being or of an animal, and whether the fibres correspond in their nature, MARKS OF BLOOD ON CLOTHING OR FURNITURE. 2l I form, and color to articles of dress on the deceased or the accused. Be- fore any coa,i>ulat('d blood is removed from a weapon, it should bo exam- ined carefully with a powerful lens. Hairs or fibres of linen, woollen, silk, or cotton may be found imbedded in the solidified blood, either on the edge or on the blade ; and evidence of this kind may occasionally be of great importance. In a case of murder by manual strangulation, so much violence had been employed by pressure with the fingers that not only was a quantity of blood effused, but portions of cuticle with the fine downy hairs of the neck of deceased had been removed. The blood with the abraded cuticle and some hairs were found upon a towel which was traced to the assailant. (Viertoljahrsschr f. Gerichtl. Med., 1873, 2, p. 112.) On a trial for murder in Ireland in 18*17, it was proved that there were hairs firmly clenched in the hands of the deceased ; and when these were compared with a like number of the prisoner's hair, they were found to correspond. Foreign substances are sometimes found in contused and lacerated wounds, which may throw a light on the mode in which they w^ere in- flicted. In gunshot wounds it is not unusual to find portions of paper or other substances used as wadding for the gun or pistol. The preservation of articles of this description, or portions of the projectiles found under these circumstances, has proved a means of fixing the crime upon the guilty person. When a gun or pistol is discharged near to the body, a portion of the wadding is generally carried into the large irregular wound produced. In a case of stabbing, a portion of the weapon may be found in the wound. 5. Marks of Blood on Clothing or Furniture. — It is proper to notice all marks of blood on the clothes of the deceased or in the apartment, and to observe Avhere the greatest quantity of blood has been effused ; this is generally found on the spot where the deceased has died. The deceased may have bled in more places than one; if so, it should be noticed whether there is any communication in blood between these different places. Blood on distant clothes or furniture may show whether the deceased has moved about, and whether he has struggled much after receiving the fatal wound. Acts of locomotion by a wounded person who has died from the loss of blood, or by a criminal whose hands and feet are bloody, are generally indicated by tracks or marks of blood. (Reg. v. Garry, Lincoln Spring Ass., 1883.) The observation of these marks, if made at the time that a dead body is found, is of great importance. They may be so situated as to show that the body of the deceased has been moved or been interfered with after death, and thus throw a light upon the question whether the act has been one of homicide or of suicide. In reference to clothing, it is advisable, if it be possible, to have some clear proof that the clothes sent for examination were actually worn by the accused or belonged to the deceased. Serious mistakes are sometimes made, and medical opinions should therefore be expressed with caution. It should be noticed on these occasions whether the blood is deposited in large patches on clothing, or whether it is sprinkled, and also whether it is in large or small quantity. The sprinkling may have proceeded from a wounded artery, or from a splashing of blood as a result of continued violence. It should likewise be observed whether, if the wound is in the throat or chest, blood has flowed down in front of the clothes or person, or w^hether it has flowed so as to collect in the armpits or on each side of the neck ; for these appear- ances will sometimes show that the wound was inflicted when the person was standing, sitting, or lying down. If the throat is cut while the person is lying down, it is obvious that the blood will be found chiefly on one or 278 MARKS OF BLOOD ON THE DEAD BODY. other side of the neck, and not extending down tlic front of the body. Few suicides cut the throat while in a recumbent posture, and the course which the blood has taken nia}", therefore, be sometimes rendered subser- vient to the distinction of a homicidal from a suicidal wound. The posi- tion in which the body was when a wound was inflicted is a frequent question at inquests and criminal trials. When spots of blood are found upon articles of dress or furniture, their form and direction may occasionally serve to furnish an indication of the position of the wounded person with respect to them. Thus, if the form of a spot is oval and elong-ated, the presumption is that the person was placed obliquely with respect to the stained furniture during- the haimorrhage. (Ann. d'Hyg., 1840, p. 397.) The force with which the blood has been thrown out will be in some measure indicated by the deg-ree of obliquity and leni>:th of the spot. This is in general wide and rounded at the upper part, but narrow and ])ointed below. 6. Marks of Blood or Violence on the Dead Dodij. — In examining a dead body, attention should be paid to the state of the mouth and throat. Assailants who make their attack during sleep sometimes endeavor to close the mouth or to compress the throat, so as to prevent an alarm being- given. In one instance there were the marks of finger-nails around the mouth ; in another, ecchymosed impressions, as if produced by a hand, were found upon the throat of the deceased. The handti of a dead person should always be examined; many recent cuts, excoriations, or incisions found upon them, esspecially if on the back of the fingers or thuml)s, will indicate that there has been a mortal struggle with the assailant. In the inspection, the examination of the stomach should not be omitted. The l^resence or absence of food, mucuS; or blood, may furnish evidence of con- siderable importance in the elucidation of the case. All marks or stains of blood or dirt on a dead body require special observation. The impres- sion of a hand or of some of the fingers may be found on the skin in a situation where it would have been improbable or impossible for the deceased to have produced it, even supposing that one or both of his hands were covered with blood. In one case of murder there was found the blood}' impression of a left hand upon the back of the left hand of the deceased, in such a position that it was quite impossible the deceased him- self could have made the mark. In all cases it should be noticed whether the inside or outside of the hand, or Avhcther one or both hands are stained with blood, and the size and position of the stains should be descriljed. Marks of blood on the dress of a wounded person or a dead body may often furnish important circumstantial evidence. If there are several stabs or cuts on the bod}^ involving the dress, it should be observed whether the edges of one or more of them are stained with blood, as if from the wiping of a Aveapon, and whether the stain is on the outside or inside of the article of dress. In simulated personal injuries, the stain of blood may be, through inadvertence, applied to the outside of the dress — a fact Avhich mic-ht, in some instances, lead to the detection of the imposture. (See case Ann. d'Hyg., 184T, t. 2, p. 219.) 7. Marts of Blood on the Assailant. — It is a very common idea that no person can commit murder in which blood is effused, without having bis person and clothes more or less covered with blood. >'othing can be more erroneous. On several occasions we have been recjuired to examine articles of clothing which have been worn by persons subsequently con- victed of murder by wounding, and either no blood has been found on any part of the dress, 'or only small spots wholly out of jiroportion to the quantity of blood which most have flowed from the deceased. (Reg. v. MARKS OF BLOOD ON THE ASSAILANT. 279 Harrington, Chelmsford Ass., 18r)2; Rog. v. Flack, Ipswich Ass., 1853; Reg. 17. Cass, Carlisle Ass., 18G0; Reg. v. Rowlands, Beaumaris Ass._, 18G1 ; Reg. u. Edmonds, Swansea Ass., 18G2 ; Reg. v. Garry, Lincoln Spring Ass., 1883 ; Reg. v. Slirimpton, Worcester Ass., May, f885 ; Reg. V. Goodale, Norwich Ass., Nov. 1885.) In the case of Gardner (C. C. C, 1862), in which there had been a large elTusion of blood from a severe wound in the throat, no blood-stains were found on the clotliing of the man who was convicted of the murder. Policemen are frequently mis- led in searching for criminals by looking for blood on clotliing, as a necessary accompaniment of an act of murder. This also leads them to magnify stains of red paint, iron rust, and fruit-stains on the dress of an accused person into marks of blood. (Reg. v. Moore, Maidstone Sum. Ass., 1872.) It is obvious that the throat of a person while standing, sitting, or kneeling, may be cut by a murderer from behind, and thus in appearance simulate suicide. Under these circumstances the clothes of the assasin would escape being stained with blood. The flowing or spurting of blood upon the clothes of the assailant will depend upon his position in relation to the deceased at the time of inflicting the wound, and this must always be a matter of pure speculation. In entire violation of this simple princi- ple, the fact of a prisoner's clothes not being marked with blood has been on more than one occasion urged as a proof of his innocence. (Reg. v. Dnhnas, C. C. C, June, 1844.) In this case the counsel for the prisoner wished to impress the jury that no person could cut the thmat of another without having his clothes covered w^ith blood ; and as there was not proved to be any blood on his clothes, the prisoner could not have been guilty of the crime. The facts were simply that the throat of the woman was cut while she was walking across Battersea Bridge, the prisoner having inflicted the wound from behind. Another circumstance to be noticed is that the accused may have had time to change his clothes in spite of the supposed vigilance of the police. This has occurred in several trials for murder. (Reg. v. Heath, Bucks Lent Ass., 1854; Reg. v. Cass, Cumberland Ass., 1860.) In one case the trousers taken from the prisoner soon after the murder presented no marks of blood ; but the trousers actually worn by him Avere found with blood upon them pending the trial. In other instances, the prisoner may have had time to remove any stains by washing. (Reg. v. Goodale, Nor- wich Ass., Nov. 1885.) Owing to this erroneous assumption that where much blood has been lost by the deceased, the assassin's clothes could not have escaped being " deluged" with blood, juries have been led to return verdicts of acquittal in cases in v^hich, although no blood-stains were found, the circumstances proved were consistent only with the theory of murder. On the trial of Sul)-Inspector Montgomery for the murder of Mr. Glasse (Omagh Ass., July, 1813), the absence of blood-stains on the clothing of the prisoner was alleged to be a strong proof of his innocence of the crime. In this case the contused wounds on the head of the de- ceased were produced by a bill-hook. There was blood on the floor around the body, but much of this had, no doubt, flowed from the wounds after death. The wounds w^ere not likely to have been attended with a great spurting of blcod or any copious effusion at the time of their infliction, yet it was assumed that such murder could not have been perpetrated without the clothes of the assassin being "covered" with blood. As the evidence against the accused was entirely circumstantial, much stress was laid upon the state of the clothes as a proof of his innocence. The 280 NO MARKS OF BLOOD FOUND OX THE ASSAILANT. prisoner had been previou.-;ly tried twice for the crime, and tlie juries were not able to ag-ree, chiefly owinu: to the fact that there was no blood upon his clothes. On the third trial he was convicted, and the conviction was immediately afterwards justified by an admission of his guilt. He idmitted that he had removed the blood-stains from his clothes with cold water sotm after the perpetration of the crime. A case like this is surely .sudieient to show the dang-er of trusting to such a fallacious criterion as a \)r()of of innoe(,'nce. The counsel who defended Courvoisier for the murder of Lord William Russell (Keg. v. Courvoisier, C. C. C, 1840) contended, in the strongest terms, that the; accused could not have perpetrated the crime because there Were no marks of blood on any of his clothes, and no bloody weapon was (ound in his possession or in the house. As all the vessels of the throat of the deceased had been cut to the vertebral column while he was lying- asleep, it was alleged to be impossible that the assassin could have escaped from the spurting of blood from the large vessels. After his conviction, the prisoner admitted that when he committed the murder at night he wore no clothes, but was in a state of nudity, and that all he did was to wash his hands. The weapon which he employed was the carving-knife of the hou.se ; this he washed and returned to the tray with the other knives. A similar defence was raised in Reg. v. Thom])son (Durham Wint. Ass., 180.3), in which the prisoner was charged with the murder of his wife, by cutting her throat with a razor. According to the medical evidence, the wound in the woman's throat was five inches in length, and in a direction from left to right, extending from the angle of the left jaw to an inch behind the right ear, dividing all the bloodvessels and nerves of the throat. The medical witness properly stated that such a wound could not have been self-inflicted. It proved rapidly fatal. No razor or other weapon that could have produced the wound was found near the body. The prisoner stated that the wounds had been produced on herself by deceased during a struggle. No blood was found on the prisoner's clothing, and on this fact the counsel for the defence mainly relied to show that this was not an act of murder, but of self-destruction. The man was convicted, and the case here quoted proved that the defence was based on a pure fallacy. (Times of Dec. 11, 1873.) The presence of spots of blood on articles of clothing, knives, etc., taken from the persons of those who are accused of murder, may be quite con- sistent with innocence. Small spots or stains have often an undue im- portance attached to them. We have known minute sjiots of blood on the shirt of a man tried for murder by wounding regarded as furnishing proof of criminality, until it was explained that they were probaljly derived frou) flea-bites, and that some were on one side and some on the other side, showing that the shirt had been worn on the two sides. The coarse cloth- ing worn by laborers may acquire blood-spots from a variety of accidental circumstances, which the accused may not always be able to explain. When he knows the stains are there, and manifests great anxiety to give some explanation of their presence, as by falsely stating that he had assisted in killing a pig, a rabbit, or that he was carrying game about him, there may be strong ground for sus])icion ; but a medical practitioner should always make due allowance for tlie accidental })resence of blood on the clothes of working men. In a case of suicide, in 1872, by cutting the throat, the son, who first discovered his father lying dead, imagined that he had broken a blood- vessel. The son lifted up the body, and then went for assi-stance. In this way his hands and clothes became bloody. At the inquest he was closely BLOOD-STAINS — CHEMICAL ANALYSIS. 281 questioned on this point. There could not be the least doubt that the act was one of suicide, and that the clothes of the son had become accidentally covered with blood iu the manner iu which he had stated. CHAPTER XXYII. EXAMINATION OF BLOOD-STAINS. CHEMICAL ANALYSIS. SPECTROSCOPIC EXAMINATION. BLOOD- CRYSTALS. MICROSCOPICAL EVIDENCE. BLOOD OF MAN AND ANIMALS. STA1N9 OF BLOOD ON LINEN AND OTHER STUFFS. AGE OR DATE OF THE STAINS. OTHER STAINS RESEMBLING BLOOD. BLOOD ON WEAPONS. ARTERIAL AND VENOUS BLOOD.— VARIETIES OF BLOOD. Examination of Blood-stains. — It may appear at first sight an easy matter to say whether certain suspected spots or stains on articles of clothing, furniture, or weapons are or are not owing to blood ; but in practice great difficulty is often experienced in answering the question. If the stains are large and recent, most persons may be able to form an opinion ; but the physical characters of blood are soon changed, even when the stuff is white and otherwise favorable for an examination. If the stains, whether recent or of old standing, are upon dark-dyed woollen stuffs, as blue, black, or brown cloth, or if they appear in the form of small or detached spots, or in thin films on dark clothing or rusty weapons, no one but a competent medical man should be allowed to give an opinion. Chemical Analysis. — There is no direct chemical process by which blood can be identified, but we presumptively establish its nature by de- termining the presence and properties of the red coloring matter, or haemo- globin. The chemical properties of the red coloring matter of blood are as follows : 1. It readily dissolves in cold water, forming, if recent, a bright-red solution, 2. The red color of this solution is not changed to a crimson or a green tint by a few drops of a weak solution of ammo7iia. If the ammonia be concentrated, or added in large quantity, the red liquid will acquire a brownish tint. 3. The red liquid when boiled is coagulated — the color is entirely destroyed, and a muddy-brown fiocculent precipi- tate is formed, the quantity of which will depend on the quantities of col- oring matter and of albumen present. The red coloring matter of blood is always more or less mixed with albumen, and it is this substance which gives to a dried blood-stain on linen or cloth a well-marked stiffness, and a glossy surface. Stains from cochineal and the red colors of wine, flow- ers, and fruit, are dull, and do not cause any stiffening of the fibre of the stained stuff, nor any appearance under the microscope at all resembling a dried coagulum of blood. 4. A solution of the red coloring matter of blood in water produces, with freshly-made tincture of guaiacum, a red- dish-white precipitate of the resin. On adding to this an ethereal solution of peroxide of hydrogen a beautiful l:)lue color is more or less rapidly brought out. If a sufficient quantity of alcohol or ether be added the pre- cipitate will be dissolved, and a deep sapphire-blue solution will result. Cochineal and other red coloring matters, when thus treated, give a red- dish color to the resin of the tincture of guaiacum, and undergo no change on the addition of peroxide of hydrogen. They are thus well marked and distinguished from the red color of blood. Whether the blood is new or old, whether concentrated or much diluted, this test produces the blue 282 SPECTROSCOPIC EXAMINATION. coloration. It produces the chanire bettor in n diluted than in a concen- trated state. A drop of blood dillusiHl through six ounces of water may be thus detected in one or two drachms of the mixture. It is to be noted that the blue color is produced by blood-pigment only with the mixture ol guaiacum and peroxide of hydrogen ; the production of a blue color with guaiacum alone is valueless as a test for blood. In all cases it must first be ascertained that tincture of guaiacum alone, is not colored, and then that it becomes colored on the subsequent addition of peroxide of hydrogen. Tincture of guaiacum is colored blue by milk, pus, saliva, and ijy many mineral compounds. Such arc the chemicnl jjroperties of Ijlood, whether taken from the hunuin body or from that of any warm red-blooded aninuil (Manunalia). Of the various red coloring-matters extracted from vegetalHe and animal .substances there are none which to the experienced eye present the pecu- liar crin)son-red tint of blood, especially when the substance is examined in a good light with a low power of the microscope. When solutions of these red coloring-matters are treated with ammonia, some, such as coch- ineal, logwood, and the colors of roots and woods, acquire a deep crimson tint ; while others, such as the coloring-matter of the rose, and the red colors of flowers and fruits, are changed to a blue or green. The red colors are not destroyed by a boiling temperature, and, even when mixed with albumen, this substance is simply coagulated, while the red coloring-matter remains unchanged. In the case of blood, the effect of heat is to destroy the color entirely. When these pigments are found upon linen' and similar stuffs, they present under the microscope the ap- pearance of a uniform stain or dye, unlike blood in color There is no glossy coagulum to be seen, and the stained stuff" is not stiffened as it is by the serum of dried l)lood. Spectral Analysis. — Spectral analysis applied to blood has been made the subject of evidence on various trials for murder. The great advantage of this optical method is that it admits of the examination of blood with- out in any way interfering with the subsequent application of the chemical tests already described. We simply anal3^ze the light as it traverses a clear solution of the red coloring matter, and, with a proper spectral eye- piece attached to a microscope, we notice whether the colored spectrum has undergone any change. If the red liquid owes its color to recent or oxidized blood, two dark absorption-bands will be seen breaking the con- tinuity of the colored spectrum. These are situated respectively near the junction of the yellow with the green, and in the middle of the green. If the blood is quite recent and of a bright-red color (oxyhaemoglobin), the two absorption-bands are distinct and well defined. A good light, either artificial or daylight, is required; the colored liquid should be clear and of sufficient intensity, and the spectral apparatus properly adjusted. The blood sufficiently diluted should be placed in a glass tulte for the purpose of examination. The spectral eye-piece allows of two of these tubes being- examined at once, and it is desirable to have a specimen of blood mounted, for comparing the actual spectrum of blood with that of the suspected liquid. The results are the same with the red blood of all animals. In the course of an hour in warm weather, and after a day or two in cold weather, the blood in the tube undergoes a remarkable change. It loses its scarlet, and acquires a purple color (reduced haemoglobin). In passing to this state it has become deoxidized, and the coloring matter is now called deoxidized haemoglobin. A small quantity of sulphide of ammonium — or an ammoniacal solution of ferrous tartrate, made by dis- solving ferrous sulphate in water, adding a sufficiency of tartrate of potas- SPECTROSCOPIC EXAMINATION. 283 sium, and then makinti;- alkaline with ammonia (Stokes's solution) — added to red blood, will produce the same effect more rapidly. In this state the two bands appear blended, and one broad, dark absorption-band is seen nearly in the same situation. That the blood is really deo.xidized is proved by the fact that on adding to that which has spontaneously changed from red to purple a few drops of peroxide of hydrogen, the blood is re-oxidized, and again aecpiires its red color, with the manifestation of the two absorption-bands. The same result takes place if the purple blood is put into a wider tube and well shaken with air. The presence of two bands, with this power of conversion and reconversion by deoxidizing and oxidizing agents, is characteristic of red blood. Blood which has been kept shows one or more bands in the red, due to a new body, methsema- glohin. When the blood, by long exposure to the air, has undergone chemical changes, it ceases to give any well-defined absorption-bands. If a solu- tion containing haemoglobin is acidified with a vegetable acid, the pigment is destroyed, a hoematin, a brown-red pigment, is produced. The same change is efiected by prolonged exposure to air. If the acid solution of hjematin be made alkaline with ammonia, and Stokes's solution (p. 283) be added, two fine dark bands of haemochromogen (reduced hsematin) make their appearance. These are more towards the blue end of the spectrum than the two bands of ox^^htemoglobin. A recent blood-stain, howevei' minute, may be made to yield successively the bands of oxyhajmoglobin, of reduced htemoglobin, and of haemochromogen. There can be no doubt that, in the hands of a competent person, and one skilled in micro-spectral observations, this optical method will enable him to discover the minutest trace of blood, provided any red coloring matter remains. Thus Sorby states that a spot of blood only one-tenth of an inch in diameter, or a quantity of the red coloring matter amount- ing to no more than the 1000th part of a grain, was sufficient to give con- clusive evidence of its presence by spectral analysis. J. G. Richardson states that by a still more delicate process he has been able to detect the 3000th part of a grain of blood on an axe-handle supposed to have been used in a case of murder. Sorby detected blood in the form of deoxidized haematin on the rusty blade of a knife with which a murder was com- mitted in 1862, after the lapse of ten years. Blood-stains which have been washed in water, and blood which has been even boiled or heated to 212° F., may be thus detected. In the latter case ammonia, with the aid of a gentle heat, should be employed to dissolve the matters rendered insoluble by boiling. Spectral analysis does not enable us to make any distinction beyond that of recent and old blood, and this distinction cannot be so drawn as to enable us to fix a specific or even an approximate date. Cer- tain accidental conditions may rapidly produce on blood the same effect as exposure to air for a long period of time. It indicates no distinction in the blood of the sexes, of the foetus and adult, or in the blood of man and animals. As a corroborative process it furnishes most valuable and trust- worthy evidence, and there is no case in which blood admits of a chemical examination in which spectral analysis does not admit of application be- fore the chemical tests are employed. In a case of alleged murder, which was the subject of investigation in 1866, some faint reddish-colored stains on grey woollen cloth, visible only in a strong light, were suspected to have been caused by blood. Other stains on an overcoat worn by the accused person were also attributed to blood. Sorby examined some of the stains by the optical process, and he obtained a distinct spectrum characteristic of blood. The author exam- 284 II yE M I N - C R Y S T A L S — JI ICROSCOPICAL EVIDENCE. Fig. 41. Blood-crystals as obtained from human blood. inod microscopically and chemicall}' other stained portions of the gray woollen cloth, and came to the same conclusion as Sorby, namely, that the faint reddish-colored stains had been caused by blood. The processes, althoug-h widely different, agreed in the results, and it may be mentioned that, from the fact of the blood-stains having been wetted and sponged, a more difficult case for investigation could hardly have presented itself. The methods of examination also agreed in the result that some suspected stains or marks on the overcoat were not cau.sed by blood. The date of a blood-stain cannot, however, be determined with any certainty by this process, unless the conditions under which it has been kept are known ; and it is not possible to distinguish by it animal from human blood. (See Sorbv, Quart. Jour, of Sci., April, 1865, p. 205 ; Pop. Sci. Rev., Jan. 18G6, p. 66.) Haeniin- Crystals. — Another process for the detection of blood consists in the pro- duction of microscopic crystals of heeinin (hydrochlorate of hajmatin). These crys- tals may be produced by evaporating to dryness a fragment of blood-clot with an excess of glacial acetic acid and a trace of chloride of sodium. More acetic acid is then added, and the evaporation re- peated, but more slowly. The residue is examined under the microscope, with a power of 300 to 500 diameters. Crystals like those seen in Fig. 41 are observed. Microscopical Evidence. Blood Co7-puscles. — Hitherto the micrcscope has been referred to as an aid to the examiner in drawing a distinction between the appearances presented by blood-stains in the dry state, and those caused by other substances. Its use, however, extends much beyond this. The spots or stains may be so small as not to admit of removal for the purpose of applying chemical tests. If an examination of the dry stain with a low power (20 or 30 diameters) justifies further proceedings, we may then employ the microscope for the purpose of de- tecting those peculiar bodies on which the color of red blood is known to depend. The red coloring matter of blood consists of minute colored cor- puscles, floating in a clear li(|uid (serum). The engraving (Fig. 42, p. 284) shows the form which the corpuscle presents in the class Mammalia. a represents the circular form when seen in front, the shaded portion being a depression, which, under a certain disposition of the light, assumes the appearance of a solid and opaque nucleus; b represents the corpuscle seen edgewise, in which case it presents somewhat the outline of a biconcave leus. It owes this form to the central depression on each face. Other red coloring matters, such as madder, cochineal, or lac, do not owe their color to independent cells or corpuscles. Hence, if corpuscles, of the form and size of those found in mammalian blood, are visible under the microscope, there can be no doubt that the liquid is blood. Such evidence can, however, be safely re- ceived only from one who has been accustomed to the use of this instrument and to the examination of blood. In order to examine the suspected substance for corpuscles, the l)est plan of proceeding, when the particles of coagulum are very small, is to breathe several times on a glass Fig. 42. Blood-corpuscle, highly magnitied. MICROSCOnCAL EVIDENCE. 285 slide, then place the small fragments of coagulum on the slide, and again breathe over them. A thin cover-glass may then be laid upon them. If they consist of blood, a red margin u'ill soon appear, and in the fluid por- tion, by the aid of a magnifying power of from oUO to 500 diameters, some of the corpuscles of the blood may be recognized. They are seldom so perfectly spherical as in the fresh state, and they appear small, and fre- quently shrunk or corrugated. In some cases onl}^ fragments of the en- velopes can be seen. The condensed moisture of the breath may serve the purpose of water in breaking up the small portions of dried blood without destroying the corpuscles by too much dilution, but in general the addition of a small quantity of water with one-ninth of its volume of glycerine, or some other liquid of the sp. gr. 1.028, is necessary. If the suspected clot is in larger quantity, it may be removed from the stuff and macerated in one or two drops of water and glycerine, as above, on a glass slide. It should be covered with thin glass, in order to prevent rapid evaporation. This method of extracting the corpuscles has fre- quently failed, owing to water alone having been employed. Under these circumstances the corpuscles are distended, become of a globular form, of less diameter, paler, and are finally destroyed, while the water simply be- comes colored. It is by no means easy in all cases to obtain from diy coagula clear and distinct evidence of the presence of these corpuscles, especially when the blood is old. In drying, the blood-cells lose their form, and they do not readily resume it when again moistened. Unless they are seen after a short maceration in a very small quantity of water, it is probable they will not be seen at all. To accelerate their separation, various chemical liquids have been recommended. Thus, strong solutions of sulphate of sodium, chloride of sodium, and iodide of potassium have been employed as fluid media for breaking up the dried clots of blood. There are some disadvantages attending the use of these saline solutions. A mixture of glycerine and water may be employed in place of them. The most convenient proportions are one part by measure of gh'cerine to nine or ten parts by measure of distilled water. A cold saturated solution of borax in water is useful. A solution of arsenious acid, in the proportion of four grains to an ounce of distilled water, as recommended by Kunze, is also a rapid solvent of the coagula. When this is used, the examina- tion should take place as soon as the liquid begins to be colored at the margin, or the corpuscles may ^'?- ^^• be destroyed, and only fragments of their envel- opes seen. In reference to stains on clothing, if they pre- sent any appearance of dry coagula, these should be cai'efully scraped off", and treated in the manner above described. If no portions of solid coagula ^^^ corpusoies of blood in can be procured, there will be but little hope of 'lincu tibre; i, a group de- obtaining evidence of the presence of corpuscles in the suspected stain. The stained portion may be cut out and macerated in a small quantity of water. Under these circumstances, the corpuscles mav be sometimes seen aggregated, or in groups, in the fibres of the stuff, as in the annexed engraving (Fig. 43), in which the stain of blood was on a shirt. The subjoined illustrations (Figs. 44 and 45) show the appearances presented by blood-corpuscles when examined by a power of about 300 diameters, and under different methods of treatment. Fig. 44 represents the appearance of a drop of healthy human blood. The red blood-globules are partly detached, partly united in rolls, and partly in irregular clusters. 286 BLOOD OF MAN AND ANIMALS. In the spaces between them there are delicate threads of fibrin. The out- lines of the blood-globules are in some instances rendered indistinct, by reason of this web of fibrin above them. Fig. 44. Ficr. 45. Human blood-corpuscles with fibrin. Human Wood-corpuscles from a dried speci- men, magnified 319 diameters. In Fig. 45 the corpuscles are seen free from fibrin, and in groups (a) as well as singly. Only a small portion of those which were in the field have been engraved. The shaded bodies (b) are the white corpuscles of the blood; they are larger, but less numerous, not so well defined in form, and they present an irregularity of surface, by which they may be distin- guished from the colored blood-globules. Some practice in the use of the microscope is required to enable a med- ical man to arrive at a correct conclusion in these investigations. Gran- ules of starch and the spores of vegetables might be mistaken for blood- corpuscles. Erdmann states that, in examining some articles of clothing in a case of suspected murder, he thought he had detected blood-globules in the liquid which he procured, but he found on further inspection that they consisted of the red-colored spores of an alga known as the Fo?'- 'phyridium cruentum. (Edin. Med. Jour., Oct. 1862, p. 370.) The size of the bodies as Avell as their shape will sometimes aid the observer. The blood-corpuscles have a definite size : the bodies seen under the micro- scope may be either too large or too small to fall within the exceptional range of size. Hence the micrometer is a necessary adjunct to the instru- ment. Granules of starch would be identified by the blue color imparted to them by iodine. Blood of Man and Animals. — When marks of blood have been detected on the dress of an accused person, it is by no means unusual to find these marks accounted for by his having been engaged in killing a pig, bullock, or sheep, or in handling fish or dead game. Of course, every allowance must be made for a statement like this, which can be proved or disproved only by circumstances; but the question here arises W'hether we possess any certain means of distinguishing the blood of a human being from that of. an animal. There are no ascertained chemical differences between the blood of man and animals. The red coloring matter, the albumen and fibrin, are the same, and chemical reagents produce on them precisely similar results. The microscopical differences refer to the shape and size of the corpuscles. 1. With respect to shape. In all animals with red blood, the globules have a disc-like or flattened form. In the mammalia, excepting the camel tribe, the outline of the disc is circular (Fig. 42 a, p. 284). In this tribe, and in birds, fishes, and reptiles, the corpuscles have the form of a length- BLOOD OF MAN AND ANIMALS. 287 ened ellipse or oval. In the three last-mentioned classes of animals they have a central nucleus, which gives to them an apparent prominence in the centre. In applying the g'uaiacum test to this vari(;ty of blood, it is found that the nucleus acquires a deep blue color, while the oval margin or envelope is of a violet tint. In mammalian blood the round corpuscle acquires a uniform bhie color. (Amer. Jour. Med. Sci., Jan, 1874, p. 128.) The blood-corpuscles of all the mammalia, including those of the camel tribe, have no central nucleus, and they appear depressed in the centre. The microscope, therefore, enables an observer to distinguish the blood of birds, fishes, and reptiles from that of a human being or from mammalian blood ; and this may be of great importance as evidence. In the case of Reg. v. Libbey (Cornwall Sum. Ass., 1871), the pris- oner, who was indicted for the murder of her child, alleged that some blood found on certain articles of clothing was fowl's blood ; but the medical witness was able to prove that this statement was untrue. He examined the stains with the microscope, and found that the corpuscles had not the oval form of those in the blood of a bird ; but he was unable to say whether they were human or animal. This evidence tended to prove the falsehood of the defence. The chief microscopical distinction between the blood of man and do- mestic animals consists in a minute difference in the diameter of the cor- puscles. This, however, is only an average difference ; for the corpuscles are found of different sizes in the blood of the same animal. In making use of this criterion, it would be necessary to rely upon the size of the majority of the corpuscles seen in a given area, and under the same power of the microscope. It is a curious fact that their size bears no relation to the size of the animal. Thus, in the horse, ox, ass, eat, mouse, pig, and bat they are, on an average, nearly of the same size : the difference is so slight as to be practically inappreciable. In these animals they are smaller than in man and in several of the mammalia. The corpuscles in man, the dog, the rabbit, and the hare are of nearly the same size. In the blood of the sheep and goat they are much smaller than in other mammalia, while in man they are larger than in any of the domestic mammalia. The size of the corpuscles bears no proportion to the age of the animal : thus in the blood of the human foetus they are to be found as large as in that of the adult. The measured diameter of the corpuscles in human blood varies, accord- ing to Gulliver, from l-2000th to l-4000th of an inch (0.00050 to 0.00025 inch), the average size in both sexes being l-3200th (0.00031) of an inch. In fresh human blood the author found the average diameter of the cor- puscles to be l-3500th (0 00029) of an inch, the maximum size being l-3000th (0.00033), and the minimum l-5000th (0.00020) of an inch. The corpuscles of human blood are larger than those of domestic animals. The subjoined measurements, in fractions of an inch, are those given b}- Gul- liver, excepting those given in italics, which are from the author's own observations. The average diameter is, in the dog, 1.3540th (0.00029), via.x. l-4000th {0.00025), min. l-6000th {0.00017) ; in the hare, l-3607th (0.00028), max. l-2000th {0.00050), min. 1-SOOOth {0.00012), average l-4000fh {0.00025); in the rabbit, l-J^OOOth {0.00025); in the mouse, l-38l4th (0.0002G); in the ass, l-4000th (0.00025) ; in the pig, l-4230th (0.00024), which accords with the author's measurements, l-4250th ; in the ox, l-4267th (0.00023) ; in the cow, l-^OOOth {0.00025) to 1-J,200th {0.00024) ; in the cat, l-4400th (0.00023) ; in the horse, I-4fi00th (0.00022), or l-5000th {0.00020); in the sheep, l-5300th (0.00019), or l-5S33d to l-6000th {0.00019 to 0.00017) ; in the goat, l-6306th (0.00016). The.-e 288 BLOOD-CORPUSCLES OF MAN AND ANIMALS. measurements apply to recent blood, which has not been allowed to be. coMi(» dry on animal and vet;-otal)lo stuffs. In this case a distinction mi<>'ht be easily made between the blood of a human bein^- and a sheei) or ^-oat. With respect to the dog, hare, and rabbit, it would be, even under these favorable circumstances, a matter of some dilliculty. When blood is dried on clothing, and it becomes necessary to extract the c()rj>uscles by means of a liquid of a different nature from the serum, it would be unsafe to rely on minute fractional differences, since we cannot be sure that the cor- puscles, after having been once dried, will ever reacquire, in a foreign liquid, the exact size which they had in serum. (See Guy's Hosp. Rep., 1851, vii.pt. ii. p. 414 ) It is generally admitted by scientific men that we have at present no certain method of distinguishing human from other mammalian blood, when it has l)een once dried on an article of clothing or on a wea])on. This is the practical form in which the problem usually comes before a medical jurist. He may be able to state that the sha|)e and size of the corpuscles, as seen by the microscope, are consistent with the blood being mammalian, and probably human, but that it is inipossiljle to say with absolute certainty that it is not the blood of an animal like the ox or pig. Richardson, of Philadelphia, U. S., has made a considerable step in ad- vance on the microscopical examination of blood. (Amer. Jour. Med. Sci., July, 1874.) By the use of higher powers up to 750 diameters, and by other appliances, he asserts that he has been able to distinguish, under favorable conditions, the blood of man from that of such animals as the ox and pig, and to give evidence thereon on certain trials for muraer. It will be understood that, as the magnifying power increases, the re- lative difference in the size of the corpuscles is more apparent. Thus, when at 300 diameters it would be scarcely possil)le to distinguish the blood of man from that of the pig, at 650 diameters the difference in size 33 well marked. The plates (Figs. 46 and 47), taken from a photograph FiR. 46. Fi-. 47. Human corpuscles, l-3500th. Pigs' corpuscles, l-4250th. by Seller, represent, under the same power (650 diameters), the corpuscles in the blood of man and the pig. In each of the engravings only a small portion of the blood is represented, the whole of the photograph, with the two varieties of blood and the micrometric scale, being much too large for a page of this work. Seller's process is described in the Amer. Med. Times, Feb. 19, 1879, p. 249. The larger size of the corpuscles in human blood (Fig. 46) is at once perceptible, and it may be observed that the smallest of the human corpuscles thus highly magnified is larger than the BLOOD-CORPUSCLES OF MAN AND ANIMALS. 289 largest of those in the pig (Fig. 47). This observation was made on fresh blood, for Seiler candidly admits that he has not been able to obtain satis- factory results with dried blood-stains, the problem which in practice most commonly ])resents itself for solution. [Prof. Reese asserts that by the employment of microscopes of still higher powers (1200 to 1800 diameters) he has been able to distinguish unequivocally between the blood of man, the pig, the ox, and the sheep, and that there is no difficulty in positively distinguishing between the human corpuscle and that of any animal whose corpuscle is less than ^oVo of ^^ '"ch in diameter.] From one well experienced in the use of the higher powers of the micro- scope, evidence of the probable nature of the blood might be receivable, but skilled experts of this kind are rarely found among medical witnesses, and when the blood is dried the evidence is generally inadmissible. In all cases in which the microscope is employed for the examination of blood-corpuscles, a comparison of the sample should always be made with the kind of blood, whether human or animal, which it is supposed to rep- resent. Copeman has recently described a method of distinguishing human from all other kinds of blood (St. Thomas's Hosp. Rep., 1888, p. 95). He asserts that human blood, as well as that of the monkey, crystallizes in the form of reduced hiemoglobin, whilst that of all other animals crystallizes in the form of oxyhaemoglobin ; and that the spectroscope reveals this difference. A few drops of putrid serum suffice to bring about crystalliza- tion of the pigment in a solution of blood. To distinguish between the blood of man and the monkey, it suffices to note that the crystals of human reduced htemoglobiu are almost invariably rectangular plates, whilst those from monkey's biood are for the most part diamond-shaped plates, or else hexagonal plates like those of the sheep and ox. This method is not altogether satisfactory when applied to dried blood. In general it is found sufficient if the witness can say that the blood- stains on an article of dress have the characters of mammalian blood, and might be blood of a human being. The blood of birds, fishes, and reptiles presents no difficulty, and in trials for murder the statement of a prisoner is occasionally proved false by the medical evidence derived from the mi- croscope (Reg. V. Libbey, see p. 287). A prisoner was charged (Reg. v. Ward, Leeds Ass., Nov. 1878) with murder and highway robbery. The deceased was found dead, with marks of severe blows on the head. Among other circumstances which connected the prisoner with this crime was a large spot of blood upon his trousers. When asked to account for this, he said it was the blood of a fowl. The medical witness was able to state that this was not the blood of a bird, but of a mammal. Poachers have their clothes often stained with blood in contests with gamekeepers. The stains have in these cases been sometimes refei'red to the carrying of pheasants or partridges, but the medical evidence has shown that the form of the corpuscles Avas inconsistent with this defence. [There is a divergence of opinion among leading American observers as to the reliability of accepting average diameters of the red corpuscles, owing to the effect of diseases upon the structure and to other causes, aside from the doubts thrown upon micrometric measurements by Prof. Marshall D. E well's researches, who disputes the views claimed by Dr. Richardson and Prof. Formad, of Philadelphia. " Micrometric Study of 4000 Red Blood Corpuscles in Health and Dis- ease," by Prof. Marshall D. Ewell: N. Amer. Prac, 1890, pp. 97 and 173; 19 290 BLOOD-CORPUSCLES OF MAN AND ANIMALS. " Study of the Subdivisioa of the first Millimeter of Centimeter A.," by Prof. M. D. Ewell: Amer. Soc. of Microseopists, 1889, p. G4, The subject was discussed before the Medico-Lef>:al Society of Xew York, in a paper by Clark Bell, Esq., on " Blood and Blood-Stains," May, 1892, by the leading- American microscopists. The following consensus of opinion was reached: — 1. That there was no difficulty in distinguishing between human blood and that of birds, fishes, and anij)hibia generally. 2. That by careful and competent observers, with instruments of high power, a reliable discrimination could be made between human blood and the blood of mammals, when the size of the red corpuscles was much smaller than that of man, notably the ox, the horse, the goat, the sheep, the pig, and most mammals, 3. That the blood of the dog, the rabbit, and the guinea-pig so nearly resembles human blood in the size or diameter of the red corpuscles that it was more difficult, and divided opinions exist among observers, Profs. Reese, Formad, Reyburn, and others claiming that by the employment of instruments of high powers, up to 10,000 diameters, the difference in diameter becomes so great when thus magnified as to make it apparent in all mammals except the guinea-pig and the opossum; while Prof. Ewell and others deny that the results of these investigations are such as make it certain and absolute when in doubtful cases human life is at stake. 4. All concur in the safety of the careful microscopist, asserting posi- tively ''that the blood examiyied is consistent ivith human blood,'''' if un- willing to state positively that it is such, or agreeing with the dictum of Prof. Wormley in his masterly treatise that ''the microscope may enable us to determine with great certainty that a blood is not that of a certain animal and is consistent with the blood of man.'" Although some might agree and some dissent from the same author's assertion added to the above quotation, "but in no instance does it in itself enable us to say that the blood is really human, or indicate from what peculiar species or animal it vjas derived:'''' Yid. Med. -Legal Journal, vol. 10, No. 1, p. 77, June, 1892; "Blood and Blood-Stains," by Clark Bell, Esq., Mcd.- Legal Journal, vol. 10, No. 2, Sept., 1892, p. 128; Reese. Med. Juris. & Tox., Ed. of 1891, p. 133; "Comparative Studies of Mammallian Blood," by Prof. Henry F. Formad, Journal of Com]). Med. and Surgery, July, 1888.] [The best contribution made to the study of the red blood-corpuscles since the last edition, has been made by Prof. M. C. White, M. D., of New Haven, Conn., which is contained in vol. xii., No. 4, page 1, of the Medico-Legal Journal for March, 1895, and is enriched by twenty-four new photographs from original studies made by Professor White reproduced by photography, some from his own studies, and the more valuable for that reason. The same article is reproduced in vol. xviii. of the Transactions of the American Microscopical Society, p. 201 et seq. and some of the plates of the engrav- ings are here reproduced as the most valuable recent contribution to the science. The tables given herewith are from the same paper, and from the article published by Mr. Clark Bell, entitled " Blood and Blood Stains," referred to above. In the table (p. 291) the measurement of 3000 corpuscles from man are given, 200 having been taken from each of fifteen different persons. The measurements are given, maximum and minimum, by tens, by twenties, by fifties, by hundreds and by two hundreds. Six hundred from pigs were measured ; 200 from a pig three weeks old, 200 from one of two months, and 200 from a pig three months old. BLOOD-CORPUSCLES OF MAN AND ANIMALS, 291 Measurements of MammaVian Blood. By J. B. Treadwell, M. D. AinpUjied u/id corrected by Prof. M. C. White, M. D, Source of Blood. 5 Men, ages 23 to 49 years... 5 Women, 18 to 55 years 3 Infants at birth, 1 male, 2 females .-. Boy, 8 years old.. Man, 70 years old 15 Persons, as above Blood-stains (human) restored.. 25 Dogs Guinea-pig, male, 3 months Woodchuck, female Muskrat, male.. 2 Rabbits, 1 white, 1 mixed 2 Hares, 1 male, 1 female Gray squirrel, 1 female, 1 male, 5 months Red squirrel, female, 5 months.. Striped squirrel, female Red fox, male, 5 months Pig, 2 of 3 months, 1 of 2 weeks . Ox, 3 male, 2 female, (one 1 day, one 3 months Horse, 10 years Ass, 1 male, 1 female Mule, 6 years Cat, 1 adult, 1 kitten, 3 weeks... Sheep, malo, 15 days; female 1 year Goat, 1 male, 1 female Mouse, house, common Mouse, house, long-tailed Mouse, fleld Rat, male Mole, male ♦Elephant Woman, 19 years, anaemia.. Child, 6 weeks old, starved to death ♦Human embryo, I43grains, non- nucleated corpuscles ♦Human embryo, nuclei of nu- cleated disks. _ A male cat, stupefied five hours by alcohol 111 1,000 1,000 600 200 200 3,000 1,000 2,500 200 200 200 400 400 400 200 200 200 600 1,000 200 400 200 400 400 400 200 200 200 200 200 100 100 10(1 20 10 100 7,941 7,927 7,950 7,983 7,916 7,938 7,910 6,918 7,476 7,280 7,283 6,365 5,764 6,876 -) 6,607 ] 6,753] 6,482] 6,101 ] 5,436] 5,503 ] 6,293 ] 5,421 1 5,463 ] 4,745] 3,567 "1 6,038 I 6,099 ] 5,095] 6,500 ] 6,216 ] 9,259] 7,346] 7,573] 11,340] 8,089] 5,489^ a-gs = = s 5.773 9.394 6.350 9,287 4.233 10,160 6,929 9.160 7.0U5 9,236 4,233 10.161) 5,570 9,687 4,618 8,931 5,849 8.390 5,387 8.467 6,158 9,391 4,618 8,082 4,618 7,120 5,926 7,851 4,92(i 8,313 5,38' 7,60' 5.541 7,312 3.849 8,391 3.916 6,774 4,618 6,774 5,003 7,69' 3,464 6,312 2,61 6,77 3,079 6,7 2,617 4,080 2,309 7,004 4,618 6,696 4,080 6.928 3,079 8,005 4,618 7,697 7,164 11.504 3.464 9.2:37 4,465 8,636 9,736 13,486 5,394 11,611 4,772 7,235 o "° « o 0) n o 't o 7,697 8,152 7,825 8,152 7,667 8,298 7.74' 8,282 7.658 8,121 7.658 8,298 7,700 8,189 6,138 7,352 7,231 8,098 7.043 7,528 6,920 7.535 6,196 6,596 5.367 6,080 6,366 7,436 6,22' 6,851 6,573 6,981 6,250 6.674 5,418 6,520 5,150 5,703 5,203 5.818 6.018 6,566 5,280 5,680 4,311 5,780 4,503 4,972 3,394 4,764 5,' 6,281 5,85' 6.258 5,733 6,041 6,289 6,820 6,095 6,435 6.674 7,6(15 7,328 7,712 11,032 11,661 8,089; oj CO 7,782 8,110 7,787 8,026 7,716 8,100 7,828 8.191 7,6(12 8,105 7,002 8,191 7,723 8,010 6,445 7,305 7,309 7,659 7,112 7,374 7,120 7,555 6,227 6,485 5,377 6.049 6,627 7,079 6,381 6.897 6,64 6,901 6,40S 6,502 5,75 6,460 5,296 5,622 5,25' 5,033 6.138 6,539 5,327 5,545 4,361 5,676 4,588 4,8()9 3.401 3 710 5,891 6.2(J0 5.90,S 6,20s 5,803 5,995 6,34(: 6,695 6.08(1 6,339 7,012 7,628 7,493 7,639 11,346 « « s «_^ 5,327 5,426 5,680| 5,846 7,845 8,061 7,873 7,993 7.833 8.031 7,891 8.079 7,708 8,ti;.'s 7,708 8,079 6,523 7,258 7,249 7,034 7,215 7,884 8,046 7,901 7,903 7,918 7,983 7,965 8,000 7.852 7,980 7,852 8,046 6,673 7,198 7,393 7,559 7,279 7,351 7,282 7,195 7,428 6,294 6,409 5,(J04 5,863 6,774 7,080 6,4!t6 6,709 6,701 6,815 0,474 (),,544 5,880 6,240 5,345 5,543 5,473 5,553 6,201 6,377 5,377 5.472 5,268 5,573 4,065 4,785 3.407 3.093 5,99l)j 0.094 6,003 (),143 5,814 5.90' 0.441 6.ti'.i4 6.131 6,293 7,177 7,515 7,57' 7,574 5,479 5,498 7.245 7,320 6,349 6,383 5,733 5,779 6,8'^3 7,004 6,.-)92 6,02r 6,74' 6,758 6.470 (>,494 0,028 0.109 5,34' 5,482 5,493 5,513 6,219 6,376 5,419 5,424 5,419 5,52: 4,725 4.764 :<,5:35 3,638 6.03' (;,039 0.089 6,109 5.891 5,919 6.490 0,510 6,175 6,258 9,259 7",346 7",573 5,489 7,902 7,983 7,913 7,950 7.938 7.970 7,983 7^9i6 7",9i3 7,983 6,354 6,37" 5,756 5,772 6.827 6,926 6,069 6,144 5,406 5,461 6,259 6,326 5,431 5,495 4,744 4,746 3,546 3,587 ' Measured by M. C, White. 292 BLOOD-COlirUSCLES OF MAN AND ANIMALS. As the corpuscles of the pig have a L'lrger average than those of the ox, horse, sheep or goat, we make our coiuparisous between the blood of man and the blood of these three young pigs. Mikrons. Mikrons. Man, smallest ten 7.658 Largest ten 8.298 Pig, " " 5.418 " « 6.520 Man, smallest twenty 7.662 Largest twenty 8.191 Pig, " " 5.757 " " 6.466 Man, smallest fifty 7.768 Largest fifty 8 079 Pig, " " 5.880 " " 6.240 Man, smallest hundred 7.852 Largest hundred 8.046 Pig, " " 6.028 " " 6.169 Smallest ten from man 7658 mikrons. Largest ten from tlie pig 6520 " Diflference 1138 mikrons. This equals 0.000045 of an inch = 22222 in<^h- Smallest twenty from man ' 7662 mikrons. Largest twenty from the pig 6466 " Difference 1196 mikrons. This equals 0.000047 of an inch = ^yiyg inch. Smallest fifty from man " 7768 mikrons. Largest fifty from the pig 6246 " Difference 1522 mikrons. This equals 0.000060 of an inch == xe Ise inch. Smallest hundred from man 7852 mikrons. Largest hundred from the pig 6169 " Difference 1683 mikrons. This equals 0.000066 of an inch = j^ji-y inch. (Med.-Legal Jour., vol. xii. No. 4, p. 426, 427.) Note. — The photomicrographs reproduced by the engraver are introduced for the purpose of showing — First. That the red blood-corpuscle has a sharply defined outline which when seen with the microscope is capable of measurement with as much accuracy as any organized structure. Second. The photos of the red blood-corpuscle of man and the goat magnified 10,850 diameters show that the great range in the diameters of the corpuscle of man and some domestic animals affords the means for the microscopist to give a safe and in every way trustworthy diagnosis between the blood of man and some domestic animals well worthy of confidence in medico-legal cases. Third. The photo of the red corpuscle of the mongrel dog magnified 2560 diam- eters, as compared with the red corpuscle of man of the same magnification, illustrates the differences shown in Dr. Treadwell's table of measurements, and shows how in some cases the medical expert can distinguish between the blood of man and that of some dogs ; while the double photo of the blood of man and of the {)Ug dog, magnified 640 diameters, which were taken without any attempt at selection, shows clearly that in case of a specimen of blood-stain whose source is not positively known, it is not safe in a legal case to say that it is more likely to be human blood than to be the blood of a dog. The other photos magnified 640 diameters show by the large number of corpuscles in each illustration that there is a wide difference between tiie blood of man and all domestic animals except the dog, justifying a very positive opinion whether the blood is human rather than the blood of a dome.stic animal where the dog is excluded. These photographs support the distinctions recorded in the table of measurements. All the illustrations marked X 640 (/. e. magnified six hundred and forty diameters) were pho- tographed by Dr. M. C. White, while those marked as magnified 2560 diameters are from negatives prepared by the late Dr. J. B. Treadwell of Boston. Tlie figures marked X 10,850 diameters are enlargements photographed from Dr. Treadwell's copies X 2560 diameters. — Communicated by Prof. White. BLOOD-CORPUSCLES OF MAN AND ANIMALS 293 Table showinq DisfribuHo?i of Various Sizes of Blood-corpuscles 3feasured in Parts of an Inch. (By J. B. Tkeadwell, M. D.)* Fractions of an inch. Man. Dog. Pig. Ox. Sheep. Goat. 1-2700 1-2800 1-2900 1-3000 1-3100 1-3200 1-3300 1-3400 1-3500 1-3600 1-3700 1-3800 1-3900 2 6 14 32 33 46 37 14 9 4 1 2 6 17 23 24 58 23 12 10 9 12 3 1 2 I 4 17 21 9 31 34 15 7 11 9 8 18 4 4 1 2 1 1 3 1 22 16 7 10 17 15 51 15 1 9 8 3 5 3 13 2 15 8 6 19 11 20 17 30 47 11 3 6 1 2 1 1 1-4000 1-4100 1-4200 1-4300 1-4400 1-4500 1-4600 1-4700 1-4800 1-4900 1-5000 1-5100 1-5200 1-5300 1-5400 1-5500 1-5600 1-5700 1-5800 3 1-5900 .... 1-6000 2 1-6100 2 l-G'^OO . ... 4 1-6300 5 1-6400 30 1-6500 1-6600 45 1-6700 20 1-6800 ... 29 1-6900 . .... 1-7000 15 1-7100 17 1-7200 1-7300 . ... 15 1-7400 1-7500 4 1-7600 4 1-7700 1-7800 . . 1 1-7900 1-8000 4 iS"o. of corpuscles . . Maximum Minimum Mean 200 1-2727 1-3870 1-3197 200 1-3203 1-4400 1-3657 200 1-3473 1-5500 1-4227 200 1-3837 1-5500 1-4654 200 1-4647 1-6600 1-6204 200 1-5892 1-8048 1-6839 * The number of corpuscles includes all found between the fraction opposite to which they are placed and the next succeeding fraction of an inch. (Med.-Legal Jour., vol. xii. No, 4, p. 428.) 294 BLOOD-CORPUSCLES OF MAN AND ANIMALS, Prof. Powell says : " INIany diseases alter the size of the red blood-corpus- cles," and he gives the result of careful nieasureiuents which he has made in a number of diseases. I take great pleasure in acknowledging the excel- lent work done in this line by Prof Ewell, and, for the present discussion, I have compiled from Prof. Ewell's reports the following table : Source of Blood. Robust man IJoy l-)6 lio'TS old . . Adult man Pnrpiira luTinorrhagica Two cases pseiido- 1 leiicocytha'mia ) Tuberculosis, anaemic . Plumbism Gastritis (?) Two cases syphilis . . Erysipelas Pernicious an?emia . . Menstrual blood . . . No. of Corpus- cles. 650 200 100 200 400 100 100 100 200 100 100 100 2350 Mean in Mi- krons. 8.03 8.86 7.85 8.26 8.04 8.35 8.65 8.32 8.11 7.83 7.69 7.71 8.14 9.98 11.39 9.32 10.87 11.04 10.70 10.10 10.18 9.32 915 9.93 8.80 11.39 Min. 5.03 5.70 6.73 3.45 6.56 5.35 5.18 6.22 3.97 6.90 6.04 5.76 3.45 By lOO's Max. 8.28 9.06 8.28 8.55 8.11 9.06 By lOO'i Min. 7.95 8.65 8.25 8.42 8.11 7.95 (Med.-Legal Jour., vol. xii. No. 4, p. 429.) As a confirmation of the possibility of restoring dried blood-stains to a condition in which their dimensions can be properly compared with fresh blood-corpuscles, I quote the following table from Prof. Wormley's Micro- Chemistry of Poisons : Examination of Old Blood-Stains. In the case of the human blood No. 1, two months old, the deposit was in the form of a thin stain on muslin, and its nature, other than that it was mammalian blood, was unknown at the time of examination. The corpuscles were readily found, and two series of thirty corpuscles were measured. In the human blood two and a half months old, fifty corpuscles ranging from gyV^ to 35*5 g of an inch, were measured. The blood stain of the dog, No. 6, was prepared by Dr. Frankertoerg, and consisted of a single stain .so minute as to be barely visible to the naked eye- its nature at the time of the examination was unknown. In the ox blood four and a half years old, the corpuscles were readily obtained, and two closely concordant series of measurements were made. (Med.-Legal Jour., vol. xii. No. 4, p. 431, 432.) BLOOD-CORPUSCLES OF MAN AND ANIMALS, 295 The following tables, quoted by the editor in his tirticle " Blood and Blood Stains " cited above, are given, to complete the present state of knowledge on the subject. The tables of Prof Wormley as to the average diameter of the red cor- puscles of the mammalia may be quoted as of high value. He has made illustrations of the apparent size of red corpuscles, under an amplification of 1150 diameters, expressing the average diameters in vulgar fractions, thus — 3250 equals 1-3250 of an inch. This table of illustration shows the corpuscle of man, the dog, mouse, ox, sheep, and goat. Blood. Reptiles. Tortoise (land) . Turtle (green) . Boa-constrictor Viper . . . . Lizard . . . Wormley. Length. Breadth. 1-1250 1-1245 1-2200 1-2538 Gulliver. Length. Breadth. 1-1252 1-1231 1-1440 1-1274 1-1555 1-2216 1-1882 1-2400 1-1800 1-2743 Bateachians. Wormley. Gulliver. Length. Breadth. Length. Breadth. TTrnfT 1-1089 1-1801 1-1108 1-1043 1-848 1-400 1-363 1-1821 Toad 1-2000 Triton 1-1280 1-737 Amphyuma tridactylum 1-358 1-622 1-615 Fishes. Gulliver. Length. Breadth. Trout 1-1524 1-2099 1-2000 1-1745 Circular. 1-2460 1-2824 Pike 1-3555 Eel 1-2842 1-2134 Nucleus 1-6400 296 BLOOD-CO KrUSCLES OF MAN AND ANIMALS, Average Size of the Bed Blood-corpuscles. Mammals. Man .... Monkey . . . Opossum . . Guinea-pig . Kangaroo . . Musk-rat . . Dog .... Kabbit . . . Eat JNIouse . . . Pig Ox Horse .... Cat ]?i1j Buffalo ". '. . Wolf (prairie) Bear (black) . Hyena . . . Squirrel (red) Raccoon . . . Elephant . . Leopard . . . Hippopotamus Wormley. Gulliver, ■3250 •3382 3145 ■3223 3410 ■3282 ■3561 3653 ■3652 3743 ■4268 -4219 -4243 4372 -4384 -4351 -3422 -3G56 3644 -4140 -4084 -2738 -4390 -3560 1-3200 1-3412 1-3557 1-3538 1-3440 1-3550 1-3532 1-3607 1-3754 1-3814 1-4230 1-4267 1-4600 1-4404 1-3938 1-4586 1-3600 1-3693 1-3735 1-4000 1-3950 1-2745 1-4319 1-3429 Mammals. Rhinoceros Tapir Lion Ocelot Mule Ass Ground-squirrel . . . Bat Sheep Ibex Goat Sloth Platypus (duck-billed) Whale Capvbara Seal Woodchuck .... Musk-deer Beaver Porcupine T 1 f long diam. Wormley. Gulliver, 1-3649 1-4175 1-4143 1-3885 1-3760 1-3620 1-4200 1-3966 1-4912 1-6445 1-6189 1-3164 1-3201 1-6408 1-3331 1-5280 1-3765 1-4000 1-4322 1-4220 1-4000 1-4175 1-5300 1-6366 1-2865 1-3000 1-3099 1-3190 1-3281 1-3484 1-12325 1-3325 1-3369 1-3361 1-6229 1-3123 1-5876 Wormley. Gulliver. Length. Breadth. Length. Breadth. Chicken 1-2080 1-1894 1-1955 1-1892 . . . 1-3483 1-3444 1-3504 1-3804 1-2102 1-2045 1-1937 1-1973 1-1836 1-2347 1-2005 1-2140 1-1763 1-3466 Turkey Duck Pigeon Goose 1-3598 1-3424 1-3643 1-3839 Quail 1-3470 Dove 1-3369 1-3500 Owl 1-4076 (Bell's Med.-Legal Studies, vol. iii., pp. 163, 164; Med.-Legal Jour., vol. X., No. 2.) BLOOD-CORPUSCLES OF MAN AND ANIMALS. 297 Elephant Great An Walrus Sloth . Ornithor W^hale . Opossum Capybar£ Man . . Seal . . Beaver Musk rat Porcupin Monkey Kangaro Guinea P Wolf . Dog . . Rabbit Ass . . Rat . . Bear . . Mouse . Mule . Squirrel Ox . . Pig . . Horse . Cat . . Sheep . Goat . M. . "> 0. . S". c . . >-i . 1.2745 1.2769 1.2769 1.2865 1.3000 1.3099 1.3557 1.3190 1.3200 1.3281 1.3325 1.3550 1.3369 1.3412 1.3440 1.3538 1.3600 1.3532 1.3607 1.4000 1.3754 1.3693 1.3814 1.4606 1.4267 1.4230 1.4600 1.4404 1.5300 1.6366 _P Gulliver, 1845 and 1875. p p p p p-." p p p p p p p p p p p p p p p p occ'ooooo. oooo -oooo -00 -000 '00 '00000000 0000000 00000000000000000000000 ►t^rf^OiOiO^OiOS. Ci^lCnO:-a^^J^l^T^^7^]^I^1^10C^J00000DC»(XCO OOOOOC;iOO*^ ^OQCCOOi-'Oh-'i»^**Oi tCOOCtOOh-Oh-'OlSootS 1.2738 1.3145 1.3164 1.3250 1.3382 1.3410 1.3223 1,3422 1.3561 1.3653 1.3620 1.3652 1.3656 1.3743 1.3760 1.4140 1.4219 1.4268 1.4243 1.4372 1.4912 1.6189 a B ppppoppoopppoooooo. . . . 000 000000000000000000 000 OcpppOOOOOOOOOOOOOO- * • ■ OO'0 l-» h-* 00 CO CO r-i •lexy from disease and compression of the spinal marrow at the same instant. Hence it is our duty, when several apparent causes for death exist, to determine which was the real cause; and, in stating it to the court, to be prepared to offer our reasons for this opinion. In most cases of local injury, when a person dies speedily, there will be no great trouble iu settling whether disease or the injury was the cause. A difficulty may, however, exist when a person has recovered from the first effects of a wound, and has subsequently died. Besides, there may be cases in which the cause of death, in spite of the most careful deliberation, will be still obscure ; or sometimes it may happen that the death of a person appears to be as much dependent on bodily disease as on an injury proved to have been received at the time he was laboring under the disease [Sometimes death is due to want of medical skill, or, worse, wrong treatment by attending physicians. The case of James Fisk, Jr., pre- sented a notable case of this character. Modern surgery would have had no serious obstacle in treating the wound (gunshot wound of the abdo- men), then by many regarded as fatal. Had Dr. James R. Wood, the eminent surgeon, who was sworn on the trial as an expert in the case, been in charge, he would have had no serious difficulty in securing a re- covery. The monograph of Dr. Eugene Perugnet, read before the Medico-Legal Society of New York, demonstrated that the death was directly due to coma, caused by large doses of morphia. The bullet might have cau.sed death, but for want of proper surgical treatment the morphia interposed, and actually caused the death : Series 2, Medico-Legal Pajiers, p. 294. The case of President Garfield presents similar considerations and reflec- tions. Did he die from the bullet of the assassin, or was his death due to other causes .^] How is an opinion to be expressed in such a case ? The course that a medical witness ought to pursue, provided he has duly deliberated on the circumstances before he appears in court, and his mind is equally balanced WOUNDS DEATH FROM HEMORRHAGE. 307 between the two causes, is to state at once his doubt to the jury without circumlocution, and not allow it to be extracted from him in cross-exami- nation. It is the hesitation to assign a satisfactory cause, or the assigning of man}^ causes for death, that gives such advantage to a prisoner's case, even when the general evidence is entirely against him. Occasionally, several causes of death are vaguely assigned by a medical witness, among which some have a tendency to exculpate, and others to inculpate, an accused person in a greater or less degree, and it is left to the jury to select from the number one upon which to found a verdict. In a case of this kind an accpiittal is comn)only obtained. Wou7ids Directly or Indirectly Fatal. — A wound may cause death either directly or indirectly. A wound operates as a direct cause of death when the wounded person dies either immediately, or very soon after its infliction, and there is no other cause, internally or externally, to account for death. In wounds which cause death indirectly, it is assumed that the person survives for a certain period, and that the wound is folloAved by inflammation, suppuration, p3"gemia, gangrene, tetanus, erysipelas, or some other mortal disease which is a direct, and not an unusual, conse- quence of the injury. Under this head may be also placed all those cases which prove fatal by reason of surgical operations rendered imperatively necessary for the treatment of an injury — presun)ing that these operations have been performed with ordinary skill and care. We shall for the present consider only the direct causes of death in cases of wounds. They are three in number : 1. Hemorrhage, or loss of blood. 2. Great me- chanical injury done to an organ important to life. 3. Shock, or concus- sion, affecting the nervous centres, whereby the functions of one or more vital organs are arrested, sometimes with but slight injury to the part struck or wounded. From any one of these causes a wounded person may die immediately or within a few minutes. 1. Death from Hemorrhage. — Loss of blood operates by producing fatal syncope (p. 65). A quantity of blood escaping from a vessel, although insufficient to cause death by affecting the heart and circulation, may readily destroy life by di.sturbing the functions of the organ or part into which it is effused. Thus a small quantity effused in or upon the substance of the brain, or at its base, may prove fatal by inducing fatal compression ; and, again, if in a case of wounded throat blood should flow into the windpipe, it may cause death by asphyxia; i. e.,hy stopping the respiratory process (p. 65). In these cases it is obvious that the blood acts mechanically ; and in respect to the last condition a medical man, nnless circumspection is used, may involve himself in a charge of mala- pvaxis. If he allows the wound to remain open, the wounded person may die through hemorrhage; if he closes it too soon, the person may die through suffocation ; and, in either case, the counsel for a prisoner Avill not fail to take advantage of a plausible objection of this kind. In wounds of the chest, involving the heart and lungs, death is frequently due, not so much to the actual quantity of blood effused, as to the pressure which it pro- duces upon these organs. A few ounces effused in the cavity of the bag enclosing the heart (pericardium) will entirely arrest the action of this organ. The absolute quantity of blood required to be lost in order to prove fatal, will, of course, vary according to numerous circumstances. The young, the aged, and those who are laboring under infirmity or disease, will perish sooner from loss of blood than others who are healthv and vigorous. Women, casteris parihii.'<, are more speedily destroyed by bleeding than men. Infants are liable to die from this cause, as a result 308 DEATH FROM INTERNAL HEMORRHAGE. of sli.tiht wounds. An infant has been known to bleed to death from the bite of a siui-lo leccli, or from the simple operation of lancing- the gums. Even the healthy and visiorous, when their vital ])()\vers have been de- pressed by maltreatment or by brutal violence, will sink under the loss of a C()ni|)aratively small quantity of blood. A medical jurist must not forget that some persons have a predisposition to excessive bleeding from slight injuries; and this condition is often hereditary. The slightest wound or puncture — the bite of a leech or the extraction of a tooth — will be attended with a loss of blood which cannot be arrested, and which will slowly lead to death by exhaustion. Cases have been frequently recorded of fatal hemorrhage following the extraction of teeth, when there had been pre- viously nothing to indicate the probable occurrence of death from so trivial a cause. Such cases are without difficulty detected ; since a sur- geon may always infer from the part injured and the extent of the injury whether the bleeding is likely to be copious or not. When a person bleeds to death from what Avould, under common circumstances, be a simple wound, the admission of this fact may in certain cases lessen the respon- sibility of an accused party. A sudden loss of blood has a much more serious consequence than the same quantity lost slowly. A person may fall into a fatal swoon from a quantity of blood lost in a few seconds, which he would have been able to bear without sinking had it escaped slowly. This is the reason why the wound of an artery proves so much more rapidly fatal than that of a vein. Death speedily follows the wound of a large artery like the carotid; but it takes place with equal certainty, although more slowly, from wounds of smaller arteries. In a case in which one of the intercostal arteries was wounded by a small shot, hemorrhage caused death in thirty -eight hours. The loss of blood which follows the division of the smaller branches of the external carotid artery is often sufficient to destroy life, unless timely assistance be rendered. If a wound is in a vascular part, although no vessel of any importance be divided, the person may still die from bleed- ing. It is difficult to say what quantity of blood should be lost in order that a wound may prove fatal. The Avhole quantity contained in the body of an adult is estimated at about one-thirteenth of its weight — i. e., about twelve pounds (Halliburton's Text-Book of Chom. Physiol., p. 220); of this, one-fourth is considered to be distributed in the heart, lungs, large arteries, and veins. In various animals the proportion of the weight of the blood to that of the body has been found to vary considerably and probably this holds good for man also, within certain limits. According to Watson, the loss of from five to eight pounds is sufficient to prove fatal to adults. But while this may be near the truth, man}" persons will die from a much smaller quantity; the rapidity with which the effusion takes place having a considerable influence, as well as the age, sex, and bodily condition of the wounded person. It has been found by experiment that a dog cannot bear the loss of more blood than is equivalent to one-twelfth part of the weight of its body. Internal Hemorrhage. — Hemorrhage may prove fatal, although the blood does not visibly escape from the body. In incised wounds, the flow externally is commonly abundant; but in contused, punctured, and gunshot wounds the effusion may take place internally, and rapidly cause death. In severe contusions, or contused wounds, involving highly vascu- lar parts, the effusion may go on to an extent to prove fatal, either in the cavities of the body or throughout the cellular membrane and parts adja- cent; several pounds of blood may thus be slowly or rapidly effused. The most fatal internal hemorrhages are those which follow ruptures of the DEATH FROM MECHANICAL INJURY SHOCK. 309 organs from violence or diseose. Ruptures of the heart, lungs, liver, and kidneys have thus caused death. In Nov. 1864, a man who had been run over was brought to Guy's Hospital. He complained of pain in the back, but there were no symptoms of severe injury, and no marks of vio- lence were seen on the skin of the back. He left the hospital, and walked with some assistance to his home. A few hours afterwards he was found dead in bed. On inspection there was a large quantity of Ijlood effused in the abdomen. This had proceeded from one kidney, which had been ruptured transversely through its whole substance. In these cases the bleeding is not necessarily immediate; but slight muscular exertion may increase it and accelerate death. In death from severe flagellation, blood ma}' be efl'used in large quantity beneath the skin and among the muscles: this effusion will operate as fatally as if it had flowed from an open wound. The means of ascertaining whether a person has died from bleeding by an open wound are these : Unless the wound is situated in a vascular part, we shall find the vessel or vessels from which the blood has issued, divided; the neighboring vessels empty, and the body more or less pallid; although this last condition is, of course, liable to be met with in certain cases of disease, as also under copious venesection — points easily determined by an examination.. The blood will commonly be found more or less clotted or coagulated on those surfaces on which it has fallen. If, with these signs, there is an absence of disease likely to prove rapidly fatal, and no other probable cause of death is apparent, this may be fairly referred to loss of blood. This opinion may, however, be materiall}' modified in reference to open wounds, by the fact of the body not being seen on the spot where the injury was actually inflicted, by the wound having been sponged, the blood removed by washing, and all traces of bleeding de- stroyed. Under these circumstances, the case must in a great measure be made out by presumptive proof; and here a medical witness may have the duty thrown upon him of examining articles of dress, furniture, or weapons, for marks or stains of blood. It must not be supposed that all the blood met with round a wounded dead body, or in a cavity of the body, was actually effused during life. As soon as the heart's action ceases, the arteries pour out no more; but the blood, so long as it remains liquid, i. e., from four to eight or ten hours after death, and the warmth of the body is retained, continues to drain from the divided veins and smaller vessels. The quantity thus lost, however, is not considerable, unless the veins implicated are large, or the part is highly vascular, i. e., full of veins or small vessels. 2. Death from Great Mechanical Injury done to a Vital Orgav. — We have instances of this becoming a direct cause of death in the crushing of the heart, lungs or brain, by any heavy body passing over or falling on the cavities, as in railway accidents. The severe mechanical injury is sometimes accompanied by a considerable efiTusion of blood, so that the person really dies from hemorrhage but in other instances the quantity of blood lost is inconsiderable, and the fatal effects may be referred to shock to the nervous system. Sometimes a slight amount of violence may prove suddenly fatal. These are, however, to be regarded as excep- tional instances. 3. Death from Shock. — This is sometimes a direct cause of death under the infliction of external violence ; and in this case life is destroyed with- out the injury being to all appearance sufficient to account for so speedily fatal a result. On several occasions persons have died in railway colli- sions from no physical injury, but purely from shock to the system. In a collision, which took place in 1873 at the Durham station, a Mrs. Coble 310 DEATH FROM SHOCK. was among the dead. On a post-mortem examination there was no ap- pearance of external or internal violence. Savory has suggested that death from shock is nothing more than death from temporary exhaustion of nerve-force, the result of a violent, sudden, and excessive expenditure of it. (Lect. on Life and Death, p. 171.) Whatever theory may he adopted to explain it, there is no doubt that a i)erson may die from what is termed shock, without any marks of severe injury being discovered on his body after death. We have examples of this mode of death in acci- dents from lightning, or from severe burns or scalds, in which the local injury is often far from sufficient to explain the rapidly-fatal consequences. As instances of this form of death from violence, may be also cited those cases in which a person has been suddenly killed by a blow upon the upper part of the abdomen or on the pit of the stomach, an accident which is supposed to operate by producing a fatal impression on the nerves and nerve-ganglia of the cardiac plexus. Whether this be or be not the true explanation, it is admitted by experienced surgeons that a person may die from so simple a cause without any mark of a bruise externally, or physi- cal injury internally to account for death. On the skin there may be some abrasion or slight discoloration ; but, as it has been elsewhere stated, these are neither constant nor necessary accompaniments of a blow. Concussion of the brain, unattended by visible mechanical injury, fur- nishes another example of this kind of death. A man receives a severe blow on the head; he falls dead on the spot, or becomes senseless and dies in a few hours. On an inspection, there may be merely the mark of a bruise on the scalp ; in the brain there may be no rupture of vessels or laceration of substance, and all the other organs of the body may be found healthy. In railway accidents persons have died under somewhat similar circumstances. There has been no physical indication of a mortal injury, and no cause apparent to account for death. This can be referred only to the shock or violent impression which the nervous system has sustained from the blow or violence — an impression which the vital powers were wholly unable to counteract or resist. A medical Avitness must give his evidence with caution in such cases; since it is the custom to rely in the defence upon the absence of any visible mortal wound or physical injury to account for death, as a proof that no injury was done — a principle which, if once unrestrictedly admitted, would leave a larger number of deaths, undoubtely occurring from violence, wholly unexplained. There is another form of shock which is of some importance in medical jurisprudence. A person may have received many injuries, as by blows or stripes, not one of Avhich, taken alone, could, in medical language, be termed mortal ; and yet he may die directly from the effects of the vio- lence, either on the spot, or very soon afterwards. In the absence of any large effusion of blood beneath the skin, death is commonly referred to exhaustion ; but this is only another mode of expression ; the exhaustion is itself dependent on a fatal influence or impression produced on the ner- vous system. A prize-fighter, after having sustained during many rounds numerous blows on the body, may either at or after the fight sink and die exhausted. His body may present marks of bruises, or even lacerated wounds, but there may be no internal changes to account for death. In common language, there is not a single injury which can be termed mortal ; and yet, supposing him to have had good health previously to the fight, and all marks of disease indicative of sudden death to be absent, it is impossible not to refer his death to the direct effect of the violence. It is a well-ascertained medical fact, that a number of injuries, each compara- tively slight, are as capable of operating fatally as any single wound MORTALITY OF WOUNDS. 311 whereby some bloodvessel or organ important to life is directly affected. Age, sex, constitution, and a previous state of health or disease, may accelerate or retard the fatal consequences. In Reg v. Slane and otliers (Durham Wint. Ass., 1872), it was proved that the deceased had sustained severe injuries to the abtlomen by kicks and other violence, but there were no marks of bruises. On a post-mortem examination, all the organs M'erc healthly. I^evertheless, death took place twenty minutes after the mal- treatment. Death was attributed to shock, and the prisoners were con- victed of murder. A case of manslaughter involving this question was tried (Reg v. McGowan and others, Leicester Ass., Nov. 1877), vvhere three men were charged with the murder of the deceased. It was proved that he had been maltreated by kicking, and by blows inflicted with heavy stones. He died in four days, obviously from the effects of the violence. The medical evidence showed that the nasal bones were much fractured as by a blow from a heavy stone, and that there were fractures of one clavicle and of several ribs. The witness assigned the cause of death to shock to the system, from the number of injuries received and the inflammation set up by them. The whole of the injuries in his opinion combined to cause death. The prisoners were convicted. From these considerations, it is obviously unreasonable to expect that in every case of death from violence or maltreatment there must be some specific and visible mortal injury to account for this event. When the circumstances accompanying death are unknown, a medical opinion should certainly be expressed with caution ; but if we are informed that the deceased was in ordinary health and vigor previous to the infliction of the violence, and there is no morbid cause to account for his sudden illness and death, there is no reason why we should hesitate in referring death to the effects of a number of injuries. Among non-professional persons an unfounded prejudice exists that no person can die from violence unless there is some distinctly mor-tal wound actually inflicted on the body. By this we are to understand a visible mechanical injury to some organ or bloodvessel important to life ; but this is obviously an erroneous notion, since death may take place from the disturbance of the functions of an organ important to life, without this being necessarily accompanied by a perceptible alteration of structure. The prevalence of this popular error often leads to a severe cross-examination of medical witnesses. Among the questions put, we sometimes find the following : Would you have said, from the wounds or bruises fl7o??e, that they were likely to have occasioned death ? Now, in answer to this it may be observed that we cannot always judge of the probability of death ensuing, from the appearance of external violence alone. Because the appearances were slight, it would be wrong to infer that they were not sufficient to cause death by shock. Then it may be inquired, Were the wounds or bruises mortal? In the vulgar sense of the word, i.e. by producing great loss of blood, or a destruction of parts, they might not be so ; but in a medical view they may have acted mortally by producing a shock to the nervous system. Again, it may be inquired, Which of the several wounds or bruises found on the body of the deceased was mortal ? The answer to this question may be, not one individually, but all contributed to occasion death by syncope or exhaustion. It must be remembered that in cases in which a person has sustained a number of injuries, the loss of a much smaller quantity of blood than in other instances will suffice to destroy life. When there are several wounds, it is difficult to decide on their relative degree of mortality, and on the share which each may have had in causing death. By a wound being of itseU mortal, we are to understand that it is 312 MORTALITY OF WOUNDS. capable of causing death directly or indirectly, in spite of the best medical assistance. It is presumed that the body is healthy, and that no cause has intervened to bring about, or even accelerate, a fatal result. The cir- cumstance of a person laboring under disease when wounded in a vital part, will not, of course, throw any doubt upon the fact of such a wound being necessarily mortal, and of its having caused death. If there should be more wounds than one, it is easy to say, from the nature of the parts involved, which was likely to have led to a fatal result. In order to deter- mine, on medical grounds, whether a wound was or was not mortal, we mav propose to ourselves this question — Would the deceased have been likelv to die at the same time, aud under the same circumstances, had he not received the wound ? There can obviously be no general rule for determining the mortal nature of wounds. Each case must be judged by the circumstances which attend it. In some Continental States, the law requires that a medical witness should draw a distinction between a wound which is absolutely and one w^hich is conditionally mortal. An absolutely mortal wound is defined to be that in which, the best medical assistance being at hand, being sent for, or actually rendered, the fatal event could not be averted. Wounds of the heart, aorta, and internal carotid arteries, are of this nature. A con- ditionally mortal wound is one in which, had medical assistance been at hand, been sent for, or timely rendered, the patient would, in all proba- bility, have recovered. Wounds of the brachial, radial, and ulnar arteries may be taken as instances. The responsibility of an assailant is made to vary according to the class of injuries to which the wound may be referred by the medical witnesses ; and, as it is easy to suppose, there is seldom any agreement on this subject. Our criminal law is entirely free from such subtleties. The effect of the wound, and the intent with which it was inflicted, are looked to ; its anatomical relations, which must depend on pure accident, are never interpreted in a prisoner's favor. Some extenua- tion may, perhaps, be occasionally admitted w^hen a wound proves mortal through an indirect cause, as inflammation or fever, and medical advice was obtainable, but not obtained until every hope of recovery bad disap- peared. It appears, however, from the case of Reg. v. Thomas and others (Gloucester Aut. Ass., 1841), that the mere neglect to call in medical assistance is not allowed in law to be a mitigatory circumstance in the event of death ensuing. The deceased died from the effects of a severe injury to the head, inflicted by the prisoners, but had had no medical as- sistance. The judge said it was possible that " if he had had medical advice, he might not have died ; but whoever did a WTongful act must take the whole consequences of it. It never could make any difference w^hether the party injured had or had not the means or the mind to apply for medical advice." The prisoners were convicted. According to Lord Hale, if a man be wounded, and the wound, though not in itself mortal, turn to a gangrene or fever for want of proper applications, or from neglect, and tlie man die of gangrene or fever, this is homicide in the aggressor ; for though the fever or gangrene be the immediate cause of death, yet the wound, being the cause of the gangrene or fever, is held the cause of death. These nice questions relative to the shades of re- sponsibility for personal injuries, occasionally arise in cases in which persons have been wounded at sea on board a ship in which there was no surpreon. DEATH FROM LATENT DISEASE. 313 CHAPTER XXIX. DEATH OF WOUNDED PERSONS FROM NATURAL CAUSES. DISTINCTION BETWEEN REAL AND APPARENT CAUSE. DEATH FROM WOUNDS OR LATENT DISEASE. ACCELERATING CAUSE. DEATH FROM WOUNDS AFTER LONG PERIODS. AVOIDABLE CAUSES OP DEATH. NEGLECT. IMPRUDENCE. UNSKILFUL TREATMENT. UNHEALTHY STATE OF BODY. Death of Wounded Pei^ sons from Natural Causes. — It is bj no means unusual for individuals who have received a wound, or sustained some personal injury, to die from latent natural causes ; and as, in the minds of non-professional persons, death may appear to be a direct result of the injury, the case can only be cleared up by the assistance of a medical practitioner. Such a coincidence has been witnessed in many instances of attempted suicide. A man has inflicted a severe wound on himself while laboring under disease ; or some morbid change tending to destroy life has occurred subsequently to the infliction of a wound, and death has fol- lowed. Without a careful examination of the body, it is impossible to refer death to the real cause. The importance of an accurate discrimina- tion in a case in which wounds or personal injuries have been caused by another, must be obvious on the least reflection. A hasty opinion may involve the accused in a charge of manslaughter ; and although counsel might be able to show on the trial that death was probably attributable, not to the wound, but to the co-existing disease, yet it must be remem- bered that the evidence of a surgeon before a coi'oner or magistrate, in re- mote parts of this country, may be the means of causing the person chai'ged to be imprisoned for some months previously to the trial. This is in itself a punishment, independently of the loss of character to which he must be in the mean time exposed. Death from Wounds or Latent Disease. — A natural cause of death may be lurking within the l)ody at the time that a wound is criminally inflicted, and a close attention to the symptoms preceding and the appearances after death, can alone enable a surgeon to distinguish the real cause. A man may be severely wounded, and yet death may take place from rupture of the heart, the bursting of an aneurism, from apoplexy, phthisis, or other morbid causes which it is here unnecessary to specify. (Cormack's Ed. Jour,, 1846, p. 343.) If death can be clearly traced by an experienced surgeon to any of these diseases, the assailant cannot be charged with manslaughter ; for the medical witness may give his opinion that death would have taken place about the same time and under the same circum- stances whether the wound had been inflicted or not. On these occasions one of the following questions may arise : Was the death of the person accelerated by the wound; or Avas the disease under which he was laboring so aggravated by the wound as to produce a more speedily fatal termination ? The answer to either of these questions must depend on the circumstances of each case, and the witness's ability to draw a proper conclusion from these circumstances. The maliciously accelerating of the death of another, already laboring under disease, is criminal; for in a legal sense that which accelerates, causes. In Reg. v. Timms (Oxford Lent Ass., 1870), it was proved that the prisoner had struck the deceased some blows on the head with a hatchet. In twelve 314 DEATH FROM LATENT DISEASE. days, under treatment, he had partly recovered from the effects; but in six weeks afterwards he was seized with iiiflamniation of the brain, with couviilsious, and died. On insi)ection, disease of the kidneys was found, of which there had been no sym])tonis. Death was referred to this disease and to inflammation of the brain as the result of the l)lows. The judge directed the jury that if they believed the blows conduced in i)art to the death of the deceased it was manslaughter, notwithstanding that other causes had combined with the blows to account for death. The prisoner was convicted. But there may be no connection between the violence and the disease causing death. In this case a charge of murder falls to the ground. A man struck his father a blow upon the back of the head with a hammer, inflicting a scalp-wound, with no signs of injury to the brain itself The avowed object was to kill the f\ither. As the injury was apparently not seriovts, the a.ssailant was summarily sentenced by a magistrate to two months' imprisonment, a punishment which the father — a drunkard — thought inadequate. Hereupon the father became greatly excited — hemiplegic six days after the infliction of the wound — and died three days later. On post-mortem examination the occipital bone was found indented at the seat of the blow, and there was a depressed fracture of the inner table of the skull at the point corresponding to the external injury. There was no effusion of blood on the surface of the brain in the neighborhood of the injui-y, but a large clot Avas found in the lateral ven- tricle. Under these circumstances two medical men very properly gave it as their opinion that the immediate cause of death was apoplexy, the clot being in the usual position in such cases, and that there was nothing in the history of the case, or in the appearances after death, that would justify them in stating that the effusion of blood, or, in other words, the man's death, was caused by the injury ; and, in spite of the remarks of the judge, the prisoner was acquitted. (Reg. v. Saxon, Lancashire Sum. Ass,, 1884, Med. Chron., vol. i, p. 118.) In Reg. v. Thompson (Liver- pool Sum. Ass,, 1876), involving a charge of murder, it was proved that the prisoner had stabbed his wife in the cheek, producing a severe but not a mortal wound. This was on April 1st. The deceased was taken to an infirmary, and was there delivered of a child on the 3d. She was at- tacked with puerperal fever and died on the 12th It was properly stated by the medical witness that there was no necessary connection between the wound and the fever. The prisoner was acquitted of the charge of murder, and his life was saved. He was found guilty of wounding with intent to murder. In another case, Reg v. Hodgson (Leeds Sum. Ass., 1876), the prisoner was charged with the manslaughter of his wife by striking her with a belt, A short time after the blow she fell back and died suddenly. The proximate cause of death was proved to be heart- disease, the violence not being sufficient to account for it. The prisoner was acquitted. In 1873 an inquest was held at Haslar Hospital on the body of one Rollings The deceased was struck by a seaman and fell with his right arm under him, breaking the two bones of his forearm just above the wrist. He died rather suddenly soon after the violence, and as this did not seem adequate to account for death, a careful inspection was made and it w^as then found that death had resulted from disease of the heart. Lord Hale, in remarking upon the necessity of proving that the act of a prisoner caused the death of a person, says, " It is necessary that the death should have been occasioned by some corporeal injury done to the party by force, or by poison, or by some mechanical means which occa- sioned death ; for although a person may, inforo conscientiae, be as guilty of murder by working on the passions or fears of another, and as certainly WHICH OF TWO WOUNDS CAUSED DEATH? 315 vDccasion death by such means, as if he had used a sword or pistol for the purpose, he is not the object of temporal punishment." Several acquittals have taken place of late years in cases in which the deaths of persons have been occasioned by terror, or dread of impending- danger produced by acts of violence on the part of the prisoners, not, however, giving rise to bodily injury in the deceased. Under 14 and 15 Yict., c. 100, the necessity for tracing death to some corporeal injury appears to be practically abolished. According to sec 4, in any future indictment for murder or manslaughter it shall not be necessary to set forth the manner or the means by which the death of the deceased was caused. This question arose in Reg. v. Heany (Gloucester Lent Ass., 18*75), The prisoner was charged with the manslaughter of his wife. She was suffering from cancerous disease. In the course of an altercation the prisoner held up a knife in a threaten- ing manner, but without touching her. This produced a shock, and she died two days after from fright. The prisoner was acquitted, as there was no distinct proof of the acceleration of death by this act. He was convicted of an assault. Which of Two Wounds caused Death? — A man may receive two wounds on provocation, at different times and from different persons, and die after receiving the second : in such a case, the course of justice may require that a medical witness should state which wound was the cause of death. A man receives during a quarrel a gunshot-wound in the shoulder. He is going on well, with a prospect of recovery, when in another quarrel he receives a severe penetrating wound in the chest or abdomen from another person, and, after lingering under the effects of these wounds, he dies. If the gunshot-wound was clearly shown to have been the cause of death, the second prisoner could not be convicted of manslaughter ; or if the stab was evidently the cause of death, the first prisoner would be acquitted on a similar charge. It might be possible for a surgeon to decide the question summarily, when, for instance, death speedily followed the second wound ; and, on inspection of the body, the heart or a large vessel is discovered to have been penetrated ; or, on the other hand, extensive sloughing, sufficient to account for death, might take place from the gunshot-wound, and, on inspection, the stab might be found to be of a slight nature, not involving any vital parts. In either of these cases, all would depend upon the knowledge, skill, and judgment of the medical practitioner ; his evidence would be so important that no correct decision could be arrived at without it ; he would be, in fact, called upon substantially to distinguish the guilty from the innocent. In Reg. v. Foreman (C. C. C., Feb. ISTS), this question arose. The prisoner, it was proved, had struck the deceased some severe blows on the head. A fort- night afterwards the deceased, who had partially recovered, had a fight with another man, during- which he again received severe blows on his head. In another fortnight he had paralysis of the left side, and died in a hospital a few days afterward. On inspection a large abscess in the brain was found, which was the cause of the symptoms and death. The question was whether this abscess had arisen from the blows given by the prisoner, or from the violence sustained a fortnight afterward. On this point there was no satisfactory medical evidence, and as the deceased had had no serious symptoms for a fortnight after the assault by the prisoner — in fact not until after the second fight — the jury acquitted him. On some occasions death may appear to be equally a consequence of either or both of the wounds; in which case probably both parties would be liable to a charge of manslaughter. (See Ann, d'Hyg., 1835, t. 2, p 432.) The second wound, which is here supposed to have been the act of 316 DEATH FROM SLIGHT PERSONAL INJURIES. anotber, may be inflicted by a wounded person on liimself, in an attempt at suicide, or it may have an accidental origin. Tlie witness would then have to determine whether the wounded person died from the wound inflicted by himself or from that which he had previously received. In the Walworth murder, which occurred in 1873, a grocer's assistant pursued a man who had stolen a parcel from a cart, and the thief took refuge in a coal- shed, followed by the assistant. The latter was stabbed by the former twice in the abdomen on the right and left of the navel. The larger wound on the left suppurated, whilst the smaller wound on the right healed at once. The man died of peritonitis. On post-mortem examination, the editor found that the suppurating wound, which had been suiiposed to be the fatal one, did not involve a vital part; but that the small wound on the right, made by a knife, passed u})wards and Ijackwards, transfixing the liver, and puncturing the gall-bladder. The peritonitis was conse(juent on the escape of bile into the abdominal cavity. There was reason to believe that the non-fatal stab was first inflicted purposely, and the second and fatal wound might possibly have been caused by the deceased rushing upon the knife, held as it were in self-defence by the thief, who has never been discovered. It is not difficult to conceive what complications might arise in a trial for murder under such circumstances. It may happen that the wounded person has taken poison, and has actu- ally died from its effects, and not from the injuries or maltreatment. Again, a wounded person may have been the subject of subsequent ill- treatment, and the question will arise — to which of the two causes his death was really due. It is to be observed of these cases that the supervening disease, the poison, or the subsequent ill-treatment, should be of such a nature as to account for sudden or rapid death; since it would be no answer to a charge of death from violence to say that there were marks of chronic disease in the body, unless it was of such a nature as to account for the sudden destruction of life under the symptoms which actually preceded death. In the medical jurisprudence of wounds, there is proba- ably no question which so frequently presents itself as this: it is admitted that the violence was inflicted, but it is asserted that death was due to some other cause, and the onus of proof lies on the medical evidence. Among numerous cases which occurred in England during a period of twenty years, the author found that the latent causes of death as regis- tered in wounded persons have been 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. In some of these cases the person was in a good state of health up to the time of the violence, and in others there was merely a slight indisposition. The history was nearly the same in all : it was only by careful conduct on the part of the medical witnesses that the true cause of death was ascertained. It is obvious that questions of malapraxis aud life insurance, giving rise to civil actions, may have a close relation to this subject. Death following Slight Personal Injuries. — An imputation has occa- sionally been thrown on the master of a school when a boy has died soon after he has been punished in an ordinary way, and when there has been no suggestion that an undue amount of violence was used. In such cases there has been commonly some unhealthy state of the body to explain the fatal result. When the disease that gives rise to doubt is seated in a part remote from that which sustained the violence, all that is required is that the examination of the body should be conducted with ordinary care. If the disease should happen to be in the part injured (the head or chest), DEATH FROM WOUNDS AFTER LONG PERIODS. 317 the case is more perplexing. The difficulty can then be removed only by attentively considering the usual consequences of such injuries. The vio- lence may have been too slight to account for the diseased appearance ; and the disease itself, although situated in the part injured, may be re- garded as an unusual consequence of such an injury. On the other hand, the presence of chronic disease will form no exculpation of acts of violence of this nature. In Reg. v. Hopley (Lewes Aut. Ass., 1860), there was chronic disease of long standing in the brain of the diseased boy, but it was proved that he was quite well and suffered from no unusual symp- toms up to the time that a violent flogging was inflicted, and that this was followed by death in less than three hours from the commencement of the violence. It was not here a question of acceleration, for the de- ceased might have lived for years in spite of tbe existence of this chronic disease. In some cases slight blows have been followed by fatal conse- quences, even when no disease existed to account for the result. Annan describes a case in which a healthy girl of four received a slight blow on the shin, about three inches below the knee, from the shaft of a wheel- barrow. There was pain, but no external mark of violence. The iujury was considered to be so slight as to require no special treatment. On the following day there was increased pain. Severe constitutional symp- toms set in, and the child died on the fourth day. (Med. Times, 1854, ii. p. 238.) Death from Wounds after Long Periods. — Certain kinds of injuries are not immediately followed by serious consequences ; but a wounded person may die after a longer or shorter period of time, and his death may be as much a consequence of the injury as if it had taken place on the spot. The aggressor, however, is just as responsible as if the deceased had been directly killed by his violence, provided the fatal result can be traced to the usual and probable consequences of the injury. Wounds of the head are especially liable to cause death insidiously — the wounded person may in the first instance recover — he may appear to be going on well, when, without any obvious cause, he suddenly dies. It is scarcely necessary to observe that, in general, an examination of the body will suffice to deter- mine whether death is to be ascribed to the wound or not. In severe injuries affecting the spinal marrow, death is not an immediate conse- quence, unless that part of the organ which is above the origin of the phrenic nerves (supplying the diaphragm) is wounded. Injuries affecting the lower portion of the spinal column do not commonly prove fatal until after some days or weeks ; but the symptoms manifested by the patient during life, as well as the appearances observed in the body after death, will sufficiently connect the injury with that event. Death may follow a wound, and be a consequence of that wound at almost any period after its infliction. It is necessary, however, in order to maintain a charge of homicide, that death should be strictly and clearly traceable to the injury, and not be dependeut on any other cause. A doubt on this point must, of course, lead to an acquittal of the accused. Many cases might be quoted in illustration of the length of time which may elapse before death takes place from certain kinds of injuries, the injui'ed person having ultimately fallen a victim to their indirect conse- quences. A case is related by Astley Cooper, of a gentleman who died from the effects of an injury to the head received about two years pre- viously. The connection of death with the wound was clearly made out by the continuance of the symptoms of cerebral disturbance during the long period which he survived. Another case is mentioned by Hoffbauer, in which a person died from the effects of concussion of the brain as the result 318 SECONDARY CAUSES OF DEATH. of an injury received eleven years before. (Ueber die Kopfverletzungen, 1.842, p. 57.') There i.s a rule in our ]a\v relative to the period at wliich a person dies from a wound — namely, that the assailant shall not be adjud-j-ed g'uilty of murder, unless death takes place xoilhin a \jear and a day after the inflic- tion of the wound. To make the killing murder, the death must follow within a year and a day after the stroke or other cause of it. In practice, the existence of tiiis rule is of little importance, but in principle it is erro- neous. Most wounds leading to death generally destroy life within two or three months after their iufliction; sometimes the person does not die for five or six months ; and, in more rare instances, death does not ensue until after the lapse of twelve months, or even several years. The pro- tracted cases occur especially in respect to injuries of the head and chest. In Reg. V. Creuse (Shrewsbury Sum. Ass., 1873), the prisoner was chai'ged with the murder of a policeman (Lloyd), by knocking him down and kicking him on the chest and abdomen on June 20, 1872. Lloyd appeared to be much exhausted, but at first no serious injury was appre- hended. The assailant was brought before the magistrates, and imprisoned for the assault. The day after the assault Lloyd began to .spit blood, l)ut he continued to do duty until July 9th following. He then got gradually Avorse, and died on June 8, 1873, from the effects of the violence inflicted on him nearly a year previously. Had the deceased lived thirteen days longer the prisoner could not have been indicted for murder, as a year and a day would have elapsed after the stroke causing death. As it was, the jury found the prisoner guilty of manslaughter. Secondary Causes of Death. — A person who recovers from the imme- diate effects of a wound may die from fever, inflammation or its conse- quences, pyasmia, erysipelas, delirium tremens, tetanus, or gangrene ; or from an operation required during the treatment of a wound. These are what may be called secondary causes of death, or secondary fatal con- sequences of a wound. The power of deciding on the responsibility of an accused person for an event which depends only in an indirect manner on an injury originally inflicted by him, rests, of course, with the authorities of the law. But it is impossible that they can decide so difficult and nice a question in the absence of satisfactory medical evidence ; and, on the other hand, it is right that a medical witness should understand the im- portance of the duty here required of him. Pyaemia or erysipelas may follow many kinds of .serious wounds, and in some few instances be dis- tinctly traceable to them ; but, in others, the constitution of a person may be so' broken up by dissipated habits as to render a wound fatal, which in a healthy subject might have run through its course mildly and have healed. When the pyaemia or erysipelas can be traced to a wound, and there is no other apparent cause of aggravation to which either of the.se disordered states of the body can be attributed, they can scarcely be re- garded Ijy a medical practitioner as unexpected and unusual consequences, especially when the injury is extensive, and seated in certain parts of the body, as in the scalp. If death takes place under these circumstances, the prisoner will be held as much responsible for the result as if the wound had proved directly mortal. This principle has been frequently admitted by our law, and, indeed, were it otherwise, many reckless offenders would escape, and many lives would be sacrificed with impunity. It is, however, difficult to lay down general rules upon a subject which is liable to vary in its relations in every case ; but when a wound is not serious, and the secondary cause of death is evidently due to constitutional peculiarities from acquired habits of dissipation, the ends of justice are probably fully COMPARATIVE SKILL IN TREATMENT. 319 answered by acquittal ; in fact, such cases do not often pass beyond a coroner's inquest. The secondary causes of death may be arranged under the following heads : — 1. The cause is unavoidable. — Of this kind are tetanus, following laceration of tendinous and nervous structures ; erysipelas, following lacerated wounds of the scalp; peritoneal inflammation, following blows on the abdomen with or without rupture of the bladder or intestines, and effusion of their contents ; strangulation of the intestines (phrenic hernia), following rupture of the diaphragm ; and others of a like nature. Here, supposing proper medical treatment and regimen to have been pursued, the secondary cause of death was unavoidable, and the fatal result certain. 2. The cause avoidable by good medical treatment There are, it is obvious, many kinds of wounds, which, if properly treated in the first instance, may be healed and the patient recover, but when improperly treated they prove fatal. In the latter case it will be a question for a witness to determine how far the treatment aggravated the effects of the violence, and from his answer to this, the jury may have to decide on the degree of criminality which attaches to the accused. Let us suppose, for instance, that an ignorant person has removed a clot of blood which sealed up the extremity of a bloodvessel, in consequence of which fatal bleeding has ensued, or that he has caused death by unnecessarily interfering with a penetrating wound of the chest or abdomen : it would scarcely be just to hold the aggressor responsible, since, but for the gross ignorance and unskilfulness of his attendant, the wounded person might have recovered from the effects of the wound. When death is really traceable to the neg- ligence or unskilfulness of the surgeon who is called to attend on a wounded person, this circumstance ought to be, and commonly is, admitted in mitigation, supposing that the wound was not originally of a mortal nature. Lord Hale observes, " It is sufficient to constitute murder, that the party dies of the wound given by the prisoner, although the wound was not originally mortal, but became so in consequence of negligence or unskilful treatment ; but it is otherwise where death arises, not from the wound, but from unskilful applications or operations used for the purpose of curing it." The medical jurist will perceive that a very nice distinc- tion is here drawn by this great judge between death as it results from a wound rendered mortal by improper treatment, and death as it results from improper treatment irrespective of the wound. In the majority of cases such a distinction could scarcely be established, except upon specula- tive grounds, and in no case, probably, would there be any accordance in the opinions of medical witnesses. In slight and unimportant wounds, i-t might not be difficult to distinguish the effects resulting from bad treat- ment from those connected with the wound, but there can be few cases of severe injury to the person, wherein a distinction of this nature could be safely made; and the probability is that no conviction for murder would now take place if the medical evidence showed that the injury was not originally mortal, but only became so by unskilful or improi)er treatment. In such a case it would be impossible to ascribe death to the wound, or to its usual or probable consequences ; and without this it is not easy to per- ceive on what principle an aggressor could be made responsible for the result. 3. Comparative skill in treatment. — If death has been caused by a wound, the responsibility of an aggressor is not altered by the allegation that, under more favorable circumstances and with more skilful treatment, 320 DEATH FROM IMPRUDENCE OR NEGLECT. a fatal result might have been averted. At the same time it is obvious that a serious responsibility is thrown on practitioners who undertake the nianag-ement of cases of criminal wounding-. Any deviation from ordi- nary practice should therefore be made with the greatest caution, since novelties in practice will, in the event of a fatal result, form one of the best grounds of defence in the hands of a prisoner's counsel. On these occasions every point connected with the surgical treatment will be the subject of rigorous inquiry and adverse professional criticism. In the case of a severe lacerated wound in the hand or foot, followed by fatal tetanus, it may be said that the wounded person would not have died had amputa- tion been at once performed. In this instance, however, a practitioner may justify himself by showing, either that the injury was too slight to require amputation, or that the health or other circumstances connected with the deceased would not allow of its being performed Avith any reasonable hope of success. On the other hand, if the practitioner per- formed amputation, and the patient died, then it would be urged that the operation was premature, or wholly unjustifiable, and that it had caused death. Here the surgeon is bound to show that the operation was neces- sary according to the ordinary rules of practice. The treatment of severe incised wounds of the throat, when the windpipe is involved, sometimes places a surgeon in an embarrassing position. If the wound is left open, death may take place from bleeding; if it be prematurely closed, blood may be effused into the windpipe and cause death by suffocation. 4. The cause avoidable hut for imjwudence or neglect on the part of the wounded person. — A man who has been severely wounded in a quarrel may obstinately refuse medical assistance, or he may insist upon taking exercise, or using an improper diet, contrary to the advice of his medical attendant ; or by other imprudent practices he may thwart the best con- ceived plans for his recovery. Let us take a common case as an illustra- tion. A man receives a blow on the head in a pugilistic combat, from the first effects of which he recovers, but, after having received surgical assist- ance, he indulges in excessive drinking, and dies. The aggressor is tried on a charge of manslaughter, and found guilty. Death under these cir- cumstances is commonly attributed by the medical witness to effusion of blood on the brain ; but it cannot be denied that the excitement produced by intoxicating liquors will sometimes satisfactorily account for the fatal symptoms. (See Reg. v. Saxon, p. 314, ante.) In the case which we are here supposing, such an admission might Ije made, and the prisoner re- ceive the benefit of it; for the imprudence or negligence of a wounded person ought not, morally speaking, to be considered as adding weight to the offence of the aggressor. If the symptoms were from the first un- favorable, or the wound likely to prove mortal, circumstances of this kind could not be received in mitigation. Our judges have shown themselves at all times unwilling to admit them. The legal responsibility of the assailant is the same, whether the deceased died on the spot, or some days, weeks, or months afterwards, unless it can be distinctly proved that his death was immediately connected with the imprudence or excess of which he was guilty, and wholly independent of the wound. But, although a prisoner should be found guilty of manslaughter under these circumstances, the punishment is so adjusted by our law as to leave a considerable dis- cretionary power in the hands of a judge. This is, indeed, tantamount to a direct legal provision, comprehending each different shade of guilt ; a man is held responsible for a wound rendered accidentally mortal by events over which he could have had no control, but which in themselves ought to be regarded as in some degree exculpatory. The punishment attached ABNORMAL STATES OF THE BODY. 321 to his offence may be severe or slight, according to the representation made by a medical witness of the circumstances which rendered the wound mortal ; if he neglect to state the full influence of imprudence or excess on the part of the wounded person, where either has existed, over the progress of the wound, he may cause the prisoner to be punished with undue severity. The humanity of our judges is such that, when medical evi- dence is clear and consistent on a point of this nature, and there are no circumstances in aggravation, they commonly pass a mild sentence. The neglect to call in a medical practitioner, or the refusal to receive medical advice, will not, however, according to the decision in Reg. v. Thomas (Gloucester Aut. Ass., 1841), be considered a mitigatory circumstance in favor of the prisoner, even although the wound was susceptible of being cured. A man may receive a lacerated wound of a limb, which is followed by tetanus or gangrene, and thus proves fatal ; he may have declined re- ceiving medical advice, or have obstinately refused amputation, although proposed by his medical attendant. This would not operate as a mitiga- tory circumstance on the part of an assailant, because a wounded person is not compelled to call for medical assistance, or to submit to an operation, while a medical witness could not always be in a position to swear that the operation would have certainly saved his life ; he can merely state that it might have afl'orded him a better chance of recovery. Again, a person may receive a blow on the head producing fracture, with great depression of bone and symptoms of compression of the brain ; a surgeon may pro- pose the operation of trephining to elevate the depressed bone, but the friends of the wounded man may not permit the operation to be per- formed. In such a case, the line of duty of the witness will be to state the facts to the court, and it is probable that, in the event of conviction, there would be some mitigation of punishment ; because such an injury, if left to itself, must in general prove mortal, and no doubt could exist in the mind of any surgeon as to the absolute necessity for the operation. But the neglect or improper conduct of a person who receives a wound thus rendered fatal does not exculpate the aggressor. The crime is either murder or manslaughter. 5. The cause avoidable but for an abnormal or unhealthi/ state of the body of the wounded person. — Wounds which are comparatively slight sometimes prove indirectly fatal, owing to the person being in an unhealthy condition at the time of their infliction. In bad constitutions, compound fractures or slight wounds, which in a healthy person would have a favor- able termination, are followed by gangrene, pyemia, or erysipelas, proving fatal. Here the responsibility of an assailant for the death may become reduced, so that, although found guilty of manslaughter, a mild punish- ment might be inflicted. The consequence might be, medically speaking, unusual or unexpected, and, but for circumstances wholl}^ independent of the act of the accused, would not have been likely to destroy life. In general, in the absence of malice, this appears to be the point to which the law closely looks, in order to make out the responsibility of the accused — namely, that the fatal secondary cause must be something not unusual or unexpected as a consequence of the particular injury. The medico-legal question presents itself under this form — "Would the same amount of in- jury have been likely to cause death in a person of ordinary health and vigor? A man otherwise healthy, laboring under rupture, may receive a blow on the groin, attended with laceration of the intestines, gangrene, and death ; another with a calculus in the kidney may be struck in the loins and die, in consequence of the calcnlus perforating the bloodvessels and causing fatal bleeding or subsequent inflammation. In these cases the 21 322 ABNORMAL STATES OF TlIE BODY. effects of the violence must be rofrai'ded as something: unexpected ; it would ■not have produced serious mischief in an ordinarily healthy person, and hence the responsibility of an assailant becomes much diminished. The crime is undoubtedly manslaughter, but the punishment may be of a lenient description. A defence of this kind will, however, be limited by circumstances. A case is reported, in which a Dr. Faljricius was tried at the Old Bailey for the murder of his servant by striking her a blow be- hind the ear whereby a large abscess, situated at that part, was ruptured, and this ultimately caused her death. The chief question at the trial was, whether the deceased had died from the effects of the violence, or from the disease under which she was at that time laboring. The doctor Ingeniously urged in his defence that he had struck the blow merely for the purpose of opening the abscess. The jury, however, did not agree in taking this professional view of the matter, and they found him guilty of manslaughter. It must be evident that there exist numerous internal diseases, such as aneurism and various morbid affections of the heart and brain, which are liable to be rendered fatal by slight external violence. The law, as ap- plied to these cases, is thus stated by Lord Hale: "It is sufficient to prove that the death of a person w^as accelerated by the malicious act of the prisoner, although the former labored under a mortal disease at the time of the act. " In those cases in which a slight degree of violence has been followed by fatal consequences, it is for a jury to decide, under all the circumstances, upon the actual and specific intention of the prisoner at the time of the act which occasioned death. According to Starkie, "it seems that in general, notwithstanding any facts which tend to excuse or alleviate the act of the prisoner, if it be proved that he was actuated by prepense and deliberate malice, and that the particular occasion and cir- cumstances upon which he relies were sought for and taken advantage of merely with a view to qualify actual malice, in pursuance of a precon- ceived scheme of destruction, the offence will amount to murder. " In most of these cases there is an absence of intention to destroy life, but the nature of the wound, as well as the means by which it was inflicted, will often suffice to show the intention o'f the prisoner. An accurate descrip- tion of the injury, if slight, may afford strong evidence in favor of the accused, since the law does not so much regard the means used by him to perpetrate the violence, as the actual intention to kill, or to do great bodily harm. Serious injury, causing death by secondary consequences, will ad- mit of no exculpation when an assailant was aware, or ought to have been aware, of the condition of the person whom he struck. Thus if a person notoriously ill, or a woman while pregnant, be maltreated, and death ensue from a secondary cause, the assailant will be held responsil)le; because he ought to know that violence of any kind to persons so situated must be attended with dangerous consequences. So, if the person maltreated be an infant or a decrepit old man, or one laboring under a mortal disease, it is notorious that a comparatively slight degree of violence will destroy life in these cases, and the prisoner would properly be held responsible. A wound which accelerates death causes death, and may therefore render the aggressor responsible for murder or manslaughter, according to the circumstances. The Commissioners appointed to define the criminal law on the subject of homicide thus express themselves: "Art. 3. It is hom- icide, although the effect of the injury be merely to accelerate the death of one laboring under some previous injury or infirmity, or although, if timely remedies or skilful treatment had been applied, death might have been prevented." This is conformable to the decisions of our judges. According to Lord Hale, if a man has a disease which in all likelihood DEATH FROM TETANUS. 323 would terminate his life in a short time, and another gives him a wound or hurt which hastens his death, this is such a killing as constitutes murder. 6. Abnormal Conditions. — When an assailant could not have been aware of the existence of a diseased or abnormal condition of parts in the wounded person, the question is somewhat different. In many persons the skull is preternaturally thin, and in most persons it is so in those places corresponding- to the Pacchionian bodies. In a case of this kind a moderate blow on the head might cause fracture, accompanied by effusion of blood, depression of bone, or subsequent inflammation of the brain and its membranes, any of which causes might prove fatal. In some persons, all the bones of the body are unusually brittle, so that they are fractured by the slightest force. Inflammation, gangrene, and death may follow, when no considerable violence has been used; but these being unexpected consequences, and depending on an abnormal condition of parts unknown to the prisoner, his responsibilit}' may not, ceeteris paribus, be so great as under other circumstances. This condition of the bones can be determined only by a medical practitioner. Facts of this kind show that the degree of violence used in an assault cannot always be measured by the effects, unless a careful examination of the injured part is previously made. 7. Difficulty of proof in death from secondary causes. — When a per- son is charged with having caused the death of another through violence terminating in some fatal disease, the case often admits of a skilful de- fence, and this in proportion to the length of time after the violence at Avhich the deceased dies. This disease, it may be urged, is liable to ap- pear in all persons, even the most healthy; or it may arise from causes unconnected with the violence. In admitting these points, it must be re- membered that death may be proved to have been indirectly a consequence of the wound by the facts: (1) that the supervention of the secondary cause, although not a common event, lay in the natural course of things; (2) that there did not exist any accidental circumstances M^hich were likely to have given rise to this secondary cause independent of the wound. The proof of the first point amounts to nothing, unless the evidence on the sec- ond point is conclusive. CHAPTER XXX. WOUNDS INDIRECTLY FATAL. TETANUS FOLLOWING WOUNDS. ERYSIPELAS. DELIRIUM TREMENS. GANGRENE. DEATH FROM SURGICAL OPERATIONS. ANESTHETICS. PRIMARY AND SECONDARY CAUSES OF DEATH. — UNSKILFULNESS IN OPERATIONS. PYEMIA. — ■ MEDICAL RESPONSIBILITY IN REFERENCE TO OPERATIONS. ACTIONS FOR MALAPRAXIS. Tetanus following wounds. — Tetanus frequently presents itself as a secondary fatal consequence of wounds, especially of those which are lacerated or contused, and affect nervous or tendinous structures. It has often occurred as a result of slight bruises or lacerations, when the injury was so slight as to excite no alarm ; and it is a disease which gives no warning of its appearance. Tetanus may come on spontaneously, i. e. independently of the existence of any wound on the body. Cases have been brought into the London hospitals, in which the only cause of this disease appeared to be exposure to cold or wet, or, in some instances, ex- posure to a current of air. It is scarcely possible to distinguish, by the 324 M'OUNDS — DEATH FROM ERYSIPELAS. syniptoms, tetanus from wounds Ctrauniatic) from that which occurs spon- taneously as a result of natural causes (idiopathic). In endeavoring to connect its appearance with a ])articular wound or personal injury, it should be observ(>d (1 ) whether there were any symptoms indicative of it before the maltreatment; (2) whether any probable cause could have intervened to produce it, between the time of its appearance and the time at which the violence was inflicted ; (3) whether the deceased ever rallied from the effects of the violence. The time at which tetanus usually makes its a])iKiarance, when it is the result of a wound, is from the third to the sixth day ; but it may not appear until three or four weeks after the injury, and the exciting cause may still be traced to the wound, which may have healed. When resulting from a wound, it is generally fatal. A medical i)ractitioner is bound to exercise great caution before he pro- nounces an opinion that a fatal attack of tetanus has arisen either from spontaneous causes, or from slight blows or personal injuries. A rigorous inquiry should be made into all the attendant circumstances. Slight punctured wounds, operating as a cause of tetanus, have been overlooked or only discovered by accident after death, and it is highly probable that many cases have been set down as idiopathic tetanus in which, by proper inquiry, the disease might have been traced to a wound or some personal injury. In one instance the tetanus was at first considered to be idio- pathic ; but shortly before death a small black mark was observed on the thumb-nail. On making inquiry, it was found that a few days previously to the attack a splinter of wood had accidentally penetrated the thumb. The patient attached so little importance to the acc'dent that he did not mention the circumstance to his medical attendant. This was no doubt the cause of the disease. (For two similar cases, see Brit. Med. Jour., 18Y2, ii. p. 594.) Many trials for murder and manslaughter have occurred in this country in which tetanus w^as the immediate cause of death ; and the defence has generally rested upon the probable origin of the disease from accidental causes. Erysipelas, like tetanus, may be a fatal result of slight injuries Wounds affecting the scalp are liable to be followed by this di.sease. Burns and scalds sometimes prove fatal through this secondary cause. Some persons are particularly prone to erysipelatous inflammation, and thus wounds comparatively slight may have a fatal termination. When a wounded person has died from this disease, an assailant cannot be made responsible for the fatal result, unless the erysipelas is clearly traced to the injury. The medical facts that the person assaulted has never recovered from the effects of the violence, and that the inflammation set up has suddenly as- sumed an erysipelatous character, are sufficient to establish this connec- tion. If there has been recovery, and an interval of some days has elapsed, a doubt may arise respecting the connection of the erysipelas with the violence inflicted. This disease is occasionally idiopathic, i. e. it appears like tetanus without any assignable cau,se. In Reg, v. Jones (Monmouth Lent Ass., 1873), the prisoner, a collier, was convicted of manslaughter under the following circumstances: the prisoner was fight- ing with another man, and the deceased, a woman, endeavored to part thenio The prisoner fixed his teeth savagely on her thumb, and bit her severely. The wound was poulticed. It was not until the fourth day that she had medical advice. Erysipelas had then commenced, and had caused great swelling of the limb up to the shoulder. She died in three weeks. The medical evidence was to the effect that she had died of ery- sipelas from the wound, but the fatal result was in a great measure due DEATH FROM SURGICAL OPERATIONS. 325 to an impaired state of healtli from excessive drinking. The prisoner was, notwithstanding-, found guilty. It is sometimes difficult to establish the connection of erysipelas with a wound, especially wiien the disease occurs some time after its infliction, and in a remote part of the body not implicated in the wound. When this connection cannot be distinctly made out, there Avill be an ac(|uittal. Delirium tremens is a disease which frequently presents itself as a secondary consequence of injuries in persons of intemperate habits. Whether the injury be slight or severe, this disease may easily supervene and prove fatal. It is observed occasionally as a consequence of opera- tions required for the treatment of wounded persons. The remarks made at p. 321 upon the influence of unhealthy constitutions on wounds, apply with especial force to cases of this description. Death frovi Surgical Operations. — In the treatment of wounds, sur- gical operations are frequently resorted to, and a wounded person may die, either during the performance of an operation, or from its consequences. A question will thence arise, whether the person who inflicted the wound should be held responsible for the fatal result. The law regards a sur- gical operation as a part of the treatment, and if undertaken bona fide, and performed with reasonable care and skill, the aggressor will be held re- sponsible, whatever may be the result. The necessity for the operation, and the mode of performing it, will be left to the operator's judgment. As the defence may turn upon the operation having been performed un- necessarily, and in a bungling and unskilful manner, it will be right for a practitioner, if possible, to defer it until he has had the advice and assist- ance of other practitioners. According to Lord Hale, if death takes place from an unskilful operation, performed for the cure of a wound, and not from the wound, the responsibility of the prisoner ceases ; but he does not appear to have considered that death may take place as a consequence of the most skilful operation required for the treatment of a wound, and yet be wholly independent of the wound itself. [If the death was due to the operation, no matter how skilfully performed, and was wholly independent of the wound itself, it is very doubtful whether the prisoner could be held responsible. Juries would be loth to convict in any case where the death clearly resulted from the operation, rather than from the wound itself, and there would be less risk of miscarriage of justice in applying the doctrine of Lord Hale, than to convict a prisoner for a death wholly due to the surgeon, which could not have been either foreseen or premeditated by the accused.] If the operation has been performed by the medical witness himself, and the necessity for its performance is questioned by counsel for the prisoner, it is open to the witness to give the requisite explanation in his evidence. It would appear from a case tried before Shee, J., that the necessity for an operation will not be assumed; but if called in question, it must be proved by witnesses for the prosecution. In Reg. v. Moreland (C. C. C, Sept. 1865), the prison threw the deceased on the ground and fractured his leg. The limb was amputated, and the man subsequently died. Counsel for the prisoner asked the surgeon from the hos])ital, who spoke to the death of the deceased, whether an operation was really necessary. The witness said he could not tell, as ho h;id not had charge of the case previous to the operation. Counsel then raised the question whether prisoner or the doctors had caused the man's death. The counsel for the prosecution suggested that the court might accept as a fact that amputation would not have been performed had it not been necessary ; but the judge said that would not do. They must deal with the case on the evidence before 326 DEATH FROM SURGICAL OPERATIONS. them. He then observed to the jury that, altliouuh undouldcdly am- putation would not be adopted at yuch a place as the London Hospital without the necessity for it, yet evidence to that efl'ect must be before them on oath. They could not act on what they had every reason to believe ; therefore they must acquit the prisoner. The failure of justice in this case rested with those who were concerned for the prose- cution. The operator, who could probably have satisfied the court that he had not cut off the wrong leg, and that there were good reasons lor performing- the operation, was not called as a witness; but in his place a witness was summoned who could not answer these necessary questions. Death is by no means an unusual result of severe operations, the secondary conse(|uences under which the patient may die being very numerous even when the case is skilfully managed. Sometimes the patient will die ou the table, although but little blood may have been lost. Fear, pain, and sudden shock to the nervous system have caused death under these circumstances. The most common indirect causes of death after severe operations are secondary hemorrhage, erysipelas, tetanus, delirium tremens, pysemia, and gangrene of the stump. Should an operation be unnecessarily or unskilfully performed, the re- sponsibility of an aggressor would, it is presumed, cease, if the death of a Avounded person could be clearly traced to it. Thus if, in carelessly bleed- ing, the brachial artery should be laid open (Ann. d'Hyg., 1834, t. 2, p. 445), or if, in performing amputation, a large artery be improperly secured, so that the patient in either case dies from loss of blood, the prisoner could not be equitably held responsible ; because it would be punishing him for an event depending on the unskilfulness of a medical practitioner. Ac- cording to Plat, B., a prisoner will be held responsible, if the original wound were likely to produce death, although unskilfully treated. Sup- posing the bleeding or amputation to be performed with ordinary care and skill, and yet, in the one case, inflammation of the veins, and in the other erysipelas, tetanus, gangrene, or fever should destroy life, the prisoner will be liable for the consequences. The practice of the law is strictly consistent with justice. Should the operation be considered to be absolutel)/ required for the treatment of a wound, which, according to all probability, would prove mortal without it; should it be performed with ordinary skill, and still death ensue as a direct or indirect consequence — it is only just that the person who inflicted the injury should be held responsible for the result. It is presumed in these cases that, were the patient left to himself, he would in all probability die from the effects of the wound. If, therefore, a surgeon, knowing that an operation would give a chance of saving life on such an occasion, did not perform it, it might be contended, in the defence, that the deceased had died, not from the wound, but from the incompetency and neglect of his medical attendant. Hence it follows that if, during this necessary treatment, unforeseen though not unusual causes cut life short, no exculpation should be admitted, if it went to attack the best-directed efforts made for the preservation of life, (See Ann, d'Hyg., 1835, t. 1, p. 231.) If an operation is rendered neces- sary by reason of the improper treatment of the wound, the responsibility of an assailant for a fatal result ceases. In another part of this work (p. 50) we have referred to the case of Kelly, who was tried for the murder of Tall)ot, (Reg. v. Kelly, Dublin Commis. Court, Nov. 1871.) The facts of this case, although made a subject of the most violent contention in a medical, legal, and political view, were really of a very simple kind. On July 12, tlie deceased re- DEATH FROM SURGICAL OPERATIONS. 327 ceived a pistol-shot wound at the back of his neck, and died from the effects on July IG. The bullet fractured and splintered the atlas, wouudiny and crushing the soft parts of the neck, and leading to the formation of an abscess in this ])art. The actual cause of death was inflammation of the spinal cord and its mcml)ranes. Stokes, who attended the deceased, considered it necessary to enlarge the wound for the purpose of removing the bullet, Avhich Avas then supposed to be lying within reach. In this operation a small artery (the occipital) was divided, but the quantity of blood lost was small; the bleeding was stopped by compression, and this bleeding had no influence in causing death. The defence was that the wound would not have proved fatal but for the bad surgical treatment ; that the probing of the wound was unnecessary, and that it was unskil- fully performed. There was the evidence of experts on both sides ; but the facts proved, apart from the opinions expressed, could leave no reason- able doubt that Stokes had treated the case with bona fides and with com- petent skill. The prisoner was positively identified by the deceased and others, and yet upon this evidence the jury returned a verdict of not guilty, (See Brit. Med. Jour., 1871, ii. p. 716.) The failure of justice in this case appears to have been chiefly owing to the fact that the jury were allowed to form their opinions on the surgical treatment pursued, whereas the rule of law is clear as to responsibility; and the only question which should have been submitted to them was, whether the prisoner was or was not the man who fired the pistol-shot. The English practice, as already quoted above, is that if a man unlawfully inflicts a dangerous wound on another, and the wounded person, after being treated by qualified practitioners acting with bona fides, and apply- ing themselves with the best of their ability to the case, dies of the wound, the man inflicting it is really guilty of murder, even although an erroneous treatment of the case by the practitioner ma}^ have been the cause of death. In fact, under no other rule would a medical man be safe in dealing with a case of criminal wounding. If Kellv's case were taken as a precedent, no surgical treatment should be adopted under these circumstances. The wound should be alloAved to take its mortal course. [In the case of People v. Stokes the wound, a pistol-shot, penetrated the abdomen and severed the intestines. Noiv, such a wound would not be con- sidered fatal ; then, it was so regarded. The subsequent investigation showed by Dr. Peugnet's analysis of the case, that the death was directly caused by the large doses of opiate administered by the surgeons. Had proper surgical treatment been resorted to, such as is in universal use in modern surgery, Fisk's recovery would have been certain. This case shows that it would be unsafe and dangerous, in a case where death resulted from ignorance of the surgeons whose bona fides could not be questioned, to hold the prisoner liable. It would be difficult, if not impossible, to induce juries to convict in such cases. There would always be a reasonable doubt as to whether the wound was absolutely mortal, which would influence juries and prevent convictions. Juries in this class of cases are the ultimate judges both in England and America. In Reg. v. Kelly there was no miscarriage of justice. It was clearly within the province of the jury to determine the question of fact as to the necessity of the operation, and the competency and skill of the surgeon in its performance. Had not the judge submitted these questions to the jury, it would have been in violation of all rules of law. They found that the operation was unnecessary and unskilfully performed, which brought the case under the doctrine of Lord Hale. It is doubtful if any jury would convict in such a case. (Van Hoaser v. BerghofT, 90 M. 328 DEATH FROM ANAESTHETICS IN OPERATIONS. 487 ; Carpenter v. Blake, 60 Bar N. Y., 488 ; vide also Law of Malpraxis, p. 357.)] Death from Ansesthetics in Surgical Operations. — In a large number of operations it is now the general practice among surgeons to administer chloroform, ether, or other antesthetics, not only to allay pain, but to prevent that exhaustion to the patient which is likely to arise from pro- tracted surgical proceedings. In spite of care on the part of the operator, these vapors are liable to destroy life in an unexpected manner, and the patient may die either before the operation is commenced, or during its performance. The facts may leave no doubt that the wounded person died from the anaesthetic, and not from the Avound or the operation. On in- spection of the body, the heart may be found in an unhealthy state, a fact which is usually considered sufficient to account for the fatal effects of chloroform vapor. In a case of this kind, what becomes of the responsi- bility of the person who inflicted the original wound? No decision, so far as we know, has ever been given on this point. Was the use of chlo- roform vapor in a professional view a necessary part of the treatment? Was it skilfully and properly administered? Could the diseased condi- tion of the heart which rendered the effects of the vapor more fatal than usual have been detected by the operator, so as to show the impropriety of administering it in this case? These questions should receive satisfac- tory answers before the aggressor is rendered responsible for death under such peculiar circumstances. An action was lirought against a medical man (Absolom v. Statham, Q. B., Nov. 1867) for forcibly administering chloroform to the plaintiff against her will, and extracting six of her teeth; also for careless and un- skilful treatment, whereby her health was injured. The medical evidence showed that the woman had consented to the operation, and that it had been properly performed; also that her health had sustained no injury by the chloroform or the operation, and that most of her symptoms were due to hysteria. Cockburn, C. J., in summing up the ease, said that the two charges or complaints were entirely distinct and different— one being for an assault, and the other for malpractice. The law was clear as to botn. No surgeon had a right to perform any operation against the will of the patient, so long as the j^aiient preserved consciousness and will; and if, therefore, the jury believed the plaintiff's story, then she was entitled to a verdict, although the amount of the damages would depend upon their im- pression as to Ithe extent of the injury. Then as to the other ground of complaint, the law was equally clear, that every medical practitioner was bound to bring a reasonable amount of skill and care to the performance of the duty he undertook. The jury found for the defendant on both grounds. This shows the state of the law in reference to the responsi- bility of medical men who undertake operations under ansesthetics. But there is another form in which a question of medical responsibility may present itself This is illustrated in the case of Lamb v. Barton and Bennett (Wicklow Sum. Ass., 1873). This was an action by a Avidow to recover damages for the death of her husband under chloroform by reason of the negligence and unskilfulness of the surgeons in administering it. Amputation was rendered necessary by an accident; chloroform was ad- ministere ; and the man died in five minutes, before the operation could be performed. The proof of negligence failed, and a verdict was returned for the defendants. (Brit. Med. Jour., 18T3, ii. p. 160.) By an operation being absolutely required, are we to understand that it is necessary to preserve life, i e., that the wound will probably prove fatal without it? Unless it could be sworn that the treatment was re- OPEKATIONS UNDER A MISTAKEN OPINION. 329 quired, in the judgment of the suvireon, for the preservation of life from the injury inflicted, it is doubti'iil whether, in the event of death occurring from such operation, the assailant would be held responsible for the fatal result. From cases hitherto decided, it would appear that the law regards three circumstances in death following surgical operations. First, the necessity of the operation itself second, the competency of the operator; and, third, whether the wound would be likely to prove mortal without it. Operations under a Mistaken Opinion. — It may happen that the wound is not of a mortal nature, and that, although an operation was skilfully performed, it was not necessary to save life; in other words, the wounded person may die from the immediate results of a serious operation, per- formed under a mistaken view of the case. A cancerous tumor has been occasionally mistaken for aneurism; or an artery has been secured, and death has followed. A case occurred in which the carotid artery was tied; and another in which the operation was performed on the common iliac artery for supposed aneurisms : in both of these instances the patients sank, and after death the tumors were proved not to have been aneurismal. The operations were not necessary, they proved fatal, and they had been performed under a mistake. In a case reported by Syme, the carotid artery was tied, and the patient died in a few days from loss of blood. After death it was found that the tumor was not an aneurism, but a cyst. (Dub. Med. Press., 1847, p. 302.) Let us assume that a man laboring under a slight aneurism of a large artery receives a blow on the part, the tumor gradually increases, and is mistaken for an abscess by three or four surgeons, whose professional standing would prevent their general competency from being questioned. Under a wrong diagnosis, it is opened, and the patient dies on the spot. In such a case it would be unjust to make the aggressor liable ; for, even admitting that the aneurism had resulted from the blow, and that a com- petent surgeon acted with bona fides, ihe treatment would be unskilful, and the case would fall under the rule laid down by Lord Hale {ante, p. 317). The real facts, however, may not transpire until after the death of the wounded person ; and it may then be alleged by a prisoner's counsel that the operation was not necessary to save life, and that the wounded man might have recovered without it. From the ruling of our judges on various occasions in which this question has arisen, it would ajjpear that the relative degree of skill possessed by medical men is not a question for a jury in a criminal case; although in a civil case, as in an action for malapraxis, the whole of the medical facts are invariably submitted to their judgment. This difference can only be justified by the assumption that a man who inflicts a wound must take all the consequences — good or bad. No operation would have been required but for the injury, and the prisoner ought not to escape on account of want of skill in a surgeon, oi of a mistake made by a skilful operator. It was decided in the cases oi Rex V. Quain and Reg, v. Pym, that, although the indictment alleged that the deceased died of the wound, while in fact he died from the results ol an operation, yet it was good in point of law. When a wounded person is taken to a hospital in which gangrene O) erysipelas is spreading, and be is attacked by one of these diseases before- or after the performance of an operation, and dies, a prisoner may be beiu responsible for the fatal result. It might be contended that the transpof- tation of the wounded man to such a locality was not absolutely necessary for his treatment, or for the preservation of his life, and that he would not have died but for the accidental presence of an infectious disease. Oases of this kind cannot easily be determined by any general rules. 330 DEATH FROM PYAEMIA. Pysemia. — la addition to erysipelas and tetanus, there is another cause of death which is lial)le to follow personal injuries and operations, namely pyaemia, or the introduction of pus into the blood by absorption or by the mouths of divided bloodvessels. The purulent matter acts as a poison. According- to Wilks's observations, pya;niia is seldom observed after super- ficial injuries during: the process of healing:, or after wounds resulting from sinijUe operations; but it occurs frequently when a bone is involved, either from the injury or as the result of an operation. Inflammation of the cellular membrane surrounding bone is a condition highly favorable to its occurrence. The medical witness must remember that pyaemia, like tetanus and erysipelas, may arise from causes totally irrespective of wounds or personal injuries. (Guy's IIosp. Rep., 1859, p. 179.) The modern antiseptic treatment of wounds has greatly reduced the risk of purulent infection and blood-poisoning ; and it is not improbable that the omission to employ antiseptic treatment in cases of Avounding may hereafter be largely made use of for the purposes of defence. Questions relative to responsibility in death following operations would come more frequently before courts of law, were it not that the cases are stopped in coroners' courts by verdicts of accidental death. (Lond. Med. Ga'z.", vol. 19, p. 151.) It often unfortunately happens that on these occasions there is a great difference of opinion among medical witnesses respecting the connection of the disease with the death, and indeed the necessity for the operation itself. The evidence of opinion in favor of the prosecution is sometimes balanced by that urged in defence, and, under these circumstances, the only course open to the court is to direct an acquittal. Differences of opinion upon these subjects among members of the profession tend to convey to the public the impression that there are no fixed principles upon which medical opinions are based, and, conse- quently, that it would be dangerous to act upon them. Thus it is that we are accustomed to hear of a medical prosecution and a medical defence, as if the whole duty of a medical jurist consisted in his making the best of a case on the side for which he happens to be engaged — adopting the legal rule for suppressing those points which are against him, and giving an undue prominence to others which may be in his favor. This is an un- fortunate condition of things, for which at present there appears to be no adequate remedy. Medical Besponsibilif y for Operations. Malapraxis. — This is a very wide subject, but it can here be only glanced at in a few of its leading- features. It was held by Lord Ellenborough that, if a person acting in a medical capacity be guilty of misconduct, arising either from gross ignor- ance or criminal inattention, by which a patient dies, he is guilty of man- slaughter. Faults — such as omissions, or errors in judgment, to which all are liable — are not visited with this amount of criminality. The same rule applies to the licensed as to the unlicensed practitioner ; but it would appear, from the charge of Williams, J. (Winchester Spring Ass., 1847), that a degree of unskilfulness v^^hich might lead to the conviction of a licensed, would justify the acquittal of an unlicensed person. This was in the case of a midwife alleged to have caused the death of a woman on whom she had been called to attend. " The charge," said the judge, "appeared to be that by want of skill or attention to her duties, she had caused the death of the woman upon whom she was attending. In order to constitute this offence, it must be shown that the party was guilty of criminal misconduct, either arising from gross ignorance or want of skill, or gross inattention. With respect to the degree of want of skill, he must sav that it was not to be expected that a midwife, who was called in to MEDICAL RESPONSIBILITY FOR OPERATIONS. 331 attend a person in the humble class of the deceased, a soldier's wife, should exhibit what a regular medical practitioner would call competent skill. It was enough if she applied that humble skill which, in ordinary cases, would lead to a safe delivery. She was not bound to have skill sufficient to meet peculiar and extraordinary exigencies, although in the case of a regular medical man such skill might be required. The class of this humble practitioner was absolutely necessary for the poorer classes, and, although on the one hand it was fit the law should protect a patient by punishing a person for gross want of skill, yet he thought there would be much to be lamented if it was applied with such severity as to render a party not possessing skill of this kind liable to punishment for man- slaughter." These observations would scarcely be strictly applicable in the present day, when certified midwives are generally available, at all events in our large towns. Charges of manslaughter have frequently been brought against medical practitioners in cases of midwifery. In some instances gross mismanage- ment has been proved ; the womb, and even parts of the viscera, have been torn away, and in such cases convictions have properly followed. It is well known, however, that much difference of opinion exists among the most eminent practitioners of midwifery respecting the treatment to be pursued in certain cases of difficulty, as where the afterbirth presents (placenta prasvia). There are eminent accoucheurs who advise in this case entirely opposite modes of practice, and who look upon that pursued by the other as of the most dangerous kind. When death is really not a result of the medical treatment, an action for damages may be brought against the practitioner on a charge of malapraxis. It has been a question whether slight deviations from the ordinary mode of performing operations should involve a medical men in a charge of malapraxis. We are not aware that this question has been hitherto raised in England. When on these occasions there is a division of opinion among men of equal experience respecting the necessity for an operation or the proper performance of it, a practitioner who is made defendant has a right to ex- pect that a verdict will be returned in his favor ; since it is not to be sup- posed that, in order to answer a charge of unskilfulness, a man's practice should receive the unanimous approval of the vjhole of his professional brethren, especially in cases in which there is an acknowledged difference of opinion respecting the treatment. All that appears to be expected is a reasonable accordance in treatment with received professional doctrines. [( Vide Malpraxis and the law upon that subject, p. 356. j] CHAPTER XXXI. CICATKIZATION OF WOUNDS. — EVIDENCE FROM CICATRICES. CHANGES IN AN INCISED WOUND. IS A CICATRIX ALWAYS A CONSEQUENCE OF A WOUND ? ARE CICATRICES WHEN ONCK FORMED INDELIBLE ? CHARACTERS OF CICATRICES. THEIR AGE OR DATE. CICATRICES FROM BLEEDING. CUPPING, SETONS, AND ISSUES CICATRICES FROM BURNS CICATRICES FROM DISEASE DISTINGUISHED FROM THOSE OF WOUNDS. Cicatrization of Wounds. — The time at which a particular wound was inflicted may become a medico-legal question, both in relation to the living- 332 CICATRICES F R il WOUNDS. and the dead. The identity of a person, and the correctness of a state- ment made by an accused party, may be sometimes determined by an examination of a wound or its cicatrix. So, if a dead body be found with marks of violence upon it, and evidence adduced that tlic deceased was maltreated at some particular period before his death, it will be necessary for a practitioner to state whether, from the appearance of the injuries, they could or could not have been inflicted at or about the time assigned. A case was tried (Re-htly elliptical, with its length in the direction of the vessel, and not across it. About sixty years ago bleedini^ from the arm was a frequent operation, the same person recpiiring to be bled at springy and fall. The cicatrices that resulted were always ])erceptible ; in some instances, when the person had been 1)led several times in or near the same part of the vein, a hard or knotted white cicatrix was produced, rising above the level of the skin. There is no reason to believe that such a mark, involving as it does the whole cutis, ever disappears. Beck quotes the case of a child (Noiseu), which had been bled in the right arm when sixteen months old. When nearly four years old the child Avas lost, and two years subsequently the godmother, seeing two boys pass, was struck by the voice of one of them ; she called him to her, and was con- vinced that it was her lost godson. The identity was also considered to be proved by the discovery of a cicatrix from bleeding in the right arm, and a cicatrix from an abscess in the left knee, both of which were present in the lost child, and also in the one that was found. The latter, however, had upon his body marks of the smallpox, while no marks of this kind were on the child when lost. The child was claimed by a widow (Labrie), and many witnesses deposed that it was really her son. The Court de- cided in her favor, chiefly on the ground that the lost child was not marked with the smallpox (Beck's Med. Jur., 2d ed., p. 222). It was admitted that the found child had, on the arm and knee, cicatrices similar to those which were known to exist in the one that was missing, and had the medical witnesses agreed about the causes of them, it is probable that the decision would have been different. The cicatrix on the knee was ascribed to the use of caustics by some of the surgeons, and to a slight abrasion by others. The widow admitted that her child had never been bled in the arm, while the missing child had certainly undergone this operation ; but on the question as to the presence of a cicatrix from bleed- ing, there was a conflict of medical opinion. Three surgeons examined the cicatrix, and declared that it had been made with a sharp instrument. Others deposed that it was not a cicatrix from bleeding, but from the opening of an abscess. As the child had been missing two years, it might have had the smallpox in the meantime. If a proper examination of the two cicatrices had been made by medical assessors appointed by the Court this conflict of medical opinion would not have arisen, and the de- cision might have been different. •" According to Caspar, the cicatrix left by venesection may sometimes disappear, although he adduces no fact in proof (Gerichtl. Med., vol. i. p. 113) ; and ordinary surgical experience is against it. Devergie correctly states that every wound which involves the thickness of the skin (cutis) leaves a cicatrix which is indelible. (M^d. Leg., vol. ii. p. 217.) Accord- ing to him, it may become less distinct by time, but it never entirely dis- appears. In all contested cases of this kind, where there is ample room for a difference of opinion, it would be more satisfactory to take the evi- dence of skilled medical assessors appointed by the Court, than to receive that of medical men specially selected by solicitors to uphold their different views of the case. This would be giving its true value to medical testi- mony, in aiding, by a proper interpretation of physical signs, to clear away the doubts which necessarily arise by trusting to a supposed remem- brance of the features, voice, and gesture, after the lapse of many years. At the celebrated Tichborne trial (Reg. v. Castro, Q. B., 1873), the SCARS CICATRICES FROM SETONS, ETC. 339 possibility of the disappearance of scars was made a matter of great im- portance as bearing- upon identity. Roger Tichborne, the missing baronet, whilst on the ship Pauline, met with an accident by which a fish-hook passed clean through one eyelid, and had to be pulled tlirough and out; and it was truly alleged that such a wound would leave a scar, and that this Avould probably be indelible. lie had also been bled, an operation which usually leaves indelible scars. It was also certain that, when a lad, Roger had either an issue or a seton on his left arm. According to the prosecution it was an issue, and was kept open by a pea. According to the defence it was a seton. On the defendant's arm there was no mark either of an issue or of a seton. Moreover, thei'e was no scar on the eye- lid such as would have been produced by the fish-hook. Further, Roger had his temporal vein opened when a young man ; and there was no scar on the defendant's temples. Although it must bo admitted that a vene- section-mark may disappear in the course of time, it is in the highest de- gree improbable that several cicatrices such as have been described would all disappear. The defendant was convicted of the attenipted imposture; or rather of perjury in swearing at the first (civil) trial that he was f^e veritable Sir Roger Tichborne (see p. 347, post). In the case of vene- section-marks a medical jurist may be required to give an opinion on the cause and date of their production; and in the case of the alleged disap- pearance of scars, he may be required to say whether — assuming them to have once existed — they could have disappeared, either from natural causes, or from chemical or other means employed to obliterate them. In some countries it is the custom to brand convicts, and the cicatrix from the brand-mark — a letter burnt into the skin — is regarded as the strongest proof of identity. By a remarkable coincidence, two persons may have cicatrices on or about the same pa-t of the body, produced by cuts, punctures, or abscesses in early life; and serious mistakes may be made under these circum- stances. A case is reported to have occurred in France, in 1794, in which a man named Lesurgues was tried, convicted, and executed for robbery and murder. There were some doubts at the time as to his identity ; and strong exertions were made to save his life. Soon after his execution, the real murderer was discovered, between whom and Lesurgues, who had had no hand or part in the crime, there existed a wonderful resemblance in stature, complexion, and features. But the most extraordinary part of the case was that Lesurgues, like the real criminal, had a cicatrix or scar on the forehead, and another on the hand ; and there is no doubt that these points of resemblance, which upon a proper scientific examination might have been proved to be really different, became the turning-point of the case, and led to the conviction of an innocent person. The parts selected for setons or issues are generally about the shoulder, the nape of the neck, or the upper arm. The situation of the cicatrices may thus serve to throw some light on their origin. The cicatrix left by an issue cannot be mistaken for the cicatrix caused by a seton. In the first place, it is single, depressed below the level of the skin, and rounded in its margin ; and, as in all cases in which the cutis is destroyed, it remains as an indelible mark. It is impossible by any process to restore to the skin its uniformity and evenness of surface. Malle has pointed out that the douljle cicatrix which is left by the application of a seton may present an appearance which might be mistaken for the entrance and exit- apertures of a bullet, since in both cases a band of hardened lymph may be felt between the two cicatrices. When a hard band of connection can- not be felt between them, the marks cannot be owing either to a builet or 340 CICATRICES FROM BURNS. a set on, but they may be due to a bite, or to separate wounds produced in the skin at or about the same time. With resi)ect to blisters, they produce only a superficial and temporary reddening of the cutis. They do not commonly leave a scar, unless their irritant action has extended to the substance of the cutis, and has led to ulceration and sup[)uration ; the ulcerated beiuf? separated from the non- ulcerated portions of the skin, and indicated, according- to Dupuytren, ))y an indelible brown mark. The cicatrices left as a result of the application of the true vaccine lymph have a peculiar irreg-ular honeycombed appearance, with white stniaks elig'htly depressed below the level of the surrounding skin. The spurious vaccine-mark is of a reddish color, not depressed, and not presenting the honeycombed appearance and white streaks of the cicatrix of the true pustule. The scars produced by smallpox are in the form of deep depressions, Bbowing a complete destruction of the cutis. Independently of the cicatrices from local injury, these cases of contested identity may present other physical signs, such as moles, nsevi (mother's marks), and other congenital defects to which ordinary witnesses may be able to testify. There can be no fallacy of memory touching the form, size, and position of such marks, and they differ from cicatrices in this — they cannot be artificially imitated. They may, it is true, be removed, but only by actual or the electric cautery, or by caustic applications. If thus removed, a cicatrix is left in the skin which is indelible. A case is reported by Beck, in which a girl, Salomd Muller, had been sold as a slave, but her identity as the child of German parents was proved after many years by two marks resembling moles about the size of coffee-grains, on the inside of the thighs. They were proved to have existed in the child, and they were proved to exist in the same parts of the body of the girl eighteen years afterwards. After much litigation, she was, upon this evidence, pronounced to be a free woman. (Med. Jur., vol. i. p. 662.) Cicatr'ices from Burns. — This subject has been fully investigated by Malle. (Ann. d'Hyg., 1810, t. 1, 422.) A superficial burn, in healing, produces a broad irregular cicatrix, var3nng from the form of the burning body. If the burn has extended to some depth below the cutis, the cica- trix is deep, and has a rounded margin ; but in the depression it is irregu- lar and contracted in proportion to its depth. Solid caustics produce cicatrices with regular edges, as the corrosive substance easily penetrates uniformly through the deep layers of the skin. Caustic liquids produce only superficial marks, unless they have been allowed to penetrate deeply, when, by the destruction of parts, they may give rise to deep and irregu- lar cicatrices. When the cutis is destroyed, an indelible cicatrix remains, whether it is the result of a burn from a heated solid, or from the chemical action of a highly corrosive liquid. In a case in which the strongest nitric acid was applied to the skin for the removal of a mole, the cicatrix produced was visil^le after twenty-five years. In the Whitechapel murder case (Reg. v. Wainwright, C. C. C, Nov. 17T5), the body of the deceased woman, Harriet Lane, was identified, spite of decomposition, and a year after death, by the presence of an old scar on the leg, the result of a "burn. The subject of cicatrices as they are found in the neck, whether arising from wounds, scrofulous disease, or burns, has been fully examined by Gutterbock, in an elaborate paper. (Yierteljahrsschr. fiir Gerichtl. Med., 1873, 2, p. 84.) TATTOO-MARKS. 341 CHAPTEE XXXIT. MEDICAL EVIDENCE OF IDENTITY FROM COLORED CICATRICES OR TATTOO-MARKS. MODE AND DATE OF PRODUCTION. DURABILITY OF THESE MARKS. THEIR ALLEGED SPONTA- NEOUS DISAPPEARANCE. CASES OF IDENTITY FROM TATTOOING. SIMULATED MARKS. — • TATTOO-MARKS ON THE DEAD. MEDICAL RESPONSIBILITY. The subject of tattooing- has been noticed by medical jurists. Several trials liave occurred of late years in France and Germany, which show the great importance of this subject in cases of contested personal identity. The Tichborne case (see pp. 338, 347), which occupied our law-courts for nearly two years, involved some issues of importance in relation to iden- tity from cicatrices and the marks of tattooing. The presence of tattooed or colored marks on the skin of a person, verified by a competent observer, may become the strongest possible proof of identity, and their proved ab- sence, if not accounted for or explained, may furnish the most convincing' evidence of non-identity. An escaped convict may allege that he never was tattooed. There may be no colored marks on his skin, but a medical expert may be able to demonstrate that there have been such marks, and that traces of them still exist. A man who is found to be tattooed may, in order to escape punishment, pass himself off as another person, also tattooed. In this case medical evidence must be derived from a compari- son of the color, form, and situation of the marks in the two. A tattooed man may claim an estate, and adduce the tattoo marks as a proof of his identity. It would be difficult for an impostor setting up a false claim to simulate marks of this kind. The operation would require time and an accurate imitation of the color and design, as well as of the part of the body selected. Members of the family would be able to say whether they were or were not such marks as those which had existed on their missing relative. There may be satisfactory proof that the missing person was tattooed, while an impostor may allege that he had not been tattooed. The fact, however, may be that at some former period of his life a man had undergone this operation, and, to prevent a discovery of his identity, he had removed the marks by cautery or other means. As the presence of tattoo-marks, and their correspondence in situation, color, and design with those on a missing person, would furnish the strongest possible evi- dence of identity, so their absence in a given case, unless clearly explained, must be considered as the best proof of non-identity. Colored Cicatrices, llode and Date of Production. — These marks arise from small punctured wounds made into the true skin with three or four sharp needles closely bound together. The needles are dipped in coloring matter at each time that the punctures are made. When the sub- stance of the cutis is penetrated, as it ought to be in order to leave a per- manent mark, there is, in a few hours, much swelling of the skin, wMth general inflammation. The colors commonly employed in tattooing are charcoal (gunpowder), China-ink, vermilion, and indigo. Other vegetable coloring matters of a fugitive kind are sometimes used. China-ink and charcoal, although black, produce designs on a white skin which have a bluish tint. The coloring matter thus deposited mechanically in these minute punctured wounds, after the first attack of inflammation has passed off, remains permanently encysted in the substance of the cutis or true 342 DURABILITY OF THE MARKS. skin and in the cellular niombraue below it. It has been there found after death. Aecordini;;- to Berchon, the local S3'ni))toms of irritation and ia- flannnation last about a fortnight. At the end of the first month the lines of color appear wider than they will bo ultimately. About the sixth week, the cuticle begins to scale oft"; and at the end of about two months, or a somewhat longer period, the skin acquires its normal condition. The de- signs in vermilion are at this early time much more intense than those in China-ink. When the local symptoms have subsided, the tattoo-marks are fixed, and it is impossible to assign a date to them. Durability of the Marks. Alleged Spo7Jtaneons Disappearance. — In imperfect cases of tattooing, when soluble and fugitive colors are used, and the surface of the cutis only is penetrated, the marks may disappear or be removed by artificial means. Not so when the coloring matter is carried completely into the substance of the cutis or true skin. It there forms an intimate combination with the fibrous structure of the skin, and remains permanently fixed. Rayer has shown by the maceration of tat- tooed skin that the cuticle may be removed, and it is colorless, as in ordi- nary skin. This, therefore, proves that the coloring matter is firmly im- bedded in the cutis and cellular tissue below it. (Ann. d'Hyg., 1855, t. 1, p. 194.) A maceration of the skin in water for two months did not affect the color of the tattoo-marks, and Tardieu found that no solvent could re- move the coloring matter without at the same time destroying the texture of the skin. Tattoo-marks are not removed, because the coloring matter is insoluble and cannot permeate the roots of the vessels. Silver marks are equally indelible when deposited from taking nitrate of silver inter- nally. Finely-divided substances, such as mercury, may penetrate; also finely-divided charcoal, taken into the intestines, has been found in the mesenteric veins. In 1874:, there was a case in Guy's Hospital that well illustrated the durability of these marks. The man, aet. 50, had been a sailor, and while in the China seas from 1842 to 1847 he was tattooed at diiferent times. There were numerous designs on both arms and the front of the chest, some of them artistically representing flowers and leaves, a flower-pot, and human figures. There were only two colors, blue-black and red, the former done with China-ink, the latter with ver- milion. The operation had been performed by an English sailor. Three needles were used — these, dipped into the color, were introduced deeply into the skin sideways, or in a valvular form, and the ink mixed with water was then well rubbed over. The vermilion was rubbed in as a powder. Some blood flowed, and after a few days the parts cicatrized, the scabs came away, and the man suffered no inconvenience. The marks were deeply imbedded in the cutis; some were deeper in tint and blacker than others, this result depending on the strength of the China-ink used. The colors had undergone no change up to 1874, although one of them at the back of the hand, representing a flower-vase with flowers, had been exposed to light and to frequent contact with water and other liquids, in- cluding naphtha, but it had made no difference in its appearance. The vermilion had also retained its color. It is a remarkable coincidence that on his left arm were the capital letters " R. C. T.," but these did not cor- respond to the initials of the name of the patient. The marks were un- changed after, at the lowest estimate, twenty-six years. In most anatomical museums, preparations of tattooed skin may be seen. In Guy's Hospital Museum there are many. The designs have been pro- duced with gunpowder, and some small portions with vermilion. In one of them, which has been preserved in spirit for fifty years, the marks on the skin of the leg represent an animal like a goat ; they are of a bluish- ALLEGED DISAPPEARANCE OF TATTOO-MARKS. 343 black color. In the part from which the cuticle has been reniovcd the color appears much more intense. There is nothing to indicate that this preparation has underutrefactioii no further evidence could be obtained from it. A man named Sehall had been in the mean time char<,red with the murder, and the circunii^tantial evidence was so stronij^ ajxainst him that nothinj,^ mure was reijuired than to jjrove that the body found was that of Eber- mann. Of two medical experts who were called to i>-ive evidence, one de- posed that the marks of cupping could always be disting-uished, and those of tattooing were indelible ; the other stated that the marks of cupping might spontaneously disappear, but with regard to the tattooing he could "•ive no opinion. As this medical evidence failed to establish the identity of the body, the opinion of Casper was required by the court. In his re- l)ort, taken from the observations made in a large asylum for aged and invalid soldiers, a class among whom tattoo-marks are common, he stated that out of 36 examples, in three the tattooing had become faint with time ; in two the marks were partially effaced ; in four they were com- pletely obliterated ; hence he came to the conclusion that the marks of tattooing mav disappear. A witness came forward and declared, during the investigation, that at fifteen he had tattooed himself on the arm with vermilion, and that the marks had become entirely effaced. The conclusion of the trial was that Sehall was condemned. (Med. Times and Gaz., 1852, ii. p. 608; also Casper's Gerichtl. Med., 1, p. 116; and Yierteljahrsschr. fur Gerichth Med., 1852, 1, p. 274, and 1853, 1, p. 338.) The singular part of this case is, that there was a want of proof that the deceased had really been tattooed ; for neither the wife who had cohabited with the de- ceased for two years, nor his three married sisters, had ever seen any tattoo-marks on his skin. Chereau (L'Union Med., Nov. 16, 1852) justly observes, respecting Casper's report, that it is not one which should influence a judicial decision, for it is not stated at what age, with what substances, and in what manner, the marks were produced in the four instances where there was complete obliteration. Were the men to be trusted ? How many years had really elapsed before the marks had be- come effaced ? What was the nature of the coloring matter used ? Was it mineral or vegetable ? and was it carried deeply into the cutis, or only disposed on the surface? These questions should have received satis- factory answers before comparisons were made, and important medical conclusions were based upon them. Casper's unqualified opinion that such marks, assuming them to have existed, might have spontaneously disap- peared, led to the conviction and execution of Sehall, The accused con- fessed his crime before execution, but the position assumed by Casper on this occasion is certainly not a precedent to be followed by medical jurists. In all cases in which an opinion is required of a medical man — whether tattoo-marks have been effaced from the skin or not — there should be no doubt whatever touching their previous existence. A question may arise in contested identity, whether any accidental or temporary marks made on the skin can be mistaken for tattooing. This does not seem at all probable. The color and the design might be imitated by water-color pigments, but this would be only superficial, i. e. on the cuticle, and they would be readily removed with water. No professional man could be deceived by such an attempt at imposture. It may be sug- gested that marks of tattooing said to have been seen by witnesses on the skin of a missing person were caused by the application of colored chalk or pencil. Such an objection to evidence hardly needs serious refutation. Colored marks could only be produced by very soft chalk, and would never have the depth, intensity, or appearance of tattooing. They would be re- moved and obliterated by the slightest friction. The most superficial IDENTITY FROM TATTOO- JI ARKS. 347 observer could not be deceived bj them. Again, it may be alleged of a missing person, by one set of witnesses, that he was tattooed, and by another set that they had had casual opportunities of seeing his skin and did not observe any tattoo-marks. In such a case, the evidence given Ijy near I'elatives, whose opportunities of observation are much more frequent, is more reliable than that of persons who could have had only an opportunity of seeing the bare skin on some rare occasions, and could have had no particular reason at the time for observing its condition. This, of course, becomes simply a question of credibility and accuracy of observation. A medical man may be consulted about the removal of these marks; and when he has tried experiments on this subject he will be able to appre- ciate the view generally entertained of their indelibility, at least so far as the carbon-marks are concerned. Some years since the author was con- sulted in the following case : By an accidental discharge of gunpowder, a portion was blown into the face of a young man. After recovery from the first effects, a bluish-black tint was left on the lower part of the fore- head, the nose, and the upper part of the cheeks and eyelids. He had con- sulted several physicians and surgeons, and, under their advice, had em- ployed various local applications for the removal of the marks, but with- out result. On examining the discolored parts a year after the accident with a magnifying-glass, it was obvious that the small particles of carbon were deeply and firmly imbedded in the cutis. Local applications to pro- mote absorption were tried, but it was quite evident that nothing but the destruction of the cutis would remove the marks. Blistering would have no effect, as this would only remove the cuticle. Medico-legal questions connected with the presence or absence of tattoo- marks on the skin have been hitherto confined to proof or disproof of the identity of persons charged with crime. Probably few cases in the present century have excited greater interest among the public or given rise to greater discussion than that which is known as the Tichborne case, already referred to (see p. 338, ante). (Tichborne v. Lushington, C. P., 1871-2 ; and Reg. v. Castro or Tichborne, Aug. 1873.) The question involved turned entirely upon personal identity. A man calling himself Sir Roger Tichborne claimed certain estates. This led to a trial of ejectment in the Common Pleas, which extended over one hundred and three days, in which be was nonsuited, and subsequently committed for trial on numerous charges of perjury. After a trial for this oflence of the unexampled dura- tion of one hundred and eighty-eight days, the claimant was found guilty of perjury and sentenced to penal servitude, Roger Charles Tichborne was lost at sea in April, 1854. No one who sailed in the same ship has ever been seen or heard of afterwards. At the time of his departure from England, in 1852, the real Roger had upon the inside of his left forearm certain tattoo-marks of a blue color, representing a cross, a heart, and an anchor. These marks had been distinctly seen up to the time of his leaving England, over a period of six years, by his mother, his tutor, and a number of friends, male and female, to whom he had at intervals purposely shown them. Lord Bellew, a schoolfellow of Roger's, deposed that in 1847-8 he saw the cross, heart, and anchor on Roger's arm, and that he himself tattooed the letters "R C T," in addition to these symbols. The letters were made with China-ink, and were half an inch in length. On the same day that he tattooed Roger's arm, Roger tattooed his arm with the mark of an anchor. This was done at the same time, and with the same materials. Twenty-five years had elapsed since they had thus tattooed each other, but the anchor was still there, and the witness showed his arm to the jury in confirmation of his statement. It was fur- 348 THE TIC II BORNE CASE. ther proved that, as attempts had been made to bleed the real Koger in the arms, feet, and temples before he left Kn,ii:laiid, there would be some cica- trices indicative of this fact. When a boy he had an issue in his arm for two years, and when this Avas removed and the i)art healed, it had left a larue and deep cicatrix. These facts were deposed to by several credible witnesses. The de|)r(>ssion in the arm, left by this issue, was seen by them as late as nine years after its removal. Such were the facts satisfactorily proved with regard to the real heir. Twelve years after the wreck of the Bella, in which Kosi-er Tichborne was lost, the defendant Castro, who was residing in Australia, first set up a claim to the estates, announcing that he was Roger, and had been saved from shipwreck. This, however, was proved to have been after some advertisements had appeared in the Aus^ tralian papers, offering a reward for the discovery of any survivor of the Bella. A large amount of evidence was received for and against the defendant's identity. It is only necessary to consider in this place the medical evi- dence derivable from tattoo-marks and cieairices. There was no mark of tattooing al)out the person of the defendant, ror any appearance indicative of his having been tattooed. Lipscombe, his physician, had examined him and found no tattoo-marks, and, to add to the force of this evidence, the defendant himself denied that he had ever been tattooed. As to cicatrices, the evidence equally failed. Fergusson, who was a witness for him, and other surgeons examined his arms, temple, and feet, but found no cicatrix such as would have followed bleeding. There were some scars on the feet near the ankles, but these had not been produced by incisions for bleeding in the feet. There was no scar or depression in the arm where an issue had been placed in the real Roger. Unless w^e are prepared to admit that a man can be tattooed and have no knowledge of the fact, and having been thus unconsciously tattooed, that all the marks had disappeared before he saw them, it is impossible that this claimant could have been the Roger Charles Tichborne, the heir to the estates. The durability of the marks was clearly proved by Lord Bellew. So, again, with regard to cicatrices. There were none to render the story of the defendant even plausible, and, taken together with the tattoo-marks, they were in flat contradiction to his assertion. Resting upon these medical facts alone, there w-as sufficient to overthrow his claim and to prove him to be an impostor ; but there was an accumulation of other evidence based upon the early history, education, travels, and habits of the lost heir, which clearly showed that this was a false claim. That this impostor' should for long a period have defied the law and deluded a large number of persons is in itself surprising. Pending the Tichborne trial a man named Jean Luie presented himself as a witness for the defendant, and swore that he was on board the Bella wath the defendant, and had escaped with him from the wreck. It was, however, proved that he was a ticket-of-leave convict named Lungren, who had been repeatedly in gaol, and was recognized by several gaolers. Lungren, according to the gaol-books, had a deformity of the little finger of each hand, and certain moles were upon his back. All these were found on the pretended Jean Luie. He was tried and convicted of thus endeavoring to defeat justice by flagrant perjury. Medical Responsibility . — The process of tattooing is not unattended wuth danger. Cases are recorded in which syphilis has been thus trans- mitted by inoculation. (Ann. d'Hyg., 1855, t. 1, p. 175.) Berchon col- lected four cases in which the operation proved fatal by reason of the after-consequences. (Ann. d'Hyg., 1870, t. 2, p. 464.) TATTOOING AND BRAND CONTRASTED. 349 [^Tattooing and Brand Contrasted. — By tattooing we mean the marking by grains of partially burned ])owder, driven into or through the skin or mucous membrane, and found in all directions about the wound. The phenomenon occurs at short range only, although if the muzzle be in actual contact with the skin, it does not appear. As the tattooing differs greatly with different weapons and different styles of ammunition, it is imperative that one should experiment with the exact weapon and load used in any given case, before offering testimony as to the distance at which the weapon was held, or any other point material to the trial. The tattooing is more distinct as we use a better and hence more efficient weapon, or a heavier one, and as we approach the target, until we get so close that the grains are unable to spread to produce the phenomenon in question. The area increases, from the natural spread of the flying grains, up to the point at which they fail to stick in the target — a distance varying, with different styles of pistol and ammunition, from a foot or two up to six or eight feet. The new nitro- powders are more perfectly burned than black powder, aud hence cause less tattooing, as a rule. The brand is the burning, usually upon the skin or clothing of the subject, caused by the flame of the burning powder. It covers a smaller area than the tattooing, is confined to a shorter range from the muzzle of the weapon, and retreats from the hole made by the bullet as we increase the range. It is always found, as shown by Fish, above the bullet-hole, unless the weapon has been inverted or turned sidewise, when it is found in a position corresponding to the direction to which the top of the front sight, or of the hammer, in the usual style of weapon, has been pointed with reference to the longitudinal axis of the barrel. The brand, then, enables us to determine the position of the weapon, as regards the direction of the hammer, at the instant of firing, and also serves as an index to the distance of the muzzle from the part wounded. Being superficial, it disap- pears in the process of healing, while the tattooing, commonly largely sub- cutaneous, remains, but gets ftiinter with the lapse of time, up to a certain point. Like the tattooing, the brand is less distinct in using uitro-powders than with the use of black powder. Ignition of Clothing. — Firing of the clothing occurs, with the ordinary revolver, very frequently at distances under a foot, and at times at greater distances, depending upon the style of the Aveapon, its load, and the firm- ness of texture and inflammability of the fabric under consideration. The ignition occurs at greater distances from flying grains of powder or wadding than from the flame, since the solid bodies travel farther than the gases of combustion. In determining the distance at which a fabric will ignite it is essential to have all the conditions, especially as regards weapon, ammuni- tion and fabric, identical with those of the case under investigation, so far as this is possible. Are Bidlet-ivounds Neeessarih/ Septic ? — Bullets, when received from the factory, have been found by LaGarde to be practically free from pathogenic organisms, and it has been found that many gunshot wounds are, at the time of infliction, aseptic. It is, then, imperative, I think, that the surgeon should observe the usual aseptic or antiseptic measures common in such cases, in gunshot wounds likely to become the subject of official investiga- tion. Will the Wound Cause Unconsciousness f — This is often a matter of ex- treme importance in trials of homicide. In an article in the Medical News, Nov. 2, 1895. Dr. J. N. Hall of Denver, Colorado, summarizes his conclu- sions as follows : " Consciousness must be immediately suspended after gun- shot wounds involving the medulla, the cervical cord above the origin of the phrenic nerve, the great centres at the base of the brain, or. the region 350 WOUNDS OF THE HEAD. about the base of the heart, if, in tlie hitter case, the parts are severely lacerated. It will with very great probability be suspended after wounds involving very extensive injury about the solar plexus, or after any injury, by a missile of considerable size, ati'ecting any ])art of the brain, unless it be the anterior or lateral parts. Temporary unconsciousness, at least, will probably follow any wound of the brain substance, or any serious jar to the cervical cord by a bullet of even moderate size, and temporary stunning or even death often follows the shock from the impact of a bullet against the skull, without gross damage to the brain, and may follow the concussion of the precordial region, caused by the discharge of a weapon in close contact, even though no penetrating wound be produced. In the majority of other injuries from the cause we are considering unconsciousness is secondary to loss of blood, shock, or a combination of these two causes. But in any injury in the spinal column involving the cord, and more especially in the upper portions, although consciousness may be retained, it is not likely that any serious resistance could be offered by the person so injured, excepting that the hands might still be of use in case the lesion Avere below the upper dorsal region." The most valuable recent work on gunshot wounds is the contribution made by J. N. Hall, M.D., of Denver, to the New York Medico-Legal Congress of 1895, {Vide Medico-Legal Jour., vol. xiii. No. 3; Medical News, November, 1895 ; Bulletin of Med.-Legal Congress of 1895.)] CHAPTER XXXIII. WOUNDS OF THE HEAD. CONCUSSION. HOW DISTINGUISHED FROM INTOXICATION. EFFUSIOW OF BLOOD AS A RESULT OF VIOLENCE, DISEASE, OR MENTAL EXCITEMENT WOUNDS OP THE PACE. DEFORMITY AS A CONSEQUENCE OF WOUNDS OF THE FACE. INJURIES TO THE SPINE AND SPINAL MARROW. — FRACTURES OF THE VERTEBRA. The danger of w^ounds, and their influence in causing death, are the two principal points to which the attention of a medical jurist must be directed. Wounds of the Head. Incised wounds affecting the scalp, unless of great extent, rarely pro- duce any serious effects. When the wound is contused, or accompanied by much laceration of the skin, it is highly dangerous in consequence of the tendency which the inflammatory process has to assume an erysipela.. tons character. The results of these Avounds are, however, such as to set all general rules of prognosis at defiance. Slight punctured wounds will sometimes terminate fatally in consequence of inflammation, followed by extensive suppuration; Avhile, on the other hand, a man may recover from a lacerated wound by which the greater part of the flesh may have been stripped from the bone. There are two sources of danger in wounds of the scalp: 1. The access of erysipelatous inflammation. 2. Inflammation of the tendinous structures, followed or not by a process of suppuration. Either of these secondary effects may be a consequence of slight or severe wounds, and prove fatal. Neither can be regarded as an unusual result of a severe wound of the scalp, but when one or the other follow^s a slight CONCUSSION OF THE BRAIN. 351 injury there is reason to suspect that the patient may have been constitu- tionally predisposed to the attack. Bad treatment may likewise lead to a fatal result from a wound not serious in the first instance, but the question, how far the responsibility of an a^'g-ressor would be atfected by a circumstance of this nature, has been considered in another place (p. 317). Wounds of the head are dangerous in proportion as they affect the brain,- and it is rare that a severe contused wound is unaccompanied by some injurv to this organ. There is, however, a difficulty which a practitioner has here to contend with — namely, that it is scarcely possible to predict from external api)earances the degree of mischief which has been produced within. These injuries, as it is well known, are capricious in their after-effects; the slightest contusions may be attended with fatal consequences, while frac- tures, accompanied by great depression of bone, and an absolute loss of substance of the brain, are sometimes followed by perfect recovery An- other difficulty in the way of forming a correct opinion consists in the fact that a person may recover from the first effects of an injury, but after some days or weeks he will suddenly die ; and, on examination of the body, the greater part of the brain will be found destroyed by suppuration, although no symptoms of mischief may have manifested themselves until wnthin a few hours of death. Concussion. — The common effect of a violent blow on the head is to produce concussion or effusion of blood, or both. Concussion is usually indicated by fainting, insensibility, or sudden death occurring immediately or soon after the application of external violence. In concussion, the symptoms come on at once, and the patient sometimes dies without any tendency to reaction manifesting itself. In the most severe form, the person drops at the very moment w^hen struck, and dies on the spot. In other cases, he may linger in a state of insensibility for several days or weeks, and then die. In concussion, there is generally more or less vomiting. It is important to remember that neither compression nor obvious physical injury to the brain is necessary to render concussion fatal. This may be entirely dependent on shock to the nervous system. After death, no particular morbid change may be discovered in the body, or there may be merely the mark of a slight bruise on the head. The state of in.sensibility observed in concussion may be only apparent, and a slight degree of consciousness may be retained. A blow on the skull may cause death by leading to abscess in the brain, although there may be no fracture or other physical injury. A case of this kind proving fatal in about a week is reported. (Lancet, 1873, i. p. 697.) Inflammation may follow the primary shock from concussion, suppura- tion may take place, and the patient die after the lapse of several weeks, or even months. It is necessary in a medico-legal point of view to notice that a person may move about and occupy himself, while apparently con- valescent, for a week or ten days after recovery from the first shock, and then suddenly be seized with fatal symptoms and die. This apparent recovery leads to the common supposition, that death must have been produced by some intervening cause, and not by the original violence to the head — a point generally urged in the defence of such cases. When the inflammation that follows concussion is of a chronic character, the person may suffer from pain in the head and vomiting, and die after the lapse of wrecks, months, or even years. Concussion may sometimes take place as a consequence of a violent fall on the feet, in which case the head receives a shock through the medium of the spinal column. The skull may be thereby extensively fractured at the base, and the brain may be evea 352 CONCUSSION AND INTOXICATION. shattered by such a fall. This was the cause of death of the Duke of Orleans, the son of Louis Philipjie. In Allen v. The Chester Ry. Co. (Com. Pleas, Feb. 1857), the plaintiff claimed damages for an injury caused by a railway collision. The evi- dence showed that the plaintiff received a blow on the head. There were no immediate effects ; but in two days he suffered from lightness of the liead and other symptoms, attributed by his medical attendant to concus- .sion of the brain, as a result of the accident. Subsequently there were symptoms of injury to the spine. There was pain in the course of the spine, ])artial i)aralysis of the bladder, rectum, and legs, with loss of memory. The medical witnesses for the plaintiff attributed these symptoms to a blow received by him at the base of the skull. The defendants contended that, if these were the results of concussion of the brain, thej^ ought to have manifested themselves immediately on the occurrence of the accident ; and this view was to some extent supported by the evidence of experienced surgeons. In substance, however, the medical evidence on the two sides was not conflicting. Concussion of the brain, as it is ordinarily known to surgeons, is generally attended with some immediate symptoms ; but the witnesses for the defence properly admitted that a "concussion of the brain (and spine?), attended with apparently slight symptoms at first, might, under peculiar circumstances, be followed by serious symptoms." As no other cause could be assigned for the symptoms, this was practi- cally admitting that the plaintiff had suffered from the injury, the degree being simply a question for the jury. They returned a verdict for the plaintiff. Concussion distinguished from Intoxication. — The symptoms under which a wounded person is laboring may be sometimes attributed to intoxication, and a medical witness may be asked what difference exists between this state and that of concussion. The history of the case will, in general, suffice to establish a distinction, l)ut this cannot be always obtained. It is commonly said that the odor of the breath will enable a surgeon to detect intoxication ; but it is obvious that a man may meet with concussion after having drunk liquor insufficient to cause intoxication, or concussion may take place while he is intoxicated — a combination which frequently occurs. Under such circumstances we must wait for time to develop the real nature of the case. Concussion may be so slight as sometimes closely to resemble intoxication, and, from the absence of all marks of violence to the head and the existence of a spirituous odor in the breath, the medical examiner might be easily deceived. If there be no perceptible odor in the breath, the presumption is that the symptoms are not due to intoxication. On the other hand, intoxication may be so great as to give rise to the apprehension of fatal consequences, and the coexist- ence of a mark of violence on the head might lead to error in the forma- tion of an opinion. What is the line of conduct to be pursued on such occasions ? The examiner should weigh all the circumstances, and if there be one cause for the symptoms more probal)le than another, he should adopt it ; if there be any doubt, this should be stated to the court. This mistake is still frequently made, and a person in a state of insensi- bility from violence or disease has had his death accelerated by confine- ment in a cell as a drunken person, when it subsequently transpires that he has not been drinking, and that he really requires medical aid. In the metropolis this aid is now usually sought by the police. There is nothing in the state of the brain in a dead body which will enable a practitioner to distinguish whether concussion or intoxication had existed and had been the cause of the symptoms. The vessels may be EXTRAVASATION OR EFFUSION OF BLOOD. 353 congested in both cases. The discovery of an alcoholic liquid in the stomach might lead to a presumption that the deceased had been intoxi- cated, while marks of violence on the head might favor the view that he had suffered from concussion. When both conditions are found, the ex- amination of the body cannot lead to a solution of the question. The answer must then depend on the special circumstances proved, and, if procurable, on the nature of the symptoms preceding death. It is to be feared that medical witnesses are not sufficiently careful on these occasions to determine whether there are signs of intoxication about an injured per- son. Subsequent proceedings may render this a material part of the inquiry. The"^distinction of apoplexy from drunkenness involves greater difficulties. In these cases we have to deal with the true diagnosis of alcoholic or narcotic poisoning (see Opium, p. 186, ante). Jackson has directed atten- tion to this medical question in a case reported in the Med. Times and Gaz., 1871, i. p. 360. Some instructive cases, in reference to this com- ])lication of wounds, have been published by Tardieu. (See Lond. Med. Gaz., vol. xliv. p. 347.) Extravasation or Effusion of Blood. — A blow on the head may destroy life by causing an effusion of blood either on the surface or in the sub- stance of the brain. In pugilistic combats, when a person is thus struck, he commonly falls, and death may take place in a few minutes. On in- spection, blood may be found effused either at the base or in the ventricles of the brain, and the question will present itself— Did the injury which caused death arise from a blow or a fall ? A heavy blow on the head may cause fatal effusion of blood, but on these occasions the effusion com- monly arises from the violent concussion which the injured person sustains by the fall. A medical witness will therefore in general be compelled to admit that the fatal effusion might have taken place either from a blow or a fall If the fall has resulted from accident, and not from a blow, this will, of course, absolve the accused from responsibility for the fatal results. This subject has important applications in legal medicine, for this is one of the most common causes of death from injuries to the head, and there are many cases of this description tried. Effusion may occur from violence with or without fracture, and it may take place without being accom- panied by any external marks of injury. In case of injury to the head proving fatal by effusion of blood on the brain, a person may recover from the first effects of the violence and ap- parently be going on well, when he will suddenly become worse and die. Effusion takes place slowly at first ; it may be arrested by the effects of stupor from concussion, by a portion of the blood coagulating around the ruptured orifices of the vessels, or by some other mechanical impediment to its escape ; but after a longer or shorter period, especially if the person be excited or disturbed, the bleeding will recur and destroy life by pro- ducing compression of the brain. How many hours or days are required in order that such an increased effusion should take place after an accident, it is impossible to say ; but in severe cases it is generally observed to follow the injury within a short time. Astley Cooper has related the case of a gentleman who was thrown out of a chaise and fell upon his head with such violence as to stun him in the first instance. After a short time he recovered his senses, and felt so much better that he entered the chaise again and was driven to his father's house by a companion. He at- tempted to pass off the accident as of a trivial nature, but he soon began to feel heavy and drowsy, so that he was obliged to go to bed. His symp- toms became more alarming, and he died in about an hour, as it afterwards 23 35-4 EFFUCJION OF BLOOD FROM DISEASE OR VIOLENCE. appeared, from effusion of blood on the lirain. When the brain has sus- tained laceration from violence, in addition to insensibility, convulsions are frequently observed. Effusion of Blood from Disease or Violence. — Blood may be found effused in various situations within the interior of the skull, and the cause of the effusion may be either disease or violence. The skill of a medical jurist is often required to determine which of these causes is the more probable, as where, for instance, a pugilist has died, after having received .severe injuries to the head, and his adversary is tried on a charge of man- slaughter. On these occasions it is often urged, in the defence, that the bleeding might have arisen either from the diseased state of the vessels of the brain, or, if the evidence render it probable that the blow was the cause, that the effects of the blow were aggravated by a diseased condition of the vessels, or by the excitement into which the deceased was thrown, either from the effects of intoxication or passion. (See case of Reg. v. Saxon, p. 314, ante.) When the brain is not lacerated by violence, the blood is effused either on the surface of the hemispheres, between the membranes, or at the base. When the effusion is caused by violence, the effused blood is not always found under the spot where the blow was in- flicted, but occasionally, by counter-stroke on the surface of the brain, directly opposite to it — a case which a medical witness has frequently been required to explain on trials, and which depends on the same cause as fracture by counter-stroke, i. e. on a separation of parts (laceration of the brain, effusion of blood, or even fracture of the bones) at the point of the skull directly opposite to that which sustains the violence. Thus fracture of the base of the skull is frequently the result of severe violence applied to the top of the head (vertex). Effusions of blood from a diseased state of the vessels more commonly take place in the substance of the brain, but they sometimes occur on the surface of the organ as a result of mere excitement, or over-exertion of the muscular powers. A diseased condition of the vessels, and probably a softening of the substance of the brain, will, on these conditions, be apparent on inspection. If the effusion depend on disease, the arteries around may. be found diseased, or the brain itself may be found softened and disorganized. The state of the brain and its vessels should be closely examined in all cases of alleged violence, since hemorrhage may take place either from excitement or heavy blows, wherever this diseased condition exists. It has occasion- ally happened, especially in old people, that the person has dropped down dead without a blow being struck, and that death has been wrongly im- puted to violence. Cerebral hemorrhage from disease rarely occurs in per- sons under forty years of age. Frequent intemperance and violent passion may, however, easily create a tendency to it in younger persons. As an effect of violence it may take place in persons of all ages, but, when the marks of violence are slight, a witness must exercise great caution before he alleges that the effusion was produced by a blow, especially when it is found that the deceased was of intemperate habits. As a summary of these remarks, we may say that, in effusions of blood from violence, the blood generally issues from a vessel which is plainly seen to be torn, as the middle artery of the brain, or the lateral sinus. The effused blood is commonly found on the surface of 'the brain, and not in its substance, unless the organ is lacerated. When situate between the dura mater (outer membrane) and the skull, but especially when immediately below the seat of violence or directly opposite to it by counter-stroke, this is strong evidence, cseteris paribus, that it has proceeded from a blow. When there is a fracture of the skull, the presumption of the extravasation EFFUSION OF BLOOD FROM EXCITEMENT. 355 being due to violence is great; because this is not only a suflRcient, but an obvious cause, while the idea of its having proceeded from disease only is remote and speculative. When, besides these conditions, there is no re- markable congestion of the brain in other spots, when the substance of the brain is firm, and the vessels are to all appearance free from disease, we have the strongest reason to believe that the effusion must have been due to violence, and to no other cause. The evidence given on some trials, when the main question has turned upon the cause of an effusion of blood on the brain, in the case of a person who has sustained violent injuries to the head, has rather tended to reflect disgrace on medical science. It has been made to appear from the mouth of the medical witness, either directly or by implication, that no sort of mechanical violence applied to the head of a man in a state of drunkenness or passion — of one whose cerebral vessels were probably diseased — could have had any effect in producing a fatal extravasation found in the head after death. In spite of an individual having received a violent blow with a bludgeon, sufficient to have killed a stout and vigorous man, or of his having been thrown with considerable force with his head against a stone floor, an unqualified admission is often made, that excitement alone, or drunkenness alone, would account for the effusion without reference to the blow. In putting the most favorable construction upon these cases, when we have clear evidence of great violence having been used to the head, with the presence of the usual post-mortem appearances, our opinion should be that the excitement or drunkenness might have predisposed to, but was not the immediate cause of, the cerebral hemorrhage. A mere inspection of the body does not always lead to the discovery of the cause of an effusion on the brain. The violence producing an effusion of blood may have been slight, and, unless attention is particularly directed to the subject, it may be overlooked. The condition of the effused blood should be accurately noticed, in order to determine whether it presents any marks indicative of its being recent or of old standing. Spontaneous effusions, or effusions from disease, are not easily distin- guished from those which are the result of violence to the head. Wilks has pointed out that in most instances of severe injury attended with effusion of blood, the structure of the brain is found bruised. In meningeal apoplexy (apoplexy of the membrane) the source of the blood is a vein of the pia mater, or inner membrane, and sometimes a large arterial trunk. The difficulty chiefly arises in those cases in which effusion is found after slight violence, and there is, at the same time, disease of the blood- vessels of the brain. Wilks gives the results of several inspections in which effusion was owing to disease, to violence, and to a mixed condi- tion. (See Guy's Hosp. Rep., 1859, p. 120.) Effusion of Blood f 7^0711 Excitement. — When engaged in the investiga- tion of these cases, it is always a fair matter of inquiry whether the vio- lence, upon the evidence, was not of itself sufficiently great to account for the effusion without the supposition of coexisting disease or excitement. Admitting that the rupture of a bloodvessel, and the extensive effusion of blood on the brain, may take place from simple excitement and passion, yet this is an event comparatively rare, at least in the young and healthy, while nothing is more common than that these results should follow violent injuries to the head, whatever the age or condition of the person. (See case of Reg. V. Saxon, p. 314, ante.) A medical witness should remember that on these occasions, if he is unable to say positively whether the effusion was due to the excitement or the blows, he will satisfy the court if he only states clearly that which is, in his own mind, the more probable cause of 356 DATE OF EFFUSION OF BLOOD ON THE BRAIN. death ; and, by weigliing all the circumstances of the case beforehand, he will rarely fail to find that one cause was more probable than the other. Thus, if a man, excited by passion, intoxication, or both, is struck on tlie head, and the blow is sligiit — such as an unalfccted i)erson would i)robably have sustained without injury — yet in this case insensibility and death follow, and, on examination, a quantity of blood is found effused in the substance of the brain : can it be a matter of doubt W'ith the practitioner that the efi'usion was chiefly due to the excitement under which the de- ceased was laborin«c ? To take a converse instance — a man engaged in a personal conflict with another is struck most violently on the head, or falls with great force on this part of the body ; on an inspection it is found that death has arisen from eftusion of blood on the surface of the brain, and it would be no unexpected consequence of the violence inflicted, that a similar appearance should be met with in an individual calm and unexcited : can the practitioner hesitate to say, under these circumstances, that the blow would satisfactorily account for the effusion, without reference to any coexisting- causes of excitement ? In these criminal investigations, when a v/itness is examined in chief, he asserts, perhaps, that the effusion of blood was owing to a blow in- flicted on the head. The counsel who cross-examines him then puts the leading question, whether vessels may not be ruptured by excitement; he answers, without any qualification, in the affirmative, and thus pro- duces an impression on the minds of the jury that excitement may have caused the rupture of the vessel in the particular case on which he is being examined. This is, of course, the sort of answer which a prisoner's counsel wishes to extract from a witness ; and the effect produced by it on the court is not always removed, even by a careful re-examination. The counsel for the defence is well aware that, in a case of this description, his only chance of obtaining an acquittal is to throw a degree of doubt on the medical evidence, and to render it probable to a jury that the death of the deceased person w^as due to some other cause than the blow inflicted by the prisoner. As leading questions are allowed to be put to any extent in a cross-examination, the answer in the monosyllable " yes" or " no" generally carries with it much more than a medical witness intends. A medical witness should remember that he is sworn to state the ivhole truth. A qualified answer should be given to what is really a general question ; and, supposing his opinion to be already formed on the subject on which his evidence is required, he should not, unless it be strictly consistent with his own views, allow his answer to a gene^^al question to be made applicable to a particular case. If, then, he is asked in cross-examination whether vessels might not be ruptured and blood extravasated by mere excitement, he should answer that such an effect might undoubtedly follow ; but that it was his opinion — and I am here supposing that his opinion has been founded upon a deliberate examination of all the medical facts — that excitement was not the cause of rupture and extravasation in the case in question. A witness has a right to insist that his evidence shall pass to the jury without having any designed ambiguity attached to it. Date of Effusions. — Recent effusions of blood are recognized by their red color, and the consistency and appearance of the clot, or coagulum. After some days the clots acquire a chocolate or brown color, and this passes gradually into an ochreous tint, which may be met with in from twelve to twenty-five days after the violence. (Guy's Hosp. Rep., 1859, p. 122.) Coagula of effused blood also undergo changes in structure and consistency ; when old they are firmer, and there is much lymph, DATE OF EFFUSION OF BLOOD ON THE BRAIN. 357 Flff. 48. which is sometimes disposed in membranous layers of a fibrous struc- ture, and these are adherent to the dura mater and the brain. The surface of this organ sometimes presents a mark indicative of pressure. When a medical man is required to give an opinion of the date of an effusion found on the brain, great caution is required. He may not be able to fix the precise date, but it niay be in his power to say whether the blood has been effused for a few days, or for weeks, or months. When a blow on the head is of a heavy, bruising kind, the whole sub- stance of the skull ma}^ be fractured without a division of the skin. There is one remarkable circumstance connected with fractures accompanied by depression of bone, which here requires to be mentioned — namely, that the person has been sensible so long as the foreign substance which pro- duced the fracture and depression remained wedged in the brain, and insensibility and other fatal symptoms began to manifest themselves only after its removal. This being admitted, it may be urged in defence that death was really caused by medical interference. But it is a sufficient answer to state that the wounded person must have died from inflamma- tion of the brain if the foreign body had been allowed to remain ; and that it is consistent with the soundest principles of practice to remove all such foreign substances without delay. In fractures of the skull with de- pression, it may become a question whether the surgeon raised the de- pressed portion of bone so soon as he ought to have done. In the description of injuries of the head, it is impossible to avoid the use of terms with which members of the legal profession are not likely to be acquainted. In giving evidence upon the situation of wounds, of the effusion of blood and the effects of fractures, medical wit- nesses are often compelled to make use of anatomical terms, and are not always success- ful in explaining them. With the view of removing this difficulty, and supplying, to some extent, the means of following the evi- dence of a witness in his description of injuries to the head and its contents, a diagrammatic engraving, representing the relative position of the membranes of the brain, is annexed. Fig. 48 represents a section of the bones of the skull, with the three membranes which cover the brain, (a) Section of the skull-bones, with the outer and inner tables, and the intermediate cellular structure or diploe, indicated by the dark shading ; the scalp, or skin of the skull, which covers the outer table, is not represented. (6) The dura mater, or outer mem- brane of the brain ; it is thick and fibrous, closely adherent to the inside of the inner table of the skull, but smooth on the side towards the brain, (c) The arachnoid membrane, so named from its delicate web-like struc- ture, forms a closed sac, covering the dura mater — to the inner surface of which it give its glistening aspect — and also the pia mater on the surface of the brain, which it closely covers, without dipping into the convolu- tions, {d) The pia mater — the membrane which immediately invests the substance of the brain and dips into all the convolutions. It contains the bloodvessels which nourish the hemispheres of the brain. These mem- branes are, for distinctness, represented as being separated from each other, but they are naturally in close proximity, and the rough side of the dura mater is closely adherent to the inside of the skull (calvarium). The ordi- nary seats of the effusion of blood from violence are between the dura The skull, with its outer and inner talile, and the three coverings of the brain (membranes), seen in section. 358 WOUNDS OF THE BRAIN. mater and inner table of the skull, and between the pia mater and the surface, or into the substance of the brain. In reference to i)ersons found dead with severe injuries to the head, attended with fracture and elfusion of blood on the brain, a medical man may be re(iuired to say whether such an amount of violence is or is not consistent with the retention of muscular exertion and power of locomo- tion l)y the deceased. For instance, a man may fall from a height, and produce a severe compound fracture of the skull, lie may, nevertheless, be able to rise and walk some distance before he falls dead. Under these circumstances there mig-ht be a strong disposition to assert that the de- ceased must have been nmrdered — the injuries being such that they could not have been produced by himself, there Ijeing at the same time no weapon near, and no elevated spot from which he could have fallen. The discovery, after death, of severe injury to the head, with great effusion of blood on the brain, must not, however, lead a surgeon to suppose that the person who sustained the violence had been immediately incapacitated. There are various cases recorded which show that a power to move has been retained under conditions which might be supposed to render a per- son incapal)le of moving from the spot. Full allowance must be made on these occasions for the possible exercise of locomotion by the decea.sed. Although a large quantity of blood ma}^ be found after death pressing on the substance of the brain, it does not follow that this effusion and pressure were the immediate results of the violence. (See case of Reg. v. Saxon, p. 814.) The importance of these observations will be further seen by the follow- ing case : A man was found dead in a stable, with a severe fracture of the temporal bone, which had caused a rupture of the middle artery of the brain. A companion was accused of having murdered him, but he alleged that the deceased had fallen from his horse the day before, and had thus met with the accident. It appeared, however, that, after the fall, the de- ceased had gone into a public-house before he returned to the stables, and had remained there some time drinking. The question respecting the guilt of the accused party rested upon the fact whether, after such an ex- tensive fracture of the skull with extravasation of blood, it was possible for a man to do what the prisoner had represented the deceased to have done. Wallace very properly gave a qualified opinion; he said it was improba- ble, l)ut not impossible, that, after receiving such an injury, the deceased could have walked into and drunk at a public-house. The extravasation was here the immediate cause of death, and probably this did not take place to the full extent, except as a consequence of the excitement from drinking. Wounds of the Brain. — Wounds of the brain, even when slight, some- times prove instantaneously mortal, while in other cases recoveries take place from contused or punctured wounds of this organ, contrary to all expectation. When a person survives the first effects of the injury, there are two sources of danger which await him: 1. The production of so- called fungus from the exposed portion of the brain. 2. Inflammation and its consequences. The process of inflammation, it must be remembered, is very slowly established in this organ ; it may not manifest itself until from three to ten weeks after the injury. In one remarkable case, where a child was accidentally shot through the brain, the ball having traversed both hemispheres, no symptoms of cerebral inflammation manifested them- selves for twenty-six days. The child died on the twenty-ninth day. (Lond. Med. Gaz., vol. xxxix. p. 41.) INJURIES TO THE SPINE. 359 Wounds of the Face. — When wounds of the face are of any extent, they are usually followed by great deformity ; and when they penetrate the cavities in which the or: causes, or from over-distention ? The spot in which the rupture con»nionly takes place is in the upper and back part, where the bladder is covered by the peritoneum. The aperture is sometimes large, at others small ; but the effect is that the urine is effused, and death takes place sooner or later from peritoneal in- flannnation. It is commonly stated that ru))tures, when attended with extravasation of urine into the peritoneal cavity, are uniformly fatal ; but if the rupture occurs in the under ytart of the bladder, so that the urine finds it way into the cellular tissue, the medical opinion is not so unfavor- able. The usual period at which death occurs from this accident is in from three to seven days ; but Ellis met with a case in which the person did not die until the fifteenth day, A person may die suddenly from this injury, as a simple result of shock. When ruptures of the bladder are produced by blows they are rarely accompanied by marks of ecchymosis, or of injury to the skin. Thus, then, there may be no means of distinguishing-, by external examination, whether a rupture was really due to violence or to spontaneous causes. Those who are unacquainted with this fact might ))e disposed to refer the rupture to disease, on the supposition that violence should always be in- dicated by some visible external injury; but there are numerous cases on record which show that this view is erroneous (p. 310). Rupture of the bladder has been caused by a fall in wrestling, proving fatal in four days. (Reg. V. Warburton, Carlise Lent Ass., 1876.) As an attempt may be made, in cases in which death has resulted from this injury, to refer rupture of this organ to natural causes, it may be observed that this is a very unusual occurrence ; a rupture is almost always the result of violence directly applied to the part while the organ is in a distended state. A spontaneous rupture may, however, occur: 1. When there is paralysis, with want of power to expel the urine. 2. When the bladder is ulcerated or otherwise diseased. 3. When there is an obstruc- tion in the urethra from stricture or other causes. The causes of sponta- neous rupture are easily recognizable by ascertaining the previous condi- tion of the deceased, or by examining the bladder and urethra after death. If a man were in good health prior to being struck; if he suddenly felt intense pain, could not pass his urine afterwards, and died from an attack of peritonitis in five or six days; if, after death, the bladder was found lacerated, but this organ and the urethra were otherwise in a healthy con- dition : there can be no doul)t that the blow must have been the sole cause of rupture and death. In such a case, to attribute the rupture to spon- taneous or natural causes would be absurd. As to the absence of marks of violence externally, this would be a difficulty only to those who had not previously made themselves acquainted with the facts attending this and other accidents affecting the viscera of the abdomen (p. 345). ]yevertheless, a medical witness must be prepared to hear the same line of defence continually brought forward, as it is always the object of a counsel to make the best of a case for the prisoner. With medical facts, opinions, and doctrines he does not concern himself, so long as they do not serve his purpose. A diseased state of the bladder might probably diminish the responsibility of an accused person for the consequences ; therefore the state of this organ should be closely looked to on these occa- sions. A distended state of the organ can be no mitigatory circumstance, WOUNDS OF THE GENITAL ORGANS. 373 since it is only when the bladder is in this condition that rupture is liable to occur. This can hardly be regarded as an abnormal condition of the organ. An accidental fall forwards over a hard surface when the bladder is distended with urine may lead to rupture. The person generally ex- periences at the time intense pain in the lower part of his abdomen, and there is an inability to pass the urine. Although a man is liable to be rendered powerless on sustaining a rupture of the bladder from a heavy blow or fall, there are several well-authenticated cases on record which prove that a man may walk some distance and move about even for two or three hours afterwards. In punctured and incised wounds of the bladder the urine is at once extravasated, but in gunshot-wounds the extravasation does not com- monly take place until the sloughs have separated. Thus life may be protracted longer in cases of gunshot, than under other wounds of the bladder. For the discovery of extravasated liquids or blood, in wounds and other injuries to the abdominal viscera, we must look to the cavity of the pelvis, as it is here that, for obvious reasons, such liquids have a ten- dency to collect. Wounds of the Genital Organs. — Wounds of these organs do not often require the attention of a medical jurist : such wounds, whether in the male or female, may, however, prove fatal to life by excessive bleeding. Self-castration or mutilation is sometimes observed among male lunatics and idiots. When timely assistance is rendered, a fatal result may be averted. Demarquay met wnth a case in which a man in a fit of intoxication cut off the whole of his genital organs with a razor. He lost much blood, from the effects of which he died on the following day. (Lancet, 1872, ii. p. 10.) The practice of circumcision on infants is some- times followed by fatal results. Schwartz met wath two cases of boys, eight days old, who were submitted to this rite. They both died of phlegmonous inflammation, one five days and the other twenty-five days after the operation. (Lancet, 1810, ii. p. 411.) Other fatal cases are reported. Incised, lacerated, or even contused wounds on the female genitals may prove fatal by loss of blood, not from the wound involving any large vessel, but from the numerous small vessels divided. When deeply in- cised wounds are inflicted upon the genital organs of either sex, the fact of their existence in such a situation at once proves wilful and deliberate malice on the part of the assailant. Accident is wholly out of the ques- tion, and suicide is improbable, except in cases of confirmed idiocy, lunacy, or intoxication. Such wounds require to be carefully examined; for the proof of the kind of wound, when fatal, may be tantamount to a proof of murder. A practitioner may be sometimes required to determine whether wounds affecting the female organs have resulted from accident, have been self-inflicted, or inflicted by others with homicidal intention. Accidental wounds of the genitals, unless all the circumstances are known, may some- times resemble those produced by design, and thus the distinction of a homicidal from an accidental or a self-inflicted wound on the female organs is sometimes attended with great difficulty. A girl, xt. 6, fell from a tree with her legs apart upon one of the sharp-pointed shoots below, about half an inch thick. This entered the vagina, and passing through its poste- rior wall, broke off. A woman removed the Avood with some difficulty. The child died in twenty-eight hours from peritonitis. (Lancet, 1811, ii. p. 14.) Had this child been found dead with the wood in her body, there might have been some difficulty in assigning an accidental origin to such an injury. (For remarks by Toulmouche on the wounds of the male gen- 374 WOUNDS OF THE GENITAL ORGANS. ital organs, see Ann. d'lTyg., 1808, t. 2, p 110; and for cases in which such wounds were homicidally inflicted upon males, see Ann. d'Hyy., 1848, t. 1, p. 443; also 18G5, t. 1, p. 66; and for a case which led to a trial for the murder of a woman, see Lond. Med. Gaz., vol. 44, p. 813.) In Reg. V. Green (Derby Wint Ass., 1872), the medical evidence estab- lished that there was a punctured wound of the g-euitals in a female, and this had caused death l)y hemorrhage; but it could not be clearly shown whether it was the result of accident or homicide; unless all the circum- stances are known, an accidental injury to the genital organs may present the characters of homicidal violence. In another part of this work (p. 258) will be found reported a case in which an accidental wound on the genital organs of a girl did not prove fatal, and an attempt was made by the parents to attribute it to inten- tional violence. Certain persons were charged with maliciously wound- ing the girl, but a surgical examination of the wound showed that this was a false charge. It has been said that lunatics, idiots, or intoxicated persons might in- flict upon themselves wounds unlike those produced in ordinary attempts at suicide. A case was tried at Glasgow in 18T3, in which a man was charged with the murder of his wife. They were both intoxicated when they went to bed. The prisoner during the night called to one of his daughters to come to her mother, who had been taken ill. She found her lying on the floor, and blood was flowing from her and there was also some substance which proved to be intestine. A surgeon who was called found a clean-cut wound in the vagina, through, which a portion of the bowel, with clean-cut ends, protruded. Seven feet and seven inches of intestine had been cleanly cut off in three pieces; they were not ragged. The woman died at the end of the Aveek from loss of blood and peritonitis. The man was charged with this act; but were these injuries self-inflicted, or were they the result of homicide? It was admitted that suicide was possible, but not probable. The woman's hands were covered with blood, but the man's were not. The man was of good character. There was no known motive for either suicide or murder ; they had been married forty years, and were much attached to each other. No weapon was found with which the wound could have been inflicted. Two pocket- knives were in the trousers of the man, but there was no mark of blood upon them, and it was not thought probable that the wound had been in- flicted with either. The woman had made a dying declaration, obviously false, which was that the wound had been caused by her falling over a chair, that no person injured her, and that she and her husband had always been on friendly terms. The jury returned a verdict of "not proven." (Lancet, 1873, i. p. 673.) Confused wounds on the female genitals may prove fatal by the lacera- tion of parts, leading to great loss of blood. Several trials for man- slaughter have taken place, in which this was proved to have been the cause of death. In Reg. v. Lewis (Maidstone Lent. Ass., 1876), the prisoner was charged with having caused the death of his wife by kick- ing her in the lower part of the abdomen. She died in a few days from inflammation. The medical witness considered that violence was the cause of death, although he would not positively swear to it. Lord Cole- ridge thereupon made this important observation to the jury: "It is not becau.se there may be the absence of absolute demonstration, which from the nature of human affairs can hardly ever be had, that therefore you should not act on your conviction. Did the violence cause death ? What FRACTURES THEIR CAUSES. 375 else could have caused it? What other cause is suggested that could have caused it?" The prisoner w-as convicted. There may be such a loss of blood in these cases as to destroy life, although no large bloodvessel may be implicated in the injury. A con- tused wound on the vulva may occasionally present an ambiguous ap- pearance, and be mistaken for an incised wound. When the soft parts of the body are struck by a blow or kick, if there is a bony surface beneath, a longitudinal rent resembling a cut may appear as a result of the force being received by the bone. A kick on the vulva or a fall on this part may produce a similar injury, and, unless carefully examined, may lead to the erroneous inference that a weapon has been used for its production. Some women are subject to frequent discharges of blood from the genital organs from natural causes. When the bleeding immediately follows a blow, and the woman has not been subject to such a discharge, the fair presumption is that violence was the cause ; but when the flow of blood appears only along time after the alleged violence, of which no traces can be seen, it is most probably due to natural causes. A case of this kind was communicated to the author by Procter. There was no difficulty in giving an opinion that the flow of blood was not due to violence. It may be alleged in defence that the injuries found on the body were inflicted after death, and not while the deceased was living. Kicks or blows on the vulva, if they destroy life at all, cause death by copious effu- sion of blood. Violence to this part after death would not produce such an effusion as would account for death. There are also other distinguish- ing characters which have been elsewhere pointed out. CHAPTER XXXV. FRACTURES. PRODUCED BY A BLOW WITH A WEAPON OR BY A FALL. BRITTLENESS OF THE BONES. FRACTURES CAUSED BY SLIGHT MUSCULAR EXERTION. FRACTURES IX THE LIVING AND DEAD BODY. HAS A BONE EVER BEEN FRACTURED ? LOCOMOTION. DISLOCATIONS FROM VIOLENCE OK NATURAL CAUSES. MEDICAL OPINIONS. ACTIONS FOR MALAPRAXIS. Fractures. Fractures of the bones have some important bearings in relation to medical jurisprudence. They may result from falls, blows, or the spon- taneous action of muscles. Causes. — Questions are sometimes put, whether a particular fracture was caused by an accidental fall or a blow ; and, if by a blow, whether by the use of a w^eapon or not. It is obvious that the answers must be regulated by the circumstances of each case. In examining a fracture, it is important to determine, if possible, whether a iveapon has or has not been used ; and this may be sometimes ascertained by the state of the parts. It is a common defence, on these occasions, to attribute the fracture to an accidental fall. Fractures more readily occur from equal degrees of force in the old than in the young, and in the young rather than in the adult ; because it is at the adult period of life that the bones possess their maximum degree of firmness and solidity. The bones of aged per- sons are sometimes very brittle, and slight violence will then produce fracture. This has been regarded as an extenuating circumstance when 376 spunta:istols with the muzzles pointed towards them, and they are then situated in front ; at other times they are produced by persons pulling towards them through hedges or dragging after them loaded guns. In the latter case the wound is behind, and it may strongly resemble a homicidal wound, although the circumstances under which the body is found generally suffice to explain the matter. (Ann. d'Hyg., 18(50, t. 1, p. 443.) A loaded gun had been placed on the top of a corn-bin in a stable. A fowl trod upon the trigger, and thus fired the gun. It seriously wounded an old man who was near. This shows by what a strange coincidence a man may be found shot with his own gun, and how difficult it might be to reconcile the dis- charge of the gun with any accidental circumstances. In suicide, there is commonly strong evidence of design ; in accident, all evidence of design is wanting. Suicides sometimes make use of extraordinary weapons, or use weapons in an extraordinary manner. Accidental gunshot-wounds sometimes simulate those which are the result of homicide. In 1884 a poacher whilst carrying a double-barrelled muzzle-loading f;un in his pocket, hoisted the carcass of a roe, which his party had shot, on to his shoulder, when the sudden movement of the body caused the weapon, a barrel of which was loaded, to fall out of his pocket, and the loaded barrel went off, the shot lodging in the abdomen, causing his death in a few minutes. In 188T a man was killed by his brother's gun, which was fired by a dog playing round the brother. The WOUNDS FROM SiVI ALL- SHOT. 385 charge lodged in the left side and the man died in an hour. In 1890, a man was carrying- his gun in his pocket in two pieces, and as he was taking out the stock the barrel also fell out, and striking on a stone went off". The charge entered the man's arm, shattering it, and he died of the injury thus inflicted. The above cases were reported to the editor by Mackintosh, who drew attention to the fact that poachers for convenience often separate the stock from the barrel of a gun, and carry both in their pockets in order to avoid observation. On Jan. 18, 1881, the body of a lawyer, named Bernays, was found in a chair, in a sitting posture, in a house into which he had been inveigled eleven days previously. There was two pistol-shot wounds — one in the right temple, of a simple character ; the other, and fatal wound, was io the nape of the neck. The latter was a perfectly clean Avound without any singeing. The ball had gone through the neck from left to right, slightly ascending, and had perforated the skull. There were blood- stains on the nape of the neck and on the right side of the head. The bleeding from the fatal wound was internal and there was little blood on the clothes. There was a small pool of blood on the carpet; and on this, it is alleged, was the impress of a foot. This must have been made after the blood had stiffened. It was endeavored to be shown, however, by the defence, that the footprint might have been made not more than ten or fifteen minutes after the effusion of blood had taken place. The prisoner, Leon Pelzer, was convicted, and admitted the justice of the conviction, AVhen, however, experts differ, as in his case, as to whether a mark on a pool of blood weighing nine ounces has been produced by a boot or by a trouser-covered knee, the evidence ought to be rejected. (See Brit. Med. Jour. 1883, i. p. 23.) Position of the Wounded Person when shot. — Did the deceased receive the shot while standing, falling, or lying down ? Was the piece, when discharged, pointed from the shoulder ? These questions can only be answered by reference to the particular circumstances of the case. In general, when a person is shot while standing, and the piece is pointed from the shoulder, the wound is more or less transverse ; but due allow- ance must be made for the deflection of balls after penetration. Was the deceased shot while running away, or when approaching the person who fired? This question is answered by observing, in the case of a trav- ersing wound, in which alone any difficulty can arise, whether the entrance- orifice be situated in front or behind. Wounds from Small-shot.- — Death is sometimes occasioned by small- shot ; and here several medico-legal questions present themselves. Small- shot may act in two ways: (1) it either strikes without spreading, in which case the discharge is always near the person shot, and its action is much more dangerous than that of a single ball, because it produces ex- tensive lacerations ; or (2) it strikes after it has spread, and here the discharge must have been distant, and comparatively little mischief is done. Lachese ascertained by many experiments on dead bodies that in order to produce, with small-shot, a round opening somewhat resembling that produced by a bullet, the discharge should take place point-blank at the distance of about ten or twelve inches from the surface of the body. When the distance was from twelve to eighteen inches, the opening made was irregular, and the borders were much lacerated ; at thirty-six inches, the one central opening was entirely lost, and the surface of the body was covered with shot-marks. The effect after this was found to depend on the distance, the kind of gun, and the strength of the charge (Ann. dllyg., ''SSG, p. 380) ; but the shot is, in general, much scattered over the surface 25 386 WOUNDS FROM WADDING AND GUNPOWDEK. of the body. From these results we may form an opinion of the distance at which the piece was fired. . It is difficult to conceive that small-shot can, under any circumstances, produce a single entrance-wound having some appearance of circularity about it, without at the same time singeing or burning the skin or dress. The difficulty of laying down any general rule.=i resjjecting the wounds pro- duced by small-shot at their entrance and exit will be apparent from the following facts. A boy was shot in the neck by the accidental discharge of his gun, loaded with an ounce of No. 8 shot. He died instanth'. He was leaning forwards on the muzzle, so that it was nearly in contact with the skin of the neck. A largo round hole was produced, one inch and a half in diameter, the edges of which were slightly blackened with powder. The exit-aperture, which was at the back of the neck a little to the left of the third cervical vertebra, was a mere slit in the skin, .scarcely an inch long, with the long diameter placed vertically. The smallncss of this aperture may have been owing to the greater part of the charge being lodged in the body. The entrance-aperture, although rounded, was too large to be mistaken for a bullet-wound ; it was evidently a near wound, from the blackening of the edges. On the other hand, Lowe found that a round aperture might be produced by a discharge of small-shot at a much greater distance from the object than that assigned by Lachese. Admit- ting such exceptional Instances, and assuming the general correctness of the inferences drawn by Lachese from the results of his experiments in discharging small-shot at dead bodies placed at different distances, it does not seem probable that a wound from small-shot can, under any circum- stances, be mistaken for one produced by a leaden bullet. A discharge of small-shot in contact with the skin or close to it will, however, produce, not a round opening, but a severe lacerated wound. Small-shot is rarely observed to traverse the body entirely, unless dis- charged so near as to make a clean round opening ; but a single pellet reaching the body may destroy life. There may be no exit-aperture, or it may be smaller than that of entrance. Such minute wounds might be easily overlooked in the examination of a dead body. Small-shot, even when wounding only the skin of the back superficially, has been known to cause death by tetanus. Wounds from Wadding and Gunpowder. — It matters not with what the piece is charged, it is capable, when fired near, of producing a wound which may prove fatal. Thus a gun loaded with wadding, or even with gunpowder only, may cause death. In these cases, an impulsive force is given bv the explosion, and the substance becomes a dangerous projectile. The lighter the projectile, the shorter the distance to which it is carried ; but when discharged near to the body it may produce a fatal penetrating wound. A portion of the dress may be carried into the wound and lead to death from bleeding ; or, if the wounded person recover from the first effects, he may subsequently sink under an attack of tetanus or erysipelas. It is unfortunate that so much ignorance prevails on this point ; for fatal accidents frequently occur from persons discharging guns at others in sport — an act which they think they may perform without danger, because they are not loaded with ball or shot. It has been observed that persons, in attempting to commit suicide, have occasionally forgotten to put a bullet into the pistol ; nevertheless, the discharge of the weapon into the mouth has sufficed, from the effect of the wadding only, to produce a considerable destruction of parts, and to cause a serious loss of blood. Fatal accidents have frequently taken place from the discharge of wadding from cannon during reviews. It is not WOUNDS FROM WADDING AND GUNPOWDER. 387 easy to say at what distance a weapon thus charged with wadding and powder would cease to produce mischief, since this must depend on the impulsive force given by the powder and on the size of the piece. Lachese ascertained that a piece charged with gunpowder is capable of producing a penetrating wound somewhat resembling that caused by small-shot, when the piece is large, strongly charged, and fired within six inches of the surface of the body. (Ann. d'Hyg., 1836, p. 3fi8.) This arises from a portion of the powder always escaping combustion at the time of discharge, and each grain then acts like a pellet of small-shot. Under any circumstances, a discharge of powder only, contuses the skin, producing ecchymosis, and often lacerating it if the piece be fired near. The dress is burnt and the skin scorched from the globe of flame formed by the combustion of the powder, and many particles of gunpowder may be actually driven into the true skin. All the substances here spoken of are considered to be projectiles ; and the weapons are held in law to be loaded arms so long as they are capable of producing bodily injury at the distance from which the piece containing them is discharged. It may, therefore, become a question as to the distance at which these light pro- jectiles cease to be harmless. The answer must be governed by circum- stances ; but it will in all cases materially depend on the strength of the charge. Swift performed some experiments with a pistol loaded with gunpowder and wadding, in order to determine the effect of a discharge at diff"erent distances. At twelve inches' distance from a dead body, he found that the clothes were lacerated and the skin abraded, but the wad- ding did not penetrate ; at six inches, the clothes were lacerated, and the wadding penetrated to the depth of half an inch ; at two inches, the wound produced, which was two inches deep, was ragged and blackened ; at an inch and a half from the chest, the wadding passed into the cavity between the ribs, and in a second experiment it carried away a portion of a rib, (Lond. Med. Gaz., vol. xl. p. 734.) This subject was investigated by Mackintosh, and he forwarded to the author the results of his experiments. As a summary he found, in refei*- ence to the wounds produced by wadding, that the amount of injur}" done is in proportion to the amount of powder in the gun, the hardness and com- pactness of the wadding or substance used in place of shot or bullet, and the distance of the object from the point of firing. A case occurred in his practice which was the subject of a trial for unlawful wounding. (Reg. V. Isgate, Norwich Aut. Ass., 186t.) The prisoner fired at a boy with a gun loaded with pieces of brown paper pressed together. He was then at a distance of two or three yards from the boy. There was a wound in the chest about the size of a shilling. The margin of the wound was jagged, had a bluish-black or mottled appearance, and the edges of one of the ribs were laid bare. The pellet took a course downwards as a result of its deflection by the rib. A quantity of brown paper was removed from the wound, and the boy ultinuxtely recovered. The question which Mackin- tosh proposed to consider was whether paper-wadding could really pro- duce such a wound as was here found when the gun was fired from a dis- tance 0^ two or three yards. Without going into details it may be stated that when the gun was charged with a small quantity of powder and brown-paper wadding, there was indentation, but no penetration at a distance of two yards. With one-third more powder and a closely-com- pressed brown-paper pellet there was penetration through the boy's jacket to an inch and a half bcN^ond. These facts bear out the conclusion already given, and confirmed the boy's account of the distance from which the gun was fired at him by the prisoner. Swift had inferred from his experi- 388 EXAMINATION OF FIREARMS. meats that a penctratin.ii; wound from wacUlino^ was not prodnccd unless the i)ieee Avas discharged within a distance of six inches ; but Maclvintosh's results clearly show that this must depend on the quantity of powder used and the loose or condensed nature of the substance employed as a projectile. Examination of Firearms. — An attempt has lieen made by French medical jurists to determine for how lont^- a jK'riod a g'un or a pistol found near a dead body may have been discharged ; but it is out of our power to lay down any precise rules on such a subject. All that we can say is that a ciuantity of sulphide of potassium, mixed with charcoal, is left adhering to the l)arrel of the piece when recently discharged ; and this is indicated by its forming a strongly alkaline solution with water, evolving an odor of sulphuretted hydrogen, and giving a deep-brown precipitate with a solution of acetate of lead. After some hours or days, according to the degree of exposure to air and moisture, the saline residue be- comes converted into sulphate of potassium, forming a neutral solution with w'ater, and giving a white precipitate with acetate of lead. If a considerable time has elapsed since the piece was discharged oxide of iron, with traces of sulphate, may be found. (See Ann. d'llyg., 1834, p. 458 ; 1839, p. 197; 1842, p. 368.) When called to a case of gunshot-wound, either accidental or criminal, it is always proper to examine the piece, if found. Has it or has it not been recently discharged, may be a material question. This is best deter- mined by a gunsmith. A trial took place on the Western Circuit, March, 1873, in which the fact was of great importance. The prisoner asserted that his gun had not been used for a long time. On examination of the barrel, however, it was found to have been quite recently discharged. This at once connected him with the act of wounding of which he was accused. In an agrarian murder in Ireland, in 1876, there was found imbedded in the heart of the deceased the half of a common marble such as children use in play. A bag of marbles of the same size and kind was found in the house of one of the prisoners, and this discovery connected him with the act. The examination of wadding or paper found in a gunshot-wound, or near a dead body, has in more than in one instance led to the detection of the person who had committed a crime. The handwriting has been traced on the paper used as wadding, or it has been found to have been part of a printed page, of which the remainder has been discovered in the posses- sion of the accused. When a gun is discharged near to the body a portion of the wadding is generally carried into the large irregular wound which is produced. This was part of the evidence in the case of Reg. v. Blagg (Chester Sum. Ass., 1857). The peculiar character of the wadding found in the body connected the prisoner with the act. Whether the wadding is found in or near the body it should be equally preserved. In Reg. v. Richardson (Lincoln Ass., Dec. I860), the accused was convicted of mur- dering a policeman under the following circumstances. He shot at the deceased, who was able before death to identify the prisoner ; but as the deceased was weak from loss of blood, and failing in consciousness at the time, there was some difficulty in relying upon the dying declaration, especially as no other person witnessed the act. Some paper-wadding had been picked up on the spot where the deceased fell; and a gun, which had one barrel loaded and one empty from a recent discharge, was found in the prisoner's house within twenty-four hours of the murder. The wadding in the loaded barrel consisted of a fragment of the Times news- paper of March 27, 1854, and the charred and sulphurous pieces of wad- BURNS AND SCALDS. 389 ding picked up on the spot were proved by the pul)li.sh(>r of that journal to have formed a portion of the same impression. Tlie i)risoner's counsel, in fact, could not deny that the act had been brought home to the instru- ment, if not to the agent, and, though the explanation of the crime re- mained obscure to the last, and the motive unassignable, the aggregate evidence proved sufficient to convince the jury. Any projectiles found in a gunshot-wound should always be preserved for evidence. In the case of Rush, who was tried and convicted of the murder of Mr. Jermy by a remarkable train of circumstantial evidence (Norwich Lent Ass., 1H49), it was proved that the projectiles removed from the body of the deceased consisted of irregular pieces of lead (slugs). Similar masses were taken from the body of the son, who was killed at the same time. They were described by the medical witness as being angular, and quite unlike the shot used in killing game. This proved that the two acts of murder were committed by the same person, or by this person acting in concert with others. The chemical analysis of a projectile may be occasionally necessary. A common bullet is formed entirely of lead. Cast bullets are commonly found to have a void space in the interior, when cut through the centre, owing to the exterior cooling more rapidly than the interior, and to the greater bulk of the metal when in a liquid state. In large bullets this cavity is frequenth^ of the size of a barleycorn. Bullets obtained by com- pression have no such space, and are of greater specific gravity. Small shot is composed of lead, with a minute portion of arsenic (l-200th part). If the arsenic is in large proportion, the shot is lenticular ; if absent, or in small proportion, pyriform (Ure). In the case of Rush, type-metal was found in the house. This consists of lead, with one-fourth part of anti- mony. The slugs were found to consist chiefly of lead, and to contain no antimony. Type-metal was thus excluded. CHAPTER XXXVII. DEATH FROM BURNS AND SCALDS. SYMPTOMS. STCPOR. CAUSE OF DEATH. POST- MORTEM APPEARANCES. BURNS ON THE DEAD BODY. ACCIDEKT, HOMICIDE, OR SUI- CIDE. WOUNDS CAUSED BY FIRE. SCALDING. — BURNS BY CORROSIVE LIQUIDS. Burns and Scalds. — A 6wrn is an injury produced by the application of a heavy solid, or a flame, to the surface of the body ; while a scald re- sults from the application of a liquid at a high temperature under the same circumstances. There seems to be no real distinction between a burn and a scald in reference to the efi'ects produced on the body ; the injury result- ing from boiling mercury or melted lead might take either appellation. Nevertheless, as a matter of medical evidence, it may be important to state whether the injury found on a body was caused by such a liquid as boiling water or by a heated solid. If the former, the injury might be ascril)ed to accident; if the latter, to criminal design. A scald produced by boiling water would be indicated by a sodden state of the .skin and flesh, but there w^ould be no desiruction of substance. In a burn by a heated solid, the parts may be more or less destroyed, or even charred ; the cuticle may be found blackened, dry, almost of a horny consistency, and presenting a shrivelled appearance. This distinction, however would 390 CAUSE OF DEATH. only apply to scalds from water. A scald from melted lead (633° F.) could not' be distinguished from a burn i)roduced by a solid heated to the same temperature. Some of the oils boil at 500° F., and they produce, by con- tact with the skin, burns as severe as those caused by melted metal. Burns from flame, such as that of gas, are indicated by extensive scorching of the skin, while burns from gunpowder are known not only by the scorch- inir, but by the small particles of unburnt carbon which are imbedded in the skin. Neither a burn nor a scald appears to be considered as a wound in law ; but in the statute of wounding they are included among bodily injuries dangerous to life. Burns and scalds may be regarded as dangerous in proportion to the extent of surface of skin which they cover, as w'ell as the depth to which they extend. The extent of skin involved in a super- ficial burn, as a result of exposure to flame, is of greater importance than the entire destruction of a small part of the body through an intensely heated solid. When the burn is extensive, death may ensue either from the severity of the pain produced, or from a sympathetic shock to the nervous system. Death takes place rapidly from burns in children and nervous females; but in adults and old persons there is a better chance of recovery. In some instances, especially in children, stupor and insensi- bility supervene; and these symptoms have been soon followed by coma and death. If, under these circumstances, opium has been given to the patient as a sedative, the stupor resulting from a burn may be attributed to the narcotic effects of the drug; and, should the person die, the prac- titioner may find himself involved in a charge of malapraxis or man- slaughter. It may be alleged, as in the following case, that the person was poisoned with opium. A medical man was charged with the man- slaughter of a child, by giving to it an overdose of opium wiiile it was laboring under the effects of a severe scald. Abernethy stated in his evi- dence, which was given in favor of the practitioner, that he thought the use of opium was very proper ; that the quantity given — eight drops of tincture of opium immediately after the accident, and ten drops two hours afterwards — w^as not an overdose for a child (the age is not stated). The circumstance of the child continuing to sleep until it died, after taking the opium, was, in his judgment, no proof that it had been poisoned. The sleep Avas nothing more than the torpor into which it had been plunged by the accident. The surgeon w^as acquitted. Notwithstanding the very favorable opinion expressed by Abernethy of this plan of treatment, it would be advisable to avoid the use of opium on these occasions in treat- ing infants and children. [Dr. C. Meymott Tidy dissents from Dr. Tay- lor's view^s regarding giving opium to burnt children. He sa3's in addi- tion,, " It must not be forgotten that extreme pain may be and often is fatal:" Tidy's Legal Med., vol. i. p. 465, Phil, edition.] Life is readily destroyed in young subjects by the smallest doses of this drug; and there are no satisfactory means of distinguishing the comatose symp- toms produced by a burn or a scald from those produced by an overdose of opium (p. 186). Cause of Death. — In some instances, especially in children, stupor and insensibility have rapidly supervened ; and these symptoms have been followed by coma and death. Of the cause of death in persons exposed to fire, little need be said. In large conflagrations persons are frequently simply suffocated from the want of a proper amount of air or from breath- ing the products of combustion — carbonic acid or carbonic oxide. The former darkens the blood and muscles; the latter renders them lighter in color. In other cases, where a large volume of flame suddenly strikes the BURNS ON THE LIVTNG AND DEAD BODY. 391 body and the person is still able to breatbe, the fatal effect may be due to shock — a sudden and violent impression on the nervous system throii. 448) show that, even with a perfect closure of the windpipe, an animal may recover si)()ntaneously after nearly four ininutes' deprivation of air. In hanging and strangulation there is sometimes great violence done to the parts about the neck. In suffocation these accidental obstacles to recovery do not exist, and the surgeon has simply to readmit the air into the lungs. All experiments go to show that, even in this form of asphyxia, which is most favorable for recovery, the comi)lete suspension of respiration for five minutes is fatal. Hanging and strangulation prove fatal from asphyxia within the same period of time, and drowning within a shorter period. Yierordt has shown that the spectroscope will enable a skilful observer to note the time at which life has passed into death, and whether there is a probability that life can be restored after a certain interval. If the fourth and fifth fingers are placed one over the other in a living body, and the line of union is brought before the slit of a spectroscope against the sunlight, or a very powerful light, the two absorption-bands of oxy-ha^mo- globin will be visible (p. 282.) In the body of one really dead, whether from asphyxia by suffocation or any other cause, only one band, that of de- oxidized hemoglobin, will be seen. Yierordt found that, even in the living body, by a compression of the fingers, local death by the withdrawal of oxygen takes place rapidly, and the two bands pass into one. On remov- ing the temporary pressure the oxygenated blood again circulates, and the two bauds are restored. Post-mortem Appea,rances. — There are rarely any considerable marks of violence externally. When the body has become perfectly cold there may be patches of lividity diffused over the skin ; but these are not always present. Tardieu has found upon the skin of the neck, face, and shoulders dotted or punctiform ecchymoses. (La Pendaison, la Strangulation, et la Suffocation, p. 267.) The lips are livid ; the skin of the face and neck may be pale or present a dusky-violet tint, with small patches of ecchy- mosis. The eyes are congested ; there is a mucous froth about the lips and mouth. The mouth, throat, and parts about the windpipe should be carefully examined for foreign substances. Internally the lungs and right cavities of the heart may be found distended with blood. The state of the lungs and heart is, however, subject to variation. The lungs are not necessarily found congested ; and sometimes, as in a case referred to the author in 1864, one lung may be found congested and the other not. In 1883 a terrible catastrophe occurred in Sunderland, whereby about two hundred children lost their lives by suffocation. By the closing of a door the children, pouring down a staircase, trampled one another to death, their bodies being heaped upon one another to a height of several feet. The same characteristic appearances were observed in nearly every case, namely, a congested puffy face, purple or blackish turgescence of the vessels of the neck, closed eyelids, protruding and fixed eyeballs, pupils dilated to the utmost, bloody froth issuing from the nose and mouth, giving the appearance of an intense degree of sufTering and anxiety ; yet, in twenty-four hours after death, much of this passed off and the face exhibited a slight smile, as if in sleep. (Brit. Med. Jour., 1883, i. p. 1248.) Tardieu states, from his observations, that the lungs are of a reddish color, sometimes pale, and not distended, and presenting occasion- ally only a slight degree of congestion at the l)ase and posteriorly. A special character which he states he has invariably noticed in these organs consists in the presence of small ecchymosed spots or patches beneath the pleura or investing membrane. He describes these spots as of a dark STATE OF THE LUNGS. 453 color, and varving- in size from a pin's head to a lentil. In the adult they are of i^till larger size. Their number is variable; sometimes five or six may be found, at others twenty or thirty, and in other cases the surface of the lung may be so studded with them as to give to it a granite-like appearance. These spots of ecchymosis are sometimes agglomerated, at other times separated, but their outline is generally distinct and well defined on the surface of the lungs. They are most frequently seen at the root of the lungs, at their bases, and about their lower margin. They are owing to small eftusions of blood from ruptured vessels, like true ecchy- mosis. They may be distinguished so long as the tissue of the lungs remains unchanged. Tardieu states that he has seen these subpleural ecchymoses in the lungs of an infant which had been lying ten months in the soil of a privy. He admits, however, that they may also be found in the lungs of children that have not breathed; hence no inference of death from suffocation should be drawn from this appearance in the lungs, unless they have actually received air. In three instances he met with subpleural ecchymoses in lungs which sank in water, and had all the usual characters of these organs in a foetal state. The children had been born living, prematurely, and under conditions in which life by respiration could not be perfectly established ; one of them had made several cries without effectually receiving air into the lungs. ( See Casper's Klin. Novellen, 1863, p. 471.) This struggle to breathe may have produced the appearance resembling that of suffocation. In newborn children dying from suffocation the thymus gland has been found in a similar condition. The same appearance may be produced during the birth of a child by pressure on the navel string, when this is prolapsed whilst the head of the child is passing down the vagina. The value of medical evi- dence derivable from the presence of subpleural ecchymoses in the lungs has been also investigated by Legroux. (Ann. d'Hyg., 1878, t. 2, pp. 174 and 335.) He believes : 1. That they may be seen in the lungs under various conditions, independently of the cause of death. 2. The}^ ai'e met with in different degrees in the different forms of death by asphyxia. 3. Unless accompanied by other indications of the mode of death, their presence will not enable us to determine the cause. In death from suffo- cation they are veiy numerous, from strangulation less numerous, and from hanging least numerous. 4. The presence of subpleural ecchymoses indicates a rapid and violent death, whether the violence be from internal or external causes. A Committee of the Soci^te de Medecine Ldgale was appointed to examine the value of this post-mortem appearance as a positive indication of death by suffocation. They reported: (1) that subpleural ecchymoses may arise from spontaneous conditions irrespective of the cause of death; (2) that they may be met with in violent asphyxia by hanging, strangulation, submersion, by compression of the chest, and by suf- focation, but in different degrees ; (3) they are of value only when associated with other signs indicating the mode of death. (Lancet, 1878, ii. p. 305.) According to Tardieu, this dotted appearance of the surface of the lungs in suffocation is not attended with the apoplectic effusions in their sub- stance which are met with in death from strangulation. Emphysema, or escape of air from rupture of the air-cells, is occasionally observed. The more rapidly suffocation has taken place, the more strongly marked are these ecchymosed spots. On the other hand, when the interruption of breathing has been slow and gradual, the substance of the lungs is more congested with blood, and then these dots or patches are merged in the general violet color of the surface of the organs. The lining membrane of the windpipe and larger air-tubes is sometimes pale, but commonly 454 STATE OF THE HEART. dark-colored when the liing-s are coDjrosted. In tlic air-passages there is occasionally a frothy, reddish-colored liciuid in small vesicles. Liman disputes the accuracy of the observations of Tardieu regarding this ai)pearance described by him as characteristic of death from suffoca- tion. (Ann. d'Hyg., 1867, t. 2, p. 388.) According to Ogston, Sen., the subpleural or punctiform ecchymoses observed by Tardieu were not ]>resent in the cases of nine adults who had died from suffocation, (Brit. Med. Jour., 1868, ii. p. 832.) On the other hand, they may be found in cases in which death has taken place from drowning, hanging, and strangu- lation. Too much reliance must not, therefore, be {)hiced on their jiresence or absence. These spots of ecchymosis were found by Ogston, not only on the surface of the lungs, but on the heart, the seal)), the pericranium, the thymus gland, and other parts. That they are frequently absent in death from suffocation is shown bv the observations of other medical jurists. (See Vierteljahrsschr. fiir Gerichtl. Med., 1867, 2, p. 146.) -In an elabo- rate paper published in the same journal, Lukomsky has endeavored to show, by a variety of experiments, the circumstances under which we may e.xpect to find these ecchymoses in death from suffocation, and the cases ia which thev are likely to be absent. (Vierteljahrsschr. fiir Gerichtl. Med., 1871, 2, p. 58.) Page, who has experimented on this subject, agrees with the above- named medical jurists in considering that Tardieu has been too hasty in making these dotted or subpleural ecchymoses a certain diagnostic sign of death from suffocation. According to him, they probably arise from the continued and violent efforts to breathe in the early stage of asphyxia. Their occurrence in the lungs of a hanged person would not, therefore, justifv the inference that the person had been first suffocated and after- wards hanged. The same remark applies to drowning. Page found, on drowning animals, that subpleural ecchymoses were so numerous on the lungs as to give to the organs a granitic aspect. (On the Value of Cer- tain Signs of Death from Suffocation, Edinb., 1873.) He has drawn the following conclusions from his experiments : 1. The ecchymoses or patches of extravasated blood found on the surfaces of certain internal organs, and notably of the lungs, are not peculiar to any one mode of death by asphyxia, but are common to all. 2. The ecchymoses are not, therefore, diagnostic of death from suffocation. 3. They probably occur with greater frequency in suffocation, owing to the absence of interference with the cerebral circulation, and the opportunity which the means usually employed afford for respiratory struggles. The heart presents no special appearance indicative of the mode of death, if we except the presence of small spots of ecchymosis found below the investing membrane, like those met with on the lungs. They have been found near the roots or origin of the great vessels, but are not so frequently observed in this organ as in the lungs. The blood is generally dark and fluid; but sometimes coagula are met with. The stomach and intestines have been observed to present patches of lividity. Casper has found the kidneys more strongly congested with blood than the liver, spleen, and other organs. The vessels of the brain are sometimes con- gested, but at other times they do not appear to be more than ordinarily full. Their condition may be affected by the congested state of the lungs, as well as by the slowness or rapidity with which death takes place. Other appearances which have been described are of an accidental nature, and are not connected with death from suffocation. In a case of alleged murder by suffocation, respecting which the author was consulted in 1857, the following appearances were met with. The EVIDENCE OP THE CAUSE OF DEATH. 455 body was hnng on the bed: the right leg was drawn up tow^ards the body; tlie right arm was bent, with the hand directed towards the face; the left hand was lying upon the chest. The lips were livid, the tongue protruded and swollen, and there was a bloody fluid issuing from the nostrils. There was no mark of constriction on the neck ; the eyes were half-open ; the body was rigid and still warm. The face and neck were much swollen, and the skin of these parts, as well as of the chest, abdo- men, arms, and legs, was covered with dark livid patches. The brain was gorged with venous blood. The lungs were congested. The heart was soft and flaccid, and its cavities were empty. The mucous mem- brane, as well as the tissues of the air-passages, was much congested with dark li((iiid blood — the blood was everywhere liquid. The stomach contained a small quantity of dark-colored liquid, and the greater end was reddened. The spleen was congested. The emptiness of the cavities of the heart was at first considered to be inconsistent with death from asphyxia ; but this condition of the heart is occasionally found. It may be stated that in this case the deceased, a female, was greatly exhausted by sickness and purging. On the second day of her illness she was found dead in the state described, and her husband was charged with having suffocated her. Evidence of Death from Suffocation. — In medical jurisprudence there is not, perhaps, an instance in which we have fewer medical data upon which to base an opinion than in a case of alleged death from suffocation. The inspection of the body of a person suffocated, if we except the peculiar condition of the surface of the lungs described by Tardieu, presents so little that is peculiar, that a medical man, unless his suspicions have been roused by circumstantial evidence, or by the discovery of foreign sub- stances in the air-passages, would probably pass it over as a case of death without any assignable cause — in other words, from natural causes. In examining the body of the woman Campbell, who was suffocated by Burke in Edinburgh, Christison was unable to come to a conclusion respecting the cause of death until some light had been thrown on the case by collat- eral evidence. On this occasion a violent death was suspected, because there were marks of violence externally, and the face of the deceased pre- sented some of the characters of strangulation. These conditions, how- ever, are by no means essential to death from suffocation, and when they exist they can only be regarded as purely accidental accompaniments. Appearances similar to those found in the bodies of suffocated persons, if we except the dotted ecchymoses on the lungs, are frequently met with in inspections when death has taken place as a consequence of disease or accident. They can, therefore, furnish no conclusive evidence of the kind of death ; they scarcely permit a witness to establish a presumption on the subject, until, by a careful examination of the body, he has ascertained that there is no other cause of death depending on organic disease or on violence. Medical evidence may, however, be serviceable in some in-, stances. Thus, let the general evidence establish that a deceased person has probably been suffocated, the witness may have it in his power to state that the appearances in the body are consistent with this kind of death; that the body is in all respects healthy and sound; and that death was probably sudden — as where, for instance, undigested food is dis- covered in the stomach. The presence of ecchymoses on the surface of the lungs may justify an opinion of death by suffocation when no other cause is apparent. In all cases of this description, we must bear in mind that an opinion relative to the supposed cause of death is to be formed from the medical circumstances and from what we have ourselves seen, unless 456 SUFFOCATION FROM ACCIDENTAL CAUSES. it be otherwise allowed b}- the court. From this want of clear evidence, a great difference of opinion on the cause of death frequently exists among medical witnesses. Accidental suffocation is not unfrequent; and there are various condi- tions under which a person may die suffocated, only discoverable after death. 1. Diseases al>out the tongue, larynx, or throat may have ad- vanced to such an extent as effectually to prevent breathing. 2. The de- ceased may have fallen, and the mouth become covered with dust, ashes, mud, or other substances; and, if helpless, as in the case of an infant or an aged person, or of one who is intoxicated, death may thus easily take place. A child was found dead in a room, with its face in the ashes under a grate ; it had fallen during the absence of the mother, and, from its help- less condition, had speedily becon)e suffocated. Some of the ashes were found in the windpipe. (Lond. Med. Gaz., vol. xvii. p. 642.) In 1878 a boy died from suffocation under the following circumstances: He was playing in a corn-loft with some companions, when, in order to hide him- .self, he got into a wheat-bin about eight feet deep. He was drawn through the wheat towards the machine, and was thus buried in the corn. Although extricated in a few minutes, he was quite dead. In trials for murder or manslaughter, a medical opinion respecting the accidental suffocation of a drunken person under similar circumstances is occasionally required. These persons, it must be remembered, are generally as helpless as chil- dren ; if they fall in a position so that the mouth is covered, they may be so powerless from intoxication as not to be able to escape. A case was brought into Guy's Hospital in 1870, in which a man subject to epileptic fits had lost his life by accidental suffocation. He was found dead, lying with his face in a quantity of mud. On a post-mortem examination, the teeth and nostrils had liquid mud adhering to them, and the tongue was thickly coated with it. The right side of the heart was full of blood, and there was a large quantity on the left side extending into the aorta. The blood, as is frequently the case in sudden death, was liquid. There were a few gritty particles in the windpipe, but no froth. There was no doubt that the man had died from asphyxia, as a result of accidental suffocation during a fit. (Lancet, 1870, ii. p. 82.) In 1877 an inquest was held, in which it was proved that the deceased was found dead in l)ed, lying with his face downwards and one arm under his head. The medical evidence showed that the cau.se of death was suffocation, by reason of the deceased having turned with his face to the pillow and so covered his mouth and nostrils. .3. A portion of food may have remained fixed in the larynx or throat. Children are sometimes accidentally suffocated by drinking boil- ing water from a tea-kettle. The parts about the larynx then become Swollen from the action of the hot water, and breathing cannot take place. 4. Accidental suffocation is not uncommon among infants when they .sleep with adult persons (overlaying). A child may be in this way speedily , destroyed. Even the close wrapping of a child's head in a shawl, to protect it from cold, may effectually kill it, without any convulsive strug- gles to indicate the danger to which it is exposed (p. 458, post). Con- vulsions by no means necessarily attend on death from suffocation. Those instances of accidental suffocation which depend on disease or on the impaction of food, are easily known by a careful examination of the parts about the throat ; and generally they present no difficulty. In other instances, when a child or a drunken person is presumed to have been suffocated owing to the position in which he has fallen, evidence as to the position of the body, or even the actual sight of the body, is necessary before forming an opinion. The following questions may here arise : Was HOMICIDAL SUFFOCATION. 457 the position such as to be explicable on the supposition of accident ? Was it not such a position as mig'ht have been given to it by a murderer? Could not the deceased have had strength or presence of mind to escape? Could he have been actually suftbcated in the position in which his body was discovered ? A little reflection upon the circumstances — for here something more than medical facts will be required — may enable us to give satisfactory answers to these questions. Some singular cases are on record in which persons have wilfully de- stroyed themselves by blocking up the throat mechanically. An instance of this form of suicide is reported. (Edin. Med. and Surg. Jour., 1842, p. 391.) A woman confined in prison forced a hard cotton plug into the back of her throat. The cavities of the chest and abdomen had been alreadv examined, and a medical certificate given that the deceased had died of apoplexy. The body was sent to one of the anatomical schools, and on reinspection it was accidentally found that the throat was firmly blocked up with a plug of spindle-cotton. Homicide by suflbcation is not very common, although it is a ready means of perpetrating murder. Hitherto the cases which have come before our courts have generally been those either of infants, or of the aged and infirm, or of persons enfeebled by illness (see, however, Reg. v. Kerr, p. 449). In regard to the latter, the rigorous administration of the law has succeeded in putting a check to this crime ; but with respect to children, it probably yet continues. Death by suffocation is most difficult to detect ; and, unless the assailant has employed an unnecessary degree of violence, it is probable that the crime may pass altogether unsuspected. Homicide by suffocation would not be attempted on healthy adult persons, unless they were in a state of intoxication, and thereby rendered defence- less. It is certain that most individuals would have it in their power, unless greatly incapacitated by disease or intoxication, to ofler such a de- gree of resistance as would leave upon their bodies indubitable evidence of murderous violence. Death from suffocation may be considered as pre- sumptive of homicide unless the facts are clearly referable to accident. Accidental suffocation is, however, so palpable, from the position of the body and other circumstances, that when death is clearly traced to this cause it is not easy to conceive a case in which it would be difficult to distinguish it from one of actual murder. In some instances, the very means that have been adopted to produce suffocation may forbid the sup- position of accident and clearly establish the fact of homicide. The suffocation of newborn children, by the introduction of substances into the mouth, is not unfrequent. The unnecessary force employed generally leaves traces of violence, which may be easily discovered by a careful examination, even should it happen that the substance used for the murderous purpose has been removed. A child, one year old, after it had been fed with a bottle, was put to bed at six o'clock, and died at midnight with signs of dyspnoea. On inspection ten hours after death, the lower lobes of the lungs were found softened, of a grayish color, and apparently pulpy. Curdled milk was found in the windpipe and bronchi. There was no doubt that the milk had been vomited after the child was put to bed, and, on account of the horizontal position, a portion of it had been drawn bv aspiration into the air-passages and had caused suffocation. (Lancet, 1873, i. p. 669.) It is necessary to point out a dangerous practice common among igno- rant nurses, which, without exciting suspicion on the part of a coroner or medical witness, may be an occasional cause of death in infants. In order to quiet a child, and to enable a nurse to sleep without disturbance, a bag 458 DEATH FROM SMOTHERING. made of wash-leather or vnv^ containing sugar is thrust into the child's mouth. It is thus completely gagged, and the child soon becomes quiet, respiring chiefly througli the nostrils. If these by any accident become obstructed, or by the act of aspiration the bag should fall to the back of the tliroat, death from suffocation results, the infant being h(»lpless. The suspension of breathing may be so gradual that the child may die without orving or convulsions. Tlie removal of the bag from the mouth, as no violence has been used, will remove every trace of the cause of death; and, in order to exculpate herself, the guilty i)erson may ascribe death to " fits." In one instance, an infant was timely saved by the mother having discovered, while the nurse was sleeping, a mass of wash-leather projecting from its mouth. The woman awoke and attempted to remove and conceal the leather, but she was discovered in the act. The detection of this dangerous practice can only be a matter of accident ; hence a fatal case can be rarely the subject of a coroner's inquest, and even then medi- cal evidence may fail to throw any light upon the cause of death. In one instance only have we known it to give rise to a criminal charge. (Reg. V. Cox, Warwick Lent Ass., 1848.) The mother, a pauper, was tried for the attempt to suffocate her infant, eleven days old. The child was dis- covered by another person with a piece of rag hanging from its mouth. It was livid in the face, but when the rag was removed it made a violent gasp and recovered its breath. There was no malice on the part of the prisoner, but it was made a strong point in her favor that instances had occurred in the workhouse, in which women had with impunity put rags with sugar into the mouths of infants in order to soothe and keep them quiet. She was acquitted. The admitted practice of infantile suff"ocation appears to have passed without reprimand or even comment, although this plan of soothing infants is just as likely to be fatal to them as that of encircling their necks with tight ligatures. Smothering. — Smothering is a variety of suffocation, and consists in the mere covering of the mouth and nostrils in any way so as to prevent the free ingress and egress of air. Like drowning, hanging, or strangulation, it produces death by asphyxia. In newborn infants it is not an unusual occurrence, sometimes originating in accident, and at others in criminal design. An infant may be speedily destroyed by smothering. If the mouth be only lightly covered with clothing or slightly compressed, so that respiration is interrupted, as in the act of carrying a child in the arms, this will suffice to cause death ; and, as it has been already remarked, death may take place without being preceded by convulsions or other striking symptoms. Smothering is not often resorted to as a means of perpetrat- ing murder, except in infants or in debilitated and infirm adults. In a case which occurred at Ayr, a woman was charged with the murder of her child by smothering it in her shawl. She was travelling in a steam- boat ; it was a cold, stormy day, and she had wrapped the . shawl closely round the head of the child. There could be no doubt, from the moral circumstances, that she had intended to kill it ; but the defence was that she had merely intended to protect the child from the cold, and it was suffocated before she was aware of it. There were no facts to exclude this defence, and the woman was acquitted. But children may be thus acci- dentally destroyed through the ignorance of persons who nurse them. According to Wakely, infants are frequently found dead owing to their being suckled at night while the woman is in bed. The child's face is pressed on the breast ; mother and child fall fast asleep ; the head slips beneath the clothes, and the child is then quietly suffocated. There is no mark of pressure or violence on the body. (Lancet, 1858, i p. TO.) This POST-MORTEM APPEARANCES. 459 statement is strongly eonfinned by the annual returns of the Registrar- General. A child (five days old) died quietly on its mother's arm while lying in bed. There was much lividity about the head, neck, and back ; but there were no marks of violence. The bronchial tubes of the right lung contained bright florid blood. The left lung was gorged with blood, but none had escaped. The heart was firmly contracted, and there was only a small quantity of blood in its right cavities. According to the return of the Registrar-General, suffocation in bed from " overlaying" is a fre- quent cause of violent death among infants. Infants are readily smothered bv the bed-clothes accidentally covering the mouth and nostrils, and they have not the power to change their position. The appearances met with in the bodies of three children who had died under these circumstances are thus described by Canton. Externally : features i)lacid ; lips congested; eyes not unduly prominent ; conjunctivae rather reddened ; hands clenched ; no patches of occhymosis found on the skin. Internally: head — patches of effused blood here and there beneath the pericranium ; great congestion of the pia mater, accompanied by numer- ous effusions of blood, varying in size from a pin's point to a silver penny {sic) in superficial extent ; a little clear fluid in the ventricles ; some frothy mucus in the windpipe and bronchi, with redness of their lining mem- brane. The lungs were much congested and crepitant, whilst beneath the pleurae blood was effused, presenting numerous small bright-red patches and fine points (punctiform ecchymoses). The pericardium contained some serum and was spotted in its whole extent in the manner described ; the vasa vasorum of the heart's great vessels and thoracic aorta were minutely injected. The right cavities of the heart in all the cases con- tained dark liquid blood ; the left cavities were nearly empty ; the tissue of the organ was free from effused blood. The surface only of the thymus gland was mottled like the heart. There is a prevalent notion that congestion of the lungs is an invariable accompaniment of death from suffocation, and where this Avas not found it has been hastily assumed that death had taken place from some other cause. Some remarks on this post-mortem appearance have been made in the chapter on Drowning ; and it is desirable, in reference to future cases, to point out the fallacy involved in the assumption that congestion of the lungs is necessarily present in death from suffocation. Watson observed that the gorged state of the right side of the heart and lungs is greatest where the act of suffocation (asphyxia) has been slow and gradual by the access of air to the lungs not having been completely prevented. When, on the other hand, death has taken place quickly or suddenly from this cause, there is little or no unusual congestion of blood in the lungs or heart. (On Homicide, p. 115.) At p. 118 he describes a case of death from suffocation in which the lungs were natural ; 'and in the case of Campbell, for whose murder by suffocation Burke was convicted and exe- cuted in 1828-9, Christison and Newbigging found the organs within the chest perfectly natural, the lungs remarkably so, and unusually free from infiltration. The blood in the heart and great vessels, as well as through- out the body, was fluid and black. (Edin. Med. and Surg. Jour., vol. xxxi. p. 239.) Again, in the case of Carlo Ferrari, for the murder of whom Bishop and Williams were convicted in London in 1831, the lungs were quite healthy, and not congested ; the heart was rather small, con- tracted, and its four cavities were perfectly empty. The prisoners in this case confessed that they had destroyed the deceased by suffocation. From these facts it will be perceived that the actual state of the lungs and heart in the bodies of those who had been notoriously murdered by suffocation, 460 BURKING MEDICAL EVIDENCE. is that which has been wrongly pronounced to be inconsistent with this mode of death. Certain trials which took place many years since clearly proved that persons in a state of intoxication or infirmity had been murdered by smothering for the sake of the money derived from the sale of the dead bodies. The victims were commonly destroyed by the assailant resting with his whole weight upon the chest, so as to prevent the motion of the ril)s, and at the same time forcibly compressing the mouth and nostrils with his hands, to prevent the entrance of air. A case of this kind was referred to the author for examination in 1831. (Rex v. Elizabeth Ross, C. C. C, Dec. 1831.) It was remarkable for the fact that the prisoner was convicted of homicidal suffocation, although the body of the deceased was never discovered. (Lond. Med. Gaz., vol. xxxvii. p. 481.) In Reg. V. Norman, C. C. C, July, 1871, the prisoner, a girl, set. 15, was indicted for murder by suffocation. She was a nursery-maid, and had had the care of three children ; the deceased, one of these children, being fifteen n^onths old. There were three other charges of murder ])y suffocation against her, and one of an attempt to murder. There were suspicious marks of vio- lence on the lower lip of the deceased, as if produced by pressure of the mouth against some hard substance. The medical witnesses attributed death to suffocation by pressure on the mouth, but admitted that the marks might have been accidental. On this admission the prisoner was acquitted. On the trial for the attempt to murder, the girl was convicted, and the evidence given in this case threw a light upon the mode in which she might have perpetrated the four murders with which she was charged. A little boy, aet. 10, was heard to give an alarm while in bed ; it was a stifled cry. The prisoner was caught in the act of getting off the bed. The boy was in great agitation, and said that the prisoner had tried to strangle him while he was sleeping. He was awoke by feeling a hand on his mouth and throat. He tried to make a noise, upon which the prisoner, who was lying upon him, gave him a sweetmeat, and told him not to cry. His lips and throat were very sore. The prisoner was convicted and sentenced to ten years' penal servitude. There can be no doubt that the four murders were all perpetrated in a similar manner, by burking — the children being helpless, and unable to give an alarm. The conviction of the prisoner on the attempt simply arose from this child being older and better able to resist. The facts show that medical science in many of these cases is powerless to aid the law. It is not always possible to dis- tinguish murder by smothering or suffocation from accident. In reference to the case of Campbell, Christison observes "that the con- viction in the public mind, that a well-informed medical man should always be able to detect death by suffocation simply by an inspection of the body and without a knowledge of collateral circumstances, is erroneous, and may have the pernicious tendency of throwing inspectors off their guard, by leading them to expect strongly marked appearances in every case of death from suffocation. That such appearances are very far from being always present ought to be distinctly understood by every medical man who is required to inspect a body and give an opinion of the cause of death." At the same time, in the absence of marked appearances to indi- cate violent death, due caution should be used by a medical witness in expressing an opinion. At the trial of the prisoner Burke, Christison restricted his opinion by stating that death by violence was, from the medical circumstances alone, very pr-obahle — a degree of caution which, on similar occasions, it will be desirable for a medical witness to imitate. It is not possible to carry medical evidence further than this. There is SUFFOCATION OR POISONING BY GASES. 461 nothing in the act of suffocation, as there is in wounds, poisoning, hang- ing, 01* strangulation, by which the hand of a criminal can be clearly and unequivocally traced. As an accident, smothering may be conceived to take place when a person falls, in a state of intoxication and debility, so that his mouth is in any way covered, or the access of air to the mouth or nostrils is inter- rupted. On an inspection of the body, the appearances elsewhere described will be met with in the lungs and heart. If the person has been able to struggle, it is probable that slight marks of violence in the shape of scratches or bruises may be found about the mouth and nostrils, with bruises or marks of pressure on the chest, legs, or arms, and redness of the mucous membrane, with a bloody mucous froth as Avell as foreign sub- stances in the air-passages. The marks of violence may be slight, or even entirely absent. In a case of suspected murder, a medical jurist should look for the special indications of suffocation in the lungs, the circumstances under which the body or bodies are found, the evidence of sudden death in the presence of food in the stomach, and lastly the absence of any other cause to account for death. All these sources of evidence may fail ; and as the means by which homicidal smothering was accomplished are not likely to be found with the body, a medical opinion on the case may be- come little more than a conjecture. Still, this may suffice when the evi- dence from extraneous circumstances is strong. CHAPTER XLII. GASEOUS POISONS. CARBONIC ACID. SYMPTOMS. APPEARANCES. ANALYSIS. EFFECTS OF CHARCOAL-VAPOR. CARBONIC OXIDE.— COAL AND COKE VAPOR. SULPHUROUS ACID. VAPORS OF LIME, CEMENT, AND BRICK-KILNS. CONFINED AIR. COAL-GAS. WATER- GAS. — CARBURETTED HYDROGEN. NITROUS OXIDE. SULPHURETTED HYDROGEN. EFFLU- VIA OF DRAINS AND SEWERS. Mode of Action of Gaseous Poisons. — In following common language, a medical jurist is compelled to apply the term "suffocation" to another variety of death — viz., to that of poisoning by gases. Physiological accuracy must here be sacrificed, in order that we may make ourselves generally intelligible. Thus, if a person die from the effects of carbonic acid, of confined air, of sulphuretted hydrogen, or of other noxious gases, he is commonly said to die suffocated. Strictly speaking, he dies poisoned — as much so as if he had taken oxalic or hydrocyanic acid. The only differences are : (1) that the poison, instead of being liquid or solid, is gaseous ; and (2) instead of being applied to the mucous membrane of the stomach, it affects that of the air-cells of the lungs. In the action of arsenetted hydrogen we have a clear instance of poisoning by a gas, and in the respiration of the narcotic vapors of chloroform and ether we have also illustrations of this form of poisoning. Owing to the fact that the poisonous material is in a finely divided state of vapor, and that in the air-cells of the lungs it meets at once with a large absorbing surface and instantly enters the blood, the effects are more rapid and more strongly marked. It has been observed, too, that some (and probably all) of these aerial poisons have an accumulative action — i. e. their effects continue to increase for a short period, even after a person has ceased to breathe them. 462 THE CAUSE OF DEATH MISTAKEN. The remarks made respectiiii,'- the action of gases on the lungs apply- equally to the eflects produced by the vapors of alcohol, etiier, chloroform, and bichloride of met^hylene. The specific action of some of these vapors has been elsewhere noticed {ante, pp. 204, 206). A person dies not only from the privation of oxygen, but from the absorption of the poisonous vapor into the blood through the pulmonary membrane. Although often described as cases of sulVocation, they are not to be regarded as such. Hydrogen and nitrogen have been considered to be the only two gases which operate as negative agents, i. e. by simply excluding oxygen ; but hydrogen breathed with oxygen in atmospheric pro^jortions has been found to produce narcotism. Norris has endeavored to determine experimentally the relative periods of time within which some of these vapors and gases may prove fatal. He employed a chamber filled with common air in which a rat could live without inconvenience for a period of three hours. When pure hydrogen was substituted for air the animal lived for nine minutes. This was taken to represent death from the privation of air or oxygen, and assuming this as a standard the following table shows the time in which death occurred with different gases and vapors : — Pure hydrogen gas in . Common air saturated with ether " " with chloroform " " with bichloride of methylene Pure nitrous oxide gas ..... Oxygen gas saturated with ether .... " " with chloroform " " with bichloride of methylene Pure carbonic acid gas ...... (Brit. Med. Jour., 1873, ii. p. 401.) In the experiments on dogs per- formed by the Committee of the Med.-Chir. Society it was found that, under complete deprivation of air, the heart's action continued for a period of eight minutes and twenty seconds. This very nearly corresponds to the time at which life ceases in pure hydrogen. These results show that the gases and vapors are directly poisonous agents, and that they do not produce their effects merely by excluding oxygen or air. The Cause of Death Mistaken. — The greater number of the poisonous gases are chiefly complex products of art, and are never likely to be met with in the atmosphere so abundantly as to produce injurious conse- quences; hence fatal accidents arising from their inhalation most com- monly occur under circumstances which can leave no doubt respecting the real cause of death. The peculiar effects of all of these it will not be necessary to describe in this place ; but there are three, a knowledge of the properties and operation of which may, on certain occasions, be re- quired of a medical jurist ; these are the carbonic acid, carbonic oxide, and sulphuretted hydrogen gases. Agents of this description can rarely be employed with any certainty as instruments of murder ; and, if they were so employed, the fact could be established only by circumstantial evidence. One alleged instance of murder by carbonic acid is, however, reported by Devergie. (Ann. d'Hyg., 1837, t. 1, p. 201.) Death, when arising from the breathing of any of the gases, is generally attributable to suicide or accident. In France it is by no means uncommon for a per- son to commit self-destruction by sleeping in a closed apartment in which charcoal has been suffered to burn ; while in England accidental deaths Min. Sec. 9 5 I 80 20 25 8 30 25 1 45 8 ACTION OF CARBONIC ACID. 4g3 are sometimes heard of where coal or coke has been employed as fuel in small and ill-ventilated rooms. On such occasions a person may be found dead without any apparent cause to the casual observer. The face may appear pale or livid, and the skin may be covered with patches of lividity. The discovery of a body under these circumstances nuiy be sufficient, in the eyes of the vulgar, to create a suspicion of murder; and some person with whom tbe deceased may have been at that period on bad terms will perhaps be pointed out as the murderer. In such a case it is obvious that the establishment of the innocence of the accused will depend entirely on the discrimination and judgment of a medical practitioner. An instance, illustrative of the consequences of this popular prejudice, occurred in Lon- don in 1823. Six persons were lodging in the same apartment, where they were all in the habit of sleeping. One morning an alarm was given by one of them, a woman, who stated that, on rising, she found her com- panions dead. Four were discovered to be really dead, but the fifth, a married man, w^hose wife was one of the victims, was recovering. He was known to have been on intimate terms with the woman who gave the alarm, and it was supposed that these two had conspired to destroy the whole party in order to get rid of the wife. The woman who was accused of the crime was imprisoned, and an account of the supposed bar- barous murder was soon printed and circulated in the metropolis. Many articles of food about the house were analyzed in order to discover whether they contained poison, when all the circumstances were explained by the man stating that he had placed a pan of burning coals between the two beds before going to sleep, and that the doors and windows of the apart- ment were kept closed. (Christison, p. 583.) Cases of a similar kind, in which there was at first a strong suspicion of poisoning, have been re- ported, (Lond. Med. Gaz., vol. xxxvi. p. 937 ; Ann. d'Hyg., 1843, t. 2, p. 56 ; Med. Chron., vol ii. pp. 80, 84.) Cabbonic Acid. This gas is freely liberated in respiration, combustion, and fermenta- tion ; it is also produced in the calcination of chalk or limestone, and is sometimes diffused through the shafts and galleries of coal-mines, where it is one constituent of what is commonly called " choke-damp." Car- bonic acid gas is likewise met with in wells, cellars, and other excavations in the earth, In these cases it is generally found most abundantly on the soil, or at the lower part of the well ; and it appears to proceed from the decomposition of animal and vegetable matters confined in such situations. The slow evaporation of water strongly charged with the gas, while trick- ling over the sides of these excavations, may likewise assist in contaminat- ing the air. Damp sawdust, straw, and decayed leaves slowly absorb oxygen from a confined atmosphere, and set free carbonic acid. H. Davy believed that carbonic acid in a perfectly pure state did not pass into the windpipe when an attempt was made to breathe it ; the glottis seemed to close spasmodically at the moment that the gas came in contact with it. On diluting the carbonic acid with about twice its volume of air, he found that he could breathe it ; but it soon produced symptoms of giddiness and somnolency. In a diluted state there is no doubt that it penetrates into the lungs, and that it is absorbed and circu- lated with the blood. In estimating the effects of this gas when mixed with air a distinction must be made. The gas may either be simply added to the air, or it may be produced at the expense of the oxygen in the enclosed space or apartment. In the latter case, it must be remembered 464 POISONOUS PROPORTIONS. that every volume of carbonic acid thus proturing bloodvessels and muscles, and causing swelling of the parts with elfusion of blood. It presented the appearance of an extensive bruise caused by mechanical violence. On the right side the current had passed down to the space above the collar-bone, causing lividity and swelling of the right ear as well as of the adjacent skin ; and it terminated in a dark-blue mangled patch of skin, in which there were several free communications with the surface. The hair on the back of the head was slightly singed, and that in front of the chest was singed quite close to the skin ; but the hair which covered the wound in the scalp, where the current had entered, was uninjured. The clothes were neither torn nor burnt, and the metallic buttons were not fused. The clothes of all three were very wet. The hat was not examined. The left side-pocket of the trousers contained several lucifer matches and a tin tobacco-box, which were unaffected by the elec- tric discharge. The right pocket contained a knife, which had acquired strong magnetic polarity. The body was placed in a warm room, and it is worthy of remark that cadaveric rigidity came on in fourteen hours after death. (Lancet, 18G4, ii. p. 118.) It is to be regretted that no post- mortem examination was allowed. It is probable that the brain sustained severe injury, causing immediate death. These cases singularly present the effect of lightning in three degrees — the effect of a slight shock in No. 1, of a severe shock in No. 2, and of a fatal shock in No. 3. There was but little bodily injury in any case, and no appearance of burning. The marks on the skin in Nos. 1 and 2 could not have been mistaken for vio- lence, but the wound to the scalp and the injuries to the neck in No. 3 might have been ascri))ed to the violence of another, had not the circum- stances been fully known. The clothes probably escaped burning or tear- ing by reason of their being wet and their readily conducting electricity. The hums occasionally found on the bodies of persons who have been struck by lightning have been hitherto ascribed to the ignition of the clothes. It appears, however, from the subjoined cases, that burns even of a severe kind may be the result of a direct agency of electricity itself upon the body. Geoghegan met with the case of a girl who had been struck by lightning; there was burning of the thigh and buttocks to the first and .second degrees, but the clothes did not show any signs of com- bustion. In 1852, a man, set. 23, while engaged in milking a cow in a wooden shed during a severe thunderstorm, suddenly observed a vivid flash of lightning, which killed the cow instantly and inflicted serious in- juries upon himself. He was seen sixteen hours after the accident, and a severe burn was found on his person, extending from the right hip to the shoulder, and covering a large portion of the front and side of his body. His mind was then wandering, and there were S3"mptoms of inflammatory fever. The man was confined to his bed for seventeen days, at the end of which time the injuries had not perfectly healed. On examining his EFFECTS ON THE NERVOUS SYSTEM. 491 dress, the right sleeve of his shirt was found burnt to shreds, but there was no material burning of any other part of the dress. The case is singular, inasmuch as it shows that the dress may be burnt without tho surface of the body being simultaneously injured; and further, that a burn may bo produced on the body, althougli the clothes covering the part may have escaped combustion. Fleming has described the cases of eight persons who were struck by lightning, and on the bodies of some of these were marks of severe burns. The dresses were in parts much singed. These cases show, in a remark- able manner, the intense heat evolved in the instantaneous passage of the electric current through the clothes and body. The persons struck were benumbed or paralyzed in various degrees, but all ultimately recovered; the burns were so severe that some months elapsed before they were en- tirely healed. (Glasgow Med. Jour., Oct. 1859, p. 251.) A man was struck by lightning in 1861. Externally there was a burn upon the nape of the neck, where the metallic watchguard rested ; and from the point where the current of electricity left the chain the skin was blistered in a straight line down to the feet, scorching the hair of the pubes in its course. The man's intellect was confused and his general condition was that of collapse. With the aid of stimulants he became sufficiently restored to communicate his feelings. There was paralysis of the legs, with loss of sensibility (anaesthesia) and retention of urine. He was deaf, and com- plained of a noise in his ears like thunder ; he had some difficulty in articulating, and pain in swallowing, with a peculiar metallic taste in his mouth. The autesthesia passed away in half an hour, but he did not com- pletely recover the use of his limbs for four days; the bladder was para- lyzed for twenty-four hours ; the urine was high-colored and contained an abundance of phosphates. The bowels were confined. All these symp- toms gradually disappeared, excepting slight deafness, and the man was discharged convalescent. The following complete account of the external and internal appearances found in the body of a healthy middle-aged laborer, w^ho was killed by a stroke of lightning, has been published by Schaflfer. The man was work- ing in the fields with several other laborers, just after a thunderstorm had passed over and had apparently subsided. He was endeavoring to kindle a light with a flint and steel, when the lightning struck him. For a moment after the shock he stood still, and then his body fell heavily to the ground lifeless. The electric current had entered at the upper part of his forehead, perforating and tearing his hat at that part ; it seemed then to have become divided into two currents, which passed down the sides of the body along the lower limbs and out at the feet. On the upper part of the forehead was found a soft swelling, of a dark-blue color, and about the size of the palm of a hand; the hair which covered it was uninjured. From this spot two dark-red streaks proceeded in different directions. One of these passed to the left, running over the temple in front of the left ear, down the neck to the surface of the chest, over which it passed be- tween the left nipple and the armpit ; and so made its way over the body to the left inguinal region, where it formed a large, irregular, scorched- looking patch on the skin. From this point the dark-red streak again continued its downward course, passing over the great trochanter of the femur, then along the outer surface of the left leg to the back of the foot, where it terminated in several small dark-blue spots. The other streak, which proceeded from the ecchymosed swelling on the forehead, passed directly to the right ear, which was considerably swollen and of a dark-blue color ; from the ear it ran downwards and backwards along the neck, 492 ECCIIYMOSES FROM LIGHTNING. crossed the right border of the scapula, and eventually reached the right groin, where a scorcliod patch of skin similar to that in the left groin was found. From this part the discolored streak continued down the outer side of the right leg, to its termination on the back of the foot, just as oa the left side. The hair on the forehead, as well as that which is present in anv part of the track taken by the electric current down to the groin, was not burnt, yet at the groin itself, and at every part hence to the foot, over which the electric current had passed, the hairs were completely burnt. The cause of the skin and hair in the groins being burnt is prob- ablv to be referred to the buckles of a belt which the man wore round his abdomen at the time of the accident ; the belt was completely destroyed. Nothin3 cautious in forming an opinion ; wo must not assert that, because a discharge continues, pregnancy cannot possibly exist, or, because thi're is no discharge, a female must be pregnant. The retention of the menses within the wonilj from any cause may produce enlargement of the abdo- men and give rise to some of the external symptoms of pregnancy. Feigned Menstruation. — The menses may be either suj)pressed or re- tained; but if there be any strong motive for the concealment of her con- dition, a woman may feign menstruation. Montgomery detected a case of this kind by the examination of the areola of the breasts. The woman had stained her linen with blood in order to make it appear that the menses continued, but she subsequently admitted that this was an imposi- tion. There are no certain means of distinguishing between menstrual and ordinary mammalian blood. Prominence of (he Abdomen. — A gradual and progressive enlargement of the abdomen is a well-marked character of pregnancy ; the skin becomes stretched and the navel almost obliterated. This enlargement in general begins to be obvious al)out the third month, although there are some women in whom the enlargement may not become perceptible until the fifth or sixth month, or even later; still, it may be detected on examina- tion. In fact, this sign can never be absent in pregnancy, although it may not be so apparent in some women as it is in others. The objection which exists to it is that numerous morbid causes may give rise to promi- nence of the abdomen. This is undoubtedly the fact, as we have occasion to witness in the various kinds of dropsy, or in suppressed and retained menses — diseases which, in several instances, have been mistaken for pregnancy by eminent practitioners. On the other hand, instances are not wanting in which, owing to the persistence of menstruation, and the absence of quickening, the gravid womb has been actually tapped by mis- take for an ovarian tumor; the operation being speedily followed by the birth of a child (Whitehead On Al)ortion, ]). 18G); but the history of a case will in general enable a ])ractitioner to form a correct opinion. (Ann. d'Hyg., 1873, t. 2, pp. 142 and 144.) A Change in the Breads. — These organs in a pregnant woman are full and prominent, and the areolae around the nipples undergo changes of color which Montgomery and others regard as highly characteristic of the preg- nant state. A mere fulness or pain in the breasts, and even in some rare instances the secretion of milk, may arise from other causes than preg- nancy. Severe uterine or ovarian irritation or disease may cause the breasts to become painful, swollen, and secrete milk. The fulness of the breasts from pregnancy is not commonly observable until about the second or third month. A more or less transparent fluid is secreted by the gland- tissue of the breast, and can be expressed from the nipples. Such cases, however, are not very common ; but after a woman has once secreted milk the secretion may be reproduced in the breasts by very slight causes, quite independently of pregnancy. The areola is generally observed during pregnancy to become consider- ably darker in color and larger in diameter. The skin of which the areola is formed is soft, moist, and slightly tumid. The little glandular follicles about it are prominent, and often bedewed with a secretion : the change of color has been chiefly attended to. The areolae are commonly well marked in from the second to the fourth month of pregnane}' — the inten- sity of color being the last condition of the areola to appear. The promi- nence of the glandular follicles does not always exist in pregnancy, and the areola may become large and dark-colored from other causes ; conse- quently, these signs are only to be looked upon as corroborative. la PROOF OF QUICKENING. 513 females of dark conii>lexion, tbe areoke are naturally dark irrespective of pregnancy ; and in some advanced cases these changes in the areolae are entirely absent. (Edin. Month. Jour., March, 1848, p. 693.) Montgom- ery has described as a sign of pregnancy the existence of a brown line ex- tending from the pubes to the navel, especially in women of dark cora- })lexion, and a dark-colored but not raised areola of about a quarter of an inch in breadth around the navel; but this also may be produced by uterine or ovarian disease. Quickening. — The signs above given are applicable to the early as well as to the late stages of utero-gestation ; but that which we have here to consider is one which is rarely manifested until about the fourth or fiftk month. Quickening is the name applied to peculiar sensations experienced by a woman about this stage of pregnane}'. The symptoms are popularly ascribed to the first perception of the movements of the foetus, which occur when the womb begins to rise out of the pelvis ; and to these movements as well as probably to a change of position in the womb, the sensation is ])erhaps really due. The movements of the foetus are perceptible to the mother before they are made evident by an external examination. The term is derived from an old Saxon word "quick," signifying living ; as, at the time when medical science was in its infancy, it was considered that the foetus only received vitality when the mother experienced the sensation of its motion. On the occurrence of quickening there is gener- ally a great disturbance of the system indicated by syncope, nausea, and other distressing symptoms. After a short time the woman recovers ; and, if sickness has hitherto attended the pregnant state, it has been fre- quently observed to disappear when the period of quickening has passed. No evidence but that of the woman herself can satisfactorily establish the fact of quickening, and this it is necessary to bear in mind ; since, in some cases in Avhich pregnancy is an object of medico-legal importance, proof of quickening may be demanded by law. Reid remarks (Lancet, 1853, ii. p. 237), with respect to this sign, that few women can tell the exact day on which they first feel it; and a large proportion cannot place it within a range of fourteen days, which is of little assistance in the calcu- lation of the probable date of delivery. Women who profess to be most exact in noting the period of quickening differ with each other as to the time. There is much self-deception as to this symptom. The discovery of the movements of a child by an examiner is really a proof that the usual period of quickening is pasi, but their non-discovery at the time of exam- ination is no proof whatever that the woman has not quickened ; since the movements are by no means constant, and may be accidentally sus- pended even at several successive examinations. Besides, cases occur in which well-formed, healthy women do not experience the sensation of quickening durmg the whole course of pregnancy ; and, what is of more importance, the movements of the child may be at no time perceptible to the examiner. The uncertainty of quickening as a sign of pregnancy is too well known to require more than adverting to. Women have been known to mistake other sensations for it, and in the end it has been proved that they were not pregnant. A woman may declare that she has felt quickening when she has not; and unless the movements of the child are perceived by the examiner at the time, how is he to confirm or disprove her statement ? Quickening, then (so far as it concerns the statement of the woman), cannot be relied on as a proof of pregnancy ; Init if the move- ments of a child can be felt by the examiner through the abdomen, this is clear evidence, not only of the woman being pregnant, but of her having passed the period of quickening. According to the general experience of 33 514 SOUISIDS OF THE F(ETAL HEART. accoucheurs, quickening takes place from the tenth to the twenty-fifth week of pregnancy ; but the greater number of instances occur between the twelfth and sixteenth week, or between the fourteenth and eighteenth week after the last menstruation. From these observations, it will be seen that an examiner may some- times detect the movements of the child about the third or fourth month, at others not until the fifth or sixth, and in other instances not at all throughout pregnancy. Ahlfeld found that in forty-three cases in which the dav of its occurrence was noted, it ranged from 108 to 134 days — the average being 132. T days. (Amer. Jour. Med. Sci., Oct. 1870, j). 5G7.) Even in those" cases in which the movements of the child have indisputably existed, they are not at all times to be perceived; hence several examina- tions should be resorted to before any opinion can be fiiirly expressed from their absence. The best mode of examining the abdomen for foetal move- ments is to allow the hand to remain at rest on the abdomen. If the patient has quickened recently, the impulse is slight, and generally at only one spot, which, however, is seldom the same. Should she have advanced further, then the movements will be more rolling, and the parts of the child be detected at the same time. In making these examinations, a diagnosis may be facilitated by previously immersing the hand in cold water and then suddenly applying it to the abdomen. When the move- ments of the child are distinctly perceived through the skin of the abdo- men, they constitute a certain sign of pregnancy ; but their non-discovery at a particular time is no proof that a female is not pregnant. The jury of matrons probably trusted to this sign ; hence their verdicts commonly turned out to be erroneous. There is another source of fallacy which may present itself when an artful woman is desirous of making it appear that she is pregnant — namely, that a woman may simulate the movements of a child by a peculiar action of the abdominal muscles. Medical prac- titioners of repute have been deceived for a time by this artifice; but this occurred before the discovery of chloroform and the stethoscope. Sounds of the Foetal Heart. — Another sign is that which is derived from auscultation. By the application of the ear or a stethoscope to the abdomen, at or about the fifth month of pregnancy (rarely earlier), the pulsations of the foetal heart may be recognized and counted. These pulsations are not synchronous wnth those in the arteries of the mother ; they are much more rapid, and thus it is impossible to mistake them. Their frequency, according to Hope, is in an inverse ratio to the stage of gesta- tion, being 160 at the fifth, and 120 at the ninth month. Sometimes, however, the foetal pulse may descend to 80 or even GO beats in a minute. This sign, when present (like the foetal movements), not only establishes the fact of pregnancy beyond all dispute, but shows that the child is living. The sound of the foetal heart is, however, not always perceptible ; when the child is dead, of course it will not be met with ; but its absence is no proof of the death of the child, because the hearing of the pulsations by an examiner will depend very much upon the position of the child's body, the quantity of liquor amnii, the presence of disease, and other circum- stances. Thus the sounds may be distinctly heard at one time and not at another ; they may be absent for a week or fortnight, and then will re- appear ; so that, although their presence affords positive evidence, their absence furnishes uncertain negative evidence; and several examinations should be made, in the latter case, before an opinion is formed. The earliest time at which the pulsations may be heard has been stated to be about the fourth month; but they will be best heard after the sixth month. The reason why the sounds of the foetal heart are not always perceived is CHANGES IN THE MOUTH AND NECK OF WOMB. 515 owing, not only to changes in the position of the child, but to the vibra- tions having to traverse the liquor aninii and the soft layers of the skin of the abdomen. The presence of much fat in these layers intercepts them. The point where the sounds can be most readily perceived is in the centre of a line drawn from the navel to the anterior inferior spinous process of the ilium on either side — perliaps most commonly on the right. When clearly detected, they furnish an unequivocal sign of the pregnant state. Besides the sounds of the fcetal heart, there are other sounds to which the name of "placental murmur" or uterine sounds has been given. These are heard from an earlier date, i. e. at any time after the third month. As they may occur in connection with fibroid tumors of the womb, they do not necessarily indicate pregnancy. In reference to these signs of the pregnant state it may be observed that, if the motions of the child or sounds of the heart be perceptible, no other evidence of pregnancy need be sought for. The mere suppression of the menses, prominence of the abdomen, and fulness of the breasts can- not alone establish the fact ; but unless the morbid causes of these abnor- mal states of the system be clearly and satisfactorily obvious to the examiner, it is a fair presumption from these symptoms that the woman is pregnant. In any case in which a doubt exists we should require suffi- cient time to form a correct opinion. Changes in the Mouth and Neck of the Womb. — The signs hitherto mentioned are chiefly relied on in medical practice; but it must be re- membered that no case can occur in civil or criminal jurisprudence in which it will not be in the power of a medical witness to make an exami- nation of the woman. He may then form a safe judgment from the changes which take place in the neck of the w^omb, and from the sensation imparted to the finger by the presence of a rounded body (like the foetus) floating in a liquid, when an impulse is given to the womb from below\ Up to the fifth or sixth month of pregnancy, the neck of the womb, of its usual length, hard and firm, may be commonly felt projecting into the vagina. After that period, the womb rises into the pelvis, and the neck is spread out and is shorter and softer, the aperture increasing in size and becoming rounder. Tow^Trds the end of gestation, the neck of the womb appears to be lost, becoming like a thin membrane, and sometimes no aperture can be felt. A well-marked test of pregnancy is the motion perceptible to the finger on giving a sudden impulse to the child through the neck of the womb. Capuron calls this the touchstone in the distinction of the pregnant state ; and, without it, he considers a medical jurist may be easily deceived. To this passive motion of a child the name of hallottement is given. It can- not be easily determined before the fifth or sixth month ; but after the latter period, especially as pregnancy becomes advanced, it is always avail- able. In the French schools, the method of applying the toucher and hallottement to pregnant females is systematically taught, and by a little practice it may be easily acquired. This motion to the child can also be given through the abdomen, by external hallottement, in two ways; either by the patient lying on her side, the hand placed on the most dependent part of the w'omb, or by placing the patient on her elbows and knees ; the womb will then fall forwards, the child also will fall in contact with the front w^all of the womb, and its presence thus be made more perceptible. This latter mode is best adapted to the early stages of pregnancy. If we find amenorrhea or suppressed menses, and a tumor distended to a size consistent with the duration of the amenorrhoea — if the tumor be more or less central, alternately relaxing and contracting, containing au 516 FEIGNED PREGNANCY. irreg-ulaiiy-sbapod body, which is freely moved within, and also self-moving, we have clear indications of a living foetus; and if we add to these the fa'tiil heart-sounds, with the other minor symptoms, we have a condition wiiich, if clearly made out, must be considered complete proof of preg- nancv. Of course, we may have certainty with the foetal heart-sounds tind 'movements if well-marked, and a strong suspicion from the other symi)toms. " As most of these signs refer to an advanced stage, a witness may be asked — What are the unequivocal indications of pregnancy before the fifth and sixth, months? The answer to this question is of little moment to a medical jurist, since he is rarely required to give an opinion under these circumstances. In all Juridical cases, when pregnancy is alleged or sus- pected, it is the practice for a judge or magistrate, on a representation being made by a medical witness, to postpone the decision one, two, or three months, according to the time required for obtaining certain evi- dence. This evidence will consist in plainly distinguishing (1) a rounded body floating freely in a tumor which alternately relaxes and contracts ; (2) the movements of a foetus ; and (3) the sounds of the foetal heart. The most experienced men agree that before the sixth month the changes in the neck and mouth of the womb are of themselves too uncertain to enable an examiner to form a safe opinion; and, d fortiori, it is impossible to trust to external signs alone. Whitehead dissents from this view, and considers that a specular examination of the mouth of the womb is not oulv more satisfactory than any other mode of exploration, but that it will enable a person to determine with certainty the existence of pregnancy during its earlier stages — from a few days after conception to the middle or end of the fourth month, when auscultation first becomes available. In the fourth week the lips of the mouth of the womb at the centre of their margins are permanently separated to the extent of one or two lines ; and the OS tincse (the aperture) itself, which was before a mere chink with parallel boundaries, forms an elliptical or sometimes rounded aperture, which is occupied by a deposit of transparent gelatinous mucus. At six or eight weeks it is decidedl}^ oval, or irregularly circular, with a puckered or indented boundary having a relaxed and lobulated character. The whole circumference of its neck is enlarged, and the commissures or angles of the mouth are obliterated. The mouth continues of this irregular form throughout the whole period of gestation ; but from the time of quicken- ing to the end of the seventh month the progressive changes are not so marked as to form a guide for determining the period of pregnancy. (Whitehead, On Abortion, p. 204.) This condition of the mouth of the womb must not be confounded with its menstrual state in the early stages, nor with a diseased state in the latter stage of gestation. [Prof. Reese says that a bluish or dusky color of the vagina, produced by venous congestion, was originally declared by Jacquemin to be an almost certain sign of pregnancy in females who are not subject to hemor- rhoids. This statement has been confirmed by Kluge, Parent, Duchatelet, Killian, Wistrand, and Montgomery, the last of whom says: "In every instance, without a single exception, in which I have found this appear- ance distinctly marked, pregnancy coexisted:" Sig. and Symp. of Preg., 2d Ed. p. 245. It should be, however, remembered that pregnancy may exist, although that sign may not be visible : Wharton & Stille, Med. Jurisp., 1873, II. p. 15. The presence of kiestein in the urine is no longer regarded as affording positive proof of pregnancy.] Feigned Pregnancy. — Pregnancy has been sometimes feigned or sim- ulated for the purpose of extorting charity, of obtaining a settlement in a CONCEALED PREGNANCY. 517 parish, or of compelling marriage ; Init it is scarcely necessary to observe that an impostor may be easily detected by a well-informed practitioner, since a woman always feigns an advanced stage of pregnancy. It is more easy to prove in most cases that a woman is not pregnant than that she is. " (Ann. d'Hyg., 1873, t. 2, p. 145.) Although she may state that she has some of the symptoms depending upon pregnancy (and, unless she has already borne children, she will not be able to sustain a cross-examina- tion even respecting these), yet it is not possible for her to simulate, without detection, a distention of the abdomen or the state of the breasts. If she submits to an examination, the imposition must be detected ; if she refuses, the inference will be that she is an impostor. Women have l)een known to possess the power of giving apparent prominence to the abdo- men, and even of simulating the movements of a child by the aid of the abdominal muscles. By placing them under the influence of chloroform, the abdomen at once collapses, and the imposture is detected. These cases of spurious or feigned pregnancy are sometimes met with in hysterical females. (Simpson, Edin. Month. Jour., 1S54, ix. 473 ; Lancet, 1855, i. j)p. 381, 429, 533.) Pregnancy may be feigned by a woman in order to escape the punishment of hard labor, to which she may have been sen- tenced. If in this case the slightest doubt should exist whether the woman is really pregnant or not, a restricted affirmative opinion should be given, since great and even irreparable mischief might result by taking an opposite course. In civil cases of feigned pregnancy, an examination should always be made before giving an opinion, or the reputation of a medical man may suffer by his forming a hasty conclusion on the subject from insufficient data. In this respect the case of Devonald v. Hope (Q. B., Dec. 1838) is of some interest. A medical man having an opinion that a female patient was pregnant, subsequently brought an action against her for medical attendance. It turned out, however, that she was not pregnant, and that there were no satisfactory medical grounds upon which his opinion was based. The plaintiff complained of having been deceived by the defendant as to her condition ; but it is obviously in the power of any medical man to prevent such a deception being practised on him. An external ex- amination only will not suffice either to affirm or negative the allegation of pregnancy, except when it is stated to be far advanced. (For a singular case in which, on a charge of assault, evidence of this kind was tendered, see Lond. Med. Gaz., vol. xxxvi. pp. 1083, 1169. On the fallacy of the sians of pregnane}^ and the simulation of this state, see papers bv Tardieu and others, Ann. d'Hvc;., 1845, t. 2, 429; 1846, t. 1, 83; also 1873, t. 2, p. 145.) Concealed Pregnancy. — By the law of Scotland, if a woman conceals her pregnancy during the whole period thereof, and if the child of which she was pregnant be found dead, or is amissing, she is guilty of an offence, and is liable to prosecution. Evidence is sometimes given as to outward appearances indicative of pregnancy ; but the main proof of a woman having been pregnant, and that which is relied on for conviction, is clear and distinct evidence of the actual delivery of a child. This is generally furnished by medical witnesses. The Scotch law, by making the conceal- ment of pregnancy under the circumstances above mentioned an offence, proceeds on the principle that every pregnant woman is bound to make preparations for the safe delivery of a child ; and it is therefore assumed that if a child be l)orn clandestinely without preparation, and is found dead or is amissing, its death is owing to the want of such preparation. The English law imposes no obligation to make a pregnancy known. 518 UNCONSCIOUS PREGNANCY. Impregnation in a State of Unconsciousness. — It was formerly a ques- tion whttber a woman could become pregnant without her knowledge. This may undouljtedly hapi)en, when intercourse has taken place during l)r()found sleep (lethargy), or when a woman has been thrown into this state l)y narcotic drugs or vapors. But it is difficult to admit that any woman should remain pregnant up to the time of her delivery without being conscious of her condition, if the intercourse took place during the waking state. A woman endowed with ordinary intellect could not avoid suspecting her condition after the fourth or fifth month; and this alone would be sufficient to induce her to seek advice whereby the fact would become known to her. When a woman is impregnated in a lethargic state, it is unlikely that she should go beyond the sixth month without being fully aware of her pregnancy ; and if her motives were innocent, she would undoubtedly make some communication to her friends. Cap- uron mentions a case of this kind, in which the fact of pregnancy was first ascertained at the end of the fourth month, by the woman having com- plained to one of her sisters of a stranije sensation which she experienced in the lower part of her abdomen. (M^d. Leg. des Accouchements, p. 86.) A young woman wh o had had intercourse knowingh' was supposed not to have been aware of her pregnancy until the seventh month ; but there is reason to believe that this woman was guilty of deception. (Lond. Med. Gaz., vol. xxxix. p. 212.) There are generally in these cases strong motives for falsehood ; hence such stories require close investigation be- fore they are allowed to influence the opinion of a practitioner. A case occurred in IS.dT, in which a woman, set. 22, described as modest and decorous in her behavior, then advanced to the sixth month of pregnancy, asserted that she had not consciously had connection with any one, although she specified a date at which she remembered she had lost her consciousness — at which date intercourse might have been had. On being questioned, she denied that she had had at any time any soreness or pain in her private parts. Although there may be unconscious intercourse followed by pregnancy, it is not probable that in the case of a virgin there should be such intercourse without the production of pain, soreness, or laceration ; and these symptoms, if not perceived at the time, should be felt subsequently and create a suspicion, if not an actual knowledge, of what had happened. This rendered the account which the woman gave wholly improbable. The fact that she was able to fix a date for her un- consciousness with an accuracy in accordance with her condition, was also a suspicious circumstance. Unconscious Pregnancy. — It is quite possible that women who are living in connubial intercourse may become pregnant without being con- scious of it. Riittel mentions the case of a woman, set. 41, who had been married upwards of sixteen years, and who, while returning from a neighl)oring village, was suddenly delivered of her first child, when only a few days before she had been complaining that she was not likely to have any children. The child was born living and mature. (Henke, Zeitschrift der S. A., 1844, p. 264.) Long met with a case in which a married woman, a3t. 24, subject to irregular menstruation, consulted him for an attack of spasms. On his arrival he found that she had suddenly given birth to a seven-months' child. Neither her husband nor herself had the slightest idea that she was pregnant. She had noticed that she had become somewhat stout and that her breasts were more full than natural. She attributed her condition to improved health, and the cessation of the menstrual discharge was set down to some accidental cause. (Med. Times and Gaz., 1857, i. p. 592. See also a case at full term by Tanner, PREGNANCY IN THE DEAD, 519 Obst. Trans., vol. 4, p. 113.) A married lady who had not had a child for a period of nineteen years found herself, as she thought, g-etting un- usually stout. She was moving about with her family to different places. At last her size alarmed her, and she thought she was suffering from dropsy : she consulted a physician, who informed her that she was in an advanced state of pregnancy. She treated this opinion with great con- tempt. In travelling with her daughter, they arrived at a miserable inn ; on the night of their arrival this lad}^ was seized with the pains of labor and was delivered of a child. She had made no preparation for the birth, and, up to the moment when she was seized with labor-pains, she had not, with all her former experience, the slightest idea that she was pregnant. (For other cases in which married women have had no consciousness of pregnancy, see Lancet, 18^0, i. pp. 609, 64.3.) Instances of this kind are important in reference to alleged unconscious delivery in women charged with infanticide. At the same time, all cases in which there are motives for pleading unconscious intercourse or pregnancy require close examina- tion : they will frequently be found to be quite unworthy of belief. This remark especialh^ applies to unmarried women who often consult a medical man on their condition with a full knowledge that they have exposed themselves to the chances of pregnancy. Up to the time at which the foetal movements are perceptible a woman may honestly attribute her condition to other causes. Dating from the middle period of pregnancy, however, she must be aware of her state, but she endeavors to dissemble this even to herself. Pr'egnancy in the Dead. — There is no special case in law wherein the fact of j^regnancij requires to be verified after the death of a woman; but an examination may be necessary in order to determine the identity of a body or to rescue the reputation of the deceased from a charge of unchastity. The discovery of an embryo or foetus with its membranes in the womb would of course at once solve the question when the necessity for an examination occurred ; and the practitioner will remember that, even supposing many years to have elapsed since interment and the body to have been reduced to a skeleton, still if the foetus had reached the period at which ossification takes place, traces of its bones will be found amidst the bones of the woman. The common practice of placing the body of a stillborn foetus in the coffin of a woman to whom the foetus bears no relation must, however, be borne in mind. It is possible, too, that where a child is buried with the body of a female the bones of the two may become intermingled in the course of time. In examining the body of a woman long after death, for the purpose of determining whether she was or was not pregnant at the time of death, it may be proper to bear in mind that the unimpregnated womb undergoes decomposition much more slowly than other soft organs. In the case of a woman who had been missing for a period of nine months — whose body was found in the soil of a privy, so decomposed that the bones separated from the soft parts — the womb was of a reddish color, hard when felt, and its sub- stance was firm when cut. The fact was of importance. It was alleged that the deceased was pregnant by a young man, and that in order to conceal her condition he had murdered her. From the state of the womb Casper was able to affirm that this organ was in its virgin condition, and that the deceased was not pregnant at the time of her death. On this rep- resentation the accused was liberated. (Ger. Leich-Oeffn., vol. 1, p. 93.) In examining bodies many months after interment, and in one case up- wards of a year, we found that while other soft organs were decomposed 520 LEGAL RELATIONS. the womb had scarcely undergone any change — its substance was still firm and hard. It may liappen that the appearances in the womb are sulTicient to create a strong' suspicion tliat a woman has been preg-nant, but the ovum, embryo, or foetus may have been exi)elled : in this case several medico-legal ques- tions will arise in reference to delivery. Legal Relations. — Tliere are two cases in English jurisprudence in which proof of the pregnancy of a woman may be required. It is im- possible that a medical opinion can be given in either case until the woman has undergone examination. If she is acting bona fide it is to her interest to submit to this, and the medical man incurs no responsi- bility. Assuming that an opinion is re([uired on the pregnancy of a woman who refuses to be examined, a medical man would be acting ille- gally in compelling her to undergo an examination, and he might bring on himself a charge of indecent assault. It is only by the free consent of the woman that such an examination can be at any time made. (See Infanticide, post.) In the two cases in which opinions are usually required, a woman alleges that she is pregnant, but she would not be benefited by the allegation until she had undergone an examination. One of them relates to the civil and the other to the criminal law. 1. Under a writ de ventre iiispiviendo. When a woman asserts that she is pregnant and is likely to give birth to a posthumous child, the heir-at-law to the estate may claim a right to have her statement vei-ified and proof given that she is really pregnant. The object of this proceeding is to prevent the possibility of the heir being defeated of his rights by the fraudulent substitution of the child of another person. Formerly the proof of pregnancy in such cases was entrusted to matrons nominated by the sheriff, but now the matter is more considerately left to skilled medical practitioners. There will be no difficulty in such a case provided the pregnancy is at all advanced. Examinations may be made at intervals, until the motions of a foetus are clearly perceived, with the other concomitant signs above described. An examination of this kind should be made completely. No woman should be able so to feign pregnancy as to deceive a skilled medical man. 2. The other case, referring to criminal law, is where a woman after a capital conviction pleads her pregnancy in bar of execution. If she is pregnant the execution of the sentence is postponed until after her delivery. The strict letter of the law requires that married women taken from any who may be in court should be impanelled to examine the convict and report on her condition. They are required to decide whether she has or has not passed the stage of quickening. It is, however, now the general practice to direct the examination to be made by medical men for the purpose of avoiding those mistakes into which a jury of ignorant matrons has fre- quently fallen. These are the only cases in which pregnancy appears to have any direct relation to medical jurisprudence ; and it is remarkable that, with respect to them the law of England has expressly provided that they should be left to the decision of non-medical persons. The following conclusions may therefore be drawn : 1. That the cases in which the signs of preg- nancy become a subject of legal inquiry in England are rare. 2. That there is no case in English law in which a medical man will not have an opportunity of performing an exaimnation per vaginam, but this can only be made with the consent of the woman. 3. That a medical opinion is never required by English law-authorities until the pregnancy is so far LEGAL RELATIONS. 521 advanced as to vender its detection certain. Hence discussions concerning areoUe, the condition of the breasts, the presence of kiestein in the urine, etc., are, in a i)ractical point of view, unnecessary to a medical jurist. By these remarks we do not intend to undervalue the importance of an accurate knowledge of the signs of pregnancy to a medical practitioner. Cases which may never come before a court of law will be referred to him, and the serious moral injury wliich he may inflict on an innocent woman by inaccuracy should make him cautious in conducting an exami- nation and in expressing his opinion. The medico-legal questions con- nected with the pregnant state have been comprehensively examined by Stolz. (Ann. d'Hyg., 1873, t. 2, p. 13T.) 622 DELIVERY. DELIVERY. CHAPTER XLV. CELIVERT IN THE LIVING. CONCEALED DELIVERY. SIGNS OP ABORTION IN THE EARLY STAGES OF PREGNANCY. SIGNS OF RECENT AND REMOTE DELIVERY. FEIGNED DELIVERY. DE- LIVERY IN A STATE OF UNCONSCIOUSNESS. SIGNS OF DELIVERY IN THE DEAD. TRUE AND FALSE COPORA L0TEA. CHARACTERS OF THE OVPM OB EMBRYO. MOLES. CONCEALMENT OF BIRTH. Delivery is a subject which much more frequently requires medico- legal intervention than pregnancy. It will be sufficient to state that the concealment of birth, the crimes of abortion and infanticide, with ques- tions relative to supposititious children, are closely dependent on the proof of parturition. This subject will admit of being considered under two heads ; 1. As it relates to delivery in the liviy\g. 2. As it relates to de- livery in the dead. In undertaking the investigation, we ought, if possi- ble, to ascertain, either from the female herself or from those around her, whether there was reason to suspect that she had been pregnant. If we can acquire any knowledge on this point, it will materially facilitate our inquiry; but this is not always possible. It has generally happened that previous pregnancy has been so concealed that few who saw the woman sus- pected her condition ; then again, as the admission of her delivery may be the strongest proof of her criminality, she will perhaps resolutely den}- it ; and a medical practitioner has no right to extort this admission from her From this it will be seen that a medical witness must often be prepared to prove the fact of delivery against the woman who is criminally charged. Delivery in the Living. Concealed Delivery. — The signs of delivery in a living woman vary materially according to the time at which this event has taken place. In common language, if the contents of the womb are expelled before the sixth month, the woman is said to miscarry, or to have an abortion ; if after the sixth month, she is said to have a prema- ture labor. The law does not admit any such distinction; the expulsion of the ovum, foetus, or child by criminal violence, at any period of utero- gestation, is regarded as a miscarriage or abortion. It has been well ob- served that the signs of delivery are indistinct in proportion to the im- maturity of the ovum. Thus, when it takes place at the second or third month there are scarcely any proofs which can be derived from an exami- nation of the woman. All the ordinary signs of delivery at the full period will be absent — the development of the embryo not having been sufficient to cause any prominence in the abdomen, or to give rise to those changes in the system which take place previously to the birth of a mature child ; e. g. enlargement of the breasts and dilatation of the mouth of the womb. Abortion at this period (the second or third month) is gene- rally accompanied by loss of blood, which may manifest itself by its effects on the body. This, however, can only give rise to a suspicion. At a later period of gestation there may be a discharge resembling the lochia, and the SIGNS OF DELIVERY IN THE LIVING. 523 mouth of the womb may be found enlarged and soft ; but from the small size of the foetus the outlet nuiy i)resent no positive evidence of delivery. The quantity of blood lost may be greater and may have a more decided etfect on the system. Of course, if the ovum, foetus, or any of its mem- branes be found, then the presumption of abortion will be strongly sup- ported ; ))ut women who designedly conceal their condition will commonly take effectual means to prevent the examiner from obtaining evidence of this kind. Signs of Recent Delivery in the Living — The woman is weak, the countenance pale, the eyes are surrounded by livid areolae, and there is an appearance of general indisposition. Any severe illness may, however, give rise to similar symptoms. Their sudden occurrence after a state of previous good health, especially when pregnancy is known or suspected, will create a strong suspicion. The breasts are large and full, especially about the third or fourth day after delivery ; the nipples are enlarged, and the areolte around them present all the characters of advanced pregnancy. If the appearances described are not well marked at the first examination, they may be seen at a later period ; and in a doubtful case, when the em- bryo or foetus is not forthcoming, a second examination should be made before a final opinion is given. 1. The skin of the abdomen is relaxed, sometimes thrown into folds ; the cuticle interrupted by light colored broken streaks {linese albicantes), passing especially from the groins and pubes towards the navel, which is more or less stretched and altered in appearance. Any disease which has caused enlargement of the abdomen may give rise to a similar appearance in the skin, so that, when taken alone, much confidence cannot be placed in these lines or streaks as proofs of delivery. The round form of the enlarged and semi-contracted womb may be felt at the lower part of the abdomen, generally lying towards one or the other side. The apparent size of this organ will depend upon the degree to which it has con- tracted, and therefore greatly upon the time at which an examination is made. Montgomery has pointed out the existence of a dark line ex- tending from the pubes to the navel, with a dark areola round the latter, in cases of recent delivery ; but he has found this line to exist indepen- dently of pregnancy and delivery — in one case in a girl aged 10, and in another instance in a lady laboring under an ovarian tumor. 2. The organs of generation will be found externally swollen, contused, or even lacerated, with clots of blood about them. The outlet is much dilated, the vagina relaxed, the mouth of the womb considerably open, and its margin much relaxed. The neck of the womb is shortened and scarcely perceptible; and the body of this organ is from two to four times the size which it has in the unimpregnated state. It occasionally happens that the neck of the womb is lacerated on one side during the passage of the head in primiparfe ; should a laceration or a cicatrix be found, it will much assist in proving delivery. 3. The Presence of the Lochia (from -Koxoi, childbirth).— This is a dis- charge, at first of a sero-sanguineous liquid, but which afterwards appears as a brown or green colored serum. It commences soon after deliver}^, and continues from a week to a fortnight, or even longer ; it may be absent after the third day. The discharge has so peculiar an odor that some have regarded this alone as furnishing strong evidence of recent delivery. The signs which have been here enumerated are found only when no delay has taken place in making the examination and the woman has been recently delivered. In some strong and vigorous women, the body re* 524 SIGNS OF REMOTE DELIVERY. sanies its natural state within a few days, and the traces of parturition may have wholly disap[»earod or have become so ambiguous as to furnish no satisfactory evidence. In others, again, proofs of delivery will be obtainable for a fortnight or three weeks afterwards. In nujst cases, how- ever, it is difficult, if not impossible, to say, after the lapse of eight or ten days, that delivery has certainly taken place, the signs having commonly by that time disappeared. In all cases, the earlier the period at which an examination is made the more satisfactory will be the evidence obtained. M(jntgomerv once examined a woman five days after her delivery at the full time, and he was ])articularly struck with the degree to which the parts had become restored to their ordinary condition, especially the mouth and neck of the womb, which hardly differed from their natural and unim- pregnated form. This inquiry becomes of considerable imi)ortance in a case of alleged child-murder. When the body of a child is not found until after two or three weeks from the time of its birth, and the suspected woman denies that she has been delivered of a child, she will probably not deny her pregnancy, but may assert that she has had an abortion at an early period. (See a case in Vierteljahrsschr. flir Gerichtl. Med., 18()3, p. 275.) In cases of abortion at an earlier period, the placenta is not always discharged at the time at w^hich the embryo or foetus is expelled from the womb. (Med. Times and Gaz., 1859, i. p. 278.) A microscopical ex- amination of the discharges might reveal placental or chorionic structures. In a case which occurred to Paxton, all the usual signs of delivery were present in a woman set. 20 ; she had evidently lost much blood, and was much reduced. From the state of the organs, Paxton considered that she had been delivered of a child within three days. There was no lochia! discharge at the date of examination. The woman had previou.sly denied her pregnancy when charged with concealment of it, but after the medical examination she altered her statement, and said that she had not only been pregnant, but was so at that time. On a further examination, the womb was found to contain a foetus advanced to about the sixth month, and in three months more she was delivered of a child. What caused the appear- ances of delivery, the condition of the breasts, etc. ? Either she had shortly before been delivered of a child or of a blighted ovum or foetus. Neither foetus nor placenta was ever seen or could be found, but the Avoman had had ample opportunity to di.spose of them. This may have been a case of twin conception or of superfoetation. It shows that, in charges of concealment of pregnancy or delivery, it must not be inferred, when the appearances of delivery clearly exist, that the womb is empty. This organ should always be examined in order to determine whether it con- tains another foetus. Signs of Delivery at a Remote Period. — A question may arise whether it is in the power of a medical practitioner to determine the period at which delivery took place, i. e. how long a time has elapsed. This be- comes necessary when, in cases of concealed birth, abortion, or infanticide (some time after suspected parturition), a child is found, and it is required to determine whether the time which has elapsed since the birth of the child, either dead or living, corresponds with the supposed delivery of a suspected woman. An opinion may be given within eight or ten days after delivery, from the state of the breasts, of the discharges (lochia), and of the mouth of the womb; but it becomes difficult after the sixth day ; and when the tenth or twelfth day has passed it is still more diffi- cult. After two or three months, it may be regarded as impossible to assign the date of delivery with any degree of precision. (See Devergie, M6d. L4^, vol. 1, p. 446.) FEIGNED DELIVERY. 525 In a case of pretended delivery, contested legitimacy, or disputed chas- tity, a medical jurist may be required to say whether a woman has, at any antecedent period of her life, been delivered of a child. This ques- tion, it must be remarked, can be raised only in respect to delivery at the full period, since there is no doubt that abortion in the early stages of pregnancy may take place and leave no traces of such an event discover- able in after-life. Indeed, a few days or weeks are sometimes sufficient to obliterate all evidence of the fact. With respect to delivery at the full term, certain signs have been mentioned, which by some are considered indelible. These are — shining streaks on the skin of the abdomen, a brown mark reaching from the navel to the pubes, and the state of the mouth of the womb, which is said never to close so efTectually as in the virgin. In regard to the appearance of the skin of the abdomen, it ma}^ be remarked that any morbid causes giving rise to a distention of the cavity — as ovarian enlargement or dropsy — will produce the same effect; so, also, to a certain extent, extreme emaciation from a state of obesity. (See Med. Times and Gaz., 1861, i. p. 450, on False Cicatrices.) Then, again, these marks on the skin are not always persistent throughout life. Besides, a woman, according to the statements of good observers, ma}' be not only once, but repeatedly delivered, without having these marks pro- duced. " (Med. Times and Gaz., 18G0, i. p. 583; also Ann. d'Hyg., 1873, t. 2, p. 139.) With regard to the state of the mouth of the womb, it is liable to vary in different women and to be affected by disease — so that a certain judg- ment cannot always be formed from its condition. In a woman who has not borne children the mouth of the womb is in the form of a slit, the angles being bent down and giving to it the appearance of the os tineas (tench's mouth). Whitehead has observed that in a woman who has borne children the mouth becomes elongated and loses the slight bend at each of its extremities ; the labia are thickened, and more nearly of equal size ; the commissures are less clearly defined, and the whole of the neck is enlarged and not so compact in texture. (On Abortion, p. 195.) It must be remembered, however, that the condition of the mouth of the womb, even in the virgin, varies at each menstrual period. Should there be congenital occlusion of the vagina, or the hymen be found imperforate, this will at once negative a previous delivery ; but the latter condition will not negative a previous pregnancy, since a woman may have been impregnated, and have had an abortion in an early stage of pregnancy, without a necessary destruction of the hymen. This sort of negative evi- dence may, however, be sometimes of great value. There is a total want of good affirmative evidence of delivery at a remote period in the living, if we except that which is furnished by the presence of cicatrices in the vagina, or of a cicatrix as a result of a lacerated perineum. It is rare, however, that any decision on this subject is required in medical jurispru- dence. It might be demanded, either in a case of infanticide, when a woman was accused of having destroyed her alleged ofi'spring some months or years before ; or in a case of contested legitimacy, when a female is accused of having substituted a child of which she pretends she had been delivered at some remote period of time. Feigned Delivei-y. — Delivery has often been feigned by women for the purpose of extorting charity, compelling marriage, or disinheriting parties who have claims to an estate, and in other cases without any assignable motive. Of course, an imposition of this kind could not be sustained before a medical practitioner ; and detection is rendered easy, because it is recent and not remote delivery which is assumed. The latter would, if pretended, 626 UNCONSCIOUS DELIVERY. be generally cleared up by an examination, as well as by circumstantial evidence. (See case, Lond. Med. Gaz., vol. xix. p. 231 ; also another by Capuron, M^d. h4.x'. des Accouchements, p. 110.) Can a Woniait be delivered unconsciously? — Another important ques- tion relative to delivery in the living- is whether a woman can be delivered without being conscious of it. The signs of delivery may be discovered by a practitioner ; the offspring' may also be found ; the woman may ad- mit the fact of her delivery, but allege that she was totally unconscious of it. The only medico-legal case in which this plea is occasionally raised is in infanticide ; and as the possibility of the occurrence may be questioned, the practitioner must be provided with a knowledg-e of those facts which medico-leg:al writers have accumulated respecting it. There is no doubt that a woman may be delivered unconsciously during profound sleep — while laboring under coma, apoplexy, asphyxia, syncope, or when suffer- ing from the effects of narcotic poisons — e. g. the vapors of chloroform and ether, or intoxicating liquors. It is said, also, that delivery has taken place spontaneously while a woman was in the act of dying. This, how- ever, has no bearing on the present question. It is in those cases where, after her recovery, a woman pleads unconsciousness of delivery that med- ical practitioners are chiefly consulted. Besides the cases enumerated, hysteria, when accompanied by loss of sense and motion, has been men- tioned as a state in w^hich parturition is liable to occur unconsciously. We need not be surprised at delivery taking place under these circumstances, when we consider that the contractile power of the womb is altogether independent of volition ; but, unless the morbid states already mentioned are accompanied by the most profound lethargy and entire loss of sensa- tion, it can rarely happen that the contractions of this organ in its efforts to expel the child should not at once rouse a woman into consciousness. We ought particularly to expect this in primiparse, i. e. in those who have never before borne children. At the same time, it must be remembered that parturition in some women, especially when ihe pelvis is wide and the child small, may take place with such rapidity and ease as scarcely to be accompanied with pain. It has been observed that when a woman has frequently borne children delivery sometimes takes place without effort, and without any conscious- ness on her part. On other occasions a woman may lie in a kind of torpor or stupor, or suffer from puerperal convulsions, and have no recollection of her delivery. The following case is possible: a Avoman may be deliv- ered w^hile under the influence of puerperal convulsions, which might have attacked her before labor set in ; and after delivery, but before com- plete recovery, she might become maniacal — a not unfrequent condition — during which interval she may have killed or injured her child ; or the child may have been born dead or suffering from some accidental injury. She would with truth assert her entire ignorance of it. Her statement would be verified by a bitten tongue and a congested conjunctiva or face. Should albumen be found in the urine, this fact would be still more con- firmative. Of course, puerperal convulsions occur Vv^ithout these results. The statement might be disproved by finding that her actions had shown care and design in other circumstances at the time she said she was uncon- scious. King has described the case of a woman, a?t. 36, the mother of nine children. She received his assistance in her tenth labor: when sum- moned, she was lying calmly and placidly in bed, and was perfectly insen- sible. He found that the child had been expelled with the placenta. The woman did not recover her consciousness for ten or twelve hours, and then stated that she had no recollection either of the birth of the child or of any UNCONSCIOUS DELIVERY. 527 Circumstances connected with this event : she suffered no pain or uneasi- ness. Another case is mentioned by him in which sensation appeared to be entirely paralyzed during labor. (Med. Times, 1874, i. p. 234.) It la beyond doubt that profound lethargy occasionally makes its appearance about the time of delivery, Schulze met with a case in which a woman remained in a state of sleep for three days, and was delivered while in this unconscious condition : on awaking, she had no recollection of having suffered any pain during delivery. (Ann. d'Hyg., 1842, t. 1, p. 216; Lond. Med» Gaz., vol. xxxvi. p. 40.) Montgomery relates the case of a lady, the mother of several children, who, on one occasion, was uncon- sciously delivered during sleep. (Cyc. Pr. Med. ; see also case in Brit, and For. Med. Rev., No. 9, p. 256.) Palfrey described a case in which labor commenced and progressed in a woman to the second stage during sleep. (Lancet, 1864, vol. i. p. 36.) The results obtained by the use of the vapors of chloroform and ether show that the expulsive efforts of the womb are often as energetic in the unconscious as in the conscious state. It may appear extraordinary, how- ever, that a primiparous woman, unless rendered unconscious by narcotic substances, should be delivered without suffering pain; nevertheless, a case of this kind is recorded by Wharrie. The woman's age was 21 ; she had been in labor about six hours ; she complained of no pain, and the child was born without effort or consciousness. The child was healthy, but small, weighing rather more than four pounds. (Cormack's Jour., 1846, p. 12.) Notwithstanding this case, it is in the highest degree im- probable that any primiparous female should be delivered during ordinary sleep, without being roused and brought to a sense of her condition. There is another condition in which a woman may state that her de- livery took place unconsciously ; and this, from its being one of the most common species of defence set up by a female charged with child-murder, must here claim our attention. Thus she will allege that, while suffering from pain, she felt a strong desire to relieve her bowels ; that she went to the closet for that purpose, and was there delivered without knowing any- thing of the occurrence, until it was too late to save the child. This kind of desire is a very common symptom of the parturient state ; and it is often difficult to restrain a woman from yielding to the feeling, when it certainly would be attended with hazard to the child. (Med. Times and Gaz., 185T, i. p. 347.) We must, therefore, admit that an accident of this kind can occur ; although here, as in every other instance in which uncon- scious delivery is pleaded, a medical witness ought to inform himself, or be informed, of all the particulars which are stated to have attended de- livery, before he gives an answer applicable to the case. As a general rule, it cannot be denied that delivery may take place under these circum- stances, and a woman not be conscious of it ; but before we make this admission in regard to any particular instance, we ought to have a state- ment of all the facts from the female herself. It is thus that we shall avoid the risk of seeing a premature medical opinion set aside by the sub- sequent production of circumstantial evidence. Besides, it has been properly observed that, after an accident of this kind, a woman cannot be ignorant of her having been delivered. Women who have raised this plea in cases of child-murder have often been known to maintain that they were unconscious of their pregnancy, and thus have attempted to excuse themselves for not having prepared the articles necessary for childbirth. It is possible that a woman, especially one who is pregnant for the first time, may not be aware of her pregnancy in the earlier stage ; but it is rare for one to advance to the full term without being conscious of it 528 SIGNS OF DELIVERY IN TUE DEAD. Women Avho have borne children have not unfrequentlj consulted niedlca! men, and although nearly at full term, they have been unconscious of their state. In the majority of instances, it luay be presumed that a woman thus situated must have some reason to suspect her condition ; and if only a suspicion existed in the mind of one who did not contemplate the de- struction of her oifsi)ring-, there would be numy circumstances forthcoming which would at once establish her innocence. If this remark applies to married women, it applies with still i^reater force to those who are un- married, since the fact of illicit connection and the fear of its consequences must render them peculiarly alive to all those changes which, by common repute, take place during pregnancy. Signs of Delivery in the Dead. — It will not be proper to examine the signs of delivery which are derivable from an examination of the body of a woman after death. Occasionally we may obtain some history of the case during life, by which our labor will be much facilitated; but, on the other hand, every fact may be studiously concealed from us, and then we may be required to prove, not only the delivery, but the previous preg- nancy. These investigations relative to pregnancy and delivery in the dead body are almost exclusively confined to Cases of criminal abortion, where the contents of the womb have been expelled at the sacrifice of the life of the woman. Death commonly ensues in these cases within two or three da3's after delivery, and then satisfactory proofs are obtainable by a post-mortem examination ; but if the woman has survived three or four weeks, it will be as difficult to determine delivery in the dead as in tho living subject. This remark applies to delivery at the full period; for if the womb have expelled its contents in the first months of pregnancy, the traces of this expulsion will have generally disappeared in the course of a few days. The following may be taken as the chief appearances when the body of a woman is examined soon after delivery at the full period : The womb is like a large flattened pouch from nine to twelve inches long, its mouth being wide open. The cavity contains clots of blood or a bloody fluid; and its surface is covered with the remains of a decidua — the outermost membrane of the embryo or foetus. In the part to which the placenta has been attached, the substance of the organ appears exposed, presenting several large semilunar or valvular openings. This portion of the womb has been found of a very dark color, which has given rise to a suspicion that the organ was gangrenous. The vessels are extremely large and numerous. The Fallopian tubes, round ligaments, and ovaries are so vascular (full of blood) that they have a purple color. The spot whence the ovum has escaped is more congested than the rest of the ovarian sur- face. Obstetric writers differ greatly in their statements respecting the size of the womb at different periods after parturition ; and these differences may be explained, partly b}- the fact that the womb contracts more rapidly in some women than in others, and partly perhaps by the circumstance of the birth having been in some instances premature. Toulmouche has re- ported some instructive eases of delivery at different periods, showing the influence of time on the appearances. (Ann. d'Hyg., 1864, t. 2, p. 349.) Montgomery states that after delivery at the full period, and under perfect contraction of the womb, if the body be examined within a day or two, the womb will be found seven inches long and four broad. Its substance, on section, will be from an inch to an inch and a half in thick- ness, and will present the orifices of a great number of large vessels. At the end of a week, the womb is between five and six inches, and at the end of a fortnight about five inches in length; the density of its structure rAllITY AND NULLIPARITY. 529 has during this period increased, but its substance has considerably diminished. The inner surface is still bloody, and covered partially with a pulpy membrane resembling the dccidua. The orbicular direction of the fibres around the internal orifices of the Fallopian tubes is at this time very distinct. In about a month, the womb will have become fully con- tracted ; but the mouth rarely, if ever, closes so completely as in the virgin state. In a case examined by Barnes, in which a primiparous woman, ait. 2G, died from puerperal fever on the sixth day after delivery, the following appearances were met with in the womb : The internal surface was blackened and congested, especially in those parts to which the placenta had been attached. There was the appearance of suppurative action in this part. The substance of the womb was healthy ; there was no pus in the sinuses. The mouth of the womb showed considerable ecchymosis. The vagina was healthy; the iliac veins contained nothing but loosely coagulated blood. There was in the left ovary a small well-marked corpus hiteum, having a central cavity. (Loud. Med. Gaz., vol. xli. p. 294.) This condition of the womb must not be confounded with the appearances which are observed when death takes place during menstruation. Judee found in the body of three women who died during menstruation that the womb was somewhat enlarged — its walls being thickened, and its interior lined by a reddish gelatinous layer about 1-1 2th of an inch thick, consist- ing of a capillary network of vessels, enclosed in a mucus-like membrane. When this was removed, the Avomb below was found to be white and firm. The interior of the neck was of a grayish color; the lips were swollen, of a dull red, bluish, or even black color. On compressing this part, small drops of blood issued. This was not observed either in the neck or body of the vagina. A section of the womb presented only the normal fibrous tissue ; but at the level of the mouth (os uteri) there was a mass of tissue resembling a portion of an apoplectic lung. The blood during menstrua- tion, according to him, issues entirely from the highly congested mouth of the womb. (Med. Times and Gaz., 1855, i. p. 6.32.) An ecchymosed condition of the neck of the womb is very commonly found as the result of even an easy labor, and therefore forms a good guide where present. This point must be borne in mind in reference to criminal abortion, in- asmuch as the neck may present an appearance as if violence had been employed. From the appearances given above, it will be seen that there must be considerable difficulty in determining the period prior to death at which delivery took place. The difficulty is increased when a woman has been prematurely delivered, or when death has not taken place until some time after delivery. A medical opinion may be then iu some degree strength- ened by searching for those signs which have been described as character- istic of delivery in the living. These, if present, will always furnish strong corroborative evidence, not oidy of the fact of delivery, but of the period at which it had probably occurred. Parity and Nulliparity. — The medical question whether a woman has ever borne a child or not may be material in reference to proof of iden- tity. In Reg. V. Wainwright (C. C. C, December, 1875), the charge against the prisoner was that he had murdered Harriet Lane, a woman with whom he had cohabited. She had been missing a Avhole year, and the remains of a woman were found buried in premises belonging to the prisoner ; they had been cut up into various portions, and were so mangled and decomposed that it was necessary to establish the identity of the body as that of the missing woman. One of the medical points raised referred to the condition of the womb — i. e. whether the appearances which this 34 530 EVIDENCE FROM CORPORA LUTEA. oriran presented were such as to indicate conclusively that the deceased had borne children. The missing Harriet Lane had had two children by the prisoner, the last having' been born some time before Christmas, 1873; therefore about nine months previous to her disappearance. From their examination of the womb, Larkin and Bond came to the conclusion that this woman hud borne a child. Meadows, who appeared as an ob- stetric expert for the defence, stated that, in his opinion, the woman of these remains had never borne a child. He qualilied this oi)inion, how- ever, by stating that he believed it to be impossible to decide this question in any case with absolute certainty. If this witness had been able to swear positively that the indications of childbeariug were absolutely cer- tain, and could never be mistaken for a virgin or unimpregnated state of the womb, his evidence would have gone far to show that this could not have been the body of Harriet Lane. He felt, however, he could not carry his evidence to such an extent, and the effect of it simply amounted to a difference of opinion on the answer to this question, (Brit. Med, Jour., 1875, ii. p. 7^4.) The condition of the Avomb, according to the evidence for the prosecution, was inconsistent with virginity. This organ was in every way enlarged. It was flaccid, and the walls were unusually thin. There were one or two white lines {linese alhicantes) in the skin of the lower part of the abdomen, and other marks of a darker color in the inguinal region. The obstetric expert for the defence considered that the shape of the womb and thinness of its walls indicated that the deceased was nulliparous, i. e. that she had never borne a child. The evidence of the medical witnesses for the prosecution was strongly corroborated by a number of facts tending to prove that this was the body of Harriet Lane; and the prisoner was convicted. It would appear from the discussions on this case that took place at the Obstetric Society, that medical science alone cannot at present furnish a certain answer to this question, (Trans, Obst, Soc, 1876, vol. xvii, p. 355, and vol, xviii, p, 69.) Corpora Lutea. — ^The condition of the ovaries has been considered to furnish strong evidence, not so much of delivery as of previous pregnancy. These organs, as it has been already stated, when examined soon after delivery, are found of a deep purple color, owing to their extreme vascu- larity. If the woman has really been pregnant, we may expect to find on one of the ovaries the appearance which is denominated a corpus luteiim. Theaccounts given by obstetric writers of the characters of corpora lutea and the evidence which they are capable of furnishing in legal medicine are very conflicting. According to Montgomery, in a true corpus luteum {i. e. of pregnancy) the ovary presents a protuberance with a distinct cicatrix on the part whence the ovum has escaped. The protuberant por- tion will be found, on section, to have an oval form and to be of a dull yellow color — hence the name corpus luteum. It is full of blood, and in texture resembles the section of a kidney. It is of its greatest size in the early stage of pregnancy, and gradually diminishes as gestation advances. In the centre of this section there may be either a cavity or a radiated white cicatrix (scar), according to the period at which the examination is made. The cavity remains for about three or four months after concep- tion, and is surrounded by a dense white cyst ; as gestation advances, the opposite sides approximate and a radiated white cicatrix results. The size and vascularity of the corpus luteum are considerably diminished by the time gestation is completed, and in about five or six months afterwards — i. e. fourteen months after its first formation — it disappears altogether from the ovary ; so that the corpus luteum of one conception is not found with that of another, unless a premature expulsion of the contents of the CHARACTERS OF THE OVUM OR EMBRYO. 53I womb has taken place. (Cyc. Pr. Med. Pregnancy, p. 496: see also Edin. Med. Jour., 1845, i. p. 58.) The presence of a corpus lutuem, as it is here described, does not prove that a woman has borne a child. In the opinion of some obstetric authorities, it establishes that concei)tion had taken i)lace; but the embryo may have been converted into a mole or blighted foetus and expelled at an early period. Baly and Kirkes concluded from their researches that cases seldom occur in which the mere presence of a corpus luteum can be taken as a proof of previous impregnation ; and they consider the following rules to be deducible from the facts which they have collected: 1. A corpus luteum in its early stage (that is, a large vesicle filled with coagulated blood, having a ruptured orifice and a thin layer of yellow^ matter within its walls) affords no proof of im])regnation having taken place. 2. From the presence of a corpus luteum, the opening of which is closed, and the cavity reduced or obliterated (only a stellate cicatrix remaining), no conclusion as to pregnancy having existed can be drawn, if the corjms Ivievni he of small size, and does not contain so much yellow^ substance as would form a mass the size of a small pea. 3. A similar corpus luteum of larger size than a common pea would furnish strong pi^esiimptive evidence, not only of impregnation having taken place, but of pregnancy having existed during several weeks at least ; and the evidence would approximate more and more to complete proof in proportion as the size of the corpus luteum was greater. From these considerations, therefore, it appears to us that the only con- clusion which we can draw is that medical evidence respecting the nature of a corpus luteum in an unknown case, if received by a court of law at all, should be received with the greatest caution, and only from a witness of great experience. The old doctrine on this subject, that the presence of such a body on the ovary affords certain and undeniable evidence of impregnation, may be regarded as completely subverted. Characters of the Ovum or Embryo to the Siorih Month. — Hitherto the examination has been confined to the woman, but it is now necessary to describe the characters of the ovum or embryo and its enveloping mem- branes at the early stages of pregnancy, since, when this can be procured, it may furnish good medical evidence. The " ovum " signifies the embr^'O and its membranous coverings ; the " embryo " is the body which is after- wards converted into the foetus ; the term " foetus " is applied to the em- bryo after the third or fourth month of gestation. If the ovum be ex- pelled within a month after conception, it is scarcely possible to detect it, owing to its small size and its being enveloped in clots of blood. Burns examined three wombs within the first month, where no expulsion had taken place, but even under these favorable circumstances he failed to discover the ovum. At first the ovum contains no visible embryo, but it appears merely to consist of vesicular membranous coverings. According to this authority, when first distinctly seen through its membranes, it is of an oblong form and about a line (the twelfth of an inch) in length. At the sixth loeek it is slightly curved, resembling, as it floats, a split pea. In the seventh iveek it is equal in size to a small bee; and by the end of the second month it is bent, and is as long as a kidney bean. After the second month development goes on rapidly ; the features are in part well marked, and the limbs are gradually formed. At the third month the foetus weighs from one to two ounces; when stretched out it measures about three inches, and the genital organs, although the sex is not then distinguishable, are large in proportion to the rest of the body. The membranes are larger than a goose's egg. At the fourth month the foetus 532 EXAMINATION OF THE OVUM. is from five to six inches long, and weighs from two to three ounces; at the fifth month it measures from six to seven inches, and weigiis from five to seven ounces ; and at the aixth month its length is from eight to ten inches, and its weight is about a pound. (For the characters of the child beyond this ]>eri(nl, see Infanticide, post.) Tlie great difficulty will cor.sist in determining the nature of the supjjosed ovum or embryo be- tween the second and third months. In making the examination the ovum should be placed iu water, and all clots gently washed away from the membranous coverings or removed by some blunt instrument. Alcohol may be used as a substitute for water after the blood has been removed. If the embryo cannot be found, the decidua and chorion or portions of them may be recognized — the former by its forming the outer investment with its smooth internal and rough external or uterine surface ; the latter bv the villous or shaggy appearance of that portion of it which would have become the placenta. Between the third and fourth months the foetus may be commonly identified without much difficulty. The ovum in manv instances escapes first, leaving the decidua behind. This comes awav after a time, but it is important to remember that in some states of the virgin decidua-like structures are thrown otf from the uterine mucous membrane, which, when examined by the microscope, resemble the true decidua. Both are constituted of the innermost portion of the uterine mucous membrane, and contain all its elements. Keiller (Edin. Med. Jour., 1865, ii. p. 82) and Bell (ibid., p. 120) have called attention to the fact that an erroneous medical opinion on the date of pregnancy may be formed by trusting too much to the appearance of the ovular membranes. The ovum or foetus may die and the membranes afterwards continue to grow, thus giving the appearance of a more remote date to pregnancy. An examination of the embryo alone can give any satisfactory results on this point. The membranes may be also enlarged as the result of dropsi- cal accumulation, and this may be set down to pregnancy of some dura- tion, when it may not actually have extended beyond the second or third month. A mole is the result of conception, the foetus having died in consequence of the effusion of blood into the decidua and the various membranes, and, should a placenta exist, into its structure. The symptoms accompanying a mole resemble those of pregnancy; and the appearances produced by its expulsion are not to be distinguished from those attending the al)ortion of a foetus at an early period of gestation. The only means of distinction would be derived from an examination of the expelled matters. The local effects produced on the organs of generation by the expulsion of these bodies are by no means so great as those arising from delivery at the full period. When from some accident the foetus dies at any time before the com- plete formation of the placenta, the villi of the chorion, instead of cora- pletel}' dying, grow imperfectly ; whilst serous fluid is effused within, and the part is distended into a globular form. This is called a vehicular mole. In the early stage of pregnancy a decidual covering will always be found more or less complete around this mole; but if the size of the mass be great, then, although present, it will be less observaljle, being spread over a larger surface. A co7-pus luteum v/ill also be found, but not so perfectly formed as in normal pregnancy. The ordinary symptoms of pregnancy accompany this state, although in all forms of mole-pregnancy it is either imperfectly marked or it only proceeds to a certain point. (See case Obst. Bee, vol. i. p. 21.) It is also to be remembered that the effects produced by the expulsion of a mole are very similar to those of an abor- tion. These facts may have iin important bearing in medico-legal practice. CONCEALMENT OF BIRTH. 53.3 Concealment of Birth. — Medical evidence respecting* delivery is re- quired in two cases: first, when the birth of a child is wilfully concealed ; and second, when the contents of the womb have been prematurely ex- pelled bv criminal means. The concealment of pregnancy is no offence in the English law ; but the concealment of delivery or of the birth of a child is a misdemeanor by the 24 and 25 Vict., c. 100, sec. 60, the words of which are to the following effect: " If any woman shall be delivered of a child, every person who shall by any secret disposition of the dead body of the said child, whether such child died before, at, or after its birth, en- deavor to conceal the birth thereof, shall be guilty of a misdemeanor." Willes, J., remarked upon the statute that women tried on this charge are punished, not for concealment of birth, but concealment of the body — a distinction which not only increases the difficulty of obtaining evidence, but excites hope in the criminal that, if she can finally do away w-ith the body, she may be free of the law. Various interpretations have been put upon the terms " concealment " or " secret disposition " of the body. This part of the evidence does not affect a medical witness, unless he himself has found the dead body or was present when it w^as found. It will rest with the judg-e to determine whether the body has been so disposed of as to constitute a misdemeanor. (Reg. v. Clarke, Chelmsford Sum. Ass., 1864.) [In the American States the statute laws make it a criminal offence to conceal the birth of a child. They vary to such an extent that the only safe rule to adopt is, that each case must be considered and construed under the law^ existing where the offence was committed. The courts in all cases construe these statutes with great strictness. In some of the American States the statutes require that it must appear that the child was born alive, and that if the child was stillhorn there could be no crime: Desty Am. Crim. Law, § 90, citing State v. Kirby, 5*7 Me. 30; State V. Jones, 4 Hawks. (N Car.) 350 ; State v. Love. 1 Bay (S. Car.), 167; Douglass v. Com., 8 Watts (Pa.), 538. It has been said of all these statutes : " That they make heavily punish- able what of itself is nearly or quite innocent, simply because of its tendency toward an unproved wrong. Hence the interpretation is always specially strict:" Amer. and English Eneycl. of Law, vol. 3, p. 416.] Medical men must be here cautioned, as in some other crimes com- mitted by w^omen, that they have no legal right, except by the consent of the woman, to examine her person in order to ascertain whether she has been recently delivered or not. According to English law, no person is bound to furnish evidence against himself or herself. A medical man who neglects this rule may find himself charged with an indecent assault, and be sued for damages. [The rule is different in the American States or many of them. A physician who attended the mother would not be per- mitted to disclose any fact coming to his knowledge while attending her in his professional capacity. The statutes of New York and many Am- erican States make all such knowledge privileged, and the physician is prohibited from testifying- regarding it.] In Agnew v. Jobson and others (Newcastle Lent Ass., 1877), the plaintiff was suspected of concealing the birth of her illegitimate child, of which she was afterwards convicted. An inspector of ])olice, wishing to have evidence of her physical condition, gave to Mackay authority to examine the plaintiff's person. Having some doubt about the legality of the proceeding, he applied to the defen- dant Jobson, a magistrate, who gave him a written order for the purpose. Jobson, Mackay, and another were sued for damages for an indecent assault. The evidence made it clear that the girl did not give her consent, 534 DEFINITION OF A "CHILD." but her alarm prevented her from resisting. The judge summed up, and the jury returned a verdict for the plaintitf, with 50/. damages. (Brit. Med. Jour., 1877, i. p. 336.) A medical man may, however, examine the clothes of the accused, as well as the body of the child, if they are handed to him by the police for this purpose. This is an ottence of which women charged with child-murder are com- monly convicted in England; while the Scotch law punishes women for th(> concealment of pregnancy if the child be dead or amissing. (Alison's Crim. Law, p. 153.) The medical evidence on trials for this misdemeanor in Scotland is exclusively derived from an examination of the mother ; and thus much will depend upon the time at which this is made. A¥ith regard to the child, its body need not even be produced, provided there be satisfactory evidence of its death ; the body may have been secretly buried or burnt, and in the latter case it may be necessary to examine the bones or ashes. According to the English statute, the child must be dead — the conceal- ment of the birth of a living child not being any offence unless it should happen to die before its birth was made known. In the case of Reg. v. Woodman (Kingston Lent Ass., 1845), the woman was acquitted be- cause the child was living when concealed. Chitty says that, in order to constitute the otfence, the child must have advanced to the end of the seventh month (Med. Jur. p. 412) ; but it is to be presumed that the con- cealment of the birth of a dead child at the sixth, or under the seventh month, would be as much an infringement of the statute as if it were more advanced. The concealment of the aborted but undeveloped ovum or embryo, of a monster — i. e. a child without human shape, a mole, or other morbid growth — would not probably be considered a contravention of the statute. We are not aware that there has been any judicial decision on this point. Lane communicated to the Med. Times (Aug. 1845) a case in which a charge of concealed birth was dismissed, because the con- cealment referred to a child born at the eighth month in its memhranefi. The woman stated that she did not consider it to be a child. The case, being entirely new, should have been sent for trial ; for a magisterial de- cision can furnish no precedent on a question of this kind. This woman must have been delivered of a child, foetus, or embryo, or of course there would have been no pretence for the charge. That a child may be thus born and removed from the membranes alive is a fact established by ex- perience. Brunton reported to the Obstetrical Society a case in which the entire ovum was expelled at the seventh month of gestation, and the child was rescued alive, although born fifteen minutes before being taken out of the membranes. (Med. Times and Gaz., 1871, i. 412.) In another case of sudden delivery the child in its membranes with the placenta was discharged into a bucket. It was not rescued in time to save life. (Amer. Jour. Med. Sci., April, 1870, p. 430.) It is difficult to suggest a proper legal definition of a "child." From some observations made by a Recorder of London, there appears to be some uncertainty on this point. In reference to the case of Reg. v. Knight (C. C. C, Oct. 1865), where a woman was charged with concealment of birth, the prisoner admitted to a policeman that she had been delivered of "a something" (not forthcoming). "Now, was she delivered of a child, and had she disposed of the body in such a way as to conceal the fact of her having been so delivered ? Then what was ' a child V — for those were the words used in the statute. He felt himself a little debarred from expressing his own opinion in reply to this question, because two of the judges had given decisions directly contrary the one to the other upon DEFINITION OF A "CHILD." 535 this subject. One of them said it was not a child unless it had attained that state in which it could live, supposing- it had been bovn alive. If it had attained that state, then he was of opinion that it was a child. The other judge said that this was not his idea of a child ; but that if it had the outward form of a child, it was a child according- to the statute. The one contended that it ought to have attained to a state in which it had a capability of living- (viability) ; and the other that at any rate it should luive the outward form of a child. Was there any proof of this kind here ? The prisoner herself said she did not know whether she had been in the family way for three months. Taking the widest view^ of the judges — Had what was born in this case the outward form of a child ? If it had not, then the prisoner was not guilty of the offence charged against her." The proposed new Criminal Code contained this provision (section 146): " No foetus shall be deemed to be a child within the meaning of this sec- tion which had not, when born, reached the period at which it might have been born alive." This, as it will be seen under Infanticide, is not A fixed period, but no doubt the earliest period at which a child has been known to come into the world living would be taken as the limit. It will be perceived that it is not material here, as in a case of alleged infanticide, to prove when the child died — whether before, during, or after its birth ; and thus those subtleties and technicalities which are met with in cases of child-murder are avoided. In regard to proof of concealment, and what constitutes it, these are essentially legal points ; but a medical practitioner may sometimes benefit an accused person if he can prove that the woman had made application to him on the subject of her pregnancy and delivery. The law is especially lenient under such circumstances. A very strict interpretation appears to be put upon this term concealment. There must be a " secret disposition" of the dead body. The medical witness may even have to deal, not with the body, but with the remains in a mutilated state or burnt. He must be able to prove that they really are human remains. In one case (Cornw^all Sum. Ass., 1871), the pris- oner, a married woman, was charged with the murder of her illegitimate child. The body was found mutilated, and partly burnt. The woman had concealed the mutilated body of the child, and had tried to get rid of it by burning. She said the burnt bones found and some blood on a rug were those of a fowl. It was proved, however, that they were the bones of a child and that the blood was not that of a fowl. Questions connected with concealment of birth do not fall under the jurisdiction of a coroner ; the medical evidence is therefore required by a magistrate. 536 ABOKTION — NATUKAL CAUSES. CRIMINAL ABORTION. CHAPTER XLVI. ABORTION FROM NATURAL CAUSES. CRIMINAL CAUSES. MECHANICAL MEANS. MEDICINAl SUBSTANCES. SIGNS OP ABORTION. SPECIFIC ABORTIVES. LOCAL APPLICATIONS.— FEIGNED ABORTION. MEANING OF THE WORD " NOXIOUS" AS APPLIED TO DRUGS. — ON INDUCING PREMATURE LABOR. PROOF OF PREGNANCY NOT NECESSARY. ABORTION OP MONSTERS. MOLES AND HYDATIDS. By abortion is commonly understood, in medicine, the expulsion of the contents of the womb before the sixth month of gestation. If the expul- sion takes place between the sixth and ninth months, the woman is said to have a premature labor. The law makes no distinction of this kind, but the term "abortion" is applied to the expulsion of the foetus at any period of pregnancy before the term of gestation is completed ; and in this sense it is synonymous with the popular term miscarriage. Crimi- nal abortion is incorrectly thought to be rarely attempted before the third month ; it is now very common to perform it before the second month, because then a woman begins for the first time to acquire a certaint}^ of her pregnancy. The causes of abortion may be either natural or violent. The latter only fall under the cognizance of the law ; but a medical witness should be well acquainted with the causes which are called natural, in contradistinction to others which depend on the application of violence. These natural causes are sometimes very obscure, and the real cause is thus often overlooked. They are so frequent, that — according to White- head's observation — of 2000 pregnancies, one in seven terminated in abortion. These causes are commonly ascribable to peculiarities in the female system, to the presence of uterine or other diseases, or to some shock sustained by a woman during pregnancy. Any diseases which strongly affect the womb or general system of a woman may give rise to abortion. An attack of smallpox has been known to produce it ; and it has been suggested by A(!ton that the presence of constitutional syphilis in the father is not only a cause of infection in the offspring, but of repeated abortions in the woman. (Lond. Med. Gaz., vol. xxxvi. p. 164 ; Ramsbotham's Obst. Med., p. 655.) These facts deserve attention, when it is proved that a woman has really aborted, and an attempt is unjustly made to fix an alleged act of criminality on another. For further in- formation on the numerous natural and accidental causes which may give rise to abortion, the reader may consult the work of Whitehead (On Abortion and Sterility, p. 252) ; and, for the effects of undue lactation and diseases of the placenta in causing abortion, the Med. Times and Gaz., 1852, ii. p. 580, and 1853, i. p. 302. In considering the operations of these causes, it is proper to Ijear in mind that, during pregnancy, the womb is subject to a natural periodical excitement corresponding to what would have been the menstrual periods dating from the last cessation. Hence comparatively trivial causes operating at these periods may lead to VIOLENT CAUSES. 537 au expulsion of the foetus, Salomon has reported two cases in which pre- mature delivery followed the mercurializatiou of the system. (Lond. Med. Gaz., vol. xxxvi. p. 658.) The violent causes of abortion may be of an accidental or criminal nature. In general the distinction will not be difficult: the kind of vio- lence and the adequacy of the alleged cause to produce abortion will be apparent from the evidence. In reference to criminal cases, the causes may be referred either, first to the use of mechanical means; or second, of irritating medicinal substances acting upon the womb or bowels. They operate with greater certainty in proportion as the pregnancy is advanced. Mechanical Cleans. — Among the mechanical causes may be mentioned — severe exercise, the violent agitation of the body, as by riding or driving over a rough pavement, in which case no marks of violence would be ai)parent. Any physical shock sustained by the body may operate indi- rectly on the womb. Violent pressure or blows on the abdomen are sometimes resorted to ; but in these cases the marks of violence will be commonly perceptible. Instruments have been devised for the purpose of piercing the membranes, destroying the child, and thereby leading to its expulsion. It cannot be denied that cases have occurred M'hich show that the crime is frequently perpetrated by persons who basely derive a profit from the practice ; and for one case that comes to light probably many are effectually concealed. In the evidence given on four trials within a recent period the cases pi'esented no feature of novelty or in- terest. Instruments were employed, and drugs in large doses were proved to have been also administered. Mechanical means are undoubtedly more effectual in producing abortion than mechanical substances ; yei when the attempt is made by ignorant persons the woman often dies from inflammation of the womb or perito- neum or other serious after-consequences. A case was tried some years since in which the evidence showed that the prisoner had attempted to produce abortion in the deceased, by thrusting wooden skewers into the substance of the womb. Inflammation and gangrene took place, and the M'oman died. The prisoner was convicted of murder. (For similar cases, see Lond. Med. Gaz., vol. xxxvi. p. 102 ; xlv. p. 693.) This kind of injury to the womb generally, but not always, implies the interference of some other person in the perpetration of the crime. Mechanical means often leave marks of violence on the womb, as well as on the body of the child. If the mother should die an inspection will at once settle the point. (Ann. d'Hvg, 1834, t. 1, p. 191; 1838, t. 1, p. 425; 1839, t. 2, p. 109.) An important case of this kind was the subject of a criminal trial in Scotland in 1858. (Case of Reid, Lond. Med. Gaz., Dec. 11, 1858.) The womb near its mouth presented two openings in its substance, descril)ed as punctured wounds by the medical witnesses for the prosecution who made the examination, and as the openings of torn bloodvessels by others who were called for the defence. There was also a rupture of one ovary. The prisoner was convicted, and the medical man who was supposed to have been the principal agent in the crime committed suicide. The case is chiefly important in showing that any apparent mechanical injury to the womb should be minutely examined at the time of inspection, so that no doubt of the cause may afterwards be entertained by any present. If, in a case of this kind, the mother should survive and the child be expelled, then marks of violence may be found on its body. These marks may not \)e sufficient to account for its death ; but this is not here the question. If it can be proved that they have not resulted from accidental causes 538 MECHANICAL MEANS — INSTRUMENTS. durini? gestation or subsequently to delivery, then their presence may furnish strong corroborative evidence of the actual means by which abortion was attempted. It is said that abortion has been in some in- stances accomplished by frequent bleeding from the arm. Ttiis effect may follow as a result of shock produced by the sudden loss of a large quan- tity of blood. An examination of the veins of the arms would show whetlier any such attempt had been made. IMiere can be no doubt that of all the exciting causes of abortion the most eff'ectual, and that which most certainly brings on the expulsive action of the womb, is the destruction of the ovum or embryo. If by accident or design the ovular membrane should become ruptured, gesta- tion is arrested, and abortion necessarily ensues. At any period of preg- nancy, therefore, a puncture through the membranes will sooner or later occasion the evacuation of the womb, (Ramsbotham's Obst. Med., p. 655.) This author remarks that the performance of the operation de- mands a most accurate knowledge of the anatomy of the ovum and the maternal structures, as well as of the state of development which the neck of the womb assumes at different periods of pregnancy. In medical practice, for the induction of premature labor the membranes are rup- tured either by the use of a catheter or by an instrument of this shape, but including a blade like a tonsil-lancet. Unless the inner membrane or amnion be opened, gestation may still proceed, and abortion will not take place. When all the membranes are completely penetrated and the waters are discharged, uterine action is invariably induced, but the time which elapses from the performance of the operation to the commencement of labor is subject to great variation. Ramsbcthani states that he has known the womb begin to act in ten hours after the rupture, but in another case a week elapsed before its action commenced. As a rule, uterine action is in general fully established in from fifty to sixty hours. In Reg. v. Sharpe (Notts Lent Ass., 1873), the prisoner, who was a charwoman, but said by profession to be an abortion-monger, was convicted of this crime. It was proved that she ruptured the membranes with an ivory crochet-needle, and three days afterwards the woman w^as delivered of a stillborn child. Another woman, proved to be an accessory to the act, was sentenced to fifteen months' imprisonment. (Lancet, 1873, i. p. 422.) It must not be supposed, how^ever, that, where a criminal intention exists, a long period is required for removing the contents of the womb. In a criminal attempt by a medical practitioner, in which the woman would be a consenting party to the act, the removal of the embryo or foetus might be effected in a much shorter period of time than in those cases of obstetric practice in which there was no desire to expose the woman to the slightest risk, and premature labor was openly induced. At any rate, the time for the completion of abortion could not be measured by cases in which the womb has been left to undergo spontaneous con- traction after the membranes had been punctured, and the waters had escaped. There Avould, however, be great danger to a woman in the necessary manipulations required. The reader will find reports by Tardieu (Ann. d'Hyg., 1855, t. 1, p. 406) of numerous cases of abortion as a result of mechanical means applied to the womb ; and some good practical re- marks by the same writer on the mode in which these inquiries should be conducted, in the Ann. d'Hyg., 1856, t. 1, p. 141. On the mechanical means for procuring abortion and the results, see a paper by Lex. (Vier- teljahrsschr. fiir Gerichtl. Med., 1866, 1, p. 253.) It is obvious that this mode of perpetrating abortion is only likely to succeed in the hands of persons who have a complete anatomical kuowl" USE OF MEDICINAL SUBSTANCES. 539 edge of the parts. The death of the woman w\\\ convert the crime into murder if instruments are introduced into her body by persons who are ignorant of anatomy. In Reg. v. Heap (Liverpool Lent Ass., 1875), it was proved that the prisoner had caused abortion by the use of instruments. The man procured abortion and brought about the death of the woman by driving a weaver's spindle into the womb, the fundus of which was comi)letely transfixed and a fatal peritonitis induced. On an inspection, two sharply-punctured wounds were found in the womb, and to these death was attributed. The prisoner, although not intending to destroy life, was convicted of murder. A midwife was convicted of a similar crime. (Reg. V. Cartledge, Manchester Wint. Ass., 1877.) The evidence showed that the prisoner had introduced an instrument for the purpose of procuring abor- tion. Inflammation followed, and the woman died in three days from peritonitis and gangrene. A method much resorted to in the metropolis is to rupture the mem- branes by the insertion of a piece of whalebone or wire into the mouth of the womb till blood appears. Pills of oil of savin, sulphate of iron, and aloes, are then freely given to aid in the expulsion of the ovum. A mis- carriage is frequently brought about by the mere insertion of a male catheter or bougie between the membranes and the wall of the womb. Other means, such as tents and Barnes's bags, are also resorted to. The editor met in his practice with the case of a married woman on whom an unqualified medical man had successfully operated ten times. The same woman had also abortion successfully induced on her by a female abortion- ist. (Reg. V. Sprowle, C. C. C, Oct. 1884.) It is to be regretted that members of the medical profession have on several occasions misused their professional knowledge and have exposed themselves to prosecutions for this crime. Sometimes it is probable the charge has been raised falsely or through misapprehension on the part of the woman ; at others, the evidence has left it very clear that the charge was well founded. Of late years medical men have rather freely used the speculum. When this instrument has been impropeiiy or unnecessarily used on a pregnant woman, a charge of attempted abortion by instruments may be easily raised against a medical practitioner. A trial took place ^Reg. V. Griffin and Venn, Exeter Lent Ass., 1854) in which it was charged that the accused Venn (a surgeon) had feloniously used an in- strument with the intent to procure a miscarriage of a woman. Accord- ing to the evidence, Venn had on several occasions passed a round polished instrument into her body, once in a coppice and at another time in a field. The defence was that the surgeon had merely used a speculum to ascertain whether the girl was pregnant in order to know how to prescribe for her; and that it was absurd to suppose that he had ever intended to procure abortion, for this had not followed, audit might have been easily produced by him at any period of pregnancy, if he had wished it. On this evidence the prisoners were acquitted. Admitting the statements of the girl and the prisoner to be correct, it may be remarked that medical practitioners, in the lawful exercise of their profession, do not commonly use a speculum in open fields or coppices to d(4erniine whether a woman is pregnant or not ; and it is a well-known fact that a speculum is not necessarily required for determining the question of pregnancy. Medicinal Substances. Emmenagogues. Echolics. — These are fre- quently resorted to for inducing criminal abortion ; but they rarely answer the intended purpose, and, when abortion follows, it is often at the ex- pense of the life of the woman. Mineral poisons have been ignorantlj employed for this nefarious object, and often with a fatal result. Among 540 USE OF MEDICINAL SUBSTANCES. these substances may be mentionod arsenic, corrosive sublimate, bichromate of potassium (Yierteljahrsschr. fUr Gerichtl. ^Med., 1862, 2, p. 113), sul- phate of co|iper, copperas or suli)hate of iron, perchloride of iron, and other irritants Metallic mercury, which is generally reputed to be innocent, has been jriven for the purpose of procuring' abortion. In a case recorded by Gibb (Lancet, 18T3, i. p. 339), it produced no effect on the womb, but caused some severe nervous symptoms, which would justify the application of the term "noxious" to this sul)stance. Solutions of perchloride of iron (steel drops) have frequently caused severe svmptoms, and seriously injured health without producing abor- tion. In a case in which the author's evidence was required (Keg. v. Rumble, Lincola Sum. Ass., 1863), it was proved that this compound of iron had Ixsen given in large doses daily to a pregnant woman for the purpose of exciting abortion. It had not this effect, but it had seriously injured the health of the woman. The prisoner also gave to her canthari- des in pill. The defence was that these were proper medicines for the treatment of amenorrhoea, under which, it was alleged, she was laboring. The large doses administered, and the secrecy with which the medicines were supplied, proved that they had been given unlawfully and with criminal intent; aud the chemist who supplied them, knowing the purpose for which they were required, was convicted. In 1878, a chemist pleaded guilty, on the analysis of the editor, of administering large doses of tincture of iron and aloes to a woman with the view of procuring abortion. The method failed, and the woman was afterwards operated on by a qualified medical man, with fatal result. (Reg. v. Darley and Moon, Lewes Sum. Ass., 1878.) Arsenic, corrosive sublimate, and other mercurial compounds may cause death without in any way exciting the womb to expel its contents. In July, 184.5, a woman who had passed the fifth month of her pregnancy, took a large dose of arsenic, as it was alleged, for the purpose of abortion. She died in less than seven hours, having suffered during that time from severe vomiting and purging ; yet abortion did not take place. Such powerful poisons as strychnine have failed to effect it. A girl, set. 17, who was pregnant, swallowed the contents of a packet of Battle's vermin- killer. The usual symptoms followed, with tetanic spasms and opisthot- onos. She recovered, and went her full time without aborting. Drugs, such as croton-oil, elateriura, gamboge, colocynth, hellebore, and other drastic purgatives, have been used with criminal intent without causing abortion. Aloes and two of its compounds — hiera picra, a mix- ture of aloes and canella bark, and Pilacotia (pilulae coccise), sometimes called "pill cochia," a mixture of aloes and colocynth — are much used as purgatives among the poor. In large or repeated doses they are supposed to have the power of exciting the womb, and are secretly employed for the purpose of abortion. Although not poisons in the strict sense of the word, it may be observed of these drugs, and of all purgatives which cause much straining, or specially affect the rectum, that they may readily bring on abortion in the advanced stages of pregnancy, while they fail in the earlier stages. The herbs which have acquired a popular repute as abortives, in the form of powdered leaves, infu.sion, or decoction, are very numerous. Some are innocent — such as pennyroyal, broom, and fern ; others are pernicious — such as white and black hellebore, yew, and labur- num. A decoction of broom simply acts as a diuretic The medicinal substances above described, if they have any effect, exert an indirect, action on the womb by producing a shock to the general sys- tem. But there is another class of bodies which are considered to act oa EMMENAGOGUES AND ECBOLICS. 541 the womb directly. These are classed under the names of emmenagoyues and ecbolics. As in trials for criminal abortion some confusion has arisen in the application of these terms (Reg. v. Wallis, Winchester Sum. Ass., 18V 1, see p. 571), it will be necessary to state here what is understood by them. Emmenagogues (from if^fir^via, the menstrual discharge, and dywyoj, exciting) signify those medicines which excite or promote the menses. Pereira enumerates among these savin, black hellebore, aloes, gamboge, rue, madder, stinking goosefoot {Chenopodiwni olidum), gin, borax, and for the most part suljstances which when taken in large doses act as dras- tic purgatives or stimulating diuretics. When amenorrhoea coexists with anaemia, the most ettectual emmenagogues are chalybeates, the prepara- tions of iron, including compound iron or Griffith's mixture. Echohcs (from ix^o-Kri, expulsion), substances which cause the expulsion of the foetus, imply medicines which operate directly as abortives. The}^ excite uterine contractions, and thereby promote the expulsion of the contents of the womb, such as the foetus, the placenta, hydatids, clots of blood, etc. The number of ecbolics known is very small. Indeed, the only known unequivocal agent of this kind is ergot. The ergot in ordinary use is that of rye ; but the ergot of wheat is said to be equalh' efl'ectual, and the same perhaps may be stated of the ergots of all grasses. Tincture of cotton-wood bark is also a reputed abortifacient, or ecbolic, and has the repute of being commonly used for purposes of abortion by the blacks of the United States. Its use has been a matter of investiga- tion in one criminal trial in this country. (Reg. v. Hardie, C. C. C, Dee. 1883.) Black snake-root {Actxa racemosa) is also another ecbolic of some repute. In addition to these, there are other substances derived from the vege- table, animal, and mineral kingdoms which have been employed for pro- curing abortion, and on the specific effects of these agents when adminis- tered to pregnant women medical opinions may be required. Such are yew leaves, grains of paradise, tansy, white and black hellebore, squills, pennyroyal, cantharides, sulphate of potassium, borax, Griffith's mixture, and iron filings. The English herbs on which medical opinions may be required are chiefly rue, pennyroyal, savin, and tansy. I\'ue (Jluta graveolens). — This common garden plant has been much used in the form of decoction. Tardieu has reported three cases in which a strong decoction of rue produced abortion at the fourth, fifth, and about the sixth month of pregnancy respectively, and the women recovered. (Ann. d'Hyg., 1855, t. 1, p. 403.) Pennyroyal (llentha pulegium). — This is a variety of mint. The infu- sion, under the name of pennyroyal tea or pennyroyal water, is used as a popular remedy for olistructed menstruation, and it has also been used for the purpose of abortion ; but it has neither emmenagogue nor ecbolic properties, and it is not now employed for any ])urpose by medical practi- tioners. Any notice of this substance here would have been quite un- uecessai'v, but for the fact that in a trial for criminal abortion (Reg. v. Wallis, 1871), strongly abortive properties were incorrectly assigned to it; and it was described as a highly noxious substance. Pennyroyal in- fusion or tea has no more effect on the womb than peppermint, spearmint, or camphor water. A medical witness at the trial above referred to stated that pennyroyal would produce abortion, but admitted in cross-examina- tion that he had had no practical knowledge of its properties, and, unless taken for some time and of considerable strength, it would have no effect. Medical witnesses should be cautious in giving evidence on these occa- sions in reference to the properties of drugs. They have to consider seri- 542 SAVIN AS AN ABORTIVE. ously, in all cases of allegecl criminal abortion by drugs, whether the sub. stance is noxious, and whether it is an ennnenanogue or really an ecbolic. Thev should base their opinions either on actual personal experience or on the authority of those who have practically studied the effects of the (lrui>s, otherwise the court may be greatly misled, as in the case of Reg. v. Wallis (see p. 541). Pennyroyal is not descril)ed by any authority as an emmenagogue or ecbolic, or as a substance having any abortive or nox- ious properties. Savin Jmiiperus Sabina. Oil of Savin. — The proi)erties of this sub- stance as a vegetable irritant poison have been elsewhere described {ante, p. 170). AVriters on Materia Medica ascribe to it emmenagogue proper- ties, i. e. that it is an excitant to the bloodvessels of the womb and is useful in certain cases of disordered menstruation, but it does not excite uterine contractions like the ergot of rye, and it is not used for the pur- pose of aiding parturition. It should not be given to a woman in the pregnant state, for its operation as an irritant might affect the womb in- directly and lead to abortion. It has been long known and employed as a popular abortive, the tops being used in the form of infusion or decoc- tion, or the oil is given to aid instrumental interference. (Reg. v. Phillips and Cayley, C. C. C, Feb. 1885.) Under these circumstances it com- monly acts only as an irritant poison, causing severe pain, with vomiting and purging. One case of its fatal action when used for procuring abor- tion was referred to the author in 1845. (Lond. Med. Gaz., xxxvi. p. 646.) A woman may die undelivered, or the foetus may be expelled dead, and the woman afterwards die from the irritant effects produced on the stomach and bowels. The powdered leaves of this plant are frequently employed as a popular abortive ; they are readily obtainable in gardens. They may be given in the form of infusion or decoction. The former ia the most powerful. Savin may also be given as a tincture or as an essential oil. In an}^ of these forms, when given in large or frequently repeated doses, it has an irritant action. The powdered leaves are not used in medical practice. The dose as an emmenagogue would be from five to fifteen grains — the medicinal dose of the oil is from two to six minims, and of the tincture {Tinctura sahinse, B. P.) from twenty minims to one fluid drachm. This holds the oil and resin dissolved. The leaves of savin may be identified by their peculiar odor when rubbed, and also by their appearance under the microscope (see ante, p. 170.) Reported cases in which the oil of .savin has been administered for the purpose of abortion are not very common. In Reg. v. Pascoe (Cornwall Lent Ass., 1852), a medical man was convicted of administering oil of savin to a woman with intent to procure miscarriage. The proof of intent rested partly on medical and partly on moral circumstances. It appeared that the prisoner had given fourteen drops of the oil, divided into three doses, daily — a quantity which, according to the medical evi- dence at the trial, was greater than should have been prescribed for any lawful purpose. The medicinal dose, as an emmenagogue, on the author- ity of Christison, is from two to five minims, and according to Pereira from two to six drops. The quantity given by the prisoner, although a full dose, was not, therefore, greater than these authorities recommend ; and his criminality appears to have rested, not so much on the doses given, as on the question whether he knew, or as a medical man had reason to sus- pect, that the woman for whom he prescribed it was pregnant. No med- ical authority would recommend oil of .savin in full doses for pregnant women; and with regard to the existence or non-existence of pregnancy in a special ca.se, medical men are reasonably presumed to have better SPECIFIC ABORTIVES ERGOT OF RYE. 543 means of satisfying themselves than non-professional persons. The pris- oner's innocence, therefore, rested on the presumption that he imj)licit]y believed what the Avoman told him regardin-i- her condition ; that he had no reason to suspect her pregnane}', and therefore did not hesitate to select and prescribe a medicine which certainl}' has an evil reputation, and is rarely used by regular practitioners. According to the evidence of the woman, she informed the prisoner that she had disease of the heart and liver, and nothing more was the matter with her. It is absurd to sup- pose that oil of savin would be prescribed by a medical man for such a disease as this. The prisoner, on the hypothesis of innocence, must have intended that the medicine should act on the womb, and must have in- ferred the existence of an obstruction to menstruation from natural causes irrespective of pregnancy. The jury do not appear to have given him credit for such ignorance of his profession, and this probably led to his conviction. There can be no doubt that the oil was administered with a guilty intention. Every qualified practitioner, acting bond fide, would undoubtedly satisfy himself that a young woman whose menses were obstructed, was not p7'egnant before he prescribed full doses of this oil three times a day, or he would fairly lay himself open to a suspicion of criminality. If pregnancy — a frequent cause of obstructed menstruation . — were only suspecled, this would be sufficient to deter a practitioner of common prudence from prescribing, in any dose, a drug w^hich may exert a serious action in the uterine system. (Med. Times and Gaz., 1852, i. p. 104.) On the Northern Circuit, Dec. 1853 (Reg. i;. Moore), a man was convicted of administering oil of savin to a pregnant woman. It made her verv ill, but did not produce abortion. (See also Reg. v. Phillips and Cayley," C. C. C, Feb. 1885.) The oil of savin is obtained by the distillation of the tops, in the pro- portion of about 3 per cent, by weight. It has a yellowish color, and the peculiar terebinthinate odor of the plant, by which alone it may be recog- nized. It may be separated from the contents of the stomach by agitat- ing them with ether, in which the oil is very soluble. The ether may be afterwards removed by distillation. The odor of the oil has been per- ceived after death in the blood and in the cavities of the body. This may be regarded as a test of its presence (Vierteljahrsschr. fiir Gerichtl. Med., 18G6, 1, p. 241.) The oil of savin forms a turbid mixture with rectified spirit of wine. When treated with an equal volume of sulphuric acid, it acquires a dark-brown color ; and when this mixture is added to distilled water a dense white precipitate is separated. Tansy. Oil of Tansy.- — Hartshorne states that in the United States the oil of tansy has acquired the character of a popular abortive, and has caused death in several instances. In England this oil and the herb have been chiefly employed for the purpose of expelling w^orms. Saffr^on in the form of a decoction of the dried stigmas of saffron (Crocus sativus) has been used as a popular abortive. Thomsen has reported a case in which abortion occurred in a woman who had taken repeated doses of a decoction of safl'ron with starch. There was reason to believe, however, that manipulations pier vaginam had also been re- sorted to, and these may have had the principal share in bringing about the result. (Yierteljahrsschr. fiir Gerichtl. Med., 1864, ii. p. 315.) Ac- cording to Pereira, although saffron was formerly used as an emmenagogue to promote uterine contractions, it was not established by any trustworthy observations that it possesses any medicinal properties. Specific Abortives. Ecbolics. Ergot of Rye. Spurred Rye (Secale cornutum). — The substance called Ergot is a diseased growth on the grain 544 SPECIFIC ABORTIVES ERGOT OF RYE. Of seed of rje, caused by a parasitic fungus. In i)()\v(lei', infusion, ol lincture, it has been for some time used by medical i)ractitioners to excite the action of the womb and aid parturition. It is also used for a similar purpose on animals in veterinary practice. Th(! ]iroperties of ergot as an abortive are well known, and it is often criminally ailministered by mid- wives to pregnant women. In one case it was proved that it had l)een supplied in large (juantitii^s to a midwife, and further, that the death of a pregnant woman from hemorrhage had been accelerated by the use of iaru-e doses of this drug. (Pharm. Jour., Dec. 1878, p. 541.) A trial which took place (Reg. v. Be Baddeley and Wife, C. C. C, July, 1871) shows also that " herl)alists" and "spiritualists" are well acquainted with the properties of ergot as an abortive, and are ready to supply it in secrecy. The prisoners in this case were indicted for unlawfully supplying a certain noxious drug — namely, ergot of rye, knowing that it was intended to procure abortion. They inserted an advertisement in a spiritualistic jour- nal, inviting people to consult at that house " Madame de Baddclc}^, the celebrated clairvoyante." From what was alleged to be transacted there, the police were induced to send a woman to consult the prisoners, and to concoct a story which might elicit their "spiritual" mode of procedure. After being put into a state of so-called "clairvoyance," the female pris- oner advised the applicant what to do in the case of a young woman whom she had mentioned, and gave her a quantity of ergot of rye to procure abortion. The drug was at once handed over to the police. They were found guilty. Ergot of rye has been found to bring on contractions of the womb at an advanced stage of gestation, or when efforts at parturition had already commenced. There is, however, some difference of opinion respecting its specific ecbolic properties. According to Lee, it has no effect in the earZy stages of gestation, although given in large doses. (Lond. Med. Gaz., vol. XXV. p. 10; see also Edin. Med. and Surg. Jour., vol. liii. p. 27.) Beatty states that when used in obstetric practice it is liable, by absorp- tion into the system of the mother, which may take place within two hours, to endanger the life of the child. (Dub. Med. Jour., 1814, p. 202.) This question was referred by the French Government to the Academy of Medicine in 1845, as there was reason to think that, under its employ- ment in the practice of midwifery, children were frequently born dead. (Ann. d'Hyg., 1846, t. 1, 204; see also Lond. Med. Gaz., vol. xlvi. p. 680.) In confirmation of Beatty 's statement, McClintock and Hardy report that out of thirty cases in which it was administered, twenty children were born dead. (Practical Observations, p. 95.) Ramsbotham considered that the drug might operate fatally on a child, according to the circumstances under which it was administered ; but that, unless it excited the expulsive action of the womb, it had no effect on the child's system. (Op cit., p. 319; also cases by Paterson, Edin. Med. Surg. Jour., vol. liii. p. 142.) According to Millet, in commencing or imminent parturi- tion, ergot procures a safe and prompt termination ; and he never met with a case in which it injured the child. (Med.-Chir. Rev., 1855, ii. p. 41.) This is also the result of the experience of Uvedale West, contained in a paper read before the Obstetrical Society (July, 1861 \ Between December, 1855, and June, 1861, he had attended 734 labors, in 172 of which ergot was given. Including one case of twins, 173 children were born under the effects of ergot, of which number only five were stillborn. These facts appear to show that ergot, as a rule, does not exert those noxious effects on the child which have been attributed to it by some obstetric writers. ACTION OF ERGOT OF KYE. 545 On trials for criminal abortion, perpetrated or attempted, a medical wit- ness must be prepared for a close examination on the ecbolic properties of the ergot of rye on the womb, as well as its general action as a poison on the woman and child. A case which occurred some years since (Reg. v. Calder, Exeter Lent Ass., 1844) has Itecn reported, with comments on this vsubject, by Sliaptcr. (Trov. jNIcd. Jour., April 10, 184 4.) It was alleged on this occasion that savin, cantiiarides, and ergot had been respectively given by the i)risoner, a medical man, for the })urpose of procuring miscarriage. The woman on whose evidence the case rested was of notorioush^ bad character, and the prisoner was acquitted. There were three medical witnesses, who agreed that savin and cantharides were only likely to occa- sion abortion indirectly, i. e. by powerfully affecting the system — the view commonly entertained by professional men. Some difference of opinion existed with regard to ergot, but the balance of evidence was decidedly in favor of its specific action as a direct uterine excitant; and, according to Griffiths, this is so well known to the inhabitants of the United States that it is there in frequent use as a popular abortive. A case occurred at Brighton in 18(')4, in which a question arose respect- ing the fatal effect of this drug on a woman who had taken it for a long period, obviously with a view to procure abortion. She died, however, without abortion having taken place; and the question at issue was whether this drug had or had not caused her death. The dose taken was about a teaspoonful of the tincture of ergot three times a day for a period of eleven weeks. On inspection, patches of inflammation were found on the mucous membrane of the stomach. No other cause for death was apparent, and one medical witness assigned it to the poisonous irritant action of the ergot, as, at the early stage of pregnancy which she had reached (the third month), this substance would not be likely to act as an abortive. Another medical man who gave evidence at the inquest asserted that*death could never be primarily caused by ergot of rye. The qualifi- cation introduced into this medical opinion is of small importance. The deceased woman is reported to have taken a large portion of the tincture, and it is quite immaterial whether the drug killed her by a primary or secondary operation. Tardieu describes the case of a woman, tet. 24, who aborted in the fourth month of pregnancy as a result of the administra- tion of ergot in powder : she died from peritonitis in about twenty-four hours. Ergot was found in fragments in the lower third of the bowels. (Ann. d'Hyg., 1855, t. i. p. 404.) At the same time he states that, in his opinion, ergot of rye has no direct action as an abortive ; in fact, that it is not an ecbolic, (Ann. d'Hyg., 1865, t. 1, p. 139.) The numerous cases showing its efficacy, and its extensive use in midwifery practice, are sufficient to prove that this opinion is not borne out by facts. In respect to its operation, it may be observed that the effects produced by its admin- istration are not such as readily to excite suspicion. It neither causes the decided symptoms of irritation observed in the action of savin, nor the nervous symptoms which are usually produced by rue. In medicinal doses, given at proper intervals, the only marked effect which it produces on a pregnant woman is a lowering of the pulse. Sometimes other symp- toms of a severe character have presented themselves, (Ann. d'Hyg, 1856, t. 1, p. 140 ) If a person dies from the effects of this drug, the results are legally the same, whether its operation as a noxious substance is of a primary or secondary kind. It must be borne in mind that ergot is largely used in medical practice to check hemorrhage Action of Ei^got. Doses. Analysis. — In doses of from half a drachm to two drachms, ergot in powder has caused nausea, vomiting, dryness of the throat, great thir.st, aversion to food, pain in the abdomen, slight 35 546 ABORTION FROM LOCAL APPLICATIONS. purging, i)ain in the head, stupor, and dilatation of tlie pupils. (Pereira.) The medicinal dose of the i)o\vder in uterine diseases is from 5 to 15 grains. It is emploN'ed in a larger dose (from 20 to GO grains at intervals of half an hour) to excite uterine action either for abortion or parturition. The dose of the tincture is one drachm (a teaspoonful) ; this is equivalent to 15 grains of the powder. The dose of the ethereal tincture, when em- ployed for the purpose of exciting uterine action, is three or four doses of one drachm every half-hour. Ergot must be regarded as a noxious sub- stance, and by some authorities it is ranked among narcotico-irritant poi- sons. Under the Pharmacy Act, 1868, it is placed in the first part of the schedule of poisons, and can only be sold under certain restrictions, with the word " Poison " attached to it. It does not easily cause death in one large dose, but its fatal operation appears to be more strikingly developed by its long-continued use in small or medicinal doses. The form and characters of the ergot in mass are well known to pro- fessional men. It consists of Fig. 49. grains varying in length from half an inch to an inch and a quarter, and the breadth of about the eighth of an inch. The grain is cylindrical, blunt at the ends, and curved like the spur of a cock. The outer coat is of a dark purple color, almost black, irregularl}^ fluted on the surface, which is often cracked and fissured. In Fig. 40, 1, 1, rep- resent the ergot of rye as it is usually seen. The smaller of the two grains represents the average size ; 2, 2, are sections of the grains ; and 3 represents a transverse section magnified thirty diameters. The spongy character of the substance of the ergot is here more distinctly seen. The powder of ergot has a faint fishy odor of trimethylamine ; this is especially observed when it is rubbed with a solution of potash. This alkali dissolves the powder in part, and the solution acquires a dingy-red color. In the form of tincture, alcoholic or ethereal, the peculiar fishy odor of the extract when treated with potash is well marked. It may, however, be concealed l)y other odors. Sometimes small particles of ergot, presenting a pink-red color in the dark external coat, may be detected in the sediment by the microscope. When ergot has 1)een taken in powder, fragments of it may be found scattered over the lining membrane of the stomach or bowels ; these may be identified by the characters above de- scribed. The ethereal tincture of ergot, evaporated to an extract, yields a yellowish-colored oil, which, if any of the coloring-matter of ergot is present, acquires a reddish color when heated with a solution of potash. In examining the body of a person to whom ergot is alleged to have been given, the medical jurist must rely upon the ph3'sical properties of the fungus if he can obtain any of it. Local Applications. Injections. — In a case which occurred in France, it was proved that abortion had been caused by the injection of some corrosive and irritating substance into the vagina. The genital organs, as well as the aljdominal viscera, were found in a high state of inflamma- tion. (Lond. Med. Gaz., vol. xxxvii. p. 171.) This is a mode of perpe- trating the crime which can hardly escape detection. An analysis of the tissues might be required in order to determine the nature of the sub- The Ergot of Rye. SIGNS OF ABORTION IN THE LIVING AND DEAD. 547 stance used. It appears from a trial that this mode of attempting- to pr*^. cure criminal abortion has been the subject of a prosecution in this country. It was established by the medical evidence that some liquid was inje ted into the vagina by a syringe, but there was no proof of the nature ot this liquid; and as it was not sliown to be of a noxious nature, the judge who tried the case directed an acquittal. (York Sum. Ass., 1858; Lrincet, 1853, ii. p. 89.) It is proper to state, however, that the mere mei-nanical effect of an innocent liquid, frequently applied, may be more ellcftual in producing abortion or premature labor than the use of any irritating liquid. In medical practice tepid water has been en)ployed as an injection for the purpose of inducing premature labor in advanced pregnancy. Lazarewitch has published twelve cases in which the injection of water at 95 F. caused the womb to contract and expel its contents. (Trans. Obst. Soc, vol. ix. p. 161.) The earliest period at which Lazarewitch employed water was ' in the thirtieth week of pregnancy. In most of the cases the women had reached the thirty-sixth week of pregnancy. This is much later than the usual period at which abortion is commonly attempted for criminal purposes, namely, the eighth to the twentieth week. At the same time, it proves that an innocent injection may be used to produce abortion, and, according to the judicial decision above given, the use of such a liquid would not render a person criminally liable. The words of the statute, however, " other means whatsoever, " appear sufficiently comprehensive to include the use of a non-noxious liquid, and, according to a judicial opinion given in one case (Reg. v. Wallis, pp. 541, 551), it is not mate- rial to prove that the liquid employed is of a "noxious" nature. In general, when the criminal means taken to procure abortion are effectual in causing the expulsion of the child, it comes into the world dead ; but it may be born alive and die after its birth. Under these circumstances, although no violence is applied directly to the body of the child, but its death is simply the result of immaturity or the feeble state in which it was born, the person causing such abortion might render himself liable to an indictment for murder. Signs of Abortion in the Living and Dead. — These are practically the same as those elsewhere described as the signs of delivery. (See ante'^]). 523, 528.) The examination may extend to the woman, either living or dead. In the former case there will be some difficulty if the abortion has occurred at an early period of gestation and several days have elapsed before the examination is made ; in the latter case the inves- tigation is not always free from difficulty. Shortt, who has bad much exy^erience on this subject, thus summarizes the symptoms which he met with in numerous cases which came before him officially. In the Madras Presidency alone there were 306 cases in two years. In the cases which he examined up to a fortnight, or a little later, after the abortion, the vulva and passages were relaxed, the mouth of the womb patulous, and in the early stage there was a lochial secretion, replaced in later cases by a white mucous secretion, having the peculiar smell common to women in the puerperal state. Among other symptoms were a distention of the breasts, a flow of milk on pressure, and a knotty feeling in them. There was a general anaemic or bloodless condition of the body, with sunken eyes, an excited pulse, and dry skin. In multiparous women, the womb was more patulous, and the neck was not distinguishable ; but in primi- parous women the mouth of the womb, although patulous to a small extent, still had the neck protuberant. (Obst. Trans., vol. ix. p. 9.) It is believed by many physiologists that menstruation is a state in some measure vicarious to conception, and the appearances presented 548 FEIGNED ABORTION LEGAL RELATIONS. by the generative organs diiriiiiz: tlie menstrual period are somewhat similar to those which are observed after concej)li()n in its early stage. Whitehead remarks that in women who died while the menses were flowing, the uterine walls were thickened and spongy, and the mucous lining was more or less swollen and suffused. The neck and lips of the womb were swollen, the orifice was open, and the vaginal membrane and clitoris involved in the increased action. One of the ovaries was found larger and more congested than usual, presenting evidence of the recent escape of an ovum (p. 530, ante). Unless these facts are attended to, an examiner may form an erroneous opinion respecting the chastity of a deceased woman. (For the mode of conducting the examination of the woman, and of the embryo or foetus in cases of abortion, see Ann. d'llyg., 1856, t. 1, pp. 149, 153.) Important questions may arise Avhen it is alleged that abortion has been caused by the use of instruments, and death is referred to peri- tonitis as the result of their employment. In these cases a medical opinion should not be based upon the statements either of the woman or of her friends, but upon some distinct and satisfactory medical proofs that mechanical violence has been done to the womb, its contents, or its appendages. Peritonitis or inflammation of the lining membrane of the abdomen may arise from a variety of causes. If we assign it to a par- ticular cause, and thus implicate another in a felonious charge, we should do this only upon medical facts obtained by an exaiuination of the dead body ; we should deal with such cases as if we knew nothing of their previous history. A druggist was charged with using instruments to cause abortion which had led to the death of a woman from peritonitis. It appeared also that he had given to her doses of tincture of perchloride of iron. The woman was delivered of a dead foetus at about the fifth month, and she herself died shortly afterwards. There was nothing in the body of the woman or of the foetus to show that instruments had been used, but it was quite clear that peritonitis was the cause of death. One medical witness thought that an operation had been performed on her body, but it was admitted that peritonitis might arise from a variety of causes in a woman who had had a miscarriage. (Pharm. Jour., 1871, p. 256.) On the diagnosis of al)ortion and its causes, see a paper by Lex. (Viertel- jahrsschr. fiir Gerichtl. Med., 1866, 1, HO.) Feigned Abolition. — For various motives, into the consideration of which it is unnecessary to enter, a woman may charge another with having attempted or perpetrated the crime of abortion. Such a charge is not common, because if untrue its falsity may be easily demonstrated. A young woman in Guy's Hospital, in 1846, charged a policeman (who, according to her statement, had had forcible intercourse with her) with having given her some substance to produce abortion, and having subse- quently effected this mechanically. She was not examined until nearly two months after the alleged perpetration of the crime, when Lever found that there was no reason to believe that she had ever been pregnant. This Avas a case of feigned abortion. When charges of this serious kind are brought forward they are always open to the greatest suspicion unless made immediately after the alleged attempt, as it is then only that an examination can determine whether they are true or false. If so long delayed, as in this instance, without any satisfactory reason, the presump- tion is that they are false. Legal Relations. — In the statute for the consolidation of the criminal law" (24 and 25 Vict., c. 100, ss. 58 and 59), the nature of this crime and LEGAL RELATIONS. 549 the medical proofs required to establish it have been more explicitly stated than iu former Acts. By s. 58 (on attempts to procure abortion; it is enacted that " Every woman being with child, who, with iuient to procure her own miscarriage, shall unlawfully administer to herself any poison or other noxious thing, or shall unlawfully use any instrument o"r other means whatsoever with like intent, and whosoever, with intent to procure the miscarriage of any woman, whether she be or be not with child, shall unlawfully administer, etc., shall be guilty of felony." As in every case a woman must be accessory to this crime upon herself, it leads to the ditticulty that her evidence, uncorroborated by circumstances, may not be received by the court. [Abortion has been legally d'^fined thus : Any person who does any act calculated to prevent a child being born alive is guilty of abortion : Abrams v. Foshee, 3 Iowa, 218; Cotton v. Cotton, 5 Martin (La.), 95. At common law, if the act be done with the mother's consent before the child quickened, it was not a punishable offence, nor was it a felony at common law to take the life of the child at any period of gestation, even in the ver}" act of delivery: Hines, J., in Mitchell v. Com., 78 Ky. 204; s. c. 39 Amer. Rep. 22f ; Com. v. Bangs, 9 Mass. 387 ; Com. v. Parker, 9 Mete. (Mass.) 2G3 ; s. c. Am. Dec. 396; Smith v. State, 33 Me. 48; State i;. Cooper, 22 K J. L. 52 ; s. c. 51 Am. Dec. 248 ; State v. Slagle, 82 N. Car. (153; People v. Sessions, 26 N. W. Rep. (Mich.) 291; Ann V. State, 11 Humph. (Tenn.) 150; Abrams i;. State, 3 Iowa, 274; s. c. Am. Dec. 77 ; Halfield v. Gano, 15 Iowa. A contrarv view was taken in Pennsylvania by the Supreme Court of that State : "Vid. Mills v. Com., 13 Pa. St. 633 ; Com. v. Domain, 6 Pa. Law Jour. 29 ; s. c. Brightly, 441. If death ensues in consequence of the means used to secure an abortion, theij the offence is murder at common law ; but in some of the American States it is in such case declared to be manslaughter : 4 Blacks. Com. 201 ; 1 Bishop Crim. Law, 328 ; State v. Moore, 25 Iowa, 128 ; State v. Dickinson. 41 Wis. 299. The intention constitutes the crime, not the means employed. The drug used mav even be harmless : State v. Owens, 22 Minn. 238 ; Wilson v. State, 2 Ohio St. 219 ; State v. Fitzgerald, 49 Iowa, 260 ; s. c. 31 Am. Rep. 148. A woman is " quick with child" from the period of conception and the commencement of gestation, but is only " pregnant with a quick child" when the child has become quickened in the womb: Evans v. People, 49 N. Y. 86 ; R. v. Wycherly, 8 C. & P. 262. This is disputed in State V. Cooper, 2 Zab. (N. J ) 52. The testimony of the physician who attended the woman subsequent to the procuring of abortion is not admissible in New York, even when he was sent by the public prosecutor to make an examination of the woman: People v. Murphy, 101 N. Y. 126. The physician who makes the post-mortem may testify : People v. Sessions, 26 :N\ W. Rep. (Mich.) 291; Com. v. Browne, 14 Gray (Mass.), 419.] In two cases tried at the Lewes Sum. Ass., 1878 (Reg. v. Brown), the woman charged with this crime was acquitted under the direction of the judge, becau.se there was no corroboration of the evidence of the two women on whom the crime had been perpetrated. In one, the drugs pre- scribed by the prisoner produced no effect ; she went her full time, and was delivered. In the other case, the woman was so ill that she could not appear as a witness, and it was admitted by counsel that he could not corroborate the evidence of either. 550 CRIMINAL ABORTION — NOXIOUS SUBSTANCES. It will be observed that the means employed, whatever their nature, must have been used with an intent to procure the miscarriage of a won)an a point which will be sulficientl}^ established by a plain medical state- ment of the means employed. Supposing that a drug has been used, the witness may be further required to state whether it is " a poison or other noxious thinf." We must refer the reader to what has been said else- where {ante, p. 75), in order that he may be able to judge how far the sul)stance administered would fall under the description above given. Whether the substance would or would not have the effect intended, i. e. of inducing abortion, is immaterial. Noxious Substances. — Is it necessary to prove that the substance pro- cured or administered is of a noxious nature ? Some uncertainty may exist as to the strict meaning of the word " noxious." All will allow that the word implies something injurious to the body, but a difference of opinion may arise among medical witnesses with respect to its application to the substance under discussion — as, for example, with respect to rue or savin. A substance must be regarded as injurious to the body, or noxious, either according to the form, quantity, or frequency with which it is ad- ministered. Savin, ergot, and rue are irritant ; and they become noxious when given in large doses, or in small doses frequently repeated. Aloes and castor-oil are innocent when taken in small doses ; but they acquire noxious or injurious properties when administered frequently, or in large quantity, to a pregnant woman. To confine the term " noxious," there- fore, to what is strictly speaking a poison per se, would be giving a latitude to attempts at criminal abortion which would render the law inoperative. (Reg. v. Stroud, Abingdon Sum. Ass., 1846.) The small quantity of the sulDStance taken at once does not affect the question, pro- vided the dose be frequently repeated. A case in which the author was consulted by Reynolds was tried at the Exeter Wint. Ass., 1844. Two powders, weighing each one drachm, were prescribed by a prisoner; one consisted of colocynth, the other of gamboge, and with them was half an ounce of a liquid (balsam of copaiba). They were to be mixed together, and a fourth part to be taken four mornings following. Reynolds said, in answer to the question whether such a mixture was noxious or in- jurious, that each dose would be an active purgative, and might thereby tend to excite abortion. One dose would not be productive of mischief in a healthy countrywoman, but its frequent repetition might lead to serious consequences in a pregiumt woman. In another trial (Reg. v. Whisker, Norwich Lent As.s., 1846), it was proved that the prisoner had caused to be taken by a woman a quantity of white helleboi'e in powder, for the purpose ofprocuring abortion. One medical witness said he considered hellebore to be noxious to the system, but he knew of no case in which it had produced death ; and, under these circumstances, he did not consider himself justified in calling it a poison. Another medical witness stated, in his opinion, it belonged to the class of poisons. The judge, in summing up, told the jury that that was to be regarded as a poisonous drug which, in common parlance, was generally understood and taken to be such ; and he thought the medical evidence sufficiently strong to bring hellebore within the meaning of the statute. The jury found the prisoner guilty, alleging that in their belief white hellebore was a poison. (Lond. Med. Gaz., vol. xxxvii. p. 830.) The only circumstance calling for remark in this case is that any doubt should have been entertained by a medical practitioner respecting the poisonous properties of white hellebore. It is a powerful vegetable irritant and has caused death in several instances. Medical proof of the nature of the substance administered, and that it CRIMINAL ABORTION — NOXIOUS SUBSTANCES. 551 was noxious, was formerly rcMiuired on these occasions. In Re^-, v. Taylor (Exeter Wint. Ass., 1859), some powders had l)een given by the prisoner to a girl with a view of inducing abortion. No portion of the powders could be obtained for examination ; but two medical men who heard the evidence deposed that in their opinion the powders were of a noxious nature. In the defence, it was urged that this had not been proved by a rhemical analysis. The jury adopted this view, and returned a verdict of acquittal. In Reg. v. Wallis (Winchester Aut. Ass., 1871 ; see p. 555, ante), Brett, J., in addressing the grand jury, called their attention to the words of the statute, v/hich declares that where any person shall unlaw* fully administer a poison or some other noxious thing, or shall unlawfully use any instrument or other means whatsoever, with intent to procure miscarriage, he shall be guilty of felony, and said that, liaving regard to the words " other means whatsoever," though there might be some doubt as to the construction of the statute, he should direct that in one count of the indictment the word "noxious" should be omitted, and he should hold that, if the person accused did administer some drug or something which he thought would procure miscarriage with that intent, although the thing itself would not procure that miscarriage, he would nevertheless be guilty of the offence, and they ought to find a true bill. According to this judicial dictum, it would appear that it is not in all cases necessary to prove by medical evidence that the substance procured or administered was of a noxious nature. The words of s. 59, as to procuring a noxious thing, or any instrument or " thing Avhatsoever," strictly interpreted, would include all substances, noxious and innoxious. If this view be generallv adopted, medical evidence will be much simplified. Counsel will not be under the necessity of cross-examining medical witnesses on the strict meaning of the word " noxious." In Reg. v. Wallis, the sub- stances procured by the accused were not noxious, but the jury acquitted the prisoner apparently on the ground that he did not actually administer the drugs ; hence the question of noxiousness did not formally arise. From the ruling in this case, it would appear that if a person procured or administered castor-oil or camphor-julep, with intent to procure mis- carriage, and with a belief that the substance would produce it, he would be found guilty of the offence. This being so, the use of the words "poison" and "noxious thing" in the statute is surplusage, and tends only to cause confusion in the medical evidence. In Reg. V. Newton (Lewes Sum. Ass., 1873), it was proved that the prisoner had given to a girl who was pregnant by him some pills and a powder, which made her very sick. A witness was called, who described himself as a laboring man, and stated that the prisoner obtained the medicine from him, that he had taken some of the pills himself, that they were antibilious pills, and that the powder was rhubarb. Under these circumstances, counsel for the defence submitted that there was no evi- dence that the medicine administered was " a noxious thing" within the meaning of the statute which created the oifence, citing the case of Reg. v. Isaacs, 32 Law Jour., M.C. Martin, B., however, overruled the olyection, and the prisoner was found guilty. A much stricter meaning is attached to the word "noxious" by judges when the substance has been given for procuring abortion, than where the intention has been to aggrieve or annoy, under the statute on poisoning. (See Reg. v. Hennah, Cornwall Lent Ass., 1877.) In this case, cantharides Avere held not to be noxious unless administered in a quantity to produce certain effects on the body. In reference to the medical proofs of this crime, it is not required that any specific injury should have been done to the woman, or that abortion should have followed, in order to complete the offence. It is not even 552 MEDICAL PROOFS REQUIRED. necessary to prove that she was with child, or tlmt the aborted substance was a foetus or child. It inij^ht be a mass of blood, a mole, or a group of hydatids. The crime is frecpient, but its perpetration is secret. Api)lica- tions are frequently made to medical men and druggists by the lower class of people for drugs for this purpose ; the applicants ajjpear to have no idea of the criminality of the act. Under the name of " female pills" or "drops," medicines are thus dispensed in secrecy, and those who supply, as well as those who receive them, appear to have no idea that they are exposing themselves to a criminal prosecution. In one case a bottle con- taining a liquid supposed to have been used for the purpose of abortion was sent to the author for examination. It was labelled " Persian Otto of Roses." It contained a strong ethereal tincture of ergot of rye. On one trial for criminal abortion, the medical evidence went far beyond its customary boundary. It appeared that the prisoners had applied to a medical man to supply them with drugs for procuring abortion. The medical man, mistaking his duty under such circumstances, gave informa- tion to the police, and, acting under their advice, supplied some drug which could do no injury. The prisoners were thus led to the commission of a felony, and at the trial the medical man appeared in the capacity of informer as well as expert — a circumstance which led to some severe ob- servations from the judge. When such an application is made to a pro- fessional man, there is no objection to the fact being made known to the police or magisterial authorities, but beyond this he should not go. He should refuse to supply the applicants with drugs or lend himself in any way as a detective for the purpose of a prosecution. The act was no doubt done with a good intention to protect the public, but under a mis- taken sense of duty. On inducing Prematin^e Labor. Medical Responsibility. — It may be proper to offer here a few remarks upon the common practice of inducing premature labor, as, e.g. in certain cases of disease, of deformity of the pelvis, and in cases of excessive vomiting from pregnancy. This practice has been condemned as immoral and illegal ; but it is impossible to admit that there can be any immorality in performing an operation .to give a chance of saving the life of a woman, when, by neglecting to perform it, it is almost certain that both herself and the child will perish. (See, on the morality, safety, and utility of the practice, Ramsbotham's Obst. Med., p. 328, 5th ed.) Any question respecting its illegality cannot be enter- tained ; for the means ai-e administered or applied with the bona fide hope of benefiting the female, and not with any criminal design. It is true that the law makes no exception in favor of medical men who adopt this practice, nor does it in the Stutute on Wounding make any exceptions in favor of surgical operations ; but that which is performed bona fide would not be held to be unlawful. The necessity for the practice ought to be apparent: thus, for instance, it should bo shown that delivery was not likely to take place naturally without seriously endangering the life of a woman. It is questionable whether, under any circumstances, it would be justifiable to bring on premature expulsion merely for the purpose of attemj)ting to save the life of a child, since the operation, even when performed with care, is accompanied with risk to the life of the mother. Hence a cautious selection of cases should be made, as the operation is necessarily attended with some risk to both. All that we can say is that, according to the general professional experience, it should place the woman in a better position than she would be if the case were left to itself. Be- fore a practitioner resolves upon performing an operation of this kind, he should hold a consultation with others; and, before it is performed he CHEMICAL EVIDENCE. 55:^ should feel assured that natural deliver}^ cannot take place without greater risk to the life of the woman than the operation would itself create. These rules may not be observed by obstetric experts in large practice ; but the non-observance of them is necessarily attended with some respon- sibility to a general practitioner. In the event of the death of a woman or child, he exposes himself to a prosecution for a criminal offence, from the imputation of which even an acquittal will not always clear him in the e\'es of the public. If the child were born alive and died merely as a result of its immaturity, this might give rise to a charge of manslaughter. Several practitioners have been tried upon charges of criminal abortion — -whether justly or unjustly it is not necessary to consider; but they had obviously neglected to adopt those simple measures of prudence, the observance of which would have been at once an answer to a criminal charge. Because one obstetric practitioner of large experience may have frequently and successfully induced premature labor without observing these rules, and without any imputation on his character, this cannot shield another who may be less fortunately situated. Cheniical Evidence. Blood in Abortion. Liquor Amnii. — In the event of an abortion having taken place, stains produced by blood or by the waters (liquor amnii) may be found on the linen of a woman, and a practitioner may be required to say whether these stains are of a nature to throw any light upon the perpetration of the crime. A woman who has aborted may allege that the stains are those of the menstrual discharge. Speaking generally, there is no practical distinction between menstrual and other blood (see ante, p. 305). The menstrual blood contains less fibrin, is commonly acid and watery from admixture with the mucous discharges, and when examined by the microscope it presents epithelial scales or cells derived from the mucous membrane. These scales or cells are columnar. (See Rape, j^ost.) Not much reliance can be placed upon tGeir discovery, since the mucous membrane of the organs of respiration is lined with similar cells. Hence expectorated blood might be mistaken for menstrual. Cells of a similar shape line the whole of the mucous mem- brane from the stomach to the anus. The blood of piles might thus be confounded with menstrual blood. The blood discharged in abortion will present the usual characters of blood, elsewhere described (ante, p. 281, et. esq.) ; but it may be diluted with the waters simultaneously discharged. This question received the special attention of the French Academy in reference to the crime of abortion ; and the report made was to the effect that, in the present state of science, there was no certain method by which the blood of menstruation could be practically distinguished from the blood discharged from a woman in a case of abortion or from blood in infanticide. (Ann. d'Hyg., 1846, t. 1, 181.) In another recent case, Devergie and Chevallier were required to state whether certain stains on the dress of a woman supposed to have aborted were or were not caused by the waters (liquor amnii). A chemical analysis merel^y revealed the presence of an albuminous liquid. The most elaborate experiments satis- fied the reporters that neither by the odor nor by any other process could the liquor amnii, dried on linen, be identified. (Ann. d'Hyg., 1852, t. 2, 414.) It may, however, be of importance to observe that this liquid slightly discolors and stiffens the fibre of the stuff on which it has been effused, and that it can be readily extracted by cold water. The solution contains albumen. The amount of albumen contained in the liquor amnii decreases as gestation advances. Chevallier's experiments show that the amniotic liquid has all the usual chemical properties of a very dilute solution of albumen, containing also urea. (Ann. d'Hyg., 1856, t. 1, 156.) 554 INFANTICIDE NATURE OF THE CRIME. INFANTICIDE. CHAPTER XLVII. NATURE OF THE CRIME. MEDICAL EVIDENCE AT INQUESTS. UTERINE AGE OR MATURITY OP THE CHILD. CHARACTERS OF THE CHILD FROM THE SIXTH TO THE NINTH MONTH.^ SIGNS OF MATURITY. RULES FOR INSPECTING THE BODY. By iufanticide we are to understand, in medical jurisprudence, the murder of a newborn child. The English law, however, does not regard child-murder as a specific crime ; it is treated like any other case of murder, and is tried by those rules of evidence which are admitted in cases of felonious homicide. In stating that " infanticide" is the term applied to the murder of a newborn child, it is not thereby implied that the wilful killing should take place within any particular period after birth. Pro- vided it be proved that the child has actually died from violence, it matters not whether it has been destroyed within a few minutes or not until several days after its birth. According to a return of the Registrar- General, it appears that out of 202 murders, 120 were perpetrated on children under one month. In the greater number of cases of infanticide, however, we find that the murder is commonly perpetrated either at the time of birth or within a few hours afterwards. Although the law of England treats a case of infanticide as one of ordinary murder, yet there is a difference in the nature of the medical evidence required to establish the murder of a newborn child. It is well known that many children come into the world dead, and that others die from various causes soon after birth ; and in the latter, the signs of their having lived are frequently indistinct. Hence, to provide against the danger of erroneous convictions, the law humanely assumes that every newborn child has been born dead, until the contrary appears from the medical or other evidence. The onus of proof that a living child has been destroyed is thereby thrown on the prosecution ; and no evidence imputing murder can be received unless it be first made certain, by medical or other facts, that the child survived its birth, and was legally a living child when the alleged violence was offered to it. Hence there is a most difficult duty cast upon a medical witness on these occasions. In the greater number of cases the woman is delivered in secrecy, and no one is present to give evidence respecting the birth of the child. It is under these circumstances that medical evidence is espe- cially required. For reasons elsewhere assigned, a medical man should be cautious in putting questions to a woman charged with this crime. Uterine Age or Maturity of the Child. Viability. — One of the first questions which a witness has to consider in a case of alleged child-murder is that which relates to the age or probable degree of maturity which the deceased child may have attained in vtero. The reason for making this inquiry is that the chances of natural death in all newborn children are great in proportion to their immaturity ; and that, supposing them to INFANTICIDE — UTERINE AGE. 555 have survived birth, the signs of their having breathed are commonly ob- scure It is found that the greater number of children who are the sub- jects of these investigations have reached the eighth or ninth month of gestation ; yet charges of murder might be extended to the wilful destruc- tion of children at the seventh month or under, provided the evidence of life after birth was clear and satisfactor3% The following are the characters whereby Ave may judge of the uterine age of a child from the sixth to the ninth month of gestation, a period which may be considered to comprise cases of abortion as well as child- murder : — 1. Between the sixth and seventh months. — The child measures, from the vertex to the sole of the foot, from ten to twelve inches, and weighs from one to three pounds. The head is large in proportion to the trunk ; the eyelids are adherent, and the pupils are closed by membranes (mem- branie pupillares). The skin is of a reddish color, and the nails are slightly formed ; the hair loses the silvery lustre which it previously possessed, and becomes darker. Ossification proceeds rapidly in the chest-bone and in the bones of the foot; the brain continues smooth on its surface; there is no appearance of convolutions. In the male the testicles will be found in the abdominal cavity, lying upon the psoas muscles, immediately below the kidneys. In March, 1885, a primiparous married woman was delivered in Guy's hospital, after severe puerperal convulsions. The foetus (male) was dead, but the foetal heart had been heard by Horrocks a week before. The foetus was fifteen inches and a half long, and weighed two pounds only. There were points of ossification in the upper portion of the ster- num ; none in the astragalus, or in the lower sacral vertebrae. Hence the uterine age of the child was judged to be six months. Nevertheless, both testicles were found in the scrotum. • 2. Between the seventh and eighth months. — The child measures be- tween thirteen and fourteen inches in length, and weighs from three to four pounds. The skin is thick, of a more decidedly fibrous structure, and covered with a white unctuous matter which now appears for the first time. Fat is deposited in the cellular tissue, whereby the body becomes round and plump ; the skin previously to this is of a reddish color, and commonly more or less shrivelled ; the nails which are somewhat firm, do not quite reach to the extremities of the fingers ; the hair is long, thick, and colored ; ossification advances throughout the skeleton ; valvulas con- niventes appear in the small intestines, and meconium is found occupying the caecum and colon. The testicles in the male about this period com- mence their descent towards the scrotum. The time at which these organs change their situation is probably subject to variation. According to Hunter, the testicles are situated in the abdomen at the seventh, and in the scrotum at the ninth month. Burns believes that at the eighth month they will commonly be found in the inguinal canals. The observation of the position of these organs in a newborn male child is of considerable im- poi'tance in relation to maturity, and it may have an influence on ques- tions of legitimacy as well as of child-murder. Curling thus describes their change of position : At different periods l)etween the fifth and six months of foetal existence, or sometimes even later, the testicle begins to move from its situation near the kidney towards the abdominal ring, which it usually reaches about the seventh month. During the eighth month it generally traverses the inguinal canal, and by the end of the ninth arrives at the bottom of the scrotum, in which situation it is commonly found at birth. (Dis. of the Testis, 2d edit., p. 17.) Their absence from the 556 SIGNS OF MATURITY IN TUE GUILD. scrotum does not necessarily indicate that the child is immature, because these organs sometimes do not reach the scrotum until alter birth. 3. Between the eighth and ninth months. — The child is from lifteen to sixteen inchas in length, and weighs from four to five pounds. The eye- lids are no longer adherent, and the membranfe pupillares have disap- peared. The quantity of fat deposited beneath the skin is increased, and the hair and nails areVell developed. The surface of the brain is grooved or fissured, but presents no regular convolutions : and the gray matter is not yet apparent. The meconium fills almost entirely the large intestines ; and the gall-bladder contains some traces of a licpiid resembling bile. The testicles in the male may be found occupying some part of the inguinal canal, or they may be in the scrotum, the left testicle is sometimes in the scrotum, \vhile the right is situated about the external ring. 4. Ninth Month. Signs of Ilaturiti/. — At the ninth month the average length of the body is about eighteen to twenty inches, and its weight from six to seven pounds ; the male child is generally rather longer, and weighs rather more than the female. Extraordinary deviations in length and weight are occasionally met with. Owens has recorded a case in which a child at delivery measured twenty-four inches in length, and weighed seventeen pounds twelve ounces (Lancet, Dec. 1838), and Meadows has veported another in which a child measured, after death, thirty-two inches, and weighed eighteen pounds two ounces. It survived four hours. (Med. Times and Gaz., 1860, ii. p. 105.) In one case which the author ex- amined, the child, a male, measured twenty-two inches, and weighed twelve pounds and a half. Davies had a case in which a child was born alive, weighing nineteen pounds two ounces, probably the heaviest new- born' child on record. (Med. Times and Gaz., 1860, ii. p. 249.) (For some practical remarks on this subject, by Ellsasser, see Henke's Zeits- chrift, 1841, Bd. 2, p. 235.) According to Duncan, the length and weight of a child vary according to the age of the mother. They are greatest among children when the mother is from 25 to 29 years of age ; but the facts collected do not support this statement ; for the child of a woman at 22 weighed seven pounds three ounces, and that of a woman of 3D, seven pound ° seven ounces. The length varied in a less degree, being for the different ages at or about nineteen inches. (Edin. Month. Jour., 18G4, ii. p. 500.) At the full period, the head of a child is large, and forms nearly one- fourth of the whole length of the body. The cellular tissue is filled with fat, so as to give considerable plumpness to the whole form, while the limbs are firm, hard, and rounded ; the skin is pale ; the hair is thick, long, and somewhat abundant ; the nails are fully developed, and reach to the'end of the fingers — an appearance, however, which may be sometimes simulated in a premature child by the shrinking of the skin after death. The testicles in the male are generally within the scrotum. Ossification will be found to have advanced considerably throughout the skeleton. The surface of the brain presents convolutions, and the gray matter begins to show itself. The internal organs, principally those of the chest, undergo marked changes if the act of respiration has been performed by the child before, during, or after its birth. The external auricle now measures an inch and a quarter to an inch and a half in length, seven-eighths of an inch to one inch in width, and varies little in children of very varied sizes. Medical jurists place great stress on the presence of a point of ossification in the lower epiphysis of the thigh-bone (femur) in its bearings upon the maturity of the foetus. This point usuallv first makes its appearance at the 36-3Tth week; at the 8T-38th week it is commonly the size of the INFANTICIDE SUMMARY. 557 head of a house-fly ; and at the full period it is of one-fourth to one-third of an inch in diameter. When this point of ossification is one-third of an inch in diameter it may be confidently affirmed that the foetus has reached the full period ; but where the point is only one-fourth of an inch in diam- eter it cannot be positively asserted that the child is mature, though it is probable that such is the case. The characters which have been here described as belonging to a child at the different stages of gestation must be regarded as representing an average statement. They are open to numerous exceptions ; for some children at the ninth mouth are but little more developed than others at the seventh. Twins are generally smaller and less developed than single children ; the average weight of a twin child is not more than five pounds, and very often below this. The safest rule to follow in endeavoring to determine the uterine age of a child is to rely upon a majority of the characters which it presents. That child only can be regarded as mature 'v>'hich presents the greater number of the characters described as met with in children at or about the ninth month of gestation, Trotsch has pointed out that the size of the external ear furnishes a good test of the age of the child, and the editor has confirmed his observa- tions. Trotsch measured both the length and breadth of the external auricle, but it usually suffices to take the greatest length only. The fol- lowing are the usual extreme lengths of the external ear in the foetus: — 5 months 6 " 7 " 8 " 9 " After birth 31 to 0.47 inch. 0.55 to 0.67 " 0.63 to 0.96 " 1.02 " 1.02 to 1.10 " 1.30 to 1.42 " It is convenient to remember that the length of the child in inches is, during the later stages of pregnancy, double the intra-uterine age in months. If the age of the child has been determined, whether it be under or over the seventh month, the rules for a further investigation will be the same. Should the child be under the seventh month, the medical presumption will be that it was born dead ; but if it has arrived at the full period, then the presumption is that it was born alive. Conclusions The following may be taken as the editor's summary of the principal facts upon which our opinion respecting the uterine age of a child may be based : — 1. At six months. — Length, from eight to twelve inches ; w^eight, one to two pounds ; eyelids agglutinated ; pupils closed by membranae pupil- lares ; testicles not apparent externally in the male ; ossification in pubes and OS calcis. 2. At seven months. — Length, from twelve to fifteen inches; weight, two to four pounds ; eyelids not adherent ; membranse pupillares disap- pearing ; nails imperfectly developed ; testicles not apparent externally in the male ; ossification in four divisions of sternum. 3. At eight months. — Length, from fourteen to eighteen inches ; weight, from four to five pounds ; memljrana! pupillares absent ; nails perfectly developed, and reaching to the ends of the fingers ; testicles in the inguinal canals; ossification in last sacral vertebra. 4. At nine months. — Length, from sixteen to twenty inches ; weight, from five to nine pounds; membranas pupillares absent ; head well covered with fine hair ; testicles in the scrotum ; skin pale ; the finger-nails well 558 INSPECTION OF THE BODY. formed and reaching to the ends of the fingers; the features perfect — these and tlie body are well developed even when the length and weight of the child are less than those above assigned. The external auricle measures an inch to an inch and an eighth or more in length, and seven- eighths of an inch to an inch in breadth. Inspection of the Body. — The questions which a medical jurist has to solve, in examining the body of a newborn child, are : I. To determine its age, or the stage of uterine life which it has reached, 2. Whether it has lived to breathe. 3. Whether it has been born alive. 4. The period of time which has elapsed since its death. 5. The cause of death, whether violent or natural. Hence, before commencing the inspection, note — 1. The length (measured from the summit of the head to the sole of the foot) and weight of the body. 2. The presence or absence of external foetal peculiarities. 3. Any peculiar marks or indications of deformity whereby identity may be sometimes established. 4. All marks of violence, in the shape of wounds, bruises, or lacerations, and the kind of instru- ment or weapon by which they were probably produced. 5. Whether the navel-string has been cut and tied, or lacerated ; the appearance of the divided vessels, and the length of that portion which is still attached to the body of the child. 6. The presence or absence of vernix caseosa about the groins, armpits, or neck — the presence of this substance proving that a child has not been washed or attended to. Y. It will be necessary to state whether there are about the body any marks of putrefaction, indi- cated by a separation of the cuticle, change of color in the skin, or offen- sive odor. It is obvious that, unless the circumstances are noticed before the inspection is commenced, they may be entirely lost as evidence. A medical man cannot be too careful in noticing upon the body of the child any special characters which may serve as proofs of identity. He must remember that the defence may be that the child is not that of the woman charged with murder. This observation applies especially to the examination of the bodies of children that may have survived their birth for some days. The body may be found wrapped in paper or in some article of clothing which may help to establish identity. If the child has survived its birth it would be well to form an opinion as to how many days it has lived. The state of the navel-string, or, if separated, whether the part of the abdomen to which it was attached is in the process of heal- ing or already healed, — are facts which may help a medical opinion re- specting the date of birth. In addition to these points, the sex of the child and the color of the hair should be noted, as well as any particular marks on the skin, naevi (mother's marks) or moles, and, of course, all wounds or other injuries — their probable cause or mode of production, and their situation. PROOFS OF LIFE BEFORE RESPIRATION. 559 CHAPTER XLVIII. EVIDENCE OF LIFE BEFORE RESPIRATION. — PHTREFACTION IN UTERO. ^EVIDENCE OF LIFE AFTER RESPIRATION. COLOR, VOLUME, CONSISTENCY. PRESENCE OF DEVELOPED AIR- CELLS, AND ABSOLUTE WEIGHT OP THE LUNGS. STATIC TEST.— WEIGHT INCREASED BY RESPIRATION. The question whether a child was or was not horn alive is of great im- portance in a case of alleged child-murder ; and it is unfortunately one which, in respect to the proofs upon which medical evidence is commonly- founded, has given rise to considerable controversy. When it is stated that in most cases of alleged infanticide which end in acquittals in spite of the strongest moral presumptions of guilt, the proof fails on this point only, it must be obvious that this question especially claims the attention of a medical jurist. The medical evidence of a child having been alive, when violence was ofiered to it at its birth or afterwards, may be divided into two parts : first, that which is obtainable before the act of respir- ation is performed ; and second, that which is obtainable afterwards. At present we shall confine our attention to the question whether the child was legally living when it was maltreated, — the fact of its having been horn alive will be a matter for future consideration. These two questions have been frequently but improperly associated, thus rendering the subject con- fused ; but it must be so obvious as scarcely to require stating, that violence of a murderous kind may be oft'ered to a living child before it is entirely born ; and that owing to this violence it may come into the world Head. Proofs of Life before Itespiration. — It was formerly supposed, if the lungs contained no air, that the child could not have breathed, and must have been born dead ; but this is now known to be an error. Children are able to breathe feebly and continue in existence many hours without visibly distending the cells of the lungs with air ; the absence of air from the lungs, therefore, furnishes no proof either that respiratien has not been performed, or that the child has not lived after birth. The restoration of many children apparently born dead is in itself a clear proof that many are born living who might be pronounced dead, simply because "breath- ing" and "life" have been erroneously considered as synonymous terms. That our law authorities will admit evidence of life in a child before the establishment of respiration is clear from the decision in Rex v. Brain, in which the judge said that a child might be born alive, and not breathe for some time after its birth (Archbold, Crim. Plead., 367) ; as also from the charge of Coltman, J., in the case of Rex v. Sellis (Norfolk Spr. Circ, 1837). In this instance it was alleged that the prisoner had murdered her child by cutting off its head. The judge directed the jury, that if the child vvas alive at the time of the act it was not necessary, in order to constitute murder, that it should have breathed. In fact, it would appear that respiration is regarded as only one proof of life ; and the law will, therefore, receive any other kind of evidence which may satisfactorilv show that a child has lived, and make up for the proof commonly derived from the state of the lungs. In these cases it will be first necessary for a medical practitioner to prove that the child under examination has recently died, or, in othei- 560 EVIDENCE FROxM MARKS OF VIOLENCE ON THE BODY. words, that there are good grounds for believing it to have been recently living. Hence, if the body is highly putretied, either from the child having died in the womb some time before birth or from its having been born and its body not discovered until putrefaction had far advanced both internally and externall}^ the case is beyond the reach of evidence. A medical witness will in general be compelled to al)andon the investigation because the body can furnish no evidence whatever of life after birth. The examination of the thoracic organs would throw no light on the case, for here we are assuming that the lungs are in an unexpanded condition. Evidence from 3[arks of Violence on the Body. — It has been proposed to seek for evidence of life under these circumstances by observing the characters presented by marks of violence on the body. In general when children are murdered the amount of violence inflicted is considerably greater than that which is required to destroy them, whereby satisfac- tory proofs of the crime are occasionally obtained. On the other hand, the body of a stillborn child, dead from natural causes, is often covered with lividities and ecchymoses ; and as the blood of the foetus or child does not coagulate with the same firmness as that of the adult, the evi- dence derivable from the extent, situation, and characters of marks of violence is often of too vague and uncertain a kind to allow of the ex- pression of a medical opinion that the child was living when the violence was offered to it. The characters which have been already described as peculiar to wounds and contusions inflicted during life (pp. 249, 252) may be met with in the body, whether the child has breathed or died without breathing. So, again, these characters are open to the exceptions there pointed out ; for they will be equally present, supposing the wounds to have been inflicted immediately after the cessation of respiration or cir- culation in the child or after the cessation of circulation only — if the act of respiration has not been performed. But marks of violence on the body of a child that had died in utero twenty-four or forty-eight hours before it was born would not present the characters of injuries inflicted on a living child. There would be no ecchymosis and no effused coagula of blood. These marks when they exist, although they may establish that a child was either living or but recently dead at the time they were inflicted, cannot show that it was horn alive. Injuries met with on the bodies of children alleged to have been born dead ought, however, to be of such a nature as to be readily explicable on the supposition of their having arisen from accident. If from their nature, extent, or situation they are such as to evince a wilful or intentional design to injure, it is a fair ground for a jury, not for a medical witness, to inquire why these extensive wounds or other marks of violence were inflicted on a child if, as it is alleged, it was really born dead. It must be confessed that in such a case there would be a strong moral presumption of murder, although medical proof of life or of actual live birth might totally fail. As a summary of these remarks it may be observed that although physiologically a child may live for a certain period after its birth with- out breathing — and legally its destruction dtiring this period would amount to murder — yet there are at present no satisfactory medical data to enable a witness to express a positive opinion on this point in the majority of cases. If other evidence were adduced of a child having lived and been destroyed under these circumstances — as where, for example, a woman causes herself to be delivered in a bath of water, or an accomplice covers the mouth of an infant in the act of birth or immediately after it is born — a medical witness would be justified in asserting that the absence of the signs of respiration in the lungs was no proof that the child had been PROOFS OF LIFE LEFORE KESPIRATION. 561 born dead. Indeed it is apparent that breathing could not be established owhig- to the criminal means actually employed to prevent it. The absence of air from the luni>-s may, therefore, really be the result of the forcible prevention of respiration during the act of birth. There cannot be any doubt that living children are occasionally thus destroyed: they die, not from the actual infliction of violence, but because either through design or accident the performance of that act which is necessary to main- tain existence when the child is born is ])revented. Whether a jury would convict under these circumstances is doubtful ; but this is of no impor- tance to the witness, for his statements ought always to be made accord- ing to correct and well-ascertained medical principles and not for the purpose of procuring either the conviction or acquittal of persons accused of crime. In general those cases in which questions relative to life before respiration might arise, are stopped in the coroner's court, the usual practice being when the signs of respiration are absent or imperfect to pronounce that the child was born dead. If the lungs sank in water the presence of marks of violence on the body would be considered as fur- nishing no evidence; for the sinking of the lungs would in general be taken as a proof that the child was born dead and that there could have been no murder. This subject has been fullv considered by Caused (Des Preuves de la Tie en Matiere d'Infanticide : Ann. d'Hyg., 1878, t. 2, p. 471.) After denouncing it as a great error to assert and act upon the principle that life and respiration are synonymous ( Vivre, c^ed respirer), he quotes many instances in which children have been born living and survive birtli for some time without breathing. It is during this period that an act of murder may be per})etrated, and satisfactory proofs of the crime may be frequently obtained by an examination of the body, irrespective of the condition of the lungs. In such children the heart continues to pulsate, and the circulation is carried on by the foramen ovale and the dtictus arteriosus, as in the fffital state. The proof of this is seen in the fact that these children may be roused and made to breathe many minutes and even a quarter of an hour after birth. Causse contends* that if any ecchymosis is found on the skin of a newborn child this is a proof that the blood was at the time circulating in the body of the child and that it had been extravasated, as it would be from violence applied to the living body. Such extravasations indicate the movement of blood towards the parts affected, and thereby furnish a proof of the existence of life at the time when the violence was inflicted. This proof would be strengthened in cases in which the blood was found coagulated and the cellular mem- brane or fractured bones largely infiltrated. These are the essential characters of injuries inflicted on a' living body, and they carry with them proofs of life from circulation as strongly as the presence of air in the lungs indicates life from respiration. The same remarks may be made respecting burns, attended with blisters containing serum or a line of redness (see p. 392). Assuming the child to have been born dead, these acts of violence could not have ])rodnced similar appearances on the body, Causse is supported by Devergie in considering respiration as only one sign of life, and that it may be absent in a child living for a quarter of an hour or longer after birth. The fatal circulation of the blood is equally a sign of life after birth, indicated by the marks of contusions, ecchynioses, and coagulation of the blood. In a case which occurred to Devergie, there were severe contusions with ecchymosis about the head of the child ; the temporal muscles were dee])ly ecchymosed, and blood was infiltrated in the muscular fibres. The lungs, entire and divided, sank in water. They 36 562 PROOFS OF LIFE AFTER RESPIRATION. contained no air, and there was no evidence of breathing. The conclusions drawn l)y him were that this child had lived and been destroyed I)}'- vio- lence to the head. The injuries were the result of violence applied during' life, and could not have been produced on the body of the child while in the womb. (Ann. d'llyg., 183Y, t. 1, p. 407.) In order to justify any inference respecting the life of a newborn child under these circumstances, the wounds or injuries should have those well-marked characters which have been elsewhere assigned to wounds on the living body (p. 249), and they should be of such a nature that they could not have been produced on the child by any accident when in the womb. There is a class of cases in which a child is born alive, but its lungs remain in the foetal condition, i. e. they present no appearance of having received air by the act of breathing. These are cases of atelectasis (p. 567). The appearances in the body are the same as in stillborn children. Don- ders, who met with one of these cases in which he, in ignorance of the facts, pronounced a child to be stillborn when it was distinctly proved that it had lived twelve hours, says : " Where the sign of an extra-uterine life, which does not betray itself by air in the lungs, are to be found, futurity must declare." Proofs of Life after Respiration. — There is no doubt that the proof of the act of respiration furnishes the best and strongest evidence of a child having lived at or about the time it was born. It does not, however, show that a child has been horn alive. The physical changes in the body of a child which result from the establishment of this process take place in the lungs immediately, and in the heart and its appendages more slowly. It is, therefore, chiefly to the lungs that a medical witness looks for proofs of respiration. Sometimes, however, these organs are found in their foetal condition, or nearly so ; for, although a child may have survived its birth many hours, there may be no evidence of the fact from the state of the lungs. To such cases the remarks now about to be made cannot, of course, apply ; the proofs of life must then be sought for elsewhere, and, if none can be found, the case is beyond the reach of medical evidence. But it is obvious that the occasional occurrence of cases of this description can present no objection to our still seeking for proofs of life in the state of the lungs, any more than the fact of poison not being always discovered in the body of one who has died from poisoning would be a bar to our seeking for the proofs of poison in aliy unknown case which presented itself. It is the more necessary to insist upon this point, because some have held that, as we cannot always derive proofs of life from an examination of the lungs of newborn children, we should abandon all evidence of this de- scription and leave the case in its original obscurity. The very object of medical jurisprudence is to endeavor to remove these difficulties, and to show in every department of the science the degree to which we may safely trust the medical proofs of crime, however insufficient, inconsistent, or contradictory they may at first sight appear. Examination of the Lungs. — The cavity of the chest may be conve- niently laid open by carrying incisions from below the clavicles downwards on each side from about half the length of the ribs backwards. The dia- phragm should be separated from the cartilages without opening the abdo- men ; the ribs sawn or cut through, and the flap formed by the front of the chest turned upwards — though some prefer to turn the flap downwards. The differences in the relative positions of the organs of the chest before and after respiration may be thus stated : 1. If a child has r^ot breathed, the thymus gland, as large as the heart, will be found occupying the upper CHARACTERS OF THE LUNGS AFTER RESPIRATION. 563 and middle portions of the chest ; the heart, within its membrane (peri- cardium), is situated in the lower and middle ])ortion, and is rather inclined to the left side. The lungs are placed quite in the back part of the chest, so as often to give the impression that they are wanting. In some instances they project slightly forwards by their anterior margins, but in no instance, unless congested, infiltrated, or otherwise diseased, do they cover and conceal the heart. The thymus gland is sometimes of a pale fawn color, at others of a deep livid hue: but there is no perceptible difference in this organ in newborn children before or after the perform- ance of the respiration. 2. On the other hand, when a child has fully breathed, the most striking differences will be observed in the color and prominence of the lungs. They are of a light-red hue, project forwards — appear to fill the entire cavity of the chest, and cover and in great part conceal, by their anterior margins, the heart and its membrane. We may meet with every variety in the appearances between these two extremes; for the process of respiration often requires a considerable time in order that it should be fully established, especially in children which are of a weakly constitution or prematurely born. ' Hence the lungs will be found to occupy their respective cavities to a greater or less extent, and to cover the pericardium more or less, not according to the length of time which a child has lived, but according to the perfection with which respiration has been performed. Although, as a general rule, the lungs are more per- fectly filled with air in proportion to the time during which a child sur- vives its birth, yet this is open to numerous exceptions. Color. — The color of the lungs before respiration is bluish-red or deep violet, but it is subject to variation. Some medical jurists have compared it to the color of the spleen, others to that of the liver. A short exposure to air will materially brighten the color in the parts exposed, so that it should be observed and recorded immediately on opening the chest. After 7'espiration the lungs acquire a light-red hue in proportion to the degree in'which the process has been performed. If imperfectly established, they will be mottled or marbled, generally about the anterior surfaces and mar- gins, the patches of light red being intermixed with the livid foetal hue, and being slightly raised, as if by distention, above the general surface of the organs. The light-red tint changes, after a short exposure to air, to a bright scarlet. Voli(me. — Before respiration, the lungs are in general scarcely visible, unless forcibly drawn forwards in the chest. When it has been yjerfectly accomplished, the volume is so much increased that the bag of the heart (pericardium) is almost concealed by them. Respiration must, however, have been perfectly performed in order that this condition should exist to the full extent described. Consistency. — The lungs, before respiration, feel like the liver, or any other of the soft organs of the body. They are firm under the finger, but their sub.stance may be lacerated by violent compression. After respira- tion has been fully performed there is a distinct sensation of M'hat is termed crepitation on compressing them, i. e. air is felt within them. If a thin section of the lung be submitted to examination with a low power of the microscope — before respiration it will present a solid appearance — after respiration air-cells will be distinctly seen in it. These conditions of the lungs must, of course, depend on the degree to which respiration has been carried. The lungs of children that have lived for a considerable time after birth will sometimes give no feeling of crepitation under the finger. Generally speaking, lungs of this kind present the other fcEtal characters ; 564 ABSOLUTE WEIGHT OF THE LUNGS. thus they are small and of a livid color, and no air-cells may be detected on a microscopical examination. Development of Air-cells. — Ou the riiiht lung, and especially on the edifcs and concave surface of its iipi)er lobe, the first appearances of respi- ration niav be visible, even when the rest of the lungs retain their foital condition. Here it is that the highly characteristic developed air-cells are first visible. These, if the lungs are fresh and full of blood, take the form of bright vermilion spots ; but if the lungs contain less blood, or are ex- amined some days after death, the spots are of a lighter tint. (Guy and Ferrier's For. Med., 5th edit., p. 104.) The form and arrangement of these cells are also characteristic — they are angular, and are not percepti- bly raised above the surface of the lung. They may be either irregularly grouped or arranged in sets of four, and their outline is distinctly polygonal. They are Ijest seen with the naked eye, or at most with a lens of low power. Their form, their immobility when the finger is passed over the surface of the lung, their color, and the fact that they are not raised above the surface of the lung, render a mistake of these cells for the minute bullae of putrefaction, melanotic spots, or minute ecchymoses, impossible, if ordi- nary care be exercised. The same development of air-cells may be brought about by artificial respiration. Nevertheless, these air-cells are of great value as proving either respiration or artificial respiration. Absolute Weight of the Lungs. The Static Test. — The absolute weight of the lungs before respiration is less than that which they have after the establishment of the process. From this an inference has been drawn that the aijsolute weight of the lungs in an unknown case, compared with cer- tain averages, will aid the inquirer in ascertaining whether respiration has or has not been performed. In order to determine the weight of the lungs, these organs should be carefully separated by dissection from the heart and thvmus gland and removed with the windpipe and bronchi attached. Previously to their removal ligatures should be placed on the pulmonary vessels, so that no blood may escape from the lungs. They should now be weighed, and the weight accurately noted. The average weight before respiration, derived from nine cases, was found to be 649 grains. Ac- cording to Traill, the weight varies from 430 to GOO grains. It is of im- portance, in taking the weight of these organs, to observe whether the child is at or near maturity, and whether its body is fully developed, or of about the average size and loeight ; owing to a neglect of this rule, it is highly probable that comparisons have been made of the absolute weight of the lungs in children of different ages, which a full statement of the facts would not have justified. If it is small and immature, or unusually large, the lungs will weigh either less or more than the average. The average weight of the lungs, after respiration, derived from three cases, was 927 grains ; but in making an estimate of this kind, much will de- pend upon the degree to which respiration has been carried. In three cases, in which the children lived half an hour, six hours, and twenty-four hours respectively, the process had been so imperfectly performed that the lungs varied ))ut little in weight from the average before respiration. (Guy's Hosp. Rep., 1837, ii. p. 318.) The truth is, we cannot compare the lungs of children, as to weight, by the time which they may have sur- vived birth, but rather by the degree to which the lungs have been pene- trated by air. Another circumstance must also be considered in basing an opinion on the absolute "sveight of the lungs. Although there does not appear to be any strict normal relation between the weights of the body and lungs in newborn children, yet it is certain that, in the bodies of children of unusual weight, the lungs will be found much heavier than SPECIFIC GRAVITY OF THE LUNGS. 565 the average, whether the child has breathed or not. The body may vary from six to eighteen i)ounds ; and the lungs under these circumstances will also differ in weight. The health}' lungs of mature newborn children become heavier after respiration, and according to its degree ; and where a deviation from this ruk- is observed, it may i)robably be explained by the circumstance that tl)e lungs of an immature have been comi)ared with those of a mature cliiid — the lungs of an undeveloped twin with those of one not a twin, or the lungs of one which has breathed imperfectly with those of another in which respiration has become well established. It is very well known to, and admitted by, all medical jurists, that there are some instances in which the fact of respiration cannot be determined by the application of the static or any other test to the lungs, simply because they contain no air. Increased weight, therefore, is only one among several circumstances to which a medical jurist should attend. Great weight of the lungs can obviously furnish no proof of respiration unless this is accompanied by the other physical changes indicative of the process ; as, for example, increase in volume from the presence of air, crepi- tation, and the detection of air-cells. If the lungs are heavy, and at the same time contain little or no air, the increase of weight must depend upon disease or other abnormal causes, not upon respiration. In one case the lungs were large, and weighed upwards of 1200 grains. They con- tained no air ; when divided into thirty pieces, not one portion floated, nor could any air be seen on the closest examination. It was therefore clearly impossible to ascribe a weight so much above the average to the effects of respiration. On the other hand, in another case, the lungs of a newborn child apparently full-grown, although fully distended with air, weighed only 626 grains. In this case the body of the child weighed only six pounds, and a quantity of blood had, no doubt, escaped from the lungs, owing to the pulmonary vessels not having been tied before their removal from the chest. It must not be forgotten that all the physical characters presented by lungs that have respired are liable to fallacies ; but these may be removed, or the force of the objection diminished, by not basing an opinion on one or two conditions only. We should take the whole combined; for it would be as wrong to regard great weight in the lungs taken alone as an absolute proof of respiration, as it would be to draw the same inference from a mere change in the color, volume, or consistency of the organs. Ploucquet proposed to determine whether the act of respiration had taken place or not by a comparison of the absolute weight of the lungs with the weight of the body of a child. This, which has been called the ted of Ploucquet, is based on the fallacy that there is an invariable relation between the weights of the lungs and bodies in newborn children. No such relation exists, and this method of arriving at a solution of the question of respiration has been abandoned by all medical jurists. The Specijic Gravity of the Lungs. — The specific gravity of the lungs is greater before than after respiration ; for although the organs become absolutely heavier by the establishment of the process, this is owing, not to the air, but to the additional ([uantity of blood received into them. The air thus received so increases the volume of the lungs as more than to counteract the additional weight derived from the blood, and thus a])par- ently to diminish their specific gravity. Under these circumstances they readily float on water. Tlu^ specific gravity of the lungs before respira- tion, i.e. in the foetal condition, varies from 1.04 to 1.05. They are about one-twentieth part heavier than their bulk of water. After respiration, 566 THE HYDKOSTATIC TJiST. the specific gravity of the lungs, with the air contained in them is 0.94 ; i.e. the organs are about one-seventeenth part lighter than their bulk of water. The introduction of a very small quantity of air will render the lungs buoyant in water, and an alteration in their volume sufficient for this purpose would not be perceptible to the eye. It will be understood that the specific gravity of the substance of the lungs is unchanged ; the organs are rendered only apparently lighter by the air contained in their cells, on the same principle as a bladder filled with air. Hence it follows that the apparent diminution of specific gravity will take place whether the air is derived from respiration, artificial inflation, or putrefaction. It is on this property of the lungs that the application of what is termed the hydrostatic test, or the docimasia pulmonaris, is founded — a subject which may be appropriately considered in another chapter. Conclusions.— ThQ general conclusions which may be drawn from the contents of this chapter are : — 1. That a child may be born alive and be criminally destroyed before it has breathed. 2. That the presence of any marks indicative of putrefaction while the child was in the womb proves that it must have come into the world dead. 3. That there are no certain medical signs by which a child that has not breathed can be proved to have been living w^hen it was maltreated. 4. That a newborn child may be destroyed by the prevention of respira- tion during delivery, 5. That by taking together the color, volume, consistency, absolute w^eight, and buoyancy of the lungs, and the presence in them of developed air-cells, we may be able to draw an inference w^hether the child has or has not breathed. 6. That the lungs increase in weight according to the degree to which respiration is established, and not necessarily according to the period which the child has survived birth. 7. That no reliance can be placed upon the test of Ploucquet, or the proportionate weight of the lungs to the body. CHAPTER XLIX. THE HYDROSTATIC TEST.— SINKING OP THE LUNGS FROM DISEASE OR ATELECTASIS. LIFE WITH PERFECT ATELECTASIS OR ENTIRE ABSENCE OF AIR FROM THE LUNGS. ERRONEOUS MEDICAL INFERENCE FROM SINKING OF THE LUNGS. FLOATING OF THE LUNGS FROM PDTKEFACTION. EFFECTS OF PUTREFACTION ON THE LUNGS. The Hydrostatic Test. — The mode of employing this test is extremely simple. Having removed the lungs from the chest, they should be placed, still connected with the air-tubes, upon the surface of distilled or river water. If they sink, it should be noted whether the sinking takes place rapidly or slowly. If they both sink, the two lungs should be tried sepa- rately ; for it is sometimes found that one, commonly the right, will float, Avhile the other will sink. Supposing that both lungs sink, they should be divided each into twelve or fifteen pieces, and these pieces placed sepa- rately on water. If after this they all sink, the inference is that, although the child may have lived and survived its birth, there is no evidence of its SINKING OF THE LUNGS FROM DISEASE. 567 having breathed. On the other hand, the organs when placed on water may float ; it should then be noticed whether they float high above the surface, or at or below the level of the water ; sometimes they indifferently float or sink. These difierences will lead to a conclusion respecting the degree to which respiration has taken place. It will now be proper to separate the lungs, and determine whether the buoyancy is due to one or both. Each lung should be divided as before, and each piece separately tried. If all the pieces float, even after firm compression, we have good evidence, cseteris payHbus, that respiration has been very perfectly per- formed. Should any of the divided portions sink in water, either before or after compression, our opinion should be modified accordingly. Some have recommended that the lungs should be placed on water with the heart and thymus gland attached; but there appears to be no good reason for this, since it is as easy to form an opinion of the degree of buoyancy possessed by the lungs, from the readiness with which they float, as by observing whether or not they have the power to support these two organs. With regard to the inference derivable from the use of this test, it should be observed that the floating of the lungs in water is not, as it is often in- correctly represented to be, a proof that a child has been borii alive ; nor is the fact of their sinking in water any proof that a child was born dead. The floating, under the limitations to be described, proves only that a child has breathed ; the sinking, either that it has not breathed or breathed but imperfectly. The fact of a child having been born living or dead has, strictly speaking, no relation to the employment of the hydrostatic test. There are cases of infanticide which may be readily established without resorting to this test, and others which cannot be proved by its use ; all that the law requires is proof that a child has been born living, and whether this proof be furnished by the state of the lungs through the hydrostatic test, or in any other manner, is of no moment. The signs of life are commonly sought for in the lungs, because it is in these organs that the changes produced by a new state of existence are most distinctly perceived ; but this examination may be dispensed with M'hen the woman confesses that the child was born alive, when others have seen it manifest life by motion or otherwise after its birth, or, lastly, in cases where, with- out being seen, it has been heard to cry. The crying of a child has been admitted as evidence of live birth on several trials for infanticide; although, as it is elsewhere stated, a child may utter a cry and die before its body is entirely born. Among the objections which have been urged to the employment of the hydrostatic test, we have first to consider those which concern the sinking of the lungs in w^ater. Sinking of the Lungs from Disease, or Atelectasis. — It is said that the hydrostatic test cannot show whether a child has or has not survived its birth, because the lungs of children that have lived for a considerable period have been observed to sink entirely in water. In some instances this may depend on disease, tending to consolidate the air-cells, as hepa- tization or scirrh us ; in others, on oedema or congestion ; but these cases can create no difficulty, since the cause of the lungs sinking in water would be at once obvious on examination. The hepatized portion of lung may be known by the firmness with which it resists cutting with a knife, as also by the fact that it is impossiljle to distend it artificially with air. On the other hand, there are cases in which the lungs appear health}' and un- affected — all that we can perceive is that they retain their foetal condition. This is a very diff'erent state from that of hepatization, because the lungs, in this unexpanded condition, may be made to receive air by artificial inflation. 568 ATELECTASIS. It is remarkable that life should continue for many hours, and sometimes even for days, under such a condition ; but the occasional existence of this state of the lung-s in a living child is placed beyond all dispute; the ex- planation of the causes upon which it de|)ends — how it is that a child may live for hours or days, and no signs of respiration be discovered in its body after death — is,*^however, involved in difficulty. The lungs appear to be simply unexpanded, or to retain their foetal condition ; a state to which the name of atelectasis has been given. This condition may be found to affect the whole or a part of the organs. Albert met with a case in which a child died thirty-six hours after its birth, having been attacked by convulsions at intervals during that time. On inspection, the whole of the right, and the lower portion of the left lung, were found to be in their fcetal condition, and they immediately sank when immersed in water. There was no diseased appearance in the organs, and the undis- tended portions were easily filled by blowing air into them. (Hencke's Zeitschrift, 1837, 2, p. 422.) D^paul found in many cases in which children had died suddenly after breathing for several hours or days, that the only unusual appearance in the body was an unexpanded condition of a large portion of the lungs. (Lond. Med. Gaz., vol. xxxix. p. 283.) it is necessary for a medical jurist to be aware that the state of the lungs which is here called atelectasis is by no means unfrequent among newborn children. When no portion of air is found in the lungs of a child, there is no test by which such a case can be distinguished from one in which the child has come into the world dead. These cases of atelec- tasis are ordinarily set down as exceptions to a general rule ; but they are more common than some medical jurists are inclined to admit. In ex- amining the body of a child the history of which is unknown, it is proper that the possible occurrence of such cases should be well borne in mind. It appears not improbable that many such come yearly before coroners in this country and that they are dismissed as stillborn children, notwithstanding that marks of violence are often found upon the bodies. If, as it has been already observed, the lungs sink in water, this fact alone is com- monly, although improperly, regarded as sufficient evidence of stillbirth. This is assuredly putting the most humane interpretation on the circum- stances, and, so far, the result is not to be objected to ; but we should take care, in carrying out this principle, that we do not throw obstacles in the way of a subsequent judicial inquiry and lead to the concealment of crime. Bernt met with an instance in which a seven months' child died two hours after birth; and when its lungs were divided and placed in water every portion sank. Remer has reported another, in which the lungs sank in water, both entire as well as M'hen divided, although the child had survived its birth at least four days. (Henke, Lehrb, der Oerichtl. Med., p. 374.) In this case the navel-string had separated naturally before death. Orfila found in a child which had lived eleven hours every portion of the lungs, when divided, sink on immersion. In three other instances in which the children survived birth four, six, and ten hours, the lungs also sank when divided; two of these were mature. (Med. Leg., vol. 1, p. 375.) Other cases of a similar kind are reported by more recent writers. (Ann. d'Hyg., 1878, t. 2, p. 489.) Yernon attended a healthy woman, who was delivered of a female child at about the sixth month of her pregnancy. The child was born before his arrival and he heard it crying strongly from under the bedclothes as he entered the room. After removal from the mother, the child cried at intervals, and it was observed that its chest rose and fell as in ordinary breathing. It lived five hours and it then appeared to die from feebleness SINKING OF THE LUNGS IN WATER. 569 and exhaustion. It was very small, weighing 2 lb. 13 oz., and its length was 12| inches; the eyelids were adherent. The lungs were of a purplish-red color and slightly overlapped the bag of the heart ; they sank in water, both entire and when divided into small pieces, were not crepitant, and broke down under firm compression. There was no appearance of air-cells in a section of the lungs when examined with the microscope. The ductus arteriosus and foramen ovale were in their foetal state. (Lancet, 1855, i. p. 121.) A more remarkable case occurred to Donders. (Rep. bv Moore, Dub. Mod. Press, Nov. 22, 18()5, p. 456.) The body of the child was sixteen inches in length and weighed nearly five pounds. It was probably a seven months' child. The lungs were of a brown color, and sank in water, entire and when divided. There was no crepitation, and on pres- sure only a reddish fluid without air escaped. The bladder was empty ; there was no food in the stomach, but there was meconium in the larger intestine. From this state of facts, Donders concluded that the child was immature, stillborn, only a short time dead, and remaining in the womb only a short time after death. It transpired, however, that the child had been born alive, had survived its birth twelve hours, and had cried dis- tinctly after it was born. As the lungs could be readily inflated and as the child had cried, he concluded that air had been received into the lungs, and had been again slowly expelled, the child dying in a kind of asphyx- iated state. Schworer delivered a woman in the hospital. The child did not breathe when born, but showed some signs of life. Thus the pulsations of the heart and navel-string were perceptible. These gradually ceased and no effort could restore the child. On inspection, the lungs were found to contain no air ; there was no crepitation when the substance of the lungs was cut and they sank in water, not only in the entire state, but when divided into numerous pieces. Poncet met with the lungs of a foetus pre- maturely born at the Hotel Dieu. The child had cried, breathed, and lived an extra-uterine life for ten hou7's, but the lungs sank completely in water as if no respiration had taken place. (Lancet, 1872, i. 227.) The author may add to these instances two which occurred under his own observation. In one, the case of a mature male child, the lungs sank in water, although the child had survived birth for a period of six hours. In the other, a case of a female twin, the child survived tweMy-four hours; and after death the lungs were divided into thirty pieces, but not a single piece floated, showing therefore that, although life had been thus protracted, not one-thirtieth part of the structure of the lungs had received, by respi- ration, sufficient air to render it buoyant. (Guy's Hosp. Rep., 1837, ii. pp. 346, 355.) In the latter instance no particular remark was made during life respecting the breathing of the child. These cases show clearly that buoyancy of the lungs is not a necessary consequence of a child having lived and breathed for some time after birth. Probably, had they called for medico-legal inquiry, the lungs would have been cut to pieces ; the sinking of the divided pieces in water, either before or after compression, would have been set down as negativing the act of respiration, and, unless other strong evidence had been forth- coming, it would have been asserted that the children had been born dead. Here, again, we perceive the necessity of not hastily assuming that a child has been horn dead because its lungs sivk in water. There may be no good medical evidence of such a child having lived after birth, but as- suredly the mere sinking of these organs does not warrant the common and positive dictum that the child was necessarily dead when born. It must be apparent, on reflection, that cases of this description are 570 SINKING OF THE LUNGS. beyond the reach of the hydrostatic as well as of all other tests applied to the respirator)^ organs ; because the lungs do not receive and retain a suffi- cient quantity of air to give buoyancy after death, although the children mnv have lived some hours. The hydrostatic test is no more capable of showing that such children as these have lived, than it is of indicating from what cause they have died. Facts of this kind demonstrate that a passive existence may be for some time maintained under a state of respi- ratory process not to bo discovered after death. In the opinion of some, these"^ cases form a serious objection to the hydrostatic test ; but it is difficult to understand how they can affect its general application, or why, because signs of respiration do not always exist in the lungs of children that have lived, we are not to rely upon them Avhen they are actually found. These exceptional instances prove that we are greatly in want of some fact to indicate life after birth when the signs of respiration are absent. Until we discover this we must, of course, make the best use of that knowledge which lies at our disposal; taking care to apply it to those cases alone to which experience shows it to be safely adapted. It has been recommended that medical jurists should consider as dead every child that has not breathed, i. e. whose lungs sink in toater ; but they who give this advice at the same time admit that children may come into the world living without bfeathing, and the law holds, under the decision of its expounders, that respiration is only one and not an ex- clusive proof of life. In order to establish life or even live birth, respir- ation need not always be proved, either in civil or criminal cases (p. 537.) A medical jurist would, therefore, be no more justified in asserting that all such children were necessarily born dead, than that they were born living ; and in stating what is plain and obvious it is not possible that this statement can ever be the means of involving an innocent person. It is certain, however, in stating what is contrary to well-known facts, that, when the lungs of a child sink in water, it is safe and just to consider such child as having been born dead, he is incurring the risk of exculpat- ing a really guilty person ; for it cannot be too strongly borne in mind that a woman is not charged with murder merely because the lungs of her child float in water, but because there are upon its body marks of vio- lent injuries apparently sufficient to account for its death, or there are strong moral presumptions of her guilt. (See Ann. d'Hyg., 1836, t. 2, p. 362.) But there is another aspect in which this question should be viewed. There may be no marks of murderous violence on the body of the child, nor any proofs of ill-treatment, yet a child born under these circumstances may have died through the culpable neglect or reckless indifference of the woman. Moore, in reporting two cases of atelectasis, in one of which a child had survived its birth twelve hours, remarks that when such a child is deserted or exposed, without the necessary attention required for its helpless state, the conditions are precisely fulfilled to cause its death within a few hours under a diminution of temperature and a total expulsion of air from the lungs. He has no douljt that many a child so found, which had met with its death through want of care, is looked upon as not having lived. (Med. Press, 1865, p. 458.) It will be seen here- after that some of our judges have given a strong exposition of the law, so as to bring cases of this description within the crime of manslaughter. Floating of the Lungs from other causes than Respiration. — Another series of objections have been urged to the hydrostatic test, based on the fact that the lungs may receive air and acquire buoyancy from other causes than respiration. These causes are two — putrefaction and artificial inflation. PUTREFACTION. 571 Pati'ef action. — The lungs of a stillborn child, when allowed to remain in the chest, are slow in undergoing- putrefaction ; but, nevertheless, they sooner or later acquire sufficient air to render them buoyant in water. Wiien the lungs are putrefied this will be determined, in general, by putrefaction having extended throughout all the soft parts of the body. The organs, according to the degree of putrefaction, will be found soft, of a dark-groen or brown color, and of a highly oft'ensive odor ; and the serous membrane covering the surface will be raised in large visible vesi- cles, from which the air may be forced out by very moderate compression. It has been remarked that, under the same conditions, gaseous putrefac- tion takes place as rapidly in the liver, heart, and thymus gland of a new- born child, as in the lungs ; we should, therefore, notice the general state of the body. The distention of the lungs with gases from putrefaction cannot be easily overlooked or mistaken for the air of respiration. The •answer to any objection founded on the putrefied state of these organs must at once suggest itself. It is impossible that any well-informed med- ical witness can expect to obtain satisfactory evidence from experiments on lungs in such a condition. He should abandon the case, and declare that, in regard to the question of respiration, medical evidence cannot establish either the affirmative or the negative. The fact of his not being able to give the evidence required cannot be imputed as a matter of blame to him, or ascribed to any deficiencies in the hydrostatic test, but is due to purely exceptional circumstances. In a case reported by Henke, the lungs and other organs in the body of a child were found in an advanced state of putrefaction. A medical wit- ness gave an opinion that the child was born dead, but the prisoner after- wards confessed that it has been born living. The medical opinion could have been no more than a conjecture, the condition of the body not allow- ing any correct conclusion to be drawn. This fact shows that it is always better to leave a doubtful case as we find it than to express a positive opinion that the child has been born either living or dead. If on these occasions a witness were simply to assure a jury that medical evidence could not solve the question whether the child had lived or not — if he were to assert, what is really the fact, that his experiments would not allow him to say whether the child had or had not breathed — it is certain that no innocent person would ever be convicted or a guilty person ac- quitted upon his evidence. It is his duty to state that doubt, and leave the decision of guilt or innocence in the hands of the court. Conclusions. — The general conclusions which may be drawn respecting the application of the hydrostatic test in cases of infanticide are the fol- lowing: — 1. That the hydrostatic test can show whether a child has or has not breathed, but does not enable us to determine whether a child has been born living or dead. 2. That the lungs of children that have lived after birth may sink in water, owing to their not having received air, or to tlieir being in a dis- eased condition. 3. That a child may live for some time when only a small portion of the lungs has been penetrated by air. 4. That a child may survive birth even for twenty-four hours, when no part of its lungs has been apparently penetrated by air. 5. Hence the sinking of the lungs (wln^ther whole or divided) in water is not a proof that a child has been horn dead. 6. That the lungs of children which have not breathed and have been born dead, may float on water from putrefaction. 572 ARTIFICIAL INFLATION OF THE LUNGS. 1. That the lungs, as situated in the chest, undergo putrefaction very slowly ; that if but slightly putrefied, the gases may be easily forced out by compression, and if much putrefied, either the case must be abandoned or other sources of evidence sought for. CHAPTER L. FLOATING OF THE LUNGS FROM ARTIFICIAL INFLATION. INFLATION NOT DISTINGUISHABLE FROM IMPERFECT RESPIRATION. RESULTS OF COMPRESSION. — IMPROPER OBJECTIONS TO THE HYDROSTATIC TEST. RESPIRATION BEFORE BIRTH. RESPIRATION A SIGN OF LIFE, NOT OF LIV^E BIRTH. GENERAL CONCLUSIONS. Artificial Inflation. — It has been alleged that the lungs of a stillborn child may be made to assume, by artificial inflation, i. e. by blowing air into them, all the characters assigned to those which have undergone respiration. Thus, it is said, a child may not have breathed, and yet the application of the hydrostatic test would in such a case lead to the infer- ence that it had. It will be seen that the force of this objection goes to attack directly the inference derivable from the discovery of air in the lungs. There is only one form under which this can be admitted as an objection, namely, as it applies to lungs which have been inflated while lying in the cavity of the chest. Any experiments performed on them after their removal from this cavity can have no practical bearing, since in a case of infanticide we have to consider only the degree to which the lungs may be distended with air by a person w^ho is fairly endeavoring to resuscitate a stilll)orn child. Assuming that the experiment has been successfully performed, and that the lungs have been artificially inflated, they would resemble, in their partial distention with air and other physical characters, those of children which had breathed imperfectly. Like them, they may float on water ; but on cutting them into pieces some of these would be found to sink. If the pieces which float are firmly compressed, either by means of a folded cloth or between the fingers, they will lose air and sink. When this pressure is produced under water, it will be seen that bubbles of air escape, but mere pressure with the fingers will not in general suffice to expel the whole. The same result is obtained when the divided portions of lungs which have breathed imperfectly are submitted to pressure. If, however, the act of breathing has been perfectly per- formed, and the air-cells are well filled, the air cannot be expelled by pressure or by any force short of the destruction of the substance of the lungs. This difference in the effect of pressure has been hitherto regarded as a criterion to distinguish lungs that have fullv breathed from those which have been simply inflated; but Braxton Hicks met with a case which shows that pressure will not always effect the expulsion of air arti- ficially introduced into the lungs of a child born dead ; hence, by an exclusive reliance on this method, a medical man might be led to infer that a lung artificially inflated had received air by respiration. He deliv- ered a woman of a full-grown child; it was stillborn, and there was no effort at respiration. An attempt was made to resuscitate the child, but unsuccessfully, by blowing air into the lungs through a catheter. On inspection the lungs were observed to be of large size, but they did not EVIDENCE FROM THE HYDROSTATIC TEST. 573 present the usual appearance of lungs which had breathed. Although about three-fourths of the organs had received air by inflation, and they were of a pale-fawn color, like the thymus gland, still, the air was con- tained in the minute air-cells. They floated on water as well as all the pieces (fifteen or sixteen) into which they were divided. When comi)ressed between the fingers under water, small bubbles of air escaped; but no amount of compression short of destroying their structure caused these pieces to sink. A fact of this kind, although perhaps exceptional, shows that the non-expulsion of air from lungs by compression must not be regarded as an absolute proof of resi)iration. It must be taken with other circumstances, e. g. absolute weight, color, and presence of developed air- cells, as a fact to show that the child has either breathed or has had its lungs perfectly inflated in a bona fide attempt to restore life after birth, either by the mother or by some person present at the birth. In these cases, the only course left open to a medical witness is to state that the evidence derived from experiments on the lungs left it uncertain whether the child in question had breathed or had had its lungs artificially in- flated. In concluding these remarks upon the objections to the hydrostatic test, it may be observed that medical practitioners have differed much at dif- ferent times in their ideas of what it was fitted to prove. At the begin- ning of the present century, it would seem that the test was regarded by some as capable of furnishing evidence of murder. Thus we find W. Hunter asking the question, " How far may we conclude that the child was born alive, and probably mwrdered by its mother, if the lungs swim in water?" From what has already been stated, as well as from the most simple reflection on the circumstances accompanying the birth of a child, it must be evident that the hydrostatic test is no more capable of showing whether a child has been born alive or dead than it is of proving whether it has been murdered or has died from natural causes. The test merely serves to furnish in many cases good proof of life from the state of the lungs ; and slight reflection will render it apparent that in no case is it susceptible of doing more. Even their utility is much restricted by numerous counteracting circumstances, a knowledge of which is essential to him who wishes to make a practical application of them. If asked to state in what cases the pulmonary tests are capable of assist- ing a medical jurist, the answer would be : First, the}- will clearly show that a newborn child has lived, when, during its life, it has fully and per- fectly breathed. Cases of this description form a certain number of those which come before our courts of assize. To them the most serious ob- jections are not applicable ; and the few^ which might be made to the med- ical inferences are not difficult to answer. Second, they will allow a witness to say that the lungs must have received air, either by respira- tion or b}'" artificial inflation. These are the cases in which a child has died soon after birth, and where the respiratory changes are but imper- fectly manifested in the lungs. They probably form a large proportion of those which fall under the jurisdiction of the criminal law. It might be considered that the qualification in the inference here drawn would neutral- ize its force ; but it must be remembered that there are few instances of actual and deliberate child-murder wherein artificial inflation could become even a possible defence for an accused person. So unusual is this kind of defence, that among the numerous trials for infanticide which have taken place in this country for many years past, we have not been able to meet with a single instance in which it was alleged, as an objection to the med- ical evidence derived from the buoyancy of the lungs, that the prisoner 574 RESPIRATION BEFORE BIRTH. had iuflati'tl them in order to resuscitate her child. The reason is obvious : Had such a defence been attempted, the whole of the circumstantial evi- dence would at once have set it aside. When, in the suspected murder of an adult, a medical man swears that a fatal wound was such that the de- ceased miji^ht have inflicted it on himself, or that the prisoner might have produced it, he is placing the jury in a position very similar to that in which he places them in a case of child-murder, when he says that the child might have breathed, or its lungs might have been artificially in- flated. It is not for him to speculate on the probabilities of respiration or of artificial inflation ; but it is for the jury to consider whether the accused was or was not likely, under the particular circumstances of the case, to have resorted to an experiment of this nature. It has been suggested that some person might inflate the lungs of a dead child in order to raise a. charge of murder against its mother ; but this suggestion presupposes, on the part of the criminal, a profound knowledge of the difficulties of medical jurisprudence ; and even then the question of murder does not depend merely on the presence of air in the lungs. Such a case is very unlikely to present itself. The circumstances of the case will commonly furnish a sufficient answer to such hypothetical views. The hydrostatic test ought not, therefore, to be lightly condemned or rejected upon a speculative objection, which, in nine-tenths of the cases of child-murder, could not possibly exist. Let it be granted to the fullest extent that a conscientious medical jurist cannot always draw a positive distinction between the effects of respiration and artificial inflation on the- langs ; still, a jury may be in a situation to relieve him from this diffi- culty. We know of only one instance in which a medical man declined to make an inspection of the body of a newborn child for the purpose of examining the state of the lungs. (Reg. v. Pitt, Dorset Sum. Ass., 1859.) The body was found much mutilated and with such injuries as would fully have accounted for the death of the child, assuming it to have been born alive. At the inquest the coroner suggested that a post-mortem examination should be made ; but the chief medical witness declined to make it, as he did not consider it to be necessary. He was then asked by the coroner whether the floating of the lungs would indicate that the child had breathed, to which he replied that that theory was now exploded. It seems that the death of the child was so recent that when the body was found it was quite warm. It also became rigid in the usual time. The medical wit- ness relied upon warmth and rigidity in the body as proofs of the child's having been born alive, when it is obvious that these conditions can prove only that the child has been recently living. The neglect to examine the body led to an acquittal. There was no proof of life as the result of breathing, and no evidence to show whether the injuries were inflicted be- fore or after death. Respiration before or during Birth. — It has been already stated that the pulmonary tests are fitted to prove whether a child has or has not lived to breathe. Neither the hydrostatic nor any other test can posi- tively show that the body of a child was entirely horn alive when the act of breathing was performed. As this is a subject that generally gives rise to some discussion in cases of child-murder, a few remarks are here made on it. First, respiration may be performed while the child is in the womb, after the rupture of the membranes — the mouth of the child being at the OS uteri. This is what is termed vagitus lUerinus ; its occurrence, although extremely rare, rests upon undisputed authority. Second, a child may breathe while its head is in the vagina, either during a presen- RESPIRATION A SIGN OF LIFE. 575 tatioD of the head or of the breech. This has been termed vagitus vagi, nalis. It is not very common, but it is a possible occurrence. Third, a child may breathe while its head is protruding from the outlet ; in this position respiration may be as completely set up in a few moments by its crying as we find it in some children that have actually been born and have survived their birth for several hours. This is the most usual form of respiration before birth. In the vagitus iderinus or vaginalis the lungs receive but a very small quantity of air ; in respiration after protrusion of the head, the lungs may be sometimes found moderately well filled, although never, perhaps, possessing all the characteristics of those which have fully breathed. The well-known occurrence of respiration under either of these three conditions strikingly displays the fallacy of making this process the certain boundary of extra-uterine life. A child may breathe in the womb or vagina, or with its head at the outlet, and die be- fore its body is born; the discovery of its having respired would not, therefore, be any sort of proof of its having enjoyed what has been termed " extra-uterine life." (For a well-marked case of this kind see Lond. Med. Gaz., vol. xxxviii. p. 394; and another in Guy's Hosp. Rep., 1850, p. 231.) The death of a child W'hich has breathed in the womb, or vagina, from natural causes before its entire birth, is a possible occurrence ; but its death from natural causes before birth, after it has breathed by the protrusion of its head from the outlet, is an unusual event. All that we can say is — it may take place ; but death under these circumstances would be the exception to a very general rule. Oberkamp states that, in four successive deliveries of the same woman, the children breathed during de- livery, but died before they were born. Respiration a Sign of Life, not of Live Birth. — The hydrostatic test is only capable of determining that respiration has taken place ; it cannot show whether this process was established during birth or afterwards. The fact of a child having the power of breathing before it is entirely born does not, therefore, constitute the smallest objection to its employ- ment, although upon this ground we find the use of it in any case de- nounced by some members of the medical and legal professions. It is obvious that most members of the law who have treated this subject have adopted, without suflBcient examination, the statements of W. Hunter, who observes: "A child will commonly breathe as soon as its mouth is born or protruded from its mother ; and in that case may lose its life before its body be born, especially when there happens to be a consider- able interval between what we may call the birth of the child's head and the profusion of its body. And if this may happen where the best assist- ance is at hand, it is still more likely to happen when there is none — that is, where the woman is delivered by herself" (On the Uncertainty of the Signs of Muj-der in the Case of Bastard Children, p. 38.) Hunter here exposes in plain language the fallac}^ of trusting to the signs of res- piration alone as evidence of a child having been boryi alive. The truth of his remarks is in the present day generally admitted; and if among medical and legal writers we find some treating respiration as a certain proof of live birth, it is from their not having sufiQciently considered the probability of a child breathing and dying before its body is entirely extruded. Although the test can prove no more than that a child has breathed, some medical witnesses in giving evidence in cases of child-murder have fallen into the error of assuming that the hydrostatic test is cajjable of proving "live birth." Medical jurists of repute have sanctioned this erroneous view, ignoring the fact that the child may breathe and die 57(5 RESPIRATION A SIGN OF LIFE. before the entire birth of tlie body, while the test cannot show whether the act of breathing was performed during birth or afterwards. Among others Casper expressed his opinion that if wc find air in the lungs of a newborn child, such a child must have been born alive. The reasoning of Casper is as extraordinary as his conclusion. He says: 1. During a rapid delivery those conditions are wanting which lead to breathing in nte.ro or during birth. 2. All cases of secret delivery are rapid, and it is in these cases only that the hydrostatic test can be applied to the lungs; hence the proof of breathing in a secretly born child must be regarded as breathing after and not in or during birth. (Gerichtl. Med.) It will be seen that this medical jurist entirely ignored the facts jiointed by W. Hunter more than eighty years ago, and accumulated by numerous obstetric authorities since that time. On a trial for child-murder, a medical witness being asked on what he based his statement that the child had been born alive, said, " The presence of air in the lungs," and quoted Casper as his authority. There may be cases in which the signs of full respiration would justify an opinion of live birth, but the dictum of Casper is quite inadmissible. The floating of the lungs in water may be owing to air received before or during birth, and it cannot be admitted that all cases of secret delivery are necessarily rapid cases — so rapid that the child has had no time to breathe until after entire birth. The reader will find a good summary of the mode of applying the hydrostatic test, as well as of the conclusions which may be drawn from its proper application, bv Devergie, in Ann. d'Hvg., 18*72, t. 2, p. 169. See also a paper bv Tardieu, Ann. d'Hyg., 186Y, t."'2^ pp. 217 and 365. Goaclasions. — The general conclusions respecting the employment of the hydrostatic test, to be drawn from the contents of this chapter, are — 1. That the artificial inflation of the lungs of a child born dead will cause them to float in water. 2. That lungs artificially inflated while in the chest resemble those organs in which respiration has been only imperfectly established. 3. That in cases of inflation of the lungs in the chest the air may be generally expelled from the divided portions of lung by firm compression so as to cause them to sink. 4 That the same result occurs with lungs in which respiration has been imperfectly established. 5. That when lungs have undergone perfect respiration the air cannot be expelled by compression of the divided parts so as to cause them to sink. 6. That the artificial inflation of fretal lungs causes no alteration of weight, and as the weight increases in proportion to the degree of respi- ration, so in healthy lungs with great buoyancy, there should be great weight if the air has been derived from respiration. t. That we should base our judgment of a child having breathed upon great weight and great buoyancy of the lungs combined; that the one condition without the other is open to the objection that the air may not have been derived from respiration. 8. That the floating of the lungs in water proves, ceeteris paribus, that a child has breathed either at, during, or after birth ; it does not prove that a child was born alive or that it has died a violent death. 9. That the sinking of the lungs as a result of the expulsion of air from them by compression does not necessarily prove that the child was born dead. It merely proves that the air contained in them was derived either from artificial inflation or from the imperfect establishment of the respiratory process. PROOFS OF LIVE LIRTH. 577 10. That the hydrostatic test is not applicable to determine the fact of respiraliou or nou-respiration iu all cases of alleged child-murder ; but that, with ordinary precautions, it may be safely employed iu the majority of such cases. 11. That a child may breathe before, during, or after birth; but the hydrostatic test will not enable us to say, in the greater number of cases, at which of these periods the act of breathing was performed. 12. That breathing is a sign of life, and not necessarily of live birth. 13. Hence, in order to constitute murder, medical evidence is required to show whether a child had breathed after it was entirely born, and whether the act of violence which caused its death was applied to it while so breathing. Some of these conclusions may require qualification ; but for the circum- stances w^hich qualify them the reader is referred to the contents of the chapter. CHAPTER LI. ON THE PROOFS OP A CHILD HAVING BEEN BORN ALIVE. EVIDENCE PROM RESPIRATION. FROM MARKS OF VIOLENCE. FROM NATURAL CHANGES IN THE FOETAL VESSELS. FROM THE DISCOVERY OF AIR AND FOOD IN THE STOMACH AND BOWELS. EAR-TEST. GENERAL CONCLUSIONS. On a trial for child-murder, the important medical question has hitherto been — Was the child completely born alive ? The interpretation set upon these words by all the judges is that the whole body of a child should be entirely delivered from the body of the mother before the question of its death from violence could be entertained. In a case iu which death had obviously taken place from criminal violence, the medical witness was suddenly stopped iu his evidence by being asked for some infallible proof of live birth in a legal sense. As a medical man not present at the de- livery could rarely be in a condition to offer such proof, the case broke down, and the accused was acquitted. By the existing law, it is murder to cause a child to die after it is born by injuries inflicted on it before or during birth ; but it is no offence to kill a living child while it is being born, unless miscarriage is caused. Under the proposed new Criminal Code there is the following provision against the murder of tinhorn children: " Every one shall be liable to penal ser- vitude for life T-v^ho causes the death of any living child which has not proceeded in a living state from the body of its mother by any act or omission which would have amounted to murder if such a child had been fully born." For the protection of medical men who perform craniotomy, or who otherwise destroy an unborn child, it is proposed that no one shall be guilty of any offence who, by means employed in good faith, for the preserva- tion of the iife of the mother of the child, and reasonably necessar}^ for that purpose, causes the death of any such child or causes any child to die after it is fully born by any such thing done before or during its birth. Thisproposed change may be objected to on a technicel ground — namely, that it creates a difference in the crime of murder, making it to depend, not on the fact of killing, but on the time at which the killing takes place. The answer to this objection is, however, that, under the present law, many escape 37 678 EVIDENCE FROM RESPIRATION. who deserve punishment, and that real cases of child-murder practically go unpunished. Under the proposed Code, juries would be less ready to acquit women charged with this crime when a sentence of penal servitude can be passed on them in ]i]ace of capital punishment. As the question of live birth must still, as a rule, be put to the witness on charges of child-murder, it will be necessary to consider the medical facts u])on which reliance can be placed, as furnishing evidence of a child having come into the world living, or of its having been born alive. Evidence from ReKpiration. — As a general rule, there will he no per- ceptible difference in the state of the lungs, whether the act of respiration is performed l^y a child during birth or after it is Ijorn, provided that its death speedily follows its birth. But should we find that this process has been perfectly established, i. e. that the lungs present all those conditions which have been described as characteristic of full and perfect breathing, there is great reason to presume that the process, even if it had commenced during birth, must have continued after the child was entirely born. This presumption becomes still stronger when the child is immature; for, gen- erally speaking, such children must be born and continue to breathe for many hours after birth, in order that their lungs should present the char- acters of complete respiration. The process is seldom so established before birth as to give to these organs a feeling of crepitation under press- ure ; the existence of this character should, tlierefore, be sought for. A witness who relied upon it as a conclusive proof of Ijreathing after birth, might be asked whether it were not possible for some children to remain so long at the outlet with the head protruding, as to render the lungs crepitant from frequent respiration before birth. Admitting the possibility of this occurrence, he should endeavor to ascertain whether there was any probable cause which could thus have protracted delivery while the head of the child was in this position ; as also what natural cause could have produced its death when its head was protruding and respiration had been so freely performed as to give crepitation to the lungs. The presence or absence of the usual scalp-tumor might throw some light upon the case. If, when present, it did not prove live birth, it might indicate protracted delivery, and show that the child had been recently living. Casper cut the Gordian knot of this difficulty by assuming that breathing before birth takes place only in protracted delivery, in which the assistance of an accoucheur is required. In those cases which are likely to give rise to criminal investigations, he assumed that the birth of the child takes place quickly, and that in rapid delivery the child does not breathe until after it has been born alive. Hence his conclusion is — if in the body of a child (secretly disposed of) the lungs are found by the hydrostatic test to con- tain air, this air did not enter the lungs at or before birth, but afterwards, and that the child was born alive. (Gerichtl. Med.) Such a conclusion is not in accordance with the facts ascertained regarding the act of respira- tion in newborn children ; it may be that they rarely die from natural causes after they have once breathed, but that they can breathe and cry during birth is a fact which cannot be disputed. Further, there is no test known by which air received into the lungs during birth can be dis- tinguished from that which has entered these organs after the child has been born alive. Evidence from Marks of Violence. — If marks of violence, apparently inflicted about the same time, are found on different and remote parts of the body, and these marks bear the characters of those produced during life, it is rendered probable that the whole of the body of the child was in the world when they were caused. Marks of great violence on one CHANGES IN THE BODY OF THE CHILD. 579 part, as the head or breech, would not always justify such a presumption, because it might be fairly objected that they had been unintentionally pro- duced by the woman in her attempts at self-delivery, and 3'et the child not have been born alive. It would be for a witness to form an opinion, from the circumstances accompanying the particular case, whether they had been thus occasioned. From this it will be seen that, in making an ex- amination after death, every mark of injury on the body of a child, even if slight, sbould be noted down. Abrasions of the skin, burns, and punc- tures, should be sought for, and the throat examined for marks of pressure by a cord or by the fingers. Evidence from Certain Changes in the Body. — In a child that has been born alive, or has survived its birth for a period of from twelve to twenty- four hours, that portion of the umbilical cord (navel-string) which is con- tiguous to the abdomen undergoes certain changes: it dries and becomes slowly shrivelled, and in from three to five or more days it separates from the body, with or without cicatrization. The cord does not separate at the part which is tied, but close to the abdomen. It separates generally within five days by a process of slough- ing, the skin connected with the dead portion of the cord presenting a red line arising from capillary congestion. During the separation of the navel-string the umbilical vessels are gradually closed. According to Billard, the obliteration of these vessels is effected in a peculiar manner. The calibre diminishes as a result of a concentric thickening of the coats, so that, while the vessel retains its apparent size, its cavity is gradually blocked up. A quill would represent the form of the vessel in the foetal state, and a tobacco-pipe in the obliterated state. It is only by cutting through the vessel that the degree of obliteration can be determined. The state of the umbilical cord has furnished good evidence of live birth when the other circumstances of the case have yielded no information. The changes in the umbilical cord, especially those indicative of its separation and cicatrization, clearly prove that a child has survived its birth, whatever may be the results of experiments on the lungs ; but the difficulty is that they require some days for their production, and in practice it is necessary to procure some signs of survivorship for only a few minutes, or at furthest for a few hours. The same remark applies to the exfoliation of the cuticle in a newborn child : such a condition of the skin can rarely be found in cases of infanticide. The absence of meconium from the intes- tines and of urine from the bladder, are not proofs of live birth, for these ma}^ be discharged during birth, and yet the child not be born alive. State of the Skin. — In the greater numljer of newborn children the skin has a dark-red color, probably owing to the first effect of the atmosphere upon it. Within an hour it begins to get of a lighter red, and so it remains for one or two days. According to Elsasser, it becomes again darker about the end of the second or on the third day, and is then of a brownish-red color. This lasts for three or four days, unless a yellowness appears from jaundice. It is about the sixth or seventh day that the skin acquires the reddish-white color such as it afterwards retains. (Ilenke's Zeitschr. der. S. A., 1842, 2, p. 223.) Evidence from Changes in the Heart and Foetal Vessels. Docimasia Circidationis. — It has been supposed that the state of the ductus arteriosus, ductus venosus, and foramen ovale would aid a medical jurist in forming an opinion whether a child had survived its birth. In general, as a result of the establishment of respiration, it is found that the communication between the auricles of the heart by the foramen ovale becomes closed ; and that the two vessels or ducts, after gradually contracting, become 580 DOCIMASIA CIRCULATIONIS. obliterated or are converted into fibrous cords. Whatever may be the con- clusions from ex[)eriments on the lunys, it has been contended that the closure of the foramen and of these vessels would infallibly indicate that a child had breathed. This inference, however, has been too hastily drawn. Researches have shown that there are some serious objections to any con- clusions based on the state of these foetal vessels ; their closure, as a natural proce.ss, always takes place slowly and sometimes it is not completed until many years after birth. Thus, tjien, in the .n'cnerality of cases of infanti- cide,' in which necessarily the child survives but for a short period, no evi- dence of the fact will be procurable from an examination of the heart and foetal vessels. As a general rule, the peculiar parts of the foetal circulation are rarely obliterated by a normal process before the eighth or tenth day after birth. The obliteration follows no certain order. The statistical facts collected by Elsasser proved that the vessels peculiar to the foetal circulation remain open as a rule for some time after birth, and that it is not possible to determine accurately, by days, the period of their closure. The closure commenced and was often completed in the ductus venosus before it manifested itself in the other vessels. The complete closure, in by far the greater number of cases, takes place within the first six weeks after birth, and the in- stances of obliteration before birth, or before the period mentioned after birth, must be regarded as rare exceptions. (Med. Times and Gaz., 1853, i. p. 5.30.) From these facts, the docimasia circulationis may be considered as useless to a medical jurist. It either proves nothing or it may lead to an error. It is the more necessary to point out the fallacies to which it is liable, because hitherto medical jurists have been disposed to place great reliance upon it in cases in which medical evidence from the state of the lungs was wanting. Evidence from the State of the Alimentary Canal. — The presence of frothy air-bul)l)les in the glairy contents of the stomach of a newborn child was thought by Tardieu to indicate live birth for ten or fifteen minutes at the least ; but the same frothy condition might be produced by attempts to inflate the lungs. Breslau found that in stillborn children no air is found in the stomach or intestinal canal ; hence the stomach and bowels as a whole sink in water. The presence of air in the stomach depends on respiration, and proba))ly reaches the stomach with the first attempt to respire. As breathing proceeds, the air finds its way into the intestines ; hence the stomach and bowels float in water when the child has re- spired. The lower the portion of the bowels that floats in water, the greater is the probability that the child survived its birth. (Ann. d'Hyg., i8G8, t. 2, p. 224.) Good evidence of live birth may be sometimes derived from the dis- covery of certain liquids or solids in the stomach and intestines, such as blood, milk, or farinaceous or saccharine articles of food; for it is not at all probable that the.se substances should find their way into the stomach or intestines of a child which was really born dead. 1. Starch. — In the case of a newborn child Geoghegan discovered by the application of iodine-water the presence of farinaceous food in the contents of the stomach ; hence the question of live birth was clearly settled in the affirmative. On another occasion Francis employed this method of testing, with satisfactory results, in a case in which the inves- tigation was beset with unusual difficulties. He was required by the coroner to examine the body of a newborn child found under suspicious circumstances. The examination of the lungs left no doubt that respiration had taken place ; and the fact that the child had been born alive was fully DETECTION OF SUBSTANCES IN THE STOMACH, 581 established by the discovery in the stomach of a small quantity of fari- naceous food. On digestin;;' in distilled water a fragment of the pulp found in this organ and adding a drop of a solution of iodine an intense indigo-blue color appeared immediatel}'. The application of this chemical test, therefore, removed any doubts which might have been entertained on the question of the live birth. (Lond. Med. Gaz., vol. xxxvii. p. 4C0.) The editor met with a similar case. The quantity of starch present may, however, be too small to produce with water a solution which would be colored by iodine in the numner described. A portion of the contents of the stomach should be placed on a glass slide, if viscid diluted with a little water, and examined under the microscope with a power of about 300 diameters. The granules (if present) may then be distinctly seen, having the shape peculiar to each variety of starch, and not unfrequently mixed with oil-globnles and epithelial scales derived from the mucous membrane. By the addition of iodine water their shape and size will be brought out by the blue color which they acquire. Blue fragments of an irregular shape indicate the presence of bread. The annexed engraving (Fig. 50) represents two varieties of starch either of which may be found in the stomachs of infants: in a the rounded gran- ules of wheat-starch are represented; and in h the ovoid granules of arrowroot. The micrometrical measurements of these gran- ules show for those of wheat, which are irregularlv spherical, diameters varying from 0.0001 toO.0009 inch in size; many have an average diameter of 0.00033 inch. The ovoid graiiule of arrowroot is 0.0011 inch in length and 0.0006 inch in width. 2. Sugar. — In a case which the author was required to examine, the presence of sugar was readih^ detected in the contents of the stomach by the application of Trommer's test. In order to apply this test a few drops of a weak solution of sulphate of copper should be added to a portion of the cold concentrated aqueous extract of the contents of the stomach. An excess of a solution of caustic soda is then added and the liquid boiled. If grape-sugar be present suboxide of copper is immediately precipitated of a yellowish or reddish color. With white cane-sugar the same precipitation is effected only when the solution is first boiled with dilute hydrochloric acid. If starch only is present, black oxide of copper may be thrown down, but there will be no produc- tion of a red precipitate. The formation of the red oxide of copper under these circumstances proves that some saccharine substance is present. In reference to the application of the sugar-test, however, it must be remarked that starch is easily convertible into maltose and grape-sugar by a chemical action of saliva or mucus, so that the test may appear to indicate sugar in small quantity, when the result may be really due to the presence of converted starch. 3. Milk. — This liquid may be found in the stomach of a newborn child ; it may be identified by the microscope in the fluids of the stomach by the numerous and well-defined oil-globules which it contains. It is not pos- sible to distinguish human from cow's milk under the.';e circumstances. In both the globules which are spherical in all aspects (Figs. 51 and 52) are remarkable for their transparency in the centre and their dark margins. They vary considerably in size. The author found those of the cow to a. Granules of b. Granules of Water starch. Arrowroot. Magnified 319 diameters. 582 EPITHELIAL SCALES IN THE STOMACH, have by nieasiireiiient the followiiitj diameters: Maxinnim, 0.00045 iDch ; niinimuin, 0.00000 inch; and niediiim size, 0.000'22 inch. They are dis- tint'ui.shed from blocid-corpuscUvs by their sliai)e and lustre, and from starch-granules by the fact that they are not colored or changed by Fig. 51. Fis;. 52. Oil-globules of Oil-globules of Human Milk. Cow's Milk. Magnified 319 diameters. Oil-globules of Colostrum with Human Milk, granular bodies. Magnified 450 diameters. iodine-water. Colostrum is the name applied to the milk first secreted after delivery ; it contains in addition to oil-glubules numerous spherical granular liodies (Fig. .52, b). When milk is present milk-sugar is gene- rally found in the contents of the stomach by the appropriate sugar-test (p. OSl). The casein of milk precipitates sulphate of copper ; but on adding an excess of a solution of soda the precipitate is redissolved, forming a purple or violet-colored solution. It is rapidly coagulated by the digestive matter contained in the gastric juice, so that the casein may be found in small soft masses adhering to the lining membrane of the stomach. It should be observed that albumen forms a deep violet-colored solution with sulphate of copper and soda, but the red suboxide of copper is not precipitated on boiling unless sugar is present 4. Epithelial Scales. — The epithelial scales commonly found associated with articles of food in the stomach are of various shapes and sizes ; they are flat, oval or rounded, and sometimes polygonal. They are nucleated, and from their pavement-like appearance they are called " tessellated." In Fig. 5.3, b, an epithelial scale from the mucous membrane of the inside of the mouth is represented magnified 570 diameters. In the long axis it was 0.002 inch, and in the shortest 0.001 1 inch in diameter. The central nucleus was 0.00025 inch in diameter, and the small granules around it 0.0001 inch. These epithelial scales are very numerous, much intermixed, and so thin and trans- parent that they are often only distinctly seen at the edges, which are occasionally folded or slightly turned over. Besides the substances mentioned, other solids and fluids, such as blood and me- conium (the fecal discharges of the foetus), may be found in the stomach of a new- born child, and a question may arise whether their presence indicates that the child was fully born. It is not impossible that a child miirht be fed and might exer* FiK. 53. Tessellated Epithelial Scales: from Sharpey ; b, from observation. LIVE BIRTH — MEDICAL PROOFS. 583 a power of swallowing when its head had protruded from the outlet, and its body was still within the bod}' of the mother. Children have been known to exert a power of sucking or aspiration under these circumstances, and, with this, a power of swallowing might be exercised. In defending a prisoner on a charge of child-murder counsel would scarcely resort to a defence of this kind. That the starch, sugar, or milk, etc,, found in the stomach should have been given to a child when its body was only half- born, is so improbable an hypothesis that the most inexperienced lawj'er •would hardly resort to it to account for the presence of food in this organ. When the substances found in the stoniach are not in the form of food, but are fluids connected with the child or the mother, the case is different. These may penetrate into the lungs or stomach during birth, either by aspiration or by the act of swallowing; they thus indicate that the child was living, but they do not necessarily show that its body was entirely in the world when they were swallowed. 5. Blood. — An instance is related by Coring in which a spoonful of coagulated blood was found in the stomach of a newborn child. The inner surfaces of the gullet and windpipe were also covered with blood. Doring inferred from these facts that the child had been born alive ; for the blood, in his opinion, could have entered the stomach only by swallowing, after the birth of the child, and while it was probably lying with its face in a pool of blood. Taken alone, however, such an inference would not be justifiable from the facts as stated. Blood might be accidentally drawn into the throat from the discharges of the mother during the passage of the child's head through the outlet, and yet the child may not have been born alive. The power of swallowing may be exerted by a child during birth, either before or after the act of breathing. This power appears to be exerted even by the foetus in xitero. Blood may be recognized in the con- tents of the stomach, not only by the color which it imparts to the mucous liquids present, but by the aid of the microscope. Robinson finds that the substances which naturally exist in the stomach of a fffitus before birth are of an albuminous and mucous nature. His observations were made on the stomachs of two human foetuses, and on those of the calf, lamb, and rabbit. The conclusions at which he arrived were — that the stomach of the foetus, during the latter period of its uter- ine existence, contains mucous and albuminous matters derived from the salivary secretion ; and that gastric juice is not secreted until after respir- ation has been established. The medical jurist will i>erceive, therefore, that the discovery of farinaceous food, milk, or sugar in the stomach will furnish evidence of birth, since substances of this kind are not found nat- urally in this organ. 6. 3Ieconiiim. — This name is applied to the excrementitious matter produced and retained in the intestines during fcetal life. It may be found in the stomach of a newborn child, and a question will thence arise whether its presence there should be taken as a proof of entire live birth. It may be discharged from the child during delivery, in cases in which there is a difficult or protracted labor. During the act of breathing it may enter the throat with other discharges, and thus be found in the stomach. That a breathing child can thus swallow meconium cannot be disputed, but, assuming that, in the body of a child which has not lived to breathe, this substance is found in the air-passages and stomach, how is the conclusion affected? From a case which occurred to Fleisher, it is probable that as some portion of the meconium may be discharged from the bowels of a child during labor, and as the mouth passes over this liquid a portion may be drawn into the throat by aspiration. When once 584 MECONIUM IN THE STOMACH, Fig. 54. there the instinctive act of swallowing would imnicdiately conve}' a por- tion of it into the stomach. (See case in Vierteljahrsschr. fiir Gerichtl. Med., 18G3, Bd. 1, p. 97 ; also for another case, Med. Times and Gaz., 18G1, ii. p. 116.) The same remark applies to the urine. The presence of fluids, therefore — such as blood, meconium, or the watery discharges attending delivery — in the stomach and air-passages of a newborn child, does not prove live birth, but merely indicates the exist- ence of some living actions in the child at or about the time of its birth. A woman was suddenly delivered of a child while sitting over a slop-pail of dirty water. On examining the body, it was obvious that it had not breathed. There was no air in the lungs, but a (puintity of dirty water like that in the pail was found in the stomach. This could have entered the organ only by the act of swallowing, and, in Ramsbotham's opinion, the child had swal- lowed the liquid under some foetal attempt to ])reathe. The coroner who held the inquest directed the jury that the child was born dead: but most physiologists will consider that the power of swallowing cannot be exerted by a dead child ; and as its body must have beea entirely delivered in order to have fallen into the liquid, there was proof that it had been bora living, and that in this instance it had died after it was entirely born, by the prevention of the act of breathing. The facts connected with the aspiration of liquids by newborn children have been fully examined by Hofmann. (Viertel- jahrsschr. fur Gerichtl. 'Med., 1873, Bd. 2, p. 228.) The meconium may be generally recognized by its dirty-green color and general appearance, as well as by the absence of any offensive odor, which it does not acquire until after the third or fourth day from birth, when it becomes mixed with feculent matter. Its microscopical characters are represented in the above engraving (Fig. 54). In the air-passages it is sometimes associated with vernix caseosa, and hairs derived from the skin. (Med. Times and Gaz., 1861, i. p. 591, and 1861, ii. p. 117; see also Ann. d'Hyg., 1855, t. 2, p. 445.) But little need be said on its chemical proi)erties ; still, as the detection of stains of meconium on clothing may occasionally form a part of the medical evidence, a few observations are here required. The stains which it produces are of a brownish-green color, very difficult to remove by washing. They stiffen the stuff, and are usually slightly raised above the surface, without always penetrating below it. Meconium forms Avitb water a greenish-colored liquid, having an acid reaction, and a boiling tem- perature does not affect the solution. Nitric acid and sulphuric acid with sugar yield with it the green and red-colored compounds which they pro- duce with bile. Cholesterin may be separated from it by hot ether. Huber has subjected meconium to an elaborate investigation. Accord- ing to him, the most important substance, medico-legally considered, met with in meconium is a greenish-yellow body which gives it its dark-green color. These bodies are admirably depicted by Tardieu. (Sur I'lnfanti- cide, plate 2.) They are ol)long, elliptical, of oval or roundish contour, not unfrequently flaky and with rounded angles^ and are very variable in Microscopical appearances of Meconium: <', crystals of cho- lesterin; b, epithelial scales; c, masses of green coloring mat- ter of bile (biliverdin); '/, e, granules; magnified 400 diam- eters. DISTINGUISHING CHARACTER OF MECONIUM. 585 size, some being excessively niinute, others as large as the epithelial cells depicted in Fig. 53, p. 582. They are homogeneous in structure, and, being envelo])ed in mucus, it is ditlicult to ascertain the action of chemical reagents upon them ; but they are unaltered by acetic acid and solution of potash, but soluble in ether. Iluber held that the discovery of these bodies in stains is characteristic of the presence of meconium. (Fried- reich's Blatter fiir Gerichtl. Med., 1884, pp. 24, 142.) Ruber's memoir contains a complete bibliography of all that relates to meconium. It may be remarked, in reference to stains produced by the feces of a child which has survived birth, that until the fifth or sixth day they re- tain a dark-green or greenish-yellow color. On the seventh day after birth they generally acquire a bright-yellow color, like that of the yolk of egg ; and, if the child is in health, they will retain this color during all the time that it is suckled. 7. Ear-test. — Wreden has pointed out that the middle ear of a newborn child is filled with epithelial cells or metamorphosed embryonal connective tissue ; and that this becomes absorbed or removed shortly after birth if the child be alive. The presence of a distinct cavity in the middle ear hence becomes an inporiant factor in determining that a child has survived its birth. (Lancet, 1877, ii. p. 741.) The editor has found this test useful in several cases. The slightest consideration will show that the various indications of live birth above described are weak and of purely accidental occurrence. If a child is destroyed either during birth, or within a few minutes afterwards, there will be no medical evidence to indicate the period at which its de- .struction took place : the external and internal appearances presented by the body will be the same in the two cases. It is most probable that, in the greater number of instances of child-murder, a child is actually destroyed either during birth or immediately afterwards ; and, therefore, the characters above described can rarely be available in practice. If any exception is made, it is with respect to the nature, situation, and extent of marks of violence ; but the presence of these depends on mere accident. Hence, then, we come to the conclusion that, although medical evidence can generally show, from the state of the lungs, that a child has really lived, it can rarely be in a condition to prove, in a case of infanticide, that its life had certainly continued after its entire birth. We could only ven- ture upon this inference when the signs of breathing were full and com- plete, or when some article of food was found in the stomach. Conclusions. — The general conclusions which may be drawn from the facts contained in this chapter, on the question whether a child has or has not been born alive, are as follows : — 1. That if the lungs are fully and perfectly distended with air by the act of breathing, this affords a strong presumption that the child has been born alive, since breathing during birth is in general only partial and imperfect. 2. That the presence of marks of severe violence on various parts of the bod}^ if possessing vital characters, renders it probable that the child had been born alive when the violence was inflicted. 3. That certain changes in the umbilical vessels, and the separation (by a vital process) and cicatrization of the navel-string, as well as a general peeling or scaling-off of the cuticle, indicate live birth. 4. That the absence of meconium from the intestines, and of urine from the bladder, are not proofs that a child has been born alive, since these liquids may be discharged during the act of birth. 5. That the open or contracted state of the foramen ovale or ductus 586 CAUSES OF DEATH IN NEWBORN CHILDREN. arteriosus furnij^hes no evidence of a cliild having been born alive. These parts may become closed and contracted before birth, and therefore be found closed in a child born dead ; or they may remain open after birth in a child born living, even subsecjuently to the establishment of respiration. 6. That the presence of air and of farinaceous or other food in the stomach and boivels proves that a child has been entirely born alive. 7. That the presence in the stomach and air-passages of blood, meconium, vernix caseosa, or the natural discharges, does not prove that a child v^'^as born alive. 8. That the presence of an air-cavity in the tympanum, or middle ear, affords additional evidence of live birth. 9. That, irrespective of the above conclusions, there is no certain medi- cal sign which indicates that a child that has died at or about the time of birth — has been born alive. CHAPTER LII. CAUSES OF DEATH IN NEWBORN CHILDREN. PROPORTION OF CHILDREN BORN DEAD.^ NATURAL CAUSES OF DEATH. A PROTRACTED DELIVERY. DEBILITY. BLEEDING FROM LACERATION OF THE NAVEL-STRING. COMPRESSION OF THE NAVEL-STRING. MALFOR- MATION. DESTRUCTION OF MONSTROUS BIRTHS. DEATH FROM CONGENITAL DISEASE. Causes of Death in Newborn Children. — The next important question in a case of infanticide, and that upon which a charge of murder essentially rests, is — What was the cause, of death ? 1. It is admitted that a child may die during birth or afterwards. 2. In either of these cases it may die from natural or violent causes. The violent causes may have origin- ated in accident or in criminal design. The last condition only involves the question of child-murder. If death has clearly proceeded from natural causes, it is of no importance to settle whether the cause operated during or after birth. All charge of criminality is henceforth at an end. It is well known that of children born under ordinary circumstances a great number die from natural causes either during birth or soon after- wards ; and in every case of child-murder death will be assumed-to have arisen from some cause of this kind, until the contrary appears from the medical evidence. This throws the onus of proof entirely on the prose- cution. Many children die before performing the act of respiration, and thus a large number come into the world dead or stillborn, The pro- portion of stillborn among legitimate children, as it is derived from statistical tables extending over a series of years, and embracing not fewer than eight millions of births, varies from one in eighteen to one in twenty of all l)irths. (Brit, and For. Med. Rev., No. 1, p. 235.) In immature and illegitimate children, forming the greater number of those which give rise to charges of child-murder, the proportionate mortality is much greater — probably about one in eight or ten. Stilll)irths are much more frequent in first than in after-pregnancies; and children are much more frequently born dead among primiparous than among pluriparous women. Males are more often stillborn than females. According to Lawrence's observations, the proportion of deaths is 1 to 1 1 among the primiparous, and I to 31.2 among the pluriparous. (Edin, Med. Jour., March, 1863, p. 814.) In most cases of child-murder, the woman is primiparous. These DEATH FROM NATURAL CAUSES. 587 facts should be borne in mind when we are estimating' the probability of the cause of death being natural. Should breathing- be established by a protrusion of the child's head from the outlet, or during the birth of the body, the chances of death from natural causes are considerably diminished. Nevertheless, as W. Hunter long ago suggested, a child may breathe and die. Thus, according to this author, "If the child makes but one gasp and instantly dies, the lungs will swim in water as readily as if it had breathed longer and had then been strangled." In general, it would require more than one gasp to cause the lungs to float readily in water ; but, waiving this point, the real question is — If the child breathed either during or after birth, what could have caused its death ? The number of gasps which a child may make, or which may be required for the lungs to swim in water, is of no moment ; the point to be considered is, whether its death was due to causes of an accidental or criminal nature. So again observes Hunter : " We frequently see children born, who, from circumstances in their constitution, or in the nature of the labor, are but barely alive, and after breathing a minute or two, or an iiour or two, die, in spite of all our attention. And why may not this misfortune happen to a woman who is brought to bed by herself?" The substance of this remark is that many children may die naturally after having been born alive; and in Hunter's time these cases were not, perhaps, sufficiently attended to. In the present day, however, the case is different ; a charge of child-murder is seldom raised, except in those in- stances where there are the most obvious marks of severe and mortal injuries on the body of a child ; and it must be admitted that the discovery of violence of this kind on the body of a newborn infant renders a full in- quiry into the circumstances necessary. Among the vatural causes of the death of a child may be enumerated the following : — 1. A Protracted Delivery. — The death of a child may proceed, in this case, from injury suffered by the head during the violent contractions of the womb, or from an interruption to the circulation in the umbilical cord before the act of breathing can be performed. As it is elsewhere explained {post, pp. 588, 590), each contraction of the womb affects the placental circulation, and a succession of these contractions in a protracted delivery will have the same effect on the child as the arrest of breathing after birth, i. e. non-oxygenated blood will be circulated and may cause the death of the child. For a similar reason, a premature separation of the placenta may lead to its death. A child, if feeble and delicate, or if prematurely born, may die from ex- haustion under these circumstances before respiration is established. This cause of death may be suspected when a serous tumor (or caput succe- daneum) is found on the head of a child and the head itself is deformed or elongated as a result of pressure ; or an effusion of blood {cephalhse- mafovia) is found beneath the pericranium. These appearances will be accompanied with a congested state of the vessels of the brain. The ex- istence of deformity in the pelvis of the woman might corroborate this view ; but in primiparous women (among whom charges of child-murder chiefly lie) with well-formed pelves delivery is frequently protracted. It is presumed that there are no marks of violence on the body of the child, ex- cepting those which may have reasonably arisen from accident in attempts at self-deliver}^. 2. Debility. — A child may be born either prematurely or at the full period, and not survive its birth, owing to a natural feebleness of system. This is observed among immature children ; and it is a condition especially dwelt on by W. Hunter. Such children may continue in existence for 588 BLEEDING FROM LACERATION OF THE NAVEL-STRING. several hours, breathing feebly, and may then die from mere weakness These cases may be recoiinized by the immature condition of the body and the appearance of a general want of developn)ent. 3. ■ Bleed i)v/ from Laceration of the Navel-string. — A child may die iponi loss of blood, owing to a sudden separation of the placenta, or an accidental rui)ture of the navel-string. In the latter case, it is said the loss of I)lood is not likely to prove fatal if I)reathing has Ijeen established ; but an instance is reported in which a child died from l)leeding even under these circumstances. (Henke's Zeitschrift, 1839, Erg. ]I., p. 200; also 1840, Bd. 1, p. 347, and Bd. 2, p. 105; Ann. d'liyg., 1831, t. 2, p. 128) Bleeding from the cord has been observed to take place at various periods after bii-th, and to have led to the death of the child. (Edin Month. Jour., July, 1847, p. 70.) Death from bleeding may be commonly recognized by the ])lanched appearance of the body and a want of blood in the in- ternal organs; but there are several instances on record in which the cord was ruptured close to the abdomen without causing the death of the child. Bleeding from the vessels of the navel-string may prove fatal several days after birth, even when a child has been properly attended to, and the navel- string has separated by the natural process. A case of this kind is reported in which, in spite of every application, the child died from loss of blood six days after the cord had separated. (Med. Times and Gaz., 1854, i. p. 287.) The impossibility of arresting the bleeding in this case appeared to depend upon a great deficiency of fibrin in the blood, and a consequent want of tendency to coagulation. ( Wieczorek, Vierteljahrsschr. fur Gerichtl. Med., 1873, Bd. 1, p. 385.) It has been believed that the danger arising from bleeding of the cord was chiefly confined to those cases in which it was divided near to the abdomen, and where a cutting instrument had been used ; and this is no doubt generally true. Page performed some experiments on this subject, which showed that hemor- rhage might take place from the divided navel-string, even when torn through at a length of eighteen inches from the body and to such an extent as to endanger the life of a child. He also found that hemorrhage from the cord might take place without any interference with the respiration ; but the arrest of this may lead to hemorrhage which might not otherwise have occurred. If there are severe wounds on the body from which blood has issued, it would be obviously wrong to refer a blanched condition of the body to acci- dental bleeding from the cord. The fatal bleeding may really have arisen from the wounds. Before a medical expert refers death to this cause, he should be well assured that the cord was really torn through or severed about the time of birth and not from any accident subsequently. A case is reported which shows the necessity for this caution. The body of a newborn child was taken from a river in which it had probably been floating for nearly a fortnight. The placenta and cord were attached to the body, but in removing it from the water the cord was torn through and the placenta carried away by the stream. A medical man examined the body, and, seeing the cord ruptured and observing no marks of violence, he came to the conclusion that the cord had been torn through by the woman at birth and that the child had died from hemorrhage. (Ann. d'Hyg., 1873, t. 2, p. 443.) The medical opinion, however, was disproved by the evidence of witnesses. 4. Compression of the Navel-string. — When a child is born by the feet or buttocks the cord may be so compressed under strong uterine contrac- tion that the circulation between the mother and child will be arrested, MALFORMATION MONSTROSITY. 589 and the latter will die. The same fatal compression may follow when, ilaring- delivery, the cord becomes twisted round the neck. A child lias been known to die under these circumstances before parturition, the cord havinij become twisted round its neck in the uterus. (Lond. Med. Gaz., Oct. 1840, p 122 ; also vol. Ixxix. pp. 232, 233.) Davis reported a case where it is probable that the child, which was heard by the mother to cry for some time, was strangled by the mother having moved her body away from the infant after delivery, and thus tightened the navel-string. (Brit. Med. Jour., 1882, ii. p. 1069.) On these occasions the child is sometimes de- scribed to have died from strangulation, but it is evident that, before the establishment of respiration, such a mode of expression is improper. There are few or no appearances indicative of the cause of death. There may be lividity about the head and lace, with a mark or furrow on the neck, and congestion of the brain internally ; it is, however, necessary to remember that vessels of the brain of a child are always more apparent than those of an adult. Hofmann considers that asphj'xia is really the -cause of death in children which have not breathed. He looks upon the placental circulation as vicarious to that of the lungs after birth, the arterial blood from the woman supphnng the oxygen (derived from respir- ation) necessary to support the life of the unborn child. The amount of oxygen required for this purpose is exceedingly small, and, according to Schwartz and Pfliiger, it is not sufficient to produce any difference of color in the blood of the umbilical vessels. (Vierteljahrsschr. fiir Gerichtl. Med., 1873, Bd. 2, pp. 219, 224.) Although, under compression of the cord, a child may die before breathing, from the want of a proper supply of oxygen through the blood, yet the appearances presented by the lungs would differ from those which are found in these organs after breathing has been once established. 5. Malformation, llonstrositi/. — There may be a deficiency or defect of some vital organ which would at once account for a child dying either during delivery or soon after its birth. Two cases are reported, in one of which the child died from an absolute deficiency of the gullet, the pharynx terminating in a cul-de-sac ; in the other the duodenum was obliterated for more than an inch, and this malformation had occasioned the child's death. (Lond. Med. Gaz., vol. xxvi. p. 542.) In a third, a child was suffocated by the retraction of the base of the tongue, owing to defect of the fraenum. (North. Jour. Med., 1849, p. 278.) The non-establish- ment of respiration sometimes arises fi'om the mouth and fauces of the child being filled with mucus. An enlargement of the thyroid gland has occasionally led to the death of a newborn child by suffocation. (Edin. Month. Jour., July, 184T, p. 64.) The epiglottis is sometimes fixed over the glottis so as to prevent the entrance of air. In a case of this kind which occurred to Hicks, a child was saved by the introduction of a finger : the air suddenly rushed in, and the child was then enabled to breathe. But a child may be born in this state when no person is at hand to assist the woman : in this case it will die ; and the lungs being found in the foetal or unexpanded condition it will be pronounced still- born. 01)struction of the air-passages is a frequent cause of death among newborn children. The varieties of inalformation are very numerous, but there can be no difficulty in determining w^hether they are such as to account for death. Persons are not allowed to destroy monstrous births; and the presence of any marks of violence in such cases should be regarded with suspicion. It is the more necessary to make this statement, as there is an idea among the vulgar that it is not illegal to destroy a monstrous birth. A 590 SPASMS OF THE LARYNX — CONGENITAL DISEASES. ladv^ was delivered of a hideous two-lieadcd monster. At the earnest solicitations of the friends the nurse destroyed it. The question was — > Was this woman guilty of murder? The only case in reference to this point, which is recorded by medico-legal writers, is that of two women who were tried at the York Assizes in 1812 for drowning a child which was born with some malformation of the head, in consequence of which it was not likely that it could survive many hours. It did not appear that there had been any malice or concealment on the part of the prisoners, who were not aware of the illegality of the act. (Paris and Fonblanque, Med. Jur., vol. i. p. 228.) The al)sence of malicious intention would probablv lead to an acquittal on the charge of murder; but such an act would doubtless amount to manslaughter, as the degree of monstrosity or the viability of the offspring cannot be received as an extenuating circum- stance. As to the first., if a liberty of judging of what was monstrous and what not were conceded to any ignorant nurse children simply deformed might be put to death on this pretence ; as to the second, it is held in law that whoever accelerates death causes it ; hence the fact that a child is not likely to live more than a few hours does not justify the act of one who prematurely destroys it. 6. Spasms of the Larynx. — Some children are born alive, and on com- ing into the world make attempts to breathe, but, owing to spasms of the larynx and retraction of the tongue, the air is unable to enter ; the child dies soon after birth, and on inspection no air being found in the lungs, the child is wrongly pronounced to have been born dead. (Guy's Hosp, Rep., 1866, p. 476.) A careful examination of the fauces may show the presence of mucus or meconium, or a condition of the epiglottis which may account for the obstruction to respiration. Hicks has on more than one occasion seen the newborn child make these inspiratory efforts, and by lifting the epiglottis has given free passage to the air, and the child has been saved. 7. Atelectasis. — Atelectasis, as it has been elsewhere explained {ante, p. 567). implies simply an unexpanded state of the lungs. In some cases it is complete, in others partial. It can scarcely be regarded as a diseased condition, as the body of a child may be otherwise healthy ; the lungs themselves are in a normal state, and they can be easily expanded by the artificial introduction of air, or by other remedial measures, when assist- ance is at hand. This imperfect expansion of the lungs is generally due to debility in the child, and it is especially a cause of death in weakly or iinniature children. But strong and healthy children may die from simple non-inflation of the lungs. Assuming that in utero the child lives by what has been called " pla- cental respiration," ^. e. a continuous supply of sufficiently oxygenated blood from the woman, another explanation may be ofTered. If anything should arrest the placental circulation during labor by interrupting the flow of blood to the child through the umbilical cord, this may cause its death before pulmonary inspiration can be established. The child is born asphyxiated, and this may explain the state of atelectasis. Every con- traction of the womb more or less interrupts placental respiration as it is above defined. The child lives inside the womb by the placenta, and out- side by the lungs. If the action of the placenta is destroyed before that of the lungs can be set up, this would exi)lain the condition known under the name of atelectasis. (See a paper by Hofmann, Vierteljahrsschr. fUr Gerichtl. Med., 1873, 2, p. 219.) 8. Congenital Diseases. — It has been elsewhere stated (p. 567, ante) that a child may be born laboring under such a degree of congenital dis- CONGENITAL DISEASES. 591 ease as to render it incapable of living-. The discovery of any of the foetal organs merely in a morbid condition amounts to nothing unless the dis- ease has advanced to a deg-ree which would be sufficient to account fof death. There are, doubtless, many obscure affections, particularly of the brain, which are liable to destroy the life of a child without leaving any well-marked changes in the dead body. According to Burgess, apoplexy and asphyxia are common causes of death among newborn children. (Lend. Med. Gaz., vol. xxvi. p. 492 ; Henke's Zeitschrift der S. A., 1843, p. 67.) Probably diseases of the lungs are of the greatest importance in a niedico-legal point of view ; because, by directly affecting the lungs, they render it impossible for a child to live, or to survive its birth for a long period. These diseases in the foetal state are principally congestion, hepatization, tubercle, scirrhus, oedema, the existence of any of which it is not difficult to discover. They render the structure of the lungs heavier than water, and thus prevent the organs from acquiring that buoyancy which in their healthier state they are known to possess. It is not com- mon to find the lungs diseased throughout — a portion may be sufficiently healthy to allow of a partial performance of respiration. Conclusions. — The following conclusions may be drawn from the pre- ceding remarks : 1. That a large number of illegitimate children, especially when Im- mature, are born dead from natural causes. 2. That a child may die from exhaustion as the result of a protracted labor. 3. That if a child be prematurely born, or if it be small and weak even at the natural period, it may die from mere debility or want of power either to commence or to continue the act of breathing. 4. A child may die from loss of blood, owing to accidental rupture of the cord during delivery ; and may even die from this cause after it has breathed. 5. That fatal bleeding is more likely to occur when the cord has been cut close to the abdomen than when it has been lacerated or cut at a dis- tance from the navel. 6. That the division of the cord, whether by rupture or incision, with- out ligature, is by no means necessarily fatal to a healthy mature child. 7. That a child may die from accidental compression of the cord during deliver}^, the circulation between the mother and the child being thereby arrested before respiration has commenced. 8. That death may speedily follow birth from some malformation or defect, or from a defective condition of organs important to life. 9. That a child may die from congenital disease affecting the organs of respiration or the air-passages. 592 VIOLENT OAUSES OF DEATH. CHAPTER LIII. VIOLENT CAUSES OF DEATH. SUFFOCATION. DROWNING. DEATH OF THE CHILD FRO>C COLD AND EXPOSURE STARVATION. DEATH FROM IJIMATURITY. WOUNDS IN NEW- BORN CHILDREN. FRACTURES OF THE SKULL, ACCIDENTAL AND CRIMINAL. TWISTING OF THE NECK. VIOLENCE IN SELF-DELIVERY. POWER OP LOCOMOTION AND EXERTION IN FEMALES AFTER DELIVERY. Violent Causes of Death. — In this chapter we have to consider those modes of death which are totally independent of the existence of congen- ital disease or other natural causes. In most cases of alleged child-murder the body of the child bears about it the marks of physical injury, such as those which are indicative of strangulation, wounds, burns, and fractures. The marks of violence may be such as to leave no doubt that they were wilfully inflicted. In order to render either the woman or a confederate criminally responsible, it must be distinctly proved that the injuries were unlawfully inflicted on a legally living child, and that they were the cause of death. If the child has died after birth from violence carelessly or ignorantly inflicted during birth or afterwards, or from culpable negligence, this will constitute a case of manslaughter- A question of medical re- sponsibility may be raised under these circumstances, as where a medical maa is charged with having caused the death of a child by gross igno- rance and carelessness in the delivery of a woman. The following in- stance is reported. (Chitty's Med. Jur., p. 416 ; also Archbold, p. 345.) A mann anied Senior, an unlicensed medical practitioner, was tried for the manslaughter of an infant by injuries inflicted on it at its birth. The prisoner practised midwifery, and was called to attend the prosecutrix, who was taken in labor. The evidence showed that when the head of the child presented, the prisoner, by some mismanagement, fractured and otherwise so injured the cranium that the child died immediately after it was born. It was argued, in defence, that as the child was not born, but in ventre sa mere at the time the wounds and injuries were inflicted, the prisoner could not be guilty of manslaughter. The judge, however, held that as the child was born alive and had subsequently died from the vio- lence, the case might be one of manslaughter. This opinion was after- wards confirmed by the other judges, and the prisoner was convicted and sentenced to imprisonment. From the decision in this case it will be seen that, if the prisoner had effectually destroyed the child before it was en- tirely born, he would not have been guilty of any crime. Some of the causes of death in newborn children are unavoidable, others may be avoided by care and ordinary precautions. In some cases where the death of the child after its birth had been traced to culpable negligence on the part of the woman, judges have directed a verdict of manslaughter, and have inflicted a severe punishment — ten years' penal service. (Reg. V. Maynard, Devon Aut. Ass., 1871 ; Reg. v. Libbey, Cornwall. Aut. Ass., 1871, and Reg. v. Sell, Hereford Lent Ass., 1873.) In no case, however, have they dispensed with the proof that the child was born alive, either from medical or other evidence, or from the confession of the woman. Some general observations have been elsewhere made on the mode in which the dead body of a child in an alleged case of child-murder should be examined (ante, p. 558). A note of all marks of physical injury, how- SUFFOCATION. 593 ever slight in appearance, may be of importance in the case. There are some forms of child-murder which are not necessarily attended with marks of violence; thus a child may he criminally destroyed by suflTocation, drowning-, exposure to cold, or privation of food. It may die under these circumstances, and its body may present no unusual appearance. These modes of destroying- life will therefore first require consideration. 1. Suffocation. — This is a common cause of death in newborn children. A wet cloth may be placed over the child's mouth or thrust into the cavity, either during birth or afterwards and before or after the perform- ance of respiration. To the latter case only could the term " suffocation" be strictly applied. In Reg. v. Eley (C, C. C, Aug. 1878), a case of alleged manslaughter, the child was found dead with a pocket-handker- chief forcibly stutied into its mouth. The state of the lungs showed that it had breathed, but it bad not been heard to cry. According to the medical evidence, the child had died from suffocation. The defence was that there was no proof that it had been born alive. Notwithstanding the plain evidence as to the mode of death the jury acquitted the prisoner. A child may be destroyed by being allowed to remain closely compressed under the bed-clothes after delivery, or by its head being thrust into straw, feathers, ashes, and similar substances. Under these circumstances, the child is not suffocated, but dies from the prevention of breathing. The ap- pearances in the body in such cases are seldom sufficient to excite a suspicion of the cause of death, unless undue violence has been employed. There is commonly merely lividity about the head and face, with slight conges- tion of the lungs. A careful examination of the mouth and throat should be made, as foreign substances are sometimes found in this situation, affording circumstantial evidence of the mode in which the suffocation has taken place. Thus wood, straw, feathers, ashes, tow, or a hard plug of linen have been found blocking up the mouth and throat, drawn into these parts by aspiration when the mouth of a child has been covered with such substances. When a child is found dead under these circumstances, a question M'ill arise whether the ashes, dust, or other substances found in the air-passages have either been wilfull}^ thrust into the mouth and throat or accidentally drawn in by aspiration. Whether an accused person has placed the ashes in the mouth or buried the face of a child in them so that ihey might be thus drawn in, can make no difference in the nature of the -crime. If the ashes are in large quantity, of large size, firmly impacted, and the lining membrane of the mouth presents signs of laceration or bruising, there can be no doubt that violence has been used. Aspiration would not explain facts of this kind. Again, the cinders and other sub- stances may be found in the windpipe and bronchi, into which parts they could not have been forced by manual violence. In all these cases the mouth and fauces require careful examination. If a child has lived sufficiently long to be fed, it may be accidentally suffocated by the entrance of portions of solid food, such as the curd of milk into the windpipe and air-passages. A newborn child may be suffo- cated by having its head held over noxious vapors, such as the exhalations of a privy or of burning sulphur; and it is here necessary to remind a medical jurist that other highly poisonous vapors, e.g. chloroform or coal- gas (the agent used for the destruction of stray dogs in Paris), may be used by a criminal without leaving any indication in the body — except possibly for a short time that which may depend upon their peculiar odor. There are few of these cases of suffocation in which a positive medical opinion of the cause of death could be given unless some circumstantial evidence were produced and the witness were allowed to say whether the 38 594 ACCIDENTAL CAUSES OF SUFFOCATION. alleg-ed facts were or were not sufficient to account for death. (Ann. d'Hyg., 1832, t. 1, p. 691.) On the other hand, if it be even clearly proved that death has been caused by suft'ocation it must be remembered that a child may be acci' dentally suffocated and the crime of murder falsely imputed. Duncan, quotiii,i>- the observations of Buhl, states that obstruction of the air-pasS' ages by mucus and other matters is a frequent cause of death in newborn children. Among- twenty-seven children dying during birth or shortly after, eleven died from obstruction of the air-passages with foreign matters. Eight were born dead, and of those which were alive at birth not one survived the first day. In ten of the cases the obstruction was produced by a greenish or greenish-brown or slimy mass (meconium and mucus) filling the larynx and windpipe. In two of the cases in which the child died during delivery air was found in the lungs, and in only one of these the air had been derived from the act of breathing during birth. (Edin, Month. Med. Jour., April, 1863, p. 924; also Med. Times and Gaz., 1861, ii. p. 117.) In Hicks's case (p. 589, ante), the base of the tongue in a newborn child was so drawn down by spasmodic action as to close the glottis by pressing backwards the epiglottis. The child w^as saved by simply raising the epiglottis, when air rushed in and breathing was estab- lished ; but many children may be born under similar conditions when no assistance is at hand. Cases of this kind, however, rarely give rise to charges of child-murder, as no air is found in the lungs. A child might be killed during delivery by pressure applied to the chest; this might be such as not to produce any mark of violence. If the child had not breathed there would be nothing to indicate the mode of death ; if air had entered the lungs then the usual appearances will be found in these organs (p. 562). In dealing with a case of this kind it should be remem- bered that a child with its head born but detained in the outlet by the size of its shoulders might die from pressure exerted on the chest by the vagina. It might hav3 breathed but be born dead, with the marks of suffocation about it. There is another accidental cause of the death of a newborn child during delivery. The membranes or caul may be carried forward over the head and face, and the act of iK'eathing thus mechanically prevented. If no assistance is at hand, the child, though born living, will die soon after birth in consequence of the prevention of respiration. If, when the dead body is found, the membranes are no longer there, the cause of the prevention of respiration would not be apparent. The child, although born living, would probably be pronounced to have been born dead. (Med. Times and Gaz., 1863, i. p. 126.) The delivery of a child with a mask or caul around its head is not an unfrequent occurrence. In 1862, Blenkinsop communicated to the author a case in which a mature and healthy child so born was allowed to perish by those who had access to it. The caul was simply not removed, so that breathing could not be set up. The lungs contained no air. There was congestion of the brain and lividity of the body, but no mark of violence. There was some evidence that the child had been born living, and that the cause of death was the prevention of respiration by omission to do that which was necessary ; but as the medical evidence showed that the child had not breathed, the coroner held that it had never had any (legal) existence, and that there was no ground for further inves- tigation. W. Hunter, who was Vi'ell aware of the risk to which a woman might be thus exposed, observes in relation to this state of things : " When a woman is delivered b}^ herself, a strong child may be born perfectly alive, and die in a very few minutes for want of breath, either by being INFANTICIDE SUFFOCATION. 595 on its face in a pool formed by the natural discharges, or upon wet clothes; or by the wet tliiugs over it collapsing- and excluding air, or being drawn close to its mouth and nose by the suction of breathing. An unhappy woman delivered by herself, distracted in her mind and ex- hausted in her body, will not have strength or recollection enough to fly instantly to the relief of her child." It may be added that a primiparous woman may faint or be wholly unconscious of her situation ; or, if con- scious, she may be ignorant of the necessity of removing the child, and thus it may be suffocated without her having been intentionally accessory to its death. In such cases, however, there should be no marks of vio- lence on the body, or, if present, they should be of such a nature and in such a situation as to be readily explicable on the supposition of an acci- dental origin. (See Yierteljahrsschr. fiir Gcrichtl. Med., 1874, 2, p. 123.) An infant is easily destroyed by suffocation. It is a frequent form of infanticide. Tardieu stated that he had had the cases of 132 newborn children to examine, and in 12 of them he detected clear evidence of death by suffocation. (Ann. d'Hyg., 1855, t. 2, p. 372.) If the mouth and nostrils of a child are kept covered for a few minutes, by the face being closely wrapped in clothes, asphyxia may come on without this being indicated by convulsions or any other marked symptoms (see p. 458, ante). A suspicion of murder may arise in such cases; but the absence of marks of violence, with an explanation of the circumstances, will rarely allow the case to be carried beyond an inquest. Sometimes the body is found maltreated, with severe fractures or contusions on the skull, and marks of strangulation on the neck ; concealed in a feather-bed or privy ; or cut up and burnt. This kind of violence ma}^ properly excite a suspi- cion of murder, and lead to the belief that the allegation of death from accidental suffocation is a mere pretence. This, however, is purely a ques- tion for a jury, and not for a medical witness. Unless the case is of a glaring nature, the violence is considered to have been employed for the purpose rather of concealing the birth of a child than of destroying it. In the present day, these cases of death from accidental suffocation, when properly investigated, can never involve an innocent woman in a charge of murder, although the facts may show in many instances that the death of the child was really due to great imprudence, gross neglect, or culpable indifference on her part. When culpable neglect or reckless indifference to the life of a newborn child has been proved against a woman charged with murder, a verdict of manslaughter is usually returned. The appearances in the body in cases of death from suffocation have been elsewhere described, in reference to adults (p. 451) ; they are similar in newborn children, provided respiration has been fully performed. Tar- dieu attaches great importance to the discovery of subpleural ecchymoses in the lungs of children; he has also noticed small effusions of blood on the surface and in the substance of the thymus gland. (Ann. d'Hyg., 1855, t. 2, p. 379.) If the lungs float on water, as the re.^ult of breathing, then the appearances described will be met with; but it is worthy of re- mark that in three instances Tardieu met with similar appearances in children whose lungs had not received air, and sank when placed on Avater. There is no doubt that these ecchymoses are very valuable signs of suffo- cation. Douillard and Gallard have, however, met with them in death from natural causes. (Ann. d'Hyg., 1872, t. 1, p. 201.) They were children prematurely born, and under conditions which prevented full vital development. One uttered several cries, but in .spite of this the lungs contained no air. The subpleural ecchymoses met with in children under these circumstances are ascribed by Tardieu to the efforts made to breathe 596 DEATH FllOiM DKOWXING. after birth. Partial emphysema of the lungs is occasionally observed. Ssiibinski is of oi)inion that a bloodless condition of the spleen is a more serviceable sign of sulfocation. (Vierteljahrsschr. fiir Gcrlchtl. Med., 18()7, Bd. 2, p. 146.) Some remarks have been elsewhere made on the evidence derival)le from the presence of sul)i)leural ecchymoses (p. 453). In death from suffocation they are not always found, and in other forms of asjdiyxia they have been occasionally seen, so that they cannot be considered as characteristic of any farm. " In 1872, a servant girl had given birth to a healthy child. The child was found alive, about a quarter of an hour afterwards, in a privy, and it lived a few^ minutes after the discovery. Its jaw was broken, its cheek torn, and the mouth contained ashes, some of which were found in the back part of the throat. The body was blanched, and there had evidently been a great loss of blood from the wounds and the torn navel- string. There was no engorgement of the lungs, nor were there any sub- plearal ecchymoses. The lining membrane of the windpipe was stained with ashes, and a small cinder was found in the left bronchus. In this case there was no question respecting live birth, as the child was living when found. But what was the cause of death ? and was this accidental or the result of violence wilfully applied after birth? In the opinion of Moore, the mouth of the child had been forcibly torn open and filled with ashes in order to suffocate it; these ashes might have been then drawn by aspiration into the air-passages, and death caused partly by suffocation aad partly by hemorrhage from the w^ounds, the child's body being blood- less. The condition of the lungs w^as not inconsistent with death from suffocation. (For some remarks on death from suffocation in child-murder, with reports of cases, see a paper by Severin Causse, Ann. d'Hyg., 1869, t. 2, pp. 122, 443.) 2. Drowning. — The fact of drowning cannot bo verified by any appear- ances on the body of a child which has iiot breathed. Thus, if a woman caused herself to be delivered in a bath, and the child was forciblj^ re- tained under w^ater (a case which is said to have occurred), it would, of course, die ; but no evidence of the mode of death would be found in the body. After respiration the signs of drowning will be the same as those met with in the adult (see p. 401, ante). The main question for a witness to decide will be whether the child was put into the water living or dead. Infanticide by drov^^ning is by no means common; the child is generally suffocated, strangled, or destroyed in other ways, and its body is then thrown into water in order to conceal the real manner of its death. The fact of the dead body of an infant being found in water must not allow a witness to be thrown off his guard; although a verdict of " found drowned " is commonly returned in these cases, the body should be carefully inspected in order to determine what was really the cause of death. All marks of violence on the bodies of children that have died by drowming should be such as to have resulted from accidental causes. The throat and air- passages should be particularly examined. It is not necessary that the whole of the body of a child should be submerged in order that it may be destro3"ed by drowning; the mere immersion of the head in water or the covering of the mouth by liquid wnll suffice to produce the usual effects of asphyxia. The outlets of the ears and the air-passages should be examined for foreign substances which may be deposited in them. Newborn children may be drowned or suffocated by being thrown into mud or into the soil of a privy. Sometimes the child is destroyed by other means, and its body is thus disposed of for the purpose of concealment. Should there be HOMICIDAL AND ACCIDENTAL DROWNING. 597 a lar^e quantity of liciuid present, the phenomena are tliosc of drowning-. The liquid portion of the soil abounding- in sulphide of ammonium may be found, if the cliild was thrown in living, in the air-passages, gidlct, or stomach. The mere discovery of soil in the mouth would not suffice to show that the child was living when immersed ; but the presence of for- eign substances, such as dirt, straw, or ashes, in the air-passages, gullet, and stomach, has usuall}' been taken as a medical proof that the child was living when immersed, and that the solid substances had been drawn into the i)assages by aspiration or by the act of swallowing. On these occasions the defence ma}' be: 1, That the child was born dead and that the body was thrown in for concealment; but the medical evidence may show that it had breathed and had probaljly been born living. 2. It may be alleged that the child breathed for a few moments after birth, had then died, and that the woman had attempted to conceal the dead body. A medical witness may be here asked whether a woman could have had power to convey the body to the place — a point which must, as a general rule, be conceded. 3 It is commonly urged that the woman, being compelled to go to the privy, was there delivered vncon- scio»s/j!/ or unexpectedly ; that her waters had broken, and that she had no idea of anything more having happened ; or that the child had dropped from her, and was either suffocated or prevented from breathing. (Med. Times and Gaz., 1861, ii. p. 646.) All these circumstances may readily occur; but, on the other hand, such statements may be inconsistent with some of the medical facts. (See a case, Ann. d'Hyg., 1855, t. 2. p. 453; also Casper's Klin. Novel., 1863, p. 585.) Thus the head or the limbs of a child may be found to have been separated or divided by some cutting instrument, or a cord or other ligature may be found tightly bound around its neck, or there may be a tightly-fitting plug in the throat. Then, again, the body may be entire, but the navel-string- may be cleanly cut. This would tend to set aside the explanation of the child having accidentally dropped from the female ; because in such an accident the cord should always be found ru2')tured. The practitioner should make a careful ex- amination of the divided ends of the cord by the aid of a lens, or a rupture may be mistaken for a section with a sharp instrument. Higginson pub- lished a case of some interest in this point of view. The child fell from the mother, and the cord broke spontaneously. "The torn ends were," he states, "nearly as sharp-edged and flat as if cut." (Lond. Med. Gaz., vol. xlviii. p. 985.) This case goes to prove that a careless or hasty ex- amination of the ends of a cord may lead to a serious mistake. When the cord is lacerated, this will be, cseteris jMrihus, in favor of tlie woman's statement as to the mode in which her delivery occurred. Drowning may be the result of accident from sudden delivery. A woman in an advanced state of pregnancy while sitting on a chamber- vessel was suddenly delivered. The child fell into the fluids in the vessel and before assistance could be rendered it was dead. Whether in any in- stance the drowning of a child was accidental or criminal must be a ques- tion for a jury to determine from all the facts laid before them. The situa- tion in which the body of an infant is found may be consistent with the supposition of accident. Thus a child may be accidentally drowned by its mouth falling into a pool of the discharges during delivery, although this would be rather a case of suffocation. The throat, windpipe, and stomach of the child should always be examined on these occasions, as mud, sticks, straw, weeds, or other substances may be found in these parts, indicating, according to circumstances, that the child had been put into the water living and that it had been drowned in a particular pond or vessel. 598 IMMATURITY IN CASES OF ABORTION. 3. Cold and Et-posure. — A newborn child may be easily destroyed by simply exposing- it uncovered or but slightly covered to a cold atmosphere. In a case of this kind there may be no marks of violence on the body or these may be slight and evidently of accidental origin. In death from cold the only appearance occasionally met with has been congestion of the brain with or without serous effusions in the ventricles. (See Cold p. 499, ante.) The evidence in these cases must be purely circumstantial. The medical witness may have to consider how far the situation in which the body was found, the kind of exposure, and the temperature of the air would suffice to account for death from the alleged cause. ' There is no doubt that a newborn child may soon perish from ( xposure to a low tem- perature, and that warm clothing is required for the preservation of its life. An inspection of the body should never be omitted on these occa- sions, because it might turn out that there was some latent cause of natural death which would at once do away with the charge of murder. Admitting that the child had died from cold, it becomes necessary to in- quire whether it was exposed with a malicious intention that it should thus perish. Unless wilful malice be made out, the accused cannot be con- victed of murder, and unless culpable neglect is proved she cannot be con- victed of manslaughter. In general, women do not expose their children for the purpose of destroying them, but for the purpose of abandoning' them ; hence it is rare to hear of conviction for child-murder where cold was the cause of death, although some medical jurists have called this infanticide by omission. 4. Starvation. — A newborn child kept long without food will die, and no evidence of the fact may be derivable from an examination of the body. There may be uo marks of violence externally nor any patho- logical changes internally to account for death. This is a rare form of murder, except as it may be accidentally combined with exposure to cold. In order to convict the mother it is necessary to show that the child was wilfully kept without food with the criminal design of destroying it. Mere neglect or imprudence will not make the case infanticide. The only appearance likely to be found on an examination of the body would be complete emptiness of the alimentary canal. Without corroborative circumstantial evidence this would not suffice to establish the cause of death, and a medical witness could only form a probable conjecture on the point. In a suspected case of this kind the contents of the stomach should be tested for farinaceous and other kinds of food. 5. Immaturity in Gases of Abortion. — From the case of Reg. iJ.West (Nottingham Lent Ass., 1848) it would appear that if by the perpetration of abortion or the criminal induction of premature labor a child be born living at so early a period of uterine life that it dies merely from imma- turitij, the person causing the abortion or leading to the premature birth may be tried on a charge of murder. A midwife was alleged to have perpetrated abortion on a female who was bstween the fifth and sixth months of pregnancy. The child was born living but died five hours after its birth. There was no violence offered to it, and its death ap- peared to be due entirely to its immaturity. The prisoner was acquitted apparently on the ground that abortion might have arisen from other causes. In a case of this kind it must be clearly proved that the child survived its birth. Among those causes of violent death which leave on the body of the child marks or appearances indicative of the cause may be mentioned wounds, strangulation, and poisoning. INJURIES TO THE HEAD. 599 6. Wounds. — This is a frequent cause of death in eases of child-murder. Wounds may, however, be found on the body of a child wnich has died from some other cause. The principal questions which a medical witness has to answer are (1) whether the wounds were inflicted on the body of the child before or after death ; (2) whether they were sufficient to account for death ; and (3) whether they resulted from accident or criminal desig'n. The child may have been destroyed by burning, and evidence must then be sought for by an examination of the state of the skin. All these questions have been fully considered in treating the subject of Wounds and Burns, and they therefore do not require any special notice in this place. Incised wounds found on the bodies of newborn children may be referred to the use of a knife or scissors by the prisoner in attempting to sever the navel-string, and they may, therefore, be due to accident. This point should not be forgotten, for a wound even of a severe kind might be thus accidentally inflicted. In such cases we should always expect to find the navel-string cut and not lacerated. The end of it may, for the purpose of examination, be stretched out on a white card. This will in general suffice to show whether it has been cut or torn. Wounds, how- ever slight, should not be overlooked ; minute punctures or incisions ex- ternally may correspond to deep-seated injury of vital organs. The spinal marrow is said to have been wounded by needles or stilettoes introduced between the vertebrae, the skin having been drawn down before the wound was inflicted in order to give to it a valvular character, and to render it apparently superficial. The brain is also said to have been wounded by similar weapons either through the nose or the thinner parts of the skull (the fontanelles). Hence in examining the head of a newborn child to determine the cause of death it is always necessary to observe the state of the fontanelles. Children have been destroyed by small punctures made through these membranous coverings. Fatal wounds of the brain have been thereby produced. (Ann. d'Hyg., 1878, t. 2, p. 498.) In some instances the body of a child is found cut to pieces, and the allegation in defence may be that the child was stillborn, and the body thus treated merely for the purpose of concealment. Toulmouche has re- ported a case of this kind, which was the subject of a trial. As the woman had not destroyed the lungs, experiments on these organs gave satisfactory results of complete respiration. The cavities of the heart and great vessels were empty ; the body was generally drained of blood, and the skin throughout very pale. This led to the inference that the mutilations must have been inflicted while the child was living ; and as all the parts were healthy, and no natural cause of death was apparent, Toulmouche ascribed the death of the child to the wounds. The woman was convicted. (Ann. d'Hvg., 1853, t. 2, p. 200.) In this country she would probably have escaped under a verdict of " concealment of birth." Injuries to the Head. — It has been elsewhere stated that, during a pro- tracted delivery, there is formed on the head of a child a tumor containing either serum, blood, or a mixture of the two. If a woman has been secretly delivered, non-professional persons may ascribe a tumor of this kind to violence, whereas it may really have been produced by natural causes. The tumor is generally situated on one of the parietal bones, its situation depending on that part of the head which presents during delivery. After the discharge of the waters, the scalp is firmly compressed by the mouth of the womb, and subsequently by the os externum. This pressure inter- feres with the circulation through the skin, and causes the con)pressed portion of the scalp to swell. In the simplest form of this tumor, serum only is found in the swollen part, outside the pericranium or membrane 600 FRACTURES OF THE SKULL. covering the bone, and is tornied Caput succedaneum : occasionally this is mixed with blood, and there are small ecchymoses of the scalp, as well as of the pericranium and skull, but there is generally no injury to the bones, nor is there any laceration of the skin externally. In other cases blood is found ett'used in the tumor under the membrane covering the skull. The term Gephalcematoma is applied to a tumor which has this natural origin (p. 587, ante). The sanguineous is more likely to be confounded with the ettects of violence than the serous tumor ; but it may be identified by tlie scalp being always uninjured, although it may present redness and lividity. Violence from blows or falls which would produce effusions of blood be- neath the scalp, or within the skull, would in general be indicated by injury to the skin or by fracture of the bones. The only injuries to the head which require to be specially considered in relation to infanticide a.ve fractures of the skull: and here the question to which we may chiefly confine our attention is whether the fracture arose from accident or criminal violence. The rules for determining whether these injuries were inflicted during life or after death have been elsewhere considered. (See Wounds, pp. 249, 377.) Although it has been a matter of frequent observation that great violence may be done to the head of a child during parturition without necessarily giving rise to fracture, yet it is placed beyond all doubt that such an injury may occur by the expulsive efforts of the womb in forcing the head of a child against the bones of the pelvis. Even the violent compression which the head sometimes experi- ences in passing the mouth of the womb may suffice for the production of fracture. (See Edin. Med. and Surg. Jour., vol. xxvi. p. 75.) It was formerly supposed that fractures of the skull in newborn children were always indicative of criminal violence ; but cases which have occurred in obstetric practice have established the certainty of their accidental occurrence. These accidental fractures, it is to be observed, are generally slight; they commonly amount merely to fissures in the bones, beginning at the sutures and extending downwards for about an inch or less into the body of the bone. According to Weber, the frontal and parietal bones are the only bones liable to be fissured or fractured by the action of the womb during delivery ; and in the greater number of cases reported, the parietal bones only have presented marks of fracture. The possible occurrence of an injury of this kind as the result of uterine action has been strained, in several cases of child-murder, to explain the origin of fractures which could not fairly or reasonably be assigned to such an accident. A case was tried at Glasgow, in April, 1852 (case of Ann Irvin), in which there was no doubt, from the state of the lungs, that the child had fully breathed, and there was violence to the head which satisfactorily accounted for its death. The whole of the right side of the head was deeply ecchy- mosed, and there was a large quantity of coagulated blood lying beneath the scalp. In the centre of the right parietal bone there was a fracture ex- tending across the vertex for fully four inches, and involving a part of the parietal bone on the opposite side ; it was in a continuous, even line, not radiated and not depressed. The pericranium, bones, and soft parts in the track of the fracture were deeply ecchymosed, while on the surface of the brain, particularly on the right side, there was a copious effusion of clotted blood. It was impossible to refer severe injuries of this kind to the action of the womb in delivery, or to violence applied after death. The prisoner alleged that the child was stillborn. Accidental fractures and effusions of blood which are caused by uterine action may be in general recognized by their slight extent. In cases of murder by violence to the head the injuries are commonly much more ACCIDENTAL FRACTURES. 601 severe : the bones are driven in, the brain protrudes, and the scalp is ex- tensively lacerated. Such severe injuries as these cannot be ascribed to the action of the womb in parturition. Here, however, it may be fairly urged that the woman was unexpectedly seized with labor, that the child was expelled suddenly by the violent efforts of the womb, and that the injuries might have arisen from its head coming in contact with some hard surface — as a floor or pavement. It must be admitted that a woman may be thus suddenly and unexpectedly delivered while in the erect pos- ture, although this is not common among primiparous women ; and that injuries may be thus accidentally produced on the head of a child. A woman is often unable to distinguish the sense of fulness produced by the descent of a child from the feeling which leads her to suppose that she is about to have a stool ; and thus it is dangerous, when a labor has advanced, to allow a woman to yield to this feeling, for there is nothing more probable than that the child will be suddenly born. Rankin reported two eases of this description where there could not be the slightest suspi- cion of criminality. In one, a primipara, the child was actually born under these circumstances, but its life was foi'tunately saved : had there been no other convenience but a privy it must have been inevitably lost. In the second, although a case of third pregnancy, the female was equally deceived by her sensations. (Edin. Month. Jour., Jan. 1843, p. 11.) It is true that this alleged mistaken sensation forms a frequent and specious defence on charges of child-murder; but still a medical jurist is bound to admit that this accident may occur to women without necessarily implying guilt. The following case shows that a fracture of the skull of a child may occur when a woman is delivered in the erect posture. In this instance there was merely the appearance of a bruise on the head, and the navel- string was ruptured (not cut) three inches from the navel. The child did not suffer from the fall, and continued well until six days after its birth, when it was seized with convulsions and died. A fissure of about an inch and a half in length was found in the upper part of the left parietal bone. A clot of blood was found in this situation between the dura mater and bone, and there was congestion of the vessels of the membranes ; but with this exception there was no morbid appearance in the body. (Assoc. Jour., Oct. 1853, p. 901.) Porter Smith communicated to the author a case in which the facts were similar to those above related. In conse- quence of the concealment of the body, however, the mother was charged with murder. The right parietal bone was fractured, and there was effu- sion of blood internally, but there was no mark of external violence. The cord had been ruptured at a distance of two inches and a half from the navel. The stomach of the child contained the usual albuminous and mucous matters of the foetal state, without any appearance of food. The lungs contained air, and were highly crepitant ; the foramen ovale and the ductus arteriosus were in their foetal condition. The child had prob- ably been drowned in the discharges from want of assistance at the time of birth. The woman, who admitted that the child had fallen from her suddenly, was acquitted. Olshausen published four cases of sudden de- livery, in each of which the child dropped from the woman, and in two of them there were fissures in the parietal bones. The children recovered from the effects of the accidents. (Med. Times and Gaz., 1860, ii. p. 219; Amer. Jour. Med. Sci., 18GI, p. ^79.) Other cases of rapid delivery in the erect posture are reported in the Lance^ (1861, i. p. 13). In these there was no injury to the child, although in one case the delivery took place on the deck of a vessel. A medical witness would find no difficulty in determining the proba- 602 POWER OF EXERTION AFTER DELIVERY. bilitj of this explanation of the accidental origin of such fractures, if he were made acquainted with all the facts connected with the delivery. But the acquisition of this knowledge must be accidental ; and it will in gen- eral be out of his power to obtain it. When the fractures are accom- panied by cuts, punctures, or lacerations of the scalp or face, although their production might be accounted for by an allogod fall during parturi- tion, the cause of these w^ounds would still remain to be explained. In fractures of the bones of the head in newborn children the presence of effusions of blood on the outside of the skull, or on the membranes within, is one of the most common appearances. Effusions of blood beneath the skin of the scalp are by no means uncommon in newborn children, and are not necessarily indicative of criminal violence. Each case, however, must be decided by the circumstances attending it. Effusions on the membranes and in the substance of the brain are generally the result of great violence to the head. (See Tardieu, L'Enfanticide, p. 133.) Twisting of the Neck. — Children are sometimes destroyed in the act of birth by the neck being forcibly twisted, whereby a displacement of ths vertebrae of the neck, with injury to the spinal marrow, may occur and destroy life. Such injuries are immediately discovered by an examination of the bod}^ It should be remembered that the neck of a child is very short, and that it always possesses considerable mobility. Destruction by Fire. — Newborn children are sometimes destroyed by placing tbeir bodies in a fierce fire. The result of this is that only charred flesh with white fragments of burnt bones may be found. In one case the body of a child was found in a saucepan, boiled. It was here a question whether it had been put in living or dead (see p. 391.) Violence in Self -delivery . — When the marks of violence found on the head, neck, or body of a child cannot be easily referred to uterine action or to an accidental fall, it is common to ascribe them to the efforts made by a woman in her attempts to deliver herself — the destruction of the child being an accidental result of these efforts. A medical opinion in such cases must depend upon the nature, situation, and extent of the in- juries; and each case must be therefore decided by the circumstances at- tending it. A medical witness, however, should ahvays be prepared to allow that a woman at the time of her delivery, owing to pain and anxiety, may be deprived of judgment, and may destroy her offspring without being conscious of what she is doing. It is, therefore, a sound principle of law that mere appearances of violence on a child's body are not per se sufficient, unless there is some evidence to show that the vio- lence was knowingly and intentionally inflicted, or the appearances are of such a kind as of themselves to indicate intentional homicide. Power of Exertion in recently delivered Women. — On these occasions, a witness will often find himself questioned respecting the strength or capability for exertion evinced by the lower class of women shortly after childbirth. Alison remarks that many respectable medical practitioners, judging only from what they have observed among the higher ranks, are liable to be led into an erroneous opinion, which may affect their evidence. He mentions a case in which a w^oman accused of child-murder walked a distance of tw^enty-eight miles in a single day, with her child on her back, two or three days after her delivery. (Case of Anderson, Aberdeen Spring Circ, 1829.) Instances have even occurred in which women have walked six and eight miles, on the very day of their delivery, with- out sensible inconvenience. In one case (Smith, Ayr Spring Circ., 1824), the woman w^as engaged in reaping; she retired to a little distance, effected her delivery by herself, and went on with her work for the re- POWER OF EXERTION AFTER DELIVERY. G03 niainder of the day, appearing only a little thinner and paler than usual. In Reg. V. Stowler (Wells Aut. Ass., 1865), two witnesses proved that the prisoner, who was tried for the murder of her child, was at work with them in a field about 800 yards from a pond in which the body was after- wards found. They left the prisoner weeding, returned in about an hour, and she was not then in the field. After a time she returned, sat on a bank, and then resumed her work. The witnesses noticed that, on her return, there was a great difference in her appearance. In this short in- terval she had been delivered, had disposed of the body of the child, and resumed her work, as if nothing had happened. A firm resolution, with a' desire to conceal her shame, may enable a woman, immediately after her delivery, to perform acts connected with the disposal of the body of her child which, from ordinary experience, might appear to be far beyond her strength. In Reg. V. May (Exch. Ct., May, 1857), for concealment of birth, it was proved that the prisoner, a domestic servant, had been sent to market with some poultry. On her return, she asked the boy who drove the cart to stop. He did so ; she got out, went to a recess in the hedge by the side of the road, in five minutes was observed following the cart, and walked home, a distance of a mile and a half. She went about her usual w^ork on that and the following day. The woman had been delivered of a child in the recess, ahd it was subsequently found there. One witness heard it cry, but it soon died. Conclusions. — The conclusions to be derived from the contents of this chapter are — 1. That a newborn child may die from violent causes of an accidental nature. 2. That some forms of violent death are not necessarily attended with external signs indicative of violence. 3. That a child may be accidentally suffocated during delivery. 4. That the usual marks of death from suffocation or drowning are not apparent, except in the bodies of children which have breathed. 5. That the state of the navel-string may often furnish important evidence. 6. That a newborn child may speedily die from exposure to cold or from want of food. 7. That slight fractures of the bones of the cranium may arise from the action of the womb on the head of the child during delivery. 8. That women may be unexpectedly delivered while in an erect posture; the cord is under these circumstances sometimes ruptured, and the child may sustain injury by the fall. 9. That the violence found on the body of a child may be sometimes referred to attempts innocently made by a woman to aid her delivery. 10. That some women recently delivered may have sufficient strength to exert themselves and walk great distances. (JU4: IMFANTICIDE — STRAN GULATIOM. CHAPTER LIV. DEATH OP THE CHILD FROM STRANG CLATIOX. STRANGULATION BY THE NAVEL-STRING. AC- CIDENTAL MARKS RESEMBLING THOSE OF STRANGULATION. CONSTRICTION BEFORE AND AFTER DEATH. BEFORE AND AFTER BREATHING. BEFORE AND AFTER THE SEVERANCE OF THE NAVEL-STRING. EXAMINATION OF WOMEN. MEDICAL RESPONSIBILITY. Among the forms of violent death which are generally attended with appearances indicative of criminal design, are the following-: — 7. Strangulation. — The destruction of a ne\vI)orn child by strangula- tion is not an unfrequent form of child-murder ; and here a medical jurist has to encounter the difficulty that the strangulation may have been acci- dentally produced during delivery, by a twisting of the navel-string round the neck. We must not hastily conclude, from the red and swollen appear- ance of the head and face of a child when found dead, that it has been destroyed by strangulation. There is no doubt that errors were formerly made with respect to this appearance; for W. Hunter observed, "When a child's head or face looks swollen, and is very red or black, the vulgar, because hanged people look so, are apt to conclude that it must have been strangled. But those who are in the practice of midwifery know that thereis nothing more common in natural births, and that the swelling and deep color go gradually off if the child live but a few days. This appear- ance is particularly observable in those cases in which the navel-string happens to gird the child's neck, and w^here its head happens to be born some time before its body." Strangulation by the navel-string can, of course, refer to those cases only in which it becomes firmly twisted round the neck after the child has' breathed. This is rather a rare occurrence, because under these cir- cumstances death more commonly takes place by compression of the cord, and by the consequent arrest of circulation, before the act of breathing is performed. The only internal appearance met with in death from this cause is a congested state of the cerebral vessels, and ecchymoses. The presence of ecchymosis on the scalp, as well as of lividity of the face, is very common in newborn children when the labor has been tedious and difficult ; and, therefore, unless there were some distinct marks of pressure about the neck, with a protrusion of the tongue, such appearances would not justify a suspicion of death from strangulation It has been supposed that the strangulation produced by the wilful application of any extraneous constricting force to the neck would be kiiown from the accidental strangulation caused by the cord, by the fact that, in the former case, there would be a livid or ecchymosed mark or depression on the neck, while in the latter there would not. Severe violence to the neck of a newborn child may produce in the seat of con- striction not only ecchymosis, but a laceration of the skin, muscles, and windpipe ; but these appearances are not always present even in homicidal strangulation. Evans communicated to the author the particulars of the case of a newborn child which had l^een destroyed b}" strangulation. Great violence had been used, but there was no trace of discoloration in the course of the ligature, or of ecchymosis in the tissues beneath. The muscles compressed were very dark in color. In most cases, when a STRANGULATION BY THE NAVEL-STRING. 605 ligature is applied to the neck during life, the skin above and below it be- comes much swollen and presents an (Edematous character. This indicates an application of violence when there is still some vital power in the bod}' of the child. The navel-string itself may be the means of constriction, and the mark or depression may sometimes present an appearance of ecchymosis. Among various cases which might be quoted in support of this statement, is the following : In 1846 Foster was summoned to attend a lady in labor with her first child. The labor was a lingering one, owing to the size of the head ; and the child came into the world dead. The navel-string was found coiled three times round the neck, passing under the right armpit ; and upon removing it three parallel discolored depressions were distinctly evident. These extended completely round the neck, and corresponded to the course taken by the coils. The child appeared as if it had been strangled (Lond. Med. Gaz., vol. xxxvii. p. 485.) Had this child been born secretly, this state of the neck might have created a strong suspicion of homicidal violence. Strangulation after birth could not, however, have been alleged, because there would have been no proof of respiration. When a blue mark is found on the neck of a child whose lungs retain their foetal characters, it is fair to presume, caeteris pai-ibiis, that it has been acciden- tally occasioned by the twisting of the navel-string during delivery. Price communicated to the same journal the account of a case in which the cord, which was short, was so tightly twisted around the neck of a child that he was compelled to divide it before delivery could be accom- plished. There was in this instance a deep groove formed on the neck, conveying the impression to himself and another medical man that, in the absence of any knowledge of the facts, they would have been prepared to say that the child had been wilfully strangled by a rope. (Lond. Med. Gaz., vol. xxxviii. p. 40.) A diagnosis might have been formed, as in the preceding case, by examining the state of the lungs, Miitter met with a case in which a child was born dead, and the cord was tightly twisted round its neck ; when removed, the neck exhibited a livid circle of a finger's breadth, smooth and shining ; but on cutting into this mark no ecchy- mosis was found. (North. Jour. Med., 1845, p. 190.) In Leg. v. Martin (Lewes Lent Ass., 18G0), the material question was whether a mark round the neck had been caused accidentally by the navel-string; this was denied by the medical witness. A similar question also arose in another im- portant case, Reg. v. Pyne (Gloucester Winter Ass., 1858). Williamson has directed attention to an important fact connected with the state of the lungs in a newborn child, and the medical opinions which maybe expressed from their condition as furnishing evidence of live birth. Referring to Price's case {suj?ra), in which the cord was tightly twisted round the neck of the child, he states that in similar cases which have occurred to himself, the child has breathed immediately on the birth of the head ; but, owing to the shortness of the cord, the child would have been strangled and born dead unless he had divided it. Thus, then, a child might die apparently strangled, and not be born alive, although it might have so breathed during birth that the lungs would present the usual chai'acters of respiration. If the circumstances were not known, a medical man might be led to say that the child had been born alive and had been destroyed by strangulation. (Edin. Med. Jour., 1858, p. TH.) The proof of respiration, as it has been elsewhere stated, is, however, not necessarily a proof of live birth. From these cases it will be perceived that ecchy- mosis in the depression on the neck furnishes no distinction between con- striction produced by criminal means, and that which may result acciden. 606 STRANGULATION BY TUE NAVEL-STRING. tally from the navel-string. In the following case (Ann. d'Hyg., 1841, t, 1, p. 127), a woman charged with the murder of her child by strangulatior^ appears to have been unjustly condemned. The child had fully and perfectly breathed ; the lungs weighed one thousand grains, and, when divided, every portion floated on water, even after firm compression. There was a circular depression on the neck, which was superficially ecchymosed in some parts. From an investigation of the facts, this ap- peared to have been a case in which a mark oa the neck was accidentally produced by the cord during attempts at self-delivery on the part of the woman; she was, nevertheless, convicted, chiefly from the opinion ex- pressed Ijy two medical witnesses, that a soft and yielding substance like the cord could not produce a depression and ecchymosis on the neck of a child during birth. They attributed the mark to the wilful application of a ligature like a garter ; but the experiments of N^grier clearly show that thenavel-string has sufficient strength to produce a mark, and with it a, fatal constriction. In the same volume of the Ann. d'Hyg. (at p. 428) will be found the report of another case, suggesting many important reflections in regard to the medical jurisprudence of infanticide. In this instance the navel-string and the membranes were actually used by a woman as a means of strangu- lation ; the child had not breathed, but was by this act of violence pre- vented from breathing. There was superficial ecchymosis on each side- over the muscles of the neck. The defence was that the child was born Avith the cord around its neck, and that it was from this circumstance acci- dentall}^ strangled ; but the medical evidence tended to show that the cord had been violently stretched and employed as a means of strangulation. The child had not breathed, and the medical witnesses considered that it bad been born dead, owing to the violence used by the woman. The cause of death here was certainly not strangulation, but arrested circulation. In the mean time, the case proves that ecchymosis (a blue mark) may be the result of violent constriction produced by the navel-string. A case oc- curred to M'Cann, in which the navel-string, which was of its full length, had been also used as the means of strangulation. It was twisted once round the neck, passed under the left arm, over the shoulders, and round the neck again, forming a noose or knot, which, pressing upon the throat, must have caused strangulation, as the tongue was protruded, and there were other clear indications of the child having been strangled. The hydrostatic test applied to the lungs proved that respiration had been per- formed. When the mark on the neck is deep, broad, much ecchymosed, and there is extravasation of blood beneath, with injury to the muscles or windpipe, and ruffling or laceration of the skin, it is impossible to attribute these appearances to accidental compression by the navel-string. The lividity produced by it in the cases hitherto observed has been only slight and par- tial, and unaccompanied b}^ laceration of the skin or injury to deep-seated parts. On the other hand, as much more violence is commonly used in homicidal strangulation than is necessary for destroying life, we may ex- pect to find great ecchymosis and extensive injury to the surrounding soft parts. On some occasions all difficulty is removed by the discovery of a ligature tied tightly round the neck ; or, if this be not found, the proofs of some ligature having been used will be discovered in the indentations or irregularly ecchymosed spots left on the skin — the depressed portions of skin being generally white and the raised edges livid or oedematous. It has been doubted whether a child can be l)orn with the navel-string so tightly round the neck as to produce great depression of the skin and MARKS ON THE NECK. 607 ecchymosis, «'. e. to simulate homicidal strangulation, and at the same time perform the act of respiration fully and completely. It is important, there- fore, when this hypothesis is raised in order to account for a suspicious mark- on the neck, to examine closely the state of the lung-s. Unless the cord be designedly put round the neck of the child after the head has pro- truded, the effect of the expulsive efforts of the womb, when a coil has become accidentally twisted round the neck, would be to tighten the cord, compress the vessels, and kill the child by arresting the maternal circula- tion, at the same time that this pressure would effectually prevent the act of breathing. Hence the lungs usually present the appearances met with in stillborn children generally; but the case which occurred to William- son (p. 605) shows that this state of things may sometimes occur, and that a child ma}^ breathe and die strangled by the cord before its body is entirely born. Medical witnesses, however, should not be too ready to accept such a suggestion ; a careful examination of the neck will generally show whether a ligature has or has not been wilfully applied after birth. In Reg. V. Robinson (Lewes Sum. Ass., 1853), there was around the neck the mark of a ligature which had been tied very tightly. The child had fully breathed, and, according to the medical" evidence, it had died from strangulation owing to an accidental twisting of the cord during delivery. In examining a suspicious mark on the neck of a newborn infant, it should be noticed whether it does not, by its form or course, present some pecu- liar indentations which may render it certain that a ligature has been wilfully employed after birth. When it is found that a child has fully breathed, the presence of a deeply ecch3^raosed or an oedematous mark on the neck, with injury to the skin and muscles, is, cseteris paribus, pre- sumptive of homicidal strangulation. Death from accidental constriction of the cord during delivery should, as a general rule, leave the lungs in their ffjetal condition. Marks on the neck of a child may be accidentally produced by the navel- string without necessarily destroying the child's life. Two cases of this kind are reported by Busch (Brit, and For. Med. Rev., vol. x. p. 579) ; and a child may be destroyed without ecchymosis being a necessary con- sequence of the constriction produced by it. There is much less risk of strangulation from twisting of the cord during birth than is commonly believed. Out of 190 cases, Churchill found the cord round the neck in fifty-two children, and the shortest cord so disposed was eighteen inches long ; Negrier found it round the neck in twenty cases out of 16G natural labors. (Ann. d'Hyg., 1841, t. 1, p. 131) The ajjpearances met with in the body in death from strangulation have been elsewhere fully considered (p, 434, ante). The facts of a case com- municated to the author by Cann will, however, serve to show the ap- pearances which may present themselves in a newborn child. A woman was secretly delivered of a child. When the body was found it was ob- served to be full-grown, and there was a piece of tape which had been tied tightly in a bow twice round the neck. The tongue protruded between the lips ; two deep furrows were found round the neck after the removal of the tape; there was great oedema, with swelling of the skin between and above them, and the right hand was clenched. The lungs were of a light-red color ; they filled the chest, were highly crepitant, and floated readily on water, even when divided info sixteen pieces, and these had been submitted to strong pressure. They weighed, however, only G26 grains. The heart was healthy ; the right side contained some clots of blood ; the left side was empty ; the foramen ovale was open. The scalp was much congested, the congestion almost amounting to small effusions 608 ACCIDENTAL MARKS ON THE NECK. of blood ; the pia mater was also congested. The inferences drawn from these facts were that the child had been born alive, and that it had died from strangulation. The lungs were as light as they usually are in the tVetal state, showing that although the}^ had received air the pulmonary circulation had not been perfectly established. Juries take a very lenient view of these cases of death by strangulation. In Keg. v. Cresswell (Gloucester Spring Ass., 1878), the child was found dead with a cord tied tightly round its throat. It was clear that it had been born alive and had died from strangulation. It was suggested for the defence that the cord was tied round the throat to conceal the birth, and not with intent to murder. The woman was found guilty of manslaughter. Accidental 3Iarks resembling those of Strangulation. — In the fore- part of tlie neck of a child a mark or depression is sometimes accidentally produced by forcil)ly bending the head forwards on the chest, especially when this has been done repeatedly and recently after death, while the body is warm ; especially if it be fat. It may occur also as an accident during labor. Such a mark must not be mistaken for the effect of homi- cidal violence. It has been a question whether, independently of the con- striction produced by the cord, the neck of the womb might not cause, during its contractions, an ecchymosed mark on tbe neck. We are not aware that there is any case reported which bears out this view ; and it seems highly improbable that any such result should follow. The discoloration may be in detached spots or patches situated in the forepart of the neck, and evidently not arising from the employment of any ligature. These marks may depend on the forcible application of the fingers to the forepart of the neck of the child, and the indentations have been known to correspond — a fact which has at once led to a suspicion of the cause of pressure and the mode of death. At the same time it should be borne in mind that a superficial mottling of the skin occurs after death in newborn infants in parts where moderate pressure only may have been accidentally produced. This would not be attended with ecchymosis, and its true nature would be at once determined by comparing the dis- colored spots with the surrounding skin. It may be alleged, in defence, that such marks might have been accidentally produced : 1. By the forcible pressure produced by the child's head during labor. 2. They will be more commonly referred to violent attempts made by a woman at self-delivery during a paroxysm of pain. This explanation is admissible so long as it is confined to injuries which, by any reasonable construction, might be caused during labor ; but supposing the marks to have been certainly pro- duced after the complete birth of the body, it will, of course, not apply (see also p. 588). Among marks simulating violence, sometimes found on the necks of newborn children, Harvey has pointed out one of a singular kind. He was present at a delivery in which a child was expelled rather suddenly; and, after making two or three convulsive gasps, it died. Whilst en- deavoring to restore animation he observed a bright-red mark extending completely across the upper and forepart of the neck, from one angle of the lower jaw to the other, as though it had been produced by strangu- lation with a cord, except that the mark was not continued round to the back of the neck. It was of a vivid red color, and not like a bruise or ecchymosis, but it had very much the appearance of a recent excoriation. It was most clearly defined in front, where it was about a quarter of an inch in breadth, and it became diffused at the sides. The face was not swollen, and there was no fulness of the veins. (Lond. Med. Gaz.. vol. xxxvii. p. 379.) A distinction in this instance might have been based ACCIDENTAL MARKS ON THE NEDK. 609 upon the color of the mark, the uainjurod state of the cuticle, and the absence of congestion of the face and venous system. Nevertheless, the fact is of some importance, and should be borne in mind during- the ex- amination of the body of a newborn child alleged to have been strangled. Another case, which was the subject of a coroner's inquest, was published in the same journal (vol. xxxvii. p. 530), in which red marks on each side of the nose of a newborn child were mistaken for the effects of violence applied to the nostrils during a supposed attempt at suffocation. Eose examined them closeh", and considered that they were nsevi (mother's marks), and had nothing to do with the death of the infant. A medical witness may be asked on these occasions whether he will undertake to sw^ear that the ligature or the fingers had been applied to the neck before or after death, or before or after the child had breathed. So far as external marks of strangulation are concerned, there is no differ- ence in the appearances, whether the constriction is made during life or immediately after death while the body is Avarm. Casper's experiments render it highly probable that, when a constricting force is applied to the neck of a dead child, at any time within an hour after death, the marks cannot with certainty be distinguished by any appearance from those made on a living body. With regard to the second point, it may be stated that, whether the child has breathed or not, provided it be living and the blood circulating, marks of violence on the neck will present precisely the same characters. In the absence of any visible discoloration of the skin, it may be a question whether this should be taken as evidence of the means of constriction not having been applied during life. What we are entitled to say from observed facts is that ecchymosis from the ligature is not a necessary consequence of constriction, either in a living or a recently dead child ; although we might expect that there would be few cases of deliberate child-murder in which, when strangulation was resorted to, there would not be some ecchymosed mark or discoloration, chiefly from the presump- tion that great and unnecessary force is suddenly applied. Besides it is not improbable that a slighter degree of force would cause ecchymoses on the skin of a newborn infant than would be required to produce such an appearance on that of an adult. Another question has been put — namely, whether a medical witness wn'll undertake to say that the constricting force has not been applied to the neck of the child until after its body has been entirely born. This of course must be a pure matter of speculation. The appearance caused by a ligatui'e applied to the neck of a living child would not be different w^hether the child was partially or entirely born. If the child had actu- ally breathed the appearances in the body would be the same, and there are no medical facts by which it could be determined wiiether the act of strangulation proved fatal during birth or afterwards. A medical witness has also had this question put to him — whether the strangulation occurred before or after the navel-string was severed. It would appear that the severance of the cord has been sometimes regarded as a legal test of an independent circulation being established in the child ; but this is obviously an error, depending on a want of projier information respecting the phe- nomena which accompany birth. Respiration, and therefore an inde- pendent circulation, may take place before the cord is divided ; and its severance, which is never likely to occur until after entire birth, cannot consequently be considered as a boundary between a child which is really born alive and one which is born dead. A premature severance might possibl}^ endanger the life of a child instead of giving it an independent existence. A healthy and vigorous child may continue to live and breathe 39 GIO INFANTICIDE POISONING. iiulependeutly of the mother before the division of the cord, and the time at which the severance is made depends on mere accident. Hence the marks of strangulation on the neck of a living- and breathing child must be the same whether the cord has been divided or not. The entire birth of the body is, however, now considered to be legally complete, although the navel-string has not been divided. 8. Poiaoning. — This is placed among the possible means of perpetrating child-murder, but we rarely hear of newborn children being thus destroyed. Children destroyed within a week of birth generally die from some acts of violence like those already described, the object of the perpetrators of the crime being to insure a rapid and certain death. Hofman describes a case in which a girl destroyed her child l)y nux vomica on the second day after birth. She mixed the powder with chamomile tea and gave it to the child. It had convulsions and died in three hours. Cadaveric rigidity was strongly developed in the body of the child when found on the third day. No particular appearances were met with except those in the chest of asphyxia. No trace of strychnine was detected in the stomach or liver. A trial took place for the murder of a child by poison at two months. (Rex v. South, Norf. Aut. Circ, 1834.) Arsenic was given to an infant and it died in three hours and a quarter after the ad- ministration of the poison. The editor gave evidence as to the adminis- tration of butter of antimony to an illegitimate child four days old, ■whereby its death was caused. The mother and grandmother were tried for murder (Reg. v. Wallis and Wallis, Worcester Sum. Ass., 1883), but were acquitted, there being no sufficient evidence as to the actual adminis- tration of the poison by the prisoners. If in a case of child-murder death from poison should be suspected, it must be sought for in the usual way. Some cases have occurred in which children have been wilfully destroyed a week or two after birth by the administration of opium or excessive doses of purgative medicine. Oil of vitriol has been also used to destroy life. In cases in which infants are destroyed by poison there is generally great difficulty in tracing the act of administration to the guilty person. The fluid food given to them renders the admixture of poison easy, and as many persons may have access to this food it is often impossible to fix upon the criminal. In one instance which came to the author's knowledge an illegitimate child had been placed out to nurse by its mother, a woman in a good social position. It w^as noticed that after each visit paid by the mother the child was sick, and after repeated attacks of illness the child died. On inspection arsenic was found in the body, and this was beyond doubt the cause of death. There was no suspicion against the nurse ; but suspicion fell on the mother, from the circumstances above mentioned. There was evidence, however, that the child was not at any time fed by the mother when she visited it, and that the mother had no access to the child's food. No poison could be traced to her possession, and she was not seen by the nurse, who was present, to give anything to the infant. The only fact that transpired was that at each visit she took it in her arms and was observed to rub its gums with her fingers, and soon after her visits sickness followed. There was reason to believe that she had concealed small quantities of arsenic under her finger-nails, and that she had administered the poison while rubbing the gums of the child. Conclusions. — The following conclusions may be drawn from the pre- ceding remarks : — 1. That congestion of the face and head in a newborn child is aot a proof of death from strangulation. EVIDENCE FROM THE EXAMINATION OF THE WOMAN. 611 2. That strangulation can take place only in children which have breathed. 8. That a child may be strangled during birth by the accidental twisting of the navel-string round its neclv, 4. That the navel-string may produce a livid or ecchymosed depression on the necli, like any other ligature. 5. That marks on the neck produced by accidental causes may resemble those which arise from strangulation. G. That the effect of constriction on the neck, either by the navel-string or any other ligature, is the same if the child be living, whether it has or has not breathed. t. That the effect is the same Avhether the child has been partially oi entirebj born. 8. That the effect of a ligature on the neck of a living child is the sam* whether the navel-string has or has not been severed. 9. That a newborn child may die from strangulation without this fact being necessarily indicated by ecchymosis on the neck. This depends oa the nature of the ligature and the amount of force used. Examination of Women. Medical Responsihility. — In general, it is the mother of the child who is charged with the murder, and in this caso it may be necessary, in order to connect her with the child, to determine whether she has or has not been recenthj delivered, Medical evidence may show that the date of delivery does or does not correspond with the date of the birth and death of the child. The usual appearances in cases of recent delivery, both in the living and dead body, have been elsewhere fully described. (See Delivery, ante, pp. 522-525.) These appearances necessarily vary according to the time at which the examination is made. Toulmouche has reported in detail several cases showing the post-mortem appearances met with at different dates, (Ann. d'Hyg., 1864, t. 2, 34y.) If the reputed mother of the child is dead a coroner or magistrate may issue an order for a post-mortem examination of the body, and the case will present no difficulty ; if living, a serious question may arise as to medical responsibility. In general, a woman consents to be examined, but it may happen that she will refuse to submit to a physical examination. An innocent woman is just as likely to refuse permission as one who is guilty ; but, if circumstances point to one out of several women in a household, the refusal to permit an examination would, of course, be in- terpreted against her. It has happened on more than one occasion that medical men have assumed to themselves the right of enforcing an exam- ination of suspected women, and, by threats or otherwise, they have com- pelled them to undergo this. Such a course of conduct is in the highest degree indecent and improper ; but when a woman willingly consents to be examined a medical man is justified in making an examination, and giving evidence thereon. It would, however, be only fair in such a case to give her the warning which every magistrate and coroner is bound to give to any woman charged with murder, before requiring an answer to a question which may be used in evidence against her at the subsequent trial. The case is widely different, however, when a medical man takes this authority upon himself, and compels a suspected woman, unwillingly, or under duress, to submit to a physical examination. By taking this illegal course, he is forcibly compelling a woman accused of murder to pro- duce positive proof of her guilt ; such a course is entirely opposed to the spirit and practice of English jurisprudence. The mischievous results of such officiousness on the part of a medical man are well illustrated by the 612 MEDICAL RESPONSIBILITY. following cases, A surgeon and an inspector of police insisted upon ex- amining two women, a mother and daughter, in order to determine whether either of them had been lately delivered of a child. This was against their consent, and in the absence of the husband and father. He brought an action against them, and recovered damages, (Lancet, 1871, ii. p. 333.) The other case was that of Weir and Wife v. Hodgson (Liv- erpool Wint. Ass., 1861). The dead body of a child had been found near the house of the plaintiff. The defendant, a surgeon, went with an in- spector of police to see Mrs, Weir, and, having informed her that she was suspected of having had a child, told her that he had come to examine her by the authority of the law, and that she must submit. She refused at first, and proposed to send for a medical man whom she knew. In the end the defendant examined her, and found that there was no ground for the charge. The jury returned a verdict of 2Q01. damages for the assault. The police can give no legal povver to a medical man to make such an examination in a suspected case, and the ultimate consent of the woman, if extorted by threats or intimidation, will be no answer to a charge of indecent assault. A later case (Warne v. Serjeant) was tried at the Manchester Wint. Ass., 1878. It was here doubtful whether the woman had given her consent to an examination, and the jury found a verdict for the defendant. The judge observed that, even if the surgeon had been honestly misled by the woman's conduct, it would still be an assault. In all cases, whether the charge against a woman be one of concealment of birth, abortion, or child-murder, a medical man must act upon his own discretion. An examination of her person, with a view to obtain evi- dence against herself, is unlawful, except with her free consent. A coroner issuing an order for the compulsory examination of a woman under these circumstances would be acting ult7'a vires, and any medical man obeying it would incur a serious responsibility. In 1871 a case oc- curred that placed this question in cases of alleged infanticide in a painful light. A young lady committed suicide rather than submit to a physical examination by two medical men under the order of a coroner. The coroner held an inquest on the body of a child in a case of alleged child- murder. A suspicion arose that this young lady had been recently de- livered. Two medical gentlemen, provided with a written order from the coroner, went to the house w'here the lady resided, and requested an in- terview with her for the purpose of ascertaining whether she had re- cently had a child. She refused to see them, and subsequently destroyed herself. All the particulars of this tragedy were not made known, but the attempt to examine this young woman for the purpose of obtaining evidence against her on a charge of child-murder appears to have had such an effect on her mind as to lead to suicide. The fragmentary partic- ulars of this sad case will be found in the Lancet for 1871, vol. ii. pp. 333, 414, and 477. The 6 and 7 Will, IV., c. 89— now repealed, except for Ireland — ^under which an order was issued by the coroner on this occa- sion, empowers a medical man to examine a dead body, and give evidence touching the cause of death ; but it says nothing about the examination of living women. Such an order would be obviously illegal, and a medi- cal man acting under it would render himself liable to an action for an indecent assault. The Coroners' Act, 1887, empowers a coroner to order examinations of a dead, not of a living body. It can be only by the free consent of the person inculpated that a per- sonal examination for evidence can be made. The Tichborne trial fur- nished a good illustration of the care taken by our judges that an accused person shall not unknowingly furnish evidence against himself. It was MEDICAL RESPONSIBILITY. 613 alleged on this oecasion that if the "claimant " had been bled in the tem- poral artery a scar would remain ; and a proposition was made that he should be then examined by two medical witnesses who had been called for the prosecution, Cockburn, L. C. J., ruled that such an examination could not be made except by the consent of the accused. This was g-iven, and the examination accordingly took place in court. A similar rule has been long acted on in the Scotch courts. Thus in a divorce case, tried in 1860 (Edin. Sess. cases, 1860), the court refused to receive certain evi- dence which was tendered regarding the condition of a woman, on the ground that they could not compel her to submit to another examination, and the evidence tendered would therefore have been entirely ex parte. In a suit of nullity in the Divorce Court, Hannen, J., was obliged to de- cide the case upon the evidence of the husband only. The wife refused to submit to an examination, and there was no legal power to compel her to undergo this against her will. (Hewitt v. Pery, falsely called Hewitt, Jul}", 1813.) These eases suffice to show the course which a medical wit- ness should pursue on all occasions in which a uerson does not voluntarily consent to a personal examination. 614 PAKTIAL AND ENTIRE BIRTH. BIRTH. INHERITANCE. CHAPTER LV. IIVB BIRTH IN CIVIL CASES. DATE OF BIRTH. SIGNS OF LIVE BIRTH INDEPENDENTLY OP RESPIRATION OR CRYING. VAGITDS UTERINUS. TENANCY BY CURTESY. LEGAL BIRTH. POST-MORTEM BIRTHS. MINORITY AND MAJORITY. PLURAL AND MONSTROUS BIRTHS. Date of Birth. — Medical evidence has occasionally been demanded in courts of law respecting the actual date of birth in those cases in which a period of a few days, hours, or even minutes was required to prove the attainment of majority — and therefore a legal responsibility for the per- formance of civil contracts into Avhich the parties had entered, either knowingly or ignorantly, when, minors. Some such cases have been de- cided by the evidence of the accoucheur himself; others, when the accoucheur was dead, by the production of his case-books ; and it is worthy of notice that the strictness and punctuality of some medical practitioners, in making written memoranda of cases attended by them, have in more than one instance led to a satisfactory settlement of such suits and the avoidance of costly litigation. The proof of the exact date of birth is also of considerable importance in certain cases of contested legitimacy. Medico-legal questions connected with this subject arise in contested suits relative to succession or the inheritance of property. A child that is born alive, or has come entirely into the world in a living state, may by the English law inherit and transmit property to its heirs, even though its death has immediately, and perhaps from morbid causes necessarily, followed its birth. Should the child be born dead, whether it died in the womb or during the act of birth, it does not accjuire any civil rights ; for it is not regarded as a life in being unless it manifests some sign of life after it is entirely born and separated from the mother. Some have con- sidered that partial birth, provided a child is living, should suffice to confer the same rights on the offspring as the proof of entire birth ; but great difficulty might arise in civil cases if the bare extrusion of a par^ of the body sufficed for all the legal purposes of entire birth. It might become a casuistical question, as to how much of a body should be in the world in order to constitute legal birth ; for there is no reason why, in a medical sense, the extrusion of the head and shoulders should constitute birth any more than the extrusion of a hand or a foot. If it be said that the act of breathing should be combined with a partial extrusion of the body, this would be unjust ; because a child is alive — its heart is evidently pulsating, and its blood circulating, as freely before the act of breathing as after- wards. Besides, it is admitted that children may be born alive and live for some time without respiring; and this want of respiration is no ob- jection to these children being considered living in law. In a case referred to hereafter, a child was pronounced to have been legally born alive, PROOF OF LIVE BIRTH IN CIVIL CASES. 615 although it had certainly not breathed ; and that a child may manifest life for a certain time without leaving in its body any evidence of respiration is clear from numerous reported cases (pp. 568, 569, ante). If, then, proof of respiration be not demanded in cases of entire, it could scarcely be re- quired in cases of partial birth. In the event of partial being treated as synonymous with entire birth, there would be no end to litigation ; and medical opinions would vary in every case. It is doubtful whether, under such circumstances, the law could be administered with an}^ degree of certainty or impartiality. Admitting, then, that a child must be enhr-eJy born in order that it should acquire civil rights, it will next be necessary to examine the proofs required to show that it has been born alive in a legal sense. The question here is different from that of live birth in reference to child-murder We may presume that a practitioner is present at a delivery in which a child is born in a doubtful state, or where its death speedily follows its birth The civil rights of the child and its heirs will depend upon the careful observation made by a practitioner of the circumstances attending the delivery. He should note the time when the birth is completed, by the body of the child being entirely out of the body of the mother. Children born at or about midnight are liable to have the date of birth wrongly registered ; and the legal difference of twenty-four hours, which a few seconds or minutes make, may hereafter affect their own rights,^ if they survive, or those of others if they die. [By English and American law, being " boi-n^^ means that the whole body is brought into the world, and it is not sufficient that the child respires in the progress of birth: Kex v. Poulton, 5 C. & S. 329. There must be independent circulation : Rex v. Enoch, 5 C. & P. 529. The whole body must have come forth from the body of the mother: Bex v. Crutchley, 7 C. & P. 814. The umbilical cord need not have been sepa- rated or cut : Regina v. Reeves, 9 C. & P 25,] Sigjis of Live Birth independently of Hesjnrafion or Crying. — The visible breathing of a child after its birth or as it may be manifested by its C7-ying is an undoubted sign of its having been born alive ; but, as it has just been stated, a child may acquire its civil rights, although it may be neither seen to breathe nor heard to cry. The pulsation of a child's heart or even the spasmodic twitching of any of the muscles of the body has been regarded as a satisfactory proof of live birth (p. 616). The latter sign has been judicially so pronounced ; a fortiori, therefore, the motion of a limb will be considered sufficient legal evidence of life after birth in an English court of law. It is to be observed that the length of time during which these signs of life continue after a child is born is M'holly immaterial ; all that is required to be established is that they were positively manifested. A child which survives entire birth for a single instant acquires the same civil right as if it had continued to live for a month or longer. In Brock v. Kelly (April, 1861), involving a claim by the widow to the estate of her husband on the ground that a child born twenty years before had been born living, although it was at first supposed to have been still- born, Stuart, Y. C, decided that proof of breathing was not necessary, and held that there was sufficient legal evidence of life after birth in the pulsations of the cord observed by the accoucheur. This decision is in accordance with law and common sense. Pulsations indicate an inde- pendent action of the foetal heart as much as a motion of the chest indi- cates an action of the intercostal muscles. Why it should be maintained that there is life with contractility of the intercostal muscles but not with a contractile power of the heart is not apparent ; that this view is not in 616 TENANCY UY CURTESY. accordance with facts is, however, proved by several cases which are de- scril)i'd under Infanticide. (See Atelectasis, p. 567, ante.) There is no doubt that the best test to ajjply to such cases for the determination of phijsiological life is auscultation. Th(! beating of the heart as determined by the ear or the stethoscope, applied even for five consecutive minutes, is an undoubted sig-n of life in a jdiysiological sense, whether the child l)reathes, cries, or moves. Bouchut noticed on one occasion of this kind that passive life continued in an infant for twenty- three hours after its birth. Feeble but distinct pulsations were heard at long intervals, but there was no motion of the ribs. Attempts at resus- citation were made, but the motions of the heart became more and more feeble until they entirely ceased. An examination showed that the lungs had not received air. As we take the cessation of the heart's action to be the only certain evidence of death, so the existence of pulsations in the heart or arteries when clearly perceived by the ear, stethoscope, or finger is positive evidence of life in a physiological sense. Is this legal life ? Would the wilful destruction of such a child constitute murder ? Would this proof of pulsation without motion, respiration, crying, or any other sign of active life, confer tenancy by curtesy or transfer an estate by inheritance or survivorship? Bouchut justly observes that ap- parent death succeeding to birth and characterized by the presence of a beating of the heart and an absence of breathing is only a mgrbid condi- tion of the newborn child (see p. 569, ante) ; and whether it is cured of this or dies it is living, although it has not breathed — or as a German jurist remarks, " Scheintod ist Scheinleben.''^ They who contend that crying or breathing alone should be taken as a sign of life after birth would of course pronounce such a child to have been born dead, even at the time that they might be listening to the pulsations of its heart. (Casper, Klin. Novel., 1883, p. 564.) Vagitus Uterinas. — Let us suppose that the evidence of a child having been born alive is stated to be that it was heard to cry ; it may be a question for a medical witness in cross-examination whether this is to be taken as an absolute proof of live birth. The answ^er must be in the negative, because a child may cry before its body is entirely born ; or there may have been what is called vagitus uterinvs — a uterine cry after the rupture of the membranes. (See Infanticide.) It is quite certain that a child may breathe without crying, but it cannot cry without breathing ; yet neither the crying nor the breathing is a necessary proof that the child was actually born alive. A child may breathe in the womb or vagina or with its head at the outlet and die before its body is born : the discovery of its having breathed would not, therefore, be proof of its having enjoyed what has been termed " extra-uterine life." As in all cases of this description there must be eye-witnesses, either professional or not, the evidence will not rest solely upon a merely medical possibility of the occurrence of such a cry before birth, and proof will then be re- quired of the crying of the child after it was born. The determina- tion of the momentary existence of children after birth is of importance in a legal point of view in reference to the following subject. Tenancy by Curtesy. — This signifies, according to Blackstone, a tenant by the courts of England. When a married woman possessed of estate dies the estate passes from the husband to her heir-at-law unless there has been a child born living of the marriage during the life of the wife, in w^hich case the husband acquires a life-interest in the property. This custom is of great antiquity. Incurable sterility, a protracted labor, de- formity in the pelvis of the wife, or the necessary performance of crani- TENANCY BY CURTESY. 617 otoniy on a healthy well-formed child may, under this custom, lead to an aversion of the inheritance. The tenancy in contested cases is generally established or disproved by medical evidence : and the following are the conditions which the law requires in order that the right should exist: — 1. The child must be born alive. Cases have been already referred to in which the motion of a lip and the pulsations of the navel-string were held to be sufficient legal proofs of live birth. Some physiologists have objected to these as inadequate proofs of life in a medical sense; and if the question were one of pure physiology and not of law there might be some ground for the objection. The law, however, does not require proof of active life in a child, but merely some evidence, however slight^ that it has been born living. The crying of a child, properly attested by disinterested witnesses, has been held in cases of disputed tenancy to be sufficient evidence of live birth ; this is, in fact, one of the tests given by Lord Coke. At pp. 545, 646, ante, some cases are related in which newborn children survived birth- several hours, but manifested no sign of active life either by crying or in any other mode, and after death there was no air in the lungs. As in cases of infanticide, if the evidence of live birth rests entirely on an exami- nation after death, the absence of air from the lungs will not necessarily show that a child has come into the world dead ; nor will the presence of air in these organs prove that it has been born alive ; because it may have breathed and died before birth. The child must be heard to cry, or be seen to breathe or move after birth. The fact that the lungs are not dis- tended with air, and that they sink in water, either when entire or when divided into small pieces, is no proof that a child has not breathed and cried during birth and afterwards. It does not require full inflation of the lungs for these conditions to exist. Barnes found that the lungs of children which had cried during birth sank in water A woman was sud- denly delivered at five months and a half. The child cried loudly when born. It survived forty-four hours. The eyelids were perfectly closed. It weighed one pound and a quarter, and was eleven inches in length. (Obst. Trans., 1875, vol. xvi. p. 86.) At page 227 of the same volume, there is another case of a child born at the sixth month, which cried loudly several times and lived twenty-one hours. It weighed one pound six ounces, and measured twelve inches in length. In a third case, which occurred to Yernon (p. 568, ante), a six months' child was strong enough to cry ; yet the lungs contained no air and sank in water. A child born at the fifth month has been known to cry, but the state of its lungs is not recorded. In the case of Gardner v. Llewellyn (1856), a medical witness, who appeared for the plaintiff, stated as his belief that a child born at the fifth month could not i-espire, and if it could not breathe (so as to fill the lungs) it could not cry. This is not consistent with facts observed by others. 2. The child must be horn while the mother is living. From this it appears that, if a living child were removed from the outlet, or extracted from the womb by the Cesarean operation after the death of the mother, the husband would not become entitled to enjoy his wife's estate ; although the child might survive its removal or extraction, and succeed to the estate on attaining its majority. How such a case would be decided in the present day it is difficult to imagine ; but one instance is quoted by most medico-legal writers from Lord Coke, in which, about three centuries since, the decision went against the husband, in consequence of the child having been removed from the womb by the Cajsarean section after the death of the wife. (For a case involving this question in France, see 618 TENANCY BY CURTESY. Ann. d'Hyg., 1838, t. 1, p. 98.) In the case of Llewellyn (supra) Alder- son, B., ruled that the husband could not take the estate unless the child was proved to have been born during the marriage, i. e. during the life of the woman. This question was raised on appeal in the case of Treheren V. Lay ton, June, 1875. An estate had been left to the wife by her grand- father, after her death to her children, and in case she died leaving no issue, then to his ne.xt of kin. She had a child, which just breathed and then died, and after her own death the estate was claimed by the ne.xt of kin, while the husband, the father of the child, claimed it as his child's heir-at-law. It was not disputed that the wife died "leaving no issue," but it was contended for the husband that the estate was vested in his child by its momentary life, and all the judges held that it could not be ■devested by the child's death. The old custom of tenancy by curtesy was thus confirmed, in spite of the words in the grandfather's will. [Tenancy by the curtesy, legally defined, is an estate for life created by the act of the law. When a man marries a woman seised at any time ■during the coverture of an estate of inheritance in severalty, in coparce- nary, or in common, and hath issue by her born alive, and which might by possibility inherit the same estate as heir to the wife, and the wife dies in the lifetime of the husband, he holds the land during his life by curtesy : 4 Kent's Com., 13th ed. 25 ; Litt., § 35 ; 2 Blackstone, 126 ; 1 Bishop, M. & W., § 473; Heath v. White, 5 Com. 228; Rawlins v. Adams, 7 Md. 26; Carrington v. Richardson, 79 Ala. 101, et mq. The law imposes four requisites before the husband can take by the curtesy, viz : 1, there must be a legal marriage; 2, there must be seisin by the wife during coverture; 3, there must be issue capable of inheriting the estate; 4, the wife must be dead: Jackson v. Johnson, 5 Cowen }^ 285th day (Obst. Rep., 1844) ; but his opinion is that 301 days may be taken as the average limit of gestation. (Lancet, 1844, ii. p. 284.) Blundell considered that the average period was 274 days. Sim{)son (Bromwich v. Waters, Chester Lent Ass., 18(j3), 277 days, i.e. nine cal- endar months and a week ; and other accoucheurs of repute have fixed ui)()n 280 days. Among 500 cases observed by Reid there were 283 in which the period of gestation was Avithin 280 days, and 217 cases in Avhich it went beyond this period. Duncan found, in a group of forty-six cases, that 275 days is the average interval between that which he terms " insemination " (intercourse) and parturition. The largest number of cases on any particular day was seven on the 274th day. (Edin. Month. Jour., 1854, vol. ix. p. 230.) The most common cause of this variation in time is that the usual mode of calculation, by reference to the suppres- sion of the menstrual discharge, even in a healthy woman, may lead to a possible error of two, three, or even four weeks, since there is no sign whereby in the majority of women the actual time of conception can be determined. Some have been able to determine, by peculiar sensations, the time at which they have conceived ; but, as a general rule, this must be a matter of pure conjecture when they are living in connubial inter- course. On the other hand, accidental and isolated cases have clearly proved that a great difference naturally exists among women with respect to the period of gestation; and it is probable that in no two is it necessarily the same. When there has been only ove intercourse the duration of pregnancy may be certainly calculated without reference to any changes in the female constitution ; for the date of conception, within certain limits to be pre- sently mentioned, would be fixed. Observations of this kind have shown that women have differed from each other ; and in several instances the time has exceeded or fallen short of the period of forty weeks, which has been usually set down as the legal limit of natural gestation. In three cases of single intercourse known to Rigby, labor came on in 260, 264, and 276 days, making a difference of sixteen days. (Med. Times, 1846, i. p. 471.) In three other instances which were communicated by Merriman, labor commenced at 281, 283, and 286 days respectively after one intercourse ; and in a case which occurred to Reid the labor did not commence until after the lapse of 293 days from a single intercourse. (Lancet, 1850, ii. p. 79.) In another case accurately observed the gestation lasted 281 days. Menstruation had ceased on the 16th Sept., intercourse took place on the 20th, quickening occurred on the 23d Jan., and a full-grown male child was born on the 28th June following. In two cases the women were delivered respectively in 249 and 260 days after a single intercourse. In a third, in which pregnancy was the result of a rape, there was an in- terval of 261 days between intercourse and delivery. [C. Weymouth Tidy reports eight cases in which the date of coitus was fixed. These all agree on the 278th day as being as near as possible the day of deliverv : Tidy Legal Med., vol. 2, Phil. Ed., p. 46,] Hence it will be perceived that in M'ell-observed cases, where there could be no motive for misstate- ment, and in which the characters of the women, some of whom were married and had already borne children, were beyond the reach of sus- picion, a difference of not less than thirty-three dni/s has been observed to occur, i. e. between the earliest case reported by Rigby, and the latest re- ported by Reid. This is worthy of remark, because in one case (Lus- 628 VARIATIONS IN THE PERIOD OF GESTATION. combe v. Prettyjohn) it was legally hold that 299 days, only six days lon.irer than in Reid's observation, was an impossible period for human gestation. In addition to the above facts showing the variability of the period after a single intercourse, the following may be cited. Macilvain has rei)orted a case of gestation which he thinks must have extended to 29(; or possibly to 299 days. (Amer. Jour. Med. Sci., 1848, p. 247.) We are indebted to Oldham for nine cases, which have fallen under his obser- vation, in which the duration of pregnancy from a single intercourse was accurately observed : Case. Days. 1 .... 266 2 . . . .268 3 .... 271 Case. Days. 6 .... 281 T . . . .283 8 .... 284 4 . . . . 280 I 9 . . . .285 5 . . . . 280 I Nos. 4, 5, and 6 represent the periods of gestation in the same woman at different times. Idelson, a recent female medical authority, made observations on the duration of pregnancy in 4870 cases. The usual duration was 279 days. (Petersburg. Med. Wochenschr., April 28, 1881.) Lockwood published the following as the result of his experience. The actual duration of the term of gestation in the human subject, i. e. the in- terval between intercourse and delivery, was ascertained by him in four cases : Xo. 1, aged 19, duration 272 days (first confinement) ; No. 2, aged 30 (first confinement), duration 276 days; No. 8, aged 17, duration 270 days ; No. 4, aged 44 (seventh confinement), duration 284 days, the child weighing fourteen pounds. (Brit. Amer. Jour., Dec. 1847, p. 214.) Devilliers also published the particulars of nine cases in which the inter- val from a single intercourse was accurately determined. Delivery took place at the following periods; 229, 246, 257, 267, 801, 276-281, 278-283, 270, and 266-272 days, making an extreme difference of 49 days in the eai-liest and the latest periods between intercourse and delivery. (Lond. Med. Gaz., 1848, p. 524.) Ahlfeld made observations on 425 women Avhose children seemed mature, and, reckoning from the day of conception, he found that the average duration of gestation was 269.9 days. Out of thirty cases of single or well-defined coitus collected by him gestation varied from 233 days to one case of 313 days. The average of all was 269.2 days, which corresponds closely with the period obtained by other modes of observation. (Amer. Med. Jour. Sci., 1870, p. 566.) Heckers' tables give an average of 278.5 days. According to Stadtfeldt, the mean duration in sixty-five pregnancies observed by him was 271.8 days, and the extent of variation was from 250 to 293 days. (Brit. Med. Jour., 1877, ii. p. 599.) Strathy reports a case (ibid., 1876, i. p. 505) in which a married woman was delivered of a child weighing about five pounds, 298 days after the last intercourse with her husband. A long period of gestation, 308 days accurately recorded, is based upon the observation of Hewett. The duration was ascertained by the sudden death of the hus- band, and rests obviously upon the statement of the wife, (Guy and Terrier, Princ. of For. Med., 6th edit., p. 123.) There is reason to believe that the date of conception after a single intercourse varies in different women and in the same woman at different times. It is customary for physiologists to date conception from inter- course ; but a variable interval may elapse, according to the situation of the ovum at the time. It has also been supposed that women conceive VARIATIOMS IN THK PERIOD OF GESTATION. G29 more readily at some periods than at others, and that intercourse had within eight to twelve days from the cessation of the menstrual discharge is more favorable to conception than at any other period. Oldham met with a case in which impregnation took place twelve days after menstru- ation ; and he states that he has known it to occur at the respective times of ten days, twelve days, and even twenty-one days after the monthly period; and he knows of no fact to disprove the opinion that the human female is susceptible of impregnation at any time between her monthly periods. According to Duncan, a single insemination at any period of the interval between two menstrual periods may result in fecundation. (Edin. Month. Jour., 1854, vol. ix. p. 233.) The experience of Oldham is confirmed by that of Reid. This authority admits that impregnation is more likely to occur immediately after the termination of a menstrual period than at any time during the interval. The next most likely period is immediately previous to the occurrence of menstruation, and the probability of conception becomes slighter as the time is more distant from this epoch ; but there is no period in the men- strual interval at which impregnation may not occur. (Lancet, 1853, ii. p. 205.) According to Raciborski, from observations made on one hun- dred women, no more than six or seven had become impregnated at the mid-term from the menstrual periods. In several cases of single inter- course, the dates being certain, conception took place twelve and fourteen days after menstruation. It may be therefore fairly taken as a fact, irre- spective of any theories of ovulation, that a woman may conceive from intercourse had at the inter-menstrual period (mid-period), although, in a given number of instances, it is probable that the conceptions would be more numerous within six or seven days after the cessation of the menses than at any other time. [Sir William Hunter names nine months as the vsual term. Sir James Simpson fixes the normal duration as between 274 and 280 days. Dr. Robert Barnes says from 273 to 278 days is the most common period, and he thinks 275 days the average normal period. Dr. Montgomery cites 56 cases resulting from a single coitus (Montgomery, p. 566), delivery took place in ten of them (17.84 per cent.) in the 39th week, twenty-two (39.28 per cent.) in the fortieth week, and in nine (16.07 per cent.) in the forty-first week. He gives 280 days as, in his judgment, the usual period, and cites Hippocrates and Herodotus as of the same opinion. Schroeder fixes 271 days as the normal period of pregnancy : Tidy Legal Medicine, vol. 2, p. 47.] In this case it is assumed that intercourse and conception are synchron- ous, but the date of conception is not fixed by the date of intercou7\He. The time occupied by the descent of the ovum along the Fallopian tube varies, while the time required for the passage of the male fluid to meet the ovum is also subject to variation. The investigations of Bischoft" and Valentin show that the spermatozoa may retain their movements, and probably their fecundating power, for so long a period as seveii days within the body of a woman. Fecundation cannot result unless the matured ovum meets these bodies in an active or living condition ; and conception may be regarded, in the language of Meigs, as the fixation of a fecundated ovum upon the living surface of the woman. Conception may therefore take place either in a few hours or, according to Valentin's ob- servations, at so long a period as seven days, after intercourse. But this does not satisfactorily explain such extreme differences as were observed in the cases of Rigby and Reid (thirty-three days), or in those of Devil- liers (forty -nine days) — ante, p. 629. We must, therefore, be prepared to 630 EVIDENCE FROM MARKS OF DEVELOPMENT. admit, either that conception may in some cases be delayed for so long- a period as from five to seven weeks after intercourse, or that there may be a difference of from five to seven weeks in the duration of pregnancy. Whatever may be the e.\})kination adopted, it is obvious that, in a medico- legal view, the only conclusion at which we can arrive is that the period of gestation in woman is not, as it was formerly supposed to be, a fixed and invariable term. Mistakes have arisen in the calculation of the period by the use of the word " month" — some intending by this a lunar and others a calendar month. Nine lunar months would be equal to 262 days, while the average of nine calendar months would ))e 274 days — the latter period varying according to the particular months of the year over which the pregnancy might extend. To prevent mistakes, or that misunderstanding of evidence which has so frequently arisen, it is advisable that medical witnesses should always express the period of gestation in weeks or days, concerning which there can be no misunderstanding ; and adopt the plan of always commencing the calculation from the period of the last cessation of the menses, rather than from two weeks later. The latter rule is often fol- lowed, and this discrepancy is another cause of confusion. Premature Births. Short Periods of Gestation. — From the preceding remarks, we may regard all births before the thirtv-eighth week as pre- mature, and all those which occur after the fortieth week as protracted cases; and one great point for a medical witness to determine is whether the external characters presented by a child correspond to those which it should present, supposing it to be legitimately born. When the birth is premature, this sort of corroborative evidence may be sometimes obtained ; because, assuming that there has been no access between the parties before marriage, children born at the fifth or sixth month after marriage cannot, if the offspring of the husband, present the characters of those born at the full period. It it not so with protracted births, for children are not more developed in protracted cases than they are in those which occur at the usual period. This would lead to the inference that, when a child has reached a certain stage of development, it ceases to grow — a view which is borne out by the observations of Riittel. (Henke's Zeitschrift, 1844, p. 247.) He observed that the size of a child did not increase in pro- portion to the length of gestation. In protracted human and animal gestation, the offspring is not remarkable for size and weio^ht. Thus robust mothers have had small children, and small mothers strong and sometimes unusually large children. Murphy states that he met with a fully- developed child which was born after a gestation of only 251 days. (Lancet, 1844, ii. p. 284.) For an account of the characters presented by children at different uterine ages, see Infanticide (p. 554, ante). Development of the Child In judging from marks of development on the body of a child as a test of uterine age, we must make full allowance for the exceptions to which they are liable. The nearer the supposed pre- mature delivery approaches to the full period of gestation, the more diffi- cult will be the formation of an opinion. Although the characters of a seven months' child, as a general rule, are usually well marked, and may be known by common observation, it is not possible to distinguish with absolute certainty a child born at the eighth from one born at the ninth month. Burns observes that gestation may be completed, and the child perfected to its natural size, a week or two sooner than the end of the ninth month; and other accoucheurs corroborate this view. (Murphy, in Lancet, 1844, ii. p. 284.) When, however, the facts are such that to be the offspring of the hus- EVIDENCE FROM MARKS OF DEVELOPMENT. 631 band it must be a six months' child, and it is born mature, there can be no reason to doubt that it is ille.^itimate. (Eager v. Griniwood, Exch. Sittings, Jan. Y, 1847.) But the fact that a child born at nine months is small, and resembles in size and weight a seven or eight months' child, cannot be taken as a medical proof of illegitimacy. Children born at the full period vary considera))ly in size and weight; yet, although small, there is commonly about them an appearance of developvient, which is especially apparent in the features. If there should be a general want of development in the body, and if certain foetal peculiarities remain — as, for example, the membranfe pupillares, or, in the male, the testes do not occupy the scrotum — these facts lead to a strong presumption that the child has not reached the full period. On the other hand, when a child is born with the full signs of nuiturit}^ about it, at or under seven months from possible access of the husband, there is an equally strong presumption that it is illegitimate. The great progressive stage of development is dur- ing the last two months of gestation — the changes which the foetus under- goes are greater and more marked at this than at any other time. The general opinion is that an eight months' child is not with any certainty to he distinguished from one born at the ninth month. If the body of a child is large and fully developed, it would be considered to have been born at the full period of gestation, and any opinion which had led to the supposi- tion that it was a seven months' child would be attributed to some mis- take in the calculation. Beck states it as barely possible that a child born at seven months may occasionally be of such a size as to be considered mature, yet he qualifies this statement by the remark that the assertion is most frequently made by those whose character is in danger of being- destroyed. The important medical cjuestion is, how^ever — Has a really seven months' child ever been born so developed as to be mistaken by an experienced person for one that was mature ? He adduces no case of this kind in support of his opinion. There can be no doubt of the correctness of this statement, that a mature child, born before seven full months after intercourse, ought to be considered illegitimate : but it would be difficult to maintain this proposition consistently with the above admission. In Bromwick v. Waters (Chester Lent Ass., 1862), the question of pre- mature development arose incidentally upon an alleged gestation of 259 days. It was stated that intercourse had taken place upon Nov. 9, 1861, and a child was born on July 26, 1862 — a period of 259 days, or thirty- seven weeks. The child had the appearance of a mature child. The counsel for the defendant admitted that a child born at this period, i. e. three weeks before maturity, might be as large as one born at the ninth month, but he denied that it would be so perfcctl}^ developed in all its parts. When the question was put to Simpson, he said that full size was generally combined with full development ; and he further stated that it was against all the laws of nature that children should be born full grown even a fortnight before the usual term of gestation, which he fixed at nine calendar months and a week. According to this view, if there had been intercourse on Nov. 9, 1861, the day of probable delivery would be a week after the 9th of the following August, i. e. on Aug. 16, 1862. Hence, as the child was actually born in a mature state on July 26, this was three weeks before the usual term ; and therefore, in his opinion, im- pregnation from some other person had probably taken place three weeks earlier than the period assigned by the woman (Whalley). Simpson con- sidered it to be as rare that a child should be born full grown three weeks before the usual period, as that a man should attain one hundred years of age. (Rep. of the Trial of Bromwick v. Waters, 1863, p. 33.) There are C32 VIABILITY. not many medical witnesses, however, who would venture to affirm that in the last three weeks of gestation there are such marked changes in the body of a child as to render this diflerence in time always perceptible, or who would venture to bastardize a child or convict a woman of adultery because, when born at the 259th day after intercourse, the child had about it the usual appearance of maturity. This would be equal to affirming that variations in size might take place at the ninth, but not at the eighth month of gestation. But facts are adverse to the theory. Kiittel has met with several instances in which women have been delivered two and even three weeks before the expiration of the ordinary term (280 days), and the children were as perfectly developed, to all appearance, as othiu- children which had been born at the full period ; at any rate, they could not be distinguished from them by competent observers. In another part of this work (Infanticide, p. 554, ante), some cases are related which prove that, at the ninth month, children are occasionally born of a size and weight greatly exceeding the average. Thus a nine months' child has been born weighing eighteen pounds and measuring thirty-two inches, whereas the usual weight is from six to seven pounds, and the length eighteen inches. In such an exceptional case there is reason to believe that, had the child come into the world at the seventh month, it would have appeared to the accoucheur to have reached the full term. As it is impossible to say when such an exception is likely to occur, and a lawyer is always entitled to take advantage of either extreme, it follows that, in any case in which this question arises, a witness will be bound to admit that a seven months' child may be born of the average size and weight of a nine months' child, or to give some valid reason for the fact that great variations in size and weight may occur at the ninth, but never at or about the seventh or eighth month of gestation. He must also be prepared to affirm from facts within his know^ledge that, in these extreme cases, the doubling of the weight and length of the child is not progressive, but that it suddenly takes place at or near the ninth month. If the child is a male, and the testicles are found in the scrotum, there is every reason to believe that it has passed the seventh and even the eighth month of uterine life. (See Infanticide, p. 554, ante.) The differences of opinion among obstetric experts in reference to this question appear to admit of explanation. All will agree that, as a general rule, a seven months' child might be distinguished from a nine months' child, unless the latter was a twin ; but at the same time, it must be admitted that, if variations in development take place at the full term, there is nothing to prevent such variations from occurring at the seventh and eighth months of gestation. Rigby said that he had often met with instances of well- developed children born within seven months of marriage, but only with the first child. The date of marriage must not, however, always be taken as the date of conception. (Obst. Trans., 1875, p. 227.) Hicks has seen a child born seven months after marriage as large as at the full term ; but, as he suggests, this child might really have been begotten so as to be born at the full term. In order to determine this point by unexceptional facts, it would be necessary to collect a series of cases of impregnation from one intercourse in which the children were born seven months after such inter- course, and were proved to have had the average size and weight of mature children. Earliest Period ot lohich a Child may he horn living. Viability. — The fact that a child has had the strength to survive its birth for a certain period has been supposed to furnish additional evidence of maturity ; for it is well known that, under a certain age, children are not born living, or EARLIEST PERIOD A CHILD MAY BE BORN ALIVE. 633 if living they speedily die. Therefore it has been argued, if a child born at the fifth or sixth month after the first cohabitation be born living or survive, this should, ipso facto, be taken as a proof of its illegitimacy. According to the English law, it is not necessary that a child, when born, should be capable of living, or viable, in order that it should take its civil rights. Thus it may be born at an early period of gestation, — it may be immature, and not likely to survive ; or, again, it may be born at the full period of gestation, but it may be obviously laboring under some defective organization, or some mortal disease, which must necessarily cause its death within a short time after its birth. Fortunately, these points are of no importance in relation to the right of inheritance; an English medical jurist has only to prove that there was some well-marked phy- siological sign of life after birth. Whether the child was mature or im- mature, diseased or healthy, is a matter which does not at all enter into the investigation. In this respect our law appears to be more simple and just than that which prevails in France. By Art. 125 of the Code Napo- leon, no child that is born alive can inherit unless it is born, as the law terms it, viable. The meaning of this word is not defined by the law itself, and there are probably no two lawyers or physicians in that country who place upon it the same interpretation. The French law seems to intend by viability in a newborn child, that it should have breathed and be capable of living out of the womb of its mother and independently of her ; also that it should be capable of living for a longer or shorter period after its birth. [The Parliament of Paris decided in the case of Cardinal Richelieu that an infant at five months was capable of inheriting under the law of France: Case 89. The Code Napoleon fixed 180 days, or six calendar months, as the earliest period when a child may be live born. The Scotch law allows an infant to be viable in six lunar months or 168 days.] The question, therefore, to be considered is — What is the earliest period of uterine life at which a healthily formed child can be born living and with a capacity to live after its birth and to attain maturity ? It is uni- versally admitted that children born at the seventh month of gestation are capable of living, although they are more delicate, and in general require greater care and attention to preserve them than children born at the ninth month ; the chances are, however, very much against their sur- viving. It was the opinion of W. Hunter, and it is one in which most modern authorities concur, that few children born before seven calendar months (or 210 days) are capable of living to manhood. They ma}' be born alive at any period between the sixth and seventh months; or even, in some instances, earlier than the sixth ; but this is rare, and, if born living, they commonly die soon after birth. There is one case on record of a child having been born living so early as the fourth, month of gestation (Brit, and For. Med. Rev., vol. ii. p. 236) ; and another in which a woman aborted at the fourth month and a half of pregnancy. Maisonneuve saw the woman two hours after delivery : he then found the foetus in its mem- branes, and, on laying these open, to his surprise it was still moving. He applied warmth, and succeeded in partially restoring it ; for a few minutes the respiratory movements were performed with regularity, but in spite of the establishment of respiration, the child died about sixth hours after its birth. (Lond. Med. Gaz., vol. xxxix. p. 97.) Edis brought before the Obstetrical Society a foetus born five months and ten days dating from the last menstrual period (5|- months' gestation). Immediately the child was born, it cried so loudl}^ that it was heard down- stairs, and continued at intervals to cry as loudly as a full-grown infant. 634 PREMATURE BIRTHS. It could not be made warm. It passed meconium, but no urine. It swallowed without trouble. The eyelids were closed. Its weight was one pound and a (piarter, its length was eleven inches. It lived forty- four hours. Other cases of a similar kind have been elsewhere described (p. 017). It was said that this child was not viable, though it had poten- tial life. (Brit. Med. Jour., 1874, i. p. 541) In two instances of abortion about the Jift/i month, Davies noticed that the foetus showed signs of life after its birth, by moving its limbs (Lond. Med. Gaz., vol. xl. p. 1022); and in the following case a child born at the Jifth month survived upwards of twelve hours. A woman in her second pregnancy, and in the 147th day of gestation, had severe flooding with rupture of the mem- branes. Labor occurred on the following night, when a small but well- formed foetus was expelled, giving no other indication of life than a feeble action of the heart and a strong pulsation in the cord. It was resuscitated, and cried as strongly as a child born at the full |)eriod of pregnancy. It weighed less than two pounds, and was twelve inches in length. It swallowed some nourishment, but died about twelve hours after birth. The membranae pupillares were entire, the testicles had not descended, the head was well covered with hair. The length and weight as well as the presence of hair indicated a foetus between the sixth and seventh months ; but, as it is asserted that the period of gestation is accurately given, this must be regai'ded as an extraordinary instance of premature development. There was clearly nothing in the organization of this child to have prevented its growing to the age of maturity ; in other words, it was viable. (Med.-Chir. Rev., 1844, p. 266.) [Vid." table of cases of early viability, No. 84, page 86, Tidy's Legal Medicine, Phil. Edition, 48 cases.] In 1865, Carter communicated to the author the particulars of a case in which a child was born living at the fiffh month of gestation. It cried slightly when it was born, and during the half hour that it was unsevered from its mother it made frequent efforts to breathe. It was perfectly formed, was about one foot in length, and its weight was fully one pound and a quarter. It died soon after it was born. Moore reported a case of a child born living at the fifth month. (Lancet, 1865, ii. p. 535.) A case is reported in which a child born at five months and a half survived its birth between three and four hours. (Lond. Med. Gaz., vol. xix. p. 165) ; and on a trial for child-murder (Reg. v. West, Nottingham Lent Ass., 1848), a midwife was indicted for causing the death of a child by bringing about the premature delivery of the mother when .she was between the fifth and sixth months of her pregnancy. The child in this instance lived five hours after its birth. Capuron mentions a case in which a child was born at the sixth month and a half of pregnancy, and at the date of the report it was two years old and enjoyed excellent health. In another instance a child was born at the same period, and lived to the age of ten years. (Med. Le'g. des Ace, pp. 162, 208.) Capuron considers that a child born at the 180th day, or at the sixth month after conception, may be sufficiently mature to live, i. e. that there would be no reason to presume it was illegitimate merely because it sur- vived its premature birth. On the other hand, if born before the sixth month with sufficient maturity to live, this fact, although by no means a proof, affords, in his opinion, a strong presumption of its illegitimacy. Of eight cases of children born living (by abortion) at the sixth month, Whitehead states that seven perished within six hours after birth, and only one attained to the age often days. (On Abortion, p. 249.) Riittel, who has examined this subject with great care, states, as the result of bis experience, that he attended a married woman, who was PREMATURE BIRTHS. 635 afterwards delivered of a living- child in the fifth month of her pregnancy ; the child survived its birth for twenty-four hours. He delivered another woman of twins in the sixth month of her pregnancy ; one was dead, and the other continued alive for three hours, its life being indicated only by the visible pulsation of the heart, but there was no perceptible breathing. This fact strongly corroborates the remarks made elsewhere, as to life without active respiration (Infanticide, p. 567, ante) ; it has also an im- mediate bearing on the proof of life in reference to tenancy by curtesy (p. 616, ante). In another instance of the birth of male twins at the sixth month, each weighed three pounds. Riittel saw them a year after their birth, and they were then two healthy strong children. (Henke's Zeitschrift der S, A., 1844, p. 241.) Barker met with a case in which a female child was born on the 158th day of gestation, or twenty-two weeks and four days after intercourse. The size and weight of the child corre- sponded with the period at which it was born : it weighed one pound, and w^as eleven inches in length. It had only rudimentary nails, and very little hair on the back of the head .; the eyelids were closed and re- mained closed until the second day ; the nails were hardly visible ; the skin was shrivelled. The child did not suck properly until after the lapse ■of a month, and did not walk until she was nineteen months old. When born, the child was wrapped up and placed in a box before the fire. Three years and a half afterwards the child was in a thriving state and healthy, but of small make, weighing twenty-nine pounds and a half. (Med. Times, 1850, ii. pp. 250, 392.) In a case which occurred to Outrepont (Henke's Zeitschrift, vol. vi.), there was the strongest reason to believe that gestation could not have exceeded twenty-seven weeks. A male child weighed, when born, one pound and a half, and measured thirteen inches and a half. The skin was covered with down and much wrinkled, the limbs were small, the nails appeared like white folds of skin, and the testicles had not descended. It breathed as soon as it was born ; and by great care its life was preserved. It is singular that its development was very slow until it had reached a period which would have corresponded to the forty-second week of gestation. Outrepont saw the child when he had attained the age of eleven years, and then he appeared to be of the size of a boy of eight years. The only remarkable point about this case is the length of time which the child lived. In a case quoted in the Lancet (1851, ii. p. ITt), a child born at six months and ten days was thriving satisfactorily when four months old. (See also Med. Times, 1850, i. p. 129.) Hence it may be considered as established that children born at the seventh and even at or about the sixth month may be reared, and that the fact of their surviving for months or years cannot be taken as a proof of illegitimacy. In forming our judgment on these occasions we are bound to look less at the period at which a child is born than at the marks of de- velopment about the body. Bonnar has published a tabulated view of 112 cases of premature births of living children — the dates of gestation ex- tending from the 120th to the 210th day. Among these cases 35 children died within the first twenty-four hours ; 13 more before the completion of one week ; 1 in six weeks ; 4 in four months. The following lived or were living at the date of the report: 1, seven months and a half; 8, from one to two years; 1, three years and a half; 5, from ten to fifteen years; 6, to adult age; 5 lived, but it is not stated how long, (Critical Incjuiry regarding Superfoetation, 1865, p. 13.) Protracted Births. Long Periods of Gestation. — The questions con- nected with retarded gestation have given rise to considerable discussion in legal medicine. That gestation may be retarded or protracted beyond 636 PROTRACTED BIRTHS. the fortieth week is now not disputed by any obstetric writer of reputa- tion. Some accoucheurs have denied it, because the}^ have not met with such cases ; but the medico-legal relations of such questions as these do not depend upon the solitary experience of practitioners. It is only by the accumulation of well-ascertained facts from all authentic sources that medical knowledge can be made available for the purposes of the law ; otherwise, owing to the mere accident of a witness not having met with any exceptional instance, a court may be entirely misled in its judgment by trusting to his opinion. It is the more important to attend to this because most of the cases involving questions either of contested legitimacy or of the chastity of women turn upon protracted rather than upon premature delivery. In standard works on Midwifer}^ will be found authentic reports of cases in which gestation continued to the forty-first, forty-second, forty- third, and even to the forty-fourth week. Murphy regarded 301 da3's or forty-three weeks as the average limit of gestation. (Obst. Rep. p. 4.) Lee met with a case in which he had no doubt that the pregnancy lasted 287 days ; the labor did not take place until forty-one weeks after the de- parture of the husband of the lady for the West Indies. (Lond. Med. Gaz., vol. xxxi. p. 917.) W. Hunter met with two instances in which gestation was protracted until the forty-second week. Montgomery met with a case in which delivery did not ensue until between the forty-second and forty-fourth weeks. (Lond. Med. Gaz., vol. xix. p. 646.) Merriman has published a table on the subject of protracted gestation, on which the most experienced accoucheurs have been in the habit of relying. Of 114 preg- nancies calculated by him from the last day at which the women men- struated and in which the children appeared to be mature, the following- were the periods : — In the 37th week ... 2 38th " . . .13 " 39th " . . .14 " 4Uth "... 33 In the 41st week ... 22 " 42nd " . . .15 " 43rd "... 10 " 44th " ... 4 Another well-marked case occurring precisely forty-four weeks after the cessation of the menses was communicated to the author by Merriman. From these results Merriman considers that in the greater number of women gestation is completed in the fortieth week from the cessation of the menses, and next to this period in the forty-first. In the evidence given by him in the Gardner Peerage case before the House of Lords in 1825, the case of longest protraction on which he was able to rely was that of a married woman who was in the habit of calculating from the last day on which her monthly period ceased. This lady was delivered 309 days, or forty-four weeks and one day, from the time at which she supposed that she had conceived. In another case mentioned by the wit- ness the period w^as 303 days, or forty-three weeks and two days from the termination of the last monthly period. It was objected to this evidence that it was impossible to fix the exact date of conception, and, as the female might have really conceived only a day or two before the expected return of menstruation, twenty-eight days (or four weeks) should be de- ducted from the periods assigned by the witness. Admitting the validity of this objection — and the fact upon which it is based is indisputable — it followed that the longest protracted case observed by Merriman might have really been only a case of ordinary gestation extending to forty weeks and one day. An objection of this kind may, of course, be suc- cessfully urged in law to any inference from a calculation so made, and it CASES OF PROTRACTED GESTATION. 637 was thus that in the Gardner Peerage case the medical evidence failed to render it certain that gestation might be so protracted as to support the legitimac}^ of the claimant ; namely, 311 days or forty-four weeks and three days. Hence in considering this question it is necessary to make full allowance for such a cause of error ; and in calculating the pregnancy from the last day of the last menstrual period we should deduct the in- terval of menstruation if known, and at least twenty-eight days if un- known. In these cases of contested legitimacy the offspring is commonly the result of a single intercourse, hence the date of conception is fixed within limits already described (p. 626) ; and a comparison can be insti- tuted only between the period of gestation thence deduced and the periods taken in other cases which are equally free from error. A well-marked case of gestation passing beyond what is commonly set down as the average period was communicated to the author by Howell. This occurred in a healthy Avoman, aged 30, who had borne three cbildren, the youngest being 4 years old. She had menstruated with regularity up to the third week in June ; the menses then stopped without any api)arent cause. Her delivery took place 323 days after their last appearance. Allowing that impregnation occurred at the intermenstrual period, this would make the gestation 309 days ; or assuming that impregnation did not occur until twenty-eight days from the date of the last menstruation, this would make the period 295 days, or forty-two weeks and one day. A case is reported by Power (Human Pregnancy), in which gestation is said to have extended to 325 days. Chattaway communicated to the author the following instance of protracted gestation. A healthy woman, aet. 36, applied to him to attend her in her confinement, which she expected to take place in Sept. 1856. The menses appeared for the last time in Dec. 1855, and she quickened in the beginning of April, 1856. About the middle of September {i. e. on the 283d day, dating from the last men- struation) Chattaway was summoned to attend her and found her laboring under severe false pains ; there was also a discharge of mucus tinged with blood. The case went on until Nov. 19, 1856, when the patient was delivered of a female child of the average size. It would thus appear, according to the ordinary mode of calculation, that, deducting twenty- eight days from the last appearance of the menses, gestation was pro- tracted in this instance to 330 days, or forty-seven weeks and one day. This, of course, is open to the suggestion that the menses had ceased from some accidental cause, and that pregnancy had taken place some weeks subsequently. It is known, in fact, that a woman may, ex- ceptionally, menstruate even more than once after conception. In reference to this objection, it may be observed that few women have such unusually protracted pregnancies. Then, again, all practitioners may not have met with protracted cases ; but the fact being clearly ascertained in one case, it is unnecessary to search for more, unless we doubt the credi- bility of reporters well qualified to observe and who could have had no conceivable motive to misrepresent the facts which came before them. The advocates of a fixed and limitable period differ from each other by a space of at least ten or twelve days and each must either take his own experience for the final decision of this question, or must allow that men of equal powers of observation with themselves have met with exceptional instances. Protracted cases of gestation are always open to the objection that the menstrual function may have been suspended from some hidden morbid cause, one or two months before the actual date of conception, and that there may have been some error in the calculation by which the period 638 CASES OF PROTRACTED GESTATION. has been detern'iincd. If, however, the objection is admitted under these circumstances, it would be only equally just to admit that in any given case the ordinary and so-called fixed period, also calculated from the ces- sation of menstruation, is based on a fallacy. The menstrual function may have accidentally ceased, or continued for several intervals after con- ception and thus a corresponding change should be made in fixing the ordinar}^ period of gestation. This view of the (juestion implies that no reliance can be placed on the date of the cessation of the menses as evi- dence of the actual duration of pregnancy, whether natural, premature, or protracted. But Ilicks met with a case in wiiich the pregnancy of a woman appeai^ed to be protracted to between twelve and thirteen months. There was every reason to believe that this woman became pregnant during the absence of the menses and that these had been suspended for some time before intercourse took place. This is no- doubt the explanation of a large number of cases of alleged protracted gestation. We have no right, in alleged protracted cases, to refer the suppression to disease, for the sake of shortening the period, when in ordinary cases we do not refer its continuance to disease, because this would tend to lengthen it ; if rejected, it would be in the highest degree unjust not to give to a claimant the beneficial presumption of his having been born legitimately, when the cases adduced in evidence against his claim are actually based upon a precisely similar mode of calculation. It is, however, difficult to admit that all the protracted cases recorded by different observers have depended upon mistakes being made in the calcu- lation of the period, since this calculation is based on the same principles as those adopted in cases of ordinary pregnancy. Hence, if there is a mistake in the one case, there would be in the other ; if an error in the exception, there would be an error in the rule. Either the average term of pregnancy is wrongly calculated by most accoucheurs at the thirty-eighth or fortieth week, or it is rightly calculated to extend occasionally to the forty-fourth, or, admitting these protracted cases, to the forty -six'th week. But, even setting aside the obvious answer to an objection of this nature, some of the protracted cases observed were instances of impregnation from a single intercourse ; and, making due allowance for the interval for conception, the general inference would not be affected and no fallacy could have arisen in these cases of protraction from mistakes dependent on the cessation of menstruation. ""^^iteid^conclusions, derived from numerous facts and cases, represent the views of an experienced observer on this much-disputed question. They are — " 1. The duration of pregnancy is not altogether a fixed period ; it varies somewhat in the human female as it does in the lower orders of animals. 2. This deviation, however, is not to any great extent; the Duly certain data of calculation are those dependent on the known time of conception (of intercourse ?). 3. The average duration of the pregnant state, when calculated from this event, is about 275 days, or it may have a range of from 270 to 280 days. 4. There is no full or satisfactory evi- 1 deuce of gestation having been prolonged beyond 29.B days. 5. The Code 1 Napoleon, which allows 300 days, may be regarded as liberal. 6. The 1 menstrual period must generally serve as our guide in default of some ! exact knowledge ; it is, however, often fallacious and is only a means of . approximation to the probable time of parturition. 7. The fortieth week after the last appearance of the menses is the most likely period and the , forty-first week the next." Strathy (Brit. Med. Jour., 1876, i. p. 505), after giving a case of his dwn which reached to 298 days after the last intercourse in the married state, refers to reported cases by different CASES OF PROTRACTED GESTATION. 639 authorities in whicli the periods were as follows : Bently, 291 days ; Skey, 293; JNlacilvvaiii, 293 ; Keid, 287 to 293; and Ashwell, 300. Duncan (Edin. Month. Jour., 1854, vol. ix. p. 230) draws the following conclusions rei^-ardiny the duration of pregnancy : 1. That the interval between conception and parturition (the real duration of pregnancy) has not been exactly ascertained in any case. 2. That the average interval between insemination (intercourse) and parturition (commonly called the duration of pregnancy) is 275 days. 3. That the average intervals be- tween the end of menstruation and parturition have no standard length, but vary \\ithin certain limits. 4, That while absolute proof of the pro- longation of real pregnancy beyond its usual limits is still deficient, there is evidence to establish the probability that it may be protracted beyond such limits to the extent of three or even four weeks. Duncan, of Shetland, has fully reported the case of a Avoman who, in her first pregnancy, was not delivered until 300 days after the last men- strual period. The second and third pregnancies lasted for about 285 days. In the fourth, to which he especially refers, she carried her child 325 clear days from the last menstruation, excepting one other case, the longest period recorded. (Med. Times and Gaz., 1877, ii. p. 712.) It will be perceived from the conclusions of Reid, that he admits a variation of 23 days, i. e. from 270 days (the shortest period) to 293 days, the longest known to himself from a single intercourse. There appears to be no valid reason why the variation should not be even greater than that which is here assigned, and why the duration of pregnancy might not ex- tend occasionally to 296 and even to 301 days. It is merely a question of individual ex})erience. An accoucheur who admitted a variation of 23 days, and who had known gestation to be protracted to the 293d day after intercourse, would hesitate to pronounce a child illegitimate merely because it has been born on the 296th or the 300th day after possible access of the husband. There is, no doubt, a limit to gestation, but it is not in our power to fix it ; hence w^e find obstetric writers of repute adopting periods which have no point of agreement among themselves. Some stop short at 280 days; others, like Reid, fix the maximum yet known at 293 days; Murphy allows from his experience at least 324 days; and Meigs considered that gestation may be continued to twelve months, or 365 days. (Obstetrics, the Science and the Art, 1849, p. 194.) The fact is, the term has not yet been fixed even approximately by medical science ; hence, in a disputed case, other circumstances must be looked to in order to lead a court of law to a safe decision. It is at present hopeless to reconcile the conflicting medical opinions which exi.st on the subject of the duration of pregnancy in the human female. There is, indeed, only one point on which all modern observers agree — namel}^ that the period cannot be lim- ited to a fixed and invariable number of days or weeks, but that it is liable to variation according to circumstances not fully understood. ^^.^--^ In Renouf t^ Eden (Q. B., March, 1870), an action for seduction, the defendant denied his liability on the ground that the plaintiff, set. 19, was not delivered until 301 days after their last interview. Medical evidence was given for the plaintiff that protraction to this extent was possible, one of the witnesses (Tanner) having seen a case beyond 293 days. Barnes and Tyler Smith, on the ])art of the defendant, would not say it was impossible, but thought it highly improba])le that gestation could have been thus pro- tracted. The Lord Chief Justice, after referring to several cases of pro- tracted gestation recorded in this work, assumed that it was possible the defendant might have been the father of the child, and summed up on the question of seduction. The jury gave a verdict for damages, thus affirm- 640 PERIODS OF GESTATION NOT FIXED BY LAW. ing that the defendant was the father of the child. (Med. Times and Gaz., 1870, i. p. 290.) It has been elsewhere observed that the date of intercourse does not furnish us with the date of conception (pp. 627, 628), and, according to some authorities, all evidence connected with the function of menstruation is untrustworthy. In spite of these objections, the menstrual period must generally serve as a guide in default of more certain criteria. It is, how- ever, curious that the date of the cessation of the menses is taken by some physicians as a guide (in married life with constant intercourse) so long as gestation does not extend Ijeyond 280 days ; while, supposing it to ex- tend to 300 days, they will assume that some other cause than pregnancy must have led to an earlier suppression and thus to an error in the calcu- lation. There may be no more evidence of suppression from a morbid cause in the one case than in the other, and the period of 280 days may be as much based on error as the period of 300 days. It is strange that those who adopt this mode of making facts square with a foregone con- clusion do not perceive that they must, in fairness, either reject altogether the evidence derivable from a cessation of the menses, or admit it ad- versely to their own views in cases in which the facts connected with the cessation have been as carefully observed and recorded by others as by themselves. No evidence on this subject can be drawn from an examina- tion of the body of the child. iHbere is no increase of size or development after the ninth month has passed. Children born at the full period of nine months have been larger and heavier than many children born, as it was believed, at a later period ; but in cases of alleged protracted gesta- tion it may be considered that the ch4id should always have attained its full growth and perfect development^^ i Stolz, after stating that the ordinary period of gestation is from 270 to 280 days, admits that it may extend to a fortnight beyond the latter period, but not longer, whatever may be the circumstances to cause pro- traction. Protracted labor, extending over five or six days, must not be included in this term. The death of a child may favor its retention in utero, and thus add to the apparent length of gestation. [See table of 38 cases of protracted utero-gestation compiled by Dr. C. Meymott Tidy : Tidy's Legal Medicine, vol. ii. p. 93, No. 109, JPhil. edition.] Period of Gestation not fixed bi/ Laiv. — In all cases of contested legiti- macy the question respecting the duration of gestation, when it arises, is left entirely open by the English law. No period of time has been fixed by English jurists within which, or beyond which, a child, if born in wed- lock, will be presumed to be illegitimate. The decisions of our courts would be founded, quoad the duration of pregnancy, on the opinions of experts selected for the occasion, and each case would be decided on its own merits. Precedents can have but little influence on these occasions, because a court may think fit to pronounce illegitimate, on non-medical grounds, a child born in the thirty-eighth week of gestation, while it may decide that another was legitimate that had been born in the forty-third week. By some law authorities /or^V weeks (or 280 days), and by others forty-three weeks (or 301 days), have been taken as the idtimum tempiis pariendi ; but it is not the custom of courts to act upon any definite rule. Nevertheless, it is clear in some extreme cases that the law may fairly in- terpose and pronounce for a reasonable limit. In the case of Cotterall v. Cotterall (Consist. Ct., July, 1847), a child was born during the mar- riage, and the husband proceeded against the wife for a divorce on the ground of adultery. The main proof was based on the fact that, in order to have been the child of the husband, it must have been born after twelve PERIODS OF GESTATION NOT FIXED BY LAW. 641 vionths^ gestation. Lnshington, without entering into the question of protracted gestation, upon proof of this allegation at once pronounced for the divorce. Such a duration of pregnancy is not supported by any known facts and is altogether opposed to medical probability. In suits of con- tested legitimacy the general practice consists in establishing possibility of access on the part of the husband; when this is proved, the medical question arises whether the term of gestation falls within the limits assigned by the best medical experience. In two instances children have been pronounced legitimate which were born, the one in forty-one weeks and three davs, and the other in forty-one weeks and four days, after the death of the husband. Legitimacy has been allowed M-here gestation was probably protracted to the forty -third week. (Anderton v. Gibbs, 1854.) In the United States, a decision in favor of paternity has been made in a case in which gestation extended to forty-five weeks and two days. (Com- monwealth V. Porter.) Legitimacy has been disallowed in the English courts, although probably on non-medical grounds, where it was pro- tracted to forty -four weeks and three days (Gardner Peerage case, 1825) ; in one case paternity was denied (judiciall}') because gestation had ex- tended to forty -two weeks and five days (Luscombe v. Prettyjohn), and in another (Dyson) because it had extended to forty -eight loeeks. The French Code cuts short all difficulties respecting the period of gestation, in cases of contested legitimacy, by fixing upon the term of 180 days after marriage, and 300 days after dissolution of marriage or non- access, between which periods children born may be regarded as legitimate. In Germany, it is laid down that gestation may be protracted to 301 or 308 days, but not beyond. The general law of Germany places the period for ordinary gestation among women not married, at 285 days, but for a married woman divorced, or whose husband has died, it allows 302 days. Hohl, who records these facts, thinks that there is injustice in this fixed rule regarding time, and that in exceptional cases a period of from 322 to 336 days might be admitted. (Ann. d'Hyg., 1873, t. 2, p. 153.) It is more reasonable and just to leave the question of duration open, than to fix it by assigning arbitrary periods, to which there must necessarily be numerous exceptions. 41 C42 DISPUTED PATERNITY. PATERNITY. CHAPTER LVII. DISPUTED PATERNITY. PARENTAL LIKENESS. — AFFILIATION. POSTHUMOUS CHILDREN. SUPERFCETATION IN RELATION TO LEGITIMACY. SUPPOSITITIOUS CHILDREN. SEXUAl MALFORMATION. Disputed Paternity. Parental Likeness. — It has been stated that the law does not pretend to determine Avho bei^at a child when it has been born during wedlock, and from circumstances it might be the child either of the husband or of an adulterer. But medical jurists have recommended that family likeness should be looked to on these occasions — not merely a likeness in feature and figure, but in gesture and other personal peculi- arities which may have characterized the alleged parent. These are called questions of paternity : they seldom occur except in reference to cases of bastardy, and, when they do present themselves the evidence thus pro- duced, even if affirmative, is properly regarded as only corroborative. In the Townshend Peerage case (House of Lords, May, 184.3) a presumption based on family likeness was admitted. The person whose legitimacy was in question was sworn by one of the witnesses to bear so strong a likeness as a child to the alleged adulterer, that he should have known him among five hundred children. The proceedings in the Douglas Peerage case (1767-9) show that evi dence of this kind is occasionally of some importance. The peerage waa claimed by Archibald Douglas — the survivor of two brothers after the death of the alleged parents, Sir John and Lady Douglas. The claim was disputed, on the ground that the appellant and his deceased brother were supposititious children. Evidence for and against the legitimacy of the claimant had been collected from every quarter, and, after it had been most minutely sifted and criticised, the case came on for judgment in the Court of Sessions in Scotland, on July 7, 1767. So important was the cause deemed, that the fifteen judges took eight days to deliver their opinions. The result was that seven of the judges voted in favor of the identity or legitimacy of Mr. Stewart, and seven against it ; the Lord President, who had the casting vote, agreed with the latter, by which Archibald Douglas, alias Stewart, was cast on the world without either name or estate. An appeal from the decision was taken to the House of Lords, by which the judgment of the Court of Session was reversed in 1769, and Archibald Stewart (or Douglas) declared to be the undoubted son of Lady Jane, the sister of the previous holder of the title. Much stress was laid, in favor of the legitimacy of these children, on the fact that they closelv resembled — the one Sir John, and the other Lady Douglas. The resemi3lance was said to be general ; it was evident in their features, gestures, and habits. Lord Mansfield, in delivering judgment, made the following remarks, which comprise all that can be said on this subject: EVIDENCE FROM PARENTAL LIKENESS. 643 " I have always considered likeness as an argument of a child being the son of a parent, and the rather as a distinction between individuals in the human species is more discernible than among animals. A man may sur- vey ten thousand people before he sees two faces exactly alike ; and in an army of a hundred thousand men, every man may be known from another. If there should be a likeness of feature, there may be a difference in the voice, gesture, or other characters, whereas a family likeness runs generally through all of these ; for in everything there is a resemblance, as of feature, voice, attitude, and action." This kind of evidence has been objected to from its uncertainty ; and it was in this instance much disputed whether one of the children did resemble Lady Douglas, but it seems to have been generally admitted that the other child resembled the husband. Sir John. From this account it will be seen that evidence from family likeness is not strictly medico-legal ; it can be furnished only by friends and relatives who have known the parties well, and are competent to speak of the facts from personal acquaintance with them. It will also be apparent that the affirmative evidence in such cases will be stronger than that which is negative, for it could hardly be inferred that a person was illegitimate be- cause he did not resemble his parent. The view taken by Lord Mansfield is based on physiological truth. The resemblance is not in features only, but in gesture — in the mode of walking, sitting, or running, and in certain habits which are really inherited, for they appear in the child when it has reached manhood, although the child may have had no knowledge of its parent. One of the witnesses in the Tichborne case (Reg. v. Castro or Orton, May, 1873), speaking to the identity of the claimant with Arthur Orton, chiefly relied on these grounds. He had known the Orton family for many years, and knew the claimant from his infancy up to the time of his leaving England in 1852. In 1870 he saw the claimant, then repre- senting himself as Roger Tichborne ; but the witness at once recognized him as the Arthur Orton whom he had known as a child, a boy, and a young man. When cross-examined on his reasons for this strong opinion after the lapse of many 3'ears, he said he had formed his opinion, " not from likeness of features alone, but from the whole appearance of the man — his figure, his tone of voice, his features, all confirmed it, and, in fact, he could see no real difference." Other witnesses deposed that he had the features, 'voice, and figure of the father of Arthur Orton. Parental likeness may be occasionally indicated by color or peculiari- ties belonging to the varieties of mankind, as of the intermixture of the negro or Mongolian with one of the Caucasian variety. In such a case the evidence afforded becomes much stronger; and, supposing that two men of different varieties have had intercourse about the same time with the Fame woman, the color of the skin of the offspring might enable a court to determine the question of paternity. It is stated to have happened, on more than one occasion, that a black woman has given birth at the same time to a black child and a mulatto; Cunningham refers to a case in which a negress gave birth to twins — one a black and the other a white child. (Lancet, 1846, i. p. 525.) This was proliably a case of supercon, ception. In Stothard v. Aldridge (Bail Ct., Jan. 1856), the plaintiff sued the defendant for damages for the seduction of his wife. The defendant was a man of color, and the child born of the alleged adulterous inter- course was proved by the medical witness to have been born colored and with woolly hair. The husl^and and wife were both light. This pecu- liarity fixed the paternity of the child on the black defendant. Personal deformities are not necessarily transmitted from parent to 644 AFFILIATION. child ; yet it would appear from the subjoined case that a disputed ques- tion of affiliation has been settled on this principle. A woman allej^ed that a fientleman in whose service she had lived was the father of a child of which she had been recently delivered. The solicitor who api)eared tu support the affiliation rested his case chiefly on the fact that the child had been born with five finders and a thumb on the ri tested under other circumstances than those connected with the duration of gestation. The alleged parent may have labored under j^ht/sical in^ capacity : if a male, he may have been ailecti'd witli impotency — if a female, she may have labored under sterility ; and if either of these conditions be proved, the illegitimacy of a child will be established, although the alleged period of gestation may be comprised within the ordinary limits The sexual conditions now about to be considered have also important bearings in relation to divorce, and occasionally to the civil rights of a child that may be the subject of the malformation. One of the most com- mon and obvious causes of impotency or sterility is malformation of the sexual organs, to which species of monstrosity the term Hermaplij^oditism is commonly applied. Owing to arrested development during the growth of the foetus, the sexual organs, which can scarcely be distinguished at the fourth month, occasionally assume an abnormal arrangement. These organs appear to be at that time more or less mixed ; and sometimes the male and at other the female characters predominate. With this defective sexual develop- ment, the other peculiarities of the sexes, are either wanting, or more or less blended. When the being has the general characters of a male with malformation of the generative organs, it is called androgynus : when the charactei's are those of a female with a like malformation, androgyna. There can be no difficulty in identifying such cases, and, according to the degree of malformation, a medical jurist can have no hesitation in pro- nouncing these persons to be physically impotent. The organs are com- monly so defective as to be wholly unfitted for the functions of either sex. It is not intended to be said that it is in all cases easy to assign the sex but this is of minor importance ; the main question is, whether the mal- formation is or is not such as to justify divorce, or to throw the imputa- tion of illegitimacy upon children claiming to be the offspring of these beings. Distinction of Sex. — The determination of sex in the cases of deformity has been considered to be necessary under certain circumstances ; as when, for instance, a title or entailed inheritance of lands is in question. Lord Coke has stated that, according to the law of England, an hermaphrodite may be either male or female, and it shall succeed according to the kind of sex which doth prevail. Thus it is obvious that the law will decide each case according to the special circumstances proved, but it must not be supposed that the decision is so easy as Lord Coke's dictum would imply. There are many cases in which neither sex can be obvioush^ said to pre- vail. The chief character of the male consists in the presence of testicles, and of the female in the presence of a womb and ovaries, but in one in- stance both the testicles and the ovaries were wanting ; there were no essential characters of either sex, and during life it would have been im- possible to say whether this being was male or female. (Cormack's Month. Jour., 1845, p. 492.) In the same journal (p. 531) is reported another case, in which, notwithstanding the external resemblance to a female, the presence of one testicle in a scrotum showed that the being was of the male sex ; yet this person passed for a woman until he had reached his 26th year. It is rare that there is external malformation without internal defect, but even when the female character preponderates, it is not im- probable that the womb or the ovaries may be absent, or the former may be malformed. Such beings are not known to menstruate, and, even if 650 LEGAL RELATIONS OF HERMAPHRODITES. there should be capacity for intercourse, they are permanently sterile. Sexual desires are, however, commonly absent. When the person is youn^, mistakes respecting the sex are more common than at an advanced period of life. So soon as the aii^e of puberty is past, certain changes take place in the configuration of the body which may aid a medical practi- tioner in forming an opinion. Thus a grave tone of voice, the presence of a beard, the width of the shoulders and narrowness of the pelvis, will in- dicate, casferis jjoribas, the male sex; while, when these conditions are absent, and there is a rotundity of the members, with want of prominence in the muscles, and a great development of the breasts and i)elvis, the female sex predominates. Although no testicles are apparent, still the being may be of the male sex, since it is well known that in jjcrsons other- wise well formed these organs are not always found in the scrotum. As a rule, the female sex, whatever may be the sexual malformation, is clearly indicated by the performance of the function of menstruation. In the case of a girl, set. 8, the pubes was found covered with black hair. There was a well-formed member like a penis, two inches long, capable of erection, but without any urethra. Below the penis there was a large urethra or meatus, and pendulous vulva, with labia resembling testicles. The parents always had doubts about the sex, but, as the child menstruated regularly, it was a female malformed. (Brit. Med. Jour., 1875, ii. p. 514.) An external examination will sometimes entirely fail to indicate the sex, and even the opportunity of an examination of the dead body may leave the case in doubt. (For a report of a case in which a body re- sembling the prostate gland and a womb coexisted in the same being, see Med. Times and Gaz., 18G0, i. p. 17Y.) A case has been already mentioned in which neither testicles nor ovaries were found after death, and more than one instance is said to have occurred in which both have been found. This last condition is a case of intermixture of the sexes, or, physically speaking, real hermaphroditism, but, of course, without the functional power of self-impregnation. ■. Medico-legal Relations. — Persons in whom the sexual organs are defec- tive or imperfectly developed, are impotent and sterile. Questions con- nected with the legitimacy of offspring, divorce, and affiliation may, there- fore, be raised with respect to them. Sexual monstrosity is not a ground for depriving a being of the rights of inheritance, except under peculiar legal conditions. Thus a right of succession or inheritance to landed estate may depend upon the sex of the offspring ; as where, for instance, two children are born, the first an hermaphrodite, the second a well-formed male child. The parents die, and a title of nobility or lands may fall to the firstborn male. Here the sex of the firstborn must be determined before possession can be had. In a case of this kind, if medical evidence should esta))lish that male peculiarities predominate in the firstborn, the second child would be cut off. Again, if an estate were limited by entail- ment, as where it is settled upon heirs (male or female) of a particular family, the birth of an hermaphrodite, an only child, would create a legal necessity for a positive determination of the predominance of sex. So, if an hermaphrodite lives but a few minutes after its birth and then dies, the rights of persons may be subsequently much affected by the opinion of the medical attendant respecting its sex. Since we cannot determine under what circumstances litigation may ensue, it is always right in a doubtful case to observe the sex, and make notes on the spot when a child thus malformed survives its birth but for a short period. The question of tenancy by curtesy, or the right of the husband to landed estate of which LEGAL RELATIONS OF HERMAPHRODITES. 651 the wife was seised, will depend entirely upon the attention of the accoucheur to this point. When these beings have reached adult age, other questions may arise with respect to them. The English law does not allow them to select their sex, but determines it for them by medical evidence. Hermaphrodites, or sexual monsters, were formerly ranked with infamous persons ; and it has been a grave question in our courts, whether the calling a man an hermaphrodite was not such a libel or slander upon him as to render it a ground for civil action. In a case reported by Chitty (Med. Jur., p. 314), the use of this term was held not to be actionable unless it was proved that it had been attended wdth special damage. A dancing-master brought an action against a person for calling him an hermaphrodite, and it was decided that it was not sustainable : 1. Because such a union of the sexes cannot exist in fact, and everyone must be supposed to know it; con- sequently the assertion could not be supposed to prejudice. 2. Because, admitting the possibility of such a double function, the party would be just as good, and, perhaps, even a safer dancing-master than if only one perfect sex had been discoverable ; consequently, the words would not, in legal presumption, injure him in his profession or occupation. It would appear that in the United States the rights of citizenship and the privilege of voting for members of Congress have depended on the determination of sex. In 1843, Barry was requested to examine a person named Levy Suydam, aged 23 years. At the warmly contested election of that year almost everything bearing the semblance of the human form and of the male sex is stated to have been brought to the ballot-box. It was at this time, and under these circumstances, that the above-mentioned person was presented by the Whigs to be made o. freeman ; he w^as challenged by the opposite party on the ground that he was more a female than a male, and that in his physical organization he partook of both sexes. Without going into the details of his physical organization it may be stated that as he was found to have a penis and one testicle the privilege of a vote as a male citizen was conceded to him. It was, however, sub- sequently proved that this being regularly menstruated, and that it had other female peculiarities. This was certainly an embarrassing case — one to which Lord Coke's rule for a decision, i. e. the prevalence of either sex, is hardly applicable. The presence of a penis and one testicle referred the being to the male sex ; while the bodily configuration, and still more strongly a periodical menstrual discharge, referred it to the female sex. The right of voting might have been fairly objected to, because, while the female characters were decided, the organs indicative of the male sex are described as having been imperfectly developed. It is possible that the question of sex may be mooted under similar conditions in this country. 652 IMPOTENCY. IMPOTENCY. STERILITY. CHAPTER LVIII. IMPOTENCY. CAUSES. PROCREATIVE POWER IN THE MALE. PUBERTY. AGE FOR VIRILITT. VIRILITY OF CRYPSORCHIDES AND MONORCHIDES. STERILITY. PROCREATIVE POWER IN THE FEMALE. EARLIEST AND LATEST PERIODS FOR CHILDBEARING. LEGAL RELATIONS. Definition. — Impotency is defind to be a [permanent] incapacity for sexual intercourse. It may depend, first, upon physical, second, upon moral, causes. With regard to the moral causes of impotency they do not concern a medical jurist. Such causes are not recognized by law, and he has no duty to perform beyond the application of the principles of medicine to the purposes of the law. Causes. — Impotency may arise from age ; from certain physical causes, e. g. disease ; or fi'om congenital malformation or defect. With regard to physical causes a distinction must be made between those which are remediable and those which are not. The presence of a disease of the testicle, such as atrophy or tumor, may give rise to incapacity ; but this Incapacity ma}^ be sometimes removed by an operation or by medical treat- ment, and therefore the physical cause may be removed — in other words, it is remediable. To such cases as these the law does not extend ; but it is always expected in alleged incapacity that the practitioner examined on the subject should be able to say whether there is or is not a prospect of cure. In forming a judgment upon this point a good knowledge of his profession can alone assist him ; no rules can be laid down for his guid- ance, for there may not be two cases that will precisely resemble each other in their features ; hence it will be necessary in this place to point out the chief causes of impotency which are of an irremediable nature or those in which the incapacity is absolute and permanent — a point upon which medical opinion is chiefly required. In strictness of language, the definition of impotency as above given may be applied to a female as well as a male ; and, undoubtedly, a phvsi- cal incapacity for sexual intercourse may exist in either sex. As an in- stance of this incapacity in the female may be mentioned occlusion of the vagina — a condition not necessarily indicative of sterility. The mere occlusion of the vagina may be a remediable form of the malady ; but its entire obliteration would be an absolute and irremediable defect. This latter condition, however, is the only instance of complete impotency in a female. A protrusion of the womb or of the bladder into the vagina is mentioned by some writers as a cause of physical incapacity for inter- course ; but these forms of disease may commonly be remedied by art, and therefore require no further notice in this place. The editor was once consulted by a gentleman who alleged that anchylosis of the hip-joint of his wife — the broken limb being flexed across the entrance to the vagina — was a bar to sexual intercourse. It is unlikely that intercourse was abso- PROCREATIVE POWER IN THE MALE. 653 lutely impossible under the circumstances; and it is known that even double anchylosis of the hip-joints is not an insuperable bar to coitus. In professional language the term " impotency" has been hitherto applied exclusively to a defect in the nude sex ; and the term " sterility" is usually confined to all those conditions in the female which not only render inter- course impossible, but which render it unfruitful. A male may, however, be sterile without being impotent — a condition observed in some crypsor- •chides ; or he may be impotent without being sterile, as where proper in- tercourse is prevented by reason of physical defect in the virile member, although the testicles may be in a normal condition. (See on this sub- ject, Curling, On Sterility in Man.) This author points out that sterility in the male apart from impotency may depend on three causes : first, malposition of the testicles ; second, obstructions in the excretory ducts ; and third, impediments to the escape of the seminal fluid. A man may not be impotent, i. e. incapable of intercourse, but by reason of one of the conditions above mentioned, such intercourse would be unfruitful. In reference to the male, the English law does not appear to go beyond the establishment of impotency from some clear and demonstrable cause, and unless the alleged sterility were accompanied by impotency it would take no cognizance of that condition. Further, sterility from such causes could hardly be demonstrated during the life of a person, and it would rest chiefly on presumption or probability. [A better definition of sterility applied to either sex would be, inability to conceive in the female and to procreate their kind in the male.] Procreative Power in the 3Iale. Puberty. — Until the period of puberty the testicles are small and they increase very little in size in proportion to other parts. Curling found that the size of the seminal tubes diff'ered but little at the ages of 18 months and 8 years. The sexual function in the male depends entirely on the development of the testicles ; but the age at which it appears differs in different persons. The age of puberty in a healthy male in this country varies from 14 to 17 years; its appearance is, however, affected by climate, constitution, and the moral circumstances under which the individual is placed : in some cases it is not fully devel- oped until the age of 21. The access of puberty in the male is indirectly connected with the sub- ject of rape. A boy under the age of fourteen years is presumed in law to be incapable of committing a rape. (1 Hale, p. 631 ; and Matthew's Digest, p. 57.) The statute law merely requires proof of penetration, so that rape might be physically perpetrated by a boy at or even under 14 years of age. In several cases, boys at 14 have been convicted of rape. In a case elsewhere related (see Rape), a boy, aged 19, communicated syphilis to a girl of 6 years of age. It appears that in India puberty shows itself much earlier in the male. Chevers, quoting from the Niza- mut Adawlut Reports, states that a boy 13 or 14 years of age was found guilty of rape. A lad of 14 was convicted of rape on a girl of the same age ; and in another case a boy only ten years old was convicted of rape on a girl 3 years of age. (Med. Jurispr. for India, p. 463.) The seminal secretion in the male is not considered to be prolific until it contains those peculiar filiform bodies which are known under the name of spermatozoa, or zoosperms. All agree that they are normal and essential constituents of the healthy and prolific seminal fluid. They are peculiar to the spermatic secretion, and in healthy males are always present in it after the age of puberty. They disappear in certain states of disease and sometimes in advanced age : they have not been found in the undeveloped testicles of crypsorchides. In cases in which they are absent, from what- 654 IMPOTENCY FROM AGE. ever cause, it is a fair inference that the person is impotent, or that he has lost the power of procreation. (See on this subject, Curling, On Sterility in Man.) In this pamphlet, one case is related in whi(5h a man, ajt. 42, who was married and whose wife had borne a son then eight years of age, had died after four days' illness from strangulated hernia. The testicles, from the fact of their being found in the inguinal canal, were examined separately by Gosselin and Gt)ddard and no spermatozoa were discovered in the fluid contained in either of them ; but these may have been merely absent at the time of examination, as the child begotten was then eight years of age. During this long interval, the secretion may have undergone a change and have become unprolific. Impotency from Age. — It moy be fairly assumed that a male is in- capable of procreation until spermatozoa have appeared in the seminal secretion and that he loses this power when they disappear. The age at which they are formed varies with all the causes that afliect puberty. lu one instance they were found by Casper in the seminal fluid of a crypsor- chid boy only 14-| years old, and Curling found them in the secretion of a boy aged 18. This observer found spermatozoa in the liquid taken from the testicles of a man upwards of 70 years of age, and on one occasion in the testicles of a person aged 87. Wagner states that they are to be found in the secretions of men between 70 and 80 years of age. Rayer found them in the secretion of a man aged 82 years. (Gaz. M^d., June 2, 1849.) Other cases of a similar kind are recorded by Debrou. (Gaz. Hebd., 1861, p. 6.) Dien examined the bodies of 106 men between the ages of 64 ami 97. In 64 cases out of the 106 there were no spermatozoa, i. e. in 61 per cent, of the cases. Four of Dien's observations were on nonogenarians : of these none had spermatozoa. (Med.-Chir. Rev., 1868, p. 279.) Facts tend to render it highly probable that a fecundating power may be retained by the male up to the age of 100. According to Duplay, the seminal fluid of old men contains spermatozoa even when they are beyond the age of fecundation ; but he does not state the circumstances which enabled him to arrive at this conclusion (Med. Times and Gaz., 1853, i. p. 581). Sexual propensities are often .strongly developed in children and thus they may be prolific at an early age. Riittel met with a case in which a female, at the age of 14, became pregnant by a boy of the same age. (Henke's Zeitschrift der S. A., 1844, p. 249.) This is the earliest age at which, so far as we can ascertain, the procreative power has appeared in the male. Hartshorne refers to an instance of extraordinary development of the male sexual organs in a child 4 years old. (Amer. Jour. Med. Sci., Oct. 1852, p. 561.) In a case of contested legitimacy or affiliation, this question regarding the age at which a procreative power appears in the male may have an important bearing on the issue. Thus the person may be sa young as to render it impossible that he should be the father of a child imputed to him. Cases involving questions of legitimacy on this ground are not heard of in the present day. The following case in reference to the affiliation of children occurred in 1840. A woman wished to affiliate a child on a youth who was in his sixteenth year. The boy denied that he was the father of the child ; and there was reason to suspect that the imputation had been wrongly thrown upon him in order to divert suspicion from the real offender. There was some difficulty in this case ; but the rule for a medical man to follow on these occasions is this : not to regard the mere age of the youth, whether he is above or below the average age of puberty, but to observe whether the sexual organs are fully developed and whether there are about him any of the marks of precocious virility, indicated by muscular develop- IMPOTENCY FROM DISEASE OR ACCIDENT. 655 ment, the growth of a beard, and a manly voice. If these signs are present, whatever may be his age, there is strong reason to suppose that the sexual functions are developed. We occasionally hear of instances of extraordinary precocity, but the development of sexual power is generally accompanied by other well-marked changes in the person. Sometimes these changes do not make their appearance until after the age of twenty- one. On the other hand, it may be a question at what time the procreative power disappears in a male. That impotency is one of the natural conse- quences of advanced age is undoubted , but this, as we know, forms no legal impediment to the marriage of parties, however old. The legal pre- sumption is that the generative faculty does not disappear through age ; and if this be alleged, and legitimacy disputed on this ground, it must be satisfactorily proved by those who would benefit by the allegation. This amounts almost to an impossibility, because it is well known that there is no fixed age at which the sexual functions cease either in the male or female ; and individuals at least of the male sex, who have passed the ages of 60, 70, and even 80 years, have been known to be capable of fruitful intercourse. Duplay believes, from his anatomical observations on the bodies of aged persons, that the causes of impotency (sterility) iu advanced age are to be found rather in the excretory than in the secretory apparatus. Thus he has met with obliterations in the canal of the epididymis, the vas deferens, and the vesiculse, the effect of which is to prevent the accumulation and passage of the seminal fluid. (Med. Times and Gaz., 1856, i. p. 650.) Lord Erskine, in the Bambury Peerage claim, quoted the case of Sir Stephen Fox, who was married at tV, and had had four children, the last when he was 81. Schneider met with a case in which a man of Yl had a child by his wife, who v/as only 11. (Henke's Zeitschrift, 1842, Bd. 2, p. 165.) Riittel mentions the case of a man who, at the age of 92 years, married and had two children by his wife. When the procreative power even appears to be lost at advanced age, the stimulus for intercourse is often very great. The same authority mentions cases in which these erotic feelings were remarked by him in reference to men between 15 and 86 years of age. (Henke's Zeitschrift, 1844, p. 252.) In all cases of prolonged virility, it is observed that the bodily and mental powers are also retained in an extraordinary degree, showing the close relation which exists between the sexual functions and corporeal and mental development, even to the latest period of life. Romilly remarked, in reference to the retention of procreative power in advanced age, that the liberality of the English law on this subject was excessive; for there was no age, from seven upwards, at which a man had been denied the power of procreating children. (See in reference to this subject, Henke's Zeitschrift der S. A., 1842, p. 332.) Males at the age of 14, and females at the age of 12, are legally competent to contract marriage. [In the American States this is regulated by the statutes of each State.] Impotency from Local Disease or Accident. — The loss or destruction of the penis or testicles, either by disease, accidtmt, or from necessary operations, would be sufficient to render a man irremediably impotent. The loss of one or both testicles, from any of these causes, would be indi- cated by the presence of distinct cicatrices in the scrotum. When both have been removed by operation, the person is incurably impotent ; but if the organs are healthy, a sufficiency of the spermatic fluid to confer procreative powers may remain in the ducts for two or three weeks after the operation. Thus it is that animals have been known to be prolific for some time after castration ; and one case is on record, in which a man, 656 IMPOTENCY FROM DISEASE OR ACCIDENT. both of whose testicles had boon carried off by a jufunsliot, is said to have retained the power of imijreynating his wife after the healing of the wound. (See a paper by Kriigelstein, Henke's Zeitschrift, 1842, i, pp. 348 and o5'2.) The loss of one testicle only, by accident or operation, does not render a man impotent. Monorvhides, as they are called, have been known to be prolific. Cases of this kind must not be confounded with those in which one or both testicles have not descended into the scrotum. In some rare instances the testicles do not descend into the scrotum at the usual period ; but one or both may remain either in the al)domen or in the inguinal canals, and only descend some time after birth ; or one may be found in the scrotum, and the other remain during life in the abdomen. In some cases of partial descent the organs have been mis- taken for and treated as ruptures by the application of a truss. (Ilenke's Zeitschrift der S. A., 1844, 1, p. 249; Curling, On Disease of the Testis, 2d ed., p. 31.) In one instance, the attempt to reduce the tumor, mistaken for hernia, and the application of a truss, caused the death of the person. (Med. Times and Gaz., 1861, i. p. 240.) When one testicle only has de- scended, there is no ground, ceeteris paribus, to impute impotency ; the descended organ has been found healthy and to contain spermatozoa. Curling has collected six cases in which the retained testicle and its ducts did not contain spermatozoa ; four of these fell under his own observation. (On Sterility in Man, 1864, p. 6; and Med. Times and Gaz., 1861. i. p. 213.) When neither testicle has descended, the scrotum will be found empty, without any scar indicative of a removal by operation, but the other marks of virility may still be present. These persons have been called Crypsorchides. It has been stated that in such cases the testicles are to be regarded as congenitally defective, and further, that the indi- vidual, although capable of sexual intercourse, is incurably sterile The non-descent of the testicles is a state rarely seen. Marshall met with only one case of non-descent of one testicle in 1000 recruits, and with one case of non-descent of both testicles in 10,000 recruits. There are three preparations, showing the non-descent of these organs in the Museum of Guy's Hospital ; one of them was taken from a man who shot himself from despondency at his supposed defective condition. Hunter thought that the undescended testicles were always imperfect, both in their struc- ture and functions, and that crypsorchides were invariably impotent (sterile). Other observations have tended to support the views of Hunter. In 1860, Partridge communicated to the Pathological Society the case of a man, set. 25, in whom both testicles were found in the abdomen. Sev- eral specimens of the secretion from these organs were examined, and no spermatozoa were detected. Another case was examined with a like result (Lancet, 1860, i. p. 66), and a third by Curling (Med. Times and Gaz., 1861, i. p. 213), The conclusion to which these observations have led is that, although in cases of non-descent there may be a capacityof sexual intercourse, it will not be prolific — the person will be sterile. According to this view, malposition of the organs must be taken as synonymous with defective condition ; as a result of this malposition, they are not capable of secreting prolific spermatic fluid, and the person is as sterile as if he had no testicles. The cases of monorchides reported by Curling to some extent support this theory, since spermatozoa were found only in the fluid of that testicle which occupied its usual position in the scrotum. He has also collected from various sources seven cases of crypsorchides, in which both testicles were either in the abdomen or in the inguinal canals : the fluid contained in them was destitute of spermatozoa, and, VIRILITY OF CRYPSORCHIDES AND MONORCHIDES. 657 although impotency did not exist, these persons either were, or were presumed to be, unprolific. Goddard has noticed that horses whose testicles are retained in the abdomen, although capable of intercourse, are sterile. On the other side of the question there are, however, facts which are wholly inconsistent with this theory. The author published the account of two cases of crypsorchides communicated to him by Cock. The testi- cles in these men had not descended, but their virile functions were un- disputed. One of them, before he had reached the age of .30 years, had been twice married, and had had children by each wife, besides illegitimate children which were aCBliated on him. In a report of cases of hernia by Poland (Guy's Hosp. Rep., 1843, vol. i. p. 163), there is the case of a man, aet. 29, whose testicles had not descended. Poland states there was not the slightest trace of scrotum ; the penis was well developed, and there were all the other signs of virility. This man had married when he was 20 ; he had had two children by his first wife, and at the time of his admission into the hospital had been married two 3^ears to a second wife. In 1862 there was in Guy's Hospital a patient under Durham ; the testi- cles of this man had not descended — they were lodged in the inguinal canals. The man was 32 years of age, well developed, with every appear- ance of virility about him, and with the same masculine development which is seen in other men of the same age. This man was married, and had had two children by his wife. Since puberty he had always been competent, and he ridiculed the idea that his testicles M^ere inefficient. Another case is referred to by Curling, which occurred to Debrou. The testicles were in the inguinal canals ; and there was no scrotum. The man had been married, and had one son by his wife. These facts prove that crypsorchides, in some cases, have a power of procreation like nor- mally constituted men, Casper relates a case in which a crypsorchid was charged with an unnatural offence He was a boy between 14 and 15 years of age, and it appeared that he had been guilty of unnatural conduct towards another boy 8 years of age. Spermatozoa were detected by Casper on his shirt sixteen days after the act. On examining the boy both testicles were found in the inguinal canals. (Gerichtl. Med.) By these facts, therefore, it is satisfactorily established that crypsor- chides are not necessarily sterile, and that no absolute rule can be laid down respecting the existence or non-existence of prolific power under euch circumstances. It has been objected that, in the above instances of prolific power, spermatozoa had not been demonstrated to exist in the spermatic secretions of the individuals, and that the evidence was there- fore incomplete. But these bodies were not proved to be absent, and most persons will agree that there is no better evidence of prolific power than the procreation of children, whether spermatozoa are or are not de- tected — a matter which will sometimes depend on the accuracy of obser- vation or experience of the examiners, or, it may be, on a morbid state of the secretion. One affirmative instance is sufficient for all the purposes of law ; and, as a physiological fact, it is obvious that the organs which have not descended are not always defective in structure or function. The cases hitherto observed are so nearly balanced that it is difficult to say whether it is the rule or the exception that crypsorchides should be found prolific ; the facts above mentioned clearly prove that there is no reason- able ground for pronouncing them to be absolutely sterile or unprolific merely because their testicles are not in the scrotum. If with a non- descent of these organs there should be a non-development of the other external organs, and this is accompanied by a total want of the characters 42 658 CAUSES OF IMPOTENCY. of virility, then the person may be regarded as impotent or sterile. The testicles may, in such a case, be either congenitally absent or physically imperfect — a fact only ascertainable by an examination of the body after deatli. On the other hand, in cases in which there are no external marks of elfeminacy, or other grounds for suspecting a want of procreative power, and the person is capable of sexual intercourse, this imperfection does not ofl'er anv bar to marriage, nor is it a sufficient ground for divorce. It would not justify a medical man in denying the paternity of a child on a question of affiliation, bastardy, or inheritance; and so long as a power of sexual intercourse existed, it would not justify him in pronouncing a person to be incurably sterile. The capacity for sexual intercourse is the fact to which the English law commonly looks on these occasions. If this exist, then it will hardly entertain the question — surrounded as it may be with conflicting medical opinions — whether, from the mere reten- tion of the organs in the abdomen, the fluid secreted is or is not of a pro- lific nature. Women may be sterile from a variety of causes affecting the internal organs, only ascertainable after death. The ovaries may be so diseased that no prolific intercourse can take place, although there may be no physical incapacity. In a case related elsewhere, the incapability of con- ception on the part of a woman was held by Lushington not to be a suffi- cient ground for pronouncing a sentence of nullity of marriage (p. 667, post) ; and doubtless a want of power on the part of a man to effect impreg- nation, unless it depend on some visible physical defect, would be viewed in a similar light. Such persons are not impotent, l)ut sterile, and sterility in an irremediable form is rather assumed than demonstrated to exist. The presence of what have been called supernumerary testicles does not affect the virile powers of a person. These have in general been found, by dissection, to be tumors connected with the healthy glands, and not at ail adding to or interfering with their functions. Even the presence of two or three penes, according to Mende, is no bar to the exercise of sexual power, provided onlr one possesses the normal characters of the male organ. (Ausfuhrl. Handb. d. Gerichtl. Med., Bd. 4, p. 337.) In 1865 a Portuguese youth, aged 19, I. B. dos Santos, was seen by many medical men in London. He was well formed, except in reference to the sexual organs. He had two complete and well-formed penes, placed side by side, the right somewhat smaller than the left, and both subject to erection at the same time. He stated that he used the left in sexual intercourse. On the outside of each penis was a scrotum with one testicle fully developed. Between them was a sunken scrotum, which contained two testicles until he was 10 years old, when they ascended into the abdomen. When the bladder acted urine issued from both penes. An engraving of this re- markable malformation is given with the history of the case in the Lan- cet, 1865, ii. p. 124. In some instances there is an arrest of development in the external organs ; and with this there is generally an absence of sexual desire. Cer- tain diseases of the appendages of the testicles may, however, render a person sterile. The spermatic secretion is commonly suspended in most severe diseases which affect the body. A frequent cause of impotency (sterility) in the adult, when the organs are apparently sound, is sper- matorrhoea, arising from abuse or excess. This, however, is remediable to a greater or less extent by treatment. (See Curling on Diseases of the Testis, 2d edit., p. 386; also Med. Times and Gaz., 1858, i. p. 95.) The incapacity for intercourse in either sex may arise from extensive disease affecting parts in and around the organs of generation. The medical opinion here must be regulated entirely by the circumstances attending each case. VIKILE POWERS IN HY POSPADI ANS. 659 On the absence of the peni^?, as well as on its defective organization, as causes of incapacity, some remarks have been already made. Some- times the defect is merely connected with the urethra. Thus the orifice may be on the dorsum penis, and in other cases underneath the organ, so that the urethra may terminate at a variable distance from the glans penis. Those laboring under the former defect are said to have Epispadia, and under the latter. Hypospadia. Rose describes a case of hypospadia in a child who had been baptized, brought up and educated as a female at a girls' school. The androgynous child was ten years old, diminutive in size, and possessing girlish features. A testicle was recognized on each side, but no distinct penis. (Obst. Trans., 1810, vol. xviii. p. 25G.) These beings a.re often mistaken for girls, but the absence of the function of men- struation is sufficient to remove doubt. The power to have fruitful intercourse will in either case depend on the situation of the urethral aperture. Some doubt has existed respecting the virile powers of those who are affected with hj^pospadia ; but Riittel knew an instance of an hypospadian having several children. (Henke's Zeit- schrift, 1844, p. 258.) In 1850 a lad, ffit. IV, was summoned before the magistrates of Kidderminster on a charge of affiliation in reference to the pregnancy of a girl, set. 18. The defence was that he could not be the father of a child, because there was such a malformation of the penis as to prevent prolific intercourse. On examination, the urethra was found to terminate on the under surface of the penis, about an inch and a half from the glans, by a small elliptical orifice, which allowed the urine to pass, but with some difficulty. One medical witness gave it as his opinion that it was not impossible, but highly improbable, that the defendant should pos- sess procreative power ; another freely admitted the boy's capacity, and the case was decided against him. (Med. Times, 1850, ii. p. 321.) This decision was physiologically correct. When the urine can pass, the sem- inal fluid can pass ; and the only question is, whether the intromission can be such as that the misplaced orifice should come in contact with any part of the vagina or even the vulva. This must depend on the situation of the orifice. (Cases illustrative of the prolific powers of hvpospadians will be found in the Med. Times, 1850, ii. pp. 292, 392. An' instance of the virility of an hypospadian has also been published in the Assoc. Med. Jour., 1853, i. p. 236.) Similar remarks apply to epispadians. These malformations are sometimes remediable ; but, whether remediable or not, they are not, under any circumstances, to be regarded as absolute causes of impotency. Impotency from General Disease. — The. influence of local disease in aff"ecting virility has been already considered. But there is a class of cases which may came before a practitioner, in which, with well-formed and healthy organs in the male, there will be a state of impotency or inca- pacity for intercourse. Sometimes this may depend on weakness, or on a want of proper development of the muscular and nervous systems; at other times it may be due to disease of a temporary nature — persisting while the body is still suffering from the disease, and disappearing on re- covery. As a converse fact, there are some diseases which appear to bring out the dormant virile powers of persons, or to excite to a higher degree of intensity those which already exist. Thus it is said that in con- valescence from fever there is, occasionally, extraordinary salaciousness ; but this statement requires confirmation. Again, there are diseases which neither interupt nor affect the exercise of the sexual functions. As a gen- eral rule, diseases which neither affect the brain nor spinal marrow, and which are not attended with great bodily debility, do not prevent fruitful 660 IMPOTENCY FROM GENERAL DISEASE. intercourse. On the other hand, diseases which are attended or followed by istered as having given birth to a child in the 57th year of her age. We cannot, therefore, pretend to fix the age beyond which pregnancy may not occur. Questions of this kind have an impor- tant bearing on the subject of legitimacy ; and unless the law looks to .something more than ordinary professional experience in such matters, the decisions of courts must be inequitaljle. It two cases, however, it appears to have been assumed that a woman could not bear a child after the age of 53. These were the decision of the Master of the Rolls in Price v. Bousted, and more recently the decision was followed by Kindersley, V. C, in Haj'nes v. Haynes (Feb. 18GG). The petition in this case in- volved the (juestion whether a, single lady, aged 53 in Dec. 18(55, could be considered as past childbearing, and it was decided in favor of this assumption. These decisions are not reconcilable with the cases given above. Stolz refers to three cases of married women bearing childten at the ages of i5, 48, and 51 respectively. In two of these cases the preg- nancy was mistaken for dropsv and treated as such. (Ann. d'Hyg., 1873, t. 2, p. 151.) Causes of Sterility. — The causes of sterility in the female are very numerous. Some of them depend upon peculiarities of constitution, the sexual organs being well formed and developed ; others upon latent changes or congenital defects in the womb and its appendages, only dis- coverable by an examination after death. Sterility I'arely becomes a medical question in contested cases of legitimacy ; for a claim on the part of a person to be the offspring of a particular woman, unless she were in collusion with the claimant, could only be made after her death ; and if not disproved by medical evidence, showing that the woman could not have borne children, it would in general be easily set aside by circumstances. It may be most important to prove that a woman was in such a bodily condition that she never could have conceived or borne a child. If the womb, ovaries, or other parts were congenitally defective or absent, or if there were external se.xual malformation, accompanied by occlusion or obliteration of the vagina, a medical witness could have no difficulty in saying that the woman must have been sterile. (Med. Times and Gaz., 1858, i. p. 96.) A mere occlusion of the vagina, removable by operation, does not necessarily indicate sterility, for the internal parts may be healthy and sound. Medico-legal Relations of the Subject. Divorce. — Sexual malformation, involving impotency or sterility, constitutes one of the canonical impedi- ments to marriage, and if matrimony be contracted by a party laboring under such malformation, the contract is voidable. The impediment con- stituting impotency may arise either from malformation, from that which the law calls frigidity of constitution, or any physical cause of whatever nature which may render intercourse impossible. When the physical defect is not apparent, or when it is alleged to be irremediable, a continued cohabitation of three years is required before a suit can be entertained (Ayliff's " Parergon") ; but according to Oughton — " heec triennalis ex- pectatio non est necessaria ubi statim possit constare de impotentia coeundi." A suit for a sentence of nullity may be promoted by either party, and the medical proof required to found a sentence must be such as to satisfy the court that the incapacity pleaded was in existence at the time of the marriage, and that it still remained without remedy. There should be no delay in instituting the suit, and there should be proof that the impediment was not known to the complaining party at the time of the contract. A longer delay in making the complaint is allowed to a CASES OF NULLITY. 667 female, without prejudicing ner ease, than to a male, by reason of the modesty of her sex. In a suit which came before the Ecclesiastical Courts in 1845 a singular question arose whether, when there was a capacity for sexual intercourse on the part of a woman, with a certainty that from physical defect it could never be prolific, this was sufficient to entitle the husband to a divorce. On the part of the woman it was insisted that, in order to entitle a party to a sentence of divorce, there must be an utter impossibility of sexual in- tercourse. The case, it was argued, was one of mere sterility, which was no ground for a sentence. Lushington, in pronouncing sentence, said that mere incapability of co??ce/3^?on is not a sufficient ground whereon to found a decree of nullity. The only question is, whether a female is or is not capable of sexual intercourse ; or, if at present incapacitated, whether that incapacity admits of removal. A power of sexual intercourse is necessary to constitute legally the marriage-bond, and this intercourse must be ordinary and complete, not partial and imperfect ; yet it would not be 13roper to say that every degree of imperfection would deprive it of its natural character. If it be so imperfect as to be scarcely natural, it is, legally speaking, no intercourse at all. As to conception, there is no doubt that the malformation is incurable. If there was a reasonable prob- ability that the female could be made capable of natural coitus the mar- riage could not be pronounced void ; if she could not be made capable of more than an incipient, imperfect, and unnatural coitus, then it would be void. It appears that, in order to justify a decree of divorce on the ground of impotency or sterility the impediment to intercourse or procreation should be established by good medical evidence, and it must be ajjparent and irremediable ; it must also have existed before the marriage of the parties, and have been entirely unknown to the person suing for the divorce; if it has supervened after the marriage, this is no ground for a suit. (See, however, p. 669, post.) The nature of the impediment is to be determined by private medical opinions or affidavits based on an examination of both parties. Such an examination must be voluntary on the part of the man or the woman. The judge of the court cannot order it against the wish of the party. All that he can do is to decide in the absence of evidence of the kind, and this may be adverse to the parly refusing. In the case of Hewitt V. Perry (Divorce Ct., July, 1873), a suit for nullity, Hannen, J., gave his decision in favor of the husband and against the wife. She re- fused to submit to an examination, and abstained from presenting herself as a witness in the case. The case was remarkable in other respects. The evidence of the husband was to the efTect that there had been more than three years' cohabitation, but no consummation of the marriage. There was no structural impediment in the way of consummation in the wife's person ; but whenever an attempt at intercourse was made it brought on an attack of hysteria, and this rendered it practically impossible. A decree nisi for annulling the marriage was granted to the husband ; but the judge at the same time observed that such a decree could only be granted on the ground that there was a physical difficulty. Thus it must not be merely a wilful refusal on the part of the wife. This alone would not justify legal interference; it must be shown, as in this case, that injury may be done to health by inducing an attack of hysteria or other disorder. Oldham has informed the author that several cases of this kind have come before him. It may be regarded as incapacity, not from structural defect, but from a general disturbance to the system induced by the attempts at intercourse. In one instance that came under the editor's notice consummation of the 6(38 CASES OF NULLITY. marriage was long delayed in consequence of the hysterical condition of the woman. The difficulty was at length overcome by the administration of ether vapor. She recovered consciousness during the act of coitus, and there was no subsequent difficulty in intercourse. St. Clair Gray pointed out another condition in a woman which may prevent consummation of a marriage and give rise to a suit of nullity. This has been called Vagmismits. In this disease there is a peculiarly sensitive state of the parts, whereby, "from excessive nervous irritability of the vagina," any attempt at sexual intercourse, or even any pressure made in the vicinity, causes intolerable pain to the woman. He describes three cases which have fallen under his notice. In one, a woman, set. 38, had been married thirteen years, but, in consequence of the intolerable pain produced, her husband had not been able to have intercourse with her. An examination showed that the hymen was persistent, but the parts were so highly sensitive that a touch with the finger only produced great suffering. Nine years passed without any change in her condition. In two other cases of married women there was a similar state of the parts, the hvmen being also persistent in both. One had been married four, and the other seven years, and they had no children. The hymen was de- stroyed by operation ; the sensibility of the parts disappeared ; and one gave birth to four, and the other to three, children. (Glasgow Med. Jour., May, 1873.) It is clear, therefore, that vaginismus would be no legal ground for divorce according to the law of England, because the defect is remediable — a fact proved by the two cases described. In the three cases the women labored under no physical malformation. They were in every respect healthy and well-formed. There is one remarkable circumstance with respect to these suits of nullity ; namely, that, in nearly all of them, the suit is by the woman against the man ; although there is no reason w^hatever to suppose that impotency and sexual malformation are more common in males than malformation and sterility in females. We rarely hear of a husband instituting a suit of divorce on the ground of sterility (incapacity of procreation) in the wife; it is, inmost instances, the wife that promotes the suit on the ground of impotency or incapacity of intercourse in the husband. The diffi- culty of establishing incapacity in the female, and the facility of proving impotency from physical causes in the male, may probably account for this difference, Suits of this kind are sometimes instituted many months and years after the union of the persons ; but it is probable that the de- sire for separation in such cases often depends on some cause which the law would not recognize as sufficient of itself, while it would admit a plea of impotency. The French law applies the principle of condonation to such cases, so that no suit for nullity of marriage can be entertained, if cohabitation has continued for six months after the discovery of the personal defect. The laws of England and France differ in reference to personal defects. Impotency or incapacity of intercourse in a woman is, in England, a sufficient ground for annulling the contract ; but not so in France. Tardieu states that the law has not placed impotency in the female among the causes for nullity of marriage. (Ann. d'Hyg., 1872, t. 2, pp. 153, 155.) Braxton Hicks (Lancet, 1885, ii. p. 198) gives interesting cases of suc- cessful suits for nullity: one on account of the frigidity of the wife; and another on account of the incompetence of the husband, he having lived with his wife for two years wnthout once attempting intercourse. He also relates an unusual case of post-nuptial insanity supervening on the CASES OF SEXUAL IDENTITY. 669 wedding night from sexual difficulties on both sides. The woman re- covered and bore several children to her husband. The validity of a marriage cannot be disputed, on the ground of physi- cal incapacity, after the death of one of the parties. The incapacity does not render a marriage void, but only voidable. It is a matter purely of personal complaint or grievance. Third parties cannot be admitted to institute a suit of nullity after the death of husband or wife. In an ad- ministration suit, July, 1868, the plaintiff claimed as the lawful husband of the intestate. The defendants, who were her next of kin, alleged that the plaintiff was not her lawful husband, on the ground of physical inca- pacity, and that the marriage had never been consummated. Wilde, J., delivered judgment against the defendants, saying that the suit of nullity was a personal one, and as this had not been instituted during the life of the woman, the validity of the marriage could not now be contested. In treating of sexual identity, Tardieu remarks that marriage implies the law^ful union of a man and woman ; that such a contract cannot be entered into except between persons who are of different sexes. When the sex is disputed, the doubt can be removed only by an anatomical and physiological examination of the person. The intervention of a medical expert is indispensable in such a case and the object of such intervention is perfectly defined. The problem for solution may be stated in these simple terms: Is the person married as a woman — a malformed woman — impotent and incapable of sexual intercourse ? In this case, according to the strict interpretation of the law of France, there is no ground for nullity of marriage. Is the person a malformed man, presenting some doubtful appearance of the female sex ? In this case there has been no legal mar- riage. It is null ah initio. Assuming that there are no beings entirely deprived of sex, there may be cases, although rare, in which a mixture of the organs of the two sexes may be found in the same person. Such a being is incapable of entering into the marriage contract, since, whatever may be the sex of the person with whom the contract is made, there must be identity of sex and therefore nullity of marriage. Insanity, if existent at the date of marriage, is a ground for instituting a suit of nullity. (Hunter v. Hunter, otherwise Edney.) When not clearly developed on the day of marriage, the suit will fail. (Durham v. Durham, otherwise Milner, Prob. Ct., Feb. 1885 ; Cannon v. Cannon, otherwise Smalley, Prob. Ct., March, 1885.) 670 RAPE — SOURCES OF MEDICAL EVIDENCE. RAPE. CHAPTER LIX. SOURCES OF MEDICAL EVIDENCE. RAPE ON INFANTS AND CHILDREN. MARKS OF VIOLENCE. PPRDLENT DISCHARGES FROM THE VAGINA. EVIDENCE FROM GONORRHOiA AND SYPHILIS. RAPE ON GIRLS AFTER PUBERTY. DEFLORATION. SIGNS OF VIRGINITY. Rape is defined in law to be the carnal knowledge of a woman by force and against her will. Medical evidence is commonly required to support a charge of rape, but it is seldom more than corroborative ; the facts are, in general, sufficiently apparent from the statement of the prosecutrix. There is, however, one case in which medical evidence is of some impor- tance — namely, when a false accusation is made. In some instances, as in respect to rape on infants and children, the charge may be founded on mistake ; but in others there is little doubt that it is often wilfully and designedly made for motives into which it is here unnecessary to inquire. Amos remarked that for one real rape tried on the circuits, there were on the average twelve pretended cases ; and common experience bears out this statement. In some few instances these false charges are at once set aside by medical evidence ; in others, medical men may be sometimes the dupes of designing persons; but in the majority, the falsehood of the charge is proved by inconsistencies in the statement of the prosecutrix herself. In Scotland, where there is a public prosecutor, and a careful preliminary inquiry, false charges of rape are said to be exceedingly rare. The consent of the girl does not excuse or alter the nature of the crime when she is under thirteen years of age, since consent at this period of life is invalid ; and the carnal knowledge of such a girl is rape in law, and is a felony by the 48 and 49 Vict., c. 69. An attempt at carnal knowledge is a misdemeanor. Even the solicitation of the act on the part of a child does not excuse it. A man who carnally knows, or attempts to know, any girl above the age of thirteen and under the age of sixteen years, even if she consents, is guilty of a misdemeanor. The duty of a medical witness on these occasions is very simple ; and perhaps this will be best understood by considering the subject in relation to females at different ages. On being called to examine a person on whom a rape is alleged to have been committed, the first circumstance which a practitioner should notice is the precise time and date at which he is summoned, taking an early opportunity of comparing his watch with some neighboring clock. This may appear a trivial matter, and one wholly irrelevant to the duties of a medical practitioner ; but it is to be observed that the time at which a surgeon is required to examine a woman may form a material part of the subsequent inquiry. It will be highly important to the defence of a person accused if it can be proved that the female did not take the earliest opportunity to complain ; and it may be also the means of defeating an alibi falsely set up for the defence Medical RAPE ON INFANTS AND CHILDREN. 671 evidence in cases of rape may be derived from four sources ; 1. Marks of violence about the genitals. 2. MarlvS of violence on the person of the complainant or prisoner. 8. The presence of stains of the spermatic fluid or of blood on the clothes of the complainant or prisoner. 4. The exist- ence of gonorrhoea or syphilis in one or both. This evidence will vary according to the age of the female and other circumstances. Rape on Infants and Children. The sexual organs should in these cases present marks of injury if the crime has been completed, and there has been any t^esistance on the part of the child; for it is impossible to conceive that forcible intercourse should take place without the production of ecchymosis, the effusion of blood, or a laceration of the pudendum. Even without reference to manual violence on the part of the adult assailant, the size of the male organ must generally cause much local injury in the attempt to enter the vagina of a child. If the violation has taken place within two or three days, the appearances presented by the parts may be as follows: 1. In- flammation, with more or less abrasion of the lining membrane. 2. A muco-purulent discharge from the vagina of a ropy consistency, and of a yellowish or greenish-yellow color, staining and stiff'ening the linen worn by the girl; the mucous membrane of the urethra is inflamed, rendering the discharge of the urine painful 3. In recent cases blood may be oozing from the abraded membrane, or clots of blood may be found deposited in the vulva. 4. The hymen may be entirely destroyed, or (what is more commonly observed) it may present on careful examination one or more slight lacerations. Owing to the inflamed state of the parts, the proper examination of the h3'men is rendered difficult — any attempt to separate the thighs for this purpose causing great pain. For this reason also, the child walks with difficulty, and complains of pain in walking, 5. Lastly, the vagina may be unnaturally dilated. It has been propounded as a serious question whether a rape can be perpetrated on children of tender age by an adult man ; and medical wit- nesses at trials have adopted conflicting opinions. Some are inclined to regard all such charges as unfounded, and to seek for other aiedical expla- nations of the symptoms above described. This practice has been carried of late years to an undue extent, simply because many of these charges have been proved to be false ; but common experience, supported as it is by the accurate observations of Casper, shows that there is too frequently a real foundation for the charge in reference to children, and that a girl is not to be discredited merely because of her tender age. This would be conferring impunity on the acts of a vile class of offenders. In all cases there should be good medical evidence and a corroboration from circum- stances. There is a deplorable vulgar error, causing this crime to be a frequent one. It is this, that gonorrhoea and syphilis in the male are cured by coitus with a female who is a virgin. It need hardly be said that this supposition has no medical basis. In 1884, a case was tried at Liverpool, in which Lowndes gave evidence that in this way a man had inoculated a young girl with syphilis. For the legal establishment of the crime, proof of penetration only is demanded, and a sufficient degree of penetration to constitute rape in law may take place without necessarily rupturing the hymen. There must be medical evidence to show that, in a special case, there was actual penetra- tion — the degree of penetration being quite immaterial. It is true that there could not be a complete introduction of the adult male organ into 672 MARKS OF VIOLENCE ON THE PUDENDUM. the vagina of a child without a rupture or laceration of the soft parts ; but the absence of such marks of violence would not justify a medical witness in denying the perpetration of the crime, since the law does not require proof either of a complete or of a violent introduction. It has been decided that penetration to the vulva alone is sufficient to constitute this crime. Medi- cal men have sometimes fallen into an error on this point, considering that, when the hymen was entire, rape could not have been committed; but the statute law says nothing about the rupture of the hymen as a necessary part of the medical evidence ; it merely requires from the medi- cal witness proof of vulval penetration — this may occur and the hymen remain intact. In Reg.f. Harris (Bristol Lent Ass., 1873), the prisoner, an adult, was convicted of rape on an infant only seven months old. Ac- cording to the medical evidence there was no great amount of violence to the genital organs. The parts were swollen, and there was slight excoria- tion about the labia minora, with a small discharge of blood. The hymen and the vagina had escaped laceration. Seminal fluid was found on the person of the child. In this case there might have been penetration of the male organ to the vulva. In so young a child there could have been no resistance, and the act might therefore have been perpetrated without leaving any serious marks of violence. In Scotland this question came formally before the judges in the case of Macrae (High Ct. of Just., 1841). It was insisted by the prisoner's counsel that there should be proof of full and complete penetration ; and there was no sufficient evidence to show that penetration had taken place into the canal of the vagina beyond the vulva. Lord Meadowbank charged the jury to the effect that the evidence of the prisoner's guilt was complete ; that scientific and anatomical distinctions as to where the vagina commenced were worthless in a charge of rape ; and that, by the law of Scotland, it was enough if the woman's body was entered. In a case like this, where there was no evidence of emission, and the girl was young, he did not consider it necessary to shov/ to what extent penetra- tion of the parts had taken place, or to prove that it had gone either past the hymen, into what was anatomically called the hymen, or even so far only as to touch the hymen. The prisoner w^as convicted. (Cormack's Edin. Jour., 1846, p. 48.) Up to the date of the case of Macrae, it had been the practice with the Scotch judges to require proof of full and com- plete penetration. (See on this question a paper by Easton, Glasgow Med. Jour., 1859, p. 129.) Marks of Violence on the Pudendum. — When there are no marks of violence or physical injury about the pudendum of a child, whether be- cause none originally existed, or they existed and had disappeared in the course of time, a medical witness must leave the proof of rape to others. He can only answer questions of possibility or probability, according to the special-facts proved. It is, however, in all cases his duty to be guarded in giving an opinion that a rape has been perpetrated when there is a total absence of marks of violence on the genitals. It is true that rape in a legal sense may be perpetrated without necessarily producing such marks on a child ; but then the proof of the crime will not depend on medical evidence only. The absence of marks of violence on the geni- tals, when an early examination has been made, furnishes a strong pre- sumption that rape has not been committed on these young persons. It is obvious that a false charge might be easily made and sustained, if med- ical opinions w^ere hastily given on the statements of a mother and child, when there was no physical appearance to corroborate the accusation. MARKS OF VIOLENCE ON THE PUDENDUM. G73 (See on this subject a paper by Toulmouche, Ann. d'Hvg., 1864, t. 2, p. 338.) Supposing at the period of examination no marks exist, it may be necessary to consider whether there has been time for them to disap- pear after the alleg-^d perpetration of the offence; but in such cases it is rarely in the power of a medical witness to express an affirmative opinion of the perpetration of the crime ; he should leave this to be proved by the general and circumstantial evidence. Casper met with a case in which a man, tet. 37, counnitted a rape on a girl only eight years of age.; he was seen in the act, and defended himself on the plea of drunkenness. The girl was examined by a medical man on the da}" following ; the labia were then reddened, and there was an injection of the membrane at the en- trance of the vagina, which was very sensitive. As an illustration of the rapidity with which the marks of rape disappear in young children, when not attended with great physical injury, it may be stated that this girl was carefully examined by Casper eleven days after the assault. The sex- ual organs were then in their natural state ; there was not the least ap- pearance of local injury, and no inference could have been drawn at this date that the girl had been subjected to any violence. Medical prac- titioners are not always sufficiently careful in the inferences which they draw from an examination of children at distant periods after an alleged rape. They allow themselves to be deceived by a plausible story, ap- parently consistent, and thus see, or think they see, proofs of rape on ex- amining the sexual organs of a girl Aveeks after the alleged perpetration of the crime ; whereas, had the girl been brought before them as a casual patient, and no suggestion of violent intercourse had been made, they would have probably ridiculed the idea of basing a charge of rape on so slender a foundation. The delay in having the examination made, unless satisfactorily explained, is in itself always a suspicious circumstance. In one case a medical man gave evidence that a rape had been committed on a girl seven years of age, although he did not examine her until six weeks had elapsed from the date assigned by the parents for the alleged perpe- tration of the crime. On the other hand, when marks of violence on the genitals are present, they must not be hastily assumed as furnishing proofs of rape ; for cases are recorded in which such injuries have been purposely produced on young children by women as a foundation for false charges against per- sons with a view of extorting money. The proof or disproof of facts of this kind must rest more upon general than on medical evidence, unless the injuries obviously indicate the use of some weapon or instrument. It should be remembered that the hym«n is not always present in young children ; it may be, according to some, congenitally deficient, or, what is more probable, it may have been destroyed by ulceration or suppurative inflammation of the parts — a disease to which female infants of. a scrofu- lous habit are very subject. The mere absence of this membrane, there- fore, can afford no proof of the perpetration of the crime, unless we find traces of its having been recently torn by violence. Other and more im- portant deductions may, however, be drawn from the presence of severe injuries on the genitals, i.e. of rupture or laceration of the vagina or perineum. It is difficult to obtain accurate medical reports of these cases as they occur in England; but it is quite clear that the male organ may produce much physical injury, whether the child does or does not resist the attempt. (Yierteljahrsschr. fiir Gerichtl. Med., 1863, p. 337.) A youth was convicted of murder at Chelmsford in 1874. He had com- mitted rape on a girl with so much violence as to cause her death. It was 43 674 FALSE CHARGES OF RAPE. found that the rectum and part of the intestines had been forced out in the act of intercourse, which, according to the confession of the prisoner, had ta]se(piently mar- ried her ; the date of intercourse was thereby accurately fixed, and a child was born after 2G3 davs' gestation. (See also Stolz, Ann. d'llyg'., 1873, t. 2, p. 14G.) It has been supposed that, in cases of pregnancy follo^A ing rape, in spite of resistance at first, a woman may in the end have voluntarily joined in the act. We know of no ground for adopting this theory ; the general opinion is that conception may occur, and is neither accelerated nor pre- vented by the volition of the sexes. Many women in married life who anxiously wish for children have none, and vice veraa ; and physical im- pediments do not suffice in all cases to explain these facts. Women are reported to have conceived during the states of asphyxia, intoxication, or narcotism. Ryan mentions a case in which a young woman became un- consciously pregnant from intercourse had with her by a man while she was in a state of intoxication, and in which it was clearly impossi])ie that her volition could have taken any share. (Med. Jurispr., p, 245.) In married life women frequently become pregnant against their will, and in a great number of cases without any consciousness of their condition until pregnancy is far advanced. Those who affirm that without the active will of the woman there can be no conception, must deny the existence of cases of impregnation in a state of unconsciousness (see ante) ; but the facts are too strong and too numerous to be met with a simple denial. A med- ical jurist, therefore, who relied upon pregnancy following alleged rape as a proof of consent on the part of a woman, and who would infer from this result that the intercourse must have been voluntary on her part, would inflict gi'eat injustice by such an opinion. The extrusion of an ovum does not depend on the will of a woman, but it is a periodical condition ; the action of the spermatozoa on the ovum is as much removed from the will of the woman as it is from that of the man. This subject would have hardly required so much notice but for the fact that in some trials it has been put forward with a view to discredit the evidence of a woman, where pregnancy has followed intercourse in a state of alleged unconsciousness. Any statement of this kind certainly re- quires a close examination, because generally there is a strong motive for falsehood on the part of the woman. In the case of Bromwich v. Waters (see ante), the woman Whalley had had a child, but stated that she had not been conscious of any intercourse. The fact that she had borne a child did not prove that her statement was false, although a sug- gestion to this effect was made. We may fairly doubt whether a woman could have intercourse unconsciously, but because impregnation follows this is no proof that she is guilty of falsehood or perjury. Microscopical Evidence. — As part of the medical evidence in cases of rape it may be necessary to examine spots or stains on the linen of the prosecutrix and the accused. Cases of rape are, however, commonly tried in this country without reference to this species of evidence ; and it is not easy to perceive how this can be necessary to the proof of the crime in the living, when the present law of England demands only proof of pene- tration, and not of emission. Thus, a rape may be legally completed without reference to emission ; and, medically speaking, it appears quite possible that there might be marks of emission without any penetration, MICROSCOPICAL EVIDENCE. 691 as in a protracted resistance on the part of a woman. Admittinj^ that certain stains of this description are found on the clothes of an accused person, are these to be taken as furnishing undeniable proof of the legal completion of rape by penetration ? It appears that, without corrob- orative evidence from the state of the female organs, they cannot be so taken ; and therefore the affirmative evidence from the microscope, under these circumstances, is as liable to lead to error as that which is purely negative. The fact that spermatic stains are found on the linen of the prosecutri.K may, however, become occasionally of great importance in charges of assault with intent. Examination of Stains. — There are no chemical tests on which we can safely rely for the detection of spermatic stains. The appearance pro- duced by a dried spermatic stain on linen or cotton is like that produced by a diluted solution of albumen. The fibre of the stuff is stiffened, and the stain, particularly at the margin, has a slightly translucent appear- ance, as if the stuff" had been wetted by diluted gum or albumen, but with- out any shining lustre. In the dry state the stains present no well-marked color or odor. Slips of the stained linen, when soaked in water, yield a slightly alkaline, opaque, muco-albuminous liquid. This liquid, unlike a solution of albumen, is rendered rather strongly yellow by diluted nitric acid. By the action of warm water the stained linen, even although it may have been kept dry for a considerable period, has been observed to evolve the peculiar faint odor of the spermatic secretion The stained linen, or a part of it, should be cut into small pieces, taking care that it is not roughly handled. These should be placed in a watch- glass, with a sufficiency of a 3 per cent solution of common salt to soak it thoroughly, and to allow the fibre of the stuff to become quite penetrated by the water. It is advisable not to move the stuff or agitate the liquid, but to allow it to be quietly imbibed. The watch-glass should be covered so as to prevent evaporation. After half an hour, the fibres may be turned and allowed to macerate for some time longer. The stained linen may then be removed, and the soaked fibres of the stuff gently pressed on several glass slides. The liquid thus obtained by pressing the stained linen is slightly opaline. It is found that this opalescence is removed by the addition of a small quantity of ammonia or diluted acetic acid ; these liquids do not affect the forms of the spermatozoa. Care must be taken not to use more liquid than is actually required to moisten the stained stuff and to allow a small portion to be pressed out of it. The liquid on the slide may be then covered with thin glass, and ex- amined under the microscope. The dead spermatozoa may then be seen as in the annexed engraving (Fig. 55). They have flattened ovoid heads, with long, ^'S- ^^• tapering tails which are from nine to twelve times the length of the head. They are usually associated with granular bodies and epithelial scales. Fibres of cotton, linen, or woollen may be mixed with them, and there may be also pus, mucus, or blood-globules. Their form is so peculiar that, when once Avell seen and examined, they cannot be con- founded with any other substance, veget- able or animal, nor with ordinary care can any vegetable fibres be mistaken for them, although these may be mistaken for their tails or filaments. Particular notice should Spermatozoa, magnified 450 diameters. 692 EXAMINATION OF SPERMATIC STAINS. be taken of any hairs or fibres found in such stains. They may be human or animal hairs, and the lil»res may, by their nature, form, and color, be connected with some article of dress worn l)y the woman or the i)erson accused of rape. Spermatozoa appear to retain life long- after the death of tlie body. Hofmanu states that he has observed the active movements of these bodies from eighty to a hundred hours alter death. Some observers have advised that the e.xpressed liquid obtained from spermatic stains should be allowed to dry spontaneously on the slide and then examined in the dry state. When humid, the bodies and especially the tails are so transparent that the whole spermatozoon may escape ob- servation. One part only may come into focus at a time. They become opaque by drying', and may be seen in darker lines, sometimes in their whole length, Roussin recommends the addition of a solution of iodine in iodide of potassium to the liquid submitted to examination. He has found that it brings out the entire form of the spermatozoon of a deep yellow color, and thus makes a distinction between it and other fibrous substances. (Ann. d'Hyg., 1867, t. 1, p. 154.) Eosin may also be used to color spermatozoa. E. Fngar (Zeitschr. f. Gerichtl. Med., 1887, i. 316), adverting to the great difficulty often experienced of obtaining unbroken specimens of epermatozoa from dried seminal stains, states that this is not due solely to the separation of the head from the tail of the organism by mechanical rupture. Spermatozoa are indeed very brittle, and easily ruptured by any rough handling of the fabric on which they may be shed ; but Ungar asserts that the separation of the head from the tail also takes place dur- ing the swelling of the dried spermatozoa when moistened with water for the purpose of examination. His method of examination is as follows. A piece of the fabric with the stain is moistened with very dilute hydro- chloric acid — one drop in H fluid oz. of water — on a watch-glass, with one end of the stuff only immersed in the liquid ; and the soaking is con- tinued for five hours. The fabric is then removed with forceps and dropped several times on to slides, avoiding tearing and much pressure. The liquid on the slides is then allowed to dry in air. A cover glass held by means of forceps is then passed two or three times through a naked flame and then deposited on the slide, which is then placed with the pre- pared surface downwards in the staining fluid (2^ per cent, eosin in spirit). When the staining has proceeded for a sufficient length of time, the slide is removed, washed with dilute alcohol, and examined. Or, a second stain- ing may be given with hoematoxylin, in which case the hinder part of the head acquires a deep blue tint, whilst the front and middle of the head and the tail are stained deep red. As it has been elsewhere stated, the spermatozoa, although peculiar to the seminal fluid, are not found in the very young, the very old, or in those who are laboring under long-standing disease of the testicles. Even in the cases of healthy married men who have had children, spermatozoa are not always found in the spermatic secretion ; their pres- ence, size, and number are subject to great uncertainty. Exhaustion from frequent intercourse, or constitutional causes without actual bodily dis- ease, appear to influence their production. There are also various other conditions in which they are not found ; these have been fully examined by Casper. (Gerichtl. Med., Bd. 2, p. 141.) Hence the discovery of spermatozoa in stains on articles of clothing demonstrates that they have been produced by the spermatic liquid; but their non-discovery, under these circumstances, does not prove that the stains have not beea caused by this liquid. 1 MICROSCOPICAL EVIDENCE. 69-3 The detection of dead or motionless spermatozoa in stains may be made at long periods after emission, when the fluid has been allowed to dry (Fiu". 56). In three cases, at intervals of from one week to seven weeks after the perpetration of the ^'S* ^^• crime, Casper was enabled to demonstrate the presence of spermatozoa on articles of clothing, and thus to fur- nish strong corroborative evidence. Koblanek made experiments on this subject, in reference to diiferent periods of time ; he found these bodies distinctly after twelve months. The discovery of one distinct and entire body is quite sufficient to justify a medical opinion of the spermatic nature of the stain. Bayard states that he has been able to detect spermatozoa in stains after six years (Man. Prat, de Med. Leg., '''"'^^'^^^^ p. 277); and Roussin, after the long period of eigh- ■'*"' teen J'ears. (Ann. d'Hyg., 1867, t. 1, p. 152.) The Spermatozoa in staina editor has found them in a stain after the lapse of three m!,^gnmed 5to dlamet^erl' years. A medical witness must be prepared to consider the precise value of evidence furnished by the microscope in the examination of stains on the dress of a man accused of rape. A shirt may present stains of blood, urine, mucus, or gonorrhoeal discharge, some of which, but for the micro- scope, might be mistaken for spermatic stains. Admitting that, by the process above described, the microscope enables an examiner to affirm that the stains have really been caused by the spermatic secretion, this does not prove that a rape has been committed, or even that intercourse has been necessarily had with a woman. Such stains may arise from spontaneous natural discharge, or from disease (spermatorrhoea), and therefore in themselves they afford no proof of intercourse. If, from other circumstances in the case, it should be clearly and satisfactorily proved that there has been intercourse, then the presence of blood mixed with the spermatic stains might, in certain cases, justify an opinion that violence had been used. The discovery of spermatic stains on the dress of a woman furnishes stronger evidence of intercourse, attempted or perpe- trated, than their discovery on the dress of a man ; but admitting that intercourse is thus proved, it may still have taken place with the consent of the woman. These stains, when found on the clothing of girls and infants, afford a strong corroborative proof of the perpetration of the crime. Microscopical Evidence from the Woman. — It may become necessary to determine, in reference to a woman, whether intercourse has or has not recently taken place. All observers agree that, within a certain period after connection, the fact may be established by an examination of he vaginal mucus. A small quantity of this mucus placed upon glass, and diluted with water, will be found to contain spermatozoa if the suspicion be correct. In addition to other characters, it may be remarked that the living spermatozoa move for many hours out of the body when kept at a temperature of 98° F., and they even retain their rapid motions when the spermatic liquid is mixed with water; but these motions sometimes cease immediately on the addition of urine or chemical reagents. According to Miiller, the spermatozoa may retain vitality (or free motion) in the body of a w^oman for the period of seven or eight days, and even longer Bayard states that he has thus detected them in the vaginal mucus of females nou subject to morbid discharges, at various intervals up to three days after in- tercourse (op. cit., p. 277) ; and Donud found them under similar circum- 69-t EVIDENCE OF VIOLATION IN THE DEAD. stances in a woman who liad been admitted into the liospital the day before (op. cit., p. 305). This evidence may become of value in a charf>e of rape, but it may be easily destroyed by the presence of leucorrhcjea ; and it is open to an o))jection that in certain morbid states of tlie vajiinal mucus of the human female there is found in it a microscopic animalcule, called by Donne the Trichomonas vaginse ; but this has a much lar<>er body and a shorter tail than the spermatozoon. Other sul)stances may be sometimes found in the va<^-inal mucus. (See case by Lender in Vierteljahrsschr. fiir Gerichtl. Med., 1865, p. 355.) Harks of Blood on Clothing. — Marks of blood upon the linen can, of course, furnish no evidence unless taken with other circumstances. The linen may be intentionally spotted or stained with blood for the purpose of frivinir apparent support to a false accusation. Bayard met with a case of this kind, in which a woman charged a youth with having committed a rape upon her infant child. On examination the sexual organs were found uninjured;, and on inspecting the marks of blood on the clothes of the child it was observed that the stains had been produced on the ovtside of the stuff, and bore the appearance of smearing ; the whole fibre had not even been completely penetrated by the liquid. The falsehood of the charge was thus established. (Ann. d'Hyg., 1847, t. 2, p. 219.) A case involving a false charge of rape was tried at the Glasgow Aut. Circuit, 1859. One of the witnesses, an accomplice, proved that she had pur- chased some blood and handed it to the woman who made the charge, and she saw her smear it over her person and on some sheets on which it was alleged the rape was perpetrated. The woman (Boyle) and her husband, w^ho made this false charge, were convicted of conspiracy. It may be a question whether marks of blood on the linen of a prosecu- trix Vv'ere caused by effusion as a result of violence or by the menstrual Jluid. In its normal state this fluid, in respect to the presence of red cor- puscles and of serum, resembles blood. That fibrin is frequently present is obvious from its being occasionally discharged in a clotted state ; hence the discovery of fibrin in a stain would by no means necessarily imply that the blood was not derived from the menstrual fluid. The French Academy of Medicine appointed as a committee Adelon, Moreau, and Le Canu, to examine this question in the most comprehensive manner. These gentlemen reported that, in the then state of science, there was no certain method by which menstrual blood could be distinguished from that effused from the bloodvessels in a ca.se of child-murder or abortion, and this statement still holds good. (Ann. d'Hyg , 1846, t. 1, p. 181 ; see ayite.) Even the presence of epithelial scales and mucus would not prove the stain to be menstrual, unless it could be shown that the mucus was actually effused with the blood which caused the stain. The epithe- lial scales naturally found in vaginal mucus are flat nucleated cells, oval, round, or polygonal in shape, and vary in size. They are spread over the mucous membrane, not only of the vagina, but of the mouth, pharynx, gullet, conjunctiva, and the serous and synovial membranes. There must be great caution in relying upon this microscopical evidence. Evidence of Violation in the Dead. — The body of a child or woman is found dead, and a medical witness may be required to determine whether her person has or has not been violated before death. There is here some difficulty, because there will be no statement from the prosecutrix herself. The witness can seldom do more than express a conjectural opinion from the discovery of marks of violence on the person and about the genital organs. Even if spermatozoa were detected in the liquid mucus of the UNNATURAL OFFENCES. 695 vagina, or on the dress of a woiuan, this would merely prove that there had been intercourse. In a ease of alleged murder tried at Edinljurgh, the first point to be determined in examining the dead body was whether a rape had or had not been committed. The examination of the stains on the dress was conclusive when taken in conjunction with the other evidence. The jury convicted the man of a rape, but acquitted him of the murder. (For another case in which evidence was obtained on the ex- amination of a dead body, see Casper's Klin. Novellen, p. 17.) Raj)e by Females on Males. — So far as we can ascertain, this crime is unknown to the English law. Several cases of this kind have, however, come before the French criminal courts. In 1845, a female, aged eighteen, was charged witli having been guilty of an act of indecency, with violence, on the person of Xavier T., a bo}^ under the age of fifteen years. She was found guilty. In another case, a girl, aged eighteen, was charged with rape on two children — the one eleven and the other thirteen 3^ears of age. It appeared in evidence that the accused enticed the two boys into a field and there had forcible connection with them. This female was proved to have had a preternatural contraction of the vagina which pre- vented intercourse with adult males. She was found to be laboring under syphilitic disease, and the proof of her offence was completed by the dis- ease having been communicated to the two boys. She was condemned. (Ann. d'Hyg., 1847, t. 1, p. 463.) Casper describes cases of this descrip- tion which have fallen under his observation. (Gerichtl. Med., Bd. 2, p. 129; and Klin. Novellen, 1863, p. 15.) By the Penal Code of France it is a crime in either sex to attempt intercourse with the other, whether with or without violence, when the child is under eleven years of age. That this offence is perpetrated in England under the mistaken notion that gonorrhoea and syphilis are thereby cured cannot be doubted. It is by no means unusual to find in the wards of hospitals mere boys affected with venereal disease In some instances this may be due to precocious puberty ; but in others it can only be ascribed to that unnatural connection of adult females with male children which is punished as a crime in the other sex. The only accessible medical proof would consist in the transmission of gonorrhoea or syphilis from the woman to the child. Unnatural Offences. Pederastia. Sodomy. Buggery. — This crime is defined to be the un- natural connection of a man with mankind, or with an animal. The evidence required to establish this crime is the same as in rape, and there- fore penetration alone is sufficient to constitute it. There are, however, tw^o exceptions : first, it is not necessary to prove the offence to have been committed against the consent of the person upon whom it was perpe- trated ; and second, both agent and patient (if consenting) are equally guilty ; but the guilty associate is a competent witness. In one case (Rex V. Wiseman), a man was indicted for having committed this offence with a woman, and a majority of the judges held that this was within the statute. Unless the person is in a state of insensibility it is not possible to conceive that this offence should be perpetrated on an adult of either sex against his or her will ; the slightest resistance would suffice to prevent its perpetration. In 1849, a question on this point was referred to the author from Jamaica. A man was convicted of the crime of sodomy, alleged to have been committed on the complaining party while he was asleep. The only evidence against him was the statement of the complainant. 696 UNNATURAL OFFENCES. The opinion given was in conformity with that of Ferguson, namely, that the perpetration of the act during a state of natural sleep was con- trary to all probability. The remarks already made in reference to rape during sleep may be applied with greater force to acts of this nature (p. 687, ante). If this crime is committed on a boy under fourteen years it is felony in the agent only ; and the same, it appears, as to a girl under twelve. (Archbold, p. 409.) The act must be in the part where it is usually committed in the victim or associate of the crime. Sodomy is commonly understood to signify unnatural intercourse be- tween man and man, while bestiality (bugger}') implies unnatural inter- course with animals. Continental medical jurists have invented a new term, Pederaatia (rtaiSoj fpaori^j, pueri amator), comprising those cases, not unfrequent, in which boys at about the age of puberty are made the victims of the depraved passions of men ; but this term is not applicable to the crime committed by and between adults. The medical aspects of this subject have been fully examined b}' Tardieu (Attentat aux Moeurs) ; also by Toulmouche (Ann. d'Hyg., 1868, t. 2, p. 121) and by Penard (Ann. d'Hyg., 1860, t. 5, p. 367). The symptoms indicative of this un- natural intercourse both in agent and patient are fully described by these writers. Casper has also dealt with this crime and the medical evidence required to prove it. (Gerichtl. Med., Bd. 2, p. 176.) The facts are commonly sufficiently proved without medical evidence, except in the cases of young persons, when marks of physical violence will in general be sufficiently apparent. In some instances proof of the perpetration of the crime may be obtained by resorting to microscopical evidence. Stains upon the linen of young persons may thus furnish evi- dence that the crime has been attempted if not actually perpetrated. Unless an examination is made soon after the perpetration of the crime, the signs of it will disappear. In the case of one long habituated to these unnatural practices, certain changes have been pointed out as medical proofs — among them a funnel-shaped state of the parts between the nates, with the appearance of dilatation, stretching, or even a patulous state of the anus and a destruction of the folded or puckered state of the skin in this part. There may be also marks of laceration, cicatrices, etc., and sometimes evidence raa\" be derived from the presence of syphilitic dis- ease. This condition of parts would represent the chronic state induced by these practices in the patient or succubus. In the recent or acute form, fissure and laceration of the sphincter ani, with bruising and effusion of blood, will be found. Trials for sodomy and bestiality are very frequent, and convictions of men and boys have taken place for unnatural intercourse with cows, mares, and other female animals. Medical evidence is seldom required to sustain the prosecution. There may be, however, circumstances which can only be properl}^ interpreted by a scientific expert. The hair of the animal may be found on the perpetrator, or marks of blood or feculent matter upon his dress, and in such cases chemical analysis or the microscope may en- able a witness to express an opinion in proof or disproof of the charge. In one case, where a man was charged with having had unnatural inter- course with a cow, the prosecution was able to show that some short, colored hairs found on the prisoner's person resembled those of the ani- mal. In another case, (Reg. v. Brinkley, Lincoln Ass., April, 1887), the editor found the peculiar colored hairs of a mare upon the prisoner's cloth- ing and spermatozoa on his trousers. False charges of sodomy are fre- quent, and are made for the purpose of extortion. UNNATURAL OFFENCES. qqj A question may arise here respecting- the examination of an accused person, which has already been considered in reference to women charged with infanticide. The examination should be with the consent of the accused, and not made against his will, since no one is bound to furnish evidence against himself (see ante). Cln reference to the evidence de- rivable from the hair of animals, see Yierteljahrsschr. fur Gerichtl.- Med, 1865, 1, 160.) ' *' 698 DEFINITIONS OF INSANITY. INSANITY. CHAPTER LXI. WHAT IS INSANITY ? MEDICAL DEFINITIONS. DISTINCTION OF SANE FKOM INSANE PER- SONS. MORAL INSANITY. L^GAL DEFINITIONS. " NON COMPOS MENTIS." — SYMPTOMS OF INCIPIENT INSANITY. — HALLUCINATIONS AND ILLUSIONS. LUCID INTERVALS. What is Insanity "I Medical Definitions. — The terms "insanity," ^'lunacy," "unsoundness of mind," "mental derangement," "mad- ness, " and " mental alieDation or aberration, " have been indifferently applied to those states of disordered mind in which a person loses the power of regulating- his actions and conduct according to the ordinary rules of society. In all cases of real insanity the intellect is more or less affected — hence the term intellectual insanity. In a medical sense this implies a deviation of the mental faculties from an assumed normal or healthy standard. In an insane person, bis language and habits are Cihanged — the reasoning power which he may have enjoyed in common M-ith others is lost or perverted, and he is no longer fitted to discharge those duties which his social position demands. Further, from perversion of reason, he may show a disposition to commit acts which may endanger his own life or the lives of those around him. It is at this period that the law interferes for his own protection and for that of society. Many attempts have been made by psychologists to define insanity ; but the definitions given are so imperfect that it would be difficult to find one which includes all who are insane and excludes all who are sane. The difficulty iji fully accounted for by the fact that mental disorder varies in its degree as well as in its characters ; and the shades of disordered intel- lect in the early stages are so blended as to be scarcely distinguishable from a state of insanity. It is this twilight condition of the mind, when it is fluctuating between sanity and insanity, which no definition can comprise, especially as the mind differs in its power and manifestations in most persons, and it is therefore difficult to fix upon a standard by which a fair comparison can be made. The vulgar notion of insanity is that it consists in an entire deprivation of reason and consciousness ; but the slightest acquaintance with the insane proves that they are not only per- fectly conscious of their actions in general, but that they reason upon their feelings and impressions, Abercrombie considered insanity to consist in a loss of the faculty of attention — that power by which we are capable of changing, controlling, arresting, or fixing the current of our thoughts. Conolly regarded it as a disorder of the power of comparison or judgment, and Marc as a loss of the faculty of volition ; so that, in the latter point of view, the acts of the insane are in a certain sense involuntary, and de- pend upon impulses which, owing to mental disease, they are unable to control. This view is now largely held by alienists. These definitions are defective, inasmuch as they are not adapted to the MORAL INSANITY. 699 various forms of the disease. Etymologically, the term implies the ne- gation of something', and not a positive state (Orange). In some cases of insanity, as in confirmed idiocy, there is no evidence of any exercise of the intellectual faculties ; but in most instances these faculties and the moral feelings are partially diseased or partially destroyed, in every variety and degree. Thus we may meet with cases in which the faculties of attention, comparison, and volition are more or less impaired or absent, or, if present, they are never perfect, although each may not be equally affected. When no two cases are precisely similar, no definition can in- clude all varieties of the disorder. A medical witness who ventures upon a definition will therefore generally find himself involved in numerous inconsistencies, for no words can possibly comprise the variable characters which this malady is liable to assume. Savage is of opinion that no stan- dard of sanity, as fixed by nature, can under any circumstances be con- sidered definitely to exist. (Insanity, p. 1.) Bucknell defines insanity as a disease of the brain affecting the integrity of the mind, whether marked by intellectual or emotional disorder ; whilst Maudsley considers it to be a disorder of the supreme nerve-centres of the brain — the special organs of mind. It will be observed that these definitions include some- thing more than mere intellectual insanity. Those who take an interest in definitions of insanity and who think they can defend them from the critical acumen of lawyers, will find them set forth in their medical and medico-legal aspects in a paper by Rorie. (Edin. Month. Jour., 1865, ii. p. 13.) [Dr. Buckham quoted a large number in his work on Insanity. The largest collection yet published, doubtless, ib that by the editor of the Medico-Legal Journal, and contained in the several volumes of that work : Vid. vol. 4, pp. 346-436 ; vol. 5, pp. 65-211-323-459 ; vol. 6, pp. 101-203 -314; vol. 7, p. 528.] There are, however, cases in which a medical man may find himself compelled, if not to define insanity, at least to draw some clear distinction between a sane and an insane person. Thus in cases in which there has been an alleged breach of the law regarding the custody of lunatics, it may be pleaded that the person is sane, and a medi- cal expert must then be prepared to say whether the person concerning whom the question is raised is idiotic, lunatic, or of unsound mind and to assign satisfactory reasons for his opinion. Moral Insanity. — In addition to that form of insanity in which the mind is affected, known as intellectual insanity, Prichard and other medico-legal writers have described a state which they call moral insanity {mania sine delirio), which is manifested simply by a perverted or dis- ordered state of the feelings, passions, and emotions, irrespective of any apparent intellectual aberration. There are no hallucinations or illusions, and there is no evidence of delusion, but simply a perversion of the moral sentiments. Thus it is alleged that this form of insanity may appear in the shape of a causeless suspicion, jealous}', or hatred of others, especially of those to whom the affected person ought to be attached ; and it may also manifest itself under the form of a wild, reckless, and cruel disposi- tion towards mankind in general. It does not seem probable, however, that moral insanity, as thus defined, ever exists or can exist in any person without greater or less disturbance of the intellectual faculties. The mental powers are rarely disordered without the moral feelings partaking of this disorder ; and conversely, it is not to be expected that the moral feelings should become to any extent perverted without the intellect being affected, for perversion of moral feelings is generally observed to be one of the early symptoms of disordered reason. The intellectual dis- turbance may sometimes be difficult of detection ; but in every case of 700 LEGAL DEFINITIONS OF INSANITY. true insanity it is more or less present, and it would be a highly dan- gerous practice to pronounce a person insane when some evidence of its existence was not forthcoming. The law does not certainly recognize moral insanity as an independent state ; hence, however perverted the affections, moral feelings, or sentiments may be, a medical jurist should always look for some indications of disturbed reason. Medically speak- ing, there are, according to Prichard, two forms of insanity, moral and intellectual; but in law, apjjarently, there is only one — that which affects the mind. Moral insanity is sometimes admitted as a bar to responsi- bility for civil or criminal acts, when accompanied by intellectual disturb- ance. Mayo denied its existence and contended that no abnormal state of mind siaould confer irresponsibility unless it involves intellectual as well as moral perversion. (Med. Testimony, p. 69.) Brodie also con- sidered that there are no reasonable grounds for admitting this to be an independent form of insanity. There has been, as he suggests, much mystification on the subject. The term has been applied to cases in which the name of insanity ought not to have been applied at all, i. e.io " moral depravity," and also to cases in which delusions have really existed, and which might therefore have been more properly classed with cases of ordi- nary mental aberration. (Psych. Inquiries, p. 99.) Others, however, stoutly contend for its legal recognition. [There has been a conflict of opinions and decisions of the courts as to moral insanity. Some confusion has arisen as to what constitutes and what has been recognized by the courts as moral insanity. Mere beliefs, opinions, or prejudices, unless involving some insane delusion, do not constitute moral insanity. Opinions as to the moral quality of acts, unaccompanied by delusions which subvert the will and reason and dominate the conduct, do not constitute moral insanit3^ Moral per- versity is not moral insanity. Moral insanity, as recognized by the courts, involves either a disorder of the brain which affects the moral faculties, or produces an inability to discriminate between right and wrong, which has, as a disease of the brain, proceeded so far as to destroy the reasoning faculties of the mind and impair or destroy the volition. This has had judicial recognition in American courts: Com. v. Moster (Gibson, C. J.), 4 Pa. St. 266 ; Forman's Will, 54 Bar. 274 ; Boswell v. The State of Alabama, 307 ; Wharton Horn., § 574 ; St. Louis Mut. Life Ins. Co. v. Graus, 6 Bush. 268; Andersons. The State, 43 Conn. 515; Buswell on Insanity, § 12 ; Ray's Contributions to Mental Pathology, 115 ; per contra. State V. Spencer, 1 Zab. 196.] Of one fact we may be well assured : if in these cases of alleged moral insanity there is no indication of a perversion of intellect, medical evi- dence is not required to determine the degree of responsibility in refer- ence to such persons. Those who administer the law, and any man en- dowed with plain common sense, will be as well qualified as a medical expert to decide the question of criminal responsibility. Further, until medical men can produce a clear and well-defined distinction between moral depravity and moral insanity, such a doctrine, employed as it has been for the exculpation of persons charged with crime, should be rejected as inadmissible. Legal Definitions. — The law of England recognizes two states of mental disorder or alienation: (1) Dementia naturalis, correspondlnf; to idiocy ; and (2) Dementia adventifia, or accidentalis, signifying general insanity as it occurs in persons who have once enjoyed reasoning power. To this state the term "lunacy" is also applied, from an influence for- merly supposed to be exercised on the mind by the moon and still believed UNSOUNDNESS OF MIND. ' 701 in by many attendants on the insane. Lunacy is a term generally applied to those disordered states of mind which are known to medical men under the names of mania, melancholia, and dementia ; and which are frequently, although not necessarily, accompanied with lucid intervals. One main character of insanity, in a legal view, is considered to be the existence of delusion; i. e. that a person should believe something to exist which does not exist and that he should act upon this belief. Many persons may labor under harmless delusions and still be fitted for their social duties ; but should these delusions be such as to lead them to injure themselves or others in person or property, then tHe case is considered to require legal interference. In addition to the terms Idiocy and Lunacy, we find another frequently employed in legal proceedings, namely " unsoundness of mind " {non com- pos mentis) — of the exact meaning of which it is impossible to give a consistent definition. [The words " non compos mentis^'' have received judicial interpretation. The doctrine of Lord Coke, " total deprivation of sense,'''' is not recognized now by the courts, either in England or America, as correct in regard to what constitutes " non compos mentis:^'' Carew v. Johnston, 2 Sch. & Lef. 280 ; Browning v. Reane, 2 Phil. 69 ; Dew v. Clark, 3 Add. Ecc. 79, 87 ; Lord Tenterden in House of Lords in Mannin v. Ball, Smith & Batty, 183 ; Bueurle on Insanity, § 5, § 6 ; Commonwealth v. Schneider, 59 Pa. St. 328 ; Commonwealth v. Haskell, 2 Brews. 491 ; although there has been a conflict of American decisions, the weight of American authority sustains the English doctrine laid down in Mannin v. Ball, before cited: Hale V. Hill, 8 Conn. 39 ; Dennett v. Dennett, 44 N. H. 531 ; Carmichael m re, 36 Ala. 514 ; Hovey v. Chase, 52 Maine, 304 ; Blanchard v. Nestle, 3 Denio, 47 ; Stanton v. Wetherwas, 16 Barb. (N. Y.) 259. In New York, Massachusetts, and several of the American States stat- utes have been passed defining the terms "insane person," "lunatic," " non compos,^'' and "insane," so as to embrace all forms of insanity except " idiocy." In many of the American States the law has made the words "lunatic," insane, and " non compos mentis'" synonymous and convertible terms, and that these embrace all recognized forms or phases of insanity, and at law it may be said "that he is insane," "a lunatic," or " non compos mentis" whose mind is affected by general fatuity or is subject to one or more specific delusions: Bushnell on Insanity, § 18.] According to Winslow, the phrase "unsoundness of mind" was first used by Lord Eldon to designate a state of mind not exactly idiotic, and not lunatic with delusions, but a condition of intellect occupying a place between the two extremes, and unfitting the person for the government of himself and his affairs. (Lancet, 1872, i. p. 108.) This definition has been since generally accepted and acted on by all the judges. From various legal decisions it would appear that the test for unsoundness of mind in law has no immediate reference to the existence of delusion in the mind of a person, so much as to proof of incapacity from some morbid condition of intellect to manage his aff"airs with ordinary care and pro- priety. (Amos.) Neither condition will suffice to establish unsoundness without the other ; for the intellect may be in a morbid state, and yet there may be no legal incompetency ; or the incompetency alone may exist and depend on bodily infirmity or want of education — conditions which must not be confounded with mental disorder. Thus, then, a person may be of unsound mind, i. e. legally incompetent to the control of his property, and yet not come up to the strict legal standard of lunacy or idiocy. A modern writer of the legal profession, on the subject of insanity. 702 UNSOUNDNESS OF MIND. thus defines the disease: "Sanity exists when the brain and the nervous system are in such a condition that the mental functions of feeling and knowing, emotion and willing, can be performed in their regular and usual manner, Insanity means a state in which one or more of the above- named mental functions is performed in an abnormal manner, or not per- formed at all, by reason of some disease of the brain or nervous system.'^ (Stephen, J., Hist, of the Crim. Law of Eng., vol, iii. p. 130.) Some medical practitioners have attempted to draw a distinction be- tween insanilij and unsoundness of mind, A case occurred in 1839, in which a medical man hesitated to sign a certificate for the confinement of an alleged lunatic because in it the words " unsound mind " were used. He said he would not have hesitated to sign it had the term " insane "^ been employed. The difference, if any exist, is purely arbitrary, and de- pends on the fact that " unsound mind " is a legal and not a medical phrase, referring to an incapacity to manage affairs, which insanity, in its most enlarged sense, does not always imply. The law, however, appears to admit some sort of distinction ; for, according to Chitty, it is a criminal and an indictable act maliciously to publish that any person is afflicted with insanity, since it imputes to him a malad}^ generally inducing man- kind to shun his society ; although it is not libellous to say that a man i& not of sound mind, because no one is of perfectly sound mind but the Deity. "Soundness" is here used as synonymous with "perfection." (Med, Juris., vol. i. p. 351.) In reference to the signing of certificates of insanity it is, however, an error to suppose that the use of one term can involve a practitioner in any greater share of responsibility than the use of the other. [It may be said that both the English and the American courts, by a^ long line of decisions, have established the rule of law to be that the presence or absence of delusion in the mind of the subject was the true criterion of the presence or absence of insanity in any case : Dew v. Clark, 3 Add. Ecc. 79; Wheeler v. Anderson, 3 Hagg. Ecc. 514; Mc- Elrov's Case, 6 W. & S. 451 ; Am. Seaman's Fund Soc, v. Hopper, 3a N. Y. 619; Duffield v. Morris, 2 Harr. 375; Sutton v. Sadler, 5 Harr. 459; Frere v. Peacock, 1 Rob. Ecc. 442; Stanton d, Whetherwax, 1& Barb, 259; Mullin v. Cottrell, 41 Miss, 291 ; Buswell on Insanitv, § 14^ Forman's Will, 54 Bar, 274. The courts have made exceptions to this general rule where ' delusion" is not the criterion: 1. Insanity congenital "ex nafivitate." 2. Cases where the mind has become enfeebled, weakened, or disorganized, due to disease or to the gradual development of senile dementia. The law now recognizes insanity as existing in certain cases without delusions : Nichols V. Binns, 1 Sw. & Tr 239; Am. Seam, Fund Soc, v. Hopper, 33 N, Y. 619 ; Regina v Shaw, L, R, 1 C. C. 145; Buswell on Insanitv, § 16,] As regards this legal view of insanity in its bearings upon crime, a distinguished Judge, already quoted, has summed up a description of mad- ness as known to the law in the following terms (Stephen's Hist, of the Crim. Law of England, vol. ii. p, 145) : "Any one or more of numerous causes may produce diseases of the brain or nervous system M'hich inter- fere more or less with the feelings, the will, and the intellect of the per- sons affected. Commonly, the disease, if it runs its full course, affects the emotions first, and afterwards the intellect and the will. It may aff"ect the emotions either by producing morbid depression or by producing mor- bid excitement of feeling. In the first, which is much the commoner of the two cases, it is called melancholia, and in the second mania. Mel- ancholia often passes into mania. Both melancholia and mania com- UNSOUNDNESS OF MIND. 703 monly cause delusions or false opinions as to existing facts, which suggest themselves to the mind of the sufierer as explanations of his morbid feel- ings. These delusions are often accompanied by hallucinations, which are deceptions of the senses. Melancholia, mania, and the delusions arising from them often supply powerful motives to do destructive and mis- chievous acts ; and cases occur in which an earnest and passionate desire to do such acts is the first, and perhaps the only marked, symptom of mental disease. It is probable tiiat in such cases some morbid state of the brain produces a vague craving for relief by some sort of passionate action, the special form of which is determined by accidental circumstances ; so that such impulses may differ in their nature and mode of operation from the motives which operate on sane and insane persons alike. The difference may be compared to the difference between hunger prompting a man to eat, and the impulse which, when he suffers violent and sudden pain, prompts him to relieve himself by screaming. Insanity affecting the emotions in the forms of melancholia and mania is often succeeded by insanity affecting the intellect and the will. In this stage of the disease the characteristic symp- tom is the existence of permanent incurable delusions, commonly called monomania. The existence of any such delusion indicates disorganization of all the mental powers, including not only the power of thinking correctly, but the power of keeping before the mind and applying to particular cases general principles of conduct. The last stage of insanity is one of utter feebleness, in which all the intellectual powers are so much prostrated as to reduce the sufferer to a state of imbecility. Lastly, paralysis and epilepsy are so closely allied with insanity that insanity frequently forms a symptom of each. In all the cases above referred to, the sufferer is sup- posed to have been originally sane, but sanity may never be enjoyed at all. This happens in cases of idiocy." [The use of the term monomania, even in the sense named by the learned Judge, was misleading and improper. The state to which allusion was made is not " commonly called vwnomania.^' That term among judges, lawyers, and lexicographers has been understood to mean derange- ment of a single faculty of the mind, or with regard to a particular sub- ject only as defined by Webster This has had judicial construction in the courts. Legally, monomania has been held to exist where the mind is deranged upon one subject, the insanity relating to one delusion, and retaining the other intellectual powers. It excuses only when this delu- sion leads to an insane impulse which controls the will and judgment, obliterates the understanding of right and wrong to the commission of an act which the accused was unable to resist, or to refrain from and yield- ing to its domination : Stevens v. State, 31 Ind. 485 ; State v. Johnson, 40 Conn. 136; Com. v. Rogers, 47 Mass. (7 Mete.) 500; s. c. 1 Lead. C. C. 94; Brailly i;. State, 31 Ind. 492; Com. i;. Haskell, 2 Brewster (Pa.), 401 ; Com. v. Frith, 5 Clark (Pa. L. J.), 455 ; Life Ins. Co. v. Teny, 21 U. S. (15 Wall.) 580; on 21 L. Ed. 320; United States v. Hewson, 7 Bost. L. R. 3G1 ; Span v State, 47 Ga. 553 ; Roberts v. State, 3 Ga. 310 ; Hopps V. People, 31 Me. 385 ; State v. Felter, 25 Iowa, G7 ; Wesley v. State, 37 Miss. 327 ; Scott v. Commonwealth, 4 Met. (Ky.) 227 ; and as to responsibilitv : Com. v. Mosier, 4 Pa. St. 264 ; State v. Iluling, 21 Mo. 464; Rovcei;. "Smith, 9 Gratt (Va.) 704; Rex v. Off"ord, 5 Carr. & P. 168; Willis v. People, 5 Park. Crim. R. (N. Y.) 621 ; Reg. v. Burton, 3 Fost. & F. 772 ; Rex v. Townley, 3 Post. & F. 839. Among medical men and authors the term monomonia means quite another thing, as was intended by Esquirol. its author, and so understood by all modern American, French, German, and Italian scientists and 704 SYMPTOMS OF INCIPIENT INSANITY. writers. Its use is therefore misleading, and it is now generally aban- doned bj the better medical authorities for that reason ; Vid. Article Monomania, 2 Bell's Medico-Legal Studies, p. 101. Maudsley, Pliny Earl, and many writers and observers, deny the existence of an insanity limited to one subject, leaving the brain normal and healthy on all other subjects. For these reasons the term monomania should not be longer employed by medico-legal writers or in text-books.] The same writer poiuts out the chief points on which medical and legal kvriters differ respecting the plea of irresponsibility (Ibid. vol. iii. ch. xvii.) ; and this chapter should be perused by all physicians who have to deal with insane criminals. It may be well to give an outline of tlie views therein expressed. "The different legal authorities" (he says, p. 125) "upon the subject have been right in holding that the mere existence of madness ought not to be an excuse for crime, unless it produces in fact one or the other of certain consequences." The English law with respect to madness is thus stated, the doubtful points being placed within square brackets: "No ace is crime if the person who does it is at the time when it is done prevented [either by defective mental power or] by any disease affecting the mind, (a) from knowing the nature or quality of his act ; or (6) from knowing the act is wrong ; [or (c) from controlling his own conduct, unless the absence of the power of control has been produced by his own default]. But an act mav be a crime although the mind of the person who does it is affected by disease, if such disease does not, in fact, produce upon his mind one or other of the effects above mentioned, in reference to the act." Speaking of knowledge of right and wrong, he says, " I think that any one would fall within that description (inability to know the quality of his act) who was deprived, by disease affecting the mind, of the power of passing a rational judgment on the moral character of the act which he meant to do " (p. 163). And again, " Knowledge and power are the con- stituent elements of all voluntary actions, and if either is seriously im- paired the other is disabled. It is as true that a man who cannot control himself does not know the nature of his acts, as that a man who does not know the nature of his acts is incapable of self-control " (p. 171). The true legal meaning of the word "know," as applied to njadness, is by no means easy to determine ; and it is also clear that the term 7-esponsi- bility is used in different senses by legal and medical authorities respec- tively. The lawyer understands by it responsibility to the law of the land ; medical writers on insanity, on the other hand, have habitually used the term in a vague and undefined sense as referring to what ought in their opinion to be the law, and as referring to some moral standard. The word wrong, too, is used in two senses — it may mean either immoral or illegal. It is here right to observe that " irresistible " is a term often applied by medical writers to impulses which can be controlled Stephen, J., quotes a remarkable instance of a woman who felt what was termed an " irre- sistible impulse " to murder her child, and yet did successfully resist her impulse. Symptoms of Incijnent Insanity. — The symptoms by which insanity is indicated at an early stage are lialjle to great variation, according to the sex, age, and social position of the person. In reference to suicide, the execution of wills, or the perpetration of crime, we often find, after the death of the person, or at the trial which follows the crime, that the most trivial and irrelevant circumstances are brought forward as indica- tions of insanity, This subject has been ably treated by Winslow. (Ob- HALLUCINATIONS AND ILLUSIONS. 705 scure Dis. of the Brain, p. 88.) The facts are there gathered chiefly from the accounts furnished to hiui by those who have recovered. There is great irritability at the most trifling circumstances — impatience of contra- diction, loquacit}^, great difticulty in directing attention to and steadily occupying the mind with any train of thought, neglect of usual employ- ment, sleeplessness, depression of spirits without reasonable cause, a dis- position to seclusion, doubts about personal identity, followed by halluci- nations and illusions. A lady, who was gradually affected, remained in- sane for nearly eleven months: she informed Winslow that during the whole of that time she fancied she was in hell and tormented by evil spirits ; she thought every person near her was the devil. Sometimes a patient fancies he is continually watched by spies, that policemen are looking after him, and that conspiracies and plots among his relatives or friends are going on secretly against him ; he believes that his food is drugged or poisoned, and will refuse to eat. Great anxiety on any sub- ject followed by headache may be the forerunners of an attack ; there is generally an entire loss of interest in the usual occupations, a silent man- ner, and a great desire for solitude. In one instance fits of immoderate laughter at the most trivial occurrences preceded the attack. Sooner or later these symptoms are attended by perverted taste or smell — by illu- sions of hearing or sight ; voices are heard, and objects are seen, which at first perplex and then confuse the patient ; they continue until he feels overpowered mentally and bodily ; and then he falls into delusions re- garding himself, his friends who are about him, his profession or occupa- tion, and his worldly circumstances. In incipient insanit}^ delusion does not necessarily exist. There is an antecedent state, in which the most prominent feature is intense self-con- ceit. A man may retain the knowledge of his personal identity, but he may fancy himself to be wiser, richer, or stronger than he really is. An- other feature is misanthropy , a general dislike to others without cause, but especially directed against those who have the greatest claim on his affection. This feeling may after a time become complicated with some delusion. A third symptom is a suspicious disposition, which sooner or later leads to delusion, and the person imagines that there are conspiracies to poison him or to do him some bodily injury. (Lancet, 1873, i. p. 411.) Intense self-conceit, misanthropy, and distrust without delusion may be regarded as the most marked forerunners of an attack of insanity. Hallucinations and Illusions. — These are the most striking symptoms which are met with in a confirmed state of insanity. Hallucinations are those sensations which are supposed by the patient to be produced by external impressions, although no material objects act upon his senses at the time ; illusions, on the other hand, are sensations produced by a false perception of objects. A man has visions of all kinds, including the forms of the dead and the living, floating before him when he is gazing upon vacancy. He fancies he hears voices speaking or mysteriously whisper- ing to him, while there is profound silence : these are hallucinations. An- other may erroneously imagine that the taste or smell of his ordinary food is earthy, metallic, or poisonous — when the perversion is in his own senses: these are illusions. Both conditions depend upon a disordered state of the mind. Instances of hallucination are furnished by the act of dreaming : while illusions occur often during the act of suddenly waking from sleep, giving rise occasionally to serious questions involving criminal responsibility. The state of insanity is in other points of view analogous to dreaming. There is equally a want of power in the two states to change or control the current of thought passing through the mind. 45 706 LUCID IMTERVALS, Things which are impossible and inconsistent are believed to have an actual existence. A voice heard during the act of dreaming sometimes becomes an illusion connected with a current of thought then passing through the mind ; it is the same in a case of confirmed insanity, with this difference in the latter, that some power of will or some exercise of reason may still exist. Illusions are sometimes met with in the sane, but when arising from external objects the false perception is soon corrected by a reference to the other senses ; and herein consists the maiu difference between sanity and insanity — namely, delusion, or a misleading of the mind. When the hallucination or illusion is believed to have a positive existence, and this belief is not removed either by reflection or an appeal to the other senses, the person is insane ; but when the false sensation is immediately detected b}^ the judgment, and is not acted on as if it were real, then the person is sane. Delusion, therefore, properly refers to the judgment, and illusion to the senses. The meaning of these terms is often confounded ; but while delusion is always connected with insanity, illusion is not neces- sarily mdicative of mental disorder. Hallucinations and illusions are the main features of those forms of insanity which are known as mania and primary delusional mania. They are rarely met with in cases of idiocy and imbecility, sometimes in dementia, but they are most common in paroxysms of mania. Acts of murder ma}^ often be traced to their exist- ence; for the person laboring under mania of general or specific delusions is unable during a paroxysm to divest his mind of the belief that what he sees has a positive existence before him. He feels impelled to suicide by the hallucination of voices calling to him, and to murder by the illusion that he is not destroying a wife, child, or friend, but an evil spirit substi- tuted for them. The acts of the insane are generally connected with their delusions, although it is not easy to trace the connection except b}^ their own admissions. When the acts are unusual and strange, it is most prob- able that they depend on hallucination, illusion, or both. Lucid Intervals. — By a lucid interval we are to understand, in a legal sense, a temporary cessation of the insanity or a perfect restoration to reason. In a remission there is a mere abatement of the symptoms. It has been said that a lucid interval is only a more perfect remission, and that although the lunatic may act rationally and talk coherently, yet his brain is in an excitable state, and he labors under a greater disposition to a fresh attack of insanity than one whose mind has never been affected. Of this there can l)e no doubt, but the same reasoning would tend to show that insanity is never cured ; for the predisposition to an attack is un- doubtedly greater in a recovered lunatic than in one who is and has always been perfectly sane. Even admitting the correctness of this reason- ing, it cannot be denied that lunatics do occasionally recover for a longer or shorter period, to such a degree as to render them perfectly conscious of and legally responsible for their actions like other persons. The law intends no more than this by a lucid interval — it does not require proof that the cure is so complete that even the predisposition to the disease is entirely extirpated. Such proof, if it could even be procured, would be totally irrelevant. If a man acts rationally and talks coherently, we can have no better proof of a restoration to reason. If no delusion affecting his conduct remains in his mind, we need not concern ourselves about the degree of latent predisposition to a fresh attack which may still exist. Lucid intervals sometimes appear suddenly in the insane : the person feels as if awakened from a dream, and there is often a perfect conscious- ness of the absurdity of the delusion under which he was previously labor- 1 VARIOUS FORMS OF IJSISANITY. 707 ing. The duration of the interval is uncertain : it may last for a few minutes only, or may be protracted for days, weeks, mouths, and even 3'ears. In a medico-legal view, its alleged existence must be always looked upon with suspicion and doubt when the interval is very short. Lucid intervals are most fre(|uently seen in cases of mania and those forms of insanity accompanied by specific delusions ; they occasionally exist in dementia when this state is not chronic, but has succeeded a fit of intermittent or periodical mania. They are never met with in cases of idiocy and imbecility. It is sometimes a matter of great importance to be able to show whether or not there exists or has existed a lucid interval, since in this state the acts of a person are deemed valid in law. The mind should be tested, as in determining whether the patient is laboring under insanity or not. He should be able to describe his feelings, and talk of the subject of his delusion without betraying any sign of unneces- sary vehemence or excitement. It may happen that the person who is the subject of a Commission of Inquiry is at the time of examination under a lucid interval, in which case there may be some difficulty in form- ing an opinion of the existence of insanity. It has been said that a person in a lucid interval is considered by law to be responsible for his acts, whether these are of a civil or criminal nature. In regard to criminal offences committed during a lucid interval, it is the opinion of man}^ alien- ists that no person should be convicted under such circumstances, because there is a probability that he might at the time have been under the in- fluence of that degree of cerebral irritation which renders a man insane. This remark applies especiall}^ to those instances in which the lucid interval is very short. Juries now seldom convict, however rationally in appear- ance a crime may have been perpetrated, if it is proved that the accused was insane within a short period of the time of its perpetration. The number of lunatics in England and Wales in 1883 was 18,528, exclusive of 228 so found by inquisition, but including 535 criminal lunatics. CHAPTER LXII. VARIETIES OF INSANITY. — MANIA. — ABSTINENCE FROM FOOD. — DELUSIONS REGARDING POI- SON. DELIRIUM DISTINGUISHED FROM MANIA. PRIMARY DELUSIONAL INSANITY.— DE- MENTIA. IDIOCY. IMBECILITY. HEREDITARY TRANSMISSION. FEIGNED INSANITY.^ APPEARANCES AFTER DEATH. ECCENTRICITY. Varieties of Insanity. — Medical jurists have commonly recognized four distinct forms of insanity: Mania, Primary delusional insanity, {Mono- mania), Dementia, and Idiocy {Amentia)} This division was proposed by Esquirol, and although of a purely artificial nature it is convenient for the arrangement and classification of the facts connected with the subject. In some instances there is great difficulty in assigning a particular case to either of these divisions, owing to the circumstance that these states of disordered mind, if we except idiocy, are frequently intermixed, and are apt to pass and repass into each other. On other occasions, a ease may represent mixed characters which appertain to all the divisions. Melan- 1 [The title Monomania is no longer used by advanced alienists in classifications of insanity for reasons given heretofore. — (Editor.)] 708 MANIA DELIRIUM. choKa may be regarded as chronic mania. General paralysis of the insane is a cause or symptom of insanity, and not a separate division of it. Mania. — In this form of insanity there is a general derangement or per- version of the mental faculties, accompanied by greater or less excitement, sometimes amounting to violent fury. (Pagan's Med. Jur. of Insanity, p. 59; Marc, De la Folic, vol. i. p. 211.) Ideas flow through the mind without order or connection, the person losing all control over his thoughts, and believing and acting upon them, however absurd and incon- sistent they may be. Rapidity of utterance and incessant agitation accompany this state ; there is also great irritability, so that not the least contradiction can be borne. Mania may take place suddenly, as after a violent moral shock, but in general it comes on slowly. It may be chronic or acute, recurrent or continued. There are very few cases which do not present remissions, more or less complete ; and in some instances after a violent attack the reason appears to be perfectly restored, forming then what is termed a lucid interval, the clear distinction of which, in a legal point of view, is of material importance. In recurrent mania the attack comes on without any obvious cause. It may last for a week, a month, or even longer. There is usually a stage of excitement followed by de- pression before recovery. Persons laboring under mania, especially when it is associated, as it frequently is, with paralysis, are comparatively insensible to severe injuries. They will bear exposure to cold without complaining, and even conceal the existence of a fracture or other injury which would cause great pain to a sane person. They will also sustain the privation of food for a great length of time without any apparent in- jury to health. In some Instances, owing to a suspicion that the food is poisoned, they refuse to take any ; it is then necessary to feed them with a stomach-pump. This delusion respecting the poisoning of food is very common in the early stages of mania. The patient will fancy that he himself, or some favorite animal, is undergoing a process of slow poison- ing by a secret enemy. We have met with a great number of instances in which this delusion of being the victim of poison was the principal feature of the mental disorder. In mania there is excitement coming on in paroxysms without any obvious cause, and leading the person to acts of violence either towards himself or others. It is necessary that a medicaljurist should be able to distinguish mania from delirium depending on bodily disease and from the action of poisons. Delirium closely resembles the acute form of mania, — so closely that mis- takes have occurred, and persons laboring under it have been improperly ordered into confinement as maniacs. The following are, perhaps, the best diagnostic differences : a disordered state of the mind is the first symptom remarked in mania: while delirium is a result of bodily disease, and there is greater febrile excitement in it than in mania. Delirium, being a mere symptom attendant on the disease which produces it, exists as long as that disease, and no longer ; while mania, depending on widely different causes, is persistent. Delirium disappears suddenly, leav- ing the mind clear ; while mania commonly experiences only remissions. (See Pagan's Med. Jur. of Insanity, p. 69.) In delirium there is gener- ally great acuteness of the senses. Inflammation of the brain or its mem- branes is distinguished from acute mania by the mode of its attack, the presence of severe pain in the head, and excessive sensibility with intoler- ance of light and sound. Primary Delusional Insanity. (Monomania.) — This name is some- times applied to that condition in which the mental alienation is apparently MONOMArJIA DELIRIUM. 709 only partial ; in other word?;, it is nothing more than insanity manifesting itself in one direction.^ In mania, the mind is disordered on all kinds of sub- jects ; in this form the disorder is confined chiefly either to one subject or to one class of subjects. Those thus affected are infected with false ideas on certain points, of which they cannot divest themselves, and out of Avhich they cannot be reasoned : they start from false principles, but, setting- this aside, their inferences and deductions from these principles often possess logical accuracy. In every subject not connected with their special delusions they are like the rest of the world; they talk and reason as justly upon facts as before the access of their malady, but their general deportment, habits, and character are changed. Thus a miser may become a spendthrift, and a hard-working and industrious mechanic may pass his time in idleness ; a man of moral habits will become immoral in conversa- tion and conduct ; and an abstemious man may become a drunkard. [The term " prhnari/ delusional insainty''^ is better and less misleading than "monomania:" Vid. Report Com. on Classification of Insanity; vol. iv. M^d. L^g. Jour., p. 209, also ib. vol. v. p. 465.] The mental disturbance may be so slight that the person will have the power of so controlling his thoughts and actions as to appear like one who is sane, provided the subject of his delusion is not referred to. There is no doubt that those who are thus affected in an early stage are frequently able to direct their minds with reason and propriety to the performance of their social duties, so long as these do not involve any of the subjects of their delusions. Their power of controlling their thoughts and feelings, as well as of concealing their delusions, implies a certain consciousness of their condition not usually met with in ordinary mania; and it also appears to imply the existence of such a control over their conduct as to render them equally responsible with sane persons for many of their acts. In a case of confirmed single delusion, however, it is not to be supposed that a man is insane upon one point onh^ and sane upon all other subjects. The only admissible view of this disorder is that which was taken by Lord Lyndhurst in one of his judgments. If the mind is unsound, it is not unsound in one point only and sound in all other respects, but this un- soundness manifests itself principally with reference to some particular object or person. There is no doubt that all the mental faculties are more or less affected, but the affection is more strikingly manifested in some of these than in the others. The delusion of such a person wnll be generally uppermost in his mind ; his will is powerless to dismiss it, just as in mania the will is powerless to stop the continuous and rapid succession of different and incongruous ideas which present themselves to the mind in that form of insanity. In the first stage the judgment may be strong and the mind apparently sound upon every point except the particular subject of delusion ; and even, in some instances, there may be such a control over this delusion that it would be difficult to discover whether or not there was any just ground for imputing mental unsoundness; but in a more advanced form of the disease the delusion, whatever it may be, whether relating to wealth, ambition, religion, or politics, so overpowers the patient that he loses • [Although courts have held that insanity may exist where there is only one specific delusion, and the manifestations are limited to that one subject, with the mind clear and unimpaired on all other subjects, based upon the opinions of medical men and popular belief, alienists of the highest attainments and largest experience deny such a condition, and they are undoubtedly correct. If the brain is diseased to such an extent as to produce a state of insanity in any respect, it is ditficult to conclude that the subject is saue in all other respects. — (Editok.)] 710 MONOMANIA — DEMENTIA. self-control. His character is changed, and his habits are such as to render him unfit for social intercourse; he becomes incoherent; his ideas are preverted on all subjects, and he gradually lapses into mania or de- mentia. The last condition happens when the disease is of long stand- ing. It may be remittent or intermittent, and it is sometimes accompanied with lucid intervals. Its progress is rapid, and its terminatioQ often un- expected ; in some instances the disease ceases suddenly without any pre- vious warning, owing to the eifects of a strong moral shock or impression. This form of insanity in its early stage is liable to be confounded with eccentricitii ; but there is this difference between them. In the insane there is obviously a change of character — the person is different from what he was ; in eccentricity such a difference is not remarked — he is, and always has been, singular in his ideas and actions, there is no observable change of character. An eccentric man may be convinced that what he is doing is absurd and contrary to the general rules of society, but he professes to set these rules at defiance ; the insane man cannot be convinced of his error, and he thinks that his acts are consistent with reason and the general conduct of mankind. In eccentricity there is the will to do or not to do ; in insanity the controlling power of the will appears to be lost. Eccen- tric habits suddenly acquired are, however, presumptive of insanity. It will be seen hereafter that the distinction of these states is of considerable importance in relation to testamentary capacity. This form of insanity frequently assumes one of two forms; either the thoughts are lively and gay, or they are oppressed with gloomy melan- choly. In the first state the persons will fancy themselves to be kings and queens, and overflowing with wealth, which they are prepared to distribute with regal profusion ; in the second state we find silence, seclu- sion, and the most heart-rending sorrow. The latter condition, by no means uncommon as a form of this disease, is called Melancholia (mania with depression), or Lypemania (tlv^jj, sorr'Oiv). Those who are affected with it suppose they have committed the unpardonable sin, and pass their hours in silence and in the most gloomy forebodings of eternal punishment. They do not sleep, will sometimes neither eat, speak, nor move ; and force must be used to make them take food and exercise. In some instances no persuasion can conquer their silence ; one patient thus affected was not heard to utter a word daring four years. If spoken to, they shed tears and violently repulse the person who addresses them. Melancholia fre- quently leads to an act of suicide or murder, and persons affected with it require close watching. In the lighter forms of the disease there is no sign of mental aberration, and the patient will go through his usual routine of duty, but always with the same desponding air, so that his occupation seems scarcely to distract his thoughts from the delusion for a single instant. In other cases the delusion is so well concealed that no suspicion exists until an act of suicide leads to inquiry, and some evidence of strangeness of conduct is then for the first time forthcoming. There is either an entire absence of motive for the act or the motive is based on a delusion. Dementia. — This is a state which, although sometimes confounded with mania, is very different in its characters. Dementia, when confirmed, con- sists in a total absence of all reasoning power, and an incapacity to per- ceive the true relations of things ; the language is incoherent, and the actions are inconsistent; the patient speaks without being conscious of the meaning of what he is saying; memory is lost, and sometimes the same word or phrase is repeated for many hours together ; words are no longer connected in meaning as they are in mania and monomania. IDIOCY AND IMBECILITY. 711 This state, often called Fatuity, is a not unfrequent consequence of chronic mania. Dementia varies in degree. The disordered mind of aged persons is one form of dementia ; here we find memory and some mental power, although the memory is restricted to objects long since past, and the exertions of the mind are only momentary. Some persons in dementia are quiet, others are in constant motion as if in search of something. In some instances this disease comes on graduall}^ — the faculties, both moral and intellectual, decay one by one; while in other instances, although much more rarely, dementia may occur suddenly from a violent shock or impression on the mind. Dementia may be acute or chronic, remittent or intermittent. The countenance of the patient is generally pale, vacant, and without expres- sion, the look vague and uncertain, and tears are abundantly shed from the slightest causes. The following may be taken as the most striking differences between mania and dementia: In mania there is an incoherence of ideas, but de- pending on too great rapidity of thought and excitement of the intellect- ual powers ; in dementia there is a want of ideas, and the incoherence depends on the loss of the power of connecting them, owing to defect of memory ; volition is lost and the brain seems in a state of collapse. (Es- quirol, Mai. Ment., t. 2, pp. 224 and 232.) In fact, in dementia there is a more or less complete abolition of the moral, intellectual, and voluntary powers ; in mania, and also in monomania, they are in a state of perver- sion. Dementia is often a consequence of these states, and sometimes alternates with them. Idiocy. Imbecility. — Idiocy is the dementia naturalis of lawyers. The term "idiot" is applied to one who from original defect has never had mental power. Idiocy differs from the other states of insanity in the fact that it is marked by a congenital deficiency of the mental faculties. There is not here a perversion or a loss of what has once been acquired, but a state in which, from defective structure of the brain, the individual has never been able to acquire any degree of intellectual power to fit him for his social position. It commences with life and continues through it, although idiots are said rarely to live beyond the age of thirty. (Esqui- rol, Mai. Ment., t. 2, p. 284.) The deficiency of intellect is marked by a peculiar physiognomy, an absence of all expression, and a vague and un- meaning look ; there is no power of speech, or only the utterance of a cry or sound ; there is no will, but the actions of these beings appear to de- pend upon impulse, a power of imitation, or mere animal instinct; they recognize no one, they remember no one, and the mind seems to be a blank. Such is the picture of what may be termed a complete idiot. This state of idiocy is often accompanied with great bodily deformity and en- largement of the thyroid gland (goitre), both in males and females ; it is then termed cretinism. A confirmed idiot may in almost all cases be recognized by the expression or countenance and the form of the skull. Idiocy is not always so complete as this description implies. There is a state, scarcely separable from idiocy, in which the mind is capable of re- ceiving some ideas and of profiting to a certain extent by instruction. Owing, however, either to original defect, or to a defect proceeding from arrested development of the brain as a result of disease, or other causes operating after birth, the minds of such persons are not capable of being brought to a healthy standard of intellect, like that of an ordinary person of similar age and social position. This state is called imbecility; it is nothing more than idiocy in a minor degree. In common language, per- sons laboring under it are often called idiots, but for the sake of precision 712 IDIOCY AND IMBECILITY. in medical language they are more correctly described as imbeciles. (Es- quirol, op. cit., t. 2, p. 28*).) In imbecility the physical organization ditt'ers but little from the ordinary standard ; the moral and intellectual faculties are susceptible of cultivation, but to a less degree than in a perfect man, and even this capacity does not e.^ist beyond a certain point. Imbeciles never attain a normal standard of intellect, and when placed in the same circumstances as other men never make a similar use of their intellectual powers. They can form no abstract ideas, and sometimes their capacity to receive instruction is restricted to a certain subject — as, for instance, arithmetic. Their memory and judgment are limited, although sometimes the former is remarkably strong. They express themselves in a hesitating manner, and differentl}^ from other men ; they require time to perceive the relations of objects which are immediately perceived by sane persons. The degree in which imbecility exists is well indicated by the power of speech. In idiots there is no speech, or only an utterance of single words ; in the better class of imbeciles the speech is often easy and unaffected, while there is every grade between these two extremes. Some have arranged imbeciles in classes, according to their capacity to receive instruction, others according to their power of speech ; but such divisions are practi- cally without value; each case must be judged by itself. The precise boundary between idiocy and imbecility cannot be defined. The major degrees of imbecility approach so closely to those of idiocy that there is no distinction between them, and in a practical view no distinction is re- quired. Idiocy has been here described as that condition in which the congenital effect is not susceptible of being removed by any kind of in- struction ; but many medico-legal writers apply the term " idiot " to one who does manifest capacity to receive instruction, although in a low de- gree. The difference is immaterial so long as the meaning of the word is understood. How are the minor degrees of imbecility to be distinguished from sanity ? This is a question by no means easy to answer, for the reason that sane persons differ remarkably in their mental power to receive instruction, to retain what they have been taught, and to allow them to make a practical use of it in the world for their own benefit. Many persons pass through life and advance in the world who are yet undoubtedly weak-minded, and who have the reputation among all who know them of being so. The truth is, the lowest degrees of intelligence legally constituting sound mind are not separable from the minor forms of imbecility, so far as the moral and intellectual faculties are concerned Idiocy and imbecility must not be confounded with mania and mono- mania. In idiots and imbeciles ideas are wanting, and the power of thought is absent or defective ; in maniacs and monomaniacs the ideas flow freely, but the}^ are perverted, and the power of thought is irregular and uncontrolled. In idiocy and imbecility we do not meet with the hallucinations and illusions which constitute the main features of mania and monomania. Idiocy is much more likely to be confounded with de- mentia, and, indeed, when dementia is confirmed and complete (fatuity) there is no appreciable difference, for in neither state is there any evidence of the exercise of mental power. In idiocy no ideas have ever been formed ; in imbecility they have been partially formed, but arrested ; in dementia they have been more or less completely formed, but have subsequently become entirely obliterated. It is important to remember that in idiocy and imbecility there is no gradual loss or sudden impairment of the mental faculties, as is generally observed in dementia ; the person is what he HEREDITARY TRANSMISSION FEIGNED INSANITY. 71.'] always has been — mentally weak and unsusceptible of any great degree of improvement by instruction. From these remarks it will be perceived that imbecility is a state exist- ing from birth or from childhood — for it is possible that it may supervene from disease after birth, in a child in whom there was no reason to suspect its existence — but it is more common to find the deficiency congenital, Still, the term is often applied to that weakness of the mental powers which takes place in the aged at the close of life, even when the mind has been well developed in maturity. Tims we speak of the imbecility of age ; this is truly nothing more than a state of senile dementia, and to appl}'^ to it the term " imbecility" tends to create confusion. In the first decennial Revision of the Nomenclature of Diseases drawn up by the Royal College of Physicians of London, idiocy is made synony- mous with congenital imbecility, and dementia is made to include acquired imbecility ; imbecility per se having no recognition. It is also stated that cases of monomania should be named according as the prevailing symp- toms are those of mania, melancholia, or dementia. Such, then, are the forms under which insanity or mental aberration may present itself to our notice, and although there are mixed states, as of mania and dementia {incoher^ency), yet it is an important feature in the distinction of mental disorders, to observe that in intellectual insanity the characters presented to us in any given case do not vary materially from those which have been described as peculiar to each of these states. This classification, it must be remembered, is made for the sake of convenience, because by it a medical practitioner may be led to form a safe diagnosis of the real state of mind of a person. It is not recognized in any of the law proceedings connected with the insane; for in these the term tinsoiindness of mind — comprehending lunacy, idiocy, imbecility, and all forms of mental Aveakness — is almost exclusively employed. In adopting this arrangement, a medical jurist must take care not to fall into an error which has been sometimes committed — i. e. of pronouncing a person to be of sound mind, because his case could not be easily placed in any one of these four great divisions of insanity. This woulcl be as serious an error as that formerly committed by some law authorities — namely, of giving restricted and incorrect definitions of lunacy, idiocy, and imbecility, and then contending that whoever was not a lunatic, idiot, or imbecile accord- ing to these arbitrary legal definitions, must be a person of sound mind. Hereditary Transmission. — The hereditary transmission of insanity often presents itself as a medico-legal question in relation to the criminal responsibility of the insane. In Reg. v. Ross Touchet (1844), in which the accused was tried for shooting a man, and acquitted on the ground of insanity, Maule, J., held that evidence that the grandfather had been in- sane might be adduced after it had been proved by medical testimony that such a disease is often hereditary in a family. It was also admitted in Oxford's ease, the prisoner having been tried for shooting at the queen (Law Times, Oct. 26, 1844) ; and since that date it has been admitted in a great number of cases in which insanity was urged as a defence on a charge of murder. This kind of evidence has, however, been frequently rejected. Feigned Insanity. — Insanity is sometimes feigned by persons accused of criminal offences in order to procure an acquittal or discharge. In the first place, when feigning is suspected, it will be proper to inquire whether the person has any motive for pretending to be insane. No sane person 714 FEIGNED DEMENTIA. feigns without a motive. It is neccssar}' to reiuoniber tliat insanity is never assumed until after the commission of a crime and the actual de- tection of the criminal. No one feigns insanity merely to avoid suspicion. In general, as in most cases of imposture, the part is overacted — the per- son does either too much or too little^ and he betrays himself by incon- sistencies of conduct and language which are never met with in cases of real insanity. There is commonly some probable cause to which insanity may be traced, but when the malady is feigned there is no apparent cause ; in this case the appearance of the assumed insanity is always sudden — in th(! real malady, the progress of an attack is generally gradual ; and when the -attack; is really sudden, it will usually be found to be due to some great moral shock or other very obvious cause. We should observe whether for some time previously there has been any marked change of character in the person, or whether his conduct, when he had no interest to feign, presented any of the usual indications of a disordered mind. Some difficulty may arise when fits of eccentricity or strangeness of char- acter are deposed to by witnesses ; but these statements may be incon- sistent with each other, and the previous acts of the person may bear no resemblance whatever to those performed by him in the recently assumed condition. A difficulty of this kind rarely presents itself, since in an im- postor no act indicative of insanity can be adduced for any antecedent period of his life ; it is only after the perpetration of a crime and its detection, that any action simulating the habits of the insane will be met with. In real insanity, the person will not admit that he is insane ; in the feigned state all his attempts are directed to make others believe that he is mad ; and an impostor may be induced to perform any act, if it be casually observed to another in his hearing that the performance of such an act will furnish strong evidence of his insanity. Mania is perhaps more frequently assumed than any other form, be- cause the vulgar notion of insanity is that it is made up of violent action and vociferous and incoherent language; but mania rarely comes on sud- denly, or without some obvious cause. A maniacal patient is equally furious day and night, while an impostor is obliged to rest after his violent exertions. Burrows recommends that close attention should be paid to the expression of the eye. The mobility of the features may be as rapid as the imagination is vivid ; but when every feature may vary, or be kept under control and be steady, the eye will still indicate the erring thought — its expression cannot be easily assumed. There is about the eyes in mania a restlessness which cannot fail to attract attention ; the patient sleeps but little, and the sleep is disturbed ; an impostor sleeps as soundly as a healthy person. The violence of a maniac continues whether he is alone or not, while the impostor acts his part only when he thinks he is observed; hence the imposition may be detected by watching him unawares. The feigning of so-called monomania is a matter of some difficulty, and would be easily susceptible of detection. As in mania, the part would be overacted and an impostor would thus betray himself. Dementia is more easily feigned : in general, this state comes on slowly, and is obviously dependent on organic changes, as old age, apoplexy, paralysis, or hemi- plegia ; or it is a consequence of recurrent mania or monomania. Idiocy and Imbecility could hardly be feigned successfully, because these are states of congenital deficiency ; they must have existed from birth, of which, of course, there would be some evidence. Among modern cases in which dementia was alleged to have been feigned is that of Lady APPEARANCES AFTER DEATH. 715 Moi'daunt. (Mordaunt v. Mordaunt, Divorce Ct., Feb. 1870.) In con- sequence of a confession made by this lady soon after her confinement, that she had committed adultery with certain persons, her husband took proceedings against her for a divorce. At the date at which she was served with notice of the writ, April 30, 1869, it was alleged that she was insane, and from mental incapacity she was unfit or unable to instruct an attorney for her defence. On the part of the husband it was alleged that she was really fit and competent, and that the state of insanity was assumed in order to avoid the exposure of a public trial. The jury, upon hearing a large amount of evidence from medical experts and others, found that this lady was laboring under "mental disorder," and that she was incompetent to give instructions for her defence. On the simulation of insanity, see a paper by Laurent. (Ann. d'Hyg., 1866, t. 2, p. 460.) He advises the complete isolation of the person, with daily watching for a certain time, as a method which seldom fails to detect the imposition, while it cannot injure the really insane. One re- markable circumstance he points out, namely, the influence of feigning Insanity on the feigner. He is of opinion that persons who have for some days or weeks pretended that they were mad have become so in the end. In support of this view he quotes the cases of two sailors who had feigned madness in order to escape imprisonment in the hulks. The imposture was at first successful, but in the end it had an unfortunate result, for they became really mad. An impostor must be ever on the watch that he does not fail in any one point. This creates a great strain on the mind, and as a result of the anxiety attendant on the maintenance of such an imposition at all times and under all circumstances, he may suffer from cerebral exhaustion with its worst consequences. Appearances after Death. — In some cases a medical practitioner may be required to state whether certain appearances found in the brain of a deceased person do or do not indicate the past existence of insanity or im- becility. Such a question is only likely to arise in chronic cases, in which the past existence of insanity from oral testimony may be disputed. (Case of Stulz, Prerog. Court, 1852.) The appearances commonly met with on an inspection of the head may be — thickening of the bones of the skull, close adhesions of the dura mater (the lining membrane), with great congestion of the pia mater, and opacity and thickening of the arachnoid or inner membrane of the brain. There is a general fulness of the blood- vessels of the brain, with remains of old cysts, hardened deposits, or even abscesses in various parts of the cerebral substance. Inferences from the existence of these appearances in the brain must, however, be drawn with caution, because it cannot be said that they necessarily indicate insanit}" ; nevertheless, such chronic changes must be considered as likely to produce greater or less derangement of the mental functions ; but the actual degree in which the impairment is alleged to have existed ought properly to be determined by actions of the deceased during life. But, as Savage has truly said, " One of the greatest difficulties which has ever presented itself to the student of insanity has been the fact that, post-mortem, so little has been found visible to the naked eye. I may say that, with my experience of years, and after seeing many hundreds of post-mortem ex- amination of bodies of the insane, I have met with few coarse changes within the skull, and even with the higher powers of the microscope all that can often be detected may be evidences of change in the nutrition of the connective tissue of the brain." (Insanity, p. 9.) In the case of Roberts v. Kerslake (Warwick Aut. Ass,, 1854, the main 716 LUNACY LAWS. question was whether certain appearances in the brain and its membranes did or did not indicate disease of long standing as well as insanity at the particular date at which a will was made. Conolly and the author con- sidered that the appearances were not inconsistent with the supposition that the testator was sane at the time of making his will. (Jour. Psych. Med., Oct. 1854, p. 573.) CHAPTER XLIII. THE L0NACT LAWS. MEDICAL CERTIFICATES. REGULATION OP L0NATICS AND IDIOTS.— APPLICATION OF RESTRAINT. ILLEGAL IMPOSITION OF RESTRAINT VIOLENCE OF TEMPER. DISCHARGE OF LUNATICS. NULLITY OF MARRIAGE. The legal relations of lunacy are regulated by an executive, at the head of which is the Lord Chancellor, as Judge in Lunacy, who is entrusted with the care and commitment of the custody of the person and estates of lunatics. He acts either alone or jointly with any one or more of the judges of the Supreme Court. The Judge in Lunacy makes orders for the custody of lunatics so found by inquisition and the management of their estates. Under the control of the Judge in Lunacy are two Masters in Lunacy, who must be barristers of not less than ten years' standing. They have to deal with those persons who are found to be lunatic by a Commission of Inquiry, commonly termed Chancery Lunatics. The term Commission of Incjuiry is now substituted for the term Commission in Lunacy, a term which was apt to be confounded with that of Commis- sioners in Lunacy. Acting under the Masters in Lunacy are three addi- tional Chancery Visitors (so that there are five Chancery Visitors), two medical men, and one a barrister of five years' standing. The three Chan- cery Visitors and the two Masters in Lunacy form a board. The Commissioners in Lunacy regulate the aifairs of asylums and supervise such lunatics as are not found to be so by a Commission of Inquiry. They are eleven in number, five of whom, including the perma- nent chairman, are unpaid ; the remainder, three barristers and three physicians, are paid. Public lunatics — i. e. criminal and pauper lunatics — are kept, the former in Broadmoor Criminal Lunatic Asylum, and the latter in the county and borough asylums — a.sylums which every local authority is bound to provide and maintain for the accommodation of pauper lunatics. The local authority may provide asylum accommoda- tion for pauper and private patients, together or in .separate asylums, and may provide separate asylums for idiots. A pauper lunatic cannot be allowed to remain in a workhouse as a lunatic unless the medical officer of the workhouse certifies that he is a proper person to be allowed to remain in a workhouse as a lunatic, and that the accommodation of the workhouse is sufficient for his proper care and treatment. Private lunatics — i. e. lunatics other than those found lunatic by inquisition, pauper luna- tics, and criminal lunatics — may be detained in registered hospitals, licensed houses, county and borough as3lums, or into houses as single patients; but the commissioners may sanction the reception of more than one lunatic in a house under special circumstances and for the interest of a single patient. The Lunacy Act, 1890 (53 Vict., c. 5), is the statute which deals with the detention and care of lunatics and their property; RULES rOR IMPOSING RESTRAINT. 717 and the Idiots Act, 188G (49 and 50 Vict., c. 25), similarly deals with the care, education, and training of idiots and imbeciles. Among the questions which may come before a medical jurist in relation to the subject of insanity are the following-: A practitioner may be re- quired to sa}^ whether a person affected with the malady should or should not be confined in an asylum ; whether he should be deprived of his civil rights by interdiction ; or whether he is so completely cured of his malady as to justify his liberation from confinement. Then, again, medical evi- dence may go far to determine whether a will or deed executed by an alleged lunatic should be set aside ; whether a marriage contract (Hunter V. Hunter, otherwise Edney ; Durham v. Durham, otherwise Milner ; Cannon i'. Cannon) or debt should be annulled ; and lastly, whether a criminal act was committed by a person while laboring under insanity — a question involving either the life, or, according to circumstances, the per- petual imprisonment of a person accused of crime. Application of Eestraint. — By restraint, in a legal sense, we are to understand the placing of attendants to watch or control the actions of an alleged lunatic, or his forcible removal from friends or relatives with or without the confinement of his person by physical force. What are the circumstances which will justify a practitioner in applying restraint to the insane ? The law has given great power in this respect to members of the medical profession, but, owing to certain abuses, the power has been of late years much restricted by various Acts of the Legislature. Most medico-legal writers agree that we are not justified in ordering restraint except when, from symptoms witnessed by ourselves, we have reason to apprehend that the lunatic will injure himself or others in person or property. It is then not sufficient to seek merely for evidence of the ex- istence of some delusion, but to determine how far that delusion, if present, affects the conduct of the person. The real question is whether we have reason to apprehend imminent danger. Unless the delusion is such as to render it probable that the patient or his friends may be injured by his insane conduct, careful superintendence will answer all the purposes of the closest restraint. The act of resorting to restraint on all occasions has been justified on the principle that it may tend to the cure of a patient by removing his. delusion. In this point of view the subject has reference to medical practice, and not to legal medicine. It ma}^ be urged with more plausibility that, by withholding restraint in Incipient cases, mis- chief may be done by the lunatic to himself or others, and that then it will be too late to interfere ; but even here careful superintendence may render close confinement unnecessary. The legal rule for interference with the liberty of a person, which re- straint always implies, may be inferred from the following statement by Stephen, J. : " There is a normal state in which all human creatures act on the same principles, and the general meaning of sanity is that the per- son conducts him.self in this normal manner ; that he is acquainted with the circumstances by which he is surrounded ; that he has objects in view in his actions ; and that he regulates his conduct with reference to them and to the general considerations which aifect matters of that class. (General Yiew of the Crim. Law of England, p. 87, et seq.) It cannot be too strongly impressed on the mind of a medical man that, before he em- ploys the powers conferred upon him by law, to confine a person who is said to be mad, he should well consider what lawyers imply by the term "madness," in a practical sense. As defined by Stephen J., it means conduct of a certain character — not as it is usually interpreted by medical men, a certain disease of the brain the existence of which is speculative, 718 IMPROPER APPLICATION OF RESTRAINT. but one of the effects of which, if present, is to produce such conduct. In examining an alleged lunatic, with a view of determining whether he should or should not be placed in confinement, his conduct must therefore be compared with that of other men, and more especially with his own conduct, in a normal state ; and here, in order to constitute sane behavior, we must look for a generic and not for a specific resemblance. Any de- gree of ignorance, vice, or folly is perfectly consistent with sane conduct in a legal sense. The power of restraint is not intended to be applied to such cases as these ; they are properly under certain circumstances amen- al)le to the criminal law. An ignorant, vicious, or foolish man may do a great amount of mischief, but he has a liiierty of choice and freedom of action ; and if from folly or depravity he selects a bad course, he is not therefore insane, but is as much responsible for his actions as a sane man w^ho prefers a good course. Such a man should not be treated as a lunatic or confined in an asylum under a medical certificate. It may be sometimes difficult to define the line which separates acts of depravity from those of insanity ; but medical men have not been in many cases sufficiently cau- tious in endeavoring to make a distinction. Lawyers look closely to con- duct as the chief ground of interference with personal liberty; the conduct must be such as to be inconsistent with the usual behavior of a normally sane person placed under similar circumstances. In examining a person proposed to be placed under restraint, we must take care not to confound acts depending on violence of temper with those which proceed from unsoundness of mind. A man may have always had a violent temper, subject to occasional fits of aggravation ; but this con- dition must not be mistaken for mental disease. In order to determine whether the acts of a person be due to violent temper or insanity, it will be proper to ascertain what may have been his natural habits. The great feature of insanity is change of charade?^ — a man who is really insane is different from what he has previously been ; but it may be proved of a violent-tempered man that he has always been the same. The greatest abuses of the restraint system have been chiefly observed in respect to insane persons who have been forcibly imprisoned and confined in asylums, because they entertained some absurd delusions, over which, however, they had so great a power of control as to render it somewhat difficult even for a shrewd and experienced examiner to detect them. When at last, after many hours' cross-examination, the existence of a delusion has been made apparent, the result has been looked upon as furnishing matter for triumph and exultation; but, as Conolly justly remarks, one point in these cases appears to have been wholly lost sight of, namely — What possible injury could have resulted to the patient or his friends from the existence of a delusion over which he had such complete control and mastery as to render it a most laborious task to obtain any evidence whatever of its existence ? It may be freely admitted that where delusion does exist, there is reason to suppose that the mind must be more or less disordered in all its facul- ties ; but such patients require only close watching, not a rigorous impris- onment in an asylum. The greatest danger is to be apprehended in those cases in which there is the least power of self-control. The forcible re- moval of a person from his or her home to a lunatic asylum, unless the circumstances are of such a nature as to render immediate interference necessary on the ground of admitted or proved insanity, is unjustifiable in law and may involve those concerned in the removal in a serious re- sponsibility. In cases of incipient insanity, such interference would not be legally justifiable and a practitioner placing restraint on a person so situated, might find himself a defendant in an action for damages. MECHANICAL RESTRAINTS. 719 In Hill V. Philip, the judges decided that a medical man, when called upon to give a certificate for the confinement of a person, may act uj)on the directions of a wife, but that the directions must be considered as only guiding his judgment and not as absolutely dictating to him and justifying his proceedings ; that he is still bound to exercise his own professional knowledge and discretion, so far as to refrain from doing anything or adopting any course which might be injurious to the patient. A medical man is, therefore, ultimately responsible for his treatment of a lunatic: no person can give him authority to do that which is not in accordance with medical practice or the necessity of the case. (For a report of this case, and some judicious remarks upon the decision, see Legal Exam., 1852, pp. 307, 318.) In Scott v. Wakem (Guildford Sum. Ass., 1862), a medical practitioner was sued for damages in placing under restraint and without necessity or authority, a man laboring under delirium tremens. In this case the wife denied that she had given any authority for interference, and on this point her evidence conflicted with that of the defendant, the medical man whom she had consulted. Fortunately, the facts proved were adverse to her statement. In future cases of this kind, it would be desirable for a medical man to bear in mind that he does not exceed what is necessary, proper, or usual for the treatment of the person ; and on this he must always exercise his own judgment, irrespective of the opinions or suggestions of others. Medical men, even w^hen acting most conscien- tiously in the discharge of their duties, cannot hope to escape harassing and vexatious actions when they are called upon to deal with cases of delirium tremens. The peculiarity of this disorder is that, with the cause, it may soon disappear and thus medical evidence may be easily procured to show that the person was in a sane state of mind and not in a condi- tion to justify any interference with his personal liberty, either a short time before or after the imposition of restraint. The series of decisions in favor of Mrs. Weldon in her actions against Semple for certifying insanity, and Winslow for receiving her into his private asylum on the representation of her husband, should convey a caution to medical men not to j)lace undue credence in the statements of interested relatives as to the insanity of an individual. As Blandford per- tinently remarks, madmen have an unpleasant way of revealing family secrets, and it is convenient to call such I'evelations delusions; and it is well, if possible, to derive independent information from others who are not primarily concerned in the patient, rather than from interested relatives. In order to provide for the protection of lunatics and for the prevention of undue violence or frequency in the application of restraint, the law compels the keepers of asylums to certify each case or of each occasion on which any mechanical restraint is resorted to. An omission to make this entry is a misdemeanor; and at the Maidstone Lent Ass., 1851, two medical men were convicted and fined for placing patients under restraint without having made the entries required by law. (Reg. v. Maddock ; see also Lond. Med. Gaz., vol. xlvii. p. 556 ; and a paper on the " Use and Abuse of Restraint," in the Jour. Psych. Med., 1849, p. 240.) By a recent enactment (53 Yict., c. 5, s. 330), medical men and others, acting bona Jide in carrying out the lunacy laws, are protected against vexatious prosecutions. \_3fechanical Restraint. — There is a divided sentiment among medical superintendents of ho.spitals for the insane in Great Britain, the con- tinent of Europe, and the United States of America, as to the propriety or necessity of the use of mechanical restraint in the care and treatment of the insane. It must be conceded that leading and prominent asylums 720 MECHANICAL RESTRAINT. for the insane have been for the past twenty years, and now are, success- fully conducted without any recourse to luechanical restraints at all. The testimony of such superintendents as Dr. William (Jrange at Broadmoor, Dr. Heiiry Maudsley, Dr. J. C. Bucknill, Dr. Richardson, Dr. William Connolly, the elder Tuke in England ; of Dr. Alice Bennett at Norris- town Asylum, Pa., Dr. AVni. B. Fleming at Indianapolis, Dr. P. M. Wise at Willard Asylum, Drs. Blumer and Pilgrim at Utica, Dr. Daniel Clark at Toronto, the late Dr. P. Bryce, of the Alabama State Hospital for the Insane, and of scores of others in charge of asylums, is given freely and without reserve, that they have not in a long experience found it at all necessary to resort to mechanical restraints in what they deem to be the best management of the institutions under their supervision. On the other hand there are superintendents of asylums, both in England, uj)on the con- tinent of Europe, and in the American States, who have not been able to successfully conduct the institutions vinder their charge without resort to mechanical restraint, and who still practise it, and believe in its utility and efficacy ; and whose purity of motive and honesty of purpose can no more be questioned thau could those of the physicians in charge of British asylums, when Connolly and the elder Tuke introduced the new system in England, or those in France when Pinel knocked off the chains of the in- sane at the Bicetre, or in Belgium when Guslain introduced the plan of kindness, gentleness, tenderness, and even affection, as means of control of the insane, rather than the force and violence which accompanies restraint. The law has not kept pace with the evolution of advanced medical thought in this direction. The law only authorizes a superintendent to order an insane patient under restraint when from sxjmptoms tvitnessed by himself he has reasons to apprehend the lunatic will injure himself or others in person or property. The real question would be. Is there immi- nent danger?" (Hill o). Philip, Legal Examiner, 1852, pp. Z07 -IS, supra ; Scott V. Wakem, Guilford Sum. Ass. 1862, supra.) In any American State, if an action was brought by or in behalf of an insane patient confined in an asylum against a medical superintendent for the use of mechanical restraint, the issue would be whether the restraint used was absolutely necessary to prevent the lunatic from injuring himself or others, and the burden of proof would be on the physician to show that it was, and that the danger was so imminent that he was obliged to resort to the restraint as a necessity. This would be a question for a jury to decide, and it is quite safe to say that mechanical restraints, as applied, coming under such tests before juries in courts of law, would, in a large number of instances, be decided against the physicians. For, while the courts would hold that they had the legal right to employ it, when indis- pensably necessary, in cases of immediate danger, juries would decide that it was not necessary, and mulct the physician in damages, so jealous is the law of the right of the citizen, and the insane man is not, by his misfortune, deprived of his legal rights. The recent trial of Dr. Wiederhold, at Kassel, in Germany, for resorting to light flagellations of a patient in his charge, suffering from hysteria, is quite in point. She had indulged in cry- ing and screaming without cause, so as to disturb the house and other patients. Every effort by the physician to quiet her had proved futile, and he had resorted at last to corporal chastisement. Dr. Wiederhold exercised his best judgment and in the exercise of his discretion resorted to this means to cure her of her morbid desire to attract attention. Prof. Tuszeck, of Marburg, testified as an expert, " that it was scientifically inadmissible to use corporal chastisement in the treatment of nervous patients." Prof. Pellman, superintendent of the lunatic asylum at Bonn, testified "that he I MECHANICAL RESTRAINT. 721 was personally opposed to the therapeutic use of corporal chastisement, that it was forbidden absolutely in the German State asylums, but that certain medical men approved of its use." The public prosecutor pressed the case and denied the existence of any extenuating circumstances. The court took the same view, and Dr. Wicderhold was sentenced to three months' impris- onment. No one who knows Dr. Wiederhold can doubt that he acted according to his best judgment and for what he believed to be the ultimate good of the patient, but the question of personal rights is higher than the mistaken and erring judgment of superintendents of asylums, or of medical men, no matter how conscientious. (Vol. III. Bell's Medico-Legal Studies, p. 142 et seq.) In England the whole subject has been settled by legislation and by the new regulations of the Board of Lunacy Act of 1890, section 40, which provided as follows : (1.) Mechanical means of bodily restraint shall not be applied to any lunatic unless the restraint is necessary for purposes of surgical or medical treatment, or to prevent the lunatic from injuring himself or others. (2.) In every case where such restraint is applied a medical certificate shall, as soon as it can be obtained, be signed, describing the mechanical means used, and stating the grounds upon which the certificate is founded. (3.) The certificate shall be signed, in the case of a lunatic in an institution for lunatics or workhouse, by the medical ofiicer thereof, and in the case of a single patient, by his medical attendant. (4.) A full record of every case of restraint by mechanical means shall be kept from day to day ; and a copy of the records and certificates under this section shall be sent to the Commissioners at the end of every quarter. (5.) In the case of a work- house, the record to be kept under this section shall be kept by the medical officer of the workhouse, and the copies of records and certificates to be sent shall be sent by the clerk to the guardians. (6.) In the application of this section 'mechanical means' shall be such instruments and appliances as the Commissioners may, by regulations to be made from time to time, determine. (7.) Any person who wilfully acts in contravention of this section shall be guilty of a misdemeanor." The Regulation now in force as to all institutions in England and Wales is as follows : " Regulation. — In pursuance of sub-section 6 of the above section of the Lunacy Act, 1890, the Commissioners in Lunacy, by this Regulation under their common seal, do hereby determine that ' mechanical means of bodily restraint' shall include all instruments and appliances whereby the free movements of the body or any of the limbs of a lunatic are restrained or impeded, but that the following instruments and appliances only shall be made use of for such purpose : 1. A jacket or dress, laced or buttoned down the back, made of strong linen, with long outside sleeves fastened to the dress only at the shoulders, and having closed ends to which tapes may be attached for tying behind the back when the arras have been folded across the chest. 2. Gloves without fingers, fastened at the wrists with buttons or locks, and made of strong linen or chamois leather, padded or otherwise. 3. If the continuous bath be employed, the use of a cover to the open bath, with an aperture therein for the patient's head, shall be deemed to be mechanical means of restraint. 4. The wet or dry pack. If, and when, either is used, the patient shall be swathed in sheet and blankets only, the outer sheet being, if necessary, sewn or pinned. No straps or ligatures of any kind shall be used, and the patient shall be released for necessary purposes at intervals not exceeding two hours. 5. Sheets or towels "when tied or fastened to the sides of a bed or other object. When these 46 722 MECHANICAL RESTRAINT. are used only for the purpose of forcible feedino;, and merely held by atten- dants, and not tied or fa.-Jtened, their use shall uot be considered to come under the head of mechanical restraint. " It is essential to the safe employment of any of these forms of restraint, except No. 2, that the patient be visited frequently by a medical officer, that he be kept under continuous special supervision by an attendant, and that under no circumstances he be left unattended ; and is hereby so ordered. The Commissioners direct that at each visit of Commissioners or a Commis- sioner to an asylum, hospital, or licensed house, or to a single patient, all instruments and mechanical appliances which may have been employed in the application of bodily restraint to a lunatic since the last preceding visit, be produced to the Visiting Commissioners or Commissioner by the superin- tendent, resident medical officer, or resident licen.see, or the person having charge of the single patient. It will be seen that the section requires that in every case where mechanical restraint is applied, a medical certificate describing the mechanical means used, and stating the grounds upon which the certificate is founded, be signed in asylums and hospitals by the medical superintendent, in licensed houses by the resident or visiting medical prac- titioner, in workhouses by the medical officer, and, in the case of single patients, by the medical attendant ; that a full record of every case of restraint be kept from day to day ; and that a copy of such records and certificates be sent to the Commissioners in Lunacy at the end of every quarter. In framing this Regulation, in which they have defined the ' mechanical means ' which may alone be used in the imposition of restraint, the Commissioners in Lunacy have merely discharged the duty cast upon them by the enactment quoted above ; and they desire to guard themselves most strictly against the supposition that they have thereby given any greater countenance to the employment of this form of treatment than they have hitherto shown. While recognizing, as the enactment recognizes, the pos- sible occurrence of cases in which its employment may be necessary and consistent with humanity, they remain of opinion that the application of mechanical restraint should always be restricted within the narrowest possible limits, that it should not be long continued without intermission, and that it should be dispensed with immediately that it has effected the purpose for which it was employed. This Regulation shall come into oper- ation on the 1st day of July, 1895, on and from which day the Regulation of the 9th April, 1890, shall cease to have effect, and a copy shall be in- serted at the beginning of every register of mechanical restraint. Sealed by order of the Board, G. Harold Urmson, Secretary. — 19 Whitehall Place, London, S. W., the 17th day of April, 1895." The Commissioners disclaim giving any greater countenance to the employment of this form of treatment than they had hitherto shown, and while they acquiesce in the Act as recognizing the possible occurrence of cases in which its employment may be necessary and consistent with humanity, they assert that " they remain of opinion that the application of mechanical restraint should always be restricted within the narrowest pos- sible limits, that it should not be long continued without intermission, and that it should be dispensed with immediately that it has effected the purpose for which it was employed." This settlement of the agitation in England by legal action and regulation of a vexed question, makes concessions to those superintendents who lack the ability to manage the insane without it, such regulation being intended to prevent the abuse of the use of mechani- cal restraint by those who deem its use necessary. (Bulletin Med. -Legal Congress ; Med.-Legal Jour., vol. xiii. p. 289 eiseq. ; Bell's Med.-Legal Studies, vol. iv.) 1 CERTIFICATES OF INSANITY. 723 It would be difficult if not impossible to legalize such treatment in the American States, so strong is the public sentiment against authorizing the use of mechanical restraints by superintendents upon the insane, except in surgical cases, where the operating surgeon would not discriminate between a sane or an insane patient, taking the same precautions for placing and securing the patient, and looking solely to the success of the operation itself The public sentiment is quite as strong against its use in England as in America, but the Act of 1890, subdivision 6 of p. 40, authorizes the Board to " designate the instruments to be applied," but it will be observed that by subdivision 1 of section 40 it is especially provided that mechanical restraint shall not be applied " unless the restraint is necessary for purposes of surgical or medical treatment or to prevent the lunatic from injuring himself or others," and by subdivision 7, p. 40, it is still made a misdemeanor to resort to mechanical restraint for any other purpose. The Commissioners attempt out of deference to public sentiment in England to qualify the effect of their action. The vice of their regulation is, that it gives to the super- intendent a power to order restraint when he thinks it necessary ; when in fact it might not be at all necessary, and he be entirely mistaken as to its necessity. In any case occurring where such eminent authorities as Maud- sley or Orange would not deem it necessary, and would not resort to its use, an inefficient, an incompetent superintendent might honestly and conscien- tiously regard it as necessary ; and the language of the regulation would leave the lunatic without protection or redress in case the superintendent was honestly mistaken. No such power would ever be conferred by law on a superintendent in American hospitals for the insane. It is remarkable that the English Lunacy Board in the views they have expressed and are known to have entertained, should have used such broad language as " nec- essary for medical treatment " to come within the purview of their regula- tion. No case of abuse of restraint has arisen since the adoption of the new regulations, or is likely to arise, that an incompetent superintendent might not, in good faith, have deemed necessary; and the action of the Board is an unfortunate step backward in lunacy reform, in the care and treatment of the insane in England and Wales.] Certificates of Insanity. — It will here be necessary to state the circum- stances which require the attention of a practitioner when he is called upon to sign a certificate of insanity, whereby a person may be placed in confinement in an asylum. The act which specially refers to this subject IS the 53 Vict., c. 5. This act is a consolidation of the statutes on the regulation of the care and treatment of lunatics. Its provisions are very stringent, both with respect to medical men who sign certificates, and those who keep asylums for the reception of lunatics. Reception of Lunatics. — It will here be necessary to state the course oi procedure necessary to procure the reception of a lunatic into an asylum, iu accordance with the provisions of the Lunacy Act, 1890 (53 Vict.» c. 5). In cases of urgency, where it is expedient, either for the w^elfare of a person (not a pauper) alleged to be a lunatic, or for the public safety, that the alleged lunatic should be forthwith placed under care and treatment, he may be received and detained in an institution for lunatics, or as a single patient, under an Urgency Order, made (if possible) by the hus- band or wife, or by a relative of the alleged lunatic, accompanied by one medical certificate (see below). An urgency order remains in force for seven days from its date, and must be accompanied by a Statement of Particulars. If it be desirable to detain the patient more than seven days, a petition must be presented and a reception order be obtained, as below. 724 RECEPTION OF LUNATICS. Should the caso not be urfront, a person, not boin": a pauper or a lunatic so found l»y incjuisition, cannot be received and detained as a lunatic in an institution for lunatics, or as a single ])atient, unless under a Ileception Order made by the judicial authority, obtained upon a |)rivate application by PtHition, presented, if possible, by the husband or wife, or by a relative of the alleged lunatic, accompanied Ijy a statement of jiarticulars as when an urireney order is given, and hvo medical certijicalea. These certificates must each be made and signed by a registered medical practitioner, each of whom has personally examined, separately from the other, the alleged lunatic not more than seven clear days before the date of the presentation of the petition. In the case of an urgency order, the personal examination of the alleged lunatic must be made not more than two clear days before his or her reception. The two (or seven) clear days do not include the day of examination and of reception or making of the order. In all other cases where two medical certificates are required, the examination of the alleged lunatic must be made not more than seven clear da3^s before the date of the order for reception made by the judicial authority. The Judicial Authority is defined (see 9) to be a justice of the peace specially appointed for the purpose, or a judge of County Courts, or mag- istrate, having respectively jurisdiction in the place where the lunatic is. Lists of the judicial authorities are pul)lished. Ul)on the presentation of the petition the judicial authority considers the allegations of the petition, the statement of particulars, and the evi- dence of lunacy appearing by the medical certificates, and whether it is necessary for him to see and examine the alleged lunatic ; and if he is satisfied that an order may properly be made forthwith, he makes it. If not satisfied he appoints a time, not more than seven days after the pre- sentation of the petition, for its consideration ; and meantime he may make inquiries. He may also visit the alleged lunatic, if not satisfied with the evidence of lunacy appearing by the medical certificates. Here it is proper to remark that in a medical certificate of the prescribed form the medical practitioner — who must be in actual practice — states that he forms his conclusions (a) on facts indicating insanity observed by himself at the time of examination, and (6) on facts communicated by others. More- over, one of the medical certificates must, if possible, be that of the ordinary medical attendant of the alleged lunatic. When the petition is considered, this is done in private, and no one ex- cept the petitioner, the alleged lunatic (unless the judicial authority shall in his discretion otherwise order), any one person appointed by the lunatic for that purpose, and the persons signing the medical certificates, is allowed to l)e present except with the leave of the judicial authority ; and all ex- cept the alleged lunatic and his nominee are bound to secrecy. The judicial authority may dismiss the petition, giving his reasons to the petitioner in writing, and send a copy to the Commissioners; or he may adjourn the consideration for not more than fourteen days; or he m.ay make Xha Re- ception Order, on the strength of which the lunatic may be admitted into an asylum, or be received into a house as a single patient. The procedure in the case of a pauper is different. Either a medical officer of a union having knowledge of a pauper deemed to be a lunatic and a proper person to be sent to an asylum gives notice thereof to the relieving officer, who when he receives such notice or has knowledge of an alleged pauper lunatic living within his district gives notice within three days to a justice having jurisdiction in the place where the pauper resides; or, in the case of a wandering lunatic, a constable or relieving officer apprehends him and takes him before a justice. The justice belore RECEPTION OF LUNATICS. 725 whom an alleged wandering lunatic is brought, or who receives notice of an alleged pauper lunatic from the relieving officer, then calls in a medical practitioner, who examines him, makes inquiries, and if he certifies to the individual's insanity the justice makes an order {Order for Beception of a Pauper Lunatic or Lunatic wandering at large), which is accompanied b}' a Statement of ParticidarH signed by the relieving oflQcer. A person found lunatic by inquisition may also be detained in an asylum or received into a house as a single patient ; also a lunatic who has been certified by a medical man at the instance of the Commissioners. We thus see that lunatics may be admitted into an asylum — 1. Under an Urgenci/ Order made (if possible) by a relative, a State- ment of Particulars, also signed (if possible) by a relative of the lunatic, and one Medical Certificate. 2. After the presentation of a Petition made (if possible) by a relative of the lunatic, a Statement of Particulars signed (if possible) by a rela- tive, two lledical Certificates, and an Order for Beception made by a justice, 3. In the case of a Pavper or a Wandering Lunatic, on a Beception Order made by a justice at the instigation of a relieving officer, and a Statement of Particulars also signed by the relieving officer, and one Medical Certificate. 4. When found lunatic by inquisition {Chancery Lunatics). 5. In the case of non-paupers, on a Summary Beception Order where a constable or relieving officer lays information before a justice on oath, and two 3Iedical Certificates. Apparently no statement of particulars is required in this case. 6. When the lunatic has been visited by the Commissioners, and one Medical Certificate has been obtained at their instance Single patients may be received when found lunatic under the above headings Nos. 1, 2, and 4, but not those so found under headings Nos. 3, 5, and 6. It cannot be too clearly understood that a lunatic cannot be legally de- tained except by judicial order, and in either a licensed asylum, a licensed hospital, a licensed house, or as a single patient ; and that ail lunatics other than those found lunatic by inquisition, are under the control of the Commmissioners. The proceedings in the case of Chancery Lunatics are much simplified, and the cost of an Inquisition reduced by the recent statute above referred to. A jury can be dispensed with and the Inquisition held by the Mas- ters in Lunacy. An 2irgency order remains in force for seven days from its date, or, if a reception order is pending, then until the petition is finally disposed of. It is manifest that the detention of a lunatic under an urgency order is only a preliminary to the regular procedure by petition and reception order made by a judicial authority on two fresh medical certificates. A reception order is not of force for a longer period than one year. It must then be renewed for two years, and after that for three years. If the lunatic has not been seen by the judicial authority before being detained under a reception order, he is entitled to be seen by a justice, and notice must be given after his reception that he is so entitled, unless the medical officer certifies that such interview would be prejudicial. It is beyond the scope of this work to enter into the subsequent details as to the treatment and discharge of lunatics; and for these the reader is referred to the Lunacy Act, 1890, a statute which should be in the hands of every medical practitioner for reference. [In the American States this 726 IDIOTS AND IMBECILES. subject is regulated by the statutes of the several States, and there is no general or universal rule.] Idiots and imbeciles are dealt with by a distinct enactment, the Idiots Act, 188G (41) and 50 A^ict. c. 25). They are received into registered hos- pitals and licensed institutions (not being asylums for lunatics) under one medical certificate, which must state that the person to be received is an idiot, or imbecile, and is cajmble of receiving benefit from the Institution. This must be accompanied by a statement of jyarticulars. No petition or judicial order for reception is necessary. Institutions for idiots and im- beciles are regulated and controlled, like lunatic asylums, by the Commis- sioners of Lunacy. A medical practitioner must not be too ready to lend himself to the signing of certificates for the confinement of persons who may be laboring under harmless delusions. In violent mania, or in monomania with a homicidal or a suicidal propensity, there can be no doubt of the propriety of applying some degree of restraint, for here the necessity is imminent. If a remarkable change has suddenly taken place in the character of a per- son ; if he has become irritable, outrageous, or threatened personal vio- lence to any one ; or if he has recklessly endangered the interests of him- self and family — he is undoubtedly a fit subject for confinement. The more he approaches to this condition the less difficulty we shall have in coming to a decision, and in a really doubtful instance there will be no impro- priety in employing temporary restraint; since, although the person is thereby deprived of liberty, it is better that this should happen than that he or his friends should incur the risk of suffering severely by his insane conduct. It is obvious from the terms of the Act that one person cannot sign a certificate as a substitute for another, and yet there have been several in- stances of its violation under these circumstances. In 1855 a medical assistant was committed for trial because he had signed the name of the surgeon with whom he was living to a certificate of insanity for the con- finement of a pauper lunatic. There was no doubt about the insanity of the person, and the plea urged in defence Avas that the surgeon whose name was thus forged was in ill health and had given the assistant an au- thority to sign papers for him. This, however, wa^ no justification for a violation of the terms of the Act ; the Avords of the certificate are so explicit on this point that no reasonable person can have any doubt about their meaning. In Reg. v. Ogilvy, C. C. C, Sept. 1872 (Lancet, 18t2, ii. 354, 467, 499), the defendant was fined fifty pounds for unlaw- fully signing a medical certificate by representing that he was a registered medical practitioner when his name was not on the register. In another case, Avhich occurred in 1872, proceedings were taken against a medical man under the following circumstances : He signed a certificate for the confinement of a woman really a lunatic, stating that he had seen and personally examined her on Aug 9, 1872, although he had not seen her since March, 1859. Further, it was proved that the certificate Avas signed on Sept. 10, but dated Aug. 9. The medical man pleaded guilty and was fined. These glaring examples of a departure from the explicit terms of the Act relating to lunatics should convey a caution to medical men that they cannot with impunity infringe the strict letter of the law. As ignorance of the laAV is not allowed to be an excuse for its violation, so a medical man, unless acquainted with all the particulars above men- tioned, may easily subject himself to a prosecution or a civil action ; and he is not likely to be spared the disgrace and mortification attendant upon either should it happen that the case is of a doubtful nature. The law \ SPECIFICATION OF FACTS INDICATIVE OF INSANITY. 727 expressly requires from each medical man a separate visit, a separate per- sonal examination of the alleged lunatic, and a separate medical certificate setting forth the special fact or facts (whether observed bv him.self or derived from the information of others) upon which his opinion is based. Oonolly has shown that there are objections to the severity of restrictions regarding these certificates (Jour, of Med. Sci., 18G1, p. 121), but several recent cases have proved that they are not even strong enough to prevent sane persons from being wrongfully sent as lunatics to asylums. Specif cation of Facts. — It will be observed that every medical practi- tioner signing a certificate of insanity is requested to specify the facts upon which his opinion isfoy^med, and whether such facts are derived from his own observation or from the information of any other person. Medical men have had some difficulty in performing this duty, i. e. in assigning the fact or facts upon which their judgment of the insanity of a person was based. (Lond. Med. Gaz., vol. xxxvi. p. 1434 ; and vol. XXX vii. p. 485.) What will constitute the description of a fact to render a certificate valid ? This important question was raised in the case of Shuttleworth. (Queen's Bench, Nov. 184T.) An application was made for the discharge of a lunatic on the ground that the medical certificates did not set forth i\\Q facts from which the opinion of those who signed them was derived. In one the medical man stated that the lunatic labored under a variety of delusioi}s, and that she was dirty and inde- cent in the extreme ; in the other the certifier stated that he had formed his opinion from the conversation which he had that day had with her. It was contended that the statement in the first certificate was not so much a fact as a conclusion drawn from other facts which ought to have been mentioned in the certificate itself. Lord Denman in giving the judgment of the court held that the certificates were valid — that it was not necessary to have all the delusions of an insane person stated in a certificate. The statement that the lunatic was dirty and indecent in the extreme was pKma /oc^e sufficient to justify the imputation of insanity, even if the certificate did not state that the patient labored under a variety of delusions. The allegation that the opinion respecting the existence of insanity was founded upon a conversation with the alleged lunatic was also sufficient to render a certificate valid. (Lond. Med Gaz., vol. xxxviii. p. 932 ; also Law Times, Nov. 1846, p. 145.) They, therefore, refused to allow the discharge of the lunatic. The judgment was given by Lord Denman, and was concurred in by those eminent judges — Erie, J., Wight- man, J., and Coleridge, J. Patteson, J., dissented to this extent: he thought a conversation had with the lunatic could not be received as the statement of a fact. The judgment might have been formed upon many sufficient facts, but the surgeon had not condescended to state what those facts were. This question of the sufficiency of " a conversation to constitute a 'fact' " in drawing up a medical certificate was raised in a case where Batteson, having duly examined an alleged lunatic, stated in his certifi- cate as a " fact" indicative of her insanity, " from the conversation I have had with her," following the decision in Shuttle worth's case, and using the same language. He quoted a former edition of this work as his authority, but the Commissioners in Lunacy refused to admit this case as a precedent, and required that some fact or facts apart from mere conversa- tion should be distinctly stated. It would therefore appear that in order to satisfy the Commissioners a medical man must state some " fact," i. e. some act or deed on the part of the alleged lunatic, on which his opinion is based. The Court of Queen's Bench regarded a certificate based on 728 CERTIFICATES OF INSANITY. "conversation" only as a substantial although not a literal compliance with the terms of the Act. Lord Donman thought that it would he mon- strous to have all the delusions stated upon the document. Many of them were indecent and many I)lasphenious. In spite of this reasonable objec- tion to entering into the details of a "conversation," it is now clear that nothing less than this will satisfy the Commissioners in Lunacy. A medical man, therefore, in drawing up a certificate should insert those parts of the conversation on which he relies, as well as a statement of any fact or facts in reference to habits or demeanor which in his jud.ument may indicate unsoundness of mind. " Facts indicating insanity observed by myself" are little appreciated or even understood by many medical men who are legally empowered as registered members of the profession to sign these certificates. The facts are frequently stated in a loose and careless manner, showing a complete misapprehension of their meaning. What is really required by the law is a statement of facts observed or witnessed by the medical man himself, which would carry conviction to the mind of any non-professional man reading it, that the person to whom the statement referred was of unsound mind. A medical man should in all cases avoid giving as a fact indicating insanity any delusion which might in reality have some foundation in truth. With respect to the second requirement of the statute — namely, " Facts communicated by others " — it may be observed that, although these do not supersede the facts observed by the medical man himself, they are of great importance in throwing light upon the propensities or habits of th« patient, and thus serve as a guide for treatment, A medical man must take care to draw a clear distinction between the facts observed by him- self and the facts communicated to him by others, and avoid such vague expressions as that he " thinks " and " believes," etc. As every medical certificate, although accepted by the Commissioners in Lunacy, may become at a future time a subject of close and hostile criti- cism in a court of law, a medical practitioner should be fully prepared to justify the use of the terms which he has employed. It is therefore desir- able that he should studiously avoid any misstatement or exaggeration of the symptoms. One of the facts cited as indicative of insanit}^ in an old lady was that she kept a cockatoo. In the case of Davies, Lord Brougham elicited from one of the witnesses, as a fact upon which he relied to indicate insanity, that, when asked the question, the alleged luna- tic did not know how much money he had in his pocket. Another relied upon the fact as indicative of a weak mind, that he said he preferred see- ing the people returning from Epsom races rather than the racing on the course. Vague and trivial facts, which do not indicate insanity, naturally tend to produce a feeling in the minds of a jury the very reverse of that for which they are brought forward. Thus in this case, although there could be no doubt, from what subsequently occurred, that Mr. Davies was a lunatic and a fit and proper person to be placed under restraint, yet the result of a skilful cross-examination in bringing into prominence the weak- ness of the facts on which the medical witnesses relied to establish in- sanity had such an influence with the jury that they returned a verdict in favor of the lunatic, and for a time he was considered as the unhappy victim of an unjust persecution on the part of his relatives. A medical man, certifying to the insanity of a gentleman who was at that time un- doubtedly insane, had stated, as facts observed hy himself, that "his (the patient's) habits were intemperate, and that he bad squandered his prop- erty in mining speculations." But on cross-examination he was obliged to confess that the only act of intemperance he had actually observed was DISCHAKGE OF LUNATICS. 729 the patient's drinking one glass of beer, and that the squandering of property was the loss of what was to him a mere trifle in a mining specu- lation, which eventually turned out to be a very good one. (Millar's Hints on Insanity, 18G1, p. 187.) Counsel properly hold a medical practi- tioner strictly to the common and accepted meaning of the words he uses. If strong points are not forthcoming, the proof of insanity must fail. "Weak points generally show a weak case, and should never be brought forward or employed by a prudent witness. A medical man is not compelled to take upon himself the responsible duty of signing certificates of insanity ; but if he does undertake it, he must perform it with reasonable care and ordinary skill. If he certifies that a person is laboring under delusions, he must take care that he under- stands the meaning of the term and what are the delusions; and admit- ting that he is correct in believing from his own observation that they exist in the mind of the patient, it must be remembered that, in order to justify restraint or imprisonment in an asylum, the law looks always to the immediate influence of these delusions upon conduct. In reference to medical responsibility, the following observations were made by a judge in the case of Hall v. Semple (Q. B., Dec. 1862) : " The true ground of complaint is the negligence of the defendant and the want of due care in the discharge of the duty thrown upon him ; and I think that if a person assumes the duty of a medical man under this statute, and signs a certifi- cate of insanity which is untrue, without making the proper examination or inquiries which the circumstances of the case would require from a medical man using proper care and skill in such a matter — if he states that which is untrue, and damage ensues to the party thereby, he is liable to an action, and it is to that I desire to direct your particular attention. In point of law, if a medical man assumes under this statute the dut}' of signing a certificate, without making that due and proper examination which under such circumstances he ought to make, not in the exercise of the extremest possible care, but of ordinary care, so that he is guilty of culpable negligence and damage ensue, then an action will lie against him, although there may have been no improper motive, and the certificate may not be false to his knowledire." In this case the jury found a verdict for the plaintiff' — that the certificate was untrue in effect, and that it had been signed without proper examination and inquiries and without probable cause. This, and the more recent actions of Mrs. Weldon against Semple and Winslow, convey a .severe caution to members of the medical profes- sion ; and also these latter actions convey the further caution that a medi- cal man should not sign a certificate at the request of the proprietor or superintendent of the asylum into which the supposed lunatic is to be admitted, nor receive a fee of unusual amount for signing a certificate. Discharge of Lunatics. — In forming an opinion relative to the propriety of discharging a person who has once been confined as a lunatic in an asy- lum, it is proper to examine the particulars of his case with the same cau- tion as if the object were to confine him for the first time. Experience shows, in reference to the criminal lunatics confined under State supervi- sion, that there are strong reasons for their detention. In 1877, two men were readmitted, after their discharge as cured, on account of their having repeated the oifences of which they had been previously convicted. The question of liberation is commonly restricted, like that of restraint, to cases of mania and monomania. It may so happen that the person has a lucid interval at the time of examination, in which case it will be necessary to make more than one visit. One who has been guilty of a heinous 730 DISCHARGE OF LUNATICS — NULLITY OF MARRIAGE. crime like murder shoiikl never on any pretence be discharged. There are often long lucid intervals in homicidal mania, and it is impossible to be certain tliat the disease is entirely removed. Instances have occurred in which persons who had been confined on account of acts of murder, and liberated on apparent recovery, have soon after their liberation murdered a wife or child, and have been again tried and sent to an asylum. Yet it appears to be the custom at Broadmoor to discharge, on their apparent recovery, patients who have been guilty of murder. A quiet and orderly manner maintained for many weeks or months may suffice to throw both physician and attendant off their guard. Orange relates a case in which a man was tried and convicted of murder in 1868. He became insane and was admitted into Broadmoor in 1809. for eigh- teen months he conducted himself with such propriety that he was allowed to go for walks with his attendant. One day, while thus walking, appa- rently quite restored, he asked his attendant a question about some rabbit- burrows near the path. The attendant stooped down to examine one of them, when, in an instant, he was felled to the ground by a heavy blow- on the back of his head. The lunatic then attempted to strangle him, and ultimately escaped. If the lunatic has manifested the least disposition to suicide, we should be extremely cautious in liberating him ; for suicidal mania is often art- fully concealed under a cheerful exterior. We cannot always test the pro- priety of granting liberation by the lightness of the offence for which a criminal lunatic has been confined. The circumstances under which the most trifling offence has been committed may show that the mind is wholly unsettled with regard to moral responsibility; and such lunatics can never be trusted, even when there is a great improvement in their language and deportment. In this respect, the case of Dodwell (C. C. C, March, 1818) is of some interest. This man discharged a pistol, in open court, at the Master of the Rolls. The motive which he assigned for the act was to draw attention to his case (a Chancery suit), and to have it brought fully before the public. He was tried for the offence and acquitted by the jury on the ground of insanity. The result was that he was consigned as a lunatic to the Criminal Asylum at Broadmoor. The court and jury thought that the act of the accused showed a total absence of self-control and that the motive assigned was irrational and not consistent with soundness of mind. It was not considered necessary at the trial to require medical evidence of the state of mind of the prisoner. Like all lunatics, he strongly denied that he was insane. Soon after his acquittal and con- finement in Broadmoor, Dodwell was seen on the part of his friends by two physicians. Their opinion was that he was quite sane and ought to be discharged; in fact, that he was a sane man, " incarcerated in a living tomb." The interests of the public do not appear to have been repre- sented on this occasion. The prisioner was subsequently visited and examined bv two other physicians, under an order from the Secretary of State, and three months afterwards by two independent medical men ap- pointed by the Commissioners in Lunacy. The result of their interviews with the convict was that he was considered to be decidedly insane and that it would be unsafe to allow him to leave the prison. Nullity of Marriage on Account of Lunacy.— It will be readily seen that the sexual perversion inseparable from various forms of insanity maj lead to a union perhaps with some one far beneath the patient, and the influence of nymphomania leads to impulsive acts which the person, who perhaps is an hysterical girl, does not stop to consider. The celebrated English case of Miss Bagster is an example of this kind. Miss Bagster NULLITY OF MARRIAGE — TESTIMONIAL CAPACITY. 781 was proved by the evidence to be a frivolous and weak-minded girl, whose education had been much neglected. She was a lady of fortune and ran jiwa}^ with and was married to a Mr. Newton. An application was made by her family to dissolve the marriage on the ground tiiat she was of un- sound mind. Amongst other facts urged before the Commission as a proof of the allegation, it was mentioned that she was occasionally violent and self-willed, that she was passionate as a child and that even in maturer years she had little or no self-control ; that she was ignorant of arithmetic and therefore incapable of taking care of her property ; that she had some erotic tendencies, which were evinced by her want of womanly delicacy and by her having engaged herself with a view to marriage to several individuals. On her examination before the Commissioners, her answers were intelligent and her conduct in no way different from that of ordinary individuals. Seven medical witnesses were summoned to support the Commission, and each of them deposed that she was of unsound mind. The Commissioners, however, had recourse to Morrison and Haslam, who visited her and who came to the conclusion that she was neither imbecile nor idiotic, and that her inability to manage her affairs arose from igno- rance. She was aware of her deficiencies, deplored her ignorance of arithmetic, and explained it on the ground that her grandfather had been too ready to send excuses for idleness when she was at school. Her con- versation greatly impressed Haslam and Morrison with a belief in her sanity. The jury, by a majority of twenty to two, returned a verdict that Miss Bagster had been of unsound mind since November, 1830, and that the marriage was consequently dissolved. In the Durham divorce suit for nullity (Durham v. Durham, otherwise Milner, Divorce Ct., Feb. 1885), the plaintiff, the Earl of Durham, failed to obtain a dissolution of his marriage with Miss Ethel Milner on the ground of insanity ; it not having been proved to the satisfaction of the judge that Lady Durham was insane on the date of her marriage. A similar su't (Cannon v. Cannon) heard about the same time, the parties to it occupying a humbler station in life, also failed, though here the wife was clearly insane a few days subsequent to the marriage. In Hunter v. Hunter, otherwise Edney, the marriage was dissolved on the ground that the bride was insane at the time of her marriage, and in- capable of understanding the contract. (See Medico-Leg. Jour., ii. p. 71.) CHAPTER LXIV. LUNATICS AS WITNESSES. INTERDICTION.— COMMISSIONS IN LUNACY. — EXAMINATION OP ALLEGED LUNATICS. — MEDICAL AND LEGAL TESTS OF COMPETENCY. — CONFLICT OF EVI- DENCE AND OPINION. Lunatics as Witnesses. — In regard to the testimonial capacity of luna- tics, it may now be considered as settled that a lunatic who labors under delusions, but who in the judgment of a medical practitioner is capable of giving a fair account of any transaction that happened before his eyes, and who appears to understand the obligation of an oath, may be called as a wit- ness. (Reg. V. Hill, Denison's Crown Cases, 2, p. 254.) The rule first laid down by Parke, B., is in accordance with this view : it is for the judge to say whether the evidence of the witness is admissible, and then bis credibility is a question for the jury. 732 INTERDICTION. Lunatics have occasionally broiiulit actions for damaf^es involving charges of assault against those in whose estaljlishnients they may have been confined. A trial (Xunn r. Hemming, Exch. I)iv., Feb. 1879) shows how such cases are dealt with, and proves that, unless the testimony of a lunatic is corroborated, it will not be accepted by a Jury. The plaintiff claimed damages from the defendant for an assault while under his care as a lunatic patient. He had made an attempt to escape, was brought back to the asylum, and was, according to his statement, violently plunged into a cold bath and nearly drowned. No complaint was made of this treatment by him to the Commissioners until three years after the occur- rence. In letters to his wife shortly after the alleged maltreatment he had not mentioned it. The story of the plaintiff was directly contradicted by every living man who could have witnessed the scene if it had occurred, and there was no confirmatory or corroborative evidence. On the other hand, seven medical men had testified that the plaintiff at this time and subsequently had labored under delusions, and had attempted suicide. The plaintiff' admitted in court that he had swallowed his three shirt-studs because he thought that, being gold, they would cure a pain in the stomach. His counsel contended that his statement was to be believed, and those who testified against him he treated as perjured witnesses. His conten- tion was, " Get rid of the plaintiff's delusion, and the facts are proved;" but this was precisely what could not be done, and the jury returned a verdict for the defendant. Any other conclusion would have been against justice and common sense. This case shows that the uncorroborated tes- timony of a lunatic laboring under insane delusions will not be accepted as evidence. Section 330 of the Lunacy Act, 1890, is intended to protect medical practitioners and others, when acting in good faith and with reason- able care, from actions at law brought by lunatics. Interdiction. — By interdiction we are to understand the depriving of a person laboring under mental disorder of his civil rights ; in other words, preventing him from exercising any control or management over his affairs. It may be with or without restraint or confinement in an asylum, for one condition does not necessarily imply the other, although there is a popular idea to the contrary. In re Smith (June, 1862), an order for a jurv was issued to try the question of sanity or insanity and in affirm- ing the order, Knight Bruce, L. J., made the following statement: "It is desirable to remove the idea, but too generally entertained by persons in different stations of life, that the finding by a jury that a person is of unsound mind necessarily involves an interference with his personal free- dom : it does not. The court places no further restraint upon a lunatic than is necessary for his protection, and I would refer to the fact that there are several lunatics living under the protection of the court who reside in their own houses wnth large establishments." When a person, from mental incompetency, is liable to be imposed upon by others, or is guilty of foolish and extravagant acts, whereby his property is wasted, a commission of inquiry may be constituted under the Great Seal ; and the inquiry may be carried out by the Masters, either alone or with other appointed persons; or an inquisition may be held with or without a jury to determine the competency or incompetency of an alleged lunatic. The object of the commission is to determine w^hether the incapacity to manage affairs is owing to some mental defect or dis- order, and not merely to want of education or bodily infirmity — otherMise all wealthy minors and infirm persons might be deprived of the control of their property. Formerly commissions were not issued unless it was evident that lunacy or idiocy existed — for weakness of mind or imbecility EXAMINATION OF ALLEGED LUNATICS. 733 was not considered sufficient to justify legal interference. This is no longer the case, unsoundness of mind with incapacity of managing himself and his affairs being all that the law requires to be established. Thus, then, whether the case be one of mania or dementia is not now the ques- tion, but whether the party be compoi^ or non compos mentis ; if the latter, whether it be to a degree to prevent him from controlling his property with careful and provident management. Some years ago, a person who had a delusion on a particular subject, although not affecting his social duties, was deemed a fit subject for a commission, and deprived of his civil rights merely because his mental disorder would fall under the defini- tion of lunacy. On the other hand, one who had no delusion but great mental weakness, such as to incapacitate him for properly managing his affairs, was not deemed a fit subject for a commission ; since weakness of mind and insanity were considered to be two entirely different states the latter alone requiring interference, although the injurious results might be the same in both cases. Examination of Alleged Lunatics. — To determine whether a person is or is not a fit subject for interdiction or deprivation of civil rights, it is necessary to bear in mind that it is not enough to show that there is delusion, as in the lighter cases of monomania ; but we are bound to ascertain how far the delusion affects the judgment of the person, so as to prevent him, like other men, from managing his affairs with provident care and propriety. In many instances, however, some proof of delusion only is sought for ; and, if this be procured, it is hastily inferred that the person must be entirely incompetent to manage his property. The most difficult cases are those which involve questions of imbecility. In con- ducting the defence of the Windham case (Dec. 1861) Cairns was allowed by his medical advisers to make the following strange statement: "In a case of insanity accompanied by delusion, the mode of investigatino- it so as to arrive at the truth is a matter of great difficulty and doubt ; but in a case of imbecility, where there is either no mind at all or next to none, the task of coming to a right and just decision is comparatively easy." Such a statement is the reverse of the truth, and must have been made under some hazy notion that the state of imbecility was identical with that of idiocy. One of his own witnesses (Sutherland), in a subse- quent stage of the proceedings, corrected this error, by the admission, in cross-examination, that " drawing the line between soundness and unsound- ness of mind in a case of imbecility is one of the most difficult questions of medical science." In conducting the examination of an alleged lunatic we should compare his mind as it is with what it is proved to have been ; and if it be a case of supposed imbecility a proper regard must be had to age, society, edu- cation, and general conduct. We should also consider whether the per- sou has been treated by his friends and relations as a lunatic or imbecile prior to the issuing of the Commission. A young person whose educa- tion has been much neglected, and who has never been entrusted with the care of money, cannot be expected to have much knowledge of the method of managing a large property. Questions are sometimes put on the moral responsibility of man and the attributes of God to one who, perhaps, never heard of ethics or metaphysics. Again, mathematical and arith- metical questions, which would embarrass many persons who are sane and competent, are sometimes put on these occasions. In one instance a physician gave evidence on a Commission that he found the alleged im- becile could not work the first proposition in Euclid; but this person ad- mitted that ho had always disliked mathematics. In another case one ex- 734 EXAMINATION OF ALLEGED LUNATICS. aniiner asked the alleged imbecile, who said he had 1200/. in the bank, and received 20/. for interest, — IIow much was that per cent. ? He .said he could not tell: he was no good hand at arithmetic. The counsel who appeared against the Commission afterwards put the same arithmetical ([uestion to one of the medical witnesses who had deposed to the imbecility of the party ; and this witness, an educated man, confessed himself quite unable to answer it — a practical illustration of the impropriety of pronouncing a person to be imbecile or incompetent merely because he is ignorant of that which he has never been taught, (Case of David Yoolow.) Unless the questions are confined to those subjects which the person has had either the opportunity or inclination to learn, a medical witness will always incur the risk of confounding mere ignorance with imbecility. One of the best tests of mental capacity will be found in determining the degree to which, with ordinary opportunities, a person has shown himself capable of being instructed; but too high a standard must not be assumed as a test of capacity. The mind of an alleged imbecile should not be compared with the most perfect mind, but with that of another person of average capacity, of the same age and station in society, and who has enjoyed like opportunities of instruction. It would be difficult to find two sane persons who were exactly equal in mental power ; in some, one faculty is prominently developed ; in others, another. All that we have to look for in these cases of alleged unsoundness is an average degree of intellectual development, so as to qualify the person for per- forming the duties of his station. To win the confidence of an alleged lunatic for the purpose of examination, we should not treat his observa- tions or delusions with levity, but rather seriously sympathize with him in his troubles ; we should listen attentively to all he has to say, for his suspicions will be excited by many questions being put to him. If we cannot agree with his conclusions, we should not contradict him abruptly, but endeavor to draw him out by asking for some corroborative evidence of his statements. Before visiting the patient we should make ourselves thoroughly acquainted with every particular connected with his history and condition, and treat him as much like a sane person as possible. The insane are exceedingly suspicious, and quick to detect any deceit prac- tised on them. They are also jealous of the intrusion of strangers, and, unless great tact is employed, will look upon a medical man as an enemy. The patient should be informed that his perceptions are merely the result of natural disease ; it is useless to tell him that he is under a delusion when his perceptions, although sometimes exaggerated, are too real to be doubted. The conflicting medical evidence given on Commissions in Lunacy is in great part to be ascribed to the fact that the whole of the mind of the person is not fairly examined. One physician tests one faculty ; another, another ; each has his own theory of insanity, and each his own standard of competency. The witnesses in support of the Commission do not go so much to test the actual state of the mind of the person as to discover what they deem proofs of insanity ; those against the Commission take an opposite course — they look only for some proofs of soundness. It can- not, therefore, happen otherwise than that different conclusions should be drawn under such different modes of investigation. There is another point which requires attention in these cases. Persons laboring under a slight degree of imbecility are very soon irritated ; they are easily per- suaded that they are ill used and persecuted ; and when they happen to be questioned by parties who are represented as their enemies they lose their self-command, and are no longer able to answer questions which CASES OF IMBECILITY. 735 under their ordinary state of mind they would reply to with perfect ac- curacy. A defective memory must not he hastily set down as a proof of legal unsoundness. This is more or less the natural result of age. A man may not have a good memory, and yet have a mind sound enough for the management of his affairs. A defective memory in an aged per- son, taken alone, proves nothing. A medical witness must not allow himself to be embarrassed by medical or legal definitions of insanity. The malady may not assume the form of lunacy or idiocy, in a strictly legal view — nor of mania, melancholia, de- mentia, or idiocy, in a strictly medical view ; but still may be a case of such mental disorder as to create an incapacity for managing affairs. This is the point to which a medical examiner has to direct his attention. Cases of imbecility present the greatest difficulty, and create the greatest conflict of opinion among medical witnesses. Imbecility strictly implies a weak or feeble mind, and this term is properly applied to one who has an intellect below par or below the normal average. The vagueness of these terms shows how difficult it is to draw a clear distinction between legal sanity and that degree of mental weakness implied by imbecility which would justify interdiction. Insanity, in the common acceptation of the term, cannot be proved in these cases: there will be no evidence of delusion, and there may be such an amount of self-control as to enable a person to maintain a rational conversation. Memory, judgment, and other faculties, although weak, are still present in a greater or less degree ; and from one or two interviews only an examiner might be disposed to pronounce the person of sound mind and competent to manage his own affairs. There is a wide field for argument here; for it may be said with some truth in a defence, " that the doctors cannot put their fingers on a single point indicative of insanity." In short, each fact specified b}^ them may be frittered away with the remark that every one must have known some person who had either a bad memory or a weak judgment ; who squandered money, who wasted it on unworthy objects, who hoarded it and refused to pay just debts, or who lost it in foolish speculations, etc. All this may be true, and yet the person in question may be legally of unsound mind and properly interdicted. As Pagan justly remarks, there is a facility of disposition in an imbecile or weak-minded person, which lays him open to be imposed upon by the artful and designing ; and our conclusion regarding his competency must therefore be the result of a just appreciation of his general knowledge of affairs derived from an ex- amination of all his faculties. We have to consider how far his imperfect mind would prevent him from attending to his own interests, not in a manner which would insure their most profitable application, but in such a way as would prevent his affairs from being involved in ruin. His knowledge and understanding may be so imperfect that his property would necessarily run to waste under his unassisted control. When it is proved that there has been habitual submission to the dictation of others, either from a long habit of being controlled, from indifference or fear — when a man has allowed himself to be disobeyed or neglected by his ser- vants, and to be openly cheated by tradesmen — these circumstances fur- nish evidence of weakness of mind and a justification of the opinion that there should be interdiction. On the other hand, if a person when left to himself has managed his affairs with reasonable care and propriety, and has acted independently of others, there can be no stronger proof of his legal competency. The testamentary capacity of imbeciles may be tried by the same rules. k man who is of such an easy disposition as to be improperly influenced 736 PROOFS OF UNSOUNDNESS OF MIND. in the use of his property while livin^r, may be equally influenced by fear or control to make an improper disposition of it by his will; but in this case the terms of the will, if drawn up by himself, will allow a fair judg- ment to be formed of the mental soundness of the testator. There is on these occasions a method of testing the state of mind which has been sug- gested by Conolly — namely, by inducing the patient to express his thoughts in writing, as in a letter addrcjssed either to his physician or to some confidential friend. This plan would probably often succeed in showing the e.xistence of a delusion, when an oral examination would wholly fail; the patient would not be led to suspect that he was being .sul)jected to an examination for a hostile purpose. The current of his thoughts would be uninfluenced by the suspicion that the act of writing was to test the state of his mind ; and as no man can long write in a con- nected manner who does not think collectedly, so we may expect to find ample evidence whether a delusion really exists in his mind or i.ot. There are cases recorded in which the evidence of delusion has been derived from the terms of a will or deed written or dictated by the lunatic himself, when there was great difficulty in obtaining proof by an oral examination. In idiocy there is no capacity for writing. In dementia, as there is no memory, it commonh^ happens that the same word is written over and over again. No person in a state of dementia can write a connected sen- tence, because, before the last part of the sentence is completed, the first is forgotten. In imbecility we may meet with every variety of mental de- fect, but the state of the mind is generally well shown by the expression of the thoughts in writing. This method, it must be remembered, cannot show whether or not a person is capable of managing his affairs; it is a mere index of a certain state of mind, and must be coupled with general habits and conduct, before any conclusion is drawn from it relative to the propriety of interdiction. It will often serve to detect the existence of a delusion when other means fail. Winslow attached some importance to handwriting as foreshadowing the occurrence of general paralysis with softening of the brain. This, however, refers not so much to composition or style as to correct writing and spelling. The reader will find a com- plete essay on the writings of the insane, and the medico-legal conclusions to which they lead, by Marce, in the Ann. d'Hyg., 18C4, t. 1, p. 379. When a verdict of insanity is returned under a Commission, it must always represent the person to be of unsound mind, and by reason of that unsoundness to be incompetent to manage his affairs. A date must be fixed at which the insanity first appeared, and this date should always be anterior to the issuing of the Commission. If there are lucid intervals, the space of time occupied by these should also be defined. Among cases well calculated to show the conflict of medical evidence on Commissions in Lunacy, is that of W. F. Windham (Dec. 1861). Fifteen of the relatives of this gentleman petitioned for an inquiry into his state of mind, on the ground that he labored under congenital deficiency of in- tellect (imbecility), and this view was supported by strong medical opinions ; on the other side, it was alleged that the mental condition of Mr. Windham, if below the normal standard, was merely the result of a neglected education. The inquiry lasted thirty-three days, during which 140 witnesses were examined — namely, fifty on the part of the petitioners, and ninety in favor of Mr. Windham, at a cost of about 30,000Z. There was no proof of the want of ojiportunity of education, but strong reason to believe that the alleged iml)ecile had not, like other boys of his age, made use of the advantages which he had enjoyed. He had been sent to Eton, but had derived little benefit there. It seems to have been admitted PROOFS OF UNSOUNDNESS OF MIND. 737 that, as c boy, be was wholly unlike other boys, and when he attained his majority in Aug. 1861, his conduct was extravagant, wild, and quite in- consistent with his social position. At the same time, he was not entirely deficient in jusiness matters ; for it was proved that his uncle, one of the petitioners, had shortly before negotiated with him for the sale of a piece of land of the value of lOUO/., thereby admitting his capacity to transact business. The t=v'idence received on this occasion was allowed to extend to the whole of hi^^ ilfe ; and it may be observed that in cases of alleged imbecility it is not possible, without doing injustice, to prevent the re- ception of evidence frojix a long antecedent date. The result of this inquiry was that the jury, by a inajority of fifteen to eight, returned the following verdict: "That Mr. Wiiiuham is of sound mind, and capable of taking care of himself and his affairs." After the verdict had been returned pro- nouncing him sane and compeient, he was guilty of mau}^ extravagant acts, exhausted a splendid fortune, and became a bankrupt ; showing that, whatever legal soundness of mjnct he might possess, he practically did not evince the capacity of taking care of his affairs. A large section of the public joined in the view prominently put forward at this inquiry by his counsel, that this uniortunate young man had been made the victim of a charge the most cruel, unjust, and unjustifiable. In- sanity, it was urged, in the ordinary acceptation of the word, did not exist in his case. There were no illusions, hallucinations, or insane delusions; but as these are never met with in the form of unsoundness imputed to Mr. Windham, namely, imbecility, their absence proved nothing for or against the existence of imbecility or weakness of mind. But what test is there for imbecility except conduct and conversation? There was no incoherency of language, but there was strong evidence of habits such as we do not meet with among men of really reasonable minds ; but opinions were divided on the question whether these indicated unsoundness of mind, or a mixture of eccentricity and moral depravity from deficient edu- cation. A majority of the jury took the latter view; and Lord Chelms- ford, in commenting upon this verdict in the House of Lords, said, " The law as laid down by Lord Lyndhurst applied to cases short of insanity, but they must be cases of unsoundness of mind ; and mere extravagance or follies, which indicated imbecility, would not be sufficient unless the imbecility amounted to unsoundness of mind." The legal test of the existence of this state of mind, we are told by high authority, is "con- duct." A lawyer means by "madness" conduct of a certain character, while a physician means by it, "a certain disease, one of the effects of which is to produce such conduct." (Stephen's Crim. Law of England, p. 87.) The whole evidence against Mr. Windham bore upon conduct, and from the verdict we learn what sort of conduct does not constitute unsoundness in a legal sense. Thus the marrying of a woman of disrepu- table character, the squandering upon her of 14,000i!. in jewellery, and settling upon her, without any reasonable grounds, 800Z. per annum, with other extravagant acts of a similar kind, do not constitute "conduct of a certain character" sufficient to render a man non compos mentis in the eye of the law ; but if these acts evince soundness of mind and a competency to manage aff"airs, what are the acts which indicate unsoundness or incom- petency ? On the other hand, we are told that the physician looks to the existence of a certain disease ; but a physician can know nothing about the existence of disease of the brain during life in any case of imbecility, except in so far as its effects may be manifested by conduct. We there- fore come round to the legal test of "conduct," which in Mr. Windham's case was considered to be quite consistent with the provident manage- 47 738 CIVIL RESPONSIBILITY OF LUNATICS. ment of a large estate and a sjylenditl fortune. That tlie legal test was here a failure in affording protection from wastefulness is proved by the result — the loss of the whole property from reckless extravagance. So strong was the public feeling in reference to medical evidence after this inquiry, that the Lord Chancellor actually proposed to exclude it alto- gether in Commissions in Lunacy, except in so far as it was based on facts within the personal knowledge of the witnesses. It was suggested that the general scientific conclusions of experts should not be received as evidence. The proposition, which would have been most injurious to the interests of the insane as well as of the sane, did not meet with a favor- able reception. The medical attendant of every person found lunatic by inquisition has every five years to send to the Masters a report as to the mental and bodily condition of the patient, and a certificate if he is still of unsound mind and a proper person to be detained. CHAPTER LXV. CIVIL KESPONSIBIIiITY. — TESTAMENTARY CAPACITY. WILLS MADE BY THE INSANE. — TEST OP CAPACITY. EVIDENCE OF DELUSION. ECCENTRICITY. Testamentary Capacity. Wills made by the Insane — Questions in- volving the testamentary capacity of persons are of frequent occurrence, and medical evidence is commonly required for their solution. When property is bequeathed by a testator out of the usual order of succession, it may be alleged l^y the relatives that he was incompetent to understand the nature of the deed — either from insanity, the imbecility of age, or that natural failing of the mind which is so often observed to occur from dis- ease or on the approach of death. A disposing mind is what the law requires to render a will valid, and this does not rest so much upon the question of sanity or insanity, as upon the proof of competency or incom- petency in the testator. The best test of capacity for this act is that a man, at the time of signing the will, should know the nature and amount of his property and the just claims of those who are nearly related to him. It has been truly said that the evidence of the medical attendant on the state of the testator's mind at the time of the execution of the will, is worth more than the opinions of experts or of witnesses who may have seen the testator at other times and under other circumstances. (Med. Times and Gaz., 1871, ii. p. 203.) A medical man is frequently of neces- sity a witness to a will, and he should always remember that when he signs his name to it as a witness he is practically testifying to the compe- tency of the testator to make it. Bodily disease or incapacity does not affect the validity of a will unless the mind is directly or indirectly disturbed fjy it. A man's mind, under these circumstances, may not be so strong as in robust health, but still it may retain a disposing power. In Harwood v. Baker (Privy Coun., 1841), a will was pronounced to be invalid owing to the general state of bodily disease in which the testator was at the time of making it. He was labor- ing under erysipelas and fever, and these diseases had produced a degree of drowsiness and stupor which rendered him incompetent to act. In the TESTAMENTARY CAPACITY. 730, case of Day (1838), epilepsy was allep^ed to have affected the mind; and in the case of Blewitt (1833), paralysis was adduced as a ground of in- competency. In all cases of this kind the law looks exclusively to the actual effect of the bodily disease upon the mind at the time the will was made; and this is commonly a question to be determined by a jury from the testimony of the usual medical attendant of the deceased, as well as from the evidence of medical experts. Test of Capacity. — A person is considered to be of a sane and disposing mind who knows the nature of the act which he is performing, and is fully aware of its consequences. From some decisions that have been given it would appear that a state of mind for which a person might be placed under interdiction or deprived of the management of his affairs would not render him incompetent to the making of a will. The validity of the will of a lunatic was once allowed, although made while he was actually con- fined in an asylum, because the act was rational, and it was such as the lunatic had announced his intention of making some years prior to the attack of insanity. (Coghlan's case' ; see Re Garden, Law Times, July 6, 1844, p. 258; also the case of Cartwright, Mayo on Med. Tes., p. 44.) In Nichols and Freeman v. Binns (Prob. Ct., Aug. 1858), the question was whether the will of a Mr. Parkinson, made in a lunatic asylum near Norwich, was executed during a lucid interval. The jury found a verdict in favor of the will. In Parker v. Lord (1876), the testator, Lord, a surgeon, was afflicted with insanity in Jan. 1875. It was proved that he had lucid intervals. He executed his will in the following February. The court pronounced for the will, in which there was a reasonable disposition of his property, on the ground that it had been executed during a lucid interval. The insanity of a person, when not already found insane under a Com- mission, must not in these cases rest upon presumption or probability, but be established by positive proof. The act of suicide is often hastily assumed to be evidence of insanity ; but it would not be allowed as a proof of this state, even when a testator had destroyed himself shortly after the execution of his will. A case has been decided where the testator committed suicide three days after having given instructions for his will ; but the act was not admitted as a proof or even as a presumption of in- sanity at the time, and the will was pronounced to be valid. In another case, Edwards v. Edwards (Prerog. Ct., Feb. 1854), it was proved that the testator had committed suicide three days after the execution of his will, and there was some evidence of eccentric habits almost amounting to insanity; but the will was found valid. In White v. Halford (Prob. Ct., Feb. 1874), a will was contested on the ground that the testator had thrown himself out of his bedroom window and had inflicted some severe injuries on himself a night or two before the will was made. He repeated these attempts on himself, and eventually died in a lunatic asylum. The jury found in favor of the will. There was no proof that the testator was laboring under any delusion when it was made. Suicide alone is not deemed to be such a proof of the existence of insanity as to render a will invalid. Delusion in the Deed. — The validity of deeds executed by persons affected with primary delusional insanity (monomania) is often a subject of dispute. The practice of the law indicates that the mere existence of a delusion in the mind of a person does not necessarily vitiate a deed, unless the delusion form the groundwork of it, or unless the most decisive evi- dence be given that, at the time of executing the deed, the testator's mind was influenced h\ it. Strong evidence is often derivable from the act 740 DELUSION IN THE DEED. itself, e.«;peciallv when a testator has drawn up the will of his own accord. In the case of Barton (1840), the Ecclesiastical Court was chiefly guided in its decision by the nature of the instrument. The testator, it appeared, labored under the delusion that he could dispose of his own property to himself, and make himself his own legatee and executor. This he had accordingly done. The will was pronounced to be invalid. But a will may be manifestly unjust to the surviving relatives of a testator, and it mav display some of the extraordinary opinions of the individual ; yet it will not necessarily be void, unless the testamentary dispositions clearly indicate that they have been made under the influence of a delusion, and, as has been already remarked, what relatives assert to be delusions are often actual facts. Some injustice may possibly be done by the rigorous adoption of this principle, since delusion may certainly enter into a man's act, whether civil or criminal, and it may not be always in our powder to discover it ; but, after all, this is perhaps the most equitable mode of con- struing the last wishes of the dead. The proof of the existence of delu- sion may be very close upon the date of the w^ill, as in Sewell v. Wells (Prob. Ct., June, 18TT), and yet the will may be held to be valid. The testator made his will on March 10, 1875. It was admitted on both sides that he was insane in May, 1875, and there was evidence that he was laboring under delusions regarding himself and his property on March 15, i. e. five days after the date of the will. The jury found that there was no delusion when he made the will. Delusions rnay exist without being in all cases manifest or discoverable. Persons who have committed suicide, or who have destroyed their own property, or done any other act from which unsoundness of mind might be inferred, might be enabled to con- ceal the delusions under which they labored dow^n to the last moment of their lives. According to Nichol, it is not necessary in civil suits to connect the morbid imagination with the act itself; if the mind is proved to be un- sound the act is void. In Roberts v. Kerslake (Warwick Aut. Ass., 1854), Lord Wensleydale held that to vitiate a will if it be a case of delirium the act must be traced to delirious delusion, but if be a case of lunacy it need not be traced to a delusion. In Sharpe v. Macauley (Win- chester Aut. Ass., 1856), Martin, B., advised the jury in coming to a conclusion on the question whether the testator had a " sound and dis- posing mind" to look, not to the opinions of others, but to the man's own acts as well as his correspondence. A disposing mind implied that a man understood the nature of his property, the use and benefits arising from it, and had sense and discretion to select persons to enjoy it after his death. A man may have labored under delusions and have been confined as a lunatic, yet at the date of his will he may have been sane and have had a disposing power. The main question, therefore, is : Was the testator of sane mind when the will was executed? This may be deduced from direct evidence of his condition as well as from the provisions of the will itself. Eccentricity in Wills. — The evidence in these cases sometimes amounts to proof of eccentricity only on the part of the testator or in the deed itself; but a clear distinction must be here drawn. The will of an eccen- tric man is such as might always have been exy^ected from him ; the will of one laboring under insanity (delusion) is different from that which he would have made in an unaffected state — the instrument is wholly different from what it would once have been. The insane are eccentric in their ideas, their language, or their conduct ; but the merely eccentric have but a voluntary resemblance to the insane in these respects. (Jamieson's I ECCENTRICITY IN WILLS. 741 Lect., Lon. Med. Gaz., vol. xlvi. p. 180.) They can if they please alter their coucluct and act like other persons neither eccentric nor insane. In a case in the Probate Court, Hannen, J., observed that it was impossible to define exactly the distinction between eccentricity and insanity or to draw the exact line between sanity and insanity, but for practical pur- poses we are able to say in a particular instance whether a man is sane or insane. The acts of eccentricity may be harmless, and the evidence ma}^ show that up to the time of death the testator may have been treated as a person of sound mind. In Burdett u. Thompson (Prob. Ct., July, 18T3), the will of a testatrix was disputed because in a codicil she had ordered the doors and windows of her house to be bricked up and the house locked up with the furniture and contents for a period of twenty years. Further, that her pony, pigeons, dogs, and poultry were to be shot after her death. It was proved that she was a shrewd and intelligent woman, and managed her own affairs down to the time of her death. On the other hand, it was contended that these acts were an indication of mental disease. Hannen, J., said it was impossible to lay down any abstract proposition as to what constituted unsoundness of mind. No person's mind could be said to be perfectly sound, just as no person's body could be said to be perfectly sound ; but the question in these cases was whether there was such a degree of unsoundness as to interfere with those faculties which required to be brought into action in making a will. The jury were not able to agree upon this question and were discharged. Wills are sometimes contested more on the ground of eccentricity than of insane delusion ; but if eccentricity only be proved a court will not interfere. In the case of Morgan v. Boys (1838), it was proved that the testator by his will had left a large fortune to his housekeeper. The will was disputed on the ground that it bore intrinsic evidence of the deceased not having been in a sane state of mind at the time of making it. After having bequeathed his property to a stranger, the testator directed that his executors should " cau.se some parts of his bowels to be converted into fiddle-strings, that others should be sublimed into smelling-salts, and that the remainder of his body should be vitrified into lenses for optical pur- poses." He further added in a letter attached to his will: "The world may think this to be done in a spirit of singularity or whim, but I have a mortal aversion to funeral pomp, and I wish my body to be converted into purposes useful to mankind." It was shown that the deceased had conducted his affairs with great shrewdness and ability ; that he not only did not labor under imbecility, but that he had been always treated during life as a person of indisputable capacity by those with whom he had to deal. Jenner in giving judgment held that insanity was not proved; the facts merely amounted to eccentincity, and on this ground be pronounced for the validity of the will. The best rule to guide the court was the conduct of persons towards the deceased; and the acts of his relatives evinced no distrust of his sanity or capacity while he was living. The deceased had always been noted for his eccentric habits, and he had actually consulted a physician upon the possibility of his body being devoted to chemical experiments after death. In the case of Mudway v. Croft (Prerog. Ct., Aug. 1843), a will contested on the ground of in- sanity but defended on the plea of eccentricity, Fust said: "It is the prolonged departure, without an adequate external cause, from the state of feeling and modes of thinking usual to the individual when in health, this is the true feature of disorder of the mind." Wills in Senile Dementia. — Wills, made in incipient dementia arising from extreme age (senile imbecility) are often disputed, either on the 742 WILLS IN EXTREMIS. o-round of mental deficiency, or of the testator, owin": to weakness of mind, having been subjected to control and influence on the part of interested persons. If a medical man be present when a will is executed, he may satisfy himself of the state of mind of a testator, by recjuiring him to re- peat from memory the mode in which he has disposed of the bulk of his property. A medical man has sometimes placed himself in a serious position by becoming a witness to a will without first assuring himself of the actual mental condition of the person making it (case of the Duchess of Manchester, 1854). It would always be a good ground of justification if, at the request of the witness, the testator is made to repeat substantially the leading provisions of his will from memory. If a dying or sick per- son cannot do this without prompting or suggestion, there is reason to believe that he has not a sane and disposing mind. It has been observed on some occasions, when the mind has been weakened by disease or in- firmity from age, that it has suddenly cleared up before death, and the person has unexpectedly shown a disposing capacity. (Ann. d'Hyg., 1831, p. 360.) In Durnell v. Corfield (Prerog. Ct., July, 1844), a case in which an old man of weakened capacity had made a will in favor of his medical attendant, Lushington held that, to render it valid, there must be the clearest proof, not only of the factum of the instrument, but of the testator's knowledge of its contents. (Law Times, July 27, 1844.) In West V. Sylvester (Nov. 1864), Wilde, J., in pronouncing judgment against a will propounded as that of the deceased,' an aged lady, said, "At the time she executed the will, although for many purposes she might be said to be in her right senses, she was nevertheless suffering from that failure and decrepitude of memory which prevented her from having pre- sent to her mind the proper objects of her bounty, and selecting those whom she wished to partake of it." Wills in Extremis. — Wills made by persons whose capacity during life has been never doubted, while lying at the point of death or, as it is termed, in extremis, are justly regarded with suspicion, and may be set aside according to the medical circumstances proved. Many diseases, especially those which affect the brain or nervous system, directly or in- directly, "are likely to produce a dulness or confusion of intellect, under which a proper disposing power is lost. Delirium sometimes precedes deaih, in which case a will executed by a dying person thus affected would be pronounced invalid. In examining the capacity of a person under these circumstances, we should avoid putting leading questions — namely, those which suggest the answers " yes" or " no." Thus, a dying man may hear a document read over, and affirm, in answer to such a question, that it is in accordance with his wishes, but without understanding its purport. This is not sat- isfactory evidence of his having a disposing mind ; we should see that he is able to dictate the provisions of the document, and to repeat them sub- stantially from memory when required. If he can do this accurately, there can be no douljt of his possessing complete testamentary capacity. But it may be objected that many dying men cannot be supposed capable of such an exertion of m.emory ; the answer is then very simple ; it is .better that the person should die without a will, and his property be dis- tributed according to the law of intestacy, than that, through any failing of his mind, he should unknowingly cut off the rights of those who have the strongest claims upon him. Habitual Intemperance. — A man may be of drunken habits, and yet not incapacitated for making a will. In Smith v. Austen (Prob. Ct., Nov. 1875), Hanneu, J., pronounced in favor of the will of a man who THE PLEA OF DEFENCE IN INSANITY. 743 was prov^ed to have been of exceedingly drunken habits. The question was whether his mental faculties had been thereby enfeebled so as to render him incapable of exercising his judgment. There was no proof of this, and during life he had not been treated by anybody as incapable of managing his affairs. Effect of Narcotics. — The habitual use of opium or other narcotics may give rise to a question respecting testamentary ca])acity. We were con- sulted in a case of this kind, in which the testator had been in the habit of taking morphine, until, according to our informant, the dose had reached fifteen grains a (\?i,y. He made a will fairly disposing of his property among his children. Nine days afterwards he made another will, entirely revoking the previous one, leaving his property to a younger son, who was alleged to have exerted an undue influence. The will was declared valid. The long use of narcotics, in large doses, may weaken the powers of the mind, and render a man more easily amenable to improper influence ; but the question will be in this case, as with drunkards, whether the habit has permanently enfeebled the mind so as to prevent a man from exer- cising a reasonable disposition of his property. The proof of this will rests with those who would benefit l)y the allegation. Restriction of Medical Opinions. — In an important case (Bainbrigge V. Bainbrigge, Oxford Sum. Ass., 1850), tried before Lord Campbell, in which the testamentary capacity of a man was disputed, it was held that a medical witness, although conversant with cases of insanity, cannot be asked his opinion as to the insanity of a testator founded upon evidence given at the trial in his hearing. (4 Cox, Crim. Cases, 454 ; see also on this subject, Lond. Med. Gaz., vol. xlvi. p. 240.) In the case of the Duchess of Manchester, however, the opinions of Sutherland, Mayo, and Conolly on the competency of the testatrix to make a will were received by the court, although based onlv upon the evidence given at the trial. The above decision may, indeed, now be considered as entirely set aside. CHAPTER LXVI. THE PLEA OR DEFENCE OF INSANITY. CIRCUMSTANCES UNDER WHICH IT IS ADMISSIBLE.— HOMICIDAL INSANITY. MORAL INSANITY. SYMPTOMS. LEGAL TESTS. MEDICAL TESTS.— DELUSION. TES¥S OF IRRESPONSIBILITY. MEDICAL EVIDENCE. The Plea or Defence of Insanity. — Responsibility here signifies noth- ing more than liability to punishment for crime, and a criminal act implies the existence of intention, will, and malice. (Stephen.) When insanity has reached a certain stage or degree, an act may be perpetrated without malice ; and in this sense the person is considered to be irresponsible in law. This is a question of fact, to be determined by a jury from the whole evidence set before them ; and the proof rests with those who make the allegation that the act in question, whether murder or arson, was not done wilfully and maliciously. " The sanity of a man's conduct," ob- serves Stephen, J., "involve^^ the presence of intention and will on all ordinary occasions ; and if the act is one of those which the law forbids, it is presumed to be malicious and wicked." (Crim. Law of England, p. 89.) This subject is of considerable importance in a medico-legal view; 744 THE PLEA OF DEFENCE IN INSANITY. for should a plea of insanity bo improperly admitted in any criminal case, then punishment is made to fall unecjuaHy on olfenders ; and if, on the other hand, it be imi)roperly rejected, punishment is administered with undue sevorit\% and loses its deterrent influence. The rule of law is that no man is responsible like a sane person for any act committed by him while in a state of insanity ; but the existence of mental disease does not necessarily exempt a person from criminal responsibility. (Reg. v. Bur- ton, Maidstone Lent Ass., 1862.) Many a man whose mind is unsound knows perfectly well that he is doing wrong; and so long as he knows that, he. is subject to the criminal law. The plea of insanity may be raised for the sumllest offence up to the highest crime — murder ; but it is rarely made a defence in smaller offences, because the confinement to which an accused person, if found insane, would necessarily be suljjeeted, would often be a heavier punishment than that which the lavv actually prescribes for the offence which he may have committed. In a case of felonious assault, it was urged by counsel in defence that the prisoner was insane; but the evidence on this point was not by any means conclusive — when it was intimated by the court that, if this plea were admitted, the party would probably undergo a much longer imprisonment than if on conviction he received the legal punishment for the offence. (Reg. v. Reynolds, Bodmin Aut. Ass., 1843.) The judge is reported to have said that there was no proof of insanity. If the prisoner was pronounced in- sane, he might be imprisoned for life, and therefore he did not think that that finding would benefit him. A verdict of guilty was returned, and the man was sentenced to eighteen months' imprisonment. This case shows that a defence of this kind may be sometimes indiscreetly put forward. Such a mode of dealing with the plea of insanity, i. e. of making it a (pies- tion of expediency dependent on the amount of punishment for ihe offence, must be pronounced indefensible. The discharge of persons who have perpetrated a criminal act or hei- nous crime, but have been acquitted on the ground of insanity and con- fined during her Majesty's pleasure, is a very serious matter, and one in which the safety of the public is deeply concerned. Some medical men appear to think that the interest of the prisoner alone is to be considered ; but this would lead to the discharge of many dangerous lunatics. (Dod- well's case, ante, p. 730.) Murder, incendiarism, and theft are the crimes for which the plea of insanity is commonly raised; and it has been generally confined in this country to those cases in which persons have been charged with murder or attempts at murder. Murder may be perpetrated by one who is obvi- ously laboring under delirium or violent mania, or by an idiot or imbecile. Apart from the circumstances connected with the criminal act, there may be clear evidence of such a disordered state of mind in the person, as at once to exonerate him from that amount of I'esponsibility which is exacted from one who is sane. The appearance of the accused, or the testimony of a medical man, renders it unnecessary to go into the evidence, and a verdict is returned accordingly. The cases of difficulty are those in which insanity presents itself in a doubtful aspect, as in mania complicated with epilepsy, or in some forms of imbecility. The mental disorder may be of so slight a nature as not to justify an acquittal for murder. In order to exculpate a person, it must be proved that insanity in a certain degree ex- isted at the time of the perpetration of the act. Whether the prisoner is or is not insane when placed on his trial, has been sometimes held to be immaterial in reference to the question of responsibility. In the case of Murray (High Ct. of Just., Edin., Nov. 1858), it was proved that the DEGREES OF CRIMINAL RESPONSIBILITY. 745 accused recovered his sanity eifjrht hours after he had killed the deceased ; but he was acquitted on the ground of insanity at the time of committing' the act. [The Act of Parliament of August, 1883, provides and the En- glish Judges charf)'e, that if the accused was insane at the time the act was committed, that the jury should so find : vid. Judge Day's charge in case of Gouedstan, Med. Leg. Jour., vol. 2, p. 343.] The proved existence of mental disease does not necessarily exempt a person from criminal responsibilirv. Even the existence of a morbid de- lusion cannot always be allowed to screen a criminal from the conse- quences of his own acts; Avhile, on the other hand, there are instances in which a plea of insanity may be properlv allowed, although no delusion can be proved. Each case must be taken with all its surrounding circum- stances. The great difference of opinion which exists between physicians and jurists in reference to this plea appears to consist in this : most jurists contend that no degree of insanity should exempt from punishment for crime, unless it has reached that point that the person is utterly uncon- scious of the difference between 7-ight and wrong at the time of commit- ting the alleged crime. Physicians, on the other hand, affirm that this is not a proper test of the existence of that degree of insanity which should exempt a man from punishment for his acts ; that those who are laboring under confirmed insanity, and who have been properly confined in asylums for years, are fully conscious of the difference between right and wrong, and are quite able to appreciate the illegality as well as the consequences of their acts. Again, those who have patiently watched the insane for years agree that the legal test of utter unconsciousness of right and wrong in the performance of acts would in reality apply only to persons who were suffering from delirium, from furious paroxysms of mania, or from confirmed idiocy ; and that if the rule suggested — that a person, in order to be acquitted on the ground of insanity, should be first proved to be as unconscious of his act as a baby (Warren) — were strictly carried out, there is scarcely a lunatic inmate of an asylum who destroyed a keeper or attendant, who might not be executed for murder. Such a rule amounts to a reductio ab absurdum ; it would abolish all distinction between the sane and the insane, between the responsible and the irresponsible ; and it would consign to the same punishment the confirmed lunatic and the sane criminal. This S])ec\es of body-unconsciousness of action exists in idiots as well as in furious maniacs, but not in the majority of lunatics ; and it may be safely asserted that, if this criterion be the true one, acquittals on the ground of insanity have involved a series of gross mis- takes for the last sixty years. It may be said that the consciousness of the insane is an insane consciousness, while the law implies the conscious- ness of a sound mind ; but this involves a petitio principii. There have been numerous cases of acquittal in which, until the act of homicide had been committed, there was no imputation either against the sanity or the sane consciousness of the accused. Having pointed out these inconsisten- cies, we must acknowledge that in theory the English law would punish a lunatic just as it would punish a sane man, provided the lunatic " had that degree of intellect wMiich enal)led him to know and distinguish be- tween right and wrong, or between what was lawful and unlawful ; if he knew. what would be the effect of his crime, and consciously committed it; and further, if with that consciousness he wilfully and intentionally com- mitted it." In practice, however, it is placed beyond doubt that some who ought to be convicted under these rules are acquitted on the legal assumption that they were at the time unconscious (or only insanely con- 746 INSANITY IN A MEDICAL AND LEGAL SENSE. scions) of the wrongfulness of their acts. Wood states, that of thirty-three men confined as lunatics in Bethlehem who had committed murder, and who had been tried and acquitted on the ground of insanity, three were reported sane ; and he was quite satisfied that two of these were not insane at the time they committed the murders. Of fifteen men who had attempted to commit murder, five were reported sane, and two of them, in his judgment, ought not to have been acquitted on the ground of insanity. (Plea of Insanity, p. 50.) According to Hood, in the six years from 1852 to 1858, 120 persons who were tried for murder, for attempts at murder, or acts of personal violence, were acquitted on the ground of in- sanity. Of that number 79 were received into Bethlehem Hospital, and in several instances they exhibited no symptoms of insanity while they were resident in the asylum. These facts then, are sufficient to show that the rule of law generally adopted does not err on the side of severity. It operates, however, with great uncertainty. Some judges have admitted that there might be a consciousness that the act was wrong and illegal, and yet the person would be exempted from criminal responsibility, pro- vided it was proved by other circumstances that he labored at the time under a disease of the mind sufficient to prevent him from exercising a proper control over his actions. [" Burden of Proof in Insanity Cases. — There has been a conflict of opinion in the courts upon this question. The early English cases and some of the later American cases have placed the burden on the defendant. (Reg. v. Stokes, 3 Car. K. 185; McNaghten's case, 10 Clark and F. 109; Com. v. Regins, 7 Mete. (Mass.) 500 ; Com. v. York. 9 Mete. (Mass.) 93, State v. Spencer, 21 N.J. Law 1896.) This view was applied by Judge Parker, U. S. Dist. Judge, in Davis v. U. S., but on appeal to the Supreme Court of the United States, that bench repudiated the doctrine. Judge Harlan writing an able and exhaustive opinion. (Davis v. United States, 16 S. C. Rep. 353 — citing Com. v. Heath, 11 Grav 308; Com. v. Pomeroy, 117 Mass. 143; People V. McCann, 16 N. Y. o8 ; Brotherton v. Peopfe, 75 N, Y. 159; O'Connell, 87 N. Y. 377 ; Walker v. People, 88 N. Y. 81 ; Chase v. People, 40 111. 352 ; State v. Bartlett, 43 N. H. 224 ; Cunningham v. State, 56 Miss. 269 ; Dove v. State, 3 Heisk 348 ; Reake v. State, 121 Ind. 433.) The doc- trine held may be thus stated : " On a prosecution for murder, where the defence is insanity, and the fact of the killing with a deadly weapon is clearly established, defendant is entitled to an acquittal of the specific crime charged, if upon all the evidence there is reasonable doubt whether he was in law capable of committing the crime." " The crime of murder neces- sarily involves the possession by the accused of such mental capacity as will render him criminally responsible for his acts ; and the burden of proving such mental capacity must rest upon those who affirm that he has committed the crime for which he is indicted." (Med.-Legal Jour., vol. xiii. No. 3, p. 343.)] When the defence of insanity is set up on a charge of murder — in order to warrant the jury in acquitting a prisoner, it must be proved affirma- tively that he wa,s inmiie in a certain legal sense at the time of perpe- trating the act; if this be left in dou1)t, and if the crime charged in the indictment be proved, it is their duty to convict him. (Reg. v. Stokes, 3 Car. and K., p. 185.) It is necessary to impress upon the mind of the medical witness that it is not medical but legal insanity which is required to l)e proved on these occasions. As hardly two medical men agree about what is madness in a medical sense, and as some doctors have even held that all great criminals are necessarily insane, it is obvious that the power to absolve from responsibility could not at pi'esent be placed in the hands of HOMICIDAL MANIA AND MORAL INSANITY. 747 the profession with a due reji^ard to the protection of society or a safe ad- ministration of the law. The facts stated by Hood and Wood, in refer- ence to the admission of alleged criminal lunatics into Bethlehem show that, either by legal or medical ingenuity, or both combined, sane criminals have been incarcerated as irresponsible lunatics. Homicidal Insanitij. — Homicidal mania is commonly defined to be a state of partial insanity, accompanied b}^ an impulse to the perpetration of murder; hence it is sometimes called impulsive or paroxysmal mania. There may or may not be evidence of inlellectual aberration, but the main feature of the disorder is the existence of a destructive impulse which, like an insane delusion, cannot be controlled by the patient. This impulse, thus dominating over all other feelings, leads a person to destroy those to whom he is most fondly attached, or any one who may be involved in his delusion. Sometimes the impulse is long felt, but concealed and re- strained: there may be merely signs of depression and melancholy, sleep- lessness, low spirits, and loss of appetite, as well as eccentric or wayward and restless habits, but nothing to lead to a suspicion of the fearful contention which may be going on within the mind. As in suicidal mania, many of those who are in habits of daily intercourse with the patients have been first astounded by the act of murder, and then only for the first time led to conjecture that peculiarities of language or conduct, scarcely noticed at the time, must have been symptoms of insanity. Oc- casionally the act of murder is perpetrated with great deliberation and apparently with all the marks of sanity. In Reg. V. Vyse (C. C. C, July, 1862), the prisoner, a respectable woman, was charged with the murder of her two children by poisoning them with strychnine. The act was done with great deliberation and forethought; the poison was purchased under false pretences, and there was an entire absence of motive. She was acquitted on the ground of insanity. This was considered to be a case of impulsive mania, as there was nothing to indicate intellectual insanity. There was an hereditary tendency to insanity, coupled with the effects of prolonged nursing and general constitutional debility ; but Hood's minute inquiries brought out facts which showed that the prisoner had labored under disease which might have affected her mind, and have deprived her of the proper con- trol of her actions. He states that on his first visit to her in Newgate, he learned that during the later months of suckling she had been mentally overworked and subjected to great anxiety and fatigue. When worried b\' her business transactions, she suffered from a painful sensation seated in the interior of the cranium on the surface of the brain, and which she spoke of as " perspiring of the brain" — a symptom often complained of by patients who suffer from mental disease, as giving a creeping, irri- tating feeling, but never more graphically described than by Mrs. Yyse. It is indicative of morbid action of the brain, which is manifested by ex- amination after death. He considered Mrs. Vyse to be suffering from cerebral disease, which rendered her at the time of the murders an irre- sponsible agent. The impulse to violence may be dormant for weeks or months and then show itself by suicidal or homicidal acts ; but such is the result, and not the proof, of mental disease. The case of Christiana Edmunds (Reg. v. Edmunds, C. C. C, Jan. 1872) is in this respect of some interest. The woman, get. 43, moving in a respectable sphere of society, was charged with the murder of a boy at Brighton, on June 12, 1871. The deceased ate some sweets purchased in a confectioner's shop, died in a short time with the symptoms of poisoning with strychnine and strychnine was 748 HOMICIDAL MANIA AND MORAL INSANITY. found in bis stomach. The prisoner had procured sweets from this shop by the agency of Httle boys, had deliberately poisoned the articles with strychnine and returned them to the shop. She had herself on various occasions left poisoned sweets about in shops. How many persons had suffered from this cold-blooded and reckless act is not known ; but she had previously attempted to poison the wife of a medical man, and she imputed the poisoninj^s to the carelessness of the confectioner. He was able to show that his sweets as purchased were wholesome, and, by a chain of circumstances, the crime of i)oisouing them was clearly fixed upon the prisoner. She had shown much cunning in her proceedings. She had procured strychnine on four different occasions under false pretences, had borrowed the poison-book of the druggist and torn out the leaves to con- ceal the fact that she had purchased the poison. The defence was insanity, but there was no proof of intellectual insanity about her. She had shown all the skill of an accomplished criminal in carrying out her plan of general poisoning and in using the most artful means to conceal it and to thrown the imputation upon the confectioner. Impulse could hardly be pleaded, for her criminal acts were extended over weeks and months. She was convicted. She then, with a view of averting or delaying punishment, put in a false plea of pregnancy in bar of execution. The capital sentence was subsequently remitted and the prisoner sent to Broadmoor Asylum, on the statement that she was of unsound mind. It appears that her father had died in a lunatic asylum when of middle age, having suffered for years before his death from homicidal and suicidal mania ; her brother died at Earlswood Asylum, an epileptic idiot ; her grandfather was a sub- ject of cerebral disease ; her sister suffered from hysteria ; other relations were afflicted with nervous diseases of some kind ; and she herself appears to have exhibited, some eighteen years before, symptoms of hysteria and hysterical paralysis. (Lancet, 1872, i. pp. 89, 107, 73i; and Med. Times and Gaz., 1872, i. pp. 71, 101, 111.) This i)roved hereditary tendency to insanity in her family and was the main cause of the commutation of the capital sentence. If we except the nature of the crime, showing as it did an utter recklessness for human life, there was nothing to indicate un- soundness of mind, either in a medical or a legal sense, in this woman. The only evidence of insanity would be the atrocity of the act itself; but on this ground Mary Ann Cotton, executed at Durham for murder by poison, might have equally been pronounced insane. There was evidence that this woman had destroyed with arsenic, in the most reckless manner, children, husband, relatives, and friends, to the number of twenty persons. She sent her son, for whose murder she w^as tried, to procure the poison with which she subsequently killed him ; but this woman was con- demned and executed. She could not plead hereditary taint or hysteria of ancient date. These cases are rendered difflcult by the fact that there may be no dis- tinct proof of the existence, past or present, of any disorder of the mind, so that the chief evidence of mental disorder is the act itself; of the exist- ence of insanity, in the common or legal acceptation of the term, before and after the perpetration of the crime, there may be either no evidence whatever, or it may be so slight as not to amount to legal proof Such cases are regarded and described by some medico-legal writers as instances of insanU;/ of the moral feelings only, and this condition has been called " Moral insanity,'''' m.ania sine delirio (p. 699, ante). Its existence, as a state independent of a simultaneous disturbance of the reason or intellect, is denied by the majority of lawyers, as well as by some medical authori- ties. Whether such a condition exists or not is a simple question of fact, I EXAMINATION OB' MANIACS. 749 to be established if possible by clear and conclusive evidence. Its exist- ence in the case of a person charg-ed with murder appears to have rested hitherto too much on a mere medical dictum. Intelligent reasons have rarely been assigned by those vv^itnesses who have sought to satisfy a court of law that this has as distinct an existence as intellectual insanity ; in g-eneral, it is only alleged, and not proved to exist in a given case. If its existence were satisfactorily established, it would, as Stephen, J., observes, do away with one of the essential ingredients of crime — malice, and thus justify a jury in acquitting a person charged with murder. The accused on these occasions is assumed to have been an involuntary agent. It might be a good defence to admit that a man loaded a pistol and pointed it at the head of another, but that it was fired by a sudden involuntary action of the necessary muscles and not by the prisoner's will. The only difficulty is to get a jury to believe it. The evidence given in support of the assertion that a man is morally insane, generally speaking, is at least as consistent with the theory that he is a great fool and a great rogue, as with the theory that he is the subject of a special disease the existence of which is doubtful. (Crini. Law, p. 95.) There is no doubt that the unrestricted admission of such a theory would go far to do away with all punishment for crime, for it would render it utterly impossible to draw" a line between (moral) insanity and moral depravity. What is crime but the perversion of moral feelings ? Moral insanity in a person of sound mind is a contradiction in terms. In dealing with this subject, Orange, late superintendent of Broadmoor Criminal Lunatic Asylum, thus expresses himself: "Moral depravity, it has been said, cares not for law ; moral insanity cares, but cannot obey ; but even if this were admitted as a direct distinction, it would still be necessary to prove that such inability to obey arises from defect of judg- ment or of will or of self-control, as a result of mental disease." (Relation of Insanity to the Criminal Law of England, 1877, p. 10.) Examination of JIaniacs. — Homicidal mania may coexist with a quiet exterior, disarming all suspicion Medical men when required to examine patients cannot be too distrustful in dealing with them. With astounding cunning they will prepare and conceal weapons of destruction, Avhich may be used in an instant and without warning. The case of Reg. v. McKane (Salisbury Sum. Ass., 1873) furnishes a proof of the difficulty of guarding against sudden acts of violence. The prisoner was charged with the murder of Mr. Lutwidge, a Commissioner in Lunacy. The prisoner had been confined in an asylum for many years. He was anxious to be re- moved from the Fisherton Asylum, where he then was, and go to Broad- moor. He had threatened to do something which would send him to some other place, but he had not been treated as a dangerous lunatic. As the Commissioner was going round the asylum with others for the purpose of inspection, the prisoner suddenly made a rush at him, and struck him violently on the temple with a large nail wrapped in a cloth. It penetrated to the brain of deceased, and he died in a week afterwards. Medical evidence was given to show that the prisoner was suffering from chronic mania ; that he was subject to delusions, and that he was not re- sponsible for his actions on this occasion. The border-line between sanity and insanity is so thin, that even experienced persons who have been all their lives associated with the insane may be deceived, when in reality the mind is unsound and the patient unsafe. A commissioner in lunacy deeply impressed with the conviction that a patient in the asylum which he was visiting was perfectly sane and fit to be discharged, in defiance of the physician's warning, trusted himself alone in the lunatic's company, 750 VARIOUS FORMS OF HOMICIDAL MANIA. for the purpose, as ho said, of a private conversation. In loss than five minutes after they were alone, and, as the lunatic believed, unobserved, the Commissioner was thrt)ttled by his companion, and, but for the timely intervention of the physician, who had been a secret spectator of the s(;ene, he would have been strangled. Some years since, Vance, an eminent surgeon, called to see a lunatic patient. When he had reached the top of the stairs the patient suddenly rushed at him and threw him down the flight, killing him on the spot. Tardieu lays down the following formula for the examination of luna- tics : 1. Mental state : Three orders of facts should bo investigated. (1) The intellectual troubles. (2) The perversion of the affective faculties and tne instincts. (3) Alteration of the sensorial functions. 2. Somatic state : The position, attitude, walk, gestures, dress, malformation of the head, physiognomy, expression. Homicidal mania, in its more common form, may make its appearance at all ages, even, it is said, in children : it is occasionally periodical, and the paroxysm of insanity is preceded by symptoms of general excitement. The patient: experiences colick}' pains and a sense of heat in the abdomen or chest ; headache, restlessness, loss of appetite, and lowness of spirits ; the face is flushed or pale, the pulse hard and full, and the whole body is in a state of convulsive trembling. An act of violence is committed with- out warning, and the patient appears as if relieved from some oppressive feeling. He may be calm, and express neither regret, remorse, nor fear; he may coolly contemplate his victim, confess the deed, and at once sur- render himself to justice. In some rare instances, he may conceal himself, hide the weapon, and, like a sane criminal, endeavor to obliterate all traces of the crime — thus showing a perfect consciousness of the illegality or wrongfulness of the act, and a desire to evade discovery. These are, however, the main features of crime, and unless there is independent evi- dence of mental disorder, or of some bodily disease affecting the brain and destroying the power of self-control, the conclusion must be that the person is sane and responsible. The great problem to be solved on these occa- sions is: What are the plain practical distinctions between defective reasoning power arising from disease and perverted moral sense ? The latter condition alone should not exculpate a person or absolve him from punishment, or persons undeniably sane Vv'ho have committed crimes should be equally exculpated and absolved from punishment. The symptoms above described have been observed to be more aggra- vated in proportion as the homicidal impulse was strong. The propensity to kill is sometimes a fixed idea, and the patient can no more banish it from his thoughts than a person afflicted with insanity can divest himself of the delusive ideas which occupy his mind. (Esquirol, t. 2, p. 105.) It has been supposed that Esquirol here implies a state in which there is no perversion of intellect. The facts which he mentions, however, clearly prove the contrary ; for if a patient has not the power to banish from his thoughts this propensity to kill, he has passed beyond the bounds of reason, and is really insane. The admission of this fact proves that his mind must be unsound. Esquirol says, before the perpetration of the act there may be no sign of irrational conversation or conduct; but he asks the question — Because there is no proof of irrationality, are we to assume that these persons possess reason ? Is it possible to reconcile the exist- ence of a rational state of mind with the murder of those who are most dear to them ? (Op. cit., vol. 2, p. 102.) In Esquirol's view, therefore, it may be taken that mere perversion oi feelings, irrespective of some I HOMICIDAL MANIA — ITS VARIOUS FORMS. 751 latent aborration of intellect, docs not exist, and moral insanity is a con- ventional term for a state in which the proofs of mental disturbance are not so clear as in the generality of cases. An erroneous notion prevails in the public mind that a homicidal lunatic is easily to be distinguished from a sane criminal by some certain and in- variable symptoms or character, which it is the duty of a medical witness to display in evidence and of a medico-legal writer to describe. But a per- usal of the evidence given at a few trials will surely satisfy those who hold this opinion, that each case must stand by itself. It is easy to classify homicidal lunatics, and say that in one instance the murderous act was committed from a motive — i.e. revenge or jealousy ; in a second from no motive, but from irresistible impulse ; in a third from insane delusion ; in a fourth from perverted moral feeling, without any sign of intellectual aberration. This classification may comprise all the varieties of homicidal insanity, but it does not help us to ascertain in a doubtful case whether an act was or was not committed under any of these psychological condi- tions. It enables us to classify those who are acquitted on the ground of insanity, but it entirely fails in giving us the power to distinguish a sane from an insane criminal, or a responsible from an irresponsible agent. According to Esquirol, whose views, more or less modified, are adopted by most writers on the medical jurisprudence of insanity, the facts hitherto observed indicate three der/7'ees of homicidal mania: — 1. In the first degree the propensity to kill is connected with absurd or irrational motives or with actual delusion. The person would be at once pronounced insane. Cases of this description are not uncommon, and they rarely create any difficulty. 2. In the second degree the desire to kill is connected with no known motive. It is difficult to imagine a rational motive for the deed ; the person appears to have. been led on by some impulse. There may have been delusion at the time, but there is no evidence of the pre-existence of this. With respect to this class of cases Stephen, J., observes: " There are motives for all acts even the maddest, but it is frequently impossible to assign them specifically. It is, however, generally possible to forni an opinion whether a given act was done from some unknown mad motive or for some unknown sane motive." 3. In the third degree the impulse to kill is sudden, instantaneous, unre- flecting, and uncontrollable. The act of homicide is perpetrated without interest, without motive, and often on persons who are most fondly loved by the perpetrator. It is in this form, which has been called " impulsive insanity," which has given rise to so much contention on trials for murder in which insanity is set up as a defence, and therefore it will be well to consider this subject in a legal aspect. Stephen, J., thus comments upon it: " It is said that on particular oocasions men are seized with irrational or irresistible impulses to kill, to steal, or to burn, and under the influences of such impulses they sometimes commit acts which would otherwise be most atrocious crimes. It would be absurd to deny the possibility that such impulses may occur or the fact that they have occurred and have been acted on. Instances are given in which the impulse was felt and resisted. The only question which the existence of such impulses can raise in the administration of criminal justice is Avhether the particular impulse was irresistible as well as unresisted. If it was irresistible the person accused is entitled to be acquitted, because the act would not then be voluntary and not properly his act. If the impulse was resistible, the fact that it proceeded from disease would be no excuse at all. If a man's 7o2 HOMICIDAL MANIA ITS SPECIAL CHARACTERS. nerves were so irritated by a baby's crying that he instantly killed it, his act would be murder ; it would not be less murder if the same irritation and corresponding desire were produced by son>e internal disease. The great object of the criminal law is to induce people to control their im- pulses ; and there is no reason why, if they can, they should not control insane as well as sane impulses. The proof that an impulse was irresist- ible depends on the circumstances of the particular case. The com. nionest and strongest cases are those of women who without motive or concealment kill their children after recovery from childl)ed." In a case tried at the Stafford Assizes (Reg. v. IIum))hreys, Nov. 1818), in which a man was charged with the murder of his wife, the medical evi- dence was to the effect that the prisoner was suffering from epileptic mania, of which an irresistible homicidal impulse was one of the features. Bram- well, J., in summing up, said everybody was presumed to be sane until proved to be the contrary. Nor was it enough that a man was mad to entitle him to an acquittal. If an insane man knew he was committing murder, that man was responsible. It was not enough to have a homi- cidal mania. The object of the law was to guard against mischievous propensities and homicidal impulses. A man might be suffering under a just sense of some grievous wrong or outrage which would impel him to violence, but that strong impulse, sane or insane, would not entitle him to an acquittal. He said this to the jury in order to disabuse their minds of a mischievous impression which existed, and which he believed had reached mad people themselves. He did not Ijelieve in uncontrollable impulses at all, and had never heard of such an inqnilse leading to action where the means of prevention were present. The jury acquitted the accused on the ground of insanity, and the judge expressed his full con- currence in the verdict. There was no direct proof of mental disease, but there was want of motive and an absence of any indication of ill will against the wife. The three forms in which a homicidal propensity may thus present itself in cases of insanity differ from each other only in degree — the first two being strongly analogous to, but lighter modifications of, th-e third. All the cases which came before Esquirol had these features in common-»-an irritable constitution, great excitability, singularity or eccentricity of character; and previously to the manifestation of the homicidal feeling there was a gentle, kind, and affectionate disposition. As in other forms of insanity, there was some well-marked change of character in the mode of life ; and this may be taken as a proof that there must have been some degree of intellectual disturbance. The period at which the disorder com- menced and terminated could be easily defined, and the attack could be almost always referred to some moral or physical cause. Attempts at suicide preceded or followed the attacks ; all wished to die, and some de- sired to be put to death like criminals. In none of the cases was there any discoverable motive for the act of homicide. Esquirol believed that there are well-marked distinctions between this state and that of the sane criminal. Among these he enumerates: 1. The want of accomplices in homicidal mania. 2. The sane criminal has always a motive — the act of murder is only a means for gratifying some other more or less criminal passion, and is almost always accompanied by some other wrongful act: the contrary exists in homicidal mania. 3. The vic- tims of the criminal are those who oppose his desires or his wishes; the victims of the maniac are among those who are either indifferent to or who are the most dear to him. 4. The sane criminal endeavors to conceal, and, if taken, denies the crime ; if he confesses it, it is only with some LEGAL TESTS. 753 reservation, and when circumstances are too strong against him ; iDut he commonly denies it to the last moment : it is the reverse with the maniac. The exceptions to which these characters are open will be considered here- after. They have, undoubtedly, greater value in their combined than in their individual application, and when in any case they coexist there is strong reason to believe that the person accused of murder is laboring under homicidal mania. The great difficulty in these cases, however, is to distinguish moral depravity from insanity. We agree with a medico- legal writer on this subject, that " no hideousness of depravity can amount to proof of insanity, unsupported by some evidence of a judgment incapacitated, or of a will fettered by disease. In those cases in which the emotions are perverted, and where there is no clear proof of deranged intellect — cases which do from time to time occur — the presumption ot insanity in regard to a criminal action has to be upheld by evidence of a suspension of the will from mental disease. If it can be proved that the act was not voluntary, this does away with its criminal nature." But in many cases it is impossible to produce satisfactory evidence of the sus- pension of the will as a result of disordered mind : this suspension can in general be assumed only from the act itself — a dangerous assumption, and one that might lead to the confusion of crime with insanity and to the exculpation of all criminals. Legal Tests. — Admitting the existence of homicidal mania, as thus de- fined, it may become a question how, when pleaded in defence for one charged with murder, it is to be practically distinguished from a case in which the crime has been perpetrated by a really sane person. Tests, both medical and legal, have been proposed ; but, singularly enough, in no single instance has the Court for Crown Cases Reserved, or any other court silting in banco, delivered a considered written judgment on the relation of insanity to criminal responsibility, though there are several such decisions as to the effects of insanity on the validity of contracts and wills. (Stephen.) Moreover, every judgment delivered during the last forty-eight years has been founded upon an authority in many ways doubtful, namely, the answers given by the judges to questions put to them by the House of Lords, in consequence of the acquittal of M'Naghten on the ground of insanity, in 1843. Stephens, J., is of opinion that the authority of the answers is questionable, and that they leave untouched the most difficult questions connected with the subject. (Hist, of Crim. Law of Eng , vol. iii. p. 154.) The questions and answers are as follows. Fourteen of the fifteen judges consulted joined in the answers. Question I. — " What is the law respecting alleged crimes committed by persons afflicted with insane delusions in respect of one or more particular subjects or persons, as, for instance, where, at the time of the commission of the alleged crime, the accused knew he was acting contrary to law, but did the act complained of with a view, under the influence of insane delu- sion, of redressing or revenging some supposed grievance or injury, or of producing some supposed public benefit?" Ansiver I. — "Assuming that your Lordships' inquiries are confined to those persons who labor under such i)artial delusions only, and are not in other respects insane, we are of opinion that, notwithstanding the accused did the act complained of with a view, under the influence of insane delu- sion, of redressing or revenging some supposed grievance or injury, or of producing some public benefit, he is nevertheless punishable, according to the nature of the crime committed, if he knew at the time of committing such crime that he was acting contrary to law, by which expression we understand your Lordships to mean the law of the land." 48 75-i LEGAL TESTS. Question II. — " What are the i)ropor quostions to be submitted to the jury when a person, attticted with iiisaiie delusions respecting- one or more particular subjects or persons, is charged with the commission of a crime (murder, for instance), and insanity is set up as a defence?" Question III. — " In what terms ought the question to be left to the jury as to the prisoner's state of mind at the time when the act was com- mitted ?" An.^ivers II and III. — " As these two questions appear to us to be more conveniently answered together, we submit our oi>inion that the jury ought to be told in all cases that every man is presumed to be sane and to possess a sufficient degree of reason to be responsible for his crimes, until the contrary be proved to their satisfaction. That to establish a de- fence on the ground of insanity it must be clearly proved that, at the time of committing the act, the accused was laboring under such a defect of reason from disease of the mind, as not to know the nature and quality of the act he was doing, or, if he did know it, that he did not know that he was doing what was wrong. The mode of putting the latter part of the question to the jury on these occasions has generally been, whether the accused, at the time of doing the act, knew the difference between right and wrong ; which mode, though rarely, if ever, leading to any mistake with the jury, is not, we conceive, so accurate when put generally and in the abstract, as when put with reference to the party's knowledge of right and wrong in respect to the very act with which he is charged. If the question were to he put as to the knowledge of the accused, solely and exclusively, with reference to the law of the land, it might tend to con- found the jury by inducing them to believe that an actual knowledge of the law of the land was essential in order to lead to a conviction ; whereas the law is administered on the principle that every one must be taken conclusively to know it without proof that he does know it. If the ac- cused were conscious that the act was one which he ought not to do, and if that act was at the same time contrary to the law of the land, he is punishable, and the usual course, therefore, has been to leave the question to the jury whether the accused had a sufficient degree of reason to knov/ he was doing an act that was wrong ; and this course, we think, is correct, accompanied with such observations and corrections as the circumstances of each particular case may require." Question IV. — -" If a person under an insane delusion as to existing facts commits an offence in consequence thereof, is he thereby excused ? " Answer IV. — " The answer must, of course, depend upon the nature of the delusion, but making the same assumption as we did before, namely, that he labors under such partial delusion only, and is not in other respects insane, we think he must be considered in the same situation as to respon- sibility as if the facts, with respect to which the delusions exist, were real For example, if under the influence of his delusion he supposes another man to be in the act of attempting to take his life, and he kills that man as he supposes in self-defence, he would be exempt from punishment. If his delusion was that the deceased had inflicted a serious injury to his character and fortune, and he killed him in revenge for such supposed in- jury, he would be liable to punishment." It would thus appear that the law, in order to render a man responsible for a crime looks for a consciousness of right and wrong and a knowledge of the consequences of the act; while the administration of justice rests on the principle that every one knows the law and fears its punishment. Thus the complete possession of reason is not essential to constitute the legal responsibility of an offender ; and it is also to be inferred, from the CRIMINAL RESPONSIBILITY OF INSANE HOMICIDES. 755 results of several cases, that a man may be civilly incompetent, but suffi- ciently sane to be made criminally responsible. The proofs required in the two cases are essentially distinct. It has been objected to this legal test that it is insufficient for the pur- pose intended ; it cannot, in a large majority of cases, enable us to dis- tinguish the insane homicide from the sane criminal. Many insane per som have committed acts which they knew to be wrongs, and of the criminalitv of which they were at the time perfectly conscious. They have been known to murder others in order to receive the punishment of death at the hands of the law ; and therefore the}^ must have been conscious of the wrongfulness, or rather of the illegality, of the act which they were perpe- trating, and have known that they were committing an offence punishable by the law of man. In short, the criminal nature of the act has often been the sole motive for its perpetration. (Ann. d'Hyg., 1852, t. 1, p. 363.) It has been suggested, with some truth, that it is rather the imperfect or defective appreciation of the motives to right or against wrong action which leads to crime among the insane, and not the mere ignorance o'l right and wrong. Most lunatics have an abstract knowledge that righl is right and wrong wrong; but in insanity the voluntary power to com trol thought and actions and to regulate conduct by this standard is inv paired, limited, or overruled by insane motives. A lunatic may have the power of distivguishing right from wrong, but he has not the power oi choosing right from wrong. A criminal is punishable, not merely because he has the power of distinguishing right from wrong, but because he vol- untarily does the wrong, having the power to choose the right. (On the Relation of Insanity to the Crim. Law, by Orange, IStT.) \_Criminal Responsihiltty of the Insane Homicide. — A wide divergence of opinion exists in the American States as to the legal effect of the ans\vers of the English judges to the questions propounded l)y the House of Lords in the excitement growing out of the M'Naghten Case in 1843. 1. It must be conceded that these judicial responses were the mere expressions of the individual opinions of the judges, and not decisions by a court of competent jurisdiction pronounced in a case before them ; in other words, that they are mere obiter dicta, and of no binding effect upon any court in England or elsewhere. Sir James Fitz James Stephen has well Said concerning them : " That they were mere answers to ques- tions which the judges were probably under no obligation to answer, and to which the House of Lords had probably no right to require an answer, as they did not arise out of any matter judicially before the house:" Stephen's Hist. Crim. Law of England, vol. 2, p. 154. 2. While these answers have been by common usage usually followed by the English trial judges, it is a significant fact that they have not re- ceived the approval of the High Court for Crown Cases Reserved. 3. The conviction of insane homicides in such cases as those of Gold- stone and Cole in England, and of similar cases in some of the American States, where judges have followed the dicta of the judges, upon what has been commonly known as the Right and Wrong Test, has led to a strong revulsion of feeling against that doctrine both in England and in the American States. The medical profession of England instantly pro- tested against the answers of the English judges, by the resolutions adopted July 11, 1844, at the session of the British Association of Medical Superintendents, which was the year after the answers of the English judges were made. In some of the American States the dicta of the English judges was followed, notably New York, Pennsylvania, Massa- chusetts, Michigan, Alabama, Ohio, and other States. Writers and jurists 756 CRIMINAL RESPONSIBILITY OF INSANE HOMICIDES. denounced the " Riyht and Wrong Test" on both sides the Atlantic. Brown's Med. Juris., §§ 18 et aeq. ; Wharton & Slille, § 59 ; Bishop Crini. Law, 7th ed., §§ 386 et seq.; Wharton's Crini. Law, §§ 33 et .sf^. ; Ordronaux on Insanity, 419; Ray Med. Juris., 1(3-19; Buclviiill & Tuke, p. 269; Bell, Med. Leg. Jour., vol. 2, p. 339 ; the same, Med. Leg. Jour., vol. 7, p. 88. 4. la August, 1833, an Act of Parliament was passed in England de- claring that if the homicide was insane at the time he committed the act a special verdict should be found by the jury. 5. In the American courts the soundness of the doctrine of the dicta of the English judges has been severely criticised and overruled, if an obiter dicta of a court can ever properly be regarded as overruled. The most notable case was that of State v. Pike, in which Chief Justice Doe, of the Supreme Court of New Hampshire, wrote the masterly opinion of the whole bench, repudiating the doctrine contained in the answers of the English judges : 49 X. Hamp. p. 399; 50 N. H. p. 3G9. Similar decisions followed in the Supreme Courts of Kentucky (Kried v. Com., 5 Bush (Ky.), 362 ; Smiths. Com., 1 Duv. (Ky.) 224) ; in Virginia (I)ejarnette v. Com., 75 Va. 576); in Mississippi (Cunningham v. State, 56 Miss. 269); in Connecticut (State v. Jolinson, 40 Conn. 136; Anderson v. State, 43 Conn. 514) ; in Iowa (State v. McWhorter, 46 Iowa, 88 ; State v. Fettes, 35 Iowa, 68); in Illinois (Hopp v. People, 31 111. 385); in Indiana (Bradly v. State, 31 Ind. 492) ; in Texas (Harris o. State, 18 Texas Ct. of App. 87) ; in Pennsylvania (Coyle v. Com., 100 Pa. 573) ; in Georgia (Roberts v. State, 3 Ga. 310); in Massachusetts (Com. v. Rogers, 7 Mete. 500); in the District of Columbia (People v. Daly, reported in Med. Leg. Journal, vol. 7, Sept. No.), and more recently in the notable case of Parsons v. State, where Somerville, Justice, wrote the opinion of the bench of the Supreme Court of Alabama, a masterly and exhaustive treatise upon the whole subject, distinctly overruling the doctrine answered by the English judges (which is, as was Chief Justice Doe in the New Hampshire cases, a leading case, and is reported in full in the September No. of vol. 7 of Medico-Legal Journal). Mr. Justice Stone wrote a dis- senting opinion as to certain propositions, but not upon the main question, and upon the " right and wrong" theory he did not dissent. 6. The acquittal of Hadfield in England, defended by Erskine, was within the doctrine as stated in State v. Pike, in New Hampshire, and Parsons v. State, in Alabama. Lord Kenyon, one of the ablest of the English judges, acted and decided correctly, under the law of England, when he stopped the case before the witnesses for the defence were all sworn, and directed the acquittal, as matter of law, on the substantial doctrine of the decision as laid down in the Alabama case. In the case of M'Xaghten, the eminent judge who tried that case correctly applied the law of England as it then existed and had been previously administered, in directing an acquittal, on the assent of M'Naghten, did not even know Sir Robert Peel, nor Mr. Drummond, and he was, beyond all question, laboring under an insane delusion which dominated his action. His acquittal was correct under the law of England, but he would have been convicted under the recent dicta of the English judges. It is doubtless true that the excitement of that era, which led to the extraordinary in- quiry, may have largely influenced the English judges in framing their answers. One of the ablest law officers of the crown. Sir William Follett, admitted upon the appeal of Judge Tyndale that he must submit to a verdict of acquittal on the ground of the defendant's insanity : Serjeant MEDICAL TESTS, 757 Ballantyne, vol. 1, p. 240. M'Naghten was defended by Mr. Cockburn, afterward the Lord Chief Justice. 7. It may be claimed that the answers of the English judges did not cor- rectly state the law of England, as it had before that time been adminis- tered in this respect, and notably in the case of Hadfield v. M'Naghten, and that the answers set up a new legal test or criterion, which upon trial has been found to be against the teachings of science and repugnant to and in conflict with the civilization of our age. 8. The action of the p]ng]ish Home Secretary and the law officers of the Crown in recent cases indicates a great change in English judicial views, and the course now taken of having a full and impartial inquisition in every case of suspected insanity, with competent experts, conducted by the government officials before the main trial, makes it extremely im- probable that any insane homicide will be likely to be either convicted or executed in Great Britain in the near future.] Medical Tests. — The tests which have been proposed by medical jurists for detecting cases of homicidal mania are as follow-s : — 1. The acts of homicide have generally been preceded by other striking peculiarities of conduct in the person, often by a total change of character. 2. Those persons who are aft'ected with it have in many instances pre- viously or subsequently attempted suicide — they have expressed a wish to die or to be executed as criminals. These supposed criteria, when tendered as medical proofs of insanity in courts of law, have been repeatedly and very properly rejected. They are of too vague a nature for practical use, and apply as much to cases of moral depravity as of actual insanity ; in short, if these Mere admitted disproofs, they would serve as a convenient shelter from punishment for many sane criminals. 3. Motive for Crime. — The acts are without motive; they are in oppo- sition to all human motives, A man known to have been tenderly at- tached to his wife and children murders them ; a fond mother destroys her infant. It is hereby assumed or implied that persons who are sane never commit a crime without an apparent motive, and that in the perpetration of a criminal act an insane person either never has a motive, or has one of a delusive nature only. If these propositions were true, it would be easy to distinguish a sane from an insane criminal ; but the rule wholly fails in practice. In the first place, the non-discovery is here taken as a proof of the non-existence of a motive ; while it is undoubted that motives may exist for many atrocious criminal acts without our being able to discover them — a fact proved by the numerous recorded confessions of criminals before execution, in cases in which, until these confessions were made, no motive for the perpetration of the crime had appeared to the acutest minds. 4. Confession. — The subsequent conduct of the person ; he seeks no escape, delivers himself up to justice, and acknowledges the crime laid to his charge. This is commonly characteristic of homicidal mania; for by the sane criminal every attempt is generally made to conceal all traces of the crime, and he denies it to the last, or until he sees that denial can be no longer serviceable to him. 5. Accomplices. — The sane murderer has generally accomplices in vice or crime; the homicidal maniac has not. Upon this it may be observed that some of the most atrocious murders committed in modern times have been proved to be the acts of persons who had neither accomplices nor any assignable inducements leading to the commission of the crimes. It is, however, a fact so far in favor of the existence of homicidal insanity, that the insane never have accomplices in the acts which they perpetrate. These criteria can hardly be described as medical ; they are circumstances 758 MEDICAL TESTS. upon which a non-professional man may form just as safe a judgment as one who has made insanity a special study. 6. Delusion in the Act. — The presence of delusion has been said to char- acterize an act of homicidal mania, while premeditation, precaution, and concealment have been considered to l)e the essential features of the act of a sane criminal. Some medical men think, if they discover anything re- sembling a delusion in the mind of an accused person, that he is necessarily irresponsible for the act, but the doubtful theory of the law, as supposed to be laid down by the judges in M'Naghten's case (see p. 753, ante), is that, notwithstanding a person labors under a delusion, if he commits an act which he knows to be contrary to law, he is liable to punishment ; if the delusion be partial, the party accused is still responsible ; and if the crime were committed for an imaginary injury, he would be held equally responsible. Much stress Avas formerly laid upon the delusion beirig con- nected loith the act in cases of alleged insanity ; but it must be remembered that, except by the confessions of insane persons during convalescence, it is not easy for a sane mind to connect the most simple acts of a lunatic with the delusion under which he is laboring. Every act of homicide per- petrated by an insane person is perhaps connected with some delusion T.nth which he is aifected ; but it is not to be supposed that one who is sane can always discover this connection. It may be further observed that premeditation, precaution, concealment, and flight are met with in crimes committed by both sane and insane criminals, although these acts are certainly strong characteristics of sanity. It should be a question for a jury whether, when they are proved to have existed in any criminal act, there might not have been such a power of self- control in the person, although in some degree insane, as to justify a conviction. It is not the presence of a slight degree of mental aljerration which necessarily indicates a loss of power of controlling actions. 7. A Number of Murders perpetrated at once. — In the acts of sane criminals one person, or at the most two, may be destroyed ; but, in cases of homicidal mania, it is not unusual to find a wife and several children killed by the husband, or four or five children at once destroyed by the wife. In these cases no motive but that which is based on some insane delusion, can be suggested for such a series of murders. Thus four infants may be found murdered by a mother, who admits the act, but endeavors to account for it by asserting that she wished to convert them into angels, or to save them from destitution and exposure to worldly temptations. It would be wrong, however, to infer from this statement that, because a man has heaped crime upon crime, he is therefore insane. This would be equal to making the atrocity of the crime or crimes a test of insanity. In the case of Southey (Reg. v. Southey, Maidstone Wint Ass., 1805), it was proved that the prisoner, a man of depraved habits, had destroyed three of his children in London, and had then proceeded to Ramsgate, and there deliberately destroyed his wife and another child. He pretended to justify these five murders, and wished to make it appear that he Avas in- sane. In regard to this man's conduct through life, nothing but moral depravity was proved. Still, he found medical defenders, who brought forward as proofs of " delirium," statements which clearly showed that they did not understand the meaning of the term. It was admitted that if the man had committed one of the murders, he might have been sane, but having committed five in succession, he was insane and incompetent to judge of the nature of his acts. The fallacy of such an argument needs no exposure. There could be no doubt of the sanity of Rush, who was tried and convicted of the simultaneous murder of three persons. (Norwich HOMICIDAL MANIA SUMMARY. 759 Lent Ass., 1849.) Thinking that he had a legal claim to an estate held by a Mr. Jerniy, the prisoner went to the house, concealing his features with a mask, and there shot, one after the other, Mr. Jermy, his son, his sou's wife, and a maidservant, killing three of them. The defence of in- sanity was not set up. He was convicted and executed. Summary. — The foregoing considerations lead to the inference that there are no certain legal or medical tests or characters whereby homi- cidal mania can be demonstrated to exist. Each case must be determined by the circumstances attending it ; but the true criterion of irresponsibility appears to be whether the person, at the time of the commission of the crime, had or had not a sufficient power of self-control to govet'u his actions; or, in other words, whether he knew^ the act was wrong, and could avoid the perpetration of it. Stephen, J., expresses a similar opinion in stating that there should be proof of an absence of the power of self- control, caused by disease affecting the mind. This involves the con- sideration, not only whether insanity existed in the accused, but whether it had reached such a degree as to destroy, not merely a consciousness of the nature of the act, but volition — the will to do or not to do it. If from circumstances it can be inferred that an accused person had this power, whether his case falls within the above rules or not, he should be made responsible and liable to punishment. If, however, he was led to the per- petration of the act by an insane impulse, or, in other words, by an impulse which his mental condition did not allow him to control, he is entitled to an acquittal as an irresponsible agent. The power of con- trolling an act appears to imply the existence of such a state of sanity as to render the party responsible ; and when there is this want of control, it may be fairly concluded that there is no sane intention, and that the person is irresponsible. A test somewhat similar to this is constantly applied by juries, under the direction of our judges, to distinguish murder from manslaughter ; and it is quite certain that sanity and homicidal mania are not more nicely blended than those shades of guilt whereby man- slaughter passes into murder. The manner and circumstances under which a crime is committed will often allow a fair inference to be drawn as to how far a power of self-control existed or was exercised. A man in a violent fit of mania or delirium rushes with a drawn sword into an open street, and stabs the first person whom he meets ; another, worn out by povert}^ and destitution, murders his wife and children to prevent them from starving, and then probably attempts to destroy himself; these are cases in which there is a fair ground to entertain a plea of irresponsibility. But when we find a man, not showing any previous intellectual dis- turbance, lurking for days together in a particular locality, having about him a loaded weapon, watching a particular person who frequents that locality, not facing the individual and shooting him, but coolly waiting until he has an opportunity of discharging the weapon unobserved by his victim or others — the circumstances appear to show such a perfect adapta- tion of means to ends, and such a power of controlling actions, that it is difficult to understand on what principle an acquittal on the ground of in- .sanity could have been allowed. We refer here to the case of M'Naghten, tried for the murder of Mr. Drummond, Jan. 1843. The acquittal in this case was the more remarkable because there was no proof of general in- sanity, and the crime was committed for a supposed injury. According to the rules laid down by the fifteen judges, from questions submitted to them in connection with this case, this man should have been convicted (ante, p. 753). \^Note. — There was nothing remarkable about the acquittal of McNaghten. The defence interposed was insanity. The counsel for the 760 ALLECJED EXISTENCE OF DELUSION. Crown was Sir William Follet. ]\IcNaghten was defended by the late Lord Chief Justice Cockburn, then at the bar. The trial was before Sir Nicholas Conyingham Tindal, Chief Justice of the Common Pleas, in 1843. Ser- geant Ballantine, writing of that trial in his work published in 1882, says : " The only question that was in issue was whether the prisoner at the time of the commission of the offence was of sound mind." McNaghten was laboring under the insane delusion that Sir Robert Peel was bent on his destruction. Sir Robert Peel did not know McNaghten, who shot Mr. Drummond supposing him at the time to be Sir Robert Peel. Sergeant Ballantine, in describing the trial, says of Lord Cockburn's argu- ment to the court, that " It was one of the most masterly arguments ever heard at the English bar." He says : " Several witnesses were called and the fact of insanity proved fully, and before the evidence was concluded, the Chief Justice appealed to Sir Wm. Follet, who admitted that he must submit to a verdict acquitting the prisoner upon the ground of insanity, and that verdict was rendered accordingly." He says : " A storm of indig- nation followed the verdict. ' Mad or not, the prisoner ought to have been hanged,' was the general statement. This outcry resulted in a very singular proceeding on the part of the House of Lords, which had no precedent and fortunately has never been repeated." The evidence of the insanity of Mc- Naghten was conclusive, and so overwhelming that the court stopped the trial and did not submit the case to the jury, but directed a verdict with the full assent of the law officers of the crown. ( Vide Works of Sergeant Ballantine, vol. i. p. 246; also Med.-Legal Jour., vol. x. p. 241.)] In cases of alleged homicidal mania, very vague meanings have been sometimes assigned to the term "delusion." In Reg. v. Burton (Maid- stone Lent. Ass., 1863), the prisoner, a youth of 18, was indicted for the murder of a boy at Chatham. There w^as no motive, but it was argued by the counsel that he labored at the time under a delusion — the delusion being a desire to be hanged. The surgeon of the prison stated that he had had frequent opportunities of examining the prisoner w^hile in gaol, and in his opinion he was perfectly sane ; so far as the witness could judge, he w^as under no delusion. The jury returned a verdict of "guilty." If the youth had believed that he had been already hanged for murder, this might have been considered a delusion ; but a desire to be hanged, or to die from any violent cause, cannot be so regarded. The remarks of Wight- man, J., upon this kind of defence contain all that is necessary to show its fallacy. In passing sentence upon the prisoner, he said, "It is stated that 3^ou labored under a morbid desire to die by the hands of justice, and for this purpose you committed the murder. This morbid desire to part with your own life can hardly be called a delusion ; and, indeed, the con- sciousness on your part that you could effect your purpose by designedly depriving another of life, for which you knew you would have to suffer the punishment due to the greatest of crimes, shows that you Avere per- fectly able to understand the nature and consequences of the act which you were committing, and that you knew it was a crime for which by law the penalty was capital. This was, in truth, a further, and I may say a deeper aggravation of the crime : for you designedly intended to compass your own death by the murder of another." In forming a judgment of the mental condition of an accused person, it is no part of the province of a witness to modify his opinion according to the punishment, which may follow if the plea be rejected ; he should sim- ply base it on the medical facts of the case. The legislature only is re- sponsible for the punishment adjudged to crimes. Mayo justly observed that a medical witness is summoned to a court of justice in order to enable THE DOCTRINE OF "IRRESISTIBLE IMPULSE." 761 the judg^e and jury to arrive at certain practical conclusions. The ques- tion proposed to him involves a simple fact, and not its consequences; and if the latter consideration be entertained by him, it will be liable to bias his evidence on the fact, which is his legitimate topic. The definition of insanity becomes very expansive when its expansion may become pro- tective to a criminal with whom we may happen to sympathize. The question whether the accused is a responsible agent is of a judicial nature : our evidence should be confined to the question whether the accused is insane in a certain sense or meaning in which it is understood and defined by law. A medical witness in these cases often moulds his evidence to a foregone conclusion on the criminal responsibility of the accused, and thus lays himself open to a remark from the judge that he must not encroach on the functions of the jury. It is certainly a great evil that, under the present mode of laying this question before a jury, the law operates un- e([ually. One case becomes a subject of prominent public interest, and every exertion is made to construe the most trivial eccentricities of char- acter into proofs of insanity, and to magnify the effects of an hereditary tendency by proving that a distant relative had been a lunatic : an acquit- tal follows. Another case may excite no interest: the accused is con- victed, and either executed or otherwise punished, although the evidence of insanity, had it been as carefully sought for and brought out, would have been perhaps stronger in this than in the former instance. The doctrine of " irresistible impulse " and the theory of impulsive in- sanity have been strained in recent times to such a degree as to create in the public mind a distrust of medical evidence on these occasions. It is obviously easy to convert this into a plea for the extenuation of all kinds of crimes for which motives are not at once apparent, and thus medical witnesses often expose themselves to severe rebuke. They are certainly not justified in setting up such a defence, unless they are prepared to draw a clear distinction between- impulses which are " unresisted " and those which are irresistible. As a judge once remarked in his address to a jury, "What is the meaning of not being able to resist an impulse? Every crime is committed under an impulse, and the object of the law is to com- pel persons to control or resist these impulses. If it is made an excuse for a person who has committed a crime, that he was goaded to it by some impulse which medical men might choose to say he could not control, such a doctrine would be fraught with very great danger to society." While the truth of these remarks is obvious, it must be admitted that the legal test for responsibility is not satisfactory. In addressing the jury in Reg. v. Cockroft, in a trial for murder (Leeds Aut. Ass., 1865), Mellor, J., made the following observations on the defence of insanity which had been set up: "It would be dangerous if the idea went abroad that per- sons committing crime under sudden impulse were therefore to be excused. At the same time, he thought that the definition of insanity which would excuse from criminal responsibility, as given in M'Naghten's case, hardly went far enough. He was of opinion that a man might know that he was doing an act which was wrong, and still he might be laboring under such disease of the mind as not to be able to restrain his impulse to do that act, and he should therefore not be amenable to the criminal law. The mere fact, however, of the prisoner being ignorant and of a low type of mind would be no excuse. If the jury thought that the prisoner knew at the time when he committed the act that he was doing wrong, and was not laboring under such a disease of the mind as incapacitated him from controlling his impulses, he was not entitled to acquittal on the ground of insanity. The doctrine of uncontrollaljle impulse, as laid down by some 762 MEDICAL THEORIES. writers, M'as a very dang-erous one, and required to be watched with the utmost care, Pa.ssion arising- from ])rovocation, however trivial, offered to a mind however ill-regulated, did not relieve the person from criminal responsibility." Hence it follows that a man might know that he was doing- wrong and committing an act against the laws of God and man, yet if with this consciousness of the illegality of the act there was a dis- eased condition of mind which prevented him from controlling his actions, he will be entitled to an acquittal on the ground of insanity. With this admission, it is unnecessary to occupy space with metaphysical discussions regarding criminal responsibility ; for however objectionable the theory — if the practice of the law be in any one case in conformity with that which has been advised by writers on the Medical Jurisprudence of Insanity, althoug-h it may be even adverse to the theory on which it is professedly based, this is all with which we have to concern ourselves — the principle is admitted. The great defect in the English criminal law is, not that it will not go even to the full extent of exculpating a person who has committed a crime with a knowledge of its illegality, and under what is called an "uncontrollable impulse," or an impulse which, owing to mental disease, his reason was noi sufficient to control, but the uncer- tainty of its application. There are many cases reported which show that an acquittal on the ground of insanity, in a trial for murder, is fre- quently a mere matter of accident. Numerous trials for murder have within the last few years taken place in which there have been acquittals on the ground of insanity, and the accused confined during her Majesty's pleasure. In some of these epilepsy has been associated with insanity. The details of these cases present no striking difference from those recorded in the text, with the exception of one, in which a man who had been a lunatic and had recovered was tried on a charge of murder and acquitted on the ground of insanity. (Reg. v. Blampied, Maidstone Sum. Ass., 1875.) The prisoner was charged with the wilful murder of a fellow-laborer named Catt. Blampied became insane in Dec. 1868, was confined in an asylum, from which he was dis- charged as cured in Dec. 1872, and had ever since worked at his trade in a proper manner. The deceased man was often associated with him, and some months previously a quarrel had taken place between them, but it was not serious, and they were apparently on friendly terms. In April, 1875, they were working within six feet of each other, when the prisoner, without any known provocation, struck the deceased violently with an adze on the back of the head, fracturing his skull and causing his death. The man pleaded not guilty, with every appearance of sanity. In the defence it was urged that he was not responsible for the act on the ground of in- sanity. Brett, J., told the jury that the law took no heed of sanity or insanity abstractedly considered, or of the presence or absence of delusions. To exempt from responsibility, a man must be so mad as not to know the nature of the act he committed. If he knew what he was doing, and if he knew that it was wrong, then, however mad he might be, he was still responsible. He also remarked that for three years previously the prisoner had been sane and had been treated as sane by his associates. These re- marks pointed clearly to a conviction, but the jury after consulting for a short time, found a verdict of guilty, but that the prisoner was not ac- countable for his acts; in other words, they acquitted him on the ground of insanity. This shows that on these occasions a jury may decline to accept the legal rule of responsibility as here laid down and act upon their own judgment. [There is no legal warrant either in England or America for the language JUDICIAL OPINIONS ON INSANE DELUSION. 763 imputed to Mr. Justice Brett, in the case of Reg. v. Blampied, Maidstone Sum. Ass., 1895. The decision of the jury was correct and eminently proper. The dicta of Mr. Justice Miller (ante) in Reg. v. Cockroft more correctly states the law applicable to such cases. 1. There is a difference between an insane delusion which dominates and controls the action of an insane person, and a mere delusion which affects the sane or the insane mind similarly^ Both sane and insane minds may rest under delusions, but whether the insane delusion be of such a character as to dominate the will and action of the accused, in reference to the act, is the crucial test of criminal responsibility. 2. No amount of moral degeneration, or vice, which has become unre- sisted or irresistible ever excuses crime. The second-nature criminal may have irresistible impulses to steal, rob, and commit crime. The light of science shines upon the path and clearly marks the boundary line of crime and vice in him who, dominated by an insane delusion, which controls the conduct and dominates the will, commits an act which lacks all the essential elements of crime. Chief Justice Gibson states the law correctly when he says in Commonwealth v. Mosler, 4 Barr. 266 : " It (insanity) must amount to delusion or hallucination controlling his willj and making the commission of the act a duty or overruling necessity," and again : " The law is that whether insanity be general or partial it must be so great as to have controlled the will of its subject, and to have taken from him the free- dom of moral action." The knowledge of right and wrong, either in the abstract or in regard to the act committed, knowledge of its character and consequences, even, may exist, as in the case of Guiteau and possibly, though not probably, in the case of Dr. Beach (at the moment of the killing), then even, in the lan- guage of Judge Gibson, " if it (th« insanity) was so great as to have con- trolled the will and taken from him the freedom of moral action," by the law of Pennsylvania the accused would not be responsible ; and in cases of moral insanity under the law of that State, as announced by the court, Mr. Chief Justice Lewis pronouncing the opinion, " We say to you as the result of our reflections on this branch of the subject, that if the prisoner was actuated by an irresistible inclination to kill, and was utterly unable to con- trol his will or subjugate his intellect, and was not actuated by anger, jealousy, revenge, and kindred evil passions, he is entitled to an acquittal." Sir James Fitz James Stephen, by far the ablest writer upon the criminal law of England, in reviewing it historically, writing as late as his treatise on the History of the Criminal Law of England (1883), says : " I know of no single instance in which the Court for Crown Cases Reserved, or any other court sitting in banco, has delivered a considered written judgment on the relation of insanity to criminal responsibility, though there are several of such decisions as to the effect of insanity on the validity of con- tracts and wills." (Stephen's Hist. Crini. Law of Eng., vol. ii. p. 152.) The question is, or should be, How far does the delusion dominate the volition ? or, in another class of cases, as Sir James Stephen puts it, " Was the accused deprived, by a disease affecting the mind, of the power of passing a rational judgment on the moral character of the act which she meant to do?" (Bell's Medico-Legal Studies, vol. ii. p. 1.) Lord Denman said, in Rex v. Oxford, 2 C. & P., p. 225, where the accused was evidently acting under the duress of a delusion, probably of an insane character : " If some controlling disease was in truth the acting power within him which he could not resist, then he will not be responsible." In State v. Pike, 49 N. H. 399 (50 N. H. 367). The opinion of Chief Justice Doe is the most masterly and instructive 764 JUDICIAL OPINIONS ON INSANE DELUSION. discussion of the law of Criminal Responsibility of the Insane extant. (Bell's Med.-Legal Studies, vol. ii. j). 14; vide also Laws on Insanity, p. 311-312, and 2 Lawson's Crini. Def. 311 et seq.; also Decisions in American States (Kriel v. Com., 5 Bush (Ky.) 362, Smith v. Com., 1 Duv. (Ky.) 224); in Virginia (Dejarnette v. Com., 75 Va. 876) ; in Mississippi (Cunningham r. State, 56 Miss., 269) ; in Connecticut (State v. Johnson, 40 Conn. 136, Anderson v. State, 43 Conn, 514) ; in Iowa (State v. McWliorter, 46 Iowa 88, State v. Feltes, 35 Iowa, 68); in Illinois (Hopp v. People, 31 111. 385) ; in Indiana (Bradley v. State, 31 Ind. 492) ; in Texas (Harris v. State, 18 Tex. Court of Appeals, 87) ; in Pennsylvania (Coyle v. Com., 100 Pa., p. 573) ; in Georgia (Roberts v. State, 3 Ga. 310) ; in Massachu- setts (Com. V. Rogers, 7 Mete. 500). The most complete recent statement of the law will be found in the opinion of Somerville, J., in Parsons r. State, given in full in Bell's Med.- Legal Studies, vol. ii. p. 16 ; and Med.-Legal Jour. This case holds that the inquiries to be submitted to the jury in any criminal trial where the defence of insanity is interposed should be : 1. Was the defendant at the time of the commission of the alleged crime, as matter of fact, afflicted with a disease of the brain affecting the mind, so as to be either idiotic, or otherwise insane ? 2. If such be the case, did he know right from wrong as applied to the particular act in question ? If he did not have such knowledge, he is not legally responsible. 3. If he did have such knowledge, he may nevertheless not be legally responsible if the two following conditions concur : (1.) If, by reason of the duress of such mental disease, he had so far lost the poiver to choose between the right and the wrong, and to avoid doing the act in question, as that his free agency was at the time destroyed. (2.) And if, at the same time, the alleged crime was so connected with such mental disease, in the relation of cause and effect, as to have been the product of it solely. (Bell's Med.-Legal Studies, vol. ii. p. 31. Vide also opinion by Dillon, C. J., in State v. Felton, 35 Iowa 67 (Bell's Med.-Legal Studies, vol. ii. p. 16). Judge Dillon held : That the capacity to distinguish between right and wrong was not a safe test of criminal responsibility in all cases, and it was accordingly decided, that, if a person commit a homicide, knowing it to be wrong, but do so under the influence of an uncontrollable and irresistible impulse, arising not from natural passion, but from an insane condition of the mind, he is not criminally responsible. " If," said Chief Justice Dillon, "by the observation and concurrent testimony of medical men who make the study of insanity a specialty, it shall be definitely established to be true that there is an unsound condition of the mind, that is, a diseased condition of the mind, in which, though a person abstractly knoAvs that a given act is wrong, he is yet, by an insane impidse, that is, an impulse proceeding from a diseased intellect, irresistibly driven to commit it — the law must modify its ancient doctrines and recognize the truth, and give to this condition, when it is satisfactorily shown to exist, its exculpatory eflfect." In the case of People v. Daly — trial in 8th District Court at Washington, D. C, Jan. 13, 1887 — Judge Montgomery charged the jury as follows : " 1. Was the defendant at the time, the time of the act, as matter of fact, afflicted with disease of the mind — was he wholly or partially insane ? " 2. If he was so afflicted, did he know right from wrong, as applied to the homicide in question ? " If he did have such knowledge, had he by reason of the duress of such mental disease, so far lost the power to choose between the right and the PUERPERAL MANIA. 765 wrong, and to avoid doing the act in question, as that his free agency was, at the time, destroyed, and if so, was the homicide so connected with such mental disease, in the relation of cause and effect, as to have been the pro- duct of it (the mental disease) solely. If you are satisfied from the evidence that the defendant was mentally afflicted, so that he did not know right from wrong, as applied to the act, or if he did know, but by reason of tiie duress, the stress of his mental disease (if he had any), he had no power to choose, no power to avoid doing what he did, and if the homicide was the product of his mental condition solely, or, if by reason of the insane delu- sions which the defendant had been harboring (if any), he had reached that condition of mind where the morbid impulse to kill became irresistible, and existed in such violence as to subjugate his intellect, control his will, and render it impossible for him to do otherwise than to yield and do as he did, then he is not to be held accountable. " ' If some controlling (mental) disease was in truth the acting power within him, which he could not resist, then he will not be responsible.' " ' If a person commit a homicide under the influence of an uncontrollable and irresistible impulse, arising 7iot from natural passion, but from an insane condition of the mind, he is not criminally responsible.' "] From the number of acquittals which annually take place on the ground of insanity, it will be understood that Broadmoor and other county asylums have a large population of criminal lunatics. In 1883, there were 535 in Broadmoor. In 1881, five murderers were discharged from Broadmoor, and six died. It thus appears that nearly half our lunatic murderers are eventually set at liberty. CHAPTEE LXVII. PUERPERAL MANIA. PYROMANIA. KLEPTOMANIA. DIPSOMANIA. RESPONSIBILITY OP DRUNKARDS. DELIRIUM TREMENS. SOMNAMBULISM. THE DEAF AND DUMB. Puerperal Insanity. — Mania may present itself in other forms than those hitherto considered. Women who have been recently delivered are liable to sudden attacks, in which a disposition to murder their offspring is the most marked symptom. This has been long known and recognized by physicians as "puerperal mania." The disorder seldom attacks a woman before the third day, often not for a fortnight, and in some instances not until several weeks after delivery. Out of ninety-two cases, Simpson oUserved that the attack occurred in twenty-one between the fifth and the fifteenth day. (Med. Times and Gaz., 1860, ii. p. 201.) The most fre- quent period is at or about the commencement of lactation, and between that and the cessation of the uterine discharges. According to Esquirol, it is generally preceded or attended by a suppression of the lochia and milk. Ashwell remarked that undue lactation might give rise to an attack of mania, under w^hich the murder of the offspring might be perpetrated. (Dis of Women, p. 732. See the case of Reg. v. Lacey, Nottingham Sum. Ass., 1858.) It may also come on after forced or voluntary weaning. The symptoms do not differ from those of mania generally, but it may assume any of the other forms of insanity ; and, in one-half of the cases, it may be traced to hereditary tendency. There is a childish disposition 76G P Y R M A N I A K L E P T M A N I A . for harmless mischief. The woman is gay and joyous, laughing, singing, loquacious, inclined to talk obscenely, and careless of everything around. She imagines that her food is poisoned ; she may conceal the suspicion, and merely avoid taking what is offered to her. She can recognize per- sons and things ; and can — though perhaps she will not — answer direct questions. Occasionally there is great depression of spirits with melan- cholia. These facts are' of some importance in reference to cases of alleged child-murder. This state may last a few hours, or for some days or weeks. The murder of the child is generally either the result of a sudden fit of delirium or a sudden impulse, with the full knowledge of the wickedness and illegality of the act; so that the legal test of responsibility, i. e. a knowledge of right and wrong, cannot be strictly applied to such cases as these, except on the assumption that insanity already exists and aflects the consciousness of the individual. A woman has been known to request her attendants to remove the child, but she has afterwards taken an opportunity to destroy it. In such cases of deliberate child-murder there is no motive, no attempt at concealment, nor any denial of the crime on de- tection. There is in general a full consciousness of the illegality of the act, but apparently an entire want of power to control the murderous feeling. Women in the pregnant state have been known to perpetrate murder, apparently from some sudden perversion of their moral feelings; there has been probablv latent intellectual disturbance, but not sufficient to attract the notice of friends. There is such a sympathy between the uterine organs and the brain as may account for the occurrence of such cases ; but we are not aware that irresponsibility on the ground of insanity, unless there were independent proofs of this condition, has been admitted in this country. It would be unsafe to act on such a principle. On the occur- rence of pregnancy, mania, melancholia, and other disordered and capricious states of mind, may show themselves in women predisposed to attacks of this kind; but it cannot be admitted that the pregnant state produces /)er se a disposition to rob, steal, or murder. An intelligent woman, a-t. 29, who was advanced in pregnancy, felt a strong desire to murder her three children, to whom she was fondly attached. She informed her husband and her' medical attendant of this feeling, which haunted her in spite of every effort to shake it off. She was sent away from the children. Suph feelino-s, when they cannot be controlled, and the current of thought changed, indicate the existence of incipient mania. There can be no doubt that, as a rule, a pregnant woman possesses a free will just as in the or- dinary condition, and that she is as fully conscious of her actions. Stolz affirms that since this doctrine of responsibility in reference to pregnant women has been made known by medical men, there has been a cessation of criminal acts on the part of \hese women. (Ann. d'Hyg., 1873, t. 2, p. 149.) Pip-omania. This is described as a form of insanity in which there is a morbid disposition of mind leading to impulsive acts of incendiarism with- out any motive. It is a condition not specially recognized by English jurists nor in English courts of justice. Kleptomania. Propensity to Thieve. — This term has been applied by Marc to that form of insanity which is said to manifest itself by a pro- pensity to acts of theft. It is alleged by him and others that this propensity has often shown itself in women laboring under disordered menstruation, or among those who were far advanced in pregnancy — the motive being the mere wish of possession. It is not, however, confined to the female sex. Pregnancy, according to him, should be a good excul- patory plea when a w^ell-educated woman, of strictly moral conduct, steals KLEPTOMANIA DIPSOMANIA. 767 some unimportant ai-ticle of no value to herself, compared with her worldly means and position in society. There are several instances on record show- ing that well-educated persons moving in a respectable sphere of society have been guilty of petty acts of theft. The articles taken have been valueless compared with their means. Instances of this kind have been brought before our police-courts, and this motiveless impulse to theft has been occasionally pleaded ; but in most of them the following facts have been established by evidence: 1. A perfect consciousness of the act and of its illegality. 2. The article, though of trifling value, has still been of some use to the person ; thus women have stolen articles either adapted to female use or on which money could be raised. 3. There have been art and precaution in endeavoring to conceal the theft. 4. Either a denial of the act when detected, or some evasive excuse. When circumstances of this kind are proved, either the persons charged with stealing; should be made responsible, or theft should be openly tolerated. The evidence of a disordered state of mind should not be allowed to depend on the nature of the act, or every morally depraved person might bring forward a plea of insanity for any crime or offence. In a trial which took place at the Middle- sex Sessions, in Aug, 1878, a man was charged with stealing a portmanteau from a railway station. In his defence, the prisoner said that he was a kleptomaniac; but the plea did not avail him. This case shows that Marc's suggestion has reached the class of common thieves. When the facts proved really justify a plea of insanity in a case of stealing, the rule appears to be (Tindal, C. J.) that there should be proof that the prisoner was incompetent to know that the particular act in question was a wrong one. (Reg. v. Yaughan, Monmouth Sum. Ass., 1844.) When there is satisfactory evidence on this point, the person will be acquitted on the ground of insanity. This is shown by the following case, which was tried at the Middlesex Sessions, Feb. 1875. A clergyman named Hall, well educated, was charged with stealing two pairs of ladies' gloves. The prisoner entered a glove-shop in the evening, and asked to look at some dress gloves. He was shown a box, but expressed a wish for a darker color. While the shopwoman turned for the purpose of getting them, he took two pairs from the drawer, and concealed them in his pocket. He at first denied that he had them ; offered to pay for them, and tried to leave ; but was detained. When before the magistrate, he said he was liable to attacks on the brain, at which times he did not know what he was doing. Tuke deposed that some years before he had on two occasions attended the prisoner for disease of the brain. He was a man of high attainments. He bad recently seen him, and found him suffering from brain-disease, so that at times he was quite mad. He believed that the prisoner did not know the nature or quality of the act he committed at the time of its com- mission, and that his opinion of the mental state of the prisoner was not affected by hearing the evidence for the prosecution. The jury found a verdict of not guilty, on the ground of insanity ; and he was ordered to be detained during her Majesty's pleasure. Although the prisoner had shown in the act the usual cunning of thieves in stealing behind the back of the vendor, in trying to conceal the theft, denying it, and trying to escape, the evidence was very conclusive in showing that he labored under mania. The articles stolen were not such as he could use or wear, and of only paltry value. Dipsomania. Drunkenness. Civil Responsihility of Drunkards — This state, which is called in law frenzy, is regarded as a temporary form of insanity. Jurists and legislators have differed widely respecting the degree in which drunkards should be made responsible for their acts. 768 CRIMINAL RESPONSIBILITY OF DRUNKARDS. When the mind of a man is comi)l('tcly \veak(>necl by habitual drunkenness, the law infers irrespoiisihility, unless it plainly a])p('ars that the person wns at the time of the act, whether of a eivil or of a criminal nature, endowed with full consciousness and reason to know its s'ood or evil tendency. Any deed or agreement made by a ])erson when drunk is not invalidated by our law, except in a case in which the intoxication has proceeded so far as to deprive him of all consciousness of what he is doing; and a court of cciuity will not interAn'o in any case, unless the drunkenness is proved to have been the result of collusion by others for the purjjoses of fraud. When the drunkenness has occasioned a temjiorary loss of the reasoning powers, the person is incapable of giving valid consent, and therefore cannot enter into a contract or agreement, for this implies a mutual assent of the par- ties. Partial drunkenness, therefore, provided the person knew what he was about, does not vitiate a contract or agreement into which he may have entered. Thus the law appears to define two states in drunkenness : one in which it has proceeded to but a slight extent, and it is considered that there is still a power of rational consent ; another, in which it has proceeded so fiir that the person has no consciousness of the transaction, and therefore can give no rational consent. The proof of the existence of this last state would render all the civil acts of a person void (see p. 7G9, ante). A confession made by a man while in a state of drunkenness is legalh^ admissible as evidence against him and others, provided it be cor- roborated by circumstances. In a case tried a few years since, the pris- oner confessed, while drunk, that he bad committed a robbery and murder which had taken place some time before, but of which he had not been suspected. He mentioned a spot where the property of the murdered per- son had been concealed by him, and the whole of the circumstances of the murder. The property was found as he had described it, and the case was clearly brought home to him, chiefly by collateral evidence from his own confession. He was convicted. In one case (C. C. C, Oct. 1849), a man pleaded his drunkenness at the time of his first marriage as a defence to a charge of bigamy. There was evidence to show that he was partly in- toxicated when the ceremony was performed; it was proved, however, that he was sufficiently conscious of the whole of the proceedings, and he was convicted. (Lond. Med. Gaz., vol. xliv. p. 762.) By the Inebriates Acts (42 and 43 Yict. c. 19, and 51 and 52 Vict. c. 19), a person given to drink may voluntarily enter a retreat provided for such persons for a definite period, not exceeding twelve months; and, having thus voluntarily placed himself under restraint, he cannot leave the house of retreat until the expiration of the stipulated time. Criminal Responsibility of Drunkards. — When Jiomicide is committed by a man in a state of drunkenness, this is held to be no excuse for the crime. If voluntarily induced, whatever may be its degree, it is not ad- mitted as a ground of irresponsibility, even although the person might not have contemplated the crime when sober. (Reg. v. Reeves, Derby Wint. Ass., 1844.) Thus it appears that when the state of drunkenness is such that any civil act would be void, a person may still be held legally respon- sible for a crime like murder. Some judges have admitted a plea of ex- culpation when the crime has been committed in a state of frenzy arising from habitual drunkenness; but even this is not general. The question whether the person was or was not drunk at the time of committing the crime may be, however, occasionally of some importance. It was held by Paterson, J., that, although drunkenness is no excuse for any crime what- ever, yet it is of very great importance in cases in which there is a ques- tion oi intention. A person may be so drunk as to be utterly unable to CRIMINAL RESPONSIBILITY OF DRUNKARDS. 769 form any intention at all, and yet he may be guilty of very great violence. (Reg. V. Cruse.) If the drunkenness has produced a diseased state of the mind, then a criminal act perpetrated by the person might admit of excul- pation, either on the ground of insanity or of the want of sane conscious- ness at the time of the act ; but the difficulty is to prove in such cases the existence of actual disease in a sufficient degree to render the person irre- sponsible in a legal sense. When it is a question whether the accused was actuated by malice or not, a jury may, under certain circumstances, be re- quired to take the fact of drunkenness into their consideration, and this may have some influence upon their verdict. While, then, drunkenness does not furnish any excuse for a crime, it may become material with reference to the intent with which a crime has been perpetrated. (Law Times, Sept. 27, 1845, p. 542.) It is obvious that, if drunkenness were to be readily admitted as a defence, three-fourths of the crimes committed in this country would go unpunished. [The law as now settled in England and the American States may be stated as follows : — While drunkenness is not per se a defence upon a charge of crime, yet mental unsoundness superinduced by excessive intoxication, and con- tinuing after it has subsided, may excuse ; or where the mind is de- stroyed by a long-continued habit of drunkenness; or where the long- continued drunkenness has caused an habitual madness, which existed when the offence was committed, the victim would not be responsible. For if the reason be perverted or destroyed by a fixed disease, although brought on by his own vices, the law holds him not accountable : Rex V. Meakin, 7 Car, & P. 297; Reume's Case, 1 Lewin, 76; Reniger v. Fogassa, Plow. 1; 1 Russ. on Crimes (9th ed.), 12; 1 Bishop Cr. L. (6th ed.) 406; 1 Wharton Cr. L. (8th ed.), sec. 48; McDonald C. L. of Scot. 16; 1 Hale, 4; Black. Com. 26; Beaslev v. State, 50 Ala. 149; Peo. V. Odill, 1 Dak. Ter. 197 ; Estes v. State, 55 Ga. 30 ; Baily v. State, 26 Ind. 422 ; Roberts v. People, 10 Mich. 401 ; s. c. 19 Mete. 402 ; State V. Hundley, 46 Mo. 414; State?;. Thompson, 12 Nev. 140; Lanergan u. People, 50 Barb. (N. Y.) 266 ; Maconnehey v. State, 5 Ohio, 77 ; Com. v. Green, 1 Ashm. (Pa.) 289; U. S. v. Forbes, Crabbe (D. C), 558; Stuart V. State, 57 Tenn. 178; Carter v. State, 12 Texas, 500; Bell's Med. Jurisp. of Inebriety, p. 10, and cases there cited. The rule of law is well settled that evidence of intoxication is always admissible to explain the conduct and intent of the accused in cases of homicide, although the rule does not apply in lesser crimes, where the intent is not a necessary element to constitute a degree or phase of the crime: Bell's Med. Jur. of Inebriety, p. 10, and cases there cited. In cases where the law recognizes different degrees of a given crime, and provides that wilful and deliberate intention, malice, and premeditation must be actually proved to convict in the first degree, it is a proper subject of inquiry whether the accused was in a condition of mind to be capable of premeditation : Gray, J., in Hopt v. People, 104 U. S. 631 ; Buswell on insanity, § 450 ; Penn v. McFall, Addison, 255 ; Keenan v. Common- wealth, 44 Pa. St. 55 ; Jones v. Com., 75 Pa. St. 403 ; State v. Johnson, 40 Conn. 136; Pirttle v. The State, 9 Humph. 663; Haile v. State, 11 Humphrey, 154; Smith v. Duval (Ky.), 224; Bosswell v. Com., 20 Gratt. 860 ; Willis v. Com., 32 Gratt. '929 ; People v. Belencia, 21 Cal. 644 ; People v. King, 27 Cal. 507 ; People v. Lewis, 36 Cal. 531 ; People V. Williams, 43 Cal. 344; Farrell v. State, 43 Texas, 508; Colbath v. State, 2 Tex. App. 391^ State i;. White, 14 Kan. 538; Schlacken v. State, SNeb. 241; 104 \ . S 49 770 CKIMIXAL RESPONSIBILITY OF DRUNKARDS. [^Judicial Evohdion as to Criminal Responsibilihj of Inebriates. — By the comiuou law of England it was conceded that the words non compos meant a total deprivation of reason. Lord Coke divided it into four parts, or, as he called them, " Manners." 1, The idiot or fool. 2. He who, of good and sound memory at hirth, lost it by visitation of God. 3. Lunatics who have lucid intervals, and sometimes of good sound memory, and sometimes noti compos mentis. 4. By his own act as a drunkard. So that drunkenness at and by common law under certain circumstances was a form or s])ecies of insanity. By the same common law it was held : 1. That the drunkard was responsible for all his acts criminally, even if the state of drunkenness was such as to make him insensible to his surroundings and unconscious of his acts. 2. That drunkenness, instead of being any defence to a charge of crime committed while in a state of intoxication, was not only no defence, but that it aggravated the act. These doctrines were upheld by the Eng- lish courts in Dammaree's case, 15 St. Tr. 592; Frost case, 22 St. Tr. 472; Rex V. Carroll, 7 C. and P., 115; and these doctrines have been held like- wise in nearly all the American States. In Ala., State v. Bullock, 13 Ala. 413 ; in Cal., People v. King, 27 Cal., 507 ; in Conn., State v. Johnson, 40 Conn. 106 ; in Del., State v. M'Gonigal, 5 Har. 510 ; in Ga., State v. Jones, 20 Ga. 534 ; and in nearly every American State, similar decisions have been made. The common law which would not uphold a deed, will, or contract, made by a drunken man in an unconscious state of intoxication, would hold the same man criminally liable for every act constituting a violation of the criminal law. To-day we are regarding these views as legal curios and relics of the past. The law should have its museums for the preservation of its antique anomalies. A silent, unconscious change has been wrought in the law, not by legislation, but by the growth of ideas, the diffusion of knowledge. Insanity is now demonstrated to be a disease of the brain, of of which it is itself an outward manifestation. Inebriety is also shown to be a disease of the man, manifesting itself through brain indications, which demonstrate it to be a form of in.sanity, sometimes wholly dominating the volition and beyond the powers of the victim to control, and is now treated as such. The essential element of crime, intention, hardly fits into the acts of the unconscious inebriate, who, while blind or dead drunk, kills an innocent victim, and the absence of motive, like the absence of intention, are missing links in that chain, which the law exacts in regard to all criminal action. It would be next to impossible now to find a judge willing to charge a jury that a crime committed by a man in a state of intoxication, in which the accused was unconscious of his act, or incapable of either reflection or memory, should be placed on a par with one fully comprehended and understood by the perpetrator. Buswell says, in speaking of the old doctrine of drunkenness being an aggravation of the oflfence: " It is apprehended that this is the expression of an ethical rather than a legal truth." (Buswell on Insanity.) Such considerations compel us to inquire, What is law ? There are two schools of thought regarding it. Webster, the great expounder of the American Constitution, is credited with saying: "Law is any principle successfully maintained in a court of justice." This represents one school. Richard Hooker, in his Ecclesiastical Polity, represents the other. He says of Law : " There can be no less acknowledged than that her seat is the bosom of God, her voice the harmony of the world ; all things in heaven and earth do her homage ; the very least as feeling her care, the greatest as not exempted from her power." The gulf intervening between these two CRIMINAL RESPONSIBILITY OF DRUNKARDS. 771 extremes is as wide and deep as that which divided Dives and Lazarus in the parable of our Lord. The framers of the New York Penal Code, Avithout the courage to hew down the error of the old doctrine, engrafted thereon a provision that enables a jury now, in that State, to pass on the motive and the intention of the unconscious and wholly insensible inebriate, so that now in New York, since the Penal Code of that State, a conviction would, in such a case, be well-nigh impossible. How have the English judges met the question? In 1886 Mr. Justice Day, in Regina v. Baines, at the Lancaster Assizes, charged a Lancaster jury that if a man was in such a state of intoxication that he did not know the nature of his act, or that it was wrongful, he was insane in the eye of the law ; and that it was perfectly immaterial whether the mental derangement resulting from such intoxication was permanent or temporary. In 1887 Chief Baron Palles held that if a person, from any cause, say long watching, want of sleep, or deprivation of blood, was reduced to such a condition that a smaller quantity of stimulants would make him drunk, and that would produce such a state if he were in health ; then neither law nor common sense could hold him responsible for his acts, inasmuch as they were not voluntary, but produced by disease. As long ago as 1865, in the case of Watson, tried at Liverpool for the murder of his wife, before Baron Bramwell, the evidence showed that he was laboring under delirium tremens. After the act he grew calm and said he knew perfectly well what he had done, and that his wife was in league with men who were hidden in the walls. Baron Bramwell, who favored hanging insane men who committed homicides when acting under an insane delusion, if of sufficient intelligence to understand the nature and quality of the act and its consequences, tried the case, and charged the jury that " There were two kinds of insanity, by reason of which a prisoner was entitled to be ac- quitted. Probably the jury would not be of opinion that the prisoner did not know the quality of his act, that it would kill and was wrong, but it was still open to them to acquit him, if they were of opinion that he was suffering from a delusion leading him to suppose that which, if true, would have justified him in the act. One more remark he would make, viz. : That drunkenness was no excuse, and that a prisoner cannot, by drinking, qualify himself for the perpetration of crime ; but if, through drink, his mind had become substantially impaired, a ground of acquittal would then fairly arise." The prisoner was acquitted. Under the English law there is no right of appeal to the convicted homicide, as in the American States, and so it is difficult to find the decision of English higher courts on the ques- tions involved in the discussion. In the American States no person is exe- cuted except on the decision of the highest court of the State, if the accused desires it and appeals. In England the appeal does not lie as a matter of right, and so the opinion and dicta of the English trial judges form the real body of the law of England upon these questions. Baron Bramwell undoubtedly regarded Watson as entitled to an acquittal, and the case shows a remarkable result in this respect : Had he been insane and committed the homicide under delusions which dominated his will and controlled his action, he would have been convicted if he had sufficient intelligence to understand the nature and the quality of the act, but the drunkenness which had caused the attack which resulted in delirium tre- mens, with a diseased condition of the brain, also resulted in a delusion which controlled his mental powers so as to render him irresponsible at law. In 1888 Baron Pollock held that the law was the same where insane pre- 772 CRIMINAL RESPONSIBILITY OF DRUNKARDS. disposition and not physical weakness was the proximate cause of the intoxication. The hite English Home Secretary, INIr. Mathews, Avas one of the ablest men connected with the English government. Under the English system this officer has the power to commute or modify the sentence of the courts in criminal cases, and he exercises it with as much effect, and more in many cases, than would the reversal of the Appellate Court, if the right of appeal existed. No eye in Great Britain sees more clearly or more intelligently the action of the criminal courts than his. It is his province to correct errors and redress grievances and abuses, if such exist or occur, in the criminal jurisprudence of Great Britain. Mr. Mathews named a commission, com- posed of Mr. J. S. Wharton, Chairman ; Sir Guyer Hunter, M. P. ; Mr. E. Leigh Pemburton, Assistant Under Secretary of the Home Department ; Mr. Daniel Nicholson, Superintendent of the Broadmoor Criminal Lunatic Asylum, and Mr. C. S. Murdock, head of the Criminal Department, to inquire into the best mode of treatment and punishment for habitual drunkards. Mr. Mathews says, regarding the appointment of this com- mittee, " Great differences of opinion have arisen as to what kind and degree of punishment for offences committed by habitual drunkards would be the most effectual, both as a deterrent and with a view to the reforma- tion of such offenders. It appears to me that advantage would result from an inquiry being made into the subject." It may be fairly claimed, so far as the British Islands are concerned, that the old common law rule no longer is enforced there, and that inebriety, as a disease, is now not only recognized as an existing fact, but that the jurisprudence of that country is receiving such modifications as are necessary to fit it for the advance made by scientific research. We are doubtless near similar results in the Ameri- can States. (Med.-Legal Jour., vol. x. No. 3, p. 259..)] The reason of this rule of law rests upon the fact that intoxication is a circumstance to be Aveighed in connection with the other circumstances surrounding the commission of the act in determining whether it was in- spired by deliberate and malicious intent, and whether immediately before and at the time of his act the intoxication of the accused w^as so great as to render him incapable of forming a design or intent, which the jury must find from the facts in the case, without regard to opinions of others: Buswell on Insanity, § 452 ; Marshall's Case, 1 Lew. Cr. Cas. 76 ; Thacher, J., in Kelly v. State, 3 S. & M. 518 ; Armor v. State, 63 Ala. 1*73 ; People V. Belencia, 21 Cal. 544. And because, since be who voluntarily becomes intoxicated is subject to the same rules of law as the sober man, it follows : that where a provocation has been received which, if acted upon instantly, would miti- gate the offence if committed by a sober man, the question in the case of a drunken man sometimes is, whether such provocation was in fact acted upon, and evidence of intoxication may be considered in deciding that question : Buswell on Insanity, § 423 ; State v. McCants, 1 Speer, 384. The New^ York Penal Code defines precisely this question of respon- sibility in that State in such cases as follows: "§ 22. Intoxicated persons — No act committed by a person while in a state of intoxication shall be deemed less criminal by reason of his having been in such condition. But whenever the actual exi.stence of any particular purpose, motive, or intent is a necessary element to constitute a particular species or degree of crime, the jury may take into consideration the fact that the accused w^as intoxi- cated at the time, in determining the purpose, motive, or intent with which he committed the act."] In cases in w hich the head has sustained any physical injury, as among ACTS DURING FITS OF DELIRIUM TREMENS. 778 soldiers and sailors, drunkenness, even when existing to a slight extent, produces sometimes a fit of temporary insanity, leaving- the mind clear when the drunken fit is over. The law makes no distinction between this state and ordinary drunkenness, although juries occasionally show by their verdicts that some difference ought to be made. Hallucinations and illusions are a common effect of drunkenness, and may lead to the commission of criminal acts. Marc relates a case where, two friends being intoxicated the one killed the other under an illusion that he was an evil spirit. The drunkenness of the accused was held to have been voluntary ; and he was condemned. A case of this description CReg. V. Patteson) was tried at the Norfolk Lent Ass., 1840. A man while intoxicated killed his friend, who was also intoxicated, under the illusion thnt he was some other person who had come to attack him. It is re- ported that the guilt of the prisoner was made to rest upon the fact whether, had he been sober, he would have perpetrated the act under a similar illusion. As he had voluntarily brought himself into a state of intoxication this was no justification, and he was found guilty of man- slaughter. The proof of drunkenness may fail, but still, if the person charged with tne death acted under an illusion, he will be acquitted. In Reg. v. Price (Maidstone Sum. Ass., 1846), it was proved that the prisoner, who had been on friendly terms with the deceased, was going home at night, having previously been in company with him at a public-house. Ac- cording to the prisoner's statement, a man sprang upon him from the hedge by the roadside, and demanded his money and his watch, or else he said he would have his life ; the prisoner closed with him and beat him severely, inflicting such injuries that he died shortly afterwards. The supposed robber turned out to be his friend, and it was believed that he had made an attempt to rob the prisoner jokingly ; the result, however was that the attempt had ended in this fatal manner. The prisoner throughout told the same story, and there did not appear to be the slightest ground for suggesting that it was untrue. Coltman, J., after hearing the evidence of the witness, said it appeared to be quite clear that the prisoner had acted under an impression that he was protectinf his own life from the attack of a robber, and under such circumstances he could not be held to be criminally responsible. The jury accordingly re- turned a verdict of not guilty, and the prisoner was discharged. Delirium Tremens. — This is a disordered state of mind proceeding from an abuse of intoxicating liquors. Habitual drunkenness is the pre- disposing, while abstinence from drink may be the immediately exciting cause. Thus the disorder frequently does not show itself until the accus- touied stimulus has been withdrawn for a certain period. It commences with tremors of the hands, by which it is known from ordinary delirium and restlessness ; and the individual is subject to hallucinations and illu- sions, sometimes of a horrible kind, referring to past occupations or events. The patients are often violent, and prone to commit suicide or murder more commonly the former ; hence they require close watching. Persons proved to be laboring under this disorder are incompetent to the per- formance of any civil act ; and they are not responsible for criminal acts committed while they are suffering from an attack. Acquittals have even taken place on charges of murder, when there was deliberation as well as an apparent motive for the act. Thus, then, although this disorder may have been voluntarily brought on by habitual drunkenness, the law admits it as a sufficient plea for irresponsibility, while in a case of confirmed drunkenness it rejects the plea. In dpli"nim there is a formed disease of 774 ACTS DURING FITS OF DELIRIUM TREMENS. the brain, while voluntary drunkenness merely produces a temporary dis- turbance of its functions. In one trial the evidence showed that homicide had been conimiited by the accused while he was laboring- under an attack of delirium tremens. (Reg-, v. Simpson, Appleby Sum. Ass., 1845.) The prisoner's mind had become unsettled from this disorder, brouj^ht on by hnl)itii:il drunkenness. In another case the plea was also admitted by the jnry, although it was scarcely supported by the medical evidence. (Reg. V. Watson, York Wint. Ass., 1845.) In one case, Reg. v. Burns (Liver- pool Sum. Ass,, 1865), a man laboring under delirium tremens was charged with the murder of his wife. After the act he appeared calm, and said that he knew perfectly well what he had done; "his wife was in league with men who were hidden in the walls." Bramwell, B., in charging; the jury, said, "there were two kinds of insanity by reason of which a prisoner was entitled to be acquitted ; probably the jury would not be of opinion that the prisoner did not know the quality of his act — that it would kill, and was wrong-; but it was still open to them to acquit him if they were of opinion that he was suffering from a delusion leading him to suppose that which, if true, would have justified him in the act. One more remark he would make — viz, that drunkenness was no excuse, and tliut a prisoner cannot by drinking qualify himself for the perpetra- tion of crime ; but if through drink his mind had become substantially impaired, a ground of acquittal would then fairly arise." The prisoner was acquitted. In Reg. v. Chaplain (Warwick Ass., Nov. 1878), the prisoner was charged with felonious wounding by firing a revolver at two persons. It was proved that, at the lime of the acts, the prisoner was sufleriug from an acute attack of delirium tremens, after sudden cessation from excessively hard drinking. Medical evidence also proved that at the time, and for two days after, he was in such a state that he would not know the nature of his acts. He fired the shots under the delusion that some one was breaking into the house. Upon this evidence the prisoner was found not guilty, on the ground of insanity. In another case (Reg. V. M'Gowan, Manchester Ass., Oct. 1878), it was proved that the pris- oner, who was charged with the murder of his wife, had been drinking heavily for two or three weeks. The medical evidence was to the effect that he was suffering from temporary disease of the brain as a result of excessive drinking ; that the man knew what he had done, as he had vol- untarily given himself up for it; but that he was not accountable for his actions. Manisty, J., said if a man's insanity was so fixed, habitual, and permanent that it reduced him to a state of being without reason or mind, then he was not accountable or responsible for his actions. But if the prisoner's insanity was only temporary and produced by his own ex- cesses the law did not excuse him from the results of his acts. The man was found guilty. In a recent case (Reg. v. Baines, Leicester Ass., Jan. 1880), Day, J., ruled that if a man were in such a state of intoxication that he did not know the nature of his act, or that his act was wrongful, his act would be excusable. [The rule of law is well established, both in England and in the Ameri- can States, that insanity produced by delirium tremens is a good defence to a criminal charge. Even if induced by intoxication, the victim is no more punishable for his acts than if the delirium had resulted from causes not under his control : Regina v. Davis, 14 Cox C. C. 563 ; Bell on Med. Juris, of Inebriety, 9, and cases there cited ; J. Crisp Poole, Med. Leg. Jour., vol. 8, p. 44; U. S. v. McGlue, 1 Curt. 1 ; Wharton's Crim. Law (8th ed.), sec. 48; People v. Williams, 43 Cal. 344; U. S. v. Clarke, 2 Cr. C C 158 ; Lanergan v. People, 50 Barb. (N. Y.) 266 ; s. c. 6 Parker ACTS IN A STATE OF SOMNAMBULISM. 775 Cr. R. (N. Y.) 209 ; O'Brien v. People, 48 Barb. 274 ; State v. Dilla- hunt, 3 Harr. (Del.) 551 ; State v. McGonigal, 5 Harr. (Del.) 510 ; Cluck V. State, 40 Ind. 563; Bradley v. State, 26 Ind. 423; O'Herrin v. State, 14 Ind. 420; Dawson v. State, 16 Ind. 428; Fisher v. State, 64 Ind. 435,- Smith V. Com., 1 Duv. (Ky.) 224; Roberts v. People, 10 Mich. 401; State V. Hundley, 46 Mo. 414; State v. Sewell, 3 Jones (N. C.) L. 245; Cornwell v. State, Mart. & Y. (Tenn.) HI ; Carter v. State, 12 Tex. 500; Boswell v. Com., 30 Gratt. (Ya.) 860; U. S. v. Drew, 5 Mason C. C. 283.] As in one of the eases above noticed, an attack of delirium tremens may be brou.s^ht on by the sudden withdrawal of alcoholic stimulants from a person long accustomed to take them in excess. The sudden ab- stinence from other narcotics, such as opium and hydrate of chloral, may induce a similar attack. A person might thus be rendered temporarily unconscious of his actions and therefore legally irresponsible for an act of violence committed while he was in this state. A case occurred in Canada, in which this question arose in reference to hydrate of chloral. There is reason to believe that this drug would operate on the brain and nervous system in the same manner as alcohol, opium, and morphine. (Guy's Hosp. Gaz., Jan. 1879, p. 9.) Somnambulism. — This term strictly applies to sleep-walking, but the medico- legal facts are chiefly confined to acts of violence, perpetrated unconsciously, or in a state of "unconscious cerebration" during sleep, in which it is presumed that malice and intention, the chief ingredients of crime, are wanting It has been a contested question among medical jurists, how far a person should be held responsible for an act perpetrated in that half-conscious state which exists when he is suddenly aroused from sleep. There is no doubt that the mind is at this time subject to hallucinations and illusions, which may be more active and persistent in some persons than in others; but it is difficult to suppose, unless we imagine there is a sudden access of insanity, that a person should not recover from the delusion before he could perpetrate an act like murder. A remarkable case of this description, that of Bernard Schedmaizig, will be found reported by Marc. This man suddenly awoke at midnight, and saw, as he believed, a frightful phantom. He twice called out, " Who is that ?" and receiving no answer, and imagining that the phantom was advancing upon him, he seized a hatchet which was beside him, attacked the sujjposed spectre and killed his wife. He was charged with murder, but was pro- nounced " not guilty,'' on the ground that he was not at the time conscious of his actions. A pedlar in the habit of walking about the country armed with a sword-stick, while lying asleep on the high-road was roused by a man accidentally passing, who .seized and shook him b}^ the shoulders. The pedlar suddenly awoke, drew his sword and stabbed the man, who died. The pedlar was tried for manslaughter. His irresponsibility was strongly urged by his counsel, on the ground that he could not have been conscious of an act thus perpetrated while in a half-waking state ; and this defence was supported by the opinion of a medical witness. The prisoner was however, found guilty. Under such circumstances, it was not unlikely that an idea had arisen in the prisoner's mind that he had been attacked by robbers and therefore had stabbed the man in self- defence. In 1878, one Simon Fraser was tried in Scotland for the murder of his child. It was proved that he lifted the child from its bed and killed it by dashing its head against the wall of the room. The defence was that it was done unconsciously while he was in a state of somnambulism. He dreamed that he had seen a wild beast jump into his bed and h§ rose to 776 THE DEAF AND DUMB. attack it. It seems that from boyhood he liad been accustomed to get up in his sleep. Clerk, L. J., directed the jury to find that the prisoner " had killed his child when unconscious of the act, by reason of his condition as a somnambulist, and that he was not i-esponsible for his actions." (Brit. Med. Jour., 1878, ii. p. 108.) In Reg. v. Byron (Winchester Wint. Ass., 1863), it was proved that a blow struck by a drunken person during sleep had caused death. The prisoner and the deceased were soldiers in the same regiment. The prisoner was in the street drunk, and the deceased, seeing this, took him in, to prevent his being arrested for drunkenness, and placed him on his bed. In this state he lay for some time insensible. In the course of the afternoon the deceased went up stairs to see him ; he tried to awaken him, when the prisoner suddenly kicked out and his boot came violently against the lower part of the abdomen of the deceased. The prisoner did not awake, but appeared then to be quite insensible. The deceased died, and it was found that the blow had caused rupture of the intestines. As in order to constitute the crime of manslaughter it must be shown that the person charged did something knowingly, and the prisoner was not in a state to have known anything, it w^as held that there was no case against him and he was acquitted. The act was committed during sleep, but the sleep was the result of voluntary drunkenness. Somnambulism may become a subject of discussion under a contested policy of life insurance, in which it may be provided that it shall be vitiated by suicide. If a man falls from a height and is killed while in a state of somnambulism, would this be considered an act of suicide within the meaning of the polic}^ ? The proviso against suicide has been held to include only intentional killing (case of Borradaile i'. Hunter, Lond. Med. Gaz., vol. xxxvi. p. 826), and in death under these circumstances the kill- ing cannot be said to be intentional : it can be regarded only as an acci- dent — therefore it is reasonable to infer that the policy would not be void. It is impossible, however, to lay down any general rules relative to cases of this description, since the circumstances attending each case will suffi- ciently explain how far the act of murder or suicide has been committed during a state of somnambulism, or under an illusion continuing from a state of sleep. The Deaf and Dumb. It was formerly laid down in the law-books, that a person born deaf and dumb was by presumption of law an idiot, but in modern practice want of speech and hearing does not imply want of capacity either in the understanding or memory, but only a difficulty in the means of com- municating knowledge ; and when it can be shown that such a person has understanding, which many in this condition reveal by signs, he may be tried and suffer judgment and execution. A deaf-and-dumb person is not incompetent to give evidence, unless he is also blind ; he may be examined through the medium of a sworn interpreter who understands his signs. This condition does not justify restraint or interdiction, unless there is at the same time mental deficiency. A deaf-and-dumb person who has never been instructed is altogether irresponsible for any action civil or criminal. Such a person cannot even be called on to plead to a charge, when there is reason to suppose that he cannot understand the nature of the proceedings, A deaf-and-dumb woman was charged with cutting off the head of her child. By signs she pleaded "not guilty," but she could not be made to understand the nature of the other proceedings against her. Upon this she was discharged and subsequently confined as a FEIGNED DEAFNESS AND DUMBNESS. 777 criminal lunatic. In Reg. u Goodman (Stafford Sum. Ass., 1841), a deaf- and-dumb man was convicted of theft and sentenced to imprisonment. He was made to comprehend the proceedings by signs and talking with the fingers. In Reg. v. Brook (Buckingham Sum. Ass., 1842), tlie pris- oner could read and write well. He was charged with feloniously cutting and stabbing. The proceedings were reported to him in writing. He was convicted, and the judge, having sentenced him to a year's imprison- ment, handed down his judgment in writing, which he recommended him to read and ponder over in prison. In Reg. v. Jackson (Bedford Sum. Ass., 1844), Alderson, B,, held that, before the evidence of a dumb wit- ness can be received, the court must be satisfied that he understands the obligation of an oath. It has been decided in the Ecclesiastical Courts that the consent of a deaf-and-dumb person, given by signs, renders a matrimonial contract valid, provided the person has a full and proper understanding of their meaning. An incompetency to enter into contracts, or unsoundness of mind, must not be inferred to exist merely in consequence of a person being deaf and dumb. In the case of Harrod v. Harrod (Vice-Chanc. Ct., June, 1854), an attempt was made to deprive the plaintiff of his rights on the ground that he was an illegitimate child. The marriage of his parents took place thirty years previously, but the marriage was said to be void by reason of the alleged incapacity of his mother to enter into the con- tract ; the mother was deaf and dumb, and of more than ordinary dull in- tellect. Wood, y. C, said there was an important dift'erence between "unsoundness of mind" and " dulness of intellect." The presumption in such cases was always in favor of sanity, and the fact of a person being deaf and dumb did not raise a presumption the other way. Ex- perience showed that the deaf and dumb were not necessarily of unsound mind. The woman had assented to the marriage in form and substance, and with a perfect knowledge of what she was doing. In the ceremony of marriage it had never been held that the repetition of the words was necessary. The woman conducted herself with great propriety before and after the marriage, and a child was born in due course. There was no ground for an issue. Feigned Dea/nesn and Diunbness. — From these statements it will be perceived that medical evidence is of but little importance in relation to the deaf and dumb. Indeed, there are only two cases in which this kind of evidence is likely to be called for : first, when there is accompanying mental deficiency, in which case the general rules elsewhere given are applicable ; and second, when there is a suspicion that the deafness and dumbness are feigned. There will be no great difficult}^ in detecting an imposition of this kind. It may be found that the alleged deafness and dumbness did not come on until a motive existed, and that there was no apparent cause but the very suspicious one of evading responsibility for some offence committed. It vf^nuires pTpat, skill to maintain an imposture of this kind. Such persons are immediately thrown off their guard by addressing them in a voice a little above or a little l)elow the common conversational tone ; when a change in the eye or the features will at once indicate that they hear and understand what is said. In Reg. V. Yaquierdo (Herts Sum. Ass., 1854), the prisoner, who was charged with murder, was found by the jury to be wilfully mute. The man refused to plead, although it was obvious that he was well aware oT the nature of the proceedings. No counsel could be assigned to nini, as this could not Ijc done without the prisoner's consent. He was convicte(i Shortly after the trial, this man was found to be insane, but not mu^^ 778 FEIGNED DEAFNESS AND DUMBNESS. If the impostor can write, he may perhaps be detected by the ingenious plan adopted by the Abb^ Sicard. When the deaf and dumb are taught to write, they are taught by the eye. The letters are only known to them by their form, and their value in any word can be understood only by their exact relative position with resjject to each other. A half-educated im- postor will spell his words or divide them incorrectly ; and the errors in spelling will always have reference to sound — thereby indicating that his knowledge has been accjuirod through the ear, and not alone through the eye. A man who had defied all other means of detection wrote down several sentences, in which the misspelling was obviously due to errors produced by the sound of the words, thereby showing that he must have heard them pronounced. The Abbe concluded, without seeing him, that the man was an impostor, and he subsequently confessed the imposition. PRINCIPLES OF LIFE INSURANCE. 7*79 LIFE INSURANCE. CHAPTER LXVIII. PRINCIPLES OP LIFE INSURANCE. MEDICAL RESPONSIBILITY. WHAT DISEASES HAVE AWD WHAT HAVE NOT A TENDENCY TO SHORTEN LIFE ? CONCEALMENT OP DISEASES. CON- CEALMENT OF HABITS. MATERIAL CONCEALMENT. WHAT IS INTEMPERANCE ? PROXI- MATE AND REMOTE EFFECTS. OPIUM-EATING. INVETERATE SMOKING. INSANITY. VOIDANCE OF POLICIES BY SUICIDE. INSURANCE MURDERS. The insurance of a life is a contract whereby the insurer, in considera- tion of a certain sum of money, called a premium, either in a gross sum or in periodical payments — proportioned to the age, sex, profession, health, and other circumstances of the person whose life is insured — undertakes to pay to the person for whose benefit the insurance is made, a stipulated sum, or an equivalent annuity, upon the death of the individual whose life is insured (or on his attaining a certain age), whenever this event shall happen, if the insurance is for the whole life ; or, in case this shall happen within a certain period, if the insurance is only for a limited time. The deed by which this contract is made is called a policy, and it is con- cerning the stipulations of the policy, and the meaning to be put upon certain medical terms used in it that litigation commonly arises. The amount of premium payable will be regulated by the mean expectation or duration of life of the individual; and this it is well known is not only different at different ages, but is greater at certain periods of life among women than among men. The sum for which a person's life has been insured cannot be recovered until after the death of the person and distinct proof of death. Those who would l)enefit by the death must prove the fact of death when this is open to doubt. A man suddenly disappeared while at Brighton within a week after an insurance had been effected on his life. The man's clothes were found on the beach, and the jur}^ were asked to infer from this fact that the man was drowned while bathing, and that his bod}^ had been carried out to sea. No one had seen him go into the water. The jury were dis- charged without a verdict. It was quite possible that the clothes had been designedly placed there, and that the man had gone off in another direc- tion, and was then living. The editor met with a remarkable case. In 1878 a young merchant was staying at an hotel in Barmouth. One morn- ing he went to bathe alone from the beach. His clothes, containing money and his watch, were subsequently found ; but the body of the supposed drowned man was not found. An insurance on his life was paid. Six months after, the supposed deceased was recognized and challenged in South America by a friend ; and the insurance money had to be refunded. The missing man had been in pecuniary difficulties. He took with him to bathe an extra suit of clothes, and decamped, leaving money in the pockets of the clothes on shore in order to avoid suspicion. 780 LIFE INSURANCE — MEDICAL RESPONSIBILITY. Different rules have been given by actuaries for calculating the expecta- i.ion or duration of life at different ages. One of the most simple of these rules for calculating the duration of life from five to sixty years has been given by Willich : He considers the probable duration to be equal to two- thirds of the difference between the age and eighty. Thus in a man twenty V^ears of age the difference is equal to sixty ; and two-thirds of this age, or forty years, is the probable duration of life for a person of average health at twenty. With respect to the influence of profession, a higher premium is de- manded by some offices for the insurance of the lives of persons whose occupations exi)ose them to great risk — as, for instance, of persons actually engaged in military or naval service. Above all other conditions, the general state of health of the person is likely to have a most important influence on the mean duration of life ; and it is here that medical science lends its aid — first, by showing how far a contract may be safely entered into when the person is affected with disease ; and second, by showing whether a diseased state of the body really existed in the person insured, although at the time of insurance it may have been alleged that he was healthy and free from disease. As in the case of all civil contracts, the law requires that there should be a strict compliance with the conditions by each party, it follows that if any fraud has been committed by the insured — if he, or those to whom he trusted in his dealings with the office, have concealed from the insurers the existence of any disease under which he was at the time laboring, or any symptoms indicative of a probable attack of disease ; or if he or they have knowingly or wilfully misrepresented his actual bodily condition — then the contract will be void, and the amount of the premiums forfeited. This forfeiture is a usual condition in the policy. Actions on policies of life in- surance are not unfrequent. In a case of life insurance an action is never likely to be brought for the recovery of the amount of a policy, except when there is reason to believe that a wilful fraud has existed in the con- tract. Juries always regard such actions with disfavor ; and, while judges interpret the law strictly, the onus of proof is entirely thrown on the offices. Hence the insured are placed in a very advantageous position. These actions, in nine cases out of ten, depend upon the construction put on the medical terms of the contract; hence it is our duty to see how medical defects are likely to arise in reference to the policy. The Relations of Medical Men with Insurance Offices. Medical Re- iponsibility. — The practice with some offices of obtaining a certificate ^ratuitousiv from the medical attendant of the person proposing to insure his life is one great source of litigation. The responsibility of causing the life to be accepted or rejected is thus thrown entirely upon the usual medical attendant of the person ; for, as we shall see hereafter, an appli- cation for a certificate from a medical practitioner who is a stranger, is verv likely to be treated as a fraud, and may lead to the disputing of the policy. The medical attendant of the person, it is true, is the only indi- vidual who can properl}^ certify to the real state of previous health, and therefore to him an application is generally made. He is sometimes expected to furnish an important certificate of this kind gratuitously ; and should it happen to be unfavorable, he is exposed to the risk of losing what may probably be a lucrative portion of his practice. The question is, whether an insurance office has a right to place a medical man in such a position as this. In the issuing of the policv the insurers and insured are equallv benefited, for the contract would certainly not be made except \!pon a supposition of reciprocal advantage. The medical attendant, with- DISEASES TENDING TO SHORTEN LIFE. 781 out whose sanction the policy could not in all cases be properly effected, not only derives no benefit, but is actually exposed to the risk of loss for performing- in an honorable and conscientious manner an invidious duty thus forced upon him. Such a state of thing-s ought not to be. Many actions for the recovery of disputed policies have shown clearly that the practice leads to great carelessness and indifference on the part of medical men in drawing- up these certificates, and this produces in the end a more serious loss to the representatives of the insured than if the life had not been accepted. It must be remembered that it is not the insurers who suffer by misconduct on the part of a medical man who signs such a cer- tificate, but the representatives of the insured. It is always professed that such communications are confidential ; but in more than one instance medical men have found that the contents of their certificates have become known to their patients, and have even been publicly used as evidence in courts of law. In the event of a medical practitioner being- called upon to sign a cer- tificate of this kind, the safer course would be that he should decline the proposal, except upon a professional consultation with the medical officers appointed by the insurers. If, however, from private considerations he is compelled to sign the certificate, it is his duty to use the greatest caution, not merely in returnin<^ answers to the formal questions on the paper, but in detailing- all particulars known to him respecting the state of health of the person. In acting otherwise, he would be doing- the greatest possible injury to the representatives of the insured, and probably damage his own reputation. There is no intermediate course : the duty must either be performed carefully, conscientiously, and honorably, or it must be de- clined altogether. It is a fallacy to suppose that any equivocation or concealment in the declaration can escape detection ; and yet, from the evidence which has been given at some trials, it is probable that such an idea had existed in the mind of the medical attendant who attached his name to the certificate. Diseases tending to shorten Life. — Let us take the case, however, that this preliminary duty has been properly performed ; important medical questions may arise respecting the alleged infringement of the conditions of a policy. The list of diseases specified in the inquiries comprises a great variety — affections of the head : apoplexy, palsy, epileptic or other fits ; disease of the brain, insanity ; disease of the lungs, spitting of blood, asthma, inflammation ; disease of the heart ; dropsy ; diseases of the bowels, liver, kidneys, or urinary organs; gout, rheumatism, hernia; phthisis, or any hereditary malady. In the proposals of some offices the mysterious word " fits" occupies a very prominent position, but it is difficult to say what this word thus isolated actually means. Thus it may comprise apoplexy, epilejisy, par- alysis, syncope, convulsions from any cause, and even asphyxia. The word is too indefinite for a certificate, and should be expunged. In the meantime, a court of law will not allow insurers to benefit by the use of ambiguous terms in the contract, and it has therefore commonly restricted the meaning of the word " fits" to attacks of epilepsy. The main condi- tion, however, is involved in the terms — " any other disease or disorder tending to shorten life.'''' Upon the meaning of these words litigation commonly turns, and the opinions of medical experts are required. It is impossible to lay down any general rules for determining what diseases have, and what diseases have not, a tendency to shorten life. Any deviation from health might be so interpreted ; but the law puts a proper limitation here upon the meaning of the words, considering them 782 MATERIAL CONCEALMENT. to apply to those diseases only which, in a medical view, are rejrarded as of a serious nature, and, as a general rule, are likely either directly or indirectly to affect the duration of life of any person laboring under them. A disease tending to shorten life must not be taken to signify only one of those maladies which have commonly a rapid and fatal course, as phthisis and malignant disease ; it may apply to dropsy, gout, asthma, insanity, and many diseases of a chronic character. When the existence of these diseases, or even a well-marked tendency to them, is concealed from the insurers, or omitted to be stated through mistake — even without fraudulent intention — the policy in the event of death becomes void, be- cause the risk incurred is really different from the risk understood and intended at the time of the agreement. Such diseases are not necessarily fatal ; bat this is not the question : their tendency is to diminish the ex- pectation of life, and if medical evidence establish this with regard to any disorder intentionally concealed, whether chronic or acute, the contract is at an end. Habits. — A person may be laboring under no actual disease at the time of effecting the insurance, but his habits may be such as to produce general injury to health, and to have a tendency to shorten life. Con- cealment of habits the eS"ect of which on health must or ought to be known to all medical men, may be just as fatal to a policy as the conceal- ment of a serious disease. Although they may not always be included in the questions put by the office, yet the law will hold that the insurers should be made acquainted with all circumstances which might reason- ably affect the risk. Concealed habits of drunkenness have thus given rise to medical questions of considerable importance ; and in one re- markable instance, which will be mentioned hereafter, a question arose as to whether the practice of opium-eating, which had been concealed from the insurers, had or had not a tendency to shorten life. Some exposures, partly of a civil and partly of a criminal nature, have rendered insurance offices much more strict in their inquiries. In the rules already quoted, special information is demanded upon the existence of material circumstances touching health or habits of life, and whether the person is or is not of temperate habits. Any facts bearing upon these questions, if known to the medical attendant, must of course be stated. The exist- ence of such habits must be known to the person himself, and the declara- tion which he signs is so explicit that, if there be intentional concealment by him, no individual can reasonably complain of the violation of the policy and the forfeiture of the premiums. Material Concealment. — Some medical practitioners entertain the opinion that, provided they can certify that the person is in good health at or about the time of the insurance, this is all that the insurers need know. The same opinion is commonly entertained by the insured, and the latter, after having been attended by one medical man for an illness, will apply to another, a comparative stranger, to certify to his condition of health for insurance. We must not lend ourselves to this system, which is based sometimes upon a mistake, at others upon fraud. If med- ical men would decline signing the papers under such circumstances they would not only save themselves from censure, but be actually conferring a benefit upon the applicant by preventing him from obtaining a policy upon terms which on his death may render it invalid, and entail a for- feiture of the premiums. From what has already been said it will be understood that the exact state of health of the pers6n at the time of the insurance does not represent the whole of the risks incurred by the office. The restoration to health, as in a case of diseased lungs, may be only MATERIAL CONCEALMENT. 783 temporary ; it may be speedily followed by phthisis, and the insurers, therefore, ought to be informed of the previous condition as well as the present state of the applicant. The conditions in the declaration are so explicit upon this point as to render it scarcely necessary to refer to the propriety of making' this addition to the certificate. The disease under which the insured had labored may have been of a trivial kind, and not likely to afilect the risk ; nevertheless, the safer plan is to state it. The option will then lie with those who are to incur the risk. .When facts of this kind are either concealed or not plainly stated, the question of how far they were or were not material to be laid before the insurers is always left to the jury, who are guided in their verdict by their own common sense as well as by medical opinions. Some medical men have adopted the plan of signing certificates, but have declined to make any written reply to certain queries; as, for in- stance, the general query — " Can you give any and what information re- specting the habits of the applicant?" If nothing more be known con- cerning these, it should be so stated ; if, however, the existence of any habits afTecting health be known to us, we shall do an injury to the appli- cant and ourselves by withholding information on the subject. It may be the means of causing a heavier premium to be demanded for insurance than if the facts were known, and if this should not happen the omission is very likely to give rise to future litigation. If, under any circumstances, a jury should find that the concealment is material, the legal consequence is that the policy is void. It is not at all necessary that the person should die of the disease concealed. This rule was laid down by Lord Tenterden in the case of a Colonel Lyon. The colonel insured his life by two policies in May and June, 1823, and died of a bilious remittent fever in October following. Payment was refused, on the ground of misrepresentation and concealment. Colonel Lyon re- ferred the office for a certificate of his health to a gentleman who had not attended him for three years previously. His answers to the printed questions were that he had had no other medical attendant, and that he had never had a " serious illness." The medical man to whom he referred certified that his life was insurable, and the policy was issued. It ap- peared in evidence, however, that the deceased had been attended by two other medical men from Feb. to April, 1823, for hepatitis, fever, and a de- termination of blood to the head. One of these employed very acute treatment ; he considered him to be in a dangerous state, and would not have certified him to bo in health until the end of May, 1823. All agreed that the deceased did not die of the disease for which he had been thus attended. Lord Tenterden stated it to be his opinion that, if a man referred to one practitioner because he could speak well of his health, and thought that if he referred to other medical men they would not so certify, although the insured did not die of the disease Avith which he was then afflicted, the policy would be void. A verdict was accordingly given for the defendants. The practice of referring to medical men who have been only recently consulted is not infrequent. The opinion of the usual medical attendant might be unfavorable, or he might report on the existence of habits which w^ould render the life uninsurable, or insurable only at a high premium. This want of fair dealing, however, commonly defeats its object. There is expensive litigation, and the policy is pronounced to be void. Among the diseases upon the concealment o^ which policies have been most frequently disputed may be enumerated gout, dropsy, paralysis, 784 M'HAT IS INTEMPERANCE? epilepsy, spitting of blood, incipient phthisis, delirium tremens; and to this list may be added drunkenness, intemperance, and irregular, lewd habits. Intemperate Habits. — In a large number of cases the payment of policies is resisted on the ground of concealed drunkenness and general habits of intemperance. There is some difficulty in those cases becau.se medical men may entertain ditt'erent opinions respectiny the effects of such habits upon the general health, and the degree to which they may be safely carried. There is one thing, however, certain — whatever may be our opinion of their ctfect on health, we are bound to state, if known to us, that they exist, and thus put it out of the power of a comi)any to dispute a policy upon such a ground. From the frequent concealment of habits of this kind, most offices now adopt the practice of making it a special question, to which a plain negative or affirmative answer should always be given — "Are you now, and have you always been, of temperate habits of life? " It is well known that "intemperance" is a relative term and may be differently construed by different medical witnesses. The real question, however, divested of its sophistry, is this — Can any person indulge in an excessive use of alcoholic liquids without this practice sooner or later leading to an impairment of health, by producing disorder of the stomach and liver and remotely affecting different organs ? The effects of such habits may not show themselves immediately : but the office requires to be informed of their existence or non-existence, and not of the period when they are likely to affect health visibly, or to engender a fatal disease. To assert that a man can be addicted to excessive drinking without im- pairing his health, is contrary to experience. There is no such compen- .sation or balance of habits as is supposed to exist in these cases. Habit may accustom a man to intemperance — it may enable him to drink a large quantity of alcoholic liquid without being apparently injuriously influenced by it at the time ; but a deranged state of the system will sooner or later follow, and delirium tremens or dropsy will probably supervene. A good constitution may enable a man to resist the pernicious effects for a certain time ; but ultimately they will show themselves in some form of disease and the result of his intemperance is made apparent in his early death. It is unfortunate that no light is permitted to be thrown on such cases by pathology. Post-mortem examinations are not always made in these cases; for the death being, as it is called, natural it is not commonly thought necessary to inspect the body, although the condition of the liver and other organs might at once remove any difficulty which arose from the conflicting evidence on the habits of the deceased. In all cases of a con- tested policy, one important principle is uniformly acted upon — those who resist the payment are bound to prove what they allege by con- clusive and satisfactory evidence. A court will not receive probability or conjecture ; the evidence must be certain. Hence many suits fail from the medical evidence going no further than to show that a particular disease or habit had probably existed at the time of insurance. If the disease or habits be shown to have certainly existed, the evidence may still fail to prove satisfactorily that the concealment was either wilful or material. Contested cases of life insurance often show^ the imperfect manner in which medical observations respecting health or disease are made, and that the medical treatment of persons whose lives are insured may become a material question in the event of a policy being disputed. In the case of Chattock v. Shawe, in reference to an insurance on the life of Greswold, a question arose, not only concerning the concealment of intemperate OPIUM-EATING. i8ti babits, but as to the concealed existence of delirium tremens — irom the examination of handwriting-, as well as from the description g-iven by non-professional witnesses. It was here even doubtful what had caused the death of the deceased. According to one medical witness, it was a curious combination of Asiatic cholera, phrenitis, and epilepsy. It was proved that, more than three years before the insurance was effected, this man had met with a fall and he was afterwards seized with a fit, described bv some witnesses as epileptic, by others as arising from concussion of the brain. The existence of intemperance and epilepsy prior to the insurance was not made out to the satisfaction of the jury, and they returned a verdict for the representatives of the insured. Opium-eating. — Thee is another habit the concealment of which gave rise to an important trial — the practice of opium-eating. The Earl of Mar effected an insurance on his life, and two years afterwards, i. e. in 1828, he died of jaundice a ad dropsy at the age of fifty-seven. The in- surance company declined to pay the amount of the policy, on the ground that the earl was, at the time of the insurance, and had been for some time previously, an opium-eater. This practice was concealed from the insurers; and it was further alleged that it had a tendenc}^ to shorten life. It was clearly proved in evidence that the earl had been a confirmed opium-eater up to the time of his death. According to Christison, the deceased had taken laudanum for thirty years, at times to the amount of two or three ounces daily — a tablespooiful for a dose. He was a martyr to rheumatism, and, besides, lived rather freely. Many persons who were constantly about him and many intimate friends, deposed that until the year of the insurance he was of a cheerful disposition and clear in his intellect. Some of them admitted that they then perceived a change in his habits, which they attributed to the adverse circumstances in which he was compelled to live. In 1825 Abercrombie found him enfeebled and broken down in constitution, but without any definite complaint. The main question at the trial was whether opium-eating had a tendency to shorten life — for on this the issue turned — whether concealment from or the non-communication of this practice to the office was or was not mate- rial. Christison, Alison, Abercroml)ie, and Duncan were examined on the part of the insurers ; and although they entertained the opinion that the habit had a tendency to shorten life, they were unable to adduce any facts or cases in support of it. Their opinion was based, not on personal experience, but on the general effects of opium as manifested by its action on the brain, by its producing disorder of the digestive organs and giving to the person a worn and emaciated appearance. In most of the instances collected there was no evidence that life had been shortened by the prac- tice. On the contrary, some of the persons had carried it on for years, and had attained a good old age. The jury returned a verdict for the plaintiffs, not on the ground that the practice was innocuous and its con- cealment immaterial, so much as on the technical point that the insurers' had not made the usual and careful inquiries into the habits of the deceased; and they were therefore considered as having taken upon themselves the risk from their own laches. It appears that the general question with respect to habits was not answered by the medical referee, and it was therefore considered that the office had waived the knowledge of them, A new trial was granted on the ground of misdirection, but the suit was compromised. Hence no decision was come to in this case on an important question, which is very likely to arise again. It will be desirable, therefore, to ex- 50 786 TOBACCO-SMOKING. amine some of the facts connected vvitli opinm-eatintr, in order, if possible, so see how far it really tends to shorten life. In the case of the p]arl of Mar, it appeared to be a fair inference that the habit did not shorten his life, for he is re])resented to have indul^f-ed in it for thirty years; and for twenty-eight years, according- to the statements of his friends, no inju- rious effects had followed. Christison subsequently collected fron'i nu- merous sources no fewer than twenty-five cases, from which we learn that opium has been taken in large quantities for forty years together without producing any marked injury to health. On the whole, however, we are l)Ound to conclude that the habit of opium-eating is, as a rule, injurious to health, and is therefore calculated to shorten life. In any proposal for life insurance, the insurers should be informed of this habit when it exists, and no medical man should sanction its concealment merely because many persons addicted to it have lived for years in apparently tolerable health. One of the questions put to a medical man is, whether he knows any material circumstances touching the health or habits of the person, to which the other inquiries in the certificate do not extend, and, if so, he is required to state them. Now, without going the length of saying that the life of an opium-eater is uninsurable upon a common risk, the habit is itself sufficiently material to require that it should be declared in reply to such a question as this. The practice may be. and often is, concealed from a medical attendant; then the insured, if not candid in avowing its existence, must expose his representatives to the risk of losing all benefit under a policy. Independently of medical facts, which appear to favor both sides of the question, a jury would prob- ably be guided to a verdict by the effect actually produced on the constitu- tion of a person who has been addicted to the practice. If it has continued many years, and there is no proof of his health having in consequence undergone any remarkable change, this might be regarded by the jury as the best possible evidence in favor of the concealment not being in such a case material. The insurers could not equitably complain of the verdict in the Earl of Mar's case, for as he began opium-eating at twenty-seven, and died at fifty-seven, without any obviously injurious effects being pro- duced by the use of the drug, it could not be said that in his case at least the practice had shortened life. It is rarely in our power to a|)ply any better or more practical test than this, under circumstances in which medi- cal facts appear to bear both ways. The case is very different from intem- perance in the use of alcoholic liquids ; and no one can doubt that in this form the results must be inevitably to impair health and shorten life. The facts here bear one way, and if instances of longevity can be adduced among spirit-drinkers, they are well known and generally admitted to be exceptions to the rule. The queries put by insurance offices are now so explicit that they must be considered as including the habit of opium- eating ; and there does not appear to be any just pretence for evading the admission of the practice, either on the part of the insured or (if known to him) of his medical attendant. Tobacco-smoking. — The prevalent habit of smoking tobacco has never been adequately regarded in relation to life insurance. Although excessive smokers are liable to attacks of dyspepsia, loss of muscular and nervous power, weakness, amaurosis, and other derangements of the system, there is no evidence to show that the practice has a tendency to shorten lif'^ The habit should be stated in the certificate, if known to the medical referee and to be of an inveterate kind, (See Ann. d'Hyg., 1866, t, 2, p. 152.) This would at least prevent objections on the part of a captious VOIDANun; OF POLICIES BY SUICIDE. T87 company. There is no rule of law on this point, if we except a dictum of Lord Man.sfield : " The insured need not mention what the insurer ought to know, what he talves upon himself the knowledge of, what he waives being informed of ; the insurer need not be told general topics of speculation." Insanity. — When we are called upon to say what diseases have a ten- dency to shorten life, there is commonly no difficulty in giving a reply, since the name of the disease, its known effects upon the body, the degree of the mortality produced by it, and its intractableness are data upon which a medical opinion may be easily expressed. There are some dis- eases, however, respecting which it is not so easy to return an answer; and among these may be mentioned insanitij, which has already given rise to discussion in a court of law. The treatment of this malady falls out of the usual line of practice; and there are comparatively few in the profession who have made themselves acquainted with statistical details respecting it. There was formerly a notion that insanity had a tendency to prolong life; but statistics have shown that the insane are more liable than the sane to various diseases, and that when attacked they sink more easily under them ; hence the mortality of the insane, cseteris iMrihus, is much above the average of that of the sane population. Among other fatal diseases, the insane are specially liable to attacks of paralysis and epilepsy ; and paralysis, however slight, is commonly the forerunner of death in these cases. In private asylums, the mortality is always less than in public hospitals ; but researches have proved that the mortality of the insane has been much reduced by the introduction of an improved system of management and treatment. Observations have shown that the mortality among male is greater than among female lunatics, and the more advanced the age the greater the proportionate rate of mortality. The concealment of insanity in any of its forms, or even the concealment of a known hereditary tendency to this malady, would be considered material, insomuch as either condition forms a special question to which a direct answer should be returned. Suicide. — Among the conditions in policies of insurance, there is gener- ally a stipulation in the contract that the policy shall be void if the per- son who insures his life commits suicide. Thus a medical question may arise as to w^hether suicide was or was not committed in a particular case. A person may die from poison, wounds, drowning, or other forms of asphyxia; and it may be difficult to say whether, in certain cases, the death arose from accident, suicide, or from violence inflicted by another. Such cases are often left in great uncertainty at coroner's inquests — the evidence received being imperfect or insufficient; because in cases of sudden death, provided there be no suspicion of murder, it is considered of little moment to make a strict inquiry. If the life of the decea,sed should happen to be insured under a policy containing this condition respecting suicide, the question may become of great importance to the interest of the insurers, and they will require clear evidence that the death was natural or accidental, and not suicidal, before paving the amount of the policy. The cause of death should in all cases of violence be determined by a medi- cal man ; this will put an end to any dispute concerning the payment of the policy, and relieve the representatives from the trouble and expense of litigation. If the death be sudden, and any suspicious circumstances are left unexplained, a civil action may follow. We are not, therefore, safe if at a coroner's inquest we suppose that we have only to satisfy a jury by a 788 INSURANCE MURDERS. hasty opinion expressed from an external view of the body, or an ill-con- ducted inspection, merely because it may appear to us quite certain that the deceased could not have })een murdered. Should the deceased be one of that class of persons on whose lives insurances are commonly effected, the whole of the circumstances connected with the examination of the body, and the medical opinion of the cause of death, must come to lijrht, and, if the examination was carelessly performed, will probalily be made the sub- ject of a severe cross-examination. There have been several painful exposures of this kind, because the medical witness thoup-ht any kind of evidence would serve the purpose of a coroner's jury. The verdict of a jury at an inquest is not bindin<>- on a company ; they have not only a rio-ht, but often good reason to dispute it, and they frequently exercise this privilege. The insurance companies are exposed to all kinds of frauds, actually leading, as in the case of burial clubs (a kind of life insurance), to the perpetration of murder for the sake of the small amount insured. Among the medico-legal questions connected with this subject is the following : Does the proviso in the policy respecting suicide include all acts of self-destruction; or is it restricted only to those cases in which a sane or a partially insane person consciously destroys himself? This question has been elsewhere fully considered. The act of suicide does not necessarily indicate insanity; but even if it did, the rule of law, as settled by a majority of the judges in reference to this proviso in cases of life in- surance, is that, whenever an insured person destroys himself ivtenlionally, whatever may be the state of his mind, the policy is void. If a person, whether sane or insane, kills himself unintentionally , then the insurers are liable ; but the onus of proof in this case lies upon the plaintiffs, i. e. those who would benefit by the policy. A question here arises — Can an insane person be said to have the same " intention" to destroy himself that could be ascribed to one who was sane ? Is not the intention aff"ected by the state of insanity. This may in some measure depend on the degree which the mental disorder has reached. According to Tardieu, the decision of a French tribunal on this subject, Aug. 8, 1854, was to the following effect : " Whosoever has caused his own death under an attack of insanity cannot be considered to have fallen a victim to ' suicide' in the sense in which this term is used in policies of insurance." (Ann. d'Hyg., 1864, t. 2. p. 394.) According to the practice of some British offices, the act of suicide does not render a policy void ; but in the Government life insurances there is a provision to tlie effect that they will be void in case of death by the hands of justice or by suicide. Insurance Murders. — The insurance of the lives of others has been considered to be objectionable, on the ground that it tends to create an in- terest in the death of a person, and thus to lead to secret acts of murder The 14 George III., c. 48, expressly enacts that no insurance on a life shall be valid, unless the person insuring has a direct legitimate interest in the person whose life is insured. This statute was enacted for the purpose of preventing gambling in policies, and to guard society against the risk of persons insuring, and then contriving the death of the insured, for the sake of the payments to be made under the policy. Its effect is simply to render the policy void; it does not require that the premiums shall be refunded, nor does it award any penalty to the offenders. As policies of life insurance may be bought and sold like other property, they may fall into the hands of persons who have no other interest in them than the de- sire that such policies should speedily become claims by the death of the insured. The interest of such holders, it has been justly observed, lies in the death, and not in the life, of the insured. INSURANCE MURDERS. 789 The revelations at Liverpool (Reo-. v. Flannagan and Higgins, Liver- pool Feb. Ass., 1884), and the case of Reg. v. Powell, (Worcester' Spring Ass., 1888), and the Deptford murder cases in 1889, show what terrible prevalence there^ is of murder for the purpose of procuring insurance moneys ; and point to the extreme necessity that exists, in consequence of the lax way in which small policies are effected, of medical men being careful as to the giving of death certificates. 790 MEDICO-LEGAL SURGERY — MILITARY SURGERY. [MEDICO-LEGAL SURGERY. CHAPTER LXIX. THE IMPORTANCE OF THIS BRANCH OF MEDICAL JURISPRUDENCE. — MILITARY SURGERY. — NAVAL SURGERY.— RAILWAY SURGERY. — ACCIDENTS ON RAILWAYS.— DAMAGE CASES. — RAILWAY SURGEONS. — THE RAILWAY HOSPITAL SYSTEM. — TRANSPORTATION OF DEAD BODIES. — HEALTH PRECAUTIONS. — CASES OF INFECTIOUS DISEASES. Medico-legal Surgery should be considered under three separate and distinct heads : Military Surgery ; Naval Surgery ; and Railway Surgery. Military Surgery. In all countries the military surgeon forms a fixed and distinct arm of the service of the army of the nation ; and its relation to medico-legal sci- ence has been well defined in the past. Through the courtesy of Surgeon D. L. Huntington, M. D., Deputy Sur- geon-general of the United States Army, the general features of the army organization of the American military surgeon may be stated as follows: The Army Medical Department constitutes one of the bureaus of the War Department, and is composed of one surgeon-general with the rank of brigadier-general ; six surgeons with the rank of colonel and styled assist- ant surgeon-general ; ten surgeons with the rank of lieutenant-colonel, styled deputy surgeon-general ; fifty surgeons with the rank of major ; and one hundred and ten assistant surgeons. All assistant surgeons enter the corps by competitive examination and are commissioned as first lieutenants ; after five years, and upon passing successfully the required examination, they are promoted to the rank of captain. Promotion throughout the corps is by seniority. There are no regimental surgeons, but medical officers for posts, armies, and commands are detailed for whatever duty may be required. The Medical Department of the Army also comprises the Hospital Corps, made up of hospital stewards, acting hospital stewards, and privates, the number of each determined by the necessities of the service. The Hospital Corps is divided among the several posts where troops are stationed, and in force proportionate to the size of the post. The army medical officer of whatever grade is a regularly commissioned staff" officer, appointed by the President and confirmed by the Senate, hold- ing his commission for life unless deprived of same by sentence of court- martial. The medical officer cannot assume command except in his own department, but by virtue of his commission he may command all enlisted men like other commissioned officers. Medical officers, by virtue of com- mission, are entitled to sit on courts-martial, boards of inquiry, and other boards or commissions, taking their places by seniority. Each military department is entitled to a medical officer on the depart- ment staff, known as the chief surgeon of the department, and in times of war, or of active field duty, a chief surgeon of an army, army corps, or di- vision is detailed to duty with the general officer commanding such forces. MEDICO-LEGAL SURGERY — NAVAL SURGERY. 791 A more specific and detailed account of the duties, etc., of medical officers of the army is contained in the Army Regulations, U. S. A. A " Circular of Information for Candidates seeking Appointment in the Medical Corps of the United States Army " can be obtained on application to the Surgeon- General's Department of the Array. Vide also Medical and Surgical His- tory of the War of the Rebellion ; Buck's Reference Handbook of the Medi- cal Sciences, vol. iii. pp. 105 et seq. ; Ibid. vol. ix. Supplem. 640 et seq. ; Pilcher's First Aid to the Wounded ; " Index-Catalogue," Library of the Surgeon-General's Office. In the several American States the National Guard has attached to it the regimental surgeon as the basis of its system. In Great Britain the Army Regulations fix the status, powers, duties, and responsibilities of the army surgeon. The Association of Military Surgeons of the United States. In the United States of America the military surgeons of the country have united in an organization — The Association of Military Surgeons of the United States — which embraces all branches of surgeons connected with the regular Army and Navy as well as the military surgeons connected with the National Guard of the several States of the American Union. This body meets annually to consider questions connected with military surgery, and its contributions to the literature of this branch have been important. Naval Surgery. The medical jurisprudence of naval surgery does not materially diflfer from that of army surgery, but it is perhaps proper to speak of it by itself. Through the courtesy of Surgeon-general J. R. Tryon, M. D., United States ^avy, the outlines of that organization may be stated as follows : The Medical Corps of the Navy is allowed by statute law a membership of 170. The corps is divided into five grades, to wit: Medical director, medical inspector, surgeon, passed assistant surgeon, and assistant surgeon, which have the relative rank respectively of captain, commander, lieuteuant- ■commander, lieutenant and lieutenant junior grade, and ensign. Admission to the Corps is based entirely upon merit as determined by examination before a board of medical officers carefully selected for this purpose. A copy of circular showing scope of examination can be obtained on application to the Surgeon-general of the United States Navy. When a candidate is successful before the board, he is commissioned by the Presi- dent, by and with the consent of the Senate, as an assistant surgeon, with the relative rank of ensign. After three years' trial in the service as an assistant surgeon he is examined by the Medical Examining Board for pro- motion to the grade of passed assistant surgeon. In the event of failure he is again examined at the expiration of one year, and should there be a second failure he is dropped from the naval service. On promotion to passed assistant surgeon a new commission is issued by the President. Pro- motion from the grade of passed assistant surgeon and the other higher grades is by seniority, after examination before a board of medical officers. The rank of the members of the Medical Corps, while conferred in the same manner as in the case of the members of the line corps, is relative, and in two grades, as shown above ; there may be two ranks in the same grade, depending upon promotion in the line corps. In Great Britain the naval surgeon occupies a similar position in relation to the service of her Majesty's Government in the department of the Navy ; 792 MEDICO-LEGAL SURGERY — RAILWAY SURGERY. and the officers of both arms of the service unite in practical recognition in Array and Navy clubs and in the united service of both branches of the service on land and water, as also in the Dominion of Canada and the colo- nial dependencies of the English crown. Railway Surgery. Railway surgery has become by far the most important branch of sur- gery in its relation to medical jurisprudence, when considered in its volume and as affecting the great body of the people, especially in the United States of America. The evolution of the railway system, especially upon the North American continent (which now has more miles of railway almost than all other countries combined) has in its train, and as a necessity, wrought radical chauges to both the legal and the medical professions, and has brought nearly every inhabitant of the United States of America and the Dominion of Canada into new and at the same time more immediate and direct communication and relation, to and with the management of railways. The railway has revolutionized commerce, manufactures, raining, agricultural production and developraent, and indeed every branch of human industry. All manufactures, all products, are now brought to the market by the railway. It has superseded all other methods of travel or transportation where distance is a factor, and has become to the body poli- tic — the State — w'hat the arterial and venous circulation is to the human structure. In 1891, the Dominion of Canada had completed and in ope- ration 14,000 miles of railways, while the United States had 214,000 miles, including double tracks and sidings. An enormous impetus and increase has since constantly occurred. (Med.-Legal Jour., vol. xi. p. 37.) Mr. Jus- tice David J. Brewer of the Supreme Court of the United States, in his address before the New York State Bar Association, stated that in 1893 there was $11,000,000,000 invested in railway property in the United States whose shareholders in this country number less than 2,000,000 persons. (Med.-Legal Jour., vol. x. p. 404.) From an inexorable necessity, where the railways transport such vast numbers of the population, in all the varied pursuits and business of men, accidents have become a part and feature of the systera ; and the well- equipped railway of the present day must almost of necessity have its sur- gical system and its legal systera. Chief Surgeon C. W. P. Brock, in his presidential address before the National Association of Railway Surgeons, in June, 1893, stated that " During the year ending June 30," 1891, 7029 persons were killed on railways in the United States, and 40,910 injured. Of these, 2660 employes were killed and 293 passengers, and of the total injured 26,140 were employes." (Med.-Legal Jour., vol. xi. p. 64.) There are a few railways which have perhaps not yet recognized this as indispen- sable, but only a few ; and it may be stated as a truism, that every first-class railway must have its legal advisers, attorneys, and counsel, on the one hand, and its chief surgeon and surgical staff, on the other. The railway that neglects to provide these two important adjuncts for its operation is not fully equipped for its work ; and without projjcr surgical organization it would not only pay double what it should in accident and damage cases, but would not properly provide for the care of the wounded, and sufferers from accidents, of its own employes in its practical operation. The railway counsel has long been a conceded and recognized factor in railway admin.- istration ; the railway surgeon is quite as necessary, almost as important, and his field of duty is an outgrowth of the railway system which is, to a large extent, a part of the growth and evolution of the railway itself The rail- MEDICO-LEGAL SOCIETY'S SECTION ON SURGEKY. 793 way surgeon has in the United States of America become a distinct and representative part of the medical profession, and he has come to stay, as a fixed part of our railway system. Section of Medico-Legal Surgery (of the Medico-Legal Society). The growing importance of railway surgery in medical jurisprudence ■was distinctly recognized by the Medico-Legal Society, on September 6, 1893, by the organization of a Section of Medico- Legal Surgery, embracing railway counsel and railway, military, and naval surgeons, under a chair- man and twenty vice-chairmen, selected ten from each jDrofession from the various States of the American Union. This action was based upon recom- mendation made in an address entitled "Railway Surgery in Law and Medi- cine," made before the National Association of Railway Surgeons at Omaha, Nebraska, June 7, 1893. {Vide Med.-Legal Jour., June, 1893, vol. i. p. 37 ; Ibid. vol. xi. p. 203.) Chief Surgeon Granville P. Conn, M. D., of Concord, New Hampshire, was its first chairman, and was suc- ceeded by Chief Surgeon J. B. Murphy, M. D., of Chicago, 111. The chief merit and usefulness of this organization lay in its uniting in its labors rail- way lawyers of eminence and distinction, and the leading chief surgeons of the prominent American railways, so that both sides of all questions could be studied, as well from the legal as from the surgical and medical side. The record of the labors of this body can be best considered and appre- ciated by its annual reports. The first annual report, of the year 1894, showed the history of the organization, and gave its officers and a list of members, embracing twenty-eight of the leading chief surgeons of American railways, and a large number of local surgeons, military and naval surgeons, and eminent railway counsel. It defined its province and domain by the following resolution : " Resolved, That all questions in Medico-legal Surgery are to be deemed within the province of the Section, including military, naval, and railway surgery and the broad domain of surgery in its relation to medical jurisprudence." {Vide full report, Med.-Legal Jour., vol. xii. p. 471.) The following abstracts are made from its second annual report, January 2, 1896 : " The Section is intended to embrace, beside naval, military, and railway surgeons and counsel, railway managers, railway superintendents, and claim- adjusters — railway officials, whether lawyers or surgeons ; many of whom have already united with the body, and who are eligible to membership under the statutes of the Society. The officers of the Section are annually chosen. Three members of the executive committee constitute a quorum, and five of the board of officers, of the Section. The work of the Section during the preceding year has been devoted to the advancement of the sci- ence of the medical jurisprudence of surgery in all of its branches. The papers contributed upon these branches of science have been in part pub- lished in the Medico-Legal Journal, which is the official organ of the Sec- tion, except those contributed to the Medico-Legal Congress of September, 1895, which will appear in the Bulletin of that Congress. At the Novem- ber meeting, 1895, of the Section held in joint session with the Medico-Legal Society in the city of New York a large number of contributions were read by members of the Section which will be published in the Medico-Legal Journal, and by authority of the joint session will be embraced in the Bul- letin of the Medico- Legal Congress." The following abstracts are made from its third annual report, January 1, 1897 : T94 MEDICO-LEGAL SOCIETY'S SECTION ON SURGERY. " The followiug is a resume of the work of the Section during the year : " 1. Paper by J. Mount Blyer, M. D., read before tlie Section in joint session in the Medico-Legal Society at April meeting, 1896 : ' The a;-Ray in Medico-Legal Surgery.' This paper was illustrated by a complete aj^pa- ratus for a display of the cathode ray and the new Koentgen ray. " 2. Report of the sUuiding committee favoring the ' Railway Hospital System,' made and adopted at April meeting, 1896. Published in Med.- Legal Jour., March, 1896, vol. xiii. p. 435. " 3. Report of the standing committee on ' Car Sanitation and Railway Transportation of Contagious and Infectious Diseases,' made and adopted at April meeting, 1896, and published in Med.-Legal Jour., March, 1896, vol. xiii. p. 437. " 4. Paper by Clark Bell, Esq., on ' The Future of Railway Surgery/ read at May meeting, 1896. " 5. Action on behalf of the Section and of the Medico-Legal Society sub- mitting both the foregoing reports to the National Association of Railway Surgeons, at St. Louis, April 30 and May 1 and 2, 1896. " 6. ' Duties and Responsibilities of the Attending Physicians in cases of Railway Surgery,' by Judge Abram H. Dailey. " 7. (Same subject), by Clark Bell, Esq. See Med.-Legal Jour., vol. xiv. p. 7. " 8. Discussion of same subject by H. W. Mitchell, M. D., Surgeon J. K. Caldwell, Chief Surgeon Frank J. Valentine, Judge Abram H. Dailey, Chief Surgeon C. M. Daniel, M, D., Sui-geon H. McDonald, Surgeon Frank J. Dow, and Mr. Clark Bell. Reported in Med.-Legal Jour., December, 1896, vol. xiv. p. 335. " 9. Discussion of the same subject by H. W. Mitchell, M. D., Judge Abram H. Dailey, Albert Bach, Esq., Frederick E. Crane, Esq., D. Ben- jamin, M. D., S. B. W. McLeod, M. D., and Clark Bell, Esq. Reported in Med.-Legal Jour., June, 1896, vol. xiv. p. 123. " 10. Address by Clark Bell, Esq., at December session of the Section, 1896, on * The Scope and Progress of the Work of the Section.' " 11. Paper by Chief Surgeon R. Harvey Reed, M. D., vice-chairman of the Section, on ' Progress and Work of the American Academy of Railway Surgeons.' "12. ' Review of the Relief and Hospital Department,' by Geo. Chaffee, M. D. "13. ' Transfusion in Severe Cases of Shock in Railway Injuries,' by H. W. Mitchell, M. D., of New York." Present Officers. — The officers of this body for 1897 are as follows : Chairman — Chief Surg. J. B. Murphy, M. D., of Chicago, 111. Vice- Chairmen {Legal)— Clark Bell, Esq., of New York; Judge John F. Dil- lon, of New York; Judge W. H. Francis, of New York City; Hon. J. W. Fel- lows, of New Hampshire; Hon. W. C. Howell, of Iowa; Judge A. L. Palmer, of New Brunswick ; Hon. George R. Peck, of Illinois ; Hon. J. M. Thurston, of Nebraska ; Hon. Rastus S. Ransom, of New York City ; Hon. Allen Zollers, of Indiana. Vice-Chairmen [Surgical) — George ChatFee, M. D., of Brooklyn; Chief Surg. Chas. K. Cole, M. D., of Montana; Prof. A. P. Grinnell, M. D., of Vermont; R. S. Harnden, M. D., of New York ; Chief Surg. W. B. Outten, M. D., of Mis- souri; Chief Surg. John E. Owen, M. I)., of Chicago; Chief Surg. R. Harvey Reed, M. D., of Columbus, Ohio; Surg.-Gen. Nicholas Senn, M. D., of Illinois ; Chief Surg. S. S. Thorne, M. D., of Ohio. Secretary — Clark Bell, Esq., 39 Broadway, New York City. Treasurer — Division Surg. Webb J. Kelley, M. D., Gallon, Ohio. NATIONAL ASSOCIATION OF RAILWAY SURGEONS. 795 Executive Committee — Clark Bell, Esq. {Chairman); Chief Surg. F. H. Cald- well, M. D., of Florida ; Surg. M. Cavana, M. D., of New York ; Surg. C. M. Daniel, M. D., of Buffalo ; Chief Surg. Granville P. Conn, M. D., of New Hamp- shire ; Chief Surg. B. F. Eads, M. D., of Texas ; Surg. Geo. Goodfellow, M. D., of California; Chief Surg. A. C. Scott, M. D., of Texas; Judge A. H. Dailey, of New York; Surg. C. B. Kibler, M. I)., of Pennsylvania ; Chief Surg. W. B. Out- ten, M. D., of Missouri; Surg. R. S. Parkhill, M. D., of Hornelsville, New York; Surg. T. I. Pritchard, M. D., of Wisconsin; Chief Surg. F. A. Stillings, M. T>., of New Hampshire. Its roll contained at the time 137 members, selected from the foremost chief surgeons on railway lines, military, naval, and railway surgeons, rail- way lawyers, and counsel in the United States. The National Association of Railway Surgeons. This is, so far as numbers go, the most powerful of the societies of railway surgeons. It was founded in June, 1888, and its first president was Surgeon J. W. Jackson, M. D., elected at Chicago, 111. The idea of its founders was to open its doors to every railway surgeon in the United States and the Can- adas, and it soon grew into a very large body. At the meeting held at Oalveston, Texas, in May, 1894, the enrolled membership exceeded 1700 names, and there were nearly one thousand persons in attendance at the session. Some there thought that the body was too large and unwieldy, and that that period was perhaps the maxinuim of its growth. It has not increased since then. The scope of the work of this society is very broad, covering the entire field of railway surgery, and it aims to interest and associate every railway surgeon. It has held annual meetings in May of each year. It has made large contributions to the literature of railway surgery, and has published a journal which was for all the earlier years under the editorship of Prof. R. Harvey Reed, then the treasurer of the organization. Perhaps the most active and influential man in this body is and has been Wm. B. Outten, M. D., Chief Surgeon of the Missouri Pacific Railway sys- tem, of St. Louis, Mo. He was president for one term, and on the retire- ment of R. Harvey Reed, M. D., became the editor of the journal now called the " Railway Surgeon," a position he still holds. Its presidents have been as follows : Surg. J. W. Jackson. Surg. J. B. Murdock, M. D., of Pittsburg, Pa., was elected May, 1889, at St. Louis, Mo. Chief Surg. Wm, B. Outten was elected May, 1890, at Kansas City. Dr. J. H. Murphy of St. Paul was elected May, 1891, at Buffiilo. Chief Surg. C. W. P. Brock of Richmond, Va., was elected May, 1892, at Old Point Comfort. Chief Surg. W. J. Galbraith, M. D., of the Union Pacific R. R. Co., was elected May, 1893, at Omaha, Neb. Chief Surg. Samuel S. Thorn of Ohio was elected May, 1894, at Galveston, Texas. Chief Surg. J. B. Murphy was elected May, 1895, at Chicago. Surg. F. J. Lutz, M. D., was elected May, 1896, at St. Louis. Dr. Geo. Ross of Richmond, Va., was elected May, 1897, at Chicago. Present Officers. — These are as follows : President — George Ross, Rich- mond, Va. Vice-Presidents — (1st) J. A. Hutchison, Montreal, Can. ; (2d) A. L. Fulton, Kansas City, Mo. ; (3d) De Saussure Ford, Augusta, Ga. ; (4th) John J. Buchanan, Pittsburg, Pa. ; (5th) H. L. Getz, Marshalltown, la. ; (6th) R. R. Lawrence, Hartford, Mich. ; (7th) W. Q. Marsh, Sierra Mojada, Coahuila, Mexico. Treasurer — E. R. Lewis, Kansas City, Mo. Secretary — Louis J. Mitchell, 71 Laflin Street, Chicago, 111. Executive 796 AMERICAN ACADEMY OF RAILWAY SURGEONS. Committee — W. B. Oiitten, St. Louis, Mo. ; J. B. Murphy, Chicago, 111. ; Jas. II. Letcher, Henderson, Ky. At its last meeting, in May, 1897, this body changed its name to " The International Association ok Railway Surgeons," and it selected Toronto, in the Dominion of Canada, as the next })lace of meeting. The American Academy of Railway Surgeons. This is an organization composed of railway surgeons of eminence in the United States, and was founded in 1894. It was largely composed of mem- bers of the National Association of Railway Surgeons, and it was due to difference of opinion among the prominent members of the older society as to the basis of organization and methods of work that the American Acad- emy of Railway Surgeons was founded. Prof. R. Harvey Reed, M. D., now chief surgeon of Columbus, Ohio, who had been a very prominent factor in building up the National Asso- ciation of Railway Surgeons, had been its treasurer and the editor of its Transactions, was prominent in the organization of the American Acad- emy of Railway Surgeons, Avas chosen its editor, and gave large atten- tion to its work. He says, in the preface to its first volume of Transac- tions, as a raison d'etre for the new organization : " The field of railway surgery has become so large and correspondingly important during the last decade that it has not only elicited the profound interest of every modern surgeon, but the serious consideration of every progressive raihvay company. With the rapid advancement of the science of modern surgery and the steady increase of the mileage of the railways of our country, has come the multiplication of railway surgeons, and, Avith them, a proportionate increase of societies and associations of railway surgeons. From the fact that few if any of our medical books teach ' railway surgery,' it has become necessary to multiply these societies and associations, where, as a member of such, the railway surgeon can exchange experience, and learn how best to treat the great army of injured employes and passengers who annually come under his care, in such a manner as to give them the best results with the least loss of time and a minimum amount of suffei'ing, thus reducing to the lowest ebb the amount of damages against the company. With a full realization of these important and practical objects, and in the firm belief that ' The higher the order of railway surgery the greater the protection to the employe, the passenger, and the company,' the American Academy of Railway Surgeons was organized." The body has a membership of about 120 and is limited by its statutes to 200 ; it aims to elect only i-ailway surgeons of the first rank upon its roll of members. Its first president — chosen November, 1894, at its first annual meeting — was Chief Surg. C. K. Cole of Helena, Mont., of the Mon- tana Central Railway. Chief Surg. John E. Owens, of the Chicago and Northwestern Railway Co., of Chicago, was elected in the fall of 1895, and L. E. Lemen of Denver, Col., is now president, having been elected in the fall of 1896. This organization though young in years has made most valuable con- tributions to the literature of railway surgery. Present Officers. — These are as follows : President — Dr. L. E. Lemen, Denver, Col. Vice-Presidents — (1st) Dr. M. Gardener, San Francisco, Cal. ; (2d) Dr. R. Ortega, C. P. Diaz, M. D., Mexico. Secretary — Dr. D. C. Bryant, Omaha, Neb. DAMAGE CASES — MEASURE OF DAMAGES. 797 Treasurer — Dr. C. B. Kibler, Corry, Pa. Editor — Dr. R. Harvey Reed, Columbus, Ohio. Chairman Execuiive Board— hr. W. R. Blakeslee, Forest City, Pa. Chairman Committee on Transportation — Dr. W. J. Galbraith, Omaba, Neb. Chairman Committee on Arrangements — Dr. John E. Owens, Chicago, 111. State Associations of Railway Surgery. The vast and growing importance of railway surgery can in no way be more strongly evidenced than by the State organizations of railway sur- geons. These bodies meet annually, choose officers, read and discuss papers germane to the subject, and have as a result great local interest in the States, being representative bodies to which the local railway surgeons are more nearly allied. Their chief value and importance is in the education and improvement of the railway surgeons themselves by conference with each other ; interchange of thought and experience ; and, taken as a whole, their contributions to the science have been most valuable. The papers contributed to the various State and local societies in the United States during the course of each year would fill several volumes, and a simple enumeration of all their titles and authors would take more space than the present edition of this work would justify. It would be a valuable and timely work to have the more valuable of this literature col- lected in a series of volumes and published as a Railway Surgery Series by an editorial revising commission to be named by the State and National organizations with instructions to edit and publish the same for the use and benefit of both professions ; such a series would be of great interest and value. State societies known to the Editor have been organized in the following of the United States : New York, Florida, Iowa, Indiana, Ohio, Texas, West Virginia. Associations of the trunk lines of railway have been organized by the surgeons of the " Big Four " railway system ; the Chicago and North- western ; the Wabash Railway system ; the Pennsylvania Railroad ; the Plant Railway system ; the Santa Fe system ; the St. Joseph Railway system ; the Southern Railway Association, and the Southwestern Railway Surgeons' Association. These various bodies meet annually, have boards of officers, and have contributed valuable matter to the literature of railway surgery. Damage Cases and the Measure of Damages. This subject embraces the most fruitful source of litigation in which the principles of railway surgery are involved, and applies to all injuries whether by railways or other corporations, or individuals, who carry on general business with the public. Liability. — A railway or other corporation is only responsible for the careless, negligent, wrongful or improper exercise of its lawful rights, powers, or duties acting under the authority of the law. This liability can only arise upon and for the manner of doing the act, and not for the act itself (Slatten v. Des Moines Valley R. Co., 29 Iowa, 148 ; Mex. Nat. Constr. Co. v. Meddlegge, 75 Texas, 634 ; S. W. Rep. 257.) This liability is unlimited, and if resulting from a wrongful act it is im- material whether or not its results Avere unforeseen and not contemplated. (Brown v. Chic, Mil., & St. P. R. Co., 3 Am. & Eng. R. R. Cases. 444 ; 54 Wis. 342 ; 11 N. W. Rep. 356-911 ; 41 Am. Rep. 41, and cases cited.) Where the injury is the result of an inevitable accident without negli- gence, carelessness, or improper conduct, no right of action accrues. (Tucker 798 LIABILITY IN DAMAGE CASES. V. Duncan, 6 Am. & Eng. R. R. Cases, 263 ; 4 AVoods (U. S.), 652 ; 9 Fed- eral Rep. 867 ; Lewis v. Flint & P. M. R. Co., 18 Am. & Eng. R. R. Cases, 263 ; 54 Mich, do ; 19 N. W. Rep., 744; 52 Am. Reg., 790.) " Unskilful medical treatment " is no defence by a railway company even when it contributed to the death, if the defendants' negligence was the im- mediate cause of death. (N. v. M. R. R. Co., 10 Am. & Eng. R. R. Cases, 702 ; 75 Mo., 653 ; 42 Am. Rep., 418 ; Goshen i\ England, 119 Ind., 362 ; 21 N. E. Rep., 977.) Proximate or Consequential Damages. — Compensation for the actual los& sustained is the fundamental principle upon which the law bases damages. The maxim is " Causa proxima non remota spectatur." " Damages " has been held to be the indemnity recoverable by one who has sustained an injury, either in his person or property or relative rights, through the act or default of another, and the loss must be the natural or proximate conse- quence of the wrong. (Collins v. E. Term. V. & G. R. Co., 9 Heisk (Term) 841 ; 20 Am. Ry. Rep., 46 ; Pullm. Pal. Car Co. v. Barker, 4 Cole, 344 ; Mil. & St. Paul R. R. Co., 5 Am. & Eng. R. R. Cases ; v. Kellegge, 94 U. S., 475 ; Medbury v. N. Y. & E. R. R. Co., 26 Barb. (N. Y.), 564.) Consequential Damages. — The same rules apply, but the plaintiff must allege or prove that the injury was the result of the defendants' negligence, carelessness, or wrong-doing. (Indianapolis P. & Co. R. Co. v. Pitger, 25 Am. & Eng. R. R. Cases, 313 ; 109 Ind., 179 ; 58 Am. Rep., 387.) _ Mere fright or shock resulting from a railway collision, producing per- manent injury to the nervous system, is too remote to be actionable. (Ewing V. Pittsburg C. C. & St. L. R. Co., 48 Am. & Eng. R. R. Cases, 506 ; 147 Pa. St., 40 ; Atl. Rep., 340.) Compensatory Damages and Exemplary Damages. — The rule is that where there has been negligence only, without malice, wanton or malicious acts, compensatory damages only are allowed ; but where the injury is attended with malice, gross insult, or outrageous conduct or inexcusably gross negli- gence, exemplary or punitive damages are proper. When a disease caused by an injury supervenes, as well as where the dis- ease exists at the time of the injury and is aggravated by it, the injured person is entitled to full compensatory damages. (Louisville, N. & C. R. R. Co. V. Miller, 58 Am. & Er.g. Ry. Cases, 304 ; 37 K E. Rep., 343 ; Louisville, N. & C. R. R. Co. v. Snyder, 37 Am. & Eng. Ry. Cases, 137 ; 117 Ind., 455.) Wilful negligence, if wanton, wilful, or malicious, will justify punitive or exemplary damages. (Atchison, T. & S. F. R. Co. v. McGiunis, 46 Kan., 109 ; 26 Pac. Rep., 253 ; Kans. City F. & S. R. Co. v. Kier, 41 Kans., 671 ; Lake Shore & M. S. R. Co. v. Rosenzueig, 26 Am. & Eng. Ry. Cases, 466.) " Mental anguish." The courts have held in a long line of cases that mental pain or distress is a proper element in estimating damages for per- sonal injuries. (Rapalge v. Machs, Digest Railw. Law, vol. iii. p. 71, and a long line of cases there cited.)] LIST OF CASES CITED. ABDUL AZIZ, case of, 266 Absolom V. Statham, 328 Agnew V. Jobson, 533 Aldridge, Stothard v., 653 Alexander, Dr., case of, 127 Allen V. Chester Ey. Comp., 352 Anderson, case of, 602 Anderton v. Gibbs, 641 Ankers, Reg. v., 256 Armand, M., case of, 264, 446, 447 Armstrong, case of, 483 Atkinson, Mrs., case of, 171 Aubert, case of, 344 Austen, Smith v., 742 B ABB AGE V. Babbage, 43 Baddeley, De, and wife, Beg. v., 544 Bagley, Frazier v., 644, 682 Bagster, Miss, case of, 730 Bainbrigge v. Bainbrigge, 743 Baines, Reg. v., 774 Baker, Harwood v., 738 Baker, Reg. v., 75, 155 Banbury Peerage case, 655 Banks, Isabella, case of, 90 Barber, Howes v., 683 Barlow, Reg. v., 225 Barnett v. Roberts, 334 Bartlett, Reg. v., 205 Barton and Bennett, Lamb v., 328 Barton, case of, 740 Bernays, case of, 385 Berri, Due de, case of, 363 Betts V. Clifford, 35 Binns, Nichols and Freeman v., 739 Bishop and Williams, Rex v., 459 Blagg, Reg. v., 388 Blampied, Reg. v., 762 Blewett, case of, 739 Bocarme, Count, case of, 210 Borradaile v. Hunter, 776 Boughton, Sir T., case of, 84. Bousted, Price v., 666 Bowes, Reg. v., 223 Bowyer, Reg. v., 230 Boyden, Reg. v., 235 Boyle and wife, case of, 694 Boys, Morgan v., 741 Brain, Rex v., 569 Bravo, Mr., case of, 158 Brinckley, Reg. v., 696 Brixey, case of, 662 Brock V. Kelly, 615 Bromwich v. Waters, 627, 631, 690 Brook, Reg. v., 777 Brown, Reg. v., 559 Budd, Reg. v., 258 Burdett v. Thompson, 741 Burke, case of, 455, 459, 460 Burns, Reg. v., 774 Burton, Reg. v., 744, 760 Byron, Reg. v., 776 nALDER, Reg. v., 545 \j Cameron, Ann, case of, 474 Campbell, case of, 455, 459 Cannon v. Cannon, 717, 731 Carlo Ferrari, case of, 459 , Cartledge, Reg. v., 539 Cartwright, case of, 739 Cass, Reg. v., 279 Castro or Orton, Reg. v., 338, 348, 612, 643 Cayley and Phillips, Reg. v., 542, 543 Chaplin, Reg. v., 11 A Chapman, Reg. v., 370 Chantrelle, Reg. v., 90, 192, 228, 478 Chatfield, Reg. v., 370 Chattock V. Shawe, 784 Chester Ry. Compy., Allen v., 352 Clarke, Reg. v., 533 Cleator Moor case, 483 Clifford, Betts v., 35 Coble, Mrs., case of, 309 Cockroft, Reg. v., 761 Coghlan, case of, 739 Collier and Jones, Reg. v., 686 Colvin, Lord v., 665 Commonwealth v. Porter, 641 Conde, Prince de, case of, 430 Cook, case of 224 Coombs family, case of, 139 Corfield, Durnell v., 742 Cotterall v. Cotterall, 640 Cotton, Reg. v., 748 Count Bocarm^, case of, 210 Countess Goerlitz, case of, 394, 443 Courvoisier, ease of, 280 Cowley, Reg. v., 531 Cox, Reg. v., 458 Cresswell, Reg. v., 608 Creuse, Reg. v., 318 Croft, Mudway i'., 741 799 800 LIST OF CASES CITED, Crook, Reg. v., 144 Cruse, Keg. v., 769 D ALMAS, Reg. v., 269, 2T9 Darley and Moon, Reg. v., 540 Dav, case of, 739 Dav, Reg. v., 223 Day V. Day, 648 Dean, Reg. v., 663 De Bad(leley and wife, Reg. v., 544 Delafosse v. Fortescue, 683 De la Pommerais, case of, 237 De Tonrville, case of, 260 Devonald v. Hope, 517 Dixblanc, Reg. v., 438 Dodd, Reg. v., 258 Dodwell, Reg. v., 730, 744 Donelan and Reed, Reg. v., 333 Donnelly, case of, 505 Dos Santos, case of, 658 Douglas Peerage case, 642 Drake, Riley, case of, 235 Drumiuond, Mr., case of, 759 Due de Beri, case of, 374 Duchess of Kingston, case of, 39 Duchess of Manchester, case of, 742, 743 Duchesse de Praslin, case of, 251 Duke of Orleans, case of, 352 Durham v. Durham, otherwise Milner, 669, 694, 704 Durnell v. Corfield, 742 Dyson, case of, 641 EAGER V. Grimwood, 631 Earl of Essex, case of, 269 Earl of Mar, case of, 785 Ebermann, case of, 345 Eden, Renouf ?;., 639 Edmonds Reg. v., 279 Edmunds, Christina, Reg. v., 747 Edney or Hunter, Hunter v., 669, 717, 731 Edwards v. Edwards, 739 Eley, Reg. v., 593 Elphick, case of, 250 lissex, Earl of, case of, 269 FABRICIUS, Dr., case of, 322 Fenwick and Fi-ench, case of, 479 Ferrari, Carlo, case of, 459 Fisher, Reg. v., 116 Flack, case of, 279 Flannagan and Higgins, Reg. v., 140, 789 Foreman, Reg. v., 315 Fortescue, Delafosse v., 683 Frank, Dr., case of, 446 c Franklin and Randall, Reg. v., 140 Phraser, Simon, case of, 775 Frazer v. Bagley, 644, 682 Freeman and Nichols v. Binns, 739 French and Fenwick, case of, 479 GAITSKELL, case of, 395 Garden, case of, 739 Gardner, case of, 279 Gardner Peerage case, 637, 641 Gardner v. Llewellyn, 617 Garry, Reg. v., 277, 279 Gavan, Reg. v., 113 Gedney v. Smith, 648 Gibbons, Reg. v., 270, 384 Gibbs, Anderton v., 641 Goerlitz, Countess of, case of, 394, 443 Golding and Neal, Reg. v., 689 Gooch, Lady, case of, 648 Gooch, Reg. v., 365 Good, case of, 421 Goodale, Reg. v., 255, 279 Goodfellow, Reg. v., 393 Goodman, Reg. v., 777 Green, Reg. v., 374 Griffin and Venn, case of, 538 Grimwood, Eager v., 631 HALFORD, White v., 739 Hall, Reg. v., 767 Hall V. Semple, 729 Halls, case of, 484 Hardie, Reg. v., 541 Hargreaves, Reg. v., 149 Harmer, Reg. v., 683 Harrington, Reg. v., 279 Harris, Reg. v., 672 Harrod v. Harrod, 777 Harwood v. Baker, 738 Haynes, Reg. v., 114 Haynes r. Haynes, 666 Haywood, Mr., case of, 100 Heany, Reg. v., 315 Heap, Reg. v., 539 Heath, Reg. v., 279 Hemming, Kunn v. 732 Hennah, Reg. v., 76, 177, 551 Hewitt V. Perry, 613, 667 Higgins and Flannagan, Reg. v., 140, 789 Hill, Reg. v., 731 Hill, V. Philp, 719 Hodgson, Reg. v., 314 Hodgson, "Weir and wife v., 612 Hodgson, Whitbv v., 622 HoUis, Reg. v., 622 Hope, Devonald v., 517 Hopley, Reg. v., 317 Hornshaw, case of, 419 Hotham, Wood v., 660 Howes V. Barber, 683 Huelin, Mr., case of, 435 Humphreys, Reg. v., 752 Hunt, case of, 239 Hunt V. Hunt, 683 Hunter, Borradaile v., 776 Hunter v. Hunter, otherwise Edney, 669, 717, 731 Hutchins v. Hutchins, 648 Hyderabad, Second, Chloroform Commis- sion, 206 1*1 ST OF CASES CITED, 801 TEVIN, ANN, case of, 600 X Isaacs, Reg. v., 561 Isgate, Reg. v., 387 JACKSON, MRS., case of, 171 Jackson, Reg. v., 235, 744 Jacobs, Sarah, case of, 510 Jacobs and wife, Reg. v., 510 James, Mrs., case of, 90 Janoo, Miissamat, case of, 648 Jeremy, Mr., case of, 339, 759 Jobson and others, Agnew v., 533 Jolni, Percy Malcolm, case of, 242 Jones and Collier, Reg. v., 686 Jones, Reg. v., 324. KELLY, Brock v., 615 Kelly, Reg. v., 50, 326 Kenimler, case of, 493 Kennedy v. Brown, 38 Kent, Constance, Reg. v., 662 Kerr, Reg. v., 450 Kerslake," Roberts v., 715, 740 King, Reg. v., 130 Kingston, Duchess of, case of, 39 Knight, Reg. v., 534. LABRIE, case of, 338 Lacey, Reg. v., 765 Laffarge, Madame, case of, 139 Lamb v. Barton and Bennett, 328 Lanison, Reg. v., 48, 243 Lane, Harriet, case of, 340, 529 Lay ton, Treherne v., 619 Lee, Reg. v., 250, 254, 394, 395 Lesurgues, case of, 340 Levy, case of, 688 Lewis, Reg. v., 374 L' Hotel Her, case of, 620 Libbev, Reg. v., 287, 289, 592 Lipski, Reg. v., 104, 396 Llewellyn, Gardner v., 617 Lord V. Colvin, 665 Lord, Parker v., 739 Lnnnnm, Reg. v., 443 Lnscombe v. Prettyjohn, 627, 641 Lntwidge, Mr., case of, 749 Lyddon, Reg. v., 188 Lyon, Colonel, case of, 783 MACAULEY, Sharpe v., 740 Macrae, case of, 672 Mackenzie, Colonel, case of, 401 McEwan, Reg. v., 687 McGowan, Reg. v., 311, 774 McKane, Reg. v., 749 McKonkey, Reg. v., 238 McMullen, case of, 75 McNaghten, case of, 753, 758, 759, 761 Maddock, Reg. v., 719 Manchester, Duchess of, case of, 742, 743 Mar, Earl of, case of, 785 51 Martin, Reg. v., 605 Maskerry v. O'Connor, 19 Mawer, Peter, case of, 171 Max ted v. Morris, 36 May, Reg. v., 603 Maybrick, Reg. v., 78, 125 Mayer, case of, 176 Mayer, Dr., case of, 242 Maynard, Reg. v., 592 Millar, Reg. v., 435 Miiner or Durham v. Durham, 669, 717, 731 Montgomery, case of, 256, 279 Moon and Darlev, Reg. v., 540 Moore, Reg. v., 279, 543 Mordaunt v. Mordaunt, 715 Moreiand, Reg. v., 325 Morgan v. Boys, 741 Morris, Reg. v., 109 Mudway v. Croft, 741 Miiller, Salome, case of, 340 Murray, case of, 744 NEAL AND CxOLDING, Reg. v., 689 Newton, Reg. v., 551 Newton v. Bagster, 730, 731 Nichols and Freeman v. Binns, 739 Norman, Reg. v., 460, 662 Nunn V. Hemming, 732 O'BRIEN, Reg. v., 437 Ogilvy, Reg.?'., 726 Orleans, Due d', case of, 352 Orton or Castro, Reg. v., 338, 340, 348, 612, 643 Owen and others, Reg. v., 625 Oxford, Reg. i;., 713 PALMER, Reg. v., 90 Pardon, Reg. v., 209 Parker v. Lord, 739 Pascoe, Reg. v., 542 Patteson, Reg. v., 773 Pauw, case of, 237 Pearson, Reg. v., 228 Pel, case of, 394 Peltzer, case of, 385 Perry, Hewitt v., 667, 713 Peters, Mrs., case of, 90 Phillips and Cavlev, Reg. v., 542, 543 Phillips, Reg. v., 170 Philp, Hill v., 719 Pinckard, case of, 437 Pink, case of, 369 Pitt, Reg. v., 574 Pommerais, De la, case of, 237 Porter, Commonwealth v., 641 Powell, Reg. v., 789 Praslin, Duchesse de, case of, 251 Prettyjohn, Luscoml)e v., 628, 641 Price V. Bousted, 666 Price, Reg. v., 773 Prince de ("onde, case of, 430 Pritchard, Reg. v., 45 802 LIST 0¥ CASES CITED. Pym, Keg. v., 329 Pyne, Keg. v., 605 Q UAIN, Reg. v., 329 RANDALL AND FRANKLIN, Reg. i., HO Kaynon, Keg. v., 332 Kedstone, Keg. v., 399 Keed and Donelan, Keg. v., 333 Reeves, Keg. v., 708 Keid, case of, 537 Reid, Rex v., 360 Kenaud, case of, 255 Renoiif r. Eden, 639 Reppingnll v. Reppingull, 681 Reynolds, Reg. v., 155, 744 Ricli r. Pierpoint, 35 Richardson, Reg. v., 388 Riel, Madame, case of, 438 Riley, Reg. v., 165 Roberts V. Barnett, 334 Roberts v. Kerslake, 715, 740 Robinson, Reg. v., 607 Rollings, case of, 316 Ross, Elizabeth, Rex v., 460 Ross, Toiichet, Reg. v., 713 Roux, Maurice, case of, 264, 446, 447 Rowlands, Reg. v., 279 Rumble, Reg. v., 389, 758 Rush, Reg. v., 174, 540 Russell, Lord W., case of, 280 Russell, Reg. v., 89 SAINSBURY, case of, 235 Sands, case of, 412 Saxon, Reg. v., 314, 320, 354, 355, 358 Schall, case of, 346 Schedmaizig, Bernard, case of, 775 Scott V. Wakem, 719 Seaham, Reg. v., 149 St-ll, Reg. v., 592 Sell is, case of, 264, 268 Sellis, Rex. v., 270 Semple and Winslow, "Weldon v., 719, 729 Semple, Hall v., 729 Senior, case of, 592 Serjeant, Warne v., 712 Sewell V. Wells, 740 Sharpe, Reg. v., 538 Sharpe r. Macauley, 740 Shaw, Reg. v., 434, 436 Shawe, Chattuck v., 784 Shrimpton, Reg. v., 279 Shuttleworth, case of, 727 Simpson, Reg. v., 774 Slane, Reg. v., 3ll Sniethurst, Reg. v., 90 Smith, case of," 602, 732 Sniitli, Gedney v., 648 Smith V. Austen, 742 Smyth V. Smyth, 336 Snarey, Reg. v., 686 Soames, Mrs., case of, 171 Solignon, case of, 344 Soutli, Rex v., 610 Southey, Reg. v., 758 Sprague, Reg. v., 221 Sprowle, Reg. v., 539 Stagg, Mr., case of, 416 Stauii', case of, 395 Staunton and others, Reg. v., 504, 507 Steele, Reg. v., 221 Stewart, Mr., case of, 101, 642 Stipler, case of, 333 Stokes, Reg. r., 746 Stone, Reg. v., 369 Stothard r. Aldridge, 643 Stowler, Reg. v., 603 Stroud, Reg. v., 550 Stultz, case of, 715 Stuart, case of, 333 Succi, case of, 504 Suydam, Levy, case of, 651 Sweenie, case of, 687 Sylvester, West v., 742 TALBOT, case of, 326 Tanner, Dr., case of, 510 Taylor, Louisa J., Reg. v., 150 Taylor, Reg. v., 551 Tluebault, Paul, case of, 510 Thomas, Reg. v., 312, 321 Thomjison, Burdett v., 741 Thompson, Reg. v., 280, 314 Thornhill, Reg. v., 622 Tichborne case, the, 338, 340, 348, 612, 643 Timms, Reg. v., 313 Tourville, De, case of, 260 Touchet, Ross, Reg. v., 713 Townshend Peerage, 642 Treherne v. Layton, 018 Troughear, Selina, case of, 450 VAMPLEW, Res. r., 622, 706 Venn and Griffin, Reg. v., 539 Vyse, Reg. v., 747 WAINWRIGHT, Reg. v., 340, 529 Wakem, Scott v., 629 Wallis and Wallis, Reg. r., 163, 610 Wallis, Reg. r., 235, 541, 542 ^ Walworth murder, the, 316, 370 Warburton, Reg. v., 372 Ward, Reg. v , 289 Warne v. Serjeant, 612 Warner, Dr., case of, 224 Waters, Bromwich v., 627, 635, 690 Webb V. Page, 35 Webster, Reg. v., 129 Weir and wife r. Hodgson. 612 Weldon, Mrs., case of, 719, 729 Weldon v. Semple and Winslow, 719, 729 Wells, Sewell v., 713 Welsh Fasting Girl, case of, 480 LIST OF CASES CITED, 803 West, Keg. v., 598, 634 West r. Sylvester, 740 Wliisker, Keg. v., 550 Whitbv v. Hodgson, 622 Wliite.'Keg. v., 168, 686 White V. Hal ford, 739 Wilson, Catherine, Kex v., 171 AVilliams and Bisliop, Keg. v., 459 V.'inslow and Sample, Weldon v., 719, 729 Winslow, Keg. v., 90 Wiseniau, Kex v., 695 Wood V. Hotham, 660 Woodford, Keg. v., 442 Woodman, Keg. v., 534 Wooler, Keg. v., 44 Wright V. Wilkin, 43 YAQUIEKDO, Keg. v., Ill Yaxley, Keg. v., 416 Yoolow, David, case of, 734 CITATIONS IN AMERICAN EDITION. ABBOTT, Baxter?'., 59 Abbott V. People, 54 Abranis v. Foshee, 549 Abrams v. State, 5-19 Adams, Rawlins v., 618 Adams, Kobinson v., 59 ^tna Life Ins. Co., Edington v., 56 Ah Lee, State v., 32 AI. Mut. Ins. Co., Leitch v., 62 Alexander v. Jonquill & Sterling, 55 Allen V. Hunter, 57 Allen r. Stout. 54 Allerton, E. v., 626 Almond v. Xugent, 380 Am. Seaman's Fund Soc. v. Hopper, 702 Anderson v. The State, 700, 764 Anderson, Upchurch v., 618 Anderson, AVheeler v., 702 Anderson, Watson v., 60 Ann r. State, 549 Anthony v. Smith, 56 Appeal, Dunham's, 58 Appeal, Passmore's, 62 Armill, McGregor v., 63 Armor v. State, 769 Armstrong v. Town of Acklev, 55 Arnold's Will, 59, 61 Atch. F. & S. F. R. Co. v. McGinnis, 798 Atchison, etc. v. Thul, 63 Atlas Ins. Co., Lapham r., 62 Augsburgh, People v., 63 Augusta Ins. Co., Perkins v., 62 Augustine, Shed v., 62 Aulago Co. V. Davis, 55 BABB, State v., 55 Baber, State v., 58 Bailev, State v., 63 Baily V. State, 769 Baines, Reg. v., Ill Baird v. Dailv, 61 Baird i\ Morford, 379 Baker, Slaler v., 380, 381 Baldwin v. State. 58 Ball, Mannin v., 701 Bangs, Com. v., 549 Barber, Dickinson v., 60 Barker v. Coleman, 55 Barker, P. Car Co. v., 798 Barley, Dewitt v., 59 Barnes v. Ingals, 62 804 Barney, Schneider v., 62 Barrett, Chandler v., 63 Barrows v. Downs, 62 Bartlett, State v., 746 Bascorab, Fairchild i\, 58, 60 Bass Furnace Co. v. Glasscock, 54 Bates, Eckles v., 56 Batten v. State, 55 Baum, Haynes v., 618 Baxter v. Abbott, 59 Beasley v. State, 769 Beaubien v. Cicatte, 58 Bederly, Durrell. ?'., 62 Belencia, People n, 769 Bell. Fenwick v., 62 Bemis v. Centr. Vt. R. Co., 62 Bennett v. Mehan, 55 Benny v. Philpot, 626 BerghofF, Van Hoaser v., 327 BergholF, Vanhoover i'., 379, 380 Bernadotti, R. v., 31 Bernal, People v., 621 Bessorne, Cunee r., 63 Bethel, Emma, People v., 134 Bierce v. Stocking, 57 Bigelow, M'Ewen v., 63 Binns, Nichols v., 702 Bird V. State, 54 Bishop V. Spining, 63 Bishop, Stowe v., 62 Blackburn, State v., 31 Blackwell v. State, 621 Blake, Carpenter v., 328, 380 Blake v. People, 55 Blampied, Reg. i'., 763 Blanchard v. Nestle, 701 Blanton, Garrison v., 58 Bloomington r. Schrock, 48 Boardman v. Woodman, 58, 63 Bodenhamer, Flynt v., 56, 63 Boehm, Carter v., 62 Boener, Gramm v., 380 Bogle n Winslow,380 Bolin V. State, 32 Booth V. Cleveland Rolling Mill Co., 54 Booth, Sheldon v., 62 Boswell V. Com., 769, 775 Boswell V. The State of Alabama, 700 Bowman, Plunkett v., 62 Bowman, State v., 57 Bowman v. Woods, 48 Bovd V. State, 55 CITATIONS IN AMERICAN EDITION. 805 Boydston r. Gittner, 56 Boyle V. State, 55 Bradley, May v., 59 Bradley v. Salmon Falls Mfg. Co., 55 Bradley r. State, 756, 764 Bragg, Ellingwood v., 57 Brailly v. State, 703 Brantley v. Swift, 62 Bravman, Commonwealth v., 59 Briggs ('. Titus, 618 Bronson, Stickney v., 27 Brooke v. Townshend, 59 Brooke, Welch v., 56 Brotherton, People v., 57 Brotherton v. People, 746 Brown v. C. M. & St. P. R. Co., 797 Brown, Travis v., 54 Browne, Com. i\, 56, 549 Browning v. Eeane, 701 Bruce, Clarke v., 57, 60 Buchanan v. State, 64 Buckley v. Rice, 54 BuflUm V. Harris, 54 Bullock, State v., 770 Burns, Utley i-., 380 Burns, v. Welch, 62 Burton v. Driggs, 54 Burton, Reg. v., 703 Butler V. Ins. Co., 59 CAHILL, Pinney v., 57 Calder, Wenger v., 380 Campbell's Case, 626 Campbell v. Richards, 62 Campbell v. Russell, 62 Campbell v. State, 32, 54 Carew v. Johnson, 701 Carmichael in re, 701 Carpenter v. Blake, 328, 380 Carpenter v. Eastern Trans. Co., 62 Carpenter v. Garrett, 618 Carrington v. Richardson, 618 Carroll, Rex v., 770 Carter v. Brehm. 62 Carter v. State, 48, 769, 775 Caryle, Ocean Nat. Bk. v., 27 (/asey, Com. v., 31 Castner r. Sliker, 63 Cattell, Mullin v., 702 Cent. Vt. R. Co., Bemis v., 62 Ceru V. Doudican, 55 Chadd, Folkesr., 62 Chamberlain, Comer v., 618 Chamberlain v. Porter, 380, 381 Chambers, Craig v., 379 Chandler v. Barrett, 63 Charter Oak Life Ins. Co. v. Rodel, 58 Chase, Hovey v., 701 Chase v. People, 746 Chase r. State, 58 C. M. & St. P. R. R. Co., Brown v., 797 Chic. R. R. Co., Curtis v., 55 Chic, etc., R. Co. v. George, 55 Chic, etc., R. Co.. Quaife v., 58 Chicago, etc., Neilson v., 54, 62 Chicago, etc., R. Co., Stone v., 63 Church V. Hubbard, 62 Cicatte, Beaubien v., 58 Citizens' Gas Light Co. v. O'Brien, 55 City of Appleton, Smalley v., 55 City of Aurora c. Hillman, 61 Clapp V. FuUerton, 59 Clark ('. Bruce, 57, 60 Clark, Dew v., 701, 702 Clark V. Fisher, 54, 62 Clark, Knox v., 62 Clark, State r., 55 Clark V. The State, 58 Clarke, Wicks v., 618 Clary v. Clary, 58 Cleveland Rolling Mill Co., Booth v., 54 Clopper, Union Pacific R. Co. v., 62 Cluck V. State, 775 Cock V. Potter, 58 Cockroft, Reg. v., 763 Colbath V. State, 769 Cole V. State, 55, 58 Cole, Washington ?'., 56 Coleman, Barker v., 55 Collins ('. E. F. V. & G. R. Co., 798 Com. V. Bangs, 549 Com., Boswell v., 769, 775 Com. i'. Browne, 56, 549 Com. V. Casey, 31 Com., Coyle v., 756 Com. i\ Demain, 549 Com., Douglass v., 533 Com. V. Frith, 703 Com. V. Green, 769 Com. V. Heatle, 746 Com., Jones v., 769 Com., Kilpatrick v., 31 Com., Kried v., 756 Com., Kriel v., 764 Com. V. Le Blanc, 621 Com., M'Lain v., 57 Com., Mills v., 549 Com., Mitchell v., 549 Com., Mockabee v., 31 Com. V. Mosler, 763 Com. V. Moster, 700, 703 Com. V. Mullins, 621 Com. V. Murray, 31 Com. V. Parker, 549 Com. V. Pomeroy, 746 Com. V. Begins, 746 Com., Smith v., 756, 764, 775 Com. ^\ Strieker, 626 Com. v. Sturtevant, 56 Com. V. Synes, 56 Com. V. Williams, 31 Com., Willis v., 769 Com. r. York, 746 Com., Young v., 31 Comer v. Chamberlain, 618 Com in v. Piper, 55 Commonwealth r. Braymom, 59 Commonwealth, Dejarnette v., 58, 756, 764 Commonwealth v. Fairbanks, 59 Commonwealth v. Haskell, 701, 703 Commonwealth, Keenan v., 769 806 CITATIONS IN AMERICAN EDITION. Coiunionwealth, Parnell v., 60 Coiuinonwealtli v. Rich, 60 Commonweiilth v. Rogers, 58, 00, G3, 003, 756, 764 Commonwealtli v. Schneider, 701 Conimonweahli, Scott v., 703 Conimonweahh v. Wilson, 69 Con. Ins. Co., Paddock v., 62 Conger, Sisson v., 60 Congress, etc., Co. v. Edgar, 63 Conlan, Ponn Co. v., 62 Conn. Milt. Lite Ins. Co., Ilagadorn v., 61 Conn. Mutual Life Ins. Co. i'. Lathrop, 58 Cook V. State, 56 Cooinbes, Ft. Wayne v., 63 Cooper V. State, 56, 549 Cope V. Cope, 626 Cornweil r. State, 775 Coryell v. Stone, 58 Cotton V. Cotton, 549 Cowen, Sullivan v., 55 Cowles v. Merchants, 59 Cowley V. People, 63 Cousin V. Sturtevant, 55 Coyle V. Com., 756, 7*i4 Craig V. Chambers, 379 Cram v. Cram, 58 Cratchle.v, Kex v., 615 Crawford, Morse v., 58 Crensliaw, State v., 55 Crittenden v. Rogers, 27 Crittenden, Russell v., 63 Cross V. Cross, 626 Cross, State v., 55 Cross, Kilgrove v., 58 Cross, State v., 63 Cuddhy, Washburn t)., 48 Culver V. Dwight, 55 Cunee v. Bessorn^, 63 Cunningham v. State, 746, 756, 764 Curtis ('. Chic. R. R. Co., 55 Cuthbertson, Yardley v., 63 Cutler, Eidt v., 55 DAILY, Baird v., 61 Daly, People v., 756, 764 Dammaree's Case, 770 Darrand, State v., 31 Darrell v. Bederly, 62 Davidson, McNiel v., 54 Davis, Aulago Co. v., 55 Davis V. Mason, 62 Davis, Regina v., 742 Davis V. State, 55, 58, 63, 746 Davis r. U. S., 746 Dawson v. State. 775 Dejarnette v. Commonwealth, 58, 756 704 Delaware & Co. v. Starrs, 61 Deuiain, Cora, v., 649 Dement, ex parte, 64 Den V. Van Cleve, 621 Dennett v. Dennett, 701 Deslinn V. Merchants' Bank, 59 Des Moines Ry. Co., Slatten v., 797 Detwiler, Mertz v., 56 Dew V. Clark, 701, 702 Dewey, Higgins v., 62 Dewitt i: Barley, 59 Dewitt, Wale v., 48 Dexter I'. Hall, 58, 63 Dick, Reed v., 61 Dickinson v. Barber, 60 Dickinson i'. Filchburgh, 54 Dickinson, State r., 549 Dillaiiiint, State v., 775 Diliard v. State, 57 Dillis r. State, 64 Doe V. Reagan, 55, 58 Dole V. Johnson, 54, 63 Dolz V. Morris, 62 Donelly v. State, 32 Doolittle, Forsythe v., 63 Doolittle V. State, 55 Doudican, Ceru v., 55 Dougherty v. Snyder, 62 Doughty V. Doughty, 61 Douglass V. Com., 533 Downs, Barrows v., 62 Dove r. State, 59 Drake v. Glover, 62 Draper, State v., 31 Drew, U. S. v., 775 Driggs, Burton v., 54 Drinkald, Jameson v., 62 Dudley, Regina v., 165 DufliekU'. Morris, 59^700 Duncan, Fencker v., 798 Dunham's Appeal, 58 Dunn V. State, 31 Duval, Smith v., 769 Dwight, Culver v., 55 Dyce Sombre, Princep v., 60 EASTERN Trans. Co., Carpenter v., 62 Eastern Trans, v. Hope, 62 Eckles v. Bates, 56 Edgar, Congress, etc., Co. v., 63 Edlington r. ^tna Life Ins. Co., 56 Edwards, State v., 621 Eggers r. Eggers, 58, 63 Eggles r. People, 55 Eidt i\ Cutler, 55 Ellingwood r. Bragg, 57 Elliott V. Van Buren, 55 Emma Bethel, People v., 134 England, Goshen v., 798 Enoch, Rex v., 615 Epp ('. State, 48, 63 Erb, State v., 58 Estate of Toomes, 55, 59 Estes V. State, 769 Evans v. People, 55, 549 Evans, Stone v., 381 Ewing V. P. C. C. & St. L. R. R. Co., 798 Ex parte Dement, 64 FAIRBANKS, Commonwealth v., 59 Fairchild r. Bascomb, 58, 60 Falerv, Louisville, etc., R. Co. v., 55 CITATIONS IN AMERICAN EDITION, 807 Farrell v. State, 769 Feltes, State v., 58, 703 Fenwick v. Bell, 62 Ferguson, Kapler v., 56 Ferguson v. Tweedy, 618 Ffttes, State v., 756, 764 Poller V. N. Y. Central K. Co., 56 Finley, People v., 61 Fisher, Clark v., 54, 62 Fisher v. Nichols, 380 Fisher i'. State, 775 Fitchburg, Dickenson c, 54 Fitzgerald, State v., 549 Flanagan v. State, 621 Fleischer, Gates r., 380 Flint, Lewis v., 798 Flynt V. Bodenheinier, 56, 63 Fogassa, Keniger v., 769 Folkes V. Chadd, 62 Folwell, State v., 55 Forbes, Walker v., 62 Forbes, U. S. v., 769 Fornian's Will, 677, 702 Forsythe v. Doolittle, 63 Foshee, Abranis v., 549 Foster v. Marshall, 618 Francke v. His Wife, 60 Franks, Sower v., 380 Frere v. Peacock, 702 Frost Case, 770 Frost, House v., 58 Frith, Com. v., 703 Ft. Wayne v. Coombes, 63 Fullerton, Clapp v., 29 GALLICK, State v., 31 Gano, Halfield v., 549 Ganse, Noblesville, etc.. Gravel Road Co. v., 55 Gaitliner v. Gardiner, 59 (Tardner r. Hooper, 618 Garrett, Carpenter v., 618 Garrison v. Blanton, 58 Gates V. Fleischer, 380 Geddis, State v., 59 Gehrer v. State, 59 George, Chic, etc., R. Co. v., 55 Getchen r. Hill. 379 Gilbert r. Guild, 62 Gittner, Boydston v., 56 Glasscock, Bass Furnace Co. v., 54 Glover, Drake v., 62 Gonzalez, People v., 57 Goodell r. Harrington, 60 Goodwin v. State, 58, 63 Goodyear v. Vosburgh, 57 Goshen v. England, 798 Gould, Wyinan r., 59 Grace, McDaniel v., 618 Gram v. Boener, 380 Grant v. Thomson, 58, 59 Grans, St. Louis Mut. Life Ins. Co. v., 700 Gray, People v., 31 Green, Com. i\, 769 Greenfield, People v., 57 (i rover, Howard v., 380 Guardian Ins. Co., Higbee v., 55, 63 Guetig V. State, 63 Guild, Gilbert v., 62 Guiteau, U. S. v., 58, 63 Guiterman v. Liverpool, etc., Ins. Co., 62 Guy V. Meads, 27 HACKETT V. People, 30 Hagadorn v. Conn. Mut. Life ins. Co., 61 Halle r. State, 769 Haire v. Eeese, 380 Haisle r. Payson, 63 Hale V. Hill 701 Halfield v. Gano, 549 Hallahan r. N. Y., etc., R. Co., 62 Hall, Dexter r., 58, 63 Hall, People v., 58 Halsey v. Sinsebaugh, 27 Hams V. State, 764 Hankins, Sutherland v., 58 Hanley v. Merrill, 55 Harbon, Hinds v., 62 Hardy v. Merrill, 58, 59 Hardy, Wright r., 56 Hargrave v. Hargrave, 626 Harrington, Goodell v., 60 Harrington, Nelson v., 380 Harris, Bufliim v., 54 Harris v. Panama R. Co., 58 Harris, A. Smiler, case of, 494, 497 Harris v. State, 756 Hartwell, Phelps v., 59 Haskell, Commonwealth v., 701, 703 Hastings v. Rider, 59, 60 Hathaway v. Ins. Co., 58 Hathorn v. Richmond, 380 Hathorne v. King, 60 Hanks, Smothers v., 380 Haven v. Wendell, 27 Hay V. State, 31 Hay, Kelsey v., 380 Hayden, State v., 58 Haynes ?'. Baum, 618 Head v. Hargrave, 63 Head v. Head, 626 Heald v. Thing, 54, 59 Heath v. Slocum, 54 Heath v. White, 618 Heatle, Com. v., 746 Helluson, Yander Denckl v., 54 Henderson, Oldham ?'., 619 Henry, Simond v., 380 Herman, State v., 626 Hewing, Reele v., 380 Hewlett V. Wood, 59 Hewson, United States v., 703 Hey, Holtzman v., 379 Hickman v. State, 59 Higbee v. Guardian Mut. Life Ins. Co., 55, 63 Higgins, Quinn v., 6.3 Hisrgins v. Dewev, 62 Hill, Getchen j>.,"379 808 CITATIONS IN AMERICAN EDITION Hill, Hale v., 701 Hill V. Philip, 720 Hill r. State, 30 Hillman, City of Aurora v., 61 Hinds c. Ilarbon, 03 H inkle. State v., 57 Hoag, Pierson v., 57 Hodgson, People v., 31 Hoes V. Van Alstine, 62 Hoffman, Rhine v., 626 Hoffinan, Rice v., 618, 619 Holcombe v. State, 59 Holtzman r. Hey, 379 Hook v. Stovel, 56 Hooper, Gardner v., 618 Hope, Eastern Trans, v., 62 Hopp V. People, 756, 764 Hopper, Am. Seamen's Fund Soc, 702 Hopps V. People, 703 Hopt V. People, 769 Horton, Stack house v., 60 Hotchkiss, Wheeler v., 618 House V. Frost, 58 House, Potts V. , 58, 59 Housekeeper, State v., 379 Hovey v. Chase, 701 Howard v. Grover, 380 Howard v. McDonough, 27 Howard, Small v., 380 Howard, Wilmot v., 380 Howe, United States v., 64 Hewlett I'. Taylor, 59 Hubbard, Church v., 62 Hubbard, R. v., 31 Hudnut, Terre Haute v., 62 Hudson River R. R. Co., Russell v., 27 Hudson V. State, 31 Huffer, Indianapolis v., 55 Huling, State v., 703 Hunipliries v. Johnson, 63 Hundley, State v., 769, 775 Hunter, Allen r., 57 Hunter v. Whitworth, 618 Hurley, Linton v., 56 Huxford V. State, 61 Hyde v. Woolfolk, 54 IDE, Needham v., 59 Indianapolis v. Huffer, 55 Ind. P. & Co. R. Co. V. Pitger, 798 Infritz V. People, 62 Ingals, Barnes v., 62 Ingham, Morrissey v., 56 Inhabitants of P'ayette v. Inhabitants Chesterville, 59 Imperial Fire Ins. Co., Woodruff i'., 62 In re Carmichael, 701 In re Roelker Sprague, 64 Ins. Co., Butler v., 59 Ins. Co., Hathaway v., 58 Irish V. Smith, 55 JACKSON V. Johnson, 618 Jagigo Schickick, case of, 495 James J. Slocum, case of, 494, 498 of Jameson v. Drinkald, 62 Jenkins, Withers v., 618 Joe V. State, 57 Johnson, Dole v., 54, 63 Johnson, Humphries c, 63 Johnson, Jackson v., 618 Johnson, Nelson v., 54 Johnson, Roberts v., 56 Johnson, State v., 703, 756, 764, 769, 770 Johnston, Carew v., 701 Johns, Smith v., 27 Jones V. Com., 769 Jones V. State, 31 Jones, State, c, 770 Jones, State v., 533 Jones V. Tucker, 54, 56 Jones V. White, 56 Jonquill & Sterling, Alexander xk, 55 Joseph Wood, case of, 494, 495, 497 KANSAS C. F. & S. R. Co. v. Kier, 798 Keenan v. Commonwealth, 769 Kellege, M. & St. P. Ry. Co. v., 798 Kellogg, Milwaukee, etc., R. R. Co. v., 62 Kelly, Regina v., 327 Kelly V. State, 769 Kelsey v. Hay, 380 Kennedy v. People, 60 Key V. Thompson, 56 Kidd, Tulis v., 58 Kier, K. C. F. & S. R. Co. v., 798 Kilgore, State v., 31 Kilgrove v. Cross, 58 Kilpatrick i'. Com., 31 Kilpatrick, Ward v., 62 King, Hathorne v., 60 King V. Luffe, 626 King, People v., 769, 770 Kings Co. Fire Ins. Co., Pendar v., 54 Kirby, State t\, 533 Kitson V. Playfair, 41 Klinger, State v., 59 Knapp, People v., 32 Knapp, State v., 56 Knight, State v., 56 Knoll V. State, 62 Knox V. Clark, 62 Kretz, Von Sachs v., 54 Kried v. Com., 756 Kriel v. Com., 764 LAKE, People v., 59, 61 Lake v. People, 56 Lake S. & M. S. R. Co. v. Rosenzueig, 798 Lambert v. State, 32 Lamphor v. Phipor, 380 Lancashire Ins. Co., Spenaley v., 63 Lanergan v. People, 769 Lanier, Zugasti v., 61 Lapham v. Atlas Ins. Co., 62 Lathrop, Conn. Mutual Life Ins. Co. v., 58 Lattin, State v., 621 Leach v. Prebster, 58 Le Blanc, Com. v., 621 CITATIONS IN AMERICAN EDITION, 809 Lee, People v., 31 Lee, Williams v., 59 Leggate, Snioot v., 618 Leigh ten v. Sargent, 379 Leitch V. Al. Mut. Ins. Co., 62 Lewis, People v., 769 Lexis V. Flint, 798 Life Ins. Co. v. Terry, 703 Lincoln v. Teuntiro Mfg. Co., 57 Linton v. Hurley, 56 Litch ('. McDaniel, 56 Liverpool, etc., Ins. Co., Guiterman v., 62 Llovd, Mrs. E. E., State of Va. v., case of, 54 Logan, Steamboat Clipper Co. v., 62 Louisville, etc., R. Co. v. Falery, 55 Louisville, etc., R. Co. v. Miller, 798 Louisville, etc., R. Co. v. Snyder, 798 Louisville, etc., R. Co. v. Wood, 55 Love, State v., 533 Lower v. Franks, 380 Luffer, Kingt'., 626 Luning v. State, 48, 54 Lynes, Cora, v., 56 M& St. P. Ry. Co. V. Kellegge, 798 Machs, Rapalge v., 798 Maconnekey v. State, 769 Mageroan, Shotte v., 626 Maine, People v., 32 Manning i\ Ball, 701 Marley i'. Shultz, 27 Marshall, Foster v., 618 Marshall's Case, 769 Martin, West v., 380 Mason, Davis v., 62 Mattason v. N. Y., etc., R. Co., 56 Mattocks V. Stearns, 618 May V. Bradley, 59 Maybrick, Florence, Reg. v., 124 Mayor of New York v. Second Ave. R. R., 27 McAllister r. State, 60 McCandless v. McWha, 380 McCann, People v., 746 McCauts, State I'., 769 McClaskley v. State, 59 McDaniel v. Grace, 618 McDaniel v. State, 55 McDonough, Howard v., 27 McElroy's case, 702 McEvoy, State v., 31 McEwen v. Bigelow, 63 McFall, Penn v., 769 McGinnis, Atch. T. & S. F. R. Co. v., 798 McGlue, U. S. v., 56, 774 McGonigal, State v., 770, 775 McGregor v. Arniill, 63 McGuire v. People, 621 McHugh V. State, 32 McKee v. Nelson, 61 McLain v. Conim., 57 M'Lenson, S. & N. Ala. R. Co. v., 55 McNaughten, case of, 746, 760 McNiel V. Davidson, 54 McPherson v. State, 32 McWha, McCandless v., 380 McWhorter, State i'., 756, 764 Mead, Guy v., 27 Meakin, Rex v., 769 Mechanics' Bk. v. Williams, 618 Meckle v. State, 48 Medbury v. N. Y. & E. R. R. Co., 798 Meddlegge, Mex. Nat. Constr. Co. v., 797 Melian, Bennett v., 55 Mellor V. Roy. Ex. Ship. Co., 125 Mercer ;■. Sheldon, 618 Merchants, Cowles v., 59 Merchants' Bank, Deshon v., 58 Merrill, Hardy v., 58, 59 Mertz V. Detweiler, 56 Mex. Nat. Constr. Co. v. Meddlegge, 797 Mig., etc.. Ore Co., Parsons v. 61 Miller, L. & N. & C. R. R. Co. v., 798 Miller, State v., 55 Mills V. Com., 549 Mills I. Winter, 61 Milwaukee, etc., R. Co. v. Kellogg, 62 Milwaukee, etc., R. Co., Watson i'. 62 Minneapolis, etc., R. Co., Tierney v., 55 Mitchell V. Com., 549 Mitchell V. State, 32, 57 Mobile Life Ins. Co. v. Walker, 54 Mockabee v. Comm., 31 Mohr, Tolum v., 63 Molloy, United States v., 63 Monroe v. Van Meter, 618 Montgomery, People v., 63 Montgomery v. State, 30 Montgomery v. Scott, 55 Moon V. State, 32 Moore, Norton v., 59 Moore v. State, 56, 549 Moore v. United States, 62 Moore v. Westervelt, 62 Morford, Baird v., 379 Morrill r. Tegarden, 63 Morris, Dalz v., 62 Morris, Duffield v., 59, 702 Morris, Rutherford v., 59 Morrison v. Porter, 62 Morrissey v. Ingham, 56 Morse v. Ci-awford, 58 Mosely, Wilkinson v., 55 Mosier, Cora, v., 703 Mosler, Com. v., 763 Mosly, R. v., 31 Moster, Com. v., 703 Moulton V. Scruton, 58 Mullin V. Cattrell, 702 Mullins, Com v., 621 Murphy, People v., 54, 549 Murray, Comm. v., 31 MurraV, R. v., 626 Nv. M. R. R. Co., 798 Napier v. Ferguson, 56 Nash, State v., 31 Nashua, Sanderson v., 56 Needham v. Ide, 59 810 CITATIONS IN AMERICAN EDITION, Neilson v. Chicago, etc, 54, 62 Nelson V. Harrington, 380 Nelson v. Johnson, 54 Nelson, McKee v., 61 Nelson v. Sun Mutual Ins. Co., 54 Nesbet V. State, o2 Nestle, Blanchard v., 701 Newcomer, Van Deusen v., 55 Newlin, State v., 58 Nicholls. Fisher v., 380 Nickels v. Binns, 702 NicoU V. Webb, 27 Noblesville, etc., Gravel Koad Co. v. Ganse, 55 : Norris v. State, 58 Nortii Brancepeth Coal Co., Slavin v., 57 Norton r. Moore, 59 Nugent, Almond v., 380 N. Y. Central R. Co., Filer v., 56 N. Y., etc., R. Co., Hallahan v., 62 N. Y., etc., R. Co., Matteson v., 56 N. Y. Cen. R. Co., Sloan v., 54 N. Y. & E. R. R., Medbury v., 798 O'BRIEN, Citizens' Gas Light Co. v., 55 O'Brien v. People, 58, 775 O'Connell, ease of, 746 Ocean Nat. Bank v. Caryle, 27 OdiU, People v.. 769 Offord, Rex v., 703 Ogden V. Parsons, 62 O'Herrin v. Stale, 775 Oldham v. Henderson, 619 Owens, State v., 649 Oxford, Rex v., 763 PADDOCK V. Con. Ins. Co., 62 Page V. Parker, 54 Page r. State, 63 Page, Webb v , 64 P. Car Co. V. Barker, 798 Pa. Ins. Co., Stennett v., 63 Panama R. Co., Harris v., 58 Parker, Com. v., 649 Parker, Page v., 54 Parkinson v. Atkinson, 64 Parnell v. Commonwealth, 60 Parsons v. Mig., etc.. Ore Co., 61 Parsons, Ogden v., 62 Parsons v. State, 756, 764 Passmore's Appeal, 62 Patten v. Wiggeii, 380 Patterson, State v., 32 Payson, Haisle v., 63 Peacock, Frere f., 702 Pearson, Wilkinson v., 59 Peel, R. v., 31 Penn Co. v. Conlan, 62 Penn r. McFall, 769 People, Abbott ?•., 54 People V. Augsburgh, 63 People r. Balencia, 769 People V. Bernal, 621 People, Blake, v., 55 People r. Brotherton, 57 People, Brotherton v., 746 People, Ciiase v., 746 People, Cowley v., 63 People V. Daly, 756, 764 People i'. Emma Bethel, 134 People, Evans v., 55, 549 People i\ Finley, 61 People V. Gonzales, 57 People V. Gray, 31 People V. Greenfield, 57 People, Hackett v., 30 People V. Hall, 58 People r. Hodgson, 31 People, IIopp v., 756, 764 People, Hopps v., 703 People, Ilopt ('., 769 People, Infritz v., 62 People, Kennedy v., 60 People V. King, 769, 770 People V. Knapp, 32 People, Lake v., 56, 59, 61 People, Lanergan v., 769 People r. Lee, 31 People V. Lewis, 769 People V. Maine, 32 People V. McCann, 746 People, McGuire v., 621 People V. Montgomery, 63 People r. Murphy, 54, 549 People, O'Brien v., 58, 775 People V. Odill, 769 People, Real v., 60 People, Roberts v., 769, 775 People V. Robinson, 57 People V. Siinford, 59 People V. Scliuyler, 58 People V. Sessions, 549 People, Shaw v., 31 People V. Simpson, 31, 32 People V. Stokes, 325 People V. Taylor, 32 People, Templeton v., 63 People r. Thurston, 61, 63 People, Tracey v., 31 People, Walker v., 746 People V. Wasson, 32 People v. Williams, 769 People, Woodin v., 56 People V. Wreden, 58 People, Ujitone v., 58 People V. Ybarra, 31 Peoples, Willis v., 703 Pepperell, Townsend v., 59 Perkins v. Augusta Ins. Co., 61 Perkins, R. v., 32, 621 Perkins v. Stickney, 63 Perkins, Williams v., 619 Perry, Smith v., 626 Phair, State v., 54 Phelps V. Hartwell, 59 Phelps V. Terrv, 62 Philip, Hill v', 720 Philpot, Benny v., 626 Phipor, Lampher v.. 380 Pidcock V. Porter, 56, 58 CITATIONS IN AMERICAN EDITION 811 Pierce v. State, 61 Pierson v. Hoag, 57 Pike, R, v., 32 Pike, State v., 58, 61, 756 Pike ('. State, 763 Pindar i'. Kings Co. Fire Ins. Co., 54 Pinney v. Cahill, 57 Piper, Corain v., 55 Pintle V. The State, 769 Pitger, Ind. P. & Co. R. Co. v., 798 Pi Its V. State. 56 Pittsburg C. C. & St. L. R. R. Co., Ewing v., 798 Playfair, Kitson v., 41 Plunkett V. Bowman, 62 Pol in V. State, 58 Polk V. State, 56, 57 Poller V. Warner, 380 Ponieroy, Com. v., 746 Pook V. State, 55 Poole V. Richardson, 59 Roots V. House, 58, 59 Poppleton, Williams v., 56 Porter, Chamberlain v., 380, 381 Porter, Jlorrison v., 62 Porter, Pidcock v., 56, 58 Porter i\ Requonnoe, etc., Co., 55 Portland Put. Co., Stacy Co. v., 61 Portsmouth, Wiley v., 56 Potter, Cook v., 56 Poulton, Rex r., 615 Powell, Price v., 62 Powell V. State, 59 Prebster, Leach v., 58 Prentice, Sean v., 380 Price V. Powell, 62 Princep v. Dyce Sombre, 60 QUAIFE V. Chicago, etc., R. Co., 58 Quimby, Willis v., 55, 58 (^uind V. Higgins, 56, 63 RAINBOLT, Van Huss v., 59 Raisler v. Springer, 55 Rapalge v. Machs, 798 Rawble v. Tryson, 58 Rawlins v. Adams, 618 Rav 11. Rav, 63 Ray V. State, 55 Raymond, Schwenger v., 63 Reading, Rex v., 626 Reagan, Doe v., 55, 58 Reake r. State, 746 Real V. People, 60 Reane. Browning v., 701 Reddingtield, R. v., 31 Reed v. Dick, 61 Reed v. State, 59 Reele r. Hewing, 380 Rees, Stewart v., 618 Reese, Haire v., 380 Reeves, Regina v., 615 Reg. V. Baines, 771 Reg. V. Blampied, 763 Reg. V. Burton, 703 Reg. V. Cockroft, 763 Reg. V. Florence Maybrick, 124 Reg. V. Stokes, 746 Regina v. Davis, 774 Regina v. Dudley, 125 Regina v. Kelly, 327 Regina v. Reeves, 615 Begina v. Richards, 60 Regina v. Scaife, 124 Regina v. Shaw, 702 Regina v. Southey, 61 Regina v. Still, 56 Regins, Com. v., 746 Reniger v. Fogassa, 769 Requonnoe, etc., Co., Porter v., 55 Reume's Case, 769 Rex V. Carroll, 770 Rex V. Crutch ley, 615 Rex V. Enoch, 615 Rex V. Meakin, 769 Rex V. Oflbrd, 703 Rex V. Oxford, 763 Rex V. Perkins, 621 Rex V. Poulton, 615 Rex V. Reading, 626 Rex V. Town ley, 703 Reynolds v. State, 30, 31 Rhine v. Hoffman, 626 Rice, Buckley v., 54 Rice V. Hofiman, 618, 619 Rich, Commonwealth v., 60 Richards, Campbell v., 62 Richards, Regina v., 60 Richardson, Carrington v., 618 Richardson, Poole v., 59 Richardson, Spear v., 57, 58 Richmond, Hawthorn v., 380 Rickerson v. State, 57 Rider, Hastings v., 59 Ritchie v. West, 380 Roberts v. Johnson, 56 Roberts v. People, 769, 775 Roberts v. State, 703, 756, 764 Robert's Will, 62 ' Robinson v. Adams, 59 Robinson, People v., 57 Rodel, Charter Oak Life Ins. Co. v., 58 Roelker Sprague, in re, 64 Rogers, Commonwealth v., 58, 63, 703, 756, 764 Rogers, Crittenden v., 27 Romaine, State v., 626 Rosenzueig, L. S. & M. S. R. Co. v., 798 Roy. Ex. Ship Co., Mellor v., 125 Royce v. Smith, 703 Russell, Campbell v., 62 Russell V. Crittenden, 63 Ru.ssell V. Hudson River R. R. Co., 27 Rutherford v. Morris, 59 R. V. Allerton, 626 R. V. Bernadotti, 31 R. V. Hubbard, 31 R. V. Mosby, 31 R. V. Murray, 626 R. V. Peel, 31 812 CITATIONS IN AMERICAN EDITION, K. V. Perkins, 32 R. V. Pike, 32 R. V. Reddingfield, 31 R. V. Scaife, 32 R. V. State, 31 R. V. Woodcock, 31 R. I'. Wycherly, 549 SADLER, Sutton v., 702 Salmon Falls Mfg. Co., Bradley v., 55 Salvin v. North Brancepeth Coal Co., 57 Sanchez v. The People, 01 Sanders v. State, 63 Sanderson v. Nashua, 56 Sanford, People v., 59 Sargent, Leigh ton v., 379 Scaife, R. v., 32, 124 Scattergood v. Wood, 62 Schichick Jugigo, case of, 495 Schlacken v. State, 58 Schlencker v. State, 58 Schneider v. Barney, 62 Schneider, Commonwealth v., 701 Schoeppe, Dr. Paul, case of, 23 Schrock, Bloomiugton v., 48 Schultz, Marely v., 27 Schuyler, People v., 58 Schwenger v. Raymond, 63 Scott r. Commonwealth, 703 Scott, Montgomery v., 55 Scruton, Moulton v., 58 Sean v. Prentice, 380 Sears v. Schafer, 59 Second Ave. R. R., Mayor of N. Y. v., 27 Seeman, Talbot v., 62 Sessions, People v., 549 Sewell, State v., 775 Shafer, Sears v., 59 Shaw, Regina v., 702 Shaw V. People, 31 Shed V. Augustine, 62 Sheldon v. Booth, 62 Sheldon, Mercer v., 618 Sheldon v. Warner, 57 Shelton, State v., 61 Sherr i\ Wiley, 27 Shotle V. Magervan, 626 Simond v. Henry, 380 Simpson, People v., 31, 32 Simpson v. State, 621 Sinsebaugh, Halsey v., 27 Sisson V. Conger, 60 Slagle, State v., 58, 549 Slais V. Slais, 60 Slaler v. Baker, 380, 381 Slater v. Wilcox, 54, 58 Slatten v. Des Moines Rj'. Co., 797 Sliker, Castner v., 63 Sloan V. N. Y. Cen. R. Co., 54 Slocum, Heath v. 54 Slocura, James J., case of, 494, 498 Small V. Com. of Pa., 31 Small V. Howard, 380 Small, Wogan v., 59 Smalley v. City of Appleton, 55 Smiler, Harris A., case of, 494, 497 Smith, Anth(jny v., 56 Smith ('. Com., 756, 764, 775 Smith V. Duval, 769 Smith, Irish v., 55 Smith ('. Johns, 27 Smitli ('. Perry, 626 Smith, Royce r., 703 Smith, State i'., 55, 549 Smoot V. Leggate, 618 Smothers v. Hauks, 380 Snyder, Dougherty v., 62 Snyder, L. & N. & C. R. R. Co. r., 798 Southey, Regina v., 61 Span V. State, 703 Spear v. Richardson, 57, 58 Spenaley v. Lancanshire Ins. Co., 63 Spencer, State r., 700, 746 Spining, Bishop v., 63 Springer, Raisler v. 55 Stackhouse v. Horton, 60 Stacy V. Portland Put. Co., 61 Stanley, State v., 63 Stanton v. Wetherwas, 701, 702 Starrs, Delaware & Co. v., 61 State, Abrams v., 549 State V. Ah Lee, 32 State, Anderson v., 756, 764 State, Ann v., 549 State, Armor v., 769 State V. Babb, 55 State V. Baber, 58 State V. Bailev, 63 State, Baily v., 769 State, Baldwin v., 58 State V. Bartlett, 746 State, Batten v., 55 State, Beasley v., 769 State, Bird v., 54 State V. Blackburn, 31 State, Blackwell v., 621 State, Bolin v., 32 State V. Bowman, 57 State, Boyd v., 55 State, Bradley v., 775 State, Bradly v., 756, 764 State, BraillV v., 703 State, Buchanan v., 64 State V. Bullock, 770 State, Campbell v., 32, 54 State, Carter v., 48, 769, 775 State, Chase v., 58 State V. Clark, 58 State, Cluck v., lib State V. Colbath, 769 State V. Cole, 63 State, Coles v., 58 State V. Cot)k, 56, 57 State, Cooper v., 56 State V. Cooper, 56, 549 State, Cornwall v., lib State V. Crenshaw, 55 State V. Cross, 55, 63 State, Cunningham v., 746, 756, 764 State, Davis v., bo, 58, 63, 746 State, Dawson v., lib CITATIONS IN AMERICAN EDITION, 813 State V. Dickinson, 549 State, Dillard v., 57 State V. Dillaliunt, 775 State, Dillis v., C4 State, Donelly v., 32 State, Doolittle v., 55 State, Dove v., 59 State ('. Draper, 31 State, Dunn v., 31 State V. Durrand, 31 State V. Edwards, 621 State, Eppt'.,48, 63 State V. Erb, 58 State, Estes v., 769 State, Farrell v., 769 State V. Felter, 703, 756 State V. Feltes, 764 State r. Felton, 764 State V. Felts, 58 State, Fisher v., 11 o State V. Fitzgerald, 549 State, Flanagan v., 621 State V. Folwell, 65 State V. Gallick, 31 State V. Geddis, 59 State, Gehrke v., 59 State, Goodwin v., 58, 63 State, Guetig v., 63 State, Haile v., 769 State, Hams v., 764 State, Harris v., 756 State, Hay v., 31 State V. Hayden, 58 State V. Herman, 626 State, Holcombe v., 59 State V. Housekeeper, 379 State, Hudson v., 31 State V. Huling, 703 State, Hickman r., 59 State V. Hinkle, 57 State V. Hundley, 769, 775 State V. Huxford, 61 State, Joe v., 57 State V. Johnson, 703, 756, 760, 769, 770 State V. Jones, 31, 533, 771 State, Kelly v., 769 State V. Kilgore, 31 State V. Kirby, 533 State V. Klinger, 59 State V. Knapp, 56 State V. Knight, 56 State, Knoll v., 56, 62 State, Lambert v., 32 State V. Lattin, 621 State V. Love, 533 State, Luning v., 48, 54 State, Maconnekey v., 769 State, McAllister v., 60 State V. McCauts, 769 State, McClaskley v., 59 State, McDaniel v., 55 State V. McEvoy, 31 State V. McGonigal, 770, 775 State, McHugh v., 32 State, McPherson v., 32 State V. McWhorter, 756, 764 State Meckle i-., 48 State V. Miller, 55 State, Mitchell v., 32, 57 State, Montgomery v., 30 State, Moon v., 32 State V. Moore, 56, 549 State V. Nash, 31 State, Nesbit v., 32 State V. Newlin, 58 State, Norris v., 58 State, O'Herrin v., 175 State V. Owens, 549 State, Page v., 63 State, Parsons v., 756, 764 State V. Patterson, 32 State V. Phair, 54 State, Pierce v., 61 State V. Pike, 58, 61, 756 State, Pike v., 763 State, Pitts v., 56 State, Polin v., 58 State, Polk v., 56, 57 State, Pook v., 55 State, Powell v., 59 State, E. v., 31 State, Ray v., 55 State, Reake v., 746 State, Reed v., 59 State, Reynolds v., 30, 31 State, Rickerson v., 57 State, Roberts v., 703, 756, 764 State V. Romaine, 626 State, Sanders v., 63 State, Schlacken v., 58 State, Schlencker v., 58 State V. Sewell, 775 State V. Slielton, 61 State, Simpson v., 621 State V. Slagle, 56, 649 State V. Smith, 55, 649 State, Span v., 703 State V. Spencer, 700, 746 State V. Stanley, 63 State, Stevens v., 703 State, Still v., 30 State, Stuart v., 769 State, Sunnier v., 63 State V. Torrall, 57 State, Thomas v., 57 State V. Thompson, 769 State, LTroe v., 31 State V. Vansent, 32 State of Va., Mrs. E. E. Lloyd, case of, 25 State, Walker v.. 32 State, Ward v., 32 State, Webb v., 58 State, Wesley v., 703 State, West v., 31 State V. White, 769 State V. Whittier, 621 State V. Williamson, 31 State 1'. Wilson, 31, 549 State, Wilson v., 549 State, Winfield v., 32 Stater. Wood, 31, 58 State, Wright v., 30 814 CITATIONS IN AMERICAN EDITION, Steatuboivt Clipper Co. v. Logan, 62 Stearns, Mattocks v., 618 Stennett v. Pa. Ins. Co., 63 Stevens Point, Strong v., 63 Stevens v. State, 703 Stewart v. Rees, 618 Stickney v. Bronson, 27 Stickney, Perkins v., 63 Still, Regina v., 56 St. Louis Mut. Life Ins. Co. v. Graus, 700 Stocking, Bierce v., 57 Stokes, People v. , 325 Stokes, Reg. v., 746 Stonan v. Waldo, 58 Stone, Coryell v., 58 Stone V. Chicago, etc., R. Co., 63 Stone V. Evans, .381 Stoudenmeir v. Williamson, 48 Stout, Allen v., 54 Stovel, Hook v., 56 Stowe V. Bishop, 62 Strieker, ("om. i'., 626 Strong V. Stevens Point, 63 Stuart V. State, 769 Sturtevant, Cora, v., 56 Sturtevant, Cousin, v. 55 Sullivan v. Cowen, 55 Sumner v. State, 63 Sun Mutual Ins. Co., Nelson v., 54 Sutherland v. Hankins, 58 Sutton V. Sadler, 702 Swift, Brantley v., 62 S. &. N. Ala. R. Co. v. M'Lenson, 55 TALBOT V. Seeman, 62 Taunton M'fg Co., Lincoln v., 57 Taunton, Williams v., 57 Taylor, Howlett v., 59 Tavlor, People v., 32 Teft V. Wilcox, 380 Tegarden, Morrill v., 63 Templeton v. People, 63 Teny, Life Ins. Co. v., 702 Teire Haute v. Hudnut, 62 Terrell, State v., 57 Terry, Phelps v., 62 The Black Warrior, Turner v., 57 The People, Sanchez v., 60 The Playfair case, 43 The State of Alabama, Boswell u, 700 The State, Anderson v., 700 The State, Clark v., 58 The State, Pirttlev., 769 The State, Wood v., 58 Thing, Heald v., 54, 59 Thomas v. State, 57 Thompson, Grant v., 58, 59 Thompson, Kay v., 56 Thompson, State v., 769 Thul, Atchison, etc., v., 63 Thurston, People v., 61, 63 Tierney v. Minneapolis, etc., R. Co., 55 Titus, Biiggs v., 618 Tobin, Western Ins. Co. v., 61 Tolum V. Mohr, 63 Toomes, Estate of, 55, 59 Town of Ackley, Armstrong v., 55 Townley, Rex v., 703 Townsend r. I^epperell, 59 Townshend, Brooke v., 59 Tracy v. People, 31 Travis r. Brown, 54 Tryson, Rawble v., 58 Tucker r. Duncan, 798 Tucker, Jones i:, 54, 56 Tulus ('. Kidd, 58 Tinner v. The Black Warrior, 57 Tweedy, Ferguson v., 618 UNION Pacific R. Co. v. Clopper, 62 United States v. Hewson, 703 L^nited States i\ Howe. 64 , United States v. MoUoy, 63 United States, Moore v., 62 U. S., Davis v., 746 U. S. V. Drew, 775 U. S. V. Forbes, 769 U. S. V. Guiteau, 58 U. S. V. McGlue, 56, 774 Upchurcii V. Anderson, 618 Uptone V. People, 58 Uroe V. State, 31 Utley V. Burns, 380 YAN ALSTINE, Hoes v., 62 V Vananken's case, 59 Van Buren, Elliott v., 56 Van Cleve, Den v., 621 Vander Denckl v. Helluson, 54 Van Deusen v. Newcomers, 55 Van Dnger v. Van Duger, 618 Van Hoaser v. Berghoff, 327 Vanhoover v. Berghotf, 379, 380 Van Huss v. Rainbolt, 59 Van Meter, Monroe v., 618 Vansent, State v., 32 Von Sachs v. Kretz, 54 Von Valkenburgh v. Von Valkenburgh, 63 Vosburgh, Goodyear v., 57 WALDO, Stonaro v., 58 Wale V. Dewitt, 48 Walker v. Forbes, 62 Walker, Mobile Life Ins. Co. v., 54 Walker v. People, 746 Walker v. State, 32 Walker v. Walker, 58 Walsh V. Wash, etc., Ins. Co., 62 Ward V. Kilpatrick, 62 Ward V. State, 32 Warner, Polter v., 380 Warner, Siieldon v., 57 Wasii., etc., Ins. Co., Walsh v., 62 Washburn v. Cuddhy, 48 W^asiiington v. Cole, 56 Wasson, People v., 32 Watson, case of, 771 CITATIONS IN AMERICAN EDITION. 815 Watson r. Anderson, 60 Watson V. Milwaukee, etc., R. Co., 54, 62 Watson V. Watson, 619 Webb, Nicoll v., 27 Webb r. Page, 64 Webb V. State, 58 Welch ('. Brook, 56 Wells V. World Disp. M. Asso., 380 Welsh, Burns v., 62 "\\'endell, Haven v., 27 Wenger v. Calder, 380 Wesley v. State, 703 West V. Martin, 380 West, Ritchie v., 380 AVest V. State, 31 Western Ins. Co. t\ Tobin, 61 Westervelt, Moore v., 62 Wetlierwas, Stanton v., 701, 702 Wharton, Mrs. E. G., case of, 23 Wheeler v. Anderson, 702 Wheeler v. Hotchkiss, 618 White, Heath v., 618 White, Jones v., 56 White, State v., 769 W' hittier. State v., 621 Whitworth, Hunter v., 618 Wicks r. Clarke, 618 Wiederhold, case of Dr., 720 Wiggen, Patten v., 380 Wilcox, Slater v., 54, 58 Wilcox, Tefft v.; 380 Wile)" V. Portsmouth, 56 Wiley, Sherr v., 27 Wilkinson r. Moseley, 55 W^ilkinson i'. Pearson, 59 Will, Arnold's, 59, 61 Will, Forman's, 700, 702 Will, Roberts', 62 Williams, Com. v., 31 Williams's Estate, Wright v., 63 Williams v. Lee, 59 Williams, Mechanics' Bank v., 618 Williams, People v., 769 Williams v, Perkins, 619 Williams v. Poppleton, 56 Williams v. Taunton, 57 Williamson, State v., 31 Williamson, Stoudenmeir v., 48 Willis t). Com., 769 Willis V. People, 703 AVillis r. Quimbv, 55, 58 Wilmot V. Howard, 380 Winfield v. State, 32 Winkler v. Winkler, 618 Wilson V. Babb, 626 Wilson, Commonwealth v., 59 Wilson V. State, 31, 549 Winne v. Winne, 618 Winslow, Bogle v., 380 Winter, Mills v., 61 Withers v. Jenkins, 618 Wogan V. Small, 59 Wood, Hewlett v., 59 Wood, Joseph, case of, 494, 495, 497 Wood, Louisville, etc., R. Co., 55 Wood, State v., 31, 58 Woodcock, R. v., 31 Woodin V. People, 56 Woodman, Boardman v., 58, 63 Woodruff I'. Imperial Fire Ins. Co., 62 Woods, Bowman v., 48 Woolfolk, Hyde v., 54 World Disp. M. Asso., Wells v., 380 Wreden, People v., 58 Wright V. Hardy, 56 Wright w. State,' 30 Wright V. Williams's Estate, 63 Wycherley, R. v., 549 Wyman v. Gould, 59 YARDLEY r. Cuthbertson, 63 Ybarro, People v., 31 Yong V. Com., 31 York, Com. v., 746 ^UGASTI V. Lainer, 61 INDEX ABDOMEN, sudden death from blows on the, 310, 367 wounds of tlie, 367 Abnormal conditions of the body, 323 Abortion, 536 causes of, 536 from drugs, 539 feigned, 548 from injections, 546 by instruments, 538 law relative to, 549 by mechanical means, 537 medical responsibility in cases of, 552 proofs required, 550 signs of, in the living and dead, 547 [Abortion, 549] Abortives, specific, 543 Absorption, poisoning by, 120, 130 Abstinence, effects of, 504 Acceleration of death from wounds, 316, 322 Accidental wounds, 270 Acetate of barium, 115 of copper, 155 of lead, 150 of morphine, 188 Acetic acid, 160 Acid, arsenic, 141 arsenious, 123 carbolic, 173 carbonic, 463 hydrochloric, 104 hydrosulphuric, 482 meconic, 190 nhric, 100 oxalate of potassium, 110 oxalic, 105 poisons, 90, 97 prussic, 194 sulphates, 100 sulphuric, 96 sulphurous, 473 tartaric and acetic, 110 Aconite, analysis of, 240 leaves and seeds of, 241 poisoning with, 237 root mistaken for horseradish, 239 tincture of, 238 Aconitia, 241 Aconitine, 241 analvsis of, 244 English (Morson's), 241, 242 816 Aconitine — fatal dose of, 241 Friedliinder's, 242 Merck's (German), 241 nitrate of, 241 symptoms of, 239, 241, 242 Aconitura ferox, 237 Fischeri, 237 Napellus, 237 ^thusa cynapinm, 233 Affiliation, evidence in oases of, 643 Agaricus campestris, 213 phalloides, 216 Age, for civil and criminal responsibility, 621 impotency depending on, 654 medical questions on, 621 of the newborn child, rules for deter- mining, 604 for procreative power, 653, 661 Air, confined, suffocation from, 480 of drains and sewers, composition of, 485 in veins a cause of death, 366 Alcohol, analysis of, 203 poisoning with, 202 Alienation, mental (see Insanity), 698 Alkaline poisons, 111 Almond, bitter, essential oil of, 199 flavor, 199 Aloes, noxious effects of, 168, 540 Amanita Csesarea, 215 citrina, death from, 214 muscaria, 215 pantherina, 215 Ambidextrous persons, wounds by, 270 Amenorrhcea, 511 a cause of insanity, 662 Amentia, 707 Ammonia, poisoning with, 112 vapor of, fatal effects of, 112 Ammoniated mercury, 149 Amraonio-chloride of mercury, 149 Ammonium carbonate, 113 sulphide of, 485 sulphocyanate, 197 Amnii liquor, stains of, 553 Amorphous phosphorus, 120 Analysis, articles preserved for, 2e o chemical reports of, 28 fallacies connected with, 25 Annmirta cocculus, 211 INDEX. 817 Androgyni and androgyna?, 659 Antimony, chloride of, 163 chronic poisoning by, 160 detection of, in the tissues, 162 tartarated, poisoning by, 158 Antipyretics, 193 Apnoea, 65, 398 Apoplexy, 66, 89, 353 meningeal, 355 Aqua fortis, 100 Areohe of the breasts, 503 Arrowroot, detection of, 581 Arsenates, alkaline, 141 Arsenetted hydrogen, 142 tests" for, 137 Arsenic acid, 141 analysis as a solid, 130 chloride of, 142 chronic poisoning with, 124 death from external application of, 129 eating, 77 fatal dose of, 1 30 Marsh's process for, 133 not a constituent of the body, 139 in organic mixtures and tissues, 134 post-mortem appearances, 128 Keinsch's process for, 133, 138 in solution, 132 sulphides of, 141 symptoms of acute poisoning caused by, 123 white, 123 [Arsenic, Reinsch's test for, 134] [Arsenic, search for, in body, 24] Arsenious acid (see Arsenic), 123 Arsenite of copper, 140 in paper-hangings, 141 symptoms caused by, 140 Arsenites, alkaline, 139 Arterial and venous blood, 305 Arteries, wounds of, 365 Artificial inflation of the lungs, 572 Asphyxia, death from, 65, 398 from gases, 461 from mechanical causes, 448 syncopal, 67 various forms of, 398 Assailant, marks of blood on the, 278 Assizes, trial at the, 35 [Ass. Military Surgeons, U. S., 791] Atelectasis, a cause of stillbirth, 568 of the lungs, 567, 590 Atropa belladonna, 217 Atropine, 217 Auscultation in pregnancy, 524, 615 BALLOTTEMENT in pregnancy, 515 Balls, apertures produced by, 382 deflection of, 385 Barber's poisoned wheat, 212 Barium, carbonate and acetate of, 116 salts of, 115 Barristers, nominal duties of, 49 Bastardy, adulterine, 644 Battle's vermin-killer, 225 52 Bearsfoot (Hellebore), 172 Beer, poisoned, 211 [Being "born," 615] Belladonna, 217 analysis, 219 appearances, 219 symptoms and effects, 217 Bestiality, 695 Bichloride of mercury, 143 Binoxalate of potash, 110 Birth, concealment of proofs of, in crim- inal law, 533 date of, 612 partial and entire, 614 proofs of, in civil law, 616 [Birth, concealment of, 533] Births, monstrous, 623 plural, 623 posthumous, 645 premature, 630 protracted, 635 Bitter almond, oil of, 199 Black hellebore, 172 snake root, 541 Bladder, ruptures of tiie, 372 Bleeding, cicatrices from, 338 Blistering-fly, poisoning by, 176 Blisters from burns, 392 marks of, 341 Blood, arterial and venous, 304 in cases of abortion, 553 on clothing and furniture, 277, 305 corpuscles or cells, 284 corpuscles of, 286 crystals, 284 effusion of, from disease or violence, 354 effusions of, in newborn children, 617 human and animal, 286 on linen, 301 loss of, a cause of death, 307 marks of, in death from wounds, 278 menstrual, 305 optical examination of, 283 in stomachs of newborn children, 583 tests for, 281 on weapons, 276, 283 Blood-stains in cases of abortion, 553 date of, 301 detection of, on weapons, 276. 283 distinguished from rust- and fruit- stains, 303 examination of, 281 human, distinguished from other kinds, 289 on linen, 301 microscopical examination of, 284 in rape, 694 spectral examination of, 282 washed, detection of, 303 Blows or falls, injuries produced by, 257 Blue rocket, 237 vitriol, 155 Bodies, exhumation of, 23 Body, burning of the, 397 cooling of the, in death, 68 818 INDEX. Body- destruction of the, by fire, 395 inspection of the, in cases of poison- ing, 21 marks of blood on the, 277 position of the, in death from hanging, 420 position of the, in deatli from wounds, 275 putrefaction of the, 71 specific gravity of the, 410 [Body, examination of, 23] [searcli for arsenic in, 24] [zinc found in,' 24] Bones, brittleness of tlie, 376 fractures of the, 375 [Books as evidence, 48] Books, quotations from, 47 Born alive, signification of, 559 Brain, membranes of the, 357 wounds of the, 350, 358 Brandy, poisoning with, 202 Breasts, changes of, in pregnancy, 512 Brick-kilns, vapor of, 476 Broom-tops as an abortive, 540 [Bronze-powder, poisoning by, 156] Brucine, efTects of, 228 tests for, 229 Buggery, 695 Bullets, examination of, 388 Buovancy of the bodv, living and dead, 410 [Burden of proof in insanity cases, 746] Burking, death by, 460 Burnett's fluid, poisoning with, 164 Burning, homicidal, 394 Avood, vapors of, 471 Burns and scalds, 389 cause of death from, 390 cicatrices from, 340 by corrosive liquids, 396 from lightning, 488 on the living and dead body, 391 the result of accident, homicide, or suicide, 394 Butler's vermin-killer, 225 Butter of antimony, 163 CADAVERIC rigidity, 69, 275 Cfesarean extraction, 619 [Cadaveric alkaloids, 183] [Cadaveric rigidity, Prof. Reese, 69] Calabar bean, 212 Calomel, 148 Camphor, poisoning with, 209 Canal is venosus, closure of the, 579 Canella, 168, 540 Cantharides, detection of, 177 effects of, 176 Cantharidin, 178 Capacity, test of, 739 testamentary, 738 Caput succedaneum, 600 Carbolic acid, 173 analysis, 175 Carbolic acid — latal dose of, 174 symptoms and appearances, 174 Carbonates of ammonium, 113 of barium, 115 of lead, 152 of potassium and sodium, 111 Cakbonic acid, analysis, 406 appearances in death from, 466 combustion in mixtures of, 467 diffusion of, 467 of lime and l)rick-kilns, 485 suffocation by, 463 symptoms caused by, 465 Carbonic oxide. 469, 472, 476 Carburretted hydrogen, 476 Caries from phosphorus, 118 Carnal knowledge, 670 Carotid arteries, wounds of, 365 [Case of Dr. Beach, 763] [Case of Guiteau, 763] [Case of McNaughton, 746-760] Castor-oil seeds, poisoning with, 170 Catamenia (see Menstruation), 663 Causes of death, 64 [Causes of sudden death, 256] Caustic alkalies, 102 Cement-kilns, vapors of, 476 Cephalhfematoma, 587 Certificates of insanity, rules regarding 719 Cesspools, effluvia of, 484 Charcoal vapor, effects of, 469 [Chemical analysis, poisoning, 95] Cheese, poisoning with, 86, 179 Chest, wounds of the, 371, 377 Child, changes in the body of the, after birth, 55y evidence from development of, 632 from the sixth to the ninth month, 555 inspection of the body of, 558 legal definition of a, 534 newborn, uterine age of, 554 Child-murder (see Infanticide), 554 Children, posthumous, 695 supposititious, 657 [Children, evidence of, 621] Chloral hydrate, 207 analvsis of, 209 fatal" dose of, 209 symptoms and appearances, 208 Chlorate of potassium, 114 Chloride of antimony, 163 of arsenic, 142 of barium, 115 of iron, 165 of mercury, 143 of zinc, 164 Chloriodide of potassium and mercury as a test, 190 Chlorodyne, poisoning with, 192 [Chloroform, effects of, due to knowledge of per.son inhaling it, 207] Chloroform, 204 death under operations with, 328 INDEX. 819 Chloroform — poisoning with, 205 vapor, 206 Cholera mistaken for poisoning, 85 Cholesterin, 594 Chromate of lead, 166 Chrome yellow, 166 Chromium, preparations of, 165 Chronic poisoning, 90 by antimony, 160 by arsenic, 124 by copper, 155 by lead, 153 by mercury, 144 by phosphorus, 117 insanity, 692 Cicatrices, colored (see Tattooing), 341 from disease, 336 growth of, 335 from surgical operations, 333 from vaccination, 337 Cicatrix, age or date of, 333 alleged changes in a, 336 from bleeding and other causes, 338 from a burn, 340 imputed, 336 nature of a, 332 permanency of, 333 from a wound or disease, 336 Cicatrization of wounds, 331 Cicuta virosa, 232 Circulation, cessation of the, in death, 68 foetal, changes in the, 579 Circumstantial evidence in hanging, 429 in wounds, 273 Citrate of iron mistaken for blood, 304 Classification of poisons, 80 Climacteric, menstrual, 664 Clothing, blood on, 285 Coal-gas, suffocation by, 476 vapor, effects of, 473 Cobra poison, action of, 73 Cocaine, 193 Cocculus Indicus, 211 Code Napoleon, 641 Coke vapor, efiects of, 473 Colchicine, 172 Colchicum, poisoning with, 172 Cold, death from, 499 infanticide by, 598 Colic, painter's, 153 Colica pictonuni, 153 Colocynth, effects of, 168 Colostrum of milk, 581 Colored cicatrices, 341 Color-tests for strychnine, 226 ( 'oma, death from, 07 Combustion, human, alleged, 394 in carbonic acid and air, 465 spontaneous, 394 Commissions of lunacy, 732 [Compensatory damages, 798] Compos mentis, 733 Compression of the brain, 353 Concealment of birth, 533 of delivery, 522 Concealment — of disease, 781 of habits, 782 material, 782 of pregnancy, 517 [Concealment of l)irth. 533] Conception, date of, 628 Concussion of the brain, 351 and intoxication, 352 Confectionery, poisoned, 140 Congenital disease in newborn children, 591 Congestion of the lungs, 567 Conia, or coniine, 231 Coninm macuiatum, 230 [Consequential damages, 798] Contused wounds, 256, 267 Contusions on the living and dead, 252 Cooling of the body in death, 08 Copper, arsenite of, 133, 141 in articles of food, 157 detection of arsenic in, 138 detection of, in the tissues, 157 poisoning by salts of, 155 in preserved peas, 157 tests for, 1 56 Copperas, poisoning with, 165 Cord, mark of the, in hanging, 422 in strangulation, 442 umbilical, death from laceration of the, 588 length of the, 606 strangulation by the, 604 Corn, poisoned, 212 Coroners' Act, 33, 589 inquests, 33 Corpora lutea, 530 Corrosion distinguished from ulceration, 96 Corrosive liquids, burns from, 396 poisons, 80 Corrosive sublimate, chronic poisoning by, 145 in organic liquids, 147 poisoning with, symptoms of, 143 from external applicatioji, 144 post-mortem appearances, 145 tests for, 146 in the tissues, 148 Cottonwood, tincture of, 541 Counsel, license of, 37 privileges of, 49 Counter-stroke, nature of, 354 Courtesy, tenancy by, 615 Cranium, fractures of the, 351 accidental, in the newborn child, 600 Creasote, 173 Cretins, 711 Criminal abortion, 536 Criminal responsibility in deafness and dumbness, 776 in drunkenness, 767 in insanity, 743 somnambulism, 775 Cross-examination, 46 820 INDEX Croton-oil, poisoning with, 170 Crying, evidence of live birth, 615 Crypsorchides, virility of. 656 [Crystals, octahedral, 134] Cupping, cicatrices from, 329 Cuts and stabs. 200 Cyanide of potassium, 198 analysis, 198 symptoms and appearances, 198 of silver, 196 Cytisine, 244 Cytisus laburnum, 244 DALEY'S carminative, 187 [Damage cases, 797] Date of birth, 614 of cicatrices, 336 of conception, 628 of effusions of blood, 356 Datura stramonium, 222 Daturine, 222 Dead body, examination of the, 21 burning of the, 394 wounds and contusions on the, 250, 252 Deadly nightshade, 217 Deaf and dumb, 776 Deafness and dumbness, feigned, 777 [Death caused by an injury, 798] Death, acceleration of, in personal injuries, 313, 322 apparent, in newborn children, 568, 590 muscular irritability after, 69 reality of, 69 signs of, 68 sudden, causes of, 68 from surgical operations on wounded persons, 324, 328 violent, causes of, 68 [Death from explosion, 256] Debility, death of a newborn child from, 587 I)ecay, food rendered poisonous by, 178 Declarations of dying persons, 21 Defloration, signs of, 681 Deformities, evidence from, 653 Deformity from fractures, 389 sexual, 659 from wounds of the face, 359 Delirium mistaken for insanity, 708 Delirium tremens, in drunkards, 773 following wounds, 324 [Delirium tremens, insanity produced by, good defence, 774] Delivery, 522 concealed, 522 date of, 529 during sleep, 526 feigned and unconscious, 525 in the living, 523 locomotion and exertion after, 602 protracted, death of the child from, 587 at a remote period, 524 Delivery — signs of, in the dead, 528 sudden, in the erect posture, 601 violence inflicted on the child during, 601 De lunatico inquirendo, 733 Delusion in insanity, 709 [763] in reference to wills, 740 [Delusion in mind criterion of absence or presence of insanity, 722] Dementia naturalis and accidentalis, 700 Dementia, 710 senile, 741 Deposits, arsenical, 132 Derangement, mental, 698 Destructive things, 76 Development of child, evidence from, 630 De ventre inspiciendo, writ of, 520 Dialysis of poisons, 99 Diaphragm, wounds and ruptures of the, 366 DifTusion of gases, 467 Digitalin, 236 Digitalis, poisoning with, 236 purpurea, 236 Dipsomania, 767 Direction of wounds, 268 in the chest, 371 Discharge of lunatics, 729 Disease, concealment of, 781 influence of, on poisons, 79 on virility, 655 on wounds, 313 Diseased flesh, poisonous, 178 Diseases tending to shorten life, 781 Dislocations, 378 Distillation-process for arsenic, 135 Docimasia circulationis, 579 pulmonaris, 566 Doubtful sex, 650, 669 Drains and sewers, noxious gases of, 484 Dress, examination of the, in wounds, 267 Dripping poisoned with lead, 154 DKO^VNING, appearances in, 401 buoyancy of the body in, 410 cause of death from, 398 a cause of death in newborn children, 596 death from secondary causes in, 401 homicidal or suicidal, 413 marks of violence in cases of, 411 medical proofs of, 401 from partial immersion, 416 in shallow water, 414 Drugs used as abortives, 540 Drunkards, civil and criminal responsi- bility of, 768 [770-771] restraint of, 768 Drunkenness, concussion mistaken for, 352 in life insurance, 784 responsibility in cases of, 768 Ductus arteriosus, closure of, 579 venosus, 579 Dumb, responsibility of the, 776 Dura mater, the, 367 INDEX. 821 Dyes, red, mistaken for blood, 302 [Dying declarations, 30] [law regarding, 30, 31, 32] Dying declarations, rules respecting, 21 Dying persons, wills made by, 742 Dvnamo-machines, death from touching, "493 EARTHENWARE, wonnds from, 257 Eccentricity mistaken for insanity, 710 in v?ills, 740 Eccliyraoses, punctiform, in suffocation, 464 [Ecchymoses, cadaveric, 253 Ecchymosis, caused by lightning, 491 changes of color in, 252 in lianging, 419 not always a result of violence, 253 natural marks resembling, 609 production of, after death, 252 in strangulation, 436 from violence, 251 [Ecchymosis, cadaveric, difficult to distin- guish from putrefaction, 254] Ecbolics, 539, 543 Eczema from arsenic, 124 Effluvia from drains and sewers, 484 Efiusion of blood (see Extravasation), 353 Elaterium, 540 Electricity, action of (see Lightning), 487 [Electrocution, post-mortem in, 493] Embryo, examination of the, 531 Emerald green, poisoning with, 140 Emetic, tartar, poisoning with, 158 Emmenagogues in abortion, 539 Enemata, poisonous, 83 [English judges as to responsibility of in- ebriates, 771] Epispadia, 659 Epithelial scales, 582 Epsom salt, death from, 114 Ergot of rye as an abortive, 543 Erysipelas following wounds, 324 Eserine, 212 Essence of mirbane, 199 Essential oil of almond, 199 Ether, nitrous, 204 poisoning with, 204 Evidence, circumstantial, in wounds, 273 exaggerated, 52 medical, 37 notes, wlien and how used, 26 of opinion, 52 rules respecting, 50 technical, 52 Evidence of poisoning in the living, 82 in the dead, 88 [Evidence of children, 621] Examination in chief, 45 cross, 46 of the dress in wounded persons, 261 of firearms, 388 of lunatics, 718, 733 Examination — of a man in child-murder, 611 of weapons, 275, 303 of wounds, 248 [Examination of body, 23] [Exceptions to rules of evidence, 59] Excessive smoking, 786 Excitement a cause of extravasation, 355 Exemplary damages, 798 Exhaustion, death from, 310 Exhumation of bodies, 23 Experts, medical, 21 [Expert in cases of insanity, a competent, 60] [Experts and expert testimony, 54] [compensation of, 63] [hypotiietical questions, 63] [Explosion, death from, 256] Exposure, death of newborn children from, 598 Extent of wounds, 267 Extract, Goulard's, 152 of opium, 187 Extravasation of blood on the brain, 353 date of, 355 Eyebrows, wounds of the, 359 FACE, wounds of the, 359 Facts, specification of, in insanity, 727 Falls, injuries from, 257 Family likeness, evidence from, 642 Fasting, long, effects of, 504 pretended, 509 [Fasting, prolonged, 510] Fat poisoned by lead glaze, 154 Fatuity, 710 Features, evidence from the, 683 Fecundity in women, 665 Fees to medical witnesses, 53 Feigned abortion, 548 deafness and dumbness, 777 delivery, 525 insanity, 713 menstruation, 512 poisoning, 86 pregnancy, 516 strangulation, 446 wounds, 262 Fern leaves in abortion, 540 Ferric chloride, 165 Ferrous sulphate, 165 Fever, death from, after wonnds and ope- rations, 318, 326 Fibres on weapons, 276 Firearms, examination of, 388 Fish, poisonous, 86 [Fisk, James, Jr., case of, 306] Flagellation, death from, 310 Fleming's tincture of aconite, 238 Flesh, diseased, poisoning by, 86 Flogging, military, deatli from, 310 Flour poisoned with lead, 154 Fly-paper, 140 Fly-water, 140 822 INDEX, Foetal circulation, changes in the, caused by respiration, 579 heart, changes in the, after breathing, 579 sounds of the, 514 stomach, contents of the, 580 Foeticide (see Abortion), 536 Foetus, age of the, determined by size of the external ear, 567 characters of the, to the sixth month, 531 from sixth to the ninth month, 553 Food, copper contained in, 156 death from privation of, 503 poison detected in, 86 poisonous, 8(), 178, 181 putrescent 182 Fool's parsley, effects of, 233 Foramen ovale, closure of the, 579 Fowler's mineral solution, 139 Foxglove, poisoning with, 236 Fractures, 375 accidental, in the drowned, 412 in the living and dead, 377 locomotion after, 378 in newborn children, 600 of the skull, 357 of the spine, 359 spontaneous, 376 Fragilitas ossium, 376 Fright, death from, 315 Frost-erythema, 501 Fruit-stains resembling blood, 293 Fungi, poisoning with, 213 Furniture, blood on, 277 GALL-BLADDEE, wound and ruptures of the, 370 Gamboge in abortion, 540 effects of, 168 Game, poisoned, 178, 183 Gangrene, effects of, 72 [Garfield, President, case of, 306] Garrote robberies, 443 Gas, suffocation by, 477, 479 water-, 479 Gaseous poisons, 461 Gelatinized perforation of the stomach, 95 Gelsemium, poisoning by, 169 Genitals, wounds of the, 373 German aconitine, 243 Gestation, duration of, from one intercourse, 626 . mistakes in the mode of computation of, 630 natural period of, 626 period of, not fixed by law, 640 protracted, 635 short periods of, 630 Gin, poisoning with, 203 Glanders, poison of, 73 Glandulse Pacchioni, 323 Glandular cicatrices, 337 Glass, powdered, effects of, 77 wounds caused by, 257 [Glass, wounds caused by explosion of, 256] Godfrey's cordial, 187 Gonorrhoea in rape, 678 Gonorrhd-al discharges, 677 Goulard's extract, 152 (ioidard-water, 152 Green hellebore, 172 vitriol, 1()5 Grievous bodily harm, 248 Griffith's mixture, 541 Guaiacum-test for blood, 282 Guelder rose, 237 Gunpowder, vapor of, 473 wounds from, 386 Gunshot wounds, accidental, 384 homicidal or suicidal, 384 nature of, 381 near or distant, 382 [Gunshot wounds, 350] HABIT, its influence on poisons, 77 Habits, concealment of, in life insur- ance, 782 Habitual intemperance, 773, 784 Hsematin, properties of, 283 Hpemin, crystals of, 284 Haemoglobin, 281 Hair, the color of, in paternity, 643 on weapons, 276 Hair-washes, 153 Hallucinations in drunkenness, 773 in insanity, 705 in sleep, 775 Hanging, appearances in death from. 420 circumstantial evidence in cases of, 429 of the dead body, 425 death from, 417 evidences of, from mai'k of the cord, 423 evidence from position of body in, 430 homicidal, 427 marks of violence on the body in, 425 Hartshorn, poisoning with, 113 Head, injuries to the, in newborn children, 599 wounds of the, 350 Heart, rupture of the, 364 wounds of the, 363 [Heart, woiuids of, not directly fatal, 362] Heat-apoplexy, 502 Heat, excessive, death from, 502 [Heat, intense, characteristic of true sun- stroke, 503] Hellebore, poisoning with, 172 Hemlock, poisoning with, 230 water-dropwort, 234 Hemorrhage, cerebral, 354 death from, 307 death of the newborn child from, 588 internal, death from, 308 Henbane, poisoning with, 216 [Hendrickson, John, Jr., case of, 95] Hepatization of the lungs, 567 Hereditary transmission of insanity, 713 INDEX, 823 Hermaphrodites, legal rights of, 650 Hermaphroditism, 649 Hernia, phrenic, 367 Hevella esculenta, 213 Hiera picra, 168, 540 Holly, noxious effects of, 237 Homicidal monomania, 750 legal tests of, 753 medical evidence of, 760 tests of, 757 symptoms of, 750 varieties of, 751 burning mistaken for spontaneous, 393 wounds, 265 Horseradish and aconite, 240 Hunger, death from (see Starvation), 503 Hydrate of chloral, poisoning with, 207 Hydrochloric acid, 104 analysis of, 104 stains of, on clothing, 105 symptoms and appearances in poisoning with, 104 Hydrocyanic acid, 194 Hydrogen, arsenetted, 142 test for arsenic, 133 Hydrostatic tkst, 566 artificial inflation, 572 efl'ects of putrefaction on the, 571 erroneous inferences from, 570 general conclusions respecting the employment of, 576 objections to the, from sinking of the lungs, 567 Hymen, evidence derived from the, in rape, 672 as a sign of virginity, 681 Hyoscyamine, 217 Hyoscine, 217 Hyoscyamus, poisoning with, 217 Hypospadia, 659 [Hypothetical questions, expert's, 63] IDENTITY, mistaken, 333 personal, from cicatrices, 332 sexual, 669 of substances, 24 Idiocy, 711 Idiosyncrasy in poisoning, 78 Idiots, rape on, 686 [Ignition of clothing, 349] Illusions in drunkenness, 773 in insanity, 705 Imbeciles, wills made by, 736 Imbecility, 711 senile, 713 Immaturity of the foetus, 598 of the partus in cases of legitimacy, 633 Impediments, canonical, to marriage, 666 Impotency from age, 652 causes of, 652 from general disease, 659 as a gromd for divorce, 658 from local disease and malformation, 652 Impulse to crime, 761 Imputed cicatrices, 336 poisoning, 86 strangulation, 446 wounds, 264 Inanition, death from, 503 Incapacity, sexual (see Impotency), 652 Incendiarism, prof)ensit}' to, 767 Incised wounds, 255 Incoherency, 713 Incompetency, mental, medical tests of, 739 Indian tobacco, 234 Indigo, sulphate of, 97 [Inebriety as a defense for crime, 770 as a disease afl'ecting responsibility, 770] Infans, 621 Infanticide, 654 after respiration, 562 examination of women in cases of, 611 inspection of the body in, 558 legal proofs of, 577 natural causes of death in, 586 Ploucquet's test in, 565 proofs of live birth in, 578 proofs of life before respiration in, 559 static test in, 564 violent causes of death in, 592, 604 Infantile leucorrhcea, 678 Infants, action of opium on, 187 in law, 621 rape on, 671 Inflation, artificial, of the lungs, 572 Inheritance, medical questions relating to, 614 Injections, poisoning by, 83 Inquests, coroners', 33 [Insane delusions, 763] [Insane homicide, criminal responsibility of, 755] Insane, responsibility of, 743 Insanity, [burden of proof in case of, 746] [produced by delirium tremens good defence, 774] evidence of, from written documents, 736 feigned, 713 hallucinations and illusions in, 705 hereditary transmission of, 713 homicidal, 747 interdiction in cases of, 732 legal definitions of, 735 in life insurance, 787 lucid intervals in, 706 medical definitions, 698 moral and intellectual, 699 plea of, in criminal cases, 743 post-mortem appearances in, 715 puerperal, 765 rules for applying restraint, 717 signing certificates of, 719 true tests of, 763 various forms of, 707 [Insanity, primary dehisional, 709] [Insanity, delusion in mind criterion of absence or presence of, 702] 824 INDEX, [Insanity, a competent expert in cases of, 60] Insect powders, 225 Insemination, 626 Inspection of the body in child-murder, 558 in poisoning, 23 in wounds, 248 Insurance (see Life insurance), 779 murders, 788 Intellectual insanity, 699 Intemperance, definition of, 784 habitual, 768, 784 [Intense heat characteristic of true sun- stroke, 503] [Intention an essential element of crime, 770] Intercourse, carnal, legal proofs of, 671 duration of gestation after, 626 Interdiction in insanity, 732 Intervals, lucid, in insanity, 706 validity of acts performed during, 85 Intestines, wounds and ruptures of the, 371 Intoxication mistaken for concussion, 352 [Intoxication, excessive, mental unsound- ness superinduced by, may excuse, 769] Iodic acid test, 190 [Iodine, symptoms, appearances, and anal- ysis, i2i] Iodoform, 207 Iron-filings, 77, 541 Iron-mould mistaken for blood, 302 Iron, muriated tincture of, 165 salts of, poisoning with, 165 Irritant poisons, 80, 96 Irritants, animal, 176 mechanical, 77 metallic. 123 non-metallic, 96 vegetable, 168 JALAP, effects of, 168 Japaconitine, 241 Jasmine, yellow, 169 [Judicial evolution as to criminal respon- sibility of inebriates, 770] Juniperus Sabina, 169 in abortion, 542 Jury of matrons, 520 KIDNEYS, ruptures of the, 370 Kleptomania, 766 IABOR, premature, induction of, 552 J Laburnum, 244, 540 seeds, 244 Lacenited wounds, 256 Lactation, a cause of puerperal insanity, 765 Larynx, spasm of the, 590 Latent disease in wounds, 313 Laudanum, poisoning with, 187 Laurel-water, poisoning with, 84 [Law, definition of, 770 regarding dying declarations, 30, 31, 32] Lead, carbonate of, 152 chromate of, 166 chronic poisoning by, 153 detection of, in the tissues, 152 meconate of, 192 oxide of, 153 poisoning by acetate of, 150 tests for the salts of, 152 Lead-glaze, poisonous efiects of, 154 Lead palsy, 153 Legal tests of insanity, 754 Legitimacy, disputed, from shortness of gestation, 630 inferred from parental likeness, 642 legal presumption, 625 period of gestation in reference to, 627 proofs of, from the state of the off- spring, 671 superfa'tation in relation to, 646 viability in reference to, 633 in what cases admitted, 640 [Legitimacy, 626] Leucorrhoea, infantile, 678 Levant nut, 211 [Liability, 797] License of counsel, 38 Life, diseases tending to shorten, 781 legal and medical, 559, 578 tests of, 68, 616 Life insurance, 779 insanity in, 787 medical responsibility in, 780 murders in respect to, 788 policies vitiated by fraud, 780 presumption of death in, 779 principles, 779 suicide in respect to, 787 Lightning, action for damages from, 499 death from, 487 ])ost-mortem appearances, 488 Likeness, parental, 642 Lime-kilns, vapors of, 475 Liquids, corrosive, burns by, 395 Liquor amnii, 553 arsenicalis, 139 Litharge, poisoning with, 145 Live birth in civil suits, 616 proofs of, in child-murder, 577 summary regarding, 585 Liver, wounds of the, 369 [Lloyd, Mrs. E. E., case of, 25] Lobelia, poisoning with, 234 Lobelacrin, 285 Lochia, evidence from the, 523 Lockjaw from wounds, 323 Locomotion after delivery, 602 after fractures, 378 after severe injuries, 358, 363 Long fasting, effects of, 503 Lucid intervals, 705 [770-771] Lucifer matches, 121 Lunacy, 698 INDEX. 825 Lunacy — Acts, breaches of the, 726 commissions of, 732 Lunatics, discharge of, 729 examination of alleged, 733 interdiction of, 732 restraint applied to, 717 testamentary capacity of, 738 wills made by, 740 as witnesses, 731 wounds inflicted by, 267 Lungs, artificial inflation of, 572 atelectasis of the, 567 examination of the, in newborn chil- dren, 562 putrefaction of, 571 specific gravity of the, 564 variably affected by respiration, 569 wounds of the, 361 Lung-tests, 566 Lypemania, 710 ril/TcNAUGHTON case, 746-760] LlTl Madness, 698 Magnetic sleep, rape during, 687 Majority, questions relative to, 621 when attained, 622 Malapraxis, 330, 379 [Malapraxis, law of, 379] Malformation, a cause of impotency, 652 death of child from, 589 sexual, 649 [Malpractice, ignorant, 379] [negligent, 379] [physician or surgeon liable to dam- ages for, 380] Mania, 707 homicidal, 747 puerperal. 765 suicidal, 710 Mania sine delirio, 699 Marriage, impediments to, 666 Marsh's process for arsenic, 133 Matches, phosphorous, poisoning with, 121 Material concealment in life insurance, 782 Matrons, jury of, 520 Maturity of the newborn child, signs of, 556 [Maybrick case, 125] Meadow saffron, 170 [Measure of damages, 797] Meat, unwholesome, 86, 178 [Mechanical restraint of insane, 719] [legalized in England lately, 723] [when authorized by law, 720] Mechanical injury, death from, 309 irritants, 77 Meconic acid, tests for, 190, 192 Meconium, 583 Medical etiquette, 44 evidence, 17, 50 in cases of insanity, 742 experts, 20 jurists, duties of, 18 Medical — privilege, 38 responsibility in wounds, 215, 309, 350 in cases of insanity, 719 in child-murder, 611 in delivery, 552 in life insurance, 780 secrets, 38 witnesses' Act, 34 witnesses, 37 presence of, in court, 48 Medical corps, U. S. Army, 790] " Navy, 791] Medical privilege, 43] Medical reticence, 41-43] Medicines and poisons contrasted, 74 poisons substituted for, 84 Medico-legal reports, 27 for coi-oners' inquests, 33 [Medico-legal surgery, 790] Melancholia, 707, 710 Melted metals, burns from, 390 Membranes, child born in the, 534 [Memorandum as evidence, 26] [purpose of, 26] [witness must know facts contained in, 27] Meningeal apoplexy, 355 Menses (see Menstruation), 511 suppression of, in pregnancy, 511 Menstrual blood, characters of, 305, 553, 694 climacteric, 654 Menstruation, absence of, in sterility, 661 age at whicli it appears, 661 age at which it ceases, 664 appearances after death, 548 appearance of, in infants, 663 fallacies in calculating pregnancies from, 640 feigned, 512 in hermaphrodites, 651 pregnancy before, 652 after cessation, 664 suppressed, crimes committed during, 662 suppression of, a sign of pregnancy, 511 Mental alienation, 698 [Mental anguish, 798] [Mental unsoundness superinduced by ex- cessive intoxication may excuse, 769] Mentha pulegium, 541 Merck's aconitine, 243 Mercury, ammonio-chloride of, or white precipitate, 149 chronic poisoning by, 145 metallic, effects of, 143 oxide of, 149 perchloride of, 143 poisoning by the salts of, 143 sulphates and nitrates of, 150 Metallic irritants, 123 Mezereon, 237 [Micniscopes of 1200 to 1800 diameters, blood of man and animals distinguished by means of, 289] -.'.'.->■ III