Cornell University Library The original of tiiis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924017515044 I OS./ Cornell University Law Library THE GIFT OF Haj?.ry..E......Har.d,iag... Estate.. Hum.e^ liIe.w....Y.o.l'k j3^j^ October 24, 1958 Cornell University Library RA 1051.T23 1861 Medical jurisprudence. 3 1924 017 515 044 A/ C^-x. ^->-^~~ 7 r C v„ '1^ MEDICAL JUKISPRUDENCE. BY ALFRED SWAINE TAYLOR, M.D., F.R.S., FELLOW OF THE EOYAL COLLEHE OF PHYSICIASS ,' HON. M. D. CNIT. ST. AKDKEWS ; MEMBER OF THE EOYAL COLLEGE OF SUKSEONS ; AND PROFESSOR OF MEDICAL JURISPRUDENCE AND CHEMISTRY IN OUY'S HOSPITAL. Qui uescit igaorare ignorat scire. FIFTH AMERICAN FROM THE SEVENTH AND REVISED LONDON EDITION. EDITED, WITH ADDITIONS, BY EDWARD HARTSHORNE, M. D., ONE OF THE SURGEONS TO THE PENNSYLVANIA HOSPITAL. PHILADELPHIA: BLANCHARD AND LEA. 1861. ^^^/^5^ Entered according to the Act of Congress, in the year 1861, by BLANCHARD AND LEA, in the Office of the Clerk of the DistricJt Court of the United States in and for the Eastern District of the State of Pennsylvania. AMERICAN PUBLISHERS' NOTICE. The sixth and seventli editions of this work having been published in London since the issue of the last American edition, have enabled the Author to bestow on it two careful revisions. The well known ability and industry of Dr. Taylor are suf&cient guarantee that he has made full use of these opportunities to introduce in them the latest results of legal and scientific investigations. The very recent date of the last London edition, in the preparation of which the Author has had the opportunity of consulting several late and elaborate American works on the subject, has rendered unnecessary any extensive additions by the Editor. Such notes and references to late American cases and decisions as have seemed to him desirable he has added, distinguishing them from the text by inclosure in brackets, marked thus [ — H.]. The skeleton Table of Contents of the English edition has been filled up with the proper headings, and the Index has been rendered more complete, thus materially increasing the facilities for reference in the American edition. Phuadelphia, September, 1861. PREFACE TO THE SEVENTH EDITION. lisr preparing for publication tlie seventh edition of the Medical JuRiSPEUDEKCE, I have not fonnd it necessary to make any extensive changes. Some articles" have been abridged in order to make room for more recent information, but the general plan of the work has been retained. Since its first appearance in the year 1844, there have issued from the press fifteen thousand seven hundred and fifty copies. I regard this as a satisfactory proof of its practical utility to those members of the Medical and Legal professions for whose assistance it hag been especially intended. This unexpected encouragement has induced me to spare no labor in order to maintain the work on a level with the progress of medical and legal knowledge. Every chapter has undergone a close revision, and many new cases and observa- tions have been added. I have retained the numerous additions and revisions made by the late Lord Justice Clerk Hope, as well as by many legal and medical contributors, who have kindly supplied me with facts in correction or confirmation of the views already pub- lished. I cannot close this Preface without publicly thanking the Eoyal College of Physicians, and the Society of Arts, for the honor conferred on this work in awarding to the author in January, 1860, under the will of the late Dr. Swiney, the quinquennial prize of one hundred pounds, and a silver vase of like value. 15 St. James's Tekkace, Regent's Park. June, 1861. PREFACE TO THE SIXTH EDITION. In the revision of the sixth edition of this work, I have made such additions as the advance of science and experience, derived from recent cases, have rendered necessary. Since the publication of the fifth edition, there has been a large accumulation of materials in Medical JURISPEUDENCE : but the limits of this work have rendered it neces- sary that I should confine myself to a selection of the more important facts and cases. Even with this limitation, the present volume extends to forty-four pages beyond the fifth edition, and to three hundred pages beyond the first edition published in November, 1843. In fact, when compared with the early editions, this may be regarded as a new work. I do not mean that the principles or facts of the science are materially changed ; but, during the last fourteen years, improvements in medi- cine and jurisprudence have taken place to so great an extent that a practitioner, whether of the medical or legal profession, would, ia the earlier editions, meet with deficiencies which on the present occasion it has been my special object to supply. In the section on Poisons, a modification of the definition of the term poison, and of the act of poisoning, has been rendered necessary by crimes of recent date. Additions have been made on poisoning by ammonia, — chronic poisoning by arsenic, — the absorption and detec- tion of arsenic in the dead body, — ^poisoning by arseniuretted hydro- gen, — ^the detection of absorbed mercury, — ^poisoning by Scheele's ■green, tartar emetic, locust beans, prussic acid, nux vomica, and strychnia. The chapter on the two last-named poisons has been en- tirely rewritten. The reader will also find additional facts and cases in the sections on poisoning by cenanthe crocata, aconite, and lobelia. The details regarding poisons are, however, given throughout in a con- cise form, as constituting only a part of the general science of Medical Jurisprudence. A new edition of my work on Poisons is already far advanced,' and to this I must refer the reader for that special informa- ' Since republished by Blanchard & Lea. viil PREFACE TO THE SIXTH EDITION. tion on facts, whetlier of a legal, medical, or medico-legal kind, -which belong to the subject of Toxicology. In the section on Wounds, the additions include the rules respect- ing dying declarations made to medical men, — the detection of blood on weapons and clothing, — the medico-legal examination of wounds, — the microscopical and chemical analysis of blood, — cicatrices, — loco- motion after severe injuries, — and the effects of concussion of the brain and spinal marrow, illustrated by recent cases. Additional facts have been introduced into the sections on Preg- nancy, Deliveet, and Aboetion ; and new cases are appended to the subjects of Tenancy by Courtesy, Protracted Gestation, and Legi- TIMACT. In the chapter on Eape, additions have been made to the medical proofs of rape on infants and children. The chapters on Deowning and other forms of death by Asphyxia will be found to contain new facts and cases; and, lastly, in the chap- ters on Insanity, the sections on Homicidal Mania and Dipsomania have been corrected and enlarged. From the patronage extended to this volume, and from the large editions through which it has passed during a period of fourteen years, I have reason to believe that it has been found a useful practical guide by legal and medical practitioners. In preparing this edition for the press, I have endeavored to maintain for the work that cha- racter which it has hitherto enjoyed as a concise manual of Medical Jurisprudence. 15 St. James's Terrace, Regent's Park. Maroli 31, 1858. TABLE OE CONTENTS. POISONING. CHAPTER I. PAGE Medical Definition of the term Poison — Legal Definition — Administering of Poison — Deadly Poisons — Meclianical Irritants — Influence of Habit and Idiosyncrasy on Poisons — Classification of Poisons — Special Characters of Irritant, Corrosive, and Neurotic Poisons .......... 17 CHAPTER II. Evidence of Poisoning in the Living Subject — Symptoms occur suddenly — Modifying Con- ditions — Action of Poisons increased or diminished by Disease — Symptoms connected with Food or Medicine — Sudden Death from Natural Causes mistaken for Poisoning — Several Persons attacked simultaneously — Evidence from the detection of Poison in Food ........... 24 CHAPTER III. On the Evidence of Poisoning in the Bead 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 Cor- rosion — Softening — Perforation of the Stomach from Poison and Disease . . 29 CHAPTER IV. Rules to be observed in investigating a case of Poisoning — "With respect to the Patient while living — The Inspection of the Body — The Exhumation of Bodies — Disposal of the Viscera — Identity of Substances — Preservation of Articles for Analysis — On the use of Notes — When allowed to be used in Evidence — Medico-legal Reports . . 39 IRRITANT POISONS. CHAPTER V. Sulphuric Acid 'or Oil of Vitriol — Symptoms caused by this Poison in the Concentrated and Diluted State — Appearances after Death — Quantity of Acid required to destroy Life — Fatal Dose — Period at which Death takes place — Chemical Analysis — Mode of detecting the Poison in pure and mixed Liquids — Its detection in Articles of Clothing — Poisoning by Sulphate of Indigo . . . . . • .47 52 CONTENTS. CHAPTER VI. PAGE Poisoning by Nitric Acid or Aqua Fortis— Action of the Concentrated Acid— Appearances after Death— Quantity required to destroy Life— Period at which Death takes place —Processes for detecting the Poison in pure and Organic Liquids— Poisoning by Hy- drochloric Acid ...•••••■' CHAPTER VII. Poisoning by the Vegetable Acids— Oxalic Acid— Symptoms and Effects— Appearances after Death— Fatal Doses— Recovery from large Doses— Period at which Death takes place- Chemical Analysis— Tests for Oxalic Acid in pure and mixed Liquids— Binoxa- late of Potash — Tartaric Acid-.- Acetic Acid— Vinegar . . • -56 CHAPTER VIII. Poisoning by the Alkalies— PotasTi, Soda, and their Carbonates— Symptoms— Fatal effects of the Carbonate of Potash— Appearances after Death— Tests for Potash and Soda- Ammonia and Sesquicarbonate of Ammonia (Sal Volatile)— Chemical Analysis — Tests for Ammonia .....•■•• ®2 CHAPTER IX. Phosphorus — Symptoms and Appearances — Chronic Poisoning by the Vapor — Fatal Dose — Chemical Analysis — Phosphorus-paste — Red or Amorphous Phosphorus . . . 67 CHAPTER X. Metallic Irritant Poisons — Arsenic — Arsenious Acid — Taste — Symptoms — Chronic Poison- ing — Appearances after Death — Quantity required to destroy Life — Period at which Death takes place — Chemical Analysis — Tests for Arsenic — Marsh's Process — Eeinsoh's Process ........ .71 CHAPTER XI. Detection of Arsenic in Organic Liquids — In the Tissues — Arsenites — Arsenite of Copper or Scheele's Green — Arsenic Acid and the A.rseniates — Sulphurets of Arsenic — Chlo- ride of Arsenic .......... 85 CHAPTER XII. Corrosive Sublimate — Symptoms — Its effects compared with those of Arsenic — Slow or Chronic Poisoning — Salivation from small doses of Mercurial Medicines — From other causes — Appearances after Death — Quantity required to destroy Life — Period at which Death takes place — Fatal Dose — Treatment — Chemical analysis in Powder and Solution — Process in Organic Liquids — Calomel — White and Red Precipitates — Sul- phurets of Mercury ......... 100 CHAPTER XIII. On Poisoning by Lead — Sugar of Lead — Symptoms — Appearances after Death — Quantity required to destroy Life — -Chemical Analysis — Lead in Organic Mixtures^Carbonate or White Lead — Chronic Poisoning — Painter's Colic — Oxides — Litharge and Red Lead ........... 112 CONTENTS. CHAPTER XIV. PAGE Copper — Blue Vitriol — ^Symptoms — Appearances after Death — Treatment — Poisoning by Verdigris — Subohloride of Copper — Carbonate — Chemical Analysis — Tests — Special Characters of the Salts — Copper in Organic Liquids — In Articles of Food . . 119 CHAPTER XV. Tartarized Antimony — Symptoms — Fatal Dose — Appearances — Chronic Poisoning — Che- mical Analysis — Antimony in Organic Liquids — Chloride of Antimony — Poisoning by Sulphate and Chloride of Zinc — Carbonate of Zinc — Preparations of Tin — Silver — Gold — Iron — Bismuth and Chrome — Bichromate of Potash . . . 123 VEGETABLE AND ANIMAL IRRITANTS. CHAPTERXVI. Mode of action of Vegetable Irritants — Aloes — Colocynth — Gamboge — Jalap — Scammony — Savin — Croton Oil— Castor Seeds — Colchicum — Hellebore — Oil of Turpentine — Oil of Tar — Mouldy Bread — Ergot of Eye^Oarob or Locust Bean . . . 137 CHAPTER XVII. Animal Irritants — Cantharides or Spanish Plies — Symptoms and Effects — Analysis — Poisonous Food — Fish — Mussels — Salmon — Cheese — Sausages — Diseased Flesh of Animals ........... 143 NEUROTIC POISONS. CHAPTER XVIII. Opium — Symptoms — Period of Commencement — Appearances — Quantity required to de- stroy Life — Death from small, and recovery from large Doses — Its action on Infants — Period at which Death takes place — Poisoning by Poppies — Godfrey's Cordial — Dalby's Carminative — Paregoric Elixir — Dover's Powder — Black Drop — Sedative Solution — Morphia and its Salts — Tests for Morphia and Meoonio Acid — Process for detecting Opium in Organic Mixtures ....... 150 CHAPTER X'lX. Prussic Acid — Differences in Strength — Taste and Odor — Conditions under which the Odor may and may not be detected — Symptoms produced by small and large Doses — Period at which the Symptoms commence — Power of Volition and Locomotion — Appearances — Quantity required to destroy Life — Fatal Dose — Period at which Death takes place — Tests for the Acid — Vapor Tests — Process for Organic Mixtures — Noyau — ^Laurel Water — Cyanide of Potassium . . . . . 160 CHAPTER XX. Nuz Vomica and Strychnia — Symptoms — Appearances after Death — Fatal Dose — Effects of Medicinal Doses of Strychnia — Period at which Death takes place — ^Chemical Analysis ........... 169 Sii CONTENTS. WOUNDS. CHAPTER XXI. PAGE Various Surgical Definitions of a Wound— Injury to tlie Skin— Legal Definition— An Abrasion of the Cuticle not a Wound— Are Injuries of the Mucous Membrane and Dislocations Wounds ?— Wounds Dangerous to Life— The Danger Imminent— Rules Regarding Dying Declarations— Wounds Producing Grievous Bodily Harm . . 173 CHAPTER XXII. Examination of Wounds in the Dead Body— All the Cavities should be inspected— Ac- quittals from the Neglect of this Rale— Characters of a Wound inflicted During Life —Of a Wound made after Death— Experiments on Amputated Limbs— Caution in Medical Opinions— Wounds or Injuries unattended with Hemorrhage— Eochymosis from Violence — Evidence from Ecohymosis — Ecchymosis from Natural Causes — In the Dead Body — Lividity — Vibices— Effect of Putrefaction — Is Ecohymosis a Neces- sary Result of Violence ? ....•••• 1°1 CHAPTER XXIII.' Evidence of the Use of a Weapon — Characters of Wounds caused by Weapons — Incised, Punctured, Lacerated, and Contused Wounds — Stabs and Cuts — What are Weapons ? — Examination of the Dress ........ 194 CHAPTER XXIV- Wounds Indicative of Homicide, Suicide, or Accident — Evidence from the Situation of a Wound — Suicidal Wounds in Unusual Situations — Evidence from Nature and Extent — Shape — Evidence from the Direction of a Wound — Wounds inflicted by the Right or Left Hand — Accidental and Homicidal Stabs — Evidence from the Presence of Several Wounds — The Use of Several Weapons — Two or more Mortal Wounds — Wounds produced Simultaneously or at Different Times .... 200 CHAPTER XXV. Evidence from Circumstances — Medical Questions — Value of Circumstantial Evidence — The Position of the Body — Of the Weapon — The Weapon or other Articles found in the Hand of the Deceased — Evidence from the Blood on Weapons — Marks of Blood on the Person, Clothes, or in the Apartment — Position of the Person when Mortally Wounded — Evidencefrom Wounds on the Deceased — No Blood on the Assailant — Fal- lacy respecting Marks of Blood. Arterial distinguished from Venous Blood — Evi- dence from the Form and Direction of Spots of Blood . . . . .' 208 CHAPTER XXVI. Distinction of Suicidal from Accidental Wounds — Wounds on the Throat — Facts Indica- tive of Suicide, Homicide, or Accident — Imputed or Self-inflicted Wounds — Motives for their Production — Characters of Imputed Wounds — Rules for Detecting False Charges ........... 220 CHAPTER XXVII. The Cause of Death in Wounds — Caution on Assigning too many Causes Wounds Di- rectly or Indirectly Fatal — Death from Hemorrhage — Loss of Blood required to prove Fatal — Modified by Age and other Circumstances — Fatal Wounds of Small Arteries — Internal Hemorrhage — Death from Mechanical Injury to a Vital Organ Death from Shock— Blows on the Abdomen — Flagellation — Death from a Multiplicity of Injuries without any Mortal Wound — Subtle Distinctions respecting the Mortality of Wounds 224 CONTENTS. CHAPTER XXVIII. PAGE Chemical Examination of Blood-Stains — Action of Tests on Organic and Inorganic Red Coloring Matters — Stains of Blood on Linen and other Stuffs — Date of the Stains — Insoluble Stains resembling Blood — Bed Paint Mistaken for Blood — Soluble Stains of Fruits, Flowers, Roots, and Extracts — Removal of Blood-Stains from Articles of Clothing — Stains of Blood on "Weapons — Citrate of Iron Mistaken for Blood — Distinc- tion of Stains from Iron-Rust — Color from Red Dyes — Blood of Man and Animals — Evidence from the Odor — Microscopical Evidence ..... 231 CHAPTER XXIX. Death of Wounded Persons from Natural Causes' — Distinction between Real and Apparent Cause — Death from Wounds or Latent Disease — Accelerating Causes — Which of two Wounds caused Death ? — Death following slight Personal Injuries . . . 241 CHAPTER XXX. Wounds Indirectly Fatal — Death from Wounds after Long Periods — Secondary Causes of Death — The Causes Unavoidable — The Cause Avoidable by good Medical Treatment — Comparative Skill in Treatment — Cause Avoidable but for Imprudence on the part of the Wounded Person — Abnormal or Unhealthy State of Body — Acceleration of Death ........... 244 CHAPTER XXXI. Wounds Indirectly Fatal. Tetanus following Wounds — Latent Causes of — Death from Surgical Operations — Primary and Secondary Causes of Death — Unskilfulness in Ope- rations — Necessity for the Operation — Erysipelas following Operations — Delirium Tremens ........... 260 CHAPTER XXXII. Cicatrization of Wounds — Evidence from Cicatrices — Changes in an Incised Wound — Cica- trices of Stabs and Gunshot Wounds — Date of Production — Is a Cicatrix always a Consequence of a Wound? — Are Cicatrices, when once formed, Indelible? — Charac- ters of Cicatrices — Date of Cicatrices from Disease or Wounds— Medical Evidence re- specting the Period at which a Wound was inflicted — Changes of Color in Contusions ■ — How long did the Deceased Survive the Wound? ..... 263 CHAPTER XXXIII. Acts Indicative of Volition and Locomotion — Injuries to the Head not Immediately Fatal Wounds of the Heart not Immediately Fatal — Wounds of the Carotid Arte- ries — Locomotion after Ruptures of the Diaphragm and Bladder — Summary . . 257 CHAPTER XXXIV. Wounds as they Affect Different parts of the Body — Wounds of the Head— Of the Scalp- Concussion — How Distinguished from Intoxication — Extravasation of Blood — Seat of As a Result of Violence, Disease, or Mental Excitement — Wounds on the Face — Of the Orbit — Of the Nose — Deformity as a Consequence of Wounds of the Face — Inju- ries to the Spine— Fractures of the Vertebrae- Death from Injuries to the Spine and Spinal Marrow ......••■• 264 CONTENTS. CHAPTER XXXV. Wounds of the Chest^Of the Lungs— Ruptures from Aocidentr— Wounds and Buptures of the Heart— Wounds of the Aorta and Large Veins— Wounds and Ruptures of the Diaphragm— Direction of Wounds of the Chest— Wounds of the Abdomen— Death from Blows on the Abdomen— Ruptures of the Liver, Gail-Bladder, Spleen, Kidneys, Intestines, Stomach, and Urinary Bladder— Medico-Legal Questions connected with Ruptured Bladder— Wounds of the Genital Organs— Mutilation . ■ -273 CHAPTER XXXVI. , Fractures— Produced by a Blow with a^Weapon or hy a Fall — Occur in the Aged— Brit- tleness of the Bones — Fractures caused by Slight Muscular Exertion — In the Living and Dead Body — Has a, Bone ever been fractured? — Questions of Survivorship — Dislocation from Violence or Natural Causes — Actions for Malapraxis . . 287 CHAPTER XXXVII. Gunshot Wounds — Their Danger — On the Living and Dead Body^— Was the Piece fired near or from a Distance ? — Evidence from Several Wounds — The Projectile not dis- covered — Deflection of Balls — Accidental, Suicidal, or Homicidal Wounds — Position of the Wounded Person when Shot — Wounds from Small Shot — Wounds from Wad- ding and Gunpowder — Identity from the Flash of Powder — Examination of the Piece and Projectile .......... 291 CHAPTER XXXVIII. Burns and Scalds — Circumstances which render them Dangerous to Life — Did the Burn- ing take place before or after Death? — Experiments on the Dead Body — Vesication and Line of Redness — Presence of Several Burns — Wounds caused by Fire — Human or Spontaneous Combustion — Homicidal mistaken for Spontaneous Combustion — Time required for the Burning of a Dead Body — Burns by Corrosive Liquids . 304 INFANTICIDE. CHAPTER XXXIX. Nature of the Crime — The same Evidence required as in other Cases of Murder — Proof of Life demanded — Body of the Child not discovered — Medical Evidence at In- quests — Age or Maturity of the Child — Viability not required to be proved — Cha- racters from the Sixth to the Ninth Month — Signs of Maturity — Abnormal Devia- tions — Position of the Umbilical Opening — General Conclusions — Rules for Inspecting the Body. . . . . . . . . . .317 CHAPTER XL. On the Proofs of a Child having lived at its Birth — Evidence of Life before Respiration Signs of Putrefaction in Utero — Evidence from Marks of Violence Summary Evi- dence of Life after Respiration — Inspection of the Body — Color, Volume, Consistency, and absolute Weight of the Lungs — Static Test — Weight increased by Respiration — Test of Ploucquet — Blood in the Pulmonary Vessels — Relative Proportion of Fat in the Lungs — Specific Gravity of the Lungs — General Conclusions . . 323 CONTENTS. XY CHAPTER XLI. PAGE Mode of Employing the Hydrostatic Test — ^Incorrect Inferences — Sinking of the Lungs from Disease or Atelectasis — Life with Partial Distension of the Lungs — Life with Perfect Atelectasis, or entire Absence of Air from the Lungs — Hydrostatic Test not applicable to such Cases — Erroneous Medical Inference from Sinking of the Lungs — Floating of the Lungs from Emphysema and Putrefaction — Effects of Putrefaction in Air — General Conclusions respecting the Hydrostatic Test , . , . . 334 CHAPTER XLII. Floating of the Lungs from Artificial Inflation — Inflation distinguished from Perfect Respiration — Not distinguishable from Imperfect Respiration — Doubtful Cases — Results of Compression — Improper Objections to the Hydrostatic Test — Summary — Respiration before Birth — Vagltus Uterinus — Respiration a Sign of Life, not of Live Birth — The Killing of Children which breathe during Birth not Child-murder — General Conclusions ......,,. 342 CHAPTER XLIII. On the Proofs of a Child having been Born Alive — Evidence from Respiration — Evidence from Marks of Violence—Evidence from Natural Changes in the Umbilical Vessels, the Foramen Ovale, and Ductus Arteriosus — Closure of the Foramen and Duct before Birth — Evidence from the discovery of Food in the Alimentary Canal — Detection of Live Birth by the application of Chemical Tests to the Contents of the Stomach — Defective Evidence — General Conclusions ...... 354 CHAPTER XLIV. Rules for determining the Period of Survivorship in Children that have been Born Alive — Appearances indicative of a Child having lived Twenty-four Hours — Prom Two to Three Days — From Three to Four Days — From Four to Six Days — From Six to Twelve Days — Uncertainty of Medical Evidence on the Period which has elapsed since the Death of a Child — Process of Putrefaction in the Bodies of New-born Chil- dren — General Conclusions ........ 365 CHAPTER XLV. Causes of Death in New-born Children— Proportion of Children Born Dead — Natural Causes of Death — A Protracted Delivery — Debility — Hemorrhage — Laceration of the Cord — Compression of the Cord — Malformation — Destruction of Monstrous Births Illegal — Death from Congenital Disease — General Conclusions . . .367 CHAPTER XLVI. Violent Causes of Death — Forms of Violent Death unattended by Marks of External Violence — Suffocation — Drowning — In the Soil of Privies — Power of Locomotion and Exertion in Pemaleg after Delivery — Death of the Child from Cold and Exposure — Starvation — Immaturity in Cases of Abortion — Wounds, Evidence from, in New- born Children — Fractures of the Skull, Spontaneous and Criminal — Death of the Child from Delivery in the Erect Posture — Accidental Injuries in Utero — Deficient Ossification — Twisting of the Neck — Violence in Self-delivery — General Conclusions 371 xvi CONTENTS. CHAPTER XLVI I. PAGE Death of the Child from Strangulation— Deceptive Appearances on the Body— Strangu- lation by the Umbilical Cord- Diagnosis— Accidental Marks resembling those of Strangulation— Constriction before and after Death— Before and after Respiration- Constriction before and after entire Birth— Before and after the Severance of the Umbilical Cord— Constriction without Bcchymosis— Examination of the Mother- Summary of Medical Evidence-Death of the Child after Birth from Wounds during Delivery — General Conclusions ..■••■■■ 387 PREGNANCY. CHAPTER XLVIII. Pregnancy in its Legal Relations— Signs of Pregnancy— Suppression of the Menses- Prominence of the Abdomen— Changes in the Breasts— Quickening—Uncertainty of the Period at which it Occurs— Sounds of the Foetal Heart— Kiestein in the Urine- Changes in the Mouth and Neck of the Uterus- Feigned Pregnancy- De Ventre Inspiciendo— Plea of Pregnancy in Bar of Execution— The Jury of Matrons— Con- cealment of Pregnancy — Pregnancy in the Dead — Pregnancy in a State of Uneon- 401 sciousness . , . • . . . • • • ■ • '"^ DELIVERY. CHAPTER XLIX. Delivery in its Legal Relations — Delivery in the Livings-Concealed Delivery — Abortion in the early stages of Pregnancy — The Signs speedily disappear — Early Examinations —Signs of Recent Delivery in Advanced Pregnancy — ■Evidence from the Skin of the Abdomen — The Organs of Generation — The Presence of the Lochia — Signs of De- . livery at a Remote Period — Feigned Delivery — Delivery in a State of Unconscious- ness — Circumstances under which this may occur — ^Natural and Morbid Sleep — Admission of the Plea in Cases of alleged Child-murder-7-Signs of Delivery in the Dead — Appearances of the Internal Organs in Cases of Recent Delivery— Their rapid Obliteration — True and False Corpora Lutea — -Fallacies to which they give rise — Examination of the Ovum or Embryo — Its Characters from the First to the Sixth Month — Moles and Hydatids — Medico-Legal Cases ..... 414 CONCEALMENT OP BIRTH. CHAPTER L. Medical Evidence required in reference to Delivery—Concealment of the Birth of a Child — Definition of the Crime — Females acquitted of Infanticide found guilty of Concealment — Medical Evidence from the Remains of the Body— Analysis of Bones — The Child must be dead — Concealment of the Ovum or Embryo — ^Not necessary to prove when the Child died ....... 427 CONTENTS. XVii CRIMITS-AL ABORTION. CHAPTER LI. PAGE General Remarks on the Crime of Abortion — Abortion from Natural Causes — Its Fre- quency — Criminal Causes— Local Violence — Abortion by Mechanical Means — From Venesection — Medicinal Substances — Popular Abortives — Signs of Abortion in the Female — Specific Abortives — Abortion not always a Kesult of Poisoning — Local Ap- plications — Feigned Abortion — Legal Eolation — Meaning of the word Noxious as applied to Drugs — On Inducing Premature Labor — Medical Responsibility — Proof of Pregnancy not necessary^ — Abortion of Monsters — Extra-uterine Conceptions — Abortion of Moles and Hydatids — Chemical Evidence — Analysis of the Blood of Abortion and of the Liquor Amnii ....... 430 BIRTH. INHERITANCE. CHAPTER LII. Evidence of Live Birth in Civil Cases — Legal Rights of the Foetus in Utero — Date of Birth — Differences between Entire and Partial Birth — Case — Signs of Live Birth Independent of Respiration or Crying — Motion of a Limb, or Pulsation of the Cord, a Proof of Live Birth — Vagitus TJterinus — Possessio Fratris — Tenancy by Courtesy — CsBsarean Extraction of Children — Legal Birth — Post-mortem BirthS' — Minority and Majority — Medical Evidence in Relation to Plural Births — Monsters — What Consti- tutes a Monster in Law — Deprivafton of Legal Rights — Double Monsters — Christina Ritta — The Siamese Twins ........ 446 LEGITIMACY. CHAPTER Llir. Legal Presumption of Legitimacy — Date of Conception not regarded — Difference between the English and Scotch Law — Children Born after Death — Natural Period of Gesta- tion — Duration from One Intercourse — Premature Birth— Short Periods of Gestation • — Viability — Earliest Period at which a Child may be Born Living — Fama Clamoaa — Evidence from the state of the Offspring — Can fully developed Children be Born pre- maturely ? — Protracted Births — Long Periods of Gestation — Cases — Longest Periods yet known — The Sex of a Child has no Influence — Period not fixed by Law — ^Evidence from the state of the Child — Legal Decisions — Mistakes in the Mode of Computation 460 PATERNITY. CHAPTER tlV. Disputed Paternity — Evidence from Likeness — Douglas Peerage Cage — Parental Likeness — Affiliation — Posthumous Children — Superfoetation in relation to Legitimacy — Cir- cumstances under which it is supposed to occur — Super-conception — Supposititious Children — Relation of the subject to Feigned Delivery and Legitimacy . . 482 XVIU CONTENTS. HERMAPHRODITISM. CHAPTER LV. PAGE Sexual Malformation — Hermaphroditism — Androgynus — Androgyna — Distinotion of Sex — Mistakes in the Sex of Children — Causes of Sexual Deformity in the Foetus — Legal Eolations — Cases in which the Determination of the Sex is Necessary — Imputation of Hermaphroditism' — Removal of Sexual Peculiarities by Operation — The Eights of Electors Dependent on a Normal Condition of the Sexual Organs — Concealed Sex . 491 IMPOTENCY. STERILITY. CHAPTER LVI, Impotency — Definition — Physical Causes — Procreative Power in the Male — Puberty — Convictions for Rape — Age of Virility — Loss of Virile Power by Age — Diseases of the Testicl6s — Powers of Chrypsorchides and Monorchides—Supernumerary Testicles — Arrested Development — Moral Causes — Sterility — Causes of — Procreative Power in the Female — Puberty — Earliest and Latest Ages for Child-bearing — Female Pre- cocity — Menstrual Climacteric — Age for Cessation — Remediable Causes of Sterility — Legal Relations of the Subject — Contested Legitimacy and Divorce . . . < RAPE. CHAPTER LVII. Nature of the Crime — Sources of Medical Evidence — Rape on Infants and Children — Legal Completion — Proofs of Penetration — Marks of Violence — Rupture and Lacera- tion — Purulent Discharges from the Vagina — Evidence from Gonorrhoea and Syphilis — Rape on Young Females after Puberty — Defloration — Signs of Virginity Proofs of Intercourse — Rape on the Married — Rape under the influence of Narcotics — On Idiots — Microscopical Evidence — Legal Relations — Sodomy .... 518 ASPHYXIA. DROWNING. CHAPTER LVIII. Drowning — Cause of Death — Death from Secondary Causes — Period at which Death takes place — Appearances in the Dead Body — ^Changes produced by Putrefaction^ Was Death caused by Drowning ?— State of the Skin — Substances grasped in the Hands — Water in the Stomach — Mucous Froth in the Trachea and Lungs . . 541 CONTENTS. XIX HANGING. CHAPTER LIX. PA SB Cause of Death. Death from the Secondary Effects — Appearances after Death — Mark of the Cord or Ligature — Unecchymosed Marks — Was Death caused by Hanging? — Hanging after Death — Summary of Medical Evidence — Marks of Violence on the Hanged — Was the Hanging tha Result of Accident, Suicide, or Homicide? — Homi- cidal Hanging — The Position of the Body ...... 561 STRANGULATION. CHAPTER LX. 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 ...... 580 SUFFOCATION. CHAPTER LXI. Suffocation from Mechanical Causes — Various Forms of— Cause of Death — Appearances after Death — Evidence of Death by Suffocation — Accidental, Suicidal, and Homici- dal Suffocation — Medical and Physical Evidence of the Cause of Death — Smothering 591 CHAPTER LXII. Gaseous Poisons — Mode of Action — Oause of Death mistaken — Carbonic Acid — Symp- toms — Appearances — Analysis — Charcoal Vapor — Its Effects' — Coal and Coke Vapor — Sulphurous Acid — Vapor of Lime and Brick-Kilns — Confined Air — Coal Gras — Car- buretted Hydrogen — Carbonic Oxide ....... 600 CHAPTER LXIII. Sulphuretted Hydrogen Gas — Symptoms — Appearances. — ^Effluvia of Drains and Sewers — Analysis. — Exhalations of the Dead ....... 609 LIGHTNING. COLD. STARVATION. CHAPTER LXIV. Lightning — Effects of the Electric Fluid — Cause of Death — Post-mortem Appearances — Cases — Legal Relations. Cold — An Occasional Cause of Death — Symptoms — Cir- cumstances which Accelerate Death — Post-mortem Appearances — Case of Murder by Cold. Starvation — A Rare Cause of Death — Symptoms — Appearances after Death — Summary of Medical Evidence — Legal Relations ..... 616 XX CONTENTS. INSANITY. CHAPTER LXV, PAGE Legal Definitions— Lunacy— Non Compos Mentis— TTnsoundness of Mind.— Varieties of Insanity— Mania^Hallucinations— Illusions— Delusion— Mania distinguished from Delirium— Monomania^Known from Booentricity— Moral Insanity — Dementia— Idiocy- Imbecility. Appearances after Death— Hereditary Transmission.— Feigned Insanity — Mode of Detection ....■•■• 629 CHAPTER LXVI. Medico-legal Questions in relation to the Insane — Imposition of Restraint — Illegal Im- position of Restraint— Violence of Temper— Certificates of Insanity— Rules for the Discharge of Lunatics ......■■• 638 CHAPTER LXVII. Testimonial Capacity of Lunatics — Interdiction — Commissions of Lunacy— Examination of alleged Lunatics — Medical and Legal Tests of Competency — Lucid Intervals . 645 CHAPTER LXVIII. Responsibility in Civil Cases — Insanity as an Impediment to Marriage — Deeds and Con- tracts — Wills made by the Insane — Testamentary Capacity — Test of Capacity — Delu- sion in the Deed — Eccentricity in Wills — Wills in Senile Dementia — Wills in Extre- mis — Restriction in Medical Opinions ....... 652 CHAPTER LXIX. The Plea of Insanity — Circumstances under which it is admissible. Homicidal Mono- mania — Moral Insanity — Causes — Symptoms — Degrees of — Legal Tests — Medical Tests — Motive — Confession — Accomplices — Delusion — Summary — ^Tests of Irrespon- sibility — Cases in Illustration — Summary of Medical Evidence . . . 660 CHAPTER LXX. Suicidal Mania — Suicide not necessarily indicative of In'sanity — Suicide a Eelony — In relation to Life-insurance — Hereditary Taint — Puerperal Mania — Pyromania — Klep- tomania — Drunkenness — Civil and Criminal Responsibility of Drunkards — Illusions — Restraint — Interdiction — Delirium Tremens — Somnambulism — Civil and Criminal Liabilities of the Deaf and Dumb . . . . . . .677 Appendix . . •••••... 693 Index ......,,,. ^ 701 MEDICAL JUEISPEUDENCE. POISONING. ' CHAPTER I. MEDICAL DEFINITION OF THE TERM POISON — LEGAL DEFINITION — ADMINISTER- ING OF POISON — DEADLY POISONS — MECHANICAL IRRITANTS — INFLUENCE OF HABIT AND IDIOSYNCRASY ON POISONS — CLASSIFICATION OF POISONS — SPE- CIAL CHARACTERS OF IRRITANT, CORROSIVE, AND NEUROTIC POISONS. Definition A Poison is commonly defined to be a substance, which, when administered in small quantity, is capable of acting deleteriously on the body ; and in popular language, this term is applied to those substances only which destroy life in small doses. It is obvious that this definition is too restricted for the purposes of medical jurisprudence. It would, if admitted, exclude numerous substances, the poisonous properties of which cannot be disputed — as, for example, the salts of copper, tin, zinc, lead, and antimony ; these, generally speaking, act only as poisons when administered in large doses. Some substances, such as nitre, have not been known to act as poisons ex- cept when taken in large quantity, while arsenic acts as a poison in small doses ; but in a medico-legal view, whether a man dies from the effects of half an ounce of nitre, or two grains of arsenic, the responsibility of the per- son who criminally administers the substance is the same. Each may be regarded as a poison, differing from the other only in its degree of activity, and in its mode of operation. The result is the same ; death is caused by the substance taken, and the quantity required to kill cannot therefore be made a ground for distinguishing a poisonous from a non-poisonous sub- stance. If, then, a medical witness be asked "What is a poison ?" he must beware of adopting this popular definition, or of confining the term poison to a substance which is capable of operating as such in a small dose given at once. In legal medicine, it is difficult to give such a definition of a poison as shall be entirely free from objection. Perhaps the most comprehensive which can be suggested is this : *"A poison is a substance which, when taken into the stomach or bowels, is capable of destroying life without act- ing mechanically on the system." But it is well known that some substances act as poisons by absorption when applied either to the skin or to a wounded surface ; while others, again, as the poison of the viper, and of rabies, may have their fatal effects limited to those cases in which they are introduced by a wound : and a third class may destroy life merely by their chemical effects upon the parts with which they come in contact, without necessarily poison- ing the blood by absorption; e. g. sulphuric acid. These facts show that it is not possible to comprise in a few words an accurate definition of what should be understood by the term "poison." 18 DEFINITIONS OF THE TERM POISON. It is equally difficult to define the boundary between a medicine and a poi- son. It is usually considered that a medicine in a large dose is a poison, and a poison in a small dose is a medicine ; but a medicine such as tartarized antimony may be easily converted into a poison, by giving it in small doses at short intervals either under states of the body not adapted to receive it, or in cases in which it exerts an injuriously depressing effect. Several deaths have been lately occasioned by this wilful misuse of antimony in doses which might be described as medicinal, although in the cases referred to, no other in- tention could have existed in the secret administration of this substance than that of destroying life. A person may die either from a large dose given at once, or from a number of small doses given at such intervals that the system cannot recover from the effects of one before another is administered. This remark applies to a great number of medicines which are not commonly in- cluded in a list of poisons. Legal Definition In reference to the medical definition of a poison, it is necessary to observe that the law never regards the manner in which the sub- stance administered acts. If it be capable of destroying life or of injuring health, it is of little importance so far as the responsibility of a prisoner is concerned, whether its action on the body be of a mechanical or chemical nature. Thus a substance which simply acts mechanically on the stomach or bowels may, if wilfully administered with intent to injure, involve a per- son in a criminal charge, as much as if he had administered arsenic or any of the ordinary poisons. It is, then, necessary that we should consider what the law strictly means by the act of poisoning. If the substance criminally administered destroy life, whatever may be its nature or mode of operation, the accused is tried on a charge of murder or manslaughter, and the duty of a medical witness consists in showing that the substance taken was the cer- tain cause of death. If, however, death be not a consequence, then the accused may be tried for the attempt to murder by poison (1 Vict. c. 85, sec. 2). The words of this statute are general, and embrace all kinds of substances, whether they are popularly or professionally regarded as poisons or not. Thus it is laid down that — "Whoever shall administer, or cause to be taken by any person, any poi- son, or other destructive thing, with intent to commit murder, shall be guilty of felony, and being convicted thereof shall suffer death." Although the administering be followed not by death but only by bodily injury dangerous to life, it is still a capital felony, provided the intent has been to commit murder. The attempt to administer to any person, any poi- son or other destructive thing, with the like intent, &c., although no bodily injury be effected, is felony, punishable by transportation for life, for fifteen years, or imprisonment for any term not exceeding three years. From the words of the statute it appears that the law requires, in order to constitute the crime of poisoning, that the substance should be administered to, or be taken hy, an individual. Several deaths have been caused of late years by the external application of arsenic and corrosive sublimate to ulcerated and diseased surfaces. Supposing that a poison is thus applied intentionally, and great bodily injury is done to an individual, it might be a question whether the crime could be punished under these sections of the statute. Lord Campbell's Act (14 and 15 Vict. c. 19) appears to provide for this description of offence, although the application or administration is herein limited to chloroform, laudanum, or other stupefying drugs. The external application of arsenic in a way to produce personal injury would no doubt be considered an act of administration. Poison is not always administered with intent to murder. On many occa- sions it has been mixed with food, and thus administered with a view to in- jure or annoy a person. Cantharides have been thus frequently given, and NEW STATUTE ON POISONING. 19 in one instance (Nov. 1859) eight members of a family suffered from severe symptoms of poisoning; by reason of the wanton administration of this drag. In April, 1860, several members of a family suffered from severe sickness, as a result of tobacco having been put into water contained in a teakettle ; and tartar emetic has been in some cases dissolved in beer or other liquids as a mere frolic, without any proved or probable intention on the part of the offender to destroy life. The case of M'Mullen (Liverpool Autumn Assizes, 1856) revealed an extensive system of poisoning in the northern counties, in which tartar emetic was the substance employed. This drug, mixed with cream of tartar, was openly sold by druggists under the name of " quietness powders," and the evidence established that women gave these powders to their husbands with a view to cure them of habits of drunkenness. Hitherto, when the intent to murder was not proved, the offender has escaped, although great bodily injury may have been done by his wanton or malicious act. To sup- ply this omission, an act has been passed (23 Vict. c. 8, March 23, 1860), of which the provisions are here subjoined. It enacts: — " 1. That whosoever shall unlawfully and maliciously administer to, or cause to be administered to or taken by any other person, any poison or other destructive or noxious thing so as thereby to endanger the life of such person, or so as thereby to inflict upon such person any grievous bodily harm, shall be guilty of felony, and being convicted thereof shall be liable to be sentenced to penal servitude for any period not exceeding ten years, and not less than three years, or to imprisonment for any term not more than three years, with or without hard labor, at the discretion of the court. " 2. Whosoever shall unlawfully and maliciously administer to, or cause to be administered to or taken by any other person, any poison or other de- structive or noxious thing with intent to injure, aggrieve, or annoy such person, shall be guilty of a misdemeanor, and being convicted thereof shall be liable to be sentenced to imprisonment for any period not exceeding three years, with or without hard labor, at the discretion of the court, and the costs and expenses of the prosecution of any such misdemeanor may be allowed by the court as in cases of felony. "3. If, upon the trial of any person charged with the felony above men- tioned, ttie jury shall not be satisfied that such person is guilty thereof, but shall be satisfied that he is guilty of the misdemeanor above mentioned, then and in every such case the jury may acquit the accused of such felony, and find him guilty of such misdemeanof, and thereupon the delinquent shall be liable to be punished in the same manner as if convicted upon an indictment for the misdemeanor." It will be perceived that the words of the statutes leave the question " What is a poison ?" to depend upon the medical evidence adduced. It must, however, be proved that the substance is either a poison or a noxious or destructive thing. In a trial which took place at the Essex Lent Assizes, 1850 {Eeg. v. Hayward), a woman was charged with administering white precipitate to her husband with intent to kill. She was acquitted on the ground that there was no evidence to show that white precipitate was either a poison or a destructive thing. It is, however, placed beyond doubt that this substance is not only capable of producing all the effects of an irritant poison, but of destroying human life ; hence, this acquittal was based on a pure mistake. White hellebore, Lobelia inflata, and Oil of turpentine have been erroneously pronounced not to be poisons under similar circumstances ; in fact, unless the medical evidence received by a court when this question is raised, be very closely investigated, the greatest mistakes may arise, owing jierhaps to want of experience or want of reflection on the part of those to whom the question is put. The quantity of a poisonous substance found in an article of food, or in a 20 INFLUENCE OF HABIT ON POISONS. dead body, does not affect the culpability of a person indicted for administer- ing it. In the case of Hartley (C. C. C, May 12, 1850), in which an attempt was made to administer sulphuric acid mixed with coffee, Cresswell J- stated, if poison be administered with intent to murder, it is not necessary there should be enough in the article administered to cause death. If any poison be there, and the intent be proved, the crime of attempting to administer poison is complete. Erie J. ruled to the same effect, in reference to the dis- covery of a small quantity of arsenic in a dead body, in Reg. v. Bacon (Lin- coln Summer Assizes, 185Y). In Reg. v. Souihgate (Chelmsford Lent Assizes, 1849), Parke B. said, in reply to an objection taken, it was quite immaterial to define or prove in what vehicle a poison was given, or whether it was ad- ministered in a solid or liquid form. This question, " What is a poison ?" may present itself under another aspect. In the Queen v. Oluderay (Exchequer Chamber, January 19, 1849), the prisoner was indicted for administering poison with intent to murder. He was proved to have administered to a child nine weeks old, two berries, in the husk, of Gocculus Indicus, and the berries passed through the body of the child without doing any injury. It was submitted for the prisoner, that being iu the husk they could not be considered a poison. The point was reserved by Williams J., who tried the case at York. It was now contended for the prisoner, that although the kernel of this nut was poisonous, still having been given in the hask, which was hard of digestion, it could not be considered an administering of poison within the statute 1 Vict. c. 85. The Chief Justice said the court was of opinion that, when a man administered something that was poison with intent to murder, but in such a way that it did not act, he was guilty. Conviction affirmed. This is the only reasonable view to take of such an objection. The seed contains the poison, but the husk is inert : nevertheless the berry must be regarded as a poison. Deadly poison. — The term "deadly" can be applied with propriety only to those poisons which may prove speedily fatal in small doses, e. g., prussic acid, arsenic, strychnia, aconitina, and nicotina; and although it has been used in indictments in reference to such substances as blue or green vitriol, and common sal volatile, this has arisen from an unnecessarily strict adhe- rence to old legal forms. In a case {Reg. v. Haydon, Somerset Spring Assizes, 1845) in which "spirit of hartshorn" was thus described as a " deadly poison," and an objection was taken to the validity of the indict- ment, the learned judge (Erie J.) held t^at the word deadly was not essential : it was mere surplusage {Law Times, April 12, 1845). This decision is in accordance with common sense. Mechanical irritants. — The substance administered may not be a poison in the medical signification of the term, and it may not be popularly considered as such ; yet, when taken, it may be destructive to life. We have examples of substances of this description in iron-filings, powdered glass, sponge, pins and needles, and such like bodies, all of which have been administered with the wilful design of injuring, and have on various occasions given rise to criminal charges. In cases of this kind, the legal guilt of a prisoner may often depend on the meaning assigned by a medical witness to the words destructive thing. Thus, to take an example, liquid mercury might be poured down the throat of an infant, with the deliberate intention to destroy it. A question of a purely medical nature will then arise whether mercary be " a destructive thing" or not ; and the conviction of a prisoner will probably depend on the answer. Should a difference of opinion exist an occurrence by no means unusual in medical evidence — the prisoner will, according to the humane principle of our law, receive the benefit of the doubt. Influence of Habit on Poisons — Habit, it is well known, diminishes the effect of certain poisons : thus it is that opium, when frequently taken by a INFLUENCE OE IDIOSYNCRASY. 21 person, loses its effect after a- time, and requires to be administered in a mucli larger dose. Indeed, confirmed opium eaters have been enabled to take at once, a quantity of the drug which would have infallibly killed them, had they commenced with it in the first instance. Even infants and young chil- dren, who are well known to be especially susceptible of the effects of opium, and are liable to be poisoned by very small doses, may, by the influence of habit, be brought to take the drug in very large quantities. This is well illustrated by a statement made by Mr. Grainger, in the Report of the Chil- dren's Employment Commission. It appears that the system of drugging children with opium in the factory districts, commences as soon after birth as possible; and the dose is gradually increased until the child takes from fifteen to twenty drops of laudanum at once ! This has the effect of throwing it into a lethargic stupor. Healthy children of the same age would be killed by a dose of five drops. The same influence of habit is manifested more or less in the use of tobacco, alcohol, ether, chloroform, morphia, strychnia, and other alkaloids. Dr. Christison has remarked that this influence is chiefly confined to poisons derived from the organic kingdom : and I quite agree with him in thinking that the stories related of the arsenic-eaters of Styria, and the corrosive sublimate-eaters of Turkey, are not to be credited. There is no satisfactory proof that any human being has ever accustomed himself, by habit, to take these substances in doses that would prove poisonous to the generality of adults. I have only met with one fact which appears adverse to this opinion. M. Flandin states that he gave to animals doses of arsenious acid in powder, commencing with ^^jth of a grain mixed with their food ; and that in nine months, by progressive increase, they bore a dose of upwards of fifteen grains of arsenious acid in powder in twenty-four hours, without be- coming affected in appetite or health! {Traiti des Poisons, vol. i. p. tSY.) This is contrary to all experience in the medicinal use of arsenic in the human subject; for, as it will be seen hereafter, a slight increase of a medicinal dose has often been attended with such alarming symptoms, as to render a discon- tinuance of the medicine absolutely necessary to the safety of the person. The only form in which I have known the question of habit to be raised in medical jurisprudence is this : whether, while the more prominent effects of a poison are thereby diminished, the insidious or latent effects on the constitu- tion are at the same time counteracted. The answer is of some importance in relation to the subject of life insurance : for the concealment of the prac- tice of opium-eating by an insured party has already given rise to an action, in which medical evidence on this subject was rendered necessary. As a general principle, we must admit that habit cannot altogether counteract these insidious effects of poisons : but that the practice of taking them is liable to give rise to disease or to impair the constitution. Influence of Idiosyncrasy. — Idiosyncrasy differs from habit : it does not, like habit, diminish the effect of a poison ; for it is not commonly found that any particular state of body is a safeguard against the effects of these power- ful agents. Some constitutions are observed to be much more affected than others by certain poisons : thus opium, arsenic, mercury, lead, and antimony are substances of this description, and this difference in their effects is ascribed to idiosyncrasy. Dr. Christison mentions a remarkable instance, in which a gentleman unaccustomed to the use of opium, took nearly an ounce of good laudanum without any effect. {On Poisons, 83.) This form of idiosyncrasy is very rare. Certain substances generally reputed harmless, and, indeed, used as articles of food, are observed to affect some persons like poisons. This is the case with pork, certain kinds of shell-fish, and mushrooms. There may be nothing poisonous in the food itself; but it acts as a poison in par- ticular constitutions ; whether from its being in these cases a poison per se, or rendered so by changes during the process of digestion, it is difficult to 22 CLASSIFICATION OF POISONS. say. The subject of idiosyncrasy is of importance in a medico-legal view- when symptoms resembling those of poisoning follow a meal consisting of a particular kind of food. In such a case, without a knowledge of this peculiar condition, we might hastily attribute to poison effects which were really due to another cause. It would appear that in some instances idiosyncrasy may be acquired, i. e. a person who, at one period of his life, had been in the habit of partaking of a particular kind of food without injury, may find at another period that it will disagree with him. When pork has been disused as an article of diet for many years, it cannot always be resumed with impunity. In cases in which the powers of life have become enfeebled by age, the sus- ceptibility of the system to poisons is increased ; thus aged persons may be killed by comparatively small doses of arsenic and opium. Cases of acquired idiosyncrasy are very rare : it appears to be, if we may so apply the term, a congenital condition. There are, however, certain diseases which appear to confer a power of supporting large and even poisonous doses of some sub- stances. Yery large doses of opium have been taken without producing dangerous symptoms by persons laboring under tetanus and hydrophobia. This condition is called tolerance. It has been witnessed in diseases of the lungs in reference to the use of antimonial medicines. Classification of Poisons Poisons have been divided into three classes, according to their mode of action on the system ; namely. Irritants, Nar- cotics, and Nakcotico-Ieritants. This classification is a modification of that originally proposed by Orfila. The Narcotics and Nareotico-irritants may, however, be regarded as con- stituting one large class, the Neurotics, as their special action is to affect directly one or more parts of the nervous system. The neurotic poisons admit of a subdivision into Cerebral, Spinal, and Cerebro-spinal, according to whether the poisonous substance affects directly the brain, the spinal mar- row, or both of these organs. Irritants. — The irritants are possessed of these common characters. When taken in ordinary doses, they occasion speedily violent vomiting and purging. These symptoms are either accompanied or followed by pain in the stomach and bowels. The peculiar effects of the poison are manifested chiefly on these organs, which, as their name implies, they irritate and inflame. Many sub- stances belonging to this class of poisons possess corrosive properties ; such as the strong mineral acids, caustic alkalies, bromine, corrosive sublimate, and others. These, in the act of swallowing, are commonly accompanied by an acrid or burning taste, extending from the mouth down the gullet to the stomach. Some irritants do not possess any corrosive action — of which we have examples in arsenic, the poisonous salts of baryta, carbonate of lead, and cantharides ; these are often called pure irritants. They exert no destructive chemical action on the tissues with which they come in contact ; they simply irritate and inflame them. Difference between Corrosive and Irritant Poisons. — As a result of the action of corrosive poisons, symptoms are commonly manifested immediately, because mere contact produces the destruction of a part. In the action of the purely irritant poisons, the symptoms are generally more slowly mani- fested, rarely showing themselves until at least half an hour has elapsed from the time of swallowing the substance. Of course, there are exceptions to this remark; for sometimes irritants act speedily, though rarely with the rapidity of corrosive poisons. It is important in a practical view to ascer- tain whether, in an unknown case, the poison which a person, requirin"- immediate treatment, may have swallowed, be irritant or corrosive. This may be commonly determined by a knowledge of the time at which the symp- toms appeared after the suspected poison was taken. We may thus often easily distinguish between a case of poisoning from arsenic and one from SPINAL AND CEREBRO-SPINAL POISONS. 23 corrosive sublimate. There is also another point which may be noticed. As the corrosive substance exerts a decidedly chemical action, an examination of the mouth and throat may enable us in some cases to solve the question. It has been already stated that there are many irritant poisons which have no corrosive properties, but every corrosive may act as an irritant. Thus the action of corrosive sublimate is that of an irritant poison, as, while it destroys some parts of the coats of the stomach and intestines, it irritates and inflames others. So again most corrosive poisons may lose their corro- sive properties by dilution with water, and then they act simply as irritants. This is the case with the mineral acids, and bromine. In some instances, it is not easy to say whether an irritant poison possesses corrosive properties or not. Thus oxalic acid acts immediately, and blanches and softens the mucous membrane of the mouth and throat, but I have not met with any decided marks of chemical corrosion produced by it in the stomach or viscera. Irritant poisons, for the most part, belong to the mineral kingdom ; and they may be divided into the Non-metallic and Metallic irritants. There are a few derived from the animal and vegetable kingdom ; but these are not often employed criminally. Some of the gases likewise belong to the class of irritant poisons. Nburotics. — Neurotic poisons act upon the nervous system, and their operation is confined chiefly to the brain and spinal marrow. Either imme- diately or some time after the poison has been swallowed, the patient suffers from headache, giddiness, numbness, paralysis, stupor, and in some instances convulsions. They have no acrid burning taste like the corrosive irritants ; and they very rarely give rise to vomiting or purging. When these symp- toms follow the ingestion of the poison into the stomach, the effect may be generally ascribed either to the form or quantity in which the poison has been taken, and the mechanical effect on the stomach thereby produced, or to the poison being combined with some irritating substance, such as alcohol. The pure narcotics, or Cerebral poisons, are not found to irritate or inflame the stomach and bowels. Notwithstanding the well-defined boundary thus apparently existing be- tween these two classes of poisons, it must not be supposed that the substances arranged in each class always act in the manner indicated. Some irritants have been observed to affect the brain or the spinal marrow, and this may be either a primary or a secondary consequence of their action. Arsenic and oxalic acid, although classed as irritants, have in some instances given rise to symptoms closely resembling those of narcotic poisoning ; namely, coma, paralysis, and tetanic convulsions. In a case of poisoning by arsenic, which occurred to Dr. Morehead, of Bombay, the symptoms of narcotism were so strongly marked, that it was believed at first the man had taken a narcotic. {Med. Gaz., vol. xliii. p. 1055.) I have met with a case of poisoning by arsenic in which there was paralysis of the limbs, with an entire absence of purging, during the eight days that the deceased survived. On the other hand, in a case of poisoning by a large dose of opium, there was an absence of the usual symptoms of cerebral disturbance, and the presence of others resembling those of irritant poisoning — namely, pain and vomiting. Thus, then, we must not allow ourselves to be misled by the idea that the symptoms are always clearly indicative of the kind of poison taken. The narcotic or cerebral poisons are few in number, and belong to the vegetable kingdom. Some of the poisonous gases possess a narcotic action. Narcotico- Irritants. {Spinal and Cerebrospinal Poisons.) — Poisons be- longing to this class have, as the name implies, a compound action. They are chiefly derived from the vegetable kingdom. At variable periods after they have been swallowed they give rise to vomiting and purging, likeirri- tants ; and sooner or later produce stupor, coma, paralysis and convulsions. 24 EVIDENCE OF POISONING IN THE LIVING. owing to their eflFects on the brain and spinal marrow. In the state of vege- tables, as leaves, seeds, or root, they possess the property, like irritants, of irritating and inflaming the stomach and bowels. As familiar examples we may point to nux vomica, monkshood, hemlock, and poisonous mushrooms. This class of poisons is very numerous, embracing a large variety of well- known vegetable substances ; but they rarely form a subject of difficulty to a medical practitioner. The fact of the symptoms occurring after a meal at which some suspicious vegetables may have been eaten, coupled with the nature of the symptoms themselves, will commonly indicate the class to which the poison belongs. Some of these poisons have a hot acrid taste ; others, like aconite or monkshood, produce a sense of numbness or tingling, while others again have an intensely bitter taste, as nux vomica, strychnia, veratria, and picrotoxia. Strychnia may be regarded as a pure spinal poison. CHAPTER II. EVIDENCE OF POISONING IN THE LIVING SUBJECT — SYMPTOMS OCCUR SUDDENLY — MODIFYING CONDITIONS — ACTION OP POISONS INCREASED OR DIMINISHED BY DISEASE — SYMPTOMS CONNECTED WITH FOOD OR MEDICINE — SUDDEN DEATH PROM NATURAL CAUSES MISTAKEN FOR POISONING — SEVERAL PERSONS AT- TACKED SIMULTANEOUSLY — EVIDENCE FROM THE DETECTION OP POISON IN THE FOOD. We now proceed to consider the evidence of poisoning in the living sub- ject. To the practitioner the diagnosis of a case of poisoning is of great importance, as by mistaking the symptoms produced by a poison for those arising from natural disease, he may omit to employ the remedial measures which have been found efficacious in counteracting its effects, and thus lead to the certain death of the patient. To a medical jurist a correct knowledge of the symptoms furnishes the chief evidence of poisoning, in those cases in which persons are charged with the malicious and unlawful administration of poison. The symptoms produced during life, constitute also an important part of the evidence in those instances in which a poison proves fatal. At present, however, we will suppose the case to be that poison has been taken and the patient survives. Most toxicological writers have laid down certain characters whereby it is said symptoms of poisoning may be distinguished from those of disease. 1. Li poisoning, the symptoms appear suddenly, while the individual is in health. — It is the common character of most poisons, when taken in the large doses in which they are usually administered with criminal intent, to produce serious symptoms, either immediately or within a very short period after they have been swallowed. Their operation, under such circumstances, cannot be suspended, and then manifest itself after an indefinite interval ; although this was formerly a matter of universal belief, and gave rise to many absurd ac- counts of what was termed slow poisoning. The symptoms of poisoning by nicotina, prussic acid, oxalic acid, or the salts of strychnia, appear immediately, or generally within a very few minutes after the poison has been swallowed. In one case, in which the dose of prussic acid was small, and insufficient to produce death, the poison was supposed by the patient not to have begun to act until after the lapse of fifteen minutes. {Hd. Med. and Surg. Journ., vol. lix. p. 72.) The symp- SYMPTOMS APPEAR DURING A STATE OE HEALTH. 25 toms caused by arsenic and other irritants, and, indeed, by all poisons gene- rally, are commonly manifested in from half an hour to an hour. It is rare that the appearance of symptoms is protracted for two hours, except under certain peculiar states of the system. It is said that some neurotic poisons, such as the poisonous mushrooms, may remain in the stomach twelve or twenty-four hours without giving rise to symptoms ; and this is also affirmed to be the case with some animal irritants, such as decayed meat ; but with regard to the first point, it has been shown by Dr. Peddie that mushrooms have produced symptoms in half an hour ; and a case has fallen under my own observation, in which the symptoms from noxious animal food came on within as short a time after the meal as is commonly observed in irritant poisoning by mineral substances. In some cases of poisoning by phosphorus, no symptoms have been observed until after the lapse of some hours. Modifying conditions. Influence of disease. — A diseased siaXe of the body may render a person comparatively unsusceptible of the action of certain poisons, while in other instances it may increase their action, and render them fatal in small doses. In dysentery and tetanus a person will take, without being materially affected, a quantity of opium sufficient to kill an adult in average health. In mania, cholera, hysteria, and delirium tremens, large doses of opium may be borne with comparative impunity. In a case of hemi- plegia, a woman set. 29, took for six days three grains of strychnia daily without injurious consequences — the dose having been gradually raised ( Gaz. Med., Mai, 1845) ; while one grain of strychnia is commonly regarded as a fatal dose to a healthy person. In a case of tetanus, Dupuytren gave as much as two ounces of opium at a dose (60 grammes), without serious consequences. (Plandin, Traite des Poisons, vol. i. p. 231.) It has also been remarked that persons affected with tetanus are not easily salivated by mercury. The morbid state appears to create the power of resisting the ordinary effects of poisons. (GoUes^s Lectures, vol. i. p. Yt.) The effect of certain diseases of the nervous system, as well as of habit, either in retarding the appearance of symptoms or in blunting the operation of a poison, it is not difficult to appre- ciate ; they are cases which can present no practical difficulty to a medical jurist. On the other hand, in certain diseased states of the system, there may be an increased susceptibility of the action of poison. Thus, in those persons who have a disposition to apoplexy, a small dose of opium may act more quickly and prove fatal. In a person laboring under inflammation of the stomach or bowels, there would be an increased susceptibility of the action of arsenic, antimony, or other irritants. One of the most remarkable instances of the influence of disease in increasing the operation of poison, is perhaps seen in cases of diseased kidney (granular degeneration), in which very small doses of mercury have been observed to produce severe salivation, leading to exhaustion and death. A knowledge of fhis fact is of importance in refer- ence to charges of malapraxis, when death has arisen from ordinary doses of calomel administered to persons laboring under this disease. Symptoms appear during a state of health. — Symptoms of poisoning often manifest themselves in a person while in a state of perfect health, without any apparent cause. This rule is, of course, open to numerous exceptions, because the person on whose life the attempt is made may be actually laboring under disease ; and, under these circumstances, the symptoms may be so obscure as often to disarm all suspicion. When poison is exhibited in medicine, a prac- titioner is very liable to be deceived, especially if the disease under which the person is laboring be of an acute nature, and attended by symptoms of dis- order in the alimentary canal. Several cases of poisoning have occurred in which arsenic was criminally substituted for medicine, and given to the parties while laboring under a disorder of the bowels. We are, however, justified in saying, with respect to this character of poisoning, that when, in 26 SYMPTOMS ATTENDING THE TAKING OF POISON. a preTiously healthy person, violent vomiting and purging occur suddenly, and without any assignable cause— such as pregnancy, disease, or indiscretion • in diet — to account for them, there is strong reason to suspect that irritant poison has been taken. When the person is already laboring under disease, we must be especially watchful on the occurrence of any sudden change in the character or violence of the symptoms, unless such change can be easily accounted for on common or well-known medical principles. In most cases of criminal poisoning, we meet with alarming symptoms without any obvious or sufficient natural causes to explain them. The practitioner will, of course, be aware that there are certain diseases which are liable to occur suddenly in healthy people, the exact canse of which may not at first sight be apparent ; therefore, this criterion is only one out of many on which a medical opinion should be founded. 2. In poisoning the symptoms appear soon after a meal, or soon after some hind of food or medicine has been taken. — This is by far the most important cha- racter of poisoning in the living body. It has been already stated that most poisons begin to operate within about an hour after they have been swallowed; and although there are a few exceptions to this remark, yet they occur under circumstances easily to be appreciated by a practitioner. Thus, then, it follows that, supposing the symptoms under which a person is laboring to depend on poison, the substance has most probably been swallowed, either in food or medicine, from half an hour to an hour previously. It must be observed, however, that cases of poisoning may occur without the poison being introduced by the mouth. Oil of vitriol and other corrosive liquids have been thrown up the rectum in injections, and have thus caused death; the external application of arsenic, corrosive sublimate, and cantharides, to ulcerated surfaces, has destroyed life. In one case, arsenic was introduced into the vagina of a female, and she died in five days under all the symptoms of arsenical poisoning. (Schneider, Ann. der ges. Staatsarzneihunde, 1. 229.) Such cases are rare ; but, nevertheless, the certainty that they have occurred, where their occurrence could hardly have been anticipated, shows that, in a suspicious case, a practitioner should not deny the fact of poisoning merely because it is proved that the person could not have taken the poison in the usual way — by the mouth. Again, persons may be destroyed by the vapors of ether, chloroform, prussic acid, or other powerful volatile poisons, intro- duced into the body through the lungs. Such a mode of suicide or murder might disarm suspicion, from the fact of no noxious material being found in the stomach. An act of Parliament has been passed, which makes it felony to administer, or even to attempt to administer, poisons in this manner (14 and 15 Yict. c. 19, sec. 3). Let us suppose, however, the circumstances to have been such that these secret means of destruction could not have been resorted to, and that the poison is one of those most commonly selected by a murderer — such as arsenic, tartar emetic, oxalic acid, or corrosive sublimate — then we may ex- pect that this character of poisoning will be made evident to us, and that something must have been swallowed by the patient shortly before the alarm- ing symptoms appeared. By observations attentively made, it may be in our power to connect the appearance of the symptoms with the use of a particular article of food, and thus indirectly lead to the detection of a criminal. Sup- posing that many hours have passed since food or medicine was taken by the patient, without any effect ensuing, it is probable that the symptoms are due to natural causes, and not to poison. When symptoms resembling those of poisoning speedily follow the ingestion of food or medicine, there is, how- ever, reasonable ground for suspicion; but caution should be observed in drawing inferences, since the most extraordinary coincidences sometimes pre- sent themselves.. In the case of Sir Theodosius Boughton, who was poisoned SEVERAL PERSONS ATTACKED SIMUITANEOTJSLT. 27 by his brother-in-law, Donellan, in 1181, the fact of alarming symptoms coming on in two minutes after the deceased had swallowed what was sup- posed to be a simple medicinal draught, was a most important fact in the evidence against the prisoner. There is no doubt that laurel-water had been substituted for the medicine by the prisoner, and that this had caused the symptoms which preceded death. The practice of substituting poisonous mixtures for medicinal draughts or powders is by no means unusual, although it might be supposed to indicate a degree of refinement and knowledge not commonly to be found among criminals. Medical practitioners are thus apt to be imposed upon, and the following case, related by a deceased judge, will serve as a caution : An apothecary prepared a draught, into which another person put poison, intending thereby to destroy the life of the patient for whom the medicine was prescribed. The patient, not liking the taste of the draught, and thinking there was something suspicious about it, sent it back to the apothecary, who, knowing the ingredients of which he had composed it, and wishing to prove to his patient that he had done nothing wrong, drank it himself, and died from the effects. He was thus the unconscious agent of his own death ; and, although the draught was intended for another, the party who poisoned it was held guilty of murder. This case contains a serious warning to medical witnesses. It is not unusual, on trials for poison- ing, when the poison is conveyed through medicine, to find a medical witness offering to swallow his own draught in a court of law, in order to furnish a convincing practical illustration of the innocence of the medicine! It need hardly be observed that an exhibition of this kind is never required of a medical witness. If any doubt be raised of the innocent properties of a draught or powder, a chemical analysis of its contents will be far more satis- factory, and attended with no kind of risk to the practitioner. On the other hand, the occurrence of symptoms resembling those pro- duced by poisoning, soon after food or medicine has been taken, may be a pure coincidence. In such a case, poison is always suspected by the vulgar; and it will be the duty of a medical jurist to guard against the encourage- ment of such a suspicion, until he has strong grounds to believe it to be well founded. No public retraction or apology can ever make amends for the in- jury which may in this way be inflicted on the reputation of another ; for they who hear the accusation may never hear the defence. In all such cases, a practitioner may entertain a suspicion, but, until confirmed by facts, he should avoid expressing it, or giving it publicity. When death is not a con- sequence, it is difficult to clear up such cases, except by the aid of a chemical analysis; but this, as we know, is not always applicable. If death ensue, the real cause is usually apparent; and a suspicion of poisoning is thus often removed by an examination of the body. 3. In poisoning, when several partake at the same time of the same food or m.edicine {mixed with poison) all suffer from similar symptoms. — This cha- racter of poisoning cannot always be procured ; but it furnishes good evi- dence of the fact when it exists. Thus, supposing that after a meal made by several persons from the same dish, only one suffers, the suspicion of poison- ing is considerably weakened. The poisoned article of food may be detected by observing whether they who suffer under any symptom of poisoning, have partaken of one particular solid or liquid in common. In a case of accidental poisoning at a dinner-party, a medical man who was present observed that those who suffered had taken port wine only : the contents of the bottle were examined, and found to be a saturated solution of arsenic in wine. In gene- ral, considerable reliance may be placed upon this character, because it is very improbable that any common cause of disease should suddenly attack with violent and alarming symptoms many healthy persons at the same time, and within a short period after having partaken of food together. We must 28 DETECTION OF POISON IN THE FOOD. beware of supposiDg that, in those cases in which poison is really present, all will be attacked with precisely similar symptoms ; because, as we have seen, there are many circumstances which may modify their nature and progress. In general, that person who has partaken most freely of the poisoned dish will suffer most severely; but even this does not always follow. There is a well-known case, recorded by Bonnet, where, among several persons who par- took of a dish poisoned with arsenic, they who had eaten little and did not vomit speedily died ; while others who had partaken largely of the dish, and had in consequence vomited freely, recovered. It was just now remarked, that there is no disease likely to attack several healthy persons at the same time, and in the same manner. This is undoubt- edly true as a general principle, but the following case will show that mis- takes may occasionally arise even under these circumstances. It occurred in London, during the prevalence of the malignant ch,olera in the year 1832. Four of the members of a family, living in a state of great domestic un- happiness, sat down to dinner in apparently good health : some time after the meal, the father, mother, and daughter, were suddenly seized with violent vomiting and purging. The stools were tinged with blood, while the blue- ness of the skin, observed in cases of malignant cholera, was wanting. Two of these persons died. The son, who was known to have borne ill-will against his father and mother, and who suffered no symptoms on this occasion, was accused of having poisoned them. At the inquest, however, it was clearly shown by the medical attendant, that the deceased persons had really died of malignant cholera, and there was no reason to suspect that any poison had been administered to them. In this instance it will be perceived that symp- toms resembling those of irritant poison appeared suddenly in several indi- viduals in perfect health, and shortly after a meal. We hereby learn that the utility of any rules for investigating cases of poisoning depends entirely on the judgment and discretion with which they are applied to particular cases. It is well to bear in mind, in conducting these inquiries, that symptoms resembling those produced by irritant poison may be sometimes due to the description oi food which may have been taken at the meal. Besides flesh rendered unwholesome from disease and decay, there are certain kinds of shell-fish, as well as pork, bacon, sausages, cheese and bread, which, under certain circumstances, may give rise to formidable symptoms, and even death. Such cases may be regarded as poisoning by animal or vegetable irritants. All the characters above described, as indicative of poisoning, may be ob- served, and the difficulty of forming an opinion is often increased by the fact that some of the persons attacked may have previously partaken of the same kind of food without inconvenience. 4. The discovery of poison in the food taken, or in the matters vomited. One of the strongest proofs of poisoning in the living subject, is the detec- tion of poison by chemical analysis, or, if of a vegetable nature, by a micro- scopical examination, either in the food taken by the person laboring under its effects, or in the matters vomited, or, after a few hours, in the urine. The evidence is of course more satisfactory when the poison is detected in the matters vomited or in the urine, than in the food ; because this will show that it has really been taken, and will readily account for the symptoms. If the vomited matters have been thrown away, we must examine the food of which the patient may have partaken. Should the results in both cases be negative, and no trace of poison be found in the urine, it is probable that the symptoms were due to the disease. In investigating a case of poisoning in the living subject, a medical jurist must remember, that poisoning is sometimes /eijmecZ and at others, imputed. It is very easy for an artful person to put poison into food, as well as to in- EVIDENCE OF POISONING IN THE DEAD BODY. 29 troduce it into the matters vomited or discharged from the bowels, and to accuse another of having administered it. There are few of these accusers who go so far as to swallow poison under such circumstances, as there is a great dread of poisonous substances among this class of criminals ; and it will be at once apparent, that it would require a person well versed in toxicology, to feign a series of symptoms which would impose upon a practitioner at all acquainted with the subject. In short, the difficulty reduces itself to this: — What inference can be drawn from a chemical detection of poison in food ? All that a medical man can say is, whether poison is or is not present in a particular article of food : — he must leave it to the authorities of the law to develop the alleged attempt at administration. If the poison has been actu- ally administered or taken, then we should expect to find the usual symptoms. The absence of these symptoms would be a strong fact against the alleged administration. The detection of poison in the matters vomited, affords no decisive proof that it has been swallowed, except under two circumstances : 1. When the accuser has previously labored under the usual symptoms of poisoning, in which case there can be no feigning, and the question of im- putation is a matter to be established by general evidence. 2. When the matters are actually vomited into a clean vessel in the presence of the medical attendant himself, or of some person on whose testimony perfect reliance can be placed. The detection of poison in the urine furnishes a clear proof that poison has been taken, that it has passed into the blood, and has been subse- quently eliminated. CHAPTEE III. ON THE EVIDENCE OP POISONING IN THE DEAD BODY — PERIOD AT WHICH POISONS PROVE FATAL. — CHRONIC POISONING — APPEARANCES PRODUCED BY THE DIF- FERENT CLASSES OF POISONS — REDNESS OF THE MUCOUS MEMBRANE MISTAKEN FOR INFLAMMATION — ULCERATION AND CORROSION — SOFTENING — PERFORA- TION OP 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 in the last chapter, as indicative of poisoning in the living subject. 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 following rule : — There is no one symptom or pathological condition which is peculiar to poisoning ; but at the same time there is probably no disease which pre- sents all those characters which are met with in a special case of poisoning. The additional evidence to be derived from the death of the person, may be considered under the following heads : — 1. The time at which death tahes place after the first occurrence of symp- toms. — 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 prac- titioner is often required to state the usual ^enorf of time within which poisons 30 EVIDENCE EROM THE DURATION OP A CASE. 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 quan- tity in which it has been taken, may differ in the rapidity of its action. A large dose 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 sub- stance a person dies, i. e. all signs of life have commonly ceased, in from ten to twenty minutes : — if he survives half an hour there is some hope of re- covery. In the cases of the seven Parisian epileptics, accidentally poisoned by this acid, 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 : if the poison be not per- fectly dissolved when swallowed, it is a longer time in proving fatal. The strong mineral acids, in poisonous doses, destroy life in about eighteen or twenty-four hours. Arsenic, under the form of arsenious acid (white arsenic), operates fatally in from eighteen hours to three or four days. It has, how- ever, in more than one instance killed a person in two hours ; although this is by no means common. Opium, either as a solid or under 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 of recovery. This must be understood to be merely a state- ment of the average results, as nearly as we are warranted in giving 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 in a court of law : the death of a party, alleged to have taken poison, may have occurred too rapidly or too slowly to justify a suspicion of poisoning. The following case may serve as an illustration : A woman of the name of Russell was tried and convicted at the Lewes Summer Assizes, in 1826, for the murder of her hus- band, by poisoning him with arsenic. The poison was detected in the sto- mach; but the fact of poisoning was disputed by some medical witnesses, for this among other reasons — that the deceased had died three hours after the only meal at which the poison could have been administered to him. The authority of Sir A. Cooper and others was cited to show that, according to their experience, they had never known a case to have proved fatal in less than seven hours. This may have been ; but, at the same time, there was sufficient authority on the other side to establish that some cases of arsenical poisoning had actually proved fatal in three or four hours. So far as this objection was concerned, the prisoner was very properly convicted. In re- ference to the medical question raised at this trial, I may observe that, within a recent period, two distinct cases have occurred in which the individuals died certainly within two hours after taking arsenic ; and several instances have been reported since the trial, in which death took place in from three to four hours after the administration of this poison. It seems extraordinary, in the present day, that any attempt should have been made by a professional man to negative a charge of criminal poisoning upon so weak a ground as this; but we must remember that this opinion was expressed many years ao^o, when the facts connected with poisoning were but little known. It is quite obvious that there is nothing, so far as we know, to prevent arsenic from destroying life in an hour, or even in a shorter period than that. A case will be hereafter related, in which death took place from arsenic most pro- bably within twenty minutes. These matters can be settled only by a care- ful observation of numerous cases, and not by any d priori reasoning, or a limited individual experience. ACUTE AND CHEONIC POISONING. 31 In all instances of sudden death, there is generally a strong tendency on the part of the vulgar to suspect poisoning. They never can be brought to consider that persons may die a natural death suddenly as well as slowly ; or, as we shall presently see, that death may really take place slowly, as in cases of disease, 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 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 poisons likely to operate with such fatal rapidity are prussic acid or nicotina. Poisoning by opium is com- monly protracted for five or six hours. This poison has never been known to destroy life instantaneously, or in a few minutes. Thus, then, it may happen that death will occur with such rapidity as to render it impossible, 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 of late fre- quently required medico-legal investigation. Most poisons, when their effects are not rapidly manifested, owing either to the smallness of the dose or to timely treatment, are capable of slowly undermining the powers of life, and killing the patient by producing emaciation and exhaustion. This is some- times observed in the action of arsenic, corrosive sublimate, and tartarized 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 poi- soning 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 impaired; a condition which leads to emaciation 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 poisoning, there is sometimes great difficulty in assigning death exclusively to the original action of the poison, since the habits of life of the party, a tendency to disease, and other circumstances, may have con- curred 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 these symptoms continued to become aggravated until the time of death ; and 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 produced by tartarized antimony, when the acute symptoms of poisoning by these substances have passed away. Several cases have come before our tribunals, in which the facts connected with this form of poisoning were of some importance. I allude to those of Miss Blandy, tried at Oxford, in 1152, for the murder of her father by arsenic; and of a woman named Butterfield, tried at Croydon, in lllS, for the murder of a Mr. Scawen, by administering corrosive sublimate. Among cases of recent occurrence, may be mentioned that of Mrs. Wooler {Reg. v. Wooler, Durham Winter Assizes, 1855), in which it was clearly proved that the de- ceased had been under the influence of arsenic, administered at Intervals in repeated doses, for a period of about seven weeks before her death. She died 32 ACUTE AND CHRONIC POISONING. from exhaustion and the secondary effects of the poison. In three other cases tartarized antimony was the poison selected. It was given in repeated doses, over different periods, and caused death, by the specific effects of poisoning in a chronic form. 1. The case of Ann Palmer (Guy^s Hospital Reports, October, 185T). 2. The case of WMullen (Liverpool Summer Assizes, 1856), in which a woman was tried and convicted for causing the death of her husband ; and 3d, the case of Reg. v, Hardman (Lancaster Summer Assizes, 1857), in which a man was convicted of the murder of his wife. In most cases, murderers destroy life by administering poison in very large doses ; but in the instances referred to, small doses were given at intervals— a fact which, in some of them, led to a medical doubt of the real cause of the symp- toms. The case of Isabella Banks {Reg. v. Smethurst, Central Criminal Court, August, 1859) gave rise to a conflict of medical opinion respecting the cause of death. Drs. Julius and Bird, who attended the deceased throughout her illness of about a month's duration, the late Dr. Todd, and myself, referred the symptoms and cause of death to chronic poisoning by antimony and arsenic, and in confirmation of this opinion antimony was dis- tinctly found by Dr. Odling and myself in the intestines after death. Arsenic was also found in an evacuation passed by the deceased three days before her death. Dr. Tyler Smith, Dr. Richardson, and others, who did not see the deceased, ignoring the existence of antimony in the body, referred the symp- toms and appearances partly to pregnancy and partly to a sudden attack of severe dysentery. The jury found the accused guilty, but upon the doubt thus raised in the public mind respecting the cause of death, the accused was subsequently discharged. A similar question arose in Reg. v. Winslow (Liverpool Autumn Assizes, 1860). The prisoner was charged with the murder of a Mrs. James by administering to her small doses of antimony. The suspicions of Dr. Cameron, who attended deceased, were excited by the intermittent and violent nature of the vomiting as well as the extreme de- pression. Antimony was found in the urine and feces by Dr. Edwards ; and after death this substance was discovered, in very small quantity, in the viscera, by Dr. Edwards, Dr. Miller, and myself. The deceased was at the time laboring under malignant disease of the caecum, but it was alleged that the antimony had accelerated her death. The jury acquitted the accused. The examination of the bodies of the sister of deceased, as well as of two other members of the family, led to the discovery of antimony also in small quantity, in the viscera of each, and from the nature of the symptoms pre- ceding death, as well as the general healthiness of the organs, no doubt was entertained by the medical witnesses that all these persons — members of the same household — had died from the effects of antimony administered at inter- vals in small doses. The law could not fix the perpetration of these four murders upon any individual, and three would have wholly escaped public notice, but for the death of Mrs. James some months after the bodies of the others had been buried under medical certificates setting forth natural causes of death ! The occurrence of such cases as these suggests grave reflections on the insecurity of life, when poison is used with skill and cunning, and on the inefficiency of the present system of registering causes of death. The editor of the Law Magazine has truly said, in commenting upon the Smethurst case, " All that is requisite for future murderers by poison to do, is to use small doses, combine the use of various destructive drugs, and subpoena the proper witnesses. If the judge and jury should, nevertheless, be convinced that the skilful poisoner was guilty, it is then open to him to work the papers and ' public opinion,' get other doctors' evidence, and apply to the Home Office." (The Trial of Thomas Smethurst, Law Magazine, Nov. 1859, p. 145.) That this will be the course pursued by future poisoners is highly probable : hence the characters of chronic poisoning have acquirM a special APPEARANCES IN THE DEAD BODY. 33 interest for the medical jurist. There is, however, a difficulty about these cases which no accuracy of observation or judgment can surmount. The poison or poisons, if found in the dead body at all, must necessarily exist in fractional parts of a grain. This alone will b§. 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 was found in the whole of the tissues of the body : in the case of Isabella Banks {Reg. V. Smethurst), the quantity was greater than this, but less than a grain altogether ; while in the case of Mrs. Peters, of Yeovil, examined by Mr. Herapath, none was found in the body, although this chemist had extracted a quantity of antimony as sulphide from the urine of deceased in less than nine days before death I In this case Dr. Garland had also found antimony in the evacuations during life, and had referred the intermittent irritation of the stomach and bowels, from which the deceased had suffered, to the secret use of this mineral. The jury returned a verdict that deceased had died from disease, and that her death was accelerated by some irritant. {Lancet, Aug. 4, 1860, p. 119.) It has been, of late years, a contested scientific question, whether a person can die from poison and no trace of the poison remain in the body. Mr. Herapath's evidence in Mrs. Peters' case not only proves the affirmative, but goes to show that antimony may act fatally and be entirely eliminated from the system in about a week. {Med. Times and Gaz., Aug. 25, Sept. 15 and 29, 1860, pp. 190, 271, 31T.) 2. JSvidence from appearances in the hody. — 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 indi- cative 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 external appearance of the body. This is now known to be an error: the bodies of persons poisoned are not more rapidly decomposed, ceteris paribus, than those of others who have died a sudden and violent death from any cause whatever. Irritant poisons act chiefly upon the stomach and intestines, which they irritate, inflame, and corrode. We may likewise meet with all the conse- quences of inflammation, such as ulceration, perforation, and gangrene. Sometimes the coats of the viscera are thickened, at other times thinned and softened by the action of an irritant. Neurotic {Cerebral and Spinal) poisons do not commonly leave any well- marked appearances in the body. The stomach and intestines present no unnatural changes. There may be greater or less fulness of the vessels of the brain and spinal marrow and 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. The Narcotico-irritant or Cerebrospinal poisons may affect either the brain or the stomach and bowels, and commonly all these parts according to their peculiar mode of action. 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, then, be procured entirely from other sources. Any evi- dence derivable from the appearances in the body of a person poisoned, will be imperfect unless we are able to distinguish them from those analogous changes often met with as the results of ordinary disease. These are can- 3 34 EEDNESS or MUCOUS MEMBRANE IN IRRITANT POISONS. fined to the mncoas membrane of the stomach and bowels. Theyare red- ness, ulceration, softening, and perforation. 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 (strife), 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 that the folds or prominences only of the mucous membrane present this red or inflamed appearance. Redness of the mucous membrane may, however, be due to gastritis or gastro-enteritis as a result of disease ; and in order to assign the true cause of the 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 sto- mach 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 some observers have remarked that a slight redness has often remained in the stomachs of those who have died during the performance of the diges- tive process. When in contact with the spleen or liver, after death, the sto- mach 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 which always takes place after death. None of these appearances are likely to be mistaken for the action of an irritant poison. There is an important class of cases in which redness of the mucous mem- brane 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 the medical jurist, since the appearances closely resemble those produced by irri- tant poison. A person may die without suffering from any symptoms of dis- ordered 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 at Guy's Hospital : and drawings have been made of the appearance presented by the stomach, and are preserved in the Mu- seum collection. The redness of the stomach, in cases of poisoning, is so speedily altered by putrefaction, when circumstances are favorable to this process, as fre- quently to render it impossible for a witness to speak with any certainty upon its cause. Putrefactive infiltration from the blood contained in the adjacent viscera and muscles, will give a reddish-colored 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 distinguishable 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 knowledge and discretion of the witness. I have dis- tinctly seen the well-marked appearances of inflammation produced by arsenic in the stomach and duodenum in an exhumed body twenty-eight days after interment {Reg. v. Jennings, Berks Lent Ass. 1845) ; and in another instance, referred to me by Mr. Lewis, the coroner for Essex, in August, 1846, the reddened state of the mucous membrane, in a case' of arsenical poisoning, was plainly perceptible on removing a layer of arsenic, nineteen months after interment. (See, on this question, a case of suspected poisoning by Orfila, Annates d'Hyg., 1839, vol. i. p. 121.) If, however, there should ULCERATION — SOFTENING — PERFORATION. 35 be a reasonable doubt respecting the cause of the redness, it would be unsafe to rely upon this appearance as evidence of poisoning, unless poison were detected. Ulceration — In irritant poisoning, the stomach is occasionally found ulce- rated ; 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 (arsenic) may be found. Ulceration 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 indications of its existence, except perhaps slight gastric disturbance, with occasional nausea, vomiting, and loss of appe- tite. 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 poisoning have occurred. In ulceration from disease, the mucous membrane is commonly only reddened in the neighbor- hood of the ulcer. In ulceration from poison, the redness is generally dif- fused over other parts of the stomach, as well as over the duodenum and small intestines. A case, however, occurred in Guy's Hospital, some years ago, in which, with a small circular patch of ulceration near the cardiac opening, the whole mucous membrane was red and injected ; but this singu- lar 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 ulceration found, may be due. Care must be taken to distinguish ulceration from corrosion. Ulceration is a vital pro- cess ; the substance of a part is removed by the absorbents as a simple re- sult of inflammation. Corrosion, on the other hand, is a chemical action ; — the parts are removed by the immediate contact of the poison ; they are de- composed ; their vitality is destroyed, and they combine with the corrosive matter itself. Ulceration requires time for its establishment, while corrosion is either an instantaneous or 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 struc- ture during life, or of the solvent action of the gastric juice after death. As this condition of the stomach, when caused by poison, is commonly produced by those substances only which possess corrosive properties, it follows 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 cardiac 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 opera- tion. Softening is not to be regarded as a common character of poisoning ; it is only an occasional appearance. I have met with a case in which the coats of the stomach were considerably hardened by sulphuric acid. Soften- ing can never be inferred to have proceeded from poison, unless other well- marked changes are present, or unless the poison is discovered in the soft- ened parts. The stomachs of infants have been frequently found softened from natural causes ; — such cases could not be mistaken for poisoning, since the history during life, the want of other appearances indicative of poison- ing, 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 disease. Perforation from poisoning. — This may arise: 1, from corrosion; 2, from 36 PERFORATION FROM DISEASE. ulceration. The perforation by corrosion is by far the most common variety of perforation from poisoning. It is occasionally witnessed when the strong mineral acids have been taken, especially sulphuric acid. The stomach, in such cases, is blackened and extensively destroyed, the aperture is large, the edges are rough and irregular, and the coats are easily lacerated. The acid escapes into the abdomen, and may be readily 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 cases of irritant poisoning. Perforation from disease. — This is by no means an unusual condition. Many cases of this disease will be found reported elsewhere. ( Guyh Hosp. Rep., No. 8.) It is invariably 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 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 sud- denly, apparently while enjoying perfect health. Hence, these cases may be easily mistaken for those of irritant poisoning. The principal facts observed with regard to this formidable disease are the following: 1. It often attacks young females from eighteen to twenty-three years of age. 2. The preceding illness is extremely slight; sometimes there is merely loss of appetite, or a capricious appetite, with uneasiness after eating. 3. The attack commences with a sudden and most severe pain in the abdomen, generally soon after a meal. In irritant poisoning, the pain usually comes on gradually, and slowly increases in severity. 4. Vomiting, if it exist 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 seldom absent. 5. The person dies commonly in from eighteen to thirty-six hours; this is also the average 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. T. 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 aper- ture 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 peri- toneal coat the least. The coats of the stomach, round the edge of the aper- ture, are usually thickened for some distance; and when cut they have almost a cartilaginous hardness. These characters of the aperture will not alone in- dicate 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 irri- tant poisoning, 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 in all these cases is, that the effects of disease may be mis- taken for those of poisoning ; for we are not likely to mistake a perforation caused by irritant poison for the result of disease. Notwithstanding the well-marked differences above described, it is very common to meet with cases of imputed poisoning where death has really occurred from peritonitis following perforation. I have been required to examine several cases of this kind; one of them will be found elsewhere recorded ^Guy's Hosp. Reports, Oct. 1850, p. 226). In another, the body was exhumed after several months' SPONTANEOUS OR GELATINIZED PERrORATION. 31 burial, and the stomach was found perforated from disease in the usual situation. [Intestinal perforation sometimes occurs from sudden strain or effort, or external violence. — H.] Spontaneous or gelatinized perforation The stomach is occasionally sub- ject to a spontaneous change, by which its coats become softened and give way generally at the cardiac or greater end. As the effusion of the contents 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 extensive 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 diges- tion. It is commonly attributed to the solvent action of the gastric juice — the spleen, diaphragm, and other viscera being sometimes softened. (For remarks on this subject by Dr. Budd, see Med. Gaz., vol. xxxix. p. 895.) In January, 1845, I met with an instance of this perforation in a child between two and three years of age. It was seized with convulsions, became insensi- ble, and died twenty-three hours afterwards. After death, the greater end of the 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 the organ for thirty-two hours before death 1 It was therefore impossible to ascribe death to the perforation, or the perforation to poison. (For a full account of this case, see Med. Gaz., vol. xxxvi. p. 32.) An inspection of the body with a gener&l history of the case, will commonly suf- fice to remove any doubt in forming an opinion whether the extensive destruc- tion so commonly met with, has or has not arisen from poison. Thus, in a cadaveric perforation, the aperture is always situated in that part of the sto- mach 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 appearance 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 (strise) 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. A case of extensive perforation of the stomach, as the result of the action of the gastric fluids, has been re- ported by Dr. Barnes. (See Med. Gaz., vol. xli. p. 293.) [It is vitally important that the post-mortem examiner should be qualified by practical training and experience, as well as judgment, to understand fully and distinctly the appearances referred to in the foregoing chapter. We fear, however, that the responsibility is too often assumed in this country by practitioners who have no right or reason to pretend to the indispensable qualifi- cations, and whose ignorance and indiscretion might easily be exposed by a well directed cross-examination. The case of John Hendrickson, Jr., convicted, on altogether insufficient medical testimony, of poisoning his wife with aconite, affords a lamentable instance of this kind of perversion of medico-legal investi- gation. (See Am. Journ. Med. Sci., October, 1855, p. 447, for an able and justly severe review of the medical evidence in this trial by Dr. C. Lee.) But it is not only in the observation of the anatomical appearances, even when fully competent to recognize their true characters, that we must exercise the greatest caution. The evidence afforded by the sight and smell of matters in the alimentary canal or other portions of the body, although sometimes very significant, should always be subjected to the closest scrutiny. Odor and color are proverbially uncertain; and although the recognition of peculi- arities of form is less liable to error, yet when these are so minute as to re- quire the employment of the microscope to determine them, the faculty of discriminating is at present restricted to an extremely limited circle of ob- 38 MICROSCOPICAL EXAMINATIONS. servers. In the hands of a judicious and genuine expert in this mode of ex- ploration, the microscope doubtless may be, as it already has been, resorted to with the happiest efifect in corroboration of other more appreciable signs ; still our inclination is to look with particular reserve upon all results derived from such a source alone. We fully agree nevertheless with Dr. M. Still6 in his indorsement of the views of Dr. Frazer, that the value of the microscope in identifying the presence of some vegetable poisons by their botanical cha- racters has not received the attention which it deserves. (Wharton and Stille, Med. Jurisp., 2d ed. p. 4Y4.) Dr. Frazer, in his interesting paper on the subject, gives some very valuable hints, and concludes with detailed instructions, which, while they must prove in the highest degree useful to the accomplished microscopist, at the same time demonstrate the absolute neces- sity of a special training on the part of any one who may desire to avail himself of such difficult tests. " In such cases I would propose," says Dr. Frazer, " that, aided by the history of symptoms, an aid of which we always avail ourselves in other forms of poisoning, the microscope be employed in their investigation ; and the most certain way, I believe, to accomplish this result, especially for those not very Intimately acquainted with the peculiar differential characters of the plants, is to compare whatever vegetable fragments may be ejected by vomit- ing during life, or found in the body after death, with some recent specimens of those vegetables which are most suspected to have been the cause of the accident. I have satisfied myself in this manner that the leaves especially of aconite, henbane, foxglove, belladonna, and several other of our indigenous poisonous plants, can be easily recognized, and that they present distinctive characters adequate to establish ample ground for their discrimination. " The point in such an investigation, which we require to determine in thS first instance, is identically similar to the first step in deciding on the nature of a botanical specimen; if the specimen consists altogether of cellular tissue, it is to be classed as one of the ' cellulares,' and possibly may prove to be some of the poisonous fungi ; should it, however, yield us distinct evidence of vascular tissue, thus demonstrating its more exalted place in the botanist's systematic arrangements, in that case we will have as our next duty, suppos- ing it is a fragment of leaf which we are examining, to decide on the nature of the venation, which at once points out whether it constituted a portion of an exogenous or of an endogenous plant, the latter having the well-known parallel venation, and the former presenting an equalled distinctive reticu- lated arrangement. Having advanced so far, we then have four other points, at least, for aiding our further identification of its source. " 1st. The presence or absence of hairs, their relative abundance on the upper or under surface of the leaf, and their shape, composition, and arrange- ment. " 2d. The appearance of the epiderm on the upper surface of the leaf, the form of the cells of which it is composed, the existence or non-existence of stomata, and if they are present, their shape, size, and disposition in the epi- derm. "3d. Similar observations on the epiderm of the under surface of the leaf. "4th. The disposition of the parenchyma of the leaf, the development of various crystalline matter (raphides) in this tissue, and their form when they exist. " An agreement in these four points, with corresponding appearances in a recent specimen, would, I conceive, afford more than an equivalent to the de- gree of moral certainty which is now derived from a chemical analysis of a mineral poison, and I can readily understand, with the scientific aids now at our disposal, that just as the chemist is able to place securely in a sealed tube and exhibit before the court sublimates of arsenic and mercury as undoubted RULES TO BE OBSERVED IN CASES OF POISONING. 39 evidences of his analytic skill, so the microscopic observer might produce, to corroborate his testimony, accurate drawings of the fragments of a poisonous plant, printed by solar light^ as photographs, or more slowly obtained with the aid of a pencil and camera." (See Edinh. Monthly Journal of Medicine, April, 1855, from Dublin Hasp. Gaz.) — H.] CHAPTER IV. RULES TO BE OBSERVED IN INVESTIGATING A CASE OP POISONING — WITH RE- SPECT TO THE PATIENT WHILE LIVING — THE INSPECTION OF THE BODY — THE EXHUMATION OF BODIES — DISPOSAL OP THE VISCERA — IDENTITY OP SUB- STANCES — PRESERVATION OF ARTICLES FOR ANALYSIS — ON THE USE OP NOTES — WHEN ALLOWED TO BE USED IN EVIDENCE — MEDICO-LEGAL REPORTS. When a practitioner is called to a case of poisoning, it is above all things necessary that he should know to what points he ought to give his attention. It is very proper that every effort should be made by him to save life when the individual is living: but while engaged in one duty, it is also in his power to perform another, supposing the case to be one of suspected criminal poi- soning — namely, to note down many circumstances which may tend to detect the perpetrator of a crime. There is no person so well fitted to observe these • points as a medical man ; but it unfortunately happens, that many facts im- portant as evidence are often overlooked. The necessity for observing and recording them is not perhaps generally known. A medical man need not make himself ofiScious on such occasions, but he would be sadly unmindful of his duty as a member of society, if he did not aid the course of justice by extending his scientific knowledge to the detection of crime. It is much to the credit of the medical profession, that the crime of murder by poisoning — a form of death from which no caution or foresight can protect an individual, is so frequently brought to light, by the announcement of suspicious facts of a medical nature to magistrates and coroners ; and on sever-al occasions the highest compliments have been passed by judges, on medical practitioners who have been thus indirectly the means of bringing an atrocious criminal to the bar of justice. The following appear to me to be the principal points which demand the attention of a medical jurist in all cases of suspected poisoning : — 1. With respect to Symptoms. 1. The time of their occurrence — their nature. 2. The exact period at which they were observed to take place after a meal, or after food or medi- cine had been taken. 3. The order of their occurrence. 4. Whether there was any remission or intermission in their progress, or, whether they con- tinued to become more and more aggravated until death. 5. Whether the patient had labored under any previous illness. 6. Whether the symptoms were observed to recur more violently after a particular meal, or after any particular kind of food or medicine. Y. Whether the patient has vomited : the vomited matters, if any (especially those Jirst ejected), should be pro- cured; their odor, color, and acid or alkaline reaction noted, as well as their quantity. 8. If none be procurable, and the vomiting has taken place on the dress, furniture, or floor of a room — then a portion of the clothing, sheet. 40 INSPECTION OF THE BODY. or carpet, may be cnt out and reserved for analysis ; if the vomiting has occurred on a deal floor, a portion of the woo(| may be scraped or cut out ; or if on a stone pavement, then a clean piece 'of sponge soaked in distilled water, may be used to remove any traces of the substance. [Some years since, an animal was poisoned by arsenic. None of the poison could be de- tected in the stomach, but it was easily found in a portion of deal floor, ren- dered humid by the liquid matters which the animal had vomited during the night.] The vessel in which vomited matters have been contained will often furnish valuable evidence, since heavy mineral poisons fall to the bottom, or adhere to the sides of the vessel. 9. Endeavor to ascertain the probable nature of the food or medicine last taken, and the exact time at which it was taken. 1 0. Ascertain the nature of all the differen.t articles of food used at a meal. 11. Any suspected articles of food, as well as the vomited matters, should be sealed up as soon as possible in a clean glass vessel, labelled, and reserved for analysis. 12. Note down, in their own words, all explanations voluntarily made by parties present, or who are supposed to be concerned in the suspected poisoning. 13. Whether more than one person partook of the food or medicine : if so, whether all these persons were affected, and how ? 14. Whether the same kind of food or medicine had been taken before by the patient or other persons without ill effects following. In the event of the death of the patient, it will be necessary for the practitioner to note down 15. The exact time of death, and thus determine how long a period the per- son has survived after having been first attacked with the suspicious symp- toms-. 16. Observe the attitude and position of the body. lY. Observe the state of the dress. 18. Observe all surrounding objects. Any bottles, paper packets, weapons, or spilled liquids lying about, should be collected and pre- served. 19. Collect any vomited matters near the deceased. Observe whe- ther vomiting has taken place in the recumbent position or not. If the person has vomited in the erect or sitting posture, the front of the dress will commonly be found covered with the vomited matters. Inspection of the Body. 20. Note the external appearance of the body, whether the surface is livid or pallid. 21. Note the state of the countenance. 22. Note all marks of violence on the person, or discomposure of the dress— marks of blood, &c. 2-3. Observe the presence or absence of warmth or coldness in the legs, arms, abdomen, mouth, or armpits. 24. The presence of rigidity or cadaveric spasm in 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 be 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. 25. If found dead— When was the deceased last seen living, or known to have been alive ? 26. Note all cir- cumstances leading to a suspicion of suicide or murder. 27. The time after death at which the inspection is made. 28. Observe the state of the abdo- minal viscera. If the stomach and intestines be found inflamed, the seat of inflammation should be exactly specified ; also all marks of softe'nino' ulcera- tion, effusion of blood, corrosion, or perforation. The stomach should be removed and placed in a separate vessel, ligatures being applied to the two ends. If cut open for examination at this period, this 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. 29. The contents of the stomach, if this organ is opened during the inspection, should be collected in a clean graduated vessel : notice a the quantity, h the odor tried by several persons, c the color, d acid or alkaline reaction ; e presence of blood mucus ON THE EXHUMATION 01' BODIES. 41 or bile; / presence of undigested food; and Iiere it may be as well to ob- serve, that the presence of farinaceous matters (bread), would be indicated by the addition of iodine water, if the contents were not alkaline — of fat, by heat ; g other special characters. 30. The contents of the duodenum should be separately collected, ligatures being applied to it. 31. Observe the state of the large intestines, especially the rectum, and note the condition of their contents. The discovery of hardened feces in the rectum would prove that purging had not existed recently before death. In one case which I was required to examine, this became a question of considerable importance. 32. The state of the windpipe, throat, and gullet — whether there are in these parts any foreign substances, or marks of inflammation and corrosion. This is of essential importance, as it throws a light upon the question, whether the poison swallowed was irritant or corrosive, and whether it had or had not a local chemical action. It also removes any doubt which might arise respect- ing death by suffocation from mechanical causes. 33. The state of the lungs and heart; all morbid changes noted. 34. The state of the brain and spinal marrow. 35. The condition of the uterus, ovaries, and genital organs should be examined, as, in the female, poison has been sometimes introduced into the system by the vagina. 36. The liver with the gall-bladder should be re- moved for a chemical examination. 37. 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 eases of suspected poisoning, a medical jurist should attend. By means of these data, noted according to the particular case to which they are adapted, 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 also to point out the dish or article of food which had con- tained the poison, if the case be one of poisoning ; and to throw light upon any disputed question of suicide or murder in relation to the deceased. Many cases of poisoning are rendered obscure, owing to these points not having been attended to in the first instance. I have not considered it necessary to enter into any details respecting the mode of performing an inspection. This the practitioner will have acquired during his study of anatomy; and the only essential points in addition to those 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 question of poisoning. It is useful to bear in mind on these occasions, that the body is inspected, not merely to show that the individual 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, who defend accused parties, very properly direct a most searching examination to the last-mentioned point, i. «., the healthy or unhealthy state of those organs which are essential to life, and with which the poison has not probably come in contact. The usual causes of sudden death have their seat commonly in the brain, the heart and its great vessels, or in the lungs. Marks of effusion of blood, congestion, inflamma- tion, suppuration, or a diseased condition of the valves of the heart, should be sought for and accurately noted, whatever may be the condition of the abdominal viscera. It has also been recommended that an examination of the spinal marrow should be made. If the cause of death be obscure after the general examination of the body, there is good reason for inspecting the condition of this organ. 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 42 ON THE IDENTITY OF SUBSTANCES FOR ANALYSIS. organs ; but decomposition may have advanced so far as to destroy all patho- logical evidence. The inspection in such cases is commonly confined to the abdominal viscera. The stomach is often found so thinned and collapsed, that the anterior and posterior walls appear to form only one coat. This organ should be removed, with the duodenum, and ligatures applied to each. The liver and the spleen should also be removed, in order that they may, if necessary, be separately analyzed. If poison is not found in one or more of these viscera, it is not likely that it will be discovered in the body. It has been recommended 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 me to be an unnecessary piece of refinement when the cofiSn is entire, or when the abdominal parietes still cover the viscera. If decomposi- tion 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. In giving a positive opinion upon such hyperchemical views, it might be fairly objected that traces of arsenic always exist in the iron and brass nails and ornaments which are used in a coffin ; and this arsenic is just as likely to furnish a valid objec- tion to medico-legal researches as that which is said to be a constituent of all soils in which oxide of iron abounds. The body of a deceased person, when exhumed, should be identified by some friend or relative, in the pre- sence of the medical examiner. In one case of murder by poison the evi- dence 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 chloride of lime, or placed in alcohol ; but this is decidedly im- proper : the use of any preservative chemical liquid would not only embarrass the future analysis, but would render a special examination of an unused por- tion of the liquid necessary — the identity of which would have to be unequi- vocally established. Preservation from air in clean glass vessels, with well- fitted corks, covered with skin, or, what is still better, sheet-caoutchouc, is all that is required in practice. There is no objection to the use of a small quantity of chloroform. The vapor of this liquid is diffused through the vessel and tends to retard putrefaction. Identity of Substances. It is necessary to observe, that all legal authorities rigorously insist upon proof being adduced of the identity of the vomited matters or other liquids 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 we have first ascertained that the surface or vessel is perfectly clean. If this point 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 sub- stance 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 his 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 case may be at once stopped : so that the care subsequently bestowed upon a chemical analysis will be labor thrown away. Evidence of PRESERVING ARTICLES FOR ANALYSIS. 43 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) when 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. Not only must clean vessels be used for receiving any liquid destined for subsequent chemical analysis, but care must be taken that the identity of a substance is preserved, or the most correct analysis, afterwards made, will be inadmissible as evidence. The suspected substance, when once placed in his hands, 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 it out of his hands, and allowed it to pass through the hands of several other persons, then he complicates the evidence for the prosecution, by rendering it indis- pensable 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 iden- tity ; for the chemical evidence, so important in a criminal investigation, will probably be altogether rejected by the court. A case was tried on the Nor- folk circuit, in which the analysis of the matters vomited by a person poisoned by arsenic, was not admitted as evidence against the prisoner, because the practitioner had left them in the custody of two ignorant women ; and these women had allowed the vessel containing the suspected liquid (which was proved to contain arsenic) to be exposed in a room open to the access of many persons. In another case, tried at the Old Bailey Sessions in 1835, the analysis of some suspected liquids was not allowed in evidence, because the practitioner, who lived in the country, and was unwilling to take the respon- sibility of analyzing them, had sent them up to town by a carrier to be examined by a London chemist. If closely sealed by a private seal, and this be observed by the receiver to be unbroken, before he proceeds to the ana- lysis, this mode of transmission will not probably be objected to. When any article (e. g. a stomach or other organ) is reserved for analysis, care should be taken to attach immediately to it, or the vessel containing it, a parchment or wooden label, upon which is plainly written in ink, the name of the de- ceased and the date of removal, including the day of the week and month. This is especially necessary when there are two or more articles for analysis. I have known the greatest inconvenience to result from the neglect of this simple precaution. Preserving articles for analysis. — In removing viscera or liquids from the body, and reserving them for analysis, it is necessary to observe certain pre- cautions. A clean vessel with a wide mouth should be selected ; it should be only sufficiently large to hold the viscus or liquid (the less air remaining in it the better) ; it should be secured by a closely-fitting cork, covered with fine skin or bladder. Another piece of skin should then be tied over the mouth, or, for this, sheet-caoutchouc may be substituted with advantage. It should lastly be covered with tin-foil, and a layer of white leather. 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 : I have known the appearances after death of the viscera of an infant, suspected to have died from poison, entirely destroyed by drying, from the evaporation which took place through the layers of paper with which the vessel in which they were contained was covered. The prac- titioner should bear in mind that all these matters are likely to come out in 44 ON THE USE OF NOTES — MEDICO-LEGAL KEPOETS. evidence ; and whatever is wortli doing at all, is worth doing well. For reasons already stated, antiseptic chemical compounds should not be used. The addition of a small quantity of chloroform to the viscera will tend to preserve them. On the use of Notes. — It has already been recommended as a rule in these criminal investigations, that a practitioner should make notes of what he observes in regard to symptoms, appearances after death, and the results of a chemical analysis. His own observations should be kept distinct from ob- servations made by others, and reported to him. He may base his conclu- sions on the former, but not on the latter. From the common forms of law in this country, an individual charged with the crime of poisoning may re- main 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 will turn in favor of the prisoner, for he will be the party to benefit by the neglect of the witness. In adopting the plan here recommended, 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 is rigorously enforced by the judges. In order to render such notes or memoranda admissible, it is indispensably necessary that they should be taken on the spot at the time the observations are made, or as soon afterwards as practicable ; and, further, it must be remembered that a wit- ness can refer to them only for the purpose of refreshing his memory. 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 symptoms; 2, in regard to the appearances after death ; and, 3, in regard to the results of an analysis. With respect to the two first divisions of the report, I must refer the reader 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 circum- stances under which the attendance of the practitioner was required, as well as the period of death, should be particularly stated. The hour, the day of the week, and the day of the month, should be invariably mentioned. Some medical witnesses merely state the day of the week, without that of the month, or vice versS.. At a trial this creates great confusion, by rendering a refer- ence to almanacs necessary. The words yesterday, next day, &c., 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. 39-41). If these facts are not observed in the order there set down, their value as evir dence of the cause of death, or of the criminality or innocence of particular parties, will be entirely lost. In drawing up a report of symptoms and ap- pearances after death, the facts should be in the first instance plainly and concisely stated seriatim, in language easHy intelligible to non-professional persons. A reporter is not called upon to display his erudition, but to make himself understood. If technical terms are employed, their meaning should be stated in parentheses. When a subject is thoroughly understood, there can be no difficulty in rendering it in simple language ; and when it is not well understood, the practitioner is not in a position to make any report. Magistrates, coroners, and barristers, are very acute, and easily detect ignorance, even when it appears under the mask of erudition. In recording facts a reporter should not encumber his statements with opinions and inferences. His conclusions should be reserved until the end of the report. The language in which conclusions are expressed, should be precise and clear. It must be remembered that these are to form a concise summary of the whole report, upon which the judgment of a magistrate or ACCIDENTAL INTEODUCTION OF POISON. 45 the decision of a coroner's jury, will be ultimately based. They should be most strictly confined to the matters which are the subject of inquiry, and which have fallen nnder the observation of the witness. Thus, they com- monly refer to the following questions : What was the cause of death ? What are the medical circumstances which lead you to suppose that death was caused by poison ? What are the circumstances which lead you to suppose that death was not caused by natural disease ? Answers to one or all of these questions comprise, in general, all that the reporter is required to introduce into the conclusions of his report. The reporter must remember that his conclusions are to be based only upon medical facts — not upon moral circumstances, unless he is specially required to express his opinion with regard to them when they are of a medico-moral nature. Further, they must be founded only on what he has himself seen or observed. Any information derived from others should not be made the basis of an opinion in a medico-legal report. It is scarcely necessary to remark that a conclusion based upon mere probalilities is of no value as evidence. In drawing up a report on the results of a chemical analysis, the following rnles may be borne in mind. A liquid or solid is received for analysis. 1. When, and of whom, or how received ? 2. In what state was it received — secured in any way, or exposed? 3. If more that one substance received, each to be separately and distinctly labelled ; appearance of the vessel, its capacity, and the quantity of liquid (by measure) or solid (by weight) con- tained therein. 4. Where and when did you proceed to make the analysis, and where was the siibstance kept during the intermediate period? 5. Did any one assist you, or did you make the analysis yourself? 6. Physical cha- racters of the substance, t. Processes and tests employed for determining whether it contained poison. All the steps of these processes need not be described ; a general outline of the analysis will suffice. The magistrate may thus satisfy himself by an appeal to others (if necessary) whether the analysis has or has not been properly made. 8. Supposing the substance to contain poison — is this in a pure state or mixed with any other body ? 9. The strength of the poison, if an acid, or if it be in solution : in all cases, the quantity of poison present. 10. Supposing no poison to be contained in it, what was the nature of the substance ? Did it contain anything likely to injure health or destroy life ? 11. Could the supposed poisonous sub- stance exist naturally or be produced within the body ? 12. Was it present in any of the liquids or solids employed in the chemical analysis ? 13. Was it contained in any of the articles of food or medicine taken by the deceased ? 14. Is its presence to be ascribed to the use of any mineral matter employed by injection after death for the preservation of the body of the deceased ? 15. What quantity of poison was actually separated? 16. How much of the substance found would, nnder the circumstances, be likely to destroy life ? In reference to the presence of arsenic in articles of food (13), it has been shown by Dr. Davy and Mr. Horsley that turnips and other vegetables, grown on soils which have been manured with arsenicated manures (now so exten- sively used), are liable to acquire an impregnation of arsenic. (Philosoph. Mag., Aug. 1859, p. 108; and Guyh Hosp. Reports, Oct. 1860.) There are few reports in which answers to many of these questions, al- though not formally put, will not be required : and unless the whole of them are borne in mind by the operator at the time an analysis is undertaken, those which are omitted can never receive an answer, however important to the ends of justice that answer may ultimately become. 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. An observation made by Mr. Aickin, 46 ACCIDENTAL INTRODUCTION OP POISON. of Belfast, shows that this is not an unnecessary caution. This gentleman 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 pre- sented 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 it in a piece of paper (used for papering rooms), placing it on the uncolored side, and he locked it in a closet until the following day. As- sisted by a friend, he then analyzed the contents, and found a trace of mor- phia with a pretty large quantity of arsenic. As the symptoms from which the child had died were not those of poisoning by arsenic, and there was no appearances of the action of arsenic on the body, he came to the conclusion that there must be some extraneous cause to account for the presence of this poison. 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 sulphuret of arsenic or orpiment 1 It was, therefore, evi- dent, as orpiment contains white arsenic, that the stomach and its contents had Imbibed a portion of the poison during the night. {Lancet, June 23, 1855, p. 632.) This satisfactorily accounted for the presence of arsenic under circumstances which might have given rise to a false charge of murder. Nearly all wall-papers, having any tinge of green or golden yellow in them, 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. Mr. Aickin's case shows in a striking point of view the danger of trusting to chemical analysis alone. Unless we look to physiology and pathology, a most erroneous opinion may be expressed. According to Professor Otto, of Brunswick, arsenic is generally found mixed with iron in all ochreous deposits. It is thus occasionally present in the soil of cemeteries but in an insoluble form. Even in the fur deposited in tea-kettles, in which there is generally some oxide of iron, arsenic has been found. From about a pound and a half of the crust or fur of a vessel, and from boiling water, he obtained well-marked arsenical deposits. Pollnitz has detected in the fur of kettles — copper, lead, tin, and even antimony. Dr. Osborn, of Southampton, has recently confirmed Pbllnitz's conclusion, namely, that lead is present in an insoluble form in the deposits of kettles and boilers. Med. Times and Gaz., Dec. 22, 1860, p. 608.) Otto discovered a much larger proportion of arsenic in the calcareous crust taken from a kitchen boiler. Ten ounces of this gave a deposit of arsenic in a glass tube, and several stains on porcelain. He thinks that if a suflBcient quantity is em- ployed, arsenic will be found in all spring and well waters {Ausmittelung der Gifte, 1856, p. 61). I have found arsenic in the water of rivers used for the supply of towns, and have extracted a well-marked quantity from two ounces of the_ dried mud of the Thames. {Guyh Hosp. Reports, Oct. 1860, on Arsenic and Antimony.') These facts, if they prove anything, tend to show the extreme danger of placing reliance on minute chemical results in the ab- sence of good physiological and pathological evidence. The results of analysis in the shape of sublimates or precipitates, should be preserved as evidence distinctly labelled in small glass tubes hermetically sealed. They can then, if asked for, be produced for examination at the in- quest or trial. SULPHURIC ACID — SYMPTOMS. 41 lERITANT POISONS. CHAPTEE Y. sulphuric acid or oil of vitriol. symptoms caused by this poison in the concentrated and diluted state — appearances after death, quantity op acid required to destroy life — fatal dose — period at which death takes place — chemical analysis — mode of detecting the poison in pure and mixed liquids — its detection in articles of clothing — poisoning by sulphate of indigo. Sulphuric Acid, or Oil of Yitriol. Symptoms. — ^When this poison is swallowed in a concentrated form, the symptoms produced come on immediately, or during the act of swallowing. There is violent burning pain, extending through the throat and gullet to the stomach — the pain is often so severe that the body is bent. There is an escape of gaseous and frothy matter, followed by retching 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 mouth is excoriated, the lining membrane and surface of the tongue white, or resembling soaked parchment — 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 cavity is filled with a thick viscid substance consist- ing of saliva, mucus, and the membrane of the mouth; this renders speaking and swallowing difficult. If the poison has been administered by a spoon, or the phial containing it has been passed to the back of the fauces, the mouth may escape the chemical action of the acid. A medical witness must bear this circumstance in mind, when he is called to examine an infant sus- pected to have been poisoned by sulphuric acid. Around the lips and on the neck may be found spots of a brown color from the action of the acid 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 abdominal muscles is attended with increase of pain. These symptoms have been sometimes mis- taken for those of disease. (Henke, Zeitschnft der S. A. 1843, ii. 284.) The stomach is so irritable, that whatever is swallowed is immediately ejected, and the vomiting is commonly violent and incessant. In a case reported by Dr. Geoghegan, of Dublin, the patient (a female) vomited for three or four hours. This symptom then ceased, and did not recur, although she did not die until thirty-four hours after the poison had been swallowed. {Med. Gaz., vol. xlviii. p. 328.) The matters _/?«< vomited generally contain the poison : they are acid, and if they fall on a limestone pavement there is effervescence, if on colored articles of dress, the color is sometimes altered to a red or yellow (if logwood), or the color is discharged and the texture of the stuff destroyed : on a black cloth dress, the spots produced by the concentrated acid are brown, and remain moist for a considerable time. An attention to 48 APPEARANCES AFTER DEATH. these circumstances may often lead to a suspicion of the real cause of the symptoms, when the facts are concealed. After a time there is great ex- haustion, accompanied by general weakness : the pulse becomes quick, small, and feeble ; the skin cold, mottled, and covered with a clammy sweat. There is generally great thirst, with obstinate constipation of the bowels ; should any evacuations take place, they are commonly either of a dark brown or leaden color— in some instances almost black arising from the 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, expressive of great anxiety, and of intense suffering. The intellectual faculties are quite clear, and death usually takes place very suddenly, in from eighteen to twenty-four hours after the poison has been taken. Appearances after death. — The marked effects of this poison are not always found in the stomach ; they may be confined to the region of the throat and windpipe. In an inspection of the body, the whole courseof the alimentary canal, from the mouth downwards, should be examined ; since in recent or acute cases it is in the throat and gullet that we generally obtain strong evidence of the action of a corrosive poison. The discovery of the usual marks of corrosion in these parts is always highly corroborative of the signs of poisoning found in the stomach. During the inspection, the exa- miner must not omit to notice any spots on the skin produced by the action of the acid : these are commonly of a dark brown color, and are situated about the mouth, lips, and neck. The appearances met with in the body will vary, according to whether death has taken place rapidly or slowly. Supposing the case to have proved fatal very rapidly, the membrane lining the mouth may be found white, softened, and corroded. The mucous mem- brane of the throat and gullet will commonly be found corroded, having a brown-black, or ash-gray color : 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 corrugated, and stained black or of a dark brown color. This blackness is not entirely removed by washing. On stretching the stomach, traces of inflammation may be found between the folds, indicated by a deep crimson red color. On forcibly removing the blackened membrane, the red color indicative of inflam- mation may be seen in the parts beneath. Both the dark color and marks of inflammation are sometimes partial, being confined to insulated portions of the mucous membrane. 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 aperture 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 viscera are attacked by the poison. In a case which occurred at Guy's Hospital, the spleen, the liver, and the coats of the aorta, were found blackened and corroded by the acid, which had escaped through the perforation. When the person has survived for eighteen or twenty hours, traces of corrosive and inflammatory action may be found in the small intestines. -In one case the mucous membrane of the ileum was corroded. The interior of the windpipe 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 reaching the stomach. A remarkable instance in STJLPHUaiC ACID — FATAL DOSE. 49 ■which the poison penetrated into and destroyed both lungs has been reported by Dr. Gull. (See Med. Gaz., vol. xlv. 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. Dr. Ogle met with a case in which the membrane of the tongue was but slightly affected. The man had swallowed a large dose of the poison and had died in nine hours. {Med. Times and Gazette, April 21, 1860.) Strange as it may appear, cases are recorded in which, notwithstanding the introduction of this poison into the stomach, the gullet has escaped its chemical action. Mr. Dickinson has reported a case of poisoning by sulphuric acid in which there was no corro- sion of the mouth and throat. The patient, a female, set. 52, recovered in about five months. The stomach had probably sustained injury, as the most urgent symptoms were constant vomiting after taking food, and obstinate constipation. The quantity of acid swallowed was half an ounce, mixed with half an ounce of water. The patient immediately felt a burning sensation at the pit of the stomach {Lancet, Nov. 26, 1853, p. 502). The acid had here evidently lost its corrosive power by dilution. (See Poisons — Sulphuric Acid.) "When the acid has been, taken in a still more diluted state, the marks of inflammation on the mucous membrane are less decided, and the blackening is not so considerable. Nevertheless, the acid, unless too much diluted, acts upon and darkens the blood in the vessels, as well as that contained in the stomach, although it may not blacken the mucous membrane or the contents. Dr. Walker, of Inverness, met with a case in which a man, set. thirty, swallowed fifteen drachms and a half of sulphuric acid (sp. gr. 1.842), and died twenty-five hours afterwards. Half an hour after taking the poison he resembled a patient in the collapsed stage of cholera. The inside of the lips, tongue, and throat were swollen, and had the appearance of being smeared with thin arrowroot. He suffered severe pain, but did not vomit until three- quarters of an hour had elapsed from the time of taking the poison : the vomiting appeared to be then excited by the liquid given to him. The vomited matters were dark, bloody, and viscid. The patient was sensible up to the time of his death. An inspection revealed the usual appearances. The mucous membrane of the stomach was destroyed, and the whole surface darkened. The greatest amount of injury was at the pyloric end, where three small perforations were found. The orifice of the pylorus was swollen, co'n- stricted, and hardened ; it was so small as to admit only a silver probe. The duodenum had also suffered. The first two inches of the arch of the aorta were very much inflamed. There were no traces of the acid in the stomach; there was a slight trace in the duodenum ; a trace in the serous fluid at the base of the brain ; — but the largest quantity was found in the blood contained in the heart. {Edin. Monthly Journal, June, 1850, p. 538.) This case is remarkable in the fact that vomiting was not immediate ; that there were no spots on the outside of the face ; that the poison was swallowed in large quantity on an empty stomach ; and there was free voluntary exertion, as, twenty hours after he had taken the poison, the man got out of bed and sat on a night-stool. Dr. Geoghegan, of Dublin, has published in the London Medical Gazette (vol. xlviii. p. 328), a full account of the symptoms and appearances after death in a well-marked case of poisoning by sulphuric acid, as well as of a process for detecting this poison when absorbed. Quantity required to destroy life. — The dangerous effects of this poison appear to arise rather from its degree of concentration, than from the abso- lute quantity taken. The quantity actually required to prove fatal must depend on many circumstances. If the stomach is full when the poison is swallowed, the action of the acid may be spent on the food and not on the stomach ; and a larger quantity might then be taken fhan would suffice to destroy life if the organ were empty. The smallest quantity which is described 4 50 CHEMICAL ANALYSIS — TESTS FOR SULPHURIC ACID. as having proved fatal was in the following case : Half a teaspoonful of con- centrated sulphuric acid was given to a child about a year old by mistake for castor oil. The usual symptoms came on, with great disturbance of breath- ing ; and the child died in twenty-four hours. The quantity here taken could not have exceeded /orty drops. {Med. Gaz., vol. xxix. p. 147.) It is, how- ever, doubtful whether this small quantity would have proved fatal to an adult. The smallest fatal dose which Dr. Christison states he has found recorded, was one drachm; it was taken by mistake by a stout yonug man, and killed him in seven days. {Op. dt., 162.) Period at which death takes place. — It has been already stated, that the average period at which death takes place in cases of acute poisoning by sulphuric acid is from eighteen to twenty-four hours. When the stomach is perforated by the acid, it commonly proves more speedily fatal. In one instance, reported by Dr. Sinclair, a child about four years old died in four hours — the stomach was perforated. When the poison acts upon the wind- pipe, death may be a still more speedy consequence from suffocation ; and, owing to this, it appears to be more rapidly fatal to children than adults. Dr. Craigie mentions a case in which three ounces of concentrated sulphuric acid destroyed life in three hours and a half. Remer met with an instance in which death took place in two hours. A case is reported by Mr. Watson, in which a woman swallowed two ounces of the strong acid. She died in half an hour, but it appears that a quarter of an hour before death she hadmade a deep wound in her throat, which gave rise to great bleeding. The stomach was found extensively perforated : but it is highly probable that the wound accelerated death in this case. The shortest case recorded occurred to M. Rapp. A man, set. fifty, swallowed three ounces and a half of concentrated sulphuric acid. He died in three-quarters of an hour. {Gazette Midieale, Dec. 28, 1850.) On the other hand, there are numerous instances reported in which the poison proved fatal frora secondary causes, at periods varying from one week to several months. Chemical analysis. — This acid may be met with either concentrated or diluted ; and a medical jurist may have to examine it under three conditions: 1. In its simple state.* 2. When mixed with organic matters, as with liquid ahicles of food, or in the contents of the stomach. 3. On solid organic sub- stances, as where the acid has been thrown or spilled on articles of dress or clothing. In the simple state. — If concentrated, it possesses these properties : 1. A piece of wood, sugar, or other organic matter plunged into it, is speedily carbonized or charred. 2. When boiled with wood, copper-cuttings, or mercury, it evolves fumes of sulphurous acid ; this is immediately known by the odor, as well as by the acid'vapor first rendering blue, and then bleach- ing, starch-paper dipped in a solution of iodic acid. 3. When mixed with an equal bulk of water, great heat is evolved (nearly 200° F. in a cold vessel). The diluted acid. — For the acid in a diluted state, but one test may be applied : a solution of a salt of baryta — the Nitrate of baryta, or the Chlo- ride ofbarivm. Having ascertained by test-paper that the liquid is acid, we add to a portion of it a few drops of nitric acid, and then a solution of nitrate of baryta. If sulphuric acid be present, a dense white precipitate of sulphate of baryta will fall down — which is insoluble in all acids and alkalies. If this precipitate be collected, dried, and heated to redness in a small platina cru- cible, or in a folded piece of platina foil, with five or six parts of charcoal powder, it will, if a sulphate, be converted to sulphuret of barium. To prove this, we add to the calcined residue, hydrochloric acid, at the same time sus- pending over it a slip of filtering paper moistened with a solution of acetate SULPHATE OF INDIGO. 51 of lead, or, what is more convenient, we place the residue on a slip of glazed card (coated with carbonate of lead), scraped and wetted on the surface. (The card should be first tested for lead ; because some kinds of glazed cards are made without lead.) If the original precipitate was a sulphate, the gas now evolved will be sulphuretted hydrogen, known by its odor, and by its turning the salt of lead, or staining the card of a brown color. The smallest visible quantity of sulphate of baryta thus admits of easy detection. In liquids containing organic matter. — If sulphuric acid is mixed with such liquids as porter, coffee, or tea, the process for its detection is substantially the same, the liquid being rendered clear by filtration through paper or well- washed gun-cotton previously to adding the test. The sulphate of baryta, if mixed with organic matter, may be purified by boiling it in strong nitric acid ; but this is not commonly necessary, as the reduction of the dried pre- cipitate may be equally well performed with the impure, as with the pure sulphate. Some liquids generally contain sulphuric acid or a sulphate, such as vinegar and porter, but the acid is in minute proportion ; therefore, if there- is an abundant precipitate, there can be no doubt, ccBteris paribus, that free sulphuric acid has been added to them. Should the liquid be thick and viscid like gruel, it may be diluted with water, and then boiled with the addition of a little acetic acid. For the action of the test, it is not neces- sary that the liquid should be absolutely clear, provided it be not so thick as to interfere mechanically with the precipitation of the sulphate of baryta. So far with regard to articles administered, or of which the administration has been attempted. A similar process may be applied to the examination of matters vomited and of the contents of the stomach — care being taken to separate the insoluble parts by filtration, before adding the test. On solid organic substances. — It sometimes happens in cases of poison- ing by sulphuric acid that it is spilled upon articles of clothing, such as cloth or linen, and here a medical jurist may succeed in detecting it, when every other source of chemical evidence fails. Again, sulphuric acid is often used for the purpose of seriously injuring a party, as by throwing it on the per- son — an offence which, when accompanied with bodily injury, renders the offender liable to a severe punishment. On such occasions, proof of the corro- sive nature of the liquid is required-; and this is easily obtained by a che- mical examination of a part of the dress. The process of analysis is very simple. The piece of cloth should be digested in a small quantity of dis- tilled water at a gentle heat, whereby a brownish-colored liquid is obtained on filtration. If sulphuric acid is present, the liquid will have a strong acid reaction, and produce the usual effects with the barytic test. Old stains are known by the complete destruction of the organic fibre. Sulphate oi' Indigo. Several cases of accidental poisoning by this substance have occurred. As the compound is nothing more than a solution of indigo in strong sul- phuric acid, the symptoms and appearances after death are the same as those which have been described for the latter substance. This kind of poisoning may be suspected when, with these symptoms, the membrane of the mouth has a blue or blue-black color. The vomited matters, as well as the feces, are at first of a deep blue-black tint ; afterwards green ; and it was observed in two instances that the urine voided by the patients had a blue tinge. It is proper to notice, that as indigo is one of the substances now directed by the statute to be mixed with arsenic when sold in small quantities, the detection of this coloring principle in the mouth and vomited matters will not necessarily show that it has been taken in the form of sulphate. 52 NITRIC ACID — SYMPTOMS. CHAPTEE VI. POISONING BT NITRIC ACID OR AQUA FOKTIS.— ACTION OT THE CONCENTRATED ■ ACID— APPEARANCES AFTER DEATH— QUANTITY REQUIRED TO DESTROY LIFE. —PERIOD AT -WHICH DEATH TAKES PLACE.— PROCESSES FOR DETECTING THE POISON IN PURE AND ORGANIC LIQUIDS.— POISONING BY HYDROCHLORIC ACID. Nitric acid is popularly known under the name of aqua fortis, or red spirit of nitre. According to Tartra, it seems to have been first used as a poison about the middle of the fifteenth century. Although it is perhaps much more used in the arts than oil of vitrol, cases of poisoning by it are by no means common. Symptoms. When the acid is in a concentrated , state, the symptoms, on the whole, bear a close analogy to those produced by sulphuric acid. They come on immediately, and the swallowing of the acid' is accompanied by in- tense burning pain in the throat and gullet, extending downwards to the stomach: there are gaseous eructations, from the chemical action of the poi- son — swelling of the abdomen, violent vomiting of liquid or solid matters, mixed with altered blood of a dark-brown color, and shreds of mucus, having a strong acid reaction. The abdomen is generally exquisitely tender; but in one well-marked case of poisoning by this acid, the pain was chiefly con- fined to the throat : probably the poison had not reached the stomach. The mucous membrane of the mouth is commonly soft and white, after a time be- coming yellow, or even brown ; the teeth are also white, and the enamel is partially destroyed by the chemical action of the acid. There is great diffi- culty of speaking, as well as of deglutition, the mouth being filled with viscid mucus: the power of swallowing is sometimes entirely lost. On opening the mouth, the tongue may be found swollen, and of a citron color; the tonsils are also swollen and enlarged. The difficulty of respiration is occasionally such, as to render tracheotomy necessary, especially in young persons. (See case by Mr. Arnott, Med. Gaz., 12, 220.) As the symptoms progress, the pulse becomes small, frequent, and irregular — the surface of the body ex- tremely cold, and there are frequent rigors (shivering). The administration of remedies — even the swallowing of the smallest quantity of liquid, increases the severity of the pain, occasions vomiting, and gives rise to a feeling of , laceration or corrosion. {Tartra, 144.) There is obstinate constipation. Death takes place in from eighteen to twenty-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. In one instance the patient was insensible, but she ultimately recovered. Death may be oc- casioned by this acid, in consequence of its action on the larynx, as in the case of sulphuric acid. Should the patient survive the first effects of the poison, the mucous membi-ane of the throat and gullet may be discharged, either in Irregular masses, or in the form of a complete cylinder of the (Eso- phageal lining. There is great irritability of the stomach, with pain on taking food, frequent vomiting and ultimate destruction of the powers of digestion : the patient becomes slowly emaciated, and dies, sometimes after many months, from starvation or exhaustion. A man swallowed nitric acid in beer : he recovered from the first symptoms, but died six months after- wards, evidently from the injury caused by the poison to the mucous lining of the stomach. He suffered from pain and from such irritability in this organ, that neither solids nor fluids could be retained. (Lancet, Nov. 24, 1860, p. 510.) NITKIC ACID — APPEARANCES AETEE DEATH. 53 The vapor of this acid may destroy life. In March, 1854, Mr. Haywood, a. chemist of Sheffield, lost his life under the following circumstances: He was pouring a mixture of nitric and sulphuric acfds 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, there was difficulty of breathing, with increase of the cough. 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 trachea 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 slightly infiamed. The blood gave a slightly acid reaction with 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 inflammatory effusion and enlargement of the parts about the opening of the windpipe. {Lancet, April 15, 1854, p. 430.) The vapors produced by a mixture of strong nitric and sulphuric acids are of a most noxious and irritating kind. On one occasion, in preparing gun- cotton, I accidentally inhaled the vapor, and suffered from severe constriction of the throat, tightness in the chest, and cough for more than a week. Appearances after death. — Supposing death to have taken place rapidly, the following appearances will be met with. The skin of the mouth and lips will present various shades of color, from an orange-yellow to a brown ; it appears like the skin after a blister or burn, and is easily detached from the subjacent parts. Yellow spots, produced by the spilling of the acid, may be found about the hands and neck. A yellow frothy liquid escapes from the nose and mouth, and the abdomen is often much distended. The membrane lining the mouth is sometimes white, at others of a citron color ; the teeth are white, but present a yellowish color about the coronas. The pharynx and larynx are much inflamed; the latter sometimes oedematous. The lining membrane of the gullet is softened, and of a yellow or brown color, easily detached, often in long folds. The trachea is more vascular than usual, and the lungs are congested. The most strongly-marked changes are, however, seen in the stomach. When not perforated, this organ may be found dis- tended with gas — its mucous membrane partially inflamed, and covered by patches of a yellow, brown, or green color, or it may be even black. This green color is due to the action of the acid on the coloring matter of the bile ; but it must be remembered that a morbid state of the bile itself may give this appearance to the mucous membrane in many cases of death from natural disease. There is occasionally inflammation of the peritoneum, and the stomach is glued to the surrounding organs. Its coats are often so much softened, as to break down under the slightest pressure. In the duodenum, similar changes are found; but in some cases the small intestines have pre- sented no other appearance than that of slight redness. It might be sup- posed that the stomach would be in general perforated by this corrosive liquid ; but this appearance has not been often observed. Tartra only met with two instances, and in one of these the person survived twenty, and in the other thirty hours. In giving this poison to rabbits, I have not found the stomach perforated, although the acid had evidently reached that organ, as its coats were stained of a deep yellow color. In these experiments, the non-perforation appeared to be due to the protective influence of the food with which the stomach was distended. In the few cases that are reported in English journals, it would appear that the stomach has not been perforated; 54 NITRIC ACID — CHEMICAL ANALYSIS. tlie poison had been swallowed soon after a meal, and its coats had thus escaped the corrosive action of the acid. In the case above referred to (p. 53), 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 harden- ing of the surrounding mucous membrane, causing a slight contraction of the pyloric orifice. The only other appearance consisted in some dark longi- tudinal lines on the posterior surface of the lining membrane of the gullet. This had probably been caused by the acid. {Lancet, Nov. 24, 1860, p. 510.) Quantity required to destroy life. — The smallest quantity of this acid which I find reported to have destroyed life, is about two drachms. It was in the case of a boy, aged thirteen ; he died in about thirty-six hours. But less than this, even one drachm, would doubtless suffice to kill a child ; and, under certain circumstances, an adult; for the fatal result depends on the extent of the mischief produced by this corrosive poison in the windpipe, gullet, and stomach. What is the largest dose of concentrated acid from the effects of which a person has recovered, it is difficult to say; since in most of the cases of recovery mentioned by authors, the quantity of the poison taken was unknown. Period at wMch death talces place. — Sobernheim relates a case of poisoning by nitric acid, which proved fatal in one hour and three-quarters. {Op. cit., 402.) This I believe to be the most rapidly fatal case ou record, where the acid acted as a poison. The usual well-marked effects were found in the gullet, stomach, and small intestines. In infants, however, life may be de- stroyed by this poison in a few minutes, should it happen to affect the larynx. The longest case is, perhaps, that recorded by Tartra, where a woman per- ished from exhaustion, produced by the secondary effects of the poison, 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. 2. By its staining organic matter yellow or brown, the color being heightened and turned to a reddish tint by contact with caustic alkalies. 3. When mixed with a few copper cuttings, it is rapidly decom- posed — a deep red acid vapor is given off, aud 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 hydro- chloric acid. On warming the mixture if nitric acid be present the gold is dissolved. Common aqua fortis (nitric acid) frequently contains as impurity a sufficiency of hydrochloric acid to dissolve gold-leaf by heat. In the diluted state. — This acid is not precipitated like the sulphuric by any common reagent, since all its alkaline combinations are soluble in water. — 1. The liquid has a highly acid reaction, and on boiling it with some copper turnings, red fumes of nitrous acid vapor are given off, unless the proportion of water be very great. At the same time, the liquid acquires 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 liquid is neither precipitated by nitrate of baryta nor by nitrate of silver. These two last experiments give merely negative results — they serve to show that the sulphuric and hydrochloric acids are absent. In order to detect nitric acid, the liquid should be carefully neutralized by potash, and then evaporated slowly to obtain crystals. If the liquid con- tain nitric acid, these crystals will possess the following characters : 1. They appear in the form of lengthened fluted prisms, which neither effloresce nor deliquesce on exposure. One drop of the solution evaporated spontaneously on glass will suffice to yield distinct and well-formed prismatic crystals. This HYDROCHLORIC ACID. 55 character distinguishes the nitrate of potash from a large number of salts. 2. When moistened with strong sulphuric acid, the powdered crystals 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 their bulk of fine copper filings. The mass is then to be moistened with water, and a few drops of strong sulphuric acid added. Either with or without the application of a gentle heat, a de- composition immediately ensues, by which red fumes of nitrous acid are evolved, recognizable by their color, odor, and acid reaction. 4. We add to the crystals a small piece of gold-leaf and hydrochloric acid; then boil for a few minutes. The gold will either wholly or entirely disappear if nitric acid or a nitrate be present. Its partial solution will be indicated by a dark purple color on the addition of chloride of tin to the liquid after boiling. In liquids containing organic matter. — Nitric acid may be administered in such liquids as tea, vinegar, or porter. In this case, besides the acid reaction, there will be a peculiar smell produced by the acid, when mixed with sub- stances of an organic nature. 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 fumes of nitrous acid are not evolved on boiling the liquid with copper cuttings. If the liquid is viscid this viscidity must be destroyed by dilution with water: and in all cases, if any solid or insolu- ble substances be present, as in the matters vomited or contents of the stomach, it must be filtered, in order to separate the insoluble portions. This opera- tion is commonly very slow. If we succeed in procuring a clear acid liquor, the color may be disregarded. We should then carefully neutralize it with a weak solution of carbonate of potash. The liquid may be concentrated to a small bulk by evaporation, and a few drops crystallized on a piece of glass. The resulting crystals may be examined for those properties which have been described as characteristic of the compound of potash with nitric acid. The crystals so obtained may be colored and impure. This circumstance does not at all interfere with the action of the most important test for nitric acid, namely the mixture of copper filings and sulphuric acid. The crystals may, however, if necessary, be purified by washing them with ether or alcohol. These liquids do not dissolve the nitrate of potash, but will often serve to remove from it the organic matters by which it is colored. When either the nitric acid, or the nitrate to which it has been converted, is mixed with com- mon salt, the copper test cannot be employed. The gold test will in such a case furnish the best evidence. Hydrochloric acid may be added to the dried resi- due, with a small portion of gold-leaf, and the mixture boiled. If nitric acid or a nitrate be present, even in minute proportion, some portion of the gold will be dissolved — a fact demonstrable by the addition of chloride of tin. Nitric acid may be detected in stains on clothing, if recent, by simply boil- ing the stained cloth in water, with or without the addition of a small quan- tity of carbonate of potash. The carbonate must be used when an acid liquor is not obtained by boiling the stained cloth in distilled water. Hydrochloric Acid. This acid, which is also called muriatic acid, and is popularly known under the name of spirit of salt, is but seldom taken as a poison. In the few cases which have been hitherto observed, the symptoms and appearances have been similar to those caused by nitric acid. One of the most recent cases of poi- soning bv this acid occurred in King's College Hospital, in May, 1859. A woman, »t. sixty-three, swallowed half an ounce of concentrated hydrochloric acid. She was received into the hospital in three-quarters of an hour. The •prominent symptoms were burning pain in the throat and stomach, feeble 56 OXALIC ACID — SYMPTOMS. palse, cold and clammy skin, retching, and vomiting of a brown matter streaked with blood and containing shreds of membrane. There was great exhaustion. The throat became swollen, the patient lost the power of swal- lowing, 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 were white, softened, and stripped in many places by the corrosive action of the acid. The membrane of the gullet was red and in- flamed. The back part of the stomach near the pylorus was black, stripped of its mucous membrane (which was generally softened), and marked with black lines. It was not perforated. (Lancet, July 16, 1859, p. 59.) In.this case the smallest quantity of hydrochloric acid was taken which has as yet been known to prove fatal. T have elsewhere related a case of poisoning by this acid {Guy's Hosp. Sep., Oct. 1850, p. 211); and for other cases in which an ounce was taken and the persons recovered, see Lancet, July 2T, 1850, p. 113, and the Medical Gazette, Dee. 28, 1849. For a more detailed account of poisoning by this acid, see On Poisons, second Am. edition, p. 265. CHAPTER VII. poisoning by the vegetable acids. oxalic acid — symptoms and efiects — appeakances after death — fatal doses — eecovery feom labge doses — period at which death takes place — chemical analysis — tests for oxalic acid in pure and mixed liquids — binoxalate of pot- ash, tartaric acid. acetic acid. vinegar. Oxalic Acid. Symptoms. — In many instances of poisoning by oxalic acid, death has taken place so rapidly, that the individual ias not been seen alive by a medical practitioner. If the 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 ex- perienced in the act of swallowing it. This is accompanied by a similar sensation extending through the gullet to the stomach. There is sometimes a sense of constriction or suffocation; the countenance is livid, and the sur- face of the skin soon becomes cold and clammy. Yomiting occurs either immediately or within a few minutes. Should the poison be 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 symptom has been incessant until death. In a case which occurred to Dr. Page, in which an ounce of the acid was swallowed, the vomiting with pain in the stomach continued until the fifth day, when the man died suddenly. {Lancet, Nov. 24, 1860, p. 509.) In a case in which the poison was much diluted, vomiting did not occur for seven hours. (Christison, 221.) The vomited matters are highly acid, and have a greenish-brown or almost black color ; they consist chiefly of mucus and altered blood. In one instance, reported by Dr. Geoghegan, they were colorless. {Medical Gazette, vol. xxxvii. p. 792.) In another case, reported by Mr. Deane in the Provincial Journal, fluid blood of a bright arterial color was vomited after some hours. (June 25, 1851, p. 344.) There is great pain and tenderness in the abdomen, with a burning sensation in the stomach. There are cold clammy perspirations and convulsions. In a case OXALIC ACID — APPEARANCES. 5T which occurred at Guy's Hospital, in May, 1842, in which about two ounces of the poison had been swallowed, there was no pain. Violent vomiting and collapse were the chief symptoms. There is, in general, an entire prostra- tion of strength, so that, if the person is in the erect 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 towards the abdomen. The pulse is small, irregular, and scarcely perceptible; there is a sensation of numbness in the extremities, and the respiration, shortly before death, becomes spasmodic. T^e inspirations are deep, and a long interval elapses between them. Such are the symptoms commonly observed in a rapidly fatal case. Should the patient survive the first effects of the poison, the following symptoms appear: there is soreness of the mouth, constriction and burning pain in the throat, with pain in swallowing — tenderness in the abdomen, and irritability of the stomach, so that there is frequent vomiting, accompanied by purging. The tongue is swollen, and there is great thirst. The patient may slowly recover from these symptoms. In a case related by Mr. Edwards to the Westminster Medical Society, the patient, a female, lost her voice for eight days. In the early editions of this work, I have treated it as doubtful whether the loss of voice in this case depended on the action of the poison. A case has, however, been reported by Mr. T. W. Bradley, from which it may be inferred that loss of voice may result from the direct effect of oxalic acid on the nervous system. A man swallowed a quarter of an ounce of the acid, and suffered from the usual symptoms in a severe form. In about nine hours his voice, although naturally deep, had become low and feeble. This weakness of voice remained for more than a month, and its natural strength had not returned even after the lapse of nine weeks. During the first month there was numbness, with tingling of the legs. {Med. Times, Sept. 14, 1850, p.. 292.) The occurrence of this sensation of numbness, and its persistence for so long a period after recovery from the symptoms of irritation, clearly point to a remote effect on the nervous system. Spasmodic twitchings of the muscles of the face and extremities have also been observed in some instances. (See Lancet, March 22, 1851, page 329.) Appearances after death The mucous membrane of the tongue, mouth, throat, and gullet, is commonly white, as if bleached, but it is sometimes coated with a portion of the brown mucous matter discharged from the stomach. This latter organ contains a dark brown mucous liquid, often acid, and having almost a 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 have taken place rapidly. This 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 water. The small vessels are seen ramifying over the surface, filled with dark-colored blood, apparently solidified within them. The lining membrane of the gullet presents the same characters. It is pale, and appears as if it had been boiled in water, or digested in alcohol ; it has been found strongly raised in longitudinal folds, interrupted by patches where the membrane has become abraded. In a case which was fatal in eight hours, the tongue was covered with white specks ; the gullet was not in- flamed, 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 be protracted, the appearances in the bowels are not strongly marked In a well-marked case of poisoning by this acid however, which is recorded by Dr. Hildebrand, the mucous or lining 58 OXALIC ACID — FATAL DOSE. membrane of the stomach and duodenum was much reddened, although the patient, a girl of eighteen, died iu three quarters of an hour after taking one ounce of the acid, by mistake for Epsom salts. (Casper's Vierteljahrschrift, 1853, 3 B. 2 H. page 256.) In a case of poisoning by this acid, in which two ounces had been taken, and death was rapid, the coats of the_ stomach presented almost the blackened 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 a case 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, Nov. 24, 1860, p. 509.) I am indebted to Mr. Welch for the following case : A woman, aged twenty-eight, swallowed three drachms of the crystallized acid. She was found quite dead in one hour afterwards. On examining the body, both lungs were observed to be extensively congested, and the heart and large vessels were full of dark-colored blood. The stomach contained about three quarters of a pint of a dark-brown fluid, and its lining membrane was gene- rally reddened. The other organs, except the brain, were healthy, and this presented appearances indicative of long-standing disease. This case is remarkable from the smallness of the dose, the rapidity of death, and the well-marked redness of the mucous membrane of the stomach. The diseased state of the body may have tended to accelerate death from the poison in this case. In one instance the larynx was found filled with frothy mucus, and the left side of the heart and the lungs were gorged with dark-colored fluid blood. In a few cases there have been scarcely any morbid appearances produced. It is worthy of remark that 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 a strongly corrosive action on the stomach, like that possessed by the mineral acids. It is therefore rare to hear of the coats of the organ being perforated by it. In many experiments on animals, and in some few observations on the human subject, I have found nothing to bear out the view that perforation is a common effect of the action of this poison. The acid undoubtedly renders the mucous coat soft and brittle, and perfora- tion of the coats may occur either during life or after de«.th as a result of this chemical action. Dr. Wood has recorded the case of a female, set. twenty-seven, found dead, whose death had been obviously caused by oxalic acid, but the quantity taken, and the duration of the case, were unknown. The stomach presented, at its upper and fore part near the cardiac opening, an irregular aperture of a size to admit the point of the finger. From this a dark gelatinous-looking matter, resembling coflfee-grounds, was escaping in abundance. The perforation was enlarged by remova,l, and presented the appearance of two large apertures separated by a narrow band. The sto- mach contained a bloody fluid, in which oxalic acid was detected, and the mucous membrane had an eroded appearance. The small intestines (jejunum and ileum) were similarly afl'ected. Quantity required to destroy life. — The smallest quantity of this poison which has been known to destroy life was one drachm (sixty grains). The boy set. sixteen, was a patient of Dr. Barker's, of Bedford, lie took 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, Dec. 1, 1855.) In Mr. Welch's case (suprk) three drachms destroyed life in an hour. 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 is upwards of OXALIC ACID — CHEMICAL ANALYSIS. 59 half an ounce, death is commonly the result ; but one of my pupils informed me of a case in which a man recovered after having taken one ounce of crys- tallized oxalic acid. Dr. Brush, of Dublin, has communicated to the Lancet a casein which recovery took place after a similar dose of the poison had been taken. (See also a case by Mr. Allison in the same journal, Nov. 2, 1850, p. 502.) The acid was in this instance taken in mistake for Epsom salts. Period at which death takes place. — Eqnal quantities of this poison do not destroy life within the same period of time. In two caseo, in which about two ounces of the acid were respectively taken, one man died in twenty min- utes — the other in three-quarters of an hour. Dr. Christison mentions an instance in which an ounce killed a girl in thirty minutes ; and another in which the same quantity destroyed life in ten minutes ; but in a third case (p. 56) death did not occur until the fifth day. Dr. Ogilvy, of Coventry, has reported a case of poisoning by oxalic acid, in which it is probable that death took place within three minutes after the poison had been swallowed. The sister of the deceasejd had been absent from the room about that period, and on her return found her dying. The quantity of poison taken could not be determined. When the dose of oxalic acid is half an ounce and upwards, death commonly takes place in an hour. There are, it must be admitted, numerous exceptions to this rapidity of action. Dr. Christison reports two cases, which did not prove fatal for thirteen hours ; and in an instance that occurred to Mr. Frazer, in which only half an ounce was taken, the individual died from the secondary effects in a state of perfect exhaustion, twenty-three days after taking the poison. Chemical analysis. In the simple state This acid may be met with, either as a solid, or in solution in water. Solid oxalic acid: It is seen more or less perfectly crystallized in four-sided prisms, in which respect it differs from all other common acids, mineral and vegetable. The crystals are unchangeable in air : they are entirely volatile by heat. They are soluble in water and alcohol, forming a strongly acid solution. 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 would be always advisable to concentrate the liquid by evaporation before applying it. The oxalate of silver is identified by the following properties : 1. It is completely dissolved by cold nitric acid. If collected on a filter, thoroughly dried, and heated on thin platina foil, it is entirely dissipated in a white vapor with a slight detonation. When the oxalate is in small quantity, thisdeto- natioD may be observed in detached particles on burning the filter previously well dried. 2. Sulphate of lime A solution of oxalic acid is precipitated white by lime-water and all the salts of lime. Lime-water is itself objection- able as a test, because it is precipitated white by several other acids. The salt of lime, 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 suspected poisonous liquid. A fine white precipitate of oxa- late of lime is slowly formed. This precipitate should possess the following properties: 1. It ought to be immediately soluble in nitric acid. 3. It ought not to be dissolved by the tartaric, acetic, or any vegetable acid. In liquids containing organic matter. — The process is the same, whether it be applied to liquids in which the poison is administered, or to the matters vomited, or, lastly, to the contents of the stomach. This poison readily com- bines with albumen and gelatin, and it is not liable to be decomposed or precipitated by these or any other organic substances ; it is, therefore, com- monly found in solution in the liquid portion, which will then have a greater 60 SALT OP SORREL — SYMPTOMS. or less acid reaction. Should the liquid be very acid, we must filter it to separate any insoluble matters; should it not be very acid, the whole may be boiled, if necessary, with distilled water, before filtration is performed. ^ On no account are the tests for oxalic acid to be employed in liquids containing organic matters, since nitrate of silver is easily precipitated by such matters, although none of the poison is present. Should the acid liquid be highly colored, it may be first boiled for some time with well-washed animal char- coal. After this it may be filtered and concentrated by evaporation. To the filtered liquid, 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 would exist in this precipitate under the form of oxalate of lead. The following plan may be adopted for separating oxalic acid from the oxalate of lead : Diffuse the precipitate in water, and pass into the liquid for about half an hour a current of sulphu- retted hydrogen gas, taking care that the gas comes in contact with every portion of the precipitate. Black sulphuret of lead will be precipitated; and with it commonly the greater part of the organic jnatter, which may have been mixed with the oxalate of lead. Filter, to separate the sulphuret of lead; the filtered liquid may be clear and highly acid. Concentrate by evaporation; the sulphuretted hydrogen dissolved in the liquid is thereby expelled, and oxalic acid may be ultimately obtained crystallized by slow evaporation in a watch-glass. If there was no oxalic acid in the precipitate, no crystals will be procured on evaporation. If crystals are obtained, they must be dissolved in water, and tested in the manner above directed. The quantity of this poison found in the stomach is generally small. In one case, in which about an ounce and a half had been taken, and the person died in two hours, I found only thirteen grains. This is owing to the ejec- tion of the greater portion by vomiting. In the case of Reg. v. Cochrane (Liverpool Summer Assizes, 1857), in which it was charged that two chil- dren, aged six and four years respectively, had been wilfully poisoned by their mother, it was stated by the medical witness. Dr. Edwards, that he found forty-two grains of oxalic acid in the stomach of the elder, and twenty grains in that of the younger child. It was not clearly established when or how this large quantity of poison could have been administered to the chil- dren, and the prisoner was acquitted. BiNOXALATE OP PoTASH, OR SaLT OP SORREL. Symptoms and effects. — The poisonous effects of this salt entirely depend on the oxalic acid which it contains. It is said to be much used for the purpose of bleaching straw and removing ink stains — being sold under the name of essential salt of lemons. Its poisonous properties are not generally known, or no doubt it would be frequently substituted for oxalic acid. Out of three cases of poisoning by this substance, two 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 by any one for an hour and a half; she 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 the 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 stomach. During the state of depression, it was remarked that the conjunctiva (mem- branes of the eyes) were much injected, and the pupils dilated. There was also great dimness of vision. {Med. Gaz., vol. xxvii. p. 480.) In another case, "two hundred and twenty-five grains were taken (rather more than half TARTARIC ACID — ACETIC ACID. Gl an ounce). Bicarbonate of soda was given as an antidote, and the patient completely recovered. (Med. Times and Gazette, Feb. 12, 1859.) The re- covery must have taken place in spite of the antidote — the oxalate of soda being just as poisonous as the oxalate of potash. For a third case of recovery see the same journal, Oct. 15, 1859, p. 378. This salt destroys life almost as rapidly as oxalic acid itself; and in the symptoms vehich 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 probably the fatal effects were in this instance accelerated by the debilitated state of the person who took it. In another ease, reported by M. Chevallier, death took place in ten minutes. (Ann. d^Hyg., 1850, vol. i. p. 162.) Chemical analysis. — Its solution in water might be readily mistaken for oxalic acid : for, 1st, it has an acid reaction ; and, 2d, it is precipitated by nitrate of silver and sulphate of lime, like oxalic acid ; but with the latter ^est the precipitation is much more copious. It is distinguished from oxalic acid — 1. By its crystalline form, which, as seen in a few drops evaporated on glass, is prismatic, or plumose; and, 2. By heating a portion on platina foil. While oxalic acid is volatile, the binoxalate leaves an ash, which, when sufficiently calcined, is alkaline; and it may be proved to contain pot- ash by its dissolving in diluted nitric acid, with effervescence, and forming nitrate of potash. Tartaric Acid. Symptoms and appearances. — Tartaric acid has not been considered to possess any poisonous properties ; but one case has occurred, in which there was no doubt that it acted as an irritant, and destroyed life. The case re- ferred to was the subject of a trial for manslaughter at the Central Criminal Court {Reg. v. Watkins), in January, 1845. The accused gave the deceased, a man aged twenty-four, by mistake, one ounce of tartaric acid instead of aperient salts. The deceased swallowed the whole dissolved in half a pint of warm water at a dose ; he immediately exclaimed that he was poisoned ; he complained of having a burning sensation in his throat and stomach, as though he had drunk oil of vitriol, and that he could compare it to nothing but being all on fire. Soda and magnesia were administered with diluent drinks. Yomiting set in, and continued until death, which took place nine days afterwards. On inspection, nearly the whole of the alimentary canal was found highly inflamed. The accused admitted that he had made a mis- take, and tartaric acid was found in the dregs of the cup. The jury acquitted the prisoner. Another case of poisoning by this acid, with a report of the results of analysis, has been published by M. Devergie. {Ann. d''Hyg., 1851, vol. ii. p. 432.) This case gave rise to a controversy between the late M. Orfila and M. Devergie, the points in dispute relating chiefly to the processes for the detection of the acid in the stomach and tissues. (See Ann. d'Hyg., 1852, vol. i. pp. 199, 382, and vol. ii. p. 230.) Acetic Acid. This acid has been generally excluded from the class of poisons. Common vinegar, which contains only five per cent, of acetic acid, has often been taken in large doses without injurious consequences. From the experiments per- formed by Orfila on dogs, and from one case which he reports as having occurred in the human subject, acetic acid, when concentrated, appears to exert an irritant action on the body. {Annales d'JIygihne, 1831, vol. ii. p. 159: also Toxicologie, vol. ii. p. 198.) This is not more than we might have G2 AROMATIC VINEGAR — POISONING BY ALKALIES. expected, seeing that the concentrated acid is highly corrosive. In the case referred to, the deceased, a young female aged nineteen, was found dying on the highway. She suffered from convulsions — complained of pain in the stomach, and died in a very short time. On inspection, the stomach was found neither softened nor corroded, but its mucous membrane near the pylorus was almost black. The mucous glands were prominent, and the vessels were filled with black coagulated blood. Vinegar, which may be regarded as an organic mixture containing but a very small proportion of acetic acid (five per cent.), may be examined by distilling a portion, and testing the distilled liquid for the acid. Yinegar, as it exists in commerce, always contains a small quantity of sulphuric acid, and occasionally traces of arsenic and lead. In general it is easily recog- nized by its odor. Pelletan observed in the case of a child that the abuse of vinegar led to a thinning of the mucous membrane of the stomach; and Landerer remarked that the milk of a wet-nurse who had been in the habit of taking large quantities of the Vinegar of Roses, became thin, very acid,, •and deficient in casein and oil. The infant which she was suckling gradually wasted and died, and the woman herself suffered severely. (Heller's Archiv., 1847, 2 H. S. 185.) [Aromatic Vinegar, which is a stronger preparation (containing at least ninety per cent, of acetic acid), rendered still more irritating by the aromatic oils dissolved in it, may be unintentionally used in such a manner as to pro- duce very serious, if not fatal injury. We have attended a lady whose hus- band, in his anxiety to restore her from a fainting fit, had poured a quantity of aromatic vinegar into her nostrils. The result of this accident was the corrosion and subsequent- violent inflammation of the lining membrane of the nostrils and of the posterior surface of the soft palate. The same amount of irritation, extending into either the larynx or oesophagus, would probably have destroyed her life. — H."| CHAPTER VIII. poisoning by the alkalies. — POTASH, SODA, AND THEIR CARBONATES — SYMP- TOMS — FATAL EFFECTS OF THE CARBONATE OF POTASH — APPEARANCES AFTER DEATH — TESTS FOR POTASH AND SODA — AMMONIA AND SESQUICARBONATE OP AMMONIA (sal VOLATILE) — CHEMICAL ANALYSIS — TESTS FOR AMMONIA. Potash and Soda. Symptoms. — The symptoms produced by potash and soda, when taken in a large dose, are so similar that one description will serve for both. Cases of alkaline poisoning are extremely rare, and have been, generally, the result of accident. The most common form in which these poisons are met with, is in the state of pearlash (carbonate of potash) and soap-lees ("carbonate of soda). The patient experiences, during the act of swallowing, an acrid caustic taste, owing to the alkaline liquid, if sufficiently concentrated, exco- riating the mucous membrane. There is a sensation of burning heat in the throat, extending down the gullet to the stomach. Vomiting is not always observed ; but when it does occur, the vomited matters are sometimes mixed with blood of a dark brown color, and with detached portions of mucous membrane : this effect depending on the degree of causticity in the liquid POISONING BY POTASH AND SODA. 63 swallowed. The surface is cold and clammy : there is purging, with severe pain in the abdomen, resembling colic. The pulse is quick and feeble. In the course of a short time, the lips, tongue, and throat become swollen, soft, and red. Appearances after death. — In recent cases there are strong marks of the local action of the poison on the mucous membrane of the mouth, throat, and gullet. This niembrane has been found softened, detached, and inflamed in patches of a deep chocolate color — sometimes almost black. The same ap- pearance has been met with in the mucous membrane of the larynx and wind- pipe. The stomach has had its mucous surface eroded in patches, and there has been partial inflammation. In one instance as a result of the action of soda, I found it puckered and blackened. Period of death. — The most rapidly fatal case which I have found reported is that of a boy, who died in three hours after swallowing three ounces of a strong solution of carbonate of potash. In a case, which occurred in 1835, a child, aged three years, took a small quantity of pearlash, which had de- liquesced, and died in twenty-four hours. Death was caused in this instance by the inflammation induced in the larynx, causing an obstruction to the pro- cess of respiration. In this respect, the caustic alkalies may destroy life like the mineral acids. But death may be a slow result of these poisons. Thus in an instance which was communicated to me, a lady swallowed, by mistake, one ounce and a half of the common solution of potash of the shops, which contains about five per cent, of caustic alkali. She recovered from the first symptoms of irritation, but died seven weeks afterwards, from pure exhaus- tion, becoming greatly emaciated before her death. Dr. Barclay has reported a case of chronic poisoning by potash, which t furnishes a good illustration of the after-effects and appearances caused by this poison. A woman, aged forty-four, was admitted into St. George's Hospital, May 2, 1853, about six hours and a half after she had swallowed a quantity of American potash — probably a saturated solution of carbonate of potash (American pearlash). She had vomited immediately after taking it. The mouth and throat were much corroded. There was burning pain in the throat and gullet, extending downwards to the stomach ; but there was no tenderness on pressure. Two days after her admission there was a little vomiting. The mucous membrane, as far as it could be seen, was abraded ; there was difficulty of swallowing, and occasionally pain after food had en- tered the stomach. In about a month there was frequent vomiting, with pain on pressure, and constipation ; when food or medicine was taken, there was much pain in the stomach, and in a short time the food was ejected. As the case progressed nothing could be retained on the stomach, and shortly before death the patient was supported only by nutritive injections. She died from starvation on the 8th July, about two months after taking the alkali. On inspection the lower part of the gullet was found much contracted, the lining membrane entirely destroyed, and the muscular coat exposed. The external coats were much thickened. The cardiac orifice of the stomach, where the ulceration ceased, was considerably contracted. At the pyloric end, the mucous lining presented a large and dense cicatrix, obstructing all commu- nication with the duodenum except by an orifice no larger than a probe. The intervening portion of the stomach was healthy, as were also the large and small intestines. {Med. Times and Gazette, Nov. 26, 1853, p. 554.) Orfila refers to two cases of poisoning by carbonate of potash, in each of which half an ounce of this substance was taken by mistake for aperient salts. The patients, two young men, recovered from the first effects, but ultimately died : the one three months, and the other four months, after the poison had been taken. The secondary fatal effects appear to be due to constant purg- ing, great irritability of the stomach leading to incessant vomiting, or loss 64 POISONING BY AMMONIA. of the functions of this organ from the destruction of the liiling membrane, and stricture either of the gullet or of the apertures of the stomach — any of which causes may prove fatal at almost any period. A fatal case of stricture, produced by soap-lees after .the lapse of two years and three months, is re- ported by Dr. Basham {Lancet, March 2, 1850). The constant use of the alka- lies or their carbonates appears to be productive of latent mischief: yet the quantity which may be s'ometimes taken in divided doses without destroying life is enormous. Dr. Tunstall, of Bath, relates the case of a man who, for eighteen years had been in the habit of taking bicarbonate of soda to remove dyspepsia. It is stated that for sixteen years he took two ounces of the bi- carbonate daily I The man died suddenly, and on examining the stomach it was found to be greatly distended and extensively diseased — conditions which were referred by Dr. Tunstall to the action of the carbonate of soda. {Med. Times, Nov. 30, 1850, p. 564.) The quantity of any of these alkaline poisons required to destroy life is unknown. Chemical analysis. — Solutions of Potash and Soda are known from those of their respective carbonates by giving brown precipitates with a solution of nitrate of silver. The Carbonates, on the other hand, yield a whitish- yellow precipitate. Potash is known from Soda by the following characters : 1. Its solution, when not too much diluted with water, is precipitated of a canary-yellow color by perchloride of platina. 2. It is precipitated in granu- lar white crystals, on adding the alkaline liquid gradually to a strong solution of tartaric acid, and occasionally stirring the mixture, or by suspending in it a large crystal of tartaric acid. Soda is not precipitated by either of these tests, which will serve equally to distinguish the salts of potash from those of soda, if we except the binoxalate and bitartrate of potash : these, from being but little soluble in water, are not precipitated. 3. If we neutralize the two alkalies by diluted nitric acid, and crystallize the liquid on a slip of glass — should the alkali be potash, the crystals will have the form of long slender fluted prisms ; if soda, of rhombic plates. 4. Potash and its salts are known by their giving a violet color, while soda and its salts give a bright yellow color, to the flame of alcohol. In liquids containing organic matter Such liquids are frothy; they pos- sess an alkaline reaction, a peculiar alkaline odor, and are soapy to the feel. The organic liquid may be evaporated to dryness, then heated to char the animal and vegetable matter, and the alkali will be recovered from it in a state of carbonate, by digesting the residuary ash in distilled water. Ammonia. Spirit op Hartshorn. The vapor of strong ammonia is poisonous. It may destroy life by pro- ducing violent inflammation of the larynx, or by causing pneumonia. It is often most injudiciously employed to rouse persons from a fit. A case is on record of an epileptic having died under all the symptoms of cronp, two days after the application of strong ammonia to the nostrils. A singular case of recovery from the poisonous effects of this vapor, by Dr. Sanchard, will be found reported in the Annales d'ffygiene (Janvier, 1841). Symptoms. — The strong solution of ammonia produces symptoms similar to those described in speaking of potash. The only difference observed is, that the sense of heat and burning pain in the throat, gullet, and stomach, is much greater. Cases of this form of poisoning are rare. Dr. Sanchard re- lates an instance that occurred in France, in which a boy, only six years old, poisoned his younger sister by pouring several teaspoonfuls of a strong solu- tion of ammonia down her throat. A case is likewise reported, in which a strong dose of the solution killed a man in four minutes. {Christison, 167.) AMMONIA — SYMPTOMS — APPEARANCES. 65 Another case is referred to in the Journal de Pharmacie (Oct. 1846, p. 285), in which from one to two drachms of ammonia, unknowingly administered, caused death. There was violent vomiting, with bloody stools ; and, on inspection, blood was found effused in the intestines. There was also a remarkably fluid state of the blood in the body. In another instance, a man walked into a druggist's shop, and asked for a small quantity of ammonia to take spots out of his clothes. The druggist poured about a teaspoonful and a half into a glass. The man suddenly swallowed it, and fell instantly to the ground. He soon afterwards died, complaining of the most excruciating pain. (Journal de Cliimie Medicale, 1845, 531.) A similar case occurred at Halifax in April, 1857 : a man swallowed a large dose of ammonia, and died in a quarter of an hour. Serious injury to the organs of respiration is sometimes the result of the action of this poison, as in the following case, which was referred to me for examination by my colleague, Mr. Hilton, in May, 185T. A gentleman liable to attacks of fainting died in three days, after swallowing a quantity of a liquid administered to him by his son. This liquid, which was at _ the time believed to be sal volatile, was, in fact, a strong solution of ammonia. The deceased complained immediately of a sensation of choking and strangling in the act of vomiting. Symptoms of difficulty of breathing set in, with other signs of irritation in the throat and stomach. The mucous membrane of the mouth and throat was corroded and dissolved ; and it was evident that the liquid had caused great local irritation. The difficulty of breathing was such as to threaten suffocation, and at one time it was thought that an opera- tion must be resorted to. The state of the patient, however, precluded its performance, and he died on the third day. On inspection, the viscera pre- sented strong marks of corrosion. The covering of the tongue was softened, and had peeled off ; the lining membrane of the air-passages was softened and covered with layers of false membrane, the result of inflammation — the larger bronchial tubes were completely obstructed by casts or cylinders of this membrane. The lining membrane of the gullet was softened, and at the lower part near its junction with the stomach, the tube was completely dis- solved and destroyed. There was an aperture in the stomach in its anterior wall, about one inch and a half in diameter : the edges were soft, ragged, and blackened, presenting an appearance of solution. The contents of the stomach had escaped. Ou the inside, the vessels were injected with dark- colored blood, and there were numerous small effusions of blood in various parts of the mucous membrane. The coats were thinned and softened at the seat of the aperture. The blackened and congested appearance somewhat resembled that which is seen in poisoning by sulphuric or oxalic acid. The mucous matter on the coats of the stomach was feebly acid. No poison of any kind was found in the layer of mucus or in the coats. There was not in any part the slightest trace of ammonia, the poison which had caused the mischief. The deceased had lived three days : remedies had been used, and every trace of ammonia had disappeared. The immediate cause of death was an obstruction of the air tubes, as a result of inflammation, caused by the local irritant action of the poison. It was quite obvious that a quantity of the liquid had entered the windpipe. The perforation of the stomach had probably taken place shortly before death, or there would have been marks of peritonitis. The injury to the stomach and gullet would have been suffi- cient to cause dea,th, even supposing that the liquid had not penetrated to the lungs. Mr. Tyerman communicated to me the particulars of a case which occurred in Nov. 1858, in which a lunatic, set. sixty-two, swallowed about two fluid- ounces of compound camphor liniment. The patient immediately complained of great heat in the stomach ; vomiting was induced by giving to him warm 66 CAEBONATE OF AMMONIA, water. The uvula, throat, and gullet were so intensely inflamed that he had lost all power of swallowing ; and the efforts to swallow liquids produced violent retching. The symptoms gradually abated, and the man recovered in four days. In this case the quantity of ammonia swallowed was small, amounting to about two and a half drachms, diluted with about six times the quantity of rectified spirits. In the Medical Times and Gazette for May 26, 1855, there are two eases reported, in which children were poisoned by swal- lowing a liniment of ammonia and oil. In one, an infant, died speedily, probably from oedema and closure of the glottis. In the other case, death took place on the following morning. These cases prove that oil does not counteract the effects of alkaline poisons. Considering the hot taste of am- monia, it is remarkable that an infant could have had the power of swallowing nearly two ounces of strong ammoniacal liniment. It had been poured down its throat by another child of five years of age. Garhonate of ammonia. — The solution of this salt (sal volatile) is probably more active as a poison than is commonly supposed. The following case occurred to my knowledge in 1832. A man, in a fit of passion, swallowed about five fluidrachms of a solution of sal volatile. In ten minutes, he was seized with stupor and insensibility ; but upon the application of stimulant remedies he recovered. He suffered for some time afterwards, from severe irritation about the throat and gullet. Mr. Iliff, Jr., has reported the case of a little boy, aged two years, who swallowed about half an ounce of strong solution of spirits of hartshorn, and in spite of rather severe symptoms reco- vered in a few days. {Lancet, Dec. 1, 1849.) In a paper above referred to (p. 63), Dr. Barclay relates the case of a female, set. nineteen, who, while in a state of unconsciousness, was made to swallow a quantity of hartshorn. She felt a severe pain in the stomach immediately afterwards, and in about an hour she vomited some blood. This vomiting of blood continued for several days. These symptoms were fol- lowed by great irritability of the stomach, and the constant rejection of food. There was obstinate constipation of the bowels, with great emaciation and loss of strength. She died in about three months from the time at which she had swallowed the alkaline poison. On inspection, the gullet was found healthy; the orifice, at its junction with the stomach, was slightly contracted. The pyloric orifice was contracted to the size of a crowquill, and the coats were thickened. On the posterior wall of the stomach, there was a dense cicatrix of the size of half a crown, and from this point fibrous bands ramified in various directions. The duodenum and other parts of the intestinal canal were healthy. {Med. Times and Gazette, Nov. 26, 1853, p. 554.) A case occurred to Mr. Procter, in May, 1852, in which a woman gave to her infant, four weeks old, a teaspoonful of hartshorn of the strength of about nine per cent. The child became more and more depressed, and died thirty-six hours after taking the liquid. There was no vomiting or purging, and the mouth and throat presented no excoriation ; there was, however, slightly increased redness of the lining membrane. An examination after death was not made. The salts of ammonia are not often used by persons who are intent upon suicide or murder, but there is one instance on record in which a man was tried for the murder of a child by administering to it spirits of hartshorn. {Regina v. Haydon, Somerset Spring Assizes, 1845.) Of the action of the other compounds of ammonia on man, nothing is known. Chemical analysis. — The three alkalies, potash, soda, and ammonia, are known from the solutions of the alkaline earths by the fact that they are not precipitated by a solution of carbonate of potash. They all three possess a powerful alkaline reaction on test paper, which, in the case of ammonia, is easily dissipated by heat. Ammonia is immediately known from potash and soda by its odor and volatility. The carbonate of ammonia may be known SYMPTOMS OP POISONING BY PHOSPHORUS. 6Y from other salts by its alkaline reaetion, its odor, and its entire volatility as a solid: from pure ammonia — 1, by its effervescing on being added to an acid ; 2, by its yielding an abundant white precipitate with a solution of chloride of calcium ; from the carbonates of potash and soda, among other properties — 1, by its giving no precipitate with a solution of the sulphate of magnesia ; 2, from the rich violet blue solution which it forms when added in excess to the sulphate of copper ; 3, by its odor and volatility. CHAPTER IX. phosphorus — symptoms and appearances — chronic poisoning by the vapor — fatal dose — chemical analysis — phosphorus-paste — red or amorphous phosphorus. Phosphorus. Cases of poisoning by phosphorus appear to have been much more nu- merous in France than in England. M. Chevallier has collected seventy- four cases of poisoning by this substance, and in forty-two of these, the phosphorus was procured from lucifer matches. Among the cases, twenty- five were the result of accident, twenty-eight Involved a criminal charge, and twenty-one were the result of suicide. (Ann. d'Hi/giene, 18b1, vol. ii. p. 226.) The cases of poisoning by phosphorus in this country are not nume- rous. They are chiefly referable to accident or suicide. One trial for the criminal administration of phosphorus took place at the Bodmin Autumn Assizes, 185T, in which there was no doubt that death had been caused by phosphorus-paste. Symptoms. — Phosphorus acts as an irritant poison, but its operation is attended with some uncertainty, according to the state in which it is taken. The symptoms are frequently slow in appearing; it is only after some hours, and sometimes even one or two days, that signs of irritation with convulsions and spasms appear ; but when these once come on, the case proceeds rapidly to a fatal termination. In the first instance the patient experiences a disa- greeable taste, resembling garlic, which is peculiar to this poison. An allia- ceous or garlic odor may be perceived in the breath. There is an acrid burning sensation in the throat, with intense thirst, nausea, severe pain and heat with a pricking sensation in the stomach, followed by distension of the abdomen and frequent vomiting. The vomited matters are of a dark green or black color ; they have the odor of garlic, white vapors may be seen to proceed from them, and in the dark they may even appear phosphorescent. Purging has been noticed among the symptoms, and the motions have been observed to be luminous in the dark. The pulse is small, frequent, and scarcely perceptible. There is great prostration of strength, and coldness of the skin, with other symptoms of collapse. The patient may die quietly, or be convulsed before death. A woman, set. twenty-six, swallowed a decoction of lucifer matches in coffee. In an hour an emetic was given to her, and she vomited half a pint of clear glairy fluid, having the smell of phosphorus, and being intermixed with particles of blue coloring matter, from the matches. She had no pain in the stomach, and no purging. In four days she appeared to have reco- vered; but about this time there was bleeding from the nose; she was jaun- 68 EFFECTS OF PHOSPHOEUS IN VAPOR — APPEAEANCES. diced, and blood appeared in the matter vomited. Febrile symptoms set in with purpura, and she died in about a week after taking the poisop. {Ed. Monthly Journal, Oct. I860.) Phosphorus vapor. Chronic poisoning. — Chronic poisoning by phosphorus is accompanied by nauseous eructations, frequent vomiting, 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 by phosphorus from the re- searches of Dr. Strohl and others on the effects of the vapor upon individuals engaged in^the manufacture of phosphorus or lueifer matches. It has been remarked that persons thus engaged have suffered from necrosis of the jaw,' carious teeth, and abscesses. There has been also marked irritation of the respiratory organs, and bronchitis has frequently shown itself among them. These effects have been attributed to the respiration of the vapors of phos- phorus, which are supposed, in becoming acidified, to act chemically upon the bones. (See On Poisons, Am. ed., p. 313.) Appearances. — Among the appearances produced by this poison, we may be prepared to find marks of irritation and inflammation in the stomach and intestines. The stomach has been observed to be much contracted; and the mucous membrane inflamed, occasionally softened and presenting purple or violet-colored spots. Inflammation of the stomach and bowels proceeding to gangrene may be a result of the action of phosphorus. M. Worbe found the stomach perforated in three places in a dog which had been poisoned by a solution of phosphorus in oil. A man, set. fifty, took a quantity of phos- phorus-paste used for destroying vermin. He was seen in his usual health at twelve o'clock P. M., and was found dead in a field the following morning. On inspection, it was observed that there was great muscular rigidity. The membranes of the brain were much congested, and there was serous effusion between them. The substance of the brain was also congested. 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 mem- brane was destroyed. On opening the stomach a white smoke escaped, accompanied by a strong smell of phosphorus. It contained a tablespoonful of viscid greenish matter, from which particles of phosphorus with some Prussian blue (used as a coloring for the poison), subsided on standing. (Dr. Bingley, Lancet, June 13, 185*7, p. 600.) Mr. Herapath states that in a case which he examined he found, besides inflammation of the stomach, the mucous membrane raised in small bladders or vesications. This was pro- bably a change produced by putrefaction, as the body was not examined until twenty-three days after death. Such a blistered appearance is fre- quently seen in cadaveric inspections, and has not been observed in other cases of poisoning by phosphorus. Schuchardt describes, among the ap- pearances, fluidity of the blood, which is of a dark color, and does not become red on exposure to the air. Ecchymoses are sometimes found on the skin and on the surface of various organs. {Brit, and For. Med. Rev., 1857, vol. xix. p. 506. Journal de Ghimie M&dicale, 1857, p. 84.) In the case of the female described at page 67, who died after the lapse of a week, there was no inflammation, ulceration, or softening of the mouth, gullet, stomach, or small intestines. There was a red patch in the caecum and another in the colon. The contents of the stomach and intestines had a coffee-ground color, like the liquid found in hEematemesis. The brain was slightly congested. There were bloody effusions in the chest and abdomen, and an apoplectic condition of the soft organs. The vomited matters, when shaken in the dark, were phosphorescent, and phosphorus was separated from them by sulphide of carbon. The viscera, and even the flesh, of animals recently poisoned by phos- PHOSPHORUS — PATAl DOSE — CHEMICAL ANALYSIS. 69 phorus, have the odor of garlic, and appear luminous in the dark. (Galtier, Toxieoloffie, vol. 1. p. 184.) Mr. Clowes informed me that, in examining some fowls which had been poisoned with phosphorus, he was struck with the strong odor of this substance on opening the gizzards, and with the ap- pearance of a fine white fume, which was luminous when observed in a dark room. In the case of a woman who died while taking phosphorus medici- nally, it was remarked that the whole of the viscera of the body were lumi- nous; thus indicating the extensive diffusion of the poison by absorption. (Casper's Wochenschrift, 21 and 28 Feb. 1846, pp. 115, 135.) For a further account of the appearances, see Chemist, Jan. 1856, p. 244. Fatal dose — That phosphorus is a powerful poison, is proved by two cases quoted by Dr. 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. It is sup- posed to operate as a poison only by becoming converted to phosphorous acid ; but, although this conversion takes place, it is probable that it passes directly into the blood, since the urine passed during life has been observed to be luminous. The production of phosphorous acid may account for the erosions met with in the stomach and bowels. Dr. Hartcop mentions that an apothecary took, by way of experiment, one grain, the next day two grains, and the third day three grains of phosphorus mixed with sugar. He was then seized with inflammation of the stomach and bowels, and died in spite of every attempt to save him. (Casper's Wo- ehenschrift, 1846, p. 117.) M. Chevallier refers to a case in which a dose of 2.3 grains proved fatal, and two other cases in each of which a dose of 4.6 grains destroyed life. The same writer quotes, on the authority of Loben- stein Lobel, of Jena, the case of a lunatic who died from a dose of one-eighth of a grain. (Ann. d'Hi/ff., 185Y, vol. i. p. 422.) Excepting this, the smallest fatal dose which I have met with, is in a case quoted by Galtier. A woman, set. fifty-two, took in divided doses, in four days, about six centigrammes, or less than one grain of phosphorus dissolved. The largest dose taken at once, i. e. on the fourth day, is stated to have been three centigrammes (0.462 grain), or less than half a grain. Symptoms of pain and irritation appeared, and the patient died in three days. The gullet, stomach, and small intes- tines were found much inflamed. (Toocicologie, vol. i. p. 8*7.) When the phosphorus is dissolved in any liquid, or when it is finely divided, as in phos- phorus-paste or in lucifer matches, its action is then more powerful, as it is in a state well fitted for absorption. The earliest period at which death has taken place is four hours. This was in a case, related by Orfila, of a young man in weak health who took a dose of this poison. The same author mentions a case in which death did not take place until after the lapse of seventeen days. In general, several days elapse before a fatal result takes place, and during this time the patient undergoes much suffering. This was observed in a young female who swal- lowed a quantity of phosphorus-paste intended for poisoning rats. She did not die until the fifth day. {Journal de Ghimie Mid., 1845, p. 580.) Chemical analysis. — Phosphorus is a solid of waxy consistency, having a peculiar odor and 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 luminosity in the dark. It melts and takes fire at a temperature a little above 100°, burning with a bright yellow flame, and producing thick white acid vapors by combustion. . It is not soluble in water, but water in which it has been preserved or washed acquires poisonous properties by rea- son of the phosphorous acid formed. {Ann. d'Hyg., 1857, vol. i. p. 423.) It is soluble in alcohol and the oils, but especially in ether, sulphide of car- bon, and chloroform. '70 PHOSPHORUS — ORGANIC MIXTURES. Organic mixtures. — The smell which phosphorus imparts to organic sab- stances is remarkably characteristic and persistent. When it has been taken in a solid form, it may be separated as a sediment in fine particles by washing the contents of the stomach in water. If a portion of the organic liquid be exposed in the dark, the particles of phosphorus will be known by their lumi- nosity, as well as their combustion, when the surface on which the material is spread is heated. Phosphorus is very soluble in sulphide of carbon, and, it may be easily separated from organic matters by digestion with this liquid. On the spontaneous evaporation of the sulphide, decanted from the organic liquid or solid, the phosphorus may be procured in small globules or beads. The phosphorus thus obtained sometimes takes fire spontaneously, and burns with its well-known iiame. Phosphorus gives off no luminous vapor when alcohol or ether is present; but the process suggested by Mitscherlich for the detection of small quantities is not exposed to this difficulty. Mitscherlich adds to the organic substance a sufficiency of water to make it quite fluid, and a small quantity of sulphuric acid. This mixture is placed in a flask, connected with a long glass condens- ing tube, placed vertically and kept cool by a stream of cold water. The tube is fitted into a receiver. The suspected liquid is distilled in the dark, and if a minute trace of phosphorus be present — l-100,000th part, or, accord- ing to De Vrij, l-200,000th, the fact will be made evident by a luminous ap- pearance in the upper part of the tube, at each successive condensation of the vapors. (See Otto, Ausmittelung der Gifte, 1856, p. T8.) If ether or alcohol should be present, the vapors of these liquids are distilled over first. {Die Vergiftungen, Bbcker, ISST, p. 83.) In the receiver in which the vapor of the distilled liquid is condensed, phosphorus or phosphoric acid may be discovered by the usual tests. There can be no doubt of the facility and delicacy with which phosphorus thus admits of detection. In a case which occurred to Mr. Herapath, this chemist failed to detect any trace of phos- phorus in a body on the twenty-third day after death: hence, like other poisons, it is liable to disappear. Phosphorus sometimes contains arsenic : hence traces of this poison may occasionally be found. {Med. Gaz., vol. xxxv. page 655.) Red or Amorphous Phosphorus. — The remarkable substance, known under the name of allotropic phosphorus, is not possessed of poisonous properties. This fact, long since announced by Liebig {Letters on Chemistry, 165), has been confirmed by experiments at the Veterinary College of Alfort. {Ann. WHyg., 1857, vol. i. p. 432.) Common phosphorus is poisonous in doses varying from one to three grains, while amorphous phosphorus has been given to animals in doses of thirty-one grains Vithout causing symptoms of poisoning. The amorphous phosphorus, by reason of its being in a fine powder, is in a state more favorable for acting as a poison than common phosphorus, and yet it is inert! M. Bussy in 1850, and M. de Vrij in 1851, proved that a dog might take with impunity thirty grains. Orfila and Rigaut have given it to animals in doses amounting to some ounces, over a period of twelve days, without producing any noxious effects. (See Annuaire de Thirapeutique, 1855, p. 103.) That it does not act as a poison in the human body appears to be established by the facts of a case reported in the Edin- lurgh Monthly Journal fov October, 1860. A woman, eet. twenty-six, swal- lowed the composition scraped from a number of lucifer matches : it turned out that these were made with red or amorphous phosphorus. She suffered no inconvenience. She procured other matches of common phosphorus, took a decoction of them in coffee ; and she died from the effects. Considering that this body is simply phosphorus in an altered physical state, and that it is again changed to common phosphorus when heated to a high temperature, we have here the instance of the same substance being POISONING BY ARSENIC — SOLUBILITY, H poisonous in one molecular condition, and not poisonous in another 1 This is probably to be explained by the great insolubility of red phosphorus, and by the fact that it is not readily convertible to phosphorous acid. Red phos- phorus is easily known by heating it in air to about 500°, when it burns like common phosphorus. It is insoluble in all liquids, and by its insolubility in sulphide of carbon it is distinguished and separated from common phosphorus. It is not luminous in the dark, unless it contains common phosphorus. In any analysis for phosphorus, we must take care to exclude it by employing sulphide of carbon as a solvent for the common or poisonous form of phos- phorus. (The reader will find a full account of the comparative effects of the common and red phosphorus by M. Chevallier in the Annates d'JIygiene, 1856, vol. i. p. 314.) See also the same journal, 1859, vol. ii. p. 370, and Casper's Vierte/jahrsch, 1860, vol. ii. p. 185. CHAPTER X. METALLIC IRRITANT POISONS. ARSENIC — ARSENIOtTS ACID — TASTE — SYMPTOMS — CHRONIC POISONING — APPEARANCES AFTER DEATH — QUANTITY REQUIRED TO DESTROY LIFE — PERIOD AT WHICH DEATH TAKES PLACE — CHEMICAL ANA- LYSIS — TESTS FOR ARSENIC — MARSH'S PROCESS — REINSCH'S PROCESS. White Arsenic Arsenious Acid. The term White Arsenic is commonly applied to the arsenious acid of chemists. It is seen under the form of a white powder, or in opaque masses resembling enamel. It is called an acid from its power of combining with alkalies, but it possesses a feeble acid reaction when dissolved in water. It is often described as having an acrid taste, but this does not appear to be correct ; a small quantity of it has certainly no appreciable taste, a fact which may be established by direct experiment, and might be inferred from its spar- ing solubility in liquids. It would appear from numerous cases on record, that it has been unconsciously taken in fatal quantities, in all descriptions of food, without exciting the least sensation on the tongue. Most of those per- sons who have been criminally or accidentally destroyed by arsenic, have not been aware of any taste in taking the poisoned substance. In cases in which the powder has been taken in large quantity, it is described as having^ had a rouffhish taste. The solubility of this substance in liquids is a frequent question on trials. The action of water is materially influenced by circumstances. I have found by numerous experiments (Guy's Hospital Reports, No. 4, p. 81), that hot water in cooling from 212° on the poison in fine powder dissolves about the 400th part of its weight. This is in the proportion of nearly one grain and a quarter of white arsenic to about one fluidounce of water. Water boiled for an hour on the poison and allowed to cool, holds dissolved the 40th part of its weight, or about twelve grains in one ounce. If boiled for a shorter time not more than l-80th part will be dissolved. Cold water allowed to stand for many hours on the poison does not dissolve more than from the 1000th to the 500th part of its weight ; i. e., one-half grain to one grain of arsenic to nearly one fluidounce of water. The presence of organic matter in a liquid renders the poison much less soluble. 72 ARSENIC — SYMPTOMS. Symptoms. — These will vary according to the form and dose in which the poison has been administered. The time at which they come on is generally in from half an hour to an hour after the poison has been swallowed. This is the average period. I have known them to appear in a quarter of an hour. Dr. Christison mentions one instance in which the symptoms began in eight minutes ; but in the case of Lofthouse, tried at the York Lent Assizes, 1835, the symptoms were proved to have attacked the deceased while he was in the act of eating the cake in which the poison was adminis- tered. On the other hand, in an instance communicated to me by Mr. Todd, where one drachm had been taken on an empty stomach, no symptoms ap- peared for two hours ; in a case reported by Orfila, the symptoms did not show themselves for five hours ; and in another that occurred to Dr. Lachfese, in which a large dose was taken, the symptoms did not come on for seven hours. {Ann. d'Hyg., 1837, vol. i. p. 344.) Dr. Thompson, of Liverpool, states that he met with a case in which from thirty to forty grains of arseni- ous acid, and the same quantity of chrome yellow were taken. Symptoms of poisoning did not appear until five or six hours afterwards. Arsenic was detected in the urine. The person recovered in three weeks. {Med. Ghir. Rev., Jan. 1854, p. 294.) There may be every variety between these ex- tremes. In one case their appearance was protracted for ten hours — the maximum period yet known. A remarkable instance occurred to M. Ton- nelier, in which the poison was taken by a young female at eleven o'clock in the morning, and no well-marked symptoms occurred for eight hours : there was then violent vomiting. After death, a cyst, formed of mucous membrane and containing arsenic, was found in the stomach : the poison having thus become sheathed over 1 {Flandin, vol. i. p. 535.) In a case communicated by Mr. Clegg to the Medical Times (Oct. 21, 1848), symptoms of violent irritation did not show themselves until twenty-three hours after the poison had been taken, and within about half an hour of the death of the patient. The girl was once sick shortly after having taken the poison, but the first symptoms were those of narcotism. The girl was a confirmed opium-eater, and this habit may iu some measure have influenced the operation of the poison. From a case communicated to the Medical Gazette by Dr. W. Burke Ryan (vol. xlvii. p. 722), it appears that the active symptoms of irri- tation which commonly attend arsenical poisoning, may not appear until after the lapse of nine hours from the time at which the poison has been swallowed. With the exception of one case recorded in my work On Poisons (Arsenic) in which the interval was ten hours, this is the longest period of protraction on record. In other instances there have been great intermis- sions. In all cases in which arsenic enters the system from without, as by its application to the skin, or to ulcerated or diseased surfaces, the symptoms are rarely manifested until after the lapse of several hours. The individual first experiences faintness, depression, nausea, and sickness, with an intense burning pain in the region of the stomach, 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 is accompanied by severe cramps in the calves of the legs. The matters discharged from the stomach and bowels have had in some instances a yellowish color, as it was supposed, from a partial conversion of the poison to sulphuret, but more probably from an admixture of bile. The vomited matters are in some cases colored by blood, and the mixture of blood with bile has often given to them a green 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 the admixture of white arsenic. The color of the vomited matters has been hitherto much CHRONIC POISONING BY ARSENIC. 73 relied on as an aid to diagnosis ; but it is necessary to direct the attention of practitioners to the probable effect of the law on the sale of arsenic (14 Vict. cap. 13, sec. 3) in completely changing the appearance of the matters vomited by a person laboring under the effects of this poison. The sale of white arsenic in any quantity less than ten pounds is prohibited, unless it is mixed with l-16th part of its weight of soot, or l-32d part of its weight of indigo. [This is not the case in America. — H.] The vomited matters may therefore be blue or black — or the admixture of bile may render them of a deep green color. In a case of arsenical poisoning communicated to me by Dr. Maclagan, the hlue vomiting at first completely misled those who were called to render assistance. The vomiting is in general violent and incessant, and is excited by any liquid or solid taken into the stomach. There is tenesmus (straining), 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, and irregular ; 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 abdomen. Before death, stupor sometimes supervenes, with paralysis, tetanic convulsions, or spasms in the muscles of the extremities. In one instance trismus (lock-jaw) appeared in three quarters of an hour. (Orfila, vol. i. p. 449.) Chronic poisoning. — Should the person recover from the first effects, and the case be protracted, or should the dose have been small and administered at intervals, there will be inflammation of the conjunctivae, with suffusion of the eyes, and intolerance of light ; a condition which is, however, often pre- sent with the early symptoms above described. In a case reported by Mr. Jeffreys, an adult female died in three hours after taking arsenic in a pudding served at dinner. There was no vomiting or purging. In two hours she was in a state of complete collapse, and at this time it was noticed that the conjunctivae (the membranes of the eyes) were red. (Med. Times, Aug. 30, 1851, p. 229.) There is also irritation of the skin, accompanied by a vesi- cular eruption, which has been called eczema arsenicale. Sometimes this has assumed the form of nettle-rash or of the eruption attending scarlet fever, for which disease arsenical poisoning has been mistaken. Local paralysis, preceded by numbness or tingling in the fingers and toes, and other symptoms of nervous disorder, are also common consequences. Exfoliation of the cuticle and skin of the tongue, with the falling off of the hair, has likewise been witnessed. (Case of the Turners, 1815, Marshall, 119.) 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, 44, 1] 1.) A well-marked case of slow poisoning by arsenic is recorded by Flandin. {Traite des Poisons, ou Toxicologic, tom. i. p. 510.) It illustrates a not unfrequent form of secret murder, and it is well calculated to inspire caution in making a diagnosis from symptoms. A woman put daily into the soup of her fellow-servant, a very small quantity of arsenious acid in powder. Shortly after dinner this person was seized with vomiting, which led to the rejection of the food and poison before the latter had caused any serious mischief As this practice was continued at intervals for about six weeks, the stomach became exceedingly irritable ; there was pain in the bowels, and the woman was much emaciated. There was also spitting of blood, with such a degree of nervous irritability, that a current of air falling upon her, caused an attack of spasms and convulsions. When the patient found that she could not bear anything on her stomach, she left the place and passed two months in the country. Her health became gradually re- established there, and she returned to resume her usual occupations. The 74 AUSENIC — APPEARANCES AFTER DEATH. prisoner, however, renewed her attempts ; and to make sure of destroying life, gave her one morning in coffee, a strong dose of arsenious acid in pow- der; violent vomiting ensued, and the poison was expelled with the food taken at breakfast. Arsenic was detected in the vomited matter, and the explanation of the cause of the long previous illness then became clear. Under proper treatment the patient recovered. I believe this mode of poi- soning to be more frequent in this country than is commonly supposed; and it behooves practitioners to be exceedingly guarded in their opinions, for the usual characters of arsenical poisoning are completely masked. (See page 31.) The case of Mrs. Wooler (Durham Winter Assizes, 1855) conveys an important lesson in this respect. [Described, ante, p. 31, as one of slow poison- ing of seven weeks' duration, in which arsenic was proved to have been intro- duced from time to time by the rectum and the mouth. (See the London Lancet, Dec. 22, 1855, and Med. Times and Gaz. of same date; also an admirable review of the case by Prof. Christison, Edin. Med. Journ., Jan. and Feb. 1856.)— H.] The suspicions of the medical attendants were confirmed, but at too late a period to save the life of the lady. The symptoms may be easily referred to chronic inflammation, or ulceration of the stomach from natural causes, leading to perforation. Some years since I was required to examine a case like that of Wooler, in which the death of a person had been caused by his housekeeper under somewhat similar circumstances. The crime was not discovered until after the lapse of two years ; and from the small_ dose given, and repeated vomiting during life, no arsenic could be detected in the body. There are many anomalous cases on record, in which the symptoms have diverged so much from the ordinary course as to embarrass medical practi- tioners. For some of these, I must refer to a paper by Dr. Ogston, Med. Gaz., vol. xlvii. p. 181; also to my work On Poisons, Am. ed. p. 329. There is one form of chronic poisoning by arsenic on which it will be pro- per to make a few remarks, as the real cause may remain wholly unsuspected. Arsenic is largely employed in this country, under the form of Scheele's green or arsenite of copper, in the manufacture of decorative papers with which the walls of sitting and bedrooms are covered. Some persons have suffered from dry cough, headache, irritation of the throat and eyes, and other symptoms of chronic poisoning by arsenic, in which no other cause was apparent than the continued respiration of the air of their rooms, charged probably at times with a fine arsenical dust. On examining the papers, I have found them in some instances loaded with arsenic, laid on in a rough and coarse manner, so as to be easily removed by friction. Arsenic is thus used in imparting a green tint to some of the most costly as well as the cheapest decorative papers. It is a practice fraught with danger in more respects than one, and under a proper system of medical police it would not be permitted. In the kingdom of Prussia, the nse of these papers is strictly prohibited. If there has not hitherto been much complaint on the subject, it may be attributed to the fact that the real cause of the illness has been mistaken, or has not been suspected. Many obscure cases of illness, referred at the time to constitutional or other causes, may probably have been due to the effects of arsenical dust thus inhaled day and night by those who inhabited the rooms. Dr. Hinds has described two cases in which the prominent symp- toms were prostration of strength, headache, thirst, loss of appetite — an inflammatory state of the conjunctivae with heat and dryness of the fauces. {Med. Times and Gazette, May 23, 1857, p. 521 ; Lancet, 1857, vol. i. p. 193.) A portion of the paper of the room in which these persons lived was sent to me, and on examination I found in the green pigment spread over it, a large quantity of arsenic. These facts should be borne in mind in cases in which it is suspected that poison is being secretly administered to another. Appearances after death. — The striking changes produced by arsenic are ARSENIC — PERIOD REQUIRED FOR INFLAMMATION. T5 generally confined to the stomach and bowels. They are commonly well marked in proportion to the largeness of the dose and the length of time which the individual has survived after taking the poison. Our attention must be first directed to the stomach. Arsenic seems to have a specific effect on this organ : for, however the poison may have entered into the system — whether through a wounded or ulcerated surface, or by the act of swallowing — the stomach has been found inflamed. This inflammation cannot, then, be always dependent on the local irritant action of the poison. The mucous membrane of the stomach, which is often covered with a layer of mucus, mixed with blood, and with a white pasty-looking substance containing arsenic, is commonly found red and inflamed in dotted or striated patches: — the color, which is of a dull or brownish-red, becomes brighter on exposure to the air : at other times it is of a deep crimson hue, interspersed with black-looking lines or patches of altered blood. The redness is usually most strongly marked at the greater extremity ; in one case it may be found spread over the whole mucous surface, giving to it the appearance of red velvet; in an- other it will be chiefly seen on the prominences of the rugse or folds. The stomach has been found highly inflamed in a case which proved fatal in two hours. Blood of a dark color may be effused in various parts within the folds, or beneath the lining membrane — an appearance which has been mistaken for gangrene. [On this point see the case of the Queen against Dore and Spry, C.C.C. August 28, 1848 I also Med. Gaz., Nov. 24, 1848 ] The stomach often contains a mucous liquid of a dark color tinged with blood. The coats are sometimes thickened in patches, being raised up into a sort of fungous- like tumor, with arsenic imbedded in them : at other times they have been found thinned. The mucous membrane is rarely found ulcerated, and still more rarely gangrenous. Ulceration of the mucous membrane, as the result of the action of arsenic, has been found as early as ten hours after the poison had been taken. Perforation of the coats is so uncommon a result of arseni- cal poisoning, that there are but few instances on record. In a case recently ex- amined by M. Chevallier, the stomach of a person who had died from the effects of arsenic, was found perforated at the larger end. The aperture is described to have been of the size of a franc piece, round, soft, and somewhat thick- ened in its margin. There was no vascularity or sign of erosion about it, nor was there any appearance of ulceration on the other parts of the mucous membrane. Externally the stomach was covered with false membranes, aris- ing from inflammation of the peritoneum. {Ann. d'Hyg., 1852, vol. i. p. 448.) This case is so imperfectly reported that it is impossible to say whether the perforation was caused by arsenic, or whether it was the result of other mor- bid changes. The mucous glands of the stomach have been found enlarged ; , but this is by no means an unusual morbid appearance from any cause of local Irritation, without reference to poisoning. Various morbid appearances are said to have been met with in the lungs, heart, brain, and urinary organs ; but they do not appear to be characteristic of arsenical poisoning. It is to the stomach and intestines that a medical jurist must look for the basis of medical evidence in regard to appearances after death. 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 atten- tion. The mucous membrane of the small intestines may be inflamed through- out, but commonly the inflammatory redness is confined to the upper part or to the duodenum, especially to that portion which joins the stomach. Of the large intestines the rectnm appears to be the most prone to inflammation. The liver, spleen, and kidneys present no appearances which can be connected with the action of arsenic, although these, like the other soft organs, may become receptacles of the absorbed poison. It is worthy of observation in relation to the known antiseptic properties of arsenic, that the parts espe- 76 ARSENIC — PERIOD AT WHICH DEATH TAKES PLACE. daily affected by the poison (the stomach and intestines) occasionally pre- sent the well-marked characters of irritant poisoning for a long time after death. In two cases ( Ohesham) referred to me by Mr. Lewis, coroner for Essex, a deep red inflammatory appearance of the mucous membrane imme-- diately below a layer of sulphuret of arsenic was well marked, although the bodies had been buried nineteen months. In a case of exhumation which occurred in March, 1848, the stomach was well preserved and retained an inflammatory redness after the lapse of twelve months. Absorbed arsenic does not, however, appear to prevent the decomposition of the soft organs in which it is deposited. For a summary of the appearances caused by arsenic, and the influence of this poison in modifying putrefactive changes, I must refer the reader to a paper by Dr. Geoghegan {Medical Gazette, vol. xlvi. pages 171 and 218; and Observations on Arsenical Poisoning, DuUin Quar- terly Journal, Feb. 1851). Quantity required to destroy life. — The smallest fatal dose hitherto recorded was observed in a case communicated by Dr. Castle, of Leeds, to the Pro- vincialJournal (Jane 28, 1848, page 347). A woman took half an ounce of Fowler's solution (Arsenite of Potash) in unknown doses, during a period of five days. She then died : and on examination the stomach and intestines were found inflamed. Death took place by syncope (mortal fainting), and there was an absence of vomiting and purging. The quantity of arsenic which here destroyed life could not have been more than two grains. In an- other case, two grains and a half of arsenic, contained in two ounces of fly-water, killed a robust healthy girl, aged nineteen, in thirty-six hours. (See Med. Gaz., vol. xxxix. p. 116.) Hence a medical witness will be justified in stating that under circumstances favorable to its operation, the fatal dose of this poison in an adult is from two to three grains. Period at which death takes place. — Some remarks on the important bear- ing, which an answer to this question may have in a case of arsenical poison- ing, have been elsewhere made (ante, p. 30.) From the numerous well ob- served cases, which are now on record, it would appear that large doses of arsenic commonly prove fatal in from eighteen hours to three days. The average time at which death takes place is twenty-four hours ; but the poisoji may destroy life within a much shorter period. There are now many authen- tic cases reported, in which death has occurred in from three to six hours. In 1845 I met with a well-marked case of death from arsenic in five hours, and in another, which occurred in April, 1849, death took place in two and a half hours. (Guy's Hospital Reports, Oct. 1850, 183. See also Ann. d'Hyg., 1837, vol. i. p. 339.) It is singular that a few years since observa- tions were so limited that it was thought to be impossible that arsenic could destroy life in a shorter period of time than seven hours (see p. 30, SusseU's case) ■ and this rapidity of death was actually considered as a medical fact, which in some measure tended to negative the allegation of death from arsenic ! i am indebted to Mr. Foster, of Huntingdon, for a case which proved fatal with unusual rapidity. This gentleman satisfactorily ascertained that a child under three years of age, died within two hours from the effects of arsenic. The quantity taken could not be determined ; but the time at which death takes place is by no means dependent on the quantity of poison taken. Dr. Borland, who formerly attended my lectures, communicated to me a case in which death probably occurred in less than two hours. The most rapidly fatal case which I have met with is that of a youth, set. 17, who died in April, 1860, from the effects of a large dose of arsenic, the symptoms from which he suffered being of a tetanic character. The poisoning was the re- sult of an accident at Ramsey, in the Isle of Man. The medical evidence at the inquest was to the effect that not more than twenty minutes had elapsed between the time at which deceased sat down to eat his supper, containing ARSENIC — ANALYSIS AS A SOLID — REDUCTION PROCESS. 7Y tlie poison, and his death. I am indebted to Mr. A. Thompson, of King's College, for a report of this case. In a case published by Dr. Dymoek, a girl aged twenty took two ounces of powdered arsenic, and died in less than two hours and a half. The girl vomited violently and was sensible to the last. The mucous membrane of the stomach was covered with bright patches of a scarlet color. {Ed. Med. and Surg. Journ., April, 1843.) In some in- stances death does not occur until long after the average period. In one case in which an adult swallowed about half an ounce, death did not take place ^ox fifty hours, and it is remarkable that there was an entire absence of pain. {Med. Gaz., vol. xlviii. p. 446.) In the case of the Duke de Praslin, one large dose was taken, but death did not occur until the sixth day. {Ann. d'Hyg., 1847, vol. li. p. 367.) In October, 1847, a man who had swallowed two hundred and twenty grains of arsenic was admitted into Guy's Hospital. He died on the seventh day. It is obvious that a patient who recovers from the first effects of this poison may still die from exhaustion or other second- ary causes many days or weeks after having taken it. In Reg. v. M^ Gormich, tried at the Liverpool Assizes, a child, after partially recovering from the first effects, died, as it appeared, from one dose of arsenic, after the lapse of twelve days. {Med. G'az., vol. xxxiii. p. 484.) In iYLQCSiSaoi Dr. Alexander death took place on the sixteenth day. {Med. Times and Gazette, April 18, 1857, p. 389.) In one instance in which arsenic was applied externally to the head, the person did not die until the twentieth day. The longest duration of a case of poisoning by arsenic which I have met with is reported by Belloe. A woman, aged fifty-six, employed a solution of arsenic in water to cure the itch, which had resisted the usual remedies. The skin became covered with an erysipelatous eruption, and the itch was cured, but she experienced severe suffering. Her health gradually failed, and she died after the lapse of two years, having suffered during the whole of this period from a general tremor of the limbs. {Gours. de Mtd. L&g., 121.) Ohemieal analysis. Arsenic as a solid. — In the simple state, white arsenic may be identified by the following properties : — 1. A sthall quantity of the powder, placed on platina foil, is entirely volatilized at a moderate heat (370°) in a white vapor. Should there be any residue, it is impurity; some- times plaster of Paris or chalk is found mixed with it. If a small portion of the white powder be very slowly heated in a glass tube of narrow bore, it will be sublimed without melting, and form a ring of minute octahedral crys- tals, remarkable for their lustre and brilliancy. IJnder a microscope of high magnifying power (250 diameters), the appearance of these crystals is re- markably beautiful and characteristic : one not exceeding the 4,000th of an inch in size may be easily recognized by the aid of this instrument. It will be observed in these experiments that white arsenic in vapor possesses no odor. 2. On boiling a small quantity of the powder in distilled water, it is not 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. When the powder is treated with a solution of hydrosulphuret of ammonia in a watch-glass, there is no change of color, as there is with most metallic poisons : on heating the mixture, the white powder is dissolved ; and on continuing the heat until the ammonia is expelled, a rich yellow or orange-red film is left (sesqui-sulphuret of arsenic), which is soluble in all alkalies, and insoluble in hydrochloric acid. Reduction-process. — When a small portion of the powder, i. e. from one- fourth to one-twentieth part of a grain, is heated with some reducing agent containing carbon (the best substance for this purpose is soda-flux obtained 78 ARSENIC IN SOLUTION — TESTS. by incinerating acetate or tartrate of soda in a close vessel) in a glass tube about three inches long and one-eighth of an inch in diameter, it is decom- posed : a ring of metallic arsenic of an iron-gray color is sublimed and de- posited in a cool part of the tube. At the same time there is a perceptible odor, resembling that of garlic, which is possessed by metallic arsenic only, while passing from a state of vapor to arsenious acid. This odor was at one time looked upon as peculiar to arsenic, but no reliance is now placed on it as a matter of medical evidence — it is a mere accessory result. In this ex- periment of reduction, there are commonly two rings deposited in the tube : — the upper ring has a brown color, and appears 'to be a mixture of finely divided metallic arsenic and arsenious acid. In order to determine the weight of the sublimate, the glass tube should be filed off closely on each side of the metallic ring, and weighed ; the sublimate may then be driven off by heat, and the piece of glass again weighed : — the difference or loss represents the weight of the sublimate. These sublimates are remarkably light, and require to be weighed in a delicate balance. By heating gently the piece of tube, with the sublimate reduced to powder, in another tube of larger diameter, the metallic arsenic, during volatilization, forms octahedral crystals of arse- nious acid, which may be dissolved in a few drops of water, and tested by one or more of the liquid reagents. The metallic sublimate, or the crystals produced from it, may be subjected to the following process, in order to de- termine their real nature : — Break the glass on which the sublimate is depos- ited into fragments, and digest these in a few drops of the strongest nitric acid previously proved to be free from arsenic. The sublimate, if due to arsenic, is thereby converted to arsenic acid. The acid solution should be evaporated to dryness ; the white uncrystalline residue dissolved in a few drops of distilled water, and a solution of nitrate, or ammonio-nitrate, of sil- ver added. A brick-red precipitate indicates arsenic acid, and thus proves incontestably that the sublimate was of an arsenical nature. The process of reduction, with these corroborative results, is, when thus applied, conclusive of the arsenical nature of the substance under examina- tion. Any doubt respecting a sublimate may be removed by a careful micro- scopical examination. It is advisable, although not absolutely necessary, that we should apply the three foregoing tests to the white powder, before attempting to extract the metal from it. Arsenic in solution in water ; Liquid tests. — The solution is clear, color- less, possesses scarcely any perceptible taste, and has a slightly acid reaction. In this state, we should first evaporate slowly a few drops on a glass plate, when a confused crystalline crust will be obtained. On examining this crust with a common lens, it will be found to consist of numerous minute octahe- dral crystals, presenting triangular surfaces by reflected light. By this simple experiment arsenic is distinguished from every other metallic poison. 1. Silver test. — On adding to the solution Ammonio-nitrate of silver, a rich yellow precipitate of arsenite of silver falls down, rapidly changing, under exposure to daylight, to a greenish-brown color. The test is made by add- ing to a strong solution of nitrate of silver, a weak solution of ammonia, 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, tartaric, citric, and acetic acids, as well as in ammonia. It is not dissolved by potash or soda. 2. Copper test— On adding to the solution of arsenic Ammonio-sulphate of copper, a rich green precipitate is formed, the tint of which varies according to the proportion of arsenic present, and the quantity of the test added ; hence, if the quantity of arsenic be small, no green precipitate at first appears, the liquid simply acquiring a blue color from the test. In less than an hour, if arsenic be present, a bright green deposit is formed, which may be easily ARSENIC — SULPHURETTED HYDROGEN TEST, '79 separated from the blue liquid by filtration. This test is made by adding ammonia to a weak solution of sulphate of copper, until the bluish-white precipitate, at first produced, is nearly redissolved. It should not be used in large quantity, if concentrated, as the deep blue color tends to obscure or conceal the green precipitate formed. The precipitated arsenite of copper is soluble in all acids, mineral and vegetable, and in ammonia, but not in potash or soda. If to the blue ammoniacal solution of this precipitate a crystal of nitrate of silver is added, a film of yellow arsenite of silver will appear around the crystal. (Ohem. News, 'No. 1, p. 12) If a strong solution of nitrate is added to the blue liquid, nearly neutralized by diluted sulphuric acid, a yellow precipitate of arsenite of silver is produced. Thus the silver and copper tests may be employed with one quantity of liquid. The dried precipitate of arsenite of copper, when slowly and moderately heated in a reduction-tube, yields a well-marked ring of octahedral crystals of arsenious acid, oxide of copper being left as a residue. 3. Sulphuretted hydrogen test The hydrosulphuret of ammonia gives no precipitate in a solution of arsenic until an acid has been added, whereby arsenic is known from most metallic poisons. On adding an acid (acetic or dilute hydrochloric free from arsenic), a rich golden yellow-colored precipi- tate is thrown down (orpiment or sulphuret of arsenic). It is better, how- ever, to employ, in medico-legal analysis, a current of washed sulphuretted hydrogen gas, which is easily procured by adding to sulphuret of iron, in a long-necked bottle, a mixture of one part of strong sulphuric acid and three parts of water. The arsenical liquid should be slightly acidulated with pure diluted hydrochloric acid, before the gas is passed into it ; at least, care should be taken that it is not alkaline. The yellow compound is immediately pro- duced if arsenic be present, and it may be collected after boiling the liquid sufiiciently to drive off any surplus gas. The precipitation is likewise facili- tated by adding to the liquid a solution of hydrochlorate of ammonia. This yellow precipitate is known to be sulphuret of arsenic by the following pro- perties: 1. It is insoluble in water, alcohol, and ether, as well as in diluted hydrochloric acid and vegetable acids ; but it is decomposed by strong nitric and nitro-hydrochloric acids. 2. It is immediately dissolved by potash, soda, or ammonia ; forming, if no organic matter be present, a colorless solution. 3. When dried and heated with three parts of soda flux, or with a mixture of three parts of dry carbonate of soda and one part of dried cyanide of potas- sium, it furnishes a sublimate of metallic arsenic. This last experiment re- quires a little care, as some sulphur is apt to be sublimed, and obscure the results. If fine pulverulent silver be used as the reducing agent, and the heat gently applied, the arsenic may be evolved at once from the sulphuret, in a ring of octahedral crystals of arsenious acid. 4. The arsenical nature of the yellow precipitate may be also conclusively proved by heating it in the strongest nitric acid, and evaporating to dryness. A residue of arsenic acid is thus obtained, which, when dissolved in a few drops of distilled water, neutralized by ammonia, and tested by nitrate or ammonio-nitrate of silver, yields a brick-red precipitate of arsenite of silver. 5. In place of nitric acid, the sulphuret may be deflagrated in a porcelain capsule with a mixture of nitrate and carbonate of soda. When the melted mass is color- less, it may be heated with strong and pure sulphuric acid, so as to drive off the nitric acid, and the residue, dissolved in hot water, can now be sub- mitted to Marsh's process. Unless two or more of these properties are proved to be possessed by the yellow precipitate formed by sulphuretted hydrogen in an unknown liquid, it cannot be a compound of arsenic ; and it would not be safe, as a general rule, to receive evidence on the point. On the other hand, when these properties (especially 3 and 4) are possessed by the precipitate, it must be arsenic, and can be no other substance. 80 AESENIC — JIAESH'S PEOCESS — HTDEOGEN TEST. Harsh'' s process. Hydrogen test. — The action of this test depends on the decomposition of arsenions acid and its soluble compounds, by hydrogen evolved in the nascent state from the action of diluted sulphuric or hydro- chloric acid on zinc. The apparatus is of the most simple kind, and is so well known as to need no description. The arsenic may be introduced into the short leg of the tube in the state of powder ; but it is far better to dis- solve it in water, by boiling, either with or without the addition of a few drops of potash. The metallic arsenic combines with the hydrogen, forming arsenu- retted hydrogen gas, which possesses the following properties: 1. It burns with a bluish-white flame, and thick white smoke (arsenious acid). _ 2. A cold plate of glass or white porcelain, held in the flame near the point, re- ceives a dark stain from the deposit of arsenic upon it. This stain is com- posed in the centre of pure metallic arsenic, which (as it is formed on glass) may be sometimes raised in a distinctly bright leaf of metal ; immediately on the outside of this is an opaque black ring (suboxide of arsenic), which, when viewed by transmitted light, is of a clear hair-brown color at the ex- treme edge. If the quantity of arsenic is small, the metallic lustre and opacity may be wanting, and the whole stain will have a brown color by transmitted light. On the outside of this black ring is a thin wide film, of a milk-white appearance, which is nothing more than arsenious acid repro- duced by combustion. 3. A white saucer, or a slip of card or paper moist- ened with ammonio-nitrate of silver held about an inch above the point of the flame, will be found, if arsenic is present, to be colored yellow, from the reproduced arsenious acid being absorbed, and forming yellow arsenite of silver, easily soluble in acetic acid and ammonia. 4. Nitrate of silver on paper is immediately blackened and reduced by the unignited gas. The chemical reaction of this gas on nitrate of silver, by which the silver is reduced to the metallic state and the arsenic is simultaneously converted to arsenious acid, presents one of the most simple methods of testing the purity of the ingre- dients used in an analysis. I?efore testing the suspected solid or liquid for arsenic, a portion of the zinc and diluted acid used should be placed in a flask provided with a tube bent at two right angles, and the ^as conducted into a small quantity of a moderately strong solution of nitrate of silver. If the materials are pure, the solution will not be darkened or blackened by the passage of the gas. If this blackening is observed sooner or later, it may depend on the presence of arsenic, sulphur, or phosphorus. In order to de- termine which of these three substances has produced the eifect — ^the gas is conducted for an equal time into a glass containing a small quantity of the strongest nitric acid saturated with nitrous acid. After some time, the nitric acid may be evaporated to dryness on a sand-bath, and the dry residue, if acid, neutralized by a few drops of solution of ammonia, and nitrate of silver then added. If arsenic was present in the gas, a brick-red precipitate of arseniate of silver will be immediately produced. An equal quantity of nitric acid should be first evaporated and the residue tested in a similar manner for arsenic acid. 5. Arsenuretted hydrogen is decomposed by a full red heat, and metallic arsenic is deposited in front of the point heated. A hard glass tube, drawn out to a capillary diameter in three separate points, is connected with the flask or tube in which the hydrogen is generated, and a strong red heat is applied to the conducting tube at or about half an inch distance from each contracted portion. Metallic arsenic of an iron-gray lustre is deposited in the contracted part of the tube, and as many metallic deposits may thus be obtained as there are contractions in the tube. The further end of the tube may terminate in an open capillary point or dip into nitric acid in the manner above described. If left open, the gas is easily tested for sulphur as it issues, by holding to the open end a slip of filtering paper moistened with a solution of acetate of lead — or for arsenic by employing paper moistened reinsoh's process. 81 with a solution of nitrate of silver. For the success of this experiment a wider piece of tube containing broken fragments of chloride of calcium should be interposed between the German glass tube and the apparatus in which the gas is generated. This prevents any moisture from being carried over. Sul- phur may also be arrested by placing paper soaked in acetate of lead and dried in the drying tube. The sublimates deposited by heat may be examined like those obtained by the reduction process. 1. If arsenical, the sublimate may be converted to octahedral crystals by heat ; and 2. It may be converted to arsenic acid by nitric acid and the residue tested. (See page Y8.) Objections to Marsh's process Other substances will combine with hydro- gen, and when the gas is burnt, a deposit will be formed on glass which may be mistaken for arsenic. The only objection of any practical force is that founded on the presence of antimony. There are these differences between the arsenical and antimonial deposits : from the combustion of the gas the deposit of antimony has rarely the bright metallic lustre which that of arsenic commonly presents ; by transmitted light it is of a smoky black, while that of arsenic is of a hair-brown color. Although the antimonial is very similar in color to the arsenical flame, yet the third property is entirely wanting. If the ammonio-nitrate of silver be held over the antimonial flame, the silver is reduced ; no yellow arsenite is formed, as in the case of arsenic. This last criterion distinguishes the arsenical flame from that produced by all other combustible gases. A few drops of sulphide of ammonium placed on the deposit and slowly evaporated will leave a yellow sulphide soluble in ammo- nia — ^if arsenic: but a reddish-colored sulphide insoluble in ammonia — if an- timony. The arsenical deposit may be further distinguished by collecting it in a capsule, dissolving it in nitric acid, evaporating to dryness, and adding nitrate of silver. A brick-red precipitate is formed if the stain has been caused by arsenic. The antimonial deposit thus acted on by nitric acid leaves an insoluble oxide of antimony which is not changed in color by nitrate of silver until a small quantity of ammonia is added, when a black compound of antimonide of silver is produced. For the application of this corrobora- tive test, the gas from the apparatus may be at once passed into strong and pure nitric acid. (For further details on this mode of employing Marsh's process, I must refer the reader to the Guy's Hospital Reports for October, 1860.) Arsenic is commonly contained as an impurity in zinc, in hydrochloric and sulphuric acid: hence the purity of the materials employed must be deter- mined before any reliance can be placed on the results. It is said that zinc and the acids can be easily obtained free from arsenic. According to my ex- perience there is nothing more difficult. When pronounced pure, it will generally be found that they have not been minutely tested. Seinsch's process. — In the application of this process, the liquid suspected to contain arsenic, or the solid dissolved in distilled water, is boiled with about one-eighth part of pure hydrochloric acid (proved to be free from arsenic), and a small slip of bright copper foil, wire or gauze is then intro- duced. If arsenic is present, even in small quantity, the polished copper acquires 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. We remove the slip of copper, wash it in water, dry it, and gently heat it in a reduction-tube, when arsenious acid will be sublimed in minute octahedral crystals : if these should not be apparent from one piece of copper, several may be successively introduced. A large surface of copper foil or copper gauze may be in this way rapidly covered. In the use of this process. Dr. Geoghegan has found that while the whole of the arsenic present is deposited on copper, but little 82 ARSENIC — OBJECTIONS TO KEINSCH'S PROCESS. more than one-half can be reobtained by sublimation in the crystalline state. {Dublin Quarterly Journal, Feb. 1851.) Dr. Rainey states that 1-lOOOth of a grain of arsenious acid will give a full steel color to one square inch of copper surface, and he properly advises the analyst not to vraste the arsenic (when present in small quantity), by spreading it in a thin film over too large a surface of copper. (See Proceedings of Glasgow Phil. Soc, December, 1849.) Dr. Maclagan has made some practical remarks on this subject, for which I must refer the reader to the Edinburgh Journal of Medical Science, for 1848-9. Ueinsch's process succeeds perfectly with powdered arsenic, the arsenites, arsenic acid, the arseoiates, and common orpiment ; but, as it has been shown by Dr. Rainey, its operation is not so delicate or certain with arsenic acid and the arseniates as with the other compounds of arsenic. The boiling must be continued for a longer time. When the quantity of arsenic is small, the polished copper merely acquires a faint violet or bluish tint, and the deposit is materially affected by the quantity of water present, or in other words, the degree of dilution. But one great advantage is, that we are not obliged to dilute the liquid in the experiment, and there is no material loss of arsenic, as in the hydrogen process :■ — the whole may be removed and col- lected by the introduction of successive portions of copper. This process is extremely delicate, the results are speedily obtained, and are highly satisfac- tory. Among the cautions to be observed are these : 1. Not to employ too large a surface of copper in the first instance ; and 2. Not to remove the cop- per from the liquid too soon. When the arsenic is in minute quantity, and the liquid much diluted, the deposit does not take place sometimes for half an hour. If the copper be kept in for an hour or longer, it may acquire a dingy tarnish from the action of the acid only. This is known by its want of metallic lustre, and its being easily removed by friction, as well as by its yielding no crystalline sublimate when heated. Objections to Heinsch's process. — Certain objections have been urged to this process. Thus arsenic may be present in the hydrochloric acid : this is at once answered by boiling the copper in a mixture of the hydrochloric acid and water before adding the suspected liquid. This should always be a pre- liminary experiment. In the case of Mrs. Wooler (Durham Winter Assizes, 1855), some doubt was thrown on the scientific evidence by reason of the use of arsenical hydrochloric acid. The discovery of the impurity was not made until after the analysis was completed. Another objection is, that other metals are liable to be deposited on copper under similar circumstances. This is the case with antimony, wjiether in the state of chloride or of tartar- emetic ; and it is not always possible to distinguish by the appearance the antimonial from the arsenical deposit. Should the quantity of antimony be small, the deposit is of a violet red tint : if large of an iron-gray color, re- sembling arsenic. There is one answer to these objections, namely, that from the arsenical deposit, octahedral crystals of arsenious acid may be procured by slowly heating either the slip of copper, or the gray deposit scraped from it, in a reduction-tube. If this experiment be carefully performed, a ring of crystallized arsenious acid will be easily obtained ; this may be examined by the microscope, and afterwards boiled in a few drops of water, and the solu- tion tested with the ammonio-nitrate of silver and sulphuretted hydrogen. When the sublimates are too small for such a solution and subdivision, they may be converted to arsenic acid, by digestion in nitric acid, by the process already described (ante, page 78), and the residue tested for arsenic acid by nitrate of silver. Such a corroboration is necessary, because the crystalline form of arsenious acid is not always distinguishable by the eye ; and the an- timonial deposit gives a white amorphous sublimate, which, however, is quite insoluble in water. Care must be taken not to mistake minute spherules of water, mercury, or hydrochloric acid for detached crystals of arsenic; and OBJECTIONS TO REINSCH'S PROCESS. 83 here the microscope will be found of great service. The facility of applyiup; Eeinsch's process renders it necessary that an experimentalist should be guarded in his inferences. It is not merely by the production of a deposit on copper that he judges of the presence of arsenic ; but by the conversion of this deposit to arsenious acid, demonstrable by its crystalline form and its chemical properties. If a deposit take place on copper, and arsenious acid cannot be obtained by heating it, then the evidence of its having been caused by arsenic is insufficient. Owing to the neglect of these corroborative re- sults, antimony and other substances have been occasionally mistaken for arsenic. In conducting the chemical analysis in the case of the Queen against Smethurst (0. C. C. August, 1859), Dr. Odling and I found that all the varieties of copper in common use for Reinsch's process contained arsenic in greater or less proportion, and that when any salt was present which, by reaction with diluted hydrochloric acid, liberated chlorine, the copper was dissolved and the arsenic was set free in the acid liqnid ; and this arsenic was deposited on a fresh and clean surface of copper. The only salt which I have found to present a difficulty in this respect, when the hydrochloric acid was used in a proper state of dilution, was an alkaline chlorate which may be occasionally present in the contents of a stomach. The nitrates and phos- phates do not liberate chlorine with the diluted acid, and therefore do not affect the action of the tests. In turning to Reinsch's original report of his discovery, it will be found, that while he enforces attention to the purity of the acid employed, he merely directs that the copper should, previously to use, be cleaned with nitric acid, washed in water, and rubbed dry with filtering-paper. These are all the precautions given by the discoverer in reference to the selection of the cop- per. In fact, upon his plan any copper might be used, provided it had a clean surface. The test which he employed to determine the parity of his materials was that which has been in use among toxicologists up to the pre- sent day,- namely, before introducing the suspected substance, to boil a piece of clean copper with the diluted hydrochloric acid for four or five minutes ; and if it did not acquire any tarnish or deposit, the copper and acid were to be regarded as sufficiently pure for the detection of the poison. Undoubt- edly a negative result under these circumstances would be a proof either of the entire absence of arsenic from the metal itself, or, if present, that it was so intimately combined with the substance of the copper (as arsenide) as not practically to affect the application of the process in a medico-legal analysis. Resting upon this simple fact, Reinsch says of his method, "Elle ne pent donner lieu k aucune m6prise." Dr. Christison, who has employed it during a period of fifteen years for detecting arsenic in the tissues, says in his last edition on Poisons, that "copper-leaf or copper-plate, worn thin by the action of diluted acid or fine copper gauze, is the best form for use. . . . In all medico-legal inquiries it is necessary to perform a preliminary experi- ment with distilled water and the hydrochloric acid used, lest the acid con- tain arsenic. . . It (the process) is not subject to any fallacy." If any additional authority is required to show how little toxicologists of great repute and enlarged experience suspected that arsenic was lurking in the copper which they were so frequently using, or that there was any better method of testing the purity of the materials than that originally devised by Reinsch, it is furnished to us in the extensive experience of Mr. Herapath, of Bristol. ( Ure's Dictionary of Arts, &c., 2d ed., Nov. 1859, p. 191. Also Guy^s Hospital Reports for October, 1860, p. 220.) This gentleman has been for many years in the habit of using and recommending the use of a coarse copper wire (No. 13) which contains arsenic in well-marked quantity; but he has never even had occasion to suspect the existence of arsenic in it. 81 OBJECTIONS TO EEINSCH'S PROCESS. In fact, as he gives no directions for testing copper for arsenic before using it in Eeinsch's process, while he scrupulously refers to the necessity of testing the zinc and acids employed, it is clear that he did not know that arsenic was there, or believed its presence to be of no importance to the result. The same may be said of the copper used by every chemist and tbxicologist. In fact, whether among English or French and German writers on che- mistry and toxicology, there is not one who has ever pointed out, or even suspected, that Reinsch's process would lead to error by reason of the uni- versal presence of arsenic in copper, commercial or refined, which is accessible to the chemist. All have hitherto relied upon the cleanness of the surface of the copper used, and the method of testing the acid and metal first pointed out by Reinsch in 1841. As a general rule, this is quite sufficient. There is no liability to fallacy unless the copper is used on a large scale, and there is an acid or salt present which acts upon and dissolves the impure metal. It is clear that if the presence of a minute quantity of arsenic in copper pre- sents that great risk of fallacy, which some chemists have recently endeavored to impress on the public mind, no one of the numerous analyses for arsenic by Reinsch's process, which have been undertaken during the last twenty years, could have been made without the inevitable discovery of arsenic. In short, if a source of fallacy, it would have led to the constant discovery of arsenic in every solid and liquid submitted, to examination. Analysts who have had much experience in the use of this process are aware, that in em- ploying samples of the same copper and acid — for one affirmative result in which arsenic is discovered, there will probably be four or five negative results, in which no deposit whatever has taken place on the arsenical copper, and no arsenic was detected. By boiling successive quantities of the same arsenicated copper in the same acid liquid containing arsenic, the whole of the free arsenic is finally removed ; the deposits on the metal become less and less decided, they at length cease altogether, and the last portion of copper put into the liquid comes out nearly as bright as when introduced, or if at all dull on the surface, this dulness arises, not from arsenic, but from oxidation, as a result of long boiling. It is obvious, that if the arsenic came from the copper itself, and not from any extraneous source, instead of the arsenic diminishing on each introduction of the copper, it would go on increasing in proportion to the quantity of the metal employed in the analysis. The hundreds of negative results which have been obtained by experienced analysts, establish the un- truthfulness of the assertion, that the process, as it is commonly employed, is attended with a serious risk of fallacy, even when copper containing arsenic is unknowingly used. In fact, so long as the copper employed is not de- stroyed, and the acid is used so diluted as not to render the copper soluble, it is impossible that any arsenic can be set free from it. There is, however, great danger in endeavoring to conceal or distort a scientific truth, especially when, as experience now shows, reliance is placed upon false criteria to de- termine the presence or absence of arsenic in any given sample of copper. Chemists have stated that arsenic rendered copper brittle, and that arse- nicated copper could not be drawn into fine wire. Numerous facts, elsewhere related, show that this statement is incorrect. ( Guy^s Hospital Reports, October, 1860, loc. cit.) Copper may contain enough arsenic to deceive an analyst, and yet retain its usual ductility and flexibility. On the other hand copper entirely free from arsenic may be so brittle as to lose in great part its malleability and ductility. Another erroneous statement has found currency — namely, that copper deposited by electrolysis is necessarily free from arse- nic. The experiments of Mr. Campbell and myself show that such copper frequently contains arsenic, and that although generally purer than ordinary refined copper, the electrotype metal requires testing before use, as much as any other sample. (Guy's Hospital Reports, October, 1860, p. 231.) ARSENIC IN OaOANIC LIQUIDS. 85 The best method of testing copper for arsenic is, I believe, the following: Expose the copper to air in a saucer or vessel containing pure and strong hydrochloric acid. In a few days a dark brown liquid is procured (a mixture of subchloride of copper in the surplus acid). This acid liquid should be slowly distilled in a flask or retort by the aid of a sand-bath. If arsenic was contained in the copper, it is obtained as a clear, colorless chloride in the receiver with hydrochloric acid. The acid distillate, properly diluted, should now be placed with pure zinc in a flask, and the gas produced should be tested for arsenic by the various methods already described. (See page lb.) It is unnecessary in this place to enter into a comparison of the processes of Marsh and Reinsch, in respect to their relative powers of enabling the analyst to detect small quantities of arsenic. It may be conceded that Marsh's process will detect a smaller quantity of arsenic than the process of Reinsch, but the latter, when the quantity of liquid is small, will detect the l-150th or l-200th part of a grain of the poison, and this is itself a point of delicacy in analysis, which, when the issues of life and death are involved, might almost suffice to justify a reasonable distrust of the resources of science. It would require considerable coarage to go beyond this, and it appears to me that in a criminal case it would not be safe to depose to the presence of arsenic from Marsh's process alone, when the quantity of poison was too small to admit of separation or corroboration by the process of Reinsch. Con- versely, the results of Reinsch's should be corroborated by those of Marsh's process. When the point of detection by Reinsch's process has been passed, then we increase the chance of fallacy to which Marsh's process is always exposed, by the fact that such very minute traces of arsenic may have existed in some of the materials used, or in the apparatus employed. It was this over-reliance on the extreme delicacy of the process in researches where it admitted of no corroboration whatever, that led Orfila to assert that arsenic was a natural constituent of the human body! CHAPTER XI. DETECTION OF ARSENIC IN ORGANIC LIQUIDS — IN THE TISSUES — ARSENITES — ARSENITE OF COPPER OR SCHEELE'S GREEN — ^ARSENIC ACID AND THE ARSE- NIATES — SULPHURETS OF ARSENIC — CHLORIDE OF ARSENIC. Arsenic in liquids containing organic matter. — Arsenious acid, when in a state of solution, is not liable to be precipitated by any animal or vegetable principles, although such substances render it less soluble in water. It has been stated that arsenic enters into combination with albumen, but this is a point of no practical importance in reference to the present subject of inquiry. The liquid for analysis should be filtered through muslin, cotton (free from any arsenical dressing), or paper, in order to separate any insoluble matters : these should be well pressed and drained. Should the liquid be colored, this is of little moment, provided it be clear. If viscid, it should be dilated with water, and boiled with 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 in a portion of the liquid, acidulated with pure hydro- chloric acid, a slip of pure copper highly polished. In a few seconds, if arsenic is present, the copper will acquire a violet blue or gray metallic coat- 86 DETECTION OF ABSORBED ARSENIC. ing. If, after half an hour, the copper remains unchanged, arsenic is either absent or present in too small a proportion to admit of this mode of separa- tion ; if, on the other hand, the copper is covered with a gray deposit, it should be dried and heated in a reduction-tube in the manner already de- scribed {ante, page 81). This may be regarded as a trial test to determine whether arsenic is dissolved in the liquid or not. Precipitation as sulpkiiret. — When arsenic is present in large quantity, in an organic liquid, it may be precipitated as sulphuret by a current of sul- phuretted hydrogen. The liquid should be boiled, filtered, and acidulated with hydrochloric acid before passing the gas into it. When precipitation has ceased, the liquid should be again filtered, the precipitate collected, dis- solved in ammonia, and reprecipitated by an acid. By digesting it in water, alcohol, and diluted hydrochloric acid successively, it may be deprived of any organic matter combined with it, suificiently to allow of its reduction by soda- flux, cyanide of potassium, or metallic silver, in the manner described (p. 79). In this way it is easy to analyze wine, coffee, tea, milk, porter, brandy, and similar liquids for arsenic when present in large proportion. The yellow precipitate must, in all cases, be submitted to the corroborative tests. The large quantity of organic matter with which the arsenic is mixed may interfere with its precipitation by sulphuretted hydrogen gas. In this case the organic matter may be most conveniently destroyed without loss of arse- nic, by resorting to the process of Fresenius and Babo. The liquid previ- ously concentrated may be mixed with its weight, or rather more than its weight, of strong and pure hydrochloric acid, water being added to make the mass fluid. The vessel containing the liquid is heated in a water bath, and finely-powdered chlorate of potash is then added to it in small quantities. Chlorine is set free, and the organic matter is destroyed. The chlorate should be added until the liquid is colorless, or nearly so, and of uniform consistency. It is then filtered and boiled until no more chlorine is evolved. Any arsenic present is converted to arseniate of potash. Sulphurous acid is now passed into the liquid, or bisulphite of soda is dissolved in it in small portions at a time, until it smells of sulphurous acid. It is again boiled to get rid of the surplus quantity of this gas. Hydrochloric acid is then added, in order to acidulate it, and the arsenic is precipitated as sulphuret by a current of sul- phuretted hydrogen gas. The precipitated sulphuret may then be tested by the various methods already pointed out (p. 80). When the quantity of organic matter is large, and the proportion of arsenic small, this process has the disadvantage of charging the suspected liquid with a large quantity of saline matter, and at the same time a variety of chemical agents are employed, to the use of which an objection may be taken. In other cases arsenic may be present, but in too small a quantity to be precipitated by sulphuretted hydrogen. On these grounds another process is desirable. Detection of absorbed arsenic. — In most cases of acute poisoning, in which the person dies within the ordinary period, arsenic may be found, but in va- riable quantity, in the muscles and soft organs of the body, as well as in the blood, bile, and urine. It may be detected in the liver, but in no other parts ; and there are well authenticated cases in which, in spite of its having been taken and caused death, it has not been discovered in any of the structures of the body. The process by which its presence may be revealed depends on the ready conversion of arsenic to a volatile liquid chloride of arsenic — the production from one portion of the chloride of arseniuretted hydrogen, with its well-known properties (p. 80) — and from another portion the deposition of arsenic on pure copper by Reinsch's process. Distillation process. 1. Conversion to Chloride If the substance to be examined for arsenic is solid, it should be reduced to a fine powder, or cut into small pieces. In the analysis of the liver, spleen, or other soft organs, ARSENIC — DISTILLATION PROCESS. 87 it will be proper to cut these into small portions, and to dry them either by a current of air or by the aid of a water-bath, so as to deprive them as much as possible of water. If we have to deal with liquids such as the blood, bile, and urine, these may be brought to dryness in a water-bath. The complete separation of the arsenic depends greatly on the perfect desiccation of the substance and the concentration of the acid employed. The dry residue is then covered with concentrated hydrochloric acid, the purity of which has previously been tested hjf operating on an equal quantity, according to the method already described (p. 80). The quantity of pure hydrochloric acid used must depend on the quantity of dry material for ana- lysis. It should be sufficient to break up, dissolve, or mix freely with the whole of the solid residue. The mixture should be made in a retort or small flask fitted with a long condensing-tube, and then gradually heated by a sand- bath until the acid liquid begins to pass over. The retort or flask may be connected with a receiver closely fitting to it, and holding a small quantity of distilled water. The water in the receiver should be just sufficient to con- dense and fix the acid vapors. The receiver, as well as the condensing-tube, should be kept cool by wetting its surface with cold water or otherwise. The perfect condensation of the distilled liquid is insured by this arrangement. The distillation may be carried to dryness on a sand-bath, or nearly so ; and it may be sometimes advisable, in order to insure the separation of the whole of the arsenic as chloride, to add to the residue in the retort another portion of pure and concentrated hydrochloric acid, and again distil to dryness. I have, however, found that portions of dried liver and stomach gave up every trace of arsenic by one distillation, when a sufficient quantity of hydrochloric acid has been used in the first instance, and the distillation had been slowly conducted by a regulated sand-bath heat. 2. Conversion of Ghloride to Hydride. — The liquid in the receiver is either a solution of chloride of arsenic in water, or a mixture of hydrochloric and arsenious acids. It is in general colorless, when care has been taken ; or, if slightly colored yellow, this will not interfere with the subsequent steps of the analysis. It contains no amount of organic matter which can lead to frothing in Marsh's tube, or to any deceptive results from the combustion of the gas produced. There is no loss by volatility at ordinary temperatures, since the water retains the chloride of arsenic ; but at the same time it is proper either to proceed immediately with the examination of it, or to place it in a stoppered bottle to prevent loss by evaporation of the distillate. The arsenical liquid in this state may be preserved for examination at any future period. One third of the distilled liquid may be diluted with four or five parts of water and boiled in a clean flask. When boiling, a piece of bright copper foil (free from arsenic), of about the size of the sixteenth of a square inch, should be introduced. If there is chloride of arsenic in the liquid, even up to 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 copper. If the liquid should be too much diluted for this purpose, it may be concentrated on the polished copper, and the deposit will after a time be apparent. If the quantity of arsenic present is believed to be very small, the surface of copper introduced should be proportionably small. The remaining two-thirds of the distilled liquid, sufficiently diluted, should now be introduced into a Marsh's tube, or an evolution flask provided with a funnel tube, the capacity of which must be regulated by the quantity of acid liquid to be examined. Pure zinc is then added, and the remaining steps of the process are precisely similar to those described under Marsh's process {ante, p. 80). When the results obtained by Marsh's and E-einsch's processes are con- 88 DISTILLATION PROCESS — OBJECTIONS. current, it is conclusively proved that arsenic must have been present in the substance analyzed. We have here, in the production of metallic arsenic and of arsenic acid, as well as in the conversion of this compound to arseniate of silver, all the evidence which an analyst can desire. Beyond this it appears superfluous to carry the chemical proof. The combustion of the gas, as suggested by Marsh, with the collection of deposits from the flame, while it necessarily entails much loss, is not required in any stage. The decomposi- tion of the hydride by a red heaij in a close tube answers all the purposes of combustion, without the risk of loss from the frequent opening of a stopcock. A larger quantity of metallic arsenic can be thus obtained in one operation ; and any gas which escapes decomposition by heat may be arrested and de- composed by the nitrate of silver or nitric acid. The zinc which has been used in one experiment is not fitted for use a second time. Some arsenic is always deposited upon it, which is evolved when hydrogen is again generated. I have substituted aluminum with hydro- chloric acid as well as with potash, but I have not found this new metal to present any advantages over zinc. It contains no arsenic, but much iron and carbon. Objections. — This process appears to be singularly free from the objections to which those of Marsh and Reinsch are exposed. In the first stage, if properly conducted, arsenic is separated from all metals excepting antimony and bismuth, and from all metalloids excepting sulphur, phosphorus, and that rare substance, selenium. Of all the metals known, fourteen produce volatile chlorides ; but, with the exception of arsenic, antimony, and bismuth, these are deposited on cooling, in a solid condition. Most of these are chlorides of the rarer metals, which are not likely to be met with in any analysis of a medico-legal nature. The chloride of arsenic is volatile, and is easily dis- tilled with aqueous vapor : the chlorides of antimony and bismuth require a much higher temperature for volatilization ; and unless the material is dis- tilled to dryness and subsequently heated, they are not likely to be found in the acid distillate. In the second stage, antimony comes over with hydrogen, like arsenic. The only other metals which combine with hydrogen to form a gas are potassium, tellurium, and zinc ; and among the metalloids, sulphur, selenium, phosphorus, and carbon. When heat is applied to the current of gas, the only substance deposited in a form to be mistaken for arsenic is antimony. (For the distinctions between these metals see page 81.) The other substances present no difficulty whatever. Arsenic acid and the alkaline arseniates, as well as the sulphide of arsenic, are not easily obtained in the form of chloride of arsenic by the distillation process. Some portion passes over as chloride of arsenic, but much remains unchanged in the retort. Arsenious acid and the arsenites, soluble and in- soluble in water, are most readily obtained in the form of chloride. These compounds chiefly concern the medical jurist. To one case of poisoning by arsenic acid or the sulphide, there will be at least one hundred cases of poi- soning by arsenious acid. Should it be required to distil arsenic acid or its compounds, it will be advisable to convert it to arsenious acid by a current of sulphurous acid, or by the addition of bisulphite of soda. Sulphide of arsenic may be similarly transformed, by being first treated with nitric acid or nitrate of potash. (See page YQ.) This process may be safely adopted without interfering with the research for other poisons. With the exception of mere traces of antimony and bis- muth that pass by distillation, all other metals remain in the residue after distillation ; and with respect to these two metals, the greater proportion remains behind. Hence after separating arsenic, the residue may be exa- mined for antimony, mercury, copper, lead, and other metallic poisons, by the ordinary processes. On the other hand, if the presence of any volatile ARSENIC — QUANTITATIVE ANALYSIS. 89 poison, such as alcohol, prussic acid, ether, or chloroform, is suspected, a water-bath distillation, to separate any of these liquids, may be resorted to, before commencing the research for arsenic. A portion of the residue may in all cases be reserved for the research for organic alkaloids. The subjoined experiments were made in order to test the efficacy of the process. The stomach. — The contents and part of the coats of the stomach of a person had been examined for arsenic by Reinsch's process, and no arsenic was found. The remainder of the stomach had been exposed for some months, and was in a dry state. A solution containing three-eighths of a grain of arsenic was poured over the surface ; in this state it remained exposed five months longer. One-third of it was then cut up and distilled with two ounces of pure hydrochloric acid, in the manner already described (p. 8t). The distillate was acid, and nearly colorless. It yielded arsenic readily by Reinsch's process, as well as metallic arsenic from arseniuretted hydrogen — arsenious acid by the use of nitrate of silver, and arsenic acid by the use of nitric acid. The dry residue in the retort was tested by Reinsch's process ; it contained no arsenic. In this experiment, the quantity of arsenic operated on in the substance of the stomach could not have exceeded one eighth part of a grain. The liver. — Sixty grains of the dried liver of a per- son who died about five years since from the effects of arsenic, were broken up and distilled with hydrochloric acid. A slightly colored, offensive liquid was obtained in the receiver, which yielded arsenic readily by the methods described, in all the forms in which arsenic admits of recognition. The residue in the retort contained no arsenic. It was found equally effectual in the separation of arsenic from the sedi- ment of river water; from arsenical paper-hangings, and a variety of sub- stances containing arsenic. (See Guy^s Hospital Reports, Oct. 1860, p. 253.) Quantitative analysis. — The quantity of arsenic met with in a free state in the stomach and bowels after death, is subject to great variation. The quan- tity found has varied from half a grain to two ounces, or 960 grains. The circumstances which affect this quantity have been elsewhere considered (pp. 33, 92), Whether we are dealing with a liquid article of food, or with the contents of a stomach, assuming that the arsenic is dissolved, we pursue the same plan. In some cases solid arsenic, in lumps or powder, may be sepa- rated by washing from the contents. In this case we simply collect it, dry it, and weigh it. When the arsenic is dissolved, a measured portion (one- fourth or one-sixth) of the liquid should be acidulated with diluted muriatic acid, boiled and filtered. A current of sulphuretted hydrogen may now be passed into it, until there is no longer any precipitation. The liquid should be again boiled, and the precipitated sulphuret of arsenic collected either by decantation, or on a filter, and thoroughly washed. While still moist, it may be dissolved in ammonia, and the ammoniacal liquid filtered into a balanced capsule, from which the ammonia may be driven off by evaporation. The sulphuret of arsenic dried at 212° may now be weighed, and as every hundred grains of sulphuret represent eighty grains of white arsenic (100: 80.4), the quantity of the latter may be found sufficiently close for practical purposes in multiplying the weight of the precipitate by 4, and dividing the product by 5. When we are dealing with the tissues, the quantity of arsenic is gene- rally too small for the application of this method. In all cases the deposited arsenic is in very small proportion, rarely exceeding a few grains in an organ like the liver, weighing four or five pounds ; and according to Flandin, although his statement is not in accordance with the experience of others, nine-tenths of the deposited arsenic are found in the liver, the other tenth being unequally diffused through the other organs. {Op. cit., vol. i. p. 564.) If the quantity of arsenic present is moderately large, it may be determined in the first stage, viz., by adding to the distillate containing chloride of 90 CONTENTS OF THE STOMACH. arsenic, a sufficient quantity of a solution of chloride of gold,, and boiling the mixture. After some time the gold is entirely reducedand precipitated. Its weight will enable the operator to calculate the proportion of arsenic pre- sent. If there is a ponderable quantity of arsenic present, thedistillate, or an aliquot part of it, should be diluted, placed, with metallic zinc, in the apparatus described, and the gas produced entirely transmitted into strong nitrico-nitrous acid. When all the arsenic has come over, the acid should be evaporated in a light balanced capsule bn a sand-bath, and the weight of arsenic may be known approximately by the weight of the fesidae. If con- verted to arseniate of silver, and the quantity is sufficient for collection on a filter, this precipitate may be dried and weighed. Every dOO parts of the arseniate of silver are equivalent to 21.38 parts of arsenious acid. In refer- ence to imponderable quantities, the only method of estimating the quantity of arsenic is by comparing the amount of metallic deposit obtained as a re- sult of heating the current of arseniuretted hydrogen, with the amount obtained from a weighed quantity of arsenic, dissolved in water, and treated in a similar manner. For determining the quantity in the tissues, a known weight — one hundred grains of dry liver, may be distilled ; — the chloride obtained converted entirely to hydride, and this, decomposed by passing the gas into nitric acid until the arsenic is exhausted. The residue left by eva- poration will be arsenic acid, of which 100 parts correspond to 65.2 of arse- nious acid. The contents of the stomach are often mixed with lumps of arsenic, which may be separated by throwing those portions that do not pass through a filter into a large glass of distilled water, and after giving to 'it a circular motion, suddenly pouring off the supernatant liquid, when the heavy portions containing solid arsenic will be found at the bottom. The lumps left in the contents may be easily removed, dried on filtering paper, and tested. If the arsenic has been taken in fine powder, there will be no lumps, but it will probably be deposited in masses, mixed with mucus and blood,- on the coats of the organ, chiefly in those parts where it is much inflamed and ulcerated. The arsenic in this state looks like moistened plaster of Paris, but it is of a darker color, and when examined by a lens it is crystalline. It may be re- moved on a spatula, spread in masses on filtering paper, and slowly dried. As it dries the granules will detach themselves from the mass, and they may then be easily tested either by the reduction or by Reinsch's process, i. e., by boiling the suspected particles, or even the stained portions of paper on which the organic matter has become dried, with hydrochloric acid and pure copper. Mucus, blood, or even a layer of the mucous membrane of the stomach, may be thus readily tested. When arsenic is discovered in the stomach mixed with food; it does not necessarily follow that it has been administered in that particular article of food. Should the person have partaken of food such as milk or gruel, sub- sequently to the swallowing of arsenic, these fluids will necessarily acquire an arsenical impregnation from the poison already 'contained in the stomach. The patients may have taken the arsenic in one kind of food, when another and an innocent description of food might thus inadvertently be pronounced to have been the vehicle. (See on this point the case of Ann Merritt, Lon- don Med. Gaz., Aug. 16, 1850, vol. xlvi. p. 291.) If the patient has died with arsenic in the body, there is scarcely any limit to the period at which it may be detected. In the cases of two children examined by Mr. Herapath, in July, 1849, the poison was discovered in the remains of the dead bodies after eight years' interment; in another case, by Dr. Glover, after twelve years {Lancet, July 9, 1853, p. 41); and in a re- markable instance which occurred to Dr. Webster, of Boston, it was dis- DETECTION OF ARSENIC IN THE TISSUES. 91 covered in the remains of a body, after fourteen years' burial in a tomb. It has been sought for, and not found, at much shorter periods after death, when there was a. very strong suspicion that the poison had been taken ; but it is highly probable that in these cases there was little or no arsenic in the bodies at the time of interment. The longer a person has survived after taking the poison, the less probable is it, cmteris paribus, that arsenic will be found in the remains. With respect to its detection in the stomach and bowels, if the vomiting and purging have been violent and the person has survived some days, none may be found. It is singular, however, to notice with what tenacity the mineral occasionally adheres to the mucous membrane in spite of vomiting and purging. In the case of the Duke of Praslin, who died in six days from a large dose of arsenic, some portion was still found in the intestines (^Ann d^ Hygiene, ISl"!, p. 402); and in a more recent case which was the subject of a criminal trial at the Leicester Autumn Assizes in 1860 (Reffina v. Holmes), Mr. Laukester informed me that arsenic was detected in the intestines although the deceased had survived the effects of a large dose for seven days, and had suffered from the usual symptoms. In those cases in which arsenic is found in a solid state after long inter- ment, it is generally under the form of sulphuret or yellow arsenic, the white arsenic being thus partially changed in composition and color during the process of putrefaction. This change of color, however, is not always met with, even in bodies which have been buried for a year, or longer. (See Guy''s ITosp. Reports, Oct. 1850, p. 206.) Care must be taken not to con- found stains produced by bile on the stomach or intestines after long periods of interment, with those caused by sulphuret of arsenic. The medical practitioner should be aware that a crystalline substance re- sembling arsenic "is very often produced in the dead stomach at variable periods after interment. These crystals consist of ammonio-phosphate of magnesia derived from putrefaction. I have met with them in several cases of exhumation. They have been mistaken for arsenic, and their occurrence has in some instances led to unjust suspicions and accusations. (See Guy's Hasp. Reports, Oct. 1850, p. 222.) An analysis will of course remove any doubt. For many important facts connected with the quantity of absorbed arsenic deposited in the tissues, the time at which it is deposited, as well as the relative proportions found in different organs, and in the same organ at different periods after the taking of the poison, I must refer the reader to a paper by Dr. Greoghegan. {Dublin Quarterly Journal, Feb. 1851.) Accord- ing to observations made by this gentleman, the largest quantity of arsenic was found in the liver, in about fifteen hours after the poison had been taken. It amounted to two grains for the whole organ. The earliest period at ■which he met with it was seven hours — the quantity being 0.8 grs., and the latest fourteen days, the quantity in the whole organ being 0. 1 7 grains. It is important, in reference to the tissues, to observe that arsenic may be found in them even at an early period, when it is either absent or only doubt- fully present in other parts. In a case referred to me by Mr. Gell, coroner for Sussex, in May, 1854, the deceased, Burton, died within /owr hours after he had been attacked with symptoms of poisoning by arsenic. Arsenic was found in small quantity in the stomach, duodenum, and rectum. It was also detected in the liver and spleen ; and the proportion found was greater in the latter than in the former organ. The precise time at which the poison was taken could not be determined ; but the fact mentioned shows that its depo- sition in the tissues takes place very rapidly. In the cases of the Atlee family, referred to me by Mr. Carter, coroner for Surrey, in January, 1854, the body of the mother was exhumed after a month. Arsenic was not found in the stomach or bowels, but it was readily detected in a small portion of the liver. The poison had probably been taken several days before death. This fact is 92 ARSENIC — QUANTITY FOUND IN THE BODY. of considerable importance in relation to a medical opinion of tbe presence or absence of poison in a dead body. It is commonly the practice to confine an analysis to the stomach and bowels only; and when no poison is found therein, to report that no poison exists in the body, and to refer death to natural causes. It is clear, however, from the above case, that such an opinion might be erroneous unless the liver or spleen had undergone a chemical ex- amination. In reserving viscera for analysis, a portion of the liver should therefore always be examined. If the person has lived fifteen or sixteen days after having taken the poison, no trace may be found in the tissues or in any part of the body. Orfilalong since expressed this opinion from his experiments on animals ; its correctness has been strikingly confirmed by the case of Dr. Alexander, who died in six- teen days from a large dose of arsenic taken by mistake in arrowroot. Dr. Geoghegan, who was deputed to make an analysis of the stomach and other viscera, found no trace of the poison, either absorbed or unabsorbed, in any part of the body which he examined. (See Med. Times and Gazette, April 18, 185T, p. 389.) In the case of Sovfflard, a large dose of arsenic had been taken ; but according to M. Legroux, no trace of the poison was found in the stomach or in the ulcerated portions of the bowels. {Univ. Medicale, June 30, 1850.) 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 bowels indicates a large dose; but the finding of a small quantity does not prove that the dose was small. Notwithstanding these very obvious causes for the removal of a poison from the body, there is a strong prejudice among lawyers that the chemical evi- dence is defective unless the quantity found is snflBcient to cause death. It would be just as reasonable, in a case in which a man has been killed by a discharge of small shot, to insist upon a failure of proof of the cause of death, because only a single pellet has been found on the body. 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 should be clear, distinct, conclusive, and satisfactory. At the same time, a reasonable 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 of arsenic in the articles used, the chemical evidence in the case of Lajfarge, in which the whole quantity discovered in the body was stated to be the hundred and thirtieth part of a grain, was of a most unsatisfactory kind, and should have been rejected by the court. No man with any respect for his character, or for the common sense of a jary, would base chemical evidence on the thousandth, or less than the thousandth, part of a grain of poison in a case of life and death : although he may make use of his alleged power to detect this, or even a smaller quantity, for the purpose of procuring the acquittal of a notorious criminal. It has been supposed that the quantity of arsenic found in the stomach and bowels might throw a light on the question, whether the poison had been taken voluntarily with the intention of committing suicide, or whether it had been criminally administered by another. There is no doubt that a much larger dose may be taken by a suicide than could be secretly administered by a murderer ; and thus, if a large quantity be found in the stomach, it is sup- posed to furnish a presumption in favor of suicide and against murder. Suicides have been known to take as much as two tablespoonfuls, or one thousand grains, of arsenic. How much may remain in a dead body must, ARSENITE or POTASH — FOWLER'S SOLUTION. 93 however, depend on the amount of vomiting and purging, and the length of time the person survives. In one case of murder by poison I found in tlie stomach, on the exhumation of a body, eighteen months after death, twenty grains of arsenic. In the case of DAngelier {Reg. v. Madeleine Smith, Ed. High Court of Justiciary, June and July, 1857), Dr. Penny stated in evi- dence* that the quantity of arsenic which he found in the stomach and con- tents of deceased amounted to eighty-eight grains, and that some part of this was in hard, gritty, colorless, crystalline particles. As there was arsenic in the contents of the intestines, and there had been vomiting and purging, it is obvious that the deceased must have taken a very large dose of the poison ; and it was one of the suggested difficulties of the case to determine how the deceased could have taken the poison in so large a quantity unknowingly. The quantity found, however, amounted to no more than half a teaspoonful ; and admitting that one-half of the dose taken had been ejected, the question resolves itself into this : whether a teaspoonful of arsenic might not have been homicidally administered in chocolate, gruel, or some viscid liquid, or in a state of admixture with solid food. Although it is unusual to find half a teaspoonful of arsenic remaining in the stomach in a case of homicidal ad- ministration, it appears to me impossible to admit that this fact is inconsist- ent with an act of murder. A man half intoxicated might be thus poisoned ; and if death took place in a few hours, even a larger quantity than that which was here found might remain in the stomach. Dr. Christison has now set this question at rest by the publication of a case in which a man was homi- cidally destroyed by arsenic, and the quantity found in the stomach after death was from ninety to one hundred grains. The man had survived from five to seven hours, and there had been frequent vomiting of a yellowish or greenish-colored liquid during this period. The arsenic was administered in whiskey-punch with sugar, and it was kept in suspension by constant stirring. {Ed. Monthly Med. Journal, December, 1857, p. 481.) In Heginav. Dodds, tried at the Lincoln Assizes, in December, 1860, the prisoner was charged with administering arsenic to deceased with intent to murder. The quantity stated to have been found in the stomach by the medical witnesses was one hundred and fifty grains. There was not the least reason to suppose that the deceased had voluntarily swallowed this quantity. The condition of the arsenic found in a dead stomach should be specially noticed. A witness should be prepared to say whether it is in fine powder or 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. Arsenic is not a normal constituent of the body. Under no circumstances is it found after death, except in cases in which it has been taken by or ad- ministered to the deceased. ^ Arsenite oe Potash. (Fowler's Solution.) All the compounds formed by arsenious acid with the alkalies are poison- ous. Those of potash, soda, and ammonia are soluble in water, and there- fore act with more energy. The Arsenite or Potash is the only preparation which here requires notice. It is used in medicine, and is well known under the name of Fowler's Mineral Solution, or Tasteless Ague Drop. It is made by boiling arsenious acid with carbonate of potash, the latter being in slight excess, and it is colored with compound tincture of lavender. In the preparation of the London Pharmacopoeia there are four grains of arsenious acid in a fluidounce (or eight fluidrachms) of the solution. Its real strength may be affected by any impurities in the arsenious acid employed. The pre- paration used in Scotland is of the same strength ; but that of the Dublin 94 AKSENITE OF COPPER — SCHEELE'S GREEN. College is rather stronger. The action of this liquid as a poison, in large doses, is in all respects analogous to that of arsenious acid. Symptoms and appearances. — There is, so far as I know, only one case recorded in which this solution has destroyed life. (^Provincial Journal, June 28, 1848, p. 347.) A woman took half an ounce of the solution (= two grains of 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 were found inflamed. The solution is much used by the poor in the Fen districts of Cambridgeshire, as a preventive of ague. It has occasioned symptoms of poisoning when given in an overdose, but I have not heard of any case proving fatal. The domestic use of arsenic in these districts may, however, account for the occasional detection of the poison in a dead body, irrespective of criminal administration. There is one form of poisoning by this compound which it is desirable to point out. 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. There is no doubt that a mixture of this kind is injurious to sheep unless very carefully used. In Black v. Elliott (Newcastle Assizes, Feb. 1859), damages were claimed for the loss of 850 sheep, said to have been poisoned by dipping them in an arsenical mixture of this description. The jury found a verdict for the plaintiff, with 1,400/. damages. Analysis. — This solution has the odor of tincture of lavender, is of a red- dish color, and has an alkaline reaction. It gives at once a green precipi- tate (arsenite of copper) with the sulphate of copper, and a yellow precipi- tate with nitrate of silver. Acidulated with hydrochloric acid, and treated with a current of sulphuretted hydrogen gas, it yields a yellow sulphuret; and when boiled with this acid and copper, a deposit is obtained which readily furnishes octahedral crystals of arsenious acid. By Marsh's process it yields arseniuretted hydrogen. The arsenite of soda is as poisonous as the arsenite of potash. In Decem- ber, 1857, three hundred and forty children belonging to an industrial school near London were poisoned by this compound. It had been incautiously used for cleansing a steam-boiler, and had thus become mixed with the hot water which was drawn for the breakfasts of the children. The dose of arsenic taken by each child was calculated to be one grain. All recovered, although some suffered severely. (See On Poisons, 2d Am. ed. p. 341.) Fly-water is a name applied to solutions of various arsenical compounds in water. Mixtures of this kind are formed by dissolving one part of the arse- nite of soda or potash and two parts of sugar in twenty parts of water. Paper soaked in this solution, and dried, is used for poisoning flies ; and per- hajjfe this is the safest form in which arsenic can be used for such a purpose. A case of poisoning by fly-water, in which two grains and a half of arsenious acid destroyed the life of an adult in thirty-six hours, will be found reported in the Medical Gazette (vol. xxxix. p. 116). Arsenite oe Copper, Scheele's Green. The poisonous properties' of this compound are undoubtedly due to the arsenic which it contains; hence, it may be appropriately considered with the arsenites. It is the only metallic arsenite which is met with in commerce and the arts, and it constitutes, wholly or in part, a great variety of green pigments, known as emerald green (aceto-arsenite of copper) employed for paper-hangings, mineral green, Brunswick, Schweinfurt, Vienna, or Mitis green, &c. It is thus found in the form of oil-paint in cakes, in boxes of water colors, spread over confectionery, in wafers, in adhesive envelops, and ARSENIC IN CONFECTIONERY. 93 lastly and most abundantly, in the various kinds of green decorative papers for covering the walls of sitting and bedrooms. Symptoms and effects. — Although the arsenite of copper is insoluble in water, it is sufficiently soluble in the acid mucous fluids of the stomach to be taken up by the absorbents and carried as a poison into the blood. A boy, aged three years, swallowed a small capsule of Scheele's green, used by its father as a pigment. In half an hour, he complained of violent colic; there was frequent vomiting, with purging, cold sweats, intense thirst, and retrac- tion of the parietes of the abdomen. The mouth and throat were stained of a deep green color. Hydrated sesquioxide of iron was given ; in about an hour the vomiting ceased, and soon afterwards the thirst and pain in the abdo- men abated. , The next morning the child was well. In another case, a child, a year old, ate several pieces of a cake of arsenite of copper used for colors. There was immediate vomiting of a liquid coutaining green-colored particles of the arsenite, but there were no other urgent symptoms. White of egg, with sugared water, was given to it. After a short time, the child became pale, and complained of a pain in the abdomen ; the pulse was frequent, the skin cold, and there was great depression. Copious purging followed, soon after which the child recovered. (Galtier, vol. i. p. 636.) In the cases of two children poisoned by confectionery colored with this substance, the chief symptom was incessant vomiting of a light green-colored liquid resembling bile diluted with water. Mr. Bully, of Reading, who reports these cases {Medical Times, April 28, 1849, p. 507), describes the symptoms as severe, although the quantity of poison swallowed was small. TJnder the use of an emetic of ipecacuanha, the children recovered. Dr. Rose met with a case similar in its details {Lancet, March 5, 1859, p. 237). (See Guyh Hasp. Reports, Oct. 1850, p. 218; also, Medical Gazette, vol. xliii. p. 304; and Edinburgh Monthly Journal, July, 1851, p. 1 ; and Lancet, March 5, 1859, p. 237.) In two cases which I examined in January, 1853, a small quantity of a confectionery ornament, colored with arsenite of copper, proved fatal to two children. The symptoms and appearances were those of poisoning by arsenious acid. The quantity taken could not have been above two or three grains. The children picked up the ornament in the street and shared it between them. The poison was spread over a layer of sugar 1 In a case which was the subject of a criminal trial, this deadly compound 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-mange served at a public dinner; the person who employed it considering that emerald or mineral green was nothing more than an extract of spinach! It led to death under the usual symptoms, and the parties were convicted of manslaughter and sentenced to imprisonment. {Reg. v. Franklin and Randall, Northampton Summer Assizes, 1848.) Most of the colors used for confectionery are of a poisonous nature; the pink color given by cochineal or madder is the only one which can be regarded as innocent. Among other uses of this noxious compound, we find it employed for im- parting a bright green color to the shelves of bakers' and green grocers' shops. An incident which occurred to myself will show that food may thus acquire an arsenical impregnation. Several loaves of bread were supplied to me, having upon the undercrust a quantity of green-colored pigment, which, on analysis, turned out to be arsenite of copper containing about fifty per cent, of arsenic I On inquiry, I found that the baker had recently painted the shelves of his shop with this pigment, and the hot loaves placed upon them had taken off a portion of the arsenical paint. It is easy to conceive that an accident of this kind, if undetected, might lead to serious results, and perhaps to erroneous suspicions. {Medical Times and Gazette, April, 1854, p. 326.) 96 POISONING BY SCHEELE'S GREEN. Another alleged form of poisoning by this substance, which has attracted some attention, is as it exists in the state of vapor or fine dust applied to the membrane of the lungs, or in the state of powder as applied to the skin. A young man, after having been engaged for nine days in printing with an arsenical green pigment, was seized with irritation and watery discharge from the nose, swelling of the lips and nostrils, and headache. The next day he experienced severe colic, and great muscular weakness : but these symptoms disappeared in about eight days. It is probable that, in this case, the arse- nite of copper had been taken into the body in the state of fine powder. I have since been informed that the persons who hang the arsenical papers on walls suffer from boils, inflammation of the eyes, and irritation of the nose and throat. According to M. Bouchardat {Annuaire de Tkerapeutique, 1846, p. 209), the workmen who handle the emerald-green in making the papers are subject to serious disorders of health. They sometimes suffer from eruptions of the skin — one of the local effects of poisoning by arsenic (see Assoc. Med. Journal, 1856, Sept. 6, p. 7.57; Sept. 20, p. 810, and ante, p. 75), with oedema (watery swelling) of the face, and boils frequently form- ing in the scrotum. There is irritation with discharge of fluid from the mucous membrane of the nose, and abundant salivation. In the more ad- vanced stage there are colicky pains, headache, and prostration of strength. (See Ann. d'Hyg., 1847, vol. ii. p. 56 ; also a paper by Dr. Vernois, 1859, vol. ii. pp. 107, 319; and Casper's Vierteljahrs., 1859, vol. ii. p. 8; also Journal de Chimie, Juillet, 1858, pp. 394, 397.) I have elsewhere referred to the effects on health of wall-papers loosely covered with the aceto-arsenite of copper (p. 74). This pigment contains fifty-nine per cent, of arsenic, and from some of these papers the noxious material may be easily scraped or removed by friction. A square foot may yield from twenty-eight to seventy grains of the arsenical compound, and in rooms exposing five or six hundred square feet, a large quantity of arsenic is thus distributed over an extensive surface. It has been supposed that because persons who inhabit such rooms were not universally poisoned, and because in those who suffered, the symptoms were not like those of acute poisoning by arsenic, the effects must have been due to some other cause. Mr. Abel, Mr. Campbell, and Mr. Phillips (the chemist of the Board of Trade), came to the same conclusion on chemical grounds, i. e., such papers must be innoxious because they could not detect in the air of the rooms, or in hot air passed over arsenical paper, any crys- talline arsenic in a volatile state. In December, 1858, I found that the green pigment itself was detached from the walls and diffused in a fine dust over the whole of the apartment, so that arsenic was readily detected on the cornices, the mouldings of pictures, and even on the tops of books in a book- case closed with glass jJoors. (Med. Times and Gazette, Jan. 1, 1859, p. 5.) The case of a friend is there related, who suffered from inflammation of the eyes and other arsenical symptoms, as a result of dusting these books. The fact, therefore, is now affirmatively established, that those who inhabit rooms with arsenicated walls, are exposed to the risk of breathing arsenical dust and of suffering injury to health. That many do not suffer under these cir- cumstances is no objection to this view, for, out of a hundred persons who are exposed to the emanations of lead, there are probably not more than ten who suffer from lead-palsy. Many cases have now been published in the medical journals, clearly show- ing that the habitation of these arsenically-papered rooms may seriously affect health ; and this has been especially noticed with respect to bedrooms. The Registrar-General has taken up the matter, and, in opposition to the Board of Trade and the paper-manufacturers, has denounced the use of arse- nical paper-hangings as dangerous to health and life. ( Weekly Return, Nov. SCHEELE'S green — ANALYSIS. 97 15, 1860.) Dr. Letheby and Dr. Metcalfe have reported the details of two cases which occurred in Nov. 1860, in which one child died and another suffered most seriously, as a result of the use of these papers in a nursery. Arsenic and copper were discovered by Dr. Letheby in the stomach and liver of the deceased child. {Journal of Society of Arts, Dec. 14, 1860 ; Lancet, Nov. 17, 1860, p. 494.) Dr. Lorinser states that at Vienna the arsenical green is unknowingly selected by preference for papering bedrooms. He relates the eases of two females, in which injury to health was produced ; and in one of these, arsenic was detected in the urine, thereby at once explaining the cause of the symptoms. (Journal de CMmie, December, 1860, p. 724.) Dr. Bbcker, of Bonn, one of the most recent writers on Toxicology, refers to the effects of chronic poisoning produced on persons inhabiting rooms of which the walls are covered with arsenical paper-hangings, and states, that on several occasions he has been called upon to treat such cases. A removal of the cause has generally proved sufficient. Dr. Bbcker considers that a damp state of the wall renders them injurious. {Die Vergiftungen, 1857, p. 132 ; also Casper's Vierteljahrschrift, January, 1858, p. 184.) Arsenical papers are extensively used for lamp-shades, and for wrapping night-lights, as well as numerous articles of food and confectionery, by per- sons who would probably shrink from the use of white arsenic under similar circumstances. The effects which may be produced by the use of arsenical lamp-shades, have been described by Mr. Briggs, of Bath, in a case which fell under his observation. A watchmaker suffered from swelling and ulcera- tion of the lips. These symptoms were clearly traced to the use of an arse- nical shade. {Lancet, Jan. 17, 1860, p. 8.) Sanitary reform in our dwellings appears to be chiefly directed to the re- moval of those vapors only which affect the sense of smell, although there are substances having no offensive odor which are liable to be inhaled, and are much more injurious in their effects on health. So difficult is it to trace out the real cause of disease, and to fix this upon the public mind, when a particular branch of trade is liable to suffer injury, that some years elapsed before the noxious effects of phosphorus on lucifer-match makers was accepted as a fact. In 1846, M. Bricheteau announced from his researches that there was not a single well-authenticated case of necrosis among 2,000 match- makers of the Paris factories I Three or four cases of disease of the jaws which he met with were referred by him to syphilis. {Lancet, March 21, 1846.) The facts which M. Bricheteau endeavored to set aside by an imperfect in- vestigation are now established beyond dispute. The arsenical papers have received a quasi-official support in England from the Board of Trade, while they have received the condemnation of the Registrar-General, whose espe- cial duty it is to report on the causes which produce disease and add to the mortality of the country. If the sale of such papers is continued, it should be only on the condition of the words "arsenic — poison" being stamped upon them. [See Boston Med. and Surg. Journal, March 14, 1861, p. 121, for a notice of three instances of the poisonous action of arsenical wall-paper ; also, an account of serious illness in a child, produced by Scheele's green coloring matter, sucked by the patient from the surface of a green concert ticket. Dr. C. T. Jackson, of Boston, Mass., who reports the cases, found that one of these green concert tickets contained 1.48 gr. of arsenite of copper. — H.] Analysis. (Scheele's Green.) — This salt is of a green color, the depth of which is modified by admixture with other substances. It is insoluble in water, but soluble in ammonia and in acids, forming a blue solution. When very gently heated in a reduction-tube, arsenious acid is sublimed in minute octahedral crystals. These may be collected, dissolved in water and tested in the usual way. (See p. 78.) The residuary oxide of copper may then 7 98 ARSENIC ACIB — ANALYSIS. be dissolved in nitric acid, and tested for that metal. The pigment called Emerald Green, which is chiefly used for covering paper-hangings, is a mixture of arsenite and acetate of copper. The presence of arsenic in this compound is easily detected by hydrochloric acid and metallic copper. All the green arsenical papers owe their color to it. There is a very simple method of detecting arsenic in a paper of this kind. A slip of it should be soaked in a moderately strong solution of ammonia. The color is removed, and the blue ammoniuret of copper is formed and dissolved in a few minutes. A crystal of nitrate of silver may now be dropped into the blue liquid. If arsenic is present, it will be indicated by the outside of the crystal acquiring a yellow color from the production of arsenite of silver. At the top of the crystal the color will be green, from the intermixture of the yellow and blue, but below and at the sides, the yellow color will be well marked. ( Ohem. News, No. 1, p. 12.) If a strong solution of nitrate of silver is added to the am- moniacal liquid, nearly neutralized by diluted sulphuric acid, a yellow preci- pitate of arsenite of silver will be formed. Arsenic Acid. (Arseniates.) This is an artificial product almost entirely confined to the chemical labo- ratory. Orfila states that it is a more powerful poison than arsenious acid, but he does not adduce any cases in support of this opinion. I have not been able to find any case of poisoning by it in the human subject. Dr. Glover ascertained that four grains of the acid, dissolved in two drachms of water, and introduced into the stomach of a stout rabbit, killed the animal in four hours, with the symptoms of irritant poisoning, and an affection of the nervous system. {Ed. Med. and Surg. Journ., vol. Iviii. p. 121.) Analysis. — Arsenic acid is a white uncrystalline deliquescent solid. 1. It is not entirely volatilized on platina foil by the flame of a lamp. 2. It is very soluble in water, forming a highly acid solution. 3. It is precipitated of a brick-red color by nitrate or the ammonio-nitrate of silver. In these characters it differs from arsenious acid. 4. It yields readily an arsenical sublimate with charcoal. 5. It yields deposits with copper and muriatic acid, or in Marsh's apparatus. But Dr. Rainey has shown that Reinsch's process does not act so delicately with arsenic as with arsenious acid. The arsenic may, however, be converted to arsenious acid by a current of sulphurous acid gas. Arsenic acid is also precipitated, although slowly and of a pale yellow color, by, sulphuretted hydrogen gas. In these properties it resembles arse- nious acid. Dr. Brett has suggested, in place of using sulphuretted hydro- gen gas, the addition of hyposulphite of soda and hydrochloric acid to arsenic acid or an arseniate. The arsenic acid is thus brought at once to the state of arsenious acid, and precipitated by the sulphur of the hyposulphite. The precipitation as sulphite takes place slowly in the cold, but copiously, rapidly, and completely when the mixture is heated. The arseniates of potash and soda must be regarded as active poisons, although there are but few instances on record in which life has been destroyed by them. Dr., Christison states that, in the course of his reading, he has met with only two reported cases of poisoning by arseniate of potash (op. eit, 284). The tests are the same as for arsenic acid. A coarse sort of blotting- paper, soaked in a solution of arseniate of potash, is extensively sold under the name of "Papier Moure." It has been erroneously represented that the substance with which it is impregnated is not poisonous to human beings. (See Lancet, February 11, 1860; also Ann. d'Hyg., I860, vol. i. p. 292.) StTLPHTJEETS OP ARSENIC. 99 SULPHURETS OF ArSENIC. There are several kinds met with in commerce — Orpiment or Yellow Arsenic, and Realgar or Red Arsenic. They are poisonous in conse- quence of their containing a large proportion of free arsenious acid ; this sometimes amounts to as much as 30 per cent, of their weight. They are rarely used as poisons. Orpiment is much employed in the arts, and is pro- curable by artisans with the most destructive facility. From its brilliant color, it is used in painting, dyeing, paper-staining, and even in the coloring of toys and sweetmeats for children ! In December, 1859, six persons suf- fered from the usual symptoms of poisoning by arsenic, owing to their hav- ing eaten -BaiA huns. It was found that the confectioner at Clifton had used, as he supposed, chromate of lead to give the buns a rich yellow color, and make them salable ; but the druggist to whom he applied had ignorantly supplied him with orpiment. This wholesale system of poisoning is one of the attendant evils of adulterating articles of food. The Bradford lozenge cases (Nov. 1858) furnish a remarkable instance of the impunity attendant upon acts of this kind. A confectioner, intending to adulterate lozenges with plaster of Paris, mixed with them a quantity of white arsenic which had been supplied to him through mistake. I am informed that more than 200 persons partook of these poisoned lozenges, and suffered the usual effects. Seventeen persons died ; twelve from acute poisoning, and five from the secondary effects. A trial took place, but the law could not fix the respon- sibility for the act upon any individual. Symptoms and appearances. — The sulphurets of arsenic produce symptoms and appearances after death similar to those caused by arsenious acid ; but the dose required to destroy life must vary according to the proportion of arsenious acid with which the sulphuret happens to be mixed. This is not a common form of poisoning ; the yellow color of the poison would lead to suspicion ; but by reason of this color it may be given or taken, by mistake, for mustard or turmeric. In a case which occurred to Dr. Jochner, two per- sons partook of some porridge, in which orpiment had been put, by mistake, for turmeric. They suffered from continual vomiting, burning pain in the stomach, and collapse. One, an old man, died in twenty-two hours ; the other, a boy, recovered. On inspection, there was violent inflammation of the gullet and stomach, the mucous coat of the latter being softened and thickened. There was a sphacelated spot, one inch in diameter, in the gul- let; and another in the stomach, three inches in extent. (Wharton and Stille, Med. Jur., 2d ed. 531.) According to Dr. Oheevers (Med. Jur. for India,]). t4), orpiment is much used in India both as a medicine and as a poison. He refers to eight instances in which this poison was found, either in food, or in the stomachs of persons who had died under symptoms of irritant poison- ing. Orpiment and realg^ are sold openly in India, and are used as depila- tories. Orpiment has been known to cause death by external application as a depilatory. (See Annales d''Hygiene, 1834, 459.) Analysis. — The powdered sulphurets yield a solution of arsenious acid on boiling them in water acidulated with hydrochloric acid. They readily give the well-known subliniates of metallic arsenic, both with soda-flux, silver, and in the hydrogen apparatus. They also yield a deposit of arsenic when boiled with copper and hydrochloric acid. The other properties of this compound will be found described at page M. Organic mixtures. — The sulphuret being insoluble in water, it is in general easily separated mechanically by allowing the matters mixed with it to become dry upon bibulous paper. If the sul- phuret cannot be separated mechanically, the organic matter suspected to contain it should be dried and boiled with nitric acid to dryness, until it is destroyed. Any sulphuret will be then found under the form of arsenic acid, 100 corrosive sublimate. Solution op Chloride of Arsenic. (Liquor Arsenici Ohloridi.) This is a pharmacopceial solution of arsenic in diluted hydrochloric acid. It contains one grain and a half of arsenious acid in one fluidounce, which is equal to the small proportion of three-sixteenths of a grain to a fluidrachm. Mr. Phillips states that it is a highly poisonous preparation, and from a case which I saw in Guy's Hospital in May, 1857, this statement is confirmed. An adult female took, in three doses, thirty minims over a period of twenty- four hours. The quantity of arsenic thus taken was not more than the tenth part of a grain, and yet the symptoms which followed were of a seyere kind, resembling those of chronic poisoning. There were constriction of the throat, pain and irritation of the stomach and bowels, tingling and numbness of the hands and feet, loss of muscular power, and a feeling of extreme de- pression. 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 this poison. The quantity taken was very small to produce such alarming effects. The usual medicinal dose of this solution is from three to ten minims. It has about three-eighths of the strength of the solution of arsenite of potash. Arsenuretted Hydrogen. This is a gaseous poison of arsenic, producing, when respired in small quantity, very serious effects upon the system. It has already occasioned death in at least three instances. (See On Poisons, p. 441.) CHAPTER XII. corrosive sublimate — symptoms — its effects compared 'with those op arsenic — slow or chronic poisoning — salivation from small doses op mercurial medicines — from other causes — appearances after death — quantity required to destroy life — period at which death takes place — fatal dose — treatment — chemical analysis in powder and solution — process in organic liquids — calomel — white and red pre- cipitates — sulphurets of mercury. Corrosive Sublimate. This substance is usually known under the chemical name of Perohloride OP Mercury ; but, according to some distinguished authorities, it is a chlo- ride. To prevent any confusion from scientific chemical nomenclature, the old and popular name of corrosive sublimate is here used. It is not often taken as a poison. In the coroner's report for 1831-8, there were about fifteen cases of mercurial poisoning, in twelve of which corrosive sublimate was the poison taken. It is commonly seen under the form of heavy crystal- line masses, or of a white powder. The taste of corrosive sublimate is power- fully austere and metallic, so that no poisonous quantity of it could be easily swallowed, without the person becoming immediately aware of it. It is very soluble in water, hot or cold, and speedily sinks in it, in which properties it CORROSIVE SUBLIMATE — SYMPTOMS. differs strikingly from arsenic. I have found, by experiment, that on^b'^Bn^T\^"*-' died grains of a cold saturated solution hold dissolved, at a maximum, ten grains of corrosive sublimate ; and it is stated by most chemists that two parts of boiling water (212°) will dissolve one part of the poison. It is also readily dissolved by alcohol and ether ; the last body takes up one-third of its weight, and has the property of abstracting it from its aqueous solution — a principle which is sometimes resorted to for separating the poison when dissolved in organic liquids. Symptoms. — The symptoms produced by corrosive sublimate generally come on immediately, or within a few minutes, after the poison has been swal- lowed. In the first place, there is perceived a strong metallic taste in the mouth, often described as a coppery taste ; and there is, during the act of swallowing, a sense of constriction almost amounting to suffocation, with burning heat in the throat extending downwards to the stomach. In a few minutes, violent pain is felt in the abdomen, especially in the region of the stomach, which is increased by pressure. Pain in the abdomen has been sometimes wholly absent. There is nausea, with frequent vomiting of long stringy masses of white mucus, mixed with blood ; and this is followed by profuse purging. The countenance is sometimes swollen and flushed, in other cases it has been pale and anxious. The pulse is small, frequent, and irregu- lar, and is scarcely perceptible when the symptoms become aggravated. The tongue is white and shrivelled, the skin cold and clammy, the respiration dif- ficult ; and death is commonly preceded by fainting, convulsions, or general insensibility. The external parts of the mouth, when examined, are swollen, and sometimes present an appearance as if the cavity had been washed with a solution of nitrate of silver ; the lips are often swollen. Suppression of urine has also been frequently noticed among the'symptoms. It existed in a well-marked case of poisoning by this substance at Guy's Hospital ; the patient lived four days, but did not pass any urine during the whole of this time. {Guy^s Hospital Reports, April, 1844, p. 24.) This symptom was ob- served in a case reported by Dr. Wegeler (Casper's Wochenschrift, Jan. 10, 1846, p. 30), in which a youth, set. seventeen, 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, reported by Dr. Herapath, in which a scruple of corrosive sublimate in solution was swal- lowed, suppression of urine and salivation came on on the third day, and the patient died on the ninth day. {Lancet, Dec. 13 and 27, 1845, pp. 650, 698.) In a case observed by Mr. Morris, the quantity of urine secreted was small, and it produced a scalding pain when voided. (Prov. Med. Journ., Nov. 18, 1843, p. 126.) In this instance, there was no purging. The application of corrosive sublimate to tumors or ulcers may destroy life with all the usual symptoms. At the Winchester Lent Assizes, 1859 {Beff. v. Crook), a quack was convicted of manslaughter by applying corrosive sublimate in powder to a cancerous tumor in the face of deceased. The man suffered from the usual symptoms. After death, the bowels were found extensively inflamed and ulcerated. Mr. May, of Reading, detected corrosive sublimate in the can- cerous tumor. This poison differs from arsenic : 1. In having a well-marked taste ; 2, in producing violent symptoms in a few minutes ; and 3, in the fact of the evacuations being more frequently mixed with blood. The symptoms pro- duced by corrosive sublimate, in the first instance, resemble those of cholera; if the individual should survive several days, they are more like those of dysentery — violent straining, and mucous discharges mixed with blood being very frequently observed. 102 CORROSIVE SUBLIMATE — CANCRUM ORIS. Slow or chronic poisoning. — The symptoms are much modified when 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 gams 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 swallow- ing and breathing. The constitutional effects are indicated by looseness of the bowels, difficulty of breathing, spitting of blood, cough, general tremor of the limbs, and palsy, with slow 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 by 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 some instances the patient dies too rapidly for this effect to follow, but even when he survives some days, salivation is not always observed. In a case related by Dr. Venables, in which two drachms of the poison had been taken, and the woman survived for the long period of eight days, this symptom did not exist. In another case reported by Mr. Wood {Ed. Med. and Surg. Journ., vol. li. p. 141), in which half a teaspoonful of the poison was taken, salivation was profuse in the course of a few hours. When the dose of this poison has been small and repeated at intervals, we may gene- rally expect to meet with salivation, accompanied by fetor of the breath, and sponginess and ulceration of the gums. Should the person survive some time, this symptom is more commonly met with than not; but in looking for it as an indication of mercurial poisoning, a medical jurist must remember that some persons are wholly unsusceptible of this condition. On the other hand, there are cases in which the salivary glands are most easily excited, so that the usual innocent doses of calomel or gray powder have been known to produce salivation to such a degree as to cause death. Oancrum oris. Canker of the mouth. — Corrosive sublimate, and other mercurial preparations, are liable to produce gangrene of the mouth and fauces — a state which may equally occur from spontaneous causes : death is commonly the result. In a case of this kind, supposing any mercurial com- pound to have been given medicinally, it may become a serious question whether death actually resulted from the mercury acting as a poison, or from natural disease. Several fatal cases have occurred among infants and chil- dren ; and the subject has become a matter of inquiry before coroners. Al- though salivation and its consequences are not common among children, as an effect of mercurial medicines, yet it is clear, from numerous cases which are on record, that small doses of mercury may have a most violent effect upon them, and render the suspicion of poisoning probable. Of two chil- dren, whose deaths became the subject of investigation under these circum- stances, oue was affected with hooping-cough and the other with measles. Powders containing calomel were prescribed in both cases — gangrene of the mouth supervened, and the children died. There was some reason to believe, froni the evidence, that the mercury had really produced the effect attributed to it, at least in one of the cases. In another instance, in spite of the ab- sence of salivation, it appears to have been produced by a drachm of mercury and chalk in a child aged five. It proved fatal in five days. {Lancet, March 2Y, 1847.) It is proper to remark, that this kind of disease— gangrene of the mouth— has been observed to occur in children to whom no calomel, nor any mercurial preparation whatever, had been given :— the subjects have been chiefly infants, badly fed and clothed, and generally laboring under, or re- covering from, fever, smallpox, measles, or hooping cough. It is, however, COKROSIVE SUBLIMATE — APPEAEANOES AFTEE DEATH. 103 far more common as a consequence of measles than of other diseases, and it is always connected with a depressed state of the vital powers. Many cases of this kind are reported by Dr. Hennis Green (see Lancet, Dec. 1839). The disease is often vulgarly called "canker of the mouth." Dr. Dugas considers that children between five and eight years of age are very liable to this form of mercurial salivation and sloughing. {Ed. Monthly Journal, May, 1851, p. 481.) Appearances after death. — These, as in the case of arsenic, are chiefly confined to the alimentary canal. Corrosive sublimate, however, affects both the mouth and throat ; the mucous membrane is softened, of a white or bluish gray color, and sometimes inflamed ; that lining the gullet is similarly affected, and partially 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 the whole cavity has a slate-gray color from the partial decomposition of the poison by the mem- brane itself; beneath this, the mucous coat may be found reddened. This gray tint of the mucous membrane has been considered by some to be indi- cative of the action of the poison on the living mucous membrane ; but it is not always present. A case occurred at Guy's Hospital, in which the mucous membrane was simply inflamed : it much resembled 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 csecum. In a case reported by Dr. Herapath, in which a scruple was 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 action of the poison in this organ. The csecum had been the seat of the most violent inflammation, the whole surface being of a deep black-red color, and there were patches of sloughing in the coats. {Lancet, Dec. 21, 1845, p. 100.) In a case which occurred to Dr. Thompson, of Perth, in which a man died forty hours after having swallowed two drachms of corrosive sublimate in powder, the mucous membrane of the stomach, duodenum, upper portion of the ileum, and parts of the large in- testines, were found of a bright red color. This appearance was most marked at the csecum and sigmoid flexure of the colon. The local action of the poison on the mouth and throat was in this instance considerable. (Edin- burgh Monthly Journal, Dec. 1851, p. 532.) Perforation of the stomach is very rare as an effect of this poison : there is, I believe, only one case on re- cord. Certain morbid changes have been found in the urinary and circulat- ing organs, and Mr. Swan states that he has found the ganglia and branches of the sympathetic nerve inflamed ; but these changes are not by any means characteristic of this variety of poisoning. Appearances iu the alimentary canal, like those just described, have been seen, not only where the case has terminated fatally in a few hours, but where it has been protracted for six, eight, and even eleven days. (Chaussier, Eecueildes Memoires, 363.) In the case of a man, set. forty-two,' who swallowed, by mistake, thirty grains, of this poison dissolved, and who died on the twelfth day, the stomach was found empty, the mucous membrane was of a dull, dark red color, chiefly about the smaller curvature. It was softened, and near the pylorus was gray, pulpy, and gangrenous. In the gullet, the lining raenbrane appeared to have been stripped off in shreds. The intestines were in a state of intense inflamma- tion, passing into gangrene. The other viscera presented no particular ap- pearance. In this case the symptoms were manifested in a few minutes : there was a burning pain down the gullet to the stomach complained of as if the parts were on fire ; there was no mark of corrosion in the mouth ; there was a sensation described as if the throat were "grown up;" the 104 CHEMICAL ANALYSIS — IN THE SOLID STATE. vomited matters contained blood, as well as the evacuations. There was no salivation at any period. {Med. Times and Gaz., Feb. 26, 1859, p. 210.) Quantity required to destroy life. — This is a question which it is somewhat difficult to answer with any degree of certainty, since it is only by accident that the quantity taken can be ascertained, and the fatal effects must vary according to many circumstances. A child aged three years died in twenty- three days from the effects of twenty-three grains of corrosive sublimate. The smallest dose which is reported to have destroyed life was three grains. This was also in the case of a child, and the quantity was accurately determined from the fact of its having been made up by mistake for three grains of calo- mel, which the physician intended to order. (This case is referred to in the Lancet, 1845, p. 297.) A very loose and imperfect report either of the same or of a similar case is given in the Annales d'JIygihne, 1835, vol. i. p. 225. It is stated that three children lost their lives. It is probable that, under favorable circumstances, from three to five grains, or even less, would destroy an adult. Persons who had taken large doses have been known to recover when remedies were timely administered, or early vomiting was produced. {Med. Times at-^ Gaz., Feb. 18, 1860, p. 162.) I have elsewhere reported a case in which a female who had swallowed nineteen grains recovered in a few days without a bad symptom. {Guyh Hasp. Reports, Oct. 1850, p. 213.) A case of recovery after forty grains had been taken in whiskey under cir- cumstances favorable to its fatal operation, i. e., on an empty stomach, is recorded by Dr. Andrews. {Cormach's Journal, Feb. 1845, p. 102.) The patient was a woman of sixty-five. The smallest dose required to destroy an adult, under ordinary circumstances, cannot, therefore, be determined at pre- sent from any reported facts. Judging from the effects produced by small quantities used medicinally, possibly the average fatal dose may not differ widely from that of arsenic, i. e., two to three grains. Period at which death takes place. — In an acute case, an individual com- monly dies in from one to five days ; but death may take place much sooner or much later than this. A person has been known to die from the effects of this poison in eleven hours {Ghrisiison, p. 402); and in one instance of a child two years old, by whom twelve grains had been taken, death probably occurred in six hours. {Niemann^ Taschenhuch, p. 451.) A case is reported in which a child, aged seven, was killed in three hours by eighteen grains of corrosive sublimate. The shortest fatal case on record was communicated to me by Mr. Welsh. The quantity of poison taken was not ascertained, but the man died in less than half an hour. (On Poisons, Corrosive Sublimate, 2d Am. ed. p. 413.) In a case reported in the Edinburgh Monthly Journal, vol. i. 1860, p. 958, an adult who took from sixty to eighty grains of corro- sive sublimate did not die until the twelfth day. The case was somewhat peculiar. On the first day there was no complaint of pain in the gullet or stomach; the throat was painful on the second day, and the mouth and gums were affected on the third day. On the eighth day the man had apparently recovered, but he gradually became weaker, and died on the twelfth day. Chemical analysis — in the solid state. — "We will first suppose that the poison is in a solid state, and in the form of a white powder. 1. A small quantity heated on thin platina foil is entirely volatilized at a moderate heat — (care should be taken in performing this experiment) — in this property corrosive sublimate resembles arsenic, but it differs from arsenic in all other respects. If heated in a close tube, it melts at about 560°, and is then sublimed and deposited in prismatic crystals. 2. It is very soluble in water if the water be warmed, the powder will be dissolved instantly. 8. A small quantity of the powder dropped into a white saucer containing a solution of iodide of potassium, is turned of a bright scarlet color. 4. Dropped into potash in a CORROSIVE SUBLIMATE — TESTS FOR THE SOLUTION. 105 similar way, it is turned of a yellow color. 5. Into a solution of hydrosul- phuret of ammonia, it is turned black. 6. When a few grains are rubbed on a clean surface of copper, with a mixture of one part of hydrochloric acid and two parts of water, a bright silvery stain is produced, which is entirely volatilized by heat. If zinc or tinfoil be used instead of copper, the surface acquires a silvery lustre, and the metal becomes remarkably brittle. 1. When mixed with three or four parts of calcined carbonate of soda, and heated in a small tube similar to that employed in the analysis of arsenic, the metal is reduced, and a ring of bright globules of mercury is formed, while common salt remains in the tube. For the success of this experiment the materials must be quite dry, and the tube at first gently heated : any undecomposed corrosive sublimate that may be sublimed should be driven higher up, before finally applying a strong heat, so that the ring of mercury may not be ob- scured by it. This last experiment is conclusive of the nature of the sub- stance; because mercury, being the only liquid metal, is the only metal which sublimes in globules. If the end of the reduction-tube, containing the fused chloride of sodium left as a residue by the decomposition, be filed ofi^, reduced to powder, and boiled with a little diluted nitric acid, a solution is obtained in which, on the addition of nitrate of silver, chlorine may be proved to exist. The analysis is then complete. The properties mentioned under 1, 2, and 5, are possessed in common by other bodies ; but the other characters are pecu- liar to the persalts of mercury ; and when the results agree, they render it absolutely certain that the powder must be a persalt of this metal. The action of nitrate of silver upon the solution of the residue will prove that the persalt must have been a Moride. There are, therefore, no objections to this mode of analysis. In solution in water. — Corrosive sublimate is very soluble in water, form- ing a clear solution which, when concentrated, has a faintly acid reaction and a strong metallic taste. A few drops of the solution may be first gently evaporated on a slip of glass, and then set aside to crystallize. If it be cor- rosive sublimate, it forms slender opaque silky prisms, sometimes of con- siderable length, and intersecting each other. When a weak solution of iodide of potassium is dropped on them, they acquire a bright scarlet color, and chloride of potassium is formed. These characters, which may be ob- tained from the minutest crystal and only one drop of solution, prove that the body dissolved in water is corrosive sublimate ; it is thus distinguished from every other mineral poison, and all other substances whatever. Tests. 1. Potash. — On adding a small quantity of caustic potash to the solution, a reddish-colored precipitate falls, becoming yellow by the addition of a larger quantity of alkali. This precipitate, when washed, dried, and heated in a reduction-tube, yields a well-defined ring of metallic mercury. The filtered liquid will be found, on being tested with nitrate of silver, to contain chloride of potassium, thus proving that the mercury was combined with chlorine, and that the compound was soluble in water. 2. Chloride of tin. — On adding this test in rather large quantity to the solution, a white precipitate at first falls (calomel), becoming speedily of a slate-gray color, and afterwards almost black. On warming the liquid it soon becomes clear, while a heavy precipitate, in great part formed of pure metallic mercury, falls to the bottom of the vessel. The mercury may be collected by pouring the liquid on a filter, and afterwards drying the filter ; or its presence may be easily demonstrated by pouring the water carefully from the heavy precipi- tate, and forcing down upon this a slip of bibulous paper; the paper absorbs the water from the mercury, and the pressure condenses the metal into one or more well-defined globules. 3. Sulphuretted hydrogen gas. — This gives at first a precipitate, partly black and partly white (chloro-sulphuret), be- coming entirely black when the current of gas has been allowed to pass in 106 CORROSIVE SUBLIMATE — TESTS FOR THE SOLUTION. for some time. Hydrosulphuret of ammonia gives a similar precipitate in the solution ; thus clearly distinguishing corrosive sublimate from arsenic. The test acts equally in an acid solution of the salt. The precipitated black snlphuret of mercury, dried and heated with carbonate of soda or metallic silver, easily furnishes a ring of pure metallic mercury. 4. Precipitation by metals. — If we acidulate the liquid with a few drops of diluted hydrochloric acid, and introduce a slip of bright copper, or, what is better, fine copper- gauze, it is soon coated in the cold with metallic mercury, having more or less of a silvery lustre, especially on friction. On heating the copper in a reduction-tube, the mercury may be obtained in well-defined globules. 5. The galvanic test There are various methods by which galvanism may be applied to the detection of mercury or corrosive sublimate. Dr. Wollaston, on one occasion, employed an iron key and a guinea ; he placed a drop of the suspected solution on a surface of gold, and touched it and the gold with the key ; the mercury was deposited on the gold in a bright silvery stain. The following is a ready method of producing the metal : Place a few drops of the solution on a clean surface of copper, and slightly acidulate it with muriatic acid ; then touch the copper through the solution with a slip of zinc foil. Wherever the copper is touched by the zinc the mercury is deposited, and on washing the surface with diluted hydrochloric acid and weak am- monia, a silvery stain is left, which is immediately dissipated by the heat of a spirit-lamp. The experiment may be modified by twisting a slip of zinc round a slip of bright copper, or copper gauze, and introducing them into the liquid ; any change or color or tarnish will be apparent on the copper. Mercury is deposited on both metals. A surface of gold with zinc, the gold foil or wire being external and twisted round the zinc, forms a still more delicate test of the presence of mercury than a surface of copper. Applied in a way to be presently explained, it will detect the metal when nearly every other method fails. Other tests have been proposed; but I omit all notice of them, because the foregoing are, in my opinion, quite sufficient for every practical purpose. In liquids containing organic matter. — The. same process of analysis will apply to the vomited matters and contents of the stomach. 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 it suddenly. This poison is decomposed and precipitated by many organic principles, such as albumen, fibrin, mucous membrane — also by gluten, tannic acid, and other vegetable substances. Thus, then, we cannot always expect to find it in the stomach, in a state of solution. We must filter, in order to separate the liquid from the solid portion ; and our first object will be to determine whether any of the poison is held in solution. For this purpose a portion of it may be shaken with its volume of ether in a stoppered tube, and after a time the ethe- real liquid decanted, and allowed to evaporate spontaneously in a watch- glass, or other convenient, glass vessel. If corrosive sublimate is present in moderate quantity, white prismatic crystals will appear, which are rendered scarlet when touched with a solution of iodide of potassium. The other pro- perties of the poison may also be brought out by dissolving the crystalline residue in water, filtering the solution through a wet filter, and applying the appropriate tests. The quantity of corrosive sublimate may be too small for this method of separation ; then we may acidulate the liquid with about one- tenth part of its volume of hydrochloric acid, and introduce a slip of copper- gauze, at the same time warming the liquid. If the poison be present, even in minute quantity, the gauze will sooner or later acquire a silvery-gray color, from a deposit of mercury. It should be well washed in water, in alcohol or ether, again in water, and then dried. On heating it in a reduction-tube, COEEOSIVE SUBLIMATE — TESTS FOE THE SOLUTION. lOT a ring of fine metallic globules will appear in a detached form, and having a silvery-white lustre. There is no angularity, transparency, or crystalline character about this sublimate, as in the case of arsenic. When examined by the microscope, spherical globules are seen, which are perfectly opaque by transmitted light, and of a bright silvery lustre by reflected light. In order to remove any doubt, the ring of glass on which the sublimate is deposited may be broken up and warmed in a wide tube with a few drops of nitromnriatic acid. On evaporating to dryness at a very low temperature (corrosive sublimate being volatile), a residue having a prismatic crystalline character remains. These are crystals of corrosive sublimate reproduced from the globules of metallic mercury. When touched with a solution of iodide of potassium, they acquire a scarlet color. In very fine sublimates this, or some corroborative experiments on their nature, are indispensably necessary. The galvanic gold test may be thus applied : Cut a slip of thin gold-foil, of about one inch in length, and one-eighth of an inch in width ; it should be just large enough to enter into a small reduction-tube. We then twist this, in a spiral form, round a similar slip of finely laminated zinc ; acidulate the suspected liquid with a few drops of diluted hydrochloric acid — suspend the gold and zinc by a thread in the midst of it, and warm the liquid. Several such pieces may be at once, or successively, suspended in the liquid. Ac- cording to the quantity of mercury present, the gold will be coated with a gray-colored deposit, either immediately, in the course of a few hours, or not until after twenty hours. If at the end of twenty-four hours the gold retains its bright yellcTw color, even after the liquid has been warmed, there is pro- bably no mercury present in a dissolved form, or the quantity is too small to admit of detection. Supposing the gold to have lost its color, owing to its having become completely coated, we should wash it in ether, and afterwards in distilled water, to remove any corrosive sublimate or organic matter adher- ing to it ; it should then be dried in air, without being allowed to touch any surface, and when dry divided into two equal portions. The zinc may be in part, or wholly dissolved, and it may be renewed, if necessary. One-half of the gold-foil with the deposit should now be introduced into a reduction-tube. On applying heat, a fine sublimate will soon appear in the cool part of the tube, which, if not perceptible to the eye, may be easily seen, by the aid of a common lens or of a microscope, to consist of minute globules of mercury. The other half of the gold-foil with the deposit may be boiled in a tube with a few drops of strong nitric acid. If the gray deposit was owing to mer- cury, it will be dissolved, and now, on dilution with water and the addition of a solution of chloride of tin, a grayish-black precipitate of mercury will be thrown down. In this experiment no more nitric acid should be used than is required to cleanse the gold. It has been proposed to use fine wires of zinc and gold in place of the foil ; but the foil has the advantage of present- ing a greater surface. To prevent any objection to the conclusion that mer- cury is present when these results are obtained, it will be necessary to test separately, and together, the gold, zinc, and nitric acid, for this metal. Let us suppose that the filtered liquid contains no trace of a mercurial salt; we must now direct our attention to the analysis of the insoluble mat- ters separated by filtration. These may be boiled in distilled water ; the liquid filtered, and tested by agitating it with one third of its volume of ether. It will be found, when the analysis has not been long delayed, that most of the compounds which corrosive sublimate forms with organic matter, yield commonly sufficient poison for detection, by boiling them in water. Should water fail in extracting the poison, the substance may be brought to dryness and heated with nitro-hydrochloric acid until all the organic matter is decom- 108 MERCURY IN THE TISSUES. posed, and the surplus acid expelled. The residue may then be digested in water, and tested for mercury by the aid of copper-gauze or of gold and zinc. Mercury in the tissues. — The liver or other tissue is cut into small pieces, and boiled in a flask until the texture is entirely broken up, in a mixture of one part by measure of pure hydrochloric acid to six or seven parts by mea- sure of distilled water. A small slip of copper gauze at the end of a polished copper wire is first introduced. If it acquires a light gray color, it is proba- ble that mercury is present. If not immediately coated, the decoction is evaporated with the copper immersed in it. The coated gauze is cleansed, washed, dried as above described, and then heated in a small tube. A minute ring of mercurial globules will be perceptible either to the unassisted eye or by the aid of a lens or microscope. The spherical form, opacity, and high metallic lustre by reflected light, are sufficient to identify a mercurial subli- mate. In some late researches on the detection of mercury in the tissues, I have found that the use of gold and zinc foil, in the manner above described, is the most certain and rapid method of separating this metal. {Gui/'s Hos- pital Reports, October, 1860, p, 483.) When the mercury has been brought to a state of solution, by hydrochloric acid if necessary, there is no deposit on the gold until the zinc is placed in contact with it. The deposition is greatly accelerated if the liquid is heated. Mercury is then proved to be present : 1, by the silvery gray coating which the exposed parts of the gold acquires ; 2, by the sublimate of metallic globules obtained, as a result of heating one-half of the coated gold ; and 3d, from the solubility of the de- posit on the other half of the gold, in strong nitric acid and the gray or gray-black precipitate which the nitrate thus formed produces with chloride of tin. Mercury is not a constituent of the body. The discovery of it, therefore, proves that it must have been received ah extra. The processes above de- scribed merely show the presence of the metal, not of corrosive sublimate in the body. Whether the substance had acted as a poison or not must be determined from symptoms and appearances : whether it had been given or taken as a medicine or not, is a conclusion which must also be deduced from other circumstances. The proof that the mercury was really in the form of corrosive sublimate, could only be derived from the discovery of some undis- solved portions of the solid poison in the stomach or its contents, or from a separation of the poison itself by means of ether (ante, p. 106). If dissolved, it would show a soluble salt : 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 deceased. Nothing is more common than to discover traces of mercury in the stomach, bowels, liver, or other organs in the dead body. No import- ance can be attached to this discovery in the absence of evidence that the deceased has actually suffered from symptoms of mercurial poisoning. As to the mercury found in the tissues, it may have been derived from a soluble or insoluble compound, or from exposure to the metal in various trades. If there should be any doubt about the nature of a sublimate, the corroborative test recommended in the preceding page may be employed. A person may die from the effects of corrosive sublimate, and no mercury may be found in the tissues. A case of this kind occurred to me some years since at Guy's Hospital; and another, in which the deceased died in fifteen days from a large dose of corrosive sublimate in whiskey, has been reported by Dr. Geoghegan. On this occasion, although the local effects of the poi- son on the throat, stomach, and bowels, were of an intense kind, the viscera, on careful analysis, yielded no trace of mercury ; the metal had been entirely eliminated. (See Med. Gaz., vol. xlvi. p. 253.) calomel — white precipitate. 109 Calomel. This substance, also called chloride or subchloride of mercury, although commonly regarded as a mild medicine, is capable of destroying life, even in comparatively small doses. Several cases have occurred in which excessive salivation, gangrene of the salivary organs, and death, have followed from the medicinal dose of a few grains. There is a case reported in the Medical Gazette (vol. xviii. p. 484), in which a boy, aged fourteen, was killed in about three weeks by a dose of only six grains of calomel. It is singular that, in this case, neither the gums nor the salivary glands were affected ; still, con- sidering the effects of calomel in other instances, it seems most probable that the ulceration and gangrene of the face which followed were due to it. Pereira mentions the case of a lady who was killed by a dose of twenty grains of calomel ; she had previously taken a moderate dose without a sufficient effect being produced. Sobernheim states that a girl, aged eleven, took, in twenty-four hours, eight grains of calomel, for an attack of croup, and died in eight days from inflammation and ulceration of the mouth and throat. In another instance, which occurred to Lesser, fifteen grains of calomel produced similar effects, with excessive salivation ; and this patient also died in eight days. Meckel relates that twelve grains have destroyed life. (Lehrbuch, der Ger. Med., 26Y.) Two cases of death from calomel, in children, are recorded in the Registration Returns for 1840. There are many other fatal cases on record, and the facts leave no doubt that calomel may, in large doses, act as an irritant poison. It was supposed that these facts might be ascribed to this compound being adulterated with corrosive sublimate ; but this supposition is not well founded. It has been also suggested that calomel might be converted into corrosive sublimate, by the free muriatic acid contained in the gastric secretions ; but the minute proportion in which this acid exists in the fluids of the stomach, is adverse to this suggestion. {Edinh. Med. and Surg. Journal, vol. xlix. p. 336.) Calomel 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 being blackened by alkalies. A mercurial sublimate may be obtained from it by heating it with dry carbonate of soda. White Precipitate. Ammonio-Chloride op Mercury. A few years since it was a contested question whether white precipitate was or was not a poison; and at the Chelmsford Lent Assizes in 1850, a woman who was indicted for administering this substance to her husband, owed her acquittal to the lenient assumption in her favor that it was not a poison. Out of fourteen cases which I have collected in which white precipi- tate was taken, in doses varying from a few grains to forty, two only proved fatal; and one of these was the subject of a trial for murder {Eeg. v. Moore, Lewes Lent Assizes, 1860). The symptoms which it produces are violent vomiting, cramps, purging, and pain in the stomach, with convulsions. After death, there is more or less inflammation of the stomach and bowels. Dr. Pavy's experiments on dogs and rabbits show that this is a more formidable poison than it has been hitherto supposed to be. The greater number of recoveries were probably owing to the substance being early ejected by vomiting. Rabbits, which do not vomit, were killed by a dose 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. Reports, October, 1860, p. 483.) White precipitate is an insoluble chalky-looking compound, containing 110 CYANIDE OF MERCURY — TTIRBITH MINERAL. about eighty per cent, of mercury. As it is sold in the shops, it frequently contains corrosive sublimate to the amount of one or two per cent. It is not used internally, but it is much employed by the poorer classes in the treatment of ringworm. It is soluble in acids, is not blackened by alkalies, and it yields a mercurial sublimate when heated with dry carbonate of soda. If boiled in a solution of potash, it evolves ammonia, and yellow oxide of mercury is precipitated. Red Precipitate. Red Oxide of Mercury. This substance is poisonous, but instances of poisoning by it are very rare. The following case occurred at Guy's Hospital in 1833 : A woman, aged twenty-two, who had swallowed a quantity of red precipitate, was brought in laboring under the following symptoms : the surface was cold and clammy ; there was stupor approaching to narcotism ; frothy discharge from the mouth, and occasional vomiting; the vomited matters contained some red powder, which was proved to be red precipitate. There was considerable pain in the abdomen, increased by pressure, and there were cramps in the lower extremi- ties. On the following day, the throat and mouth became painful, and the woman complained of a coppery taste. The treatment consisted in the use of the stomach-pump, and the free administration of albumen with gluten. She left the hospital four days afterwards, still under the influence of mer- cury. The quantity of oxide here taken was not ascertained. Sobernheim relates a case in which a man, aged twenty-six, swallowed an ounce of red precipitate. He was speedily attacked with pain in the abdomen, nausea, purging, cramps, and general weakness. The vomited matters consisted, of masses of mucus containing red precipitate. He continued to get worse, and died in less than forty-eight hours after taking the poison. On inspec- tion, the mucous membrane was found eroded and inflamed in patches — small particles of the poison being imbedded in it. The duodenum was in a simi- lar state, and there was a large quantity of red precipitate in the contents of this intestine, as well as in the stomach. {Op. cit., p. 250.) A common opinioQ exists among the vulgar, that this compound is possessed of active poisonous properties, hence it is sometimes administered with criminal design. Cyanide OF Mbrcury. This is a substance which is but very little known, except to chemists,. yet it is an active poison, and has caused death in at least two instances. In April, 1823, a person who had swallowed twenty grains of this compound (thirteen decigrammes), was immediately seized with all the symptoms of poisoning by corrosive sublimate, and died in nine days. There was con- tinued vomiting, with excessive salivation, ulceration of the mouth an^ throat, suppression of urine, purging, and, lastly, convulsions of the extremi- ties. On inspection, the mucous membrane of the stomach and intestinal canal was extensively inflamed. {Orfila, vol. i. p. T35.) Dr. Christison quotes a case in which ten grains destroyed life within the same period of time. {Op. cit., p. 421.) As a poison, the cyanide is not much inferior in activity to corrosive sublimate, but it has no corrosive properties. TuRBiTH Mineral. Subsulphate of Mercury. Fatal cases of poisoning by this compound are by no means common. Although insoluble in water, it is undoubtedly an irritant poison, and is capable of causing death in a comparatively small dose. A well-marked instance of its fatal operation was communicated to the Pathological ' Sociiety NITRATES OP MERCtTEY. Ill by Mr. Ward, in March, 1841. A boy, set. sixteen, swallowed one drachm of this preparation on the night of February 19th. It produced a burning sensation in the mouth and throat, and vomiting in ten minutes. In about an hour there was paleness, with anxiety of countenance, coldness of surface, constant sickness, sense of heat and constriction in the throat, and burning pain in the stomach, with cramps. The irritability of the stomach continued in spite of treatment, and after two days there was salivation with mercurial fetor. The gums acquired a deep bluish tint, and began to ulcerate. The patient died in about a week after he had taken the poison, without convul- sions, and without suffering at any period from symptoms of cerebral disturb- ance. The principal appearances in the body were : — inflammation of the gullet, its mucous membrane at the lower part peeling off; the inner surface of the stomach near the two openings (cardia and pylorus) was covered with petechial spots; the small intestines were contracted, the inner coat reddened, and petechial spots were found, but chiefly in the large intestines. The parotid and submaxillary glands were swollen. Mercury was detected in the intes- tines. (See Med. Gaz., vol. xxxix. p. 4^4.) From this account it will be perceived that turbith mineral produces effects somewhat similar to those of corrosive sublimate, but it is less active. Nitrates op Mercury. These are corrosive poisons which are used for various purposes in the arts. They are solid white salts, easily dissolved by cold water where there is a little excess of acid present. The acid pernitrate caused death in a case reported by Mr. Bigsley in the Medical Gazette (vol. vi. p. 329). A butcher's boy dissolved some mercury in strong nitric acid, and swallowed about a teaspoonful of the solution. Soon afterwards he suffered excruciat- ing pain in the throat, gullet, and stomach : — there was great anxiety, with cold skin, small pulse, colic, and purging. He became gradually weaker, and died in about two hours and a half. On inspection, the throat, gullet, and stomach were found corroded and inflamed. Although he survived so short a time, the mucous membrane of the stomach was of a deep red color. I have elsewhere related a case in which the application of the pernitrate of mercury to the throat as an escharotic caused immediate death by asphyxia. (See Guy's Hosp. Reports, Oct. 1850, p. 206.) The acid nitrate of mercury has often been employed by accoucheurs as a local application in diseases of the neck of the uterus. In one instance in which it was thus used, the ordi- nary symptoms of mercurial poisoning showed themselves, and the patient appears to have suffered severely. (^Medical Gazette, vol. xlv. p. 1025.) At the Leicester Summer Assizes, 185T, a girl was charged with adminis- tering nitrate of mercury to her mistress {Reg. v. E: Smith). The evidence showed that the accused had put the poison into some chamomile tea pre- scribed for the prosecutrix. Only a small quantity was taken, as the tea had a nauseous taste. The symptoms were : — a burning sensation in the throat and stomach, violent vomiting, with severe pain in the abdomen. By some extraordinary blunder the girl was indicted under the statute which makes it penal to cast or throw or apply to any person any corrosive fluid, &c.^— and although the words " cause to be taken" are introduced, Cresswell J. ruled that this statute implied external, and not internal, administration. As the indictment was wrongly laid, the accused was acquitted. 112 POISONING BY SUGAR OF LEAD. CHAPTER XIII. ON POISONING BT LEAD — StTGAR OF LEAD — SYMPTOMS — APPEARANCES AFTER DEATH QUANTITY REQUIRED TO DESTROY LIFE — CHEMICAL ANALYSIS — LEAD IN ORGANIC MIXTURES — CARBONATE OR WHITE LEAD — CHRONIC POISONING — painter's COLIC — OXIDES — LITHARGE AND RED LEAD. Sugar of Lead. Acetate. This is more frequently taken as a poison than any of the other salts, although cases of acute poisoning by lead in any form are not common. The substance is commonly met with in solid heavy crystalline masses, white, or of a brownish-white color ; it much resembles loaf-sugar in appearance, and has often been mistaken for it. It has also a sweet taste, which is succeeded by an astringent or metallic taste. It is very soluble in water. Four parts of distilled water at 60° will dissolve one part ; it is much more soluble at a boiling temperature. Symptoms. — Acetate or sugar of lead is by no means an active poison, although it is popularly considered to possess a virulent action. In medical practice it has often been given in considerable doses without any serious effects resulting. Dr. Christison states that he has given it in divided doses to the amount of eighteen grains daily for eight or ten days without remarking any unpleasant symptom, except once or twice slight colic. When, however, the quantity taken has been from one to two ounces, the following symptoms have been observed : A burning pricking sensation in the throat, with dry- ness and thirst — vomiting and uneasiness at the pit of the stomach, which is sometimes followed by violent colic. The abdomen is tense, and the parietes have been occasionally drawn in. The pain is relieved by pressure, and has intermissions. 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 to sulphuret. The skin is cold, and there is great prostration of strength. When the case is protracted, the patient has been observed to suffer from cramp in the calves of the legs, pain in the insides of the thighs, numbness, and sometimes paralysis of the extremities. The affec- tion of the nervous system is otherwise indicated by giddiness, torpor, and even coma. A well-marked blue line has been noticed round the margin of the gums, where they join the teeth. A remarkable series of cases of poisoning by acetate of lead has been reported by Mr. Banks, of Stourbridge. {Lancet, May 5, 1849, p. 478.) By some accident, about thirty pounds of this substance were mixed at a miller's with eighty sacks of flour, and the whole was made into bread by the bakers and supplied as usual to their customers. It seems that no fewer than five hundred persons were attacked with symptoms of poisoning after partaking of this bread. In a few days they complained of a sense of constriction in the throat and the pit of the stomach, violent crampy pains round the navel, rigidity of the abdominal muscles, a dragging pain in the loins, and cramp with paralysis of the lower extremities. There was obstinate constipation, and the urine was scanty and of a deep red color. The pulse generally was slow and feeble ; the countenance anxious and sunken, frequently of a peculiar livid hue; tongue flabby; gums marked by a deep blue line. The surface was cool, and there was a general arrest of the secretions. Sickness was not a uniform symptom, and even when it existed at first, it speedily subsided. The mental faculties were undisturbed. Not one of the cases proved fatal, SUGAR OP LEAD — QUANTITY REQUIRED TO DESTROY LIFE. 113 but among the more aggravated, there was great prostration, with collapse, livid countenance, universal cramps, numbness, and other alarming symptoms. After apparent convalescence, some of the symptoms returned in a more aggravated form without any obvious cause, and for a long time the patients were out of health. Inflammation was not observed. Purgative medicines were found most effectual in the treatment. The quantity of acetate of lead taken by each person could not be determined, as, on analysis, the samples of bread were found to be very unequally impregnated with the poison. Even when the patient recovers from the first symptoms, the secondary effects often last for a considerable time. Mr. Gorringe has recorded the cases of two girls, each of whom swallowed an ounce of the acetate of lead by mistake. Soon afterwards they felt a burning pain in the mouth, throat, and stomach, and in a quarter of an hour they vomited freely : in half an hour, there was severe pain in the bowels, with purging. Under treatment recovery took place. {jProv. Med. Journ., April, 1846.) After the lapse of a year, they both suffered from severe pain in the pit of the stomach, which was tender on pressure. Nothing could be retained on the stomach; and there was a choking seusation in the throat, with other constitutional symp- toms. Paralysis and other symptoms of nervous disorder are, however, by no means necessary consequences. A girl who had swallowed sixty grains of acetate of lead, and suffered severely from the primary symptoms, recovered in about three weeks without any paralysis or other disorder affecting the muscular system. {Lancet, April 4, 1846, p. 384.) This lead-palsy appears to be a more common consequence of chronic poisoning ; i. e., of small doses repeated at intervals. Appearances. — In one acute case related by Dr. Kerchhoffs, the mucous membrane of the stomach was found removed in several places, especially near the pylorus or intestinal opening; and most of the intestines were in a state of high inflammation. A trial for murder by this substance took place at the Central Criminal Court, in November, 1844. {Reg. \. Edwards.) The stomach and intestines are stated to have been found inflamed, and there were dark spots on the former. In animals, according to Dr. Mitscherlich, when the dose is large, the mucous coat of the stomach is attacked and cor- roded ; this change appears to be purely chemical, and takes place in all the organs 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 power on the mucous membrane. When the 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 corroded. This corrosive action belongs to the neutral salt, and is not manifested when the dose is small or when the poison is combined with an acid. Quantity required to destroy life Nothing is accurately known concerning the fatal dose of sugar of lead. The facts already detailed show that it may be taken in comparatively large quantity without producing serious effects. Thirty and forty grains have been given daily, in divided doses, without in- jury. The following additional cases, in some of which recovery took place under disadvantageous circumstances, prove that the acetate of lead is far from being a virulent poison : — Dr. Iliff met with an instance in which an ounce was swallowed in solution. The symptoms were pain in the abdomen resembling colic, vomiting, rigidity, and numbness. It was three hours be- fore any remedies were used, and five hours before the stomach-pump was employed ; but the person recovered. In the second case, also, an ounce was swallowed : sulphate of magnesia was freely exhibited, and the stomach- pump was used. On the following morning there was slight excoriation of the gums, which were white, with a sensation of heat in the throat : the bowels were relaxed, probably from the effect of the medicine. The day 8 114 CHEMICAL ANALYSIS — LEAD IN ORGANIC MIXTUEES. following, there were pains in the calves of the legs and thighs, with restless- ness and thirst. In a week the woman perfectly recovered. In a case which occurred to Dr. Alderson, a man swallowed an ounce of the acete of lead in a drunken fit. There was violent vomiting, and the man recovered. 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 off vapors of acetic acid ; a black mass is left in the tube, consisting of carbon and reduced metallic lead. There is no sublimate formed. 2. It is very soluble in water, even when cold ; common water is turned milky by it, from the presence of carbonic acid and sulphates. 3. A small portion of the powder dropped into a saucer containing a solution of iodide of potassium acquires a fine yellow color. 4. When dropped into caustic potash it remains white. 5. Into sulphuretted hydrogen water or hydrosulphuret of ammonia, 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 the acetate of lead. Acetate of lead in solution. — If acetate of lead be presented in a state of solution, or if the solid salt be dissolved in water for the purpose of making further examination, we should note the following points. 1. A small quan- tity, slowly evaporated on a slip of glass, will give white and opaque pris- matic crystals, which are turned yellow by iodide of potassium, and black by hydrosulphuret of ammonia. The solution is said to be neutral : but I have found the common acetate of lead to have at the same time both an acid and (with rose paper) an alkaline reaction, i. e., reddening litmus-paper, and turning rose-paper green, a circumstance which might create some embar- rassment in an analysis. 2. Potash, added to the solution much diluted with water, throws down a white precipitate, which is easily soluble in an excess of the alkali. 3. Diluted sulphuric acid produces an abundant white preci- pitate, insoluble in nitric acid, but soluble in hydrochloric acid and in a large excess of potash. 4. It is precipitated of a bright yellow color by the Iodide of potassiutn ; the yellow iodide of lead is soluble in potash, forming a color- less solution. It is also dissolved by concentrated hydrochloric acid. 5. Hydrosulphuret of ammonia or sulphuretted hydrogen gas, produces a deep black precipitate, even when less than the 100,000th part of the salt is dis- solved. 6. Place a few drops of the solution on clean platina foil — acidulate it with acetic acid, then apply, through the solution, to the surface of the platina, a thin polished slip of zinc : — bright crystals of metallic lead are in- stantly deposited on the zinc : by this method a small quantity of lead may be detected. Lead in organic mixtures. — The acetate of lead is precipitated by many organic principles, especially by albumen and tannic acid. Thus, we may have to analyze either an organic liquid containing lead, or a solid precipi- tate consisting of mucus or mucous membrane, intimately united to oxide of lead. The liquid must be filtered and examined by a trial test, i. e., either by adding to a portion, sulphuric acid, or by exposing bibulous paper, dipped into the suspected liquid, to a free current of sulphuretted hydrogen gas. If the paper is not stained brown, there is no perceptible quantity of lead dissolved; if it is stained brown, we dilute the liquid if necessary in order to destroy its viscidity, and pass into it a current of washed sulphuretted hydrogen gas until all chemical action has ceased. The black sulphuret 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, to nitrate of lead soluble in water. This liquid, when filtered, may be evaporated to dryness, and the GOULARD'S EXTRACT — CARBONATE OF LEAD. 115 residue dissolved in water, or it may be at once cautiously neutralized by potash (free from lead) or by ammonia, and the tests added. If the quantity is too small for the application of all the tests, we may add sulphuric acid; should a white precipitate be formed, soluble in potash (free from oxide of lead), and this alkaline solution be again turned black by hydrosulphuret of ammonia, this is sufficient evidence of the presence of lead. Should there be no lead dissolved, we must decompose the solid and insoluble matters in nitric acid slightly diluted, at a boiling temperature, filter, and test the filtered liquid, previously neutralized ; or we may evaporate to dryness, de- stroy the organic matter by heat and redissolve the residue in nitric acid for testing. Goulard's Extract. Subacetate op Lead. Symptoms and effects. — This substance has caused death in at least four instances — one in France and three in England. Dr. Aklis describes the case of a woman, set. twenty-one, who swallowed about three-quarters of a pint of Goulard's extract of lead (strength not stated), having begun with small doses. When first seen she was in great agony. There was severe colicky pain in the abdomen which she rubbed frequently, and the muscles of the belly were drawn inwards. The pulse was feeble, there was trembling of the hands, and she was in constant motion with her body from severe suffer- ing. There was heat in the throat and abdomen with intense thirst, and a desire to vomity but there was no vomiting or purging. A dose of sulphate of magnesia produced vomiting and she recovered; but there remained ob- stinate constipation of the bowels. {Lancet, Jan. 14, 1860.) Goulard Water is nothing more than a mixture of one drachm and a half of this solution to a pint of water. Carbonate op Lead. Symptoms A case of poisoning by the carbonate of lead was reported, in October, 1844, to the Westmnister Medical Society, by Dr. Snow. A child aged five years ate a portion not so large as a marble, ground up with oil. For three days he merely suffered from pain in the abdomen, and cos- tiveness. On the third night, the child became rapidly worse, and there was vomiting. He died ninety hours after taking the poison, having passed some offensive motions of a greenish-black color (probably from admixture with sulphuret of lead) before he died. The mucous membrane of the stomach was much inflamed, and of a dark red color throughout. Lead could not be detected in the contents or tissues of the stomach, or in the matter vomited. It is remarkable that in this case so small a quantity should have proved fatal without exciting any marked symptoms of irritation in the first instance. A young man, set. twenty, was recommended to take chalk on account of aci- dity and heartburn. He took by mistake a piece of carbonate of lead, and ate about five or six drachms of it. After a few hours he complained of vio- lent burning pains in the stomach, with vomiting. Twenty-four hours after- wards, when first seen, he suffered from violent pain, particularly in the pit of the stomach and the navel. His face was red and swollen, his eyes shin- ing and prominent ; his tongue and mouth dry and very red ; abdomen dis- tended and extremely sensitive to superficial pressure, whilst stronger pressure alleviated the pain ; great thirst ; the bowels were constipated. Sulphate of magnesia dissolved in water, with one scruple of tincture of opium, was given to him, and larger doses of the same salt to be repeated with an oily emul- sion, by which means the patient soon recovered. (Casper's Wochenschrift, 116 CHRONIC POISONING BY LEAD. No. 36, 1844.) Most of the cases of poisoning by carbonate of lead have been of a chronic character. Chronic poisoning. Colica pictonum, or Painter's Colic, may be considered as the chronic form of poisoning by carbonate of lead. It is often difficult to trace the cause, so slowly and insidiously are the effects manifested. In some instances the poison is received through the lungs, although no physical or chemical evidence of this mode of introduction can be obtained. In an- other work (On Poisons, 2d Am. ed., p. 434), I have referred to cases in which colic and paralysis have occurred in persons who had slept in newly painted rooms. Dr. Alderson mentions several instances of this kind. (Lan- cet, Oct. 30, 1852, p. 391.) I have myself suffered from a severe attack of colic as a result of sitting in a room for a few hours a day in which a large surface of canvas for an oil-painting had been covered with white lead and drying oil. The late- Mr. J. Lizars, of Edinburgh, communicated to me the following case: A military officer, set. fifty, fond of painting in oil-colorSj worked for some time in a room eight feet square which had a large stove in it. He was attacked with wrist-drop (paralysis) in December, 1855, and soon afterwards with paralysis in both legs. It appears that his servant always ground his colors, mixed them, and cleaned his brushes. He had had an attack some years before ; but from this, by laying aside oil-painting, he completely recovered. In these instances the emanations of lead must have been received through the lungs. Doubtless chemists might be found who would undertake to prove, by ingeniously devised experiments, that there was no lead in the air of the room ; and coupling these results with the fact that few artists are known to suffer from such symptoms, would contend that lead was not the cause. The symptoms, however, were of the character peculiar to lead-poisoning, and as they disappeared on the removal of the patient to another atmosphere, there could be no doubt about the cause. These insidi- ous effects of lead should be borne in mind by those who deny that any noxi- ous emanations can proceed from arsenical papers in inhabited rooms, merely because the greater number of persons who live in them do not suffer, and because some chemists have affirmed that they could detect no arsenic in a volatile state in the atmosphere of the room. Among white-lead manufac- turers the carbonate finds its way into the system either by the skin, the lungs, or both together ; — it is diffused in a fine powder through the atmosphere, and thus enters into the lungs. It has been remarked in France, that in manufactories where the powder was ground dry, not only have the laborers suffered, but horses, dogs, and even rats have died from its effects ; the rats have been affected with paralysis in their hind legs. Since the practice has arisen of grinding the carbonate of lead in water, cases of colica pictonum have not been so numerous. Men employed in the manufacture of pottery or glazed cards are liable to attacks of this kind. There are numerous other cases in which lead, or its preparations, by mere contact with the skin, have been known to produce the usual results of lead-poisoning. Mr. Scanlan communicated to me a case in which an infant was paralyzed by reason of its having been washed with water containing a finely-diffused oxide and carbonate of lead. Dr. Todd mentions the case of a man in King's College Hospital who suffered from lead-palsy; he had been a potman, and the palsy was attributed to the con- stant handling and cleaning of pewter pots. (Med. Gaz., vol. xlviii. p. 104';. For another case, see Lancet, Jan. 21, 1860, p. 60.) The mere handling of lead or its oxides is, therefore, sufficient to produce all the effects of chronic poisoning. I have been informed of a case in which a tea-dealer was seized with symptoms of lead-poisoning, and the cause remained long unsuspected, until he admitted that, in the course of his trade, he had the idle habit of often placing pieces of tea-lead in his mouth and crushing the metal between CHRONIC POISONING BY LEAD — SYMPTOMS. ] 1 7 his teeth. One cause of lead-poisoning among infants may be the use of farinaceous food wrapped in lead-foil having a thinly tinned surface. I have found such infants' food to be strongly impregnated on the outside with car- bonate of lead. (See On Poisons, 2d Am. ed., p. 450.) Snuff and tobacco, cho- colate, and other substances in ordinary use, are frequently wrapped in spurious tin-foil. If the articles are kept in a damp place, they may thus become im- pregnated with carbonate of lead. (For an account of the causes as they affect mariners, see Ann. cfHyg., 1859, vol. 1. pp. 95 and 296.) In a case which was under Dr. Rees at Guy's Hospital, in January, 1861, no source of lead could be traced, although the symptoms were those of chronic lead-poisoning, and lead was found in the urine. Cosmetics and hair-dyes containing prepa- rations of lead may also produce dangerous effects. I have met with an in- stance in which paralysis of the muscles on one side of the neck arose from the imprudent use of a hair-dye containing litharge. Mr. Lacy has pointed out the injury to health which is likely to follow the use of white lead as a cosmetic by actors. {Medical Times and Gazette, Aug. 1852, p. 223. See also Ann. d'Hyg., 1861, vol. i. pp. 342 and 389.) Symptoms and appearances The symptoms of chronic poisoning by lead are well marked. There is 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 abdominal parietes, loss of appe- tite, thirst, 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 or earthy color, generally well marked in the face, and the patient experiences a saccharine, styptic, or astringent taste in the mouth. A symp- tom of a peculiar nature has been pointed out by the late Dr. Burton and others {Med. Gaz., vol. xxv. p. 687), namely, a hlueness of the edges of the gums, where these join the bodies of the teeth ; the teeth are of a brownish color. Dr. Chowne considered that the presence or absence of this blue line was not connected with the administration or non-administration of lead. {Lancet, Oct. 26, 1844.) It has, however, been so frequently observed, that most pathologists now regard it as an established pathognomonic symptom. Dr. Chambers afiSrms that the blue line on the gums is an early consequence of lead-poisoning in any form, and is a distinguishing sign of lead-colic. A gas engineer, who had worked for eighteen years in his trade, had, during this time, used a quantity of red and white lead for various purposes. It was, however, only within the last eighteen months of this time that he felt any ill effects from it. He had then suffered from the usual symptoms of lead-poisoning. {Lancet, Jan. 21, 1860, p. 60.) It is worthy of note in this case that, although the person had been so many years exposed to the causes of lead-disease, he did not suffer from any symptoms until the latter part of the time. A blue mark around the edges of the gums has been noticed in some cases of poisoning by mercurial preparations ; and it is possible that in an advanced stage of chronic poisoning by lead it may be absent (see a case by Mr. Fletcher, Med. Times, Feb. 14, 1846, p. 395) ; as where, for example, the individual has ceased to expose himself to emanations of lead. Many facts tend to show that it is an early symptom. This disease often kills the patient ; and, after death, the large and small intestines are found much con- tracted, and their coats thickened. These changes have been especially ob- served in the colon. The most frequent cause of chronic lead-poisoning is the use of water kept in leaden cisterns or pipes. For an mstructive series of cases showing the effects of water so poisoned T must refer the reader to a paper, by Dr. De Mussy, published in the Dublin Quarterly Journal for May, 1849 ; also Medical Gazette, vol. xliv. p. 260. These cases occurred at Claremout, in ]18 RED LEAD — OXIDES OF LEAD. the members of the ex-royal family of France. The effects were traced to the use of pure water which had acquired an impregnation of lead by contact with that metal, in the proportion of one grain to the imperial gallon. Thir- teen out of thirty-eight persons were affected, and to such a degree, that the nails of the toes and fingers acquired a bluish discoloration. The children of the family did not suffer. Tor an account of the circumstances under which water is liable to be poi- soned with lead, and the effects produced by the use of such water, I must refer the reader to my work On Poisons, 2d Am. ed., p. 436. Analysis. — Carbonate of lead is a solid white powder, insoluble in water, and immediately blackened by sulphuretted hydrogen or hydrosulphuret of ammonia. 1. When heated on platina, it leaves a residue of yellow or orange-colored oxide of lead, soluble in nitric acid. 2. The carbonate is easily dissolved with effervescence, by diluted nitric acid — a fact which shows that it contains carbonic acid. The oxide of lead, combined with nitric acid, may be readily detected in the solution by the tests already mentioned. This salt of lead is sometimes contained in small proportion in loaf sugar, owing to the moulds in which the loaf is set to crystallize being painted with white lead, and a portion being thus mechanically taken up. This is a noxious prac- tice, and ought to be prohibited. Oxides of Lead. The yellow oxide (massicot), and the brown oxide (peroxide), are but little known except to chemists. Litharge and minium or Red lead are, however, much employed in the arts, and have sometimes given rise to acci- dental poisoning. In October, 1849, a woman who had swallowed two and a quarter ounces of the red oxide of lead, was admitted into Guy's Hospital. No symptoms appeared for nine hours. There was then colicky pain, with urgent vomiting, followed by headache and general tenderness of the abdo- men. She entirely recovered in about twelve days. (Guy's Eosp. Reports, October, 1850, p. 209.) Liquids used for culinary or dietetic purposes, especially if they contain a free add, are liable to become impregnated with oxide of lead, derived from the glaze of the vessel in which they are kept, and thus form poisonous salts. If vinegar be used, acetate of lead may result. Litharge-glaze is also easily dissolved by alkaline ov fatty substances. The eating of dripping, or the fat of meat baked in a newly-glazed vessel, has been known to give rise to a slight attack of colic ; while the symptoms were referred by the person to some substance mixed with the food. Por cases of this kind see the Medical Gazette, vol. xlvii. page 659 ; see also Lancet, 1860, vol. i. p. 962. I am indebted to Mr. Procter, of York, for the particulars of a case of some novelty, in reference to the contamination of food with lead. In July, 1852, four men partook of rhubarb pie and milk for supper ; shortly afterwards they were all seized with violent vomiting and intense colic. A portion of the vomited matters and food was examined by Mr. Procter, and lead was detected in them. The only source to which the lead could be traced, was the glaze of the pans in which the milk was kept. Lead pipes are largely used by publicans for the supply of beer. It is possible, therefore, if the beer is acid, and is allowed to remain some time in the pipe, it may acquire an impregnation of lead, which mighLgive rise to colic and other unpleasant symptoms. When liquids of this kind are impregnated with oxide of lead, the fact is immediately known by their being turned of a brown color by hydrosulphuret of ammonia. All newly-glazed vessels yield traces of lead, more or less, on boiling in them vinegar, pure acetic acid, or a solution of POISONING BY COPPER — BLUE VITRIOL. 119 pure potash. In this manner the poisonous nature of the glaze may be tested : — the oxide of lead being dissolved either by the acid or the alkali. I have found common acetic acid itself containing, as impurity, two per cent, of acetate of lead. Litharge was formerly much used to remove the acidity of sour wine, and to convey a sweet taste. Acetate of lead, or some other vegetable salt of the metal, is in these cases formed; and the use of such wine may be productive of alarming symptoms. Many years since a fatal epidemic colic prevailed in Paris, owing to this cause : — the adulteration was discovered by Fourcroy, and it was immediately suppressed. Wine thus poi- soned is known by its being blackened by hydrosulphuret of ammonia. Snuff has been adulterated with red lead : in one instance this mixture is supposed to have caused death : in other cases it has given rise to paralysis and other serious symptoms. {Medical Gazette, vol. xxxii. p. 138 ; also Annales d'Hygihie, 1831, vol. ii. p. 197 ; Lancet, Jan. 21, 1860, p. 60.) CHAPTER XIV. COPPER — BLUE VITRIOL. SYMPTOMS. APPEARANCES AFTER DEATH — TREATMENT. POISONING BY VERDIGRIS — SUBCHLORIDE OP COPPER — CARBONATE — CHEMICAL ANALYSIS — TESTS — SPECIAL CHARACTERS OF THE SALTS. COPPER IN ORGANIC LIQUIDS — IN ARTICLES OF FOOD. All the salts of copper are poisonous. The two most commonly known in commerce are the Sulphate or Blue Vitriol, and the Subacetate or Verdigris. The former has been frequently taken and administered in large doses for the purpose of suicide and in attempts at murder. In the latter case the attempt has been immediately discovered, owing to the strong me- tallic taste possessed by the salt. This would in general render it impossible that the poison should be taken unknowingly. With the exception of these salts, poisoning by copper»is usually the accidental result of the common employment of this metal for culinary purposes. There is one copper salt — the Arsbnite (Scheele's Green) — which chiefly owes its poisonous properties to arsenic. This has been elsewhere considered (page 94). Sulphate of Copper. Symptoms. — Sulphate of copper has been fre- quently given for the purpose of procuring abortion. In doses of ^ half an ounce and upwards, it acts as a powerful irritant on adults, and a much smaller quantity would suffice to destroy infants or children. The salt speedily induces vomiting of the most violent kind ; this sometimes expels the poison from the stomach, and the person recovers. The vomited matters are remarkable for being generally of a blue or ffreen color ; and broken crystals of blue vitriol were discovered in them in a case in which the poison was taken in a loosely pulverulent state. If the green color of the vomited liquids be owing to altered bile, it will not acquire a blue tint on adding to a portion of the liquid a strong solution of ammonia ; but if it be caused by a salt of copper, this change of color will serve to indicate the fact. There is headache, pain in the abdomen, with purging ; the pain is of a colicky character ; and in aggravated cases there are spasms of the extremities and convulsions. Dr. Percival met with a case in which violent convulsions were produced in a young female by two drachms of the sulphate of copper. Paralysis, insensibility, and even tetanus, have preceded death, when the poison was administered to animals. Among the symptoms usually met with 120 COPPER — POISONING BY VERDIGRIS. ill the human subject, may be mentioned jaundice. This has been observed to attend poisoning by the sulphate, as well as by Scheele's greeu. The medicinal dose of sulphate of copper as an emetic, is from five to fifteen grains, and as a tonic from one to three orfour grains. There are but few instances in which this poison has proved fatal in the human subject. In 1836 a girl, sixteen months old, put some pieces of Blue stone (sulphate of copper), which were given to her to play with, into her mouth. In a quarter of an hour the child vomited a bluish-green colored matter, with pieces of sulphate of copper in it ; the skin was alternately cold and hot, but there was neither purging nor convulsions. The child died in four hours, and was insensible before death. {Medical Gazette, vol. xriii. p. 742.) TJnfortunately no inspection of the body was made ; and yet, in the event of murder being committed by the administration of this substance, it will be somewhat unreasonably expected that medical witnesses should be fully acquainted with the appearances produced by it 1 Appearances. — In poisoning by the salts of copper, the mucous membrane of the stomach and intestines has been found more or less thickened and in- flamed in the few fatal cases which have been hitherto examined: the mem- brane has been also found eroded and softened in poisoning by verdigris. The gullet has presented an inflammatory appearance. In a case of poison- ing by verdigris, quoted by Orfila, the stomach was inflamed and thickened, especially towards the pylorus (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 eifased into the abdomen. The large intestines were distended in some parts, and contracted in others, and the rectum was ulcer- ated on its inner surface. {Toxicologie, vol. i. p. 623.) The lining membrane of the alimentary canal has been found throughout of a deep green color, owing to small particles of verdigris adhering to it. It has been said that this is an uncertain character of poisoning by copper ; since a morbid state of the bile often gives a similar color to the mucous membrane of the stomach and duodenum. This objection cannot apply when the green color is found in the gullet, and throughout the intestines ; and, under any circumstances, the evidence from the presence of a green color would amount to nothing in the judgment of a prudent witness, unless coppej were freely detected in the parts so colored. It is well to remember that the green stain, if due to cop- per, would be turned blue by ammonia. Verdigris. Subacetate of Copper. — This salt produces symptoms some- what similar to those caused by the sulphate. There is a strong styptic metallic taste, with a sense of constriction in the throat, followed by severe colicky pains — vomiting of a green-colored liquid, and purging, with violent straining. In a case reported by Pyl, a woman who swallowed two ounces of verdigris died in three days : in addition to the symptoms above described, there were convulsions and paralysis before death. Niemann relates that a female, aged twenty-four, swallowed half an ounce of verdigris, and died under symptoms of severe irritation of the stomach in sixty hours. (Taschenbuch, p. 458.^ In consequence of the great uncertainty of its operation, subacetate of copper is not employed internally. SuBCHLORiDE OP CopPER. — This is a rich green compound, known as Oxy- chloride or Brunswick green. It is formed when common salt has been used in a copper vessel, and has thus given rise to accidental poisoning. It is used as a pigment for ornamenting confectionery. It generally contains arsenic derived from metallic copper. Carbonate op Copper. — A case of poisoning by this substance has been reported by M. Desgranges, of Bordeaux. A man died in about six hours, as it was supposed, from the effects of an unknown quantity of this poison DETECTION OP COPPER IN ORGANIC LIQUIDS. 121 which he had taken. He had sustained some violence from a fall, and when first seen he was in a state of complete stupor, and there was great coldness of the extremities. There was neither vomiting, purging, nor pain in the abdomen on pressure. On inspection, the gullet and stomach were covered with a green-colored substance. The larger extremity of the stomach was vascular, and the mucous membrane of the intestines, as well as the liquid contained in them, was green. Carbonate of copper was found in the sto- mach, and traces of the metal existed in the urine — none was found in the blood. {Med. Gaz., vol. xxxi. p. 495.) It is remarkable that in this case there should have been neither vomiting nor purging. The carbonate seems to have acted more like a narcotic or cerebral than an irritant poison. Chemical Analysis of the Salts of Copper. — The salts of copper are gene- rally known by their color : whether in the solid state, or in solution, they are either blue or green. The salts of one other metal are also of a green color, namely, nickel ; but there are striking chemical differences between the salts of this metal and those of copper. There are three very soluble salts of copper ; two of these are blue, the sulphate and nitrate — and one green, the chloride. The solutions of the cupreous salts have generally an acid reaction. The salt should be dissolved in water, diluted, and the following tests may then be applied. Tests. — 1. Solution of ammonia: this gives, in a solution of copper, a bluish-white precipitate, which is soluble in an excess of the test, forming a deep violet-blue liquid. 2. Ferrocyanide of potassium, gives a rich claret-red precipitate ; if the quantity of copper be 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. The ferrocyanide of potassium will act on the violet-blue solution produced by ammonia, provided it be much diluted or an acid added (sulphuric) to neutralize the ammonia. One portion of the liquid may thus be tried by the two tests. 3. Sulphuretted hydrogen gas, or hydro- sulphuret of ammonia, gives a deep chocolate-brown precipitate, even in an acid solution ; or if the copper be in small proportion merely a light-brown color. 4. A slip of Polished Iron (a common needle) suspended by a thread in the liquid, is speedily coated with a layer of copper, even when the salt is in very small proportion. When much diluted, a drop of diluted sulphuric acid may be added. If the needle be left for some days in the liquid, the iron will be slowly removed, and a hollow cylinder of metallic copper will remain. This may be dissolved in diluted nitric acid, and tested with the foregoing tests ; or the needle coated with copper, may be immersed in ammonia and ex- posed to air. The liquid then becomes slowly blue. ' Half a grain of sulphate of copper dissolved in sixteen ounces of water may be thus easily detected. It was long since proposed by Orfila to substitute phosphorus for polished iron. This substance most effectually separates metallic copper from its salts, even when they are dissolved in organic liquids. 5. The Galvanic test. — If a few drops of the copper-solution be placed on platina-foil, slightly acidu- lated with a diluted acid, and the platina be then touched through the solu- tion with a thin slip of zinc, metallic copper, of its well-known red color, is immediately deposited on the platina. When the quantity of copper is 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 platina and zinc wire may be substituted for the foil. Copper in organic liquids. — The oxide of copper is liable to be precipitated by certain organic principles — 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 cupreous salt. A portion at least of the salt of copper is, therefore, 'commonly held dissolved. In such cases, there is one peculiar character possessed by these liquids, i. e., they have a decidedly green 122 COPPER IN ARTICLES OP FOOD. color even when the copper-salt is in a far less than poisonous proportion. The sulphate of copper used in medicine and chemistry generally contains traces of arsenic. About ten grains of the crystallized sulphate will be suf- ficient to yield evidence of the presence of this poison. When the sulphate has been given as an emetic, traces of arsenic may be found in the contents of the stomach or in the matters vomited. Separation ly iron. — We first filter the liquid, and save the insoluble por- tions for a separate operation. We may use as a trial-test either a needle, zinc with platina wire, or add to a portion oxalic acid ; the last gives a bluish- white precipitate only when the copper is in a moderately large quantity, and the liquid is not very acid. If the needle be not coated with copper in the course of a few hours, it is certain that there is no detectable quantity of the poison present in the liquid. Separation as a sulphuret. — If the copper-salt is present in large quantity, any of the trial tests will indicate it immediately. We destroy the viscidity of the liquid by diluting it and filtering it if necessary; we then pass into it a current of sulphuretted hydrogen gas, in order to precipitate all the copper in the state of sulphuret. The black sulphuret may be collected, washed, dried, and boiled in equal parts of nitric acid and water for a quarter of an hour. Nitrate and sulphate of copper are produced and dissolved — a fact indicated by the liquid acquiring a rich blue color; and some sulphur is at the same time separated. This liquid, when filtered, will give the usual re- actions with the tests for copper. Separation by platina. — The following is an expeditious and simple method of obtaining copper from organic liquids which contain the soluble poisonous salts of this metal. Having filtered the liquid, let a portion of it be placed in a clean platina capsule or crucible. A few drops of diluted sulphuric acid may be added, and a slip of zinc foil introduced. Wherever the platina is touched by the zinc, metallic copper is deposited : and, after having in this way coated the platina capsule, the surplus liquid may be poured off and the capsule well washed out. The copper is then dissolved in diluted nitric acid, and the tests may be applied after the excess of acid has been driven off by heat. This is, perhaps, the most expeditious and certain method of detecting a salt of copper in an organic liquid. It is, however, less delicate than the iron -test. Copper in articles of food. — The medico-legal history of poisoning by cop- per would be incomplete without some remarks on the action of certain arti- cles of food on this metal when used for culinary purposes. This is not an unfrequent form of accidental poisoning. The symptoms rarely appear until after the lapse of three or four hours. There is commonly nausea, witii colicky pains and cramps in the limbs. It results from the experiments of Falconer and others, that metallic copper undergoes no change by contact with water, unless air is present, when a hydrated carbonate, mixed with oxide of copper, is formed. If the water contain any acid, such as vinegar, or com- mon salt, or if there be oily or fatty matter in contact with the metal, then the copper is more rapidly oxidized, and the liquor or fat acquires a green color. If the copper vessel is kept perfectly clean, and the food prepared in it is allowed to cool in other vessels, there is not much risk of its acquiring a poisonous impregnation : nevertheless, no acid, saline, fatty, or oily liquid should be prepared as an article of food in a copper vessel. (See Ann. cfHyg., 183-2, vol. i. p. 102.) Under the influence of heat and air, a portion of cop- per becomes dissolved, and the oily or other liquid acquires a green color. The preparation of fruits, such as preserves, in copper vessels, is necessarily attended with some risk ; for, on cooling, a green crust is apt to form on the copper, just above the surface where the air and acid liquid meet. Some liquids while boiling appear to be but little liable to this impregnation ; thus. POISONING BY TARTARIZED ANTIMONY. 123 coffee, beer, milk, and tea, have been separately boiled for two hours together, in a clean copper vessel, without any portion of the metal being taken up by either of the liquids. (See Falconer, On the Poison of Copper, p. 65, London, 1774; also, OrJila,\o\A. p. 611.) Accidents of this kind are usually pre- vented by lining the copper vessel with tin ; but in very large boilers this plan is not always adopted, cleanliness alone is trusted to, and this, when properly observed, is a sufficient preventive. According to Paasch, of IBerlin, many of the accidents attributed to this form of cupreous poisoning are really due to other causes. {Casper's Vierteljahrschrift, 1852, B. i. H. i. S. 78.) It has been elsewhere stated that all the ordinary copper employed for utensils contains arsenic (page 84). In those cases in which the metal is converted to insoluble oxides or salts — by salts, acids, or fat — the arsenic may be found in an insoluble form in the green incrustation produced. When, copper thus forms an insoluble salt, I have not found any arsenic dissolved. It has been stated that an impure alloy used by some of the lower grade of dentists has been so largely composed of copper as to affect the health of those who have used the plates for the support of artificial teeth. The acid and salts in the saliva would facilitate the production of a poisonous salt of copper, and set free arsenic. In the making of preserved /rm7« and vegetable pickles, the salts of copper (blue vitriol) are sometimes used for the purpose of giving a rich green color. Many of the green pickles sold in shops are thus impregnated with the vege- table salts of this metal, to which they owe their bright grass-green color. If the fruit or pickle is placed in a solution of ammonia, and copper is con- tained in it, the substance is speedily turned blue. The iron-test is, however, more delicate. A bright needle immersed in the pickle, or plunged into the solid, will be speedily coated with copper. The quantity of copper contained in such articles may not be sufficient to cause fatal effects; but serious symp- toms of gastric irritation are sometimes produced, and in young persons these may assume an alarming character. (See Falconer, 87.) CHAPTER XV. TARTARIZED ANTIMONY — SYMPTOMS — FATAL DOSE — APPEARANCES — CHRONIC POISONING — CHEMICAL ANALYSIS — ANTIMONY IN ORGANIC LIQUIDS — CHLO- RIDE or ANTIMONY — POISONING BY SULPHATE AND CHLORIDE OF ZINC — CAR- BONATE OF ZINC — PREPARATIONS OF TIN — SILVER — GOLD — IRON — BISMUTH AND CHROME — BICHROMATE OF POTASH. TARTARIZED ANTIMONY (TARTAR EmETIC), StIBIATED TaRTAR. Symptoms and effects. — When this substance is taken in a poisonous dose, a strong metallic taste is perceived in the mouth during the act of swallow- ing. There is great heat and constriction of the throat, with 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, sometimes imperceptible ; the skin cold, and covered with a clammy perspiration ; and the respiration is painful. Should the case prove fatal, death may be preceded by giddiness, insensibility, great prostra- tion of strength, and sometimes violent spasms of the muscles of the ex- 124 TARTARIZED ANTIMONY — FATAL DOSE, tremities, which may assume a clonic or a tetanic character. Such are the symptoms in au acute case of poisoning by this substance. The quantity actually required to destroy life is unknown. It will pro- bably depend in some degree on whether active vomiting and purging have been excited or not; for these symptoms have not been present in all cases. Doses of from twenty grains to one ounce have been taken without destroy- ing life ; although alarming symptoms of irritation have followed. In one case, related by Orfila, a man, aged fifty, took forty grains of tartarized anti- mony, and died in about four days. This was the only one out of five cases of poisoning by this substance quoted by Orfila which proved fatal. {Orfila, vol. i. p. 480.) Dr. Beck mentions a case in which fifteen grains of tartar- ized antimony in solution killed a child in a few weeks : vomiting and purg- ing ensued, followed by convulsions and death. This case proves that a patient is not always saved by vomiting and purging: — the fatal effects on such an occasion are probably due to rapid absorption. (See Medical. Gazette, vol. xliv. p. 334.) Dr. Pollock has recorded a case in which an adult was killed in ten hours by a dose of one drachm, in spite of early and violent vomiting. {Med. Gaz., vol. xlv. p. 801.) In two cases observed by Mr. Hartley, which will be presently described, ten grains killed each child in a few hours. A dose of four grains, however, has been known to produce alarming symptoms. Dr. Lambert, who reports this case in Oasperh Woch- enschrift, states that this dose gave rise to violent pain in the abdomen, vomiting, and purging. The patient then fell into strong convulsions, which lasted half an hour. He became speechless — no pulse could be perceived, the skin was cold, and it was supposed that he was dead. Stimulating fric- tions and poultices were employed, and he slowly recovered in about fourteen days. This poison might, in a much smaller dose, occasion death by reason of its exerting a depressing influence on the action of the heart. Aged per- sons, or those who are debilitated by disease, may die under these circum- stances from a dose or doses which would produce no injury to strong and healthy adults. The effects, however, should be clearly traced to the action of the poison, and not be owing to exhaustion as a result of disease. In February, 1853, Mr. Wakley referred to me, for examination, a case in which it was supposed that two doses of antimonial wine, equal to alDOut three grains of tartar emetic, had caused the death of a man who was in a diseased condi- tion, by its remote effect upon the heart. No trace of poison was fouud in the stomach or tissues; there were no symptoms to indicate poisoning, and under these circumstances death could not be reasonably attributed to the medicine. The man died in about twenty hours afterwards, probably as a result of the exhaustion of the vital powers from disease, and not from the action of this substance. In a case reported by Mr. Freer, of Stourbridge, a man, set. twenty-eight, swallowed two drachms of tartarized antimony by mistake for Epsom salts, and recovered from its effects. An hour after the poison had been taken he was found in the following state: — his pulse imperceptible; tongue dry and red; countenance cold and livid, bathed with clammy perspiration, and indi- cative of great suffering; violent pain in the stomach and over the whole of the abdomen, with constant spasmodic contraction of all the muscles, par- ticularly of the abdomen and upper extremities. The fingers were firmly contracted, and the muscles quite rigid. He vomited only once, about half an hour after he had swallowed the poison, and after this he had constant in- voluntary aqueous purging. An emetic of mustard and salt was given to him, and this produced violent vomiting of bilious matter. Green tea, brandy, and decoction of oak-bark were freely given. The cramps, vomitings, and aqueous purging continued for six hours. The symptoms then became miti- gated, and he gradually recovered, suffering chiefly from profuse night per- SYMPTOMS — APPEARANCES AFTER DEATH. 125 spirations. {Lancet, May 22d, 1847, 535.) This case is remarkable for the anomalous character of the symptoms, as, in the absence of active vomiting, an emetic was actually required to be given — also for the recovery of the in- dividual after a large dose of the poison. In the Association Medical Jour- nal for April 1, 1853, at page 281, will be found reported a case in which a physician took half an ounce of tartarized antimony by mistake for Rochelle salts. Vomiting did not come on for half an hour; but under good medical treatment he recovered in a few days. In another case fifty-five grains caused the death of an adult in sixteen hours. In one instance a small dose of this substance caused death by prodncing intestinal hemorrhage. (See the same Journal, June 10, 1853, p. 513.) Mr. Procter, of York, communicated to me, in July, 1860, the cases of four children to whom, by mistake, a mixture of sulphur and tartar emetic had been given. An ounce of sublimed sulphur and one drachm of tartarized antimony had been divided among the four. The symptoms presented the same characters in each ; early vomiting which became violent and incessant, pain in the bowels, purging, great thirst, cold clammy perspiration, feeble pulse, cramps of the limbs and twitchings of these parts, with great depression. There was no sense of heat or constric- tion in the throat, and no difiBculty of swallowing. Under treatment they all recovered. Appearances after death The following cases, reported by Mr. Hartley, show the nature of the appearances likely to be found after death: Two chil- dren, a boy aged five years, and a girl aged three years, each swallowed a powder containing ten grains of tartarized antimony 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 in eight hours, and the girl in twelve or thirteen hours after swallowing the dose. The bodies were inspected between fonr 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 intestinal canal, although the color was of a deeper yellow in the large Intestines ; there was no ulce- ration. The peritoneal coat of the stomach was inflamed. The mucous membrane of this organ was much inflamed, especially about the larger cur- vature, and at the cardiac orifice ; there was no ulceration. The contents (about two oijnees and a half of a dark bloody fluid, having a slightly acid reaction) were adherent to it ; and in one case there was a patch of lymph. 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 natu- ral appearance. On opening the head, the dura mater was found vascular ; 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 blood, the whole surface having a deep purple color. Every portion of the brain, when cut, presented many bloody points. The cerebellum and medulla ob- longata were also extremely vascular ; 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 ; there were also patches, resembling the eruption of scarlatina, on the arms, legs, and neck. The arachnoid membrane was more opaque than usual ; and on the mucous membrane of the stomach, where the inflam- mation 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, April 25, 1846, 460.) A girl, set. sixteen, swallowed a dose of tartarized 126 CHRONIC POISONING BY TARTARIZED ANTIMONY. antimony, amounting to from forty to sixty grains. There was severe vomit- ing in a quarter of an hour, and this was soon followed by purging ; these symptoms continued for about three hours. She also complained of pain, and a burning sensation down the gullet. The vomited matters were of a dark color. On the following morning she had recovered from the severity of the symptoms ; but in the afternoon there was a relapse. She continually threw her head back and screamed ; the skin was warm and moist ; the pupils were dilated, and the knees drawn up. She died in about thirty-six hours after taking the poison, and during the six or eight hours previous to her death she was quite delirious. An inspection was made thirty-six hours after death. The throat appeared swollen ; the lungs were slightly congested ; the heart was healthy, and contained about six drachms of fluid blood. The stomach contained sixteen ounces of a thick bloody fluid ; at the greater extremity the coats were softened, and blood was effused under the mucous coat in seve- ral places. The small intestines contained a similar fluid, with much mucus, but there was no appearance of inflammation. Only slight traces of the poi- son were found in the contents of the stomach by the usual tests, the greater part having probably passed off by vomiting and purging. (Mr. Beale, in Lancet, Jan. 21, 1854.) In animals poisoned by this substance, it is com- mon to find general inflammation of the alimentary canal. It has been hitherto supposed that the eases in which this poison has proved fatal have been few ; but I have elsewhere reported thirty-seven, of which sixteen were fatal. The smallest fatal dose was in a child — three- quarters of a grain, and in an adult, tivo grains ; but in this case there were circumstances which favored the fatal operation of the poison. (Guy's Hos- pital Reports, Oct. 1857.) Chronic poisoning. — A good account of the effects produced by this poi- son, given at intervals in small doses to healthy persons, has been published by Dr. Mayerhofer {Heller's Archiv., 1846, pts. ii. iii. iv. page 100 et seq.). The principal symptoms are — great nausea, vomiting of mucous and bilious liquids, great depression, 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. Several cases have recently occurred in this country, which show that tartarized antimony has been thus criminally used. In ad- dition to the cases of Ann Palmer and J. P. Oook [see London Lancet, Jan. 19, and Feb. 2, 1856.— H.] there are those of Reg. v. M' Mullen, Liverpool Summer Assizes, 1856 ; Reg. v. Freeman, Drogheda Spring Assizes, 1857 ; and the cases of the James family at Liverpool {Reg. v. Winslpw, Liverpool Autumn Assizes, 1860). The prisoner Winslow was indicted for the murder of his mistress, Ann James. It was clearly proved that antimony had been administered to the deceased, not only by the careful discrimination of the symptoms made by Dr. Cameron, but by the detection of the poison in the urine during life by Dr. Edwards. The deceased was at the time laboring under malignant disease affecting the csecum and stomach, but that her death had been accelerated by antimony there could be no doubt. The prisoner was acquitted owing to the difficulty of proving the act of administration. The poison had been given at intervals in small doses, and as deceased sur- vived about a fortnight after the last dose, it was only found in traces in the various organs. The death of this woman led to the exhumation of the bodies of three of her relatives who had lived in the same house with her and the prisoner, and had died suddenly some months previously under suspicious circumstances. The viscera of these bodies were examined by Dr. Edwards, Dr. Miller, and myself, and in each case antimony was found in small quan- tity but still extensively diffused through the organs. There was no reason to suppose that they had taken this antimony voluntarily, and there is no IN LIQUIDS CONTAINING ORGANIC MATTER. 127 reason to doubt, so far as the history of their cases could be obtained, that they were victims to chronic poisoning by antimony. This was the only cause of death, but it was not suspected at the time. (See ante, p. 31 ; Guy's Hospital Reports, October, 1851, and October, 1860; also Eeg. v. Hardman, Lancaster Summer Assizes, 1851.) Chemical analysis. Tartarized antimony as a solid. — In the state of pow- der it is white and crystalline. It has been occasionally sold by mistake for tartaric acid with soda powders, and sometimes for cream of tartar. — 1. It is easily dissolved by water — it is taken up by fourteen parts of cold, and two of boiling water ; the solution has a faint acid reaction, and an acrid caustic taste; it is decomposed by long keeping. It is insoluble in alcohol. 2. The powder dropped into hydrosulphuret of ammonia is turned of a deep reddish- brown color, and is thereby known from other poisonous metallic salts. 3. When heated in a reduction-tube, it is charred, but does not melt before char- ring, like the 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. I have not found that a metallic sublimate is produced in this expe- riment by the heat of a spirit-lamp. 4. When boiled with pure hydrochloric acid and metallic copper, a gray deposit of antimony takes place on that metal. The color of the deposit is violet red if the quantity be very small, and the deposit is black and pulverulent if very large. Tartarized antimony in solution. — 1. On slowly evaporating a small quan- tity on a slip of glass, it will crystallize in tetrahedra. If obtained from a very diluted solution, this crystallization is confused, and resembles that of arsenic. 2. Diluted nitric acid added to the solution, throws down a white precipitate (subnitrate of antimony) ; the other two mineral acids act in the same way ; but, as they precipitate numerous other metallic solutions, there are objections to them which do not hold with respect to nitric acid. The white precipitate thus formed possesses the remarkable property of being easily and entirely dissolved by a solution of tartaric acid ; it is also soluble in a large excess of nitric acid, so that if much of the test be added at once, no precipitate is produced. 8. Ferrocyanide of potassium does not precipi- tate the solution, whereby tartarized antimony is known from most other metallic poisons. 4. Hydrosulphuret of ammonia, or sulphuretted hydrogen gas, produces in the solution a reddish orange-colored precipitate, differing in color from every other metallic sulphuret. The precipitate is not soluble in ammonia, but is dissolved in the dry state by strong hydrochloric acid. The only test available when the quantity of tartarized antimony present is small, is sulphuretted hydrogen gas. The foregoing tests, it will be observed, merely indicate the presence of oxide of antimony — but this is in reality the poison which we have to seek — the cream of tartar with which it is combined being merely the vehicle ; and in a case of poisoning, this is no more the object of medico-legal research than if it were the vehicle for the administration of arsenic or corrosive sub- limate. It is, besides, well known that tartarized antimony is the only salt of the oxide of antimony in a soluble form which is likely to be met with in medicine or chemistry. Should it be required to prove the presence of cream of tartar, this may be done by filtering the liquid from which the oxide of antimony has been entirely precipitated by sulphuretted hydrogen gas. On evaporating this liquid, the cream of tartar may be obtained. In liquids containing organic matter. — Tartarized antimony is precipitated by tannic acid in all its forms, but not readily by albumen or mucous mem- brane ; therefore it may be found partly dissolved in the liquids of the stomach, provided no antidote has been administered. The liquid must be filtered, and then strongly acidulated with tartaric acid. A current of sulphuretted 128 ANTIMONY IN THE TISSUES. hydrogen gas is now passed into it, until there is no further precipitation. The sulphuret is collected, washed, and dried. If it is the sulphuret of an- timony, it will have an orange-red or brown color, it will be insoluble in a solution of ammonia, and when dried, will be dissolved by a small quantity of boiling hydrochloric acid (forming chloride of antimony) with the btoIu- tion of sulphuretted hydrogen gas. Tiae boiling should be continued for several minutes until the liquid is colorless. On adding this solution, if not too acid, to a large quantity of water, a dense white precipitate of oxychlb- ride of antimony (powder of Algaroth or Algarotti, Mercurius Vites) falls down. This is characteristic of antimony. If it be objected that nitrate of bismuth undergoes a similar change when dropped into water, hydrosulphuret of ammonia will easily enable ns to distinguish the two metals ; the antimo- nial precipitate is turned of an orange-red by that solution, while the bis- muthic precipitate is turned of a deep black. There are other methods of identifying the precipitated sulphuret of antimony. The dry sulphuret placed in a hard glass tube through which a current of hydrogen is passing, and intensely heated, is converted to iron -gray metallic antimony, and sulphuretted hydrogen escapes. The best method of identification is to dissolve in pure hydrochloric acid, and introduce the solution with pure zinc into a Marsh's tube or flask, similar to that described under arsenic (page 80). The anti- moniuretted hydrogen produced may be dried by chloride of calcium, and the tube through which it is passing heated to redness : — metallic antimony is deposited. This is dissolved by nitric acid, and on evaporation leaves a white insoluble residue of peroxide of antimony, on which a solution of nitrate of silver has no effect. The gas may be at once passed into a strong nitric acid : in this case the peroxide of antimony is obtained on evaporation of the acid. A medical jurist must remember that the discovery of tartarized antimony in the contents of a stomach is by no means a proof of its having been taken or administered as a poison ; since it is frequently prescribed as a medicine, and often taken as such by persons of their own accord. We could only suspect that it existed as a poison, or had caused death, when the quantity present was large, and there were corresponding appearances of irri- tation in the alimentary canal. The presence of any quantity, if not law- fully administered as a medicine, is always a suspicions fact, and demands explanation. In two cases of criminal administration in small doses, the quantity found in each body did not exceed three grains. The discovery of it in a medicinal mixture would not of itself be evidence of an intent to poison. In the tissues.. — For the detection in, and the separation of antimony from, the tissues, the best plan, according to my experiments, is that which was originally suggested by Reinsch, in 1841. The antimonial compounds, when distilled with liydrochloric acid, do not readily pass over into the receiver. They are much more fixed than those of arsenic. In the examination of the tissues of persons poisoned by antimony, I have not been able to procure, by distillation with hydrochloric acid, any trace of the metal in the distillate, although antimony was readily found by Reinsch's process in the residue in the retort. If this fact should be corroborated by future inquirers, the dis- tillation-process will furnish an easy method of separating absorbed arsenic from absorbed antimony. In reference to the distillation of tartarized anti- mony with hydrochloric acid, I have found that, contrary to what might he expected, the metal passes over more readily into the distillate when the acid is mixed with water than when it is concentrated ; but even in this case the quantity thus obtained by distillation is small. It is the reverse with arsenic. (See page 88. Also Guy's Hospital Reports, Oct. 1860, p. 263.) The method of proceeding for antimony is as follows : — 1. Boil the viscera, in a finely-divided state, in one part of pure hydrochloric acid, and from four ANTIMONY IN THE TISSUES. 129 to six parts of water. Boil in a flaslc or retort, and condense by a funnel the acid vapor as it issues. Introduce slips of polished copper-foil (free from antimony). Continue the boiling for at least two hours before concluding on a negative result. In certain cases it may be necessary to employ from twelve to sixteen ounces of organic matter, and a proportionate quantity of acid and water, in one operation. 2. Wash in water the pieces of copper vphen coated, and observe the violet-red or steel-gray film, according to the thickness of the metallic deposit. The deposit of antimony obtained from a very diluted solution has a reddish or violet tint : and Reinsch considered this color to be a sufficient distinction from the deposit of arsenic on copper. In addition to the color, it may be noticed, that while the arsenical deposit is sublimed at a low heat (400°) in a crust of octahedral crystals, the anti- monial deposit is much more fixed, and when heated to a very high tempera- ture yields only a white amorphous film of oxide of antimony. This can, however, rarely be obtained in sufficient quantity to be dissolved by a solution of tartaric acid (free from lead), and precipitated by a current of sulphuretted hydrogen gas. We may, however, identify the deposit of antimony by the following process : 3. Boil as many of the coated pieces of copper as can be collected, in a solution of pure potash (proved to be entirely free from lead), in a test-tube, occasionally exposing the coated surfaces of metal to the air. The antimony is oxidized and dissolved by the potash. 4. Filter the potash-solution ; acidulate with pure hydrochloric acid, and pass into the liquid a current of sulphuretted hydrogen gas. An orange-red sulphuret of antimony is precipitated. If small in quantity, this may appear at first of a pale yellow color, but as it subsides it becomes of an orange-red. . The sulphuret may now be treated with ammonia and hydrochloric acid, and tested by Marsh's process in the manner described at page 128. This process is sufficiently delicate for all practical purposes. As a proof of this, I may mention that it enabled Dr. Miller, Dr. Edwards, of Liver- pool, and myself, to procure good evidence of antimony in a liver containing not more than l-160th of a grain in two ounces of its substance. We also employed the process successfully for the detection of free and absorbed anti- mony, when existing in very small quantity in sixteen separate analyses of the viscera. Three of the bodies, from which the viscera were taken, had been buried from a period of from six to nine months. It is preferable to the method of carbonization whether with or without the use of sulphuric acid. Chlorate of potash may be occasionally employed for the destruction of organic matter as described under arsenic {ante, p. 86 ; Ann. d^Hyg., 1859, vol. i. p. 192). Dr. Odling has recommended the oxidation of the antimo- nial deposit on copper by permanganate of potash alkalized with pure pot- ash. The result is more rapidly obtained, and is indicated by the loss of color in the permanganate. As nearly all the solutions of potash contain oxide, of lead, this metal must be precipitated by sulphuretted hydrogen, and separated by filtration either before the alkaline liquid is used, or after boil- ing the coated copper in the alkali, and before the addition of hydrochloric acid. Hydrochloric acid sometimes contains antimony as an impurity. The separation of antimony from the tissues does not necessarily indicate that it has been criminally administered or has caused death ; but its presence 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. Conversely, when no antimony is found, or the mineral is present in the tissues in minute quantity, it is still consistent with medical experience and observation that the person may have died from anti- mony. The case of Mrs. Peters, of Yeovil (July, 1860), furnishes a recent 130 POISONING BY BUTTEE OP ANTIMONY — ANALYSIS. and remarkable illustration of this fact. (See page 33.) This lady had symptoms during her illness which were referred by her medical attendants to the effects of small doses of antimony. Antimony was found in the urine both by them as well as by Mr. Herapath : but after the death of this lady {i. e., in about nine days) no antimony was found in the body. Upon this fact and the evidence of coexisting disease, it was alleged that she had died from disease and not from' poison.. The jury returned a verdict to the effect that her death had been accelerated by irritant poison. (Med. Times and Gazette, Aug. 25, 1860, p. 190; Sept. 15, p. 211 ; and Sept. 29, p. 31T.) Assuming the results of the analysis of the urine during life to be correct, there can be no question that antimony was administered to her ; and the statement of the acceleration of death is rendered probable. The case is important in this respect ; it shows that antimony may be found in an eva- cuation and that death may be accelerated by it ; but although the person may die within nine days, none will be found in the body. The medical and chemical evidence given in this case furnishes a curious commentary on the evidence given for the defence of William Palmer for the murder of John Parsons Cook. Chloride of Antimony. Sesqtjiohloride or Butter op Antimony. Symptoms and appearances. — A boy, aged twelve, swallowed by mistake for ginger beer four or five drachms of a solution of butter of antimony. In half an hour he was seized with vomiting, which continued at intervals for two hours. There was faintness, with general weakness, and great prostra- tion of strength. Remedial means were adopted, and the next day the chief symptoms were heat and uneasiness in the mouth and throat, with pain in swallowing. There were numerous abrasions on the mucous membrane of the mouth and throat ; and there was slight fever, from which the boy quite recovered in about eight days. Another case of recovery from a dose of an ounce is reported in the Lancet, Feb. 26, 1848, p. 230. I am indebted for the following case to Mr. Mann. An army surgeon swallowed, for the pur- pose of suicide, from two to three ounces by measure of chloride of antimony. About an hour afterwards he was seen by Mr. Mann. There was entire prostration of strength, with coldness of skin, and incessant attempts to vomit. The most excruciating griping pains were felt in the abdomen ; and there was a frequent desire to evacuate the bowels, but nothing was passed. In the course of a few hours reaction took place, the pain subsided, and the pulse rose to 120. There was now a strong disposition to sleep, so that he appeared as if laboring under the effects of a narcotic poison. In this state he continued until he died — ten hours and a half after he had swallowed the poison. On inspection the interior of the alimentary canal from the mouth downwards to the jejunum, presented a black appearance, as if the parts had been charred. In general, there was no mucous membrane remaining, either on the stomach or elsewhere; only a flocculent substance, which could be easily scraped off with the back of the scalpel, leaving the submucous tissue and the peritoneal coat. All these parts were so soft that they were easily torn by the fingers. Analysis. — If any portion of the chloride be left in the vessel, it may he tested by adding a few drops to a large quantity of water, when the whitish- yellow oxychloride of antimony will be precipitated ; the supernatant liquid will contain hydrochloric acid, which may be detected by nitrate of silver. It has been already observed, that the only objection to this mode of testing is, that the salts of bismuth are also decomposed by water ; but the precipitate in this case is insoluble in tartaric acid, and is blackened by hydrosnlphuret POISONING BY ZINC — CHLORIDE OF ZINC. 131 of ammonia ; while in the case of antimony it is soluble in that acid, and is changed to an orange-red color by the hydrosulphnret. As all the commer- cial chloride contains iron, the color given by this test may be greenish-black. Preparations op Zinc. Sulphate op Zinc. White Vitriol or White Copperas. Symptoms and appearances. — The symptoms produced by an over-dose of sulphate of zinc are pain in the abdomen and violent vomiting, coming on almost immediately, followed by purging. After death the stomach has been found inflamed. The sulphate appears to act as a pure irritant ; it 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. {Med. Times and Gaz., July 16, 1853, p. 78.) Dr. Gibb has reported a case of poisoning by this substance, in which a lady recovered after taking sixty-seven grains. {Lancet, May 17, 1856.) A case is reported by Dr. Ogle, in which it is supposed that this substance destroyed life by its slow or chronic effects. {Lancet, Aug. 27, 1859, p. 210.) Analysis. — The pure sulphate is seen in white prismatic crystals, closely resembling in appearance sulphate of magnesia and oxalic acid : from oxalic acid it is distinguished by remaining fixed when heated on platina foil — from the sulphate of magnesia, by tests applied to its solution. It is readily dissolved by water, this fluid taking up about one-third of its weight at common tem- peratures. Analysis of the solution. — The solution has a slightly acid re- action. The following tests may be used for the detection of oxide of zinc : 1. Ammonia gives a white precipitate, soluble in an excess of the alkali. 2. Sesquicarbonate of ammonia, a white precipitate, also soluble in a large excess of the test. 3. Ferrocyanide of potassium, a white precipitate. 4. Sulphuretted hydrogen and hydrosulphnret of ammonia, a milky- white preci- pitate, provided the solution is pure and neutral, or nearly so. If the solu- tion is very acid, sulphuretted hydrogen produces no effect whatever. In organic mixtures. — If the sulphate of zinc is dissolved and the solution is not too acid, we may pass into it a current of sulphuretted hydrogen gas ; the presence of zinc is immediately indicated by a milky-white froth — the sulphuret may be collected, and decomposed by boiling it with hydrochloric acid. The solution may be then tested for zinc. This compound being fre- quently employed as an emetic, may be innocently present in an organic liquid, or in the contents of the stomach. Chloride op Zinc. The Chloride of zinc is sold to the public as a disinfectant, under the name of "Sir W. Burnett's Fluid." This is a highly concentrated solution of the pure, or sometimes impure, chloride of the metal ; it has been taken by acci- dent in several cases, and in one instance was supposed to have been crimi- nally administered as a poison. Symptoms. — In a case reported by Dr. Stratton, about two ounces of a solution containing only twelve grains of the chloride were swallowed. The patient immediately felt pain and nausea ; vomiting followed, and she reco- vered, but suffered from some indisposition for three weeks. In a second case, a wineglassful, equivalent to at least two hundred grains of solid chloride, was swallowed. The man instantly experienced burning pain in the gullet, burning and griping pain in the stomach, great nausea, and coldness. Vo- miting came on in two minutes ; the legs were drawn up to the body ; there 132 POISONING BY CHLORIDE Or ZINC — ANALYSIS was cold perspiration, with other signs of collapse. The man perfectly re- covered in sixteen days.' {Ed. Med. and Surg. Journal, Oct. 1848, p. 335; and British American Journal, Dec. 1848, p. 201.) Other cases show that the concentrated liquid has a strong corrosive action locally, destroying the membrane of the mouth, throat, gullet, and stomach. There has been froth- ing of the mouth, with general lividity, and coldness of the skin. In a case in which only a mouthful of the fluid had been swallowed, the patient expe- rienced giddiness and loss of sight, with immediate burning heat in the sto- mach ; vomiting and purging came on, and the former symptom continued for a week. There was so much irritability of the stomach for a period of three weeks, that the patient became greatly reduced. Among the early symptoms was loss of voice, which did not return for five weeks. {Med. Times, Oct. 11, 1851, p. 382 ; and Nov. 8, 1851, p. 491.) Dr. R. Hassall has re- ported a case in which the nervous symptoms were strongly marked, and were of a peculiar kind. Three ounces of "Burnett's Fluid" were swallowed. There was immediately a sense of constriction in the throat, with a hot burn- ing sensation in the stomach. There was no pain in the mouth, and there was no appearance of corrosion in this cavity or on the lips. There was in- cessant vomiting, the vomited matters consisting of thick mucus, streaked with blood, and some portion of mucous membrane was discharged. There was no purging until the third day, when the discharges from the bowels had a coffee-ground appearance. After the lapse of a fortnight a train of nervous symptoms set in, indicated by a complete perversion of taste and smell. The patient recovered in about three months. {Lancet, Aug. 20, 1853, p. 159.) A case which occurred to Dr. Markham proved fatal in about ten weeks after the poison had been swallowed. The patient, a woman, ast. forty-six, took half a wineglassful of Burnett's liquid, equal to about one hundred grains of chloride of zinc. Immediately after taking it she suffered from vomiting and pain in the stomach. She drank freely of water : the vomiting ceased in a few days, and she appeared to have recovered. In about three weeks the vomiting returned : it was incessant, and with this there was pain in the sto- mach. She sank exhausted, evidently from the secondary effects of the poison. {Medical Times and Gazette, June 11, 1859, p. 595.) Appearances after death. — In the case of an infant, aged fifteen months, who died from the effects of this poison, the lining membrane of the mouth and throat was white and opaque. The stomach was hard and leathery, con- taining a liquid like curds and whey. Its inner surface was corrugated, opaque, and tinged of a dark leaden hue. The lungs and kidneys were con- gested. The fluid of the stomach was found to contain chloride of zinc. {Med. Times, July 13, 1850, p. 4T.) These facts show that the concentrated solution of chloride of zinc is both a corrosive and an irritant poison, exert- ing also occasionally an action on the nervous system. In a case which proved fatal at Guy's Hospital, in 1856, the coats of the stomach were ex- cessively thickened, and had a leathery consistency. In Dr. Markham's case, the stomach was so constricted at the pyloric end by a cicatrix that it would only admit a crow-quill. The pyloric opening was involved in this cicatrix, which was about one quarter of an inch wide. There was no other sign of disease in the body. This case proves that death may occur from this poison even after apparent recovery. The chloride of zinc may destroy life either by producing stricture of the gullet or pylorus, or by its chemical action on the lining membrane of the stomach leading to a loss of power of digestion, to emaciation, and exhaustion. Analysis. — The chlorine may be detected by nitrate of silver — the zinc by the tests above described, (See Sulphate.) All the samples which I have examined contained iron. POISONING BY ZINC, TIN, SILVER, GOLD, AND lEON. 133 Zinc can be detected in the tissues only by incineration and an examina- tion of the ash. The chloride is, however, sometimes used for the preserva- tion of the dead body. This might account for its presence. Carbonate of Zinc (Calamine). This compound does not appear to have any poisonous action : and it would probably require to be given in large quantity to produce any effect. Car- bonate of zinc is the white substance which is formed on the metal when long exposed to air and moisture. Its effects may become a subject of investiga- tion as a matter of medical police, since zinc is now much used for roofing, and also in the manufacture of water-pipes and cisterns. (See Ann. d'Hyg., 1887, 281, vol. ii. p. 352 ; also Edinburgh Monthly Journal, Aug. 1850, p. 181.) Preparations of Tin. The only preparations of this metal which require to be noticed as poisons are the (Morides, or Muriates, a mixture of which is extensively used in the arts, under the name of Dyerh Spirit. The salts may exist in the form of whitish-yellow crystals ; but more commonly they are met with in a strongly acid solution in water. They are irritant poisons ; but so seldom used as such, that only one death occurred from them in England and Wales during a period of two years. Preparations of Silver. Nitrate of Silver. Lunar Caustic. Lapis Infernalis. — This substance, which is commonly met with in small sticks of a white or dark-gray color, is readily soluble in distilled water ; in common water it forms a milky solu- tion. It acts as a powerful corrosive, destroying all the organic tissues with which it comes in contact. There are at least two cases on record in which it has proved fatal in the human subject: one of these occurred in 1837-8, but the particulars are unknown. The symptoms come on immediately, and the whitish flaky matter vomited is rendered dark by exposure to light. Dark-colored spots on the exposed parts of the skin will also indicate the nature of the poison. Preparations of Gold. Perchloride. — This is the only preparation of gold which requires notice. It is a powerful irritant poison, acting locally like the nitrate of silver. Nothing is known of its poisonous effects on man ; but, in administering it to animals, Orfila has found that it caused extensive inflammation, and even ulceration, of the mucous membrane of the stomach. (Toxicologie, vol. ii. p. 30.) The metal is absorbed and carried into the tissues, but its poisonous action appears to be wholly independent of absorption. Preparations of Iron. Sulphate of Iron. Copperas. Green Vitriol. — This compound has been several times administered with malicious intention. One death from it took place in 1837-8. 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 On Poisons, p. 506.) Green vitriol or copperas is sometimes given as an abortive. A suspicious case is reported, in which a woman far advanced in pregnancy, but enjoying 134 POISONING BY THE SALTS OP IRON. good health, was suddenly seized about midnight with vomiting and purg- ing, and died in about fourteen hours. The body, which had been buried, was disinterred, and iron found in large quantity in the viscera. The symp- toms are not always of this violent kind. In a case which occurred to M. Chevalier, a man gave a large dose of sulphate of iron to his wife. There was neither colic nor vomiting. The woman lost her appetite, but ultimately recovered. In another case reported by the same authority, a woman was tried and convicted of poisoning her husband with sulphate of iron : but in consequence of the great diversity of opinion among the scientific witnesses at the trial respecting the poisonous properties of this metallic salt, and the dose in which it would be likely to operate injuriously, the court and jury recommended that the sentence of death should not be carried into execution. (^Ann. cfHyg., 1851, vol. i. p. 155.) The reader will find some remarks in reference to the action of the sulphate of iron on the body, by the late M. Orfila, in the same Journal, 1851, vol. ii. p. 33t. At the Nottingham Au- tumn Assizes, 1859, a woman of the name o^ Riley was indicted for adminis- tering 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 evi- dence of an intent to murder, and it was then lawful to administer poison with any other intent, the prisoner was acquitted. This omission of the Jaw re- garding the administering of poison has been supplied by the recent Act 23 Vict., chapter viii. 1860. (See page 19.) Muriate of iron. Tincture of sesquichloride of iron. — This is an acid solu- tion of perchloride of iron with alcohol, of a red color, much used in medicine. Dr. Christison relates an instance in which a man by mistake swallowed an ounce and a half of this liquid : the symptoms were somewhat like those pro- duced by hydrochloric acid. He at first rallied, but died in about five weeks. The stomach was found partially inflamed, and thickened towards the lesser end (the pylorus). This salt has been much used for criminal purposes in France. (See Medical Gazette, vol. xlvii. p. 30Y : also Ann. d^Hyg., 1850, vol. i. p. 180, 416; and 1851, vol. i. p. 155, vol. ii. p. BS?.) A case was reported to the Westminster Medical Society, in November, 1842, in which a girl, aged fifteen, five months advanced in pregnancy, swallowed an ounce of the tincture of muriate of iron in four doses in one day, for the purpose of inducing abortion. Great irritation of the whole urinary system followed; but this was speedily removed, and she recovered. Another case of recovery from a large dose of this preparation has been reported by Mr. Amyot. A healthy married female swallowed, by mistake for an aperient draught, one ounce and a half of the tincture of muriate of iron. She immediately ejected a portion, and violent retching continued for some time. There was great swelling of the glottis, with cough, and difficulty of swallowing. These symptoms were followed by heat and dryness of the throat, with a pricking sensation along the course of the gullet and stomach ; and in the afternoon a quantity of dark liquid blood was vomited. The motions were black, owing doubtless to the action of sulphur upon the metal. In about a month the patient was perfectly restored to health. {Provincial Journal, April 7 and 21, 1841, p. 180.) Another case of recovery from a large dose has been reported by Sir James Murray. The patient, set. seventy-two, swallowed by mistake three ounces of the tincture in a concentrated state. The tongue soon became swollen; a ropy mucus flowed from the mouth and nose; there was croupy respiration, with a sense of impending suffocation. The pulse was feeble, the skin cold and clammy, and the face swollen and livid. A castor- oil mixture brought away inky evacuations, and the patient rapidly recovered. {Dul. Med. Press, Feb. 21, 1849.) This liquid has been used in large doses for the purpose of criminal abortion. POISONING BY BISMUTH AND CHROMIUM. 135 Chemical analysis. — The hydrochloric acid may be detected by nitrate of silver and nitric acid, while the peroxide of iron is immediately indicated by a precipitate of Prussian blue on adding a solution of Ferrocyanide of po- tassium. Prepaeations of Bismuth. Suhniirate of Bismuth. Pearl-white. Magistery of Bismuth This sub- stance, in a dose of two drachms, caused the death of an adult in nine days. There was a strong metallic taste in -the mouth, burning pain in the throat, with vomiting and purging, coldness of the surface, and spasms of the arms and legs. On inspection, the throat, windpipe, and gullet were found in- flamed ; and there was inflammatory redness in the stomach and throughout the intestinal canal. {Sohernheim, p. 335.) In a case mentioned by Dr. Traill, a man took by mistake six drachms of the subnitrate, in divided doses, in three days. He suffered from vomiting and pain in the abdomen and throat, but finally recovered. (^Outlines, Tp- 115.) These cases are sufiBcient to prove that a substance very slightly soluble in water may exert a power- fully poisonous action on the human system. The oxide and subnitrate of bismuth are frequently contaminated with arsenic in the form of arsenic acid. The symptoms produced by large doses have closely resembled those caused by arsenic, and as the medicinal subnitrate generally contains arsenic, the symptoms may have been due to this impurity. I found arsenic in compara- tively large proportion in samples obtained from three respectable retail druggists. Only two specimens out of five were found free from arsenic. The poison may be detected by dissolving the subnitrate in pure hydrochloric acid slightly diluted, and introducing it into Marsh's apparatus. The arsen- ical flame is apparent on combustion, and the usual deposits may be obtained on glass and porcelain. On collecting the products of combustion in a saucer wetted with ammonio-nitrate of silver the yellow arsenite of silver is pro- duced. This fact may modify a conclusion respecting the presence of traces of arsenic in a body when bismuth has been administered medicinally. (See Brit, and For. Med.-Chir. Rev. Oct. 1858.) [See also Am. Journ. Med. Sci., July 1858.— H.] Analysis The subnitrate is a whitish chalky-looking uncrystalline powder insoluble in water, dissolved by hydrochloric acid, and again precipitated white by dilution with water : — this white precipitate is blackened by a solu- tion of sulphuretted hydrogen, or by hydrosulphuret of ammonia. Preparations of Chromium. Bichromate of Potash. — Well-observed instances of poisoning by this compound, which is now extensively used in the arts, are rare ; and there- fore the details of the following case, communicated to the Medical Gazette (vol. xxxiii. p. 734) by Mr. Wilson, of Leeds, are of practical interest. A man, aged sixty-four, was found dead in his bed twelve hours after he had gone to rest : he had been heard to snore loudly during the night, but this had occasioned no alarm to his relatives. When discovered he was lying on his left side, his lower limbs being a little drawn up to his body : his counte- nance was pale, placid, and composed ; eyes and mouth closed ; pupils dilated ; no discharge from any of the outlets of the body ; no marks of vomiting or purging, nor any stain upon his hands or person, or upon the bed linen or furniture. The surface was moderately warm. Some dye-stuff, in the form of a black powder, was found in his pocket. On inspection, the brain and its membranes were healthy and natural ; there was neither con- gestion nor effusion in any part. The thoracic viscera were equally healthy, 136 POISONING BY BICHROMATE OP POTASH. as well as those of the abdomen, with the exception of the liver, which con- tained several hydatids. A pint of a turbid inky-looking fluid was found in the stomach. The mucous membrane was red and vascular, particularly at the union of the greater end with the gullet : this was ascribed to the known intemperate habits of the deceased. In the absence of any obvious cause for death, poison was suspected ; and on analyzing the contents of the stomach they were found to contain bichromate of potash. The dye-powder taken from the man's pocket consisted of this salt mixed with cream of tartar and sand. It is remarkable that in this case there was neither vomiting nor purg- ing. The salt does not appear to have operated so much by its irritant pro- perties as by its indirect effects on the nervous system. This, however, is by no means an unusual occurrence, even with irritants far more powerful than the bichromate of potash. A case has been communicated to me by Mr. Bishop, of Kirkstall, in which a boy recovered from the effects of a dose of this salt 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. A report of this case will be found in Guyh Hospital Reports, Oct. 1850, p. 214. There can be no doubt that bichromate of potash is an active poison. Mr. West has published a case from which it appears that a medical man, who had inadvertently tasted a solution of it, suffered from severe symptoms re- sembling those of Asiatic cholera. {Provincial Journal, Dec. 24, 1851, p. "TOO.) Mr. Wood, of St. Bartholomew's Hospital, has furnished me with the particulars of a case in which two drachms of this substance destroyed the life of a woman in four hours. In the first two hours she suffered from vio- lent vomiting and purging, the vomited matters being of a yellow color. When admitted, she was in a dying state, pulseless, unconscious, and breath- ing slowly, and with great effort. The skin was cold ; the lower lip swollen and purple, and the tongue swollen. The chief appearances were — a dark and liquid state of the blood ; the mucous membrane of the stomach in great part destroyed, of a dark brown color approaching to purple ; the duodenum at its upper part was of a florid red color, at its lower part it was much cor- rugated, as well as the upper half of the jejunum, POISONING BY ALOES AND GAMBOGE, Itl VEGETABLE AND ANIMAL IRRITANTS. CHAPTER XVI. MODE OP ACTION OF VEGETABLE IRRITANTS — ALOES — COLOCTNTH — GAMBOGE — JALAP — SOAMMONT — SAVIN — CROTON OIL — CASTOR SEEDS — COLCHIOXJM — HELLEBORE — OIL OE TURPENTINE — OIL OE TAR — MOULDY BREAD — EKQOT OP RYE — CAROB OR LOCUST BEAN. General Remarks. — The poisonous substances of an irritant nature which belong to the vegetable kingdom are very numerous as a class ; but it will here be necessary to notice only those which hare either caused death, or have given rise to accidental poisoning. Aloes. Colocynth. Gamboge. Jalap. Soammony. These different substances, which are used in small doses as medicines, are liable, when taken in large quantities, to excite vomiting, purging, and other symptoms of irritation. Colocynth has occasioned death in several instances ; in one case, a teaspoonful and a half of colocynth powder destroyed life ; and one drachm of gamboge, a medicine much used by quacks, has proved fatal to man. (Traill's Outlines, 150.) Aloes and colocynth mixed are said to be the basis of a certain quack medicine sold under the name of Morison's Pills. These have proved fatal in many instances from the exhaustion pro- duced by excessive purging, owing to the large quantity of these pills taken in frequently repeated doses. Our knowledge of the symptoms and appear- ances produced by these irritants is, indeed, chiefly derived from the cases which have proved fatal under this pernicious treatment. In the seventeenth volume of the Medical Gazette, will be found four cases of this description. The most prominent symptom is excessive purging, with the discharge of large quantities of mucus ; the individual becomes emaciated, and slowly sinks. In some instances, the symptoms are those of inflammation and ulce- ration of the bowels. In 1836, a man was convicted of having caused the death of a person by the administration of these pills ; in this instance, the death of the deceased was clearly due to the medicine ; and, on inspection, the stomach was found inflamed and ulcerated ; the mucous membrane of the small intestines was inflamed and softened, and there was the appearance of effused lymph upon it. An ingenious attempt was made in the defence to draw from the medical witness a statement that the good effects of some medicines invariably increased in proportion to the quantity taken. This was, however, very properly denied. The same remarks apply to Holloway's pills, although they are of a more innocent description. The principal in- gredient in them is aloes. In all cases, it must be remembered that these drastic purgatives may cause serious symptoms, or even death, when admi- nistered to infants or to persons debilitated by age or disease ; and it is not necessary that the dose should be very large in order that fatal effects should follow. The question here will be, whether the medicine caused death, or 138 POISONING BY HIEEAPICRA AND SAVIN. whether it simply accelerated it; although, in a legal view, that which accele- rates, causes. i HiEaAPiCRA {Holy litter) is 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 procuring criminal abortion. A man was tried and convicted of this offence at the Aylesbury Lent Assizes, 1857 {Reg. v. White), and the noxious properties of this compound then became a subject of inquiry. The dose, and the condition of the woman to whom it is administered, will of course aflFect the answer to this question. At the trial above mentioned, it was properly considered to be a noxious substance within the meaning of the statute. The fact that, under the name of Pulvis Aloes cum Ganelld, it was formerly admitted into the British Phar- macopoeias, cannot justify the mischievous uses to which it may be put. Hierapicra is a snuff-colored powder, of an intensely bitter taste. It con- sists 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 pregnant females are chiefly due to the aloes. This 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 female unknowingly. Death has been caused by aloes taken in nitric acid; but in this case the mineral acid was most probably the destructive agent. A singular case oc- curred in Germany a few years since, wherein a medico-legal question was raised respecting the poisonous properties of Aloes. A woman, aged forty- three, not laboring under any apparent disease, swallowed two drachms of powdered aloes in coffee. Violent purging supervened, and she died the following morning, twelve hours after having taken the medicine. On in- spection the stomach was found partially, and the small intestines extensively, inflamed. There were no other particular appearances to account for death, and this was referred to the effect of the aloes. Savin. (Juniperus Sabina.) This is a well-known plant, the leaves or tops of which contain an irritant poison in the form of an acrid volatile oil of a remarkable odor. They exert an irritant action, both in the state of infusion and powder. They yield by distillation a light yellow 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 pur- pose of destroying life ; but this is occasionally an indirect result of its use as a popular means of procuring abortion. In this manner it appears to have proved fatal in one case in 1837-8. From the little that is known of its effects, it acts by producing violent pain in the abdomen, vomiting, and strangury. After death, the gullet, stomach, and intestines, with the kidneys, have been found either much inflamed or congested. It has no action as an abortive, except, like other irritants, by causing a violent shock to the system, under which the uterus may expel its contents. Such a result can never be obtained without placing in jeopardy the life of a woman ; and when abortion follows, she generally falls a victim. On the other hand, the female may be killed by the poison without abortion ensuing. In May, 1845, I met with a case in which death had been caused by savin-powder — abortion having first taken place. Eight ounces of green liquid were found in the stomach, which, with the gullet and the small intestines, was highly inflamed. The poison was easily identified by placing some of the minute portions of the leaves found in the stomach under a microscope. {Med. Gaz., vol. xxxvi. p. OROTON OIL — CASTOR SEEDS. 139 646.) The oil of savin is also powerfully irritant. For an account of this, see Criminal Abortion. Croton Oil. This is an oil extracted from the seeds of the Croton tiglium. It is a powerful drastic purgative, producing, in a large dose, severe purging, col- lapse, and death. A case occurred in Paris, in 1839, in which a man swal- lowed by mistake two drachms and a half of croton oil. In three quarters of an hour the surface was cold and clammy, the pulse imperceptible, respira- tion difficult, and the extremities and face were as blue 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 1 In June, 1850, I was consulted in a case in which it was supposed that this liquid had been employed for the purpose of destroying life ; and, al- though arsenic was found in the stomach, it became a question to determine what was the fatal dose of this oil. In this instance sixty drops had been sold, mixed with two ounces of linseed oil. This is considered a proper dose for cattle. In man, a dose of from fifteen to twenty drops of the pure oil might give rise to excessive purging, and thus cause death by exhaustion. The cases recorded of its fatal operation are very few, and do not enable us to solve this question from observed facts. According to Landsberg, as quoted by Christison {Dispensatory, p. 382), thirty drops of the oil have killed a dog, and Dr. Christison states that he has known four grains of the oil to produce an alarming degree of purging. It is frequently adulterated with castor oil and other substances, and these adulterations must of course influence the dose required to act fatally. In the Medical Gazette there is a report of a case in which a woman died from the effects of an embrocation containing croton oil, with other drugs. A teaspoonful was incautiously given to her : she immediately complained of a hot burning sensation in her throat. She was an aged person, and died in convulsions in three days. {Med. Gaz., vol. xliii. p. 41.) Castor Seeds. Of castor oil itself nothing need be said. It is not commonly known that the seeds from which this oil is extracted contain in the embryo an active poison, and that a few of them are sufficient to produce violent purging and death. The following is an instance of poisoning by these seeds — the only one with which I have met. The deceased, aged eighteen, was the sister of a gentleman who was at the time attending my lectures at Guy's Hospital. The deceased, it appears, ate about twenty castor-oil seeds ; one of her sis- ters ate four or five, and another two. This was on a Wednesday evening. In the night they were all taken ill. About five hours after the seeds were eaten the deceased felt faint and sick ; vomiting and purging came on, and continued through the night. On the following morning she appeared like one affected with malignant cholera. The skin was cold and dark-colored, the features contracted, and the breath cold ; the pulse was small and wiry ; there was restlessness, thirst, pain in the abdomen, and she lay in a sort of drowsy, half-conscious state. Whatever liquid was taken was immediately rejected, and the matters passed by stool consisted chiefly of a serous fluid with blood. She died in five days without rallying ; the two other sisters recovered. On inspection, a very large portion of the mucous membrane of 140 POISONING BY COLCHIOUM — HELLEBORE. the stomach was found abraded and softened in the course of the great cur- vature. There was general redness of the organ, and the abraded portioa presented the appearance of a granulating surface of a pale rose-color ; it was covered by a considerable quantity of slimy mucus. The small intes- tines were inflamed, and the inner surface of them was abraded. The effects produced on the sisters who recovered, bear out the statement of Dr. Chris- tison, that two or three of the seeds will operate as a violent cathartic. CoLCHicuM (MaiDow- Saffron). Meadow-saffron (Colchioum Atitumnale) contains a poisonous alkaloid — eolchicina — the effects of which on animals are similar to those of verairia, the alkaloid existing in White hellebore. The most noxious part of the plant are the bulbs (or roots) and seeds, but the leaves and flowers have also an irritant action. Symptoms and appearances. — In November, 1839, a gentleman swallowed by mistake one ounce and a half of wine of colchicum. He was immediately seized with severe pain in the abdomen : other symptoms of irritation came on, and he died in seven hours. No examination of the body was made ! In another instance, in which an ounce of the wine was taken, death occurred in thirty-niue hours. (^Schneider'' s Annalen, vol. i. p. 232.) In one case in ■which this dose was taken, the person recovered after suffering from cramps in the limbs and twitching of the tendons. {VUnion Med., Aug. 24, 1848.) A woman, set. fifty-six, suffering from rheumatism, for whom wine of colchi- cum had been prescribed, took by mistake an ounce of the wine of the seeds, in divided doses, in twelve hours. She suffered from nausea, violent and pro- fuse vomiting, slight purging, with heat and burning pain in the throat, great thirst, cold clammy skin, feeble pulse, pain in the stomach, and pain in the forehead. Inflammation of the stomach supervened, and the retching, vomit- ing, thirst, and pain continued for three days. She then recovered. {Amer. Journ. Med. Set., Jan. 1857 ; and JBrit. and For. Rev., vol. xix., 185T, p. 409.) In a well-marked case of poisoning by the wine of colchicum, re- ported by Mr. Fereday, two ounces were taken. The symptoms did not come on for an hour and a half; there was then copious vomiting of a yel- low 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. The chief morbid appearance was a patch of redness in the mucous membrane of the stomach, near the cardiac orifice ; the intestines were slightly inflamed. The head was not ex- amined. (^Medical Gazette, vol. x. p. 161; see also Casper, Ger. Med., p. 450.) A case of poisoning by the medicinal administration of colchicum has been communicated to me by Mr. Mann, of Bartholomew Close. Three and a half drachms 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 fol- licles. 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. (Casper, Ger. Med., 185T, p. 45J.) For a case of alleged poisoning by wine of colchicum, see Casper's Vierteljahrschrift, 1860, vol. i. p. 1. Black and White Hellebore. There are several species of Hellebore ; but the two plants which are most commonly used as poisons under this name, are the Black and White Hellebore. < OIL OF TURPENTINE — OIL OP TAR — MOULDY BREAD. 141 Symptoms and appearances. — According to Wibmer, the roots of the Black Hellebore possess the greatest activity : but the leaves are also highly poisonous when used in the form of infusion. By long boiling the poisonous properties of the plant are diminished, probably owing to the loss of the volatile principle, which is an acrid oil. The roots and leaves have a local irritant action, producing violent vomiting and purging in small doses, with severe pain in the abdomen, followed by cold sweats, convulsions, insensi- bility, 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, aged fifty, in eight hours. The symptoms were severe pain in the abdomen and violent vomiting. After death the whole of the alimentary canal was found inflamed, but especially the large intestines. (Wibmer, op. cii., Helleborus.) A case is quoted by the same writer, in which a tablespoonful of the finely-powdered root (taken by mistake for rhubarb) caused severe symptoms of irritant poisoning, which did not disap- pear for four hours. The man recovered on the fourth day. The experi- ments performed by Orfila on animals show that this poison acts like a local irritant when applied to a wound. (Op. cit., vol. ii. p. 369.) Hellebore is a favorite remedy for worms with quacks and rural doctresses. It is not, therefore, surprising that it should be occasionally administered in an over- dose, and cause death. Oil of Turpentine. The few cases in which this liquid has produced any noxious symptoms have occurred among children. From these it appears to have rather the effects of a neurotic (narcotic) than an irritant poison. In a dose of three drachms it has produced intoxication. A dose of a tablespoonful caused in a child aged eighteen months symptoms bearing a strong resemblance to those occasioned by an overdose of opium, although they were not so rapidly manifested. (See case by Mr. Johnson, Medical Times, Oct. 11, 1851, page 380.) In three hours there was complete insensibility — stertorous breathing, strongly contracted pupils, rapid arid weak pulse — coldness of surface, pale- ness of the countenance — general relaxation of the muscles, with occasional convulsive movements. In no instance yet recorded has this oil caused death. A case of recovery in an infant that had swallowed four ounces is recorded in another work (On Poisons). A case in which this liquid was criminally administered to an infant was the subject of a trial at the Central Criminal Court, December, 1856 {Reg. v. Rodanhosh) : it did not destroy life, but the child suffered for some time from the effects. The defence was, that the oil of turpentine was poured down the child's throat by the mother with a view to cure it of a cough 1 She was acquitted. Oil of Tar. This is a powerful vegetable irritant. In 1832, about ten drachms of it caused the death of a gentleman, to whom it had been sent by mistake for a black draught. The party who sent it was tried for manslaughter, but acquitted. The irritant properties are owing to creasote, carbolic acid, and other compounds. Mouldy Bread. There is a common article of food, namely, hread, upon the occasionally noxious effects of which some observations have been made by toxicologists. (In the Annales d^Hygiine, 1843, pp. 85 and 347, will be found communica- 142 POISONING BY LOCUST BEAN. tions on this subject from MM. Guerard, Chevallier, and Gaultier de Claubry ; also in the same journal, 1852, vol. i. p. 350.) The changes which take place in the decomposition of flour and bread, and the production of various kinds of mouldiness, are here investigated, together with the effects of such bread upon the animal system. It would appear that in some parts of France the peasantry manifest no repugnance to the eating of mouldy bread; and that in many instances the practice appears to be attended with no ill effects. The nature of the mould produced, however, is subject to great variation, and it is not improbable, as M. Chevallier suggests, that in some cases a poisonous principle is actually developed. In two instances of children, who had partaken of mouldy rye bread, symptoms resembling those of irritant poisoning supervened. The countenance was red and swollen ; the tongue dry ; the pulse quick ; there were violent colics, with pain in the head, and intense thirst. Vomiting and purging supervened with a state of collapse, but the children eventually recovered. These symptoms were ascribed to the production of "mucor mucedo" in the bread. In 1829, alarming effects having followed from the use of a certain kind of bread in Paris, M. Barruel was called upon to determine whether any irritant poison had or had not become accidentally intermixed with it. The bread was simply in a mouldy state ; there was no trace of poison. It is unnecessary to enter further into this subject; the facts adduced, together with experiments performed on animals, show that bread, in a state of mouldiness or decay, may not only produce symptoms of poisoning, but actually cause death ; and as it is im- possible to distinguish the noxious from the innoxious kind of mould, the use of all bread in such a condition should be avoided. Eren fresh bread may occasionally seriously affect the body. The brown bread of London has been known to produce giddiness, lethargy, and other unpleasant symptoms, indicative of an affection of the brain and nervous system. This has been ascribed, with some probability, to the presence of Darnel seeds in the corn. Carob or Locust Bean. The locust beans or locust nuts have been much used in England for the fattening of cattle ; but in a few cases in which they have been eaten by children, they are supposed to have occasioned violent irritation ; and in one case (March, 18b1), a boy, aged ten years, died in about sixteen hours, ap- parently from their poisonous action on the body. The chief symptoms during life were pain in the head, vomiting, and purging, with clenching of the hands, and a spasmodic action of the muscles of the face. On inspection, the stomach and intestines were found much inflamed. The viscera were carefully examined by Mr. Watson, of Bolton, but no poison could be de- tected. Another fatal case, as it was alleged from eating locust nuts, oc- curred subsequently in London, and was the subject of an inquest before Mr. Wakley. The facts at present scarcely admit of an explanation. The nuts contain no substance injurious to animals, and as it is alleged that many human beings have eaten them with Impunity, the effects produced in the above cases may have been dependent on idiosyncrasy in those who have suf- fered (ante, page 21). Other vegetable irritants might be enumerated, but these are the principal which have given rise to medico-legal inquiries. The treatment of such cases must depend on the nature of the symptoms ; the main object should always be to remove the poison either from the stomach or bowels, by mild emetics or purgatives (castor-oil), with as little delay as possible. The nature of the poison is commonly apparent from the circumstances ; for these cases, if we POISONING BY CANTHAEIDES. 143 except poisoning by Savin, which is sometimes criminally administered, are generally the result of accident. These vegetable poisons are beyond the reach of chemical processes : — they are only to be recognized either by their physical properties, or by the botanical characters of the berries, seeds, or leaves. CHAPTER XVII. animal irritants — oantharides or spanish flies — symptoms and effects — analysis. poisonous food — fish — mussels — salmon — cheese — sau- sages — diseased flesh of animals. Cantharides. (Spanish Plies.) Symptoms and effects. — Cantharides are not unfrequently administered, either in the state of powder or tincture, for the criminal purpose of procur- ing abortion. When taken in powder, in the dose of one or two drachms, it gives rise to the following symptoms : — a burning sensation in the throat, with great difBculty of swallowing — violent pain in the abdomen, with nausea, and vomiting of bloody mucus : — there is also great thirst and dryness of the fauces, but in a few cases observed by Mr. Maxwell, salivation was a promi- nent symptom. As the case proceeds, 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 nrine is passed at each effort. The abdominal pain becomes of the most 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 liquids, shining green particles may be commonly seen on examination, whereby the nature of the poison taken will be at once indicated. After a time, there is severe priapism, and the genital organs are swollen and inflamed both in the male and female. In one instance, observed by Dr. Pereira, abortion was induced, probably owing to excitement of the uterus, from the severe affection of the bladder : for there is no proof that this substance acts directly on the uterus to induce abortion. With respect to the aphrodisiac propensities said to be caused by cantharides, these can seldom be excited in either sex, except when the substance is administered in a dose which would seriously endanger life. When the case proves fatal, death is usually preceded by faiutness, giddiness, and convulsions. The tincture of cantharides produces similar symptoms : — they are, however, more speedily induced, and the burning sensation and constriction of the throat and stomach are more strongly marked : this symptom is often so severe as to render it impossible for the individual to swallow ; and the act of swallow- ing gives rise to excruciating pain in the throat and abdomen. This poison has been in some cases wantonly used, and with great danger to life, with a view of exciting sexual feelings in females. The doses in which it has been given have been such as to cause symptoms of irritant poisoning. In Nov. 1859, six female servants in a gentleman's family, as well as the master and mistress, were attacked with all the symptoms of poisoning by cantharides. It appeared that the coachman of the family had, shortly before the occur- rence, purchased an ounce of this poison; that he had put the cantharides into beer and coffee, and had thus poisoned the whole household. He was 144 CANTHARIDES — APPEAKANCES — FATAL DOSE. tried, but acquitted of any indictable offence, on the ground that his intent was not to murder. It was this case which led to an alteration in the law. Appearances. — In one well-marked case of poisoning by this substance, the whole of the alimentary canal, from the mouth downwards, was in a state of inflammation, as well as the ureters, kidneys, and internal organs of genera- tion. The mouth and tongue seemed to be deprived of their mucous mem- brane. 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 sto- mach was not inflamed ; but it was pulpy, and easily detached. The kidneys were, however, inflamed. The brain has been found congested, and ulcera- tion 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 who have taken this poison have recovered. In a case which occurred to Mr. Saunders, death took place in about twenty-four hours. The deceased must have taken the greater part of half an ounce of cantharides in powder. The symptoms were such as have been above de- scribed. On inspection, the vessels of the brain were filled with dark-colored blood, and the ventricles were distended with serum. Both lungs were highly engorged with dark-colored blood. The gullet was partially inflamed, and there were patches of inflammation on the mucous coat of the stomach, which had become detached in several places. The same inflammatory ap- pearance existed in the small intestines, in the folds of which the powder of cantharides was abundantly seen. The vessels were distended, and the liver was engorged with dark blood. The gall-bladder was much distended with bile, and none of this secretion appeared to have passed into the bowels. The spleen and kidneys were highly congested ; the ureters were inflamed ; the bladder was contracted and empty, and its internal surface pale. The glit- tering of the particles of cantharides in the viscera during the inspection by candlelight was very remarkable. {Medical TVwes, Feb. 3, 1849, p. 287.) Cantharides have no local action of a chemical nature. The poison is pure irritant, and the effects observed are entirely due to irritation and inflamma- tion. Fatal dose. — The quantity of this poison required to produce serious effects, or to destroy life, has been a frequent subject of medico-legal inquiry. Dr. Thomson represents the medicinal dose of the powder to be from one to three grains. On a late criminal investigation one medical witness stated that one grain was the maximum dose, but this is an under-statement ; according to Thomson, it is three grains. The dose of the Loudon Pharmacopoeial tinc- ture is from ten minims gradually increased to one fluidrachm — of the powder, from one to two grains. (Pereira, Mat. Med., part 2, vol. ii. p. 754.) Doses above this, whether of the powder or the tincture, are likely to be injurious, and to give rise to symptoms of poisoning. On a trial which took place at Aberdeen, in 1825, it appeared that a drachm of the powder had been ad- ministered ; severe symptoms followed, but the person recovered. Dr. Dyce, the medical witness, said he had given ten grains of the powder as a medi- cinal dose. In three cases, observed by Mr. Maxwell, a drachm of the pow- der mixed with six ounces of rum was taken by each person ; they were robust, healthy negroes — they suffered severely, but recovered in about ten days ; in these cases, irritation of the urinary organs did not appear until after the men had been bled. The smallest quantity of powder which has been known to destroy life, was in the case of a young female, quoted by Orfila — the quantity taken was estimated at twenty-four grains in two doses. She died in four days ; but as abortion preceded death, it is difficult to say how far this may have been concerned in accelerating that event. Her in- tellect was clear until the last. In one instance a man recovered after having taken twenty grains of the powder {Ed. Med. and Surg. Journ., Oct. 1844) ; CANTHARIDES — CHEMICAL ANALYSIS — POISONOUS FOOD. 145 and in another, after having taken two drachms {Med. Gaz., vol. xlii. p. 873). An ounce of the tincture has been known to destroy life. It was taken by a boy, aged seventeen, and he died in fourteen days. This, I believe, is the smallest dose of the tincture which has proved fatal. Tour drachms and even six drachms have been taken ; and although the usual symptoms followed, the parties did well. The last case was the subject of a trial at the Central Criminal Court, in September, 1836. Six drachms of the tincture were ad- ministered to a girl, aged seventeen ; the medical witness was required to say whether half an ounce was sufficient to kill a person, as also what proportion of cantharides was contained in an ounce of the tincture ; he said, five grains. One ounce of the tincture (P. L.) is equivalent to six grains of the powder ; but considering that the principle cantharidine is the substance on which the poisonous properties depend, it is not unlikely that the tincture varies in strength, according to its mode of preparation. A case is quoted by Pereira, from Dr. Hosack (Mat. Med., vol. ii. Am. ed. p. 1124), in which it is said six ounces of the tincture were taken by a man without causing dan- gerous symptoms 1 This must have been an extraordinarily weak prepara- tion ; and probably the insects from which the tincture was made contained little or no cantharidine. The same writer mentions a case within his own knowledge, in which one ounce of the tincture caused serious symptoms. Chemical analysis. — Orfila has applied reagents to detect cantharidine in the tincture ; but without success. It has been recommended to digest the suspected solid or the liquid contents of the stomach evaporated to an ex- tract, in successive quantities of ether — to concentrate these ethereal solu- tions by slow evaporation, and then observe whether the concentrated liquid applied to the skin of the lips produces vesication or not : the medical jurist being expected in such cases to make himself the subject of experiment. By this method Barruel discovered cantharides in some chocolate. (Ann. d''Hyg., 1835, vol. i. p. 455.) In an elaborate essay on this subject {Ann. d'Hyg., Oct. 1842), M. Poumet recommends that the suspected liquids, mixed with alcohol, should be spread on sheets of glass, and allowed to evaporate spon- taneously to dryness. The shining scales will then be seen, on examining, by reflected light, either one or both surfaces of the glass. This process answers only for the detection of the powder. The evidence of the presence of cantharides, or of their having been taken, is necessary to support a criminal charge ; for however unambiguous the symptoms produced by this poison may appear to be in its peculiar effects on the generative and urinary apparatus, the medical jurist should be aware that similar symptoms may proceed from disease. An important case of this kind has been reported by Dr. Hastings. {Med. Gaz., vol. xii. p. 431.) A young lady was suddenly seized with vomiting, thirst, pain in the loins, strangury, and considerable discharge of blood from the urethra : the gene- rative organs were swollen and painful. She died in four days. She was governess in a family, and there was some suspicion that she had been poi- soned by cantharides. The stomach and the kidneys were found inflamed, and the bladder also ; this contained about two ounces of blood. There was no trace of poison ; and indeed, it was pretty certain, from the general evidence, that none could have been taken. PoisoNotrs Food. Certain kinds of animal food are found to produce, occasionally, symptoms resembling those of irritant poisoning. In some cases this poisonous effect appears to be due to idiosyncrasy ; for only one person out of several may be affected. These cases are of importance to the medical jurist, since they are very likely to give rise to unfounded charges of criminal poisoning. In the 10 146 POISONOUS POOD. absence of any demonstrable poison, we must test the question of idiosyncrasy by observing whether more tlian one person is affected, and whether the same kind of food, given to animals, produces symptoms of poisoning. If, with this latter condition, several persons are affected simultaneously, 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 given rise to symptoms of poisoning, may be mentioned — Poisonous Fish. Mussels Of all the varieties of shell-fish, none have so frequently given rise to accidents as the common mussel. The symptoms which it produces are uneasiness and sense of weight in the stomach, sensa- tion 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, with a profuse secretion of tears, and heat and itching of the skin, followed by an eruption resembling nettle-rash. 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 gene- rally great exhaustion and debility. These symptoms have proceeded from the eating of not more than ten or twelve mussels. Two eases, reported by Dr. Christison, proved fatal, the one in three, and the other in about seven hours. In general, however, especially when there is free vomiting, the patients recover. In the inspection of the two above-named fatal cases, no appearance was found to account for death. A case in which two mussels produced in a boy aged ten, alarming symptoms, followed by an eruption resembling scarlatina and nettle-rash, will be found elsewhere reported (Guy's Hosp. Reports, Oct. 1850, p. 213). In July, 1860, a number of persons living at Tralee were poisoned under the following circumstances. A woman picked up some mussels which she found at the bottom of the basin of the ship canal. She distributed them among her neighbors, and during the night twenty-one persons who had eaten of them were attacked with symptoms of having been poisoned. Three children had died, and six individuals were in imminent peril. The rest were soon out of danger. Eight of the twenty-one persons attacked were adults. {Medical Times and Gazette, July 28, 1860.) The poisonous action of mussels can neither be referred to putrefaction nor disease; nor in all cases to idiosyncrasy, since in one instance those mussels only which had been taken from a particular spot were poisonous; all persons who partook of them suffered, and a dog was killed to which some of them were given. From a case which occurred to M. Bouchardat, it would appear that copper is sometimes present, and may be the cause of the poisonous effects. Two women were poisoned by mussels, and he found on analysis sufficient copper in the fish to account for the symptoms of irritation from which they suffered. {Ann. d'Hyg., ISST, vol. i. p. 358.) Copper is not, , however, present in all cases, and it is therefore probable that there is in some, if not in all, instances, an animal poison present in the fish. (See Ann. d'Hyg., 1851, vol. i. p. 381, vol. ii. p. 108.) Oysters and periwinkles have occasionally given rise to similar symptoms. Salmon, sold in the state of pickled salmon, or even herrings salted, may also act as irritants ; this may be due to the fish being partially decayed before it is used, or to the noxious effects of the pickle. For some remarks by Dr. Hamilton on the poisonous properties of fish, see the Pharmaceutical Journal, Jan. 1853, p. 344. OAeese.— The symptoms produced by cheese have been those of irritant poisoning. The nature of the poison is unknown. In some cases, the irri- tant property is undoubtedly due to a putrefied state of the curd, or to the production of an irritant oil. Again, it has been supposed that the poison is occasionally derived from certain vegetables on which the cows feed. In NOXIOUS ANIMAL FOOD. 141 1858 a case was referred to me for examination, in which twenty-five persons had suffered from vomiting and purging, more or less violent, owing to their having partaken of cheese. The only articles of food taken in common were bread, beer, and cheese. The bread and beer were excluded from any suspi- cion of containing poison. All the persons recovered. On a close examina- tion of the cheese, I found it to be strongly acid ; it had an offensive musty smell, and yielded a quantity of acrid oil to ether. It had not been properly pressed, and the casein had undergone a chemical change. The ashes yielded copper and lead in traces. The cheese had acquired irritant properties, not from the presence of any poisonous matter added to it, but from partial decay. There was abundant evidence that cheese from the same dairy had been eaten without causing any injurious symptoms. This negative evidence, however, is quite consistent with one cheese acquiring noxious properties. Sausage poison. — The symptoms caused by sausage poison are very slow in appearing — sometimes two, three, or four days may elapse before they mani- fest themselves ; they partake of the narcotico-irritant character. This poison is of a formidable kind ; its effects have been chiefly observed in Germany. In the Medical Gazette for Nov. 1842, there is an account of the cases of three persons who had died from the effects of liver sausages, which had been made from an apparently healthy pig, slaughtered only a week before. The inspec- tion threw no light on the cause of death. The poisonous property is sup- posed to depend on a partial decomposition of the fatty parts of the sausages. It is said, that when extremely putrefied they are not poisonous. In a case in which I was consulted, a few slices of a German sausage, evidently of old manufacture, caused the death of a child, with violent symptoms of irritation of the stomach and bowels. I examined a portion of the sausage : it con- tained no poisonous matter which admitted of detection. 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. Dr. Tripe has published a complete account of the effects produced by sausage poison. {Brit, and For. Med. Rev., Jan. 1860, p. 191.) It appears that in Novem- ber, 1859, sausages made and sold by a pork-butcher, at Kingsland, were eaten more or less by sixty-six persons, of whom sixty-four were attacked with violent symptoms in from three and a half to thirty-six hours subsequently to the meal. One case only proved fatal, on the seventh day. No symptoms appeared on this man until after the lapse of six hours. It seems 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 comatose, and died on the seventh day. Latterly, he chiefly complained of pain in the bowels. Dr. Letheby found, on inspec- tion, no signs of inflammation or of the action of an irritant in the stomach. The small intestines were much inflamed at the lower end, and the gall-bladder was distended. The other organs were healthy. The viscera contained no vegetable or mineral poison. The sausages were made with 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 sausages 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 vomit- ing and purging ; then giddiness or confusion in the head, and in some there was delirium. In the man who died, the delirium was well marked, and the I eyes were red. In those persons who recovered, the noxious animal matter was probably early thrown ofl' by vomiting and purging. [See Med. Exam., Feb. 1855; also, Journ. de Chim. Mid., April, May, and June, 1855. — H.] 148 NOXIOUS ANIMAL FOOD. Porh. 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 idiosyn- crasy ; but in others it can only be explained by supposing the food to have a directly poisonous action. The noxious effects of pork have been parti- cularly shown by the cases published by the late Dr. MacDivitt. {Ed. Med,, and Surg. Joum., 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. [See Med. Exam., vol. i. and ii. — H.] There is no doubt that epizootic disease may be a frequent cause of render- ing animal food poisonous. Partial decay may also render unwholesome and injurious the flesh of the most healthy animal. What the nature of the poison is which is thus produced, has not yet been determined. Liebig im- agines that its noxious effects are owing to the production of a fermenting principle, and that this operates fatally by producing a kind of fermentation in the blood. It has been said that the symptoms of irritant poisoning pro- duced by animal food seldom appear until five or six hours after the meal. This may be generally true, but in certain instances it has undoubtedly hap- pened that the symptoms have come on in from a quarter to half an hour after the noxious food was taken. Much of the butcher's meat, fish, and game sold to the poor in this metro- polis is in a state of decay, and is quite unfit for human food. The decayed meat is no doubt a prolific source of disease. In January, 1851, the family of a surgeon near London were all affected with symptoms resembling irri- tant poisoning, after having partaken of a hare which had been stewed in a clean earthen vessel. The surgeon informed me that on the second day, his wife was seized with vomiting and purging, giddiness, heat in the throat, and general numbness, with inflamed eyes. Other members of the family vomited, and in the course of a few days the symptoms disappeared. I ex- amined the vomited matter, and found it to consist of portions of the hare partially digested, but in a state of putrefaction, so that there was abundant evidence of sulphuretted hydrogen in the liquid. There was no mineral poison of any kind, although the symptoms, it will be observed, were rather like those occasioned by arsenic. It had been remarked by the 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 sulphu- retted hydrogen ; and this may be taken as a good domestic test of the putre- fied condition of such food. Nature generally applies an appropriate remedy, in the fact that the food itself produces copious vomiting and purging. Cases of this kind must be distinguished 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 is a very common practice to steep grain in a solution of arsenic, previous to sow- ing, and pheasants, partridges, and other birds may be accidentally destroyed by eating the grain. In some instances, grouse and other game are malici- ously destroyed by corn saturated in arsenic being laid in the localities where the birds abound. There is no law to prevent the sale of poisoned game by poulterers, and there is no precaution which can be taken by the purchasers, except by observing whether the birds have or have not been shot. (See on this subject, On Poisons ; also a letter by Dr. Fuller, Med. Gaz., vol. xlii. p. 1036.) [The most frequent cases of poisoning from animal substances in the United States have occurred from the pheasant. {Tetrao umhellus.) This bird, dur- ing the winter season, has sometimes caused dangerous symptoms in persons who have eaten it. These have generally been attributed to the fact of the NOXIOUS ANIMAL FOOD. 149 bird having fed upon the leaves and buds of the laurel (Kalmia), and many facts have been adduced which are considered as corroborating this opinion, the most striliing of which is the occurrence of the leaves of the plant in the crops of the birds. Notwithstanding this almost universal belief, Dr. Grifllth, in the former edition of this work, is not satisfied with this explanation, but is inclined to attribute it to some change in the flesh analogous to that noticed above as taking place in other meats, since the symptoms are almost identical, and these cases are rare, whilst nearly all these birds feed on the laurel, when the ground is covered with snow, and other food cannot be readily ob- tained — H. ] 150 NEUROTIC POISONS — OPIUM. NEUROTIC POISONS. (Narcotic or Cerebral and Spinal Poisons.) CHAPTER XVIII. opium — SYMPTOMS — PERIOD OF COMMENCEMENT — APPEARANCES — QUANTITY REQUIRED TO DESTROY LIFE — DEATH FROM SMALL, AND RECOVERY FROM LARGE DOSES — ITS ACTION ON INFANTS — PERIOD AT WHICH DEATH TAKES PLACE — POISONING BY POPPIES — GODFREY'S CORDIAL — DALBY'S CARMINATIVE — paregoric elixir — dover's powder — black drop — sedative solution — morphia and its salts — tests for morphia and meconic acid — pro- cess for detecting opium in organic mixtures. Opium. Symptoms The symptoms which manifest themselves when a large dose of opium or its tincture has been taken, are in general of a uniform character. They consist in giddiness, drowsiness, a strong tendency to sleep, stupor, succeeded by perfect insensibility, the person lying motionless, with the eyes closed 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 rousje him. The pulse is at first small, quick, and irregular, the respiration hurried, and the skin warm and bathed in per- spiration — sometimes livid : but when the individual becomes comatose, the breathing is slow and stertorous : the pulse slow and full. The skin is occa- sionally cold and pallid. The pupils are, in the early stage, contracted ; in the later stage, and when progressing to a fatal termination, they may be found dilated. In a case referred to me in 1846, one pupil was contracted and the other dilated. They are commonly quite insensible to light. The expression of the countenance is placid, pale, and ghastly : 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 ; and it may then be, perhaps, ascribed to the mechanical effect of the poison on the stomach. The odor of opium is occasionally perceptible in the breath. Nausea and vomiting, with headache, loss of appetite and lassitude, often follow on. recovery. In cases likely to prove fatal, the mus- cles of the limbs feel flabby and relaxed, the lower jaw drops, the pulse is feeble and imperceptible, the sphincters are in a state of relaxation, the tem- peratare of the body is low, there is a loud mucous rattle in breathing, and convulsions are sometimes observed before death : but these are more com- monly met with in children than in adults. One of the marked effects of this poison is to suspend all the secretions except that of the skin. During the lethargic state the skin, although cold, is often copiously bathed in perspira- OPIUM — SYMPTOMS — APPEARANCES AFTER DEATH. 151 tion. It is a question yet to be determined, whether this may not be a medium by which the poison is principally eliminated. These symptoms 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. In a case reported by Dr. Skae, the person was found totally insensible in fifteen minutes. As we might expect, from the facts connected with the absorption of poisons, when the drug is taken in the solid state, the symptoms are commonly more slow in appearing, than when it is dissolved in water or alcohol. It has been frequently observed, in cases of poisoning by this drug, that a person has recovered from the first symptoms, and has then had a relapse, and died. 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. In December, 1843, a gentleman swallowed a quantity of laudanum, and was found laboring under the usual symptoms. The greater part of the poison was removed from the stomach by the pump : and he so far recovered from his insensibility as to be able to enter into conversation with his medical attendant ; but a relapse took place, and he died the following night. The case of the Hon. Mrs. A7ison (Jan. 1859), for the particulars of which I am indebted to Mr. Arthur Durham, furnishes another illustration of this singular condition. This lady swallowed, while fasting, an ounce and a half of laudanum by mistake. In a quarter of an hour emetics were given, but she did not vomit for half an hour; and she was not treated medically for two hours and a half. The matter then drawn from the stomach had.no smell of laudanum. She was quite un- conscious, and had lost the power of swallowing. After remaining in this comatose state for upwards of nine hours, the patient revived, the face became natural, the pulse steady, the power of swallowing returned, she was able to recognize her daughters, and, although in a thick voice, to give an account of the mistake she had made. This state lasted about five minutes — the tor- por then returned, she sank into profound coma, and died fourteen hours after the poison had been taken. It is not improbable that, in these cases, death may be occasioned by the accumulation of the poison, carried by the absorb- ents into the system, i. «., the morphia may be more rapidly carried into the system than it is eliminated from it. A remarkable case illustrative of this remittent form of poisoning by opium has been published by Mr. Kirby. (Dublin Med. Press, Dec. 24, 1845, p. 406.) Appearances. — In a case which proved fatal in fifteen hours, the vessels of the head were found unusually congested throughout. On the surface of the anterior part of the left hemisphere there was an ecchymosis, apparently pro- duced by the effusion 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 men- tioned as a common appearance in cases of poisoning by opium. There is also engorgement of the lungs : most frequently observed, according to Dr. Christison, in those cases which have been preceded by convulsions. ( Op. cit., p. 732.) Among the external appearances there is often great lividity of the skin. Extravasation of blood on the brain is rarely seen ; serous effu- sions in the ventricles, or between the membranes, are sometimes met with. The stomach is so seldom found otherwise than in a healthy state, that the inflammatory redness said to have been occasionally seen, may have been due to accidental causes. When tincture of opium has been taken and retained on the stomach, increased redness ofthe mucous membrane may occasionally be pro- duced by the alcohol alone. In a case of poisoning by a large dose of tincture of opium. Dr. Sharkey found the following appearances twelve hours after death : — the body warm and rigid ; the stomach healthy, containing a quan- 152 OPITJM — QUANTITY EEQUIKED TO DESTROY LIFE. tity of gruel-like fluid, without any smell of opium. The intestinal canal and all the other viscera were healthy. The veins of the scalp, as well as of the dura mater and sinuses, were gorged with blood ; but there was no effusion in any part of the brain. The contents of the stomach yielded no trace of morphia or meconic acid, but there was no doubt that death had been caused by opium, taken the previous night. {Med. Gaz., vol. xxxvii. p. 235.) A case was communicated to me by Dr. Ogston, which was the subject of a trial at the Aberdeen Autumn Circuit, in Sept. 1853, in which a child, aged six months, died in a few hours from a dose of sixty drops of wine of opium. The brain was congested to a marked extent. Although the dose was com- paratively large, and death rapid, there was no decided indication of the pre- sence of opium in the stomach. From this account of the appearances in the dead body, it will be seen that there is nothing but a fulness of the vessels of the brain, which can be looked upon as specially indicative of poisoning by opium, and even this is not always present. This congested condition of the brain, however, if it exist, can furnish no evidence of poisoning when taken alone, since it is so frequently found, as a result of morbid causes, in other- wise healthy subjects. Quantity required to destroy life. — The medicinal dose of opium, in extract or 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 is from ten minims to one drachm — as an average, from thirty to forty minims. The smallest dose of solid opium which has been known to prove fatal to an adult was in a case reported by Dr. Sharkey, of Jersey. A man, aged thirty-two, died very speedily in a convulsive fit, after having taken two pills, each con- taining about one grain and a quarter of extract of opium. This quantity is equivalent io four grains of crude opium. {Med. (?az., vol. xxxvii. p. 236.) It is stated that Henrietta Maria, the Queen of Charles I., was destroyed by a dose of three grains of opium. The smallest fatal dose of the tincture in an adult, which I have found recorded, is two drachms. The case is reported by Dr. Skae. {Ed. Med. and Surg. Journ., July, 1840.) The patient was a robust man, aged fifty-six ; — he swallowed the tincture at ten in the evening, and died under the usual symptoms on the following morning; the case hav- ing lasted only twelve hours. The quantity actually swallowed, however, appears to be involved in some doubt; for it is subsequently stated (p. 160) that half an ounce of laudanum may have been taken. Very large doses of the tincture have frequently been taken without proving fatal. I have else- where recorded a case in which five ounces of laudanum were taken even without producing sleep, and the patient recovered. {Guy's Hasp. Reports, Oct. 1850, p. 220.) There is a difference of opinion respecting the strength of laudanum, or the pharmacopoeial tincture of opium. According to some, one fluidrachm, or sixty minims of the tincture, contains _y?2;e grains of opium, while the Lon- don Pharmacopoeia assigns only about three grains. The strength of the tinc- ture, as it is procured of different druggists, varies greatly. (See Perelra, Mat. Med., vol. ii. Am. ed. p. 1051 ; also Lancet, March 12, 1853, p. 251.) Action of opium on infants. — In connection with this subject, it is import- ant for a medical jurist to bear in mind that infants and young persons are liable- to be killed by very small doses of opium ; they appear to be pecu- liarly susceptible of the effects of this poison. Dr. Ramisch, of Prague, met with an instance of a child,. four months old, that was nearly killed by the administration of one grain of Dover's powder, containing only the tenth part of a grain of opium; — the child suffered from stupor and other alarming symptoms. The following case occurred in June, 1822. Four grains of Dover's powder (containing less than half a grain of opium) were given to a child four years and a half old. It soon became comatose, and died in seven OPIUM — ACTION ON INFANTS. 153 hours. Death was referred to inflammation of the throat, and the jury re- turned the usual unmeaning verdict of "Died by the visitation of God;" but there was no doubt, from the evidence, that death was caused by the opiate medicine. Dr. Kelso met with an instance in which a child, nine months old, was liilled in nine hours by four drops (minims ?) of laudanum, equal to only one-fifth part of a grain of opium ; it was much convulsed before death. A case is referred to in the Medical Gazette, in which two drops (minims ?) of laudanum, equal to the tenth part of a grain of opium, killed an infant. The following is a more recent illustration of the fatal effects of a similar dose. A nurse gave to an infant, five days old, two drops (minims ?) of laudanum, about three o'clock in the morning. Five hours afterwards the child was found by the medical attendant in a state of complete narcotism. It was revived by a cold bath, but a relapse came on, and it died the same evening, about eighteen hours after the poison had been given to it. On inspection, the brain and abdominal viscera were found in a perfectly healthy state, and there was no smell of opium in the stomach. {Prov. Med. Journ. Oct. 28, 1846, p. 519.) The fatal dose here, as in the former case, was equal to the tenth part of a grain of opium, and to only an infinitesimal dose of morphia. Dr. E. Smith has reported a case {Lancet, April 15, 1854), in which an infant, seven days old, died in eighteen hours from the effects of one minim of the tincture, or the twelfth part of a grain of opium. Coma with the usual symptoms was complete in half an hour. On inspection, the heart was found distended with black liquid blood ; the lungs were collapsed but not congested. The brain was cougested, but there was no effusion either into the ventricles or on the surface. The foramen ovale was still quite open. (See also Med. Times and Gazette, April 15, 1854, p. 386.) The smallest fatal dose recorded (in an infant) was in a case communicated to me by Dr. Edwards of Liverpool (November, 1857). An infant, four weeks old, died from the symptoms of poisoning by opium, in seven hours after a dose of paregoric elixir, equivalent to one-nineteenth of a grain of opium, had been administered to it. "With a knowledge of these facts, it is not surpris- ing that infants are occasionally destroyed by opium under circumstances in which an adult would not suffer. In December, 1860, an inquiry took place at Chester respecting the death of a child, aged six weeks, under the follow- ing circumstances. A fomentation composed of laudanum and gin was ap- plied to the side of the mother, and the child was put to the breast shortly afterwards. The child fell into a sleep from which it did not awaken, and died, in spite of treatment, the next morning. The cause of death was left obscure owing to the imperfect manner in which the inquiry was conducted ; but it is not improbable that the child drew a quantity of laudanum into its mouth, sufficient to destroy life. {Med. Times and Gaz., Jan. 19, 1861, p. 70.) In some instances infants have been found to manifest an astonishing power of recovery. Dr. Guy met with a case in which an infant of six months recovered after having had administered to it ten grains of Dover's powder, equal to one grain of opium {Lancet, June 8, 1850); and Mr. Tnbbs has informed me, that in a case which^ occurred in January, 1852, an infant of nine months recovered under treatment from a dose of two teaspoonfuls of laudanum, given by mistake. This quantity left by evaporation four grains of an impure extract of opium. In 1860 a case was communicated to me in which an infant of between two and three months old, recovered after five grains of opium had been given to it by mistake for rhubarb. Dr. Hays met with a case in which a child not quite six years old, swallowed a powder con- taining seven and a half grains of opium mixed with powdered chalk. The child was not seen until fourteen hours afterwards. It was at first excited ; there had been no vomiting. The narcotjsm was at no time very profound — 154 POlSONINa BY POPPIES. it gradually subsided, and at the end of three days the child had recovered I (Am. Journ. of Med. Sd., April, 1859, p. 36Y.) Period at which death takes place. — It has been remarked, that most cases of poisoning by opium prove fatal in from about six to twelve hours. They * who recover from the stupor, and survive longer than this period, generally do well; but from cases above related (see p. 151), it would seem that there may be a partial recovery, or a remission of the symptoms, and afterwards a 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 de- stroyed life in from seven to nine hours. One has occurred within my know- ledge, in which an adult died in five hours after taking the drug prescribed for him by a quack. Dr. Christison met with a case which could not have lasted above five, and another is mentioned by him which lasted only three hours. Dr. Beck quotes a case which proved fatal in two hours and a half. (Beck, Med. Journ., p. 873.) Mr. Procter, of York, communicated to me the case of a female, agt. fifty, who, in January, 1851, swallowed an ounce of laudanum of the pharmacopceial strength, and died from the effects in less than two hoars. Opium was found in the stomach. The only appearance in the body was a congested state of the membranes of the brain. The most rapid case of death yet reported, was that of a soldier who was accidentally poisoned, in September, 1846, in the Hospital of Val-de-6race. It appears that he swallowed by mistake about an ounce of laudanum, and died in con- vulsions in three-quarters of an hour. (Journal de Medecine, Oct. 1846, p. 4T5. For a similar case, see Med. Gaz., vol. xlv. p. Y43.) It is possible that the drug may even kill with greater rapidity than this ; but, as a medico- legal fact, we are at pi'esent entitled to state, that it has destroyed life within the short period above mentioned. On the other hand, the cases are some- times much protracted. There are several instances of death in fifteen or seventeen hours. I have known one case fatal in twenty-two hours, and among those collected by Dr. Christison, the longest lasted twenty-four hours. (Op. cit., 112.) [See paper by Dr. Morland, reported from Boston Society for Med, Improvement, in Am. Journ. of Med. Sci., Oct. 1854. — H.] Poisoning by Poppies. The heads of the white poppy grown in this country have a narcotic action. They yield an inspissated extract called English opium, which, according to Mr. Hennell, contains five per cent, of morphia. The white poppy-heads, therefore, yield to water, in the form of decoction, a poisonous substance capable of acting deleteriously on children. Many cases of poi- soning have occurred from the injudicious use of syrup of poppies, which is nothing more than a sweetened decoction of the poppy-heads. This syrup is said to contain one grain of extract (opium) to one ounce (Thomson). The common dose of it, for an infant three or four months old, is half a drachm ; for adults, two to four drachms (Pereira, vol. ii. pt. 2, p. 643). There is some reason to believe that what is often sold by many druggists as syrup of poppies as a soothing or cordial medicine for children, is nothing more than a mixture of tincture or infusion of opium with simple syrup : it is, therefore, a preparation of variable strength. This may account for what appears to many persons inexplicable, namely, that an infant may be de- stroyed by a very small dose. In January, 1841, a child six months old is said to have died from the effects of less than half a teaspoonful of syrup of poppies bought at a retail druggist's. The narcotic symptoms were fully developed in three-quarters of an Jiour. The syrup in this case probably contained tincture of opium. Several children are reported to have lost DALEY'S CARMINATIVE— PAREGORIC ELIXIR. 155 their lives by this syrup in 1837-8. In one of these instances a teaspoonful and a half was given. Stupor came on in half an hour, and the child died the following day. A teaspoonful has been known to prove fatal to a healthy child. {Pereira, vol. ii. pt. 2, p. 644.) Godfrey's Cordial. This is chiefly a mixture of infusion of sassafras, treacle, and tincture of opium. The quantity of tincture of opium contained in it is stated by the late Dr. Paris to be one drachm in six ounces of the mixture, or half a grain of opium to one ounce; but it is probable that, like the so-called syrup of poppies^ its strength is subject to great variation. A case has been reported, in which half a teaspoonful = l-32d part of a grain of opium — was alleged to have caused the death of an infant. In 1837-8, twelve children were reported to have been killed by this mixture alone. The explanation of this is, that the medicine is given in large doses by very ignorant persons. Daley's Carminative. This is a compound of several essential oils and aromatic tinctures in pep- permint water, with carbonate of magnesia and tincture of opium. Accord- ing to the late Dr. Paris there axe five minims of the tincture, or one-quarter of a grain of opium, in rather more than hoo ounces of this mixture, or the one-eighth of a grain in an ounce. The formula commonly given is — car- bonate of magnesia two scruples, oil of peppermint one minim, of nutmegs two minims, of aniseed three minims, tincture of opium five minims, spirit of pennyroyal and tincture of assafcetida of each fifteen minims, tincture of castor and compound tincture of cardamoms of each thirty minims, and of peppermint water two ounces. According to this formula, tincture of opium forms the l-211th part by measure, or one teaspoonful contains the l-64th part of a grain of opium. Like most of these quack preparations, it varies in strength. An infant is reported to have been destroyed hj forty drops of this nostrum — a quantity, according to the strength assigned, equivalent to more than two minims of the tincture, or from one-sixth to one-tenth of a grain of opium. Accidents frequently occur from its use, partly owing to ignorance, and partly to gross carelessness on the part of mothers and nurses. The quack preparation, known under the name of Locoekh pulmonic wafers, contains opium. A boy, set. four, suffered from all the usual symptoms of poisoning by opium as a result of eating a quantity of these wafers or lozenges. {Lancet, Oct. 27, 1860, p. 420.) Paregoric Elixir. Compound Tincture of Camphor. This is a medicinal preparation of alcohol, opium, benzoic acid, oil of ani- seed and camphor. Opium is the active ingredient, and of this, the tincture contains rather less than one grain in every half ounce (nine grains to five ounces). In one case of poisoning by this tincture, a child aged seven months died from the effects of a teaspoonful (equal to one-quarter of a grain of opium), given in two doses at an interval of a day. {Pharmaceutical Journal, April, 1845.) In another, an infant of five weeks recovered from a similar dose, although no treatment was resorted to for nine hours. {Med. Times and Gaz., Aug. 6, 1859, p. 145.) An infant has been killed by a dose equivalent to not more than the ninetieth part of a grain of opium {ante, ,p. 153). 156 DOVEE'S POWBEK — black DEOP — SEDATIVE SOLUTION. Dover's Powder. (Ptjlv. Ipecac. Comp.) This is a preparation of opium, the effects of which on young children have been already adverted to. The proportion of opium is one tenth part, or one grain in every ten grains of the powder. A child has been killed by four grains ; therefore by a quantity containing about two-fifths of a grain of opium. On the other hand, Mr. Ewens met with a case in which an infant of nine months recovered from a dose of five grains. {Med. Times and Gaz., May 19, 1860.) Dr. Guy has reported another, in which an infant of six months recovered, under active treatment, from a dose of ten grains. {Lancet, June 8, 1850.) And I am indebted for a still more remarkable instance of recovery to Mr. R. Read, of Dublin. Fifteen grains of Dover's powder were given to an infant under five months of age. The mistake was discovered immediately, and by active treatment the child recovered. Black Drop. This is a preparation of opium, in which the morphia is combined with acetic acid, and very little meconic acid is present. In the black drop, ac- cording to Pereira {Mat. Med., vol. ii. pt. ii. p. C50), verjuice, the juice of the wild crab, is employed as a menstruum instead of vinegar. The black drop is considered to have from three to four times the strength of the tinc- ture of opium. The formula for this preparation will be found in Dr. Neli- gan's work. On Medicines, &c., p. 235. According to this, it is a compound of half a pound of opium to three pints of the expressed juice of the wild crab. It resembles the Acetum Opii, and has more than twice the strength of laudanum. Sedative Solution. (Battley's.) This is an aqueous solution of opium holding a little spirit and less meconic acid than the common tincture. {Pereira, vol. ii. pt. ii. p. 646.) It is con- sidered to have three times the strength of tincture of opium ; but there is so great a difference of opinion on this point, that Dr. Neligan represents it as being only of about the same strength as laudanum. {Medicines, &c., p. 236.) He states that it is composed of three ounces of extract of opium, six drachms of spirit, and as much distilled water as will make up two pints. It appears to be an energetic preparation. Mr. Streeter stated at the Westminster Medical Society, Dec. 1838, that he had known one drachm and a half of it prove fatal to a lunatic; and twenty minims of the solution destroyed the life of an old woman. A medical gentleman, lying dangerously ill from an attack of dysentery, took, by mistake, about seven drachms of Battley's solu- tion. Within five minutes salt and water, with mustard, were administered, and twenty-four grains of sulphate of zinc. Yomiting ensued ; the emetic was repeated, and with- the same effect ; the fluid evacuated at the second vomiting having the usual smell of opium. Half a drachm of ipecacuanha was subsequently given to complete the emptying of the stomach. Notwith- standing repeated vomiting, symptoms of narcotism presented themselves speedily, with contraction of the pupils, and great drowsiness — rendering it necessary to remove the patient from bed in his debilitated state, and keep him constantly moving, until about 9 P. M. (seventeen hours), \Phen vomiting came on spontaneously, and he was put to bed and allowed to sleep. The original disease afterwards resumed its course (complicated by an attack of gastritis), and at length terminated favorably; but the patient had no recol- lection whatever of what occurred for twenty-four hours after the administra- tion of the emetics ; and it appeared to his medical attendants that an excited POISONING BY MORPHIA — CHEMICAL ANALYSIS. 157 state of mind remained for some days afterwards. {Prov. Journ., Jan. 28 1846, p. 42.) The death of Dr. Badeley, of Chelmsford, from a dose of this solution taken medicinally, furnishes an additional proof of the dangerous uncertainty in the strength of this preparation. Morphia and its Salts. The two principal salts of morphia are the hydrochlorate and the ace- tate, Symptoms. — They generally commence in from jive to twenty minutes after the dose of poison has been swallowed ; and they closely resemble those ob- served in poisoning by opium. As a summary, it may be stated that they consist in dimness of sight, weakness and relaxation of the muscular system, tendency to sleep, stupor, loss of consciousness, coma, stertorous respiration, and more commonly than in poisoning by opium, there are convulsions. According to Orfila, in nineteen-twentieths of all cases the pupils will be found strongly contracted, a statement which I believe to be correct : the few exceptional cases were those in which the dose was excessive, and the symp- toms were unusually violent. The state of the pupils gave rise to great dif- ference of opinion among the medical witnesses on the trial of Dr. Castaing. {On Poisons, 2d ed. page 619.) The condition of the pulse varies greatly. In some cases there is great irritability, as well as itching of the skin, and irritability of the bladder with difficulty of passing urine. Vomiting and purging have been met with in those instances in which the dose was large. Appearances. — The only appearance which can be referred to the action of morphia is fulness of the cerebral vessels, with occasionally serous effusion. These poisons have no local irritant action, and they therefore leave no marks of their operation in the stomach and bowels. An account of the appear- ances produced by an overdose of sulphate of morphia has been published by Orfila in a report of the case of Dr. EUenherger. {Ann. d'Hyg., 1852, vol. ii. p. 359.) The case presents some curious features. The deceased imagined that he had discovered a certain antidote for morphia and its salts, and proposed, while Orfila was at Prague in October, 1851, to swallow the poison and the antidote in his presence. Orfila consented to witness the experiment. A powder was produced, which was found to have a bitter taste, and to possess some of the chemical properties of morphia, evidently mixed, however, with some other substance. The Doctor swallowed about twenty- three grains of this powder, and immediately afterwards his so-called anti- dote, which was a fine white powder having a sweetish taste. He did not suffer from any feymptoms of poisoning. Orfila, with a keen eye to the prac- tical use of antidotes, inquired whether he had ever allowed a certain interval to pass before taking the remedy. Dr. Ellenberger said that the results were the same. Six months after this experiment. Dr. Ellenberger died from a dose of about ten grains of sulphate of morphia. He had taken his antidote, but not until a considerable interval had elapsed. A minute inspection of the body was made, and the principal appearance was a well-marked conges- tion of the brain and its membranes. There were traces of sulphate of mor- phia in the stomach. The so-called antidote was examined, and found to consist of a mixture of magnesia and carbonate of magnesia. Chemical analysis. Opium, — There are no means of detecting opium itself, either in its solid or liquid state, except by its smell and other physical properties, or by giving a portion of the suspected substance to animals, and observing the effects produced. The smell is said to be peculiar, but a simi- lar smell is possessed by lactucarium, which contains neither meconic acid nor morphia. The odor is a good concomitant test of the presence of the drug, 158 OPIUM — TESTS FOR MORPHIA. whether it be in a free state, or dissolved in alcohol or water, but it is not perceptible when the solution is much diluted. I found that half a grain of powered opium, dissolved in half an ounce of water, lost its characteristic smell by a short exposure. The odor is decidedly volatile, and passes off when an opiate liquid is heated ; it also escapes slowly at common tempera- tures. Again, it may be easily concealed by other odors, or the drug may undergo some change in the stomach during life which may destroy the odor. The analysis in cases of poisoning by opium is therefore limited to the detec- tion of morphia and meconic acid. Morphia. — Morphia is known by the following properties : 1. It crystallizes in fine prisms, which are white and perfect, according to their degree of purity. 2. When heated on platina, the crystals melt, become dark-colored, and burn like a resin with a yellow smoky iame, leaving a carbonaceous residue. If this experiment be performed in a small reduction-tube, it will be found, by employing test-paper, that ammonia is one of the products of decomposi- tion. 3. It is scarcely soluble in cold water, as it requires 1000 parts to dissolve it : it is soluble in one hundred parts of boiling water, and the hot solution has a faint alkaline reaction. By its insolubility in water it is readily known from its salts. It is not very soluble in ether, thus differing from nar- cotina ; but it is dissolved by forty parts of cold, and rather less than this quantity of boiling alcohol. It is soluble in oils and in the caustic alkalies (potash). 4. It is easily dissolved by a very small quantity of all diluted acids, mineral and vegetable. 5. It has a bitter taste. Tests. — In order to apply the chemical tests for morphia, the alkaloid may be dissolved in a few drops of a diluted acid, either the acetic or the hydro- chloric. If the hydrochlorate or the acetate of morphia be presented for analysis, the salt may be at once dissolved in a small quantity of boiling water. The tests for this alkaloid are the following : 1. Nitric acid. This, when added to a moderately strong solution of a salt of morphia, produces slowly a deep orange-red color. If added to the crystals of morphia or its salts, deutoxide of nitrogen is evolved : — the morphia becomes entirely dis- solved, and the solution acquires instantly the deep red color above described — becoming, however, lighter by standing. In order that this effect should follow, the solution of morphia must not be too much diluted, and the acid must be added in pretty large quantity. The color is rendered much lighter by boiling ; therefore the test should never be added to a hot solution. 2. Perchloride of iron (sesquichloride), or colorless persulphate. Either of these solutions, when saturated and neutralized (by a small quantity of potash if necessary), produces an inky-blue color in a solution of morphia. If the quantity of morphia be small, or the test has a deep red or yellow tint, the color is greenish. The blue color is entirely destroyed by acids — is also de- stroyed by heat : thus the iron-test should never be employed with a very acid or a very hot solution of a salt of morphia. It may be observed, that the blue given by the test in a solution of morphia is entirely destroyed by nitric acid and replaced by an orange-red color, so that the nitric acid will act through the iron test, but not vice versa. In this way two tests may be applied to one quantity of liquid. 3. Iodic acid. Morphia in the solid state or in solution decomposes this acid, taking part of its oxygen, and set- ting free iodine. In order to make this evident, the iodic acid should be first mixed with starch ; and a part of this mixture only, added to the suspected solution — part being reserved, to allow of a comparison. (If the iodic acid be added to a solution of morphia without starch, the liquid becomes brown, and smells of iodine.) When the quantity is very small, there is only a red- dish or purple tint slowly produced : — when large, the dark-blue iodide of farina is formed in a few seconds. The color being destroyed by heat, the test must not be added to a hot solution. The test succeeds equally well DETECTION OF OPIUM IN ORGANIC MIXTURES. 159 witb morphia or its salts, when unmixed with organic matter ; but the analyst must remember, that the blue iodide of farina forms a colorless combination with a large quantity of starch : hence but little of this substance should be used, if the quantity of morphia be small. 4. Sulphuric acid and bichromate of potash. When strong sulphuric acid is poured on pure morphia 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 potash, or a small frag- ment of a crystal, it immediately becomes green (from oxide of chromium), and retains this color for some time. Other alkaloids (strychnia) are not thus affected. Narcotina is turned of a bright yellow by sulphuric acid ; therefore, although it becomes green when mixed with bichromate of potash, it could not be mistaken for morphia : besides the green rapidly passes to a dingy brown color. Meconic acid. — This is a solid crystalline acid, seen commonly in scaly crystals of a reddish color. It is combined with morphia in opium, of which, according to Mulder, it forms on an average six per cent. {Brande's Che- mistry, Tol. ii. p. 1403) ; and it serves to render that alkaloid soluble in water and other menstrua. Tests. — Many tests have been proposed for meconic acid ; there is only one upon which any reliance can be placed, namely, the perchloride or persulphate of iron. This test gives, 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 causes a deep red color in tincture and infusion of opium, as well as in all liquids containing traces of meconate of morphia, the effects of the iron test with morphia being counteracted by the presence of meconic acid. The red color of the meconate of iron is not easily destroyed by diluted mineral acids, by a solution of corrosive sublimate, or by chloride of gold; but it is by sulphurous acid and chloride of tin. In liquids con- taining tannic acid — e. g., tea or beer — the action of this test is obscured. Detection of opium in organic mixtures Opium itself may be regarded as an organic solid, containing the poisonous salt which we wish to extract. It is not often 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 morphia in the stomach. It is probably removed by vomiting, digestion, or absorption. If the matter be solid, it should be cut into small slices; if liquid, evaporated to an extract; and, in either case, digested with distilled water and a small quantity of acetic acid for one or two hours at a gentle heat. The aqueous solution should be filtered, some acetic acid added, and then treated with acetate of lead, until there is no further precipitation. The liquid should be boiled and filtered ; meconate of lead is left on the filter, while any morphia passes through under the form of acetate. The surplus acetate of lead contained in the filtered liquid (contain- ing the morphia) should now be precipitated by a current of sulphuretted hydrogen, the sulphuret of lead separated by filtration, and the liquid evapo- rated at a very gentle heat to an extract, so that any sulphuretted hydrogen may be entirely expelled. On treating this extract with alcohol, the acetate of morphia, if present in sufficient quantity, may be dissolved out and tested. The meconate of lead left on the filter may be decomposed by boiling it with a small quantity of diluted sulphuric acid ; and in the filtered liquid, neutral- ized if necessary by an alkali, the meconic acid is easily detected by the iron test. This analysis requires care, as well as some practice in the operator, in order that the morphia should be obtained in a sufficiently pure state for the application of the tests. Before resorting to this process, it is advisable to employ trial tests on the original liquid, in order to determine whether any meconic acid or morphia is present or not. The smell of opium may be en- tirely absent. The best trial tests are nitric acid and the permuriate of iron. These will produce in the infusion or liquid, if it contain opium, the changes 160 POISONING BY PRUSSIO ACID — SYMPTOMS. already indicated. In testing for raeconie acid, it is advisable to dilute the organic liquid, if colored, with a sufficient quantity of water to render the production of a change of color by the test perceptible. In respect to this method of detecting the meconate of morphia in a suspected liquid, it is pro- per to observe, that nitric acid will indicate the presence of morphia, and chloride of iron the presence of meconic acid, in infusions containing so small a quantity of opium as not to be precipitated by the acetate of lead. The chief difBcnlty in the detection of morphia is that the alkaloid does not form more than one-tenth part of opium, and the quantity of opium present in an organic liquid is generally very small. CHAPTEE XIX. PRUSSIC ACID — DIITERENOES IN STRENGTH — TASTE AND ODOR — CONDITIONS UNDER WHICH THE ODOR MAY AND MAY NOT BE DETECTED — SYMPTOMS PRO- DUCED BY SMALL AND LARGE DOSES — PERIOD AT WHICH THE SYMPTOMS COM- MENCE — POWER OF VOLITION AND LOCOMOTION — APPEARANCES — QUANTITY REQUIRED TO DESTROY LIFE — FATAL DOSE — PERIOD AT WHICH DEATH TAKES PLACE — TESTS FOR THE ACID — VAPOR TESTS — PROCESS FOR ORGANIC MIX- TURES. BITTER ALMONDS. NOYAU. CYANIDE OF POTASSIUM. Symptoms. — The acid has a hot, bitter taste, and an odor resembling that of bitter almonds diluted. The time at which the symptoms of poisoning commence in the human subject is liable to great variation from circumstances not well understood. When a large dose has been taken, as from half an ounce to an ounce of the diluted acid, the symptoms usually commence in the act of swallowing, or within a few seconds. It is rare that their appearance is delayed beyond one or two minutes. When the patient has been seen at this period, he has been perfectly 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 respiration at long intervals, and the patient appears dead in the intermediate time; the pulse is imperceptible, and involuntary evacuations are occasionally passed. The respiration is slow, deep, gasping, and sometimes heaving or sobbing. The following case was communicated to me by Mr. French ; it presents a fair example of the 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, but was quite insensible when discovered, i. e., 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 process of respiration appeared to cease entirely for some seconds; it was then performed in convulsive fits, and the act of expiration was remarkably deep, and lasted for a very long time. When the dose is large, the breath commonly exhales a strong odor of the acid, and this is also perceptible in the room. Convulsions of the limbs and trunk, with spasmodic closure of the jaws, are usually met with among the symptoms; the finger-nails have been found of a livid color and the hands firmly clenched. The breathing is generally convulsive, but when the coma or insensibility is profound it is sometimes stertorous. This was noticed in a case which occurred to Dr. Christison {Edinburgh Monthly Journal, Febraary, 1850, p. 91). It was PKUSSIC ACID — APPEARANCES AFTER DEATH. 161 also observed in the case of Marcooley {Reg. v. Boroughs, C. C. C, February, 1857). Stertorous breathing has not been hitherto recorded by toxicologists as one of the symptoms of poisoning by prussic acid. In the inquiry which took place at Rugeley, in January, 1856, respecting the death of Walter Palmer, it was contended that the fact of the deceased having had stertorous breathing was a proof that he had died from apoplexy, and not, as it was alleged, from prussic acid; but the facts here recorded show that such an in- ference is erroneous. When a small dose («'. e., about thirty minims of a weak acid) has been taken, the individual has first experienced weight and pain in the head, with confusion of intellect, giddiness, nausea, a quick pulse, and loss of muscular power; these symptoms are, however, sometimes slow in appearing. Vomit- ing has been occasionally observed, but it is more common to find foaming at the mouth, with suffusion or a bloated appearance of the face, and prominence of the eyes. If death result, this is preceded by tetanic spasms, opisthotonos, and involuntary evacuations. Vomiting is sometimes the precursor of reco- very. (See cases in Medical Gazette, vol. xxxvi. p. 103; vol. xxv. pp. 859, 893.) A case which occurred to Mr. Bishop (Prov. Med. and Surg. Jour., Aug. 13, 1845, p. 511) was remarkable in several particulars: the individual swallowed, it was supposed, forty minims of an acid (at three and a quarter per cent.), and was able to give an account of his symptoms. He was con- scious for some time after he had taken it, and he recollected experiencing the sensation of his jaws becoming gradually stiff and tight. One of the most marked effects of prussic acid is to produce insensibility, and loss of muscu- lar power, much more speedily than any other poison. In some instances, there may be loss of consciousness in a few seconds ; in others, certain acts indicative of volition and locomotion may be performed, although requiring for their performance several minutes. 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 especially 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, or other powerful odors. In a case in which a person poisoned himself with two ounces of the acid, and his body was examined twenty-eight hours after death, the vapor of prussic acid which escaped on opening the stomach, was so powerful that the inspectors were seized with dizziness. In cases of suicide or accident, the vessel out of which the poison has been taken will commonly be found near ; but there is nothing to pre- clude the possibility of a person throwing it from him in the last act of life, or even concealing it, if the symptoms should be delayed. (See/)os<, case by Dr. Christison, page 163.) Owing to the great volatility of the poison, the vessel may, if left uncorked, not retain the odor when found. Putrefaction is said to be accelerated in these cases ; but from what I have been able to collect, there seems to be no ground for this opinion. (See case in Prov. Med. Journ., July 80, 1845.) Externally, the skin is commonly livid, or is tinged of a violet color ; the nails are blue, the fingers clenched, and the toes con- tracted ; the jaws firmly closed, with foam or froth about the mouth, the face often pallid, but sometimes bloated and swollen, and the eyes have been ob- served to be wide open, fixed, glassy, very prominent and glistening, and the pupils dilated : but this condition of the eyes has been observed in other kinds of death. Internally, the venous system is gorged with dark-colored liquid blood : the stomach and alimentary canal may be in their natural state; but in several instances they have been found more or less congested. The mucous membrane of the stomach of a dog which died in a few minutes from a dose of three drachms of Scheele's acid, was intensely reddened through- out, presenting the appearance met with in cases of arsenical poisoning. In U 162 PRUSSIC ACID — FATAL DOSE. a large number of experiments upon dogs, Mr. Nunneley states that he found generally a congested condition of the mucous membrane of the stomach : if empty at the time the poison was taken, the organ was found much contracted, and of a brick-red color. This appearance of congestion was observed on the mucous membrane of the vagina, the rectum, and conjunctiva, when the acid was applied to these parts. {Prov. Trans. N. S., vol. iii. p. 79.) Red- ness of the stomach was noticed in the case of the Parisian epileptics {An- nates d'Hygiine, 1829, vol. i. p. 507). Dr. Geoghegan, of Dublin, has communicated to me the particulars of a case in which this redness of the mucous membrane was well marked. In April, 1847, a healthy man, sst. thirty, swallowed a large dose of prussic acid. He was soon afterwards found dead in his bed. The body was inspected five hours afterwards : rigidity had commenced, but there was some warmth. The face was pale, the eyes were half closed, not presenting any remarkable brilliancy or prominence, and there was great dilatation of the pupils. The mouth was closed, and no froth issued from it. The abdomen was the only cavity examined. The muscles were red, and gave out, on section, a good deal of fluid blood, which had a strong odor of prussic acid ; the odor of the poison was also percep- tible in the abdomen. About eight ounces of a thick farinaceous mass were found in the stomach : the odor of prussic acid was very perceptible in this organ, but it was mixed with that of rancid food. The mucous membrane had everywhere, except at the greater end and posterior wall, a vivid inflam- matory redness, of a well-marked character, and it was covered with a layer of viscid mucus to a considerable extent. The mucous membrane, even when washed three times in water, gave out a strong odor of prussic acid. In a case which I examined in May, 1850, in which death had been caused by a large dose of the acid, there was a generally congested state of the mucous membrane of the stomach. I am indebted to Mr. Blaker, of Lewes, for an account of the appearances found in the body of a medical student who de- stroyed himself in March, 1860, by swallowing about one drachm of Scheele's acid. He was found in a state of collapse, and breathing heavily in about half a minute from the time at which he was last seen. He died in twenty minutes. The coats of the stomach were, greatly congested towards the cardiac end. The minute vessels throughout were filled with dark blood, and there were some spots of effused blood beneath 'the mucous coat. The in- testines were highly congested, the small vessels being visible all over the coats. There was no congestion of the membranes of the brain. Quantity required to destroy life. — The smallest dose of this acid which is reported to have caused death, was in a case which occurred to Mr. Hicks. {Med. Gaz., vol. xxxv. p. 896.) The female, a healthy adult, died in twenty minutes from a dose equivalent to nine-tenths of a grain of anhydrous prussic acid. This was equivalent to forty-nine grains of the London Pharma- copceial acid ; and taking Scheele's acid at five per cent., to about twenty grains of this acid. In a case reported by Mr. T. Taylor {Med. Gaz., v.ol. xxxvi. 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. The vomited matters had no odor of the poison, showing that if not concealed by other odors the whole of the acid must have been here absorbed. He had a very narrow escape of his life. Dr. Banks has published a case in which a female recovered after swallowing thirty drops of prussic acid {Ed. Med. and Surg. Journ., vol. xlviii. p. 44.) The largest dose from which an adult has recovered, was probably in a case which has been reported by Mr. Burman {Lancet, Jan. 14, 1854). His father, set. sixty, of a strong constitution, took by mistake a drachm of prus- sic acid, equivalent to 2.4 grains of anhydrous acid. In a few seconds he perceived the mistake, and swallowed half an ounce of aromatic spirits of PEUSSIC ACID — FATAL DOSE. 163 ammonia with a little water. Four minutes after taking the poison cold affu- sion was employed, and sulphate of iron and spirits of ammonia administered. Vomiting with convulsive shuddering took place. In twenty minutes con- sciousness returned, and fifteen minutes later he was able to walk up stairs to bed. He perfectly recovered, but in the absence of the treatment resorted to, it is most probable that he would have died. Dr. Christison has reported in the Edinburgh Monthly Journal (Feb. 1850, p. 91) the case of an adult who recovered after having taken a dose of a grain and a half or two grains of anhydrous acid. The treatment consisted in the evacuation of the stomach by the stomach-pump, and in pouring a current of cold water on the head. The symptoms were such that the man would have died, but for immediate treatment. It is a remarkable fact that in this case no bottle or vessel could be found in the room or under the window. The patient hastily summoned his wife one evening, told her that he had taken prussic acid, and immediately fell down senseless on a sofa, without either cry or convulsion, but drawing his breath deeply, forcibly, and slowly. He recovered in about three hours, but had an unusual disposition to sleep even on the following day. Another remarkable case of recovery from a dose nearly as large occurred to Mr. Bishop. (Prov. Med. Journ., Aug. 13, 1845, p. 511.) From the facts hitherto observed, we shall not be wrong in assuming that a quantity of Scheele's acid (at five per cent.) above twenty grains (i. e., one grain of anhy- drous acid), or an equivalent portion of any other acid, would commonly suffice to destroy the life of an adult. This I believe to be the nearest ap- proach that we can make to the smallest fatal dose. In Reg. v. Bull, tried at Lewes Aut. Assizes, 1860, a question arose respecting the minimum fatal dose of this poison. The accused, a young medical man, was charged with the manslaughter of his mother, a woman set. sixty-six. He had prescribed prussic acid for her to relieve sickness. He procured a bottle of Scheele's acid, said to contain one drachm. He administered four minims to deceased in the morning, and it appeared to benefit her. In the evening he gave to her another dose amounting, according to his statement, to "seven drops." The deceased went up stairs, became insensible, and died in a few minutes. When the bottle was examined twenty-five minims remained in it : hence thirty-five minims were alleged to be missing, but the druggist who sold the acid poured out the quantity conjeeturally, and the bottle was found to have a broken cork. The strength of the acid had not been determined. Under these circumstances the prisoner was acquitted. In this case the court de- sired to know the relation of drops to minims ; but no satisfactory answer could be given. A drop of water is considered to be equSl to a grain in weight or a minim by measure ; but the size of a drop materially depends on the nature of the liquid and the rapidity of the measurement. Seven drops of Scheele's acid dropped from a small phial measured seven minims. There can be no doubt in the above case that the poison caused death, and unless we assume that seven drops or minims will destroy life, which is not probable, the deceased must have taken a much larger dose than the prisoner had in- tended. Period at which death takes place. — When the dose is two drachms and upwards, we may probably take the average period for death at from two to ten minutes. In Mr. Hicks's case, forty-nine grains of the PharmacopoBial acid destroyed life in twenty minutes. It is only when the dose is just in a fatal proportion, that we find the individual 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 recovers altogether. According to Dr. Lonsdale, death has occurred in the human subject as early as the second, and as late as the forty-ffth minute. But although death does not commonly ensue until after the lapse of a few minutes, insensibility, and con- 164 CHEMICAL ANALYSIS — THE IRON-TEST. seqaently a want of power to perform acts of volition and locomotion, may come on sometimes in a few seconds. The time at which this loss of muscular power is supposed to take place, has frequently become an important medico- legal question ; and on the answer to it the hypothesis of suicide or murder in a particular case may rest; Chemical analysis Prussic acid is limpid like water ; it possesses a faint acid reaction, and its vapor has a peculiar odor, which, when the acid is con- centrated, although not at first perceptible, is sufficient to produce giddiness, insensibility, and other alarming symptoms. The tests which are best adapted for the detection of this poison, either in liquid or vapor, are equally appli- cable whether the acid is concentrated or diluted, and, so far as the detection of the vapor is concerned, whether the acid is pure or mixed with organic matter. In the simple state, the tests are three in number : the Silver, the Iron, and the Sulphur. 1. The Silver Test. Nitrate of Silver. — This 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 strong acid is added, it is easily dissolved on boiling, h. It evolves prussic acid when digested in muriatic acid. c. The precipitate, when well dried and heated in a small reduction-tube, yields cyanogen gas, which may be burnt as it issues, producing a rose-red flame and blue halo. This is a well-marked character, and at once identifies the acid which yielded the precipitate as prussic acid. By this property, the cyanide is eminently distinguished from all the other salts of silver. In the employment of the silver-test for the detection of the vapor of the poison, we place a few drops of the silver solu- tion in a watch-glass, and invert it over another watch-glass containing the suspected poisonous liquid. Cyanide of silver, indicated by the formation of an opaque white film in the solution, is immediately produced, if the acid be only in a moderate state of concentration. One drop of the pharmacopoeial acid (containing less than the l-50th of a grain) produces speedily a visible effect. When the prussic acid. is much 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. 2. The Iron Test. — The object of the application of this test is the pro- duction of Prussian Hue. We add to a small quantity of the suspected poi- sonous liquid^a few drops of potash and of a solution of green sulphate of iron. A dirty green or brownish precipitate falls ; on shaking this for a few minutes, and then adding diluted hydrochloric or sulphuric acid, the liquid becomes blue ; and Prussian blue, of its well-known color, unaffected by diluted acids, subsides. If the prussic acid is in small quantity, the liquid is at first yellow, from the salt of iron formed ; it then becomes green, but the precipitate ultimately subsides so as to appear of a blue color in the mass. The same result is obtained by adding the solution of the iron-salt to the potash-solution of the cyanide of silver ; and thus, in this way, the two tests may be applied to only one portion of the poison. The iron-test may be employed for the detection of the vapor of prussic acid, by the same method as that described in speaking of the silver-test. For this purpose we place a few drops of caustic potash in a small white saucer, and invert it over the suspected liquid. After a few minutes a drop of solution of green sulphate of iron may be added, and then a drop of diluted hydrochloric acid — when Prussian blue will appear. The recently precipitated mixed oxides of iron with potash, may be placed in the upper vessel with the same results. The silver and the iron-tests may be easily conjoined in testing the same quantity PRTJSSIC ACID — DETECTION IN OKGANIO LIQUIDS. 165 of poison. If the precipitated cyanide of silver, obtained by the addition of nitrate of silver to the suspected liquid, be moistened with strong hydro- chloric acid, and the vapor collected in a watch-glass or saucer, on the plan just described, Prussian blue will be procured, and thus strongly corroborate the action of the silver-test. 3. The Sulphur Test. — Liebig has proposed the following process for de- tecting prussic acid as a liquid. ( Oesterreichische Med. Wochenschrift, 27 Marz, 1847, p. 396.) If a small quantity of hydrosulphate of ammonia (containing a little excess of sulphur) be added to a few drops of a solution of prussic acid, and the mixture be gently warmed, it becomes colorless, and, on evaporation, leaves sulphocyanate of ammonia — the sulphocyanic acid being indicated by the intense blood-red color produced on adding to the dry residue a solution of a persalt of iron ; this color immediately disappears on adding a few drops of a solution of corrosive sublimate. The intensity of the color is also destroyed by moderate dilution with water. This process is very delicate, and it therefore requires some care in its application ; thus, if the boiling and evaporation be not carried far enough, the persalt of iron will be precipitated black by the undecoraposed hydrosulphate of ammonia ; and, if the heat be carried too far, the sulphocyanate of ammonia may itself undergo decomposition, and be lost. It will be perceived, too, that it re- quires a longer time for its application than either the silver or the iron-test. If the prussic acid contains traces of Prussian blue or a salt of iron, it will acquire a dark color on the addition of hydrosulphate of ammonia. The great utility of the sulphur test, however, is in its application to the detection of the minutest portion of prussic acid when in the state of vapor. In this respect it surpasses any other process yet discovered. In order to apply it, we place the diluted prussic acid in a watch-glass, and invert over it another watch-glass, holding in its centre one drop of the hydrosulphate of ammonia. No change apparently takes place in the hydrosulphate ; but if the watch-glass be removed after the lapse of from half a minute to ten min- utes, according to the quantity and strength of prussic acid present, sulpho- cyanate of ammonia will be obtained on gently heating the drop of hydro- sulphate and evaporating it 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 the persulphate of iron to the dried residue brings out the blood-red color instantly, which is intense in proportion to the quantity of sulphocyanate present. Such is the simple method of employing the test. When the prnssic acid is much diluted, the warmth of the hand may serve to expedite the evolution of the vapor. I have elsewhere made some remarks on the ap- plication of this process for the detection of prussic acid. (See Med. Gaz., vol. xxxix. p. 765.) Prussic Acid in Organic Liquids. Detection hy vapor without distillation. — The organic liquid may be placed in a wide-mouthed bottle, to which a watch- glass has been previously fitted as a cover. The capacity 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 in the way already described. If the l-200th of a grain of prussic acid be present, and not too largely diluted, it will be de- tected (at a temperature of 60°) by the drop of nitrate of silver being con- verted into an opaque white film of cyanide of silver, the chemical change commencing at the margin. We may then substitute for the nitrate of silver the hydrosulphate of ammonia, and proceed in the manner above described. It may be sometimes necessary to place the bottle in a basin of warm water. If the solution of silver is tarnished by sulphuretted hydrogen — the sulphur- test alone can be used. By this process I have detected prnssic acid in the stomach of a person poisoned by it, as late as twelve days after death. After 166 PRTJSSIC ACID — IN THE TISSUES — NOYAU. the stomach had been exposed for a few days longer, all traces of the poison had disappeared. Detection hy distillation. — This process was originally suggested by Las- saigne. The organic liquid should be distilled in a water-bath, at 212° and about one-sixth or one-eighth of the contents of the retort collected in a re^ ceiver kept cool by water. The tests may now be applied to the distilled liquid. If the trial-tests indicate that the quantity of poison is small, a solu- tion of nitrate of silver or caustic potash may be placed in the receiver, to fix the acid as it is distilled over ; Prussian blue may then be procured in the manner described, or the vapor may be at once absorbed by hydrosnlphate of ammonia in the receiver, and the liquor evaporated to obtain sulphocya- nate. Prussic acid has been found in the stomach by distillation, so late as seven days after death, although the odor could not be perceived before dis- tillation. In the case of Montgomery (Report of trial of Thompson, Glasgow Circuit Court, 1851, by Hugh Cawan, pp. 9 and 53), the deceased died in about fifty minutes after having taken two drachms of prussic acid (three and a quarter grains of anhydrous acid). The death took place on the 13th September; the body was buried on the 17th, and exhumed on the 30th, The parts removed were then put into stoppered bottles, and on the 5th of October the Drs. McKinlay detected prussic acid doubtfully by the odor, but distinctly by the three tests, in the stomach, before distillation, as well as in the liquid distilled from the stomach and its contents. They did not succeed in detecting its presence in the tissues. About five weeks subsequently to this analysis, the viscera, which had been kept closely secured in glass bottles, were examined by Dr. Maclagan. The heart, kidneys, and intestines gave no indication of the presence of the poison, but it was detected by the sul- phur-test, in the form of vapor, in one-half of the spleen, although there was no odor of the poison. When the viscera containing the poison have under- gone putrefaction no trace of the acid may be found either by its vapor or by distillation. In this case it may have been converted into sulphocyanate of ammonia by the hydrosnlphate produced during putrefaction. The sulpho- cyanide may be dissolved out of the dried viscera or liquids by alcohol, and the solution tested by a persalt of iron. Much is lost by reason of the great volatility of the acid. I have found the vapor to traverse wet and dry bladder in a few minutes. Hence all viscera suspected to contain prussic acid should be preserved in well-stoppered bottles. 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 to be far more convenient and satisfactory than the process by distillation. In the case of a dog poisoned by a large dose of prussic acid, Mr. Hicks brought to me the stomach after it had been exposed twenty-four hours, and thoroughly washed under a current of water, and yet the poison was readily detected by placing the whole organ in a bottle, and absorbing the vapor by nitrate of silver. This shows how completely the animal tissues at death are penetrated by prussic acid, and how firmly for a time it is retained by them. The poison has been thus discovered, in experiments on animals, in the blood and in the serous exhalation of the chest. NoTAU. Cherry Ratafia. These liquors, which have the smell of bitter almonds, are considered to be poisonous when taken in large doses. The quantity of prussic acid present in them is liable to vary; it may be separated by distillation at a gentle heat, and then tested. I have found that an ounce and a half of good noyau hav- ing a strong odor and flavor, when distilled to two-thirds, yielded scarcely a POISONING BY LAUREL WATEK — CYANIDE OF POTASSITM. 167 trace of prussic acid either by the silver or iron test. It had been kept some time in a well-closed bottle. An equal quantity of cherry ratifia, similarly treated, gave no ponderable quantity of Prussian blue. The prussic acid in many of these liquors is derived from cherry, peach, and apricot kernels. A case is reported in the Journal de Ghimie Medicale, 1853, page 38, in which a child, two years of age, suffered severely in consequence of having eaten ten or twelve apricot kernels. [See Am. Journ. of Med. Sci., Jan. 1853, for a fatal result from a similar indulgence. — See also Trans, of Phil. Coll. of Physicians for an account of the successful treatment, by Dr. Keating, of a child three years old, who had been dangerously poisoned by eating a num- ber of peach-kernels. (Vol. iii. No. 3.) — H.] Laurel Water. Cherry-Laurel Water. This is a very weak solution of prussic acid, containing only about one- fourth of a grain per cent, of the strong acid, but it is stated to be more poi- sonous than this quantity of acid would indicate. {Pereira, ii. 1783.) In some specimens which I procured by distilling the bruised tops and fine shoots of the laurel with water, the odor was powerful ; but the proportion of prus- sic acid present was considerably less than this. The water is a limpid color- less liquid, possessing a strong odor of bitter almonds, and producing, in large doses, the usual effects of poisoning by prussic acid. Cherry-laurel OIL. — By distillation, the leaves of the plant yield also an essential oil, re- sembling that of the bitter almond, but much weaker, as it contains on an average less than three per cent, of prussic acid. According to Christison, almost every part of the plant is poisonous, but especially the leaves, flowers, and kernels ; the pulp of the cherry is not poisonous. Articles of food are often flavored with the leaves, and accidents are said to have arisen from this practice. Cyanide oe Potassium. Symptoms and effects. — This is a poisonous salt, now much used in the art of electro-gilding and plating. It is a solid, sometimes seen crystallized, at others in the form of a white chalky-looking powder. It is without odor until put into water, when it is freely dissolved, forming an alkaline solution, from which prussic acid is abundantly evolved, either by exposure to air, or by the addition of an acid. It acquires a strong smell in a damp atmosphere, and becomes dark-colored. The cyanide of potassium is used on the con- tinent as a medicine, and a few years since it occasioned the death of a per- son at St. Malo, under the following circumstances: A physician prescribed for the deceased rather more than one drachm of the cyanide in two ounces and a half of orange-flower water and syrup ; and of this mixture three spoon- fuls were to be taken daily. It seems that tablespoonfuls were taken, and the patient died in three-quarters of an hour after the first dose. None of the poison was found in the stomach ; but a portion of the mixture, from which the dose had been taken, was examined and found to contain cyanide of potassium. A criminal procedure was instituted against the physician, and he was fined and imprisoned. M. Malaguti, who gave evidence on the occasion, stated that a dog was killed in a few minutes after taking less than three grains of the cyanide in solution ; and that the largest medicinal dose of this substance to a human being was five-sixths of a grain. {Lancet, Jan. 1743.) The mixture in the above case contained about three grains of the cyanide in one drachm ; therefore, had teaspoonfuls been taken by the de- ceased, he would have taken quite sufficient to destroy life. The medicine had evidently been prescribed by a person totally ignorant of its poisonous 16S POISONING BY CYANIDE OF POTASSIUM. properties. Another case occurred at Breslau, in which a man, aged thirty, died in a quarter of an hour under all the symptoms of poisoning by prussio acid, after taking a dose of a mixture containing fifteen grains of cyanide of potassium, which had been prescribed for hira by his medical attendant. (Henke, Zeitschrift der S. A., 1843, 7. See also Ann. d'Hyff., 1843, i. 404.) [This salt is freely prescribed in minute doses by American practitioners, but we are not aware of any case of poisoning. therefrom. It is much used, also, externally, to remove stains of nitrate of silver from the skin, and as a deodorizer to the fingers, after post-mortem operations. This is a dangerous practice, however, in careless hands, and we are glad to see that a French chemist and photographer has been induced by his personal experience, espe- cially in a case where the skin had been cut, to give a public warning against it._H.] Cases of poisoning by this agent have been rather frequent of late years. The cyanide of potassium is much used as a solvent for silver, and is largely employed by coiners for covering base metal. In most of the cases, the poi- son has proved so rapidly fatal, that the persons have died before they were seen by a medical practitioner. The symptoms have not, therefore, been ob- served ; but, so far as we can form a judgment, they are identical with those produced by prussic acid. (See Med. Times, Oct. 12, 1850, p. 390; also, Nov. 9, 1850, p. 482; and July 12, 1851, p. 41.) [Med.-Chir. Rev., Jan. 1855, from Gasper''s'Vierteljahrsch. July.] It has been supposed that the cyanide of potassium might exist in the state of vapor, and destroy life by its accidental introduction into the lungs. When this salt is exposed to a damp atmosphere, or is acted upon by acids, hydro- cyanic acid freely escapes, and the respiration of this vapor may produce in- jurious, or even fatal eft'ects. It does not appear probable, however, that the cyanide should itself ever be respired in the state of vapor. In December, 1853, an inquest was held at Elsecar by Mr. Badger, under the following remarkable circumstances : Three members of a family named Sadler, and a lodger, went to bed in their usual health at about ten o'clock, sleeping in different bedrooms. At seven the following morning they were all found dead. The house in which this accident occurred abutted one of the blast furnaces of the Elsecar Ironworks ; and it was obvious that some noxious vapors from the furnace must have escaped into the rooms through a crack in the house wall. It was considered by a gentleman who examined the premises, that the noxious agent in this instance was the cyanide of potas- sium in vapor ; but as this salt is not volatile under a white heat, it is diffi- cult to conceive how it could exist and spread itself in the form of a respirable vapor through the air of the apartments in which the deceased were sleeping. The more probable explanation, as it appears to me, is, that carbonic oxide or nitrogen from deoxidized air was the agent of destruction in this instance, supposing that no carbonic acid was formed by the combustion of the car- bonic oxide. It is inconceivable that a substance which remains fixed at a heat of 1000° and upwards, should be diffused in the form of vapor through air at common temperatures ; and nothing short of its detection in and upon the bodies of the deceased, could warrant the admission that the respiration of this substance in vapor was really the cause of death. NUX VOMICA — STRYCHNIA — SYMPTOMS. 169 CHAPTER XX. NUX VOMICA AND STRYCHNIA — SYMPTOMS — APPEARANCES AFTER DEATH — FATAL DOSE — EFFECTS OF MEDICINAL DOSES OP STRYCHNIA — PERIOD AT WHICH DEATH TAKES PLACE — CHEMICAL ANALYSIS. Nux Vomica. Strychnia. Symptoms. — Nux Vomica, in powder, is a poison which is frequently taken by suicides. Its intensely bitter taste in a quantity far from dangerous to life, renders it difficult to administer it unknowingly. With respect to Strychnia, it has acquired, within the last few years, great notoriety as a poison. It has an intensely bitter taste when dissolved, but when adminis- tered in the form of pills, this of course would not be perceived. At a variable interval, after taking either nux vomica or strychnia, the patient experiences a sense of impending suffocation. There are twitchings and jerk- ings of the head and limbs — with a shuddering or trembling of the whole frame. Tetanic convulsions then commence suddenly with great violence, and nearly all the muscles of the body are simultaneously affected. The limbs are stretched out, the hands clenched — the head, after some convulsive jerkings, is bent backwards, the whole body is as stiff as a board — and assumes, by increase of the convulsions, a bow-like form (opisthotonos), being arched in the back and resting on the head and heels. The head is firmly bent backwards, and the soles of the feet are incarvated or arched and everted, the legs sometimes separated. The abdomen is hard and tense — the chest spasmodically fixed — so that respiration appears to be arrested — the face assumes a dusky 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 in requiring to be turned over, moved or held. With respect to the muscles of the lower jaw — these, which are the first to be affected in tetanus from disease, are generally the last to be affected by the poison. The jaw is not primarily attacked, and is not always fixed during the paroxysm. The patient can frequently speak and swallow, and great thirst has been observed among the symptoms. In some cases of poisoning by nux vomica the jaw has been fixed by muscular spasm ; but, unlike the lock-jaw of disease, this has come on suddenly in full intensity, with tetanic spasms in other parts, and there have been intermissions which are not witnessed in the tetanus of disease. The sudden and universal convulsion affecting the voluntary muscles has sometimes been so violent that the patient has been jerked off the bed. After an interval of half a minute to one or two minutes, the convulsions sub- side, there is an intermission — the patient feels exhausted and is sometimes bathed with perspiration. It has been noticed in some of these cases that the pupils during the paroxysm were dilated, while in the intermission they were contracted. The pulse during the spasms is so quick that it can scarcely be counted. Slight causes, such as the attempt to move, a sudden disturbance, or 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 exhausted. The tetanic symptoms produced by strychnia, when once clearly no STRYCHNIA — FATAL DOSE. established, progress rapidly to death or recovery. 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 the severity of the paroxysms and the strength of his constitution. The time at which the symptoms commence appears from the recorded cases to be subject to great variation. In poisoning by Nux Vomica the symp- toms are generally, more slow in appearing than in poisoning by strychnia. 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 M. 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'ffyg., 1861, vol. ii. p. 431 ) On an average in poisoning by strychnia the symptoms appear in from five to twenty minutes. In two cases at least an hour has elapsed. {Lancet, August 31, 1850. On Poisoning by Strychnia, 1856, p. 139.) In a case which occurred to Drs. Lawrie and Cowan in June, 1853, an hour and a half elapsed. The longest interval recorded was in a case which occurred to Dr. Anderson in 1848, in which two hours and a Aa?f elapsed before the appearance of symptoms. (Poisoning by Strychnia, p. 42.) In spite of these facts, an attempt was made in the medical defence of Palmer to mislead the jury by the assertion that an interval of an hour and a quarter in the case of Oook rendered it impossible that the symptoms could have been caused by strychnia I (Reg. v. Palmer, C.C.C., May, 1856.) Appearances after death. — The body is commonly observed to be relaxed at the time of death, but speedily stiffens and retains an unusual rigidity for a long period. In the case of Gooh, who was poisoned by William Palmer, the rigidity of the limbs, including the hands and feet, was still well marked on exhumation, after two months' interment. In most cases the hands are clenched — and the feet arched, or turned inwards. Among the Internal ap- pearances are — congestion of the membranes and substance of the brain — as also of the upper part of the spinal marrow — congestion of the lungs — the heart is contracted and empty; but its right cavities in other instances are distended with liquid blood. The blood has been found black and liquid throughout the body. The mucous membrane of the stomach has occasion- ally presented patches of congestion, probably depending on extraneous causes ; since in other instances the stomach and intestines have been found quite healthy. Of the appearances produced in poisoning by strychnia, there are none which can be considered strictly characteristic. Congestion of the membranes of the brain and spinal marrow is probably the most common. In a case which occurred to Mr. Startin, a man who had taken strychnia medicinally, died in less than three hours from a dose of a grain and a half. On inspection, there were extensive patches of extravasated blood beneath the arachnoid membrane of the lower half of the spinal cord. (Med. Times and Gazette, March 21, 1857, p. 291.) With regard to the state of the heart and lungs, their condition as to fulness or emptiness must depend rather on the mode of dying, than on the actual cause producing death. Quantity required to destroy life. — The sixteenth part of a grain of strych- nia killed a child between two and three years of age in four hours. In two cases of adults, in each of which a quarter of a grain had been taken by mistake, the patients only recovered under early treatment. (Lancet, July 26, 1856, pp. 107, in.) The smallest fatal dose in an adult was in the case of Dr. Warner. Half a grain of the sulphate of strychnia here destroyed life. (On Poisoning by Strychnia, pp. 138, 139.) So powerful are the effects of this drug in certain cases, that ordinary medicinal doses can scarcely be borne. PERIOD AT WHICH DEATH TAKES PLACE, 171 A gentleman took one-twentieth of a grain of strychnia in six doses over a period of two or three days. Severe fits of tetanus occurred although half a grain had not been taken altogether. It is probable in such cases that elimination is either arrested or it is imperfectly performed. In May, 1859, Dr. Tweedie informed me of a case in which he had prescribed for a gentle- man pills containing 1-1 5th grain of strychnia. He took altogether five of them, or one-third of a grain at proper intervals. The patient was seized with the most alarming tetanic convulsions continuing for some time. There was also opisthotonos of a severe kind. He only slowly recovered. Butler's Vermin powder, which is a mixture of strychnia with flour and Prussian blue or some other coloring material, has been and is a fertile source of poisoning either through accident or design. The quantity of strychnia is probably not uniform : but the sixpenny packet has been found to contain three grains: — the half packet contains from one to one grain and a half. In 1859 a man recovered after taking a whole packet (nearly three grains of strychnia. (£d. Monthly Journal, 1859, vol. ii. p. 507.) In 1860 a case occurred to Dr. Part, in which a female recovered after having taken a half packet of this powder. Recovery in these cases was chiefly due to the vomit- ing excited by emetics. A case iu which a drachm-packet of this powder destroyed the life of a girl, set. seventeen, in about one hour, under the usual symptoms, is reported by Mr. Saville. (Med. Times and Gaz., November, 1857.) There are at least three instances recorded in which persons have recovered after taking one grain, and in one instance a person is said to have recovered from a dose of seven grains of strychnia {Medical Gazette, vol. xli. p. 305). These, however, must be regarded as exceptional cases. A fatal dose of strychnia for an adult may be assigned at from half a grain to two grains. With respect to nux vomica, three grains of the alcoholic extract have destroyed life. The smallest fatal dose of the powder was in a case reported by Hoffmann, and quoted by Christison (p. 901), also by Trail {Outlines, p. 137). Thirty grains of the powder, given in two doses of fifteen grains each, proved fatal. The poison was given by mistake for bark to a patient labor- ing under quartan fever. This is about equivalent to the weight of one full- sized seed. The dose required to destroy life became of some importance in Reg. V. Wren (Winchester Spring Assizes, 1851). The prisoner was con- victed of an attempt to administer this poison in milk ; the quantity separated from the milk amounted to forty-seven grains. The intense bitterness which the nux vomica gave to the milk led to detection, and this would, in general, be a bar to the criminal administration of this poison, except in the form of pills. Period at which death takes place. — In fatal cases death generally takes place within two hours after the taking of the strychnia. One of the most rapidly fatal cases recorded is that of Dr. Warner. The symptoms com? menced in five minutes, and he was dead in twenty minutes. In the case of Cook, the symptoms commenced in an hour and a quarter, and he died in twenty minutes. One of the longest cases for duration was communicated to me by Mr. Wilkins. The deceased, an adult, died in six hours from a dose of three grains of strychnia. {Guy's Hasp. Reports, Oct. 1857, p. 483.) In poisoning by nux vomica, death usually occurs within two hours ; but Dr. Christison mentions a case in which a man died m fifteen minutes after taking a dose (p. 898). This is probably the shortest period known. There are several instances of recovery on record, even after large doses. Mr. Iliff has reported a case in which a female recovered after taking two drachms of this poison. {Lancet, Dec. 15, 1849.) [Strychnia is largely consumed by the hunters and farmers in the United States as a poison for dogs, wolves, and other carnivorous animals; and cases of intentional and accidental poisoning with it aro mnrp p nmmnn in this fnnntrv than fnrmprl y. A Committee of the 172 STRYCHNIA — CHEMICAL ANALYSIS. Am. Pharmaceutical Assoc, estimated, in 1853, that between five and si.t thousand ounces are annually manufactured in this country from about one hundred and twenty thousand of nux vomica, besides what is imported. — Proc. of the Am. Pharmaceut. Assoc, 1853, p. 11. — H.] Chemical analysis. — Nux vomica is well known as a flat round kernel, about the size of a shilling, with radiating silken fibres, slightly raised in the centre. It is of a light brown color, and covered with a fine silky down. It is very hard, brittle, tough, and difficult to pulverize. The powder is of a gray brown color, like that of liquorice : it is sometimes met with in a coarsely rasped state : it has an intensely bitter taste. It yields to water and alcohol — strychnia, brucia, igasuric or strychnic acid, and some common vegetable principles. Heated on platina foil, it burns with a smoky flame. Nitric acid turns it of a dark orange-red color, which is destroyed by chloride of tin. In one case of poisoning by this substance {Reg. v. Wren) I found a quantity of guaiacura powder mixed with the nux vomica. This so com- pletely changed the action of nitric acid as in the first instance to create some difficulty in identifying the substance. The analyst must be prepared for these admixtures or adulterations. The aqueous infusion or decoction is reddened by nitric acid, and is freely precipitated by tincture of galls. Persulphate of iron gives with it an olive- green tint. These properties are sufficient to distinguish it from various medicinal powders which it resembles. The fine silky fibres which cover the surface of the kernel may be identified by the microscope. The powder, owing to its indigestible nature, and the rapidity with which it causes death, will generally be found in the stomach and bowels. If a sufficient portion should remain in the body, it may be collected, and strychnia extracted from it. The quantity of the alkaloid contained in it is, however, very small. It amounts to from a half to one per cent. Strychnia. — This alkaloid crystallizes from its alcoholic solution in length- ened octahedra and in prisms of a peculiar form, some of which cross each other at angle of 60°. 1. It is white, of an intensely bitter taste, even when it forms only 1-30, 000th part of a solution. 2. When heated on pla- tina, it melts and burns like a resin, with a black smoky flame. 3. It is not perceptibly dissolved by cold water: it requires 7000 parts for its solution. 4. It is easily dissolved by acids, and is precipitated from the concentrated solutions by potash, in which it is insoluble. 5. Strong nitric acid imparts to it a reddish color, owing to the presence of brucia. 6. Sulphuric acid produces no apparent change : but when to the mixture a small crystal of bichromate of potash, of ferricyanide of potassium, or a small quantity of black oxide of manganese or of peroxide of lead is added, a series of beautiful purple and violet colors appear, which pass rapidly to a light red tint. In organic mixtures, the process of Stas is generally preferred for the separation of this poison. The principle of its operation consists in dissolv- ing the strychnia by rectified spirit mixed with a vegetable acid (the tartaric, oxalic, or acetic). The acid solution of strychnia is concentrated in a water- bath at a low temperature. The concentrated liquid is neutralized by potash or ammonia, and a slight excess of alkali is added. The alkalized liquid is then shaken in a long stoppered tube with its volume of a mixture consisting • of equal parts of chloroform and ether. This liquid dissolves the strychnia set free by the alkali. It may be separated from the watery liquid by a pipette, and the acid submitted to spontaneous evaporation, when, if strych- nia is present, crystals of the alkaloid will be obtained. These may be examined by the tests above described. For further details respecting this process, I must refer the reader to my work On Poisons, 1859, Am. ed., p. 690. [See Chaps. XLII. and XLIII. of the same work for a full discussion of the whole subject, including the consideration of the eases of Palmer, Dove, and others. — H.] DEFINITION OF A WOUND. lYS WOUNDS. CHAPTER XXI. VARIOUS SURGICAL DEFINITIONS OF A WOUND — INJURY TO THE SKIN — LEGAI, DEFINITION — AN ABRASION OP THE CUTICLE NOT A WOUND — ARE INJURIES OP THE MUCOUS MEMBRANE AND DISLOCATIONS WOUNDS ? — WOUNDS DANGER- OUS TO LIFE — THE DANGER IMMINENT — RULES REGARDING DYING DECLARA- TIONS — WOUNDS PRODUCING GRIEVOUS BODILY HARM. When a person is the subject of a wound or external injury, from the effects of which he ultimately recovers, a medical witness is often rigorously examined with respect to the precise nature of the injury, and how far it involved a risk of life. The answers to these questions may have an im- portant influence on the defence of a prisoner, when the crime is charged under particular forms of indictment. Definition of a wound. — It may, I think, be safely asserted, that we shall look in vain for any consistent definition of a wound, in works on medicine and surgery. A wound is, perhaps, most commonly defined to be, a "recent solution of continuity in the soft parts, suddenly occasioned by external causes." Yet they who adopt this view, do not regard as wounds, ruptures qf the liver or spleen, burns by heated bodies, or simple dislocations and fractures; although these injuries are comprehended in such a definition. The following definitions of a wound were furnished to me by three eminent surgeons : — " A solution of continuity from violence of any natural continuous parts." " An external breach of continuity directly occasioned by violence." " An injury to an organic texture by mechanical or other violence." Owing to the unsettled meaning of the word wound, it has happened on more than one occasion that medical witnesses have differed in their evi- dence ; and some difficulty has arisen in the prosecution of criminal charges. It has been asserted that, in order to constitute a wound, the skin should always be broken or injured ; and this, as we shall see presently, is the inter- pretation commonly put upon the term by our judges. But those who adopt tliis definition do not regard hums, produced either by heated metals or cor- rosive liquids, as wounds ; although there seems to be no good reason why they should be excluded. Technical difficulties of this kind, which only lead to the embarrassment of witnesses and to the acquittal of prisoners charged with serious offences, might be avoided if the medical witnesses of England were allowed to adopt the comprehensive definition sanctioned by the legal tribunals of certain States on the continent, namely, that "a wound includes every description of personal injury, arising from whatever cause, applied externally." It may appear contrary to propriety to designate a contusion or fracture as a wound ; but the common definitions will be found, on exa- mination, to be equally inconsistent, and to be attended, in legal medicine, by evil results, inasmuch as they lead to acquittals, not upon the merits of 174 WOUNDS — LEGAL DEFINITION. the case, but upon the most trivial pretences. This could not happen if the above comprehensive definition was generally adopted. It appears to me, that in a case of this kind we should rather regard the wants of justice than the rules of surgery. If medico-legal cases fail from diflFerences respecting the meaning of scientific terms among surgical writers, it is time that some fixed rule should be adopted. "While the science of surgery cannot possibly suffer by such an innovation, the administration of the law^ will be rendered much more efficient. The statute, 14 and 15 Yict. c. 100, has, however, sup- plied a remedy for some of the evils which have hitherto arisen from a mis- description of personal injuries in indictments. Legal definition. — It cannot be denied that an alteration in the use of medical terms must, in order to be attended with any good effects, receive the support of our legal authorities. This, probably, would not be long vfithheld, if good reasons for the change were afforded by medical witnesses. The present rule appears to be, that no injury constitutes a wound in law, unless the continuity of the shin he broken; so that in a case in which blows were inflicted with a hammer or iron instrument sufficient to break the collar- bone, and violently bruise but not break the skin, it was held not to be a wounding within the statute. {R. v. Wood, Matthew's Digest, p. 415.) The Act 1 Vict. c. 85, has in some measure provided for the punishment of per- sons guilty of inflicting such severe injuries, but still it has left the legal sig- nification of the word wound, unsettled. The 14 and 15 Yict. c. 100, is still more precise, but this also avoids the definition of a wound. In order to remove any difficulty in future cases, and to put an end to con- flicting decisions, the Commissioners for codifying the Criminal law have suggested that internal breaches of continuity should be included under the term wound. They have defined a wound to be "that whereby the shin is divided either externally or internally." The late Mr. Justice Talfourd ob- jected to this definition, because, in his opinion, the division of the skin in- ternally without a division externally was impossible. The use of the word " skin" leads to ambiguity; and, in this instance, it shows that those who frame laws are not sufficiently careful in the selection of professional termp. The skin consists of the cuticle and cutis. It has been held on more than one occasion that an abrasion of the cuticle, or outer skin only, is not a wound. A man was tried at the Central Criminal Court in August, 1838, on a charge of cutting and wounding the prosecutor. The prisoner struck the prosecu- tor a severe blow on the temple with a heavy stone bottle, which was thereby broken in pieces. The prosecutor fell senseless, and it was a long time be- fore he recovered from the effects of the violence. The medical witnesses in this case underwent a rigorous cross-examination by the prisoner's counsel, respecting the meaning of the word "wound." They said that there had been a separation of the cuticle or outer skin of the temple, although there was no absolute wound in the usual acceptation of the word. They further deposed that the prosecutor bad lost the sight of his left eye, and the hearing of his left ear ; and he was for a considerable time in a state of great danger, from which he had scarcely recovered. The prisoner's counsel contended that the injuries were not such as to constitute cutting and wounding in law. The judges said, in order that a wound, in contemplation of law, should have been inflicted, it was necessary that the whole shin, and not the mere cuticle, should have been separated and divided ; and as the evidence did not show distinctly that there was such a wound, those counts of the indictment could not be sustained. The prisoner was found guilty of an assault. A division of the cutis or true skin has always been regarded as a wound, whether blood is effused or not. The boundary of the cutis towards the inside of the body is not easily determined -, siace there is a gradual transition of the cutis into the subjacent fibrous tissue, in which the fat and sudatory glands are con- ■WOUNDS OF THE MUCOUS MEMBRANE. 175 tained. According to Qaaln and Sharpey {Elements of Anatomy, vol. i. p. 285), the cutis measures in thickness from a quarter of a line to a line and a half (a line being about one-twelfth of an inch). It is thicker in some parts than in others. Taking the true skin, or cutis, at the thickness usually as- signed, it is impossible to conceive that such a very thin layer of membrane as this can be divided externally without an external division being produced. Allowing the maximam thickness of the eighth of an inch, it would be diffi- cult for any medical man to affirm that a fractional part of this membrane had been divided internally, when there was no evidence of external separa- tion ; and it would be certainly impossible for him to prove it. What the Commissioners probably mean, is a division of the structures beneath the skin. Their definition is, however, vague and unsatisfactory, because it does not reach an important class of cases in which wounds are inflicted, not in the skin, but in the mucous membrane lining the outlets of the body. Thus cuts, punctures, or lacerations of the lining membrane of the nostrils, mouth, and throat, rectum and vagina, are undoubtedly wounds, although the skin may not be directly touched by the weapon. Injuries of a serious description have thus been frequently inflicted on females by cutting and pointed instru- ments ; they have been hitherto properly treated as wounds, but they would not be comprised under this term by a strict adherence to the proposed defi- nition. The subjoined case shows that an injury to the mucous membrane is regarded as a wound in law. The prisoner was charged with maliciously wounding a mare. He had thrust forcibly down the throat of the animal a stone, which had torn the throat and gullet. It was objected that the iujury was not a wounding within the statute, the parts injured being internal, and there being no proof of an external blow or violence. The judge who tried the case was of opinion that it fell within the statute. Blood had flowed from the broken skin, or membrane lining the throat, and the stone was forced into the flesh ; and it had been held that the injury need not be " ex- ternal" to bring the case within the statute. The prisoner was convicted. iBeg. v. Bolton, Norwich Summer Assizes, 1849.) Other cases, in which the vagina in females has been thus wounded are given under the section of Wounds of the Genital Organs. Do all breaches of continuity involving the skin or raucous membrane fall under the head of wounds ? Burns appear to constitute an exception ; but there is no reason why a burn producing a destruction of the skin, as by a red-hot poker, should not be regarded and treated in law as a wound. No definition of a wound, medically or legally, can be contrived so as to exclude such an injury. The question, however, mainly to be considered is this : May not a breach of continuity be regarded as a wound, although neither the skin nor the mucous membrane is directly implicated in the injury ? Is a simple dislocation or fracture a wound ? Is a rupture of the bladder, liver, or other organ, suddenly caused by external violence without implicating the skin, to be regarded as a wound? In a case before the Queen's Bench, in November, 1847, it was held that a dislocation was a wound. An action was brought against a medical practitioner for negligence in the treatment of a dislocation of the arm, and a verdict was returned for the plaintiff. An application was made to the court for a new trial, on the ground of a mis- direction of the Chief Baron, who tried the case. The declaration alleged that the plaintiff had employed the defendant, who was a surgeon, for the treatment and cure of certain wounds, fractures, bruises, complaints, and dis- orders; but the evidence showed that the defendant had been employed to cure the plaintiff of a dislocated arm. At the close of the plaintiff's case, it was submitted that there was no word in the declaration which was applicable to the case ; but this objection wa;s overruled. A dislocation, it was argued, was neither a wound, bruise, nor fracture; and the words "complaint and 176 DISLOCATIONS — INTERNAL INJURIES. disorder" were not at all applicable to a snrgical ease, but to internal com- plaints which require to be treated medically. Lord Denman, in delivering the judgment of the court, said : " It is rather strange that the pleader should have omitted the most appropriate word ; but we think the Chief Baron was quite right. — Rule refused." With respect to fractures, it was held in Eex V. Wood (4 C. and P. p. 381), that a fracture of the collar-bone was not a wounding within the statute, because the skin was not broken. There are, however, at least two recent cases in which contrary decisions have been given. The first of these is Reg. v. Smith (8 C. and P. 173). In this case prisoner struck prosecutor with an iron hammer on the side of the face. A surgeon from the London Hospital deposed that the lower jaw was broken in two places ; that the skin was broken internally but not externally. There was not a great deal of blood effused. On the objection being taken that this was not a wound within the statute, Denman, C. J., observed, "If it is the immediate effect of the injury, we think we cannot distinguish this from the cases already decided ;" and Parke, J. (in summing up), said, "We were of opinion that there was a wound, and upon consideration, I am more strongly of that opinion than I was at the outset. There must be a wound- ing ; but if there be a wound (whether there be an effusion of blood or not), it is within the statute whether the wound is internal or external." The same point arose in another case. {Reg,, v. Warman, 1 Denison, C. C. 183.) This was an indictment for inflicting a mortal wound ; and a question arose whether it was supported by proof of a blow which caused an internal breach of the skin (although externally there were only the appearances of a bruise.) The death of the deceased had been caused by a single blow on the head by a piece of wood ; and the medical witness described the injury as follows : "I found on examining the head no external breach of the skin. I found a collection of blood in the back part of the head : the deceased died from effusion of blood, which pressed on the brain. On examining the scalp, I found a collection of blood between the scalp and cranium, just above the spot where, within the cranium, I had found the pressure on the brain. I call that a contused wound with effusion of blood ; that is the same thing as a bruise. The internal part of the skin was broken. Medically, we call the breaking of the skin, whether broken externally or internally, a wound." This case was reserved for the judges, and considered by Denman, Tindal, Pollock, Alderson, Williams, Creswell, Parke, Coltman, Wightman, Patte- son, Erie, and Piatt. All thought that this internal wound was a sufficient wound to support the allegation in the indictment. In each of these cases the court appears to have been misled by the medical witnesses affirming that the skin (cutis) was broken internally but not externally. There is no doubt that they intended by this, not the cutis merely, but the areolar fatty tissue and soft parts beneath. Their evidence has, however, served to mislead the commissioners, and to induce them to propose a faulty and erroneous definition. I know no instance in which a rupture of the bladder or liver, without any external injury, has been called a wound, although this term might be applied with as much propriety to this kind of injury as to a simple fracture or dislocation. The brain is sometimes lacerated by a blow on the skull which does not break the skin. This must be regarded as a wound of the brain ; it admits of no other de- scription. Two of the definitions given ante, p. 173, include all injuries of this kind ; but it appears to me that the best definition which we can at present give to the word "wound," is that it implies "a breach of continuity in any of the structures of the body suddenly occasioned by violence." I have good authority for stating that these refinements and technicalities are not met with in the law of Scotland. The amount of injury inflicted, and the intention of the assailant, are alone regarded. RULES REGARDING BYING DECLARATIONS. l^T Wounds dangerous to life. — A medical witness is often asked whether a wound is or is not dangerous to life. In -reference to persons charged with an attempt to murder or maim, a written medical opinion, or a deposition, may be demanded of a surgeon by a magistrate, in order to justify the deten- tion of prisoners. The law has not defined the meaning of the words, " dangerous to life," or stated to what kind of wound the term dangerous should be applied. This is a point which is left entirely to the professional knowledge of a witness. It is not sufficient on these occasions that a witness should make a naked declaration of the wound being dangerous to life ; he must, if called upon, state to the court satisfactory reasons for this opinion ; and those reasons are rigorously inquired into by the counsel for the defence. As a general principle it would not be proper to consider those wounds dan- gerous to life, in which the danger is not imminent. A wound of a great bloodvessel, of any of the viscera, or a compound fracture with depression of the bones of the head, must in all instances be regarded as bodily injuries dangerous to life ; because in such cases the danger is imminent. Unless timely assistance be rendered, these injuries will most probably prove fatal, and, indeed, they often destroy life in spite of the best surgical treatment. When, however, the dauger is remote, as in a puncture or laceration of the hand or foot, which may be followed by tetanus, or in a laceration of the Bcalp, which may be followed by erysipelas, or in penetrating wounds of the orbit, which may be attended by fatal inflammation of the brain or its mem- branes, the case is somewhat different. Snch injuries as these are not directly dangerous to life — they are only liable to be attended with danger in certain cases ; and therefore the medical opinion must be qualified. The law, on these occasions, appears to contemplate the direct and not the future or possible occurrence of danger ; if the last view were adopted, it is clear that the most trivial lacerations and punctures might be pronounced dangerous to life ; since tetanus or erysipelas proving fatal, has been an occasional con- sequence of very slight injuries. A difference of opinion will often exist among medical witnesses as to whether a particular wound is or is not dan- gerous to life. Unanimity can only be expected when the judgment and experience of the witnesses are equal. The rules for forming an opinion in these cases will, perhaps, be best deduced from the results of the observa- tions of good surgical authorities in relation to injuries of different parts of the body. This will form a subject for consideration hereafter. [In case of application for release on bail, the medical attendant may be called upon to testify as to the amount of danger to life involved in the injury inflicted; and must be governed, in his deposition, by the principles here laid down. The opinion should be qualified in every case of injury not directly dangerous to life but only incidentally liable to fatal termination. Unless this distinction be clearly expressed, great injustice may be done in withholding a privilege which the law expressly grants in cases of trifling wounds. — H.j -Dying declarations. — The wound may be of such a nature as to cause death speedily, so that a practitioner may arrive only in time to see the wounded person die. In this case, the dying person may make a statement or declara- tion as to the circumstances under which the wound was inflicted : he may also mention the names of the parties by whom he was assaulted. This dying declaration or statement, according to the circumstances under which it is made, may become of material importance in the prosecution of a party charged with homicide. It is therefore proper that a practitioner should notice the exact condition of the dying person : whether at the time he makes the statement, he is under the conviction that he must die, either expressed in language or implied by his conduct. According to some authorities, it is not necessary that a man should declare that he believes himself to be dying, in order to render his statement admissible; but he must, at the time of 118 RULES REGARDING DYING DECLARATIONS. making it, be under the full conviction of approaching death. The question respecting the admissibility of a dying declaration was argued in vthe Court of Exchequer, January, 1845, in Reg. v. Howell, when Alderson, B. said it was not necessary that the deceased should be in articulo mortis, or even that he should think so. It is enough if he thinks he shall die of the sickness under which he labors. {Law Times, January 25, 1845, p. 317.) When it is made clear to the court that all hope of life was lost, the statement will be received as evidence against an accused person ; for the law supposes, that in the act of dying, all interest in this world is taken away ; and that the near contemplation of death has the same powerful effect upon the mind as the solemn obligation of an oath. It is presumed that there can be no dis- position on the part of a dying person to wilfully misrepresent facts, or to state what is false. Much, therefore, often depends on the conduct of a medical practitioner under such circumstances ; for the usual method of test- ing the truth of a statement by cross-examination is, of course, out of the question : it must, if admitted at all, be received as it was made. It was formerly believed, that if the person at the time of making the statement had still some hope of recovery, it would not be legally admissible. This questiou was raised in Mr. Setori's case {Reg. v. Pym, Hants Lent Ass., 1846). The deceased had been told by his medical attendant, Dr. Stewart, that there was "not the least hope of recovery." He then made a statement, and two or three hours after, he asked the surgeon whether he thought he was better; but his (the witness's) conviction was that he then believed that his immediate death was approaching. Counsel for the prisoner objected that this declaration was not admissible. It plainly appeared, from the question put by the deceased, that he had not given up all hope of recovery, but that he still thought he might recover. ( Cftn'sft'e's case, 2 Russ. on Crimes, T54; Bonner's cuse, ib. 759; and 6 Car. and P. 386; Fagent's case, 7 Car. and P. 238.) "Erie, J. : I think the evidence is admissible.' The principle is that a person who speaks with the conviction that his death is fast approaching, speaks under such a sense of responsibilty, that the law presumes that he will tell the truth. Here Mr. Seton had a firm belief that his death was fast approaching. Upon the answer of the surgeon, he burst into tears, and thanked the medical men for their exertions. It has, no doubt, been held in some cases that all hope must be given up, but this is now de- cided not to be necessary. Indeed, if it were so, no declarations could be received, for scarcely a human being could be found, in any circumstances, who would not retain some hope. The law admits these declarations, not because recovery is impossible, but because there is the conviction of approach- ing death. Mr. Seton was shown to be in this state ; the evidence is admis- sible. The statement was then received." {Law Times, March 21, 1846, p. 500.) It is not, therefore, necessary, that to render a declaration valid, the person making it must entertain "no hope of recovery." At the Special Commission in Ireland (Jan. 1848, Reg. v. Butler), a declaration was ad- mitted where the words were, that the deceased entertained "little or no hope" of recovery. In Reg. v. Bayley (Exchequer Chamber, Jan. 1857), in which it appeared that the surgeon had given some hope to the dying person before the declaration was made, while the declarant stated that he did not himself believe that he could recover ultimately, its reception was objected to on the part of the prisoners because the surgeon had given the man some hope. He died two days afterwards. Pollock, C. B. ruled that the real belief of the man was the question, and here he had said, notwithstanding the opinion of the surgeon, he believed he could not recover. In the case of Reg. V. Harvey (Exeter Summer Assizes, 1854), the chief evidence against the prisoner consisted of certain statements made by the deceased. They were admitted by Wightman, J. because it appeared clearly from the evidence WOTJNDS CAUSING GKIEVOXJS BODILY HARM. 119 that when they were made, deceased had expressed an opinion that she should die shortly, and had not changed that opinion. Her whole conduct intimated that she had no hope. It was observed on this occasion that the medical and other witnesses were more desirous of telling the deceased her state, than of ascertaining what her own opinion was. It is no part of the duty of a medical witness to form a judgment on this important subject. He should give the statement as it was made, and leave the court to decide upon its admissibility from the circumstances carefully observed by him with respect to the condition of the patient. He should not render himself officious, in extracting information. He should receive what is voluntarily uttered, and, either immediately or on the earliest possible opportunity, write down the statement in the identicalviorAs,, carefully avoid- ing his own interpretation or any paraphrase of them. On no account should leading questions be put: — and any question should be simply confined to the purpose of explaining what may appear ambiguous or contradictory in the declaration. It is well known that when death takes place from violence, especially when this proceeds from loss of blood or a wound of the head, delirium is apt to supervene, or the intellect of the dying person becomes confused. Under these circumstances, great caution should be used in re- ceiving a declaration, since it may lead to the implication of innocent parties. It is also proper to remark, that the identity of a person is, under these cir- cumstances, liable to be mistaken; and that it is in general an injudicious proceeding to take a suspected party before one who is dying, in order that he may be identified. A fatal mistake of this kind was made many years since in London. A woman was maltreated by some men on Kennington Common: — she was taken to St. Thomas's Hospital: and while dying from the effects of the violence, a suspected party was brought before her, as one of the supposed assailants: she stated that he was, one of those who had assaulted her. The man was tried, upon her declaration, respecting his identity — found guilty and executed; but a year after the execution, his in- nocence was satisfactorily established by the discovery of the real murderers! In Reg. v. Quaker (Stafford Lent Assizes, 1854), the escape of a criminal was attributed to the neglect of the medical attendant in reference to a dying declaration. The deceased was grossly ill-treated, as it was alleged, by the prisoner and others. He lingered from the 19th June until the 8th of Au- gust, 1853, when he died from the injuries received. On his death-bed he made certain statements implicating the prisoner, and upon these the case for the prosecution chiefly rested. Qualter was tried for the murder. The deceased told his wife that he knew he should not recover, but as the decla- ration against Qualter was made previously, it was of course inadmissible. A similar declaration affecting the prisoner was subsequently made by the deceased to the medical attendant ; and it seems that this witness had told the wife that her husband would not recover, but not in the presence of the deceased : hence the declaration made to him was inadmissible, and the pri- soner was acquitted. There was a want of proof, in fact, that either declara- tion had been made by the dying man while he was under the conviction of approaching death. It is probable that had the surgeon announced to the deceased that he could not recover, or had he made the announcement to the wife in his presence and hearing, the declaration would have been admissible. It is certainly advisable, in all cases when a medical man perceives that the recovery of a wounded person is impossible, that he should take the first oppor- tunity of stating his opinion to the individual, so that the ends of justice may not be defeated by reason of the non-observance of these legal forms. (See also the case of JReg. v. Harvey, Exeter Summer Assizes, 1854.) Wounds causing grievous bodily harm. — If the witness admits that the wound is not dangerous to life, then he may be required to state whether it 180 WOUNDS CAUSING GEIEVOUS BODILY HAKM. was such as to have produced "grievous lodily harm." This question is sometimes put, although the usual practice is to leave it as an inference to be drawn by the jury from a professional description of the injury. These words have a vague signification ; but it would perhaps be difficult to substi- tute for them others less open to objection. They evidently refer to a minor description of offence, and are applied commonly to those injuries which, while they are not actually dangerous to life, may be attended with consider- able personal inconvenience, or be in some way detrimental to the health of the wounded party. It is always a question for a jury, whether the intent of the prisoner, in inflicting a wound, was or was not to produce grievous bodily harm. Sometimes the nature or the situation of the wound, as well as the kind of weapon used, will at once explain the intent : so far the medical witness may assist the court, by giving a plain description of the injury, as well as of the consequences with which it is usually attended. It may hap- pen that the wound itself is not of a serious nature, and yet the intention of the prisoner may have been to do grievous bodily harm to the wounded per- son ; or, as in the following case, the injury may be really serious, and yet the prisoner may not have intended to do grievous bodily.harm. A man was indicted for feloniously wounding a girl, with intent to do grievous bodily harm. He kicked her in the lower part of her abdomen — the surgeon de- scribed the injury as of the most serious character, and said that at one time he considered the life of the prosecutrix in danger. She was -still suffering, and would probably feel the effects of the Injury for the rest of her life. The judge, in summing up the case, told the jury that the material question for them to consider was the intent of the prisoner. It was not because serious injury was the result of a prisoner's act, that they were therefore to infer his intention was to do that injury ; and they were to judge from all the circum- stances, whether, at the time he kicked the prosecutrix, he intended to do her grievous bodily harm, as was imputed to him by the indictment, or whether he was merely guilty of a common assault. He was found guilty of a common assault. {Beg. v. Haynes, Central Criminal Court, September 184T.) In cases of this description, the intent with which a wound was in- flicted must be made out by evidence of a non-medical kind. (See also the case of Reg. v. Maslin, Devizes Summer Assizes, 1838.) These are the principal medico-legal questions connected with wounds when the wounded person is seen while living. We will suppose, however, that the wounded person is found dead, and an examination of the body is required to be made. The most difficult part of the duty of a medical jurist now commences. Among the numerous questions which here present them- selves, the first which demands examination is, whether the wound was in- flicted on the body before or after death. EXAMINATION OF WOUNDS. 181 CHAPTER XXII. EXAMINATION OF WOUNDS IN THE DEAD BODY — ALL THE CAVITIES SHOULD BE INSPECTED — ACQUITTALS FROM THE NEGLECT OP THIS RULE — CHARACTERS OP A WOUND INFLICTED DURING LIFE — OF A WOUND MADE AFTER DEATH — EXPERIMENTS ON AMPUTATED LIMBS — CAUTION IN MEDICAL OPINIONS — WOUNDS OR INJURIES UNATTENDED WITH HEMORRHAGE — ECCHYMOSIS FROM VIOLENCE — EVIDENCE FROM ECCHYMOSIS — ECCHYMOSIS PROM NATURAL CAUSES — IN THE DEAD BODY — LIVIDITY — VIBICES — EFFECT OF PUTREFACTION — ^IS ECCHYMOSIS A NECESSARY RESULT OF VIOLENCE ? Examination of wounds. — In examining a wound on a dead body, it is proper to observe its situation, extent, length, breadth, depth, and direc- tion : — whether there is about it effused blood, either liquid or coagulated, and whether there is ecchymosis in the skin. It should also be ascertained whether the surrounding parts are swollen — whether adhesive matter or pus is effused — whether the edges of the wound are gangrenous, or any foreign substances are present in it. Care must be taken that putrefaction is not mistaken for a gangrenous condition of the wound. The wound may be examined by gently introducing into it a bougie, and carrying on the dissec- tion around this- instrument, avoiding as much as possible any interference with the external appearances. The preservation of the external form will allow of a comparison being made at any future time between the edges of a wound and a weapon found on a suspected person. Of all these points notes should be taken, either on the spot or immediately afterwards. In the dis- section, every muscle, vessel, nerve, or organ involved in the injury should be traced and described. This will enable a witness to answer many col- lateral questions that may unexpectedly arise during the inquiry. Another point should be especially attended to. A medical practitioner has fre- quently contented himself by confining his dissection to the injured part, thinking that on the trial of an accused party the questions of counsel would be limited to the situation and extent of the wound only: but this is a serious mistake. If the cause of death be at all obscure, on no account should the inspection be abandoned, until all the important organs and cavities of the body have been closely examined ; since it may be affirmed that a natural cause of death might have existed in that organ or cavity which the medical witness had neglected to examine. {Reg. v. Solloway, Abingdon Ant. Ass. 1860.) It rests with the practitioner to disprove the probability thus urged by counsel, but he is now destitute of facts to reason from : legal ingenuity will triumph, the witness will be discomfited, and the prisoner, of whose guilt there may be, morally speaking, but little doubt, will have the benefit of his inattention, and be acquitted by the jury. In making an inspection of the body, the state of the stomach should not be overlooked. Death may have been apparently caused by violence, and yet really be due to poison. Wildberg was called upon to examine the body of a girl, who died while her father was chastising her for stealing, appa- rently from the effects of the violence. On the arms, shoulders, and back, many marks of violent treatment were found ; and under some of them blood was -effused in large quantity. The injuries, although severe, did not, how- 182 CHARACTERS OF A WOUND MADE AFTER DEATH. ever, appear sufiSeient to account for sudden death. He therefore preceded to examine the cavities, and on opening the stomach, he found it very much inflamed, and lined with a white powder, which was proved to be arsenic. It turned out that on the theft being detected, the girl had taken arsenic for fear of her father's anger: she vomited during the flogging, and died in slight convulsions. Upon this, Wildberg imputed death to the arsenic, and the man was discharged. Dr. Geoghegan communicated to me a case which occurred in Ireland in 1853, in which a gentleman having taken eleven grains of strychnia, threw himself out of a window, and sustained great bodily injury. The surgeon finding so much more spasm than could be accounted for by the violence sustained, discovered the real state of the case from the patient's confession. There was also evidence of the purchase of the poison. The cause of death may be easily assigned in such cases when the circum- stances are known ; but it is evident tiiat without proper inquiry and great care in conducting examinations after death, the apparent may be sometimes mistaken for the real cause. (For some interesting cases and good practical suggestions on this subject, see Belloc, Cours de Med. L^g., 148.) Even when there may be no suspicion of poisoning, it will be necessary to observe the state of the stomach and its contents — i. e., to determine whether it con- tains food, the nature of the food, and the degree to which it may have undergone digestion. In the case of Reg. v. Spicer (Berks Lent Assizes, 1846), the falsehood of one part of the prisoner's defence was made evident by an examination of the stomach. The deceased was found dead at the foot of a stair. The prisoner stated that after he and his wife had had their din- ner, he heard a fall. The woman had died instantaneously, and the fall was heard by neighbors at or near the dinner-hour. Mr. Hooper, the medical witness, found the stomach quite empty ; there was no trace of food. It was therefore clear that this part of the prisoner's story was untrue, as, had the deceased died immediately after dinner, some portion of undigested food would have been found. Characters of a wound inflicted daring life. — If we find about the wound marks of gangrene, the effusion of adhesive or purulent matter, or if the edges are swollen and enlarged, and cicatrization has commenced, it is not only certain that the injury must have been inflicted before death, bnt that the person must have lived some time after it was inflicted. Marks of this description will not, however, be commonly found when death has taken place within ten or twelve hours from the infliction of the injury. A wound which proves fatal within this period of time will present throughout much the same characters. Thus, supposing it to have been incised, there will be traces of more or less hemorrhage, having chiefly an arterial character, and the blood will be coagulated where it has fallen on surrounding bodies ; the edges of the wound are everted, and the muscular and cellular tissue around is deeply reddened by effused blood. Coagula are found adhering to the wound, provided it has been interfered with. The principal characters of a wound inflicted during life, are, then, the following: 1. Eversion of the edges, owing to vital elasticity of the skin. 2. Abundant hemorrhage, often of an arterial character, with general infiltration of blood in the surround- ing parts. 3. The presence of coagula. The wound may not have involved any vessel, and there may be no appearance of bleeding— still the edges will be everted, and the muscles and skin retracted. By an observation of this kind made on the body of a new-born child (Case of Elphich, March, 1848), Mr. Prince was enabled to state that the child was living when it was inflicted — an opinion afterwards confirmed by the confession of the mother. Characters of a wound made after death.— l^ the wound on a dead body be not made until twelve or fourteen hours have elapsed from the time of death, it cannot be easily mistaken for one produced during life. Either no WOUNDS IN THE RECENTLY DEAD BODY. 183 blood is effused, or it is of a venous character — i. e., it may have proceeded from some divided vein. The blood is commonly liquid, and does not coa- gulate as it falls on surrounding bodies, like that poured out of a wound in the living. The edges are soft, yielding, and destitute of elasticity ; they are therefore in close approximation. The cellular and muscular tissues around are either not infiltrated with blood, or only to a very partial extent. There are no coagula within the wound. In experimenting upon ampu- tated limbs, I have found these characters possessed by a wound produced two or three hours after death, although they are best seen when the wound is not made until after the body has lost all its animal heat. In wounds on the dead body, divided arteries have no marks of blood about them ; in the living body the fatal hemorrhage commonly proceeds from these vessels ; hence in a wound on the living, it will be found that the surrounding vessels are empty. The chief characters of a wound after death are, therefore : 1. Absence of copious hemorrhage. 2. If there is bleeding, it is exclusively venous. 3. The edges of the wound are close, not everted. 4. There is no infiltration of blood in the cellular tissue. 5. There is an absence of coagula. But it may happen that a wound has been inflicted soon after the breath has left the body, and while it was yet warm. The distinction between a wound then made and one made during life is not so well-marked as in wounds in- flicted at a later period after death. Observations of this kind on the human subject must of course be purely accidental ; and there are many obstacles to the performances of experiments on the recently dead. I, there- fore, selected limbs immediately after amputation ; and there is no reason to suppose that the results obtained in these cases would differ widely from those derived from experiments made on the entire body. Wounds on the dead body. — In the first experiment, an incised wound, about three inches in length, was made in the upper part of the calf of the leg two minutes after its separation from the body, by which the thick mus- cles of the calf, and the fascia (membrane) covering the deep-seated layer of the leg, were divided. At the moment that the wound was made, the skin retracted considerably, causing a protrusion of the adipose substance be- neath ; the quantity of blood which escaped was small — the cellular mem- brane, by its sudden protrusion forwards, seeming mechanically to prevent its exit. The wound was examined after the lapse of twenty-four hours ; the edges were red, bloody, and everted ; the skin was not in the least degree swollen, but merely somewhat flaccid. On separating the edges, a small quantity of fluid blood escaped, but no coagula were seen adhering to the muscles. At the bottom of the wound, however, and in close contact with the fascia, was a small quantity of coagulated blood ; but the coagula were so loose as readily to break down under the finger. In a second experiment, ten minutes after the separation of the member from the body, an incision of similar extent was made on the outer side of the leg, penetrating through the peronei into the flexor longus pollicis of the deep-seated layer of muscles. In this case the skin appeared to have already lost its elasticity, for the edges of the wound became but very slightly everted, and scarcely any blood es- caped from it. On examining the leg twenty-four hours afterwards, the edges of the incision were pale, and perfectly collapsed, presenting none of the cha- racters of a wound inflicted during life. Still, at the bottom of the wound, and inclosed by the divided muscular fibres, there were some coagula of blood ; but these were certainly fewer than in the former experiment. A portion of liquid blood had evidently escaped, owing to the leg having been moved. Other experiments were performed at a still later period after the removal of the limbs ; and it was found that in proportion to the length of time suffered to elapse before the production of k wound, so were the appear- ances less distinctly marked ; that is to say, the less likely were they to be 184 WOtrNDS UNATTENDED BY LOSS Or BLOOD. confounded with similar injuries inflicted upon a living body. When the in- cised wound was not made until two or three hours after the removal of the limb, although a small quantity of liquid blood was effused, no coagula were found. It is necessary to remember that, when an incised wound is the cause of death, the person dies either immediately — in which case there is copious bleeding from the wounded organ or some large vessel — or he dies after some time, in which case, as the wound continues to bleed during the time that he survives, the longer he lives the more copious will be the effusion of blood. In a wound inflicted after death, and while the body' is warm, nothing of this kind is observed. Unless the weapon injure one of the large veins, the bleed- ing is always slight, so that the quantity of Mood lost may assist us in deter- mining whether the wound was made during life or after death. When the body has been moved, and all marks of blood effaced by washing, rules of this kind cannot serve a medical witness ; the time at which the wound was actually inflicted must then be deduced from other circumstances. In the case of Greenacre, who was tried in 1837 for the murder and mutilation of a female, this formed a material part of the medical evidence. The head of the deceased had been severed from the body, and the question was, whether this severance had taken place during life or after death. The prisoner al- leged in his defence that it was after death ; but the medical evidence went to establish that the head must have been cut off while the woman was living, but probably after she had been rendered insensible by a blow on that part, the marks of which were plainly visible. This medical opinion was founded on two circumstances. Tiie muscles of the neck were retracted, and the head was completely drained of blood, showing that a most copious and abundant flow must have ensued at the time of separation; and, therefore, indicating that the circulation was probably going on at that time. On cutting off a head after death, a small quantity of blood may escape from the jugular veins; but this soon ceases, and the quantity lost is insufficient to affect materially the contents of the cerebral vessels. The chief medical witness, Mr. Gird- wood, expressed himself with proper caution, by stating, in answer to a ques- tion from the judge, that all the wounds in the neck had been inflicted either during life or very shortly after death, while the body still preserved its warmth. The circumstantial evidence tended to show that the deceased was first stun- ned, and that her head was cut off while she was in a state of stupor. In any case in which it is doubtful whether a wound was inflicted on a living or dead body, it will be proper to adopt the same cautious mode of expressing a medical opinion ; since it must be remembered there are no decisive characters by which wounds of the kind referred to can be distin- guished ; and a medical witness is as likely to be wrong as right in selecting either hypothesis. It is a considerable step in evidence, when we are able to assert that a particular wound, found on a dead body, must have been in- flicted either daring life or immediately after death ; for it can scarcely be supposed that, in a case calling for criminal investigation, any one but a murderer would think of inflicting upon a body immediately after death a wound which would assuredly have produced fatal effects had the same person received it while living. So soon as such an opinion can be safely expressed by a witness, circumstantial evidence will often make up for that which may be, medically speaking, a matter of uncertainty. Wounds or injuries unattended with hemorrhage. — The copious effusion of blood has been set down as a well-marked character of a severe wound re- ceived during life ; but this observation applies chiefly to cuts and stabs. Lacerated and contused wounds of a severe kind are not always accompanied by much bleeding, even when a large bloodvessel is implicated. It is well known that a whole member has been torn from the body, and that little blood ECCHYMOSIS FROM VIOLENCE. 185 has been lost ; but in such cases coagula are commonly found adhering to the separated parts — a character which indicates that the wound was inflicted either during life or soon after death. When a lacerated or contused wound involves a highly vascular part, although no large bloodvessel may be impli- cated, it is liable to cause death by loss of blood. In a case tried at the Liverpool Winter Assizes, 1841 {Reg. v. Gawley), the prisoner was charged with having caused the death of his wife by kicking her in the lower part of the abdomen. Copious bleeding followed, and in spite of medical assistance the woman died very shortly afterwards, evidently from exhaustion produced by the loss of blood. It was stated in evidence that there was no external laceration, but an examination of the body showed that a contused wound (of the genitals) had been produced internally, and had given rise to fatal bleed- ing. There is nothing at all remarkable in such a result, considering the great vascularity of these parts in the female. Ecehymosisfrom violence. — Contusions and contused wounds are commonly accompanied by a discoloration of the surrounding skin, to which the term ecchymosis is applied. The subject of ecchymosis is of considerable import- ance in legal medicine, since it has often given rise to numerous difficulties and complicated questions. It consists essentially in the extravasation or effusion of blood from ruptured vessels into the surrounding cellular texture. An ecchymosis is in genei'al superficial, affecting only the layers of the skin, and showing itself externally, either immediately or in the course of a short time, in the form of a deep blue or livid red patch. According to Dr. Chowne, the former color is met with in the ecchymosis slowly produced ; while that which is the immediate result of violence is red or livid red. In some instances the ecchymosis is deep-seated — the blood being poured out among the muscles and beneath the fascia ; its extent cannot then be so readily determined by the external discoloration, for this is commonly slight, and it appears only after the lapse of some hours, or even two or three days. Sometimes the ecchymosis shows itself not over the immediate seat of injury or around it, but at some distance from it. Dr. Chowne met with an instance in which a young man received a severe bruise on the inner side of the ankle. In two days, ecchymosis appeared around the outer ankle. When blood has once escaped from the small vessels, it will diffuse itself where it meets with the least resistance, and the layers of skin in the part struck, may become so con- densed by the blow, that the blood is diffused in the cellular membrane of the adjoining parts. Mr. Syme met with a case in which a compound fracture of the tibia, about one-third down, was produced by the wheel of a carriage passing over the leg of a woman. There was no ecchymosis around the seat of injury ; but after some days, the skin of the knee and lower part of the thigh became discolored. {£ld. Med. and Surg. Journ., Oct. 1836.) Ecchy- mosis may sometimes proceed from causes irrespective of the direct applica- tion of violence to the skin. Strong muscular exertions— the act of vomiting, and many other conditions, may give rise to a rupture of the minute vessels, and to an effusion of blood in parfs which have been stretched or compressed. I have known it to have been produced to a great extent around the knee (without any blow), from the stretching of the ligament of the kneepan in an individual who was trying to save himself from suddenly falling forwards with his knee bent under him. Such cases are commonly recognized by there being no mark of mechanical injury about the part — the skin is smooth and un abraded. Ecchymosis strictly signifies the effusion or pouring out of blood; but the effusion may be so deep-seated as not to present any external discoloration (ecchymosis). It is scarcely necessary to observe that the term ejfusion applies to internal as well as to external hemorrhage, and unless this be borne in mind medical testimony may be wholly misunderstood. Dr. Chris- 186 CHANGES or OOLOE. tison states that some years ago, on a trial in the High Court of Justiciary at Edinburgh, the public prosecutor attempted to prove that the person assailed had been wounded to the effusion of blood, which, according to the law of Scotland, is an aggravation of guilt in such cases. When the principal medical witness was examined as to the injuries inflicted, he was asked whether any blood had been effused; and he replied that a good deal must have been effused. But he meant effusion of blood under the skin, constitut- ing the contusion or bruise described, while the court at first received the answer as implying that there had been a considerable loss of blood from a wound externally. The ambiguity was, however, detected. {Edinburgh Monthly Journal, Nov. 1851, p. 454.) This case shows the importance of medical evidence being given in language intelligible to all. At the same time the amount of personal injijry inflicted is not at all dependent on the external effusion of blood. The assault may be of a most grievous kind, and yet no blood be efl'used through a wound in the skin. Violence inflicted on a living body may not show itself under the form of ecchymosis until after death. A case of this kind was communicated to me by Mr. J. Steavenson. A man received from behind several kicks on the lower part of the abdomen, which caused a rupture of the bladder, and death by peritonitis. He died in about thirty-five hours ; but there was no ecchy- mosis in the seat of the blows, i. e., the pubic and lumbar regions, until after death. Dr. Hinze met with a case of suicidal hanging, in which it was ob- served that ecchymosis appeared in the course of the cord only after death. (See Ha,nging.) It has been remarked by Devergie that ecchymoses are often concealed on the bodies of the drowned, when first removed from water, owing to the sodden state of the skin; they may become apparent only after the body has been exposed for some days, and the water has evaporated. A medical jurist must guard against the error of supposing that when a blow has been inflicted on a living person, it is necessary that the individual who is maltreated should survive for a long period in order that ecchymosis should be produced. Among numerous instances proving the contrary, the case of the Duchess of Praslin (August, 184'?) may be mentioned. Tliis lady, who was assassinated by her husband, was attacked while asleep in bed. The number of wounds on her person (thirty) showed that there had been a mortal struggle, which, however, could not have lasted more than half an hour. Yet, on inspection, there were the marks of numerous ecchymoses, which had resulted from the violent use of a bruising instrument. {Ann. d'Eyg., 184"?, t: ii. p. sn.) Changes of color. — The changes which take place in the color of an eechy- raosed spot are worthy of attention, since they will serve to aid the witness in giving an opinion on the probable time at which a contusion has been inflicted. After a certain period, commonly in eighteen or twenty-four hours, the blue or livid margin of the spot is observed to become lighter ; it acquires a violet tint, and before its final disappearance it passes successively through shades of a green, yellow, and lemon color. During this time, the spot is much increased in extent, but the central portion of the ecchymosis is always darker than the circumference. These changes have been referred by Chaussier and others to the gradual dilution of the serous portion of the effused blood by the fluid of the cellular membrane, and its slow and uniform dispersion throughout the cells. The color is finally entirely removed by the absorption of the blood. The extent and situation of the ecchymosis, the degree of violence by which it has been produced, as well as the age and state of health of the person, are so many circumstances which may influence the progress of these changes. Thus an ecchymosis is longer in disappear- ing in the old than in the young. Mr. Watson, of Edinburgh, found effused blood in an ecchymosis in an old person, five weeks after the infliction of the CONTUSIONS ON THE DEAD BODY. 187 injury. Where the cellular membrane is dense, the ecehymosis, croteris pari- bus, is not so rapidly formed; nor, when formed, do the above changes take place in it so speedily as when the blood is effused into a loose portion of membrane like that surrounding the eye or existing in the scrotum. In some instances an ecehymosis has been observed to disappear without undergoing changes of color at its margin. On examining an ecchyraosed portion of skin which has suffered from a severe contusion, we find that the discolora- tion affects nrore or less the whole substance of the true skin, as well as the cellular membrane beneath ; it is necessary to remember this in forming our opinion. Evidence from the form of an ecehymosis It not unfrequently happens that the ecehymosis produced by a contusion will assume a form indicative of the means by which the violence was offered. In hanging, the impression caused by the cord on the neck is sometimes ecchymosed, and indicates its course with precision ; so also in strangulation, when the fingers have been violently applied to the forepart of the neck, the indentations produced may serve to point out the manner in which life was destroyed. A case is men- tioned by Starkie, which shows that the form of an ecehymosis may occasion- ally furnish presumptive evidence against an accused party. In an attempt at murder, the prosecutor, in his own defence, struck the assailant violently in the face with the key of the house-door — this being the only weapon he had near at hand. The ecehymosis which followed this contusion corre- sponded in the impression produced on the face to the wards of the key ; and it was chiefly through this very singular and unexpected source of evidence, that the assailant was afterwards identified and brought to trial. {Law of Evidence, vol. i. art. Circ. Ev.) Contusions on the dead. — For our knowledge of the effects of contusions on the recently dead body, we are chiefly indebted to Dr. Christison. This gentleman found that blows inflicted two hours after death, gave rise to ap- pearances on the skin similar to those which resulted from blows inflicted recently before death. The livid discoloration thus produced generally arose from an effusion of the thinnest possible layer of the fluid part of the blood on the outer surface of the true skin, but sometimes, also, from an effusion of blood into a perceptible stratum of the true skin itself. He likewise found that dark fluid blood might even be effused into the subcutaneous cellular tissue in the seat of the discolorations, so as to blacken or redden the mem- branous partitions of the adipose cells ; but this last effusion was never ex- tensive. From this, then, it follows, that by trusting to external appearance only, contusions made soon after death may be easily confounded with those which have been produced by violence shortly before death. If a contusion has been caused some time before death, there will be swelling of the part, and probably also certain changes of color in the ecchymosed patch, in either of which cases there will be no difficulty in forming an opin- ion. Although ecehymosis, or an opinion analogous to it, may be produced after death, the changes in color are then met with only under peculiar circum- stances, to be presently mentioned. If the blood found beneath an ecchy- mosed spot be in the state of coagulum, this will afford a remote presumption of its having been effused during life, although, in fact, it only proves that the effusion must have taken place before death, or very soon after it. The experiments related, in speaking of incised wounds, show that the blood effused from a wound ten minutes after death may still be found in a coagu- lated state. (See page 183.) Again, the circumstance of the blood effused under a contused wound being liquid, is not a proof that the effusion took place after death ; for sometimes, as in death from a sudden and violent shock to the nervous system, or in cases of rupture of the heart, the effused blood does not coagulate. Blood effused into the spinal canal during life is often 188 CONTUSIONS ON THE DEAD BODY. fluid : and it is well known that the blood may be found coagulated in some parts of the body, while it remains uncoagulated in others. There is reason to believe that the blood coagulates more slowly in the dead body than in a vessel into which it has been drawn during life or after death. The blood may remain fluid in the dead body from four to eight, and, according to Donne, twelve hours after death (Cours de Microscopie, 52.) It rarely be- gins to coagulate until after a lapse of four hours ; but if drawn from a bloodvessel and exposed to air, it would coagulate in a few minutes after its removal. In general those contusions which have been produced during life, and in which the effused blood remains liquid, may be recognized by the extent of the effusion. If, under the ecchymosed part, we find a large quantity of liquid blood, and the seat of injury is so situated that the blood could not have be- come infiltrated into it, and at the same time there is no ruptured vein from which it might have flowed, we may confidently pronounce that the effusion must have preceded death. In a dead body, a contusion would cause but little extravasation, unless a vein of large size were torn through. The sign which is most satisfactory as a criterion, in the opinion of Dr. Christison, is, however, the following : — In a contusion inflicted during life, the ecchymosed portion of cutis (true skin) is generally dark and much discolored by the in- filtration of blood throughout its whole thickness ; the skin at the same time is increased in firmness and tenacity. This is not, however, a uniform conse- quence of a contusion during life ; for a blow may cause effusion of blood beneath the skin without affecting the cutis in the manner stated. The state of the skin here described, cannot, however, be produced by a contusion on a dead subject ; although it is questionable whether it might not be produced if the contusion were inflicted a few minutes after death. As it is, the value of this sign is somewhat circumscribed — it is not always produced on the living — it might be possibly produced on the recently dead ; so that when it does not exist, we must look for other differential marks ; and when it does exist, we ought to satisfy ourselves that the contusion was not inflicted recently after death. The period at which such injuries cease to resemble each other, has not been fixed with any degree of precision ; but, as in the case of incised wounds, it would seem that there is little danger of confounding them, when a contu- sion has not been inflicted on a dead body until after the disappearance of animal heat and the commencement of cadaveric rigidity. Dr. Christison found that sometimes the appearance of contusions could hardly be produced on the dead body two hours after death ; at others they may be slightly caused after three hours and a quarter ; but this period is very near' the extreme limit. Whenever the warmth of the body and the laxity of the muscles are not considerable at the time the blow is inflicted, the appearance of con- tusions during life cannot be distinctly produced. It is, therefore, only on the trunk that, even in the most favorable state of the body — namely, when the blood remains altogether liquid — that a mark resembling a contusion on the living body can be produced so late as two hours after death. {-Ed. Med. and Surg. Journ., No. 99, p. 247 et seq.) Notwithstanding these satisfac- tory results, it will be seen, that from the moment of death until after a lapse of two hours, contusions may be followed by appearances on the dead almost identical with those observed on the living. The earliest period after death in which an experiment was tried on the human body was one hour and three- quarters; in this case the similarity was so strong, that we may infer, if the experiments had been performed within half an hour, or even an hour after dissolution, it would have been difficult to say whether the blow producing the discoloration had been inflicted before or after death. Dr. Christison's experiments lead to the conclusion that severe blows inflicted on a recently APPEARANCES RESEMBLING ECCHYMOSIS. 189 dead body, prodace no greater degree of ecchyraosis or cutaneous discolora- tion than slight blows inflicted before death. Assuming that the great extent of an ecchymosis would in all cases serve to show that the violence producing it had been inflicted during life, it must be remembered that the importance of these facts, in relation to medical evidence, is not affected by the extent of the discoloration. It may be just as necessary to have a posi- tive opinion on the origin of a slight, as on the origin of an extensive bruise. Trivial ecchymoses, as in cases of strangulation, if they can be certainly pronounced vital, may make all the difl'erence between the acquittal' or con- viction of a person charged with murder. Again, slight ecchymosis on the bodies of the drowned may excite a suspicion of strangulation and subse- quent immersion of the body in water. This question is quite irrespective of the extent of the ecchymosis — the great point for a medical witness to consider is, whether it occurred during life or after death. Cases in which a mistake might easily have arisen, will be related in speaking of marks of violence on the drowned. The practical inference, then, is, that these discolorations caused after death are liable to be mistaken for marks of violence to the living body. An instance has been communicated to me, on respectable authority, in which, for the sake of experiment, blows with a stick were inflicted on the recently dead body of a female, while still warm. The body was afterwards accident- ally seen by non-professional persons, who were not aware of the perform- ance of these experiments, and so strong was the impression, from the appearances, that the deceased had been maltreated during life, that a judicial inquiry was actually instituted, when the circumstances were satisfactorily explained. The fact, therefore, that severe blows after death resemble slight blows during life, is, in a practical view, unimportant. It does not aid our diagnosis, nor prevent serious mistakes from occurring. Ecchymosis from natural causes in the living. — There are certain conditions of the body in which ecchymosed marks are found on the skin, that a witness must be careful not to confound with ecchymosis arising from violence. First with regard to the living body — in aged persons, it is not unusual to find the legs and feet covered with livid patches, sometimes of considerable uniformity of color, and at others much mottled. These discolorations, which, after death, might be mistaken for ecchymosis from violence, arise from the languor of the capillary circulation in such persons : the blood with difficulty finds its way through the venous capillaries, and the marks are commonly observed on the lower parts of the body, because they are far removed from the centre of circulation, and the blood has to rise contrary to gravitation. This is the condition which has been denominated by Andral asthenic hypersemia. (An- dral, Anat. Pathol., t. i. p. 40.) Similar discolorations are sometimes met with on the bodies of those who have died from scurvy, typhus, and other adynamic diseases. In persons severely aflfected with scurvy, it is well known that the slightest pressure on any part of the skin will suffice to produce a spot resembling the ecchymosis of violence, and arising like it from a rupture of minute cutaneous vessels; but the effusion of blood, which causes the dis- coloration, is commonly confined to the superficial layers of the true skin. These patches, under certain states of the system, occur spontaneously, and often cover the body to a great extent ; when small, they take the name of petechice; but when extensive, in which case they bear some resemblance to the ecchymosis of violence, they constitute the pathognomonic character of the disease tevmed purpura. To all these effusions of blood in the living body, the term Sugillation (from sugillatio, a black mark) has been applied. Some medical jurists have attempted to draw a distinction between ecchy- mosis and sugillation : thus it is said : ecchyraosis proceeds from external, sugillation from internal, causes — ecchymosis is confined to the marks which 190 CADAVERIC LIVIDITY. occur in the living body, sugillation to those which occur in the dead : in ecchymosis the vessels are ruptured, in sugillation there is mere congestion ; again, some have considered that ecchymosis and sugillation might take place both in the living and in the dead. From this statement, it appears impossi- ble to give a consistent deiinition of the meaning of either of these terms ; but it is altogether unnecessary to make the attempt, for the error, after all, consists in the introduction of a superfluity of words to express a simple condition of the body, depending on different causes. Why, according to the view taken by Chaussier, an ecchymosis should not also be called a sug- illation, it is difficult to say : for the definitions above given create no real distinction. I would advise a medical jurist to avoid the use of the term sugillation, if by employing it he considers that he is speaking of a condition essentially different from ecchymosis. It may be occasionally necessary to distinguish ecchymoses in the living body arising from infirmity or disease, from those which have their origin from violence. In regard to the spots or patches on the legs of old persons, the appearance of the body, and their general extent, enveloping, as they often do, the whole circumference of leg, are sufficient to establish a clear distinction. In distinguishing' the spots of purpura, a difficulty may sometimes exist ; but here also the appearance of the subject, the general diffusion of the spots over the whole of the body, and their simultaneous existence on the mucous membrane of the throat and alimentary canal, cannot fail to point out that they originate from some other cause than violence. In the living, these spots have been observed to undergo the same changes of color as the true ecchymosis of violence. It has been alleged, on the authority of Zacch'ias, one of the early writers on medical jurisprudence, that a distinction is obtained in these cases after death by a dissection of the part. According to this authority, in what is termed sug- illation, i. e., the ecchymosis of disease, the blood is fluid, while in the ecchy- mosis of violence it is described as being in a thick and concrete state. In the remarks already made respecting contusions, facts have been mentioned which show that such a mode of distinction is inadmissible ; neither the state of the blood nor its situation will alone suffice to determine the question. Although it has been usual to describe the ecchymosis of disease as being due to a superficial extravasation on the true skin, yet certain cases recorded by pathologists prove that in purpura or scurvy the discoloration may occa- sionally extend through the whole substance of the skin to the fatty tissue beneath. Ecchymosis in the dead body. Lividity. — Ecchymosis may present itself in various forms on the skin of a dead subject. The first form, when it occurs, is almost an immediate consequence of death, but it is not fully developed until the body has cooled. It is commonly called cadaveric lividity. It pre- sents itself in diffused patches of very great extent, sometimes covering the whole of the forepart of the chest q,nd abdomen, at other times, the lateral regions of the back. The upper or lower extremities, either on their internal or external surfaces, or on their whole circumference, are often thus completely ecchyraosed. The color is sometimes purple, at others livid, and often mot- tled in interspaces; but it is commonly well defined in its extent by the whiteness of the surrounding skin. This form of ecchymosis is generally seen on the bodies of those who die suddenly or by a violent death, as well as in persons who perish from apoplexy, or who are hanged or suffocated. When the skin is divided, the color is found to be confined to the upper surface of the cutis, and never to extend through it. This discoloration is ascribed to the congestion which takes place in the capillary system at the moment of death, in subjects that are full of blood. It is rarely seen in the bodies of those who have died from profuse bleeding — the skin is in these cases commonly pallid. The circumstances under which it occurs, and the CADAVERIC IIVIDITY. 191 characters above described, distinguish it from the ecchymosis of violence. Its existence on a dead body mast be regarded as a sign of the vigor and activity of the circulation at the moment of death, and generelly as a mark of death having taken place suddenly. It might seem improper to call this which has been described as a mere capillary congestion, "eccliymosis," this word signifying effusion ; but the term sugillation has been so vaguely em- ployed by different writers, that I think the former preferable to the latter, in spite of the apparent inconsistency of its application to every variety of cutaneous discoloration. (See Henke, Zeitschrift der S. A., 1844, vol. i. p. 199.) Vihices. (Weals.) — Sometimes, instead of seeing this cadaveric lividity diffused in large patches over the skin, it will be disposed in stripes or weals which traverse and intersect each other in all directions, and often cover the whole surface of the body. These marks, which vary from a scarlet to a dark red or livid hue, have been supposed to resemble those produced on the skin by the act of scourging or flagellation. On this account they have received the above designation. Sometimes the body is completely covered with them — they are often of considerable length, and pass in a symmetrical but occasionally tortuous course ; they are chiefly observed about the sides, the upper part of the shoulders and back. In meeting with this appearance for the first time on a dead body, an individual, unacquainted with its nature, might look upon it as a strong proof of violent treatment during life, espe- cially in a case of suspected violence ; but the practitioner will distinguish it readily, by the uninjured state of the cuticle and the superficial nature of the discoloration, from those marks of violence which it is considered to resemble. In general, it appears to be produced by the wrapping of a body in a sheet or other covering soon after death, and allowing it to cool while thus wrapped up ; even if a dead body is allowed to cool merely with the clothes covering it, these peculiar marks will often be produced. In many cases they exist only on the back, and here they are to be ascribed to the pressure produced by "the irregularities Or folds in the sheet on which the body has been lying. The capillaries, it is to be observed, are always congested in or near those ~ parts of the skin which are exposed to the least pressure. A few years since I saw a well-marked case of vibices, in which the suspicion was so strong that violence had been used to the deceased, that a coroner's inquest took place. The fore part of the body was covered with stripes, which were of a red and livid color ; they appeared to correspond exactly to the folds of a sheet drawn tightly across the chest ; and it was subsequently ascertained that the body of the deceased had been treated in this manner after death. The blood was superficially diffused, and the cuticle uninjured. The circum- stance above mentioned at once satisfactorily explained the cause of the appearance. These vibices or weals, like the cadaveric lividity already de- scribed, are commonly seen in plethoric persons ; they indicate great vigor of circulation at the moment of death. But lividity sometimes presents itself in a more deceptive form than in either of the instances just mentioned; as in the following case. A man, set. thirty-three, died suddenly from disease of the heart. Eighteen hours after death, the body was examined, and the skin was then found to be covered in different parts with patches of ecchymosis, varying in size from small spots to others of several inches in diameter. These patches were evi- dently due to simple lividity, although they closely simulated marks of vio- lence produced during life. On cutting into them the layers of the cutis as well as the cellular tissue beneath were throughout reddened by a congestion of blood. There was no decided extravasation, but small rounded semi- coagulated masses oozed out from the cells on slight pressure. There was another extraordinary circumstance, in which these patches of lividity resem- 192 ECCHTMOSIS NOT A NECESSARY RESULT OP VIOLENCE. bled the ecchymosis of violence produced during life. Around many of them there was a wide border or ring of straw color, with various shades of green, precisely similar to those witnessed in the disappearance of an ecchymosis from the living subject. By all medical jurists, it has been hitherto consi- dered that these rings of color, when not depending on putrefaction, are peculiar to an ecchymosis of the living body, and are never seen in an ecchy- mosis taking place spontaneously after death. The occurrence of this case shows with what caution general rules should be framed for medico-legal practice. Had the body of this person been found lying dead exposed on a high road, and had it been proved that another man had been seen quarreling with him, it is easy to imagine that an unfavorable medical opinion might have been expressed against the person accused of the violence. This kind of ecchymosis could only have been distinguished from that of violence during life, by the unruffled state of the skin, and the slight extravasation of blood compared with the extent of the ecchymosed surface. It is worthy of note, also, that the principal seat of the ecchymosis was in those parts which were recumbent or depending. The formation of the colored zones around some of the patches of lividity was fully explained by the fact of the man having labored under general dropsy. The serum effused in the cells here acted upon and diluted the blood as it became extravasated ; and diffused it around, much in the same manner as the serous exhalation of the cellular membrane acts on the blood effused in the living body. A wax model of this remark- able appearance is preserved in the museum of Guy's Hospital, and is well worthy of inspection. Effects of Putrefaction. — Another form of ecchymosis observed in the dead body, is that which occurs some time after death. This appears to proceed from au infiltration of blood into the depending parts of the body, and to be a result of incipient putrefaction. They who are much engaged in inspec- tions are well aware that the skin of the back, especially that covering the loin and buttocks, often presents irregular discolorations resembling ecchy- mosis. The skin of the back of the head is a well-known seat of this form of ecchymosis. On cutting into the skin of any of these parts, the whole of the cutis is found to be more or less discolored, and the fatty tissue is filled with a bloody serum, which readily escapes. In proportion as putrefaction advances, the discoloration becomes greater, passing from a dark red to a green color. The general characters of this kind of ecchymosis are so well- marked, that it cannot easily be confounded with the ecchymosis of violence. The parts of the body in which it is known to occur as well as the state of the body, are circumstances which distinguish it from all the other forms de- scribed. This variety of ecchymosis is also termed sugillation by some medi- cal jurists. (On the subject of Ecchymosis, see Ann. d^Hyg., 1838, t. ii. p. 383.) Is ecchymosis a necessary result of violence ? — This medico-legal question has often created great difficulty to medical witnesses. It has been repeatedly asserted in courts of law, that no severe blow could have been inflicted on a deceased person in consequence of the absence of ecchymosis from the part struck ; but we shall see that this assertion is entirely opposed to well ascer- tained facts. However true the statement may be that severe contusions are commonly followed by ecchymosis, it is open to numerous exceptions; and unless these are known to a practitioner, his evidence may mislead the court. The presence of ecchymosis is commonly presumptive evidence of the inflic- tion of violence ; but its absence does not negative this presumption. It was long since remarked by Portal, that the spleen had been found rup- tured from blows or falls, without any ecchymosis or abrasion of the skiu appearing in the region struck. This has been also observed in respect to ruptures of the stomach, intestines, and urinary bladder, from violence directly INTERNAL INJURIES WITHOUT EOCHYMOSIS. 193 applied to the abdomen. Portal supposed that the mechanical impulse was simply transferred through the sufiple parietes of the abdomen to the viscera behind, as in the striking of a bladder filled with water. Whether this be the true explanation or not, it is quite certain that the small vessels of the skin often escape rupture from a sharp blow, so that their contents are not effused. A case is reported by Henke, in which a laboring man died some hours after fighting with another ; and on inspection of the body the peri- toneum was found extensively inflamed owing to an escape of the contents of the small intestines, which had been ruptured to a considerable extent. There was, however, no ecchymosis or mark on the skin externally, and the medical inspectors were inclined to affirm, contrary in this case to direct evi- dence, that no blow could have been struck ; but others were appealed to, who at once admitted that the laceration of the intestines might have been caused by a blow, even although there was no appearance of violence exter- nally. Mr. Watson states, that a girl aged nine, received a smart blow upon the abdomen from a stone. She immediately complained of great pain ; col- lapse ensued, and she died in twenty-one hours. On inspection there was no mark of injury externally ; but the ileum (small intestines) was found rup- tured, its contents extravasated, and the peritoneum extensively inflamed. (On Homicide, p. 18*1.) Dr. Williamson, of Leith, met with a case in which a man received a kick on the abdomen from a horse : — he died in thirty hours from peritonitis. The ileum was found to have been torn completely across in its lower third. There was not the slightest trace of ecchymosis exter- nally ; and this fact is the more remarkable, since the blow was here struck by a somewhat angular or pointed body — the hoof of a horse. (Med. Gaz., May, 1840.) In a fatal railway accident which occurred at Leicester in November, 1854, there were no marks of external violence on the head, but Mr. Macaulay found a laceration of the left hemisphere of the brain with effu- sion of a large quantity of blood which had coagulated. Many cases might be adduced in support of the statement that ecchymosis is not a necessary or constant result of a severe contusion ; but those already related sufficiently establish the fact. This medico-legal question frequently arises in cases in which the bladder is ruptured, as, owing to the general ab- sence of marks of violence, it is often alleged in defence tliat no blow or kick could have been inflicted on this part of the abdomen. The incorrectness of this view will be apparent by a reference to cases of ruptured bladder related in another part of this work. I am indebted to Dr. Easton, of Glasgow, for a case of rupture of the liver, under circumstances in which the appearance of ecchymosis would have been generally expected as a result of violence. In January, 1852, a woman, aged seventy-five, was run down by a cab in the streets of Glasgow, and died in less than half an hour. No ecchymosis ex- isted, although four ribs on the right side of the chest at the lower part were broken, and the liver was ruptured in two places longitudinally, and through- out the entire length of its anterior and convex surface. The laceration of this organ had not been caused by the fractured ends of the ribs penetrating downwards, for of these there was no displacement, but the organ seemed to have burst in consequence of the heavy compression to which it had been subjected, which had not been sufficient, however, to occasion discoloration of the skin externally. That murderous violence may be produced by blows on a body without leaving any external marks, is proved by a case tried in Scotland {Cuming for the murder of his wife, Dec. 19, 1853). The woman died from a severe injury to the head ; but she chiefly complained of great pain in one of her breasts, and in her chest on that side. From her state- ment it appeared that the prisoner had used great violence to this part of her body ; yet on a careful examination, during life and after death, there were no marks of ecchymosis or contusion. The case of Slater and Vivian (Cen- 194 INCISED AND PUNCTTJKED WOUNDS. tral Crim. Court, Sept. 1860), charged with the manslaughter of a lunatic at Colney Hatch Asylum, presents many points of importance in reference to this medico-legal question. ( Winslow's Med. Critic, and Psychological Jour- nal. No. 1, Jan. 7. 1861, p. 91.) ' CHAPTER XXIII. EVIDENCE OF THE USE OP A WEAPON — OHAEACTERS OF WOUNDS CAUSED BT WEAPONS — INCISED, PUNCTURED, LACERATED, AND CONTUSED WOUNDS — STABS AND OUTS — WHAT ARE WEAPONS ? — EXAMINATION 03" THE DRESS. Evidence of the use of a weapon It may happen on a criminal investiga- tion, that a weapon is presented to a medical witness ; and he is required to say whether the wound, found on the body of a person, was produced by it. When, upon the clearest evidence, it is certain that a weapon has been used, it is not uncommon for prisoners to declare that no weapon was employed by them, but that the wound had been occasioned by accidental circumstances. A witness should remember that he is seldom in a position to swear that a particular weapon produced at a trial, must have been used by the prisoner: — he is only justified in saying, that the wound was caused either by it or by one similar to it. Schwbrer relates the following case. A man was stabbed by another in the face : and a knife, with the blade entire, was brought for- ward as circumstantial evidence against him — the surgeon having stated that the wound must have been caused by this knife. The wounded person re- covered ; but a year afterwards an abscess formed in his face, and the broken point of the real weapon was discharged from it. The wound could not therefore have been produced by the knife which was brought forward as evidence against the prisoner at the trial. (Lehre von dem Kinderraorde.) Although the criminality of an act is not lessened or impugned by an occur- rence of this kind, it is advisable that such mistakes should be avoided by the use of proper caution on the part of a witness. (On this question, see the case oi Renaud, by Dr. Boys de Lonry, Ann. d^Hyg., 1839, t. xi. p. 110. As to what is a weapon, see Henke, Zeitschrift der S. A., 184.4, vol. i. p. 6Y.) Characters of wounds produced by weapons. — Let us now suppose that no weapon is discovered ; and that the opinion of a witness is to be founded only on an examination of a wound. It is right for him to know that on all criminal trials, considerable importance is attached by the law .to the fact of a wound having been caused by the use of a weapon ; since this often implies malice, and in most cases a greater desire to injure the party assailed, than the mere employment of manual force. Some wounds, such as cuts and stabs, at once indicate that they must have been produced by weapons. Incised wounds. — In incised wounds, the sharpness of the instrument may be inferred from the cleanness and regularity with which the edges are. cut: in stabs, also, the form and depth of a wound will often indicate the kind of weapon employed. Stabs sometimes have the characters of incised punc- tures, one or both extremities of the wound being cleanly cut, according to whether the weapon was single or double-edged. Dupuytren has remarked, that such stabs, owing to the elasticity of the skin, are apparently smaller than the weapon — a point to be remembered in instituting a comparison between the size of a wound and the instrument. A lateral motion of the weapon may, however, cause a considerable enlargement of the wound. (See WOTINDS BY GLASS OR EARTHENWARE. 195 case, Ann. ePHyg., 1847, t. i. p. 400.) When a stab has traversed the body, the entrance-aperture is conimonly larger than the aperture of exit; and its edges, contrary to what might be supposed, are sometimes everted, owing to the rapid withdrawal of the instrument. That facts of this kind should be available as evidence, it is necessary that the body should be seen soon after the infliction of a wound, and before there has been any interference with it. Punctured wounds. — It is necessary to notice whether the edges of a punc- tured wound are lacerated and irregular, or incised; because it may be alleged in defence, that the wound was produced by a fall on some substance capable of causing an injury somewhat resembling it. In a case that occurred to Mr. Watson, a deeply penetrating- wound on the genital organs of the deceased, which had evidently caused the woman's death, was ascribed by the prisoners charged with the murder, to her having fallen on some broken glass; but it was proved that the edges of the wound were bounded everywhere by clean incisions, which rendered this defence inconsistent, if not impossible. I have known a similar defence made on two other occasions, where the cases came to trial. In one, a man struck the prosecutor, and knocked him against a window. Oq examination, ther^e were three deep cuts on the face of the pro- secutor, but no weapon had been seen in the hands of the prisoner. He was charged with cutting and stabbing. The surgeon deposed that the wounds appeared to have been inflicted with a knife or razor-blade, and not by broken glass. If the wounds had been made by glass, particles of that substance would probably have been found in them ; but there were none. The prisoner was acquitted, the infliction of the wounds by a weapon not being considered to have been made out. In another case that occurred in August, 1841, the prosecutor was knocked down, and his throat was found severely cut ; but there was no direct proof that a weapon had been used. In the defence it was urged that the wound had been produced by a broken pane of glass ; but the surgeon described it as a clean cut, five inches in length, and one inch in depth, laying bare the carotid artery. He considered that it must have been inflicted hy a razor or knife ; and that it was a cut made by one stroke of the instrument. In Reg. v. Ankers (Warwick Lent Assizes, 1845), a clean cut as from a penknife, about two inches long, and one deep, was proved to have existed on the person of the prosecutor, who had fallen during a quarrel with the prisoner. Some broken crockery was lying near the spot, and it was alleged in the defence that a fall upon this had caused the wound. This allegation was quite inconsistent with the clean and even appearance of the wound. The prisoner, in whose possession a penknife had been found, was convicted. In general, wounds made by glass or earthenware, are characterized by their great irregularity and the uuevenness of their edges. Cases of this kind show that as it is not always possible to know when this sort of defence may be raised, a medical witness should never fail to make a minute examination of a wound which is suspected to have been criminally inflicted. A trial for murder took place at the Worcester Summer Assizes, in 1838, in which it appeared in evidence that the deceased had died from a small punctured wound in the thorax. It was five inches and a half deep ; it had completely traversed the right ventricle of the heart, and had led to death by hemorrhage. The wound was supposed to have been produced by a small skewer, which was found near the spot : but in the defence it was alleged that the deceased had fallen over a tub, and that the wound had been caused by a projecting nail. This allegation, however, was negatived by the surgeon, from the fact of its being a clean cut wound. Had it been produced in the manner alleged by the prisoners, the fact would have been indicated by an irregularity of margin. In the case of Bryant (Taunton Lent Assizes, 1849), which involved a charge of maliciously stabbing the prosecutor, the defence was that, as many 196 WOUNDS FROM BLOWS. flints were lying about in the road, and the assault took place in the dark, the wound might have been inflicted accidentally during a fall. The medical witness could not say that the wounds had been positively caused by a wea- pon : they might have been produced by the flints. The prisoner was ac- quitted. A careful examination made at the time of the injury would most probably have enabled the witness to give a positive opinion, instead of leav- ing the case open to doubt. A puncture made by a flint during a fall is not likely to resemble a stab with a knife. The wound would present some marks of laceration and great irregularity. As the wound was under the ear, it was by no means probable from the situation that it could have been thus caused accidentally. In January, 1853, Mr. Hancock was enabled, by the careful examination of a wound, to disprove a charge of maliciously wounding made against in- nocent persons. A little girl was represented to have received, while sitting over an iron grating, a wound in the pudendum, by some persons pushing a toasting-fork, or pointed instrument, between the bars of the grating. There were no marks of punctures, which would have been found had tliis statement been true, but a slight laceration of the parts, such as might have been pro- duced by an accidental fall on the edge of the grating while the girl was in a sitting position. There were also marks of bruises on the thigh, such as would have occurred from an accident of this kind. The mother of the child had made a false charge for the sake of exciting public compassion and pro- curing money. A proper examination of the injury clearly established that it had resulted from accident. The part of the body in which the injury ex- isted in this case is not usually exposed to lacerations or punctures from ac- cident ; but the child, for a certain purpose, had placed herself voluntarily in this position, and had, on her own admission, slipped, and thus probably in- jured herself. Lacerated and contused wounds. — Lacerated wounds do not in general present greater difiSculty with regard to their origin than those which are in- cised or punctured. The means which produced the laceration are commonly well indicated by the appearance of the wound. These injuries are generally the result of accident ; they are, however, frequently met with on the bodies of new-born children, in which case they may give rise to charges of infanticide. Contused wounds and severe contusions present much greater difSculty to a medical jurist. It is not often in his power to say whether a contused wound has resulted from the use of a weapon, from a Mow of the fist, or a fall, by reason of the deceased having accidentally fallen against some hard surface. The question is frequently put to medical witnesses, on those trials for man- slaughter which arise out of the pugilistic combats of half-drunken men. One of the combatants is generally killed, either by a blow on the head, by a fall, or by both kinds of violence combined. The skull may or may not be frac- tured ; and the person may die of concussion, inflammation of the brain, or from effusion of blood. The general defence is that the deceased struck his head against some hard substance in falling on the ground ; and the surgeon is asked whether the particular appearances might not be explained on the supposition of a fall. This, in general, he admits to be possible, and the prisoner is acquitted. A medical witness is rarely in a position to swear with certainty, that a contused wound of the head must have been produced by a weapon and not by a fall. Some circumstances, however, may occasionally enable him to form an opinion on this point. If there are contused wounds on several parts of the head, with copious effusion of blood beneath the skin, the presumption is that a weapon must have been used. If the marks of violence are on the summit of the head, it is highly probable that they have been caused by a weapon, since this is not commonly a part which can receive injury from a fall. According to the medical evidence given on this question, LEGAL DEFINITION OF WOUNDS. lOT an indictment may or may not be sustained. A case is reported in which a prisoner was indicted for striking the deceased, and fracturing his sliull with a piece of brick. The evidence showed that the prisoner struck with his fist, and that the deceased in consequence fell upon a piece of brick, which caused the fracture and led to his death. The judges held that this was a fatal varia- tion. {Law Times, Mar. 21, 1846, p. 501.) Technicalities of this kind will probably be set aside in future under the statute 14 and 15 Vict. c. 100 ; and indeed, in one case {Reg. v. Bodd, Shrewsbury Summer Ass., 1853), Cole- ridge, J., is reported to have expressed a strong opinion against the distinc- tion thus made respecting the cause of the injury. The prisoner, it was alleged, threw a stone at the deceased, who immediately fell on a stone floor. The deceased was able to go about for several days, but he died a week after he had sustained the violence, from iniiammation of the brain, as a result of fracture of the skull. The medical witness referred the fracture to a blow from a stone. In the defence it was urged that the fracture might just as well have arisen from a fall on the stone floor. Coleridge, J., is reported to have said, that if the prisoner knocked the deceased down, it would make no difference whether the deceased died from a fall on the stone floor or whether a stone was thrown at him. A doubt may arise whether a weapon has or has not been used in reference to lacerated or contused wounds. Contused wounds on bony surfaces, as on the head, sometimes present the appearance of incised wounds, the skin being evenly separated ; still, when a wound is recent, a careful examination will generally enable a witness to form a correct opinion. If some time has elapsed before the wound is examined, great caution will be required. In some in- stances, an accurate observation of the form of a wound, and a comparison of it with the supposed weapon, will justify a medical witness in giving a strong opinion on the point. The depth and nature of the wound may be snch that no accidental fall would reasonably account for its production. A ease of considerable importance in reference to this medico-legal question was tried at the Cornish Assizes, 1851 ; for a report of which I must refer the reader to the Medical Gazette, vol. xlviii. p. ^29. {Reg. v. Teague, Cornwall Summer Assizes, 1851.) Stabs and cuts. — It has been remarked that the law in some cases attaches great importance to the clear proof of the use of a loeapon; and a medical man has, therefore, a serious responsibility thrown upon him when, in the absence of a weapon or, of evidence of its use, he is called upon to say, from an examination of the wound, whether one has or has not been used. The statute on wounding makes no difference in respect to the means by which wounds are inflicted ; but the words have been hitherto held by the judges to imply, in all cases, the use of some weapon or instrument. The following are the provisions of the law: "Whosoever shall stab, cut, or wound any person, or shall, by any means whatsoever, cause to any person any bodily injury dangerous to life, with intent in any of the cases aforesaid to commit murder, shall be guilty of felony." (1 Vict. c. 85, s. 2.) The word stah has been held to import a wound from a pointed instrument; the word cut from an instrument having an edge ; and the word wound comprises incised, punc- tured, lacerated, contused, and gunshot wounds : thus including all stabs and cuts, and, medically speaking, rendering the separate nse of these words in the statnte wholly unnecessary. All medical men know that stabs and cuts are varieties of wounds ; and it is difficult to understand why these terras should have been retained, and the other varieties of wounding, as " incise., puncture, lacerate, and contuse," omitted. It was formerly held that an in- dictment for cutting would not be supported if the medical evidence proved that the alleged cut was a stab, and vice versa ; and further, in an indictment for cutting and stabbing, it was not considered sufficient to prove that it was 198 WOUNDS THROUGH THE DRESS. a contused or lacerated wound. Again, some doubt existed regarding the meaning of the word weapon. Thus, the teeth, the hands or feet uncovered, were held by the majority of the judges not to be weapons ; and injuries pro- duced by them, however severe, were not treated as wounds within the mean- ing of the statute. Parties were tried on charges of biting off fingers and noses, and although the medical evidence proved that great disfigurement and mischief had been done to the prosecutor, yet the nature of the injary pro- duced the division of the cutis — was not so much regarded as the actual method by which it was accomplished. The persons charged were acquitted under an indictment for "wounding." From a trial which took place at the Nottingham Assizes in 1832, it appeared, however, that artificial arras and legs were not exempted under the statute. In the case alluded to, a strenuous effort was made by the prisoner's counsel to show that a wooden arm with which an assault was committed had become, by long use, part of the body of the prisoner, and that, like a natural arm, it ought not to be considered a weapon in law 1 The objection was overruled. Within a recent period, a great improvement has taken place in this part of our criminal law. The technicalities which arose out of the necessity of strictly defining the nature of a wound, and whether it had or had not been caused by a weapon, are now in great part removed by the 14 and 15 Vict. c. 19, sec. 4. It is herein provided that punishment shall follow the convic- tion of a person who has inflicted grievous bodily harm, whether with or without any weapon or instrument, or who has maliciously cut, stabbed, or wounded any person. A man has been tried under this statute, for biting off part of the nose of another; and in another case a man was convicted of maliciously maiming by biting off a large piece of the tongue of the prose- cutor. The old objection, that the teeth are not weapons, cannot now be raised in defence. The 14 and 15 Yict. c. 100, is also adapted to meet those cases in which Trivial technical objections are raised to the description of wounds in an indictment and of the circumstances under which they have been inflicted. Examination of the dress. — The use of a weapon on these occasions may be sometimes inferred from the dress having been cut; although it is quite possible that a contused wound may be inflicted by a bludgeon through the dress, without tearing or injuring it. The perforation of the dress is by no means necessary for the production of considerable laceration of the skin and muscles, supposing the article of dress to be at all of an elastic or yielding nature. In stabs or cuts with sharp-pointed instruments, the part of the dress covering the wound should present marks of having been perforated or cut by a weapon. In self-inflicted or imputed wounds, this is one character by which the correctness of a statement may be tested (see Imputed Wounds). A wound may be indirectly produced by a weapon, and medical witnesses have been often questioned on this point. Thus, the prosecutor may at the time have worn about his person some ar,ticle of dress which received the blow, and this may have caused the wound. On a trial for maliciously wound- ing, which took place at the Reading Spring Assizes in 1831, it appeared in evidence that the prisoner, while poaching, assaulted a gamekeeper by inflict- ing on his head severe blows with a gun. At the time of the assault, the prosecutor wore a strong felt hat, which, it was contended in defence, had caused the wounds that formed the subject of the charge. The medical wit- ness admitted that the wounds might have been produced either by the hat or the gun. The prisoner was convicted ; but the judge intimated a doubt whether this could be considered a "wounding by a weapon," within the statute. In another case, a blow was struck with a bludgeon at the head of the prosecutor who wore spectacles. Wounds were produced, which, it was argued in the defence, had resulted from the glass of the spectacles. The MISTAKES REGARDING INJURIES THROUGH DRESS. 199 prisoner was acquitted. Every case of this kind must be determined accord- ing to the circumstances accompanying it. One fact appears to me to be well established from the foregoing cases — namely, that a medical practitioner should always make a minute and careful examination of wounds which are likely to become the subject of criminal charges. In performing his duties as a surgeon, he is bound, so far as he consistently can, to notice, as a medical jurist, the characters of all personal injuries. I am indebted to Mr. Codd, coroner for Essex, for an instructive case which occurred in August, 1853, showing the importance of comparing the article of dress with the injuries which may have proved fatal. A woman, eet. sixty, was found dead in her bed. She had vomited slightly, and there was a small quantity of blood on the floor, which had flowed from the nose. She had been seen in her usual health on the previous night. On inspection, there were found two indentations about the middle of the right parietal bone, and there was a large clot of blood in this situation beneath the skin. On removing this clot, the bone was found fractured to the extent of four inches. Nearly three ounces of dark clotted blood were found on the outer membrane of the brain (dura mater), between it and the skull. All the other viscera were healthy. This was the only injury, and quite sufficient to account for death ; but a question arose respecting the mode in which this fracture was caused. It was in evidence that, on the evening before her death, deceased had been suddenly knocked down, while she was walking in a public road, by a man accidentally running against her. One witness stated that she fell heavily on the back of her head, on which at the time she wore a bonnet. She appeared stunned, was raised up by the men, some brandy was given to her, and she recovered sufficiently to walk home and eat her supper as usual, after which no one saw her until she was found dead the following morning. Some suspicion arose that the violence done to the head was too great to be accounted for by the mere fall, and it was a question whether, with such an amount of injury, the deceased could have walked to her home, at the distance of a mile and a half. At first it was thought that this was a case of murder, and a man who lodged in the house with deceased was suspected. His room was searched, and a hammer with two claws was found. On comparing these claws with the two indentations and fracture, this weapon appeared to account for their production. Deceased and this man had been in the habit of quarreling, and they were the only persons in the house on this occasion. The lodger said that he let the woman in about 9 o'clock (the fall on the road occurred about 7.30) ; her appearance presented nothing unusual, and he saw no more of her until called at 7 the next morning, when she was found dead and cold. At the adjourned inquest, the bonnet worn by the deceased at the time of the fall was called for by the coroner. Two indentations were found upon the back part of it, corresponding to those on the skull of de- ceased. The indentations on the bonnet contained dust and dirt, thereby confirming the statements of the witnesses, and rendering it probable that the fall had caused the injury. The examination of the dress, in this case, cleared up what might have been otherwise doubtful. It is probable that the large internal effusion of blood which caused death did not take place until deceased had reached home, and perhaps as a result of the exertion made. She must have died very soon after she went to bed, as her body was found cold at seven o'clock the next morning. In addition to the caution which this case conveys respecting medical opinions on the origin of wounds, it shows that persons may walk and -die at a great distance from the spot where a serious injury to the head has been sustained. 200 WOTJNDS — EVIDENCE PROM SITUATION. CHAPTER XXIY. WOUNDS INDICATIVE OF HOMICIDE, SUICIDE, OR ACCIDENT — EVIDENCE FROM THE SITUATION OF A WOUND — SUICIDAL WOUNDS IN UNUSUAL SITUATIONS — EVI- DENCE FROM NATURE AND EXTENT — SHAPE — EVIDENCE FROM THE DIRECTION OF A WOUND — WOUNDS INFLICTED BY THE RIGHT OR LEFT HAND — ACCIDENTAL AND HOMICIDAL STABS — EVIDENCE FROM THE PRESENCE OF SEVERAL WOUNDS — THE USE OF SEVERAL WEAPONS — TWO OR MORE MORTAL WOUNDS — WOUNDS PRODUCED SIMULTANEOUSLY OR AT DIFFERENT TIMES. Wounds indicative of homicide, suicide, or accident. — Supposing that the wound which is found on a dead body is proved to have been caused before death, it may be necessary to inquire whether it was the result of suicide, homicide, or accident. It might at first sight be considered that the deter- mination of a question of this nature was wholly out of the province of a medical jurist. In^some instances it may be so, and the settlement of it is then properly left to the legal authorities ; but, in a large number of cases, it is so closely dependent for its elucidation on medical facts and opinions, that juries could never arrive at a satisfactory decision without medical evidence. Let US suppose, then, that a medical jurist is consulted in a doubtful case — What are the points to which he must direct his attention ? These are, with regard to the wound, 1, its situation; 2, its nature and extent; and, 3, its direction. 1. Evidence from the situation of a wound. — It is a general principle in which most medical jurists agree, that wounds, inflicted by a suicide, are usually confined to the fore or lateral parts of the body. The throat and chest are commonly selected, when cutting instruments are employed ; while the chest, especially in the region of the heart, the mouth, the orbit and the temples, are the spots generally chosen for the perpetration of suicide by fire-arms. But it is obvious, that any of these parts may be also selected by a murderer, with the especial design of simulating a suicidal attempt ; there- fore the mere situation of a wound does not suffice to establish the fact of suicide. Dr. Smith considers, in reference to pistol-wounds, that if the weapon has been introduced into the deceased's mouth and there discharged, we may also take it for granted that " it has not been done by another" {For. Med., p. 302) ; but this inference has been rather too hastily drawn, because it is quite within the range of possibility, that a cool and calculating assassin may purposely resort to this method of destroying a person in order to con- ceal the crime. In suicidal wounds from fire-arms, a discoloration by powder of the fingers of the hand which discharged the weapon is sometimes observed; this has also been looked upon as a source of evidence of suicide under doubt- ful circumstances, but a similar objection, although not with equal force, might be made to its admission. Some have regarded it as fully established in legal medicine, that when wounds exist at the back part of the body, it is a positive proof that they have not been self-inflicted. This situation is certainly unusual in cases of suicide ; but, as Orfila observes, it is not the situation, so 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 attempt ; at least, it must be obvious that it would require more preparation and contrivance on the part of a self-murderer, so to arrange matters, that WOUNDS — EVIDENCE FROM NATTJKE AND EXTENT. 201 such a wound should be produced, than we can believe him to possess at the moment of attempting his life. • ]3esides, his object is to destroy himself as quickly and as surely as circumstances will permit; he is, therefore, 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 a surgeon would pronounce to be, the most appropriate situation to produce instant destruction. A want of knowledge, or a want of resolu- tion on the part of a suicide, or the accidental slipping of the hand, will often cause a wound in a part where we might least expect to find it. Wounds which result from accident or suicide are generally in exposed parts of the body. An incised wound in a concealed or not easily accessible part is presumptive of murder ; because this kind of injury could have resulted only from the deliberate use of a weapon. Suicidal wounds, are, however, sometimes found in the most unusual situations. In December, 1842, a sur- geon destroyed himself by cutting through the brachial artery and the prin- cipal veins of his left arm with a penknife ; and in another instance, which occurred in 1839, a young man committed suicide by dividing the arteries of the forearm on both sides. It is very rare that we find suicidal stabs in the abdomen or throat, but an instance occurred a few years since, in which a woman destroyed herself by a stab in the lower part of the abdomen ; and several similar cases are recorded by medico-legal writers. In an attempt at suicide, which fell under my own observation, a stab was inflicted by a carv- ing-knife on the fore part of the neck traversing the parts from the windpipe to spinal column. In regard to situation, it has been remarked, that there is no wound which a suicide is capable of inflicting upon himself, which majf not be produced by a murderer ; but there are many wounds inflicted by a murderer, which, from their situation 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 degrees of probability. A remarkable instance of the singular situation selected for suicidal wounds is reported in the Medical Gazette, vol. xlv. p. 439. 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 generally exist on those parts of the body which are exposed. Some wounds, however, forbid the supposition of accident even when ex- posed ; as deeply-incised wounds of the throat, and gunshot wounds of the mouth and temples. For the report of a case in which an accidental wound on the head, by an axe, closely simulated a homicidal wound, see Gasper's Wochenschrift, May 24, 1845. 2. Evidence from the nature and extent of a wound. — Generally speaking, the wound met with on the body of a suicide, when fire-arms have not been used, is incised or punctured. Contused wounds are rarely seen in cases of suicide, because in producing them there is not that certainty of speedily de- stroying 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 any considerable 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, voluntarily inflicted. A case is related by a medico-legal writer in which a man first attempted to destroy himself by running with his head against a wall ; and not having succeeded in this attempt, he struck himself repeatedly on the forehead with a cleaver. By this he produced such violent injury to the brain, that death soon followed. The man was seen to commit the crime by several witnesses; had not this been the case, the nature of the wound 202 SUICIDAL WOUNDS BY MANIACS. was such as to excite suspicion that it had been inflicted by another, and that the man had been murdered. A close attention to the shape of wounds made by cutting instruments will sometimes lead to the development of cases rendered doubtful from the cir- cumstances under which the dead body of a wounded person is found. A few years since, the body of a farmer was found lying on a high-road, in one of the midland counties. The throat was severely cut, and he had evidently died from the bleeding which had taken place. A bloody knife was discovered at some distance from the body, and this together with the circumstance of the pockets of the deceased having been rifled, led to a suspicion of murder. The suspicion was confirmed when the wound in the throat was examined by a surgeon. It was cut, not, as is usual in suicides, by carrying the cutting in- strument from before backwards, but as the throats of sheep are cut, when slaughtered by a butcher. The knife had been passed in deeply under and below the ear, and been brought out by a semicircular sweep in front, all the great vessels of the neck, with the gullet and windpipe, having been divided from behind forwards. The nature of this wound rendered it at once impro- bable that it could have been self-inflicted ; and it further served to detect the murderer, who was soon afterwards discovered. The prisoner, who was proved to have been a butcher, was subsequently tried and executed for the crime. When persons laboring under insanity commit suicide, they often inflict upon themselves wounds of an extraordinary nature — such as would, at first view, lead to a suspicion that they had been produced by the hand of a mur- derer ; and, therefore, the rules which are here laid down to distinguish homicidal from suicidal wounds, must be guardedly applied to the cases of those individuals who are known to have been insane. A gentleman was found lying in a state of insensibility in the kitchen of his house, with a cleaver by his side. On' examiningthe head, upwards of thirty wounds were found over the posterior portion of the occipital bone. The wounds, many of which were superficial, had a horizontal direction from behind forwards. One, however, had removed a portion of the skull from the middle of the lambdoidal suture, so that the brain had escaped. This person, who was a lunatic, died four days afterwards, but recovered so far as to admit that he had produced the wounds on himself, of which, from other circumstances, there could be no doubt. This was a most unusual mode of committing sui- cide. Had the deceased been found dead on a public highway, thus wounded, it is probable that a suspicion of murder would have arisen. In 1850, a case occurred at Guy's Hospital, in which a person in a fit of delirium tore away the whole of the abdominal muscles from the lower and fore part of the ab- domen. Had the body of this person been found dead with such an unusual and serious personal injury, it is not improbable that it would have been pronounced homicidal and not suicidal. In this point of view, a case which occurred to Dr. W. B. Ryan is also of interest. The suicide here contrived to cut his throat exactly between the os hyoides and the larynx, having pre- viously made two distinct cuts on the thyroid cartilage. The wound was of an extensive kind, reaching backwards through the pharynx to the cervical vertebrae, one of which had been touched by the razor. The carotids and jugulars had escaped, but some of the larger branches were divided. The man survived about seven hours. {Med. Times, Jan. It, 1852, p. 13. For another case of extensive wounds in the throat.by a lunatic, see Med. Times and Gazette, August 2T, 1853, p. 219.) Cases of this kind should be borne in mind, when we are called upon to speak to the possibility or impossibility of certain wounds found on a dead body, having been self-inflicted. {Med. Gaz., vol. xxiv. p. 216.) The extent of a wound, by which we are to understand the number and WOUNDS — EVIDENCE FROM DIRECTION. 203 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 vertebral column, could not be inflicted by a suicide. 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 completely divided to the vertebral column. These are cases in which, perhaps, with a firm hand, there is a most determined pur- pose of self-destruction. In a case of suicide, observed by Marc, the weapon had 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 anterior vertebral ligament. A wound so extensive as this is rarely seen in cases of suicide ; but there is no ground for the assertion, that such extensive wounds in the throat are incompatible with self-destruction. Incised wounds in the throat are generally set down as presumptive of suicide ; but murderers sometimes wound this part for the more effectual concealment of crime. Circumstances connected with the form and direction of a wound, often, in such cases, lead to detection ; for, unless the person attacked be asleep or intoxicated, resistance is offered — evidence of which may be obtained by the presence of great irregularity in the wound, or the marks of other wounds on the deceased. In some instances, however, it is extremely difficult to say whether the wound is homicidal or suicidal — the medical facts being equally explicable on either hypothesis. (See case by Marc, Ann. d'Hyg., 1830, t. ii. p. 408; another by Devergie, ib. 414; and a third by M. Ollivier, Ann. d'Hyg., 1836, t. i. p. 394.) The nature and extent of a wound or of other injuries on the person, will sometimes allow us to distinguish accident from homicide. These personal injuries may be such, that they could not possibly have had a suicidal or accidental origin. In a case that occurred at Manchester, in October 1836, it was shown by the medical evidence, that seven ribs were fractured on one side of the chest of the deceased, and five on the other. The person charged with murder alleged in defence, that he had merely struck the deceased a ■slight blow, and that the ribs were broken subsequently by an accidental fall. The medical witness, however, satisfied the court that the fall, as described by the prisoner, was inadequate to the production of such extensive violence ; and that even had the deceased fallen on one side this would not account for the fracture of the ribs on the oilier. When, therefore, we find in a dead body, severe injuries referred to a fall, we should search the whole of the body carefully for marks of violence. The insides of the arms or thighs might present marks of injury, which could not possibly be explained on the suppo- sition of an accidental fall. Severe contusions on both sides of the body, or anteriorly and posteriorly, commonly indicate homicidal violence. 3. Evidence from the direction of a wound. — The direction of a wound has been considered by some to afford presumptive evidence sufficiently strong to guide a medical jurist in this inquiry. It has been remarked 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 down- wards ; in suicidal stabs and 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 reverse. 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 ti real assistance to the inquirer, especially when the body has not been moved 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 extremity moved towards the wouuded 204 WOUNDS INTLICTED BY THE EIGHT OR LEFT HAND. part, so that 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 observed : this may be the case in wounds situated on the back. It is obvious that if a murderer makes an incised wound in the throat from behind, the direction will be the same as that commonly observed in cases of suicide. (See on this point the case of Reg. v. Balmas, Cent. Cfim. Court., May, 1844.) Again, if the person attacked is powerless the wound may be deliberately made, so as to simulate a suicidal act ; indeed, murderers would seldom attack the throat, but with the design of simulating an act of suicide. A homicidal stab may also take the same direction as one which is suicidal; but this would be confined to those cases in which the murderer 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. Oblique 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 ; it is at least extremely rare, that a suicide, unless a lunatic, thus uses a weapon. Homicidal incisions, especially 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 grad- ually in a sharp angle, and the" skin itself is the furthest point wounded— the weapon is not carried either behind, below, or beneath it. Exceptions to these characters may exist ; but in a dark and intricate subject of this nature, we have only these 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 even- ness of the cut, and its length with the depth of the incision or stab. It is no uncommon occurrence for a murderer to substitute some instrument, be- longing to the deceased or another person, for that which he has employed ; and this by its size, shape, or bluntness, or other peculiarities, will not account for the appearances presented by the wound. Wounds inflicted hy the right or left hand. — Some remarks have been made in reference to the direction of a cut or a 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 ambidextrous, i. e., who have equal facility in the use of the right or the left hand. 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' Circ. .Evidence, p. 91.) He was found dead on his bed with the throat cut — the razor was discovered on the left side of the bed ; whereas it was generally supposed and asserted that he was a right-handed man. The truth was, he was ambidextrous — equally expert in the use of the razor with his left and right hand ; and thus the apparently suspicious circumstance of the razor being found on his left side, was at once explained away. Accidental stabs Severe incisions on vital parts do not often happen hy accident ; but severe punctures and stabs affecting vital organs have fre- quently an accidental origin. These stabs arise 'generally from falls, while the person is in the act of running with a pointed instrument in his hand or his pocket. There is one character which, when thus produced, they are commonly observed to possess, namely, that their direction is from below upwards. In this way the truth of a defence may be sometimes tested, as when a prisoner alleges that the deceased threw himself or fell upon the weapon. Homicidal stabs may be likewise directed from below upwards ; EVIDENCE PROM SEVERAL WOTINDS. 205 but this is somewhat rare, and not probable, unless the person is stabbed by an oblique blow, while in the recumbent posture. Rules of this kind may- appear to be susceptible of but little practical application ; yet cases occa- sionally present themselves, wherein a close attention to situation and direc- tion may materially assist a medical jurist in forming an opinion. In a case of alleged murder, which was tried in 1843 at the Central Criminal Court, the surgeon deposed that he found, on examining the body of the deceased, a stab on the left side of the chest, near the armpit, about six inches in depth. It had wounded the right lung, and had penetrated obliquely into the right auricle of the heart, passing from left to right. He contended, very properly, that, considering the situation and direction of the wound, it was very impro- bable that the deceased could have inflicted it upon himself. The fact that there may be some instances in which rules of this kind will not be ap- plicable, must not deter us from endeavoring to make a cautious application of them in doubtful cases. At the trial of a Mrs. Mackinnon for murder (1823), a careful observation of the direction of a stab in the chest clearly proved the falsehood of the defence. The deceased had been stabbed with a knife, and on an inspection of the body it was found that the wound, which was situated over the cartilage of the second left rib, penetrated towards the left, backwards, and very much downwards, into the lungs. On the part of the prosecution it was alleged that the prisoner held a long table-knife daggerwise, drew a blow from her left ear, and struck the deceased in a direction downwards, forwards, aiid to her right side. The prisoner alleged in defence that she merely held the knife before her, sloping upwards, to deter the deceased from attacking her ; that he stumbled forward, and fell upon the point of the knife. This state- ment was in some measure confirmed by some bystanders. As the witnesses on both sides were intoxicated and of disreputable character, the important medical fact to guide the jury was the direction of the wound. This was wholly inconsistent with the statement of the prisoner, but perfectly in ac- cordance with the evidence for the prosecution. {Ed. Monthly Journal, Nov., 1851, p. 418.) The presence of several wounds In suicides, commonly, one wound 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 considered 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. A case is reported in which a gentleman, laboring under mania, attempted to destroy himself. Besides many wounds on the fore-arm, neck, and face, which disfigured him, there were twenty-two in front of his chest. One of these had traversed the heart, producing death after some hours, by causing effusion of blood. {Lancet, July, 1839,) In wounds of the throat, owing to ignorance of the situation of vital parts, or to tremulousness of the hand, a suicide often produces one or more incisions of greater or less extent near that which may have destroyed him. This is especially the case when the instrument happens to lodge in the first instance on the cartilage of the larynx. The same remark applies to suicidal stabs, when the point of a weapon, in being directed against the chest, comes first in contact with the ribs or their cartilages. With respect to the throat, many cases might be cited in which two, three, and even six or more incisions have been made in this part by suicides before they have destroyed themselves. A case oc- curred to Dr. Handyside {Ed. Med. and Surg. Jour., Jan. 1838), in which a medical man destroyed himself by inflicting several wounds on his throat. Incisions were found on each side, just below the angle of the jaw and in the 206 EVIDENCE FEOM TWO OK MORE WOTTNDS, hollow behind it. They were irregular in form, and bore the character of deep stabs. The only important vessel divided vras the internal jugular vein on the right side; but, nevertheless, a large quantity of blood was lost, and this was, no doubt, the real cause of death. The case is in many points of view singular; for such wounds, so far as I know, have never before been found in cases of suicide. It would appear that the deceased was ambidextrous, and that the wounds on each side of the neck were inflicted by the hand of the opposite side. The following case, which occurred in London in 1839, is somewhat similar : A lady, who had been for several days in a desponding state, was found one morning dead in her bed in a sitting posture. On ex- amination, two very deep and extensive wounds, which had divided the principal bloodvessels, were perceived on the right side of the neck. There were two penknives on the bed covered with blood. Prom the situation and other characters of the wounds, it was inferred that they must have been in- flicted with the left hand: although nothing satisfactory could be ascertained on this point. The husband and son slept in the adjoining room. There was no doubt that this was a case of suicide; although it is singular that two deep wounds should have been found thus inflicted by two different weapons on the right side of the neck, in the case of a person who was not known to be left-handed. The use of several weapons. — In general, suicides, when foiled in a first attempt, continue to use the same weapon ; but sometimes, after having made a severe incision in the throat, they will shoot themselves, or adopt some other method of self-destruction. These cases can only appear 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 vifeapons, can be considered, of themselves, to furnish any proof of the act being homicidal. One instance has been already related, in which a lunatic, in committing suicide, inflicted thirty wounds upon 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 stab or cut may be close to a con- tusion or contused wound, and although a fall or other accident might ac- count for the latter, the former would indicate violence separately inflicted. Two or more mortal wounds. — When we find several wounds on the body of a suicide, it generally happens that one only bears about it a mortal cha- racter; 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 a body, and particularly if one of them is of a stunning or stupefying tendency (i. e., aft'ecting the head), they must be considered incompatible with suicide. An inference of this kind can be applied to those cases only in which the two wounds, existing on diflerent parts of the body, were likely to prove immediately fatal. It must, however, be borne in mind, that all sui- cides 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 was likely to destroy life so rapidly as to render it impossible for the person to have inflicted an- other 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. There are no rules by which, in unknown cases, the instantaneous mortality of wounds can be accurately determined ; a fact which will be apparent hereafter, from a description of wounds of the head, heart, and throat. It is not possible to say, from the mere discovery of marks of contusion or injury on the head, that the deceased must have necessarily labored under WOUNDS PRODUCED AT DIFFERENT TIMES. 20'! insensibility or concussion, and have therefore been afterwards unable to in- flict any other wound upon himself. Injuries of the head are attended with the most singular anomalies in this respect. One person will be rendered insensible and powerless by a blow which may leave scarcely any appreciable marks, while another will be able to walk and exert himself when the skull has been fractured and depressed, blood effused, and even when a portion of brain has been lost : in short, the appearances may be such as to induce many surgeons to, express an opinion that death must have taken place instanta- neously. It is quite right that a medical jurist should be fully prepared for the occurrence of such anomalous cases ; but a strong suspicion of homicide may fairly exist, when, besides marks of great injury to the head, a severe cut or stab is found on the body. A man is not likely to cut or stab himself after having sustained severe violence to the head ; but it is quite possible that he may have had the power of precipitating himself from an elevated spot, and thereby of producing great injury to the head, after having pre- viously attempted to cut his throat or to stab himself. 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 called 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, however, a question to which it is not easy to give a general 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. I here refer to it, because 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. The case of Reg. v. Spicer (Berks Lent Assizes, 1846) affords an illustra- tion of the importance of examining wounds minutely, as well as the locality where a dead body is found. The prisoner was charged with the murder of his wife, and the evidence against him was chiefly circumstantial. The de- ceased was found dead at the foot of a stair, as if she had accidentally fallen. The parietal bone was fractured, and the fracture had extended to the base of the skull. The brain was lacerated, and there was great effusion of blood. The second vertebra of the neck was fractured, and the spinal marrow torn through. These injuries were quite sufficient to account for death ; and had they existed alone, there might have been no reason to charge the husband with the murder. But there was a wound on each temple, partly lacerated and partly bruised, and a branch of the right temporal artery had been divided — this injury having been inflicted, apparently, with a pointed blunt instrument. There were marks of blood on the wall at the top of the stair- case, and a pointed stone, covered with blood, was found near the body. It was therefore obvious, as the deceased had fallen on the summit of the head, that the injuries to the two temples laterally, could not have been accident- ally produced, for there was no projecting body against which she could have fallen in her descent; and when the force of the fall had been spent on the head, her body could not have rolled over, so as to produce punctured and lacerated wounds on both temples. All the facts tended to show that a mur- derous assault had been made upon her at the top of the stair, and that she had afterwards fallen, or had been pitched, headlong backwards. The inju- ries received previous to the fall might have stunned her, and might not have sufficed to account for death ; but their nature and situation furnished strong proof that they could not have arisen from any causes operating simultane- 208 WOTJNDS — EVIDENCE EEOM CIKCUMSTANCES. ously, and that they were neither of accidental nor suicidal origin. The pri- soner was convicted and executed. {Med. Gaz., vol. xxxvii. p. 610.) If several wounds have been inflicted through the dress, an examination of this may sometimes suffice to show which was first received. A man, in strug- gling with an assailant, received three stabs with a knife — two on the left elbow, and the third in the back. The latter was at about the level of the eighth rib ; it was vertical to the chest, and had clean edges. The lower margin was obtuse — the upper acute ; hence it was evident that .the cutting edge of the weapon had been directed upwards. It had traversed the left lung and the heart, and had caused immediate death. It was obvious, on examination, that this mortal wound had been first received, and the stabs at the elbow inflicted subsequently. These two stabs, which were slight, had divided the cloth coat and shirt, and had only grazed the skin, so that no blood had been effused. But the edges of the cuts in the cloth coat and shirt were stained with blood ; hence it was evident that they must have been pro- daced by a weapon already rendered bloody by a previous wound. The fact was of some importance in the case, and the correctness of the medical opinion was confirmed by the evidence at the judicial inquiry. (See Ann. d'Eygilne, 1847, t. i. p. 461.) CHAPTER XXV. EVIDENCE FROM CIRCUMSTANCES — MEDICAL QUESTIONS — VALUE OF CIRCUM- STANTIAL EVIDENCE — THE POSITION OF THE BODY — OP THE WEAPON — THE WEAPON OR OTHER ARTICLES FOUND IN THE HAND OF THE DECEASED — EVI- DENCE FROM BLOOD ON WEAPONS — MARKS OF BLOOD ON THE PERSON, CLOTHES, OR IN THE APARTMENT — POSITION OF THE PERSON WHEN MORTALLY WOUNDED — EVIDENCE FROM WOUNDS ON THE DECEASED — NO BLOOD ON THE ASSAILANT — FALLACY RESPECTING MARKS OF BLOOD. ARTERIAL DISTINGUISHED FROM VENOUS BLOOD — EVIDENCE FROM THE FORM AND DIRECTION OF SPOTS OF BLOOD. Evidence from circumstances. — In pursuing the examination of the ques- tion respecting the homicidal or suicidal origin of wounds, the attention of the reader may be called to the force of evidence which is sometimes derived from the circumstances under which the body of a person, dead froin wounds, is discovered. It may be said that this is a subject wholly foreign to the duties of a medical jurist ; but I cannot agree to this statement : there are few in the profession, who, when summoned to aid justice by their science, in the detection of crime, do not seek for circumstances by which to support the medical evidence required of them. A practitioner would certainly be wrong to base his professional opinion exclusively on circumstantial proofs : but it is scarcely possible for him to avoid drawing an inference from these, as they fall under his observation. His evidence may be of itself weak, and insuffi- cient to support the charge against an accused party ; in such a case, if any suspicious circumstances have come to his knowledge, he may be often un- consciously induced to attach greater importance to the medical facts 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 evi- dence. But if a proper degree of caution is used in drawing inferences from the circumstantial proofs, and they are not allowed to create a prejudice in ■WOUNDS — CIRCUMSTANTIAL EVIDENCE. 209 his mind against the accused, a practitioner is, I think, bound to observe and record them ; for being commonly the first person called to the deceased, many facts, capable of throwing an important light on the case, would remain unnoticed or unknown, but for his attention to them. The position of a dead body — the distance at which a knife or pistol is found — the direction of the instrument — whether situated to the right or left of the deceased — the marks of blood or wounds about the person, 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 without the assistance of a medical man. In the case of Davidson, who was tried for murder before the Aberdeen Spring Court of Justiciary, April, 1855, the origin of certain wounds on the head of the deceased turned on the question of the presence or absence of nails at the head of the bed. On this occasion Lord Deas, the judge, re- marked : "A medical man when he sees a dead body should notice every- thing." There was reason to believe that some nails had been driven into the head of the bed subsequently to the infliction of the violence, so as to give the appearance of the wounds having resulted from accident. There was some medical evidence in support of the view of their accidental origin, but according to Dr. Ogston there was no blood on the bedstock where the nails were represented to have been : and as the woman had died from bleed- ing, this was not likely to have escaped being stained with blood. In his opinion, too, the nails would not have accounted for the wounds on the temple as the result of accident. The whole of the difficulty in this case appears to have arisen from want of proof that there were no nails in the bedstock when the woman was found dead. The prisoner was discharged on a verdict of "not proven." 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 an- swering either of these questions, it is necessary to take into consideration the extent of the wound, and the period 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 consideration of the nature of circumstantial evidence," observes Starkie, " and of the principles on which it is founded, merits the most pro- found attention. It is essential to the well-being, at least, if not to the very existence of civil society, that it should be understood, that the secrecy with which crimes are committed will not insure impunity to the offender. At the same time it is to be emphatically remarked, that, in no case, and upon no principle, can the policy of preventing crime and protecting society warrant any inference which is not founded on the most full and certain conviction of the truth of the fact, independently of the nature of the offence and of all extrinsic considerations whatever. Circumstantial evidence is allowed to prevail to the conviction of an offender, not because it is necessary and politic that it should be resorted to, but because it is in its own nature capable of producing the highest moral degree of certainty in its application. Fortu- 14 210 ■WOUNDS — MEDICAL CIKCTJMSTANOES. nately for the interests of society, crimes, especially those of great enormity and violence, can rarely be committed, without affording vestiges by which the offender may be traced and ascertained. The very measures which he adopts for his security, not unfrequently turn out to be the most cogent arguments of guilt. On the other hand, it is to be recollected, that this is a species of evidence which requires the utmost degree of caution and vigi- lance in its application : and, in acting upon it, the just and humane rule, impressed by Lord Hale, cannot be too often repeated: tutius semper est errare in acqnietando quam in puniendo, ex parte misericordite quam ex parte justitise." (Vol. i. p. 480.) Evidence is direct when a fact is proved by wit- nesses, and circumstantial when the fact is at once proved by circumstances. More commonly the evidence is presumptive, i. e., founded on an inference from circumstances. The common rule respecting the admissibility of this kind of evidence ap- plies to circumstances of a medical as well as those which are of a physical or moral kind. Medical circumstances, when properly observed, are often of the highest importance. In order to convict an accused person on circum- stantial evidence, the facts proved in the case should square with the hypo- thesis of his guilt, and be utterly inconsistent with his innocence ; or, in the language of another learned judge, a certain number of material facts should be incontestably proved in the case, which are quite inconsistent with the in- nocence of the prisoner. These facts should be such as to render it impos- sible in the minds of the jury, that any one but the prisoner could have com- mitted the murder. The late Baron Alderson, in charging a jury to this effect made an observation which should be remembered by medical witnesses, in reference to circumstantial evidence. He pointed out to them " the prone- ness of the human mind to distort the facts in order to establish such a pro- position (the guilt of the prisoner), forgetting that a single circumstance which is inconsistent with such a conclusion, is of more importance than all the rest, inasmuch as it destroys the hypothesis of guilt." There are many cases on record in which an observance of slight and un- expected circumstances by medical men has led to the detection of offenders. In the Life of Sir Astley Cooper, it is mentioned, that when called to see Mr. Blight, of Deptford, who had been mortally wounded by a pistol-shot in the year 1806, he inferred from an examination of the localities, that the shot must have been fired by a left-handed man. The only left-handed man near the premises at the time was a Mr. Patch, a particular friend of the deceased's, who was not in the least suspected. This man was, however, subsequently tried and convicted of the crime : and he made a full confession of his guilt before execution. The rules for investigating a case of poisoning (see p. 40) may be equally observed in many cases of death from violence. Among the circumstances to which a medical witness should specially direct his attention on these oc- casions are the following : — 1. The position of the hody, — The body may be found in a position which the deceased could not have assumed on the supposition of the wound or in- jury 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 determine 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 decomposition, and to what degree this may have advanced. In the case of a female who was found dead in her apartment with her throat cut, in November, 1847, it was ascertained that when first discovered, the body was so warm as to render it highly probable that the crime must have been committed within an hour. This observation tended to prove the innocence of a party who was suspected of the murder, WOUNDS — POSITION OF THE WEAPON. 211 because it was known that he had been absent from the house for at least five hours. Criminals sometimes unknowingly furnish important evidence in reference to the condition of the body. In Reg. v. Hopley (Lewes Autumn Assizes, 1860), the prisoner was convicted of flogging a pupil to death. There was reason to believe that the boy died during the actual beating. The accused stated before the coroner that he went into deceased's bedroom about six , o'clock in the morning, and found deceased dead, his body cold, and his arms stiffening. He suggested that he might have died from natural causes. It was proved that the prisoner was heard in the act of beating deceased up to 11.30 on the previous night, and as the body was cold when found, and rigidity was commencing, there was a strong probability that deceased must have been dead at least six or seven hours, and, therefore, at the time when the prisoner was last known to be with him. The body was well developed, covered with bedclothes, and the temperature not at the time low. 2. The position of the loeapon. — If a person has died from an accidental 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 consider 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, all evidence from the relative position of it and the weapon will be inadmissible. In a case which was referred to me some years siuce, a woman had evidently died from a severe incision on 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 turned over before it was seen by the surgeon who was first called. We must re- member that it is quite compatible with suicide that a weapon may be found at some distance, 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, and the razor lying closed or shut by his side. In another case, the bloody razor closed, was found in the deceased's pocket. In the case of a Captain Wright, who was found dead in one of the French prisons (during the war with France), it is stated on good authority that the razor shut, was held in the hand of the deceased. In a wound involving the great blood- vessels of the neck, it is most improbable that there should be any power to close or shut the razor with which the wound was inflicted ; and there are fair grounds to suspect interference when a razor is thus found closed. There is, however, one circumstance in relation to a weapon strongly confirmatory of suicide. If the instrument is found firmly grasped in the hand of the deceased, no better circumstantial evidence of suicide can, perhaps, be offered. It is so common 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 persisting after death, and manifesting itself under the form of what has been called cadaveric spasm — a condition quite distinct from rigidity, although often running into it. It does not seem possible that any murderer could imitate this state, since the relaxed hand of a dead person cannot be made to grasp or retain a weapon, like the hand which has firmly held it by powerful muscular contraction at the last moment of life. Of this the case of Reg. V. Saville (Nottingham Summer Assizes, 1 844); furnishes an illus- tration. A woman was found dead with her throat cut, and there was a razor loose in her hand. There was no blood upon the hand which held the razor, and this, together with the fact of its being quite loose, rendered it 212 WOUNDS — CONDITION OF THE WEAPON. certain that it mast have been placed there by the prisoner after having cut his wife's throat. A case, in which the facts were somewhat similar, was tried at the Liverpool Winter Assizes, 1855 {Reg. v. Heywood). The de- ceased in this case, a female, was found dead in bed with her throat cut. The medical evidence showed that the wound was six inches from right to left — extending across the throat to a point under the left ear, the upper portion of the windpipe was severed, and the jugular vein, as well as the muscul.ar branches of the carotid artery, were divided. The medical wit- nesses considered that the wound in the throat had not been inflicted by herself It was such a wound as a /e/i-handed person would have inflicted, and the hand inflicting it, as well as the weapon, could not have escaped being marked with blood. It appears, that when the body was found there was a razor in the right hand, not tightly held. The arms were folded across the chest, the right hand resting on the left, the back of the razor being towards the person of deceased. There was no Hood on the hands, arms, or chest, and only one small spot on the razor. There was blood on the under side of a pillow, and a corresponding stain on the bolster, showing that this must have been turned over, and the head placed on the clean side after the infliction of the wound. All the circumstances concurred in showing that an attempt had been made to simulate an act of suicide, while the facts were only consistent with homicide. The prisoner was connected with the act by the moral as well as circumstantial evidence, and he was convicted and executed. The deceased may be found with some article grasped in the hand. (See case, Ann. d'Hyg., 1829, t. i. p. 464.) It may be her own or the prisoner's hair torn off in the'struggle for life ; and on this point a question of identity may be easily raised. {Reg. v. Ellison, Bodmin Summer Assizes, 1845.) In a case which occurred to Dr. Marc, a woman was found assassinated in her house, and when the body was discovered, a small snuff-box was still held firmly in one hand. This proved that the murder must have taken place very suddenly, and without anv resistance on the part of the deceased. {Ann. d'Hyg., 1829, t. i. p. 465.) If the weapon cannot be discovered, or if it be found concealed in a distant place, this is strongly presumptive of homicide, provided the wound be qf such a nature as to prove speedily fatal. In the case of Lord William Russell (1840) no weapon could be discovered : and although the wound in the throat bore some of the characters of a suicidal incision, the absence of the weapon was sufficient to show that it must have been the act of a murderer. With respect to the weapon being found at a distance from the body, other circumstances should be taken into consideration before any opinion is ex- pressed. We may observe whether the weapon, if it be a sharp cutting instrument like a razor, has been recently notched ; for this might show that a degree of force or violence has been used, not easily reconcilable with the suicidal use of the instrument. The well-known case of the Uarl of Essex, who was found dead in the Tower, in July, 1683, gave rise to a doubt on this point. The deceased was discovered with his throat cut, and a razor without a handle lying near him. This razor was found to be much notched on the edge, 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 notched the razor by drawing it 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 completely divided I WOUNDS — BLOOD ON WEAPONS. 213 3. Blood on weapons. — It does not always happen that the weapon with which a wound has been inflicted is covered with blood. It has been re- marked, that in the case of stabs, the knife is frequently without any stains of blood upon it; or there is only a slight film, which, on drying, gives to the surface a yellowish-brown color. The explanation of this appears to be that in a rapid plunge the vessels are compressed, so that a 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 out- side of the dress should present a bloody mark, unless the weapon had pre- viously been wiped. The blood may have been removed by washing from the blade of a knife or dagger. The handle and inner portions should, there- fore, be closely examined. In a case of alleged murder (Nov. 1857), I found no blood on the blade of a knife or in the notch for opening it : but on re- moving the buck-horn handle, I found a coagulum of blood between this and the plate of iron to which it was riveted. When a weapon is bloody, particular attention should be given to the manner in which the blood is diffused over it. In cases of imputed wounds, or in the attempted concealment of murder, it is not unusual for a criminal to besmear with blood a knife or other weapon which has probably not been used. A case of this kind occurred to the late Dr. Marc. A young man alleged that he had received a cut on the forehead by a blow from a cutlass, which he produced. It was remarked, that the weapon was smeared with blood on both surfaces: but the layers were thicker towards the handle than at the point. The wound on the forehead was a clean incision; a cap, which the complainant wore, had been cut through. It was obvious, therefore, that the blood on the weapon could not have proceeded from this cut : for it would have been wiped, or only left in thin streaks, and more towards the point than the handle, by the act of drawing it through the clothes in pro- ducing the wound. There was no doubt that blood had been intentionally apyjlied to the blade. {Ann. d'Eyg., 1829, vol. i. p. 263.) The blood on a weapon may be in a partly coagulated state, and not dif- fused as a mere film. This would render it probable that it had issued from the body of a living person or animal, or from a body recently dead. The blood of a dead animal dried in small spots on the blade of a knife may some- ti'taes present a similar appearance, and thus lead to a mistake in evidence. This question arose in the case of Reg. v. Nation (Taunton Spring Assizes, 1857). Deceased was found dead in a cart, with his throat cut, and there could be no doubt that this was an act of murder. The prisoner, who had been last seen in his company, was arrested, and a knife was found in his possession, on the blade of which there were marks of blood. On the part of the prosecution, it was contended that the knife had been used for cutting the throat of the deceased, while, according to evidence given for the defence, it had been used for cutting raw meat (beef). Mr. Herapath, who was called for the prosecution, stated that the knife had been immersed in living blood up to the hilt — that it was not the blood of an ox or a sheep, and that there were on the blade of the knife certain scales or empty cells, such as are found in the mucous membrane of the throat (epithelial scales ?). They were much larger than the globules of the blood, and were perfectly distinguish- able by the microscope. From the appearance he thought the knife had passed through the mucous membrane which forms the lining of the throat I If this evidence were trustworthy there was an end to the defence ; and with the admission of the statement that there were scales of the mucous mem- brane of the throat (the gullet ?) upon the blade, no further proof was re- 214 StTBSTANOES ON WEAPONS AND IN WOUNDS. quired that the weapon had been used for cutting a throat. Fortunately for the ends of justice, there were other circumstances which brought the crime home to the prisoner, and he was convicted. {Med. Times and Gaz., April 11th, 1857.) Chief Justice Cockburn, in commenting on these microscopic subtleties, said: "Mr. Herapath took upon himself to say it was not the blood of a rfeac? animal. It was living blood, and human blood; and he had shown them the marvellous powers of the modern microscope. At the same time, admitting the advantages of science, they were coming to great niceties, indeed, when they speculated upon things almost beyond perception, and he would advise them not to convict upon this scientific speculation alone." 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 be of a bruising kind. The main question will be, in such a ease, whether the hair is that of a human being or of an animal. The importance of examining closely the hair found on weapons is shown by a case quoted by Dr. Lyons, in which a hatchet having clotted blood and hair adherent to it was produced as evidence against an accused person, under whose bed this weapon had been found. This, with other circumstantial evidence, had turned public opinion strongly against the prisoner, when a physician who happened to be in court, examined the hair with a pocket lens, and pronounced that it was not human, but belonged to some animal. This circumstance led to a more complete sifting of the evidence, and the accused was acquitted. It turned out that he had killed an animal with the hatchet, and had carelessly thrown the weapon under the bed. {Apology for the Microscope, p. 24.) In Reg. v. Hansen (Bodmin Lent Assizes, 1856) the weapon by which the deceased lost his life was a heavy stone found near the dead body. The base of the skull was fractured, and there were upon the stone, marks of blood with some hair similar to that of the deceased. The prisoner was connected with the act by his having been seen with the stone, or one closely resembling it, in his possession. On these and other circumstances he was convicted. Before any coagulated blood is removed from a weapon it should be ex- amined carefully by the microscope. Hairs or fibres of linen or cotton, or other substances, 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 Reg. v. Harrington (Essex Lent Assizes, 1852), a razor was produced in evidence, with which it was alleged the throat of the de- ceased had been cut. I examined the edge microscopically, and separated some small fibres from a coagulum of blood, which, under a high magnifying power, turned out to be cotton fibres. It was proved at the trial that the assassin in cutting the throat of the deceased, while lying asleep, had cut throup;h one of the strings of her cotton nightcap. This was a strong cir- cumstance to show that the razor produced was the weapon with which the fatal wound had been inflicted. 5. Foreign substances in wounds. — In gunshot wounds, the examination of wadding or paper found in a wound or near a dead body has in more than one instance led to the detection of the person who had committed the crime. His hand-writing 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 his possession. 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 Summer Assizes, 185T). The peculiar character of the wadding found in the body connected the prisoner with the act. Foreign substances are sometimes discovered in contused or lacerated wounds : and these may throw an important light on the circumstances under BLOOD ON CLOTHING AND FURNITUKE. 215 which the crime was perpetrated. In Beg. v. Eazell (Taunton Lent Assizes, 1848), the body of the deceased was found in a well. When examined, there were on the head several severe wounds quite sufBcient to account for death. There was much blood on the clothes and face, and in the blood were stick- ing a quantity of hay-seeds, which led the medical witnesses to consider that the wound must have been inflicted in a stable or in some place where there was hay. On examining a neighboring stable, the spot where the murder was committed was rendered evident by the discovery of marks of blood. There may be found in the wound a portion of the weapon. The preser- vation of this is important, as it may serve to connect the prisoner with the act, should his criminality be otherwise doubtful. In Reg. v. Be Salvi (C. 0. C. October, 185T), it was proved that the deceased died from a stab in- flicted on him by the prisoner. Two inches of the pointed portion of the blade of a knife were found imbedded in one of the vertebrae. The spinal cord had been divided, and paralysis ending fatally, was a result of the wound. The identity of the weapon was not only established, but the force with which it had been used by the prisoner was clearly indicated. 6. Marks of Mood on clothing or furniture. — It is proper to notice all marks of blood on the clothes of the deceased or in the apartment, and ob- serve where the greatest quantity of blood has been effused : this is generally found in the spot where the deceased has died. The deceased may have bled in more places than one; if so, it is proper to notice whether there is any communication in blood between these different places. Blood on distant clothes or furniture will show whether the deceased has moved about, and whether he has struggled much after receiving the wound. Acts of locomo- tion by a wounded person who has died from loss of blood, or by a crimi- nal whose hands and feet may be bloody, are generally indicated by tracks or marks of blood. The observation of these marks is of medical importance at the time that a dead body is found. They may be so situated as to show that the body 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 suicide. In Reg. v. Hatto (Bucks Lent Ass., 1854), a mark of blood, as from the smear of a hand, was traced along a passage of the house in which the body of the deceased was found. The mark was continued over the door-post into a back room, which was found locked and bolted on the inside. The crime was thus fixed upon the prisoner ; for no one breaking into the house in front could have had access to this room. The evidence thus brought against him was-derived from his feeling his way with a bloody hand in the darkness after the murder. He was not at the time aware that he was thus leaving impressions which would show that no one but himself could have perpetrated the crime. It is a fair subject of medico-legal inquiry on these occasions, whether there are any marks of blood about the apartment, which no one but the assassin could have produced. 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 opinions should there- fore be expressed with caution. In the case of Hatto (Bucks Lent Assizes, 1 854), the clothes said to have been worn by the prisoner on the night of the murder were sent to me for examination. On the shirt there were no marks of blood : on the trousers and cap there were a few stains of blood ; but it was admitted that, from the appearance of these, they might have been on the clothes five or six weeks, and therefore several weeks prior to the date of the murder. Owing to this want of certainty respecting date, the clothes were not produced in evidence ; and it subsequently turned out by the con- fession of the prisoner, and the discovery of other articles of dress in places where he admitted he had concealed them, that those which had been ex- 216 WOtrNDS — BLOOD-STAINS ON THE CLOTHING. amined were not the clothes worn by him when he perpetrated the murder I In the case of Munro (Cumberland Spring Assizes, 1855), the clothes sup- posed to ha?e been worn by the prisoner were also sent to me for examina- tion. There was no blood on the trousers, and it appeared from the evidence given at the trial that the prisoner had changed this article of dress. We must observe likewise, whether, if the wound be in the throat or chest, blood has flowed down in front of the clothes or person, or whether it has flowed so as to collect in the armpits; for these appearances will sometimes show whether the wound was inflicted when the person was standing, sitting, or lying down. If the throat is cut while a person is lying down, it is ob- vions that the blood will be found chiefly on either side of tlie neck, and not extending down the front of the body. Pew suicides cut the throat while in a recumbent posture, and the course which the blood has taken may, there- fore, be sometimes rendered subservient to the distinction of a homicidal from a suicidal wound. The position in which the body was, when the wound was inflicted, is a frequent question on inquests and criminal trials. In the case Q^ Lord William Russell {Reg. v. Gourvoisier, C. C. C. 1840), the throat had evidently been cut while the deceased was lying in bed ; the blood was effused on each side of the neck only. There was also found a wound on the thumb of the right hand of the deceased, which was probably inflicted at the time the hand was put up to defend the throat. Recent wounds on the back of one or both hands, when found in persons who have died from wounds in the throat, are, cseteris paribus, strongly presumptive of homicide. There may, however, be no marks of wounds on the back of the hands, if the person was attacked unexpectedly — if he was intoxicated, or rendered powerless, or if several had combined to attack him, while he was pinioned and held by an accomplice. If the deceased had been wounded with his clothes on, we should notice whether any part of his dress has or has not been cut or injured over the situation of the wound : — whether the cut portions of dress are bloody, and whether the blood has been effused or applied on the inside or outside. When, together with a wound in the throat, we find the cravat and the shirt, or part of the dress, cut through, this is, all other circumstances being equal, strongly presumptive of homicide ; for it is not usual that a suicide, unless laboring under confirmed insanity, would allow any mechanical obstacles of this kind to remain as an obstruction to the use of a weapon. In a case of homicidal wound of the throat, inflicted in the recumbent posture, the cravat of the de- ceased had been lifted up, and afterwards allowed to drop over the wound in order to conceal it. The importance of examining the dress, and comparing it with the marks of violence on the body, has already been pointed out. (See case by Mr. Codd, ante, p. 199.) The nature of the dried spots of mud on clothing may occasionally serve to connect an accused person with an act of murder. In the case of the Queen v. Snipe and others (York Winter Assizes, 1852), evidence was ad- duced to show that some spots of mud on the boots and clothes of the pri- soner, when examined microscopically, presented infusorial shells, and some rare aquatic vegetables, particles of soap, confervs, and hairs from the seeds of groundsel. The mud of a ditch close to which the body of the deceased was found, presented the same microscopic appearances as the mud on the prisoner's boots ; and the witness who gave this scientific evidence, deposed that in his opinion the mud-spots were derived from this ditch. He had exa- mined the mud of all the other ditches in the locality, and found it to be dif- ferent. Admitting the opinion to have been correct, this circumstance clearly connected the prisoner with the act ; and it was borne out by the fact that he had been seen near the spot on the night of the murder. In a recent case (Nov. 1857) I found granules of wheat-starch mixed with the blood-stains on ARTERIAL AND VENOUS BLOOD. 21T the gaiters of a man charged with murder. He had been just before the oc- currence engaged in sowing seed-corn. 7. Marks of blood on the person. — All marks or stains of blood on a dead body require special observation. The impression 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 bloody impression of a left hand upon the back of the hft hand of the deceased, in such a position, that it was quite impossible the deceased himself could have made the mark ! In all cases we should notice whether the itiside or outside of the hand, or whether one or both hands, are marked with blood, and to describe the size and position of the marks. Stains of blood on the dress of a wounded person may often furnish important circumstantial evidence. If there are several stabs or cuts on the body involving the dress, it should be observed whether the edge of one or more of them is stained with blood, as if from the wiping of a weapon, and whether the stain is on the outside or inside of the article of dress {a7ite, p. 213). In simulated personal injuries, the stain of blood may be, through inadvertence, applied to the outside of the dress — a fact which might, in some instances, lead to the detection of the imposture. (See case by Dr. Bayard, Ann. d'Hi/ff., 184*?, vol. ii. p. 219.) In judging from marks of blood in the apartment, we must take care that we are not un- consciously misled by the accidental diffusion of this liquid by persons going in and out. The following case, which occurred in France, will show the necessity of extreme caution. A young man was found dead in his bed- chamber with three wounds on the front of his neck. The physician who was first called to see the deceased had, unknowingly, stamped in the blood with which the floor was covered, and had then walked into an adjoining room, passing and repassing several times ; he had thus left a number of bloody foot-prints on the floor. No notice was taken of this at the time ; but on the following day, when the examination was resumed, the circum- stance of the foot-prints was particularly attended to, and excited a suspicion that the young man had been murdered. Ttie suspected person was arrested, and would have undergone a trial on the charge of murder, had not M. Marc been called in to examine all the particulars of the case. A similar circum- stance occurred in the case of Uliza Grimwood, who was murdered at Lam- beth in June, 1838. 8. Arterial distinguished from venous blood. — It is not possible to distin- guish arterial from venous blood by any physical or chemical characters, when it has been for some days effused, and has fallen upon articles of dress or fur- niture; but this, in medico-legal practice, is not often a subject of much im- portance, since there are few cases of severe wounds, either in the throat or other parts of the body, in which the two kinds of blood do not escape simul- taneously. The most striking and apparent difference between them, when recently effused, is the color ; the arterial being of a bright red, while the venous is of a dark red hue ; but it is well known that the latter, when ex- posed to air for a short time, acquires a florid red or arterial color ; and the two kinds of blood, when dried, cannot be distinguished by any known crite- rion. If the coat or other stuff, covered with blood, were of a dark color, the liquid would be absorbed and lose its physical characters. Arterial blood contains more fibrin than venous, and coagulates more firmly. Even the microscope shows no appreciable difference in the blood-corpuscles ; and chemistry does not enable us to apply any test so as to make a satisfactory distinction between them. In this deficiency of microscopical and chemical evidence, an attempt has been made to establish a distinction by noticing the physical appearances of the blood-stains. Thus, it is alleged, arterial blood 218 WOUNDS — FORM AND DIEEOTION OF SPOTS OF BLOOD. will be indicated by its being sprinkled over surfaces upon which it has fallen, while venous blood is always poured out in a full stream. In most wounds which prove fatal by bleeding, the blood is poured out simultaneously from arteries and veins. The sprinkled appearance of blood, when it exists, will, ccBieris paribus, create a strong presumption that it was poured out from a living body ; for, after the heart has ceased to act, the arteries lose the power of throwing out the blood in jets. This mode of distinguishing arterial from venous blood was adduced as evidence in the case of Sellis, who destroyed himself after having attempted to assassinate the Duke of Cumberland. There was the appearance of sprinkled blood on the coat-sleeve of Sellis, and the temporal artery of the duke had been wounded in the struggle. Sir Everard Home thence inferred that Sellis had attacked the duke, and wounded the artery, which had led to the sprinkling of the sleeve. (Will's Oirc. JEv., 98.) This physical method of distinguishing the two kinds of blood, therefore, may be occasionally available for practical purposes ; but it must be remembered that accident may lead to the sprinkling of blood from a small vein which has been wounded, while blood may be poured out in considerable quantity from an artery, especially if large ; and if it fall on one spot at a short dis- tance it may produce a soaked appearance. The sprinkling may be expected only when the wounded artery is small, and the blood is effused at a distance. This is a fact which a medical jurist should not overlook, although, for the reasons stated, too great a reliance must not be placed on it. The blood, if thrown out from a living bloodvessel, very speedily consolidates in small spots ; and the fibrin, with the greater portion of the coloring matter, is found of a deep red color at the lower part of the spot, the upper portion being of a pale red. The lower and thicker part has commonly a shining Instre, as if gummed, when the spot is recent, and when it has been effused upon a non- absorbent surface. The glazed appearance is probably given by the evapo- ration of the aqueous, and the rapid desiccation of the albuminous portion. When the blood falls upon porous articles of clothing, as linen or cotton, it is absorbed and produces a dull stain. In dark-colored articles of dress, it is difficult by daylight to perceive these stains. The part appears stiffened, and there is a dull red-brown color, which is sometimes more perceptible when seen by the reflection of the light of a candle. Stains of tobacco, or of the juices of certain vegetables, may present the appearance of those of blood. Such mistakes frequently occur. The distinction between them will, however, be rendered immediately apparent by the application of the micro- scope, and of the chemical processes to be hereafter mentioned. (See Blood- stains.) In trusting to the coagulaiion of the blood as evidence of its escape from a living vessel, it must be remembered that there are certain diseases, as scurvy and typhus, in which, owing to morbid causes, the blood does not readily co- agulate after death : while, again, some hours elapse before it coagulates in the healthy body after death. Hence blood which has escaped from a recently dead body, although it would not be found diffused as if by spirting, might, in so far as coagulation is concerned, assume the appearance of having been effused from a living body. (See case of Reg. v. Nation, ante, page 213.) On this fact Donne has founded a process for determining whether a person is really dead. {^Qours de Microscopie, p. 54.) 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 posi- tion of the person with respect to them when the wound was inflicted. Thus, if the form of a spot is oval and elongated, the presumption is that the per- son was placed obliquely with respect to the stained furniture, during the hemorrhage. {Ann. d'Hyg., 1840, p. 39Y.) The force with which the blood has been thrown out, will be in some measure indicated by the degree of ob- INSPECTION OP THE BODY. 219 liquity and length of the spot. This is in general wide and rounded at the upper part but narrow and pointed below. The case of Spicer {ante, page 207) furnishes some suggestions on the importance of evidence occasionally derived from an examination of the form and direction taken by spots of blood. At the top of the stair, and at the height of four or five feet above the level, several spots of blood were observed upon the brick wall. These were ren- dered evident by the wall having been recently white-washed. The spots took an oblique direction from above downwards, were of a pale red color at the upper part, but dark red below, terminating in a point consisting of the fibrin and the greater part of the red coloring matter. Their form and re- gularity proved that they had proceeded from a small artery, and that the wounded individual could not have been very distant from the wall, while their shining lustre rendered it probable that they were of recent origin, and their well-defined termination in a firm coagnlura, showed that they had pro- bably proceeded from a living bloodvessel. The deceased had died from fracture of the skull and vertebral column by a fall from the top stair ; one branch of the right temporal artery was found divided, and this wound could not have been produced by the fall. It was therefore evident that a murder- ous assault had been made upon the deceased at the top of the stair, and this had led to the spirting of the arterial blood on the brick. The height at which the spots existed, and their appearance, proved that the jet of blood had been from above downwards; thereby rendering it probable that deceased was standing up, or that her head was raised at the time the wound was in- flicted. Further, as the brick with the spots was on the left hand in the descent, and the wounded artery was on the right side, it is probable that deceased was face to face with her assailant in the act of ascending the stairs, and that she was killed by being precipitated backwards to the bottom. The position in which the body was found in the cellar corroborated this view. (See Med. Gaz., vol. xxxvii. p. 612.) 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 from being given. In the case of the Duchess of Praslin, there were the marks of finger nails around the mouth. In another case, ecchymosed impressions, as if produced by a hand, were found upon the throat of the deceased. The hands of the dead person should always be examined ; many cuts, excoriations, or incisions, found upon them, especially if on the dorsal surface (back), 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 presence or absence of food, mucus, or blood, may furnish evidence of considerable importance in the elucidation of the case. Thus, in the stomach of the Duchess of Praslin, a quantity of bloody froth was dis- covered. This rendered it certain that she had lived sufficiently long to swallow a quantity of saliva mixed with blood, and that probably she had made some attempts to give an alarm. The fact that several days have elapsed since death, will not prevent the discovery of food in the stomach, provided it has been taken within one or two hours before death : since the digestion of food does not appear to go on to any perceptible extent after death. I have thus discovered food in the stomach twenty-eight days after interment. This question connected with the digested or undigested state of the food found in the stomach, frequently arises on criminal trials. (See Spicer's case, ante, p. 207.) 220 SUICIDAL WOUNDS. CHAPTER XXVI. DISTINCTION OF SUICIDAL PROM ACCIDENTAL WOUNDS — WOUNDS ON THE THROAT — FACTS INDICATIVE OF SUICIDE, HOMICIDE, OR ACCIDENT — IMPUTED OR SELF- INFLICTED WOUNDS — MOTIVES FOR THEIR PRODUCTION — CHARACTERS OF IM- PUTED WOUNDS — RULES FOR DETECTING FALSE CHARGES. Suicidal wounds. — It is not often that any difficnlty is experienced in dis- tinguishing a suicidal from an accidental wound. When the 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 reconcilable 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 transported 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 direction of the wound by which tlie deceased has fallen. It is unnecessary to dwell further on this subject, since the observations made in the preceding pages will sug- gest to a practitioner the course which he should pursue. Circumstantial evidence is commonly sufiicient to show whether a wound has been accident- ally 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 inspec- tion of the wound. Homicide is only liable to be confounded with accident in relation to contusions and contused wounds. In cuts and stabs, the evi- dence of design will be in general too apparent to allow of any doubt being entertained respecting the real origin of the injury. It would not be difficult to produce many instances in which murderers, in their defence, have alleged that the wounds observed in 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 secrecy, 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 felo- nious homicide, on the question whether the wound might or might not have been accidental. Our law requires that it should be rendered evident to a jury, before such a charge can be sustained, that the fatal wound could not have been accidental or suicidal. Hence this preliminary question is deserving of the attention of a medical jurist. The death of a person from wounds has hitherto been considered as a subject connected with a criminal charge ; but an investigation of the cir- cumstances under which death ensues, is occasionally rendered necessary when the deceased has effected an insurance upon his life. A policy of life- insurance is in some cases rendered void by the act of self-destruction ; and therefore an individual bent on suicide might, for the sake of his family, take precautions to conceal the manner in which he intended to destroy himself His body might be found wounded in a manner which would render it uncer- tain whether he had been wounded accidentally, whether he had been mur- dered, or whether he had fallen by his own hand. In a disputed case, it is IMPUTED OR SELF-INrilCTED WOUNDS. 221 incumbent on the Office to prove the act of suicide {felo de se), while the relatives of the deceased would attempt to show the contrary. Such litiga- tion must, of course, call forth a searching investigation into all the circum- stances connected with the death of an insured party, and the whole case would, in some instances at least, rest almost exclusively on medical evidence. {3Ied. Gaz., vol. xxxvi. p. 826.) The late Mr. Dodd, of Chichester, consulted me on the following case : — He was called to examine the body of a woman, who was found dead with her throat cut. The deceased, when seen by him, was lying on her back, and the razor with which the wound was inflicted, was found under the left shoulder. On inquiry, it was ascertained that, when first seen, she was lying on her face, and the body had been turned round on the back. Blood had evidently run down the forepart of her person, rendering it probable that she had been wounded while in the erect position. The incision in the throat was deep, and extended obliquely from the right side of the chin, to within about an inch of the left collar-bone. It had divided the windpipe, the gul- let, all the muscles of that side of the forepart of the neck — the carotid artery, jugular vein, and the muscles on the forepart of the spine, penetrating even into the bodies of the cervical vertebrae. The incision was double — one superficial, close under the chin, and the other, the deeper one, appeared to be continued from this. The deepest part of the right end of the incision was nearly three inches in a direct line behind the right angle of the wound, so that it extended at that part behind and beneath the sound skin. The cut was four and a half inches long, and two and a half deep. The main question was, whether this could have been a suicidal wound, inflicted by a razor, the only weapon found near the body. Considering its character, Mr. Dodd in- ferred that it must have been inflicted by another person, and not by the deceased upon herself. The deceased was right-handed, which would have added to the difficulty of supposing the wound to have been suicidal. The inference drawn was precisely that which the medical circumstances appeared to me to justify. Imputed or self-injlicted wounds. — The question whether a wound was or was not self-inflicted, may refer to the living as well as to the dead. Thus a man may produce wounds upon himself for the purpose of simulating a homicidal assault, which, for various motives, he may allege to have been committed upon him. With the motives for the self-infliction of wounds, a medical jurist is not concerned — it is of the fact only that he can take cogni- zance. From the cases that have yet occurred, it would appear that the object has been to extort money, to conceal murder, robbery, or some other crime, and to turn away suspicion from the wounded party. One of the most remarkable cases of this kind which have occurred in England, was that of Bolam, who was tried for the murder of a man named Millie, at the New- castle Autumn Assizes, 1839. It is impossible to enter into all the particu- lars of this singular trial ; but it may suffice to state that the prisoner Bolam was found lying in an apartment which had been fired by himself or, as he alleged, by some incendiary, and near him was the body of the deceased, who had evidently been killed by violence — the skull having been extensively fractured by a poker lying near. The prisoner, when found, was either in- sensible or pretended to be so. He stated that he had been suddenly attacked by a man, and knocked down by a blow on the right temple. After attempt- ing to escape, he was again knocked down. He then felt a knife at his throat, but admitted that he did not put up his hands to protect it. His hands were not cut. He said he remembered receiving some blows on his body, but he became insensible, and recollected nothing more. On examin- ing his throat, there was a wound an inch and a half in length on the left side of the neck, a quarter of an inch below the jaw. It had penetrated 222 CHAKACTERS OP SELF-INFLICTED WOUNDS. merely through the true skin, and was of inconsiderable extent. A small quantity of blood, which had flowed down on the inside of his cravat, had escaped from this wound. There were many cuts on his coat at the back and sides, through his waistcoat, shirt, and flannel shirt ; but there were no corresponding cuts or stabs, nor, indeed, any mark of injury upon the skin. The question was, whether these wounds had been inflicted by the nnknown person who was alleged to have fired the premises and murdered the deceased, or whether the prisoner had inflicted them on himself, in order to divert attention and conceal the crime which he was accused of having committed. No motive for the imputed crime was discovered, and he had borne a very good character ; but, nevertheless, the medical facts relative to the probable self-infliction of the wounds were so strong, that he was convicted of man- slaughter. There was no doubt that the prisoner produced the wounds upon himself in order to remove from himself the suspicion that he had caused the death of the deceased. They were superficial, involved no important organs, and bore the characters which those wounds only would have, that had not been produced with a suicidal intention. Soon after Bolam's case, one somewhat similar occurred in London. The steward of a club-house was found one morning in bed wounded, and the cash box of the club was missing. Circumstances led the police to suspect that no one could have broken into the house; but the man himself was con- sidered so trustworthy, that no suspicion was entertained of his having been concerned in the robbery. The surgeon who examined him found the wounds on his person of a trivial character ; and there was no doubt from what sub- sequently transpired, that he had produced them on himself for the purpose of averting suspicion. It is not always easy to trace the motive for the production of these in- juries ; and when a reasonable motive is not immediately discovered, persons are apt to be misled and to credit the story. Individuals who have been convicted of thus imputing violence to others have frequently borne a re- spectable character until the occurrence, and this has contributed to disarm suspicion. When a person intending to commit suicide fails in the attempt, he has sometimes, under a sense of shame, attributed the infliction of a wound in his throat to another ; but facts of this kind may without difficulty be cleared up by circumstantial evidence. Imputed wounds, if we except the case of an actual attempt at suicide, in which the injury is commonly severe, are generally of a superficial character, consisting of cuts or incisions not extending below the true skin : deep stabs are seldom resorted to where the purpose is not suicide, but merely to conceal other crimes. Further, these wounds are in front of the person, and may be on the right or left side, according to whether the person is right or left-handed. They have also been generally numerous, and widely scattered : sometimes they have had a complete parallelism, unlike those which must have been inflicted by an adversary during a mortal combat with a weapon. The hands are seldom wounded, although in the resistance to real homicidal attempts these parts commonly suffer most severely. The injuries are not usually situated over those parts of the body in which wounds are by common repute considered mortal, and there is in general an entire want of correspondence between the situation of the wounds on the person, and the cuts or other marks on the dress. This is a fact which requires the attention of a practitioner. In a case which occurred to Marc, a young man alleged that he had received a sword-cut on the forehead from some assailants who had escaped. He was allowed to relate the whole of the particulars, and they formed a romantic and improbable story. He stated that he wore at the time a handkerchief round his head, a cotton cap, and a common cap with an elastic front, which he alleged had been cut through. There was a longitudinal wound, quite WOUNDS — CORRESPONDING OUTS ON THE DRESS. 223 superficial and about an inch long, at the upper and right part of the frontal bone, passing downwards from left to right. The cut in the felt of the cap, which was very soft, passed obliquely from right to left, and was about three inches in length. The cut was not so clean or regular as if it had been pro- duced by a sword : there was very little blood upon the cap, and only on the edge of the incision. The silk handkerchief was cut in an irregular manner. When the party was requested to place the cap and other articles upon his head in the position in which he stated they were when he was attacked, it was found to be utterly impossible to adjust them — the incisions could not be made to correspond, and the cap could not be worn over the folded hand- kerchief. This rendered it certain that the wound had not been inflicted in the manner described. Besides a blow of a sword which would have divided the felt and silk handkerchief, would at the same time have produced a much deeper wound on the forehead than that which was found. In a case reported by Dr. Bayard, the falsehood of a charge was demonstrated by the want of correspondence between the cuts in the clothes and those found on the per- son. {Ann. d'Hyg., 1847, vol. ii. p. 222.) In comparing cuts on the dress with wounds on the person, there are several circumstances to be attended to. What articles of dress were worn at the time of the assault ? In a case of stabbing all ought to present marks of perforation, corresponding in direction, form, size, sharpness of the edges of the weapon, &c. In imputed wounds, the marks on several layers of dress may not correspond with each other in the characters above mentioned. It is very difficult for a man simulating such injuries so to arrange his clothes when off his person, as to deceive a careful examiner. There will be some inconsistency or want of adjustment. Apart from the fact that several stabs or cuts cannot exist on the same part of the clothes, without one or more being stained with blood on the outside or inside, an impostor may do too much or too little, and thus lead to his detection. In a case which excited much public discussion, a simple circumstance led to the inference that certain stabs or cuts through a shirt had not been produced while the shirt was on, but while it was off the body. There were two cuts near to each other, pre- cisely similar in size, form, and direction. In fact, the knife or dagger pro- ducing them must have gone through a fold of the shirt, so accurate was the correspondence. Then, however, it followed that the shirt could not have been upon the body of the alleged wounded person, because a stab through a shirt when worn, must, in order to reach the body, traverse not only a fold (producing two cuts), but another layer in contact with the skin, and thus produce three cuts, or in the event of traversing two folds, five cuts. In simulating the wounds by cuts on the shirt, the person is supposed to have forgotten this, and have merely stabbed a fold of the shirt while lying on a table, or in some situation convenient for the purpose. This,, among other facts, rendered it probable that the slight wounds on the chest were self- inflicted. It has been contended that no rules can be laid down for the detection of such cases : each must be decided by the facts which accompany it. Never- theless, the details of those above mentioned will serve to direct the inquiries of a practitioner. The facts which he must endeavor to ascertain are the following : 1. The relative positions of the assailant and the assailed person at the time of the alleged attack. 2. The situation, direction, and depth of the wound or wounds. 3. The situation or direction of marks of blood or wounds OD the person or dress of either, or of both, the assailant and assailed. 4. The marks of blood, and the quantity effused at the spot where the mortal struggle i*: alleged to have taken place. The importance of these inquiries cannot be over-estimated. A strong suspicion was raised against the late Duke of Cumberland, in the year 1810, in reference to the death of Sellis, 224 WOUNDS — OATJSE OF DEATH. when a proper examination of the wounds would probably have shown that they could not have been self-inflicted. It is worthy of remark, that imputed wounds are generally cuts or stabs. They are seldom of the contused kind ; the impostor cannot, in reference to contusions, so easily calculate upon the amount of mischief which is likely to ensue. Pistol-shot wounds are sometimes voluntarily inflicted for the pur- pose of imputing murder or extorting charity. A man Intending to commit suicide by fire-arms, and failing in the attempt, may, from shame and a desire to conceal his act, attribute the wound to the hand of some assassin. In ex- amining such imputed wounds they will not be found (except in cases of attempted snicide) to involve vital parts; and they will possess all the cha- racters of near-wounds produced by gunpowder, wadding, or a bullet. (See Gunshot. Wounds.) The skin around will be extensively lacerated and bruised: there will be much ecchymosis, and the hand holding the weapon, as well as the dress and the wonnded skin, may be blackened or burnt by the exploded gunpowder. A pistol-shot wound from an assassin may be pro- duced from a distance, while an imputed wound which is produced by a person on himself, must always partake of the characters of a near-wound. If the weapon has been charged with gun-cotton, there will be no marks of blacken- ing on the person or dress, but there may be marks of burning. CHAPTER XXVII. THE CAUSE OF DEATH IN WOUNDS — CAUTION ON ASSIGNING TOO MANY CAUSES — WOUNDS DIRECTLY OR INDIRECTLY FATAL. — DEATH FROM HEMORRHAGE — LOSS OF BLOOD REQUIRED TO PROVE FATAL — MODIFIED BY AGE AND OTHER CIRCUMSTANCES — FATAL WOUNDS OF SMALL ARTERIES — INTERNAL HEMOR- RHAGE — DEATH FROM MECHANICAL INJURY TO A VITAL ORGAN — DEATH FROM SHOCK — BLOWS ON THE ABDOMEN — FLAGELLATION — DEATH FROM A MULTI- PLICITY OP INJURIES WITHOUT ANY MORTAL WOUND — SUBTLE DISTINCTIONS RESPECTING THE MORTALITY OF WOUNDS. Cmise of death. — It is important for a medical witness to bear in mind that in all cases of wounds criminally inflicted, the cause of death must be certain. No man is ever convicted upon mere medical probability. In general there is only one real cause of death, although other circumstances may, have assisted in bringing about a fatal result. Thus a person cannot die of a dis- ease in the bowels and a stab in the chest at the same time, nor of apoplexy 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 deter- mine 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 per- son dies speedily, there will be no great trouble in ascertaining 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 party 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 disease. How is an opinion to be expressed in such a case ? The coarse which I apprehend a medical witness ought to pursue, provided he has duly WOUNDS FATAL PROM LOSS OP BLOOD. 225 deliberated on the circumstances before he appears in court, and his mind is equally balanced 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 by an adverse cross-examination. It is the hesitating to assign a satisfactory cause, or the assigning of many causes for death, that gives such advantage to a prisoner's case, even when the general evidence is entirely against liim. Occasionally many causes of death are assigned by a witness, among which some have a tendency to exculpate and others to inculpate the prisoner 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 1 In a case of this kind an acquittal is commonly obtained. Wounds directly or indirectly fatal. — A wound may cause death either directly or indirectly. A wound operates as a direct cause of death when the 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 deceased survives for a certain period, and that the wound is followed by inflammation, suppuration, gangrene, tetanus, erysipelas, or some other mortal disease, which is a direct, and not an unusual consequence of the injury. Under this head may be also arranged all those cases which prove fatal by reason of surgical operations rendered imperatively necessary for the treatment of the injury — presuming 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 mechanical injury done to an organ important to life. 3. Shock, or concus- sion, aifecting the brain or spinal marrow, whereby the functions of one or more vital organs are arrested, sometimes with but slight injury to the part struck or wounded. From either of these causes, a wounded person may die immediately or within a few minutes. I. Death from hemorrhage. — Loss of blood operates by producing fatal syncope. A quantity of blood escaping from a vessel, although insufficient to cause death-by affecting the heart and circulation, may readily destroy life by disturbing 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., by stopping the respiratory process. In these cases it is obvious that the blood acts mechanically ; and in respect to the last condi- tion, a medical man, unless circumspection be used, may involve himself in a charge of malapraxis. If he allow the wound to remain open, the wounded person may die through hemorrhage — if he close it too soon, he may die through suffocation ; and, in either case, the counsel for a prisoner will 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 produces upon these organs. A few ounces effused in the cavity of the membrane in- cluding the heart, will entirely arrest the action of this organ. The absolute quantity of blood required to be lost in order to prove fatal, must, of course, vary according to numerous circumstances. The young, the aged — they who are laboring under infirmity or disease, will perish sooner from hemorrhage than others who are healthy and vigorous. Females, cseteris paribus, are more speedily destroyed by hemorrhage than males. In- fants are liable to die from hemorrhage resulting from slight wounds. An infant has been known to bleed to death from the bite of a single leech, or from the simple operation of lancing the gums. Even the healthy and vigor- ous, when their vital powers have been depressed by maltreatment or by 226 APPEARANCES IN DEATH FROM LOSS OP BLOOD. brutal violence, will sink nnder the loss of a comparatively small quantity of blood. (See Watson on Homicide, p. 90.) A medical jurist must not forget that some persons have a predisposition to hemorrhage ; 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 in our medical journals of fatal hemorrhage following the extraction of teeth, when there had been previously nothing to indicate the probable occurrence of death from so trivial a cause. (For striking instances of this remarkable tendency to hemorrhage in a family, see £rii. and For. Med. Rev., vol. xvii. p. 24Y ; also Med. Gaz., May, 1842.) In the thirty-ninth volume of the latter journal, p. 86, a case is reported by Mr. Druitt, in which an unusual degree of hemorrhage followed a compound fracture of the leg. Such cases are without difBculty 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 would, under common circumstances, be a simple wound, the admission of this fact may in certain cases lessen the responsibility of au accused party. A sudden loss of blood has a much more serious iniuence than the same quantity lost slowly. A person may fall into a fatal syncope from a quantity of blood lost in a few seconds, which he would have been able to bear with- out 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 hemorrhage which fol- lows the division of the smaller branches of the external carotid artery, is often sufficient to destroy life unless timely assistance be rendered. A case was tried at the Berkshire Spring Assizes, 1832, in which it was proved that the prisoner had killed his wife by stabbing her in the leg : the anterior tibial artery was divided, and she died from hemorrhage half an hour afterwards. Wounds of arteries, even smaller than these, might in some subjects prove fatal, if no assistance were at hand. Mr. Watson mentions a case in which the internal mammary artery on the left side was divided by a stab in the chest. The woman died on the ninth day, and four pounds of blood were found effused on that side. In another case in which an intercostal artery was divided, six pounds of blood were effused. {Op. cit., 101.) In both cases, as in most wounds of the chest, the blood not only affected the system by its loss, but by its compressing the lungs and impeding respiration. Wounds of large veins, such as the jugular, may, from the quantity of blood suddenly effused, speedily destroy life. If a wound is in a vascular part, although no vessel of any importance be divided, the person may die from bleeding. It is difficult to say what quantity of blood should be lost, in order that a wound may prove fatal. The whole quantity contained in the body of an adult is calculated at about one-fifih of its weight i. e., about thirty pounds : of this, one-fourth is considered to be arterial, and the remaining three-fourths are venous blood. According to Mr. Watson, the loss of from five to eight pounds is sufficient to prove fatal to adults. But while this may be near the truth, many persons will die from a much smaller quantity, the rapidity with which the effusion takes place having a considerable influence. 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 escape from the body. In incised wounds, the flow externally is WOUNDS — DEATH FROM SHOCK. 22T commonly abundant ; bnt in contused, punctured, and gun-shot wounds, the effusion may take place internally, and rapidly cause death. In severe con- tusions, or contused wounds, involving highly vascular 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 adjacent. In death from severe flagellation, blood may be effused 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. Many pounds of blood may thus be slowly or rapidly effused. 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 examina- tion. 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 be apparent, it may be fairly referred to loss of blood. This opinion may, however, be materially modified in reference to open wounds, by the fact of the body not being seen on the spot where the injury was actually in- flicted — by the wound having been sponged — the blood removed by washing, and all traces of bleeding destroyed. Under these circumstances, the case must in a great measure be made out by presumptive proof: and here a medical witness may have an important duty thrown upon him, namely, that of examining articles of dress, furniture, or weapons for marks or stains of blood. It must not be supposed that all the blood met with round a wounded dead body was actually eS'used 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 foar to eight or ten hours, and the warmth of the body is retained, continues to drain from the divided veins and smaller vessels. The quantity thus lost, however, is not considerable, unless the veins implicated are large. A question relative to the degree of this bleeding after death has sometimes been put in a court of law. II. Death from great mechanical injury done to a vital organ.—SWQ 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 effusion of blood, so that the person really dies from hemor- rhage ; but in other instances the quantity of blood lost is inconsiderable, and the fatal effects may be referred to shock. Sometimes a slight amount of violence may prove fatal. These are, however, to be regarded as exceptional instances. (See case by Mr. Annan, Med. Times and Gaz., Aug. 1854.) III. Death from shock, — This is sometimes a direct cause of death under the infliction of external violence ; and in this case life is destroyed without the injury being to all appearance sufficient to account for so speedily fatal a result. There is no medical doubt that a person may die from what is termed shock without any marks of severe injury lieing discovered on the body after death. We have examples of this mode of death in accidents 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, which is supposed to operate by producing a fatal impression on the cardiac plexus. Whether this be or be not the true ex- 228 WOUNDS — DEATH FEOM FLAGELLATION. planation, it is admitted by experienced surgeons, that a person may die from so simple a cause without any mark of a bruise externally, or physical 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. (An account of the ap- pearances observed in a, case of this kind, by Mr. Wood, will be found in the Medical Gazette, vol. xliv. p. 213.) Convictions for manslaughter have taken place, when death has been produced under these circumstances. (See Travers on Constitutional Irritation, p. 432 ; and B. Cooperh Lectures on Surgery, p. 443 ; Wounds of the Abdomen, post ; also Watson on Homicide, p. 15.) Concussion of the brain, unattended by mechanical lesion, is 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 in- spection, 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 structure, and all the organs of the body are found healthy. In certain railway accidents persons have died under somewhat similar circumstances. There may be no physical indication of a mortal injury, and no cause apparent to account for death. This can only be referred to the shock or violent impression which the nerv- ous system has sustained from the blow or violence — an impression which the vital powers were wholly unable to counteract or resist. A medical witness 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 — a principle which, if once unrestrictedly admitted as correct, would leave a large number of deaths, undoubtedly occurring from violence, wholly unexplained. A trial took place at the Liverpool Autumn Assizes, 183'!, wherein several persons were charged with the manslaughter of the deceased, by kicking him behind the right ear. The medical witness deposed that there was in this spot the mark of a severe contusion, but there was no injury whatever to the brain, and the body was otherwise healthy. He very properly ascribed death to the violent shock given to the nervous system, and the court admitted that the cause of death was satisfactorily made out. The person who inflicted the wound was convicted. 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 which, taken alone, could, in medical language, be termed mortal ; and yet he may die directly from the effects of the violence, 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 nervous system. A prizefighter, after having, during many rounds, sustained 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 comparatively slight, are as capable of operating fatally, as any single wound 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. A case of a somewhat similar kind may present itself in the military punish- ment oi flagellation, which is occasionally followed by death, either as a direct consequence of shock, or from indirect causes, such as inflammation and its DEATH FROM A NUMBER OF SLIGHT WOUNDS. 229 consequences. At the trial of Governor Wall, the judge directed the jury- that the long continuance and severity of pain (in flagellation) may be pro- ductive of as fatal consequences as if instruments or weapons of a destructive kind were used. It is not often that scholastic flagellation is a cause of death in this country. One case, however, has recently excited public attention from the atrocity of the circumstances attending it. It was the subject of a trial for manslaughter at the Lewes Autumn Assizes, 1860 {Reg. v. Hopley). The evidence showed that the prisoner had beaten deceased, a youth of six- teen, most severely for nearly two hours with a rope and a stick. The external wounds were slight, but an inspection showed that the muscles as well as all the soft parts beneath the skin had been considerably bruised and lacerated, and that there were extensive effusions of blood in the cellular membrane of the arms and legs. There was no mortal wound in the common sense of the term, but there was no reasonable doubt that the deceased had died from the violence inflicted on him by the prisoner. His guilt was established by the fact that he had endeavored to conceal the effects of his violence by removing the marks of blood — that he had covered the body of deceased with clothing so as to conceal the bruises — that he had procured a coroner's inquest to be held in haste, and while concealing from the jury the fact that he had beaten the youth on the night of his death, stated that he had found him dead, and suggested that he might have died of disease of the heart. There can be no doubt from the medical facts of this case that the deceased died either while the prisoner was inflicting the violence or soon afterwards (see p. 211). No attempt was made to dispute the cause of death. Apart from the depressing effects on the nervous system of long-continued and severe pain, there was in this instance such an eifusion of blood internally as would account for the production of fatal syncope. On a trial for murder, which took place in Germany a few years since, it was proved that the deceased had been attacked with sticks, and that he had been afterwards flogged on the back with willow switches. He died in about an hour. On inspection, there was no mortal wound, nor any injury to a vital organ ; there were simply the marks of lacerations and bruises on the skin, apparently not sufBcient to account for death ; but this was nevertheless very properly ascribed to the violence. (Henke, Zeitschrift der S. A., 1836 ; also, Brit, and For. Med. Rev., Jan. 1837, p. 249.) The case of the Duchess of Praslin, who was murdered by her husband in Paris, in August, 184Y, furnishes an additional proof of the fatal effects produced by numerous in- juries. On an inspection of the body, it was found that on the head, neck, and both of the hands, there were no fewer than thirty distinct wounds, some contused, and others incised and punctured. There were also the marks of many bruises, and the impressions produced by the nails of the murderer's hand over the mouth. For the most part, these injuries were slight, and not one could be said to be necessarily mortal. The most serious wound was situated on the right side of the neck ; but even here the carotid artery and internal juglar vein had escaped injury. Death was referred to the loss of blood which had taken place from the numerous wounds inflicted during the struggle with the assassin. {Ann. d^Hyg., 1847, vol. ii. p. 377.) Prom these considerations, it is obviously absurd to expect that in every case of death from violence or maltreatment, there must be some specific and visible mortal lesion to account for that 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 230 WOUNDS ABSOLUTELY AND CONDITIONALLY MORTAL. die from violence unless there be some distinct mortal injury 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 erro- neous notion, since death may fake place from the disturbance of the functions of an organ important to life vfithout 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 alone, 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 in any case 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 mor- tal ? The answer to this question may be — Not one individually, but all contributed to occasion death by syncope or exhaustion. It must be remem- bered, that in cases in which a person has sustained a number of injuries, the loss of a much smaller quantity of blood than in other instances, will suffice to destroy life. It is sometimes a difficult question to decide on the relative degree of mor- tality of wounds, and on the share which they have had respectively in caus- ing death. By a wound being of itself moria?, we are to understand that it is 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 circnmstance 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 determine, on medical grounds, whether a wound was or was not mortal, we may propose to ourselves this question : Would the deceased have been likely to die at the same time, and 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 dis- tinction between a wound which is absolutely and one which 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 conditionally mortal wound is one in which, had medical assistance been at hand, been sent for, or timely rendered, the patient would, in all probability, have recovered. Wounds of the bra- chial, 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 sup- pose, there is seldom any agreement on this subject. Our criminal law is entirely free from such subtleties. The effect of the wound, and the intents^ with which it was inflicted, are looked to : its anatomical relations, which must depend on pure accident, are never interpreted in the prisoner's favor. Some extenuation may, perhaps, be occasionally admitted when a ffonnd proves mortal through an indirect cause, as inflammation or fever, and medical BLOOD-STAINS — CHEMICAL TESTS. 231 advice was attainable, but not obtained until every hope of recovery had dis- appeared. It appears, however, from the case of the Queen 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 assistance. The judge said it was possible that, "if he had had medical advice, he might not have died : but whoever did a wrongful act must take the whole consequences of it. It never could make any difference whether 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, although not in itself mortal, turn to a gangrene or fever for want of proper applications, or from neglect, and the man die of gangrene or fever, this is homicide in the aggressor ; for though the fever or gangrene be the imme- diate cause of death, yet the wound being the cause of the gangrene or fever, is held the cause of death, causa causati. These nice questions relative to the shades of responsibility for personal injuries, occasionally arise in cases in which persons have been wounded at sea on board of a ship in which there was no surgeon. CHAPTER XXVIII. CHEMICAL EXAMINATION OP BLOOD-STAINS — ACTION OF TESTS ON ORGANIC AND INORGANIC RED COLORING MATTERS — STAINS OP BLOOD ON LINEN AND OTHER STUPPS — ^DATE OP THE STAINS — INSOLUBLE STAINS RESEMBLING BLOOD — RED PAINT MISTAKEN FOR BLOOD — SOLUBLE STAINS OP FRUITS, FLOWERS, ROOTS, AND EXTRACTS — REMOVAL OP BLOOD-STAINS PROM ARTICLES OP CLOTHING — STAINS OP BLOOD ON WEAPONS — CITRATE OP IRON MISTAKEN FOR BLOOD — DISTINCTION OP STAINS FROM IRON-RUST — COLOR PROM RED DYES — BLOOD OF MAN AND ANIMALS — EVIDENCE FROM THE ODOR — MICROSCOPICAL EVIDENCE. Examination of Mood-stains. — It may appear at first sight an easy matter to say whether certain suspected spots or stains on articles of clothing, furni- ture, or weapons, are or are not due 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 competent to form an opinion ; but the physical characters of blood are soon changed, even when the stuff is white and other- wise favorable to an examination. Again, when the stains, whether recent or of old standing, are upon dark-dyed woollen stuffs, as blue, black, or brown cloth, or when they appear in the form of small or detached spots or 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 determining the presence and properties of the red coloring matter, or hcematosine. The microscope may be usefully employed in these medico-legal investigations — either alone, or in those cases in which chemistry fails to aid the practitioner. The chemical properties of the red coloring matter of blood are as follows: 1. It readily combines with cold distilled water, forming, if recent, a rich red solution. 2. The red color of this solution is not changed to a crimson or a 232 STAINS OF BLOOD ON LINEN — ANALYSIS. green tint by a few drops of a weak solution of ammonia : if the ammonia is concentrated, or added in large quantity, the red liquid will acquire a brown- ish tint. 3. The red liquid when boiled is coagulated — the color is entirely destroyed, and a muddy brown flocculent precipitate is formed — the quantity of which will depend on the quantity of coloring matter and albumen present. 4. The coagulum produced by boiling, when collected on a filter and dried, forms a black resinous-looking mass, quite insoluble in water, but readily dissolved by boiling caustic potash, forming a green-colored solution. 5. To the above tests some have united the action of strong nitric acid, which coagulates the red coloring matter, turning it of a dirty brown hue. Such are the chemical properties of blood, whether derived from the human body or from that of any warm red-blooded animal. Objections to the tests. — It will now be proper to mention the action of the tests upon red coloring matters, extracted from the animal or vegetable king- dom. Some of these are changed to a green color by ammonia, as the color- ing matter of the rose — others to a crimson, as the red coloring matters of cochineal, logwood, and lac. But these red colors are not coagulated or de- stroyed by boiling. In these respects, therefore, the coloring matter of blood is eminently distinguished from them. M. Raspail has objected that a mix- ture of madder and albumen possesses all the characters assigned to blood ; but this objection is more theoretical than practical. These red liquids can only deceive those who trust to a red color alone. It may be observed of all such artificial mixtures, that they are changed by ammonia to a crimson or a green tint (sometimes passing through a blue), and that under no circum- stances is the red color destroyed by boiling the solution in water. The albumen, if in sufBcient quantity, is coagulated, but the coagulum still retains the red coloring matter locked up within it. In the case of blood, the effect of heat is to entirely destroy the color. Those vegetable coloring principles which are not affected by ammonia (kino and catechu) are readily known by the application of heat or by special tests. The colors are not coagulated and destroyed like the red color of blood. (See Gufs Hospital Reports, October, 1851.) Stains of blood on linen and other stuffs. — Supposing the stuff to be white or nearly colorless, the spot of blood, if recent, is of a red color; but it sooner or later becomes of a reddish brown, or of a deep brown color. The change of color to a reddish brown I have found to take place in warm weather in less than twenty-four hours. After a period of five or six days, it is scarcely possible to determine the date of a stain even conjecturally. In a large stain of blood on linen, no change took place during a period of five years : it had a brown color at the end of six weeks, which it retained for the long period mentioned. Indeed, it is extremely difficult in any case, after the lapse of a week, to give an opinion as to the actual date of a stain. Upon colored stuffs, or dirty clothes, it is of course impossible to trace these physical changes in stains of blood — on red-dyed stuffs the stain of blood appears simply darker from the first, and in all cases the fibre of the stuff is more or less stiffened. Aftention should be paid to the side of the stuff, if an article of dress, e. g., a shirt, which has first received the stain : sometimes both sides are stained. The evidence derived from an observation of this kind may be occasionally of importance. Analysis In order to determine whether a stain is due to blood, we cut a slip of the stained part of the linen, and suspend it by a thread in a small test-tube containing a small quantity of distilled water. After a few minutes, or a few seconds, should the stain be recent, a red liquid will be seen falling in fine dark threads, and collecting at the bottom of the test-tube, giving a red color to the lower stratum of water : and a dark red-brown color, if it he of old standing. The separation may not take place in less than an hour, if STAINS RESEMBLING BLOOD. 233 the stuff is thick and coarse or not readily pervious to water. When the stain is on thin silk it is speedily separated. Several slips of the stuff may be thus successively treated, until a liquid, sufBciently deep in color for testing, is procured. If the quantity of colored liquid thus obtained is small, the super- natant clear water may be carefully poured off, or drawn off by a pipette ; but it is better to use a small tube and a small quantity of water. The colored liquid may then be tested by weak ammonia, and by the application of heat. If ammonia produces any effect upon the solution of blood, it is simply to brighten it — this alkali neVer changes the red color of blood to green or crimson. When the stain is of old standing, the solution in water is more slowly obtained, and does not present the bright red color of blood. The action of ammonia may also be obscure, although it never gives to the liquid a green or crimson tint. The action of heat is in such cases certain and effectual : if the colored solution is in such small quantity that there is no coagnlum obtained by heat, it will be difficult to give a decided opinion, from the application of chemical tests, that the stain is due to blood, and in these cases it will be absolutely necessary to resort to the use of the micro- scope. When the quantity of blood effused is moderately large, it may be easily detected by the above process, even after the lapse of a great length of time. I have thus detected the blood of the human body, and of the bul- lock, on cotton, linen, and flannel, after the lapse of three years. If the stuff is dyed, we should proceed to examine the stains found upon it, by a similar process. The dye is commonly fixed, and is not soluble in water. Should the color be soluble, and form an obstacle, the microscope must be resorted to. Thus, then, in testing for blood, we rely upon — 1, the ready solubility of the hasmatosine (or red coloring matter) in water; 2, the negative action of ammonia ; and 3, the positive effect of heat in entirely coagulating and destroying the red coloring matter. Objections. — It may, however, be objected, that red stains closely resem- bling blood are occasionally found on linen and other stuffs. All such stains are either entirely insoluble in cold water, or they are soluble: if insoluble, they cannot by any possibility be mistaken for blood. Should the linen or stuff which is stained with blood have been heated to a high temperature, the coloring matter may, as a result of coagulation, be rendered insoluble in water : — but this is an exceptional condition. In the case of a body found wounded and burnt, it would be proper to allow for such a change, and the chemical evidence would fail. Should the blood-stain be mixed with oil or grease, this will interfere with the solvent action of water. Should it be on a plaster-wall or on wood, we must scrape or cut out a portion, and digest it in a small quantity of water in a tube or watch-glass. An unstained por- tion of the plaster or wood should also be examined. (See, on the subject of blood-stains, Ann. d'Hyg., 1829, pp. 26Y, 548; 1830, p. 433; 1831, p. 467 ; 1833, p. 226, t. ii. p. 160; 1834, p. 205 ; 1835, t. ii. p. 349 ; 1839, t. i. p. 219 ; 1840, t. i. p. 387 : also, Henke's Zeitschrift der S. A., 1844, b. ii. p. 273. See also, for a full account of this subject, Guy^s Hospital Reports, Oct. 1861.) [See also, for the latest and most thorough practical discussion of it, an excellent monograph On Blood-Stains in Criminal Trials, by Dr. A. Fleraming, of Pittsburg, Pa., Am. Journ. Med. Sci., April, 1860. — H.] Insoluble stains. — Among insoluble stains are — 1, certain red dyes, as mad- der, which when fixed by a mordant is not readily affected by ammonia. 2. Iron Moulds. These are of a reddish-brown color, sometimes of a bright-red ; they are quite insoluble in water, but are easily dissolved by diluted hydrochloric acid, and on adding ferrocyanide of potassium to the hydrochloric solution, the presence of the iron will be at once apparent. Care should be taken that the acid used for this purpose contains no iron. The stained article of dress should also be proved to be free from any iron dye, or a blood-stain might 234 STAINS RESEMBLING BLOOD. be erroneously pronounced to be due to iron. Some years since, a man was found drowned in tlie Seine, at Paris, under suspicious circumstances. The body had evidently lain a long time in tiie water. On examining the shirt of the deceased, a number of red-brown stains were observed on the collar and body — resulting, as it was supposed, from spots of blood, which had be- come changed by time. On a chemical examination, however, they were found to be iron moulds produced by the rusting of a steel chain which the deceased had worn round his neck ! 3. Red paint. Stains made with red paint containing peroxide of iron, have been mistaken for blood. They may be easily known by digesting them in diluted hydrochloric acid, and applying to the solution the tests for iron. Like those produced by iron moulds, they are insoluble in water, and therefore cannot be confounded with blood-stains. The same may be said of spots of the ammonio-nitrate of silver changed by light, which I have known to be mistaken for old stains of blood. The stuff on which the spots of blood are found, may be itself stained with a red dye or color, or it may be dyed with iron ; in this case it will be necessary to test by the same process a piece of the colored or stained portion, in order to furnish negative evidence that the suspected stains are due to blood. In Spicer's case (mite, p. 219), an apron which the prisoner wore was found with stains of blood upon it; but the greater part was covered with dark red stains, which turned out to be owing to a logwood-dye that the prisoner had used in his business. (Med. Gaz., vol. xxxvii. p. 613.) Soluble stains. — Among the soluble stains resembling those of blood, are the spots produced by the juices of the mulberry, currant, gooseberry, and other red fruits. These are commonly recognized by dropping on them a weak solution of ammonia — when the spot is turned either of a bluish, olive- green, or green color. The red of cochineal is changed to a crimson on the addition of ammonia or potash. A spot of blood thus treated undergoes no change from the alkali. Further, if a piece of the stained stuff is suspended in water, the colored liquid, if any be obtained, is easily known from blood, by its acquiring a green or crimson tint on the addition of ammonia, and by the red color not being coagulated or destroyed when the liquid is boiled. Independently of the fruits mentioned, there are many vegetable juices that will produce stains of a red or red-brown color, which might be mistaken for blood. In one instance, the red petals of the poppy gave rise to an error only removed by a proper examination. (Bayard, Man. Prat, de Med. Lig,, 217.) In some red stuffs, the dye is often so bad, that water will dissolve out a portion of the color ; but in this case the action of ammonia and heat will serve readily to distinguish the stains from blood. The soluble red or brown stains given by woods or roots, such as Logwood, Brazil-wood, or Madder-root, are changed to a crimson color by ammonia. They also gene- rally coutain tannic acid, and acquire a dark olive-green color when a persalt of iron is added to the liquid. Red-brown extracts, such as Kino and Ca- techu, are not affected by ammonia; but the color given to water is different from that of blood, and the addition of a persalt of iron reveals the presence of tannic acid. [For a further account of the differences between red dyes and blood, see Guy's Hospital Reports, October, 1851.] Removal of blood-stains. — An attempt may have been made to wash out blood-staius, so that the color may be more or less changed, and no chemical evidence obtained. There is a common notion that certain chemical agents will remove or destroy these stains ; but this is not the case — the color may be altered, but when dried on the stuff it is not easily discharged or bleached. Chlorine, a most powerful decolorizing agent, turns the coloring matter of blood of a green-brown color. Hypochlorous acid has a similar effect. This acid has been recommended as useful by its bleaching properties for distin- guishing the stain of blood from all other stains, excepting those produced DETECTION OF BLOOD ON WEAPONS. 235 by iron rust. Orfila has, however, shown that it is not iitted for such a pur- pose, and that there are no better methods of testing than those above de- scribed. {Ann. d'Hi/ff., 1845, vol. ii. p. 112.) I have found that nothing removes a blood-stain, whether wet or dry, so effectually as simple macera- tion in cold water, although, when the stain is old, the process is sometimes slow. Detection of blood on weapons. — When recent, and on a polished instru- ment, stains of blood are easily recognized ; but when of old standing, or on a rusty piece of metal, it is a matter of some difiSeulty to distinguish them from the stains produced by rust or other causes. If the stain is large, a por- tion will readily peel off on drying. This may be placed in a watch-glass with some distilled water — the solution filtered to separate any oxide of iron, and then tested. If the water by simple maceration does not acquire a red or red-brown color, the stain is not due to blood. Sometimes the stain ap- pears on a dagger or knife either in the form of a thin yellowish or reddish film, or in streaks, and is so superficial that it cannot be mechanically de- tached. We should then pour a stratum of water on a piece of plate-glass, and lay the stained part of the weapon upon the surface. The water slowly dissolves any portion of the coloring matter of blood, and this may be exa- mined by the process recommended. If the weapon has been exposed to heat, this mode of testing will fail. Objections. — There is often a remarkable resemblance to the stains of blood on metal, produced by the oxide or certain vegetable salts of iron. If the juice or pulp of lemon or orange be spread upon a steel blade, and remain exposed to air for a few days, the resemblance to blood produced by the formation of citrate of iron is occasionally so strong that I have known well-informed sur- geons to be completely deceived: they have pronounced the spurious stain to be blood, while the real blood-stain on a similar weapon was pronounced to be artificial. The difficulty of distinguishing such stains by the eye is well illustrated by a case which occurred in Paris a few years since. A man was accused of having murdered his uncle, to whose property he was heir. A knife was found in his possession, having upon it dark-colored stains, pro- nounced by those who saw them to be stains of blood. M. Barruel, and another medical jurist, were required to determine the nature of the stains, and the examination was made before a magistrate in the presence of the accused. They were clearly proved, by these and other experiments, to be spots produced by the citrate of iron. It appeared, on inquiry, that the knife had been used by some person a short time previously, for the purpose of cutting a lemon ; and not having been wiped before it was put aside, a simple chemical action had gone on between the acid and the metal, which bad given rise to the appearance. This case certainly shows that physical characters alone cannot be trusted in the examination of these suspected stains. Stains of the citrate of iron may be thus distinguished. The substance is soluble in water, forming, when filtered, a yellowish-brown solution, totally different from the red color of blood under the same circumstances. The solution undergoes no change of color on the addition of ammonia. It is unchanged in color, but may be partially coagulated at a boiling temperature : and it is at once identified as a salt of iron, by giving a blue color with the ferro- cyanide, and a deep red with sulphocyanide of potassium. I have observed that spots of the citrate of iron on knives, for they are not found on other weapons, are often soft and deliquescent, while those of blood are commonly dry and brittle. It is not always easy to distinguish by sight a stain of blood on a weapon from a mark produced by iron rust. When suspicion exists, marks are yjro- nounced to be due to blood, which, under other circumstances, would liave passed unnoticed. One source of difficulty is this : the iron rust is often 236 MISTAKES REGARDING BLOOD-STAINS. mixed with articles of food on an old knife, or even with blood itself. We must here pursue the same mode of examination as if the stain were of blood ; we macerate the weapon or a portion of the colored deposit in a small quan- tity of distilled water, and filter the liquid. If the stain is due to iron rust this will be separated by filtration, and the liquid will pass through colorless. The absence of blood is thereby demonstrated : for I need not here consider the objection, that the weapon may have been exposed to heat, and thus have rendered the blood-stains insoluble in water. If we now digest the brown undissolved residue left on the filter, in diluted hydrochloric acid free from iron, we shall obtain a yellowish solution, which will give with the ferro- cyanide and sulphocyanide of potassium the proper reactions for iron. It has been recommended to put the acid on the stained weapon, and then test the liquid, as the red spot of rust is soon removed by the acid; but a spot containing blood may be thereby pronounced to be one of rust only, since the acid, in all cases, dissolves a portion of iron, and the solution would give the characters of an iron stain with the tests. In all old blood-stains, when the weapon is rusty, blood and oxide of iron are intermixed. The blood may be easily separated by digesting the compound in distilled water, and filtering the solution: the coloring matter is dissolved, and passes through, while the rust is left on the filter. Acetic acid will also dissolve the blood and leave the rest. The following case was referred to me for examination a few years since. A man was suspected of murder, and some stains existed on his shirt, which were supposed to have been produced by blood. Around the collar and upper part of the shirt there was a large and somewhat deep pinkish-red stain, in some respects resembling washed blood. This I considered as a very unusual situation for blood to be found sprinkled : and upon trying the stained linen by the processes mentioned, the color entirely resisted separa- tion by water, and was turned of a slight crimson tint by ammonia. The stain was thus shown not to be due to blood. On inquiry, it was ascertained that the man had worn round his neck a common red handkerchief during a wet night, and while taking violent exercise! The stain was thus accounted for. There were, however, some other marks on the shirt which required examination, as there was a very strong suspicion against this man. These were on the sleeves, at those parts which would be likely to receive stains of blood if they had been rolled or turned up at the wrists ; and it was clearly ascertained that the murderer, in this case, used a quantity of yellow soap in washing his hands. These stains were of a brownish color, without any shade of red ; they were faint in parts and diffused, conveying the impression that an attempt had been made to wash them out. So far as external characters were concerned, it was difBcult to say whether they had been pro- duced by blood or not. On examining the parts of the shirt corresponding to the armpits, stains precisely similar were there seen, evidently resulting from cutaneous perspiration; since the suspicion of blood being effused on these parts of the shirt under the circumstances, could not be entertained. Slips of linen from the stained portions of the sleeves were digested in water. In twenty-four hours the stains were entirely removed ; and the lower stratum of water in each tube had acquired a straw-yellow color. There was not the least shade of a red or brown tint; and the solution was wholly unlike that produced by blood under any circumstances. The solution was unaffected by ammonia, as well as by a heat of 212°; but it acquired a faint opales- cence on the addition of nitric acid. These results not only indicated the absence of blood, but showed that the stains were due to cutaneous perspira- tion issuing from a dirty skin, and through a dirty dress. The stains on the parts corresponding to the armpits could not be ascribed to blood ; and from the similarity in physical and chemical properties, it was impossible to attri- VARIETIES OP BLOOD. 23T bate those on the sleeves to any sanguineous effusion. It happened, how- ever, that a large pocket-knife, with numerous dark red stains on the blade and between the layers of the handle, was found upon this man ; and this was also sent for examination. Several persons who saw the knife pronounced a strong opinion that the marks were due to blood. The stains were composed of some soft viscid matter, which gave out ammonia when heated, and left a residue of peroxide of iron. On digesting the matter in water no portion was dissolved; and it was, therefore, evident that they were due not to blood, but to a mixture of some animal matter, probably food, with iron rnst. These results were somewhat in the man's favor — at least, they removed what was considered to be a strong circumstantial proof of his guilt. He was subsequently tried for the murder, and acquitted on an alibi, established by the evidence for the prosecution. Varieties of blood. — The means of distinguishing arterial from venous blood, available to the medical jurist, have been elsewhere described (see ante, p. 218). There is no method known by which the blood of a man can be distinguished from that of a woman, or the blood of a child from that of an adult. The blood of a child at birth contains less fibrin, and forms a thinner and softer coagulum than that of the adult. A medico-legal ques- tion has arisen on more than one occasion, whether there were any means of distinguishing menstrual blood from that of the body generally. This liquid contains fibrin, although the proportion is much less than in venous or arte- rial blood, red coloring matter, and the other constituents of blood. The only differences noticed are of an accidental kind : — 1st, that it is acid, owing to its admixture with vaginal mucus; and 2d, that under the microscope it is mixed up with epithelial scales, which it has derived from the mucous membrane in its passage through the vagina. (Donne, Cours de Microscopic, p. 139.) A case occurred in France, which induced the Minister of Justice to refer the consideration of this question to the Academy of Medicine. The reporters, MM. Adelon, Moreau, and Le Canu, came to the conclusion, that there were no means of distinguishing menstrual blood dried on clothing from that which might be met with in a case of infanticide or abortion. (^Ann. d'Hyg., 1846, vol. i. p. 181.) Blood of man and animals. Tests hy odor. — When marks of blood have been detected on the dress of an accused person, it is by no means unusual to find these marks referred to his having been engaged in killing a pig or a sheep, or handling fish or dead game. Of course every allowance must be made for a statement like this, which can only be proved or disproved by circumstances; but an important question here arises, namely, whether we possess any certain means of distinguishing the blood of a human being from that of an animal. M. Barruel, and other French medical jurists, state that by mixing fresh blood with one-third or one-half of its bulk of strong sul- phuric acid, and agitating the mixture with a glass rod, a peculiar odor is evolved, which differs in the blood of man and animals, and also in the blood of the sexes. This odor, it is said, resembles that of the cutaneous exhala- tion of the animal the blood of which was made the subject of experiment. They have hereby pretended to determine whether any given specimen of blood belonged to a man, a woman, a horse, sheep, or fish. Others assert that they have been enabled by this process to identify the blood of frogs and fleas! (See Devergie, M^d. Lbg., vol. li. p. 907.) It is true that strong sul- phuric acid does give rise to a particular odor when mixed with fresh blood, probably owing to its decomposing some of the animal principles ; it is pos- sible that some persons may discover a difference in the odor, if not accord- ing to the sex, at least according to the animal — but even this point is far from being established: and if it were admitted, there is probably not one individual among a thousand, whose sense of smelling would be so acute as 238 MICEOSOOPICAL DISTINCTIONS IN MAN AND ANIMALS, to allow him to state with undeniable certainty, from what animal the un- known blood had really been taken. Any evidence short of this would not be received in an English court of law ; for it is considered better not to decide at all than to decide on principles which are exposed to unavoidable fallacy. Besides, it must be remembered that, in general, the operator has not before him the fresh blood, but merely a diluted solution of the dried coloring matter mixed with a small quantity of serum. In a case of import- ance which occurred in Paris, the testing of blood by odor completely failed in the hands of M. Barruel and two other eminent French medical jurists, MM. Tardieu and Chevalier. The mistakes made by these experts are ad- mitted by themselves to have been of so serious a nature as to render this mode of obtaining evidence in any future case inadmissible. [Annates d'Hyg., 1853, t. i. p. 413.) For additional remarks on this subject, see paper in Guy's Hospital Reports, Oct. 1851. Microscopical evidence. — The microscope has been of late years employed not only to distinguish blood from other colored liquids, but for drawing a distinction between the blood of different classes of animals. The red coloring matter of blood consists of minute colored globules or particles, floating in a clear liquid. Other red coloring matters, such as madder, co- chineal, or lac, do not owe their color to independent corpuscles or globules. Hence, if colored globules, of the form and size of those found in mamma- lian blood, are visible under the microscope, there can be no doubt that the liquid is blood. Such evidence can, however, be safely received only from one who has been accustomed to the use of this instrument. The examination of a blood-stain in the dry state may be made with a power of from twenty to thirty diameters. Coagula or clots not visible to the naked eye, will then plainly appear. These will be found to have a rich crimson-red color in the thinner portions ; the tint, when compared with other red coloring matters, is sufficiently peculiar to enable the examiner to form an opinion, whether the stain is or is not owing to blood. The dis- covery of coagula or clots, fixed in the fibres of the stuff, is also a strong proof of the stain being caused by blood. Red colors do not give this clot- ted appearance ; but they have merely that of a dried dye, tinging the stuff uniformly without stiffening the fibre. Small portions of kino derived from a solution of that extract, have presented a very strong resemblance to coa- gula or clots of blood. The action of a persalt of iron on a solution of the stain in water, by striking a greenish black color, will, however, show that this extract is really the cause of the stain. In order to examine the stain for globules, a portion of it cut out, or what is better, a small fragment of the supposed clot, should be placed on a glass slide, and moistened either with distilled water, or with pure glycerin safiS- ciently diluted with water to render it a good substitute for the serum of blood, i. e., brought to a sp. gr. of about 1.030. After a short time, the liquid, supposing the stain to be owing to blood, will acquire a reddish or reddish- brown color. A piece of thin microscopic glass should then be placed over it, and the liquid examined by a power of from 260 to 300 diameters. If the stain is owing to mammalian blood, the globules will present a rounded or (in some aspects) lenticular form, and a pale yellowish or reddish color. They may be measured by the micrometer. Some articles of dress yield starch-granules — care must be taken not to confound these with blood-glo- bules. Water alters the size and shape of the latter; hence various liquids have been recommended for separating them from the clot. A solution of sugar, potash, of sulphate of soda, phosphate of soda, common salt, oil, and albumen, have been successively employed ; but these are evaporable liquids; they become dry and interfere with the observations. By the use of glyce- rin, I obtained clear evidence of the existence of globules in a minute frag- MICROSCOPICAL DISTINCTIONS IN MAN AND ANIMALS. 239 ment of blood which had been kept in a dried state for a period of three years. (See Ann. d'Hyg., 1859, t. ii. p. 151 ; also 1860, t. i. p. 416.) The microscope has been- chiefly employed with the view of determining whether the blood is that of a human being or an anunal. This question is constantly arising in criminal investigations. When blood is detected on the dress of a person charged with the death of another, it is frequently asserted in the defence, that the blood-stains were caused by his having killed a hare, a pig, a sheep, or a bullock, or by his having accidentally han- dled the dead carcase of some animal. In a few cases, the situation of these stains on different and remote parts of the dress, back and front, as well as in concealed or covered parts, may show that the defence is inconsistent with the facts ; but in the large majority, a medical witness will be required to state whether the blood is or is not human. It has been already observed that there are no chemical differences between the blood of man and animals. The red coloring matter, the albumen and fibrin, are the same, and chemical tests produce on them precisely similar results. The microscopical differ- ences refer to the shape and size of the globules. 1. With respect to shape. In all animals with red blood, the globules have a disk-like or flattened form. In the mammalia, excepting the camel tribe, the outline of the disk is cir- cular. In this tribe, and in birds, fishes, and reptiles, the globules have the form of a lengthened ellipse or oval. In the three last mentioned classes of animals they have a central nucleus, which gives to them an apparent pro- minence in the centre. The blood-globules 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 the observer to distinguish the blood of birds and fishes from that of a human being ; and this is often of great im- portance as evidence. In Reg. v. Drory (Essex Lent Assizes, 1851), it was suggested in the defence, that the blood-stains on the clothes of the prisoner had been caused by his having killed some chickens. The shape of the globules negatived this part of the defence. [A similar defence was contra- dicted in the same manner by the evidence of Dr. Leidy, in the case of Arm- strong, recently convicted of murder in Philadelphia. — H.] In another case the blood was alleged to be that of a fish ; this was also disproved by the shape. Water causes an alteration in the shape of the oval corpuscle, render- ing it larger and giving to it a circular outline. Dr. Bennett states that on one occasion he was called to see a patient (laboring under bronchitis) who was spitting florid blood. On examining the sputum with a microscope, he found that the colored blood-corpuscles were those of a bird. On his telling the patient that she had mixed a bird's blood with the expectoration, she was astounded, and confessed that she had done so for the purpose of imposition. (^The Microscope as a Means of Diagnosis, p. 185.) The chief microscopical distinction between the blood of man and domestic animals, consists in a difference in the size of the globules. This, however, is only an average difference ; for the globules 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 the size of these globules in the blood bears no relation to the size of the animal. Thus in the horse, ox, ass, cat, mouse, pig, and bat, they are on the 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 smaller than in other mammalia. The size of the corpuscle bears no proportioQ to the age of the animal : thus in the blood of the human fcetus they are to be found as large as in that of the adult. 240 MICEOSCOPICAL DISTINCTIONS IN MAN AND ANIMALS. The measured diameter of the globules in human blood varies, according to Gulliver, from l-2000th to l-4000th of an inch, the average size in both sexes being l-3200th of an inch. From an examination of various specimens of human blood, I have found the average diameter of the globules to be the l-3500th of an inch, the maximum size being l-3000th, and the minimum l-5000th of an inch. The globules of human blood are larger than those of domestic animals. The subjoined measurements, in fractions of an inch, are those given by Mr. Gulliver, excepting the figures in brackets, which are from my own micrometrical observations. The average diameter is, in the dog, l-3540th (max. l-4000th, min. l-6000th)— in the hare, l-3607th (l-4000th; max. l-2000th, min. l-8000th)— in the mouse, l-3814th— in the ass, l-4000th —(rabbit l-4000th)— in the pig, l-4230th (l-4250th)— in the ox, l-4261th —(in the cow, l-4000th to l-4200th)— in the cat, l-4400th— in the horse, l-4600th (l-5000th)— in the sheep, l-5300th (l-5333d to l-6000th)— in the goat, l-6366tb. These measurements apply to recent blood which has not been allowed to dry on animal and vegetable stuffs. In this case a distinction might be made between the blood of a human being and a sheep. With respect to the dog, hare, and rabbit, it would be, even under these favorable circumstances, a matter of difiSculty. When blood is dried on clothing, and it is necessary to extract the corpuscles by means of a liquid of a different nature from the serum, we cannot rely upon slight fractional differences, since we cannot be sure that the globules, after having been dried, will ever reacquire in a foreign liquid the exact size which they had in serum. Medical evidence must there- fore be based in such cases on mere speculation. (See Guy's Hospital Reports, vol. vii. pt. 2, 1851.) Dr. Schmidt has proposed to dry the corpuscles of each animal, to measure them in their dried or shrivelled state, and to com- pare the suspected blood (also dried) with these various samples. {Die Diag- nostik verddchtigen Flechen in Kriminalf alien, Leipzig, 1848.) I have tried this process, but have not found it practically available. In the present state of science the question must in my opinion be regarded as unsolved. When blood has been dried on clothing, we cannot, with certainty and accuracy, distinguish that of an ordinary domestic animal from the blood of a human being. The extent to which a medical witness is justified in going on such occasions appears to me to be this. The size and shape of the corpuscles are consistent with their being the corpuscles of human blood ; but it is im- possible in the present state of science to affirm that the corpuscles extracted from stains dried on clothing or weapons are not those of some domestic animal. This v/as the substance of the evidence which I gave in the case of Beg. V. Munro (Cumberland Lent Assizes, 185.5), a case in which everything turned on circumstantial evidence of a medical and moral kind. I declined to say absolutely that the stains were caused by human blood, although the corpuscles coincided in measurement with them. In one instance a medical witness professed to make a distinction between certain spots on a man's clothes — assigning some to the blood of a horse, and others to human blood; but in criminal jurisprudence no one has probably gone so far as Mr. Hera- path in a case, on some points of which I have elsewhere commented. {Reg. V. Nation, Taunton Spring Assizes, 185T, see p. 219 ; also, Med. Times and Gazette, April 11, 1857, p. 365.) For information on this important sub- ject, see Hitter's Prize Essay, Ueher die Ermittelung der Blutjlecken in Krimi- nalfallen, Wurzberg, 1854, and Friedberg's Histologie des ^Zwies, Berlin, 1852. These authors affirm from their observations, that it is not possible to distin- guish by the microscope human from animal blood in criminal cases. Evi- dence based upon such varying averages as those above given, must be treated as speculative and unsafe. WOUNDS — DEATH FROM LATENT DISEASE. 241 CHAPTEE XXIX. DEATH OF WODNDED PERSONS FROM NATURAL CAUSES — DISTINCTION BETWEEN REAL AND APPARENT CAUSE — DEATH FROM WOUNDS OR LATENT DISEASE ACCELERATING CAUSES — WHICH OF TWO WOUNDS CAUSED DEATH ? — DEATH FOLLOWING SLIGHT PERSONAL INJURIES. Death of wounded persons from natural causes. — It is by no means unusual for individuals who have received a wound, or sustained some personal in- jury, to die from latent natural causes ; and as, in the minds of non-profes- sional 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 followed. Without a careful exami- nation of the body, it is impossible to refer death to the real cause. The importance of an accurate discrimination in a case in which wounds or per- sonal injuries have been caused by another, must be obvious on the least re- flection; a hasty opinion may involve an accused party in a charge of man- slaughter ; and although a barrister might be able to show on the trial that death was probably attributable not to the wound, but to coexisting disease, yet it must be remembered, that the evidence of a surgeon before a coroner or magistrate, in remote parts of this country, may be the means of causing the accused to be imprisoned for some months previously to the trial. This is in itself a punishment, independently of the loss of character, to which the accused must be in the mean time exposed. In Guy's Hospital Reports, Oct. 1850, p. 230, will be found two cases communicated to me by Mr. Proc- ter, of York, in which death from natural causes was wrongly assigned to violence. In a case reported by Dr. Berncastle {Lancet, Feb. 15, 1845, p. 185), the deceased, a boy, died, from internal strangulation of the intestine from morbid causes, after wrestling with another boy, who might, but for the inspection, have been erroneously charged with having caused his death. (For a similar case, see Medical Gazette, vol. xxxviii. p. 702; also Gasper's Wochenschrift, May 24, 1845.) Death from wounds or latent disease. — A natural cause of death may be lurking within the body at the time that a wound is criminally inflicted, and a close attention to the symptoms and appearances after death can alone enable a medical man to distinguish the real cause. A man may be severely wounded, and yet death may take place from rupture of the heart, the burst- ing of an aneurism, from apoplexy, phthisis, or other morbid causes which it is here unnecessary to specify. {GormacKs Ed. Journ., May, 1846, p. 343.) If death can be clearly traced to any of these diseases Ijy an ex- perienced surgeon, the prisoner 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 circumstances whether the wound had been inflicted or not. The case of Golonel Gordon, which occurred in April, 1854, proves that slight causes may lead to death, when there is latent disease of the heart or any other important organ. This case was the subject of a trial at the Chester Lent Assizes, 1854 {Reg. v. Sandars). It Ifl 242 WOUNDS — ACCELERATION OP DEATH. appeared from the evidence that the accused, who was the conductor of a railway train in which deceased was travelling, attempted to eject hira from a carriage. The deceased resisted, and in the struggle the prisoner struck him on the left arm. The deceased made no further resistance, but sat quietly in his seat. It was soon afterwards perceived that he was dead. The medical evidence showed that there was ossification of the valves of the heart and aorta, and that this disease had been of long standing. The hfe of the deceased was at all times in great peril, and his death might have arisen from the excitement which took place previous to the prisoner's laying hands upon him. It might have followed in the course of half an hour. As it was thus admitted that excitement alone would account for the fatal result, the prisoner was acquitted. There was no corporeal injury done to the de- ceased which could account for death. In another case, which was the subject of a trial at the Central Criminal Court, in June, 1854 (Beff. v. Ghamplonier), appearances sufficient to account for death existed in the part which sustained the violence ; but the medical witness could not with certainty refer them to the violence. An old mau passing along a road was struck on the forehead by a stone thrown by the prisoner. The surgeon stated that there was a contused wound, and that his nose bled profusely. The bleeding was arrested, and on the following day he considered the deceased to be out of danger. At a later period of the day, however, the deceased was seized with an apoplectic fit, from which he did not recover. The appearances in the brain were quite sufficient to account for death ; but he could not undertake to say that the injury by the stone had in any way produced the appearances. Upon this evidence the supposed connection of the death with the violence was at once set aside, and the prisoner was discharged. On these occasions one of the following questions may arise : Was the death of the party accelerated by the wound, or was 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 the case, and the witness's ability to draw a proper con- clusion from these circumstances. The maliciously accelerating of the death of another already laboring under disease is criminal ; for that which accelerates, causes. 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 yn'h\c\i occasion death; for although a person may, in foro conscientia, be as guilty of murder by work- ing on the passions or fears of another, and as certainly occasion death by such means, as if he had used a sword or pistol for the purpose, he is. not the object of temporal punishment." (I. 247. ) Several acquittals have taken place of late years, in cases in which the deaths of parties had been occa- sioned 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. Conformably to Lord Hale's view, the Criminal Law Com- missioners, in their report on the subject of homicide, state : "Art. 1. The law takes no cognizance of homicide unless death result from bodily injury occasioned by some act or unlawful omission, as contradistinguished from death occasioned by an influence on the mind, or by any disease arising from such influence. Art. 2. The terms 'unlawful omission' comprehend every case where any one being under legal obligation to supply food, clothing, or other aid and support, or to do any other act, or make any other provision for the sustentation of life, is guilty of any breach of such duty." Under the statute (1 Vict. c. 85, s. 2), it appears from the following case that physical injury only is intended. In Beg. v. Grey (Huntingdon Lent Assizes, 1857), WOUNDS — DEATH FROM OTHER CATISES. 243 the prisoner was indicted for causing a bodily injury dangerous to life — to wit, a congestion of the lungs and heart — with intent to murder. It appeared that she had exposed her child to cold and wet, and that congestion or in- flammation of the lungs was a result of such exposure. Erie, J., held that the statute under which the indictment was laid contemplated the infliction of some wound or visible injury to the person. The woman was found guilty ; but in June, 1 857, the point having been reserved, the conviction was quashed by the Court for Crown Cases reserved, on the ground that, looking to the other offences provided for in this statute, this case did not come within it. In Reg. v. Percival (Midland Circuit, March, ISSt), a man was charged with the manslaughter of deceased by causing his death from fright, i. e., by personating a ghost. The evidence showed that the boy had sustained no physical injury, but he had received a shock from which he did not recover. Wightman, J., held that, in his view, the ease would fall within the definition of manslaughter. Under the 14 and 15 Vict. c. 100, the necessity for tracing death to some corporeal injury appears to be practically abolished. Accord- ing to the fourth section, 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. Which, of two wounds caused death. — It is possible that 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 re- quire that a medical witness should state which wound was the cause of death. Let us take the following illustration : 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 for a longer or shorter period, he dies. If the gun- shot wound was clearly shown to have been the cause of death, the second prisoner could not be convicted of manslaughter ; or if the stab were 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 science, skill, and judgment of the medical practitioner ; his evidence would be so important that no correct de- cision could be arrived at without it; he would be, in fact, called upon sub- stantially to distinguish the guilty from the innocent. On some occasions, death may appear to be equally a consequence of either or of both of the wounds ; in which case, probably both parties would be liable to a charge of manslaughter. (See Ann. d'Hyg., 1835, vol. ii. p. 432.) The second wound, which is here supposed to have been the act of another, may be inflicted by a wounded person on himself, in an attempt at suicide, or it may have an accidental origin. The 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. (See Tetanus, post.) It may happen that the wounded person has taken poison, and actually died from the effects of this, and not from the injuries or maltreatment. Cases of this kind have been already related (page 182). Again; a wounded per- son may have been the subject of further ill-treatment, and the question will arise to which of the two causes his death was really due. It is to be ob- served of these cases, that the supervening disease, the poison, or the subse- quent ill-treatment, should be of such a nature as to account for sudden or 244 WOUNDS INDIRECTLY FATAL. 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 symp- toms which actually preceded death. In the medical jurisprudence of wounds, there is probably 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 have occurred in England during the last twenty years, I find that the latent causes of death in wounded persons have been chiefly inflammation of the thoracic or abdominal viscera, of apoplexy, diseases of the heart and large bloodvessels, 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 a slight indisposition. The history is 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 and life-insurance, giving rise to civil actions, may have a close relation to this subject. Death following slight personal injuries. — An imputation has occasionally 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 sugges- tion that an undue amount of violence was used. In such cases there has been commonly some unhealthy state of the body to explain this result. When the disease which gives rise to doubt is seated in a part which is re- mote 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 dis- ease should happen to be in the part injured (the head or chest), the case is more perplexing. The difficulty can then be removed only by attentively considering the ordinary consequences of such injuries. The violence may have been too slight to account for the diseased appearance ; and the disease itself, although situated in the part injured, may be regarded as 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 (p. 229), there was chronic disease of long standing in the brain of deceased, but it was proved that be was quite well and sufl^ered from no unusual symptoms up to the time that the violent flogging was inflicted, and that this was followed by death in less than three hours from the commence- ment of the violence. It was not here a question even of acceleration, for the deceased might have lived for years in spite of the existence of this chro- nic disease. CHAPTER XXX. WOUNDS INDIRECTLY EATAL — DEATH FROM WOUNDS AFTER LONG PERIODS- SECONDARY CAUSES or DEATH — THE CAUSE IS UNAVOIDABLE — THE CAUSE AVOIDABLE BY GOOD MEDICAL TREATMENT — COMPARATIVE SKILL IN TREAT- MENT — CAUSE AVOIDABLE BUT FOR IMPRUDENCE ON THE PART OF THE WOUNDED PERSON — ABNORMAL OR UNHEALTHY STATE OF BODY ACCELERA- TION OF DEATH. Wounds indirectly /atoZ.— Certain kinds of injuries are not immediately followed by serious consequences, but the person may perish after a longer WOUNDS — SECONDARY OATJSES OF DEATH. 245 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, howevei", is jnst 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 insi- diously ; the person may in the first instance recover — he may appear to be going on well, when, without any apparent cause, he will suddenly expire. It is scarcely necessary to observe, that in general an examination of the body will suffice to determine whether death is to be ascribed to the wound or not. In severe injuries affecting the spinal marrow, death is not an imme- diate consequence, unless that part of the organ which is above the origin of the phrenic nerves be 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 appear- ances 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 against an individual, that death should be strictly and clearly traceable to the injury, and not be dependent on any other cause. A doubt on this point must, of course, lead to an ac- quittal. Death from wounds after long periods. — 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 injured party having ultimately fallen a victim to their indirect consequences. A case is related by Sir A. Cooper, of a gentleman who died from the effects of an injury to the head received about two years previously. 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. There is a singular rule in our law relative to the period at which an indi- vidual dies from a wound — namely, that a party shall not be adjudged guilty of homicide, unless death takes place within a year and a day after the inflic- tion of a wound. {Archhold, p. 345.) In practice, the existence of this rule is of little importance, but in principle it is erroneous. Most wounds lead- ing to death generally destroy life within two or three months after their in- fliction: — 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. These protracted cases occur especially in respect to injuries of the head. In Reg. v. ITynes (Winchester Summer Ass., 1860), it was proved that the prisoner had inflicted severe wounds on the head of deceased, and that death took place two months afterwards. The medical witnesses were perfectly agreed that death was caused by an abscess in the brain as a result of these wounds. The jury had great difficulty in finding a verdict of guilty, because in their opinion too long a time had elapsed for the injuries to have been the cause of death ! But for the firmness of the judge, the prisoner would have escaped conviction, and would have owed that escape to the profound ignorance of the jury who tried him. Strict justice demands that the responsibility of a person who has inflicted a wound should depend upon its having really caused death, and not upon the precise period at which death takes place ; for this must be a purely accidental circumstance. Secondary cause of death A person who recovers from the immediate effects of a wound may die from fever, inflammation or its consequences, erysipelas, delirium tremens, tetanus, or gangrene ; or an operation required during the treatment of a wound may prove fatal. These are what may be called secondary causes of death, or secondary consequences of a wound. The power of deciding on the responsibility of an accused person for an event 246 DEATH FROM UNSKILFULNESS. 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 on so difficult and nice a question in the absence of satis- factory medical evidence ; and on the other hand, it is right that a medical witness should understand the importance of the duty here required of him. Fever or erysipelas may follow many kinds of serious wounds, and in some few instances be distinctly 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 fever or erysipelas can be traced to a wound, and there is no other apparent cause of aggravation to which either of these disordered states of the body can be attributed, they can scarcely be regarded by 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 take 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, difBoult 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 answered by an 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 rupture of the bladder or in- testines, with effusion of their contents — strangulation of the intestines, as phrenic hernia, following rupture of the diaphragm, and others of the 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 avoidaile by good medical treatment. — There are, it is ob- vious, 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 deter- mine 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 a prisoner. Let us suppose, for instance, that an ignorant person has removed a clot of blood, which sealed up the extremity of a ves- sel, 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 negligence or unskilfulness of a 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 ori- ginally of a mortal nature. Lord Hale observes : " It is sufficient to con- stitute 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." (I. 428.) The medical jurist will perceive that a very nice distinction is here drawn by this great judge, between death as WOUNDS — COMPARATIVE SKILL IN TREATMENT. 24T 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 speculative grounds, and in no case, probably, would there be any ac- cordance in the opinions of medical witnesses. In slight and unimportant wounds, it might not be difBcnlt to distinguish the effects resulting from bad treatment 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 ori- ginally mortal, but only became so by unskilful or improper 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 perceive on what principle an aggressor could be made responsible for the result. 3. Comparative skill in treatment. — If death be owing to a wound, it sig- nifies not that, under more favorable circumstances, and with more skilful treatment, a fatal result might have been averted. As an illustration, the following case, reported by Alison, may be quoted : The prisoner was one of a party of smugglers who fired at an officer of excise. The wounded man was carried to the nearest village, where he was attended by a surgeon of the country, who was not deficient in attention ; but a great collection of matter having formed in the leg, fever ensued, and the patient died at the end of three weeks. In defence, it was urged that, by slcilful treatment, the man might have recovered ; but the court held that it was incumbent to prove that death arose ex malo regimine. The true distinction in all such cases is, that if the death was evidently occasioned by grossly erroneous medical treatment, the original author of the violence will not be answer- able ; but if it arise from the want merely of the higher skill which can only be commanded in great towns, he will be responsible, because he has wilfully exposed the deceased to a risk from which he had practically no means of escaping. (^Criminal Law of Scotland, ^. 150.) In the case oi Macewan (Perth Sept. Circ, 1830), the prisoner was indicted for the manslaughter of a boy, by striking him a blow on the shoulder, which dislocated the arm. Two days after the blow, an ignorant bone-setter was consulted, and owing to his manipulations, inflammation took place, and the boy being of a sickly and scrofulous habit, this proved fatal. Under the direction of Lord Mea- dowbank the prisoner was acquitted. In charging the grand jury, in refe- rence to Mr. Seton's case (Winchester Aut. Ass., 1845), Piatt, B., is reported to have observed, that if a man inflict a wound likely to produce death, and the wounded party should fall into the hands of an unskilful practitioner, whereby death was hastened, the aggressor would still be responsible for the result. If the wound had not been likely to produce death, but by unskil- ful treatment death ensued, then that would not be murder. A case of this kind was tried at the Lewes Summer Assizes, 1858 {Seff. v. Kingshoot). A man in a quarrel received a bite on his thumb. He went to a quack, who applied some irritating ointment, which led to severe inflammation, and this rendered amputation of the arm necessary. He died from the effects of the operation. There was evidence that the original injury was slight, and would probably have healed but for the improper applications. On this evidence the prisoner was acquitted. It will be obvious that a serious responsibility is thrown on practitioners who undertake the management of cases of criminal wounding. Any de- viation from common practice should therefore be made with the greatest caution, since novelties in practice will, in the event of death, form one of the best grounds of defence in the hands of a prisoner's counsel. On these occa- sions every point connected with the surgical treatment will be rigorously 248 WOUNDS — ABNORMAL STATE OF THE BODY. inquired into. In the case of a severe lacerated wound to the hand or foot, followed by fatal tetanus, it may be said that the wounded person would not have died had amputation been 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 con- nected with the deceased would not allow of its being performed with any reasonable hope of success. On the other hand, if the practitioner performed amputation, and the patient died, then it would be urged that the operation was unjustifiable and had caused death. Here the surgeon is bound to show that the operation was necessary, according to the ordinary rules of treat- ment. The treatment of severe incised wounds of the throat, when the trachea is involved, sometimes places a practitioner in an embarrassing position. If the wound is left open, death may take place from bleeding ; if it be prema- turely closed, blood may be effused into the windpipe, and cause death by suffocation. 4. The cause avoidable hut for imprudence or neglect on the part of the loounded 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 conceived plans for his recovery. 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 circum- stance in favor of the prisoner, even although the wound was susceptible of being cured. A man may receive a lacerated wound of an extremity, which is followed by tetanus or gangrene, and thus prove fatal : he may have de- clined receiving medical advice, or have obstinately refused amputation, although proposed by his medical attendant; but this would not be received as a mitigatory circumstance on the part of a prisoner; because the wounded person is not compelled to call for medical assistance, or to submit to an operation, and a medical witness could not always be in a condition to swear that the operation would have positively saved his life ; he can merely affirm that it might have afforded to the deceased a chance of recovery. In the case of the Queen v. Hulnie (Liverpool Aut. Assizes, 1843), it was proved that the deceased had died from tetanus, caused by an injury to a finger some time before. Amputation was advised by the surgeon, but the deceased would not consent to the operation. The prisoner was convicted of man- slaughter, and sentenced to the severest punishment prescribed by the law for that crime. 5. The cause avoidable hut for an abnormal or unhealthy state of the body of the wounded person. — Wounds which are comparatively slight sometimes prove indirectly fatal, owing to the person being in an unhealty state at the time of their infliction. In bad constitutions, compound fractures or slight wounds, which in a healthy subject would have a favorable termination, are followed by gangrene, fever, or erysipelas, proving fatal. Here the respon- sibility of an assailant for the death may become reduced, so that, although found guilty of manslaughter, a mild punishment might be inflicted. The consequence may be, medically speaking, unusual or unexpected, and, but for circumstances wholly independent of the act of the accused, would not have been likely to destroy life. In general, in the absence of malice, this appears to be the point to which the law closely looks, in order to make out the re- sponsibility of the accused — namely, that the fatal secondary cause must be something not unusual or unexpected as a consequence of this particular injury; and the medico-legal question presents itself under this form : — Would the same amount of injury have been likely to cause death in a person of ordi- nary health and vigor ? Men who have suddenly changed their habits of living, and have passed from a full diet to abstemiousness, are unable to bear ■WOUNDS — ACCELERATION OF DEATH. 249 up against comparatively sliglit injuries, and often sinii from the secondary consequences. So a man, otherwise healthy, laboring under rupture, may re- ceive a blow in the groin, attended with rupture of the intestine, gangrene and death — another with a calculus in the kidney may be struck in the loins, and die in consequence of the calculus perforating the renal vessels and caus- ing fatal hemorrhage, or from subsequent inflammation. In the case of Ben- nett V. Gredley (Exchequer Sittings, Hilary Term, 1854), which was a suit for compensation by reason of injuries inflicted on a boy's arm, it was urged in defence that the state of the arm was partly owing to a former injury; in reference to which the Chief Baron remarked, that a man was not bound to have his body in so sound and healthy a state as to warrant an unauthorized assault upon him. A man, therefore, who commits an unauthorized assault upon his fellow-man must take his chance of the effects which such an assault may produce. Acceleration of death. — It must be evident that there exist numerous other 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. Now, the law, as applied to these cases, is thus stated by Lord Hale : — "It is sufficient to prove that the death of the party was accelerated by the mali- cious act of the prisoner, although the former labored under a mortal disease at the time of the act." (I. 428.) 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. And, 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 preconceived 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 develop the intention of the prisoner. An accurate description of the injury, if slight, may afford strong evidence in favor of a prisoner, 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 admit of no exculpation when the prisoner was aware, or ought to have been aware, of the condition of the party 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 responsible; because he ought to have known that violence of any kind to persons so situated must be attended with dangerous conse- quences. 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 ap- pointed to define the criminal law on the subject of homicide thus express themselves: — "Art. 3. It is homicide, although the effect of the injury he merely to accelerate the death of one laboring under some previous injury or infirmity, or although, if timely remedies or skilful treatment had been ap- plied, death might have been prevented." This is conformable to the deci- sions of our judges. According to Lord Hale, if a man have a disease which in all likelihood would terminate his life in a short time, and another give him a wound or hurt which hastens his death, this is such a killing as con- 250 TETANUS FOLLOWING WOUNDS. CHAPTER XXXI. WOUNDS INDIRECTLY FATAL. TETANUS FOLLOWING WOUNDS — LATENT CAUSES OF — DEATH FROM SURGICAL OPERATIONS — PRIMARY AND SECONDARY CAUSES OP DEATH — UNSKILFULNESS IN OPERATIONS — NECESSITY FOR THE OPERATION — ERYSIPELAS FOLLOWING OPERATIONS — DELIRIUM TREMENS. Tetanus following wounds. — Tetanus frequently presents itself as a second- ary 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 very slight bruises or lacerations, when the injury was so super- ficial as to excite no alarm ; and it is a disease which gives no warning of its appearance. Dr. Brady met with a case in which a man slipped in walking, and fell flat on his back. He was stunned, but able to walk home. He apparently recovered from this simple accident, but on the following day he was attacked with tetanus and died in seventy hours. {Lancet, May 15, 184*7, p. 516.) In Eeg. v. Butcher (Warwick Lent Assizes, 1848), it was proved by the medical evidence that the deceased had received a blow on the nose which caused severe bleeding. In spite of good surgical treatment, the man was attacked with tetanus on the fifteenth day, under which he- sank. On inspection, it was found that one of the small bones of the nose had been broken, and this had given rise to the fatal attack. Tetanus may come on apparently from spontaneous causes, i. e., independently of the existence of any wound on the body. In this form it is called idiopathic, to distinguish it from the tetanus of wounds, which is called traumatic. Many cases have been brought into the London hospitals, in which the only cause of this dis- ease appeared to be exposure to cold or wet — or in some instances, exposure to a current of air. (Lancet, Dec. 14, 1844, p. 351.) Dr. Watson met with a case in which tetanus appeared in a severe form in a man who had received no wound, but who had been simply exposed to cold or wet. (Gormack's Monthly Journal, Dec. 1845, p. 902.) It is scarcely possible to distinguish, by the symptoms, tetanus from wounds from that which occurs spontaneously as a result of natural causes. In endeavoring to connect its appearance with a particular wound or personal injury, it will be proper to observe — 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 appearance, when it is the result of a wound, is frora about 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 has healed. When resulting from a wound it is generally fatal. A medical practitioner 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 case occurred in St. Bartholomew's Hospital, in September, 1853, which exem- plifies the necessity of making a rigorous inquiry into all the attendant cir- cumstances. A boy, set. 15, while quarrelling with another, received a blow in the back from his companion's fist, and this was followed by a kick, but not of a severe character. He was able to get up and walk home ; in about two hours he complained of stiffness about the jaw. He passed a restless WOUNDS — DEATH FROM SURGICAL OPERATIONS. 251 night — the stiffness increased ; there was great pain, and subsequently diflB- culty of swallowing. On the second day he was admitted into the hospital — the pain and stiffness gradually increased, and the jaw became partially fixed. Spasm of the muscles of the back supervened, occurring in paroxysms, and there was confirmed tetanus. He died on the fourth day after he had received the blow on the back, and apparently from tetanus as a result of that violence : it turned out, however, on inquiry, that six days previously to the first ap- pearance of the tetanic symptoms, the boy had accidentally driven a rusty nail into his foot, and that the suppurating wound which resulted from this injury had only closed on the day on which the blow was inflicted. On an examination of the body a small puckered cicatrix, such as would result from the healing of a punctured wound, was found on the ball of the great toe, and there could be no doubt from the circumstances, that this, and not the slight blows struck by the assailant, had been the cause of the fatal attack of tetanus. (See Lancet, Dec. 10, 1853, p. 550.) This case has an important bearing on the question considered at p. 243. It is 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 idiopathic ; 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 accident that he did not mention the circumstance to his medical attendant. This was no doubt the cause of the disease. Death from surgical operations. — In the treatment of wounds, surgical operations are occasionally resorted to, ij,nd a wounded person may die either during the performance of an operation, or from its after-consequences. A question may thence arise, whether the person who inflicted the wound shall be held responsible for the fatal result. The law regards a surgical operation as part of the treatment, and if undertaken londfide, and performed with reasonable care and skill, the aggressor will be held responsible, whatever may be the result. The necessity of the operation, and the mode of perform- ing it, will be left to the operator's judgment. As the defence may turn upon the operation having been performed unnecessarily, 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 assistance of other practitioners. Accord- ing to Lord Hale, if death takes place from an unshilful operation, performed for the cure of a wound, and not from the wound, the responsibility of the prisoner ceases ; but this eminent lawyer does not appear to have considered that death may take place as a consequence of the most.skilful operation re- quired for the treatment of a wound, and yet be wholly independent of the wound itself. Should an operation be unnecessarily or unskilfully performed, the responsi- bility of an aggressor would, it is presumed, cease, if the death of a wounded party could be clearly ascribed to it. Thus, if in carelessly bleeding a wounded person, the brachial artery should be laid open {Ann. d''Hyg., 1834, t. ii. 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 Piatt, B. (p. 331), a prisoner will be held responsible, if the original wound were likely to produce death, although unsldlfully treated. Supposing 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 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. 252 ERYSIPELAS FOLLOWING OPEEATIONS. Should the operation be considered to be absolutely required for the treat- ment 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 in- flicted 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 proba- bility, 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 wonnd, 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 short life, no exculpation should be admitted, if it went to attack the best-directed efforts made for the preserva- tion of life. (See Ann. d'Hyg., 1835, t. i. p. 231.) When a wounded person is taken to an hospital in- which gangrene or erysipelas is diffusing itself by infectious propagation, and he is attacked by one of these diseases before or after the performance of an operation, and dies — a prisoner may be held responsible for the fatal result. It might be contended that the transportation of the wounded man to such a locality was not absolutely necessary to the preservation of his life, and that he would not then have died, but for the accidental presence of an infectious disease. Cases of this kind cannot be easily decided by general rules: but the question has already been raised before a legal tribunal, in a trial which took place at the Maidstone Lent Assizes, 1839. {The Queen against Connel and others.') The deceased was assaulted by a number of soldiers, and received two blows on the head with a stick. Tlie wound was not of any great extent, and the deceased did not appear to suffer much from it. Two days afterwards, he was attacked by erysipelas in the head and face, and he died in about a week. On inspection, there was no appearance of disease. The surgeon referred death to erysipelas, which was prevalent in the hospital at the time the de- ceased was brought in. The man would probably have recovered but for the attack of erysipelas, and he did not think that he would have been attacked by that disease but for the wound. Erysipelas was an infections disease, and a common consequence of wounds of the head. Upon this evidence the prisoners were convicted. In Reg. v. Morris (Wells Summer Assizes, 1860), the deceased, a gamekeeper, died from tetanus following amputation of the leg, rendered necessary by a gunshot wound inflicted by the prisoner. No attempt was made to deny the responsibility of the pri- soner for the fatal result. 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 the coroners' courts by verdicts of accidental death. (See Med. Gaz., vol. xix. p. 151.) It unfortunately happens that on these occasions there is great difference of opinion among medical witnesses respecting the connection of the disease vrith the death, and, indeed, the necessity for the operation itself. The evidence of opinion in favor of the prosecution is sometimes exactly balanced by that urged in the defence : and under these circumstances, the only course open to the court, is to discharge the accused. 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, consequently, 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 CICATRIZATION OF WOUNDS. 253 be in his favor. This is an unfortunate condition of things, for which at present there appears to be no other remedy than that of appointing a Medi- cal Board of competent persons to whom such questions might be referred, in the same manner as questions relative to navigation are referred by the Admiralty Court to a Board formed of members of the Trinity House — professionally acquainted with the matters in dispute. CHAPTER XXXII. CICATRIZATION OP WOUNDS — EVIDENCE FROM CICATRICES — CHANGES IN AN INCISED WOUND — CICATRICES OP STABS AND GUNSHOT WOUNDS — DATE OP PRODUCTION — IS A CICATRIX ALWAYS A CONSEQUENCE OP A WOUND ? — ARE CICATRICES, WHEN ONCE FORMED, INDELIBLE ? — CHARACTERS OP CICATRICES — DATE OP CICATRICES FROM DISEASE OR WOUNDS — MEDICAL EVIDENCE RESPECTING THE PERIOD AT 'WHICH A WOUND WAS INFLICTED — CHANGES OP COLOR IN CONTUSIONS — HOW LONG DID THE DECEASED SURVIVE THE WOUND ? Cicatrization of wounds The period of time at which a particular wound was inflicted, may become a medico-legal question, both in relation to the living and dead. The identity of a person, and the correctness of a state- ment made by an accused party, may be sometimes determined by an exami- nation of a wound or its cicatrix. So, if a dead body be found with marks of violence upon it, and evidence adduced that the deceased was maltreated at some particular period before his death, it will be necessary for a practi- tioner to state whether, from the appearance of the injuries, they could or could not have been inflicted at or about the time indicated. A case was tried at the Taunton Spring Assizes, 1841 {The Queen against Raynon), wherein evidence of this kind served to disprove the statement made by the accused. He was charged with maliciously cutting and wounding the pro- secutrix. There was a cut upon his thumb, which he accounted for by saying it was from an accident that had occurred three weeks before. The medical witness declared, on examining it, that it could not have been inflicted more than two or three days, which brought the period of its infliction to about the time of the murderous assault. This and other circumstances led to his conviction. An incised wound inflicted on the living body, gradually heals by adhesion when no circumstances interfere to prevent the union of the edges. For eight or ten hours the edges remain bloody — they then begin to swell, showing the access of inflammation. If the parts are not kept well in contact, a secretion of a serous liquid is poured out for about thirty-six or forty-eight hours. On the third day this secretion acquires a purulent character. On the fourth and fifth days, suppuration is fully established, and it lasts five, six, or eight days. A fibrous layer, which is at first soft and easily broken down, then makes its appearance between the edges : this causes them gradually to unite, and thus is produced what is termed a cicatrix. Cicatrization is com- plete about the twelfth or fifteenth day, when the wound is simple, of little depth, and only affecting parts endowed with great vitality. The length of time required for these changes to ensue will depend — 1. On the situation of the wound; wounds on the lower extremities are longer in healing than those on the upper part of the body. If a wound be situated near a joint, so that the edges are continually separated by the motion of the parts, cicatrization 254 -WOUNDS — DTJEATION OF CICATRICES. is retarded. 2. On the extent. Wounds Involving many and different struc- tures are longer in healing than those simply affecting skin and muscles. 3. On the age and health of the wounded party ; the process of cicatrization is slow in those who are diseased and infirm. In an incised wound, the cicatrix is generally straight and regular ; but it is semilunar if the cut be oblique. It is soft, red, and tender, if cicatrization be recent : it is hard, white, and firm, if of long standing. On compressing the skin around an old cicatrix, its situation and form are well marked by the blood not readily entering into it on removing the pressure. It has been said that the cicatrices of incised wounds are rectilinear, but this is not always the case ; in general, they are more or less elliptical, being wider in the centre than at the two ends — this appears to be due principally to the elasticity of the skin and the convexity of the subjacent parts ; thus it is well-known that in every wound on the living body the edges are much separated in the centre, and this physical condition influences the process of cicatrization. When the wound is in a hollow surface, or over a part where the skin is not stretched, as in the arm- pit or groin, then the cicatrix may be rectilinear, or of equal width through- out. If there were any loss of substance in an incised wound, or if the wound were lacerated or contused, the cicatrix would be irregular, and the healing would proceed by granulation. The process might then occupy five, six, or eight weeks, according to circumstances. When healed, the cicatrix would be white, and if there had been a loss of substance it would have a puckered appearance ; the surface of the skin would be uneven. See an essay on this subject by Dr. Krugelstein, Henlte's Zeitschrift der S. A., 1844, b. 2, s. 75.) Is a cicatrix always a consequence of a wound'} — If we here use the term wound as implying a breach of continuity affecting the layers of the true skin, a cicatrix is always produced in the process of healing. In even cuts made by a very sharp instrument, especially if they are in the direction of the fibres of subjacent muscles, and the parts are kept in close apposition, the cicatrices are even, linear, and sometimes so small as to be scarcely per- ceptible. If the skin is white, they may be easily overlooked. Wounds of this kind are not, however, commonly the subject of medico-legal inquiry. If, on examining a part, where at some previous time a stab or a cut is alleged to have been inflicted, we find no mark or cicatrix, it is fair to assume that the allegation is false, and that no wound has been inflicted, making due allowance for the fact that mere abrasions of the cuticle, or very slight punc- tures and incisions, often heal without leaving any well-marked cicatrices. Is a cicatrix, when once formed, ever removed or so altered by time as to be no longer recognizable? — This is a question which sometimes presents itself to a medical jurist both in civil and criminal proceedings. They who have given close attention to the subject, agree in considering that cicatrices, when they are once so produced in the cutis as to be easily perceptible, are indelible : they undergo no sensible alteration in their form or other external characters. The tissue of which a cicatrix is formed, is different from that of the skin; it is harder and less vascular, and is destitute of rete mucosum, so that its whiteness, which is remarkable on the cicatrized skin of a negro, is retained through life. If any cicatrices were easily obliterated, it would be those which are even and regular — the results of incised wounds by sharp instruments ; but I have observed that cicatrices of this kind have certainly retained their characters unchanged in one instance for twenty, and in another for twenty-five years. According to the observations of Dupuytren and Del- pech, the substance of a cicatrix is not converted into true skin — it never acquires a rete mucosum. In the cicatrices of lacerated and contused wounds, the form of the weapon with which the wound was inflicted is sometimes indicated. It is not, however, easy to distinguish the cicatrix of a stab from that produced by a pistol-bullet fired from a distance. In both cases the CIOATEICES FROM WOUNDS OE DISEASES. 255 edges may be rounded and irregular, and the cicatrix puckered, unless the stab has been produced by a broad-bladed weapon. Characters of cicatrices. — It is important to observe that all cicatrices are of smaller size than the original wound ; for there is a contraction of the skin during the process of healing. This is especially observed with regard to the cicatrix of a stab, which is frequently of a triangular form. A recent wound, as it has been elsewhere stated, is apparently smaller than the weapon ; and the resulting cicatrix is always smaller than the wound. Hence it is difiScult to judge of the size of the weapon from an examination of the cicatrix. In gunshot wounds, if the projectile has been fired from a distance, the cicatrix is of smaller diameter than the ball : it represents a disk depressed in the centre, and attached to the parts beneath; while the skin is in a state of ten- sion from the centre to the circumference. If the bullet has been fired near to the body, the cicatrix is large, deep, and very irregular. If the projectile has made two apertures, the aperture of exit is known by the greater size and irregularity of the cicatrix. (See Ed. Monthly Journal, 1854, vol. x. p. 310.) As the age of a cicatrix increases, it becomes smaller, thicker, more shining, fainter in color and less sensitive. Cicatrices from disease or wounds. — In certain cases a question may arise whether the cicatrix on a person has resulted from a wound or from loss of substance through disease, e. g., scrofulous ulceration. In the case of Smyth V. Smyth (Gloucester Summer Assizes, 1853), the plaintiff claimed to be the rightful heir to certain estates occupied by the defendants. He based his claim upon some deeds (alleged by the defendants to have been forged), in which it was stated that the lost heir to these estates would be known by certain marks on his right hand and wrist, suggested to have been received at the time of his birth, in ligT, by reason of his having been brought into the world by instruments. It was one of the curious features of this extraordi- nary case of imposture, that no medical opinion was taken or required by the claimant on the probable nature and origin of these marks. When requested at the trial to show his hand to the jury, the mark had the appearance of a puckered cicatrix from a scrofulous ulcer near the wrist. Similar marks from scrofulous sores were seen upon his neck. His statements regarding himself, and the circumstances on which he based his claim, were so improbable and contradictory, that the case speedily broke down. A question of this kind may occasionally present some difficulty, but a close examination of the cica- trix, with a consideration of the statement of the person as to its mode of pro- duction, will generally enable a practitioner to arrive at a satisfactory conclu- sion respecting its origin. Scrofulous ulcers are generally observed to leave irregular and furrowed cicatrices, with smooth depressions, surrounded by hard and uneven margins. According to Schneider, the scorbutic cicatrix is dark, bluish-red in color, soft to the touch, somewhat raised and rather pain- ful ; in the course of time it becomes flatter, of a reddish-brown color ap- proaching to green (?) in the centre, and very thin and easily injured. Syphilitic cicatrices are characterized by great loss of substance ; they approximate the margins of the deep ulcers before their granulations have had time to reach the surface. Glandular cicatrices are irregularly tumefied, generally deep, hardened, and of a reddish-brown color. These varieties cannot easily be mistaken for the cicatrices of wounds. When was the wound inflicted^ — When an individual is not seen until after death, and there are recent wounds on his body, a medical jurist may be re- quired to state at what period they were probably inflicted. It may be taken as a general rule that there are no appreciable changes in any wound until eight, ten, or twelve hours have elapsed from the time of its infliction ; then we have the various phenomena of inflammation, followed by adhesion, sup- puration, or gangrene, during any of which stages the wounded person may 256 HOW LONG DID THE DECEASED SURVIVE. die. Some remarks have already been made on the time at which adhesion and suppuration are established in wounds ; and with respect to gangrene it may be observed, that the deceased must have survived at least fifty hours, in order that this process should be set up ; in old persons it may take place earlier. In examining a dead body, we must take care not to confound the effects of putrefaction in a wound with those of gangrene. Putrefaction always commences sooner in parts which are wounded than in those which are un- injured; but the general appearance of a body will show whether the changes in the wound are or are not due to putrefaction. The collapse of the eye will indicate the existence of this process ; but the presence of warmth or rigidity of the members will show that death may have been too recent for putrefaction to have become established. The time at which a severe con- tusion has been produced, may be commonly determined by noting the changes of color which take place around it. It is rarely until after the lapse of twenty-four or thirty-six hours that these changes of color appear. (See Ecchymosis, ante, p. 193.) The livid circumference passes into a green circle, which is gradually diffused into a wide straw-yellow band, bounding the ecchymosis on every side, if it be in a free or loose part of the skin. In four, five, or six days, the dark livid color slowly disappears from the cir- cumference to the centre, while the colored bands spread more widely around. A central dark spot may be perceived after ten days or a fortnight, and in an extensive ecchymosis it is some weeks before all traces of color are lost. The rapidity of these changes will be modified by circumstances elsewhere stated. Observations of this kind often lead to useful results when proper caution has been taken. The appearances presented by a contusion inflicted recently before death, and of another inflicted some days before, are of course differ- ent; and by an appreciation of this difference, a person charged with murder may or may not be connected with one or the other period of infliction, or with both. In a case of alleged manslaughter, in which I was consulted some years since, there were found on the person of the deceased, the wife of a mechanic, the marks of severe bruises; some of them, in the immediate neigh- borhood of each other, had the rings of color peculiar to a disappearing ec- chymosis, while others had not. The man alleged in his defence that he had only struck his wife once, a few hours before her death, whereas the above medical facts proved not only that the deceased had been struck more than once, but that some of the blows must have been inflicted probably several days before her death. These inferences were corroborated by the evidence of an apprentice who had witnessed the assaults. Such is an outline of the facts which may occasionally enable us to say how long before death particular injuries have been received, or to assign a pro- bable period for their infliction on the living. By their aid we may have it in our power to determine whether two wounds found on a dead body were or were not inflicted at or about the same time. The law in these cases sel- dom requires a precise medical opinion ; indeed, it would be scarcely possible to give this under any circumstances. If a medical witness can only state about what time the injury was inflicted, circumstantial evidence will make up for the want of great medical precision or accuracy on the point. How long did the deceased survive ? — This question, it will be perceived, is indirectly connected with the preceding, although sometimes put with an en- tirely different object. Supposing the wound not to have been such as to prove rapidly fatal, the length of time which a person has survived its inflic- tion may be determined by noting whether it has undergone any changes towards healing, and in what degree. As a wound remains in the same state for about eight or ten hours after its production, it is not possible to say, within this period, how long the person may have survived. Then it has ACTS INDICATIVE OF VOLITION AND LOCOMOTION. 257 been supposed that a medical opinion migtt be formed ffom the nature of the injury, and the parts which it has involved. Thus, a wound may have in- volved large bloodvessels, or organs important to life : in this case, it is pretty certain that the individual must have died speedily. Let us, however, bear in mind that these so-pronounced rapidly mortal wounds sometimes do not prove fatal until after the lapse of some hours or days — a fact which has been much overlooked by surgeons, although of considerable importance in relation to the medical jurisprudence of wounds. CHAPTER XXXIII. ACTS INDICATIVE OP VOLITION AND LOCOMOTION — INJURIES TO THE HEAD NOT IMMEDIATELY FATAL — WOUNDS OF THE HEART NOT IMMEDIATELY FATAL — WOUNDS OF THE CAROTID ARTERIES — LOCOMOTION AFTER RUPTURES OF THE DIAPHRAGM AND BLADDER — SUMMARY. Acts indicative of volition and locomotion. — In cases of death from wounds criminally inflicted, it is often a matter of serious inquiry, whether a person could have performed certain actions, or have moved after receiving an injury which is commonly regarded as necessarily mortal, and likely to destroy life speedily. In respect to wounds of a less grave description, if we except those affecting the members directly, which will be hereafter examined, the power of willing and moving in the person who has received them cannot be dis- puted. The best method of treating this subject will be, perhaps, to select a few cases of severe injuries to important parts or organs, which are usually considered to destroy life speedily. The question relative to the power of exercising volition and locomotion, has been chiefly confined to those cases in which there were injuries to the head, wounds of the heart, the large blood- vessels, the diaphragm, and bladder. Injuries to the head not immediately fatal. — The following case occurred a few years since in the Norfolk and Norwich Hospital : A boy, owing to the bursting of a gun, had the breech-pin lodged in his forehead. He got out of the cart, in which he had been brought four or five miles, and walked into the hospital without assistance. The pin was firmly impacted in the frontal bone, about the situation of the longitudinal sinus. On its removal, a por- tion of brain came away with several pieces of bone, and the aperture in the cranium was nearly an inch in diameter. Symptoms of coma then came on, and the boy died in forty-eight hours. The brain was found to be considera- bly injured. (Med. Gaz., vol. xviii. p. 458.) Mr. Watson mentions a similar case. Daring a quarrel between father and son, the latter threw a poker at the former with such violence that the head of the poker stuck fast in his forehead, and was with some diflBculty withdrawn. The father asked those who were near him to withdraw the weapon, and he was afterwards able to walk to the infirmary. He died from inflammation of the brain. (On Homi- cide, p. 62.) A case occurred to Dr. Wallace, of Dublin, in which a man fell from a scaffold on the summit of his head. He was stunned by the fall, but, on reaching the hospital, dismounted from the car which conveyed him, and walked up stairs with very little assistance. He died in three days, but he remained perfectly rational, and was enabled to get up and go to the water-closet the day before his death. On inspection, there was only a slight abrasion on the summit of the head, but the skull was found split into two 258 WOUNDS OP THE HEART AND nearly equal halves from the frontal bone backwards, and the longitudinal sinus was laid open throughout. In the hemispheres of the brain, there was a large quantity of effused blood in a semi-coagulated state ; and more than two ounces were found at the base of the skull. (^Lancet, April, 1836.) Sup- posing this person to have been found dead with such extensive injuries, the medical opinion would probably have been that he was not likely to have lived or moved afterwards ; and yet the power of volition and locomotion re- mained with him for two entire days ! [Cases of this kind are by no means rare. We might easily recall several which have occurred within our own experience. During a service as resident in the Pennsylvania Hospital, in 1841, we were applied to by an Irish lad whose skull had been laid bare and fractured by the kick of a horse. He walked to the hospital from his stable, but insisted on leaving the house rather than have his head touched. He walked out of the wards with a triangular fragment of the parietal bone ex- posed to view and moving with the pulsations of the brain on which it was depressed. After having spent at least two hours in visiting the ofiSces of two different surgeons, at a considerable distance, he finally permitted the re- moval of the depressed bone and the application of a proper dressing. — H.] It is easy to conceive many cases in which a question of this kind will be of material importance. For instance, a man may fall from a height, and produce a severe compound fracture of the skull. He may, nevertheless, be able to rise and walk some distance before he falls dead. (See case, ante, pp. 199, 206.) Under these circumstances there might be a strong disposition to assert that the deceased must have been murdered — the injuries being such that they could not have been produced by himself, there being 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 lead a surgeon to suppose that the person who sustained the violence had been immediately incapacitated. In Reg. V. Milner and others (Derby Summer Assizes, 1854), in which a Mr. Bagshawe had been assaulted by the prisoners, and had died from the inju- ries sustained, it was proved that the temporal bone was beaten in, the base of the skull fractured, and there was a large coagulum of blood efi'used on the left side of the brain, which by its pressure had flattened this organ. Not- withstanding these injuries, deceased walked a considerable distance, and he survived about twelve hours. There is reason to believe that in this and other cases of a similar kind the large effusion of blood was an after-result. [See paper by Dr. Lente, On Statistics of Fractures of the Skull, during twelve years at the New York Hospital {N. Y. Journ. of Med,, Jan. 1852, and Am. Journ. of Med. Sd., April, 1852).— H.] Wounds of the heart not immediately fatal. — Wounds of the heart were formerly considered to be immediately fatal to life ; but this only applies to those wounds by which the cavities of the organ are extensively laid open. Per- sons who have sustained wounds of the heart have frequently lived sufficiently long to exercise the power of volition and locomotion. Mr. Watson met with a case in which a man who had been stabbed in the right ventricle ran eighteen yards after having received the wound. He then fell, but was not again able to rise ; he died in six hours. On dissection, it was found that a punctured wound had extended into the right ventricle in an obliquely trans- verse direction, dividing in its course the coronary artery. The pericardium was nearly filled with blood, and about four pounds were effused on the left side of the chest. {On Homicide, p. 98.) One of the most remarkable cases of the preservation of volition and locomotion after a severe wound of the heart will be found reported in the Medical Gazette (vol. xiv. p. 334). In this case the patient, a boy, survived five weeks, and employed himself dur- ing that period in various occupations. After death a mass of wood was LARGE AETERIES NOT IMMEDIATELY FATAL. 259 found lodged in the substance of the heart. Had this boy been found dead with such an injury, it is most probable the opinion would have been that his death was instantaneous. Dr. Darling, of New York, has communicated to me the particulars of a case which occurred in February, 1855, in which a man survived for a period of eleven days a bullet-wound of the heart. Soon after receiving the wound he became senseless, cold, and pulseless, and re- mained in this collapsed state for four hours. He then rallied, but died on the eleventh day. On inspection, there was no effusion of blood ; the peri- cardium was much distended by serum, the result of inflammation. A bullet, one-third of an inch in diameter, was found lodged in the septum or fleshy partition between the right and left ventricles, about midway between the a))ex of the heart and base of the ventricles. There was no communication with the cavities — the wound had entirely cicatrized ; and inflammation of the pericardium was obviously the cause of death. [Numerous examples of wounds of the heart not directly fatal are cited by Beck (ii. 329-332) and by Stills ( Wh. and Stills, 2d ed. p. 580). We know of at least three others, occurring in Philadelphia, not noted in these works, in which the victim was proved to have walked several steps after having been wounded in the heart. See Proc. of Path. Soc. ofPhilad., in N. A. Med.-Ohir. Rev., March, 1859, p. 299 ; also New York Med. Times, April, 1855, for the case of Poole, referred to above from Dr. Darling; and in the same journal (May, 1855), Statistical Observations on Wounds of the Heart, and on their relations to Forensic Med.; with a table of forty-two recorded cases, by Dr. Purple ; also Am. Journ. Med. /Sci., July, 1861, p. 293, for a case of bullet in the wall of the heart for twenty years. See, further, a paper On Wounds of the Heart, by Dr. Jno. Redman "Coxe, ^OT. Journ. Med. Sci., Aug. 1829, 307; and Archiv. GSnSr. de Med., Sept. 1839, for a valuable paper On Penetrating Wounds of the Heart, by M. Jobert De Lamballe. Two cases have recently occurred at the Pennsylvania Hospital at Philadelphia, which are worth noting. One is that of a negro, ret. 18, who was admitted, in a very prostrate condition, at 5 o'clock P. M. on Friday, May 31, 1861, a half an hour after having received a penetrating wound of the chest inflicted with a dirk-knife. He soon rallied somewhat in strength, and was able to sit up in bed, but suffered much from dyspnoea until some three or four hours before his death, which took place rather unexpectedly, at 6 o'clock A. M. the following Wednesday, just four days and fourteen hours after the reception of the wound. A post-mortem exami- nation proved that the instrument had grazed the lung, without opening its cellular tissue, and had penetrated the left ventricle at its apex, making a transverse wound a quarter of an inch in length and not valvular. The left long had collapsed, and the pleural cavity of that side contained a consider- able amount of bloody serum. The pericardium, although open at the wound, was distended with blood, and the wounded ventricle presented a small heart- clot, which covered and partially closed the wound. The other case is that of Chas. Keen, white man, aet. 40, who was stabbed by a lunatic, with a pair of tailor's shears, on the 28th of July, 1859, and was at once brought to the Pennsylvania Hospital. He suffered greatly from palpitation of the heart, prostration, and difficulty of breathing, but improved so much during the first ten days, that our diagnosis of a wound of the heart was beginning to be unsettled. The dyspnoea, prostration, and disturbance of the heart, how- ever, returned, and he was evidently in a hopeless condition, when, on the 12th of August, he and his family insisted on his being taken to his own house. He was accordingly carried at least a mile on a settee, in a city rail car, and died about twelve hours after leaving the hospital, on the 13th of the month, sixteen days after the infliction of the wound. At the inspection made by the coroner's examiner for the inquest. Dr. S. P. Brown, he ascer- tained that " the left auricle had been punctured in its upper part, the heart 260 RUPTURES OF THE DIAPHRAGM. completely encased in plasma, the pericardium filled with serum, and the left lung had partially collapsed." — H.] A case of some interest in reference to the power of surviving a severe wound of the cavities of the heart, occurred at Guy's Hospital, in February, 1854, for the particulars of which I am indebted to Mr. Callaway. An Ita- lian, set. 38, discharged a brace of pistols into his chest on the left side. The man was brought to the hospital, was able to converse on his condition, and lived one hour and fifteen minutes after the infliction of the wound. After death it was found that one bullet had perforated the pericardium, entered the right ventricle, and, after traversing the septum of the ventricles, made its exit from the heart at the junction of the left auricle with the ventricle. It traversed the upper lobe of the left lung, and was found fixed in one of the dorsal vertebrae. The second bullet perforated the left ventricle, and then traversed the left lung. This wound was of such a nature, that at every contraction of the ventricle, the opening must have been closed so as to arrest the flow of blood. This man, owing to severe suffering, rolled about the floor, and was with difficulty kept quiet. It will be seen that in this case there were bullet-wounds traversing completely the cavities of the heart; yet the man could talk and exert himself, and he actually survived their infliction 07ie hour and a quarter. Had the body been found dead in a suspicious locality, the discovery of such wounds in the ventricles of the heart might probably have led to a medical opinion that the death of the man must have been instantaneous I In these cases, little or no blood probably escapes from the heart in the first instance, but it may afterwards continue to ooze gently, or suddenly burst out in fatal quantity. It must not, therefore, be supposed, when a person is found dead with a wound of the heart, attended with abundant hemorrhage, either that the flow of blood took place in an instant, or that the person died immediately, and was utterly incapable of exercising any voluntary power. Only one condition will justify a supposition of this kind — namely, when the cavities of the organ, especially the auricles, are largely laid open. Wounds of the carotid arteries not immediately fatal. — Questions relative to the power of locomotion perhaps more frequently occur with respect to wounds of the great bloodvessels of the neck than of the heart — suicide and murder being more commonly perpetrated by the infliction of such wounds. There are several cases on record which show that wounds involving the common carotid artery and its branches, as well as the internal jugular vein, do not prevent a person from exercising voluntary power, and running a cer- tain distance. In one of these (^Rex v. Danks, Warwick Lent Assizes, 1832) it was proved that the deceased had died from a wound in the throat inflicted by the prisoner, which divided the trunk of the carotid artery, the principal branches of the external carotid and the jugular veins. The evidence rendered it probable, if not certain, that after the infliction of this wound, the deceased had been able to run twenty-three yards and to climb over a gate — the time required for the performance of such acts being at least from fifteen to twenty seconds. Most medical witnesses would have probably given an opinion that the deceased could not have moved from the spot where such a wound had been inflicted ; but it was clear that she had gone this distance — there was no dragging of the body, and no motive for its being dragged by the prisoner and exposed in an open road, where it was found. (^Medical Gazette, vol. x. p. 183.) Such cases as these show the necessity of caution in giving an opinion respecting immediate death from wounds. i There is one circumstance which requires notice in relation to severe wounds in the throat — namely, that although the individual may have the power of locomotion, he may not be able to use his voice so as to call for assistance. It sometimes excites surprise at an inquest, how a murder may in this way lOCOMOTION AFTER RUPTURES OF LIVER AND BLADDER. 261 be caramitted without persons in an adjoining room hearing any noise ; but the fact is well known medically, that when the windpipe is divided, as it generally is on these occasions, the voice is lost. Ruptures of the diaphragm. — A rupture of the diaphragm has been con- sidered sufficient to deprive a person of the power of locomotion ; but there appears to be no good ground for this opinion. The general effect of such an injury may be to incapacitate a person ; but still there may be a power of moving and walking after a rupture of this muscle. Ruptures of the liver, unless attended at once with great loss of blood, do not prevent a person from exercising his muscular power. In the case of Gordon (Glasgow Spring Circuit, 1856), it was proved that the deceased had died from ruptured liver ; but after sustaining the violence, he had been able to reach home on foot, although with some difficulty. Ruptures of the bladder. — In ruptures of the bladder, attended with extra- vasation of urine, a question has arisen respecting the power of locomotion. The following cases will show that this power does exist in some instances, although the general result is perhaps to incapacitate the individual from moving : A man, aged thirty-one, while intoxicated, received a blow on the lower part of his abdomen. He was sobered by the accident, and walked home, a distance of a quarter of a mile, although suffering severe pain. When seen in the evening, twelve ounces of bloody urine were drawn off by a cathe- ter, and he complained of having felt cold immediately after he had received the blow. He died four days after the accident. On inspection, there was no mark of bruise or ecchymosis on any part of the abdomen. The bladder was ruptured in its upper and posterior portion for about an inch. {Lancet, May 14, 1842.) The second case was related to me by a pupil. A gentle- man who had been compelled to retain his urine, fell accidentally, in descend- ing a staircase, with the lower part of his abdomen against the edge of one of the steps. The sense of fulness in his bladder immediately ceased, and he walked to a friend's house to dinner. The nature of the accident was men- tioned to a surgeon there present, who immediately suspected that the bladder must have been ruptured. The case terminated fatally in twenty-four hours. A case is reported by Mr. Hird, in which a man walked a distance of two miles after having sustained a rupture of the bladder ; and in another which occurred in January, 1852, communicated to me by Mr. Rake, the man, who sustained the injury in a scuffle, was able to walk a mile between two and three hours after the occurrence. (See also Lancet, Oct. 31, 1846, p. 480.) Thus, then, from these various instances, it is evident that locomotion and muscular exertion may take place after an accident of this description. Summary. — Under survivorship from many severe accidents or personal injuries, this power of moving, if not exerted to a large extent, may take place in a small degree ; and this may become occasionally an important question in legal medicine. Thus it must not be lost sight of, when we are drawing inferences as to the relative position of an assailant and a murdered person from the situation in which the body of the deceased is found. A dead man, with a mortal injury to the head or heart, may be found lying on his face, when he actually fell upon his back, but still had had sufficient power to turn over before death ; or he may have fallen on his face, and have after- wards moved, so that the body may be found lying on the back. A slight motion of this kind is very easily executed ; it does not always depend on volition. Individuals suffering from severe concussion have been frequently known to perform acts unconsciously and automatically. The cases above related may perhaps be considered rare, and as exceptions to the general rule. The medical jurist must bear in mind, however, that he is not required to state in how many, out of a given number of persons similarly wounded, this power of performing acts indicative of volition and locomotion may remain, 262 STRUGGLING AFTER WOUNDS OF THE HEART. but simply whether the performance of these acts is or is not possible. • It is on this point only that the law requires information. The hypothesis of guilt, when we are compelled to judge from circumstances in an unknown case, can only be received on the exclusion of every other possible explanation of the facts. On surgical prognosis or treatment, such cases, from their rare occur- rence, may have little influence ; but in legal medicine the question is widely different. Medical facts, however rare, here admit of a very important and unexpected application. Struggling after severe wounds. — Although, in cases of severe wounds, we may allow that persons may survive for a sufBciently long period to perform various acts of volition and locomotion, yet the presence of a mortal wound, especially when of a nature to be accompanied by a great loss of blood, must prevent all struggling or violent exertion on the part of the wounded person; such exertion we must consider to be quite incompatible with the condition of the wounded person. A medical jurist may thus have it in his power to de- termine whether a mortal wound found on the deceased has been inflicted for the purpose of murder or in self-defence, as the following case, reported by Mr. Watson, will show : — A man was tried at the Lancaster Assizes, in 1834, for the murder of a woman at Liverpool, by stabbing her in the chest. Prisoner and the deceased, with two other females, were quarrelling in the passage of a house. A struggle ensued between the prisoner and deceased, which one of the witnesses said lasted for ten minutes. When the prisoner had reached the door, he pulled out a knife and stabbed the deceased in the chest. She fell, and died almost immediately. The prisoner alleged that he was attacked by several persons, and that he stabbed the woman in self-defence. The judge said, if the blow had been struck with premeditation before the struggle, the crime would be murder — if during the struggle, it would be manslaughter. The medical evidence showed that the blow could not have been struck be- fore the struggle, because it was of a speedily mortal nature ; and the de- ceased would not then have been able, as it was deposed to by the witnesses, to struggle and exert her strength with the prisoner for ten minutes afterwards. This being the case, it followed that in all medical probability the deceased had received the wound towards the conclusion of the quarrel ; and therefore it might have been inflicted while the prisoner was attempting to defend himself. The jury returned a verdict of manslaughter. A case involving this medico-legal question was tried at the Gloucester Lent Assizes, 1849 (JReg. v. Hobbs). The prisoner was indicted for the wilful murder of a man with whom he had been drinking and quarrelling. It appears that in the early part of the quarrel the deceased threw the prisoner down and struck him unfairly. The deceased was told by the landlord of the inn to go home. He replied, " Very well," and then leaving the prisoner, went through the entrance-arch of the inn up the yard, which was his usual way of going home. About seven minutes afterwards the prisoner, who had complained to the landlord of the maltreatment which he had undergone, re- turned into the inn-yard, and was seen on entering it to pull down his waist- coat and button his coat. A witness advised him to go home, and he left the spot. A short time afterwards the deceased was found at the back of the yard, lying on his face and quite dead. On examining the body it was ascertained that the deceased had been stabbed in two places, one of the stabs having penetrated the ventricle of the heart. On apprehending the prisoner, a large clasp knife was found in his pocket stained with blood. The prisoner admitted that he had stabbed the deceased, but said it was during the quarrel, and that he had used the knife in self-defence while they had him on the ground. This was the defence. Tor the prosecution it was contended that the deceased had been stabbed by the prisoner subsequently to the quarrel — that he had gone through the gate into the yard to meet the deceased, had AFTER WOUNDS OP THE HEAD. 263 there stabbed him, and had caused his instant death. The medical witness who was called, stated, at first, that from snch a wound death must have been instantaneous. In cross-examination, however, he admitted that the deceased might have lived some time after he had been stabbed ; and on this evidence the prisoner was convicted of manslaughter, and sentenced to six months' imprisonment. The medical facts of this case are rather imperfectly reported : hence it is difficult to give a decided opinion respecting the time at which the deceased was stabbed in the heart. It is true that the Due de Berri survived a punc- tured wound of one of the ventricles for the loug period of eight hours ; but every case must be judged by the special circumstances accompanying it. The size of the stab in the ventricle is not stated ; nor is it in evidence whether any blood was found on the spot where the deceased was struggling with the prisoner. That the deceased should have struggled with the prisoner for one minute after he had been stabbed in the ventricle of the heart is con- trary to all medical experience and probability. It is also irreconcilable with the existence of such a wound, that the deceased should have spoken to the landlord — that he should not have called the attention of the latter to the fact of his having been stabbed by the prisoner while struggling with him — that he should have been stabbed in the heart without knowing It, or without being aware of his condition — that he should have been able thereafter to walk away through the inn-yard to the house, and survive seven minutes while thus walking ; and yet all these circumstances must have happened, in order that the defence, and the verdict based upon it, should be true. Taking the facts as reported, it appears to me that it is impossible to arrive at any other conclusion than that the deceased was stabbed by the prisoner subse- quently to the quarrel, while he was walking through the inn-yard. The only circumstances for the defence were the prisoner's statement, and that, in some rare eases, certain wounds of the heart do not prove immediately fatal. The case of Heg. v. E. M. Brown (Dorchester Summer Assizes, 1856), presents some points of interest in reference to the question under considera- tion. The prisoner was charged with the murder of her husband by blows on the head while in her room. Her statement was that the violence on the head was produced by the kick of a horse. The medical evidence showed that the bones of the nose were broken ; there was a triangular wound ex- posing the bone above the left eyebrow, another triangular wound exposing the bone at the top of the head, and a third wound at the back of the head. The left ear was perforated ; and behind it was a long wound divided into two. The frontal bone was fractured from the orbit, through the parietal into the occipital bone. Seven pieces of bone, varying in size from half an inch to three inches, had been driven into the brain, and a large quantity of blood was effused. The prisoner's account was that she found her husband thus wounded and bleeding outside the house, that she dragged his body into an inner room, and, further, that though thus wounded, he held her tightly by the clothes for two hours afterwards. It was proved that there was no blood over the front of the person or dress of deceased, and that there was no blood in the passage or in any part of the house, except in the room where the body was found lying. Further, the injuries were not such as a kick from a horse would explain ; and the medical witness properly stated that a man thus injured could not have held the prisoner by the clothes for two hours, so as to prevent her from seeking earlier for assistance. The facts showed that deceased had been killed by blows where the body was found ; and the prisoner was convicted. 264 WOUNDS OF THE SCALP. CHAPTER XXXIV. WOUNDS AS THEY AFFECT DIFFERENT PARTS OF THE BODY — WOUNDS OP THE HEAD — OF THE SCALP — CONCUSSION — HOW DISTINGUISHED PROM INTOXICA- TION — EXTRAVASATION OF BLOOD — SEAT OP — AS A RESULT OF VIOLENCE, DISEASE, OR MENTAL EXCITEMENT — WOUNDS OP THE FACE — OP THE ORBIT — OF THE NOSE — DEFORMITY AS A CONSEQUENCE OP WOUNDS OP THE PACE- INJURIES TO THE SPINE — FRACTURES OP THE VERTEBRAE — DEATH PROM INJU- RIES TO THE SPINE AND SPINAL MARROW. The danger of wounds, 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, rarely produce any serious effect ; but this will, of course, depend on their extent. When the wound is contused, and accompanied by much laceration of the skin, it is highly dangerous, in consequence of the tendency which the inflammatory process has to assume an erysipelatous character. The results of these wounds are, however, often such as to set all general rules of prognosis at defiance. Slight punctured wounds of the scalp will sometimes terminate fatally, in consequence of in- flammation being set up in the tendinous structures, followed by extensive suppuration beneath, while, on the other hand, a man will recover from a lacerated wound by which the greater part of the skin 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 occi- pito-frontalis tendon, followed or not by the process of suppuration. Either of these secondary effects may operate fatally in slight or severe wounds. Neither can be regarded in the light of an unusual consequence of a severe wound of the scalp ; but when one or the other follows a slight injury, there is reason to suspect that the patient may have been constitutionally predis- posed ; and if fatal effects ensue, the influence of the predisposition may be considered a mitigatory circumstance. Bad treatment may likewise lead to a fatal result from a wound not regarded as serious in the first instance ; but the question, how far the responsibility of the aggressor would be affected by a circumstance of this nature, has been considered in another place {ante, p. 246). 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 injury 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 the external appearance of a wound, the degree of mischief which has been produced internally. These injuries, as it is well known, are very capri- cious in their after-effects ; the slightest contusions may be attended with fatal consequences, while fractures, accompanied by great depression of bone, and an absolute loss of substance of the brain, are sometimes followed by per- fect recovery. {Gormach's Journ., Sept. 1845, p. 653 ; Med. Gaz., vol. xxxix. p. 40; and PM. Med. Exam., Nov. 1845, p. 696.) Another diflS- culty in the way of forming a correct prognosis consists in the fact that a person may recover from the first effects of an injury, but after a short time he will suddenly die ; and on examination of the body, the greater part of CONCUSSION — EFFECTS NOT ALWAYS IMMEDIATE. 265 the brain will be found destroyed by the suppurative process, although uo symptoms of mischief may have manifested themselves until within a few hours of death. For a medico-legal account of injuries to the head, see a paper by M. Toulmouche, Ann. dPHyg., 1859, vol. ii. p. 395, and 1860, vol. i. p. 143. Concussion — The common effect of a violent blow on the head is to pro- duce concussion or effusion of blood, or both. In concussion, the symptoms come on at once, and the patient sometimes dies without any tendency to re- action manifesting itself. Concussion is usually indicated by fainting, insen- sibility, or sudden death occurring immediately after the operation of external violence. In the most severe form, the person drops at the very moment when struck and dies on the spot. {Gheliush Surgery, Am. ed. vol. i. p. 449.) In other eases, he may linger in a state of insensibility for several days or weeks and then die. In this state there is generally more or less vomiting. It is important to remember that neither compression nor physical injury to the brain is necessary to render concussion fatal. ( Traversh Constitutional Irrita- tion, p. 488; Chelius^s Surgery, Am. ed. vol. i. p. 451.) 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. In Eeg. v. Burgess (Liverpool Lent Assizes, 1845), the de- ceased, who was the subject of violence, fell and died on the spot, and there was no lesion externally or internally. The state of insensibility observed in concussion may be sometimes only apparent. Mr. Guthrie relates the follow- ing singular case : — A gentleman who had met with an accident on board of a vessel at sea, while lying apparently deprived of sense and motion, heard a discussion between a relative and another person, who supposed he was dying, as to the mode in which they would dispose of his body, and he was conscious of his utter inability to make any movement indicating that he was alive and understood their conversation. Fortunately they resolved to convey him to the port to which the vessel was bound. Inflammation may follow the primary shock from concussion — suppuration will take place, and the patient may die after the lapse of some weeks, or even months. (See case Med. Times and Gaz., June 80, 1860, p. 645.) It is im- portant, in a medico-legal point of view, to notice that an individual may move about and occupy himself, while apparently convalescent, 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 sup- position, 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 de- fence 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 weeks, months, or even years. (See Travers, op. cit., p. 445.) A case is mentioned by Hoffbauer, in which a person died from the effects of concussion of the brain, as the result of an injury received eleven years before. {Ueber die Kopfverletzungen, 1842, p. 5'7.) 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 extensively fractured, and the brain may be even shattered by such a fall. This was the cause of death in the case of the late Buhe of Orleans. {Med. Gaz., vol. xxxvi. p. 368.) In Allen v. The Chester Railway Company (Court of Common Pleas, Feb. 1851), the plaintiff claimed damages for injury caused by a railway collision. The evidence showed that the plaintiff received a blow on the head. There were no immediate symptoms ; but in two days the plaintiff suffered from lightness of the head and other symptoms, attributed by his medical attend- ant to concussion of the brain, as a result of the accident. Subsequently there were symptoms of injury to the spine. There was pain in the course 266 -vrouNDS of the head fatal of the spine, partial paralysis of the bladder, rectum, and lower extremities, with loss of memory. The medical witnesses for the plaintiff, including Mr. Solly and Mr. Wells, attributed these symptoms to a blow received by plain- tiff at the base of the skull. The defendants contended that if these were the results of concussion of the brain, they ought to have manifested them- selves immediately on the occurrence of the accident ; and this view was to some extent supported by the evidence of Mr. Lawrence, Mr. Arnott, Mr. Fergusson, and others. 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 immediate symptoms ; but the wit- nesses 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 practically 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, but this cannot always be obtained. It is commonly said that the odor of the breath will detect intoxication ; but it is obvious that a man may meet with concussion after having drunk liquor insufficient to cause intoxication, or concussion might 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 ; but concussion may be so slight as sometimes closely to resemble intoxication ; and in the absence of all marks of violence to the head, and in the existence of a spirit- uous 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 symp- toms 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 coexistence of a mark of violence on the head might lead to error in the formation 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 probable than another, he should adopt it : if there be any doubt, this should be stated to the court. There is nothing in the state of the brain in a dead body which will enable a practitioner to distinguish whether concussion or intoxication has been the cause of the symptoms. The vessels may be congested in both cases. The discovery of alcoholic liquid in the stomach may lead to a presumption that deceased had been intoxicated, while marks of violence on the head may favor the view that he had suffered from concussion. When both conditions are found, the examination of the body cannot lead to a solution of the ques- tion. Tiie answer must then depend on the special circumstances proved, and 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 any signs of intoxication about an injured person. Subsequent proceedings may render this a mate- rial part of the inquiry. In November, 1851, the house-surgeon of a London hospital was severely reprimanded by a magistrate, in consequence of an omission to inquire and satisfy himself whether, in addition to the results of violence, a policeman, who was brought to the hospital, was or was not intoxicated when admitted. The question was of importance; the injuries to the head might have arisen from a fall ; and a drunken man might readily meet with such injuries from accident. A person was charged with an FROM EFFUSION OF BLOOD. 267 assault on the policeman, but upon very suspicious evidence ; and, in fact, could intoxication have been proved or rendered probable, there would have been no ground for the charge. The medical man had already certified that the patient was not intoxicated, but when pressed in cross-examination, could not say whether he was or was not. The case was immediately dismissed. There can be no excuse for not making an inquiry into the precise condition of an injured person, and arriving at the best judgment of which the case admits. A state of intoxication often renders it difficult to form an accurate opinion in cases of alleged criminal wounding. Some instructive cases, in reference to this complication of wounds, have been published by M. Tardieu. (See 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 on the surface or in the substance 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 inspection, blood may be found effused either at the base or in the ventricles of the brain, and the question will arise — Did the injury which caused death arise from a blow or a fall? Two cases of this description are reported by Dr. Wharrie. The men were knocked down by blows with the fist, and they were taken up dead. (CormacFs Monthly Journ., Feb. 1846, p. 117.) It is not easy to give an answer to this question, and its relevancy in a legal view is not apparent ; for as it is presumed the blow was the cause of the fall, it is fair to infer that the assailant should be responsible for the effects of either or both. In a case of this kind {Seff. v. Williams, Denbigh Lent Assizes, 1856), in which deceased had received a blow and sustained a fall, and his death was proved to have resulted from the violence, the judge directed the jury, if the death was caused by "the fighting," to return a verdict against the prisoners. They, however, persisted in returning a verdict of not guilty ; assuming that the fatal injury was caused by the fall and not by the blow I A heavy blow on the head may cause fatal effusion of blood ; but in these instances the effusion more commonly arises from the violent concus-sion 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. This subject has important applications in legal medicine, for this is one of the most common causes of death in injuries to the head, and there are gene- rally many cases of this description tried at the assizes. Effusion may occur from violence, with or without fracture, and it may take place without being accompanied by any external marks of injury to the head. In the Queen v. Phelps and others (Gloucester Aut. Ass. 1841), it was proved that there was great effusion of blood, and even laceration of the brain, in the deceased, without any corresponding external injuries. (See also, at the same Assizes, the case of the Queen v. Thomas.) The late Dr. Griffiths, the American editor of this work, mentions a case which was the subject of a trial in Mas- sachusetts, in which a person received a blow from a small stone, and died in ten minutes. On examination, there was no external bruise or fracture of the bones : the ventricles were filled with coagulated blood, and all the ves- sels were gorged with blood. It is remarkable that the skull was, in this instance, unusually thin (p. 287, 1st Amer. ed). The chief source of the effusion in violence to the head arises from a rupture of the meningeal artery, and this may occur from the mere shock or concussion, with or without a fracture of its bony canal. The blood thus effused acts by compressing the brain ; this compression does not always cause death unless the blood is in large quantity, or unless it is effused in or around the base of the brain (me- dulla oblongata). Thus, the hemispheres will bear a degree of compression which, if it affected that portion of the base of the brain from which the spinal 268 EFFUSION OF BLOOD FKOM DISEASE OR VIOLENCE. marrow proceeds, would instantly destroy life. The most fatal effusions, therefore, are those which take place in a fracture of the base of the skull, whereby -one or both lateral sinuses are commonly ruptured. There may, however, be laceration of the brain, with effusion of blood to some extent at the base, and yet the person may survive some days. Dr. Paterson, of Edin- burgh, communicated to me a case which occurred in February, 1854, in which a woman survived severe injuries to the head, supposed to have been inflicted by her husband, for a period of twelve days. She was insensible during the whole of this time, but some of the external marks of violence had nearly disappeared, and others had undergone the usual changes in color. A severe blow had obviously been inflicted on the summit of the head. On inspection after death, it was found that there had been laceration of the brain by counter-stroke, and a large clot of blood was observed to occupy the lacerated part, extending over the surface of the base of the brain and into the ventricles. In this case, the woman survived a severe injury for an unusually long period. In the case of Cuming (Edinburgh, Dec. 1853), the deceased, the wife of the prisoner, died on the 8th of November, from lacera- tion of the brain, produced by blows on the head inflicted by the prisoner on the 26th of October. The woman lay in a state of insensibility during the whole period of thirteen days. In cases of injuries to the head proving fatal by effusion of blood on the brain, a person may recover from the first effects of the violence, and appa- rently be going on well, when he will suddenly become worse and die. Effu- sion 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 producing compression. 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. Sir 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 attempted to pass off the accident as of a trivial nature, bat he soon began to feel heavy and drowsy, so that he was obliged to go to bed. His symptoms became more alarming, and he died in about an hour, as it afterwards appeared, from effusion of blood on the brain. Effusion ofhloodfrom disease or violence. Diagnosis. — 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 manslaughter. On these occasions, it is often urged in the defence, that the fatal bleeding might have arisen either from a 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 in- toxication or passion. 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 inflicted, but occa- sionally, 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 EFFUSION OF BLOOD FROM EXCITEMENT. 2G9 trials, and which depends on the same canse as fracture by counter-stroke, i. «., on a separation of parts (laceration of the brain, effusion of blood, or even fracture of the bonesj at the point of the skull directly opposite to that which sustains the violence. Dr. Paterson's case above related {ante, p. 268) furnishes a good instance of extensive injury by counter-stroke. A severe blow had been inflicted on the summit of the head, as the mark was plainly visible, but the fatal injury was found in the base of the brain, i. e., on the part opposite to that which received the blow. Here the brain was lacerated and blood effused. Again, fracture of the base of the skull is frequently the result of severe violence applied to the summit. (See case by Dr. Haworth, Med. Gaz., vol. xxxvi. p. 368.) 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 in these cases be apparent on inspection. A mere inspection of the body does not always lead to the discovery of the cause of an effusion on the brain. The violence causing an effusion of blood may have been slight, and unless attention is particularly directed to the sub- ject, it may be overlooked. In the case of a female who died in a London hospital, in August, 1857, there was no fracture of the skull, or external in- jury to account for Effusion of blood on the brain. The brain was not injured, and in fact there was no apparent cause of death but the effusion, and this was somewhat precipitately assigned to disease. A certificate of death from "apoplexy" was given, and the deceased was buried. It subse- quently transpired that she had been maltreated by her husband, and that the effusion of blood was owing to the maltreatment I The condition of tbe effused blood should be accurately noticed, in order to determine whether it presents any marks indicative of its being recent or of old standing. Effusion of hlood from excitement. — When engaged in the investigation of a case of this kind, it is always a fair matter of inquiry whether the violence, upon the evidence, was not of itself sufficiently great to account for the effusion of blood 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. 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 state clearly that which is, in his own mind, the moTe probable canse of death ; and by weighing all the circumstances of- the case exactly beforehand, he will rarely fail to find that one canse was more pro- bable than the other. Thus, if a man, excited by passion and intoxication, is struck on the head, and the blow is slight — such as an unaffected person would probably 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 with the practitioner that the effusion was chiefly due to the excitement under which the deceased was laboring ? 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 that part of the body : on inspection it is found that death has arisen from effusion of blood on the surface of the brain, and it would be no unex- pected 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 270 WOUNDS OF THE FACE. account for the effusion, without reference to any coexisting causes of excite- ment ? These may be allowed to have their influence, in giving an increased tendency to cerebral hemorrhage, or in aggravating the consequences of the blow, but no further. Effusion of Mood causing death after a long period of time. — Admitting that blood has been effused on the brain as a result of violence, the persou injured may survive the effects for so long a period as to create a legal doubt whether death can be strictly assigned to the violence. In this respect the case of Reg. v. Sullivan (C.C.C. Sept., 1853), is of some interest. I am indebted to Drs. M'William and Stevens, who gave evidence at the trial, for the particulars of this case. Deceased, who had been previously a healthy man, was knocked down by the prisoner, and fell with his head upon the ground. He appeared as if he was stunned, and staggered in attempting to walk: he complained of pain in the head and general weakness. This was on the 11th April, 1853. Although he suffered from pain in the head, he had no medical advice until the 12th May, and had performed his duties as an officer of the Customs. After this he suffered from dimness of sight, and became delirious. On the 29th he came under the care of Dr. M'William. There were marks of bruises on the head, there was impairment of vision, a faltering gait, and other symptoms indicative of pressure on the brain. He improved under treatment, but the symptoms returned in an aggravated form about the 12th June. He became insane, and was transferred to St. Luke's Hospital. Dr. Stevens, under whose care he was placed, stated that deceased had delusions, and was evidently suffering from pressure on the brain. He recovered so far that he was about to be discharged, when the symptoms of pressure became aggravated, and death took place on the 17th August, «'. e., four months after the infliction of the violence. On inspection a shot was found imbedded in the frontal bone, not penetrating the skull. A large clot of blood existed between the layers of the arachnoid membrane, occupying the whole surface of the left hemisphere. The clot had evidently been there for some time, because it was partially invested with a false membrane. No large vessel was rnptured ; there bad probably been an escape of blood at different times, and this would explain the intermittent nature of the symp- toms. The clot amounted to at least two fluid ounces, and the surface of the brain had been obviously indented by its pressure. Another clot of old standing was found in the pons varolii. The witnesses concurred in attribut- ing death to the effusion of blood on the brain, and the effusion to the vio- lence inflicted by the prisoner, although it was admitted to be probable that some additional effusion had taken place just before the last fatal recurrence of symptoms. The prisoner was convicted of manslaughter. The fact that the deceased had been healthy previous to the violence, and that after this he had constantly suffered more or less from symptoms of pressure on the brain, fully justified the medical opinion in spite of the protracted nature of the case. There was no other cause but the violence to account for the effusion and death. 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 organs of the senses are situated, they often prove fatal, either by involving the brain and its membranes, or by giving rise to inflammation in this organ. Wounds of the eyebrows are not of so simple a nature as might at first sight be sup- posed. Besides being attended by deformity when they heal, they are liable to give rise, during the process of healing, to serious disorders of the neigh- boring parts. Amaurosis and neuralgia are recorded among the secondary and not unusual consequences of such wounds, when the supra-orbitar nerve INJURIES TO THE SPINE. 2T1 has become implicated. TJnder certain conditions of the system, there may be inflammation of the parts within the orbit, extending by "contiguity to the membranes of the brain, and proving fatal by leading to the formation of matter within that organ. Amaurosis in the right eye has been Iinown to occur from a contused wound, not of a violent nature, to the right eyebrow. Dr. Wallace, of New York, has reported two cases of amaurosis following blows over the infra-orbitar nerve. {Med. Gaz., vol. xxxi. p. 931.) Wounds apparently confined to the external parts of the face, frequently conceal deep- seated mischief A sharp instrument penetrating the eyelid, and passing upwards with any force, will produce fracture of the orbitar plate of the frontal bone, which is known to be extremely thin, and even injure the brain beyond. Wounds of the orhit — Sir Astley Cooper relates that a girl, while playing with a pair of scissors, accidentally fell, and the point of the scissors passed upwards under the upper eyelid. It was found difiicult to extract them : the eye became inflamed, but for some days after the accident the child was in the habit of walking a considerable distance daily to receive medical advice. In about ten days she suffered violent pain, with symptoms of inflammation of the brain, under which she died. On inspecting the body, it was found that the orbitar plate of the frontal bone had been fractured, the dura mater torn, and the anterior lobe of the brain lacerated. (For a similar case, see Med. Gaz., vol. xli. p. 553.) In several instances in this country, trials for murder have taken place, in which death has been caused by a penetrating wound of the orbit, leading to fracture of the orbitar plate and injuring the brain. Wounds of nose. — These wounds are, generally speaking, of a simple nature, rarely giving rise to serious symptoms ; but they are almost always attended with great deformity. If the injury be contused and, at the same time, ex- tensive, a loss of the faculty of smelling will probably result. A penetrating wound of the nose, produced by passing a sharp-pointed instrument up the nostril, may destroy life by perforating the cribriform plate of the ethmoid bone, and injuring the brain. Such a wound, it is obvious, might be pro- duced without leaving any external marks of injury. The late Dr. Corkin- dale, of Glasgow, met with a case in which a man died in nine weeks from the effects of a wound of the nose, whereby the nasal bones were fractured. On inspection, there was copious inflammatory effusion at the surface of the brain, particularly at the part corresponding to the seat of the violence. An injury to the bones of the nose may prove fatal by giving rise to an attack of tetanus. A case of this kind has been elsewhere related (ante, p. 250.) Deformity as a consequence of wounds of the face. — Wounds of the face, when at all extensive, are always followed, in healing, by greater or less de- formity. A medical witness may perhaps find these questions put to him in relation to them. Is the wound likely to be attended with deformity ? Could such a wound of the face heal without deformity ? or. Could the deformity, if it exist, have been produced by any other cause than the wound ? These questions are of some importance. A person may allege that he was severely wounded in the face, when the medical witness, on examination, may find no trace of such a wound as that described. Again, a person may seek damages from another in a civil action, by alleging that a particular deformity was produced by a wound, when the medical witness may be able to trace its origin to disease, or to some accidental cause. Injuries to the Spine. Injuries to the spine and spinal marrow seldom require medico-legal inves- tigation ; but this organ is liable to concussion from blows, to compression from fracture of the vertebrre, or the effusion of blood, with all the secondary 272 INJURIES TO THE SPINAL MARROW. consequences attending such accidents. Concussion of the spinal marrow commonly produces paralysis, aifecting the bladder, rectum, or lower extremi- ties. These symptoms may not appear at once, but come on after some hours or days. {Bowling v. S. E. Railway, Exchequer, Feb. 1859.) After death no traces of mechanical injury may be discovered. Blows on the spine, unattended with fracture or dislocation, may, according to the observations of Sir B. Brodie, be followed by inflammation and softening of the spinal marrow. A slight injury has been known to cause death by giving rise to inflammation of the spinal marrow. (See Henke's Zeitshcrift der S. A., 1840, ii. 407.) This organ is also liable to compression from slight causes. Fractures of the vertehrae These fractures are generally attended by dis- placement, and thus produce compression of the spinal marrow. They are the more rapidly fatal, in proportion as the injury is high up in the vertebral column. The whole of the body becomes paralyzed below the seat of injury, by the compression of the spinal marrow. If the seat of compression be above the fourth cervical vertebra, death is commonly immediate : asphyxia results from paralysis of the phrenic nerves. In falls on the summit of the head from a height, it sometimes happens, not only that the skull is exten- sively fractured, but that the dentiform process of the second vertebra is broken off, owing to the head being doubled under the body. This injury to the second vertebra may be the cause of death. From a case related by Mr. Phillips, it would appear that this accident is not always attended by fatal compression of the spinal marrow. {E. 31. Sf S. J., Jan. 1838.) In one instance the individual survived fifteen months (lb., Oct. 1845, p. 537); and in another, in which the fracture was caused by the patient turning in bed while his head was pressed on the pillow, death did not take place for sixteen months. (Copland, Did. Pr. Med., Paralysis.) On several criminal trials, this injury was proved to have been the cause of death : and in a case tried at Glasgow (the Kinff against Held), it became a material question, how far such a fracture might result from disease. It may happen that caries, of the bone or disease of the transverse ligament will cause a separation of the dentiform process from the second cervical vertebra. The state of the bone in these alleged fatal accidents should, therefore, be closely examined. In Reid's case an acquittal took place, partly because the deceased had labored under disease of the spine, and the exact state of the parts had not been noticed. Disease of the ligaments may also lead to a separation, fol- lowed by slow or rapid death, according to the degree of pressure. A slight cause may sometimes produce severe and fatal injury to the neck. A man while holding his head in a butting position during a struggle with a friend died suddenly. The friend had forcibly rotated or twisted the deceased's head a few times from side to side by the brim of his hat. On inspection, it was found that the four first cervical vertebrae were fractured — the ligaments were bruised and torn, and blood was effused on the coverings of the spinal cord. This fully accounted for death. (Med, Times and Gazette, May 17, 1856.) It is not stated whether there was any disease of the bones. Injuries to the spine and its contents are generally the result of falls or blows either on the head or the lower part of the column. The secondary consequences of these injuries are sometimes so insidious as to disarm suspi- cion, and death may take place quite unexpectedly some weeks after the accident. Spicnla of bone separated by fractures may remain adherent for some time ; and by a sudden turn of the head, be forced off and destroy life by penetrating the spinal marrow, at a long period after the infliction of the injury. This has been known to happen in fractures involving the margin of the foramen magnum, and in such cases death is immediate. The spinal marrow has been in some instances wounded in its upper part by sharp- pointed instruments introduced between the vertebrae. Death is an instanta- ■WOUNDS OP THE CHEST. 2^3 neous result when the wonnd is above the third cervical vertebra : there is no part of the spine where a weapon can so readily penetrate as this, espe- cially if the neck be slightly bent forward. The external wound thus made may be very small, and if produced with any obliquity by drawing aside the integuments, it might be easily overlooked, or it might be set down as super- ficial. For a medico-legal account of a case in which death occurred from a stab ill the back of the neck, causing a division of the spinal marrow, see Henke, Zeitschrift der S. A. H., ii. 1836 ; and for another case of homicidal injury to the spine, reported by Dr. Eade, see Lancet, May, 1855, p. 520. In fractures of the vertebrae a person is generally so disabled, whatever may be the situation of the fracture, that he cannot walk or exert himself. We must be prepared, however, for exceptions to this common surgical view of such injuries. On the 27th February, 1861, a man, set. 35, was admitted into the Northamptom Infirmary suffering from paralysis of the legs and great pain in the back and in the abdomen. He could give no intelligible account of the cause of his illness. He soon died; and on & post-mortem examination, the tenth dorsal vertebra was found broken in its body and arch. There was slight displacement but it was not such as to press upon the spinal cord. A large clot of blood was situated on the sheath of the cord. This had caused the paralysis. It was proved at the inquest that deceased met with a heavy fall on the 15th of February, but that he walked some distance afterwards, visited several public houses, went home intoxicated, and lay down to sleep in a yard. He awoke in the morning sober, but was unable to move his legs. In addition to paralysis the man when admitted was laboring under peri- tonitis. There was no evidence that he had sustained any injury subsequently to the fall twelve days before his admission ; hence there was reason to believe that in spite of the fractured vertebra he had not been rendered incapable of motion. There is no doubt that the' effusion of blood was the cause of the paralysis, and this did not occur until some time after the fracture, as a result of slow oozing. (See for a case somewhat similar, ante, p. 199, also the case of Slater and Vivian, C. C. C, Sept. 1860. Insanity, post.) CHAPTER XXXV. •wotjnds of the chest — op the lungs — ruptures from accident — wounds and ruptures of the heart — wounds of the aorta and large veins — wounds and ruptures of the diaphragm — direction of wounds op the chest — wounds of the abdomen — death from blows on the abdomen — ruptures op the liver, gall-bladder, spleen, kidneys, intestines, stomach, and urinary bladder — medico-legal questions connected with ruptured bladder — wounds of the genital organs — mutilation. Wounds of the Chest. Wounds of the chest have been divided into those which are confined to the parietes or coverings, and those which penetrate the cavity. This divi- sion is important, so far as it relates to the prognosis of such injuries. Incised or punctured wounds of the parietes of the chest are rarely followed by dan- gerous consequences. The loss of blood is not considerable, and is generally arrested without much difficulty. They heal either by adhesion or suppura- tion, and unless their effects be aggravated by incidental circumstances, the 274 ■WOUNDS OP THE CHEST AND LUNGS. prognosis is very favorable. Contusions or contused wounds of the chest are, however, far more dangerous, and the danger is always in a ratio to the degree of violence used. Such injuries, when severe, are ordinarily accom- panied by fractures of the ribs or sternum — by a rupture of the viscera within the cavity, including the diaphragm — by profuse bleeding — or, as an after effect, by inflammation of the organs, with or without suppuration. Fractures of the ribs are dangerous for several reasons : the bones may be splintered and driven inwards, thereby wounding the lungs and causing loss of blood, or leading to inflammation of the pleura or lungs. The fracture of one rib may thus prove fatal, without any external marks of violence being pro- duced. (Med. Times and Gaz., Dec. 12, 1860, p. 607.) In fractures of the upper ribs, the prognosis is less favorable than in those of the lower, because commonly a much greater degree of violence is required to produce the frac- ture. A simple fracture of the sternum, without displacement of the bone, is rarely attended with danger, unless the violence has at the same time pro- duced mischief internally, which will be known by the symptoms. When, however, the bone is depressed as well as fractured, the viscera behind may be mortally injured. In a case of depressed fracture of the sternum, recorded by M. Sanson, the individual died after the lapse of thirteen days ; and on inspection it was found that the fractured portion of bone had produced a transverse wound of the heart, about an inch in length. The cavities of the organ had not been penetrated, but the piece of bone was exactly adapted to the depression produced by it on the parietes. (Devergie, Med, Leg., vol. ii. p. 243.) A practitioner will frequently be required to take into consider- ation the effects of contusions on the chest, with or without fracture, in cases of death from pugilistic combats, which have given rise to numerous trials on charges of manslaughter. Cuts or stabs penetrating the cavity of the chest are generally dangerous, even when slight, in consequence of the nu- merous accidents with which they are liable to be complicated. In these wounds the lungs are most commonly injured; but, according to the direction of the weapon, the heart, or the great vessels connected with it, as well as the gullet and thoracic duct, may share in the mischief Wounds and ruptures of the lungs. — The immediate cause of danger from wounds of these organs is the consequent loss of blood, which is profuse in proportion to the depth of the wound, and the size of the vessels wounded. Should the weapon divide any of the trunks of the pulmonary veins, the in- dividual may speedily sink. The degree of hemorrhage cannot be deter- mined by the quantity of blood which escapes from the wound; for it may escape internally, and collect within the cavity of the pleura, impeding the respiratory process. This is especially to be apprehended when the external orifice is small and oblique, and one of the intercostal arteries has been touched by the weapon. A wound of the lung is generally known, among other symptoms, by the frothiness and florid color of the blood which issues from the orifice, as well as by the expectoration of blood. The lungs may sustain serious injury from a blow or fall, and yet there may be no external marks of violence or symptoms indicative of danger for some hours. A young man, while riding, fell from his horse on his left arm. He complained of no pain for five hours, but in twelve hours he was seized with an alarm- ing flow of blood from the mouth. He died in the course of a few days. After death there was no mark of injury to the chest, but the right lung was ruptured posteriorly throughout its length, and much blood had been effused. {Lancet, November, 1842.) A case somewhat similar to this is reported by Mr. Jardine, of the Winchester County Hospital. {Med. Times and Gaz., Dec. 31, 1853.) A boy, aged fourteen, fell to the ground from a height of about twenty feet. He was admitted an hour after the accident, and he died in about two hours after his admission. On examination of the body twelve WOUNDS OF THE HEART. 275 hours after death, there was no mark of external injury. The collar-bone was fractured, but the ribs had escaped injury. The right lung was found ruptured to the depth of four inches into its substance, and from this a large quantity of blood had escaped, which caused death. This case furnishes another illustration of the production of fatal internal injuries without any corresponding marks of violence externally. (See p. 193.) For another case of laceration of the lung without fracture of the ribs from a carriage passing over the chest, see Med. Times and Gaz., Jan. 19, 1861. During the convalescence of an individual who has survived the first effects of a pene- trating wound of the chest, the surgeon should observe whether death, when it occurs, may not have been caused by imprudence on the part of a patient, or by .abuse of regimen, or other misconduct; for circumstances of this na- ture may be occasionally regarded as mitigatory on the trial of an aggressor. It is properly recommended that, in all cases where a party is progressing to recovery, a relaxation of the antiphlogistic regimen should be made with great circumspection. Too much nourishment, too frequent talking, or any exertion, are circumstances that may cause a renewal of the bleeding and extravasation. A case is related, in which a soldier died instantly from in- ternal hemorrhage, brought on by throwing a bowl at some nine-pins, two months after he had been apparently cured of a wound of the lungs. (Some remarks on penetrating wounds of the lungs will be found in Med. Times and Gaz., July 24, 1858, p. 98.) Wounds of the heart. — Wounds of the heart are among the most fatal of penetrating wounds of the chest. It was formerly considered that all wounds of this organ were necessarily and instantly mortal. (See ante, p. 259.) Undoubtedly, when either of the cavities is laid open to a large ex- tent, the bleeding is so profuse on the withdrawal of the weapon, that death must be immediate. But when the wound is small, and penetrates into the cavities of the heart obliquely, life may be prolonged for a considerable pe- riod ; and cases are on record in which it is probable that such wounds would have healed, and the patients have finally recovered, but for the superven- tion of other diseases which destroyed life. Dupuytren has reported the case of a man who received a stab on the left side of the chegt, on Novem- ber 5th, 1831. He was brought to the Hotel Dieu, but the symptoms under which he labored did not lead to the suspicion that he had received a wound of the heart. The man died in eight days, of cerebral disease. On an in- spection of his body, it was found that the left ventricle was wounded about the middle, and a little to the right ; its cavity having been penetrated in a transverse direction. The wound was three lines and a half across, and one line from above downwards. The external fibres of the organ were most separated ; the openings diminished gradually, so that the internal fibres were in contact, and closed the wound. A boy, in pulling a knife from a companion with the point towards him, accidentally stabbed himself in the chest. A small quantity of florid red iDlood escaped ; he vomited, and fell to the ground. He died in eight days. The left ventricle had been perfo- rated, and one pound and a half of blood was effased in the chest. This case shows that fatal hemorrhage is not always immediate. {Med. Gaz., vol. ii. p. 721.) In another instance recorded by Dupuytren, five or six wounds were made by means of a saddler's needle — most of them penetrating into the right ventricle of the heart. This man died of cerebral disease, twenty- five days after the wounds could have been possibly inflicted ; for the needle was taken from him twenty-five days before his death, without any suspicion being entertained of his having wounded himself with it. The external cica- trix was visible on an inspection of the body. The quantity of blood found in the chest amounted to about three ounces, and this appeared to have pro- ceeded from the substance of the heart. {Med. Gaz., vol. xiii. p. 662.) For 2T6 KTIPTURES OF THE HEART. a case of sudden death, as the result of an accidental wound by a flsh-bone, see Med. Times and Gaz., May 12, 1860, p. 667 ; and for cases in illustra- tion of the fact that wounds of the heart are not instantaneously mortal, see Med. Gaz., vol. ii. p. 721. It was the opinion of Dupuytren, that these injuries were not necessarily fatal, although I believe, with one exception (infrd,), there is no case on re- cord in which a person has i-ecovered from a penetrating wound of the cavi- ties of the heart. (Ed. M. and S. J., Oct. 1844, 557 ; also Ann. d'Hyg., 1846, t. i. p. 212.) There are few, probably, who will be inclined to con- sider them curable ; a remote possibility of simple wounds healing, and of the patient recovering, may be admitted ; but until some clear instances of recovery from penetrating wounds of the cavities are reported, the majority of practitioners will continue to look upon them as fatal. From a series of cases collected by MM. Ollivier and Sanson, it appears that out of twenty- nine instances of penetrating wounds of the heart, only two proved fatal within forty-eight hours. In the others, death took place at the varying periods of from four to twenty-eight days after the infliction of the wound (Devergie, Med. Lig., vol. ii. p. 253.) These differences in the time at which death occurs, as well as the fact that wounds of the heart do not in- stantly destroy life, have been ascribed to the peculiar disposition of the muscular fibres of the organ, and to the manner in which they are penetrated by a weapon. Thus, as a general principle, it is stated that wounds which are parallel to the axis of the heart are, ccsteris paribus, less rapidly fatal than those which are transverse to its axis. In a wound which divides the fibres transversely, the opening will be larger, and the hemorrhage greater, than in one which is parallel to these fibres; and as the heart is composed of different layers, of which the fibres pass in different directions, so, in a pene- trating wound of its cavities, while one set tends to separate the edges, an- other tends to bring them together, and thereby to restrain the flow of blood. It is this action of the fibres which renders wounds of the ventricles less rapidly fatal than those of the auricles, all other circumstances being equal (see case by Mr. Callaway, ante, p. 259) ; but a man has been known to snr- vive a laceration of the left auricle eleven hours. In the 17th volume of the Medical Gazette, page 82, a case is reported in which a person is stated to have recovered from a punctured wound of the heart ; and Dr. Trugien met with a case in which a man who had been stabbed in the left ventricle sur- vived Jive days. The wound in the heart had partly cicatrized. (See Med. Gaz., vol. xlvii. p. 42.) In reference to penetrating wounds of the chest, it may be proper to state that the base of the heart corresponds to the upper margin of the third rib on the left side ; and the apex to the lower margin of the fifth rib on the same side. [See ante, p 260 for references. — H.] Ruptures of the heart. — The heart is liable to be ruptured either from dis- ease or accident. In the latter case, the organ generally gives way towards the base, and through one of the cavities on the right side. (For cases, see Med.-Chir. Rev., vol. xxxi. p. 532.) Dr. Hope asserts that in ruptures from natural causes, it is the left side of the heart, and particularly the left ventri- cle, in which a rupture is most frequently found. The symptoms are sudden pain, collapse, cramps, cold extremities, and rapid death. According to the circumstances under which they occur, cases of rupture from disease may ex- cite a suspicion of death from violence. Sometimes the substance of the heart appears to have undergone a fatty degeneration. Dr. Quain met with a case in which, under this diseased condition, the left ventricle had become rup- tured during slight muscular exertion. {Med. Gaz., vol. xxxviii. pp. 774 and 857.) Mr. Marshall has reported a case of rupture of the right ventri- cle nnder similar circumstances. {Lancet, Feb. 16, 1857.) In other in- stances there has been no apparent alteration of structure. Dr. Stroud DEATH FROM ENTRANCE OF AIR INTO VEINS. 21*1 reported to the Med.-Chir. Society a case of this kind, which occurred in a young man aged twenty-nine. The deceased died in ten hours after his first seizure ; on inspection there was a small aperture in the right auricle near the vena cava. This did not appear to be connected with any morbid con- dition of the heart. (Med. Gaz., vol. xxvi, p. 518; Lancet, Nov. 1843.) As a medico-legal subject, it is Worthy of note that when this alarming acci- dent proceeds from blows or falls, it is not always accompanied by marks of external violence — or any fracture or other injury to the exterior of the chest. The natural causes of rupture of the heart are violent mental emotions, such as anger, fright, terror, paroxysms of passion, sudden or excessive muscular efforts, or violent physical exertions in constrained positions. The heart, like any other muscle, may also give way from its own powerful contraction. The left auricle of the heart has been ruptured as a mere result of great physical exertion. (See case, Med. Gaz., vol. xlvii. p. 1063.) Ruptnre of the heart from any of these natural causes is, however, a rare occurrence. {Med.-Chir. Rev., Oct. 184T,p. 460; Lancet, 3&a. 28, 1860, p. 88; and Gamgee's Patho- logical Anatomy, p. 7.) Wounds of arteries and veins. — Wounds of the large arterial and venous trunks, around the heart, must be considered as decidedly mortal ; death is generally instantaneous from the sudden and profuse bleeding which attends them. Dr. Heil, of Bamberg, has related a case which he considers to prove that a person may recover from a penetrating wound of the ascending aorta. {Henkeh Zeitschrift, 183'7, b. ii. s. 459.) With regard to these fatal effu- sions of blood within the chest, as well as in the other great cavities, it may be proper to mention that, from whatever vessel or vessels the blood may have issued, it is not commonly found coagulated to any extent. The greater part of it generally preserves the liquid state ; and it is rare that so much as one-half of the quantity effused is met with in the form of coagulum. These effusions of blood in the chest may be sometimes traced to wounds of the in- tercostal and the internal mammary arteries or of the vena azygos. Wounds of the carotid arteries have been considered in the section on wounds of the throat {ante, p. 203.) Of wounds of the other bloodvessels, whether arteries or veins, it is unnecessary to make any further remark. Death is generally owing to loss of blood, and the bleeding from a compara- tively small vessel may prove fatal, according to its situation and the state of the individual. Death from the entrance of air into wounded veins. — In wounds of veins there is an occasional and a peculiar cause of death which requires notice, namely, the entrance of air by the open mouth of the divided vessel. Among many cases of this kind I select one which occurred to Dr. Willis, of Barnes, in March, 1848 : — A man was laboring under chronic laryngitis, and it was considered proper to introduce a seton at the forepart of the neck. The skin was raised, and the seton-needle was passed horizontally through the skin, about two inches and a half above the breast-bone, and not at all near the jugular vein or any other important bloodvessel. At the instant of its en- trance there was a momentary hissing sound — the man became pale — his features were set — he fainted, and he subsequently became rigid and con- vulsed. The man did not recover his consciousness, was attacked with lock- jaw, and died in seven hours. The medical evidence given at the inquest proved that death had not arisen from loss of blood, but from air penetrating through a small vein which had been accidentally divided. A verdict was returned accordingly. After the inquest the body was inspected, and it was then found that the jugular veins and the large vessels of the neck were un- injured. The right auricle and pulmonary artery were distended with frothy blood, and the lungs were emphysematous. {Med. Gaz., vol. xli. p. 608.) For another case of sudden death from this cause, see Med. Gaz., vol. xliii. 278 WOUNDS AND EtrPTXIRES OF THE DIAPHKAGM. p. 1098. See also a paper on this subject in the same journal by Mr. Lane, vol. xlv. p. 926. Dr. Bernard has shown that the air thus introduced into veins does not act by paralyzing and obstructing the action of the heart : the obstacle which it creates to the circulation is in the lungs. (Legons, p. 163.) It has been long known that air injected into the jugular vein would destroy life by interfering with the functions of the heart. The exact nature of this accident, as it occurs in operations, is not well understood. (Ferguson's Sur- gery, Am. ed., p. 466.) According to some, the air rushes into the cavity of the vessel owing to atmospheric pressure during the expansion of the heart, while others believe it to be dependent on the act of inspiration. It is difficult to account for the entrance of air by atmospheric pressure, unless the cut orifice of the vein be kept open, or unless its coats be morbidly thickened, so that it does not readily close when divided ; nevertheless, death may thus occur without the slightest imputation on the skill of the operator. Dr. Cormack has shown that in some alleged cases of this kind, death was probably due to loss of blood. When the bleeding is slight, and the hissing sound is heard at the time of the incision, it may fairly be ascribed to the entrance of air. This opinion would be confirmed by the discovery of a frothy state of the blood in the right cavities of the heart. It is worthy of remark, that death may take place from this cause, although the person may recover from the first symptoms. A case has been reported in which a man died under these circumstances in thirteen hours, although he had so far recovered in the interim, that the functions of the lungs and heart were completely destroyed. {Association Journal, Jan. 28, 1853, p. 91.) Wounds and ruptures of the diaphragm. — The diaphragm, or muscular partition between the chest and abdomen, is liable to be wounded either by weapons which penetrate the cavity of the chest or abdomen, or by the ribs when fractured by violent blows or falls ; but, under any circumstance, wounds of this muscle are not likely to occur without implicating the important organs that are in contact with it. It is scarcely possible, therefore, to estimate the danger of these injuries abstractedly, as the medical opinion must materially depend on the concomitant mischief to the adjoining viscera. Slight penetrating wounds of the diaphragm may heal like those of other muscular parts ; and cases of this kind are on record. There is, however, especially when the wound is of a lacerated kind, a consecutive source of mischief which no remedial means can avert — namely, that after the wound has, to all appearance, healed, the life of a person may be cut short by the strangulation of a portion of the stomach or bowels in the half-cicatrized aperture. An instance reported by Dr. Smith affords an illustration of this. A sharp-pointed weapon had penetrated the diaphragm, notwitbstandinp; which the patient apparently made a rapid and perfect recovery. At the end of about three months, however, the man died from a strangulated hernia or rupture of the stomach, which had passed through the wound of the dia- phragm into the thorax. {For. Med., p. 2T9.) In a case of this description, when death occurs at a long period after the infliction of a wound, the wit- ness will probably be required to say — Whether the wound was the cause of death ? or whether there were any other circumstances which would have caused or facilitated the production of a hernia. The degree of culpability of an aggressor may materially depend upon the answers returned to these questions. Phrenic hernia, as this form of internal rupture is termed, is not by any means an unusual or unexpected fatal consequence of a wound of the diaphragm ; and therefore it would appear, at first sight, that death, at whatever period this event may occur, should be referred to the original wound. But the question is of a delicate nature ; as it is possible that a slight blow on the stomach, received subsequently to the wound, or even any WOUNDS OF THE ABDOMEN. 2'79 violent exertion on the part of the deceased, might actually produce the fatal strangulation. The most serious injuries to the diaphragm are unquestionably those which are produced by violent contusions, or falls on the abdomen, while the sto- mach and intestines are distended. In these cases the muscular fibres are commonly found ruptured to a greater or less extent : the bleeding is not considerable, rarely exceeding two, three, or four ounces. A uniform result of these ruptures, when extensive, is a protrusion of the stomach into the chest, with sometimes a rupture of the coats of that organ and extravasation of its contents. Severe lacerations of the diaphragm are more readily pro- duced during the act of inspiration than during expiration — the fibres of the muscle being then stretched, and receiving, while in this state of tension, the whole of the force. According to Devergie, the rupture most frequently takes place in the central tendinous structure, where it is united with the left mus- cular portion above the crura. He has remarked that it is observed more commonly on the left side than on the right. (Ojo. cit., vol. ii. p. 250.) It has been supposed that death was an immediate consequence of this accident; but this view is not supported by facts. In a case of extensive rupture of the diaphragm, related by Devergie, in which the stomach and colon were found in the chest, the person lived nine months after the only accident which could have produced it, and then died from another cause. Besides the sto- mach, it sometimes happens that the liver, spleen, or intestines pass through the opening, and, like it, these organs are liable to become strangulated : the lungs are at the same time so compressed that respiration is stopped, and asphyxia or suffocation is often an immediate result. Direction of wounds in the chest, — In judging of the direction taken by wounds which traverse the antero-posterior axis of the chest it is necessary to remember the great difference that exists in the level of the same rib an- teriorly and posteriorly. This must be especially attended to when we are called upon to state the direction of a traversing wound from the description of it given by another. The point here referred to had an important bearing in the case of a fatal gunshot wound which was the subject of a criminal charge some years since. (ITenke's Zeitsehrift, 1836.) Wounds os the Abdomen. Wounds of the parietes. — Incised and punctured wounds, which affect the parietes or coverings of the abdomen, without penetrating the cavity, are not quite of so simple a nature as might at first sight be imagined. The danger is immediate if the epigastric artery be wounded ; for a fatal hemorrhage will, in some instances, take place from a wound of this small vessel. Con- tusions are attended generally with far more serious effects on the cavity of the abdomen than on the chest. This arises from the coverings of the abdo- men having less power to resist external shocks. In the first place, death may be the immediate result of a blow in the upper and central portions ; no particular morbid changes may be apparent on inspection, and the violence may have been so slight as not to have produced any ecchymosed mark on the skin. Death has been ascribed in these cases to a fatal shock transmitted to the system through a violent impression produced on the solar plexus. Some remarks have already been made on sudden death from blows on this part of the abdomen (see p. 229). Travers, Alison, Watson, Cooper, and other writers on surgical injuries, have referred to cases of this kind as of not unfrequent occurrence. They are of considerable importance in a medico- legal view, as, in the absence of marks of physical injury in the part struck, a jury may be led to doubt whether the blow could have been the cause of death. In Hex vl Jones (Warwick Summer Assizes, 1831) — a case of alleged 280 ETJPTTJRES OP THE LIVER. manslaughter — prisoner was charged with having struck deceased several blows on the breast, and one on the pit of the stomach, by which he instantly fell down senseless and expired. On dissection no morbid appearances were found. The prisoner was convicted. ( Watson on Homicide, p. 75.) In another case, tried at the Central Criminal Court in Aug. 1841 (The Queen against Sayers), death was thus caused by violence during a pugilistic combat. The man received a blow in the stomach, and fell dead. As there were no marks of external injury, the surgeon thought the man had died of apoplexy I The prisoner was acquitted. A similar case was the subject of a trial at the Norwich Lent Assizes, 1854 {Reg. v. Laws). The deceased, a powerful man, received during a pugilistic encounter a blow on the abdomen, and he in- stantly fell backwards, dead. On an examination of the body there were no marks of injury, either externally or internally. The surgeon attributed death to sudden shock ; and this, no doubt, was the true cause. The learned judge left it to the jury to say whether they thought the death of the deceased was caused by a blow ; but if they could not say what was the cause of death, or if they should think that death was attributable to excitement and that it was independent of the blow, the prisoner would be entitled to an acquittal. A ver- dict of Not Guilty was returned. Although the blow was seen to be struck, and was a sufficient cause of death under the circumstances, the jury pro- bably thought that there should be some visible injury to the body ; and, in the absence of this, declined to refer death to the violence. Had the jury possessed any medical experience or knowledge on the causes of death, they would have seen their way through this apparent difficulty. Blows on the abdomen, when they do not destroy life by shock, may cause death by induc- ing peritoneal inflammation. Among many instructive cases of this kind, is one recorded by Dr. Allen, in which fatal peritonitis followed a slight amount of violence. (See Lancet, Jan. 5, 1850, p. 29.) Deeply penetrating wounds of the abdomen are generally fatal by reason of the injury done to the intestines and other organs. In a remarkable case recorded by Mr. Todd, a soldier by accident so fell upon his bayonet, that although the weapon traversed the whole cavity of the abdomen (entering at the back and coming out below the navel), the man recovered in about six weeks. {MecL. Times and Gaz., March 30, 1861, p. 329.) This case is of Importance in reference to the situation and direction of wounds. (Page 200, ante.) Had there been no knowledge of the facts, this accidental wound might have been pronounced homicidal. Rupture of the liver. — Blows on the abdomen may also prove fatal by caus- ing a rupture of the liver or other viscera, with extravasation of blood : and, as it has been elsewhere stated (p. 193), these serious injuries' may occur without being attended by any marks of external violence. Of all the in- ternal organs, the liver and spleen are the most exposed to rupture, owing to their compact structure, which prevents them from yielding to a sudden shock, like the stomach and intestines. Ruptures of the liver may occur from falls or blows ; but this organ may be ruptured merely by a sudden action of the abdominal muscles. An accident of this kind happened to a person who was endeavoring to avoid a fall from his horse. (Male's Jur. Med., p. 119.) A fall on the feet from an elevated spot may also determine laceration of this organ. {Ami. diRyg., 1846, t. i. p. 133.) Ruptures of the liver are gene- rally seen on the convex surface, seldom extending through the whole sub- stance of the organ, but consisting of fissures, varying from one to two inches in depth. Their usual direction is from before backwards, with a slight obliquity; they rarely intersect the liver transversely. The lacerated edges are not much separated, while the surfaces present a granular appearance. But little blood is met with in the laceration ; it is commonly found effused in the lower part of the cavity of the peritoneum, or in th'e hollow of the RUPTURES OF THE GALL-BLADDER, SPLEEN, AND KIDNEYS, 281 pelvis, and is only in part coagulated. Ruptures of the liver, unless they run far backv?ards and involve the vena cava, are not in general attended vi'ith any considerable effusion of blood; but the bleeding, should tliis vessel be implicated, is sufiBcient to cause the instant destruction of life. Under other circumstances, a person may survive some hours (p. 261). The blood may escape only slowly. Rupture of this organ may take place from violence applied to the chest and there may be no marks of injury over the region of the liver. (See case, Med. Times, Aug. 30, 1851, p. 234. For other cases, see Med. Gaz., vol. xlvii. p. 156.) Mr. Partridge lately presented at the Pathological Society the liver of a boy vi'ho had been run over by a cart. He died almost immediately from loss of blood. There was no external bruising. {Lancet, Jan. 21, 1860.) Wounds of the gall-bladder. — Wounds and ruptures of the gall-bladder are necessarily attended with the effasion of bile. This irritant fluid finds its way into the cavity of the abdomen, and the person dies from peritonitis. A fatal case of this description occurred to Dr. Maclachlan. An old man while getting out of bed fell with great violence on the floor. He died from peri- tonitis in forty-eight hours. The gall-bladder was raptured, and a large stone was found impacted in the cystic duct. (Med. Gaz., vol. xxxvii. p. 968.) [Perforation of the gall-bladder, or of the cystic duct, resulting from ulcerative irritation produced by one or more gall-stones is not a very rare occurrence, and would be very apt to take place from violence, as it does in the case of impacted appendix vermiformis. We have seen cases of spon- taneous, and gradual perforation of the gall-bladder and of the duct, but never met with one produced by accident. — H.] Rupture of the spleen. — Ruptures of the spleen may occur either from violence or disease, and it would appear from the following case, reported by Mr. Heddle (Med.-Chir. Rev., Oct. 1839), that a slight degree of violence is sufficient to rupture this organ, while there may be no marks of injury ex- ternally. A middle-aged man was observed fighting with a boy about fourteen years of age, who in stature scarcely reached to his waist. When the fight had terminated the boy ran away : the deceased was observed to become very weak and faint, and he complained of uneasiness in his left side. He expired a few minutes afterwards. On inspection, no mark of violence could be de- tected externally ; but the cavity of the abdomen contained a large quantity of blood. The spleen was found enlarged, and so softened, that its structure was broken down by the slightest pressure. There was a laceration across its surface, about half an inch in depth, from which the fatal bleeding had proceeded. A similar case, in which death occurred in fifteen minutes, is reported in the Medical Gazette, vol. xxxv. p. 942. The rupture was caused by a blow, but there was no mark externally to indicate that a blow had been struck. A case of spontaneous rupture of the spleen, which was en- larged and in a diseased condition, is reported in the same journal for June, 1842. Dr. Easton communicated to me a case (Feb. 1856) in which a little girl died in fourteen hours from rupture of the spleen. The rupture had arisen from the wheel of a cart passing over her body. There was no mark of external violence. It is highly probable, that when the liver and spleen are ruptured from slight causes, the structure of these organs will be found to be in a diseased condition — a circumstance which may in some cases be regarded as mitigatory of the act of an assailant. (See also Med. Gaz., vol. xxxv. p. 942.) Rupture of the kidneys. — The kidneys are occasionally ruptured from vio- lence; but this appears to be a rare accident. Two cases were reported by Mr. Stanley to the Med.-Chir. Spc. (Lancet, Nov. 1843). In one, the person recovered ; in the other, death did not take place for a considerable time. Another case, which occurred in 1847, has been communicated to me 282 WOTJNDS AND RUPTURES OF THE STOMACH. by Dr. Beveridge. The injury occurred during a scuffle, but its existence was not suspected during life. Euptures and wounds of the intestines. — Ruptures of the intestines some- times occur from disease; and, in a case of rupture alleged to have been produced by violence, we must always take this possible objection into ac- count. The ruptured part of the bowel should be carefully examined, in order to see whether there are any signs of ulceration or softening about it. If not, and there is clear evidence of violence having been used, it is impos- sible to admit this speculative objection. If with the proof of violence there should also be a diseased condition of the bowel, we may be required to say whether this did not create a greater liability to rupture — a point which must be admitted. (For medico-legal eases of ruptured intestines, see Watson on Homicide, p. 159 ; also, Henke, Zeitschrift der S. A., 1836, Erg. H. xxii., and Brit, and For. Rev., vol. iv. p. 519.) The intestines may be ruptured by an accidental fall. {Med. Times and Gaz., April 13, 1861, p. 403.) I am indebted to Dr. Croker King for a report of two fatal cases of ruptured jejunum, one arising from a kick on the abdomen and the other from an acci- dental fall. Dr. King has observed that persons who have sustained this injury, retain the power of locomotion and muscular exertion. ^ [Ruptures of the appendix vermiformis, when already ulcerated by irrita- tion of fecal accumulations, seeds or other foreign bodies from the intestinal canal, occasionally occur as the result of violence. Many such are recorded as having been precipitated if not wholly caused by accidental violence or sudden effort. "We attended, ten years ago, a young lady, eet. 14, who had been suddenly attacked by sharp pain in the right iliac region, with nausea and vomiting, about a week after having jumped with a skipping rope back- wards forty times in succession ; the only symptom, at the time of the gym- nastic effort, being a sense of tearing pain in the right groin and of faintness, which soon passed away. She died of peritonitis in five days, and was found to have a sacculated appendix containing a fecal calculus about the size and shape of an olive stone, which had led to gangrenons inflammation and a small transverse rupture near the neck of the sac. She had not complained of abdominal pain or especial ill health until directly after the unfortunate trial of her power in skipping with the rope. See Trans. Goll. of Phys. of Philad., vol. i. N. S., April, 1851, p. 86; see, also. Am. Journ. Med. Sci., July, 1861,. p. 291, for a similar case by Dr. F. D. Lente.— H.] Punctured wounds, which merely touch the bowels without laying open the cavity, are liable to cause death by peritonitis. These injuries to the intestines sometimes destroy life by shock ; there is but little blood effused, and .the wounded person dies before peritonitis can be set up. Severe wounds to the intestines may, however, be inflicted almost without the consciousness of the individual, and the wounded person may be able to walk a consider- able distance. {Med. Gaz., vol. xlvi. p. 24.) Wounds andruptures of the stomach. — Wounds and ruptures of the stomach may cause death by shock : ruptures commonly give rise to severe pain, which of itself is sufBcient to bring about rapid dissolution. It is proper to state, however, that the stomach may be ruptured from spontaneous causes, as in cases of ulceration as a result of disease ; but sometimes there is no morbid cause apparent. In April, 1828, a man, aged thirty-four, was brought into St. Bartholomew's Hospital, complaining of severe pain in the abdomen. Ten hours afterwards he was seized with violent vomiting ; the pain ceased ; the vomiting also ceased ; and he died in five hours more. The posterior surface of the stomach was found lacerated to the extent of three inches, and the contents of the organ had escaped through the aperture : the mucous membrane was reddened, but there was no thickening, ulceration, or any apparent disease of the stomach. {Med. Gaz., vol. ii. p. 182 ; see also Dub. WOUNDS — RTJPTTJEES OF THE BLADDER. 283 Med. Journ., May, 1845; and Ed. Med. and Surg. Journ., Oct. 1845, p. 522.) Penetrating wounds of the stomach generally prove rapidly mortal ; they seldom form a subject of medico-legal investigation ; but a singular case was tried at the Norwich Assizes in 1832, in which a man was charged with the murder of his wife, by throwing at her a red-hot poker. The weapon completely perforated her stomach, and the woman died in six hours. It might be a question whether this was a wound in the common sense of the term ; it was an injury compounded of a burn, puncture, and laceration. [See Ed. Med. Journ., March, 1861, for an interesting account of a case of perforation of the stomach, produced by excessive exertion in running, in a lad IT years of age, and of previously delicate health. — H.] Rupture of ike Madder. — This injury, which has on several occasions given rise to medico-legal discussion, is frequently the result of blows on the lower part of the abdomen. The principal questions to be answered are: Was the rupture the result of wilful violence or of an accidental fall ? or. Did it pro- ceed from spontaneous causes, as from over-distension ? The spot in which rupture commonly 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 eft'used, and death takes place sooner or later from peritoneal inflammation. It is commonly stated that ruptures, when attended with extravasation of urine into the peritoneal cavity, are uniformly fatal ; but if the rupture occurs in the under part of the bladder, or the urine finds its way into the cellular tissue, the prognosis is not so unfavorable. Mr. Syme has reported a case of recovery under these circumstances. {Surgical Contributions, p. 332.) The usual period at which death occurs from this accident is in from three to seven days ; but Mr. Ellis met with a case in which the person did not die until the fifteenth day. The cause of death is obviously peritoneal in- flammation ; but a person may die suddenly from this injury as a result of shock. Dr. Paterson has communicated a case of this kind to the Associa- tion Journal (Jan. 28, 1853, p. 88.) A man, while struggling with another, received a severe kick in the lower part of the abdomen. He fell backwards, and died immediately. On inspection, the brain was congested, but other- wise healthy : the heart was free from disease, but much distended with black coagulated blood. The bladder presented, on the left side of the body, a rent of about two inches ; but this organ was in other respects healthy, as well as the urethra. There was some bloody effusion in the cellular tissue. The peritoneum and viscera of the abdomen were uninjured. There were no marks of violence on the body. When these ruptures are produced by blows they are rarely accompanied by the slightest mark of ecchymosis, or of injury to the skin. Thus, then, there may be no means of distinguishing, by an external examination, whe- ther the rupture was really due to violence or to spontaneous causes. They who are unacquainted with this fact, might be disposed to refer the rupture to disease, on the supposition that violence should be indicated by the usual characters externally ; but there are numerous cases on record which show that this view is erroneous. 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 an unusual occurrence : a rapture 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 a want of power to expel the urine ; 2, when the bladder is ulcerated or otherwise diseased ; 3, when there is an obstruction in the urethra from stric- ture or other causes. A fatal ease of rupture of the bladder arising from obstruction as a result of disease occurred to Mr. Field (Med. Times and 284 ACCIDENTAL EUPTURB OF THE BLADDEE. Gazette, Dec. 13, 1856, p. 590). The causes of spontaneous rupture are easily recognizable by ascertaining the previous condition of the deceased, or 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 attaclc of peritonitis in five or six days ; if, after death, the bladder was found lacerated, but this organ and the urethra vpere otherwise in a healthy condition, there can be no doubt that the blow must have been the sole cause of rupture and death. In such a case, to attribute the rupture to spontaneous or natural causes would be equal to denying all kind of causation. As to the absence of marks of violence externally, this would be a difiSculty 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. 194). Nevertheless, a medical witness must be prepared to hear the same line of defence continually urged ; it is, of course, the object of a counsel to make the best of a case for the prisoner, and his duty consists in seeing him judged according to law, and not condemned contrary to law. With medical facts, opinions, and doctrines he does not concern himself, so long as they do not serve his purpose. Can the bladder he ruptured by an accidental fall, and if so, by what kind of fall? — The following case, reported by Mr. Syme, shows that this acci- dent may readily occur. A woman, aged twenty-six, fell forwards over the edge of a tub, and fainted immediately. On recovering herself, she com- plained of intense pain in the abdomen, with inability to pass the urine. Peritonitis came on, and she died in a week. On inspection, a small aper- ture was found in the upper part of the bladder ; the peritoneum was exten- sively inflamed, from the urine which had become effused. The ruptured surfaces had become partly glued together. (Hd. Med. and Surg, journ., Oct. 1836.) Rupture of the bladder may take place from an accidental fall, and cause death without necessarily laying open the peritoneal cavity. Two cases of this kind have been reported by Mr. Spencer Wells. {Med. Gaz., vol. xxxvi. p. 621.) The patients were sailors who fell from their hammocks while in a state of intoxication. The usual symptoms followed — one died in five, and the other in eight days, from peritonitis ; and after death it was clearly found, in one instance at least, that the bladder had been ruptured in the usual situation, but the peritoneum was entire, although in a state of in- tense inflammation. Another case of this kind, which was the subject of a trial {Reg. v. Dixon, Durham Lent Assizes, 1846,) was communicated to me by M. Steavenson. The prisoner kicked the deceased in the pubic region from behind. The man died from peritonitis in thirty-five hours. On in- spection, the bladder was found ruptured near its neck for about half an inch, immediately above and to the left of the prostate gland. The urine was ex- travasated in the cellular tissue of the scrotum ; but although there was extensive inflammation, the peritoneum was not lacerated. On the other hand, a remarkable case is reported by Mr. Bower, in which a man died on the sixth day from rupture of the bladder ; and after death, although the peritoneum was lacerated, and the cavity of the abdomen was filled with dark-colored urine, there was no sign of peritoneal inflammation. {Lancet, Dec. 19, 1846, p. 660.) This accident is liable to occur in females during parturition, owing to the pressure of the child's head ; an occurrence which may throw a charge of malapraxis on the medical attendant. He is expected to know the probability of such an accident occurring, and to guard against it, if necessary, by the frequent use of the catheter. In Reg. v. Ralsoner (Liverpool Lent Assizes, 1838), a surgeon was tried on a charge of this kind. It is important to remember, that although rupture of the bladder is com- monly attended, at the time of the occurrence, with intense pain, sickness WOUNDS OP THE GENITALS. 285 and prostration of strength, yet persons may occasionally retain the power of exerting and moving themselves after the accident. In punctured and incised wounds of the bladder, the urine is immediately extravasated ; but in gunshot wounds, the extravasation does not commonly take place until the sloughs have separated. Thus, life may be protracted longer in cases of gunshot than under other wounds of the bladder. Bar- zellotti relates the case of a medical student, shot through the bladder in a duel, who did not die until the twentieth dayhom the peritonitis which super- vened on the extravasation. {Qaestioni di Med. Leg., t. iii. p. 174.) One instance of a person recovering from a gunshot wound perforating the blad- der, is reported by Mr. Douglas, in the Ed. Med. and Surg. Journ., vol. xiii. For the discovery of extravasated liquids or blood, in wounds and other in- juries 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 tendency 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 hemorrhage. Self-castration or mutilation is not nnfrequent among male lunatics and idiots. An inquest was held some time since in London, upon an idiot, who had bled to death from a wound of this description. When timely assistance is rendered a fatal result may be averted. Incised, lacerated, or even contused wounds of the female genitals, may prove fatal by loss of blood, not from the wound involv- ing any large vessel, but from the numerous small vessels which are divided. Two females were in this way murdered in Edinburgh some years since. The wounds were inflicted by razors, and the women bled to death. (See cases by Watson, p. 104.) This crime appears to have been at one time frequent in Scotland. When deeply incised 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. (See ease, ante, pp. 195, 201.) Accident is wholly out of the question, and suicide is improbable, except in cases of confirmed idiocy and lunacy. Such wounds require to" be carefully examined ; for the proof of the kind of wounds, when fatal, may be tantamount to the proof of murder. A practitioner may be sometimes required to determine whether wounds affecting the female organs have resulted from accident, have been self- infiicted, or inflicted by others with homicidal intention. In June, 1842, a woman received a wound in the genitals by a cutting instrument, on the left side, to the extent of one inch and a half in a longitudinal direction. There was a smaller wound on the right side. The accused alleged that the woman had inflicted the injury on herself; and Dr. Easton, of Glasgow, on being required to state his opinion on the question at issue, came to the conclusion : 1. From the regular edges of the wounds, that they had been produced by a clean cutting instrument, and therefore could not have been caused by a fall, excepting the person had fallen upon some sharply cutting projection. 2. If the woman had injured herself by thrusting a knife into the private parts, the situation and direction of the wounds would have been different. There was a want of proof to connect the prisoner with the act, and he was discharged. This is an improbable situation for the self-infliction of wounds with a view to suicide. Some rules which have been elsewhere given (p. 200) may enable a witness to form an opinion when a question of this kind is involved in doubt. (For a case in which such a wound was homicidally inflicted upon a male, see Ann. d^Hyg., 1848, t. i. p. 443, and'for another which led to a trial for the murder of a female, see Med. Gaz., vol. xliv. p. 813.) Contused wounds on the female genitals prove sometimes fatal by the lace- ration of parts leading to great loss of blood. Several trials for manslaughter have taken place in which this was proved to have been the cause of death. 286 WOUNDS OF THE GENITALS. (See the ease of Reg. v. Oawley, Liverpool Winter Assizes, IM*1, also a paper by Mr. Barrett, Assoc. Med. Journal, June 28, 1856, p. 538.) There may be such a loss of blood in these cases as to destroy life, although no large bloodvessel is implicated in the injury. A contused wound on the vulva may occasionally present an ambiguous appearance 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 may appear as a result of the force being received by tlie bone (p. 205). A blow on the cranium with the fist produced in one instance a rent which was at first mis- taken for a cut. A kick on the vulva, or a fall on this part, may produce a similar injury, and unless carefully examined, may lead to the inference that a weapon has been used for its production. Mr. Barrett, in the paper above referred to, has properly directed attention to this subject. A case in which a contused wound of the clitoris proved fatal has been communicated to the Lancet by Mr. Gutteridge. (Oct. 31, 1846, 418.) A woman, 83t. 36, re- ceived a kick from her husband in the lower part of the abdomen while she was in a stooping posture. She was seen by Mr. Gutteridge in about three- quarters of an hour, and she had then lost from three to four pounds of blood. She was sinking, and expired in a few minutes after his arrival. On inspec- tion there was no injury to the uterus or vagina ; the wound was situated at the edge of the vulva, extending from the pubis along the ramus of that bone. It was about an inch long and three-quarters of an inch deep. The left crus clitoridis was crushed throughout its length, so as to exhibit its cavernous structure. From this the fatal bleeding had proceeded. The heart and great vessels contained no blood. The bleeding from such injuries is always likely to be more profuse when the female is pregnant. A case of recovery from a contused wound to the genitals in a pregnant woman, set. 40, is reported by Dr. M'Clintock. It is stated that there was profuse bleeding from a laceration involving the urinary passage, but under early treatment the woman did well. {Medical Times, May 15, 184'7, p. 233.) It is well known that some females 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 ap- pears only a long 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 has been communicated to me by Mr. Procter, of York. 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 effusion of blood. Violence to this part after death would not produce such an effusion as would account for death. There are also other distinguishing characters which have been elsewhere pointed out (see p. 182). A case was tried in Edinburgh, in which this defence was set up ; but Dr. Simpson was enabled to say, from his observation of the effects of such violence to a dead body, that the injuries in question could not have been produced after death. FRACTURES — ACCIDENTAL AND SPONTANEOUS. 281 CHAPTER XXXVI. fractures — produced bt a blow with a weapon or by a fall — occur in the aged — brittleness of the bones — fractures caused by slight muscular exertion — in the living and dead body — has a bone ever been fractured ? — questions of survivorship — dislocation from vio- lence or natural causes — actions for malapraxis. Fractures. Fractures of the bones have some important bearings in relation to medi- cal jurisprudence. They may result from falls, blows, or the spontaneous action of muscles. Causes. — Questions sometimes arise — 1, whether a particular fracture was caused by an accidental fall or a blow ? and, 2, if by a blow, whether by the use of a weapon 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 weapon has or has not been used; and this may be sometimes known by the state of the parts. It is a common de- fence on these occasions, to attribute the fracture to an accidental fall. Frac- tures 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 persons are sometimes very brittle, and slight violence will then produce fracture. This has been regarded as an extenuat- ing circumstance, when the fracture was followed by death. Certain diseases, such as the venereal disease, gout, rheumatism, cancer, scurvy, and rickets, render the bones more fragile ; but they are sometimes preternaturally brittle in apparently healthy persons, and this brittleness appears occasionally to be hereditary. (Bub. Hasp. Gaz., Feb. 1846, p. 189.) In such cases, a defence might fairly rest upon an abnormal condition of the bones, provided the vio- lence producing the fracture was slight. Several trials have taken place in which this brittleness of the bones became a subject of injury. In a case of fractured skull leading to death from inflammation of the brain, it was proved that the bones of the skull were unusually thin and brittle, and this led to a mitigation of punishment. {Reg. v. Kennedy, Gloucester Winter Assizes, 1855.) Spontaneous fractures. — Supposing that there are no appearances of dis- ease, the fracture may be ascribed to spontaneous causes. Thus bones have been fractured by moderate muscular exertion. The olecranon, os calcis, and patella, are particularly exposed to this accident. The long bones are seldom exposed to an accident of this kind, but the os humeri or arm-bone, in a healthy man, has been broken by the simple muscular exertion of throwing a cricket-ball. {Medical Gazette, vol. xvi. p. 659.) Mr. May has reported the ease of a young lady, who fractured the neck of the scapula or blade-bone, by suddenly throwing a necklace round her neck. {Med. Gaz., Oct. 1842.) In July, 1858, a gentleman, set. about 40, was in the act of bowling at cricket, when on delivering the ball he and some bystanders heard distinctly a sharp crack like the breaking of a dry piece of wood. He fell to the ground as if he had been shot. The thigh-bone was found to be fractured, and evi- 288 FEACTUEES IN THE LIVING OE DEAD BODY. dently from muscular exertion only. No person can meet with an accident of this kind without being instantly conscious of it. It is probable that in such cases, if there were an opportunity of examining the bone, it would be found to have undergone some chemical change in its composition, which had rendered it brittle. A case of spontaneous fracture of the femur was brought into Guy's Hospital in Dec. 1846. A healthy man, set. 33, of temperate habits, was in the act of placing one leg over the other to look at the sole of his foot, when he heard something give way, and the right leg immediately hung down. On examination, it was found that the right thigh-bone had been transversely fractured at the junction of its middle with the lower third. This case is remarkable, inasmuch as spontaneous fractures of the thigh-bones are very rare — as the man had not suffered from any of those diseases which cause preternatural fragility, and the fracture was not caused by violent mus- cular exertion. The actual condition of the bone was of course unknown ; but it healed readily, and the man left the hospital at the usual period. In fractures arising from this cause there will be no abrasion of the skin, nor any appearance to indicate that a blow has been struck, while the marks of a blow would, of course, remove all idea of the fracture having had a sponta- neous origin. Fractures are not dangerous to life, unless, when of a compound nature, they occur in old persons, or in those who are debilitated by disease or dissipated habits. They may then cause death by inducing irritative fever, erysipelas, gangrene, tetanus, or delirium tremens. Fractures in the living or dead lady. — It is not always easy to say, whether a fracture has been produced before or after death. A fracture produced shortly after death, while the body is warm, and another produced shortly before death, will present similar characters, except, perhaps, that in the former case there would be less blood effused. A fracture caused ten ,or twelve hours before death, would be indicated by a copious effusion of blood into the surrounding parts and between the fractured edges of the bones, as well as by laceration of the muscles ; or if for a longer period before death, there may be the marks of inflammation. Fractures caused several hours after death, are not accompanied by an effusion of blood. A medical wit- ness may be asked, How long did the deceased survive after receiving the fracture ? This is a question which can be decided only by an examination of the fractured part. Unless the person has survived eighteen or twenty- four hours, there are commonly no appreciable changes. After this time, lymph is poured out from the surrounding structures. This slowly becomes hard from the deposition of phosphate of lime, and forms what is called "callus." In the process of time, the callus acquires all the hardness of the original bone. The death of a person may take place during these changes, and a medical man may then have to state the period at which the fracture probably happened, in order to connect the violence with the act of a parti- cular person. Unfortunately, we have no satisfactory data, if we except the extreme stages of this process, upon which to ground an opinion. We can say whether a person lived for a long or a short time after receiving a fracture, but to specify the exact time is clearly impossible ; since this process of re- storation in bone varies according to age, constitution, and many other cir- cumstances. In young persons, bones unite rapidly, in the old slowly ; in the diseased and unhealthy, the process of union is slow, and sometimes does not take place at all. According to Villerme, the callus assumes a carti- laginous structure in from sixteeli to twenty-five days ; and it becomes ossified in a period varying from three weeks to three months. It requires, however, a period of from six to eight months for the callus to acquire all the hardness, firmness, and power of resisting shocks possessed by the original bone. A force applied to a recently united bone will break it through the callus or bond of union, while, after the period stated, the bone will break as readily HAS A BONE EVEE BEEN FEACTURED — LOCOMOTION. 2S9 through any other part. It is generally assumed, that the period required for the union of a simple fracture, is, for the thigh-bone, six weeks ; for the tibia (leg), five weeks ; for the os humeri (arm), four weeks : and for the ulna and radius (forearm), three weeks ; for the ribs, about the same period : but cases have been known in which the ribs had not perfectly united in two months, and in some fractures of the other bones, it was found that union had not taken place in four months. Has a bone ever been fractured? — This question is sometimes put in refer- ence to the livinff subject. It is well known that a bone seldom unites so evenly that the point of ossific union is not indicated by a node or projec- tion. Some bones are so exposed as to be well placed for this examination, as the radius, the clavicle, and tibia — these being but little covered by skin ; in others the detection is difficult. It is impossible for us to say when the frac- ture took place ; it may have been for six months or six years — as, after the former period, the bone undergoes no perceptible change. These facts are of importance in relation to the dead as well as to the living ; since they will enable us to answer questions respecting the identity of skeletons found under suspicious circumstances : and here medical evidence may take a wider range, for a fracture in any bone may be discovered, if not by external examination, at least by sawing the bone longitudinally through the suspected broken part, when, should the suspicion be correct, the bony shell will be found thicker and less regular in the situation of the uuited fracture than in the other parts. So, in such cases, it will be easy to say whether a fracture is recent or of old standing. In the case of Clarke, who was murdered many years since by Eugene Aram, the traces of the fracture and indentation of the temporal bone were plainly distinguishable on the exhumation of the skeleton of the deceased thirteen years after the perpetration of the murder. The manner in which the murder was committed was confessed by an accomplice, and the medical evidence corroborated this confession. An instance of the utility of this kind of knowledge came out on the trial of a gentleman in India, in 1833, for the murder of a native, Meer Khan. There was some reason to suppose that the prisoner had been falsely accused of causing the death of the native. Two witnesses deposed that a few hours before the death of the deceased, the prisoner had struck him several blows on the chest, and had broken his ribs. The alleged murder having taken place some 'months previously to the trial, a skeleton was produced as being that of the deceased, by one of the persons who had assisted in burying the body. On examining the ribs, the medical witness found that only one rib was broken, and the fractured portions were united by a firm osseous callus. He therefore declared, that the fracture could not have been caused a few hours before death ; but that it must have existed for a period of at least eight or twelve days. Hence the account given by the witnesses was rendered improbable; for the prisoner had used no violence to the deceased, except just before his death; the fracture must therefore have taken place from another cause some time previously. The witness much understated the period at which the fracture probably occurred; for ossification only commences in the cartilage about the sixth day, and the specks of bony matter continue to increase from the eighth to the twelfth day ; but the union is soft, and some weeks elapse before the callus becomes firm and hard as it is here described to have been. Locomotion — With respect to the power of locomotion after a fracture, it may be observed, that when the injury is in the arm or in the ribs, unless many of them are broken, a person may move about, although unfitted for straggling or making great exertion. Fractures of the leg generally incapa- citate a person from moving except to short distances. See case by Syme, Ed. Med. and Surg. Journal, Oct. 1836 ; also another in which one bone of the leg was fractured and a power of walking some miles was retained, Amer. 290 FRACTURES AND DISLOCATIONS. J. Med. Set., Oct. 1845, p. 484. (The reader will find additional information on this subject in the Ann. d'Hyg., 1839, t. ii. p. 241 ; and 1844, t. ii. p. 146.) [The best American authority on this and all other questions relating to fractures and to dislocations, is the Treatise on Fractures and Dislocations, by Dr. Frank H. Hamilton. See also the excellent American translation, by Dr. Packard, of the classical work of Malgaigne On Fractures. — H.] Dislocations. Dislocations are not frequent in the old or in those persons whose bones are brittle. They rarely form a subject for medico-legal investigation. A witness is liable to be asked, what degree offeree, and acting in which direc- tion, would produce a dislocation — a question not difficult to answer. They are not dangerous to life, unless of a compound nature, when death may take place from secondary causes. A dislocation which has occurred in the living body may be known after death by the laceration of the soft parts in the neighborhood of the joint, and by the copious effusion and coagulation of blood. [For an account of the appearances presented by a dislocation of the shoulder four days after death, see Med. Gaz., vol. xxxi. p. 266.] If of old standing, a dislocation would be identified by the cicatrices in surround- ing structures. Dislocations may occur from natural causes, as from disease and destruction of the ligaments in a joint; also from violent muscular spasm during an epileptic convulsion. Dr. Dymock met with an instance of dislo- cation of the shoulder forwards during puerperal convulsions. {Ed. Med. and Surg. Journal, April, 1843; see also Lancet, April, 1845, p. 440.) A power oi locomotion may exist, except when the injury is in the lower limbs: but it has been observed, that for some time after a dislocation of the hip- joint, considerable power over the limb Remains ; it is only after a few hours that the limb becomes fixed in one position. Exertion with the dislocated member is in all cases out of the question. Diagnosis — malapraxis. — There are certain fractures of an obscure kind which closely resemble dislocations. This has been pointed out by Sir A. Cooper, in relation to fractures of the anatomical neck of the os humeri (arm- bone). {Guy's Hasp. Rep., No. 9, p. 212.) This accident might be easily mistaken for a dislocation of the shoulder. {Med. Gaz., vol. xxxvi. p. 38.) In attempting to reduce the bone, the head continually falls back into the axilla. In such a case an action for malapraxis might be brought against a surgeon, and heavy damages recovered. It could only be by a dissection of the part after death that the real nature of the case would be ascertained. It is requisite, therefore, that great caution should be used in giving an opinion. The same observations apply to fractures of the neck of the thigh-bone, although with less force, because this is a more common accident. It is well known that fractures and dislocations, when cured, are often attended either with some slight deformity of the limb, or with some impairment of its func- tions. [See op. citat. of Dr. Hamilton ; also his elaborate reports on De- formity after Fractures, in Transact. Amer. Med. Assoc, vols, viii., ix., x. A very good digest of the conclusions of Dr. H. may be seen in Dr. Blwell's Treatise on Malpractice, chap. vi. ; see also, in same work, a full exposition of the subject, with many adjudicated cases. — H.] This result is occasionally inevitable under the best treatment ; but it is commonly set down as a sign of nnskilfulness in the medical attendant. An action for malapraxis is insti- tuted, and, in spite of good evidence in his favor, the surgeon is sometimes heavily fined for a result which could not be avoided. There is often great injustice in these proceedings, and the mischief can only be remedied by referring the facts to a competent medical tribunal, which alone should be empowered to decide whether or not unskilfulness had really been shown in GUNSHOT WOUNDS — THEIR DANGER. 291 the management of a case. The system of allowing each party to select his own medical witnesses invariably leads to a conflict of opinion and evidence. [The proof of ordinary care and skill and judgment exercised in the treat- ment of a case is a sufficient defence in law against a claim for damages on account of alleged malpractice ; but it is too apt to fail with the juries in this country, and will not protect the victim of a prosecution from its attendant expenses. Although our judges, in many instances, have done their best to secure just verdicts, the juries are notoriously stupid and unjust ; so that the only real security to the attending surgeon is in an indemnity bond against all consequent prosecution, to be previously assumed by the patient H.] CHAPTER XXXVII. GUNSHOT WOUNDS — THEIR DANGER — ON THE LIVING AND DEAD BODY — WAS THE PIECE EIRED NEAR OR PROM A DISTANCE ? — EVIDENCE FROM SEVERAL WOUNDS — THE PROJECTILE NOT DISCOVERED — DEFLECTION OE BALLS — ACCI- DENTAL, SUICIDAL, OR HOMICIDAL WOUNDS — POSITION OP THE WOUNDED PER- SON WHEN SHOT — WOUNDS FROM SMALL-SHOT — WOUNDS PROM WADDING AND GUNPOWDER — IDENTITY FROM THE FLASH OP POWDER — EXAMINATION OF THE PIECE AND PROJECTILE. Gunshot wounds are of the contused kind, but they differ from other wounds in the fact that the vitality of the parts struck by the projectile is destroyed, and this leads ultimately to a process of sloughing. The legal definition of a wound applies here as in other cases, so that, in order to con- stitute a gunshot wound within the meaning of the statute, the cutis, or true skin, must be injured. In the Queen against Mortlock (Cambridge Lent Assizes, 1843), the surgeon deposed that there was a circular wound on the skin, by which it had been deprived of its cuticle, but the true skin was not penetrated. The bullet had struck obliquely at a considerable angle ; had it been otherwise, it must have entered the abdomen. The judge said that, as the true skin was not penetrated, there was no wounding within the meaning of the statute. Their danger. — The medico-legal questions which arise out of gunshot wounds, are similar to those which have been examined in relation to Other wounds. They are dangerous to life, especially when they penetrate or traverse any of the great cavities of the body. Death may take place directly either from loss of blood or from shock; although immediate or copious bleeding is not a common character of these injuries. Death from shock is occasionally witnessed. In the case of Daly, who was killed by a pistol- bullet in Hornsey Wood, May, 1842, it was found, on inspection, that the bullet had traversed the distended stomach at the greater end from behind forwards. The two apertures were about the size of a shilling, and the edges black. There was but little blood eflfused, and the other viscera were unin- jured. The deceased died a few seconds after receiving the wound, obviously from a shock to the nervous system. {Lancet, May, 1842.) Indirectly, these wounds are attended with much danger ; sloughing generally takes place uniformly throughout the whole of the parts perforated, and inflammation or fatal bleeding may cut short life. If the person survive the first effects, he may die at almost any period from suppurative fever, erysipelas, gangrene, or from the results of operations absolutely required for his treatment. Gun- 292 NEAR AND DISTANT GUNSHOT WOUNDS. shot wounds may thus destroy life after long periods of time. Marshal Maison, one of Napoleon's generals, died in Paris in 1840 from the effects of a gun- shot wound received, it is said, forty years before. In gunshot wounds of a severe kind, the first symptoms by no means indicate the degree of mischief. Thus in the case of Mr. Drnmmond, who was shot by M'Naughton, in January, 1843, the symptoms were in the first instance so slight, that the bullet was supposed not to have penetrated the cavity of the abdomen., but to have coursed round the skin. Death took place in a few days, and it was then found that the bullet had completely traversed the abdomen, perforating the diaphragm. Army surgeons have also remarked that slight wounds of the pariet«s are often insidiously attended with deep-seated injury. Death might in such a case be improperly ascribed to mismanagement, when it may have been really caused by the wound. (See cases by Mr. Alcock, Med. Gaz., vol. xxiv. p. 850.) It is not easy to mistake a gunshot wound for any other injury. If the circumstances under which it is produced do not satisfactorily account for its origin, a simple examination will suffice to show its true nature. Sometimes the projectile, or a part of the dress, is found lodged in the wound. On the living and dead body. — A medical witness may be asked whether the wound was inflicted Before or after death. It is by no means easy to answer this question, unless the bullet has injured some vessel, when the effusion of blood aud the formation of coagula will indicate that the person was living when it was received. In a gunshot wound on the dead body, no blood is effused unless the bullet happens to strike a large vein. Was the piece jired near or from a distance'^ — A gunshot wound produced by the muzzle of a piece being placed near to the surface of the body, has the following characters : There may be two apertures, the one of entrance and the other of exit; but it sometimes happens that the bullet lodges and does not pass out. The edges of the aperture of entrance are torn and lacerated, and appear blackened, as if they had been burnt : this arises from the heat and flame of the gunpowder at the moment of explosion. The skin is often ecchymosed, and is much blackened by the powder : the clothes covering the body are blackened by the discharge, and sometimes ignited by the flame. If the muzzle of the piece was not in immediate contact with the part struck, the wound is rounded ; but if there has been direct contact, the skin, besides being burnt, is torn and much lacerated. The bleeding is usually slight, and when it occurs it is more commonly observed from the orifice of exit than from that of entrance. It should be remarked, that the aperture of entrance is round, only when the bullet strikes point-blank or nearly so. If it should strike obliquely, the orifice will have more or less of an oval or valvular form ; and by an observation of this kind we may sometimes determine the relative position of the assailant with respect to a wounded person. Sup- posing the bullet to have been fired from a moderate distance, but so near as to have had sufBcient momentum to traverse the body, then the appearance of the wound will be different. The orifice of entrance will be well defined, round or oval, according to the circumstances — the skin slightly depressed — the edges presenting a faintly bruised appearance, but the snrronndiog parts are neither blackened nor burnt, and they do not present any marks of bleed- ing. In these cases the orifice of exit is large, irregular, the edges somewliat everted, and the skin lacerated, but free from all appearances of blackness or burning: it is generally three or four times as large as the entrance-aperture. This is denied by Dr. Malle {Ann. d^Hyg., 1840, t. i. p. 458), but it appears to me upon insufficient grounds. The orifice of entrance is generally large and irregular when the bullet strikes near the extremity of its range. Under common circumstances, the entrance-aperture may have the appearance of being smaller than the projectile, owing to the elasticity of the living skin. {Ann. d'Eyg., 1839, t. ii. p. 319.) It is the same with the aperture in the NEAR AND DISTANT GUNSHOT WOUNDS. 293 dress, when this is formed of an elastic material : according to Dupnytren, the hole in the dress is always smaller than that made by a bullet in the skin. These points shonld be remembered in fitting projectiles to wounds which they are supposed to have produced. Useful evidence -may be sometimes obtained by a careful examination of the projectile, which, if found, shonld be preserved by the medical witness for the purpose of identity. When the projectile cannot be found, and there are no marks of burning, or other signs of a near wound on the skin, we must be cautious in expressing an opinion. Mr. Ward has reported a case in which a perforating wound of the skull closely resembled a bullet wound. (Med. Gaz., vol. xliv. p. 76T.) Was the deceased shot while running away or when approaching the per- son who fired ? — This question is answered by observing in the case of a traversing wound, in which alone any difficulty can arise, whether the en- trance-orifice is situated in front or behind. A trial took place at the Maid- stone Assizes, some years since, in which this question was material. (Smithes For. Med., p. 290.) The question whether a piece was fired near to or at a distance from the wounded person, may be of material importance either on a charge of homi- cide, or of alleged suicide. Two persons may quarrel, one having a loaded weapon in his hand, which he may allege to have been accidentally discharged, aud to have killed the deceased. If the allegation be true, we ought to find on the body the marks of a near wound ; if, however, it were such that it had been produced from a distance, and, therefore, after the quarrel — the medical proof of this fact might imply malice, and involve the accused in a charge of murder. The following case occurred in Ireland in 1834 : — A tithe-collector was tried for the murder of a man by shooting him. It appeared in evidence that the prisoner, while on duty, was attacked by the deceased and two of his sons, and he drew a pistol to intimidate them. He was dragged off his horse by these parties, and during the scuffle, it is supposed, the pistol was dis- charged accidentally and inflicted a wound on the deceased, of which he died shortly afterwards. The sons of the deceased swore that the prisoner took a deliberate aim, and fired the pistol at their father when at some distance ; and a priest came forward to depose that such was the dying declaration of the deceased. From some doubt of the truth of this story, the body, which had been carelessly inspected in the first instance, was ordered to be disinterred. It was carefully examined by a surgeon, who was enabled to swear positively, that the pistol must have been fired close to the body of the deceased, and not at a distance, since there were the marks of powder and burning on the wrist. Hence it clearly followed that the pistol had been discharged during the scuffle, either by accident or in self-defence. The prisoner was acquitted, and the parties who had appeared as witnesses against him were indicted and convicted of perjury. In the case of Mr. Pearce, a surgeon, who was tried at the Central Criminal Court, in 1840, for shooting at his wife, and was found insane, it appeared from the medical evidence that the pistol had been fired so near to the person of the prosecutrix, that her dress was burnt, and the skin blistered. Mr. Marshall relates that when stationed at Ceylon with troops, a man, who had but recently joined the regiment, was placed as sentry in a position where he was occasionally fired at by the enemy from the surrounding jungle. The man was one day found severely wounded ; the calf of his leg was greatly torn ; the whole charge of a musket having passed through it. He attributed the wound to a shot from the enemy ; but from the skin of the leg having been completely blackened by charcoal, it was clear that it must have arisen from the discharge of his own musket. He had inflicted this wound upon himself in order to obtain a discharge from the regiment. These examples, then, show that both the dress and skin of a person who has received a gun or pistol-shot wound should be closely exa- 294 GUNSHOT WOXINDS — SPLITTING OF BALLS. mined. The result may be, that the statement given of the mode in whieh'a wound was received will be entirely disproved. The ease of M. Peytel, tried in France, in September, 1839, furnishes an additional illustration. This gentleman was travelling in a carriage, in company with his wife, and at- tended by a man-servant. The wife and the man-servant were found dead on the road, and the account given by M. Peytel was, that the servant had dis- charged a pistol into the carriage and shot his wife, and he had afterwards pursued and killed him. The facts, however, were so suspicious against M. Peytel that he was charged with the double murder. From an examination of the body of the wife, it appeared that there were two pistol-wounds in the face which had most probably been produced by two separate pistols. The prisoner alleged that about nine o'clock at night, when it was dark, he desired the servant to get down and walk in order to relieve the horses. Two minutes afterwards some man, whom he found to be the servant, approached the carriage-door, discharged a pistol at him, and wounded his wife ; but the evidence showed that two weapons must have been used, or at least two dif- ferent discharges made by a person sitting very near to the deceased, so that the muzzles must have almost touched her face, the eyelashes and skin hav- ing been much burnt by the powder. These facts, together with other strong circumstances against him, led to the prisoner's conviction. The late Dr. Ollivier, who appeared in the prisoner's favor, considered that the deceased might have been shot by the servant, and that the two wounds might have been produced by one pistol loaded with two bullets ; also, that the marks of burning about the face of the deceased might be attributed to the wad- ding, and therefore they afforded no proof that the muzzle of the pistol had, at the time of its discharge, been close to her person. He further contended that the deceased had not died from the wounds. Notwithstanding these ingenious suggestions, there can be no doubt that the prisoner was properly convicted. (See Ann. d'Hyg., 1839, t. ii. p. 339; 1842, t. i. p. 368.) The amount or degree to which the clothes and body of a person may be bnrnt by the near discharge of fire-arms has given rise to medico-legal inquiry. A fact of this kind can only be determined by the circumstances of each case. (Ann. d'Hyg., 1860, t. i. p. 125.) It has been said that when a bullet is fired near, it commonly traverses the body; and, therefore, it has been rather hastily assumed that when there is only one external wound, and the bullet has lodged in the body, this is a proof that the piece has been fired from a distance. This inference is,' how- ever, erroueous. A bullet may be fired close to a person, and yet not tra- verse the body, either from its impulsive force not being sufficiently great, or from its meeting a great resistance in its course. Many cases might be cited to show that, in the near wounds produced by suicides and murderers, the bullets have not always traversed the body (p. 260). In suicide, when the piece is discharged into the mouth, the projectile often lodges in some part of the head. Evidence from several wounds. — When several wounds are found on a body, can we determine whether they were produced by one or several dif- ferent discharges ? This question was raised in PeyteVs case, as there were two wounds on the deceased, and the prisoner alleged that the servant had fired but one pistol. M. Ollivier thought that this might be explained by supposing that there had been two bullets in the pistol ; it was, however, affirmed by some military officers and other witnesses, that these wounds had been produced by separate pistols, a fact which overthrew the defence of the prisoner. {Ann. d'Hyg., 1842, t. 1. p. 368.) It is proper to remark, that one ball may sometimes produce several wounds on the body ; there will be only one orifice of entrance, but, owing to the ball occasionally splitting within the body, and dividing itself into three or four pieces, there may be DEFLECTION OF BALLS. 295 several orifices of exit. This splitting of a ball has repeatedly occurred when the projectile in its coarse has encountered an angular surface or a pro- jecting ridge of bone. Dupuytren met with an instance in which a ball, after having struck the ridge of the tibia, divided itself into two parts, which tra- versed the calf of that leg, and penetrated into the calf of the opposite leg. Thus, no fewer than five wounds were produced in one instance by a single ball; three of entrance and two of exit. Had this man been found dead, and nothing known concerning him, this singular circumstance would proba- bly have given rise to considerable embarrassment. After a careful exami- nation, a surgeon might have been induced to declare, that this person must have received at least three distinct shots. A similar effect was observed in another case, in which the bullet struck the parietal bone and divided itself into two portions; one passed out superficially through the integuments, the other penetrated into the brain, and lodged on the tentorium. This fact shows that the discovery of an exit-aperture does not always prove that the whole of a projectile has passed out — a matter which may influence a medical opinion as to the result. Deflection of balls. — When a ball traverses the body, it sometimes happens that the two apertures are opposite to each other, although the ball may not have taken a rectilinear course between them, but have been variously de- flected by the subjacent soft parts. This deflection of a ball from a rectilinear coarse is met with in those cases in which it happens to strike obliquely a curved surface, and it is found that when a ball enters and does not pass out, its course is often circuitous, so that it is not always easy to say in what part of the body it will be found. In 1830, I saw at the Hotel-Dieu a boy who had received a gunshot wound in the upper part of the abdomen ; the entrance- orifice was plainly situated there, but there was an opening at the back, nearly diametrically opposite, out of which the ball had passed, so that it conveyed the impression that the ball had completely traversed the abdominal cavity. There was, however, no sign of collapse or depression, nor any indication of serious injury; and Dupuytren gave an opinion — which was afterwards veri- fied — that the ball had not penetrated, but had been deflected beneath the skin, and had taken a circuitous course through the cellular membrane to the back. Many similar facts are recorded. The same deflection may occur even when the piece is discharged close to the body, as in cases of suicide. Mr. Abernethy was once called to examine a man who had shot himself, as it was supposed, through the head. He found two openings in the scalp, nearly opposite to each other. It was soon perceived, on examination, that the ball had not penetrated the bone, but had followed the curve of the ex- terior of the skull to its point of exit. The deflection of projectiles may occur not merely when they come in contact with bone, but when they meet skin, muscles, tendons, or membranes; the ball then takes its course in the spaces between these different structures. A ball which entered at the ankle has been known to make its exit at the knee ; and another which entered at the back of the left shoulder, passed down on the inside of the scapula, and was found below the right ear. This deflection of a ball by slight obstacles has been ascribed partly to the obliquity with which it strikes, and partly to the rotatory motion on its axis which every spherical projectile is considered to have. It does not appear to be much connected with the degree of velo- city, for the same deviation has been found to occur when the bullet was fired near or at a distance. If we can at any time discover two fixed points where a ball has touched a building without being deflected, it will be easy to determine the situation from which the piece was discharged. A singular example of this kind is stated by Mr. Watson to have occurred at Ayr in 1831. Several shots had been maliciously fired into a church. Some of the bullets traversed a window. 296 GUNSHOT WOUNDS — SUICIDAL OK HOMICIDAL. making holes in the glass, and struck against a wall on the other side of the church — a fact plainly indicated by the marks which they left. A straight line carried from these two points reached a window on the opposite side of the street, from which it was afterwards ascertained the bullets had beeu fired. Survivorship. — A witness may be asked — When was the gunshot wound inflicted, and how long had the wounded party survived after receiving it? A gunshot wound undergoes no change for eight or ten hours after its inflic- tion. Our judgment in reference to these questions may be assisted by ob- serving the parts which are involved, although we cannot always infer from the quantity of blood found near to the body that the bleeding was an imme- diate consequence of the wound, or that the whole of the blood was efi'used at once. We cannot, then, always affirm that the deceased could not have moved or exerted himself in some degree, after receiving it. The exertion thus made subsequently to his being wounded, may have actually caused the fatal bleeding. Suicidal or liomieidal wounds. — When it is doubtful whether a wound was the result of suicide or homicide, the point may be often settled by paying attention to its situation and direction. Suicidal gunshot wounds are almost always directed to a vital part — to the heart or tO the brain. They possess those characters which belong to wounds inflicted near to the body ; the skin is blackened or burnt, the wound wide and lacerated, the hand which dis- charged the weapon often blackened, and sometimes still grasping the pistol. The ball may or may not have traversed, as this will depend on the momen- tum which it derives from the charge, and the resistance that it experiences. (See the case of the Queen v. Thomas, Brecon Lent Assizes, 1845.) The situation in this instance negatived the supposition of suicide. Suicidal gun- shot wounds are seldom situated at the back of the body; therefore, the determination of the point of entrance, if the ball has traversed, is of some importance. The direction of these wounds is probably of less moment than their situation, because the projectile is liable to be deflected in the body. In a duel which occurred in Paris, in 1827, one of the parties, a tall man, was killed by a ball which was found to have entered below the right shoul- der, and to have taken a direction downwards. In consequence of this, it was thought that he had been shot unfairly by his antagonist, who was short in stature. Breschet and others explained the suspicious coarse of the wound, by assuming that the ball had struck the under part of the clavicle, and had thence probably been deflected downwards. This question excited consider- able attention at the trial of a Dr. Smith for the murder of a William Mac- donald, at St. Fergus, in Scotland (High Court of Justiciary, Edinburgh, April, 1854). It appeared from the evidence that the deceased was found dead in a field belonging to the prisoner, on the morning of Sunday the 20th November, 1853. The body, according to the testimony of eye-witnesses, was lying at full length on its left side in a ditch. The left arm was partly beneath, and the right partly across the body. There was a blackened wound or hole in the cheek, and a little blood on the cheek. A pistol was lying on the ground, according to one witness, about four feet from the head of the deceased. The time at which the deceased died was fixed, with tolerable precision, at twenty-five minutes before eight o'clock on the evening of the 19th November; and, although the prisoner was not seen near the spot, there was evidence that he had made an appointment to meet the deceased that evening, and the testimony of many witnesses showed that he had had an opportunity of being on the spot at the time when the discharge of a pistol had been heard. The defence was that this was an act of suicide. The pistol could not be identified as belonging to the prisoner ; and one witness for the defence positively swore that, six years before, he had sold to the deceased a GUNSHOT WOUNDS — HOMICIDE OR SUICIDE. 29T pistol resembling that found near his body I Upon this statement, and upon the failure of the medical evidence to throw any light upon the important question of homicide or suicide, the prisoner was discharged on a verdict of Not Proven. {Med. Times and Gazette, April 22 and May 20, 1854.) It was proved by the two medical witnesses who gave evidence at the trial, that deceased had died from a pistol-shot, the bullet having penetrated the brain. From the characters of the wound, one thought that the muzzle of the pistol, when discharged, must have been within from three to twelve inches of the face. He admitted that, as an act of suicide, the body might have assumed the position in which it was found, but that the probabilities were against it. The other witness thought that the pistol, when discharged, might have been twelve or thirteen inches from the face ; and although a person standing could, in his opinion, have made the wound that appeared on the cheek, yet a suicide would probably have made more sure of his aim, by selecting another position. The only information regarding the wound was, that it was in the right cheek, below the malar prominence ; that the opening was blackened, and the nose scorched with gunpowder. It appears that the medical witnesses did not see the body until after the lapse of two days! It had in fact been removed from the spot, washed, dressed in grave- clothes, and put into a coffin, before they saw it. (Letter by Dr. Gordon, Med. Times and Gaz., May 20, 1854, p. 525.) Thus the marks of gun- powder on one of the hands, generally found in suicide by pistols, were not seen here ; and the removal of the body from the spot placed the medical men in a difficulty, since they could base their opinions only on the statements of Ignorant witnesses. There were marks of blood on the ground ; but these, it was suggested, might have been accidentally caused during the removal of the body. The situation of the wound, i. e., below the malar prominence in the cheek, is rather unusual for an act of suicide : it was such as a murderer walking by the side of the deceased could have easily selected. The distance at, which the pistol was held appears to have been greater than we find in cases of suicide ; for had it been close, as it usually is in suicide, there would have been marks of extensive burning and laceration of the soft parts about the wound. The position of the pistol with respect to the body, as described by the witnesses who found it, is inconsistent with the supposition that de- ceased had thus fallen accidentally after having himself discharged the pistol. There was no motive for suicide, and no reason why, had suicide been con- templated, the deceased should have selected the prisoner's field for perpe- trating the act. Deceased had been seen transacting business within half an hour of the time at which he must have died; and it was stated by his friends that they had never seen him with a gun or pistol in his possession, and had never known him to use fire-arms. Every fact, medical and moral, tended to prove that this was an act of homicide, and not one of suicide: further, there was no mark of struggling or scuffling, and no robbery had been perpetrated. The motive suggested by the prosecution against the prisoner, was based on the fact that he had effected insurances to the amount of about two thousand pounds, in three different offices, upon the life of the deceased, in whose life, however, he had no pecuniary interest. The insurances were for short periods ; and it appears to be the practice in the Scotch offices that the policy is not rendered void by the act of suicide. It is important to state, as a sup- posed motive for the act, that the risk connected with the largest insurance (for one thousand pounds) commenced on the 24th November, 1852, and terminated on the 24th November, 1853. Only one premium to the amount of about eleven pounds had been paid, and, as it was proved, by the prisoner Smith. The deceased was found dead on the 20th November, *'. e., only four days before the date at which the policy of insurance upon his life would have lapsed. The accused had thus the motive, means, and opportunity of com- 298 WOUNDS FROM SMALL SHOT. mitting the crime, but there were no circumstances which could directly con- nect him with it. The early interference with the body, and the neglect to call for a medical investigation, probably led to the obliteration of parts of the evidence which would have clearly satisfied the jury that this could not have been an act of suicide. Accidental gunshot wounds bear the characters of near wounds: — they may touch vital pans, but, if the body has not been disturbed, the presence or absence of design in the infliction of a wound is commonly made apparent by the relative position of the body and the weapon. They frequently arise from persons drawing the charges of gnns or pistols 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 a hedge, or dragging after them, a loaded gun. 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. (See Ann. d'Hyg., 1860, t. i. p. 443.) In the following case of attempted suicide, the characters of the wound somewha,t resembled those which are commonly im- puted to homicide. In March, 1844, a man was brought to Guy's Hospital, with a large ragged gunshot wound on the right side of the head, behind the angle of the jaw, and between it and the ear. No slugs or bullets could be found; the direction was from behind forwards, and from above downwards. According to this man's statement, the pistol missed fire three times, but he succeeded in discharging it into his mouth at the fourth attempt. He lost a large quantity of blood, but after some time he walked to a table at the dis- tance of five yards, reloaded the pistol, and discharged it at the back of his head in the situation described. Thus, then, there were In this case two wounds, one of them being apparently homicidal in its characters : and there was a power of locomotion after the first wound, in spite of great loss of blood. A gunshot wound in the mouth or temple would seldom be set down to accident, and yet attempts are occasionally made to ascribe to such wounds an accidental origin. The admission of a near wound in the temple occur- ring from accident, must depend entirely upon the circumstances proved. (See the case oi Reg. v. Tottenham, Norwich Lent Assizes, 1845.) Position of the wounded personwhen 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 refer- ence 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 allowance must be made for the deflection of balls after penetration. (The Queen v. Magarity, Central Criminal Court, July, 1841.) Wounds from small shot. — Death is sometimes occasioned by small shot, and here several medico-legal qnestions 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, and its action is much more dangerous than that of a single ball, becaase it produces extensive laeerations; or 2, it strikes after it has spread, and here the discharge must have been distant, and comparatively little mischief is done. Dr. Lachfese 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, a central opening was entirely lost, and the surface of the body was covered by shot. The effect after this was- found to depend on the distance, the goodness of the gun, and the strength of the charge (^Ann. WOUNDS FROM SMALL SHOT. 299 sd'Hyg., 1836, p. 386): but the shot is in general much scattered over the surface of the body. From these results we may form an opinion of the dis- tance at which the piece was fired. In the Queen v. Chapman (Oxford Lent Assizes, 1839), it was proved that the deceased had been killed by small shot fired from a gun ; that the discharge must have taken place very near, as the shot had not been scattered, and the point of the gun must have been below the level of the wound, as the direction was rather upwards. Two medical witnesses were examined, and both agreed that, judging from the direction of the wound, the gun, when fired, could not have been pointed from the shoulder. A similar question was raised in Reg. v. Hull (Oxford Summer Assizes, 1846), and it was decided that the discharge of the gun took place accidentally during a struggle. The case of the Queen v. Kendr'ew (York Winter Assizes, 1844) is in this respect of some medico-legal importance. The medical evidence was very satisfactory. It was shown to be highly im- probable that deceased could have shot himself with small shot from a gun, as the shot were scattered, and there was no round opening or mark of burn- ing. 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. Admitting the correctness of the inferences drawn by Dr. Lachfese, 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 circumstances, be mistaken for one produced by a leaden bullet. This question, however, arose in a case tried by Parke, B. {Reg. v. Spriggs, Lewes Lent Assizes, 1854), in which the prisoner was charged, upon his own statement, with having caused the death of his wife by discharging at her a loaded gun. When seen shortly after by the medical witness, deceased was quite dead. There was a "jagged" wound upon her forehead, about an inch above the right eyebrow. The witness described it as a wound which, from its appearance, might have been produced by any blunt instrument, or by a gun fired from a short distance ! On further examination it was found that the back part of the head had been driven in (?), and it appeared as though the shot had passed completely through the head and brain, passing out be- hind in a direction slanting downwards, the wound behind being three inches lower than that in front. He did not see any shot, nor did he open the head to endeavor to find any; but a portion of the skull and hair had been driven into the wound. The learned judge properly suggested that the brain should have been examined, as some shot might have remained there; and this would have shown exactly how the mortal injury was produced. The medical wit- ness was pressed to say whether he was certain the injury had been caused by shot, and not by a bullet. He said he was certain it was by shot, as he had had much experience on bullet wounds in Ireland I Fortunately, there was good evidence to show that one barrel of the prisoner's gun had been dis- charged, and the undischarged barrel was found loaded with shot, The prisoner was convicted. There appears to have been no indication of burning or singeing of the hair or dress in this case, or the witness would not have suggested that the wound might have been occasioned by a blunt instrument. Considering that there were two penetrating wounds on opposite sides of the head, this was a singular part of the evidence. It is clear that there was one great central wound (the entrance-wound), which, although described as "jagged," appeared difficult to be accounted for, as no shot were scattered or could be found on the skin. Yet this single wound was obviously caused by small shot. In all similar cases, it would be proper to examine the track of a wound throughout. According to Lachfese's experiments it is probable that the piece was in this case discharged at from twelve to eighteen inches from the surface of the skin. 300 WOUNDS FROM WADDING AND GUNPOWDER. A discharge of small shot in contact with the skin or close to it, will, how- ever, produce not a round opening, but a severe lacerated wound. In the case of a gentleman of the Scotch bar (now on the bench), an accidental gun- shot wound in the leg occurred under the following circumstances. He had, during a sporting excursion, lain down on the grass and fallen asleep, the muzzle of his gun being close to the back of the calf of his left leg, and pointing in a slanting direction downwards. By some accident the gun went off, and the shot produced a complete laceration of the whole of the fleshy part of the leg, with no appearance of a round perforation. As might be expected from the closeness of the discharge, the leg of the trousers was much burnt, as well as cut and torn. Although, according to Dr. Lachfese's ex- periments, a round opening may be produced by small shot when the piece is fired at the distance of a foot from the body, the above case clearly proves that the shot may be scattered, and an extensively lacerated wound caused, when the muzzle is close to the skin, and the piece is not discharged point- blank. The scattering of the shot, however, in such a case, could not lead to the inference that the discharge had taken place from a distance, because the skin and dress would always present distinct marks of burning. Small-shot is rarely observed to traverse the body entirely, unless discharged so near as to make a clean round opening ; but a single pellet reaching the body may destroy life. Two cases have already been mentioned ; one in which a young man was killed by a single pellet wounding the fifth intercostal artery : the other, in which a girl was killed by a pellet traversing the orbitar palate and wounding the brain. Such minute wounds might be easily over- looked in an examination of the body. Small-shot, even when wounding only the skin of the back very 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 by the explosion, and the substance becomes a dangerous projectile. The lighter the projectile, the shorter the distance to which it is carried; but when dis- charged 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 are con- tinually occurring 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. In the Queen v. i?ace (Bury Lent Assizes, March, 1840), it was proved that the prisoner had killed the deceased by discharging at him, within a few feet, a gun loaded with powder and paper-wadding. The deceased fell, and died in a few minutes. It was found that the chest was penetrated, and that the wadding had wounded the left auricle of the heart. (See Ann. d^Hyg., 1859, vol. i. p. 421.) It has been observed, that persons in attempting to commit suicide have occasionally forgotten to put a bullet into the pistol ; nevertheless, the dis- charge of a piece 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 dis- charge of wadding from cannon during reviews. It is not 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. Dr. Lachfese has ascertained by experiment that a piece charged with gunpowder is capable of producing a IDENTITY FROM THE FLASH OF GUNPOWDER. 301 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. 368.) 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 ; 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 in- jury 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 circumstances ; but it will in all cases materially depend on the strength of the charge. In Reg. V. Collier (Abingdon Lent Assizes, 1844), the prisoner was charged with firing a gun loaded with small-shot at the prosecutor, with intent to do griev- ous bodily harm. It appeared that the gun was deliberately pointed at the prosecutor, who was then at a distance of from seventy to eighty yards from the prisoner. The shot, which was very small, had marked the clothes, but had not penetrated the skin or inflicted any wound. The defence was, that, from the slight injury done, the prisoner merely intended to frighten the pro- secutor, and not to do him any bodily harm. He was found guilty of a com- mon assault. The question was here a delicate one, for had the prosecutor been a few yards nearer, and the pellets touched an exposed part of his body, the result might have been serious. One pellet has destroyed life (p. 300). A case occurred in the United States, involving the question as to the dis- tance at which a pistol not loaded with ball, would suffice to produce a serious wound. A boy, in play, discharged a pistol at a companion, producing on the fleshy part of the left hip a wound one inch in diameter and four inches in depth. The skin was destroyed, and the muscles presented a blackened, lacerated mass. There was no ball in the pistol; but it is not certain whether there was wadding. Death took place from tetanus on the seventh day; and, on examination, no wadding was found in the wound. There were, however, grains of gunpowder, with which the wound was blackened throughout its whole extent. At the inquest, the witnesses differed respecting the distance at which the pistol was held when the wound was inflicted. Some said one foot ; others two or three yards. The deceased had stated his belief that the pistol almost touched him ; and, judging by the state of the wounded parts, this was probably the truth. Dr. Swift contended that the wound had been produced by gunpowder only, without wadding. He performed some experi- ments with the pistol used by the prisoner, but loaded with gunpowder and wadding, in order to determine the effect of discharges at different distances. At twelve inches distance from a body, he found that the clothes were lace- rated and the skin abraded, but the wadding 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 one and a half inch 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. {Med. Gaz., vol. xl. p. 734.) These results confirm those obtained by Dr. Lachfese (p. 300). Identity from the flash of gunpowder. — Among the singular questions which have arisen out of this subject, is the following : — Whether a person who fires a gun or pistol at another during a dark night, can be identified by means of the light produced in the discharge ? This question was firsti.re- ferred to the class of Physical Sciences, in France, in 1809, and they answered 302 CHEMICAL EXAMINATION OF FIRE-ARMS, it in the negative. A case tending to show that their decision was errone- ous was subsequently reported by Fodere. A woman positively swore that she saw the face of a person, who fired at another during the night, sur- rounded by a kind of glory, and that she was thereby enabled to identify the accused. This statement was confirmed by the deposition of the wounded party. Desgranges, of Lyons, performed many experiments on this subject; and he concluded that on a very dark night, and in the absence of every other source of light, the person who fired the gun might be identified withia a moderate distance. If the flash were very strong, the smoke very dense, and the distance great, the person firing the piece could not be identified. The question was raised in this country, in the Queen v. White, at the Croy- don Autumn Assizes, 1839. A gentleman was shot at, while driving home in his gig during a dark night; he was wounded in the elbow. When he observed the flash of the gun, he saw that the piece was levelled towards him, and the light of the flash enabled him to recognize at once the features of the accused : — in cross-examination he said he was quite sure he could see him, and that he was not mistaken as to his identity. The accused was skil- fully defended, and he was acquitted. Evidence of this kind has, however, been received in an English Court of Law. A case is quoted by Paris and Fonblanque (^Rex v. Haines), in which some police-ofBcers were shot at by a highwayman during a dark night. One of the officers stated that he could distinctly see, from the flash of the pistol, that the robber rode a dark-brown horse of a remarkable shape in the head and shoulders ; and that he had since identified the horse at a stable in London. He also perceived, by the same flash of light, that the person had on a rough brown great coat. This evidence was considered to be satisfactory. Prom the information which I have been able to collect on this point, it appears to me there can be no doubt that an assailant may be thus occasion- ally identified. It is widely difierent, however, in respect to the following case referred to by Mtiller, in his Physiology ; namely, where a man declared that he recognized a robber through the light produced by a blow on his eye in the dark! As Miiller observes, this is a clear impossibility; because the flashes thus perceived are unattended with the emission of light, and there- fore can never be visible to any other person than the subject of them, and it is not possible that they can ever make other objects visible. [For some re- marks on this subject by Dr. Schilbach, see Henke's Zeitschrift der S. A., 1842, vol. i. p. 197.] Dr. Kriigelstein has lately opposed the inference de- duced by Muller, and has supported his views by cases, which, -however, do not appear to me to be satisfactory. (Henke's Zeitschrift der S. A., 1845, vol. iii. p. 172.) [It is well known that the phosphenes, or flashes of light pro- duced by pressing momentarily upon the eyeball, are as distinct in an eye blinded by cataract, or by an opaque cornea or a closed pupil, as in a sound eye ; and they may occur, through cerebral irritation, without a blow or pres- sure, in amaurotic eyes which are utterly devoid of sight. The presence or absence of the luminous ring in consequence of sadden pressure upon the eye is the test proposed by M. Serres, of Uzfes, to enable us to determine in certain cases whether the vision is impaired through loss of function in the re- tina, or only obstructed, as in cataract, through opacity of the anterior struc- tures of the organ. See Mackenzie On the Eye, Am. ed., pp. 869, 872. — H.] Chemical examination of fire-arms. — An attempt has been made by French medical jurists, to determine for how long a period a gun or a pistol found lying 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, a quantity of sulphuret of potassium, mixed with charcoal, is left adhering to the barrel of the piece, when recently discharged ; and this is indicated by its forming a strong alkaline solution with water, evolving an odor of sul- CHEMICAL EXAMINATION OP PROJECTILES. 303 phuretted hydrogen, and giving a deep brown precipitate with a solution of acetate of lead. After some hours or days, according to the degree of ex- posure to air and moisture, the saline residue becomes converted to sul- phate of potash, forming a neutral solution with water, 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 An7i. d'Hyg., 1834, p. 454; 1839, p. 197 ; 1842, p. 368.) This sub- ject has excited some attention on certain trials which have taken place in France in reference to the death of M. Bujarrier. It was considered here of some importance to determine whether, by the mere discharge of powder, such a deposit of charcoal or powder took place at the mouth of the pistol, as to soil the finger when introduced three hours after the alleged discharge. M. Boutigny conducted the investigation, and found in his experiments that the finger was not blackened under the circumstances. He considers that sulphate and carbonate of potash are formed, and that the charcoal is en- tirely consumed. The facts proved at the trial were, however, adverse to the view thus taken ; and it really appears that this most elaborate inquiry, involving physics, chemistry, and mathematics, might have been spared, on the simple ground that the result produced by a discharge of powder in the manner supposed, must depend on the quantity of powder employed (its perfect or imperfect combustion), and the proportion of charcoal contained in it! The elements for solving this pyrotechnic question must therefore in most, if not in all cases, be wanting. {Ann. cfHygiine, 1848, vol. i. p. 392.) Projectiles. — In the case of Rush, who was tried and convicted of the murder of Mr. Jermy, by a remarkable train of circumstantial evidence (Nor- wich Lent Assizes, 1849), 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 un- like the shot used in killing game. Each piece weighed from eleven to thirteen grains, and there were fifteen pieces in all. As the learned judge remarked, this demonstrated that the two acts of murder were committed by the same person, or by this person acting in concert with others. In the Queen v. Lloyd (Shrewsbury Lent Assizes, 1854), it was proved that de- ceased had been killed by the discharge of a gun through a window. He was struck on the head by about thirty shots, one of which had penetrated the brain and caused death. The assailant was not seen, but the charge was brought home to him by numerous circumstances : among others, by the dis- covery, in one of his pockets, of shot of the same sizes as those removed from the head of deceased (Nos. 3 and 4). The surgeon had very properly re- moved and preserved the shot, so that they were afterwards available as evi- dence against the prisoner. With respect to the evidence derivable from wadding found in gun-shot wounds, see page 287. The chemical analysis of a projectile may be occasionally necessary. A common bullet is entirely formed of lead. Oast 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 the liquid state. In large bullets this cavity is fre- quently of the size of a barleycorn. Bullets obtained by compression have no such space, and are of greater specific gravity. Small shot consist of lead with a minute fractional portion of arsenic (^^^th part). If the arsenic is ih large proportion the shot is lenticular — if absent, or in small proportion, pyriform (tire). In the case of Rush, type-metal was found in the house. This consists of lead with one-fourth part antimony, the latter being left by digestion in nitric acid. It was, therefore, considered advisable to examine the slugs chemically, and they were found to consist chiefly of lead, and to contain no antimony. 304 BUENS AND SCALDS. CHAPTER XXXVIII. BURNS AND SCALDfa — CIRCUMSTANCES WHICH RENDER THEM DANGEROUS TO LIFE — DID THE BURNING TAKE PLACE BEFORE OR AFTER DEATH ? — EXPERIMENTS on the dead body — vesication and line of redness — presence of several burns — wounds caused by fire — human or spontaneous com- bustion — homicidal mistaken for spontaneous combustion — time re- quired for the burning of a dead body — burns by corrosive liquids. Burns and Scalds. A Burn is an injury produced by the application of a heated substance to the surface of the body ; while a Scald results from the application of a liquid at or near its boiling point, under the same circumstances. There seems to be no real distinction between a burn and a scald in reference to the effects produced on the body : — the injury resulting 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 living or dead Ijody was caused by such a liquid as boiling water, or by a heated solid. If the former, the injury might be ascribed 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 would be no destruction of substance. In a burn by a heated solid, the parts may be more or less de- stroyed, or even charred : the cuticle may be found blackened, dry, almost of a horny consistency, and presenting a shrivelled appearance. This destruc- tion would only apply to scalds from water. A scald from melted lead could not be distinguished from a burn produced by a solid heated to the same temperature. Some of the oils boil at 500°, and produce, by contact with the skin, burns as severe as those caused by melted metals. 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 scorching, but by the small particles of unburnt carbon which are imbedded in the skin. Action of melted metals. — A singular case in which an attempt on life was made by pouring a melted metal into the ear, occurred to M. Boys de Loury. The mother of an idiot, aged twenty-five, wishing to get rid of him, adopted the plan of pouring melted pewter into his right ear while he was lying asleep. Great pain and violent inflammation followed, but the young man recovered. The mother then alleged that he had himself poured the melted metal into his ear. At a judicial investigation, M. Boys de Loury was required to say whether such an act was likely to occasion death, and if so, how it happened that the party had in this instance recovered. The alloy was formed of seven parts of tin and three of lead, and the melting point of ^such an alloy would be about 340°. M. de Loury stated that such an act might lead to death by causing inflammation and caries of the internal ear extending to the brain. The recovery of the youth was owing to the mischief which followed having been comparatively slight. In performing some experiments on the dead body, he found that it was difficult to fill the ear-passage with such an alloy, in consequence of the sudden expansion of the air caused by the high tem- perature. {Ann. d^Hyg., 1847, vol. ii. p. 424.) Various degrees of burns. — Dupuytren has divided burns into six degrees, which are commonly recognized by medical jurists. VAUIOTJS DEGREES OP BURNS. 30ft 1. The heat produces a simple inflammation of the skin without vesication. The skin is red, but the redness disappears on pressure : there is slight and superficial swelling, with severe pain, relieved by the contact of cold sub- stances. The inflammation subsides after a few hours, and the skin resumes its natural condition : or it may continue for several days, and the cuticle then peels off. 2. There is a severe inflammation of the skin, and the cuticle is raised into blisters containing a yellow-colored serum. This kind of injury is generally the result of the action of boiling liquids. Some blisters are commonly formed immediately; others are produced during a period of twenty-four hours, and those which are already formed become enlarged. Suppuration takes place if the cuticle is removed, and the person survives for a period sufficiently long. As the cutis or true skin is not destroyed by this degree of burn, there is no mark or cicatrix to indicate its past existence. 3. The superficial part of the cutis is destroyed. The burn appears in the form of yellow or brown patches, insensible when gently touched, but giving pain when strongly pressed. An inflammatory redness, accompanied by vesication or blistering, is perceived in the healthy portion of skin around the eschars. A white and shining cicatrix, without contraction of parts, remains after healing. This degree of injury is commonly observed in burns from gunpowder, and the part which was the seat of the burn is frequently stained black, when the particles of gunpowder have not been removed soon after the accident. 4. The skin is disorganized as far as the subcutaneous cellular tissue. There are firm and thick eschars, which are quite insensible. If the burn has arisen from a boiling liquid, the eschars are soft and of a yellowish color ; if' from a red-hot solid, they are firm, hard, of a brown color — sometimes black. The skin around appears shrivelled and puckered towards the eschar, which is depressed below the cutaneous surface. The surrounding integu- ments present a high degree of inflammation, and vesications appear. From the fourth to the sixth day, the eschar falls off, leaving an ulcerated surface, which heals slowly, and is always indicated by a cicatrix. 5. In the fifth degree, the whole of the layers of the skin, the cellular membrane, and a portion of the muscles beneath, are converted into an eschar. The appearances are similar to those of the fourth degree, but in a more aggravated form. 6. The burnt part is completely carbonized. If the individual survives, violent inflammation is set up in the subjacent tissues and organs. 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 dan- gerous to life. (1 Vict. c. 85, sec. 2.) Burns and scalds are dangerous to life in proportion to the extent of surface which they cover, as well as the depth to which they extend. The extent of surface involved in a superficial 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 intensity 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. Appearances. — When death has been caused by intense pain, no changes have been detected in the dead body ; but under other circumstances, it has been found on inspection that there were patches of redness on the bronchial mucous membrane, as well as on that of the alimentary canal. The brain has been found gorged, and the ventricles have contained an abundance of serosity. The serous liquids of the pericardium and pleura have also been 20 306 BURNS BEFORE AND AFTER DEATH. in larger quantity than natural. In short, besides congestion, there is gene- rally abundant serous effusion in one of the three great cavities, especially in the cranium. This arises from the sudden refluz of blood into the interior. (See case by Mr. Long, Med. Gaz., vol. xxv. p. 143; also, by Mr. Erichsen, vol. xxxi. p. 551.) In a case in which a woman died on the thirteenth day from a superficial burn involving the skin of the lower part of her body — the stomach was found inflamed at its greater extremity, and the duodenum at its lower portion — the raucous folds of the intestines having a scarlet color. The other intestines as far as the caecum were also more or less inflamed. {Amer. Jour. Med. Sciences, Jan. 1861, p. 181.) If the person survive the first effects, he may die from inflammation, suppuration, gangrene, irritation, or fever, or be may be worn out by exhaustion. In this respect, burns of the 4th, 5th, and 6th degrees are especially dangerous to life ; and it would be unsafe to give an early opinion, as inflammation of deep-seated viscera only appears after several days. Stupor from hums. — In some instances, especially in children, stupor and insensibility have supervened, owing to a sympathy with the brain ; and these symptoms have been followed by coma and death. If, under these circum- stances, opium has been given to the patient as a sedative, the stupor result- ing from the burn may be attributed to the effects of the drug ; and should the person die, the practitioner may find himself involved in a charge of mala- praxis. It may be alleged; as in the following case related by Mr. Abernethy, that the person was poisoned by opium. A medical man was charged with the manslaughter of a child by giving to it an overdose of opium, while it was laboring under the effects of a severe scald. Mr. Abernethy stated in his evidence, which was given in favor of the practitioner, that he thought the exhibition of opium very proper: — that the quantity given, eight drops of tincture of opium immediately after the accident, and ten drops two hours afterwards, was not an overdose for a child (the age is not stated). The circumstance of the child continuing to sleep until it died, after the exhibi- tion of the opium, was no proof that it had been poisoned. This sleep was nothing more than the torpor into which it had been plunged by the accident. The surgeon was acquitted. Notwithstanding the favorable opinion expressed of this plan of treatment, it would be advisable to avoid the use of opium on these occasions in respect to infants and children. Life is readily destroyed in young subjects by the smallest doses of this drug (see p. 152) ; and there are no satisfactory means of distinguishing the comatose symptoms produced by a burn or scald from those produced by an overdose of opium. Did the burning take place before or after death ? Vesication. — The pro- duction of vesication or of blisters containing serum, is commonly regarded as an essential character of a burn which has been produced during life, but it is not a necessary or invariable effect of a burn on the living body. Vesi- cation is especially seen in scalds, or in those cases in which the skin has been burnt by flame or by the ignition of the clothes, provided the cuticle has not been destroyed. It is not so commonly observed in burns produced by in- tensely heated solids. In vesication, the cuticle is raised from the true skin beneath, and is converted into one or more blisters containing serum, while the skin around is of a deep-red color. It is uncertain as to the time at which it appears ; it may be produced in a, few minutes, or sometimes not for several hours: thus, death may take place before vesication occurs; and the non- discovery of this condition does not warrant the opinion that the burn could not have taken place during life. If the cuticle is removed from. a vesicated part of the living body, the skin beneath will become intensely reddened ; but if the cuticle is stripped off in a dead subject, the skin will become hard, dry, and of a horny-yellow color; it does not acquire the intense scarlet in- jection which is acquired by the living skin when vesicated and exposed. EVIDENCE FEOM VESICATIONS Oft BLISTEES. 307 Vesication as an effect of dry heat. — There have been conflicting opinions whether the presence of blisters (vesication) on a dead body should be talien as evidence of biirning during life. The following may be taken as a summary of the facts hitherto ascertained. Dr. Christison on one occasion, had an opportunity of trying experiments on the effects of dry heat on the same body before and after death ; this was the case of a young man who had poisoned himself with opium. While he was lying in a hopeless state of coma, four hours before death, a hot iron was held on the outside of the hip-joint ; and half an hour after death, a red-hot poker was applied to three places on the inside of the arm. Vesication followed the burns in both instances ; but those caused during life contained serum, and those which were formed after death, air. In another experiment, a cauterizing iron produced no blisters on a leg, half an hour after amputation ; but vesications, containing air, were formed, when in another case the iron was applied ten minutes after amputa- tion. On the whole. Dr. Christison thinks that a vesication containing serum, indicates a burn during life, and one containing air, a burn after death. I have performed some experiments on the bodies of infants eighteen and twenty hours after death, both with boiling water and heated solids ; but in no case have I observed any kind of vesication to follow at that period. The skin was shrivelled, and was partly destroyed by the heat, but there were no blisters produced. (See case by M. OUivier, Ann. d'Hyg., 1843, vol. i. p. 383.) ITnder certain morbid states, blisters containing serum may be pro- duced in the dead body, even twenty-four hours after death. M. Leuret observed, that this took place in an anasarcous subject, in the vicinity of which a heated brazier had been placed.- The cuticle was hardened, then raised and blistered; and the blister contained an abundance of reddish- colored serum. In repeating this experiment on other dead bodies not infil- trated, it was observed that no vesications containing serum were produced. (Ann. d'Hyg., 1835, vol. ii. p. 381.) M. Champouillon has repeated the experiments of M. Leuret on anasarcous bodies, and he finds that blisters may be produced in these cases at almost any period after death. Thus, they occurred when heat was applied to the anasarcous subject recently dead — to another when in a state of cadaveric rigidity, and to a third when putrefac- tion had commenced. The blisters do not appear immediately — the time which he found requisite for their production varied from two to six hours. The serum effused beneath the raised cuticle was rarely tinged with blood. (Ann. d'Hyg., 1846, vol. i. p. 421.) These experiments only confirm the results obtained by M. Leuret; they add nothing to our knowledge of the subject. The conclusion to be drawn from them is, that in the examination of burns on the body of a person affected with anasarca, it is necessary to be cautious in expressing an opinion. In such cases it would not be possi- ble, from the existence of mere vesication, to say whether the burn took place before or after death. The late Dr. Wright, of Birmingham, has published the results of some experiments on burning after death, from which he infers that the production of 3. serous blister in the dead body is not dependent on the presence of serum in the cellular tissue (anasarca), but upon the amount of (latent) organic life remaining in the body. He states that he has produced a serous blister in a dead body more than a dozen times — twice within half an hour, and once within fifteen minutes after death ; and in amputated limbs he has produced them in from half a minute to'four minutes and a half after amputation. The only favorable opportunity which occurred to him for producing, after death, a serous blister, was in the person of a female thirty years of age, who died suffocated from acute congestion of the lungs. She was slightly anasarcous. Three hours and a half after death, when the body was quite warm, and the joints were flexible, a spirit-lamp flame was applied to the lower and back 308 PRODUCTION OF A LINE OF REDNESS. part of the left leg. After the lapse of an hour, blisters had been formed and were filled with serum of a pale straw color ; one contained two and the other three drachms. Ten and fifteen hours after death, when the body had become cold and rigid, the flame produced only gaseous blisters. (Patholo- gical Researches on Vital and Post-mortem Burning, 1850.) Vesication as a result of scalding in the dead body. — Dr. Christison found that when boiling water was poured upon a dead body ten minutes after death, the skin was simply ruffled and shriyelled; but the cuticle was not raised into a blister. The same effects were produced so long as the body retained its warmth. Accident has enabled me to state the result within a shorter period than that above mentioned. The body of a drowned man within a few min- utes of the accident, was removed and placed in a warm (hot?) bath. It was found impossible to resuscitate hira, but owing to the great heat of the water, portions of the cuticle came off, when the body was removed. On inspection there were several vesications Jilled with bloody serum over a considerable portion of the skin, especially of the extremities. There was no anasarca here to account for their production ; and the fact of their occurrence ap- pears to bear out the view of Dr. Wright, that the production of a serous blister on the dead body depends on the amount of latent organic life remain- ing in the body. The man was pulseless, and to all appearance dead, when placed in the hot bath ; hence the effects of hot liquids on the living and the recently dead body, so far as the production of vesication is concerned, are proved by this case to be similar. Dr. Chambert has lately published the results of numerous experiments on the effects of burns on the living and dead body. These have been made on the bodies of persons, from the moment of death until twenty hours after dissolution, and some were per- formed before death. The general results of his researches are : that vesica- tions, or blisters, may be produced by burns both on the living and dead body ; that they are produced at a lower temperature in the living than in the dead ; that in the living a burn produces great capillary congestion, with the effusion of a mixed serum in the blisters, and that this serum when heated, or treated with nitric acid, sets into a nearly solid coagulum. The blisters pro- duced in a dead body, even a few minutes after death, contain a thin watery serum, which is only rendered opaline or milky by heat and the action of nitric acid. {Ann. d^Hyg., 1859, vol. i. p. 342.) Aline of redness. — In burns, especially in those produced by red-hot solids, other effects besides vesication follow. The edge of the skin immediately around the p9,rt burnt is commonly of a dead white ; and close to this is a deep red line, gradually shaded off into the surrounding skin, which is red- dened. The diffused redness is removable by pressure, and disappears with life; the red line here referred to, however, is not removable by pressure, and is persistent after death. This line of redness is not always met with in severe burns ; and when a person survives one or two days, its production appears to depend upon a power of reaction in the system. Thus, then, its absence furnishes no proof of the burn having been produced after death; for it is not a necessary accompaniment of a burn during life. Dr. Christison has endeavored to determine by experiment whether this line of redness could be produced by applying a heated solid to a dead subject. He found that when the person had been dead only ten minutes, no such effect was produced. In repeating his experiments on dead subjects many hours after death, I have found that no line of redness ever presented itself; so that its discovery in a dead body burnt, would appear to indicate either that the burning took place during life, or within ten minutes after death — most probably the former. M. Champouillon takes exception to the inference derivable from these experi- ments. He says that he has caused the production of a line of redness by the application of heat to the dead body, and that it is a uniform accompani- BURNING OF A DEAD BODY. 309 ment of the formation of blisters in the dead. He admits that it is in this ease a mere capillary infiltration, quite superficial, and surrounding the mar- gin of the blister, while in the red line produced during life, the tissues of the skin are deeply injected, and it is evidently the result of vital reaction. (See Ann. d^Hyg., vol. i. p. 442.) It would appear that he has only remarked this condition in dead anasarcons bodies, in which vesications had been pro- duced, and it is obvious from the description, that he is referring to a slight congestion of the vessels, occasioned probably by the stagnation of the fluid portion of the blood in the superficial capillaries. It is altogether distinct from the line of redness described by Dr. Christison as a frequent conse- quence of severe burns. In the case of Mr. Westwood (June, 1839), the fact of certain burns on the body having been produced during life, was deter- mined by Mr. French, from an observation of this sign. The deceased was found dead, with his skull extensively fractured. His throat cut, and his body burnt in various places. Mr. French, who gave evidence on this occasion, remarked, that the burns were surrounded by a line of redness : — that they were probably produced about the same time as the other injuries, but cer- tainly while there was some vital action in the system. When, however, vesi- cation and a line of redness are absent, we have no medical data on which to found an opinion — whether the burn was caused before or after death. Dr. Wright considered that in a low state of vitality a line of redness might not be produced by a severe burn on the living body, and that more certain reli- ance may be placed on the red marks found beneath the blisters and crusts of vital burns. These latter were well marked when he found the line of red- ness itself indistinct. {Op. cit., p. 25.) The recent researches of Dr. Cham- bert confirm this view. In a burn on a living person, if the skin has not been entirely charred and destroyed, the cutis will present a dotted or pointed redness — these dots or points corresponding to the sndiparous and hair-fol- licles. After complete death, the burn does not produce any such effect: the cutis is of a dead-white on its surface and its substance. In one experiment performed ten minutes after death, there was no redness of the cutis, either beneath the blisters or in the surrounding parts. {Ann, d'Hyg., vol. i. p. 1859, 368.) This reddened or congested state of the bare skin is more con- stant than any other appearance, and forms at present the best criterion of the infliction of a burn on the living body. The medico-legal facts connected with burns on the living and the dead underwent a minute scrutiny in a re- markable case of alleged matricide at Bridgenorth. {Reg. v. Newton, Shrews- bury Lent and Summer Assizes, 1849.) When several hums are found on a dead body, it may be a question whe- ther they were all produced at the same time. This is a point which can be determined only by observing whether any of them present signs of gan- grenous separation, of suppuration, granulation, or other changes that take place in a living body after accidents of this kind. The witness may be asked, how long did the deceased survive the burn ? A person may die in a few minutes, or live some hours after receiving a most extensive burn ; and yet there will be no change in the part burnt, to indicate when death actu- ally took place. There may have been no time for inflammation or its con- sequences to become established. Suppuration generally follows vesication, and in severe cases it may occur on the second or third day ; but often not until a later period. In regard to gangrene, this takes place when the vita- lity of a part burned is destroyed. The time of its occurrence is uncertain, but it sometimes very speedily follows the accident. After murder has been perpetrated, it is not uncommon for a criminal to attempt to dispose of the body by burning it. This occurred in the case of Mr. Paas {King v. Cook), likewise in the case of the Queen v. Good, and in another case at Leeds (Jan. 1843), where a mutilated body was found float- 310 WOUNDS CAUSED BY FIRE. 4 ing in a river with marks of burning about it. In general, the body is not burnt until all signs of life have disappeared ; we shall therefore meet, in such cases, with nothing but the charring of dead flesh, so that no difficulty can exist in forming an opinion. When the burning is partial, and has probably taken place from a wilful ignition of the clothes, at or about the time of death, some caution is required in expressing an opinion, since marks of vesication and a line of redness are not always present in burns during life. It is by no means unusual, however, to find it stated in evidence, that blisters are a constant accompaniment of a burn in the living body 1 In the Queen v. Taylor (York Lent Assizes, 1842), the deceased was found dead with marks of strangulation on her neck, and her clothes were much burnt from her waist to the knees. She was lying across the hearth — the body was burnt as well as the upper and lower extremities and the neck; in the opinion of the medi- cal witness, the burn on the neck could not have been produced by the fire extending from the other parts of the body. In cross-examination he stated that the burns must have occurred after death ; they could not have taken place before, nor at the time of death, because there was no vesication, and he had never seen a burn on a living person which was not followed by blis- tering I The prisoner was convicted, his counsel having failed to prove or render it probable that death was caused, as alleged, by accidental burning. The reader will find some remarks on the burning of the living and dead body, in the report of the trial of Dr. Webster for the murder of Dr. Park- man. (See Report by Dr. Stone, Boston, 1850.) Wounds caused hy fire. — On the discovery of wounds on a body burnt by fire, it is necessary they should be closely examined, in order that a witness may be enabled to say whether they have been caused by cutting or other instruments, hefore death by burning, or whether they are not simple me- chanical results of the effects of fire on the skin. Mr. Curling has communi- cated to me a case which will show the necessity for this inquiry. A boy, two years of age, was brought to the London Hospital, Nov. 11th, 1840, so severely burnt on the face, neck, abdomen and extremities, that he survived the accident only three quarters of an hour. It appeared that the step- mother, who had charge of the child, left him at home locked up in a room where there was a fire, while she went out. Some of the neighbors shortly afterwards hearing screams proceeding from the room, broke open the door, and discovered the child enveloped in flames, and its clothes on fire. The flames were immediately extinguished, and the boy was brought to tBe hos- pital. Suspicion of unfair treatment having been excited by the appearance of wounds about the knees which were observed 'as soon as the child was ad- mitted, and by the reported neglect and ill-usage of the child by the step- mother, the coroner directed an inspection to be made. The body was plump and well-formed. The skin in the burnt parts was denuded of cuticle and converted into a deep yellowish or blackish dry mass, which was very tense, hard, and easily torn. There were gaping wounds on both knees. On the right side, a fissure in the skin commenced about the middle of the thigh, and proceeded for two inches and three-quarters to the inside of the patella, where it became somewhat jagged, and making a sudden turn inwards passed to the extent of two inches towards the back of the joint. A transverse laceration of the skin, three-quarters of an inch in length, was observed on the front of the left thigh a little above the left knee ; and another, which was also transverse and measured an inch and a half, was situated below, on the inner side of the joint. These fissures in the charred skin were all about three lines in width and two in depth, and exposed the adipose tissue beneath, which was white, and free from all appearance of effusion of blood. The edges of these fissures were not uneven, but they did not present the clean and smooth appearance usually observed in incised wounds. The vessels on BURNS — CAUSE OF DEATH. 311 the surface of the brain were full of blood, and the cortical structure appeared diirk-colored. The lungs were congested, but the heart contained little blood. The mucous membrane of the stomach presented a slight pinkish hue, but that of the Intestinal canal was nearly white. From the absence of any trace of effusion of blood, the sound condition of the exposed adipose tissue, its exemption from the action of the fire, and the irregular character and ap- pearance of the fissures, Mr. Curling concluded that they were not the result of wounds inflicted before the occurrence of the burn; he considered them to have been occasioned by the influence of heat, which had forcibly corru- gated the skin and completely destroyed its elasticity, and the superficial layer of adipose tissue being closely adherent to the cutaneous tissue, neces- sarily gave way at the same time. In several places some small vessels con- taining blood were observed running across the fissures ; these, being more tenacious than the adipose tissue, had not yielded with it. This appearance alone was sufficient to negative the supposition of the infliction of wounds by catting instruments. The production of the fissures might have been aided by the child's struggles immediately after the occurrence of the burn, but it did not appear that these were at all violent. The conclusion at which Mr. Curling arrived was justified by the facts ; and the case is calculated to throw an important light on the accidental origin of fissures or wounds of the skin in cases of death from burns. Summary. — The conclusions which, it appears to me, we may draw from the foregoing statements, are: 1, that, as a general rule, when we discover marks of vesication, with serous effusion, or a line of redness, or both, about a burnt part of the body, we are justified in saying that the burn has oc- curred during life; 2, that when these. appearances are not met with, it by no means follows that the burn had not been produced in the living body ; the affirmative evidence derived from such appearances being much stronger than the negative. Cause of death. — Whether a burn or a scald was or was not sufficient to account for death, must be determined by the extent, depth, and situation of the injury ; but even when the burn has clearly been caused during life, the body should be carefully examined for other marks of violence, such as blows upon the head, wounds, marks of strangulation — and internally for hemor- rhage, disease, or poisoning. It must be remembered, that in burns which are rapidly fatal, the serous liquid found in the cavities has commonly a red color, and the mucous membranes are also reddened. The subject of scalding scarcely requires a separate notice. A scald from boiling water would, when recent, be indicated by vesication and the sodden state of the skin. The living structures are not charred or disorganized as by the application of a red-hot solid. At the Liverpool Summer Assizes, 1847, a woman was convicted of throwing boiling water over her husband, with intent to maim him. {Reg 7. King.) In another case {Reg. v. Blewitt, Worcester Summer Assizes, 1847), the prisoner was convicted of the man- slaughter of his wife by pouring over her the contents of a kettle of boiling water. At the Stafford Winter Assizes, 1859 {Reg. v. Hill), a man was convicted of feloniously casting boiling water over the prosecutor with intent to do him grievous bodily harm. The medical evidence was to the effect that the scalds were on the head, cheek, neck, and arm, and were of a danger- ous character. A woman at Glasgow attempted to kill her husband by pour- ing boiling water over his genital organs while he was asleep in bed. He died, but his death could not be clearly traced to this cause. These are the only recent instances of criminal scalding which are reported. 312 HUMAN OE SPONTANEOUS COMBUSTION. Human or Spontaneous Combustion. Supposing that a dead body is found burnt, and tliere is no apparent caose of death about it, it may be said that the burning was neither the result of accident nor of homicide, but that it was the effect of spontaneous or human combustion. There are two opinions concerning this so-called spontaneons destruction of the human body. On the one hand, it is alleged that the combustion may take place from internal causes, i.e., that the process is literally spontaneous; on the other hand it is contended that the contact of a substance in a state of ignition is necessary for the production of the phe- nomenon — so that, according to this view, the human body merely becomes preternaturally combustible. The hypothesis of those who advocate spon- taneous combustion, is, it appears to me, perfectly untenable. So far as I have been enabled to examine this subject, there is not a single well-authen- ticated instance of such an event : — in the cases reported which are worthy of any credit, a candle, or some other ignited body, has been at hand, and the accidental ignition of the clothes was highly probable, if not absolutely certain. It is in vain that they who adopt this hypothesis appeal to the electrical state of the atmosphere or of the individual, coupled with the im- pregnation of the system with the inflammable principles of alcohol, as con- ditions snfBciently explanatory of their views — such explanations may be reserved until the occurrence of this spontaneoas combustion from internal causes is placed beyond all dispute. For a full description of the phenomena which are said to accompany this condition, I may refer the reader to Oos- perms Wochenschrift, 1841, Nos. 8, 9, 10; also Henke's Zeitschrift der S. A., 1842, vol. ii. p. 228; 1843, vol. ii. p. 39; and the Ann. d'Hyg., 1851, vol. i. p. 99 ; vol. ii. p. 388. We have, then, only to consider, in this place, how far the views of those who allow that the body may acquire preternaturally combustible properties are consistently borne out by facts. It is generally admitted that the un- clothed human body is highly difficult of combustion ; and, Jiherefore, if in any case the degree to which it is consumed by fire is great in proportion to the small quantity of combustible matter destroyed about the person, it ap- pears not unreasonable to refer this to its possessing greater combustible properties. This is precisely the species of evidence which is furnished by the alleged cases of spontaneous combustion : the body has been found almost entirely consumed, and the clothes and other articles of furniture surround- ing it but little injured. It must be remembered, however, that a crafty assassin may employ naphtha or some other inflammable spirit, of which no trace will be found, and the secret destruction of the body may therefore be due to this extraneous cause, and not to any increased combustibility of its parts. The contact of a volume of flame will speedily consume the body, owing to its high temperature and the large surface which it would at once envelop. Articles of female dress, from the quantity of air inclosed between the layers, are capable of producing much flame : — and in a body in which fat predominated, this would, after a time, add to and augment the efl'ect of other combustibles with which it might be surrounded. Even allowing that the human body may, in certain cases, acquire increased combustible proper- ties, the medical jurist will perceive that this admission does not involve any difficulty in the judicial determination of a question of murder by burning, since it is contended that the combustion of the body cannot take place ex- cept by contact with ignited substances. But whether the ignition of the clothes of a deceased person took place accidentally, or by the criminal act of an accused party, is a totally different question — it is one in which a medi- cal jurist is no more concerned than a non-professional witness — this is, in HOMICIDAL TAKEN FOR SPONTANEOUS COMETISTION. 313 fact, a point which can be cleared up only by general or circumstantial evi- dence. If it be admitted that the body of one person will burn more rapidly and completely than that of another, this will be no gronnd of exculpation to a prisoner who is proved to have wilfully set fire to the clothes of that person. It may be urged in defence, that the prisoner might not have in- tended to destroy the deceased ; and that although he ignited the clothes, he did it withoiit any malicious intention ; and that death would not have been caused by his act, but for the preternatural combustibility of the body of the deceased ! The intention which a person may have had in setting fire to the clothes of another, when he could not possibly know to what degree the burning would extend, is, of course, a question for a jury, to be decided from the circumstances. The relation of this subject of the alleged spontaneous combustion of the body to medical jurisprudence, appears therefore to have been much exaggerated. The only credible part of the doctrine can never present any sort of difficulty to a medical jurist. Homicidal mistaken for spontaneous combustion. — It is singular that, ao recently as the year 1850, some German physicians should have been found to advocate the hypothesis of spontaneous combustion in a case of murder. A trial took place at Darmstadt in March and April, 1850, in which a man named John Stauff was charged with the murder of his mistress, the Count- ess of Goerlitz. The Countess was found dead in her apartment ; the dress on the upper part of the body was almost wholly consumed ; the head exhi- bited the form of a nearly shapeless black mass, in which the mouth was im- perfectly distinguishable, with the charred tongue protruding from it. The skin of the neck, as well* as the skin and muscles of the face and upper part of the chest, were much blackened and charred. The joints of both arms were charred on their surfaces, and the blackened ends of the bones protru- ded. There were no marks of fire on the clothes anywhere beyond the mar- gins of the burns on the body. A writing-desk near the body had been par- tially burnt, and the floor beneath and in front of the desk, over a space of a foot and a half, had been entirely consumed. The feet of a chair placed near the writing-desk were slightly charred. A folding board and the drawers were also much burnt. With this clear evidence of the partial destruction of a human body by fire, the physician who was consulted could suggest no other explanation of the phenomena than that the body of the Countess must have taken fire spontaneously, while she was engaged in writing at her desk 1 He could not even admit that her cap or dress might have become ignited by a candle, because, had this been the case, she would, in his opin- ion, have had time to escape, or call for assistance! The other reasons as- signed for the adoption of this hypothesis were, that deceased went to bed in good health — that there was a greasy black or sooty substance found about the room, and the body exhaled an empyreumatic odor. It may be observed that when the room was first broken into, and the Countess was found dead, flames burst out simultaneously from the hangings, the writing-desk, and the floor beneath it, which required to be extinguished by the ordinary process — namely, by water. The scientific opinion thus given amounted to this — the Countess's body had undergone slow combustion until it reached a full red heat ; it then ignited the furniture around 1 The Countess was thus found dead on the 13th of June, 1847. On the 26th of November of that year, it was intimated to the Count that an inquest would be held, and the valet Stauff, having made an attempt to poison his master, was then first suspected of having murdered the Countess, the death by burning having up to tliis time been treated as an accidental occurrence. The body, which had been buried, was exhumed on the 11th of .August, 1848, i. e., fourteen months after death ; it was subjected to a special examination, and the Hessian Medical College, to whom the case was referred, came to the conclusion that 3U BURNING OF THE DEAD BODY. the Countess had not died from spontaneous combustion. The case was sub- sequently referred to Prof. Liebig and Bisehoff, of Giessen, and their report was issued in March, 1850, at which date the man Stauff was put on his trial. They found no difficulty in coming to the conclusion that a murder had been perpetrated, and the body wilfully burnt after death for the pur- pose of concealing the crime. There was some doubt whether the deceased had died from strangulation, or from violence to the head. Stauff was con- victed upon circumstantial evidence. He subsequently confessed that the Countess had entered her room as he was in the act of committing a robbery. A struggle took place, he seized her by the throat, strangled her, and after- wards placed the body in a chair, piling around it combustible articles of fur- niture. He set fire to these with the view of destroying the proofs of his crime. It will be observed that the tongue was found protruded, as it is in violent strangulation, and in its charred state it retained the position given to it by the act of murder. One of the difficulties in the case (as it was considered before the facts were known) was, that the body appeared to have been so much consumed, com- pared with the amount of combustibles near it; another point which excited notice was, that the clothes were not consumed beyond the margins of the burns on the body — a circumstance which has been hitherto regarded as a special character of spontaneous combustion. The dark greasy matter on the furniture and the empyrenmatic smell are also conditions, which, by this ease, are proved to be the results of homicidal attempts to conceal a foul murder, and they are not indications of spontaneous combustion. . (See, for a further report of this case by Dr. Ogston, Medioal Gazette, vol. xlvi. pp. 889 and 948.) Time required for the burning of a dead body. — It may be a medico-legal question, whether, on discovering a body thus burnt, it could be determined from its appearance how long a period it would require to produce the amount of destruction observed. An answer to such a question may appear necessary, in order to connect a person with the perpetration of a crime; but the question does not admit of a precise answer ; a conjecture mfiy be formed from the facts proved in each particular case. The human body contains a large proportion of water ; this gives to the soft structures a power of resist- ing combustion. At the same time there is a quantity of fat in the body, varying in different parts, but amounting to an average of about five per cent. This tends to increase its combustibility ; and this is still further increased if it be placed on any combustible articles — such as a rug or a deal floor. The nature of the dress will also make a difference. Under a strong and active flame, which might subsequently burn out before the discovery of the body, there would be a degree of destruction in half an hour which a more slow and smothered combustion would not effect in several hours. In the case of the Countess of Goerlitz, it was proved that she retired to her room between three and four o'clock in the afternoon ; the Count returned at seven o'clock, and knocked at the door of her anteroom, but receiving no answer, be again went out. Had the burning of the body then commenced he would have perceived it by the smell, or by the appearance of smoke. He returned again at nine o'clock, and during this second absence, covering an interval of two hours, a bright light had been seen at one of the windows, and a thick smoke issued from one of the chimneys. There is a little discrepancy as to the time, but taking the maximum, the amount of destruction described in this case (p. 313) must have occupied less than two hours, and probably not more than one hour. This question actually arose in lieg. v. Hatto (Aylesbury Lent Assizes, 1854). The deceased, a female, was found dead in her room, and her body much burnt. She was last known to be living at about a quarter past eight BURNS BY CORROSIVE LIQUIDS. 315 o'clock in the evening, and her body was found with fire still smouldering on the floor of the room at about a quarter past eleven o'clock. The only per- sons known to have been in the house were the prisoner and deceased. The prisoner pretended that he knew nothing of the circumstances attending her death, and endeavored to make it appear that robbers might have broken into the house, and committed the murder, at some period of the three hours during which he alleged that he was asleep in bed. For the prosecution, it was suggested, in order to exclude this hypothesis, which, however, was suffi- ciently excluded by other facts, that the act of murder, with the attendant burning, must have occupied the whole of the time intervening between the period at which deceased was last seen living, and the period at which her body was found. The medical gentleman who examined the deceased found that "both knees were consumed by fire, and the thighs also burnt to a cinder; the private parts also — leaving the shafts of the thigh-bones exposed and charred for several inches. Between the thighs and feet, the floor underneath was burnt away, and the leg-bones had fallen through the floor, leaving the feet nnburnt on the floor." He expressed an opinion that it would take from two and a half to three hours in order to consume the body to this degree ; thus covering the whole interval during which deceased and prisoner were in the house together. It should be stated, that the clothes of the deceased were much burnt, and that beneath the body there was a hempen mat, so combus- tible owing to the melted human fat with which it was impregnated, that when ignited it burnt like a link. The guilt of the prisoner did not depend on an answer to this question ; that was made sufficiently clear from other circum- stances proved in the case, which were quite inconsistent with his innocence. It is obvious that an opinion on such a subject must be in all cases conjec- tural, since the effects, cateris paribus, depend as much on the intensity as on the duration of the heat. It was indeed just as probable, medically speak- ing, that, with a large body of flame, the amount of injury met with might have been produced in an hour as in three hours ; and if the question were proposed to any number of medical men in entire ignorance of the bearing which their answers would have on the case, .there would be probably no two answers alike. The confession of the prisoner, subsequently made, shows that the burning observed must have taken place in less than two hours, and pro- bably within an hour and a half The Groerlitz case and some others prove that a short period may suffice for a large amount of destruction, and that, judging by what remains, the combustible materials consumed appear to bear only a small proportion to the parts of the body burnt. Burns by Corrosive Liquids. Among the cases in which medical evidence is sometimes required, are those of throwing sulphuric acid or other corrosive liquids on the person. This crime was at one time prevalent, and there was no adequate punishment for it. On one occasion, the prisoner escaped the charge of felony, because it could not be considered, in law, that sulphuric acid was capable of pro- ducing a, wound — the man having been indicted for wounding! This case clearly showed a strong necessity for some legal definition of a wound, as well as the uncertainty of medical opinions ; for while one surgeon considered that the injury produced was a wound, another thought that it was not. The judges decided that it was not a wound within the meaning of the statute. (7%e King v. Murrow, Liverpool Autumn Assizes, 1835.) The Act 1 Vict. c. 85, s. 5, while it punishes the offence, omits all reference to a definition of the word wound. The nature of the liquid thrown is merely defined in general terms to be "any corrosive fluid or other destructive matter" — a point which will require medical evidence for its elucidation. In common language, and 316 DEATH FROM COEROSIVE LIQUIDS. according to the statute, the injury thus produced is called a burn ; but it is wholly different in its origin, as well as in its progress. I do not know that there has been a single instance in which such an injury has directly destroyed life; but great deformity and actual blindness have' resulted. A medical man is sometimes required to distinguish these injuries from burns and scalds : this may be easily done in the first instance, by the appearance of the part injured, as well as by the description of the first symptoms. The stain is brown when sulphuric acid has been used, and yellow when nitric or muriatic acid has been employed. The eschar is soft, and not dry as in a burn from a heated solid. The skin touched by a concentrated acid is destroyed and sloughs away, exactly to the extent of the part to which the corrosive liquid was applied, leaving a suppurating and granulating surface. There is no capillary congestion or redness of the cutis around the injury as in a burn. The period of recovery will depend on the extent of the injury. Although a person may not die from the direct effects of the acid, yet in certain irritable constitutions the inflammation which follows in deep-seated parts may prove fatal. In infants, or delicate nervous females, an extensive injury thus pro- duced may readily destroy life. In the case of Miss Oasliin, for whom an escharotic liniment was prescribed by a quack, there was no doubt that death was caused by the great local mischief produced by the application. The nature of the acid may be determined by applying wetted linen to the part when the injury is recent, and examining the liquid thus absorbed. In gene- ral, however, evidence is readily obtained by examining the spots or stains left on articles of clothing or furniture. Sulphuric acid is most commonly used : but in a case which occurred at Guy's Hospital, nitric acid had been thrown at the person, and had led to the destruction of the sight of one eye. The caustic alkalies might also be used under these circumstances, as well as numerous other liquids, on which the only medical opinion required would be, whether the liquid employed should or should not be considered as cor- rosive or destructive matter. To constitute a felony, it is necessary that the person should have sustained, from the act of throwing, some grievous bodily harm. A damage to clothes only does not fall within the provisions of the statute. Unless vital reaction has taken place, there are no means of distin- guishing the effects of a corrosive liquid on the living, from those produced on the dead body. i^Ann. d^Hyg., 1859, vol. i. p. 396.) The mineral acids are sometimes used in other ways for the destruction of life. In June, 1883, a man poured a quantity of strong nitric acid into the ear of his wife while she was lying asleep. She awoke suddenly with a vio- lent pain in the ear, which continued for three days, whereby she became weak and exhausted. Soon afterwards there was copious bleeding, and a portion of membrane escaped. She lost the use of her right arm, and became com- pletely deaf Suppuration took place from the ear, and blood escaped daily. She gradually sank, and died six weeks after the injury, the right half of the body being convulsed before death. On inspection, a portion of the external ear was wanting, and the ear-passage was much wider than natural. The brain, near the petrous portion of the temporal bone was softened, and the bone itself carious. The injury had led to death indirectly, by producing disease of the brain. {Medical Gazette, vol. xvii. p. 89.) In a case tried at Aberdeen, a woman poured oil of vitriol down the throat of her husband while he was lying asleep with his mouth open. She was tried and convicted of the murder. In another case at Aberdeen, a woman killed her husband by pouring a solution of corrosive sublimate down his throat while asleep. These, however, were treated as cases of poisoning, as death did not depend on the local or- external mischief produced by the cor- rosive agent employed. INFANTICIDE — NATURE OT THE CRIME. 311 INFANTICIDE. CHAPTER XXXIX. NATURE OF THE CRIME— ^THE SAME EVIDENCE REQUIRED AS IN OTHER CASES OP MURDER — PROOF OF LIFE DEMANDED — BODY OP THE CHILD NOT DISCOVERED — MEDICAL EVIDENCE AT INQUESTS — AGE OR MATURITY OP THE CHILD — VIABILITY NOT REQUIRED TO BE PROVED — CHARACTERS FROM THE SIXTH TO THE NINTH MONTH — SIGNS OF MATURITY — ABNORMAL DEVIATIONS — POSITION OF THE UMBILICAL OPENING — GENERAL CONCLUSIONS — RULES FOR INSPECTING THE BODY. Nature of the crime. — By infanticide we are to understand, in medical juris- prudence, the murder of a new-born cliild. Tiie 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 terra applied to the murder of a new-horn child, it is not thereby implied that the wilful killing should take place within any particular period after birth. Provided the child be actually born, and its body entirely in the world, it matters not whe- ther it has been destroyed within a few minutes, or not until several days after its birth. In the greater number of cases of infanticide, however, we find that the murder is commonly perpetrated within a few hours after the birth of the child. Although the law of England treats a case of infanticide as one of ordinary murder, yet there is a particular difference in the medical evidence required to establish the murder of a new-born child. It is well known that, in the course of nature, many children come into the world dead, and that others die from various causes soon after birth. In the latter, the signs of their having lived are frequently indi^inct. Hence, to provide against the danger of erroneous accusations, the law humanely presumes that every new-born child has been born dead, until the contrary appears from medical or other evidence. The onus of proof is thereby thrown on the prosecution ; and no evidence imputing murder can be received, unless it be made certain, by medical or other facts, that the child survived its birth, and was actually living when the violence was offered to it. Hence, there is a most difficult duty cast upon a medical witness on these occasions. Body of the child not discovered. — In cases of child-murder, medical evi- dence is commonly founded upon an examination of the body of the child ; but it must be borne in mind that a woman may be found guilty of the crime, although the body of the child be not discovered. It may have been de- stroyed by burning, or by being otherwise disposed of, and a medical witness may have only a few calcined bones to examine. {Ann. d^Hyg., 1845, vol. ii. p. 129.) In these cases of the non-production of the body, good legal evi- dence of the murder would, however, be demanded ; and this evidence should be such as would satisfactorily establish a matter of fact before a jury. The production of the body of a child is, therefore, no more necessary to convic- tion than in any other case of murder. A- woman has been tried for the 318 UTERINE AGE OR MATURITY OF THE CHILD. murder of her child, the body of which was not discovered. It must not be supposed from this statement, that the fact of the murder is to depend upon the fact of disappearance. There may be clear evidence of a child having been murdered, and its body so disposed of, at or immediately after the act of murder, as to render the production of the body impossible; as where a woman kills her child, and is seen to consume its body by fire, or to throw it at once into the sea or into a deep lake or pond. In the case of the Lemoines, mother and daughter, tried before the French courts in December, 1859, the evidence went to show that the elder prisoner (the mother) burnt the body of a child of which her daughter had been secretly delivered. Some bones of a child were recovered, and among others the frontal bone. The medical evidence was to the effect that the bones were those of a child which had reached about the seventh or eighth month. Upon this corroboration, the jury convicted the elder prisoner, and the court sentenced her to twenty years' imprisonment. In a case tried in Edinburgh, in 1841, there were strong; grounds for believing that the woman had disposed of the body of her child by throwing it to some half-starved pigs, which had eaten it. Medical evidence at inquests. — In most instances, however, the body of the child is found, an inquest is held, and medical evidence is demanded. In giving evidence at a coroner's inquest on a case of infanticide, as much care should be taken by a practitioner as if he were delivering it before a judge at the assizes. Some witnesses are disposed to treat an inquest with indiffer- ence, and to be careless in their evidence, thinking probably that, should the case come to trial, they could prepare themselves, and amend any statements which, from subsequent reflection, might appear to have been hastily made before a coroner. But it ought to be known that the depositions taken by this officer are, at the trial, placed in the hands of the judge as well as of the prisoner's counsel ; and should a witness deviate in his evidence at the assizes from that which he gave at the inquest, or should he attempt to amend or explain any of the statements then made, so that they might, by the inge-" nuity of a barrister, be represented as having a new bearing on the prisoner's case, he would expose himself not merely to a severe cross-examination, but probably to the censure of the court. If medical men were to reflect that in delivering their opinions before a coroner and jury, they are, in many in- stances, virtually delivering them before a superior court, it is certain that many unfortunate exposures would be easily avoided. Uterine Age or Maturity of the Child. 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 utero. The reason for making this inquiry is, that the chances of natural death, In all new-borif children, are great in proportion to their- immaturity : and that supposing them to have survived birth, the signs of their having respired are commonly obscure. 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 ges- tation ; yet charges of murder might be extended to the wilful destruction of children at the seventh month or under, provided the evidence of life after birth was clear and satisfactory. Proof of viability not required. — The English law does not act on the principle that a child, in order to become the subject of a charge of murder, should be born viable, i. e., with a capacity to live. It is observed by Mr. Chitty, although no authority is quoted for the statement, that " the object of the law is to prevent injuries to infants having capacity to maintain a separate existence;" and he further suggests that such a capacity should be INFANTICIDE — VIABILITY OF THE CHILD. 319 proved, in order to complete the offence of infanticide. {Med. Jur., vol. i. p. 411.) This argument, carried to its fnll extent, would render it no offence to put to death all persons afllicted with any mortal disease. I have been unable to find, in the numerous reported trials for infanticide, any ground for this statement. The capacity of a child continuing to live has never been put as a medical question in a case of alleged child-murder ; and it is pretty certain, that if a want of capacity to live were actually proved, this would not render the party destroying it irresponsible for the offence. Children may be born alive at the sixth or seventh month ; but because they are much less likely to survive than those born at the eighth or ninth month, this is not a ground of exculpation for any person who may wilfully destroy them. The real question, as we shall presently see, does not refer to the period of gesta- tion at which a child may be born, but to the fact of its being living and entirely horn when the murderous violence is offered to it. The French law, although it requires in some cases proof of viability in relation to the rights of inheritance, demands only proof of life after birth in reference to a charge of infanticide. (Briand, Man. Complet de Med. Leg., 201.) Although the doctrine of viability is not recognized in English jurispru- dence, yet in a case which occurred in October, 1836, a coroner refused to bold an inquest on the body of a child, because it had not reached an age (seven months) at which children are commonly born alive 1 In this case there was probably no harm done; but when we consider — 1st, the great difficulty of determining the exact age of a child from the characters found on its body ; and 2d, that many children born under the seventh month have not only been born alive, but have lived to adult age, the acting on a principle of this kind would be likely to give rise to dangerous abuses. It is impossible to admit that children are to be destroyed with impunity because they happen to be born under the seventh month, or that a child should be assumed to have been born dead and any inquiry into the cause of death dispensed with, unless it can be medically established that it has passed the seventh month of ges- tation. According to one medico-legal authority, if it can be proved that the child which is the subject of investigation has not attained this age (the seventh month), no charge of infanticide can or ought to be entertained. Are we to understand by this, that children proved to have been born living before the seventh month, may be wilfully destroyed, and the law take no cognizance of the matter ? If this be not the meaning, the statement amounts to nothing, because whether the child has reached the seventh, eighth, or ninth month, life and live birth must still be proved, before the question of murder can be entertained. I have known an instance of a child born between the sixth and seventh months living a fortnight; and many similar cases are recorded. On the doctrine above laid down, the deliberate destruction of such children, although actually living, ought not to be considered or treated as murder 1 It is satisfactory to know that such a principle as this is not recognized by the law of England. In the case of Reg. v. West (Nottingham Lent Assizes, 1848), a midwife was tried on a charge of causing the death of a child under the seventh month of uterine life (in the perpetration of abortion), not by direct violence applied to its body, but merely by leading to its premature birth. This case proves, therefore, that a case of infanticide may be fairly entertained with respect to children under the seventh month. The female in this instance was alleged to have been between the fifth and sixth month of pregnancy. The proof of this fact did not, however, prevent an indict- ment for murder, or a full investigation of the facts of the case. We also learn from it, contrary to the suggestions of Mr. Chitty {supra), that the viability of a child is not by the English law required to be proved on an indictment for child-murder. This child was certainly from mere immaturity 320 CHAEACTERS FEOM THE SIXTH TO THE NINTH MONTH. incapable of maiutaining a separate existence, and it was therefore not viable; but the judge who tried the case, in answer to an objection taken by prisoner's counsel, said that if the child was proved to hare died under the circumstances alleged for the prosecution, it would be murder. Characters from the sixth to the ninth month. — The following are the characters whereby we 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 com- prise all cases of child-murder. Between the sixth and seventh : — 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 (membranse pupillares). The skin is of a reddish color, and the nails are slightly formed ; the hair loses the silvery lustre which it previously pos- sessed, 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 psose muscles immediately below the kidneys. Between the seventh and the eighth months : — The child now measures between thirteen and fourteen inches in length, and weighs from three to four pounds. The skin is thick, of a more decidedly fibrous struc- ture, and covered with a white unctuous matter, which now for the first time appears. 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 becomes long, thick, and colored. Ossification advances throughout the skeleton. Val- vula3 conniventes appear in the small intestines, and meconium is found oc- cupying the caecum and colon. The testicles in the male are considered about this period to commence their descent — or rather, the child's head being downwards, their ascent towards the scrotum. The time at which these organs change their situation is probably subject to variation. Ac- cording to J. 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 new-born male child is of considerable importance in relation to maturity, and it may have an influence on questions of legitimacy as well as of child-murder. Mr. Curling thus describes their change of position : — At different periods between the fifth and sixth months of foetal existence, or sometimes 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. (Diseases of the Testis, 2d ed. p. It.) Its absence from the scrotum does not necessarily in- dicate that the child is immature, because the organ sometimes does not reach the scrotum until after birth. Between the eighth and ninth months the child is from fifteen to sixteen inches in length, and weighs from four to five pounds. The eyelids are do longer adherent, and the membranae pupillares will have disappeared. The quantity of fat deposited beneath the skin is increased, and the hair and nails are well developed. The surface of the brain is grooved or fissured, but presents no regular convolutions : and the cineritious matter is not yet ap- parent. The meconium occupies almost entirely the large intestines ; aud the gall-bladder contains some traces of a liquid resembling bile. The tes- ticles in the male may be found occupying some part of the inguinal canal, INFANTICIDE — SIGNS OF MATURITY. 321 01' they may be in the scrotum. The left testicle is sometimes in the scrotum, while the right is situated about the external ring. Signs of maturity. — At the ninth month the average length of the body is about eighteen' inches, and its weight about six pounds, or between that and 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. Mr. Owens has recorded a case in which the child at delivery measured twenty-four inches, and weighed seventeen pounds twelve ounces {Lancet, December, 1838), and Dr. Meadows has reported another in which the child measured after death thirty-two inches, and weighed eighteen pounds two ounces. The child survived four hours. {Med. Times and Gaz., Aug. 4, 1860.) In a case which I was required to examine in June, 1842, the child, a male, measured twenty-two inches, and weighed twelve pounds and a half. (For some practical remarks on the subject, by Dr. Ellsasser, see Henkeh Zeitschrift, 1841, vol. ii. p. 235.) 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 con- siderable 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 ends of the fingers ; — an ap- pearance, however, which may be sometimes simulated in a premature child, by the shrinking of the skin after death. The testicles in the male are gene- rally within the scrotum. Ossification will be found to have advanced con- siderably throughout the skeleton. (See, in relation to the progress of ossi- fication, a paper by M. Ollivier, Ann. d'Hyg., 1842, 248.) The surface of the brain presents convolutions, and the cineritious 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 relative position of the point at which the umhilical cord is attached to the abdomen, has been considered by some medical jurists to furnish evi- dence of the degree of maturity. Chaussier thought that in a mature child, at the ninth month, the point of attachment of the cord exactly corresponded to the centre of the length of its body. Later observations, however, have shown that this is not quite correct. Out of five hundred children examined by M. Moreau, at the Maternite, in Paris, the nmbjlical aperture corresponded to the centre of the body in four cases only. In the majority of these cases, the point of insertion was eight or nine lines below the centre. Among many cases of mature children which I have had an opportunity of examin- ing, the umbilical aperture has generally been situated from a quarter to half an inch below the centre of the body. {Guyh Hosp. Rep., April, 1842.) M. Moreau found, on the other hand, that in some children, born about the sixth or eighth month, the cord was attached at the middle point of the length. {Lane. Franc, 1837.) On the whole, it will be perceived that no value can be attached to the situation of the umbilical opening, as a sign of maturity or immaturity. 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, it is well known, open to numerous exceptions ; for some children at the ninth month are but little more developed than others at the seventh ; although the converse of this proposition is not true — i. e., we do not find that children of the seventh month have undergone such prema- ture development as to be mistaken for children at the ninth month. Twins are generally less developed than single children ; — ^the average weight of a twin child is not more than five pounds, and very often below this. The 21 322 CONCLUSIONS RESPECTING THE SIGNS OF MATURITY. 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, which presents the greater number of the cha- racters above described, and which are met with in children at or about the ninth month of gestation. 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 its full period, then the presumption is that it was born alive. Conclusions. — The following may be taken as a summary of the principal facts upon which oar opinion respecting the uterine age of a child may be based : — 1. At six months. — Length, from nine to ten inches ; weight, one to two pounds ; eyelids agglutinated ; pupils closed by membranes pupillares ; testi- cles not apparent in the male. 2. At seven months. — Length, from thirteen to fourteen inches ; weight, three to four pounds; eyelids not adherent; membranse pupillares disappear- ing ; nails imperfectly'developed ; testicles not apparent in the male. 3. At eight months. — Length, from fourteen to sixteen inches ; weight, from four to five pounds ; membranes pupillares absent ; nails perfectly de- veloped, and reaching to the ends of the fingers ; testicles in the inguinal canal. 4. At nine months. — Length, from sixteen to twenty-one inches ; weight, from five to nine pounds ; membranes pupillares absent ; head well covered with fine hair ; testicles in the scrotum ; skin pale ; features perfect — these and the body are well developed even when the length and weight of the child are less than those above assigned. 5. The point of attachment of the umbilical cord, with respect to the length of the body, affords no certain evidence of the degree of maturity. Inspection of the body. — The questions which a medical jurist has to solve, in examining the body of a new-born child, are — 1. 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 — 1. The length (measured from the vertex to the sole of the foot) and weight of the body should be taken ; 2. The presence or absence of external fcetal peculiarities noticed ; 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 instrument or weapon by which they were probably produced ; 5. Whether the umbilical cord has been cut and tied, or lacerated ; the appearance of the divided ves- sels, 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, arm- pits, or neck — the presence of this substance proves that the child has not ijeen washed or attended to ; 7. It will be necessary to state whether there are about the body any marks of putrefaction, indicated by a separation of the cuticle, change of color in the skin, or offensive odor. It is obvious, that unless these circumstances be noticed before the inspection is commenced they may be entirely lost as evidence. Notes should be made on the spot, and the original retained, even if copies be subsequently made. EVIDENCE OE LIFE BEFORE RESPIRATION. 323 CHAPTER XL. ON THE PROOFS OF A CHILD HAVING LIVED AT ITS BIRTH — EVIDENCE OF LIFE BEFORE RESPIRATION — SIGNS OF PUTREFACTION IN CTERO — EVIDENCE PROM MARKS OP VIOLENCE — SUMMARY — EVIDENCE OF LIFE AFTER RESPIRATION — INSPECTION OF THE BODY — COLOR, VOLUME, CONSISTENCY, AND ABSOLUTE WEIGHT OF THE LUNGS — STATIC TEST — WEIGHT INCREASED BY RESPIRATION — TEST OP PLOUCQUET — BLOOD IN THE PULMONARY VESSELS — RELATIVE PRO- PORTION OP PAT IN THE LUNGS — SPECIFIC GRAVITY OP THE LUNGS — GENERAL CONCLUSIONS. On the proof s of a child having lived at its birth. — The question whether a child was or was not horn alive, is of the greatest importance in a case of alleged child-mnrder; 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 presump- tions of guilt, the proof fails on this point only, it must be obvious that this question specially claims the attention of a medical jurist. The medical evidence of % child having been alive, when violence was offered to it at its birth or afterwards, may be divided into two parts : 1, that which is obtain- able before the act of respiration is performed ; and 2, that which is obtain- able afterwards. At present it will be proper to confine our attention to the question, whether the child was alive when it was maltreated — the fact of its having been born alive will be a matter for future consideration. These two questions have been frequently but improperly associated, thus rendering the subject confused ; but it must be so obvious as scarcely to require stating, that violence of a murderous kind may be offered to a living child before it is entirely born ; and that owing to this violence it may come into the world dead. Evidence of Life before Respiration. It was formerly supposed, that if the lungs contained no air, the child could not have respired, and that it must have been born dead. But neither of these views is correct : — children have been known to respire faintly, 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 respiration has not been performed, or that the child has not lived. (G. H. ^«/i., April, 1842.) The restoration of many children apparently born dead is a clear proof that many are born living who might be pronounced dead, simply because breathing and life have been considered synonymous terms. (See on this subject a paper by Dr. Marklin, Gasper''s Vierteljahrschr., 1859, vol. ii. p. 26 ; also an article in the same volume " Leben ohne athmen," p. 297.) That our law authorities will admit evi- dence 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, Grim. Plead., 367), as also from the charge of Coltman, J. , in the case of Rex v. Sellis (Norf. Spr. Circ, 1837). In this instance it was alleged that the prisoner 324 EVIDENCE FROM MAKKS OF VIOLENCE. had murdered her child by cutting off its head. The judge directed the jury, that if the child were 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 satisfactorily show that the child has lived, and make up for the proof commonly derived from the state of the lungs. It will be first incumbent on a medical practi- tioner to prove that the child under examination has recently died, or in other words, that there are good grounds for believing it to have been recently living. Hence, if the body be highly putrefied, either from the child having died in the uterus some time before birth, or from its having been born and its body not discovered until putrefaction had far advanced both internally and externally, the case is utterly hopeless. The medical witness will in general be compelled to abandon 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 their foetal condition. Signs of putrefaction in utero. — The phenomena of putrefaction in air re- quire no notice in this place; but the changes which ensue when a child dies and is retained within the uterus, may be briefly adverted to, because they may sometimes form a subject for judicial inquiry. According to Devergie, when a child dies in utero, putrefaction takes place as rapidly as in the open air {Med. Leg., i. 526) ; but this is doubtful. In an advanced state of uterine putrefaction, the body of the child is so flaccid, that when placed on a table it becomes almost flattened by the mere gravitation of its parts. The skin is of a reddish-brown color, not green as in a putrefied body exposed to air. The cuticle covering the feet and hands is white, and sometimes raised in blisters — the cellular membrane is filled with a reddish-colored serum, the bones are movable, and readily detached from the soft parts. In the opinion of Devergie, the principal difference between uterine and atmospheric putre- faction in the body of a uew-born child, is seen in the color assumed by the skin : — but it must be remembered, that should the child remain exposed to the air after its expulsion, the skin may acquire the color observed in cases of atmospheric putrefaction. The changes which have just been described are such as we may expect to find when the child has been retained in utero eight or ten days after its death. When it has remained for some weeks in the uterine cavity, the body has occasionally been found saponified, or even incrusted with phosphate of lime. If in any case we are able to state dis- tinctly that the body of a child has undergone uterine, and not atmospheric, putrefaction, it is clear that it could not have come into the world alive. Under ordinary putrefaction in air, the child may have been really brought into the world living, and the process may have destroyed every proof of that fact. Let us suppose that the child died in utero from forty-eight to twenty-four hours before it was born ; if it be soon afterwards examined, there will be no marks of putrefaction about it, and the appearances will closely resemble those met with in the body of a child that has been born alive, and died without respiring ; or of one that may not have been born alive, but have died in the act of birth. It will be impossible to say, in such a case, whether the child came into the world living or dead. Evidence from marks of violence. — It has been proposed to seek for evi- dence of life, under these circumstances, by observing the characters pre- sented 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 satisfactory proofs of the crime are occasionally obtained. On the other hand, the body of a still-born child, INFANTICIDE — EVIDENCE BEFORE RESPIRATION. 325 dead from natural causes, is often covered with lividities and ecchymoses : — the foetal blood does not coagulate with the same firmness as in the adult ; hence the evidence derivable from the extent, situation, and characters of marks of violence, is generally of too vague and uncertain a kind to allow of the expression of a medical opinion that the child was living when the vio- lence was offered to it. The characters which have been already described as peculiar to wounds and contusions inflicted during life, may be met with in a child, whether it has breathed, or died without respiring. 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 circulation in the child, or after the cessa- tion of circulation only — if the act of respiration has not been performed. 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 the living. There would be no ecchymosis and no effused coagula of blood. These marks, when they exist, although they may esta- blisli that a child was either living or but recently dead at the time they were inflicted, can never show that it was born 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 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 actually live birth, might totally fail. Summary. — 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 respiring — and legally its destruction during 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. 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 water-bath, or an accomplice covers the mouth of an infant in the act of birth, or imme- diately 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 born dead. Indeed, it is apparent that the process could not be established, owing to the criminal means actually employed to prevent it. Whether a jury would convict upon such evidence is doubtful ; but this is of no importance to the witness : — his statements ought always to be made ac- cording to correct and well-ascertained principles, and not for the purpose of procuring either the conviction or acquittal of parties accused of offences against the law. 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 pro- nounce that the child was born dead. If the lungs sank in water, the pre- sence of marks of violence on the body would be considered as furnishing no evidence : — for the sinking of the lungs would be taken as positive evidence of still-birth, an inference upon which some remarks will be made in speaking of the hydrostatic test. The following case was the subject of a criminal charge at Havre, in 1828: — A woman was delivered of twins. So soon as the first child was born, but not before it had breathed, she killed it by frac- turing its skull with a wooden shoe.. In a few minutes afterwards the second child was born, but scarcely had its head presented, when she seized it and fractured its skull in the same manner. This double crime was soon disco- 326 INFANTICIDE — PEOOFS OF LIFE AFTER BESPIRATION. vered. On an examination of the bodies of both children, the same degree of violence was found, presenting in each case precisely similar characters. There could be no doubt, from the appearance of the injuries, that they must have been inflicted on both children at a time when the circulation was soing on. In one child, however, it was proved that respiration had taken place; in the other that it had not. In the latter case many practitioners would at once have affirmed that the child had not lived, because there was no proof that it had respired ; and they would have proceeded to draw the inference that this could not have been a case of infanticide. Dr. Bellot, however, stated that, although the child had not breathed, he had no doubt it had been horn alive, and that it would have lived to respire, but for the violence inflicted. This opinion was chiefly founded upon the similarity in the cha- racters presented by the marks of violence in the two cases. {AnnaUs d'Hy- giine, 1832, vol. ii. p. 199.) See further remarks upon this subject, by M. Ollivier, Ann. d^Hyg., 1843, vol. i. p. 149 ; also by M. Devergie, MU. L'eg., 1837, vol. i. p. 400. The great question involved in this, and in all similar cases, is the follow- ing: Does the law regard the wilful prevention of respiration as murder? There cannot be the slightest medical doubt that living children are occa- sionally thus destroyed in the act of birth : they die, not from the actual infliction of violence, but because, either through accident or design, the performance of that act which is necessary to maintain existence when the child is born is prevented. Such a case has not yet been decided, although from the dicta of our judges, it would probably involve a charge of murder. In a case published by Dr. Wharrie, a pregnant woman, thinking she was about to have a motion, sat on an earthen pitcher, two feet in depth, which happened to be full of water. She was there delivered of a child, which fell into the water, and was thus prevented from breathing. The child was full- grown, and its body was free from putrescency. It weighed six pounds, and measured twenty inches. There were no external marks of violence, and tbe cord had been tied. The lungs weighed two and a half ounces ; they were of a liver color, contained no air, and sank in water. The medical opinion was, that from the size and general appearance of the child, and the state of the parts discovered on dissection, it was mature — that it had never breathed, and life might have been either wilfully or accidentally -destroyed. The ex- aminers wisely declined giving the usual opinion from the sinking of the lungs; i. e., that the child had been born dead. The woman was not prosecuted, probably on the assumption that the death of the child might have been ac- cidental. As Dr. Wharrie truly observes, there was no medical proof that the child was born alive ; although there was a strong moral presumption that life was extinguished after birth. {Sd. Monthly Jour., Oct. 1845, p. 796.) Dr. Bayard mentions a case, in which a female, under somewhat similar circumstances, was convicted of the murder of her iiifant, and sentenced to the galleys for five years. In this case there was no evidence of respiration, but the woman admitted that she fractured the skull of the child, with the intention of destroying it, thinking that she perceived a motion in its legs after it was born. (Ann. d'Hgg., 184'7, vol. i. p. 455.) One physician thought that the child was living when the blows were inflicted ; two others that it was dead. In Dr. Bayard's opinion the absence of the signs of respiration must be taken as a negative circumstance in favor of the accused. Evidence op 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 INFANTICIDE — EXAMINATION OF THE LUNGS. 327 physical changes in the organs of a child, which result from the establishment of this process take place in the lungs immediately, but 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 a poisoned subject would be a bar to our seeking for the proofs of poison in every 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 new-born children, we should abandon all evidence of this description, 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. — Some have pretended that the fact of respira- tion having been performed, would be indicated by the external configuration of the chest. Thus it is said, before respiration the chest is flattened, while after that process it is arched in front. The diameters of the cavity have also been measured, and certain comparisons instituted (Daniel), but these experiments have been attended with no practical results, and have long been abandoned by medical jurists. Admitting that such a visible change of form is occasionally produced by respiration, it is obvious that in these cases, ex- periments on the lungs may be readily made ; and on the results of these, and not upon minute changes in the capacity of the chest, would a medical opinion be based. The cavity of the chest may be conveniently laid open by carrying incisions from below the clavicles downwards on each side from about half the length of the ribs backwards. The diaphragm may be separated from the cartilages without opening the abdomen ; the ribs sawn or cut through, and the flap formed by the anterior parietes of the chest turned upwards. If the child has not respired, the following appearances will be seen. The thy- mus gland, as large as the heart, occupies the upper and middle portions of the cavity; the heart in its membrane (pericardium) is situated in the lower and middle portion, 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 — at others of a deep livid color : but there is no perceptible difference in this organ in new-born children, before or after the performance of respiration. On the other hand, when the child has fully respired, the most striking differences will be observed in the color and pro- minence of the lungs. They are of a light red hue, project forwards — appear to fill the 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 he fully established, especially in those 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. 328 COLOK, VOLUME, AND CONSISTENCY OP THE LUNGS. not according to the length of time which a child has lived, but according to the perfection with which the process of respiration has been performed. It will be seen hereafter, that although, as a general rule, the lungs are more perfectly filled with air in proportion to the time during which a child sur- vives its birth, yet this is open to numerous exceptions. It will next be necessary to give particular attention to certain other physical characters presented by the lungs. Color of the lungs. — The color of the lungs before respiration is of a blaish red, or deep violet, but it is subject to slight variation. Some medical jurists have compared it to the color of the spleen. It is important to remark, that a very short exposure to air will materially alter the color, so that it should be observed and recorded immediately on opening the chest. After respira- tion, 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 mot- tled, generally about the anterior surfaces and margins, the patches of light red being intermixed with the livid foetal hue, and being slightly raised, as if by distension, above the general surface of the organs. The light red tint changes, after a short exposure to air, to a bright scarlet. This change in the color of the lungs is not a necessary, nor is it an invariable consequence of a child having lived after its birth. I have known a child to live twenty- four hours respiring feebly, and on examining the body, the color of the lungs was identical with that of the organs in the foetal state. The change of color is then a usual, but by no means a necessary consequence of the enjoyment of life : so that the retention of the foetal color does not furnish positive evi- dence of still-birth. Again, the circumstance of the lungs having a light red color is not an infallible criterion of the child having lived and breathed ; for the artificial introduction of air by a tracheal tube, or otherwise, in the attempt to resuscitate a still-born child, is attended with the same physical change. In the course of numerous experiments, purposely made, I have found no appreciable difference. Bernt says, that artificial inflation will not produce a scarlet red color in the organs, and therefore that this is a criterion of re- spiration. {Ed. Med. and Surg. Journ., vol. xxvi. p. 367.) I have not only observed this color to be absent after respiration, but have actually produced it by artificial inflation in the lungs of a dead child. 2. Volume of the lungs. — The difference in the relative situation of the lungs before and after respiration, has been already described. This difference de- pends entirely upon the increiased volume or dilatation of the organs arising from the introduction of air. Before respiration, the lungs are in general scarcely visible, unless forcibly drawn forwards in the chest. When respira- tion has been perfectly accomplished, the volume is so much increased, that the bag of the heart (pericardium) is almost concealed by them. Respiration must, however, have been very perfectly performed in order that this condi- tion should exist to the full extent described ; but I have known the lungs to acquire a considerable volume, in a healthy and vigorous child, from only two or three respirations. The child was destroyed by craniotomy, and died before it was entirely delivered. In other instances, a child may live for one or two days, and the volume of the organs be but little altered. Schmitt has remarked, that the lungs have sometimes a considerable volume before respi- ration. - I have met with this in more than one instance ; but this condition will probably be found in general to depend on disease. As the altered volume of the healthy lungs depends on the introduction of air, the effect is the same, whether the air be derived from respiration, from artificial inflation, or generated by putrefaction. Other circumstances must, therefore, be con- sidered, before we draw an inference from this physical change. 3. Consistency of the lungs. — The lungs, before respiration, feel like the liver or any other of the soft organs of the body. They are firm under the ABSOLUTE WEIGHT OF THE LUNGS. 329 finger, but their substance may be lacerated by violent compression. After respiraiion has been fully performed, there is a distinct sensation of what is termed crepitus on compressing them — i. e., air is felt within thera. This condition of the organs must, of course, depend on the degree to which respi- ration has been carried. The lungs of children that have lived for a consi- derable time after birth, will sometimes give no feeling of crepitation under the finger. Generally speaking, lungs of this kind present the other foetal characters : thus, they are small and of a livid color. There are, however, cases in which the lungs may have the light-red color of respiration, and be actually much dilated in appearance, yet no feeling of crepitus will be per- ceptible on pressure. This character, therefore, is by no means a necessary accompaniment of the other two. Crepitation furnishes a presumptive evi- dence of respiration ; but it may be equally met with in lungs that are putre- fied, or which have received air by artificial inflation. The characters here described are seldom found in the lungs of children that have been born pre- maturely, although these children may have lived some time after birth. They depend on respiration ; and, in the exceptional cases referred to, this process is only slowly established. 4. Absolute weight of the lungs. The static test. — It is generally admitted by medical jurists, that the 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 absolute weight of the lungs in an unknown case, compared with certain 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 dis- section, from the heart and thymus gland, and removed with the trachea 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 in grains. In taking this weight it does not appear necessary to make any distinction founded on the sex of the child, or on the difference of weight in the two lungs ; the only exception would be, perhaps, in relation to twin children imperfectly deve- loped. The average weight before respiration, derived from nine cases, was found to be 649 grains. According to Dr. Traill, the weight varies from 430 to 600 grains. It is of importance, in taking the weight of these organs, to be certain that the child is at or near maturity, and that it is of or about the average size and weight : 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 be immature, or unusually large, the lungs will weigh either less or more than the average. The average weight of the lungs after respi- ration, derived from three cases, was 921 grains ; but in making an estimate of this kind, much will depend 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 per- formed, that the lungs varied but little in weight from the average before respiration. (G. If. Hep., No. V.) The truth is, we cannot compare the lungs of children, as to weight, according to the time which they may have survived birth, but rather according to the degree to which the lungs have been penetrated by air. In one instance of alleged infanticide, where a child was probably killed soon after birth, the lungs weighed 1000 grains. In another instance, where the child had certainly lived eight or nine days, the lungs weighed only 861 grains. In the first case, respiration had been per- fectly performed ; in the second, imperfectly. Hence, to say that the lungs weigh so much after respiration, amounts to nothing, unless we can estimate, by a sight of the organs, its degree ; and any calculation founded upon such 330 WEIGHT OF THE LUNGS. dissimilar cases, must unavoidably lead to error. This increase of weight after birth is commonly ascribed to the altered course of the blood under the establishment of the respiratory process, as well as to the fact that more blood circulates through the lungs after than before respiration. Practically, this view is confirmed by the contraction of the ductus arteriosus, and the simul- taneous enlargement of the pulmonary arteries ; changes which have been occasionally observed when the child had survived its birth for only a very short period. As these normal changes in the duct depend on the establish- ment of respiration, so we cannot expect to find them when the process has been imperfectly performed, although the child may have lived several days. Weight of the lungs increased by respiration. — It appears to me that the general opinion on this subject is correct, namely, that the healthy lungs of mature new-born children become heavier after respiration, and according to its degree ; and where a deviation from this rule is observed, it may pro- bably be explained by the circumstance that the lungs of an immature have been compared with those of a mature child, 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. In this respect the extensive tables drawn up by Lecieux are liable to lead to erroneous inferences relative to the effect of respiration on the absolute weight of the lungs. The weights of the organs are noted, but the degree to which respiration had been performed is so loosely stated, as to allow of no fair inference of the effect of this process upon the weight. The time which the children survived is stated ; but this, as it is very well known, furnishes no criterion of the degree to which respiration has been carried. Again, we are not informed whether due care was taken to ascertain if the lungs were healthy or diseased. (^Considerations sur V Infanticide, Paris, 1819.) The following table of the weight of the lungs, in four cases, will show how much the organs are liable to vary in weight after birth, according to the degree of respiration. Case. Weight. 1. Born dead ....... 687 grs. 2. Lived 6 hours 114 " 3. " 24 hours 675 " 4. " 9 hours . . . ; . . 861 " Relying upon a table of this kind only, without comparing the other cha- racters of the lungs with the weight, it might be inferred that the organs would weigh less in a child which had survived its birth twenty-four hours, than in another which had been born dead, and that there would be very little difference in the weight, whether the child lived six hours or nine days; but when it is stated, that in Case 3 the lungs had every foetal character pos- sessed by those in Case 1, and that in Case 4 respiration had been obviously very imperfectly performed, the difficulty is removed. Such cases should rather be compared with the lungs in the foetal than in the respired state. They merely show what 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. But this is certainly no valid reason why evidence from this source is to be rejected in all other cases.* It may be fairly granted that the weight of the lungs of some children that have outlived delivery may not come up to the weight assigned to those of children that have breathed ; because, as we have seen, children may survive birth many hours without the process of respira- tion being properly established. On the other hand, as in Chaussier's obser- vations, the lungs of the still-born may be sometimes as heavy as those of children that have respired ; but since the lungs of the still-born would con- INFANTICIDE — WEIGHT OF THE LUNGS. 331 tain no traces of air, the weight above the average in these cases could not be assigned to respiration. Among such subjects, whatever might be the weight of the lungs, if the facts were unknown, it would be impossible to say whether the children were born living or dead. (See Ed. Med. and Surg. Journ., vol. xxvi. p. 375.) Increased weight, therefore, is only one among several circumstances to which a medical jurist should attend. We must not fall into the error of supposing that the lungs increase in weight according to the length of time which a child survives its birth ; it is within the limits of a few days, according to the degree of perfection with which a child breathes : hence we may meet with cases of children born alive, sur- viving some hours or days, and yet after death the lungs will retain their foetal weight. This is the case in immature children, in most twin children, and in those which are mature but weakly. Among many instances that have come to my knowledge, no difficulty of this sort, however, has occurred. The signs of respiration have been sufficiently well developed to justify a medical opinion, although the child had probably not survived its birth above a few hours, or even minutes. {G. H. Rep., April, 1842). The cases of im- perfect respiration above alluded to rarely go beyond a coroner's inquest, for want of clear evidence of life. There may be a difference of opinion as to the relative number of instances of perfect and imperfect respiration in new- born children ; but a case is never likely to proceed to trial, unless the signs of this process are well marked ; and thus many charged with murder must escape, through the want of sufficient medical evidence to establish the fact of respiration and life. It is scarcely necessary to observe, that the air which the lungs receive by respiration cannot add to their absolute weight. This is because they are in the condition of a bladder, which weighs the same, whether it be filled with air or empty. The increase of weight is solely due to the additional quan- tity of blood, which, owing to the altered course of the circulation, perme- ates their structure. Hence it follows that when the lungs are distended with air, either from artificial inflation, or from putrefaction, the foetal weight will remain unaltered ; and by this means, it is contended, we may distinguish lungs that have respired from those which have been artificially inflated. Orfila states that the foetal lungs weigh more before they are artificially inflated than afterwards — a circumstance which may depend upon the fact that the impulse employed in inflation may have forced out a portion of blood or other liquid. In carefully performing \Ms experiment, I have found that there was not even the least fractional difference, but that the inflated lungs weighed precisely the same as in the uninflated state. From what has already been said, it follows that great weight of the lungs can ohviously furnish no proof of respi- ration, unless this be accompanied by the other physical changes indicative of that process — as, for example, great increase in volume from the 'presence of air and crepitation. If the lungs be very heavy, and at the same time contain little or no air, it is certain that the increase of weight must depend upon disease or other causes — not upon respiration. In one case which I had to examine, the lungs were large, and weighed upwards of 1200 grains. They contained no air ; when divided into thirty pieces, not one portion floated, nor could any air be seen on the closest examination. It was there- fore clearly impossible to ascribe a weight so much above the average to the effects of respiration. It must not be forgotten that all the physical charac- ters presented by lungs that have respired, are liable to certain fallacies ; but, as in the evidence derived from tests used in poisoning, these may be removed, or the force of the objection diminished, by not basing an opinion on one or two conditions only. We must 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 organ. This is in accord- 332 INFANTICIDE — BLOOD IN THE PULMONARY VESSELS. ance with the view adopted by the late Professor Orfila. {MM. L^g., 1848, vol. ii. p. 229.) 5. Test of Ploucquet This so-called test for determining whether or not the act of respiration has taken place, was proposed many years since by M. Ploucquet. It is founded on a comparison of the absolute weight of the lungs with the weight of the body of a child. Admitting that the lungs in- creased in weight from the establishment of the respiratory process, it was supposed that a like difference would take place in the relative weight of these organs.to the body ; and that the ratios thus procured, compared with certain averages, would enable a medical jurist to determine, in an unknown case, whether or not a child had respired. Ploucquet conceived that the average ratio of the weight of the lungs to the body, in children which had not breathed, was 1 : 10 ; and in those which had breathed, 2 : 70, or 1 : 35. Subsequent researches, however, made by Chaussier and others, have shown that these numbers cannot be considered to represent the true average. The most serious objection to the employ- ment of this test, in cases of infanticide, is, that the lungs and the body are liable to vary in their relative weights, in children of the same age ; and d. fortiori, this variation must exist to a greater extent among children which have reached different ages. There may be various degrees of development in the body of a child, without any necessity existing for a corresponding development taking place in the lungs. It is unnecessary to enter into spe- culations relative to the causes ; experience has shown that such variations really exist ; and all that a medical jurist has to consider, is whether the dif- ference can be reduced within limits which may make the test available in practice. M. Devergie states from his experiments, that Ploncquet's test affords no satisfactory results, when applied to the bodies of children that have not reached the eighth month of gestation. According to him, the ratio is, for the eighth month — Before respiration, 1 : 63 ; after respiration, 1 : St ; Ninth month — Before respiration, 1 : 60 ; after respiration, 1 : 45. The ratio, he observes, becomes higher after respiration, in propor- tion to the perfection with which the process has been carried on. (M&dedne Legale, vol. i. p. 556. See also Ann. d^Hyg., 1835, vol. i. p. 485 ; Med. Gaz., Nov , 1842, p. 208.) The facts which have been collected by different ob- servers appear to me to show that Ploucquet's test is not fitted to determine, in an unknown case, whether a child has breathed or not. 6. Blood in the pulmonary vessels It has been asserted that if blood be found in the pulmonary vessels of a new-born child, we are justified in as- suming that respiration has taken place. On the other hand, the absence of blood from these vessels has been considered to prove that a child has not respired. This assertion must have originated in a want of correct observa- tion. The pulmonary vessels contain blood, both in the child which has, and in that which has not, respired. It is possible that the vessels may con- tain more after respiration than before ; but in most cases of infanticide it would be difficult to found any distinction on a point of this nature. In ex- amining the bodies of children that have died without respiring, and those of others that have lived and respired for some time after birth, no percep- tible difference was found in the quantity of blood existing in the vessels in the two cases. The fact is, the excess of blood after the establishment of respiration, is distributed throughout the minute capillary system of the lungs; it does not remain in the large trunks. The state of the pulmonary vessels, therefore, furnishes no evidence either of respiration or the contrary. The same observation will apply to the presence of blood in the substance of the lungs. It is said that on cutting through lungs that have breathed, the in- cisions are followed by a copious flow of blood ; this, it is alleged-, does not happen with lungs that have not breathed. In performing this experiment CONCLUSIONS PROM THE STATE OF THE LUNGS. 333 on several occasions, I have not been able to perceive any well-marked dif- ference. The blood in the new-born child may be found coagulated or not, and there is no difference in this condition, whether it is born living or dead. 7. Relative proportion of fat in the lungs. — In July, 1847, a memoir was presented to the Academy of Sciences by M. Guillot, in which the author proposed to determine the question of respiration by the relative proportion of fat contained in the lungs before and after birth. According to M. Guil- lot, the quantity of fat contained in the pnlmonary tissue is always greater before than after respiration, and it begins to diminish from the moment that the act of breathing commences. Before respiration, the dried Inngs yield from ten to eighteen per cent, of fat ; after respiration, not more than six per cent. The process followed by M. Guillot is to dry the organs at a high temperature, so as to expel all the water — reduce them to powder, and digest this powder in ether. (Comptes Rendus, Juillet 12, 1847, p. 777. J It need hardly be observed that this process could not be made available in practice. Admitting the facts as stated, the assigned difference between six and ten per cent, may disappear by further observations. A want of chemical accuracy might lead to serious mistakes. The process, however, is open to this objec- tion : — if respiration has been fully performed, this will be sufflciently evident from the state of the lungs ; and if imperfectly performed — as the change is alleged to depend on the respiratory act, the result of an analysis would not remove the difficulty. 8. The specific gravity of the lungs. — The specific gravity of the lungs is greater before than after respiration ; for although the organs become abso- lutely heavier by the establishment of the process, this is owing, not to the air, but to the additional quantity of blood received into them. The air thus received, so increases the volume of the lungs, as to more than counteract the additional weight derived from the blood, and thus apparently to dimi- nish their specific gravity. Under these circumstances they readily float on water. From several experiments, I have found that the specific gravity of the lungs before respiration, 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, the specific gravity of the lungs with the air contained in them, I found in one experiment to be 0.94 ; i. e., the organs were about one- seventeenth part lighter than their bulk of water. The introduction of a small quantity of air will render these organs buoyant in water; and an alte- ration in the volume of the lungs sufficient for this purpose would not be per- ceptible to the eye. It will be understood that the specifio gravity of the substance of the lungs is unchanged; the organs are rendered only appa- rently lighter by the air contained in their cells, on the same principle as a distended bladder. Hence it follows, that the same apparent diminution of specific gravity will take place whether the air be 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 pul- monaris, is founded — a subject which may be appropriately considered in another chapter. Conclusions. — The general conclusions which may be drawn from the con- tents 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 of putrefaction in utero proves that the child must have come into the world dead. 3. That the characters accompanying certain marks of violence may occa- sionally show that the child was living when the violence was applied to it. 4. That there are no certain medical signs, by which a child which has not breathed, can be proved to have been living when it was maltreated. 334 THE HTDKOSTATIO TEST. 5. That a new-born child may be destroyed by the prevention of respira- tion during delivery. 6. That the proof of respiration shows that the child has breathed; not that it has been born alive. 7. That by taking together the color, volume, consistency, absolute weight and buoyancy of the lungs, we may be able to draw an inference whether the child has or has not respired. 8. 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. 9. That no reliance can be placed upon the test of Ploucquet or the pro- portionate weight of the lungs to the body. 10. That no reliance can be placed either upon the relative quantity of blood in the pulmonary vessels, or upon the relative proportion of fat con- tained in the pulmonary tissue, as evidence of respiration having been per- formed. CHAPTER XLI. MODE OP EMPLOYING THE HYDROSTATIC TEST — INCORRECT INPERENCES — SINK- ING OF THE LUNGS FROM DISEASE OR ATELECTASIS — LIFE ^ITH PARTIAL DIS- TENSION OF THE LUNGS — LIFE WITH PERFECT ATELECTASIS, OR ENTIRE AB- SENCE OF AIR FROM THE LUNGS — HYDROSTATIC TEST NOT APPLICABLE TO SUCH CASES — ERRONEOUS MEDICAL INFERENCE FROM SINKING OF THE LUNGS — FLOATING OF THE LUNGS FROM EMPHYSEMA AND PUTREFACTION — EFFECTS OF PUTREFACTION IN AIR — GENERAL CONCLUSIONS RESPECTING THE HYDRO- STATIC TEST. Mode of employing the hydrostatic test. — The hydrostatic test has been long known, and various opinions have been entertained relative to its efficiency and value. Many of the objections that have been urged to its use, appear to have arisen from a mistaken view of the evidence which it is capable of furnishing. The term " test" is decidedly improper, since there are numerous cases in which it does not enable us to decide whether a new-born child has come into the world living or dead. It is, however, for the sake of conveni- ence, here retained. When the hydrostatic test is properly applied, and with a full knowledge of the exceptions to which it is exposed, it may afford in many cases good evidence whether a child has or has not respired. The mode of performing the experiment is extremely simple. Having removed the lungs from the chest, they should be placed, still connected by the trachea and bronchi, 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 separately ; for it is sometimes found that one, commonly the right, will float, while the other will sink. Supposing that both lungs sink, it will then be proper to divide each into twelve or fifteen pieces, and place these pieces separately 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 having respired. 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; some- times they indifferently float or sink. These differences will lead to a conclu- CAUSES or SINKING OF THE LUNGS. 335 sion 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, coeteris 'paribus, that respiration has been very perfectly per- formed. Should any of the divided portions sink in water, either before or after compression, our opinion may 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 of supporting these two organs. Incorrect inferences. — Such, then, is the method of employing the hydro- static test in cases of infanticide. With regard to its use in medical juris- prudence, it should be observed that the floating of the lungs in water is not, as it is often incorrectly represented to be, a proof that a child has been horn alive; nor is the fact of their sinking in water, any proof that a child was horn dead. The floating, under the limitations to be now described, proves only that a child has hreathed ; the sinking, either that it has not hreathed, or breathed but imperfectly. The fact of a child having been horn living or dead, has, strictly speaking, no relation to the employment of the hydrostatic test. ■ There are, indeed, cases of infanticide which may be readily established without resorting to this test; all that the law requires is proof of a child having been born living ; 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 first per- ceived ; but this examination may be dispensed with, when the woman con- fesses 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, without 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, from what will be hereafter stated, it is possible that a child may be heard to 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 water. 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 con- siderable period have been observed to sink entirely in water. In some in- stances, this may depend on disease tending to consolidate the air-cells, as hepatization or scirrhus; in others, on oedema or congestion: but these cases can create no diflBculty, 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 impossible to distend it artificially with air. On the other hand, there are cases in which the lungs appear healthy and unaffected ; all that we can perceive is, that they retain their foetal condition. This is a very different state from that of hepatization, because the lungs may, in this case, be made to receive air by artificial inflation. It is remarkable that life should continue for many hours, and sometimes even for days, under such a condi- tion ; but the occasional existence of this state of the organs in a living child is placed beyond all dispute ; the explanation of the causes upon which it depends — how it is that a child may live and breathe for hours or days, and 338 INFANTICIDE — IMPEKFECT DISTENSION OF THE LUNGS. no signs of respiration are discovered in its body after death — is, however involved in great difiiculty. The researches of Dr. B. Jorg, of Leipzig, have thrown some light upon the subject; and these'may probably lead the way to other discoveries in this obscure department of physiology. Some of Dr. Jorg's vievrs are peculiar. He considers that the act of parturition, as well as the duration of the process, has a material influence upon the system of a child ; and that these conditions serve to prepare it for the efforts which it has to make in performing respiration. (IHe Fotuslunge,, Grimma, 1835.) Supposing the first inspirations made by a child to be, from any cause, feeble or imperfect, then the organs will become only partially distended ; the re- maining portions will preserve their foetal condition. Dr. Jorg considers-this as a positively diseased state of the lungs in the new-born child, and he has given to it the name of atelectasis (dft^^j, "incomplete ;" E*roBif, "expan- sion"). It may proceed from various causes. He considers that children that are born after an easy and rapid ^delivery are subject to it; and thns it may be found in a mature as well as in an immature child. Any cause which much weakens the vital powers of a child before its actual birth, may give rise to the occurrence of this imperfect dilatation of the lungs. In this way, it may be due to long-continued pressure on the head during delivery, or to bleeding from the cord. All the causes of asphyxia in a new-born child will, when operating only in a very slight degree, also produce this ateleotasic, con- dition. When only a part of the lung is, in the first instance, distende(i with air, the child may not afterwards acquire sufBcient strength to fill the remain- ing portions; it may thus live on for some hours or days, respiring at inter- vals, and becoming occasionally convulsed, in which state it will probably sink exhausted and die. Jorg has remarked, that those portions of the lung which are not speedily distended by air, afterwards become consolidated or hepatized, so that all traces of their vesicular structure are lost. The length of time which a child survives will depend upon the degree to which its lungs have become dilated. This condition of the lungs is sometimes to be clearly traced to the diversion of the blood from these organs, by reason of the ductus arteriosus or foramen ovale remaining open after birth. Life with partial distension of the lungs, — It is not necessary that the whole of the lungs should have received air, in order that a child should continue to live even for several months after its birth. Some years since, I met with the following case, which will serve to illustrate this statement. A child aged six months, had been, it was supposed, destroyed by suffocation. Upon opening the thorax, the viscera were found healthy ; but the whole of the inferior lobe of the right lung was, so far as regarded color, density, and struc- ture, precisely, like the lungs of a foetus — no air having ever penetrated into it. It had become developed in size, but its vesicular structure was perfectly destroyed. When the whole of the lung was placed in water, it floated ; but when the inferior lobe was separated, it immediately sank to the bottom of the vessel. I have no doubt that this was a case of partial atelectasis, such as is described by Jorg. The lobe had not received air in the first instance; and had become afterwards consolidated or hepatized, so that it could not be inflated. Dr. 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 lobe of the left lung were found to be in their foetal condition, and they immediately sank when immersed in water. There was no diseased appearance in the organs, and the undistended portions were easily filled by blowing air into them. (Henke's Zeitschrift, ISST, vol. ii. p. 422.) M. D^paul found that in many cases in which children had died suddenly after breathing for several hours or days, there was no other morbid appearance to be perceived than an un- LIFE WITH UNDILATED LUNGS. 33T expanded condition of a large portion of the lungs. {Med. Gae., vol. xxxix. p. 283.) Life with perfect atelectasis, or entire absence of air from the lungs. — It is quite necessary for a medical jurist to be aware, that this state of the lungs, which is here called atelectasis, is by no means unfrequent among new-born ■^children, although attention has been only of late years drawn to the subject. 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 atelectasis are ordinarily set down as exceptions to a general rule ; but I believe they are more common than some medical jurists are inclined to admit. In examining 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 to me not improbable, that many such come yearly before coroners in this country ; and that they are dismissed as cases of still-born children, notwithstanding that marks of vio- lence are often found upon the bodies. If, as it has been already observed, the lungs sink in water, this fact alone is commonly regarded as sufficient evidence of still-birth. This is assuredly putting the most humane interpre- tation on the circumstance, 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 judicial inquiry, and lead to the concealment of crime. Professor 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 fragment sank. Remer has reported another, in which the lungs sank in water, both entire, as well as when divided, although the child had survived its birth at least /owr days. (Henke, Lehrhuch der G. M., p. 31 i.) In this case the navel-string separated naturally before death. Orfila found, in a child which had lived eleven hours, every portion of the lungs, when di- vided, to sink on immersion. In three other cases, in which the subjects sur- vived birth, four, six, and ten hours, the lungs also sank when divided ; two of these were mature children. {Med. Leg., vol. i. p. 375.) Dr. Yernon at- tended a healthy woman, who was delivered of a 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 and exhaustion. It was a female child, and very small ; the body weighed two pounds thirteen ounces, and its length was twelve and three-quarter 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 ; they were not crepitant, and broke down under firm compression : — there was no appearance of air-vessels in a section of the lungs when exa- mined by the microscope. The ductus arteriosus and foramen ovale were in their foetal state. {Lancet, Feb. 3, 1855, p. 121.) In these cases the respi- ration is what is called bronchial, or confined to the upper part of the air- passages. The following is another instance of atelectasis. The child was born prematurely at the seventh month, and cried strongly. The breath- ing became slower and slower, until the death of the child, four hours after birth ; but during this time it cried at intervals. The head and face were livid, and remained so after death. The heart continued to beat after respi- ration had ceased. The blood on inspection was found fluid and black ; the lungs were of a dark color, like the liver, and they sank in water even after an attempt had been made to inflate them by a blowpipe. {Med. Times and Gaz., May 28, 1857, p. 523.) Metzger supposed that premature children 22 338 EERONEOUS INFERENCES PROM SINKING OF THE LUNGS. alone were likely to present this anomaly; i. e., of continuing to live after birth, without leaving any clear signs of respiration in their lungs. I may add to these instances, two which have occurred under my own ob- servation. In one, the case of a mature male child, the lungs sank in water although the child had survived its birth during a period of six hours. In the other, the case of a female twin, the child survived twenty-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 from respi- ration sufficient air to render it buoyant. {Guyh Hospital Reports, No. v. p. 355.) In the latter instance no particular remark was made during life re- specting the respiration of the child. These cases show most 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 this been a case call- ing 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 were forthcoming, the fact of the child having snr- vived its birth. Here, again, we perceive the necessity of not hastily assum- ing that a child has been born dead, because its lungs sink in water. There may be no good medical evidence of such a child having lived after birth, but assuredly the mere sinking does not warrant the common and positive dictum, that the child was necessarily dead when born ; it would be as rea- sonable to pronounce, in a question of poisoning, that the fact of an indi- vidual having died from poison was negatived by the nou-discovery of a poisonous substance in the stomach of the deceased. Hydrostatic test not applicable to such cases It must be apparent, on re- flection, that cases of this description are beyond the reach of the hydrostatic as well as of all other tests applied to the respiratory organs ; because the Inngs do not receive and retain a perceptible quantity of air, although the subjects may have lived some hours. The hydrostatic test is no more capa- ble of showing that such subjects as these have lived, than it is of indicating from what cause they have died. Pacts of this kind demonstrate that a pas- sive existence may be for some time maintained under a state of the respira- tory process not to be 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 when they are actually found. Poison is not always discoverable after death in the stomach of a person who has taken it; but this does not prevent a medical jurist from searching for it, and, under proper precautions, relying upon its discovery as evidence of poisoning in another case. These singular instances prove that we are greatly in want of some sign to indicate life after birth, when the marks of respiration are absent. Until we discover this, we must, of course, make the best use of that know- ledge which lies at our disposal; taking care to apply it to those cases alone to which experience shows it to be safely adapted In the meantime, the common inference that a child had been born dead because its lungs sink ia water, is never likely to implicate an innocent party ; it can only operate by sometimes leading to the liberation of the guilty. Erroneous medical evidence from sinking of the lungs. — From the cases already reported, it is a fair subject of consideration whether a great error is not committed by those medical practitioners who pronounce all children to have been born dead, merely because the lungs contain no air and readily sink when placed on water. This, it is true, is the common opinion, but it is not warranted by observation. We are only entitled to say, in all such cases, ERRONEOUS INFERENCES FROM SINKING OF THE LUNGS. 339 that there is no evidence of a child having breathed or lived. Many might be disposed to consider it an unnecessary degree of refinement to hesitate to express an opinion that a child was born dead when its lungs sank entirely in water, because certain cases have occurred wherein these characters have been possessed by lungs taken from the bodies of children that have survived their birth many hours. To those inclined to adopt this view I would say, the answer to such a question is of far greater importance in a medico-legal than in a medical light. In the latter case, no responsibility can be attached to the expression of the opinion commonly adopted ; in the former case, how- ever, when the question refers to child-murder, a serious responsibility is in- curred by a practitioner, and he can only guard himself from unpleasant consequences by basing his evidence on carefully observed facts. If a child can live for six or twenty-four hours without receiving into its lungs sufficient air to allow even one-thirtieth part of their substance to float, it is clear that such a child may be the subject of a murderous assault; and if a medical practitioner, losing sight of this fact, proceed to declare from the lungs sinking in water, that the child must have been born dead, his assertion may afterwards be contradicted, either by circumstances, by the testimony of eye-witnesses, or by the confession of the woman herself. He will be required, perhaps, to revise his opinion ; and he will then find that the fact of the lungs sinking in water is rather a want of evidence of life after birth, than a positive proof of a child having been born dead. It cannot be denied that the sinking of the lungs is & presumption in favor of still-birth, but it is nothing more ; — it is not, as it is often set down, a direct or positive proof of the child having been born dead. There are many cases reported which show that this is not an unnecessary caution. Meckel relates two instances in which the lungs sank in water, but the women respectively confessed that they had destroyed their children : according to the general rule, these children must have been born dead, and no murder could have been committed I {Gerichtl. Med., )). 365.) For other examples of a similar kind I must refer to the following journals: Ann. d'Hyg., 1837, vol. i. p. 43T ; also, 1841, p. 429; Henke's Zeitschrift, 1840, vol. xxvii.. Erg. H. ; Brit, and For. Med. Rev., Jan. 1842, p. 250. The cases there reported appear to me to convey a serious warning to medical witnesses on the danger of expressing an opinion not strictly warranted by the medical facts, and which must be in such cases merely speculative. A case of some interest in this point of view was com- municated to the Medical Gazette, by Dr. Davies, of Hertford. In Novem- ber, 1847, he was required to examine the body of a child found under suspicious circumstances. It was in a pasteboard box of small size, with the lid turned inside out, and on the top there was a quantity of mould. The body was found buried in a garden. It turned out on inquiry that there had not been exactly a concealment of birth on the part of the mother, who was an unmarried woman. The body was thirteen inches long from crown to sole ; eyelids were adherent ; testicles (it was a male child) had not de- scended ; it weighed one pound and three-quarters. It was ascertained that it had been buried a fortnight, which accounted in some degree for the light- ness of its weight in proportion to its length, and for a slight peeling off of the cuticle from some parts of the arms : the body looked otherwise healthy. The age was probably about seven months. On examining the lungs, they were found to be quite firm, like the liver ; they sank in water, both wholly and in parts. The right lung was of a dark brown mahogany color, but the upper lobe of the left was of rather a lighter color than any other part of the lungs. However, this lobe sank immediately upon being placed on water. The evidence at the inquest proved that the child was not only born alive, but that it had lived ten minutes at least, and perhaps longer after birth. It appeared that an elderly woman, living close by, was sent for, and when 340 FLOATING OF THE LUNGS. she arrived she found the child, with the placenta attached to it, in the close- stool. She noticed that the child moved its arms ; she therefore took it up with the placenta, and wrapped it in flannel. It continued to move its limba for ten minutes, according to her account, hut it uttered no cry. When the child ceased to move, she divided the cord seven inches from the body, and tied it into a knot. {Med. Gaz., vol. xl. p. 1022.) It has been recommended that medical jurists should consider as dead every child that has not breathed, i. e,, whose lungs sink in water ; but they who give this advice at the same time admit that children may come into the world living without breathing, and the law holds, under the decisions of its ex- pounders, that respiration is only one, and not an exclusive, proof of life. In order to establish life, or even live birth, respiration need not always be proved, either in civil or criminal cases. (Hee post, Birth.) 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 the plain and obvious truth, it is not possible that his statement can ever be the means of involving an innocent person. It is certain, however, in de- parting from the truth, and 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 exculpating a really guilty person ; for it cannot be too strongly borne in mind, that a woman is not now charged with murder, merely because the lungs of a child float or sink in water, but because there are upon its body marks of violent injuries apparently sufficient to account for the death of a new-born child, or there are strong moral presumptions of her guilt. (See Ann. d'Bi/ff., 1836, vol. ii. p. 362.) Floating of the Lungs from other Causes than Respiration. Another series of objections has 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 injlation. It was supposed, that the lungs of a still-born child might become emphysematous from a compression of the sides of the thorax during delivery ; but it is difficult to understand how in this way air should be extricated from these organs any more than it would be from the liver under similar circum- stauces. The truth probably is, that what has been described as emphysema of the lungs in still-born children was nothing more than partial or imperfect respiration performed during delivery. In examining the bodies of many still-born children, I have never met with any appearance resembling what has been described as a state of emphysema independently of respiration and putrefaction. It may be proper, however, to state, that, according to some observers, emphysema of the lungs may be produced under the following cir- cumstances : the thorax of the child is compressed in passing the outlet — the lungs within are thereby compressed ; and if this compressing force be sud- denly removed, as by the passage of the thorax, the elasticity of the parietes will cause the chest to expand, and air, it is presumed, will enter as a neces- sary consequence. The simultaneous compression of the abdomen might aid in the entrance of the air. {Lancet, May 20, 1837 ; also, June 17, 1887.) It is contended that not only may respiration take place during birth, but that even the lungs of a dead foetus may become thus mechanically inflated, and respiration be thereby simulated. This opinion appears to be founded on an erroneous view of the condition of the thoracic viscera in the chest. The lungs, before air has entered into them, are as dense as the liver. If they are compressed they may become elongated, but when that pressure is removed, they will, if the child be dead, INFANTICIDE — FLOATING FROM PUTREFACTION. 341 simply return to their original foetal condition. To suppose that they would expand and receive air, is to Suppose that the reaction of the thoracic parietes is greater than the force with which they have been compressed. But what is to carry the thorax of a dead child beyond the point at which equilibrium is restored ? Besides, this would not suffice to distend the air-cells, which are yet coiled up, as it were, and condensed. If this view were correct, scarcely a child would be born without having air in its lungs. In experi- menting on this subject, I have never observed the least portion of air to enter: the air-cells of the lungs do not, therefore, appear to be in the con- dition of spiral strings, which this hypothesis would represent. Floating of the lungs from •putrefaction. — The lungs of a still-born child, when allowed to remain in the thorax, are slow in undergoing putrefaction ; but nevertheless, they sooner or later acquire sufficient air to render them buoyant in water. This form of gaseous putrefaction may even take place in the lungs of a child which has died in utero. One instance of the kind is recorded by Dr. Albert {Henke's Zeitschrift, ISSt, vol. ii. p. 179), in which the child was cut out of the uterus in a putrefied state, and its lungsfloated when placed on water. It has been also alleged, that the formation of air may take place in the lungs from putrefaction, without this being indicated by change in color, smell, or other properties of the organs ; but admitting that this may occur, it can create no difficulty in the investigation. When the lungs are putrefied, this will be determined, in general, by putre- faction 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 green or brown color, and of a highly offensive odor ; the serous membrane covering the surface will be raised in large visible bladders, from which the air may be forced out by very moderate compression. It has been remarked, that, under the same conditions, gaseous putrefaction takes place as rapidly in the liver, heart, and thymus gland of a new-born child, as in the lungs. We should, therefore, examine the general conditions of the body ; the dis- tension of the lungs with gas 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 im- possible that any well-informed medical witness can expect to obtain satis- factory evidence from experiments on the lungs of such subjects. He should at once abandon the case, and declare that in regard to the question of respi- ration, 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; because this is due to circumstances over which he has no control. In a case of poisoning, the appearances after death in the viscera may be entirely destroyed by putrefaction ; but no practitioner would think of looking for proofs when the circumstances rendered it utterly impossible for him to obtain them. A case may possibly occur wherein the characters presented by the lungs will be such as to create some doubt whether the buoyancy of the organs is due to putrefaction or respiration, or, what is not unusual, whether the putrefied lungs may not also have undergone the changes of respiration. The facts may be apparently explicable on either assumption. Even here a proper investigation may serve to remove all doubt. (See case by Dr. Francis, Med. Gaz., vol. xxxvii. p. 460.) It has been recommended on these occasions that the witness should lean to the side of the prisoner — in other words, he should give an opinion, that the child suspected to have been murdered had not respired. This advice is equal to recommending a witness to take upon himself the duty of a jury, and virtually to acquit a prisoner upon a doubt existing in his own mind, in respect to only one portion of the evidence adduced against her. _The_eviL_effects__ofLJollowing this kind of 342 FLOATING OF THE LUNGS FROM ARTIFICIAL INFLATION, advice are well shown by a case reported in Henkeh Zeitschrift (1843, vol. i. p. 102, Erg H.), in which an opinion was improperly given by a medical witness, that the child, the whole of the organs in whose body were in an advanced state of putrefaction, was born dead; and the prisoner afterwards confessed that it had been born living ! This shows that it is always better to leave a doubtful case as we find it, than to express a positive opinion on one side or the other, when this opinion can never amount to more than a conjecture. If a witness were simply to assure the jury, that medical evi- dence could not solve the question whether the child had lived — 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 respired — tit is certain that no inno- cent person would ever be convicted or a guilty person acquitted, upon his evidence. It is for a jury only to judge of guilt from all the circumstances laid before them; but it is assuredly not for a medical witness to prevent further investigation, and put an end to the case, by leaning to the side of the acciised when there is really a doubt upon his mind. 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 from the con- tents of this chapter, respecting the application of the hydrostatic test in cases of infanticide, are the following : — 1. That the hydrostatic test can only show whether a child has or has not breathed, it 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 their being in a diseased condi- tion. 8. That a child may live for a considerable period when only a 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 penetrated by air. 5. Hence the sinking of the lungs (whether whole or divided) in water is not a proof that a child has been born dead. 6. That the lungs of children which have not breathed and have been born dead, may float in water from putrefaction or artificial inflation. 7. That the lungs as situated in the chest undergo putrefaction very slowly, that if but slightly putrefied, the air 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 XLII, FLOATING OF THE LUNGS FROM ARTIFICIAL INFLATION. INFLATION DISTIN- GUISHED FROM PERFECT RESPIRATION — NOT DISTINGUISHABLE FROM IMPER- FECT RESPIRATION — DOUBTFUL CASES — RESULTS OF COMPRESSION — IMPROPEK OBJECTIONS TO THE HYDROSTATIC TEST — SUMMARY — RESPIRATION BEFORE BIRTH — VAGITUS UTERINUS — RESPIRATION A SIGN OF LIFE, NOT OF LIVE BIRTH — THE KILLING OF CHILDREN WHICH BREATHE DURING BIRTH NOT CHILD-MURDER. GENERAL CONCLUSIONS. Floating of the lungs from artificial inflation It has been alleged that the lungs of a still-born child may be made to assume, by artificial inflation, all the characters assigned to those which have undergone respiration. Thus, INTANTICIDE — RESULTS OF ARTIFICIAL INFLATION. 343 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 inference that it had. It will be seen that the force of the objection goes to attack directly the infer- ence derivable from the presence of air in the lungs. This objection can, it appears to me, be admitted only under one form, namely, as it applies to lungs which have been inflated while lying in the cavity of the chest. Any experiments performed on inflation 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 inflated by a person who is fairly endeavoring to resuscitate a still-born child. The diflSculty of inflating the lungs of a new-born child is too well known to require to be here adverted to ; the greater the violence used, the less likely is the air to pass into these organs, but it rather finds its way through the gullet into the bowels. Dr. Albert, a late writer on the subject, denies that the organs, while lying in the chest, can be so filled with air, either by the mouth or. by means of a tube, as to be rendered buoyant in water. . In performing this experiment several times, he never found a trace of air in the air-cells ; and he contends that medical jurists have begun at the wrong end (den Gaul von hinten aufgezaumt), in endeavoring to seek for answers to an objection, before they had ascertained that such an objection could have, practically speaking, any valid existence. (Henke, Zeitschrift, ISST, vol. ii. p. 390.) M. Depaul has still more recently found that it requires great force to inflate the lungs, and that their, resiliency was sufficient to expel the greater part of the air in- troduced. (Med. Gaz., vol. xxxix., p. 283.) Having had several opportunities of examining the lungs of children in which inflation had been resorted to, not for the express purpose of creating an objection to the hydrostatic test, but with the bond jfide intention of re- suscitating them, I may here state the results. In some of these instances a tube had been used, and in others the mouth. In the first case it was found, on inspection, that only about one-thirteenth part of the structure of the lungs had received air. In the second, no part of the lungs had received a trace of air, although inflation had been repeatedly resorted to ; the air had passed entirely into the abdomen. In a third, attempts were made for upwards of half an hour to inflate the organs ; but, on examination, not a particle of air was found to have penetrated into them. In a fourth, no air had entered the lungs, and in a fifth, although a small portion had penetrated into the organs, it was readily forced out by compression. In repeatedly performing experiments on dead children, the results have been similar; the lungs, after several attempts, were found to have received only a small quan- tity of air. Thus, then, it would appear, that the lungs of a new-born child may be inflated in situ, although with some difficulty, and that the quantity of air which they receive under these circumstances is inconsiderable. If the efforts at inflation be continued for some time in the dead body, and the tube be violently introduced into the larynx or trachea, or if the organs be inflated after removal from the chest, with the express intention of causing them to resemble respired lungs, the result is different ; but this is not the mode in which the objection can possibly occur in a case of infanticide — a circum- stance which appears to have been strangely overlooked by some of those who have examined this alleged objection to the hydrostatic test. It is not likely that a woman, if able to perform the experiment at all, would be capa- ble of doing more than a practised accoucheur; and the probability is, that she would, in general, altogether fail in the attempt. One case is recorded, in which a woman, recently delivered, is stated to have succeeded in artificially inflating the lungs of her child (Meckel, Lehrb. der G. M., 368 : — see also Ed. Med. and Surg. Journ., vol. xxvi. p. 374) ; and another, in which this defence was urged on the part of a female, is reported by Dr. Von Siebold, 314 INFLATION DISTINGUISHED FROM EESPIKATION. of Gottingen {Henke's Zeitschrift der S. A., vol. iii. 1845.) The child in this instance, was found with its head cut off, and the lungs contained air. The inconsistency of the woman's statement as to the mode in which she in- flated the lungs was clearly proved, and the examiners did not hesitate to give a decided opinion that the air found in the lungs had been derived from the act of respiration, and not from artificial inflation. This case shows that when a theoretical objection of this kind comes to be tested practically it ceases to present any difficulty. It may happen, however, that another per- son may inflate the lungs, and if the mother has been secretly delivered she may be wrongly charged with murder. (See case. Gasper's Vierteljubesch, 1859, vol. ii. p. 38.) A midwife here attempted to revive the child by breathing into its lungs after its removal from the soil of a privy; but the circumstances of the case were well known from the statement of the midsvife. Other instances of inflation are reported by Dr. Dommes, in the same journal, 1860, vol. ii. p. 131. But let it be admitted that the lungs have been artificially inflated; in this case, they would resemble, by their partial distension with air, and other phy- sical characters, those of children which had imperfectly breathed. . Like them, they may float on water; but on cutting them into pieces, some of these would be found to sink. If the pieces be firmly compressed either by means of a folded cloth or between the fingers, they will lose their air and sink; so that in fact there are no physical means of distinguishing artificially inflated lungs from those that have imperfectly breathed. Experiment has repeatedly shown that when respiration has been feeble, and no artificial inflation re- sorted to, the air may be forced out of the lungs by moderate compression, and the portion so compressed will sink in water. If the compression be produced under water, bubbles of air may been seen to rise through the liquid. The results have been exactly the same when the lungs were inflated artifi- cially as they were lying in the chest. (See Guy's Hospital Reports, No. V., and for some good remarks on this subject by Dr. Christison, see Ed. Med, and Surg. Jburn., vol. xxvi. p. 74.) Artificial inflation distinguished from perfect respiration If respiration has been perfectly established, and the lungs are well filled with air, it is impossible so to expel this air, by compressing the divided portions of the organs, as to cause them to sink in water. It has been asserted that It is equally impossible to force the air out of lungs that have been artificially inflated ; but it is highly probable that in these cases the lungs had been inflated to a maximum degree when removed from the thorax, a case in which much difficulty is certainly experienced in expelling the air; but this is not the form in which the objection can ever present itself in a case of in- fanticide. If the lungs are inflated in the ordinary way, i. e., while lying within the chest, there is never, according to my observation, any great diffi- culty in causing them to lose their air by compression — a result which has been repeatedly demonstrated to the medico-legal classes of Guy's Hospital. Although no reliance can be placed on the effects of compression in cases of imperfect respiration, yet it appears to me that when with great weight of the lungs there is great buoyancy in water, the fact of these organs not losing the air contained in them, and not sinking after firm compression, ought to be considered as a good corroborative proof of a child having breathed. It has been just stated that compression will not extricate 'air from lungs which have fully respired. By this, it is not to be understood that the experiment of compression can only be practically applied, to dis- tinguish respiration in those cases in which a child has lived for a consider-' able time after its birth. I have found it to succeed, even when a child had lived to make no more than one or two respirations, and had died before it was actually born. In this case, it was found necessary, in order to effect RESPIRATION DISTINGUISHED FROM ARTIFICIAL INFLATION. 345 delivery, to destroy the child while the head was presenting. It lived, how- ever, a sufficient time after the protrusion of its head with the greater part of the brain destroyed, to cry loudly for an instant. The general appearance of the body showed that it had attained to the full period of gestation. On opening the thorax, the lungs were seen projecting slightly forwards over the sides of the pericardium. They were of a light-red color, but not crepitant under the finger. They had the external physical characters which these or- gans are known to acqnire on the first establishment of respiration ; but the absence of crepitation proved that the process could not have been perfectly performed. The color of the external surface was throughout uniform ; a circumstance which I have never witnessed in lungs that had been artificially inflated, except when the inflation had been carried to its fullest extent out of the body. Then, however, there is, commonly, distinct crepitation. When removed and placed on water, these organs floated freely ; and on being sepa- rated, both appeared equally buoyant. Each lung was next divided into six- teen pieces, and every piece floated. In dividing them, it was observed that the color was uniform throughout their substance ; there was no sense of crepi- tation or cracking under the knife; and the cells, in which the air was diffused, could not been seen. The pieces were then subjected to forcible compression, for some time in a folded cloth. The cloth was ruptured by the force em- ployed ; yet on removing the pieces, and placing them on water, they all continued to float. A portion of air had, undoubtedly, been forced out, but not sufficient to deprive any of them entirely of their buoyancy. By this we learn that in some instances two or three respirations only may suffice to stamp upon the lungs characters whereby they may be easily distinguished from those organs that have undergone artificial inflation. The compression was carried to the furthest possible limit consistently with the preservation of the organic structure of the lungs. It must not be supposed, that, in all children which h-ave lived but a second or two to respire, similar results will be obtained. The respiration of an in- stant may distend the lungs of one child, as much as respiration continued for several hours would those of another. The time which a child has survived its birth does not allow us to predict to what degree its lungs will be found distended on inspection, or what the results of experiments on these organs will be. A child may have feebly respired, and have died "either in a few minutes or hours, or not until many days have elapsed after its birth. There is, of course, no definite boundary between the perfect and imperfect disten- sion of the lungs, but by the latter condition we may understand that state of the healthy organs in which they contain only sufficient air to render them buoyant in water; and from the slight difference in their specific gravity and that of water, a small quantity will suffice for this. In these cases, the color, volume, and consistency of the lungs are scarcely changed from the foetal condition. The admission that air may be compressed out of feebly respired lungs by the same means as out of those which have been submitted to arti- ficial inflation, may appear to render compression useless, as a distinguishing sign of artificial inflation ; but we must not forget, that other corroborative sources of evidence may be forthcoming. The experiment of compression will, I believe, when properly applied, enable ns to distinguish cases of com- plete respiration from those of artificial inflation of the lungs in situ; and, if for this circumstance alone, it ought to be regarded as an adjunct occasionally useful in these investigations. Artificial inflation not distinguishable from imperfect respiration. — It must, however, be admitted, that there are no means of distinguishing /e«We respi- ration from artificial infliction. The physical characters of the lungs will be unaltered ; and compression will, in either condition, destroy their buoyancy. In a case of this kind, I apprehend the only course left open to a medical 346 INFANTICIDE — DOUBTFUL CASES. witness is, to state to the jary, that the evidence derived from experiments on the lungs left it uncertain whether the child in question had respired, or had had its lungs artificially inflated. The jury will then know how to return their verdict; for it must be remembered, they have always circumstances, as well as medical opinions, to guide their judgment ; and it is upon the whole, and not upon a part, of the evidence laid before them, that their verdict is founded. It is singalar that this occasional difficulty of distinguishing tirti- ficial iniation from respiration, should have been represented as a serious objection to the employment of the hydrostatic test. Even admitting, in the very few instances in which such a defence on the part of a prisoner is possi- ble, that a practitioner is unable to distinguish one condition from the other, this becomes purely a point for the consideration of a jury : it cannot affect the general application of the hydrostatic test. Examples of this sort of difficulty are by no means uncommon in the practice of medical jurisprudence, Many instances might be adduced of medical evidence being rendered doubt- ful by circumstances wholly independent of the skill of the practitioner, and over which he has had no possible control. In the determination of any single point in a case of child-mnrder, whether it relates to live birth or the actual cause of death, a doubt may arise ; the question relative to the respiration of a child is not exempted from this rule; but it would be the height of incon- sistency to contend, that, because certain means of investigation will not always enable us to express a positive opinion, we should never have recourse to them. I presume that in the present day, no practitioner would trust to the floating of the lungs as a sign of breathing, before he had ascertained that the air contained in them could not be expelled by compression. The charge against an accused party is not likely, therefore, to be sustained by medical evidence of the respiration of the child, unless the child have actually respired; but it is possible, that owing to a want of evidence to characterize feeble respiration, a really guilty person may escape upon the bare assump- tion that the lungs might have been artificially inflated. The mischief to be apprehended is not, then, as it has been often alleged, that the employment of this pulmonary test may lead to the condemnation of an innocent, but rather to the acquittal of a guilty person. This is certainly an unfortunate result ; but it is one for which medical science is not yet in a condition to provide an adequate remedy. In reference to this objection, there are, it appears to me, only two cases which may give rise to some doubt respecting the source of the air contained in the lungs of a new-born child. DouUful cases. — 1. In the case of a child that has not breathed, the lungs may be disproportionately heavy, weighing nine hundred to one thousand grains, and they may have been artificially inflated in the attempt to resusci- tate it. Unless, in this case, the air were expelled by compression, an infer- ence might be hastily drawn, that the child had probably breathed. The error could be removed only by circumstantial evidence : which, however, is generally sufficient to remove a speculative objection of this kind. But unless the fcetal Inngs were highly congested, diseased, or of extraordinary size, it is not likely that they would weigh so much as is here supposed. These doubtful cases may always be suspected to exist when, with considerable ab- solute weight, the lungs contain very little air. Let us, however, consider what would be its practical bearing on the question of child-murder, supposing the case not to be cleared up by any of the methods above suggested. Ist- The fact of respiration would not be clearly proved because the great abso- lute weight of the lungs, without their structure being permeated with air, amounts to nothing. 2dly. Although the proof of respiration might not be made out, this would not show that the child was born dead; for we know that a child may live many hours, and yet no evidence of life may be derived INFANTICIDE — RESULTS OF COMPRESSION. 347 from an examination of the lungs (p. 337, ante). Sdly. Admitting that there was proof of the child having lived after its birth, vehether there were evi- dence of respiration or not, the cause of death would have still to be made out: and unless this be clearly traced to the wilful and malicious conduct of the prisoner — proofs of which are not likely to be derived from the body of a child whose lungs she has innocently inflated — she must be acquitted. Thus, then, it is difficult to understand how, in the hands of one who has attended to the subject of infanticide — and no others ought to be allowed to give medical evidence — this objection, on the ground of inflation, can lead to any difficulty whatever in practice. Such a case as that which I have here sup- posed actually occurred to me in June, 1842. A male child, weighing up- wards of twelve pounds, died during delivery in a difficult labor. It gave no signs of life when born, and there was no pulsation in the cord. Its lungs were artificially inflatgd in the attempt to resuscitate it. The organs weighed nine hundred and ninety-four grains. They were slightly crepitant and floated on water, but gentle ])ressure by the fingers caused them to sink. It was clear that the increased weight depended on their great size, and not on any change produced by respiration. They contained but a small quantity of air, which was easily expelled by pressure. In another case, which I examined in June, 1847, the child was born dead. The body was well developed, and the lungs weighed 748 grains. These organs were inflated as they were lying in the chest. On moderate compression, when divided, they immediately sank in water. 2. We will now take the converse objection. A child may live and breathe, and its lungs weigh much under the average of respired lungs, i. e., about seven hundred grains. In a case like this, unless the air resist expulsion by compression, a converse mistake might be made, and we should pronounce a child that had really breathed and survived birth, to have been still-born and to have had its lungs artificially inflated. This might happen in numerous cases of imperfect respiration after birth, did we not know that the sinking of the lungs, whether containing air or not, and whether this air be expelled by compression or not, does not necessarily prove that a child was born dead. It can only show, under the most favorable circumstances, that it has either not respired, or respired imperfectly. The sinking of the lungs may take place in a child that has survived birth and has really been murdered ; but in such a case there may be no proofs of life ; and therefore a person actually guilty of a crime, would be discharged for want of sufficient medical evidence to convict. This, however, could no more justify the entire abandonment of medical evidence in such cases, than it could of general evidence ; because this, like evidence which is purely medical, is but too often insufficient to bring home guilt to the really guilty. The objection, therefore, on the ground of artificial inflation, when closely examined, is more speculative than real. Admitting, as some contend, that there is no positive criterion to distinguish this condition from respiration, it is difficult to conceive a case in which the objection could be sustained ; and, if sustained, it never could lead, in the hands of proper witnesses, to the inculpation of the innocent : unfortunately for society, it would only add another loophole to the many which, through the necessary forms of law, now exist, for the escape of the guilty. Results of compression. — It is proper to observe, that the results obtained by submitting the lungs to compression i^ cases of respiration and artificial inflation, have been very different in the hands of experimentalists equally competent. Some state that they have been able to force out the air in both instances — others in neither case. These discrepancies may depend either upon the different degrees of pressure employed, or upon the actual degree of distension of the lungs. The fact of their existence shows, at least, that the lung-tests cannot be safely trusted in the hands of persons who have not 34S IMPROPER OBJECTIONS TO THE HYDROSTATIC TEST. been used to such investigations. It appears to me tbat there las been a great deal of misplaced discussion on this subject. One case should at least be adduced, in which a woman charged with child-murder has been or can be hypothetically exposed to any risk of conviction from the admission that air cannot by compression be forced out of artificially inflated, or that it can be expelled from respired, lungs. I am not aware that there is a single in- stance in our law records, of such an objection being raised upon any but merely hypothetical grounds, in opposition to all the circumstances of the case. It might be imagined, however, from the discussions among medical writers on the necessity for certain and infallible means of distinguishing artificial inflation from respiration, that every woman tried for child-murder had made the praiseworthy attempt to restore a still-born child, although circumstances "may show that she had cut its throat, severed its head, or strangled it, while circulation was going on I (See case, Prov. Med. Journal, April 23, 1845.) If compression be trusted to as a criterion, without a pro- per regard to other facts, a practitioner not used to such cases may undoubt- edly be easily led into error ; but he may be equally deceived if he trust what has been proposed as a substitute for compression — i. e., a mere physical in- spection of the lungs. Improper objections to the hydrostatic test. Summary. — In concluding these remarks upon the objections to the hydrostatic, test, it may be observed that medical practitioners have differed much at different times in their ideas of what it was fitted to prove. About fifty years ago, it would seem that this test was regarded by some as capable of furnishing evidence of murder ! Thus we find Dr. Hunter asking the question : " How far may we conclude that the child was born alive, and probably murdered by its mother, if the lungs swim in water?" Later authorities, and, indeed, mainy in the present day, assert that the test is capable of proving whether a child has been born alive or not I From what has already been stated, as well as from the most simple reflection on the circumstances accompanying the birth of children, I think it must be evident that the hydrostatic test is no more capable of show- ing whether a child has been born alive or dead, than it is of prbving whether it has been murdered or died from natural causes. The majority of those who have made experiments on this subject have only pretended to show, by the use of this and other tests, whether or not a child has breathed — they merely serve 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 are they susceptible of doing more. Even here 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 the facts connected with them. (See Edinburgh Medical and Surgical Journal, vol. xxvi. p. 365.) If asked to state in what cases the pulmonary tests are capable of assisting a medical jurist, the answer, it appears to me, would be : — 1st. They will clearly show that a new-born child has lived, when, daring its life, it has/M% and perfectly respired. Cases of this description form a certain number of those which come before our courts of law. To them, the most serious ob- jections are not applicable ; and the few which might be made to the medical inferences are not difficult to answer. 2dly. They will allow a witness to say, that the lungs must have either received air by respiration, or by artifi- cial inflation. These are the cases in which a child has died soon after birth, and where the respiratory changes are but very imperfectly manifested in the lungs. They probably form the large majority of those that fall under the jurisdiction of the criminal law. It might be considered, that the qualifica- tions in the inference here drawn would neutralize its force ; but it must be remembered, that there are few instances of actual and deliberate child-mur- der wherein artificial inflation could become even a possible defence for an "WHAT THE TEST IS ADEQUATE TO PROVE. 349 accused party. So unusual is this kind of defence, that among the nume- rous trials for infanticide which have taken place in this country for many years past, I have not been able to meet with a single instance in which it was alleged, as an objection to the evidence derived from the buoyancy of the lungs, that the prisoner had inflated them in order to resuscitate her child. The reason is obvious ; had such a defence been attempted, the whole of the circumstantial evidence would at once have set it aside. When, in the sus- pected murder of an adult, a medical man swears that a fatal wound was such that the deceased might 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 artificia,lly in- flated. How would a jury decide in the two cases ? Assuredly, by connect- ing certain facts with which a medical witness is not concerned, but which- may, in their opinion, satisfactorily supply the place of what is defective in bis evidence. It is not for him to speculate on the probabilities of respira- tion, or of artificial inflation ; but it is for them to consider whether an ac- cused party was or was not likely 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 a profound knowledge of the difficulties of medi- cal jurisprudence ; and even then the question of murder does not happen to depend merely on the presence of air in the lungs. Such a case is very un- likely to present itself; indeed, its occurrence is no more probable than that in poisoning, it should be considered a good defence that some person might have introduced poison into the stomach after death. 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 re- jected 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 respiration and artificial inflation, still the jury may be in a situation to relieve him from the difBculty. In short, it would be as reasonable to con- tend that all murderers should be acquitted because homicidal are not always to be distinguished from suicidal wounds, as to argue that all cases of infan- ticide should be abandoned because these two conditions are not to be known from each other by any certain medical signs. If juries do frequently dis- miss such cases, it is, I apprehend, to be ascribed rather to their great un- willingness to become the means of administering what they consider to be severe laws, than to" their want of power to balance and decide on the pro- babilities laid before them. If the pulmonary tests were wholly set aside, it is easy to conceive what would be the consequences. Thus, let us suppose that a new-born child is found, under sflspicious circumstances, with its •throat cut; we are called upon to say, that it is impossible for medical evi- dence to establish whether the child had lived or not, and therefore we are to decline making an inspection of its body. But this would be the same as declaring that child-murder could never be proved against an accused party, and that new-born children might henceforth be destroyed with impunity 1 It appears to me that conduct of this kind, on the part of a medical Witness, would be wholly unwarrantable ; for we may sometimes acquire, by an in- spection, as great a certainty of respiration having been performed, and therefore of a child having lived, as of any other fact of a medico-legal na- ture. Cases of poisoning often give rise to greater difficulties to a medical jurist ; as where, for example, he attempts to found his opinion of the cause of death on symptoms or the appearances in the dead body. But we may 350 INFANTICIDE — RESPIEATION A SIGN OP LirK, put the question in this light. In the body of a healthy full-grown child, which has but recently died, we find the lungs filling the cavity of the ciiest, of a light red color, spongy, crepitant beneath the finger, weighing at least two ounces, and when divided into numerous pieces, each piece floating on water, even after violent compression. Is it possible in such a case to doubt that respiration has been performed ? If there is no certainty here, it ap- pears to me that medical experience is but little fitted in any case to guide us in our inquiries. It would be difficult to point out an instance in which an affirmative medical opinion would be more surely warranted by the data upon which it was founded. Respiration before birth. — It has been already stated that the pulmonary tests are fitted to prove only whether a child has or has not lived to respire. Neither the hydrostatic nor any other test can positively show that a child was entirely born alive when the act of respiration was performed. As this is a subject which generally gives rise to some discussion in cases of child- murder, I shall here make a few remarks on it : 1st. Respiration may be performed while the child is in the uterus, after the rupture of the mem- branes ; — the mouth of the child being at the os uteri. This is what is termed vagitus uterinus ; its occurrence, although extremely rare, seems to me to rest upon undisputed authority. 2dly. A child may breathe while its head is in the vagina, either during a presentation of the head or the breech. This has been termed vagitus vaginalis. It is not very common, but it must be set down as a possible occurrence. 3dly. 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 uterinus or vaginalis, the lungs receive but a very small quantity of air; in respiration after protrusion of the head, the lungs may be some- times found moderately well filled ; although never, perhaps, possessing all the characteristic properties of those which have fully respired. The well- known occurrence of respiration under either of these three conditions strikingly displays the fallacy of making this process, as some have done, the certain criterion of uterine life. A child may breathe in the uterus or vag'ina, or with its head at the outlet, and die before 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 Medical Gazette, vol. xxxviii. p. 394, and another commu- nicated to me by Dr. Crothers, of Coy, will be found in Guyh Hospital Reports, Oct. 1850, p. 231.) The death of a child whioh has respired in the uterus 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, I believe, a very unusual event. All that we can say is — it may take place ; but its death, under these circumstances, would be the exception to a very general rule. Oberkamp, in four successive deliveries of the same female, observed that the children breathed before delivery, but died before they were born. A case of this kind also occurred to Diemerbroek. (See Meckel, Lehrhuch der G. M., p. 367; Bechh Med. Jur., vol. i. p. 498; also Ed. Med. and Surg. Journ., vol. xxvi. p. 374.) The cases reported by Beck, of which there are three, lose much of their value from the fact that the lungs were not examined. 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 employment; although upon BUT NOT NECESSARILY OF LIVE BIRTH. 351 this ground, we find the use of it, in any case, denounced by many eminent members of the medical and legal professions. Thus, Archbold says: "Very little confidence is placed in this test as to the lungs floating, particularly if the child were dead any length of time before the experiment was made" (Criminal Pleading, 367); Mathews speaks of the test as being "quite exploded" {Digest, 251) ; and Jervis makes the same remark (On Coroners, 127). It is obvious that most members of the law who have treated the subject have adopted, without suflBcient examination, the statements of Pr. William Hunter. This author observes: "A child will commonly breathe as soon as its mouth is born or protruded from the mother ; and in that case, may lose its life before its body be born, especially when there happens to be a considerable interval between what we may call the birth of the child's head and the protrusion of its body. And if this may happen where the best assistance 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 Murder in the case of Bastard Children, p. 33.) Dr. Hunter here exposes, in plain language, the fallacy of trusting to signs of respiration alone, as evidence of a child having been horn alive. The truth of his remarks is, in the present day, generally admitted ; and if, among medico- legal writers, we find some still treating of respiration as a certain proof of live birth, it is from their not having sufficiently considered the probability of a child breathing, and dying before its body is entirely extruded. But we may ask. How does the admission of these views affect a case of deliberate child-murder ? A living and breathing child may be wilfully destroyed before its body is entirely born, as well as afterwards ; and if the law of England does not contemplate the wilful destruction of a living and breathing child, before its entire birth, as a crime, this omission cannot be imputed as a fault to the medical jurist ; nor can it at all diminish the real value of the hydrostatic test as furnishing indisputable evidence of life. Most persons might consider the crime of murder sufficiently made out, when the medical evidence showed that a child had lived, and that it was living when criminally destroyed. If, however, this does not constitute infanticide in law, and evi- dence be further insisted on, to set forth where the child was actually living when murdered — whether half protruding from the vagina, or altogether external to the body of the mother, then the fact of respiration before birth is an objection rather against the principles of the law, than against the test used to determine the presence of life. In a case tried a few years since, in which a child had been found with a ligature firmly tied round its neck, the medical evidence showed clearly that it had breathed ; and the whole of the appearances in its body were such as to leave no medical doubt that it had died by strangulation. The judge, in charging the jury, said, "if they were of opinion that the prisoner had strangled her child before it was wholly horn, she must he acquitted of the murder !" The prisoner was acquitted. How- ever we may regard the question of the utility of pulmonary tests, we must look upon that law as but very imperfectly adapted to its purposes, which makes the proof of murder to rest, not upon the actual and wilful destruction of a living child, but upon the precise moment which a murderer may select for the accomplishment of the crime. Impunity is thus held out to all offenders, who destroy a living child during the act of birth ; but there is an additional evil, accompanying the operation of this legal rule, which seriously affects the medical evidence given on these occasions. It would seem, from cases to be presently related, that the law will assume, until the contrary appears from other circumstances, that the respiration of a child, if proved by the best of evidence, was carried on before it was entirely born. Let the witness, then, in a case of alleged infanticide, ever so clearly establish the fact of respiration, and therefore of life, at the time the violence was used, 352 INJANTICIDE — LEGAL DECISIONS ON LIVE BIRTH. this evidence is not sufBcient. He is asked whether he will depose that the child had breathed after its body was entirely in the world. IJnless he can make this deposition — which, for obvious reasons, he can rarely be in a con- dition to do — it will be presumed that, although the child had breathed, it came into the world dead. Hence, we perceive a legal shield is effectually thrown around those who may have been really guilty of destroying their children immediately after birth. Under any moral consideration of the circumstances, it appears to me impossible to admit, that a woman who kills her child in the act of birth is less guilty of murder than she who chooses the moment of its entire expulsion to destroy it; and any such distinction, car- ried to its full extent, must virtually go to the entire abrogation of the law. It is quite necessary that medical witnesses should know what they are required to prove on these occasions ; and the following cases will, perhaps, serve to place this matter in a clear light. The killing of children which breathe during birth, not child-murder In the case of liex v. Poulton, good medical evidence was given to show that the child was living when the violence was offered to it. Of three medical witnesses, who were called, the first said in answer to questions put to him : It frequently happens that a child is born as far as the head is concerned, and breathes, but death takes place before the whole delivery is complete. My opinion in this case is, that the child had breathed, but I cannot take it upon myself to say that it was wholly born alive. The second said that death might have occurred when the child was partly bom, if no medical man was present to assist in the delivery. The third witness said : It is impossible to state when the child respired ; but there is no doubt from the condition of the lungs, when they were examined, that the child had breathed: children may breathe during birth. (Chitty, Med. Jur., 412.) The evidence here given shows that the witnesses were intelligent men ; and that they had duly reflected upon that which the hydrostatic test is really capable of proving. The judge held that this medical evidence was not sufficient : — " Something more was required than to show that a child had respired in the progress of its birth ; it must be proved that the whole body of the child was brought into the world." (See Mathews'' Digest, supp. 25; also, Archbold, (Mm. Plead., 36T.) In the case of Rex v. Simpson, tried at Winchester, in March, 1835, Baron Gurney would not allow the case to proceed against a prisoner, so soon as the medical witness stated that the lungs of the child might become distended by the act of respiration during birth. In Rex v. Brain, it was held that the child must be wholly in the world in a living state to be the subject of murder ; and in Rex v. Sellis (Norfolk Spring Circuit, 1881), Mr. Justice Coltman held, that to justify a conviction for child-murder, the jury must be satisfied that the entire body of the child was actually in the world in a living state, when the violence was offered to it. In relation to an im- portant case of infanticide, tried at the Herts Lent Assizes, 1841 (see Guyh Hospital Reports, April, 1842), the learned judge (Parke, B.) thus charged the grand jury : "With respect to all these cases (of infanticide), there is a degree of doubt whether the infant has been horn alive. The law requires that this should be clearly proved, and that the whole body of the child should have come from the body of the parent. If it should appear that death was caused during delivery, then you will not find a true bill 1" In another {Reg. V. Christopher, Dorset Lent Assizes, 1845), Erie, C. J., drew a distinction between medical (physiological) and legal life. The medical evidence clearly established that the child had respired. It was found with its head nearly severed from the body. Erie, C. J., directed the jury that before they returned a verdict of guilty, they must be satisfied that the child was completely born, that it had an existence distinct and independent from the mother, and that it was murdered by her. It was possible the child might have respired without GENERAL CONCLUSIONS ON THE HYDROSTATIC TEST. 353 being completely born into the world, and although this might medically he a live child, it was not one legally. In law, the birth of the child must be com- plete. The jury acquitted the prisoner. {Prov. Med. Jour., April 23, 1845.) In another case a medical witness was reprimanded for drawing the inference that the child was born alive, from the application of the hydrostatic test. This case was tried on the Midland Circuit in 1853 {Reg. v. Stevens'), before the late Baron Alderson. The body of the child was taken from a river : it was found in a pillow-case with a stone attached to it. There were several incisions on the throat, and the navel-string had been torn away. The state of the lungs showed that the child had breathed, and it was clearly proved to be the child of the prisoner. The medical witness is reported to have stated during his examination, that he had no doubt that the child was born alive ; upon which the learned judge reproved him for his rashness, and in- quired whether the appearances which he had observed enabled him to say more than that the child had breathed. The witness admitted they did not, and also that the child might have breathed hefore it was completely born. In his sum- ming up, the learned judge remarked, that "the medical evidence only proved that the child had breathed ; but a child may breathe before it is separated from the body of the mother, that is, before it is born, and this child may have died before it was born. We have therefore no certainty of there ever having been a person on whom murder could be committed." The prisoner was acquitted. From these decisions it will be seen that it is not sufficient for a medical witness to depose, from the state of the lungs, that the child was alive at or about the time of its birth ; according to the present views of our judges, it is indispensably necessary for him to prove that the child was horn alive, or that it was living after its body had entirely come into the world. Conclusions. — 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 while lying in the chest, the foetal lungs are not easily inflated, and that the difficulty in inflating them is great in proportion as the child is immature. 3. That lungs artificially inflated in the chest resemble those organs in which respiration has been only imperfectly established. 4. That in cases of inflation in the chest, hitherto tried, the air may be so far expelled from the divided portions of lung by firm compression as to cause them to sink. 5. That the same result occurs with lungs in which respiration has been Imperfectly established. 6. 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. T. That the artificial inflation of foetal lungs causes no alteration of weight, and as the weight increases in proportion to the degree of respiration, so in healthy lungs, with great buoyancy, there should be great weight if the air has been derived from respiration. 8. That while respiration increases the absolute weight of the lungs, it diminishes their specific weight by leading to the distension of the pulmonary cells with air. 9. That when the lungs are very heavy, and contain but little air, it cannot with certainty be inferred, that respiration has been established. The facts, cteteris parihus, may be explained by supposing that the lungs have been arti- ficially inflated. 10. That we should base our judgment of a child having breathed, upon 9.5 354 EVIDENCE OF LIVE BIRTH FROM RESPIRATION. great weight and great buoyancy of the lungs combined — that the one con- dition without the other is open to the objection, that the air may not have been derived from respiration. 11. That experiments on fcetal lungs, artificially inflated with air aftei' re- moval from the chest, have no practical bearing on this inquiry. 12. That the floating of the lungs in water proves, cceteris 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. 13. 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. 14. That the hydrostatic test is not applicable to determine the fact of respiration or non-respiration in all cases of alleged infanticide ; but that with ordinary precautions, it may be safely employed in the majority of such cases. 15. That a child may breathe before, during, or after birth, but the hydro- static test will not enable us to say, in the greater number of cases, at which of these periods the act of respiration was performed. 16. That respiration is a sign of life, and not necessarily of live birth. It. That according to the present state of the law, the killiog of a child which breathes during hirili is not murder. 18. Hence medical evidence is required to show whether a child breathed after it was entirely born ; and whether the act of violence which caused its death was applied to it while so breathing. These conclusions are here, for the sake of clearness, expressed with brevity. Some of them may appear to require qualification ; but, for the circumstances which qualify them, the reader is referred to the contents of the chapter. CHAPTER XLIII. ON THE PROOFS OF A CHILD HAVING BEEN BORN ALIVE — EVIDENCE FROM RES- PIRATION — EVIDENCE FROM MARIiB OP VIOLENCE — EVIDENCE FROM NATURAL CHANGES IN THE UMBILICAL VESSELS, THE FORAMEN OVALE, AND DUCTUS ARTERIOSUS — CLOSURE OP THE PORAMEN AND DUCT BEFORE BIRTH — EVIDENCE FROM THE DISCOVERY OP FOOD IN THE ALIMENTARY CANAL — DETECTION OF LIVE BIRTH BY THE APPLICATION OF CHEMICAL TESTS TO THE CONTENTS OF THE STOMACH — DEFECTIVE EVIDENCE — GENERAL CONCLUSIONS. The great question on a trial for child-murder is, whether the child has been born alive ; and in order to answer this it is necessary to consider what are the proofs of live birth which are available to a medical witness. Evidence from respiration. — As a general rule there will be no perceptible difl'erence in the state of the lungs, whether the act of respiration is performed, by a child during parturition or after it is born, provided that its death speedily follows its birth. Bnt 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 respiration, 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 presump- EVIDENCE OF LIVE BIRTH FROM MARKS OF VIOLENCE. 355 tion becomes still stronger when the child is immature ; for, generally speak- ing, such children must be born and continue to respire for many hours after birth, in order that their lungs should present the characters of complete respiration. The process is seldom so established before birth as to give to these organs a feeling of crepitation under pressure ; the existence of this character should, therefore, be sought for. A witness who relied upon it as a conclusive proof of respiration after birth, might be asked by counsel, 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 entire birth. ' Admitting the bare possibility of this occur- rence, he should endeavor to ascertain whether there were any probable causes thus to protract 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 when 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. Evidence from marks of violence. — If marks of violence, apparently in- flicted 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 severe violence on one part, as the head or breech, would not always justify such a presumption, because it might be fairly objected that they had been unintentionally produced by the woman in her attempts at self-delivery, and yet the child not have been born alive. It would be for a witness to form an opinion from the circumstances accompany- ing the particular case, whether they had been thus occasioned. From this it will be seen that, in making an examination after death, it is proper that every mark of injury on the body of a child should be noted down. In March, 1848, I was consulted by Mr. Prince, a former pupil, in reference to a case in which the presumption of live birth rested mainly on the degree of respiration, and the position and nature of certain marks of violence found on the child's body. The child, which was said to have been born dead, was exhumed two days after burial, and eleven days after birth, and the body examined by Mr. Prince. It was full-grown, and not putrefied ; the skin pale, and free from lividity. There was a clean cut on the right arm, divid- ing th^ membrane (fascia) and muscles, as if made by a sharp instrument. The edges were much retracted, and the whole of the wonnd was of a florid red color ; but there was no swelling or other marks of inflammation. There was a large vesicle (like the vesication of a burn) on the scrotum, containing three drachms of yellow-colored serum. On the right leg tiie muscles were exposed for nearly the whole length : the surface of the wound was of a deep scdrlet color, and the margin widely inflamed. It had the appearance as if ; fire had been applied to the leg, although there was no sign of charring. '"These facts tended to show that the child was living when the injuries were inflicted ; while the nature and situation of the injuries rendered it impossible that they could have arisen from any accident during delivery. The state of the lungs was somewhat remarkable — the left floated freely in water, and there was distinct crepitation in it : the right sank in water — no portion of it when- divided, was observed to float. From the buoyant and crepitant state of the left lung, there was reason to presume that if respiration had commenced during birth, it had continued afterwards. Mr. Prince therefore inferred that the child had been born alive : — this inference was corroborated by the appearance of the marks of violence. It is probable that the child did not 'live long after birth. The air could not have been derived from putrefaction 356 EVIDENCE FROM CERTAIN CHANGES IN THE BODY. or artificial inflation : therefore the only question here was, whether the child had breathed after its body was wholly in the world. The facts above mentioned justified the inference drawn by Mr. Prince. From a confession subsequently made by the female, it appeared that the child had been born alive, and had cried, but owing to the injuries inflicted on it, it did not sur- vive birth longer than a quarter of an hour. Although it is a rare circum- stance that one lung should become thus fully distended with air, while the Other receives none, cases of this kind are on record. Chaussier met with the left lung much more distended than the right in the bodies of children that had survived birth some hours. (Capuron, Med. Ltg. des Accouchemens, p. 411.) The general opinion is, that the right lung receives air more readily than the left, owing to the larger size and more direct course of the right bronchial tube. Evidence from certain changes in the hody In a child that has been born alive, or has survived its birth, that portion of the umbilical cord which is contiguous to the abdomen, undergoes certain changes ; thus it becomes slowly shrivelled, and separates from the body with or without cicatrization, The umbilical vessels are at the same time gradually closed. According to Billard, the obliteration of these vessels is effected in a peculiar manner. The calibre diminishes as a result of the 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 often furnished good evidence of live birth, when the other circumstances of the case were inadequate to furnish decisive proof. In the following case, for the particulars of which I am in- debted to Mr. French, it might have been suspected, but for the state of the cord, that the child had been still-born, and that its lungs had been artifi- cially inflated. The body of the child had been exhumed soon after burial, in consequence of some suspicion respecting the cause of death. It weighed nearly five pounds, and was eighteen inches long ; the opening for the navel was exactly in the centre of the body. The hair on the scalp was abont an inch in length, and plentiful ; the nails reached to the extremities of the fin- gers and toes. There was no mark of violence about it. The navel-string had separated by the natural process, but the skin around was not quite healed. The tendon of one of the muscles of the leg was prominent, and apparently contracted at the instep. The left testicle alone had descended into the scrotum — the right was still in the inguinal canal. This rendered it probable that the child had not quite reached maturity. It was by this pecu- liarity of the instep that the body of the child was identified. In the first instance the body of another child had been brought from the same burial- ground, but rejected, from the absence of this appearance of the foot. On opening the chest, the lungs were observed to be situated posteriorly, and not filling the cavity. They weighed together 861 grains — the right vceigh- ing 430, and the left 431 grains. The heart, thymus, and lungs, were placed together in water, but they immediately sank to the bottom. The lungs when separated from the other organs, floated, but with a slight degree of buoyancy. Indeed, this was established by the fact, that they sank with the heart and thymus attached. The lungs were cut into twenty-two pieces- three from the apex sank ; the remaining nineteen pieces floated, and they were not made to sink by pressure. The foramen ovale was but slightly open and contracted, as well as the ductus arteriosus, to about one-half of the foetal diameter. The bladder was perfectly empty — the intestines contained only mucus. The conclusions at the inquest were : — 1. That the child had been born alive, and had lived certainly not less than three days, and proba- EVIDENCE FROM CHANGES IN THE FCETAL VESSELS. 351 bly longer. — 2. That respiration during that time had been but imperfectly established. — 3. That in all probability it had died a natural death. The conclusions were well warranted by the medical facts. Experiments on the lungs were here not absolutely necessary, owing to the state of the umbilical cord. It might have been objected to any inference from the condition of these organs, that the facts were explicable on the supposition of their hav- ing been artificially inflated. The case, therefore, furnishes another proof of the ease with which a speculative objection on this ground may be set aside. It was subsequently proved that the child had lived eight days after birth. These changes in the umbilical cord, when found, 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 develop- ment, and in practice it is often necessary to procure some sign of survivor- ship of only a, few minutes, or at farthest of a few hours. The same remark applies to the exfoliation of the cuticle in a new-born child ; such a condition of the skin can rarely be found in cases of infanticide. The absence of me- conium from the intestines, and of urine from the bladder, are not proofs of live birth, for these may be discharged during birth, and yet the child not be born alive. Evidence from changes in the heart and foetal vessels. Docimasia circula- tionis. — It has been supposed that the state of the foramen ovale, ductus arteriosus, and canalis venosus, 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, after gradually contracting, become obliterated, or are converted into fibrous cords. Whatever may be the results of experiments on the lungs, it has therefore been contended, that the closure of the foramen and vessels would infallibly indicate that a child had breathed. This inference, however, has been too hastily drawn. Recent researches have shown, that there are some serious objections to any conclusions based on the state of the foetal vessels. The entire closure of these parts, as a natural process — always takes place slowly, and sometimes it is not complete until many years after birth. Thus, then, in the generality of cases of infanticide, in which neces- sarily the child survives but for a short period, no evidence of the fact will be procurable by an examination of the heart and foetal vessels. Ductus arteriosus. — Prof. Bernt, of Vienna, who has made many observa- tions on this subject, has arrived at the following conclusions respecting the period required for the closure of the ductus arteriosus in children which have lived after birth : — 1. If a child has lived only a few seconds, the aortal end of the duct appears contracted, and the vessel instead of being cylindri- cal throughout, acquires the form of a truncated cone. 2. If a child has lived for several hours, or a whole day, the duct becomes again cylindrical, although shortened and contracted in diameter. Its size is about equal to a goose's quill ; it is, therefore, much smaller than its root, and about as large as either of the two branches of the pulmonary artery, which have in the meantime become increased in size. 3. If a child has lived for several days or a whole week, the duct contracts to the diameter of a few lines — about equal to a crow-quill, while the two branches of the pulmonary artery are equal in size to a goose's quill. 4. The duct is found perfectly closed and quite impervious, at a much later period; i. e., after the lapse of an uncertain number of weeks or even months. Among the exceptional conditions, Bernt remarks that the contraction may be first observed at the cardiac instead of the aortal end. In one instance of a still-born child, that was resuscitated and breathed feebly for a short time, and in which the thymus gland was ab- 358 EVIDENCE FROM CHANGES IN THE FCETAL VESSELS. sent, the duct was of the size of a crow-quill, as in children which have Jived several days. He also states, on the authority of Joseph Schallgriiber, that the duct is sometimes entirely absent. {Das Verfahren bey der gerichtlich- medicinischen Ausmiltelung zweifelhafier Todesarten der Neugehornen, von Joseph Bernt, s. 67, Wien, 1826 ; also, Systematisches Handbuch der gericht- Hchen Arzneihunde, s. 275, Tierte Auflage, Wien, 1834.) The conclusions of Professsor Bernt are here given iu order to show that the natural closure of the duct is a slow process ; but the conclusions are open to many more exceptions than those admitted by the writer. Neither in his works, nor in those of other authorities on medical jurisprudence, is any case recorded which shows that the duct can become quite impervious from natural causes in a child which has lived only a few hours. Although the closure may take place as a result of the establishment of respiration, it is obvious that the time of its occurrence after birth is so un- certain as to render any evidence derivable from the non-closure altogether fallacious. I have examined the bodies of several children that have sur- vived birth for some hours, and have not been able to discover any percepti- ble alteration in the diameter of the duct either at its aortal or cardiac end. In other cases partial contraction has been apparent. As the closure depends on a diversion of blood through the lungs, so it follows that, when respira- tion is feeble or imperfect, the duct will be found either of its natural patency, or, if closed, the closure must be regarded as an abnormal deviation. In the case of a child that died at the age of ten weeks, the ductus arteriosus was found to be freely open. {Med. Gaz., vol. xl. p. 994'.) The researches of Dr. Norman Chevers have shown, that there are numerous abnormal condi- tions which may give rise to non-occlusion of the duct. {Med. Gaz., vol. xx-xvi. p. 190, and vol. xxxviii. p. 961 ; see also Orfila, Med. Leg., 1848, vol. ii. p. 212.) From the facts collected by Dr. Chevers, it appears that the duct is liable to become contracted and even obliterated, before birth, and before the child has actually breathed. In these cases there has been, in general, some abnormal condition of the heart or its vessels ; but this, even if it existed, might be overlooked in a hasty examination : hence the contracted or closed condition of the duct cannot be taken as an absolute proof that a child has been born alive or survived its birth. In January, 1847, Dr. Chevers pre- sented to the London Pathological Society, the case of a child born between the seventh and eighth months, in which this vessel was almost closed, being scarcely one-twelfth of an inch in diameter, and capable of admitting only the shank of a large pin. The tissues of the duct had altogether an appear- ance of having undergone a gradual process of contraction; and its state proved that its closure commenced previously to birth. In fact, the child survived ovXj ffteen minutes; while, according to Bernt's rule, the medical inference might have been that this child had lived a week. It is important to remark, that in this case the heart and lungs were in their normal or natu- ral state. {Med. Gaz., vol. xxxix. p. 205.) The evidence derivable from the condition of the ductus arteriosus in a new-born child, was submitted to a rigorous examination in the case of Frith. (Ayr Circ. Court of Justiciary,. Oct. 1846.) This important case was tried before the late Lord Justice Clerk, of Scotland, to whose kindness I am in- debted for a full and accurate statement of the evidence. The body of the child was found in a bag which had been buried in the sands on the seashore at Ayr, a little above high-water mark, with such marks of violence about it as left no doubt that it must have been deliberately and intentionally destroyed. Independently of severe injuries to the -throat externally, the mouth and throat internally were found to be so closely stuffed with tow and other substances, that there was some difficulty in removing them. The body when found was much decomposed; the brain was pulpy, and the cuticle, as well as the bones EVIDENCE FROM CLOSURE OP THE DUCT. 359 of the skull, were easily separated. The weight of the body was seven pounds, and the child had the characters of maturity. The prisoner had, beyond doubt, been delivered of a child about three weeks previously to the discovery of this body. It was alleged that this was her child, and she was put on her trial for the murder. The material question in the case was therefore one of identity. It de- pended on two sets of facts — ordinary and medical. The bag in which the body was found was part of a cloth covering of a cushion belonging to the mother and grandmother of the child. This being made out to the satisfac- tion of the jury, the evidence so connected the prisoner with the dead body, that the medical facts raised in the defence became only of secondary import- ance. On an inspection of the body the following appearances were met with : — The heart and lungs weighed one ounce ; the latter organs were col- lapsed. The right lung was considerably decomposed, and sank when placed on water ; the left was of a red color, iirm in texture, and floated on the surface when immersed in a vessel filled with water ; but on pressure there was no crepitation. The right side of the heart was filled with coagu- lated blood, the foramen ovale being partly open, and the ductus arteriosus impervious. The liver was large, and of a leaden hue, the ductus venosus almost obliterated, and meconium was found in abundance in the lower bowels. The reporters were of opinion, from the perfect conformation of the child's body, and the above-mentioned appearances, that it had been born alive. The circumstantial evidence established that no more than Jive hours could have elapsed from the birth of the child to the time at which its body was buried in the spot where it was subsequently found; and that, admitting it to have been born alive, there was the strongest reason to believe that it did not survive its birth more than ten minutes. The results of experiments on the lungs were not alone snflScient to show that the child had been born alive. The organs were light, and not crepitant; the right lung was decom- posed, and yet it sank in water, while the left was firm, and floated. The defect in this part of the medical evidence was, however (admitting the iden- tity), removed by the evidence of a man lodging in the prisoner's house, who deposed that he distinctly heard the child cry. He slept in the same room with the prisoner on the morning on which she was delivered, and there does not appear to have been any reason to doubt his testimony. Under these circumstances the defence taken up was, that, considering the state in which the ductus arteriosus was found, this could not have been the child of the prisoner, because, if destroyed after being born alive (which was disputed), it must clearly have been destroyed immediately after birth. In that case the ductus arteriosus could not have been found impervious ; ergo, the body found was not the body of the prisoner's child. It was contended that, according to all previous experience, the duct could not be found impervious in a child which had ceased to live within a, few minutes, or even a few hours, after birth. One medical witness for the prosecution admitted that it required some days or weeks for the duct to become impervious ; but a case was re- ported by Beck in which it had closed within a day. Another stated that it is generally a considerable time before the duct becomes closed. Medical evidence was given in defence, to the effect that the earliest case of closure was twenty-four hours, and from the state of the duct in this case, the witness considered that the child must have survived for one day at least, or not much less. Another witness stated that the discovery of the closure in a body would lead him to infer that the child had survived three or four days. According to this evidence the body produced could not have been that of the prisoner's child. The jury, however, found that the child had been born alive, but that murder had not been proven. (For reports of this case, see Med. Gaz., vol. xxxviii. p. 897; and ^rf. Monthly Journal, Nov. 1846, p. 385.) 360 AKTEEIAL DUCT AND FOKAMEN OVALE. It appears from the evidence given at ttie trial that circumstances quite irrespective of medical testimony, proved that this child had been born alive that it was the child of the prisoner, and that it could have survived its birth only a few minutes. The medical evidence left it undoubted that the child had been destroyed by violence. The facts that the mouth and throat were firmly packed with tow, and that there had been copious effusion of blood in the seats of violence, admit of no other explanation. To what, then, is the early closure of the duct in this case to be referred ? So far as I am aware, there is no instance on record of the arterial duct becoming impervious within a period of five or six hours (in this case only as many minutes could have elapsed) after birth. Its closure is naturally the result of free and perfect respiration in a healthy child ; but the state of the lungs in this instance showed that respiration had neither been full nor complete. It is probable, therefore, that the case was similar to that described by Dr. Chevers, and that there was an abnormal condition of the duct. (See ante, page 358.) Either this must be assumed, or the closure must depend on other causes than perfect respiration ; but experience shows, as a general rule, that it proceeds pari passu with this process. Admitting that this abnormal state of the duct, i. e., its closure previous to birth, is in general accompanied by malformation either of the heart or of the great vessels connected with it, yet Dr. Chevers's case already related proves that this is by no means a necessary accompaniment. Hence, con- sidering the serious responsibility attached to a medical opinion in a case of child-murder, the better rule will be to place no confidence on a contracted condition of this duct as evidence either of live birth or of the time during which the child has lived. It can only have any importance as evidence, when the death of a child speedily follows its birth ; and these are precisely the cases in which a serious fallacy is likely to arise, for the contraction or closure may be really congenital, and yet pronounced normal. If a child has lived for a period of two or three days (the time at which the duct naturally becomes contracted or closed), then evidence of live birth from its condition may not be necessary : the fact of survivorship may be snfiSciently apparent from other circumstances. Hence this species of evidence is liable to prove fallacious in the only instance in which it is required, and the case of Frith shows the dangerous uncertainty which must attend medical evidence based on the closed condition of the duct. Canalis venosus. — There is not, so far as I know, any instance of the obli- teration of this vessel previous to birth. When respiration is fully established, it collapses, and becomes slowly converted in a variable period of time, to a ligamentous cord or band, which is quite impervious. There is no doubt that in those cases in which it is stated to have become obliterated in children that could have survived birth only a few minutes or hours, the collapse of the coats has been mistaken for an obliteration of the canal. It is probably not until the second or third day after birth that its closure begins, although nothing certain is known respecting the period at which it is completed. The condition of this vessel, therefore, can throw no light upon those cases of live birth in which evidence of the fact is most urgently demanded. Foramen ovale. — This valvular opening in the heart in general becomes closed after the establishment of respiration ; but I have found it repeatedly open in children that had survived birth several hours ; and, as it will be hereafter stated, the period of its closure is as variable as in the case of the ductus arteriosus. Hence it is not capable of supplying with certainty, evi- dence of live birth, in those instances in which this evidence is most required. According to Billard, the foramen becomes closed between the second and third days ; but there are numerous cases in which it is found not closed at much later periods after birth. Dr. Handyside states that it is more or less INFANTICIDE — CLOStTRE OP THE P(ETAL VESSELS. 361 open in one ease out of eight. In 1838 two subjects were examined at Guy's Hospital, one aged fifty, the other eleven years, and in both the foramen was found open. There is, however, another serious source of fallacy, which must be taken into consideration : the closure of the foramen ovale has been known to occur as an abnormal condition previously to birth and the performance of respiration. One case is mentioned by Capuron {Med. Lig. des Accovche- mens, p. 33'!), and another, of an instructive kind, is reported in the Medical Gazette (vol. xxxviii. p. IClB). Other instances of this abnormal condition are adverted to by Dr. Chevers (Med. Gazette, vol. xxxviii. p. 96'!) ; and it appears that in these the arterial duct remained open, in order to allow of the circulation of blood, not only before, but subsequently to, respiration. The children rarely survive birth longer than from twenty to thirty hours. Dr. Chevers justly observes, that "eases of this description are of the highest importance in a medico-legal point of view, as' they fully disprove the opinion maintained by many anatomists, that obliteration of the foramen ovale must be received as certain evidence that respiration has been established. It is assuredly impossible to deny that in the heart of a child which has died within the uterus, and has been expelled in a putrid condition, the foramen ovale may be found completely and permanently closed. In such cases as these it would, however, probably be always possible to determine, by an examination of the heart and its appendages, that the closure of the foramen had occurred at some period antecedent to birth." It would, therefore, be unsafe in prac-, tice to rely upon the closure of this aperture as a proof of live birth, in the absence of other good evidence : and in no case can its patency be regarded as a proof that a child has come into the world dead. Dr. Kidd met with the case of a new-born child, in which a thick layer of lymph had been depo- sited across the aperture so as nearly to block it up. The ductus arteriosus was completely closed. The child could not have survived its birth more than a few hours (Assoc. Journal, Feb. 4, 1853, p. 104). This deposit of lymph is a condition not usually found. Dr. Peacock considers that the foramen is closed by the contraction of muscular fibres of which the valve is constituted. In a medico-legal point of view, the patency or closure of this aperture pos- sesses no longer any importance. (Assoc. Journal, Feb. 25, 1853, p. HT.) As a general rule, these peculiar parts of the foetal circulation are rarely obliterated by a normal process before the eighth or tenth day after birth. The obliteration, according to Bernt and OrBla, takes place in the following order : 1. The umbilical arteries. 2. The canalis venosus. 3. The ductus arteriosus; and 4. Theforamen ovale. (Orfila, Med. L&g., 1848, vol. ii. p. 210.) The circumstances connected with the closure of these foetal vessels have been statistically investigated by Dr. Elsasser. Among 70 still-born children they were found open in 69. Among 300 children who died soon after birth, 80 out of 108 prematurely born, and living from one to eight days, presented all the passages open: 127 out of 192 infants born at the full time had all the passages open but partly contracted. The ductus arteriosus was open in 55 cases, and completely closed in 10 cases; the canalis venosus was open in 81, and completely closed in 37 cases ; while the foramen ovale was open in 47, and completely closed in 18 cases. These facts, according to Dr. Elsasser, prove 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. This physiologist remarked that the closure commenced and was often completed in the canalis 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 instances of obliteration before birth or before the period mentioned after birth, must be regarded as rare exceptions. (Med. Times and Gaz., May 21, 1853, p. 530.) 362 INFANTICIDE — TESTS FOR FOOD IN THE STOMACH. The result of this inquiry respecting Professor Bernt's docimasia circula- tionis is essentially negative: it either proves nothing, or it may lead the medical witness into a fatal error. It has been the more necessary to point out the serious fallacies to which it is liable, because hitherto medical jurists have been disposed to place great reliance upon it, in cases in which evidence from the state of the lungs was wanting. The necessity 'of these facts being known is shown by the case which occurred at Ayr {ante, p. 359), in which great reliance appears to have been placed upon the following statement by Dr. Beck: "If, therefore, the ductus arteriosus be found cylindrical in its shape, and not contracted towards the aorta, and if it equal in size the trunk of the pulmonary artery, the inference would be that the child was not born alive. On the other hand, if the ductus arteriosus be contracted towards the aortal end, and if its size be much less than the trunk of the pulmonary artery, the inference would be, that the child had been born alive." (JBeck's Med. Jur., 5th edit. p. 251.) From a consideration of the preceding facts, it'will be seen that such inferences might seriously mislead a court of law. Evidence from the state of the alimentary canal. — Good evidence of live birth may be sometimes derived from the discovery of certain liquids or solids in the stomach and intestines, such as blood, milk, or farinaceous or saccha- rine articles of food ; for it is not likely that these substances would be intro- duced or swallowed during parturition, nor is it at all probable that they should find their way into the stomach or intestines of a child which was really born dead. Starch. — In the case of a new-born child, Dr. Greoghegan, discovered, by the application of iodine water, the presence of farinaceous food in the con- tents of the stomach ; hence the question of live birth was clearly settled in the affirmative. In a more recent case. Dr. Francis, of Manchester, employed this mode of testing, with satisfactory results, even when the investigation was beset with unusual difficulties. He was required by the coroner to ex- amine the body of a new-born 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 established by the discovery in the stomach of a small quantity of farinaceous food. On digest- ing a fragment of the pulp found in this organ with distilled water, and add- ing a drop of a weak solution of iodine, an intense indigo-blue color appeared immediately. The application of this chemical test, therefore, removed any doubts which might have been entertained on the question of live birth. {Med. Gaz., vol. xxxvii. p. 460.) Sugar. — In one case which I was required to examine, the presence of sugar was easily 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 solu- tion of sulphate of copper should be added to a portion of the concentrated aqueous extract of the contents of the stomach. An excess of a solution of pure potash is then added, and the liquid boiled. If sugar be' present, the sub-oxide of copper is immediately precipitated of a reddish-brown color. With white sugar the same decomposition is effected, but more slowly. If starch be present, black oxide of copper may be thrown down, but there is no reduction. The production of the red oxide proves that some saccharine substance is present. Milk. — This liquid, or its principle casein, forms a rich violet-blue solution with a few drops of a solution of sulphate of copper, and an excess of caustic potash. The red suboxide will be thrown down on boiling, if sufficient lacline (sugar of milk) be present. Casein, or the curd of milk, owing to its con- taining a trace of sugar, acts in a similar manner, but the decomposition takes place more slowly. Albumen forms a deep violet-blue solution with potash and sulphate of NATTJEAL CONTENTS OE STOMACH — EVIDENCE DEFECTIVE. 363 copper, but the red suboxide is not precipitated on boiling. Either there is no effect, or if the caustic potash be in large quantity, the black oxide falls down. An instance is related by Dr. Doring, in which a spoonful of coagu- lated Mood was found in the stomach of a new-born child. The inner sur- faces of the gullet and windpipe were also covered with blood. Dr. Doring inferred from these facts, that the child had been born alive ; for the blood, in his opinion, must have entered the stomach by swallowing, after the birth of the child, and while it was probably lying with its face in a pool of blood. (See on this subject Menheh Zeitschrift, 1842, vol. ii. p. 219.) In forming a judgment in a doubtful case, a question may arise whether any and what substances naturally exist in the stomach of a foetus born dead. Dr. Robinson has drawn the following conclusions from his observations on the stomachs of two human foetuses, and on those of the calf, lamb, and rab- bit : 1. That the stomach of the foetus, during the latter period of its uterine existence, invariably contains a peculiar substance, differing from the uterine liquid (liquor amnii), and generally of a nutritious (?) nature. 2. That in physical and chemical properties, this substance varies very much in different animals, being in no two species precisely similar. 3. That in each foetal animal the contents of the stomach vary much at different periods ; in the earlier stages of its development consisting chiefly of liquor amnii, to which the other peculiar matters are gradually added. 4. That the liquor amnii continues to be swallowed by the foetus up to the time of birth ; and, conse- quently, after the formation of those matters and their appearance in the stomach. 5. That the mixture of this more solid and nutritious substance with the liquor amnii constitutes the material submitted to the process of chymification in the foetal intestines. He considers the contents of the alimen- tary canal to be chiefly derived from the salivary secretion. It is his opinion that there is no gastric juice secreted until respiration is established. The medical jurist will perceive, therefore, that the discovery of farinaceous food, milk, or sugar in the stomach, will furnish evidence of birth ; since sub- stances of this kind are not found in the fcetal stomach. The substances which naturally exist in the stomach of the foetus are of an albuminous and mucous nature. Evidence from the mode ofhirih. — It has been suggested that when a child is born by the feet, and there are full marks of respiration in the lungs, the mode of birth will at once establish that the body of the child must have been entirely in the world in order that the breathing should have taken place. Dr. W. B. Herapath met with an instance of this kind in September, 1858, and communicated the particulars to me. It is assumed that the head, under these circumstances, is born instantaneously, and that the child cannot breathe until the head is released from the outlet. Before such a conclusion can be drawn, there must be clear evidence that the child was actually born by the feet. Dr. Herapath has published a report of the case on which his opinion was requested, as well as the grounds on which he would rely to establish the fact that a child had been born by the feet. {British Med. Journ., May 15, 1859.) Defective evidence. — The slightest consideration will show that the signs of live birth above described are weak, and of purely accidental occurrence. If a child is destroyed during birth, or within a few minutes afterwards, there will be no medical evidence to indicate the period at which its destruction took place. The external and internal appearances presented by the body would be the same in the two cases. It is most probable that, in the greater number of instances of child-murder, the 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 be made, it is with respect to the nature, situation, and extent of marks of violence ; but 364 INFANTICIDE — CONCLUSIONS ON LIVE BIRTH. the presence of these depends on mere accident. Hence, then, we come to the conclusion, that although medical evidence can often 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 certainly continued after its birth. We could only venture upon this inference when the signs of respiration were full and complete, or when food was found in the stomach. Why the de- struction of a child should be treated in the one case as a venial offence, and in the other as a capital crime, is one of those anomalies in our criminal juris- prudence for which it is impossible to account. The inference which we may draw from these observations is, that if positive proof of entire live birth be in all cases rigorously demanded of medical witnesses on trials for child- murder, it is scarcely possible, when the prisoner is ably defended, that any conviction for the crime should take place. The only exception would be, where a confession was made by the accused or the murder was actually per- petrated before eye-witnesses. The numerous acquittals that take place on trials for this crime, in face of the strongest medical evidence, bear out the correctness of this opinion. The child is proved to have lived and breathed, but the medical evidence fails to show that the living and breathing took place or continued after entire delivery. [For some judicious remarks on this defective state of the law, see Prov. Journ., April 2, 1851, p. 182.] 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 horn alive, are as follows: — 1. That if the lungs be fully and perfectly distended with air by the act of respiration, this affords a strong presumption that the child has been horn alive, since respiration during birth is in general only partial and imperfect. 2. That the presence of marks of severe violence on various parts of the body, if possessing vital characters, renders it probable that the child was entirely 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 umbilical cord, as well as a general peel- ing 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 entirely 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 arte- riosus, furnishes no evidence of a child having been born alive. These parts may become closed and contracted before birth, and, therefore, in a child born dead ; or they may remain open after birth in a child born living, even after the establishment of respiration. 6. That the presence of farinaceous or other food in the stomach proves that a child has been entirely born alive. t. That, irrespective of the above conclusions, there is no certain medical sign which indicates that a child, that has died at or about the time of birth, has been entirely born alive. PERIOD OF SURVIVORSHIP. 365 CHAPTER XLIV. RULES FOR BETERMINING THE PERIOD OF SURVIVORSHIP IN CHILDREN THAT HAVE BEEN BORN ALIVE — APPEARANCES INDICATIVE OF A CHILD HAVING LIVED TWENTY-FOUR HOURS — FROM TWO TO THREE DAYS — FROM THREE TO FOUR DAYS — FROM FOUR TO SIX DAYS — FROM SIX TO TWELVE DAYS — UN- CERTAINTY OF MEDICAL EVIDENCE ON THE PERIOD WHICH HAS ELAPSED SINCE THE DEATH OF A CHILD — PROCESS OF PUTREFACTION IN THE BODIES OF NEW-BORN CHILDREN — GENERAL CONCLUSIONS. If we suppose it has been clearly established, that a child not only lived but was actually horn alive, it may be a question whether it lived for a cer- tain number of hours or days after it was born. The answer to this question may be necessary in order to connect the deceased child with the supposed mother. It has been remarked that scarcely any appreciable changes take place in the body of a living child, until after the lapse of twenty-four hours ; and these changes may be considerably affected by its degree of maturity, healthiness, and vigor. The following may be taken as a summary of the appearances in a child that has survived its birth for different periods : — 1. After twenty-four hours. — The skin is firm and pale, or less red than soon after birth. The umbilical cord is somewhat shrivelled, although it remains soft and bluish-colored, from the point where it is secured by a liga- ture, to its insertion in the skin of the abdomen. The meconium is discharged ; but a green-colored mucus is found on the surface of the large intestines. The lungs may be more or less distended with air, although in a case of sur- vivorship for a period longer than this, no trace of air was found in them. With regard to the state of the lungs, it should be remembered that when these organs are fully and perfectly distended, the inference is that the child has probably survived many hours ; but the converse of this proposition is not always true. Several cases already reported show that when the lungs contain a small quantity of air, it does not follow that the child must have died immediately after it was born. 2. From the second to the third day. — The skin has a yellowish tinge, the cuticle sometimes appears cracked, a change which precedes its separation in scales. {Bevergie, vol. i. p. 519.) The umbilical cord is brown and dry between the ligature and the abdomen. 3. From the third to the fourth day. — The skin is more yellow and there is an evident separation of the cuticle from the skin of the chest and abdomen. The umbilical cord is of a brownish-red color, flattened, semi-transparent, and twisted. The skin in contact with the dried portion presents a ring of vas- cularity or redness ; but Dr. Geoghegan met with this appearance in two cases of still-born children, and I have also seen it in four cases in which the child- ren were born dead. {G. H. Eep., April, 1842.) The colon is free from any traces of green mucosity. 4. From the fourth to the sixth day. — The cuticle in various parts of the body is found separating in the form of minute scales or of a fine powder. The umbilical cord separates from the abdomen usually about the ffth day, but sometimes not uiitil the eighth or the tenth. The membranous coverings become first detached, then the arteries, and afterwards the vein. If the umbilical aperture is cicatrized and healed, it is probable that the child has lived from three weeks to a month after birth. The ductus arteriosus may 366 CHANGES IN THE DEAD BODY — CONCLUSIONS. be found contracted both in length and diameter ; the foramen ovale may be also partly closed. 5. From the sixth to the twelfth day. — The cuticle will be found separating from the skin of the limbs. If the umbilical cord was small, cicatrization will have taken place before the tenth day after birth. If large, a sero-purnlent discharge will sometimes continue for twenty-five or thirty days. The ductus arteriosus is said to become entirely closed during this period ; but this state- ment is open to exceptions which have been elsewhere pointed out {ante, p. 358). It need hardly be observed that the body rapidly increases in weight when the child has enjoyed active existence. On the whole, it will be seen that the signs of survivorship for short periods after birth are not very distinct. There is commonly no difiBculty in deter- mining the fact after the second day. The changes stated to take place in the umbilical cord during the first twenty-four hours, may be observed in the deadi as well as in the living child ; and the other changes occur with much uncertainty as to the period. These are, however, I believe, the principal facts upon which a medical opinion on such a subject can be based ; and it is in some respects fortunate, that great precision in assigning the time of survivorship is not demanded of medical witnesses. Putrefaction in the new-lorn child. — A practitioner may be further re- quired to state how long a period has elapsed since the death of the child. The answer to the previous question was derived from the changes which take place in the body of a child during life, while, in relation to the present inquiry, we must look to those which occur in the body after death: in other words, to the different stages of putrefaction. From the observations of Orfila, it would appear that the body of an infant putrefies more rapidly than that of an adult. {Traits des Exhumations.) In forming a judgment on tbis point, due allowance must be made for the influence of temperature, humidity, and the free access of air. If the body has been sunk in water, putrefaction takes place more slowly than usual, and the process is slower in running than in stagnant water. When the body is floating on the surface of water, so as to be at the same time exposed to air, then putrefaction takes place very rapidly : — and this also happens when the body, after removal from water, has been exposed to the air for some time. Putrefaction is retarded when the deceased child has been buried in the ground in a box or coffin, unless the process had commenced prior to interment. When the body has been cut up and mangled before being thus disposed of, putrefaction takes place with much greater rapidity. (The Queen v. Railton, Stafford Winter Assizes, 1844.) Conclusions. — The general conclusions respecting survivorship are : — 1. That the period for which a new-born child has survived birth cannot be determined by any certain sign for the first twenty-four hours. 2. That after this period, an inference may be drawn from certain changes which take place progressively in the skin and umbilical cord externally, and in the viscera on inspection ; — that these changes allow only of an approxi- mate opinion within the first five or six days. 3. That the contraction of the foramen ovale and ductus arteriosus takes place from natural changes at such uncertain intervals, as to render it difficult to assign a period of survivorship from the state of these parts. 4. That the period which has elapsed since the child died, after it was born, can only be determined by observing the degree of putrefaction in the body compared with temperature, locality, and other conditions to which it has been exposed. CAUSES OF DEATH IN NEW-BOEN CHILDREN. 36t CHAPTER XLY. CAUSES OE DEATH IN NEW-BORN CHILDREN — PROPORTION OF CHILDREN BORN DEAD — NATURAL CAUSES OF DEATH — A PROTRACTED DELIVERY — DEBILITY — HEMORRHAGE — LACERATION OP THE CORD — COMPRESSION OP THE CORD — MALFORMATION — DESTRUCTION OP MONSTROUS BIRTHS ILLEGAL — DEATH PROM CONGENITAL DISEASE. GENERAL CONCLUSIONS. Causes of death in new-horn 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 originated in acci- dent or in criminal design. The last case only involves the corpus delicti 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 thenceforth at an end. Proportion of children horn dead. — It is well-known that of children born under usual circumstances, a great number die from natural causes either during birth or soon afterwards : and in every case of infanticide, death will be presumed to have arisen from some cause of this kind, until the contrary appears from the evidence. This throws the onus of proof entirely on the prosecution. Many children die before performing the act of respiration ; and thus a large number come into the world still-born or dead. The pro- portion of still-horn among legitimate children, as it is derived from statisti- cal tables extending over a series of years, and embracing not less than eight millions of births, varies from one in eighteen to one in twenty of all births. {B. and F. Med. Rev., No. Y, p. 235.) The late Dr. Lever found, that among three thousand births, one child in eighteen was born dead. In im- mature and illegitimate children, the proportionate mortality is much greater, probably about one in eight or ten. In Gottingen the deaths were found to amount to one in seven, and in Berlin, to one in ten. {Ed. Med. and Surg. Jour., vol. xxxvi. p. 172.) Males are more frequently born dead than females, in the ratio of 140 : 100 — while the males to females born, has only a ratio of 106 : 100. (Dr. Simpson, Ed. Med. a7id Surg. Jour., Oct. 1844, p. 395.) The preponderance of still-births among males is ascribed to the large size of the head, and the injury thus likely to be inflicted on the brain during de- livery. Still-births are much more frequent in first than in after pregnancies. These facts should be borne in mind, when we are estimating the probability of the cause of death being natural. Should respiration be established by the protrusion of the child's head from the outlet, or the birth of its body, the chances of death from natural causes are considerably diminished. Never- theless, as Dr. Hunter long ago suggested, a child may breathe and die. Thus, according to this author — " If the child makes but one gasp and in- stantly 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 swim readily in water; but waiving this point, the real question is — If the child breathed 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 368 INFANTICIDE — NATURAL CAUSES OF DEATH. criminal nature. So again observes Dr. Hunter: "We frequently see chil- dren 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 hour or two, die in spite of all our attention. And why may not this misfor- tune happen to a woman who is brought to bed by herself ?" ( Op. cit.) The suRstance of this remark is, that many children may die naturally after birth; and in Dr. 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 instances where there are the most obvious marks of severe and mortal injuries on the body of a child ; and un- less it be intended to defend and justify the practice of infanticide, it must be admitted that the discovery of violence of this kind on the body of a new- born infant, renders a full inquiry into the circumstances necessary. Among the natural 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 uterus, or from an interruption to the circulation in the umbilical cord before respi- ration is established. A child, especially if feeble and delicate, may die from exhaustion under these circumstances. This cause of death may be suspected when a sero-sanguinolent tumor (called cephalamatoma, or caput succeda- neum) is found on the head of a child, and the head itself is deformed or elongated : — internally by the congested state of the cerebral vessels. The existence of deformity in the pelvis of the woman might corroborate this view ; but in primiparous females (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 arisen accidentally in attempts at self-delivery. 2. Debility. — A child may be born prematurely, or at the full period, and not survive its birth, owing to a natural feebleness of system. This is espe- cially observed with immature children ; and it is the condition more espe- cially dwelt on by Dr. Hunter. Such children may continue in existence for several hours, feebly respiring, and then die from mere weakness. These cases may be recognized by the appearance of a general want of development ' in the body. 3. Hemorrhage. Laceration of the cord. — A child may die from loss of blood, owing to a premature separation of the placenta or an accidental rup- ture of the umbilical cord. In the latter case it is said the loss of blood is not likely to prove fatal if respiration has been established ; but an instance is reported in which a child died from hemorrhage even under these circum- stances. (Henlce's Zeitschrift, 1839, Erg. H. p. 200 ; also, 1840, vol. i. p. Mn, and vol. ii. p. 105. Ann. d'Hyg., 1831, vol. ii. p. 128.) Bleeding from the cord has in some cases taken place at various periods after birth, and has led to the death of the child. (^Ed, Month. Journ., July, \M*l, p. 70.) Death from hemorrhage may be commonly recognized by the blanched appearance of the body and a want of blood in the internal organs; but there are several cases on record in which the cord was ruptured close to the ab- domen without causing the death of the child. It was formerly a debated question whether, in the event of the umbilical cord being left untied after cutting or laceration, such a degree of hemorrhage could in any instance oc- cur as would prove fatal to a child. The case just now referred to renders it unnecessary to discuss this question. Bleeding is more likely to prove fatal when the cord is divided by a sharp instrument, than when it is lace- rated ; and its dangerous effects on a child are likely to be great in propor- tion as the division is made near to the navel. It has been improperly described as a case of infanticide by omission, when a self-delivered woman neglects to apply a ligature to the cord under these circumstances ; because, DEATH DURING DELIVERY — MALFORMATION. 369 St is said, she ought to know the necessity for this in order to prevent the child dying from hemorrhage. Such a view assumes not only malice against the accused, but that in the midst of her distress and pain she must necessarily possess the knowledge and bodily capacity of an accoucheur — a doctrine wholly repugnant to the common feelings of humanity. This question was, however, actually raised in the case of the Queen v. Dash, August, 1842, There was no doubt in this instance that the child had breathed, and that its death had been caused by bleeding from the lacerated umbilical cord. The medical witness properly admitted, that the cord might have been torn through by the mere weight of the child during labor; and the jury acquitted the prisoner on the ground that she might have been ignorant of the neces- sity or not have had the power to tie the cord. The cord, especially when short, may become accidentally ruptured during delivery. A case of this kind occurred to Mr. Mackie. (Med. Times, July 24, 184t, p. 433.) T.he child was born alive, after a strong pain, and on examination it was found that the cord was torn through at about an inch from the abdomen. Bleeding from the vessels of the cord 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. Mr. Willing has reported a case of this kind, in which, in spite of every application, the child died from loss of blood six days after the separation of the cord. (Med. Times and Gaz., March 25, 1854, p. 281.) 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. 4. Compression of the cord. — When a child is born by the feet or buttocks, the cord may be so compressed under strong uterine contraction that the cir- culation between the mother and child will be arrested, and the latter will die. The same fatal compression may follow when, during delivery, the cord becomes twisted round the neck. A child has been known to die under these circumstances before parturition, the cord having become twisted round its neck in utero. (Med. Gaz., Oct. 1840, p. 122.) Other cases from this cause, during delivery, will be found in the same journal. (Vol. xix. pp. 232, 233.) On these occasions, the child is sometimes described to have died from stran- gulation ; but it is evident that before the establishment of respiration such a form of expression is improper. There are few or no appearances indica- tive of the cause of death. There may be lividity about the head and face, and cerebral congestion internally ; it is, however, proper to state, that the brain of a child is always more congested than that of an adult. 5. Malformation. — There may be a deficiency 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 had occasioned the child's death. (Med. Gaz., vol. xxvi. p. 542. In a third, recorded by Mr. Pairbairn, a child was suffocated by retraction of the base of the tongue, owing to defect of the frasnum. (North Jour. Med., March, 1849, p. 278.) The varieties of malformation are very numerous, but there can be no difficulty in determining whether they are such as to account for death. Individuals are not allowed to destroy these monstrous births ; and the presence of all 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. Mr Pooley, of Cirencester, communicated to me a case which occurred some years since in his practice : — A lady was delivered of a most hideous dice- phalous monster. In his absence, and at the earnest solicitations of the friends, the nurse destroyed it. The question was — Was this woman guilty 3T0 GENERAL CONCLUSIONS. of child-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 malforma- tion of the head, in consequence of which it was likely that it could not sur- vive many hours. There did not appear to have been any 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 absence of mali- cious intention would probably lead to an acquittal on a charge of murder ; but such an act would doubtless amount to manslaughter. The degree of monstrosity or the viability of the offspring cannot be received as extenuat- ing circumstances ; as to the first, if a liberty of judging what was monstroug 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 the offspring is not likely to live more than a few hours, does not justify the act of one who prematurely destroys it. 6. Congenital disease. — It has been elsewhere stated, that a child may be born laboring under such a degree of congenital disease as to render it inca- pable of living. The discovery of any of the Toetal organs in a merely mor- bid condition, amounts to nothing, unless the disease has advanced to a de- gree which would be suflficient to account for 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 body. Ac- cording to Dr. Burgess, apoplexy and asphyxia are common causes of death among new-born children. (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 medico-legal view; because, by directly affecting the organs of respiration, they render it impossible for a child to live or to survive its birth for a long period. These diseases iu the foetal state are principally conges- tion, hepatization, tubercles, scirrhus, and 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 buoy- ancy which in their healthy 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. The lungs may not be found diseased, but simply in that state which has been elsewhere de- scribed under the name of atelectasis {ante, p. 337). The causes upon which this condition of the lungs depends, are not well understood. The non- establishment of respiration sometimes arises from 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 new-born child by suffocation. (-S2. Month. Jour., July, 1847, p. 64.) Conclusions. — The following conclusions may be drawn from the preceding remarks : — 1. That a large number of illegitimate children, especially when immature, 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 in the constitution either to commence or to continue the act of respiration. 4. A child may die from loss of blood, owing to accidental rupture of the cord during delivery. It may even die from this cause after it has breathed. 5. That fatal bleeding is more likely to occur when the cord has been cat close to the abdomen, than when it has been lacerated or cut at a distance from the navel. INFANTICIDE — VIOLENT CAUSES OF DEATH. 371 6. That the division of the cord, whether by rupture or incision, without 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 delivery — the circulation between the mother and child being thereby arrested before respiration has commenced. 8. Thai death may speedily follow birth, from some malformation or defect of important organs. 9. That a child may die from congenital disease affecting the organs of respiration or the air-passages. CHAPTER XLVI. VIOLENT CAUSES OP DEATH. — FORMS OF VIOLENT DEATH UNATTENDED BY MARKS OF EXTERNAL VIOLENCE — SUFFOCATION — DROWNING — IN THE SOIL OF PRIVIES — POWER OF LOCOMOTION AND EXERTION IN FEMALES AFTER DELIVERY. — DEATH OF THE CHILD FROM COLD AND EXPOSURE — STARVATION — IMMATURITY IN CASES OF ABORTION. — WOUNDS, EVIDENCE FROM, IN NEW-BORN CHILDREN — FRACTURES OF THE SKULL, SPONTANEOUS AND CRIMINAL — DEATH OF THE CHILD FROM DELIVERY IN THE ERECT POSTURE — ACCIDENTAL INJURIES IN UTERO — DEFICIENT OSSIFICATION — TWIStING OF THE NECK. — VIOLENCE IN SELF-DELIVERY GENERAL CONCLUSIONS. Violent causes of death. — In this chapter we shall have to consider those modes of death which are totally independent of the existence of congenital disease or other natural causes. It is proper for the medical jurist to remem- ber that there are certain forms of child-murder which are not necessarily attended with any appearance indicative of violence — these are, suffocation, drowning, exposure to cold, and starvation. 1. Sijffocation. — This is a very common cause of death in new-born child- ren. A wet cloth may be placed over the child's mouth, or thrust into that cavity during birth or afterwards, and before or after the performance of respiration. To the latter case only could the term suffocation be strictly applied. A child may be thus destroyed by being allowed to remain closely compressed under the bedclothes after delivery, or by its head being thrust into straw, feathers, and such-like substances. The appearances in the body 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 congestion in 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, dust, tow, or a hard plug of linen, may be, and in some cases have been, found blocking up the mouth and fauces {ante, p. 359, joos<, Suffocation). Again, a child may be suffocated by having its head held over noxious vapors, as the exhalations of a privy or of burning sulphur ; and it is here necessary to remind the medical jurist that other highly poisonous vapors may be used by a criminal without leaving any trace upon the body, except, possibly, that which may depend upon their peculiar odor. There are few of these cases of suffocation in which a medical opinion of the cause of death could be given, unless some circumstantial evidence were produced, and the witness were allowed to say 372 ACCIDENTAL SUFFOCATION OF INFANTS. whether the alleged facts were sufficient to account for death. {Annak$ d'Hyg., 1832, t. i. p. 621.) On the other hand, if it be even clearly proved that death has been caused by suffocation, it must be remembered that a child may be accidentally suf- focated, and the crime of murder falsely imputed. Dr. Hunter, who was well aware of the risk to which a female might be thus exposed, observes in relation to this point — "When a woman is delivered by herself, a strong child may be born perfectly alive, and die in a very few minutes for want of breath, either by being on its face in a pool formed by the natural discbarges, or upon wet clothes ; — or by the wet things over it collapsing and excluding air, or drawn close to its mouth and nose by the suction of breathing. An unhappy woman delivered by herself, distracted in her mind and exhausted in her body, will not have strength or recollection enough to fly instantly to the relief of her child." {Op. cit., 35.) It may be added that a primiparons female may faint or become wholly unconscious of her situation ; or if con- scious, she may be ignorant of the necessity of removing the child, and thu,s it may be suffocated without her having been intentionally accessory to its death. In such cases, however, there should be no marks of violence 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 accidental origin. An infant is very easily destroyed by suffocation. If the mouth and nostrils 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. A suspicion of murder may arise in such cases; but the absence of marks of violence, with an explanation of the circum- stances, will rarely allow the case to be carried beyond an inquest. Some- times the body is found maltreated, with severe fractures or contusions on the skull, with marks of strangulation on the neck — concealed in a feather- bed or privy — or cut up and burnt. This kind of violence may properly excite a suspicion of murder, and lead to the belief that the allegation of death from accidental suffocation is a mere pretence. This, however, is purely a question for a jury, and not for a medical witness. Unless the case be of a very 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, neglect, or indifference on her part. The following case (the Queen v. Mortihoys), tried in 1841, will show that even when the evidence is strong against a person, the circumstances will be favorably interpreted. In this instance it was proved that the body of the child was discovered in a box containing wool : it was lying on its abdomen, with its face raised and its mouth open. A red worsted comforter had been passed twice round the neck, and was tied a second time in a single knot over the chin. In the mouth, which was open, was found a small quantity of fine flocks of wool. The medical evidence showed that the child had been born alive, the left lung being fully inflated. The brain was congested. There was no mark produced by the ligature on the neck, either externally or internally. Death was referred to obstructed respiration (suffocation), caused partly by the ligature and partly by the wool in the mouth — but the latter was considered to be the more active cause. In the defence it was urged that the ligature could not have produced strangulation, because the comforter was tied upon the chin — that the medical evidence showed the wool in the mouth to have been the immediate cause of death — this was probably taken into the mouth by the child itself in the instinctive action of DEATH TROM DROWNING. 373 breathing, and not put there by the prisoner for the purpose of suffocation. The child had probably been placed carelessly on a quantity of wool, into which it had sunk by its own weight, and this had caused its death. It is reported that the judge joined in this view, and in charging the jury, said, that had the prisoner intended to choke the child with the wool, she would have inserted enough to fill its mouth. The prisoner was acquitted. In this case, admitting that the evidence did not bear out the charge of murder, still it is pretty clear that death was caused by the child being placed on its face, with a ligature round the neck, in a close box filled with wool. Admitting the facts to have been as represented, there appears to have been in this case something more than an accident : for the prisoner must have known that a new-born infant was not likely to live long under such circumstances, and had the child been a week or a month old she would probably have been convicted of manslaughter or murder. A case of alleged infanticide, by suffocation, has been reported by Dr. Easton. {CorrnacJc's Journal, Feb. 1845.) There is no doubt that the child in this case was suffocated by a quantity of mud being forced into its mouth and throat. Its presence in the gullet was incompatible with its having entered by gravitation. In the case of Macintt/re (Glasgow Aut. Circ, 1829), several small pieces of straw were found in the stomach of a child, of the same kind as those which were in the bed where the birth took place. In another case reported by Dr. Littlejohn, it was found that a mass of dough, or bread-pulp, had been forcibly impacted in the throat and larynx of the child. It was found to be accurately moulded to the parts. (£!d. Med. Journ., December, 1855, p. 521.) 2. Drowning. — The fact of drowning cannot be verified by any appear- ances on the body of a child which has not breathed. Thus, if a woman caused herself to be delivered in a bath, and the child was forcibly retained under water (a case which is said to have occurred), it would of course die ; bat no evidence of the mode of death would be found in the body. [For a case in which a child was thus destroyed, probably however through acci- dental circumstances, see Cormack^s Ed. Journal, Oct. 1845, p. 796.] After respiration the signs of drowning will be the same as those met with in the adult. (See •post. Drowning.) The main question for a witness to decide, will be whether the.child was put into the water living or dead. In- fanticide by drowning is by no means common : — the child is generally suffo- cated, 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 so 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 drowning, should be such as to have re- suited from accidental causes. It is not necessary that the whole of the body should be submerged, in order that a child should be destroyed by drowning : the mere immersion of the head in water will suffice to produce all the usual effects. The air passages should therefore be examined for foreign sub- stances. A case occurred in London in 1842, in which a woman attempted to destroy her child by immersing its head only in a bucket of water. The child was discovered, and resuscitated. New-born 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 purposes of concealment. Should there be a large quantity of liquid present, the phenomena are those of drowning. This liquid abounding in hydrosulphuret of ammonia may then be found, if the child was thrown in living, in the air-passages, gullet, or stomach. The mere discovery of soil in the mouth would not suffice to 3T4 INFANTICIDE — DEATH FKOM SUFEOOATION. show that the child was living when immersed. The presence of foreign substances, such as dirt, straw, or ashes in the air-passages, gullet, and sto- mach, has usually been taken as a medical proof of the child having been living when immersed in the dirt, &c., and that the substances had been drawn into the passages by inspiration or the act of swallowing. Here, however, there is a wide field for conflicting medical opinions. In Seg. v. AUridge (Derby Winter Assizes, 1859), the dead body of a child was found buried in a garden. On examination, there was earth in the mouth and throat, and in both nostrils at the back part; and particles of earth were found in the windpipe and bronchi, as well as in the stomach. The medical witness referred the death to suffocation, and considered that the earth must have been inhaled. Another medical witness, called for the defence, affirmed that the earth might have been carried into the passages of the body acci- dentally by the percolation of water (in eight days), and that it had not fonnd its way there by inhalation. The jury upon this acquitted the prisoner. Although the mouth and throat may thus receive accidentally foreign mat- ters, it is improbable that earth should be carried into the bronchi or stomach. The child was probably thrust into the earth with some power of breathing and swallowing, and the earth found in the month and throat might be as- signed to the violence with which it was forced into the soil. The nature of the soil, and the circumstances under which the dead body is fonnd, must materially guide a medical opinion in cases of this nature. This subject has been fully examined by Dr. Marklin {Casper's Vierteljahrsch, 1859, vol. ii. p. 32), and by Dr. Simeons, in the same jotirnal, 1860, vol. ii. p. 287. On these occasions, the defence may be — 1, that the child was born dead, and that the body was thrown in for concealment ; but the medical evidence may show that the child had breathed and had probably been born living. 2. It may be alleged that the child breathed for a few moments after birth, but then died, and that the female thus attempted to conceal the 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 most commonly urged, that the woman being compelled to go to the privy, was there delivered unconsciously, and that the child dropped from her, and was either suffocated or .prevented from breathing. All these circumstances may readily occur, but on the other hand the explana- tion may be inconsistent with medical facts. Thus the head or the limbs of a child may be found to have been separated or divided by some cutting in- strument — 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 umbilical cord 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 be found rup- tured. The practitioner should make a careful examination 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. Mr. Higginson, of Liverpool, has lately published 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 nearly as sharp-edged and flat as if cut." {Med. Gaz., vol. xlviii. p. 985.) This case goes to prove that a careless or hasty examination of the ends of the cord may lead to a serious mistake. Sometimes the mark of a previous cut may be found on the cord near one of its divided ends — the first cut with scissors not having effectually divided it. In a case tried at Lewes Lent Assizes, 1852, Mr. Gardner proved, in reference to the body of a child which had been found in a privy, that the cord had been ineffectually cut in one spot previous to its complete division. The cord had also been pulled out after this cut, so as to elongate the vessels ; hence they projected from one POWER OF EXERTION IN RECENTLY DELIVERED FEMALES. 375 part of the sheath at one cut portion, while they were retracted in the other. This accurate observation showed not only that the cord had not been rup- tured by the child accidentally falling from the mother, but it served to esta- blish the identity of the placenta, which was found concealed at a distance from the body. When the cord is lacerated, this will be, ceteris paribus, in favor of the woman's statement as to the mode in which her delivery occurred. (For a case involving this question, see Med. Gaz., vol. x. p. 374.) In a case which occurred to Dr. Wharrie, in which the child fell from a female while sitting over a large jug containing water, and in which it was evident there had been no respiration, the cord was found tied. The child was re- moved from the vessel dead ; therefore the ligature must have been applied after death. 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. (See a case in Oosperms Vierteljahrsch, 1859, vol. ii. p. 36.) Oircumstantial evidence. — Whether, in any instance, the drowning of a child was accidental or criminal, must be a question for a jury to determine from all the facts laid before them. The situation in which the body of an infant is found may plainly contradict the supposition of accident. On the other hand, 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 stomach of the child should always be examined on these occasions, as mud, sticks, straws, weeds, or other substances, may be found, 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. Sudden delivery. The pains of labor mistaken for other sensations In eases like that reported by Dr. Wharrie, where a female, under the impression that she was about to have a motion, sat over a large water-jug and was delivered of a child, it is proper to make full allowance for a mistake which may be compatible with innocence. 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 an evacuation : and thus it is dangerous, when a labor has advanced, to allow a female to yield to this feeling ; for there is nothing more probable than that the child will be sud- denly born. Mr. Rankin, of Carluke, has reported two cases of this descrip- tion, where there could not be the slightest suspicion of criminality. In one, a primipara, the child was actually born under these circumstances ; but its life was fortunately saved — had there been no other convenience than 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. (^Ed. Monthly Journ., January, 1846, p. 11 ; see also a case in which twins were thus born, Med. Times and Gaz., March 2, 1861, p. 235.) 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 an accident which occurs to females of the middle class, may also occur to the poor without necessarily implying guilt. (For a case of rapid delivery in a primipara, see Med. Times and Gaz., Feb. 6, 1858.) Power of exertion in recently-delivered females. — On these occasions, a wit- ness will often find himself questioned respecting the strength or capability for exertion evinced by the -lower class of women, shortly after child-birth. 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 be injurious to an accused party. He mentions a case, in which a woman charged with child-murder walked a dis- tance of twenty-eight miles in a single day, with her child on her back, two 3T6 DEATH FROM COLD AND STARVATION. 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, without sensible inconvenience. {Criminal Law, 161.) In one case (Smith, Ayr Spring Circuit, 1824), the woman was engaged in reaping — retired to a little distance, effected her delivery by herself, and went on with her work for the remainder of the day, appearing only a little paler and thinner 1 In the case of Maedougal (Aber- deen Spring Circuit, 1823), the prisoner, who was sleeping in bed with two servants, rose, was delivered, and returned to bed without either of them being conscious of what had occurred. Cases like the last have often presented themselves in the English courts. 3. Cold. — A new-born child may be easily destroyed by simply exposing it uncovered, or but slightly covered, in 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 ap- pearance occasionally met with has been congestion of the brain with or without serous effusion in the ventricles. (See Cold.) 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 new-born child is easily affected by a low temperature, and that warm clothing is required for the preservation of its life. An inspection of the body should never be omitted on these occasions ; because it might turn out that there was some latent cause of natural death which would at once do away with the charge of mur- der. Admitting that the child died from cold, it becomes necessary to in- quire whether the prisoner exposed it with the malicious intention that it should thus perish. Unless wilful malice be made out, the accused cannot be convicted of infanticide. In general, females 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 convictions for child-murder, where cold was the cause of death, although some medical jurists have called this infanticide by omission, an offence which does not appear to be recognized by the English law. In the case of the Queen v. Walters (Oxford Autumn Assizes, 1841), it was proved that the prisoner, while travelling in a wagon, had suddenly left it, and that she was delivered of a child, which was afterwards found dead and exposed on the road. There was no doubt that the child had been born alive ; for it was heard to cry after it was abandoned by its mother, who ap- peared to have carried it some distance after it was born. The child had died from exposure to cold. The woman was convicted of manslaughter, and sentenced to ten years' transportation. (For other medico-legal cases of death from cold, see Henke's Zeitschrift, 1836 ; also, 1840, vol. i. p. 168, Erg. H.) In the case of Eeg. v. Waters (Exchequer Chamber, Jan. 1849), the judges held on appeal that the count which charged the prisoner with causing the death of her child by throwing it on a dust-heap, and leaving it exposed, was good, and the conviction was affirmed. 4. Starvation. — A new-born 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 no marks of violence externally, nor any pathological changes internally, to account for death. This is a rare form of committing murder, unless 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 wilfnlly 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 examination of the body would be complete emptiness of the alimentary canal. Without corroborative circumstantial evidence, this would INFANTICIDE — DEATH FROM WOUNDS. 377 not suEBce to establish the caase of death : 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. (See Starvation, post.) 5. Immaturity in cases of abortion. — From the case oi Reg. v. West (Not- tingham Lent Assizes, 1848), it would appear that if by the perpetration of abortion, or the criminal inducement of premature labor, a child be born at so early a period of uterine life that it dies merely from immaturity, the party 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 between the fifth and sixth month of pregnancy. The child was born living, but died five hours after its birth. There was no violence offered to it ; and its death appeared to be due entirely to its imma- turity. The prisoner was acquitted, apparently on the ground that abortion might have arisen from other causes. Among those cases of violent death which leave on the body of the child certain marks or appearances indicative of the cause, may be mentioned wounds, strangulation and poisoning. 6. Wounds. — Probably this is one of the most frequent causes of death in cases of infanticide. Wounds may, however, be found on the body of a child which has died from some other cause. The principal questions which a medical witness has to answer, are : — 1. Whether the wounds were inflicted during or after birth, or, to adopt the legal view of the matter, before or after the child was entirely in the world in a living S'tate : for according to the de- cisions of our judges, a child is not considered living in law, at least its de- struction does not appear to be murder, until its body is entirely born. In most cases it will be utterly impossible for a medical witness to return any answer to a question put in this form. All that medical evidence can pre- tend to show, is whether a child was living or not when the wounds were produced : — for whether the whole of its body was or was not in the world at this time, they will possess precisely the same characters. In a few cases only, a conjectural opinion may be formed from the nature, extent, and situa- tion of these injuries. — 2. The witness will be required to state, whether the wounds were inflicted before or after death. — 3. Whether they were sufBcient to account for death. — 4. Whether they originated in accident or criminal design. 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 they therefore do not require any further notice in this place. A case of infanticide was tried at the Buckingham Summer Assizes, 1840 (the Queen v. Wood), in which the main question was, whether five severe wounds found on the head of a child were inflicted before or after death, and accidentally or criminally. The mother confessed that the child was born alive, and had cried, but that it had died in five minutes after its birth. Its body was buried and it was assumed that the wounds might have been acci- dentally inflicted after death by a spade, which had been used for the burial. The medical witness attributed death to the wounds, which, in his opinion, could not have been accidentally produced, but he very properly admitted, in cross-examination, that the wounds would have presented the same appear- ances had they been inflicted immediately after death, while the blood was in a fluid state. Answers to questions of this kind can of course be given only in those cases in which the body has been examined soon after the infliction of the wounds. It would be extremely hazardous to pronounce an opinion when the child has been long dead. In the case of the Quee7i v. Taylor (York Lent Assizes, 1843), the child had been dead about a year, and when its body was found in a garret, it was so much dried up, that the medical witnesses 3Y8 INFANTICIDE — DEATH PROM WOUNDS. were unable, with certainty, to state the sex. The left arm had been removed from the body, and on the throat was a cut extending nearly from ear to ear which was considered to have been made by some sharp instrument ; and from the retraction of the edges of the wound, the witnesses thought that it must have been produced during life or immediately after death. The pri- soner was acquitted. In this case there do not appear to have been any good medical reasons for the opinion expressed respecting the time at which the wound had been caused. Certainly, the retraction of the edges could furnish no evidence in a wound produced a year before, and in a body so dried up as to render the recognition of the sex difficult. This may have been a case of child-murder, but there was no medical proof of it : it was not even proved that the child had come into the world living. Incised wounds found on the bodies of 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 piece of white card. In the case of the Queen v. Wales (Central Criminal Court, Sept. 1839), it was proved that there was a wound on the right side of the neck of the child, not involving any important vessels, although it had caused death. The medical witness allowed that it might have been accidentally inflicted in the manner suggested, and the prisoner was acquitted. As this question may be unexpectedly put at a trial, a witness should prepare himself for it by a careful examination of the wound and of the navel-string. This will in general suffice to show whether an incised wound has been produced accidentally in the manner alleged, or by criminal design. Intra-uterine wounds have been in some cases met with. Dr. Priestley has described one which involved a part of the scalp. (Med. Times and Gaz., March 12, 1859,) Slight marks of external violence should not be overlooked : minute punc- tures or incisions externally may correspond to deep-seated injury of vital organs. The spinal marrow is said to have been wounded by needles or sti- lettoes introduced between the vertebras, the skin having been drawn down before the wound was inflicted, in order to give it a valvular character, and to render it apparently superficial. The brain is also said to have been wounded by similar weapons, through the nose or the thinner parts of the skull (the fontanelles). In some cases the body of a child is found cut to pieces, and the allegation in defence may be that the child was still-born, and the body thus treated merely for the purpose of concealment. Dr. Toulmouche has reported a case of this kind, which was the subject of a trial in France in 1852. As the woman had not destroyed the lungs, experiments on these organs gave satis- factory results of perfect 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 apparent. Dr. Toulmouche ascribed the death of the child to the wounds. The woman was convicted, and con- demned to twenty years' confinement in the galleys. {Ann. d'Eyg., 1853, t. ii. p. 200.) In this country she would probably have escaped under a verdict of concealment of birth, and have been sentenced to a year's imprisonment. Marks of violence on the head. — It has been elsewhere remarked (_ante, p. 368) that in a protracted delivery there is on the head of the child a tumor containing either serum, blood, or a mixture of the two. Non-professional persons may, when a woman has been secretly delivered, ascribe a tumor of this kind to violence, whereas it may really have been produced by natural FRACTURES OF THE SKXJLL. 119 causes. The tumor is generally situated on one of the parietal bones, its situation depending on that part of the body which presents during delivery. After the discharge of the waters, the scalp is firmly compressed by the mouth of the uterus, and subsequently by the os externum. This pressure interferes with the circulation through the skin, and causes the compressed portion of scalp to swell. In the simplest form of this tumor serum only is found in the swollen part : 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 no injury to the bones, nor is there any laceration of the skin externally. In other cases blood is found effused in the tumor either under the scalp, the membrane covering the skull (pericranium), or within the skull itself. The term Gephalcematoma or Caput succedaneum is applied to tumors which have this natural origin. The sanguineous variety is more likely to be confounded with the effects of violence than the serous tumor ; but it is identified by the scalp being always uninjured, although this may present redness and lividity. Violence from blows or falls which would produce bloody effusion beneath the scalp, or within the skull, would in general be indicated by injury to the skin or by fracture of the bones. At the same time the following case, which occurred to Dr. West, shows that caution is required in forming an opinion. In this case the child died twenty-three days after birth. The tumor (cephalaematoma) was about the size of a walnut originally, but it extended so as nearly to cover the right parietal bone. On dissection, it was found to be filled with coagulated blood, beneath which was a layer of dense fibrin- ous matter. The right parietal bone presented a fissure with clean edges running from the coronal suture obliquely backwards and upwards. On the inner surface of the bone was an effusion of blood between the cranium and dura mater more than half an inch in thickness, and occupying the whole of the hollow of the parietal bone. There was no reason to doubt that the frac- ture and effusion were the results of compression during delivery. They had not been occasioned by external violence. {Trans, of Med.-Ghir. Soc.,yo\. xxviii. See for further information on this subject, Churchill on the Diseases of Children, p. 66.) Fractures of the skull. — The only injuries which require to be specially considered in relation to infanticide, are fractures of the skull ; and here the question to which we may confine our attention is, whether the fracture arose from accident or criminal violence. Although it has been a matter of fre- quent 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 this injury may occur by the expulsive efforts of the uterus forting the head of a child against the bones of the pelvis. Even the violent compression which the head sometimes experiences in passing the mouth of the uterus, may suffice for the production of fracture. (See Ed. Med. and Surg. Journ., vol. xxvi. p. "75.) Until within the last few years, it had been generally supposed that fractures of the cranium in new-born children were always indicative of criminal violence ; but the cases collected by Dr. Schworer, of Freiburg, and others, 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 Dr. Weber, the frontal and parie- tal bones are the only bones liable to be fissured or fractured during the act of parturition. {American Journ. Med. Sci., Jan. 1853, p. 254, and Ameri- can edition of this work, by Dr. Hartshorne.) In the greater number of cases reported, the parietal bones only have presented marks of fracture. The following cases occurred to Dr. Schworer while performing his duties at the Obstetric Institution : — A child was still-born ; he received it into his 3S0 SUDDEN DELIVERY IN THE ERECT POSTURE. hands at birtb, so that the head could have sustained no outward violence. On inspection, the skin over the summit was found swollen ; and on remov- ing it, there was a large effusion of blood beneath, especially over the right parietal bone. The bone was fractured or fissured in two places. Blood in a half-coagulated state was found beneath the fissures, between the bone and the dura mater, as also between this and the tunica arachnoides. (Beit, zur Lehr. V. d. Kindermord, Freiburg, 1836.) Here, then, were all the signs indicative of external violence ; and possibly, had this woman been delivered in secret, and the body of the child found in a concealed place, she might have been charged with the murder. A second case is reported in Gasper's Wochenschrift (Oct. 1840), in which about half a drachm of Blood was effused on the right parietal bone, which was compressed in the centre, and presented a radiated fracture. Coagula were found on the dura mater. (See also Brit, and For. Med. Rev., vol. xxi. p. 254, and vol. vii. p. 333.) In a third case, where there was deformity of the pelvis, the child was born dead, and there were two fissures about an inch long, in the left parietal bone ; and both parietal bones were considerably flattened. (Gasper's Wochenschrift, Sept. 1837.) Dr. West has reported the following case of spontaneous fracture of the left parietal bone, which occurred to Dr. Gotz, during a natural but tedious labor, in which the head of a child was five hours in the pelvic cavity, although the pelvis was well formed. There were three fissures in the bone J one running into the sagittal suture, one to the anterior inferior angle, and the other to the middle of the anterior edge of the bone. The child was still-born. Much blood was effused beneath the scalp, but none under the skull. {Med. Gaz., vol. xxxix. p. 288.) In respect to these accidental fractures and extravasations, it may be re- marked that they are in general recognized by their very slight extent. In cases of murder by violence to the head, the injuries are commonly much more severe ; the bones are driven in — the brain protrudes, and the scalp iS extensively lacerated. Such severe injuries as these cannot arise accidentally from the action of the uterus during parturition. (See report of a case by Dr. Wiseman, in which, in addition to severe injuries to the brain, coal-dust and minute pebbles were found driven into the skin of the head by the body being thrown from a height. (Ed. Med. Journ., Dec. 1855, p. 492.) In these cases, however, it may be fairly urged, that the woman was unex' pectedly seized with labor, that the child was expelled suddenly by the vie lent efforts of the uterus, 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 de- livered while in the erect posture, although this is not common am6ng primi- parous females ; and that injuries may be thus accidentally produced on the head of a child. Sudden delivery in the erect posture. — A case of sudden delivery in the erect posture in a primiparous female, without injury to the child, is reported by Dr. W. Burke Ryan, in the Lancet. (June 21, 1845, p. '707.) The um- bilical cord was in this instance ruptured at the distance of about two inches from the navel. This gentleman has communicated to me the particulars of a second case, which occurred in his practice in Oct. 1852. A woman who had borne a child was suddenly delivered while standing. The child fell to the floor on its vertex, and the cord was ruptured. A small quantity of blood escaped from the part struck, but there was no open wound or frac- ture of bones. The child sustained no injury. In another case of a primi- parous female, sudden delivery took place while the woman was in the act of sitting down. The child was forcibly expelled, and fell with its head on the floor of the room. It was taken up dead, the cord being still attached to it and the placenta, which came away shortly after the birth of the child. (Med. INFANTICIDE — INJURIES FROM SUDDEN DELIVERY. 381 Gaz., vol. xxxvii. p. 808.) It appears from cases collected by Dr. Klein, that fractures of the cranium under these circumstances are of rare occurrence. Out of one hundred and eighty-three cases reported by him in which the women were rapidly delivered while sitting, standing, or inclined on the knees — the child falling on the ground or floor, there was only one instance in which a child was killed ; and there was not a single instance in which the bones of the cranium were fissured or fractured, so far as could be ascer- tained by external examination. (Devergie, t. i. p. 631 ; Briand, p. 271.) Chaussier performed some experiments on the bodies of still-born children, allowing them to fall with their heads downwards on a paved floor, from a height of eighteen inches; and he found that out of fifteen cases one or other of the parietal bones was fractured in twelve. Although these results are conflicting, yet Klein's observations appear more to the purpose ; because they were made under circumstances in which the question would really arise in a case of Infanticide. They are strikingly supported by the following case, which occurred to Mr. Blacklock. {Lancet, July 26, 1845.) A mar- ried woman was suddenly delivered while standing : — the child fell to the floor, but sustained no injury. The umbilical cord was ruptured close to the umbilicus. (See also Dr. Ryan's case, supra.) A case analogous to these, also in a primipara, is reported in the Gazette Medicale, 26 Juin, 1847. A woman, set. 27, was delivered of a child while in the act of walking to the hospital, at the distance of a mile. She stated that she had lost a large quan- tity of blood. The child, which she brought in her apron, was mature and living; the navel-string had been ruptured close to the abdomen. (See also another case by Dr. Pickford, Med. Gaz., vol. xlii. p. 731.) A more recent case has been reported by Mr. Dermott. (Lancet, March 12, 1853, p. 245.) A young married woman, set. 23, pregnant of her first child, was delivered suddenly while in the erect posture. The child, which was healthy and full- grown, fell upon the floor, and the cord was broken off within three inches of the navel. It was separated as cleanly as if it had been divided by an accoucheur. Excepting the production of a swelling on the forehead from a bruise, the child had sustained no injury by this sudden expulsion. A simi- lar case occurred to Dr. Chevers. (Med. Jur. for India, 1856, p. 523.) These observations lead to the inference that such accidents are not likely to occur, yet we cannot deny the possibility of their occurrence ; therefore a barrister is fully justified in endeavoring upon this ground to exculpate a person charged with child-murder. Dr. Swayne, of Bristol, has published in the Association Journal (Oct. 14, 1853, p. 901) a case which shows that a fracture of the skull of a child may occur when a woman is delivered in the erect posture. In this case, there was merely the appearance of a bruise on the head ; the cord 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 con- vulsions 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 ; with this exception, there was no morbid ap- pearance in the body. Dr. Porter Smith, of Bath, has communicated to me a case which occurred in November, 1856, in which the facts were similar to those above related. In consequence of the concealment of the body, how- ever, the mother was charged with the murder. The right parietal bone was fractured, and there was effusion of blood internally, but there was no mark of external violence. The cord had been ruptured at a distance of two and a half inches 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 were inflated and highly crepitant. The foramen ovale 382 ACCIDENTAL FRACTURES DURING DELIVERY. and the ductus arteriosus were in their foetal condition. The child had pro- bably been drowned in the discharges from want of assistance at the time of birth. The woman was acquitted. She admitted that the child fell from her suddenly. Dr. Olshausen has published four cases of sudden delivery, in which the child dropped from the woman, and in two of these there were fissures in the parietal bones. Both children recovered from the effects of the accidents. (Med. Times and Gazette, Sept. 1860. Am. Jour. Med. Sd., Jan. 1861, p. 2*? 9.) Other cases of rapid delivery in the erect posture are reported in the Lancet. (Jan. 5, 1861, 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 probability 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 acquisi- tion of this knowledge must be accidental ; and it will in general be out of his power to obtain it. Sometimes the fractures will be accompanied by in- cisions, punctures, or lacerations of the scalp or face : — in this case, although the origin of the fractures might be accounted for by the alleged fall during parturition, the cause of the other injuries would still remain to be explained. (See the case of the Queen v. Beeve, Cent. Crim. Court, Feb. 1839. The Queen v. Stevens, Bodmin Lent Ass., 1845.) Injuries of this nature, with the fact that there are bruises or contusions, as well as fractures not connect- ed with each other in various parts of the skull, would be inexplicable on the hypothesis of an accidental fall. I am indebted to Mr. Kesteven, of Hol- loway, for the following case. An inquest was held in Feb., 1854, on the body of a female infant, of which a young woman had been delivered on the ' 21st of December, 1853. The infant had been born, according to the state- ment of the mother, in the pan of a water-closet on the ground floor of the house, and was afterwards carried by her up two pairs of stairs, and placed beside her in bed. She admitted that the child had been born alive, but stated that it was dead when she lifted it up from the pan to carry it to the bedroom. The navel-string was torn at the distance of four inches from the abdomen. The child, she alleged, had fallen into the water-closet pan. No trace, however, of blood or other discharge was found on or near the seat of the closet, while upon the opposite side of the chamber the floor was stained with blood, which had been imperfectly wiped up. On an examination of the body of the infant, it was found to be a well-formed mature child, weighing seven pounds. The lungs had been fully expanded to their mar- gins, covering the heart, and floating in water with or without the latter organ. The scalp presented no trace of injury. The usual tumor of the scalp was apparent. On dividing the scalp, there was some ecchymosis at this part. The bones of the skull were found extensively fractured. There was a horizontal fracture nearly an inch long over each orbital prominence ; upon the right frontal eminence the bone was broken and depressed, in an acute triangular form, three-quarters of an inch in length ; the parietal bones on each side were fractured vertically from their eminences downwards to the extent of an inch and a quarter ; on the left side the lower end of this fissure was joined by another of similar extent, passing horizontally forwards at a right angle to the edge of the bone. Several minor fractures were found at difierent parts of the upper surface of the skull ; they were not apparently connected with each other. Within the cranium, blood was extravasated on the surface of the brain, and in the membra,nes. No fractures were detected at the base of the skull. The mother alleged that the injuries to the head were owing to the child having fallen into the pan of the water-closet. This explanation, however, was inadmissible, as it was very doubtful whe- ther the body of the child had been in the pan at all. Even supposing the HOMICIDAL INJURIES TO THE HEAD. 383 child to have thus fallen, the distance was too small to have caused such an amount of injury situated on various parts of the skull ; besides which, as the child would have passed in an oblique direction forwards from the out- let, it would have glided safely down the side of the pan. In the absence of evidence as to the mode in which the injuries were inflicted, it was sug- gested that they might have been caused by the mother having fallen upon the child on her way up stairs ; and this hypothesis was ultimately adopted by the coroner's jury. There was no doubt that the child's death was caused by the injuries to the head ; and the jury took, what is called a lenient view of the facts, in rejecting the woman's explanation of the cause of the vio- lence, and in assuming that such a variety of severe injuries to the bones of the head could have been produced by the mother falling upon the body of the child. (See another case in Med. Times and Gaz., April 4, 1857, p. 347.) The medico-legal importance of this subject will be further apparent from the evidence given in a case tried before the Criminal Court of New York, in November, 1834. {Med. Gaz., vol. xviii. p. 44.) One of the medical wit- nesses in this case positively denied that the bones of the head could be frac- tured by the action of the uterus daring parturition I It appeared highly probable that the fracture had been here occasioned by the accidental fall of the child during delivery ; and the prisoner was acquitted. Dr. Wharrie has published a case, also the subject of a criminal charge, in which it is proba- ble that a fracture of the head of a child was produced by the expulsive action of the uterus. The body had been found secretly buried. It was fully developed, but had evidently not breathed. The navel-string had been cut and tied ; six inches of it still remained attached to the body. On the left side of the cranium, near the vertex, there was a small effusion of blood ; and on removing this, a fissure half an inch in length was found in the edge of the left parietal bone, close to the line of the sagittal suture, and near the posterior fontanelle. On shaving off the hair, there was no discoloration, nor any mark on the skin indicative of a blow. There was no evidence to show that any violence had been used to the child at its birth, and from the description of the fissure it was a fair presumption that it had arisen during delivery from the muscular contractions of the uterus. ( Gormaclc's Monthly Journ., Nov. 1844, p. 847.) The possible occurrence of an injury of this kind has been strained, in several cases of child-murder, to explain the origin of fractures which, how- ever, could not be fairly assigned to such a cause. A case was tried at Glas- gow, in April, 1852 (case of Ann Irwin), in which Dr. Easton gave evidence. 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 death. The whole extent of the right side of the head was deeply ecchy- mosed, and there was a considerable amount of coagulated blood lying be- tween it and the cranium. In the centre of the right parietal bone, there was a fracture extending across the vertex for fully four inches, and involving a part of the parietal bone on the opposite side. The fracture was a con- tinuous 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 hemisphere, there was a copious effusion of clotted blood. It was impossible to refer severe injuries of this kind to the action of the uterus in delivery, or to violence applied after death. The prisoner alleged that the child was still-born. (See Edin- burgh Monthly Journ., June, 1825.) In the case of the Queen v. Mussett (Bury Lent Assizes, 1856), the head of a child was almost flattened from the violence sustained. It was clear that no fall or other accident could exiilain this condition. Some fresh blood and a single hair were found on a shelf in 384 INFANTICIDE — ACCIDENTAL INJURIES IN tITEEO. the cellar, for which the prisoner accounted by stating that she had there killed a rabbit. A microscopical examination, however, showed that it was a human hair. The medical evidence established from the state of the lungs that the child had breathed, and that it had had an independent existence. The prisoner was convicted. Length of the umbilical cord. — It has been recommended on these occa- sions, that we should observe the length of the umbilical cord, and notice whether it is cut or lacerated; as these facts may, it is presumed, throw some light on the question. But a medical witness can seldom procure the cord for examination, although it will generally be in his power to ascertain whether it was cut or lacerated, by examining the portion which is attached to the body of the child. The cord varies in length — the average being from eighteen to twenty inches: but it has been met with so short as six inches (Lancet, June 13, 1846, p. 660), and even five inches. (Lancet, July" 11, 1846, p. 49.) In a twin case which occurred to Mr. Stedman, of Guild- ford, the cord was on\y four inches long. (Lancet, Aug. 28, 1841.) On the other hand, in one instance, where it was found twice twisted round the child's neck, it was fifty-three inches long. Dr. Churchill found, out of three hun- dred and ninety-one cases, that the shortest cord was twelve inches, and the longest fifty-four inches in length. In a case reported by Mr. Wood it was sixty-one inches long, and coiled twice round the abHomen of tiie child. (Med. Gaz., vol. xlv. p. 263.) As the whole of the cord can rarely be ob- tained, it is unnecessary to discuss the question, whether it were long enough to admit of the falling of the child without rupture. It has been remarked, that when the cord is ruptured from accidental causes during delivery, the rupture takes place either very near to the placental or the umbilical end. In twenty-one of the cases observed by Klein, it was found to have been forcibly torn out of the abdomen ; but it may be torn or lacerated at any part of its length, although the rupture is commonly observed near to one ex- tremity. Ainong the four eases of sudden delivery reported by Dr. Olshausen (page 382), the cord was torn through at three inches from the navel in one, and no bleeding followed. In two the cord was torn through its middle, and at first there was great bleeding. In three it was torn close to the umbilicus, and no bleeding had occurred. In four the cord was torn at five or six inches from the navel, and there was no bleeding, although it remained untied for ten minutes. In Seg. v. Martin (Lewes Lent Assizes, 1860), the medical witness was closely examined by the judge whether rupture of the cord might not lead to fatal bleeding. The above facts show that a rupture of the cord is not necessarily fatal, even when the circumstances are unfavorable. It does not appear how the examination of the cord can throw any light upon ■ the origin of these fractures of the cranium. Injuries accidentally/ sustained in uiero. — A practitioner must remember that if, while in an advanced stage of pregnancy, a female should accidentally fall, the child may sustain injury by a blow through the abdominal parietes. This is not to be strained into a specious defence for violence which has ob- viously occurred subsequently to birth, but the fact itself is of sufficient im- portance to merit attention, as the following case will show : — A pregnant woman, within five days of the ordinary term of gestation, fell while running, BO that her abdomen struck sharply against an angular stone. There was an immediate loss of blood, and the movements of the child ceased. Pour days after the accident parturition came on. Dr. Stanelli found the head of the child much enlarged, and in a putrid state. The female died in an hour. On examining the child, the skull was found almost crushed, the parietal having become separated from the temporal bones as if by external violence. The marks of injury were entirely limited to the head. ( Gazette des Hopitaux, Nov. 7, 1846, p. 523.) INFANTICIDE — TWISTING OP THE NECK. 385 In accidents of this kind it is most probable that the child would be born dead. There might also be marks of violence on the abdomen of the mother. Some observers have described cases in which the limbs of the foetus in utero have become deeply indented or spontaneously amputated, by the twistingof the umbilical cord around them.» {Dublin Hospital Gazette, Jan. 1846, p. 153.) It is not possible that these or other accidental injuries before birth, could ever be mistaken for violence inflicted on the body of a child after its birth. A remarkable case of this kind has been communicated to the Med. Times and Gaz. (Dec. 10, 1853, p. 604) by Mr. Maclauglin, in which a child was born without limbs. It is difficult to account for the occurrence of such a singular case as this : but practically it could have occasioned no medico-legal difficulty, had the body of the child been found dead, since the absence of the limbs could not have been referred to an act of mutilation. Dr. H. Barker, of Bedford, has directed attention to the subject of intra- nterine fractures, in their pathological and medico-legal relations. He ad- vises that the bones of the body should be examined, in reference to their strength, osseous development, and other physical characters. It will pro- bably be found, as in fractures in adults from slight causes, that the bones are preternaturally brittle (ante, p. 288). In this case, due allowance should be made for the occurrence of an intra-uterine fracture, as the result of a fall during pregnancy. {On Intra-uterine Fractures, p. 21, 1857.) D^ective ossification simulating violence In reference to injuries of the bones of the head in a new-born child, it may be proper to mention the particulars of a case which was referred to me by Mr. Lord, in 184'7. The dead body of a new-born child, wrapped in brown paper and a towel, was found in a pond. Mr. Lord examined it for the coroner's inquest. The head was much decomposed, and the scalp was extensively lacerated and de- stroyed over the parietal bones, which readily separated. The brain was reduced to a bloody pulp. The umbilical cord, which had not been tied, was cut obliquely at about six inches from the navel. The lungs, which were very crepitant, readily floated on water, and bore up the heart. The body was generally bloodless. The point of difficulty which the case presented, consisted in the presence of two apertures on one parietal bone. These aper- tures were small and rounded, and it was at first doubtful whether they had not been wilfully produced by some perforating instrument applied to the head. It was remarked that one aperture was situated near the temporal ridge, and in this situation the scalp was entire and uninjured. The other was situated in that part of the bone which corresponded to the lacerated portion of the scalp. It was ascertained that no violence had been used in the removal of the body from the water. The bone was macerated, and carefully examined by the aid of a lens. It was then perceived that the aper- tures were quite regular at the edges, which were remarkably thin, evidently passing into a membranous condition. The internal table was also deficient, so that, from the interior, the bone was bevelled off gradually from each aper- ture. This examination left no doubt that the holes in the bone were not due to any mechanical violence applied during life, but to deficient ossifica- tion. These spaces had been membranous, and the membrane destroyed by decomposition. The putrefaction of the scalp, and its separation, might have been accelerated by a bruised condition of these parts during a difficult labor. Twisting of the neck. — Children are sometimes destroyed in the act of birth by the neck being forcibly twisted, whereby a displacement of the cervical vertebrae, with injury to the spinal marrow, may occur, and destroy life. Such injuries are immediately discovered by an examination. It should be remembered, however, that the neck of a child is very short, and that it always possesses considerable mobility. 25 386 VIOLENCE IN SELF-DELIVERY — CONCLUSIONS. Violence in self-delivery. — When the marks of violence found on the bead neck, and body of a child cannot be easily referred to an accidental fall, it is common to ascribe them to the efforts made by a woman in her attempts at self-delivery, and without any intention on her part of destroying life. The rules to guide a medical opinion in such atiase must depend upon the nature, situation, and extent of the injuries ; and each case must be therefore decided by the circumstances attending it. (The Queen v. Harder, Abingdon Sum- mer Ass., 1840.) This should be contrasted with two other cases fthe Queen V. Trilloe, Hereford Summer Ass., 1842; Queen -v. JWrraer, Worcester Win- ter Ass., 1843.) In the two first cases, the children were admitted to have been living ; — in the one the violence was chiefly confined to the head, and the prisoner was acquitted — in the other the marks of violence were upon the neck, and the prisoner was convicted. These cases show the uncertainty attendant on a plea of this kind. (See also two other instances, Brit, and For. Med. Rev., vol. viii. p. 521.) Sanguineous tumors simulating frac- tures are sometimes found on the heads of new-born children. These depend on natural causes, and must not be confounded with marks of violence. {Med. Gaz., vol. xxxvi. p. 1082.) They may be known by the unruffled state of the skin. A medical witness, however, must be prepared to allow that a woman at the time of her delivery, may from pain and anxiety become de- prived of all judgment, and may destroy her offspring without being conscious of what she is doing. It is therefore a sound principle of layv that mere ap- pearances of violence on a child's body, are not per se sufficient unless there is some evidence to show that the violence was knowingly and intentionally inflicted, or the appearances are of such a kind as of themselves to indicate intentional murder. (Alison.) The benefit of a doubt will always be given in favor of the accused. See Puerperal Mania, post. Conclusions. — The conclusions to be derived from the contents of this chapter are : — 1. That a new-born child may die from violent causes arising from acci- dent. 2. That some forms of violent death are not necessarily attended wilh external signs indicative of violence. 3. That a child may be accidentally suffocated during delivery. 4. That the usual marks of death from drowning are not apparent, except in children which have breathed. 5. That the state of the umbilical cord may often furnish important evi- dence. 6. That some females recently delivered may have strength to exert them- selves and walk great distances. t. That a new-born child may speedily die from exposure to cold and privation of food. 8. That slight fractures of the bones of the cranium may arise from the action of the uterus on the head of the child during delivery. 9. That females may be unexpectedly delivered while in an erect posture: the umbilical cord is, under these circumstances, sometimes ruptured, and the child may sustain injury by the fall. 10. That the violence found on the body of a child may be sometimes referred to attempts innocently made by a female to aid delivery. INFANTICIDE — DEATH FROM STRANGULATION. 387 CHAPTER XLVII. DEATH OF THE CHILD FROM STRANGULATION — DECEPTIVE APPEARANCES ON THE BODY. — STRANGULATION BY THE UMBILICAL CORD — DIAGNOSIS. — ACCIDENTAL MARKS RESEMBLING THOSE OP STRANGULATION — CONSTRICTION BEFORE AND AFTER DEATH — BEFORE AND AFTER RESPIRATION — CMSISTRICTION BEFORE AND AFTER ENTIRE BIRTH — BEFORE AND AFTER THE SEVERANCE OP THE UMBILICAL CORD. — CONSTRICTION WITHOUT ECCHYMOSIS — EXAMINATION OP THE MOTHER ■ — SUMMARY OF MEDICAL EVIDENCE — DEATH OF THE CHILD AFTER BIRTH FROM WOUNDS DURING DELIVERY — GENERAL CONCLUSIONS. Among the forms of violent death which are almost always attended with appearances indicative of criminal design are the following : — 7. Strangulation. — The destruction of a new-born child by strangulation is not an unfrequent form of child-murder : and here a medical jurist has to encounter the difficulty, that the strangulation may have been accidentally produced by the twisting of the umbilical cord round the neck during deli- very. We must not hastily conclude from the red and swollen appearance 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 Dr. Hunter observes : "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 there is 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 appearance is particularly observable in those cases where the navel-string happens to gird the child's neck, and where its head happens to be born some time before its body." {Op. cit., p. p7.) Strangulation by the umbilical cord can of course refer to those cases only in which the cord becomes firmly twisted round the neck after the respiratory process is established, and this is rather a rare occurrence : because death more commonly takes place by compression of the cord under these circum- stances, 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. The appearance of ecchy- mosis on the scalp, as well as lividity of the face, is very common in new-born children when the labor has been tedious and difficult ; and, therefore, unless there were some marks of injury about the neck, this would not justify any suspicion of death from strangulation. Strangulation hy the umbilical cord. — It has been supposed that the stran- gulation produced by the wilful application of any constricting force to the neck, would be known 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. But it maybe objected to this view, that such a mark, although, from the great violence used, a common, is not a constant accompaniment of homicidal strangulation. On the other hand, although it was formerly a disputed question, it is now certain that the umbilical cord may itself produce, in some instances, a livid or ecchymosed depression. Among various cases which may be quoted in support of this view, is the following reported by Mr. Poster. In April, 1846, he was summoned to attend a lady in labor with her first child. Owing to the size of the head. 388 STRANGULATION BY THE TJMBILICAL COED. the labor was of a lingering kind, and the child came into the world dead. The umbilical cord was found coiled three times round the neck, passing under the right armpit, and upon removing it, three parallel discolored depres- sions were distinctly evident. These extended completely round the neck and corresponded to the course taken by the umbilical cord. The child ap- peared as if it had been strangled. (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 re- spiration. When a blue mark is found on the neck of a child whose longs retain their fcetal characters, it is fair to presume, ceeteris paribus, that it has been occasioned accidentally by the twisting of the umbilical cord during delivery. Mr. Price has communicated to the same journal the account of a case in which the cord was so tightly twisted around the neck of a child, that he was compelled to divide it before delivery could be accomplished. There was in this case a deep groove formed on the neck, and it conveyed the im- pression to himself and a medical friend, that in the absence of any know- ledge of the facts, they would have been prepared to say that the child had been wilfully strangled by a rope. {Med. Gaz., vol. xxxviii. p. 40.) In this instance the cord was short. A diagnosis might have been formed, as in the preceding case, by examining the state of the lungs. Dr. Mutter 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 ; bnt on cutting into this mark, no subcutaneous ecchymosis was found. {North. Journ. Med., Jan. 1845, p. 190.) In Reg. v. Martin (Lewes Lent Assizes, 1860), the material question was, whether a mark round the neck had been caused accidentally by the umbilical cord : this was denied by the medical witness. This question also arose in another important case, to which I can only here refer, Reg. v. Pyne (Gloucester Winter Assizes, 1858). Dr. Williamson, of Leith, has directed attention to an important fact con- nected with the state of the lungs in a new-born child, and the medical opinions which may be expressed from their condition as furnishing evidence of live birth. Referring to Mr. Price'^ case, 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 ; bnt, owing to the shortness of the cord, the child would have been strangled and born dead unless he had divided the cord. Thus, then, a child might die ap- parently strangled, and not be born alive, although it may have so breathed during delivery that the lungs will present all the characters 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 died from strangulation. {Ed. Med. Journ., Feb. 1858, p. 714.) From two of these cases it will be perceived that by trusting to ecchymosis in the mark as an absolute means of distinction between constriction pro- duced by criminal means, and that which results accidentally from the um- bilical cord, a serious error may be committed. As in the following case (reported in the Ann. d'ffyg., 1841, t. i. p. 127), a female charged with the murder of her child by strangulation may be unjustly condemned. The child had folly and perfectly respired : — the lungs weighed one thousand grains, and, when divided, every portion floated on water, even after firm compres- sion. There was a mark on the neck, which was superficially ecchymosed in a part of its course. From an investigation of the facts, this appeared to have been a case in which the mark was produced accidentally by the um- bilical cord, during attempts at self-delivery on the part of the woman, i «., by her manipulations with the cord. She was, nevertheless, convicted, and MAKK PRODUCED BY THE COED. 389 condemned to a severe punishment. The case establishes three points : 1, that partial ecchymosis may be produced on the neck by the umbilical cord being twisted around it ; 2, that this may lead to the accidental strangula- tion of a child after it has breathed at the outlet — the cord was twenty-four inches long; 3, that a child's lungs may in a/«w seconds become sufficiently distended with air to give satisfactory evidence of respiration with the pul- .monary tests. In the same journal, p. 428, will be found the report of an- other case, suggesting many important reflections in regard to the medical jurisprudence of infanticide. In this instance, the umbilical cord and mem- branes were actually used by the female as a means of strangulation ; the child had not breathed, but was thereby prevented from respiring. There was superficial ecchymosis on each side of the neck over the sterno-cleido- mastoidei muscles. The defence was, that the child was born with the cord around its neck, and that it was from this circumstance accidentally strangled; but the medical evidence tended to show, that the cord had been violently stretched, and used as a means of strangulation. The child had not breathed, and the witnesses considered it to have been born dead, owing to the violence used by the woman. The cause of death here was certainly not strangula- tion, but arrested circulation. In the meantime, the case proves that ecchy- mosis (a blue mark) may be the result of the constriction produced by the cord. See the case of Reg. v. Martin, Lewes Lent Assizes, 1860. (For additional remarks on this subject, see Henke's Zeitschrift, 1837, vol. iv. p. 352 ; also Ed. Med. and Surg. Journ., Oct. 1838, p. 282 ; Casper's Viertel- jahrsch, 1859, vol. ii. p. 55.) A case occurred to Mr. M'Cann, in Septem- ber, 1888, in which the umbilical cord, which was of its full length, had been 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 indi- cations of the child having been strangled. The hydrostatic test applied to the lungs proved that respiration had been performed. Distinction. — When the mark is deep, much ecchymosed, and there is ex- travasation of blood beneath, with rufiSing or laceration of the skin, it is impossible to attribute this to the accidental position of the umbilical cord. The lividity produced by the cord in the cases hitherto observed has been only slight and partial, and unaccompanied by laceration of the skin, or in- jury to deep-seated parts. (For an instructive case by Dr. Scott, in reference to this point, see Hd. M. and S. J., vol. xxvi. p. 62.) On the other hand, in homicidal strangulation, much more violence being used than is necessary for destroying life, we may commonly expect to find great ecchymosis and extensive injury to the surrounding soft parts. On some occasions all diffi- culty is removed by the discovery of a rope, tape, or ligature 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. It is questionable whether a child can be born with the umbilical cord so tightly round the neck as to produce great depression of the skin and ecchy- mosis, i, e., to simulate homicidal strangulation, and at the same time per- form the act of respiration fully and completely. It is important, therefore, when this hypothesis is raised, in order to account for a suspicious mark on the neck, to examine closely the state of the lungs. Unless the cord be de- signedly put round the neck of the child after the head has protruded, the effect of the expulsive efforts of the uterus, when a coil had become accident- ally twisted round the neck, would be to tighten the cord, compress the ves- sels, and kill the child, by arresting the maternal circulation, at the same 390 MARKS ON THE NECK FROM ACCIDENT, time that this pressure would effectually prevent respiration. The lungs, as in the eases above cited, should present the appearances met with in still- born children. This point is frequently lost sight of in medical evidence, and marks produced by ligatures wilfully applied, are set down as having been caused by the cord. In the case of Beg. v. Pratley (Oxford Summer Ass., 1853), the mark on the child's neck was attributed to the navel-string. In the case of Reg. v. BoUnson (Lewes Summer Ass., 1853), there was tlie mark of a ligature round the neck, which had been tied very tightly; tlie child had fully breathed, and, according to the medical evidence, it had died of strangulation. The strangulation was referred to an accidental twisting of the cord during delivery. It is to be feared that this kind of defence is too readily accepted by medical witnesses in cross-examination. In examin- ing a suspicious mark round the neck of a new-born infant, it is desirable to notice whether it does not, by its form or course, present some peculiar in- dentations which may render it certain that a ligature had been employed after birth. When it is found that a child has fully respired, the presence of a deeply ecchymosed mark on the neck is, cceteris paribus, presumptive of homicidal strangulation. Death from accidental constriction of the cord should, as a general rule, leave the lungs in their foetal condition. Marks on the neck may be produced by the umbilical cord, without neces- sarily destroying the child's life. Two cases of this kind are reported by Prof. Busch. (£r. and For. Med. Bev., vol. x. p. 579.) Or the child may be destroyed without ecchymosis being a necessary consequence of the con- striction produced by it. (See case by Dr. Hanff, Senke's Zeitschrift, 1836, Erg. H.) There is much less risk of strangulation from twisting of the cord than is commonly believed. Out of one hundred and ninety cases. Dr. Churchill found the cord round the neck in fifty-two children. The shortest cord so disposed was eighteen inches long, and it occurred twice in seventy- five cases. Insulated or detached marks of ecchymosis, as from local pres- sure, cannot be set down to the twisting of the navel-string. Other acci- dental causes may here come into operation. In the case of Beg. v. Sampson (Bodmin Lent Assizes, 1853), it was proved that there was a mark on the neck of the child, and it was charged against the prisoner that this had been caused by pressure of the fingers, i. e., by pinching the windpipe. The mark was described as being red and inflamed, and an inch and a quarter in length. It was suggested in defence, that the mark might have been produced by tbe tying of a cap. The medical witness stated that it was below the spot where a cap would be generally tied, but the mark might by possibility have been occasioned by the knot of the tie. The prisoner was acquitted. In admit- ting this kind of defence, it is to be observed that the tying of a cap may actually be made the means by which death by strangulation is effected. Accidental marks resembling those of strangulation. — In the fore part of the neck of a child a mark or depression is sometimes accidentally produced by forcibly bending the head forwards on the chest, especially when this has been done repeatedly and recently after death. It may occur also as an accident during labor. Such a mark must not be mistaken for the effect of homicidal violence. It has been a question whether, independently of the constriction produced by the cord, the neck of the uterus might not cause, during its contractions, an ecchymosed mark on the neck. I am 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 tbe fore part 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 fore part 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 MARKS RESEMBLING THOSE OF VIOLENCE. 391 pressure and the mode of death. 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, an explanation which is highly improbable, if respiration has been performed — although a child has been known to breathe in breech-presentations, while the head was still in the vagina. 2. They will be more commonly referred to a violent attempt made by a woman at self-delivery, during a paroxysm of pain. This explanation is admissible, so long as it is confined to injuries probably received during labor ; but supposing the marks to have been certainly produced after birth, it will not of course apply. The following case (the Queen v. AncUffe, Not- tingham Lent Assizes, 1842) is in this respect worthy of attention ; for it appears to me to show that a defence of this kind may be sometimes strained : The evidence proved that the prisoner was delivered of a child, under much suffering, on a stone floor, and in the presence of another woman — a witness. The child was born alive, and was heard to cry several times. The witness left it in charge of its mother, and on returning shortly afterwards, she found it dead, with black marks upon its throat. The female midwife, who sepa- rated the child from the mother, deposed that it gave a sort of half-cry ; she thought it was dead when she first saw it, and the marks on the neck were not more than a woman might have caused in attempting to deliver herself. The medical evidence showed that there were many ecchymosed marks about the throat of the child, and on the right side of the neck blood was effused. The marks may have been produced by the fingers : death had been caused by pressure on the windpipe. The judge left it to the jury to say, whether the marks of violence might not have been unconsciously inflicted by the prisoner during labor. The jury returned a verdict of not guilty. (See also a case by Bellot, Ann. d'Hyg., 1832, vol. ii. p. 205.) In Reg. v. Parkinson (Liverpool Lent A.ssizes, 1859), some suspicions marks were referred to the tightening of the string of the child's cap. It is obvious from numerous acquittals that a jury are ready to act upon any sug- gestions to account for marks of violence on the body of a new-born child. In Reg. v. Ashton (Lewes Lent Ass., 1858), it was proved by the medical evidence that the child was found dead in the soil of a privy with a piece of ribbon tied tightly round the neck — the mark of a bruise on the head — two deep cuts in the throat, and about seventeen punctured wounds on the body, of which one had penetrated the heart. The medical witness stated he had no doabt the child was born alive and that these injuries were the cause of death. The counsel in defence suggested that there was no proof of existence after entire birth of the body, and the injuries found on the child were "very probably the result of accident in the course of self-delivery by an unhappy young creature like the prisoner 1" The jury accepted this view of the facts and acquitted her of the murder. The cases of Reg. v. Money (Norfolk Summer Assizes, 1858), and Reg. v. Grady (Liverpool Lent Assizes, 1858), furnish additional illustrations of the impunity with which new-born children may be destroyed. Among marks simulating violence, which are sometimes found on the necks of new-born children, Mr. Harvey has pointed out one of a very singular kind. In February, 1846, 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 endeavoring to restore animation, he observed a bright red mark extending completely across the upper and fore part of the neck, from one angle of the lower jaw to the other, as though it had been produced by strangulation 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 : 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 392 CONSTKICTION BEFOKE OR AFTER DEATH. breadth, and it became diflPused at the sides. The face was not swollen, and there was no fulness of the veins. {Med. Gazette, vol. xxxvii. p. 379.) The distinction here would have been based upon the color of the mark — the nn- abraded state of the epidermis, and the absence of congestion of the face and venous system. Nevertheless, the case is of great importance, and the facts should be borne in mind, in the examination of the body of a new-born child alleged to have been strangled. Another case, which was the subject of a coroner's inquest, was published by Mr. Rose in the same journal (vol. xxxvii. p. 530), in which red marks on each side of the nose of a new-born child were mistaken for the effects of violence applied to the nostrils during a supposed attempt at suffocation. Mr. Rose examined them closely, and considered that they were nsevi, and had nothing to do with the death of the infant I Constriction before or after death — before or after respiration. — A medical witness is sometimes asked to state on these occasions, whether the ligature or the fingers had been applied to the neck of the child before or after death — or before or after it had breathed. It is proper to observe, that so far as the external marks of strangulation are concerned, there is no difference in the appearances, whether the constriction take place during life or imme- diately after death, while the body is warm. Casper's experiments render it highly probable, that when the constricting force is applied to the neck of a dead child at any time within an hour after death, the marks cannot with cer- tainty be distinguished by any appearance from those made on a living body. (Wochenschrift, Jan. 1837.) With regard to the second point, it maybe stated, that whether the child has breathed or not, provided it be livinif, the marks of violence present precisely the same characters. The following case is related by Casper : — The body of a new-born child was found concealed in a cellar, and the mother was charged with having murdered. it. She con- fessed that she had heard the child cry at the birth, but that it soon died. In about an hour afterwards, she tied tightly round its neck a band made of a few straws, which she had hastily twisted together for that purpose, in order, as she alleged, " to prevent it from awaking." On the fifth day the body was examined ; the child was mature, well formed, and had evidently breathed. The examiners referred death to strangulation ; the woman was convicted, and sentenced to be imprisoned for life. An appeal was made against this sentence, and Casper's opinion was called for on the propriety of the medical inference of strangulation during life, from the mark on the neck. The witnesses had stated "that each straw in the band had pro- duced a well-defined depression, which was whiter than the surrounding skin, while the little folds or elevations between the straws were red : — and on cut- ting into these reddened portions, slight ecchymosis was found beneath." Casper gave his opinion, that the slight ecchymosis observed might have re- sulted from the application of the straw band soon after death — while the body was warm ; and the circumstantial evidence allowed that the ligature might have been applied at some time within an hour after death. Hence he declared that there was a want of proof that this child had died from strangulation. In consequence of this opinion the punishment was miti- gated. It is impossible to deny the correctness of the inference drawn by Casper, since the mark was undoubtedly such that it might have been pro- duced either before or recently after death. Which of these two supposi- tions was the more probable, and whether it was more likely that a ligature should be put round a child's neck an hour after death to prevent it from awaking (?), or before death for the alleged purpose of destroying it, it was of course for a jury, and not for a medical witness, to decide. If there was nothing more in the prisoner's favor than her own statement as to the time when she applied the ligature and her object, in applying it, it is certain that a very humane interpretation was put on the facts. If the court believed INFANTICIDE — CONSTRICTION AFTER DEATH. S93 Casper's opinion to be correct, the woman should have been altogether ac- quitted, instead of having the punishment merely mitigated. It can be no crime, however absurd and unaccountable it may appear, for a person to place a ligature round the neck of a child after death, to give the appear- ance of strangulation. When such an extraordinary plea as this is raised, it is a fair matter of inquiry for a jury, to consider the motives of human con- duct, and to judge of such a defence on the principles of common sense. If carried too far, no one who was not seen by others to perpetrate the act, could be convicted of homicidal strangulation. In the case of the Queen v. TTrew, tried at the Winchester Lent Ass., 1840, the medical evidence went to show that the child had breathed, and was born alive. There was a piece of tape tied round its neck very tightly, and fastened behind, and there was a discoloration of the skin beneath. The tongue was livid and swollen, and blood was effused beneath the scalp. The medical witness admitted that the mark on the neck might have been produced after death : and as he could not positively say that the child had been destroyed by strangulation, the prisoner was acquitted. (See also the Queen v. Hyland, Cent. Crim. Court, Aug. 1844.) In Reg. v. Green (C. C. C. Feb. 1860), the body of the child was found with a ribbon round the neck, so tightly fixed that the parts around were swollen. Death was referred to strangulation, but it was sug- gested in the defence that the ribbon ligature might have been placed there as an ornament or as part of the dress ; and as the post-mortem examination of the body was not made until forty-eight hours after death, it was assumed that the tightening of the ligature was the result of a swelling of the body after death. The jury acquitted the prisoner. Constriction before or after entire birth. — Judging from what has occurred on several recent trials, a medical witness must prepare himself for another and a more difficult question. Let us suppose it to be admitted that the ligature was applied to the neck of a child while it was living, and after it had breathed ; — it still remains to be determined, whether it was applied before or after the %aZ birth of the child, or, as some judges have laid down the rule, before or after an independent circulation has been established in the child's body. In the case of R. v. Enoch, it was held " that there must be an independent circulation in the child before it can be accounted alive." {Archbold, 367.) By an " independent circulation," we can only understand that condition in which respiration is established, and the blood no longer passes from the mother to the child. Thus, this state would be proved by a cessation of pulsation in the cord, and the crying or audible respiration of the child. It will be seen that this is tantamount to insisting upon absolute proof of respiration, as evidence of life ; and, therefore, entirely conflicts with the opinions of other judges, who have held that proof of respiration is not necessary on a charge of murder, because a child might be born alive and not breathe for some time after its birth. {R. v. Brain, Archbold, 367.) On the other hand, if the presence of an independent circulation be the test of a child being legally alive at the time of the violence, the entire birth of its body is certainly not necessary for this ; because, as it is well known, respi- ration may be established and consequently an independent circulation ac- quired, before the body of the child is entirely born. Here, again, this judg- ment is opposed to the opinions of those judges who have repeatedly held that, whether a child has breathed or not, entire live birth must be proved. One of the most common judicial objections to the hydrostatic test is, that a child may breathe, i. e., substantially acquire an independent circulation, but die before its body is born. In this state of uncertainty, it is difficult to say what medical evidence is required to prove. If an independent circulation alone is sufficient, it cannot be always necessary to prove entire live birth ; but if proof of entire live birth be sufficient, then it cannot be always neces- 394 INFANTICIDE — SEVEEANCE OF THE NAVEL-STRING. sary to show that the child had acquired an independent circulation when the violence was oflfered to itl In a case of tenancy by courtesy {Fish r. Palmer 1806, post, Birth), the judges of that time are reported to have held that the quivering or spasmodic motion of a lip after birth, without respiration, independent circulation, or any other sign of vitality, was sufficient to show that the child was born alive — and that it had thereby acquired civil rights which it could transmit to others — its heirs. Why is the proof of an inde- pendent circulation in a child to be demanded of medical witnesses in a case involving a question of its murder, when in respect to its acquisition of civil rights, such a proof is not called for? If the question were fairly considered by all the judges, probably proof of an independent circulation in this sense would not be required ; at any rate it could not be consistently demanded, in the face of other decisions, that proof of respiration was not absolutely neces- sary to constitute live birth in law, even in cases of child-murder. Among cases in which this question has been raised one occurred on the Oxford Spring Circuit, 1841 (the Queen v. Wright). The child was found concealed in a garden ; its throat was completely cut, and there was a stab under the left arm. Gurney, B., is reported to have stopped the case because there was no proof that the child had had- "an independent existence" when the wounds were inflicted. It is worthy of remark, that one form of murder may. be the actual prevention of the establishment of an independent circulation or ex- istence in the child, as where the navel-string is designedly tied before the commencement of the respiratory process. It has been suggested that igno- rance of this point among midwives may be a cause of numerous still-births. In the meantime one fact is obvious, that whether the means of strangulation, if that be the form of murder, be applied to the neck of a living child before the entire birth of its body or afterwards — before the establishment of an in- dependent circulation (i. «., the act of respiration) or afterwards — the appear- ances will be the same ; and from these it will be impossible to say when the strangulation was accomplished. Constriction before or after severance of the umbilical cord. — There is still another novel form which this question has taken. The witness may perhaps be asked whether the strangulation occurred before or after the umbilical cord was severed. It would appear that the severance of the cord has been sometimes regarded in law as a test of an independent circulation being established in the child : — but this is obviously an error, depending on the want of proper information respecting the phenomena which accompany birth. Respiration, and therefore an independent circulation, may exist before the cord is divided; and its severance, which is never likely to take place 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 prema- ture severance, as it was just now stated, might positively endanger the life of a child, instead of giving to it an independent existence. A healthy and vigorous child may continue to live and breathe independently 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 be divided or not. The object of putting such a question is not apparent, unless it is intended to be implied that no child is legally born alive until the accoucheur or the woman herself chooses to sever the cord. It would therefore follow, on this doctrine, that to strangle a living child (entirely born) with the um- bilical cord, provided this be not lacerated in the attempt, would not con- stitute infanticide! If this inference be incorrect, it is impossible to deter- mine what can be the object of asking a medical witness such a question on these occasions. A case in which the cord was actually used as the means of destruction has been already given. (See ante, p. 389.) EVIDENCE IN CASES OF ALLEGED STRANGULATION. 395 The following cases will illustrate the difficulties which a witness may have to eocoanter when it is alleged that a child has been destroyed by strangu- lation. The first is that of Rex v. Grutchley (Monmouth Lent Assizes, 1837). In this case the body of a child was discovered by a medical man (one of the witnesses) under the bed of the prisoner, who had been secretly delivered. There was a ribbon tied in a knot so tightly round its neck, as to have pre- vented respiration. The child had evidently been dead some hours, and the prisoner alleged that it was born dead. On inspection, the face was found swollen and the lips were livid : the lungs contained air, and were of a florid color ; they were crepitant and floated on water, so as to leave no doubt that the child had breathed. The vessels of the brain were gorged ; and other viscera were perfectly healthy. He attributed death to strangulation ; — he thought that the ligature had been placed round the neck before the umbilical cord, which had not been tied, was secured ; but the reason for this opinion is not stated. He considered that the child had been born wholly alive, but admitted that the ligature would have produced the same appearance on the neck, had it been applied before the complete birth of the child. Another witness, however, stated that he thought the ligature might have been placed round the neck before the entire body of the child was born. The defence was, that the ligature had been used by the woman for the purpose of assist- ing herself in the labor ; and that the medical evidence allowed, whether this was the motive or not, that it had been applied before the child was actually born. The judge desired the jury to consider whether the prisoner wilfully killed the child ; — if so, whether the killing occurred before or after the entire birth of its body — and lastly, whether the killing took place while it was still attached to the body of its mother. Unless the child was destroyed after entire birth, the prisoner would be entitled to an acquittal :^if destroyed while still attached to the body of its mother, the point would be reserved for the consideration of the judges. The prisoner was acquitted. There can be no doubt that, provided a child be born entirely in a living state, the de- struction of it would be murder, whether the cord were severed or not. In the case of the Queen v. Byron (Chester Aut. Ass., 1838), the dead body of a child was found with a piece of rag tied round its neck, which in the opinion of the medical witness had caused death by strangulation ; but on being questioned by the judge he admitted that the appearances might be explained by supposing that the prisoner had produced them in attempting to deliver herself. In the case of the Queen v. Mitigate (Central Criminal Court, Nov. 1842), the child was discovered dead, and on examination the face was livid, the tongue protruded, and the hands were clenched. Around the neck was a ligature which had been passed round four times, and was tied tightly. The vessels of the brain were congested, the lungs partially inflated, and the general appearance of the body was healthy. The medical witness thought that the child had been born alive, and had died from the effects of the ligature on the neck. The judge directed the jury that they must be satisfied that the child was completely born at the time the ligature was placed round the neck. The prisoner was acquitted. In another case, the Queen v. Webster (Worcester Lent Ass., 1839), the following facts were deposed to by the surgeon : — The child was full-grown and was born alive : this was inferred from the lungs being completely inflated. A ligature was found on the neck — it had been passed round twice — was very tight, and fastened in a knot : it had caused two deep indentations. The vessels of the scalp.and brain were distended with blood, but there were no marks of ex- ternal violence. Death was caused by strangulation. The judge left it to the jury to say, whether they were satisfied that the child was wholly boru into the world alive; and if so, whether the prisoner had knowingly and wilfully destroyed it after it was born. The prisoner was acquitted. 396 CONSTRICTION OF THE NECK WITHOIIT ECCHYM0SI8. Constriction without ecchytnosis. — It may be an important question whether, in these instances, the absence of any mark or discoloration of the skin by the ligature 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 dead child : — although we might expect that there would be few cases of child-murder in which, when strangulatiott was resorted to, there would not be some ecchymosed mark or discoloration, chiefly on the presumption that great force is suddenly applied. Besides, it is not improbable that a slighter force would cause ecchymosis on the skin of a new-born infant than would be required to produce such an effect on that of the adult. When there is no mark from a ligature, an attempt may be made to show that death could not have been caused by strangulation, as in the following case (the Queen v. Hagg), which was tried at the Carlisle Sum- mer Assizes in 1841 : — The medical evidence was to this effect. The deceased child was discovered with a tape tied tightly round its neck. It was fall- grown and healthy, and had been born alive, as respiration had been fully established. The lungs filled the chest, floated on water, and crepitated when pressed. From the livid appearance of the face and neck, the con- gested state of the brain and an effusion of blood on the surface, combined with the ligature round the neck, the witnesses were of opinion that the child had died from strangulation. On cross-examination, they said that a child may breathe when partially born. The floating of the lungs in water is of itself an uncertain test, if the body is at all decomposed. With other tests it affords a proof of a child having been born alive. One witness said the ligature had produced no mark or discoloration on the neck, while others said it was perceptible. The inference is, that the mark could not have been very apparent, or there would have been no discrepancy on this point. It was ingeniously urged in the defence that the child could not have died from strangulation, because a tape tied so tightly round a child's neck as to cause death in this manner, would necessarily leave a discoloration of which no person could have any doubt. The prisoners were convicted. Had the de- fence been, as in the former cases, that there was no proof whether the liga- ture had been applied before or after entire birth, or the establishment of an independent existence in the child, the result might have been different. From the cross-examination it will be seen how certain stock,-objections to the hydrostatic test are ingeniously made to affect medical evidence. An answer to a general question is rendered applicable to a particular case. A witness admits on a trial that the lungs may float from putrefaction or arti- ficial inflation : in short, from other causes than respiration. If this answer be not qualified, an impression is immediately conveyed to the court, and not always removed by a re-examination, that some of these causes may have given rise to the floating of the lungs in this particular instance — when in fact there may not have been the least trace of putrefaction, nor the least ground for suspecting that artificial inflation had been practiced. As con- trasts to this case, see report of a case which occurred to Mr. Coales (Gny's Hosp. Rep., 1842); and another by Dr. Scott {Ed. Med. and Surg. Joum., vol. xxvi. p. 62). 8. Poisoning. — This is placed among the probable means of perpetrating child-murder, but we rarely hear of new-born children being thus destroyed. The earliest age at which I have known a trial to take place for the murder of a child by poison, was two months. (H. v. South, Norf. Aut. Circ, 1834.) A quantity of arsenic was given to an infant, and it died in three hours and a quarter after the administration of the poison. At this age the case can scarcely be called one of infanticide, in its medico-legal signification; because all that it would be necessary to prove would be the cause of death — the ACQUITTALS IN CASES OF OHILD-MTJRDEE. SOf question of life or live birth would not require to be entered into. If, in a case of child-murder, death from poison should be suspected, it must be sought for in the usual way. Some cases hare 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. Examination of the mother. — The duties of a medical practitioner, so far as they relate to the mother of the child, generally the accused party, are slight. He may be required to prove, by an examination made under an order from proper authority, whether she has or has not been recently deli- vered of a child, and to state the probable period at which the delivery took place. (See post, Delivery, p. 416.) This examination may be necessary in order to connect her delivery with the period, which may have elapsed since the birth and death of the child. Unless the examination of a female be made within twelve or fifteen days, no satisfactory evidence of delivery can in general be obtained. It has happened, on more than one occasion, that medical men have assumed to themselves the right of enforcing an examination of a suspected female, and, by threats or otherwise, have com- pelled her to undergo this. Such a course of conduct is in the highest degree indecent and improper : if a female willingly consent to an examina- tion, or an order be obtained from a magistrate or other official person, the case is different. In taking this authority upon himself, a medical practi- tioner is forcibly compelling an accused party to produce positive proof of her guilt — a principle which is entirely opposed to the spirit and practice of English jurisprudence. Conclusions The following conclusions may be drawn from the preceding remarks : — 1. That congestion of the face and head, in a new-born child, is not a proof of death from strangulation. 2. That strangulation can only take place in children which have breathed. 3. That a child may be strangled during birth by the accidental twisting of- the umbilical cord round its neck. 4. That the umbilical cord may produce a livid or ecchymosed depression on the neck, like any other ligature. 5. That marks on the neck, arising from accidental causes, may resemble those which arise from strangulation. 6. That the effect of constriction on the neck, either by the umbilical cord or any other ligature, is the same if the child be living, whether it has or has not breathed. 1. That the effect is the same whether the child has been partially or entirely born. 8. That the effect of a ligature on the neck of a living child is the same, whether the umbilical cord has or has not been severed. 9. That a new-born child may die from strangulation, without this fact being necessarily indicated by ecchymosis on the neck. This depends on the nature of the ligature, and the amount of force used. Summary. Frequent acquittals, in spite of medical evidence of crimina- lity. — From the foregoing considerations, it will be seen that the two great points to be established by medical evidence, in a case of child-murder, are — 1st, that a child was entirely horn living when the alleged violence was ap- plied to it ; and 2d, that its death was due to that violence, and to no other cause whatever. The leniency with which these cases are regarded by the law, and the extreme rigor with which the medical evidence of live birth, as well as of the cause of death, is treated, must show that they who consider that the use of the hydrostatic test can ever lead to the conviction of an in- nocent woman, have taken a very limited and incorrect view of the subject. 398 INFANTICIDE — FREQUENT ACQUITTALS The question of murder rests here, as in all other cases, npon clear and un- doubted proof of the cause of death ; and more than this, it must be shown that the violence was criminal, and not by any possibility accidental. Then it should be proved that this violence, if criminal, had been applied to the body of a child at a particular period — i. e., after entire birth; a case which, from what has been already stated, can rarely admit of clear medical proof. If strangulation, for example, be rendered probable from the facts, the wo- man cannot be convicted, unless proof be afforded, 1st, that the child was strangled after its entire body was born ; — and 2d, that she could not possi- bly have produced the marks of strangulation in her convulsive or half-con- scious attempts at self-delivery. Medical evidence can rarely be in a con- dition to establish either of these points, and the assumptions will therefore be, as in the numerous cases already reported, in favor of a prisoner. A serious question will probably here suggest itself, from the number of impos- sible medical proofs, so to term them, which the' law requires in these cases, namely — How can a conviction for child-murder ever take place, when there are no eye-witnesses to the crime ? The answer is, that these difficulties may not be raised in the prisoner's favor ; but this, of course, is a matter of ac- cident. On most charges of infanticide, if the counsel for the defence in- sisted upon distinct medical proof of the child having been entirely bom alive, when the violence was offered to it ; or that respiration, if clearly established by evidence, took place, not daring labor, but after complete birth, or after the child had acquired an independent circulation ; neither of these proofs can be possibly afforded, and the case, so far as medical evidence was con- cerned, would fall to the ground. That this is not an exaggerated view of the subject, will be evident from a case tried at the Lancaster Lent Assizes, 1846 {Seff. V. Hacking). A female servant was charged with the murder of her infant child. The evidence went to prove that she had attempted to con- ceal her pregnancy. It was ascertained that she had been delivered of a child, and themedical evidence was to the effect that its throat had been cut by some thin-bladed sharp instrument — « portion of the gullet and windpipe having been cut away. The prisoner stated that the child was bcfrn dead, and con- fessed that she had, as she believed, cut its throat with a penknife, which she had afterwards wiped and put away. The weapon was found in her pocket. The medical witness deposed that the child had certainly breathed, and he was inclined to think that it had been born alive. He admitted that a child may breathe when partially born, and die before it was wholly born ; also, that the appearance of the wound, whether inflicted before or immediately after death, would be very similar ; and it was impossible, from the examina- tion of it, to say whether the child had been partially or wholly born at the time of its infliction. The counsel for the prisoner contended that no evi- dence had been adduced which could satisfy the jury that the child had been fully born alive; — a circumstance without which the charge must fall to the ground. The jury acquitted the prisoner of the murder. {Med. Gaz., vol. xxxvii. p. 382.) In examining this case, it may be observed, that such a wound with a penknife was hardly likely to have been inflicted on the child by any accident, or for the purpose of aiding its expulsion during delivery. As the child had breathed, it is absurd to suppose that the woman waited until it had died from some other cause, of which there was no appearance j and that after death, without any conceivable motive, she cut out a portion of its throat. So far as the report goes, the acquittal appears to have de- pended on the allegation that the child was destroyed before it was wholly born ; and although it had breathed, there was a want of evidence to show that this breathing had continued after it was entirely in the world. (See also another case in the same vol. p. 1001 : and Prov. Med. Journ., April 2, 1851, p. 182.) IN CASES OP CHILD-MtTRDER. 399 The frequent acquittals which take place on charges of child-murder, in spite of strong evidence of criminality, most probably depend on the fact, that there are many extenuating circumstances in a prisoner's favor. She may be young, unfortunate, friendless, and perhaps tempted by a seducer, or by utter destitution, to the perpetration of the crime. According to the pre- sent state of our law, the jury have no alternative but to convict her of a capital offence, or acquit her of the charge of murder, and find her guilty of the concealment of birth, the extreme punishment for which is two years' imprisonment. This is substantially the punishment at present inflicted for the crime of infanticide in this country ; for it is not to be concealed that, medically speaking, these technical points relative to " live birth," to "entire birth," or to an "independent circulation in the child," or lastly, "concealed birth," are only so many ingenious legal means for evading convictions on a capital charge. Whatever doubt may exist according to the forms and prin- ciples of law, there can be no doubt, medically, that living children are often criminally destroyed, and that the law, from the peculiar nature of the proof required, as well as from the severity of the punishment attached in all cases to the crime, cannot reach the perpetrators. In many of these cases the punishment of death would be as much too severe, as the punishment of two years' imprisonment for " concealed birth" is too slight ; and with a full con- templation of this difficulty, the Civil Code of France (Art. 319) wisely per- mits the court, on proof of extenuating circumstances, to mitigate the pun- ishment. Some such provision is required in our law ; and the unnecessary perplexities which are now thrown on medical evidence, as well as the con- flicting, opinions on what is live birth and what is not, would then disappear. A change of this kind might undoubtedly be made, without prejudice to the accused, or interference with the course of justice. A writer in the Legal Examiner (Sept. 11, 1852, p. 555) has suggested that a special act of Par- liament should be passed to render proof of " entire birth" unnecessary, and that there should be at the same time some mitigation of the punishment. A modification of this kind appears to be necessary, unless we are prepared to admit that the destruction of a living and breathing child during the act of birth is not a crime. It is a question which it would be here out of place to discuss, whether a verdict of manslaughter might not be proper on many of these occasions ; for to say that the whole offence consists in concealing the birth of a still- born child, is virtually to disbelieve and reject the clear and satisfactory medical evidence often adduced. A verdict of manslaughter would not, however, cover those numerous cases in which it is assumed that the child had only lived to respire during the act of birth, and not afterwards ; and yet in a recent case {Reg. v. Tommey, Warwick Lent Assizes, 1854), tried before Coleridge, J., in which a medical witness declined to say positively that a child was born alive and had breathed after birth, the jury convicted the prisoner of manslaughter. Respiration had been established, but it was admitted by the witness that this might have occurred during birth. There was a cut on the right side of the neck of the child, and a circular wound in the windpipe. The jury considered, notwithstanding the medical doubt, that the child had really come into the world alive. At the same time, they appear tiS*have thought that the wounds on the neck were caused during attempts at self-delivery, and had not been inflicted with the intention of murdering the child. Dr. Christison, in commenting upon the frequent acquittals on the capital charge, and convictions only on a minor offence, which cannot always be proved, attributes it to a feeling sometimes enter- tained in the present day, that the killing of a new-born child, when perpe- trated under the impulse of injured honor and the fear of disgrace, should not be classed with the other varieties of murder. (See Ed. Med. and Surg. 400 INFANTICIDE — CONVICTIONS FOR MANSLAUGHTER. Journ., vol. xxvi. p. 76.) There can, I think, be no doubt that this is the true explanation. (See case by Mr. Coales, Guy^s Hospital Reports, April 1842.) It may be mentioned, in concluding this subject, as the point has given rise to a trial for malapraxis, that if injuries should be criminally inflicted on a child during birth, and the child be born alive and afterwards die from the injuries so caused, the case would be murder or manslaughter, according to the circumstances. The following instance is reported by Chitty {Med. Jour., 416 ; also ArehboM, 345) : A man of the name of Senior, who, it appears, was an unlicensed medical practitioner, was tried, in 1832, for the man- slaughter 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 it died immediately after it was born. It was argued in defence, that as the child was not born {in ventre sa m^e) at the time the wounds and injuries were inflicted, the prisoner could not be guilty of man- slaughter. The judge, however, held that as the child was born alive and had died, 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 the law makes the question of criminality to depend upon the period at which the injuries prove fatal, and not upon the time at which they are inflicted on the body of a child. The decision appears to depend on this principle of the criminal law, that the person killed must be a reasonable creature in being, and under the king's peace : therefore to kill a child in its mother's womb (or during birth) is no murder. (ArchboM, 845.) The child, unless entirely born alive, does not come under the description above given. It is under these circumstances medically but not legally a living child. Ad- mitting the wisdom of adopting some fixed rule of this kind in a legal view, it is undoubtedly proper that the lives of children during the act of birth should be protected : at any rate, that their destruction should not be treated, as it now appears to be, with perfect impunity. If a child be born alive, as a result of criminal abortion, and die, not from any violence applied to its body, but as an effect of its being immature, this will be suflflcient to render the party causing the abortion indictable for murder. It is difflcult to determine the number of cases of infanticide which take place annually in this country; but in Trance, where criminal statistics are more closely attended to, there were, in 1838, one-hundred and twenty-nine cases ; and in 1841, one hundred and forty-seven cases. (See Annales d'Hy- giene, Oct. 1840.) PREGNANCY — LEGAL RELATIONS. 401 PREGNANCY. CHAPTER XLVIII. PREGNANCY IN ITS LEGAL RELATIONS — SIGNS OF PREGNANCY — SUPPRESSION OF THE MENSES — PROMINENCE OF THE ABDOMEN — CHANGES IN THE BREASTS — QUICKENING UNCERTAINTY OP THE PERIOD AT WHICH IT OCCURS — SOUNDS OF THE r